212

DISEASES OF THE URINARY ORGANS.

Low specific gravity, with diminished urinary secretion, points to disturbance in the secreting function, as in Bright's disease: an abundant secretion, with high specific gravity, leads to the supposition that sugar is excreted. The medium specific gravity of a healthy man is 1020; according to Becquerel, it is 10189. A man weighing 100 kilogrammes (200lb.) voids in the hour 103 grammes of urine; of which 41 grammes, or rather more than a drachm and a quarter, is the weight of solid parts. In most chronic diseases, the amount of solid parts is diminished; while in two classes the quantity of urine is excessively increased: in one, there is an addition to the number of solid constituents, namely, in diabetes mellitus and insipidus, attended with emaciation, &c.; in the other, namely, hydruria, there is diminution of the solid parts and loss of specific gravity. In the latter case, there is no emaciation, and the process favours the elimination of morbid products, as in many cases of dropsy. In acute fevers, the quantity of the urine is less, but the specific gravity increases in proportion as the amount diminishes. The urine, in such cases, contains, it is true, less solid matter than that from a perfectly healthy man, but not less than that voided by a person suffering from some chronic complaint. Such patients are in the position of one starving, the solid matter of the urine being obtained at the cost of the body. At the quick approach of death there has been noticed a continued increase of specific gravity with a continued decrease in the urinary secretion. When death ensues from injury to the medulla oblongata, the quantity of urine remains considerable to the last, but the specific gravity is small. A great amount of combinations of chlorine will be poured forth in the hydruria which removes hydræmia; and this agrees with the observation of Schmidt, that a deficiency of albumen in the blood may be supplied by the taking up of a certain quantity of chloride of sodium.

The author arranges the colour of the urine under three divisions, namely yellow, red, and brown; and he establishes the colour by comparing it with definite mixtures of gamboge; gamboge and carmine; gamboge, carmine, and Prussian blue. Each of these falls into three subdivisions, namely, pale yellow, bright yellow, yellow; reddish yellow, yellowish red, red; brownish red, reddish brown, brownish black. These hues can be accurately obtained by different dilutions of the above-mentioned colours. In health the colour of the urine varies mostly between reddish yellow and bright yellow; but every individual has some standard colour of his own. In diseases the colour varies greatly. Pale urine is voided in hysterical and nervous patients; in many cases of anemia; in convalescence. In all feverish attacks the urine is yellowish red or red, containing absolutely more colouring matter than in the normal state. In many cases of typhus, in Bright's disease, in scorbutic attacks, it becomes brown or brownish black, from admixture of blood-discs. The author succeeded, by boiling, in separating a coagulum of hæmato-globulin in these last cases, after which the urine was paler.-Archiv. fur Wissenschaft. Heilk.-Med. Times and Gaz., Oct. 15, 1853, p. 404.

SURGERY.

FRACTURES, AND DISEASES OF THE BONES AND JOINTS.

76.-ON UNUNITED FRACTURE OF THE FEMUR. Under the care of E. STANLEY, Esq., F.R.S., at St Bartholomew's Hospital.

[Several cases of ununited fracture, treated by Dieffenbach's Peg Operation, will be found in Braithwaite's Retrospect, Vol. xxvi., p. 150. The following important case, in which Mr. Stanley lately had recourse again to the same operation, slightly modified, is thus recorded in the Lancet':]

Edward W., aged 27 years, was admitted into Darker ward on the 13th of August, 1853. The patient has been mostly employed in the country, is married and of very temperate habits; both his father and his mother are alive, no kind of taint seems to pervade the family, and the man himself looks healthy and robust.

He states that thirteen months before admission a tree which was being felled rolled over his thigh, and broke it towards the upper third. He was conveyed to his house, and the limb, after having been set, was put up by a surgeon. The fracture seems to have been simple, and the apparatus used for keeping the fragments in apposition was, according to the patient's account, one long splint placed under the thigh, and two short ones on either side. This was left on without being disturbed, for six or eight weeks; the splints were then taken off, and the man thinks that after a little handling of the leg he heard something snapping at the seat of the fracture. As it appears that no consolidation was found, the same splints were put on again; but some swelling now took place from the knee downwards. The application of a roller somewhat controlled the oedema, and the apparatus was now left on for twelve weeks more, the patient remaining all the while in good health. He maintains that no blame can be attached to himself as to the non-union of the fragments, as he lay very quiet for the whole of the period above mentioned. It became, however, evident that the ends of the fragments did not evince the slightest disposition to consolidation, and after various ways of obtaining it were tried, the patient applied at this hospital.

It was found, on examination, that the fracture was situated a few inches below the trochanter major, on the left side, and that the ends of the fragments were riding upon one another. Mr. Stanley ordered

a gum-and-starch bandage to be carefully applied, hoping that the pressure of the apparatus would promote the throwing out of callus. This bandage was allowed to remain for several weeks, and on being taken off, it became evident that no union had occurred.

It was now thought that a system of direct pressure upon the spot where the ends of the fragments were in apposition might perhaps sufficiently excite the parts, and bring on inflammatory action, and a subsequent formation of callus. Mr. Stanley had, therefore, an apparatus constructed which allowed the patient to get up and walk about on crutches, while the fragments were kept in close apposition, and a certain amount of pressure exerted upon them. Small doses of mercury were given at that period, as this metal had in several recorded instances, had the effect of promoting the secretion of callus.

This system was persevered in for a number of weeks, but it did not conduce to the desired effects; and Mr. Stanley now resolved to have recourse to Dieffenbach's plan, modified by the addition of a wire, intended to excite inflammation in the bone, besides securing the fragments in perfect apposition.

The operation took place on March 11th, 1854, whilst the patient was under the influence of chloroform. Mr. Stanley made a semilunar incision, about six inches in length, on the external part of the thigh, laying open the seat of the fracture. The ends of the fragments were easily brought into view, as the pressure which had been used in the attempts to obtain union had considerably thinned the soft parts over the ununited portions of bone. On examining the wound, a large piece of muscle was found lying between the ends of the fragments; this great obstacle to union having been removed, Mr. Stanley introduced pegs of ivory, about two inches long, into the extremities of the broken portions of bone, one peg in the upper, and two in the lower fragment. A hole was now bored towards the end of the latter, and a double iron wire covered with silver was passed through the whole thickness of the bone. The wire was drawn through the shaft to a pretty great length, and the two extremities brought down and introduced into a perforation made through the end of the upper fragment. These extremities were carefully drawn through this second hole, and when they had been pulled out to some length, the ends were twisted, and connected with the loop hanging out of the original osseous perforation in the lower fragment. The flap was then brought down, and one suture applied.

Mr. Stanley had the limb placed in a suitable apparatus, and the patient has progressed pretty well since the operation. The two principal features that have marked the course of the case are a slight attack of erysipelas and sudden hemorrhage. But it may be hoped that these untoward events will not interfere with the success of the operation, and we hope soon to give an account of the successful issue of the case.-Lancet, April 1, 1854, p. 361.

77.-Galvanism in Ununited Fracture.-A case occurred some months ago, at the York County Hospital, in which, under the care of Mr. Holl, the house surgeon, galvanism was employed for the production of union in an ununited fracture. Mr. Holl introduced a needle from each side of the limb into the interspace between the bones, and then passed a continuous galvanic current through. The operation was repeated every day for about a fortnight, and a cure ultimately resulted. The fracture was of the leg, very moveable, and had existed more than a year.-Medical Times and Gazette, Nov. 12, 1153, p. 501.

78.-On Extemporaneous Woven Wire Bandages, Splints, &c.— [In a communication to the Medical Society of London, by JAMES STARTIN, Esq., after speaking of the advantages which these apparatus afford, he says:] Each apparatus consists of woven and flattened copper, brass, or iron wire, of various thicknesses and strength, which may be plated with tin, or other metal, or lacquered. The cost of the woven and flattened wire is 8d. to 1s. 4d. the square foot, which, for splints or cages, can be cut with scissors into any desired form, and the edges covered with strips of thin lead, gutta percha, or stickingplaster; or bindings of cotton, wash leather, &c., may be stitched on by needle and thread. The wire rollers require no binding, if in cutting them from the piece, care be taken to follow the wires of the woof closely with the scissors, so as to leave no projecting points. The flatting (i. e., passing the woven wire in the piece through the flatting mill-rollers) will prevent unravelling, both in the bandages and splints, whilst at the same time it gives the required uniformity of surface. The mode of applying either splints or cages is most facile. A piece of stout cartridge paper is to be employed to take the necessary pattern, which being accomplished with as few cuttings as possible, is to be laid upon the piece of woven and flattened wire, and a counterpart cut from it, the edges of which are to be protected in any of the manners before indicated. When this is done, simple folds of lint or linen, wet in warm water, are to be applied smoothly to environ the limb or joint affected, when the wire splint, cage, or roller is to be adapted accurately to it, and fixed with tape or bandage. It will be obvious that the material forming these rollers or splints, whilst it ensures the necessary quietude to the injured part, will allow without difficulty or removal, the ready escape of discharges, and the use of wet applications; the splints and cages will also admit of openings (trap doors they may be called) being cut into them, through which the wounds, &c. can be dressed, without disturbing the support afforded by the splint.-Lancet, Feb. 4, 1854, p. 138.

79.-DESCRIPTION OF A NEW SPLINT.

Invented by CHARLES JOHN GIBB, Esq., House-Surgeon to the Newcastle Infirmary, &c.

[There can be no question of the value of a splint, simple in principle, and capable of adaptation to all fractures of the extremities and to any size of patient. Such a splint Mr. Gibb believes the one he has invented to be. He says]

I have invented a splint which, I believe, will be found, in general practice, capable of almost universal application in fractures of the limbs. The principle of the whole splint is that of the simple slide. Each part is made of pieces of sheet iron, which slide alongside of, or within each other, and can be fixed at any required length by a finger-screw. The various parts are designed in such a manner, as when fitted together in different ways, to form a splint of varying size, suitable to the limb of a child or a man, and in shape combine all the advantages of various sizes of the long straight, Liston's, McIntyre's, and Greenhow's double incline splints, for the lower extremity, or of small straight or angular splints, for the upper extremity.

The complete splint, pulled out to its largest size.

The splint consists, as will be seen, of a thigh-piece (1); lateral thigh and side-piece (2); two leg-pieces (33); a foot-piece (4); an additional side-piece (5); and a sling cradle. When required for use, the thighpiece (1) can be shortened or lengthened to the size of the patient's limb, by relaxing the finger-screw seen at its under aspect, and pulling out or pushing in the one slide piece upon the other; and can be narrowed or made broader by shifting one or other of the holes seen in the lateral thigh and side-piece (2) on to the projecting male screws (a a) seen at the under surface of either side of the thigh-piece, and fixing it there by the corresponding female finger-screws. The lateral thigh and side-piece (2) as is evident, may be fixed on either side of the thigh-piece to suit a fracture of either limb; can be made of any required length, to extend to the short ribs of the patient for the purposes of counter-extension having two slits above for the ends of the