wheel-work or winches, or complex machinery, in its construction; that it may be transferred, without fear of derangement, to any house where it may be required, and placed on any four-post bedstead that presents itself, with the greatest ease and facility.

Dimensions of Apparatus.-Diameter of wheel, three feet five inches; diameter of axis, two inches; length of axle six feet four inches; bedstead, six feet five inches by three feet three inches; height from floor to axis, seven feet; height from floor to upper surface of mattrass, two feet.

Fig. 2 represents an instrument or machine whereby the most severely wounded person can be transferred from one bed to another, or one place to another, with the least risk of deranging dressings, or or inflicting pain. A is a pole, about seven feet long, to which is affixed, at equal distances, and equal spaces between, a number of loops of webbing or girthing, about two feet six inches long, and two inches wide. B is the antagonist pole. C is the needle for drawing the loops. D D are iron stays, about two feet four inches long.

When the patient is to be removed or transferred, the pole A must be placed on the bed, alongside the patient, taking care to have all the loops on that side; then pass the needle C under the legs of the patient, either above or below the sheet on which he lies; and hooking it into the loop of the first web, draw it towards you. Do so in succession up to the head, and the patient will then be lying on the webbing. Now slip the pole B through the loops of the webbing, and place the iron rods D D on the ends of the poles, and the machine is ready for use. Two men-one at the head, and the other at the foot -can now raise and transfer the patient with ease and safety to wherever required.

The transferrer will, in many cases, by not using the iron rods, be found more safe and convenient than a chair for the removal of weakly and somnolent patients up and down stairs.

The Lawson bed and transferrer is made by Mr. Roper, carpenter and builder, Guinea-lane Bath.-Med. Times and Gazette, Dec. 24, 1853, p. 651.

81.-ON THE PEDUNCULATED EXOSTOSIS OF THE LONG

BONES.

By JAMES SYME, Esq., Professor of Clinical Surgery in the University of Edinburgh.

As the expression exostosis literally implies merely an inordinate growth of bone, it has been employed to denote a great variety of morbid conditions in which this circumstance happens to exist. The "callus" that repairs a fracture-the new osseous shell which supplies the place of a dead shaft-the spina ventosa or expansion caused by the accumulation of pus or other fluid-the spicular or foliated excrescences that shoot into the substance of an osteo-sarcomatous;

tumour-and the bony prominences of morbid growth resembling the natural processes connected with the origin and insertion of muscles, have all been included within this comprehensive title. It is to a particular form in which the last mentioned of these productions appear, that I now wish to direct attention.

[Puberty is the period of life when these simple growths are chiefly developed. Indeed, in young and growing persons, the symmetry of the bone is often lost from the processes and articulating extremities growing more rapidly than the other parts, but as a rule we may always express an opinion, that in time the proper proportions will be restored.]

The constitution of these growths is quite similar to that of the spongy extremities of the long bones, being composed of a thin, osseous lamina externally, and a more or less compact, consolidated texture within it. While enlarging, they have an incrustation of cartilage, whence they have been called by Sir A. Cooper and others -in my opinion, very improperly-the cartilaginous exostosis, since any bone in the body might with equal propriety be designated cartilaginous and as this nomenclature is sure to occasion confusion between the truly osseous growths and those of a fibro-cartilaginous nature, which anatomically, pathologically, and practically require to be carefully distinguished. Thus Sir A. Cooper describes under the same title, well marked cases of these two most dissimilar conditions, and in his lately published work, Mr. Paget has pursued this course with, if possible, still less regard to the diversity of the tumours thus associated together. Anatomically, they differ in constitution, which, in one case, is the simple bony texture encrusted externally, so long as it is growing, by a plate of cartilage; and, in the other, it is a fibro-cartilaginous growth enclosed within the expanded bone, or dispersed through the interstices of its honey-comb looking structure. Pathologically, they differ in the one sort of growth being limited in its tendency to increase, and producing no inconvenience except from the peculiarity of its position, as when seated under the nail of the great toe, while the other has no bounds to its enlargement, which depends upon the fibro-cartilaginous substance, and not upon the bone. Practically, they differ in this important respect, that while the one may be removed by division of its neck or base; the other cannot be extirpated except by taking away the whole bone, or dividing it at a sound part beyond the confines of the disease. It was from not attending to these distinctions that Mr. Liston, who first drew professional attention to the exostosis of the toe, insisted upon amputation as essential for the patient's permanent relief; while due regard to them led me to practice removal of the growth alone, as sufficient for attaining the object in view-a procedure which, though for a time reprobated by Mr. Liston and his followers. has long since become the esthed le functies. On the other hard, a knowledge of the

depth to which the fibro-cartilaginous growth strikes its roots into the bone affected, has put an end to those painful scenes which surgeons of the present day witnessed in their youth, when attempts were made, of course in vain, to dig out such tumours from the upper and lower jaws. By disarticulation or division of the bone, where ascertained to be sound, the patient is now effectually relieved in a few minutes, instead of being subjected to the prolonged torture of hours, without the chance of benefit to his case, and with the greatest risk of its aggravation. Having happened to remove the first superior maxillary bone that was removed upon this principle in Great Britain, and having entered upon the records of surgery the first instance of this operation which they contain, I must here protest against the unjust appropriation of any credit that may be due on this account, which has been copied from each other by the writers of students' books, of whom I may mention Mr. Erichsen as the most recent. My operation was performed in the Edinburgh Surgical Hospital on the 13th of May 1829, and the case was published in the 'Edinburgh Medical and Surgical Journal' for July of the same year, so that the question of priority admits of no dispute.

Under the title of cartilaginous tumour, have been comprehended two morbid conditions of the osseous system, of the most different natures, which require to be distinguished for the establishment of their proper treatment. In regard to the osseous growths, associated with malignant tumours, serous cysts, and abscesses-as the newformed bone is always perfectly sound in its textures, and owes its production to the influence of another morbid condition,-I think the disease in such cases should be named, not from the exostosis, but from the cause which has occasioned it, whether this may be a growth, a cyst, or an abscess. The expression exostosis would thus be restricted to its proper sense of denoting the change effected in the bone itself, and would only require to be farther divided into the solid, hollow, and spicular forms. Attention would thus be directed to the disease essentially requiring remedy, and not to an accidental concomitant.

I may now proceed to the special object of this communication, which is to explain a circumstance in the constitution of the simple exostosis when it proceeds from the long bones of the extremities, which may be of considerable consequence in regard to both its diagnosis and treatment. The most frequent situations of this growth, are the inner side of the thigh bone a little above the condyle, and the neck of the humerus, just below the tuberosities into which the scapular muscles are inserted. It has a neck from half an inch to an inch in length, which is usually placed obliquely in relation to the shaft, and beyond this expands into an irregularly rounded form, nodulated on the surface, which is covered by a thin incrustation of cartilage, that presents a shining, pearly lustre, and has no communication with the surrounding parts. In the case of a young man who came from Rothesay to the hospital for the removal of an exostosis on the outer

side of the thigh bone, I find the same characters. The tumour consists of perfectly sound osseous substances, more or less tensely cancellated.

About five-and-twenty years ago I was consulted by a gentleman residing in this city, on account of a very large exostosis, in the usual situation, on the inner side of the thigh. He was a tall, strong, active man, and, in consequence of over-exertion, was suffering from swelling, redness, and pain of the limb at the seat of enlarge ment. I advised soothing measures, and expressed the opinion that an operation would not be requisite if he abstained from undue exertion in future. I frequently afterwards saw this gentleman, apparently in the enjoyment of perfect health, and had no reason to entertain any doubt as to his being so for more than twenty years, when, in the month of February 1851, Dr. Handyside asked me to see him, on account of an alarming change that had taken place in the condition of the tumour. The thigh was considerably swelled and painful, especially when pressure was applied on the seat of the exostosis, which could not be felt distinctly in consequence of the thickening around it that had taken place, together with the effusion of some fluid that was detected by a deep fluctuation. In explanation of this circumstance, as it was stated that the patient had lately been leading a life of much greater exertion, particularly in walking, than he was previously wont to do, Dr. Handyside enjoined rest, and, after a time, applied a blister. We thought that there was something seriously wrong, and were not free from the apprehension of cerebriform degeneration, but resolved to try the farther effect of rest, with gentle pressure. In the course of a few weeks the swelling and tenderness disappeared, the fluctuation could no longer be perceived, and the exostosis was felt no less distinctly defined than in former times.

I felt quite at a loss to account for this case, until the following one completely explained it. In November of last year Dr. Duncan asked me to take under my charge, in the hospital, a female servant who, in crossing the ferry from Fife, had received a blow, which was supposed to have detached an exostosis from its usual seat of attachment, above the knee, on the inner side of the thigh bone. As the limb was very much swelled, and extremely painful, I feared that delay might lead to suppuration, and therefore cut freely down to the exostosis; but in doing so was surprised to find a quantity of serous fluid, tinged with blood, lying between it and the surface immediately surrounding it. The whole truth at once appeared, and I no longer felt any difficulty in accounting for the smooth shining surface presented by growths of the kind in question, or for the fluctuation which, in the former case, had so much perplexed Dr. Handyside and myself. It was plain that a synovial membrane surrounded the exostosis, and was reflected from its neck, so as to afford a double covering, just as on the joints-the half of one being

VOL. XXIX.

thus represented by the osseous growth, its crust of cartilage, and investing membrane.

I hope that the condition of what may be called the pedunculated exostosis, thus fully ascertained, may be of service, not only in its diagnosis, but also with reference to the means of remedy, since the complete insulation from surrounding textures, except at the comparatively small point of its attachment to the bone affords great encouragement to attempt removal, even under circumstances apparently much opposed to success. Thus, in the case of a young lady from Lancashire I saw lately with Dr. Simpson, there was an exostosis at the neck of the humerus, which pressed upon the axillary nerves, so as to occasion great and increasing distress; and, from this position, had been deemed beyond the reach of removal. having ascertained that the point of attachment was at the posterior surface of the bone, I made an incision between the deltoid and triceps, exposed the neck, detached it by cutting pliers, and extracted the exostosis, with hardly any bleeding, and no injury to the neighbouring parts.-Monthly Journal of Medical Science, January 1854, p. 1.

But,

82.-On the Treatment of Fractures of the Base of the Cranium. By JOHN HILTON, Esq., F.R.S., Surgeon to Guy's Hospital.—If the patient be collapsed from the immediate effects of the accident, cover him up with blankets next his skin, add artificial heat by placing bottles of hot water in his bed, but not in contact with the skin; give brandy or ammonia to aid reaction, and as soon as vascular and nervous reaction are sufficiently re-established after the accident, as evidenced by the gradual recovery of the natural temperature of the the body, and by the improved state of the pulse, purgatives should be employed to clear the bowels efficiently. If the patient has been accustomed to take large quantities of stimulants, the same kind of drinks must be had recourse to, especially if the pulse flag, or the temperature of the surface be disposed to decline. After the purge has acted satisfactorily, give the patient mercury and chalk and Dover's powder: if an adult, five grains of each twice or three times daily during a few days, or until he become slightly mercurialized. The patient to be kept as quite as possible reclining in bed, and not allowed to sit up or attempt to walk. If the pulse become hard, full, and incompressible, cup the back of the neck or apply leeches to the head, or bleed from the arm, but do it with care and discretion. Should the patient be very irritable, the head a little hot, the pulse a little accelerated, thirst slightly increased, the skin hotter than natural and dry, and the tongue furred and white, apply a blister to the nape of the neck, and give diaphoretics in the form of the solution of acetate of ammonia. Farinaceous food and iced water to be the first diet; if