Mr. Douglas on Fracture of the Neck of the Thigh-bone. 17

several disorders attributed to spinal irritation, as any person may convince himself, by reference to Dr. Abercrombie's work on diseases of the brain and spinal cord.

It is a fact, that in these disorders in which there exists such strong presumption of spinal disease, tenderness of tile spine, on pressure, is almost invariably found ; that such tenderness very commonly corresponds with the situation of the trunks of the spinal nerves, distributed to the distant, pained, oraffected parts ; that pressure in such situation very often excites or in- creases the pain or affection in those parts ; and finally, filet remedies applied in such situation often give very immediate relief, and sometimes effect a permanent cure.

I cannot but believe that the foregoing observations, which have run out to a length I did not at all intend, must lead to one of two inferences, either that the reviewer took a very superficial and prejudiced view of the subject, or thai he had not studied it sufficiently. I am only sorry the British and Foreign Medical Review, conducted by its present able and distinguished editors, and so well calculated, in other respects, to advance medical science in this cmmtry, should, at its very outset, give ground for a suspicion of either nature : but the doctrine, whose merits it has undertaken to criticize, is, even imperfect as our knowledge of it may be, of too much practical importance to admit of its being so complacently set aside in a discussion on some of the least appropriate cases in Dr. Mar- shall's work.

AnT. II.--Remarks on Fracture of the Neck of the Thigh- bone, external to the Capsule. By JAMES DOUGr.AS, Mem- ber of the Faculty of Physicians and Surgeons, Glasgow, and Lecturer on Anatomy.

Is perusillg the last number of the Dublin Journal, I was much gratified with Mr. Porter's account of the dissection of a very

VOL. XI. NO. 31 . 1)

18 Mr. Douglas's Remarks on

recent case of fracture of tile neck of the thigh-bone within the capsule, and with his remarks upon the senile alteration of structure which predisposes to that accident. I wonder, how- ever, that Mr. Porter's opinions respecting the diflbrence of ca- pability of union in fi'actures within and without the capsule are so little settled; and I am particularly surprized at his con-

cluding sentence, viz. " that there is no evidence as yet to de- monstrate by dissection a perfect bony union in a subject of any age, or where the fracture has occupied any situation either

within or without the capsule." I agree with Mr. Porter that there is no evidence of bony union within the capsule, but there is most certainly evidence of bony union of fractures without the capsule, all of which necessarily implicate the great fro- chanter; and in corroboration of this statement I beg to submit the followingcases : ~

I . An elderlyman was admitted into the surgical wards of the Glasgow Royal Infirmary, ~on account of fracture of the neck of the femur, external to the capsule. His limb was put up in Desault's splints, as is the constant practice in that hos- pital in all fractures of the thigh, and at the end of six weeks it was found firm. Still on rotation a crepitus was perceived at the inner part of the thigh-bone, and a suspicion being ex- cited that all was not right, tile splints were re-applied, and after a considerable time he was dismissed, because able to walk, although this crepitus had not disappeared. Shortly after this he was brought up to the wards of which I had charge, as physician's clerk, in articulo mortis, it was said from cholera, and died immediately after being put to bed. Learning that this was the same individual who had been above stairs witil the fractured thigh, I speedily possessed myself of his femur, the state of which is as follows : -

The bone has been split into four pieces, the neck be- ing detached from the shaft immediately beyond the inter- trochanteric lines, and depressed about half an inch below its proper level, though still retaining its natural obliquity. The

Fracture oftheNeckoftheThigh-bone. 19

greater trochanter is split from above and before downwards and backwards, and the loose portion is thrown a little in- wards upon the neck. The lesser trochanter is drawn a little upwards and forwards. The fractured surfaces of the neck, shaft, and great trochanter, are firmlyunited by bone, except at the top of the great trochanter, where an epening exists be- tween the two pieces, leading downwards into the medullary cavity. The trochanter minor is supported by a buttress of new bone, to which it is connected by ligament only, and on which it is still moveable. It was this motion which produced the crepitus after the other fractures were united, and led to the re- application of the splints. The preparation is preserved in my museum, and bears a striking resemblance to the specimen figured by Mr. Colles in the Dublin Hospital Reports, vol. ii. fig. 3, only that the neck is not driven across the shaft.

IL As another proof of cure of fracture external to the cap- sule, I may adduce the following case, which was successful in very unfavourable circumstances. Near the end of the year 1834, a woman, aged 68, of intemperate habits, was admitted into the wards where I was then house surgeon, with a fracture of the neck of the left femur, splitting the trochanter major, produced by a fall upon the side. I put up the limb in the straight position. She was seized with delirium tremens, and pulled off the whole apparatus once or twice, but was at length calmed by strong opiate enemata. In a fortnight it was found that a bed-sore had formed over the sacrum, and the surgeon, Dr. M. S. Buchanan, was afraid of her sinking under it, and advised tile removal of the splints. On taking them off, I found that callus was already eflhsed and that the limb was stiffening, and I begged Dr. Buchanan to allow me to replace the ap- paratus for another week, and to take his chance of curing the bed-sore afterwards. He consented; the limb was again put up, and on the twenty-first day was so firm as to enable us to turn

20 Mr. Douglas on Fracture of the Neck of the Thigh-bone.

the patient on her right side and attend to the sore, and she afterwards got perfectly well.

III . I shall relate another case in which I had an opportunity of examining the parts at a pretty early period after the accident. A man was admitted into the hospital on account of a fall on the left buttock : he complained of pain and difficulty in walk- ing, but no fracture was detected. He was seized with some internal affection, of which I can give no account, as I never saw him under it, and he died at the end of a fortnight. I was requested to perform the inspection, and possess the prepara- tion. The capsule of the hip joint was entire ; and the bone was not in the least displaced. From the top of great trochan- ter a fracture was found running downwards and inwards ; the lines before and behind the neck meeting at an acute angle at the trochanter minor, and passing through the external lamina of the bone in such a way, that the neck remained wedged in the shaft ; and no crepitus could be produced. The outer part of the top of the great trochanter was also detached. In front, the line of fracture passed higher on the neck than the anterior inter-trochanter line, so as to tear slightly both the periosteum and the reflected synovial membrane. In consequence of this, the membrane was inflamed, and contained some thick fluid of a dirty red colour. Not the slightest progress had been made towards union. The only morbid appearance in the cavities illustrates the sympathy between synovial and serous mem- branes, viz. about two ounces of thick reddish fluid was found in the pericardium, very similar to what existed in the capsule

of the hip joint. I had the other day the opportunity of examining the femur

of a female aged eighty, who was brought to the dissecting room ; and I found the appearance of the cancellous texture of the neck to correspond exactly with Mr. Porter's description. Besides, the compact lamina of the lower edge of the neck was much thinner than it ought to have been ; and indeed, in the

Dr. Churchill on the Length of the Umbilical Cord. 21

middle of the former, it seemed also to be relaxed, for it crashed under the saw when making a transverse section, in a way which I never felt before. I was in search of alteration of the angle of the neck by absorption, but was disappointed.

ART. I I I . - -On the Length o/the Umbilical Cord and its me- chanical Influence upon Parturition. By F. CHUnCmLL, M.D., Physician to the Western Lying-in Hospital, and Lecturer on Midwifery at the Richmond-Hospital School.

[Read at a Meetingof the College of Physicians December 19, 1835.]

MUCH has been written about the structural peculiarities of the runts, with its functions during embryonic life, and in addition, certain mechanical effects have been attributed to it under cer- tain circumstances. It is to thls latter point that I would beg the attention of this meeting, as it appears to me that certain errors have crept into these statements, which a little more minute observation would have prevented.

Almost all authors who touch upon the subject agree, that the ordinary length of the cord is tolerably regular, but that many instances of preternatural shortness or extraordinary length are observed. Some give examples of such from their own ex- perience, others merely copy or quote their predecessors. None seem to have undertaken any extended examination of the sub- ject. Again, every one knows that the cord is often twisted round the child's neck, so as to diminish its entire length, and much evil is said to result from this shortening. We are told fl~at it may render the labour tedious, by retracting the head of the child at the termination of each pain ; that the life of the child may be endangered by its being put upon the stretch when the foetus is expelled ; ttlat there is a risk of the too early and forcible detachment of file placenta, or of inversion of the uterus, if the child be rapidly driven through the passages with the funis thus shortened, and we are impressed with the necessity of uncoiling it as soon as possible, by slipping it over the child's