had the disease rather severely-the first one, especially; two of them came in from the country to nurse her, but became soon infected themselves with it, in spite of all disinfectants. Their throats were penciled and gargled with carbolic acid, Tr. ferr. mur., quinia, nitr., arg., chlor. potass., etc., early and late, and yet they all caught the diphtheria, except the old father, who stayed entirely away from the patients, in another room.

It is still undecided whether diphtheria commences first locally in the throat or in the blood, and Lewis Smith expresses the opinion that it may commence both ways. In the present cases, it undoubtedly appeared to have commenced in the blood-probably through inhalation; and the necessity of using either ferrum or cuprum leads us to acknowledge diphtheria as a constitutional affection. I also tried internally, here, the use of sulphite of soda, Tr. ferr. and chlorat. potass. and quinia, which gave no satisfaction at all; but when I gave Tr. cupri acet. 3j aq. font. v, aqua cinnamon mucilage acacia aa. s., one tablespoonful every hour, they all pointed to it as the remedy, and improved instantly. They also noticed great benefit from having their throats penciled with permanganat. potass. gr. v., x, aqua destillata zii. In this epidemic, the disease easily also sneaked into the larynx; but the same treatment, combined with the inhalation of limewater, succeeded beautifully, even in some desperate and givenup cases.

I was also once called to a boy on Miller street, who suf fered from what in Kunze's text-book on practice of medicine is described as "Ludvig's inflammation of the cervical connective tissue," and said to occur during epidemics of diphtheria. The cuprum showed here, too, most decidedly its healing power as the epidemic or favorite remedy. In all my practice, I have only seen diphtheria in its asthenic character, and always succeeded promptly with ferrum or cuprum, and rarely penciled; but found it very important to discriminate between their indications; and only when I should find this very uncertain and the help very urgent, I might combine the Tr. ferr. with Tr. cupr. acet.

[Iv.]

ALLEN'S METHOD IN DISLOCATIONS OF THE HIP-ANOTHER CASE.

BY A. F. KINNE, M. D.

Since Bigelow's monograph "upon the mechanism of the hip-joint" was written, there would seem to be rational ground for the hope that the old method of reducing dislocations of that joint by extension and counter-extension in the line of the patient's body, will be finally laid aside.

But the new method by manipulation, has not, perhaps, been carried to perfection even now. There would seem to be

room for a simplification of it, at least.

In the Ohio Medical and Surgical Journal, for October, 1877, there is a report of four or five cases in point, made by Dr. S. J. Allen, of White River Junction, Vt., who seems to have hit upon the method in question, as long ago as 1841. All Dr. Allen's cases were dislocations upon the dorsum illii. The one which I wish to report here was a displacement into the ischiatic notch, showing, as far as it goes, that the new method is as well adapted to a lodgment of the bone below the tendon of the obturator internus, as above it. But before I proceed to do so, I will insert here, in Dr. Allen's own words, the substance of his very simple procedure, for the benefit of such readers as may not have seen the report. I quote from his second case, page 387.

"After the patient was fully chloroformed, the muscles being thoroughly relaxed, I stepped upon the bed, flexed the leg upon the thigh and the thigh at right angles with the body, and, placing his foot between my legs and my hand beneath the bend of his knee, I lifted the hip well from the bed, and held it immovably in that position less than half a minute, when the head of the thigh bone returned into the socket with a sensible and audible shock."

I was called, August 21, 1878, to see Johnnie M., nearly five years of age, who had been run over by a two-horse wagon loaded with straw. Found him lying upon a bed, where they had placed him, and, both legs being well flexed upon the body, it was plain at a glance, that the left femur was shorter than

its fellow by more than an inch. And a peculiar "knuckle," a little above the middle of its shaft, revealed the existence of a fracture of the shortened thigh at that point.

Was the shortening due to this fracture? examination showed that it was not.

A moment's And upon taking hold of the upper fragment, I found that the limb could be neither extended, rotated nor abducted. Its axis was directed upward and inward, diagonally across the front of the body. And it was also inverted-everted, to be exact for in displacement of the hip backward, inversion with the limb extended becomes eversion when it is strongly flexed upon the body.

Here, then, was not only a fracture but a dislocation also of the same femur. The thigh had been pushed downward and backward out of joint, after being strongly flexed upon the body, and the head of the bone was probably now lying, not in the ischiatic notch, but upon the sacro-sciatic ligament below it.

It was not long since the time when this complication of a fracture and a dislocation of the same femur, was regarded as the most difficult possible in the surgery of this bone. Sir Astley Cooper, would have first mended the broken bone, and then, if possible, reduced the luxation, after the lapse of four or five weeks.* But all this is happily now changed, and I think it highly probable that in this case, the luxation might have been reduced by manipulation as taught in recent textbooks. But I had seen Dr. Allen's report, and as the leverage to be gained by flexing the leg upon the thigh, must be lost at the point of fracture, the case seemed to be an especially good one, and a new one in some respects, in which to make further trial of the new method.

I gave chloroform, therefore, to the point of complete anæsthesia, this, in some cases at least, being an essential prerequisite to the success of this method. Then passing my right hand from within outward, under the knee of the affected limb, the head of the bone was easily drawn upward into the

*Cooper on Dislocations and Fractures. Boston, 1825, p. 398.

sciatic notch; and the displacement was then simply ischiatic, or dorsal below the tendon. The shortening was then nearly gone and the mobility of the joint much improved. Continuing the same procedure, I then carried the thigh to a perpendicular, and, holding the leg in a line parallel with the axis of the body, made gentle extension upward. In less than half a minute, and before I had used quite force enough to raise the little hips from the bed, the head of the bone began to glide upward, the pelvis, at the same time, rotating outward; and, as soon as abduction enough was thus indirectly secured, it rotated into the acetabulum with that peculiar shock, both sensible and audible, which every surgeon so well knows how to appreciate. And thus, before the bystanders knew what was the matter, I had reduced an ischiatic luxation of the hip with one hand.

Of course, it must be admitted, that Dr. Allen's method, when he first began to practice it, was empirical. And so indeed, originally, was the method by manipulation also. But a better understanding of the mechanism of this joint, has shown that both these methods are thoroughly scientific and rational; and that the principles involved in both are essentially the same; the only difference being, that, by Dr. Allen's method, abduction is obtained by permitting the pelvis to rotate outward, away from the thigh, and that eversion of the thigh is secured beforehand (or inversion corrected) by holding the leg parallel with the axis of the body.

Upon taking off the pants in order to dress the fracture, the track of the wheel was very distinct; it did not seem difficult to see, also, how the thigh had been both broken and dislocated. The broken thigh showed no marks of external violence, and must have been drawn up out of the way. The right leg being extended, the wheel seems to have passed over the front of the body in the line of the right groin, and just below the scrotum and penis, which were very small and closely retracted. There was a small quantity of feces in the pants and the anus was patulous and bloody, indicative of the pressure to which that part of the body has been subjected. And the surgical lesions would seem to have been caused by the hub

or some other part of the passing wheel impinging upon the flexed knee in the direction of the shaft of the femur.

YPSILANTI, September, 1878.

DISEASES OF THE HEAD.

[Excerpts from Prof. I. J. M. Goss' Manuscripts of the Practice of Medicine, now Preparing.]

ANEMIA.

An abnormal quantity of blood within the brain; a deficiency of that fluid, or a deficiency of arterial blood in particular, leads to anæmia of the brain. Upon examination, the grayish substance appears paler, or nearly white. When cut into, few clots, if any, are seen as in the normal state of the brain. Very frequently the blood-vessels appear empty; and, in most cases, an increased quantity of serum will be found between the subarachnoid spaces. This condition is caused by such influences as bring on general anæmia, as blood-letting, hemorrhages, loss of vitality by diarrhoea, starvation and debilitating diseases, by cutting off the supply of vital fluids, compression of the carotids and vertebral arteries, by tumors or emboli, which prevent the flow of blood to the head. This condition of the brain may be known by slow breathing, loss of consciousness (in bad cases), dilated pupils and sometimes paralysis or convulsions. As this condition advances, there may be headache, sensitiveness to light and to sound, flickering before the eyes, vertigo, and noises in the ears. In some cases, there is high excitability, sleepiness, etc. In some extreme cases, there is delirium; and in some cases even rage; and the pupils are insensible to light; the pulse is frequent and small.

Treatment. If there is general anæmia, we should meet this condition by food and medicines. And if the heart's impulse is very feeble, we should enjoin complete rest in a horizontal position. As regards the medical treatment, that must depend upon the case. If this condition depend upon exhaustion by previous diarrhoea or hemorrhage, in addition to good diet, we should give arsenic and iron, alternated with the fluid extract of bark and nux vomica. I usually give 5 drops of