as in that event, the Faculty in a body would resign. Such would be the action, we presume, of every regularly organized Faculty throughout our country.

New York Eye Infirmary.-The building on Mercer Street, having been found not to furnish suitable accommodation for the large number of patients, and which are annually increasing, the Trustees applied to the Legislature for a grant of $10,000, on condition that $20,000 should be raised by private subscription. We are happy to state, that the requisite amount has been made up, and that two lots on the corner of 2d avenue and 13th street have been purchased: contracts have been made for the erection of a building, 51 feet front by 75 feet in depth, to be completed by April 1st, 1856. The Trustees, in their appeal to our fellow citizens, state," that the additional sum of $12,000 will be required for the completion of the building; and they confidently ask, What other charity presents stronger claims than this, which relieves the poor man from his incipient or confirmed blindness, restores him to usefulness and happiness, and to the capacity to support his family?"

Editorial Changes.-Dr. Austin Flint has retired from the editorial department of the Buffalo Journal, having, with great ability, filled that post, during ten years. In his valedictory Dr. F. states, "that during the ten years of his editorship, but two editors, Drs. Isaac Hays, of Philadelphia, and L. P. Yandell, of Louisville, have kept their places on the tripod." Professor S. B. Hunt (late associate) is now sole editor.- Western Lancet.-Prof. Lawson, having removed to Louisville, Ky., has retired from the editorship, and is succeeded by Dr. T. Wood, of Cincinnati, O.-Ohio Medical and Surgical Journal, Columbus, O.-R. Gundry, M. D., has been appointed assistant editor.New Orleans Medical and Surgical Journal.-Dr. Bennet Dowler announces in the May No., that he will continue to edit this Journal, and that his projected Quarterly Journal has been abandoned.- -The American Journal of Insanity is now printed and published at the Utica State Asylum. The assistant Physicians are the editors, and it is printed by the patients.-The Stethoscope.— The Medical Faculty of Virginia has sold out its interest in this Journal.The British and Foreign Medico-Chirurgical Review-has passed under the editorial charge of Dr. Sieveking. Professor Parkes, late editor, has been appointed Superintendent of the English Civil Hospital in the East.- -The Edinburgh Medical and Surgical Journal, and the Monthly Journal of Medical Science-have been amalgamated. Prof. Bennet retires from the editorial chair. -We may remark, in this connection, that some idea of the opinion entertained in Great Britain on the subject of the cauterization of the bronchi, and throat swabbing in general, as practiced in this city, may be obtained by consulting the May No. of the Monthly Edinburgh Journal, and the Dublin Medical Press for the 27th Dec. last. They are well worthy of the attention of American specialists.

The Annual Meeting of the Association of the Medical Superintendents of the Insane-occurred at Boston on 23d May. Dr. Ray, of the Butler Hospital, R. I., was elected President, in place of Dr. L. V. Bell resigned; Dr Kirkbride, of Philadelphia, and C. H. Nichols, of Washington, D. C., were appointed Vice Presidents (proceedings in our next).- -Mortality in Large Cities.From a published statement it appears that in 1854 the ratio of mortality was as follows: New York, 1 to 21.95. Philadelphia, 1 to 42.33. Baltimore, 1 to 36.59. Boston, 1 to 36.21.

Woorara as a Remedial Agent.-Dr. John W. Green, of this city, is now engaged, with some distinguished physiologists, in experimenting upon animals with this poison by the endermic method. The peculiar effects induced seem to favor the opinion that important results may be anticipated from the sedative effects of this poison in cases of tetanus, or rabies.

Weekly Mortality. CITY.-For the week ending April 28th, 399:-Consumption, 58; apoplexy, 4; congestion of brain, 9; bronchitis, 5; pneumonia, 31; croup, 9; scarlet fever, 22; measles, 17; small pox, 1; typhus fever (including "typhoid "), 11. For the week ending May 5th, 438:-Consumption, 63; apoplexy, 1; congestion of brain, 8; bronchitis, 11; pneumonia, 27; croup, 10; scarlet fever, 25; measles, 5; small pox, 2; typhus fever (including "typhoid "), 12. For the week ending May 12th, 431:-Consumption, 56; apoplexy, 5; congestion of brain, 5; bronchitis, 3; pneumonia, 34; croup, 11; scarlet fever, 24; measles, 11; small pox, 4; typhus fever (including "typhoid "), 9. For the week ending May 19th, 457:-Consumption, 72; apoplexy, 6; congestion of brain, 8; bronchitis, 7; pneumonia, 25; croup, 9; scarlet fever, 25; measles, 17; small pox, 3; typhus fever (including "typhoid"), 9. For the week ending May 26th, 394:-Consumption, 45; apoplexy, 4; congestion of brain, 6; pneumonia, 13; croup, 15; scarlet fever, 22; measles, 14; small pox, 2; typhus fever (including "typhoid "), 13. Comparative Record of the Weather and Deaths in New 21st Week, ending May 25th.

York to the

The mortality during the 17th and 21st weeks being smaller than in any others since the autumn of last year, their weather may be considered as of the healthiest type for our climate. It may be noted that there seems to have been in those weeks a relative decrease of deaths from diseases of the respiratory organs, and corresponding increase of mortality from fevers.

NECROLOGY.

DIED, on the 25th April, at Newtown, Bucks county, Pa., Dr. RALPH LEA. -At Troy, N. Y., on the 4th May, Dr. PEYTON R. HULBERT, æt. 74.—On 28th April, at Randall's Island, N. Y., Dr. E. H. KIMBALL, æt. 23, one of the Resident Physicians.— At Baltimore, Md., on the 29th April, Dr. H. B. CHEW, æt. 20.- At Fort Plain, N. Y., on 23d March, Dr. ELIAS P. PHELPS, æt. 55. At Stockbridge, Mass., on 3d May, Dr. JOSEPH C. FOWLER, æt. 35.On 5th May, at Lowell, Mass, Dr. MOSES KIDDER, late Surgeon U. S. Navy. -At Middletown, Conn., May 21, Dr. HAMILTON BREWER, æt. 40.—At Constantinople, early in March, Drs. AUCINELLE and FOUCAULT, of the French Military Hospitals.- -At Columbus, Miss., on 3d May, Dr. F. LIGHTFOOT LEE, formerly of Virginia. In London, March 5th, Mr. AVERY, for many years Surgeon to Charing Cross Hospital. -At Honolulu, S. I., on 12th March, Dr. PAGE, late of California, formerly of Boston.-At Taboga, near Panama, in April, by drowning, Dr. WATSON, an American physician practicing on the island.- On 28th March, Mr. H. E. BULL, æt. 88, for fifty-five years House Surgeon to the Royal Cornwall Infirmary.- -At Sebastopol, on the 20th March, of typhus fever, Dr. ISAAC DRAPER, jr., of South Attleboro', Mass., American Surgeon in the service of the Russian army.-At Kertch, in the Crimea, Dr. COURTENAY S. KING, of Charleston, S. C., æt. 24, an American Surgeon in the Russian service.

THE

NEW YORK MEDICAL TIMES.

VOL. IV.

JULY, 185 5.

No. 10.

Original Communications.

Fracture of the Neck of the Os Brachii, complicated with Luxation of the Head of the Bone in the Axilla, treated successfully by immediate Extension and direct Manipulation over the Luxated Fragment. By JOHN WATSON, M. D., Surgeon to the New York Hospital.

TO THE EDITORS OF THE NEW YORK MEDICAL TIMES:

Gentlemen-Permit me to call your attention to the following cases of dislocation of the shoulder, complicated with fracture at what is called the surgical neck of the os brachii.

Accidents of this sort are of rare occurrence, and have hitherto been looked upon as offering but little hope of recovery. My present object is, to demonstrate the advantages of attempting the immediate reduction of the dislocation by extension of the arm and direct pressure upon the displaced head of the os brachii, over the plan of treatment laid down by Chelius and others; and to show that the let-alone system spoken of by Sir Astley Cooper and Mr. Key in "Guy's Hospital Reports," vols. 4th and 5th, is not always the best. I have not taken time for much research to determine what success other surgeons may have had in the management of these injuries. Sir Astley Cooper, though he acknowledges he had frequently met with such accidents, and of which, indeed, he gives the postmortem appearances of three cases, does not report a single case in which he has succeeded in overcoming the luxation, and restoring the arm to its proper functions. The case reported by Mr. Key was left unreduced; so, also, the case of my colleague, Dr. Buck, of which he has furnished me the particulars, and which, with his permission, I have given below. Judging from the manner in which Chelius alludes to the accident, it is clear that he had never witnessed it at all. VOL. IV. NO. 10.

28

Before alluding to my own cases, I may authenticate these observations. And, first as to Chelius:

"Fracture of the neck of the upper-arm bone," says he, "has also been noticed simultaneously with this dislocation." [South's Translation, 1031.] He does not report, however, any instances of it as having fallen under his own notice. And elsewhere, speaking of the treatment, he says, "When dislocation is connected with fracture of the bone, the latter [former] must be attempted to be set, if it can be done without extension of the limb. If this be not possible, the fracture must be treated first; and on the length of time requisite for that purpose depends whether, after union has occurred, putting to rights the old dislocation can be undertaken." [Ibid. § 997.]

The little likelihood of restoring the head of the bone to its proper place after a sufficient time has elapsed to allow of firm union at the seat of fracture, is well shown by the cases reported by Sir Astley Cooper, and still further by that furnished me by Dr. Buck, and which is as follows:

1847, June 12. ery with her child.

Mrs. K., patient of Dr. B-s was crossing the BowOn reaching forward to catch him, as he was going on in advance of her, she fell upon her left shoulder.

Dr. B. had made some efforts to reduce it, supposing it to be luxation only. The marks of luxation into the axilla were clear; the fingers could be insinuated under the acromion process, and the head of the bone felt deep in towards the thorax. The mobility of the arm was very great in every direction; but, on careful examination, it was obvious that the head of the bone did not move with the shaft, and in certain motions, crepitus was distinctly felt, and even heard, especially when slight extension was made at the same time. Attempts were made to reduce the dislocation by introducing the fingers passed flatwise between the thorax and the head of the bone, so as to get above it, and crowd it downwards towards the glenoid cavity, moderate extension at the same time being kept up at the elbow. No impression was made by this proceeding, though persevered in for a considerable length of time. The fracture having taken place at the juncture of the head and shaft, the former could be acted on in no other way than by the proceeding that was employed.

It was then decided to procure union of the fracture; and after it had become sufficiently consolidated, to renew the attempt at reduction. The arm was secured against the body, with a narrow pillow interposed.

After the lapse of nine weeks, when the fracture had united, an attempt was made to reduce the luxation, which re-fractured the bone. At the expiration of four or five months more, an attempt was made with Jarvis's Adjuster, the patient being put under the influence of ether, and was persevered in for at least half an hour, in which time the insensibility to pain, and the relaxation of the muscles were complete.

The reduction was not effected; the mobility of the limb at the shoulder was increased by the stretching of the ligaments, &c.

Sir Astley Cooper, in the 4th volume (page 265, et seq.) of "Guy's Hospital Reports," has published an important article on injuries about the shoulder joint, supplementary to his work on Dislocations and Fractures, in which, speaking of the accident now under consideration, he says, "As to the treatment, extension is of no further use than to bring the broken shaft of the os humeri into the glenoid cavity, where it forms an useful articulation; but no extension, however violent, disturbs the broken head of the bone; for no proper force could bring it into the glenoid cavity of the scapula. If reduction be ever effected, it will probably be by an extension with the heel or knee in the axilla." "But let the surgeon do what he will, the head of the bone will probably remain in the axilla, and the upper motions of the arm will be in a considerable degree lost. These cases," he adds, "should teach the members of our profession to be kind, generous, and liberal towards each other; and not to impute to ignorance or inattention that which is the result of a generally incurable accident."

*

With these introductory remarks to show the difficulty that has hitherto attended all attempts to treat injuries of this sort, I give the only two instances of this accident that have fallen under my own observation, and in both of which, the broken and dislocated head of the bone was reduced with comparative facility, the deformity overcome, and the arm restored to its proper functions.

CASE I. Dec. 29th, 1851.-Henry Ringe, a coal-carman, fell from his loaded cart, and suffered a severe injury by the passage of the wheel over his left shoulder. I saw him at the office of Dr. Vanderpool soon after the accident, and detected the head of the os brachii in the axilla, and at the same time a fracture of this bone just below the tubercles, or midway between its upper extremity and the point of insertion of the deltoid muscle. After a careful examination, and before the patient had fairly rallied from the shock of the accident, I placed him flat upon