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ACCOUNT OF A NEW APPARATUS FOR THE TREATMENT OF FRACTURE OF THE THIGH.
44 does not embrace the question of the whole of the perturbations in the system by which the morbid state is produced, and by which means only the problem in question can be satisfactorily solved. But the difficulties that stand in the way of this solution have already been mentioned in No. IX., every step made in the knowledge of the chemistry and dynamics of the system, tending to furnish additional data, which are necessary to solve the more general questions presented to us in physiological pathology. What is wanting in the works on morbid anatomy, is a more accurate description of all the phenomena which the system presents during the progress of the disease, and it will always be an unfruitful task, merely to delineate the minute structures of morbid products, without a correct knowledge of those peculiar conditions of the system under which they were produced. Müller ascribes the formation of enchondroma to the depressed vitality of the part, but he does not say to what cause we are to ascribe this state, or why this state should affect the osseous system with enchondroma in one individual, and the soft parts in another. But these ACCOUNT OF
A NEW APPARATUS FOR THE TREATMENT OF FRACTURE OF THE THIGH. BY GEORGE
BOTTOMLEY, ESQ., Surgeon, Croydon.
VARIOUS have been the modes of treatment adopted in cases of fracture of the femur, and with the very best of these, unless very great attention be paid, either shortening of the limb or considerable deformity is almost certain to occur; indeed, it has been stated by an eminent hospital surgeon in London, that in adult cases this is the invariable result. I have frequently been an eye-witness to the truth of this statement, as evidenced by instances both of metropolitan and provincial practice; and the knowledge of these failuresfor such, to a certain extent, they must be considered-suggested to me a mode of treatment which I was resolved to apply whenever an opportunity presented itself for the purpose. Having been appointed, some few years since, surgeon, in connexion with an important line of railway then in progress of formation, upon which the number of woikmen
part of the system without or apparent, in other parts of the system-at least, to suppose otherwise is contrary to experience. The whole of the conditions must be taken into account, in order to bring to a satisfactory result the resolution of each problem; and this principle, although lamentably neglected by pathologists, applies to physiology and pathology, as well as to every other branch of science. As enchondromatous tumours do not, like carcinoma, reappear after their extirpation, theirs urgical treatment is much more satisfactory. This disease often produces considerable deformity of the part in which it is seated. There are morbid preparations of these tumours in the Hunterian, St. Bartholomew’s, and Guy’s Hospital museums, the study of which will prevent the surgeon’s mistaking them for those malignant tumours which, after extirpation, reappear either in the same or some other portions of the body. changes surely cannot go
some
on
in
one
corresponding changes, either concealed
ERRATUM.—In our last paper, p. 529, vol. i. for 1847, the 2 and 3 should be transposed.
description
to
figures
under my care sometimes exceeded 2000, ample opportunities afforded me of carrying out my views with respect to fractures of the femur, and of testing their value. I invariably used an apparatus described by the subjoined sketch, which was made under my direction, and in every instance the results were most gratifying and satisfactory; for, with but one or two exceptions, it would now be difficult to discover in my former patients, -either by their gait or by their mode of using the limb, which of the two had been the subject of fracture; and their recovery at the time was more than usually rapid. The screw power of which I have availed myself has been noticed by Bowyer; but his mode of adapting it does not offer sufficient means of extension and counter-extension, and requires the use of tightly-drawn bandages, which are entirely dispensed with by my apparatus. It will also be observed, by reference to the diagram, that the whole of the fractured limb is exposed to view, and should the slightest contraction be observed, the remedy can be instantly applied by means of the screw, the management of which is as simple as can well be conceived. were
Fig. 1. The splint and appendages applied.-2. View of the inner side of the leg attached to the splint.-3. Belt for the chest.-4. Splint unattached.-5. Ditto ditto, placed horizontally, to show the metal rod connected with the screw, which slides into a box across the sole of the boot.
45 The rnod118 operandi is as follows:-The belt, A, is secured round the upper part of the chest by braces over the shoulder. A pocket in the belt receives the head of the splint, B, where it is made fast by a piece of tape. The foot is placed in a well-padded boot, C, and straps from each side of the boot are fastened to a belt, D, round the lower portion of the thigh, immediately above the patella. The long splint has at the lower end a revolving screw, E, to which is attached, at right angles, a short metal rod, F, fitted into a brass box, fastened transversely to the sole of the boot, which can thus be moved up and down the splint at pleasure. The splint is secured to the lower portion of the patient’s body by a wellpadded pelvic strap, G, and there are one or two other straps, to be used round the leg or not, according to the judgment of the attendant. When once properly applied, the screw must be turned to bring the limb to its proper length by extension, and no bandage to it will, under any circumstances, be required. Having thus established a fixed point at the head of the splint by means of the braces, it will be at once appa. rent that the apparatus confers the power both of extension and counter-extension, and is, moreover, so completely undei the control of the screw, that it may be regulated to thE greatest nicety by a mere application of the finger and
simply, modifications of the same style of idiomatic expression, by which the instrument employed to effect a backward-bending posture of the arms, or of the body, is designated by the distinctive term of the posture itself, as ozrza8o7-OVOC (), the backward-bending cord, or rope. In our nosological descriptions, these three terms are intro-
are
duced to characterize certain varieties of tetanus, a spasmodic disease of the muscles; and it is remarkable that another variety which it has been thought necessary to specify, is named completus, being thus particularized by this adjective term for complete, or general spasmodic rigidity of the muscles of the body. This circumstance, trivial in itself, goes far, I apprehend, to establish satisfactorily the true character of the words under consideration, for it proves that in any attempt to distinguish a new variety of tetanus, recourse must be had to a term expressive of the special adjective quality by which that variety is to be recognised, and this cannot be fitly done by a noun substantive. Again: this fact reflects light upon what, with the same necessity for distinctive appellation, was originally intended by the adoption of terms similar to completus in quality and purpose. While it is admitted that the instance of oa!rs6orovog being stated to be used substantively gives some colour of authority for its like use in the Latin, and in our own tongue; a use, indeed, which, thumb. by the idiom of these respective languages, would havebeen made of all the terms, in absence of any such authority; nevertheless, it affords no ground whatever for converting ON THE NOMENCLATURE OF THE SCIENCE them into nouns substantive, a violation of the proprieties of OF MEDICINE. grammatical arrangement quite indefensible. In fine, as in the Greek, the first two are indubitably adjecBY R. G. MAYNE, M.D., Leeds. tive, although one of them is, somewhat unnecessarily, declared to be used substantively, and the third, more recently formed on their model, is of course the same; as in the pathological No. VI. literature of the present day; each of them, like completus, is PLEUROTHOTONOS-PLATYSMAEMPROSTHOTONOS, OPISTHOTONOSAND employed to distinguish, by the indication of a particular form, MYOIDES—CONCLUSION. varieties of the disease tetanus,as, farther, none of them has, or Emprosthotorzos, opisthotonos, and pleurot7totonos.--These three can have, a perfect or independent substantive signification, terms, which have been hitherto presented in medical dic- I therefore must they be maintained in the original and proper tionaries as nouns masculine, the names of particular forms of ’, character of their classical synonymes, namely, of adjective spasmodic disease of the muscles, are adjective in their cha- terms agreeing with the noun tetanus. racter, requiring to be joined to nouns, to which they add, There is another variety of tetanus, which, to avoid misconseverally, the expression of a certain quality. The first of ception, had as well be here alluded to. It is that named them, ernprost1wtonos, is adopted literatim from the Greek ad- trismus, or locked-jaw, ( from to gnash,) for this jective , (formed of , adverb,signifying word being a noun masculine, it may occur to some that it before, and uivúJ, to bend, stretch, or extend,) bent, or constitutes a reason for characterizing the other terms as stretched forwards, also meaning pertaining or belonging to nouns also. There is a wide difference between it and them, the disease itt-rPO60070via, a convulsion of parts forwards. however. Trismus stands, per se, as the distinctive name of a The second, opisthotonos, in like manner, is from the Greek spasmodic affection of the muscles of the jaw, and, in profesadjective , (, adv. behind ; and the same sional parlance, is coupled with tetanus, or spasmodic disease verb, uívúJ, to bend, &c.,) meaning bent, or stretched back- of the muscles generally, only, for sake of nosological distribuwards, and, like the former, pertaining or belonging to the tion, being ranked as a variety of that genus of disease, but disease , a convulsion of parts backwards. The having no grammatical association with it of any kind. third, pleurothotonos, is of modern invention, being constructed, Platysma—Myoides.— This term, familiarly known in its in imitation of the other two, to convey the idea of bending, application to the broad muscle of the neck, occupies, I take or bent to the side, (, adv., from the side, and .) liberty to state, a false position with reference to its spelling, It is fair to state, that in respect to the term opisthotonos, derivation, and, consequently, to the precise meaning attached there exists a peculiarity which would, at first sight, seem to to it and its employment in medical language. In " Hooper’s militate against the opinion just offered, and it is this-the Dictionary,"it is inserted as follows:-" Platysma-Myoides, Greek adjective 67rtaO67ovoc is sometimes used substantively (from broad, µvs, a muscle, fuos, resemblance.") No and synonymously with the noun Ò7/’LU80TOvia, or a convulsion farther explanation of the term is added, but the plain signifiof parts backwards. Similarly employed, it is made to signify, cation left to be inferred is, resembling a broad muscle, or, it too,"a person labouring under that disease", (viz., ò7rLu8o,ovía,) might be, broad, (and) like a muscle. I need scarcely say, likewise a cord or fetters by which the hands are bound that either of these is very vague and unsatisfactory, affording behind the back." None of these, however, is, in strict lan- no explicit idea of the real meaning of the term. The object guage, the sense in which this term is used in modern patho- to which it is applied is not only like, but actually forms and logical literature. No similar peculiarity, so far as I have constitutes, a broad muscle, styled, accordingly, latissimus been able to discover, attends entprosthotonos, nor (of course) (rrzzcsculus) colli, by Albinus and Douglas. By now endeavourpleurothotonos. The adjective Ò7rLUeÓTOVOr; being thus made to ing to show the erroneousness of the derivation quoted, I serve the same purpose as the noun ò7rLu8o,ovía, just forms hope to provide the best means of arriving at a correct unan illustration of the idiom of the Greek language, which, derstanding of this term, for which end it is necessary to conlike that of the Latin, and of our own, admits of adjective sider, separately, its two components. The first one, platysma, terms being used substantively. Still, 67rtaO67-ovoc is not the may be quickly disposed of. Its Greek original, &pgr;&lgr;á&ngr;&sgr;a less an adjective, neither does it really exist at all as a sub- does not immediately come " from &pgr;&lgr;avs broad," but from stantive. &pgr;&lgr;avw to render full and spacious, or to dilate; and it sigTaking its first application as a synonyme of o7rto’6oTOfta, nifies a broad sheet of linen, or of anything similar, on which a convulsion of parts backwards, it must be evident that the a plaster is spread; also, generally, that which is extended word yocroc, noun fem., a disease, is understood, and that it is breadth-wise, a dilatation, or an cx)xtiz,3ioii. The other comintended to be expressed in this way- (), ponent, myoides, (according to the usual, but incorrect spellthe backward-bending, or backward-stretching disease. In ing,) requires more lengthened consideration. The proper word is myódès; it is not formed from "µs, a the same manner, its second application to a person labouring under the disease 07r!ueoTovia, it is as evident, requires the muscle, resemblance," but is the literal synonyme of an adjective term, signifying " pertaining to muscles, ower, ãvepùJ7ror;, a man, to be understood tIlUS-6,-,LU0070VOC a man labouring under the disease Ò7rLûe070vía, or, of muscles, or of flesh," being simply a derivative of µsZcvs, as it be rendered more aptly in English, an opisthotonic, a muscle; the root, os, which alone would have warranted or an opisthotonous man. The other applications of this term orthography in use, constituting no part of its etymology.
(
µvôns
! full
the
A NEW APPARATUS FOR THE TREATMENT OF FRACTURE OF THE THIGH. BY GEORGE
BOTTOMLEY, ESQ., Surgeon, Croydon.
VARIOUS have been the modes of treatment adopted in cases of fracture of the femur, and with the very best of these, unless very great attention be paid, either shortening of the limb or considerable deformity is almost certain to occur; indeed, it has been stated by an eminent hospital surgeon in London, that in adult cases this is the invariable result. I have frequently been an eye-witness to the truth of this statement, as evidenced by instances both of metropolitan and provincial practice; and the knowledge of these failuresfor such, to a certain extent, they must be considered-suggested to me a mode of treatment which I was resolved to apply whenever an opportunity presented itself for the purpose. Having been appointed, some few years since, surgeon, in connexion with an important line of railway then in progress of formation, upon which the number of woikmen
part of the system without or apparent, in other parts of the system-at least, to suppose otherwise is contrary to experience. The whole of the conditions must be taken into account, in order to bring to a satisfactory result the resolution of each problem; and this principle, although lamentably neglected by pathologists, applies to physiology and pathology, as well as to every other branch of science. As enchondromatous tumours do not, like carcinoma, reappear after their extirpation, theirs urgical treatment is much more satisfactory. This disease often produces considerable deformity of the part in which it is seated. There are morbid preparations of these tumours in the Hunterian, St. Bartholomew’s, and Guy’s Hospital museums, the study of which will prevent the surgeon’s mistaking them for those malignant tumours which, after extirpation, reappear either in the same or some other portions of the body. changes surely cannot go
some
on
in
one
corresponding changes, either concealed
ERRATUM.—In our last paper, p. 529, vol. i. for 1847, the 2 and 3 should be transposed.
description
to
figures
under my care sometimes exceeded 2000, ample opportunities afforded me of carrying out my views with respect to fractures of the femur, and of testing their value. I invariably used an apparatus described by the subjoined sketch, which was made under my direction, and in every instance the results were most gratifying and satisfactory; for, with but one or two exceptions, it would now be difficult to discover in my former patients, -either by their gait or by their mode of using the limb, which of the two had been the subject of fracture; and their recovery at the time was more than usually rapid. The screw power of which I have availed myself has been noticed by Bowyer; but his mode of adapting it does not offer sufficient means of extension and counter-extension, and requires the use of tightly-drawn bandages, which are entirely dispensed with by my apparatus. It will also be observed, by reference to the diagram, that the whole of the fractured limb is exposed to view, and should the slightest contraction be observed, the remedy can be instantly applied by means of the screw, the management of which is as simple as can well be conceived. were
Fig. 1. The splint and appendages applied.-2. View of the inner side of the leg attached to the splint.-3. Belt for the chest.-4. Splint unattached.-5. Ditto ditto, placed horizontally, to show the metal rod connected with the screw, which slides into a box across the sole of the boot.
45 The rnod118 operandi is as follows:-The belt, A, is secured round the upper part of the chest by braces over the shoulder. A pocket in the belt receives the head of the splint, B, where it is made fast by a piece of tape. The foot is placed in a well-padded boot, C, and straps from each side of the boot are fastened to a belt, D, round the lower portion of the thigh, immediately above the patella. The long splint has at the lower end a revolving screw, E, to which is attached, at right angles, a short metal rod, F, fitted into a brass box, fastened transversely to the sole of the boot, which can thus be moved up and down the splint at pleasure. The splint is secured to the lower portion of the patient’s body by a wellpadded pelvic strap, G, and there are one or two other straps, to be used round the leg or not, according to the judgment of the attendant. When once properly applied, the screw must be turned to bring the limb to its proper length by extension, and no bandage to it will, under any circumstances, be required. Having thus established a fixed point at the head of the splint by means of the braces, it will be at once appa. rent that the apparatus confers the power both of extension and counter-extension, and is, moreover, so completely undei the control of the screw, that it may be regulated to thE greatest nicety by a mere application of the finger and
simply, modifications of the same style of idiomatic expression, by which the instrument employed to effect a backward-bending posture of the arms, or of the body, is designated by the distinctive term of the posture itself, as ozrza8o7-OVOC (), the backward-bending cord, or rope. In our nosological descriptions, these three terms are intro-
are
duced to characterize certain varieties of tetanus, a spasmodic disease of the muscles; and it is remarkable that another variety which it has been thought necessary to specify, is named completus, being thus particularized by this adjective term for complete, or general spasmodic rigidity of the muscles of the body. This circumstance, trivial in itself, goes far, I apprehend, to establish satisfactorily the true character of the words under consideration, for it proves that in any attempt to distinguish a new variety of tetanus, recourse must be had to a term expressive of the special adjective quality by which that variety is to be recognised, and this cannot be fitly done by a noun substantive. Again: this fact reflects light upon what, with the same necessity for distinctive appellation, was originally intended by the adoption of terms similar to completus in quality and purpose. While it is admitted that the instance of oa!rs6orovog being stated to be used substantively gives some colour of authority for its like use in the Latin, and in our own tongue; a use, indeed, which, thumb. by the idiom of these respective languages, would havebeen made of all the terms, in absence of any such authority; nevertheless, it affords no ground whatever for converting ON THE NOMENCLATURE OF THE SCIENCE them into nouns substantive, a violation of the proprieties of OF MEDICINE. grammatical arrangement quite indefensible. In fine, as in the Greek, the first two are indubitably adjecBY R. G. MAYNE, M.D., Leeds. tive, although one of them is, somewhat unnecessarily, declared to be used substantively, and the third, more recently formed on their model, is of course the same; as in the pathological No. VI. literature of the present day; each of them, like completus, is PLEUROTHOTONOS-PLATYSMAEMPROSTHOTONOS, OPISTHOTONOSAND employed to distinguish, by the indication of a particular form, MYOIDES—CONCLUSION. varieties of the disease tetanus,as, farther, none of them has, or Emprosthotorzos, opisthotonos, and pleurot7totonos.--These three can have, a perfect or independent substantive signification, terms, which have been hitherto presented in medical dic- I therefore must they be maintained in the original and proper tionaries as nouns masculine, the names of particular forms of ’, character of their classical synonymes, namely, of adjective spasmodic disease of the muscles, are adjective in their cha- terms agreeing with the noun tetanus. racter, requiring to be joined to nouns, to which they add, There is another variety of tetanus, which, to avoid misconseverally, the expression of a certain quality. The first of ception, had as well be here alluded to. It is that named them, ernprost1wtonos, is adopted literatim from the Greek ad- trismus, or locked-jaw, ( from to gnash,) for this jective , (formed of , adverb,signifying word being a noun masculine, it may occur to some that it before, and uivúJ, to bend, stretch, or extend,) bent, or constitutes a reason for characterizing the other terms as stretched forwards, also meaning pertaining or belonging to nouns also. There is a wide difference between it and them, the disease itt-rPO60070via, a convulsion of parts forwards. however. Trismus stands, per se, as the distinctive name of a The second, opisthotonos, in like manner, is from the Greek spasmodic affection of the muscles of the jaw, and, in profesadjective , (, adv. behind ; and the same sional parlance, is coupled with tetanus, or spasmodic disease verb, uívúJ, to bend, &c.,) meaning bent, or stretched back- of the muscles generally, only, for sake of nosological distribuwards, and, like the former, pertaining or belonging to the tion, being ranked as a variety of that genus of disease, but disease , a convulsion of parts backwards. The having no grammatical association with it of any kind. third, pleurothotonos, is of modern invention, being constructed, Platysma—Myoides.— This term, familiarly known in its in imitation of the other two, to convey the idea of bending, application to the broad muscle of the neck, occupies, I take or bent to the side, (, adv., from the side, and .) liberty to state, a false position with reference to its spelling, It is fair to state, that in respect to the term opisthotonos, derivation, and, consequently, to the precise meaning attached there exists a peculiarity which would, at first sight, seem to to it and its employment in medical language. In " Hooper’s militate against the opinion just offered, and it is this-the Dictionary,"it is inserted as follows:-" Platysma-Myoides, Greek adjective 67rtaO67ovoc is sometimes used substantively (from broad, µvs, a muscle, fuos, resemblance.") No and synonymously with the noun Ò7/’LU80TOvia, or a convulsion farther explanation of the term is added, but the plain signifiof parts backwards. Similarly employed, it is made to signify, cation left to be inferred is, resembling a broad muscle, or, it too,"a person labouring under that disease", (viz., ò7rLu8o,ovía,) might be, broad, (and) like a muscle. I need scarcely say, likewise a cord or fetters by which the hands are bound that either of these is very vague and unsatisfactory, affording behind the back." None of these, however, is, in strict lan- no explicit idea of the real meaning of the term. The object guage, the sense in which this term is used in modern patho- to which it is applied is not only like, but actually forms and logical literature. No similar peculiarity, so far as I have constitutes, a broad muscle, styled, accordingly, latissimus been able to discover, attends entprosthotonos, nor (of course) (rrzzcsculus) colli, by Albinus and Douglas. By now endeavourpleurothotonos. The adjective Ò7rLUeÓTOVOr; being thus made to ing to show the erroneousness of the derivation quoted, I serve the same purpose as the noun ò7rLu8o,ovía, just forms hope to provide the best means of arriving at a correct unan illustration of the idiom of the Greek language, which, derstanding of this term, for which end it is necessary to conlike that of the Latin, and of our own, admits of adjective sider, separately, its two components. The first one, platysma, terms being used substantively. Still, 67rtaO67-ovoc is not the may be quickly disposed of. Its Greek original, &pgr;&lgr;á&ngr;&sgr;a less an adjective, neither does it really exist at all as a sub- does not immediately come " from &pgr;&lgr;avs broad," but from stantive. &pgr;&lgr;avw to render full and spacious, or to dilate; and it sigTaking its first application as a synonyme of o7rto’6oTOfta, nifies a broad sheet of linen, or of anything similar, on which a convulsion of parts backwards, it must be evident that the a plaster is spread; also, generally, that which is extended word yocroc, noun fem., a disease, is understood, and that it is breadth-wise, a dilatation, or an cx)xtiz,3ioii. The other comintended to be expressed in this way- (), ponent, myoides, (according to the usual, but incorrect spellthe backward-bending, or backward-stretching disease. In ing,) requires more lengthened consideration. The proper word is myódès; it is not formed from "µs, a the same manner, its second application to a person labouring under the disease 07r!ueoTovia, it is as evident, requires the muscle, resemblance," but is the literal synonyme of an adjective term, signifying " pertaining to muscles, ower, ãvepùJ7ror;, a man, to be understood tIlUS-6,-,LU0070VOC a man labouring under the disease Ò7rLûe070vía, or, of muscles, or of flesh," being simply a derivative of µsZcvs, as it be rendered more aptly in English, an opisthotonic, a muscle; the root, os, which alone would have warranted or an opisthotonous man. The other applications of this term orthography in use, constituting no part of its etymology.
(
µvôns
! full
the