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DISLOCATION OF THE WRIST?
663 tense and prominent, particularly when the nance was deadly pale ; the respiration con. foot is twisted outwards. The plantar fascia siderably impeded with a little stertorous The gastrocnemius is snort, about every third inspiration, accomfeels contracted. very imperfectly developed. The peronaRi panied by a deep sigh; pulse weak and muscles being very small, he possesses very irregular; involuntary action of the bowels ; little power of abducting the foot. There is and spasmodic twitchings of the muscles of a small ulcer just above the outer malleolus. the face and arms. The head was immediately shaved, and March 18. Mr. Quain divided the tendo Achillis with a narrow scalpel, and also a the child put to bed ; a piece of lint, dipped firm band of fascia placed on the inner side in cold water, having been placed over the of the plantar surface of the foot; the skin in tumour. Fearing that the case would tereach case being left entire, except at the minate fatally, the assistance of Mr. White was requested. That gentleman promptly point of entrance of the instrument. 23. An apparatus was applied to the attended, and after a little deliberation, the foot, by which the heel was drawn down- pulse having, in the mean time, slightly ralwards, and the foot at the same time in- lied, he decided upon opening the temporal clined outwards. artery. At first, but a small quantity of 26. The tendons of the tibialis anticus, blood oozed from the wound ; it after a few as well as that of the extensor pollicis pro- seconds, however, came freely, per saltum, prius, and the inner and outer tendons of the and a teacupfull was extracted. The puextensor longus digitorum, were divided pils now began to contract, and in a few about an inch behind the metatarso-phalan- minutes the little patient lost its stertorous geal articulation. A thick fibrous band was snort, the breathing became quiet, the spasalso divided on the plantar surface of the modic twitching ceased, and he fell into a . foot at its inner side. quiet sleep. The next morning he was quite 28. The apparatus was reapplied with well. Mr. White, at the time, related a case very trifling inconvenience to the patient. May 5. The apparatus has been discon- which had occurred in his private practice, tinued ; the patient walks very well, and and in which the symptoms were exactly without limping, and can place the entire similar. In this case, however, it was some hours before he saw the patient. He then sole of the foot firmly on the ground. This consisted of a foot-board, to which directed that the temporal artery should be the foot was secured by pads and straps, opened. This proceeding acted like a charm; and of a lateral splint formed of iron, about the child in a few seconds after beginning to rub its feet, to which a few hours before one inch in width, and extending from the foot-board along the outer side of the leg to some mustard poultices had been applied. a little below the knee, and secured by A better illustration of returning conscious. straps to the leg. An « universal joint" ness could not have occurred. Mr. Holt thinks that the above cases are placed in the splint opposite the ankle, allowed the foot to be flexed on the leg by extremely instructive, from the fact of the means of a strap carried from the fore part symptoms in both instances being exactly of the foot-board to a buckle near the knee, those which result from the combined effects and to be turned outwards or inwards by of concussion and compression ; but which, as was proved by the treatment and its the action of a screw placed near the joint. success, were mainly dependent upon a loaded state of the vessels of the brain, WESTMINSTER HOSPITAL. caused by the injury which had been sus.
The heart not having sufficient tained. to the quantity of blood conpower dislodge OPENING THE TEMPORAL ARTERY. tained in the cerebral vessels, the circulation MR. B. W. HOLT, of the Broad Sanctuary, was imperfect and impeded. The abstrachas communicated the following case which tion of blood from the temporal artery equaoccurred at the Westminster Hospital, dur- lised the circulation, and the urgent symping his temporary residence as house-sur- toms began to decrease ; the pupils became geon to that institution. and the breathing quiet. W. Edy, aged four, was admitted into contractile, Mr. Holt finally believes, that unless Mr. the hospital on the 4th of July, with concus- White had suggested the opening of the sion of the brain. The mother states that, the child would have died. while playing at the first-floor window, he artery, was precipitated to the ground, a height of DISLOCATION OF THE WRIST? about fourteen feet, and that his head struck against the stone pavement. He was found To the Editor of THE LANCET. to be perfectly insensible, and was immeSIR:—In last week’s number of your to the diately brought hospital. Upon examining the head, Mr. Holt found a large valuable Journal, is a reply to some remarks puffy tumour, over the junction of the parie- made by me on a case of supposed dislocatal and occipital bones. The pupils were tion of the wrist-joint, as reported to have dilated and permanently fixes ; the counte- occurred at the University College HosCONCUSSION OF THE
BRAIN,
EFFECTS OF
664
pital,
under the
care
of Mr. Liston.
I re-
uncommon.
How many persons have been
gret that the opinions I advanced in my deprived of the use of their hands by similar
errors ? Daily practice shows their frequency ; and if such men as Pelletan,Bozer, Marjolin, have erred, surely it is possible that Mr. Taylor, even 11 with a guide on the opposite side," might have been mistaken. In asserting that one of my objections to the accuracy of the diagnosis was, "that no surgical knowledge. precedent had occurred in the practice of In objecting to the accuracy of the term French surgeons, and therefore, that it was dislocation, being applied to an accident not likely to occur here," the reporter to evidently consisting of fracture of the in- your Journal has unfortunately made aslight
have appeared rather curious to the reporter of the above case, for, far from belonging to myself, they were but a repetition of opinions professed by one of the greatest surgeons that ever existed, Baron Dupuytren, and are those of many surgeons of the present day renowned for
remarks, should
ferior extremity of the radius, I by no means wished to impugn the professional skill of the house-surgeon, who no doubt is situation he holds, perfectly deserving of the gained as it was by his " mental trial ;" but, however "capable of distinguishing the nature of the accident," he may appear to be to the reporter of the case in question, in mistaking a fracture of the inferior extremity of the radius for dislocation of the wrist, Mr. Taylor stands not alone; it is an every-
mistake. The words I made use of were: that no well-authenticated case had as yet been published ;" meaning, not only in France, but even in England. For the present, I must content myself with the above remarks. In a future communication I will endeavour to show that, notwithstanding the 11 mention of the characteristic signs of the injury by all English surgical authors,’’ dislocation of the wristjoint, from falls on the hands is an exceedday occurrence ; and many persons, not stu- ingly rare occurrence, and that probably it dents or young surgeons, but professors, has never existed. I remain, E. S. hospital-surgeons, men celebrated for knowJuly 26, 1841. ledge and talent, have similarly erred. In proof of this let us take the following cases, nearly thirty years ago, when Pelletan and GLOUCESTER ASYLUM Dupuytren were surgeons of the Hotel-Dieu PROPOSITIONS. of Paris ; a mason was brought to the hosOF RESTRAINT LUNATICS—IMPORTANT REASON pital, having fallen from a considerable FOR PREFERRING LARGE TO SMALL AND with and several wounds, height ; together PRIVATE PLACES. a fracture of the cranium, he presented at one of his wrists a displacement, having all To the Editor of THE LANCET. the signs of dislocation of the carpus backPelletan Mr. SIR :-The statement of the visiting comdislowards ; diagnosticated cation ; M. Dupuytren, fracture of the in- mittee of the GLOUCESTERSHIRE LUNATIC ferior extremity of the radius. At the post- ASYLUM for the year 1810, has accirlentally mortem examination, so strikingly similar fallen under my notice. It contains four to a dislocation was the accident, that it was propositions of the medical officers,-too imonly on exposing the joint that the fracture portant, notwithstanding the lapse of time was evident, with the articulation un- since the’ publication of the document, to touched. be passed over in silence. They are as fol:Many years afterwards, another case oc- lows " curred at the Hopital Beaujon. At this 1st, That to avoid personal restraint, so time Dupuytren had publicly announced far as may be considered compatible with that,without absolutely denying that dislo- security, has always been a standing and cation of the wrist could result from falls on peremptory rule of the institution, and the hand, he denied that any case existed ; strictly attended to under all circumstances. " and that in every case, published as dislo2nd, That the combined and correcation, a fracture of the inferior extremity of sponding evidence of several large lunatic the radius had been taken for dislocation. establishments has clearly shown that per. He further defied any one to show him a sonal restraint may be avoided to a much single case of real and well-established dis- greater extent than was formerly considered location. A man died at Beaujon, with all either possible or advantageous in the treatthe signs of dislocation of the wrist back- ment of the disease. " wards : glorying in the opportunity of refut3rd, That they dissent from the general ing him, Mr. Marjolin sent for Dupuytren; proposition that personal restraint is, under on laying bare the parts, a comminuted frac- all circumstances, prejudicial ; and are of ture of the inferior extremity of the radius opinion, that notwithstanding all that has was found. Since then, Mr. Marjolin be- been said upon the subject, the experiment came a convert to the opinions of Du- has not yet been virtually and really tried in any large establishment, the confinement puytren. These are recorded and well-authenti- of refractory patients in their cells being not cated facts, and unfortunately they are not only an obvious personal restraint, but most "
Sir, yours, &:c.
The heart not having sufficient tained. to the quantity of blood conpower dislodge OPENING THE TEMPORAL ARTERY. tained in the cerebral vessels, the circulation MR. B. W. HOLT, of the Broad Sanctuary, was imperfect and impeded. The abstrachas communicated the following case which tion of blood from the temporal artery equaoccurred at the Westminster Hospital, dur- lised the circulation, and the urgent symping his temporary residence as house-sur- toms began to decrease ; the pupils became geon to that institution. and the breathing quiet. W. Edy, aged four, was admitted into contractile, Mr. Holt finally believes, that unless Mr. the hospital on the 4th of July, with concus- White had suggested the opening of the sion of the brain. The mother states that, the child would have died. while playing at the first-floor window, he artery, was precipitated to the ground, a height of DISLOCATION OF THE WRIST? about fourteen feet, and that his head struck against the stone pavement. He was found To the Editor of THE LANCET. to be perfectly insensible, and was immeSIR:—In last week’s number of your to the diately brought hospital. Upon examining the head, Mr. Holt found a large valuable Journal, is a reply to some remarks puffy tumour, over the junction of the parie- made by me on a case of supposed dislocatal and occipital bones. The pupils were tion of the wrist-joint, as reported to have dilated and permanently fixes ; the counte- occurred at the University College HosCONCUSSION OF THE
BRAIN,
EFFECTS OF
664
pital,
under the
care
of Mr. Liston.
I re-
uncommon.
How many persons have been
gret that the opinions I advanced in my deprived of the use of their hands by similar
errors ? Daily practice shows their frequency ; and if such men as Pelletan,Bozer, Marjolin, have erred, surely it is possible that Mr. Taylor, even 11 with a guide on the opposite side," might have been mistaken. In asserting that one of my objections to the accuracy of the diagnosis was, "that no surgical knowledge. precedent had occurred in the practice of In objecting to the accuracy of the term French surgeons, and therefore, that it was dislocation, being applied to an accident not likely to occur here," the reporter to evidently consisting of fracture of the in- your Journal has unfortunately made aslight
have appeared rather curious to the reporter of the above case, for, far from belonging to myself, they were but a repetition of opinions professed by one of the greatest surgeons that ever existed, Baron Dupuytren, and are those of many surgeons of the present day renowned for
remarks, should
ferior extremity of the radius, I by no means wished to impugn the professional skill of the house-surgeon, who no doubt is situation he holds, perfectly deserving of the gained as it was by his " mental trial ;" but, however "capable of distinguishing the nature of the accident," he may appear to be to the reporter of the case in question, in mistaking a fracture of the inferior extremity of the radius for dislocation of the wrist, Mr. Taylor stands not alone; it is an every-
mistake. The words I made use of were: that no well-authenticated case had as yet been published ;" meaning, not only in France, but even in England. For the present, I must content myself with the above remarks. In a future communication I will endeavour to show that, notwithstanding the 11 mention of the characteristic signs of the injury by all English surgical authors,’’ dislocation of the wristjoint, from falls on the hands is an exceedday occurrence ; and many persons, not stu- ingly rare occurrence, and that probably it dents or young surgeons, but professors, has never existed. I remain, E. S. hospital-surgeons, men celebrated for knowJuly 26, 1841. ledge and talent, have similarly erred. In proof of this let us take the following cases, nearly thirty years ago, when Pelletan and GLOUCESTER ASYLUM Dupuytren were surgeons of the Hotel-Dieu PROPOSITIONS. of Paris ; a mason was brought to the hosOF RESTRAINT LUNATICS—IMPORTANT REASON pital, having fallen from a considerable FOR PREFERRING LARGE TO SMALL AND with and several wounds, height ; together PRIVATE PLACES. a fracture of the cranium, he presented at one of his wrists a displacement, having all To the Editor of THE LANCET. the signs of dislocation of the carpus backPelletan Mr. SIR :-The statement of the visiting comdislowards ; diagnosticated cation ; M. Dupuytren, fracture of the in- mittee of the GLOUCESTERSHIRE LUNATIC ferior extremity of the radius. At the post- ASYLUM for the year 1810, has accirlentally mortem examination, so strikingly similar fallen under my notice. It contains four to a dislocation was the accident, that it was propositions of the medical officers,-too imonly on exposing the joint that the fracture portant, notwithstanding the lapse of time was evident, with the articulation un- since the’ publication of the document, to touched. be passed over in silence. They are as fol:Many years afterwards, another case oc- lows " curred at the Hopital Beaujon. At this 1st, That to avoid personal restraint, so time Dupuytren had publicly announced far as may be considered compatible with that,without absolutely denying that dislo- security, has always been a standing and cation of the wrist could result from falls on peremptory rule of the institution, and the hand, he denied that any case existed ; strictly attended to under all circumstances. " and that in every case, published as dislo2nd, That the combined and correcation, a fracture of the inferior extremity of sponding evidence of several large lunatic the radius had been taken for dislocation. establishments has clearly shown that per. He further defied any one to show him a sonal restraint may be avoided to a much single case of real and well-established dis- greater extent than was formerly considered location. A man died at Beaujon, with all either possible or advantageous in the treatthe signs of dislocation of the wrist back- ment of the disease. " wards : glorying in the opportunity of refut3rd, That they dissent from the general ing him, Mr. Marjolin sent for Dupuytren; proposition that personal restraint is, under on laying bare the parts, a comminuted frac- all circumstances, prejudicial ; and are of ture of the inferior extremity of the radius opinion, that notwithstanding all that has was found. Since then, Mr. Marjolin be- been said upon the subject, the experiment came a convert to the opinions of Du- has not yet been virtually and really tried in any large establishment, the confinement puytren. These are recorded and well-authenti- of refractory patients in their cells being not cated facts, and unfortunately they are not only an obvious personal restraint, but most "
Sir, yours, &:c.