ON THE TREATMENT OF FRACTURES OF THE THIGH WITH TRACTION BY WEIGHT AND PULLEY.

98 memorial should vote against the Lord Justice-General at the and I am glad to have this opportunity of acknowledging the of Chancellor. But when they learn the very kind attention I received from Mr. Syme. He informed trick that has been played upon them, they will probably be me that Hildanus* had described an apparatus for the purpose. It, more disposed to express approval of the Curators who have however, appears that his patient could scarcely have borne it protected the University from the appointment of a Principal as there represented--at all events it fell into disuse. It is now more than thirty years since I was induced to capable of sanctioning a procedure so disingenuous. I am, Sir, &c., employ this plan, from occasional failure in muscular subjects, JAMES SYME. Edinburgh, July 13th, 1868. by Desault’s long splint, however carefully applied. The failure from the constant tendency of the muscles to contract, proceeded Mr. consolation can We do not he Syme any *** begrudge while the control over them was at intervals only ; and any get out of the above attempt to disparage the accuracy of our failure in the retentive apparatus would give them the advantage. statements in regard to the recent election of Principal of the This is met by the constant action of the weight and pulley ; and Edinburgh University. Of course we do not pretend to such I found it very advantageous in fractures of the lower part of the femur. a knowledge of all the means by which Sir James Simpson’s I found ere long that although this method of extension in the has to the been election Principalship prevented as Mr. Syme straight was successful in the lower part of the thigh, it has. " Where ignorance is bliss," &c. : we know more than failed to position obviate the difficulty which has alwaysbeen found to But we are somewhat astonished at Mr. exist in the upper third, we are glad to know. especially in muscular subjects, where in Syme’s courage impugning the correctness of our statements the flexors of the thigh and the pelvis exert a predominant power, when his own letter proves their truth. We spoke of the pain- and produce what is called " The rising end of the bone ;" which ful fact that Sir James had been virtually defeated by the extra- if it cannot be controlled, produces both an angular union and shortening of the limb. To obviate this, Mr. Pott, as is well ordinary opposition of his medical colleagues. Mr. Syme says known, laid his patient on the side and placed the limb in the of sixteen professors who objected, seven belonged to themedi- flexed position ; but although this is calculated to bring the two cal profession. This word " objected" is convenient. We be-i portions into a straight line, yet it provides no adequate power lieve weare right in saying that only twelve professors signed to prevent shortening, and if the patient cannot be prevented the memorial presented to the Senatus. Of these twelve, from occasionally turning on his back there is a strong tendency to carry the upper portion inwards with the pelvis. To meet seven were medical professors. Not only were they a majority, these difficulties I availed myself of the bed the grandson of that but Mr. Syme knows that they were the influential names in celebrated surgeon brought into use-I mean my late friend, Mr. the memorial. Mr. Syme’s attempt to weaken our statement Henry Earle’s. The thigh, being surrounded by four light splints that Sir James was objected to as an obstetric physician is still to prevent lateral displacement, I laid upon the second segment more lame. The objection was not put in the memorial; but of this bed at the most convenient angle, the knee corresponding with the joint of the bed-which is capable of adaptation as to as the memorial went round for signature-according to our length-the leg and foot resting on the third segment. Two information it was taken from house to house by a very dis- short pads of a wedge-shape, with the base corresponding to the tinguished professor-it was accompanied by a letter request- condyles, and short splints over them, are grasped by a cord ing signatures; and this letter-Mr. Syme tells us-" did con- having a clove hitch, the two ends carried down from the contain the allegation" that Sir James was an obstetric physician. dyles united at a convenient distance and then carried over a We never said it was in the memorial. Mr. Syme admits it pulley, and connected with a bag of sand, which I found the most convenient mode of proportioning the weight. The use of was among the written arguments of the memorialists against these short pads and corresponding splints was to prevent the Sir James Simpson’s appointment. Mr. Syme’s admissions cord from slipping over the joint (and I may mention that I have only assure us of the accuracy of our information, both of found the same plan useful in reducing dislocations). The counter that which we have published and of more that we have extension was provided for by a firm buckle belt round the pelvis, withheld. As to the bearing of the Lord Justice-General’s with straps carried round the lower part of the first segment of behaviour in this matter on his prospect of election to the the bed, and occasionally with a permanent strap also. By this mode the fractured pieces were kept in a straight line, displaceChancellorship, we shall see. Mr. Syme’s language on that ment in every direction being provided against, and sufficient point is not much more convincing than on others.-ED. L. extension maintained to prevent overlapping. The cases treated in this way did perfectly well. Since the account was published to which I have alluded, I ON THE TREATMENT OF FRACTURES OF THE have in vain hoped that the method proposed would have been THIGH WITH TRACTION BY WEIGHT AND carried out by others. But I may fairly conclude that from the manner in which Mr. Erichsen speaks of Dr. Buck’s plan, that PULLEY. this hitherto has not been the case. It was with great satisfacTo tlte Editor of THE LANCET. tion I found that one so distinguished as Mr. Erichsen had Sm,-Since my memoir on difficult dentition was sent off, my adopted it with satisfactory results. Although now for some years I have been unable to pursue friend, Mr. Lydall, who kindly suppliesme with that information yet I feel the greatest interest in all that appermy loss of have otherwise which my sad excluded, read tainsprofession, sight would to it ; and if in introducing the principle of traction I may to me Mr. Erichsen’s important communication with respect to have contributed to promote it, more especially if the methods fractures of the thigh. To these my attention has always been which I adopted should be found useful, it is all that I especially directed. Mr. Erichsen mentionthethree modes of treat- desire. The Transactions in which the account was published unforat the ment

approaching election

employed

University Hospital-i.e., by

long splint,

tunately were discontinued, and have since been greatly neglected; permanent bandage, and traction by weight and pulley; the last but had the memoir I published met Mr. Erichsen’s eye, I am in terms of considerable He seems to consider Dr.

approbation. he is the last person who would have omitted its mention. of New York, as the originator of this mode of treatment. sure I am yours obediently, I am sure that if he had been aware that I had any just claim J. H. JAMES, F.R.C.S., &c. Exeter, May 25th, 1868. to the introduction of the method, he would not have omitted to have mentioned it. I may, however, state, that in the introductory address given by me at the meeting of the Provincial Association, at Liverpool, in 1839, I gave an account of the THE LOTHIANS’ MEDICAL ASSOCIATION. method I had been in the habit of employing for some time, by traction with weight and pulley ; and this account, as contained THis Society, which was formed two years since to further in my address, was published in the " Transactions of the Provincial Medical and Surgical Association," vol. viii. p. 215 ; to- the common interests of the profession, and to promote gether with a plate, showing the apparatus. A model was also friendly feeling amongst its members, has just issued its sent to the Exhibition of 1851. Up to this time I was not second annual report, which contains the results of the deliaware that this mode of treatment had ever been employed ; and I believe we must go back as far as Hildanus for proof that it had berations, and the recommendations of two separate committees on "The Medical Charities of Edinburgh," and on "Medical been. * A few days after the meeting at Liverpool I was at Edinburgh; Hildani opera, p.47. Buck,