under an exceeding difficulty of mak

most in drops, with much effort and straining. On examination, I found the external orifice of the urethra so much contracted that it would scarcely admit a small probe. It was, however, dilated by means of bougies, and the patient voided her urine in a moderate stream. Some time afterwards she was seized with an attack of fever, which proved to be dependent on inflammation of the peritoneum covering the liver, unconnected with the stricture, and of this she died. You will observe that the stricture is quite at the extremity of the urethra, occupying about half an inch of the canal.

Mr. Clarke has described another disease of the female urethra, of which only a few examples have come under my own observation. It consists of a tumor, or excrescence, having its origin from the urethra immediately within the external meatus. The tumor projects externally; is of a soft texture; of a bright scarlet colour; possessed of exquisite sensibility; and it varies in size from that of a large pin's head to the size of a horsebean. It may be removed by the probe-pointed scissars, the basis of it being afterwards destroyed with the potassa fusa, or it may be removed by the application of a ligature. The first of these methods is that which I have myself adopted, and which my own experience in these cases would induce me to prefer. Cut off the tumor first as close to the base as possible; wait until the bleeding has ceased, and then apply the potassa fusa for a short time to the cut surface. On these as on other occasions, where you employ this excellent and most useful caustic, you should take care that it is of the very best quality, and recently made and after you have applied it, the parts in the neighbourhood should be bathed with vinegar, which will neutralize the caustic alkali, and prevent it acting where the action of it is not required. Mr. Clarke's experience on the subject is however greater than mine, and probably more deserving your attention; and he prefers the use of the ligature, which he recommends to be applied tight enough to cause the tumor gradually to drop off, but not tight enough to cut it through in the first instance.

(To be continued.)

RIMENTAL PHYSIOLOGY.

BY M. MAGENDIE.
Lecture 3d.

IN our last Number we gave an abstract of the two first Lectures, and we now proceed to the third, in which M. Magendie treated of the contractility which he calls vital, to distinguish it from the contractility from elasticity, which only takes place after a previous distension of the organ, and concerning which he spoke in the first Lecture.

The contractility of different organs is a point of physiology at once so obscure and important, that it is exceed. ingly desirable that it should engage the attention of some one ex professo.

The following are the most prominent facts on the subject, as illustrated by experiment.

Experiment 1st.—The abdomen of a young dog being opened, we see that the intestine and stomach, which were at first thin, capacious, soft, and flaccid, soon become thickened, firmer, and of smaller capacity. The same is observ ed in the bladder. This viscus, which is flaccid and soft when it is first examined, contracts in all its parts upon itself, so that its parietes are accurately applied to the urine contained in its cavity. Nevertheless the liquid does not flow out; and it is curious that some moments after the animal's death, which results from the opening of the chest, the bladder contracts powerfully but slowly, and the urine flows out almost entirely.

Experiment 2d. The galvanic stream (at least when we apply the two poles to the external surface of the hollow viscera) causes only a very slow contraction in the parietes of the stomach, intestines, and bladder. All these organs acquire, under its influence, more firmness and compactness than they originally possessed, but they do not, on that account, empty themselves of the liquids which they contain; scarcely a single drop escapes.

Experiment 3d.-These phenomena of contractility are much less strongly marked in the gall bladder of the dog, and of mammiferi in general, in the stomach and intestine of the carp, frog, and of cold-blooded animals in general, and lastly, in the crop of the pigeon, and of birds in general. The galvanic

stream does not produce even a slow contraction of these parts. The gizzard of birds, on the other hand, contracts visibly, although slowly, when it is pricked, or subjected to the galvanic action, &c.

Experiment 4th.-When the intestine is cut longitudinally, the edges of the wound turn out each to its own side. When it is cut perpendicularly to its length, the two ends separate from one another. The first effect is produced by the contraction of the circular fibres; the second effect is produced by the contraction of the longitudinal fibres. These two facts are by no means novel; but they are very important.

Experiment 5th.-The contractions of the esophagus are much more sudden and distinct than any of those hitherto examined. When we prick it, or pinch a branch of the eighth pair of nerves which sends filaments to it, or when we put it under the influence of the galvanic stream, it contracts strong ly and suddenly, by a movement similar to that by which we close the hand. These sudden contractions cease at the cardia. It is necessary to remark, that in these movements the esophagus is drawn upwards, apparently towards the pharynx, raising with it the stomach. This direction of the movement of the œsophagus is evident, when we place the stomach in communication with one of the poles of the pile, and the oesophagus with the other. It depends on the number and power of the longitudinal fibres, which, in contracting from below upwards, produce a kind of undulation of the canal, so that the contraction or diminution of its calibre affects, first the part nearest to the cardia, and then by degrees the parts nearest to the pharynx. It is very seldom, on the contrary, that we can produce a contraction in the parietes of the stomach, by pinching its nerves. However, this does sometimes happen.

Experiment 6th.-The spleen itself is contractile. We know that it increases in size, when the absolute quantity of the blood is augmented, and that it contracts on itself when this quantity is diminished. To prove that this contraction does take place, M. Magendie injected by the jugular vein of a young dog fourteen syringes full of tepid water. The abdomen being opened, he observed that the liver, the kidneys, the spleen, &c. increased in size, and were thicker and more turgid

than natural. The spleen which at first was three inches and a half in length, became reduced to three inches: its breadth and thickness diminished still more visibly, in proportion as the blood was expelled by a slow contraction, like that from elasticity. The following is peculiar in the contractions of the spleen :-About a spoonful of the tincture of nux vomica having been injected into the cellular tissue of the flank, stiffness and tetanic convulsions came on at the end of three minutes; and at the same time very well marked nodosities formed on the spleen.

Experiment 7th.-Bichat has said, that instead of exciting the contractions of the heart, the galvanic stream caused them to stop when they still existed. This takes place, indeed, sometimes; but often the action of the pile renews the pulsations of the heart after they have stopped. Indeed, the two poles of the pile having been put in contact with the hearts of a young dog and pigeon, whose pulsations were regular and not very frequent, they became more rapid, then stopped at intervals, and became exceedingly irregular; but every time the pulsations ceased, the contact of the poles renewed them directly. The pigeon's heart, when completely separated from the body, exhibited these phenomena in a more striking manner.

Experiment 8th.-I have already said (first experiment) that the bladder of the dog contracted strongly upon itself, and was almost entirely emptied, soon after the death of the animal. To give a fresh example of the contraction from elasticity, M. Magendie, having removed the bladder with a portion of the urethra from the body, filled and distended it with water, withdrew the syringe, and placing the bladder on a table, observed that, in contracting on itself, the organ thrust the fluid along the urethra; and that the action of the pile did not increase the jet. This jet was feeble, and the expulsion of the fluid soon ceased; the bladder did not contract near so soon as it had done spon-taneously after the animal's death.

Experiment 9th.-I here mention this last fact, although it belongs to another Lecture, since it relates to contractility. The abdomen of a young dog having been opened, a concentrated solution of corrosive sublimate in water was injected through the oesophagus into the stomach. For many minutes

we absolutely saw no contraction in the parietes of the organ, either sudden or slow. But all at once the stomach, instead of contracting, became distended to triple its former size: it was tense as the parchment of a drum; its vessels appeared to be more developed and fuller of blood; and at the same time we saw the animal, although feeble, exhausted by vain efforts to vomit. These phenomena continued till it died. M. Magendie observed that it was by this experiment he had shown how erroneous the ancient theory of vomiting was, by which it appeared that the

stomach contracted on itself. That so far from contracting the stomach actually dilated at the moment when nausea supervened, and that the vomiting was reproduced an instant, a second, sometimes many minutes afterwards, as the result of the antagonist action of the abdominal muscles, which are as essential to vomiting as the stomach itself is. That he had directly proved this assertion, by returning the stomach into the abdominal cavity, keeping it there by stitches connecting it to the parietes of that cavity; which subjected it to the action of the abdominal muscles, as takes place in the natural state, and which determined real vomiting, that is to say, an ejection of the substances contained in its cavity; a vomiting which we see cannot take place without this condition. M. Magendie, moreover, remarked, that the lower part of the abdominal muscles of the animal being untouched, and the large intestine being actually contained in the abdomen, this intestine was found subjected to the action of the muscles; and that, consequently, the animal had just evacuated and continued to evacuate its excrement; for it is always the same system of evacuation by the stomach and intestines.

Such are the principal facts concerning contractility. Most of them, being already well known, do not on that account less deserve to be repeated, for they are opposed to what has been long believed, and to what many physiologists still believe, from tradition.

In order to understand the right principle of treating fractured bones, and the means of keeping them in proper the effects of muscles in displacing the position, we direct our observation to bones of a recently fractured limb. We see the muscles tortured into action by the irritation of the fractured portions of bone, displacing them in various directions, drawing the lower fragment upward, forcing it over the upper, and producing the deformity usually attendant on severe accidents of this kind. This displacement is attributed (and correctly) to the action of the muscles upon the lower fragment, which, being to which the body is appended, is the more movable than the upper portion more readily displaced. The greater mobility of the lower fragment lasts, however, in the case of a fractured thigh, only as long as the limb lies on the bed unconfined by splints or bandage; for as soon as the lower part of the limb is securely fixed by bandage to the leg and foot pieces of a fracture box or splint, the relative disposition to displacement becomes changed, and the attention of the surgeon must be trans

ferred from the lower to the upper portion of bone.

The greater liability to displacement in the upper portion appears but little to have engaged the attention of surgeons, and the provision for preventing overlapping in a fractured thigh and shortening of the limb, have accordingly been defective. The tendency in the pelvis and upper portion of bone to descend is caused by rendering the foot and leg fixed points, from which the muscles attached to the upper fragment of bone and pelvis act, and must be familiar to those who are conversant with the nature and treatment of these accidents. On examining a patient who has been carefully placed in splint with the limb apparently well secured, we find, on the following day, his head occupying a lower part of the pillow, his buttocks sliding towards the splints, and the whole trunk gradually descending in bed, in obedience to the action of the long muscles of the thigh attached to the pelvis. This, however, is not the only direction in which the trunk and pelvis become displaced in a few days we observe the bearing of the whole trunk to be oblique; the patient finding ease by favouring the action of the muscles, inclines his body over to the injured side, and so alters the axis of the pelvis as not unfrequently to give the appearance of elongation to the fractured limb. This obliquity in the pelvis is mischievous, in deceiving the surgeon, and in causing the upper fragment to descend upon the lower.

It is this twofold inclination of the pelvis, and the consequent displacement of the upper portion of bone, that I have endeavoured to rectify by the application of the splint now laid before the Society. The leg piece of the splint is one that has been long introduced into practice by Mr. M'Intyre, Surgeon, of Newcastle-on-Tyne, who has for some years extensively used it in the coal mine practice of the north; and finding it, under a peculiar mode of application, answer the purpose better than those commonly employed, he brought it to town for the trial and approbation of some surgeons in London. The splint, which he left with me, I have almost exclusively employed in my private and in hospital practice for the last few years; and I can truly aver, that I have seen more success attending its application than where other more complicated plans have been resorted to. One of its

merits, and certainly not the least, is its simplicity, and the ease with which it can be applied, an advantage of firstrate importance in surgical mechanics. Mr. M.'s mode of applying the splint is to prepare a large and thick cushion of chaff, which shall not only cover the splint, but can be folded up on each side of the limb so as to give it considerable lateral support. The limb being securely fixed in proper position by assistants, and care being taken to retain the broken ends in apposition, the whole limb with the splint is involved in a firmly applied roller, beginning with the leg and proceeding upward to the pelvis, around which it should be continued. To the application of bandages on a recently fractured limb, with contusion of the surrounding soft parts, I am aware that objections are generally made; but the practice of immediately securing a fractured limb by as firm pressure as can be borne, possesses great advantages. The muscles, unless restrained by moderate pressure, continue by spasmodic twitchings to displace the limb, and if they are allowed to remain for a few days in a permanent state of tonic contraction, a greater degree of extension is required to restore the symmetry of the limb. I have also generally found that where delay has taken place in securing the limb, the shortening has been greater when union has taken place. From the event of my own cases, I am disposed to give a decided preference to the immediate confinement of a simple fracture of the thigh, unless some unusual circumstance forbid it: it saves the surgeon much trouble, and the patient much suffering. Mr. M. does not employ short splints over the bandage, and when the chaff pad is made large and thick, it alone answers all the purpose that well-directed pressure can effect: it will seldom be found to give the patient much uneasiness by unequal pressure, and greater compression may be employed in securing the muscles than with the common short pads and splints. I generally use the latter in addition to the large pad and roller. At the end of eight or ten days the bandage should be reapplied, and the limb readjusted, should any displacement have occurred.

The desideratum attending this splint in common with others, is a provision for preventing a descent of the pelvis ; which I have endeavoured to supply by adding a stay to the upper part of the

thigh piece, and a crutch which extends from the knee to the axella. The thigh piece of splints, as most of them are constructed, fails in supporting the upper part of the limb, and is defective in the point most essential in its applica. tion, viz. exerting a counterpressure against the tuberosity of the ischium; for the edge of the plane, which should press into the fissure between the thigh and nates, sinks into the bed, leaving the limb without support, and the ischium free to descend. To remedy this a piece is added, by which the thigh piece is raised so as to support the limb. In the common inclined plane this defect does not exist. The other addition, which will be seen in the drawing, is an arm piece, acting on the principle of Boyer's splint, which can be lengthened or shortened at pleasure. This counterpressure which Boyer's splint exerts against the axilla, gives it a great advantage in making counterextension; but it is of course inapplicable to fractures requiring the bent position, and it loses considerable power by acting from the foot. In the present instance the counterforce acts directly upon the condyles of the femur, and thus immediately upon the lower portion of bone, saving the expenditure of force which in Boyer's splint is lost upon the tarsal knee-joints; added to which, its applicability either as a straight splint or a double inclined

plane renders it more fit for general use. The action of the arm piece is not, however, confined to counterextension: it acts in a twofold manner on the trunk and pelvis; the former it preserves in a straight line with the limb, preventing it inclining to the injured side, and thus favouring the descent of the pelvis; and by pressing against the crista of the ilium, it prevents the lateral inclination of that bone, a tendency to which invariably occurs in fractured thigh. It also more completely enforces the horizontal posture, a deviation from which occasions a change in the bearing of the pelvis, and thus causes displacement of the upper fragment of bone.

The advantages which I propose in the application of the splint are shortly these:

1. The closer adaptation of the thigh piece to the thigh, and more efficient counterextension against the tuberosity of the ischium.

2. A more efficient counterextending force acting from the axilla directly upon the lower fragment of bone.

3. A control over the lateral inclination of the trunk and pelvis.

The sketch, which does not represent the pads or bandages, is taken from the splint as constructed by Laundy, instrument maker to the hospital, and is intended to show its application to the bare limb.

OPERATION

By A. COPLAND HUTCHISON, F.R.S.E. Surgeon to the Westminster General Dispensary, &c.

Mr. Editor,

DR. LOCOCK did me the honour to consult me, on the 20th of November last, in the case of a female infant, named Mary Scanler, born with imperforate anus; this being the sixth instance of the kind that has happened in my practice. The usual mark, or hollow, in the situation of the natural anus was most distinct. Upon making pressure over the abdomen with my hand, I could not discover any particular fulness or tension of the parts; and, there

proposed to delay the operation until the following day, by which we would ensure a greater distension of the rectum with meconium, when the operation should be performed. The infant had vomited ever since its birth, and would not take the breast, so that it was necessarily fed with spoon-meat.

On the 21st November, just sixty hours from its birth, I performed the operation, after the usual manner,* at the Westminster General Dispensary, in the presence of Messrs. Jennett, Davis, and Wade, besides some pupils; when, at the distance of an inch and a half from the surface, we

See Practical Observations in Surgery, &c. second ed tion, by A. Copland Hutchison.