174 



a single case can be taken as a guide,) is attended with but little 

 danger, and may be capable of caring hydrorachitis. 



Dr. .Iii>». C. Warren writes, that in the treatment of fractures of 

 the condyles of the oa humeri, a course is usually recommended 

 which he believes to be hurtful, inasmuch as it favours the worst 

 consequence of the injury, namely, loss of motion in the joint. The 

 common practice, he observes, in the treatment of the -. is to 



apply angular splints destined to prevent motion, and in about two 

 weeks, to make passive movements for the purpose of preventing 

 the adhesion of the fractured portions in such a manner as to impede 

 the free action of the joint. By this mode of treatment, the frac- 

 tured piece becomes sufficiently fixed to create partial anchylosis; 

 and there is so much pain afterwards in the proposed passive move- 

 ments, as to cause the omission of these measures, until permanent 

 stiffness takes place. The proper course in the management of 

 these accidents, he conceives, to be — 1st. To apply no splints, but 

 in the earlier days to make use of the proper means to prevent 

 inflammation. 2d. To accustom the patient to early and daily 

 movements of flexion and extension. 3d. When the action of the 

 joint becomes limited, to overcome the resistance by force, and repeat 

 it daily until the tendency of the joint to stiffen ceases. 



The accomplishment of this process, he adds, is so very painful, 

 that few patients have courage to submit to it, and few surgeons 

 firmness to prosecute it. The consequence has been, that in a great 

 number of cases the use of the articulation to a greater or less ex- 

 tent has been lost. The introduction of etherization by preventing 

 the pain, gives us, in the opinion of Dr. Warren, the means of over- 

 coming the resistance. By its aid, he has restored the motion of a 

 considerable number of anchylosed elbows, and has successfully ap- 

 plied the same measures to other joints, particularly to the shoulder 

 and knee. This has now become his settled practice, with the results 

 of which he is entirely satisfied. The inflammation consequent upon 

 the forced movements of an anchylosed joint, is not to be lost sight 

 of. By a reasonable abstraction of blood and other anti-inllamma- 

 tory treatment, he lias never found it alarming. 



Within a year or two past, attention has been, in a particular 

 manner, directed to derangement of the cerebral functions following 

 ligature of the common carotid artery. These cerebral symptoms 

 are attributable either to cutting off the direct suppl y of blood to the 

 brain, or to disease consequent upon the altered condition of the 

 circulation in that organ. Nearly one-fifth of the recorded cases of 



