HEY’S PRACTICAL OBSERVATIONS IN SURGERY. 
Chap. 5th. On dislocations.—Various 
useful remarks are made in this chapter, 
on the nature of luxations or the mode 
of reducing them ; but they are ‘too 
much connected with description to ad- 
mit of abridgment. 
Chap. 6th. On internal derangement 
of the knee joint.—This sometimes hap- 
pens in consequence of trifling injuries, 
and if it is not attended to, will intime 
produce a considerable degree of perma- 
nent lameness. The nature of this com- 
plaint may be judged of from one of the 
cases given by the author. 
<< In 1784, the honourable Miss Harriet 
Ingram (now Mrs. Aston), as she was play- 
ing with a child, and making a considerable 
exertion, in stretching herself forwards, and 
stooping to take hold of the child, while she 
rested upon one leg, brought on an imme- 
diate lameness in the knee joint of that leg 
on which she stood. The disorder was consi- 
dered as a simple sprain ; and a plaster was 
applied round the joint. As the lameness 
did-not diminish in the course of five or six 
days, I was desired to visit her. 
«* Upon comparing the knees, I could per- 
eeive no difference, except that, when the 
limbs were placed:in a state of complete ex- 
tension, the ligament of the patella of the 
injured joint seemed to be rather more relax- 
ed than in that joint which had received no 
injury. When I moved the affected knee by 
a gentle flexion and extension, my patient 
complained of no pain; yet she could not 
erfectly extend the leg in walking, nor bend 
It in raising the foot from the floor ; but 
moved as if the joint had been stiff, limping 
yery much, and walking with pain. 
«© I thought it probable, that the sudden 
exertion might in some degree have altered 
the situation of the cross ligaments, or other- 
wise have displaced the condyles of the os 
femoris with respect to the semilunar carti- 
lages ; so that the condyles might meet with 
some resistance when the flexor or extensor 
muscles were put into action, and thereby 
the free motion of the joint might be hinder- 
ed, when the incumbent weight of the body 
ressed the thigh bone closely against the ti- 
cn. though this derangement was not so 
great as to prevent the joint, when relaxed, 
from being moved with ease. 
«« To remedy this derangement, I placed 
my patient upon an elevated seat, which had 
nothing underneath it that could prevent the 
leg from being pushed backward towards the 
posterior part of the thigh. I then extended 
the joint by the assistance of one hand placed 
just above the knee, while with the other 
hand I grasped the leg. During the conti- 
nuance of the extension I suddenly moved 
the leg backwards, that it might make as 
acute an angle with the thigh as possible. 
This operation I repeated once, and then de- 
sired the young lady to try how she could 
783 
walk. Whatever may be thought of my 
theory, my practice proved successful ; for 
she was immediately able to walk without 
lameness, and on the third day after this re- 
duction she danced at a private ball without 
inconvenience, or receiving any injury from 
the exercise.” 
Chap. 7th. On loose cartilaginous sub- 
stances in the joints.—These substances, 
ithas generally been thought necessary 
to remove, by an incision made into the 
joint. But as this operation is a very 
dangerous one, the author was induced 
to make use of a well adapted laced 
knee cap, or a quilted knee piece, which 
answered the purpose of retaining the 
substance within the interior parts of the 
joint, and allowed a free motion without 
inconvenience. The substances were in 
time absorbed. 
Chap. 8th. Of wounds of the joints.— 
The author has had considerable success 
in the treatment of such cases, by taking 
due care to prevent inflammation. 
Chap. 9th. Compound luxation of the 
ancle joint.—In those cases he agrees 
with Mr. Gooch, on the propriety of saw- 
ing off the head of the tibia or fibula, if 
either of them protrude through the in- 
teguments. 
Chap. 10th. Of retention of urine.— 
Many useful remarksare contained in this 
chapter, on the different modes of intro- 
ducing the catheter, an operation which | 
is often attended with considerable difh- 
culty. The necessity of early having 
recourse to this remedy, when symp- 
toms of retention appear, is strongly in- 
dicated by several cases, and the author 
was particularly led to remark, that an 
involuntary discharge or even the power 
of expelling a small quantity of urine, fre- 
quently succeeded to retention, but never 
had the effect of emptying the contents of 
the bladder. The use of the catheter was 
therefore as strongly required in such 
cases, as where the retention was com- 
plete. ‘To preserve the flow of urine, an 
elastic catheter was sometimes left in the 
bladder for a continuance ; but the best 
plan appeared to the author, to be that 
of introducing it at certain short inter- 
vals. By the latter means, the patient 
sooner regains the power of emptying 
the bladder by natural efforts, than 
when it is suffered to remain constantly 
in the urethra. 
Chap. 11th, Cure of the procidentia 
ani in adults. ’ 
«« The relaxed state of the part which. came 
down at every evacuation, and the want of 
