do modern authorities controvert his opinion, and even in this case Hippocrates has a high modern authority on his side-I mean the comparative frequency of the different forms of dislocation; he, and all the ancient authorities after him, having stated that dislocation inward is the most frequent, whereas Sir Astley Cooper and all our late authorities hold that dislocation upward is the most frequent. It is deserving of remark, however, that if Cooper be against Hippocrates, Paré is upon his side, and I need scarcely remark that he is not one who bows servilely to ancient authority, but was an original observer, and thought for himself; and, moreover, his experience was on a very large scale. On another point connected with this class of accidents, it is worthy of remark, that it was only the other day that an eminent anatomist in London decided that Hippocrates was right, and that all our modern authorities were wrong; I mean with respect to the situation of the head of the femur in the fourth form of dislocation. Sir Astley Cooper, Mr. Liston, Sir Charles Bell, Mr. Samuel Cooper, and, in a word, all our best authorities of late years, maintained that the head of the bone in this form is lodged in the ischiatic notch; but Mr. Richard Quain has lately determined, by actual dissection, that the bone is lodged where it is described to be by Hippocrates, namely, behind the acetabulum in the nates.-See the note on Articulations, § 57.

The methods of reduction, too, which our author describes, are all based on the most correct principles, and some of them might, perhaps, be held preferable to those now in use. He does not appear, indeed, to have been acquainted with the use of pulleys in the treatment of this accident, but the axles which he describes as being attached to the bench which bears his name (Scamnum Hippocratis) must have been quite capable of exercising a degree of force fully adequate to effect the desired purpose.' The method, too, according to which the patient was placed astride upon a cross-beam, and with a weight attached to the injured limb, would seem to be one admirably adapted to wear out the strength of the contracted muscles, and in this way facilitate the adjustment of the bone.

But in all the works on ancient surgery, I verily believe there is not a more wonderful chapter than the one which relates to Club-foot, § 62. In it he has not only stated correctly the true nature of this malformation, but he has also given very sensible directions for rectifying the deformity in early life. Now it appears to me a lamentable reflection, as proving that valuable knowledge after being discovered may be lost again to the

have seen cases of congenital impediment at the hip-joint at a very early age, I never had an opportunity of ascertaining their nature by actual dissection.

The reader will see the machine and the process of reduction figured in the Armamentarium Chirurgicum of Scultet, Tab. xxv.; in the edition of Galen's Works by the Juntas; and in Littré's edition of Hippocrates. I have given the last two; and the first is scarcely at all different from the second.

world for many ages, that not only did subsequent authorities, down to a very recent period, not add any thing to the stock of valuable information which he had given on the subject, but the important knowledge which he had revealed to the profession came to be disregarded and lost sight of, so that, until within these last few years, talipes was regarded as one of the "opprobria medicinæ." I cannot omit this opportunity of mentioning, however, that some centuries ago certain individuals would appear to have practiced successfully the treatment of club-foot on the principles laid down by Hippocrates. To give an instance in point, Arcæus, who, in his work "De Curandis Vulneribus," (Amstel, 1658,) has given a chapter on the treatment of club-foot, not only describes the process correctly, but actually gives the form of two mechanical contrivances for reducing the derangement of the foot, and keeping it in situ. The former of these contrivances is evidently the original of Scarpa's apparatus, now very generally used in the adjustment of club-foot; and the other is as evidently the very same as the boot delineated in Syme's "System of Surgery," and which I myself have often used in the treatment of club-foot. As a matter of curiosity, I shall give drawings of them. That the author (I mean Arceus) was very successful in the treatment of congenital club-foot appears obvious, from the terms in which he speaks of the results of his experience in this way: "Sæpe accidit, ut infans nascatur aut altero aut utroque pede distorto, aut incurvo, aut repando, ita ut ægrè admodum possit incedere. Eâ de causâ hoc loco volui methodum tradere, qua plurimos valde claudos liberavi, inter quos unus curatu difficillimus,” etc. The whole process of cure is most circumstantially described, and the author concludes with the very proper advice, that the patient should be made to wear the boot for six months after the parts have been restored. All this shows, that although our author's excellent instructions for the management of this deformity were long lost to the profession at large, there were not wanting individuals who knew how to appreciate their value.

With regard to the description of the mode of bandaging a distorted limb in club-foot, as given by our author, I have little to add to what is stated in my annotations on the passage. Though there be certain obscurities in some of the expressions which occur in it, its general meaning is sufficiently obvious and I can attest from ample experience recently acquired in the treatment of this surgical case, that the rules of treatment here laid down by our author are very judicious, and I have no doubt would be found amply sufficient for restoring a recent case of talipes. The reader will remark, that our author concludes his account of club. foot with the declaration, that treated in this way it may be cured sooner than one would have thought, "without burning or cutting, or any other complicated method." And here I cannot deny myself the pleasure of quoting the very candid reflections which Dr. Little, in his work "On Club-foot" makes on the account of talipes given by Hippocrates. He

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says, Hippocrates describes the bandages to which he resorted for the cure of varus, and his success may be estimated from the encomiums he bestows on them,-'citius enim talia medicinæ obtemperant, quam quis putarit.' The candor displayed throughout the writings of the Father of Medicine leaves little doubt that he has not exaggerated the success which he experienced; and we may conclude that, by commencing the treatment at the earliest period of life, aided by his unremitting perseverance, many of these distortions were remedied. An observation, which would have passed unheeded prior to the introduction of the division of the tendo Achillis, follows the last quotation: atque hæc quidem est curatio, et neque sectione, neque ustione, neque aliâ varietate quicquam opus habet,'-of the import of which, doubts may now be entertained. Whether Hippocrates, or any of his contemporaries, had discovered the means of curing this distortion by section of tendons, but preferring the application of bandages, nevertheless rejected it, or whether he employed this observation with a different meaning, cannot at the present day be decided. It is possible that Hippocrates, being accustomed to cure external disorders by the knife or cautery, may have adduced his treatment of this disease as an exception to the more severe methods so frequently resorted to in other affections; whilst it would not be surprising if, by his great ingenuity and skill, he had detected the possibility of removing the obstacles to a cure by a division of the tendons. He may have apprehended suppurations and other unfavorable symptoms from the section of so important a tendon as that of Achilles; or, having been unsuccessful in his first attempts, he may have been deterred from a repetition." (Introduction, p. 48.)

The description which our author gives of luxations at the wrist, Articulations §§ 26, 27, 28, and Mochlicus §§ 16, 17, 18, is attended with peculiar difficulties, and hence it has given rise to a good deal of confusion and misapprehension from the time of Paré' down to Malgaigne and Littré. His usage of the terms "inward" and "outward" is somewhat vague; but it appears to me that we need have little hesitation in deciding them to apply to the modern acceptation of "forward" and "backward. But the great puzzle is, does he mean that the bones of the carpus are displaced from those of the fore-arm? or does he recognize the carpus as the fixed point? His language would certainly apply most naturally to the interpretation that the bones of the hand were the parts which he understood to be displaced; but yet M. Malgaigne holds, that our author understood the bones of the fore arm to be the movable part. We shall

1 The disagreement between Paré and the ancient authorities (especially Hippocrates and Galen) in the use of the terms which he applies to the parts in describing dislocations at the wrist, is adverted to in the marginal notes to all the old editions. See Book XV.

examine the question somewhat more narrowly. One of the best of our recent authorities on dislocations lays it down as a rule, that in dislocation of the carpus backward there is permanent flexion of the hand, and in dislocations forward, that there is permanent extension. (See Mr. B. Cooper's Lectures, Med. Gaz. 1065.) Now, according to Hippocrates, in luxation inward (meaning, as stated above forward) the patient cannot bend his fingers, (this then, agrees with the character of dislocation of the carpus forward), and in luxation outward (meaning, in modern language, backward), that he cannot extend them; this case, then, would seem to agree with the characters of dislocation backward, agreeably to modern views. All this would lead us to the conclusion, that Hippocrates agreed with our recent authorities in regarding the bones of the hand as the part which is displaced. Moreover, it is difficult to understand Celsus, who, it is probable, translated the words of Hippocrates, in any other sense: he says, "Manus quoque in omnes quatuor partes prolabitur. Si in posteriorem partem excidit, porrigi digiti non possunt" (Mr. B. Cooper's description of dislocation of the carpus backward is, "permanent flexion of the hand")" si in priorem non inclinatur" (Mr. Cooper's description of dislocation forward is, "it is characterized by permanent extension of the hand") viii. 17. Still, however, I believe, that not only is the literature of this subject perplexed by an ill-defined nomenclature, but that the nature of the accidents which befall the bones of the wrist is far from being satisfactorily determined even at the present day. For my own part, after full thirty years' experience in treating these and other surgical cases, I must say that I never saw a distinct and decided case of dislocation at the wrist, and that I incline with Baron Dupuytren' and Professor Syme in regarding most of the accidents which have been set down for luxations as having been in reality fractures of the bones of the forearm in the vicinity of the joint. And in conclusion, I beg leave to state it as my decided opinion, that with regard to the accidents which befall the elbow, the wrist, and the ankle-joints, much misapprehension still prevails. While a certain creed is established on any given professional subject, most people are disposed to see the phenomena connected with it as they fancy that they should see them, and independent thought and original observation are talents rarely vouchsafed to any one. Professional

men of late have been impressed with the idea, that by entirely renounc

See the Syd. Soc. edition of his works. I perceive, from the note given on Chelius's chapter "On Dislocations at the Wrist," that the opinions of Dupuytren have been controverted by Voillemier, who thinks he has shown the existence of such dislocations by the most careful examination of a complete displacement of the wrist backward, and of the bones of the fore-arm forward. Now I do not pretend to deny the actual possibility of such an occurrence; but I must say that my own experience leads me to the conclusion that a case of dislocation without fracture must be extremely rare indeed.

VOL. II.-6.

ing the authority of the ancients, they show themselves to be original observers; but such persons are more the slaves of established modes of thought and conventional opinions, than if they were familiarly acquainted with all the authorities in medicine from the earliest time down to the present day; for it is only when possessed of this knowledge, that a man of a well-constituted mind feels that he is fully warranted to exercise an independent judgment of his own. In literature, as in warfare, it is knowledge which confers true self-reliance.

A very interesting subject handled by our author in this work is the treatment of compound luxations. One can readily perceive, that he had correctly estimated the dangers of this very grave class of accidents; and accordingly, in one place, he makes it a consideration, whether or not the surgeon should incur the responsibility of undertaking the charge of them. As a general rule, he forbids reduction, unless in the case of the smaller joints, such as those of the hands and feet. Now it is curious to remark, that in the time of Celsus and Galen, this rule of practice was still adhered to, but Paulus Ægineta ventures for once to rebel against the authority of the Coan sage. In the section "On dislocations with a wound," he says, "Wherefore Hippocrates, by all means, forbids us to apply reduction and strong bandaging to them, and directs us to use only antiinflammatory and soothing applications to them at the commencement; for that, by this treatment, life may be sometimes preserved. But what he recommends for the fingers alone, we would attempt to do for all the other joints: at first, and while the part remains free from inflammation, we would reduce the dislocated joint by moderate extension; and, if we succeed in our object, we may persist in using the anti-inflammatory treatment only." (vi. 121.) All the Arabian authorities follow the rule of practice here laid down by Paulus Ægineta. See the Commentary, 1. c. Syd. Soc. ed. I need scarcely remark, that this mode of treatment is that now followed by the profession. It will further be remarked, that at § 68, our author treats of resection of the bones in compound luxation of the bones of the hands, feet, ankle, and wrist; and that, upon the whole, he approves of the practice. In the annotations on that section, I have briefly adverted to modern experience in the application of this method of treatment; and in this place I shall merely add the rule of practice as laid down by Chelius, which the reader will find it interesting to remark, is very little different from that recommended by Hippocrates, except that Chelius, in all cases, approves of attempts at reduction: “If the reduction of the head of the bone, protruded through the soft parts, be in no way possible, even after proper enlargement of the wound in the skin, nothing remains but to saw off the protruding bone, by which the stretching and tearing of the muscles are relieved, and the joint can be brought to its natural position; after which the symptoms, in general, soon and considerably diminish. When the reduction of a bone pro