medical profession to become their accomplices in this wicked and base attempt to stay the course of God's providential government of the world.

The gauntlet being, as it were, thus thrown down to us, must be my apology for bringing this subject before you. You are aware the chairman of the society in question, Lord Amberly, has been severely criticised by the press for the remarks he is reported to have made on the occasion of the discussion. His lordship has since, it is true, repudiated to some extent the sentiments attributed to him; but the fact, nevertheless, remains that he identifies himself with the doctrines of Malthus; that he assumes an axiom "that we are tending to over-population, and that large families are an evil." He also compliments the ladies of America, as being in advance of us, by being in the habit of keeping back their families, though he does express disapprobation of their manner of effecting this purpose; this disapprobation, however, being rather directed against the injury to health, and not to morals. In the course of this paper I shall bring under your notice a work, emanating from the same school of political economy, in which the practice of infanticide was openly recommended. This work was published in 1838, when Lord Russell was a Cabinet Minister, and no prosecution was instituted on the part of the Government against the publishers of this scandalous and infamous libel.

In our mind, the idea of making a legitimate practice of infanticide and artificial abortion, excite at once a feel

(To be continued.)

GESTED INSTITUTIONS.

By EWING WHITTLE, M.D., M.R.I.A., Lecturer on Medical Jurisprudence and Toxicology to the Liverpool Royal Infirmary School of Medicine.

OUR profession has recently been startled by a suggestion publicly made, and apparently emanating from high authority, that its members should lend themselves to some scheme of limiting the numbers of children born into families. I allude to the proceedings of a London society called the "Dialectical," who, not long since, in a discussion on the "Happiness of the community as affected by large families," boldly started the assumptions that large families were an unquestionable evil, that population increased too fast for the means of subsistence, that the indispensable remedy lay in the limiting of the number of births; and the medical profession was appealed to by this society of political economists to devise some scheme by which this purpose could be effected without injury to the health of the married couples who might be induced to enter upon this struggle with nature to keep down the natural growth of our species.

The experience of mankind has ever held in honour the fathers of large families. Even now in healthy society they are ever looked up to with honour and respect. The holy writings teach that large families are a special blessing from heaven. "Lo, children and the fruit of the womb are an heritage and gift that cometh of the Lord. Like as arrows in the hand of a giant, even so are young children. Happy is the man that has his quiver full of them." And, again, "Thy wife shall be as the fruitful vine, thy children like the olive branches, round about thy table. Lo, thus shall the man be blessed that feareth the Lord."

But our political economists of to-day, greater in their wisdom than either Solomon or David, reject with equal scorn the dictates of Revelation and the results of human experience, and boldly affirm that nature must be wrestled with, that the natural increase of births must be prevented, and have even the audacity to challenge the

quently a part of our duty to assist, by evidence, in bringing to punishment the authors of these crimes against society and against nature; indeed, these are not the feelings of medical men alone, but of all whose minds have not been contaminated by the specious sophisms of this pseudo-philosophy of which Malthus was the founder. shame of such teaching. In the beginning of this century, and for some time afterwards, this theory of Malthus was accepted by political economists as the true theory of population, and anyone who thought of questioning it was regarded as a heretic among political economists. This slavish subjection to the monstrous propositions of Malthus continued without question and without reaction, until the growth of the doctrine culminated, in 1838, in the publication of the book that I have already referred to. As this book was very speedily suppressed, I am sure most of my younger readers have never seen it possibly many of them have never heard of it. The title of this work was- On the Possibility of Limiting Populousness. By Marcus. It was issued in the form of a one-and-sixpenny pamphlet, the paper good, and the type elegant; it was evidently intended to circulate amongst the select, and was by no means intended for the enlightenment of the million. The author commences by glorifying Malthus as a great discoverer, and adds that he shrunk back appalled at the inevitable results to which his theory led. He then lays down four maxims, the substance of which were as follow:

Maxim 1.-Excess of population is at once the main evil and the main cause of all the other evils that affect human society.

Maxim 2.-Every superfluous portion of population is not merely doomed itself to degradation and suffering, but is an agent force, ultimately deteriorating the whole social body in general.

Maxim 3.-Whenever society, by favour of a casual clearance of population, makes some progress, the return of the excess carries it back again.

Maxim 4.-The steps by which these effects take place are the deterioration of morals, the cheapness of men, misery, and the discouragement to the efforts of the benevolent caused by the prospect of a fruitless enterprise, and a mortifying failure.

The author then moralizes on what he calls ideas hitherto entertained, foremost among which he places the phrase, "The strength of a country is the people." This

b

-DEATH BY COMA.

BY RICHARD BARWELL, F.R.C.S., Surgeon and Lecturer on Anatomy to Charing Cross Hospital, &c.* To this case Mr. Barwell was called in consultation with

Sir Thomas Watson and Dr. Thistelton Dyer, the latter gentlemen wishing to give up attendance.

The author then goes on to state that, "as slavery was abolished, the greatest of all disorders, procreation without rule or limit, would pass unprohibited and unheeded. The truth is, this great change came about surreptitiously. It never was deliberated or accorded by any law giver or law giving body. Up to this day, then, the omission has been rectified. The condition in the bargain of liberty remains still to be imposed and enforced, the means of enforcing it are to be invented, and the delicate task of introducing a new practice is yet to be performed."

In the brief quotations that I have instanced from the first two chapters of this daring publication, there is not a shadow of an attempt even to prove the first maxim, that an excess of population is the main cause of the evils that afflict society. Are people more happy in a thinly inhabited country? Was the country too populous in the time of the Russian War, when we could with difficulty get enough of soldiers to keep up our forces in the field; but, if this were even conceded, is the remedy to be found in all mankind becoming murderers? With what a shudder do we sometimes hear of shipwrecked mariners, in the frenzy of starvation, agreeing that one of their number should be sacrificed to furnish food to his fellows! But this writer, sitting in his study, in the name of political economy, coolly suggests that one half of mankind should stifle the other half, and from the sordid motive that they may get more comfortably through the world from having fewer competitors in the attie of life. Then, his statements as to the practice of infanticide among the ancients, and their management of their slaves, are mere asumptions, put forward to bolster up his argument without a shadow of authority, and some of them manifestly absurd. The next chapter professes to treat of the remedy for this evil of over-population, the proposed remedy being that families should be limited to three; that marriage should be delayed to about the age of twenty-five; that about eight years should intervene between the births of each child that this should be carried out at first by a system of permitted association, and in time, as the world becomes sufficiently enlightened, be made general, and enforced by penal regulations, as openly suggested in the following:

Thus determined, let us make regulations, such that the possession of children, beyond the due number, be no longer a matter of gain nor even one of impunity.

"We may, at most, place the third child as a terminus not quite to be reached and never to be exceeded. "We must make up the account by delaying the day of procreation, or by refusing to rear the infant inopportunely born.

"It will be made matter of vow and rigid law that all the progeny intervening during the consecrated years be rejected and considered as null.

We shall be driven, as to a last resource, to deal out with a still more sparing hand the permission for rearing the third child; and to visit transgressions, if we cannot with penal severity, yet with all possible discouragement

and restraint."

(To be continued.)

Three weeks previously the patient, aged thirty-four, felt, in using some gymnastic exercise, a severe pain in the right axilla. Some days after a swelling appeared at the spot, and at the same time the young man's temper became so morose and aggressive as to be all but unbearable. The swelling soon fluctuated and was punctured; and a few days after, Sir T. Watson being consulted, found extensive pneumothorax on the right side. After a few days more, the left knee became painful, tender, and swollen. Mr. Barwell found the patient emaciated, of a dusky yellow hue; the abscess in the axilla discharging from a small opening high up; the knee very tender, and containing fluid. He diagnosed the condition as pyæmia. Sir T. Watson pointed out the extent of pneumothorax. In the progress of the case the axillary abscess, that in the knee and two others, were opened. Under the influence of stimulants, strong food, and tonic medicines the patient's strength improved; but there somewhat suddenly arose a loss of command over the muscles of pronunciation and of the hands, which was followed by coma and death.

The particular interest in the case lies in two points; the singular change of temper, and the mode of death. On the first subject Mr. Barwell stated that he has in many cases of pyæmia which he described, observed similar sudden variation, and submitted that after injury or operation, such should be considered as the first symptom or prodroma of pyæmia. This symptom, it is true, is not always present; but when it occurs, it is pathognomic, and is the very earliest herald of the disease. In two cases he was able to predict the condition three and five days before any secondary abscess appeared.

On the mode of death, he observed that most cases of exhaustive disease (except chest disease) which had been kept alive by high feeding, end in coma from serous effu sion. This is generally ushered in by a vagueness of action and a want of distinct will in the movements of the body. If strabismus come on, the coma is close at hand. On the subject of treatment, Mr. Barwell did not wish to enter, although the question of diminishing the stimulus might well be entertained.

There is a minister of public instruction and a council of public instruction, of which he is president. The being senators, three conseillers d'état, "conseil supérieur" is composed of 32 members, three three catholic archbishops or bishops, three belong to other creeds, three eight inspectors-general, two free teachers. One of the members of the "cour de cassation," five of the Institute, inspectors-general has charge of the inspection of the &c., &c. schools of pharmacy, the preparatory schools of medicine,

the lycées and schools, selects the handbooks, and is conThe council makes the programme of the lectures in sulted as to the whole public education in France. The Institutes, such as the College de France, the Museum of superior instruction consists of the faculties and of certain Natural History, where lectures are given on chemistry, mineralogy, zoology, &c. The French universities consist of five faculties, one being that of medicine. There pelier and Strasbourg. The university teachers are pris are three medical faculties in France, viz:-Paris, Montfessors, assistant professors, and "agrégés libres." Paris

A paper read before the Clinical Society, a brief abstract of which appeared in our last.

has 25 ordinary professors, and a great number of supernumerary professors and lecturers. The dean is at the head of the faculty. The professors discuss at their meetings the budget, educational matters, &c. There is a permanent committee of five. Each of the university towns has a superior school of pharmacy, and there are 21 preparatory schools or academies of medicine and pharmacy, viz.:-At Amiens, Angers, Arras, Besançon, Bordeaux, Caen, Clermont-Ferrand, Dijon, Grenoble, Lille, Limoges, Lyon-Marseilles, Nancy, Nantes, Poitiers, Reims, Rennes, Rones, Toulouse, Tours, Chambéry and Algiers are designated to become seats of learning. A military school is connected with the Val de Grace hospital, and military naval schools with some naval military hospitals, for instance, that of Brest.

There are lycées for secondary education, where the pupils are prepared for the examination for the baccalauréat ès sciences. This is in writing and vira voce, and corresponds to the English grade of B.A.

Having obtained the certificate the student may get matriculated at a faculty. He follows his studies for four years in accordance with a programme sanctioned by authority, at least if he wishes to become a graduated doctor. There are two classes of medical men in France, the M.D.'s and the "officers de santé." The latter study only three years, their examien is easier and less expensive, but they have only the right to settle in their own department, and not to undertake certain difficult operations. They do not practice pharmacy, but may occasionally be obliged to dispense their own medicines; they are, however, dying out.

The higher class of students have to devote two years to the natural sciences, anatomy, physiology, and the theory of medicine and surgery, and two more years to the practice of medicine, surgery and midwifery. Formerly the clinical instruction was postponed to the fourth year, but a recent law of June 16th, 1860, makes it obligatory to devote two years to the "stage" of the cliniques.

Externes and Internes.-The externes are hospitalassistants living outside the walls, the internes live in it. Those who wish to become externes must be 18 years old, and inscribed in the faculty, but one inscription is sufficient. The externes are, however, chosen from the pupils, who pass a competitive examination according to merit. They attend the visits of the professors to whom they are alloted, and assist the internes in keeping the books. It is a rule to become externe to a suburban hospital before being admitted to a central one. There are "feuilles de présence" kept, wherein they have to inscribe their names to control their regular attendance, but this rule has often been evaded by others putting down the names of their friends. No one is entitled to be externe for more than three years. The "internes" are choosen out of the externes who pass with most credit at the next competitive examinations, they are appointed for two years, generally after the four years of study are over. They then live in the hospital, receiving small salaries and board, and perform the duties of house physicians or surgeons. After the professional visit, they fill up from their notes three books, one for the diet, another for prescriptions, a third one for transference of patients or discharges.

The students pass examinations at the end of each year (examen de fin d'année.) The first year's is on physics and chemistry, the second on anatomy and physiology, the third on pathology. Those who distinguish themselves at the examen of the fourth year, generally become internes at once. The examination for the licence is in writing and viva voce, includes questioning at the bedside and operations on the dead body. The doctorate is the last and least stringent act of the state examinations. The thesis which is read before the representative of the faculty is generally written in French and defended in the same language, and it must be admitted that the first instalments of many excellent scientific works

It is, however, public, before the professors in the provinces, who

examine them in the elements of medicine, surgery, and pharmacy.

are produced during an academic year. As soon as an interne has obtained the degree of M.D., he has to give up his appointment. They often remain internes for three or four years, and even longer. After this they often become military surgeons, or poorlaw officers, or get other appointments.

The Concours.-Most appointments are obtained by passing competitive examinations. The concours are open for the externes and internes, those foreigners not being excluded who have taken their domicile in France. The Concours date from the year 1802. There are public meetings at the end of the academical year before juries. The members of the juries are nominated by lot; no jury contains more than two members belonging to the same establishment. The concours of the "externate is confided to the medical affairs of the "bureau central." They take into account the testimonials of the clinical professors. The jury for the election of medical officers of the bureau central are hospital physicians and surgeons, five in number. For a surgical appointment, four of the members are surgeons, and one a physician; for a medical one, four are physicians, and one a surgeon.

The juries for the appointment of hospital physicians includes the leading members of the profession. The nomination is by the minister.

There is no apprenticeship in France as in this country, but a sort of pupilage to a medical practitioner. Pupils who had no medical education assisted practitioners in the country in visiting, went afterwards to the provincial schools of medicine and became "officiers de santè."

There is no particular state examination for medical officers of health. Medical inspectors are appointed by government and they have usually been in office before. There is a class of special inspectors for mineral baths, and for stations in the East.

Hospital Reports.

METROPOLITAN FREE HOSPITAL AND FARRINGDON DISPENSARY.

CASES OF SYPHILIS TREATED WITHOUT

MERCURY.

By CHARLES R. DRYSDALE, M.D., M.R.C.P., F.R.C.S.,

AND

ROBERT W. DUNN, Esq., M.R.C.S.,

A part of which was read at the Harveian Society on March 18, 1869.

CASE 1.-Charlotte D., aged sixteen, seen by Dr. Drysdale August 2nd, 1863, with roseola, alopecia, and enlarged posterior cervical glands. Had felt a small sore on the vulva a month or so before, which healed of itself. Patient complained of pains in the head. To take the following mixture of chlorate of potash :-B Potassa chloratis, gr. v. ; acidi hydrochlorici diluti, m v.; aquæ, 3j.; ft. haustus ter diesumendus. Under this treatment the disease progressed favourably. She had slight angina, which was treated by a chlorate of potash gargle. By the month of October, 1863, the roseola had disappeared, and she was in very good health. The patient was pregnant at the time.

ASE 2.-T. P., a young man, aged twenty, father of Charlotte D.'s child, and subsequently her husband, came soon after the appearance of Charlotte. He was suffering from gonorrhoea and a scaly syphilitic eruption, sore throat, enlarged posterior cervical glands and inguinal glands. Treated by the chlorate of potash mixture, he lost all of his symptoms in about two months. The child with which Charlotte D. was pregnant was born at full time, but only lived seven weeks. It was said to have died of convulsions. Charlotte D., in the year 1865, then in excellent

health, brought her second child to be seen by Dr. Drysdale, then five months old. No trace of syphilis was seen on this child, and although it, as well as both of its parents, have been under observation since that date, no further traces of the disease have been remarked in any of them. Such cases are, of course, of themselves sufficient to demonstrate that, contrary to the doctrine of John Hunter and his school, syphilis tends to wear itself out in many constitutions in about a year and a half or two years.

CASE 3.-Mary B., aged thirteen, came under the care of Mr. R. W. Dunn, July 10th, 1865. When first seen, she complained of painful micturition, discharge, and pain in the labia majora, which, on inspection, were observed to be much swollen and enlarged. August 17th. She had a discharging bubo in the left groin; labia much swollen and painful micturition continued, appetite bad; pulse 110; poultices to bubo; ammonia and bark, fomentations to fabia. August 24th. Groin still discharging; pulse 110; roseola over the body; bark and nitric acid; poultices to groin. August 31st. Angina and roseola; gargarisina potassae; riss-medicinam. September 7th. Rash paler; throat better. 14th. Psoriasis syphilitica on face, legs, and arms; repeat same medicine. 21st. Cervical glands greatly enlarged; B. Tincturae ferri perchlorid, mv., aquae, zij, t.d. 26th. Complained of pain in right arm and elbow joint; glands in the neck enlarged and painful; rash fading, repeat. Oct. 25th. Cervical glands still much enlarged, repeat. November 10th. Skin hot and dry; pulse 120; pains in the limbs ; B Liquoris ammoniae acetates 3ij; ammoniae sesqui-carbonates, gr x ij; ætheris chloric Zij; aquae, 3vj. 3j t.d.s November 30th. Much better; only a few spots on face; cervical glandular enlargements nearly gone; to take cod-liver oil and venum ferri. January 5th, 1866. Complained of pains in limbs; a few spots still seen on the face; to have change of air and live well. April, 1866, looked quite well, indeed, the picture of health, and said she had not felt so well for years; a few cervical glands still enlarged. In 1867, she was quite well, with no relapse; and in 1868, continued quite well, without any relapse. In this case the space of one year was sufficient to remove all symptoms in what at first seemed a severe case, and apparently without any probability of a relapse taking place.

SURGICAL SOCIETY OF IRELAND.
(Continued from page 249.)

THE Society held a meeting on Friday evening, March 5th, in the Albert Hall, Royal College of Surgeons,

Mr. PORTER, President of the College, in the chair. Members present:-B. Wills Richardson, Hon. Sec.; Drs. W. Moore, Morrogh, Willis, Roe, Murdock, T. Stoker, Purcell, Jameson, Henry Gray Croly, R. Fennell, Robinson, Stewart, Brassington, Wharton, Henry Kennedy, J. Hawtrey Benson, Charles Benson, Hon. Sec.; Shannon, White, Buchannon, Mapother, O'Grady, Colles, Jacob, Guinness Beatty, R. Daniel, Hewitt, Churchill, jun., Brady, C. Fleming, Stapleton, Stokes, jun., and Henry Croly.

COMPOUND DISLOCATION OF THE RIGHT ANKLE-JOINT.

Mr. RICHARDSON read the following case, sent to the Society by Dr. NOLAN, of Wicklow:

:

On Christmas Eve, 1867, about nine o'clock, a young man, aged twenty-one, driving a bread cart rapidly down a steep thrown out of the cart, by which he sustained a compound dishill at Newtown Mount Kennedy, was upset and violently location of the right ankle-joint. He was immediately seen McC. washed a quantity of gutter from the wound and atby Dr. McClelland, and brought into his dispensary. Dr. tempted to reduce the dislocation; but, failing to do so, he sent him to Wicklow Infirmary, a distance of eight miles, where he arrived about half-past three in the morning. I saw him immediately, and found the tibia driven down through a transverse slit below, the ankle being laid bare for about four inches, its extremity being on a level with the sole of the foot, which was partially drawn aside, and the end of the fibula broken off. My first consideration was, whether to amputate at once, or try to save the foot, or, if necessary, to have recourse to secondary amputation. Seeing that the patient (though of a very fair complexion and light hair) was a healthy well nourished young man, I decided on the latter course, and but before making extension I found it necessary, as the applied the pulleys and placed the patient under chloroform; bone was tightly clasped by the lips of the wound, to make an incision downwards from the under lip, which was turned in, so as to admit of the more easy return of the tibia. I then tracted state of the gastrocnemii, &c., I was unable to effect reduction without employing more force than I thought safe. I then sawed off about an inch and a quarter of the end of the bone, and at once replaced it without any difficulty, applied a pledget of lint, and laid the limb on the side. The patient fell asleep almost immediately, Dr. McClelland having judiciously given him a large dose of Battley on sending him in. and, considering the nature of the injury, less inflammation Next day I found him cheerful, and not complaining much; followed than might have been expected, and never extending above the knee. A blush of redness appeared on the outside of the foot, reaching from the ankle to the toes, and which I attributed to the pressure of the bandage used in the pulling of the foot, but which I found afterwards proceeded from the small fragment of the fibula, which was unfortunately overlooked by me in replacing the bone, and which caused a great deal of trouble afterwards, producing a good deal of inflammation and suppuration, requiring opening, and not healing till it was extracted. However, it must be recollected I was alone, attend to the chloroform, &c. I need not enter into a detail with only the assistance of a very intelligent hospital man to bers of the Society. I had, however, to contend with much of the progress of the case, which must be obvious to the memsuppuration and hectic, and at one time was most anxious and dubious of the result; but, thanks to a good constitution, as the event proved, and to abundance of support, the young man was able to leave the hospital on the 17th of May (four month and a half from the accident), with a useful limb, about one

CASE 5.-Catherine Č., aged twenty-four. April 25th, 1864, with stains of café-au-lait colour on face and breast, and spots of psoriasis on thighs. Was under treatment for these symptoms for a space of four and a half months. The treatment consisted of gargle and mixture of chlorate of potash. The eruption, though far more tedious than that of Case 4, gradually disappeared. The patient was seen in 1866 in excellent health by Dr. Drysdale, no relapse having occurred.

CASE 6.-John L., aged seventeen; seen first by Mr. Dunn, on the 24th June, 1864, with sore on the penis, very slightly, if at all, indurated; but with multiple enlargement of the inguinal glands. Treated by means of a mixture of chlorate of potash, the sore soon healed up, and he left for a time. September 8th, 1864. He returned, with a scaly syphilitic eruption over the body, face, and extremities. Treated by chlorate of potash mixture. September 29th. Sore throat; ulceration of the tongue. Repete medicinam, and use an astringent gargle. October 24th. Discharged without any further symptoms. No relapse since that date.

inch shorter than the other.

I may mention that this was the fourth case of bad compound dislocation of the ankle, attended with much injury to the soft parts, which I had successfully treated without ampu tation, experience of which influenced me in my decision to give the patient the chance of saving the foot.

Mr. RICHARDSON observed that Dr. Benson received a letter from Dr. Nolan, on Tuesday last, stating that he had seen the young man on Monday, and that the foot is now slightly turned out, the leg being barely an inch shorter than the opposite one. There is also a considerable degree of motion at the instep. POTTS' FRACTURE.

Mr. H. G. CROLY said he wished to bring under the notice of the Society the subject of fracture of the fibula in the vicinity of the ankle-joint, known as Potts' fracture. His object in bringing the matter forward was to elicit discussion as to Dupuytren's apparatus. He also wished to draw particular attention to a plan which he had adopted with the greatest satisfaction-the very simple mode of strapping the splint and the pad on the limb with adhesive plaister, instead of bandage. Mr. Croly then read the following:

Case 1.-M. M., aged fifty-seven years, was admitted into the female accident ward of the City of Dublin Hospital, under my care. History.-She was running down stairs, and turned her right foot violently inwards. She suffered intense pain in the ankle-joint; could not attempt to put her foot under her. Symptoms on admission.—Foot everted; ankle-joint increased in width; internal malleolus prominent; intense pain produced by making pressure over the lower part of the fibula, which was found to be fractured about two and a half inches above the malleolar tip.

Reduction effected in following manner :-Leg flexed upon the thigh and the thigh upon the abdomen, to relax the muscles; knee-joint grasped by an assistant to keep the limb in the flexed position; foot was grasped and inverted, and the tibia pressed outwards on the astragulus. Dupuytren's apparatus applied and fixed by means of soap plaster in the following manner :-The conical pad was placed on the side of the limb, its base extending as far as the internal malleolus; the splint was then adjusted. Broad strips of soap plaster were applied evenly around the leg, for about a hand's breadth, below the knee-joint to fix the upper end of the appliance. The foot was then approximated to the end of the splint, and retained in the inverted position by means of strips of plaister applied in a figure-of-eight form, embracing alternately the dorsum of the foot, the end of the splint, and the heel; the limb was then flexed and placed upon a pillow, lying on its fibular side. The apparatus was kept on for a month, and was then removed, and the joint supported by strapping with plaster covered with a woollen bandage. The patient was discharged from hospital in nine weeks from the date of admis sion, with complete union of the fracture, and without deformity.

Case 2.-L. McE., aged twenty-seven years, a labourer, was admitted into the male accident ward. History.-In jumping off a height he turned his foot under him, and suffered great pain. Does not know whether his foot turned inwards or outwards. Symptoms.-Foot slightly everted; inner malleolus projecting; considerable tension produced by effusion into the ankle-joint; ecchymosis of leg and over the base of the internal lateral ligament; great suffering caused by pressure applied over the lower end of the fibula, which was fractured about one inch and a half above the tip of the malleolus. Reduction effected as in Case 1, and Dupuytren's apparatus applied with plaister; cold evaporating lotion to the joint. Patient discharged in six weeks, the foot and ankle being previously well-strapped and bandaged.

Case 3.-P. M., engine-driver of the train to which the accident occurred near Bray Head, was admitted into the hospital suffering from fracture of the fibula, two inches above the end of bone. Patient said he jumped off the engine, and fell a considerable height, and turned his right foot under him. On admission, there was very great effusion into the joint, and extreme tenderness over the fibula.

Dupuytren's apparatus applied as in previous cases; iced lotion to joint. Patient discharged in one month, with starched bandage applied. He was a considerable time in recovering the free use of the leg, as he was a very heavy man.

Case 4.-P. N., aged twenty-three years, a coal porter, had been drinking, and turned his right foot under him; suffered much pain; admitted almost immediately into the hospital. Symptoms.-Inability to walk; ankle-joint swollen; severe pain on pressure over the lower end of the fibula, two inches above the end of the bone; foot slightly everted; yielding of fragments on pressure being applied over seat of fracture; internal ankle prominent, and integument tense; effusion into joint. Dupuytren's apparatus applied as in preceding cases. Patient discharged in a month; starched bandage applied.

Case 5.-J. D., an in-door servant, slipped coming down stairs, and turned his left foot under him; felt something snap. Symptoms.-Inability to walk; pain in lower end of fibula; effusion into joint.

Case 6.-Mr. -, aged thirty-eight years, residing near the hospital, slipped off the foot-path one dark night, and turned his left foot violently under him; he fainted from the pain, and was carried by his own request to the hospital.

Symptoms.--Left foot everted; a depression was observed about two inches and a half above the end of the external malleolus. The internal ankle was very prominent, and threatened to burst through the integument, which was tightly stretched over it; effusion into the joint and entire leg.

Patient complained of most excruciating pain. Reduction effected as in other cases, and Dupuytren's apparatus applied, from which the accompanying drawing was taken.

Cold

lotions were applied; large bullæ formed along the leg. Patient discharged in a month.

Case 7.-M. T., a female, aged sixty years, turned her left foot inwards; fibula fractured two inches and a half above malleolar tip; marked eversion of foot. Dupuytren's appa ratus applied as in previous cases; never required a second dressing. Patient discharged in a month cured.

Case 8.-M. M., a man, aged thirty-four years, turned his right foot violently; fibula fractured one inch and a half above tip of malleolus. Dupuytren's apparatus applied with plaister. Result satisfactory.

Fracture of fibula two inches and a half above end of malleolus, with fracture of lower end of tibia, and displacement backwards of the foot.

Case 9.-J. F., aged thirty years, a policeman, was lifting a heavy cask of porter, and his left foot turned under him; he felt his ankle snap, and suffered much pain in the part; admitted at once into hospital.

Symptoms.-Left foot slightly everted and displaced backwards; enormous effusion into the ankle-joint; leg swollen. Internal malleolus remains attached to the astragulus; lower end of upper fragment protruding forwards on the neck of the astragulus; tendo-Achilles arched; heel unnaturally pro

minent.

Treatment.-Foot flexed upon the leg, the leg upon the thigh, and the thigh upon the abdomen. Reduction was then easily effected by pressing the tibia backwards, and inverting the foot. Dupuytren's apparatus was applied to the back of the limb in the following manner :-The wedge end of the pad was placed in the hollow above the heel, the splint underneath it; broad straps of plaister were then applied around the limb, a hand's breadth below the knee, and also above the anklejoint (a compress of lint being placed on the front of the tibia low down to bear off the pressure of the plaister). The limb