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with a small knob of exuded ossific matter at

Ithe outer extreme point of fracture. Lubri-cates the leg with the embrocation still.

Remarks.—Mr. Puddicombe, a surgeon ofmuch experience at Moreton Hampstead,,saw the limb yesterday, the 15th day, andexpressed his satisfaction at the progress ofthe system of "non-interference by force"in the treatment of fractures. Many othergentlemen interested in the accident haveseen him, and all have been particularlystruck with his comfortable appearance andhis laughing round face under the misfor-tune. Nine years ago he fractured the thighof the same limb now fractured ; that wasby a fall from a donkey, without contusion ;he was then splintered up, and the splintsnot untied for a fortnight. His feelings ofease now, and his recollections of the painhe suffered then, are very significantly ex-pressed by a few plain words that might bevastly edifying to many if they could hearthem,-to those who still stretch a limb

upon a galling apparatus, or who still investa sore fracture in hard splints. When four

days more have elapsed it will be threeshort weeks from the fracture, and then,with a circular plaster of litharge plaster orlamb’s skin, he may, supported by a rollerbe taken out of bed, resting his leg on apillow. By the old pinching method restoration would have been retarded to as manymonths, or how long the Lord only knows.

DR. WRIGHT ON FRACTUREAPPARATUS.

To the Editor of THE LANCET.SIR:—In the numbers of THE LANCET

dated Oct. 14th and 21st of last year, youpublished an interesting account of Mr.Liston’s admirable treatment of fractures ofthe lower extremity, by Mr. Barker, thatcontains allusions to the splint invented bythe late Mr. M’Intyre, of Newcastle, re-specting which I will thank you to allow mespace for a few words in reply. It was nottill a few days ago, when the last half-yearlyvolume of your useful Journal came to mein the course of its circulation from theWakefield Medical Library, that Mr. Bar-ker’s paper fell under my perusal, or 1should certainly have addressed a rejoinderto you more immediately succeeding the re-marks to which I allude.

Mr. Liston’s splint for fractures of theleg, of which a detailed account, with twodrawings, is given in the numbers of THELANCET I have named is, no doubt, very wellcontrived for the purposes of hospital prac-tice, but Mr. Liston and his commentator,Mr. Barker, must allow me to protestagainst the advantages which the latter as-serts are possessed by Mr. Liston’s over Mr.M’Intyre’s splint ; and I would particularlyrefer to the advantage first stated in Mr.

Barker’s essay, because the part of thesplint alleged to be defective is, in myopinion, the very point of its chief merit;for it is here capable of accomplishing whatno other contrivance had previously effect.ed,-perfect immunity from the danger towhich Mr. Barker adverts; and it is hisapparent misconception of the powers of llIr.M’Intyre’s instrument in this respect, whichis my chief inducement to take up the sub.

ject.At page 114 Mr. Barker says,-" I will

now refer to a few advantages which thatapparatus (Mr. Liston’s) possesses over theone which was originally introduced by Mr.M’Intyre. First. By an improvement in Mr.Liston’s apparatus, there is a space to admitthe heel. It was frequently observed thatabrasion of the skin of the heel occurredfrom the pressure to which that part wassubjected, in consequence of the unyielding’ plate of iron beneath the paddings. ***

To remove this inconvenience Mr. Listonhas left a space for the protrusion of the por.tion of the cushion beneath the heel." Ifthere is not a hollowed space for the heel inthe M’Intyre’s splints used at the NorthLondon Hospital, they differ from any of thevarieties Mr. M’Intyre employed during sixyears that I resided with him as pupil andassistant. If his splint be properly appliedit is impossible that abrasion or ulcerationof the heel can occur from pressure, becausea sock is fitted on to the foot, and by meansof a strap or a piece of tape passing from thesock over the point of the foot-board andfastened to a buckle or hutton on its lower

surface, the weight of the foot is suspended;it is not merely ’’ somewhat useful," as Mr.Barker details in page 86, "in detractingfrom the pressure upon the heel," but thereis no pressure whatever on that part, in factno cushion or other support is needed underthe heel, except to prevent lateral motion,Should a. sock or the foot of a stocking notbe readily at hand, a loop of bandage passedunder the heel and brought over the toes tothe button will answer sufficiently well.Mr. Barker complains, in the second

place, that the angle at the kneejoint of llr,M’Intyre’s splint is liable to produce thesame accident. Possibly it may, when thechaff-pillow on which the limb rests is not

carefully adjusted to the form of the partsin contact with it. If that inconvenience isfound to result, Mr. Liston’s splint willavoid the risk : it is an accident, however,which, under Mr. M’Intyre’s judiciousmanagement, I never witnessed in a veryample series of cases. A void space heingleft at the knee entirely precludes any useof the splint in fractures of the thigh, as it

prevents that continued extension whichmay be and ought to be maintained in thosecases.

11 Third. In the new apparatus," Mr. Bar-ker proceeds, " there is not a sliding thigh.

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piece, because it is not adapted to fracturesof the femur." To this remark I have no ob-

jection to urge, as it involves a principle oftreatment respecting which it would be pre-sumptuous in me to contradict the axiomsof one of the first surgeons of the age. I

may be permitted to observe, nevertheless,that after hearing Mr. Liston’s opinions in-culcated, when I had the pleasure of attend-ing his course of lectures in 1825-6, andtesting them by practice during a few suc-ceeding years, I am far from being convincedthat the double inclined splint, when pro-perly applied, is not at least equally effec-tive and much more easy to the patient thanthe long straight splint which Mr. Listonrecommends.

’

The fourth advantage is stated to bethat the foot-board is more steady, andcan be shifted more readily, inclined so asto bend or extend the foot, or increase thedistance from the knee." In the splintsused by Mr. M’lntyre the foot-boards werefixed in almost every possible variety ofmanner : hardly two were alike ; but nearlyall were made to bend or extend the foot atpleasure. In one specimen of the instrument(sent, I believe, to the Admiralty) of whicha sketch is given in Mr. M’Intyre’s pamph-let, a pivot was added, by means of whichthe foot could be inverted or everted, as

well as flexed or extended to any allowableangle,"Fifth. The plate that is placed trans-

versely at the end is moveable. * * * In

Mr, 1H’Intyre’s it is fixfd," according to Mr.Barker. Now, in most of Mr. M’Intyre’ssplints the cross-bar was fastened merely bya screw and moveable nut, so as to be alter-ed at pleasure; the advantage alluded to isnot very obvious.

Sixthly. Mr. Barker says, 11 the new ap-paratus is lighter, and more portable, andlastlv, it is much less expensive." If its

lightness consist in being made of sheet-iron,I would inform Mr. Barker that Mr. M’ln-tvre had several made of that material, butfound them less convenient, less Srm, andless agreeable (for private practice, at anyrate,) than those made of wood ; and ctterisparibus, they were not much less expensive.The sliding thigh-piece and the formation ofthe joint at the knee, are costly parts of theinstrument, and, of course, in omitting themMr. Liston considerably reduces its price,

z’

though, at the same time, it i9 deprived of alarge share of its intencied usefulness. As

Mr. M’lntyre’s splint may be readily takenin pieces, there cannot, I apprehend, bemuch difference on the score of portability.

I hope, Sir, these few remarks will be ac-cepted by Mr. Barker, and by Mr. Liston,should he favour them with perusal, in thespirit in which they are offered ; not as cap-tions criticisms on the new splint, but as ex-planations regarding Mr. M’lntyre’s appa-ratus, which I feel to be due to the memory

of the deceased inventor ; prompted, too, bymy desire that the advantages of a systemof treatment which appears to me so esti-

mable, may be more fully understood by theprofession, and more generally applied tobenefit the unfortunate patients to whom itis applicable, than has hitherto been thecase-

As a friend of Mr. M’lntyre, it is gratify-ing to me to find that these advantages arenow highly appreciated in the hospital of myfavourite alma mater, and their usefulnesswidely diffused by the students of that ex-cellent school. My class-fellows in 1830may recollect that I brought the machineunder the notice of the University MedicalSociety, while I had the honour of being itspresident, and that we had before us on thatoccasion a modification of Mr. Mllntyre’ssplint, which had been then recently adopt-ed by Mr. Key, at Guy’s Hospital. Thatmodification consists in the addition of acrutch when the splint is applied to a frac-tured thigh. If Mr. IWlntyre’s planbe adopted of making the thigh-piece aninch or two longer than the fractured limb,and flexing the kneejoint rather more thanusual, so-as to suspend the weight of thepelvis in some measure from that joint, andthus keep up a constant gentle extension ofthe injured thigh, Mr. Key’s crutch isnot needed. Mr. M’lntyre used to objectthat it tended to throw the patient into atwisted position. That subject, however, isnot quite relevant to my present comments,and therefore without extending them to

greater length, I beg to subscribe myself,Sir, yours obliged,

T. G. WRIGHT, M.D., M.R.C.S., &c.; 3akefield, April 12,1838.

FATAL

FALSE ANEURYSMAL TUMOUR

OCCUPYING NEARLY THE WHOLE OF

THE DUODENUM.

To the Ed2t01’ of THE LANCET.SIR:-Having, in No. 17 of THE LANCET

for the present year, observed a case relatedby Dr. James Johnson, at the WestminsterMedical Society, I beg to transmit you thefollowing, which occurred to me a shorttime ago, and which in several particularsresembles that case. Your insertion of itin an early number of THE LANCET willmuch oblige your obedient servant,

JAMES M’LAUCHLAN.Dumfries, April 24, 1838.

Mr. -, setat. 49, a gentleman of sparebody and uniformly temperate habits, for thelast twenty years has been subject to a ma-lady, which was considered to be disease ofthe duodenum. The following is the historyof his case previously to 1835) as related by