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402

Want of Union in Fracture
Salf to door sits to

sule shrinks in proportion as the direct union renders it 213 nonging295 2di lo the capsule has AFI Co2olɔni maMIT 9000

unnecessary. After a few months

disappeared, the bone has shrunk to the natural size, and

even its cavity is gradually restored.

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redto ai aping deta Thus it appears established upon a very extensive induction, that union of internal parts greatly depends A w rod at 90t upon changes, which take place in the adjacent textures. This conclusion derives support from, at the same time that it serves to explain, the curious circumstance, that fractures of an isolated bone never unite by bone. In na sarydmism Sir Astley Cooper's capital work upon Dislocations the 20 20 90ed to fact is proved by reference to a vast body of evidence, poodi loghieijo that when the neck of the femur is broken within the capsular membrane, bony union does not follow. Hour vapmbro ada ni Of several instances, which I have myself had an opportunity of examining, let me select the following to illustrate this anomaly. A woman about the age of fifty fell with great violence upon the left hip. The limb was not shortened, but was rendered

291

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cg virgeme ell ing followed. She was confined to her bed for five DEMI ZAVỤ JQuisite MA months; after which she gradually regained strength i eron and to sha the injured hip, and became enabled to walk with the assistance of a stick. Thirteen months after the accident, she died suddenly of apoplexy. Upon examination, the neck of the femur was found to have been broken within the capsular membrane: union had taken place by a layer of soft but tough substance three lines in thickness, in which however not the least trace of earthy matter, was discovered. The specimen is in the Museum in Great Windmill Street, and was given to me by friend Mr. Sweatman: there is an engraving from it in Sir Astley Cooper's work on Dislocations. In a fracture

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of the Neck of the Femur explained.

405

farsbret nomu mas obvious that the broken ends of of this description it is obvious

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bone remain inclosed in a synovial cyst, excluded from

the contact of those parts, the changes in which accom DOTOJe97 Vimbing af vlizno di nave

plish union in other cases.

When the neck of the femur is broken, and the fracture is half within and half without the capsular mem 29101201 Jasperbe sie n

brane, the former part unites by ligament, the latter by smm 908 9.) ishti norgubuoɔ eidT

bone.

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When the fracture is entirely within the capsular ΩΙ Brod d membrane, and ligamentous union ensues, some growth of bone is occasionally found to have occurred on the outside of the capsular membrane,-the commencement of the same process, which has been already described in the ordinary reparation of bone, but which in this case is prevented extending to the substance that intervenes between the broken surfaces. masis to piausioq

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Let me conclude with mentioning an instance of deficient union after partial division of a nerve, which se seem's to be singularly parallel to the case last considered. Jon

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nerve at the

An attempt was made to divide the fifth fiore side of the pons Varolii in a young cat. The animal immediately lost the sense of feeling in the parts supplied by the first and second divisions of the fifth, and the cornea became partially opake: but the iris moved, and the animal saw distinctly with the eye, which had lost 998lg the sense of touch. During eighteen months no further change ensued: not the slightest return of common sensation was observable in the eye, the nostril, or cheek of the mutilated side. At this period the animal was killed. Upon examination, the following appearances presented themselves. The fifth nerve had not been entirely divided; which accounted for the continuance of sensa

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404 Result of dividing a Nerve in the cranial Cavity.

tion that had been observed in the parts supplied by the third division of that nerve. What remained undivided of the fibrils of the fifth held the severed portions at the distance of a line asunder: they were united by a thin film, which seemed a thin clot of blood, which had nearly lost its colouring matter, and gave way on slight pres

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Now a nerve when traversing the cavity of the arachnoïd membrane is in a position analogous to that of the neck of the thigh bone: it is not in any sort of contact with the cellular texture; and its restoration when divided is equally imperfect.

Yet in such a case every other condition favourable to reparation is present: the divided surfaces are nearly in apposition, the supply of blood is not interrupted, and the parts are kept perfectly at rest.

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VIN page 95 I have mentioned the discrepancy which

exists between the observations of Mr. Brodie and of M. Magendie respecting the influence of the bile in digestion. The following experiments, which I have subsequently made, agree in their result with Mr. Brodie's.

The ductus communis choledochus was tied in three cats, each about four months old, which had fasted for twenty-four hours previously. They each took food after the operation, which they threw up; but they afterwards again took food, consisting of milk and raw or boiled meat, and continued to eat occasionally with a natural appetite.

"One of these animals was killed between five and six hours after the duct had been tied. The stomach contained a full meal of meat, consisting in part of morsels, which were softened by the action of the gastric juice, but had undergone no further alteration; in part of a pulpy mass of a reddish grey colour, in part of a brownish-grey viscid liquid, in which innumerable small globules of oil floated. The small intestines were perfectly empty.

"The second died within fifty hours after the experiment. The stomach contained a small quantity of halfdigested food; the small intestines contained scarcely a trace of a greyish semifluid substance, which here and there admitted of being scraped from the villous surface.

"The third was killed three days after the operation. The stomach contained half-digested food; the small

406

Experiments upon the Influence of the Bile.

intestines contained a quantity of a greyish viscid liquid, very like the liquid contents of the stomach. The great intestines, in this and the preceding instance, were distended with a greyish, tenacious, and highly offensive semifluid matter.

was

“An adult dog, in which the duct had been tied, was found dead on the second morning of the experiment. The mucous membrane of the stomach and bowels inflamed; the stomach contained water only; the small intestines held a quantity of yellowish ropy liquid.

"Finally, the duct was tied in two young dogs, which had fasted for twenty-four hours; one died, the second was killed, about forty-eight hours after the operation. Both had senten boiled flesh, and had taken milk. In the first the stomach contained half-digested food; and the small intestines contained a quantity of grey liquid, separate from a viscid ropy material that adhered to the villous surface. In the second the stomach contained a frothy mucus only; but the small intestine was moderately distended with a quantity of yellowish liquid.

Le bon VIA ad to "The animals which were killed were immediately examined: those which died were examined from four to five hours afterwards. In each case the duct was found to have been accurately secured; the gall-bladder and gall-ducts were distended with bile: there was no trace whatever of chyle in the lacteal vessels."

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