No. 1749.

Contents.

PAGE

CLINICAL LECTURES, &c.

By JONATHAN HUTCHINSON, F.R.S.,

Emeritus Professor of Surgery to the

London Hospital.-On Injuries to the

Elbow joint in Children......

By GEORGE JOHNSON, M.D., F.R.S., Pro-

fessor of Clinical Medicine, Senior

Physician to King's College Hospital.

-On the Influence of the Auricles in

the Production of Cardiac Sounds and

Murmurs

Lecture III.-By J. MATTHEWS DUNCAN,

M.D., F.R.S., Physician-Accoucheur

and Lecturer on Midwifery at St. Bar-

tholomew's Hospital.-Terminations of

Peri- and Para-Metritis

By ALFRED SANGSTER, M.B. Cantab.,

M.R.C.P. Lond., Physician for Diseases

of the Skin, Charing Cross Hospital;

and J. MITCHELL BRUCE, M.D. Lond.,

F.R.C.P. Lond., Physician to Charing

Cross Hospital, and Assistant Physi-

cian to the Hospital for Consumption,

Brompton.-On a Rare Form of Itching

Vesicular Eruption (? Hydroa Bulleux

of Bazin)

REPORTS OF HOSPITAL

PRACTICE.

GUY'S HOSPITAL:

Jaundice from Impaction of Gall-stone

in common Bile-duct - General

Tuberculosis with Tubercular Peri-

carditis, and Meningitis-Death.

Under the care of Dr. Frederick

Taylor

1

3

15

Sanitation in Egypt

15

Dr. Drummond on Diseases of the Brain

and Spinal Cord.....

Sir Thomas Browne's Religio Medici.....

15

The Diagnosis and Treatment of Diseases

15

of the Ear

Consultants' Fees

16

The Dissector's Manual

5

16

The Alienist and Neurologist

The American Psychological Journal... 30

Elements of Practical Medicine

ELBOW JOINT IN CHILDREN.

By JONATHAN HUTCHINSON, F.R.S.,

Emeritus Professor of Surgery to the London Hospital.

GENTLEMEN, I have often asked your attention to

the fact, that the elbow is almost the only joint

which in children is liable to be dislocated from vio-

lence. Now and then we see a dislocation at the hip,

even in very young subjects, but as regards the

shoulder, the knee, the ankle, the wrist, and the finger

joints, those of us who have had the largest experience

could easily count up all that we have seen. They are

exceedingly rare, the cause of their rarity being that,

in each, separation of the adjacent epiphysis usually

occurs instead. Of this latter accident at the shoulder,

the ankle, and the wrist, we see plenty, and at the

knee and hip a few; contrary, however, to what is

known to obtain at all the other articulations, disloca-

tions at the elbow in young persons, are reputed to be

common, more common, I think, than they are in

adults. This fact is probably to some extent ex-

plained by the circumstance, that in young children

the coronoid process is low and imperfectly ossified.

It is, of course, in the adult the chief hindrance

to dislocation, but in children its cartilaginous

tip may easily be crushed down, or possibly detached

This explanation, however, does not cover the whole

ground. To a large extent, I feel sure that the

popular belief as to the frequency of clean disloca-

tions at the elbow in children is a mistake. They are

VOL III. 1884. No. 1749.

being a partial detachment of the lower epiphysis of

the humerus. The ossification of the lower end of this

bone occurs, as you know, at several separate points.

These are, however, pretty much on a level; and

whilst it is quite possible for any one portion to be

detached alone, it is also quite possible for the whole

epiphysis to be cleanly separated from the shaft by a

transverse line of detachment, which permits the con-

dyles and epicondyles to pass backwards together with

the bones of the forearm. I need not stop to tell you

how to distinguish such an injury from a true dis-

location, although mistakes constantly occur; they are

excusable only by the fact that the swelling is often

very great, the child difficult to examine, and anæs-

thetics usually omitted. I am sure that you will bear

me out that cases are very common in which, after

the treatment of a case diagnosed as dislocation back-

wards at the elbow, the joint remains stiff, swollen,

and with much apparent thickening of bones for

many months afterwards. Other opinions are often

sought in such cases, and the surgeon who reduced the

dislocation is often discredited. Such cases are almost

always examples of displacement of the epiphysis, com-

plete or partial.

I have seen many examples of complete transverse

detachment of the whole lower epiphysis, and have
had opportunities of demonstrating several to you.
Most of them have come to me late, on account of
awkward union, but in a certain number I have had
an opportunity of examining the state of things imme-
diately after the accident. I show you here a photo-
graph of one which I examined, and had taken within