dustry on your part, I have no doubt that our term will be both pleas ant and profitable. One thing I am free to say that our efforts in teaching, are never better appreciated than by the earnest and energetic student, who has resolved, that however others may do, that for himself he will know "whereof we speak."

ON THE RECIPROCAL DUTIES OF PHYSICIAN AND PATIENT.

Extract from an address read before the Southern District Medical Society in May, 1854. By A. F. CARR, M. D.

"I am aware that the members of legitimate medicine exhibit as high a degree of moral excellence in their character as any class of men in the world; yet in no other calling is it more necessary and important and I might perhaps add in no other calling are there stronger inducements thrown in the way to divert our minds from a course of simple rectitude; not of a kind to create decided obliquity of moral character; but of a nature which compliments our veracity as skillful physicians, and permits us with both eyes of our conscience staring us in the face to adopt, with all the complacency in the world, a most palpable operation of the vis medicatrix naturea as our own work. And it sometimes requires quite an effort of courage to resist this honor, which is thrust upon us with an importunateness, by our poor patient who seems determined to reward us with the glory of his cure; if he has nothing else to bestow; and which would almost give offence to decline. "And yet for all these things we are brought to an ac

count."

If there was not sufficient inducement in the quiet and repose of our conscience to reject these false honors, there should be sufficient in the fact, that if our patient is not set right in the first instance, he will be likely to go wrong in the second. If we do not permit him by the light of our knowledge to discover the agency we had in his cure and that of his own reparative energy, he will have no means of judging wisely between the best physician in the world and the most arrant quack. It is a fact or I am much misinformed that in times past medical men have taken upon themselves more credit for a favorable turn of disease than what really belonged to them, and it naturally

RECIPROCAL DUTIES OF PHYSICIAN AND PATIENT.

15

happened that they were correspondingly blamed for an unfavorable turn, when the influence they exerted in producing either result was equally far removed. And this is only the natural consequence of reasoning from false premises. If they had abjured all credit which did not fairly belong to them in the first instance, and this had been their uniform habit, the simple assertion that any unfavorable occurance was beyond their control would have been satisfactory to all concerned.

It is a trite saying that "this is an age of progress," which of itself should be a strong inducement to adhere strictly to truth. We may be but a few steps in advance of some inquisitive mind among our own patrons and if overtaken in error, we can have no just grounds of complaint, that confidence is withheld.

"Men in all employments have begun to send searching glances into old systems, whether religious, political, or medical and have detected so many abuses and so much asumption of knowledge that a suspicion of all which does not bear the impress of truth upon its face, is beginning to take the place of stolid credulity; and though free inquiry occasionally generates skepticism, these can always be met and refuted by the physician who is thoroughly indoctrinated with the principles of his science." The desire of every one who entertains a sin. cere regard for his profession should be to throw aside petty differences and jealouses forever; to substitute in their stead, brotherly love, a community of interest in the advancement of our science and to make our reading, our thoughts and conversation subsidiary to the one great object the promulgation of correct views of medical practice-adopt this course and the collossus of Quackery will be shattered by the progress of truth among our patrons and the explosive force of ideas.

ON INTERNAL DERANGEMENT OF THE KNEE-JOINT. BY MR. STEELE.

Internal derangement of the knee-joint is the appellation given to an injury, the precise nature of which, as may be inferred from its vague title, is not very clearly understood. The accident, however, is not very uncommon, nor is it unimportant in its consequences; for, if overlooked, it may prove very embarrassing to the surgeon, and may lay the foundation of more serious disease. The elder William Hey has

the credit of having first called attention to this injury. It is noticed by Sir A. Cooper, in his work upon the joints, and by other surgical writers; but the subject appears scarcely to have received the attention which its importance deserves.

I have no recollection," writes Mr. Steele, "of seeing a case, or hearing one mentioned during my attendance on hospital practice in London, and elsewhere, and it was only recently that my attention was particularly drawn to it by a clinical lecture of Mr. Smith, of Leeds, which appeared in the Lancet' of the 20th September, 1851. A short time after perusing that lecture, I met with a case which I at once recognized from his description. I was also then able to explain satisfactorily to my own mind cases which had come under my notice previously, and which had puzzled me a great deal. The accident is generally produced by some slight fall, slip, or sprain. Sir A. Cooper observed that it occurred most frequently when a person in walking strikes his toe, the foot being at the same time everted, against any projecting body, as the fold of a carpet; he also relates cases in which the accident happened from a person having suddenly turned in his bed, when the clothes not suffering the foot to turn with the body, the thigh-bone has slipped from its semilunar cartilage. The symptoms, when the accident is recent, are very characteristic and readily recognized, when attention has once been drawn to these cases: but yet so slight as very likely to be overlooked or misunderstood by those who are not aware of their occurrence. There is little or no alteration in the appearance of the joint; no swelling or effusion; and no pain when the limb is at rest. The patient walks with a limp, with or without pain, and cannot bring the heel to the ground from inability to accomplish full extension of the limb; the motions of the joint are unimpaired, except that extension, either by the patient's efforts, or those of the surgeon, can only be partially effected, so that the limb remains constantly a little bent. In some instances, the cure takes place suddenly and accidentally; in others, the mischief will continue for days, weeks, or months. Some patients are liable to a recurrence of the accident, as is recorded by Sir A. Cooper, and as I have observed in one instance in my own practice. When accompanied by other severe injury or disease of the knee-joint, as may happen either from the violence producing the accident, or from rheumatic or scrofulous inflammation consequent upon it, the case assumes a more curious and complicated character, is less readily detected and less easily remedied.

"The exact condition of the internal structures of the joint, which is subjected to this derangement is not accurately known. Mr. Hey says, 'an unequal tension of the lateral or cross ligaments of the joint, or some slight derangement of the semilunar cartilages, may possibly be sufficient to bring on this complaint.' Sir A. Cooper regards it as a partial luxation of the thigh-bone from the semilunar cartilages.' Mr. Smith, of Leeds, thinks that the edge of the semilunar cartilage is turned upwards.'

INTERNAL DERANGEMENT OF THE KNEE-JOINT.

17

"The treatment to be adopted in the recent uncomplicated cases of this injury is exceedingly simple and usually very satisfactory in its results. It is clearly and graphically described by Mr. Smith, in the lecture before alluded to; and I cannot do better than give it in his own words: ‘If the right knee be the one affected, I place the patient at length on a sofa on his left side, I then take hold of the right ankle with my right hand, and by slow and gentle means gradually flex the limb until the heel presses upon the buttock; now is the time that a little cunning and art is required to perform the full extension, for if you attempt this without manoeuvering properly, you are foiled, the muscles resist the action, and you can only succeed by cheating them. I now take care the patient does not see what I am about. I place the left hand above the knee, grasping the vasti muscles, hold the ankle above the heel with the right hand, make several gentle extensions, but no further than to a right angle; and when my patient seems fully impressed with the belief that I am going to proceed no further, when I am satisfied I have caught him off his guard, I suddenly and powerfully perform the full extension of the limb. Generally I succeed; sometimes I fail, and I have to repeat it once or twice. When the full extension is accomplished, the cure is usually complete.'

"Where this plan fails, and especially in cases of long standing, Mr. S. Hey recommends flexing the leg fully, placing the arm under the popliteal space as a fulcrum, to separate as far as may be the head of the tibia from the condyles of the femur, and at the same time to produce rotation of the tibia.' I will now relate some instances of this affection, which have fallen under my own notice.

“CASE 1.—The first case which I recognized was that of a young female, who stated that the sprained her knee some six days before, by a trip, while going up stairs; she had consulted a surgeon, who ordered her an embrocation, but she was still unable to walk without great difficulty. There was no pain or swelling of the joint; but the patient was unable to place his heel flat upon the ground, or fully to extend the limb. I adopted the manipulation described by Mr. Smith, and the limb was at once restored to its natural condition, except some weakness, which remained for two or three days, after which she had no return of the complaint.

"CASE 2.-The next case was that of a mechanic who fell down a a steep bank while carrying a rocking-horse; he had contusions on various parts of his body, and suffered severely from the general concussion of the fall, and was confined to his bed for some days; on attempting to walk, he found he was unable to put his foot flat to the ground; and, on examination, I was satisfied that the knee was in the condition peculiar to these cases; there was also in this case acute pain when firm pressure was made on the inner side of the joint. Manipulation, as in the former case, enabled the patient at once to place his foot firmly to the ground, and in a few days he walked as usual.

"CASE 3.-The next case I shall relate was of a more complicated nature. An iron-moulder, æt., about 40, of intemperate habits, and very liable to rheumatic inflammation, fell down and sprained his ankle, which became hot, painful, and much swelled; but these symptoms subsided in a few days, and his knee became similarly affected, and he then applied to me for advice. The knee-joint was leeched and blistered repeatedly, and the treatment appropriate for rheumatic synovitis carried out, under which the case slowly improved; and the joint was, with the exception of some thickening of the synovial membrane, restored to its usual state, except that the patient was unable to extend the limb completely; flexion and extension gave no pain, but he was unable to walk across the room, from inability to put the foot to the ground. After carefully examining the limb, I became satisfied that the peculiar derangement of the joint we are speaking of had occurred probably at the time of the accident; but my attention being drawn to the more evident acute affection, aud as semifiexion was the position I wished to preserve, as most conducive to the relief of the pain and inflammation of the joint, it had escaped my notice. I adopted forcible extension in the same way as in the other cases, and the patient at once jumped out of bed and walked across the room. It was some time before the whole of the thickening about the joint was got rid of; but there was no more difficulty in placing the foot to the ground, or of fully extending the limb."

Mr. Steele also refers to two cases in which he had every reason to believe that the same kind of mischief existed without being detected, one of which was set right by the rough practice of a "bone-setter," after foiling his own efforts to relieve it. He then adds, a similar derangement of parts may occur in other complicated joints, as the shoulder or hip, and these eluding the ordinary examination of a medical man, are unconsciously remedied by the rude handling and rough manipulations of these ignorant pretenders. A small balance of good to place against the incalculable amount of mischief, which these unscrupulous gentlemen inflict upon the limbs and lives of those who intrust themselves to their care."-Assoc. Med. Journal.

[See an article on this subject by the editor on the 2d page of volume 3d.]

THE CONSUMPTION CURERS OF NEW YORK.

BY AN INVALID M. D.

we per

With regard to life it has been said by a late writer, that " suade ourselves that it teems with novelties and delights; that it abounds with high festival days and gala shows, somewhere in happier