we can only find room for the tabular view of the cases (each of which is detailed in the paper and illustrated by a woodcut), and the conclusions deduced therefrom by the author.]

From what has been stated in the preceding pages, and from the evidence afforded by the post-mortem examination of fifty specimens of fractures of the neck of the femur, forty-two of which have been detailed, I think I am justified in deducing the following conclusions:

1. A slight degree of shortening, removable by the extension of the limb, indicates a fracture within the capsular ligament. 2. The degree of shortening, where the fracture is within the capsular ligament, varies from a quarter of an inch to one inch, or one inch and a half. 3. The degree of shortening, when the fracture is within the capsule, varies chiefly according to the extent of laceration of the fibro-synovial folds which invest the neck of the femur. 4. In some cases of intracapsular fracture the injury is not immediately followed by shortening of the limb. 5. This absence of shortening is generally owing to the integrity of the fibro-synovial folds. 6. In such cases the retraction of the limb may occur suddenly, many weeks after the receipt of the injury. 7. This sudden retraction of the limb, which indicates a fracture within the capsule, is, in general, to be ascribed to the accidental laceration of the fibro-synovial folds. 8. The degree of shortening, when the fracture is external to the capsule and not impacted, varies from one inch or one inch and a half, to two inches or two inches and a half. 9. When a great degree of shortening occurs immediately after the receipt of the injury, we usually find a comminuted fracture external to the capsule. 10. The extracapsular fracture is generally accompanied by fracture with displacement of one or both trochanters. 11. The extracapsular impacted fracture is generally accompanied by fracture without displacement of one or both trochanters. 12. In such cases the fracture of the processes unites more readily than that of the cervix. 13. The degree of shortening, when the fracture is impacted, varies from a quarter of an inch to one inch and a half. 14. The exuberant growths of bone met with in these cases have been by many erroneously considered to be merely for the purpose of supporting the acetabulum and the neck of the femur. 15. The difficulty of ascertaining crepitus, and of restoring the limb to its natural length, are the chief diagnostic signs of the impacted fracture. 16. The position of the foot is as much influenced by the obliquity of the fracture and the relative position of the fragments, as by the action of the muscles. 17. Inversion of the foot may occur in the intracapsular, extracapsular, or impacted fracture of the neck of the femur. 18. When in the intracapsular fracture the lower fragment is placed in front of the upper, the foot is usually inverted. 19. When in the extracapsular fracture with impaction, the superior is driven into the inferior fragment, so as to leave the greater portion of the latter in front of the former, the foot is generally inverted. 20. In cases of comminuted extracapsular fracture without impaction, but with separation and displacement of the trochanters, the foot may be turned either inwards or outwards, and will generally remain in whatever position it has been accidentally placed. 21. The consolidation by bone of the intracapsular fracture is most likely to occur when the fracture is also impacted. 22. Severe contusion of the hip-joint, causing paralysis of the muscles which surround the articulation, is liable to be confounded with fracture of the neck of the femur. 23. The presence of chronic rheumatic arthritis may not only lead us to suppose that a fracture exists when the bone is entire, but also when there is no doubt as to the existence of fracture, may render diagnosis difficult as to the seat of the injury with respect to the capsule. 24. Severe contusion of the hip-joint, previously the seat of chronic rheumatic arthritis, and the impacted fracture of the neck of the femur, are the two cases most liable to be confounded with each other. 25. Each particular symptom of fracture of the neck of the femur, separately considered, must he looked upon as equivocal: the union of all can alone lead to correct diagnosis.

On the Use of the Tincture of the Muriate of Iron in Diabetes Mellitus. By Charles Clay, Esq., Surgeon, Manchester.-The folllowing three cases yielded so decidedly to the use of the tinct. ferr. mur. P. L., after many other remedies had been tried, that I trust that placing them before the public will be the means of testing its merits still further. It is quite necessary, in order to succeed, to give it in large does, as I have repeatedly tried the same remedy in small doses without any effect. The cases I am about to give were of sufficient standing as to time and obstinacy (and could only be considered bad cases), and of such a character that the trial of any new remedy was perfectly justifiable.

CASE 1.-James Newton, of Ashton-under-Lyne, February, 1836, aged 75 years, had been for two years suffering from diabetic flows of urine, which for nine months had considerably increased; he had been under the care of different persons, and a variety of remedies were tried, but no abatement of the symptoms was observable. When he applied to me, the quantity of urine discharged was nine pounds and a half by weight in twenty-four hours, fully charged with saccharine matter; his appearance was emaciated, anxious countenance, and a dry, furred tongue. After trying various plans, without any apparent benefit (with the exception of temporary relief for a few days by the exhibition of nitrous acid), at last, without any particular hope of benefit, I ordered the following mixture:

Tincture of opium, 3jss;

Tincture of muriate of iron, zij;
Sulphate of quinine, grs. viij;

Distilled water, 3vj. An ounce to be taken three times a day. After continuing this formula for three days, I was agreeably surprised by a sensible abatement of the quantity of urine, but still as fully charged with saccharine matter; in five days more (that is, eight from the commencement), the abatement continued; the countenance less anxious, tongue clean, and evidently improving in constitution. On the eighteenth day, barely four pounds of urine were discharged in twenty-four hours, in which little saccharine matter could be detected. In four weeks, with a continuation of the medicine, he appeared in perfect health, and at the end of six weeks ceased taking medicine entirely, and since has had no return of the complaint.

CASE 2.-W. Grundy, aged 30, of Hurst, came under my care in April, 1838, after being treated by different persons without any apparent benefit. From the decided success of the tinct. fer. mur. in the case of Newton, I began immediately with the same dose, as above stated. The quantity of urine was, at the commencement, eight pounds in twenty-four hours, and full of saccharine matter. For five days no improvement in either the quality or quantity of the discharge was observable; after that time, however, the abatement began to show itself, but without any diminution of the saccharine principle. On the fourteenth day, the diminution of the discharge was remarkable, not more than three pounds and a half in twenty-four hours, and the character of the urine much less sweet. On the twenty-fourth day the discharge was natural in quality as well as quantity, and before the expiration of five weeks he left off taking medicine.

CASE 3-Mary Wild, aged 56, of Ashton, had been subject to a diabetic discharge for eight months; her general health had for some time been very precarious, from the cessation of the menstrual discharge: about seven pounds and a half of urine in twenty-four hours. In this case the saccharine matter was not so abundant as in the former cases. I gave the tinct. fer. mur. mixt. for six days, when a slight abatement was observable; but on the twelfth day the quantity was more than at the commencement. On the fifteenth day the abatement again showed itself: and from this time to the end of four weeks kept continually decreasing. At this time pleuritic

1 1 Lancet, Oct. 10, 1840; and Brit. and For. Med. Rev., Jan. 1841, p. 265.

symptoms called for a cessation of these remedies and a substitution of others, during which time a slight increase of urine came on; but on going on with the old medicine the improvement returned. She finally ceased taking medicine at the end of eight weeks, feeling her health quite restored, and has had no return since. The date of this case was March, 1840.

Mr. Combe. It was with no little regret that we observed in the volumes of Mr. Combe on the United States, which have just been published, an allusion evidently to a private conversation which took place at a dinner table, in which Mr. Combe makes the editor of this journal do Dr. Beaumont the signal injustice of stating, that the suggestions and experiments made at Washington, and detailed in Dr. Beaumont's book, were by the editor.

The error is another instance of the difficulty and impropriety of travellers attempting to detail private conversations. Mr. Combe was informed, that certain suggestions were made to Dr. Beaumont, and certain experiments performed by the editor in Washington along with him, whereas the observation of Mr. Combe would lead to the inference that Dr. Beaumont himself suggested and performed none of them.

The editor of this journal has been extremely careful not to detract from the results of the meritorious and persevering investigations of Dr. Beaumont, and it is painful to him to have the subject brought forward in this manner. It is strange, indeed, that Mr. Combe should not have seen the injurious effect of such a statement to one party, even if the impropriety of attempting to detail private conversations had not impressed him.

Jefferson Medical College,-Reorganisation.—It is with the greatest gratification that we announce the reorganisation of this college, with a corps of professors whose names and professional acquirements are known over every portion of this country. At a late meeting of the board of trustees, the following professors were unanimously appointed to the respective branches: Dr. Dunglison, Institutes of Medicine and Medical Jurisprudence. Dr. Huston, Materia Medica and General Therapeutics.

Dr. Pancoast, General, Descriptive, and Surgical Anatomy.

Dr. J. K. Mitchell, Practice of Medicine.

Dr. Randolph, Practice of Surgery.

Dr. Mütter, Institutes of Surgery.

Dr. Meigs, Obstetrics and Diseases of Women and Children.
Dr. Franklin Bache, Chemistry.

Of these gentlemen Drs. Dunglison, Huston, and Pancoast are medical officers of the Philadelphia Hospital; Drs. Randolph and Meigs of the Pennsylvania Hospital; and Dr. Mütter is surgeon to the Philadelphia Dispensary.

With the college thus fitly organised, the effect must be to render Philadelphia still more the centre of medical education in the Union. The higher the reputation of the schools, and the more harmonious their cooperation in the great work of medical instruction, the more certainly must this result be accomplished. Unworthy rivalry should be abolished, but an honourable competition as to which institution can be most extensively useful to the profession and the public should endure.

ART. I.-ON THE PRESENCE OF KIESTEINE IN THE URINE AS A TEST OF PREGNANCY.

To Professor Dunglison.

Philadelphia Hospital, April 12th, 1841.

Dear Sir,-At your suggestion we have instituted a series of experiments for the purpose of ascertaining the existence of kiesteïne in the urine of pregnant women. They have been conducted after the manner pursued by Dr. Golding Bird, as published in Guy's Hospital Reports, of April, 1840. Daily observations were made, and every change as it presented itself carefully noted. The results of our observations are as follows: The urine of twenty-four out of twenty-seven women, in different stages of pregnancy, from the second to the ninth month of utero-gestation, on the second day began to lose its transparency; on the third, became quite opalescent. From the second to the fourth day, a whitish scum made its appearance, which, as described by previous observers, might aptly be compared "to the layer of greasy matter which covers the surface of fat broth when it has been allowed to cool." This continued to increase until the fifth or sixth day, when, in each case, it was so unequivocally marked as not to be mistaken. From this until the fourteenth day, when the observations closed, the pellicle became gradually thinner by the detachment and subsidence of flocculi, though it never entirely disappeared. The odour, which was peculiar, could not be recognised by us as "cheesy," although our attention was particularly directed to this point. The filtered specimens of the same urine underwent similar changes.

Of the three remaining cases, in which the pellicle did not appear, one was labouring under peritonitis, and subsequently had an attack of puerperal fever, and another had incipient phthisis. We are unable to say whether the third was labouring under disease or not.

The urine of one suckling woman, two weeks after delivery, presented all the characteristics of kiesteïne. That of two others, twelve months after delivery, whose children were still at the breast, underwent no change.

So far as we observed, the presence or absence of milk in the breasts, previous to delivery, appeared to exercise no influence over the formation of the scum.

An elevated temperature of from 60° to 80° appears most favourable to the speedy and perfect formation of the kiesteïnic pellicle, whilst one low enough to freeze the urine occasionally prevents or very materially retards the process. This may perhaps account for some apparent discrepancies