Before I conclude I must notice a mistake which Dr. Waterhouse has fallen into, at page 35 of his valuable publication, where he says" It is remarkable that neither at New-York, Philadelphia, Charleston, nor Savannah, did any of the vaccine matter, repeatedly imported from London by different practitioners, ever communicate the disease." By referring to my pamphlet, he will find that the eighth case (noticed in the tables) had the disease, both from the infection I procured through President Jefferson, and from some I received a day or two afterwards from Mr. Ring. The child had five pock, two of which were from the last mentioned stock; and from this English source I communicated the disease to case 11, and again from this to case 20: so that, at the same time, it was spreading in this town from a double source. What was more to the point was, the coincidence of the disease produced by each proving its genuine nature-at that early period of vast importance and utility to me.

I meant to have said something relative to the point of revaccination about the fifth day, as recommended by Mr. Bryce, to test the constitutionality of the disease produced; but I have already far exceeded, I fear, the limits of a communication for a work of the nature of the Medical Reposi→ tory. I can only apologise from the wish to advance, as much as lies in my power, the knowledge of this wonderful prophylactic, which is yet, indeed, imperfect, but is daily becoming better understood.

Philadelphia, August 1, 1803.

ARTICLE IV.

A CASE of FRACTURE of the Os HUMERI, in which the broken Ends of the Bone not uniting in the usual Manner, a Cure was effected by means of a Seton. Communicated to Dr. MILLER by PHILIP Š. PHYSICK, M. D.

ISAA

SAAC PATTERSON, a seaman, twenty-eight years of age, applied to me in May, 1802, in consequence of a fracture of his left arm, above the elbow joint, which had taken place several months before; but the ends of the bone not having united, rendered his arm nearly useless to him.

The history he gave me was, that on the eleventh of April, 1801, after having been at sea seven months, his arm was frac

tured by a heavy sea breaking over the ship. Nothing was done for his relief until next day, when the captain and mate bound it up, and applied splints over it. No swelling supervened, nor did he suffer any pain. Three weeks after this accident, he arrived at Alexandria, when the state of the arm was examined by a physician, who told him, that the ends of the bone were not in a proper situation. After making an extension, the splints and bandages were again applied. He remained in Alexandria four months, when, finding his arm no stronger, he left off all dressings, and went on board the NewYork frigate as steward: in this capacity he remained near the Federal City six months, and by being under the necessity of using his arm as much as possible, he found the connection between the ends of the bones became looser and looser, till, at length, the arm bent as easily as if a new joint had been formed at the place of the fracture. From the frigate he went to Baltimore, where an attempt was made by machinery to extend the arm, and keep the ends of the bone in apposition, by continuing the extension. Under this treatment he remained two months, but experiencing no benefit, he was advised to come to Philadelphia. On examining the arm, I found that the humerus had been fractured about two inches and a half above the elbow joint, and that the ends of the bone had passed each other about an inch the lower fragment, or that nearest the elbow, was situated over and on the outside of the upper portion of the bone. The connection that existed between the ends of the humerus was so flexible as to allow of motion in every direction, and, by forcible extension, the lower end might be pulled down considerably, but never so low as to be on a line with the end of the upper extremity.

He was admitted into the Pennsylvania hospital the latter end of May; but the weather becoming very hot, it was judged best to defer any operation that might be necessary until the fall of the year. Unfortunately he then contracted a bilious fever, of which he was so ill that his life was despaired of for some days. From this fever his recovery was so slow, that it was not thought proper to perform any operation until December. It still remained to decide by what means a bony union of the humerus might most probably be effected. In the year 1785, when a student, I had seen a case in our hospital similar to this in every essential circumstance, in which an incision was made down to the extremities of the fractured bone, which were then sawed off, thereby putting the parts into the condition of a recent compound fracture. No benefit how

ever was derived from this painful operation, and some months afterward the arm was amputated. This case had made a strong impression on my mind, and rendered me unwilling to perform a similar operation. I therefore proposed to some of the medical gentlemen of the hospital, who attended in consultation, that a seton-needle, armed with a skein of silk, should be passed through the arm, and between the fractured extremities of the bone, and that the seton should be left in this situation, until, by exciting inflammation and suppuration, granulations should rise on the ends of the bone, which uniting, and afterwards pssifying, would form the bony union that was wanting. This operation being agreed to, it was performed on the 18th of December, 1802, twenty months after the accident happened. Before passing the needle, I desired the assistants to make some extension of the arm, in order that the seton might be introduced as much as possible between the ends of the bone. Some lint and a pledget were applied to the orifices made by the seton-needle, and secured by a roller. The patient suffered very little pain from the operation. After a few days the inflammation (which was not greater than what is commonly excited by a similar operation through the flesh, in any other part) was succeeded by a moderate suppuration. The arm was now again extended, and splints applied. The dressings were renewed daily for twelve weeks, during which time no amendment was perceived; but soon afterwards the bending of the arm at the fracture was observed to be not so easy as it had been, and the patient complained of much more pain than usual whenever an attempt was made to bend it at that place. From this time the formation of the new bony union went on rapidly, and, on the fourth of May, 1803, was so perfectly completed, that the patient could move his arm, in all directions, as well as before the accident happened. The seton was now removed, and the small sores occasioned by it healed up entirely in a few days. On the 28th May, 1803, he was discharged from the hospital, perfectly well, and he has since repeatedly told me that his arm is as strong as it

ever was.

ARTICLE V.

An ACCOUNT of the MEASLES, and some other DISTEMPERS, as they appeared in several Towns in the District of Maine, from January, 1802, to January, 1803. Communicated by Dr. JEREMIAH BARKER, of Portland,

FROM the first of January, 1802, to the 22d of February, the weather was unusually moderate and rainy; scarcely any snow falling during this period.

On the 22d of February a violent N. E. snow-storm commenced, and continued for five days, with very little abate

ment.

During the spring months, the weather was remarkably cold and wet, so that vegetation was in a very backward state. The summer was cool and rainy; the fall, for the most part, dry and pleasant.

In January the measles appeared in some of our interior towns, and progressed to the sea-ports, where it made its appearance about the middle of March, and was very prevalent till June, when it disappeared. The distemper, however, continued in several country villages, in scattered instances, till the close of the year.

The symptoms which characterized the measles pretty uniformly commenced and progressed in the following order, viz.

A disturbed and nauseated stomach, chilliness followed with heat, pain in the head, heavy and watery eyes. On the first or second day, a soreness of the throat was generally perceived, and a cough supervened; pulse quick, and in plethoric habits full.

On the third day these symptoms were increased, and the patient was thirsty; tongue white and moist.

On the third or fourth day, a spontaneous vomiting and purging sometimes took place, and on the latter of these days. the eruption appeared.

When these evacuations took place to any considerable degree, the fever was reduced, and the eruptions were not remarkably numerous; the cough also was moderated. But when a vomiting and purging did not occur, the fever continued to increase, and the eruptions seemed to be proportionally numerous. The face too would swell, and the eyes become red and pained; the cough distressing, and respiration laborious.

Besides pain in the stomach, diarrhoea and bloody stools frequently occurred; but when these gastric and intestinal affections were considerable, the other symptoms were much less violent.

In some few instances there was no cough, nor soreness of the throat.

A great proportion of the sick were attended only by nurses, who, in general, confined their patients to their beds, and administered snake-root tea and spirits.

I am credibly informed, that in the spring months, sixteen persons, chiefly adults, died of the measles, in a remote country town, under this mode of treatment.

In several other towns more or fewer have died of this distemper.

The first cases of measles to which I was called, occurred in the middle of March. Seven were attacked in one family. Two of these were seized with vomiting and purging on the fourth day, when the eruption began to appear. I was then called, and found that the discharges were profuse. The matters ejected by vomit were green. I gave an aqueous solution of alkaline salts between the vomitings, which soon ceased, and a moderate cruption came on, without any considerable fever. Cool air, as well as water were allowed, and the patients readily recovered. Their ages were ten and sixteen. Another in the family, a boy aged six years, was attacked with the disease, though not violently. I was called on the fourth day, when the eruption began to appear. No evacuations had taken place. I left an emetic, as also a cathartic. The emetic was omitted, but the cathartic was given, which operated freely. Cool air, as well as water were allowed; but the fever increased, and a full eruption came on. I was called again on the ninth day, when his bowels were tense, pained, and sore to the touch. His pulse was quick, and respiration hurried. His tongue was dry and dark coloured, and he was very thirsty. I then gave an alkaline emetic, which operated five times, and ejected much dark green matter. A dose of castor-oil was then given, and his stools were of a bottle-green colour. After this, a scruple of sal. soda was given once in two hours, until two drams were taken, when he asked for food, and soon recovered.

The recovery of this patient, who was considered by his friends as hopeless, made a happy impression upon the minds of many in favour of alkalizing and cleansing the stomach and intestines in the measles. To the other four alkaline emetics, and alkaline and oily cathartics were given on the second day