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sinuation that one of the proprietors of thatj’ournal was the individual who foolishlyexcluded THE LANCET from the library someyears since. Now, Sir, 11 ALETHES " mustknow that the Librarian of the College hasnot the privilege of taking in or rejectingbooks at his pleasure; this duty rests withthe Library Committee ; and, with respectto his insinuation against Dr. Jacob, no onebetter thaa "ALETHEs" knows, that thegentlemen who carried that measure are nowprominent members of the United MedicalClub ; and that, in becoming their ally andadvocate, it is he who, to use his own elegantexpression, has "jumped Jim Crow."Growing bolder as he proceeds, "ALE-

THES" next threatens Drs. Jacob and Maun-sell with expulsion by his party from theirprofessorships in the College of Surgeons,unless they give iip their "disagreeableexposures," &c. This may be " Club law,"but certainly is a curious way to meet

argument. Its conception rellects the highestcredit upon the genius of "ALETHES;" andthe manner in which he advocates it is cal-culated to shed a strong light upon theliberal feelings that pervade the party ofwhich he aspires to be the organ, and ofwhich he appears to wish to be consideredthe champion, but of which he is in realityonly the tool.There are some other topics in « ALETHES’"

Familiar Epistle " which I would touchupon, did I not fear to encroach too muchupon your valuable space. I beg to sub-scribe myself,

A MEMBER OF THE ROYAL COLLEGE OFSURGEONS IN IRELAND.

Dublin, April, 1840.

LETTER FROM DR. MAUNSELL.

H. MAUNSELL.

To the Editor of THE LANCET.SIR :-As you have thought proper to

open your pages to anonymous libels affect-ing my character, objects, and property, Ipresume you will not refuse insertion in

your next Number to this brief note. All Idesire to make known in it, is, that both the ’,letter signed " ALETHES," published inTHE LANCET of the 18th ult., and that signed i

"AN INDIGNANT LICENTIATE OF THE DUBLIN ICOLLEGE," published in THE LANCET of the I2nd inst., contain several statements regard-ing me which are falsehoods, and that thewriter, whoever he may be, must know themto be such, and would not dare to make themin my presence. Your obt. sert.,

H. MAUNSELL.

Dublin, May 4, 1840.

DISLOCATION OF THE HUMERUS.

Cure of an Old Dislocation of the Humerus byDivision of the Pectoralis Major, Latissi-mus Dorsi, Teres Major, and Teres MinorMuscles.

BY PROFESSOR DIEFPENBACH.

HERR T a large landowner, upwardsof thirty years old, had his right shoulderdislocated two years ago by a fair from hishorse; the nature of the accident was not atfirst recognised, and afterwards, though allall the usual means were adopted by severalsurgeons, the bone could not be returned toits place. The patient, therefore, came toBerlin; he was of a gaunt, powerful form,with a pale complexion and but little fat, andhis muscles were strong and prominent underthe skin. The injured right shoulder wasau inch higher than the left; the acromionformed a sharp angle; on the outer side theshoulder was deeply hollowed, and the sca.pula lay flat. The right arm was thinnerthan the left, and stood out far from thebody. The head of the humerus lay on theanterior side of the chest, close to the clavi.cle, and two inches from the upper portionof the sternum. The patient had a constantsensation of cold in the limb, and the creep.ing which he had formerly felt had ceased.The pulse in the right radial artery wasrather weaker than that in the left. The

limb was useless, and only the hand couldperform some slight actions.

By moving the arm in different directions,severe pain was produced in the part wherethe head lay, surrounded by a thick wall ofdense ligament, into which it had workeditself. In drawing the arm outwards fromthe body, the pectoralis major, latissimusdorsi, teres major, and teres minor becametense with extreme pain. The last three ofthese muscles felt hard and tense, evenwhen the arm was not drawn outwards.An attempt to reduce such a dislocationwithout dividing these muscles and the newjoint would have been extremely dangerous,and had been found impossible ; but (saysthe Professor) I anticipated success fromthe subcutaneous division of every thing thatresisted me.The patient being placed on the table,with

one folded sheet passed under the rightaxilla, and held by six assistants, anotherfastened round the right hand and held bysix more, and a third round the upper partof the humerus held by three more (in themanner usually adopted by me in old lu13’tions), the two first sets of assistants wereordered to pull against each other. I nextbade them make a slowly-increased exten-sion, and then stop ; I then passed a smallscythe-shaped knife through the skin, auddivided the most tense portion of the pecto’ralis major close to its tendon, which yieldedwith a cracking sound’. I then again intro-

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daeed the knife at the posterior border ofthe axilla, and divided one after the otherthe latissimus dorsi, the teres major, andthe teres minor. All these muscles gaveway with a cracking noise, which was in-creased by the resonance of the chest. Inext passed my knife into three places bythe head of the humerus, and divided in asimilar manner, under the skin, the denseand hard false ligaments which surroundedthe new joint, and, lessening the extension,I loosened the head by a few rotations.A powerful extension was now again com-

menced on both sides, and the three assist-ants behind the patient pulled suddenlywhile I conducted the humerus towards the

joint into which it slipped on a sudden,without again springing out. One shoulderlooked now just like the other. The thorax,the shoulder, and the arm were envelopedwith bandages which were soaked withpaste, and after a few hours they all be-came dry and hard, and prevented any mo-tion of the right side.The bleeding from the wounds,which were

not larger than those made in phlebotomy,was at most a few drops. No unpleasantsymptoms ensued, and the patient sufferedeven less than the majority of persons inwhom I have reduced old dislocations. Onthe ninth day I took off the bandage ; bothshoulders had exactly the same level andform, and there was neither swelling norpain. The punctures in the axilla had com-pletely healed, and scarcely a trace of themcould be found ; there was no collection ofblood or pus. The arm was already capa-ble of motion, and its actions were far lesshindered than they are sometimes after thereduction of a recent dislocation ; because inthem there is often for a long time a sensi-tive contraction of the unnattirallv stretchedmuscles, while in this case the division ofthe resisting muscles and of the newly-formed joint not only rendered the reduc-tion possible, but at the same time dimi-nished its after consequences. The limb isnow again restored to perfect utility.-Medicinische Zeitung, and Foreign MedicalReview-Dec. 1839.

THYMIC ASTHMA.

THE following cases, of a disease whichGerman writers denominate Thymic Asth-ma, we extract from an American Journal.They may serve as a point of comparisonwith the cases which have, already, beenpublished in various numbers of THELANCET:-CASE I.—Congenital Cough; Repeated and

increasing Paroxysms of Strangulation; ;Sudden Death. Enlarged Thymus Gland; ;Hypertrophy of the Heart.

March 12,, 1838. An infant boy, seven

months old, was fat and stout, although of

late somewhat neglected by the mother,who could nurse him only once a day, be-ing obliged to work away from home.From birth he had been subject to slightcough, and to attacks of strangulation ex-cited by the cough. These attacks had oflate grown more frequent, occurring five orsix times during the twenty-four hours;less frequently however at night. The childwould grow blue in the face, struggle forbreath, and recover itself again : each pa,-roxysm continuing about a minute. Duringthe interval, the child was perfectly well,except the cough : no dyspnoea; no gastricor intestinal derangement. Last eveningthe child was sitting upon its mother’sknee lively and well, when one of theseattacks of strangulation occurred, and in aminute it was dead.

Post-mortem Examination, Fourteen Hoursafter Death.-Lips violet; large livid spotsabout the lower portion of the back, and onthe thighs ; considerable rigidity of thelimbs. Body well-formed, and fat.

(Jn removing the sternum with the carti-lages of the ribs, the whole space beneath wasfound occupied by the thymus gland, evident-ly hypertrophied. It was pyriform in shape,witth its smaller extremity attached to theanterior portion of the trachea, commencingabout midway between its laryngeal extre-mity and its bifurcation, and extendingdown in close connection with the fibrouscoat of the pericardium so as completely tocover the great vessels and the heart, excepta line or two near the apex, and touchingthe diaphragm. Its length was four inches(French), its greatest breadth three inches,its greatest thickness, which was at itsmiddle, three quarters of an inch, or oneinch : it was divided by a long fissure intotwo lobes; its colour and consistence were

natural. The phrenic nerve on one sideerosst’d the superior portion of the en-

larged gland, that of the other passing un-der and to the side of it; one was noticedto be much larger than the other. The parvagum was not at all implicated. Theheart, after raising the enlarged gland, wasnoticed to be also larger than natural : andon opening the nericardium. which was

healthy and contained no fluid, this enlarge-ment was found to reside entirely in theleft side of the organ, the right side appear-ing as a sort of appendage to the left. Bothauricle and ventricle were considerably hy-pertrophied, and perhaps slightly dilated ;the different orifices were free: the cavitiescontained no blood, but it was noticed,when the great vessels were divided in re-moving the heart, that a large quantity ofdark-fluid blood was discharged.The fauces, the larynx, the trachea,, and

the bronchi examined through the divisionsof the second order, were perfectly natural.The lungs were of a pale flesh colour, and,in every part, dense and firm, crepitating