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half long. Half a broad sheet, folded cravat-wise, served the purpose very well. Laying this by its centre across his palm, letting the ends hang to the floor, he with his hand seized the patient's elbow on the affected side, and carried the end of the cravat falling next the patient's body up in front of the shoulder of the same side, across the back, and under the sound axilla. The other end was thrown inwards over the patient's forearm, carried thence across the back, and over the sound shoulder, to meet and be tied to the first end. The two extremities of the bandage thus formed one-half of a figure-8 around the sound shoulder, while its middle portion formed the other half of the figure around the forearm and elbow. Hence he had styled this "the elbow figure-8." The borders of the affected axilla were not pressed upon, and that side was made perfectly comfortable; but the patient would sometimes complain of galling on the sound side. To complete the dressing, the three or four inches in width of the cravat left loosely embracing the back of the elbow should be smoothly pinned over; and the hand should be slung up by a strip of bandage pinned to the inner edge of the cravat on the affected shoulder, where it overlies the sternal fragment.

Dr. Warren's paper was referred to the Committee of Publication, and the Section adjourned.

THURSDAY, May 9th.

The Section was called to order by the Chairman, at three P. M. Dr. W. F. PECK, of Iowa, read the history of a case of Removal of the Upper Portion of the Left Femur for Disease of the Hip-Joint in a boy six years old.

On motion, the paper was referred to the Committee of Publication.

Dr. HARRISON ALLEN, of Pennsylvania, read a paper, illustrated by drawings, on The Soft Palate in Health and Disease.

On motion, the paper was referred to the Committee of Publication.

Dr. CHARLES N. HEWITT, of Minnesota, read a paper entitled Principles involved in the Treatment of Fractures by the StarchBandage, with a Modification of the Dressing.

The array of "principles" was a long one. Among the practical points were these: In any dressing, the inflexible splint should be placed upon the extensor rather than the flexor surface of a limb, so as to be nearer the bone and to avoid pressure in the

great vessels and nerves. A dressing, generally applicable, must be made of materials that can be found everywhere and can be manipulated with little skill. It must be such that it can be applied once for all by the surgeon; therefore it must accommo. date itself to the varying size of the limb, with such aid only as may be rendered by unskilled attendants. It must not confine the patient to his bed or to the house.

The dangers shared by the ordinary starch bandage with the other forms of " the movable" dressing were mentioned, and the speaker then described his own modification. It consisted in

starching only the overlapping ends of the many-tailed bandage employed, the central portion applied to the flexor surface of the limb being left free from stiffening. The unstarched part of the muslin would stretch if the limb swelled; and, when the swelling went down and the bandage became loose, a roller thrown around would mould it again to the limb, the unstiffened part falling into wrinkles or folds.

In illustration of his method, the doctor related four cases which had prospered under it-one of fracture of both leg-bones; one of severe contusion and fracture just above the ankle-joint; one of simple fracture of the thigh, where the patient was on crutches the eighth day; and one of compound fracture close above the knee.

Dr. J. M. KELLER, of Kentucky, recited a remarkable case which had come under his care a year ago. A boy eight years old fell seventy feet, but the fall was broken by the railing of a staircase, so that he was not killed outright. The doctor saw him almost immediately, and found the right radius and ulna with a multiple fracture extending from within an inch of the wrist to within the same distance of the elbow; the right humerus broken near the elbow and again near the shoulder; the right femur broken in its lower third; the right tibia and fibula badly comminuted, the fracture of the former involving the ankle-joint; four or five ribs broken; and (we believe) some other breaks, besides the bruises.

Of course the first business was to resuscitate the child and quiet his pain. He was placed in the most comfortable position, and kept under anæsthetics and opiates. The limbs were left exposed to the air, and cold water applications alone were employed for sixty-five or seventy hours. Then a fixed starch dressing was applied, made not of muslin but of paper. First the limbs were enveloped in cotton wadding, over which was drawn, for the lower

extremity, the leg of a pair of knit drawers, and for the upper the sleeve of an undershirt. Then slips of manilla paper were cut, from half an inch to an inch wide, and long enough to encircle the limb and overlap at the ends. These were covered with starch on both sides, and applied in the usual manner over the wadding and knit stuff. Four or five courses were laid on, beginning each time at the fingers and toes. To keep the radius and ulna apart, the forearm was held semi-prone and the paper pressed in between the bones, so that when dry it formed a perfectly moulded splint for the purpose. The lower limbs, after dressing, were placed on a triple inclined plane.

About the end of the fourth week the dressing was removed, and the boy presented to his parents as sound as before he was hurt, with perfect motion of both the injured limbs. Though union seemed everywhere complete, yet the starched paper was reapplied as a matter of safety. At the expiration of seven weeks it was taken off for good. The broken lower extremity was then found, on repeated trials, to measure one-fourth inch longer than its fellow. The doctor had attributed this not to actual elongation of the injured limb, but to wasting of the sound one, from its long disuse; for, owing to the rib-fractures on the left side, and the pain caused by any movement of that limb, it had got less exercise than the one done up in starch.

The speaker had referred to this case to attest his confidence in the immovable starch apparatus, and also to show the superiority of that form of it here employed. He thought paper surpassed muslin as much as the common starch bandage did every other kind of splint. Nothing else, he believed, would have secured perfect motion in that ankle-joint.

Dr. A. C. POST, of New York, had had considerable experience with the starch bandage, and thought surgeons were too apt to lose sight of the dangers attending its application very soon after the injury. In the New York Hospital he had seen two broken legs mortify from this cause, necessitating amputation. In one case under his own charge, the circulation was so much obstructed that he had to relieve it by slitting down the bandage. Effects like these had led him to suspend the application of the immovable dressing until the traumatic inflammation had subsided, and to use, for the first week or two, carved splints or the fracture-box.

Dr. QUIMBY, of New Jersey, had seen it necessary to remove the bandage to prevent gangrene. Buck's extension was safer for

the general profession, but this, like other niceties, should be left to experts.

Dr. KELLER said that with the paper dressing it was easier than with the cloth to make little trap-doors, whether for ventilation or to see what was going on inside. He would not apply any immovable apparatus until inflammation had subsided.

Dr. KINLOCH, of South Carolina, thought the chief advantage of the immovable dressing was that it could be applied so speedily as to free the patient at once from restraint. Only one agent, by its rapid hardening, met the indications perfectly, and that was plaster-of-Paris; when we had this at hand, it was foolish to wait thirty-six hours or longer for starch to dry. The dressing was applicable even to limbs considerably shortened, since they could be brought to their length under chloroform, and held so until the plaster set. The Doctor then explained in detail the mode of application.

Dr. NEWMAN, of New York, was strongly impressed with the importance of the last speaker's remarks. He thought the dressing was sometimes unjustly blamed for gangrene incidental to the injury.

Dr. QUIMBY reiterated his cautions against a dressing that would shut the limb from sight. He had seen bad results from the plaster splint in two instances where it had been well applied by men of skill.

On motion, Dr. Hewitt's paper was referred to the Committee of Publication.

Dr. S. B. MERKEL, of Pennsylvania, introduced to the section, George Thomas, a colored man who could play such queer tricks with his heart and his belly that Profs. Pancoast and Gross had found this case worthy of examination, and the latter had hinted that he was probably in league with the devil. He was born in Brazil and raised in London; had spent some time in Germany and at Paris, where, as at London, he had attracted scientific attention; and he had now taken up his abode at Frederick City, Maryland. He claimed that he could stop his heart, "throw" it into different parts of the abdomen, and "roll” the latter about the navel. The last peculiarity had been discovered by his mother when he was six months old. He got his living by exhibiting himself, and seemed anxious for a while about his pay; but, satisfied at length that the hat would not be empty, he lifted the curtain and opened the show.

First he made the abdominal wall undulate by a peristaltoid movement of the recti from above downward, there being about one and a half, or possibly two and a half, waves visible at once. The motion became very rapid, and was kept up for a minute or more. (He said he could do it all day.) Then he reversed the action, sending the undulations from below upward; and thus he alternated several times. Next he "threw his heart" into the belly, and a swelling like a phantom tumor appeared above the crest of the right or the left ilium at will. Finally he "stopped his heart," until several observers said they could neither hear nor feel it.

Voted that a committee be appointed to retire and examine the case, and report to the Section before its adjournment. The Chair appointed Drs. E. M. Moore, Moses, Allen, Quimby, and McDowell.

The paper on Four Cases of Fractures of the Femur, presented yesterday by Dr. P. R. Hoy, of Wisconsin, having been revised by the author, was now re-read by the Secretary for action by the Section. A vote of thanks was passed.

Dr. Hoy presented a tonsillotome of his own invention, which he had used for many years. It was a pair of strong scissors having both blades curved edgewise, like curved bistouries or the concave blade of a costotome.

Dr. BRONSON, of Massachusetts, related a recent case in his practice, of compound dislocation of the tibia from the astragalus, together with compound comminuted fracture of the fibula, in a lad fourteen years old, thrown from his horse. The wound was washed out, a number of detached fragments of the fibula were removed, the dislocation was reduced, and adhesive straps and cold-water dressings were applied. The patient was suffering severely from shock, and it was several hours before reaction could be established. The case progressed well, and the boy recovered with perfect motion of the joint. He was fed well from the date of the accident to the end of treatment, and was stimulated for a number of days. The doctor believed that to this, more than to anything else, the favorable result was due. He had known several such cases die in the Massachusetts General Hospital within the last four or five years; and he believed it conceded that they had erred in not sustaining the patients sufficiently during the first fortnight.

Dr. GARRISH, of New York, related a case of nævus maternus over the anterior fontanelle. It was noteworthy only from its

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