methods employed, in order to show that apparently nothing was left undone that might have assisted in securing the coveted union. Finally at his urgent solicitation, and because of the uselessness of the limb, I consented to make an operation for his relief, and for the purpose of making the last effort to secure union.

November 24th, 1888, in the amphitheatre of the Southern Medical College, in the presence of the class, and assisted by Drs. Hogan, Joye, Divine, and others, the operation was made.

Upon examination of the limb when the patient was anæsthetized, there was found a point about two inches above the wrist joint almost as movable as the joint itself, and extending through both bones. There was a decided thickening of the tissues over the radius, making an enlargement over the false union. I determined to cut down upon the seat of fracture, remove the fibrous tissue, and wire the fragments with silver wire. An incision four inches long was made along the external border of the radius, down to the bone. There was some deficiency in the lower end of the wound on account of protecting the radial nerve from injury. The upper end of the lower fragment was found projecting in a sharp point, and from this an oblique line of fracture passed downwards, and outwards towards the ulna. There was complete fibrous union, binding the fragments closely together, so that though it would permit of bending, there was no gliding motion between them. A strong cartilage knife was thrust between the fragments, and by pressing them apart, the fibrous tissue was divided with the point of the knife; then with chisel and ranguer the ends of the bone were bared until crepitus could be distinctly elicited by rubbing the fragments together. With the parts held in position, a Brainerd drill was passed through the projecting end of the lower fragment, and then obliquely through

the upper fragment. A silver wire was then passed through the opening and loosely twisted.

An incision was now made over the inner border of the ulna, corresponding with that on the radial side, and the fragments freed from fibrous tissue as in the radius. The patient was now taking the ether so badly, that I concluded not to drill the ulna, but to trust to the bones being held in position. The radial wire was now tightly twisted, and the end buried between the fragments upon removal of the constricting band that was only capillary oozing, so the wounds were immediately closed by cat gut suture, and rubber drainage tubes inserted. The line of fracture was now freely movable, and crepitus perfectly distinct.

During the entire operation antiseptic details were rigidly observed, with one deviation, which, in my opinion, yielded fortunate results.

The entire fore-arm was enveloped in a voluminous gauze dressing and over all a plaster of Paris bandage was applied, extending from the axilla to the tips of the fingers. The patient came from under the ether well, and going down to see him three hours later, I met him walking home.

On the following day the temperature was 102°, and there was considerable pain at the seat of the wound. There was some staining of the plaster by the blood that had oozed from the radial wound. In the course of two days the temperature fell to nearly normal, and so remained until the 12th day, when there was a sharp rise to 102°, and the patient informed me that through a break in the plaster he could see a drop of pus.

I removed the bandage and found the dressing over the radial wound saturated with pus, and the wound, on account of the yielding of the sutures, was gaping open and granulating. The ulna wound had united without suppuration, and was

solidly healed except at the drainage opening. Upon the back of the fore-arm, between radius and ulna, there was a fluctuating tumor, evidently of pus, but not connected with either wound. Thinking it would find an exit into the radial wound, I did not open it. Drainage tubes were removed and a plaster dressing applied over the gauze.

In spite of unfavorable condition of the radial wound, there was evidently considerable bony consolidation. Six days later the dressings were removed on account of the great pain, and the skin over the abscess on the back of the fore-arm was found tense and red. It was incised and discharged a large amount of pus and was drained with a tube. The radial wound was granulating prettily, and that on the ulna was solidly healed. As the consolidation was now so decided an anterior board splint was applied and worn for ten days, when the wounds being all healed, on the 25th of December, in my absence from the city, an excellent plaster dressing was applied for me by Dr. Hugh Hogan. On January 12th, this was removed and bony union seemed perfect. As a matter of precaution a Levis metallic splint was worn three weeks longer. At this writing (April 16th), upon examination there is absolutely solid union in the radius, with apparently slight bending of the ulna. The. man is following his trade as a moulder, and can do just as much manual labor as before the injury. The motions of pronation and supination are perfect. The only deficiency in the limb is the want of good motion in the extensor muscles of the thumb, which has existed ever since the injury. By some oversight a gentleman whose hands had not been cleansed was requested to examine the radial fragments, and to this I attribute the suppuration. That this suppuration was salutary I have no doubt, for without it I am confident sufficient bony material would not have been thrown out. To this I

attribute the weakness of the ulna, which healed in two dressings. Though such operations upon bone are numerous, the literature of the subject does not present many in this region, hence my apology for bringing this before you.

POST-NASAL CATARRH, ITS CAUSES, EFFECTS,

AND TREATMENT.

BY FRANK O. STOCKTON, M. D., ATLANTA, GA., LATE PROFESSOR OF LARYNGOLOGY, IN THE COLLEGE OF PHYSICIANS ANE SURGEONS OF CHICAGO, AND THE

CHICAGO POLICLINIC.

This disease so common in this country as to give it the name of American Catarrh, has been the Mecca of the Laryngologist, and many have been the so-called new cures discovered only to find that the old saw "one man's food is another's poison" still true.

So much has been written on this subject and by such able writers, that I must beg your indulgence in presenting the subject again.

Many theories have been presented as to the cause for this peculiar disease, but none of them are complete. Beverley Robinson suggests that it is due to a special constitutional tendency. For this to be true all Americans must have this tendency, and foreigners soon acquire it a rather peculiar hypothesis. Lennox Browne considers all patients suffering from this disease to be the subjects of a scrofulous diathesis. This again is faulty, for it is a well known fact that we have less scrofula here than in Europe. Sir Morrell MacKenzie attributes it to dust, sudden changes and high winds, all of which are present in this country, but which alone, it seems to me, could not produce such a universal disease as this. We must look further and seek something in which we differ from other races, and this we find in our mode of living. Ameri(113)

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