among even so many worthy investigators Pasteur, as yet, stands head and shoulder above them all. Although the views of de la Tour, of Schwann and of Schulze were confirmed by several trustworthy investigators yet they made no marked impression, remaining the property solely of a few skilled investigators. It was Pasteur who first conclusively convinced the scientific world. Because of his precision and accuracy his experiments remain, even to day, unimpugned and above reproach. Pasteur's observations first resulted in facts of value-especially from a surgical and medical stand point. The practical application has saved the vine. yards of France from the dreaded depredations of phylloxera and has prevented and eradicated many parasitic diseases of both plant and animal life. But most of all they enabled Lister to formulate his immortal system of antiseptic surgery which has saved many useful lives. He first claimed that the processes of fermentation, decomposition, suppuration and the occurrence of contagious diseases were all due to the presence of micro-organisms-which principle he called contagium animatum. He also claimed that the processes which were due to the access, proliferation and multiplication of germs might be prevented by securing non-access of such germs. He was not the first nor was he the only one to ob serve the facts embodied in his contagium animatum or infection by an organism, for the belief in its rudiment ary state can be traced back to the year 1700 when the question was warmly discussed under the subject of spontaneous generation. Nevertheless his work, his investigations, his discoveries prepared and paved the way for the deductions of Lister who himself acknowl edges his indebtedness to Pasteur and his researches. In 1874 Spencer Wells, before the British Medical Association, pointed out the fact that the recent experiments of Pasteur had "all a very important bearing upon the development of purulent inflammation and the whole class of diseases most fatal in hospitals and other overcrowded places." He said further: "Their in fluence (germs) on the propagation of epidemic and contagious diseases has yet to be made out." Strange to say, though he recognized and admitted the effect and power of the organisms, he introduced no systematic method of combating them or of eliminating their injurious effects and yet in his own particular and peculiar sphere of practice has antiseptic surgery been most conspicuous and complete in its triumph. As we observe, the time is now ripe, medical theory and practice is ready to receive the truths of a new and doughty champion whose work prior to this time would doubtless have fallen upon sterile and unfruitful soil. The time has come when the efforts are to be crystallized, or the blossom to merge into the tangible fruit. Only at this particular time would his advent have been successful and at the precise moment of the need of his trenchant blade Joseph Lister steps into the arena. The setting of the bones, the manner and use of ex tension, splints, rollers and plasters to adhere to the skin, the making a suitable bed and keeping it properly, consideration of the general treatment of the patient as well as the local treatment. Many surgeons, and of these some good ones, use the immovable plaster-of Paris or a similar material as a dressing from first to last in fractures. In simple fractures where there is but little swelling, and where the case is handy to all, no doubt much trouble is saved in the use of an immovable dressing. If there is much swelling or a liability to it, it is safer, especially for the general practitioner, to use some other method. Many consider a thick layer of cotton next the skin a safeguard for retention. This is a great help, but when swelling subsides it will not prevent the broken parts from rattling! Some surgeons claim that with antisepsis, compound fractures may be encased in plaster, making provision for drainage. They use bracketed splints. Packard, of Philadelphia (In. Cy. Surgery vol. 4, pp. 245-251), does not like plaster as a primary dressing, because it prevents the necessary constant inspection of the limb. In comminuted fractures of the leg he uses a box and swings it, nor does he like bracketed splints, and thinks most practitioners had better rely on simpler means. Agnew (vol. 1, p. 737) says the proper time to use plaster is after the swelling has gone down. Suppose in place of plaster which is heavy and unwieldy and soon smeared with discharge in a comminuted fracture you use a Hodgen's splint or a swinging box. Your patient is far more comfortable, unless you swing the plaster splint, while you are enabled to see clean. You do not depend altogether on the thermothe contour of the limb and to keep the parts very clean. You do not depend altogether on the thermometer to tell you that pus is collecting at some point, nor go to the prodigious trouble of making a new bracketed splint in case a new abscess forms. One time I put one of those hinged plaster splints on a leg with a Pott's fracture. The man was middle aged and was fat and heavy. The leg swelled much under the splint, the pain became intolerable so that I had to take it off. Blisters appeared. This occurred in less than 24 hours. skill, though my medical neighbors whether skilful or The application of plaster requires much care and not are ready and eager to put it on at first. table college, uses plaster for all fractures, even of the A young doctor in our vicinity, a graduate of a repu ribs and clavicle! In another town a surgeon dressed a broken leg with plaster. It seemed to him to be doing well, though he could'nt see the contour of the leg. When the dressing was taken off the leg was very crooked. In another case of fracture of the shaft of the femur a doctor applied a thick plaster casing to the thigh only. The splint reached from patella to groin, nor was there even a roller from toes to knee. doctors would not do this, saying that he was all right and must endure the pain. In a short time gangrene appeared in the hand, and when I saw him an amputa. tion had to be done. I do not think pain can always be relieved by redressing but it is safer to do it. I have had patients who complained very much until a new dressing was applied and where I could see no reason I have just seen a man, who eight months ago broke for their complaints;on the other hand I have found too his femur in middle one-third. He goes on a crutch much pressure on some spot which, being removed, and cannot now bear his weight on his foot. He has produced comfort. In any case where there is at first an enormous callus and a shortening of two and a half great inflammation swelling and pain, it is better to inches! He was encased in plaster by two reputable support the limb on a pillow, or a padded board or on doctors who waited thirty-five days before they removed strips of cloth attached to iron rods so that lotions or the casing! cooling irrigations can be used. In another case and another town a lad had a simple fracture of the humerus. Two doctors attended him. They applied a plaster casing from hand to shoulder. But great pain settled in the arm, the fingers became swollen, cold, and purple. The doctors took off the dressing. I, in a fracture of the radius near the wrist where a man had fallen several feet on his hand I dressed it as usual in padded boards but not tightly drawn together. The man complained so much of pain that I took off the dressing and laid the forearm on a board for about a week and applied cooling lotions. I then redressed it with splints, and he got along without pain and got well. A farmer, over 60 years of age was kicked by a Stimson (Fractures) declares that a first or primary plaster dressing must be seen frequently in the first forty hours. In a hospital with a resident surgeon horse, producing a compound fracture in the lower third that might do, but it is too risky and dangerous for a general practitioner. Almost a lifetime of success with plaster will not condone one case of gangrene or bad sloughing. I do not think it good practice to use plaster as primary dressing in the humerus, femur, or forearm; I think the weight of authorities is against it. of the humerus. In a day or two erysipelas attacked the wound so that I could not apply snug dressings. When the erysipelas was gone I put on a dressing of plaster rubbed in cheese cloth. This casing extended from the hand to the shoulder. I cut a door for the exit of pus and was well pleased for a few days, but I could not keep the pus from seeping under the dressing; I could not keep it from stinking. My patient complained so much of the bad smell that I redressed it and varnished it with paraffine. But in spite of all my pains, I could not keep it sweet, and abandoned the plaster for an anterior angular splint that allowed the arm to be easily and thoroughly cleansed. As I said above, this man had an attack of erysipelas. Malgaigne (St mson Fractures, p. 204) says erysipelas I consider that there is a great difference in the gravity of even simple fractures. A simple fracture of the shaft of a bone, transverse and caused by a minimum of violence may be followed by but little swelling and inflammation. A cure is readily affected and there is little or no attendant pain. On the other hand, a simple fracture may be oblique or splintered. There may be a subcutaneous tearing of the tissues and blood vessels. Swelling and inflammation are necessary results. A joint may be invaded and arthritis induced; generally retards the solidification of the callus. It Anchylosis may follow, ostitis may follow, then necrosis; or there may be suppuration of the joint. Stimson (Fractures, p. 226) says that a "prominent German surgeon has expressed the view that a fracture is now to be considered rather as an inconvenience than as a misfortune," Stimson thinks this too sweeping a remark and that not only a compound fracture but a simp.e one may endanger life; that crippling may follow for a considerable period and may be permanent. was so in this case. Long after the wound healed the fragments remained ununited. I despaired of getting a useful arm. I gave him tonics and had him exercise by walking in the open air every day. On account of the stiffness of the elbow he had to keep the arm steady with an angular splint. I used passive motion for wrist and fingers. After several months the fragments united and he had a fairly useful arm with considerable motion of the elbow. This man had extraordinary confidence, patience and courage, or he could not have got so good a cure. Doctors are sometimes to blame; they may be pig headed, as in the following case. A vigorous young man had a simple fracture of the shaft of the humerus A strong man, about 35 years old, fell down a mining A couple of doctors dressed the arm, binding it up shaft over 100 feet. In his descent he felt that he with some kind of stiff splints. In some cases perhaps would strike head first. So he put out his arms hoping their method of treatment would have done well enough, to reach the wall of the shaft. He succeeded and turned but it happened in this case that one of the fragments a sommersault before alighting. He fell on his left was pressed against the vessels and nerves of the arm causing swelling and terrible pain. foot, side and arm. There was a compound fracture of the left humerus, the lower third. The lower fragment The man begged to have his arm redressed. The or fragments were comminuted, one of the condyles was torn from the elbow joint. The sharp ends of the fragments had torn larger holes through the muscles and skin posteriorly. The periosteum was stripped off the sharp ends. I turned out these ends and sawed off little pieces so the bones would not pierce the flesh at every movement of the arm The vessels and nerves were uninjured. Dressing antiseptically, I flexed the arm slightly and laid it in a bran box, but I found too much movement with this method and so suspended it on iron rods and pieces of cloth on the principle of a Hodgen's splint, getting a little extension. In ten days I was able to flex the arm to a right angle and put on an anterior tin splint reaching from shoulder to hand and sling the arm. In a little over two months the fragments united. After a certain time I used passive motion to obtain some pronation and supination and flexion of wrist and fingers. Finally the elbow joint was slightly movable with hope of more extensive motion. The great shock and traumatic fever following this terrible fall were withstood by wonderful vitality; while a minimum tension of the wounds and free drainage conspired to cure. The encasement of limbs with plaster need have but a limited use. A distinguished surgeon of Boston lately lectured on the treatment of fractures (B. M. and Surg. Jour. Aug. 10, 1893) of the lower extremities. He does not use plaster for femur at all but a Bucks apparatus for extension, and long outside splint to keep leg and foot straight in fracture of shaft of femur. In upper third he used a double inclined plane. In lower third he uses a padded beam splint as an adjuvant to extension In fractures of tibia and fibula he uses plaster. In a Potts fracture a posterior plaster splint. Dr. Roberts of Philadelphia (Med. News July 8, 1893) says there is no question but that the best splints are those moulded to the limb after reduction of the frac ture. He makes them of cheese cloth dipped in plas`ter, or paste, or glue, or uses felt, or gutta percha softened by hot water. Roberts prefers plaster because it sets so quickly. He makes lateral, anterior or pos terior splints of any shape and holds them in place with a roller bandage. He stiffens a splint with strips of metal. I have no objection to this use of plaster. It is cheap and handy, yet I think a splint of binders' board, felt or leather is stronger, lighter and not so apt to break as plaster. Southam (in Treves Surgery Manual, vol. 2. p. 9) says the advantage of splints is that the seat of injury can be seen, whereas a stiff bandage conceals it; such a bandage must be interrupted or slit up its whole length after it has set so as to allow its removal from time to time. I have recently treated a simple fracture of the lower third of the right leg in a man about 60 years old who has extensive epithelioma of the face. At the first dressing I used felt and found that it must be moulded to the parts very quickly as it sets very rapidly. I have found as soon as swelling commences to subside the least bit that broad strips of adhesive plaster applied over the roller keep all the parts more steady than with the roller alone. In case you do not wish to redress your case tighten these adhesive strips by pulling them off and then putting back in same place a little more snugly. A roller yields a little, while ad hesive plaster does not. In this case I kept on the felt ten days. My patient was unruly and whined a great deal, so that I was never certain whether he told the truth about this or that pain. I now felt safe in putting on a hinged plaster dressing that I could readily open. After three weeks more I applied a crinolin roller rubbed in plaster. This sort is the cleanest, nicest, toughest and lightest of all the kinds of plaster-dressing I know of. The only drawback to it is, that it takes over a day to harden, so that you must support it by temporary splints for that time just as you would a starched roller. Speaking of patients being unruly you will read in text books that you must demand obedience or else throw up the case. Now I doubt very much whether a doctor can legally throw up a case because it is troublesome and unruly, unless the patient desires it. It is as much ones duty to govern these cases as it is one of hysteria. One ought, however, to he very frank with his patient, giving warning as to bad results, and should wisely protect himself by having an honorable consultant. To go back to my case: In six weeks the bones were stiff enongh for him to go on crutches allowing the leg to swing. In spite of strenuous direction he bore some weight on his foot. The callus became painful and hot to the touch and I was sent for. He denied everything, but fortunately, his wife knew what he did and gave him away to me. Elevation of the leg with quiet in bed and a cooling lotion cured him. He is now well and can walk. The epithelioma did not defer the union of the bones. There are variously modified physiological processes whose sum is inflammation with disturbance of function. In inflammation there is an increased porosity of the vessel walls so that there is a filtra ion of solids as well as liquids; this exudation is the most essential element of swelling; its origin and fate is the most important feature of the pathology of inflammation (Pepper's System, vol. 1, p. 42, etc.). The degree of inflammation in fractures varies as well as the duration. The theory of an infection does not explain joint affections and such like in simple fractures. It was simply luck for me to see this case when hurt. I have no doubt he would have thrown all the blame on me if he had got well with a crooked arm. of having any trouble with the case. In spite however days as there was no pain or swelling, I applied a of faithful attention he suffered with pain and many hinged plaster dressing. He now did well. days or rather nights with spasms of the femoral mus cles, loss of sleep, and more or less fever. I used ex tension with leg on a Volkman's sliding rest and coap. tation splints. I increased the weight, but again had to lessen it as he complained so much. I only gave opiates at night, and used the most careful diet. In twenty-eight days the callus was somewhat firm and I applied a strong crinoline plaster roller, reinforced with strips of tin, from toes to waist. He was comfortable in this dressing and had more liberty in his - bed. I kept this on a month. When I took it off, and raised the leg off the bed the broken place would bleed There was a larger ensheathing callus than usual and it was quite painful to the touch and when he moved. There was but little shortening and the knee was not twisted. I did not reapply plaster. I had a splint made of sole leather reaching from the ankle to the waist and reinforced along outside with a strip of steel fashioning it like unto a Thomas splint used in cases of morbus coxarius. I wet the leather and strapped it on; when dry it was snug, light, strong and comfortable. It was easily taken off every day so that the limb could be rubbed, as there was edema of the limb, a harsh branny skin and flabby muscles. This case also exemplifies the truth of what Packard (Cy. S. Vol.2, p. 56) says about the comfort felt in a prop erly dressed limb. Comfort is not a sign that a proper. dressing has been applied. Authorities warn us to be prudent in our prognosis, and to positively insist on obedience on the part of the patient; also to truthfully tell what must be expected as to lameness and deformity. I recall three cases where I had crooked legs. One, a boy of fifteen, tall for his age was violently struck on the leg just above the ankle by a hose cart. The fracture was simple. I made two attempts at intervals of a few days to pull and bend the leg right. Both times chloroform was used. But I could not succeed. At the first attempt I had one doctor as an assistent at the second, two assistant doctors. This must have been a toothed fracture. Stimson says (Fractures, p. 157) complete reduction is sometimes impossible and that extreme force must not be used. In the second case a man of middle age had his arm torn off and a leg broken by a revolving set screw. I got the leg right and could keep it so by snug ban. I made him wear the splint, though not buckled daging but the man would loosen it in my absence. He tightly, for a while at night. We put him on a reclining made solemn promises to continually break them. Could chair, gave him tonics and in time got him on crutches. I abandon such a poor devil? He got well but his leg was crooked! He however never seemed to care at all. The callus slowly grew solid but it was seven or eight months before he could bear his weight on it. A low He was light and spry too. form of inflammation must have existed in the large callus preventing the usual consolidation. In the outcome of this case I consider myself very lucky. The man was patient and tried to bear up under his misfortune. Under the strenuous treatment of our fathers, this man would have had bedsores, ulceration of the peri neum, sloughing of the heel and possibly a false joint in his femur. In a third case there was a compound fracture near the ankle. The foot was suspended by adhesive plaster to the lower end of a fracture box. The man would not lie on his back and so twisted the knee and upper frag ment out of line with the feet. would be pigeon toed. He declared that it was imposIn readjusting him I repeatedly warned him that he sible for him to lie all the time on his back and he did'nt! When he got well he growled for months; refused to It is much to the credit of surgeons that we have so pay, and made terrible threats of what he would do. many methods of treatment. As you may well believe this was very disagreeable to bear. Electric Treatment of Uterine Fibromata. -Bergonie and Boursier give a summary of the results obtained by them in the treatment of 100 cases of uterine fibromata by monopolar positive electrolysis, according to the practice of Apostoli. They conclude: 1. That the treatment of uterine fibroids by this method is principally a palliative-efficacious in hemorrhagic fibroids, 90 per cent. 2. That it acts favorably on the general condition, 79 per cent. Last winter, when it was very cold I dressed a fore arm that seemed only cracked as there was no dis placement. The man neglected me though he could walk without pain. I happened to meet him and found the splints loose and the forearm very much bent. He said he had been free from pain and did not think it ne4. That as regards the size of the tumors, its action. cessary to visit me. I straightened his arm and in two is rarely efficacious, 9 to 10 per cent.-Brit. Med Journ. 3. That it often diminishes pain, 50 per cent. EDITORIALS L. T. RIESMEYER, M.D., Editor. DEPARTMENT EDITORS: DR. F. J. LUTZ, General Surgery. Yearly Subscription, $3.50. TO CONTRIBUTORS and CORRESPONDENTS. All letters whether intended for publication or not must contain the writer's name and address, not necessarily for publication. No atten tion will be paid to anonymous communications. Secretaries of medical societies will confer a favor by keeping us informed of the dates of the meeting of their respective societies, and of officers elected. Members of the profession who send us information of matters of general interest to our readers will be considered as doing them and us a favor, and we shall take pleasure in inserting the substance of such communications. All communications for the editor, and all books for review, should be addressed to the editor, 914 Locust street. All letters containing business communications or referring to the publication, subscription, or advertising department of this REVIEW, should be addressed to 914 Locust Street, St. Louis. Entered at the St. Louis Postoffice as Second-class Matter. Indications for Glycerin Clysmata. A New and Rapid Method of Anesthesia. William S. Magill, M D., of Chicago, Ill., writes in the Medical Record: As the first American to employ this method, it may be permitted me to invite the attention of American surgeons to this subject by this brief notice. The method was devised and developed, during the summer and fall of 1892, by Dr. Bourbon, anesthesist of Hospital Bichat, Dr. Hartman, acting surgeon, and my. self, and, since its introduction, is the preferred method in the surgical service of Professor Terrier, at Hopital Bichat. The modus operandi cannot be better described briefly than is done by Professor Terrier, in his communication of the subject to the Societe de Chirurgie of Paris, October 19, 1892. "The bromide of ethyl should be given in large doses. After pouring it abundantly (about three grammes) upon a folded towel, it is placed over the nose and mouth of the patient, who is told to breathe deeply. Generally at the second or third inhalation a slight agi tation appears, but at the fifth or sixth the anesthesia is complete, with total loss of consciousness. With the continuance of this anesthetic, in a moment, sometimes preceded by tonic contracture, the complete muscular resolution is accomplished, with congested face and dilated pupil. At this moment the towel saturated with ethyl bromide is rejected, and another upon which chloroform is poured, is substituted in its place, with out allowing any interruption of anesthesia in changing. The first dose of chloroform only should be fairly strong (one gramme). At this moment the operation may be commenced (about three-quarters to one minute since the commencement of the anesthesia). The facial congestion diminishes little by little, the pupillary dilatation gives place to contraction; in a word,the transition from the anesthesia of the bromide to that of chloroform is accomplished without the slightest interruption of the sleep. From this moment the continuance of the anesthesia is done in the ordinary way (chloroform in small and regular doses). The difference is simply that the complete anesthesia is immediate, instead of resultant of a period often long which is necessary in the process of chloroform anesthesia." [And more so in case of employment of ether] The injection of small quantities—one to four drachms —of glycerin into the rectum is a well known remedy for habitaal constipation due to sedentary habits and inappropriate food. Daily injections, repeated at the same time of the day will gradually bring about a regu lar action of the bowels, so that later on a daily evacu ation will take place without any injection. Glycerin clysmata are only efficacious when the rectum contains feces, when they will bring about a physiological evac uation, i. e., there will be no diarrheal stools produced. After the evacuation of the rectum the contents of the The matter in brackets is not a part of Professor sigmoid flexure and the large bowel are succes Terrier's communication, but inserted as explanatory. sively evacuated. The injections are ineffective It will be seen that the duration of the anesthesia where constipation is due to febrile diseases, to may be prolonged at the will of the operator. Exaff ctions of the brain and spinal cord, or to a me perience has demonstrated that by this process a re chanical obstruction in the intestinal circulation, yet, markably small quantity of anesthetic agents suffices for according to Anacker (Deut. Med. Woch) they are not complete and protracted unconsciousness, and that by absolutely contraindicated in these latter cases and he reason of the smallness of the quantity used, the awakrecommends them particularly in irreducible hernias as ening of the patient almost immediately follows the the very first procedure. The same author has also cessation of administering the chloroform. noticed an increased number and intensity of labor I have performed a complete anesthesia for ovarioto pains after glycerin injections, so that they seem par- my by Professor Terrier, with the administration of ticularly indicated as an evacuant of the bowel before three grammes of ethyl bromide and twelve grammes or during labor. of chloroform, recovery from sleep immediate, and no |