stant activity of the secretions, and last but not least, an almost superabundance of good, restful sleep.

As remedial agents, iron in one form or another and iodine are, I think, the ideal remedies.

The syrup of the iodine of iron has long been popular.

After over seventeen years of observation of these cases, comparing the results obtained by the use of the above and the various hypophosphites, I have arrived at the conclusion that Gardner's Syrup of Hydriodic Acid is theoretically and practically the best remedy within our reach.

I heartily accept and emphasize the tributes of praise that have already been extended to the Gardner Hydriodic Syrup by Drs. J. B. Oliver of Boston, Burral of New York, Shoemaker of Philadelphia, Wile of Connecticut, and other eminent authorities.

"One fluid ounce of this syrup contains 6.66 grains of iodine converted into hydriodic acid. Its action will be found more efficient in equivalent doses than iodide of potassium, while it produces none of the unpleasant effects of the latter, such as loss of appetite, soreness in the fauces, nausea, etc. Physicians who use iodide of potassium largely will appreciate this, because it is more active than iodide of potassium, and should be given in smaller relative doses, thus not interfering with digestion. Its effect on mucous surfaces is more marked than with other forms of iodine, while it is effective in smaller relative proportions, and when required, it is so free from irritant action that it may be given to the youngest infant.”

Children whose sense of taste has been developed take to it readily, and this is a matter of no small import. Enlarged glands which have been a blemish and discomfort for years to their possessor will melt away rapidly under the use of nature's divine quintette, viz.: sunshine, fresh air, abundant sleep, good food, muscular activity, aided and abetted by proper stimulation of the secretory, glandular system, which can be best accomplished by the remedy to which I have referred, viz. : Gardner's Syrup of Hydriodic Acid.

Gunshot Fractures of the Femur.*

It would be out of place to review the authorities, or event the treatment of gunshot fractures of the femur by leading surgeons, in this article. During our civil war the average shortening was two inches and thirty-one hundredths of an inch. Certainly better results should be obtained, and with appliances which can at all times be made in camps and farmhouses. I hope to be able to present such a plan, and trust that its simplicity and cheapness will be arguments in its favor. I will not now discuss the class of cases requiring amputation or those in which a more conservative course should be pursued, but will propose the use of more effectual treatment.

The appliances which I use can be well made for a dollar and eighty cents, exclusive of a small air pillow required to elevate the knee slightly; and this pillow will last during the treatment of many cases. With the knee slightly elevated the limb is in an easy position, and yet not so crooked as to lose any advantage, so far as extension and counter-extension are concerned, as compared with the straight position.

I

Dr. Gurdon Buck's extension is sufficient in all cases. have used with his appliances a thin board about nine inches long, to go between Buck's thin block and the foot, to support the foot, and to keep the heel above the bed; also instead of a roller, a many-tailed bandage with the ends tied together over a strip of leather, in front of the leg, to retain the adhesive plaster securely applied. Coaptation is secured by wooden splints about three-fourths of an inch wide, rounded and smoothed next the skin. These splints should be kept at equal distances from each other by tacking tapes on their outside. Where two splints are near a wound, their edges should be cut out so as to avoid pressure on the wound, and to allow the wound to be washed without removing the splints. Strips of cloth should be tied around these splints. They sink into the flesh partly, and act on the bone better than a splint with an unbroken smooth surface. When it is necessary to dress the wounds, the air pillow should be inflated a little more, the strips of cloth removed from the splints except at

*Read at the meeting of the Southern Surgical and Gynecological Association, Nashville, Nov. 12, 1889, by John Brownrigg, M.D., of Columbus, Miss.

their ends, a rubber cloth placed under the thigh, and the wounds bathed without relaxing the pressure of the splints. When spicule of bone cause irritation, it is sometimes necessary to attach to the extending cord a twenty-five pound weight. This necessitates sufficient counter-extension. The want of this has been the principal cause of bad results. The perineal band has been relied on by many surgeons. This presses on a few inches of tender skin, and has been condemned by high authority. In the counter-extension appliance described below, the pressure is on about five hundred inches of tough skin and embraces in its grasp the bony framework of the chest.

It is composed of a jacket made of strong cotton cloth, to fit the form, from below the lower margin of the ribs, to near the axillæ. A plait on either side about three inches long will make it fit very well. A piece of bootmaker's strap, or some substitute for it, should be sewed along both its edges to the jacket, just above the lower margin, on its outside; so that a buckle on one end of the strap will enable one to buckle the strap tightly around the waist, just below the margin of the ribs. Tapes are sewed to the edges of the jacket in front, about an inch apart, to lace it. This is better than a cord and eyelet holes, as the patient may loosen them when he wishes to do so, until he gets accustomed to the jacket.

Straps of cotton cloth doubled, or other material about an inch wide, should be sewed to the upper edge of the jacket, one in front and one behind each shoulder, about half-way from the outside of the shoulder to the neck. They should be long enough to reach the posts at the head of the bed. They should be fastened at an elevation, and be wide enough apart to allow free motion of the head from side to side.

This jacket will afford any amount of counter-extension that may be required. Twenty-five pounds until the muscles become relaxed, then fifteen, and the last two weeks ten pounds will answer in powerful subjects, even where there is muscular spasm. The patient may complain at first, but if it is removed he will ask for it in a few hours. I have used it thirteen times in different cases of fractures of the femur,

and in one case of gunshot fracture, in which there was considerable comminution, without any shortening. The effectiveness of this jacket depends upon keeping the band at its lower margin buckled tight below the margin of the ribs, and if it stretches so as to slip up at first, it is necessary to loosen the jacket and its fastenings to the bed-posts, and to reapply it.

A patient with a fractured femur always tries to move his hips away from the injured side. This is prevented by a band around the hips, secured to a board at the side of the bed, resting on the floor, and the upper end about a foot higher than the bed, so that the band will be secured to it at an elevation. The extending cord, and counter-extending bands, being also secured at an elevation, the patient rests lightly on the bed, and bed-sores are prevented.

It is not necessary to have a sectional mattress, as the раtient can support himself on the foot of his well leg and his elbows, so that a bed-pan can be placed under him, without relaxing the extension or counter-extension, or interfering with coaptation, or bending the bone at the point of fracture. I was not convinced of this until after frequent careful observations. These appliances can therefore be used with the patient lying on a bed-sack filled with straw, on the ground in a tent, with two stakes driven in the ground near the head of his bed, and two forks at the foot, with a smooth round stick across the forks for a roller, over which the extending cord is placed. With a piece of cloth, a cord, an ordinary spool, or a round stick in two forks for a roller, a buckle and strap, a piece of moleskin or rubber adhesive plaster, and an air pillow or a good substitute for it, all these appliances can be made. Anything except an air pillow gets hard and interferes with the circulation, and requires constant watchfulness.

The opinion has prevailed that where there is much loss of bone with its periosteum, if too much hiatus is left between the ends of the broken bone, it will not unite. I am convinced that this is not the case. I have often observed in cases of that nature, where the wound was open so as to admit of it, that when bone and flesh were growing together, during the restorative process, the bone was always a little in

advance of the flesh, and have seen four inches of bone restored in that way, the new bone growing from each broken end. until the ends met.

If there is sufficient extension and counter-extension, fragments of bone which are left in the wound do not cause much irritation.

After the bone has united securely, it is best to place the limb on a double inclined plane, until the bone is strong enough for the patient to sit up and use crutches. These can be made anywhere with some boards, a few tacks and a piece of leather.

Four years of service in the field, and in hospitals for the wounded, and the results of treatment then witnessed, have awakened an interest in the subject, which has prompted me ever since to attempt to obtain the great wants-viz., efficient counter-extension and such efficient coaptation as will admit of proper attention to the wounds.

Of sixteen femurs which united after gunshot fracture of the shaft, which are depicted in the Medical and Surgical History of the War, Part III, Surgical Volume, from preparations in the Army Medical Museum, eleven were shortened by overlapping of the broken ends. These silent witnesses admonish us to be prepared before another war.

Malaria.

In the Epidemiological Society (London), Sir Wm. Moore remarked it had been stated that malaria caused more human. misery than any other form of disease. Many theories had been originated as to the nature of malaria, but hitherto he considered we were ignorant of what malaria really was. He did not believe that the bacillus malaria of Crudeli and Klebs was the true malaria germ, any more than he admitted that the spores of algoid plants of the palmetto species, stigmatized as such years ago by Salisbury, was the true malaria germ. He mentioned what had been advanced by Klebs, Crudeli, Marchiafava, Lavaran, and others, on the subject of the bacillus malaria. But there were fatal objections. The bacillus had not been found everywhere where paroxysmal fevers prevailed. Neither was it reasonable to suppose that every