usual and often limited; vertigo is frequent; convulsions are common; coma is frequent; vomiting is common and peculiar, expressive and incoerscible; optic neuritis may be found in a large number of cases; the cortical lesion giving rise to peripheral symptoms or tremore, abscesses, traumatism, inflamation, hemorrhage and Jacksonian epilepsy. Their differentiation is often apparent at a glance; sometimes they may be difficult to diagnose. Tumors are slow and insiduous. The brain, as you know is tolerant of slow pressure and may accommodate itself to considerable misplacement, when slowly produced.

Abscesses are preceeded by chills and fever and there may be purulent discharges from the nose and ears; pyemic symptoms may be present, usually rapid in development, accompanied by subnormal temperature.

The most important thing we should observe in operation upon the cranium is the locality. We must observe two large and important fissures, if we are not thoroughly familiar with these important landmarks, we might make a fatal mistake to ourselves and our patient. Remember the fissure of Rolando dividing the two ascending convolutions and the fissure of Sylvius that divides the temporal from the frontal and parietal lobes. These are important landmarks in cerebral localization.

Now, gentlemen, Ithink I have trespassed upon your valuable time too long already, though I hope you will bear with me a short time longer as I am anxious to report a case of cerebral surgery.

About two years ago, a stout negro that had been shot with a thirty-eight calibre pistol, was brought to my office, thought to have received a fatal shot. He was partially conscious. I was satisfied I could not operate un

less he was perfectly quiet, though I disliked to give him an aneasthetic under the circumstances, I took the risk and did so. After being aneasthetized, I shaved his hair. Remember the bullet entered just at the root of the hair, to the right of the median line. I made a cross incision. dissected the flaps back carefully and found that the bones were badly broken; a piece of bone the size of a twentyfive cent piece had been driven by the bullet and was partially imbedded in the brain substance. After extracting the bone, I introduced my finger, locating the bullet, and of course, removing it. Though the bullet had not penetrated the brain proper, yet it had lacerated the membranes. I did not interfere with the membrane at all, but left them for nature to restore. After raising the depressed bones and trimming as nicely as possible, I took a syringe and washed out the cavity with hot water until the hemorrhage had subsided. I used as drainage tubes, hair from a horse's tale, of course, first submerging my device in hot carbolized water; then stitching my flaps back carefully, pouring fresh turpentine on the scalp, placed a bandage around the head and put him to bed with instructions. Gave him 10 grains calomel; grain one-eighth ipecac; grains five bi. cabb. soda. His nourishment consisted of soups, broth, milk, etc. He had fever for several days. Gave him nothing but anti-pyretics. Within three weeks he was able to drive a wagon.

J. N. D. CLOUD, M. D.,

Newnansville, Fla.

On the Treatment of Fractures of the Fore Arm with
Special Consideration of Colle's and Barton's Frac-
tures.

BY W. L. HOUGHTEN, M. D.,

Cocoa, Florida.

For meeting Florida State Medical Association at Palatka
April, 1897.

Mr. President and Gentlemen:

I take pleasure in submitting for your consideration
a brief paper on "The Treatment of Fractures of the Fore
Arm with Special Consideration of Colle's and Barton's
Fractures."

The question of the treatment of fractures will al-
ways command our attention. In proportion to other
serious lesions, accidental in character, fractures take first
place. They are of frequent occurrence in the practice
of general practitioners and we should study to treat them
skillfully. It is of the highest importance to secure to
the patient a useful limb, and to save ourselves from law
suits for damages.

I was lead to write on this particular subject by a
remark made by a prominent surgeon of this State to the
effect that "if he was going toward his office and should
see a man going in ahead of him with a fracture of the
fore arm he would feel like turning around and going

the other way;" and not this remark alone, but only a few weeks ago I was called on to remedy a deformity caused by a Colle's fracture which had been treated by a physician as a sprained wrist, a misfortune that should not have occurred. Certainly we are all liable to error and sometimes our best lessons are from the mistakes of others.

The two fractures to which I shall refer-Colle's and Barton's are described in nearly all the works on surgery. Colle's fracture first described by Colle's in the Edin Medical and Surgery Journal 1814, and Barton's by Barton of Philadelphia in 1838. In the former (Colle's) the fracture is usually transverse generally involving the radius alone sometimes the ulna as well and its most common seat is from three-fourths of an inch to an inch above the radio-carpal articulation.

In Barton's fracture the fragment is broken off from the margin of the articular surface of the radius, the fracture extending through the cartilaginous face of the bone and into the joint.

The character of the deformity in both cases is the same, and the treatment identical, but the prognosis as to complete restoration of the motions of the radio-carpal articulation is probably less favorable in Barton's than in Colle's fracture because inflammation of the joint is likely to be more severe in the former than the latter. (Of course where the line of fracture runs into the joints or synovial pockets the danger is increased.

This incomplete recovery is an important matter for consideration in the treatment of these fractures.

Not only do we often find marked deformity, but limited use of the hands and wrist with constant pain. These

accidents are generally caused by falls, the patient throwing the hands either forward or backward to catch ones self; consequently in addition to the ordinary fracture we frequently have impaction of the fragments, and it is sometimes a serious question-especially in aged personswhether or not we shall use violence in restoring the parts to a normal position?

I do not consider it necessary before this intelligent body of physicians to refer in detail to the many forms of splints and apparatus used for the relief of these fractures. They They are valuable in proportion to the ingenuity of the surgeon applying them, and many are good; but the greater question for us to decide is "whether or not we shall use passive motion as a preventive of anchylosis.

Hamilton-a great authority-advocated passive motion on the seventh day. Many eminent surgeons at the present time advocate passive motion differing somewhat as to the time it should be begun. My opinion, based however on rather limited experience, is that passive motion is of no advantage, and may do harm.

If the joint structure is not invaded perfect rest is what is required for satisfactory union of the fragments, and if the joint is invaded motion must provoke increased secretion of callous material whereas nothing is gained toward repair.

An argument recently advanced on the ambulatory treatment of fractures is that the motion favors increased secretion of callous. We all know that excessive secretion of callous thrown out about a joint is anything but desirable, and in my opinion favors what we try to remedy.

If for instance callous material has forced itself