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a flannel-roller bandage is carefully applied from the foot to the
waist, finishing the turns around the upper part of the waist by
the spica of the groin. A number of bandages of crinoline,
with dry plaster rubbed in the meshes of the cloth, have been
allowed to soak for a few minutes in a vessel of water. The
foot of the injured side is grasped by one assistant and extension
in the axis of the limb made, while counter extension is made by
another assistant grasping the patient under the arms.
A plas-
ter bandage is now applied to the foot and ankle, and from that
point carried spirally up the limb over the thigh, and finished
by oblique turns around the abdomen and upper part of the thigh.
A number of bandages are thus used until the requisite degree
of thickness has been obtained, after which a thick, watery mix-
ture of plaster is smeared over the entire dressing so as to
strenghen the plaster casing. Extension is kept up until the
plaster sets sufficiently, when the patient is removed to his ward.
An objection to this method of treating fractures of the femur
is that as reduction of the swelling takes place the limb becomes
loose in the casing and the extension is lost. Besides, deformity
from angular displacement may occur. Another objection is that
the seat of fracture, not being exposed to view, mischief may go
on for some time undetected.

[The patient was exhibited to the class a week afterward, and the bandage was seen to be perfect. The patient was entirely comfortable and everything seemed to be progressing favorably to recovery.]


Samuel T., colored, æt. 13, was admitted to City Hospital yesterday with a simple fracture of the right leg, caused by a horse he was riding falling upon him. The limb, between the knee and ankle, is very much swollen, being nearly twice the size of the sound leg. Every motion or handling of the part causes him to cry out with pain. There is no deformity present, though preternatural motion at the site of the fracture at the middle of the tibia can be made out. The depression at the point of fracture can be detected by passing the hand over the tibial spine. On grasping the limb with one hand above the other below the fracture characteristic, crepitation can be elicted.

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So in the present case the special signs of fracture, crepitus, mobility and deformity can be easily made out. Of the common signs of fracture, pain, swelling and ecchymosis all are present. Of pain, it is important to note that it is always accentuated at the point of fracture. The fracture, being due to direct violence, the line of fracture is nearly transverse. Only the tibia is fractured, as there is present no shortening of the limb. Fractures of the leg constitutes one of the most frequent accidents with which the practitioner has to deal-when simple good results may be obtained with any of the numerous splints devised for this variety of injury.

Great improvement in method of treatment of this fracture has been made. I prefer to treat all fractures of the leg with the plaster-of-Paris splints. I mean splints, not the plaster-ofParis bandage, which I advise my students against for reasons already given in the case of the fracture of the femur. I prefer the plaster splints on account of ease of application and removal, safety as regards mortification and the accuracy with which fragments are maintained in position by their use. I shall employ the splints in this case, and shall apply them as follows: Eight or ten thicknesses of gauze sewed together in the middle, so as to hold them together, are cut to fit each side of the leg from the knee to the sole of the foot. These are soaked in water, and wrung out and hung up on the back of a chair ready for use. Several bandages of crinolin, about four inches in width, are rolled and immersed in water. The limb is then covered with a flannel bandage, or, what is better, a stocking of proper length is drawn on the limb. A mixture of plaster is made in a saline solution, of the consistence of a poultice, in which the splints are placed and the plaster worked thoroughly in the meshes of the cloth. These splints are then first one and then the other applied to the sides of the leg and foot, taking care that the edges do not meet either in front or behind, and are held in place by the crinoline rollers already prepared. The plaster is allowed to set, and when it has dried thoroughly the connecting bandage may be cut in the interval between the edges in front, and the splints may be sprung open and the seat of fracture exposed. Afterwards the splints may be held in place with an ordinary domestic roller.

[The splints were put on in the manner described. The plaster set rapidly, and before the patient was removed to his ward had become firm and hard.]


This little colored girl, Annie C., æt. 10, an out-patient of the City Hospital, has an enlargement on the left side of the neck, just underneath the ear. The swelling is hard, closely attached to subjacent parts, irregularly globular, somewhat elastic to the touch, painless and giving rise to no inconvenienco save from its size, it having attained the dimensions of a small orange. The external jugular vein passes over its surface, and the indications are that it lies under the sterno-mastoid muscle.

The history of the growth is that it appeared some months ago as a very small lump, following an attack of measles, since which time it has been steadily growing larger. The little patient's health is good, and she suffers no pain from the swelling. There is no history of chills or fever complicating the trouble. The tumor is without doubt an enlarged cervical gland or lymphoma. It is doubtless of strumous origin, as most negroes, as you are aware, are of scrofulous habit. The gland may have broken down in its interior into pus, though there are no external manifestations of this being so. General treatment is of little avail towards the removal of enlarged glands when they have attained any great size, as in this case. In general glandular enlargements iodide of potash and cod-liver oil are always indicated, as they are in this case, to combat the strumous diathesis; but treatment in such cases as this should be radical. If the gland has degenerated, and is hollowed out by an abscess in its interior, incision into it should be made, the cavity thoroughly curetted and then packed with iodoform gauze, and healing by granulation promoted. If the gland is intact, excision of the enlarged gland in its entirity should be done and the wound closed, as after the removal of all tumors.

I shall be governed by the conditions of the growth in this case, removing the tumor if it be not the subject of an abscess, laying the abscess open if it be present, afterward curetting the cavity and packing with gauze.

[Incision of about three inches was made in the direction of

the fibres of the sterno-mastoid muscle and that muscle divided in its length to reach the gland. Efforts at removing it caused it to break down, so that after removing with knife and fingers as much of the degenerated gland as possible, the curette was used and its interior hulled out as thoroughly as possible. Iodoform gauze was used to pack the cavity, and the wound left to heal by granulation.]

Selected Articles.


There is a current story illustrative of an unfortunately common phase of human nature, which runs thus: A judge before whom two malefactors were presented for sentence deemed them each deserving one hundred lashes, and a question arose who was to administer the whipping. The judge, understanding human nature pretty well, said to the jailer, "Strip these men, furnish each of them with a good whip, tell them to give the prescribed number of lashes to each other, and I'll guarantee it will be well done." So the jailer did as he was ordered, and the men with glee and complete acquiescence in the judge's apparent leniency commenced to carry out the sentence of the court by giving each other alternately a light tap of the whip. After a little of this play one of the prisoners thought the other had given him an unnecessarily sharp cut, and responded with what he considered an equivalent, creating in the other the same apparent cause for complaint. Thus a desire of mutual revenge was engendered, and it became necessary for the jailer to call for assistance to prevent the two men from going beyond the judgement of the court. In like manner law and crime become vengeful, and the result is that in many cases both suffer unnecessarily. Years ago law and lunacy whipped each other more severely than law and crime do to-day, but now law does not return the imaginary blow from the insane, and all the teachings of the present time

*The Inaugural Address delivered before the Society of Medical Jurisprudence, January 11, 1897, by E. F, Brush, M.D., Mt. Vernon, New York.

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