anxiety, or is the subject of such various opinion and practice as compound fractures of the femur. Unfortunately in a large number of cases the law of expediency must overrule all other considerations. However much opposed the surgeon may be to immediate amputation, as a rule, its propriety ceases to be a question when the patient must be transported many miles over execrable roads, before reaching the shelter of a hospital. I trust the plaster of Paris splint, as recommended by Dr. James Little, of New York, may be thoroughly tested, and hope it may overcome the painful difficulties of transporting cases of fracture. Many lives and limbs might be saved could the patient be transported without jarring and laceration and grinding of the tissues by the fragments of broken bone. The great majority of our best military surgeons are in favor of the conservative plan of treatment. The course I invariably adopted, and it met the approbation of my medical staff, was to give the patient the benefit of the doubt when there was any chance of saving the limb; never to make a primary thigh amputation where the chances that life (not the limb) could be saved by putting off the operation. It must be borne in mind that we often attempt to save a limb with little hope of its being ultimately useful where immediate amputation would almost surely prové fatal. After the battles of Chickamauga and Lookout Mountain, where the brave Eleventh, with Hooker at its head, bore our victorious banner above the clouds, a great many compound fractures of the femur came under my observation. At the end of three months most of these cases were doing well, and in quite a number there was a fair prospect of a moderately useful limb. It may be asked what kind of apparatus is best suited for cases. Machinery for fractured femur is as varied as the surgeons who may have to use it are numerous. The surgeon should bear in mind that his first care must be to save the patient's life; his second to save the patient's limb; his third to make him as good and useful a limb after the critical stage has been passed as the patient's constitution and his own skill will permit. For the rational treatment of compound fractures of the femur by gunshot wounds, it is quite impossible to lay down any but general rules, as almost every case requires a method adapted to its own. peculiarities. After removing any loose spicule of bone and

foreign matters, put the patient in the most comfortable position with sufficient dressings to steady the limb and control muscular action, and take care of the general system. To persist in the methods of Liston, Desault, Physic or Smith, will often be to lose your patient in trying to give him a good limb. In the early stages extension and counter-extension can be borne in but few cases. The many-tailed bandage to quiet muscular contractions; a few strips of paste-board, cushions to keep the limb from rolling, perhaps a long side splint, these are all that can be used with advantage during the first month; after this, if the patient is in a proper condition, an apparatns may be applied more with a view to steadiness and straightness than with the hope of securing the required length of limb, as only the most moderate extension I will be tolerated. Muscular action will almost always cause angular deformity, and there is no plan of treatment, that I know of, yet devised to overcome this difficulty. The flaccidity of the large muscles of the thigh by long continued pressure may be relieved by Smith's anterior splint, or some of its modifications, if not contra indicated by other considerations. When the bony union is sufficiently firm and suppuration not to profuse, the application of the starched bandage, nicely adjusted and fenestrated if necessary, will produce favorable results. When this has become firm, if the patient has sufficient strength, he may be given a pair of crutches, have the foot suspended in a sling and be allowed to go about. There is one more point in the treatment of these cases of which I wish to speak. For many months after such an injury as . has been described, there will be fistulous openings and sinuses indicating the presence of dead bone, and if a probe is introduced it comes into contact with sequestra in almost all directions. What is the best course to pursue in such cases? I answer unhesitatingly, let them alone. Any explorative operation will, in a great majority of cases, lead the surgeon upon shoals and quicksands on which he or his patient will be surely wrecked. The new bony material is thrown out in such large quantities and is so intimately interlaced with the splintered shaft, that to attempt the removal of dead bone by forceps, saw, and gouge, will endanger the breaking up of all boney union and leave the patient in a worse condition than when he first fell; may render amputation imperative and

sacrifice the life of the patient. Mild, astringent and stimulating injections may be necessary to moderate the discharge and conduce to cleanliness, but no further local treatment is indicated. The general condition of the patient should be carefully watched and his vital resources husbanded. Pain should be quieted by opium, fever allayed by cooling drinks and saline mixtures, the body should be sponged with alcohol and water; the flagging energies of life stimulated and sustained: Where there is a lack of bony material in the system the phosphates of lime and soda may be used with decided advantage. The dangerous complications that arise are irritative fever, erysipelas, gangrene, pyæmia, exhaustive suppuration, secondary hemorrhage, etc. These are the lions in the way and unfortunately for the poor patient are ever unchained. The surgeon must stand as a wary sentinel to challenge all these enemies, to repel them with vigor, and if possible, put them to flight. The treatment of these complications opens too wide a field for present discussion. I will limit myself to a few words on

that scourge of military hospitals, hospital gangrene.

The treatment of this disease has been made the subject of a monograph by Dr. Goldsmith of Louisville, Kentucky, in which he claims to be the author of the bromine treatment. This opinion was endorsed by Dr. Goldsmith's friends, Dr. Hammond, exSurgeon-General, and Dr. Wood, Assistant Surgeon-General, who recommended that the book and bromine should be added to the supply-table. I have no fault to find with the use of bromine as an adjuvant in this disease, but I do most decidedly objeet to an unfounded claim of pre-eminence and originality. As early as 1826 chloride of bromine entered largely into the composition of a salve or paste that was used as an escharotic in malignant ulcerations, and was brought into disrepute by the claims of quacks for the cure of cancer. Any one who will take the trouble to consult the Prussian Pharmacopeia will find that the idea thus given has been simply elaborated by Dr. Goldsmith. Moreover it is now quite generally conceded that bromine does not possess any specific influence over hospital gangrene, nor any special advantage over nitric acid or permaganate of potassa, and that it is the most painful of all escharotics. Hospital gangrene has long been recognized as a local disease, yet Dr. Goldsmith considers himself VOL. 5, NO. 4-18.

"very bold," (I use his own language) when he claims this as a new doctrine. It is highly communicable from one patient to another by basons, sponges, the agency of insects, etc. The first indication for its treatment is the removal of the decaying animal tissue as rapidly as disintegration takes place so as to prevent the infection of the sound tissue beneath the diseased. When a stump is attacked after amputation or the disease attacks a wound of the extremities the tepid water douche is one of the most efficient and comfortable applications. A most simple and useful contrivance for its administration is a tin vessel with the spout inverted like an old fashioned watering-pot; to the water may be added a solution of chlorine, tincture of bark or any gentle stimulant or disinfectant. When the gangrene occupies the track of a deep and tortuous wound the frequent injection of such solutions will be highly beneficial. Should the disease continue to extend after removing thoroughly all accessible dead and sloughing tissue make a free and thorough application of some escharotic; strong nitric acid is about as convenient, and its results quite as satisfactory, as any I have seen employed.

In comparing the mortality from hospital gangrene in our own army and that of the English army in the Crimea, it is seneless to attribute to any one remedy a difference for which there were so many adequate causes. The English army was stationary; where they first pitched their tents there they were compelled to remain till the close of the siege. The army of the United States has been an army of moving columns. The English army was poorly supplied with shelter, commissary and quarter-master's stores through a long winter, in a proverbially unhealthy climate, without fuel, except the few roots they could dig after a day or a night in the trenches, through rain, cold and mud; their scanty meal was thus prepared by the smoke they could extract from the smouldering of wet roots. Camp diarrhoea, dysentery and scorbutus were their scourges, and the hospitals were filled with cases of gangrene. The sick and wounded of the English army were thus huddled together in illy ventilated and filthy transports, and sent to hospital across the Black Sea. It is no wonder that men subjected to such influences died of hospital gangrene. A summary of the treatment of hospital gangrene would be, 1st, the

observance of all hygienic laws; 2d, full stimulation and support of the vital forces; 3d, the local application of detergents and disinfectants; 4th, cauterization by nitric acid, permanganate of potassa, bromine or the actual cautery.

ART. II.-Abstract of Proceedings of Buffalo Medical Association. TUESDAY EVENING, October 3d, 1865.

The Association met pursuant to adjournment, the President, Dr. Ring, in the chair. Present, Drs. Gay, Samo, Gould, Congar, Strong, Gleason, Little, Whitaker and Johnson.

DR. CONGAR presented the following paper:

Defective Power of Expression in a case of Hemiplegia of the right side. Mrs. T. M. Y., aged forty-one years, has had eight conceptions in twenty years of married life. She has always been of a hemorrhagic temperament, which has obliged her accoucheur to give ergot before the termination of each labor, except the first two, for the purpose of securing the permanent contraction of the uterus. At the third month of the last pregnancy after a journey of leisure in a private conveyance of three or four days, on May 8th, she dined heartily; and about an hour after dinner was suddenly attacked with a most profuse uterine hemorrhage; in about thirty minutes she was completely blanched, very restless, fainting even in the horizontal position, at the wrist pulseless, and completely hemiplegic on the right side, although the ovum was at this time found to have been thrown off, and the hemorrhage itself to have ceased. The patient was now found to have lost nearly all ability of psychical expression. Speech, as a voluntary articulation of words for the intended expression of wants, desires, feelings, thoughts and ideas, was gone. She appeared to understand her condition, the efforts of her attendants, the language addressed to her, and spoken in her hearing, but could give no assent, no denial; could manifest uo psychical function whatever. That she wanted something, was known, by increased restlessness, turning the head on the pillow, by a gaze of the eye, by voice in the larynx, and the use of the left upper and lower extremities; but what the thing desired was, could only be learned by trying the supply of the