THE TREATMENT of Compound FRACTURES.-Among the noteworthy papers read before the Surgical Section of the American Medical Association, at its recent meeting, was one by Dr. F. S. Dennis, on the treatment of compound fractures, in which are tabulated 144 cases, without a death from sepsis, and 100 cases without a death from any cause. Of the entire number 23 are of the skull, 3 of the femur, 58 of the bones of the leg, 12 of the humerus, 14 of the radius and ulna, 9 of the maxilla, 21 of the bones of the hand and foot, and 4 of the ribs and nasal bones. The favorable results, and the simple measures by which they were obtained, are so conspicuous that they are entitled to a somewhat detailed examination.

Of the 23 compound fractures of the skull, 6 succumbed to shock within forty-eight hours after the injury, so that they were not amenable to any plan of treatment. Of the remaining 17, all of which recovered, 10 were trephined, the lacerated dura mater having been stitched with catgut sutures in one. The wounds were managed openly with carbolic acid, or balsam of Peru,

Of the 61 compound fractures of the. thigh and leg, 2 died of shock within twelve hours after their admission, and all of the remainder recovered, despite the fact that 14 underwent amputation, and that in 10 the fracture opened into the knee and ankle-joints. In one case, indeed, both bones of both legs were comminuted and the bleeding was alarming, while in another both legs and one forearm were broken. Of the 26 fractures of the humerus, radius, and ulna, all recovered save one, which died of shock within twenty-four hours. In 6 amputation was resorted to, and in 7 the adjacent joint was involved. All of the cases of fracture of the maxilla and other bones terminated favorably.

The treatment adopted by Dr. Dennis includes absolute cleanliness, immediate fixation, and provision for free drainage when necessary. The patient having been anesthetized, the injured limb is thoroughly scrubbed with soap and warm water, and the wound irrigated with a 1 to 40 solution of corrosive sublimate. If the projecting ends of the bone cannot be reduced without too much violence, physiological rest is insured by the subcutaneous section of the tendons of the resisting muscles, aided, if need be, by the removal of the ends of the protruding fragments themselves. Loose spiculæ having been extracted, the wound having been thoroughly washed out with one of the above-mentioned solutions, and the fracture having been adjusted, the opening, if small, is closed with adhesive strips and sealed with collodion, or, if large, is partially united

with catgut sutures, a drainage-tube inserted, and covered with iodoform and antiseptic gauze. The entire limb is next enveloped in previously heated Gamgee's absorbent cotton, and the dressing finished with the plaster-of-Paris bandage.

Should the case progress favorably nothing more need be done; but, under opposite circumstances, a fenestrum should be cut over the site of the fracture, and the wound be examined. If the latter be inflamed and

the tissues tense, it should be enlarged and washed out with the carbolic or sublimate solution, and be left to suppurate under free exposure to the air, care being taken to keep it absolutely clean and free from all sources of contamination.

The management of compound fractures of the long bones of the extremities, thus outlined, is extremely simple and rational, and the results obtained will compare favorably with the best heretofore recorded. We are unable, however, to understand what Mr. Dennis means when he states that he wishes "it to be understood that I do not undervalue antiseptic surgery," but that the same results are attainable "by other and simpler methods which are within the reach of all," and that "wounds and compound fractures can repair kindly and quickly without danger, though exposed to the air." While it is true that the strict Listerian method was not carried out in his cases, and few practice it now-a-days, it is none the less true that his treatment is, in the strict sense of the term, thoroughly antiseptic, and not the open method of Humphry or James R. Wood. In the majority of his cases, indeed, a fenestrum was not required at the seat of the injury, and when it was, he is most explicit in his directions to enlarge the wound down to the fracture, wash it out with a solution of corrosive sublimate or carbolic acid, keep the parts absolutely clean, and provide free drainage when necessary. If this is not antiseptic treatment, we have failed to comprehend its principles; and, instead of speaking of the open treatment of compound fractures, we fancy that Dr. Dennis, in recording his great success, would have more correctly described his methods had he called them the antiseptic occlusive and the antiseptic open methods of treating compound fractures.Phil. Med. News.

PRURITUS ANI and the distressing itching of urticaria and mosquito bites can be much alleviated by local applications of menthol. It may be used by rubbing the menthol pencil lightly over the surface, or by dissolving a small amount in alcohol and bathing the part. Ibid.

MEDICINE.

THE PHARMACOPEIA AND PHYSICIANS' PRESCRIPTIONS.-Prof. William P. Bolles, late of the Harvard Medical Sshool and the Massachusetts College of Pharmacy, some months ago read a paper before one of the Boston Medical Societies, which, though never published, contained much that is of interest in regard to the materia medica.

As some points of Dr. Bolles' paper will be of use to this writer in reviewing the Pharmacopeia, permission was obtained to make use of them. There are a great many articles in the Pharmacopeia that are of so little use to physicians that it has been supposed they might be dismissed with advantage, but it is very difficult to get trustworthy testimony on this point, and therefore they have been retained from one revision to another, and are growing more numerous; or at least articles are being gradually abandoned so that their numerical relation to the more important articles is becoming larger as therapeutic knowledge increases.

Dr. Bolles had the prescription files of three prominent pharmacists in different parts of the city of Boston examined and counted to ascertain the titles of officinal medicines, which occurred on the prescriptions of physicians. The total number of physicians' prescriptions which were then analyzed and counted as representing the practice of the city of Boston was 3,726. The number of titles in the present revision of the Pharmacopeia is about 994. Of these titles 504 occurred in these 3,726 prescriptions.

Sulphate of Quinine leads the list and is found in 272 of the 3,726 prescriptions. Sulphate of Morphia ranks next, and is found in 172 prescriptions. Bromide of Potassium in 171. Iodide of Potassium in 155. Tincture of Chloride of Iron in 134.

Subnitrate of Bismuth in 133.

Glycerin, and Syrup of Tolu in 120 each. Syrup in 108. Carbolic Acid

in 92. Extract of Nux Vomica in 87. in 80. Bicarbonate of Soda in 77.

Camphorated Tincture of Opium Calomel in 72. Chlorate of Potas

sium in 71. Compound Tincture of Gentian in 67. Lime water in 65, and so on down. It will be thus seen that of the 994 articles of the Pharmacopeia only 17 occur more than 65 times in 3,726 prescriptions, and of these 17 three are vehicles or adjuvants which are in such common use as to bring their numbers into prominence.

But it is rather to those which are rarely used to which attention is drawn. It is to be regretted that the list did not embrace articles which occurred once or oftener, instead of 5 or more times. As it is, however, 490 titles, or nearly one-half, do not occur 5 or more times in 3,726 prescriptions, while 91 of the 504 titles which do occur are found only 10 times, or less than 10.

Dr. Bolles subsequently carried his investigations to about 10,000 prescriptions, but without altering the general results.

Now a medicine may be of primary importance and still not be wanted by physicians once in 700 prescriptions, yet the number of such must be so limited and the articles so easily recognized that they might be retained while others were dismissed.

It is, dowever, in duplicates and triplicates that the Pharmacopeia is most redundant, and in regard to these Dr. Bolles' lists give some interesting testimony. There is not a Decoction and but one Infusion in the entire 3,726 prescriptions, but Tinctures are still largely used where Fluid Extracts of the same drugs are accessible, while three Wines are still found among the low numbers of the lists. It is remarkable that the Fluid Extracts being so much the better and more accurate preparations do not more rapidly displace the Tinctures. The Fluid Extracts have almost entirely displaced the Decoctions, Infusions and Wines, and their advantages are such that their displacement of the Tinctures, with their large doses, large proportion of alcohol, and uncertain composition, is only a question of time. There is probably not a single drug the origi nal use of which was in the form of a fluid extract that ever afterward came into use either as a decoction, infusion, spirit, tincture, or wine, and this is but a natural progress, since a well made fluid extract is all that is needed and fulfills the role of all others better than they do.

If the Pharmacopeia has the crude drug as a material, and for the purpose of definition, description and tests, and then has a fluid extract of it, nothing more is needed, nor is really useful except in the comparatively few instances in which a solid extract is convenient and serviceable.

To have any drug, -as in the case of Digitalis,—in substance, in Abstract, in Decoction, Infusion, Extract, Fluid Extract and Tincture is cer

tainly surplussage of a very useless kind; and there is no more reason for it than for the other two possibilities, namely, a Syrup and a Wine. In this list of 3,726 prescriptions Digitalis occurs 10 times as powder, 5 times as Infusion, and 34 times as Tincture, but in no other form, while the uses of the drug would have been better accomplished by the Fluid Extract in any supposable case whether used alone or in combination. The individual habits of physicians are the cause of much of this surplussage, and the pharmacist who keeps himself in readiness to supply all these forms of every drug, has his shelves overloaded and cannot possibly have all the forms of proper freshness and in proper condition for use. The individual preferences of physicians are largely prejudices adopted from teachers in the schools, and therefore if the schools would but reason upon the subject and direct only the best preparation of each drug, a needed reform in the Pharmacopeia would soon follow, and the pharmacists' supplies would be much fresher and more trustworthy. As it is, that physician is always safest who orders his drugs in the forms which are best made and which keep best, and which are in most general use, so that the supplies may be in the freshest condition, and all these conditions are best fulfilled by the fluid extracts. That so many physicians are doing this is probably the reason why tinctures are so rapidly following the decoctions, infusions and wines out of use with those in this country, who think most about their materia medica. In England and France, where progress is sometimes looked upon with conservative suspicion, the decoctions, infusions, syrups, wines and tinctures fall into disuse much more slowly, and large nauseous doses seem to be much less objectionable.

Accuracy and uniformity in strength being of the first importance in the materia medica, while liability to change by keeping being the prominent thing to be avoided, each physician can easily select that preparation of each drug which best meets these indications.—Squibb's Ephemeris.

PAIN IN THE SIDE IN PHTHISIS.—Rigaud discusses in Jour. de Ther. the various means for the relief of the pleuritic pains which are so often the cause of severe suffering in consumption. These pains are considered as they occur in the later stages of the disease, when they are due to the inflammation caused by the presence of a superficial cavity. They are aggravated by motions of the thorax. The treatment which Rigaud recommends for their relief is the application of collodion. After washing and drying the part, a succession of layers of this substance is applied to it by means of a hair-brush, until a kind of cuirass is formed, which offers suf