merges into a layer of a more fibrous construction, with relatively less numerous lymph-corpuscles. There is a larger number of blood-vessels found in this layer, which on an average exhibit a wider calibre than those of the adenoid tissue. Fig. 4.-Rhinitis Arrophica Chronica: A, adenoid layer; B, epithelial layer; C, blood-vessel empty; E, acinous gland; F, submucous connective-tissue layer, the remains of the The prominent features of the atrophic process are briefly as follows: First. Decrease of the covering epithelium, with profuse desquamation. Second. Decrease of the adenoid layer, with lack of blood-vessels, together with destruction of the acinous glands. Third.-A total disappearance of the venous sinuses of the submucous layer of the membrane. In brief, we find here an atrophy of the mucous membrane in which the morbid process is not due to a connective-tissue hypertrophy encroaching on the glandular structures of the membrane, but rather to the transformation of epithelial structures into inflammatory corpuscles, together with an active epithelial desquamation from the surface of the membrane and the lining of the acini. As has been seen, the follicles are surrounded by heaps of lymph-corpuscles, but there is no evidence of transformation of these corpuscles into connective tissue, showing thus that the inflammatory process is most marked in the neighborhood of the acini, but that it does not develop into a hyperplastic process. The morbid changes are therefore atrophic from their outset, and bear no relation whatever to the hypertrophic form of disease. Atrophic catarrh commences in the very large majority of cases in early childhood, but its progress is so exceedingly slow and insidious that it may exist for several years before it gives rise to any prominent symptoms. In the early stage it consists merely in a moderate coryza, with no tendency to the dryness or formation of incrustations which characterize its later stages. As it develops, and the glands become destroyed, the mucous membrane commences to feel their loss. The supply of mucus becomes deficient, and the natural result is that it dries upon the surface of the membrane. There is thus formed on the convexity of the turbinated bones a thin, dry pellicle of inspissated mucus, resembling in its appearance, and also in its action, a film of collodion. In drying it contracts, and thus clings closely to the rounded turbinated bones, extending into the sinuosities beneath them. This condition gives rise for the time to more or less irritation in the parts, with a feeling of burning or prickling, which lasts until the small incrustations may be dislodged. These crusts may recur again and again for weeks, or longer, and the parts improve and the symptoms disappear for a time. The further progress of the disease shows a tendency to more frequent recurrence of these incrustations; they adhere more closely and remain longer in the cavity, and finally a new development of symptoms sets in. As these crusts form on the surface of the turbinated bones, and remain for days even at a time, the secretion of mucus goes on beneath them, but being protected by an air-tight covering it remains fluid until it has forced or broken its way out, thus lifting up the incrustation. In this way the dry mass is builded up from beneath. Moreover, the imprisoned mucus soon commences to degenerate into pus, and become decomposed. We thus find a new symptom commencing to show itself in the stench which these decomposing masses emit. It is easy to understand the progress of the disease thus far: a loss of glands giving rise to inspissated mucus, this drying and adhering to the convexities of the bones, and being retained thus for days, decomposing and giving rise to an odor; but there is another prominent feature of the late stage of the disease which, as far as I know, has not been satisfactorily accounted for, and that is, the atrophy of the turbinated bones. If we examine the nasal cavities of one who has suffered from this disease a number of years, we find them exceedingly roomy, and looking through them see plainly a considerable area of the wall of the pharynx. This roominess is due to an almost total disappearance, in many cases, of the lower and middle turbinated bones. These bones are seen simply as small cordlike projections from the outer wall of the cavities. In cases in the earlier stages, of course, the atrophy of the bones may not have advanced so far. condition I believe to be caused by the pressure exercised on these bones by the drying and contraction of the inspissated mucus, and is an illustration of what we very often see in disease, viz., comparatively trivial causes acting through a long number of years resulting in morbid changes apparently disproportionate to the vigor of the exciting canse. This atrophy is undoubtedly due, in part, to this direct pressure upon the bone, but its mode of action is, of course, to interfere with the nutrition of the bone by the pressure upon the membrane and the submucous tissue which, in this region, forms the periosteum, or, at least, is merged with it. This Hartmann, Gottstein, and Fränkel speak of this condition of the turbinated bones as a lack of development rather than an atrophy. I have found that, as a rule, the extent of the atrophy of the bones is an indication of the duration of the disease, and that the complete atrophy, which characterizes the later stages of the disease, is only met with in cases which have lasted many years, while, in cases of a few years' standing, this wasting of the bone is not prominent. As the secretions become pent up, and the muens becomes imprisoned beneath the crusts, we find that the mucous discharge becomes converted into a purulent one. As a rule, when a mucous discharge occurs in a closed cavity, as the vagina or urethra, it becomes purulent, the secretion seeming to infect the membrane, exciting a renewed activity in cell proliferation, by which the discharge is converted into a purulent one. This, it seems to me, is what takes place in the nasal cavity under the conditions above described. Another symptom of ozæna may be here alluded to, and that is the occurrence of a dry pharyngitis. This symptom is very constant, and its occurrence should always suggest an examination of the nasal cavity for the probable existence of an atrophic catarrh. The method of its development is very simple. The accumulation of dry crusts in the nose, with the atrophy of the turbinated bones, robs the nares of their normal function by which the inspired air is rendered warm and moist. Hence the air which reaches the pharynx is abnormally dry, and, consequently, its membrane is soon deprived of its moisture. The pharyngitic sicca, therefore, is a symptom, artificially produced, rather than an extension of the disease. The fetor I believe to be due entirely to retention of secretion; that this is true is shown by the fact that it is removed entirely by cleansing, nor does the odor return until there is a new formation of incrustations. We thus find the fetor developed from a purely catarrhal process, without ulceration or necrosis, and due entirely to retention of secretions and their subsequent decomposition. A fetid discharge never occurs in the hypertrophic form of catarrh, but is only met with in the atrophic form. As we have seen, the stench is only a symptom of the late stage of the disease, but still it is the symptom which has given the name to it of ozæna. The name is objectionable, and should only be accepted as applying to a class of diseases in the nose which are attended with stench, including syphilis, scrofula, etc. At the recent medical congress, in London, the subject received a very thorough discussion, but it only served to bring out various divergent opinions. Krause, of Berlin, reported the results of two autopsies on patients suffering from ozæna or atrophic catarrh, in which microscopic changes were found almost identical with these I have given, with the exception that he finds large numbers of fatglobules, the result of cell disintegration. The secretion of this fat, its retention beneath the crusts, and its further change into the fatty acids, he says, accounts for the fetor which attends the disease. Loewenberg suggests that the fat-granules which Krause describes are micrococci. Certainly, the existence of decomposing fat would not give rise to the peculiar odor of ozæna. E. Fränkel finds numerous bacteria and micrococci in the discharges, and reasons that the fetor is due to their presence. This, it seems to me, is simply asserting the existence of decomposition, which is always attended with the development of micrococci. Zaufal attributes the development of ozæna to the peculiar formation of the nose, which favors the accumulation of the secretions. The peculiar formation of the nasal cavity in ozæna is a result of the disease, and not a cause, the atrophy of the turbinated bones occurring as a result of the atrophy of the membrane, as I have already shown. Fournier believes that the odor of ozæna is due to the secretion of the glands, and that the fetor is a secretion peculiar to the glands of the nasal mucous membrane, and that it is made prominent by the inflammatory process. This is ingenious, but I believe that it is a universal rule that a fetid secretion does not occur; an excretion may be fetid, but not a secretion. The development of a fetor occurs after the matter is secreted. Fournier also describes a dry and a moist form of the disease. These I believe to be one and the same, the secretion of purulent matter being often coincident with the formation of incrustations. Watson recognizes three forms of ozæna: I cannot but think there is an element of confusion here in classifying syphilitic and scrofulous disease of the nose, which I believe always to be ulcerative in character, with the atrophic disease which I have described, and which I believe to be purely local and uncomplicated with any constitutional taint whatever. Causes.-I know of no cause for the disease other than taking cold; but why in one case this should lead to desquamation of the epithelial lining of the glands and their subsequent destruction, while in another case it leads to the development of a hypertrophic process, I cannot say. I believe the disease to be a purely local one, and in no way connected with any constitutional condition or diathesis. As a rule, patients suffering from the disease enjoy thoroughly good health. Indeed, it is the rare exception to meet with it in one suffering from impaired health from any cause. This statement I believe to be contrary to the generally accepted belief, but I make it advisedly. Certainly, it holds true in my own experience, and it has been a large one, covering several hundred cases. I have sought also for evidences of syphilis and scrofula as a possible cause, but I have not as yet been able to trace a single case to either of these taints. It may involve one or both nasal cavities, or it may involve only a portion of one cavity. It may attack the middle or lower turbinated bone, one or both. We find occasionally hypertrophy in one cavity and atrophy in the other. I have seen a few cases of hypertrophy of the lower turbinated bone with atrophy of the middle. A constitutional condition. will scarcely explain these vagaries. It has been a favorite idea to regard the disease as a manifestation of scrofula. As a rule, patients suffering from atrophic catarrh enjoy perfect health. Furthermore, it is exceedingly rare to find it in one suffering from any of the manifestations of scrofula. With syphilis it has absolutely no connection. Syphilitic disease of the nose consists in ulceration and necrosis. I have never in a single case of atrophic catarrh found ulceration. The mucous membrane is absolutely unbroken. In this connection I may say that for many years I have been in search of the so-called ulcers in catarrhal diseases of the nose and throat not due to syphilis, scrofula, or one of the constitutional taints, and that I have yet to find the first one. By the term ulceration should be understood a solution of continuity with progressive waste of tissue. I have examined many hundreds of cases, and by this I mean I have seen the whole cavity satisfactorily, and I have never seen any ulceration which was not due to a constitutional condition, excluding, of course, those due to the presence of foreign bodies. Diagnosis.-The diagnosis in this disease will be made, as a rule, by an examination through the nos trils. In the early stages there will be seen adhering to the lower or middle turbinated bone a grayish semi-transparent membrane with a wrinkled, parchment-like or shrivelled aspect. The cavity will be seen to be fairly patent. In the later stages there will be seen either the broad, roomy cavity, before alluded to, with the shrunken, cord-like turbinated bones, or there will be brought into view a greenish yellow mass of dried muco-pus of unsightly appearance and unsavory odor, which more or less completely obstructs the cavity and prevents a view of the parts beyond. If this be removed and the cavity cleansed, there will be found the condition before described of a roomy cavity and shrunken, turbinated bones. The diagnosis is based on the elimination of ulcerative disease; hence, after cleansing it will be comparatively easy to discover the absence of any ulcerative process. Treatment.-The first indication in the treatment of the disease is of course the thorough cleansing of the cavities by the removal of all the incrustations. In the accomplishment of this end there is no especial virtue in any remedy or local agent. The literature of the subject embraces a formidable array of drugs, among which are prominent carbolic acid, salicylic acid, boracic acid, permanganate of potash, phosphate of soda, bicarbonate of soda, thymol, borax, etc. The essential requisites of a good cleansing solution are secured by any solution which is alkaline and disinfectant. The fluid should be alkaline for its solvent action upon mucus. should be disinfectant in order to neutralize the results of the process of decomposition which is going on in the retained secretions. Any fluid, then, possessing these qualities is an efficient cleansing solution. The formula I generally prefer is the following: It Of quite as much importance is the method by which the cleansing is accomplished. The most efficient douche we possess is the ordinary post-nasal syringe. By means of this instrument a stream can be driven with great force through the cavities. In ordinary cases this is sufficient to thoroughly detach all the crusts, and cleanse the parts. In advanced cases, however, it will be necessary to use a probe with a pellet of cotton. This can be passed through the nostril and along the turbinated bones, thereby separating the crusts, after which they can be easily washed out with the syringe. Occasionally it will be necessary to throw a stream through the nostril by means of an ordinary ear-syringe. The essential point is to remove all secretions from the nose, and the success of the manipulation can only be determined by repeated inspections by means of a good illumination, and with the anterior nasal speculum in place. After the parts are thoroughly cleansed, the next step consists in the application of a stimulant agent. If the disease is essentially an atrophic process, and the fetor is due to a process entirely outside of the membrane, then the rational treatment and the one directly curative of the disease in the membrane proper, is to stimulate the parts to a better performance of their normal function, viz., the secretion of mucus. Gottstein, in the Berliner Klinische Wochenschrift, No. 4, 1881, advocates the use of the cotton tampon for the promotion of secretion and the correction of fetor in atrophic rhinitis. His plan consists in packing pellets of cotton between the turbinated bones and the septum, and allowing them to remain twentyfour hours. His paper has been the subject of much comment, and has excited no little interest since its publication. The plan is a novel one, certainly, but it seems a somewhat cumbersome and roundabout way of accomplishing a very simple purpose. It is, moreover, attended with no little discomfort, as it involves a plugged-up nose for the twenty-four hours. What is accomplished by Gottstein's plugs is simply the stimulation of the membrane by the irritating presence of a foreign body. A flow of mucus is necessarily excited, and of course the fetor corrected, for the cause of the fetor in retained secretion no longer exists as long as the profuse discharge of mucus continues. Gottstein's plan, therefore, is rational in its action, but we can accomplish the same end by means much more simple, more thorough, and with much less discomfort to the patient. It is alluded to here mainly on account of its originality, and from the fact that it recognizes the main indication for treatment in stimulating the membrane. After the thorough cleansing of the cavities, therefore, there should be applied a stimulating agent. For this purpose I know of nothing better than Galanga. This should be applied in the form of powder and by means of the Smith powder insufflator. Another almost equally valuable agent is Sanguinaria, applied in the same manner. I have used many different remedies, but I know of none possessing the same valuable qualities as the above. They stimulate the membrane without possessing too irritant qualities. By their action a flow of mucus is excited, which not only supplies the deficient moisture to the membrane, but also does more: it seems to flush all the conduits of the membrane, as it were, and wash out the worn-out detritus, cleanse the glands of their exfoliated epithelium, and restore a healthier action to the diseased secreting apparatus. If the glands are destroyed they cannot be restored but there unquestionably remains a large number of glands in the membrane whose proper function is hampered, and these undoubtedly can be restored to a healthier activity, and this is all that can be hoped for at the commencement of treatment. This plan should be carried out faithfully every day. In this manner the fetor is entirely arrestedfor, as a rule, fetor cannot arise from secretion retained no longer than one day-and the patient entirely and immediately relieved of one of the most distressing features of the disease. In the course of a few weeks it will be found that two days may elapse, and then three, without treatment, the rule being that the formation of incrustations must be arrested from the outset, and that the intervals of treatment must be regulated by the length of time which a patient may be without the treatment without the formation of crusts in the nose. In addition to the treatment at the hands of the physician, the patient may use the cleansing solution already given daily at home, by means of the post-nasal tube attached to a fountain-syringe. This is much better than the Weber nasal douche, in that the parts are more thoroughly bathed. In many cases, however, it will be difficult for patients to learn to introduce the post-nasal tube, in which case they may use the ordinary anterior douche. I have never found the use of this to be attended with danger to the ear; certainly in this form of catarrh. If there is any objection to the douche, the Delano or Goodyear atomizer may be used. The object to be accomplished is to soften and moisten the membrane daily. In By the above plan of treatment, I believe we accomplish all that can be done for these cases. The question presents, Can we cure them? Fränkel, of Berlin, very frankly says: "A cured ozana is unknown to me," referring to the atrophic catarrh. In the early stage of the disease, before the fetid symptom has set in, I have seen cases recover. the advanced stages, characterized by fetor, and in which the turbinated bones have almost entirely disappeared, I have not seen a case cured, if, by a cure, is meant a condition secured in which there remains no necessity for any measure of local treatment. All cases can, I believe, by thorough and painstaking treatment, be brought to that point when, by the use of very simple means, the ground that has been gained can be secured, and the patient be kept entirely free from any annoying symptoms whatever. If the physician, by local treatment, has so far helped a patient suffering from atrophic catarrh, with fetor, that, by the daily use of the post-nasal douche at home, he is entirely free from both fetor and incrustations, nothing more can be accomplished. The patient must be content to place his nasal cavities in the same category as his hands and teeth, as something to be cleaned with his morning toilet. For this purpose, a solution of common salt answers every purpose. This may be used by simple insufflation from the palm of the hand, by the Weber douche, by the post-nasal douche, or by a Goodyear atomizer. The instrument used is of little importance provided the whole membrane is bathed and softened and moistened. This may seem a poor result, but it is certainly a great deal gained, and is something, moreover, which I think can only be attained by the aid of a physician. A patient cannot accomplish it by using syringes and douches himself. The crusts adhere so tenaciously in the sinuosities of the nasal cavity, that it is impossible to detach them by means of syringes or douches. These cases should be treated, then, with painstaking and care, but with definite ideas as to what we can accomplish, and, even if the cure is not a radical one, the partial success attained is well worth the effort. Moreover, I think entire candor with our patients in the matter of prognosis will be better than to lead them to expect an entire and thorough cure when our hopes of such a result are based on such insecure grounds. NOTE. I am much indebted to Dr. Charles Heitzman, of this city, for valuable aid in making the microscopic examinations above described. I should also state that the above report of the pathological changes in nasal catarrh formed part of a paper read by myself at the International Congress in London last summer. 26 WEST FORTY-SIXTH STREET, NEW YORK. CHRONIC RHEUMATIC ARTHRITIS IN A DOG.-At the Pathological Society, of London, recently, Dr. Norman Moore exhibited a specimen showing bony outgrowths on the carpal and metacarpal bones, with ankylosis. The disease was of long duration. It probably caused great pain, and was believed to be one of the commonest causes of the howling of dogs at night. The President (Dr. Wilks) said that the dogs of the Hospice of St. Bernard were very subject to chronic rheumatism, on account, the monks believed, of their exposure to cold. SOME PRACTICAL SUGGESTIONS IN THE TREATMENT OF SPINAL CARIES.* BY AP. MORGAN VANCE, M.D., LATE INTERNE HOSPITAL FOR RUPTURED AND CRIPPLED, NEW YORK; ORTHOPEDIC SURGEON TO KENTUCKY INFIRMARY FOR WOMEN AND CHILDREN. EVERY practitioner of experience knows the importance of the closest attention to the "small detail so necessary as in the orthopedist's departthings" in surgery. Nowhere is the observance of ment, and it is especially so in the treatment of spinal caries. One will hear this plan of treatment and that plan advocated, viz., the various forms of plaster and steel braces, with modifications; but it is not the form of apparatus used that insures success, or results in failures; it is the degree of skill with which applications are made. In my opinion, good results can be obtained with any of the recognized forms of apparatus if properly applied and afterward attended to by the surgeon himself. The two old sayings, "What is worth doing at all, is worth doing well," and "What you want well done, do yourself," are nowhere better exemplified than here. It is my purpose in this paper to give some practical points in the treatment of this ailment, culled from experience. The diagnosis, as a rule, is easily made, for you are not called until deformity has taken place. Before this stage of the disease, the diagnosis is not difficult, though, of course, there are exceptional cases-especially if either extremity of the column is involved. Given the diagnosis, what shall the treatment be? The indications are to secure as perfect rest as is possible to the diseased structures, and this can best be secured by mechanical appliances. The splint or brace that attains the object as well as any other, and at the same time requires the least attention in keeping it in such repair that the indications can be continuously met, and has the fewest objections to its employment, that form of apparatus is the one to be used. So far as my own observation goes, there has not been proposed any splint that is free from objections. A discussion in this connection of the two principal forms-the steel brace and plastic dressings-will not be out of order. The chief objection to the use of the former is that, as a rule, the surgeon is not mechanic enough to construct the instrument, or even to give it the proper attention after adjustment, and he consequently requires the assistance of the instrument maker. This individual has his own ideas, and these always conflict with those of the medical man, thus giving to the machine when constructed and applied to the patient a "hybrid" character that may or may not fulfil the indications. The mechanic is paid for his work, the case is turned over to the mother with the usual result, and the disease slowly progresses with the additional torture which a misapplied brace causes. This is in private practice; but in hospital, where one can daily observe the case, and can adjust the instrument with an eye to all the indications, the result is different, and very good results are often obtained. There are, of course, other minor objections, but they can be easily overcome. The objections to the latter are manifold; but after a large experience with both forms I believe Read before the Kentucky State Medical Society, Louisville, April, 1882. the advantages which the plastic dressings possess over the steel are undeniable, and sufficiently answer all criticism. It is unnecessary to note in this connection the progress that has been made within the last decade. The plaster jacket, as applied by Dr. Sayre-its greatest advocate-has, to my mind, a great many defects. These have occurred to me in my own practice, as well as from the observation of cases in the hands of fellow practitioners. In many instances the failure depends not upon the jacket, but upon its improper application. To many men the one thing necessary, be the disease located where it may, is to get the child's body enveloped in a plaster casing. The following case will illustrate this point: A girl, fourteen years of age, with sacrolumbar caries, wore a splint, the lower border of which reached only to the upper border of the deformity. I have seen also several cases of disease in the upper dorsal, where the upper border of the jacket was above the kyphosis, and not even supplemented by a head support. I refer to these simply to relieve the apparatus of the odium of failure. Cases have come to me in which the splints-that had been applied by men high in our calling-were doing absolute injury instead of giving the required rest in the comfortable manner described by the advocates of this plan. Of the plaster jacket, as it is usually applied, I may be pardoned for the following suggestions: Never suspend a patient with caries of the spine. It cannot possibly do good, and may do much harm. Do not use any dinner or respiratory pads. The use of these pads, in my opinion, is a great mistake, and in many cases they interfere with the proper support. The plaster jacket should be renewed every three or four weeks. Use a head-support whenever the disease is above the sixth or seventh dorsal vertebra. Apply the jacket while the patient is lying upon a hammock, after the plan of Mr. Davy, of London. The advantages of this method will be referred to farther on. This splint cannot be used carelessly. Each case must be studied individually, and this must be kept up after the brace is fitted. If this rule is not followed, trouble will come sooner or later. Excoriations, increase of deformity, and abscesses will appear without your knowledge. To meet the objections, a number of modifications have been introduced within the past five or six years. One of the most important is the substitution of removable splints of lighter material. In the summer of '77 the writer devised and first used the removable paper brace. Since that time modifications and improvements have suggested themselves, so that to-day I am able to exhibit what I believe to be that appliance which will meet all demands in the treatment of the disease, and against which fewer objections to its use can be urged than against any plastic dressing yet proposed. The results are certainly as favorable as could be reasonably expected. It is requisite that a cast of the trunk be first obtained by plaster-of-Paris. process is simple, and the details are already given in my original article in this journal (June 21, 1879), and referred to again at the last meeting of this society. They are substantially as follows: In order to cause the plaster to set very quickly, a tablespoonful of alum should be added to the quart of water. The plaster jacket is then applied in the usual way, The and it can be almost immediately removed by a vertical incision in front. The cut edges should be brought together after its removal and fastened in apposition with twine. Place the jacket thus removed on a table, and render it water-tight by plastering around the base and up the incision. Partially fill with bricks, or other solid material, in order that less plaster may be employed in making the cast, the spaces being well filled with plaster of the consistency of thick cream; the external jacket can be removed within ten or fifteen minutes. First, grease the cast thoroughly, to prevent any moisture from the plaster retarding the drying of the paper jacket. Secondly, apply an ordinary roller to protect the brace from grease, and to give a smoother surface. Thirdly, let Canton flannel be fitted tightly and smoothly over the cast, and secured by a seam in the back. This forms the lining of the brace to be constructed. Fourthly, apply with a common painter's brush the glue, consisting of two parts of Irish glue, two parts of oxide of zinc finely powdered, four parts of hot water. The Irish glue is first dissolved in water. The addition of one part of potass. bi-chromate to fifty parts of glue renders it more impervious to water. The glue thus prepared will keep indefinitely, and is always ready for use by simply reheating it. Fifthly, the next step is to apply horizontally, beginning at the bottom of the back, strips of brown Manilla paper, one and one-half inches in width, previously coated with glue. The paper is of moderate weight, such as is used by mechanical draughtsmen. The strips are long enough to reach a little more than half-way around the cast, and one overlaps the other about half-way in going from below upward. Having finished the back, cover the front in a like manner, lapping the ends of the sides, so as to give support where it is most needed. Narrow steel springs, such as are used in hoopskirts, two inches shorter than the cast. are placed vertically at intervals of one and one-half inches, and held accurately to the cast by means of strong flaxthread wound around the whole. Another coating of glue is now applied, and a second layer of paper slips placed vertically, lapping as before. A few turns of thread will secure accurate adaptation to the cast; then a thickness of heavy linen or duck to add toughness and strength. A third coating of glue followed by a roller tightly drawn and smoothly applied completes the process. When dry the brace is removed by cutting down the front and springing the whole off the cast. Perforations by means of an ordinary penknife to the desired extent are made, care being taken to avoid the steel springs. Strips of heavy leather one-half inch in width, with metal eyelets one inch apart, are sewed half an inch from the edge in front, and when applied to the patient double laces are used. The edges of the splint should be neatly bound with leather. The apparatus is applied by springing it open enough to admit the patient's body, and should be worn over a tightly fitting knit shirt. At a meeting of the Louisville Medico-Chirurgical Society, October 14, 1881, I reported a few practical modifications, such as strips of thick linen instead of the paper, and thin sheepskin applied with glue. The best method probably, considering all the conditions, is that of saddle-skirt or saddle leather, soaked in hot water and moulded to the cast, the stiffness being regulated by the degree of heat in the water. An ordinary roller is used for compression, but if there is much deformity a Martin's bandage is more serviceable. This is the sim |