in the respiratory tract, it has been suggested, and by some attempted in practice, to apply germicidal medicines directly to the respiratory mucous membranes. This plan, at first glance, appears to solve the problem; but aside from the danger of poisoning the patient by such remedies, we must remember the great difficulty of spraying the larynx of children, especially very young infants, in which the disease is most dreaded.

The day may not be far distant when some "serum-therapist" will launch a specific antitoxin, "a few drops of which may be administered with a hypodermic syringe and cure in one night." Enterprising manufacturers have entered the field and have already offered us "at a reasonable price numerous contrivances for curing whooping-cough, such as fumigating lamps, sulphur candles, syrup of chestnut leaves, whooping-cough lozenges, etc. However, up to the present we are undetermined in the matter of treatment, and, as Dr. Dolan says, we only hope as science advances we may find a

cure.

If we never find a remedy which may be called a one night cure," I believe we already have means which will cure in a few nights and days. It is most desirable to cut short the disease before it reaches the dangerous (spasmodic) stage, especially in the case of young infants. By limiting the disease to the first (catarrhal) stage it is robbed of its danger to life, the first stage not being dangerous even in younger infants.

Within the last few years I have experimented with different remedies, aiming to find one which would abort the disease, and will conclude by briefly outlining the plan that has been most satisfactory and the treatment which I use almost exclusively. I cannot fully explain the modus operandi of the remedies employed (this, however, might be said of most of those we administer).

The remedies are not new, nor do I claim originality in their application; I may claim, however, that I push the dosage more rapidly than is deemed advisable by others. The great danger to life, especially in young infants with pertussis, during hot weather, fully justifies the procedure.

The moment the disease is recognized, I order an average dose of the tincture of belladonna given once every eight hours, to be increased one drop daily until the full physiologi

cal effect is obtained, viz: widely dilated pupils, flushed cheeks, dry fauces, etc.

The maximum dose being reached in five or six days, it is continued until there is decided lessening of the severity of the cough, which may be confidently expected within ten days from the beginning of treatment. In addition to the bella

donna I give every three hours during the night full doses of potassium bromide combined with phenacetin, which insures prolonged tranquil sleep and fewer coughing spells.

Sig. One drop every eight hours, increasing one drop each day until the tenth day.

Label bottle "No. 1."

M.

Aqua Pura...

Ft. sol. Sig.-Teaspoonful every three hours during the night.

Label bottle "No. 2."

It will be observed I have addressed the treatment wholly to the relief of symptoms, believing the symptoms due to general hyperesthesia of the nerve filaments supplying the mucous membrane lining the air passages. Whether the remedies given internally act upon and destroy the "bacillus tussus convulsiva" or not I am unable to state. I can understand, however, that tone and tranquility of the neuropathic element of the disease may be restored by the remedies named; and lastly, the efficiency of the treatment has been abundantly proven in my clinical experience.

712 Third street.

REDUCTION OF AN OLD DISLOCATION OF THE ELBOW JOINT*

By WILLIAM L. RODMAN, A. M., M.D.,

Professor of Surgery and Clinical Surgery in the Kentucky School of Medicine, Surgeon to the Kentucky School of Medicine

T

Hospital, etc., Louisville, Ky.

HIS case is an old dislocation of the elbow joint. The history is as follows: A boy, 13 years of age, while wrestling with an older lad, was thrown and caught himself upon his hand; he felt as if he had sustained some injury of the elbow joint, and he suffered considerable pain. Examination was made under chloroform, and the diagnosis was made of a sprain, no fracture or dislocation could be made out. There was considerable swelling for some days after the accident, and a second examination did not reveal any other other trouble.

An examination yesterday convinced us that there is not only a dislocation, but a complete one of both bones of the forearm. My own opinion is based upon a very beautiful skigraph made by my assistant, Mr. Dunn. I am glad to learn that Professor Holloway has recently been lecturing to you on injuries to the elbow joint, and he has, doubtless, described. many of the lesions which may occur. You can have a dislocation of both bones backward, as in this case, and, strange as it may seem to you, you may have a dislocation of both bones forward. You can also have a dislocation of both bones externally, or a dislocation of the radius alone, backwards, forwards, or externally, but it cannot be dislocated internally on account of its attachment to the ulna; and you may have a dislocation of the ulna backward.

This is one of the most difficult joints to treat, whether the trouble be fracture or dislocation, and elbow joint dislocations undoubtedly give more trouble and cause more chagrin to the surgeon than lesions of any other joint in the body. Therefore in these cases one should be most careful and guarded in making a diagnosis or prognosis. An anesthetic

* Clinical Lecture delivered at the Kentucky School of Medicine Hospital.

should always be used for diagnosis. Swelling after lesions of the forearm is rapid and great, and on account of this swelling you will often be in doubt unless an anesthetic is given. Therefore I enjoin upon you in all cases of injury about the elbow joint, whether you are satisfied with your diagnosis or not, to give an anesthetic and make certain that you are right. You can then not only make a more accurate diagnosis, but you can also reduce the fracture or the dislocation more readily on account of the relaxed condition of the muscles.

There is another feature about dislocations of the elbow joint. You may make an error of diagnosis in a dislocation of the shoulder joint, and even after two or three weeks there will be no trouble in getting the bone back in place. Unfortunately this is not true of the elbow joint. I have never seen an unreduced dislocation of the elbow joint that could be reduced after three weeks had elapsed. I have seen some of the most distinguished surgeons make repeated efforts to do this, yet I have never on any occasion seen an elbow joint dislocation reduced after the third week. Therefore authorities speak of this joint particularly as one where the dislocations become old or chronic very soon. The shoulder joint and the hip joint are so situated that you can reduce dislocations three, six or twelve months after the injury. The reason why disloeations of the elbow joint become chronic or old in so short a time is usually due to this fact: The bone comes back as in this case; the periosteum is stripped up; the olecranon process is bound down by adhesions to the posterior surface of the humerus; true bony adhesions are thrown out between the elecranon process below and the posterior surface of the humerus above, and it is so difficult to break these adhesions that you will invariably fail after the joint has been out of place for a short time.

We propose today to perform an operation such as will give this boy a useful arm. We will put him thoroughly under the influence of an anesthetic; then make attempts to reduce the joint without an opening or converting a simple into a compound dislocation; if we do not succeed in getting the bones back in place by the ordinary measures, then we will resort to cutting into the joint and forcibly press the bones into position if we can. This boy is young, and it would seem altogether wrong to allow him to go on through life a helpless cripple.