dressing, then without, still on crutches. If no contra-indications exist,-old age, constitutional anomalies, etc., which would tend to hinder the ossification. of the callus, the patient may be allowed to go about with two canes on the fourteenth day, with one cane on the seventeenth or eighteenth day, and he may dispense with this at the beginning of the fourth week. "Here," says Landerer, "the soft parts receive the same attention as the bony, the ossification is hastened through the local hyperæmia, and oedema is removed."

In the case of a Colles' fracture, after immediate absolute reduction, short flexible splints are moulded to the limb, These do not confine the fingers, active motion in which is encouraged. They are curtailed on the fourth day, and entirely dispensed with on the eighth day, after which time the limb is simply subjected to massage. After fourteen days the patients are able to do light work. The author does not employ plaster of Paris in Colles' fractures, saying with right that he cannot be as certain of the maintenance of reduction when using it.

In fractures of the patella Landerer follows Tilanus and Von Wagner in relying chiefly on massage of the quadriceps, the fragments being drawn together by plasters and the limb resting in a simple splint. At the end of the third week or the beginning of the fourth the patients begin to walk, and are said to be functionally capable, in many cases, in the fourth or fifth week. The author justly deprecates the conventional employment of any form of suture. Fractures of the neck of the femur or of the upper part of the humerus are treated in the same way, passive motion being commenced at a later date in the impacted than in the non-impacted cases. So, as well, with fractures of the leg; these are subjected to massage at the end of the third week, while one week later the patients are allowed to begin to walk. As a matter of course other plans are adopted when the lesions are very oblique.

Fractures of the thigh are treated in the usual way with extension apparatus, massage being begun in the fourth week. In the fifth or sixth week the dressings are discarded, the patient keeping his bed a week or two longer.

When the author commends the employment of very early passive motion in such lesions as the multiple fractures at the lower end of the humerus we cannot feel that he will command the support of American surgeons, who are now, as a rule, very fully in favor of the principle of rest. We may easily believe him, however, when he says that massage is of much value in cases of delayed union. It is to be regretted that we are denied access to the histories of Landerer's cases or to the only satisfactory testimony, namely, final results, with elapsed time and individual details. His clearly stated propositions are, however, of much interest, and the publication will repay cereful study.-Annals of Surgery.

THE REMOVAL OF NECROTIC AND CARIOUS BONE WITH HYDROCHLORIC ACID AND PEPSIN.

SOMETIMES it is desirable to remove dead bone without subjecting a weak patient to a dangerous or deforming operation. Attempts have been made with some success at clearing out this bone by a process of decalcification, but there are two chief reasons why failures have resulted as a rule. In the first place, it was discovered that superficial layers of dead bone were decalcified easily enough,

but the acids did not reach deeply through the mass, especially if portions were infiltrated with caseous or fatty debris. In the second place, cellulitis was pretty apt to develop during the course of treatment. After much experimentation I have finally adopted a method of work which seems to be complete. An opening is made through soft parts by the most direct route to the seat of dead bone, and if sinuses are present they are all led into the one large sinus if possible. The large direct sinus is kept open with antiseptic gauze and the wound allowed to remain quiet until granulations have formed.

Granulation tissue contains no lymphatics, and absorption of septic materials. through it is so slow that we have a very good protection against cellulitis. The next step consists in injecting into the sinus a two or three-per-cent. solution of hydrochloric acid in distilled water. If the patient is confined to bed the injections can be made at intervals of two hours during the day; but if it is best to keep the patient up and about the acid solution is thrown into the sinus only at bed-time. In either case the patient is to assume a position favorable for the retention of the fluid. Decalcification takes place rapidly in exposed layers of dead bone, and then comes the necessity for another and very important step in the process. At intervals of about two days an acidulated pepsin solution is thrown into the sinus (distilled water, four fluid ounces; hydrochloric acid, sixteen ounces; Fairchild's pepsin, one-half ounce), and this will digest out decalcified bone and caseous or fatty debris in about two hours, leaving clean dead bone exposed for a repetition of the procedure. The treatment is continued until the sinus closes from the bottom, showing that the dead bone is all out. Even in distinctly tuberculous cases the sinuses will close if apparatus for immobilizing diseased parts and tonic constitutional treatment are employed, as they should be in conjunction with our efforts at removing the dead bone.

If suppuration is free in any cavity in which we are at work, it is well to make a routine practice of washing out the cavity with peroxide of hydrogen before each injection.-R. T. Morris, M. D., in New York Medical Journal.

CASES OF PNEUMOTOMY FOR GANGRENE OF THE LUNG. THE first case was that of a man, twenty-four years of age, who, one day in the spring, while eating, aspirated a piece of potato into his trachea. In September he presented consumptive symptoms and signs of a cavity in the apex of the left lung, together with extensive burrowing of pus out into the region of the left nipple. On opening the pus cavity a fistula was discovered leading up to the lower edge of the left rib, of which a piece was resected. A trial puncture into the lung revealed a slight quantity of pus. An opening was made into the lung by means of the handle of the scalpel and the fingers, as the pulmonary tissue was easily torn with the finger. No large cavity could be found; the wound was tamponaded with iodoform gauze. The patient's condition improved after the operation; the purulent discharge ceased and the fistula healed. The physical signs of the apex as well as a profuse purulent secretion, although it had lost its gangrenous odor, showed that a cavity was still present. As the general condition of the patient improved and he wanted to return home, while the cavity showed a tendency to heal, he was permitted to go.

The second case was that of a man greatly run down, who was admitted to

the hospital with terribly putrid expectorations as well as symptoms of a large cavity in the lower lobe of the right lung. Trial puncture evacuated one hundred cubic centimetres of a penetratingly putrid fluid. On the day of the operation this fluid was found to have leaked through the track of puncture and produced a gangrenous emphysema. A portion of the eighth rib was resected below the scapula and the adherent layers of the pleura punctured with the thermo-cautery. A large cavity with smooth walls was discovered containing gangrenous fluid and loose gangrenous pulmonary detritus. Although the gangrenous expectorations ceased and the temperature sank, the patient perished the third day after the operation from septic intoxication. At the necropsy the cavity was found empty, but in its vicinity were found another gangrenous focus of the size of a hen's egg, together with two similar and smaller ones in the same lobe.

The third case was that of a gangrenous empyema, due to a large gangrenous focus of eight to ten centimetres diameter, situated on the surface of the lung. The usual operation for empyema was performed, with resection of the eighth rib in the left scapular line; the gangrenous spot cast itself off and, after seven weeks, the patient was completely well.-Finska Läkaresällskapets handlingar.— Annals of Surgery.

THERAPEUTICS.

THE PHARMACOLOGY OF ASPARAGUS.

ASPARAGUS is the edible lily. Belonging, as it does, to the same order of plants as the lily-of-the-valley, it is not wonderful that it has become a fascinating article of diet. Botanically, asparagus is nearly related to the asphodel, dear to the ancients, those two plants differing chiefly as regards their fruit. The old fables taught that the manes of the Greeks feed upon the roots of the asphodel, while the gastronomes of to-day delight in the tender shoots of this less comely liliaceous form. It is believed that asparagus was known to the Greeks, although probably not in the finely cultivated stage, in which it now comes to our tables. Pliny and other Latin worthies noted its peculiarities as an aliment, and the Asparagus officinalis is supposed to be the payos of Dioscorides.

The plant is probably indigenous to England, and it was a favorite article of food there two hundred years before the art of its cultivation was brought over from Holland. The London markets dispose of vast quantities of this esculent annually, cultivated to a high point of perfection.

The root and shoots of asparagus are not yet discarded from the French "Codex," as they have been from the "British Pharmacopoeia." The French use a syrup, to which are ascribed diuretic and soothing properties. At Aix-lesBains and some other Continental health resorts this vegetable forms a notable part in the regimen of rheumatic patients. It does not agree with all persons alike; in some it occasions more or less gastric disturbance. Partly this may be due to the vegetable itself, since it is not always cut at the period of its tenderest growth, and partly an inadequate amount of cooking may give rise to indigestion. An alkaloid was separated from asparagus as long ago as in 1805. named asparagine, and has been supposed to act, like convallaria and its preparations, as a cardiac sedative.

This was

In former times the plant had some popular repute as an antilithic. The strong odor imparted to the urine of all who partake of the young shoots will account for this notion. Saccharinity of the urine has been observed after its use. It has been reported as the cause of urethritis and as an aggravator of that disease, but very little is known of the truth of these statements as a result of any systematic observations.

The pharmacology of this vegetable is worthy of a closer study than it has yet received. The profession has rested satisfied with the general feeling that the ingestion of asparagus was followed by a renal depuration, without entering a demand for proof thereof. According to the Medical Press and Circular, however, "there are grounds for believing that the asparagus tops not infrequently exercise a disturbing influence on the renal functions, causing in some instances a notable decrease in the amount of urine excreted. It is very improbable, however, that any injurious effect is produced on the healthy organism, or this succulent vegetable would not have become a general favorite. As it may give rise to undesirable symptoms in certain special cases, it is well that the medical profession should be made acquainted with the real nature of its physiological action, and we shall look to our scientific pharmacologists for some information on this point." If this suggestion is carried out we trust that those who give their attention to the question will confine their researches at first to that part of the plant which is used so lavishly as an article of food. At the same time, it would be well to determine what differences, if any, can be found in the renal excretion, before and after the ingestion of asparagus.-New York Medical Journal.

OBSERVATIONS ON EUROPHEN.

ALTHOUGH in view of the short time that has elapsed since the introduction of europhen the number of cases treated is too small to warrant positive deductions, the utility of the remedy is rendered probable by the observations of many authors, and further experiments are therefore called for. Up to this time I have treated seven cases with europhen, comprising two cases of ulcer of the leg, one case each of chancroid, scrofuloderma, and burns of the second degree, and two cases of recent wounds with loss of substance.

The two cases of ulcers of the leg presented the most unfavorable condition for treatment. The patients were female, belonging to the laboring class, and were respectively sixty-nine and fifty-five years of age. In consequence of their occupation they had been unable to take the proper amount of care, and hence ulcers had formed over the marked varicosities, which persisted for many years despite the employment of remedies of all kinds. In the case of the older patient, Mrs. B., the entire left leg and foot were the seat of a firm infiltration and eczema. On the middle surface of the lower third of the leg there was present an ulcer about as large as the palm of the hand and covered with flabby, torpid granulations, which had resisted various methods of treatment and was constantly spreading. The younger patient, Mrs. F., had on the inner aspect of the middle third of the right leg an ulcer about four centimetres in length and three centimetres in breadth, which had originated from a number of varicose nodes and was surrounded completely by inflammatory induration. I ordered the fol

lowing treatment: In the evening a tepid bath of chamomile flowers, then insufflation of the entire surface with europhen, application of a loose dressing of gauze and cotton and of a muslin bandage. In the morning a two per cent. ointment of europhen with vaseline and lanolin (equal parts) was applied and the parts dressed and bandaged as before. The chamomile baths and the alternate use of europhen in the form of a powder and ointment had the effect of preventing the crust formations. Under this treatment vigorous granulation tissue soon developed and at the end of about three weeks the ulcers had cicatrized, and the healing has remained permanent up to the present time. These cases are opposed to the statement of Rosenthal that europhen is valueless in ulcers of the leg.

In the case of chancroid I obtained extremely prombt healing by means of europhen. The patient consulted me for a large ulcer which had spread over the entire upper surface of the glans penis and had produced an extensive loss of substance. I employed the method described by Nolda which is as follows: Every morning and evening the ulcer is thoroughly irrigated with sublimate solution, dried with cotton and insufflated with europhen. At the end of ten days the patient was discharged cured.

Europhen was employed also in a case of scrofuloderma occurring in a girl thirteen years of age. The patient had erethic habitus and besides the other symptoms of a severe scrofulosis showed on the neck, the nucha, the angles of the lower jaw, the forearms and legs, numerous deep ulcerations which for the most part took their origin from the lymphatic glands. The long continued employment of such remedies as iodoform, balsam of Peru, and nitrate of silver had had no effect in diminishing the torpidity of the ulcers. I then adopted the following local treatment: The abscesses were opened and the ulcers incised wherever it seemed indicated. Europhen was then applied in the form of the powder and of a two and one-half per cent. ointment with vaseline and lanolin (equal parts) alternatively morning and night. Every third evening a dressing consisting of wads of cotton soaked in a two per cent. solution of carbolic acid was applied and allowed to remain all night. These procedures were always preceded by careful antiseptic cleansing and drying of the parts. To improve the patient's general condition I also ordered arsenic and a proper diet.

After this treatment had been continued for a number of weeks the ulcer cleared up, vigorous granulations developed and cicatrization occurred, while the tendency to formation of new ulcers seemed to have been diminished.

At any rate, by this method of treatment, I obtained results which previously could not be obtained in any other way, and by persisting with it I hope to effect ultimately a comparative cure.

The case of trauma due to thermal influences which I treated with europhen was one of the second degree. A servant girl while engaged in washing was scalded over the entire left forearm by a large quantity of boiling water, so that an extensive formation of bullæ took place. After careful evacuation of the blebs I applied a dressing of the europhen ointment as described above, which was renewed daily, and under which healing ensued promptly in the course of a week.

My further experience with this remedy relates, as above mentioned, to two cases of fresh wounds.