important factor in producing the respective results as detailed above.

It is an old saying that a "chain is no stronger than the weakest link." And, again, "that a man is no stronger than his weakest point.". So, then, in the cases narrated, the enfeebled functions, either of circulation, digestion, or secretion, were not equal to the demands put upon them during the closing months of pregnancy, and, as a consequence, we had puerperal nephritis. If, then, by further observation, we are able to establish it as a fact, that traumatism is one of the causes of puerperal nephritis, it becomes a matter of great importance, either from a medical or a medico-legal standpoint. It would enable the medical man to become a wiser counselor or a stronger witness. Unsafe marriages might be prevented; pregnancy, occurring in a person in a traumatic condition, would be watched with redoubled vigilance, and possibly the life of both mother and child be saved. If these words provoke profitable discussion, such as shall throw light upon the topic of this paper, then its purpose I will have been attained.

FRACTURE OF THE SHAFT OF THE FEMUR.

BY DR. CHAS. R. HUNT, NEW BEDFORD

[Read before the Massachusetts Homeopathic Medical Society.] The seat of fracture in the long bones of the skeleton of man, as a rule, is in the lower third, but the femur is an exception to this rule; our best authorities agree that the shaft of the femur is most frequently fractured at the upper portion of the middle third.

According to statistics of 146 cases treated by Hamilton, 30 belong to the upper third, 80 to the middle, and 36 to the lower. [Dislocations and Fractures, eighth edition, p. 352.] Of 234 cases treated at Bellevue Hospital, 34 belong to the upper third, 169 to the middle, and 31 to the lower. [Medical Record 1875.] Of 70 cases observed by Holmes, 8 belong to the third, 46 to the middle, and 16 to the lower. [Holmes' Surgery, Vol. 1, p. 941.]

upper

The greatest number of these fractures are caused by direct violence, and the fracture is usually oblique. The direction and degree of obliquity vary greatly. Hamilton states that in the upper and middle thirds of the shaft the direction is generally downward and inward, but in the lower third it is generally downward and forward, and the superior fragment is found lying in front of the inferior. A transverse fracture is more often found in the middle third than at any other point of the shaft of the bone; in the upper third the obliquity is generally extreme.

In whatever part of the shaft the bone is broken, and whatever may be its direction, it is rare that displacement of the fragments does not occur; the degree of obliquity is generally so great that the fragments cannot support each other when placed in apposition.

The usual symptoms of a fracture of the shaft of the femur are common to all fractures, such as shortening, pain and swelling, crepitus, and abnormal mobility at the seat of fracture, and usually inability to move the limb.

The nature of the injury is so apparent that it is not easily mistaken for any other, but owing to the swelling, or the great amount of muscle covering the thigh, it is sometimes difficult to determine the exact point of fracture, and the direction of the fracture is still more difficult, and not always possible to determine.

The prognosis must depend on the nature of the fracture, and the age of the patient. A simple fracture of the shaft, if properly managed will nearly always do well, although there will usually be some shortening of the limb. If the fracture be compound, or complicated with the wound of a large blood-vessel, or results from great violence, especially in an old person, the prognosis must be guarded.

Some surgeons have claimed that in fractures of the femur, in the adult, a complete restoration of the bone to its original length was to be expected, but the greater number declare that shortening cannot be prevented.

Hamilton states in the last edition of "Fractures and Dislocations," p. 385, that he is convinced that in case of an oblique fracture of the shaft of the femur occurring in an adult, whose muscles are not paralyzed, but which offer the ordinary resistance to extension and counter-extension, and where the ends of the broken bone have been completely displaced, no means have yet been devised by which an overlapping and consequent shortening can generally be prevented. That when in consequence of displacement, an overlapping occurs, the average shortening of simple fractures in adults, where the best appliances and the utmost skill have been employed, is from onehalf to three-quarters of an inch.

Dr. Stephen Smith, in a paper read before the American Surgical Association at Washington, September, 1891, says: The records of all past time show that shortening of the fractured limb was the universal rule, whatever the method of treatment pursued, and the question to be determined in each case was simply as to the degree of such shortening existing. The recent discovery of the natural discrepancy in the length of the lower limbs has considerably modified our estimate of this test of

treatment. It is established by careful measurement that ninety per cent. of healthy, uninjured persons have lower limbs of unequal lengths. This fact proves that shortening of one lower limb, as compared with the other, is the normal development of the skeleton of man. But the difficulty of estimating the value of shortening as a test is still further enhanced by the fact that one limb, as the left, is not invariably longer than the other, or the right. It appears that in 35.8 per cent. the right limb is the longer, while in 54.3 per cent. the left is the longer. The difference in length varies from one-eighth of an inch to one inch.

In conclusion, Dr. Smith says: That if the shortening does not exceed the extreme limit of difference in the lengths of natural limbs, viz., about one inch, the result should be regarded as satisfactory. An unsatisfactory result, as regards shortening, exists only when the degree of shortening exceeds the greatest difference of natural limbs, viz., one inch.

In regard to treatment much diversity of opinion exists. Many splints and apparatuses have been used for fractures of the femur. There has been much discussion as to the relative advantage of the straight or flexed position, but most surgeons of the present day prefer the straight position with extension, to the double inclined plane, which at one time was much used. In the treatment of fractures of the adult the following indications should be fulfilled: I. Coaptation and fixation of the fragments. 2. Moderate extension. 3. Gentle compression and support of the limb. It matters little what apparatus is used if these rules are followed, but that which can be applied with the least disturbance of the fractured bone and the most comfort to the patient should be preferred.

Each surgeon having become thoroughly acquainted with the application and results of his favorite method, is loath to change his apparatus. However, I think that what is known as Buck's method, or a modification of the same, will meet the requirements of almost every case of fracture of the shaft and give the greatest satisfaction. This is applied as follows:

The patient should rest upon a hard mattress. Reduce fracture by extension and counter-extension; cut two strips of adhesive plaster about two and one-half inches wide, and long enough to extend from above the knee to about six inches beyond the sole. Lay these strips upon the outer and inner surfaces of the leg, exactly opposite each other. The roller should then be applied, commencing near the toes. The bandage is interposed between the strips and integument until above the ankle-joint; then the roller is continued outside the strips of plaster up to the knee. In order to prevent pressure upon the malleoli a stick about four inches in length is placed between the ends of

the adhesive strips, thus forming a loop, and the extensionweight is attached to this by a cord which passes over a pulley in an upright fastened to the foot of the bed. The pulley ought to be one or two inches higher than the malleoli, so as to lift the heel gently from the bed. The amount of weight varies somewhat with the patient,- usually from fourteen to twenty pounds. To effect counter-extension, make a wedge of thin boards, six inches at base and three feet long, and slide it under the mattress.

Coaptation splints should be applied on the sides, back and front; these should be held in position by strips of adhesive plaster, and then a roller applied. To obviate the tendency to eversion which exists, long bags, filled with sand may be laid along either side of the leg and thigh, and large sand bags should be placed on each side of the pelvis; or in place of the sand bags a long side splint may be used. The splint should be four inches wide, and extend from near the axilla to beyond the foot. From the lower end a foot-piece should project six inches outward, to more effectually prevent eversion. This splint should be well padded and firmly secured to the leg, thigh and body.

The extension should not be dispensed with until the union is complete. The usual time required in the case of an adult is from six to eight weeks. When the support is removed the patient will have some pain and often swelling. When the patient is permitted to leave his bed a pair of crutches must be used, and but little weight should be borne upon the limb for the following two months.

The following case came under my care last winter: Mr. C., age 76, a farmer, was leading a calf, when he was thrown to the ground, fracturing the left femur near the junction of the upper and middle thirds. He was placed on a Crosby bed, and Buck's method of extension was used. For the extension weight at first, I used two sad-irons, each weighing eight pounds. Sand bags were placed each side of the pelvis, and on the outer and inner sides of the leg and thigh. At the end of the fifth week about one-third of the weight was removed, and at the end of the seventh week the weight was all removed. The patient was kept in bed another week, then was allowed to get up and move around on crutches. I had him wear a shoe with a sole one inch thick on his right foot. He was not allowed to bear any weight upon the injured limb for six weeks after he commenced using crutches. There was shortening of fiveeights of an inch. At the present time he goes around as well as before the accident, does not limp, and he says the leg is equally as good as the other.

ADDRESS DELIVERED AT THE EIGHTH ANNIVERSARY MEETING OF THE CALCUTTA HOMOEOPATHIC CHARITABLE

DISPENSARY.

BY DR. D. N. BANERJEE.

Mr. President and Members:

I take the first opportunity that presents itself to offer my most sincere condolence in the afflicting dispensation of God, which has overtaken Her Most Gracious Majesty, the Queen and Empress of our country, in the death of His Royal Highness Prince Albert Victor, Duke of Clarence and Avondale, and I can assure you of our heartfelt participation in the feeling of sympathy throughout India with Her Majesty and family, under this most grievous affliction, entertained by all classes of Her Majesty's most loyal subjects.

I feel great pleasure in saying that this Charitable Dispensary has now existed for nine years. Its status has improved; the percentage of cures has increased; public opinion has been most favorable to us; some of our noble-hearted and respected members like Dr. Schwabe, and from the far West (Dr. Geo. E. Shipman, of America,) have come forward to help us pecuniarily, and have presented books and journals; and our learned and kind-hearted honorary secretary has increased his annual subscription. I appeal earnestly to my countrymen, and to the lovers of the healing art both here and in foreign countries, to come forward for the assistance of this Institution; and beg to mention here that their contributions will not only help this, but three similar institutions which I have established in Nolikul, Arrah and Dinapur. Let them in this matter imitate the example of Drs. Shipman, Villers, Schwabe, Oscar Hansen, Sauter, Jolly, Boniface Schmitz, Fisher, Mumaw, Ludlam and Bailey, Windelband and Sulzer, Boericke and Dewey, Hale, Hoyne, Howell, Capeday, Anshutz, James; Messrs. Burgoyne, Burbridge, and the Mellin's Food Co. of America. Foreign

people come to help us for the good of our country, but I regret to say that my countrymen cannot understand how greatly such institutions are for their own good. I therefore beg to request all of them to help these institutions, if but with a pice daily in the name of Charity. Mr. President and Members, what can be more hopeful than this, that my American colleagues are trying their best to raise public subscription for the support of this useful institution, by opening charity-boxes at their churches and in the medical societies, that our celebrated confrére, Dr. Schwabe, offered his valuable assistance for the future good of this institution. May I not expect a pice or a cent or any small coin daily from gentlemen and ladies of every calling amongst