considerable amount of inodorous pus was evacuated. A curette was passed down to the bone and came in contact with denuded bone, and there was probably not the slightest attempt at bony union; on the contrary there was apparent necrosis of the ends of the fragments, thus necessitating in all probability further operation. A drainage tube was inserted. This caused the temperature to fall so rapidly that by December 6 it was again normal. The appearance of the leg, however, was not satisfactory, it was swollen and œdematous and pasty looking, and a bacteriological examination of the pus showed that the affection was due to the streptococcus. I felt that the case was more than usually a serious one, and although the temperature continued satisfactory, the general appearance of the patient was far from being so, and it seemed to me that, if the case continued as it was now going, the best that could be hoped for would be to save the patient's life, but with the loss of the leg close to the hip. After consultation with the family and physician, and placing the whole matter before them, I advised another operation. My idea was to expose the ends of the bone and go back far enough upon the shaft to remove these ends through the whole diameter of the bone, then to butt these broad-ended fragments directly together and wire them there, recognizing that if union took place there would be two and a-half inches or more of shortening. If union failed, it seemed then as if the leg would have to come off.

On December 11, I again opened the leg to the fracture, making a semilunar incision just inside the former one. Considerable callous was found about both fractured ends of bone, which was a symptom of encouragement, inasmuch as the previous operation had shown there was not the slightest development of callous. It seemed to indicate that the ability to secrete a callous was not lacking, only the proper conditions for the same. The ends of the bone were found in apposition and the effort at repair had been so 'successful that at first sight it seemed remarkable that there was failure.

Separating and exposing the ends of the bones, an irregular piece of bone from one-half to two-third inches long, and of considerable width, was sawed off from the upper fragment at right angles to the long axis of the shaft, and in doing this I unwittingly got at what I believe to be the root of the whole trouble, as will be explained shortly. Then from the lower fragment a piece from one and a-quarter to one and a-half inches long was removed. This was necessary because periosteum was lacking for this distance and it was thought wiser to go sufficiently far to get a section through a thoroughly nourished part of the shaft. The ends of the bone were then accurately fitted together and secured.

Examination of the fragments showed that the upper one was pyramidal, somewhat honeycombed in appearance, and easily broken up into additional pieces.

In the centre of the medullary substance of this piece was found a bit of the external part of the shaft, pyramidal in shape and completely imbedded. The periosteal surface was flush with the sawn surface of the fragment. It was entirely shut in, and must have found its present location as the result of extreme and sudden violence. Also, in this same fragment is a small piece of steel or iron, completely imbedded, bright and glistening, and surrounded by softened and discolored tissue with sinuses leading to it, and, in my opinion, this was the cause of the difficulty in obtaining a proper union after the last operation. Manipulation at that time allowed access of air, which in turn favored the development of germs which up to that time had been encapsuled.

Inflammation following this last operation, progress was not satisfactory, and on December 18 all dressings were removed and the wound was found to be septic. The leg was œdematous and enormously swollen. The wound was opened throughout and down to the bone, there being a profuse discharge of creamy pus. This was all washed out with sterile water and afterwards with peroxide of hydrogen, and the wound left wide open. Microscopical examination showed.

It was

the inflammation was caused by the streptococcus. therefore dressed daily, improved quickly, and the bony union was finally satisfactory except the shortening. He was discharged March 14, entirely well, but with about two and a half inches shortening of the affected side.

My own explanation of all this is that in the first instance, while reduction was complete, it was well nigh impossible to maintain it with so large a loose fragment from the linea aspera. This, together with the fractured bone ends, caused a series of inclined planes, besides preventing a blending of the parts by a provisional callous.

The fracture was originally caused by a direct impact of a metal such as a bolt or rod, which penetrated the soft parts to the bone in the course of his flight to the ground. This blow was delivered with such force that it broke out the large fragment from the linea aspera, and at the same time left a chip from itself behind. This was so forcibly driven into the bone that it was shut in, and when my first operation opened to it and exposed it, somewhat indirectly to be sure, but enough to light up infection, did it show itself, and this interfered with the union at that time and probably was the entire cause of failure. The second operation, removing more bone, exposed the deeper parts and also showed the beginning necrosis of the end of the bone, the latter being secondary to the former operation. Then followed the streptococcus infection.

Had union occurred under the first dressing, the probabilities are that there would have been trouble at some future time, since it is hardly probable that so much comminuted bone and foreign matter could have been successfully encapsuled and sterilized. Amputation was seriously considered at one time, and this case is recorded merely as encouragement for somebody else under like circumstances.

NOTES ON THE WATERS OF GASTEIN.

BY WALTER WESSELHOEFT, M. D.

The observations I venture to offer at this time are by no means new. But, like many other forgotten or half-forgotten experiences, they have a value which I think we should recognize and build upon. In the earlier homoeopathic literature the waters of Gastein, a health resort in the Austrian Tyrol, with their peculiarly obscure chemical and physical properties and their centuries-old fame for curative powers, were repeatedly the subject of original investigation and both scientific and practical essays, such as we rarely see in these days. Indeed, since the manufacturing chemist has come to be the teacher of the physician in all matters pertaining to medicinal therapeutics, and claims to produce substances curative for almost every known form of disease, we are too apt to overlook the fact that nature also possesses a laboratory in which she compounds remedial agents of great purity and much efficacy. For us, the waters of Gastein, celebrated as they are throughout the continent of Europe, should continue to have a very special interest, since their qualities were first studied scientifically by a member of our own school. It was the late Dr. Trolle who subjected them to modern chemical and physical tests and called the attention of Liebig, Rettenbach and others to the results he obtained. During the last two years, at the instance of the town authorities, Prof. Von Thau, of Budapest, has once more taken up these inquiries, and gives in his text-book of electro-chemistry some remarkable data which we would do well to contemplate with some care. His experiments are not yet concluded and are only partially published, but when complete will undoubtedly afford some degree of comfort to those who retain a lingering regard for the genius of Hahnemann.

The origin of these waters, like much else concerning them, is still a matter of conjecture. They gush in some twentythree springs from the mountain-side at an elevation of be

tween three and four thousand feet above the sea level, their temperature varying according to location from 120° to 170° F. Although they pass through gneiss and conglomerate rock, it can be shown that they derive none of their chemical constituents from these formations. They are collected in reservoirs admirably constructed, and distributed through wooden and galvanized iron pipes to the various hotels and baths, where they are used by thousands of patients anually for a great variety of ailments.

Their temperature makes it evident that they come from a great depth beneath the earth's surface, but unlike other hot springs and geysers, their chemical composition gives no clue to the strata in which they take their origin. Like the waters of Poland Springs, in Maine, they are as pure as spring waters can well be, containing in 10,000 parts less than three parts of solid matter. From this it is assumed that they originate in steam produced at an intense heat and condensed in the cooler strata through which they pass to the surface. These matters are still under investigation. To us they are of int erest only in consideration of the unusual purity of the water and its unquestioned effect upon certain pathologic states, proved by many centuries of experience.

The chemical and physical properties of all the springs are the same, showing them all to be of one origin although escaping through different channels.

The chemical analysis of Prof. Ludwig and others shows the water to contain potash, soda, lithia, caesium, rubidium, calcium, strontium, magnesium, aluminium, iron, manganese, arsenic, chlorine, fluorine, sulphuric, phosphoric, carbonic and titanic acids, and one or two volatile organic acids. With the figures in fractions of the quantitative analyses I will not weary you. Suffice it to say that these substances are present in almost infinitesimal amounts, of which the sum is, as before stated, between two and three parts in 10,000 or, to be exact, 2.421 parts in 10,000. Which of these constituents may be the bearer of the curative virtues no one can say. For us these waters constitute one substance or, better, one