remedies in cases of serious and copious hemoptysis. To be useful, they must be given frequently and in full doses. It may be given by the stomach or hyperdermically.

It is in copious and continued hemorrhage that ergot and its preparations are chiefly of value. In the sudden profuse hemorrhage of advanced cavity cases due to aneurismal rupture, it is not so suitable a remedy.

The object of this paper, however, has not been to prefer drugs to the hygienic and nutritional measures, to go into details of treatment, or to advocate the use of any special agent in any special condition. I have wished simply to indicate for what purposes drugs may wisely be employed, and to suggest different groups of agents applicable for these purposes, from which choice is to be made according to the particular patient, time and place. Bearing in mind that drugs for the sake of doing something should be carefully avoided, that drugs may do harm as well as good, and that no drug should be used unless for a well-defined reason.

A MEDICAL AND SURGICAL HODGE-PODGE.

By W. B. HARDMAN, M.D., COMMERCE.

Perhaps most of my audience, from hearing the title of this paper, have formed a correct idea of its tenor and scope. It is, so to speak, a medical and surgical crumbpudding a little of several things.

Every one, no doubt, who has attempted to practice medicine has encountered difficulties in his years of experience which are matters of plain sailing to him when he becomes more mature in his profession. In his early years he may know of more methods, or even know more methods, of treating diseases than he does after years of experience, but he does not know as well when and how to apply them to get the best results. He does not then know so well how to make "the punishment fit the crime." As one grows in experience he does not necessarily grow in book knowledge, but he grows in the specific knowledge of when and how to use what he already knew, or thought he knew.

In this paper I shall tell you nothing new, but I will give you a few points that have been of value to me in my experience along certain lines. I am not writing for the specialist, but for the general practitioner, who more often runs up against difficult propositions.

1. The Importance of Using on Anesthetic in Setting Fractures.—I dare say that a great majority of physicians set any and all fractures (or set at them) which come under their care without an anesthetic. An anesthetic

should be used, unless contraindicated, especially if the fracture is near to, or involves important joints. The patient is relieved of much suffering, and the results obtained are much better. Professor Bodine, of New York, will not set a Colles fracture if the patient refuses an anesthetic. He says he always sends such patients to his worst enemy in the profession, for he is sure he could do him no more harm in a gentlemanly way than to have him set a few Colles fractures without the use of ether or chloroform.

2. The Treatment of Colles Fractures.-There are, doubtless, but few of us here to-day who do not number among his friends or enemies (more likely the latter) some one who occasionally exhibits for his especial benefit a beautiful silver-fork arm. I think we can all avoid this unpleasant advertisement in ninety-nine cases out of a hundred if an anesthetic be given and the fracture properly reduced. A crooked arm from a Colles fracture nearly always means it has been improperly set. In a great majority of the cases it means the bony impaction has not been broken up, and the ends of the bones put in proper apposition. It is hard to relieve this impaction without the use of ether. When the impaction is once broken up and the bones put in proper apposition it is very little trouble to keep them there. They will almost. stay in apposition without any splint at all. The following method of treatment, which is not original with me, but which I have used in all my later cases, I consider ideal:

(1) Anesthetize your patient.

(2) Reduce the fracture by grasping the upper and lower fragments and using traction, at the same time forcibly extend the lower fragment, also using some gentle lateral motion, if necessary, to break up the impaction.

Then with free traction flex the lower fragment, at the same time with the upper hand and thumb on the dorsum of the wrist just above the fracture, use firm downward pressure, pushing the skin and tendons toward the fracture. The ends of the bone can thus be put in perfect apposition, and with the end of one thumb over the seat of the fracture may be held there, even though the arm be considerably shaken about.

(3) Use only a single padded hardwood dorsal splint that extends from the elbow to the middle joints of the fingers. Use only a thin layer of cotton under the arm. Start your bandage from the radial toward the ulna side of the arm, and when reaching the hand, bring the bandage under the end of the splint always, thus producing as much abduction as you wish. With a pad of gauze or cotton under the end of the splint and on the dorsum of the wrist, with the bandage brought around it, produce the proper flexion of the wrist.

I have an old splint here which I used on one case, and I can show you better by illustration than I have explained it in words.

With this method of treatment the patient suffers almost no subsequent pain. It is astonishing how comfortable they are, as compared with any other method I have ever tried.

At the end of a week or ten days this splint may be removed and, with the arm resting on a table, a pad under the wrist and the hand flexed, cut several layers of gauze the length of the wooden splint and a little wider than the hand of the patient; and with a few stitches unite these layers of gauze one upon the other. Dip this gauze in a milk of plaster of paris, and mould it to the back of the hand and arm. When it hardens remove it, cut off the ragged edges and tape the edges with rubber adhesive

plaster. You now have a perfect dorsal splint for subsequent treatment, which may be easily removed to massage the joint and arm when needed. This massage may be done by gentle manipulation and by alternate applications of hot and cold, with wet cloths. Often this last splint and procedure is entirely unnecessary.

If this method of treatment of Colles fractures be properly carried out, crooked arms and stiff wrist joints will be almost a thing of the past. It is, then, almost a pleasure for both physician and patient to have a Colles fracture.

3. Antitoxin in Diphtheria.-Most general practitioners hesitate or procrastinate about using antidiphtheritic serum. I have been along that road and I know how it is. You perhaps have never used it, and don't know just how to go about it. You think, perhaps, your case will do all right without it, and you can save your client. the expense. If the case gets very bad, in a very critical condition, you will, of course, use antitoxin as a last resort; using it then with fear and trembling. Thus you have reasoned with yourself no doubt, and if you have had my experience you have thus reasoned to your sor

row.

Any one who can give a hypodermic injection of morphine can administer diphtheritic antitoxin. It is necessary, of course, to cleanse the parts at the point where the injection is to be made, but the procedure is simple. The danger to the patient from using it is practically nothing. There is no question now but what it is the remedy par excellence in diphtheria. Then why hesitate? To get the best results its administration must be prompt, and in sufficient dosage, twenty-five hundred or three thousand units of XX serum being none too large for the initial dose, except in very small children. Use reliable