1896. Horse stepped on right wrist, one and one-fourth inches from wrist-joint; ulna was fractured-simple fracture. Considerable extension on hand to reduce-under chloroform. Flat wooden splints internal from elbow to wrist-joint; external splint from elbow beyond ends of fingers; little padding used. Bandage tightly applied over arm and hand to fingers before swelling and application of splint. No cotton used over hand. Pain very severe for two weeks. Bandages were loosened one month after accident. Fingers much swollen and discolored morning after accident. Two weeks after injury sloughing began at outer side of little finger, proximal end of thumb, inner aspect of wrist, back of hand, and at end of splint near elbow. Ulceration at base of little finger and thumb deep, at other points superficial. Dressing was allowed to remain two weeks longer, during which time there was considerable suppuration. When dressings were removed four weeks after their application they had adhered to ulcerated surfaces, and a considerable amount of pus escaped. Ulcerated surfaces were covered with unhealthy granulations. At this time there was no sensation in the fingers; they were pale in color, both fingers and wrist were straight and stiff, and there was no motion in either of them. Ulcers were dressed with ointment. In one week, as soon as circulation was somewhat improved, there was decided wrist-drop and flexion of all the fingers tightly into the palm of the hand. The thumb was so closely bound down to the hand that a knife blade could hardly be passed between them. Radius and ulna were united. One week after removal of the first dressing perforated tin splints were very loosely applied internally and externally, and an effort made to over. come wrist-drop without results. These were not left on long. The ulcers were healed some time in December. During the latter part of January patient was given electricity and massage in Atlanta for three weeks. She was given home treatment similar in character, for about one

year. Radius and ulna were separated about six months after the accident. The skin over the back of the hand which was closely adherent at first, was gradually loosened by means of manipulations. At the present time the length of the middle finger of the right hand is 2 3-8 inches, while that of the left is 2 3-4 inches. The circumference of the right hand at the base of the fingers is 6 inches, while that of the left hand is 6 3-4 inches. The length of the right ulna is 9 1-4 inches, while the left is 9 1-2 inches. I have here some radiographs showing the present condition of the bones in the arm, wrist, and hand. The accompanying radiograph gives a very good idea of the position of bones as they were when patient first came under my observation.

I wish it to be expressly understood that this case was not seen by me until a short time ago-over two years after the injury occurred. Since that time I have been using electricity and massage, and have broken up to some extent a part of the firm adhesions.

My object in bringing this case before the Association is to give them a living object-lesson that will show them how easy it is for the average surgeon to make a mistake, and the dire results that may follow.

SOMETHING OF THE TACT AND PATIENCE NECESSARY IN THE PROGNOSIS AND TREATMENT OF CHRONIC DEAFNESS.

BY ARTHUR G. HOBBS, M.D., ATLANTA, GA.

Walter Besant has defined a "knack" as a something that cannot be taught, but must be caught on to. In the prognosis and treatment of chronic deafness "tact" is not unlike this "knack" as defined by the novelist. Here, tact must be caught on to, and it must always follow experience, however naturally it may seem to some in applying it elsewhere without experience.

Patience, like tact, may be born in one-it may be a natural attribute of a hopeful nature or a phlegmatic temperament-but it requires a special nursing and a careful development before its possessor can hope to reach any decided success in the treatment of deafness. It is true that it may be said that such attributes are necessary to success in any branch of medicine or surgery, but the only excuse for the caption of this paper is that ceteris paribus, it is particularly essential here, possibly even more essential than a knowledge of all the technique of the conventional methods of treating chronic ear diseases.

Tact will compromise at first on the second best means when the patient seems averse to the first, and thereby soon gain his hearty co-operation, which is so essential; and the exercise of patience will, in the end, gain his intelligent assistance in the application, if need be, of the more effective though more painful methods. Tact will suggest when to test the hearing distance, whether, for example, in a quiet moment or during rumbling noise in the streets, and thereby encourage or avoid the natural question as to why the hearing is best, in case it is so, in a railroad train, and at the same time it will greatly assist the examiner in arriving at some form of treatment, and consequently, at a prognosis. Perhaps, better than judgment, tact will deide whether the watch, the clock, the voice, or which of the many testing instruments, is best to be used in each case, and to gain much value from the tuning fork, patience is necessary in teaching the subject what is expected of him and of the test, particularly when it is found advisable to use tuning forks of different vibrations.

The intricacy and delicacy of the hearing apparatus, when regarded from a physiological standpoint, presupposes the probability of its many and varied forms of pathology, some of which are masked and not easily recognized, hence the prognosis should always be guarded, and often not attempted at the first examination; and, indeed, not until after some test treatments have been made tactfully and patiently.

The science of medicine does not always receive its deserts from its votaries, and much more is it true that the art of medicine, which is its practice, is not honored as it should be by the persistent application of tact and patience, which are requisite to any degree of success in other arts, even when all the other necessary qualifications exist.

We cannot always comprehend the effects of any one of the many means or methods that may be resorted to in the treatment of non-suppurative catarrhal deafness, otherwise than by patient and tactful trials; and this is none the less true in the diagnosing and the prognosing of this class of ear diseases.

Since the nicety of distinction as to the cause, the charac