gia will soon be rid of her habitues. Now, some brother will say, "What is the number of habitues in Georgia?" "Why, it will break the State to relieve them." If that be the case, the more the necessity to interfere and that right now, and I want to state right here that the immensity of this undertaking is beyond individual comprehension, and the only thing that is necessary for the people at large to aid the physicians is that they be thoroughly informed as to the status of affairs, for the masses are almost wholly ignorant as to the vast number of our inhabitants who are addicted to this terrible habit. For as you well know the one addicted to the habit is always anxious to keep his own council. Another thing we might do, let us ascertain through the profession the number of habitues which physicians prescribe for during a specified time and also how many could defray their own expenses, with treatment given free. But you say, suppose you find one who refuses to take the treatmentwhat then is the course? Simply refuse to give a prescription for the drug and he will of necessity take the treatment, or suffer the consequences. Since the new law has been in effect relative to the sale of narcotics, the physician has been besieged almost daily by the unfortunates, and it is simply impossible to get rid of them without writing a prescription for the drug, and it is a pitiable. sight to behold a human being so tightly bound by habit. Gentlemen, let us help them, let's ask our State to relieve them. It is within our power and I am firmly persuaded that she should not probihit the sale of such drugs and leave the child of its domain to die in consequence of such deprivation, or suffer the torture of the damned in consequence of such denial, unless she offers assistance in a substantial manner. Georgia should not only stop the sale of drugs of this class, but every patent nostrum that contains

it in such quantity as will lead any one to form a habit, and she should as promptly offer assistance to those who need such, and thus rid her borders of the most degrading and damaging curse we have. Now, what say you? Is the undertaking too stupendous? Does not the end warrant the effort? Are we true to our calling if we refuse the undertaking? What says the Medical Association of Georgia?

TREATMENT OF SPRAINS.

BY THEODORE TOEPEL, M.D., ATLANTA.

Sprains are the most common form of injury to a joint. A sprain is a wrenching of a joint, producing a stretching, or laceration, of the ligaments. It is most frequent in the wrist, knee, and ankle joints. It may be slight, and the symptoms subside quickly, or it may be severe, and of uncertain length of duration.

The synovial membrane is compressed on one side, while on the other it is unfolded, stretched or torn. Ligaments are usually stretched on one side only. Some of the fibres are torn, and sometimes the whole ligament may be detached from its osseous attachment, and even small parts of the bone may be torn off.

There is more or less laceration of vessels, with attending hemorrhage into the joint cavity and the surrounding tissues in consequence of which the limb in a few days becomes discolored for some distance above and below the joint.

The sprain is rapidly followed by swelling and inflammation of the joint and investing tissues, often very chronic and tedious. As the inflammation subsides, stiffness and pain in using the part continue for a considerable length of time, and are in some cases followed by rigidity and wasting of the limb. In individuals of a rheumatic or gouty habit of body, the inflammation of the joint consequent of the sprain is often most tedious and chronic, and will yield only to appropriate constitu

tional treatment. In strumous subjects, destructive disease of the joint may ultimately be induced.

Upon the receipt of a sprain, and after a careful examination, you find no fracture, immerse the part in hot water or have hot compresses applied for one hour, or place the part in a dry, hot-air apparatus, and expose it to the dry hot air, the temperature being about 300′′ F, for one hour, to relax the tension, then treat with massage, beginning with gentle friction, gradually increasing in force (as a peripheral nerve sedative), follow with gentle kneading, long-continued, beginning at a distance from the injury and gradually approaching it. End with palmar percussion. Bandage tightly with wet bandage, then order ice bags to take down the inflammation, and insist on perfect rest. Keep the joint elevated for twelve to twenty-four hours in order to limit the formation of passive congestion in and around the joint.

On the second day repeat the treatment of first day, omit ice, and add passive circumduction and passive flexion and extension. On the third day use treatment of the first two days with resistive movements added. Encourage activity between treatments after the second day. Remove the bandage permanently the third or fourth day.

A light sprain takes from seven to ten days to cure, though one of hip and shoulder requires longer time, and it is safer not to use them for one week.

Except in the case of unusually severe sprains, where ligaments are torn or detached, movements of the joint, passive, active and resistive in their order, when properly supported, are very beneficial. When there is much. effusion in the joint, the limb should be kept elevated, and active movement of the joint suspended until the

effusion has subsided. If the injury has been severe, where tendons have been torn across, or have become detached, and the part is very sensitive to motion or jar, the joint having been protected with gauze, is fixed in a light plaster bandage. This is cut after the eighth day to allow for daily massage and exposure to hot air, which is of great service in hastening the absorption of the effusion. Care must be taken to return the limb to the cast after each treatment in exactly the same position as when the cast was first moulded to the part. In most cases, this procedure must be continued for about four weeks. I consider this method superior to that of applying adhesive strips, where the physician is unable to do anything more for his patient, who, in many cases, is left to rely upon nature to affect a doubtful cure. The use of hot air and massage is of great service in relieving the discomfort and especially in stimulating the circulation of the blood, upon which repair depends. As soon as practicable, begin the use of active and resistive exercise to prevent stiffness, and to strengthen the weakened tendons and ligaments. Resistive exercises are especially indicated in this condition, because of the necessity of localized movements which must be confined to the affected tendons and ligaments.

A chronic sprain may be the result of an inefficiently treated acute injury, in which an improper attitude, originally assumed to spare the sensitive part finally becomes habitual. In other instances persistent disability may be the result of fixation of the joint for too long a time in splints. Such disuse causes atrophy of the muscles and of the bones as well, while the effused material within and without the joint remains, because of the imperfect circulation.

The same disability may follow simple disuse of the