14. Sept. 13, 1897.-Willie Jacobson, 12 years old, fell from a window of second story sustaining a T fracture of lower end of humerus, also a complete backward dislocation of both ulna and radius at the elbow; the joint was very much swollen and discolored.

Treatment: anesthetized, reduced, and a plaster cast applied with the forearm extended for eight weeks. Result perfect.

15. April 7, 1898.-Arthur Cohen, 7 years old, fell down one flight of stairs, sustaining an oblique fracture of lower end of humerus separating the internal condyle and backward dislocation of ulna at the elbow; marked deformity and swelling of the joint.

Treatment: anesthetized, reduced, and a plaster cast applied with forearm extended for seven weeks. Result perfect.

16. Sept. 18, 1898.-Louise Hyle, 7 years old, by a fall fractured left humerus through external condyle.

Treatment: anesthetized, reduced, and a plaster cast applied with the forearm fully extended for six weeks. Result perfect.

17. April 20, 1898.-Baby Herdlicka, 1 year old, fell down stairs and fractured lower end of right humerus through the condyles. This was in all probability a separation of the whole epiphysis.

Treatment: anesthetized, reduced, and a plaster cast applied with the forearm fully extended for five weeks. Result perfect.

18. Nov. II, 1897.-Assyrian boy, 14 years old, by a fall sustained an oblique fracture through lower end of humerus, separating the external condyle.

Treatment: anesthetized, reduced, and a plaster cast applied with forearm extended for six weeks. Result perfect.

19. Dec. 4, 1898.-Assyrian boy, 10 years old, fractured radius and ulna near elbow-joint.

Treatment: anesthetized, reduced, and a plaster cast applied with the forearm extended for five weeks. Result perfect. 20. March 14, 1898.-Nic Miller, adult, transverse fracture of olecranon.

Treatment: plaster cast, forearm extended.

This man removed the cast himself before the end of two weeks and reported that his arm was all right. The joint was, however, still swollen and we have received no report of the case since. In this case an anesthetic was not used.

21. Aug. 2, 1896.-James Duffy, II years old, fell from a turning-pole and sustained a comminuted fracture of lower end of left humerus. This injury consisted of a supracondylar fracture and an epiphyseal separation of the internal epicondyle. The joint was very much swollen.

Treatment: anesthetized, reduced, and a plaster cast applied with the forearm extended for four weeks at which time the Motion boy's mother insisted on having the cast removed. was then limited to 45° flexion, and after using the arm for a few days with no dressing except a roller bandage the boy returned to the office with the joint swollen, and motion painful and less free than when the cast was removed.

The mother consented then to the application of another cast, which was worn for two weeks. Motion then was practically what it had been when the first cast was removed and passive motion was begun. The arm was occasionally flexed, by using force, to a right angle, which caused the boy much pain, and for a few days following such treatment the motion was less free. After several weeks' treatment in this way we concluded that it was decidedly of no benefit to the joint, and left the case to nature. At the present time all movements at the elbow-joint are free, with the exception of flexion, which is only a trifle less than to a right angle. For all working purposes this is practically a perfect arm, much more so than if fixed at a right angle.

22.

Oct. 20, 1900.-Bessie Lilly, 9 years old, fell from a fence and sustained a comminuted fracture of lower end of right humerus, both condyles being separated from each other and from the shaft of the humerus; joint very much swollen.

Treatment: anesthetized, reduced, and a plaster cast applied with the forearm extended for six weeks. Motion was then found to be limited to 45° flexion. Passive motion was employed for two weeks with the result of increased swelling and a lessened degree of flexion. A fixed dressing was then applied for two weeks with the arm flexed as much as it could be. After the removal of this dressing the treatment was left to nature, and at the present time all movements at the elbow joint are free, except that flexion is limited to a little less than a right angle. The arm is a useful one, there being practically nothing disabling about it, as she uses this arm on all occasions in preference to the other.

23, 24, 25, 26.-During the summer of 1896 there had been a circus in town, and some very alluring acrobatic feats were exhibited. As a result we were called upon during the ten days following this circus to treat four boys who had sustained fractures of the lower end of the humerus, all being caused by falling in an attempt to duplicate the circus performance. These cases were treated as patients of the city and county, and we have not the definite records which are noted in the other cases. However, the same treatment was used in all,-anesthetized, reduced, a plaster cast applied with the forearm extended from six to seven weeks, and the results were all perfect.

27. Suppurating case, Oct. 1898.-Boy, 13 years old, charity case, came under treatment one week after injury to elbow, which consisted of a compound comminuted fracture of condyles of left humerus described as a T fracture. The joint was very much swollen, suppurating freely, and the tissues infiltrated with pus.

Treatment: irrigation, antiseptic dressing and plaster cast applied with forearm extended for five weeks. Motion then was free in the elbow-joint, but flexion was limited to 45°. Case never seen afterwards.

28. Reported by Dr. J. T. Christison. Oct. 15, 1901.Thompson, boy 9 years old, oblique fracture of lower end of humerus; internal condyle separated; plaster cast applied in

extension, and removed at the end of five weeks. The day following removal of cast the boy fell from a chair on which he was standing, the arm going down between the wall and radiator, producing a second separation of fragments. A similar dressing was reapplied, and removed seven weeks later. Some stiffness of joint. Result now perfect motion.

29. Oct. 12, 1900.—George Fealland, aged 8 years, sustained a compound fracture of the lower end of the humerus "supracondyloid." The wound was very slight. It was thoroughly cleansed, and dressed antiseptically. The child was anesthetized, arm fully extended, plaster cast applied from the fingers to the arm-pit, and the dressing was not removed for four weeks. Union seemed to be complete, but the cast was readjusted. No attempt at motion was made at the joint, and the child wore the cast four weeks longer. Result perfect.

30. Dec. 30, 1901.—Lammers, aged 10 years. Fracture of the external condyle. Did not consult a physician for one week after the injury. The swelling about the joint was considerable, and was very tender. This child was not given an anesthetic, as it was easy to demonstarte a fracture of the external condyle, since he was very thin, and gradual extension and traction relieved the pain as it relieved the reflex muscular spasm. This cast was removed at the end of two weeks, as we were anxious about the relation of the fragments, for in this case we attempted treatment without an anesthetic, but no motion was made at this time, and the straight position was continued for eight weeks, and then the child began to use the arm, and is now perfect in every respect.

The results obtained in cases Nos. 21 and 22, while being imperfect, are not really bad results as to usefulness. Physical examination of these cases at the present time shows in each that the internal condyle was not properly replaced at the time of dressing, for in each the epicondyle can be felt displaced forward and outward, and firmly ossified to the anterior surface of the lower end of the humerus. This was corroborated by the fluoroscope, and when flexing the arm this bony protuberance could plainly be seen to lock further flexion. The removal of these displaced condyles will undoubtedly be followed by much better flexion.

CONCLUSIONS

First, this is a dressing of easy application. Second, in most instances it is the most comfortable for the patient. Third, the circulation is less interferred with. Fourth, it is shown in our own cases and in those of others that the fracture of the external or internal condyle is the most frequent fracture, and that the muscles arising from these condyles have a tendency to draw the

fractured portion toward the median line and in front of the elbow-joint, thus blocking flexion, and being easily held in position with the straight splint (Fig. 2). Fifth, if there is a great deal of callus there is no danger of the

Not one of the cases here reported.

Photograph of arm, as shown by the X-ray, flexed to the limit, dressed at a right angle, and showing a not infrequent result. olecranon fossa becoming filled with it, thus blocking extension, and the olecranon process furnishes an admirable splint to keep in place the fragments when the con

dyles are fractured. Sixth, the traction which is made with extension and supination keeps the normal bony surfaces, with the exception of the epitrochlear surface

Not one of the cases here reported.

Photograph of arm, as shown by the X-ray, flexed to the limit, dressed at a right angle, and showing a not infrequent re

sult.