If a cuirass cannot be had a double Thomas hip-splint will answer the pur pose if combined with traction by weight and pulley. The wound should be dressed as frequently as may be neces sary to keep it clean, the packing gradu ally being removed as new bone regener ates from the inner surface of the peri with a most excellent joint on which the patient walks well having been reported by Dr. J. C. Spencer after the removal of nine inches of femur.
In certain cases of malignant growths or tubercular invasions, which are not amenable to ordinary operative inter ference, the removal of the lower ex tremity, together with the ilium, at one operation recommended, disarticulating at the symphysis pubis and the sacro iliac junction. Jaboulay (Lyon 11ftld., Apr. 15, '94).
Three consecutive successful amputa tions at the hip-joint, in which the fol lowing procedure was adopted. In the first place, as much blood as could be safely returned to the body from the osteuni, and in some cases Nature will form an artificial joint almost as perfect as its fellow, although this is not to be expected, and a certain amount of short ening and more or less disability usually result.
Cases of double hip disease must be treated by rest in bed or by the use of the cuirass, as it is not possible to apply an apparatus which will allow them to walk in a convenient manner and still protect the joint.
In exceptional cases amputation at the hip-joint may be a necessity to save life, but this is most uncommon, recovery limb to be amputated, by means of posi tion or elastic bandage, was so returned. Then an incision was made through the abdominal wall about inches inter nal to the anterior spine of the ilium. Through this incision an assistant passed his index finger and readily reached and compressed the common iliac artery. Entire absence of bleeding was readily maintained throughout the amputation which followed. The field of operation was free from bandage or appliances of any kind. The author recommends the procedure on account of its simplicity, its certainty, its aseptic character, and because it can be applied to cases which require that the deeper tissues should be severed at an unusually high level. In performing the amputations, it was found that this method of controlling the ar tery has the advantage that all the smaller arteries in the stump can be readily identified and ligated, it being only necessary to lift the finger for a fraction of a second and so allow a mi nute quantity of blood to escape. Charles
_McBurney (Annals of Slug., May, '97).
All affected structures should be re moved, and all healthy bone preserved. The greatest amount of healthy bone preservation and the consequent insur ance of best possible joint-function makes early incision imperative. In surance of best possible function means, besides early evacuation of intra-articu lar tuberculous products and diseased structure removal, a thorough disinfec tion. The most effective disinfectant method is the application of carbolic acid and alcohol. The greatest possible obliquity of the upper end of the bone is required if the retention of the femoral extremity in the cotyloid cavity is con tinued. This must be done by preserv ing as much of the neck as possible, but a certain obliquity could be obtained by removal of the trocnanter major when a portion of the neck is destroyed or re moved. A portable extension brace must be used for a long time to insure permanent usefulness of the hip-joint. Excision of the femoral bead, neck, and trochanter must, if possible, be avoided. Jonas (Med. Record, Jan. 12, 1901).
HOMATROPINE.—When atropine or hyoscyamine is heated with baryta water, the alkaloid is resolved into tro pine (an artificial alkaloid) and tropic acid. Tropine, mandelic acid, and dilute hydrochloric acid are then mixed, and a prolonged, gentle heat is applied; when the mixture is evaporated homatropine crystallizes out in deliquescent, color less, regular, prismatic crystals. Homat ropine is freely soluble in alcohol, ether, chloroform, and oil; more slowly in water. Its salts with hydrochloric, hy drobromic, and sulphuric acids arc white and crystallize well. In therapeutic prac tice homatropine hydrobromate is most generally used. It occurs in small, white, lustrous, non-hygroscopic crystals, and is soluble in 10 parts of water. The solu tion is quite permanent. For internal use homatropine may be taken in doses of 7120 to grain.