make a sort of skeleton fracture-box, with four longitudinal wire splints, and a foot-piece inclined at a proper angle. The wires are connected by sliding cross-bars, which give firmness to the entire frame-work. The two upper cross-bars serve to suspend the apparatus in a Salter's cradle by means of two pairs of pulleys, and are curved so as to allow the lower pair of pulleys to travel transversely through an arc of about thirty degrees. The limb is thus allowed to find naturally its position

of greatest ease, which is an attitude of slight rotation outwards. The object of this arrangement is to avoid consolidation with inversion of the lower fragment and foot, a result which is sometimes found to have occurred when the foot has been kept vertical in a fracture-box throughout the treatment. Free antero-posterior motion is obtained by means of another pair of pulleys traveling back and forth along the longitudinal wire at the top of the cradle.

Adhesive-plaster extension is provided for in the following manner: at the upper end of the frame, on either side, are projecting arms, formed of loops of wire, on the vertical portions of which, as axes, rotate a pair of upright spools of hard rubber, five inches apart. The counterextension strips of adhesive plaster are reflected around these spools, and thence pass downwards to a pair of buckles, by which they can be drawn tight. The extension strips, on the other hand, are fastened around the lower end of the frame, below the foot-piece.

1 Since writing the above remarks I have seen a description of a somewhat similar contrivance for suspension, devised by Dr. Geo. A. Van Wagenen. See the New York Medical Record, 1873, page 145.

The limb, secured by the tightened strips of adhesive plaster and by the foot-piece, without pressure upon the heel, occupies the axis of the frame-work. Accurate coaptation is then effected and maintained by means of strips of bandage suspended to the wire splints by as many pairs of buckles with S-shaped attachments. In default of the latter, strong pins might perhaps suffice to fasten the bandages to the wires. The leg, exposed to view on all sides, as shown in the wood-cut, is thus supported at various points, and any tendency to displacement of either fragment in any direction is readily recognized and obviated. If the upper fragment, for instance, is seen to project forwards, as is so often. the case, it can be effectually restrained by means of a strip of bandage buckled on to the two lower wires in such a manner as to exert direct downward pressure upon the protruding fragment. The position of this strip should be slightly varied from day to day, to avoid the ill effects of long-continued pressure on one spot; and if necessary a short coaptation splint, properly padded, can be applied to the limb underneath the strip of bandage. By this simple means the displacement for which Malgaigne devised his pointed screw is effectually prevented. If, on the other hand, the fragments show a tendency to become displaced inwards or outwards, they can easily be kept in proper position by means of bandages so arranged as to exert lateral pressure at any point in either direction.

Such is the apparatus and its mode of application. This use of four wire splints surrounding the limb on all sides without being in contact with it or concealing it, and controlling the fragments by means of semi-encircling loops of bandage, is, so far as my knowledge goes, a novelty. The apparatus proved successful in two cases in which it was applied by me at the Necker Hospital in Paris, when interne under Professor Guyon in 1872. Both were cases of compound fracture, which had been doing badly in wire gouttières. Both began to get well as soon as the limbs were placed in this apparatus, which, however, did not then comprise extension by adhesive plaster, the limb being supported by a posterior wire splint.

Suspension I believe to be a valuable means of treatment, insufficiently utilized by the profession. When the injured limb is immobilized, anchored, as it were, to the bed, in a heavy fracture-box, every displacement of the patient's body is directly transmitted to the upper fragment, while the lower one must perforce remain motionless; the former, impelled from above as the patient sinks towards the foot of his bed, is forcibly driven downwards over the latter. Moreover, with every slight movement, be it only a cough or a sneeze (as may be seen by watching the exposed ends in a compound fracture), the sharp end of the upper fragment is kept digging at the superjacent skin, until perforation sometimes ensues. But when the leg swings freely, the

upper fragment cannot move independently of the lower one; the entire limb sways back and forth, without any motion taking place between the broken ends, whose relations remain undisturbed however restless the patient may be. He can thus be allowed some liberty of motion, so that his position is much less irksome than it is when his broken limb is kept motionless, with the expectation that he will remain so likewise. This is, however, not the only way in which suspension is of benefit. It also serves a useful purpose by keeping the limb flexed, whereby the muscles of the calf are relaxed, and the liability to angular displacement with projection of the upper fragment forwards is counteracted. It is true that flexion at the knee only would increase the tendency of the anterior muscles of the thigh, acting through the ligamentum patellæ, to raise the upper fragment, but the accompanying flexion at the hip-joint, by which the quadriceps femoris is relaxed, fully compensates for this unfavorable action. For these reasons a position of flexion at both knee and hip, as in Pott's method of treatment, seems preferable to the straight or extended position.

Extension by means of adhesive plaster is resorted to in this apparatus; rather, however, for the sake of the additional support which is thereby afforded than with the idea of diminishing the extent of the overlapping by drawing down the lower fragment. It must often be extremely difficult, if not impossible, to elongate the shortened limb by this means, for, when extending and counter-extending strips of plaster are so arranged as to pull against each other through an intervening patch of tightly-stretched skin, each must be effectually antagonized by the other. It can hardly be possible to draw down the lower fragment by this means,1 unless each segment of the broken limb is firmly grasped by circular strips of plaster, prevented from slipping by resting upon bony prominences (malleoli, condyles). Such circular constriction must often be out of the question, especially in compound fractures, where the vulnerability of the soft parts is greatly increased.

In compound fractures this apparatus seems to offer some advantages. The strips of bandage can be so arranged that the wound remains readily accessible for changes of dressings, and, if soiled, they can be removed or changed singly, with little or no disturbance of the limb. If necessary the wound can be laid bare and thoroughly washed, a basin being placed beneath the leg.

My chief object in publishing this description of my apparatus has been to call attention to the resources afforded by a new form of wire frame-work taking the place of a fracture-box. Such a frame can readily be made by a smith, at little cost, from the design of the surgeon, and with a few pulleys and buckles, or perhaps pins, can be made to fulfill all the complex indications of a difficult case. If a Salter's cradle

1 See F. H. Hamilton on Fractures and Dislocations, fifth edition, 1875, page 496.

be not at hand other means can be employed for suspending the frame, such as the gallows devised by Dr. Van Wagenen,1 or, better still perhaps, the ingenious contrivance for suspension lately described by Dr. Wm. D. Robertson,2 in which a really efficient means of extension seems to be provided.

RECENT PROGRESS IN PATHOLOGY AND PATHOLOGICAL ANATOMY.3

BY R. H. FITZ, M. D.

PATHOLOGICAL ANATOMY.

4

Regeneration of Nerves. - Gluck has recently conducted a series of experiments with reference to the healing of nerves after they have been cut. The sciatic nerve of fowls and the pneumogastric of rabbits were exposed and cut through, the results of the operation depending upon the subsequent relation of the cut ends to each other.

Immediately after the section was made the nerve fibres projected beyond the retracted sheath, and the myeline escaped. The cut ends were united during the next few days by a grayish-white, translucent tissue. If a considerable portion (one centimetre or more) of the nerve was removed, the intervening gray tissue became converted into a dense fibrous callus, no regeneration of the nerves occurred, permanent paralysis resulted, and the animals died during the subsequent five months. When, however, the cut ends were closely united, without the removal of a portion of the nerve, the results were quite different, being the more favorable the less the displacement. In certain cases where the nerve was simply perforated, longitudinal rows of fusiform cells, surrounded by abundant homogeneous intercellular substance, were found within seventy-two hours after the operation. These bridged over the interval between the cut ends, sometimes extending from a central to a peripheral fibre. After eight days the ends were united by non-medullated nerve fibres, which slowly and gradually became thicker.

When the nerve was wholly cut across, and the ends united by sutures, the healing process took place in a similar manner, more time beng required. Within eighty hours after the operation the wound was closed by a gray granulation tissue, in which, within a fortnight, spindle cells arose, apparently from the nuclei of the neurilemma, and served to

1 Medical Record, 1873, page 145. F. H. Hamilton on Fractures and Dislocations, fifth edition, 1875, page 492.

2 See the JOURNAL, May 23, 1878, page 662.

8 Concluded from page 670.

Virchow's Archiv, 1878, lxxii. 624.

unite the cut axial fibres. A differentiation into axis-cylinder and myeline apparently took place later within these cells.

The author considers that the newly-formed fibres arise from these large granular spindle cells, which are to be regarded as of new formation rather than as outgrowths from preëxisting fibres. They resemble ganglion cells rather than those of connective tissue.

The results of the histological examination were confirmed by physiological experiment, the time of the return of the function to the nerve trunks corresponding with the appearances observed under the micro

scope.

Diagnostic Value of Epithelium in Sputa. -Since Buhl, in 1872, declared that acute miliary tuberculosis and cheesy pneumonia could be diagnosticated by the microscopic examination of the sputa before evidences of solidification could be obtained by auscultation and percussion, numerous observers have directed their attention to this subject. The results in the main have been corroborative of the statement of Buhl, although Fischl has maintained that the sputum from a simple catarrh did not differ from that occurring in phthisis. Heitler1 has therefore endeavored to ascertain whether forms of epithelium are to be found in the sputa from diseases of the lungs terminating in phthisis which do not occur in those pulmonary affections not ending in this disease.

His results have been wholly negative, and he further maintains that it is not always easy to determine whether the epithelium found in various affections of the lung is to be considered as coming from the alveoli. In this respect he agrees with Fischl, who states that epithelium from various parts of the respiratory tract resembles that coming from the alveoli. The only forms which are wholly characteristic of their place of formation are the large pavement cells and the ciliated epithelium. All other varieties may come from different parts of the tract, and may become so altered after being detached that their original form is no longer to be recognized, just as is the case with cells found in the urine.

Attention is called to the greater quantity of epithelium in the sputum from certain cases than in that from others. In abundantly purulent sputum the epithelium is often scanty, while again sputum may be found composed almost wholly of large, round, or angular fatty degenerated epithelium, the pus corpuscles being exceedingly few. The latter variety was present in a case of chronic bronchial catarrh occurring in an otherwise healthy individual. The so-called alveolar epithelium was also observed in a case of pulmonary œdema; at the autopsy, however, the parenchyma of the lung was found to be quite healthy. In many cases of infiltration of the apices these epithelial cells were quite numerous, while in others they were absent. They might even be quite abundant on certain days, while in the same case they were wanting at other 1 Wiener medicinische Wochenschrift, 1877, xlix. 1185.