but surely evolving a regular school of medicine which will stand preeminently above all other schools. Other schools always will exist for there are millions of people who seek mystification and the unknown. This school of medicine of the future will not put stress on the virtue and power of drugs alone to heal the sick.

It is true every plant and mineral that has not been gathered, will be; and will be investigated chemically and physiologically until we have a definite knowledge of its potential power to produce a given physiological effect under known and certain conditions.

This, then, is the age of exact scientific medication. We must know the physiological action of each remedy we administer. Within the last half century the cause of almost every diseased condition of a contagious or infectious character has been worked out definitely; this leads to specific medication. If we have a patient who has imprudently overloaded the stomach and is suffering from this condition, we know we have a remedy in apomorphine or ipecac that will relieve him. If we have a patient with a weak heart we know we have a remedy in digitalin that will make that heart work with more force, or if the heart is hammering away with great force, we know we have a remedy in veratrum that will calm the heart and soften the pulse.

If we have a patient suffering some agonizing pain we know we have a remedy in morphia that will banish that pain and frown and pinched expression from the face and crown the brow with a halo of joy.

If we have a patient with a broken bone we know we have a remedy in the anaesthetic that will suspend all sensation and hold the patient between life and death until the broken bone can be adjusted.

No greater boon has been given to poor, mortal man than this general anaesthetic, by its power to suspend sensation, surgery has made a most marvelous advance in the last twenty years; it has enabled the suregon to go into the very citadel of life with his cold steel and thread and needle and restore to life, home and loved ones, many a one who, otherwise, would go to a premature grave.

The microscope has in very recent years lifted the veil off of an invisible world to us. As we look down through it we see millions of pathogenic organisms. These lowly forms of life are responsible for a very great per cent of all the suffering and death in the human race. They are responsible for puerperal septicemia, influenza, meningitis, pneumonia, measles, scarlet fever, dyspepsia, typhoid fever, hydrophobia, the great white plague and a great many other pathological conditions. In this class of cases, the vaccines, antitox

ins, serums and phylacogens, will in the near future be our first, if not our only remedies.

Beyond all this class of cases that can be relieved by drugs or vaccines there are many other forms of sickness that must be reached by some other means.

There is perhaps twenty millions of people in the United States treated every year for forms of sickness that do not come under the class I have referred to in the foregoing pages and are not relieved by drugs, serums and antitoxins.

In this class of human frailties which I shall now bring before you is the great field of speculation.

Here the theorist finds his most prolific field. Here it is that the charlatan and the

pretended's purse grows fat on the gulibility of poor frail man.

We have those with us who are fear-sickjoy-sick, society-sick, fashion-sick. jealousysick, sin-sick, religiously-sick, disappointmentsick, love-sick, home-sick and a long list of other mental conditions which must and will be treated.

These cases should at all times be treated by the regular profession upon scientific methods and not be allowed to drift to the hoodoo man.

These are real cases of sickness and must be treated but not by drugs or vaccines.

This is the class and these are the people who keep the patent medicine on the market

This is the class and these are the people whom the charlatan and the pretender appeal to with success.

This is the class and these are the people who have helped to multiply the number of church denominations.

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This is the class and these are the people who have organized so many "isms” and creeds in the healing art.

This is the class and these are the people who follow John Alexander Dowe and Mrs. Eddy in their unscientific and false theologieal teachings.

Far away across the fields of the centuries at the dawn of historic time the medicine man was groping his way in darkness; songs, incantations, charms, superstition, ignorance and hoodooism were his chief remedies.

Scientific medical knowledge was locked up in man's brain and possibilities, as the rose is locked up in the bud through a long winter night.

In those far-off times men were healed by the direct power of God. Ex. 15:26: "If thou wilt diligently hearken to the voice of the Lord thy God and will do that which is right in his sight and will give ear to His commandments and keep all His statutes. I will put none of these diseases upon thee which I have brought upon the Egyptians, for I am the Lord that healeth thee.

As the years slipped away into the centuries, Jesus came into the world to set up a spiritual kingdom. He healed all manner of sickness and that, too, without medicine. “And Jesus saith unto him, I will come and heal him.”—Matthew 8-7.

This was the man sick of palsy. Jesus said unto the Centurian, "Go thy way and as thou hast believed so be it done unto thee." And the servant was healed in the selfsame hour.

Was it faith, and by whom? Matthew 10:1: "And when he had called unto him his twelve disciples he gave them power against unclean spirits, to cast them out and to heal all manner of diseases."

Acts 14:10: "The same heard Paul speak who steadfastly beholding him and perceiving that he had faith to be healed, said with a loud voice, stand upright on thy feet and he leaped and walked."

I make these quotations to impress the fact that spiritual healing, faith healing, mind healing, had their beginning before scientific drug healing and is not to be scoffed at or taken lightly, but to be looked into earnestly and with a desire to find the truth and the facts. These stand preeminently by right of age. Here, then, we stand on the border line tween the mind of one human being and that of a great subject.

There is an invisible connecting link beof another. The veil has not been rolled away and we do not see the soul and life with our physical eyes as an open book, yet wireless messages pass in silent hours which may change the hopes and destinies of many a one for weal or for woe.

Faith and thought are the elements that have wrought their marvelous and sometimes apparently miraculous cures.

Many an old splint and bandage and crutch were left at John Alexander Dowie's door, as he claims, in answer to prayer; he taught that the existence of a physical body afflicted with disease because the devil controlled it. He cured hundreds.

Mrs. Eddy cured thousands and founded the sect of Christian Scientists; she taught that there is no physical body, no sickness, that these things exist only in the mind.

These teachings are absolutely opposite and both can not be true.

It is a problem of mind cure and the elements of cure are not in the correctness of the theological teachings, but the intensity of the faith in the idea of the sick person. It is the new thought, the faith, the intense belief that cures and not one particular system.

The mind is that part of man which thinks. It is the inner man, the soul, the thinking heing. It is this living, thinking beng which dwells within the physical body that rules supreme in the living human being.

The brain is a physical body and is the central station through which thoughts of the soul are made manifest to the outward world. These thoughts are real entities produced through and by the brain and are sent out over the living nerves as impulses and we taste, feel, hear or speak or give expression. by some physical means. It is this thinking and sending out of wrong impulses over nerves or system of nerves, which makes a function pathological.

By some external influence, or a cause you may not be aware of, there may be produced, or coined, or created, in your brain a thought that you have heart disease, the moment this thought is portrayed upon your brain, an impulse is sent down to the heart and causes it to work with greater force or to waver. At once the will takes control, and a finger is placed on the radial artery, and on finding that the impulse of the heart's beat does not coincide with your preconceived idea of the normal, this intelligence is dispatched to the brain, then a new and stronger impulse is hurried to the heart. The circuit is now established and you have a real imaginary heart disease. You are possessed of a thought and it must be cast out.

In an unguarded moment some external influence may cause an evil thought of murder to be created in the brain, and still in unguarded moments and days be retained. Every day and hour that this thought is retained it makes a deeper impression and takes more room in the mental laboratory. This thought will grow more and more bold, wear deeper grooves over the part of the brain which is retaining it until it takes complete possession and sends out overwhelming impulse after impulse to take the life. He is possessed of a devil and it should be cast out.

Then the problem for the doctor in these cases is to know how to cast the thought out of the mind which is causing the abnorma! condition or sickness, and cause the soul through the physical brain to coin or create a new and health-stimulating thought to take the place in the brain. To do this he must know human nature, and be able to read the life lines of his particular patient and have the penetrating power to break through all of his defenses and see and know what the thoughts are which must be cast out.

His next problem is to know how to bring into existence the new thought. A normal health-stimulating thought. A correct physiological thought.

Each case is a law unto itself. First of all, you must get the attention. This may often be done through very ordinary things or events. Sometimes the daily occurrences of life may be your means of reaching one. You may appeal to others through some social

problem or church work. The attention of another may be secured through some beautiful poem:

The purple, the gold, the crimson rays,

Have set the western sky ablaze;

They burn on the fading light of day,
Like soldiers dying in the fray."

or,

"Full many a gem of purest ray serene.

The dark unfathomed caves of ocean bear, Full many a flower is born to blush unseen,

And waste its sweetness on the desert air." Still another may be reached by the melody of some beautiful words well rendered in song. You may get the attention of another of greater literary attainments by talking to him of the beauties of Calculus, or of the joys of digging out the Greek roots, perusing the Latin and plodding over the higher sciences in his school days.

Still another may be reached through that grand old classic poem:

"Of man's first disobedience and the fruit of that forbidden tree

Whose mortal taste brought death into the world and all our woe,

With the loss of Eden till one greater Man restored us,

And regained the blissful seat."

To illustrate one phase of what I have been saying, I will report one case, by your permission.

Early one bright moonlight night in October some years ago I received a hurried call to a country home some miles out from town. Being well mounted and having a good road, I was soon at the old farm house. There were about twenty people standing about in small groups as I rode up to a tree to tie my horse, some fifty yards out. One man came out to meet me and hurriedly told me of his patient. He said he had been with her for thirty-six hours and she was suffering an intense headache that heroic doses would not relieve. She was in a stage of great excitement and wild to an extreme degree. A number of means had been applied. Hydrotherapy had been used until the clothing, bedding and even the house was all dripping wet, with no relief.

The patient was a young woman of twenty summers whom I had never previously seen. Some six or eight women had spent the last ten hours in holding her in bed. As I waved them back they turned her loose, a wild shriek rang out on the still, clear night air: "Let me go, I am going to die."

With her raven black hair streaming down over her bare shoulders and back and her dark eyes flashing defiance at those who had been holding her captive; she sat bolt upright in bed.

The house had now been filled with the friends and the curious. As these stood around

in silence like neglected statutes in a long forgotten art gallery, I asked her to be silent for a moment and look into my face while I took both of her hands in mine and pressed them firmly together. Every muscle was in a state of excitement, every nerve fiber was greatly distressed. Her bust rose and fell in unison with the waves that surged and rolled through her soul.

I caught her eyes. They were dark, wild and searching. Then came a long intense silent gaze. Was I looking at the soul of a raving maniac, or was I in communion with a soul suffering intense agonies from some real or imaginary wrong?

The intense silence was oppressive. In a low voice I asked Dr. S. to give a teaspoonful from a bottle I had taken from my case. With a shudder she recoiled from this. With a firm grasp I pressed her hands and looked deep into her eyes.

In three minutes I asked her to go down on her pillow, this she did, and kept that steadfast and penetrating look into my face until I felt the cold chills creep over me. Impulse after impulse and wave after wave rolled through her soul until my face grew hot and flushed and my eyes faltered for a time. Soon all was still. The great wave of torture ceased to surge. In a low voice from the silent group a whisper came. "Is she dead?" Another, "Its all over, poor child."

I waved for silence and told them "no." that her eyes had closed in peaceful sleep.

I thought now is the storm over, while she is out somewhere, oh somewhere, in the great self-forgetting happy dreamland.

I gave instructions for only one person to stay in the room over night, and in half an hour I had returned and invited sleep, but it was long delayed in its coming, wrapped now in the darkness and silence of the night my mind wandered afar afield, and I thought now of mother, home and heaven and that troubled soul.

To go down to the last analysis, the foundation of all medical learning is to know the physical body of a human being, with its soul that thinks and wills and lives. The body with its telegraph, batteries and wireless stations. With its bones and tissues and fluids. With its hundreds of chords and bands and pulleys and levers. With its mills and laboratories and refineries and factories. With its furnaces and refrigerators and repair shops. With its rivulets and rills and rivers and locks and dams and pumping stations. With its cargo of new material forever bounding away on the crimson tide to the hands of the master builders With its dark and turbid stream freighted with the debris from the repair shop. With its picture galleries and memory walls and thinking stations.

With

its hopes and doubts and fears. With its loves and joys and sorrows. With its wonderful, mysterious, secret and silent chambers of thought and life and self.

MULTIPLE FRACTURE OF LOWER END OF HUMERUS-OPEN OPERATION.*

By GUY P. GRIGSBY, Louisville.

In reporting this case I wish to acknowledge my indebtedness to Dr. Garland of the interne staff of the City Hospital for his assistance in the operation, subsequent treatment of the patient and for his co-operation in getting up this report.

Miss May H., age 30, white, admitted to the City Hospital on February 27th, 1914. Came into the hospital for fracture of the lower end of the right humerus. Family history is negative except for specific history in the father. Patient is well nourished and in fact suffer

ed from obesity. Gives history of hereditary syphilis, evidenced by recurrent attacks of iritis and the appearance of mucous patches in the mouth. Several years ago the patient

had both tubes and ovaries and uterus removed and suffers from the resulting nervous symptoms.

On the night of February 26th, 1914, patient fell on the street injuring her right arm and was brought into the hospital. Examination the next morning showed the elbow joint greatly swollen and ecchymotic. Arm was fixed and was unable to be moved. complete fracture of the lower end of the humerus was easily made out, the upper fragment being nearly compound as it was just beneath the skin posterior.

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An X-ray picture was taken and under anaesthesia an attempt was made to reduce the fracture and put the arm in acute flexion. The reduction was not satisfactory and attempts to flex the arm were abandoned because of the fear of making a complete fracture due to the sharp end of the upper fragments. The arm was then put at a right angle and open operation was decided upon. On account of the great amount of swelling we decided to wait until this had subsided. So consequently twelve days after the receipt of the injury the patient was subjected to an open operation.

An incision about five inches long was made on the posterior aspect of the elbow. The sharp lower end of the upper fragment was just beneath the skin and pushed through the triceps muscle. The muscle was split and the lower fragments exposed. There was a wide separation of the fragments. The lower fragments were displaced forward and the space

* Read before the Jefferson County Medical Society.

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between the two was filled with a blood-clot as large as an orange. This was cleaned out and the fracture extending into the joint was clearly shown. One fragment comprised only the internal condyle, with a bridge of bone about three inches long and a half inch in width. This bridge was extremely thin because a piece had been chipped from its outer surface. All of the structures in front of the joint were dissected loose from the bone by the blood clot. They were apparently uninjured. The hemorrhage was evidently due to rupture of vein in the injured triceps muscle. The fragment composed of the internal condyle and the bridge of bone was comparatively free of the surrounding structures with the exception of being slightly attached to one portion of the internal lateral ligament. This fragment was freed and removed. clear view was then obtained of the transverse fracture about two inches above the condyle. This fracture was oblique, leaving a sharp end on upper fragment and this is what had pushed through the triceps muscle. By the use of instruments the fragments were approximated, but were difficult to maintain in position because of the obliquity of the opposing surfaces. We deemed the only way of holding them in position was by the use of a steel plate. Accordingly a plate was adjusted and the fragments and plate held in position by a Lambote clamp, while the holes were drilled and the screws inserted. After this was done and the clamp removed the fragments were held in very firm apposition. The arm was flexed several times with no appreciable movement in the fracture line. We were then confronted with the problem of dealing with the fragment composition of internal condyle. We decided to put it in position and endeavor to nail it to the other condyle. This was done by the use of an ordinary fourpenny finishing nail. This apparently held the fragments securely. There was no way of securing the upper end of this fragment as there was only a very thin spicule of bone. The opposition of the fragments after fixation was all that could be desired. However we were afraid that the internal condyle might work loose, since it was only fixed at one point. The tricep muscle was sutured with cat-gut and a small cigarette drain was left in the cavity from which the blood-clot was removed, the skin closed with cat-gut and the arm put up in moderate flexion in molded plaster splint. The patient's temperature following the operation varied from normal to 101. She suffered very little pain. Temperature was normal after about the seventh day. small drain was removed the first twenty-four hours. The wound healed without infection. At the end of two weeks, passive motion was attempted but gave patient pain and it was

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discontinued for another week. After that the arm was given massage every other day, and passive motion instituted. After the third week slight crepitus was noticed and we judged this was due to the loosening of the internal condyle. We thought perhaps this might become attached later and since there is no crepitus at present we hope that such is the case. The patient was discharged from the hospital on March the 25th wearing only a sling and use of the arm was in moderate amount encouraged. At the present time she has really full range of motion of her arm and is able to attend to any of her household duties.

I feel justified in the report of this case because of the nature of the fracture and the impossibility of any hope of a satisfactory result under any treatment other than operation.

Dr. Bayless has very kindly consented to show the X-ray plates that show very clearly the fracture before and after the operation.

DISCUSSION.

Jno. W. Price, Jr.: I wish to congratulate Dr. Grigsby upon the excellent result obtained in this case. The open operation is certainly the procedure of choice in this class of fractures. Today I saw a young man, about nineteen years of age, who had fallen from a horse when he was eight or ten years of age, and had sustained a fracture apparently very similar to the one in Dr. Grigsby's case. Open operation was not done, however, and the result as seen to-day is that the arm is fixed in a semi-flexed position, having a range of motion of only two or three inches. The upper part of the arm is completely withered and looks very much like the arm of an individual who has had infantile paralysis. He is unable to do any carrying with this arm. An attempt at carrying produces severe pain and subsequent aching which disturbs his rest at night. He is able to use the forearm to a limited extent, and also has the use of the hand, because the muscles below the elbow are not so atrophied. I believe that open operation will give this boy some relief, but the proper time to do the open operation is immediately after the injury, that is, within two or three weeks. When done at a subsequent date, there is less chance of securing a satisfactory result.

W. Barnett Owen: Dr. Grigsby is certainly to be congratulated upon the excellent result obtained in this case, especially when we consider the report made by Dr. Thomas, of the Cook County Hospital, Chicago, of a series of cases operated upon by the open method for the reduction and cure of fractures, in forty-seven per cent. of which the plates had to be removed subse

quently because of infection and necrosis of the bone.

I had the pleasure of being present at this operation, and also saw the patient prior to operation, and I agree with Dr. Grigsby that it was a typical case for the use of a plate.

Wonderful advances have been made in the past few years in the treatment of complicated and obstinate fractures, and possibly in many instances plates have been applied where the condition was not suited to that method of treatment. In other cases, the plating has been improperly done. To my mind the most decided advance in the open method of treating fractures is the bone inlay. However, I think the procedure followed by Dr. Grigsby was the one best suited to the condition present, as the injury was so close to the joint that it would have been almost impossible to have transplanted sufficient bone to have held the various fragments in apposition.

Jno. B. Richardson, Jr.: The principal objection which has been advanced to the use of the Lane plate in the treatment of fractures, is that the screws fail to hold. Evidently, however, in Dr. Grigsby's case, they have done so.

At the last meeting of the Mississippi Valley Medical Association, Dr. H. R. Allen, of Indianapolis, presented what appealed to me as a very practical device for overcoming the above opjection. He introduces an aluminum arm through each of the fragments, and solders them together by means of electricity, in such a manner that it is impossible for any motion to occur in the line of fracture. In addition to this, he has a very clever device for pulling the bones apart. He tries to get them just short of apposition. His method appears to be a most practicable one. I believe, however, that in Dr. Grigsby's case, with the injury so close to the joint, the use of the Lane plate was the proper procedure, although Allen claims to use his method successfully in the treatment of fractures of the neck of the femur.

F. T. Fort: In my opinion, fractures at or near the joint are ideal cases for the use of the Lane plate. Of course, each case must be a law unto itself; fixation is the principal thing in securing a functionating joint. If the fragments are not fixed and pull apart, more callous will be thrown out, which will impinge upon the joint and more or less immobility will be the result. In fractures between the joints, the bone should not be plated, because in following this procedure we oppose Nature's method of healing the fracture by throwing out callous, but where the fracture is at or near the joint, we can get much better results from plating.

A. David Willmoth: I wish to discuss this very interesting ease from only one standpoint; that is, with the method used and that suggested by Dr. Richardson. The use of any foreign material in the treatment of a fracture is a very