ment at the base of the lesser trochanter, pulled the limb down until the end of the lower fragment was in proper relation to what remained of the upper fragment, washed out with H2O2, closed wound with deep and superficial catgut sutures, and applied a long, fenestrated wire splint, under which extension straps extended to above the knee. A moderate weight was applied and the foot of the bed elevated. The fragment removed measured 4 inches in length and embraced fully half the circumference of shaft.

The accompanying Figure I shows the line of original fracture at the black line and the line of fracture during operation at the dotted line. The upper end of the lower fragment was united to the shaft at A.

Figure II shows the position of the fragments before operation.

Figure III shows the position at the end of operation and the gap left by the removal of the fragment.

His temperature did not go above 37.5°. Dressing removed on the fifth day and wound found to be closed throughout by primary union. Adhesive plaster strips were applied around limb, over a gauze pad, in order to relieve tension on the freshly united surfaces. He stood confinement badly, and at the end of fourth week began to cough; examination showed a few râles at apices, and a little later tubercle bacilli were found in his sputum. The splint was at once replaced by one of plaster of paris, and the patient encouraged to get about on crutches. Under ascending doses of creosote he rapidly improved. Eight weeks after operation the splint was discontinued, but extension applied at night while the limb was steadied with sand bags. The fracture of the tibia was found firmly united, and an enormous callous, feeling as large as a small cocoanut, had developed about the site of the fracture in femur. This rapidly diminished in size. The aligument of fragments was apparently accurate and the union perfect. There was, however, complete ankylosis of the knee. Careful measurement showed the limb to be 23 inches shorter than its fellow, a gain of 14 inches by the operation. He was given a high-soled shoe and crutches, but soon discarded crutches for a stick.

He went out on pass, got drunk, and wanted to kill the night nurse, so was discharged. At this time (four months after operation) his lung seemed about well, and he walked fairly well with a stick and a 23-inch sole on the shoe for the foot of the injured leg. The knee was still partially ankylosed. This rapidly improved, and he resumed his occupation as deck hand on an ocean-going steamship, being able to get about perfectly in all kinds of weather.

The infection with tuberculosis doubtless came from a patient in the next bed, who was suffering with that disease, there being no facilities for isolating cases of tuberculosis. At any rate, he did not have it on being put to bed after operation, and developed it in four weeks after being exposed to a very probable source of infection. The very large piece of bone removed and the extensive opening of the medullary canal, together with the subsequent complications, seem to render the case sufficiently unusual to warrant the report in detail.

SYPHILITIC PARALYSIS FOLLOWING URETHRAL CHANCRE.

I. H. (colored); aged 23 years. Five years ago he had a purulent discharge from his urethra. The onset was sudden, the period since intercourse uncertain, the discharge thick and creamy. Did not have marked pain or burning on urination. Had a swelling in one groin at the same time. The discharge ceased without any treatment in about two weeks and swelling in groin also disappeared. Has never had any sore throat or any eruption on body. Careful examination of genitals fails to show signs of scars anywhere. Skin over body and limbs smooth and without scar or discoloration. Has chain of enlarged glands in either groin and also enlarged post-cervical and epitrochlear glands.

Ten days ago was taken with pain in left shoulder, extending down side of chest. Pain not very severe, but lancinating in character. During that night pain became more severe and side and shoulder felt numb. He soon began to feel numbness all over-face, lips, tongue, trunk, and limbs. This was on the second day of attack, and on that night he had severe pain just under tip of xiphoid cartilage. During the afternoon of that day his legs and feet began to swell. Since the date of onset has gotten steadily worse. At present he walks with a moderate amount of ataxia, reels slightly when eyes closed, knee jerk entirely absent. More or less complete anesthesia and analgesia over entire cutaneous surface; also over lips and tongue. No involvement of the ninth pair, but marked involvement of fifth and tenth. The diagnosis was made of a multiple neuritis, of syphilitic origin, following urethral chancre. Patient put upon mercury and ascending doses of potassium iodide. Began at once to improve. At the end of six weeks he left the hospital nearly well. I saw him at intervals thereafter and he had entirely recovered.

A PORTABLE OPERATING ROOM.

By Assist. Surg. L. E. COFER.

The portable operating room, sketches of which are seen below, is intended for use in caring for the wounded after a battle or after a skirmish on marches either with army or naval landing forces. It may be dragged either behind an ambulance or by members of the hospital corps. In action, it should be unfolded, in a protected place near by, and the canvas spread to protect the patients from the elements. In the cage in the center should be kept artery forceps, tourniquets, gauze, sponges, bandages, ether, and such other necessary supplies as will insure the greatest facility in giving first aid to the injured. The cross arrangement of the tables not only admits of four patients being operated on at once, but they can be cared for all night in these improvised hospitals. For lightness and durability, I would suggest that the material used be white enameled sheet iron, with steel frame and strong bicycle wheels. Not being a mechanic, I must leave the details to the instrument maker. The tent sections, steel extension tent rods, guy ropes, pegs, and lanterns may be packed underneath the cage between the wheels.

Water-tight cap to sterilized water tank, the spigot opening into the cage (").

h Water tank.