apy or thermotherapy, but none of these are peculiar to the place and in the tub only is seen the true Hot Springs effect.

Before closing I wish to reiterate and impress upon you that this is not merely hot water, that none of the peculiar effects secured at Hot Springs are due to the heat of the water, that when you have told your patients in the past that "hot water is hot water anywhere," and have advised them to take hot baths at home instead of going to Hot Springs, you have made an error only excusable by lack of information as to the true physiological effect of these waters.

DISCUSSION.

DR. BASS. If the belief of Dr. Martin and other observers be correct that the waters are radioactive, it would, to my mind, far from recommend the water until the therapeutic effects of radium rays are better understood. The application of such powerful agents as radium and X-rays produce certain toxins, and we ought to be very careful about sending our patients there, and ought to be careful to send them to Dr. Martin or someone who will be careful. Another thing, an exposure to X-ray of even ten minutes is dangerous. I know one man who is spending thousands of dollars in getting an equipment which will enable him to make his pictures quicker.

DR. G. R. Fox. I speak from personal experience of the wonderful properties of these waters. Only a few years ago I went there suffering from pericarditis with effusion, and was almost cured in nineteen days. I talked with an old army surgeon who was in charge of the Government baths, and told him I had read an article in one of the popular magaines concerning radium, and it was stated therein that many of the deep springs of Europe were radioactive, and asked his opinion as to the possibility of the waters of Hot Springs being radioactive. He replied that he had been making investigation, and had found evidences of radioactivity. He also stated that he believed the water more potent when used as recently as possible after being piped from the springs, and that when cooled in tanks it lost much of its potency.

He was also of the opinion that some of the springs on the reservation were much more radioactive than others.

While visiting the Government baths that morning, I noticed that the whole atmosphere seemed charged as with electricity, which seemed very stimulating, more so than any other bath room I had previously visited at the springs, and I had visited nearly all of them.

I presume this peculiar phenomenon was due to the radioactivity of the atmosphere, as many tubs were being filled at the time with very hot water, because no cooled or tank water is used by the Government, but the water is drawn at the temperature at which it arrives direct from the spring, and is allowed to cool in the tub to the desired temperature for the bath.

I wrote to Dr. William J. Morton, of New York, shortly after this, and asked his opinion concerning the possibility of these waters being radioactive, and he replied that it was his opinion that they undoubtedly were, and probably owed their remarkable curative powers to this property.

I think Dr. Martin's discovery that these baths cause a rise of temperature, and that the bath can be given to better advantage as to duration and temperature by using the clinical thermometer as a guide, is very valuable. I move that the Society tender him a vote of thanks for his valuable paper.

DR. DANNA. I have been enlightened by the doctor's paper. I have sent a number of patients to the Springs and they improved. I have been of the idea, however, that their efficacy was all a matter of "hotair" on the part of the doctors there. At first he dispelled that belief, but as he went on he increased my belief that it really was the hot air, but that the hot air is in the water, but just when I was beginning to think we could bring the water down here and treat our patients, he tells me that when it stands it loses its hot air.

I think we owe the doctor a good deal of credit for bringing to our minds the cause for the benefits coming from the use of the water.

DR. MARTIN, (closing.)-I accept your thanks with becoming humility. If I can get you to remember that it is not just hot water, which we have at Hot Springs, I will be well repaid for this paper. In reply to Dr. Danna's suggestion that you may be able to ship a few car loads of the water here, I believe that in the

years to come you will be able to get a Hot Springs bath at any Turkish bath house, probably in your own home, but the radium salts will have to become cheaper than they are at present. I have been asked privately a number of times what the waters of Hot Springs are good for, and while I do not wish to go outside of the title of my paper, I will give you briefly the most important diseases treated there with benefit. First: In importance on the list is chronic malaria. The increase in the hemoglobin is very rapid after a few baths, if they are not too high in effect. Second: The whisky cases get the next best and most prompt results. The baths certainly will kill your patient's taste for liquor (very few people living at Hot Springs ever take the baths!) The third in degree of benefit received, I think, are certain forms of the various conditions classed as rheumatism, which receive benefit in proportion to the form, subacute rheumatism the most promptly. Fourth: Tertiary syphilis is benefited in two ways; by elimination and by permitting larger doses of medicine to be used. Last of all are the most numerous cases that come, that is, secondary syphilis. There is no doubt they do receive some benefit from the routine treatment. You will find sometimes that the hemoglobin will drop constantly after the mercurial treatment, and the baths keep up the hemoglobin. Also, more medicine will be used and the insurance against syphilis in later vears is worth the expense of the trip.

And in the future 1 can see a great field for the treatment at Hot Springs of arterio-sclerosis and kindred diseases through the marked effect on the blood pressure, which is lowered very much during each bath.

All other chronic diseases in which elimination is indicated are more or less benefited by these baths.

A Case of Forward Dislocation of the Humeral Head
Irreducible by Manipulation, Reduced by
Open Operation.

By DR. F. W. PARHAM, New Orleans.

J. R. W., age 44 years, on Sunday evening, September 30, about 7 o'clock, while alighting from a railroad train at Gloster, Miss., was thrown by a sudden forward jerk of the car from the steps to the ground, striking on his right shoulder. I saw him at the New Orleans Sanitarium on Thursday, October 11. I had little difficulty in making out a forward dislocation, under the coracoid process. The arm stood out at an angle of nearly 45 degrees from the body. The pressure below the acromion and Dugas' test showed the head of the bone not in the glenoid cavity, although there was considerable movement of the arm on manipulation. The arm could be carried out to a right angle and a little above the level of the shoulder, though with considerable pain. Under general anesthesia I made attempts by manipulation, including Kocher's method, to reduce the dislocation, but failed. The radiograph, taken for me by Dr. Hatch in order to ascertain, if possible, the cause of failure of reduction, revealed nothing that adequately explained the difficulty. You will observe in the picture a small fracture in the neighborhood of the tuberosity. There was no break in the longitudinal continuity of the bone.

On October 18 I made another attempt, under general anesthesia, putting Stimson's method to a severe test. The arm was freely moved, but in spite of all our efforts it remained out of place. The shoulder was made quite sore by these manipulations, so I determined not to make any further effort in this way to reduce the dislocation.

On Saturday, October 20, I cut down on the joint through the anterior oblique incision, exposing the neck of the bone and the glenoid cavity. The head of the bone was not visible through the incision, although the whole of the glenoid cavity could well be seen. With the kind assistance of Dr. E. D. Martin, who manipulated the arm for me, I ascertained that the difficulty lay at the anterior rim of the glenoid, where the head of the bone could be