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The greatest objection to Lane plates is that of leaving in the tissues a large foreign body. This excites a reaction in the tissues which lasts until it is finally, surrounded by a sheath of fibrous tissue. Being held tightly against the bone by the screws, absorption of periosteum and the cortical layer of bone occur to a variable extent. In most cases the plates in time becomes separated from the bone sufficiently to allow repair of the damage to it, so that the periostoma can again cover the defect.

It often happens that when the screws hold well, a mortar-like growth of bone springs up all around the plate in an attempt to cover the foreign body. In the tibia this growth frequently leads to sinus formation, necessitating incision and removal of the splint and the bony growth.

While the object in using Lane's plates is to hold the bones firmly together so that perfect union can occur, evidence is not wanting to show that this method delays the healing of the fracture in most cases and in certain per cent of cases union does not occur. It often fails in the treatment of ununited fractures.

Infection is undoubtedly more common in this than in any other clean operation. The injury to the bone nearly always damages the soft tissues severely to which is added the operative trauma and the presence of a large foreign

body.

It is believed that only those who can master the details of the operation as set forth by Mr. Lane, should undertake to use this method of treating fractures. In order to master this technique the surgeon has to drill the nurses and everyone connected with the operation. This is well nigh impossible in many hospitals, due to the changing personnel in the operating rooms, consequently many men are turning to the use of obne grafts either as inlays or intra-medullary splints, hoping to get better results than is obtained by Lane's plates. It remains yet to be seen whether or not they will do so. I, personally think it quite doubtful unless they at the same time improve their technique.

I believe that fracture cases will do better under non-operative measures in the hands of the average surgeon. I also believe it would be much better if all cases in every community were treated only by men who have prepared themselves to treat fractures, by whatever method may be indicated in each case. At present the general practitioner treats most of the cases primarily, calling in a surgeon when bad results are obtained.

The instruments used in the operative treatment of fractures resembles the tools used by skilled mechanics. The surgeon using them should not only be a good surgeon but in addition should be a first rate mechanic.

COMMENTS ON METHODS OF SUSPEN-
SION AND TRACTION IN THE TREAT-
MENT OF FRACTURES OF
THE LONG BONES

T. G. ORR, M. D.

Suspension and traction splints allow limited motion; this limited motion promotes repair of fractures.

Ernest W. Hey Grove, in his experiments on bone grafts, says: "Provided that secure fixation of the graft to its bed is not disturbed, mobility of the limb favors ostro-genesis, whilst immobilization hinders it."

Bucholz reports 2,000 cases of old fractures treated with plaster casts in which there were more than 25 with delayed union and then mentions Bardenheuer's series of 10,000 cases treated by traction with not a single case of pseudoarthrosis. In Bardeneuer's series no fractures of the femoral neck were considered.

Bucholz states: "We wish to state our opinion that the traction represents the best methods for most kinds of fractures, and we believe that it is only a question of time until American surgeons will apply it more frequently and more generally.

The Hodgen splint with many modifications has been used extensively in suspension and traction work. These splints give much comfort to the patient, allowing the patient to have a certain amount of freedom, enables the nurse to keep bedding in better condition, and permits comfortable use of bed pan. An objection to the Hodgen type of splints is that all need constant care and adjustment to obtain satisfactory results.

Blake, in the recent treatment of war fractures, has used the suspension and traction methods quite extensively, resorting to an elaborate frame-work over the bed. In femur fractures he used a Hodgen or modified type, allowing traction in one or more direction. Blake says that there is an immediate amelioration in the circulation of affected parts. The edema disappearing early, the interference with circulation removed. He finds that best results are obtained by applying traction treatment with the muscles of the thigh relaxed, thigh being flexed on trunk and lower leg on thigh.

Traction by Steinmann's method has been used rather extensively in the last few years. The method requires that a steel pin be put through the bone; the traction applied upon this pin by pulley and weight. This type is best adapted to femur fractures, the value being that great traction is easily obtained and much weight can be safely used. Eastman considers this method invaluable in overcoming partial union and muscle contracture.

The method consists in inserting the pin through condyles about 2 cm. above articular

surface, being careful not to pierce medullary cavity. Traction weights are added gradually until overlapping of fragments is overcome, fluoroscope, palpation, manipulation, and measurements helping to control proper reduction. The objection some have against the use of the pin is on account of the pain produced; compared. to operative procedures the pain is negligible. Infection, injury to nerves and vessels, if occuring, are the results of careless operating.

In fat patients the Steinmann pin is especially valuable, other forms of treatment being difficult to apply. Also, in supracondylar fracture, in patients having severe injury to skin and soft parts of the thigh and in some fractures with considerable deformity and overlapping of fragments, is this method useful.

THE TRANSPLANTATION OF BONE

ERNEST F. ROBINSON, M. D.

The recent development of modern surgical technic has at last placed the subject of bone transplantation on so firm and scientific a basis that it has finally made it a satisfactory and safe procedure. In fact, it has been found to be the only one that will cause union in many cases of obstinately ununited fracture, and is often the only hope in bridging large bony defects or preventing mutilating deformity.

The advantage and posibilities of this method of treatment are at once apparent. With proper asepsis, union is certain in even the most persistent ununited fractures. No unabsorbable foreign body is left in the wound, necessitating early or later removal. There is little if any delay in the establishment of bony union. Large deforming and often painful exuberant callus

are avoided and function is much earlier established.

By bone transplantation bony defects may be filled and many possible amputations prevented. By this procedure the surgical field is materially widened, for patients will submit to a resection or excision of bone (as in tumor of bone or giantcelled sarcoma), when an amputation would be refused. The bone graft may be extended even into the joint cavity with assurance of success.

In many cases failure of broken bones to

unite is due to the fact that the bone-forming process reaches a certain degree of development and then stops. It is arrested before the gap between the bone is bridged over. The bone transplant acts as a superstructure or framework over which the osteoblasts are carried.

In the opinion of many surgical pathologists, when this structure has served its purpose it is then torn down, i. e., absorbed, as its place is taken by new formed bone.

"The graft," says Murphy, "is per se not osteogenic but osteoconductive. The regenerat

ive force and cells are entirely supplied from the living bone. The graft, however, is an absolute necessity in the regeneration." Others, notably McWilliams and Albee, do not believe that the graft is absorbed but that it becomes an intimate part of the osseous framework. Such bone grafts, when properly placed, reach beyond the immediate area of transplantation and carry new bone forming elements from uninjured bone itself. This is unquestionably one of the important reasons that union can be established even in those cases where there is absolutely perfect approximation of the fragments, and yet where no union had occurred.

How long the transplant remains in the tissue before its complete absorption or regeneration is, as yet, undetermined. If firm, bony union, however early, results, even with the persistence of the graft, the ultimate disposal of the transplant becomes one only of academic interest.

is asepsis. Without it failure is certain. The great secret of success in all bone surgery As one's experience widens and his familiarity with technic is perfected he sees how it is possible to being placed in the wound. In my cases of bone operate these cases without even the gloved hand transplantation I have been able to carry out this technic absolutely. I am confident it has materially aided in lessening the operative risk. Any portion of bone of whatever thickness may be transplanted.

The accessibility and formation of the crest of the tibia makes it peculiarly adaptable to the from which most bone grafts should be procured. fashioning of a transplant. This is the location By the use of proper instruments a piece of the readily cut. This is triangular in shape and for crest of the tibia of the desired length can be the larger bones should measure about 1⁄2 by 3-5 by 1⁄2 inches on its three sides. No effort is with chisel after being cut with a motor saw to made to denude it of periosteum. It is detached the desired depth. The newly formed granubones are bored out with the bone reamers. The lations and medullary cavity of the fractured transplant is at once, with as little handling as possible, driven into the lower fragment far enough to allow it to be inserted into the prepared cavity of the upper fragment. The bones closed without drainage and a well fitting plaster. are then firmly brought together. The wound is cast applied. Thus, with the "dowel peg" no foreign body or non-absorbable material is left in the wound, while the "bone inlay" must be retained by kangaroo tendon. This necessitates more handling of the graft and less stable implantation. Consequently, whenever possible, I use the "dowel peg." Accuracy in the mechanical adjustment of the bony structure hastens union, which occurs usually in from five to seven weeks. A much longer period is necessary in the

"bone inlay" cases, often two to three months of external fixation being necessary.

My own experience now includes bone transplantation in ununited fractures of the inferior maxilla, ulna, radius, humerus, femur, tibia and the vertebra. In most of these I have used the so-called medullary splint or "dowel peg," usually taken from the tibial crest. The periosteum has been left intact adherent to the transplant, as I believe it favors union.

Reconstruction, rather than excisive surgery, is the highest aim of surgical art. Transplantation of bone is one of the greatest steps in this modern surgical procedure and we can see in it infinite possibilities for good.

(To be continued)

CLAY COUNTY MEDICAL SOCIETY The Clay County (Mo.) Medical Society began its 64th year with a meeting at Snapp's Hotel in Excelsior Springs, on the evening of January 28. Some 20 members and visitors were present.

Dr. A. Sophian of Kansas City, addressed the society on "Successful Immune Therapy." This live topic was listened to for some two hours with the keenest attention. Dr. Sophian is a tireless worker, a most thorough investigator, of abundant experience, and a fluent speaker. His handling of the subject was no less than masterful, and brought out a rousing vote of thanks, coupled with an invitation to meet with us later for further discussion.

It would be futile for a general practitioner to try to give the readers of the Herald anything like the full scope of Dr. Sophian's lecture. Therefore I shall try to mention only such points as were specially impressive to me. One of the striking statements to the writer, was that in many instances, the good results of vaccine and serum therapy are simply due to the introduction of an alien protein into the system of the patient. For instance, a coli-vaccine is often quite as useful in typhoid therapy, as typhoid vaccine. The good effect being due to the alien protein.

The doctor's explanation of the "negative phase" and the handling of its manifestations, aroused much interest.. During the intravenous injection of the serum or antitoxin, a fall of some 20 mm. in blood pressure was the signal for immediate discontinuance of the process.

The many manifestations of anaphylaxis were interesting. The doctor said that asthmatic attacks, and certain convulsive seizures were merely the expression of the action of a non-specific protein, which is being absorbed in overpowering quantities.

Much was said as to the "valence" of sera and vaccines. They have come to stay and are dependable. The locality of injection is most

important. Antitoxins given hypodermically do not yield full effect for 24 hours; intramuscularly, effect is reached in 18 hours. Intravenous injections are almost immediately responsive. From these facts, the method of injecting sera may be determined by the time in which the effects are in highest demand.

"Normal serum" has a more wide applicability than many of us had dreamed. It may be applied locally, administered internally, or employed intravenously, but the chief thought in administering it is the introduction of an alien protein. I believe the doctor gave this as the basis of serum therapy, preference over the bactericidal idea in therapeusis by this method.

No preference was mentioned among the sera of standard makes. Dr. Sophian spoke of the dangers which may be encountered by overdose, or faulty technique. In pronounced "negative phase" he would bleed the patient, separate the serum from the blood obtained, and re-inject with, the patient's own serum.

I wish I were capable of giving this lecture in full. The discussion of meningitis was an appropriate aftermath, and many points were brought out from Dr. Sophian's rich clinical experience. Many of our members were busy taking notes, for use in the field. The speaker fears. that we are on the verge of an epidemic of this disease, and exhorts us to be ready for it. The weather conditions are similar, if not worse, than at the time of the severe scourge which Kansas City experienced.

If I have misrepresented the doctor, I hereby make the most blood-curdling apology of which I.am capable. With kindest regards to "friend Editor" and the folks in K. C.

J. J. GAINES, Secretary. BUCHANAN COUNTY MEDICAL SOCIETY Minutes of regular meeting, Wednesday evening, Jan. 2, 1918; 28 members present; Dr. Floyd Spencer in the chair.

The minutes of the previous meeting were read and approved. The following bills were presented and a warrant ordered drawn on the

treasurer to pay same:
Robidoux Hotel Company.
Secretary, for postage on Bulletin and 125
addressograph tags...

$27.50

6.40

The secretary and treasurer's reports were read, and the latter referred to the executive committee for their approval. After the various special committees had been called upon for their reports and discharged, the incoming chairman was introduced and delivered his address, outlining a program and policy for the year 1918, subject, of course, to its adoption by the society.

The following standing committees for the year 1918 were announced:

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Motion by Dr. Spencer, seconded by Dr. Bansbach, that the society pay the county and state dues of all members entering the military service of the United States, and assigned to active duty; carried.

Motion by Dr. Lau, seconded by Dr. Ladd, that the library committee request the Public Library to secure such books as a medical officer may need, for service of the society; carried.

Motion by Dr. Owens, seconded by Dr. Lau, that this society go on record as favoring the issue of Good Road Bonds.

Having no further business for the society, the meeting adjourned.

W. F. Goetze, Secretary.

BUCHANAN COUNTY MEDICAL SOCIETY At the regular meeting of this society held at the St. Francis Hotel, January 16th, Dr. G. Wilse Robinson, Kansas City, read a paper on "Intra-Cranial Localization" with lantern slides, which proved entertaining and instructive. An excellent dinner preceded the lecture. Dr. Robinson, in his preliminary remarks, urged the establishment of a medical library for the local society, and explained in detail the plan followed by the Medical Library Club of Kansas City. He also recommended a more cordial and harmonizing relationship between the various county societies, and extended to the Buchanan County members a most urgent invitation to attend the meetings of the Jackson County society. Dr. Robinson further agreed to arrange for a St. Joseph evening in Kansas City, when a program would be presented by members of the Buchanan County Medical Society.

Dr. Daniel Morton, who presided, stated that he was heartily in favor of the fraternal ideas. advanced by Dr. Robinson and was interested in the establishment of a medical library for St. Joseph, as he had long advocated the plan.

The executive committee reported that the Public Library Auditorium could be secured as a meeting place for the society without expense and upon motion the report of the committee was adopted, and the society will hold its sessions in the library building hereafter. A vote of thanks was extended to the Board of Education for its courtesy in giving the society the use of this excellent meeting place.

Buchanan County Members, Attention!

Medical Advisory Board No. 4, District No. 17, has organized and selected Dr. C. R. Woodson's office as a permanent meeting place. The Board will act en banc, and for purposes of efficiency has divided into sections on the various medical specialties. The personnel of the Board is as follows: Dr. C. R. Woodson, president; Dr. Daniel Morton, secretary; Doctors W. H. Minton, J. J. Bansbach, L. J. Dandurant, Fred J. B. Reynolds, O. G. Gleaves, John M. Doyle, Eliscue, F. G. Thompson, A. R. Timmerman, J. M. Bell, A. B. McGlothlan, Floyd H. Spencer, H. S. Conrad, J. F. Owens. All are members of our society and in addition, Dr. W. F. Ross represents dentistry.

Hospital Staff Elected-After one year's trial the Welfare Board is greatly pleased with the Hospital Staff Plan. The work has been done with conscientiousness and efficiency and with advantage to both patient and doctor. The staff has the hearty support of the Welfare Board in the determination to give to the poor the best service St. Joseph has in a medical and surgical way. At the January meeting of the Board the following stalf were elected for the year 1918: Internal Medicine, J. M. Bell, H. W. Carle, C. A. Good, J. T. Owens ; General Surgery, J. I. Byrne, L. J. Dandurant, J. M. Doyle, H. S. Forgrave, W. J. McGill, F. H. Spencer, H. S. Conrad. Obstetrics, A. L. Gray; Nervous Diseases, C. R. Woodson; Genito-Urinary Surgery, J. J. Bansbach, T. M. Paul; Eye, Ear, Nose, Throat, A. A. Laboratory, A. B. McGlothlan. Disque, W. H. Minton, W. C. Proud; Medical

New Officers-At the annual meeting of the Western Surgical Association, in Omaha, the following officers were elected: President, Dr. J. F. Percy, Galesburg, Ill.; Drs. D. N. Eisendrath, Chicago, and D. C. Brockman, Ottumwa. vice-presidents; secretary and treasurer, Dr. A. T. Mann, Minneapolis (re-elected). Next meeting in San Antonio, Texas.

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ASSOCIATE EDITORS

P. I. LEONARD, St. Joseph.
J. M. BELL, St. Joseph.
JNO. E. SUMMERS, Omaha.

CONTRIBUTING EDITORS
H. ELLIOTT BATES, New York.
JOE BECTON, Greenville, Texas.
HERMAN J. BOLDT, New York.
A. L. BLESH, Oklahoma City.
G. HENRI BOGART, Paris, Ill.
ST. CLOUD COOPER, Fort Smith, Ark.
T. D. CROTHERS, Hartford, Conn.
W. T. ELAM, St. Joseph.
JACOB GEIGER, St. Joseph.

S. S. GLASSCOCK, Kansas City, Kan.
H. R. HARROWER, Los Angeles, Cal.
JAS. W. HEDDENS, St. Joseph.
VIRGINIA B. LE ROY, Streator, Ill.
DONALD MACRAE, Council Bluffs.
L. HARRISON METTLER, Chicago.
DANIEL MORTON, St. Joseph.
D. A. MYERS, Lawton, Okla.
JOHN PUNTON, Kansas City.
W. T. WOOTTON, Hot Springs, Ark.
HUGH H. YOUNG, Baltimore.

diagnosis from gumma may be difficult. Artificial mucous patches are produced by the lighted end of a cigarette. They make lesions on the left side, situated on the inner surface of the lower No. 2 lip not far from the commissure, in the cheek, or on the velum, never on the pillars of the fauces or the tonsils.

"Our country; its need is our need, its honor our honor, its responsibility our responsibility. To support it is a duty, to defend it a privilege, to serve it a joy. In its hour of trial we must be steadfast, in its hour of danger we must be strong, in its hour of triumph we must be generous. Though all else depart, and all we own be taken away, there will still remain the foundation of our fortunes, the bulwark of our hopes, a rock on which to build anew-our country, our homeland, America."-From American Medicine, May, 1917 (National Number.)

The Editors' Forum

SIMULATION OF DISEASE

Simulation is resorted to for the purpose of evading military service. There is an artificial resort to produce disease or deformity. One can produce artificial skin eruptions of which pustulodermatitis is the most common, the lesions being gathered together in patches, mostly placed on the hairy parts of the face. An important diagnostic point is that the pustules are all in the same stage of evolution. The lesions are generally produced by croton oil. Milan states that automobile oil sometimes produces lesions suggesting at first sight an erysipelas. Edema is produced by tying a wide flat strap on the forearm or the lower part of the leg during the night. Persistent ulcer in a young man, otherwise healthy, is probably artificial. These sores are not in the usual position for chronic ulcers. They may be caused by a blister or a caustic agent. If the patient be an old syphilitic

Carruccio notes that he has seen more than a hundred soldiers with an acute dermatosis of practically identical nature. These lesions were produced by the application to the skin of vegetable substances, such as the juice of the cactus leaf. When rubbed over the entire body they caused a somewhat intense erythema.

Ascarelli states that one of the most common forms of lesions inflicted on themselves by Italian soldiers are abscess and phlegmon produced by injection of petrol, turpentine, benzine, chloride of lime in benzine solution, etc. There is always slight albuminuria, without casts. At times there is emphysematous crepitation. An incision shows comparatively little pus. Gradenigo states that artificial otitis is fairly common. As a rule the effects produced are suppuration, exceptionally perforation of the membrane. Caustic is used to produce destructive inflammation. The complications at times are

serious.

Conjunctivitis is produced by powdered ipecas. Caustics can produce ulcers of the cornea and infection may result.

Maligners may wish to evade military service by feigning total loss of vision in one eye or partial loss of vision in one or both eyes. The visual requirement for recruits is 20-40. There is something peculiar in the maligner's manner, but the examiner must gain his confidence by apparently believing his story. The oculist has the prism test and the test with colored glasses and letters. Red letters are invisible to the eye that has a green glass before it, while green letters are invisible through the red glass. There is a test with trial glasses and the stereoscopic test. There is oblique and ophthalmoscopic examination and the mirror test with special test cards. There are those who feign diplopia. It is very difficult, after a judicious and careful test, to deceive the examiner in the absence of organic disease. P. I. L.

PHYSICAL REGENERATION

One of the most illuminative lessons already accruing from war activity, and one which must be appreciated by the medical profession, is the ability of the body to recuperate when placed under favorable hygienic environment. While the philosophic principle has long been known, it has been neglected as a therapeutic agent. The possibilities which lie in the wake of rigidly enforced hygiene are truly remarkable. Young

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