remain one week, being three weeks from date of injury. At the end of this time we were advised to bring her to Denver."

On my first examination it was found that the callous was very large and there was marked outward and forward angular deformity, more than two inches of shortening, with no union at all in the bones.

C. W., aged 6. Fracture of Right Femur. Skiagraph taken eight weeks after injury. Lateral view through plaster paris cast. Partial reduction.

I regret that an X-ray picture of this case was not taken before operation, but if in your examination of cut No. 1, of the case just reported, you imagine the under fragment drawn up and the fragments overlapping each other at least two inches with a broad, flat callus at the end of each fragment, you will have a

fairly correct picture of the case. Drs. Packard and J. M. Perkins, who were with me in the case, will bear me out in this statement. An anaesthetic was given and an attempt at reduction was made. This could not be accomplished, owing chiefly to the large callus at the ends of the bones. Patient was put to bed for several days with limb on an inclined plane and was treated

with weight and pulley. This failed to make any difference in the length of the limb and operative treatment was decided upon. On the 9th day of August she was operated upon. An incision was made over the point of fracture and a number of small fragments of bone, together with considerable callus which held

them together, were removed. The ends of the bone, which were sharp and irregular, were freshened and the two fragments of bone were wired together with medium sized silver wire. Two holes were drilled in each fragment and two loops of wire were used. In this, as in the previous case, the functional result is fine and the anatomical result, as shown by cut No. 5, is likewise quite satisfactory. By measuring this patient, who is also here to-night, you will find no appreciable difference in the length of the limbs. These children are both romping, healthy specimens, and appear to have no need for better limbs than those they now possess.

X-RAY REPORT OF ABOVE CASES.

By S. B. CHILDS, A.B.. M.D.,
Denver, Colo.

Professor of Anatomy, Denver and Gross College of Medicine: Surgeon to the Mercy Sanitarium.

A skiagraph shows the shadows cast upon a photographic plate by the denser structures with which the X-Rays come in contact and requires that the rays have sufficient penetration to pass through the area and be capable of outlining the shadows upon a fluorescent screen. As these rays diverge from the anode of the tube it is absolutely essential for the correct representation of the existing relations of the parts in question, that the target be accurately focused over the exact seat of suspected fracture or injury and that the central rays strike the object and the X-Ray plate at a right angle. Having taken these precautions in adjusting the tube and having placed it a sufficient distance from the plate to prevent magnifying the structures, we can depend upon the skiagraph for a practically accurate representation of the flat relations of the parts examined. It is the lack of attention to these details that has thrown discredit upon the reliability of certain skiagraphs; it is not the fault of the X-Ray, it is entirely the fault of the X-Ray operator.

As it requires some experience to interpret properly the significance of the different shadings found in an X-Ray picture, I take the liberty of briefly explaining the skiagraphs in the order in which they are enumerated.

Number I shows the typical appearance of an oblique frac

ture of the upper third of the femur and is a lateral view of the first case reported by Dr. Perkins. The lower fragment is usually drawn up behind the upper by the action of the hamstrings, rectus, tensor vaginae femoris and the adductors, the latter group being chiefly instrumental in carrying it to the inner side. The lower end

C. W., aged 7. Fracture of Right Femur. Firm union. Skiagraph taken ten months after injury. Antero-posterior view.

of the upper fragment is tilted forward and outward by the pushing up of the lower fragment assisted by the action of the iliopsoas muscle, thus producing an angular deformity. The angular deformity in this case is well marked. We notice that the intervening space between the fragments is filled by a shadow of less density than the bones but greater than that of the muscles,

and in this shadow we see several much lighter spots. The first shadow referred to represents the callus which nature had so lavishly poured out for the repair of the bones, and the lighter spots represent the solution of continuity of the same, produced by movements of the fragments; so that at the time of taking the

picture, eight weeks after the reception of the original injury, despite the liberal amount of callus the fracture was still ununited.

Number II was taken a few minutes later than number I, the X-Ray tube maintaining the same relative position and represents the appearance of the fragments after reduction had been attempted by extension and manipulation under complete anaes