CLINICAL OBSERVATIONS ON SO-CALLED LA GRIPPE: B. M. Randolph (N. Y. Med. Jour., Feb. 17, 1917) discusses an epidemic with the following clinical characteristics: sudden onset, fever, muscular and neuralgic pains, depression, and usually, exudative inflammation of some portion of the respiratory tract. Twenty-two cases were studied by bacteriological control.

In not a single case was the Pfeiffer bacillus, the supposed causative agent of influenza, found; but in every case the streptococcus hemolyticus was demonstrated.

The leucocyte count was relatively low, from 5,000 to 10,000, only two or three cases showing 13,000 and 16,000.

This study is quite interesting for we know the effects of the streptococcus hemolyticus and this may account for the marked prostration and slow recovery from attacks of so-called La Grippe.

The

The introductory chapter, "The Myths of Yesterday and the Problems of Today," calls attention to the marked change in the attitude of the medical profession regarding what may be considered a good result following the treatment of a fracture. author very tritely considers the relation between Form and Function-"Cases of Good Form with Bad Function," "Cases with Bad Form and Good Function," "Cases with Bad Form and Bad Functions;" "The Kind of Deformity which Leads to Disuse," "The Relation of Age, Occupation, and Lapse of Time to the Importance of Bone Deformity." He calls attention to the nature of the modern problem and the modern methods of solving the problem. These

methods he divides into three classications: First, Methods of Massage and Mobilization; second, Extension Methods; third, Operation Methods. He also calls attention to the need of co-operation between the different systems.

In chapter two massage and mobilization are considered in detail. The author describes the difference between massage as advocated by Lucas-Championniere and his pupils and the ordinary massage "with all its manifold pressures and kneadings."

Those who have not practiced scientific massage will be surprised to learn that by its use complete relaxation of the muscles in the region of the fractured bone may be obtained and reduction accomplished, without pain to the patient, in a considerable proportion of cases. The author states that in the treatment of a fracture, after reduction has been accomplished, massage and passive motion are of the utmost importance, and that it is no longer permissible securely to bandage a limb, immobilizing the joints in the region of the fracture for any consid erable period without the use of this therapeutic measure. Reduction of pain and early return of function are its salient features.

Chapter three deals with Extension by Adhesive Appliances. Advantages as well as difficulties of applying extension are discussed, and the work of Bardenheuer is commended. The necessity of massage, as well as passive motion of the associated joints, is once more insisted upon. The different forms of wire splints of the Thomas variety are warmly advocated in fractures of the femur. Many ingenious mechanical devices are shown.

Chapter four deals with Mechanical Modifications of the Extension Method. The methods of Codivilla and Steinman, with their application, are carefully described. In this chapter a double transfixion method developed by the author is shown. This consists of external extension applied between the ends of two metal pins which transfix the bone fragments at some distance from the point of fracture. This apparatus has given excellent results both experimentally and clinically.

Chapter five takes up Operative Treatment and Experimental Observations. In this chapter the work of MacEwen is verified to some extent, and the Lane plate very distinctly discredited. Briefly, this experimental work shows that the important points which make for success in open treatment of fractures are perfect immobilization and asepsis; that foreign substances are tolerated by the tissues; that the size of a foreign substance is relatively unimportant; that it makes little difference whether the internal splint is used as a plate or a dowel. "Firmness of fixture is the dominant factor which determines most often whether a plate will remain in position or become loose." Nickel-plated steel is recommended as the most satisfactory foreign material. Circular or spiral fixation with wire or a band was found to interfere with the circulation by destroying the periosteum. In the author's experimental work are cases in which the fixation appa

ratus became loose and suppurated. Small, ill-fitting bone chips should not be used to fill defects between the bone ends. The author's experiments all bear out this contention. Attention is also called to the discussion whether the periosteum produces bone, and the author says this depends largely upon what we consider the periosteum to include, the outer or fibrous layer being a simply limiting membrane, the inner layer containing osteogenetic elements. He also calls attention to the fact that bone will always reproduce new periosteum, adding “if, then, the bone is certainly the mother of the periosteum, it is very unlikely that the periosteum is also the mother of the bone."

Chapter six deals with the Operative Treatment of Fractures, and gives a very comprehensive review of the important points one must consider when deciding between the open and closed treatment. In this regard the author is very conservative, and calls attention to the fact that great haste is unnecessary, giving, therefore, plenty of time in which to try out the closed method. Metal and bone fixation are described, and many clever devices developed by the author are shown. One cannot help but be impressed by the excellent results obtained by the use of foreign material.

Chapter seven considers the Operative Treatment of Special Fractures, and the most satisfactory incisions are outlined. Wire is recommended as the material par excellence in fractures of the patella and olecranon. The author has never been called upon to try a fracture of the clavicle by the open method. For fracture of the neck of the femur extension and abduction treatment are condemned. Senile cases are gotten up early, and in younger people a square bone peg taken from the tibia is driven into a round hole, uniting the neck to the head of the femur. These patients are allowed to place weight upon the limb six weeks after the operation. The open operation is believed to be indicated in the majority of complete fractures of the shaft of the femur in adult life. Fractures into the joints, if accompanied by much displacement, should be operated upon.

In chapter eight open fractures are discussed at some length, and in cases of infection it is recommended to turn the bone ends outward, thus angulating the limb for the purpose of drainage. An excellent wire cradle-leg splint is shown for the purpose of treating and transporting cases injured in war. Transverse incision of the muscles of the leg, dividing, however, only a portion of each muscle, is recommended on account of the opportunity for drainage. In compound injuries into large joints the removal of loose pieces of bone is recommended. The placing of plates or screws in infected fractures is deprecated.

Chapter nine deals with Ununited Fractures. Chief causes of non-union are: (1) Interposition of soft parts; (2) Unrestricted mobility; (3) Eburnation of the bone ends before maturity of the callus; (4) Loss of bone substance.

Under operative treatment, efficient fixation, stimulation of callus production, and bone-grafting are the methods considered. Eburnated ends are treated by freshening and by longitudinal multiple sawcuts or drill holes in the ends of the bone. It is in this class of cases that bone-grafting has its greatest application.

Since reviewing the book of MacEwen upon the Growth of Bone the reviewer has not had the pleasure of reading anything upon the subject which seemed to present so many practical points. Any one who essays to handle this class of cases cannot well afford to be without this work.

A POCKET FORMULARY. (By E. QUIN THORNTON, M. D., Assistant Professor of Materia Medica in the Jefferson Medical College, Philadelphia. Eleventh Edition, Revised. Published by Lea and Febiger, Philadelphia and New York. Price, $2.00.) This pocket volume of 292 pages contains an enumeration of diseases arranged alphabetically and under each are given what are believed to be the most efficacious prescriptions for simple cases as well as for various stages and complications.

The reviewer feels that this volume is a good one of its kind. For one who, from lack of time or knowledge, finds it necessary to resort to predigested drug theory this work may serve a useful purpose.

PAUL D. BERRISFORD.

IMPOTENCE AND STERILITY WITH ABERRATIONS OF THE SEXUAL FUNCTION AND SEX-GLAND IMPLANTATION. (By G. FRANK LYDSTON, M. D., D. C. L. Published by the Riverton Press, 25 E. Washington Street, Chicago. 1917. Price, $4.00.)

The thorough way in which the author presents the subjects described in the title of his book, places it in the front rank as first class reading for the practitioner as well as the specialist. Not a detail is overlooked. The chapter on Sex Gland Implantation is especially interesting and scientific, not only for its originality, but because it opens up a new field in the line of therapy.

H. N. KLEIN.

COLLECTIVE papers oF THE MAYO CLINIC, Rochester, Minn. (Edited by MRS. M. H. MELLISH. Published by W. B. Saunders Company, Philadelphia and London. 1918.)

This collection of 1917 papers from the Mayo Clinic is even more complete than the papers collected in former years. Like the preceding volumns composed of papers from this Clinic it is full of "meaty" articles on interesting surgical subjects as handled at the Mayo Clinic, together with voluminous references and bibliographies. In addition the book deals with research work at the Mayo Clinic in conjunction with the University of Minnesota.

While the whole volume is well worth reading even by those who have previously read most of the articles in the different journals, special mention should be directed to the article "War's Influence on Medicine," by Col. C. H. Mayo.

After one has read the whole volume he should again turn to the articles by Col. W. J. Mayo, which for pure scientific discussion of surgical conditions, rhetoric and clear presentation cannot be surpassed by any medical writer in the country.

H. J. O'BRIEN. THE THIRD GREAT PLAGUE. A Discussion of Syphilis for Everyday Peaple. (By JOHN H. STOKES, A. B., M. D., Chief of the Section of Dermatology and Syphiology, The Mayo Clinic, Rochester, Minnesota; Assistant Professor of Medicine, The Mayo

Foundation Graduate School of the University of Minnesota. Published by W. B. Saunders Co. 1917. Price, $1.50.)

This little volume is certainly deserving of the widest circulation. The subject of syphilis is very cleverly handled and presented in such a manner that the layman can easily understand the different phases and dangers of this disease. It serves a great purpose inasmuch as the knowledge gained from reading this book will aid materially in starting a crusade against syphilis. No doubt the author had this in mind.

H. N. KLEIN.

MEDICAL SERVICE AT THE FRONT. (By LIEUT.COL. JOHN MCCOMBE, C. A. M. C., and CAPT. A. F. MENZIES, M. C., C. A. M. C. Published by Lea and Febiger, Philadelphia. 1918. Price, $1.25.)

For those physicians who are anticipating entrance into the Medical Reserve Corps this small book will prove of inestimable value. The subject matter is arranged under the following heads: A Division in the Front Line, The Regimental Medical Officer, The Ambulance, The Field Ambulance in Peace Warfare, The Field Ambulance in Battle, The Selection of Field Ambulance Positions, The Casualty Clearing Station, etc. The work is amply illustrated with diagrams and the text written by men who have been "through the mill."

PAUL D. BERRISFORD,

Vol. I

ORIGINAL ARTICLES

CHANGES AHEAD.*

M. L. BURTON,

President of the University of Minnesota.

Minneapolis, Minn.

Mr. President and Members of the Southern Minnesota Medical Association :

I believe it was Cicero who once said that the first duty of a public speaker is to place his audience in a benevolent frame of mind. Don't be disturbed. I am not going to propose that we take up a collection. (Laughter); Before I begin to speak on "Changes Ahead,' I would like to say this: From my point of view, the only motive which can ever control the decision of any man in the use he makes of his time, in the motive which concerns himself, his personal interest, is that it is the supreme duty of every man to look at himself through his abilities, his capacities, his powers, and do what needs to be done in such a crisis

as that which now confronts our nation. I have absolutely no sympathy with, or admiration for, individuals, parties, or institutions that in these days of stress would seek to make their interests paramount to those of the federal government. (Applause).

I believe that you and I are living in the most stupendous moment of all history. I believe. the old order has passed away and a new order is in the making. There is absolutely no place for the present methods or policies of the imperial German government. (Applause). In other words, changes of all kinds are ahead of us regardless of what has transpired recently

*Address delivered without notes before the Southern Minnesota Medical Association, Winona, Minn., June 24, 1918

No. 9

on the Italian front. We cannot live for a single hour without being conscious of the changes that have come upon us.

I am not a prophet or the son of a prophet. I am not particularly concerned about whether what I say ever comes to pass or not. I do not mean to be encouraging or threatening, optimistic or pessimistic; but I do propose to get before you, if possible, one very clear proposition, namely, that we are in the midst of overwhelming changes. Whether we like it or not, whether we are part of it or not, whether we approve of it or not, the fact remains that the old civilization is being torn into shreds, that the old order is rapidly passing away, and that a new order is in the making. The question is precisely what part you and I are going to play in the making of this new order.

Please observe that the issue I am trying to get into our minds is this: That just as sure as fate, the things which made our civilization in recent decades are passing away and totally new and unexpected and unanticipated and uncomprehended situations are going to arise. We are in the midst of forces which we neither understand nor can comprehend. The whole world is in a state of flux, and no previous generation of men and women has ever faced the problems that you and I must face in the decade just ahead.

I want to discuss for just a moment the most intimate details of our life, and to have you see that if you and I this afternoon are loyal and patriotic American citizens, we must almost instantaneously, over night, make changes in our methods of living. Take the question of food, something that relates itself very closely to the things that you and I do every day of our life. You and I are not loyal unless we

have recognized at once our responsibility to our government and to our associates in that we should eat less wheat, less meat, less fats, and less sugar. If you and I are eating the same breakfast foods and as much white bread as we ate before our entry into the war, then we are not making the response we ought to in the midst of the present crisis. Likewise, there ought to be a change in another matter of our daily living, namely, our clothing. I am not talking against the tailors, or the clothing shops or the millinery shops, but I do believe that in these war times it becomes our duty to recognize that possibly we ought not to spend so much money, and certainly not so much. time, on the question of clothes, as many people in our generation have been spending in recent years. I believe that all of the things which come closest to us and affect in the most intimate way our daily living ought to become objects of very careful consideration. More and more in every community there are homes from which the husband or the son have gone forth to war, and it is not going to be possible for those famlies to maintain the same standard of living as they maintained in the past. It is for you and me to make sure that we create a genuine social approbation of those people. You and I ought to be able to say to them, "We respect you, yes, we congratulate you, for the contribution that you have made to your country in this hour of crisis." Instead of gathering together somewhere and gossiping about how Mrs. Smith cannot live and dress just the way she used to, we ought to make it clear to her that in our hearts we have a profound regard for what she is doing, for the suffering and the sacrifices through which she is going, in order that there may be a better world for us to enjoy.

Men, you and I are less than human if we permit for one instant any of these persons to suffer because they cannot live just as they used to live. (Applause). So, I say, there must be a change in our food, in our clothing, in our standards of living, and also in that thing which concerns all of us-our work.

Now and then I hear a man say, "My business is not what it was before the war began.' Of course, it is not. It is not the same with

any of us. My work is not what it was before the war began. Every day brings to us new problems and situations, because we are at war. All of our work must inevitably change, for we are not living in times of peace but in times of war. And the same thing applies to recreation. It is a significant fact that the President of the United States has not seen fit to take a vacation since our entry into the war. You and I have no right to think so much of rest as we used to think.

Again, every atom of our strength, physical and nervous, must be given to the end that the United States and her Allies may win this war. (Applause). Eating, drinking, living, working, playing-these are the things that make up our daily life.

But there is one other thing that concerns all of us more intimately than any of these. I do not care what your attitude is to it, I am not particularly concerned about how you define it; I am not concerned as to what may be your thought about the external manifestations of it in our common life, or the organization which represents it; you may even scoff at it if you please, but it is only because we do not understand it or the organizations which represent it. I have reference to religion. I believe that this war is going to make more phase of our common life. Are you a father change in religion than in almost any other and did you march beside your boy to the station the day he took the train to go away to the camp? If you did, or if you saw some other man that you loved do the same thing, how did you feel? And didn't there go up out of your heart that day some silent, unformulated hope that that boy might do his duty, that he might have the strength to resist the awful temptations which gather about the soldier, that he might be faithful and loyal to the United States flag, and that he might come back when the war is over? (Applause). Yes. And when he goes across the ocean and enters the trenches, and then when that crisis comes and he goes out over the top in No Man's Land, and then possibly when he slips into the Great Beyond, I am a little inclined to think that that realm which for a generation has seemed less real than before, will again be more vital and of more significance in American thinking and