N. Y. MED. JOUR. AND

The x ray tube, diaphragm up, was then adjusted immediately beneath the fractured limb allowing a space of about four inches between the surface of the table and that of the bulb. The tube was then energized and another fluoroscopic examination was made of the limb to see that everything was in working order. Arrangements were then made for the adjustment of the fractured ends by fastening a strong crash towel around the limb just beneath the knee and another above the ankle to allow for extension and counterextension. Everything being in readiness, and the assistants in their proper places, the tube was again energized and, by placing the fluoroscope over the injured part, the condition of the bones could be constantly seen. Directions were then given to the assistants as to the amount of extension to be made and, by this method, very little trouble was experienced in extending and bringing together the broken ends, notwithstanding the large

amount of swelling present and the interval that had elapsed between the time of the accident and the time of setting. The bones being in good apposition from an anterior and posterior aspect the tube was then adjusted so that a lateral view could be obtained and, this being satisfactory, proper splints were applied to the limb to retain the fractured ends in position.

The practical value of this method, however, extended beyond the mere diagnosis and treatment of this case, for by periodical examinations with the rays, the condition of the bones was ascertained and the progress of the fracture was followed quite readily without disturbing the limb in the least, the splints and dressings being translucent to the rays. The man not only made a rapid recovery, but a perfect one, there being no apparent bad effects resulting from the injury, and he has been restored to duty.

CASE II.-M. M., aged thirty-eight years, col

ored, civilian laborer on the reservation, entered the hospital on the morning of August 23, 1903, complaining of a severe pain in the right forearm. He stated that, a few minutes before, while working upon a scaffold some eight or ten feet high, he lost his balance and fell headforemost to the ground, striking upon the right hand. A casual examination showed that he had sustained a fracture of the forearm and a more thorough examination made by the aid of the Röntgen rays showed that both bones of the forearm were fractured about three inches above the joint with considerable displacement of the fragments. The treatment of this case in the adjusting of the fractured ends was similar to the one already noted. A small wooden topped table was brought in and the patient was requested to rest the injured arm on this. The x ray tube, diaphragm up, was then placed immediately beneath the under surfaces of the table; the fluoroscope was then adjusted above the fracture (see Fig. 3) allowing sufficient space between it and the arm for manipulation. The tube was then illuminated and every movement of the fragments noted through the fluoroscope while the fractured ends were placed in apposition, which was accomplished with very little manipulation and without much pain to the patient. Proper splints were applied and a final examination was made, through these, to see that the bones were in good position. The patient was requested to report here daily for examination that the condition of the

and IV.

CASE III.-C. E., aged twenty-two years, private, 116th Company, Coast Artillery, while scuffling with a companion, was thrown to the ground, striking his arm against the edge of an elevated sidewalk inflicting what appeared to be a painful bruise. Being a recruit he did not like to go on the sick report and performed his duties until four days after the accident, when he entered this hospital with the arm terribly swollen and very painful. An x ray examination showed an oblique fracture of the radius above the lower third with some overriding of the fragments. The method adopted in setting the fracture was the same as described in Case II., with similarly excellent results.

CASE IV.-J. K.. aged twenty-seven years, private, Fifth Company, Coast Artillery, while assisting in elevating a heavy projectile from a casement up to the gun, was accidently struck upon the back of the hand by the handle of a flying windlass, fracturing the middle metacarpal bone. The man came to the hospital shortly after the accident and the fracture was set by the same methods as described in Case II, with equally good results.

The apparatus necessary for this method of managing fractures is a complete x ray outfit, of

either coil or static machine, and the usual accessories. An ordinary wooden topped table can be utilized for the patient, or one could be improvised by laying two pieces of pine lumber, 6 feet long, by 12 inches wide, and I inch thick, on a firm support about 18 inches high. The tube is placed on a stand underneath the table from 4 to 8 inches from the under surface of the board (see photograph).

As the length of exposure for doing this work would not be long and, as the rays would have to penetrate the board and in some cases the mattress, the probability of producing a burn would be very slight, but, as an extra precaution, the table could be covered with a rubber blanket which would not obstruct the rays in the least.

Although this method of setting fractures has been tried in a limited number of cases, the results thus far obtained have been so gratifying that I would recommend its trial by others. The essential points in its favor are the ability to see every movement of the fractured extremities during their adjustment, thus avoiding the necessity of giving an anesthetic for diagnostic purposes: saving the patient many painful manipulations and the tissues from bruising and laceration by unnecessary handling.

INACCURACY IN CLINICAL THER

MOMETERS.*

BY CASWELL A. MAYO, PH. G.,

NEW YORK,

EDITOR OF THE American Druggist.

Having had an opportunity some months ago to observe the methods used in the manufacture of clinical thermometers, I was impressed by the importance of accuracy in these instruments. With a view of determining the reliability of the thermometers on the market, I purchased eleven lots of one half dozen each in six different cities. Each of these lots bore different marks, but all were of a grade sold by jobbers at $6.00 to $7.00 per dozen, and fairly represented the average grade of thermometers purchased by pharmacists for sale over the counter. All were provided with certificates purporting to be from the manufacturers. Having collected these thermometers, I submitted them to the United States Bureau of Standards for examination.

Where thermometers vary more than three tenths of a degree from the standard thermometers of the bureau, they are rejected. Thermometers are also rejected which fail to repeat within three twentieths of a degree in two readings at the same point. The results of the examination of this lot of 62 thermometers (the remainder being broken in transit) are shown in the tabulated statement attached to this paper. These results may be summarized as follows:

1. 0.0 -0.1 -0.1 -0.2 2.-0.5 -0.4 0.4 -0.4 Reject. 3.-0.5 -0.6 -0.6 -0.6 Reject. 4.-0.5 -0.6 -0.5 -0.5 Reject. 5.-0.4 0.4 0.4 0.4 Reject. 6.-0.3 -0.1 -0.1 -0.4 Reject. E.

1.-0.4 -0.3 -0.2 -0.2 Reject. 2. 0.0 0.0 0.0 0.1 3 -0.1 -0.1 -0.2 -0.3 4.-0.2-0.3 -0.2-0.2 5.-0.1 0.2 0.2 0.2 6.-0.3 -0.3 -0.3 -0.2 G.

1. 0.0 0.0 -0.1 -0.1 2.-0.1 -0.2-0.2-0.2 3.-0.1 -0.2 -0.2-0.3 Reject. 4.-0.2-0.2-0.2-0.2

5. 0.0 -0.1 -0.1 -0.2 6.-0.2-0.2 -0.2 -0.1

I.

1.-0.3 -0.4 0.4 0.4 Reject. 2.-0.2-0.3 -0.3 -0.4 Reject. 3.-0.4 -0.6 -0.6 -0.5 Reject. 4. 0.0 -0.2-0.1 0.0

5. (Broken when received.) 6. (Broken when received.) K.

1. 0.0 0.0 0.0 0.0 2. 0.0 0.0 0.0 0.0 3. +0.1 +0.1 +0.1 +0.1

Nos. Corrections at Remarks. B. 96° 100° 104° 108° 1.-0.2-0.2-0.2 0.0 2.0.2-0.3 -0.3 0.3 Reject. 3.-0.2-0.2-0.1 -0.1 4.-0.2-0.3 -0.2-0.2 5. -0.1 0.0 -0.1 0.0 6. (Broken when received.) D.

A careful analysis of the results of this investigation brings to light several interesting facts. In the first place, there are only about twelve manufacturers of clinical thermometers, and of these only about five really make their own therThe others buy the ungraduated tubes, graduate them, put their own marks on them, and send them out as if they were of their own make. The majority of the thermometers sold are made by two or three manufacturers,

mometers.

Lot K.

.0 out of 6 rejected.

This shows that 29 per cent. of the thermometers bought were not sufficiently accurate to meet the requirements of the Bureau of Standards. Only II per cent. of all the clinical thermometers examined by the bureau during last year were rejected. It would appear, therefore, that manufacturers exercise greater care with the thermometers which they submit to the Bureau of Standards for certificates than with those found on the open market.

Read at the fifty-second annual meeting of the American Pharmaceutical Association, held in Kansas City, Mo., September 4 to 10, 1904.

FIG. 1.-Holder loaded with 24 thermometers.

who put on them any desired brand or mark, and in this way probably a thousand apparently different makes are found on the market. It is hardly necessary to state that where the real maker's name does not appear, the maker is apt to be careless. For instance, one of the lots examined, though bearing a small dealer's name, was made by one of the large makers whose certificates are usually to be relied upon, but of this lot, five out of six were rejected. There is one so called manufacturer who makes a practice of buying up the rejected "tubes," as the ungraduated thermometers are termed, graduating them, and selling them a little below the market price. It is hardly It is hardly necessary to say that such thermometers are worse than useless.

The positive criminality of the manufacturers in selling clinical thermometers which are so misleading in their results must be apparent to any one who has observed the grave importance which attaches to the variations in temperature in many febrile diseases. The mere fact that the pharmacist is not in position to carry out the testing of thermometers in his own shop by no means acquits him of responsibility in the matter. He can have his thermometers tested by the government at a very slight expense.

HOW TO SECURE GOVERNMENT CERTIFICATES.

All that is necessary is to pack up a dozen thermometers carefully and express them, prepaid, to the United States Bureau of Standards, Washington, D. C., putting the name and address of the shipper on the package, and enclosing $2.00 in money or post office money order (checks not being accepted) to cover cost of certification. The thermometers will be tested and returned within ten days or two weeks, each being accompanied by a government certificate which will not only enable the pharmacist to learn the actual facts as to the accuracy of his thermometers, but will increase the market value of those which stand the test sufficiently to make the investment a profitable one. It has been suggested that the pharmacist should test his own thermometers by comparing them with what he believes to be accurate thermometers plunged into a teacup of water. The absurdity of this procedure becomes quickly apparent when one considers the various sources of possible error involved in such a rough and ready procedure.

AGING THERMOMETERS.

Experiments made by the Bureau of Standards have demonstrated that where ordinary domestic glass is used in making all parts of the thermometer the average increase in the reading at the end of two months is three tenths of a degree, and

at the end of fourteen months sixty-eight one hundredths of a degree. The average change, however, in thermometers made with what is known as Jena normal glass or with French hard glass, at the end of two months amounts to only six one hundredths of a degree, and, at the end of fourteen months, eleven one hundredths of a degree, showing that with this glass one half the total observed change takes place during the first two months, and, as a matter of fact, the changes which occur after three or four months are practically negligible. These changes in the reading of thermometers are due to the fact that when glass is heated it expands quite rapidly to a volume corresponding to the temperature, but upon being cooled to the initial temperature it does not resume its original volume for some time, the length of time depending upon the character of the glass and the amount of change in temperature. The gradual contraction of the glass to its initial volume results in a diminution in the size

FIG. 2.-Complete set of apparatus for examining clinical thermometers..

of the bulb, and consequently the mercury is caused to rise higher in the tube and give a higher reading after the thermometer has stood for some time than when it is first completed. Since the volume of mercury contained in the stem is very minute, the change in the volume of the stem may be disregarded, and as a consequence it has become customary in the United States to make the stem of soft glass, using hard glass for the bulbs only. It occasionally happens also that in recovering from the stress caused by the great heat used in making the contraction of the bore

which makes the thermometer self-registering, a small splinter of glass is thrown off in the tube. This is not apt to take place until some time after the thermometer is made, but, if it does occur, it, of course, vitiates the readings of the thermometer.

Taking all these facts into consideration, it will be seen that it is highly important to "age" thermometers before they are put into use, and this point is fully appreciated by careful makers, who always age their thermometers before graduating them.

THE EXAMINATION OF THERMOMETERS BY THE BUREAU OF STANDARDS.

The United States Bureau of Standards referred to is a bureau of the Department of Commerce and Labor, and is authorized to establish and to examine standards for the determination of electrical units and units of capacity, mass and length, and to standardize thermometers and scientific instruments generally. Up to the time that this bureau was established, in 1901, the standards of the Yale Observatory were generally accepted. It has been found, however, that the Yale standard thermometers are slightly at variance with what is known as the international hydrogen scale, based upon the researches of Chappuis carried out at the International Bureau of Weights and Measures. This scale is defined. as follows in a resolution of the International

FIG. 3.-Holder in observation stand, with micrometer eyepiece.

Committee on Weights and Measures, adopted October 15, 1887:

The International Committee on Weights and Measures adopts as the standard thermometric scale for the International Service of Weights and Measures the centigrade scale of the hydrogen thermometer, having as fixed points the temperature of melting ice (o degrees) and of the vapor of distilled water boiling at standard atmospheric pressure (100 degrees); the hydrogen being taken at an initial manometric pressure of

DETAILS OF THE METHODS.

The routine pursued by the bureau in carrying on the work of standardization of clinical thermometers may be outlined briefly as follows: On each of the thermometers there is engraved a mark of identification for the use of the bureau. The thermometer is then examined for defects of construction, such as the presence of air bubbles, air, or moisture, in the mercury or in the bore, cracks in the glass, and defective graduations.

If this test is satisfactory, the thermometer is then compared with the standard thermometers of the bureau at the four test points, 96, 100, 104, and 108 degrees, two independent comparisons