Harry Platt

TRACTION LESIONS OF THE EXTERNAL POPLITEAL NERVE

One of the more serious but relatively uncommon forms of violence to which the kneejoint is exposed is a sudden and powerful adduction of the leg on the thigh. The essential injury produced by this mechanism is an extensive rupture of ligamentous structures on the lateral aspect of the joint, sometimes associated with a temporary subluxation. In exceptional circumstances, when other forces, such as torsion and hyperextension, are combined with adduction, the knee-joint may be completely dislocated. Under such violence it is not surprising to find that the external popliteal nerve shares in the damage and is either overstretched or even completely tom across. Nine examples of traction lesions of the external popliteal nerve produced in this manner have come under my care during the past twenty years. The circumstances in which the injuries were sustained were as follows:

COLLES'S FRACTURE

the accepted principle of indirect rule involves the education of the chiefs and people to develop their own service -political, educational, and health-under the advice and guidance only of the European staff, and direct action taken by an energetic European sanitary staff in a native city may entirely destroy the delicate growth of a system of responsibility thrown upon chiefs, sub-chiefs, ward heads, and family heads, quite apart from the inherent difficulties of house inspection among a Mohammedan population. It must also be realized that a campaign against yellow fever alone will receive small support from a native population which is not impressed with the seriousness of the disease, and that the medical authorities in West Africa must face such serious diseases as smallpox, yaws, sleeping sickness, relapsing fever, leprosy, guinea-worm, and schistosomiasis, for the control of which organized campaigns undertaken by survey parties followed by treatment parties are necessary. Some 56,000 cases of yaws alone are being treated each year in Nigeria, anid between 5,000 and 10,000 cases of sleeping sickness. An enormous expansion of health work among the population is taking place in West Africa, and in Nigeria this is becoming more and more effective through the native administrations, which are now entirely supporting eight large hospitals and 140 dispensaries, and are producing well-educated candidates for training as sanitary inspectors, dispensers, and medical assistants. Native administrations are also becoming more and more anxious to install pipe-borne water supplies into their cities. It will be generally agreed that the right way to attack yellow fever is to improve general sanitation and to educate the local population. The programme which we are attempting in WVest Africa is upon the following lines:

A Clinical Lecture ON BIRTH PALSY

Cost of Process. To be generally used the method must not only be reliable, but also cheap. This requirem-ent is fulfilled by nmy metlhod. To supply a battalion of 1,000 men with one gallon a Ilead a day for a miontlh of tlhirty days will require 900 (say 1,000) 5-grain tablets of potassium clhlorate and 5 pounds of concentrated hydrochloric acid. The tablets cani be purclhased at Rs.1.8 (2s.) a 1,000 and acid at 8 annas (8d.) a pound. Tlle totalcost per month, therefore, for 1,000 men at a gallon a lhead is only Rs.4 (5s. 4d.). The cost of boiling water is infinitely more. Soldiers are allowed four-fifths of a pound of wood a hlead a day for boiling drinking water. For 1,000 men this comes to 800 lb. (equals 10 nmaunds) a day, or 300 maunds a montlh. The cost of wood is 10 annas (lOd.) a maund, so that the cost of boiling water comes to Rs.187.8 (£12 lOs.) as against Rs.4 (5s. 4d.) for chlorine. Comimnict is unnecessary.

British Orthopaedic Association: first Founders' lecture.

I am deeply conscious of the honour you have done me in inviting me to give this, the first Founders’ Lecture. I have no doubt that your choice was influenced by the fact that of the three surviving Founding Fathers-Sir Thomas Fairbank, Mr Arthur Rocyn Jones and myself-it fell to my lot to be the first Honorary Secretary of the young Association launched forty years ago. The story of the growth of the Association from small beginnings in 1918 is a chapter in the history of the evolution of orthopaedic surgery in Great Britain during the first half of the twentieth century. Some of this story has been admirably told by Mr Rocyn Jones in his Presidential Address to the Orthopaedic Section of the Royal Society of Medicine in 1937. and more recently by Mr H. Osmond-Clarke in the special commemorative number of our official Journal in 1950. But, unlike the elephant, “ young men forget “; and some of the events of those early years will, I hope, bear repetition-and perhaps embellishmentwhen related by one who was an eye witness of the scene. At the turn of the century orthopaedics in Great Britain occupied an unimportant position as a differentiated speciality within the realm of surgery, and by common consent its field was limited to the correction of established deformity. The great mass of deforming diseases and injuries was at that time treated by general surgeons in general and children’s hospitals. Amongst the forty original members of the short-lived British Orthopaedic Society founded in 1894. there had been a mere handful of surgeons who practised orthopaedics exclusively. But in the decade before the outbreak of the first world war the scene had begun to change, and the stage was being prepared for the launching of a new specialist association. In London the three independent and rival charities, the Royal, National, and City orthopaedic hospitalsall institutions of small size-had merged in the new Royal National Orthopaedic Hospital, opened in Great Portland Street in 1909. Of the five surgeons brought together on the staff of the combined hospitals, two only were orthopaedic surgeons and nothing else-Mr E. Muirhead Little and Mr Evan Laming Evans. A. H. Tubby, well known for his writings, T. H. Openshaw. and J. Jackson Clarke, were also general surgeons at the Westminster, the London. and the Hampstead General respectively. It was true that at St Bartholomew’s an orthopaedic department, so-called, had existed since 1864; but until 1912, when Mr R. C. Elmslie was appointed to take charge, the department had been simply a special out-patient clinic conducted by one of the assistant surgeons of the hospital. Of these, one who made notable contributions to the literature of orthopaedics was Howard Marsh. In 1906 the Charing Cross Hospital had unwittingly made history by creating a department with a few beds under H. A. T. Fairbank, who had already begun to achieve distinction in children’s orthopaedics at Great Ormond Street. At Guy’s also orthopaedics was emerging from its subordinate status under the control of the general surgeons, and, after a period of travel which included Liverpool and Scandinavia, W. H. Trethowan was elected as the first specialist orthopaedic surgeon in 1913. Blundell Bankart, also a Guy’s man, had previously thrown in his lot with the Royal National Orthopaedic Hospital, where after serving as registrar he had been appointed Assistant Surgeon with the duty of acting as substitute in the absence of any one of the five senior surgeons.

EXCISION OF THE HEAD OF THE FEMUR IN ARTHRITIS DEFORMANS

every civilized country; the door of admission must be narrow, and those only should be admitted who in the opinion of the Council in charge of registration were up to the standard. The larger the area the Council covered the easier it was for it to set up a high standard. , He suggested that the question of an i-India Medical Council should be considered, composed of representatives of the provincial Councils, to discuss all problems of medical education. He further suggested an interchange of examiners between the different universities for the purpose of raising and standardizing the qualifications of all.