reaction another and last dose of 10 milligrams, after another interval of three days, is given. If fever results it is essential that the patient be confined to bed until it disappears.

of Tuberculosis.

The Ophthalmic Reac- Campbell, McKee tion in the Diagnosis and White (Montreal Medical Journal, April, 1908) have collected 4219 cases (from the literature chiefly of France, Germay and the United States) where this test has been carried out. There are undoubtedly many omissions, but also, perhaps, some repetitions. Of this number 1675 cases were tuberculous, with 1426 positive and 249 negative reactions (14.8 per cent. error). Five hundred and fifty-seven were questionable or suspected, with 289 positive and 269 negative results, while 1987 cases were not tuberculous, with 169 positive and 1818 negative reactions (8 per cent. error).

Such statistics have some fallacies, but the percentage of error keeps very close to 14 and 8 per cent. in each series. While an open mind is still the only attitude to maintain in reference to this reaction, the authors feel that a test so easy of performance, which has so few contraindications, is so simple in its interpretation, and where a prompt, sharp reaction occurs, so certain an index of tuberculosis, deserves a wider and more extensive trial. (For a further account of this reaction see MEDICAL REVIEW OF REVIEWS, November, 1907, p. 831.)

ministered in such a way that in the first place the foot end of the bed was raised by a simple contrivance to suit individual requirements; it was thus not necessary to move the patient himself. The gelatine solution (usually 5 per cent.) was introduced by means of an irrigator at a temperature of 48-50°C, the injection being made as slowly as possible, and under a low pressure, since a rapid introduction of the fluid may give rise to tormina and tenesmus, which should be very carefully avoided in these cases.

F. R.

Treatment of Epidemic Cerebrospinal Menin- W. H. Porter (Post gitis. Graduate, May) has treated four cases of epidemic cerebrospinal meningitis with diphtheria antitoxin, which he reports with the following conclusions:

Since 1805 epidemic cerebrospinal meningitis has been known as a distinct disease.

2. Formerly it occurred only in widespread epidemics.

3. In recent years it has in many localities become an endemic disease.

4. The etiological factor is the diplococcus intracellularis meningitidis of Weichselbaum.

5. The presence of this special diplococcus in the spinal fluid is diagnostic of epidemic cerebrospinal meningitis.

6. Some cases die from the intense toxæmia with very little inflammatory exudation.

7. Other cases have very little toxicity, but considerable inflammatory exudate, which causes death by compressing the cerebral centers.

8. In the past this disease was considered practically incurable.

9. Recently the reverse has been claimed, and the four cases here reported

hæmorrhage subsided and the patient recovered without untoward sequelæ.

This case affords an unusually striking illustration of the familiar fact that an inflamed tonsil or the peritonsillar tissues may suppurate and give rise to grave complications, such as ulceration into the carotid artery and suffocation from rupture into the larynx. Recovery under these conditions represents an exceptionally favorable outcome. F. R.

Embolism of Pulmon- Strauss
ary Arteries
Months After Patellar
Fracture.

(MonatsThree schriftf. Unfallheilk. u. Invalidenw., XIV., 7, 1907). Sudden

deaths in connection with bony fractures are not a very uncommon occurrence. As a rule, these cases constitute fat embolism in the area of the brain capillaries and minute pulmonary vessels, generally appearing a few hours or days after the accident. Far more rare the cases of em

bolism of the large pulmonary arteries, which originates from thrombotic veins in the vicinity of the fracture, leading to sudden death several weeks, or even months, after the accident. The anatomical connection can sometimes be established only under great difficulties, especially in those cases where the thrombus formation failed to give rise to distinct symptoms in the lifetime of the patient, or where an autopsy cannot be obtained. In a personal observation of the author's, death from embolism of the pulmonary artery ensued three months. after a transverse fracture of the patella. The starting point of the repeated embolisms was in the thrombotic femoral vein. F. R.

A Contribution to the Knoke (Beitrag zur Treatment of Supra- Behandlung der sucondylar Fractures of the Humerus.

pracondylären Humerus - Frakturen) (Dtsch. Ztschrft. f. Chir., Vol. 90, H.

1-3, 1907). According to the author, Helferich's procedure has hitherto been successfully employed in 15 cases of supracondylar extension fractures of the humerus. This method is carried out as follows: The forearm having been scrubbed with benzin or ether, and shaved, if necessary, a strip of adhesive plaster is applied in the first place to the flexor and extensor surface of the forearm. Starting at the elbow, these strips extend a little beyond the finger-tips, and are not adherent to the hand. This is obtained in the simplest manner by doubling back the strips with the sticky surfaces turned against each other, from the fingertips as far as the wrist, or by wrapping the hand in a gauze bandage. These strips are either drawn through a small ring at the point where they have been doubled back or they may be perforated in this locality for the application of a rubber tube (to be discussed later). After the position of the fracture ends and the desired flexion in the elbow-joint have once again been ascertained, the entire arm is padded, with the forearm in supination, giving especial attention to the anterior surface of the upper arm, since the greatest pressure is to be exerted at this point. The proper splints for the purpose are the flexible Cramer splints, which should be approximately of the width of the padded arm. The splint is curved to meet the requirement of the case, and is then applied in such a way at the extensor surface of the arm that in the first place it projects a hand's width beyond the finger-tips, and in the second place, above the shoulder and towards the neck it is bent at a right angle about a hand's width away from the upper region of the shoulder. The splint is next fastened moderately tight to the forearm by means of a bandage. The next following junction of the splint to the upper arm

aims at the double purpose of fixation of the fragments and extension of the upper arm downwards. The circular turns of the bandage in the vicinity of the elbow joint are, therefore, tightened to some extent in order to solidly fix the replaced fracture ends. The splint is, moreover, pressed downwards by a number of well-padded tours of the bandage passing from the axilla beyond the vertes of the splint. This serves to push aside the flexed forearm, thus bringing about an extension of the forearm. Finally, two

rubber tubes are drawn through the rings of the adhesive plaster strips at the side of the fingers; these tubes are tied with a certain amount of tension to the anterior transverse bars of the Cramer splint, and in this way the necessary extension traction in the direction of the forearm is secured and maintained. F. R.

Treatment of Frac- Bardenheuer

(Be

tures of the Upper Arm. handlung der Frakturen des Oberarmes, etc.) (Mediz. Klin. No. 44, 1907. Illustrated). The author discusses the treatment of fractures of the upper arm, more particularly in the shoulder region, including the upper third of the humerus, taking into consideration the simultaneous treatment of complicating joint injuries. The leading principle is the necessity for early gymnastic treatment without interference with the healing of the bony fracture. A number of drawings and X-ray pictures serve to illustrate the application and action of the traction apparatus in injuries of the outer end of the clavicle, the scapular neck, the coracoid process, the upper end and shaft of the humerus, the elbow joint. In those cases where extension upwards or downwards is not feasible, the author's spring extension splints are employed. He never observed the otherwise common delayed repair, or pseudo-arthrosis, in the

lower third of the humerus. Whenever there is a suspicion of small fragments scattered in the muscles or in the joint, especially in case of the elbow joint, massage and passive movements are contraindicated, since in these cases they may give rise to myositic new formations or periosteal deposits, with considerable interference with motion, as was repeatedly observed by the author.

Bardenheuer prefers active movements, or a combination of slight active. with gentle passive movements such as those produced by the weight. They are to take place within the scope of painlessness, and all unintentional and uncalculated passive movements are to be avoided. Any sensation of pain is a sign of injury of the interior of the joint, which should be most carefully guarded against. These exercises are carried out at first for five minutes at a time, gradually increasing up to thirty minutes, twice daily; later on, three times daily. These gymnastic exercises, with their normal physiological stimulus, serve to improve the circulation of the blood and the nutrition of the tissues. Elasticity is preserved and fatty degeneration of the muscles and other nutritive changes are avoided. The extension not only corrects the dislocation, but checks the primary inflammation of the injured tissue, bone and muscle, favoring the absorption of the extravasated blood, the inflammatory exudate and the cellular infiltration. The capsule is stretched by the extension so as to separate and relieve the contact surfaces of the cartilage. The extension also serves to diminish the interfragmental pressure and lessens the inflammation at the point of fracture, limiting the production of callus, a very important consideration for the functional results.

F. R.