process known as plastic skiography was originated by Alexander of Budapest in 1906, and although it excited very little but the modified process as used by the author is extremely simple. Technique: The first step is to obtain a good contrasty negative. A dispositive is then made by placing the negative and a slow unexposed plate, with the film sur FIG. 2.-(MacKee Dental Digest, May, 1908). Plastic Reproduction of Fig. 1. FIG. 3.-(MacKee, American Journal of Surgery, July, 1908). Plastic Reproduction from Radiograph of Normal Knee FIG. 4.-(MacKee, American Journal of Surgery, July, 1908). Plastic Reproduction from Radiograph of Norma Elbow. One coin and one bone was placed on the plate; the other objects being placed on the forearm. The true relations of these bodies are no better portrayed than in the original plate. plate is then developed in the usual manner. When dry the two plates are placed manner the edges are bound with lanternslide binding to prevent slipping. The two plates are then placed in a printing frame with the positive side up, and a print is made by exposing to light at an angle of about 40 degrees. The image appears in bold relief instead of the customary silhouette. This effect is entirely. due to shading, one side of the image being shaded while the other edge is illuminated, much in the same manner as letters are made to stand out on a signboard. The practical value of the process is limited. It produces very beautiful, artistic effects. The bones stand out in relief, cavities appear to possess depth and contour, but true relations are portrayed with no more acuracy than in the original radiograph. The main value of the method seems to be as a means of reproduction. The Treatment of Menier (Bulletin Hay Fever. Général de Thérapeutique, September 15, 1908) advises the inhalation of a solution of menthol in chloroform (1 part of menthol in 25 parts of chloroform), or a spray of adrenalin solution, I in 2000, to ward off an expected attack of hay fever. The derangement of vision and eye trouble may be overcome by the instillation of one drop of either of the following solutions in each eye: (1) R Eserine sulphate... Distilled water.. Ꭱ ...IO 02 (gr.) (Jiiss) M. (2) M. When the asthmatic symptoms pre ORIGINAL COMMUNICATIONS. FRACTURE OF THE ACETABULUM. By A. WÖRNER, M.D., (Translated from the Beiträge zur klinischen Chirurgie by Dr. F. Robbins.) There is an isolated fracture of the floor of the acetabulum, with passage of the femoral head into the pelvis, the result of a single traumatic force, usually a fall, acting upon the injured hip. This fracture corresponds to the so-called luxatio centralis femoris, described in textbooks. The injury has so far been very rarely. positively demonstrated, but the cases are sure to increase before long, since the Xray examination alone permits the diagnosis upon the living subject in an unobjectionable manner. The pathological picture of isolated acetabular fracture is to be retained, although up to the present time no case is known in which the fracture lines did not radiate beyond the direct circumference of the acetabulum. As long as this proof has not been furnished, the author considers as impossible the smooth passing of the femoral head through a hole in the acetabulum without these radiations of the fracture lines. The first case of isolated fracture of the acetabulum, with entrance of the femoral head into the pelvis, was observed by him in 1905, and he is now enabled to contribute four additional cases. Case 1-Man, age 36 years; carpenter. Fall upon right side of pelvis and right arm from a height of 2 m., April 12, 1905. Able to rise, go upstairs and go to bed. Nothing was found next day on examination, but patient was sent to hospital on April 20, on account of constant complaints of severe pain in region of right hip. Walked laboriously with two canes and was carried upstairs. Accurate examination and measurements yielded entirely negative findings. Pelvis not tender on pressure; movements in hip-joint easily possible in all directions and full circumference with but slight pain; no shortening of leg, no abnormal position, no crepitation; trochanter exactly in Roser-Nélaton's line. No bloody extravasation visible in hip nor in right arm where elbow-joint was complained of as painful. Discharged after two days. Unfortunately, no X-ray picture was taken at that time. Patient returned for examination on October 2 of same year, when he presented a very different picture. He had been able to walk fairly well with a cane, but the disturbances in the right hip did not subside, and he had been unable to resume his work. The X-ray pictures showed a slight flexion-contracture in the hip-joint, the right leg was somewhat rotated outward and shortened by about 2 cm. The right trochanteric region was distinctly flattened, and above Poupart's ligament a rather voluminous rounded and somewhat sensitive tumor of bony hardness could be felt in the pelvis, distinctly following the rotatory movements of the thigh. This tumor could also be felt very distinctly on the right side per rectum. Besides the slight flexion-contracture there existed at that time no essential limitation of mobility in the hipjoint. The external rotation could not be entirely compensated, but otherwise the leg could be well rotated and flexed. Abduction was most seriously impaired, and was possible only by overcoming a rather powerful resistance. A series of X-ray pictures was made of the entire pelvis, as well as the two individual hip-joints, yielding entirely unobjectionable findings. The articular head was seen driven into the pelvis fully as far as possible. After an unsuccessful attempt at improvement of the flexioncontracture had been made by 14 days' extension with weights, the patient was discharged, since the results seemed to be fair enough in view of the severe injury which had been demonstrated, and further improvement could be expected. This failed to occur, however, and when the patient was re-examined about a year after the last examination, the following findings were noted: The flexion-contracture in the right hip had increased considerably, amounting to about 45 degrees, and the mobility of the joint, which had been remarkably good before, was now reduced to a minimum of passive flexion. The thigh is very atrophic, the great trochanter stands 2-3 cm. above Roser-Nélaton's line, external rotation the same as before, also the findings on palpation in the pelvis, from without and per rectum. A compensatory lordosis is beginning to develop. Patient walks on the ball of the toe. Right trochanter 11⁄2 cm. nearer to middle line than left trochanter, but this had been previously the case. The head could not possibly enter any farther into the pelvis, but whereas half a year after the accident the mobility in the hip-joint had still been very fair, it was now as good as lost, with subjective disturbances in proportion. Case 2-Man, age 54 years; bricklayer. Fall from a carriage, with great force, upon right side, especially pelvic region, from a height of about 11⁄2 cm. Immediately such severe pain in the hip that he could not rise, and had to be carried to the hospital. Was unable to move; lay upon his back with the leg slightly flexed in the hip and knee. Cautious attempts to straighten out the leg produced a slight external rotation, which could be compensated only by force and under severe pain. There was slight shortening, and the right trochanter major was less prominent. The skin in its surroundings presented a distinct bloody extravasation. Transverse compression of the pelvis, however strong, was not painful, but pressure upon the right horizontal ramus of the pubes gave rise to pain. The right lower abdominal region was painful, and a hard resistance was distinctly felt above Poupart's ligament. Examination per rectum showed swelling of the soft parts. on the right side and marked tenderness of the region of the ischium. A bony tumor was only indistinctly palpable. Movements in the hip-joint could be carried out to a rather normal circumference under manifestation of much pain. The X-ray pictures served to show that the articular head on the right side projected into the pelvis in such a way that the great trochanter almost touched the pelvis. The patient was kept in bed, and careful movements were carried out in the recumbent position, with massage of the leg muscles, to guard against stiffening and favor the formation of a new joint. On the first of October he was allowed to go about with a walking apparatus, and since the beginning of November he walks fairly well without apparatus, with the assistance of a cane. In walking and standing the right leg is held stiff in the hip, with the body bent forward; the leg is still slightly rotated outward, internal rotation is impossible, otherwise |