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If the bones are allowed to remain in their present position rotation of the radius about the ulna will be practically impossible. Can we reduce this fracture without a cutting procedure? This, I believe, cannot be done for the reason that the amount of callus that will have formed in the two weeks that has elapsed since the accident will be sufficient to prevent the approximation of the ends of the bones. If we are unable to do this, then we must expose by an incision the fractured bone, separate the callus from the ends, and then bring these ends in proper position, after which we must adopt some procedure to retain them in that position.

There are three methods, any of which we may employ for the purpose after the ends of the bones have been brought together. We may either suture together the periosteum covering the fragments of the bone, or we may drill a hole through each fragment and unite them with a silver wire passed directly through each portion of the bone; or we may apply a steel plate, to bridge over the hiatus and fasten this plate to the two ends of the bone by means of screws.

Having put the boy under the anaesthetic, we will now attempt a manual reduction of the fracture. You will see that we are able to make the arm fairly straight so that it would seem as though we have really approximated the ends of the broken bone. In order to prove whether we have or not, we will examine it with a fluoroscope. As the X-ray pictures the limb, we see at once that a reduction has not really occurred. The bones still ride each other as shown in the picture, so we will at once proceed to the open method of treating this fracture.

A three-inch incision over the outer portion of the bone will readily let us down upon it without involving any important structures. The bone is readily exposed and we see the callus that binds the broken portions together. By manipulating the arm you see that we can readily turn out the broken bone. The two extremiities are exposed and we

will now even them by cutting off with the bone shears the ragged ends. This allows the upper fragment and the lower fragment to drop together comfortably. The friable condition of the periosteum, due to the exduate that has been thrown out, makes it impossible to secure apposition of the ends of the bones by means of suturing, so we may resort either to plating or uniting the ends of the bone with silver wire. The little chap being only seven years of age, necessarily has small bones, hence the ordinary sized plate would be cumbersome to apply in this instance.

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Fig. 2. From X-Ray by Dr. Geo. C. Williamson, ends of radial fragments secured by wire.

The silver wire, in my opinion, will serve our purpose very much better than a metal plate. So we will now proceed to drill a hole through the end of each bone. This, as you see, is easily accomplished and we are able to pass this No. 26 silver wire through the holes that we have made, and by twisting the ends of the wire together we bring the bones in close apposition. It is now necessary to approximate the soft parts which we will do with No. 0 iodized catgut, after which the skin can be closed with the same material.

The great advantage of the open method of treating fractures is, that we are not bothered either with tying the small blood vessels in an operation of this kind or with approximating the deep soft parts. We merely unite the skin opening, believing that nature will take care of any small amount of blood that may escape.

We will support this arm on an internal angular splint that will fix both the wrist and elbow joints. The union should be complete so that the splints may be removed at the end of three weeks.

Success in a case of this kind depends upon not only accurate diagnosis, made by the use of the X-ray examination, but also upon absolute surgical cleanliness. Any infection of the wound is likely to be followed by failure of the operation.

You will have observed while I was doing this operation that I was extremely careful to touch no part of the wound with my hands, even though covered with rubber gloves. We use only boiled instruments, and even these we carefully protect by not handling the parts that are applied to the open surfaces.

This little fellow will not be kept in bed, but will be allowed to run around the hospital for a few days at the end of which time, if no untoward symptoms arise, he will be sent home to be under the care of his family physician.

PREVENTION OF BLINDNESS.

We live in a day and in a land of waste. The prevention of disease is a matter of knowledge. Knowledge is one of the most valuable assets of mankind, and yet we are to-day, notwithstanding all our boasted erudition and high degree of civilization, so little removed from the customs, measures and methods of our savage and unenlightened forbears that it is necessary to have legislative enactments to compel our people to accept the beneficent advantages of known and established facts of well defined and demonstrable knowledge, just as it was at one time necessary by law to forbid cannabalism, and even the eating of human bodies that had died of the plague.

The loss of the most wonderful and marvelous faculty of vision is a calamity terrible to the individual as well of grave moment to the community, greatly to be deplored, and notwithstanding the beneficent results secured by our Schools for the Blind in alleviating to some extent this so pitiable, grievous and well nigh irreparable affliction, we can and do, most earnestly and sincerely commend the work of the "National Committee for the Prevention of Blindness” in their grand and noble work in limiting to some extent this individual, local, municipal, State and National waste.

In a recent issue of this journal we reproduced "Publication No. 5," issued by this important Committee, and sincerely hope that it was of interest to our readers and that it may be of benefit to some of those under their care. The following excerpts from the Committee's "News Letter" No. 3, we deem well worthy of careful reading and consideration, dealing with such important etiological factors in the production of blindness as Ophthalmia Neonatorum, Trachoma, Wood (methyl) alcohol, etc., as well as showing what is being done and what has been accomplished in eighteen States and Canada. (Ed. S. P.)

While ophthalmia neonatorum (babies' sore eyes) continues to send to the schools for the blind a large percentage of unfortunate children (nearly 100 in the school year 1914-15) a gratifying reduction is shown by comparing the reported percentages for the five years since 1910. Of the new pupils entering in each of the following years the per cent blind from babies' sore eyes is:

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More care in making reports and greater accuracy in diagnoses are probably responsible for some of the reduction indicated, but it is believed that the agitation which has been conducted by the various Committees, Commissions and Societies for Prevention of Blindness is beginning to bear fruit.

The Journal of the American Medical Association has opened a campaign to secure the prohibition of the manufacture of methyl alcohol, commonly known as "wood alcohol." The extreme danger attending the use of methyl alcohol, even when confined to external application, and particularly the danger of confusing the poisonous wood alcohol with grain alcohol is the animus inspiring the Journal's editorial campaign, in which, as the mouthpiece of the American Medical Association, it must have the backing and co-operation of the members of the association. Recently three persons died and two others were made completely blind from drinking a cordial made partly of wood alcohol, says the Journal of the American Medical Association.

Alabama:-A survey of the trachoma situation in Tuscaloosa was made sometime ago by Dr. Herring of the United States Government and steps were immediately taken to remedy the condition in public schools. The spread of the disease has been checked and no further danger is now felt. No cases were found among the students of the University.

Arkansas:-The State School for the Blind during the summer sent out thousands of circulars on "Preventable Blindness."

Trachoma is the principle source of blindness in the Arkansas School for the Blind. Naturally, in the campaign for the prevention of blindness in that state which is under the direction of Supt. John H. Hinemon of that school, the first stroke is against trachoma. An eight-page leaflet, written by Dr. John G. Watkins, oculist and aurist to the school, describing the disease and giving general directions for

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