NATURE 



493 



THURSDAY, JANUARY 15, 1920. 



SURGERY OF DEFORMITIES. 

 Menders of the Maimed: The Anatomical and 

 Physiological Principles Underlying the Treat- 

 .nient of Injuries to Muscles, Nerves, Bones, and 

 Joints. By Prof. A. Keith. (Oxford Medical 

 Publications.) Pp. xii + 33S. (London: Henry 

 Frowde; Hodder and Stoughton, 1919.) Price 

 16s. net. 



PROF. KEITH'S book is undoubtedly one of the 

 most interesting and instructive which have 

 vet been written on this important branch of sur- 

 gical work. The author treats the subject from an 

 entirely new point of view ; instead of following 

 up each forward step and discussing the influence 

 which the various workers in this field had on that 

 progress, he gives us a restimi of the career of the 

 workers who made this advance possible. 



Nothing could be clearer or more concise than 

 the way in which Prof. Keith has selected from 

 the career of the men who are chiefly responsible 

 for this progress the various points of importance 

 in making us understand the influence which these 

 men had on the progress of the surgery of 

 deformities. 



The book enables us to understand how great 

 was the handicap under which these pioneers had 

 to conduct their studies. It shows us how two 

 men such as John Hunter and Hugh Owen 

 Thomas, whilst working in widely different fields, 

 the one finding most of his data in the dissecting 

 room and the other gathering all his observations 

 from clinical studies at the bedside, each arrived 

 at practically the same conclusions in regard to 

 the healing of wounds and the cure of disease. 



These are two men who in their practice had 

 found that the proper treatment for inflamed or 

 injured bones or soft tissues was not the method 

 of movements and massage which was the popular 

 one in their time, but fixation, which promotes rest 

 of the tissues and allows Nature's reparative 

 changes to come unhindered into action. 



Hunter perhaps better than any other clearly 

 defined the relationship between fixation and mas- 

 sage in an injured or diseased joint in the principle 

 which is enunciated in his book on " Diseased and 

 Wounded Joints respecting their Motion," in 

 which he states that " nothing can promote con- 

 traction of a joint so much as motion before the 

 di.sease is removed." 



The subject with which Prof. Keith deals is one 

 that has always interested surgeons, and al- 

 though of late years the great advances which 

 have been made in abdominal surgery have tended 

 to overshadow this important branch of surgery, 

 NO. 2620, VOL. 104I 



yet no more opportune moment could have been 

 selected for the publication of this work. 



The hundreds, or rather thousands, of soldiers 

 and ex-soldiers who are to-day walking about in 

 our cities with deformities of joints, with mal- 

 united fractures, or with paralysis of one or more 

 limbs are a constant reminder of the importance of 

 a clear grasp of the principles for the treatment of 

 these injuries. 



The great disadvantage under which a medical 

 man labours at the present time is that he can find in 

 no library a trustworthy history of the work of those 

 who have gone before him in any special field. 

 The result is that careful and capable workers 

 in some special branch of surgery or medicine 

 are often found struggling with the solution of 

 a problem which has already been solved, or 

 proved by the work of a forerunner to be of little 

 importance. 



This is where Prof. Keith's book is of such 

 great value. He forces us to realise the work 

 which has been accomplished by the men who were 

 the pioneers in the art, and in a few all too short 

 chapters follows up that progress through the 

 careers of those who followed. 



No part of the book is better conceived than the 

 chapters which Prof. Keith has devoted to the 

 growth of bone and the practice of bone grafting. 

 Here we follow down through the years the 

 gradual increase of knowledge from the work of 

 Goodsir and Syme to that of Albu and Hey 

 Groves. We see how each succeeding investigator 

 added in some way to what was known of the 

 subject, and built up our present knowledge, 

 which is daily increasing and changing. 



At no time in the history of the subject has 

 there been such an immense number of cases on 

 which this problem of bone regeneration and bone 

 transplantation can be studied, and in many cases 

 fractures have occurred of a bone g'raft soon after 

 its implantation, with a subsequent union of the 

 parts of the graft. 



The book is intended primarily as a rdsumd of 

 the history of the subject, and does not enter into 

 a discussion of treatment except in the broadest 

 .sense of the term, and perhaps its one weak spot 

 is the short discussion on the relative values to be 

 placed on different lines of treatment. 



This is seen in the remarks on the relative advan- 

 tages of the treatment of fractures by means of 

 plating as compared with non-operative methods. 

 Here Prof. Keith follows entirely the report of a 

 commission, and from the purely theoretical point 

 of view decides that the results of the treatment of 

 fractures by plating is superior to those obtained 

 by splints, etc., and does not realise that we are 

 comparing the work of the best surgeons on the 



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