DISCOVERY 



117 



demands several long sledge journeys and a good deal 

 of ship work. 



Concurrently with that there should be a definite 

 co-ordinated attempt to investigate as fully as possible 

 the various phenomena which have a bearing on con- 

 ditions elsewhere, or are peculiar to the continent. 

 This can only be done bj' the establishment of stations 

 which can be occupied by the necessary parties of 

 observers for long periods. Together with these 

 definite problems come a host of minor ones, and also 

 the continued though normally unsuccessful search 

 lor fresh resources which may be put to man's use. 

 The economic aspect of exploration must be kept in 

 \iew throughout, though in this case there seems 

 little likelihood of any great discoveries being made. 



In the past exploration has been carried out for 

 the most part by private expeditions, which have 

 done magnificent work and it is to be hoped will con- 

 tinue to do so. But there is a national and even an 

 international aspect to the matter, and until that is 

 fully recognised and an organised onslaught is made 

 on the whole continent, a great part of the deeper 

 scientific problems will have to remain unanswered. 



BOOKS FOR FURTHER READING 



The Lands of Silence. By Sir Clements Markham, K.C.B. 

 (Cambridge University Press, 45s.) 

 This book contains accounts of the chief polar explorations, 

 and gives references to the books dealing with the Antarctic. 

 The Geographical Journal for March 192 1 contains a lecture 

 by the author on the future of polar exploration, delivered 

 before the Royal Geographical Society. 



Orthopaedic Surgery 



By A. B. Appleton, M.A., M.R.G.S. 



Senior Demonstrator of Anatomy in the University of Cambridge 



That special branch of surgery which is distinguished 

 by the title " Orthopjedic " is one of rapidly increasing 

 scope and importance. This is largely an indirect 

 result of the Great War, though actually dependent 

 on new knowledge as to the behaviour of muscle and 

 bone under altered conditions. 



Previously concerning itself for the most part with 

 deformities, especially those of children, it has now 

 extended its sphere to include many conditions which 

 are especially benefited by the application of its 

 principles. Fractures are tending to become the 

 special study of the orthopaedic surgeon ; tuberculosis 

 of bones and joints is often now passed to him too, 

 as one who must see to it that after cure there shall 

 remain as little disabling deformity as possible. 



Since, moreover, so much loss of usefulness in limbs 

 was in the war directly due to injury of the nerves 

 which control muscles, it has become necessary to 

 develop the study of nerve repair, and of the muscular 

 changes associated with injury to nerves. 



Tlie importance of rendering a wounded man as 

 useful a member of society as possible is now realised 

 as never previously, for the large numbers of the 

 disabled render some solution of the problem of vital 

 importance to the whole community. For the 

 deformed in previous years pensions and institutional- 

 ism were the accepted fate ; pubUc opinion, indeed, 

 conceived the man as helpless, and he in turn generally 

 insisted on remaining so. Not but he sometimes 

 found in his deformity a lucrative career. Witness 

 the Court Fool or Jester. His lot, however, was a 

 hard one ; Christianity had brought a little ameliora- 

 tion, in almsgiving, but the Indians cast their cripples 

 into the Ganges and the Spartans hurled them from 

 precipices. 



The problem of minimising defects and of edu- 

 cating the disabled to suitable occupations remained 

 unsolved till this war. A start was made in 1914, 

 by the Mayor of Lyons, who instituted the first 

 training school for disabled soldiers ; and somewhat 

 later the need was met in this country by the es- 

 tablishment of large handicraft departments attached 

 to special orthopaedic hospitals. The combined 

 " treatment and training " centres of to-day, adminis- 

 tered by the Ministry of Pensions, represent our 

 latest endeavours at providing a disabled man with 

 a new and appropriate occupation, continuous antici- 

 pation of which is the duty of the orthopaedic surgeon 

 throughout the period of treatment. 



Treatment, moreover, and training, are found to be 

 of mutual assistance. Treatment gives far less satis- 

 factory results if the recovering limb is not willingly 

 and intelligently used by the patient. 



The very earliest stages of the treatment of a wound 

 have a profound influence over its future possibilities. 

 It is hard in the later stages to undo the faults of 

 earlier ones ; and the unsatisfactory results attained 

 when the time came to find occupations for the earlier 

 war casualties led to the taking over by (Sir) Robert 

 Jones of special responsibilities in the British Army 

 for the cure of disabled limbs from start to finish. 

 The United States Army was able to build where its 

 colleague had laid the foundations, and from the 

 beginning an organised attempt was made at the 

 continuous supervision of men with injured limbs by 

 expert orthopaedists right from the line of battle. 



Good ultimate function, is, then, the ambition of 

 every surgeon engaged in orthopaedic work. 



The term " orthopaedia " was employed as long 

 ago as 1 741 by Dr. Andry, Professor of Medicine in 



