151 



i)is(.()Vf:in' 



art- taken. The most interesting developments of 

 this method are taking place at present in cinemato- 

 graphy. Here it is no disadvantage not to be able to 

 obtain a coloured print, and three lenses are not 

 necessary to project the three coloured pictures. One 

 lens can project all three one after another, so rapidly 

 that they fuse into one. Similarly the three pictures 

 can be taken in rapid succession by means of the same 

 lens, and the elaboration of apparatus and difficulties 

 of registration can be avoided. So that the prospects 

 of success are greater here. 



Colour photography is a subject on which the text- 

 books become out of date. It has been impossible in 

 this article to do more than give an outline of it. 

 Probably the best method for the amateur to obtain 

 further information is by studying the literature 

 supplied by the photographic dealers. 



Orthopaedic Surgery 



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



S.'itior Dsmonslralor of Analom'j in llie Uniiicrsilij o/ Cambriiljc 



(Coniinued jroni May Xo., p. 122) 



We find that already in the time of that pioneer 

 surgeon-anatomist Hunter, when Mrs. Mabb drove her 

 carriage and four into London ' " to take charge of 

 the dislocated limbs of the nobility and gentr}'," the 

 medical profession was putting behind it the old secrecy 

 which had characterised the alchemists and healers of 

 old. It is only the pursuit of truth for truth's sake, 

 and the publishing abroad for all to know of every 

 treasure as it is unearthed, that- has rendered 

 possible modern medical knowledge and science. As 

 time goes on, the difference of motive between quack 

 and professional becomes still more marked, but 

 even now a large proportion of educated men and 

 women are ignorant of the altruistic spirit behind 

 the spread of medical knowledge, and they readily 

 condone the reticence of the quack. Such reticence, 

 however, if there were anything to conceal, would be 

 the enemy of all progress. 



Diagnosis of the nature of joint disability is, then, 

 of essential importance ; if the bone-setter could form 

 a rational diagnosis, he would avoid the cases which 

 are made worse by manipulation ; he would cure the 

 appropriate cases only, and avoid the disasters which 

 are inevitable with empirical methods. 



Thorough manipulation is appropriate for cases 

 where adhesions are present. But very similar 



' Quoted by Dr. .\rthur Keith, reference No. 2 ; see also 

 p. 308 of the same work. 



symptoms arise in a knee where the patient is suffering 

 merely from loss of power in wasted thigh muscles. 

 For these the orthopaedic surgeon will not " manipu- 

 late " ; he will prescribe a course of Graduated Con- 

 tractions. Again, a torn " cartilage " or ligament 

 may be present ; if so. Graduated Contractions will 

 not cure ; but the condition may heal spontaneously 

 after replacement, or it may need operation to remove 

 the torn fragment. But if, after healing, the tear is 

 reopened, there will this time be a greater liability tc 

 adhesion formation, and to weakening of the joint 

 from fluid effusion, and this is aggravated every 

 time the " cartilage comes out." A clear understand- 

 ing of these circumstances requires the orthopaedic 

 surgeon of to-day to recommend operative treatment 

 after trial has shown that replacement of the torn 

 cartilage by manipulation has not resulted in thorough 

 repair. 



As in other spheres of surgery, we find in " diagnosis 

 before treatment " the keynote of success ; the nearer 

 we can approach this ideal, the better shall we succeed. 

 Owen Thomas, the son of an unqualified practitioner, 

 spending his boyhood observing his father's treatment 

 of joint troubles, later making a special study of 

 bone-setters' methods, and noting their failures and 

 successes, deliberately concluded that a knowledge of 

 causes was necessary ; that as a bone-setter he would 

 never cure all cases, and that he must learn wherein 

 the differences lay that he might cure all of them. 

 Since his pioneer work, the mechanism of the knee- 

 joint and the manner in which derangement occurs 

 have become much more fully understood from the 

 anatomical investigations of Hey, of Leeds, andGoodsir 

 in Edinburgh. If only all the " medical practitioners 

 of England had been familiar with the observations of 

 William Hey, and grasped his method of treatment," 

 says Dr. Keith,- " bone-setters would not now be 

 flourishing in the West End of London." 



There is another method of dealing with adhesions 

 other than " manipulation," one which is most particu- 

 larly applicable to tough or extensive adhesions, to con- 

 tracted scars or to fibrous changes in muscles (ischa;mic 

 and other contractures). It has developed out of the 

 methods of Owen Thomas, and is illustrated in Fig. 2,' 

 showing the later stages of a successful slow prolonged 

 stretching extending over weeks. Such " continuous 

 spUntage " has been found to be vastly more effective 

 for certain types of stiffness than the immediate forcible 

 manipulation previously discussed. 



The caliper splint, an offspring of Thomas's knee 

 splint, has pro\-ided a means of making a lower limb 

 functionate even when an incompleteh- repaired 

 fracture is present, and when the full weight cannot 



' See reference No. 2, pp. 319 and 323. 

 ' See reference Xo. i. 



