HELIOTHERAPY), and in the absence of sun extended observation favours the conclusion that we have in various forms of artificial light a promising substitute. This treatment, as in the case of heliotherapy, must be looked upon merely as an accessory measure in surgical tuberculosis. It is most effective when used in combination with other surgical procedures. It should be pointed out that there is grave danger in spreading a belief that other forms of treatment are unnecessary and subsidiary.
Infantile Paralysis.—The further study of infantile paralysis has resulted in a more widespread knowledge of the early symp tomatology and important work has been done, especially by the late Prof. Lovett of Harvard from 1916 onwards. It hat now been proved that complete rest and immobilisation and the elimination of meddlesome therapeutics during the acute and con valescent stages have resulted in lessening the severity of symp toms by limiting the paralysis. The mass of material rendered available during late years by epidemics has thrown new light on the actual treatment of deformity. Tendon transplantations for various deformities of the feet have given place to operative stabilisation of the flail foot, and transplantations when practised are now associated with reconstructive operations upon bone. This combination has resulted in more satisfactory function.
Rickets.—Rickets and allied nutritional diseases have like wise received within recent years close investigation by many observers abroad and at home with valuable results. Consider able work on the aetiology, particularly with reference to diet, exercise and sunlight, has been carried out at Johns Hopkins Hospital, the Lister Institute and by Findlay of Glasgow, Mell anby and Chick. Much has been discovered regarding "vita mines" or "accessory food factors" (see VITAMINES). The report of the Research Committee provisionally dealt with only two varieties ; one known as vitamine A, or fat soluble A, and the other as anti-rachitic vitamine. Both are essential to the diet of growing animals. Defect in the one leads to arrest of growth and loss of weight ; in the other a deficiency in the deposit of lime salts. The committee conclude that an anti-rachitic
vitamine is a central factor in the prevention of rickets ; and that a deficiency of calcium and phosphorus, in conjunction with a deficiency of anti-rachitic vitamine, hastens rickets. The greater the discrepancy in the calcium phosphorus intake the greater need for an appropriate anti-rachitic intake. It has now been proved that sunlight and ultra-violet rays act as an antidote to a deficiency diet, and can ward off the on-coming of rickets. This work has added considerably to the knowledge of orthopaedic surgeons, and has rendered unnecessary a good deal of the opera tive treatment for rachitic deformities.
Spinal Treatment and Other Operations.—The writings of Albee, Hibbs, Calve, Girdlestone and Waldenstrom have enabled us to place in accurate perspective the bony fixation of the vertebral column in tubercular disease of the spine. Forcible correction and fixation of the spine in lateral curvature is being abandoned in favour of less drastic measures, and bony fixation of the flail spine in paralytic cases is being performed with promising results.
Operative treatment in osteoarthritis, especially in the non articular type, is being more widely practised. This consists in stabilising the joint by exercising the joint surfaces and in the complete removal of diseased synovial membrane in the knee joints. The so-called operations of arthroplasty, or mobilisation in ankylosis of joints is becoming more common, and the results more encouraging. They mainly consist of the loosening and reconstruction of the bone ends, and the introduction of trans planted or living tissue between the bone ends to secure movement.
The treatment of fractures of the neck of the femur by wide abduction of the limb with internal rotation have been still further perfected by Royal Whitman of New Yorke, and a large percentage of recoveries in this obstinate type of fracture occur ring in old age is reported. The pathology of the rarer bone dis eases such as "cysts of bone," "myeloid sarcoma," "Paget's disease" have been closely studied by many observers, resulting in valuable information in relation to operative procedure.