REVIEWS AND NOTICES OF BOOKS 349 Problems in Surgery : University of Washington Graduate Medical Lectures, 1927.

By GEORGE W. CRILE, M.D. Edited by AMY F. ROWLAND. Medium 8vo. Pp. 171, illustrated. 1928. Philadelphia and London: W. B. Saunders Co. 18s. net.

THIS volume consists of a series of lectures delivered a t a graduate course a t the University of Washington. It does not claim to be exhaustive in regard to any of the subjects dealt with, but it reflects very clearly the author’s views in regard to subjects of commanding interest in present-day surgery. Of the six lectures included in the book those on LL The Management of the Acute Infections ”, “ Opera- tions on the Bad-risk Patient ”, and “ The Mechanism of Hyperthyroidism ’’ are of special interest and give very clear and readable digests of the author’s well-known views on these subjects. The informal manner in which the various questions raised are dealt with, and the abrupt and dogmatic presentation of the author’s opinions on these problems, give to this book a characteristic personal touch which, whilst inviting, a t the same time disarms, criticism-a most interesting little book.

Osteomyelitis and Compound Fractures and Other Infective Wounds : Treatment by the Method of Drainage and Rest. By H. WINNETT-ORR, M.D., F.A.C.S., Chief Surgeon of the Nebraska Orthopedic Hospital, etc. Medium 8vo. Pp. 208, with 54 illustrations. London : Henry Kimpton. 21s. net.

FOR many reasons this book is a most noteworthy addition.to surgical literature and teaching. In the first place, it is evidently the expression of an honest and earnest worker’s whole mind and soul. Secondly, it is the outcome of much patient work and observation begun during the strain and stress of war and continued since. The main principles enunciated have been put in practice for seven years by the author, and for the past few years by many others. Thirdly, it advocates methods of treatment which revolutionize our ideas and which if true will ease the suffering of patients and relieve the surgeon of much thankless work.

The Orr method of treatment is the application to infected wounds, especially of the bones and joints, of the principle of thorough antiseptic cleansing, absence of any suturing-the wound being left widely open and packed with sterilized vaseline gauze-prolonged and absolute rest obtained by fixing the whole limb and, if neces- sary, the trunk in a plaster case, and leaving the wounds untouched for long periods -that is, for about a month or six weeks. Dr. Orr seems to be much more concerned in claiming that his method is founded on well established principles than in suggest- ing that he has introduced any innovation or violated orthodox teaching. He labours long and anxiously to prove that he is only carrying out the pure teaching of Lister’s gospel. In this we confess we are not convinced, but equally we are not much concerned.

To describe the Orr method as that of ‘drainage and rest’ entirely fails to indicate its essential features, which are the non-suture of the wound, the use of vaseline gauze as a drainage material, and the sealing up of the limb in a plaster case which is unopened for several weeks. In the treatment of open infected fractures the patient is placed on a traction apparatus and the fracture fully and accurately reduced. Then adhesive plaster or skeletal transfixion is applied so as to maintain the corrected position after the plaster has been put on. The open wound is cleaned with iodine and then spirit, left widely open, and packed with vaseline gauze. The whole limb, including the joints above and below the fracture, is put up in a plaster case to which are attached the transfixion pins or traction bands. Nothing more is then done for four to six weeks. It needs no argument to establish the advantage of this method if i t can be carried out safely, for it will not anly save the pain and worry of daily dressings, but also may allow the patient to return home between the monthly re-application of plaster and dressings.

It is admitted that these infected limbs usually develop a marked odour before the time comes to change the dressing, and in some cases there is actually a trickling out of discharge from the plaster splint, but this does not affect the main points, which are that the patient has no pain or temperature, and that the wound closes and heals