Ununited Fracture of Head and Neck of Raji E.

388 Ununited Fracture of Head and Neck of RaJi~e.~.
still largely occupied b y the poor, t h a t the city drainage

admSts of m u c h improvement, t h a t the ~ a t e r supply is
excellent and abundant, and t h a t there is m u c h drunkenness
among women, with consequent neglect of y o u n g children.
The last mentioned feature is boun~ to influence the infan-
tile death-rate, while over-crowding and defective drainage
tell more on the general death-rate. Both rates being ex-
ccnsive in Waterford, the city should be a good field for both
social reformer and sanitarian. The Corporation, now t h a t
their water supply is right, should not hesitate r expend w h a t
m a y be necessary to put the drainage of th~ city in order,
and more suitable houses should be constructed for the
poorer classes. A n y expenditure in this direction would be
a sound financial investment, if ,human life has value in a
m o n e t a r y sense.
Ca~e of Ununited Fracture of the Head and

ART. X V I . - - A
Neck of Radius treated by Exci~'ion. By T. E. GOaDON,
M.B., F.I~,C.S.L ; Surgeou to the Adelaide Hospital.
A PATIENT presented himself for t r e a t m e n t at the Adelaide
Hospital in M a r c h last suffering from the crippling effects
of ununited fracture of the upper end of the radius.
CASE.--Hc iS a eoachman, aged fort,-five years. He gave me
the following history of his injury : -
On November 26th, 1896, he fell from a high-wheeled dog-cart
and struck the ground first with his outstretched right hand.
Before he could get clear the horse, which had fallen, struck him
on the shoulder, throwing him violently on to the right elbow. He
was first seen by Dr. Woodroffe, of Fermoy, who reduced a dislo-
cation of the forearm backwar~ls. He found that the man had
also sustained a Colles' fracture. Dr. Woodroffe informs me that
he detected much crepitus about the elbow-joint, but, owing to the
excessive swelling, he was unable to make a complete diagnosis.
The patient came to Dublin in December, and consulted me at
the hospital in March. The arm was at this time quite useless
lo him. He was unable even to carry a spoon to hfs mouth or
button his clothes. He had considerable pain about the elbow
when he attempted to bend or straighten the arm.
With the exception of crepitus over the position of the upper
end of the radius there were no distinctive signs of the fracture--
B y DR. T. E . GORDON. 389
no tumour, for instance, to be felt about the front of the joint.

Evidence of the Collcs' fracture was sufficiently clear.
Movement was very limited, both as regards flexion and exten-
sion, pronation and supination. Indeed, the latter movements were,
I think I may say, quite impossible.
A skiagram was taken by Dr. Haughton, which demonstrated a
fracture of the neck of the radius.
A t the man's urgent request I decided to operate. F i r s t I put
him under an anmsthetic, and broke down some adhesions at the
inferior radio-ulnar joint, which allowed of some rotation of the
forearm. I was also able to increase the range of flexion and ex-
tension. A considerable degree of inflammation followed upon this
treatment, but soon sub~ided. The disappearance of the swelling
was hastened by massage.
On April 17th I operated. Having exposed the injured bone by
a posterior incision about three inches long, I found the head split
vertically into two nearly equal parts, both of which were sepa-
rated from the shaft. There was some difficulty in removing the
fragments, particularly the more posterior, owing to adhesions into
the lesser sigmoid cavity. I was surprised to find a mass of soft
bone about the upper end of the shaft, evidently periostcal new
bone. This I gouged away, but I did not succeed in removing as
much of the shaft as I should have wished. I believe further
removal would have given a greater degree of rotation for the fore-
arm, but it would have required a considerably more extensive
dissection to accomplish, and I was unwilling to disturb the parts
further than I had already done. I closed the greater part of the
incision, but left some iodoform gauze packing in the depth of the
wound, on account of the persisting oozing. I removed this at
the first dressing.
The wound remained aseptic, and was consequently so far
healed as to allow of passive movements being commenced in
about a week.
The result of this operation has l~een satisfactory. I examined
the arm about the first week in July~ and was pleased to find the
man had then almost all the natural movements of the part, The
power of supination remained, however~ very l i m i t e d - - h e could
not carry the arm in the direction of supination beyond the mid
position. There was evident a considerable bony enlargement of
the upper end of the radial shaft, and I imagined this to be in part
the cause of the limited range of rotatory movement. The patient
has been able to resume his occupation, and is now driving a pair
of horses.
390 The Medicine and Surgery of thp. Tfomerie Poems.
Remarks.--I wish to emphasise the following points : - -
1. The case is an example of a rare form of a rare frac-
ture-i.e., a vertical fracture of the head, with transverse
fracture of neck of radius.
2. I t was not accompanied by fracture of the coronoid.
There was associated with it a dislocation of the forearm
backwards, and, in addition r this, a Colles' fracture.
3. The fragments were quite ununited, and one was par-
tially ankylosed into the lesser slgmoid cavity, the result
being almost total annihilation of function at the elbow-
joint.
4. Excision would appear to offer the best chances to the
patient in such cases (and previously recorded instances,
such as Mr. Jacobson's and Mr. Wainwright's, bear out this
statement, as well as the result I now record). Ankylosis
of the elbow-joint is, of course, a danger to be feared, but it
is very unlikely to take place if one is careful to prevent the
occurrence of sepsis.
ART. X V I I . - - T h e Medicine and Surgery of the Homeric

Poems. By J o g s KNOTT, M.A., M.D., Ch.B., and Dip.
Star. Med. (Univ. Dubl.) ; M.R.C.P.L ; M.R.I.A. ; Fellow
of the Royal Academy of Medicine in Ireland; &c.
(Continuedfrom Vol. OIL, page 400.)
LONGEVITY--continued.
T I ~ lines of Ausonius which give his rendering of Hesiod
on the subject of animal longevity, have often been
quoted and commented on by the older writers on Natural
History :--
,, Ter binos deciesque novem super exit in annos
Justa senes centum quos implet vita virorum,
Hos novies superat vivendo garrula cornix,
F4 quater egreditur cornicis s~ecula cervus,
Alil~edem eervum ter vincit corvus."
[" To ninety-six the life of Man ascendeth,
Nine times as long that of the Chough extendeth,
Four times beyond,the life of Deer doth go,
And thrice is that surpassed by the Crow."]
This curious passage would give 96 years for the limit of
the life of man ; 864 for that of the Chough ; 3,456 for that
of the Deer; and 10,368 for that of the Crow ! How such

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388 Ununited Fracture of Head and Neck of RaJi~e.~.

still largely occupied b y the poor, t h a t the city drainage

Ca~e of Ununited Fracture of the Head and

no tumour, for instance, to be felt about the front of the joint.

ART. X V I I . - - T h e Medicine and Surgery of the Homeric

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