870

is the other. This statement is true where the shedsare grouped by thermometer readings or wherehumidity is artificially introduced. The fact, however,became clear that the atmosphere in many so-called"dry" sheds contained as much moisture as inhumidified sheds. Hence, the recommendation ismade to abolish any legal distinction between thetwo types of weaving shed when establishing regula-tions for maintaining atmospheric conditions favour-able both for the efficiency of the weaver and for thequality of the cloth. Such optimal conditions appearto prevail at dry-bulb temperatures between 72.5°.and 75° F., with a relative humidity of 75-80 per cent.It is therefore proposed that artificial humidifica-tion shall cease at 725° F. wet-bulb instead ofat 75° F. as heretofore. Advantage is to be gainedat such temperatures from local air movement,obtained by paddle fans, which cools the weaver but.does not appreciably affect the warp thread ; meansto this end have not yet been perfected. Havingregard to physiological evidence as to the influenceof high wet-bulb temperatures upon health, theproposal is made that when the wet-bulb reaches80° F. all work shall cease in any given shed, and theworkers shall leave the premises. This course mayseem stringent, but in practice the number of shedsaffected should not be high, and it is just these shedswhich should take more effective steps to improvetheir working conditions. This report is an excellent.example of the application of modern knowledge toindustrial practice. ____

THE Linacre lecture, of St. John’s College, will bedelivered by Sir George Newman at 3 P.M., on’Saturday, May 5th, at the Arts School, Cambridge.His subject will be Linacre’s Influence on EnglishMedicine.

____

THE death is reported from Taunton of Dr. JamesAlexander Macdonald, at the age of 78. Dr.Macdonald was a Direct Representative on the GeneralMedical Council, and served as chairman of the- Council of the British Medical Association from 1911to 1920.

The Services.ROYAL NAVAL MEDICAL SERVICE.

Surg.-Comdr. C. H. Dawe is placed on the Retd. List withthe rank of Surg. Capt.W. W. Darley and F. C. M. Bamford to be Surg. Lts.Surg. Comdrs. : R. J. Inman to Marlborough; A. J.

Tozer to Victory, for R.N. Barracks, Portsmouth ; A. G.Bee to Champion G. Carlisle to President, for three months’post-graduate course ; and F. E. Scargill to Nelson, temp.

ROYAL ARMY MEDICAL CORPS.

Temp. Lt. F. R. How relinquishes his commn.TERRITORIAL ARMY.

Capts. D. Stewart and J. P. Clarke to be Majs.Lts. D. L. Kerr, J. C. Adam, W. A. Ramsay, and

W. B. A. Lewis to be Capts.H. W. L. Nichols, late R.F.A. Spec. Res., to be Lt.

TERRITORIAL ARMY RESERVE OF OFFICERS.

Capt. G. F. Shepherd, from the Active List, to be Capt.ARMY DENTAL CORPS.

Capts. to be Majs. : F. H. W. Beer, J. P. Duguid, andT. K. Place.Temp. Capt. T. G. Doig, Dental Surg., Gen. List, to

be Capt. -

- ROYAL AIR FORCE.

Flying Officers R. J. I. Bell and R. G. Freeman are pro-moted to the rank of Flight Lts.

INDIAN MEDICAL SERVICE.Lt.-Col. R. W. Anthony to be Maj-Gen.Capt. W. E. R. Dimond to be Maj.Temp. Capt. Chandrian Krishna Row, the relinquishment

of whose temp. commn. has been announced, is granted therank of Capt.

Modern Technique in Treatment.A Series of Special Articles, contributed by invitation,on the Treatment of Medical and Surgical Conditions.

CCLXXIII.

THE TREATMENT OF THE COMMONERINJURIES OF THE CARPUS.

THE mechanism of the wrist is unique among thearticulations of the human body. It allows morekinds of movement than any other joint, and it takesa great part in the finely coordinated actions whichcharacterise the hand. In the normal wrist a goodmany landmarks can be made out by palpation. Ina case of recent injury, however, inflammatoryswelling generally masks all or most of these points,and it is from radiographs that definite informationmust be sought.

It is therefore of importance to consider the

manner of the use of X rays. In all cases twoviews should be taken with the forearm in fullsupination, one antero-posterior and one lateral. Thelateral view should be taken with the radius and outerside of the wrist resting on the plate and the handand fingers in line with the forearm. In cases ofdoubt it may be advisable to take a third, an obliqueview, from a point midway between the two others. Incases of unilateral injury radiograms of the sound wristshould always be taken for the purposes of comparison.The first point to be ascertained in examining radio-graphs is the integrity of the individual carpal bones.

If there is no obvious fracture, the contours of the carpalcondyle should be closely studied. Any interruption orirregularity of its line of curvature, either in an antero-posterior or lateral view, is evidence of displacement orfracture of the scaphoid or semilunar, which if not correctedleads to arthritis, or at least’ to loss of smooth working ofthe joint. Gross displacement of a bone or bones will beobvious, but slight chipping of the edge of the articularsurface of the radius may be less easy to detect, althoughsuch an injury may lead to ankylosis of the wrist. Fractureof either styloid process is generally obvious enough. Thescaphoid, although not fractured, may be so tilted round atransverse axis as to cast an almost circular shadow on theplate in an antero-posterior view, but viewed in profile itskidney shape will be evident with its lower end projecting

forwards beyond the neighbouring carpal bones.In all carpal injuries symptoms attributable to

interference with the median or ulnar nerves are

likely to be encountered, especially in cases of dislo-cation. These include loss of sensation, pain, and inlong-standing dislocations trophic signs, such as

glossy skin.According to Destot of Lyons, fractures of the

scaphoid or semilunar and dislocation of the latteraccount for 95 per cent. of injuries to the wrist,excluding sprains.

Sprains.The symptoms of sprain of the wrist are familiar

and in no essential way different from those of carpalfracture. Differential diagnosis depends upon a

careful study of X ray plates. When this providesno evidence of fracture or dislocation, sprain may beassumed by a process of elimination. Pain, stiffness,and swelling are the outstanding symptoms. Smallmarginal fractures of the radius are to be-carefullylooked for, and if found the case must be treated asof more gravity than a simple sprain, although thelines of treatment will be the same. Rest on a lightpalmar splint extending from the upper third of theforearm to the heads of the metacarpal bones, andsupported by a sling, is advisable. Gentle move-ments of the fingers and thumb should be encouragedfrom the first. Massage is not recommended. Thelength of time during which the splint should beworn must depend upon the duration of the painand swelling : in most cases of average severity a

fortnight should suffice.