1086

puncture in the way of treatment, but in a certain number ofcases recovery was apparently due to its repetition. Dr.

Landon’s paper is of distinct value, and an extensive biblio- ,

graphy will render it easy for any reader to study the subjectmore fully.

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!

THE OCCURRENCE OF ADVENTITIOUS SOUNDSIN THE NORMAL CHEST.

UNLESS the normal sounds heard on auscultation of thechest are fully understood errors in diagnosis are likely to

. occur. For instance, the breath sounds heard immediatelybelow the clavicle on the right side instead of being of theusual vesicular nature may be blowing or broncho-vesicularin character, although no morbid condition is present ; soalso occasionally adventitious sounds may be heard whichare not due to disease. In another column we publish aletter from Dr. R. D. Rudolf of Toronto on this subject.Dr. Rudolf read a paper at the Winnipeg meeting of theCanadian Medical Association in August, 1909, in which hepointed out that it is usually considered and taught that inauscultating the normal chest nothing should be heard overthe respiratory tract but the breath sounds and the vocal

resonance, and as a rule this is undoubtedly true. In manychests, however, on careful auscultation, especially during afull inspiration, there may be heard fine or even mediumsized crepitations. They are probably due to the unfoldingof partially collapsed portions of the lungs. In out-patientpractice it is a common experience to find that manypatients, especially women, rarely expand their chests fully.When shown how to do so, during the forced respira-tion crackles may at first be heard over the bases ofthe lungs. The same result is less commonly experiencedin examining the apices of the lungs, and unless this

fact be remembered the crackles first heard when the

patient is told to "breathe deeply " may be mistaken for

signs of early tuberculous infiltration. Dr. Rudolf rightlymentions, however, that these sounds are chiefly heard

along the edges of the lungs, and especially just behind thecardiac notch. The fact that they readily clear up uponfull respiration, the absence of causes of cedema, and thewant of all symptoms and signs of respiratory disease

usually make it an easy matter to recognise their true

nature. If all children were taught to respire fully suchsigns would be very rare.

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THE TREATMENT OF DRY ARTHRITIS BYINJECTION OF VASELINE.

ABOUT six years ago Th. Rovsing of Copenhagen treatedtwo cases of dry traumatic arthritis of the hip by vaselineinjections, with results of so favourable a character as toencourage him in the application of the same method toother forms of joint disease without effusion. His latest

paper on this subject 1 summarises results obtained by theinjection of sterilised vaseline into 35 joints, results whichhave been observed over periods of at least 18 months follow-ing the injection. These 35 joints correspond to a total of30 cases, in 5 of whom two joints were treated. In one

group of 7 cases of gouty arthritis and arthritis deformans(multiple symmetrical arthritis with swelling and exacerba-tions) the results were in the main disappointing ; injectionwas followed by a recrudescence of inflammatory change, andthe vaseline appeared to act as an irritant. Rovsingis disposed to think that the treatment is inapplicable tothese types of arthritis, except in cases where all activeinflammation has died out and a dry joint remains ; and hesays that when fluid is found in a joint of this (inflammatory)type by puncture vaseline ought not to be injected, but that

1 Annals of Surgery, December, 1909.

if the joint yields no fluid a small quantity of vaseline,insufficient to distend the synovial capsule, should be intro-duced. A second group, comprising 19 cases, is labelled

"traumatic dry arthritis"; this includes senile osteo-

arthritis of the hip and knee, as well as chronic arthritis

following upon definite injury or continuous overstress.

Puncture of the joint in such cases discovered an absenceof synovial fluid, and injection of vaseline producedalmost uniformly good results. Rovsing accounts for

this by suggesting that the vaseline takes the place ofthe absent synovial fluid as a lubricant. His success

in these cases encouraged him to apply his method in fourcases in which arthrotomy and arthrectomy were practisedfor the relief of chronic traumatic arthritis ; here also he

obtained good results. In many of his cases he claims tohave diminished pain and to have increased the range ofmobility of the joints treated. Sterilised yellow vaseline isused, in quantities varying with different joints; for the

hip-joint 20 to 25 cubic centimetres, for the knee 10 to 12cubic centimetres, for the shoulder about 15 cubic centi.metres are recommended. The hip should be exposed byincision, and the temporo-maxillary joint needs a similar

precaution; the knee and shoulder may be approached bydirect puncture. A special form of trocar with cannula isused, which can be screwed on to collapsible tubes of vase-line ; the use of this instrument enables the operator toascertain whether synovial fluid is present within the jointbefore the injection is made. Similarly, if no blood flowsthrough the cannula after puncture it proves that no vesselis opened and that vaseline emboli need not be appre-hended.

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THE Surgical Section of the Royal Society of Medicinewill hold a debate on the Present Position of the Treatmentof Syphilis on Tuesday, May 10th, and Tuesday, June 14th,at 5.30 P.M. Mr. J. Ernest Lane will open the debate, and SirJonathan Hutchinson, Dr. Alexander Fleming, and Mr. ArthurShillitoe are amongst those who have promised to take part.The debate will be held in the Botanical Theatre at Uni-

versity College. Gentlemen wishing to speak in the debateare requested to send their names as soon as possible to thehonorary secretary, Mr. J. Hutchinson, 1, Park-crescent,Regent’s Park, London, W.

THE Hon. Sir John Cockburn, K.C.M.G., M.D., will

lecture to the Royal Sanitary Institute, 90, BuckinghamPalace-road, London, S.W., on the Public Health Aspect ofFood-supply in the Colonies on Wednesday, April 20th, at5.15 P.M.

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A LARGE sum of money has been placed at the disposalof a prominent official of the British Dental Association in

order that that body may put upon a working basis a schemeof dental treatment which is to be national in its scope.

DONATIONS AND BEQUESTS. - Mr. CedricHoughton of Colwyn Bay has left by will .f.500 to thePreston and County of Lancaster Royal Infirmary and :E300to the Chorley Dispensary and Cottage Hospital.-The lateMiss Emily Miller has left a sum of about 15,000 for charit-able purposes. Subject to the payment of duties, one moietyis to be paid to the North London Consumption Hospital andone moiety to Dr. Barnardo’s Homes.-Under the will of thelate Mr. Jacobus Bernardus Gelder, the Great NorthernCentral Hospital, Holloway-road, N., and the Association forthe Oral Instruction of the Deaf and Dumb will each receive91000. Subject to certain interests, the sum of k6000 is torevert to the Great Northern Central Hospital.-Mrs. MarthaSophia Webb has bequeathed B400 to Addenbrooke’sHospital, Cambridge.