The New York herald., 1922-07-30


A'nericdn Medical Association, st.
journal Of the Association.
Orthopedic or reconstruction surgery
in this country is still very poorly done.
We have still many thousands OF chi;-
dren and industrial workers who are
crippled, deformed and physically ham
dicapped because of inadequate medical
and surgical attention. There are as
yet insufficient hospitals. We lack spe-
cal training schools for selected voca-
tions for the crippled. and there is even
now no real public or even professional
conception of what may be done in the
prevention and cure of deformity, the
relief Of disability and the retraining OF
the physically handicapped
To illustrate If only the splinting Of
fractures and infantile paralysis were
promptly and properly done in the
United States the total amount of Grip
ping and serious disability would be
reduced by about 10 per cent. Or il
suitable measures were appreciated AMI
encouraged by physicians to prevent
and relieve foot strain. foot pronation
and acquired foot deformities another
15 to 20 per cent of our partially or
totally disabled workers could be made
more comfortable and more efficient
With regard to the latter cases alone
Colonel Goldthwait's special training
battalons in France furnished lesson
from which every city In this country
could profit if the message were carried
by our orthopedic surgeons and other
members of the medical profession.
The war taught us that much disabil-
ity and deformity may be prevented by
adequate first aid treatment. Our ex-
perience in this regard. though less ex-
tensive, was just as convincing as the
prophylaxis that succeeded so well In
typhoid fever and tetanus. 1t Is only
necessary to refer here, by way of IL
lustration. to the saving OF life and
limb. that was accomplished by the ap-
plication of the Thomas splint in COM
pound injuries OF the femur by splint
teams on the battlefield. The results
be sufficient reason for placing Thomas
splints and spint teams at every point
in America where such accidents are
likely to occur. AS it is there are al
ready hundreds Of places where a
Thomas splint had never been seen
before where there are now adequate
provisions for the immediate splnting
Of such injuries.
This section should acknowledge, ms
one Of the outstanding achievements OF
the war. the results of the labors Of
Goldthwait, Allison. Osgood and Baer in
the simplification and Standardization of
.,.l,., ,..l T.. ttxts
spect. at least. we caught step with and
/ think even, went ahead OF our allies.
We are now certainly getting better re-
suits than formerly in the care of many
Industrial accident cases. / believe that
these results are due more largely TO
the earlier and better application of
splints than to any other cause.
In any discussion of progress in war
surgery one of the first topics to be
suggested Is that of the CarrelDakin
treatment Of infected wounds. The re-
suits of such wound treatment in few
instances were such as to give the whole
subject almost an atmosphere of ro-
nance. The rapid and obvious reduce
ton in infection, the diminishing num-
ber of septic organisms, the improve
ment of the patients general condition
and finally even the secondary closure
Of certain wounds made a strong appeal
both to patient and surgeon. j believe
can say, however. that out of these
very experiences we should get one of
the important lessons of the war. The
field of application Of the Carrel-Dakin
method has already been fairly well
realized and we shall admit without ar
gument that the method has a certain.
If limited. value.
My principal point. however. from the
standpoint Of an orthopedic surgeon. Is
that neither the Carrel- Dakin method
nor any other kind Of wound treatment
should be permitted to interfere serious
ly with the fundamental principles in the
treatment of bone and joint injuries
Those principles are. first. the imme-
date replacement. as nearly as possible
of injured parts In anatomic relation
ship, and, second, the maintenance OF
fmmobilization ("enforced, uninterrupted
and prolonged" Owen Thomas)
of such injured parts in proper relation
ship until healing occurs.
In other words. wound treatment OF
whatever kind must not interfere with
splinting in correct position. In the ap-
pncation OF the Carrel-Dakin method
the disturbance Of splints, and the dis
carding of casts has been very common.
It is my belief that splintng should
come first In compound injuries. just as