Prof. Helferich (Archiv. f. Klinische Chirurgie, Band 36, 4. Heft, 1888). In cases of delayed union, and even in normal cases, to hasten the natural process of repair, H. advises the application of an elastic rubber bandage in such a manner as to retard the return flow of venous blood, by this means favoring an increased amount of pabulum to the field of repair, thus indirectly augmenting the formation of callus. The patient must be taught to regulate the pressure, attention being directed to the condition of the nails, in order that the bandage may be adjusted to suit the varying condition of congestion present. Œdema may be controlled by the application of a flannel bandage to that portion of the limb below the site of fracture. It is claimed that by this method the cure, in normal cases even, is considerably shortened. The process of repair is hastened by keeping the limb in a dependent position. The presence of small erosions at the site of fracture is not a contra-indication to the use of the elastic band. The time of application is of some importance, a too early application leading to too active hyperæmia; while, on the other hand, if too long delayed, the period of time in which the action will take place has passed. In wired compound fractures and in resections, pressure may be applied in from five to fourteen days after the operation, providing inflammatory symptoms are absent.
Thomas, of Liverpool, has recommended a procedure, which is known as the percussion method, to hasten the repair in delayed bony union, in cases of imperfect union, and in ununited fractures. This consists of percussing, once in a day or two, the site of the injury with a small copper hammer for five minutes or more, and subsequently bandaging the parts firmly.
It is suggested that the formation of varicose veins may be an objection to the method of Helferich. Further, it is quite clear that the method is not to be thought of in tuberculous subjects, as well as in cases of large open wounds at the site of fracture, or where a gap is left by resection of bone, removal of tumors, etc. The question of its applicability to atrophic members is an open one.
COMMUNICATION OF TUBERCULOSIS BY RITUAL CIRCUMCISION.