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Its rooms are large, well lighted, well ventilated,and heated in winter by stoves resembling those seenin Holland." It will be seen that the charitable work done

by the institution is well appreciated by the number of thepatients relieved. It appears that the average annual numberof in-patients is about 400, while the last annual reportshows that there were 12,964 out-patients who were mostlyTurks, Greeks, and Armenians. The majority of patientstreated in the wards are Russians, Bulgarians, Servians, andother Slavs. Almost all receive treatment free of charge.In connexion with the hospital there exists also a charitablefund for the purpose of aiding poor patients who on beingdischarged recovered are in consequence of their illness leftwithout any means of livelihood.

RE-INTEGRATION OF THE MIDDLE THIRD OFTHE TIBIA IN A CHILD.

IN the Australasian Medical Gazette for November, 1906 ’Dr. Thomas Fiaschi has reported the following remarkableoperation. A girl, aged five years, was admitted into hospitalon Nov. 20th, 1905, with her.right leg flail-like and useless.Four years previously a rusty nail was driven into the leg alittle below the knee. Abscesses followed and diseased bonewas removed. After this the leg was unable to bear the

weight of the body. The patient was well nourished. The

right leg presented a longitudinal scar, apparently the resultof an operation. The fibula felt normal but the middle thirdof the tibia was absent and its place was occupied by a bandof cicatricial tissues devoid of any ossification. Dr. Fiaschidecided to form the lost portion by two flaps of skin, peri-osteum, and bone taken from the upper and lower thirds ofthe tibia at different operations. On Dec. 4th, under chloro-form and with Esmarch’s bandage applied, a longitudinal in-cision was made in the anterior aspect of the leg in the middlethird. This was deepened and expanded by blunt dissectionso as to form a deep cavity for receiving the new bone graft.The ends of both fragments of the tibia were freshened byslightly chiselling them. The longitudinal incision wascontinued upwards along the middle of the internal or

subcutaneous surface of the upper third of the tibia for

two and a half inches. Then the incision was curved out-wards and brought downwards parallel to the ascending limband distant from it three-quarters of an inch, but stoppingshort half an inch from the fresh bone surface so as toallow room for a pedicle. The incision was carried throughskin and periosteum down to the bone. With a chisel thebone was cut into to a depth of three-eighths of an inch.Following the line of incision by cutting and prisingup a layer of bone three-eighths of an inch thick was

detached. This was attached to skin and periosteumand had a narrow pedicle half an inch thick. This

osteo-periosteo-cutaneous flap was carefully turned downby making it describe a semicircle inwards and down-wards. Its upper end was brought into close contact

with the freshened bone in the lower third of the

tibia. The bony part of the flap was pressed in so

as to fit in the cavity made to receive it. The skin

edges were sutured with catgut. The gap left in the upperthird of the tibia was covered by sliding over it a skin flaptaken from the outer surface of the leg. Double cyanidegauze dressing was used and the leg was immobilised by aback and side splints and starch bandages. Healing wascomplete by Feb. 28th, 1906, when a plaster-of-Paris bandagewas applied. The x rays then showed that the transplantedbone had considerably grown and had become attached tothe upper third of the tibia, but no very good union withthe lower third appeared to have occurred. On April 30ththe second operation was performed, a flap being turnedupwards in a similar manner. The limb was put on a backsplint and was not touched until May 18th, when cicatri-sation was found to be proceeding favourably. Oomplete

healing did not take place until June. Then a solid column

of bone was found to have been formed. A succession of skia-graphs showed that the grafts were gradually increasing insize. In August the child was allowed to stand on the leg,any possible bowing being prevented by a leather case withlateral steel supports. At the time of the report she couldstand and walk but Dr. Fiaschi insists on her wearing thecase for the next 12 months. An alternative operation wasone performed by Huntingdon of San Francisco 1-trans-plantation of the middle third of the fibula to the tibia.

Against this operation were the following considerations:1. It would risk the future of the leg too much, for if thetransplanted bone necrosed the patient would be without anysupport in the middle of the leg. 2. Bowing occurredin Huntingdon’s case. The presence of an ietact fibula issome safeguard against this.

THE METROPOLITAN STREET AMBULANCEASSOCIATION.

THE work of the Metropolitan Street Ambulance Associa-tion has now been in progress for about three years, duringwhich time energetic efforts have been made to direct

public attention to the need of a satisfactory system ofrendering aid to persons who have met with accidents or

have been taken ill in the streets. A few days before theelection of the new London County Council took place onMarch 2nd Dr. Arthur James, the secretary of the associa-tion, wrote to every candidate, summarising the facts of thecase and pointing out the disadvantages of the presenthaphazard methods. Candidates approving of the objects ofthe association were at the same time invited to sign and toreturn to its offices at 69, Gloucester-terrace, Hyde Park, W.,

a postcard in the following terms :-

If elected a member of the London County Council I hope to interestmyself in the provision of an efficient street ambulance service, fordealing with the rapidly increasing number of cases of severe accidentand sudden illness occurring in the street and other public places ofLondon, and in the event of the Government committee now sittingrecommending the cooperation of the London County Council in anadequate scheme, I am prepared to support it.

Dr. James now informs us that 65 of the 118 elected membershave expressed their full approval of the terms of the post-card, so that there will be on the Council a small majority infavour of an adequate ambulance scheme without countingthe large number of other members well known to holdsimilar views, though not so definitely formulated.

INJECTIONS OF FRESH SERUM IN HÆMORRHAGICCONDITIONS.

AT a meeting of the Societe Medicale des Hôpitaux ofParis on Jan. llth M. P. Emile-Weil read an importantpaper on the Treatment of Hasmorrhagic Conditions withFresh Blood Serums. Physiologists have shown the favour-able action of calcium salts on the coagulation of blood andSir A. E. Wright has pointed out their value in the treat-ment of hsemorrhagic conditions. Physiologists have alsoshown in vitro that incoagulable blood recovers its coagula-bility on the addition of fresh serums, but, curiously, theheamostatic value of such serums in man has never been

tested. M. Emile-Weil has found that in vitro the additionof fresh serum completely corrects the various defects of

coagulation of the blood of haemophiliacs. The same effectis produced in vivo by injections of serum and the patientwhose blood has become normal comports himself as a normalperson. In one case a tooth was extracted 25 days after theinjection of serum without notable haemorrhage and inanother case the operation for empyema and incision of a peri-nephritic abscess were performed without any remarkablehaemorrhage two days after the injection of 20 cubic centi-metres of fresh horse serum. In a third case a patient who hadhæmarthroses every month ceased to suffer for 11 weeks. In a

1 Annals of Surgery, February, 1905.

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fourth case hæmaturia which had lasted for a monthdiminished and ceased in three days. In purpura, whether

primary or secondary, acute or chronic, excellent results

were also obtained. A woman, aged 51 years, addicted toalcohol, was admitted into hospital on Sept. 19th, 1905,with febrile polyarthritis. Her gums were fungatingand bleeding and there was epistaxis. On the 23rd

subconjunctival haemorrhages, large purpuric spots on thelimbs, and intense haematuria appeared. An intravenous

injection of 15 cubic centimetres of ox serum was

followed by remarkable improvement. On the followingday the temperature fell from 102’ 20 F. to 99’ 5° ; the urinewas almost clear; the gums were no longer fungating orbleeding; and the arthritis had disappeared. In another

case a man had been suffering for three days from intenseheamaturia, the urine consisting of almost pure blood.There were also purpura, in the form of large ecchymoses,melæna, and fungating and bleeding gums. The tempera-ture was 102°. This state was a sequel of typhoid fever,complicated by double pneumonia. The urine containedinnumerable pneumococci. The blood showed delayedcoagulation and want of retraction of the clot. 30 cubiccentimetres of antidiphtheritic serum two days oldwere injected under the skin. On the following daythe gums no longer bled and were not fungating, andthe renal haemorrhage had much diminished. On the

next day there was not a trace of albumin or blood

in the urine and the temperature was 99.3°. The following isan example of the results obtained in chronic purpura. A

man, aged 42 years, addicted to alcohol, had a large liver,articular pains, and purpura of the legs and arms. During,three months ten eruptions of purpura occurred and thearticular pains alternated with abdominal crises. The urine

constantly contained blood and there was prolonged heamor- (rhage whenever the patient cut himself in shaving. 15 cubic centimetres of ox serum were injected on July 22nd and thehasmaturia, purpura, and pains disappeared. M. Emile Weil iconcluded that fresh serum is an effective remedy for the arrest of hæmorrhages in all dyscrasic states-moreeffective than any other, including calcium salts. Herecommended the following technique. For dyscrasichaemorrhages in adults 15 cubic centimetres of fresh serum rshould be injected into the veins, or 30 cubic centimetresunder the skin. A second injection may be given without ill effects two days later. In children half doses may be given. The serums of man, the rabbit, the horse, or the ox are tequally efficacious, but in vitro human serum has a more marked effect on defective coagulation. The serum should not be more than a fortnight old. Ox serum, though veryactive, should not be used. It was the only serum which iproduced ill effects. These occurred immediately after

(

injection and were always fugitive but sometimes marked. 1They consisted of considerable rise of temperature, rigors, rcyanosis, vomiting, headache, and backache. In hospitals thuman serum is generally available; in private practice (rabbit serum may be obtained easily by antiseptic bleeding from the carotid artery. Antidiphtheritic serum may be used Ibut simple serum is preferable.

THE BOROUGH OF ST. MARYLEBONE HEALTHSOCIETY.

THE Borough of St. Marylebone Health Society was con- stituted on Feb. 22nd, 1906, the members being connected r

with charitable, municipal, or religious organisations i

working in the borough. The chairman and the honorary s

secretary are medical men, the former being Mr. Alex- t

ander Winter Blyth, the medical officer of health, and the ilatter being Mr. Bernard F. Hartzhorne, 39, Loudoun-road, ISt. John’s Wood, N.W. Following the example of a similar e

association established in the city of Westminster, several t

philanthropic lines of action were adopted as the definite

objects of the society, the first three being as follows:

(1) to work in cooperation with the public health autho-rities, the Poor-law medical officers, and the charitableand social agencies of the borough ; (2) to utilise the

services of local medical institutions and of trained localworkers and others in giving general practical instructionand advice in matters of health and sanitation to the

people in their homes ; and (3) to arrange for the training ofsuch local workers and for popular lectures on health andsanitation. The first annual meeting of the society washeld at the town hall, Marylebone-lane, on Feb. 25th,under the presidency of Sir Samuel Scott, Bart. The report,which was then presented, dealt with the society’s operationsfor a period of nine months ending Dec. 31st, 1906. Duringthis period two series of lectures were given at the St.

Marylebone General Dispensary with a view to the instruc-tion of members of the local visiting staff. An effort was

also made to instruct mothers by means of "lectures orinformal talks." Among the most important aids to the

work of the society have been the "infant consultations" "

at the St. Marylebone General Dispensary, by means ofwhich healthy infants may be kept under medical super-vision during the first two years of life. The report furthershowed that the society had given a great deal of attentionto the prevention of tuberculosis.

THE BACTERICIDAL POWER OF VARIOUS SILVERPREPARATIONS.

AN experimental study of the bactericidal power of varioussilver preparations has recently been published in the trans-actions of the American Ophthalmological Society. The

investigation was made in the pathological laboratoryof the Massachusetts Charitable Eye and Ear Infirmary byDr. George S. Derby of Boston, Massachusetts. The method

adopted was to place two cubic centimetres of the solution tobe tested in a small sterilised glass dish and a loopful of a24-hour culture of the staphylococcus pyogenes aureus wasstirred in thoroughly. From this loopfuls were taken atstated intervals and stirred into the water of condensationof blood serum slants. The water of condensation was thenrun over the surface of the blood serum and the tubewas placed in the incubator for 24 hours, at the end ofwhich time it was examined, and if no growth had takenplace the water of condensation was again run over and thetube was replaced in the incubator for a second 24 hours.Remarkably constant results were obtained in the 600to 700 cultures taken in this way. The preparations testedwere silver nitrate, argyrol, protargol, collargol, largin,ichthargan, albargin, argonin, and argentamin. Solutionsof silver nitrate containing from 2 to 2 per cent. of the saltkilled the staphylococcus pyogenes aureus in from two to fiveminutes. Protargol in 2 to 4 per cent. solutions usually killedthe same bacterium in from three to five minutes, thoughoccasionally a few colonies would grow after ten minutes’exposure. Collargol possesses a relatively weak bactericidalpower, as a growth of the bacterium could be obtained at theend of 20 minutes with the 4 per cent. solution. Albarginin 1 per cent. aqueous solution is very irritating. 10 per cent.solutions killed the bacterium in from two to five minutes.

Ichthargan is also very irritating. Solutions of from

loth to 1 per cent. arrested growth after from one to fourminutes. Argentamin in 5 per cent. solutions acted like

ichthargan. Largin is rather irritating, but a 10 per cent.solution kills the staphylococcus pyogenes aureus in fromtwo to five minutes. Argonin in a 5 per cent. solution is lessirritating than any of the four last-mentioned preparations.No growth of the bacterium could be discovered after

exposure to its influence for from three to six minutes. The

bactericidal power of argyrol is extremely weak. Dr. Derby