MENDERS OF THE MAIMED.*
WmLE one is on an all too short holiday the arrival of a book for review is hardly disposed to rejoice the heart of the holiday- maker. However, a perusal of but a few pages of Professor Keith's Menders of the Maimed converted an attitude of half-
resentment into one of absorbed interest, which was maintained until the end of the last page had been read, and one laid down the book with a determination to re-read it again and again until the wonderful lessons it teaches have become part of one's own mental equipment.
A short time ago the Edinburgh Pathological Society started a series of addresses and discussions on the present state of medical- education, the whole being afterwards published in book form. The addresses were given by well-known medical men and teachers of natural science in Scotland and England, and are notable contributions to the subject discussed. Among the many branches of medical education reviewed were phys- ology and anatomy. The general consensus of opinion was that from the medical point of view the teaching of these subjects was not sufficiently practical ; both physiology 'and anatomy were taught in water-tight compartments closely shut off from contact with clinical medicine and surgery. On entering the wards the student was informed that medicine and surgery were based on physiology and anatomy, but heard little more of these subjects during the remainder of his clinical studies, and by the time he had obtained his qualifications to practise he had usually forgotten most of what he had previously learned about them.
That the picture is no -whit exaggerated most medical men will agree, but many of them, while rendering lip-seavice to the twin- subjects of physiology and anatomy, will maintain that, although a knowledge of the elementary laws is no doubt essential, in the present state of progress a close acquaintance with the former is of no practical importance, and may even be a hindrance at the bedside, and that anaesthetics by removing the necessity for haste in operations, have made a minute knowledge of the latter not so necessary as it was to our forefathers. This view is wrong; but as physiology and anatomy were taught until quite seccntly—changes are now being introduced—the prevalence of such an opinion can be explained.
How is this great and important change to be brought about ?
How are physiology and anatomy to be brought into closer relation with the practice of the clinician ? Professor Keith has no difficulty in showing how this can be done in such a way as to rivet the attention of the reader, and, moreover, his success is the more remarkable as in this volume he is dealing with that part of these subjects concerned with muscles and bones, usually dreary systems for the student in the early years of his medical course of studies, when it is impossible for him to appreciate the bearing of much which ho has to commit to memory.
This change of mental attitude of the reader is produced by showing the practical application of the hard-won knowledge of physiology and anatomy to the work of tho orthopaedic surgeon. " Orthoraedia " was the name which the French physician
• Menders of the Maimed. By Arthur Keith, M.D. (Abdo.), F.E.C.S. (Eng.). LL.D. (Abdo.), B.B.B. London : Henry Fronde. and Hodder and Stoughton. 1116s. net.1 Andry, who was bom in the year 1660 and published L' Orthopaedia\ in 1741, gave to that branch of medicine dealing with the deformities of children. The word connotes more now; ortho- paedic surgery is concerned with the correction of deformities' in adults as well as children, and its marvellous and beneficent' results have been evident to the public in the restoration of the: terribly deformed bodies of many of our soldiers. How the knowledge which rendered these results possible was obtained,' and how opinions fluctuated from decade to decade, is shown: by Dr. Keith in a series of personally conducted tours in the course of which the reader is introduced to the leaders of ortho- paedic practice at work on their investigations. In the first tour we are carried back a hundred and fifty years and meet the great John Hunter. " Were I to be asked," says the writer,' " to cite the most important contribution that Hunter made to surgery, I would reply that it was his clear recognition of the fact that restoration is effected by powers inherent in the living tissues of the patient ; the surgeon can only help recovery by tending these powers." Hunter fully recognized the im- portance of muscles in producing and correcting deformities, and, ignorant as he necessarily was of the nervous mechanism controlling muscular movements, failed not to recognize that they could be modified by psychological influences. The work of Hilton, Marshall Hall, Owen Thomas, Arbuthnot Lane, McEwan, and many others among British medical men ; Duchenne, the Boulogne practitioner, who sought only "per- mission to glean behind the backs of appointed harvesters " ; Stromeyer, Delpech, Duhamel ; Oilier and Wolff, and other European surgeons and men of science; Bauer, Sayre, and Abbott, the American orthopaedists, is all carefully and pleasingly reviewed, and the reader finds himself absorbed in the progress of experiments apparently conclusive and yot shown later to reveal only part of the truth. Finality on the questions of the proper place of rest and movement in treatment, of the rule played by the various parts of the bone and its sheath in its building up and destruction, has not yet been reached. Some of the recent work on the formation of periodic structures is colloidal media may even prove that Professor Keith has ascribed too much to the osteoblasts, the builders and destroyers of bone, and that Julius Wolff was wise to leave them out of account in enunciating his law connecting function with structure. But if finality has not been reached, progress has, nevertheless, been enormous, and will steadily continue if the principles which the author seeks to inculcate am understood and acted upon by the medical profession.
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