in mammals up to the ourang, but is rare in the adult human wrist. The dorsal element is the more common. It usually fuses with the scaphoid, but may disappear entirely or fuse with the os magnum or possibly with the trapezoid.

13. Epilunatum-Often appears as a knob on the dorsal horn of the semi lunar (lunatum) at its radial side. It has been found separate, but probably occurs separate as a rule only in pathological conditions.

14. Hypolunatum-This forms the tip of the palmar point of the semilunar (lunatum). It is rare as a separate finding and apparently of little practical importance.

15. Epipyramis-Forms the radial angle on the dorsal surface of the cuneiform (triquetrum). It is a very rare finding in the adult human wrist. It occurs on the dorsum between the semilunar, cuneiform and unciform, where it is liable to be mistaken for a fracture.

16. Ulnare externum On the dorsal aspect of the cuneiform near the unciform. Situated between the tuberosity of the fifth metacarpal, the unciform and cuneiform. It may be fused with the cuneiform. It is rare as a separate bone in the adult human wrist in the absence of evidence of pathology.

of

17. Trapezium-The diagnosis fracture of the trapezium should take into account the possibility of the development of the more rare elements in this region, especially the epitrapezium, paratrapezium, pretrapezium and the trapezium secondarium.

18. Trapezoid-Has been found divided into a dorsal and a palmar portion. It is so situated that it is difficult to study in flat radiographs, owing to the overlapping trapezium. The wrist, like all joints, is best studied in stereoscopic radiographs, which give the advantage of perspective. The styloid may be found fused with the trapezoid. The greater part of the dorsum of the

trapezoid is formed by the epitrapezoid. 19. Metastyloid-Is found on the dorsum between the trapezoid and the os magnum, at the tip of the styloid of the third metacarpal bone. It may be free or fused with any of these bones. When free, it may be confused with fracture. When fused, it causes considerable alteration in the appearance of the wrist, depending upon what bone it is fused with.

20. Capitatum proprium-Forms the proximal portion of the os magnum (capitatum). The os magnum theoretically consists of three portions formed respectively by the capitatum proprium, the capitatum secondarium and the subcapitatum. When considering fracture of the os magnum, it is well to remember the possibility of the separate existence of one or more of these elements.

21. Unciform or hamatum-Probably the chief interest in the unciform lies in the variations in size and shape of the unciform process. There may be separate precartilaginous centers and also separate centers of ossification for the unciform (hamatum) and the unciform process (os hamuli).

22. Paratrapezium-Forms the outer distal angle of the trapezium. Has been reported distinct only once.

23. Pretrapezium-On the palmar aspect of the tuberosity of the trapezium. May appear as a knob on the ridge, or as a small separate bone. Should be differentiated from fracture.

24. Trapezium secondarium-Forms the ulnar distal angle of the trapezium, between the bases of the first and second metacarpals. Has usually been found only in pathological conditions.

25. Secondary trapezoid-Occurs on the dorsum between the trapezoid, trapezium and second metacarpal bone. It represents the tip of the radial side of the base of the second metacarpal resting against the trapezium and the trapezoid. May occur as a separate bone with articular surfaces. Should be differentiated from fracture.

26. Epitrapezoid-Forms the greater part of the dorsum of the trapeezoid.

27. Parastyloid-Forms the dorsal ulnar projection of the base of the second metacarpal bone. Has been re ported found as a separate bone in the adult human wrist.

23. Styloid-Forms the styloid process of the third metacarpal bone. Is probably the most frequent of the socalled extra bones of the wrist. As stated, it usually forms the styloid process of the third metacarpal bone. It has been observed that the styloid may be fused with the third metacarpal bone in one hand and with either the os magnum or the trapezoid in the other, but it is never fused with the trapezoid in one hand and with the os magnum in the other. The fusion may be by a true joint, by fibro-cartilage, or by true bone. Curiously, it has been stated that the styloid may be found in two places in the same hand, as by a swelling on both the metacarpal and the os magnum.

29. Subcapitatum-Forms the swelling in the palm on the distal half of the os magnum. This is one of the three parts of the os magnum (capitatum), and like the others may occur separately.

30. Capitatum secondarium-Forms the dorsal distal portion on the ulnar side of the os magnum (capitatum). Has been reported as a separate bone only twice.

31. Gruber's ossicle-This is a very rare little pyramid, with the base on the palmar aspect of the hand and the apex in the space between the third and fourth metacarpals and the os magnum and unciform.

32. Os hamuli-Uusually forms the unciform process of the unciform (hamatum). The hook varies greatly in size and shape. When the os hamuli

occurs as a separate bone, the differentiation from fracture may be difficult, especially in cases of injury.

33. Vesalianum or bone of Vesalius -This is the tip of the ulnar side of the base of the fifth metacarpal bone. It was described as a separate bone by Vesalius, who regarded it as a sesamoid. This element forms but a part of the tip of the tuberosity of the fifth metacarpal bone, which varies greatly in size and shape independently of the vesalianum. When separate, it is situated between the metacarpal and the unciform. It may be prolonged from the metacarpal and lie on the outer side of the unciform.

Normal Bone Fusions.

Fusions of the bones of the wrist should be accepted as normal with great care. In the great majority of instances, fusions of the bones of the wrist in the human adult are the result of either present or past pathological processes. However, fusions of these bones do occur normally, or at least in cases in which there is no evidence of pathology. Though unusual, the possibility of such normal fusion should be kept in mind.

Normal fusion of the scaphoid and semilunar, such as is common in the carnivora, has not been reported in

man.

Normal fusion of the semilunar and cuneiform almost always occurs at the proximal surfaces of the bones, where they are normally connected by an interosseous ligament. The union is usually bony; sometimes the bones may be separated by maceration. Of twentysix reported cases, fourteen were in blacks.

Normal fusion of the cuneiform and pisiform. There is but one report of fusion of these bones in the absence of more general bone fusion, and in that instance it occurred in both wrists. In general fusion of the bones of the wrist, these two bones are the last to unite.

Normal fusion of the trapezoid and scaphoid has been reported but once.

Normal fusion of the trapezoid and os magnum has been observed. The union occurs at the dorsum, both by bone and fibrocartilage.

Normal fusion of the os magnum and unciform has been reported in two cases, in one of which it was bilateral.

Normal fusion of the second metacarpal with the trapezoid has been reported in four cases.

Normal fusion of the third metacarpal with the os magnum and trapezoid has been cartilaginous in the reported The fusion does not necessarily occur by means of the styloid. Fusion with the trapezoid may be either cartilaginous or bony.

cases.

Normal general fusion of the bones of the wrist must be regarded as but a bare possibility. The general fusions of the bones of the wrist are almost always either teratological or pathological, usually the later.

Pathological Variations.

We will give this phase of our subject but scant consideration at this time, not because it is in any wise wanting in importance but solely because we have devoted so much space to the normal variations.

1. Tuberculosis-Tuberculosis of the wrist is marked by slowly progressive destruction of bone with little or no attempt at regeneration. Probably the most characteristic radiological appearance is due to the lessening of the lime salts causing the bones to appear more shadowy and less distinct, so that the plate is less "satisfactory" in that it lacks he detail and sharp contrast of the normal wrist.

2. Osteo-arthritis-Here the radiographic appearance is just the opposite of that observed in tuberculosis. There

is unusual brilliancy in contrast. The plates are unusually satisfactory". 3.

Fractures-The bones of the wrist most frequently fractured, in the order of frequency, are the scaphoid, cuneiform, and the os magnum. In cases of doubt, stereoscopic plates should be made and studied with a lens.

Conclusions.

1. It doesn't pay to let your ire be aroused by the silly statements of able men regarding things of which they know not. This article was written, or at least was begun, because one of our profession, an educated man of ability along his special line of practice, tried to tell the writer that anyone could make a diagnosis of bone lesions by means of X-ray plates. He had just overlooked an interesting trigonum in a plate of the tarsus, and the writer had just come from the view-box, where he had been called upon to read a plate made in another laboratory by a nonmedical X-ray man. The result was the writing of this article, wasting all this time and space.

2. There is a vast difference between roentgenologists and X-ray men". Wish there were sufficient space to elaborate satisfactorily on this aspect of the subject.

3. No non-medical man and no physician without special training, may be safely entrusted with the reading of radiographs. Nor can one untrained in radiology and diagnosis, be relied upon to make radiographs that may be safely used in diagnosis. In short, the radiographs made by those untrained in radiology and diagnostics, are dangerous and deceitful, and are most potent in bringing radiography into disrepute.

4. The training commonly given in our medical schools would not enable one to read even so simple a radiograph as that of the wrist. But it is better than no training at all in anatomy. Think it over.

1414 South Hope Street.

and Arizona.

1414 South Hope Street, Los Angeles, Cal.

GOVERNMENT WANTS WORKERS IN VENEREAL DISEASE

CAMPAIGN.

The recently created Interdepartmental Social Hygiene Board of the United States government is in need of a number of specially trained men and women to complete its organization. The United States Civil Service Commission has announced examinations for the following positions: Chief of division for scientific research, $3500 to $4500 a year; chief of division for educational research and development, $3500 to $4500 a year; educational assistant, $2800 to $3600 a year; chief of division of relations with states, $3500 to $4500 a year; chief of division of records, information and planning, $3500 to $4500 a year; supervising assistant and inspector, $2800 to $3600 a year; field agent, $1800 to $3000 a year. All positions are open to both men and women.

Applicants for these positions will not be given scholastic tests in an examination room but will be rated upon

their education, experience, and writings. Published writings of which the applicant is the author will be submitted with the application. For most of the positions a thesis on one of a number of given subjects will be accepted in lieu of published writings. The receipt of applications will close on November 4. Detailed information and application blanks may be obtained from the United States Civil Service Commission, Washington, D. C., or from the secretary of the United States Civil Service Board at the postoffice or customhouse in any of 3000 cities.

The law creating the Interdepartmental Social Hygiene Board provides for the co-operation of the War and Navy Departments and the Public Health Service of the Treasury Department for the prevention, control, and treatment of venereal diseases. The duties of the board as set forth in the act are (1) to recommend rules and regulations for the expenditure of moneys allotted to states for the use of their respective boards or departments

of health in the prevention, control, and treatment of venereal diseases; (2) to select universities, colleges, or other suitable institutions which shall receive allotments for scientific research for the purpose of discovering more ef fective medical measures for the prevention and treatment of venereal diseases; (3) to recommend such general measures as will promote correlation and efficiency in carrying out the purposes of the act; and (4) to direct the expenditure of certain moneys appropriated by the act.

RED CROSS SPLINTS.

a

Of all the services performed by the American Red Cross for the American Expeditionary Forces, none met greater need than did the Splint Department. Among 50,000 wounded men there is a percentage of forty fracture cases; accordingly, when the army went overseas, agreement was made whereby the American Red Cross should supply the splints and the army placed with the organization an order for 462,350 splints. Of this number, 294,583 were shipped before the signing of the armistice cancelled the remaining number.

At a conference of medical officers called by Col. Bradley, chief surgeon of the A. E. F., the types of splints to be used were announced as follows: The Thomas tractor-arm, the Sinclair modified Thomas arm, Jones Humerous, tractor; Jones cock-up wrist; Thomas traction leg; hinged half-ring thigh and leg (Blake-Keller); Long interrupted liston; Anterior thigh and leg, Cabot posterior wire leg; ladder wire splints; Balkan frames and accessories; galvanized net wire gauze; Maddox or Bradford frame and clamps.

Much difficulty was experienced in obtaining material for the manufacture of the splints, but the problem was solved by the purchasing department of the Red Cross. Orders were placed with

John Thorne Company and with the British Red Cross, being distributed among various factories. The weekly production averaged from 15,000 to 22,000. The largest order given by the army during any one month, was placed August, 1918, and was for 353,000. There were 205 tons of steel used in the manufacture of the splints.

A manual of drawings of the standardized splints was published by the Red Cross. It was later recalled by the army, revised and republished in February, 1919, and is to continue in

use.

The Red Cross also provided for the storing of the splints by taking over a warehouse in Paris and placing it in charge of Maj. Arthur Kelly. Eight laborers were employed here, and there were times when as many as one carful a day of splints left the warehouse, which was open from 7:30 in the morning until midnight. To facilitate shipping, the cases were standardized. From December 1 to 14, 1917, there were 8085 cases shipped, having a total tonnage of 575,046. 6 which did not include packing material or racks.

Several new appliances were developed as a result of war needs; the first was the trench litter or snowshoe litter invented by Lieut. Col. Garcia of the U. S. Medical Corps. This litter is made like a huge snowshoe on which the man can be strapped and carried through the narrowest of trenches.

Stretcher-bars were next made, to raise the leg of a man wearing a Thomas splint to the desired angle when being conveyed from the front to the evacuation hospital, for the Ford-ambulances would not permit a man wearing such an appliance to lie flat in the ambulance. Its success caused the army to increase its order from 500 to 1000.

A wire leg-rest to raise the limbs of patients in the hospitals was also devised by Major Kelly, one which would fit either arm or either leg. Of these