* See, for example, Ferd. Schulze,"Arch. f. Orthopaed. Mekanoth. and Unfallschirurgie,"' 1903. "Om traumatiska meniskrubbningar i knaleden," Emil Bovin. Akad. afh. : Upsala, 1903.

Some doctors treat dislocation of a meniscus surgically either by removing the dislocated meniscus or by suturing it.

It is still usual in many places, however, to use other methods, and nowadays the method Introduced by Bennett seems to be considered the best.

This treatment requires first of all the replacement of the dislocated cartilage. This is done by flexion of the already somewhat flexed knee, combined with inward rotation if the inner meniscus is displaced, but outward rotation if the outer meniscus is concerned, followed at once by extension. After reduction has been effected in this way the limb is put into plaster of Paris from the thigh to the malleoli, and the patient is kept in bed for fourteen days. When half this time has elapsed the plaster case is converted into a capsule, preferably by cutting along both sides, and the joint and muscles of the upper and lower leg are massaged and effleurage is applied to the whole limb. Bennett begins cautious passive movements after the first week. If massage is given twice daily there is no danger of loss of functional power in the future and thorough healing is assured. During the third week the patient may be allowed to be up with the plaster capsule still on. After this a bandage may be used or may be unnecessary, and massage and movements are continued until normal mobility is restored.

Of the fractures affecting the knee that of the patella is the most common. If one does not make sure that firm union between the fragments is effected a long connective tissue union is formed, resulting in uncertain jerky extensions of the lower leg and inability to control flexion. For these reasons we have not in Sweden adopted Mezger's proposal, that in the case of patellar fractures massage and gymnastics * should be begun at once, without aiming at the short, firm, if possible, bony union between the fragments.

Nowadays one always tries to produce short, firm, if possible, bony union between the fragments. The treatment originated by Scheele in 1879 is sometimes used to effect this. Here the knee joint, which is generally distended with blood and exudation, is first washed out with a trocar of large calibre, then the upper fragment is drawn down and the lower drawn up, and the two are fixed against each other by long strips of strapping, 3 cm. broad, placed so as to overlap one another like the tiles of a roof. Over this is applied first a flannel bandage and then light plaster of Paris. The whole is replaced for careful observation every week for six weeks, the limb being extended all the time, and for several (four to six) months the patient has to wear a splint which only allows 20° of flexion. At this stage the joint and muscles concerned are treated with massage, and gentle passive and active flexions form part of the treatment. In this way a short, firm fibrous union is always, and a bony union not uncommonly, produced, but disturbances in functional power last long on account of contractures, and it is uncertain whether normal flexion can be restored.

* Rossander and Berghman, "Hygiea," 1879.

The modern tendency to suture fragments after a fracture when it is found difficult to promote bony union between them is of special importance in cases of patellar fracture. Most surgeons have given up all other methods and now employ suture of the fragments, and if need be of the lateral ligaments as well. After eight to ten days the sutures are removed, and even at this point effleurage may be applied to the muscles. Healing, however, takes four weeks, during which time the limb is fixed in an extended position, but the fixing apparatus is taken off every now and then so that massage may be given, and small gentle passive movements are given after the first fourteen days. In most cases quite useful mobility results.

In massage of the knee the anterior portion of the capsule is the most accessible for frictions, and it is also in this part that the changes due to trauma are generally situated. But here I must remind my readers that effleurage can only produce its beneficial effects on nutrition and absorption and its antiphlogistic effect on the knee joint when applied at the back of the knee, for it is in that part that the five arteries and their corresponding veins which carry the blood to and fro pass in and out.

In massage of the front of the knee the best position for the patient is half-lying position on a plinth; in effleurage of the back of the knee forward-lying position is the best.

With regard to Affections of the Joints of the Foot I shall here state what is essential with regard to sprains, fracture of the fibula, and fracture of the fibula and tibia just above the malleoli.

I feel impelled to say a few introductory words on the mechanism of the foot, about which there are many false impressions, partly owing to the complicated nature of the question, and partly owing to the custom that exists both in writing and practice of evading difficult questions. All will remember that the ankle joint is a ginglymus joint where dorsal flexion is combined with a certain degree of eversion, and where plantar flexion is combined with some inversion, and that with plantar flexion when the narrower posterior part of the upper surface of the astragalus is in contact with the tibial articular surface small movements in other directions can take place. Apart from this older physicians must give up their rooted idea that there is a lower foot joint, and must grasp the fact that there is a posterior joint (posterior talo-calcaneal) between the concave under surface of the body of the astragalus and the posterior convex upper surface of the os calcis, and that this joint is a rotatory joint, which controls and always takes part in eversion and inversion. The joint between the lower articular surface of the head and neck of the astragalus and that of sustentaculum tali and the anterior portion of os calcis (anterior talo-calcaneal) is quite a separate joint from the former, and is a very irregular and variable one, in which the articular surface of astragalus is slightly convex and that of os calcis slightly concave. This joint has a capsule in common with the talo-navicular joint, the joint between the convex articular surface of the head of the astragalus, and a concave articular surface composed of the concave surface of the navicular and part of the inferior calcaneo- navicular ligament. This joint may be considered as belonging to either of the nearly related classes of joints known as arthrodia and ellipsoid joints. The movements of this joint are, however, limited in that, although separated from the calcaneo-cuboid joint by its own capsule, it forms the medial part, whereas the calcaneo-cuboid forms the lateral part of a joint which functions as one. The calcaneo-cuboid joint is considered by some to be an amphiarthrosis, by others to be a saddle joint. The functional joint formed by the anatomically separate joints above mentioned is called, as we all know, the transverse tarsal joint, or Chopart's joint. The central articular surface of this joint is convex forward medially and concave forward laterally. Chopart's joint as a whole is now regarded as acting like a ginglymus or hinge joint on an almost vertical axis, so that the foot can be pointed outward (abduction) or inward (adduction). Movement in this joint is always combined with movement in the anterior and posterior talo-calcaneal articulations, so that with eversion, when the outer border of the foot is raised, the foot is pointed outward, and with inversion, when the outer border is lowered, the foot is pointed inward.