the tubercle of the fifth metatarsal

1318 MEDICINE AND THE LAW.

throughout a vegetarian diet and on others having ahigh sugar diet. These figures will be published indue course. Dr. Peters notes that there were fourcases of nephritis in my alkaline series, one endingin death, but he does not mention that in three ofthese cases the alkali had been omitted 48 hoursbefore the nephritis occurred, or that in the fatalcase the kidneys at autopsy showed microscopicalevidence of an antecedent chronic nephritis.

Finally, I would like to take the opportunity ofpointing out that I have only suggested the use of. alkalies in scarlet fever for the prevention of nephritisand not as treatment for the primary disease.

T ann 1T* "<7on...." f".;t.hfn 11..,

London, Dec. llth, 1927. A. A. OSMAN.

’THE TUBERCLE OF THE FIFTH METATARSAL.To the Editor of THE LANCET. IS]iP.,-l should like to congratulate Mr. A. G. R.

Foulerton and Dr. G. F. Stebbing on their veryinteresting paper on Fractures of Metatarsal Bonesby Indirect Violence, with special reference to AvulsionFracture of the Tubercle of the Fifth Metatarsal(THE LANCET, Dec. 10th, p. 1225).May I at the same time point out that while they

quote Testut and Gruber as having met only threecases in which the tubercle of the fifth metatarsalwas a separate bone, in reality a separate ossific centre.for the styloid of the fifth metatarsal occurs quitecommonly. In radiograms of 50 subjects betweenthe ages of 10 and 17 I found a styloid epiphysispresent in 14 (28 per cent.), and in a paper on the: subject, recently sent to the Journal of Bone andJoint Surgery, while speculating on the occurrence.of this epiphysis I suggested that it may representa traction epiphysis produced by the tendon of theperoneus brevis or possibly the abductor of the fifthmetatarsal (Wood’s muscle) frequently present inman &mdash;I am Sir vours faithfully

LAMBERT ROGERS,Surgical Unit, Welsh National School of Medicine,

Dec. 12th, 1927. Royal Infirmary, Cardiff.

STATUS OF MENTAL NURSES.To the Editor of THE LANCET.

SIR,-You commented last week on the meeting,of the Royal Medico-Psychological Association atwhich this subject was considered. My own view;may be stated thus. In any attempt to assess thecomparative merits of the examinations of the RoyalMedico-Psychological Association and the General- Nursing Council for Mental Nurses, the followingpoints deserve consideration : 1. Registration shouldgive every nurse a national qualification and status.2. The preliminary examination should be the same;for all branches of nursing, so that a nurse can qualifyin more than one branch without undergoing a test,in practical elementary nursing more than once.

:3. The devising and management of examinationsfor nurses should be in the hands of the nursingprofession. The certificate of the Royal Medico-Psychological Association provides none of these.things.&mdash;I am, Sir, yours faithfully, ;

H. WOLSELEY LEWIS,Medical Superintendent, Kent County Mental

Dec. 12th, 1927. Hospital, Maidstone.

MERCUROCHROME INTRAVENOUSLY.To the Editor of THE LANCET.

SIR,-Mr. Martindale’s warning, under this head-ing in THE LANCET last week, is warranted. In’’ New and Non-Official Remedies," a volume in whichare entered products approved by the Council onPharmacy and Chemistry of the American MedicalAssociation (and accepted by them for inclusion)there will often be found precepts of practical value.to British practitioners.

I am, Sir, yours faithfully,M.D.

MEDICINE AND THE LAW.

DAMAGES AGAINST A SURGEON.

AFTER conflicting evidence, a verdict was given forthe plaintiff in the case of Tyndall v. Alcock at BriotolAssizes in an action for damages for negligencebrought against a surgeon. A girl of 8 years of agefell from a donkey in July, 1926, and fractured herleft arm. She was then taken 10 miles in a motor-carto Gloucester where she was treated by Dr. ArnoldAlcock, at first in a nursing-home and later in theGloucester Royal Infirmary. The case for theplaintiff was that the arm became fixed at the elbowand, as the result of the development of Volkmann’scontracture, movement was permanently impaired.Dr. H. Chitty, giving evidence for the plaintiff, saidthat he examined the patient in October, 1926, andfound no voluntary movement of the wrist, fingers,and thumb ; there was fixation and contracture suchas usually arose from tight bandaging or splintpressure. Dr. Alcock, the defendant, gave evidencethat at his first examination he found a fracture atthe lower end of the humerus ; the fragments werein a bad position, the elbow slightly swollen, and theends of the bone injuring the tissues. He manipulatedthe bones into position and a screen examinationshowed the fragments in alignment ; he was satisfiedthat the fracture had been properly reduced. Thearm was then suspended from the shoulder and anX ray. photograph obtained. He stated-though thiswas one of the facts in dispute-that he had from thefirst taken a serious view of the injury and had soinformed the girl’s mother. The upper bony fragmentwas almost through the skin and threatened severedamage to other structures. He gave instructionsthat the circulation should be carefully watched.Next day the hand was slightly swollen and thebandages were loosened. Four or five days laterthere was more discoloration. He realised thatcirculation was obstructed ; the bandages were

loosened and the strapping removed. Three or fourdays after the accident he suspected the possibilityof Volkmann’s contracture ; by the third week oftreatment he was sure of it. He knew the fracturewas slightly over-reduced, but he thought thisadvisable since it involved less interference with theblood-vessels. Prof. Hey Groves, of Bristol, gaveevidence for Dr. Alcock, as also did Dr. C. V. Knight(senior surgeon at the infirmary), the matron of thenursing-home, and a masseuse. Prof. Groves observedthat the skiagram showed severe fracture of thelower end of the humerus with satisfactory reductionor over-reduction ; if symptoms of Volkmann’s con-tracture occurred, it was much more important torestore circulation than to restore alignment. He

thought Dr. Alcock had adopted the proper course’of treatment. Counsel for defendant submitted thatDr. Alcock had not omitted any necessary step ; hehad made radiological examinations in consultationwith a skilled radiologist. The jury, after an absenceof one and a half hours, returned a verdict that thedefendant had not properly set the bone and hadfailed to treat the case properly afterwards. Mr.Justice Shearman refused to accept this, and, after afresh retirement, the jury found a verdict for theplaintiff with JE2000 damages and &pound;150 for the mother.A stay of execution was granted on terms.

REDHILL HOSPITAL, EDGWARE. - Mr. NevilleChamberlain, the Minister of Health, last week opened thenew Redhill Hospital, Edgware, which has been built by theHendon Board of Guardians at a cost of 123,000. Thereare at present 175 beds, but the accommodation can beextended in the future to provide for 500. In his speechMr. Chamberlain pointed out that in the county of Middlesexthe voluntary hospital accommodation, in proportion to thepopulation, is considerably below the average for the wholeof London, or even for the country. The new institution isessentially for the treatment of acute medical and surgicalcases.