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separation of fragments, both antcroposteriorly and later- ally. Patient was operated on by me December Jist. Ot'i-rnlion. — The entire leg wa-; sterilized the night lie- fore operation and on the day cf operation was painted with three per cent, iodine. A five inch incision was inade along llie crest of tibia down to within one inch of the ankle joint, the npner and lower fr;igments of tibia hein.g brought to view. Some fibrous union between upper and lower fragments was easily broken by blunt dissection. The ends of the fragments were scraped with a sh'arp curette and fragments were freed from surrounding tissues. Apposition not obtainable because of atrophy and shortening of the bones. A three inch piece of Forum Dove Acquistare Cialis Online the tibial crest, prismatic in shape, three inches in length, by half inch in width, by half inch m tiiickness, v.as removed from the upper fragment about two inches above the frac- ture. The anterior surface of the upper and lower frag- ments were grooved with the exact shape of the hon;- Forum Dove Acquistare Cialis Online graft that had been removed from the upper fragrnent The bone graft was wedged in a groove made for it in surface of tibia, upper and lower fragments, raw surface to raw surface. The periosteum was not removed from the bone graft. The graft was held in place by five chromic catgut sutures, three placed completely along the tibia at its upper and lower fragments and lied to one side of the bone graft. One pair of chromic catgut sutures was placed through a hole bored through the upper end of graft and the upper fragment. The same was done with lower end of graft. The fascia was then sutured over the bone with catgut and skin closed over the whole with silkworn\ gut. One per cent, formalin dressing was put over the skin incision and loose Forum Dove Acquistare Cialis Online gauze over this. A plaster cast was applied from the toes to the middle of the thigh. The patient recovered uneventfully from eflFective oper- ation. Two weeks later a window was cut in cast through the field of operation and the wound was examined. There were no sloughing, no infection, Forum Dove Acquistare Cialis Online no sinus, and pri- mary union. The sutures were removed and the window closed. The patient was allowed out of bed and in a wheel chair. Six weeks later the entire cast was removed. E.xaniination showed good union and a well shaped foot and leg with no deformity. .'\ light removable cast was applied and the patient was instructed to massage the foot and log daily. Eight weeks after operation the patient wa.* permitted to walk around on crutches with a brace below the knee to ankle. After two weeks the crutches were discarded and only a brace was used. When seen three months after operation, he had removed brace and was walking around almost normally. There was one inch shortening of leg with a partial ankylosis at ankle, but no visible deformity. A slight limp was only noticeable after attention had been called to it. Syphilitic Joint Disease Simulating Tubercu- losis. — i'ercy Willard Roberts (Journal A. M. A., February 9, 1918) says that until very recently the diagnosis of Forum Dove Acquistare Cialis Online tuberculosis joint disease was consid- ered one of the easiest in medicine, but that this is wholly unwarranted by the facts, for a considerable proportion of cases with gradually developing ar- thritis, spasm of muscles on passive movement, gen- eral limitation of motility, atrophy, limp, pain, and alteration of posture will be found on Forum Dove Acquistare Cialis Online careful ex- amination to be due to congenital syphilis. The diagnosis of the Forum Dove Acquistare Cialis Online syphilitic origin of these cases of arthritis must include the most careful investigation of the family and past history of the child, and the most thorough physical examination of the child for evidences of syphilis. Of these the occurrence of dental deformities, such as Hutchinson's teeth, widely spaced incisors, early decay, and the several types of irregularity in the development of the molars, is perhaps the most important. Other evi- dences should be sought in scars of skin lesions, corneal opacities, and tender tibx. All cases of chronic joint disease in children should be regarded as syphilitic until this is excluded. This is impor- tant becatise syphilitic joint conditions are amenable to treatment by mercury and the iodides, while permanent disabilities may be produced if they are subjected to the measures employed in the treatment of lesions due to tuberculosis. Our Readers' Monthly Prize Forum Dove Acquistare Cialis Online Discussions Twenty-five Dollars Is Awarded for the Most Satisfactory Paper All persons, whether subscribers or not, are invited to compete for the prize of $25 offered for the reply deemed best by the editors to the following questions : CXCI. — Hoiv do you treat lobar pneumonia? (Closed.) CXCII. — How do you treat whooping cough? (Answers due not later than March 15th.) CXCI II. — What kind of feet must a soldier have? (Answers due not later than April 15th.) The award will be based solely on the value of the information contained in the answer. No im- portance will be attached to literary style. Answers should preferably not contain more tlian six hundred words, and should be written on one Forum Dove Acquistare Cialis Online side ul the paper only. Forum Dove Acquistare Cialis Online All papers submitted become the property of the Journal, and should bear the full name and address of the author for publication. The prize will not be awarded to the same person more than once within a year. The price of $25 for the best answer tn Question CXC has been awarded Dr. T. J. Tudcr, of Kcokce, Va., whose paper appeared Forum Dove Acquistare Cialis Online on page 404. PRIZE QUESTION NO. CXC. TREATMENT OF BURNS. (Continued from page 406.) Dr. Louis Neinvelt, of New York, makes the fol- lowing contribution : The problem of the treatment of burns consists of four elements: i, the prevention and treatment of shock ; 2, applications to the burned area, includ- ing the first dressing and subsequent dressings for the prevention of sepsis; 3, the prevention and treatment of contractures ; 4, the prevention and treatment of the complications resulting from the toxemia — duodenal ulcer, nephritis. To prevent or treat the shock in a burned patient is the first and most important part of the treatment. The patient should not be moved or the clothes removed until he has received an adequate dose of morphine. In marked shock, subpectoral or rectal saline enemas are given. Suflicient blankets to cover exposed areas should be provided to prevent chilling. As soon as the shock has passed off the clothing is carefully cut away. The room temperature should be about 110° F. Compresses of a one per cent, picric acid solution are applied in sections to facili-