Recent Fractures of the Upper End of the Tibia

disease in which man acts the part of intermediate host to a very minute tape worm of the dog is comparatively common in some countries. In the Shetland Isles, for instance, where the dog is very much one of the family in confined accommodation, hydatid disease is, I believe, not rare. I read once that in Glasgow hospitals in abdominal troubles in natives of Shettand the possibility of hydatid disease is always borne in mind. The obvious methods of control are the destruction of all organs in slaughterhouses showing the least sign of hydatid disease. Dogs should be excluded from slaughterhouses , and anthelminthic treatment of dogs should be adopted where possible. Trichinosis, which has an ancient history going back probably to the Hebrew prohibition of pork, promulgated by Moses about 1500 B.C., is continually being recorded in other countries where the adequate cooking which is the rule in this country does not obtain. A recent annotation in the "Lancet" dealt with the examination of three hundred human diaphragms, of which forty-one were positive for trichinosis. Fortunately we have no trichinosis problem in this country and, as I said, our system of cooking has to be thanked for that. THE importance of fractures at the upper end of the tibia has only recently been brought to the notice of the medical profession, mainly through the startling increase in road accidents in the past ten years. Their importance is due to the fact that they all involve the knee-joint, and they present today one of the biggest groups of knee-joint injuries necessitating in-patient hospital treatment. In a consecutive series of 106 cases of injury round the knee-joint which I had the opportunity of treating whilst in the Manchester Municipal Service, thirty-one cases were fractures of the tibial head; i.e., twenty-eight per cent. of the whole. In the same series there were :-21 cases of semilunar cartilage injury.