Treatment of Compound Fracture of the Femur

acknowledge the assistance my paper has been in the construction of her own contribution, and, secondly, because by making full use of fragmentary excerpts torn from their contexts she attributes to me a bias which is, I think, undeserved. Upon reading her remarks I learn that I have stated that cold creams and vanishing creams block the sebaceous and sweat glands, and that their use leads eventually to acne rosacea and acne vulgaris. What any person who troubles to consult the article in question will find is that, in discussing the probable and possible ill effects of the frequent application of cold and vanishing creams (formulae for which are given), I have emphasized the fact that " any remarks made under these headings refer to the prolonged use of the preparations. The reservation is justifiable, because once a woman has taken the trouble to learn a beauty treatment the routine is usually carried on daily for some years." I certainly stated that " the fats block the sebaceous and sweat glands," and if I had written " the fats and waxes tend to block the sebaceous and sweat glands," it might have been more accurate. With regard to the production of acne vulgaris, the actual words used were " the formation of comedones is thus facilitated and acne vulgaris may develop, especially if the patient is between 17 and 25 years of age." I am not, as Dr. Carleton insinuates, unaware that dirt may be removed with cold cream, but I still believe the definition " clean-free from foreign matter," and a skin is not clean which is wiped down with cold cream, massaged with vanishing cream, and then powdered, being left coated with a layer of grease to which dust, as well as toilet powder, readily adheres. With regard to Sutton's experiments on the absorption of fats, even though a very small proportion of the fats in a cream or skin food are absorbed, is there any evidence to show that they are absorbed by the epidermal cells and act as " foods "? We are told that McCafferty and Genovese made experiments with patients with " moderately dry skins," and observed the effect of washing their faces with soap and water. We are not told the extremely important facts as to why these patients had " moderately dry skins." Was the moderate dryness due to chronic seborrhoeic dermatitis, hypothyroidism, xeroderma, or to the gradual atrophy of their sebaceous glands due to years of cosmetic treatments? If so, the use of soap and water was not en'tirely to blame for any desquamation that occurred, and the conclusion which is reached is not valid. Finally, I object to being classified by insinuation as a person who condemns cosmetics as wholly injurious. Cold cream is a useful emollient, and vanishing cream a less useful preparation for the same purpose. The windmill against which I have tilted is the continuous use of cosmetic preparations--the endless application of astringent lotions and fatty and waxy ointments to the detriment of the individual and the very definite benefit of numerous commercial interests. I am, etc.,