The causes of accident are very numerous. Defects of parts of the aeroplane are now rare. Stopping of the motor is no longer a cause of death if it occurs at a sufficient height so that the pilot may volplane and choose a suitable landing place but it is dangerous at small distances from the ground and especially shortly after starting. Among 58 accidents collected by Graeme Anderson, 2 occurred in the air and 46 in landing which is the bete noir of aviator students. In general accidents are due to an error in judgment or to a defect of binocular vision on the part of the pilot. Nervous fatigue, especially and quickly developed in the inexperienced, is the principal cause of "losing one's head." Thus short flights should always be enjoined at the beginning.

To provide immediate assistance in case of accident, every camp should have an observer who communicates by telephone to the surgeon on duty who has an automobile in readiness with a fully equipped surgical and medical chest. A very practical addition to this is a tool kit including cutting pincers, hammer, fire extinguisher, etc. The camp is divided into sectors with established boundaries, in order to locate accidents without delay.

Vesical Calculi. C. E. Park of Prae, Siam, Int. Jour. of Surg., April, reports a native farmer, aged 24 who received a wound of the thigh 4 inches below the pubic bone, 12 years previously, in diving and striking a snag of teak wood. The

wound discharged for a year; thereafter there was no complaint except of slight pain in the lower quadrant of the abdomen on exercise, till 3 years ago when dysuria and foul

urine were noticed. The urethral sound clicked against a calculus which was operated upon. The calculus was encysted in a cancerous mass. The stone measured 22x134 inch and weighed 4 drachms and had as a nucleus, a piece of teak 14 inch long. The patient recovered from the operation but died later of cancer.

D. W. MacKenzie of Montreal reports a calculus in a farmer aged 55, symptoms dating back 20 years, palpable bimanually, demonstrated by X-ray and successfully removed. It was ovoid, 172 to 122 inches in circumference, weight 381/2 ounces.

Lipolysis and Bacteriolysis of the Tubercle Bacillus. E. A. Bossan and E. Le Moignic, Le Prog. Med., Mch. 23. Metchnikoff and Metalnikoff have called attention to the immunity of the honey-comb mite, which they ascribe to a specific lipase. Deycke, Much and one of the authors have shown. that the envelope of the tubercle bacillus as well as of the non-pathogenic streptothrix leproe, contains a resistant wax which, injected into a tuberculous organism, produces active antibodies. They were unable to obtain satisfactory biologic results, as the attempt at extraction with hot xylene, boiling alcohol and ether decomposed too much of the bacillary contents and largely prevented a vaccinating power. Deycke, in 1906, showed that, in analogy with albuminoids and lipoids, the fatty substance extracted from acido-resistant bacilli (named nastin) could produce specific antibodies. The authors have shown that Le Moignic's oily mixture dissolves the waxes of the tubercle bacillus and that the acid resistance falls rapidly to zero in about 3 weeks. They have employed two kinds of vaccine, a complete suspension still containing the bodies of the bacilli, and one freed from bacilli by filtration. Using the latter in guinea pigs and rabbits, lipolytic and bacteriolytic anti-bodies were produced. Controls died 3-4 weeks after injection with tubercle bacilli. The vaccin

ated animals survived several weeks to several months after the injection of 3 centigrams of very virulent tubercle bacilli. Cultures to which blood from vaccinated animals was added, after even 12 hours incubation at 37 deg. showed morphologic changes, with development of 2-4 very darkly staining granules connected by a lighter-stained filament. Bacilli with a single granule at one end resembled spermatozoa. Some bacilli took the couter stain. Similar appearances were found in bacilli from the vaccinated and infected animals. They imply that the obstacle to successful therapeutic use of the extract of bacillary waxes in Le Moignic's oily mixture, is that the production of lipolytic and bacteriolytic antibodies does not directly destroy the vitality of the bacilli, experimentally or accidentally introduced.

Haemothorax and Empyema. Lt. Col. Dobson, Brit. Med. Jour., Feb. 2, after performing pleurotomy at the site of election and evacuating the pleura, introduces a curved canula in the mammillary line in the 3d or 4th space, the canula ending blindly but having a dozen lateral openings. An antiseptic is introduced by a fountain or bulb syringe and drainage is effected through the drain behind, in the pleurotomy wound. J. Campbell, ibid. Jan. 26, fills the pleural cavity with Dakin's solution and withdraws it after 2 hours, repeating the process several times a day. Failure indicates a foreign body, a septic clot or the formation of an intrapulmonary abscess. He claims to have abridged the process of healing very considerably.

Thoracic Wounds-Experience at an Advanced Surgical Center. A. Rees and Gerard S. Hughes, Lancet, Jan. 12, report on 140 chest wounds. Primary haemorrhage is the principal cause of death early. This is due mainly to bleeding from the intercostal artery but also to that from the pulmonary vessels. While the latter is arrested by pulmonary collapse, the tamponment of the vessels by the blood collected in the pleural cavity cannot be efficacious till a very abundant, even fatal haemorrhage has occurred. In widely open wounds with trauma of the lung, 27 deaths occurred in 44 cases-61%. If the wound is not closed in 48 hours, infection is inevitable. Simple lavage is often sufficient to close a small open wound. Tamponing is insufficient in large wounds and dangerous on account of liability to sepsis. Suture of the wound, with or without extraction of the projectile is to be recommended in all cases of open wounds for infection of the pleura can be avoided in half the cases. The operation is done after shock has passed, under light general anaesthesia with chloroform and warm oxygen. Extraction

of projectiles from the pulmonary parenchyma and suture of the visceral pleura prolong the operation and should not be practiced as a rule. Closed wounds (haemothorax and pneumothorax closed): 72 cases, 14 deaths, 19.3%. The complication to be feared is infection, indicated by the persistance of tachycardia, fever and acute pain on percussion of the wounded side.

Acute Non-Suppurative Encephalitis. Creyx, Jour. de Med. de Bordeaux, Mch., reports a case fatal after 4 days, temperature ranging from 40 to 42 (104-107.6 F.) in which syphilis, typhoid, tuberculosis, diabetic and nephritic coma were excluded and blood cultures negative. No exact etiologic diagnosis made. According to etiology, he submits the following classification: Malarial, Syphilitic, Hydrophobic, Disease of Heine-Medin, Tuberculous, Streptococcic, Straphylococcic, Pneumococcic and infections with other bacteria, not specific. In case of association suppuration is the rule. As to symptoms and localization, he classifies thus: Diffusedelirious, convulsive, comatose. Focal-partial epilepsy, localized, choreiform movements; Paralyses characterized by syndromes varying according to level of the neuraxiscortical, meso-cephalic, Wernicke's acute superior polioencephalitis, bulbo-protuberantial, acute bulbar, cerebellar; participation of the spinal marrow-encephalo-myelitis. According to age: Foetal (Little's Disease?), Infantile, common syndromes of infantile hemiplegia or diplegia-Chorea of Sydenham, Milan, Grabois?, sequellar forms presenting a number of destructive and cicatricial localizations, Encephalic forms of certain sceroses in plaques.

Comparison of Percussion and Roentgenograms of Pericarditis. Morris and Bader, Arch. des Mal. du Couer, Feb., mention the dispute as to the accuracy of the former method, especially as to the limits of effusion detectable by percussion. They have experimented with 4 cadavers, the pericardium being injected with 250 c.c. at a time up to 1500 c.c., the usual maximum of distensibility. The first change in percussion was noted above, when 250 c.c. had been injected. Retro-sternal dullness was detected with 500 c.c. except that in one cadaver it failed with 750. An obtuse cardio-hepatic angle could not be obtained even with 1500 c.c. The liquid was first detected by the X-rays at 150 c.c. In the sitting posture, both retro-sternal dullness and the enlargement of the shadow disappeared by gravitation. Regarding the maximum quantity of effusion, they quote Verney as having obtained 4000 c.c. while Sibson gives the total capacity of the normal pericardium as 420-660.

Thoracic Wounds-Infected Haemothorax. Wm. Hutchinson, Brit. M. J., Feb. 16, reports a total of 450 military cases with only 29 deaths. In uninfected haemo- and pneumothorax, aspiration should be done and is usually sufficient if the dullness does not exceed two fingers' breadths. If the effusion of blood is massive, the pleura should be opened as soon as possible and the liquid blood and clots removed and the cavity irrigated and closed. Open haemothorax should be closed as soon as possible. Early diagnosis of infection should be made, pleurotomy with resection of rib practiced, blood and clots removed, and irrigation should be done with an antiseptic leaving a small quantity in place and closing the cavity. In case of development of infection after aspiration or recrudescence after pleurotomy, the pleura should be opened promptly. Attempt at extraction of a foreign body should not be made immediately and, in the case of British troops, not till the patient has reached England.

Soap in War Wounds. Haycraft, Brit. M. J., Jan. 19, removes foreign bodies and dead tissue and cleanses with 25% soap solution. 91 of 98 cases thus treated and sutured primarily, healed by first intention. A few developed pyrexia and local reaction but returned to normal in a few days. He attributes a haemostatic action to the soap and, without claiming a positive antiseptic action, contends that it penetrates the crevices of wounds and removes debris mechanically. (Note: Some 30 years ago, a physician was discharged from a public position in Buffalo for having used soap suds in a case diagnosed as diphtheria. It may be that public sentiment owes a belated apology to him or his memory-we do not know which. At any rate, many isolated reports have indicated that, whether strictly speaking an antiseptic or not, soap may well supplant many antiseptics in numerous instances.)

Flora of Wounds in Relation to Secondary Suture. Fleming and Janes, Brit. Med. Jour., Feb. 9, found in 55 unsuccessful cases, streptococci, spore-bearing bacilli and anaerobes digesting the tissues and yielding gas having the odor of rotten eggs. On the other hand, when the culture did not yield these microorganisms, healing occurred even with 20-30 bacteria to a field. The authors, therefore, urge cultural studies before undertaking secondary suture. (Note: This communication is in line with various others based on war experience, dealing with the most diverse problems but all having the common point that we must get away from the conception of non-specific bacteria. The determination of the exact microorganism is of great practical importance.