case the screw was a source of considerable suffering and some infection, and this is quite a common experience with nails and screws in the treatment of other fractures when they are allowed to project through the skin. In December, 1904, I operated upon a patient 46 years of age, who had sustained a fracture of the neck five months before, and in which there was nonunion. I employed the anterior opening. The ligamentous union was cut away with a chisel, and a silver-plated screw was inserted through a separate opening over the trochanter. The most difficult part of the operation was in properly adjusting and holding the short fragment while introducing the screw. The hemorrhage from the bone was very free, so iree as to make it a decidedly dangerous complication. I gained the impression from this case that the screw can really be of very little use in holding the short fragment because it enters into the soft central part of the bone and its hold is very frail. Unfortunately this patient died a few days after operation from ether pneumonia.

The treatment by the long hip-splint, as recommended by Dr. Shaffer, is rational and efficient in the hands of an experienced orthopedist, but the general practitioner and most general surgeons would fail through lack of proper skill in its application. We can all understand how Thomas secured results with his splint. He was a mechanical genius as well as an orthopedist of exceptional skill. Dr. Ridlon has also demonstrated that he can secure results better than the average by means of this same splint. Aside from the fact that this splint does not afford proper facilities for preventing shortening, it is open to the same objection that we offer to Dr. Shaffer's splint. I know from personal experience that the Thomas splint is a clumsy affair, more difficult to apply successfully than any other hip-splint, and one that would surely fail in the hands of the average surgeon.

Senn acts upon the theory that since union takes place when impaction occurs, the nearer we approach impaction the more likely we are to get union. As you all know, he recommends a plaster-of-Paris splint extending from the foot to the ribs with direct side pressure upon the great trochanter by means of a pad and screw. This splint will secure the desired rest, but that

the side pressure aids in producing artificial impaction, and that this impaction is desirable if secured, is extremely doubtful. We do not crowd the fragments toward each other in any other fracture. Why should we in this? The application of a plaster splint to an aged patient, who is often feeble or fat, and sometimes both, is extremely trying and something to be avoided if possible. Granted that this treatment will secure bony union, we must surely expect shortening.

Royal Whitman (Annals of Surgery, 1902, and Medical Record, March 19, 1904), teaches us that, contrary to the generally accepted belief, fracture of the neck of the femur occurs in children and young adults. In children the fracture is usually of the green-stick variety, the outer fragment being forced upward and the inner

one downward. Whitman demonstrates that if the femur be forcibly abducted as a lever the trochanter and upper side of the neck will impinge upon the upper edge of the acetabulum, which becomes a fulcrum forcing the head of the femur against the lower part of the capsular ligament, thus overcoming the deformity. He holds the limb in this position of extreme abduction by means of a long plaster-of-Paris spica bandage, and reports very satisfactory results. Of late he advocates the same treatment for adults. While I can heartily endorse the treatment of this, or any other fracture of the femur in children, by means of plaster-of-Paris, I am equally positive that it is not good or safe treatment for adults, particularly old people. If the position of extreme abduction holds the fragments in proper apposition in adults where the fracture is not of the green-stick variety, it is because the capsular ligament is kept taut, and this can be accomplished by the easier, more comfortable, and safer method advocated in this paper.

The principle of extension and counter-extension by means of weight and pully to overcome muscular contraction, has long been accepted as the most rational treatment of fractures, and if it can be demonstrated that its application is simpler and easier than all others it is surely the best.

To the International Archives of Surgery of 1903 Professor Bardenhever contributed a valuable article on "Treatment of Fractures by Permanent Extension." The article is profusely il

fening. I did this, but it seems I did not do it thoroughly enough. After the first few days the patient was assisted into a sitting position every day, and after a time she was able to assume that position with little or no help. The weights adjust themselves over the pulleys so that the fracture is not disturbed by this procedure. My patient experienced less discomfort than any patient I have ever had with a broken femur.. In fact, she experienced very little more discomfort than she would had she been confined to the bed

1.

Fig. 4.

pain or soreness, and is freely movable in every direction. She cannot fully flex the knee.

The second case I did not see, but I heard very frequent reports of her condition from my colleague, Dr. J. Clark Stewart, who applied this treatment from my description. The patient was a very fleshy woman, sixty-six years old, and the result was bony union with one-half inch shortening. She was walking about the house at the end of three months.

I saw the third case in consultation in Chicago

seven weeks after the accident. The patient was a well preserved woman of seventy-nine years. I found her at this time very comfortable and in good health, but with one inch shortening. Crep itus was present, showing that union was not taking place. She had a well adjusted long sidesplint and a weight of about fifteen pounds at the foot of the bed. The foot weight was increased to about twenty pounds, and a side pull of ten pounds applied. I saw her one week later when she was very comfortable and both limbs were of the same length. I now believe that the side pull

would have overcome the shortening without adding to the foot weight. The last I heard of this patient she was walking with crutches and with no apparent shortening.

At the present time I have a case of compound fracture of the neck of the femur under treatment by this method at the Northwestern Hospital. It is now three weeks since the accident, and the patient is perfectly comfortable. He has a normal temperature and one-half inch shortening. I hope to be able to give a favorable report of his case in the future.

ST. BARNABAS HOSPITAL

MINNEAPOLIS

ABLATION OF THE SCROTUM

BY L. C. WEEKS, M. D.
Detroit, Minn.

Injuries to the scrotum are comparatively rare on account of the protected position of that organ, and the literature dealing with the subject is very meagre. My own experience covering a period of thirteen years, including eighteen months' interne service in the Presbyterian Hospital in Chicago, is confined to three cases, of which the following is a report of the last case: Sept. 21, '04, B. H—, a young man aged 26, a carpenter by trade, was working in a planingmill. His overalls were ragged, and he had been warned to be careful not to get caught in the machinery. A vertical shaft two inches in diameter stood in one corner of the shop, about a foot from either wall. While working near this shaft the torn overalls of his right leg became caught. Feeling the pull, he braced himself against the walls of the shop and managed to free himself, but not till the overalls, pants and drawers were loosened from his waist and pulled down to his ankles. He slipped the clothing off his feet, stopped the machinery and called for help. On my arrival a few minutes later, I found him sitting on the edge of a tool chest with a coat thrown over his knees. He threw the coat to

one side and said: "That's all there is left, doctor." Seeing that his scrotum was injured, I pinned on a perineal band of sterile gauze, and had him removed to his home, a few blocks away. Examination there showed that the entire scrotum had been torn off, the skin of the penis, with the exception of a ring of foreskin an inch and a half wide, had been removed, together with a strip of skin over the pubes about two inches wide.

The denuded area extended back to the anal margin, and the lower two inches of the rectum had been dissected backwards, leaving a cavity in front of the rectum that admitted the thumb. From this point in front of the rectum 'the edges of the wound extended forward and outward to the pubic spine on either side, and then inward. to meet above the penis. The entire area was somewheat heart-shaped with the base upward. Above, in the middle line, hung the skinned penis, with the testicles below hanging separately, each from its individual cord, and covered by tunica vaginalis only. Hemorrhage was not extensive, and the pain, though severe, was not unbearable. A neighboring physician was called, the patient. anesthetized, the adjacent surfaces shaved, and the wound rendered aseptic. The remaining portion of the foreskin was drawn back, and sutured to the skin over the pubes, and each testicle was anchored to its cord close to the penis by catgut sutures. A dressing of sterile gauze wet in a one-half per cent solution of lysol was applied, and the patient put to bed. The following day