RESULTS.

I know of no more satisfactory results in the whole field of surgery than those which are obtained by an early nephrectomy in unilateral kidney tuberculosis. With this fact established, it becomes our duty to make it more widely known and to plead for early recognition and early radical operation for kidney tuberculosis.

On the seventeen patients which I have handled surgically for tuberculosis, 21 operations were performed, 12 nephrotomies, 7 nephrectomies, I opening of a perinephritic abscess and I resection. Nephrotomy was made in most of the cases in my earlier work. None of these proved curative. The same result followed in the single resection which was performed. The histories of the seven nephrectomies have been very satisfactory. They have all recovered from the operation, except one, and have been apparently entirely cured.

The one fatal case is a case in which nephrotomy had been done with a slight temporary improvement. A nephrectomy, which was performed later, was made extremely difficult by the extensive perinephritic inflammation, which resulted from the first operation. An ill-advised attempt was made to remove the kidney with its capsule. This made the operation very bloody and very prolonged, the patient dying of shock within a few hours. Since that time we have saved similar patients by removing the kidney from within the fibrous capsule, when the perinecedure and seems to give very satisfactory results.-The Journal A. M. A.

Extracts trom Home and Foreign Journals.

SURGICAL

PASSIVE HYPEREMIA IN THE TREATMENT OF FRACTURES.

Dr. Deutschlander is strongly impressed with the value of this method in the treatment of fractures on the ground of his observations in 10 cases. The hyperemia materially promotes formation of callus and prevents stiffness and atrophic processes in the muscles and bones. It also diminishes pain, so that far more extensive movements can be carried out than otherwise. As regards the technic, the author recommends at first only slight constriction, the bandage being applied for an hour or two, at intervals of longer or shorter duration (one or two hours). The object of this is to bring into play the effect of the hyperemia in promoting liquefaction and absorption of crushed portions of tissue. Later the method was employed only once daily for a period of 6 to 8 hours in two sittings, with an interval of two hours. If its use was interfered with by the plaster dressing a fenestrum was cut at the site of fracture, while in fractures of the lower extremity the hyperemia treatment was combined with the use of a splint enabling the patient to walk about.—International Journal of Surgery.

THE SURGICAL TREATMENT OF TRIGEMINAL NEURALGIA.

Alexis V. Moschowitz sums up his paper as follows: (1) Eliminate any possible etiological factors, such as tumors, carious teeth, antral disease, malaria, syphilis, etc. (2) Determine accurately the nerve branch or branches involved. (3) The operation should be performed as near to the periphery as possible. (4) The operation should be performed early. This is important, because the earlier the case, the more chances there are that a peripheral operation will be of benefit. (5) Whatever the char

acter of the operation may be, the dominant principle must be the prevention of regeneration of the affected nerve. More specifically the operations may be classified as peripheral and central. If the supraorbital, infraorbital, mental, malar, or inferior dental branches, either singly or collectively, are involved, the nerve should be divided and the foramen plugged by a gold or silver wire or button. If the superior or inferior maxillary is involved, Abbe's operation is indicated. A celluloid or gold button should be substituted for the rubber tissue. The writer believes that by following these suggestions the extirpation of the Gasserian ganglion will be rendered unnecessary.-Medical Record, September 29, 1906.

METABOLISM IN OSTEOMALACIA.

Limbeck and Naumann each found in metabolism experiments on subjects of osteomalacia that the body lost calcium in this disease. A recent and more complete investigation by Goldthwait, Painter, Osgood, and McCrudden confirms this discovery. Their studies were made on a young girl of sixteen, the subject of well-marked osteomalacia. The first observations covered a period of eight days. The metabolism technique employed was that devised by McCrudden. The patient was allowed to eat what she chose. Solid food was cut into small bits and well mixed. The patient received a certain weight, and the same weight was taken for analysis. Liquid food was thoroughly mixed, and a volume equal to that consumed by the patient was likewise saved. All the food taken for analysis was mixed together, evaporated to dryness on the water bath, ground to a fine powder, and thoroughly mixed. Analyses were made in triplicate. The first experiment showed that much of the sulphur taken in the food was retained in fact 63 per cent. There was a considerable loss of calcium, amounting to 24 per cent, and a slight retention of nitrogen and magnesia. Calcium was excreted chiefly in the urine, and the magnesia in the feces, instead of in the urine. This is the reverse of the normal. In health only 0.12 to 0.18 gms. of calcium are excreted daily in the urine. In this case there was

from 0.10 to 0.65 gms. After the first period of study the ovaries of the patient were removed as a therapeutic procedure. A second set of analyses made a few months later showed the beneficial effect of castration. There was a striking difference in the metabolism. The daily excretion of sulphur was found to be decidedly greater. The daily output of calcium was lower than before, but still considerably above the normal. While the first period showed a loss of 24 per cent of calcium by the organism, in the second there was retention of 28 per cent. That the bones in osteomalacia are poor in inorganic material has long been known. Normal bones contain from 34 per cent to 44 per cent of organic material, and from 56 to 66 of inorganic material.

They conclude, as a result of this work, that in osteomalcia there is at first a decalcification of the bony tissue, and then a replacement of the inorganic material of the bone by organic osteoid tissue. Although some magnesia takes its place, the calcium chiefly replaced by an organic substance that is rich in sulphur and poor in phosphorus.-The Boston Medical and Surgical Journal.

A REVIEW OF THE EVOLUTION OF THE MODERN SURGICAL TREATMENT OF FIBROID TUMORS OF THE UTERUS.

LeRoy Broun, after reviewing the history of the surgical treatment of uterine fibroids, gives as his conviction that we conserve the interests of our patients in advising them not to consider palliative measures. He believes in the removal of fibroid tumors, whether they give rise to distressing symptoms or not. He bases his belief on the knowledge that the death rate from removal is now based on less than 1 per cent in individual statistics, to 4 per cent in combined statistics, while in patients who have fibroid tumors which are not operated upon, the mortality is at least 10 per cent. There is less risk to the patient and a greater possibility of saving the uterus, also, in removing the intrapelvic smaller tumors. This does not include the small fibrous nodules recognized only by one with trained touch, and which occur in women near the menopause. Unless these tend to increase in size there is no need for interference.-Medical Record.

CAPILLARITY OF INTESTINAL SUTURES.

It has long been accepted and taught as a cardinal maxim in intestinal anastomosis that a suture should not penetrate into the lumen of the gut, since if the stitch be returned through to the serosa of the gut-wall, infection would follow the suture line and involve the peritoneal cavity.

When the Connell suture was introduced it was readily recognized as furnishing a tight line of union that could be quickly But the fact that the sutures were deliberately penetrating made many surgeons hesitate to use it.

Recently, Connell (Jour. A. M. A., Aug. 11) has made some ingenious and timely experiments to determine this question of capillarity of intestinal sutures. The nature of his experiments need not here be reviewed, but the results quite clearly indicate that infection does not travel along the line of the stitch, and that sutures may be placed with impunity through the gut-wall into the lumen and out again to the serosa without fear of peritoneal infection.

It is probable that these experiments are accurate, since clinical experience practically corroborates Connell's findings. Unquestionably many sutures intended to be placed through the sub-mucosa have gone through into the lumen without any bad effects.

Since the perforating suture is firmer and more quickly placed, the verdict of its innocuousness will probably result in its more extended employment, most likely by Connell's method.

APPENDICITIS-TO OPERATE OR NOT TO OPERATE.

J. J. Brownson gives the principles on which he bases the proper time for operation in cases of appendicitis: (1) The operation for appendicitis ought to be done in the primary stage or before the high fever period. The appendix should be removed to guard against fulminating cases and those in which rupture occurs into the abdominal cavity. (2) In the secondary period after suppuration, drainage should be instituted, and na