as these are a source of infection. Plaster splints, I do not think, accomplish anything and are usually a nuisance. The operation, as nearly as I can learn, has been performed in this city fifteen times; that is, ten cases at Mercy Hospital, and five at the City Hospital. At the Mercy Hospital two operations each were performed by Drs. Dougherty, Butler, Wagner, Wolfe and myself. At the City Hospital, two by Dr. Guthrie, two by Dr. Harvey, in one of which he was assisted by Dr. Biddle, and one by myself. I have performed the operation three times, and acted as first assistant at five other operations. In none of the fifteen operations was a cure affected, although in nearly all of them some improvement resulted, and in one, performed at Mercy Hospital, the patient, to quote the words of the resident physician, “died cured;" that is, motion and sensation and control of the sphincters returned but the patient died from other causes. Of Dr. Wolfe's two cases, the first was operated upon three years ago. Operation took place forty-eight hours after injury. There was complete paralysis of all the portion of the body supplied by the nerves given off the cord below the seat of injury. Knee jerks were completely absent. Arms were partially involved in the anaesthesia and paralysis. Upon cutting down, the laminae of the sixth and seventh cervical and first dorsal vertebrae were found fractured and these were removed. The meninges were lacerated and the cord crushed. In this case, there was no improvement and death occurred one week later from exhaustion. I assisted Dr. Wolfe with his second case, which was operated on two years ago. Injury was located in the lower dorsal region. The paralysis and anaesthesia of the lower half of the body was complete. The knee jerks were abolished and control of the sphincters completely lost. Patient would not consent to operation until one week after the accident. We removed the laminae of the eleventh and twelfth dorsal vertebrae which were fractured and pressing on the cord. The meninges were intact. We opened them, however, and found the cord apparently normal. Improvement began within forty-eight hours after operation. The patient regained control of the sphincters. Motion and sensation returned to one leg. There was some return of the knee jerk. This, however, was the extent of the improvement. The patient was able to sit up in a chair and lived for eighteen months, when death finally occurred from bedsores. Had this patient consented to an operation immediately, it is not improbable a cure might have been effected, as is proven by the marked improvement within forty-eight hours after operation. Of Dr. Dougherty's two cases, the first resulted from a railroad accident, the patient lying helpless along the railroad track all night until discovered in the morning, when he was removed to Mercy Hospital. Two days after the patient consented to operation, which was immediately performed by Dr. Dougherty and myself. Injury was located in the lower dorsal region. There was complete paraplegia and anaesthesia, with loss of knee jerk and loss of control of sphincters. Upon cutting down we found the five lower dorsal vertebrae involved and removed the laminae of these vertebrae. We removed also spicules of bone which had penetrated both membranes and cord, the former being badly torn. After operation, there was a slight return of sensation to the legs, but the paraplegia, loss of sphincter control and loss of knee jerk were not improved. The patient died of pneumonia forty-eight hours after operation. Whether the pneumonia was the result of the all night exposure on the railroad track or was caused by the ether, it was impossible to determine. The Kearney case most of you have heard of. This young man was caught in a machine belt at the Hazard rope works, carried up and thrown down with such force to the floor, as to break his neck. He was taken to Mercy Hospital, and shortly after was operated upon by Dr. Dougherty and myself. Upon cutting down, we found a dislocation of the atlas upon the axis and comminuted fractures of the laminae of the fourth, fifth, sixth and seventh cervical vertebrae, and also of the body of one of the vertebrae. After cutting the ligaments, we attempted to reduce the atlas-axis dislocation. Drs. Dougherty, Wagner, Roderick, Wolfe, Reichard and myself took hold, some at the head and others at the legs, and after exhausting all our strength, succeeded in partly reducing the dislocation. We then removed the laminae of the four lower cervical vertebrae and a portion of the fractured vertebral body. We also removed some spicules that had penetrated the cord, put in drainage, closed the wound and got union by first intention. Before the operation, examination revealed complete paralysis and anaesthesia from the shoulders down; loss of patellar and other reflexes and complete paralysis of the sphincters. The fifth nerve root evidently had escaped injury because the boy could flex and abduct the elbow although he could not extend or adduct it. After operation, sensation returned in spots all over the legs and body. He regained intermittent control of the sphincters and was able to move both feet a little. There was no improvement in the arms, except that he was able to flex the fingers slightly. The patient lived four months and two days, when, a few days before death, he developed a cerebral meningitis which carried him off. The trophic centres seemed to become somewhat active after operation, as he had very little tendency to bedsores. The young man displayed wonderful grit and remained cheerful and hopeful, maintaining until the end, that he would fool us all and get well. This was certainly a most remarkable case, when you consider that the patient lived over four months with a fracture of the four lower cervical vertebrae and a dislocation of the atlas on the axis; this last being the thing that causes instant death in hanging. As stated above, however, we succeeded in partly reducing this dislocation. Of Dr. Wagner's two cases, one was operated upon two hours after injury. This patient had fractures of the five upper dorsal vertebrae; the ribs were broken off the vertebrae; the pleurae were full of blood and the cord crushed and mangled. This case died on the operating table-probably from hemorrhage into the pleurae. In his second case, in which I assisted, the cervical vertebrae, from the third to the seventh, were involved. The cord was crushed. After operation, the patient regained control of his bladder and moved his feet. There was also some slight return of sensation. There was no further improvement and the patient died at 11 P. M. on the day of operation, as a result of embolism. In Dr. Butler's two cases, one was a child four and one-half years old, shot through the laminae of the third and fourth dorsal vertebrae, the ball lodging in the body of the second dorsal. The membranes were lacerated but the cord apparently was uninjured. The badly crushed laminae were removed and the meninges closed. There was no improvement in symptoms. On the seventh day, cerebro-spinal fluid began to escape from the wound and the patient died of meningitis on the ninth day. In his second case, the last dorsal and first lumbar were involved and the cord severed. We removed the laminae and sutured the cord. There was no improvement in symptoms. The patient lived ten months and died of bed sores. At the City Hospital, Dr. Harvey operated twice. Dr. Biddle, of Fountain Springs, assisted him with his first case in 1897. The fracture was in the lower dorsal region. The laminae of two and part of the body of one vertebrae were removed. The cord and membranes were uninjured. The patient left the hospital slightly improved. He still lives, and I learned to-day, that while he cannot walk, he can stand, move his legs in every direction, sensation has returned, as has also control of the sphincters. This is the best result obtained in this city, although I understand Dr. Gibby, of Pittston, obtained an even better result, in a case upon which he operated. Dr. Harvey's second case died five days after operation, unbenefitted. Dr. Guthrie had two cases, one involving the cervical region, which died five days after the operation; the other, with injury in the dorsal region, living nine months after operation. In neither of these cases was there any improvement in symptoms. I operated on a case while on duty at the City Hospital, last July, removing the laminae of the last dorsal and first two lumbar vertebrae. There was no improvement, except return of sensation to the thighs. The patient is still living but is in such a bad way with bedsores that he will not last much longer. I also operated on two cases at Mercy Hospital. In the first, there was fracture of the last three dorsal vertebrae, with all the symptoms found in such an injury, including complete absence of the reflexes. After operation, the patient regained motion and sensation in all the muscles of the legs. He also partially regained control of the sphincters and showed every indication of ultimate recovery, when at the end of the sixth week he contracted an uncontrollable diarrhoea which caused his death three weeks later. The other case was one involving the last two dorsal and first two lumbar vertebrae. The cord was completely severed. I sutured the cord and removed the broken laminae but the patient died of exhaustion two months after. Dr. Biddle, of Fountain Springs, has had probably more experience in this line of work than most other surgeons, and has obtained good results in many cases. AN UNIQUE CASE OF APPENDICITIS. APPENDI- BY DR. E. C. WAGNER, WILKES-BARRE, PA. Male, aged 21. Referred to me by Dr. E. Dougherty. In November, 1903, patient discovered his condition, a right inguinal, indirect hernia, which was reduced at that time. Since that event until the present attack, patient has had intermittent attacks of right inguinal pain with descent of hernia. This was reduced several times. Present attack.-On March 9th, 1904, patient complained of severe pain in the right inguinal and scrotal regions, accompanied by bilious vomiting. There appeared a slight scrotal swelling, which gradually grew larger, harder and more painful, swelling and tenderness extending up in the inguinal region to a level with the ant. sup. spine of ilium. The swelling was irreducible. On admission to the Mercy Hos |