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5. That nephrectomy while the opposite organ is occupied by calculus is fraught with the greatest danger to life; whereas nephrectomy, after the opposite kidney has been freed of stone, will probably be followed by recovery from the operation and possibly by very good health for many years afterward.

6. That when renal calculus causes reflected or transferred vesical or ovarian pain, the removal of the calculus will be followed by complete cure of the bladder or ovarian symptoms.

7. That in some renal calculous conditions are attended by very remarkable nervous symptoms, sometimes without high temperature, and that information as to the cause of these symptoms is needed.

8. That unsuspected renal calculi are a source of very real danger to their possessors; and when, whether by accident or by the systematic examination of the urine, we have cause to suspect the presence of a calculus, we should recommend its immediate removal, regardless of the fact that it is not causing renal or transferred pain.

9. That quiescent calculus is as dangerous to the individual as unsuspected calculus, and ought to be removed by operation.

10. That the hitherto accepted teaching, that a renal calculus, if causing only mild symptoms, or attacks of severe colic of only recent occurrence, should be treated on the expectant plan, ought to be discarded as unsound in theory and dangerous in practice.

11. That the same principle should be applied to renal calculus which has long been the rule in regard to vesical calculus-namely, when suspected it should be searched for, when known to exist removed, without waiting in the hope that it may become encysted or spontaneously expelled.

12. That the very low mortality of nephrolithotomy puts this operation upon the same footing for renal calculus as lithotrity in the most experienced hands for vesical calculus.

J. H. W.

TUBERCULOUS GLANDS OF THE NECK; THEIR EARLY AND COMPLETE REMOVAL. LAPLACE, (JOUR. AM. MED. ASSOCN, JUNE, '98)-Adenitis so often seen in adolescence and middle age wherein tubercle bacilli invade the lymphatic glands of the cervical region, though not always so regarded, is one of the most important pathological conditions coming under the observation of the surgeon. In all such cases the danger of systemic infection exists, and if such does not actually take place, the toxines generated are absorbed to the detriment of the general vitality of the organism.

By direct anatomic connection these glands are infected with tubercule bacilli through the lymphatics of the nose and mouth. Their irritant action in the lpmph channels between the acini of the glands induce an increased activity of tissue change which causes a proliferation of endothelial cells. There is also an increaseed development of the glandular fibrous tissue but notcommensurate with the growth of the former. This accelerated activity of tissue change usually begins at the center of the gland and during the first stage presents hyaline appearance. Later caseation or fatty degeneration

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takes place. It is at this stage that secondarry infection of the enlarged glands by streptococci may occur with the result of inducing supuration. An interesting analogy is here noticeable between this process and similar changes in the lungs where a cheesy tubercule suppurates under the influence of the infective germs introduced through the atmosphere.

That every tuberculous foci when accessible should be removed is too well established at the present day to demand further consideration.

In tubercular enlargements of the cervical region two methods may be considered. One, the local applications by injection or external treatment based on the idea of exciting active inflammatory changes with a view to hastening absoprtion and elimination, is not to be condemned, but it is not the best way of dealing with such tissues.

The sooner the complete dissection and removal of these chronically enlarged glands is undertaken the better it is for the individual. To describe in detail the method of removal is unnecessary; suffice to say due care should always be had not to injure other structures. The existence of wellmarked tubercular pulmonary disease is really the only contraindication to the prompt excision of all enlarged cervical glands. With judicious administration of tonics after removal there will be a marked improvement in the general health of patients quite surprising to one who has been in the habit of treating such cases by the methods formerly so much in vogue. The deformity resulting from a careful dissection is far less than is seen where the tissues break down under streptococci infection. Hence from a cosmetic standpoint the operative treatment has much to commend it.

J. H. W.

OPERATIVE SURGERY AT GREAT AND SMALL ALTITUDES.-Dr. Charles A. Powers, of Denver (Western Medical and Surgical Gazette, N. Y. Med. Journal,) discusses the comparison of surgery at small and great attitudes. He advises the avoidance of operation where possible on persons who have recently come from the sea level, and especially if they show any cardiac weakness, owing to the increased action of the heart and lungs rendered neccessary by the ratefied atmosphere. Pulmonary invalids, however, who are well at great altitudes frequently suffer if removed for operation, and in some caes such invalids might with advantage be removed from the sea to a higner level for that purpose. As to the anesthetic, Dr. Powers finds that he is getting to place more and more reliance upon chloroform, ether being generally more irritating than in a moist climate, probably because of the moisture of ether vapor. Of two hundred and forty-eight operations in four years in Colorado, Dr. Powers employed ether in one hundred and fifty-nine, and chloroform in eighty-nine. One of his deaths he attributes to ether. The author's personal observations do not bear out the general idea that shock is more severe than at the sea level. Hæmorrhage in general is rather more profuse at great altitudes' particularly the oozing from the smallest vessels; bleeding, however, he considers a little better borne, and saline infusion less frequently demanded. The chance of asepsis he considers equal in either situation, with a proper technique. Operation wounds in tuberculous patients

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he considers heal more rapidly, and the healing is more permanent in Colorado, and he remarks upon the small proportions of pulmonary invalids in whom surgical tuberculosis is developed.

J. H. W.

VOLVULUS OF THE CÆCUM.-M. Zoge von Manteuffel (Gazette hebdomadaire de medecine te de chirurgie, N. Y. Med. Journal.) reported to the Congress of the German Society of Surgery at Berlin an account of twenty recorded observations of volvulus of the cæcum, to which he added four cases of his own. He remarks that those patients submitted to expectant treatment all died, while of those operated on by laparotomy three recovered. M. Zoge had only one death in his own four cases, that death taking place in a case where an artificial anus was made. J. H. W.

SARCOMA OF the right clavicle; resecTION FOLLOWED BY ENTIRE RESTORATION OF FUNCTION.-M. A, Besson (Journal des sciences medicales de lille, N Y. Med Journal, in a communication to the Anatomico-clinical Society reports a case in which the entire clavicle was resected by Professor Duret for sarcoma. Union took place by first intention, and the patient left the hospital at the end of three weeks having recovered perfectly all the movements of the right arm. J. H. W.

PEDIATRICS.

IN CHARGE OF

J. W. P. SMITHWICK, M. D., LAGRANGE, N. C.

LORNEZ METHOD OF FORCIBLE CORRECTION OF CONGENITAL DISLOCATION OF THE HIP: Royal Whitman, M. D. (Pedatrics' Vol. Nos. 9 & 1c) gives a very lucid description of Congenital Dislocation of the Hip and its treatment by the Lornez method. The condition is hardly ever recognized until the patient begins to walk, and then there are limping, protuding abdomen, shortening of the affected leg, and lordosis. These symptoms are often mistaken for those of Rachitis. The most important element in success, he claims, is early treatment before the changes about the joint have made a cure by this or other means, difficult or impossible. He says, that a persistent limp, if not attended by pain, and if not caused by paralysis or evident deformity, is almost pathognomonic of dislocation. If the thigh be flexed and adducted to the extreme limit, the head of the displaced bone may be easily palpated beneath the gluteal muscles. In the Lornez method of treatment the parts about the joint must be stretched sufficiently to allow the head of the bone to be brought into direct contact with the rudimentary aectabulum, in which position it must be held, so that the weight of the body will constantly force the head against the soft tissues of the cavity, thereby enlarging it to its

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normal capacity. This is called the "functional weighting" method in contradistinction to the forcible correction of Paci.

The steps to the operation are: First, Elongation of the limb. The trochanters must be brought down to the level of Nelaton's line, or lower. This may be done by weights or manual force at the time of operation, the latter usually sufficing. The child having been anæsthetised, a folded sheet is passed between its legs and the two ends are held by an assistant above the shoulder of the side to be operated upon, The operator then seizes the thigh and begins a series of alternate stretchings and relaxtions until the reresistance of the tissues is entirely overcome. The leg is now as long or longer than its fellow, and lies limp in an abducted position. The second step is Reposition, in which attempts are made to force the head of the femur over the posterior margin of the acetabulum through the opening in the contracted capsule. To do this; flex the thigh to about 90 degree to relax the capsule; then gradually, but forcibly, abduct under traction to a right angle with the body; then rotate slightly inward, and press downward above the head of the displaced bone, and it is then lifted up and drawn over the obstacle formed by the rim of the acetabulum. If this is successfully accomplished, a distinct sound and shock is heard and felt, and the leg remains fixed in a position of fexion and abduction. The third is Acetabulum formation. The enlargment of the opening into the acetabulum part of the capsule is attempted. In this the thigh is rotated forcibly outward again. and again and extended to its full limit, so that the capacity of the new articulation may be increased. When the manipulation is complete the thigh is fixed by a spica-plaster bandage extending to the knee, in the attitude of extreme abduction and extension. It is kept in this position for two or three months when the bandage is taken off and replased. It is well to continue the treatment for a year or more in most cases.

J. W. P, S.

Notes and Items.

ANIMAL FASHION.-A writer in a Chicago exchange tells the following story: While attending a confinement he saw the nurse return, soon after the placenta had been expelled and taken from the room, with a small piece of meat well peppered and salted, which the young mother ate. It was explained that "the meat was a piece of the afterbirth, taken to prevent afterpains; for that is how all animals do." The revolting morsals was given the credit for an early "getting up."-Med. Age.

VACCINATION IN JAPAN.-In Japan not only is vaccination

35 compulsory, but the law directs that revaccination shall be practised after every five years. In 1896 legal enactments were especially made for the production and distribution of vaccine, and calf lymph is exclusively employed, prepared with antiseptic precautions. Thus the Far East profits by the teaching of the West, and afterwards the West has to learn wisdom from the East. Med. Age.

SEABOARD MEDICAL ASSOCIATION. -The next meeting of this young association which was to have been held at Nag's Head, N. C., will be held at Virginia Beach, July 14th and 15th. The place of meeting had to be changed on account of the failure of the hotel of Nag's Head to be opened.

P. BLAKISTON'S SON & Co.-The partnership hitherto existing between Presley Blakiston and Kenneth M. Blakiston, under the firm name of P. Blakiston, Son & Co., expired June 30, 1898, on account of the death of the senior member.

The business of publishing, importing, and dealing in medical and scientific books, as established in 1843, will be continued by Kenneth M. Blakiston, trading as P. Blakiston's Son & Co.

The consolidation of the University and Bellevue Hospital Medical Colleges, of New York, has been consummated, and the 126 professors of the new school announced. Dr. E. G. Janeway will be the Dean. The New York University has received a gift of $50;000 for the Productive Endowment Fund. The giver is not announced, but it is beleived that Miss Helen Gould, who has been liberal in her donations to the University, has added to the sum of her benefactions.

Reading Motices.

"THE SHIP'S DOCTOR."-Intense interest to-day centers about our gallant navy; and the recent daring exploits of our sailor heroes add new luster to the brave record of the past. Americans are proud to inscribe new names standing for heroic deeds -the names of Dewey, Hobson, and Powell.

Numerous are the current chronicles of sea warfare, danger