munication between the anterior interosseous of the median with the posterior interosseous of the musculo-spiral. The trophic disturbances on the fingers are attributed to an anomalous distribution and partial degeneration of the radial nerve. The article is illustrated. REQUIREMENTS FOR SUCCESS IN SURGERY.-The requirements for a successful surgical career are, according to L. C. Bosher, Richmond, Va. (Journal A. M. A., March 3), first, a thorough natural fitness for the work; second, a thorough liberal education including as much as possible of studies of a scientific nature, especially physics, biology and chemistry, in the order named. Next the very best available medical school should be selected where a complete all-around medical education may be obtained. After completion of the medical course a term of hospital service is now considered an absolute essential, and, if choice is possible, it should be in a hospital where the cases are seen under the masters in the profession, and where the interne's time is divided into service in the medical and surgical wards, in the order named, if he wishes to become a surgeon. In such a one he can learn the methods of the masters and learn the responsibilities of a surgical assistant. Mere observation alone, however, will not suffice, but operations on the cadaver and on the lower animals are invaluable in acquiring technical skill without risk of human life. From the simpler operations on the patient, the interne can gradually advance to those more difficult as his skill and judgment improve. The best advantages of hospital training are obtained by the interne who gives his full attention to his duties, and he will thus gain the confidence of his superiors and lead them to entrust work of greater importance into his hands. After finishing the medical course and the hospital interneship, and perhaps also a term as surgical assistant, there are still generally months and even years before a special surgical practice can be developed, but this is an advantage rather than a drawback, as it favors the acquirement of the breadth of view which is sometimes notably absent in those who settle down too early into the practice of a specialty. In conclusion, he refers to the other indispensable requirements, health, energy, honesty and temperate habits, as well as the incidental advantages of attractive personality and tact, here as in every other position in life. With these requisites one may count on a reasonable measure of success in the practice of surgery, and even the rare exceptions who are "born surgeons" would also be the better for them. ON THE CAUSATION OF APPENDICITIS.-The cause of appendicitis is discussed in the same journal quoting from Umschau, Frankfort-on-the-Main. Kremmer of Hamburg, who has performed over 1,000 operations for appendicitis, has found the ingestion of much meat as a cause, and finds the disease frequent in Hamburg, England and America; in fact, where the people are well-to-do. The relation between la grippe and appendicitis he thinks very well marked. He points out that appendicitis occurs most frequently after epidemics of la grippe, and demonstrates the presence of la grippe germs in the abscesses from appendicitis. Three very valuable articles on tuberculosis are abstracted in the same issue from Italia Moderna, Rome; Lancet, London, and the Deutsche Medicinische Wochenschrift. THE TREATMENT OF APPENDICITIS.-C. H. Wallace, St. Joseph, Mo. (Journal A. M. A., March 31), divides appendicitis into six stages: 1, Inceptive stage, first forty-eight hours; 2, rapidly progressive stage, third, fourth and fifth days; 3, nonprogressing or stationary stage; 4, interval or chronic stage; 5, abscess stage; 6, the diffuse peritonitis stage. In the first of these all surgeons and many internists agree as to the advisability of operation. In the second, few surgeons favor operation, and observation shows that it increases rather than lessens mortality. Here Ochsner's plan of lavage and peristaltic rest by rectal feeding is sound surgery. In the third, rest and a guarded diet is advised, the case should be allowed to pass on to the interval period. This, the fourth stage, is the time for hopeful and ideal surgery. In the fifth or abscess stage he prefers two safe operations rather than one dangerous operation, first opening the abscess and later removing the appendix. In the sixth stage he believes that the least manipulation means the least mortality; simple incision with effective drainage with Fowler's position is the most hopeful treatment. Wallace summarizes his views as follows: "I believe, with the mind open for conviction and liable to complete reversal by future advancement, that: First. Appendicitis is always a surgical disease. Second. Every patient should have and is entitled to operative measures within the first forty-eight hours. Third. The rapidly progressing stage is the stage of applicability of the Ochsner treatment, and this offers the lowest mortality. Fourth. In cases coming to the surgeon with evidence of gradually subsiding symptoms, operation should be deferred to a more favorable period. Fifth. Operation should be urged in every interval or chronic stage. Sixth. In abscess cases two safe rather than one hazardous operation should be done. Seventh. In diffuse peritonitis all dependent cavities should be carefully incised and drained and not flushed, and, secondarily, the offending organ should be removed." UTERINE MYOMATA AND MALIGNANT DISEASE.-T. S. Cullen, Baltimore (Journal A. M. A., March 10), calls attention to the danger of incomplete examinations after hysteromyomectomy as regards the possible existence of malignant disease. He has been surprised to find how frequently myoma is associated with carcinoma in the large experience at the Johns Hopkins Hospital, and in 1903 he advised opening the uterus immediately on its removal to ascertain whether or not any chance carcinoma of the uterine body existed, and he now recommends not only the careful examination of the uterine cavity, but also of the myomatous nodules. As an illustration of this, he reports a case of supravaginal hysterectomy supposedly for simple interstitial and subperitoneal myomata. Two years later sudden collapse occurred due to hemorrhage from sarcoma of the cervical stump. Re-examination of the original tumor showed typical sarcomatous changes of the myoma. The patient died eight months after a second laparotomy and about two months after the progress of the growth had necessitated an operation for obstruction of the bowels. The case, he says, clearly indicates that physicians should examine carefully, not only the uterine cavity but also the myomata before the cervical stump is closed. TREATMENT OF ANEURISM BY DIRECT GRADUAL ARTERIAL CLOSURE.—The advantages of utilizing the method of active clot formation for the cure of aneurism are pleaded by R. T. Stratton, Oakland, Cal. (Journal A. M. A., March 10), who points out that it is the natural method when spontaneous cure occurs and also that by which the best results have been obtained in the surgical treatment of the condition. He reports in detail a case of aortic aneurism thus treated by a constrictor applied above the sac and gradually tightened. The patient did well for nearly two days, but then rapidly failed with sensory and motor paralysis of the lower limbs and died on the second day after the operation. The autopsy showed that the constriction had been applied above the celiac axis, the aneurism extending above that branch; the death was attributed to inhibition of the functions of the abdominal viscera by the final withdrawal of the blood supply. There was no perceptible evidence of injury of the vessel at the point of constriction, and the sac was very well filled with a stratified clot of the active type, in spite of the short time that had elapsed. Notwithstanding the fatal outcome of this case, Stratton considers that it warrants a hopeful future for this method. The ease with which the constriction was borne by the patient; the formation of a large mass of laminated coagulum; the apparent maintenance, up to the last closure, of the lumen of the arterial branches arising within the sac and distributed to the vital organs; and specially the freedom of the aorta itself from evidence of traumatism, inflammation or necrosis, all form the basis of a belief that this method will be available for many cases of otherwise hopeless aneurismal disease. Its chief field of usefulness will undoubtedly be found in cases of aneurism of the abdominal aorta, where ligation is almost necessarily fatal and other methods are either impracticable or still more dangerous. He points out, nevertheless, still other conditions in which he thinks it will be of value and preferable to the ligature. The advantages of gradual occlusion over ligation in cases in which arterial branches supplying vital organs from the sac is obvious. The article is illustrated. THE COLUMBUS MEDICAL JOURNAL. A MONTHLY MAGAZINE of MedicinE AND SURGERY. EDITORS. JAMES U. BARNHILL, A. M., Ph. D., M. D., 248 E. State Street. D. N. KINSMAN, M. D. ASSOCIATES. V. A. DODD, M. D. H.H, SNIVELY, M. D. J. A. RIEBEL, M. D. Communications relating to the editorial department should be addressed to Dr. J. U. Barnhill, 248 East State Street; those relating to business management should be addressed to Dr, W. J. Means, 715 North High Street. Per annum, in advance, subscription price, including postage.. ..15 cents. $1 00 2.00 Original articles, scientific and clinical, nemoranda, correspondence and news items are cordially solicited from the profession. MAY, 1906 Editorial. MEDICAL LEGISLATION. The Seventy-seventh General Assembly passed several measures of interest to the medical profession, the most important of which were the Reciprocity bill, a bill providing for the selection of site and erection of buildings for a State Institution for the Treatment and Education of Crippled Children, and the appropriation of funds for the erection of a State Sanatorium for the Treatment of Persons Afflicted with Pulmonary Tuberculosis. The Formula measure failed, probably more on account of lack of time for its consideration than because of opposition to the measure. In the discussion of proposed legislation to compel the placing of the formula on proprietary medicines it was evident that commercial considerations constituted the chief objection. While these constitute a spe |