tion when convalescence may be a matter of weeks and months.

In the third place, there is no danger from disastrous falls, from pressure-paralysis, and consequent wrist-drop so often seen when weak and emaciated patients have tried to use crutches. It is well known how much delay in recovery is experienced when such an accident supervenes.

In bringing this rather simple device to your attention may we not hope that you will give it your kindly attention, and trust that you will feel that, to do your full duty to such patients, it is not sufficient to prescribe a pair of crutches and leave them to their fate? Let us realize that our obligation extends further and that we have not finished until we have helped the patient to ultimate functional recovery.

DISCUSSION

DR. C. H. WALLACE (St. Joseph, Mo.): I want to recommend this apparatus of Dr. Nifong. We can readily see the utility of this simple device in this class of injuries. I think we have all appreciated the difficulties we sometimes have in getting these patients to venture out on crutches, and this device will find a useful place in the convalescing period from the bed to the crutch.

DR. BYRON B. DAVIS (Omaha, Nebr.): I am particularly impressed with this little apparatus on account of some experiences I have had in trying to train patients in the use of crutches. If the patient is nervous and a little fearful, or if he happens to be old and heavy, it is almost impossible to get him to muster up enough courage to use crutches. It takes a long time to do this, and I think, with something like this, we could begin its use a good deal earlier than with crutches. In the second place, I have had two or three rather bad accidents with crutches. Patients have started out too quickly and injured themselves badly. It seems to me that this apparatus would fill the function of the crutches when patients begin their ambulatory treatment, and do it much better than the crutches can. I certainly am going to use this kind of an apparatus; try it at any rate, for it looks to me like a sensible invention.

DR. RICHARD W. CORWIN (Pueblo, Colo.): I hope that Dr. Nifong will give us the dimensions of this apparatus for I want to make some when I go home. I want the size of the material and the size of the apparatus.

DR. NIFONG (closing): I was a little diffident about presenting something so simple to men who ought to have known such things before, but the simplest things are sometimes the ones we overlook. I should not apologize for it, for I have used it for a number of years successfully and have come to appreciate how much it means to the class of patients I have mentioned. It is not intended to replace the crutch, but to be used before crutches for those weakened patients who cannot possibly use crutches and who often have not the money to supply themselves with attendants, and very often attendants are not as efficient as this thing. Those patients do not soon get confidence in themselves, and confidence is very necessary. You have all seen patients who were mentally and physically incapable of walking. They were scared when you put them on their feet; but, if you put them on the side of the bed and let them try this thing as far as putting their hands on the side bars, they will gradually and rather rapidly get in and begin to use it. As you know, crutches in the case of old, thin individuals, or even young, thin ones, are liable to make some damaging pressure if they are used. Crutches are really for pretty agile individuals. Take and try them yourselves and you will not use them very efficiently at first.

This device was suggested to me many years ago. I used to see an old farmer, a cripple, who had no use of his lower extremities. He would come into town, and take something of this sort out of the back of his buggy and hop right along. He had no seat in his contrivance, but sat on the side rail-or the court-house fence.

When I put the article in the Transactions I will put the dimensions down accurately, but I do not have them with me now. I will gladly furnish them if you will write me. The body is not more than twenty-nine inches long, the seat is about sixteen inches high, and the top varies in height. They are preferably made of light, strong material. not too heavy. For hospital use, where they would be roughly used, they would require a little heavier material, but they want to be easy to handle. I have one that is made of hickory that has been used for a long time. They do not fold up.

PAROTITIS AS A POSTOPERATIVE

COMPLICATION

CLIFFORD U. COLLINS, M.D., F.A.C.S.

PEORIA, ILLINOIS

In the year 1915, 4 of our patients developed parotitis, and 3 of them died. This was considered a sufficient reason for making a study of the subject, which was done. The things that were learned from that study seemed to be valuable because we have had only two cases of parotitis since, both postoperative, and neither one died.

First, we went over our records, and found that in 6,100 patients who had been operated on, 7 had developed parotitis, and 1 patient developed parotitis and died while waiting for operation. A study of these cases was made, which follows.

All of these 8 patients had been in the same hospital, which had no special significance, we thought, because practically all of our operative work is done at this hospital. Five were males, and 3 were females. All of these 8 patients had had abdominal operations except one, and he had an abdominal infection, peritonitis following appendicitis. Three were operated on for obstruction of the bowels, 2 were operated on for ulcer of the stomach, 1 had a panhysterectomy done, and 2 had peritonitis. Two of the patients had fecal fistulæ, and 1 had a colostomy when the parotitis developed. In 5 patients both glands were inflamed, and in 3 the right gland only was affected. Five patients died, while 3 recovered. Of the 5 that died.

3 had abdominal conditions that might have caused death anyway, but in 2 of the 5 the parotitis was evidently the principal cause of death.

In 6 of the patients there was no positive evidence of suppuration in the glands. Two recovered without suppuration, and 4 died. Of the 4 that died, 3 died in so short a time after the parotitis developed that there was hardly time for suppuration to become manifest. In 2 of the patients suppuration became apparent, and the glands were drained.

It was deemed significant that 7 of these patients had had abdominal operations, and the other 1 had an abdominal infection, peritonitis. The 7 patients operated on had received scopolamine, 100 gr., and morphine, % gr., as a preliminary hypodermic before the operation. As is well known, scopolamine dries up the secretions of the mouth and salivary glands. But 1 patient had not been operated on, and had not received scopolamine. So evidently scopolamine was not a factor in the production of parotitis in that patient. All of the patients had been on the Ochsner treatment and nothing had been administered by the mouth for several days. An effort had been made to supply these patients with sufficient water by administering salt solution and bicarbonate of soda solution. per rectum.

After a study had been made of the case records of these patients a study was made of the literature. Nearly all of the cases of postoperative parotitis reported in the literature we studied followed abdominal operations. This seemed to be significant.

One of the most interesting articles we found was by H. B. Rolleston and M. W. B. Oliver.1 They studied 1,000 cases of gastric ulcer treated in St. George's Hospital in twenty years, from 1889 to 1908. These patients were all treated medically and not surgically. In 470 patients treated by oral starvation there were