Thorndike advises early operation in all cases of spina bifida, saying that although prognosis is bad in all cases, an early operation will lessen the mortality.

FRACTURES.

Several new ideas have been published in regard to the treatment of fractures.

Roberts of Philadelphia, in the Philadelphia Medical Journal of May 5th, advocates subcutaneous tenotomy in the treatment of fractures with persistent deformity, claiming it has produced excellent results in fractures of the leg. the femur.

Thinks it would also do well in fractures of Strict antiseptic precautions should be used. Dr. L. A. Stimpson of New York has diagnosed several cases of fracture of the scaphoid bone, by means of the X Ray and savs he thinks that this injury occurs much oftener than is commonly supposed. The deformity is not unlike that produced by Colles' fracture.

H. L. Smith, in the Journal of Medicine and Science, April. 1898, as a result of experiments on fractures of the elbow-joint, artificially produced, claims that in no way can the fragments be so accurately reduced and held in place as by strongly flexing the forearm upon the arm. He reports thirty cases treated by this method in the last three years with results which, he says, are superior to those produced by any other method.

Many operations have been devised for treatment of fractures of the patella, and many different methods have been devised for holding fragments in apposition without operation. But in all probability the one means at our command which would give best results if used alone is to elevate the foot. Dr. Stimpson of New York has proved by experiments that when the foot is thus elevated no contractions of the muscles on the anterior surface of the thigh will cause the fragments to separate, and this position, supplemented by pads above and below the patella and by traction on these pads with adhesive

plaster after the fragments have been strongly rubbed together to free them from clots and other substances, will in most cases give first class results. If, however, a patient is so situated that a surgeon could have skilled assistants and could be sure of his antisepsis, operation measures would also give good results, especially in fractures by muscular action. In all probability, the best operation is to make a vertical incision over the patella, free the edges of the patella of all foreign materials, bring them in apposition and hold them there with a suture running through the tendon of the quadriceps down over the patella and then through the ligamentum patellæ. Now close the external wound without drain and elevate the leg and keep it elevated until union has taken place.

Dr. Doyen, at the Congress of German Surgeons, read a paper on treatment of congenital dislocation of the hip, in which he advocates cutting down the joint and boring out the acetabulum and then placing the head of the femur in the socket which he has prepared. He gets good results and says this method is applicable up to the twentieth vear.

SURGICAL PROGRESS IN GYNECOLOGICAL AND

GENITO URINARY.

F. M. TUKEY, M.D.,

BRIDGEPORT.

Perhaps the most important sign of progress which strikes one in reviewing surgical work is the earnest effort of all our best surgeons to establish in every branch of surgery a more rational conservatism. This feeling is not a spontaneous outburst of hasty conclusion by any means, but is the result of mature deliberation after years of careful, conscientious work. There can be no doubt but that for some time past it has been becoming less common to remove the ovaries and uterus for vague and indeterminate conditions-so much so, that many of the so-called hysterectomy and ovariotomy "record " men have begun to wage war on this spirit of ultra-conservatism, as they term it, arguing that already the pendulum of conservatism has swung back too far, and that we are not now operating as much as we should, as is right and demanded by circumstances. The above pertains to some extent in genito-urinary work and to castration for the relief of various conditions in the male. But the influence of such men as are so prominently arrayed on the side of more rational operating must prevail, and we can hope for still further advances in this direction.

More specifically, the general trend of feeling seems to indicate a growing preference among gynecologists to both explore and operate through the vagina whenever possible, after the method described and practiced by Dübrossen of Berlin-so that with not a few, only the largest tumors demand the abdominal

route for their removal. Of course there are some, many, who still advocate and use the abdominal route as being more familiar and accessible-but in the light of a longer experience and an improved technique, the vaginal method offering as it does less danger from sepsis and shock, seems likely to become more and more popular. The chief advantages claimed for the vaginal route are that it is a much less serious operation than abdominal section-that the intestines once pushed out of the way with a sponge are not seen again-there is no abdominal scar with risk of hernia, and there is less discomfort after the operation, the patient being able to turn on her side at once and is usually up in two weeks. A small vagina makes this route difficult, even with lateral incisions. A fixed uterus that cannot be drawn down at all makes the operation impossible.

The nervous system in its delicate relation to the female sexual apparatus has been more thoroughly studied the past year than ever before; the great importance of its appreciation for the proper understanding and treatment of disease has been one of the most significant gynecological advances of 1897-8.

The question of bicycling for women, whether it is beneficial or injurious, is still under discussion, with opinions about equally divided. There can be no doubt as to its benefit in some cases; as in anemorrhea, especially when the uterus is undeveloped; also in dysmenorrhea, and in all cases where the uterine disorders are due to a relaxed condition of the parts. Uterine flections are not particularly influenced. But it should be absolutely forbidden in salpingitis, subacute and chronic peritonitis of whatever origin; fibroids and ovarian tumors. Bladder troubles too, are usually aggravated by bicycling.

Gonorrhea, with its ulterior effects, still continues to

form in both male and female, a very important feature of gynecological and genito-urinary surgery.

Genito-urinary surgery generally has experienced few important changes or advances, but the improved technique of cystoscopy has opened a wider field, so that by means of more accurate diagnosis in obscure conditions we shall expect the coming year to yield something of interest in this direction.

The relation of the ureteral catheters to the surgery of the kidneys in women has attracted considerable interest of late. The study of the separated urines of the two kidneys provides a method of physical examination of these organs which is wonderfully accurate and safe. The importance of this examination rests upon the fact that it enables one to isolate the disease, and to determine with certainty, not only which kidney is afflicted, but how it is afflicted.

Reynolds formulates the following results from these examinations: (1) That the symptoms may be transposed; that is, the pain and tenderness may be referred by the patient to the comparatively sound kidney; (2) There may occur transitory and inflammatory affections of the sound organ, which would decide one to defer operation till they had passed away; (3). The choice between nephrotomy and nephrectomy and often the decision as to whether any operation at all is permissible, should be decided by comparing the relative condition of the two kidneys; (4) In patients with patients with renal calculus, the question between nephro-lithotomy and nephrectomy must depend on whether the condition of the affected kidney affords a prospect of good healing and a useful kidney after nephrectomy.

Many of our best operators are strongly advocating earlier interference for acute inflammations and suppurative processes of the kidney, claiming that time is of much value in these cases and a lower mortality will result.