statistics; Dr. Huntington's for operating on all cases are 3 per cent better than Dr. Deaver's, whose mortality is 15 per cent. Ochsner, of Chicago, who takes the other side, took over 400 cases and treated them as I have outlined and his mortality was between 4 and 5 per cent.

DR. ALLEN: I have been interested in the classification of cases, and I make appeal for a closer tabulation; e. g., perforative cases should be classified into perforation with abscess, and perforation with peritonitis.

DR. THORNE: I think the character of the infection makes a great difference and determines whether perforation will cause general peritonitis or abscess.

DR. EVANS: I wish to call attention to the diagnostic value of albumoses in the urine, in cases where albumose disappeared the abscess was found walled off, but while it persisted the walling off was incomplete.

"A few Remarks on Gastric Surgery," by DR. DUDLEY TAIT, San Francisco: Surgeons of late are performing less gastro-enterostomies-are doing pylorectomy and gastrectomy with lessening mortality. Are lately doing lateroinferior-gastro-duodo-enterostomy, or by incising peritoneum and freeing second part of duodenum, a lateral anastomosis is made between it and the pre-pyloric pouch. DR. BARBAT: I have not had the privilege of doing this operation, but it seems the best proposed because it 'disturbs the physiologic relations the least possible.

"The Surgical Occlusion of Large Arteries by a Gradual Method. Its relative Advantages, Together with an Experimental Inquiry as to its Feasibility," by DR. R. T. STRATTON, Oakland: Dangerous results that attend ligation of large arteries, especially if done suddenly. Paralysis and mortification of lower extremities if ligation of aorta is done, and so in proportion. Experiments on dogs with a silk ligature around the aorta and gradually tightened through a canula, showed the feasibility of gradual occlusion till the femoral pulse could be controlled. Possibilities of use preliminary to ligature for aneurism.

"Un-United Fractures of Bones of Lower Extremity. A Report of Cases," by DR. LEMOYNE WILLS, Los Angeles: [Illustrated by X-Ray photos.]

Conclusions. Difficulty arises in fractures of femur near hip; futility of any means but incision, excision, and

VOL. XLVI-26

wiring, wire can be left; necessity of plaster to waist to prevent breaking of wire. Flexion of knee to 45 degrees.

"The Injection of Paraffin for the Correction of Deformities," by DR. A. W. MORTON, San Francisco: Description of technique-paraffin 1-5 c. c. introduced at such temperature as to be thread-like. Dangers include-slough if temperature is too high, or tension too great; infectionembolism, proved by one case in Europe due to injection in rectum, not fatal. Comstock, of Minneapolis, had fatal embolism with injections into animals but the temperature is not stated. Exhibition of microphotos of specimens from patient in which at end of four months but little paraffine remained. Report of 21 cases, all free of accidents, results good.

"The Correction of Deformities Following Anterior Poliomyelitis by Subperiosteal Implantation of Tendons of Unaffected Muscles," by DR. JAMES T. WATKINS, San Francisco: Tendon grafting not ultimately satisfactory in many cases, due to faulty technic, or more probably to the fact that diseased tendons stretch too much. Implantation of healthy tendon under periosteum at proper point, most satisfactory method. [Illustrated by drawing.]

"Report of a Case of Gallstones, Infective Cholangitis, Multiple Abscesses, Destruction of the Right Caudate and Quadrate Lobes, and Hyperplasia of the Left Lobe," by DR. HARRY M. SHERMAN, San Francisco: Symptoms, course; operation, death from pneumonia, autopsy, illustrations and specimens.

"Value of Blood Pressure Tracings in Surgery," by DR. WALLACE I. TERRY, San Francisco.

The Legislative Body elected: Dr. H. Bert Ellis, of Los Angeles, President; Dr. Geo. H. Evans, Secretary; Drs. Kenyon, Nutting, Ross, Adams, Jones, Martin, Hare, Rosenstirn, Matteson, Reinhardt, and Baer, as Trustees. Drs. Kenyon, Jones and Ellis, with Ball, Adams, and Brainard, as alternates, Delegates to American Medical Association.

Board of Medical Examiners-Drs. Tait, Buteau, Thorne, Pottenger, and Thorpe. Alternates-Drs. Burnham, Kirk, and Reinhardt.

After the closure of the Session, dinner was served at the Hotel Potter for members, their families, and invited guests, during which various toasts were responded to.

SAN FRANCISCO COUNTY CLINICAL SOCIETY.

The May meeting was held at 528 Sutter Street, with DR. PLYMIRE in the chair.

DR. A. W. MORTON presented a patient and read a paper, "CARCINOMA OF SUPERIOR MAXILLA, REMOVED UNDER SPINAL ANESTHESIA."

[Paper to be published.]

The patient presented had carcinoma of the right superior maxilla resultant from a wound received two years ago from a pipe stem driven into the jaw while blasting rock. The entire bone was removed under spinal cocainization last December. The resultant deformity was corrected by injection of paraffine, and patient has been at work some time, articulates fairly, takes food easily, but beginning recurrence called forth discussion as to the advisability of further measure.

DR. C. A. McQUESTION presented

"NOTES ON A CASE OF FRACTURE OF PATELLA SUBSEQUENT TO SEPARATION AND REPAIR OF LIGAMENTUM PATELLA." Jan. 6, 1903.-Patient, male, age 84 years, fairly well nourished, health good; accident was a fall from lower step in house. The case was first seen one hour later. Examination showed a gap between superior border of patella and ruptured end of quadriceps extensor tendon. There was inability to extend leg and rupture was apparently complete. The patient was removed to the McNutt Hospital where an operation, having for its object the suturing of the ruptured end of tendon to the patella, was performed about five hours after accident. The operation, under strict asepsis, consisted of a semilunar incision over the patella; the incision commenced on the inner border, carried in a circular line one inch above superior border, terminating on outer border. The flap turned back exposed the patella and showed the complete rupture of the ligament. The suturing was performed by drilling three holes through the superior borders of patella, through which were passed three sutures. The under end of these sutures were passed through the ruptured end of ligament and tied to outer ends. The wound was then flushed well with hot normal salt solution and then closed by cat-gut sutures. A strong plaster paris bandage was then applied

reinforced by a posterior wooden splint, and the patient put to bed to remain quiet for six weeks. There was no pain, swelling, or temperature rise, the patient complained only of the enforced quiet. Two months after operation splint was removed; complete union had taken place without complications, and the knee was mobile. No tenderness or swelling remained about the joint. A long posterior wooden splint was applied, patient allowed to leave bed and given instructions-use the greatest care in his movements about the house, and under no conditions to remove the splint, either day or night.

About two months after the accident and operation the patient removed his splint and while passing from one room to another fell to the floor, down a step which he did not see between the doors. The injured knee was flexed under him with sudden force. I saw the patient a few hours after this; on examination I found the joint to be greatly swollen, hot, tender, and painful, with profuse extravasation of blood throughout. The patient stated that he had fallen on the injured knee. On account of the intense swelling, and the previous accident, an exact diagnosis of the condition could not be given, When swelling subsided a transverse fracture of the superior border of the patella was found, and firmly adherent to the upper fragment was the quadriceps tendon, that had formerly been ruptured. A proper splint was applied, adhesive plaster so placed as to draw the skin tense over the knee, and compresses so placed as to secure the fragments in opposition, with the hope that a short ligamentous union will result. Rupture of the ligamentum patella is a common occurrence, while a permanent union seldom occurs, and probably never, unless by a surgical operation, as mentioned in this case. The rupture generally occurs by a fall with the leg in the flexed position; cases have been reported where the rupture occurred while running, the fall being a result of the rupture. Ununited rupture of this ligament would result in a total loss of power to extend the leg, and consequent inability to walk without the aid of a crutch or other assistance.

DR POOLE spoke of a case of ligamentous union of patella with three inches separation of fragments which he wired over gauze to shorten the union.

DR. MACDONALD described a case recently seen in his hospital practice. A case came in with rupture which had become hard and tense subsequent to a fall. It was a

Omental mass showing continuity of its peritoneum and
vessels with lining of sac.

large scrotal hernia which the patient said he had all his life. It appeared to be omental. Upon operation and opening of the sac it still appeared omental but found the peritoneal covering and vessels of the mass continuous with the peritoneum and vessels lining the sac. Instead of adhesions there seemed to be absolute continuity. It

seemed to be a congenital condition. Dr. Macdonald exhibited photos of the mass removed and the sac lining.