A coincidence in the case of the 63-year-old woman is that Winslow operated on her husband for the same trouble when he was 69 years of age, and after a lapse of nine years he still enjoys good health and is an exceptionally active business man. Besides the 3-year-old boy, a number of patients of tender years came under treatment-one aged 6, one aged 7, two 9 years old, two 10 years old, two 11 years, and one 13 years of age. The second oldest patient was 51 years of age, and there were four between 40 and 50 years of age. These statistics agree with the well-known facts that the extremes of life, while not exempt from appendicitis, are comparatively rarely affected. Twenty-eight patients were seen during the first attack and were operated on as follows: On the second day three, one of which was clean, that is, there was no suppuration present, and two were purulent. On the third day three, in all of which an abscess had formed. On the fourth day three, one clean, two purulent. On the fifth day three, one clean, two purulent. On the sixth day one, clean. On the seventh day one, purulent. On the eighth day one, purulent. On the tenth day one, clean. On the eleventh day one, clean. Of six weeks duration one, purulent. Of unknown duration two, one clean, one purulent. It will be noticed from the above that eleven, or 39 per cent., were clean, and seventeen, or 60 per cent, purulent, and • we are thereby admonished not to delay operation, as pus may be found in the peritoneal cavity at a very early period. Five patients were operated on during the second attackone on the second day, one on the fifth day, one each in three weeks, six weeks, and two months, respectively. Contrary to what might have been expected, all these were clean cases. Three cases are recorded as having been operated on during the third attack, of which two were clean and one purulent. Four cases are stated to have had numerous attacks, of which two were clean, and in one pus was present. The number of attacks in the remaining cases is unknown, but from the fact that most of them were purulent it is probable that they were acute cases. The number of recurrent cases is too small to be of much use from a statistical standpoint, yet they seem to indicate that if a patient survives the first attack there is a probability that the inflammation will become chronic and the appendix undergo thickening rather than rupture, with abscess formation or peritonitis. The Treatment of Fractures of the Radius Between the Insertions of the Pronator Muscles. J. R. Horbensack (Univ. of Pa. Med. Bul., vol. 16, no. 10) says: 1. In the treatment of any fracture the best result cannot be obtained unless the part be dressed in that position in which reduction of the fracture can be maintained. 2. Fractures of the radius between the insertions of the pronator muscles should be reduced and fixed with the forearm in the position which corresponds to that in which the upper fragment is found, thus obviating the tendency to displacement of the only fragment that is controlled with difficulty. 3. The comparatively perfect reduction and immobilization secured by this method dispose of the tendency to excessive exudation of lymph, formation of exuberant callus, and ossification of the interosseous ligament. 4. Judicious massage and passive motion, begun early, favor prompt union and restoration of function, although they do not always entirely prevent temporary atrophy, loss of power, and decrease of mobility of the part, as no manipulations can thoroughly compensate for the natural exercise of the tissues which is a major factor in the processes of nutrition and absorption. Consequently more uniformly good results can be obtained by that extent of fixation of the part which is just sufficient to prevent displacement of the fragments and angulation at the line of fracture. NOSE, THROAT AND EAR. UNDER CHARGE OF RICHMOND McKinney, m.d. Laryngologist to East End Dispensary. Vicarious Nasal Hemorrhage, with Hystero-Epileptical Spasms. This case occurred in a woman aged 20 years, who, after considerable irregularity in menstruation, remained amenorrheic for a year and a half. At this time she came to the author complaining of severe nasal hemorrhage, which had already existed nearly five weeks, during which time it had remained uninterrupted, at times weaker, at times stronger, often asserting itself very severely during the day. Eight days before she came to Richter she began to suffer with severe spasms. Cauterization along the involved left side of the septum with chromic acid, and tamponing with iodoform gauze, controlled the hemorrhage. Having in mind the hysteroepileptical character of the spasms, Richter made digital examination of the patient, and found the sacral region susceptible to touch and the uterus retroflected, although normal in size, with a small external orifice. Restoration of the uterus to an approximately normal position brought in the same night strong menstruation, with complete cessation of the spasms and nasal hemorrhage. For three months this condition continued, but at the end of that period she again had nasal hemorrhage and a short while afterward another attack of convulsions. Five weeks later the patient began again, without menstruation, to bleed from the nose, which was checked in the usual manner. A month later the nasal hemorrhage with the concurrent symptoms again developed, and the uterus was found upon examination to be retroflected. While manipulating this organ for the purpose of restoring it to position, the patient was seized with a severe attack of convulsions, going into unconsciousness, and blood flowed from the left naris. In the same night normal menstruation again began. Four weeks later symptoms as formerly set in, and after fourteen days severe edema of the feet developed so that the patient could not wear her shoes. An electrode was passed into the external orifice of the uterus, while the other elec trode was passed into the rectum. This latter was changed, however, to a flat electrode, which was placed on the abdom inal wall. After application of a sinusoidal alternating current, normal condition supervened and menstruation remained normal, although the patient, fourteen days before this report was made, again bled at the nose. The author believes that this hysterical condition arose from poisoning of the cerebral nervous system due to retention of menstrual impurities. A second patient was a woman 36 years of age, who came to the author complaining of an increasing difficulty in hearing. She was anemic in appearance, with a history of irregular menstruation. From her eighteenth year she had every three weeks, then every four weeks, and from the twentieth to the twenty-eighth years, every fourteen days, severe nasal hemorrhage. At this time she had had pains in the lower portion of the abdomen, pains in the back and headache, so that she frequently consulted a physician. During a stay in America the hemorrhages and the headache were very severe. While there she had been advised to submit to an operation, of what nature the author was unaware. For eight years the nasal hemorrhage, which had existed ten years, has ceased, but she frequently has periodical pains in the lower abdomen. On account of the apparent connection between nasal hemorrhage and the genital region, the patient was sent by Richter to a gynecologist, who reported that under anesthesia he had found the patient to have atresia of the hymen, an undeveloped uterus and an atrophic left ovary. The Serum Treatment of Hay Fever. L. S. Somers (Proceedings Phila. Co. Med. Soc., vol. 24, no. 10) reports his experience with Dunbar's pollen serum in the treatment of hay fever. His experience embraces ten cases, the disease being well developed in all when they were first seen; and both on this account and the severity of the attack, they were peculiarly suitable cases in which to test the value of the serum, as any result from its administration could be readily ascertained. He used the antitoxin made from golden rod, and employed it both in the form of a serum and as a powder. He concludes thus: 1. The serum produces prompt and positive amelioration of the symptoms of fall hay fever in the majority of cases. 2. In a smaller number this favorable result is soon accompanied with the complete disappearance of the affection. 3. Where slight or no action is seen after its use, pollen as an etiological factor does not predominate. 4. When results are obtained, it favorably influences all the manifestations of hay fever. 5. While I am unable to state from personal experience the effect of the serum upon hay fever occurring at other times of the year, or upon its effects when administered in advance of the attack, yet when given during the attack, irrespective of its severity, it produces marked palliation rather than absolute cure. 6. Its effects upon future attacks remain as yet unknown. 7. The serum in powder form is slightly soothing to the nasal mucosa; has but little influence upon the other symptoms of the affection, and in occasional cases it may act as a direct irritant. Finally, as a result of larger experience, especially with hay fever occurring at other times of the year, it may become necessary to modify some of the opinions in regard to this antitoxin. GYNECOLOGY AND OBSTETRICS. UNDER CHARGE OF T. J. Crofford, M.D. Professor of Gynecology, Memphis Hospital Medical College, AND W. D. HAGGARD, M.D. NASHVILLE, TENN. Professor of Gynecology and Abdominal Surgery in University of the South (Sewanee); Gynecologist to the Nashville City Hospital; Professor of Gynecology, University of Tennessee. Drainage in Abdominal Surgery. The practice of employing drainage tubes in abdominal operations seems likely to follow that of the clamp into the limbo of discredited appliances, (Editorial Med. Press & Cir., vol. 76, no. 3354), and a formidable blow to its prestige has been dealt by Professor Olshausen, the distinguished German gynecologist. His personal opinion on the subject may be inferred from the fact that in 1555 laparotomies, during the last six years, he had recourse to drainage only nine times; indeed, he recognizes only one indication for its use, viz.: the exist |