of 407 cases of morbus coxarius treated between 1S59 and 1880, exclusive of exsections. Of these there were, in the first stage, 118; sec ond stage, 119; third stage, 82; not mentioned, SS. Total number of cases, 407. Results: cured, motion perfect, 71; cured, motion good, 142; cured, motion limited, 83; cured, ankylosed, 5; un known, 78; under treatment, 14; aban doned treatment, 3; discharged, 2. Died of exhaustion, 2; died of phthisis, 1; died of pneumonia, 1; died of tubercular meningitis, 5. Total deaths, O. Total number of cases, 407.
Above cases in which the writer knows the result and the kind of splint worn, excluding cases under treatment. Cures with perfect motion: long splint, 19, or 21.59 per cent.; short splint, 54, or 2S.12 per cent. Total, 73. Cures with good motion: long splint, 34, or 38.03 per cent.; short splint, SO, or 44.79 per cent. Total, 120. Cures with limited motion: long splint, 29, or 32.95 per cent.; short splint, 49, or 25.52 per cent. Total, 78. Cures with ankylosis: long splint, 3, or 3.40 per cent.; short splint, 1, or 0.52 per cent. Total, 4. Deaths: long splint, 3, or 1.50 per cent.; short splint, 2, or 1.04 per cent. Total, 5. Treated with long splint. S8; treated with short splint, 192. Total number of cases, 280.
The ambulatory treatment in an early stage is extremely unsatisfactory, recum bency and complete rest giving better results.
A persistent high temperature, with no obvious cause in the early stages of hip joint disease, indicates that the disease will run a rapid and destructive course, and is ominous of an unfavorable end.
Under recumbency and fixation the temperature becomes, if not quite nor mal, at least constant. R. L. Swan (Med. Press and Circular, May 12, '96).
A communication by the author be fore the Surgical Society of Paris on re section of hip in cases of tuberculous disease with abscess was followed by a long discussion in which very differ ent opinions were expressed. Felizet strongly supported resection, and con siders the conservative treatment un satisfactory. Of SO patients with morbus come, aged from fifteen months to puberty, only 9 lived to the age of twenty. Of the remaining 7t, 20 died from exhaustion, 15 of tuberculous men ingitis, many had a secondary infection of other joints, and a large number de veloped spondylitis. He stated that, of 300 resections of the hip for tuberculous eoxitis, he had lost 2 only. In his view
albuminuria is the only contra-indica tion to operation. He does not wait for abscess or fistula, if the hip is painful; if this pain is not removed by extension and immobilization or if the patient has fever and is declining in general condi tion, he recommends proceeding to the radical operation. Nelaton (Bull. et 3Iem. de la. Soc. de Chin de Paris, t. xxv, p. 887, 1901).
The treatment of abscesses occurring in tuberculous joints, is one which has been very widely discussed, and in re gard to which there have been many dif ferent opinions. The prevailing trouble with many surgeons is that they fail to regard the abscess as an incident in the career of a tubercular joint, and treat it as a thing by itself, neglecting the bone-inflammation which was the orig inal starting-point of the abscess. If it were possible to locate the focus or foci of disease and to remove all foci without doing great damage to surrounding healthy parts, the logical treatment of all tubercular inflammation would be the radical excision of all tubercular foci as soon as detected. This proceeding, in deed, became quite fashionable some years ago abroad, but experience has shown that better results are obtained by older and more conservative methods. we cannot absolutely eradicate all tubercular foci, the chances of securing a good result are better by leaving them alone, provided they remain incapsulated and are not subjecting the patient to gen eral systemic infection. Under rest and compression, good hygienic surround ings, and forced feeding many collections of tubercular matter disappear. If they come to the surface it is the best plan in many cases to disinfect the skin with great thoroughness, apply a sterilized dressing, and allow them to open spon taneously; wash the cavity thoroughly with peroxide of hydrogen or chlorinated soda (Labarraque's solution). Abscesses treated in this way rarely give rise to any disturbance and usually close in a few months.
Treatment of hip-joint disease is fixa tion and traction. Excision of abscesses should be performed when they enlarge rapidly, are associated with great pain, are burrowing and producing pressure upon other important structures, or are attended with marked sepsis.