In dislocations the X-ray has continued to demand greater employment because of its worth.
In the past 10 years it is pleasing to ob serve that the methods of scientific X-ray work have become very much more extensive and precise; that with the ability to use the X-ray apparatus, in examinations of the head, thorax, abdomen, pelvis and extremities, greater pre cision has been reached and the results much more reliable and satisfactory• that in the understanding of the location of 'foreign bodies, much has been accomplished in reading the shadows correctly.
It is in the diagnosis of fractures and dis locations that there has been a steady, con tinuous improvement. This observation be comes very appropriate when referring to lesions of the spinal column and surgery of the spinal cord.
This knowledge also applies to the better understanding of pathological conditions, espe cially within the abdomen and the location of stone in the kidney and bladder ; however, this must be said, that in the past few years phy sicians, surgeons and specialists have come to recognize the Roentgenographer as the one alone who can interpret the radiograms and make it clear to the surgeon who is respon sible for the case, when an operation is tinder taken. In the past it has been too much the custom for the attending medical man to trans late the X-ray picture himself and many errors have occurred in that way. This is especially true in reduction of dislocations.
Operations upon the head and teeth, due to the study of X-ray work, have become much better understood, the classifications calling for such procedure much more reliable and show ing more and more perfect results.
Compartively recently pathology has dem onstrated that septic teeth have much to do with the development of many surgical lesions, in the past overlooked, and, which, like the tonsils, frequently become the bed for the in troduction of pathological micro-organisms into the system.
There has been added to the history of general surgery a very interesting chapter on the treatment of phlegmons and inflammatory, septic conditions, by employment of the method known as passive hyperemia. When promptly and effectively made use of it is of great value in cutting short infective invasion of the lymphatic system, especially when applied to the extremities.
The treatment of malignant disease by means of serums, especially Coley's fluid, main tains a semi-quccessful position, but, consider ing the length of time it has been employed, it would seem as though it ought to have offered more encouraging results.
The same applies to X-ray treatment, ad vocated by some so earnestly in its use previous to, and after, an operation for relief of malig nant troubles, yet not establishing itself as a positive curative agent.
The range of general surgery is becoming so great, the multiplicity of theories and papers presented such that one grasps with satisfac tion any contribution and conclusion, regard ing the methods of diagnosis and treatment that may be said to be final and the results such as to command the confidence and respect of the operator.
The history of modern methods, regarding general surgery, in pathology and diagnosis, through bacteriological, laboratory work, is wonderfully encouraging, but much more time is required than was made use of by the sur geons of a somewhat recent and later date, in their examination of cases.
The thorough study of the- blood, bac teriologically and otherwise, the vaccines, are all to be considered in the present history of surgery and proving elements of great im portance. This applies to all modern surgery, reaching all points that have developed through research work and of great use in the study of general surgery to-day.
In the study of the history of general sur gery, the many papers that are presented in our medical journals, also in our textbooks, from year to year, it is to be observed that advances are being made in the methods of diagnosis and proper treatment. There is this criticism: That too often exploitation of sup posed new discoveries, in their proper rela tion, have failed to maintain the expected high standard of success, for instance, in appen dicostomy. At suggestions for this opera tion met with a great deal of encouragement in the hope that, as the appendix was per manently fixed in the incision, it could be made the source of successful treatment of patholog ical changes within the large intestine; ever, it does not seem to have found approval to the extent of many cases appeanng on record, or employed so extensively as at one time thought possible.