immediate operation. She was exquisitely tender and no thorough examination of the general cavity could be made. She was operated in the evening of the afternoon following my first visit, and an acutely inflamed appendix was found and removed; but after she was anesthetized there was also discovered, high up in the left side, a cyst. The incision for the removal of the appendix was enlarged sufficiently to allow of the introduction of the whole hand for the purpose of examining this cyst. This showed it to be behind the peritoneum and filling the whole of the space lying posterior to the descending colon. Her condition was such that it was deemed unwise to attempt an extirpation of what was without doubt a cyst of the left kidney. To have done it at this time it would have been necessary to make another incision, since it could not be dealt with through the one through which the appendix was removed. Furthermore, it was impossible to determine exactly what influence this cyst had upon her condition, since its presence had not before been known; therefore it was deemed best, through a lumbar incision, to open the cyst. This was done, and an amount of fluid estimated at about a pint and a half was evacuated, and free drainage instituted. From that time on her condition was very unsatisfactory. The appendix wound healed by first intention, and all symptoms referable to the appendix disappeared but her general condition was unfavorable, and in spite of all we could do, it was impossible to get her satisfactorily recuperated. It was determined, therefore, to extirpate the kidney through a lumbar incision and a month after the first operation this was done, and a large multi-locular cyst of the left kidney was removed. It was so large, despite the fact that its largest cyst had been evacuated, that it filled the upper portion of the left half of the abdomen, although I think it was still growing and had increased in size since the last operation. It was finally enucleated and delivered, the vessels tied off, and as much of the ureter, about two-thirds of it, was obtained as could be done without the expenditure of too much time. This was done without opening the peritoneum, and very free drainage was instituted through the lumbar incision. No hemorrhage of any kind occurred, yet the shock was profound, and for a long time her condition was most precarious. The remaining kidney was uncertain in its function, and at one time for several days it seemed impossible for her to survive; but slight improvement took place and by careful attention to her diet and unfailing persistence in care and attention she gradually improved until complete recovery followed. The wound healed, the stomach, which had been very intolerant, became more normal, the remaining kidney took up its function splendidly, and a complete recovery is the result. Examination of the cyst revealed no kidney substance whatever.

Miss G. G. (aged twenty-two years). Entered hospital Nov. 22, 1905. Late in the afternoon this patient's hair caught in the shafting in the shop where she worked, and with greater rapidity that the eye could follow, she was tossed in a heap on the floor with a profuse hemorrhage covering her head and face and accumulating in a pool. Her mates were frightened and left her, and she, alone and unassisted, went to the faucet, turned the water on and held her head beneath it. Assistance then appeared, her head was swathed up as best it could be, and she was sent to the hospital, where we were able to minister to her about two hours after the occurrence of the accident. She was pale and bled out, the hair was matted into an enormous blood-clot from which protruded several hairpins, and the real nature of the injury could not be determined until the whole head was shaved. Then it was found that she had been completely scalped, and that there was a defect in the scalp which had been torn away, running irregularly across the vertex from before backward, nearly as large as the palms of two hands. The scalp itself was separated from the cranium throughout its whole extent, so that had an incision been made just above the brows, extending around the head just above the ears and beneath the occiput, the whole scalp would have dropped away. As she lay on her back on the operating table, the loosened scalp sagged away from the cranium so that one could have put a double fist into the pouch formed below the occiput. In the mass of hair and blood-clot were found two pieces of detached scalp. These were carefully preserved, shaved, and kept moist in a warm salt solution. After shaving and thorough cleansing of the scalp, these two pieces were inserted into the defect, with the hope that they would maintain their integrity and grow back into place. This they failed to do eventually, but they served the useful purpose of bringing the loosened and sagging scalp into accurate position upon the cranium and holding it there. These flaps were sewn in by means of silk-worm gut and catgut and accurately coaptated to the margins of the scalp. When they were finally in place, that portion of the scalp which was intact but separated from the periosteum below, was drawn into position and held there. There was still however an insufficiency of scalp to cover the defect greater than the palm of an average hand. The wound was dressed in sterile gauze wrung out of normal salt solution, and at first it looked as if the parts inserted were going to be maintained.

On Nov. 24 (two days later) dressed for the first time, and drainage (rubber tissue) removed. Impossible to tell if the inserted skin-flaps will be revived. Nov. 25, no discharge whatever, and everything satisfactory and most promising. On the fourth day the inserted portions rapidly changed, and one could see that they had lost all vitality. In the meantime,

however, these portions of the scalp that they had held in place had set up adhesions so satisfactorily that one would never suppose any such general separation had taken place. On the sixth day a portion of the stitches were taken out, and on the ninth day all of the inserted pieces were removed. On the fifteenth day after the accident, the bottom of the wound having granulated well in the meantime, skin-grafting was undertaken by the Thiersch method. Large grafts were taken from the thigh and carried directly to the wound, where they were put into place without coming in contact with anything. No salt solution was used in connection with them, and they were rapidly cut and rapidly transplanted. The whole of the denuded area was not covered, probably about three-quarters of it only, and every graft thus transplanted was most satisfactorily maintained in place. They did not spread, however, as rapidly as was hoped they would to cover the places still denuded, and granulation became so exuberant in these places that on Dec. 29 the skin-grafting was repeated, and the smaller denuded areas were all covered with grafts again taken from the thigh. These in turn all maintained themselves until, when she was finally discharged, the defect in the scalp was entirely closed.

The outcome of this case is far beyond what one could reasonably expect, and there were several noteworthy features about it.

The accident happened with such rapidity that there was no pain, and from beginning to end, the patient (a nervous and excitable young woman) never complained of a bit of pain. The only time she made complaint was on the cars when she was being brought to the hospital, and this was caused because the comb or the hairpins which were mixed up in the blood-clot were pressing into the wound.

Then from beginning to end there was no slightest sepsis about the case, which seemed almost remarkable, because of the extensive denudation and the remarkable vicissitudes to which the wound was subjected before we had it in hand.

Then also the inserted portions of the flap just failed of nourishment, and had they been out of position a shorter length of time, or had they not become chilled, I believe they would have survived. At any rate, under similar circumstances, nothing could be devised which would so satisfactorily hold the rest of the scalp in place.

Mr. E. F. F. (aged fifty-six years). For a long time this patient had had trouble with his urine, until, at the time he was first seen by us, the desire to urinate was well-nigh constant, as often as every half-hour, with perhaps longer intervals at night; and he got rid of a very small amount of urine. He was sensitive to pressure above the pubis. Upon introducing a

sound into the bladder, it immediately came in contact with a stone; and the next day after his admission a supra-pubic cystotomy was undertaken, and a stone was removed, which was the largest the writer has ever seen removed from a living person. The bladder was much thickened, and so contracted above the stone that the latter practically filled the bladder in its contracted state, and there was no room for an accumulation of urine. He bore the operation well and made a most satisfactory recovery, and at the time he left the hospital the bladder had held at one time twelve ounces, and he was passing between forty and fifty ounces of urine per day.

Seven months afterward he was referred back to me because of an irritated condition of the bladder. At first I was inclined to scout the idea that there could be any further trouble with the bladder beyond the fact that the prostate was somewhat enlarged; and I had him under observation some time before passing a sound, when I again found a stone. As I was absolutely positive no stone was left behind at the first operationthe very nature of the case forbidding this-it seemed almost incredible that in six months a stone of any considerable size could be formed again. This time I determined to open the bladder through the perineum, and at the same time deal with the prostate; and this was done. Upon opening the bladder, a stone as large as the lower half of one's thumb was found and readily removed, and at the same time the enlarged prostate gland was taken away. He was very nervous and excited through the following night, talking constantly, and at first his temperature was sub-normal, 97 2-5, with a pulse of 120, but he quickly rallied from this and made a most satisfactory and prompt recovery. After the operation the temperature went to 100, and staid there for two days, was then 99 3-5° the next day, after which it dropped to normal with a pulse between 70 and 80. He was up and about, and had been told he could go home. His wife came to see him to arrange for him to go at the time of her next visit, and he went with her to escort her to the cars when she left. The day was a little unseasonable (although the latter part of July), and he "took cold," and the next day had a temperature of 100 2-5 in the morning with a pulse of 118; in the evening it was 102; and the next evening 106, with a pulse of 150, at which time he had a violent chill. For the thirty-six hours preceding the chill he had passed practically no urine. There was frequent desire to urinate, but in the whole twenty-four hours there was only six to ten ounces; nor could we, in spite of all attempts, again get a satisfactory secretion of urine. The temperature the morning after the chill fell to 99 and the pulse to 100, but temperature and pulse were both erratic thereafter; and he died on the tenth day.

Mrs. While standing on one foot with the other bare foot resting on a marble wash stand, the upper foot slipped suddenly into the wash bowl. The heel struck with such violence that an irregular piece was knocked out of the bottom of the bowl and the heel and part of the foot were thrust through with such great violence that the jagged edge of the fracture in the bowl completely severed the ligamentum achilles just above the insertion into the os calcis. A ragged and gaping wound was made.

The patient was brought to the hospital at once and after etherizing, the wound was most carefully and thoroughly cleansed. The ligament was cut so definitely with absolute lines of demarcation from other tissues that most accurate union was possible. Two deep silk wound gut sutures were put in, and one stout silver wire was passed quite high through the upper end of. the ligament. These brought the cut ends together, after which accurate coaptation of the edges of the ligament were made with fine catgut. The skin was closed and the leg put on a right angled knee splint with the foot held in extreme extension. Union took place throughout by first intention and the result is perfect. One would not know the accident had occurred except by the cicatrix in the skin.

All the cases upon which this report is based are summarized in the accompanying table.

ROCKEFELLER INSTITUTE FOR MEDICAL RESEARCH.- The new laboratories of this institute were opened on May 11th with due ceremony. Addresses were made by President Eliot of Harvard University, President Butler of Columbia University, and Dr. W. H. Welch, President of the

Board of Directors.

QUITE Contrary to the generally-expressed opinion concerning the ability of human beings to live for a prolonged length of time without food of any kind is the case of those miners recently entombed in a mine in northern France. It was supposed, after a week or ten days subsequent to the entombment, that none of the men could be rescued alive. Efforts directed toward such a possibility were therefore terminated. One of the members of the salvage corps engaged in repairing the mine twenty-five days after the accident was much shocked to encounter in his excavations a sufferer who called to him for aid. Several of the miners have thus been unexpectedly rescued, and feeling in the adjoining village has become very bitter because attempts at rescue were so soon stopped. This, with other similar accidents, should teach us that where individuals can obtain even a small amount of water it is possible to live without food for a much longer time than has formerly been supposed.