home, but time was an element, and so he was put under the care and attention of his mother and wife, which has been very good. Under all the circumstances, he has gotten good attention. Not such attention as could have been given in a hospital, but I would say here that we must not wait for hospitals, or anything else, when life is at stake, and where the habits and condition of the patient are such that probably he would get along just as well at home, where he was accustomed to be, and where the atmosphere and the surroundings were such as not to infect and frighten him, and where he could see his loved ones. And it is found, in a great many cases, that there is a good deal of trouble from crowding of patients, especially negroes, in wards where they hear that so and so said this and that about them. In this case, probably this young negro man did not know but that all that was done was to remove the bullet, although we told him, before the operation that the kidney was involved. He wanted to know afterwards if we got the bullet, but the fact is, the bullet was not found. It had probably ranged downward, and there was a tract in the muscles through which the incision was made, showing where the bullet had found its way. In these cases, we know that the bullet is a dangerous thing, only if in contact with some nerve or some blood-vessel; that the bullet has done most of its work where it has traversed an important organ, and that the ravages done by the bullet being repaired, the man can get well without the removal of the bullet.

We hoped in this case that the man would soon recover, as he did. However, the prognosis should be very guarded in all these cases. The mortality, under the best surgeons, has been two out of five in wounds, and ordinary nephrectomy 50 per cent., by Greig Smith in ear

lier edition. The lumbar operations, however, have given better results and the statistics show that the mortality. here has not been over 40 per cent. You understand that where the peritoneum has been traversed, there is always more danger, but in cases where the lumbar incision has been made for any cause, whether for floating kidney or otherwise, the muscles can be opened up safely, and the hbers can be turned aside. I found it absolutely necessary to cut the muscles only at the last point, and the incision was five inches in length.

There have been cases where abscesses have formed in the wake of wounds of the kidney similar to this, when no operation was performed, and these abscesses were the result of suppuration which came about by urinary infiltration. There have been some cases which have recovered without operations, where the kidney was examined post-mortem, and found to have healed. They are, however, very few. There are a great many cases, where an autopsy was held, where a diagnosis of wound of the kidney was not made beforehand, but was seriously wounded by the bullet. Brewer's case only a slight hemorrhage existed to warn him.

There have been some natural cures well authenticated. They do not warrant the assertion that these cases are safe without operation. They are only the exceptions that prove the rule. There is one case mentioned in Ashhurst's International Ency. of Surgery where a certain amount of cicatricial tissue only remained. That kidney was useless. It really atrophied and was not doing the purpose. Nature had formed a barrier, such as is done by nephrectomy, to the normal function of the kidney. Urine of that kidney would have been poison.

I have given you briefly some of the main points about an operation for nephrectomy for gun-shot wounds, where

the indications were clear and well-defined for an operation. I will state that that does not mean that every case where blood in the urine is found, in gun-shot wounds, should be operated upon. Each case is a law unto itself, and has to be carefully and prayerfully considered.

A SIMPLE AND EFFICIENT TREATMENT OF

EMPYEMA OF THE CHEST.

By J. H. HAMMOND, M.D., LAFAYETTE.

The procedure here recommended consists in making an incision through a suitable intercostal space at a point where the hypodermatic syringe shows no adhesions to exist, using local anesthesia, and as soon as matter ceases to flow inserting a piece of sterile rubber tubing, as large as practicable, and about five or six inches in length. The tube should have openings for drainage, but care should be taken to have none at or near the surface. Once a day for a variable length of time, usually several weeks, a longer piece of tubing, say twelve inches in length, is connected with that inserted in the side through the medium of a short glass tube, leaving a part of the latter exposed to show the character of the discharge, and by reverse action of a glass syringe applied to the free end of the rubber tubing, alternately removing the syringe to discharge its contents and clamping the tube to prevent backward flow into the chest, completely remove from the side all matter and gas contained within the pleural cavity. After each dressing of this kind the attached piece of tubing should be removed, and, with the syringe, thoroughly cleaned. The drainage-tube may be plugged during the intervals to prevent the ugly sound of air entering during respiration, but especially that the lung may not be allowed again to collapse into the upper part of the chest on account of the air entering beneath it. Fre

quently, however, it will be found necessary to remove the plug and permit the air to enter in order to relieve the intense pain caused by the great strain on adhesions, which can not, without too much suffering, be so quickly broken up. Occasionally the tube may be removed and cleaned, or replaced with a fresh piece. No fluids of any kind should be thrown into the pleural cavity. After a few weeks, or months in some cases, the dressing may be made less frequent until the discharge ceases. But a sudden elevation of temperature at any time will generally be an indication for drainage, and when this has been secured the fever will quickly subside.

The simplicity of this operation commends it to a very large class of practitioners. We believe that in the country some cases of purulent pleurisy are lost, because the operation for their relief appears formidable. As a matter of fact, as here described, it is entirely free from difficulty, there is far less danger than is met with in the opening of many abscesses, the instruments and appliances required are such as any practitioner generally has with him every day, and so uncomplicated is it that any one may perform the operation, if necessary, even without assistance. The treatment is very tedious, demanding at great deal of patience, and if the practitioner can not give reasonable attention to his patient better results might be obtained by giving the pus freer vent or by making a counter opening. Generally a nurse can be found who, with a little training, can do daily dressing efficiently.

With proper attention, the efficiency of the treatment is as satisfactory as its simplicity. Not depending on gravity for the evacuation of the matter, it is less imperative that the opening should be in the most dependent part of the pus cavity; that which gravitates below the opening is drawn by suction to the tube and discharged.