is in the fibrous tissues and muscles. The muscles will stretch and if the fibrous tissue tears this is what we desire.

In the operation of wiring a fractured femur there are two points I wish to emphasize :

First-Never make an incision until you have rendered the limb bloodless. Hemorrhage is most alarming when a tourniquet is not used.

Second-Never operate unless you are assured of as near perfect asepsis as surgery gives us to-day.

DISCUSSION ON DR. JABEZ JONES' PAPER.

Dr. W. D. Travis, Covington: I have been very much interested in what the Doctor says about fractures of the femur treated by operation. We do not all have specially devised apparatus for treating these cases and are often called upon to treat them without any appliances. The plan I have used has been to employ a splint something like Hodgen's splint, which goes over the upper part of the thigh with the leg flexed and down below the foot. The foot and knee are put up in plaster, with which we expect to make our traction. We have rings on the wire splint at two points, on either side, and the weight is determined by a draw scale that is attached to the wire and ceiling and then by fixing the pelvis and moving the patient you can tell how much traction you have. In this way you can always determine the amount of traction we are giving to the femur. The patient is made confortable and the leg swings from side to side and the bed pan can be used without any trouble.

Where operation is not performed it is a good idea to try this splint.

Dr. Harrolds, Macon: I have listened to the paper with a good deal of interest and have been wondering why the

doctor does not use the Royal Whitman method without operation in those cases of fracture of and around neck of femur.

Dr. G. R. White, Savannah: I think this is a very valuable apparatus which the Doctor has exhibited. Any one who has operated upon a fractured femur without any special apparatus will recall that they were very liable to get into trouble and any apparatus which renders us assistance in these cases will be appreciated.

To get good results with any kind of apparatus is an uncertain process. The limb may be put up carefully for six weeks and then upon examination if we find a shortening of less than an inch we are doing well.

While I am not prepared to agree with Dr. Jones that all fractures of the thigh should be wired, I may change my mind on that point when I have seen more of his good results.

There is one point that Dr. Jones mentioned that should be spoken of. After putting a limb in a plaster of paris bandage and leaving it without further attention you will not infrequently have a shortening of two or two and a half inches. Every time a plaster bandage is put on a fractured thigh and left in this way you are liable to get a permanent deformity.

Dr. Downing: I have been very much interested in Dr. Jones' illustration for the operation. I believe that of all cases there are more deformities resulting from treatment of fractures of the thigh than anything else. I have devised an apparatus by which we can treat them as well as anything else. I have used the double angular plaster, beginning at the base of the toes and used the double Esmarch plane, bringing it up to the knee so as to get muscular relaxation. After this sets, then go on up well onto the chest. In this way you get absolute fixation and you can always apply new dressings when necessary.

The two acute angles give a restful position and there is no use to keep up continuous traction. I have about twelve of these cases treated with this apparatus and they have less than one inch of shortening. These cases have been able to be out of bed and sit up in six or eight days. Many of them are able to get up to attend to the calls of nature.

Dr. Hancock, of Atlanta, has used this apparatus successfully in two cases. At the University of Maryland they have used it in four or five cases and had perfect results.

Dr. Michael Hoke, Atlanta: It delights the orthopedic man's heart to see any apparatus. I do not see many fractures in my work, but I do see many malformations resulting from the treatment of fractures. If the bones are put in position and held there we ought to get good results. Buck's extension should be thrown out of the window in treating fractures. It is all right to use Buck's extension in getting us into position, but plaster should be used to mobilize the parts. I am constantly working in plaster and see many bandages applied by other men. I think the majority of failures are due to the kind of plaster and the way it is used. The average doctor buys his plaster from the drug-store and gets a very inferior article. I do not agree that the dental plaster is the best, as the plaster should harden the same all the way through. You will find that the bandage on the lower part of the leg has hardened when you begin to apply the upper part and therefore it is impossible to get perfect results, as the bandage will be in two layers, which will cause it to peel. That is why you have to reapply these bandages so frequently. Instead of using the prepared plaster bandages, if you will make your own bandages, using nineteen parts of plaster and one part of cement, you will

have a bandage that will remain for months. In our work on the chest it sometimes takes half an hour to apply the bandages and it is necessary that it should harden slowly in order to prevent peeling. This slowing is accomplished by the addition of dextrin.

Immobilization is the necessary thing. To put the leg in the straight posture is all right when the fracture is not in or near the neck of the femur, but when you get to the neck you can not keep it in a straight line. I am constantly seeing old fractures of the head of the femur that have been treated with Buck's extension and the lack of union is due to the lack of immobilization. Dr. Downing has devised a most ingenious piece of apparatus by which immobilization can be secured. If you will immobilize the parts you will not have to send the case to the orthopedic surgeon afterwards.

Dr. White: I would like to ask Dr. Hoke if he has any trouble in getting off his cement plasters?

Dr. Hoke: I do not have any trouble in removing the plaster. The best thing with which to get it off is an ordinary I. X. L. splaying knife. If you will hack a line down the plaster and wash it with water, you can soon cut through.

Dr. Jabez Jones, of Savannah, (in closing): In reference to the dental plaster, this is the only thing that I have seen that we could use. If there be any better I would be glad if the doctor will tell us. As to the hardening. the S. S. White Company makes three different kinds of plaster, which harden with different degrees of rapidity.

In reference to Dr. Royal Whitman's treatment, I spoke of the wiring of fractures of the upper thigh because I did not get good results without it, as the muscles will pull the fragments out of position.

SUPRAPUBIC PROSTATECTOMY.

BY EUGENE R. CORSON, M.D., SAVANNAH.

Perhaps no operation of equal importance has so rapidly established itself as a legitimate procedure in surgery as the removal of the hypertrophied prostate. While the operation has been done for a number of years by a few men, it has not been a common one, and those surgeons who have attempted it could count on their fingers the number of their cases. But within the last five years the number of operators and the number of cases have so increased that not a week goes by without the appearance of some important paper on the subject, statistical as well as descriptive, showing improvement in the technique and in the mortality rate. It is a sign of the times in the medical world. The experimental spirit and the surgical spirit are abroad. For centuries surgeons cut for stone by the perineal route and the thought did not seem to have occurred to them to try another route; and if it did occur the experimental spirit was not sufficiently strong to induce the trial. But a change has come. From a mere servile following of a leader we have passed to an individual independence. The evolution of the idea of experiments has been accomplished, and the experimental spirit is abroad. There must always be the first one to try before we can advance. The first one who did the suprapubic operation for stone was a great man and a benefactor of his race. The first one who did a suprapubic prostatectomy was also a discoverer and a benefactor. The discoverers, however, are few, the followers are