external ring and lay in front of the external oblique aponeurosis.

2. The tunica vaginalis had been brought down with the testicle on each side, and not being able to enter the scrotum, had attached itself to the locality indicated. That on the left had not been obliterated above.

3. It is rather uncommon for both testicles to remain undescended.

4. The defect was apparently in the scrotum itself. The cord was not too short nor could any fault be found with any of its coverings, unless it was the lack of prolongation of transversalis fascia.

DISCUSSION ON PAPER BY DR. E. G. JONES.

Dr. Kime: I was interested in the report of the case and the unusual conditions that Dr. Jones had to deal with. It reminds me of a case that I had several years ago. The testicle was on the right side and had become infected with gonorrhea. I removed the testicle and obliterated the hernia. The man is a hard worker and has had no return of the hernia since then. His wife died and he remarried again, but has had no children. since then.

Dr. J. A. Crowther, Savannah: I want to commend the excellent judgment of the doctor in not attempting to bring the atrophied testicle down into the scrotum. He must have been strongly tempted to attempt this, when he found the cord sufficiently long to do it. The possibility of the effect upon the mind of the patient upon discovering its lack of being of normal size was, of course, to be considered.

Dr. E. G. Jones (in closing): I merely want to ask whether any one has seen such a hernia in front of the external oblique aponeurosis. As to whether this state of affairs is common, I am ignorant. It might accompany any undescended testicle, but it is strange so very little is said about it, if it does happen.

REPORT OF CASE OF ANTEPARTUM HEMORRHAGE DUE TO SEPARATION OF NORMALLY ATTACHED PLACENTA.

BY WHATLEY W. BATTEY, M.D., AUGUSTA.

With permission of Dr. J. E. Allen I report this case: Mrs. C., 35-Married.

Family History-Negative.

Past History-Has had three children. No miscarriages. Labors easy.

Menstrual History-First menstruation at fourteenth years. Always regular; little pain.

Present History-During sixth month of present pregnancy patient had some edema of feet and headaches. Family physician was consulted in regard to early termination of pregnancy. A consultation was held. The decision was to try to carry her to time, at least to eight months.

Urinary Examination-Albumin, granular and hyaline

casts.

Patient responded well to treatment.

During early part of eighth month patient was sent to hospital where she could be under constant observation.

On morning of twenty-fifth of January, 1907, Dr. Allen visited patient and found her doing very well. Three hours after visit patient had hemorrhage from uterus and seemed markedly shocked, the same increasing rapidly. The house surgeon packed vagina and cervix uteri, sending for Dr. Allen who could not be located. Dr. Battey, Sr., was 'phoned for, he being out I responded.

I found upon entering room a patient with deathly pal

lor, pulseless and cold, air hunger, sighing respiration and thirst. The history of case was quickly obtained. The uterus was not symmetrical to palpation, soft with no tendency to contraction. The diagnosis of concealed hemorrhage was made and the question of immediate delivery appealed to me as being the only rational thing to do. But before doing so I decided to give her an intravenous infusion, so hurriedly opened up the median basilic vein. Dr. Wright, who heard commotion in the room, came in and arrived at the same diagnosis and suggested immediate delivery.

Just as soon as I could feel slightest response to infusion I began (without an anesthetic, of course) manual dilatation of cervix, which was quite soft, the external os admitting two fingers. I experienced little trouble in dilating, accomplishing it in five minutes. The head was the presenting part. It had not engaged. Taking pair of Boseman dressing forceps I ruptured membranes, following immediately with hand doing a podalic version.

With Dr. Wright's assistance body and head were quickly delivered, followed by blood clots. I immediately inserted hand into uterus and removed placenta, which was detached without difficulty, there being an antepartum detachment of a portion size of hand's breadth. The uterus contracted down well. The after-treatment was mainly stimulative and restorative. Patient made good recovery, though she has a slight nephritis.

In considering cause of antepartum hemorrhage, renal insufficiency is suggested as a most probable one.

A PLEA FOR CAREFUL SURGICAL TECHNIQUE

BY WHATLEY W. BATTEY, M.D., AUGUSTA.

The title of this paper is academical in a measure, but after searching literature for a careful solution of the problem of infections and accidents which are of such frequent occurrence in presumably careful surgical procedures, and having found the literature not only voluminous and exhaustive, without depicting briefly and explicitly the underlying factors which materially influence or retard wound-healing, leads me to enumerate in a brief way the factors that appealed to me so forcibly during my years of hospital experience.

We owe much to Lister for the principles that he has laid down relative to wound infection. Notwithstanding the fact that his ideas were in a measure erroneous, the atmosphere playing only a minor part in wound infection, his classical teaching to which is added the germ theory of disease, gives us the basic principles upon which all surgery should depend. This in our modern surgical technique receives the name of aseptic surgery. The term signifies the absence of living pathogenic bacteria, and in its practice it is our endeavor to remove all micro-organisms from everything in connection with the operation, so that we may have an aseptic wound. At best our asepsis is imperfect, but as the resisting power of the tissues will care for a limited number of microorganisms, and when we keep the number entering a wound within that limit we have accomplished practical asepsis. Some surgeons practice antiseptic as well as aseptic surgery. In the former germs have supposedly

gained entrance into the tissues, and the effort is made to destroy them by chemical antiseptics, while in the latter it is our object to prevent their entrance. The use of chemical antiseptics can come to no good for the reason that if the living germs be destroyed the tissue's resistance is lowered by the direct effect of the chemica! agents, and their dead bodies will act as foreign material, together with exfoliation of the cells from wound, thus interfering with proper union.

Im

It is not my purpose to go into an exhaustive recital of the methods of sterilization and disinfection. portant as they are, and realizing that a single breach in any proper method will undo the asepsis of the operator and assistants, and convert an otherwise primary result into a bed of infection.

No one, professional or otherwise, wishes to attach blame upon himself for ill results when such blame can be thrust upon others who may be engaged in the same procedure. Many surgeons are sometimes apt to blame their assistants for poor results, and credit themselves with expertness, fitness and undeniable asepsis when good results accrue. But we all know that investigation has proven that many things can influence or retard first intention healing, thus obviating the possibility of attributing ill results directly to one, or a series of things. Assuming that the preliminary preparatory steps: preparation of operating-room, gowns, sheets, instruments. twenty-four hour preparation of patient, etc., have been carefully executed by a competent nurse, the surgeon and his assistants now deserve consideration. One important detail which is sometimes neglected is the proper cleaning of nails. The same should be neatly trimmed, and all collection of matter removed from under surface. The hands and arms, including the elbows, should be scrubbed briskly from above downward in running water for