is a total absense of energy, they avoid activity, the amount of air they change is small, and is produced by the action of the diaphragm. Such a lowered vitality offers a splendid opportunity for the invasion of tubercular bacilli. I believe the general practitioner too often neglects these conditions. How often are we called to see children with infected mucous membrane, enlarged tonsils with a light fever and pronounce the case as threatened with pneumonia.

We give a cathartic and something to reduce the temperature and probably see the case no more, when we should have it come to our office for a thorough examination, and if we are not prepared to remove the obstruction it is our duty to send them to a specialist for treatment. I am confident that every inflammed or infected mucous membrane snould be treated, that adenoids should be removed as early as possible, that all nasal obstructions should be removed as early as detected, and that all diseased tonsils should be removed. This done, I am confident that one of the main avenues through which tubercular bacilli enter the human system would be removed.

Now just a word as to the treatment of these cases. We should first endeavor to cleanse the mucous membrane of the post nasal cavity, and for the general practitioner there is no better cleansing agent than a normal salt solution, with forty-pound pressure from a compressed air tank, after thoroughly douching the cavity, an oily spray with liquid alboline as a base is applied to the membrane. If this treatment is kept up a sufficient length of time we can often relieve an acute condition that would otherwise result in nasal obstruction. If after such treatment permanent obstruction remains it should be removed. As to the treatment of diseased tonsils and ulcerated throats, I am confident that there is no remedy that compares with a strong solution of nitrate of silver. I have yet to see a chronic enlarged tonsil reduced to its

normal size by any treatment, and believe that they should be removed.

I use nitrate of silver ten to twenty grains per ounce for ordinary applications. The pure stick for applications to ulcers. The advantage of applying pure cautery to these ulcers is that it is the proper treatment whether the case be tubercular or not. I know in two cases I removed a tubercular ulcer, one of uvula and one of larynx with nitrate of silver stick. I know both were tubercular for both afterwards died of tuberculosis.

Now, gentlemen, there is nothing new or very interesting in this paper. My aim in presenting it is to emphasize the importance of the general practitioner giving more attention to this class of work, for there is a great per cent. of these cases that can never reach a specialist and consequently suffer through their ignorance and our neglect.

DISCUSSION

Dr. Crook, Columbus. This is a most interesting subject to me. Recently I have gone over some of the records of my cases of adenoids and tonsils, and I have become very much interested in this question of tuberculosis, that is, the question of the tubercle bacilli gaining an entrance through the tonsils. I had one case four weeks ago, a little girl who gave a family history of tuberculosis. She had a very marked case of cervical adenitis, very suspicious looking tonsils, and some adenoids, and I felt sure that here was the beginning of her tuberculosis, or cervical adenitis. But an examination of the tonsils microscopically did not reveal any tubercle bacilli. However, if such a case fell into the hands of some surgeons, they might have removed those glands. So soon as the tonsils were removed in toto the cervical adenitis disappeared. Some cases of tuberculosis seem to have been infected through the tonsils. I wish to mention one case I recently saw, a very marked case of adenitis. The

patient was a child nearly three years old, and she had her adenoids and tonsils removed. But before the operation I noticed that the child had a very marked sunken nose. I supposed it was a congenial affair and did not pay much attention to it. However, the mother called my attention to it eight days after the operation. The child's face was almost normal in appearance. I said to the mother, "Have you noticed any change in the expression of the child's face?" She answered, "I noticed a change on the second day after the operation." I do not see how it is possible that such a change could take place in the child in such a short time. The general practitioner does not always appreciate the importance of removing adenoids and tonsils in toto.

Dr. Adair, Atlanta: This subject is one of vast importance to the general practitioner and the paper just read is a very timely one. The greneral practitioner a few years ago neglected to make examinations for adenoids and enlarged tonsils. Not long ago I talked with a man from Chicago and he showed me some anatomical specimens of sections of the head; they showed the deformities these children had to bear because these things had not been attended to. This set me to thinking. The last year or two I have examined every mouth of every patient who appears before me and I find a vast amount of trouble in children and young people, especially in Atlanta, that otherwise would have escaped attention. The results of the medical examination by the Medical Inspectors in schools are simply astounding as showing the number of children who are diseased. The general practitioner should wake up. These examinations often will reveal the cause of so many facial blemishes, the lack of beauty, often a face absolutely destroyed of beauty because of the presence of adenoids or other removable conditions. If the general practitioners do not see these things, the specialists do. Recently I read a paper be

fore the Fulton County Society on "Medico-Surgical Operations", in which I gave the cost of an outfit for the removal of tonsils. Any physician can get such a outfit for the removal of tonsils for from two to five dollars.

SUBPARIETAL INJURIES

OF THE KIDNEYS,

WITH REPORT OF A CASE REQUIRING IM

MEDIATE NEPHRECTOMY.

C. W. Roberts, M.D., Douglas, Ga.

It would seem from the study of this subject that there are two principal reasons for the comparatively low proportion of injuries to the kidney when contrasted with that of other abdominal viscera. Hidden deeply in the recesses of the abdomen the kidney is protected from traumatism, which anatomic reason is reinforced by the fact that the organ lies deeply imbedded in a large quantity of loose fatty tissue, acting as a bluffer against blows upon the lion or ileo-costal region. Thus in a report of two thousand six hundred and ten deaths from injury recorded by one investigator, there were thirteen instances of injured kidneys.

The kidney suffers injury from direct and indirect violence, constituting the class of cases generally spoken of as subparietal. In this class the soft parts, or abdominal parities, escape laceration, the damage resulting from crushes and blows upon the kidney region (direct violence) or from indirect violence, as in falls from a height accompanied by sudden bending of the trunk at the time of alighting, crushing the kidneys between the costal margin and the iliac crest. Another class of injuries to this organ are designated penetrating, embodying all those re sulting from wounds extending through the soft parts to the kidney, seen most often in the military practice. By far the most frequent variety, however, is the former, seen in civil practice, and not unfamiliar to the majority of physicians who have labored for a few years in applica