was now introduced into the bladder when bright red blood escaped in large quantity. The bladder was then tested and found to hold water. The kidney region was more resistant by this time, the hardness extending over the whole right abdomen. Patient complained of inability to get breath, and great thirst. A diagnosis of ruptured kidney with intraperitoneal hemorrhage was now made and steps looking towards surgical help were taken. Being more than twenty-four hours removed from well equipped hospitals, in addition to the precarious condition of the patient, which was hourly becoming worse, it was determined to operate upon him in his home with whatever aid could be readily summoned.

It was noon the following day before all preparations were ready. Every hour had witnessed the rapid sinking of the patient, haematuria had continued well marked. A tumor was easily made out about injured kidney. The abdomen was dull to percussion, painful all over to palpation. Patient was semi-comatose, pulse one hundred and forty, respiration, ten (due to morphia), temperature one hundred, three-fifths. Vomiting had become more frequent; collapse well marked.

Operation. After a distinctly rural operating room and equipment had been prepared, there being marked abbreviation, both in quality and quantity of instruments and dressings, with the aid of three other physicians, two or three laymen acting as nurses, the patient, now moribund, was placed upon the table. The right kidney was hastily exposed by the ordinary lumber incision. It was found imbedded in and surrounded by blood, its capsule being stripped off by its entravisation. A rent partially dividing the kidney into halves, extending into the hylum, was made out by the palpating hand. The patient's condition being such as to demand the quickest disposition of the condition at hand, it being necessary already to heroically stimulate by strychnia and whiskey, hypodermically as well as normal salt intravenously, clamps were placed on the renal vessels, the

ureter severed, and the kidney removed. The clots of blood surrounding the kidney having been removed, the cavity was packed with gauze and the wound partially sewed up. As an index to the degree of exsanguination present, I need simply mention that it was unnecessary to liligate or clamp a single vessel, save the renals.

Now, the patient was hastily turned on his back and the abdomen opened. The peritoneal cavity contained several hundred cubic centimeters of bloody fluid which was washed out with normal saline solution.

Drainage wicks were again placed, and both wounds dressed. After some twenty minutes work directed at overcoming the shock which was now alarming in the extreme, the patient was removed to his bed, showing signs of slight reaction.

After Treatment and Convalescence: Stimulation was kept up and pushed to point of intollerance. Repeated infusions were given. Slowly, response became evident, the pulse gained in tone and rythm. Urine was soon voided and contained only a trace of blood. No postoperative vomiting. The day following operation found the patient in encouraging condition. Mentally good, urine voided in sufficient quantities, no further signs of bleeding. Pulse fairly strong, regular and running about one hundred to the minute. Wounds draining nicely. No evidence of peritoneal inflammation.

On the third day, the wounds were dressed, clamps removed and the cavities repacked. Convalescence was at this time well established. The daily output of urine was normal in amount and constituents, save a decided ring of albumin, which was interpreted as "Congestive Albuminuria," and which soon disappeared. Patient began eating, the nourishment confined altogether to liquids. Bowels moved normally, pulse came down to 85, temperature remained around normal, reaching 100 only twice or three time during convalescence. Patient was urged from the first to drink large quantities of water. Notwithstanding this, and the preliminary blad

der irrigation, a mild degree of cystitis developed about the tenth day, causing considerable temporary trouble, but was quickly controlled by the use of twenty grains of hexamethylinamine per day gradually decreased. This a slight annoyance was the only complication noted during the eight weeks indoors. Following this, his recovery was uninterrupted. Daily dressing of wounds witnessed rapid healing. Patient was kept in bed five weeks, then allowed in a reclining chair. At the end of six weeks was put on his feet.

At present, patient is going about his farm free from pain or inconvenience of any kind. Now, nearly two years since the injury, patient presents a most gratifying appearance, his mode of life being little changed from that preceeding the fall.

I want especially to invite attention to the following facts concerning this case:

First The severity of the lesion found, there being no adjacent structures involved.

Second: The apparent absolute indication for operation at once under rural handicap, it being considered impossible to transport the patient, alive, to the nearest hospital.

Third: The absence of infection, although the perenephritic space and peritoneal cavity were both contaminated with urine, to be explained perhaps by the early establishment of drainage.

Fourth The marked albuminuria which developed early after operation, only to gradually disappear as the compensatory action of the sound kidney was established.

DISCUSSION

Dr. W. W. Battey, Jr., Augusta: The statement has been made that the peritoneal cavity should have a ready escape for the urine and blood after these operations. Blood is the most important thing to consider. Any blood that escapes into the peritoneal cavity forms a clot

and will give subsequent symptoms of sepsis. Take, for instance, any ordinary operation upon the abdomen where the operator is engaged in the problems of technique; often a little blood is allowed to escape along the intestines and accumulate under the liver, the diaphragm or other viscera; the abdomen is closed without any irrigation of the peritoneal cavity. If this blood has accumulated in the pelvic cavity, it will become localized there and form a pelvic abscess which will require drainage. But if it has accumulated under the diaphragm, the stomach, the liver, or other of the abdominal viscera there will subsequently appear symptoms of sepsis; these symptoms are nothing more than those of sepsis as the result of the presence of undisturbed blood clots. By thoroughly irrigating the abdominal cavity, and thus diluting the blood, it will enable the peritoneum to take care of it without any difficulty.

REPORT OF CASES TREATED WITH RADIUM

BROMIDE.

Theodore Eugene Oertel, M.D., Augusta, Ga.

When Mme. Curie and her late lamented husband discovered radium they opened up a new world of investigation to the physicist and one may say that this discovery and the subsequent train of investigations with radio-active substances is the greatest single forward stride in the progress of the human race. It would seem that radium first changes into emanations. Then successively into radium, A, B, C, D, E, and F, the latter being in all respects like polonium, which elemental body has recently been separated from pitchblende by Mme. Curie and her co-laborer, M. Debierne. They succeeded in isolating only the tenth part of one milligram which was found to throw off sensible emanations of ozone and helium and to add to the spectrum seven rays which are not detectible in any other known substance. So powerful are its emanations that it rapidly decomposes all chemic and organic substances and split in all directions the quartz vase used as a container. Naturally the medical world turned with avidity towards this new substance and it was heralded by the over-enthusiastic as a probable panacea for all human ills.

The scarcity of radium and its high price has rendered it inaccessible to the medical profession at large, but a large number of investigators have been using it therapeutically for a sufficient length of time for us to begin to draw some conclusions as to its merits as a therapeutic agent. Much more time must necessarily elapse before definite conclusions can be drawn, but we are warranted already in the assumption that it will fill a place now vacant in our medical armamentarium.