and was conveyed upon a cot to have the ball located and removed. With the fluoroscope the ball was seen in the spinal canal of the eleventh dorsal vertebra and photographed. As operation offered the only (though forlorn) hope, a laminectomy was performed and the ball removed from between the cord and vertebral body. The cord, unfortunately, was so nearly severed by the long-continued pressure that I was agreeably surprised at even the small improvement that followed.* Figure 1 is a 38-caliber bullet in the leg. It was located and removed.

Figure 2 shows a needle in a woman's hand. After a vain search the family physician assured her it was not there. Removed with one incision.

Figure 3 (a) is the right (normal) elbow of a ten-year-old lad from Owington, Ky. Three weeks before coming to me he had fallen upon the left elbow. The family physician examined the joint, even under chloroform, and detected no fracture or dislocation. The arm was in rigid extension. Through the fluoroscope I saw both bones dislocated backward, as shown in Figure 3 (b). After a fruitless effort, under full anesthesia, to reduce the dislocation, the joint was opened posteriorly and the obstinate ligaments divided, when the reduction was easily accomplished. The arm was dressed at right angle in a plaster-ofparis dressing, and on the third day I again placed the arm, incased in the plaster dressing, beneath the rays, and I found the bones in good position, as shown in Figure 3 (c). The result obtained in this case is excellent, inasmuch as the boy has fair motion at the elbow.

Figure 4 shows a fracture of the olecranon with a comminuted fracture of the humerus, the result of a fall.

Figure 5. This is an enlargement of the fibula in a child six years. old. The enlarged portion was resected.

Figure 6 shows a ball between the tibia and fibula. It was easily extracted.

Figure 7 shows the condition found in a gentleman from Southern Kentucky, who came to us only a few days ago. Last February he was riding horseback and the horse fell, and, falling upon his leg, fractured the tibia. He comes to us now, four months later, with an ununited fracture. Here again the wonderful rays show us the true position of the bones. How could a surgeon know what to do in such cases if he could not see the bones? It enables him to go down, know

*Skiagraphs, by the author, illustrative of each case were exhibited.

ing exactly what to do. Notice how the lower fragment overrides the upper. And there is another thing shown in this picture which was entirely unsuspected by the attending physician or the patient himself, and that is a second fracture in perfect apposition about three and one half inches below the overlapping one. An operation was performed, removing the overlapping ends of these fragments and the bones drilled and wired in position. In a few days I will again make a shadowgraph of the limb as it is, in plaster, to see the position obtained.

Figure 8 is the arm of a colored man who has had no use of his arm for months. A shadowgraph shows a spontaneous fracture of the ulna, possibly from sarcoma. Notice the callus thrown around the seat of fracture.

Figure 9 is the shadowgraph of an ankylosed knee-joint, showing the tibia and patella to be adherent to the femur. The joint was resected and limb dressed straight.

Figure 10 shows a dislocation of the ulna upon the radius at the wrist. This patient has not yet been operated upon, so I can not relate the condition found upon operating.

Discussion. Dr. Curran Pope, Louisville: I wish to relate one case in connection with the paper of Dr. Dunn regarding the benefit of the X-rays. A boy received a shot from a pistol which severed the nerve connection below the knee, with the result of ankylosis. The knee was slightly flexed, and the question arose as to whether any good could be obtained from a persistent attempt to loosen the joint, such result being dependent entirely upon whether the joint was injured or not. Being somewhat of an electrician and quite skillful in mechanics, the boy took a skiagraph of his own leg in four different positions, and demonstrated that the joint was present. It is now about twelve or fourteen months since he took these skiagraphs, and there is very fair though slight movement at the joint, enabling him to change his gait from a sliding gait to the whole limb of the partially flexed joint. He has entirely recovered from the neuritis.

Dr. James B. Bullitt, Louisville: Every thing Dr. Dunn has said is very good. There is no question of the ability of the X-rays to determine such things as fractures of the limbs and the presence of foreign bodies in the tissues. I believe the time is not far distant when every man who expects or pretends to do modern surgery will be compelled to have at his command, if not in his possession, an outfit of this kind.

which he can use in his daily office practice. For this purpose, as Dr. Dunn has intimated, it is necessary that a shadowgraph be taken-a photograph, in other words, of the bone. But the most useful thing for daily use is the fluoroscope, by which the practitioner can run over the limbs of the body in a few minutes and determine whether or not there is a foreign body present or a fracture which will require further record of the injury. The chief difficulty heretofore has been the inaccessibility of such an apparatus. The apparatus was costly to start with and required technical knowledge for its manipulation, and in the smaller towns the electric currents were not sufficiently powerful and the voltage high enough to be of any use in this way. Believing that we should have an apparatus which is less expensive and one which will meet our wants, I have looked around to see what could be procured in the way of instruments. I have seen Dr. Dunn's instrument; it is a very expensive one and takes a very high voltage to rnn it. I have seen a little machine called the Standard New Volt Machine, which answers the same purpose as the more costly apparatus, and it produces skiagraphs with clearness. Of course it takes a little longer time than is required with Dr. Dunn's instrument. It requires very little skill to run the machine I speak of. The machine itself costs about $40.00, the fluoroscope $18.00, the total expense being about $60.00 or $63.00. The more expensive apparatus costs $200.00. The less expensive machine has further advantage in that it can be carried from house to house, which can readily be appreciated in cases of severe fractures where it is impossible to transport patients any considerable distance.

Dr. Dunn is to be complimented upon the excellence of his work, and I believe the future will show that better work will be done than has been accomplished up to the present time.

Dr. Louis Frank, Louisville: While I admit the value of the X-rays for diagnostic purposes, yet we must not let the X-rays run away with us. In the use of X-rays as a diagnostic measure there is a tendency on the part of some practitioners to do meddlesome surgery, such as that undertaken for the removal of bullets and other foreign bodies imbedded in tissues which cause no trouble whatever. They remain for years and cause patients no inconvenience. The tendency to do. ineddlesome surgery in this class of cases must be overcome, and we ought not to let our work in this line run away with us. I merely call attention to that one point.

LOUISVILLE.

Reports of Societies.

TRI-STATE MEDICAL SOCIETY OF ALABAMA, GEORGIA, AND TENNESSEE.

Ninth Annual Meeting.

The President, Dr. W. F. Westmoreland, of Atlanta, called the meeting to order, and it was opened with prayer by Rev. J. B. Hawthorne.

Gov. Robert L. Taylor welcomed the society to Nashville in an earnest and pleasing address. The President responded fittingly on behalf of the society.

The President then delivered his annual address, "Carcinoma of the Breast," in which he deplored the fact that cases are referred to the surgeon too late for operation. He called especial attention to the importance of early diagnosis. Every tumor of the breast is suspicious. All writers agree that inflammation of the breast predisposes to cancer. Traumatism plays an important part in causation. In his experience, when there is a bad family history, the tumor will return. He called particular attention to Halsted's operation. The greatest infiltration is in the skin next the subpectoral and axillary glands. Cells may be widely scattered early. Carcinoma extends through the vessels. The pectoralis minor should be left until the pectoralis major is excised. Every thing that looks suspicious in the axilla should be removed. Nerves should be cut, especially if connected with infiltrated glands. Operation should be complete even to excising of axillary veins. In a case where a complete operation did not seem necessary there was a return in four months. If half can be saved it will be as good as can be expected. No living man can lose only six per cent if the three years' rule is observed. Figures are fallacious. The large area, if left to granulate and cicatrize, predisposes to carcinoma. As a rule he grafts in a week. All cancer patients have a lack of red blood-corpuscles, the hemoglobin reduced to ninety per cent; when the hemoglobin is reduced fifteen per cent patient will die. This accounts for many lost. after operation with no apparent cause.

J. B. Cowan said that it was not an easy matter to clean out the axilla. He had seen Abbey cover half the bare surface by undermining the surrounding skin and stretching it.

R. M. Cunningham said that we did not know what caused cancer. It spread by lymphatics. It can not be diagnosed in operable stage. All tumors of breast are suspicious. If in doubt operate. If skin undermined too far it will slough. Cancer rare in negro male. Cancer of breast rare in negro. When tissue broken down will get no good from operation.

B. Sherwood Dunn, of Paris, France, said that he fully concurred with the position of the essayist that the operation ought to remove not only such tissue that gave rise to suspicion, but to go further and remove tissue which he was satisfied to be healthy, for the reason that the line of demarkation can not be readily defined. He felt that clinical experience did not support the favorable statistics reported by most operators, and that operations for carcinoma rarely resulted in permanent cure.

Paul F. Eve said that if all cancer cells were removed there would be no recurrence. He removes tissue which seems normal. Before regional infiltration cancer can be removed. Then there will be no return. We are looking to the day when the surgeon will recognize all cancer tissue and remove same.

In closing the discussion Dr. Westmoreland said that Dr. Abbey to-day would not try to cover wound by stretching skin over it. This is bad practice. In the last year had a large per cent of cases in negroes, so that Dr. Cunningham's idea, which is also in Warren's Pathology, is not correct. The axilla can not be cleaned out without removing pectoralis muscle and cutting veins which come from axillary plexus. Drawing up skin will restrict movements of arm.

J. B. Cowan, Tullahoma, Tenn., discoursed on the subject of Psychology," and said that the subject should be differentiated from mental operations. We ought to know something of this science. We all use it, consciously or unconsciously. No man who studies psychology can be a skeptic. All the phenomena we see in the external world are but the result of the co-relation of forces acting on matter properly arranged. He differentiated between the material man, the mental man, and the psychological man.

G. W. Drake said that the differentiation made by the author was We study the relations between body and mind and soul by

correct.