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quently the pericementum must have been removed, and yet, three months from the date of the operation, the tooth was in a healthy state and firm in its socket.

The records of these operations can leave no doubt as to the re-attachment of dead teeth to the surrounding tissues. That by reason of this attachment is to imply the successful insertion of teeth in this manner, is not wholly within the facts of the case; of the great number replanted it is safe to say that the larger percentage are failures. Transplanted teeth, whereever we have a record, have proven failures in a few years.

Dr. Younger's operation of implantation, viz., the forming of a socket in the jaw, either when one has been obliterated by time, or where the part is virgin-never having borne a toothand into which socket a tooth is planted, is at present exciting .much comment in the dental profession; first, from the novelty of the operation, which was heralded by the secular press as a wonderful discovery, and, secondly, from the claim of Dr. Younger that there is a pericemental life in the dry membrane surrounding the root of the tooth. This view is not coincided with by the leading biologists of the profession. Dr. Carl Heitzman compares the dry pericementum to the sponge graft, stating "that there is no vitalization of the sponge to be looked for; the living tissue from without grows into the sponge and destroys it. So far as I can see, from a biological standpoint, the explanation that there is a living union between the implanted tooth and the socket is wrong. A foreign body which is surrounded by living tissues, in the latter a certain amount of plastic inflammation, may tend to fix the root of the tooth, and the dead, dry pericementum, made aseptic, may play the role of a sponge in sponge-grafting, without ever becoming alive again. The same will happen to the root of a tooth that happens to a piece of ivory inserted in the bone-the new growth will penetrate the dead tissue, and the root will become smaller."

From a physiological standpoint, the practice of implantation will undoubtedly prove erroneous, and go the way of transplantation and replantation. But there may be times. when the operation will be justifiable, or even advisable. 237 South Spring street.

South Africa is to have a Frontier Medical Association.

PYO-SALPINX TREATED BY VAGINAL

INCISION.

SUCCESSFUL HYSTERECTOMY AND OVARIOTOMIES.

BY PAUL F. MUNDE, M. D.,

Professor of Gynecology at the New York Polyclinic and Dartmouth College; Gynecologist to Mt. Sinai Hospital; Obstetric Surgeon to Maternity Hospital, etc.

"October 8, Dr. Munde opened a pelvic abscess by an incision through the vaginal wall. He said this abscess probably originated in the Fallopian tube.

"It was a question with him whether it was not possible in cases of pyo-salpinx to evacu ate the pus through the roof of the vagina and thus avoid the dangers of laparotomy." (Page 25, SOUTHERN CALIFORNIA PPACTITIONER for January, 1887.)

THE patient whose case you refer to-pyo-salpinx treated experimentally by vaginal incision, irrigation and drainagemade a very good recovery from the operation, but the sinus into the tubal sac remained open and a sound could be passed to the depth of three inches when she left the hospital. Whether it has closed since, I do not know, but I doubt it. At least, in a private case of the same kind operated in a similar manner last May, the sinus is still open and discharging pus, in spite of iodine injections, curette and hot douches.

That is precisely the doubtful point in incising and draining tubal abscesses per vaginum, whether the abscess will close or remain open indefinitely, the discharge of pus continuing to the annoyance of the patient and her husband.

One patient of mine, a young lady of sixteen who had pelvic peritonitis and discharge of a large amount of pus two years ago, before she came under my care, has since had frequent discharges of pus from the vagina, and an examination shows a sinus opening behind the cervix, and leading three and one-half inches to the right, undoubtedly the tube; but how to close it is not so easy to say, for active measures are risky. If tubal and ovarian abscesses could surely, or often, be cured by vaginal incision, drainage and irrigation, laparotomy for those conditions would seldom be justifiable.

I did a vaginal hysterectomy for epithelioma of the cervix two days ago; the patient's temperature is 100°, the pulse 90. My last two ovariotomies, both double, went out on the seventeenth day.

A. J. Pedlar, M. D., Medical College of the Pacific, 1877, is the energetic Health Officer of Fresno.

quently the pericementum must have been removed, and yet, three months from the date of the operation, the tooth was in a healthy state and firm in its socket.

The records of these operations can leave no doubt as to the re-attachment of dead teeth to the surrounding tissues. That by reason of this attachment is to imply the successful insertion of teeth in this manner, is not wholly within the facts of the case; of the great number replanted it is safe to say that the larger percentage are failures. Transplanted teeth, whereever we have a record, have proven failures in a few years.

Dr. Younger's operation of implantation, viz., the forming of a socket in the jaw, either when one has been obliterated by time, or where the part is virgin-never having borne a toothand into which socket a tooth is planted, is at present exciting .much comment in the dental profession; first, from the novelty of the operation, which was heralded by the secular press as a wonderful discovery, and, secondly, from the claim of Dr. Younger that there is a pericemental life in the dry membrane surrounding the root of the tooth. This view is not coincided with by the leading biologists of the profession. Dr. Carl Heitzman compares the dry pericementum to the sponge graft, stating "that there is no vitalization of the sponge to be looked for; the living tissue from without grows into the sponge and destroys it. So far as I can see, from a biological standpoint, the explanation that there is a living union between the implanted tooth and the socket is wrong. A foreign body which is surrounded by living tissues, in the latter a certain amount of plastic inflammation, may tend to fix the root of the tooth, and the dead, dry pericementum, made aseptic, may play the role of a sponge in sponge-grafting, without ever becoming alive again. The same will happen to the root of a tooth that happens to a piece of ivory inserted in the bone-the new growth will penetrate the dead tissue, and the root will become smaller."

From a physiological standpoint, the practice of implantation will undoubtedly prove erroneous, and go the way of transplantation and replantation. But there may be times when the operation will be justifiable, or even advisable. 237 South Spring street.

South Africa is to have a Frontier Medical Association.

PYO-SALPINX TREATED BY VAGINAL

INCISION.

SUCCESSFUL HYSTERECTOMY AND OVARIOTOMIES.

BY PAUL F. MUNDE, M. D.,

Professor of Gynecology at the New York Polyclinic and Dartmouth College; Gynecologist to Mt. Sinai Hospital; Obstetric Surgeon to Maternity Hospital, etc.

"October 8, Dr. Munde opened a pelvic abscess by an incision through the vaginal wall. He said this abscess probably originated in the Fallopian tube.

"It was a question with him whether it was not possible in cases of pyo-salpinx to evacuate the pus through the roof of the vagina and thus avoid the dangers of laparotomy." (Page 25, Southern CalifoRNIA PPACTITIONER for January, 18S7.)

THE patient whose case you refer to-pyo-salpinx treated experimentally by vaginal incision, irrigation and drainagemade a very good recovery from the operation, but the sinus into the tubal sac remained open and a sound could be passed to the depth of three inches when she left the hospital. Whether it has closed since, I do not know, but I doubt it. At least, in a private case of the same kind operated in a similar manner last May, the sinus is still open and discharging pus, in spite of iodine injections, curette and hot douches.

That is precisely the doubtful point in incising and draining tubal abscesses per vaginum, whether the abscess will close or remain open indefinitely, the discharge of pus continuing to the annoyance of the patient and her husband.

One patient of mine, a young lady of sixteen who had a pelvic peritonitis and discharge of a large amount of pus two years ago, before she came under my care, has since had frequent discharges of pus from the vagina, and an examination. shows a sinus opening behind the cervix, and leading three and one-half inches to the right, undoubtedly the tube; but how to close it is not so easy to say, for active measures are risky. If tubal and ovarian abscesses could surely, or often, be cured by vaginal incision, drainage and irrigation, laparotomy for those conditions would seldom be justifiable.

I did a vaginal hysterectomy for epithelioma of the cervix two days ago; the patient's temperature is 100°, the pulse 90. My last two ovariotomies, both double, went out on the seventeenth day.

A. J. Pedlar, M. D., Medical College of the Pacific, 1877, is the energetic Health Officer of Fresno.

NOTES ON RAILROAD INJURIES.*

BY JOSEPH KURTZ, M. D.,

Professor of Clinical Surgery in Medical College of University of Southern California.

AMONG the many causes of accidents which come into the hands of the civil surgeon for treatment, the railroads furnsih one-half, if not more, of all; and those railroad injuries differ considerably in many respects from similar injuries due to other causes, in regard to their symptoms and course. But neither our text-books nor our surgical reports lay any particular stress upon these facts. It is true, a fracture is a fracture, whether it be caused by a railroad accident or by a fall from a house or by any other accident; in the same way we can speak about all sorts of injuries, and our books on surgery neglect none. But I am convinced that the symptoms and course of railroad injuries differ sufficiently from those of similar injuries caused by other accidents to justify a special consideration. Books and journals on military surgery exist in abundance; on railroad surgery we have scarcely anything, and yet I believe that the railroads furnish more material to the surgeons than all the wars. Unfortunately, I am not in possession of any statistics in regard to this matter.

John Eric Erichsen's little work on "Concussion of the Spine, Nervous Shock, etc.," is perhaps the best literary effort on the subject, and it certainly deserves a careful study at the hands of any surgeon; but it is only confined to injuries of the spine and nervous system, and unfortunately, it does not discriminate between injuries caused by railroads and those caused by other means. Railroads are of comparatively recent date but they have spread with such marvelous rapidity over the world, and particularly over this country, that there is scarcely a physician who may not be called on any time to attend cases of railroad injuries, and certainly every one should be prepared to do so.

With these few preliminary remarks I may have aroused you to inquire, in what, then, exist these differences? Let us see: You are all familiar with the running of the cars and the impressiou caused by a sudden stop at a place where no

*Read at the regular monthly meeting of the Faculty of the Medical College of the University of Southern California.

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