ing, infection and discomfort contributed so obviously to the recoveries of all these patients, that anyone with a very limited experience with this appliance, must see that in comparison with it any method that comprehends treating a dangerously inflamed limb lying flat and immovable on the bed, is necessarily crude, cruel and dangerous. In all such cases the Hodgen splint gives the very best results in saving life and limb and avoiding deformities; gives the greatest ease to the patient and in all cases the minimum amount of work to surgeon, assistants and nurses.

I have long had the idea that suspension with extension as furnished by this splint would have a good effect on hip joint disease and since writing the body of this paper I have had the opportunity of treating the little girl whose picture is shown in photograph No. 10.

In beginning hip disease the inflammation is practically confined to the synovial membrane, later the articular cartilages are involved. The ligaments are perhaps not involved until a much later stage. This being the case the chief requirement in the treatment should be extension to keep the inflamed lining membranes and articular cartilages separated and not necessarily fixation of the joint. As the Hodgen splint is the only apparatus known that will in all supply constant extension I had resolved to use it at the first opportunity.

E. B., 6 years of age, well nourished and healthy looking, has had symptoms of hip disease for three years. Three years ago she began to limp and complain of pain in the right hip. Her mother is sure that she had slight fever for several weeks at this time. Without any regular treatment the symptoms have been variable ever since; she has never been without the limp and has frequently had periods of fever lasting from a day to a month. She was brought to me February 15th, 1906, with the statement that she had had fever every day for two months with steady increase in the pain and limp. She is fat and healthy looking but now can hardly walk at all. Can bear very little upward pressure, and pressure over the trochanter causes her to cry out with pain. Her evening temperature is 101 F to 102 F. Her limb, pelvis and waist were put up in plaster with extension and she was kept in bed for two weeks. At the end of this time her fever was gone. The plaster was now cut off at the knee and she was given crutches and a high soled shoe on the sound foot. She walked about a little for another week with the result that the whole limb became painful and she be

gan having fever again. The plaster had now become loose and soiled so it was changed again, but the pain and fever went on increasing. Two weeks after this the plaster was again removed. This time with great difficulty on account of the great sensitiveness of the limb. All idea that the ambulatory treatment could be carried out was now abandoned and the mother was persuaded to send her to the hospital. On admission she was plainly showing the effects of her suffering. All day she suffered from the slightest movement of her body; her temperature was 102 F, to 103 F. At night, when asleep, she constantly cried out and was awakened by the starting pains. An hour after the limb was swung up in the Hodgen she was playing about the bed. From this time she never complained of any movement of her body in bathing her, changing her gown or using the bed pan. She made constant use of the bars of the head of the bed to pull herself to a semi-sitting position and showed no uneasiness about an examintion. The first four nights she had starting pains steadily decreasing in violence and frequency until the vanishing point was reached. Her fever disappeared even quicker. The improvement was so instantaneous and continuous that I would have grave doubts about the diagnosis had the patient not been under my daily care for three months. After three weeks of this treatment in bed during which she got plenty of fresh air and a good deal of exercise from pulling herself about over the bed by means of the bars at the bed head and the Hodgen splint she was discharged and sent to her home in New England. Her hip and thigh were put in a slight spica plaster for traveling. The report came back that she made the trip entirely free from pain and that she was comfortably swung up in the Hodgen which she took with her, and that all symptoms of hip disease, so far as can be judged while the patient is confined to bed, have disappeared.

SENILE ENLARGEMENT OF THE PROSTATE THE DEVELOPMENT AND PRESENT STATUS OF TREATMENT.

JOHN HOWARD BLUE, M. D., Montgomery.

Member of the Medical Association of the State of Alabama.

One year ago, the distinguished surgeon who delivered our Jerome Cochran lecture on the "Problems of Surgery," classed as among those problems as yet unsettled, but which are nearing an accepted solution, the treatment of senile enlargement of the prostate, or prostatic hypertrophy. So it would not seem amiss to present to you a review of the development and present status of treatment of this condition.

The importance of this subject is evident when we realize that it is one of the most common diseases to which the human male is heir, occurring in one of six men past the age of 55. Not all of these have severe symptoms, but a large majority do sooner or later present symptoms. Still further importance is given to this subject by the recent work of Albarran and Halle who in a series of 100 cases of supposed benign prostatic hypertrophy, found more or less pronounced invasion by carcinoma in 14 cases,-4 per cent.

There are few diseases in which it is so important for the practitioner to know what may be accomplished by the methods of treatment at his command. To procrastinate, hoping that some intercurrent disease will terminate life before active treatment for the prostatic condition becomes necessary, is neither ethical nor humane. Each individual case should be considered especially from the two following points of view:

1. Will the proposed treatment increase or decrease the expectancy of life?

2. Whether the certainty of a life of considerable discomfort for a prolonged period is not less to the patient's ultimate advantage than the immediate risk of an operation which, if successful, will enable that patient to live out his life in comfort and ease.

The treatment must be along one of two lines. It must be: (1.) Palliative, or:

(2.) Radical or operative.

PALLIATIVE TREATMΕΝΤ.

Palliative treatment should aim for the maintenance of gencral health, for the avoidance of pelvic and renal congestion, and for the prevention of intravesical tension and infection. Of the usefulness of hygienic and dietetic precautions, and of the usefulness of drugs except for symptomatic relief, there can be little room for discussion. The mainstay of palliative treatment is the use of the catheter, catheterism or catheter life. The use of the catheter dates back to ancient times, and it is not beyond the memory of the younger surgeons when the catheter was practically the sole instrument of treatment. Yet the number of surgical expedients that have been offered from time to time bear evidence that its use was ever, as now, unsatisfactory, and its field of usefulness has yearly become more and more restricted. By its use, no immediate mortality can ensue if ordinary surgical cleanliness is observed; but the expectancy of life is distinctly decreased. The average duration of catheter life is not over five years, and probably less, and that time is attended with discomfort and often much suffering. By its use no cure can be held in prospect. In view of the above facts, the more radical surgeons hold that as a rule, when habitual use of the catheter becomes necessary, the patient's best interest will be conserved by a radical operation. The more conservative surgeons advocate its trial in all cases. Between these two divergent views, the safe course must lie, and there are undoubtedly cases where catheter life is preferable.

I. There are cases in which there is a slow onset of symptoms, so that when the patient presents himself, he is feeble and most likely a victim of some complicating disease. Such cases are obviously bad surgical risks. In these, catheterism often gives a life of comparative comfort, whereas operation would be possible only in the face of a high mortality.

2. There is a class of cases, often comparatively young and vigorous, with clean bladders, but bladders that have been distended for a long time and bladder walls in the condition of atonic degeneracy. In these, even after operation, there is lack of expulsive power, and the catheter is necessary. As well be contented with the catheter until the atonic condition is overcome, if cver it is overcome.