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have been considered one of fracture of the petrous portion. He trephined, removed the fragments, and the child recovered. In conclusion, he called attention to the fact that he had not said that the trephine should be applied in all classes of cases but two. In two classes of conditions, be had said that the trephine should not be employed under any circumstances; in two, that it should possibly be used ; in two, that it should probably be used, and in another, that it should always be used. Dr. S. W. Gross, of Philadelphia, then read a paper on NEPHRECTOMY: ITS INDICATIONS AND CONTRAINDICA- TIONS. The information for his paper he had collected from a large number of sources ; from the authorities who had written on the subject and from correspondence with a large number of eminent men at home and abroad. He was inclined to think that the operation was made more frequently than is proper, and he had endeavored to define as accurately as can now be done the cases in which it should and those in which it should not be performed. He also considered it in connection with the operations of nephrolithotomy, nephrotomy, and nephrorrhaphy . The paper will appear in full in The American Journal of the Medical Sciences for July. Dr. L. McLane Tiffany, of Toprol Xl 25mg Baltimore, then read a paper on NEPHROLITHOTOMY. It was based upon the report of a case in which the author had successfully removed a calculus weighing 556 grains from the pelvis of the right kidney after the subject had suffered from symptoms for a period of six years. After reviewing the several steps of the opera- tion and the methods employed, he entered into a dis- cussion of the etiology of the affection, the symptoms and the various modes of treatment, together with a review of the statistics of operations. In discussing the symptomatology, considerable stress was laid upon the character of the pain, and the statistics of a large number of cases were reviewed with reference to this and other symptoms. This paper will appear in full in an early issue of The Medical News. Dr. S. W. Gross congratulated Dr. Tiffany upon the successful termination of his case, the more particularly because he had removed from an otherwise healthy kidney the largest calculus that has as yet been re- corded, the only one approaching it being the concre- tion, weighing nearly one ounce, excised by Mr. Ben- nett May. As Dr. Tiffany has stated, the operation is a com- paratively safe one. Thus, of 21 cases that Dr. Gross bad collated, 2, or 9.52 per cent., died — the patient of Cullingworth from the blocking of the opposite ureter by a stone, and that of Mr. Pepper, as he writes me, from the effects of morphia. In Mr. Thornton's 3 cases, the operation was by the combined lumbar and ventral in- cision, while the remainder were by the lumbar inci- sion. In the cases of Butlin , Anderson, and Culling- worth, the Order Toprol Xl stone was removed through an incision in the pelvis of the kidney. He also agreed with the author of the paper in re- garding the diagnosis of renal calculus as being far from easy. Intermittent attacks of renal colic, with tenderness on pressure, the presence of blood, and, it may Toprol Online be, of a little pus, in the urine, with frequency of micturition, are, in die absence of vesical and prostatic lesions, the best diagnostic signs ; but they may be present in cases of highly acid urine, and in the early stage of tubercular kidney. The group of symptoms which he had just mentioned being present, the sur- geon is certainly warranted, after the failure of ordi- nary remedies to relieve them, in cutting down upon the kidney Toprol Xl 50 through the loin, with the view to its ex- ploration with the fingers, a needle, and, if needed, by an incision of the kidney substance itself, through which the finger can be carried into the calices and pelvis of the organ. And this brought him to the third conclusion, that incision down to and exploration of the kidney are eminently proper, in which he entirely agreed with Dr. Tiffany. Thus, of 22 exploratory operations which he. had Toprol 50mg collated, all recovered, and the organ was incised in 3. Should incision in every case of failure of the ordinary methods of exploration to detect a stone be the practice of the future, the risks will doubtless be added to ; but he believed that Mr. Morris is right in recommending its adoption. It certainly should be resorted to before the kidney is sacrificed by extirpation. Dr. J. W. S. GouLEY, of New York, called attention to the report of a somewhat similar case that was read at the first meeting of the New York State Medical Association. In his opinion, a great deal of good was done by crush- ing the stone before an attempt was made at its removal, as had been done in both these cases. In the case just reported the stone was made up chiefly of Toprol Price the phos- phate of lime. This he considered an important point, as throwing light upon the remarks that were made at the last meeting of the Association, when it was stated, in contradiction of his views, that a stone found in the Cheap Toprol prostatic portion of the urethra, and consisting chiefly of the phosphate of lime must of necessity have had its origin in the prostate. This he thought proved his former statement, that any inflamed mucous membrane would lead to the formation of such a calculus. He also considered the incision through the outer edge of the kidney preferable to the incision through the pelvis, as being less liable to result in permanent fistula. A free incision should also be made. Dr. T. a. McGraw, of Detroit, remarked that cal- culi Metoprolol Toprol Xl are rare in the State of Michigan, but for that reason he could give one or Buy Toprol Online two suggestions as to their pathology when they do occur. The stones are almost invariably the result of obstruction, coming chiefly from a stricture of the urethra Toprol Xl 100mg or an injury of the prostate. While stones are rare, there are a good many cases of renal abscess in Lopressor Toprol Xl the State, and he had observed that in these cases, where the ureters remained impervious, there were found no small calculi, but where the ureter has become thickened so as to cause an obstruction to the flow of urine, calculi are apt to be met with. Dr. p. S. Conner remarked that we are much en- Digitized by Google 500 AMERICAN SURGICAL ASSOCIATION. [Medical News couraged in resorting to operative procedure in serious cases by the happy result that has been reported for these cases. We are encouraged to cut down upon these kidneys, knowing that if we find a stone we will relieve the kidney of its trouble, and that if we Toprol 100 Mg do not find a stone we will do no injury to the patient. Toprol Recall Dr. T. F. Prewitt, of. St. Louis, asked for more definite statements in regard to the comparative ad- Toprol Cost visability of cutting through the kidney substance and the pelvis. Dr. Tiffany stated that all the cases with which he was acquainted, including that reported in the volume of the New York Medical Association's Transactions, which, however, he did not think properly came under this head, where the incision was made through the substance of the kidney, had recovered. As far as Buy Toprol Xl his
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