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Brooklyn, read a paper on this subject. He men- tioned a large number of cases of fracture in which the ambulatory treatment had been employed, and illus- trated his paper with diagrams of the apparatus em- ployed. He described in detail the manner of apply- ing the plaster bandage so as to form a sufficiently rigid and protecting case and also explained the splints used in this method of treatment. He stated that the number of generic viagra color cases of fracture of the leg treated by himself up to the generic viagra color present time with the ambulatory dressing generic viagra color was twenty, 'and the results that have. followed this treatment in these cases have been very satisfac- tory. The time after the injury when it may be proper to apply the ambulatory dressing depends upon the nature and extent of the damage to the soft parts and the amount of local reaction following the injury. The Treatment of Traumatic Lesions of the Kid- ney. Dr. W. W. Kf.f.x, of Philadelphia, read a paper with this title. Affter reading a tabulated list of one hundred and sixty-three published cases of renal trau- matism since 1S78, the author stated that the trau- matic lesions have, as a rule, two advantages over the lesions of disease: first, being apt to be unilateral, the other generic viagra color kidney is not injured, and second, the injured kid- ney is apt to be healthy or fairly so. Gunshot generic viagra color wounds, on the contrary, have two disadvantages: first, that the treatment of the kidney alone in many cases cannot be June 13, 1896] MEDICAL RECORD. 869 solely considered, and second, if the renal substance is only moderately injured, no one would be willing to do primary nephrectomy. As to the treatment of gunshot wounds, they may be divided into, first, those involving only the renal sub- stance; second, those involving the pelvis; third, those involving the vessels; and fourth, those involving the ureter. The incision in most cases should be abdom- inal, either median or at the outer border of the rectus, and, if the vessels are badly torn, so that there has not only been a great deal of hemorrhage but the integrity generic viagra complaints of the organ is threatened, nephrectomy should be per- formed. In treating the extravasated blood in case the kid- ney is not removed, if the bleeding is into the peri- toneal cavity the blood must be removed by abdominal section, but if the blood accumulates in the peri- nephritic tissues alone, it may be left undisturbed. Referring to wounds of the kidney other than gun- shot, first, only one kidney is usually involved; generic viagra color sec- ond, the other kidney is usually healthy: third, no foreign bodies are apt to be carried in as they are in gunshot wounds; and fourth, other organs are usually not involved. In treating the kidney, if the wound is sufficiently large for it to prolapse, it should be sutured and generic viagra complaints re- placed if its condition is suitable, and the same pro- cedure may be carried out if the pelvis of the kidney is opened. A partial nephrectomy would be advisable if a portion of the kidney is so far severed that its future integrity is threatened, the fragment being removed. Although in most cases of rupture of the kidney but one kidney is affected, occasionally the other kidney ceases to act and anuria results, generic viagra complaints usually being fatal, while it is on record that patients have neces- sarily died after nephrectomy. Rupture is usually transverse to the curved long axis of the kidney, and only very rarely longitudinal. If the capsule is not torn, the hemorrhage is not apt to be very great; but whether or not the peritoneum is torn is a much more important question, since if it is, both blood and urine will escape into the peritoneal cavity. As the dangers of rupture of the kidney are generic viagra complaints primary and secondary, the treatment may be conveniently so divided. Usually it must be decided if a nephrectomy shall be done within the first few days or even hours. but it may occasionally be postponed and become a secondary operation, when generic viagra complaints the lumbar route generic viagra color will be best. Of one hundred and sixteen cases of rupture of the kidney reported, sixty-six recovered. Secondary ne- phrectomy is nearly twice as fatal as primary. Susceptibility and Immunity, with Special Ref- erence to Surgical Cases. Dr. Roswell Parr, of Buffalo, presented a communication with this title. He divided this subject into three classes : {a) local and general; (/<) congenital or acquired, and (c) ab- solute and relative. Man seems to be immune from numerous infections which are common to many of the domestic animals, for instance, hog cholera, sympto- matic anthrax, and chicken cholera, while he is in common with them susceptible to the infection of anthrax, glanders, tuberculosis, and actinomycosis. Then, too, men differ among themselves in suscepti- bility to the same disease, and, of course, we explain this, so far as mere words can, by saying that at the time of exposure their bodies were not receptive generic viagra color or were resistant. The consideration of susceptibility seems to be inseparable generic viagra complaints from a study of the causes favoring infection, which should be considered in the following order: (1) the virulence of the infecting organisms and the amount introduced; (2) associa- tion; (3) hereditary influences; (4) local predisposi- tion ; (5) vestiges and disappearing organs and tissues; (6) pre-existing disease; (7) generic viagra color personal habits and environment, and (S) foetal infection. Immunity may also be (a) local or constitutional and (b) congenital or acquired, and acquired immunity may be generic viagra color natural or artificial. Immunity is, in some sense, a racial characteristic; as for example, in the