J. Shelton Horsley

THE STATUS OF BLOOD TRANSFUSION

To the Editor: —In an editorial (The Journal, September 29, p. 114) you comment on the present status of blood transfusion. After reviewing some of the work showing the disadvantages of the citrate method of transfusion, you commend very heartily whole blood transfusion. This commendation appears to be in keeping with results of physiologic and clinical investigations, but it is difficult to understand your position with regard to direct transfusion, in which the blood is directly conveyed from the artery of the donor to the vein of the recipient. The obvious objections to blood vascular suturing in transfusion are the technical difficulties and the rather prolonged incisions necessary to expose the vessels. These objections do not obtain when a short jointed cannula, such as the Bernheim cannula, is used. In a communication in the Archives of Surgery (September, 1923, pp. 466-468) I have reported fifty-four consecutive cases, in which this

TREATMENT OF NON-UNION OF FRACTURES

A fracture which has been apparently. properly reduced and treated according to the orthodox manner is supposed to go on to successful healing. Fortunately, this is usually the case. Occasionally, however, without any apparent cause, union fails to occur, and such an outcome is both distressing to the patient and embarrassing to the surgeon. Theoretically, bone should repair perfectly, as it belongs to the connective tissue group of tissues that are simple in construction and consequently easy of repair. We know that simple tissues repair readily, whereas the more complicated tissues, such as brain and epithelial and glandular structures, either do not repair at all, or else very imperfectly after a prolonged time. This is a simple, common-sense, biologic law that we would naturally expect. The exception in the case of bone is more apparent than real. The general connective tissueframe-work of the bone is built up even where no

PLASTIC OPERATIONS IN THE FACE

Surgical operations are usually designed to save life or to increase function. Even plastic operations on other parts of the body than the face have as their chief object the restoration of function. Operations on the vaginal outlet are performed for the purpose of correcting malpositions. of the uterus or of returning the bladder and rectum to their proper position and so rendering these organs better able to functionate normally. Plastic operations on the hands or feet for deformities, on the bowel or bladder for fistulous openings, or on the throat or mouth for congenital defects, are intended to restore to usefulness the parts affected. Plastic operations on the face, however, are done chiefly for their cosmetic effect, as the function of no organ is materially altered by the facial deformities which such operations are designed to correct. While the correction of facial deformities cannot be classed as life-saving, such

SURGICAL REPAIR OF INJURED NERVES.

The Principles of nerve suture are so intimately connected with degeneration and regeneration of peripheral nerves that a brief review of the histologic process involved may not be inappropriate. The method of regeneration of a mixed nerve has been the subject of much discussion, and even now there is no view that receives the general sanction of neurologists. The Wallerian or continuous theory, which claims that regeneration of the axis cylinder occurs from the central stump only, is being somewhat discredited. Recent researches tend to confirm the discontinuous theory or some of its modifications. Huber and Howell, in 1892, and later Bethe of Strassburg, have shown quite definitely by numerous experiments that in young animals regeneration of an injured nerve may be practically complete without any connection with the central end. In older animals regeneration without connection with the central stump also occurs, but is imperfect. Schutte, 1 after an