parts together as they ought to be put. I have seen excellent results produced by that operation, but what percentage of results is one going to get by such an inaccurate method?With reference to Dr. Stern's remark about the wide angle, of course, the lever is automatically held to that wide angle by the posture of the limb that is put up in strong abduction, completely out beyond the limits of physiologic abduction. I have used small bone grafts in that V cavity, and at other times, I have not. Of course, we have a greenstick fracture there at the lower end and it is very favorable to union. Incrusted cystitis is a chronic inflammatory condition of the urinary bladder manifested clinically by symptoms of dysuria, urgency and frequency, and the passage of gritty material or sand. In certain cases the urine is strongly alkaline, the degree depending somewhat on the severity and chronicity of the process. Usually the urine contains a large amount of blood and mucus, and sometimes pus. The marked discrepancy between the number of red blood corpuscles and pus cells in the urine in this form of cystitis has often been contrasted with the ratio in ordinary cystitis.Because of the nature of the gritty material and the alkaline condition of the urine, this particular type of cystitis has been referred to as chronic alkaline phosphatic cystitis. On cystoscopic examination the bladder presents crusted material which is hard, is firmly embedded in the mucous membrane, and may be limited, affecting only a small area of the bladder surface, usually in the trigonum, or generalized, covering almost the entire mucous membrane. Often these deposits are found when patients give a history sug¬ gestive of previous ulcer of the bladder or mild cys¬ titis, and they sometimes appear in the bladder after fulguration following catheterization, or when tumor growths have been previously observed.Without considering the clinical characteristics of the disease further than to state that this rebellious form of cystitis is much more prevalent than is generally sup¬ posed, and that the treatment has often been unsatis¬ factory because of the obscure nature of the infection, we shall review some of the results obtained by an inten¬ sive study of three cases and a series of experiments on animals.Various etiologic factors and numerous types of bacteria have been regarded as specific causes of this disease. Since a large percentage of bladder infections descend from the kidney or are carried by the blood from remote primary foci, a systematic clinical study of patients so infected was made. While no particular focus could be found in the patients we felt it desirable to carry on some experimentation along the lines that have been so successfully pursued by Rosenow, Meisser, Hayden and others. It was difficult to obtain accurate information concerning the kidneys on account of the technical difficulties encountered in catheterizing the ureters. The small size of the bladder and the ten¬ dency of hemorrhage to follow overdistention, together with ...
