With a light hand of the famous Russian surgeon S.P. Fedorov, who has placed in the "New Surgical Archive" for 1926 (Vol. X, No. 4-5) article "Surgery at the crossroads," numerous reports have appeared concerning the questions raised in this article: mainly surgeons responded, then a gynecologist, a pathologist and an oculist. Only internists are silent, as if all is well on our front, and as if we don't have the same pressing issues that have so interested doctors in other specialties, especially surgeons. I believe, that the modern fascinations, marked so brightly and talented by Prof. Fedorov in surgery, exist also in our specialty and give us the right to touch them in the special report, which I will allow to make in the present session.

Clinic based on the modern doctrine of tbc, in connection with the works of Hamburger, Naegeli, Umber, Albrecht, Pirquet, Thille, Ghon, Burchardt and others on the prevalence of tbc, however, presents completely different requirements. The factual data of the above authors on the pathological and anatomical material undoubtedly speak about the presence of tbc in the majority of urban residents. And yet we know that in only a small proportion of those infected it leads to clinically provable organic changes, while biologically tbc can nest in the human body for decades.

We will not deal with the enormous literature on the subject, but will proceed directly to the presentation of our own observations in the clinic of Prof. J. A. Lovtsky for the last three years and in the polyclinic of the Vasileostrovsky district. During this time we have observed 56 patients with ulcer in the female therapeutic department of the clinic, and in the polyclinic - 26, 82 patients in total. Of this number there were 70 women and 12 men from the polyclinic material. Gastric ulcer occurred in 32 patients, peptic ulcer in 50.

Studying vegetative nervous system in patients with various diseases of internal organs, we, by the way, paid attention also to its condition in gastric patients. It was interesting for us to check results of researches of other authors in this direction and also to trace connection of vegetative nervous system with types of gastric cell secretion in various gastric diseases. We determined the tone of autonomic nervous system by the method of Daniélopolu and Garniol'a, as relatively more exact and devoid of sub'ectivism. We did not see any threatening, harmful influences on the patients from this method application. We studied 41 patients from 25 to 45 years old. Of them 20 patients had peptic ulcers (16 cases) and 12 duodenal ulcers (4 cases), 6 patients had hyperacidity, 12 patients had subacid and anacid catarrhs and 3 patients had stomach cancer.

The etiology of postoperative bronchitis and pneumonia, which still occupy not the last place among postoperative complications, still cannot be considered quite established, although their study began in the 80s of the last century, -When the number of other postoperative complications decreased due to the introduction of aseptic and antiseptic, the question about them was repeatedly discussed at the surgeons' congresses both Russian and foreign, and at the III and Vth congresses of Russian surgeons it was even on the agenda.

The surgery of the sympathetic nervous system is being persistently developed, and of all the operative methods with which this new department of nervous surgery has managed to enrich itself, the periarterial sympathectomy is especially popular. The idea and the first experiments of this operation belong to Jaboulay, the further development and propaganda of the method to Leriche. By proposing the mentioned operation, these authors meant to change the blood supply to the limb, thus causing hyperemia in it by destroying the sympathetic plexuses, which lie in the periarterial tissue and vessel walls, for a certain extent.

One of the severe complications of childbirth, often life-threatening and often permanently debilitating, is bleeding either during the separation and expulsion of the placenta, or immediately upon expulsion, i.e. at the end of the labor process, postpartum hemorrhage. Since both of these bleedings are caused by uterine atony, they are called atonic, as opposed to bleeding caused by ruptured walls of the birth canal.

From the point of view of practical surgery, the most pressing issue here is the fate of the placenta in cases of late-gestational and postpartum ectopic pregnancies. While the removal of the fetus in such cases usually presents no particular difficulties, the surgeon in most cases of late ectopic pregnancy has to consider how to deal with the fetal sac, because removing the latter is often very risky and proves to be very difficult, and sometimes completely technically impossible, such as when the placenta is attached at the root of the mesentery, in the area of large vessels. From this point of view, the following 2 cases of late ectopic pregnancy, observed by us among the total number of 38 cases of ectopic pregnancy admitted to the department from 1920 to 1926, are of a certain interest.

In our previous work, we stated that when examining children for Diek's reaction, we noticed a difference between Russians and Tatars in sensitivity to Dick's toxin. Comparing the total % of positive reactions we obtained in Tatars with the same % obtained in Russians, we notice a lower % in Tatars compared to Russians: the former give 23.1% of positive reactions, the latter 29.9%.

Of the skin diseases amenable to the action of X-rays, malignant neoplasms deserve special attention. The powerful radiant energy of X-rays often brings a complete cure even in those severe, far advanced, non-operable cases where all other treatment methods are powerless. Some favorable reports of this kind date back to the beginning of the X-ray era, when the technique of irradiation was far from being perfect. Since then, the literature on the subject has grown considerably. Nevertheless, we still think it is worthwhile to share the results of our observations, because until very recently, there is far from being a unified, established view both on the biological effect of x-rays and on the method of their application.

Excellent results obtained by many physicians during autohemotherapy in a number of cases of different diseases, especially some dermatoses of bacterial origin (acne vulgaris, impetigo, furunculosis, etc.), prompted me to test this therapeutic method for acute angina as well. In fact, if the influence of the patient's own blood (I do not touch here the theoretical grounds of this method) on pathological processes at the named diseases gives such a successful therapeutic effect, then, taking into account homogeneity of pathogens in both cases, the same effect can be expected also at angina, the nearest etiological moment of which should be considered introduction to the nasopharynx mucosa, mainly, of different cocci species. The results are so encouraging that I will allow myself to stop my comrades' attention to them.

One of the causes of the development of flat feet is prolonged standing, when the foot continuously, for several hours serves as a support for the entire weight of the person and is under great strain. Those professions in which workers have to spend a lot of time on their feet, while standing in a stationary position or performing very little movement, must have a particularly adverse effect on the foot, causing a lowering of its arch.

I consider it necessary to point out that receiving precipitating sera in our study was organized only in recent years, when a primitive room for experimental animals was equipped and some equipment was purchased. This could not but affect the course of work, since, due to the material difficulties of the office, it still does not have sufficient equipment. As a consequence of this I have been able to work with comparatively small material so far, and the results I report as preliminary. At present conditions of work are improving little by little, and the results of my further work will be reported later.

This lecture is dedicated to the interests of novice surgeons who are sufficiently familiar with the basics of classical inguinal herniotomy. Therefore, I will limit myself in it only by, firstly, drawing attention to some weaknesses inherent in inguinal hernia surgery in general and in the surgery of the novice surgeon in this area in particular, and secondly, highlighting from the achievements in this area what might be useful for the novice surgeon.

The authors conducted a large number of experiments on white mice with inducing cancer by smearing coal tar on the skin. The most interesting thing about these experiments is that sometimes the cancer after these lubrications occurred in places other than where they were applied.

The authors found that the work of radiologists entails, in the great majority of cases, an impairment of the blood coagulation process towards its lowering. There is a direct correlation between length of service and decreased blood clotting.

By injecting various chemical poisons under the skin of white mice, the authors observed pathologically and anatomically a picture of chemical inflammation with more or less pronounced necrosis.

Based on his own observations and literature data, S.L. Feldman finds that appendicitis can reflexively cause pylori spasm, and this spasm is often caused by a chronic asymptomatic form of appendicitis.

According to Wichmann, it is not always easy to distinguish these two conditions. The author advises to pay attention to the pulse, which in diabetic coma is frequent and small, but correct, while in hypoglycemic, it is frequent, irregular and arrhythmic.

In 4 cases of exudative serous pleurisy, the author obtained good results from subcutaneous injection of serous exudate extracted from patients.

The author finds that air injected into the subcutaneous tissue of both humans and healthy dogs is the agent that causes eosinophilia, while being injected into the cavities of the pleura and peritoneum, it does not cause eosinophilia in a healthy dog.

Most cases of hypertension in the absence of renal disease fall on people who have passed their 4th decade of life. However, it is relatively not uncommon, according to the observations of Mog'a and Voiv, for essential hypertension, with pressure of 145-215 mm Hg, to be observed also in young sub-people. This hypertension is expressed in the latter by the same sub-ective disorders as in elderly people, but often does not give any seizures at all.

A prerequisite for rapid healing of gastric ulcers is complete rest for both the stomach itself and the upper intestinal tract. To achieve this, Tillmann recommends feeding the patient exclusively by intravenous injection of grape sugar solution (5.00 per 1000.0 saline) for 10-12 days.

Having studied 277 sera, including 80 taken from obviously cancer patients, the author found that the Botehloo reaction could not be considered specific for cancer.

According to Willkower and Petow, small doses of atropine (not more than 0.4 mg pro die) can achieve as good results in bronchial asthma as large ones, without the unpleasant effects inherent in the latter.

The author thinks that the transection of the sensitive nerves around the cancerous tumor in some cases does not affect the growth and structure of the latter, while in others it stimulates its growth while weakening the body; therefore the use of this method should be limited to non-operabolic cases only, to reduce the pain.

The author observed two such cases, one of which turned out to be status tliymico-lymphaticus, and the other developed paralysis of both lower extremities and incontinence of feces and urine.

The author suggests anesthesia of the brachialis plexus according to Kühlenkampf, intercostal anesthesia of the six upper intercostal nerves and injections into the medial part of the operating field. The latter start from the acromion along the clavicle to its attachment to the sternum, then along the parasternal line to the rib arch and along the rib arch to the puncture point on the VIII rib.

The author recommends apomorphine for this purpose, usually in a dose of 0.005, and only undecomposed, pink-red solutions of this agent should be used. The gastric lavage should be performed only after gastric emptying, because more voluminous pieces of mushrooms usually already from the very beginning clog the lumen of the probe, and make attempts to lavage ineffective.

The authors are against morphine as a preparatory agent before anesthesia and prefer ether anesthesia with preliminary preparation of the patient with atropine. Hunger diet, laxatives and enemas before surgery they consider unnecessary. To reduce postoperative acetoneemia it is advisable to prescribe carbohydrate-rich food in the last day before surgery. The authors attribute an important physiological role to the mesentery in protecting the abdominal organs from irritations arising from the disruption of normal relations in the gastrointestinal tract.

This question is still not completely elucidated. Most of the studies on this question are based on material traced for a relatively short time.

In 263 cholecystectomies, the author observed 29 recurrences of colic, which he attributed to spasm either in the biliary tract or in the adjacent stomach and intestines.

The author believes that with every right-sided herniotomy we should strive to remove the appendix; likewise, with every appendectomy (undertaken in the cold period) we should take care to preventively close the internal inguinal ring to avoid the development of inguinal hernias later on.

The author cites data on such results in 50 patients operated on in different ways in the clinic of Prof. Hesse. The best results were obtained by complete removal of v. saphenae magnae on the thigh and lower leg.

The author observed 151 new cases of this kind during 3 years, where he applied early treatment by probing. The vast majority of patients were successful, and only one case (189) was fatal. Suggesting early treatment, the author insists that the greatest caution, excluding any schematism, must be observed.

According to the observations of Ya. M. Krinitsky, treatment of burns with ointments and fatty oils should be considerably limited. Of all the ways of treating them the best are either dry and, if possible, open method, or wet, with the use of antiseptic substances.

D'Aprile used a new method to test the functional capacity of the kidney in a pregnant woman using the Nyiri test.

The author proceeds from the assumption that metabolism in all tissues is under the influence of the general incretory-vegetative-mental system, and the coordinated acting incretory and vegetative apparatuses are under the regulating influence of the central nervous system, and therefore are amenable to the influence of mental moments.

His study of eclampsia led him to a series of conclusions, formulated by him in 42 points, of which we present the most important. Eclampsia is a disease specific to pregnancy and associated with a delay in the body of NaCl and increased blood pressure, without which there are no seizures. Neither albuminuria nor kidney damage causes seizures. The cause of the onset of eclampsia sub partu is not dependent on uterine contractions, per se, but is related to the presence of emotions, pain and body tension.

Neumann y 30 women could state before and during menstruation liver enlargement by 2-7 cm. Heilid's observation that most women on the 1st-2nd day of menstruation reacted with glycosuria and hyperglycemia to administration of 100.0 sucrose could not be confirmed.

Hofstätter in 1909 introduced pituitrin into obstetrical practice, which soon gained a wide range of use. However, due to the not infrequent cases of misuse, the remedy has been discredited in the eyes of many.

Исходя из теории Zangemeister’a, что в основе экламптических судорог лежит отек мозга, главным моментом терапии эклампсии автор считает обезвоживание организма. Его профилактическое лечение заключается в сухой, бессолевой диэте, в движениях на свежем воздухе, применении 0,05 камфоры 3 раза в день и mixturae diureticae.

The author collected 20 cases from the literature where treatment of pregnant women with x-rays resulted in the birth of microcephaly, often with signs of mongolism, visual disturbances, etc.

In a sample of 22,922 births in Copenhagen, the author found that this cord abnormality was no more common in the unfolded presentation than in the occipital presentation, namely, in the anterior-cranial in 19.6%, in the frontal in 22.2%, in the facial in 20.3%, while in the occipital in 22.1%.

The author cites statistics from the Charité clinic from 1910 to 1925. For 28,917 births a caesarian section was performed 357 times (1.2%). The mortality rate was 1.4%. Subsequent pregnancies occurred 118 times, with no complications during them.

The author collected 276 cases of this kind from the literature, adding to them two of his own observations.

Using X-ray treatment in 71 patients with peripheral nerve inflammations, the author obtained a complete cure in 41 cases (58%), and a significant improvement in the remaining 30.

The authors consider the main point of nonspecific therapy (which includes artificial inoculation of malaria) the increase of amino acids in the blood, which comes either by destroying proteins in the disease focus (focal reaction), or by a general increase in protein metabolism.

S. S. Maykov recognizes luminal as the best existing remedy for epilepsy (the author received favorable results from it in 80%).

Statham found 91 simultaneous lesions of the appendix in 300 gynecological laparotomies. The latter lesion was particularly common in inflammatory diseases of the appendages (70 cases, 39 times).