to cut away the redundant mucous membrane till they found the ectropion was due to the shape of the eyelids. In ectropion of the bladder, we should repair the perineum. If the posterior part of the vagina is attended to, the anterior wall will have its support and will not prolapse. Dr. George J. Engleman, St. Louis, said that his own experience with this operation had been unsatisfactory. He thinks it only profitable as an adjunct to the operation on the posterior wall. Dr. Alexander Dunlap, Springfield, Ohio, was not in favor of leaving sutures in two and three weeks, but removed them on the third day. A telegram was read announcing the sudden death of Dr. W. H. Byford, of Chicago. "The Surgical Treatment of Non-Pedunculated Abdominal Tumors," was the subject of a paper by Dr. Henry O. Marcy of Boston. After reviewing in brief what is known of the origin and development of the cystic growths of the pelvis, the writer stated that developing beneath the deeper structures, they necessarily are inclosed by the peritoneum as an investing membrane; and that the demonstration made years since by the late Dr. Miner, of Buffalo, N. Y., has special value in this class of cases: the enucleation of the cyst by what he called the process of stripping the peritoneum from it. This Dr. Miner recommended in all the ovarian cystomata, without regard to the formation of a pedicle. For obvious reasons, this method thus generally applied fell into disuse, and has been largely forgotten. In that class of cases, however, where the development has left so broad an attachment that there is wanting a pedicle, Dr. Marcy advocates a modification of the method as presenting many advantages. This he practices as follows: After a partial emptying of the cyst contents, the peritoneum is divided at a considerable distance from the base of the tumor and the cyst is enucleated. The bleeding vessels are temporarily secured, and the peritoneal pocket thus formed is seized with large compression forceps and held by an assistant. The base, and if possible, which is surely not difficult, the attachment of the cyst should be sewed evenly through with an even, continuous tendon suture, in double stitch, effected by means of a long covered needle, set in handles with eye near point, and generally known to the profession after the name of the author. This suture encloses all the tissues, and when properly placed, not only controls hemorrhage, but constricts without necrosing the tissues. The superfluous structures are cut away to within an inch of the sewing, and the edges are intra-folded by a continuous tendon suture, the line of the stitches being taken parallel to the cut edges. This method of adjustment allows of the replacement of the parts without strain or tension and closure of the abdominal wound without drainage. Dr.Marcy also advocates and practices suturing the basic uterine tissues after the the removal of the fibroid tumors in a similar manner, his first observation and studies on the subject having been published about ten years ago. They are all founded upon the use of the buried animal suture (tendon for many reasons much preferred), itself aseptic, as aseptically applied in an aseptic wound. Dr. Marcy showed his tendon sutures, which are taken from the kangaroo's tail which he has prepared in Australia. Dr. T. A. Reamy, of Cincinnati, in discussing the paper, said, he was not so dumfounded by these cases as formerly, but had lost one case operated on before the class during the past winter. It was because the adhesions were so great. He should have abandoned the operation, introduced drainage, and left the cyst in situ. Dr. Marcy, in reply to a question, said, that he would not under any circumstances use a drainage-tube, unless there was a septic condition present. The President of the Section of Obstetrics, Dr. W. W. Potter, of Buffalo, in his address gave some advice as to the management of the Section. He favored the election of a vice-chairman of the Section, to provide against death, disability or detention; certainly a very good idea. It was advised that a register of the members of the Section be kept. A good recommendation, and one which has been tried before, but the trouble is to get the members to register. The Secretary, he thought, served just long enough to get acquainted with his work and the members, and his usefulness was greater at the close of his year of office than ever before. He would recommend that the Secretary be chosen with a reference to a certain amount of permanency. A good rule in all societies. His last recommendation was that the proceedings of the Society should be published in pamphlet form each year, the discussions to be reported by a stenographer, the expenses to be met by an annual subscription. Stenographers in medical societies have proved themselves next to worthless. It is doubtful if this recommendation can be carried out and whether it would be wise if done. It would look like the proceedings belonging to the journal, and the reports which appear in other medical journals are certainly about as near a trespass on the rights of the organ as can be permitted. The expenses would be great, and voluntary contributions are often involuntary. The subject of antisepsis in obstetrics was discussed at length, and in a favorable strain. The elastic forceps were discussed, and commended, especially in cases where the head was only partially engaged at the brim, cr in contracted pelves, and to accomplish delivery through traction in the axis of the brim where this was impossible with the classic forceps. The duration of the labor is materially shortened with a saving to both mother and children. In cases of impaction of the head in the pelvic basis with uterine inertia they are valuable. The cancerous uterus, so long the bête noir of surgery, seems to be reclaimed to the realm of curability through a legitimate surgical procedure. Published reports show results which no other method can. With improved technique and the multiplied experience of operators in almost every city of the land, the method adds favor and silences adverse criticism. Whatever the future, may bring forth, the operation of the present for cancer of the uterus, whether it be carcinoma of the body or neck, or epithelioma of the cervix, is vaginal total extirpation of the organ. Electricity in the diseases of women received the last, but not least consideration. Apostoli's published results are such as to challenge careful analysis of his cases and a thorough investigation of his methods. Electricity is now in the air, and advocates of it quote a list of prominent names in support, while those who oppose also name their men, probably of equal renown. The discussion of electricity in uterine myomata and ectopic pregnancy, followed, the general opinion being that abdominal section with its present improved technique, affords the surest chance of cure with the minimum risk The real place of electricity in gynecology has not yet been determined, and its true value cannot, therefore, be properly estimated at present. Meanwhile, let us watch carefully, wait patiently, test cautiously, speak gently, and above all, adhere tenaciously to the mandate of the Apostle: "Prove all things; hold fast to that which is good." Dr. F. H. Martin, Chicago, read a paper: "A Plea for Early Vaginal Hysterectomy for Cancer of the Uterus," in which he claimed that vaginal hysterectomy for cancer of the uterus will in the future give an immediate mortality among general operators of not more than 10 per In the hands of experts it will not exceed 5 per cent. cent. Dr. L. H. Dunning, of Indianapolis, could not agree with the essayist in the sweeping assertion that total extirpation of the uterus was the operation par excellence. Any operation must fail unless all diseased tissues are removed. If the cervix is primarily affected, and only a part of it, removal of the cervix is all that is necessary. Hoffmeier's statistics show us that the amputation of the cervix is of less danger primarily and the longevity of the patient is greater. The speaker had done 25 high amputations of the cervix without a death. We should not remove the whole uterus in every case of epithelioma of the cervix. Dr. H. Graff, of Claire, Wisconsin, had a case so much in point that he thought it worth reporting. It had been stated by the previous speaker that cancer was a local disease, but he queried the truth of this fact. one. Dr. T. A. Reamy, of Cincinnati, read the statistics of Dr. A. Martin, of Berlin, which he presented to the International Medical Congress at Washington. The speaker believed that skill will bring the operation to such perfection that it will not be a primarily dangerous As the Fallopian tubes are a part of the uterus, why would you remove the uterus and leave a part of it behind? Will anyone deny the anatomical and physiological proposition? He reported a case where he removed a cancerous cervix seven years ago. The specimen was submitted to Dr. Kebler, of Cincinnati, one of the best pathologists in that city, and under the microscope it proved to be a cancer. This patient is still living, and has two healthy, happy children. He had two other cases where he had done the same operation, and the patients also bore children. Had he removed this uterus, the result could not have been better, the dangers would have been greater, and she would not have had these children. If cancer commences in the body of the uterus, any man who would recommend any other operation than total extirpation would be foolish and dangerous. Why do so many cases of high amputation get well? Why have advertising quacks been able to remove mammary glands with arsenic paste, and the disease did not return, when in similar cases in which we have operated it does return? The less traumatic surface you can have, if you remove the whole disease, the better. The less surface you have and open vessels for absorption, the less danger you have for recurrence. Dr. Wm. H. Wathen, of Louisville, was of the opinion that in a great many cases where amputation of the cervix had been made for cancer and the patient recovered, the diagnosis, be it either clinical or microscopical, was incorrect. Dr. J. L. McIntyre, of St. Louis, wished to enter his earnest protest against the assertion that total extirpation of the uterus was an ideal operation. Dr. Martin closed the discussion, and cited a case on which he was operating before the class at Chicago, and Professor Byford came along and told him to amputate the cervix and let the rest alone. He removed the entire uterus, and presented the specimen at the Chicago Gynecological Society, where it was cut open and the disease found to extend in a narrow line clear up to the fundus. This was examined by the pathologists of the Society, and found to be carcinoma. Vomiting of pregnancy was introduced by Dr. E. W. Mitchell, of Cincinnati, who reported two cases, very severe in character. Both were multipara; both had obstinate vomiting in the first pregnancy with much prostration, which ceased spontaneously at three and one-half months. Both had sustained some laceration of the cervix with some cicatricial deposit in the rent. RESOLUTIONS ON TUBERCULOSIS. Presented at the Twenty-sixth Meeting of the United States Veterinary Medical Association, by L. McLean, V. S., Brooklyn, N. Y. Whereas, We, the members of the United States Veterinary Medical Association, being sensible of the prevalence of bovine tuberculosis in the United States, particularly in the dairy stock of the eastern States, it being computed that at least from 10 to 15 per cent. are so affected in one form or another, and being satisfied of its infectious and contagious character and of its identity with tuberculosis, or consumption in the human family, and that it can be conveyed to others both by inoculation and ingestion, believing that a large percentage of this disease in mankind can be traced to this source: Resolved, That we strongly condemn the use of the milk or flesh of animals so affected in any form, as an article of diet. 2. Resolved, That this Association urgently protests against the employment of empirics as meat or dairy inspectors; that such duties should be confined to duly qualified veterinarians having a comprehensive knowledge of comparative pathology. 3. Resolved, That the inspection of meat can only be properly conducted at the abbatoirs. 4. Resolved, That all dairies should be periodically visited, the cows carefully examined and their condition reported upon to the local authorities. 5. Resolved, That a committee of three be appointed by the Chair to place these resolutions before the Secretary of Agriculture, so that national measures may be adopted by which this disease can be placed under the same category as contagious pleuro pneumonia, and to be similarly dealt with. |