breaths at a time. The patient was carried to the Bay the blood has poured into the right pleural cavity and State Hospital and seemed refreshed by the trip. infiltrated into the retro-peritoneal tissues and to a Soon after his arrival high enemata were resorted to moderate extent into the peritoneal cavity. again, and considerable mucus, some of it stained slightly with blood, was the chief result. There was now hardly any pain, but the patient said he by no means felt right. That night he slept fairly and was comparatively comfortable the next day. Small quantities of milk and lime water were retained. The day after entering the hospital a high enema was very successful in bringing away considerable fecal material and gas. It was now assumed that at least the bowel's patency was established. A considerable degree of pallor continued, however; the pulse did not fall below 104 and was unsteady at times, though fairly strong. Hiccough and spells of shortened breath recurred. The tenderness on the left side of the abdomen was a little less marked. Dr. Franz Pfaff saw the patient at the end of the second day and was of the opinion that an internal hernia or intussusception had occurred but had been greatly relieved. The shock he believed to be an indication that the sympathetic ganglia had been pressed on by the affected intestine. On section, the aorta shows, extending along its wall as far down at least as the celiac axis, a black red coat, 2 to 3 cm. thick, which consists of a thick layer of bloodclot-like material apparently resting between the mus cular wall of the aorta on the inside and a layer of the adventitia on the outside, limited by the pleura in the thoracic cavity. On section, the intima of the aorta all along its course presents innumerable smaller and larger roughened plaques, fibro-calcareous in instances, and the central portions of many of which show ragged openings which extend into the layer of blood clot and fibrin just beneath the dissected layer of adventitia. At a point in the wall of the aorta just as it passes through the diaphragm there is a ragged opening in the wall margined by arteriosclerotic changed tissue and a ragged interruption in the continuity of the surrounding layer of adventitia, fibrin, and blood clot. Anatomical diagnosis. - Arteriosclerosis of the aorta; dissecting aneurism of the aorta, with rupture and hemorrhage into the right pleural cavity, the retroperitoneal tissues, and the peritoneal cavity. The condition was little changed for the next two days except that the third night in the hospital there Reviewing the clinical features of the case the was more shortness of breath coming and going in such pain stands out most prominently of all the a way as to resemble the Cheyne-Stokes type. The symptoms. There were four periods of pain: temperature ranged from normal to 100°. The urine at the onset, nine hours later, a grumbling diswas normal and fairly abundant, in quantity reaching comfort in the back for forty-eight hours before 50 oz. in twenty-four hours. death, and the final death pang. Also there was some pain and tenderness over the descending colon. The pain probably coincided with ex The fourth night in the hospital there was an uneasy feeling in the back, as though lame. He could not get into a comfortable position; rubbing relieved for a short time only. tension of dissection. Its character and location seem of great significance in differentiating pain originating from dissecting aneurism. The pain was limited to the back and was not more noticeable on one side though it extended across the back and upwards and outwards toward the scapula. It was severe, dull, deep aching and boring in character; most distressing and giving The next day hiccough was rather constant, though he ate more and had a satisfactory movement of the bowels and was rather brighter. He was weak and said he was not right. The uneasy grumble continued in the lumbar region, not more on one side than on the other at any time, and was a source of a good deal of uneasiness and restlessness. Later a menthol liniment relieved him and he slept well for the night. On the morning of the fifth day of his illness he ex-rise to feelings of anxiety. The slight pain over pressed himself as feeling better than at any time since the descending colon may very well have been due the onset. He ate a fair breakfast and was so com- to extension of blood extravasating in the perifortable that after the meal he took a short nap. He toneum. The final pain immediately preceding answered the inquiries of the nurse cheerily. He sat death cannot be defined. on the side of his bed in the act of passing his water when he suddenly gave a piercing scream, audible all over the hospital, and grasped his right loin with his right hand, exclaiming in agony; he fell forward, but was caught by the nurse, and after one or two gasps, life was extinct. Next in importance was the condition of shock which did not disappear at any time, though it varied in intensity. He was pale and his pulse was continuously high after the second attack of pain, except in the last twenty-four hours. It was, of course, now realized that a large internal when it got as low as 88. hemorrhage had been the cause of the final catastrophe. Third, the vomiting was a prominent symptom Fortunately, permission for an autopsy was obtained, in the first twenty-four hours of the illness. In and Dr. Oscar Richardson's record of the aneurismal the absence of any complaint of indigestion before findings follows: the onset of the pain it seems fair to assume that The intestines were not obstructed. The peritoneal the vomiting was due to the aneurismal hemorcavity contains a moderate amount of free fluid blood and the retro-peritoneal tissues are swollen, black red rhage rather than to coincident irritation by the in color, and infiltrated with a considerable amount of stomach contents. The vomiting was probably blood-like material. About the region of the mesentery reflex and symptomatic. Of negative value as the swollen, blood-infiltrated retro-peritoneal tissues symptoms was the practical absence of abdomibulge forward under the transverse colon. The colon nal pain, distension, or anything abnormal on on section is not remarkable. The other abdominal palpation. viscera show nothing worthy of note. On opening the thoracic cavity the right pleural cavity is found to contain an enormous quantity of fluid blood and blood clot, and at a point about where the aorta passes through the diaphragm there is a ragged opening in the wall of the aorta through which It ran its course in five days. THERE has been an enormous increase in the number of rats in San Francisco, and a bonus is being offered for their destruction.-N. Y. Med. Jour. DYSTOCIA DUE TO FIBROIDS. INTRA-UTER- She was advised and consented to, later on, have an INE DEATH OF FETUS. CRANIOTOMY. BY JAMES R. TORBERT, M.D., BOSTON, MRS. R. Primipara. Aet., thirty-six. operation for myomectomy or whatever seemed best when the abdomen should be opened. The number of patients with uterine fibroids who pass successfully through pregnancy and labor is really most surprising. First seen after ten hours of moderately hard labor, The obstetrical importance of uterine fibroids the last six hours of which there had been no progress.depends upon their situation,- whether subObstetrical examination showed, externally, an unusually large abdomen; uterus completely filling serous, interstitial or submucous, and whether abdominal cavity. On the anterior surface of the connected with the upper or lower uterine seguterus was a firm, movable tumor the size of a large ment. orange; on the right side and fundus, several nodules the size of walnuts, on the left cornu a nodulum the size of a cocoanut. The fetal parts could not be palpated and no fetal heart was heard. Feeble uterine contractions were evidenced on palpation. External pelvic measurements, crestal, 28 cm. Spinous, 22 cm. Antero-posterior, 20 cm. There was no uterine tenderness. Internally: head through the brim of pelvis, no fore waters, os dilated 1 inches. No fibroid involvement of cervix or lower uterine segment. Internal conjugate not felt. The maternal pulse was 80, of good quality and regular but as the contractions of the uterus had about ceased and no progress had been made for six hours, operative interference was decided upon. Subserous fibroids are of no obstetrical importance. Interstitial and submucous fibroids in the upper segment of the uterus complicate parturition only by their tendency to produce irregular and feeble pains and thus prolong labor. They are afterwards attended by an increased liability to post-partum hemorrhage, a tendency to delayed involution, and an increased risk of sepsis from sloughing of the tumor. If the tumor growths are not situated at the periphery of the zone of the uterus which dilates, they do not generally give rise to any accident. In the lower segment of the uterus, they offer obstruction to the exit of the fetus; are liable to cause malpresentations and malpositions, and occasionally renThe patient was prepared with especial reference der delivery by the natural passages impossible. to asepsis. On account of the possibility of fetal life Rupture of the uterus may take place in healthy it was thought best to attempt a forceps delivery. uterine structures as a result of mechanical Under ether the os was fully dilated manually and resistance offered to the advance of the fetus, or the forceps applied; repeated traction showed no it may commence at the site of the fibroid where advance of the head so the blades were removed. In- the uterine tissue is particularly thinned. troducing the hand by the head, a firm constriction ring was found encircling the infant's neck and shoulders, the ring including the center of the large fibroid on the anterior uterine wall. Carefully stretching the ring. the hand passed it and the cord was found pulseless. Very little liquor amnii was present and escaped at this time. Craniotomy with Braun's cranioclast and the Smellie scissors was done and extraction of the fetus accomplished without difficulty. There was no maceration of the fetus showing a recent death. The uterine muscle contracted at once and in ten minutes the placenta came away naturally. Hemorrhage was absent and the uterus behaved well. A large intrauterine douche of salt solution was given and a minor laceration of the perineum repaired. pulse rose to 140 during the delivery, but one hour afterwards dropped to 100. The maternal The conduct of this case with the terminal result naturally raises the query whether, if discovered early enough before the beginning of labor, some operative procedure might not have relieved the condition sufficiently to have accomplished a safe termination of the pregnancy. The co-existence of a fibroid with pregnancy is not always an indication for operation, but it is extremely desirable to frequently examine women who have such tumors, to note the size, position and rapidity of growth, using such knowledge for the proper conduct of the individual case. Statistics show that cases of pregnancy complicated with palpably large fibroid growths have a maternal mortality of over 30%, and a fetal mortality of probably 50%. The convalescence was uneventful, save for a slight pyrexia 100.8° F. and a scanty flow of lochia on the It has been easy to collect 100 cases of palpably third and fourth days. This was met and relieved with large fibroids complicating pregnancy where copious intra-uterine douches of weak creolin solution myomectomy on the pregnant uterus was perfollowed by 3iv of 5% alcohol which was left in the formed. In less than 5% was the pregnancy uterus. There was no further pyrexia, the lochial discharge continued a trifle more bloody than usual interrupted. The labors have occurred without but gradually ceased. incident, good uterine contractions have been Involution was exceptionally slow; on the third day present and no complications have existed. of convalescence the fundus was an inch below the ensi-Subsequent pregnancies have occurred without form cartilage and the fibroids were very easily pal-incident. pated. Myomectomy is adapted to only certain classes The case without the chart was shown to the students of cases, - where the fibroid is subperitoneal or at this time and one of whom made a diagnosis of a interstitial, where its size is not too great, and full term pregnancy, palpated the fetal head and small where the uterus may be handled without too parts, but strangely enough had negative results with much trauma. The hyperplasia of connective his auscultation. The patient was discharged at the end of three weeks, and final examination showed an irregular enlarged uterus extending about one inch above the symphysis. tissue in these growths favors the manual separation of the tumor from the uterine walls, therefore rendering operation easier for the existence. of pregnancy. Although Cesarian section fol- tions could be done under local anesthesia. Local lowed by enucleation of the fibroid would be the anesthesia for the treatment of hemorrhoids should not ideal treatment of obstructed labor due to a be denounced, nor should local anesthesia be recommyoma, yet experience teaches that the great mended for all kinds of hemorrhoids. There were majority of the tumors as so situated are of such character as to render attempt at enucleation hazardous, and for these the Porro Cesarian section, or hysterectomy is imperative. Those fibroids which have already caused a premature or nonsuccessful labor should be operated upon by enucleation, if possible, when the uterus is empty. Keports of Societies. MISSISSIPPI VALLEY MEDICAL ASSOCIATION. The scientific work was divided into medical and surgical sections. LOCAL VERSUS GENERAL ANESTHESIA IN RECTAL SURGERY. DR. G. B. EVANS, of Dayton, Ohio, believed that by using a local anesthetic previous to general anesthesia the amount of the general anesthetic was appreciably lessened; the dread and fear were diminished, also shock and danger. Therefore the combined method of narcosis, less anesthetic, suspending shock incident to conscious dread, as well as anesthetic shock, rendered more complete the operative area and consequently more satisfactory work. It was easy to operate on prolapsing piles, but not so simple to operate on piles above the sphincters, yet they demanded operative interference. Operation for hemorrhoids was serious, often attended by some shock, and the greatest caution should be observed to secure asepsis. He did not think it was best for patients that general practitioners should be taught that aseptic precautions at the time of operation and rest at home for a few days were unnecessary. certain hemorrhoids that could be removed radically without anesthesia. He cited such cases. The trend of the times was not to put patients to bed for days and weeks for the removal of hemorrhoids, when they could be removed at the office of the surgeon or at the homes of patients with impunity. Hemorrhoids should be properly classified, and each class should receive a separate and distinct treatment, some with and some without anesthesia; some with and some without ligature; some with crushing and some with simple incision. DR. J. RAWSON PENNINGTON, of Chicago, emphasized the importance of making a correct diagnosis. If a patient had a small contracted anus, with a few painful hemorrhoids, he or she should be given a general anesthetic and operated on. If the patient had a patulous anus, and the hemorrhoids were easily prolapsed, especially internal hemorrhoids, there was no need for a general anesthetic. He described his method of removing hemorrhoids. When the rectum was everted and the hemorrhoids were on the outside, with a pair of scissors they could be removed very readily, the rectum then dressed in extension, and putting into the bowel a rubber-covered tampon. When this was done there was no tissue under stress. Tissue under stress was not in the best possible condition to defend itself against infection. DR. H. O. WALKER, of Detroit, had operated on a large number of cases of hemorrhoids, and had not yet had serious bleeding from the rectum. Hemorrhoids should be operated on under the same surgical principles as were carried out in operating upon other parts of the body. If there should be hemorrhage, it could be controlled by ligature or hemostatic forceps. DR. E. B. SMITH, of Detroit, referred to the importance of making a complete and thorough examination. This could not be done under local anesthesia. He had never been able to do it, nor had he seen any one else do it with satisfaction. He had had the privilege of operating secondarily on patients who had been operated on under local anesthesia. He operated on these cases under general anesthesia. THE OF FREQUENT INTERDEPENDENCE DISLOCATED DR. BERNARD ASMAN, of Louisville, gave a few reasons for some unsatisfactory results in the treatment KIDNEY, GALL-BLADDER TROUBLE AND APPENDICITIS. of ano-rectal diseases. A correct diagnosis was always DR. EARL HARLAN, of Cincinnati, summarized the a first essential, for without it all treatment was largely salient features of his paper as follows: (1) That guesswork. Of all rectal ailments, anal fissure was ordinarily thought to be one of the simplest and lesion of dislocated kidney, gall-bladder trouble and dependent pathology, accompanying the primary easiest to cure, yet experience frequently proved it to appendiceal irritation of a severe nature, is of frequent be most unyielding. Ninety-nine out of every one concomitant occurrence. (2) Many cases have underhundred of the laity assumed that all ano-rectal troubles were hemorrhoidal in character, and it was not trouble wherein the causal factor was a dislocated gone operation for appendiceal trouble or gall-bladder uncommon for them to approach the physician with a diagnosis ready-made, and to preface a description of the bile outflow or bowel current. (3) All cases prekidney, the latter producing pressure interference to the case in question with, Doctor, I have piles."senting for abdominal treatment, complaining of inThe doctor was then apt to accept the diagnosis with definite and recurrent distress, discomfort and pain, but a superficial examination, or perhaps no examination at all, and hence failure to afford relief followed. There were comparatively few cases of hemorrhoids, pure and simple; they were usually complicated by other local disease, perhaps requiring attention at the same time if a perfect result was to be expected. Cases were cited in point. the attacks being accompanied with the presence of an and in which the involvement of the stomach, gall excess of stagnant gas at certain points in the bowel, bladder and appendix are more or less equal, should receive the careful consideration of the physician, in order that an accurate differential diagnosis may be made. (4) In the vast majority of cases a freely movable kidney presents no pathology on the part of the organ itself, and this immunity may cover a conDR. B. MERRILL RICKETTS, of Cincinnati, said that siderable space of time, after which there may appear surgical anesthesia should be eliminated as far as symptoms of functional and mechanical disturbance on possible in all work, especially now as capital opera-l the part of the stomach, cholecyst and bowel. (5) On DISCUSSION. account of the wide and uncircumscribed range of DR. RICKETTS, in closing the discussion, said the pathologic symptoms produced by a dislocated kidney, so-called absorbable ligatures failed in many of these it is more often liable to go undiagnosed than are other cases, and that there was nothing better than catgut symptoms producing abdominal lesions. (6) Perma- or linen. They could be boiled and thoroughly sterilnent and complete relief results only from a correction ized. He had done 400 appendectomies, without a of the primary lesion with its dependent pathology. serious hemorrhage or infection, and had never had to take a ligature out. He never used catgut in his abdominal operations, but employed Pagenstecher linen for almost everything. THE DISPOSITION OF THE APPENDICEAL STUMP. WHEN SHOULD GASTRIC ULCER BE TREATED DR. B. MERRILL RICKETTS, of Cincinnati, concluded that the stump should be as short as possible. Any one of the pursestring methods is dangerous. Ligation for the firm appendix and extirpation for the soft one were the better methods. Hemorrhage from the appen- DR. MILTON R. BARKER, of Chicago, said that all diceal vessel was a common accident, and one that cases of gastric ulcer, regardless of any class in which could be avoided. The escape of feces into the peri- they might be placed, excepting the neglected class, toneal cavity was also frequent. Infection from the should primarily be treated medically, but that in the stump occurred rarely. Adhesions resulting from a light of surgical achievements in this malady the indenuded stump, or mesocolon resulting from ligature, ternist had a double responsibility to his patients. were of little consequence. Ligature around the stump First, to do all his methods could do, and, second, to without mucosa between it and a stenosed Gerlach discontinue those methods before his patient had valve would not cause pain, otherwise it might do so. reached such a condition that surgical methods could A more definite classification of the pathologic appendix not be instituted without undue hazard. When and its results should be more generally accepted. The medical and surgical science could thus work together, mortality in cases with vomiting, ileus, obstruction, the treatment of gastric ulcer would have attained the peritonitis and distention was much higher than re-acme of perfection. ports would indicate. It was probably as great as 90%, if not more. It was difficult to understand why so few such cases had been reported, and still more difficult to understand why they were absent in the work of one and numerous in that of others. The average per cent of mortality for acute cases (7.50), and the average per cent for chronic cases (1.75) was probably a fair estimate for the work during the last five years. Linen and silk ligatures had more advantages than catgut, without the disadvantages, and should therefore be given preference. Ligatures of any material or character should be transfixed in any tissue, especially within the peritoneal cavity. Stumps of living tissue should be sutured or ligated with transfixion, especially if there were canals of any character within the stump. DISCUSSION. DR. H. O. WALKER believed in ligating the stump of the appendix. After tying off the appendix close to the cecum, he disinfected it with carbolic acid and alcohol, and then by means of a pursestring suture covered it up. As long as the suture material was aseptic, it did not make much difference what was used. He had never had a death from hemorrhage in appendicitis, except where it occurred some ten days or two weeks after the operation, due to the sloughing of the omentum, rupture and obstruction from a gangrenous condition of the arteries of the appendix from which the patient died. DR. A. M. HAYDEN, of Evansville, said that if one used silk or linen in uncomplicated cases, there were liable to be suppurating sinuses as a result. In these cases he would use catgut, which, in infected cases, becomes disintegrated in seven or eight days, and there were no suppurating sinuses following. He used linen in all of his clean cases, but in the infected ones he preferred catgut. DR. CHARLES STOLTZ, of South Bend, Ind., spoke of the use of the thermo-cautery, and believed if it was used it would afford hemostasis without the unsurgical method of tying off a mass and letting it stick up in the cavity, without knowing what would become of it. DR. CHARLES A. BONIFIELD, of Cincinnati, had excised the appendix, closed the wound with chromicized catgut, and then covered the surface by bringing the meso-appendix up over it. He had done this for several years, and to his knowledge had never had a patient die from the bowel opening. THE REMOVAL OF ADENOIDS. DR. JOHN F. BARNHILL, of Indianapolis, described a safe and rapid method of removing adenoids. The selection of a proper curette having been made, an assistant took the child upon his lap, placed the patient's knees between his own knees, and thus clamped them as in a vise. The child's head was placed upon the left shoulder of the assistant where it was firmly held between the two hands of a second assistant. Neither a tongue depressor nor mouth-gag was necessary. The operator sat on a chair facing the patient, who was requested to open the mouth. The curette was quickly inserted behind the palate, the posterior surface of which it should closely hug until the crest of the instrument pressed firmly against the vomer at its point of junction with the body of the sphenoid. In this position the patient's mouth must be opened to its fullest limit, and the curette would occupy a position in a plane about 45° to the horizontal, when the ample width of the fenestra surrounded the entire growth. Keeping the curette exactly in the center line of the patient's naso-pharynx, the crest of the instrument was pressed firmly against the vault, in which situation it was quickly pushed backward and downward, the cutting blade of the curette closely hugging the entire base of line attachment of the adenoid, which was thus completely severed en masse and fell from the patient's mouth when the head was held forward for that purpose. In the majority of cases only twenty or thirty seconds were required to do the entire work after all was in readiness. THE SURGICAL TREATMENT OF SOME INFLAMED GLANDS. DR. E. B. SMITH, of Detroit, urged the enucleation of inflamed suppurating glands. Where there was a hernia and the protruding tissue irritated a set of glands, then the hernia and not the glands must be cared for. Where the inflammation had progressed to the stage where resolution could not be brought about by poulticing, or where a simple incision would not affect a cure, and the tissue was broken down, or there was an accumulation of germs, then the only logical procedure was a radical operation. Glands found beyond hope of repair were excised, thus getting rid of a large number of germs, the remaining tissues being treated antiseptically and repaired. Repeated attacks of inflammation rendered the glands weak and susceptible to disease and suppuration. When the glands were incised the inflammation and suppuration either subsided or became quiescent for a time, and then from a slight trauma became inflamed and suppurated. GOITER. stronger portion of the ligament should be chosen. (7) Operation for retrodisplacement must often be performed after much more operating, and so should not offer any tedious technicalities, such as are found in the external search for the ligaments. (8) His internal inguinal shortening and transplantation of the ligaments through the abdominal wall is submitted for comparison with external shortening of the ligaments, or ventrosuspension operations, as one seeming to meet the essential requirements of an operation for DR. GEORGE W. CRILE, of Cleveland, recently made a study of his cases of operations upon the thyroid gland, numbering 152, and he briefly summarized them from the standpoint of the practical management of the surgical thyroid. The development of the surgery of retrodisplacements. the thyroid is best appreciated by the statement that WHAT WE CANNOT DO WITH PURGATIVES. the mortality from thyroidectomy in simple goiters, in nonmalignant and benign tumors, had fallen from DR. EDWIN WALKER, of Evansville, Ind., said the 40% to a fraction of 1%. In his own series, the last action of purgatives was not well understood. Authori101 such operations had been done without a fatality. ties varied widely as to how they affected the human The surgery of benign tumors and hypertrophies of the organism. Practically all agreed that they were thyroid gland was now placed upon a basis compara-canal presented the same symptoms, namely, liquefacirritants. Purgatives and infections of the alimentary ble with that of appendicitis in the quiescent period, tion of feces, increased albuminous exudate, the formaof gallstones and of ovarian tumors. The mortality tion of gas and pain. The physician used purgatives from unexpected complications was perhaps one in one hundred or two hundred cases, in the hands of a least benefited, and nearly all were made worse. In in chronic constipation, when very few were in the surgeon experienced in this line. Graves's disease was obstruction of the bowels, both acute and chronic, demanding much further investigation. Excision of the thyroid in Graves's disease broke a pathologic chain they did harm, besides, the time lost often decided the and the cure was permanent. In a goiter under ob-fate of the patient. The routine practice of preceding servation, if the gland began to grow, it should be every surgical operation with a purge was absurd. If promptly excised because of the great possibility of its becoming a malignant growth. Many more thyroid glands should be removed, just as benign tumors elsewhere were removed, to prevent the appearance of a malignant growth. NEUROSES OF THE BLADDER. the operation was not on the alimentary canal, there URETHRA. DR. ROBERT C. M. LEWIS, of Marion, Ohio, considered a few of the neurotic conditions which were traceable quired after operation, as the bowels would move as to the genito-urinary organs, especially those involving soon as it was necessary. Patients did better without the vesical neck and the deep or prostatic urethra. In them. Purgatives were useful, but should not be neurotic bladder troubles he gave first place to hyper-given in a routine manner. esthesia because he believed it was met with more when there were clear indications. They should only be given frequently than any other of its order. Mental worry or over-tension of the nerves for a long period might PERINEAL SECTION FOR OBSTRUCTION OF THE PROSTATIC produce a vesical hyperesthesia with a train of symptoms simulating a true cystitis; but, as a rule, if there were no inflammation, the absence of mucus or mucopus in hyperesthesia would give a line of distinction so that cystitis might be excluded as a complication or as a sequel to other diseases of the bladder; there was found no other condition which gave so much mental and physical discomfort as hyperesthesia. Men were quite sensitive when it came to genito-urinary troubles, but if a physician once gained the confidence of such patients, and afforded them relief, they would not run DR. CHARLES E. BARNETT, of Fort Wayne, Ind., summed up the cause and effect of acute retention of urine. He considered catheterization more dangerous than operation. He believed that bladder drainage through a median perineal section was the operation of choice. Patients who were practically moribund recovered following improved operative technic with a minimum quantity of anesthetic, oxygen inhalation post-operative, Fowler's position, aspiration irrigation with large drainage tubes, and out-of-bed posture second day. Simplicity, but thoroughness, in the INTRAMURAL TRANSPLANTATION OF THE ROUND LIGA- post-operative treatment was the desideratum. He away. MENTS VERSUS THE ALEXANDER OPERATION OR reported several cases. EARLY DIAGNOSIS AND REMOVAL OF UTERINE FIBROIDS. DR. A. D. WILLMOTH, of Louisville, made a plea for the early removal of these growths. He expressed the opinion based on the statistics at hand and his personal experience that it was the duty of the surgeon to remove uterine fibroids as soon as they were diagnosed, unless some constitutional disease or diseases existed that made operative procedures inadvisable because of the risk involved, or where the surgeon had to deal with a young and childless woman who desired a child, or in those in whom the tumor was subperitoneal, small, and giving no trouble. DR. CHANNING W. BARRETT, of Chicago, gave a résumé of the work done with intramural transplantation of the round ligaments, and, after comparing it with the Alexander operation and ventrosuspension, presented the following conclusions: (1) The Alexander operation fails because most cases of retrodisplacement are complicated. (2) An operation to be widely useful must open the abdomen for inspection and correction of complications. (3) It should be capable of being combined with the best incision for doing work. (4) It must not create false ligaments which will not evolute during pregnancy and involute thereafter. (5) There must be no abnormal arrangement of natural ligaments which allows them to run transperitoneally. DR. JOHN E. CANNADAY, of Hansford, W. Va., said (6) When the round ligaments are ample, the inner, that operative and non-operative treatment had their TREATMENT OF PUS TUBES. |