tion with or without the implication of the cord and epididymis. They may also be involved with tubercular inflammation, although practically never primarily.

One observer reports a case in which the autopsy showed that the vesicle was primarily involved. The most important symptom is the disturbance of the sexual function. The character and appearance of the seminal fluids are more or less changed. Its consistency is so increased at times that it is gelatinous. The diagnosis of subacute or chronic seminal vesiculitis would be difficult to make, were we to depend entirely upon symptoms in reaching a conclusion. They are vague and at times misleading except the appearance of the blood in the semen, which, if thoroughly mixed with it, would determine diseased condition of one or both vesicles at once. The author reported two cases, discussed the treatment as applied to them, as well as that generally used in the subacute and chronic forms.

In conclusion, he said that if inflammation of the vesicle occurs in one whose urethra is strictured, cure the stricture before we can hope for permanent results in vesical treatment. SYPHILIS AND ITS TREATMENT. This paper was contributed by DR. C. T. DRENNEN, of Hot Springs,

The author spoke more directly of the treatment of this disease in connection with the use and abuse of certain so-called antisyphilitic remedies. He said, we are unable as yet to form definite conclusions as to the usefulness of sero-therapy in the treatment of syphilis from the most recent researches, but the reports are quite encouraging, and there is hardly a doubt but that it possesses value in at least the tertiary lesions. Fournier believes the good effect to be due not to any specific. but to its rehabilitory effect upon the system. The author said, in closing, that the hot water at Hot Springs was well-known to exert an influence peculiar in its effects for good, and in it we have a veritable Mecca for syphilis. That its action is eliminative, stimulative and antiseptic, and that larger doses of mercury and the iodide of potassium can be given without harm is known to the writer,

602

based upon experience and observation; that its exact or specific action is unknown, and that its value is attested to by the multiplied thousands throughout the country, are propositions that are incontrovertible.

DR. WILLIAM T. BELFIELD, of Chicago, described and presented an instrument for the purpose of securing asepsis in bladder and prostate operations.

THE ELEMENT OF VASCULAR COMPRESSION IN FRACTURE TREATMENT.

This paper was read by DR.. THOMAS H. MANLEY, of New York City. The author considered at length the anatomical structure and vascular function as related to fracture. The extent of damage borne by the vessels in a given case of fracture will primarily depend upon the degree and quality of force applied and the line of treatment adopted. In a series of experiments made during the past year on the blood and blood vessels, under a multiplicity of conditions in the lower animals under anesthetics. one question which the author spared no pains to definitely determine was whether in fracture, as a general rule, the circulation to the distal part of the limb was retarded in cases of fracture. Without entering into detail on the great diversity of vascular phemomena observed in a frog's webbing under the microscope, after single, multiple and compound fractures were produced, it will suffice to say that with few exceptions, immediately and for a considerable period of time after the bone was broken, the circulation in the capillaries and the smaller arteries was completely arrested. In several it was found that for several days all the smaller vessels were motionless, and in a few they so remained until after the fractured ends of the bones united. These experiments were extended to the mammalia, the shafts of the limbs of pups, kittens and adult dogs, of different age and of various sizes.

DR. H. O. PANTZER, of Indianapolis, Ind., read a paper entitled THE SIGNIFICANCE OF FISSURE

FRACTURES OF THE ARTICULAR ENDS OF THE LONG BONES. He reported a case of fissure fracture involving the outer third of the

head of the radius, having loose attachments to its body. An excessive callus had likewise developed in its site, without affecting a union. This splinter and callus were removed, when reposition of the joint was easily attained. The crepitus felt at the first examination and the failure

to find it again, should have suggested fissure fracture in the opinion of the author. When the first dressing was removed, the limb seemed to present a perfect condition, and to promise full restoration. These prospects were changed as soon as passive and active mobilization was begun. The probability is that the attempts at mobilization for this kind of injury were made too soon, and that they were at least partially responsible for the subsequent unfavorable developments. The author concludes that when undue painfulness and subsequent swelling with no gain or even a loss of mobility attends the efforts of mobilization after kindred lesions, we should delay further efforts at mobilization. The possibility of a fissure fracture should be considered in determining the diagnosis and treatment of all cases of joint injury. DR. E. W. ANDREWS, of Chicago, contributed a paper entitled

IMBRICATION OR

LAP

JOINT

METHOD-A PLASTIC OPERATION

FOR HERNIA.

The principle of imbrication or overlapping the several aponeurotic layers of the abdominal wall may enter into other abdominal operations to advantage, as he had repeatedly shown. The present paper referred only to its use in inguinal hernia. Here he makes use of it to supplement and reinforce existing methods without losing sight of their good qualities. While based upon the best modern, open method, and while confessedly an outgrowth experienced with the Macewen, Bassini, Halsted, and similar operations, yet the carrying out of the imbrication idea so far changes the technique as to make it as different from them all as they are from each other, and perhaps entitle it to the term "A new operation." It was impossible, said the author. to describe this operation without going into details concerning those which had preceded it, which he did.

of

The interlocking or overlapping principle of uniting the musculo-aponeurotic layers of the abdomen is in reality an outgrowth of the author's clinical experience rather than theory. He adopted at first as an expedient in cases where the Bassini operations seemed difficult and needed supplementing, but of late the value of the principle had seemed to him more and more evident, and he had used it in all his cases. The author concluded as follows: (1) Any successful method of radical cure must be a true plastic operation upon the musculo-aponeurotic layers of the abdominal wall. Cicatricial tissue and peritoneal exudates are of no permanent value. (2) A large strong flap, of any needed size to fill the internal ring. (3) Triplicate layers of aponeuroses. (4) Interlocking of layers giving broad surfaces of union. (5) Shortening of anterior as well as posterior wall of canal, making them mutually supporting, and relieving tension on deep sutures. amply protected.

(6) Cord

FURTHER OBSERVATIONS ON THE RADICAL CURE OF RUPTURE BY THE INTRAPELVIC METHOD, WITH ILLUSTRATIVE CASES. This paper was read by DR. CHARLES A. L. REED, of Cincinnati. In what essential particulars does this intrapelvic method differ from the several methods of radical operation now in vogue? It differs, in the first instance, in the fact that it is intrapelvic, while the others, Bassini's, Halsted's McBurney's, Macewen's, are extrapelvic.

The essential point of difference between Dr. Reed's operation and that of Bassini, consists in (1) leaving undisturbed the extremely tense fascia composing the anterior wall of the ring; (2) in leaving the cord in the position which nature assigned for it, and entirely protected by the normal fascia; (3) in closing the internal ring on the inside of the pelvis, and in protecting it by a strong peritoneal pad; (4) in avoiding the menace to virility arising from a transplantation of the cord, its possible constriction by an artificial ring of tense fascia, and its necessary investment by an inflammatory exudate; (5) in increasing the resistance of the parts

by fortifying the fascia comprising the anterior wall of the ring, and by increasing and making permanent the obliquity of the cord within its normal canal.

The advantage of the operation consists in securing by the unfolding of the redundant but unattenuated median fascia, the formation of a column which, when consolidated by inflammatory adhesions, has a certain retentive and supportive power the influence of which is of value in preventing recurrence. The anchorage of the recti in the median line restores the retentive power of the wall.

DR. HENRY O. MARCY, of Boston, followed with a paper entitled SURGICAL TREATMENT OF HEMORRHOIDS.

This paper was in the nature of a reply to the strictures cast upon the Whitehead operation by Dr. Edmund Andrews, of Chicago, in a paper read before the last meeting of the Illinois State Medical Society. Dr. Marcy believes that if in the statistics given by Dr. Andrews the names of the operators were mentioned most of the disastrous results will be found to have followed the work of incompetent men. His results had been excellent in those cases in which he had done the Whitehead operation, slightly modified by himself.

DR. JOHN RIDLON, of Chicago, read a paper on

CLUB FOOT.

He defined it as a distortion of the foot in its relation to the leg. The simple and compound varieties of club foot were dealt with. Nearly all of the congenital cases present the compound variety-equino-varus; a few present equino-valgus; rarely there is seen a simple calcaneus. Of simple equiuns, the author had met with but a single instance, and of simple varus and simple valgus, he had seen none. Of the acquired variety, simple equinus is by far the most frequently found; next in frequency we find simple valgus; then equino-varus, calceneo-vargus, equinovalgus, simple varus, and varus in one foot and valgus in the other. The acquired deformity occurs more than three times as frequently as the congenital form. The etiology of the congenital forms was next dealt with, as

well as of the acquired forms. Then followed the symptoms, diagnosis and prognosis.

The treatment of club foot is mechanical or operative, or both mechanical and operative. Both of these measures were dealt with at length.

VAGINAL CASTRATION.

This paper was read by DR. E. E. TULL, of New York. The author claimed for this method a lower mortality, a shorter convalescence, and a wider adaptability as it may be prac ticed in cases too weak for abdominal section.

DR. F. J. GRONER, of Grand Rapids, Mich., read a paper entitled

A NEW PHASE OF CELIOTOMY. He related a suit for malpractice which had just been terminated in Grand Rapids. The suit was commenced against a doctor some time ago, and was for fifty thousand dollars. The defendant died, but the Court held that the cause of action survived and that the suit could be brought against the estate. The jury returned a verdict for ten thousand dollars. The author claimed that he knew there was no malpractice because he was interested in the case and knew just what was done in the operation. He found fault with the laws which permitted a suit against a doctor to survive his death, and be a menace to the widow and children. The speaker thought that the next legislature should remedy the law. He had the draft of a bill prepared which he thought would remedy the present law, and which he read. RESULTS OF FIVE YEARS EXPER

IENCE WITH INTRA-ABDOMINAL
SHORTENING OF THE ROUND
LIGAMENTS.

This paper was contributed by DR. J. FRANK, of Chicago. Since his last publication. November, 1889. he had had the opportunity of performing this operation seventeen times. with only one failure, and without any deaths. All of the seventeen cases operated upon were for retroversion, prolapsus, and retroversion with prolapsus of the uterus.

Technique of the operation: The median incision is made a trifle lower than for ordinary celiotomy, the round