the mucous membrane well up in the cul-de-sac, in case of uterine displacement, etc.

I am credibly informed by a medical gentleman of Baltimore that this operation for vesico-vaginal fistula has been performed by Dr. Emmet of the Woman's Hospital, New York, and in private practice, two hundred and fifty times. It is truly marvelous from whence come so large a number of cases. Females, doubtless, to a great extent, religiously conceal their physical infirmities, especially when those infirmities select for their habitat the genital organs, consequently in private practice these cases do not come to light, the victims of them perhaps passing through a world of trouble and physical torture more intolerable and dreaded than death itself, preferring to suffer present ills than acknowledge their disability. This is at least one powerful reason why the charities of communities should be exercised in the direction of establishing institutions for the exclusive medical and surgical treatment of the female. May we not hope, before the expiration of another decade, to see establi shed in our city a Woman's Hospital? The time has now come when uterine surgery must be separated from "general surgery; there is a distinction between them as broad as that between medicine and surgery. We absolutely need a division of labor, and this need must soon be realized. The field of uterine surgery has just begun to be intelligently cultivated; implements for use have but recently been placed in our hands at all adequate to the demands made upon them, and as we go on with our explorations within this comparatively new field of labor, which is to be set apart from the domain of operative surgery, to be cultivated by itself, it will be found, I trust, that the vast area, which ever has, and does now, claim the undivided energies of the profession, is quite too extensive and large, and that the department of uterine diseases will be set off by themselves as quite sufficient in themselves for the exercise of all the higher intellectual endowments of the wisest physician, and to cope successfully with these protean forms of physical disability, the studies of a life-time may be regarded none too much.

Dr. Anthony O'Reilly, of Springfield, Mass., has sued Dr. F. D. Mueller, of the same city, for $5,000 damages, for disparaging remarks touching O'Reilly's professional ability.

ART. III-Clinical Remarks upon Surgical Cases in the Buffalo General Hospital-Removal of both Ovaries--Death. Br J. F. MINER, M. D.

The present interesting case, in an intelligent and highly respectable private patient, who has consented to your being invited to be present, will be explained by Prof. White, who has invited you to see an operation which I understand has been fully described and explained in his lecture this morning, and who has kindly consented to be present and assist in the operation. He will also make such further explanations as he may deem proper, and describe the processes found necessary to adopt in this particular The description of the peculiar features present and worthy of especial notice, will be given by him. I shall also be assisted by Drs. Eastman, Lothrop, Wyckoff, and C. Nichell, and by a number of professional friends, both from the city and neighboring towns, among whom I may mention Drs. Skinner, Eddy, Mixer, Loomis, Brown, E. Barnes, Shaw, Smith, Potter, Eddy, of Lewiston, Diehl, Janson, Daggett and others, whose names I am now unable to call.

case.

PROF. WHITE, after expressing his pleasure in having opportunity to take his class from the lecture hall directly to the operating room, and thanking Dr. Miner for such rare opportunity, remarked nearly as follows:

Gentlemen: The patient now presented before you, Mrs. B—, is thirty years old, has enjoyed tolerable health during her whole life until within the last five years. She is the mother of one child, and appears free from disease except what is situated in the abdominal cavity and the effects it may have produced else where. The abdomen is immensely distended, we have no doubt, from serous effusion-that there is ascites in connection with and complicating disease of the ovary. Such immense distension of the abdomen is uncommon, and when present in so great degree, is an unfavorable symptom. To determine the existence of adhesion in this case is certainly impossible; in almost all cases it is difficult and uncertain.

The patient has been suffering with the condition you observe, relieved occasionally by tapping, for the last three years, and come at length to desire the chances, whatever they may be, of ovariotomy. As I have this morning told you, statistics thus far, will not justify expectation of a greater than about 50 per cent. of recoveries; making it an operation not to be lightly or unhesitat

ingly adopted. Recent improvements in making the operation it is believed will raise the per cent. of recoveries, and if only the most favorable cases are selected and these placed in the hands of judicious operators, a very large per cent. of recoveries could be reasonably expected. But the condition of this disease is such that without removal there is no hope of recovery; if there is any chance, however small, patients frequently insist upon their right to it, and the humane surgeon cannot refuse operation, though his judgment may decide the chances very unfavorable; he must do his duty and leave the results; sometimes most unfavorable cases unexpectedly recover.

The first procedure in the operation, after every preparation has been made, and the patient has been brought fully under the anæsthetic, is the exploratory incision; this, you will observe, has been most carefully and skillfully made, and you can now see through the transparent walls of the peritoneum the clear serum which fills the cavity of the abdomen in so great degree. A large trocar is introduced and something near forty-five pounds of serum removed. This brings the ovarian tumor into distinct view, and the incision is extended through the linea alba, five or six inches. Upon examination we find that it is strongly adherent throughout its whole extent to the peritoneum, the connection being by strong, firm bands and broad fascia like expansions, of similar material as the bands, being prolongations, either from the peritoneum to the tumor, or vice versa. These are separated at the tumor, carefully broken or peeled off from its surface, and after great care and effort the pedicle of the tumor is reached, which is large, short, and contains several arteries of large size. Upon examination, also, the other ovary is diseased, consists of a sac which is filled with a steatomatous material, intimately mixed with hair. These sacs

sac.

are rare, and have given rise to a great deal of speculation as to their origin, some regarding it as evidence of former extra uterine pregnancy; others believing the hair a growth from the walls of the The small tumor which will weigh three or four ounces, is readily removed by applying the clamp and dividing the pedicle with the actual cautery; no hemorrhage follows its division, and its removal is quite satisfactorily obtained. The large tumor, which has been allowed to remain until after the smaller is removed, is treated in similar manner; but the vessels are large, and though

subjected to ample and satisfactory cauterization, when the clamp is removed, immediately show that the hemorrhage cannot be thus arrested. There are so many of these large vessels that in this case it is deemed best to apply double ligature, tying both ways upon the pedicle and bringing it out at the lower angle of the incision. All the fluid from the tumor and the bloody serum from the torn adhesions which has accumulated, is now carefully sponged from the cavity of the pelvis, and the incision closed by deep silver sutures extending to the peritoneum, and a few superficial ones to more completely adapt the margins. Adhesive strips are applied after the method already described, extending completely around the body so as to insure rest and support. The patient is removed to her room, and has well borne, so far as can now be seen, the fearful operation of removal of both ovaries, and ascitic fluid sufficient to make in the aggregate sixty-one pounds.

Upon opening into the interior of the principal tumor, we find another, much larger sac than before, containing similar matter, and completely filled with long, coarse hair, some of which can be shown to have grown from the cyst wall, certainly to be closely adherent to it at one extremity.

Whatever may be the termination of this interesting and instructive case, the care, skill and judgment in its removal by Dr. Miner could not be surpassed, and it offers the only possible ground of hope which such disease affords, though it seems that in this case recovery cannot be very confidently expected.

NOTE.-The first and second days after operation the patient was remarkably cheerful, hopeful and comfortable, vomiting being the only unpleasant symptom. The third day signs of depression were present, and neither food or medicine retained upon the stomach. Death took place on the morning of the fourth day, from exhaustion.

ART. IV-Abstract of Proceedings of the Buffalo Medical Association. TUESDAY EVENING, November 5th, 1867. The meeting was called to order by the President. Members present-Drs. Eastman, Jansen, Abbott, L. F. Harvey, C. F. A. Nichell, Wetmore, Strong, Daggett, Gleason, Rochester, Congar, Smith, Potter and Johnson.

The report of the proceedings of the last meeting were read and approved.

DR. ROCHESTER moved that Dr. Eddy, late of Lewiston, now of

Buffalo, be invited to participate in the proceedings of the meeting. Carried.

The Secretary read a communication from the Business Committee of the Young Men's Association, asking this Association to pay the pro rata expense of the janitor.

DR. ROCHESTER moved that the communication be received, and that if the Young Men's Association will guarantee the proper care of the rooms, this Association be directed to pay the amount required by the Young Men's Association. After brief informal discussion the motion was carried.

The President announced that the consideration of the revised Constitution and By-Laws was the next business in order.

DR. STRONG moved that the Secretary read the Constitution and By-Laws as reported by the Committee, and unless objection be made to any part thereof, the whole be adopted as read. The motion was carried.

DR. ROCHESTER moved that Article II. of Chapter VI. which relates to impeachment, be so modified as to direct that when charges of impeachment are made against a member, the case shall be investigated by a committee before coming before the Association. Carried.

DR. STRONG moved that the consideration of the fee bill be deferred until the next regular meeting. Carried.

DR. C. F. A. NICHELL said, that Dr. Miner being unable to be present had invited him to present two specimens of disease of nerve, of rare interest and value. The first is a section of the median nerve, showing in its centre an enlarged condition, the result of a gun-shot wound. The patient, W. C., accidentally wounded himself in October, 1866, the ball passing from within outward, two inches above the condyles of the humerus. Nine weeks from the time of receipt of the injury the wound had closed, but the patient suffered the most excrutiating pain in the hand, which was flexed. At the expiration of twenty-two weeks he presented himself to Dr. Miner for treatment, the pain being so intense as to make existence intolerable, and calling for relief by some means, even amputation, if necessary. He was much emaciated, and the digestive functions impaired by the pain and the large amount of opium taken. An incision was made upon the inner margin of