after the advice of any one you choose to follow; but listen to one word from me upon those two points, vital to the success of your operation. Provided with suitable instruments, those now made for this purpose, consisting of a hook, three pairs scissors, short needles and silver wire, you may rely upon your own dexterity in their use, and proceed to do the operation as adroitly as you can. You can use such speculum as you find exposes the parts best, you can place your patient as you please, and change as you find convenient, but the two important steps in the procedure must be well taken or you fail of success. First then, you are to pare the edges of the aperture so deeply and thoroughly that the hardened cicatrix is removed, beveling off the edges towards the vaginal surface, making this paring more free, much more free, than you would be likely to do if unadvised upon this point. You will make this freshening with knife or scissors of whatever pattern you please, but above all, be sure to do it properly, safely, and thoroughly. There is no difficulty in doing it with the curved scissors now made for this purpose. The knife, in all forms yet proposed, is not as convenient. When this step has been completed, and the hemorrhage ceased, your sutures are to be introduced. Short needles, armed with silver wire, are to be inserted from before backwards. They are to extend down to the mucous membrane of the bladder and be placed at suitable distance back from the beveled edge. When all the sutures you need, have been introduced, placed not more than one-sixth or one-eighth of an inch apart, the wires can easily be drawn sufficiently tight to perfectly approximate the wound. They are not to be drawn too closely, lest you strangulate the parts, not to loosely lest you fail of complete and perfect coaptation and union. Now do not go off after any new or complicated method of tying up this wound; twist the wire gently until it is secure and sufficiently tight, and nothing better or more satisfactory can be desired. It is a simple, safe, and usually successful operation; it has been complicated by great refinement of description and parade of preparation, but paring the edges thoroughly and sewing them together nicely is all that is necessary to insure success. This patient is very old and infirm; success not so certain as in younger and more vigorous patients. Though but a few years more to live, still she thinks she is yet "worth mending," and as the operation involves but little risk, and, if successful, will add so

much to her comfort and happiness, we have made it without hesitating as to its propriety; of its success or failure, I will inform you hereafter. *

Entropion.-We have an operation upon the eye-lid, which I suppose is the last of our operations before you during the present term. I will detain you but a few minutes longer, in describing its nature and showing you our method of cure. If the tarsal margins of the lids turn inwards against the surface of the eyeball, the rubbing of the eye-lashes against the conjunctiva causes constant irritation and discomfort. This turning in of the lid, from whatever cause, is called entropion, and in cases of any extent and severity can only be remedied by operation. You will observe that to remedy this case I have removed what I judge to be a sufficient amount of the skin of the lid and of the muscle beneath it, and after this unimportant hemorrhage has ceased, shall very accurately unite the wound with sutures. It is a matter of great importance to rightly estimate the amount of tissue to be removed; too much might cause the opposite deformity, turning outwards of the lid called ectropion; you will hence see the necessity of judging rightly in this, as in all other surgical operations.

After thanking you, gentlemen, for your constant and earnest attention to the clinical opportunities afforded you during the past term in the Buffalo General Hospital, and for all the repeated evidences you have given of appreciation of the value of such opportunities of observation, offered you mainly by the favor of the Trustees and Superintendent of this institution, allow me in conclusion to express the hope and expectation, that you will hereafter engage in the practice of surgery, with greater confidence and better preparation, and will remember these simple and plain clinical lessons in operative surgery.

At a recent trial in the United States Court in the city of Chicago, Judge Drummond sustained a physician in refusing to testify as an expert without having first received honorary fees therefor.-Chicago Journal.

* Examination of the patient May 14th, eight weeks after operation, shows the closure of the fistula complete. At no time after the sutures were adjusted (has there been the least escape of urine. It now requires the most careful examination to detect the site of the old fistula, so perfect is the union. There is slight incontinence of urine, and it is necessary to urinate every two or three hours when up about the house, or there is apt to be involuntary escape of urine through the urethra; during the night there is no trouble, and she rests without disturbance.

Miscellaneous,

Annual Meeting of the American Medical Association.

The nineteenth annual session of the American Medical Association was held in Washington, commencing Tuesday, 6th inst. The Convention was called to order by the President, Dr. L. D. Gross of Philadelphia, who introduced Dr. Grafton Tyler of Georgetown, who delivered an address of welcome, after which Professor Gross delivered his inaugural address. He returned his profound gratitude for the distinguished honor conferred upon him in placing him in a position so often occupied by the distinguished men of the profession. For this mark of respect and confidence he could only promise to do his duty impartially, and, as far as possible, expedite the business of the Association. The Professor then, at length, explained the object and ends of the Association, the duties of the profession, the advancement of the science, the brilliancy of the rank attained by the American faculty in the ranks of the profession throughout the world, the great good the Association has done in the past twenty years by its annual gatherings, and the continued good promised by its uninterrupted meetings. He gave at length his views on the reception of prize essays on medical subjects, and of the duties of professors of colleges, the management of hospitals, etc. He spoke in eloquent and impressive language of the departed members of the Association, and was exceedingly brilliant in his hopes and sanguine expectations of a bright future for this great Republic; entreated the great fraternity to go on doing good, as usual, throughout the length and breadth of the land, and concluded by again returning thanks to the Association for the honor they have conferred upon him.

At the conclusion of the address, on motion, it was ordered to be printed.

The regular business next followed-and the committees were called. Most of the committees responded as they were called, and their reports were referred to their appropriate sections.

The Committee on Medical Ethics, on consultation with female practitioners, made a report, closing with the following resolution:

Resolved, That the question of sex has never been considered by this Association in connection with consultations among med

ical practitioners, and that in the opinion of this meeting, every member of this body has a perfect right to consult with any one who presents the "only presumptive evidence of professional abilities and requirements" required by this Association, viz: "a regular medical education."

The Committee on Prize Essays reported that four essays had been submitted, and the two prizes of $100 each were still in the hands of the committee, as no award had been made. They recommended that both should be offered for the best essay, but the subject was indefinitely postponed.

SECOND DAY.

A number of papers were received and referred to the various committees.

The Association took a recess of fifteen minutes in order to give the various State delegations an opportunity to select a member from their respective States to form the nominating committee for the ensuing year.

At 10 o'clock the Association re-assembled, and the names of the delegates selected were sent in. They are as follows:

Maine, Dr. N. P. Monroe; New Hampshire, Dr. C. B. Twitchell; Massachusetts, Dr. H. R. Storer; Rhode Island, Dr. O. Bullock; Connecticut, Dr. A. Woodward; New York, Dr. Arnesby; New Jersey, Dr. S. Lilley; Pennsylvania, Dr. S. Pollock; Delaware, Dr. H. Askew; Maryland, Dr. T. J. Hellsby; Virginia, Dr. Owen; West Virginia, Dr. Cummings; Georgia, Dr. R. D. Arnold; Ohio, Dr. W. H. Mussey; Illinois, Dr. Hildreth; Tennessee, Dr. Kellar; Alabama, Dr. Wetherly; Indiana, Dr. Sutton; Iowa, Dr. Clever; Michigan, Dr. Palmer, District of Columbia, Dr. F. Howard; U. S. Army, Dr. G. A. Otis.

Prof. John Gange, veterinary surgeon from Prince Albert College, London, was introduced to the Convention, and delivered a very interesting address. Senator Drake, of Missouri, who wae present, was invited to the stand, and he delivered an interesting address.

The report of the Committee on Medical Ethics was submitted. A lengthened debate then ensued in relation to the admission to practice of female physicians. Dr. Davis, of Chicago, moved that the question be indefinitely postponed, which motion was carried unanimously.

The resolution of acceptance of the resignation of Dr. Homberger was next taken up. Dr. Sayre moved that the name of Dr.

Homberger be stricken from the rolls because he had violated the code of ethics. After a lengthy debate as to whether the resignation should be accepted or the member expelled, the question was finally taken, and Dr. Homberger was expelled.

Dr. Hartman, of Baltimore, offered a resolution censuring those physicians of Baltimore who endorsed a certain foreign specialist by permitting the use of their names in his behalf. Referred to

the Committee on Ethics.

The Convention. then adjourned to meet at 9 o'clock on Thursday morning.

The Medical Association united in a body on Wednesday night, at the United States Medical Museum on Tenth street, where Dr. Woodward, of that institution, delineated the microscopical views of the intestines as affected by dysentery, and the eruption of the skin as caused by camp-fever and small-pox, which views were, in many instances, thrown upon a screen or piece of canvass twelve feet square and magnified to nearly that extent. This exhibition was very fine and received the admiration of the members presThe entertainment at the Army Medical Museum was one of the greatest attractions of the session.

ent.

The medical fraternity proceeded from the Museum to the residence of Senator Morgan, corner of Fifteenth and I streets, where they were received in fine style by the distinguished Senator and the accomplished ladies of his household.

THIRD DAY.

The Convention resumed its session, Dr. Gross in the chair. The report of the Committee on Nominations was presented and accepted. The report names New Orleans, La., as the place to hold the next meeting of the Convention, and fixes the time for May next.

The following officers of the Convention were nominated by the committee:

President, Dr. William O. Baldwin, of Alabama; first Vice President, Dr. George Mendenhall, of Ohio; second Vice President, Dr. Noble Young, of Washington, D. C.; third Vice President, Dr. N. P. Monroe, of Maine; fourth Vice President, Dr. S. M. Bemis, of Louisiana; Treasurer, Dr. Caspar Wistar, of Philadelphia; Committee on Publication, Dr. Francis G. Smith, jr., of Philadelphia, chairman; Dr. Wm. B. Atkinson, of Philadelphia;