one form of flexion, and would not divide it into flexion of body and of neck. Anteflexion is always congenital, and is usually due to lack of development of the uterus, and probably of the associated organs. Therefore, in cases of congenital flexion, he did not consider that he had the uterus alone to deal with. This is why we are so rarely successful in removing sterility and dysmenorrhoea by operation. It had succeeded in some cases in his hands when the external os had been very small. Operation should be only performed when the uterus is well developed in every other respect. When dysmenorrhoea is due to congenital defect of development, the fault may extend throughout the whole system.

Dr. BAKER Congratulated the lecturer upon his success, and attributed it to his great care in the after-treatment. One thing which had not been alluded to was the danger of hemorrhage after the operation. He had seen such a case in the hands of Marion Sims, and had one of his own. The paper is valuable as a contribution to the surgical treatment of the disorders named, and helps to decide the question when it should be done and when it should not be done.

Dr. BARKER referred to the early history of the operation, and its frequent performance by Simpson, which he witnessed while in Edinburgh. He had brought back with him Simpson's instrument, which was the first one of the kind in this country. He was astonished at seeing Simpson operate in his office and let the patients go home after it; but in reply to his question he was told that the surgeon had never seen any severe hemorrhage from the operation. He learned, however, that Simpson lost two cases from hemorrhage during the same year, after he left. After his return he operated for sterility upon a patient with stenosis, but no flexion, who had been married fourteen years, and she subsequently became pregnant. He also showed the instrument to Dr. Sims, who, with his usual genius, .invented many improvements upon it. After performing the operation many hundreds of times, he had ceased to operate years ago, being dissatisfied with the results. Until Dr. Emmet spoke, however, he had been unaware that there had been so many deaths from the operation.

Dr. SCOTT recommended that immediately after the operation a tampon of cotton tinctured with iodine solution be placed against the raw surface, in order to prevent suppuration, and the patient kept in a state of absolute rest in bed. He seldom performs the operation, and always under certain restrictions, and with the precaution named in order to avoid bad results.

Dr. HOWARD had been led to the conclusion that for cases of dysmenorrhoea and sterility no one form of treatment will an

swer. Dr. Sims complained to the last days of his life that surgeons did not discriminate. He prefers the bilateral incision where the uterus is symmetrical and where he operates merely to widen the canal; in other cases he uses the antero-posterior incision. His rule is to treat these cases first in accordance with the teachings of the therapeutic school of gynæcologists, at the head of which stands Dr. Barker, before resorting to surgical measures. The statement of Matthews Duncan, that the descriptions of mechanical dysmenorrhoea were 'mere garrulity," he was not prepared to accept. With regard to the reported bad results from the operation, he asked what operation is not, at times, followed by bad results? We should not reject an operation because the results are not uniformly good, but should endeavor to learn its limitations. With our present improved methods we should obtain better results than ever before. After operating under antiseptic precautions, he introduces an ebony plug in the cervix with a light tampon, and leaves it undisturbed for four or five days, by which means the treatment is considerably shortened. He had had one case of death after divulsion.

Dr. H. P. C. WILSON had heard nothing in the discussion that would convince him that, in properly-selected cases, division of the cervix is not the best operation to perform. At the same time, he always warns patients that unless they can give the proper care to aftertreatment the operation had better never be performed. When the hypertrophied neck of the uterus is bent almost parallel with the body, he maintained that the discharges were retained during the inter-menstrual period, and they become acrid and remain there month after month until labor-pains come on, which expel the accumulated secretions. When the uterus is bent upon itself, the canal is closed and obstruction exists. The only treatment is to open the canal by anteroposterior incisions, and make the canal pervious. Where the operation fails, it is due to want of proper after-treatment. In his present treatment he does not pass a probe until two weeks have elapsed since the operation.

With regard to Dr. Scott's suggestion, he believes that the best thing to use to prevent infection is a solution of carbolic acid, glycerin, and iron. He preferred that the cervix should bleed after the operation, and he then avoided possible septicemia by plugging the vagina with the iron solution.

The object of the paper was to discuss the comparative value of division and divulsion of the cervix in the treatment of certain cases of anteversion with stenosis. To his own mind there was no comparison between the two: he believed that the danger to the patient from the former does not begin to compare with that from the latter.

ANOTHER MODIFICATION OF EMMET'S CERVIX OPERATION, WITH A CASE IN POINT,

was the title of a paper by R. STANSBURY SUTTON, M.D., of Pittsburg, Pennsylvania. Some cases of lacerated cervix present peculiarities which make some modification of Emmet's operation a necessity. Last year the speaker reported one such expedient; this year he had devised another. In a patient presenting a torn cervix of almost cartilaginous density, and with the angles filled with hyperplastic tissue, he performed the following operation. Thrusting one blade of a pair of strong scissors into the cervical canal, the cervix was divided antero-posteriorly. With a double-edged knife the four surfaces were pared, except that a strip of mucous membrane was left on each side, so that when brought together these secured a patulous cervix.

Dr. EMMET thought the operation ingenious: its value could be tested only by experience. As a rule, where there is much old cystic degeneration and hypertrophy, he would do just as he would in a case of enlarged tonsils,-amputate; and he then would cover the stump with vaginal mucous membrane.

Dr. ENGELMANN believed that a piece of catgut would preserve the canal as well as the strip of mucous membrane. The modifiIcation did not seem to him to be very different from that proposed by the same speaker last year. Referring to Dr. Emmet's remarks, he called attention to the fact that in Germany what is known as amputation of the cervix is not exactly what we understand by it.

Dr. BAKER urged the importance of preliminary treatment and the preservation of mucous membrane. His own modification was the cutting of a "V"-shaped piece of mucous membrane and covering the wound with it, thus preventing rolling outward. He thought the operation of Dr. Sutton ingenious and likely to be of service.

Dr. ENGELMANN defined amputation as merely the removal of diseased tissue. When this operation of Dr. Sutton's is called for, the parts are very thoroughly diseased and degenerated, and there is no healthy mucous membrane left.

Dr. DUDLEY asked how the sutures were to be introduced.

Dr. CHADWICK. One of the speakers has referred to the fact that amputation of the cervix means something different in Germany from what it does here. He learned that at Schroeder's clinic it was about what we call Emmet's operation, the result being the same.

Dr. SUTTON. The operation was suggested by the character of the case. If in a given patient you can do what is aimed at in Schroeder's and Martin's operations, by removing a wedge-shaped portion of cervical tissue and doubling it in so as to turn inside what before

was outside, that is good; but, as in the case reported, where you have either to cobble out a cervix or leave it alone, you cannot do the ordinary operation. He believed that the mucous membrane is not absolutely diseased, and that in the course of time it will become healthy mucous membrane. With regard to the introduction of the sutures, their position can be seen in the diagrams: no particular mechanical skill is required to introduce them so as to produce a good cervix.

A paper by ELLWOOD WILSON, M.D., on

THE TREATMENT OF LACERATIONS OF THE CERVIX UTERI,

was read by the Secretary.

In this communication the writer called attention to a new treatment of cases of laceration of the cervix, where the wound is recent. He had found nothing better in many cases of old laceration than Emmet's operation, which he valued highly, but thought that it was performed in some cases to which it was not suitable. Where after delivery laceration of the cervix exists, he recommended the use of irrigation with mercuric chloride solution on every second or third day, with antiseptic napkins, and cervical suppositories, or bacilli, containing iodoform. In the course of ten or twelve days after delivery another examination is made, and a solution (3j to j) of nitrate of silver painted over the surface after it has been cleaned. This can be repeated every four or five days until it heals up. Several cases were reported in illustration.

Dr. BAKER approved the recommendation of the lecturer to defer the treatment until some days have elapsed after delivery. He strongly deprecated operative interference until the patient recovers from the exhaustion of confinement. In his own experience he had never seen a case which had required a second operation until within the last year, while those operated on at once very frequently require another operation.

Dr. EMMET believed that the only excuse for surgical interference immediately after labor is where hemorrhage is present with recent laceration. It is not in all cases in which it exists that a fissured cervix gives trouble. He thought that in all cases in which laceration of the cervix had given trouble it was owing to septic poisoning. He believed that many lacerations heal of themselves, and thought that with hot-water injections Dr. Wilson would have obtained just as good results as from the silver salt.

Dr. SCOTT reported one case of immediate operation, with a successful result.

Dr. BAKER reported the only primary operation of this kind which he had ever performed. In a case of forceps-delivery, of face-presentation, and the occiput backward (the only case of this character that he had ever seen born alive), the cervix and perineum were both torn, and he operated upon

both without delay. The patient made a good recovery; the stitches did not tear out, but the patient was very sick. It is significant that among forty-one cases of puerperal fever, which was epidemic in New York last spring, six had suffered a laceration of the cervix, which had been at once sewed up, and only one of these showed complete union.

Afternoon Session.-T. ADDIS EMMET, M.D., read a paper entitled

PELVIC INFLAMMATIONS. CELLULITIS versus

PERITONITIS.

The dangers of limited inflammations of the peritoneum, the frequency, and the difficulties in the way of diagnosis, were dwelt upon in connection with disorders of the pelvic viscera. Cellulitis commonly accompanies peritonitis, but it is not of much importance unless associated with the presence of foreign microbic organisms. When the inflammation stops before producing pus and forming abscesses, the products may be completely absorbed. Where pus has formed, adhesive inflammation occurs, with subsequent cicatricial contraction.

In conclusion, he referred to the production of pus in the Fallopian tubes and ovaries as one of the results of gonorrhoea, and deprecated the frequency with which these organs are removed at the present day. He believed that if the true mortality of this operation were known it would appall the profession; although in New York it is performed with as good results as anywhere. It should be done only as a last resort, after therapeutic means have been faithfully employed without relief. If performed without proper restrictions, the good name of the profession is bound to suffer. He condemned laparotomy for diagnostic purposes, and the sacrifice of the whole of one or both ovaries when only a part is diseased.

Dr. BATTEY looked at the shield from the other side than that seen by the lecturer. His observation had shown him that pelvic inflammations commence very commonly in diseased ovaries. In a private letter to him, Dr. Emmet said that in his early life he had found a number of cases with ovaries in a state of cystic disease due to inflammation, in which he could find no symptoms during life to correspond with the decided condition of disease.

With reference to the frequency of abdominal operations at the present day, he was very much of the opinion of the lecturer, that they are done too frequently. A short time ago a general practitioner expressed great umbrage because he had returned a case which had been sent with a request for operation, because he did not regard it as a suitable one. It is not every case of organic disease of the ovary that requires this mutilation of its owner. He recalled a case of a

young woman under his care in the Infirmary some years ago with large ovaries, which he advised her to have removed. She refused to permit the operation to be performed, and she afterwards recovered, married, and has borne two children, and is in good health. He had seen one or two other cases in which operation had been advised, but not performed, and the patients afterwards bore children. He was therefore not prepared to say that all cases of diseased ovaries should be operated upon.

Dr. BARKER requested the speaker to state succinctly the grounds which to him would justify the operation.

Dr. BATTEY replied that each case must be considered for itself. A poor woman in the mountains of Georgia, who is rendered a hopeless and helpless invalid by disease of the ovaries, and who by the removal of the ovaries will be restored to health and usefulness, would be a proper case for operation in Georgia; but at the same time if she lived in New York, with all the comforts and resources of a private hospital at command, the same kind of a case might be saved without an operation. In either case all ordinary means in our power should be used for relief before resorting to operation. This commends itself to his judgment and his conscience. He does not insist that there shall be always an exact diagnosis of the condition of the ovaries and tubes: it is sufficient to know that the patient is worn out and utterly miserable from faulty performance of function, and he extirpates the ovaries. Observation has shown that in these cases the ovaries are commonly diseased. The operation is justified by its results. The reply to the question would be the same as that made a few years ago: "I remove the ovaries when the general health of the patient is broken down and destroyed and I can see no other hope of restoration by any known means, and where I do see a reasonable hope of recovery as a result of the operation.'

Dr. BARKER Congratulated himself upon having certain points made clear, and thought that the preceding speaker had laid surgical gynæcologists and the ranks of suffering women under obligation, in stating that he did not wait to make his diagnosis until he opens the patient's abdomen.

Dr. SUTTON believed that when an ovary is diseased and cannot be cured by medical means, and it is interfering with the health of the patient and her duties in life, it should be extirpated. He agreed with the reader of the paper that laparotomy is performed too much; not that it is done too much by competent men, but it is done too much by incompetent men. It would have been far better if Tait's statistics had never been published. It is not always possible to make an exact diagnosis before opening the abdomen, nor

is it always easy afterwards. (Several specimens were shown illustrating difficulties of diagnosis.)

Dr. BUSEY referred to the histological analogy existing between serous membrane and

cellular tissue, and claimed that the affections named should be included under one head,pelvic lymphangitis. He hoped the time would come when we could have some surer guide to the limits of usefulness of the operation than moral or social considerations and the general appearance of the patient.

Dr. SCOTT reported several cases of successful operation.

Drs. MANN and H. P. WILSON Concurred in the sentiments of the paper.

JOHN C. REEVE, M.D., of Dayton, read an interesting account of

A CASE OF ABDOMINAL SECTION FOR CHRONIC SUPPURATIVE PERITONITIS,

followed by a successful result, except that a fæcal fistula had formed, pus having been discharged per rectum prior to the operation.

A general discussion took place upon the operation, in which Dr. SCOTT, Dr. GOODELL, Dr. C. C. LEE, Dr. R. S. SUTTON, and Dr. J. T. JOHNSON participated. Dr. REEVE then made some concluding remarks.

The Society then adjourned, to meet the following morning.

The Baltimore Gynæcological and Obstetrical Society gave a reception and banquet to the Association in the evening, at Rennert's Hotel.

Second Day, Business Session.-The following officers were elected:

President.-A. J. C. Skene, M.D., Brooklyn. Vice-Presidents.-J. C. Reeve, M.D., Dayton, Ohio; Ellwood Wilson, M.D., Philadelphia.

Secretary.-J. Taber Johnson, M.D., Washington.

Treasurer.-M. D. Mann, M.D., Buffalo. Members of Council.-W. H. Baker, M.D., Boston; F. M. Drysdale, M.D., Philadelphia; C. C. Lee, M.D., New York; A. Reeves Jack son, M.D., Chicago.

The next place of meeting, New York; time, September 15, 1887.

With regard to the proposition to co-operate in the movement for confederation of the various special societies, it was received, and, on motion, delegates were appointed to express favorably the sentiments of this body at the convention called for September 24, 1886. (To be continued.)

ANTIPYRINE NOT TO BE GIVEN IN PNEUMONIA.-Posadski reports a number of illustrations of the bad effects from antipyrine administered during the course of pneumonia.

MEETING OF COMMITTEES ON CONFER

ENCE OF VARIOUS SPECIAL ASSOCIATIONS REQUESTED TO PARTICIPATE IN A CONJOINT SESSION.

N response to the notice issued by the Secretary of the Committee on Conference of the American Surgical Association, the several Committees on Conference met at the Army Medical Museum, Washington, D.C., at twelve o'clock noon, on Friday, September 24, 1886.

The meeting was organized by the election of Dr. S. C. Busey, of Washington, Chairphia, Secretary. man, and Dr. J. Ewing Mears, of Philadel

The Secretary reported that he had received notification of the appointment of the following Committees:

1. American Ophthalmological Association. -O. F. Wadsworth, M.D., Boston; C. T. Bull, M.D., New York; George C. Harlan, M.D., Philadelphia ; Samuel Theobald, M.D., Baltimore; R. E. Freyer, M.D., Kansas City,

Missouri.

2. American Otological Association.-C. R. Agnew, M.D., New York; H. Knapp, M.D., New York; John Green, M.D., St. Louis; W. H. Carmalt, M.D., New Haven, Connecticut; George Strawbridge, M.D., Philadelphia.

3. American Gynecological Society.-S. C. Busey, M.D., Washington; Fordyce Barker, M.D., New York; J. R. Chadwick, M.D., Boston; J. Taber Johnson, M.D., Washington; Thomas A. Emmet, M.D., New York.

4. American Laryngological Association.— J. Solis Cohen, M.D., Philadelphia; F. I. Knight, M.D., Boston; G. W. Lefferts, M.D., New York; F. H. Bosworth, M.D., New

York; E. L. Shurly, M.D., Detroit.

5. American Dermatological Association.H. G. Piffard, M.D., New York; F. B. Greenough, M.D., Boston; R. B. Morrison, M.D., Baltimore; L. N. Denslow, M.D., St. Paul, Minnesota; G. H. Tilden, M.D., Boston.

6. American Surgical Association.-C. H. Mastin, M.D., Mobile; C. T. Parkes, M.D.,

Chicago; N. Senn, M.D., Milwaukee; J. Ford Thompson, M.D., Washington; J. Ewing Mears. M.D., Philadelphia.

7. American Neurological Association.-L. C. Gray, M.D., Brooklyn; J. Van Bibber, M.D., Baltimore; E. C. Seguin, M.D., New York; Wharton Sinkler, M.D., Philadelphia; Philip Zenner, M.D., Cincinnati.

8. American Climatological Association.A. L. Loomis, M.D., New York; F. Donaldson, M.D., Baltimore; F. C. Shattuck, M.D., Boston; E. T. Bruen, M.D., Philadelphia; W. W. Johnston, M.D., Washington.

9. Association of American Physicians and Pathologists.-William Pepper, M.D., Philadelphia; Francis Delafield, M.D., New York; R. T. Edes, M.D., Boston; J. Palmer Howard, M.D., Montreal; J. T. Whittaker, M.D., Cincinnati.