been having a like experience. In some cases I have seen there has been very obstinate nausea and considerable disturbance of the bowels, lasting anywhere from twenty-four to forty-eight hours and sometimes longer.

DR. FLEXNER: I have seen a number of cases of the sort mention-ed by Dr. Marshall. I have a patient who has been one of the most obstinately constipated persons I have ever seen; being proof against twoounce doses of castor oil. Two nights ago he developed a sudden rise in temperature and had one of the most severe attacks of diarrhea that has ever come under my observation.

DR. LEAVELL: In reply to Dr. Marshall's question, I wish to say that in almost every case of croup or influenza I have seen in the last two months there has been disturbances of the stomach and dowels, with loss of appetite for a period of one or two weeks.

DR. WATHEN: Four weeks ago I reported to this Society a clinical case of gastrostomy, and I intended this evening to present another patient who was operated on two weeks ago, but as an appendectomy was also done on this man at the same time, I deemed it unwise to bring him out to-night.

This patient had been suffering for about seven or eight months, but had never vomited. The pain was mostly in the region of the stomach, upon the left, radiating across to the right and down into the appendicular region. He suffered a great deal and lost flesh very rapidly. When the abdomen was opened there were extensive adhesions upon the right side down into the pelvis. The appendix, which was about seven incheslong and extended deeply into the pelvis, adhered in its entirety. This was separated and removed. The adhesions were under the stomach and around the upper part of the jejunum. There must have been ulceration about the pyloric end of the stomach, and I am inclined to think that there were small perforations either at this point or in the duodenum; otherwise, how account for these adhesions. Gastroenterostomy was performed by taking the stomach, the transverse colon and the omentum out of the abdomen, separating the adhesions, opening the mesentery and attaching the jejunum to the stomach three inches below its origin, the incision being two and one-half or three inches long. A piece of mucous membrane of the stomach and jejunum half an inch wide was also removed. This left the jejunum in the stomach in a practically normal position. The patient has about recovered and will probably leave the hospital in a few days.

I have some schematic drawings here, the first showing the position of the stomach, the small peritoneal cavity, the posterior attachment transvers emeso-colon behind the stomach and the beginning of the jejunum; second, the same schematic drawing showing the same conditions except the jejunum, brought up and attached to the stomach with posterior drainage from the stomach; and third, the stomach itself, showing.

the condition that exists in these parts to-day, with the jejunum three inches below the point of attachment of the transverse meso-colon, without any jejunic loop.

The only operation of this kind that is going to stand the test of time is that done without the intestional loop; there is very little traumatism and it leaves the parts in a practically normal position. Recently the Mayo Bros. did some of the posterior operations, but they used the loop. The latter is a prolonged operation, full of traumatism and leaves the parts in an abnormal state.

DR. COOMES: I have two cases of typical tuberculosis which I wish to report. The first case was that of a man about forty-five years of age, a saloon-keeper, whom I saw about three years ago. He was having a terrific nasal hemorrhage, and was very much frightened over it. I told him it was caused by drinking; that the blood vessels had broken down and that his nose was the safety valve. I called in some other physicians and held a consultation and succeeded in checking the hemorrhages, and he got well and quit drinking. About two years ago this man came to my office and told me that he had been spitting blood. I had him expectorate on a piece of paper, and upon examination the expectoration was found to contain tubercle bacilli. He insisted on knowing his trouble, and I told him, and he asked me how long he had to live. I inquired his weight, and he told me 151 pounds, and I informed him that he would live just as long as he weighed 151 pounds. He insisted, however, that I should treat him, and I did so. I told him not to drink anything but red wine and insisted upon his eating one rare beefsteak each day. The blood in the expectoration rapidly disappeared, and he recovered fully.

The next case is that of a woman who had her leg amputated some years ago for tuberculosis. I saw this woman five or six months ago,

and she told me that she had lost thirty pounds in four months. had a cavity in one lung. I did not have her expectoration examined, but she spit large quantities of muco pus. The left vocal chord was intensely congested, and all the membranes in the immediate neighborhood were enormously swollen, and she was very hoarse. She was brought to me by one of her relatives, who was very anxious to have something done for her throat. I told him that I could not do much for her throat directly, and that the best thing in a case like this was to spray the throat with menthol with a little carbolic acid in it. This woman was put on a rigid diet, and gained forty pounds in six months. All the throat symptoms have subsided, and the involved space is normal. She is talking naturally, and has no temperature.

In my opinion, these two cases are typical ones, and show that even here the disease may be arrested and the patient given a new lease on life.

DR. M. K. ALLEN: Dr. Coomes has reported two very interesting.

cases. I believe it is recognized that the open-air treatment is the proper thing for consumption. It is claimed by sanitariums that 60 per cent. of the cases which come to them are cured, yet I am a little doubtful of this, because of the fact that the persons who conduct these sanitariums have no means of following up the patient after he is discharged and knowing whether he is permanently cured or not. My own experience teaches me that very few cases of consumption are cured, especially in this climate. If a patient can be taken to a more suitable climate and be given the benefit of the open air, I believe the chances of recovery are considerably greater than in this climate.

So far as medication is concerned, I do not believe that, up to this date, anything has been discovered which really cures consumption. This is a question which should concern, not only the profession, but the laity. Any disease which causes, as it is said this one does, the death of one person out of every seven who die, should certainly receive the earnest consideration of the public at large. I believe a great deal could be done to prevent the spread of this disease by the passage and enforcement of an anti-spitting ordinance, and by the elimination of teachers who are suffering with tuberculosis from the public schools. Several years ago the attention of the School Board was brought to the fact that a number of teachers in the public schools were afflicted with consumption, and a resolution was passed providing that every teacher should be examined and obtain a certificate showing perfect physical health.

If a cure for consumption is ever discovered, I believe it will be some sort of serum treatment, although up to this time we have no serum that will effect a permanent cure.

PROCEEDINGS OF THE ACADEMY OF MEDICINE,

STATED MEETING FEBRUARY 5, 1905.

DR. DUNCAN: I have a specimen to exhibit to the Society to-night. This is a uterus with two fibroid tumors, removed twelve days ago from a colored woman about forty years of age. The interesting part of it is that it exhibits such an unusual shape, and that, although very small, it was lying in such a position as to practically choke up the pelvis. It lay almost transversely in the pelvis, slightly inclined upwards and backwards. It was adherent above, on the sides, and posteriorly to the intestines, and on account of the thickness and breadth of the mass. It was very difficult to get at. The peritoneum was stripped down in front and behind, and a supra-cervical amputation was done.

This woman had suffered for about two years, but I suppose the tumor had existed for a longer time than that. She had not been preg

nant for thirteen years.

Complicating the tumor was a condition resulting from an inflammatory disease of the pelvis. The tubes and ovaries were imbedded in an inflammatory exudate which filled Douglas' cul-de-sac, and the only way to locate them was by following the tubes from the cornea of the uterus and ascertaining that they must be down in the cul-de-sac. There was no way to recognize them by the sense of touch or sight. After getting the uterus out of the way and controlling the hemorrhage from the stump, the ovaries were removed.

DR. SIMRALL ANDERSON: I have one or two specimens to exhibit tonight; the first of which is somewhat similar to the specimen presented by Dr. Duncan. Dr. Freeman probably remembers the case, which was one of fibroid, complicated with pus tubes, which filled the entire pelvus. The intestines were adherent and all landmarks destroyed, which made removal very difficult. The pus tubes are of pretty good size. The appendix was adherent to the right tube, and also was removed. Drainage was used, and the patient did not have any trouble at all.

I have another specimen here which I removed this morning from a woman who was sent here from the country with a terribly enlarged abdomen. She measured forty-eight inches around at the umbilicus. Upon opening the abdomen we found the peritoneum very much thickened, and soon came across this cyst wall. It was opened, and a chocolate-colored fluid ran out. We got out a little of the sac and found that she had extensive papillomatous disease. The whole interior of the cyst, as well as the outside, was studded with little warts. It was found impossible to remove the cyst, so we used two cigarette drains, one placed behind the uterus and the other in the sac; there was very little hemorrhage.

DR. ABELL: Any warts on the intestines or abdominal wall?

DR. ANDERSON: The whole uterus was studded with them, and they

also appeared on the abdominal wall.

DR. ABELL: Has she ever been pregnant?

DR. ANDERSON: I believe she has had one child.

DR. FRAZIER: How much fluid came out of the sac?

DR. ANDERSON: About four or five gallons.

DR. BULLITT: Was it all in the sac and none in the cavity?

Dr. AnderSON: All in the sac.

I believe these small

DR. JAS. VANCE: Dr. Duncan's specimen is very interesting on account of the diffculty experienced in removing it. inflamed pelvis-bound tumors are about the most difficult problems a surgeon has to deal with in the pelvis, especially where they are closely adherent to the intestines, as reported by Dr. Duncan.

The second case reported by Dr. Anderson was unquestionably a malignant one, and teaches us to have more respect for a cyst. It is

generally supposed that a cyst is a very harmless sort of a tumor, but Shauta teaches that 20 per cent. of them are malignant. When the cyst can be removed in its entirety, the prognosis in these cases is generally very good, but when seen as late as the case reported by Dr. Anderson there is very little chance for recovery. Cystic degeneration of the ovaries is not, in this country, regarded as malignant, for the reason that, in a majority of instances, the entire growth is removed.

DR. DUNCAN: I overlooked one point in connection with the case which might be of interest. Recognizing the fact that the pelvis was pretty well choked up with this mass, and that there would be some difficulty in avoiding the ureters, I attempted to catheterize them before administering the anesthetic. I used the Bransford Lewis female ureter cystoscope, and succeeded in introducing the catheter into the right ureter. I also found the left orifice, but, owing to the too great flexibility of the catheter, I was unable to introduce it. There was no question about having found the right place, but the catheter was not stiff enough. Thirty-six hours after the operation, which was long and tedious, the patient passed a considerable amount of blood with the urine, which I believe to have been the result of trauma in the longcontinued effort to catheterize the left ureter. The catheter was left in the right ureter during the entire operation.

DR. JAS. B. BULLITT: The specimen exhibited by Dr. Duncan is illustrative of two things: First, that the symptoms produced by fibroids are not always in proportion to their size; and, second, that the small tumors are often the most difficult to remove. As Dr. Vance stated, where a fibroid has risen well out of the pelvis it is generally easier to remove than one with a short neck.

I believe that in operating on cases of this kind, we probably neglect a method which would often make the operation much simpler. A good many years ago, and even at the present time, there are operators who remove tumors of this kind through the vagina without a great deal of difficulty, although I believe it would be dangerous for a person who had never done any work of this kind to attempt it. The tumor should be tackled first from the vagina; then the abdomen should be opened, and the operation completed from above. In these particular kinds of tumors where this method is applicable, the operation is simplified very much.

However, a fibroid tumor, just because it is a fibroid tumor, does not necessarily demand surgical interference, unless it produces symptoms, such as hemorrhage, general discomfort, or pressure symptoms. cite a case illustrating this point. A woman who had borne a child when quite young, but who had been a widow for seventeen years, married a second time. About two years afterward she became pregnant and miscarried about the third month, but she did not exhibit any unusual symptoms. She became pregnant again, and between the fourth and fifth months of pregnancy she developed great pain about the neck