MINUTES OF THE SECTION ON SURGERY AND ANATOMY. TUESDAY, May 3, 1881. HUNTER MCGUIRE, M.D., Virginia, Chairman; DUNCAN EVE, M.D., Tennessee, Secretary. Dr. J. H. WARREN, of Massachusetts, presented various new surgical instruments, consisting of vermicular-pointed catheters, his modification of Sir Henry Thompson's tube, having a tip, one-half of which is thrown back by a spring after it has entered the bladder; also Bigelow's tube with a vermicular point, a uterine probe with a revolving point, urethral and uterine sounds with revolving bulbular points, etc. Dr. L. A. SAYRE, of New York, asked, why complicate all these instruments by the addition of a joint and a rotary point? Dr. WARREN replied, that the vermicular point facilitated introduction. Dr. J. W. S. GOULEY, of New York, regarded it as a complication in the construction of instruments, the chief idea of which should be simplicity. Besides, the jointed arrangement gave opportunity for the retention of poisonous material, and, therefore, its possible transfer from one patient to another. In sounding for stone we should have an instrument with an absolutely rigid extremity. If anything was to be added it should be at the distal and not the vesical extremity. We need not trust to resonance, for the surgeon's experienced touch is sufficient to enable him to recognize a vesical calculus. He hoped the instruments would not be introduced into surgical practice. Dr. S. N. BENHAM, of Pennsylvania, believed that the joint was in violation of acoustic principles; that an unbroken communication offered the best possible means for the transfer of sound. VOL. XXXII.-26 Dr. H. O. MARCY, of Massachusetts, presented a Double Irrigation and Injection Tube, which could be used as stomach tubes, uterine and rectal tubes, and catheters. Dr. GOULEY remarked that he had had a double soft rubber catheter during the last five years. He, however, never uses the double catheter in the male bladder. Irrigation should be done as quickly as possible, and not kept up constantly. Dr. MARCY believed that cystitis could be treated satisfactorily with heat, and that it could be applied by means of the double soft rubber catheter better than by any other. Dr. WM. A. BYRD, of Illinois, uses a single rubber tube for a stomach tube, and fills it from a funnel, reversing the patient. and allowing the fluid to run out. He was taught to do so by Dr. Hodgen, of St. Louis. The chairman referred to a case in which a soft rubber catheter was rubbed completely into the bladder, from whence he removed it the next day with a lithotrite. Dr. Wм. A. BYRD, of Illinois, presented A Specimen of Ulceration and Perforation of the Appendix Vermiformis. He had operated in four cases, previously published. His plan was to cut down, stitch the edges of the opening into the abdominal section, and then keep the wound thoroughly clean and antiseptically protected. Dr. T. HERRING BURCHARD, of New York, spoke of acute perforation, and proposed operation immediately after the patient had rallied, and before the supervention of peritonitis. Dr. C. B. NANCREDE, of Pennsylvania, referred, among the causes of intestinal obstruction which might require laparotomy, to inflammation of all the coats of the intestine, and so arresting peristaltic action. An acute inflammation of some portion of the intestinal tract might follow any of the causes of peritonitis, and be severe enough to involve all the coats of the bowel without becoming general peritonitis. He referred to a case in which that view was sustained by autopsy. Dr. JAMES E. REEVES, of West Virginia, presented for Dr. B. W. Allen, the report of a case of Pyonephrosis, with a Nephritic Calculus weighing 480 grains. The patient was a widow, aged fifty-five years. Her urine was always found normal. The tumor was aspirated, and eighteen pounds of sero-purulent fluid removed; the sac refilled, when aspiration was repeated, and fourteen pounds of purulent fluid were withdrawn. At the autopsy, ten pounds of pus escaped from the sac, which was fifteen inches long, twelve inches wide, and six inches thick. The pressure of the tumor occluded the ureter, and prevented any of the fluid from finding its way to the bladder. The Section then adjourned, to meet on Wednesday at 3 P. M. WEDNESDAY, May 4, 1881. Dr. CHARLES F. STILLMAN, of New York, read a paper on A New System of Surgical Mechanics. Dr. R. A. KINLOCH, of South Carolina, thought too much advantage was claimed for such contrivances; thought much could be done by rest secured in other ways; wished this fact was better appreciated; was sorry he could not share the enthusiasm of Dr. STILLMAN, but had failed to secure as good results. Dr. I. N. QUIMBY, of New Jersey, endorsed fully Dr. KINLOCH's remarks, and was especially emphatic in approving the treatment of club-foot with adhesive strips, plaster-of-Paris, etc., instead of costly shoes and braces. Thought mechanical instruments were sometimes useful, but were also capable of great abuse, and thought that they did not control muscular contraction. Dr. ALFRED C. Post, of New York, read a paper on Plastic Operations on the Face. Dr. D. H. GOODWILLIE, of New York, read a paper on Arthritis of the Temporo-Maxillary Articulation. Dr. E. M. MOORE, of New York, called attention to cases in which cicatricial bands caused the trouble, division of which usually cured them. Dr. S. D. GROSS, of Pennsylvania, had seen comparatively few such cases since the abuse of calomel had ceased. He had not been able to accomplish much with wedges, etc. He also alluded to section of the bone, and had performed the operation successfully. The Chairman thought that treatment with wedges, etc., should be prolonged. He referred to a case in which a bony bridge passed from the lower jaw, giving rise to apparent anchylosis. He divided the bridge, and movements were soon restored. Dr. LEWIS A. SAYRE applied a plaster-of-Paris jacket to a patient suffering from a lateral curvature of the spine. Dr. J. C. HUTCHISON, of New York, believed that lateral curvature of much duration could not be cured by any mechanical appliances. Dr. J. T. HODGEN, of Missouri, had seen some unpleasant effects produced upon the lower jaw by the jury-mast, and he also spoke of the liability of the plaster jacket to produce hernia. Remarks were also made by Dr. S. D. GROSs, and on his motion a vote of thanks was extended to Dr. Sayre. The Chairman announced as Commitee on Prize Essay, from the Surgical Section: Drs. R. A. KINLOCH, of South Carolina, T. F. PRATT, of Missouri, and T. HERRING BURCHARD, of New York. The Section adjourned, to meet on Thursday at 3 P. M. THURSDAY, May 5, 1881. Dr. B. A. WATSON, of New Jersey, read a paper entitled An Experimental and Clinical Inquiry into the Etiology and Distinctive Peculiarities of Traumatic Fever. Dr. A. C. POST, of New York, directed attention to Dr. MARKOE's plan of thorough drainage, and thought it superior to that practised by LISTER. The paper was further discussed by Drs. II. F. CAMPBELL, of Georgia, I. N. QUIMBY, of New Jersey, and C. B. NANCREDE, of Pennsylvania. Dr. CHAS. A. LEALE, of New York, read a paper on Labial Carbuncle; or, Malignant Pustule and its Treatment. Dr. ALFRED C. POST, of New York, stated that the subject was a most important one, and he was very much pleased with the paper of Dr. LEALE. Dr. Post thought that when we see the patients early with malignant pustule a large proportion can be saved. He usually operated by cutting through the vermilion border of the lip. The Section adjourned. OPERATIVE INTERFERENCE IN GUNSHOT WOUNDS OF THE PERITONEUM. BY HUNTER MCGUIRE, M.D., VIRGINIA. IN the British army, in the Crimean war, penetrating gunshot wounds of the abdomen gave a mortality rate of 92.5 per cent. (Matthews); and in the small number reported as recovered, some of the cases were not unequivocal. M. Chenu records the death-rate in similar injuries in the French army at 91.7 per cent.; and Dr. Otis, who has collected the records of 3717 cases of penetrating wounds of the belly during the late American war, gives the ratio of mortality for the whole number at 87.2 per cent., and in some of the instances of reported recoveries, the compiler doubts, after a rigorous examination, whether penetration of the peritoneal cavity existed. In 2599 cases where visceral injury had taken place, 92.2 per cent. died. There are other reports of penetrating gunshot wounds of the peritoneum in other wars, where the ratio of mortality will reduce those given above. These reports, not embracing the three above recorded, make the death-rate of such wounds a little over 75 per cent., but I have not employed them here because in some instances the records are incomplete, in others only a small group of cases is mentioned, and in others, wounds of the pelvis, which are far less fatal than wounds of the belly, have been included. Such is the appalling record of penetrating wounds of the abdomen in cases coming under surgical treatment, for the list does not embrace the killed, or those dying on the field from hemorrhage or shock. More than nine cases in ten of wounds. of the belly, opening the cavity of the peritoneum, perish. There are no other gunshot wounds so deadly. Penetrating and perforating wounds of the skull are less fatal. Is it not time that we were trying some other course of treatment in |