monary or pleuritic involvement, for the reason that some apparently hopeless cases fully recover. 8. When there is a tubercular peritonitis, a sequel of tubercular tubes, ovaries or appendix, the primary focus should always be removed. 9. In these tubercular cases the mesenteric glands have not been found frequently involved, and when they are operation accomplishes very little good. 10. In tubercle of tubes and ovaries, the adhesions are usually firm, sometimes, though not usually, very vascular, and not infrequently involve loops of the small intestine; hence the greatest care is necessary to avoid serious injury.to the bowel and at the same time separate completely all adherent surfaces and provide complete drainage. 11. Drainage is the great factor in recovery, when properly carried out.

Pyloroplasty with the McGraw Ligature. DR. J. HENRY CARSTENS, Detroit, said that many cases with disturbances of digestion can not be diagnosticated or relieved by medication. These should be subjected to an exploratory celiotomy. Gastroenterologists should not treat patients for months and years if they can not make a positive diagnosis or cure a patinet. After reasonable efforts the patient should be sent to the surgeon for relief.

The McGraw ligature is a valuable means of relieving stricture at the pylorus and the resulting dilatation of the stomach. This method of operating is easy and quick; the danger is very small, and the operation is preferable to those heretofore used in benign operations and tractions of the pylorus. It is a great deal better than gastroenterostomy, as one restores as nearly as possible the normal condition.

Ovarian Cystoma.- DR. L. P. LUCKETT, Terre Haute, Ind., reported a case of ovarian cystoma on which he had operated. The tumor originated from the left ovary, was attached by a broad pedicle, which was tied off in sections. The uterus and right ovary. were found to be normal. The fluid and tumor were estimated to have weighed between seventy and eighty pounds. The patient made an excellent recovery.

Closure of Vaginal Fistulae.— DR. MAURICE J. ROSENTHAL, Fort Wayne, Ind., said that a considerable area of scar tissue and vaginal mucosa may be inverted into the bladder without producing ill effects. Ureteral fistula embedded in scar tissue may be inverted into the bladder and continue to discharge its urine without becoming stenosed. Even large vaginal fistulae, where part of the bladder walls are lost in scar tissue from a previous hysterectomy may be successfully

operated by denudation and suture through the vagina without disturbing the relations of the bladder or by any adhesions of pelvic viscera which may have formed in the scar.

Sprained Ankle.-DR. ROBERT CAROTHERS, Cincinnati, drew the following conclusions: although some are more prone to it than 1. No one is exempt from a sprained ankle,

others.

2. In severity a sprained ankle will' range from a trivial accident to one of extreme severity and everlasting. 3. The outer side more often than the inner side of the ankle is the seat of trouble. 4. The diagnosis, which is ordinarily made with ease, is at times made with difficulty, and occasionally an X-ray examination is required to make the diagnosis certain. 5. The treatment by immobilization with a plaster of Paris cast is unsatisfactory and at times injurious. That the treatment instituted by Coteral, the so-called adhesive plaster strappings, advising and urging the patient to walk on the injured foot, the early removal of these straps, followed by massage, gives the most satisfactory and best results. 7. That the old cases are to be, under anesthesia, converted into acute sprains and treated in the same manner.

6.

Shall the Profession or Laity be Responsible for the Death Rate in Appendicitis.- Dr. J. C. O'DAY, Oil City, Pa., said that every physician, when confronted with a case of appendicitis, should frankly tell the patient the nature of this trouble; explain to him, honestly and candidly, the disposition of his disease; that no one can tell what an inflamed appendix will do, and that there is no safety till the offending organ has been removed. If the patient then decides to postpone operation, he, not the surgeon, should be responsible. If this were done, he thinks we would have no more complaits of, "Why did not the physician advise operation before it was too late?"

(To be continued.)

A urethral endoscope will be found a great help as a means of introducing a rubber drainage tube into a narrow, tortuous sinus.

THE SENN BANQUET.- The testimonial banquet to Dr. Nicholas Senn, at Chicago, on November 11th, was a happy event, and attended by over 600 of the great surgeon's professional friends. Among the speakers were Drs. J. D. Bryant, New York; L. S. McMurtry, Louisville; Wm. J. Mayo, Rochester; C. A. L. Reed, Cincinnati; J.A. Witherspoon, Nashville, and others. Dr. Wm. J. Evans, Chicago, was the toastmaster.

THE MEDICAL FORTNIGHTLY

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MEDICAL MISCELLANY

ACUTE PANCREATITIS.-John G. Sheldon

(Medical Record) suggests that the following points be made the subjects of discussion

by writers on acute pancreatitis: (1) The presence of glycerin in the urine, which Cammidge and Robson claim is characteristic of pancreatic disease. (2) Regarding the infections or mcehanical nature of the process in the stages of the disease. (3) The significance of the condition of the gall blad

der.

The author has found it distended and very tense in three out of four cases of acute pancreatitis operated on or observed at autopsy, and did a cholecystotomy in a supposed instance of acute pancreatitis twelve hours. after the onset of symptoms, the case terminating in recovery.

THE VAPOR METHOD OF ANESTHESIA. The stated meeting of the Medical Society of the County of New York was held at the Academy of Medicine on Monday, September 25th, 8:15 p. m. Dr. James T. Gwathmey read a paper on "The Vapor Method of Anesthesia."; He portrayed the evolution in the administration of anesthetics from the time when chloroform was given "powerfully and speedily," and when an unmeasured quantity of ether was poured into the open cone up to the present, when each drop of these powerful drugs is both measured and timed. Snow, Clover, Paul Bert, Junker followed in succession and assisted in elimin

ating the unknown and placing anesthetics on a firm and solid basis. The Harcourt chloroform inhaler in England, the Braun chloroform-ether inhaler in Germany, and the Gigliementi oxygen-chloroform inhaler in France, represent the very latest contributions towards the accurate administration of anesthetics. The objection to the French and English inhalers is, that they are for chloroform alone and use closed masks with valves. The Braun inhaler is the best, but the mask was undesirable. Dr. Gwathmey then exhibited his own inhaler, the unique features of which are that chloroform or ether can be given singly or combined in any desired proportion; the ability to increase or decrease the air or oxygen without, at the same time, increasing or decreasing the anesthetic; the mask, an anatomically correct, fitting face piece, the rim of which is hollow and perforated around the inner margin to allow the vapor to escape; otherwise identioal with a folding Esmarch mask. This is covered with four layers of gauze over which is placed a piece of oiled slik or rubber tissue. A small opening is cut in the middle of this gauze, so that, during the induction period, a few drops of chloroform may be added as with vigorous alcoholics. Dr. Gwathmey's inhaler gives a maximum 2% The inhaler, which is made by Kny-Scheerer chloroform vapor with a minimum of 1-10%. Company consists of three ounce bottles in each of which are four tubes, varying in length from one that reaches the bottom of the bottle to one that penetrates only the stopper. These tubes represent four degrees of vapor strength, the longest with the mask just described, as an estimated 1% vapor strength; the shortest, No. 1, representing a very attenuated vapor, one-tenth per cent. A the mask is not air tight, the vapor can not be compressed, thus avoiding the danger of an over-dose. The advantages of this form of anesthesia are: 1st. A pleasant induction 3d. stage. 2d. Stage of excitement absent. Pulse and respiration normal. No mucus rale or billowy breathing. 4th. Complete relaxation. 5th. Absence of unpleasant after effects on account of the attenuated vapor used. 6th. The continued use of an attenuated oxygen or air and chloroform vapor of known percentage, to which an attenuated ether vapor can be added or substituted, when conditions require a change. 7th. A possible change in the vapor percentage with the same flow of oxygen or air, by a change of tubes or by varying the pressure in the same tube or by a combination of the two methods. In the discussion following Dr. John A. Bodine urged the desirability of overcoming the element of fear.