silver was employed by inunction ended in recovery, and it did seem to me that the favorable result was in a measure induced by the inunctions of the silver.

Before closing I desire to lay especial emphasis on the importance of watching very carefully every puerperal woman who shows the slightest elevation of temperature. If it be assumed that such elevation denotes sepsis unless some other cause unmistakably accounts for it, and the proper treatment instituted at once, then, in my opinion, it will rarely occur in private practice that a case of puerperal sepsis will be encountered in which any serious surgical intervention will be needed.

Clinical Reports.

CLINICAL SOCIETY OF THE NEW YORK POLYCLINIC MEDICAL SCHOOL AND HOSPITAL.

STATED MEETING HELD FEBRUARY IST, 1904.

The President, Dr. James Hawley Burtenshaw, in the Chair. GASTROPTOSIS.

Dr. W. V. V. Hayes showed a patient, a woman 38 years of age, who first came under his observation three years ago, suffering from gastroptosis. She gave a history of severe gastric pain, which ran through to the back, coming on after eating and lasting for two or three hours. She vomited frequently, and was unable to obtain relief until the stomach was empty. Eructations of gas, anorexia and constipation were marked symptoms. The stomach, on examination, proved to be sensitive to the touch, and was displaced downward about the width of three fingers, as shown by the position of the lesser curvature. The functional signs revealed an adenasthenia gastrica, there being no free HCL and a total acidity of only 20. Tincture of nux vomica and fluid extract of condurango were administered. (Incidentally, in the course of treatment, she was relieved of a tape worm). The Vanvalzah-Nisbet bandage was applied to the abdomen. This

bandage reverses the action of the ordinary corset and pushes the stomach upward and backward. Occasionally the use of a supporting bandage produces a decided change in the position of the stomach, but ordinarily this can hardly be expected. There was a distinct improvement in the condition of the patient. She had gained several pounds in weight, which doubtless helped to keep the stomach in better position. Her general condition was much improved, and there had been practically no symptoms for three months. The supporting belt was no longer required.

She was given solutions of bicarbonate of soda and tartaric acid, about a minute apart, to demonstrate the improvement in the position of the organ, which was found to be two fingers' breadth higher than when originally observed.

ATROPHIC GASTRITIS.

This patient, a man fifty years of age, was also presented by Dr. Hayes, who first saw him in 1897. The patient then gave a history of having suffered for about a year from vertigo, nausea, regurgitation of food and expulsion of gas three hours after eating; his appetite was poor, and there was a tendency to diarrhoea and extreme nervousness. He had been moderately addicted to the use of alcoholic drinks, and had taken large amounts of strong medicines. He was treated for syphilis in 1890-1891. Analysis of the stomach contents during the past six years gave practically the same results. The total acidity ranged from 6 to 10. No free hydrochloric acid was found. Ferments were absent, but mucus was always present. The condition was one of atrophy of the mucus membrane. The speaker said that there had been very little change in the condition of the patient and there would probably be very little, so long as the motor function of the stomach was retained and the intestinal compensation maintained, but if these should fail, very little could be done to help him. During the six years the stomach had practically done nothing except to pass the food onward. This patient demonstrated how a person with atrophic gastritis may live for a long time in comparatively good health.

Dr. Morris Manges opened the discussion of the second patient presented by Dr. Hayes. He called attention to the statement which had been made in the presence of the patient,

that large quantities of the iodides which the man had taken were probably responsible for the atrophic gastritis. The speaker said that in his opinion atrophic gastritis was one of the most complex and least understood of all diseases of the stomach. There is no positive evidence as to whether it comes from the mucosa or the submucosa further down. It is known that cases of pernicious anemia exist and are associated with atrophic gastritis. The exact pathological classification is unknown. As regards the influence of strong medicines in the causation of gastritis, it may occur as well in the late stages of alcoholism, but that is an entirely different picture. Atrophic gastritis is largely due to changes in the portal circulation, secondary to changes in the liver itself, and there is a clear distinction in the etiological elements of the cases, and subsequent changes have nothing whatever to do with the disease. Many syphilitics have had larger doses of iodides than the patient under discussion, and no atrophy resulted, but the patients derived the greatest benefit from this medication. The speaker said he prescribed for all cases of atrophic gastritis 5 to 7 minims of hydrochloric acid at each meal, for the remainder of their lives, and thought that this treatment and the motility of the stomach were the chief factors in the disease.

DERMOID CYST.

Dr. James P. Tuttle showed a very unusual specimen of a dermoid cyst. There was practically no history until the day previous to the operation, when the patient, a girl about 18 years of age, went to the office of her family physician and complained of difficulty in making her bowels move, and excessive pain when they did move. She was given an enema and a laxative. The next morning she had a chill. Examination then revealed a tumor in the left inguinal region about the size of a small orange. Her temperature was about 100 degrees F. Three hours later the tumor had apparently increased about two-thirds in size, and the girl's temperature was 102 degrees F. Dr. Tuttle was called in consultation and found her with a temperature of 102 degrees F., inability to move her bowels, and a fluctuating mass in the left iliac region and in the recto-sigmoidal juncture. His diagnosis was hematoma. The following day her pulse was faster and there seemed to be

hemorrhage, so the vagina was opened through the posterior cul-de-sac, and about six ounces of clear, serous fluid was evacuated. Passing his hand further up, a large tumor was found, and the operator, supposing it to be an abscess, poked his finger through a rent in the apparent capsule, and fluid gushed forth, which, on bacteriological examination, proved to be filled with fat. Inside the capsule was a tumor, which was removed through the vaginal opening. On one side of the tumor were four protuberances, just in line. This mass, which was on the left side, was attached by a pedicle to the posterior surface of the right lobe of the liver. The tumor had apparently been lying in the posterior cul-de-sac, and the hemorrhage pushed the tumor up to the position in which it was found at the time of operation.

Dr. J. Riddle Goffe said that Dr. Tuttle's specimen was a remarkable one. These masses are commonly found in con nection with the ovaries, and the most he thought of the development of a dermoid teratoma, the more inclined he was to believe that it was necessary for some form of degenerate conception to have occurred previous to their development. However, in the specimen under discussion, this was probably not true, as the patient was a young girl, and Dr. Tuttle said that both ovaries were present and absolutely undisturbed. It seemed that one might trace a faint outline of a fetal mass, the larger projection at the top of the mass representing the head, two projections lower down for the shoulders and arms, and two at the other end for the lower extremities.

VESICAL CALCULI.

Dr. E. L. Keyes, Jr., presented a large number of specimens of vesical calculi, and gave a most interesting talk on the formation of these stones, the differences in their composition and appearance and the procedures by which they had been taken from various patients. He said that the first interesting feature about stone in the bladder is the different varieties that occur and the manner in which they may be distinguished from each other. If the bladder is opened and the specimen taken out whole, the stone presents one picture, and it is crushed and sucked out through the urethra, the picture differs. The first specimens shown represented stones under the two forms.

The first distinguishing characteristic of these calculi is that they are either primary or secondary. The primary stone forms itself for no reason that can be recognized; the sec ondary stone is formed by the inflammation produced by the primary stone. While there are a great many different varieties under either head, the chief groups are the oxalate of lime stone, the uric acid stone, and the urate of soda stone. There are many kinds of secondary stones, but they are all modifications of one mixed mass of the various phosphates, and are known as mixed phosphates stones. Among one hundred and fifty stones, all of which had not been examined chemically, the speaker said that as far as he knew, all were included in one of these four classes.

Specimens were shown representing four different varieties of stone under two different guises. Some were composed of oxalate of lime, and were very irregular in shape. For this reason they are sometimes known as mulberry stones. The color is not very clearly brought out, but they vary in shade. A urate stone shown at the same time was distinctly lighter in color than the mulberry stone, and the surface of the former was much more regular, but not entirely smooth. The phosphatic stone is smoother and somewhat resembles white agate in appearance. In the crushed specimens the color is much the same as in the whole stones, but is more distinct. The primary stones are all distinctly darker than the secondary phosphatic stones. Very frequently uric acid and urate stones are mixed in one deposit. Both have a distinctly reddish hue, as compared with the brown of the oxalate.

A point worth noting is that the secondary stone sometimes forms as the result of inflammation caused by the primary stone; consequently in many secondary stones the beginning is primary, and the primary stone rolls about in the bladder, cystitis results, and changes occur in the alkaline urine, which throws out phosphates which are deposited on the primary stone. The speaker showed one stone which had existed for many years as a primary stone before it developed a phosphatic covering. The proper bacteria were not present to render the urine alkaline; a cystitis must have been present for many years before it became alkaline. Another specimen was an oxalate stone through which peaks of oxalate showed through the deposit of phosphatic covering. One great Eng