tion. Third Paper. Abdominal Diagnosis as Tested by Opera Dr. J. N. Hall presented the paper with the view of comparing diagnosis with operative findings. A working diagnosis should be arrived at, and in doubtful cases an exploratory operation should be urged, and thus many lives would be saved. His paper was based upon a study of 312 cases, in which the diagnosis was substantially correct in 244; the remaining 68 cases showed mistaken diagnosis, yet operation was necesary. Life was prolonged in a great number of these cases. Dr. Mayo said that the advance in intraabdominal diagnosis was made possible by the living pathology learned on the President of Colorado State Medical Society. Secretary of Colorado State Medical Society. operating table in the last few years. We have learned that in 85 per cent of tuberculosis of the kidneys only one kidney is involved. Exploratory operation is advisable in cases where we know that something is wrong, although nothing definite is established. Kidneys should be examined more thoroughly in abdominal operations. Half of our failures are due to hasty examinations. The patient should always be stripped and every organ thoroughly examined. A whole lot of mortality accepted by the surgeon should not occur. The condition of the glands is too often overlooked prior to operating. Dr. Powers. Some of the errors in diagnosis committed by Dr. Hall should not be counted. Palliative and temporizing measures should be discouraged in intestinal conditions. Make a surgical diagnosis in intraabdominal operations. Careful examinations will be productive of correct diagnosis. Paper No. 4. Tubercular Seminal Vesiculitis. Dr. J. F. McConnell said that it was a very common affection, forming one-third of all the tubercular affections of the genito-urinary tract. The cases as presented to him were subacute and chronic, usually unilateral, and frequently disregarded on account of slight symptoms. Functional symptoms come first. The urinary act is very tardy, with various neurotic symptoms during urination. The diagnosis can only be made from the more nodulated outline of the seminal vesicles when examined digitally than in any other condition. When the disease is clearly limited to the vesicle the treatment should be operative and the disease radically removed. other cases it should be hygienic and supporting. Dr. Mayhew thought that the disease is always associated with tuberculosis of other organs of the genito-urinary tract. Rest and climatic treatment is of no avail, surgical interference being the only rational method of procedure. He advises thorough removal of the diseased organs. Dr. Niles said that the paper is very suggestive in the matter of diagnosis. He can recall some cases where the patients would have benefited, had a diagnosis been made. The diagnosis in these cases should be painstaking. He would like some information regarding the pathology, especially in cases of primary tuberculosis of the genital organs; also the relation, if any, between tuberculous epididymitis and vesiculitis. He doubts whether the disease remains unilateral as it progresses. Dr. Freeman called attention to the progress made in the study of genital tuberculosis. It was formerly thought that it took place primarily in the bladder, but at present it is universally conceded that the tuberculous process originates in the epididymis, and becomes only secondary in the seminal vesicles from that source, and may stop in the vesicle or prostate. Tuberculous cystitis usually comes down from the kidney. Experiments have shown that tuberculous cystitis may be improved and in some cases even cured by the removal of the kidney. In tuberculosis of the seminal vesicles think of the epididymis and try to get rid of it, thus removing the original focus. The operation of choice is epididymectomy, while an operation for the seminal vescicles is tremendous, and should not be thought of in the majority of cases. Dr. McConnell in closing said that he fully agreed with the last speaker. In answer to Dr. Niles would say that the disease becomes bilateral in time. The hardest problem in this disease is the diagnosis, which is made still more difficult by the rare possibility of finding the tubercle bacilli in the expressed secretion from the vesicle. He would lay great stress, however, upon the freedom from pain and the nodulations upon digital palpation, these two forming the most important symptoms. Presence of pus in the urine, also positive test for albumosis should be thought of. The prognosis is fairly good in the early stages. Paper No. 5. Bone Cavities and Interspaces and their Treatment. Dr. H. G. Wetherill considered dead spaces the dread of surgeons, especially in bones where the obliteration of cavities and spaces forms a very difficult problem. The indications are well understood, and some cavities are amenable to treatment. The material used in the obliteration of bone cavities must be of such character that will gradually give way to the new granulations and connective tissue. All conditions, however, are not fit for this material, and some failures must be attributed to faulty technique. The bone cavity must be properly prepared. The substances commonly used are plaster-of-Paris, sponge, blood clot, decalcified bone chips and iodoform wax or Moorhoff's plumb. In using the last named preparation, which has given such exceptional results in the Moorhoff clinic, one must acquire the correct technique. Its application is adaptable to unopened and unmixed tubercular infections of bone. The plumb casts a deep shadow with the X-ray, and the results can thus be followed from week to week. The formula for Moorhoff's plumb is iodoform powder 60 parts, spermaceti with oil sesamum 40 parts. After its introduction into the cavity the periosteum and the skin are sutured over it. The author emphasized the following two features when using the plumb: (1) Absolute sterilization of the cavity; (2) absolute drying of the cavity. Keep the moisture away from the cavity by the use of a tourniquet. Mop cavity with pure carbolic acid and neutralize with alcohol. This preparation is employed in all forms of osteomyelitis, sinuses and all kinds of joint fistulæ. The essayist has made several inquiries from surgeons who have used the method extensively, and concludes that when properly used it gives excellent results in about 60 per cent of all cases; many surgeons attribute their failures to faulty technique. Dr. Mayo, speaking from considerable experience with the Moorhoff plumb, claims that in osseous tuberculosis one should get primary healing, while in mixed infections three to four applications may be necessary. His advice is not to curette all the granulation tissue out, before putting in the plumb. In loose cancellous structures the wound can not be kept clean in spite of the Esmarch bandage. In such cases he uses iodoform gauze to pack the cavity and puts the plumb in 4 to 5 days later. Dr. Grant said that the great difficulty lies in the getting of an absolutely clean cavity in chronic osteomyelitis. In the past we have neglected to remedy the inefficient blood supply, and this has given rise to the great success attained in these cases by the Bier treatment. He advises that the Bier method of artificial hyperemia be added to the Moorhoff plug in the treatment of cases of osteomyelitis, and that the combined method has given most excellent results. Paper No. 6. cases. Recoveries. Acute Pancreatitis with Report of two In the absence of the essayist, Dr. Walter A. Jayne, it was moved and carried that the paper be read by title. Paper No. 7. Results in Cases of Amputation at the Shoulder Joint. Dr. C. A. Powers in presenting the subject said that it was of general interest owing to the questions which usually arise: Should amputation be done, and the time chosen for its performance. A short segment of the humerus is preferable. to complete dislocation. His conclusions were based upon six cases, two of which were operated for sarcoma, two for sepsis and two for trauma. All patients made good recoveries. He employed the racket-shaped incision, the method of Spence, and considers it the operation of choice. One must endeavor |