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Dr. Andrew C. Smith discussed several of the most important papers, and no one who has ever heard him speak or who knows of his large surgical practice, need be told that the society felt much pleased to see him an active participant of the session.
Dr. Henry Waldo Coe, of Portland, Oregon, read a paper upon "Tubercular Meningitis," a fasciculus in the symposium upon the general subject of Tuberculosis.
THE MOSCOW COUNTRY.
“The Inland Empire," as it is called, that great body of territory directly tributary to Spokane, and indirectly to Portland, Seattle and Tacoma, is in many ways the most remarkable region upon the face of this remarkable old globe of ours. The present prosperity of Spokane is easily explainable to the visitor who goes through its immediate tributary agricultural country, and the advancing future of that city is beyond any question of doubt, in the mind of the fortunate observer of the resourcefulness of the soil thereabouts. Then too Spokane has almost everything else in addition to agriculture; gold, silver, coal, granite, wool, etc., to warrant indefinite improvement and advancement.
The Palouse region has to be seen to be appreciated. Its vastness in wheat farming is almost beyond computation, and its possibilities unrealizable. Dr. Watkins and Dr. Worthington took the visitors at the recent meeting to a hill top three miles from Moscow, where upon one hand and the other, there stretched open to the delighted gaze of the visiting delegates, an area of wheat nelds easily seen by the naked eye, cut, uncut or under the reapers ravages, at least sixty miles square, 3,600 miles square of land, smiling under fruitful and remunerative wheat producers. One county alone in the Palouse valley, Whitman county, Washington, will this year yield over 8,000,000 bushels of wheat. cow has reason to be proud of its State University, where $150,000 has already been expended in placing this needed institution upon a firm and lasting foundation. The expenditure of this money seems to have put the institution into most excellent working order, and with an additional appropriation of $25,000 or $50,000 it will be in a condition credit
able to the new state and to those who have had to do with the institution and its construction and management.
THE O. R. & N.
The Oregon Railroad and Navigation Company is one of the two railroads which carries the great wheat crop of Eastern Washington, Eastern Oregon and Idaho, and over which the Portland visitors came and went to the meeting. The impressions created by a trip over this line of the O. R. & N., added to those gained in former journeyings over other land and water routes of this great corporation, leave the observer in a state of amazing wonder at the vastness of the lines of travel which it covers, and the almost fabulous resources of the regions, which the building of the lines of such corporations has largely succeeded in developing. This corporation in rail and water lines covers about 3,000 miles, and travelers over almost every foot of this aggregation of thoroughfares, is insured the limit of ease and comfort incident to the most advanced means of transportation of these modern times, the passenger department under that veteran of Pacific coast travel, Mr. W. H. Hurlburt, having reached about the limit of possibilities in this regard.
Under the re-organized management of the corporation, the present president Mr. A. L. Mohler, has for months been engaged in straightening out the road, putting in fills in place of culverts, increasing the size of the rails and ballasting the road with rock, until its main lines and many of its branches are as smooth as a roadbed can be made, comparing favorably with the best eastern roads. Four years ago the road was in a receivers hand, but today owing to the gen eral improvement in the times, and especially to the present business methods employed in management, it has become one of the most attractive pieces of railroad property in America. The passenger earnings have increased during the last year over the year preceeding by 80 per cent. Freight earnings showed a like increase and the prospects of this harvest give promise of an increase in the coming twelve months over even the excellencies of the past year.
Portland Medical Society. The regular meeting of the Portland Medical Society was held in the Hotel Portland on the evening of October 5th, 1898, President Dr. E. F. Tucker presiding. Present: Drs. Amos, Binswanger, Boys, Brook, Coe, Cauthorn, Fries, Giesy, Jefferson, Josephi, Locke, Moore, McKay, K. A. J. Mackenzie, Parker, Panton, Rand, Smith, Thornton, Walker, Wilson, Wood and Labbe.
The meeting was called to order at 8:25, and the minutes of last meeting were read and confirmed. The application of Dr. R. E. Johnson for active membership was read and referred to the Board of Councillors. Dr. A. C. Smith drew attention to the continued membership of Dr. F. B. Eaton, who was formerly a resident of Portland, and now of San Francisco, and considering that the doctor was a charter member of the society, has always taken a keen interest as well as being an active participant in all its objects until his change of residence, he would move that he be placed on the roll of honorary membership. The matter having been discussed it was decided to proceed according to the constitution, balloting to take place at next meeting.
Pathological Exhibitions.-Dr. E. H. Parker exhibited an epithelioma of the cervix which had been removed recently from a patient, aged 46, mother of six children. The specimen, he said, was interesting on occount of the advanced stage of the disease before the patient was aware of the seriousness of ner trouble, it was also interesting on account of its multiple fibroid condition. The operation was very radical. The entire upper half of the vagina and a wide portion of broad ligaments and fundus removed by clamps.
Dr. A. J. Giesy then presented the paper of the evening, namely, "Retroversion, and Recroflexion, the Cause, Diagnosis and Treatment," which will be published in a future issue of the Sentinel.
Dr. H. C. Wilson opened the discussion by stating that the subject was of great interest on account of its frequency as met in general practice, and he said that too much stress was laid upon cases so called not requiring treatment. Retroversion when realy existing caused a great deal of pain and annoyance with varied symptoms, and was a condition hard to treat save by surgical means. Pessaries are still used but seldom give satisfactory results. Discussed the operation referred to by the writer of the paper, and drew attention to the advantage of Martin's operation, and the cases in which it is especially applicable.
Dr. Wm. Boys was pleased with the paper, he thought that the early treatment of this condition should be attended to, and one-half or more of the cases, said he, could be traced back to the result of childbirth. Examination should be made three or four weeks after every case of labor. One casc of retroflexion not mentioned in the paper in the non-puerperal as well as in all cases, is the anatomical difference between the body and cervix, thus making the junction weaker. Very frequently there are no symptoms until complications such as adhesions, etc., occur, then the condition is discovered, which early examination and proper treatment would have prevented. Those that resist treatment, if the condition calls for it, should be operated upon.
If adhesions exist and are removed by operation or otherwise, Alexander's operation, or one of its modifications, in his opinion, should be preferred.
Dr. J. M. Brooke was pleased to note the emphasis laid on the importance of suspension instead of fixation, the latter being a bad surgical proceeding. Had just heard of a case of Cæsarian section treatment at the Sloan Maternity Hospital due to the fixation operation. Of seven cases of suspension reported by Dr. Cragin followed by pregnancy, two had prolonged labor only, no instruments were used in any of the cases. Could not agree with Dr. Giesy that all cases of oophorectomy should be followed by suspension, as in the case of enlarged tubes, and operations with the uterus not relieved, or if relieved not adhering. In these cases if uterine pressure is removed, it will in most instances resume the normal position, and if enlarged will diminish in size after the operation.
Dr. E. H. Parker believed that not all retroflections and retroversions produced symptoms, or many that do are without operative interference. When the symptoms are marked and are unrelieved by local and general measures, he beneved practical ventral suspension, either single, multiple or in connection with other plastic operations. Disagreed with Dr. Giesy and believed in correcting retroversion and retroflexion, wherein the other plastic work as his experience taught him, that the symptoms are not relieved in these cases unless the dislocation is correct. Said he preferred suspension and not fixation. The cause of retroflexion and retroversion was, no doubt, due mostly to dorsal decubitus following parturition, and for that reason he is in the habit of advising literal decubitus, etc., as well as examination several weeks afterwards in order to find if the parts are normal. Reported normal pregnancies and confinements in three patients who have been subjected to ventral suspension.
Dr. K. A. J. Mackenzie said he had noticed frequently in practice the absence of adhesions in retroflection and when they were present invariably associated with inflammation of the tubes or ovaries. He had said he also noted that when, for instance, a torn perineum or troublesome hemorrhoids,etc., are properly dealt with, retroflections, etc., are very often corrected.
Dr. A. C. Smith drew attention to the gynecological work done in this city by the late Dr. Holmes, and much the same rules are advocated before the society this evening; he thought that Dr. Holmes could well be regarced as a pioneer in work of this kind, and that he was often unjustly criticised.
Dr. Giesy, closing the discussion, in reply, said that Dr. Martin had abandoned his operation. One of the many objections to Alexander's operation was the smallness of the broad ligament and the difficulty with which it is found compared with Edboh's. Said he had always made it a habit to examine patients several weeks after parturition for any displacements, and he regretted to say that a great many did not show up that promised to come.
Dr. Henry W. Coe reported a case which had possessed many strange symptoms, some of these having the looks of grave disease of the bulb and other portions of the cord. The patient was a man, aged 21, mechanic, unmarried, who had quit work on account of dizziness. He had dragged his left leg in walking for a few days and nually took to his bed. This was four months ago. He appeared to have difficulty in speaking and three months ago ceased to talk. It was with difficulty that he could be induced to eat, and what was eaten was quickly bolted. He would in the midst of eating, suddenly begin to choke and then vigorously dig out of his mouth such food as was therein and refuse to eat onger. He showed signs of difficulty in breathing and would sit up in bed until 4 or 5 in the morning clutching for breath and with each inspiration the nose became drawn and a peculiar noise was made by the incoming air. On account of distress in his throat, as was supposed, he made a peculiar noise at times, sometimes lasting for half a day. He did not control his urine, but passed it in bed, or sometimes in his clothing while standing. His muscles would sometimes become fixed in his extremities and remain in this condition for hours. Sometimes he would stand in such a fixed position for half a day. He was removed to the sanitarium where close observation was had over him. He was ferocious relative to friends and family, and it was with difficulty that he could be moved, and when forcibly put into the ambulance, he first showed evidence of ability to speak. The case quickly developed into one of hysteromaniacal catalepsy, under the close observation and study possible under institutional care. The incontinence of urine has nearly passed away under somewhat vigorous sounding administered by Dr. J. K. Locke, the patient objecting to the procedure in language forceful and not always polite.
Dr. Smith reported a case of appendicitis, third recurrent attack, in a girl 12 years old, and upon opening the abdominal cavity found a convoluted, densely adherent appendix, containing concretions and pus, and the most interesting of all the extraordinary features was the presence of the infiltrated omentum attached to the parietal peritoneum at a point over the appendix, and with which there was no connection with the appendix. And the question is how did it get there?
Dr. A. D. Walker reported having extracted a pessary after it had been in position for two years. It was perfectly clean and had caused no discomfort or obvious effect.
Dr. J. M. Brook reported tae successful extraction of a 38 calibre bullet twelve years after the accident, during which period there was partial displacement and severe neuralgia of the anterior tibial nerves. Examination showed the wound and entrance into the anterior of the upper third of the leg, and the skiagraph distinctly showed the bullet which at the operation was found lying on the posterior tibial nerve. There was no recurrence of the neuralgia.
Dr. K. A. J. Mackenzie reported a case of carcinoma of the rectum two inches above the sphincter. Kraske's operation was performed and