Wertheim, of Vienna, and Bode, of Dresden, would be even better than the method used in this case. I feel confident suspension of the uterus to the anterior abdominal wall will not stand the test of experience. I have had to regret that method of operating. I have had to do over some of my work in which I had fixed the uterus to the anterior abdominal wall for the relief of incarcerated omentum, and in one case intestine between the uterus and abdominal wall. In the latter case the intestine was firmly fixed by adhesions, causing incomplete intestinal obstruction from which the patient suffered greatly. If vaginal fixation proves as satisfactory as is claimed it will be of great benefit to many women. The operation does not appear to me to be as serious an undertaking as a section, and the patient certainly suffers less afterwards.

DISCUSSION.

the operation of fixation of the uterus. What little grounds the pessary had for its use, I think, have fallen as the result of this operation. In other words, the last hope of the pessary, that has been such an instrument of torture, is gone. As the doctor states, he labored under some disadvantages in trying to work through a longitudinal incision. It seems to me, with the lateral incision, the operation can be done in much shorter time. I have not seen any literature as to the bladder symptoms. As Dr. Hall has said, it is too early to arrive at any conclusions as to the permanency of the results in his case. Το see this patient after the operation, even in the short time that has elapsed, and to see the difference in the conditions, to see the vaginitis disappear and all these obscure painful troubles of the pelvis clear up, is very grateful I assure you. I want to congratulate the doctor upon being the first operator in this city to do this operation, and I am sure we will have more of these operations and fewer pessaries in the future.

DR. JOHNSTONE: The operation has always commended itself to me more than any other. I have been gradually getting myself up to the point of some

DR. BONIFIELD: Unfortunately, I was in Berlin when Duhressen and Mackenroth were warring over the operation. I think it was Mackenroth's idea, followed by Martin, to make the incision longitudinal with the vagina, while Duhressen always made the transverse incision. Duhressen ad-time trying it, but as yet I have not vised the specially constructed sound, which looked something like a No. 12 male urethral sound. After he had brought the uterus forward, he introtroduced the sound and held it in position, and then introduced a temporary stitch, after which he sewed it in place, I think with silkworm-gut. He was very enthusiastic about the operation, and often did it in the clinic, letting his patients be sent home in a couple of hours in a second-class cab. I have seen since that he is not so enthusiastic, for in some cases it seems to give rise to bladder symptoms. Sometimes the uterus seems to encroach upon the bladder. Some cases have become preg. nant, and there was no difficulty in delivering them.

DR. EDWIN RICKETTS: It was my pleasure to examine the case of double uterus reported this evening. It was as clearly a case of double uterus as it is possible to conceive. I was present at

seen the case in which I would try it.
My ardor was somewhat dampened by
the case of a wealthy German patient,
whose husband took her off to Europe
and came home with this operation
having been done. The cellular tissue
was inflamed and she had attack after
attack of acute inflammation. It was
only an irritation of the cellular tissue.
If all these patients go through the
trouble this woman did we cannot
expect very much from the operation.
But this patient had a very large uterus
and a chronic metritis, and she should
have been curetted before the operation.
The Alexander operation has promised
more to me than any other. But I can-
not agree with the previous speaker,
that the pessary is banished to the
dump. I often wish it were.
But we
have not gotten to the point where we
can say to every young girl who comes
to us that we do not cure some of them
with pessaries. Some of them I know

I have cured with the pessary. If we curette them and get rid of all of the inflammation and make them wear a pessary for a year or eighteen months, they finally are completely cured. That, for a young woman, I think, is often better than to go to doing reparative work. But particularly when there are adhesions this operation commends itself

to me.

nancy occurred subsequently, in case of marriage, simply as the result of mechanically holding the uterus forward. In some of these cases I have allowed the instrument to be worn most of the time for years-of course, the patients in all cases being required to report from time to time for examination as to condition of the vaginal mucous membrane. No competent man would be the idiot to adjust a pessary that causes pain. In several instances retro-deviation of the uterus in the class of sub

DR. TATE: Dr. Ricketts seems to think that if we can just fasten the uterus down all the trouble is gone. But we all know how much trouble we|jects now under discussion I have known have with uteri normally, we might complete recovery from the malposition say, in this condition. Dr. Emmett, in as a result of the pessary alone. It a discussion of this sort some months would be a shame to subject such paago, claimed he had never yet seen tients to surgical measures. I beg of a case which required suspension of any my friend that because he has seen kind, either by the Alexander method cases where an improperly placed and or abdominal fixation. Of course, we neglected pessary had to be cut out, are not all of us so skillful as Dr. and cases where the pessary had proEmmett, but I think you must all bear duced evils, he should not therefore conin mind that the uterus is not normally demn its use altogether. The pessary a fixed organ, and when we tie it to in the hands of a skillful man, who anything we are liable to produce more will not be blinded to its proper use by trouble than we relieved. prejudice, is a most valuable appliance. I hope that my friend will add to his other accomplishments skill in its use.

DR. REAMY: Before you close this discussion I would like to say just a word for the benefit of my friend on the left. I regret that a man so able as himself and so conscientious, and usually so thoroughly right, would persist in sinning in this one direction. This brilliant operation might have been discussed thoroughly, as it has been, without his going out of the way to attack the pessary, and saying this would remove the last possible excuse for the pessary. This is all gratuitous. The pessary is not an issue in cases of this character. I can show the notes of very many cases of women, some of them virgins, who had suffered from some inflammation, where the uterus was light (not very heavy) and retroverted or retroflexed so as to give great discomfort. Some of these cases have had painful menstruation, and after marriage sterility, and were in an abominable condition. In a large percentage of these cases the introduction of a long, narrow, hard rubber retroversion pessary has not only relieved all the symptoms of distress, including leucorrhea and often dysmenorrhea, but preg

DR. JOHNSTONE: Before you take your seat, Doctor, tell us the condition of those girls who have had retroversion and have gotten well after the use of the pessary. What is the condition after delivery?

DR. REAMY: In the considerable proportion of these cases after the child is born the condition returns, where there is flexion, not so much where there is retroversion. Those are cases of poor development, where even a pregnancy did not cure them. But in a considerable number of cases of retroversion the pessary has been effective. In retroflexion there is often thinning of the tissue. Isn't that your observation?

DR. JOHNSTONE: Yes, about that; but you have to watch these patients.

DR. HALL: I will simply remind the gentlemen that in the normal anteflexed uterus we have a different condition from that of an anteflexed uterus from the operation mentioned to-night. The gentlemen will remember that the normal virgin uterus that is anteflexed has an elongated cervix with a sharp

tumor. The remaining portion of the cyst was not more than one-eighth of an inch thick. The fluid contained in the cyst was straw-colored and had the appearance of blood serum. The body of the uterus was enlarged and contained a fibroid the size of a large orange in the posterior wall, and one, half as large, in the anterior wall. Both ovaries and tubes were healthy but were removed with the uterus.

kink, the uterus being doubled upon | was about one inch in thickness at the itself, and these patients suffer chiefly thickest part. This thick portion combecause the uterus does not drain prised about half the surface of the properly. It is in order to secure better drainage that we dilate these cases. But all this does not apply to the condition produced by the operation described this evening. I do not want to discuss the pessary in connection with the operation. I believe there are conditions in which the retroversion pessary is very advantageous in the management of cases. But the cases that require operation, like the one mentioned, are practically beyond our relief unless it is by operative procedure. If the bladder is dissected away and the uterus fixed forward, as described, I can understand how we may have bladder symptoms, but not because the uterus is pulled forward and the bladder impinged upon, but because we dissect so close to the ureters, and possibly that prevents the emptying of the ureter properly into the bladder, and thus we have an anatomical reason why the patient has an irritable bladder.

DR. BONIFIELD: Don't you think it is possible that after a while the uterine wall will lose its tone and that in this way it may interfere with drainage?

DR. HALL: Possibly. As I said, the operation is on probation.

DR. GILES S. MITCHELL: What was the cause of the retroversion?

DR. HALL: I do not know. I think from the history of the case the patient had a retroverted uterus, and perhaps the sexual function caused the uterus to become more painful. There was a vaginismus due to the remains of the hymen.

DR. RICKETTS: I wish to call attention to the vaginal hysterectomies, where we introduce stitches higher up and

have no trouble.

DR. REAMY: That is, higher up than

the bladder.

Cystic Fibroid of the Uterus.
DR. HALL then presented a cystic

fibroid of the uterus.

The tumor was somewhat larger than an adult head. It grew from a broad base, from the anterior portion of the body of the uterus. The tumor wall

The patient from whom the specimen was removed to-day, is thirty-eight years old, married two years, no children. Referred by Dr. Quinn, of Wilmington, O. She discovered a tumor in her abdomen about three years ago, which appeared to be about the size of her closed hand. It did not enlarge perceptibly until about four months ago, since which time it has rapidly increased.

November 23. Patient convalescing. DR. GILES S. MITCHELL presented a four and a half months fetus in a fibroid uterus, removed last Monday.

The Plexus of Nasal Blood-Vessels not Normal.

Dr. Thos. F. Rumbold says in the Atlanta Med. and Surg. Journal: The plexus of vessels, that is so plainly seen in the adult turbinates on dissection, is not seen in the infant. In a few heads that I have examined, that were nearly three years old, the blood-vessels were beginning to form plexuses. It is easy to distinguish the arteries from the veins even in the third year of age, and even when the plexus of the vessels is partially formed. This condition of the blood-vessels and mucous membrane is also seen in the nasal passages of the healthy dog, sheep, hog, goat, cat, mouse, rat, rabbit, squirrel, cow, horse, etc., tending to show that the enlarged condition of the blood-vessels—that is, in the form of plexuses seen in adult life -is not the normal condition.

SCOTLAND has more physicians in proportion to the population than has any other European country.

personal observations and speculations | ture indicating infection, we have concerning its probable origin and cause. marked abatement of symptoms, and The central regions are not the most the patient becomes rapidly better after common starting-points for ulceration. the canthotomy operation. In infants with gonorrheal conjunctivitis central perforating ulcers are more commonly observed than in adults, and in the former especially among marasmic subjects. In such cases exposure, with its resulting traumatisms, and not pressure of the swollen lids, can be regarded as an influential exciting cause. Certain it is that in adults especially, the most treacherous and destructive ulcers are those which invade the marginal regions. They advance insidiously, their course is rapid, the area of ulceration is covered or overlapped by swollen and chemotic conjunctiva, so that perforation often occurs without special warning, followed in many cases by sphacelation of the central region, with hopeless destruction of the eye.

The real origin of ulcer remains unsolved. It is probable that in most cases pressure of the swollen lids contributes its share as an exciting element to the destructive process once established, but it is more probable that the specific mycotic elements and the toxines they generate find in this most delicate and complicated of tissue fabrics of the body a favorable soil for their inherent destructive properties.

Gonorrheal conjunctivitis is one of the most dangerous of ocular lesions, and is always regarded with alarm and apprehension by the specialist.

DR. VAIL: In answer to the question raised by Dr. Wolfstein, as to whether infection from the gonococci can take place in the wound produced by canthotomy, I have only to say that all ophthalmic surgeons from time immemorial have been doing this operation; and all the books recommend that it should be done, while none speaks of the possibility of the germ infecting the wound. I have seen it done many times, and have done it myself in the three cases mentioned in my paper, and have never seen infection occur. He speaks of serous membranes throughout the body being affected by the gonococci. There is no serous membrane in the eyelids. Instead of the chill and rise of tempera

Regarding the frequency of ulceration at and below the centre of the cornea, there is nothing written, so far as I was able to ascertain from a thorough canvass of the literature on the subject, excepting in the reports of W. T. Holmes Spicer referred to. He reports nineteen cases of ulceration in the lower part of the cornea out of fortythree cases of corneal involvement— less than one-half, to be sure, but still a large per cent. deserving of our special attention. No one has written of the binding influence of the lower lid against the ball as a special cause of ulceration in this location.

In reference to there being but fortynine cases reported in the records of the Cincinnati Hospital in the last thirtyone years, I myself could hardly believe that there were so few. I took great pains to go over the records, taking year by year, and could find no more. Purulent conjunctivitis and gonorrheal conjunctivitis are recorded side by side, and it is quite possible that some of the former cases should have been catalogued with the latter, but there is now no way of knowing that such an error was made. It does not seem unreasonable that in our general hospital there should have been but forty-nine cases in thirty-one years, when we remember that in the two crowded English hospitals referred to there were but 158 cases in twenty-two years.

Malignant Disease of the Orbit.

DR. ROBERT SATTLER: This specimen, a sub-periosteal round-celled sarcoma, and this photograph, may be of general interest because they illustrate one of the most dreaded forms of malignant disease.

The bones of the skull and the soft tissues of the head are among the localities in which a surgeon always dreads to discover these neoplasms, and, of all the cavities or openings of the cranium, the orbits are a favorite and frequent starting-point for these treacherous new growths.