The general practitioner today appreciates the specialist, and to his credit, be it said, demands of him advanced and modern methods.

What can we say of American gynecology? We may surely claim that gynecological surgery had its beginning in our own country. I think it is conceded that American surgeons stand at the head in surgical technique.

There is still before us a vast field for cultivation in pathology and pathologic anatomy, and here we may learn from our colleagues across the seas. But American gynecologists are awake and studying and working all along the line. We are not ashamed of the progress we have made since McDowell showed his splendid courage and saved a life; since Sims picked up in the street the rusty wire which suggested to him the silver wire suture. We are going to work on to a still more useful future.

We will preserve gynecology from dismemberment, and prove her right to be a special and distinct branch of our honored profession.

MALARIAL HEMATURIA.

Two Cases Treated by Transfusion of Normal Salt Solution.

BY J. K. HAMPSON, M.D.

NODENA, ARK.

Case I. M. S., 29 years old, white, had chills all summer, for which he took several bottles of chill tonic. On the afternoon of the 5th of September, at 5 o'clock, I was called to see him and found him with a marked case of malarial hematuria. His temperature was 106°F., pulse 148, respiration 40, tongue coated, skin dry and jaundiced, liver and spleen both very much enlarged, bowels constipated, urine scanty, dark (black) and thick, resembling coal tar, nauseated and vomiting a thick black substance, known as black vomit, mind clear but very bad headache.

I transfused three pints of normal salt solution into the median basilic vein. In twenty-five minutes, the time it took to transfuse that amount, his pulse had dropped from 148 to 84 beats to the minute, his respiration from 40 to 24, his temperature from 106 to 103, his skin was moist and he was in a gentle perspiration. In half an hour his temperature had

gone up to 105°F., and his pulse to 108. I gave him 10 grains of acetanilide, also 12 grains of calomel in four doses, one every three hours.

I saw him at 8 o'clock the following morning; his temperature was 100, pulse 84, respiration normal, skin moist and not so jaundiced as the afternoon before; his bowels had acted several times during the night, he had passed a pint and a half of urine; the last which he passed was at 7.30 a.m., and was of light amber color. I gave him 10 grains of potassii bitartras every four hours. When I saw him that afternoon at 4 o'clock he was free of fever and has been ever since. I placed him on Fowler's solution. Patient made a rapid recovery, and I discharged him on the 10th.

Case II. G. H., white, 17 years old, had chills for three weeks previous to attack of malarial hematuria. For the chills he took several bottles of a patent chill tonic. I was called to see him on the 10th of September at 3 p.m. and found him with a marked case of malarial hematuria, which he had had since the morning of the 9th. His temperature was 100, pulse 160 and hardly perceptible at wrist, respiration was very rapid and shallow, tongue coated, skin dry and jaundiced, urine scanty, black and thick; there were two or three ounces of urine in a vessel which he claimed was all that he had passed in twenty four hours; bowels constipated, nauseated and vomiting a large quantity of black vomit, semi-comatose condition.

I transfused three pints of normal salt solution into the median basilic vein. In half an hour his pulse had dropped from 160 to 120 beats to the minute and was stronger, respiration was slower and deeper, skin moist and just beginning to perspire. He dropped into a quiet sleep, and slept the greater portion of the night. I gave him 12 grains of calomel in four doses, one every three hours. When I saw him the following morning at 6 o'clock he was free of fever, pulse 100, though still weak, respiration normal, skin moist and had begun to clear up, bowels had acted several times, he had passed something over two pints of urine; the last was passed at 4 o'clock, and was the color of amber. He was free from nausea and all indications of coma. I gave him grain of strychnia nit. every four hours, also 10 grains of potassii bitartras every three hours.

I saw him at 4 o'clock the same afternoon: temperature normal, pulse 80, very good; respiration normal. I then placed him on Fowler's solution, 5 drops three times a day, also grain of strychnia nit. three times a day. He made a rapid recovery and I discharged him on the 14th.

FOUR CASES OF APPENDICITIS.

BY T. J. CROFFORD, M.D.

MEMPHIS.

Case I. Miss M., æt. 20,was for a long while the subject of diarrhea, afternoon fevers, and sustained a great loss of flesh. The abdomen grew tender, and finally she could not sit up without pain, so she took to her bed and had kept it for three years. The diarrhea, abdominal tenderness and marasmus had increased to an extreme degree when I saw her. There being great tenderness over the region of the appendix I decided to operate. Upon opening the abdomen abundant evidences of inflammation were found, but no appendix was visible, although the ileo-cecal site was found. Finally, deep down under the cecum, a small tit-like process was observed. This was removed in the absence of something more definitely indicated. It weighed seven grains only. The recovery was prompt and thorough: she gained forty or fifty pounds, and has since remained in excellent health.

Case II. Mr. B., æt. 35, locomotive engineer, was the subject of pain in the left iliac region, exactly opposite the vermiform appendix. This increased to such an extent that he would frequently fail to return from a trip with his engine, and finally temporarily resigned his position. He fell into my hands, the pain continuing on the left side.. There was a lump and some tenderness over the appendix.

When the abdomen was opened there was a very large chronically inflamed and omental adherent appendix, which was removed. He was ever afterward free of pain, and resumed his work in the course of two months. He has remained well since.

Case III. Miss W., æt. 18, came under my charge after eighteen months' illness, and numerous attacks of pain in the region of the appendix, accompanied by fever and great constitutional disturbance. Her health had become greatly im paired. Her digestion and general nerve tone materially interfered with. She became a neurasthenic. After nine attacks an operation was done; no appendix was to be seen till the peritoneum was incised at the appendix site. It was found retroperitoneally located and removed. It was not so much enlarged and inflamed as expected. She has not had any more attacks of severity. Now, three years since, her general health is much better, and the local tenderness has subsided.

Case IV. Miss II., æt. 22, has been suffering at intervals for the past three years with pain in the right side. For the

last year she has been confined to her bed, not able to get out at all on account of the pain. It is doubtful if any enlargement could be made out over the appendix site. The operation was performed one week ago, and an elongated and chronically inflamed appendix, containing five portions of inspissated fecal accumulation, removed. She is of course not well, but we have every reason to believe that the pain will be a thing of the past with her.

155 Third Street.

CORRESPONDENCE.

OBSERVATIONS AT HOME AND ABROAD.

To the Editor of the Monthly:

During my summer vacation I visited the principal hospitals of London, seeing a great deal of their surgery and gynecology. Albeit the surgeons and gynecologists of England are doing good work, it can not be gainsaid that we have just as good operators on this side of the Atlantic. One has only to compare the work to be convinced.

On my return home I stopped in Philadelphia for a few weeks. Here I first called on Dr. Jos. Price and found him busy, as usual. It is a duty every aspiring gynecologist owes to himself and patients to visit Dr. Jos. Price's private hospital and witness his wonderfully simple technique and marvellously successful work.

One can see on an average two abdominal sections daily, which during a course of three months will give him quite a varied experience, enabling him to prosecute his work, realizing the full meaning of cleanliness, thorough and complete work, and being convinced of the grave responsibility that rests upon the man who undertakes to do blind surgery, or incomplete work which leaves many of his patients in a much worse condition than he finds them. Dr. Price's success as a gynecologist is being appreciated by medical men in Philadelphia, as well as by doctors from all over the Southwest, who are taking patients to him daily with pathological conditions requiring the greatest skill for their removal and the restoration of the patient to perfect health.

With all complicated cases referred to him (because of his superior skill) his mortality remains low, thus emphasizing the correctness of his methods and the faultlessness of his technique.

He still clings to the extra-peritoneal method of dealing with fibroids of the uterus. The objections urged against this method are that it is unsurgical, not "up-to-date," and the length of time required for complete healing of the stump. No one says the mortality is higher. When we consider that now and then by the intra-peritoneal method a patient's life is sacrificed from hemorrhage or acute septic infection from absorption through the stump, not to mention the many who narrowly escape death by the grace of God, the abscess rupturing into and being discharged per vaginam, or more wonderful still, making its way through the abdominal incision-I repeat, when we consider all this-can we, as gynecologists, afford to assume the risk? To the conscientious gynecologist the good and safety of his patient must be his consideration first, last and always.

Dr. Price continues to employ glass drainage where there is pus, and in cases where adhesions have been extensive, and consequently great oozing of blood.

It is noteworthy to observe that a great many operators who have abandoned drainage by the suprapubic route are now resorting to blind surgery by the vaginal route, giving as one of the reasons for their resort to this method and the success of their work, that natural drainage is in this way obtained. This admission on their part is evidence they did not know how to use drainage from above. Often a method is charged with results when the fault is in the operator. Every abdom inal operation done for pelvic inflammatory trouble is a surgical and pathologic appeal for suprapubic work.

I met Dr. J. B. Deaver at the German hospital. He is one of the most skillful surgeons in America. I know of no place where a general practitioner may go and be better paid for his time than to visit Dr. Deaver at his work in the German hospital.

I dare say he does as much work for appendicitis as anyone in America, with results that cannot be excelled anywhere.