Physician and Surgeon

OPERATIONS CLASSIFIED.

Abscesses treated, 19: aspirated and injected, 6; incised, 13.

Amputations, 4: finger, 2; leg, 1; thigh, 1.

Aneurysm, arteriovenous, of the internal carotid, I: ligation of the internal carotid artery.

Appendectomies, 14.

Breaking adhesions, 3: hip-joint, I; prepuce, 2.

Cauterizations, 3: cauterizing bite, 1; sinus, 1, for opening bowel.
Circumcision, 2.

Cleft palate, I lowering intermaxillary bone to place.
Cystotomy (suprapubic for stone), I.
Cystoscopic examinations, 2.

Colostomy (inguinal), 1.

Dermoid cyst, I: excision.

Dislocation, 3: compound, 2; open fracture of the radius wired; tibia immobilized with plate and screws; simple fracture of the lower end of humerus reduced.

Gall-stone, I cholecystotomy and choledocotomy.

Glass in foot, I removed.

Goitre cystic, I removed under local anesthesia.

Hemorrhoids, 4: removed by excision, ligation, and cautery.
Herniæ, 2: femoral, I, operation; inguinal, 1, Bassini operation.
Injections, 6: bladder, 4; elbow-joint, 1; knee-joint, I.
Nephrectomy, I, for multiple abscess of the kidney.

Nephrorraphy, 1, for movable kidney.

Osteomyelitis, curetment, 3: femur, I; rib, I; ulna, 1.

Plastic operation, 2: face, 1; penis (hypospadias), 1.

Sinuses treated, 11: carbolized, 3; curetted, 4; injected, 4.

Sounding for stone, I.

Stricture dilated, 7: esophagus, I; urethra, 6.

Tuberculous glands: excision, 1.

Tumors excised, 7: carcinoma, 4; cervical glands, 2; hand, 1; rectum, I.

Epithelioma of the lip, I.

Sarcoma, 2: lymphatics, I; testicle, I.

Ulcer of tongue, I excision.

Undescended testicle, 1: lowered to scrotum.

Urethrotomy, external, 2.

Varicocele, I treated by exposing and ligating veins.

There were three deaths during the summer session. The first occurred in a case of nephrectomy, and resulted from sepsis and shock. This patient, a young lady, had a large abscess of the right kidney opened some weeks before but she still continued septic wth a free discharge of pus from the sinus. Thinking she had gained all that was possible under existing conditions, I ventured to remove the kidney, which was found to contain a number of abscesses and very little

kidney structure. The other kidney began work at once in a faithful manner but the heart failed and she died two days after the operation.

The second case was that of an old man brought to the hospital with cystitis and retention of urine because of long-standing stricture. External urethrotomy was done immediately to relieve the long continued retention and give drainage to a badly infected bladder. The patient was septic when he entered the hospital. This was not an operation of choice; it was the only thing to do under the circumstances. There was continued temperature, rapid pulse, and loathing of food. The patient died six days after the operation.

The third case was that of a young man horribly crushed in a railroad accident. The journey by wagon and rail to the hospital took about two hours. He was in the last stages of shock when he arrived and died half an hour later. The only operation attempted was for transfusion.

DEPARTMENT OF GYNECOLOGY.

REUBEN PETERSON, M. D.

PROFESSOR OF OBSTETRICS AND GYNECOLOGY.

· Nor infrequently the clinical teacher in the University of Michigan is asked, "How large is Ann Arbor?" When told that it is a town of less than twenty thousand inhabitants, the next query is, "What do you do for clinical material?" These questions are but natural from one who is unacquainted with the situation. Having given the matter but small thought, he assumes that the hospital material is drawn largely from the town in which the University is situated. But when he once grasps the idea that only a very small proportion of the material comes from the town, and that the loyal alumni of the medical school, located not only in Michigan but in three or four surrounding states, refer their patients to the hospital for treatment, his eyes are opened to the possibilities of an institution so situated. He is no longer amazed when informed that there are over two hundred beds in the University Hospital usually filled and patients waiting their turn for admission. His. eyes are opened, unless for reasons of his own, he keeps them tightly closed and refuses to be convinced. The following report of the work in the Gynecologic Clinic during the last summer session is not submitted for those who know the facts, yet still keep up the cry of "no material." Their cry would be the same if a thousand major operations were to be performed daily in the hospital.

It has been the writer's good fortune to teach postgraduate students in various medical schools. He has seen larger clinics, but never at teaching clinic that could compare with the one at his disposal last summer, and for that matter during the past four years he has given the course in gynecology at the University of Michigan. Patients come to the University Hospital with the understanding that their cases are to

be thoroughly investigated not only by the professor in charge but by the students under him. Hence the eighty patients who entered the Gynecologic Clinic during the summer session were there for teaching purposes. Under proper supervision, if his time permitted, the student could examine and follow every case from the time of entrance to the hospital until the patient was discharged. He was privileged to see her not only once, but many times during her stay in the hospital. He was able to verify his diagnoses by what he saw at the operations. Above all, he could follow the postoperative course of the patient and judge whether primarily the operation was or was not successful. In other words the student was able to come in close contact with the patient. Amphitheatre teaching, with the benches filled with students who could see and hear but not touch, was conspicuous by its absence. The following tabulated list of diseases and operations speaks for itself. It was possible to demonstrate all of the commoner gynecologic affections, not once but many times. There were two operative deaths, both desperate cases. One resulted from the removal of double pustubes from a weakened, septic patient. The other was a case of chronic postoperative intestinal obstruction of nearly a year's standing. The adhesions were released but reformed a week after the operation. Complete occlusion of the intestine followed. The patient and family refused further operative treatment and death soon ensued.

SUMMARY OF GYNECOLOGIC SERVICE, UNIVERSITY HOSPITAL,

DURING SUMMER SESSION, JUNE 26, TO AUGUST 3, 1906.