Ind,, and Dr. A. C. Bernays, of St. Louis, Mo. DR. F. W. BEARD, of Vincennes, Ind., related a case in which he had observed emission of semen in death by hanging, in an executed criminal. The paper was discussed by Dr. Bernays, of St. Louis; and Dr. J. A Wagner. of Quincy.

The Society then adjourned to 7:30, P. M.

The Society re-convened at 8:00 P. M., and a paper was read by

Dr. A. H. OHMANN-DUMESNIL, of St. Louis, Mo., on a case of Lupus Erythematosus. In his case, that of a farmer fifty-two years of age, who had always been in good health, the lupus involved the dorsum of the hand and arm, and occasioned no complaint on the part of the patient. He had applied a concentrated solution of lactic acid in the treatment of the trouble. He had several microscopes, and illustrated the pathology of the disease to the members by several very fine mounts of sections of the skin in his case.

The specimens demonstrated the cellular infiltration of hair follicles in this trouble, also the yellow degeneration. Photographs were shown, showing the gross appearance of the case. It was moved and carried that the thanks of the Association be tendered to Dr. O., for his instructive paper and demonstrations. The paper was discussed by Dr. Arch. Dixon, and Dr. Isaac N. Love, of St. Louis.

DR. ROBERT BARCLAY. of St. Louis, read a paper on "Noises in the Head and Ears," giving some account of the pathological conditions giving rise to them and their The paper was discussed by Dr.

treatment.

Robbins, of Quincy.

THE PRESIDENT called Dr. F. W. Beard to the chair, while he read a paper on "Perineal Lacerations." He gave an account of Simon's method of repairing these lacerations which he had used with much satisfaction. The paper was discussed by Dr. Bernays.

DISCUSSION OF DR. LOVE'S PAPER ON ARTI

FICIAL ALIMENTATION.

Reconvened Wednesday morning at 9 o'clock.

DR. BERNAYS, of St. Louis, thought that it had not been proven that the normal skin or the mucous membrane of the vagina could absorb anything, their histological structure tending to prevent it. Had no confidence whatsoever in the absorptive power of the skin or the mucous membrane of the vagina or rectum. He thought these methods of alimentation worth trying, but thought the trials would prove futile. Thought strong proof would be required to change his opin

ion.

DRS. M. ROONEY AND VIRGIL MCDAVITT, both thought it an established fact that the vagina will absorb medicines, as demonstrated by constitutional effects produced by local application.

DR. BAUER inquired of Dr. Bernays how he explained the treatment of syphilis by mercurial inunctions.

DR. BERNAYS replied that he thought that some of the horny layer of the epidermis was removed by the frictions.

DR. J. L. GRAY, of Chicago, said that after a warm bath, he had found that the skin would absorb a great deal. He had kept patients alive by inunctions of peptonized codliver oil.

DR. ROBT. BARCLAY, of St. Louis, had observed that mucous membranes will absorb medicines, and thought it reasonable that aliments would be absorbed.

DR. O. H. OHMAN-DUMESNIL said that late experiments had proven that oily substances were absorbed by the skin in small quantities, lanolin being the most readily absorbed; next lard, and last, vaseline. Aqueous solutions. were not so readily absorbed. He thought that some of the peptones might be absorbed, but that life could not be much prolonged by baths.

DR. LOVE after asking all to speak who had views or experience upon the question, closed the discussion by saying that in his paper he had only given his experience, and had cited literature to prove the absorptive power of the rectum. Rectal feeding was an

Was surprised that any one should question

the absorptive power of mucous membrane and the skin. Cited the securing of salivation by inunction already mentioned by Dr. Bauer, also referred to the ringing in the ears produced by putting a quinine pad over the stomach and bowels, also the dilating of pupil and drying of fauces, following the painting of a limited surface of skin with tincture of belladonna, in fact felt that the mentioning of these facts was superfluous, as they were accepted by all save the one person who had spoken a few minutes ago. Claimed that the only unique point in this paper was that referring to vaginal feeding and medication. The cases reported were his proof, the evidence given by an observer in reporting cases and preparing papers depended entirely upon the character of the individual. Reports of cases were only valuable in so far as they were reliable. Hoped others would make observations upon the points he had made in his paper. He did not claim that any form of supplemental alimentation would indefinitely nourish referred to by Dr. Bauer. He trusted that the experiments in peritoneal alimentation would continue to be made on dogs; they were interesting however in that they were evidences showing that other tissues would absorb-however we are all familiar with the fact that almost all substances will absorb by contact even iron, wood and stone will absorb soluble materials.

A nominating committee was appointed by the president as follows:-Dr. Jos. Robbins, of Quincy, Ill.; Dr. Dudley S. Reynolds, of Louisville, Ky.; Dr. Frank R. Fry, of St. Louis, Mo., and Dr. F. W. Beard, of Vin

cennes,

Ind. DR. FRANK R. FRY, of St. Louis, read a very learned, able and practical paper on "The Etiology of Chorea", opposing the theory of its origin being in embolism, and claiming it as a neurosis, although the exciting causes were exceedingly various.

DR. DUDLEY S. REYNOLDS, of Louisville, Ky., offered the following resolution which was seconded by Dr. Wm. Porter, of St. Louis:-Resolved, That the Mississippi Valley Medical Association adopts as part of its organic law, and binding upon all its members, the code of ethics of the American Medical Association.

DR. LOUIS BAUER, of St. Louis, moved to refer the question of a code to a committee of

seven.

Dr. WM. PORTER, of St. Louis, opposed this, saying that the members of the society there present could consider the question as well now as after it had been referred to a committee of seven. The last three meet.

ings of the Association had not been as well attended as formerly. There was something wrong. He believed it was because the Association had heretofore neglected to place itself upon record as to its standard, although asked to do so by different societies, members and medical journals. "You say any gentleman may become a member, I say anybody may, and in proof of the assertion, point to the fact that not a single registration has been challenged for four years. The record shows that men can and do become members of this Association who are not and cannot be members of their local societies. This is why to my certain knowledge, good men are absent this year who otherwise would have been present."

He appealed to the members present to aid in lifting the Asociation out of the unfortunate position in which it had been placed, and to put it in its proper relation to the state societies and the National Association.

DR. LOUIS BAUER bitterly opposed the adoption of the resolution, expressing his hostility to the American Medical Association and its code of ethics, which he characterized as the mouse which the mountain had brought forth, after going into so great labor. He thought the working value of a society was entirely independent of its adoption of any codes.

DR. BERNAYS, of St. Louis, opposed the resolution, saying that the code was not a necessity for this society and would not in any way enhance its value as a scientific body. He characterized a late meeting of the Illinois State Medical Society with its code as of little more value than a gathering of schoolboys. He moved to lay the whole matter on the table. Motion lost.

DR. BAUER, by permission of the society, withdrew his amendment to the resolution. A vote on the original resolution was then taken and adopted, with only two dissenting votes.

DR. BAUER tendered his resignation and withdrew from the association.

DR. HENRY M. LYMAN of Chicago, then read a paper on "The Discovery of Anæsthetics" giving many interesting documents connected with the early use and introduction of ether by Dr. Morton.

Society adjourned to 2 p. m.

DR. ROBT. BARCLAY, of St. Louis, was called to the chair on the re convening of the society in the afternoon, in the absence of the president. Dr. Bernays, of St. Louis, related a case of epilepsy, in which 150 attacks had occurred per diem. Had tied both vertebral arteries at the request of Dr. Hazard, of St.

Louis, under whose care the case had been. This was the first time that it had been done in St. Louis, although it had been done in Chicago five times. There had been thus far no attack in his case since the operation. Dr. B. also showed a specimen derived from a post-mortem of a lady who had died from a rupture of the cyst in extra-uterine preg nancy and consequent hemorrhage. The specimen showed a double uterus with the foetus lying in the left Fallopain tube. He also showed a specimem of an ovarian cyst in which the pedicle had been twisted and during life he had drawn off at the first puncture of the cyst some pinkish fluid and at the second puncture a dark red, due to the twisting of the pedicle.

its

The committee on nominations then read report as follows:

For President, Isaac N. Love, M. D., of St. Louis, Mo.

For First Vice-President, Dr. Joseph Robbins, of Quincy, Ill.

For Second Vice-President, Dr. Jacob L. Geiger, of St. Joseph, Mo.

For Third Vice-President, Thos. B. Harvey, M. D., Indianapolis, Ind.

For Secretary, J. L. Gray, M. D., 1558 Wabash Ave., Chicago, Ill.

For Treasurer, Dr. A. H. Ohman- Dumesnil, St. Louis, Mo.

For Ass. Secy., Dr. Edw. Allcorn, Houstonville, Ky.

COMMITTEE OF ARRANGEMENTS. Dudley S. Reynolds, M. D., Louisville, Ky. Louis S. McMurtry, M. D., Danville, Ky. James H. Letcher, M. D., Henderson, Ky. J. N. McCormick, M. D., Bowling Green, Ky.

L. B. Todd, M. D., Lexington, Ky. John Q. A. Stewart, Frankfort, Ky. James M. Holloway, M. D., Louisville, Ky. J. M. Mathews, M. D., Louisville, Ky. Place of meeting: Crab Orchard Springs, Ky.

Time of meeting: Second Tuesday in July,

1887.

The report of the committee was received and adopted unanimously.

The newly elected president was then escorted to the chair. He made a few appropriate remarks expressing thanks for honor conferred and a determination to do his duty. Dr. Frank R. Fry, of St. Louis, and Dr. J. L. Gray, of Chicago, discussed the tying of the veretebral arteries as a therapeutic measure in intractable cases of epilepsy. Dr. Fry did not think that there was much promise in the procedure; that owing to the copious col

lateral circulation ligation could be of but little use cutting off the supply of blood from those parts of the brain concerned in the production of epilepsy. Dr. Gray had seen all of the five cases in which the operation had been done in Chicago. He thought that the operation only did good where the attacks were due to irritation of the digestive tract. He gave the account of the cases in which the operation had been done in Chicago-three times by Dr. Edwin Andrews, and twice by Dr. Christian Fenger.

.. DR. AMOS SAWYER, of Hillsboro, Ill., read a paper on "The Therapeutics of Bismuth and Asclepias Tuberosa."

DR. DUDLEY S. REYNOLDS, of Louisville, Ky., read a paper on "Optical Defects in the Eye and their Correction," describing an in

strument for the measurement of lenses which could be readily used without the possession of any great amount of technical skill.

DR. J. L. GRAY, of Chicago, Ill., showed a stomach pump with siphon attachments which could be used for the purpose of introducing aliment, or for washing out the stomach with medicated waters.

The paper was discussed by the president, Dr. Love, and by Dr. Reynolds.

Dr. L. H. COHEN, of Quincy, Ill., read a paper on "Electro-Therapeutics," which was discussed by several members.

The President appointed the following as the Committee to draft Constitution and ByLaws Robert Barclay, of St. Louis, Wm. Porter, of St. Louis, Jos. Robbins, of Quincy, Illinois.

Dr. E. B. MONTGOMERY, of Quincy, Ills., read a paper on "Therapeutics of Hot Wa ter," detailing its uses in a great variety of conditions. The paper was discussed by Dr. Barclay, of St. Louis; Dr. Jos. Robbins, of Quincy, Ill.: Dr. Geiger, of St. Joseph, Mo.; Dr. Beard, of Vincennes, Ind.; Dr. Reynolds, of Louisville, Ky., and Drs. Love, Fry, and Porter, of St. Louis.

It was moved and carried that the thanks of the Society be exteded to the retiring President and other officers of the society, the local profession, the local press, the railroads and hotels, for favors extended to members of this society.

After some talk by various members, about the place and future outlook of the society, it adjourned to meet at Crab Orchard Springs, Ky., on the second Tuesday in July, 1887.

E. B. MONTGOMERY, Sec'y.

five has been formed for the purpose of making arrangements for attending the Medical Congress in Washington next year.

-In Vienna, Austria, a committee of twenty

CHICAGO GYNECOLOGICAL SOCIETY.

1886.

DR. A. REEVES JACKSON stated that he understood from the notice received, that he was expected to introduce the general subject of pelvic cellulitis. If anything should cause a sense of humiliation to come to us as medical men, it was the impression which was forced upon us of how little accurate knowledge we had upon even the most ordinary topics, when we attempted to study any medical subject in detail. In order to introduce the subject of pelvic cellulitis, he should say at least something about its pathology, diagnosis and treatment. In regard to the first of these subjects, Professor Thorburn says that he inquired of several experienced anatomists whether they knew of the existence of cellular tissue in the broad ligaments, and they replied that they did not know of it except from current gynecological literature; of course that was because they had not investigated the subject practically; we do know that there is a substance called cellular tissue in the pelvis, that it exists in and between folds of the peritoneum forming the broad ligaments, between the uterus and the bladder, and also posteriorly to the uterus. When we speak of cellulitis, we mean an inflammation affecting this tissue and all that is connected with it, that is, its lymphatics, glands, bloodvessels and nerves. Some think the starting point is nearly if not always in the lymphatic glands, so that here in the outset we are met with this evidence of lack of certain knowledge. He thought it did not matter much to us as practitioners whether that layer called cellular tissue is affected in one portion only or whether other structures are also involved. The diagnosis presents difficulties, as we all know. In the first place, we do not always know when the disease is present, and in every stage we feel doubt as to whether this disease or some other is present; sometimes even when it goes on to its later stages, we have doubt. The first evidence of this disease consists in an effusion of serum, which produces a hardness in the part, and which becomes more and more marked as the disease progresses; this may be of longer or shorter duration; it may disappear by absorp. tion; or it may not disappear at all, but go on until the effusion becomes pus, forming pel

vic abscess. Pelvic cellulitis and pelvic peritonitis frequently exist together, and as it does not affect our treatment of the case in difference to us as practitioners. Coming to the question of treatment, he had always felt a great deal of doubt as to the efficacy of the usual means employed-opium, digitalis, quinine, etc.; that is, as to whether they have any controlling influence upon the progress of the disease. From the very nature of the inflammatory process, he scarcely thought these things do more than simply palliate the symp. toms. Prolonged hot water douches are doubtless remedial, and may abort the disease. Latterly, interest has been more centered in the treatment of the condition when it has advanced to the stage of abscess. Heretofore the treatment has been notoriously unsatisfactory, so that cases have gone on for weeks, months and years, the woman being constantly subject to discharges of pus, and the remedial means have done little more than assist nature in the escape of the fluid. But during the last few years, since attempts have been made to treat the disease radically by surgical means, there has been offered an additional and efficacious method of dealing at least with some of these cases. He alluded to laparotomy. The success that has been attained in this way should lead us to look upon it with favor. He thought, however, that where radical surgical means are resorted to there is danger of too frequently performing operations dangerous in themselves, to relieve a disease which perhaps would not end life, although rendering the patient an during her lifetime. He believed the discussion would be profitable if it should largely take the course of considering this latest and most formidable measure of treatment. He had read the account of Dr. Fenger, giving an account in detail of three operations made by himself; two of the operations were followed by death, which was attributed to some other disease, co-existent perhaps with the abscess itself; the other was successful. You are familiar with Lawson Tait's treatment for these encysted collections of pus. His success is simply marvelous. In 1883 the British Medical Journal published an account of twenty-four cases in which he had been successful, and in a letter which Dr. Jackson had received from him recently, he said that up to that time he had operated successfully on thirty-two cases.

This was all the introduction Dr. Jackson had to offer, and it opened the whole subject. He was reminded that he had not stated whether he approved of abdominal section

for this cause. He said he did, unhesitatingly, and thought there was as good reason for operating in inflammation of the pelvis as in any other disease which produces life-long invalidism, provided it were were not curable by other means. Laparotomy offers a method which is perhaps applicable to a compara tively small number of cases, and yet here it is the only remedy, that is, in cases of long standing in which the abscess cavity cannot be otherwise reached for the purpose of drainage, and where the woman is of such an age that makes it reasonable to suppose she will suffer for many years. He considered it a dangerous operation, and there had been errors in diagnosis. Mr. Tait is justified in his bold method of diagnosticating abdominal disease by laparotomy. He follows it up with removal of the disease. Where the diagnosis is fairly established he believed that laparotomy is a proper procedure as a last re

sort.

DR. W. H. BYFORD thought there was no much more to be said than had been said by Dr. Jackson, who had given an admirable résumé of the subject in all its bearings, in such a way as to set it before the Society with clearness, and he approved of all Dr. Jackson had said, without exception. Dr. Byford had already said to the Society what he had to say on the subject of pelvic abscess, and what he thought of the conditions of the operation of laparotomy for the abscess. He could not get rid of the idea that the operations performed by Lawson Tait, were cases in which the abscesses were largely in the abdominal cavity, and were not pelvic abscesses, properly speaking-certainly were not confined to the pelvis; and he believed from what he had seen in regard to his cases, that almost all were encysted peritoneal, instead of encysted pelvic abscesses. In speaking upon the subject before, he had taken the stand that the operation of cutting into the peritoneal cavity for the purpose of going down into the pelvis when the abscess did not reach above the pelvic rim, was not justifiable in many instances, if at all. Where there has been a bar thrown out by the effusion of lymph in the peritoneal cavity, so as to isolate the purulent collection, and it extends up into the abdominal cavity, then he had no doubt of the propriety of the supra-pubic op eration. He had recently seen an abscess, which formed mainly above the pelvic brim, open into the rectum at the top of the pelvis, taking its course above and across the fundus uteri and opening in the side of the rectum. The collection of pus was entirely above the pelvis, and it was necessary to cut through

the muscles and fascia to get into the pus cavity and then establish a process of drainage through the rectum. It would have been impossible in that case to have effected the opening through the vagina.

DR. J. H. ETHERIDGE said he had had no experience in opening the abdomen for treatment of abscess in the pelvis. He had seen one abscess opened through the abdominal wall, which had a spontaneous opening into the rectum. It was done at the Presbyterian Hospital about a year ago. The top of the abscess could be felt through the wall, and an attempt was made to find the opening, wash it out and inject it; but this being regarded as impracticable, abdominal section was decided upon, and a very curious combination of pathological conditions was discovered. The abdomen was opened, and a protruding something was discoverable; there was a discharge of perhaps an ounce and a half of serum, then it was cleaned. It was really a cystic growth, and upon introducing the finger, another cyst, apparently, was discovered, that was opened and thoroughly evacuated, then another protruding by it was discovered, which was found to be the abscess cavity itself. That was opened and cleaned out and a drainage tube introduced and fastened to the wound, and the patient dressed, but she died within twenty-four hours. Post mortem examination was made, and the track of the opening readily marked out. He had seen pelvic abscesses that opened in all directions through the abdominal cavity, into the bladder, vagina and rectum, but never saw one that opened into the uterus. He saw at the Woman's Hospital, an abscess that opened through the vagina and abdominal wall. The patient died. Dr. Etheridge said he had under treatment a pelvic abscess that opens into the rectum, in which general cellulitis is present. About once in six weeks the woman wonld have a fever, and after undergoing a great deal of suffering, nights of pain, in which she would have to take large quantities of opium, there would be a discharge of pus into the rectum. She was put on tonics, and her general health improved greatly. Now she goes a great many weeks at a time without any return of the symptoms. A slight discharge of pus is present with every discharge from the bowels. It seemed to him as if the true estimate to make of the justifiability of laparotomy for abscesses, is the ability to reach the top of the abscess through the abdominal wall, and where it cannot be reached, it seemed to him that purulent discharge of the abscess into the abdominal cavity would surely take place.