4. Because the incisions are certainly more easy to perform than those of lateral lithotomy; while the removal of a large stone, always the most difficult and dangerous part of the operation, is safe and easy by the suprapubic route.

5. Because, during the after-treatment, the urine leaves the suprapubic wound more directly and safely than it does by the long lacerated opening which forms the communication between the bladder and the perineal surface after the lateral operation for a large

stone.

6. Because antiseptic dressing can be employed in the former operation and can not be made available in the latter.

7. Because, in the suprapubic operation it is impossible to cut into the rectum, to inflict injury on the sexual organs, or to make an urethro-rectal or perineal fistula, any or all of which are liable to follow the lateral operation in a patient with a large stone.

The objections raised against the suprapubic method,-the danger of opening the peritoneum and the risk of extravasation of urine around the base of the bladder-Sir Henry does not regard as valid. The risk of extravasation, he says, is small because it can only happen as the result of unnecessary and unwarrantable interference with the tissues outside the bladder. As for the danger of lacerating the peritoneum, the experience of the modern operation demonstrates this danger as now virtually non-existent.

The writer then describes the technique of the operation at length, and adds tables of experience with the various methods.

In conclusion, Sir Henry expresses his strong and favorable estimate of the proceeding and regrets that the method was not in his power to apply at an earlier period of his He takes pride and satisfaction from having introduced the operation in England.

RESECTION OF THE ANKLE.-In the Revue du Chirurgie (London Medical Record) Prof. Reverdin, of Geneva, describes an oper

the diseased parts, permits either extirpation of the astragalus or tibio-tarsal resection or amputation of the foot.

The operation is as follows: In the first stage an incision made through skin and cellular tissue is carried from the inner edge of the tendo Achillis, just above the calcaneum, outward and forwards over the tip of the external malleolus, and then obliquely forwards and inwards to the tendon of the peroneus tertius, terminating at a distance of about two inches from the bi-malleolar line.

Thereupon the calcaneo-astragaloid joint is opened by dividing the tendo Achillis and the tendons of the peroneal muscles, together with the subjacent ligaments.

In the third stage, the insertions of the anterior and posterior peroneo-astragaloid ligaments are separated from the astragalus by a raspatory, and next, in the lower flap, the outer portion of the astragalo-scaphoid liga. ment. The foot is then forcibly twisted in. wards, and the pulley of the astragalus turned into the wound. The astragalus may then be separated from all its attachments and removed. Finally the malleoli are removed by the saw, after separation of the periosteum.

The indications for this operation are, almost always, tuberculous affections. The mortality of tibio tarsal resection has, under antiseptic methods, been reduced from 25.3 to 2.5 per cent.

The functional results are reported better after removal of the astragalus or tibio-tarsal resection than can be attained with the best amputation stump.

The risk of relapse is the one impending danger after the described extirpation for tuberculous affection; and this constitutes the most powerful argument for amputation. In extirpation, the greatest caution therefore should be exercised to follow the disease into all nooks and recesses. Every morbid deposit should be removed by scraping or cutting by the actual cautery, and the use of germicides, such as iodoform, lactic acid, or

chloride of zinc.

recurrence

RESORCIN IN THE TREATMENT OF VENEREAL WARTS and condylomata is employed by Dr. Cæsar Boeck, of Christiania. After clipping off the warts by scissors, or curettes, a four or five per cent watery solution of resorcin is applied several times a day by saturating compresses. Thus is avoided. On old indurated papillomata with a broad base, the writer applied resorcin in powder form, mixed with a little sugar or bismuth or boric acid. In using such a powder it is well to bear in mind the varying degree of tolerance to resorcin in individuals, and it is best to see the patients each day. If the powder is not well borne, the use of a solution, as above given, for several weeks ally leads to the desired result.

usu

-How beautiful on the mountains and in the valleys of Teutonia, bonnie and fair, were the feet of the admirable, proud but imprudent Paul,

who acted not as the man Mundé for the obstructionists of the Ninth International Medical Congress, but as their good man Friday, as he threaded his way among the corpses or meandered among the hedges and by-ways, and like a babbling brook, told his sweet story of the failure of the coming Congress, and all because he was left out. The aforementioned proud but imprudent one must view with grave disapproval the refusal of the polite scientists abroad to swallow his finely

spun narrative.

-The seventeenth annual session of the Medical Society of Virginia, takes place at Fredericksburg, Va., Oct. 26, 1886.

DR. MEISSENBACH presented a specimen of cancer of the stomach, removed at a postmortem during the summer. Patient had come under his care in the early part of the summer complaining of loss of appetite, and failure of his food to agree with him; general debility quite marked. Upon a careful examination nothing was found indicating any thing more serious than a chronic functional trouble of the stomach, and a diagnosis was therefore made of chronic dyspepsia; under the treatment applied for this disorder, however, the patient did not improve but on the other hand grew worse. About three months after first seeing patient there could be de tected in the right hypochrondium a slight dullness, which gradually extended, and in a short time there could be felt a small nodule, which also increased in size. Dr. Robinson called in consultation, and the diagnosis of have an operation performed as the only hope cancer was confirmed; family did not agree to for recovery, and patient rapidly emaciated and died. Until about two weeks before his death he had very little pain and hardly ever vomited; the liquid extract of malt seemed to agree best with him, the stomach retaining it better than any other substance given. Postmortem revealed a well-defined tumor, cancerous, occupying the greater curve of the stomach near the pylorus, and free from any adhesions posteriorly; no glandular involve

and a drop of it added to a solution of meth ylene blue; the normal secretion of the stomach is acid, due to a small proportion of free hydro chloric acid, and if this acid is present in the filtered food it gives a greenish tint to the methylene blue solution. Spoke of the invariable fatal results of resections of the stomach, and said that as far as he knew there had not been a single permanent cure from the operation; that in from three to six months the disease had made such progress again that the patient had died from DR. LOVE wished to ask if he thought the test could be made use of in the very early stages of cancer, saying that he did not think it very probable, in the beginning, that the small amount of cancerous material could destroy the acidity of the secretion of the stomach; that a few glands concerned in the manufacture of acid being diseased could not affect the acid secretions of all the peptic glands.

it.

DR. HURT asked if it was now regarded as a fixed fact that hydrochloric acid was a secretion of the stomach glands, saying that it was at one time looked upon as being formed from decomposition of the contents of the organ.

DR. GREGORY asked if a neutral or alkaline state was not frequently found in many chronic functional disorders of the stomach.

DR. BREMER in reply to Dr. Hurt's question, stated that the hydrochloric acid was a secretion of the glands, and not the result of food decomposition. In reply to Dr. Love's remarks, said that in the first place the test would perhaps never be called into play in the earliest stages of cancer of the stomach, as the patient did not seek advice until it was of such extent as to give rise to symptoms. Beside this, the question as to whether or not a small cancer spot could change the entirere action of the stomach, was no more strange than that a small ulcer, perhaps no larger than a dime, could produce that effect on the secretions of the organ, and therefore did not see why a small cancerous spot could do the same.

Dr. Gregory said that he remembered seeing mentioned in some work a condition of the stomach characterized by atrophy of the glands, and he supposed in that case there would also be a disappearance of the acid

reaction.

DR. HUGHES asked what part of the area of the stomach was concerned in the secretion of the stomach.

DR. BREMER drew a diagram of the stomach, and drawing a line about three or four inches above the pylorus, stated that the glands

lying on the cardiac side of the line secreted acid, those on the pylorus side mucus.

DR. HUGHES did not think this test could be looked upon as a sign of cancer, but only as a symptom, and stated that there was a great difference between the two; that a symptom was common to several diseases perhaps, but a sign was peculiar to one only.

DR. LUTZ presented a specimen of fracture of lower end of the radius. The man, a carpenter, fell from a house, striking on the palm of his hand, fracturing the radius, and presenting what appeared to be a typical case of Colles' fracture; succeeded in getting the fragments in good apposition, but the hand remained cold. Dressed in pistol-shaped splint; hand continued very cold, bullæ formed on the skin, and gangrene set in; waited until the line of demarcation had formed, and then amputated, the operation being made in middle of humerus. The bone being examined, it was found to be not a ty pical Colles' fracture, but the lower end of the radius was split into five fragments, the line of fracture extending into the articulation of the wrist. The radial artery was torn through, and the ulnar thrombosed as high as the elbow; brachial artery in good condition. Spoke of the results of Colles' fracture, and said he thought it was very seldom that results could be obtained with no deformity.

DR. TUHOLSKE stated that this was the fracture described by John Rhea Barton, and named after him Barton's fracture; that is, an oblique fracture of the lower end of the radius, extending through its articular surface. Society then adjourned.

THE CHICAGO GYNECOLOGICAL

SOCIETY.

[CONCLUDED.]

DR. C. T. PARKES said: I do not think I have anything new to offer on the question of treatment of hematocele. My experience embraces only three cases. The first was a lady whom Dr. Fitch saw with me about a week after the initial symptoms which present themselves in these troubles, had appeared, and we concluded to make an opening through the cul-de-sac of Douglas. I used the Paquelin cautery for the purpose of opening up the mass, which was not very extensive. The principal symptom which led us to think it was necessary to resort to interference, was the evidence of the presence of probable suppuration. The lady had been having slight chills and some cor

we

responding rise of temperature, and thought it best to be certain whether or no the mass had decomposed and broken down, so we opened it with the cautery, and quite a quantity of grumous, broken down blood, with clots came out. The lady was relieved of her pain and distress. We introduced a drainage tube, and through this tube passed a large catheter as long as the opening would permit, and washed out the cavity every day, and followed it up for a long while, with a diminution in the size of the mass, until it got so that it was merely perceptible above the pubes, then the chills came on again more severely, and after suffering for a month or six weeks she finally died of septicemia. In that case I was satisfied from the fact of being able to fill the cavity apparently, under the force of hydrostatic pressure, and then have something give way, and the fluid rapidly disappear, that we had a series of cavities which were opening into each other. I think if I had such a case to manage now, I should do differently. I should use thorough antiseptic precautions, and care at present; such treatment was not then deemed necessary. The next case, a very interesting one, happened last winter; I saw the lady four or five weeks after she was taken ill. She was taken as though she were going to have a miscarriage after having missed menstruation twice, and when I saw her she was in an extreme condition of collapse; upon examining the abdomen, it was found full of something, dull on percussion, resonant above, and to the sides; on digital examination, the ordinary signs of hematocele were present. This woman was in such a weak condition that I could not bring myself to the idea of interfering, and tried to support her and wait for events. I attended her two weeks, while she varied from one condition to another, all the time life hanging by a thread. In the third week, on examining her abdomen, I thought I detected fluctuation, and in two or three days was certain of it. I aspirated in the linea alba midway between umbilicus and pubes, and at first withdrew a quart of blood, but, although I was satisfied there was more there, I did not repeat the aspiration that day. Two days afterwards I aspirated again, and withdrew two quarts. She began to improve from that moment; 1 merely put her on tonics and supporting treatment; this was in February. I saw her about a month ago, and she was going about the house the same as anyone else. The third case was a little later in the same year, a lady who had been bleeding a little for some time, with the presence of signs of conception of two months' date. I

made an examination, and was satisfied that I detected to the right of the uterus a mass as large as one's fist easily reached by manipu lation internally and externally, tense to the touch, and elastic. I diagnosed a probable hematocele, kept her quietly in bed, but did nothing special for her. The occurrence of this tumor was accompanied by extreme shock, prostration, pallor of the body and symptoms of collapse. She has now entirely recovered without any interference whatever. That last case led me to think of some of the reports I have read about surgeons being called to see a patient in collapse, finding she has flowed a little, with a history of probable pregnancy, making an examination, and discovering a little tumor, diagnosing extra uterine pregnancy, using electricity and curing the patient. It seems to me there may be a possibility of there being a mistake in some of these cases of extra-uterine pregnancy that are cured so readily by the use of electricity. They are becoming very frequent. I must say, that it was a very difficult matter for me to decide in this case, whether it was extrauterine fetation or hematocele, still I am satisfied that it was an hematocele.

DR. H. T. BYFORD said; Before closing the discussion, I would like to add the following case to the series reported in the paper:

CASE VI.-Mary H., a German servant, 25 years old, was taken sick with pains about the lower abdomen, nine months ago. The attack, which came on after a menstrual period, kept her in bed little of the time, but did not pass off. In six weeks, her menses came on and lasted two weeks. The bleeding ceased for a few days, then returned and had con tinued in varying quantity, until stopped by ergot about a week before I saw her, Vesical iritation was an almost constant symptom. Up to that time, she had tried to attend to her work, but then gave up her place. She told me, a little over a month ago, when I first saw her, that she felt worse since taking the medicine. the medicine. The great pelvic tenderness subsided rapidly under the "absolute rest" treatment, and in less than a week afterwards, I was able, without paining her, to completely circumdigitate a large boggy or semielastic tumor in the right broad ligament, extending behind the uterus from a level with the the internal os upwards, and reaching into the left left broad ligament, where it felt harder and nodulated. The uterus was anteflexed, displaced anteriorly, and to the left (leaving only room enough between the cer vix and the pubes for the index finger,) and intimately attached to the surrounding mass. The probe entered three inches,

turning forwards. After keeping off her feet, although not in bed, using hot douches, iodine applications to the abdomen, iron internally, and having glycerine plugs applied about every three days for three weeks, the tumor had become harder, somewhat nodulated in places, and perceptibly smaller. She had felt quite well again until the last few days, when she undertook to resume her domestic duties.

This case shows well the positive benefit of rest, and the positive harm that is sure to result from want of it. Its history is similar to the history of many such tumors which go on to suppuration, but which, with proper treatment, would have been promptly absorbed.

The unfortunate case related by Dr. Bartlett bears witness to the dangers of the curette in pelvic hematoceles, and is probably one among many somewhat similar ones that have not been reported. The necessity of a large opening, perfect drainage and great antisep tic precaution is vividly shown by one of the cases recited by Dr. Parkes. His view as to the liability to the formation of pus pockets is corroborated by the sudden discharge of half an ounce or more of pus on March 26, in the case of Mary St. -, followed by the rapid sinking of the uterus back into its natural position. This pus pocket, had the operation not been performed, would probably have formed and pointed upwards in the direction of the least resistance, and would have become an abdominal abscess, and a serious thing to manage. I quite agree with Dr. Parkes that simple hematoma and hematocele are too often thought to result from extrauterine pregnancy, and think it is partly the result of Gallard's theory that all non-trau matic cases are extra-uterine pregnancies, a theory which has done its good and has had its days. The intensity and persistence of the local symptoms, the passage of the decidua, and the past or present characteristic symptoms of the pregnant condition should usually prevent such a mistake.

come to the conclusion that with our present knowledge of antiseptics we need not be frightened out of opening up these accumulations, and had acted upon it, before I knew of Bandl's views; and so had many others whose veneration for long established authority had not overpowered their individual judg

ment.

A. Martin's method of operating for hematoceles and hematoma is one method, but that it is the method cannot be maintained upon scientific grounds so as to convince the profession; nor has it yet been so proved by its success. As to the frequent bunglesomeness of operations per vaginam and per rectum, there is scarcely to be found an opportunity for the bungler like the performance of laparotomy for pelvic disease. I doubt if I exaggerate in saying that half of the abdominal sections are done in a bungling manner, especially when compared to those of Martin and a few others.

In my paper I advocate the expectant plan of treatment, and have used it, and, so far succeeded with it, in all of this series of cases except one. That case was operated upon because the conditions for a cure without an operation were not attainable; because even if attainable, they would have taken too much time to restore the patient to usefulness; and because if properly done, the operation in such a case is almost devoid of danger. I regard it as a good illustration of when we may operate in case the expectant plan does not afford relief. In case VI., Mary H., which I have just reported, I shall use every effort to do without surgical interference, because the interior of the sac cannot be easily and safely touched.

Protheroe Smith, M.D., M.R.C.P., of London, was then elected Honorary Fellow of the Society.

W. W. JAGGARD, M.D., Editor. 2330 Indiana Ave., Sept., 1886.

CHICAGO MEDICAL SOCIETY.

Stated meeting, Sept. 6, 1886, E. J. DOERING, President, in the chair.

OFFICIAL REPORT.

DR. J. S. JEWELL gave a partial verbal ab

OVERFILLING AND DILATATION OF THE COLON.

He said that for the last ten years this subject had attracted more or less of his attention. During the last eight or ten years he had accumulated a list of over five hundred carefully studied cases, in which the condition named