account of palpable organic disease. The operation, however, was not performed. He kept the patient under constant treatment, and her general health very much improved, the tenderness greatly subsided, but the enlargement remained, and since that time the patient had been married and had borne two children, and is in a thoroughly comfortable state of health. He had seen other similar cases. But, on the other hand, there were cases in which he believed he did good service when he sacrificed the ovaries. The circumstances under which he would remove the ovaries were: First, the general health of the patient must be broken down, destroyed, and there must be no reasonable expectation of restoring health by any other known means, and there must also be a reasonable prospect of restoration of health by loss of the ovaries. In the second place, it must appear that there is no other practicable remedy, and in the third place, it must appear probable that it must eventuate in a cure.

DR. R. STANSBURY SUTTON, of Pittsburg, believed that when an ovary is diseased and cannot be cured by ordinary means, and that when it involves the health of the patient and places her in a condition in which she is prevented from discharging the ordinary duties of life and renders her life miserable, it should be extirpated. As a diseased organ, the ovary was not entitled to any more respect than any other organ of the body. It mattered not to him whether the inflammation began in one place or in another, if the Fallopian tube was full of pus or an ovary was diseased to such an extent as to render married life a burden, or the life of a single woman a burden, he regarded it as his duty as a surgeon to remove that diseased ovary and tube as he would remove a diseased eyeball. He agreed, however, with the gentleman who said that this operation was being abused. It was not because it was being done too much by competent men, but too much by incompetent men. Put the blame where it belongs, not upon the operation, but upon those who are doing the operation. DR. S. C. BUSEY, of Washington, had supposed that Dr. Emmet's paper was a contribution toward determining whether in pelvic inflammations a peritonitis or a cellulitis is the primary affection. He had no doubt that either the one or the other was a primary affection, but he did not hold to any exclusive view. And it occurred to him that the differences in opinion could be reconciled most readily by reference to the histological anatomy of the tissue. If this was done, there would be less disagreement in pathology. All these tissues are closely allied by histologists who regarded the cellular tissue as a vast lymphatic sac and the peritoneum as normally a dilated lymphatic sac. So far as distinguishing these affections was concerned, they could be more easily classified under the term pelvic lymphangitis, varying in different cases.

With regard to operative procedures, he believed, with most of those who had spoken, that too many operations had been performed, and perhaps too many operators had undertaken it. He

thought the time, however, had come when diagnosis should be based upon other data than the general appearance of the patient, and upon something more than merely social or ethical considerations.

DR. M. D. MANN, of Buffalo, thought it of very great importance, to determine whether the cases which were so frequently seen with hardened tissue behind the uterus, etc., were due to thickening and induration of the connective tissue, or to adhesions or thickening of the peritoneum with involvement of the ovaries and tubes, etc., for therapeutics must depend upon diagnosis, and diagnosis must depend upon pathology. After labor or miscarriage, there is probably a true cellulitis. And in other cases there is a condition resembling to a great extent this condition of true cellulitis, but absorption does not take place in the same manner, and we go on treating that for weeks, months, perhaps for years without much effect. If these cases are peritonitis, that is the result we should expect, because we do not expect adhesions to be affected by this mode of treatment. Now, the question of removing the offending organs, provided they have created sufficient difficulty to seriously compromise the woman's general health, must be taken into consideration. For his part he did not believe that cellulitis was as common as had been taught. He had operated several times with the result of bringing about a perfect cure in cases where all the symptoms were apparently on one side of the pelvis. And he thought it was objectionable to remove both ovaries when only one organ was diseased.

The paper was further discussed by Dr. H. P. C. Wilson, of Baltimore.

DR. JOHN C. REEVE, of Dayton, Ohio, then read a paper on

ABDOMINAL SECTION FOR CHRONIC SUPPURATIVE PERITONITIS.

The recent great advances in abdominal surgery, and especially the treatment of abdominal and pelvic inflammation by operation, justified the author of the paper in presenting the following case:

Annie, 19 years of age, living as if married, always healthy. and without accurate account of the history of the earlier part of her illness, gave a history of repeated attacks of pain and tenderness in the abdomen, accompanied with fever. When Dr. Reeve first saw her, she presented all the symptoms of chronic peritonitis. Not long afterward, she began to pass pus by the rectum and with the stools. That continued daily, or several times daily, until the operation. It was not a case of pelvic, but of abdominal disease. Finding her condition becoming so deplorable, and all means of relief having failed, Dr. Reeve offered her all the chance there. might be in laparotomy, which was declined. Nearly two months afterward, the patient asked for the operation. Examination revealed great tenderness and great hardness of the abdomen over the lower portion. The hardness extended above the umbilicus and with ill-defined limits, but most marked in the left iliac re

gion. Internally the cervix uteri was normal and movable, but the body of the uterus was fixed. No definite hardness could be felt in the vaginal roof upon either side or in any direction. Careful examination did not reveal any opening into the rectum. The patient was extremely emaciated.

The details of the operation were then described, the result of which was to find a collection of pus in the left side of the abdomen. The walls of the cavity were so dense and thick that it was impossible to bring them up and stitch them to the edges of the incision, and the adhesions of the intestines were extensive and firm. At the end of a week, the patient presented an open. cavity in the abdominal wall below the umbilicus over three inches long by about one inch wide. The bowels moved naturally almost every day, pus never appeared in the stools after the operation. On the fourteenth day quite a large quantity of fecal matter came through the wound, and this has occurred more or less frequently since.

As bearing upon operative treatment in abdominal inflammation, Dr. Reeve thought that the case spoke strongly in its favor. The great diminution of suppurative discharge consequent upon cleaning out its source, the immediate and entire cessation of discharge of pus by the rectum, the prompt and decided improvement in the appetite and digestion of the patient, all indicated that under more favorable circumstances the case would have been a brilliant success.

Upon one important point relating to abdominal section for suppurative peritonitis, the evidence furnished by the case may seem far from satisfactory. He referred, of course, to the question of fecal fistula. It has been most positively asserted by Dr. Henry T. Byford that a fecal fistula is an inevitable consequence of laparotomy under these conditions. Should the fistula in this case prove permanent, Dr. Reeve could not consent to the case being adduced in support of this doctrine. He would attribute the result rather to the special conditions present than to the effect of the general rule. These special conditions were extreme emaciation, lessened nutrition, the change in the character of the tissues involved, preventing the approximation of the edges of the wound. But the question seems well worthy of consideration, is a fecal fistula an inevitable result and the necessary consequence of laparotomy for pelvic and abdominal inflammation when pus has made a way of escape by the rectum ?

The paper was discussed by Dr. Scott, of San Francisco, Dr. Goodell, of Philadelphia, Dr. C. C. Lee, of New York, who thought that in certain conditions of suppurative peritonitis laparotomy was justifiable and the procedure to be adopted; Dr. Chadwick, of Boston, Dr. Sutton, of Pittsburg, and Dr. Joseph Taber Johnson, of Washington. The discussion was closed by Dr. Reeve.

Second Day-Morning Session.

The Secretary read a paper on

ERGOT AFTER LABOR,

written by DR. JOHN GOODMAN, of Louisville, Kentucky, who said that the custom had become very general to administer a dose of ergot immediately after the completion of labor. The purposes for which ergot is administered are, first, to prevent after-pains; second, to promote, involution; and third, to prevent post-partum hemorrhage.

If the agent was incapable of doing harm, and there was evidence that it would accomplish either of these purposes, its use should be continued. But if it was in any way deleterious, we must either reject or restrict its use. The author of the paper related two cases in which tetanic spasm of the uterus was produced by small doses of ergot, and in one of which septicemia developed. These cases were extreme ones, but he had seen similar ones in which the deleterious effect of the drug was less marked. With reference to ergot hastening involution, the writer of the paper regarded it as an absurdity, as involution was a natural process and a certain length of time was required for its accomplishment. The worst case of involution which he had seen was one in which ergot was given early in the second stage. That in ergot we had an agent which was capable of averting or arresting after-pains could not be doubted, but it does so by setting up an action of the muscles which is not physiological. The only benefit of ergot after labor is in the prevention of hemorrhage, but its use is attended by dangers so great that it should not be administered indiscriminately. In his opinion, it should be laid down as an invariable law never to give ergot at the close of the third stage unless the danger of hemorrhage was imminent, and then hypodermic injections of ergotin was the preferable method.

DR. BARKER, of New York, regarded the paper as the most original one he had ever listened to in the Society, for the reason that it was original in its peculiar manner of reasoning.

The PRESIDENT said that he had prepared a paper in which, not so well said or radically put as in the paper written by Dr. Goodman, he had entered his protest against the routine practice of administrating ergot after the third stage of labor. He had carefully watched the action of the drug at the bedside, and his reflections would aid in establishing what Dr. Goodman had claimed for it. As to the primary physiological influence by which it reaches its conclusions in its actions on the unstriped fibre in the uterus, he would not detain the Society to discuss. The contraction which was produced was not like the contraction which takes place during the process of labor. The natural state of the circulation in the uterine wall after the placenta has been delivered cannot be reached if the normal intermittent contraction of the uterine muscle is made persistent.

Ergot not only closes up the uterus, but likewise interferes with the circulation within the uterus, and therefore interferes with the process of involution and must lay the foundation for sepsis. He was perfectly certain that within eight years at least the practice of obstetrics would be revolutionized in this direction, and he was perfectly certain in his own mind, although it might seem like an extravagant statement, that more evil is being done to-day by this item in obstetric practice throughout the country than by any other one thing.

DR. GOODELL, of Philadelphia, said he did not suppose that every woman who had given birth to a child needed ergot, but that it was not always known which were the women who did need it, and he had been in the habit of giving it in the twentyfive hundred cases of labor which he had attended, and had not seen that any harm had been done by it. He had formerly given it for two purposes; first, to prevent hemorrhage, and, second, to prevent absorption of septic matter by setting up firm contraction. However, since the days of antisepsis, since the use of bichloride-of-mercury solutions, which should be used in private practice as well as in public practice, he did not think that ergot played any rôle at all with reference to the prevention of septicemia. But he did think it was important with reference to post-partum hemorrhage, and did not think it did the injury and harm which the President thought it was capable of doing. At the same time he was willing to admit that it was not every case which needed ergot, but must claim that of the many cases of labor which he had attended he did not know of one in which injury had been done by its administration.

DR. PARVIN, of Philadelphia, believed that small doses of ergot simply increased the normal uterine contractions; that it might with propriety be administered prior to emptying the uterus, as had been proven so well by Elwood Wilson, of Philadelphia, and Murphy, of England, who were the two men who gave ergot and who treated placenta previa most successfully; that it assisted in obtaining normal uterine contraction which prevented hemorrhage and promoted involution. He was unable to see how a diminished blood supply could prevent uterine involution, but, on the other hand, involution was promoted by this condition.

The discussion was continued by Dr. Engelmann, of St. Louis, Dr. Skene, of Brooklyn, and Dr. P. C. Williams, of Baltimore.

THE PRESIDENT'S ANNUAL ADDRESS.

DR. THAD. A. REAMY, of Cincinnati, President, then delivered his address.

The "lex non scripta" of this Society not only demands an annual address from its President, but the same authority, as precedented in former addresses, makes it customary for these inaugural words to be to some extent retrospective and advisory.

Having spoken of the growth and flattering prospects of the Society, the President spoke of its great loss, occasioned by the