Menstruation occurs normally, and there is no bleeding at any time from the wound. DR. PARISH made a few remarks upon the history of this case, and the difficulties surrounding a diagnosis. The patient was thirty years of age, and perfectly healthy. She missed one menstrual period, and a week later, possibly in the fifth week of pregnancy, there were signs of internal hemorrhage with shock. Dr. O'Hara at this time made his diagnosis, doubtless correct, of tubal pregnancy with rupture of the cyst. The patient commenced after a few hours to rally. Dr. Parish was called in consultation the next day; he suggested an operation to remove the cause of the trouble, but did not urge it as the symptoms had ameliorated. The patient continued to improve for several days. Afterwards a tumor appeared. The first hemorrhage being into the folds of the broad ligament and limited, did not show, but, as repeated hemorrhages occurred, the tumor increased, pus formed, the embryo softened, septicemia without peritonitis was developed, and then the operation was performed, and was then imperatively demanded. Three months after the original shock, a sudden and nearly fatal hemorrhage occured simultaneously from the wound, vagina, and rectum. Evidently there was a tubal communication between the uterus and the wound, and a large rectal fistula had formed. This fistula healed without any separate operation. There was evidently at the beginning a pelvic hematocele without peritonitis, due to a ruptured Fallopian tube. The early operation was proposed, but did not meet with approval. It was evident the hemorrhage was extraperitoneal, as it would most probably have been fatal if it had burst into the peritoneal cavityHe deprecates the expectant plan of treatment of cases of rupture of the cyst of tubal pregnancy, but in this instance the ameliora. tion of the symptoms at the time when first seen by him led him to hesitate as to the necessity for immediate operation. The sequel showed that, in this case, an early laparotomy would have been of no service. The patient's recovery is complete. DR. HARRIS heard of this case a week after its commencement, and believed, from what he knew of it at that time, that it would be advisable to perform the laparotomy; but subsequent developments indicated that the hemorrhage was extra-peritoneal and gradual, and there was therefore no immediate danger to be overcome. When, however, he saw the patient, October 28th, he was satisfied that her constitutional symptoms required that an exploration of the abdominal cavity should be made, the blood cyst defined, and then that the blood should be evacuated above the left groin. This opinion being sustained in the consultation, the operation was performed accordingly. DR. PRICE inquired if any examination of the condition of the gall-bladder and duct had been made at the time of operation. Was the jaundice due to mechanical obstruction or to the general condition? DR. BAER at first thought an error had been committed in not operating at first when the diagnosis was made and the tube ruptured; but the full history puts the matter in a different light and would cause great hesitancy about rushing in in a similar case. DR. O'HARA had made his diagnosis at the time of the accident. Operation could not have been performed then on account of the collapse, and after that passed away it did not seem called for until the time of its performance. One question has risen in his mind from the subsequent history of the case. Would it not have been better if the wound had been packed from the time of the operation? SAENGER'S CESAREAN OPERATION. DR. ROBERT P. HARRIS said: I desire, through this Society, to give publicity to the following statement, received a few days ago in a letter from Dr. Sänger, of Leipzig, by which it will be seen that his method now stands unrivalled in the world, in its ability to save human life. Locally considered, the Porro operation, as performed in the Santa Caterina Hospital, of Milan, Italy, has, until recently, far exceeded, in its proportionate success, all other Cesarean methods in any hospital or country; but this, the best of all Porro successes, has now to be rated second, as compared with its younger German rival. Laparo-ely trotomy, a year ago, stood upon the same level with the Sänger operation, in its rate of success; but now, the latter far outstrips it in the number of times it has been performed and in its proportion of cures. According to Dr. Sänger's letter, his operation, with its modifications and simplifications, has been performed 25 times; saving 18 women (or 72 per cent) and resulting in 22 children being delivered alive, or 88 per cent. In these are included three fatal American cases, which, if not in an absolutely hopeless state before the operation, gave a very minimum hope of success. The European 22 operations saved 18 women, or 81 per cent. In the Maternity Hospital of Leipzig, Dr. Sänger has operated four times, Dr. Obermann once, and Dr. Donal once, saving all of the women and children; in but one woman was there any special trouble after the operation. Dr. Leopold, of the Dresden Maternity Hospital, has operated nine times, and Dr. Corn once; the former lost one woman, all of the children were saved. Thus we have 15 women and 16 children saved under 16 operations, a mortality for the former of only 64 per cent. Of the four deaths in Europe, two resulted from septic poisoning which existed at the time of the operation, and in the other two subjects it followed it. Dr. Sänger has such confidence in his method, from the success that has attended it in Germany, that he believes the time has come when it should be preferred to craniotomy, because of its moderate fatality, and its saving the child. We should be glad if all of the Cesarean operations of the United States should be performed after Sänger's method, as simplified by Garrigues and Leopold, but we must not expect very happy results here, until our accoucheurs become alive to the fact that delay in operating will make any method fatal in a large proportion of cases. In no country are the capabilities of the old Cesarean operation greater than in the United States, and in few has this form of delivery been of late more uniformly fatal. To find eighteen recoveries under it we must search backward to January, 1863, and through a record of time covering more than twenty-three years; in which period seventy-three operations have been performed, proving fatal in about seventy-five per cent. This occurred notwithstanding the established fact that early operations will save seventy-five per cent of the women and still higher of the children in the United States. TAIT ON FARADIZATION. DR. R. P. HARRIS also presented the following letter from Mr. Lawson Tait, of Birmingham, dated April 16th, 1886. “I have very strong objections to the proposal to treat cases of extrauterine pregnancy by faradization. In the first place, the diagnosis of these cases must always be haphazard, that is to say, a correct diagnosis will not be made probably more than once in three times; the result will be that all such cases will be dealt with mischief only, and I venture to predict that this treatment will be dropped, as all such treatments are, without explanation of the case, in a very short time." "My greatest objection is, that supposing the fetus has passed through the stage of tubal rupture and remained alive, what right have you to murder that child? If it goes on to the full time it may be delivered alive, and the woman will have a chance of recovery from the operation, far greater than with the faradization treatment of destroying the child. The cases, according to my experience, which recover from the operation are about six out of seven. "Every one who has had much experience with pelvic tumors must have seen a certain number of cases where the fetus has died between the fourth and sixth month, and where after a prolonged course of suppuration it comes out through the rectum, bladder, etc.; these are, of course, the cases where the tubal rupture has taken place into the broad ligament on the left side. I have seen one right-sided case going into the bladder; it, of course, killed the patient. "In the whole course of my life I have only known of one case where the woman has carried an extrauterine pregnancy for a number of years after the death of the fetus. We know with perfect certainty all about this case, and for about eighteen years she has carried on the left side a condensed ovum of extrauterine pregnancy. I doubt very much if there could be found in the whole world three other such cases; whereas the number of cases who die or who have prolonged illnesses, after the suppuration and discharge of the fetus, is even in my own experience very great." In closing his letter Mr. Tait writes: "I wish you would make this opinion of mine known on your side." In reply I will state: 1. We do not, in this country, practise electrolysis in cases of extrauterine pregnancy. No puncturing needles are used, and the electro-magnetic current will not endanger the life of the patient any more if the growth to be acted upon is a tumor, than if it be, as presumed, an ectopic fetal cyst. The experience of seventeen years in the United States, in which no fatal result is believed to have taken place, has only tended to establish this feticidal method as a valuable means of saving women when in great danger of death from rupture of the fetal cyst and internal hemorrhage. 2. We do not propose to act upon the fetus after it has escaped into the abdominal cavity, unless the fetus should be very small, and be easily accessible to the pole of the battery placed in the vagina. We cannot see that it is any more a murder to destroy a two or three months' fetus after it has escaped from a Fallopian tube by rupture, than while it is still in it. The chief objection lies in the fact that such ectopic fetus will be much more likely to give trouble after its destruction, than one that is securely inclosed in a sac from which the amniotic fluid shall have been absorbed. It is true that an abdominal fetus may be delivered alive at term, if permitted to live; but it is not correct to estimate the risk of such an operation as lower than faradization properly performed, for it is far higher. Primary laparotomy, as far as we know of the operation, has been fatal in fifteen out of nineteen cases. It is not proposed in this country to operate by faradization upon fetuses of from four to six months. Dr. T. G. Thomas has, it is true, proposed to make the limit four and one-half months, but the general impression is, that feticide is much safer, immediately and remotely, if done in the second and third months, when fetal ossification is very incomplete. The entrance of fetal débris into the bladder is not necessarily fatal, as in the case related by Mr. Tait; for Parry refers to nine cases four of which recovered. Mr. Tait appears not to be aware of the fact that cases of prolonged ectopic gestation have been comparatively numerous, as witness the following partial records: 1. Nebel reports the case of a woman of 91, who died in 1767, and in whose body a fetus was found that she had carried fifty-five years (Campell on Extrauterine Pregnancy," 1840, page 45). 2. Brandt records one of a woman of 80, who died in 1858, after carrying a fetus for fifty-six years, and bore two children while it was still in her abdomen (Ranking's Abstract, 1863, vol. i., page 216). 3. Parkhurst reports one of a woman of 77 who carried a fetus, fifty-two years (British and Foreign Med.-Chi. Rev., 1856, vol. i. page 271). 4. Chiari gives a case of a patient who died of peumonia when 82, and who carried an eight months' fetus for fifty years (Lancet, London, 1876, vol. ii., page 141). 5. Conant's case was a woman of 63, who died in June, 1863, after carrying a fetus thirty-five years (New York Med. Jour., May, 1865). 6. Majon found in a woman of 78 a calcareous fetus computate d at three months (Cruveilhier, "Essai sur l'Anatomie Pathologique," Paris, 1816, tome ii., page 130). 7. Mangin and Vernier found two fetuses in the body of a woman of 74 which she had carried thirty-three years (Jour. de Médecine, 1786; Gaz. Méd., July 29th, 1837). 8. Morand also found a three months' fetus in a woman of 78; she had carried it thirty years ("Mém. de l'Acad. Royale des Sciences," 1748). 9. Kristian Grön found a three months' fetus in a woman of 49 which had been carried eighteen years (Norsk Magazin for Lœgevidensk., Band xvii., Heft 2). 15. Johannis Ambosi (1582) reported a case of a woman of Lens who carried a fetus twenty-eight years (See Astruc, "Traité des Mal. des Femmes," Paris, 1765, tome iv., page 78). 11. Campbell reports the case of a woman of 75 in which was found a fetus that had been carried thirty years; a fetus of about two months was also found (C. on "Extrauterine Gestation," ed. 1540, page 55). 12. Pepper relates the case of a patient of 53, married twentyseven years, in whose body Dr. Loder found two fetuses, one carried twenty-three years (Trans. Pathol. Soc., Philadelphia, 1876, page 102). 13. Francis Boyle removed an eight-pound fetus after the death of a woman of Toulouse that she had carried twenty-six years ("Philos. Trans. Abrid.," London, 1794, vol. iii., page 222). 14. Cruveilhier, in his "Anatomie Pathologique," gives a plate representing a calcified fetus which had been carried many years. 15. Oelinger reports the case of a woman who carried a six and and one-half months' fetus about fifteen years (Prog. Méd., Paris, 1884, vol. xii., page 196). 16. Johnson's case, aged 68, carried a fetus fourteen years, after which she discharged fetal remains, at intervals, during thirty years (Med. Times, London, 1872, vol. i., p. 655). 17. Leinzell in 1720 removed from the body of a woman of 94 a fetus that she had carried for 46 years. 18. Watkins examined a woman of 74, who died of kidney disease January 13th, 1866, and removed a fetus which she had carried for forty-three years (Brit. Med. Jour., March 3d, 1866). 19. Van Sweiten also records the case of a woman of Lyons, who died at 68, and had carried a fetus for twenty-seven years (opus cit.). 21. Fabri, of Ravenna, found in a woman of 55 a fetus she had carried for some years. The pregnancy was her fifth, and she bore two children at later periods (Brit. Med. Jour., March 7th, 1863). Many more cases of the same character might be added to this list, some of which would go to show that an extrauterine fetus may prove fatal by purulent disintegration and pointing after |