waist of the shape and dimensions shown in the drawing will fit the great majority of women. The amount of overlapping in the median line and on top of the shoulders can be varied so that it will fit either a stout or a thin woman, and it affords a perfectly even support to the breasts. A second advantage is that regularity of nursing is promoted, as the trouble of unpinning and repinning is enough to make the wearer delay a little, rather than put the infant to the breast whenever it cries. At the hospital it is the custom to apply this binder immediately after delivery, and it is worn for fully two weeks.

Under its use, the slight amount of mammary disturbance met with is surprising. The second, or Y-bandage, is described in "Monthly Nursing" by Dr. A. Worcester, and constitutes an admirable means of support whether the patient is lying or standing. Straps over the shoulder assist in keeping it in place if the patient is moving about. Two or three linked safety pins will nicely approximate the bandage between the breasts. The best use to which this bandage can be put is to hold up a pendulous breast.

DR. FOWLER asked if the first bandage described was not also abdominal, and if the present fashionable Jersey garment would not answer a similar purpose as regards the breast?

DR. PARTRIDGE stated that in the photograph two bandages were represented, the one abdominal and the other mammary, and that he thought the Jersey would prove too elastic.

DR. HANKS thought that the first bandage described should be recommended on account of its simplicity.

THE PRESIDENT inquired if the object of this bandage was purely to support the breast, or if it was also applicable to cases of mastitis. He stated that he had recently received a letter from a gentleman from the West in which a similar binder was de

scribed for use in the prevention of lactation, and that he had informed him that the idea was by no means new.

DR. PARTRIDGE replied that the main object of the binder was to give equable support to the breasts, and thus to prevent mastitis. In his experience at the Maternity, during a number of years, he could recall but one case of mastitis, and this fact spoke strongly for the use of the binder.

CASE OF PROLIFERATING OVARIAN CYST.

DR. HANKS reported a case of this nature, in which he had operated successfully about three weeks previously. He had been called to Greenwich, Conn., to see a farmer's wife suffering from an abdominal tumor. On reaching her, as no preparations had been made for ovariotomy, he tapped to relieve the abdominal distention. Four days after he was telegraphed for, and found the patient rapidly failing. He at once exposed the cyst through a three-inch incision, and found the angry look suggestive of malignant disease. The adhesions were numerous, and the cyst-wall extremely friable. The pedicle arose from the left ovary, and was as thick as the little finger. The solid matter of the tumor weighed fully ten pounds. The patient made an uninterrupted recovery, and the case was related principally to prove what might be done under discouraging circumstances, in the absence of trained assistants and nurse.

DR. JANVRIN inquired if the cyst contained colloid material, and as to how long it had been developing.

DR. HANKS replied that there was no colloid material, and that the cyst had been growing for about three months.

THE PRESIDENT stated that it had been his misfortune to see a number of cases similar to the one just related, and that, since his own cases had terminated fatally, he would congratulate Dr. Hanks on his result. A few years previously, he had had a case in New Hampshire, where before operation the suspicion was that one of the two cysts present had ruptured. The patient's condition was very low, and he operated unwillingly, finding two tumors excessively rotten. This patient did not rally from the operation. Glandular proliferating cysts he considered papillomata, and although in appearance malignant, they were in reality not so. He inquired how long the operation lasted in Dr. Hanks' case. [When informed that the duration was fifty minutes, he said he considered Dr. Hanks fortunate in having been enabled to complete the operation in so short a time.]

DR. JANVRIN stated that Dr. Hanks' case must be considered an instance of friability of the cyst, the result of very rapid growth. DR. PARTRIDGE inquired if nowadays the length of the abdominal incision was deemed of such importance as Spencer Wells had formerly claimed.

THE PRESIDENT stated that the incision must be made to fit the

case.

DR. HANKS believed that the majority of operators preferred the short incision.

DR. WYLIE agreed with the President, and stated that the incision should always be sufficient to allow of easy extraction of the cyst.

THE PRESIDENT said that in Schröder's and Martin's clinics long incisions were made with impunity. For intra-pelvic tumors he believed that the deep incision, down to the symphysis, was to be preferred. It was to be remembered, however, that Tait was in the habit of operating through very short incisions. Personally he was in the habit of beginning with a short incision, and enlarging it to suit the necessities of the case.

DR. WYLIE believed that the lower the cut the greater the liability to ventral hernia, particularly where the drainage-tube was used.

DR. JANVRIN inquired if ventral hernia was of frequent occurrence. He had seen only a few cases in his life, and in two of these the drainage-tube had not been used, and the hernia was high up. It was his belief that to-day most surgeons made a short incision in order mainly to lessen the chance of septic infection at the line of incision.

DR. WYLIE said that, in his experience, hernia at the line of abdominal incision was not so very rare. Surgeons, however, differed widely in their practice, and Hegar had told him during the past summer that he considered it a mistake to make a short incision.

THE PRESIDENT remarked that, in regard to the length of incision, the Germans, in their preference for the long, differed from both the English and American operators.

TRANSIENT ELEVATIONS OF TEMPERATURE AFTER DELIVERY, AND THE INDICATIONS FOR A RESORT TO THE INTRAUTERINE DOUCHE.

DR. HANKS opened the discussion on the above topic by considering, in particular, the influence of the malarial element in the puerperal state. He considered it very difficult to tell, within the first twelve hours after delivery, whether a rise of temperature was due to septic or malarial influence. If on careful examination of the genital tract, he found a laceration of the cervix or perineum, or an edematous state of the vagina around the cervix, he was inclined to attribute the rise of temperature to the absorption of septic matter. In case the uterus was large, and the lochia fetid, he resorted to the douche. To exemplify the difficulty in the way of diagnosis, he related a case where the rise and fall of temperature were extreme and rapid for days in succession, and where, although everything pointed to malarial infection, he had not been able to divest his mind of the thought that the cause was septic phlebitis, resulting from a hypodermic injection.

DR. RODENSTEIN stated that he saw a great deal of malaria after confinement. A chill coming on suddenly and followed by sweating was apt to mean malaria. A strong point in differential diag

nosis he considered to be the state of the external os. In sepsis, he had noticed that the os was always patent, in malaria, usually closed.

DR. FOSTER inquired as to the number of exacerbations of temperature, in the case reported by Dr. Hanks; and DR. HARRISON asked in regard to the condition of the uterus.

DR. HANKS, in reply, stated that for many days the temperature

would range to 104° or 106°, and then suddenly drop; that there was nothing about the uterus to suggest sepsis.

DR. MORRILL suggested that the element of periodicity would assist largely in differential diagnosis.

DR. PARTRIDGE stated that it was frequently difficult to differentiate to perfect satisfaction. We should ever reach our diagnosis by means of careful exclusion. The pelvic organs should be carefully and thoroughly examined, not alone once, but repeatedly, for frequently the second or third examination would reveal a cause not appreciable on the first. If, finally, he could find no cause for sepsis, he then concluded he was dealing with malaria. When we remembered how much constitutional disturbance might result from a simple abrasion on the surgeon's finger, it was amply evident how a slight lesion of the cervix, for instance, might be overlooked, and yet be at the bottom of septic infection.

DR. MURRAY had never seen a case in which careful examination would not reveal some cause for the elevation of temperature, aside from malaria. He pleaded for careful examination of the genitals, both external and internal, and recalled the fact that a patient might have a large plastic exudation without much febrile disturbance, and yet this be entirely overlooked if a vaginal examination was not made. He had noticed the fact that in every case of sepsis the external os was patent, but he believed that the prime differential point between malaria and sepsis lay in the fact that in the latter there was never complete remission in the temperature, and that generally there were two exacerbations daily. The constitutional depression also was greater in sepsis than in malaria.

DR. FOWLER called attention to the examination of the blood as a means of differentiating the two affections. He had several times thus found the micro-organisms of malaria.

THE PRESIDENT stated that it was his habit to assume rise of temperature after delivery as probably due to septic absorption. A very careful examination is often necessary to reveal the lesion. Patency of the external os to him signified something within the uterus, remnant of placenta, or decomposed clot. He had recently seen a case in a pronounced malarial neighborhood, where the attending physician was convinced he was dealing with malaria. The patient's temperature was 104°, the pulse 130, the facies bad, the lochia very offensive, the uterus large, the os admitting three fingers. With his long curette he had removed a mass of offensive blood clot at the placental site, washed out the uterus, and given antipyrine and applied the ice-coil. The temperature was lowered, but for three days there had since occurred chills and rise in temperature, which he was now inclined to believe were due to malaria. Malaria, he was well aware, was a hobby with some gentlemen, as was evident in a case he had recorded a few years ago, where one of his consultants clung to the diagnosis of malaria in the face of a metastatic abscess on the wrist. This case he had considered pure septic pyemia. He was convinced that periuterine exudations were often overlooked, for the simple reason that careful vaginal examinations were not resorted to. These were, of course, the very cases where intrauterine irrigations would be productive of harm instead of good.

DR. HANKS stated that he doubted if a woman could have a chill and fever during puerperium which was not dependent on a septic element.

DR. WYLIE inquired how often the douche was used in the case the President had just reported?

THE PRESIDENT replied that the indication for repeating the douche was the rise of temperature.

DR. WYLIE believed that the general condition of the patient would guide us largely in our diagnosis. He was in favor of washing out the uterus every hour as long as there was high temperature, and he cited in support of this opinion the results he had obtained at Bellevue, and which he had later reported in the New York Medical Journal.

THE PRESIDENT differed in this regard from Dr. Wylie, and was sorry the discussion had not turned more particularly on intrauterine douching, for he believed that the members of the Society generally would take exception to such frequent douching. He had certainly seen harm result from too frequent douching. He could recall at the time three cases where violent chills had followed the douche, and these chills he considered the result of the manipulations. To DR. MURRAY'S question as to whether it was not the experience of the President that the temperature rose a trifle, immediately after the douche, the latter replied in the affirmative, and stated that he did not look for an immediate fall o

utre.

After all, intrauterine douching-as regards frequencycalled for the exercise of common sense.

TRANSACTIONS OF THE OBSTETRICAL SOCIETY OF PHILADELPHIA.

Thursday, June 3d, 1886.

The President, B. F. BAER, M.D., in the Chair.

DR. R. P. HARRIS read for DR. HOWARD A. KELLY, then in Europe, a paper entitled

GONORRHEAL TUBO-OVARIAN ABSCESS-RIGHT SIDE; LAPAROTOMY; REMOVAL OF FALLOPIAN TUBE AND OVARY; RECOVERY,

of which the following is an abstract:

In this case the disease of the woman could be directly traced to gonorrheal infection on the part of the husband, although she had never, to her knowledge, had any uterine discharge other than blood, and had always been regular in her menses during the three years of her married life.

At 14, Mrs. H. commenced to menstruate; at 17 she weighed 135 pounds, although of medium stature, after which she failed somewhat in health from an abscess of a finger, and when married at 20 was quite spare, as was also her husband, both of whom are of German blood. The husband has since reached a maximum of 167 pounds. Three years before marriage, Mr. H. contracted