ing the use of the spray, are enjoined by a surgeon of Mr. Thornton's acknowledged ability and experience, all antiseptic agents are discarded by so successful an operator as Mr. Lawson Tait. One fact is clear amid all the confusion respecting the details of antisepticism, and that is the great value of absolute cleanliness, which is the essence of Mr. Lister's teachings. Modern statistics show the great value of these principles in abdominal surgery, and he would be indeed a bold operator who failed to apply these principles, modified only as to details.

DR. CHUNN questioned the advisability of introducing a drainage-tube in those cases where there were no adhesions, and consequently no blood or fluid of any kind left in the peritoneal cavity. This opinion he based upon the teachings of Mr. Keith. He considered if any fluid did collect in Douglas' space, it would be easily detected and gotten rid of. He was of the opinion that a woman of forty with a growth like that shown could be tided over until after the menopause, which could not have been many years distant in the case reported.

DR. H. P. C. WILSON questioned the report that some distinguished operators entirely ignored antiseptics. Some, he was aware, did not use the spray, but he was under the impression that they were careful to see that all sponges, instruments, and appliances that had been used in an operation were rendered thoroughly antiseptic before being used in another. Several acids, bichloride of mercury, and other agents were antiseptic, and if any of them were used to guard against septicemia, those employing them could not be said to be opposed to antiseptics in abdominal surgery. As far as he personally was concerned, he still had great faith in antiseptics, especially in hospital practice, and he favored the use of the spray in such cases, having it stopped only just before beginning the operation. He never could understand why we should be so careful in disinfecting sponges and not use as great precaution to render antiseptic the air around hospital operations. In one case he did a laparotomy upon a patient at the same time that there was a case of erysipelas in the next room, and the result was uninterrupted recovery. At another time he removed an ovarian tumor from a woman who occupied the same room and bedstead that had been vacated only ten days before by a patient having a sloughing fibroid from which the stench was so great that it was nauseating to enter her room, and rendered the air of the whole floor offensive. In this room the carbolic spray was used liberally for several hours before the operation, and especially under, around, and in the bed. In some cases he washes out the abdominal cavity with bichloride solution before closing the incision.

DR. ASHBY said he had not had any opportunity of seeing Mr. Tait operate, and so was not personally familiar with his methods; but Mr. Tait had published the fact that he has no faith in the socalled antiseptic agents, and believed they did more harm than good. At one time he (Mr. Tait) had practised the Listerian ideas in all their details, but they disappointed him and he gave them up. He took water from the tap and put it into the basin for the sponges, over the instruments, and into the abdomen, but he practised the most rigid enforcement of cleanliness. Dr. Ashby had recently, through the courtesy of Dr. Chambers, the resident physician, had an opportunity to examine Dr. T. G. Thomas' private hospital from cellar to garret. Every idea that prevails in its con

struction and management has reference to purity of air, scrupulous cleanliness, and absolute comfort. But, with every convenience for ventilating, heating, and lighting, Dr. Thomas still employed a thorough system of antisepsis, and in every detail of his operative work reference is had to disinfection and absolute cleanliness. Dr. Ashby expressed the opinion that, in our country at least, omission of antiseptic precautions in abdominal surgery would mean an increased death-rate, and that no surgeon could, in justice to his patient or to his own reputation, afford to hazard an operation within the abdominal cavity without using those methods of antisepticism that are expressed in the Listerian idea.

Dr. A. asked permission to relate the following case, which he considered of interest in connection with the case reported by Dr. Erich. The patient was a negro woman, age 31, and had been married between nine and ten years. Her youngest child was about eight years old. For four or five years past, she has lost considerable blood during menstruation, and has noticed an enlargement of the abdomen, but attributed the latter to taking on flesh. For several months past, menstruation has been very profuse, generally lasting about eight days. During the intermenstrual period, she has a discharge from the vagina of a clear watery fluid varying in amount from a teacupful to a pint in twenty-four hours. The discharge of fluid is spasmodic in character, deluging her clothing. Her general health is at about par. Physical examination reveals a globular tumor about the size of a uterus at the fifth month of pregnancy. The tumor has thick, dense walls, and is largest at its upper part. The cervix uteri is normal in size and feel. The sound enters the uterus five and one-half inches, is grasped tightly by the lower segment, but rotates freely in the cavity near the fundus. Dr. A.'s diagnosis is, a fibroid of the uterus undergoing cystic degeneration. The indications for treatment are palliative, as in the present condition of the patient no operative procedure would be justifiable. The case is of interest from the fact that the woman's health remains so good, and that the cyst should have opened into the uterine cavity and allowed its contents to discharge as described.

Dr. W. E. MOSELEY thought one great source of misunderstanding in regard to antisepticism came from the inclination people showed to limit disinfectants to the so-called antiseptic solutions and powders. Those surgeons who decry most loudly the use of antiseptic precautions are very careful to expose their sponges, etc., to a high degree of heat before using, and thereby make use of the most powerful means of rendering them aseptic. Live or free dry steam is found to be the most effective agent in disinfecting on a large scale. The numerous antiseptic preparations have their places, but many of them are almost or quite useless, unless used in very concentrated form; and others are poisonous or irritating, and caution must be exercised in their application.

DR. ERICH said that in institutions having arrangements for disinfection by heat, much could be done by that means, but in our own hospitals he thought it necessary to have recourse to antiseptic fluids.

If any question arose as to the diagnosis of the case reported, he would refer those present to Billroth's work mentioned in his paper, and ask a comparison of the specimen with the description found there. He thought many cases were diagnosticated fibro

cysts which were 'not really such, as, for instance, one operated upon by himself, which proved to be an old abscess of a broad ligament. The rule laid down by authorities is that fibro-cysts contain either blood, serum, or lymph, and that the diagnostic value of coagulability of the fluid contents depended entirely upon the character of cystic degeneration. In the seventy cases of fibrocystic tumors collected by O. Hear, only eleven contained fluid coagulating spontaneously.

He thought the social position of the patient had much to do with the question whether the removal of a growth, the size of that shown, was a justifiable procedure or not. He considered that a rich woman would have been able to endure the growth for a considerable time, even until the menopause, as she could place herself among the best surroundings, and have proper care; but, in the case in hand, the woman was poor and obliged to earn her own living, which the growth prevented her from doing. He had represented fully to his patient all the dangers attending the operation, and she had insisted upon undergoing it. In such cases, he thought we had no right to refuse to operate.

He considered the detection of a small amount of fluid in Douglas' cul-de-sac, unless encapsuled, an impossibility, as free fluid would recede upon the slightest pressure from without. The peculiar form of drainage he had adopted was that recommended by Martin, of Berlin, and had been used by him in several cases with the best results.

DR. P. C. WILLIAMS asked for an explanation of the fact that, in a woman dying from asthenia, there should be a temperature of 96° F. immediately after the operation, and that it should rise each day until it reached 104.8° F. on the day of her death. Would not such a range of temperature indicate some inflammatory or septic complication?

DR. ERICH replied that he considered it an advantage to have a slight rise of temperature after an operation, as he thought it indicated a greater amount of vitality in the patient than if it had a tendency to remain subnormal; that, with the closure of the peritoneal edges by the exudation of lymph, there must be some local peritonitis.

DRS. ASHBY and H. P. C. WILSON emphasized the importance of taking the patient's social position into account in considering the advisability of any operative procedure, and agreed with Dr. Erich in his conclusions.

DR. ROBT. T. WILSON exhibited some surgical needles, the invention of David Genese, D.D.S., of this city. Dr. Genese calls his needles

"IRIDINIZED PLATINA NEEDLES."

They are made with a platinized gold head, hardened under hydraulic pressure. Needles can be made by this process of any shape or size, and they are said to be indestructible under the pressure of forceps or the action of acids, but can be bent to any desirable curve.

DR. MOSELEY thought that, judging from the needles shown, they would be useless in any operation where much force would be required for their introduction. Strong steel needles will often bend and sometimes break in the hands of skilful operators, and in such cases a needle which can be bent as easily as the samples

would be of absolutely no value. They might be of use in a limited class of cases where their introduction would require but little force.

DR. ERICH said that the danger of the steel needle breaking at the eye could be obviated by heating it at that end, and allowing it to cool slowly. This would not interfere much with temper of the the needle at its point.

In his operations for lacerated cervix, he uses a tourniquet, and supposes he is a marked exception to the rule in so doing. The instrument he uses is his own device, is like a light écraseur, with catgut for a chain. His special reason for using it, aside from preventing hemorrhage, is that it so benumbs the cervix that he does not need to use any other means of producing anesthesia, except in the case of very nervous women, when he has recourse to ether or chloroform. The use of this instrument demonstrated to him the fact that, after the parts had been ligated for some time, they would shrink, allowing the bleeding to return, and requiring the tightening of the tourniquet, and had thus taught him not to depend upon a ligature in supra-vaginal amputation of the

uterus.

DR. B. B. BROWNE said that in many cases of deep laceration of the cervix, extending up to and beyond the vaginal junction, he thought it would be difficult, if not impracticable, to apply the tourniquet above the seat of laceration. He asked Dr. Erich how, in such cases, he prevented cutting the ligature of the tourniquet while removing the cicatricial tissue from the angles.

DR. ASHBY stated that he continued to employ the tourniquet in a certain number of cases. He had found it useful in those cases where the cervix uteri was much elongated, and where there was hyperplasia and congestion of the cervical flaps. He could verify the assertion made by Dr. Erich as to the necessity of constantly tightening the loop of the tourniquet, in consequence of a shrinkage of the tissues. He had never employed catgut as a loop, but used very flexible wire.

DR. H. P. C. WILSON could not see how, in those cases in which the laceration extended up to the vaginal junction, it would be possible to apply the tourniquet so as to clean out the angles without cutting the catgut cord. He thought that in certain special cases the instrument might be of use.

DR. ERICH replied that, when the uterus was easily movable, by drawing the cervix well down, the tourniquet could be applied above the angles of the deep laceration, even above the internal os; that the only cases in which he had difficulty were those in which there was a very short and conical cervix, or the uterus was fixed, so that it could not be drawn down far enough.

TRANSACTIONS OF THE OBSTETRICAL SOCIETY OF LONDON.

Annual Meeting, Wednesday, February 3d, 1886.

J. B. POTTER, M.D., F.R.C.P., President, in the Chair.

The following specimens were shown:

(1) Uterus showing a Dilated Cavity, Dr. W. Griffith. (2) Sarcoma of Uterus, Dr. W. Griffith.

(3) Papilloma of Ovary, Wm. Thornton.

The following paper was read:

A CASE OF REMOVAL OF BOTH OVARIES DURING PREGNANCY.

By WM. KNOWSLEY THORNTON.-M. W., married, æt. 22, in the third month of pregnancy, was known to be large twelve months before marriage. Is now large beyond the size of pregnancy, and has a large fluctuant tumor in the abdomen, which is growing fast. Has suffered from several attacks of pain in abdomen, with rise of temperature, sickness, and faintness. Diagnosis, ovarian tumor complicated by pregnancy. Ovariotomy advised and performed Feb. 4th, 1885. Dermoid tumors of both ovaries removed. Rapid and uninterrupted recovery. Premature delivery at eighth month. Labor uncomplicated. Lochia normal. Fine, healthy child and plenty of milk to nurse it. On examination uterus is found atrophic, patient is, while nursing, suffering from flushes, chills, etc., just as others do who have an artificial menopause brought on by operation. The author made remarks on the interesting physiological and pathological problem which this unique case suggests.

DR. JOHN WILLIAMS said that, in a note read before the Society in 1884, he described the involution of the puerperal uterus in the absence of the ovaries. In that case the left ovary had been removed some years previously, and the right was removed soon after labor set in. The course of the process of involution might have been affected directly by the interference of the operation in this case, but in Mr. Thornton's such could not have been the case, for the operation had been performed months before labor set it. He would ask Mr. Thornton if any observations had been made on the process of involution in his case.

DR. ROUTH remarks that the atrophy of the uterus could not impede lactation, and quoted Dr. Livingstone, who stated that the wives of African kings were not allowed to suckle their own children as it was thought derogatory. The child was given to the grandmother, generally an old woman, to whose mammæ and pudenda certain plants were applied and the child put to her breasts, with the result that she was able to suckle the child. He also alluded to well authenticated cases in which men had