DR. T. A. EMMET asked for a general expression of opinion as to the occurrence of pyo-salpinx in unmarried women. He said that he had never met with a case except in married women whose husbands had strictures.

THE PRESIDENT asked Dr. Janvrin if his patient was a virgin. DR. JANVRIN replied that, as far as a rigid, intact hymen was any indication, she was.

DR. HUNTER said that he had presented two undoubted specimens of pyo-salpinx during the previous winter, which he had removed from virgins.

DR. LEE remarked that ten days before he had removed an ovary and tube from a virgin. The condition was not true pyosalpinx, but the tube contained several drops of muco-purulent fluid, indicating a state of inflammation which would doubtless have culminated in pyo-salpinx..

THE PRESIDENT said that the views of Dr. Noeggerath concerning the direct relation between gonorrhea and pyo-salpinx were gaining ground, and the question was whether his followers were not going to extremes.

DR. LEE agreed with Dr. Emmet that in the latter's cases it was proper to draw the inference that the salpingitis was due to gonorrhea; but there did not seem to be any reason why a purulent inflammation of the tubes could not arise independently of a previous gonorrheal infection.

A SPECIMEN OF EXTRAUTERINE PREGNANCY.

DR. LEE presented a specimen of probable tubal pregnancy, which was removed post-mortem by Dr. Maher. The doctor was called in haste to see the patient, and found her in a state of collapse, with every evidence of internal hemorrhage. She died within half an hour. On opening the abdomen, a large quantity of coagulated blood escaped, together with a four-months' fetus. The specimen was shown because it seemed to the speaker to be a very beautiful one. [Photographs of the specimen were also presented.]

DR. B. EMMET asked what the probable source of the hemorrhage had been.

DR. LEE replied it was doubtless due to the general detachment of the placenta, since no single ruptured blood-vessel could be discovered.

ACUTE PULMONARY EDEMA FOLLOWING LAPAROTOMY-RECOVERY.

DR. HUNTER narrated the case of a girl, 24 years of age, from whom he had recently removed the tubes and ovaries, with the view of curing epilepsy. She had suffered for fourteen years with epileptic attacks, which had recurred at every menstrual period since puberty, and had resisted all methods of treatment. Dysmenorrhea was marked. She had been under the care of a number of practitioners, but had continued to grow worse, having lately developed symptoms of insanity. Dr. Hunter made a careful examination under ether, and discovered an enlarged and prolapsed ovary upon the side to which the pain was referred during menstruation. Laparotomy was proposed as a last resort. The

operation was an easy one, and was completed in a little over half an hour, the patient being under ether about forty-five minutes. An hour after the operation she became blue and comatose, râles developed over both lungs, and her condition was most alarining. Assisted by Dr. Coe and the attending physician, Dr. Hunter worked over her all night, employing artificial respiration, hot poultices, and hypodermics of ether, brandy, and digitalis. Dry cups were applied to the chest, and five ounces of blood were withdrawn from the arm. Five hours after the operation, the case was regarded as hopeless. Towards morning, however, the patient rallied, and was soon breathing easily. She made a perfect recovery, in spite of the vigorous manipulation which she had undergone, her temperature never exceeding 100 F. It was too soon to judge of the curative effect of the operation. A careful examination of the heart and lungs had been made before the anesthetic was administered, and they were found perfectly normal. The ether was carefully given, less than half a pound being used. Her alarming symptoms might have been due to her peculiar nervous condition, or she might have had an epileptic seizure while she was under the anesthetic.

In connection with the case, Dr. Hunter referred to one that he had previously reported, in which the patient never recovered from the ether. In that case, however, it was afterwards ascertained that, previous to the operation, the woman had taken a large dose of morphine, to the use of which drug she had been long addicted.

DR. T. A. EMMET said that he had often noticed that opium tended to increase the action of ether, and vice versa. He cited the case of a patient upon whom he was about to perform an operation for vesico-vaginal fistula. As she resisted the effects of the ether for a long time, a small hypodermic of morphine was administered. The effect was so powerful that it was six hours before she could be resuscitated.

DR. LEE could not understand how ether could have produced the phenomena which were observed in Dr. Hunter's case. There must have been some peculiar susceptibility to the drug. It was well known that there was a diminished power of the heart and lungs in opium-eaters, but this could not be compared with the effects which followed a single hypodermic. The speaker recalled a case of craniotomy, in which the patient's attendant had kept her under chloroform for eight consecutive hours. She recovered from the immediate effects of the anesthetic, but developed pulmonary edema within twenty hours, which resulted fatally.

DR. COE said that there were certain features of the case which were most peculiar. The patient's pupils were contracted, and in some respects her condition suggested opium-poisoning. As soon as a fresh poultice was applied she responded immediately to the stimulus, her pupils dilated, she moved her limbs, and several times tried to sit up and talk, but soon relapsed into her former semi-comatose state. There was certainly some factor beside the pulmonary edema.

THE PRESIDENT remarked that the important question was

whether it was always safe to administer an anesthetic to patients with peculiar neuroses, chiefly vertigo, epileptiform convulsions,

etc.

DR. HUNTER suggested that the large amount of potassium bromide which the girl had taken might have contributed to render her peculiarly susceptible to ether.

DR. HANKS thought that it was unnecessary to attribute her condition to the ether. He had observed a case in which acute edema of the lungs developed suddenly during labor, the patient dying in three minutes before the child could be delivered, although the forceps were applied at once. It was undoubtedly due to the exposure, excitement and exertion, induced by labor. He did not believe that it was possible to predict what patients would recover readily from the anesthetic.

THE PRESIDENT did not regard Dr. Hanks' case as analogous to the one under discussion, since the respiratory and circulatory conditions during labor were entirely different from those in the non-pregnant state, with or without the influence of anesthesia.

DR. B. EMMET called attention to the beneficial effects of large doses of calomel in such accidents, as recommended by the late Dr. Lente.

A CASE OF ACUTE PROCIDENTIA IN A NULLIPAROUS WOMAN.

THE PRESIDENT said that a woman thirty years of age, single, came to the out-door department at Mt. Sinai Hospital, and stated that while washing she had occasion to lift a tub of water. She felt a sudden pain in the abdomen, there was a gush of blood, and something protruded from the vulva. Examination revealed a procidentia. The uterus was easily replaced by Dr. Jos. G. Wallach, the physician in charge of the department, was kept in position by tampons, and she was sent into the hospital. When examined on the following day the uterus was found to be in position, but there was an extensive ecchymosis beneath the vaginal mucous membrane, and there was every evidence that the vagina had been forcibly torn away from its connections. Such cases of acute prolapse were certainly rare in the unmarried, and in women who had never borne children.

DR. T. A. EMMET thought that the accident was not a very unusual one, as he could recall several cases in his own practice. Some of the patients were old single women, but in every instance there was a fibroid attached to the uterus. He did not understand how it could occur under any other circumstances.

DR. JONES recalled the case of a girl sixteen years of age, who had a complete procidentia from carrying a coal-scuttle up-stairs. DR. JANVRIN asked if there had been any hemorrhage in the other cases. (Both gentlemen replied in the negative.) He thought that the occurrence of hemorrhage was the peculiar feature in the President's case. What was its source?

DR. EMMET thought that the blood might have come from the ruptured hymen.

THE PRESIDENT said that there was no evidence of recent laceration of the hymen. The hemorrhage (the occurrence of which was taken from the patient's own statement) doubtless came from a

laceration of superficial vessels of the vagina. The ecchymoses were submucous.

SUBJECT FOR DISCUSSION: FREQUENT MICTURITION IN THE FEMALE. THE PRESIDENT proposed that the discussion for the evening be limited to the causes of frequent micturition.

DR. T. A. EMMET thought that thickening of the utero-sacral ligaments as the result of a former cellulitis was a condition far more common than he had formerly believed. It was almost certain to be overlooked unless an examination was made by the rectum. As the ligaments were shortened, constant traction was exercised upon the neck of the bladder, and hence there was a frequent desire to empty that organ. It was rare to find the bladder itself diseased. He cited the case of a young girl who had been treated for cystitis, and had even had an artificial vesico-vaginal fistula established for its relief. He made a button-hole in the urethra, and she was at once relieved. After making a buttonhole it was common to find inflammation of the urethral mucous membrane, and if this was removed, the symptom of frequent micturition would soon disappear.

THE PRESIDENT asked if the button-hole operation actually relieved vesical tenesmus.

DR. EMMET replied that it did. By cutting through the hypertrophied mucous membrane, the proper circulation of the part was restored.

DR. COE asked if the symptom of frequent micturition, almost invariably observed in cases of anterior displacement of the uterus, was due entirely to traction on the neck of the bladder, or if the superincumbent weight of the uterus could not be regarded as a

factor.

DR EMMET said that the mere displacement of the uterus had nothing to do with it, unless the organ was in such a position as to drag upon the bladder. The irritation of the bladder was due to traction, not to pressure.

DR. HUNTER asked if the operation did not occasionally fail to relieve the symptoms.

DR. EMMET replied that it was nearly always successful, so that, whenever he failed to cure a patient, he ascribed the failure to a defect in the technique of the operation. It was not intended to cure cystitis, but to relieve vesical irritation.

Stated Meeting, November 17th, 1885.

The President, DR. PAUL F. MUNDE, in the Chair.

A CASE OF SPONTANEOUS AMPUTATION AND ARRESTED DEVELOPMENT.

DR. MURRAY exhibited a living male infant, fourteen days old, which possessed the following remarkable deformities. The right upper arm was amputated near the junction of the upper and middle thirds. There were only three separate fingers on the left hand, the fore and middle fingers being united by a firm web, and possessing one nail in common. Both lower extremities were deficient below the condyles of the femurs, the thighs terminating in small spurs, or flippers, which were apparently composed of

skin. The palate showed partial non-union of the opposite halves. Dr. Murray stated that the mother of the child had borne two living and five premature children, none of whom were deformed. When called to the case, the infant was already delivered, but the placenta had not been expelled, so that he was sure that no amputated part had been lost. The child was feeble, and it seemed unlikely that it would survive.

The speaker stated that there were three theories with regard to the cause of so-called spontaneous amputations in utero, the first of which was supported by Montgomery, who claimed that they were true amputations produced by the twisting of the umbilical cord around the limb. The detached member might, or might not, be disintegrated in the liquor amnii. This author reported but one case in which the amputated limb was found. He also believed that fibrous bands might exist within the uterus, which by continued pressure caused gangrene of the fetal limb, eventually leading to its complete separation. The second theory was proposed by Martin, who claimed that there was originally a fracture of the limb, the amputation being then effected by the pressure of the broken bone. He based his idea upon a case reported by him, in which a pregnant woman sustained a severe injury by falling from a ladder. She was delivered soon after, and one of the child's arms was found to be amputated, the stump being only partially healed. According to the third theory, there might be constricting bands which extended between two limbs, since children had been born in which an amputated member was discovered suspended midway between the extremities. As a rule one arm, especially the left, was amputated.

DR. GILLETTE believed that the deformity in the right arm was a pure amputation, since the stump had clearly undergone a healing process, but that the other limbs showed evidences of arrested development. This was most marked on the right side, as the right femur appeared to be more deficient than the left. The case was certainly a most rare and interesting one. As to the cause of the deformity, he thought that there was no question but that it was due to the constriction of the members by fibrous bands, so that their nutrition was interfered with.

THE PRESIDENT thought that there was considerable doubt as to whether the condition in the different limbs was due to one and the same cause.

DR. PARTRIDGE was inclined to believe that all three limbs had been amputated, because of the perfect development of the muscles above the points at which the separation had occurred. Montgomery had affirmed that, when the constriction of the limbs occurred at such an early period in fetal life, their development was arrested, the muscles would be found in a state of atrophy, whereas after spontaneous amputation this atrophy was not observed. The speaker did not believe, however, that much reliance could be placed upon this point of differentiation, since he had made careful dissections in a case of undoubted arrest of development, and had found the muscles fairly normal.

THE PRESIDENT said that he had described a case of arrested