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scess in the cellular tissue about the uterus does not differ materially in nature, principles of treatment, nor results, from abscesses in the cellular tissue in other parts of the pelvis and abdomen. One set of laws governs them all, both in pathology and treatment. A point to be remembered is, that many cases recover spontaneously in early stages, contrary to the statements of some eminent men. A professional gynecologist or surgeon, whose patients are attracted to him from long distances on account of his reputation, gets a class of cases because of their long standing and obstinate character. He has to combat the same tendency to error of judgment in one respect which besets the mind of a pathologist, whose conclusions are too exclusively drawn from the dead-house; that is to say, neither of them sees the numerous cases which recover under ordinary treatment, and therefore do not come before them. Recoveries from abscesses in the cellular tissue in all parts of the abdomen and pelvis are common, though they are apt to be very slow.

I recall two cases, attended by well-known physicians in this city, which recovered from such abscesses after suffering about a year. These abscesses discharged through the rectum. I have, perhaps, been somewhat slow in the treatment of these cases. For example, a retro-uterine abscess was brought to me from a distant State. It periodically discharged into the rectum above the reach of the finger. The patient arrived in Chicago in fair general health. Directly after her arrival, the discharges grew smaller in quantity, with longer intervals of time between, and she continued to progress in that way. Improving constantly in strength and activity, she began to make excursions and long visits to friends in neighboring States, and, in short, enjoyed life so thoroughly that I deemed laparotomy not justifiable so long as she progressed so well towards recovery without it. I presume she got tired of my dilatory plan. At any rate, after some months of improvement, she ceased to report herself for periodic examination, and I lost sight of the case. I have a case now on hand in a more debilitated condition. She is confined to her bed the greater part of the time. I expected to operate many weeks ago, but soon after I took charge of the case she showed signs of improvement, which led me to postpone the laparotomy to see what would occur. The discharges, which were from a point high up in the rectum, grew less in quantity and further apart in time. The temperature went down to the normal standard and remained there, the tumor about the uterus diminished in size, and nearly two months have now elapsed since the last small discharge of pus. The patient's vigor is slowly returning. Under such conditions, it is not certain that any pus cavity remains. I deem it my duty to wait until the presence of such a collection of pus is reasonably certain before subjecting the patient to the perils of laparotomy. Not long ago I had the opportunity to make a post-mortem examination in a case of circum-uterine abscess. The abscess had formed several years ago, after a difficult parturition. I saw the patient in consultation a few times during the last weeks of life. The pus was discharged partly by the rectum and partly through a fistula midway between the symphysis pubis and the umbilicus. She had been subjected twice to some surgical operation, whose exact nature I did not learn. The operations were not laparotomies. Having received no benefit, the patient was determined that no more surgery should be tried on her. After some weeks,

she died of asthenia, and I was allowed a limited autopsy. The fistula above the pubes, after passing through the integuments, led downward and to the right, and at a point which seemed to be the right external inguinal ring, it entered the inguinal canal, and followed the round ligament into the pelvis. Here it became more spacious, but exceedingly crooked and complicated, winding irregularly backward until it opened into the upper part of the rectum. All the viscera in the vicinity were glued together in a mass by old inflammatory deposits. There was no large abscess cavity at any one point, but still there was a flattened pocket, some three inches long and an inch or more in width, lying behind the rectum in the hollow of the sacrum. It contained a little pus and feces. This pocket might have been safely opened from below, working up outside the posterior surface of the rectum, had it been possible to ascertain its existence. I do not see how it could have been reached by laparotomy. The anterior fistula might have been benefited by freely slitting up the inguinal canal. I feel compelled to differ with my friend, Dr. Henry T. Byford, in one point. He suggests very naturally that Tait's operation, performed after the abscess cavity has opened into the rectum, would make a complete intestinal fistula, which it might be impossible to heal. This thought is natural, and I confess I would think the same thing myself had not an extensive observation upon the fecal fistulæ shown me the reverse. Experience teaches that an abscess cavity opening into an intestine, and filled with putrid pus and feces, is very reluctant to heal so long as it is not freely drained and disinfected; but if it is widely opened, so as to make and maintain the shortest and straighest possible route from the opening in the cut to the external air, and if it be kept well cleansed and disinfected, fresh granulations will spring up, the orifice will contract, and the fistula will heal, provided there is no stricture in the intestine below. This fact, or law, is very important, and applies equally to fecal and urinary fistulæ, as I have verified by an abundant experience. A striking case in point occurs to me at this moment. An eminent physician on the South Side requested me to take charge of one of his patients, a lady who seemed to have an anomalous hernia, and was sinking under a suppurative discharge from the bowels. On examination, I found her confined to bed, and rapidly approaching fatal exhaustion. There were several evacuations daily of mingied pus and feces from the rectum. The left hip was found prominent over the whole gluteal region. The tumor fluctuated on palpation, was resonant on percussion, and gave a succussion on coughing. At times, it gurgled under pressure. I opened it very slowly and carefully, fearing to find an intestine there. After passing through the atrophied gluteus maximus, I entered a broad cavity, containing neither intestine nor omentum, but filled with pus and feces. This cavity being emptied and washed out, was easily traced up to the sciatic notch, where it entered the pelvis by an orifice of moderate size. I now ripped the cavity open for nearly its whole length, and kept it cleansed. Vigorous granulations sprang up at once, and the sac healed up rapidly and permanently. The patient seemed relieved of a great depressing influence, and rebounded at once towards health. She became plump and rosy, and rapidly regained her full strength.

DR. F. E. WAXHAM presented for examination a

FEEDING BOTTLE FOR USE IN CASES OF INTUBATION OF THE

LARYNX.

The feeding bottle consists of an ordinary nursing flask, with a rubber cork, with a small vent, through which a tube passes to the bottom of the bottle. To this tube is attached another leading to the bulb of a Davidson's syringe, and this in turn is attached to a small-sized esophageal tube. In using this apparatus, the gag is placed between the jaws, the tube introduced into the esophagus, and the contents of the bottle quickly introduced by means of the bulb.

Many patients, especially young infants, do not take sufficient nourishment after intubation has been performed, on account of the coughing produced by the trickling of the liquid into the trachea. This apparatus obviates this difficulty.

TRANSACTIONS OF THE OBSTETRICAL SOCIETY OF LONDON.

Meeting of Wednesday, March 3d.

DR. POTTER, President, in the Chair.

The following specimens were shown:

1. Tubercular disease of the Fallopian Tubes, by Dr. W. S. A. Griffith.

2. Pellets of Corrosive Sublimate, by Dr. Champneys, for Dr. Ely Smith.

3. Cancerous Uterus Extirpated by the Vagina, by Dr. Lewers. 4. A Calculating Ruler for fixing the precise date of labor, by Dr. Playfair.

5. A Double Monster of the Syncephalic Cyclops Variety, by Dr. Godson.

DR. BARBOUR, of Edinburgh, showed a most interesting series of frozen sections, drawings, and diagrams, illustrating the anatomy. of the first stage of labor, of the third stage of labor from four cases of Porro's operation, and of the condition at the close of labor from two cases of death post partum. He drew attention to the value of frozen sections, but said that allowance must be made for post-mortem changes and to those due to the posture in which the cadaver was frozen. The points of chief interest in the first group were the remarkable thickness of the lower segment of the uterus, the course of the ureters, and the disposition of the peritoneum and cellular tissue. The Porro preparations showed the contraction of the uterine wall and diminished area. The

membranes are crumpled and partially detached, but the placenta is not separated. The placental site may therefore be diminished without the placenta being separated. He concluded that it was separated by detrusion. The absence of space into which it could bulge, the absence of hemorrhage between the placenta and uterine wall are against the mode of separation described by Baudeloque, Schultze, and Ahlfeld. These sections bore out the description of the method of expulsion so lucidly described years ago by Dr. Matthews Duncan.

The chief point of interest demonstrated by the third group was the large amount of cellular tissue between the cervix and bladder.

DR. MATTHEWS DUNCAN was astonished at the amount of good and original work which Dr. Barbour had laid before the Society. He referred to the length of time which had elapsed since William Hunter published his work on the gravid uterus which was supposed to finish the subject. Frozen sections or homolographic anatomy had since done much to increase our knowledge, and now Dr. Barbour had passed from the anatomy of pregnancy to the anatomy of labor, a new field. Frozen sections could not be entirely depended upon to display the conditions during life, but they were of great value. Braune's plate of the anatomy of the second stage was of great value, but was notably misleading in some points, such as the position of the bowels, uterus, and peritoneum. Similar errors had been referred to by Dr. Barbour in his own sections.

Dr. Duncan was reluctant to adopt Barbour's theory of the detrusion of the placenta. He had a strong liking for the shrinking site theory, because it combined separation and arrest of hemorrhage. Everything connected with flooding was of great importance and therefore he hoped to see Dr. Barbour's views thoroughly sifted. One great fact he had given, that with the site reduced to four inches in diameter, the placenta might remain attached.

DR. CHAMPNEYS, while greatly admiring Dr. Barbour's work and beautiful specimens, dissented from some of the conclusions drawn from the Porro specimens. Illustrations drawn from them as to the physiology of the third stage of labor could only be accepted when consonant with its clinical course. The flattened form of the uterus with the entirely adherent placenta seen in these preparations was contrary to the condition observed in nature, and where women had been examined by the introduction of the whole hand immediately after the birth of the child, the placenta had been found entirely detached. Again, he could not agree with Dr. Barbour that these preparations prove that at the beginning of the third stage of labor there is no uterine cavity; its shape proves that it does not alone contain the placenta lying flat against the uterine walls as do these preparations. Lemser advocated the "detrusion" theory from experiments on pregnant rabbits, but it must be accepted with caution, as the similarity between them and the human female is only slight. Dr. Barbour did not appear to rest on Lemser's observations, but arrived at his conclusions by a process of elimination of the other theories. The mode in which the placenta presents at the os uteri is an indispensable test as to the correctness of views as to its mode of separation.

The President tendered the thanks of the Society to Dr. Barbour for his demonstration, and they were very cordially given, and Dr. Barbour replied.

A paper by DR. LEWERS, describing

A CASE OF CIRCUMSCRIBED SARCOMA OF THE VAGINA AND UTERUS was then read.

The patient was a married woman of 50, had eight children, and was admitted into the London Hospital on June 27th, 1885. She had had three attacks of flooding, unattended by pain, but each followed by fainting and vomiting; was losing flesh and had had a dirty-colored vaginal discharge. A lump now protruded from the vulva. She had had an attack of flooding nine years ago, then was regular for six years, and had another attack. The mass, on examination, was seen to be tri-lobed, and it was attached to the posterior vaginal wall by a broad pedicle. There was a second mass on the right side as large as a walnut. The uterus felt heavy, but was mobile. The growths were removed on July 2d, and the patient died of septicemia on the 7th.

At the post-mortem three circumscribed growths were found in the liver and there were numerous small secondary growths in both lungs, but none elsewhere. Microscopic examination showed the growths to be mixed, round, and spindle-cell sarcomata. Dr. Lewers thought that the uterine growths were probably the primary ones. There were no lung symptoms during life.

DR. GERVIS gave details of a case of vaginal sarcoma upon which he had operated three times at lessening intervals and which now again required operation. It was a small round-celled sar

coma.

DR. W. DUNCAN was doubtful whether cases of sarcoma of the uterus and vagina should be operated on at all, as a radical cure was improbable.

DR. M. HANDFIELD JONES mentioned the case of a girl of 16, upon whom he had operated a year ago, who still remained in good health. He thought if the growths were removed early enough, there was a reasonable prospect that they would not recur.

MR. KNOWSLEY THORNTON pointed out that it was often necessary to operate for the comfort of the patient, and could not think that the chance of recurrence was a ground for leaving the patient in misery, and each operation would give her, at any rate, a period of health and hope. The recurrence at lessening intervals was familiar to surgeons in all sarcomata, and hence the old name given by Sir James Paget to these growths, "recurrent fibroid."

DR. ROUTH advocated the removal of these growths and the destruction of their site with strong caustic, such as nitric acid and bromine. He mentioned a case in which, after a third operation, there was no recurrence.

At the close of the meeting the President announced that in future the Transactions would be published in monthly or bi-monthly parts, but those Fellows who preferred it, could still have the Volume sent to them as heretofore, at the end of the session.

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