Women," relates a case in which, the diagnosis being obscure, a small opening was discovered by the finger, and afterwards seen through a speculum, on the posterior wall of the top of the vagina, similar to Dr. Johnson's case. A sound was passed through the opening into the cavity of the hematic cyst. The patient recovered.

Dr. King believed more cases of hematocele occurred than were suspected in practice, for in many the effusion was small, producing no marked symptoms, and recovery followed. Large effusions of blood, with symptoms of collapse, were generally expected, but smaller ones, occurring in the cellular tissue of the pelvis, or from regurgitated menstrual fluid, or from a ruptured Graafian follicle, might also occur and escape notice. During menstruation, we find the corpus luteum filled with effused blood, but this, according to Coste, was an abnormal condition. Abnormal or excessive coition, especially during pregnancy and menstruation, may cause rupture of vessels, and lead to hematocele. It was important to remember that when the diagnosis between hematocele and pelvic cellulitis and peritonitis was doubtful, it was better to remain in doubt than injure the patient by frequent manipulations and examinations, since the treatmentchiefly rest and anodynes-was nearly the same in each of these affections.

It was curious that in Dr. Johnson's second case the injection of warm fluid should have been followed by simulated hysterical symptoms, so exactly resembling the actual symptoms of perforation and injection of the peritoneum.

DR. FRY said it was remarkable, considering the great vascularity of the female sexual organs during pregnancy, that these cases were not more frequent. Some years ago, he was called to see a young married woman whom he had attended before for pelvic cellulitis. She had been delivered by a midwife, six weeks before his visit. There was severe abdominal pain, coming on in paroxysms of several hours' duration, and at certain hours. On vaginal examination, he found on the right side a pear-shaped mass which was not tender. The uterus was movable. He diagnosticated hematocele of the right broad ligament, and relief came ten days afterwards, with the discharge of a black clot per vaginam.

DR. KLEINSCHMIDT supplemented Dr. Johnson's paper by saying that, at the time of the last injection followed by the alarming symptoms mentioned, he felt about as Dr. J. did, and saw visions of laparotomy. Finding, however, that the pulse was normal, and that there were no symptoms of collapse, he became reassured, remembering that the patient was excitable and hysterical. After Dr. Johnson left for his vacation, the vaginal injections were continued, and in a few days the passage of shreds of clotted matter ceased, giving way to a discharge of a leucorrhea-like fluid possessing the characteristic odor of liquor amnii. He examined the patient just previous to Dr. Johnson's return, and could find no trace of the opening behind the cervix. As to the exciting cause of the nervous attack, subsequent inquiry seemed to show that it was not the injection, but pressure of the speculum on the coccyx which in the hyperesthetic patient led to the general explosion in the sensory nerve centres.

DR. JOHNSON, in closing, said Dr. King was perfectly right in holding that these cases had better be left alone. He aspirated in

the first case, because he believed an abscess existed. In the second case the opening was spontaneous. Although Dr. Kleinschmidt had not mentioned it, he would agree, no doubt, that the odor of the discharged coagula was fearful.

TRANSACTIONS OF THE GYNECOLOOF CHICAGO.

GICAL SOCIETY

Regular meeting, Friday evening, September 18th, 1885.
The President, DR. H. P. MERRIMAN, in the Chair.

REMARKS UPON ABDOMINAL AND GYNECOLOGICAL SURGERY IN
ENGLAND, SCOTLAND, AND HEIDELBERG.

DR. E. C. DUDLEY made some informal remarks relative to his observations in gynecological and abdominal surgery, during a summer holiday, in Europe. His observations were confined to the work of a few operators in England, Scotland, and Heidelberg.

In Heidelberg he called upon Professor Kehrer. Dr. Dudley inspected the hospital and saw evidence of considerable work in abdominal surgery. Professor Kehrer's laboratory gave evidence of active research into gynecological bacteriology. His work bore the stamp of thoroughness and efficiency. Professor Kehrer is a medium-sized man, frail and delicate, with a large head and small body.

A call upon Dr. Bantock, at his office, No. 18 Harley Street, W., London, resulted in a pleasant hour's conversation upon subjects pertaining to ovariotomy and hysterectomy. Patients at the Samaritan Hospital sometimes die within twenty-four hours after laparotomy, with a high temperature. This condition was called acute sepsis by certain systematic writers. Dr. Bantock thought the true pathology of the condition was unknown, and was not satisfied with the term acute sepsis. Dr. Dudley saw Dr. Bantock operate at the Samaritan Hospital. The first operation was the removal of a small, solid ovarian tumor. The remaining ovary and tube, although normal, were removed on account of a small intra-mural uterine fibroid. The striking feature of the operation was great rapidity without haste. Dr. Bantock caught up the edges of the peritoneum with small compression forceps, so that these edges were drawn up towards the cutaneous edges, and were held in this position by the weight of the instrument against the abdominal surface. This maneuvre greatly facilitated the passage of the sutures. The pedicle was secured by means of silk ligature, applied in the operator's peculiar figure-of-eight turns. In closing the wound, a needle of ovoid shape, curved on the

edge, instead of on the flat, was employed. This needle combines the maximum of strength with the minimum of size. Two or three sutures were passed through at each angle of the wound. Their ends were joined by knots. An assistant, passing the index finger of each hand through the loops thus formed, made traction at each angle of the wound in such a manner as to draw its sides into contact, and to lift the peritoneal edges nearer to the surface. The introduction of the remaining sutures was in this manner greatly facilitated. The sutures were so closely passed that no superficial stitches were required. They were made to include a very narrow margin of skin and peritoneum, and very little if any muscular tissue. Fine silk-worm gut was employed.

The ends of the sutures, on each side of the wound, were now grasped in lock forceps, which prevented them from being drawn out, or becoming tangled during the separation of the wound for the toilet of the peritoneum, which was most thorough, the entire cavity being rendered perfectly clean and dry. The lock forceps were then removed from the ends of the sutures, and the hands of the assistant substituted. Traction was thus made on all the sutures, in the direction of the upper angle of the wound, and they were tied in order from below upward and cut short. This prevents tangling of the threads and otherwise facilitates tying. Antiseptics, throughout the operation, were conspicuous by their absence. The dressings were of the most simple character. Dr. Bantock kindly showed Dr. Dudley over the hospital, which contained a number of convalescents from hysterectomy, ovariotomy, and oophorectomy. Dr. Bantock's exceptionally good results, in the last operation, are recognized throughout the world. His wonderful statistics in abdominal surgery are due to downright splendid operating. Dr. Meridith, at the same time, was removing a tumor in another room, under the most extreme antiseptic conditions. The famous Samaritan Hospital is an unpretentious building, seemingly a large reconstructed dwelling, in the middle of a block, with houses joining on either side, and, like

great men, has a modest appearance.

It is generally supposed in America that the Woman's Hospital in the State of New York, established by Marion Sims in 1855, was the first of its kind in the world. This is a mistake. Dr. Sims himself, in a letter to Dr. Protheroe Smith, of London, dated July, 1883, accords to that gentleman the honor of having established the first hospital specially for the treatment of the diseases of wcmen. This hospital, founded in 1842, is now a flourishing institution in London, and is called the Hospital for Women.

Its venerable founder visited Chicago a year ago. Dr. Dudley again met him in London. His enthusiasm for the specialty, in which he has been a pioneer, continues, indeed, seems to increase with advancing years. He retains his official connection with the institution, as senior physician, and is still engaged in active prac

tice. He was among the first, against bitter opposition, to advocate anesthesia in labor. Efforts are now being made, with great promise of success, to raise funds for the construction of a larger and more appropriate hospital building.

Dr. Dudley visited Birmingham, in response to a polite telegraphic invitation from Mr. Lawson Tait. On the train he occupied the same compartment with a sleek, well-fed, high-church London clergyman of the most conservative order, who intimated in no uncertain manner that the conservative people of London looked down upon the inhabitants of the radical city of Birmingham as a semi-barbarous community. So decided were his denunciations of the radical party in general, and of Birmingham in particular, which as the chief stronghold of radicalism always return John Bright and Chamberlain to Parliament, that Dr. Dudley, in an apologetic manner, explained that he was only going into the jaws of the Philistine to witness an operation by a distinguished surgeon, from whom he hoped to learn something. The clergyman inquired who the surgeon was, and upon hearing the name of Lawson Tait, exclaimed: "Oh, I know all about him, he is just as bad as any of them;" which means that Mr. Tait is a radical in politics, as he is in surgery.

Mr. Tait's ridicule of antiseptics is well known. His rapid method of operating conveys to the casual observer the idea of haste and almost of carelessness.

But closer observation very soon shows him to be one of those rare operators, whose dexterity amounts almost to sleight of hand. An ovariotomy, in his hands, does not impress the observer as a capital operation. It seems almost as trivial as opening an abscess. His methods of operating did not materially differ from those of Dr. Bantock. In closing the wound he used but one needle, threaded with a piece of long silk, introducing this as if for a continuous suture, but did not draw the thread tight. After the introduction of the needle, he left a long loop before the reintroduction. Then, after taking the last stitch, he lifted the free loops of silk on the index finger, and severed them with the scissors, thereby converting the continuous into an interrupted suture. These were tied in the ordinary way, and the wound was dressed in a manner which would be eminently acceptable to his most bitter antiseptic enemy.

During the day, Mr. Tait performed ovariotomy, lumbo-colotomy, perineorrhaphy, and excised a urethro-vulvar cyst, besides attending to a large number of consultations, in one of which Dr. Dudley accompanied him to a distance of forty miles. This was for him only a moderate day's work. It is indeed evident that no other man in England controls a larger practice in abdominal surgery.

Mr. Tait impressed Dr. Dudley as a sincere man of exceptionally strong and positive character and very much in earnest.

Like Virchow he is politically inclined; indeed, his temperament is such that he cannot see things go on without having a hand in them. He has taken active part in the city government of Birmingham, and, as Dr. Dudley was informed, had already declined to stand for Parliament.

During a brief visit in Edinburgh, Dr. Dudley was pleasantly entertained by Dr. Thomas Keith, who had just returned from a consultation with Dr. Homans in Boston, but unfortunately Dr. Keith did not operate during this time, although a large number of patients were waiting for him at the Royal Infirmary. His son, Dr. Skene Keith, kindly invited Dr. Dudley to an ovariotomy, his forty-eighth operation. Up to this time, he had only lost one or two patients. His operation presented some interesting peculiarities. He used probe-pointed scissors of a peculiar pattern, instead of the director, in going down through the deeper layers of the abdominal walls. By pressing firmly against the adhesions with a sponge, at the point of their attachment to the cyst, he literally sponged them away from the tumor. It was surprising to note the facility with which rather firm adhesions were thus broken. It is much easier to tear them from the tumor with the sponge than to tear the tumor from the adhesions. The breaking of the adhesions in this way is also much more gentle, and, in the opinion of Dr. Keith, diminishes the danger of shock.

The adhesions were ligated with fine catgut as fast as they were divided. In passing the ligatures a forceps, similar to the ordinary compression forceps, was used. This instrument had blades more than an inch long, of very small diameter, terminating in sharp points, so sharp that when the blades were closed they could be thrust through any soft tissue like a large needle. Grasping the ligature in the point of these blades, the tissue to be ligated was transfixed. The ligature was then pulled through and the forceps withdrawn.

The pedicle was transfixed and ligated with fine silk in the same way.

The cautery, to which much of the elder Keith's success has been attributed, was not employed in this case, because the pedicle was very slender. The reason why the cautery, in the hands of other operators, has not proved a more perfect protection against hemorrhage, becomes apparent to any one who has witnessed its application in the hands of Dr. Keith. The whole secret of his method is, first, in the powerful compression of the pedicle between the broad blades of a heavy Baker-Brown clamp; second, in the prolonged application of the red-hot cautery iron, not only to the pedicle, but, after this has been burned to the level of the clamp, also to the clamp itself. In this way the clamp becomes so hot that the included portion of the pedicle is slowly and thoroughly cooked, so that when the instrument is removed, the end of the pedicle is thin and translucent, resembling a horny