DR. MOSELEY was present at the meeting of the Clinical Society at which Dr. Chunn reported his case and exhibited the specimen. He had carefully examined the specimen and had no doubt that it was an ovarian cyst, and he felt certain that was the opinion of all who examined the specimen, among them being Drs. Keirle, Councilman, and Tiffany. He did, however, consider that, judging from the specimen shown, the operation as done was not justifiable, as he believed the cyst could have been ligated and removed without involving any portion of the uterus.

DR. CHAS. O'DONOVAN, JR., said he too wished to add a few words in regard to this case. Dr. Chunn requested him before the operation to stand opposite him and sponge, which he did during the entire operation, so that, after him, he had the best opportunity of any one to see the condition of the parts in the abdominal cavity before the removal of the tumor, and he could state, without hesitation, that before the tumor, with the uterus, had been cut away, it was next to impossible to make out the exact amount or the locality of the attachments that existed. He knew that Dr. Chunn had been very severely criticised in his method of operating, by those especially who saw the tumor for the first time after it had been removed from its surroundings, when the cut edges of the enormously thickened, broad ligament could be turned back, thus exposing the tumor from below, and giving a clear view at once of the location of the pedicle and its extent, but he desired to say, in defence of Dr. Chunn, that the view he had of it during the operation, and from above, was very apt to mislead. The tumor, in developing, had gradually spread out the broad ligament and pushed it before it, being all the while intimately connected with its inner surface, so that to say, at the time of the operation, when, through the escape of the contents of the cyst mixed with blood, the appearance of the different tissues in the cavity had become very indistinct, where the exact ending of the broad ligament lay on the cyst-wall was next to impossible. In more than one operation that he had witnessed, he had seen the same thing happen, but usually, by very careful inspection, it was possible to make out the line of junction, when, by cautiously peeling off the ligament, the cyst could be shelled out, as it were, from its covering. From the criticisms made upon this case, one might infer that Dr. Chunn hastily applied the clamp and cut off the uterus, without making any examination of the attachments whatever, but nothing could be further from the case: he very carefully went over the mass more than once, both in front and behind, but nowhere could he make out the line of junction. It was only then that he determined to do a hysterectomy, in preference to cutting away the great mass of the tumor and leaving part of the cyst behind. After the operation, when Prof. Michael had demonstrated that the tumor was not attached directly to the uterus, as was apparent from the view beneath the broad ligament, it seemed plain to all, except Dr. H. P. C. Wilson, that the uterus should never have been removed, but he would repeat that, until that moment, it was impossible for any one to say for certain what was the attachment of the tumor. One word for the diagnosis: Before the operation, as Dr. Howard had stated, he and all who saw the case, except Dr. Howard, inclined to the diagnosis of fibro-cyst of the uterus, but with a considerable margin of doubt; after the operation we all, except Dr. H. P. C. Wil

son, conceded that we had been wrong, and that the tumor was ovarian.

DR. A. F. ERICH exhibited a new tourniquet he had invented for the temporary compression of the stump in supra-vaginal amputation of the uterus. The tourniquet has the usual male and female screw, but the canula is made somewhat heavy, and the eye at the end large enough to allow the loop of a rubber tube the size of the little finger to be passed through. The ends of this rubber tubing, which is used in place of wire or catgut, are tied together and hooked over a stout hook attached to the shaft of the instrument. By this arrangement the tubing can be repeatedly loosened and tightened without the annoyance and delay occasioned by tying and untying the knot, or danger of bruising the parts.

The general impression of the members present was that the instrument would prove a very useful adjunct in the cases for which it was intended.

TRANSACTIONS OF THE GYNECOLOGICAL SOCIETY OF CHICAGO.

Meeting, Friday, May 28th, 1886.

The President, DANIEL T. NELSON, M.D., in the Chair. The Secretary, Dr. Edward WARREN SAWYER, read the following letter from Mr. Lawson Tait:

7, THE CRESCENT, BIRMINGHAM, April 14th, 1886. MY DEAR DR. NELSON:-If not too late, I should like to take part in the discussion which was entered into at the Gynecological Society of your city upon "Abdominal Section for Pelvic Abscess. My remarks, of course, are discursive and not very conclusive, because they are based upon only a very few points to which I want to draw attention.

The first is this: I object to the use of words ending in otomy, to mean various operations, all of which are practically identical in character but different in detail, and not one of which can have any exclusive or absolute identification by any particular name. Thus, Professor Christian Fenger, in the discussion, objects to the use of the word laparotomy, and he introduces another which is perfectly new to me, and I hope it will never be used again; it is oncotomy. Dr. Fenger objects to laparotomy in a sense where I certainly have no objections, and his very objections only show how utterly absurd all these words are. There really ought not to be any such word as laparotomy in existence, because the signification of its derivatives in the use of the people who spoke the language is such that it could not by any human ingenuity be applied to any modern surgical proceeding. Now the words

"abdominal section" are sufficiently English to be understood by everybody, and they are sufficiently distinctive to enable us to understand at once that when they are used the peritoneum is opened. I therefore wish, through your powerful Society, to protest against the use of all these stupid words of Greek formation. I wish also to protest against the absurd distinctions drawn by Sänger, which are quoted by Dr. Fenger on the subject of pelvic abscess.

He distinguishes six kinds of salpingitis.

1. Septic, the existence of which I entirely dispute as a specific ailment.

2, Tuberculous, which again I deny, except that it has an existence as the third and contracting stage of pyo-salpinx.

3. Syphilitic; not one particle of evidence of this have I ever

seen.

4. Actino-Mycotic, which is an equally ridiculous subdivision, based on mere theory, not on fact.

5. Gonorrheal; to which the great bulk of the cases belong.

6. A mixed form. Instead of this sixth, or mixed form, I would say that there are a great many cases to which we cannot attribute any actual origin, a number of cases occurring in virgins where the existence of gonorrhea would be an impossibility, and where there was no puerperal mischief.

Dr. Fenger's paper has always seemed to me to be an illustration of the German savant evolving the descriptions of the camel out of his own consciousness. My descriptions, on the other hand, are taken from some hundreds of cases upon which I have performed operations, and the history of which I know as completely as it is possible to obtain information.

In Dr. Reeves Jackson's paper, there are two points to which I want specially to draw attention, and they are not of much importance, because they are chiefly questions personal to myself.

The first is a passage in which it is said "Lawson Tait, of Birmingham, and Martin, of Berlin, were the first who attempted to prevent the terrible contingencies of pelvic inflammations by attacking the disease at its original seat; Lawson Tait removed the suppurating uterine appendages, Martin operated for suppurating peri-uterine hematocele. Tait operated for a suppurating hematoma of the right Fallopian tube in 1878, and he removed both tubes for pyo-salpinx, and an ovary for abscess in 1885. In 1885, Martin performed laparotomy in three cases of intraperitoneal hematoma, namely, retro-uterine hematocele." Now accuracy of date in a matter of this kind is rather important for one's own personal reputation, and Professor Reeves Jackson has underestimated my claim for priority by at least seven years. The first operation which I performed for suppuration of the uterine appendages was done on the 11th of February, 1872, and there will be found in the last edition of my book on "Diseases of

the Ovaries" twenty-two cases which I had performed up to the middle of August, 1882, without a death. Since then I have operated upon hundreds. The first case of suppurating hematocele which I operated upon is published in detail in the same book; it was in February, 1879, and since then I have operated upon thirty-two cases without a death, and all have been completely cured. It will thus be seen that in none of these matters have the German surgeons approached English surgery as rivals in priority. They have been mere followers in every particular, and I regret to say their following has been practised without that recognition to which our priority gives us every just claim.

The second point is that in which I find Professor Byford speaking in terms of my own work, which no words of mine can sufficiently recognize or express my appreciation of, and here certainly his words of caution are worthy of a little note. What I fear, in fact what I already feel, is that the remarkable success which I have had, and of which Professor Byford speaks in such strong terms, is really leading astray those whose opportunities have not been as my own, into the belief that the work is easy, simple, easily acquired, and free from risk. It is not so, and unless those who practise it choose to follow me in the rigid precautions and immense care which I give, not only to the mere performance of the operation, but to the surroundings of my patients and to every detail in connection with them, they will not obtain, they must not expect, the success which I have had. I have said that I fear, in fact I already feel, that this success of mine is leading people astray, and I want to urge in the name of humanity, as well as for the sake of the art we practise, that there should be less of the indiscriminate rushing into this kind of work which has been already deplored on both sides of the Atlantic. I am, etc.,

LAWSON TAIT.

DR. A. REEVES JACKSON Said: We ought, I am sure, to feel honored by having among us in spirit, if not in person, so eminent a man as the writer of this letter. Lawson Tait is in some respects the greatest living surgeon, a Gamaliel at whose feet we all find ourselves sitting, and, withal, a man so observant that not a single gynecological sparrow falls in any part of the world unnoticed by him. I must plead "not guilty" to the charge-made against me by Mr. Tait-of inaccuracy regarding the date of his first laparotomy for pelvic abscess, the remarks upon this point having been made by another and not by me. As stated in the letter, his first operation of this nature was done February 11th, 1872, at Birmingham, on a patient of Mr. Halwright. I am sure that Mr. Tait will not for a moment suppose that any of us would willingly do injustice to one whom we all esteem so highly, and from whom many of us have been recipients of acts of kindness and courtesy. In regard to the justice of Mr. Tait's criticism on the prevalent use of the words ending in "otomy," I do not feel like being an arbiter. Technical words are frequently necessary, and yet, as a general rule, I think it preferable to use simple language. The ordinary English words are commonly sufficient to answer all the

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purposes of language. Besides, large and unusual words are sometimes embarrassing. When, some weeks ago, Dr. Fenger charged me with performing an "oncotomy," I was afraid that I had done something very dreadful, and the worse because I did it without knowing it. I felt very much as the fisherwoman did when Daniel O'Connell, in response to her volley of ordinary, undecorated profanity, called her a parallelogram. The fisherwoman did not know what to say, and I could not reply; we both had evidently lost the thread of the discussion. I am glad that Mr. Tait speaks so strongly in regard to the tendency now so frequently indulged in to perform laparotomies, and that he is willing to correct, to some extent, by his words the mischief that has been done by his powerful and successful work. It seems that, when some persons visit Mr. Tait and witness his success and simple but effective methods, they come back thinking life is a blank unless they can own and manage an abdominal hospital, and spend the remainder of their days in the cheerful occupation of removing uteri and ovaries.

DR. CHRISTIAN FENGER said:

The letter which Mr. Lawson Tait wrote to Dr. Nelson relates, in a number of points, to my paper on Laparotomy for Periuterine Abscess," as well as to some remarks which I made before the Society in a previous discussion. I must, therefore, beg the Fellows of the Society to bear with me if I take up a little of their time in answering Mr. Tait's letter.

Discussing Dr. A Reeves Jackson's paper, I objected to calling the operation in question a laparotomy. According to the doctor's description of the case, he had opened an abscess which was adherent to the anterior abdominal wall. He had consequently simply performed an oncotomy-an operation which, notwithstanding the division of the abdominal wall, does not differ materially from opening a deep-seated abscess in any other region of the body, as e. g., in an extremity.

Whether opening the abdominal or peritoneal cavity be termed laparotomy or abdominal section or Bauch-Schnitt is, of course, a matter of indifference, provided only that the meaning of the word be agreed upon. There is but one way of getting at the signification of a medical term, and that is by learning in what sense the term is employed in the medical literature of the different nations.

I must again maintain that laparotomy is not merely section of the abdominal parietes, but that the word implies opening of the general peritoneal cavity, with a view to perform some operation within that cavity. (See Linhardt's "Operationslehre," Wien, 1862, p. 705; and Eulenburg, "Realencyclopædie," Bd. II., p. 37.) French authors occasionally use the word gastrotomy instead of laparotomy. Recently the operation has been called peritonotomy, which, on account of its correctness, should perhaps be preferred to the other terms.

It is of importance to distinguish between a laparotomy and the evacuation of a limited abscess by simply incising the abdominal wall. The two operations differ widely as to their consequent dangers. Where the general peritoneal cavity is opened, a wellknown series of precautionary measures is required before and during the operation, in order to protect the patient from general septic peritonitis.

Where an incision through the abdominal parietes leads directly