measure.

tissues and multiple pockets of pus in suppurative salpingitis, and the same principles should be applied in operating for appendicitis as in salpingitis. There are, of course, cases of appendicitis in which ideal surgery is impossible, and in which we must be content merely to open, evacuate and drain as an immediate life-saving But in all cases where the patient's strength will permit, a thorough operation should be done. Adhesions should be separated, multiple posterior pockets of pus should be emptied and the appendix removed with free flushing and drainage. I could report in detail numerous cases coming under my own observation, where prolonged illness and secondary operations would have been averted by carrying out this plan thoroughly in the beginning.

Dr. J. D. GRIFFITH, of Kansas City: I would ask the gentlemen who have spoken, particularly Drs. Morris, Price and Murphy, who have had a large experience in this particular line of work, whether they have noticed that a catarrhal condition of the appendix produces a stricture. A year ago, in an article in the Annals of Surgery, Dr. Binnie wrote about appendicular colic as calling for operative interference; and Dr. Carstens, in an article published quite recently, speaks of the same thing. I have operated within the last six months on three cases for appendicular colic, not for suppurative appendicitis, and I have been able to demonstrate satisfactorily to myself that in at least two of the cases there was nothing beyond a stricture except an enlargement of the canal. I could only pass a whalebone guide through the strictured portion. There was marked thickening of the circular and longitudinal fibers of the appendix, showing that the circulation had been interferred with to such an extent that there was the commencement in one of the cases of an active ulcerative process. A collection of mucus beyond the stricture and its escape back toward the colon was the cause of the appendicular colic. It seems to me we have an easy way to account for some of these cases, as in the one cited by Dr. Reed where there was no fecal matter, but the orifice of the appendix was closed. We speak of closure of a stricture in the urethral canal, and why cannot the same thing occur in the Fallopian tubes. Why can we not account for the cutting off of the circulation in this way? I think appendicular colic has come to stay.

Dr. M. HARTWIG, Buffalo, (by invitation,) took a conservative stand with reference to appendicitis. While the preceding speakers had shown proof of the great danger attending this disease, still if

we take the average cases as they come to the general practitioner, appendicitis was not very fatal. German statistics give about ninety per cent. of recoveries in cases not operated on. He admits that we may have the relapsing form of the disease, and he has had five or six cases of this form occur in his practice. Dr. Macdonald has done a good service by pointing out the difference between the operable and non-operable cases, as the speaker fully believes that such a distinction can be made.

Dr. DONALD MACLEAN, Detroit: First of all, I desire to endorse very heartily the doctrine that has been presented by my friend Dr. Carstens namely, that when you have appendicitis with adhesions fencing off the abdominal cavity and pus outside, you should open it as you would an ordinary abscess and wash it out. But not even the eloquence of Dr. Murphy, the logic of Dr. Price, or the experience of the members of this Association, would induce me to break up the adhesions and enter the peritoneal cavity. I am firmly settled on that point in my own mind.

As to the question of early operation, if I had my patients entirely under my control in the hospital, I certainly would advise and advocate early operative interference. Let us take, for example, a hundred cases in which an early operation is done for appendicitis, and I believe a great many of them would have recovered without an operation and permanently. I have had quite a number of cases under my observation and the opportunity of watching them. One was a coachman who had an acute severe attack of appendicitis, but was unwilling to have an operation performed. He got well without it. I have watched ever since and he is well today. I could cite many other cases, if necessary. In our practice we have to contend with the opposition of the friends or relatives of the patients regarding surgical interference, and this is a serious matter. It takes a man with a good deal of moral courage to go into a family and say to a mother or father, "your lovely daughter of fourteen has got appendicitis and must be operated on at once." It causes the family great sorrow, and sometimes catastrophies of another kind result from it. For instance, in Detroit, a young lady of a prominent family was taken with appendicitis and so diagnosticated by her physician. He called in a surgeon, who advocated immediate operation, which had the effect of horrifying the family to such an extent that my surgical friend and physician were both dismissed from the case. A homeopath was called and sure enough the case got well.

Dr. W. G. MACDONALD, Albany: From what I have seen, the operative treatment of appendicitis has been largely confined, among a great many operators, to two classifications-cases of localized abscess with plastic peritonitis, and cases of relapsing appendicitis. Of all cases of relapsing appendicitis upon which I have operated, every one of them has gotten well, and of the other class of cases there is a mortality of 28 per cent. Five of these cases can be attributed to the breaking up of adhesions and establishing a communication between the general peritoneum and this area of the abdomen which has been suffering. I do not believe there is any system by means of which you can make it safe to turn this portion of infected peritoneum into the general peritoneum again, drainage or no drainage, or by any system of drainage.

Dr. JOSEPH HOFFMAN, of Philadelphia: Why gonorrheal pus is less irritating than that from the coccus which is supposed to inhabit the colon, is beyond my understanding. It is only an effort on the part of some to explain what we cannot understand, and the explanation does not go far, for the reason that we can constantly open up these colonic abscesses and they get well. There is no reason why, if the coccus of the colon is more poisonous than any other, one patient should get well and another should not, if there has been an abscess opening into the peritoneum. case was cited in point.

A

THE MEDICAL ASSOCIATION OF CENTRAL NEW YORK. Reported by EDWARD B. ANGELL, M. D., Secretary, of Rochester, N. Y.

THE twenty-seventh annual meeting of the Medical Association of Central New York was held at the Academy of Medicine Parlors, in the City of Buffalo, N. Y., Tuesday, October 16, 1894. The association was called to order at 10 o'clock by the president, Dr. H. L. Elsner, of Syracuse. The minutes of the last meeting were read and approved.

The president then announced the following committees :

On Business--Drs. Lucien Howe, of Erie; Geo. E. Clark, of Onondaga; A. S. Hall, of Cayuga.

On Credentials-Drs. John O. Roe, of Monroe; A. L. Benedict, of Erie.

On Reception-Drs. Floyd S. Crego, M. D. Mann, Roswell Park, Chas. G. Stockton, A. A. Hubbell, of Erie County.

Dr. F. S. CREGO, of Buffalo, vice-president, then took the chair while the president's address, on Clinical and Bacteriological Aspect of Mixed or Concurrent Infection in Pulmonary Tuberculosis, was delivered by Henry L. Elsner, M. D., of Syracuse, N. Y.

Dr. ROE, of Monroe, moved that a vote of thanks be tendered to the president for his very able and instructive address. Carried.

Dr. Howe, as chairman of the business committee, then announced the order of business, and stated that on account of the length of the program it would be necessary to limit the reader of each paper to ten minutes, and its discussion to two and a half minutes.

Papers were then read as follows:

1. Hydrotherapy of Appendicitis, by Dr. George E. Clark, of Skaneateles, N. Y.; discussed by Dr. Jacobson, of Syracuse, N. Y. 2. Some Points in the Ethiology, Pathology and Indicated Treatment of Diphtheria, by A. A. Young, M. D., of Newark, N. Y.; discussed by Drs. Roe, Jacobson and Thornbury and, in closing, by Dr. Young. 3. The Home Treatment of Hay Fever, by A. L. Hall, M. D., of Fair Haven; discussed by Dr. Roe and, in closing, by Dr. Hall. 4. A New Microorganism Discovered in Pork, by F. J. Thornbury, M. D., of Buffalo, N. Y. 5. Atonic Dyspepsia, by A. L. Benedict, M. D., of Buffalo, N. Y.; discussed by Dr. Jones and, in closing, by Dr. Benedict. 6. The Treatment of Lactic Acid Excess in the Stomach, by A. A. Jones, M. D., of Buffalo, N. Y.; discussed by Drs. Benedict and Zimmer and, in closing, by Dr. Jones. 7. Exhibition of a Neurological Bust, devised by Wm. C. Krauss, M. D., of Buffalo, N. Y. 8. A Case of Nephrectomy, by Herman Mynter, M. D., of Buffalo, N. Y.

5.

Recess was then taken, and the members proceeded to the Genesee Hotel, where they were entertained at dinner as the guests of the Medical Society of the County of Erie.

AFTERNOON SESSION, 3 P. M.

The report of the treasurer was read and showed a balance on hand of $214.05. Approved.

The election of officers for the ensuing year resulted as follows: President, Dr. Floyd S. Crego, of Buffalo; first vice-president, Dr. William S. Cheeseman, of Auburn; second vice-president, Dr. E. L. Mooney, of Syracuse. The secretary and treasurer hold their offices for another year. Drs. E. B. Potter, E. B. Angell and A. A. Young were elected delegates to the American Medical Associa

tion, and the secretary was authorized to give the necessary credentials to any member desirous of attending the meeting.

The report of the publication committee was presented by the secretary, announcing the arrangement made with the BUFFALO MEDICAL AND SURGICAL JOURNAL for the publication of the proceedings. The committee had considered it unadvisable this year to print a revised constitution and list of members. The report was accepted and the committee discharged.

The president then appointed as publication committee for the ensuing year the secretary, Dr. Angell, and the treasurer, Dr. Mercer, to which committee Dr. Wm. C. Krauss, of Erie County, was added. The committee was authorized to publish at their discretion the revision of the constitution with list of members.

The chairman of the business committee then read two letters of regret, one from Dr. M. D. Mann, of Buffalo, and the other from Dr. L. A. Weigel, of Rochester.

Papers were then read as follows:

9. Report of two Cases of Extra-uterine Pregnancy-Operation-Recovery, by Herman E. Hayd, M. D., of Buffalo, N. Y. 10. The Pathology of Trichinosis-Original Observations-Illustrated, by F. J. Thornbury, M. D., of Buffalo, N. Y. 11. Observations Upon an Anencephalic Monster, by E. B. Angell, M. D., and S. L. Elsner, M. D., of Rochester, N. Y. 12. Discussion Upon the Management of Occipito-posterior Positions-participated in by Drs. Van Peyma and Frederick, of Buffalo, N. Y. 13. Report of a Recent Case of Abdominal Pregnancy-Laparatomy-Recovery, by H. T. Williams, M. D., of Rochester, N. Y.; discussed by Dr. Mynter. 14. Atrophic Changes in the Optic Nerve, the Result of Nervous Disease, by A. A. Hubbell, M. D., of Buffalo, N. Y.; discussed by Drs. Howe, Crego and, in closing, by Dr. Hubbell. 15. Dangers of the Intra-uterine Tampon, by W. E. Ford, M. D., of Utica, N. Y.; discussed by Dr. Williams. 16. Septic Inflammation of the Cerebral Sinuses, by Roswell Park, M. D., of Buffalo, N. Y. 17. Uterine Hydatids, by H. D. Ingraham, M. D., of Buffalo, N. Y.; discussed by Dr. Van Peyma. 18. A Report of One Year's Work in Abdominal and Gynecological Surgery at the Buffalo Women's Hospital, by C. C. Frederick, M. D., of Buffalo, N. Y. 19. 19. Faradic High Tension Coils and Currents, by Dr. F. W. Ross, of Elmira, N. Y.; discussed by Drs. Park, Ford, Crego and, in closing, by Dr. Ross. 20. Report of a Case of Sarcoma of the Abdomen Cured by the Toxines of Erysipelas,