passed. The tympanites was not relieved. The patient was reported to have passed gas in great quantities. The resident physician The resident physician in attempting one day to reduce the hernia thought he had succeeded. In less than two days, however, it had re-appeared. The case went on from bad to worse. The man had vomited during this time, perhaps twice a day, but there was no stercoraceous matter as I could learn. He was unable to take food, and was nourished per rectum.

The abdominal wall remained tympanitic, belly very tight, and his pulse became very frequent and feeble.

I called another consultation, several surgeons being present who were not present before. All except one favoring the operation, it was done immediately.

The questions were, was there strangulation at the inguinal ring, and whether the gut was gangrenous. There was found a rent, perhaps two rents, in the gut, but whether made during the operation or not is uncertain; an opening was established, and its edges stitched to the ring, and the omentum was tied and returned. Feces now passed freely through the opening in the bowel. The shock was profound, but the patient rallied somewhat. He died the next night. Drs. Vance, Rodman, and Leber were present at the postmortem. We found at the site of the ring just enough plastic lymph thrown out to cause slight adhesions, evidently from the operation. There was no general peritonitis; no adhesions whatever to the bowel; the small intestines were greatly distended, the large ones appearing unusually small; there was no fluid in abdominal cavity. In tracing the bowel from the ring we found the seat of the obstruction to be in the ileum. It was therefore not a strangulated hernia, properly so called. It is asked, what caused this condition in the ileum? I should say that this was the point injured, and that when the patient fell the inflammatory lymph thrown out in the process of repair gave rise to the obstruction.

The case demonstrates to my mind the advisability of early operations in hernias

with symptoms, in order to find the character of hernia, whether strangulated, incarcerated, or obstructed. I was mistaken in the case, in so far as I could not locate the obstruction. I thought we should find it at the ring, or in that neighborhood. I think the case also proves that an early operation might have saved the patient's life. Doing the operation when we did it certainly shows that the character of operation for hernia proper at the ring did no good. The question before the operation was, what operation should be done? One consultant thought laparotomy should be done. That was not done. Now the questions are, was the operation the correct one, and was it done at the proper time?

Dr. Vance: The operation was the ordinary one for strangulated hernia. As soon almost as the true sac was opened the first thing that came out was a gush of feces. This came from back of the hernial mass, where no incision had been made during the operation. It was, I take it, a spontaneous fistula by slough. I do not believe that the operation relieved the obstruction at all. There was no peritonitis, and the stricture in the gut corresponded with the external abdominal ring. I believe the case was lost by failure of early operation. I had recently a case of hernia somewhat corresponding to this. I operated, and found a congenital hernia, with so-called hydrocele, and introduced catgut sutures through Poupart's lig ament. The case did uninterruptedly well, the wound healed quickly, the patient being discharged in nine days. E. R. PALMER, M.D.

Secretary.

FRENCH SURGICAL CONGRESS.* The regular annual session of the French Surgical Congress was held in the Amphitheatre for Public Assistance, at Paris, March 13th and the two days following.

M. Verneuil, the president, was in the chair, and thanking M. Perron, and the Director of Public Assistance, as well as the many eminent surgeons who had done so much for the success of the congress,

Reported by E. S. McKee, M. D.

delivered the usual opening discourse. He would for himself prefer to sit in the ranks, than as president, for to-day no one is first in surgery. The president took this occasion to refute the unkind charges against French surgery made by Prof. Billroth. This eminent Vienna professor disdainfully reproaches the French School of Surgery, which, he says, follows lamely after the German and English schools. This very singular assertion of Prof. Billroth is because he is not well posted, for no one ignores French surgery more than he. In proof of this, in his work on General Pathology he makes no mention of the best French works. He does not cite them because he does not know them, consequently he does not know if our progress is lame in comparison with our neighbors. The truth is, that French surgery does not build at the temple of the god Bistoury. In his eyes the French surgical operations remain at rest, ratio ultima et non prima. Yet French surgery only avoids those unripe operations tottering on an insecure foundation. Surgery has only one duty to relieve or cure in the most simple manner and with the least possible expense. The only duty of the bistoury is to be very clean, and to cut in the best possible manner. French surgery is, in brief, eclectic. Particularly do we owe to it some very ingenious instruments. French surgery manifests a certain preference for bloodless procedures. We find the contrary is true with us, but it is of foreign importation. I hope those foreign ideas will not find in this country favorable centers of culture. The French surgeons will remain true to their eclecticism, and continue to pursue their relative kindness and simplicity. We can and we must make useful loans to our rivals, but we can claim reciprocity. I thank my confrères who are present, and am much complimented at the large audience, and glad to see the growing democracy of

surgery.

Resection of the Wrist-joint was the subject of a paper by M. Ollier, of Lyons. He made a report of his treatment of anchylosis of the wrist-joint by resection. Under the

antiseptic method, it is to-day possible to make the resection of the wrist and retain the action of the tendons of the wrist and hand without danger and without fever. It is permissible to make a simple orthopedic operation, having only as its aim to combat a deformity and give more movability to an anchylosed joint. The time is now past when the surgeon esteems himself happy in obtaining an anchylosis after a resection of the wrist. The articulations which we obtain to-day have an amplitude and force. A man on whom he had operated can lift a dumb-bell of twenty-four pounds, and a woman, also operated upon, can play the piano very agreeably.

The Extirpation of the Larynx was the subject of a report by M. Domons, of Bordeaux. He gave full statistics of his operation. Medicine, he thinks, can not compare with the surgeon in curing cancer when the latter extirpates the organ. The operation is very grave in its effect, but not necessarily fatal. It is indicated in epithelioma of the larynx when the diagnosis is well established. It permits of radical cure, and even in those cases where the disease must return after a number of months or years, it is more preferable than tracheotomy, which is only a palliative operation, and permits of long but miserable survival.

The presence of the caruncle irritates the trachea, provokes coughing, and the patient operated upon is subjected to suf focation, and the pain is sometimes severe. In comparison to this M. Domons cites the example of one of his patients who was subjected to the extirpation of the larynx. He considers the advantage to be certainly on the side of extirpation rather than tracheotomy. The surgeon will have to determine himself, after considering the particular indications in each case. It would be unscientific to practice extirpation of the larynx in every case of cancer of this organ, and to always refuse to practice the operation.

M. Molliere, of Lyons, agreed with M.' Domons. He has also had the privilege of extirpating the larynx for a case of well

defined and well-circumscribed cancer of the larynx. The operation was done under anesthesia from ether, and was relatively easy. The sequel has been good, and M. Molliere will not hesitate to repeat the operation under analogous circumstances.

M. Verneuil, the president, in opening the second session, March 13th, proposed the following names of honorary presidents: MM. Socin of Basle, Labola of Rio de Janeiro, Thirat of Brussels, and from France, Rochard, Dupluy, Guyron, LeFort, Perrin, Lannelongue, and Panas. The congress ratified the nominations by acclamation.

The order of the day was the discussion of the question, "The subsequent treatment of gunshot wounds of the visceral cavities."

M Chauvel thought that the proper conduct of these cases varied as to whether the wound was in the cranial, thoracic, or abdominal cavities. Wounds of the cranial cavity and thorax are but slightly exposed to danger of infection, as they do not occur from projectiles or foreign bodies which carry away much tissue; also, in these cases the surgeon is more apt to abstain from deep probing. In wounds of the abdomen, on the contrary, active intervention is undertaken at once, for death is imminent. The perforation of the intestine results in throwing infection matter into the peritoneal cavity and the engendering of inflammation. He praised the use of laparotomy in these cases, but the operation must be made early. Twenty-four hours after the reception of the injury is too late.

M. Reclus experimented on dogs with favorable results, but had not been so fortunate with men, and particularly soldiers in time of war.

M. Delorme, of Val de Grace, acknowledged that the active surgical intervention in case of wounds of the abdomen was followed by favorable results, yet he thought this was only the case in the cities where all the means of procedure were at hand.

M. Poucet spoke of contusions of the abdomen from the ancient round projectiles. These are much more rare with the new projectiles.

M. Reclus opposed the laparotomy. He recommended absolute quiet, opium in large doses, and energetic compression of the abdomen.

M. Trelat was fond of dogs and fond of men, but he could not draw conclusions about one from the other.

M. Labbe practiced laparotomy as the last resource. He has lost his patients, but it was the operating under bad conditions which explained his lack of success. He accords fully with the doctrine of active intervention.

Professor Panas then made an interesting communication concerning the circulation of blood in the orbit, and M. Thirat on the extraction of the gall bladder. Professor Lannelongue on treatment of dermoid cysts of the region of the anterior fontanelle. M. Baker presented a sterilizer. M. LucasChamponniere acknowledged the apparatus of M. Lucas to be very pretty and ingeuious, but he contested the principle of it.

At the meeting of Wednesday, March 14th, M. Verneuil, president, in the chair, the subject discussed was that of the radical and definite cure of hernia.

M. Lorin, of Basle, thought the term "radical cure of hernia" was a little pretentious and misleading. He thought it should be replaced by the term "surgical cure" or "operative cure" This operation does not offer serious dangers, and its results are excellent. He has practiced this treatment in numerous cases, and reports sixtytwo per cent cures, and thirty-eight per cent relapses.

M. Lionte of Bucharest, M. Thirat of Brussels, and M. Molliere of Lyons supported early surgical interference in hernia with great energy. The operation is without gravity, it is easy, and the results are marvelous.

M. Trelat said that the surgical cure of hernia is a benign and efficacious one, and that it had the approbation of all.

M. Trelat, after being hostile a long time, is now a convert to this manner of treatment. The true progress, however, is to promote the recovery of those individuals

otherwise doomed to a certain death; the operation appears useless in those cases of hernia easily reducible.

M. Segond thought the full benefits of the operation were not attained unless the patient was obliged to continue wearing a light bandage.

M. Lucas Championniere thought the bandages not always necessary after the operation.

Prof. Lannelongue made an interesting communication on the Resection of the Inferior Border of the Thorax.

MM. Demons of Bordeaux, Pozzi, Pean, and Richelot, spoke concerning hysterectomy. MM. Demons and Pozzi were in favor of the ligature of the broad ligament. The use of the hemostatic forceps should be a matter of choice, and it is wrong to make it a necessity. MM. Richelot and Pean defended the hemostatic clamp, which invention they both claim.

Thursday, March 15th, the congress held no session. They spent the day visiting the hospitals, and especially the institute of Pasteur. A very enjoyable banquet reunited the members of the congress in the evening.

Friday, March 15th, the order of the session was: Chronic Suppurations of the Pleura and their Treatment, Operations of Lietievant and Estlander. This operation, first indicated by Lietievant of Lyons, and practiced for the first time by Estlander in October, 1880, consisted in the resection of the side in order to permit the thorax walls to compress the vacuum made by the retraction of the lungs. Prof. le Font and M. Thirat of Brussels, opened the discussion. M. Boeckel of Strasbourg, recommended that the operation of Estlander be abstained from when tuberculous or heart trouble is present.

M. Berger recommended to avoid as much as possible the resection of the ninth and especially the tenth ribs, which are the most useful in the mechanism of respiration.

The subject was first discussed by M. Bouilly and M. Delorn.

In the afternoon session M. Pozzi enter

tained the congress on the subject of the Extirpation of Hydatid Cysts of the Liver by way of the Pleural Cavity.

M. Labbe reported a case of laryngotomy in a case of foreign body of the larynx. The patient was an infant who had swallowed a metal star at play, and which fixed itself between the vocal cords.

M. le Barronne Larrey was elected president of the congress for the ensuing year. The congress will meet on the first Monday in October, 1889, in Paris.

Reviews and Bibliography.

The Transactions of the American Ophthalmological Society for 1887.

The volume contains numerous interesting papers on topics new and old. The subject of cataract operations, which at the present time appears to be undergoing a retrogressive change, is dealt with in papers by Drs. Bull, Knapp, and Randall. The former reports thirty-six cases without iridectomy, after the method I saw practiced in the clinics of DeWecker and Panas in 1884. His results were uniformly good. This operation is simply a revival of the operation of Daviel, which, before the introduction of the Graefe operation, was the one altogether in vogue. The difficulties in the adoption of this method have always seemed to me to be many. First, the wound must be larger than in the modified Graefe. The iris is apt to prolapse and the soft lens matter is much more difficult of removal. The only thing in its favor is that it is said to leave a central movable pupil. I have found this to be rarely the case. The portion of iris that is pushed in front of the lens during extraction is so injured by pressure that (in my experience) it will not react to mydriatics or myotics. The iris becomes fixed and immovable, and presents an oval pupil that is apt to become blocked by capsular opacities, for the removal of which many secondary operations are required. These are always sources of danger, and often lead to hyalitis and a low form of choroiditis that ultimately ends in almost

total obscuration of vision. The operation, as described by Dr. Bull, will doubtless have its day and again fall into neglect.

Dr. Randall brings forward the kind of knife used by the late von Jaeger, and urges its superiority. It is known to oph thalmic surgeons from its resemblance to the Beer knife, which is still used by some with success, especially the late Mr. Streatfield, who used it with much dexterity. Its superiority was not admitted by those who took part in the discussion, notably Dr. Noyes, who said the narrow Graefe knife gives far better control of the movements necessary in making a proper section than a knife of a greater width.

The paper most interesting to those engaged in cataract operations is that of Dr. Knapp. For years he has been reporting his operations in series of one hundred, furnishing a vast amount of practical information with each series. He now draws conclusions from a summary of one thousand operations with iridectomy, and the showing is good, com- paring favorably with the operation without iridectomy. This series, as he says, exemplifies the assertion that it is to the merits of Graefe's extraction that the losses by suppuration have been reduced from ten per cent or twelve per cent to five per cent or six per cent; and he might add that the resulting acuteness of vision, as obtained by the Graefe methods, is as good as that by any other. In the last three hundred cases antiseptics were employed in every other case so as to test their value. From the results gained antisepsis evidently had much influence, as the losses from primary suppuration were reduced to one per cent. perience justifies his saying "that to remain refractory to the application of such antiseptic means as the eye will tolerate, would to-day be an anachronism." He concludes that the leading principle, as borne out by the experience of Gracfe's times, is not lost. Extraction with iridectomy will be always the operation of necessity in certain cases, and the safest to choose in others

His ex

Dr. D. B. St. John Roosa reports a case of amaurosis following the administration of

large doses of quinine. The patient, during an attack of intermittent fever, was given thirty-grain doses of quinine sulphate for the relief of convulsions supposed to be malarial. When she recovered she was unable to distinguish light from darkness. When examined ophthalmoscopically the discs were found pale, the vessels small. Vision was gradually restored under hypodermic injections of strychnia. In the discussion of this case Dr. Gruening reported a case in which there was temporary blindness and deafness following a thirty-grain dose of quinine. He found no visible lesion in the fundus oculi.

Dr. Swan Burnett furnishes a paper on Ring Scotoma. He thinks that this condition will not be found to be so rare as supposed, if it is searched for more carefully, and that often it will prove to be of as much importance as other defects to which more attention has been given. He thinks from a study of two cases, which are given in detail, that we are warranted in placing the origin of the defect in the optic tracts. Heretofore it has been considered as a local lesion in the choricd. I have studied one case in which this defect was found. It was plainly a local lesion, due to retinitis pigmentosa.

An interesting paper on Passive Motion in the Treatment of Paralysis of the Ocular Muscles was read by Dr. C. S. Bull. The method, which is that recommended by Michel, has, since the introduction of cocaine, become available. It is based on the principle of passive motion by seizing the conjunctiva over the paralyzed muscle with fixation forceps, and, by pulling the eyeball backward and forward, forcing into use the paralyzed muscle. paralyzed muscle. This orthopedic method. has been tried by others, and with some success. I have tried it in one case without any marked success. Nevertheless, it demands. our consideration after a thorough trial by internal medication and galvanism has failed.

A very practical paper is contributed by Dr. J. A. Lippincott, in which attention is drawn to circumscribed hyperemia, especially over the insertion of the internal rectus muscle, as indicative of insufficiency.