to be of normal size; it was unengaged above the pelvic brim. The woman was prepared for a symphyseotomy, etherized, put upon a table, and an attempt was made to engage the head with

FIG. 3.-Minor grade of hydrocephalus, unrecognizable by the ordinary tests.
FIG. 4.-Well-marked hydrocephalus, easily recognized during labor.

forceps. This failed after twenty minutes' effort. The symphysis and the subpubic ligament were cut while the forceps was still attached to the child's head. It was then easy to pull

the latter through the pelvis. I have never seen the utility of the operation better demonstrated. The mother and child did well. This makes my sixth symphyseotomy, which Dr. Harris tells me (March 28th) is the largest number performed by any operator in America. Four of the children lived and all the women recovered. They all had afebrile convalescences except

the first, who developed phlegmasia, not from the operation, but from the difficult labor that preceded it.

A few words are still in order about the technique of this operation. Increasing experience convinces me that it is one of the most difficult and troublesome of the obstetrical operations, both in its performance and in its after-care. The difficulties in the operation are decreased by the suprapubic incision and by the use of the Galbiati knife. This plan has the advantages of a wound more easily guarded from infection, of less danger of

FIG. 5.-Hip-binder fcr use after symphyseotomy.

hemorrhage, and of less risk of injuries to the urethra and bladder. It has the disadvantage that the subpubic ligament is harder to cut. I have failed, I think, in every case to cut the ligament with the upward stroke of the knife that severs the joint, and I have been compelled to reinsert the knife to cut the ligament.

For this purpose the Galbiati knife is a clumsy implement, and

I have had constructed a special knife for the ligament that, I think, will prove convenient (Fig. 5).

The difficulties in the after-care of the patient are decreased by the use of a good hip-binder, and by the use, as suggested by Dr. Dickinson, of sand bags under the mattress.

I have employed the binder illustrated in Fig. 6 in three cases, and shall continue to use it. The anus, vulva, and urethra are left accessible, while the pelvis is well supported. It is wise, in addition, to pass a broad strip of rubber adhesive plaster around the hips, leaving the gauze attached to that portion of it which runs across the back.

SYMPHYSEOTOMY VERSUS SYMPHYSIOTOMY.

BY

ROBERT P. HARRIS, A.M., M.D.,
Philadelphia.

As these two titles have the same pronunciation, the slight difference in their spelling would appear of no consequence but for the fact that the first indicates a proper derivation and the second an improper one.

When Sigault wrote his thesis in 1773, he gave as its title Sectio symphyseos ossium pubis. He operated in 1777. In 1778 Roussel de Vauzème, of Paris, repeated the title of Sigault in reporting his own case.

In 1787 Verdier du Clos gave the operation a triple Greek title and called it symphyseotomie, which is still its name in France. The central word of this title, quo15 (phusis), by its genitive puoεws (phuseōs), determines the spelling of symphyseos and symphyseotomy. Quoɛws is the genitive of Attic Greek and is retained in the modern language.

Pubiotomy and ischiopubiotomy are correctly spelled with an "i" because the genitive of pubes is pubis (of the pubes). It is just as incorrect to spell "pubiotomy" with an "e," from the nominative, as it is to write "symphyseotomy" with an "i" from the same case. We therefore write "pubiotomy" and "symphyseotomy" for the same reasons.

In languages other than English we find the Greek genitive

carefully adhered to. This is the case in the ten examples here

In Ionic Greek, which is not the standard of the language, the genitive of quos is written quoios. Possibly the originator of the spelling in "i" may have thence obtained it, but it is more probable that it came directly from the nominative as

an error.

In Italian the spelling is exceptional and national: the term "sinfisiotomia" is compounded of sinfisis and tomæ.

There should be but one way of spelling in English, and the term ought to be based upon the Attic Greek genitive, “ φύσεως.”

329 S. 12TH STREET.

DOUBLE TUBERCULAR TUBO-OVARIAN ABSCESS-CELIOTOMY.'

BY

JOHN B. SHOBER, M.D.,

Surgeon to the Howard Hospital; Assistant Surgeon to the Gynecean Hospital,
Philadelphia, Pa.

(With one illustration)

It is not the intention of the writer to give a detailed clinical history of this very desperate case, but rather to point out some of its more important and striking features.

Fortunately, it is no longer an almost daily occurrence to meet with cases of pelvic disease so far advanced as the one about to be described. We are all, however, familiar with the type, although we seldom if ever meet two cases which are alike.

The interest in this case lies in the prostrated and almost hopeless condition of the patient when first seen; the impossibility of doing more than to free adhesions and effect drainage at the operation; the measures adopted to keep up drainage, subsequent nursing of the patient, and the pathological report.

M. H., colored, single, æt. 27, was admitted to the Gynecean

1 Read before the Section on Gynecology, College of Physicians of Philadelphia, April 18th, 1895.

Hospital February 9th, 1895. Her previous and family history reveals nothing important. She had always enjoyed excellent health until five years ago, when she had an attack of peritonitis which kept her in bed nine weeks.

She has not been well since then, her chief discomfort arising from painful menstruation and intestinal disturbances. Her menstruation, however, was regular and normal in quantity and quality until last September. This period, which occurred on the 5th of the month, was ushered in with an attack of excruciating pain, principally confined to the left side, was very scanty, and lasted only two days. The pain persisted, and has continued with but slight interruption ever since. She has steadily lost weight and strength, and there has been no further showing of the menstrual period. Her normal weight is one hundred and fifty pounds; her present weight is one hundred and fifteen pounds. Her bowels have been irregular, with a tendency to diarrhea. She has been unable to leave her bed since the September attack.

She was first seen by me February 8th, 1895. The temperature was 100°, pulse 100, respirations 24. Urine negative. Heart weak but normal, bowels loose. She was suffering severe pelvic pain and was much emaciated.

The abdomen was very tender to palpation, with flat percussion note as high as the umbilicus. Nothing could be outlined per vaginam but a small virgin cervix protruding from a dense and tender mass which completely filled the pelvis.

On the following day celiotomy was performed. The pelvis was filled with a mass which consisted of the uterus firmly fixed between two large abscesses, over which lay the Fallopian tubes. Everything was matted together by adhesion, and loops of intestine were adherent posteriorly and over the mass and to the anterior parietes. In separating a loop of intestine from the right side the abscess was opened, the intestine having formed part of the wall of the cavity. About five ounces of pus having a fetid and fecal odor escaped; a cover glass preparation was at once made by Dr. Beyea, and it showed streptococci in large numbers, and a long-stemmed bacillus and a short bacillus, probably bacillus coli communis. The right tube was removed with a portion of the abscess wall on this side. The same was accomplished on the left side. Both abscess cavities were thoroughly flushed out. A small rent which occurred in the serous coat of