reason, for asking your attention to night, I wish to bring to your consideration a comparatively recent operation colpotomy, for, when more thoroughly studied and better understood, there will be fewer celiotomies and hysterectomies. In performing Martin's operation of anterior colpotomy, by opening the vesico-uterine Dr. F. J. LUTZ, General Surgery. Dr. E. C. RUNGE, General Medicine.

I have still to be convinced that the abdominal route Yearly Subscription, $3.50. Single Copies, 10 Cents.

after it has been in use for a sufficient length of time to is a member of the faculty of the St. Louis Medical demonstrate its utility and value in diminishing disease. College where he graduated and in which he now holds The achievements of the Society during the past year the chair of dermatology. He is also a graduate of the are closely interwoven with the energetic efforts of its St. Louis University. Dr. Grindon will be most ably ex-president, Dr. George Homan, whose great ability seconded in his duties as a presiding officer by the Viceas an expert hygienist as well as a presiding officer are President-elect, Dr. Bransford Lewis, who has also been much appreciated by the members of the Society; and for many years identified with the interests of the to him is due the larger share of the introduction of the local profession. medical inspection of public schools in this city. The Society is in a most flourishing condition and there is excellent reason to believe that it will continue to be so in all time to come.

The Annual Meeting of the St. Louis
Medical Society.

The St. Louis Medical Society held its annual meeting Saturday evening, January 7, and elected the officers for the ensuing year, whose names appear at another place in this issue of the REVIEW. The election of offi cers was characterized by that harmony which is a distinguishing feature of scientific bodies. The past year has been a most successful one in the annals of the Society, which was due in no small measure to the efficiency and good judgment of the ex-president, Dr. J. C. Mulhall. The meetings were of a most profitable character and the papers and discussions of an instruc tive and practical nature. Also the presentation of patients and pathological specimens has contributed in no small measure to the interest of the meetings. The discussions during the past year were characterized by an exclusively scientific character and all the transac tions were synonymous with harmony and good-fellowship.

The Newly-Elected President of the
St. Louis Medical Society

Dr. C. R. Dudley.

The readers of the MEDICAL REVIEW will be pleased to learn that our able collaborator, Dr. C. R. Dudley, has been elected recording secretary of the St. Louis Medical Society. We are convinced that in Dr. Dudley the Society has elected a most efficient officer.

Election of Officers of the St. Louis
Medical Society.

The following officers were elected at the annual meeting of the St. Louis Medical Society, held Saturday evening, January 7:

President-Dr. Joseph Grindon.

Vice-President-Dr. Bransford Lewis.
Recording Secretary-Dr. C. R. Dudley.
Corresponding Secrdtary-Dr. F. W. Hilscher.
Treasurer-Dr. A R. Kieffer.

Successful Nerve Suture.

We glean from Le Progrès Médical of December 3, 1898, that at the Twelfth French Congress of Surgeons, Dr. Reboul, of Nimes, reported three cases of nerve lesions, the result of fractured limbs (forearm, trochlea, and humerus), which were successfully treated by nerve suture. The author sutured the cubital nerve twice, once the radial nerve. In the third case the nerve was found-not inclosed in callus, but compressed by a pro. trusion of the bone or a band of cicatricial fibrous tissue. After the suture of the nerves the paralysis disappeared.

The choice of Dr. Joseph Grindon as the President of the St. Louis Medical Society has been a most appropriate one and was received with much satisfaction by the members of the Society. Dr. Grindon has been actively identified with the history of the St. Louis medical profession for about twenty years, during which A New Behring Patent. According to the time his colleagues have had ample opportunity to ap- Berlin correspondent of the British Medical Journal for preciate his good qualities as a gentleman and brother December 17, 1898, Professor Behring and a Dr. Rup. practitioner. His very successful career has been with- pel have applied for a German patent for a tuberculosis out a blemish and in strict harmony with the ethics that ing a highly poisonous and immunifying substance from serum. His application alleges "a method for produc. govern the action of a gentleman and the professional tubercle bacilli or from cultures of tubercle bacilli."intercourse between reputable physicians. Dr. Grindon N. Y. Medical Journal.

Washington

Dumas

(Colored)..

Stoddard..

Shields.....

Riddick ....

Jefferson..

Franklin..

Dozier.....

Crow.

Carr Lane

:

1

SOCIETY. PROCEEDINGS

Conjunctivitis (all

forms...

Strabismus..

Nystagmus.

Imperfect sight (w.

:

6

4

DR. FUNKHOUSER read a paper (see page 21, this issue) on the

Treatment of Pelvic Suppuration.

DR. MCCANDLESS being called on for some remarks, 6-29 said: I am not prepared to discuss the paper; I have simply given thought to what the writer had to say and not to the idea of discussing the paper at all. I think it is directly in the line of present thought upon that subject-the approaching of pus in the pelvic cavity through the vaginal route. I thoroughly appreciate, however, the difficulties sometimes in determining that you have pus present, and an exploration can certainly be made much more thoroughly through the abdominal route. I have had some rather unhappy experiences in 3-212 attempting to reach pus through the vagina, then I have gone above and evacuated the abscesses and cured my patient. I have felt that uncertainty and fear because of the teaching of the distinguished operator, Joseph 2-11 Price, and what I have heard him say has always been in condemnation of approaching these abscesses through the vagina; and his marvelous success though the other route has satisfied me that usually it is safer to go through the abdomen, and the arguments are very forc ible concerning the operation, as it has been made, of opening the belly, for you are sure of a sinus a long time in draining an abscess of any size.

5

3

1

3

4

1

:

90 64 44

#:

37

1

2

30

16 94 104

15

20

3

*Without visible cause.

42

422

Now, there are abscesses that are removed-that is to say, an abscess of the tube. It is unnecessary to leave any open track after having removed an abscess of the tube, and it is certainly very unsatisfactory to deal with an abscess of the tube through the vagina when it can be removed; but there are abscesses where leakage has taken place and the pus passes into the broad ligament, where drainage must be effected; then you may have ugly adhesions remaining and possibly you may have a hernia.

I believe that there are cases, and that I have seen some in the last year, where it would be wrong and al most criminal to open the abdominal wall where the abscess was in easy reach of the vagina. I saw an ab. scess not long ago of the appendix, but the pelvis was filled with pus and pushing it out, so I could put my finger into the rectum and feel a great fluctuating mass. I opened it through the rectum and the patient got well. But there are abscesses of the tube where I think it is wiser and better to open through the abdom. inal cavity and remove the tube and abscess in its entirety and in that way cure your patient, which you

can not do nearly as safely or well through the vaginal to let out the pus the instrument which Dr. Funkhouser

route.

I was very much pleased with Dr. Funkhouser's paper; it is up to date, in line with the present proced ure, and we are now doing far better work through the vagina than we ever did before. We put our patients in a different position, elevate the hips, let the intestines fall toward the diaphragm, if there are any adhesions. There are apt to be adhesions lasting a considerable length of time.

DR. J. H. MCINTYRE.—This is a very interesting paper with which I am greatly pleased and one reason why I came to-night was to hear it; I expected something good and am not disappointed. The Doctor is certainly in line with the trend of thought at the pres ent time. Of course there are cases where we feel safer in going through the belly route, but it is true that in certain cases you will effect a good cure by let ting out the pus through the vagina. A case comes to my mind in which there was a long-winded discussion over a woman who was in the throes of agony. Hypo dermics of morphia did not relieve the pain, and she had to be placed under the influence of an anesthetic; when the incision was made the bulging abscess threw out a stream of pus three or four feet. I have seen other cases where getting through the lower route was attended by considerable difficulty, and when you are not quite sure you feel a little apprehensive. I will say that had I such an instrument as the one the Doctor has shown I should feel I was on safer ground; his in strument simplifies the matter very materially and adds much to its safety. Like the distinguished gentleman who preceded me, I have attempted to let out pus by the vaginal route and finally had to go up and do a celiotomy before I was satisfied with the case. Then there is another matter that must not be forgotten, that these abscesses are often multiple and you may tap one of them and not get at others, then, of course, you will have trouble later and be compelled to do the ventral operation.

has devised is undoubtedly a most practical and useful one in certain cases. Where the parts are readily ac. cessible a division of tissues, layer by layer, would be more in harmony with surgical rules and preferable if the patient has been anesthetized.

There is, perhaps, one objection to the essayist's statement, that the uterus should always be removed with the appendages even if it is not diseased. This objection is based upon the fact that when the uterus is left it may help to prevent the formation of a troublesome and very annoying hernia, which is more apt to occur-and when it occurs to be more pronouncedwhen the uterus is removed than where it is left in situ. DR. H. C DALTON, being called on, said: I have noth ing to say except that I heartily concur in the state. ments made by Dr. Funkhouser. I think the vaginal method is the best; it is the most convenient place to evacuate the pus and the place where it is most easily gotten at.

DR. EMORY LANPHEAR, being called on, said: I thank you for the invitation. There are one or two points in connection with this paper which should re ceive more attention than has been devoted to them. In the first place, I believe Dr. Riesmeyer is correct, and, according to my experience, it is best, whenever possible, to leave the uterus in situ. Of course, there are many cases in which it would be best to remove the uterus because it is freqently a source of infection and, if left in the pelvis, will necessitate a secondary operation for the removal of the infecting focus. But in many cases it is only the channel of infection, and as it is not itself seriously infected (it simply letting the poison pass through to affect the delicate structures beyond, itself remaining practically free from disease), and, in such instances it should not be removed, as it is still of use as the keystone of the pelvic arch, and of much use to the average woman in completing the sexual act. Of course, I can recall cases in the past in which, I am sure, the fatal ending might have been avoided if I had had the courage of my convictions to follow the advice now given by the essayist, and removed everything; but a few years ago it was not the practice, and it would have been thoroughly condemed by those doing pelvic surgery.

Yet in spite of this, I can not quite agree with the position of the essayist when he says (practically) that it is best whenever we can locate the abscess to go

DR. L. T. RIESMEYER being called on said: There is hardly any field in surgery where it is necessary to in dividualize more than in pelvic suppurations. It is best, as a rule, not to interfere surgically during the acute stage of pelvic suppuration excepting to let out the pus by a simple incision. It has been pointed out clinically, as well as by animal experiment, that a certain degree of immunity is established after suppuration has existed for a time and that for this reason a radical operation, in from below. I certainly must take the same position such as necessitates the surgical entrance of the perito- that Dr. McCandless did, that in many instances it is neal cavity either per vaginam or through the abdomi- preferable to make an abdominal incision. The chief nal wall, is much more successful at a later stage than reason is that, in many instances, a much larger produring the acute inflammation. Statistics teach that portion than is generally believed, the abscess is in the when a radical operation is done during the acute stage Fallopian tube and therefore must be removed because the mortality is exceedingly high, while when the oper simple drainage of the Fallopian tube does not, as a ation is done later the chances of recovery are much rule, cure the pyosalpinx. Those of you who were pres better. The vaginal route is to be preferred, whenever ent at the Detroit meeting of the American Medical feasible, as it produces drainage at the most dependent Association will recall the discussion between Paul point. When the operation consists in a mere incision | F. Munde, of New York, and Joseph Price, of Phila

delphia, in which Munde said he treated such cases die, but she pulled through and is alive to-day. I could with simple incision and drainage, and that there were not remove all the material. I made a mistake in that a good many women going about the streets of New case, and have made it in others, in not operating York with gauze hanging out of the roof of the pelvis through the vagina. I remember the teaching, by no into the vagina, discharging pus; and Dr. Price said means to open the vagina, especially that there was that Dr. Munde should come to Philadelphia and learn danger of infecting the abdominal cavity. how to treat pelvic abscess by extirpation! And there is more truth in that than some would think. I must take exception, also to the statement of the essayist, that when one is in doubt, it is best to go in from be low. I would reverse this rule.

The patient above referred to, finally got over this attack and over the operation, but there were sinues left. She was brave enough to allow me to try again, and I operated again, and there was general peritonitis following the first and second operation-pus continued to form in the abdominal cavity, in the second operation, however, I drained through the vagina, but that drain was only sufficient for one side of the abdominal cavity.

Now, in regard to the multiple foci, the Doctor is mistaken when he says I did not mention that. I was particular to make a division, separate and distinct of the multiple foci of suppuration, with an opening through the skin or mucous surfaces. In this case I was compelled to open the wound again and, although the patient recovered and is well to-day, she has an inci sional hernia. A great deal of the peritoneum had been destroyed and a quasi peritoneum was formed and along the line of the incision the abdominal incisional hernia developed eventually.

DR. FUNKHOUSER.-I said to go in from above. DR. LANPHEAR-Then I must agree with you. When in doubt as to the location of the abscess we should go in from above, first, because the probability of the pus being in the tube, in spite of the symptoms not point. ing to that, and second, because if it is not in the tube, we may see and feel the exact location of the pus, and if it is about the folds of the broad ligament, or any where except the tubes, we may very intelligent direct the trocar or knife from below into the abscess cavity, with one hand above and another below; seeing as well as feeling; and in that way reaching the one or more foci of infection. In that way only can we accomplish what is necessary in these cases: reach and drain every one of the pus pockets. It is the experience of every man doing much pelvic surgery that where the pus is I will say that I trust to clamps nearly altogether in not in the tube, there is more than one abscess, and in the lower operation; it takes less time; there is less making the attack from below alone, one or more of danger; less shock, and that is a great point to discuss these pus pockets may be left with a fatal ending of in the consideration of these cases. Recently I had a the case; whereas, if we have the pelvis open above case which I opened through the vagina; the patient with the aid of the eye the hand in the pelvis may de- was almost moribund; already there had been a passage tect the abscesses and allow one to drain them. I am a of toxins and very likely micro-organisms through the little in doubt as to the efficacy of the doctor's trocar in natural inflammatory protecting wall into the general many instances. I lelieve that in a majority of cases, peritoneal cavity, causing intense tympanitis; her belly as clumsy an operator as I am, would do more harm was swollen to enormous proportions; there was hicthan good with it. I prefer to go after the pus with coughing. I saw her on a Saturday and finally she the finger rather than with a knife or other sharp in concluded to an operation on Monday, and on Saturday strument of any kind, simply cutting the vaginal mu night following she sent for me in haste. I found her cous membrane and then burrowing with the finger. I almost in extremis and did not expect her to live believe that a man will get better results ultimately if through the night. The next day she was willing to be does this, as the finger is a pretty safe guide in have a laparotomy, which I did without a general anes searching out a pus cavity, and a safe means of making a large hole without injury to any of the neighboring viscera which may be attached to it.

thetic. (I had advised the operation years ago; then advised it again eight weeks before she finally allowed me to open through the vagina, by incision with this. instrument.) I performed laparotomy, let out the pus, and the mere letting out of the pus, relieving the tension in that case was beneficial; the pressure was reduced and, strange to relate, the patient is now able to sit up; that occurred five weeks ago.

DR. ROBERT FUNKHOUSER.—I am very much obliged to the members who have discussed the paper and ap preciate the points where it can be criticised. At the same time I mentioned in the paper very particularly the trouble in the abdominal route is the danger in these cases in attempting to remove them when they I have kept a record of twenty or twenty five cases are connected with the ovaries and tubes, or inflamma- in which I have used this instrument. I do not mean tion following. I recall a case where, comparatively to say this instrument will cure the case, not at all, but recently, I opened the abdomen and the whole pelvic I think, as I stated in the paper, many cases, far more cavity looked as if much plaster of Paris had been than is supposed, are benefited immediately, and the thrown into it; the structures were all matted together; ultimate results are all that could be wished. It is true there were pockets with caseous material, pus-pockets, that there are cases which call for another operation. pockets with blood; when I got through, we all said Now, in regard to the dangers of hernia, I consider the patient would not recover, that she was bound to that the dangers of hernia are by no means less no