on the left side and seven on both sides.

The proportion of cases in which these bodies were found to be present to the total number of cases of congenital inguinal hernia was therefore to 14, or 7 1-7 per cent. A large proportion were reducible.

In 1886 Dr. J. C. Tedford38 reported a case of an ovary expelled from the anus. A woman aged twenty-eight, married ten years, three children. January 9 she had a miscarriage. On January 14 she was taken with severe tenesmus and disposition to strain, whereupon a tumor was expelled from the anus. A finger introduced could feel the pedicle extending as high up as it could reach. The tumor, which was covered by the peritoneum, was pulled down, the pedicle tied and a cystic ovary removed. Peritonitis followed, and the patient died on Janu

ary 20.

Post mortem examination showed that a portion of the bowel had been invaginated, and that the ovary had escaped through a rent at the sigmoid flexure.

In 1885 John Ward Cousins related a case in the British Medical Journal, in which hernia of an ovary and the Fallopian tube took place through a rupture in the vaginal wall. There had been complete prolapse of the uterus, and protrusion of the rectum to the extent of four inches. The vaginal walls were rent and the hernia took place by that channel. A case of left inguinal irreducible hernia of the ovary, Fallopian tube, bladder and intestine was reported by Reymond32 in the Bulletin de la Société Anatomique de Paris, 1894. The bladder was recognized during the operation and reduced without injury.

REPORT OF TWO CASES.

Case I-Mrs. G., aged about forty, the mother of several children, the last about ten years old, has suffered with an inguinal hernia on the right side for about twenty years. During this time she has worn a truss, which had always kept her comfortable up to the birth of her last child. During the labor the hernia protruded in a large mass, and the doctor had much difficulty in returning it, which, however, he succeeded in doing, and she got along quite well until she commenced

sitting up, when she felt a small hard knot immediately under the hernial protrusion, which remained after the hernia was returned and caused a great deal of pain when the truss was applied. This lump has always been more painful, and has increased in size at the menstrual period. The intestinal hernia frequently occurred, sometimes she could reduce it herself, sometimes, she was obliged to call on her physician.

This condition went on for several years, during which time she has always suffered from constant dragging pains and discomfort, and at times has had attacks of severe pain in the hernia which caused excessive nausea. On January 10, 1892, her physician, Dr. Wm. J. Clendenin, was called to see her while the hernia was down. She had previously been constipated, and had taken purgative medicine, which had failed to act. He reduced the hernia and she became more comfortable. On January 12 the strangulation became complete, and all his attempts by taxis, etc., failed. He felt a hard lump behind and below the intestine, which he took to be a lump of impacted feces, when he succeeded in getting the hernia back this lump seemed to be connected with it and exercised traction upon the hernial mass.

On January 13 all the symptoms had become more urgent. Her temperature, which ran up to 103° on the previous night, was now sub-normal, and stercoraceous vomiting had been going on fo some hours. He sent for me to operat and I saw her about 5 o'clock in the afternoon. She was then in a state of collapse, her temperature sub-normal and her pulse too weak and too fast to be counted.

In cutting down on the hernia I found about twenty inches of the intestine in the hernial sac. It was of a dark purplish color, and almost gangrenous. The intestines were enormously distended above the seat of obstruction. The sac was opened up to the internal ring, and the agglutinated intestines separated both from the sides of the sac where they were adherent and from each other. There was a hard mass posterior to and below the intestine, which seemed to be

attached to it by a thick cord. This mass proved to be an ovary. The internal ring was blocked by a dense hard conical body projecting into it and completely obliterating it lumen. I concluded the safest plan to be to open into the abdomen from above and made an incision about three inches in length, reaching down to the internal ring, thus making plenty of room for the return of the intestinal loop, which was first carefully washed off with hot water and as much of the exudate as possible removed. I found the conical mass to be the cornu of the uterus, which, with the tube, had been drawn into the canal by the prolapsed ovary which I had previously found in the lower portion of the sac. The thickened cord, before mentioned, was the elongated broad ligament which formed the pedicle to the ovary. I ligated the pedicle and Fallopian tube close to the cornu of the uterus and removed them. I then ligated the sac close to the intestinal ring and cut it off. The abdomen was closed with silk-worm gut. The patient remained in a weak condition during the night, but on the following morning reaction set in and she finally made a complete recovery.

Case 2.-C. S., aged thirty-eight, married twenty years, has had several miscarriages and three children, the last two years ago. Has had a swelling in the right groin since the birth of her last child. Had a similar swelling on the left side three years ago, which disappeared after she become pregnant. Her abdominal muscles are thin and relaxed, although she is a well-formed woman and enjoys excellent health with the exception of this lump, which is exceedingly sensitive and tender, and hurts her when she stoops down or moves about. It becomes more painful and larger at the menstrual period and incapacitates her for her work, which is that of house servant.

I examined her in April, 1896, and found a tumor resembling a hernia in the right inguinal region. It was hard and unyielding, and did not present the physical signs of intestinal or omental hernia or of hydrocele of the round ligament. It was slightly movable, but

could not be returned into the abdominal cavity. cavity. Upon bi-manual examination the uterus was found to be anteverted, with the cornu inclined to the right side. By grasping the tumor and moving it downwards the uterus was drawn still more towards the inguinal opening. When the uterus was carried over to the left side the tumor was drawn up close in the inguinal canal. When the sound was introduced and these movements repeated the same results were obtained. The ovary on the left side could be distinctly palpated, but none could be felt on the right side. The internal ring as felt through the anterior vaginal wall was sufficiently patulous to admit the tip of the index finger, and the tumor could be felt by it when pushed up against it, but when let go it retracted somewhat forcibly away from the internal ring as if pulled down by some cord-like attachment from below. Examination per rectum confirmed the results already obtained.

The diagnosis of right inguinal ovarian hernia was made and she entered the Good Samaritan Hospital on April 10 for operation. operation. This, however, had to be postponed until the 15th, as her menses came on during the night of the 10th and afforded an opportunity of examining the tumor during the menstrual period. It increased nearly one-third in size, and was very sensitive to the touch, and caused her great pain in walking. On the 15th the examination was repeated, while under the anesthetic previous to operating for its removal. The condition appeared the same as at the first examination except that all the parts were more relaxed and the tumor was more movable. During the above manipulations the tumor slipped back into the abdomen and the operation was not done. A bi-manual examination found both the ovaries within the pelvis.

It was thought that perhaps by wearing a truss the return of the hernia might be prevented. This, however, was not the case, as she returned to the hospital on June 10 with the protrusion even larger than when first seen. On the 11th the sac was cut down upon and opened, the ovary was found in the bot

tom of the sac, and as it appeared to be healthy the incision was extended up to the abdominal cavity. The sac, which was firmly adherent in the inguinal canal, was dissected off close to the inner ring, the ovary was returned into the abdominal cavity, the sac was ligated close to the internal opening, cut off and the whole incision and canal closed up. The round ligament was thoroughly adherent to the sac, and although flattened out was of greater thickness than normal. When examined by Dr. Cone, the pathologist to the hospital, it was pronounced to be in a myomatous condition. It doubtless was a prominent factor, if not in producing, certainly in maintaining the ovary in its abnormal position.

The patient left the hospital two weeks after the operation feeling entirely relieved. On the 17th of January the ligature with which the sac was ligated was removed, it having caused for a short time previously a fistulous opening, fistulous opening, which, however, soon healed up. There has been no pain in the right ovary since. the operation.

From the history of this trouble and a study of these cases the following conclusions seem warrantable:

1. That hernia of the ovary, although not very common, occurs much more frequently than has generally been supposed.

2. That congenital hernia of the ovary is almost invariably associated with and

caused by some arrest of development during intra-uterine life.

3. That congenital hernia of the ovary is always inguinal, often double, but when single generally on the left side, it is caused by abnormal descent of the ovaries analogous to the normal descent of the testicles" constituting anomalies. rather than diseases, and coinciding usually with anomalies of the genital organs, such as embryonic uterus, uterus unicornis, hermaphroditism, etc.

4. That the persistence of Nuck's canal favors its production; also the size and shape of the ovary, which is at first a long flat body, with its apex pointing towards the canal; also the fact that at the birth of the child the ovaries are yet situated above the ileo-pectineal line and descend

during the first few months of the child's life into the true pelvis.

5. That as congenital hernia of the ovary occurs so frequently as a result of arrest of development and borders so closely on pseudo-hermaphroditism, it is important in all cases that the glands, when removed, should be examined microscopically.

6. That the sac in this hernia generally contains the ovary and Fallopian tube. It is irreducible, except soon after birth, on account of the adhesions formed and the early closure of the internal ring.

7. That accidental or acquired hernia may occur at any of the ordinary hernial openings, in which case it frequently follows a pre-existing intestinal or omental hernia. They are almost always unilateral and more frequent on the right side. They are most apt to occur soon after labor, when the abdominal walls are relaxed and the uterus and ovaries are above the above the pelvic brim. Therefore women who suffer from any form of hernia should be carefully watched before, during and after their confinements, so as to prevent and rectify any undue strain. upon the weak point

Parker, R.27 British Medical Journal, 1893, Vol. I, p. 68.

Parsons,28 G. W. Annals of Surgery, Philadelphia, 1895, XXI, pp. 691-698.

Pott, Percival.29 Surgical Works, London, 1783, Vol. III, p. 329; Med. oper. t. I, p. 211, Paris Ann. III.

Puech.30 Des Ovaires, de leurs Anomalies, Paris, 1873.

Puech.31 Nouvelles Recherches sur les hernies de l'ovaire, Annales de Gyn., Paris, 1878, pp. 321-338, and 1879, XI, 402, 430.

Reymond.32 Bulletin de la Société Anatomique de Paris, 1894, 482.

Routier.322 Centralblatt für Gynecol ogie, Vol. XVI, p. 166.

Seymour.33 Medical News, New York, 1897, LXX, p. 241.

Simpson.34 Intra-uterine pathology. Edinburgh Medical and Surgical Journal, Nos. 137 and 140.

Smith Heywood.35 Journal, 1885, II, 870.

British Medical

MEETING HELD APRIL 1, 1898. THE meeting was called to order by the president, Dr. William Greene.

Dr. T. C. Gilchrist gave an “Exhibition of Cases of Diseases of the Skin" (see page 701).

Dr. Cullen: What is the difference between herpes iris and herpes zoster apart from the position of the lesion? Are the histological changes the same? If the changes be due to a primary toxic substance, where does it originally come from, and may it not be that the nerve terminals give rise to this change?

There

Dr. Gilchrist: There is not much likeness between the two diseases. The herpes zoster is supposed to occur in the course of the nerves, and presents groups of vesicles on an inflamed base. is no comparison either histologically. I have examined sections from a number of zoster cases, and the vesicle is always in the middle of the epidermis, while in the iris cases it is beneath the epidermis. Again, in the zoster there are no pigmented nuclei, and the pictures are entirely different. It does not seem possible to me that stimulation of the nerves would kill the nuclei as fast as they appear as is the condition in this case.

Dr. Harlan: You did not say anything about the treatment of prurigo.

Dr. Gilchrist: In mild cases much may be done, but nothing in the severe cases. The treatment consists in attention to the

Dr. W. T. Watson read a paper entitled "Health Department Disinfection" (see page 699).

Dr. C. Hampson Jones, Health Commissioner of Baltimore, said: I suppose it is necessary that I should make some remarks, representing, as I do now, the City Health Department. All fairminded men are only too glad to hear criticisms, whether they be favorable or unfavorable, and I think if all the physi

cians of Baltimore would take the same interest in this matter that Dr. Watson has, not only would the physicians themselves be benefited thereby, but the community in general would be improved by the information thus gained being distributed through the health department. No one is better aware of the infirmities of the department than I. Only lately I have been before the ways and means committee asking for better facilities, and I now await their answer as to what they are going to do. In our department there are two disinfectors, enough to take care of a town of 1,000 inhabitants probably, not many more, and I therefore wish to have more disinfectors, so as to be able to put into practice the work we have already outlined for these men and to have them put a check upon themselves. We wish to do the very thing Dr. Watson has spoken of. Dr. Stokes and I have talked the matter over, and we think of sending out cultures with the disinfector, and after their work is completed they shall return this culture to us. If the germs are not all dead that room shall be disinfected again and repeated until the germs are destroyed.

The preparation of a room takes well on to two hours, and a man working all day, taking twelve hours as the working day, could not possibly, leaving distances out of the question, disinfect more than six rooms a day. Last fall, on Monday mornings particularly, from twenty-four to thirty cases of diphtheria were reported, and, of course, there would be just so many places to be disinfected at or about the same time. With two disinfectors, under the most favorable conditions, this work could not possibly be at

extent be accounted for that some people have had to wait to have their rooms apparently disinfected.

As to the material for disinfection, I think Dr. Watson is quite right; formaldehyde is the proper thing. It has been demonstrated, however, that it disinfects only for the surfaces and apparently has not a deep penetrating power. Surface disinfection, however, is important, and if carried out it will do much to keep down epidemics. The quantity to be

used has been recommended as fifteen grains for fifteen cubic feet of air space. I believe this is not enough, and as Dr. Watson has said, is part of the trouble, but we shall be glad to increase the number of pastiles and the capacity of our apparatus.

As to the question of inspectors, as I was one of those gentlemen a short time ago, I may speak feelingly on the subject. I know there are certain inspectors who do not do their work, and I know they shall do it in the future, and I know also that there are a number of physicians who, instead of helping the department by telling us of these things, permit them to go on without doing the work the department expects of them. am glad Dr. Watson has spoken of the subject, and I should be glad to have the other physicians of the city do the same. If you will tell me at any time that a disinfector or an inspector has not done his work as laid down by the health department for him, and you will stand up and face that gentleman with your charge, I will be only too happy to call him to account, but do not send a complaint unless you are willing to do that. I would be only too glad if you would bring complaints and bring them properly. It is not the work of the private practice of these gentlemen that keeps them from doing their work properly, it is the enormous amount of work to be done. The question has been before me as to whether it is well to appoint physicians as inspectors. The physician that starts out this way is, I believe, above the average intelligence of the ordinary ward worker, and can render better help to the department, and also if we should have a