MASSACHUSETTS SURGICAL AND GYNÆCOLOGICAL

SOCIETY.

The twenty-first semi-annual meeting of the Massachusetts Surgical and Gynecological Society was held at the Hotel Nottingham, Boston, on Wednesday, June 14, at three o'clock. The president, J. P. Rand, M.D., presided. The records of the last meeting were read and approved. Dr. H. E. Rice, of Springfield, Mass., was proposed for membership.

The following physicians were elected to membership: W. Morrill Colby, F. P. Batchelder, George L. Van Deursen, and David W. Wells.

The committee appointed at the last meeting to draw up changes in the constitution and by-laws reported through its chairman, Horace Packard, M.D., who spoke of the advisability of the alterations recommended by the committee, and read several letters from physicians outside the State who approved of the changes, also one or two offering objections. A motion was then made that the report of the committee be accepted and the changes adopted as a whole. Eleven voted in the affirmative and nine in the negative. As a two thirds vote is necessary to alter the constitution or bylaws, the motion was lost. The whole matter of change in the constitution and by-laws was referred back to the same committee, with instructions to report at the next meeting.

Dr. Alonzo Boothby was elected delegate to the American Institute of Homoeopathy to represent this society.

It was announced that during the past year the society had lost three of its members by death, and the society elected the following obituary committees: Drs. Jane K. Culver, Mary L. Swain, Sarah A. Jenness, to prepare an obituary of Laura M. Porter, M.D.; Drs. Alonzo Boothby, A. Howard Powers, and T. M. Strong, one of Henry A. Houghton, M.D. ; and Drs. C. H. Leland, N. H. Houghton, and J. K. Warren, of H. M. Hunter, M.D.

Scientific Session.

1. Surgical Diseases of the Faucial Tonsils. T. M. Strong, M.D., of Boston. Discussion by G. B. Rice, M.D., and N. H. Houghton, M.D.

Nathaniel W.

2. A Complicated Case of Fibroma Uteri. Emerson, M.D., of Boston. Discussion by Alonzo Boothby, M.D., and J. W. Hayward, M.D.

3. Hemorrhage. A. Howard Powers, M.D., of Boston. Discussion by F. P. Batchelder, M.D., and Carl Crisand, M.D. 4. Surgical Peritonitis. Sidney F. Wilcox, M.D., of New York. Discussion by Horace Packard, M.D., and H. A. Whitmarsh, M.D.

5. Professional Etiquette and Medical Courtesy. Chas. Sturtevant, M.D., Hyde Park. Discussion by E. P. Colby, M.D., and J. K. Warren, M.D.

Dr. Boothby opened the discussion of Dr. Emerson's paper. He remarked that the paper had to deal with an exceptionally severe case of fibroid tumor with a most fortunate outcome. He considers it not an uncommon thing for ovarian tumors to become inflamed, and spoke of the impossibility of telling the exact state of affairs within the abdominal cavity until after the incision is made. The fact that a fibroid tumor grew after removal of one or both ovaries is, in his experience, nothing unusual. He cited a case where he had removed both ovaries and tubes, with the hope that a fibroid would disappear. It did retard the progress for a time, but later the tumor grew rapidly, and another operation was performed. In this, he, like Dr. Emerson, wounded the bladder, but with. out serious results. A fistula persisted for a time, but finally healed. In his experience, the ovaries and tubes are usually much enlarged in cases of fibroid tumors, and are, in his opinion, a cause for the pain which patients with fibroids. usually suffer.

Dr. J. W. Hayward, in the discussion of Dr. Emerson's paper, spoke of the peculiarity of the different colors and densities of the fluid found in the case of Dr. Emerson's, and said he had never observed it in his practice in a unilocular cyst. He spoke of peritonitis as a frequent complication in fibroid tumors, which often resulted in much pain and danger to life. He recommended the early removal of fibroid tumors, while they were easily operable and before they take on malignancy.

Dr. Horace Packard, in the discussion of Dr. Wilcox's paper, spoke of the cause of peritonitis as always the result of the invasion of the peritoneum with septic microbes, frequently from contamination with septic material from the surgeon's or assistants' hands, sutures, or sponges. He spoke of the great infrequency of septic peritonitis nowadays in the practice of experienced operators. The loss of intestinal peristalsis from septic peritonitis is always an exceedingly unfavorable symptom. All means employed to move the bowels have proved ineffectual. Every one feels helpless in the treatment of cases of septic peritonitis. Prophylaxis is the essential feature. The condition can be prevented, if it cannot be cured. Drainage of the abdominal cavity should be instituted only in such cases where there is excessive oozing. In the treatment of septic peritonitis little good results from the use of cathartics as given by the old school. Cold applications to the abdomen and rectal enemata are both of advantage.

Dr. H. A. Whitmarsh said that all of us who do abdominal surgery have had cases of septic peritonitis. He prefers the use of hot application rather than cold. He considers all cases of acute septic peritonitis as really inflammatory in character, but too profoundly septic in character for nature to rally the leucocytes in sufficient numbers to prevent dissolution. He spoke of the advisability of covering all exposed intra-abdominal surfaces with peritoneum if possible, as this tissue is much better adapted to combat septic infection than connective and cellular tissue.

Dr. Batchelder spoke of the excellent results obtained immediately by flushing the peritoneal cavity with hot saline solution. He has repeatedly observed an improvement in the patient's pulse within sixty seconds after its introduction. In cases of sepsis he considers a thorough washing of the abdominal cavity very essential.

Dr. Powers considers the use of either hot or cold applications beneficial in inflammatory processes, inasmuch as they both produce a lessening of the blood current. He claims plain sterile water is absorbed more quickly by the peritoneum than the normal saline solution.

Upon motion of Dr. Warren, a vote of thanks was tendered Dr. Wilcox for his valuable and interesting paper.

Dr. Strong's paper was discussed by Dr. Rice, whose remarks were in writing.

Dr. H. C. Clapp reported a fatal case of septic endocarditis following a tonsillar abscess.

Drs. Worcester and Bellows also participated in the discussion.

Dr. Batchelder opened the discussion of Dr. Powers' paper, and spoke upon the advisability of securing all important vessels by clamp or ligature before cutting them. He had observed greater irregularity of the veins of the upper extremities than of the arteries, especially of the median basilic which is so frequently opened for the intravenous saline solution. In treating hemorrhage it is important that we bear in mind that we have in many cases to deal with diseased vessels rather than healthy ones, and the treatment must be modified to meet the pathological condition there existing.

Dr. Crisand spoke against the use of the tampon and of the subsulphate of iron and similar hæmostatics. He uses in his practice antipyrine or peroxide of hydrogen.

Dr. F. W. Elliott advised solution of acetic acid for intrauterine hemorrhage.

Dr. Southwick reported a severe case of hemorrhage following curettement, which was stopped by painting the endometrium with a solution of equal parts of carbolic acid and iodine. Dr. Briggs reported three cases of severe and persistent hemorrhage which were directly attributable to the hemorrhagic diathesis.

Dr. Colby discussed Dr. Sturtevant's paper on "Medical Etiquette."

It is important for physicians to realize that they belong to a liberal profession, not to a trade. It is therefore in our dealings with each other a matter of conscience; as the physician has an active conscience, so will he act by ethical laws. The whole subject of medical ethics can readily be reduced to that simple rule, "Whatsoever ye would that men should do unto you, do ye even so unto them."

Dr. Warren said that, with few exceptions, his experience with his fellow physicians had been pleasant, but spoke of the advisability of considering this subject frequently.

The society adjourned its scientific session at 7.45 o'clock, after which dinner was served. The day being excessively hot, the attendance was not as large as usual.

J. EMMONS BRIGGS,

Secretary.

BOSTON UNIVERSITY SCHOOL OF MEDICINE.

GRADUATION EXERCISES AND CLASS DAY.

Boston University School of Medicine, at the close of its present scholastic year, instituted a new and pleasant observance; or, to speak more accurately, revived, with modifications, a custom once in approved use. On Monday, June 5, the school celebrated a Class Day.

It was formerly the custom for the school to hold its Commencement exercises apart from those of the University at large, the occasion combining the features of a Commencement and a Class Day. This custom was abandoned, when the degrees of the Medical School were conferred simultaneously with those of all other departments of the University at a general Commencement, which custom still obtains. With the growth of esprit de corps among the students of the Medical School - which growth has been watched by its friends with the keenest satisfaction - came the suggestion of certain exercises, at least, which should belong to that school alone, on the occasion of its bidding farewell to the men and women who carry forth its won degree. This suggestion embodied itself, on the date referred to, in a Class Day, which proved so welcome an innovation that its becoming an established institution seems assured.

On the afternoon of June 5, the laboratories of the school were thrown open to the friends of students, and the methods and results of certain branches of the school work were exhibited and explained by instructors in attendance. Many friends availed themselves of the opportunity thus