for appendicitis. Two papers were read on Appendicitis. One by Dr. Miles S. Porter, of Ft. Wayne, Ind., entitled "Appendicitis: Colitis as an Etiological Feature, and the Operation for Removing the Appendix in two Cases Operated on." This brought out two very different points. First, as to whether appendicitis is often caused by colitis, or whether or not the colitis may not continue to exist and be troublesome even after the removal of the appendix. The second part of the paper considered the question of "Whether the Appendix should be removed in all cases operated on." Dr Porter inclined to the opinion that in some cases it was safer and better to not attempt the removal of the appendix at the primary operation, that in a certain proportion of cases there would be a recurrence, and for this reason it might be desirable to seek out and remove the appendix as soon as the suppurative period was passed. This seemed to be the opinion of the majority of those taking part in the discussion, however, there were a few speakers, notably, Drs. John B. Deaver and Joseph Price, of Philadelphia, who were positive in their practice of removing the appendix in every case operated on. Dr. Deaver's paper was on "Appendical Fistula," and the discussion following was almost entirely confined to two points. First, the old and much discussed question as to whether every case of appendicitis should be immediately operated; and secondly, as to whether in every case operated the appendix should be removed. As is well known, Drs. Deaver, Price and Morris and others recognize positively that every case should be operated on immediately after diagnosis is made, and that in every case operated the appendix should be removed. Dr Nicholas Senn, of Chicago, led the opposition to this view, stating that he believed eighty per cent of cases of appendicitis would recover without operation, and that it was very unsafe and wrong to attempt operation in every case, While we recognize Dr. Senn's standing in the profession as one of its leaders, his discussion on this occasion contains several things that savored of personal pique. To illustrate, he said that he was glad that Dr. Deaver was neither a professor or a teacher. The bringing in of such personal matters certainly tended to seriously wound his argument, and he undoubtedly failed to receive the sympathy of the majority of surgeons present. His discussion was severely attacked by a large number of speakers. The position of Dr. Keen on the subject was far more tenable. While he does not agree that every case of appendicitis should be operated, arguing that a less radical ground should be taken in reference to appendicitis as in reference to all other diseases. His objection was based on the reason that it is dangerous to lay down a single rule or line of procedure for the treatment of any disease. That it is far safer to make each disease a law unto itself, and treat it according to the indications presented in the particular case. He said, however, in the vast majority of cases he should undoubtedly act as promptly and energetically as would Deaver, Price or Morris. We are inclined to feel that Dr. Keen's position in the matter is after all the strongest yet expressed. Drs. Price, of Philadelphia, Dawbarn of New York, Minter of Buffalo, Murphy of Chicago, Gray of Jersey City, and several other speakers fully agreed with Dr. Deaver in regard to immediate operation in every case of appendicitis.

The third day was occupied in the morning with the consideration of the subject of hernia. Dr. A. J. Ochsner, of Chicago, presented an interesting paper on the treatment of "Hernia in Children." He called attention to the existence of the opening of the inguinal canal, weaknesses of the abdominal wall and hereditary tendency, as predisposing factors in hernia. He called attention to the fact that in children, that if the hernial sac is kept empty and the abdominal pressure is removed, the majority of cases will be cured spontaneously. To accomplish this, the child has to be put to bed and the foot of the bed elevated. The gastric disturbances are carefully guarded.

Dr. M. M. Johnson, of Hartford, Conn., presented a paper on Ventral Hernia. He stated that nearly ten per cent of all abdominal operations were followed by ventral hernia. Drainage, granulating wounds, stitch abscesses, division of the motor nerves; also vitality of the patient and hereditary diseases were pointed to as the most influential factors in causation.

Dr. H. O. Marcy, of Boston, presented a paper on the Cure of Inguinal Hernia in the Male. This paper was largely a restatement of Dr. Marcy's well-known position on this subject. These papers were all discussed together, the discussion was participated in by Dr. W. B. DeGarmo of New York City, Dr. A. H. Ferguson of Chicago, and W. J. Mayo of Rochester, Minn.

Dr. W. L. Willis, of Los Angeles, Cal., presented a paper on "External drainage of superficial lung cavities, with report of two successful cases." His operation consisted simply in locating the cavity and getting into it externally and draining it as one would drain any other abscess.

Dr. Carl Beck, of New York, distributed a large number of skiagraphs and called attention to surgical errors which had occurred from skiagraphs, and pointed out the ways of avoiding such errors.

Dr. C L. Leonard, of Philadelphia, presented a paper on "The diagnosis of calculus disease of the kidney, ureters and bladder by Roentgen Rays." He reported twenty cases in which the diagnosis of calculus was confirmed by operation of necropsy or passage of the stones. He showed that positive diagnosis could be made by the X-ray if sufficient care was exercised.

Dr. B. B. Davis, of Omaha, Neb., had as his subject," Treatment of Injuries of the Ureter." He reported a case in which the ureter was injured and repaired by what he considered to be a very simple method. The lower end was split up and threaded needles were passed through the walls of the upper end and then through the lower end, and in drawing on the needles the upper end was drawn down and invaginated into the lower.

These papers were discussed by Drs. Kelly of Baltimore, Bevan of Chicago, Bovee of Washington, Goodhue of Dayton, O., Winslow of Baltimore, Beck of New York, MacArthur of Chicago, Summers of Omaha, Neb., and Carpenter of San Francisco.

A paper on "Exstrophy of Bladder, with exhibition of a Case" was presented by Dr. Ap Morgan Vance, of Louisville, Ky., "Surgical Asepsis of Urethra and Bladder" by Dr. Fred. C. Valentine, of New York City, and Treatment of Prostatic Hypertrophy" by Dr. Parker Syms, of New York City. This completed the work of the session for the third day.

In the Section on Obstetrics and Diseases of Women, the most notable papers were read on the morning of the third day on the general subject of cancer. The first was the "Prophylaxis and Diagnosis of Cancer of the Uterus" by Dr. L. S. McMurtrie, of Louisville, Ky. He called attention to "the fact that there was no symptoms in the initial stage of carcinoma, that pain as a rule does not appear until late in the disease, and that the diagnosis must depend on the symptoms, touch, sight and the microscopical examination of bits of tissue cut away or scrapings from the endometrium.

The second paper was on the "Technique of Vaginal Extirpation for Cancer of the Uterus" by Dr. R. B. Hall, of Cincinnati, O. He strongly advocated vaginal hysterectomy. If cauliflower-excrescences are present uses the cautery to remove them, and does not make a radical operation until ten days later. He prefers twisted silk ligatures, and always removes the tubes and ovaries.

The third paper was "Combined Abdominal and Vaginal versus Vaginal Hysterectomy for Carcinoma" by Dr. John B. Deaver, of Philadelphia. He made a strong point in favor of the abdominal route, by saying that it was the only way in which the pelvic glands could be removed. He considered it very important to remove these glands.

The fourth paper was on "Cancer of the Uterus" by Dr. W. H. Humiston, of Cleveland, O. He laid great stress on the importance of early diagnosis.

The fifth and last paper was on "The Treatment of Cancer of the Uterus," and was presented by Dr. W. R. Pryor, of New York City. He, like Drs. Deaver and Humiston, strongly advocated the abdominal route as preferable in these operations. While he conceded that the mortality of the abdominal hysterectomy was little more than by vaginal, he pointed out that recurrences are much more frequent after vaginal than after abdominal operation, for the reason that by the abdominal route the lymphatic glands and upper third of the vagina could be removed.

These papers were discussed by Drs Boldt, of New York, Baldy, Massey, Price and Goelet of Philadelphia, and several others. These papers attracted a large attendance at this part of the session.

Hungry Evil in Epileptics.- (Ch. Fèré, Alienist and Neurologist, January, 1900.)-Faim-valle is a condition occurring in horses, of imperative desire for food followed by immobility if the appetite is not appeased. A similar condition has been observed in the human. Boulimia is desire for a quantity and pica for a certain kind of food, and neither are associated with the anxiety and loss of consciousness which characterize faimvalle. Under the influence of habit, the condition may occur in hysteria, neurasthenia or insanity, but the form most resembling that in horses is seen in epilepsy. It may occur isolated or as an aura, and the author regards it as an epileptic equivalent, and entirely distinct from the greediness frequently observed in epileptics. Two cases are reported.

Formerly Resident Physician Pennsylvania Institution for Feeble-Minded Children; Formerly Assistant Physician Illinois Central Hospital for the Insane; Physician to Oak Lawn Sanitorium and Passavant Memorial Hospital; Neurologist to Our Savior's Hospital; Lecturer

Psycho-Physics, Illinois College.

AND EGBERT W. FELL, B. S..

JACKSONVILLE, ILL.

A Case of Hysteria, with Remarks. (Fotheringham, Canadian Pract. and Rev., April, 1900)-School girl aged 18; present condition developed after what appeared to be an attack of rheumatism. Patient is well nourished, pulse, temperature, digestive system, circulatory system and genitourinary system normal. Breathing typically hysterical, shallow and irregular, costal in type, with occasional inspiratory stertor. Nervous System.1. Intellect. Ideation exalted, disordered; not delusional, but very emotional. Volition unstable and hysterical. 2. Motor Functions. Reflexes exaggerated, ankle clonus well marked. A hysterical rigidity of the limbs was followed by a soft, flaccid condition, and were the seat of odd sensations, being now in a condition of co-ordinated subconscious movement. Hysterical aphonia exists. 3. Sensory Symptoms. Very severe photophobia simulated; hearing very acute. No anesthetic areas and no hyperesthetic, except tenderness over ovaries. Skin reflexes active. Formications were described with much gusto and in great detail. Treatment consisted in Removal from home to private hospital; nervine sedatives, especially hyoscine and the valerianates of iron, quinine and zinc; and plenty of good food. The patient recovered, but was emotional and easily upset.

The Mental Element in the Treatment of Headache.-Zenner (New England Medical Monthly, January, 1900) calls attention to the great influence of the mind in the cure of disease, especially that of nervous origin. He relates two cases of headache supposed to be of uterine origin, in which gynecological operations gave relief for a short time, and which on postmortem examination revealed cerebral tumors. The temporary relief was the result of suggestion and not directly attributable to the operation. He says that the narrowing influence of specialism very frequently leads to a misconception of the cause of headache, each specialist referring the trouble to some organ in his particular line.

The Relation of Eye-Strain to Epilepsy, Insanity and Allied Conditions.-Satter white (Medical Age, April 25, e900) thinks that every institution for the treatment of nervous disorders should have a competent person to examine the eyes of each patient at the time of admission. An excess of expenditure of nervous energy to any one organ is accomplished at the expense of other organs. The eyes are in constant use during the waking hours, and any impairment requiring extra effort to maintain perfect equilibrium will have its evil effect sooner or later. In epilepsy, chorea, etc., every reflex irritation should be removed and nature given a chance to restore lost nerve control. The author cites cases of chorea, epilepsy, insomnia and insanity which were reliexed by removal of ocular defects.

Some Observations on Modern Cerebral Surgery. -Brewer (Med. News, December 23, 1899) says that the results of exploratory cerebral surgery have been unsatisfactory. The first condition treated of is traumatism, with or without fracture. Hemorrhage, contusion, laceration of or pressure on the parts, with abscesses, cysts, areas of chronic meningitis or cerebral softening as secondary results, require prompt surgical interference and measures to prevent sepsis. Four cases are reported, one of which died as a result of sepsis, and another from a depression of the cortex. In cases of recent traumatic epilepsy of the Jacksonian type, or where the general form results, operation is advisable, but in old cases where the habit has become established or cortical degeneration taken place, it is of little use. One case of the latter kind is reported, the fits ceasing for a few weeks, but finally recurring. In a case of recent Jacksonian epilepsy of the left arm and hand, relief followed the removal of the depressed bone. Another case in which general attacks followed the local was relieved by operation. A case of tumor of the cerebellum is reported as follows: Man 26 years old; had constant occipital headache, persistent vomiting, marked dizziness, staggering gait, impairment of vision, and did not improve on treatment. Knee jerk gradually disappeared; slight ataxia of the upper extremities and double optic neuritis developed. Recovery followed the removal of a small tumor from the cerebellum, one and one-fourth inches in, near the middle line. In persisting and progressive trifacial neuralgia complete relief can only be obtained by removal of the gasserian ganglion and the intercranial portions of the trunk. In the operation suggested by Hartley, entrance is effected through the temporal bone just above the zygoma. A case of the author's showed no unpleasant effects, except a numbness of the side of the face.