the back of the uterus, and under the entire left broad ligament. The abscess wall was enucleated, torn from its fastenings, and delivered. It consisted of three distinct abscesses-an abscess the full length of the tube, a dermoid cyst (the contents of which had become infected), and a large handful of hair and dermoid débris—which occupied the space close to the crest of the ileum and well under the broad ligament. All were removed. There was thorough irrigation of the abscess cavity, and which was extended into every nook and corner where pus was likely to have worked its way, everything thoroughly washed out, and glass drainage used for two days. The patient's pulse, temperature, and septic condition rapidly changed, and she made a perfect recovery. It would have been utterly impossible to have said before operation in this case what amount of work would have to be done. It would have been impossiblle to have corrected the lesions of the bowel; to have broken up adhesions, or to have removed the sac of the abscess or pyogenic membrane; to have dealt with the dermoid, or to have treated this case in any way safe to the patient except by abdominal section and drainage from above. By the vaginal route the operation must have proved a failure.

I have used the term methods. It has become a term of rather loud use. The inventive genius of the profession of the period seems to be in the direction of " new methods." If there was less deception about results we would have less confusion and be better able to determine the value of any given surgical procedure, and our patients would be greatly the gainers. While it is digressive, I regard it as an important and profitable question to ask ourselves, Have we advanced any in the last ten years in our relative position to the men who stand to us as pioneers, who gave us our first lessons, our advanced position? If so, in what respect? Have what we have called our own advances, improved ways, lowered our mortality? In pelvic surgery Tait stood first-taught us the best we know. He has had no very close second. His disciples have not greatly improved upon his ways, but it is near home our concern lies. We can profitably inquire, What new truths have we added to the stock of our scientific knowledge-we mean that which is original with ourselves? Along this line how do we stand with our brothers across the seas? We have names we can place by the side of the great names in our science, no matter of

If we

what land or nativity. While we welcome from any and all sources new truths-all those results of research which advance our science we do not want foreigners to do our thinking for us any more than we want them to make our laws for us. In the line of our professional literature we want less foreign importation and better and more home production. Above all, let us be more American; as doctors, think and act with the spirit of Americans. Yet another important inquiry: How much do these associations do for us by way of stimulating in our profession the spirit that is American? How much in the direction of making us our own teachers, investigating and inventing for ourselves? How much to make false the reproach of being foreign-taught? desire to act in the genuine honest American spirit we must admit we have been stealing very much from our foreign brothers and. proclaiming it as peculiarly our own. We have, in a degree, been following a bad foreign example in grabbing and claiming very much that was not our own. We have done our grabbing very much as if it was one of the privileges guaranteed to us by the Declaration of American Independence. In this grabbing game it is very true that we have followed closely the example of our English brothers, who believe that the great English Magna Charta blankets the world. As Americans we need to go forward. In this forward movement each one of us is one of the procession. We can add our enthusiasm, cheer, and strength. Our courage should be strong; we want great masters in our science to grow up among us. Frequently some one of our medical or surgical brothers comes running out of the bushes, crying, "I have found something." It is usually a bug and antitoxin or a new method. There are few more potent factors in the mid-direction of our surgical efforts than the importunities of our subjects for immediate bodily relief or comfort. The idea has, I am sure, much influence with the younger practitioners anxious to please and show their resources. This brings up the important fact that a clear judgment as to methods for the eventual welfare of the patient must be uninfluenced by any consideration of present desire. Of course, we would not bar any harmless comfort, since we aim always at a favorable condition of mind; but there can be no doubt that even a quick sympathy will urge the physician to hesitancy or a rash performance. He must be far above any effects of the patient's talk.

There is little reason in speaking of conservatism in connection with surgery. It is not a business which exhibits such a phase. There are corporations which affect to deal conservatively in stocks, nothing but gilt-edged securities; but when you consider surgery as clinging solely to well-defined treatments and operations, practised only in cases of undoubted precedent and by methods of certain establishment, you suppose a regulation of diseases which would be comfortable. But surely such a condition is not considerable for a moment. True, we report such a number of cases of appendicitis, perforating typhoid ulcer, tubercular ulcers, fixation of pus-tube at the head of cecum, as successfully treated in such manner. Yet we are sure that exactly the same troubles are never encountered in any set of patients whose diseases take the same names. And how do we prosper if we are not radicals? There is radicalism which means sure progress. The physician is foremost, best, and most helpful to us who clubs his way through the sceptics. There is surely enough slowness and dulness abroad to excuse a little radicalism. The valuable aids in our work are bold-not too bold, but it takes a considerable overconfidence to be successful in our difficult operations. Not haste, not sloth, not timidity, but of all things thoroughness.

Talk to men who have searched all things in their line and are completely prepared for work, and such men are duly prepared to be radicals. We note the men who have an intuitional advantage and peculiar power individually. They have it pre-eminently by experience, by work, and are far from conservatism; they do not cling to things to which the mosses and lichens cling; they are not idolaters of fossils. There can be nothing, to my mind, more discouraging than a great series of doubts and speculations attached to various cases treated. They start thought decidedly in hindering directions, and possess undeniably hurtful influences on young practitioners who read carefully much of the work of their elders. There is more hesitation and lack of confidence in the work of the younger men than need be. As to moral hesitation, I will quote, for they have a general application, the words of the greatest general surgeon in America, one pure and splendid in his motive, heroic and successful in his work-Dr. Nicholas Senn: "I am free to confess that I have never been able to muster my courage to attempt to attack the skull of a poor microcephalic child,

because I have always regarded the operation as useless in promoting brain development. The responsibility of the surgeon is not limited to the defective mental development of the child, nor the importunity of the parents in demanding an operation at all hazards. The surgeon should stand guard over such a charge. Mindful of the limits of surgery, have we a right to estimate human happiness? The drivelling idiot has many enjoyments that you and I know nothing about. His responsibilities to God and man are limited, and his existence on earth is a long, happy dream, which only ceases when the soul leaves the imperfect body and returns whence it came, where mental distinction is unknown."

These words, gentlemen, go out to the world, showing there is great conscience in our surgery. They go with the imprint and authority of the name of one who is every day busy. As we age, as our experiences crowd upon us, our science, with all its mysteries, becomes a clearer science; and the more weighty grow our responsibilities, the more enlarged our conceptions of duty, we feel the more keenly the issues we carry in our hands-there is sensitiveness to all breathing about us.

SOME OF THE SEQUELE FOLLOWING SUPRA

VAGINAL HYSTERECTOMY.

BY RUFUS B. HALL, M.D.,

CINCINNATI.

THAT method of operation in abdominal hysterectomy which will yield the best results, both primarily and secondarily, is a problem that has not yet been solved. A few years ago the extraperitoneal treatment of the stump was the almost universal method. The radical change from that method to total extirpation and the supravaginal amputation led the majority of operators to believe the problem was solved. They accepted the methods at once, and believed that nothing more was to be desired. They considered the technique of abdominal hysterectomy completed; there could be nothing further in that direction. With one or the other of these methods all operable cases could be dealt with satisfactorily. Whichever method was chosen, definite and satisfactory results could be safely anticipated.

It seems to me we have been too hasty in giving these methods our unlimited approbation. All the methods so far have some serious defects. I have no new method to offer, but I will give you some of the unpleasant sequela following the supravaginal operation in my work, hoping the discussion may bring out much that is interesting and profitable.

The objections to the extraperitoneal or clamp method are too well known to need comment. Yet in the hands of a few men, notably Price and Bantock, the results are excellent.

I was one of the first to advocate total extirpation, and the first to make the operation in my own State. I attained excellent results with it. It is an ideal surgical procedure in technique and in results up to the sixth or seventh day. Then the trouble begins.