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tinued to complete recovery. It was interesting to note the action of the left kidney, ranging from eighteen to sixty ounces of urine in twenty-four hours, and always normal.

Report of specimen examined by Dr. Blumer, of the Bender Laboratory: Tubercular kidney. Specimen presented with photographs. Patient has gained nearly fifteen pounds in weight, looks well, and said he was in full strength, August 1, 1897.

CASE II. Strangulated right inguinal hernia, several days' duration; resection of about eight inches of lower end of ileum; anastomosis with Murphy button; latter passed seventeenth day; recovery.Mrs. P. C. H., aged thirty-nine years, mother of one child; family history excellent; patient always well; had scarlatina at twenty; good recovery.

Seven years ago she had severe abdominal pains, followed by syncope. Two years ago in January her daughter had typhoid fever, and patient had a great deal of running up and down stairs to do, being on her feet a great deal. She then noticed for the first time a small bunch in the right iliac region, near groin, and began to have severe pains in her abdomen. These pains began to come more frequently and very suddenly. She used hot-water bags, brandy and hot water, peppermint and mustard plasters, and the pain would gradually disappear. Since then, at times, she has had spells of colicky pains, which would shoot up to her shoulders, etc. Sometimes she would have weak spells, having to stop work and sit down to rest. A year and a half ago she had a severe case of jaundice. Since then the pains had been more frequent and more severe. They usually lasted twenty-four hours. In May, 1897, one attack lasted thirty-six hours.

On Tuesday, June 8, 1897, at 2 P.M., pain began in epigastric region and spread over the whole abdomen. At 5 P.M. the bunch began to increase in size and ache. Pains continued until 2.30 A.M., when she vomited much fluid, then almost entirely ceased. On Wednesday, June 9th, at about 9 A. M., she began to vomit, first what she had eaten, then a bitter, greenish fluid, then mostly pale, and occasionally greenish. This condition lasted from Thursday until Sunday at 2.30 P.M., when she vomited nearly a wash-basinful of yellow-colored fluid. In fact, she had not retained anything for four days, and now called the attention of her physician, Dr. Jones, to the bunch in her side. He, after examining it, sent for Dr. Mac

donald; the latter made a diagnosis of strangulated hernia, and advised her immediate removal to the Albany Hospital. In the mean time Dr. Macdonald had met with an accident, and I was called to operate at 8 P.M. On examination, I found patient much emaciated (recent), eyes sunken, expression of her face very anxious; pulse feeble, 120; temperature, 100.2°; nearly in a condition of collapse. There was present a right inguinal hernia, size of a goose-egg; skin discolored; tumor non-elastic, yet parts very sensitive to the touch. Abdomen much distended from gas, evidently free in the peritoneal sac. Fairly good preparation by nurse. Ether. Incision. On exposure, sac-coil, small intestines, muscular tissue and fascia all were found in a condition of profound gangrene. My first thought was in line with my early teaching and professional work: "Let the patient alone and trust to artificial anus." Not so, however. I cleaned up the external parts as well as I could, found the coil of intestine was very near the ileo-cecal valve, and there being, evidently, some old adhesions of the cecum, I had difficulty in introducing the button in distal end of the ileum. However, the operation was quickly over. Cleaned out the cavity of pelvis of lymph and some yellow serum, packed with iodoform gauze, introduced three interrupted silkworm sutures, to be tied later. Dressed the wound, and the patient was placed in bed. Transfusion, rectal injections of whiskey, and hypodermics of strychnine, digitalis, etc., and at the end of thirtysix hours our patient began to show improvement. Vomiting ceased, urine in fair quantity. No increase of distention of abdoGauze removed at the end of forty-eight hours; rubber drainage-tube then introduced and wound washed with boric-acid solution. In consequence of very offensive odor from the wound, a hot bichloride pack was applied to it, and over abdomen (1 to 8000).

men.

Patient had a movement from lower bowel on third day, and loose movements after the fifth day. She passed the button on the seventeenth day, and in time made a good recovery.

BY JOSEPH PRICE, M.D.,

PHILADELPHIA.

SPECIMENS.

Mr. President: I am satisfied we cannot spend a half day more profitably in our meetings than in returning to our specimens. Many of them illustrate the trials and triumphs of pelvic and intraperitoneal surgery. In this particular meeting the collection is that of summer work.

Malgaigne says, in his statistics of Paris hospitals, that surgical cases do best in midsummer. This has been my experience for some years. I prefer an open, clean house to work in-blankets and footwarmers are scarcely ever required-an open, clean house, plenty of light and fresh air, a clean bed in a clean, bright room, and then good clean work by operator and nurse give better results than at other seasons of the year.

One feature of the work I object to is the doing over the unfinished work of others in a class of patients that feel that something more must be done for their safety and cure. Again, another class is urged to wait until the operator returns from his summer vacation, and the attendant and patient in this class decide that the wait will be too long.

This group of specimens, Mr. President, illustrates beautifully the mixed nature of pelvic disease.

The malignant degenerations of both hard and cystic growths in one of the large specimens, show malignancy of ovaries and also in cavity of uterus. They also demonstrate beautifully the distinctive invasion or disorganization of surrounding viscera. I have here specimens of tubal and ovarian suppuration treated first by douches and applications, second by vaginal puncture and drainage-the last method always results in the most serious complications to a perfected operation, that of chronic sepsis and strong vaginal scars. The enucleation of such an anchorage prolongs an operation, increases hemorrhage and shock, and fouls a pelvis by dirty points hard to clean.

The present confusion in pelvic surgery is more harmful to good and legitimate surgery than the electrical craze. It is very interesting now to read reports of work from members of the old elec

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