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SPECIMENS REMOVED BY ABDOMINAL SECTION

from six patients at the German Hospital within the last week, all representing inflammatory diseases of the uterine appendages. Two cases of chronic interstitial salpyngitis of both sides, the tubes not forming pus sacs, but they were contorted and presented hard infiltrated masses; pus was present in lumen of tubes at time of operation; the ovaries were also more or less degenerated. Three cases of double salpyngitis with large abscesses of each ovary; the tube-walls were unfiltrated, lumen distended and containing pus; the ovaries were transformed into large sacs filled with thick pus at time of operation; on examination for bacteria, there was a negative result, cultures were not made; one of the other ovaries had changed into a multi-locular kystoma. One case of salpyngitis, a single tube, the walls of which were indurated by hyperplastic connective tissues, removed incidentally with fibroma uteri.

The patients gave the usual history, their sufferings had lasted in some instances for years, and different modes of treatment had been tried. Upon opening the abdomen the usual picture presented itself. All organs in pelvic cavity matted together and forming one coherent mass. The removal of the appendages was done in a typical way, severing the intestine first, working from the abdominal end of the tubes toward the uterus and ligating. Drainage was resorted to in one case, where much pus bad escaped from the ruptured ovarian abscess. Examination showed sensitive masses in the pelvis more or less large, fluctuating where abscesses were present. The uteri in some instances immovably retroplaced; moderate fever (evenings) in all the pus

cases.

The doctor considered it important: 1. To make the incision sufficiently long to have a good view of every step of the operation. 2. Trendelenburg posture for the same reason. 3. Painstaking work, careful control of hemorrhage, no matter what time be consumed during operation. 4. Gauze, drainage only in emergency cases, no flushing.

The immediate results of the operations are good, all the six patients recovered. Another question is, how about ultimate results? The great majority get perfectly well, but in some women the good result is marred by an exudation around the stump. These exudations seem but natural, considering the torn, wounded aspect of the pelvic cavity after operations of this kind, but they will usually finally disappear and rarely

necessitate further incision and drainage (extirpation of the uterus). Other sequelæ are abdomino-pelvic fistulæ, which may persist for a long time, discharging ligatures until the last has escaped, when the fistula will close up quickly, ventral hernia. These and fistulæ are seen only when the wounds are drained. In view of the fact, that articles are constantly written, urging conservative, non-operative treatment in inflammatory disease of the uterine appendages, we must ask ourselves is this operation justifiable? No doubt can be had as regards the clear abscess cases, but how about interstitial salpyngitis?

Dr. Kreutzmann gave it as his opinion, that we should operate in these cases, if under judicious treatment the palpable tuboovarian masses do not disappear. Restitutio ad integrum will not take place, sterility is present without exception, the appendages are useless for the patients, and are only a source of continuous suffering. Operations for removal of inflamed organs are done daily by surgeons, joints are excised, testicles removed, eyeballs extirpated, not to speak of the appendices which are operated on. Yet the decision whether or not to operate will be difficult sometimes, many circumstances have to be considered, even the social standing of the patient. As far as the modus operandi is concerned, removal of the uterine appendages per laparotomiam seems the natural procedure, incision and drainage of abscesses through vagina or above pubes may be necessary for the time being, to restore the patient's vital forces for a radical operation. Extirpation of the uterus will be called for only in extreme cases.

Dr. Kuhlman urged the making of the incision from the ensiform cartilage to pubes. He said we are not justified in operating in all cases of gonorrheal origin. The tendency now is to operate too soon and too often.

Dr. W. F. Cheney said that the pathology has become very important on account of the ascertainable cause.

Dr. Kreutzmann's clinical experience showed that the majority of cases are due to gonococci and that is the generally accepted theory at present. From pure culture experiments it seems that apparently dead gonococci have spores remaining that will produce pure gonococci capable of producing inflammation, infection, etc. There are some disadvantages of the Trendelenberg position, but they are overbalanced by the advantages of it. He believed in as small an incision as possible, but it may afterward need to be enlarged. In puerperal peri

tonitis and in puerperal metritis it is sometimes better to operate in the acute stage than to wait.

Dr. G. W. Davis thought the gonococcus is too often named as the cause of the pelvic troubles. It appears that infection may extend from the endometrium (or an endometritis) following confinement, abortion, etc. Make as small an incision as possible. He thought drainage used probably more often than necessary. As to operation in acute cases he thought it must be left to the judgment of the surgeon in each individual case. Generally he believed in waiting till the acute stage has passed.

Dr. Kreutzmann, in closing, said he must emphasize that gonorrhoea is the principal cause. It is a question now about syphilis as a cause of some of these pelvic diseases. He believed in operating during fever; fever is an indication for operation. In his observation almost every second woman examined at the Polyclinic has some disease of the ovaries and tubes. It is not necessary to operate in all such cases. Make incision as long as necessary, it makes no difference in process of recovery.

The next business was the election of officers. Drs. Kuhlman and Cheney were appointed tellers. The following officers were elected: President, C. C. Wadsworth; First Vice-President, C. G. Kuhlman; Second Vice-President, F. B. Carpenter; Recording Secretary, A. P. Woodward; Assistant Secretary, L. M. F. Wanzer; Corresponding Secretary, L. M. F. Wanzer; Treasurer, W. S. Whitwell; Librarian and Curator, D. W. Montgomery. Trustees-Henry Gibbons, W. F. McNutt, Jas. Simpson. Committee on Medical Ethics-J. Simon, F. Z. Bazan, J. H. Barbat, G. W. Davis, J. G. Whitney.

Committee on Admissions-H. H. Hart, G. F. Shiels, J. M. Williamson, T. B. DeWitt and E. R. C. Sargent.

Committee on Finance-H. M. Sherman, Kate I. Howard, C. E. Farnum.

Committee on Library and Publication-D. W. Montgomery, G. W. Fuller, W. B. Lewitt.

Executive Committee-W. F. Cheney, C. G. Kenyon, S. S. Herrick.

President W. W. Kerr retired from the chair after installing and introducing his successor, Dr. C. C. Wadsworth, who made no extended address, but said that he hoped to work for the best interests of the Society to the end, that at the close of his term the Society would show an advance in every way. No further business, the Society adjourned.

A. P. WOODWARD, M. D., Rec. Sec'y.

Licentiates of the California State Board of Examiners.

At a meeting of the Board of Examiners of the Medical Society of the State of California held Dec. 13th, 1894, the following were granted certificates to practice in this State:

ADAMS, CHARLES ELI, Santa Clara; Dartmouth Med. Coll., N. H., Nov. 21, 1893.

BECKINGSALE, D. L., Covina; University of Edinburgh, Scotland, Aug. 1, 1872.

CARTWRIGHT, CHAS. O., San Francisco; Med. Dept. Univ. Michigan, June 27, 1889.

FLYNN, ANNA M., San Jose; Med. Dept. Univ. Michigan, June 30, 1892. FREEMAN, RICHARD T., San Francisco; Royal College Surg., England, Jan. 27, 1864.

GERLACH, FREDERICK C., San Jose; Med. Dept. Univ. Penn., June 7, 1894. GORDON, HOWARD S., Pomona; Kansas City Coll. Phys. and Surg., Mo., March 4, 1878.

KOBAYASHI, SHINOBU, San Francisco; Niigata Med. Coll., Japan, July 20, 1887.

LAYNE, E. R., San Francisco; Med. Dept. Arkansas Industrial Univ., Ark., March 1, 1888.

MEZGER, L. K., Los Angeles; Med. Dept. Univ. Michigan, June 26, 1889; Rush Med. Coll., Ill., March 31, 1891.

MYGATT, ALBERT S., Otay; Albany Med. Coll., N. Y., Dec. 26, 1871. PILKINGTON, JOHN B., Los Angeles; Cooper Med. Coll., Cal., Nov. 4, 1882. SCOTT, MARY, Los Angeles; Woman's Med. Coll., Pa., May 5, 1892.

WALLIS, NATHANIEL, Sidney, Australia; Med. Dept. Univ. Vermont, Aug. 17, 1894.

WEBSTER, FRED. F., Sunol; Med. Dept. Univ. Buffalo, N. Y., Feb. 23, 1875. WHITEHOUSE, L. H., Oakland; Dartmouth Med. Coll., N. H., Oct. 31, 1866. YEARGAIN, ORVILLE W., San Jose; Med. Dept. Willamette Univ., Or., April 6, 1891.

BOOTH, JOHN RICHARD, San Diego; Med. Dept. Univ. Cal., Nov. 20, 1894. BUNNELL, EDWIN, San Francisco;

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