he got inside. No one has had more experience in such cases than Dr. Richardson. Dr. Carmalt mentioned a case which had been in the hospital for six months, and which a hospital staff of seven men agreed upon as an extra-uterine fetation. An abdominal section revealed the fetus where it ought to be. The mistake was due to an absolutely characteristic and typical history. Physical error was due to abdominal contraction, which is not overcome until ether is administered, and ether is not generally given until the abdominal section is made. This woman, the one spoken of, had well-marked firoid tumor with pedicle. This tumor was removed. The error of diagnosis was due, as has been said, to contraction of the abdominal wall, which deceived such a number of men. It is just as well to feel a little modest regarding our statements of diagnosis. An absolute diagnosis can sometimes be made only by abdominal section and in such cases an exploratory operation is justifiable. We may be justified in making an abdominal section for diagnostic purposes. Dr. Harris in answer said that the diagnosis of fractures of the seaphoid was given by Dr. Stimson and that it was a medico-legal case. It had been treated for a Colles's fracture. The skiagraph showed that it was really a fracture of the seaphoid. Extra-uterine pregnancies, said Dr. Harris, have been epidemic in Norwich. Dr. Tingley called him in consultation to see a case of a woman with a tumor. There was a question as to whether this was a fibroid or an extra-uterine pregnancy. An operation was performed and a tubal pregnancy found, the fetus having been dead a year, but still in good preservation. The tube was removed close to the uterus. The patient made a good recovery. Another one was a colored girl with a supposed fibroid. Both a fibroid tumor and an extra-uterine pregnancy were found. The fibroid and the sac were removed, but the patient died. Dr. Tingley showed the pathological specimen of the first case cited. It was marked as follows: Fetus, Placenta and Sac of Extra-Uterine Gestation, Removed from the Abdomen of Mrs. Z-, May 18, 1898 by Dr. Tingley. Sac, with contents, had remained in the abdominal cavity over one year after the completion of the gestation period, at which time she had labor pains and a physician was called to deliver the child. Weight of fetus four and three-quarter pounds. Dr. Wiggin said that he had been much interested in the report. He was interested most in the allusion to anesthetics. He had been trying the new anesthetic, petroleum ether; had used it in the City Hospital in New York. He had had one or two cases of heart-failure, and had given it up. He saw no advantage over the old manner, with a closed inhaler. He used a modified Clover. There was no excitement and no greater quantity of ether. He afterwards got Dr. Squibb to make an examination and it was found that what he had been using was an equivalent of alcohol, chloroform and ether mixture, and was not petroleum ether. He had used nitrous oxide and ether, and finally ether after Bennett's method. In abdominal work one of the greatest sources of danger was the mal-administration of ether. For the last six or seven years he had found the closed inhaler satisfactory. The patient seldom vomited and was able to take food a few hours after the operation. Four ounces of ether were sufficient for an hour's work, and six ounces for two. The length of time of the operation was of less consequence than a limited amount of ether. If six ounces were used in two hours it was better than if ten or twelve ounces had been used in an hour. Dr. Hawkes had not had much experience with the actual cautery in hypertrophy of the prostate, but had used electrolysis in the urethra, carrying one electrode up to the prostate, beyond the sphincter, placing the other in the anus, opposite the sacrum. In cases where the urethra was sensitive one electrode was carried up to the prostate in the anus, while the other was placed above the symphisis. The treatment was modified according to the excitability of the urethra. It was not followed by scar tissue. He would not be willing to give up electrolysis in such work. Dr. Gouley is much interested in the discussion about the prostate. Much is heard about therapeusis which is not based on sound pathology. Methods were being suggested for treatment of enlarged prostate as if it were one fixed morbific quantity, whereas it may be the result of several different morbid conditions. He has traced thirteen varieties of enlargement of the prostate. Can any one method of treatment apply for all? The rational method of treatment is to find the morbid condition. Nasciet, to whom we owe our first studies in prostate disease, based his methods of treatment on the form of the disease. His success was good. In certain cases, where there was little enlargement and a small obstruction at the base of the bladder, an incision was made. Where there was an enlarged third lobe, this was excised. Some of his followers were unsuccessful. Some of them operated on a disease too far advanced and death was due to pyonephritis. Among later operators, Battini used the galvano-cautery fifteen years ago. He still pursues the same method for diseased prostate. He claims more than I think he has done. I condemn it as bad practice. Electrolysis destroys the prostate. What occurs after, I do not know; I have had no experience. I do not feel disposed to employ it. In that form described by Mercier, with dilatation of the acini, the more common form, the promising operation is enucleation of the prostate. This has been done in London-complete enucleation of both lateral and the third lobes. Much will come of it. If enucleation is done early in the disease there will be fair results, so far as urination is concerned. The object is to make continuous urination possible. This is coming rapidly. Dr. Alexander has had excellent results. In orchodectomy, how was that going to cure cystitis? Dilated acini, so large that they can be seen with the naked eye, how could orchodectomy cure such a condition? I fail to see. I do not wish to condemn it, but it does not seem rational. The mortality from orchodectomy is greater than that from excision of the prostate. With the Mercier operation of enucleation bi-manual manipulation above the pubes, and in the perineum, while enudeation is being done, there is little hemorrhage, and the recoveries are great. The best results are given by Alexander, but the totality from orchodectomy is greater than from prostatectomy. A COMPLICATED CASE OF INTUSSUSCEPTION. MELANCTHON STORRS, M.D., HARTFORD. We will first give the outlines of the case as taken from the records of the Hartford Hospital: "John Curran, admitted September twenty-fourth, 1886, aged twenty-one. Buffer by trade. Family and personal history negative. Has had obstruction of the bowels since the eighteenth, six days ago. At that time he had diffuse pain over the right side, with tenderness over the appendix; since that time there has been no marked pain or soreness on pressure. Attempts were made to move the bowels by cathartics and enemata, but without success. Vomiting commenced on the afternoon. of the twenty-first and became fecal on the following day. On admission the abdomen was somewhat tympanitic on the left side, dull on the right. Palpation negative on account of tension of the abdomen. Pulse and temperature normal, and general condition fair, but countenance anxious. Etherized and abdomen opened by incision over the appendix. Caecum slightly congested; appendix thickened, containing a fecal concretion, which was removed. The distended coils of small intestines were dragged out and the cause of the stoppage found an intussusception of the ileum of about eight inches in length. The gut for several feet above this was dark, much distended, and paralyzed. The invagination was reduced without injury to the peritoneum and at the apex was found a diverticulum the full size of the intestine, and four inches in length. This itself was invaginated into the gut and had apparently started the trouble. The diverticulum was ligated and removed, |