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perturbations which have resisted all other means of cure.” We cannot believe that this operation will ever become a recognised surgical procedure. In the discussion which follows this paper, the general feeling appears adverse to the adoption of this as a recognised and justifiable operation.

Dr. Paul F. Mundé gives an excellent paper on "the value of electrolysis in the treatment of ovarian tumours.” The conclusions he arrives at are as follows: 1, Unquestionably a number of cases of ovarian tumours reported on reliable authority have been completely cured or permanently improved by electrolysis. 2. It is equally unquestionable that in a number of cases the electrolysis was followed by dangerous and even fatal results. 3. Further, six cases out of fifty-one received neither benefit nor injury from the treatment, and four were only temporarily improved. 4. The lack of accurate reports of the anatomical character of the cyst in the cases collected, prevents any definite conclusion as to whether monocysts or polycysts are more or less amenable to electrolysis, or unfavourably affected by it. 5. How the cures were effected is a matter still open to investigation. 6. Notwithstanding these undoubted cures the percentage of successes (55 per cent.) compares unfavourably with that of ovariotomy. Spencer Wells had 78 per cent., and in 1876 as high as 91 per cent. of recoveries. 7. Judging partly from these statistics, and partly from general considerations, it would seem that electrolysis can in no wise supplant ovariotomy, and that to try electrical experiments with patients whose tumours and constitution are in every way prepared for the radical operation, looks very like trifling with their lives.

Notwithstanding these conclusions, based on a most careful analysis of all the cases so far published, we cannot altogether agree with Dr. Mundé, as it must be admitted that the number of cases in which the electrolytic treatment has been practised do not bear comparison with those in which ovariotomy has been followed. Electrolysis in ovarian cysts is yet in the very outset of its career, and we cannot but believe that it has a bright future, and that in the hands of scientific and hɔnest men it will yet be found a powerful means for good.


There is an excellent paper by Dr. Emmet, of New York, on congenital absence and accidental atresia of the vagina. Dr. Giddings reports a case of sarcoma of the kidney in a negro child ; this is illustrated. Dr. Parvin gives a supplementary report of a case of xenomenia, which was published in the first volume of the transactions ; this is accompanied with two heliotypes. Dr. Engelmann writes a paper on the hystero-neurosis, with especial reference to the menstrual hystero-neurosis of the stomach. The volume proper closes with an obituary sketch, by Dr. Lyman, of the late Charles Edward Buckingham ; this is accompanied with an excellent likeness of Dr. Buckingham, who was one of the original fellows of the society. There is also published a number of supplementary papers, presented to the council by the candidates elected to fellowship of the American Gynecological Society at its second annual meeting in 1877. These consist of cases illustrating important points connected with the operation of ovariotomy, by Dr. Kimball, of Lowell, Mass. · The radical treatment of dysmenorhoa and sterility by Dr. Elwood Wilson, of Philadelphia. Dr. Wardale West's views

. of rotation, by Dr. John P. Reynolds, of Boston. Vascular tumours of the female urethra, by Dr. A. Reeves Jackson, of Chicago. The simple varieties of perineal laceration, by Dr. Thaddeus A. Reamy, of Cincinnati. On Lying-in institutions, especially those in New York, by Dr. H. J. Garrigues, of Brooklyn, N.Y. The menstrual cycle, by Dr. John Goodman, of Louisville, and also an appendix to Dr. John Byrne's paper on amputations and excisions of the cervix uteri.

We have thus far, we hope without prolixity, endeavoured to give our readers some conception of the contents of this excellent volume ; it is a credit to the society from which it emanates, and we believe it will be hailed with satisfaction by the profession generally.


Extracts from British and Foreign journals.

Unless otherwise stated the translations are made specially for this Journal.

Lithotomy.--A case of Lithotomy, in which an enlarged middle lobe of the prostate gland was accidentally removed. By CHARLES WILLIAMS, F.R.C.S., Assistant Surgeon to the Norfolk and Norwich Hospital.— The specimen which I have the pleasure to exhibit to you represents an enlarged middle lobe of the prostate gland, accidentally removed from a gentleman on whom I performed the operation of lithotomy.

The patient was a tall thin man, aged 72, living about ten miles from Norwich. He had had symptoms of stone in the bladder for upwards of twelve months. A few months before I visited him, he had passed on one or two occasions, a large quantity of blood in his urine. Of late he had suffered much from the presence of the stone. He had been greatly disturbed during the night and had become low-spirited. His urine was found to be quite healthy and free from albumen. His feet were in no wise oedematous; and he could eat freely. There was a loud systolic bruit heard over an extended area of the chest giving rise to no inconvenience. Five years previously he fractured the neck of the right thigh-bone; ankylosis of the hipjoint resulted from the injury, and he now walks with a perfectly straight and stiff, and shortened, limb.

On July 6th, with the assistance of Messrs. Morton, surgeons, of Aylsham (under whose care the patient had been), I performed the usual lateral operation, and removed a single stone, of an oval flattened shape, weighing five drachms, of uric acid formation. An enlarged middle lobe of the prostate becam engaged between the blades of the lithotomy-forceps, anterior to the hinge, and was unconsciously torn off and came away with the stone. There was free arterial hæmorrhage from a deeply seated vessel, which was without much difficulty seen and secured by ligature. A tube was placed in the wound.

On visiting the patient next day I found him easy and comfortable. There had been no sickness; he had slept fairly well ;

pulse 61. The wound looked well; the urine was clear, and dropping freely from the tube and abundant in quantity. On the ninth day, he passed the whole of his urine through the penis, and the wound was healing rapidly. Three weeks later, I found him in excellent health, and the wound perfectly healed. He seldom found it necessary to micturate more than once during the night.

REMARKS.— This case presents some points of much interest.

1. The presence of a loud systolic bruit is not a pleasant sign in connection with the administration of chloroform, of which my patient inhaled from four to five drachms, and from which he suffered not the slightest inconvenience, either during the operation or subsequently.

2. The fracture of the neck of the right os femoris had resulted in ankylosis of the joint. The limb was immovably fixed in the straight position ; therefore it could not be tied up in ordinary lithotomy fashion, but was held by an assistant in a straight direction over my left shoulder. This rendered the performance of the operation somewhat less easy than usual. The parts forming the perinæum were lax instead of being tense, and in order not to wound the rectum, which was large and flaccid, I passed my left forefinger into the bowel, and retained it until the point of the knife was lodged in the groove of the staff; and, by directing the edge of the knife very obliquely outwards, the rectum escaped injury—an event which, in all probability, would have occurred had not these precautions been adopted. If such an accident had happened, taking into account the age of the patient, I fear the termination of the case would have been unfavorable.

3. The removal of a large portion of the middle lobe of the prostate, though quite accidental, was attendant with a happy result. The man was relieved of a trouble which, sooner or later, would have been a source of grievous annoyance to him.

I witnessed the same accident in a case operated on by Mr. Cadge. In the forceps, between the stone and the blades, there came away three masses, which were apparently fibrous outgrowths of the prostate, and which weighed one drachm two scruples. In two months the wound had healed, and the patient was strong and well. Mr. Cadge remarks : “ It has happened to me twice before to remove small fibrous tumours of the prostate gland during the operation of lithotomy, and apparently without harm to the patient.” (Transactions of the London Pathological Society, vol. xiii, 1862.) And he gives the experience of an expert modern lithotomist on this subject, who says: “ It has occurred to me, eight or ten times, to bring away portions of the prostate and without noticeable injury to the patient. In more than one instance, it was the prominent front lobe that got between the handles, anterior to the hinge, and was torn off entire ; and although I have never known unpleasant results to the patient, and that sometimes he has been benefited in afterlife, by having got rid of an useless impediment to a natural function, I would not willingly that such an occurrence should happen, and I try to avoid it by turning the blade of the forceps to the lower angle of the wound as I leave the bladder; but when it does occur, I lay no account by it.”British Med. Journal.

Congenital Absence of One Kidney.In the current number of Virchow's Archiv, Dr. Beumer has collected from various sources forty-eight cases of this interesting malformation. In forty-four cases it was entirely absent, and in the other four rudimentary. It was as often absent on one side as on the other. It was of more frequent occurrence in the male than the female. In most cases in which the kidney was absent the supra-renal body was present; in two cases it was enlarged, in five cases it was absent. In thirteen cases an arrest of development of the sexual organs was observed.

The remaining kidney was in all cases enlarged and increased in size and weight, and a corresponding development of the vessels and ureter.

This is a fresh and striking proof of the completeness with which the one kidney can carry on the functions of two without suffering degeneration in consequence of the increased work.Medical Journal, N. Y.


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