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MINUTES OF THE SECTION

ON

SURGERY AND ANATOMY,

MAY 4, 1875. THE Section was organized by electing, on motion of Dr. L. A. SAYRE, of New York, Dr. Paul F. Eve, of Tennessee, as Chairman pro tem., and Dr. S. N. Benbam, of Pennsylvania, Secretary pro tem.

The first paper presented and read was by Dr. E. ANDREWS, of Illinois. Title, Some Results of Operative Surgery.

Dr. L. A. SAYRE, of New York, said: I am very happy to see, in the paper just read by Dr. ANDREWS, that he has by accurate observations taken an opportunity to rectify the mistaken ideas of many persons throughout the country in respect to the infectious condi. tion of our large hospitals, and to correct the prevailing impression that on account of this poisonous condition these hospitals should be destroyed and new ones erected in their place.

The observations of Dr. Andrews prove that we have it in our power to correct this infectious state without any necessity of tearing down the hospitals themselves. All that is requisite 10 accomplish this object is to force the chemical antidote by ineans of pressure into the same pores through which the poisonous gases passed, and thus neutralize their evil influence. Having effected this, silicate the walls and ceilings, and you make the old hospitals as pure and free from pyæmia as if they were new.

On motion the paper was referred to the Committee of Publication.

The second paper was presented by Dr. LEWIS A. SAYRE, of New York. Title

, Partial Paralysis and want of Co-ordination, from Genital Irritation. Dr.

I wish to inquire of Dr. Sayre what difference there is between the symptoms he has just related as occurring in cases of paralysis due to phimosis, and the symptoms presenting in infantile paralysis ?

Dr. SAYRE. That is just the question I want explained, and the query is, are not a great many of these cases of infantile paralysis due to some undiscoverable or overlooked reflex irrita. tion? I have not had my attention called to this subject until comparatively recently, and have not had the time to investigate it as I should like; but only a few days before I left New York I had a case sent me by Dr. E. D. Morgan, of a child, 4 years old, totally paralyzed in the lower extremities, and unable to stand without support, and which, upon examination, was found to bave

, adherent prepuce. The operation of circumcision was performed, and in three days after the operation, the child walked. The curi. ous part of this case is, the quick recovery of the child after the source of irritation was removed.

Dr. J. B. MURDOCK, of Pennsylvania. I have been very much pleased with and interested in the remarks of Dr. Sayre, but it has occurred to me to ask him how he could know when an elongated prepuce was likely to produce this reflex irritation ? It is my experience to find this condition existing normally in a very large number of male children, under two years of age, without any of the symptoms of reflex irritation coexisting. I do not wish to call in question the cases which Dr. Sayre bas narrated, as there can be no doubt of their cause and effect, but if the long prepuce in infants is capable of producing paralysis, it is a wonder the disease is not more frequent.

I have, also, observed that phimosis is often a physiological condition in the young male child, and even with some adhesion. I have known this condition to exist in cases in which there was no interference, and in time the prepuce retracted naturally.

Dr. SAYRE. There is an agglutination, and there is an adhesion; two totally different conditions, one perhaps physiological and the other pathological. In either the secretions of these parts are imprisoned; thus, acting as a foreign body, they set up an irritation and active inflammation. This secretion can be found in hardened triangular masses, like the putty from a window pane, back of the corona, and, like a chestnut-burr in the rectum, produces an engorgement from a constant irritation, and resulting in a continual erection, and affecting the entire system the same as in excessive venery. I do not say that phimosis produces paralysis, but that paralysis is the effect of this continual priapism. Dr. Webb, of Michigan. I wish to inquire if Dr. Sayre ever

WEBB knew of a case of adhesion of the prepuce in which paralysis did

not occur.

Dr. SAYRE. There are most probably a great many such cases in which this condition exists without the paralytic symptoms manifesting themselves. In the case of the old man alluded to in the paper, the phimosis existed many years before a marked result was produced on the system at large.

Dr. J. R. BRONSON, of Massachusetts. Is there not a physiological agglutination and a pathological adhesion ?

Dr. SAYRE. That covers the point exactly. All these cases I have related were pathological and not physiological, and in many of them the tissues forming the prepuce had degenerated into a circular fibro-cartilaginous band, which offered the utmost resistance to its division with the knife.

Dr. J. M. KELLER, of Kentucky. I would like to ask if Dr. Sayre ever knew of this condition which he has described existing in Hebrews?

Dr. SAYRE. Never.

Dr. LEACH, of Indiana. Does this condition of the penis exist in adults affected with club-feet?

Dr. SAYRE. Well, I don't know. I never examined the penis of an adult with club.feet, nor do I desire to be understood as say. ing that all cases of club-feet are due to phimosis.

Dr. L. ELSBERG, of New York. I would like to ask Dr. Sayre if it is not his desire that the paper should remain with him for revision before leaving it in the hands of the Committee of Publi. cation. This is suggested by several passages in the paper showing that it was, at the time it was written, not intended for publication.

Dr. SAYRE. I am very much obliged to Dr. Elsberg, and am surprised at his divining my own thoughts upon this matter. The paper was written in haste for the New York Society of Neurology and Electrology, and was presented here merely for discussion, and, with the addition of the views of the Association, it was my intention to ask the privilege of revising and completing it.

Dr. BRONSON, of Massachusetts, made a remark which was construed by Dr. Elsberg as conferring upon members the privilege of making material alterations in a paper after reading before the Association and before publication in the Transactions. This gave rise to considerable discussion, and it was finally ruled by the Chairman of the Section, Paul F. Eve, that it was improper and contrary to the custom of the Association to allow of material alterations in manuscript after being read before the members assembled, but that for mere revision such a request could be consistently granted.

On motion the paper was referred to the Committee of Publication.

On motion of Dr. KELLY, of Kentucky, Dr. Sayre was allowed a susficient length of time to revise the paper before submitting it to the Committee of Publication.

The next was a paper read by Dr. C. B. KING, of Pennsylvania. Title, Operation for Extrophy of the Bladıler.

Dr. ANDREWS, of Illinois. I would like to ask the gentleman, what is to become of this boy when he arrives at the age of puberty, and this integument which has been taken from the pubes and placed so as to serve for the inner lining of the bladder is covered with hair? In my opinion it may give him a great deal more trouble in the future than would his former condition. It may do very well for the boy, but I think not one here would be willing to perform such an operation.

Dr. King, of Pennsylvania. The trouble which Dr. Andrews thinks is liable to follow this operation, i.e., irritation of the bladder, is obviated by the urine acting as a depilatory. Dr. Pancoast, of Philadelphia, to whom belongs the honor of first performing this operation, and Dr. Wood, of London, both hold this view.

Dr. JAMES R. W00D, of New York. I am delighted with the result which my friend Dr. King has reported. I have seen the cases of my namesake in London, and they are not more favorable than this. As far as the accumulation of hair is concerned there is no trouble to be feared. I know objections have been made by many surgeons to the operation, but the comfort accruing to the patient is beyond description, and this, together with previous successes, should warrant its being performed. An operation which

, I performed some time ago resulted very favorably, and in every case where the operation has been performed by intelligent surgeons it has proven successful; the result being hailed both by surgeon and patient with delight. You all know the success of the some. what similar operation for vesico-vaginal fistula as performed by Dr. Sims, of New York, to whom womankind is so much indebted, and it is to the young men of our profession, Mr. Chairman, we must look to perform these operations. They require study, thought, and labor, which the older men of the profession have either not the time, or are not willing to bestow. There are poor wretches to-day travelling over this country with protruding blad

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