titis venenata is not of itself contagious, but the poison that produces the disease may still be in contact with the part before it is cleaned and so produce other cases. Theoretically we all agree that some method should be devised by which we may lessen the danger of contagion. Prostitution should be under government control. We may do much towards lessening the danger of infection by calling public attention to the danger of contamination. It is a well recognized fact that venereal diseases may and often are conveyed to the innocent through cups at drinking fountains, water closet seats, bed clothing in hotels and sleeping cars. Barber shops are a most prolific source from which all forms of contagious diseases are propagated.

Parents should be warned of the danger of allowing their children to be embraced and kissed by every stranger that may be so inclined; a child should never be kissed on the lips. Some years ago I saw a man at the post graduate school in New York who had a chancre on the lip; he had conveyed the disease to his wife by kissing, and from the initial lesion on her lip she had contaminated her child, who had a chancre on the tonsil. Eruptive fevers and vegetable parasitic diseases may be conveyed to human beings from domestic animals; I have seen a child affected with favus, who contracted it from a cat who in turn probably derived it from mice.

The opinion has been expressed that the etiology of skin diseases is obscure and the treatment is of necessity many times at fault, but is this alone true of cutaneous maladies, is it not equally applicable to other diseases? Rheumatism follows defective processes of elimination, producing lactic acid, it may be due to the nerve centers being primarily affect. ed by cold, and the local lesions are really trophic in character, or as still

others consider, arthritis is due to microorganisms. Gout, due to excess of uric acid in the blood, may be hereditary. According to Duckworth the condition is brought about by neurosis of the nerve centers. Bronchitis is usually the result of "catching cold", but according to Osler is probably microbic in origin. Croupous pneumonia may or may not be caused by micro-organisms.

DISCUSSION.

Dr. W. W. Johnston said: In treating of the etiology of skin diseases Dr.

McGuire had covered almost the whole range of medicine. The general constitutional condition was closely connected with the diseases of the skin, though this doclrine was not endorsed by all dermatologists. There was a very close association between diseases of the skin and the uric acid diathesis, and there was no doubt that the skin was prone to such diseases as urticaria as a manifestation of this diathesis. It was a most interesting relation; he had seen cases of urticaria extending over years, due to this cause. The treatment was a carefully regulated diet; sometimes it would even be necessary for a time to resort to an exclusive milk diet. He had had under treatment lately a lady with one of the worst forms of urticaria he had ever seen. The pressure of her dress or corsets, or the touch of the finger, would be sufficient to bring out the eruption at the points of pressure. She had persistent uric acid in the urine; she was treated by limiting the diet, and finally was put on a milk diet exclusively, when the urticaria disappeared. He also referred to the coincidence of chronic eczema with constitutional disease.

Dr. S. S. Adams said: He agreed with Dr. Johnston's views on urticaria, at least so far as children were concerned, and he believed that heredity played a very small part in its causation. Urticaria was generally due to errors in diet. The diet should be corrected, for the child would not improve until its food had been changed. And in speaking of food he referred particularly to mercantile articles of food, and more

particularly to condensed milk. Most cases of urticaria now occurring in children were due to condensed milk. As regards impetigo contagiosa, he had just had removed from the hospital several cases occurring in the children in one family. In another case the mother had it on her face, and the nurse also had it. He had seen more cases of it in recent years (or at least he had made the diagnosis of it more frequently) than ever before.

Dr. W. P. Carr said: There could be little doubt that many skin diseases bore some relation to general nutrition. He drew an analogy between the causes of catarrh and dermatitis. Catarrh was usually due to a lack of nutrition, while eczema on the contrary, was more often found in plethoric subjects. Catarrh was due to a lack of nutrition in children, and this produced a condition of the system in which the cells were not active. Germs gained entrance and produced catarrh, furunculosis and scurvy; the skin becoming involved from a lack of resistance.

and as being only a manifestation by an eruption on the skin of other diseases, he was forced to disagree with him. Advocates of the theory of a close relation between skin diseases and the general constitution lost sight of the fact that the skin was an organ, and just as liable to its peculiar diseases as any other organ in the body. If the liver or kidney, or any other internal organ, was the seat of disease we did not search around among other organs for the cause, but when the skin was affected physicians were not satisfied until they found some other cause for it. If a patient had eczema they must search for a constitutional cause for it. If those who thought it was caused by gout would search the records they would find that there were no more cases occurring in gouty patients than in any others. In reply to Dr. Adams he said that he had not stated in his paper that impetigo contagiosa was a rare disease, but he would say it was rare in his experience. He had been practicing in Washington eight years as a dermatologist, and in that time he had seen only a few cases. The cases Dr. Adams saw were undoubtedly transmitted from one to the other.

MEETING OF DECEMBER 2, 1896. Dr. S. C. Busey, President, in the Chair.

MULTIPLE ABSCESS OF THE LIVER AND OF THE MESENTERY.

Dr. D. S. Lamb presented a specimen with the following history:

The patient was a mulatto woman, forty-eight years of age, who had been sick about two months and died two days after admission to the hospital. Her most marked symptoms while in the hospital were delirium and abdominal tympanites; temperature ranged between 100 and 102°. The necropsy showed a circumscribed abscess filled with greenish pus, located above and to the right of the umbilicus; it was bounded by the greater omentum, intestines and anterior abdominal wall; in some way which I was unable to determine this abscess communicated with another in the apical portion of the vermiform appendix; the appendix was bent on itself about midway of its tract and in the distal end was greenish pus. The mesentery was full of abscesses containing The liver throughout was as described in the specimen. Some adhesions around the circumscribed abscess were old and the color of the abscess contents was greenish; this therefore was chronic, as was also that in the

whitish pus.

appendix, the contents of which were also greenish pus. Those in the mesentery were apparently more recent but of course, secondary to that in the appendix. Throughout the remainder of the abdomen were recent adhesions, lymph and straw-colored serum. Peyer's patches of the lower ileum showed deep pigmentation suggesting a prior typhoid fever. Whether this fever had to do with the vermiform abscess is an interesting question. The lungs were generally œdematous.

I would suggest the possibility of the following sequence of events in this case. Beginning with a typhoid fever from which she convalesced and recovered; perhaps leaving an appendicitis which became a chronic abscess; in some way not determined this abscess caused the intraperitoneal abscess higher up, and also the multiple abscesses in the mesentery; these of course through the superior mesenteric vein; thence from the mesentery through the portal tributaries to the liver, pilephlebitis and multiple hepatic abscesses.

ABDOMINAL PREGNANCY.

Dr. J. Wesley Bovee reported a case of abdominal pregnancy and presented the fœtus, placenta and sac.

The foetus weighed four pounds and the sac with the placenta two and a half

DISCUSSION.

vagina since December and it lasted six weeks, during which period she passed fleshy masses from the uterus, accompanied with severe pain. In May she first noticed a tumor in the lower part of the abdomen which increased in size. Up to September there had been fœtal movements. Milk had flowed freely from the breasts in September and was yet present in the left breast, November 18, 1896. At this time she had quite a large abdominal fluctuating and irregular tumor. The right side contained fluid. and the left was more solid. Abdominal pregnancy was diagnosed; the urine contained a small amount of albumen and some hyaline casts.

The operation showed it to be a case of abdominal pregnancy. though not in-, traperitoneal, with the placenta attached low and to the left side of the pelvis. The foetus was delivered by the feet and the sac enucleated; slight hemorrhage occurred and after carefully washing out

Dr. H. D. Fry, in discussing Dr. Bovee's case, said that the history of this case was typical of tubal pregnancy rupturing into the broad ligament. He had the pleasure of seeing Dr. Bovee remove the specimen, and the only criticism he would make was to say that he had been surprised that the doctor attempted to remove the sac, for this certainly added very much to the danger of the operation. He thought it would have been wiser not to have attempted the enucleation of the sac, but to have removed the placenta, cut away as much of the sac as possible and sewed up the remainder.

Dr. J. W. Bovee replied: That the attachment of the placenta was inside the sac, and all over the outer side were adhesions which he did not know how he could tie without getting out the sac, besides he would much rather have such a sac outside of the abdomen than in it, for it would furnish a dangerous focus for infection if left.

Dr. I. S. Stone said: He thought the doctor would probably find more difficulty in removing the sac prior to the ninth month, and he wished to know how he would treat the sac in such cases.

Dr. Bovee replied that at that time he would expect to find a larger blood supply since the placenta circulation would be probably normal-if the child was living. He thought he would probably stitch the placenta to the abdominal wall and pack gauze around the placenta.

those who believe that perfect success may be almost uniformly obtained by surgical means, whether it is good advice to urge a continuance of local treatment, including pessary wearing, when the patient is not relieved after a fair trial of these expedients.

Generally speaking, a dislocated uterus gives rise to symptoms. There are some exceptions, however, to this rule. Some women appear to have no symptoms or pain, with a retroflexed and very adherent uterus. Others may have a severe case of prolapse of the uterus, with no distress or pain, but are merely inconvenienced. We return to the statement that women generally do suffer from dislocations of the uterus. They

may not have local pain or any of the pressure symptoms, but may instead have reflex and often very distressing symptoms, which are only relieved by the restoration of the uterus to the normal position. Thus we see neuralgias, headaches, gastralgia, nausea and vomiting, due to the cause above mentioned. We have seen the most distressing pruitus ani of ten years standing, promptly relieved by the restoration of a retroverted uterus. We have seen recently quite a number of patients with rectal pain, who have undergone numerous operations for fissures, hemorrhoids, ulcers, etc., due to an undiscovered retroversion, with adhesions to the rectum. These cases are opposed to any further surgery, with good reason, but it is always best to correct such a displacement at any cost, even if the abdomen must be opened to accomplish that end.

The writer believes that cases of retrodisplaced uteri are uteri are seldom or never cured by a resort to pessaries, if the cases are of long standing. Some acute cases, as for instance those we occasionally see after an accident, may be restored by timely treatment: but those

coming to our notice with over-stretched ligaments, and especially those having adhesions to viscera, are rarely if ever permanently cured, so that the patient. can lay aside her pessary.

A pessary is a makeshift, a crutch, a temporary expedient, the lesser of two evils. It means a distended vagina, a substitution of one form of pressure for another, and not the least of its evil effects is its office of filth collector. It is impossible to use any kind of pessary without occasionally removing it in order to cleanse it, and thus every woman wearing one is a regular visitor at her physicians office. She is obliged to submit to repeated examinations, and almost endless annoyance and inspection while she wears a pessary, yet in spite of the many disadvantages we must needs use them occasionally.

Given then a patient who has a retrodisplaced uterus, who has either become tired of wearing a pessary, or who can not be relieved by one, we may consider some form of surgical treatment. The writer thus omits purposely all other 30called methods of cure, such as electricity, massage, etc.

There are a certain number of cases of adherent uteri to be relieved by forcible separation of adhesions under anæsthesia (see Schultz). As there is always a doubt as to the cause of infection, or at least there is a doubt as to the cause of the adhesions, one must carefully exclude infectious disease of the pelvic organs before attempting so radical at measure. The writer has frequently tried this method, and on more than one occasion immediately opened the abdomen and witnessed the result. The uterus can be liberated from adhesions which envelop its entire anterior, superior and posterior surfaces. The broad ligaments nay be unfolded, which will often liberate imprisoned tubes and ova