PROCEEDINGS OF SOCIETIES. "Etsi non prosunt singula, juncta juvant." ART. I.-PROCEEDINGS OF THE LOUIS- Dr. Newman exhibited to the Society a very ingenious instrument designed by Dr. David Cummins, of this city, for making wire sutures in the operation for vesico-vaginal fistula, and made by Charriere, of Paris, under his immediate instructions. Dr. Newman had just used the instrument with complete satisfaction. The use of the canula-needle in this operation is not new; the modifications, however, made by Dr. Cummins on the instrument generally used constitute a greater improvement upon that than it was upon the ordinary surgeon's needle with forceps. Indeed this instrument, with its case of needles of every desirable curve, is complete, and the operation for vesico-vaginal fistula, which before had been so tedious, is now not only a very simple but a very easy feat in surgery. The instrument is used after the following manner: The end of the silver wire is inserted in the perforated handle (the perforation being slightly greater in diameter than that of the wire ordinarily used in the operation for which the instrument is designed) and pushed forward with the thumb and finger until it passes the toothed wheel seen in the cut, where the tube through which the wire passes becomes an open groove, so that the little wheel, which is held up by a spring, may be pressed down upon it by the thumb. By turning the wheel now towards himself with his thumb the operator can propel the wire forward into the stem of the instrument. A needle may now be attached by inserting its butt into the hollow end of the stem over the small tube which carries the wire seen projecting in the cut. The end of the stem is slit up the length of a few lines, and has its inner surface cut with longitudinal serrations to fit in corresponding serrations cut in the butt of the needle, so that when the slide seen in the cut is pushed forward the needle is firmly clasped and prevented from turning when the instrument is used. After the operator has transfixed both lips of the fistula, he turns the wheel and readily feeds the wire through the needle, and when a sufficient length has been forced through, he gently withdraws the instrument, pulling the wire with it, until he has length enough projecting from either lip to be easily manipulated, when the sutures are to be secured. Or, as there is danger of cutting the parts by drawing the wire through them, a few. inches may be fed through and held with forceps while the instrument is withdrawn, the wheel being turned at the same time until a sufficient length projects from the lip in which the instrument was entered. By this means the wire is not drawn. through the tissues at all. It may now be cut with a pair of scissors, and the end projecting through the needle drawn back,, when the instrument is ready, armed for use again. The instrument, however, is than the representation, the There were about two dozen The instrument and some of the needles are represented in the cut with moderate accuracy. about an inch and a half longer needles being about the same size. needles in the case exhibited by Dr. Newman of such a variety of curvature as to render the instrument applicable under every conceivable condition. It may be readily seen that the instrument is just the thing for staphyloraphy, the needles, however, with double curves (especially suitable in this operation) are not represented in the cut. In this description minute details are given, because in them. are set forth the many points of excellence in the instrument. Dr. Newman next read the following paper on CHRONIC OVARITIS. As but little has been said on this subject by the writers on gynæcology, it is important in the very beginning of the consideration to inquire whether chronic ovaritis is of rare occurrence and of little importance in its nature and consequences, or whether it is so obscure in its character and manifestations as to have escaped the careful attention of these writers. It cannot be unimportant; for if the ovaries are of that supreme power in the female economy that we are taught by modern physiology to believe they are, if the woman's physiological, psychological, and moral characteristics are formed and controlled by their power when in a state of health and activity, it cannot be doubted that they must (when affected with disease, especially inflammatory disease) exert an equally profound disturbing influence. That inflammation of the ovaries is comparatively rare might be inferred from their location and other circumstances. They are situated in the depths of the pelvis, and are completely surrounded and protected by important soft parts. But, on the other hand, reflecting on the active physiological offices which they have to perform-offices which involve an extreme degree of irritation and congestion, with the rupture of Graafian vesicles-they should not be expected to be so entirely exempt from inflammatory disease; so that although chronic inflammation of the ovaries may not be of frequent occurrence, it is, nevertheless, of more frequent occurrence than is generally believed, and it is highly important in its nature. It is necessary to discriminate between the chronic and the acute ovaritis. Acute inflammation of the ovary occurring suddenly after some violent cause, attended with intense pain and congestion, and tending rapidly to suppuration, must not be confounded with that state of moderate pain and congestion and the slower alterations of structure which constitute chronic ovaritis. While the acute ovaritis is violent in degree and tends rapidly to the production of abscess, the chronic, on the contrary, is slow in its progress, and is not inclined to abscess. In chronic inflammation the products are so slowly formed that nature, it would seem, is equal to the work of repairing the injuries almost as fast as they are inflicted. Although chronic inflammation does not tend to rapid and extreme softening or breaking down of the tissues, there is still more or less softening, and this process extending too far may cause the blood vessels of the part to rupture, thus giving rise to extravasation and acute inflammation. The development of the Graafian vesicle may be retarded or accelerated by chronic ovaritis. They may become excessively developed, constituting ovarian cysts or ovarian dropsies. But the most frequent and important change that occurs in the ovary, as a consequence of chronic inflammation, is atrophy. It is said that hypertrophy never occurs. Certain it is that atrophy is the rule. This relates only to the substance proper of the ovary. It will be shown further on that enlargement occasioned by exudation, extravasation, or something else, is one of the signs of chronic ovaritis. It may be asked by those who deny the frequency of ovarian chronic inflammation and insist on the greater frequency and importance of uterine inflammation, do not evidences the most positive of uterine disease exist in nearly all of the cases of so-called uterine disease, and do not the secondary or constitutional troubles disappear as soon as the uterus is restored to a healthy state? It is necessary to examine these questions carefully in order to see how far they are true. The ovaries can scarcely be affected with chronic inflammation without the uterus, sooner or later, participating in the inflammatory action, just as it is true that inflammation of the uterus may be transmitted along the ligaments or the fallopian tubes to the ovaries. In the treatment of these cases it no doubt frequently results, owing to the intimate association of the uterus and the ovary, that the remedies employed for the one will effect, even cure, the other. This is especially true as regards the general treatment. The local treatment of inflammation of the uterus often consists of such remedies as would be indicated in the treatment of chronic ovaritis, as the caustic applications, which, by their revulsive or substitutive action, tend to cure chronic inflammation of the ovary. Clinical records alone can settle the matter as to the frequency of chronic ovaritis; but while this is true, one should not assume that chronic ovaritis is of such infrequent occurrence. It will not do to assume that in the consideration of the so-called uterine disorders-that because some lesion is found upon the uterus-that therefore the whole trouble is due to this uterine lesion without examining the ovaries at all. It is not denied that many of the disorders of the uterus are capable of profoundly disturbing the entire system of the woman; but the teachings of modern physiology will justify the statement that these general disturbances are, in not a few of the cases, caused or produced through the agency of the ovaries. How are cases of chronic ovaritis to be diagnosed? Slight pain in the ovary-which is increased by gentle pressure along with enlargement and an uneven or nodulated appearance of the ovary, to be detected by vaginal or rectal touch-may be set down as the first indications of chronic ovaritis. But the most important sign or symptom is an extreme degree of constitutional or general derangement. The uterus, when not enlarged or displaced so as to afford pressure upon the surrounding nerves, has little power to awaken reflex disturbances. When, therefore, these secondary disorders arise they should most generally be referred to the ovaries as their source. Another interesting sign of chronic ovaritis is hypersecretion of the lining membrane of the uterus. These secretions or excretions are mucus and the menstrual blood. Many of the cases of excessive discharge of mucus from this surface are due to chronic inflammation of the ovaries. So also are menorrhoea and metrorhagia due to the same cause if the monthly discharge |