large as an orange, which if left would certainly be a serious barrier to delivery, more especially if it grew rapidly. On this account we determined to perform total hysterectomy. The pedicle uniting the large tumour to the uterus was ligatured with silk and divided. The patient was then put in the Trendelenberg position, and both broad ligaments were tied and divided down to a point below the round ligaments. The peritoneum on the anterior aspect of the uterus was divided from side to side about an inch above the reflection of the bladder. A similar incision was made posteriorly. The anterior flap with the bladder was pushed well down in front, and the posterior flap was reflected as low down as the vaginal roof. A wire was now passed round the cervix and tightened, and the body of the uterus, along with the ovaries and tubes, removed by a circular incision at the isthmus uteri. During this procedure the liquor amnii gushed out, and was followed by the foetus. The removal of the uterine body at this stage was not necessary, but was done with the object of making the vaginal roof and the bases of the broad ligaments more accessible. The vagina was now opened in front on the tip of a pair of clamp forceps passed from below, and the opening widened by the fingers. A finger was then passed into the posterior fornix and made to project behind the cervix within the posterior flap of peritoneum. An opening was here made into the vagina and widened with the fingers. Clamps were applied on the base of each broad ligament, and the cervix cut out between them. Gauze was now placed in the vagina and between the clamps, and the anterior and posterior flaps of peritoneum stitched together over the gauze and clamps. In this way the peritoneal cavity was shut off from the base of the broad ligaments and the vagina. The abdominal wound was closed without drainage. The clamps were removed on the second day, and the gauze on the day following. The patient made an easy and uninterrupted recovery. There was less discomfort than is usually felt after abdominal operations, and the temperature never rose above normal. She now feels perfectly well.

Remarks.-The most noteworthy feature in this case was the rapid growth of the tumour. In the beginning of January the patient was not aware of the existence of any swelling; by the middle of March the tumour had reached the upper limits of the abdomen. We know that pregnancy hastens the progress of fibroids, but the rate of growth in Mrs B.'s case surprised me, and made me fear some form of degeneration. As it turned out, the tumour on section presented a number of cavities showing mucoid degeneration. The pain was probably caused by the rapid expansion of the tumour. Slight modifications in the operation of 'pan-hysterectomy' may be referred to, as carried out in this case, viz. :-(1) Using clamps on the uterine arteries instead of

ligatures; (2) making the opening in the posterior fornix not into Douglas' pouch, but within the posterior flap; (3) stitching the anterior and posterior flaps of peritoneum over the clamps and gauze, thereby shutting off the peritoneal cavity from the vagina. The clamps and gauze provided effective drainage downwards.

SEVENTH (ADJOURNED) MEETING.-JUNE 22, 1898.

DR R. MILNE MURRAY, Vice-President, in the Chair.

I. The following gentlemen were duly elected Honorary Fellows of the Society-Charles J. Cullingworth, M.D., D.C.L., London; Lombe Atthill, M.D., Dublin; Professor S. Pozzi, M.D., Paris; G. Leopold, M.D., Dresden; Professor Howard A. Kelly, M.D., Baltimore; Professor Henry C. Coe, M.D., New York; E. Doyen, M.D., Paris.

II. The following gentlemen were duly elected Ordinary Fellows of the Society: John Christie Forbes, L.R.C.P. & S.E., L.F.P. & S.G., Northfield, Liberton; A. C. Ainslie, M.B., C.M., 20 Newington Road, Edinburgh; and Dr Dumat, Durban, South Africa.

III. Professor Simpson showed-(a) Specimens of OVARIAN TUMOURS, in the removal of which Doyen's forceps had been used; in all the result had been satisfactory; and (b) DOYEN'S FORCEPS for compressing the pedicle referred to.

TUMOUR WITH

IV. Dr Brewis showed (1.) AN OVARIAN STRANGULATED PEDICLE, and gave the following notes of the case:-The patient, a healthy young woman, had during the last four months had several acute attacks of pain in the right side. The first of these occurred in February, lasted a week, and at that time was thought by her medical attendant to be an attack of typhlitis. In the end of May she had a similar seizure. Her last period, which terminated on June 11, was accompanied by considerable pain. On the 13th she was seized with acute pain. in the right side and with vomiting. The latter continued all next day, and the pain remained severe till relieved by operation. Dr Brewis saw her with Dr Veitch on the 16th, and found a tender fixed cystic swelling occupying the hypogastrium. By vaginal examination the tumour was felt lying above the retroverted uterus. The bowels had refused to act for five days, and the temperature ranged from 99° to 103°. A provisional diagnosis of ovarian tumour with strangulated pedicle was made. The abdomen was opened on the 18th. A marked increase in the size of the swelling was observed to have taken place during the

previous two days. The surface of the tumour when reached. presented a black, mottled appearance, and a considerable quantity of blood was present in the peritoneal cavity. The posterior aspect of the tumour was adherent to bowels by soft adhesions. The pedicle was thin and tightly twisted three or four times from right to left. When the tumour was removed, the bowels lying below the site of the tumour were found closely adherent to each other, and were evidently blocked. The coils were gently separated, the peritoneum cleansed, and the abdomen closed without drainage. The patient's bowels moved freely on the afternoon of the operation, and several times next day. Recovery was uneventful. The temperature kept subnormal after the operation. The tumour was considerably larger than a foetal head, was nearly round in shape, and black in colour. The swelling was situated between the layers of the outer end of the broad ligament. On the anterior surface a rounded, somewhat transparent cyst, of the circumference of a five-shilling piece, bulged through the peritoneal covering. The tube encircled about two-thirds of the circumference of the swelling, coursed over its upper aspect, and was greatly hypertrophied. It measured eight inches. The fimbriæ were enlarged and very vascular, and were placed on the free surface of the swelling. The ovarian fimbria was markedly thickened. The swelling appeared to have originated from the hilum of the ovary, and to have developed between the layers of the broad ligament. The ovary proper was enlarged, soft, and pulpy. Farre's line was well seen. The swelling when opened was found filled with blood, and the interior was dotted over with papillomata.

2. A LARGE OVARIAN TUMOUR WEIGHING 44 LBS., from a young woman who had had amenorrhoea for eleven months.

V. Dr Foulis gave a demonstration of the GENITO-URINARY ORGANS OF FETAL DEER.-He said that last autumn he had made a collection of foetal deer, and that for some months past he had been working at the development of genito-urinary organs, and he now showed the Society four dissections in which, under a low magnifying power, it was possible to see the Wolffian bodies, and the Müllerian and Wolffian ducts passing downwards towards the tail end of the young animals to form that structure known as the genital cord, which became attached to the sinus urogenitalis, a part of the allantoic stalk. It was also possible to see in these preparations the urachus, the bladder, and the two large hypogastric arteries on either side of the allantoic stalk. In one preparation the genital cord was dissected out; and it could be seen that the Müllerian and Wolffian ducts made up the cord; and in this same preparation a part of the sinus urogenitalis had been cut away, just at the spot where the genital cord joins it, and on the urethral floor thus exposed could be seen an eminence which

was evidently the verum montanum, said by some observers to be the analogue of the hymen in the female. In another preparation the sexual eminence was well seen, and on its under surface was a distinct fissure which might close in during the formation of the urethra, or might be the vaginal orifice with the nymphæ on either side within the labia majora.

VI. Dr D. Berry Hart read a communication

ANALOGUES OF THE MALE AND FEMALE GENITAL TRACT.

on THE

Dr Foulis said he was sure he was expressing the opinion of every Fellow present when he said that the paper just read was a most elaborate one on a most important and difficult subject. With regard to that part of the subject which Dr Hart seemed to be most interested in, viz., whether the Wolffian ducts took part along with the Müllerian ducts in the formation of the vagina, Dr Foulis thought he was correct in stating that the subject had been well worked at by many observers, some of whom had stated that the Wolffian ducts did actually enter into the formation of the vagina. The question as to the analogue of the hymen was an extremely interesting one; and if it should turn out to be correct that the epithelial bulbs at the ends of the Wolffian ducts were the analogue of the hymen, as stated by Dr Hart to-night, he deserved all credit for his investigations and conclusions; but Dr Foulis thought that point was by no means settled as yet. As regards the ovary and testicle, Dr Foulis had satisfied himself that the ovary is at no time of its existence a tubular structure, and that the cells which nourish the young ova are, with the bloodvessels of the ovary, all of mesoblastic origin.

VII. ON THE POSITION OF THE PROMONTORY OF THE SACRUM AS SHOWN BY FROZEN SECTIONS.

By A. H. F. BARBOUR, M.D., F.R.C.P. Ed., Assistant Gynecologist, Royal Infirmary; Lecturer on Midwifery and Gynecology, Royal Colleges School of Medicine, Edinburgh.

IN teaching students methods of gynecological examination, I always begin with palpation of the lower region of the abdomen and the position of the promontory of the sacrum. This determines the brim of the pelvis in relation to which the pelvic organs can be localised. With the patient under chloroform, the promontory can be easily made out, and its height above the symphysis measured. In doing this I have been struck with the variability in its position, apart from posture. The change in the inclination of the brim, due to changes in posture, is of course a commonplace, but I was not prepared to find such variations in the level of the promontory with the patients placed, as far as possible, in the saine posture. With the patient on the back and

the limbs extended, the position of the promontory varies from 21 to 4 inches above the symphysis. At first I was inclined to attribute this variability to difference in the length of the conjugate, but a study of frozen sections has shown me there is another factor which has not received attention, and which I wish to bring forward in this paper.

Hitherto the pelvis has been studied only in the dry preparation out of the body, or clinically in the living subject. The first method has its advantages and drawbacks; while it allows us to measure the diameters with precision, it gives no data for determining the position of the pelvis during life, and it disregards altogether the effect of the soft parts. Hence the information gained must be corrected and supplemented by such investigations as have been made in the living subject by Schultze and Skutsch. In dealing with a living subject a new set of difficulties arise from the way in which the pelvis is buried in the soft parts and the difficulties of getting at it so as to make exact measurements. There is a further difficulty when we endeavour to measure one pelvis after another, for it is not easy to place and to keep one patient after another in the same position while the different measurements are being made.

Frozen sections offer a third means of investigating the form and position of the pelvis, and their study brings forward a new series of facts to correct and supplement the information gained from the two methods already mentioned. This third method, like the other two, has also its advantages and drawbacks. The advantages are that it shows us the pelvis set in the body. It is now no longer a question of holding a pelvis with dried ligaments in any position, or at any angle you please, but you see it kept in the position it occupied during life. Further, and what is of the first importance for clinical work, you see the pelvic cavity in relation to the abdominal cavity: Hence the pelvis can be studied in a way which is of the greatest value both to the gynecologist and to the obstetrician. The gynecologist locates structures in their relation to the brim of the pelvis, and the position of the promontory is of interest to him when determining the position of structures, e.g., uterus and ovaries, with reference to the brim. It is however, specially to the obstetrician that this method of looking at the pelvis is of importance. The contents of the uterus are abdominal in position at the end of pregnancy, while they have to pass through the pelvis in labour; hence the relation of the long axis of the abdomen to that of the pelvis is of the first importance. A drawback to this method of study is that there will be variations in the set of the pelvis according to the position in which the cadaver is frozen. Fortunately frozen sections are usually made with the cadaver on the back, that is to say, with the body in the same position as it occupies both in gynecological examination and during labour. But even with the cadaver in this position