Current Medical Literature
Journal of the American Medical Association (JAMA)
Dr. George F. Comstock, Saratoga Springs, presented a very perfect specimen of extrauterine pregnancy which he had recently successfully removed. UTERUS BIC0RN1S. Dr. E. D. Ferguson reported a case on which he had oper¬ ated the day before for what had been supposed to be a chronic appendicitis and a rétroversion of the uterus. After having removed the appendix he had found what appeared to be a band of adhesion running from the mesoeolon across Douglas' pouch to the base of the bladder.
... the bladder. Careful search showed that he was dealing with a U-shaped uterus bieornis. The woman had borne two children, and both uteri were retroverted. the radical cure of hydrocele. Dr. Crawford E. Fritts, of Hudson, presented this paper, which will be published in a future issue of The Journal. Dr. William Finder supplemented the paper with some re¬ marks founded on his own experience. In one case, under •cocain anesthesia, he had made an incision and stitched back the tunica vaginalis, but the case had relapsed. The operation had been repeated twice since then, with the same result. He had then tried the method known as Wincklemann's. The scrotum is incised and the tunica vaginalis is separated from all adhesions. It is then opened, and the fluid evacuated. The tunica vaginalis is turned inside out, and finally the testicle and the distorted tunic are returned to the scrotum and sewed up. The wound healed by primary union, and in a week's time the man had returned to his work. There had been no relapse or other discomforts. In this case he had used a 5 per cent, solution of cocain, yet there had been no symptoms of poison¬ ing. Dr. Ferguson said that the bichlorid method was a novel one to him. Personally, he had always used the injection of iodin, adjusting the quantity somewhat to the capacity of the sac. So far as he knew there had been no failures. The use of the iodin he believed had not been responsible for the occasional occurrence of gangrene. One of his earliest surgical experi-' enees had been the tapping of a hydrocele in an old man. This had been followed by gangrene and sloughing, but the man had ultimately recovered, and his hydrocele had remained cured. He believed it was not the iodin that caused the mischief, but the infection introduced by the surgeon. The results described in the paper were so exceedingly good that he felt disposed to try it. He thought it might be an advantage to dissolve the bichlorid of mercury in normal salt solution instead of in pure water. Some weeks ago he had seen a case in which a seton had been used for the radical cure of a hydrocele. The scrotum was much swollen on the affected side, and with the aspirator he had withdrawn a moderate amount of serum. He had been inclined to think that the bulkiness of the scrotum was largely owing to the presence of an omental hernia. The man had sub¬ sequently submitted to operation, and the correctness of this diagnosis had been amply verified. Dr. George E. McDonald, Schenectady, said that he had operated a number of times by the old method, and, so far as he knew, with invariable success. In the last case he had left the fluid in and had simply injected a dram of iodin. The re¬ sult in this, as in the other cases, had been a complete cure. He had treated a very large number of cases in this way. implantation of ureter into the bladder. spoke on the surgery of the ureters, reporting the following case: A woman had been delivered of her first child, and this had been followed by puerperal sep¬ ticemia and pelvic abscess. The result had been destruction of the ureter and the formation of a uretevo-vaginal fistula. After some weeks the case had come under his observation, and he had found the fistula to be located to the left side of the uterus at the line of the broad ligament fold. The ureteral sound could be passed up to the kidney and into the bladder, but it had been absolutely impossible to enter the ureteral opening on that side through the bladder. The fistula being so close to the bladder wall, he had felt justified in attempting to denude the tissues at that point. He had accordingly done a preliminary operation as for closing a vesicovaginal fistula, but the operation had failed. After an interval of two weeks he had passed a sound into the ureter, and dissected away about one inch of the ureter through Uie broad ligament. He had then formed a vesicovaginal fistula, and had approximated the' vesieal walls laterally so as to allow the ureter to lie freely in the bladder. The patient was put to Oed and the implantation of the ureter was found to have been successful. It was now nearly three weeks since the operation, and the chances were that the remaining vesicovaginal fistula, being the result of operative interference, would close within a few weeks. This operation of implantation, the speaker said, was nut very difficult in ordinary cases, and was an operation quite generally accepted at the present time. If the ureter could not be made to readily reach the bladder, a simple dissection would liberate the bladder anteriorly, and allow it to drop back a little, thus giving the operator an additional inch or two. The ureter could be handled quite freely with safety if no sharp instruments were used. The ureter could be conven¬ iently seized and controlled by means of small alligator for¬ ceps, one blade of which protrudes beyond the other, and so easilv enters the ureter. These forceps were invented by Dr.