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abdominal operation presents extraordinary difficulties.In malignant disease, when the fundus is affected andlarge, and especially if with foul contents, the abdominaloperation was best : for cancer of the cervix the vaginalwas the more suitable in most cases. In inflammatoryconditions the vaginal operation was best for very bad anddangerous cases of pelvic abscess with clear signs of pus.The operation was for the evacuation of pus, whilst theremoval of the uterus was incidental if necessary. It wassuitable also for cases of pyosalpinx where both sideswere affected and where the uterus was movable. Thevaginal operation was not suitable when after labour orabortion the uterus was fixed, because in sucha case the organ was friable and bled easily. Here theabdominal operation was suitable ; but in many instancesthe choice would depend on the general considerationsfirst mentioned. The general rule was to remuve the uterus.He wuuld sum up as follows :-The abdominal opera-tion was clearer, surer, and saved all that could be saved ;the vaginal operation was quicker, was accompanied byless shock and disturbance of intestine, and involved nocicatrix.Dr. Skene (Brooklyn) formerly advocated vaginal sec-

tion ; but was impressed by the favourable results of theabdominal section.Dr. John Campbell (Belfast) said that danger to the

patient was the true test of the suitability of an operation,and they were not yet so certain of the safety of the vaginalmethod to enable them to prefer it. Cases naturally fellinto two groups : (lst Those in which the inflamed masswas small and localized. For these the best course wasabdominal section. (2nd) Cases in which the inflamma-tion was diffused in the pelvis.Dr. Ross, of Toronto, still thought the method of oper-

ating from above to be preferable. Hernia occurred aftervaginal operations as well as after abdominal ones ; andwhen it occurred through the vagina it was more difficult Ito deal with than when it was through the anterior abdo- Iminal wound. He concluded by enumerating many drew- ’backs to the vaginal method. ’

Dr. Lapthorn Smith (Montreal) warmly supported theabdominal method, not from theory, but from experience.Dr. Berry Hart (Edinburgh) thought this question

should be considered impartially, and not as one of specialpleading for the abdominal or the vaginal incision. Themajority of cases could best be treated by abdominal sec-tion ; but in some cases, especially where the uterus andappendages were fixed down, or where there was part -metric suppuration, the vaginal route was excellent.Dr. Currier (New York) agreed that the personal equa-

tion, as stated by Dr. Cushing, was after all the essentialpoint, i.e. every man should use the method which he coulddo best, the interest of the patient being paramount. Theadvantage of drainage wa, probably that which gave thegreatest value to the vaginal route, and this advantagewas undoubted. The wholesale removal of uteri by thevaginal method, whether diseased or not, was a blot uponthe record of the operation.

Dr. Cushing briefly replied.Dr. Howard Kelly gave a demonstration on the examina-

tion of the female bladder and ureters at the RoyalVictoria Hospital.

E. PHARMACOLOGY AND THERAPEUTICS.Dr. C. R. Marshall, Ferndale, exhibited various prepara-

tions of cannabis indica, and afterwards discussed thequestion of absorption of insoluble compounds of mer-cury, such as calomel,-a combination of which withalbumen and salt would, he thought, be absorbed to acertain extent.A discussion on the treatment of syphilis was then heldin conjunction with the Section of Dermatology. It wasopened by Dr. Whitla, of Belfast, who said mercury andthe iodides were the remedies to be used ; and that theremust be very few, if any, non-mercurialists. The actionof alteratives was ill-understood, perhaps it was antagon-istic to the microbe of syphilis. Calomel acted locally oncondglomata ; mercurial ointment may be absorbed by thehair follicles and mouths of sebaceous glands. In smalldoses mercury is a tonic; but syphilitic subjects, espe-cially infants, bore large doses well. Iodides were notgermicidal, but influenced all growth. It may be possible,but very rarely, to abort syphilis, and one could never besure, when no symptoms developed, whether the prolongedmercurial treatment had been really needed. Hegenerally continued mercury for nine months, and helaid stress on the importance of watching the body-weight,a decrease being an indication to stop the mercury.After an interval he resumed the administration for

periods of 6 weeks, alternating with a like period ofabstinence, and continued this for two years. The greeniodide ( or gr.) was a convenient form, and he also pre-scribed grey powder, calomel and Plummer’s pill. Inunction was mot certain in its effects, but was disagree-able, the patient applying a drachm of the ung. hydrargyri(33 per cent.) daily. S,)dium iodide was suitable for affec-tions of the eye and ear ; and for the resolution of gum-mata large amounts often being necessary.Dr. Morris Hyde, of Chicago, said there was no routine

treatment for syphilis, and that iodine might; be dispensedwith.Mr. Malcolm Morris, of London, said that mercury acted

by increasing metabolism, and should be pushed from thevery first. If restricted to one form he would preferinunction. Plummer’s pill was useful in late stages; andfor rupia calomel fumigations. He related a severe case ofextra genital syphilis where such treatment was curativeafter four months’ trial. The essential is to continuemercurial treatment as long as possible. Sodium iodidewas often better borne when given with ammonia andsarsaparilla.Dr. Hervieux, Montreal, Dr. Allan, of New York, and

Dr. L. D. Bulkley, of New York, also joined in the discus-sion, the two last named confirming Mr. Morris’statementas to the severity of extra-genital syphilis.The President (Dr. Leech) considered that the thera.

peutical favor of such drugs as guiacum and sarsaparillahad not been proved; and Dr. Whitla briefly replied.Dr. A. R. OU"3hing, Ann Arbor, read a paper on the Phar.

macology of the Mammalian Heart, and showed the car-

diography he had used in his experiments. The aconiteand veratrine group stimulate the inhibitory centre, sectionof the vagus preventing their action. The digitalis,squill, strophanthus and oleander group also show theheart, but increase the systole. Caffeine greatly increasessystole, while strychnine has almost no action. Nitro-glycerine has only a paralyzing action. Alcohol has onlya transient action, even when given in large amounts.Chloroform and ether slightly slow the heart.Dr. Mary Putnam Jacobi, New York, referred to her re-

searches on the same subject in non-mammalian hearts,and had found strychnine act differently from Dr. Cushing.Nitroglycerine, by dilating peripheral arteries, should in.crease the amplitude of the cardiographic tracing.Dr. Marshall read a paper on the treatment of heart failure

in arterio-sclerosis, and referred to the prescription ofdigitalis with nitrites ; and to the rapid action oferythNl-tetra-nitrate.

F. PATHOLOGY AND BACTERIOLOGY.

The Session was entirely taken up with a discussion on" Serum diagnosis in Typhoid Fever."Prof. J. G. Adami opened the discussion with some re-

marks on the historical aspects of the subject. To Dr.Wyatt Johnston, of Montreal, was due the credit of hav-ing reduced the whole subject of serum diagnosis in

typhoid to a practical basis, his methods of examinationhaving been introduced in the Public Health Laboratoriesof the Province of Quebec over a year ago. At the timeof the first observations in typhoid fever with regard tothe agglutinative action of serum, this clumping actionwas by no means a novelty, having been long before notedby Roger in the case of the B. Prodigiosus. If any namemust be used we should rather employ the expression’ Widal’s Test,’ as Widal was apparently the first to fullyrecognise the importance of the subject and bring it tosome sort of practical basis. Later researches had shewnthat by means of this test it was possible to diagnose bet-ween ’Malta fever ’ (Wright), ’Picton cattle disease’(Adami and Hammond), and typhoid fever.In the discussion on " Technique," Dr. A. S. Grunbaum

stated that Gruber at the time of his observations fullyrealized the importance of the subject, but had beenhampered in his efforts to obtain sufficient typhoidpatients. The microscopic method was the one now gen-erally preferred. He regarded the dry method,’ when theblood is collected on glass or paper, as being less sensitivethan the moist. He used a 3 per cent. dilution of theserum with a time limit of 30 minutes. An agar cultureof low virulence was to be preferred. He always madecontrol experiments. The reaction occurred after the 14thday ; the agglutinative action varied in intensity from dayto day, and on some might be absent altogether.Prof. Wyatt Johnston’s paper was read by Dr. C. Martin.His method, now much used in America, was to take theblood on a platinum loop and to smear it on a glass slide.Using the same loop, he added to it four loopfuls of dis-tilled water or bouillon, thus making a standard dilution