of constipation. A number of years ago, when I used the clamp, I had a bad result, but the result in that case was from insufficient dilatation and bad after-treatment. I had in that case some sloughing and incontinence for perhaps three and a half months; but notwithstanding these complications the patient was greatly benefited and was very glad indeed to have had the operation. DR. MONROE asked if there was a physician present who knew of a case of incontinence following the operation that has lasted for two years, of course, eliminating all such cases as had no control of the bowel before the operation. W. E. GREEN, M.D.: Within the past six months I had a letter from a lady, asking me if I could correct an incontinence; three years ago the American had been performed upon her and since she has had no control of the bowel. I know of two other ladies in my vicinity who had undergone the operation and were left with the same trouble. The case that I spoke of in my paper was operated upon a year and a half ago, and suffers from a resultant stricture. I know, if he would return, I could correct this condition and thereby affect a cure. I always state to patients, who require the American, that consequent trouble may arise that will require further treatment, and I exact of them a promise that they will continue with me until a cure is complete, otherwise I will not take the case. It must be remembered that these people who require such heroic measures are all very sick, that they have been treated by many doctors and have taken all sorts of medicine without benefit. They want to get well, and an operation is offered them as a last resort; they are justifiable in taking a risk that promises so much. Because one patient is injured, has incontinence, is that sufficient reason to withhold a cure from many others? We are not operating on trivial cases, the young and vigorous; it is, from a therapeutical standpoint, the incurables. We are operating to cure chronically deranged minds, congested livers, enlarged spleens, diseased bowels, etc. It has been but a short time since a patient came to me suffering from pernicious anæmia. He had been for six months in the hospital under the treatment of the most scientific old-school physician, and yet he was nearing the grave. Do you mean to tell me that this man had not sufficient medication, that these allopathic physicians of St. Louis had not given him sufficient Iron, Arsenic, Strychnine and other blood-making remedies? When he consulted me I offered him no treatment, but only proposed a surgical operation. He eagerly consented to it. I did the American; the bleeding was profuse and the blood was so pale, so scarce of red corpuscles that I feared union would not follow. To my surprise there was union by first intention and no cicatricial contraction followed. The man recovered promptly, and in seven weeks he returned to his work during that time the only medicine given was a few doses of Nux vomica 6x, for some temporary gastric disturbance. He has remained well. This is a sample of the cases that come to us for this kind of work, and when such results follow I think it is nonsensical to bring up a few cases of stricture or incontinence, the result of poorly executed operations, in condemnation. DR. PRATT said, in defence of the American operation, that many of these newer apostles of the work forget that it was instituted, as Dr. Green said, not for trivial cases, but to almost resurrect the dead. It is or should be used in cases that have been given up-that used to be chronic invalids; it should be used when the rectum is so diseased that nothing else will do it any good, when a view of its lining will speak for itself, when ordinary orificial surgery doesn't work; then you must go higher and deeper. You must do the whole work. He said that this work must be properly done and completely done, else it is worthless. There are many cases to day that would give a great deal to be operated on in this way if they only knew it. He did not believe there was a single case of incontinence to-day following the American operation that could not be cured; but, as has been a number of times said, it must be done by some one who understands it thoroughly, and it must be followed through to the end. The incontinence may come not at all from trouble in the rectum, but from some distant point-sometimes it is in the sexual system. "I hate the American operation, and I never do it if I can help it. I dread it. I seldom do it for local conditions. When I operate for fistulæ, I always use it, but not always for hæmorrhoids." Dr. Pratt compared the human body to the operations required of a dentist. Sometimes the dentist finds that the tooth he has been attending to is worse than before his attentions. Then he must look for the cause elsewhere. Dr. Pratt spoke at some considerable length on the theories underlying the operation, and, indeed, the whole system of orificial surgery, and declined to believe that the reported accidents, as the sequelae of the American operation, were true. He described minutely the operation, and detailed what other concomitants were used to perfect the work. He especially directed attention to the after-treatment. He referred briefly to the critics who opposed the operation, as not being conversant with the theory of the capillary flushing of the system, and thus bringing life to stagnant points at a distance. If these critics would take a little time to understand this theory, they would be better off, and not talk so much about, the failures of the operations. The system of orificial surgery was a boon to mankind, and will continue so in the hands of competent operators. DR. PARSONS, answering Dr. Pratt's aspersions on his honesty and ability to do good surgical work, and his power of understand ing the capillary circulation, arose and said that it was himself that had told Dr. Pratt at Galesburg, about the capillary flushing. He said, I am never going to be forced to believe what is not within my comprehension, and there is no man can force an argument down my throat by sheer strength. If I can see the practical workings of an operation, I adopt it; but the mere theoretical speculations of whoever it may be have no effect upon me. I will investigate and I have investigated this matter. I know a good deal more about it than Dr. Pratt thinks I do. My intellect may not be so stupid after all. I have seen some of Dr. Pratt's results, and I have seen the results of other operators of Pratt's system-those who profess to understand this plan of treatment-and they were ruinous results. And this will be the result just so long as these operators will take every case that comes along, and treat them in a similar manner, regardless of their condition. When Dr. Pratt says I don't know about the flushing of the capillaries, I say to him that I was the first to suggest this matter to him, at Galesburg. Did I not, Dr. Pratt? (Dr. Pratt assents to this.) I believe I understand the matter quite as well as Dr. Pratt. I know what these operations will do just as well as he does. I know what parts and organs it is proposed to help. I am not totally deficient in knowledge of anatomy and physiology. THE CHAIR here interrupted Dr. Parsons, saying that he was confident Dr. Pratt had no intention of being personal in his remarks. DR. PRATT said that such was certainly not the desire on his part. He was a good friend of Dr. Parsons, and loved him like a brother. They had occasional passages at arms, but wholly in a scientific way -never personal. He was confident Dr. Parsons would not take it in a harmful sense. MOVABLE KIDNEY IN WOMAN. BY MILTON J. BLIEM, M.D., SAN ANTONIO, TEXAS. THIS paper is not intended to be systematic and exhaustive treatise on the subject of movable kidney. It is proposed to discuss briefly three points with reference to the relations of this condition 1st, Frequency; 2d, Symptoms, and 3d, Treatment. to woman. I.-FREQUENCY. All observers are agreed that movable kidney is far more frequent in women than in men. I have met with but one case among male patients; this was clearly due to traumatism, but was unrecognized by physicians for years. Among women such observers as Lindner, Edebohls and Kellogg have recorded a movable kidney out of every five or six of their gynæcological cases. To say, however, that this proportion holds good throughout would, in my judgment, be a gross exaggeration. These statistics are compiled from hospital and sanitarium cases, where we are apt to find the worst class of patients. One would, therefore, expect to find movable kidney far more frequently among hospital patients than in the ordinary run of private or general practice. To say, then, that one woman out of every five or six has a movable kidney must be considered far beyond the facts. Nevertheless, it occurs with sufficient frequency to make it incumbent upon every gynæcologist to bear the possibility in mind and to make it a rule to give every gynæcological patient a thorough abdominal examination. It is true that in past discussions upon this subject other authorities have made the claim that movable or floating kidney is practically a myth and cannot be found in the deadhouse. Such observers must surely be blind because they will not see. A movable kidney is, as a rule, easily diagnosed. The sufferers are usually thin, making it an easy task to outline and grasp the misplaced organ. The frequent occurrence of movable kidney in woman, we may, then, consider a well-established fact and makes the subject one of special interest to the gynæcologist. A peculiarity equally as well marked as the difference between men and women is its relative frequency with reference to the right. and left sides. It is very much more common on the right side. Out of 22 cases reported by Edebohls, 20 had movable right kidney; the remaining two had both organs movable. The most probable explanation of this fact is the position of the right kidney under the heavy liver. Another interesting point as regards frequency is the occurrence in single and married women. The general impression seems to be that it is far more common in married women, presumably because the overstretching and relaxation incident to childbirth, is supposed to be a common cause of the dislocation. However, in Edebohl's list, for instance, we find a surprising proportion in favor of single women. Out of the 22 cases already referred to, 15 were single and only 7 married. There must be other causes at work then, prominent among which, in my mind, are faulty posture in sitting and standing, faulty and constricting dress and debilitating sickness, leading to emaciation, with marked loss of the perirenal fat. II. SYMPTOMS. Coming now to consider the train of symptoms to which movable kidney may give rise, we find a second important reason why the gynecologist should know all about it. Many, in fact, the majority, of the symptoms which diseases of the female generative organs exhibit are reflex rather than local in character. Precisely so with movable kidney; and, what is more, the same nerve wires are tapped by the one as the other, and it is the easiest thing in the world to attribute the symptoms to the wrong source. In a recent very marked case of movable kidney under my care, a local gynæcologist persisted in ignoring the kidney and insisted upon attaching blame to a perfectly normal uterus and ovaries. On account of her extreme emaciation it was possible to make a completely satisfactory examination of all the pelvic organs, and I am positive that in this case the distressing nervous and digestive symptoms were due to the dislocated kidney. I would place first in prominence the general nervous disturb- ances. |