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Meeting of May ^, 1S86. Dr. L. a. Stimson in the Chair. Eesection of the Elbow Joint for Ankylosis.— Dr. H. B. Sands presented a patient fifteen years of age who was first seen by him last autumn, in consultation, in Dartmouth, N. S. The ankylosis at that time maintained the arm and forearm in almost a Order Levitra Over The Counter right line ; the ankylosis, he thought, was almost Order Levitra Over The Counter complete, and had existed since the boy was about two years of age. The usual operation was performed, but, when the patient was again seen by Dr. Sands about a month ago, very much the same condition existed as before, and there was little if any motion, the arm being almost useless. He repeated the opera- July 3, 1886. PliOCEEDINOS OF SOCI£T/ES. 19 tion of resection of the joint nineteen days ago, when he re- moved about two inches of bone and placed the forearm at a right angle. Primary iiuiim of the divided soft parts occurred in thirteen days; the dressings were then Order Levitra Over The Counter removed, exjjosing the line of the incision. Only one incision was made, situated iu the median line ; the adhesions were then forcibly broken up, and the ends of the bones turned Order Levitra Over The Counter out of the wound and sawn off to an extent of two inches. Dr. T. M. Markoe asked if the periosteum was saved. Dr. Sands replied that it was not, and that he thought the snb-periosteal operation Order Levitra Over The Counter in these cases was often prejudicial in- stead of being of advantage, as one could never tell how much bone was going to be reproduced, and the reproduction often caused stiffness of the joint or limitation of motion — the very thing to be avoided. Dr. A. G. Gerster asked if any signs of previous tubercular disease were discovered. Dr. Sands replied that there were none. Dr. Gerster would venture to say the explanation of the prompt healing of the wound was because there was no tuber- culosis present. Dr. Markoe asked Order Levitra Over The Counter if there were any evidences of disease of the bone. Dr. Sands replied that there were not. The Chairman asked if the wound was absolutely dry in thirteen days. Dr. Sands replied that it was, and that during the operation the one-to-a-thousand bichloride solution was used, and the dressings were saturated in the same and partially dried. The Chairman asked if he had given up iodoform. Dr. Sands replied that he had almost done so. Dr. Gerster remarked that he had noticed these secondary operations, as a rule, did well, and he thought the explanation might be that in the primary operation intermuscular planes of connective tissue were opened into almost as a rule; that the wounds, therefore, were of a rather irregular and sinuous char- acter, drainage was difficult, and spreading of inflammation was easy; and that these circumstances formed favorable opportuni- ties for Order Levitra Over The Counter suppuration ; whereas, when a secondary operation was performed, the work was in uniformly dense, firm tissues, which gave a comparatively smooth capsular wound, the drainage of which was perfect and tended to rapid recovery. Dr. Sands had no doubt that might be one explanation of the successful results, but lie had noticed that, when operations had been performed upon cicatricial parts, Order Levitra Over The Counter union by the first intention was less apt to Order Levitra Over The Counter occur when the parts were in a normal condition. Dr. Gerster asked if the Esmarch bandage was used in this case. Dr. Sands replied that it was. Glinical Aphorisms on Fibro-myomatous Tumors of the TIterus. — The following paper was read by Dr. F. Lange: Among a limited number of fibro-myomatous tumors of the uterus which have altogi-ther come under my observation, I have had the opportunity in three instances to see a rather uncommon termination of the disease — namely, in two cases by expulsion of tumor masses after spontaneous sloughing; in the third case by shrinkage of the tumor after central suppuiation and soften- ing. In all of these cases more or less surgical help became necessary to aid the natural process, but Order Levitra Over The Counter all of them, in spite of a protracted serious illness, at last ended with recovery, and illustrate in a very eloquent manner the ability of nature to find — in spite of heavy obstacles — its way toward ultimate recov- ery. The following short histories may sutiiciently point out the essential features of the above cases: Case I. — On the 12th of October, 1883, 1 saw, in consultation with Dr. Schaie, of this city, Mrs. B., forty-five years of age, who was suffering from a large abdominal tumor which had ex- isted for about three years, and by a number of physicians, both here and abroad, had been diagnosticated as a fibro-myoma of the uterus. To Dr. Schaie I owe most of the following notes about the history : Mrs. F. had been advised everywhere not to have an operation done, on account of the great risk attached to it. Within the last year she had been treated repeatedly, for long periods of time, with ergot, administered hypodermically as well as internally, but without any noteworthy success in refer- ence to hseraorrhage or the size of the tumor. The latter, when I saw the patient, filled, as a resistant, somewhat irregular-shaped mass, almost the entire abdomen. Having at that time already operated successfully upon several patients with exceptionally large, sohd uterine tumors, I proposed, in view of the intense suffering of the patient, the radical operation. The patient de- clined. In the beginning of November her condition became feverish, there appeared an offensive discharge from the vagina, and she lost rapidly in flesh. On the 18th of November Dr. Schaie was able to remove a piece of the tumor of about the size of the fist, in a decomposed necrotic condition, from the vagina, which for the next two weeks was almost daily followed by others of smaller or larger size. A particularly large piece was extracted from the uterus at the end of November. I then saw the patient