Genital Malformation in a Child of Eight Years, Associated with Acute Suppurative Appendicitis

AM.

formed pubiotomy cases nor does it DR.

HALL.-You

DR.

BILL.-A

ASSN.

OBST.,

has no direct add materially cannot rertain

QYNEC.,

connection with to the danger say

that

percentage

with of

AND

reference craniotomies

iu a Child Appendicitis.

of Eight (For

303

SURG.

the sepsis which of infection.

DR. H. W. YATES, DETROIT, MICE., presented

Malformation Suppurative

ABD.

is present

to

eraniotomy?

is

followed

a report

Years, A.sm5a.W

original

article

by

in these

sepsis.

of the Genitd

with

Acute

see page 261.)

DISCXJSSION DR. G. VAN AMBER BROWN, DETROIT, MICHIGAN.---Dr. Yates spoke of the mental development associated with this malformation and some work which I have been doing this summer on the urinary tract leaves with me the impression that malformations of the urinary tract are frequently associated with malformations of the brain. This will be referred to in my paper tomorrow. While the doctor was presenting this case I was reviewing in my mind the comparative anatomy of the pelvis. In all forms of the higher vertebrate we have complete bony vertebrae. The elements may vary in proportion as well as in their placement. For instance, the acetabular bone which in the mole is very large we very seldom think of in considering the human pelvis; and yet it is present, although not very manifest. In the lower forms of life, like the snake, the fish and the shark, there is an incomplete pelvic girdle. I know it is often said, the snake has no pelvic girdle, but in some of the larger ones of the Orient, like the cobra, they not only have a pelvio girdle, but they have hind legs. In the shark there is lack of fusion of the elements, which elements are connected with the pelvic fin. The bony fishes present another type in which the elements are united at the center and connect with the vertebral column. The amphibian has a complete pelvic girdle-wrhile the elements may be cartilaginous, the girdle is always complete. So in nearly every animal, except in snakes, we have some form of a pelvic girdle, and except in the snake it would seem to be impossible to have locomotion on the ground without some form of peivic girdle. In this connection it is interesting to note in this patient of Dr. Yates’ how much locomotion is interfered with on aecount of the pelvic girdle deformity. DR. ROBERT cases of exstrophy

FARR, MINNEAPOLIS, MINNESOTA.-& of the bladder we have the absence

it not true that in of the bony symphysis?

most

DR. RUFUS B. HALL, CINCINNATI, &iro.-The remark in reference to congenital absence of the vagina, and that these patients were mentally defective, brings up a point in my personal experience. I was consulted some years ago by a woman, 36 years of age, a teacher physically well developed, with perfect development of the breasts, but she had never menstruated. She wanted to know if she could get married. She did not know why she did not menstruate. She had never been examined. A most thorough examination failed to find even the rudiments of ovaries or uterus. She had no vagina, otherwise the vulva apparently was all right, until you separated the la.bia you would think she was a normal woman. Another ease more recent than that was a married girl, and while she was not an imbseile, she was not bright. She married when she was eighteen. She was an orphan girl who had been earning her living since she was twelve years of age as a domestic. She had never menstruated; she had no ovaries or uterus that could

304

THE

AMERICAN

JOURNAL

OF

OBSTETRICS

be found, and, no vagina, and an attempt her urethra open, and she had incontinence weeks after her marriage.

at

AND

GYNECOLOGY

sexual intercourse resulted in tearing of urine when she came to me three

DR. DAVID WILLIAM TOVEY, NTEW YORK CITY.--I desire to mention the ease of a young, well developed Italian woman, 34 years of age, married four years, she had no vagina. Her husband brought her to me for an operation and to find out if she could ha\-e d~ildren. At that time we did not know of the Baldwin operation but only the operation of making a hole for the vagina and transplanting some skin. As I have said, she had been married four years, and as near as I could ascertain from what she said, they had intercourse between her thighs. This woman disappeared from my observation. Later I was called to court and the judge annulled the marriage. The husband was willing to live with her if she could have had a vagina made. DR.. YATlG‘3 fclosing).-With regard she has as good locomotion as any child. desire to play with other children.

to

the locomotion, as far as I can see, As to her mental attitude she has no

Regarding exstrophy of the bladder in association with lack of union and fusion of the- pubic bones, I will say that the point of Dr. Far-r is well taken and eommorily reeogni72d Fusion of these ‘bouer is not pr’s<‘nt n-lien exstrollll>of till, bladder exists.

DR.

FRANCIS

REDER,

ST. LOUIS,

MO.,

Tragedy of a &ma1 Periostesl page 266.)

presented

glascom&.

a paper (For

original

entitled article

3% see

DISCUSSION DR. JAMES F. PERCY, S,AX DIMO, ~&IFORNJA.-It is difficult for me to talk about cancer without alluding to my method of eautery heat in its treatment. As I see it the profession is not quite ready to accept this method at its full value. I cannot refrain from questioning if the outcome in this patient would not have been different if the mass had primarily been removed with the cautery knife, slowly dissected out as Dr. John Byrne dissected out a careinomatous cervix in former days. Then when the growth was
REDER.-No. PERCY.-1 pelvic bones

have had following

two patients, both uterine carcinoma

women, where metastasis developed in one case and from a maliguaney