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A study of fetal mortality
was not identified outsillr the certain criteria. The left tube Whether the sac which is continuous with the uterus is an t~nr~rmously which ruptured at the fiml~rinted extremity must still i)e (l~~ci~le~l.
gestation enlarged
WC. tulle
DR. E. B. PIPER-The high mcrtxlity SIWWII on sonar of these charts was some times largeay a question of knowing the child was lost on admission, and too Therefore they were treated as seemed hest in late for a cesnrean section safely. We do ilot, believe there is any routine way. the eyes of the individual doctor. As for the statements made about, outMoor obstetric services, I desire to state that the fourth-year medical student of today is a great deal better prepared to take care of obstetric cases in private homes than were many of the older men when the: The fourth-year medical student is t,raincd to 1~ received their degree in medicine. 111 :I series of four thousand and some able to diagnose and send in bad eases. hundred cases in the Routheastern Dispensary of Phil:ttlelI~hin. the morl.ality of the cases handled by students was 3.2 per cent. DR. WlLLIAM R. NIC’HOL80N.---I am thoroughly in favor of the statement made regarding the use of forceps in the after-coming head cases. I think there is no doubt that, infant death rate is very much reduced hy forceps delivery. DR.
JOHN
Urethra.
A.
MCGLINN
(For
original
read a paper entitled Reconstruction art,iicle SC<’page 262.)
of the
DR. EDWARD 9. RCHUMASN.---(I;~ses of rrconstrut~t,ion of the urethra may 111’ divided into two groups. One group includes the fundamental eases, the other those of traumatic origin. connected with an insufficient The first group, of hypospadias cases, are always and in them reconstruction is much more ~lifllcult lreeause of the blood supply, danger of anemic tissues breaking down. The second group offer an almost, equally strong ob,jrction to closure, in that most of them have suffered so many ntt,emptn at repair, and the vagina has been reduced to a mass of filnous tissue. In one ease in which I :ittempted the Ward teehnie nith a rennonal~le degree of success, the bladder fistnla was so large that I felt I could not get a wide enough flap of tissue to close it. I therefore made a successful attempt to reduce the size of the bladder tissue, anti this method has now heeome habitual with me. DR. F. II. MAIER.---lt has I~rn out practice Pfnnnenstiel incision urinary fistulae which were vagina and which had heen unsuccessfully operated
to correct through the suprapubic diffic,ult of correction through the upon hefore.
DR. J. H. GIRVlW.-1 have recently had two reconstructions of the urethra and had rather unfortunate results in both cases. The first I have operated upon at least fifteen or sixt,een times. We gradually closed the opening of the bladder, and then reconstructed the urethra, Iiut of course with no muscular control. This looked so favorable that I tletermined I woultl bury some muscle filter around the urethra. I used fibers of the Ierator ani muscle, and got a very successful result: lmt she left the hospital with a rc~ctovaginal fistul:r which I hare not yet heen nlile to close.
gestation enlarged
WC. tulle
DR. E. B. PIPER-The high mcrtxlity SIWWII on sonar of these charts was some times largeay a question of knowing the child was lost on admission, and too Therefore they were treated as seemed hest in late for a cesnrean section safely. We do ilot, believe there is any routine way. the eyes of the individual doctor. As for the statements made about, outMoor obstetric services, I desire to state that the fourth-year medical student of today is a great deal better prepared to take care of obstetric cases in private homes than were many of the older men when the: The fourth-year medical student is t,raincd to 1~ received their degree in medicine. 111 :I series of four thousand and some able to diagnose and send in bad eases. hundred cases in the Routheastern Dispensary of Phil:ttlelI~hin. the morl.ality of the cases handled by students was 3.2 per cent. DR. WlLLIAM R. NIC’HOL80N.---I am thoroughly in favor of the statement made regarding the use of forceps in the after-coming head cases. I think there is no doubt that, infant death rate is very much reduced hy forceps delivery. DR.
JOHN
Urethra.
A.
MCGLINN
(For
original
read a paper entitled Reconstruction art,iicle SC<’page 262.)
of the
DR. EDWARD 9. RCHUMASN.---(I;~ses of rrconstrut~t,ion of the urethra may 111’ divided into two groups. One group includes the fundamental eases, the other those of traumatic origin. connected with an insufficient The first group, of hypospadias cases, are always and in them reconstruction is much more ~lifllcult lreeause of the blood supply, danger of anemic tissues breaking down. The second group offer an almost, equally strong ob,jrction to closure, in that most of them have suffered so many ntt,emptn at repair, and the vagina has been reduced to a mass of filnous tissue. In one ease in which I :ittempted the Ward teehnie nith a rennonal~le degree of success, the bladder fistnla was so large that I felt I could not get a wide enough flap of tissue to close it. I therefore made a successful attempt to reduce the size of the bladder tissue, anti this method has now heeome habitual with me. DR. F. II. MAIER.---lt has I~rn out practice Pfnnnenstiel incision urinary fistulae which were vagina and which had heen unsuccessfully operated
to correct through the suprapubic diffic,ult of correction through the upon hefore.
DR. J. H. GIRVlW.-1 have recently had two reconstructions of the urethra and had rather unfortunate results in both cases. The first I have operated upon at least fifteen or sixt,een times. We gradually closed the opening of the bladder, and then reconstructed the urethra, Iiut of course with no muscular control. This looked so favorable that I tletermined I woultl bury some muscle filter around the urethra. I used fibers of the Ierator ani muscle, and got a very successful result: lmt she left the hospital with a rc~ctovaginal fistul:r which I hare not yet heen nlile to close.