able rules for treatment. They would teach the student of medicine that there must be a fixed diameter of these cavities, to be made so if necessary by wholesale destruction of tissue. They seem to forget that the Divine Creator never made a perfect man and we might say perfectly proportioned nasal cavities.

This aggressive treatment of nasal diseases is much to be deplored. I mean by aggressive such things as the too frequent use of the electrocautery, the operative intervention for every anomaly which prevents the nasal chambers from being mathematically corrret in their proportions, and last but not least the daily use of sprays, which is unscientific and the producer of an exceedingly pernicious habit. In a recent address, Dr. Chas. H. Knight, of New York, has most happily expressed my own views on this important subject. He says: "In consequence of this rhinological enthusiasm, the nose has been looked upon as a probable source of every human ill, and a ruthless slaughter of intranasal structures, without regard to their physiological functions, has been universally practiced. Happily a saner view is coming to prevail, and the belief is growing that epilepsy, asthma, dysmenorrhoea and arthritis of the knee may have other causes than a hysterogenic zone or a point of pressure within the nasal fossæ."

DISCUSSION OF PAPER BY DR ROY.

Dr. Shorter: No man is too well grounded in medicine before taking up a specialty. We have specialists in gynecology who believe that every ailment is due to something in their specialty. There are some in our specialty in same way who believe that everything is due to eye-strain. I think this is a question, as Dr. Roy says, not of new expedients, but to refrain from removing things which are not really pathological. Fifteen years ago we operated five times where we operate once now. People forget that the

nose or the eye is just as much a part of the body and amenable to systemic treatment as the liver is. I have seen a case of seeming organic stenosis relieved by doses of calomel and Carlsbad salts. In the same way cases of chronic congestion of the mucous membrane in any part of the body may be relieved. In the treatment of acute rhinitis the homeopathists are often triumphant, for they consider everything as serious and put the patient to bed, and if we could only do this all our patients would get well without any trouble.

I think that Dr. Roy's paper is a very valuable one as a whole, and teaches us that we should not rush in with the knife and saw and destroy what can not be replaced.

Dr. Roy (in closing): I have nothing of importance to say in closing. The main object in reading this paper was to call attention to what I believe to be many defective lines of treatment that are being used every day, and especially about the spray habit. I don't think there is any doubt that this is as much a habit as that of the cocaine or morphine. Many patients have to take their spray every morning as they would their cup of coffee, and the result is a dry condition of the mucous membrane by the constant application of this oily menstruum, and in time it makes the mucous membrane cry for more and more of the remedy. In the large majority of cases if there is any secretion in the nose an oily spray is not the kind to prescribe. Oil and mucus will not mix, as the latter forms a coating over the other and does not remove it, but if you will use a saline solution you can cleanse the surface and it will then act beneficially.

We can not look at the spray habit blindly. We see it too often. We often have the cocaine habit following it, as they will continue to use it until made one of the worst habitues possible. I do not think that cocaine should be put

in any spray. I have not used such for eight years. These are the cases which get the toxic effect. When I use it I place it on a pledget of cotton and put it on the exact spot I wish it, and in this way you do not get the systemic effect. When we remember that many cocaine habitues are produced by physicians thus prescribing it, we should call a halt.

REPORT OF COMPLETE OPERATION WITH RECOVERY OF PATIENT.

A few years ago ectopic gestation was considered rare enough to be interesting only to those engaged in the special work, or as a surgical curiosity. With more careful diagnosis and extensive investigation, it no longer takes its place as rare or uncommon, but is encountered with great and often distressing frequency, so much so that the general practitioner must be prepared to recognize this condition and take care of it himself, or else summon aid as early as needed for the saving of the patient. I do not desire or intend in this brief paper to do more than call attention to a few of the essentials connected with this condition, and I trust a free discussion may follow.

The causes of ectopic pregnancy, based as they are on theory, must be numerous, and, as our knowledge of the condition increases, the number of causes assigned will diminish.

The chief causes are as follow:

1. Fertilization of ovum in the tube was considered by Lawson Tait as one cause of this condition; he, believing that normal fertilization should occur in the uterus, and when this took place in the tube ectopic gestation ensued. This has been proven fallacious.

2. Tait also believed that a desquamative salpingitis

paved the way for an implantation of ovum in Fallopian tubes, as he believed menstruation prepared the uterus for implantation of ovum. Hart also believed that there must be a solution of continuity of the mucous membrane in order that implantation should take place; if this occurred in Fallopian tubes then tubal pregnancy ensued, etc.

3. Webster claims that in ectopic gestation there is a decidual formation in the Fallopian tubes which may interfere with the progress of the fertilized ovum.

4. Peters and Sippel claim that instead of a decidual reaction, there is an epithelial reaction which may obstruct the passage of the fertilized ovum.

5. External transmigration advanced by Sippel.

6. Virchow attributes ectopic gestation to perimetritic adhesions.

7. Infantile tubes, in which the tubes are very much distended-Freud.

8. Diverticula and tortuosities of tubes.

9. Polypi occluding the lumen of tube or myomatɛ distending or compressing the tube.

10. Hyperinvolution of tubes.

11. Strassman views this as purely an obstructive condition due to inflammation.

12. From no assignable cause.

From the above it is plain to see that the causes are rather obscure, or they are numerous. All will agree, however, that the vast majority are due to inflammatory conditions of the generative tract.

VARIETIES.

The division has been for years into tubal and ovarian. There is, however, no case of pure ovarian pregnancy which has not been very strenuously assailed and its origin disputed. The tubal is subdivided into (1) inter