in order to prevent the extension of the septic process into the lung the internal jugular must be ligated, low down in the neck, immediately beneath the sterno-clavicular junction. The incision should then be carried along the anterior border of the sterno-mastoid to a point midway between the angle of the jaw and the tip of the mastoid process.

The internal jugular should be located in its sheath with the internal carotid and pneumogastric nerve. The numerous tributaries of the vein should then be ligated and severed, and the vessel, with its infected sheath, excised and dissected out from its point of ligation to a point as close to the jugular foramen as possible. If no infected material has escaped into the neck wound, the incision may be closed with sutures of silk or silkwormgut. In the majority of cases, however, it is safer to leave the wound open to heal by granulation.

The ever-present dangers of chronic suppuration are. before you. How will you act? I heartily endorse the words of a recent writer:

"The day is past when intelligent people will be lulled into a false security by the belief that a running ear means nothing, and that a child will outgrow it.

"They are learning to appreciate it as a dangerous condition, while the medical fraternity recognizes that chronic suppuration of the middle ear is responsible for by far the greatest number of intercranial complications and deaths."

DISCUSSION ON DRS. COX'S, ROY'S, CALHOUN'S, STIRLING'S AND CUNNINGHAM'S PAPERS.

Dr. A. W. Calhoun: I did not hear all of Dr. Roy's paper, but Dr. Stirling's and Dr. Cunningham's were not only interesting, but very important. Paralysis of the ocular muscles is of variable duration. I am sorry that

Dr. Stirling did not say more about his cases and give us some treatment that he would suggest.

As to the cases of Dr. Cunningham, they are much more common than paralysis of the muscles, and we realize more and more how very dangerous they are. It is true that we allow these to go without operation, and it is also true that they should not be operated upon by an incompetent person. I have been fortunate enough never to have had thrombus of the sinus, or possibly have not been able to recognize it. I do not care to get these cases if I can avoid it. If you make a mastoid operation and cut into the sinus it looks as if the entire body is coming out at one time.

As to the case of Dr. Roy, of which I heard only the latter part on infantile stenosis of the lachrymal duct, I see many of these cases and they are usually due to some unknown cause of obstruction, and possibly through some little irritation of the nose. It has been my experience that they do not require an operation. I do not remember to have operated upon but one, and all the others got well. The treatment is about as Dr. Roy has outlined. Look after the condition of the nose, and use some astringent with a constant pressure. This will almost invariably

cure these cases.

Dr. J. L. Hiers: I regret very much that I was not present to hear the papers presented by Drs. Roy and Cox, and also regret that Dr. Stirling and Dr. Cunningham did not read their papers in full. There is nothing like hearing the clinical history, and nothing so good as hearing this from the author himself. You can read them, but this is not so good as hearing them from the essayist.

As to Dr. Calhoun's case, we must consider the cataract as the most important operation which we are called upon to perform, because the patient's future de

pends upon the result of the operation. Especially is Dr. Calhoun's paper of great value on account of the opinion. which exists among the leading ophthalmologists in our country and the lack of positive literature upon the subject, and particularly on account of Dr. Calhoun's broad experience and his fitness to present the subject in such an able manner. I concur most heartily in all that Dr. Calhoun has said upon this subject, and I feel that we are greatly indebted to him for the presentation of this subject at this particular time.

Dr. Ross P. Cox: In reference to bilateral operation upon cataract, I think Dr. Calhoun's position in the main is correct. I think that to lay down an absolute rule is carrrying it too far. Where the patient is in good physical condition, and where we can be reasonably sure of our asepsis, and the patient has come a long way, it is proper I think in such cases to do both operations at the same time. We know this is done. Many and many a time I have stood behind Professor and seen him remove one with the right hand and the other with the left and get good results. Of course, you should be careful of the condition of the patient. In very old and feeble cases we should not subject them to the double operation, on account of the shock, etc.

In reference to the suppurating mastoids and lateral sinus thrombosis, I have seen half a dozen operations in the last year, and all recovered, and I had three cases which consulted me and whom I advised to have the operation, as they had other symptoms, and who declined and died, and half a dozen others who declined and recovered. There is no doubt that the exact knowledge to tell just which cases should be operated upon is still lacking. There is still a certain amount of doubt as to when we should operate, but the general practitioner is too con

servative along this line. In proper hands it is not at all a dangerous operation to open the mastoid and expose the lateral sinus and get at the bottom of the trouble.

Dr. A. W. Stirling: I agree in these papers. I think there is not a one of us who would like to say that a patient should or should not have the double operation, as there are many things to be decided in each individual

case.

In most instances of lachrymal stenosis, the passage of a probe is all that is required.

In regard to Dr. Cunningham's case, I have seen the sinus opened in three cases with recovery.

Dr. W. E. Campbell: I think the paper that should receive the most general consideration is the suppuration of the middle ear, leaving out the thrombosis of the lateral sinus. I have thought that nine out of ten of these cases should be surgical cases, and should be so treated. We must get down to the bottom of the trouble to cure it. I venture to say that 20 per cent. of these cases are not cured by the specialist, and they should be treated as surgical cases. I realize that the operation is often denied, and it is often treated as a simple trouble.

PROSTATIC MASSAGE.

By W. L. CHAMPION, M.D., ATLANTA.

In a few words I desire to bring before this Association a comparatively recent adjunct in the treatment of deep-seated gonorrheal infection that is indispensable in many cases, if a cure is perfected. This advancement is not original, but one that sufficient attention has not been called to to lessen the number of infections and gain the results in practice we all hope for. The profession as á whole will never be enlightened as to the serious nature of gonorrheal infection, and become so familiar with the disease that each and every member can knowingly inform a patient when he is no longer infected, or can safely marry. Still the work that has been accomplished within the past few years along this line, showing the large percentage of innocent women with acute pelvic troubles, due to the gonococcus, has opened the eyes of many, and it is to be hoped that in the near future the men in our ranks, as well as the laity, will not look lightly upon a disease that causes more suffering than tuberculosis or syphilis. A statement of this kind may be looked upon as a joke or flippantly dismissed, but any gynecologist of experience or genito-urinary surgeon will bear out the assertion. The careless manner in which gonorrhea is treated and dismissed by many practitioners is a stumbling-block to more rapid advancement in the treatment, and in a measure to the suppression of this disease. When the profession looks upon gonorrhea as a disseminator