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the flow of bile through the duct, has relieved the ob- struction and been followed later by restoration amoxil 875 mg of the biliary flow. The author's experience has been that an amoxil 250 mg artificial opening from the gall-bladder or the common duct into the alimentary canal has only been thought proper when other methods have failed to overcome com- plete occlusion of the duct. Anastomosis may be effected with the duodenum or the small intestine, but the method with the colon which is sometimes employed is the least desirable of all. He then referred to his experiments upon dogs which dem- onstrated the feasibility of a fistulous communication of the gall-bladder with the bowel. From statistics he showed that the various methods are comparatively free from danger amoxil 875 and are really attended with considerable success. Dr. H. W. Cushing of Boston read a amoxil price paper, en- titled TRAUMATIC RUPTURE OF THE PANCREAS; FORMA- TION OF amoxil buy HEMORRHAGIC CYST; OPERATION FOL- LOWED BY A PANCREATIC FISTULA AND RECOVERY. The rupture of the pancreas in this case was caused by a blow on the abdomen and was rapidly followed by the formation of a large pancreatic cyst closely resembling an abdominal aneurism. 500mg amoxil Five weeks after amoxil 400 the injury the author evacuated the cyst through an incision in the ab- dominal wall and put in drainage. On the third day fol- lowing the operation there cheap amoxil was spontaneous evacuation of a subphrenic abscess through amoxil buy online a bronchus, following which rapid improvement in the patient's condition was noted. Considerable pancreatic fluid escaped from the abdominal amoxil 875mg wound, the cyst rapidly became merely a small sinus and this healed seventy-seven days after the opera- tion. During the amoxil 250mg patient's convalescence the author took ad- vantage of the rare opportunity to investigate the char- acter of pancreatic fluid in the human subject. It was found to be strongly alkaline in reaction and was of a specific gravity of ion instead of 1030 as quoted by many authors. When this fluid came in contact with the epidermis it destroyed it, much to the patient's annoyance, but it did not effect the peritoneum or the granulation tissue. Upon measuring the amount of secretion it was found to vary from 5 to 60 cubic centimeters per hour, the maximum being during digestion. The total amount per day was quite double that generally stated by physi- ologists who claim about 300 cubic centimeters, whereas in this case it amounted to from 500 to 660 cubic centi- meters. The interesting features of this case were the peculiar character online amoxil of the injury which caused the lesion, the amoxil tablets diffi- culty of diagnosis, amoxil 500 the complication of a double parotiditis, and its connection with the abdominal injuries, to say nothing of torticollis, a subphrenic abscess, and the ex- ceptional opportunity afforded to investigate human pan- creatic fluid. So far as amoxil 500 mg the author knows on no previous occasion has the rate of flow and accurate measurement of this fluid been made. Fifteen months after the opera- tion the patient was well and seemed none the worse for his experience. Dr. W. W. Keen of Philadelphia referred to a case which came under his observation in which there was no Digitized by VjOOQLC May 7, 1898] AMERICAN SURGICAL ASSOCIATION. 605 wasting, no sugar in the urine, and no fatty stools. He inclined to the belief that simply opening and draining these cases was usually sufficient. Dr. Halsted stated that he had seen four or five cases of pancreatic cysts. Dr. T. F. Prewitt of St. Louis referred to a case of enlarged spleen which he observed some fifteen years ago. and when operated upon a cyst of the pancreas amoxil 250 was found connected with it. The woman made a perfect recovery. He also stated that he had seen a case which had lost much flesh while confined to bed for four months with a large tumor-like swelling amoxil order in the median line. Upon opening this, much pus and fluid escaped and it was noted that the tumor extended to the backbone, making a counter-opening necessary. A calculus, believed to be of pancreatic origin, was found and removed and was probably the cause of the tumor. Dr. N. B. Carson of St. Louis presented a paper, entitled . cerebellar tumors. He called attention to a much- neglected symptom in these cases, namely, the so-called "cranial cracked-pot sound." This sound is due to separation of the sutures from internal pressure caused by an accumulation of fluid in the brain cavities owing to pressure upon the veins of Galen. He had been able to elicit this sound in four cases but cautioned surgeons against mistaking it for certain high pitched sounds that are occasionally present in certain brain tumors. The sound, he claimed, may be present at any time of life before the sutures have become per- manently united. Dr. Keen mentioned a case in which this sound was first elicted by a patient himself when feeling his head one morning after having the night before fallen through the roof and fractured his purchase amoxil skull. It was a valuable symptom and particularly where any doubt existed as to the frac- ture or the necessity for operation. He had observed hydrocephalus in the acquired form amoxil generic many times during the

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