having equal rights and privileges, except that none but permanent members shall be eligible to office." Section 2.-Permanent Members. "Permanent members shall consist of those who, coming as delegates and complying witth the requirements of the Association, shall sign a statement in a book to be kept for that purpose, signifying to the Treasurer a desire for permanent membership."

Dr. Foster:-It seems that in the reading of that clause, Dr. Slater would not be a member of this Branch. He is a member of the National as a delegate from the Tennessee State Society, but is not a member of this Society.

Dr. Johnson-It seems that the question before the house is whether he is a member of the Branch or not. 'Tis not a question of his eligibility. He may have been a member before the amalgamation, but is he a member now? We cannot make an officer of one who is not a member of the Southern Branch.

Dr. Melindy:—According to the reading of the Constitution of the National Association, members of this Branch are members of the National, but the converse does not necessarily hold.

Eleventh section was adopted.

After the reading of the next section, the report was adopted as a whole.

Dr. J. Y. Crawford, Nashville:-I have a few things to say about Dr. Brophy's very interesting lecture made last night. I want to thank him for his presence here, and for the great work he is doing in this line. We are certainly under many obligations to him. He suggested some very interesting technical features with regard to the operation for closing cleft palates, hare-lips, etc. There is a great deal to be learned from the study of this work from Dr. Brophy's standpoint. It is of especial interest to us from the standpoint of the unfortunate sufferers, who are born with these defects, making the appreciation of Dr. Brophy's work all the more marked. It is of special importance in that it saves human life. There is no operation in surgery in which the beneficial results are more marked than in this. The fact that it is capable of preserving human life commends it to us. When children are born into the world with complete cleft of the hard and soft palate, not being able to partake of the food provided by nature, their physical and mental faculties cannot be properly developed, and

operation that will obviate this disadvantage, and place the child on equal footing with those born without any abnormality, I say, is of vital importance to the profession and to humanity.

Dr. S. W. Foster, Atlanta:-I want to thank Dr. Brophy personally for his lecture delivered to the Association last evening, and also for the great work he is doing on this particular line. I have one or two questions I would like to ask Dr. Brophy with regard to his operation for the closing of a cleft: Where it is necessary to perform two operations for the closing of a cleft, how long after drawing the maxillary bones together would you wait to perform the second operation for closing the soft parts? And, further, in running these sutures through the maxillary bone, how long do they have to remain?

Dr. Brophy:-It is not always necessary to make a division at the malar process. It is done only in such cases as would make it impossible to bring the parts into proximity without this. In the event of having a broad cleft in the palate, we make these incisions in order to bring the parts in contact. Pressure upon the sides of the bones will serve the purpose of bringing the jaws in contact. These wires are adjusted and the parts kept in contact by pressure for about five or six weeks, sometimes longer. I remember one case where the wires remained in three months. When the patient returned, the parts were firmly knitted with no special detriment to the tissue. No marked inflammation followed, nor any breaking down of the tissue. I have never seen a case of the breaking down of the hard parts from such pressure. The bone tissue ordinarily requires six weeks to reunite. After the bone tissue is thoroughly adapted, we allow it to remain two months at the shortest. The plates are removed by raising the plates from the tissues, clipping the wire, and removing one plate, and then the other together witth the wires passing through the tissues. Some six months should pass before the soft palate is operated upon. After we have the pre-maxillary bones brought back into position, we then operate upon the soft palate.

Dr. Foster-With regard to passing the sutures through the plates, do you have the wires passing through the pre-maxillary bones four different times, and do you have two loops-one at each end of the lead plates?

Dr. Brophy:—If the tissue is wide, we have four sutures passing through. The technique should be clearly understood before. attempting this operation. Use strong needles, carrying strong silk sutures through the tissues at the median line, having the silver sutures attached to this silk suture in order to carry it through the plates. The needles are not used to carry the silver suture through the plates. The stiffness of the wire makes it difficult to carry it with the needle. The silk, however, is pliable, and may be carried through the tissues with no difficulty, and, when we get the silk sutures through the wire sutures are easily carried through the plates, and the parts are brought into proximity by pressure simply twisting the silver wires together. We do not divide the bone through the entire length at the malar process. It is only divided about half way.. When this has been divided, we find that the tissues will stretch something similar to the bending of a green stick. With pressure the two sides may be brought into proximity.

Dr. Bland: What effect does this operation have on the voice? Dr. Brophy:-In all the cases that I have seen there is no difficulty with the voice as compared with the voice of others. Their articulation is usually very good.

Dr. Crawford: In older patients, how long do you let the sutures remain?

Dr. Brophy:-The silk sutures are removed in about a week, except in certain cases I may leave them nine or ten days. Usually the coaptation sutures are removed in a week. The lead plates and silver sutures are allowed to remain two weeks, sometimes longer. After having the parts well united, it is better to let them remain a little longer, so that the parts will become strong, and prevent any foreign substance from being forced through. I remember in one case, that I operated upon with good results, after I removed the coaptation sutures and lead plates, and dismissed my patient, the family had a reception at the Palmer House to rejoice over the result of the operation upon the child. During the evening the child forced something through the tissues, opening the cleft again. I was sent for immediately, and had to perform three operationc before succeeding in closing it the second time. This simply illustrates the value of allowing the parts to grow to

gether and reunite firmly. The question was raised in New York last winter about putting, something in to keep the patient from forcing any foreign substance through the tissues after the operation. It was suggested that a rubber denture be made, and placed in the mouth as a protection to the parts. I have never used such a protection, and do not think it necessary.

Dr. Chase, Ocala :-How many cases prove failures?

Dr. Brophy: In the address that was delivered at Paris, which was distributed to you last night by Dr. Chapple, I reported all cases, and out of that number two deaths occurred, which I did not attribute to the operations, but to the conditions that followed two weeks later. Unfortunately, the second patient I operated upon died. The patient had not only a double hare-lip and cleft palate, but the fontenelles were involved. In both these cases meningitis resulted almost simultaneously, and we could not save them. It seemed to be more from external conditions than from any other.

On motion the subject was then passed and Dr. L. G. Noel, of Nashville, Tenn., read a paper on

A CASE OF ALVEOLAR ABSCESS WITH OPENING UPON THE OUTSIDE OF THE FACE CAUSED BY DEATH OF THE PULP IN A THIRD MOLAR INDEPENDENT OF CARIES.

In October last Mr. M., a gentleman aged about 30 residing in West Tennessee, applied for my advice about an abscess opening upon his face at a point about mid-way between the mental symphysis and the right lower wisdom tooth, and upon the body of the lower jaw. An examination of his teeth revealed no cavities that could be the cause of this condition, nor was there at this time any pain caused by tapping sharply upon his teeth with the handle of a heavy steel instrument. Upon questioning my patient, I brought out the following facts: He had had repeated swellings in the gum and underlying tissues about the right lower wisdom tooth, sometimes involving the throat which would become intensely sore. These attacks had lasted sometimes for weeks at a time and had been experienced at intervals through a period of six years. (Perhaps ever since the eruption of the wisdom tooth.) There was a rather crowded condition of the teeth in the jaw, but not extraordinarily so, the wisdom tooth was fairly well placed

and fully erupted. The last swelling and closure of the jaw had occurred in June and had been the most serious attack of all. The patient had sought the advice of a physician who, after a number of days of treatment, had lanced the abscess from the outside of the face, discharging a great quantity of pus. From that time it had continued to discharge a thin offensive pus, irritating to the skin, and soiling the clothing. At the time I first saw the case in October, all acute symptoms had passed, the patient had regained free use of the jaw, there was no tenderness upon percussion, the teeth were all tight in their sockets and nothing but the appearances then presented and the history of the case to guide to a correct diagnosis. My mind was, however, soon made up and I advised the immediate extraction of the wisdom tooth. When questioned by the patient as to whether this would end his troubles, I expressed the belief that it would, but pointed out the possibility that a small area of necrosed bone might exist and have to be removed surgically before a cure could be effected. Being a very timid man, he deferred the operation, sought the advice of other dentists and surgeons, and at last returned to his home without having anything done for his relief. After the elapse of a month he returned to me and timidly suggested his willingness to submit the case to me, provided I would use anæsthetics. After the injection of 1⁄2 grain of Nirvanin into the peridental membrane at several points around the neck of the wisdom tooth, I proceeded to extract it, and though firmly set and difficult, I succeeded in accomplishing this without fracture of either of its roots. I next proceeded to wash out the wound with pasteurine solution, forced through a dental syringe, and was much pleased to find a portion of fluid escaping at the external opening. I then took the tooth to my bench vise in my labaratory and cracked it open. Here I was again lucky, for I had the good fortune to crack it along the line of the canal in the anterior root. The pulp had been dead for some time but its chamber and much of this anterior canal was occupied by a mass of secondary dentine. I present this tooth with my report to verify my statement.

My theory is that the repeated swellings of gum and peridental membrane were caused by particles of food lodging about the gum edges, and undergoing putrefactive fermentation. This produced