DR. GILES S. MITCHELL: Mrs. S., very stout, aged thirty-eight, married nine years. Saw her for the first time in January, 1894, at which time she gave the following history: Had never been pregnant but once, and that was during the first year of her marriage, and terminated by abortion at the end of the second month. Menstruation, always profuse, during the past year had become menorrhagia, and for the past two months had been a severe and continuous uterine hemorrhage. A careful examination revealed a symmetrical uterine tumor as large as at the sixth month of gestation. The uterine cavity measured six inches. A diagnosis of interstitial uterine fibroid was made and an operation for its removal recommended. This was positively refused. The patient was then ordered half-drachm doses each of fluid extract of ergot and fluid extract of hamamelis three times daily, and requested to remain in bed for ten days. Hemorrhage ceased and did not return; the medicine, however, was continued for two months. Menstruation became irregular, recurring at intervals of six to eight weeks and continuing for seven or eight days. A I did not see the patient again until December, 1895, at which time she consulted me for a gastro-intestinal catarrh. She had lost considerable flesh, was having from four to eight stools daily, and vomiting almost constantly. careful examination of the abdomen at this time revealed a tumor only onehalf the size of one year before. After remaining in bed for four weeks, with adherence to a milk diet, she made a good recovery. Patient's health remained uniformly good. I did not see her again until August, 1896, when she called at my office and informed me that she was pregnant. She said she had not menstruated for two months, and had other symptoms which led her to believe she was preg nant. No examination was made at this time, but I assured her that such a condition was not probable. In September I was sent for to make an examination to determine the cause of the abdominal enlargement, if it did not depend upon pregnancy. A large, irregular tumor, extending from one hypogastric region to the other, and as high up as the umbilicus, was readily mapped out. As she objected to a vaginal examination it was not made. I informed her that she had a large fibroid tumor, but as to a pregnancy complicating it I was not prepared to say. I examined her again in October. This time I carried my finger high up in the vagina. The os was up above the symphysis and almost beyond reach, and did not seem softened. The discoloration of the vaginal mucous membrane was not marked. The mammæ gave negative testimony. I again informed her that it was impossible to determine positively whether she was pregnant or not. Ten days subsequently she sent for me in great haste, the messenger stating that she was in labor. I found her in great distress, having severe abdominal pains recurring at short intervals. A vaginal examination at this time revealed a hard mass as large as a fetal head, behind the uterus and filling up the concavity of the sacrum. An attempt to move this body upward inflicted severe pain. Patient's temperature 100°, pulse 100. The pain increased, and morphia was given by the mouth, one-fourth grain every three or four hours. The following day temperature was 102°, pulse 115; abdominal tenderness general. I now recognized that I had a peritonitis to deal with. At the end of ten days the patient was free from fever and quite comfortable. I then insisted that she be removed to a hospital, to which she reluctantly consented, and selected the Good Samaritan. Two days subsequently, by request, Dr. A. W. Johnstone saw her with me, and concurred in my diagnosis. In view of the history of the case and the possibility of pregnancy existing, an early operation was insisted upon. Operation was made November 9, | fered with. The labors allowed to go to a natural termination were undoubtedly those in which there was the least hindrance to delivery, and yet they ended as fatally as did those subjected to delay, injury and sepsis. In the more recent statistics collected by Stately there are 597 cases in which no interference occurred before labor. Of these, 220, or 37 per cent., died. This reduction in mortality is owing to the improvement in technique within the last decade. 1896, Dr. A. W. Johnstone joining me The specimen here exhibited is in many ways the most remarkable I have ever seen a uterus containing a fourand-a-half-months fetus and nine distinct fibroid tumors. Dr. Vanderveer, of Albany, N. Y., in the Medical News for December 12, 1896, reports two similar cases upon whom he operated, both recovering. Of 228 cases of labor complicated by fibroids, collected by Gusserow, more than one-half of the mothers and twothirds of the children died. The assumption that many of these deaths may have been due to meddlesome interference on the part of the obstetrician is contradicted by Gusserow's carefully compiled tables. Among 147 cases of labor collected by him, 78 mothers died. Of the 61 mothers requiring manual or instrumental aid 33 died. The remaining 45 deaths were therefore among the 86 cases not inter In view of these statistics it remains no longer a question difficult to decide. between an operation and permitting a patient to take her chances of going to term. It is only too plainly manifest in the case reported and the specimen exhibited that the period at which a child can be delivered and survive could not have been attained. Operation was delayed as long as possible. The acute nephritis that caused the lethal termination was probably due to the ether. Ovarian Cyst with Twisted Pedicle. DR. RUFUS B. HALL showed a specimen of an ovarian cyst with a twisted pedicle. It was removed last Thursday at the Presbyterian Hospital, from a German woman, aged forty years. The specimen is an interesting one. The history, as given by the patient, is that five months before she had a sharp attack of pain in the abdomen, confining her to bed for several days. Before this, however, she had observed that the abdomen was considerably larger than normal, but it had caused her no uneasiness. After this attack the abdomen remained sore and tender, so that she was unable to do any work. Some ten days preceding the operation she had a second attack of abdominal pain and sent for her physician, Dr. B. F. Lyle, of this city. He diagnosed ovarian cyst, with peritonitis. Soon after this I saw the patient with Dr. Lyle, and a few days later she went to the hospital for operation. The abdomen was enlarged to about equal gestation at full term. Fluctuation in every part of the tumor. The patient had a temperature of 100°, pulse 96, the day of the operation. The interesting feature in connection THE with the specimen is that it was uni- Cincinnatì Lancet-Clinic: versally adherent, and received its entire blood-supply from the adhesions. The principal blood-supply was from the omentum. The pedicle was twisted to a rope-like mass, not as thick as the A WEEKLY JOURNAL OF MEDICINE AND SURGERY. ISSUED EVERY SATURDAY. Annual Subscription Rates.-In advance, $2.50; within the year, $3.00. little finger, and for a space of about J. C. CULBERTSON, M.D., Editor and Publisher. one-half inch was almost necrotic in appearance. From her history and the condition present, she must have had twisting of the pedicle of the tumor at the time of the first attack of pain. This twist was sufficient to cut off cir culation entirely through the pedicle. The adhesions took place at once from the inflammation, and were established quickly enough to prevent the cyst becoming gangrenous. While there are similar cases on record, yet they are not very frequently met with. It is the first one of the kind I have ever seen. The patient is convalescent, and, I believe, will recover. Treatment of Constipation. Abstain from administering cathartics in slight transient disturbances of digestion; rather let Nature take her own course. Never put a patient on a one-sided diet for too long a time; the exclusion of vegetables, fruits, and starchy foods in general from the diet is frequently the cause of marked constipation. A hygienic mode of living, regular habits, less business strain and worry, and more outdoor life and exercise, are of greatest importance to prevent constipation. The treatment of habitual constipation demands a hygienic mode of living, correction of faulty diet, increased amount of vegetables, fruits, starchy foods and fats (butter); also the patient should be impressed with the importance of not worrying and not bothering much about his bowels; train him to have an evacuation once a day at a certain time, either giving him no drugs whatever, or administering a very slight cathartic for a short period, then gradually diminishing and ultimately discontinuing its use.-EINHORN, in PostGraduate. Advertising Rates.-Fifty cents a line of ten words (brevier type). to be addressed to, and all checks, drafts and All letters and communications are money orders made payable to DR. J. C. CULBERTSON, 317 W. SEVENTH ST., CINCINNATI, 0. CINCINNATI, MAY 1, 1897. Editorial. NEW HOSPITAL WANTED. The crowded condition of the City Hospital is causing officials of that institution considerable uneasiness. All the wards are full, and it is only with the greatest difficulty that accommodations can be made for patients suffering from contagious diseases, which necessi tate them being isolated from the other patients. Eight of the fifty-nine nurses are sick and the staff is further diminished by several of them being assigned to the care of the patients suffering from contagious diseases. To say the least, the City Hospital is now being taxed to its utmost capacity, but whether or not it can stand it long is another matter. It is this fear that is causing the officials uneasiness, and which has led to the discussion of an important question and one that will undoubtedly be brought to the attention of the Board of Trustees. It is nothing less than the with a branch in the heart of the city to be erection of a new hospital outside of the city, used as an emergency hospital. That the time has come for this to be done is evidenced by Hospital, which, if it is to be used another the constant crowded condition of the City winter, will have to be equipped with an entirely new heating apparatus. Nearly all the steam pipes are worn so thin that they will have to be replaced, and this, together with outlay of at least $50,000, must be done before other necessary repairs, which will involve an next winter. The question for the Board of Trustees to determine now is, whether it would not be better to make the change at once and erect a new hospital, instead of going to the expense of repairing and relaying new pipes in a build ing that in another year will not be able to meet the requirements expected of it. Physicians of this city are almost unanimous in the opinion that the time has come for the erection of a new hospital. They believe that it should be built on the hilltops, where the fresh air would be of so much benefit to the patients. Cases that required prompt attention could be taken to the emergency hospital and daily transfers could be made between the two buildings, so that at no time would the emergency hospital be overcrowded. By disposing of the present building, which is owned by the city, the proceeds would more than suffice for the erection of a new building. The railroad companies centering in this city have for a long time been anxious to turn the hospital building into a depot. A change will have to be made in the near future. The rapid growth of the city demands it, and it is not improbable that the matter will be brought to the immediate attention of the Board of Trustees. The above sparklets are from the unconscious cerebrations of a reporter for a morning paper, which aptly illustrate the possible visions that may flit through the brain of a highly sensitized imaginative young man who has dreams of grandeur, indicative of a raggededged alienation which is likely to require him to make an involuntary call upon the Judge of the Probate Court. The young man saw a crowded condition in the City Hospital at a time when there were fewer patients in the hospital than at any period for several years. The consequent uneasiness of the officials is lest their occupation be taken from them by reason of a lack of patients. "Wards full and greatest difficulty that accommodations can be made for those suffering from contagious diseases," when some wards are actually closed, or have less than half-adozen inmates, where fifty beds are empty. Some of the nurses are sick. That is nothing remarkable. In an institution of this kind some of the nurses or internes are always sick. The continuous inhalations of the exhalations from the bodies of the sick produces sickness, and is an accepted penalty of a service which is in the highest degree humanitarian in character. As to the City Hospital being taxed to its utmost limit, twice as many patients can be easily accommodated as are at present in the hospital, and no beds or wards would be crowded or officials, nurses or internes overworked. Some pipes are worn out, which is nothing strange; some floors also need to be renewed, which is not remarkable. These things simply belong to the natural wear of any building that is in constant use. The unanimous opinion of the physicians of the city referred to by the visionary writer must have come to him through the medium of some clairvoyant seventh daughter who was born with a caul. His finishing touch is in a final disposal of the present City Hospital and the grounds turned into a railway depot, to which the immediate attention of the Board of Trustees is demanded. Well, now, there is the wrinkle. A double twister is taken in his cerebral convolutions, and the railway depot scintillates and flashes in printer's ink before an anxiously waiting world. A study of some pertaining ancient history would have informed the visionary of our esteemed morning contemporary of the fact that the ground on which the hospital stands cannot be diverted from its present uses. Such an act would cause its reversion to the heirs of original owners. The young man who wears his imagination in the fingers of his good. right hand should make frequent visits to the City Hospital. It will do him any amount of good, and he can just have his quiver filled chuck full of the horriblest borborigmal flatulence that ever sizzled into the cerebellum of a real original hypercephalic newspaper man. Newspapers are an invaluable ad- | urer $3,500, City Auditor $5,000, Judges junct of our civilization, but their value of Common Pleas Court $6,000, while is in direct proportion to their reliability. the Health Officer receives $3,000 and Such misinformation as found in the has but one professional assistant, at a above abstract is only permissible on the salary of $700. The Health Officer is first day of April, and when a little certainly as valuable a man to the munislow in getting into the composing cipality as the Corporation Counsel, room should be pigeon-holed for a year. and should receive similar compensation, and then he should be required to give his entire time to the office. A NEW HEALTH OFFICER. Last week mention was made of a probable vacancy in the Cincinnati Health Office. This occurred, and Dr. J. M. Withrow has been appointed to fill this very important position. Dr. Withrow is well and favorably known to the medical profession. Although he has not attempted to do any special work in sanitary lines, he is so well qualified as a general practitioner and man of general education and information that no one will or can question his ability to fill the office with credit to himself and benefit to the city. There is not a more important official in the city than the Health Officer. In times of general health people usually think and care little for members of the medical profession, but when sickness and threatenings of death are in the air he is the man who must come to the front and by his skill avert disaster. Then there is a call for the most scientific and abstruse attainments that can be acquired through years of toil and continuous observations. For this reason members of the medical profession should be compensated in proportion to the value of their services, and in ratio with men engaged in other occupations who are required to possess special attainments. The Corporation Counsel receives a salary of $5,000, and has five assistants at salaries ranging from $3,000 to $1,600; the Judge of the Police Court $4,000, City Treas The new Cincinnati Health Officer does not propose or intend to give up his private practice or other official positions. For this he is not to be blamed, simply because the compensation given him by the city is not in accordance with the value of his professional services when compared with that given the Corporation Counsel. Furthermore, his tenure of office is not specific, and he is liable to be discharged at any time, while the Corporation Counsel holds office for a term of three years. MONTREAL BLUNDERS. The meeting of the British Medical Association at Montreal, in August of this year, has frightened the local committee of arrangements into the saddest kind of confession. In the same way they have conceived the impression that vast armies of physicians in the States have an inward yearning to attend this meeting, and as a result they will swarm over the borders in such numbers as to literally overwhelm the Association. In the language of Brother Shrady, of the Record, it will be "an American association with English office-holders." Brother Shrady has taken deep interest in their fears, and advises all his readers to stay away, and not break up this first great party given by the colonial members to its venerable mother. The committee, in taking counsel of their fears, have become demoralized and are |