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and calm, but with incessant talking, the patient continued entirely insane, sleeping only in short snatches about two hours out of the twenty-four until the 19th. She then began to show signs of amelioration, especially in saying that she knew she was mad. On the 21st, Mr. Barwell ordered an ice-bag to the head. After this she slept more and gradually improved. On the 28th she would be pronounced sane. During all December she was well enough to take walks, but was, for various reasons, kept under supervision till December 29th, when she was discharged in perfect mental and bodily health. In spite of several attacks of violence, and of struggling, the abdominal cicatrix had held well, and there was no sign of hernia; nevertheless, it was thought prudent to provide her with a belt. Mr. Barwell remarked that several views might be taken of this case:

ated with abnormal states of that system. Perhaps some might see an analogy between puerperal insanity and mental disturbance in this case.

5. Mere coincidence might be justly considered the best way of accounting for insanity thus following ovariotomy, if this were an isolated instance, but Mr. Barwell was acquainted with several other examples.

Thus Dr. Keith had had one case (after hysterectomy); Mr. Thornton, two (ovariotomy and hysterectomy); there had been a case at St. Thomas's Hospital, and one had been noted by Mr. Dent. Thus, mere coincidence would not account for the circumstances which it appeared desirable should be known in the profession.

The President remembered that Mr. Lawson Tait had read a paper some time ago, in which symptoms of mania had occurred during

1. There might have been hereditary ten- convalescence from ovariotomy. He himself dency to insanity.

2. Insanity might follow any of the major operations, ovariotomy not more than any other.

had seen mania occur in two cases after ovariotomy, which did well surgically; and although in his experience of general surgical cases it it was rare, he could not help think

3. It was the result of disturbance of the ing there was some connection between it urinary organs (kidney).

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and the operation of ovariotomy. cases there was no kidney mischief.

In these

Mr. Doran mentioned the case of a young married woman who had had both ovaries removed for chronic inflammatory disease; she had previously presented no mental symptoms, but was the subject of an attack of mania a few weeks after the operation; she was still deranged. Insanity connected with organic disease of the genital organs was not necessarily of the nymphomania type.

Mr. Meredith thought the cases not quite so rare as Mr. Barwell had concluded them to be. He had seen symptoms of insanity come on two weeks after the operation; but once, for four weeks after the removal of a large tumor, weighing 70 pounds, from a single woman, aged 54, no bad symptoms resulted, and then the patient was seized suddenly with acute melancholia; she was apathetic, but not really violent. The symptoms lasted for two months without intermission, and then disappeared suddenly, and she had remained

quite well ever since (four years).

There were no urinary symptoms, and no hereditary tendency. He had seen acute mania follow amputation of the breast.

Dr. Edis said that patients were often very nervous, and subjected to high nerve-tension, before the operation. In many, the nervous system was immobile, and easily gave way under such provocation. He remembered the case of a farmer's wife who was hypochondriacal, with oval face, dark skin, weighing her words, as if with a sinister meaning, who, after the operation of ovariotomy, developed symptoms of melancholia. She became quite well, the symptoms lasting for ten days. He thought the symptoms of insanity were not so unusual as one might imagine.

Mr. Benham thought these cases might be parallel to those of puerperal insanity, which he had never seen well explained.

Dr. Blandford was inclined to think there were many circumstances connected with ova. riotomy which might give rise to mental symptoms. The patient had before her mind, for some time before the operation, what she had to undergo, not taking much food, and her bowels locked up with opium, and opium had a peculiar effect upon some persons of keeping them awake. He did not think the mania had anything to do with urinary trouble. The case was one of genuine mania.

Mr. Barwell, in reply, said that, although he might not have been exactly correct in his description of the mania, he hoped its occurrence was unusual. His object had been fully achieved if he had succeeded in directing at tion to the matter. Every operation, of course, must disturb the thoughts for a little time; but, in simple cases of this description, the patients recovered with remarkable ease. He thought the case of Dr. Edis was hardly comparable with his, as that patient was prob ably half mad before the operation was performed.


Dr. Gillette reported to the New York Obstetrical Society, a case of profuse purulent

discharge, leucorrhea. He stated that vaginal injections had been ordered, that red ants had taken up their abode in the fountain syringe, and unknown to the patient were for some time projected into the vagina whenever the syringe was used. Their bites caused the discharge.


Dr. Malcom McLean concludes a paper published in the American Journal of Obstetrics with the following rules:

First. In any case avoid the application of all chemical styptics, which only clog the va gina with inert coagula, and do not prevent hemorrhage. At the very first, the patient should be put in a state of absolute rest--body and mind-and a mild opiate is often desirable at this stage to quiet irritation.

Second. Inasmuch as the dangers from hemorrhage are greater than all else to both mother and child, at the earliest moment preparations should be made to induce premature labor, and labor once started, the case should be closely watched to its termination by the accoucheur.

Third. In primiparæ, the mothers with rigid tissues, the vagina should be well distended, by either the colpeurynter or tampon, as an adjuvant to the cervical dilatation.

Fourth. In the majority of cases generally, and in all cases especially where there is reason to believe that rapid delivery may be required, it is more safe to rely upon the thorough, continuous hydrostatic pressure of a Barnes' dilator than on pressure by the fetal


Fifth. Where the implantation is only lateral or partial, and where there is no object in hurrying the labor, bipolar version, drawing down a foot, and leaving one thigh to occlude and dilate the os, may be practiced according to the method of Braxton Hicks, except in cases where the heard presents well at the os, when

Sixth, the membranes should be ruptured, the waters evacuated, and the head encouraged to engage in the cervico-vaginal canal. Seventh. In the majority of cases, podalic


version is to be preferred to application of

the forceps within the os.



children, youngest of which is sixteen years Mrs. A., aged 52 years, mother of two old, came to consult me as to the nature of a tumor of her left breast on April 3rd, 1886.

Eighth. In some cases, in the absence of CARCINOMA OF BREAST, AND ITS REsufficient assistence or the MOVAL BY AMPUTATION. necessary ments, the complete vaginal tampon, in part or wholly of cotton, may be applied and left in situ until (within a reasonable time) it is dislodged by uterine contractions and the voluntary efforts of the mother. In case of favorable presentation-occiput or breech-the tampon will not materially obstruct the descent of the child, and in some cases the tampon, placenta, and child will be expelled rap. idly and safely without artificial assistance. Ninth. The dangers of septic infection by means of the tampon or Indian rubber dilators are so slight, if properly used, as not to be considered as seriously impairing their

great value.

Tenth. Whenever it is possible, dilatation and delivery ought to be deliberately accomplished, in order to avoid maternal lacerations.

Finally. As cases of placenta previa offer special dangers from post-partum hemor rhages, septicemia, etc., the greatest care must be exercised in every detail of operation and nursing to avoid conveying septic material to the system of the woman. Absolute cleanliness, rather than chemical substitutes for that virtue, should be our constant companion in the practice of the obstetric art.

HYPOPHOSPHITE OF SODA IN TUBERCULAR INFLAMMATIONN.-According to the London Medical Record, Dr. Sturges narrates in the Westminster Hospital Reports, six cases of tubercular inflammation in children. He gave large doses of hypophosphite of soda and concludes as follows:

1. That doses of ten to twenty grains may be given to even young children, and that the

large dose is sometimes of service when a smaller failed.

2. That when benefit was derived from the use of the drug, it was in cases of (a) chronic inflammation occurring in 'tubercular' children, and of (b) the wasting and pyrexia, which, without any distinct localized seat of mischief, sometimes precede the actual development of acute general tuberculosis in early life.

Mrs. A's general health was very good, no hereditary taint of cancer in her family history. She stated that the growth for which she came to consult me about first appeared the fore part of last winter in the shape of a small hard lump at one side and near the nipple. This lump gradually grew around the nipple, and began as it were to pull in or retract it.

At the time Mrs. A., presented herself at my office, the tumor was as large in circumference as a silver dollar, and directly under the nipple which was considerably retracted.

Mrs. A., stated that within the past month or six weeks her breast had pained her very much, that the pains were sharp and cutting, pains running through her breast at different times during the day, which really caused her to seek consultation.

From the patient's history and the characteristic appearance of the tumor, I concluded that the patient was suffering with a malignant tumor, of which I informed her to her great surprise. But, more to my surprise, after informing her that its early removal by the knife would lend her the only chance of its removal and cure without in all probability its ever recurring again, she very soon submitted to my treatment, and, on the tenth of April, 1886, one week after the visit to my office, Dr. Rockwell and myself removed the lution of the bichloride of mercury. The gland, using for an antiseptic a 1 to 2000 sobreast was removed by making elliptical incisions from the sternum toward the axilla. After its removal and securing all bleeding vessels by "torsion," the wound was thor

oughly cleansed with the above mentioned solution. Edges of wound closely coaptated with six iron dyed silk ligatures, with small superficial ligatures intervening. After its coaptation, the dressing consisted of pulv. iodoform sprinkled over incision with a thick pad of absorbent cotton layed over, that had been previously prepared by soaking in a solution of the bichloride 1 to 2000 for twenty

four hours previous to applying. This cotton

was wrung out and dried just before applying, and was snugly bound on to wound by rollers running around the chest tightly. Once every Once every day this dressing was taken off and a new one applied, until the fourth day when I removed three of the stitches, and applied in their stead adhesive strips. And, on the seventh day, I removed all of the stitches, the result being perfect union by first intention throughout. I may add that this patient's pulse never exceeded 100 beats per minute, respirations never exceeded twenty per minute, and temperature over 994° F.



In a paper, of an exhaustive nature, read before the Ohio State Medical Society, at Akron June 4th, 1886, the writer came to the following conclusions:

1. Like breeds like, good or bad, entirely independent of consanguinity.

2. Evil results have undoubtedly followed consanguineous marriages, but whether dependent upon consanguinity is extremely doubtful.

3. Intemperance, luxury, dissipation, sloth and shiftlessness, as well as hygienic surroundings and innumerable other causes, among them the depraved moral state dependent on births, the result of incest, should bear much of the responsibility laid at the door of consanguinity.

4. Testimony is often weakened by religious or other prejudices.

5. Data are of doubtful reliability, full of flaws and false reasoning. The noted cases are the unfortunate ones. The favorable are unknown or forgotten. It is the ill news which travels fast and far.

6. We, as physicians, know that there is much more illicit intercourse than is generally discovered. May not many people be related though not aware of it. Many marriages may thus occur between relatives presumed to be non relatives, thus again vitiating statistics.

8. Atavism explains fully the fact that in some instances healthy consanguineous parents beget unhealthy children. This, as is well known, occurs in most hereditary troubles; furthermore, a less superficial examination may show this healthfulness to be only apparent.

9. Evil results, in the offspring of consanguineous marriages proves that something was wrong. That it was the consanguinity has not been proven. It may have been one of a hundred things and dependent on all of the antecedents for generations. Such results remaining absent after these marrriages, proves, for that case at least, that consanguinity was harmless, for it was known to be present. Further, if consanguinity was the cause, the effect should follow where the cause is present.

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10. Consanguineous marriages which bring together persons having a disease or morbid tendency in common are dangerous to the offspring. Not, however, one whit more than the marriage of any other two persons not related yet having an equal amount of tendency to disease in common. Conditions present in both parents, good or bad, are simply augmented, and the result would have been the same were they not related.

11. Given a malformation or disease firmly established, we have a tendency to breed true. Given a defect or peculiarity in a family, race or sect, this will naturally be propagated by intermarriage, e. g. by intermarriage, e. g. Color blindness is remarkably hereditary among the Jews and Quakers. The Quakers are educated to abhor color. Those who admire color separate themselves from the sect, and thus intensify the tendency in the remainder. The defect has probably crept among the Jews and is kept up and intensified by intermarriage. The same means has also had its effect among the Quakers.

12. Certain inherited diseases, as scrofula, phthisis, and rachitis which are ascribed to consanguineous marriages probably in every instance, could be traced back to an ancestor.

13. Man is an animal, anatomically, physiologically, and sexually, He is subject to the same laws of propagation. In and in breeding in animals is carried on to an extent not only not permissible in the human species, on moral grounds, but also beyond the bounds of human possibility. Yet this is done by cun

7. Statistics show about the same proportion of deaf mutes, idiots and insane persons descendent from consanguineous marriages to the whole number of these unfortunates, as the number of consanguineous marriages is toning breeders to improve the stock and put the whole number of marriages. They show fertility among the consanguineous to be slightly greater than among non consanguineous. They also show a somewhat greater frequency of retinitis pigmentoas.


money into their pockets. The Jersey cattle have been bred for the last 150 years on small island six by eleven miles. You would not raise them for beef or oxen, yet they command a high price for their milk and butter.

This was probably the recommendation of the first cattle on the island, and this quality has improved from that time to this through in and in breeding.

14. It would be better for the offspring were consanguineous marriages under medical supervision. Certainly no better than for all marriages to be under like supervision.

15. The half a hundred abnormalities asscribed to consanguinity, including almost "all the ills that flesh is heir to;" among others, whooping cough approaches the ludi


16. The factors which lead to consanguineous marriages are, portions of country geographically isolated or mountainous, rendering communication with the outside world difficult, religious or political sects of an exclusive nature, and aristocratic ideas. As examples, note the per cent of consanguineous marriages in Scotland, 5.25 per cent, to those in England, 3 per cent, the preponderance in Martha's Vineyard, the commune of Batz and among the Jews and Quakers.

17. The facts do not warrant us in supposing that there is a specific degenerative effect caused ipso facto by consanguinity.

18. Consanguineous marriages, no other objection being present, should not be opposed on physiological grounds.



speak of. Five years ago she weighed one hundred and sixty-three pounds; and three years ago she noticed that she was losing flesh all over her body, but in the abdomen, where she felt weighty and had a heaviness. The abdomen has been increasing in size for the past two years. In June last, she measur d around the abdomen thirty-eight inches, and in July, forty inches.

During the past two years, she has suffered with dragging and bearing down feelings in the back, and pains frequently shooting through back and abdomen. At times she would pass a very small quantity of urine. Bowels generally regular. Two years ago, and also last summer, she laced tightly. She did so, because she was told to do it, and not that she felt better from it, for she noticed no change in her feelings. Only from worry would she have headaches. She has been married twenty years, but showed the lines of care well depicted upon it; the "facies ovariana" was observed. She was confident that each day she was getting larger in the abdomen and her strength daily lessening, she said she must be helped, and if there was a chance for her to be relieved of the tumor, she would like to have it removed, as she felt that she could not last longer as she was, her sufferings having increased the past four or five months.

Upon examining the abdomen, I found dullness on percussion over the whole abdomen; uncertain and indistinct resonance on percussion in the left lumbar region; clearness in the right; below the umbilicus, and to the left side, upon palpation, fluctuation was distinctly felt. By digital examination, per va

Read before the Baltimore Gynecological and Obstetrical ginam, pelvis was clear, and the uterus meas

Society, May 11, 1886.

It will be remembered that at the meeting of the "Obstetrical and Gynecological Society of Baltimore City," held January 12th, I exhibited a specimen of a very large fibro-cystic tumor, which I removed the day before from a woman at the Union Protestant Infirmary. I then promised to give you a history of the case and of the operation at a future meeting, and I am here this evening to fulfil that promise. I also desire to show to you, by a photograph, which I made myself, the appearance of the abdomen before the operation.

In January, of this year, Mrs. J. M. came under my care at the Union Protestant Infirm ary. Upon questioning her, I found that she was forty years of age, and born in this state. She first menstruated at eleven years of age, and it has come on regularly every four weeks ever since, each period lasting four to five days, but not too free, and having no pain to

ured three inches in length. From this examination, and the size of the tumor being so great, and its growth within the last few months being so rapid, surgical interference became imperative. So, on the 11th of January, the patient being etherized by Nathan R. Gorter, M. D., I made an incision four inches in length in the median line, beginning two inches above the pubes. As soon as the cav

ity was opened, there was a great discharge of bloody serum. Pressure upon the tumor by the finger, also gave the sensation of fluid within.

The trocar (Well's) was pushed into the tumor, but only a little blood escaped. The incision was enlarged to six inches and further exploration made with the hand, when it was found to be a tumor in which the uterus and ovaries were involved.

The incision was carried above the umbilicus, the length of incision then being eleven

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