The tumor grew from the whole back part and side of the uterus; it was attached to the left iliac fossa and left brim of pelvis, and left side of the abdominal walls back to spinal column. It was attached also to the omentum, intestines and bladder.

The omentum could be peeled off, but its vessels were very large, so that in many places it had to be ligated and cut from the tumor in sections.

The intestines were situated] behind, and above the tumor.

The tumor at its lower part, projected prominently forward over the symphysis pubis, and evidently contained fluid at this point, so that I was in doubt whether it was a cyst or the bladder distended with urine.

This point was cleared up by passing a sound into the bladder which accurately outlined the extent of its attachments to the tumor, and with the sound as a guide, I punctured the cyst and evacuated from this part of the tumor a pint of transparent straw-colored fluid, which spontaneously coagulated, and the sac only in part collapsed. With great difficulty the bladder was separated from the tumor, but numerous bleeding points had to be ligated before the oozing from its surface was controlled. By hard pulling and pushing, the huge mass was slowly drawn forwards, as far as its connections to the back and left side of pelvis would permit. The intestines were carefully peeled off from the tumor. The attachments were so dense and vascular that they could only be separated by gathering them up in sections, applying double ligatures, and cutting between, so that when the tumor was freed from its pelvic and abdominal adhesions there were thirty-three ligatures left in the abdominal cavity. During the operation she lost very little blood. As all vessels were clamped or ligated, as soon as the tumor was freed I placed Keith's hysterectomy clamp around the uterus, just above the vaginal junction, and cut away the mass. Three drainage tubes were introduced, one to the bottom of the pelvis, and others at different points in the abdominal cavity. The reason for introducing so many drainage tubes was on account of the great amount of bloody serun that poured out from the surfaces of the extensive adhesions.

The stump was closely trimmed off, and the portions above the clamp touched with liq. ferri sub. sulph. The wound was closed with nine silver wire sutures, and iodoform freely sprinkled around the stump, the usual dressing applied, and the patient placed in bed.

Just before the operation she was given, by the mouth, a tablespoonful and a half of whis

key in some water. The heart's action not being good, ether was the anesthetic given. Her pulse, under the ether, in the beginning was 100, and very feeble. And during the operation it was necessary to give her repeated hypodermics of whiskey, and she received by this means 3xvi (m, 960). A syringe was used which holds m. 75.

During the operation her body was kept warm by hot bottles and blankets. The operation lasted one hour and twenty-five minutes. She never reacted, and died in twenty-six hours from shock. Much bloody serum flowed from the drainage tubes, and the abdominal cavity was washed out several times with bichloride of mercury, sol. gobo, the fluid being thrown in through one tube and flowing out freely through the others.

Previous to operating, the urine was chemically examined, and was found to be acid in reaction; color, deep amber hue; specific gravity 1020; slight amount of albumen (heat and nitric acid tests); measurement around the body forty-six inches.

The tumor weighed thirty-one pounds after much bloody serum had drained away from it. The tumor was placed in the hands of Dr. Wm. T. Councilman, of the Johns Hopkins University, for examination, and I herewith read you his report:

JOHNS HOPKINS HOSPITAL,
Baltimore, January 27th, 1886.

DR. ROBERT T. WILSON:

DEAR SIR-The following is the result of my examination of the specimen you sent me. The smaller mass, which presented the appearance of a bifid uterus, was found to be a portion of the uterine canal with a large myoma on either side. These were the size of small oranges, and one was degenerated in the cen tre. The large mass was smooth on the sur face, and gave unmistakable fluctuation. At tached to the surface was a Fallopian tube anda corner of the uterus.. The tube was elongated and dilated.

On section the tumor presented a fibrous appearance, was very edematous and contained numerous cysts of various size. These cysts did not communicate with one another, and were filled with a clear straw-colored fluid. Some of them contained attached to their walls, large masses of fibrin. At various points in the edematous tissue of the tumor, were small round nodular masses which projected above the cut surface. The fluid contained in the cysts, was slightly alkaline, gave, on boiling, an abundant precipitate of albumen, and had a specific gravity of 1017. Microscopic examination of the tumor,

the body. A current may be passed which is strong enough to act upon the stricture without giving any discomfort, except, perhaps, at the moments of making and breaking.

Very truly,

W. T. COUNCILMAN.

was

When undertaking the operation, I was in doubt as to the exact character of the tumor, whether it was a fibro-cystic tumor of the uterus, or a compound multilocular tumor of the ovary. It was so large, and growing so rapidly, and the sufferings of the woman were so great,that she demanded relief,and desired to undergo any operation which would give her a reasonable chance for life, and hence, I made every preparation, either for an ovariotomy or a hysterectomy.

THE TREATMENT OF STRICTURE BY ELECTROLYSIS.-The British Medical Journal, of May 29th, contains the following criticism of this, as yet unsettled, method:

more

The treatment of urethral stricture by electrolysis is one of which there is, as yet, very little practical knowledge in England; and we confess we were very glad to see it brought forward by Dr. W. E. Steavenson and Mr. Bruce Clarke, at the Royal Medical and Chirurgical Soeiety. Interest in the subject was first aroused by one of the daring attempts of American surgery, made by Dr. R. Newman, of New York, who published about eighteen months ago, Tabular Statistics of One Hundred Cases of Urethral Stricture treated by Electrolysis, without Relapse. It would have appealed, perhaps, even strongly to those who believe in the fallibility of human nature, if there had been one or two relapses. The fashion of operating admits of many small variations; but the essential points are, that one pole of the battery shall be of metal, and in contact with the surface of the stricture, and the other widely spread out by means of a pad over a considerable surface of the body, the back or elsewhere: and that between these poles a current of considerable strength should be passed. It is found most successful and least uncomfortable that the negative pole should be in contact with the urethra; the positive with

the cicatricial tissue may be, we are hardly in a position to say, though the actual watching of the process by means of an endoscope, as practiced once by Dr. Berkeley Hill, may throw more light upon it. It is covered at present, by the word "electrolysis," of which, when applied to fibrous tissues, we must admit that the limits are somewhat indistinct.

At any rate, it is alleged that not only does the resistance of the stricture give way, but that more or less of the tissue which forms it is turned into a slimy mass of broken down epithelium, and so disappears, without leaving a contracting cicatrix. The a priori impression is certainly strong that, where tissue has disappeared, there must be a cicatrix; and

that, if there is a cicatrix, it must contract,

electrolysis will gain a much more attentive sooner or later. Those who have practised hearing and a more zealous following when they show a longer maintenance of good results than the eight months which have elapsed since Mr. Bruce Clarke's operations. When the malady is chronic, it naturally needs a long time to judge of the cure; but, at the same time, the habits of scars, due to different causes, are known to vary greatly in contraction, and it is possible enough that there may be less contraction after electrical

com

action than any other, even than those from caustic alkalies. And, further, we are not yet experienced enough to assert how pletely similar or dissimilar to an ordinary cicatrix this process of electrolysis may be.

MISSOURI DENTAL COLLEGE FACULTY.-At the annual meeting of the faculty the following changes were made. Dr. H. H. Mudd resigned the professorship of Descriptive Anatomy and was elected Professor of Surgical Anatomy and Clinical Surgery, a new chair in the college; he was also re-elected Dean.

B. J. Primm, M. D., was elected to fill the chair, Professor of Descriptive Anatomy, left vacant by the action of Dr. Mudd.

SATURDAY, JULY 3, 1886.

MACKENZIE IN THE FORTNIGHTLY REVIEW.

We have just read in the June number of The Fortnightly Review, a very interesting essay by Dr. Morell Mackenzie, whom everybody knows, with the title: "Is Medicine a Progressive Science?"

It is needless to say that the article is interesting. Dr. Mackenzie wields a facile pen, and his ideas upon any subject are original and entertaining. He gives a running resumé of the history of medicine from the times of the fathers to the present, showing conclusively that greater progress has been made from the beginning of this century, when "the recognition of diseases of the vital organs was guess work, and fevers and other disorders, which are as distinct in their character and course as a horse from a cow, were classed together and treated in an indiscriminately drastic manner, just as at the same period, the law hanged with Draconian impartiality for murder and for sheep steal ing.

And tumours were arranged in a few hap hazard groups, as motley in their composition as the various sections of the "great Liberal party." He admits that great things may be expected from advances in hygiene, suggesting the time when everything can be prevented and there will be nothing left to cure. "Medicine will, then, like Alexander, have to sheathe its sword for want of fresh worlds to conquer; it will cease to exist or become transformed into a religion of the body, preached by properly qualified ministers, or into a code of health promulgated and enforced by the state. Death or suffering from

"A WICKED IDEA."

The New York Medical Record of June 26, has the following: "A Homeopath invited to St. Louis. It appears that the members of the Medical Press and Library Association of St. Louis conceived and carried out the wicked idea of inviting to the medical editor's banquet the editor of the N. E. Medical Gazette, a monthly journal of homeopathic medicine."

Yes, we plead guilty to the conception and the execution of the wicked idea. We did more than that, we invited the editors of the Record. The latter invitation was accepted, and the representative who came and was our guest, won golden opinions on all sides and was instrumental in removing many unfavorable impressions which had been formed regarding We think in these days of gen. the Record. erosity and good feeling it requires a greater stretch of hospitality and politeness to receive as a guest a journal which is uncertain, indefinite and hybrid, and, worst of all, narrow and provincial to a painful degree, than it does one which is frank and honest, even though (in our opinion) it be wrong. We refer the Record to the reports of the meeting made by Prof. Yandell in the American Practitioner. He says: "Of course what was said on the occasion was, 'under the rose,' but we feel we violate in no sense the hospitalities, when we state that every allusion to the code from first to last was welcomed with cheers-was received with the utmost enthusiasm. The evening closed what was clearly the most successful meeting yet held by the Association of Medical Editors, and certainly both host and guest will remember the occasion as one of great enjoyment."

We venture to suggest that had the N. E.

Med. Gazette been present, it would probably have cheered all allusions to the code as loudly and as long as has the Record during the past few years. The record made by the latter journal in this direction has not been a good one, and it will require more than one visit of the able, discreet, careful and honorable representative among us to blot it entirely. out. We wish we could assure the Record that it "has in no sense violated the hospitalities of the occasion," by criticising our list of invitations.

MORTALITY OF DOCTORS.

The death rate of the medical profession is a subject of vital interest to us all. Dr. Ogle, the Superintendent of the statistical department of the Registrar General's office of England, has recently made a report which furnishes abundant material for study on this point, and which may well startle the members of the medical profession into deep thoughtfulness. Statistics we know are not always reliable, but the system of vital statis ties of the older countries and particularly of England, are very nearly perfect. This report shows a condition of things which is very unsatisfactory to the profession, indicating, as it does, that the death rate among physicians, is greater than in any other calling, and, worse than all, it is on the increase. In 1880, 1881 and 1882, the mortality was above that of any other class, and greater than it had been in the medical profession for two decades or more before. When the record shows that medical men die at the rate of 25.53 per 1000, it is indeed time for them to stop and think, to delve into the subject, to ascertain the cause; to make a direct application of the text, Physician heal thyself.

Members of the legal profession died only at the rate of 20.23 per 1000, and the "briefless barristers" of the land may sigh a deep sigh or smile a glad smile according as they may view the poorer prospects of more clients or the good chances of a long life. The "well-fed" parsons, in spite of the fact that but a few relatively of the world's inhabi

tants were saved by their efforts from the torments of hell, show a death rate of only 15.93 per 1000. Evidently, the anxieties and burdens occasioned by a knowledge of the fact that men are dying every day and going direct to eternal sorrow, does not weigh sufficiently heavy upon the minds of the clergy to result in much increase of their mortality.

Teachers, commercial travellers, lecturers, brewers, quarry men, cutters, tradesmen and mechanics all have the advantage of the doctor in the matter of long life; and even the millers, miners and coal movers, in spite of surroundings injurious to the lungs, have better chances for old age than "Ye healers of men." The various causes of medical deaths are given by Dr. Ogle in a thoroughly interesting manner. Taking the deaths per million of doctors and all other men he shows the various proportions. The death rate per million of doctors and per million of all other men in typhus fever is as 79 to 38; diphtheria, 59 to 14; typhoid fever, 311 to 238; alcoholism, 188 to 130; scarlet fever, 59 to 16; suicide, 363 to 238; and so on with varying proportions through the entire list of diseases.

It is, of course, a matter of interest to trace the cause of this excess, and there can be no question that having ascertained the cause, the profession will be very culpable, and deserve the misfortune, if they do not take steps to guard against it.

Diphtheria, typhoid fever, typhus, scarlet fever and many others of their class, of course secure more victims among physicians on account of greater exposure to the contagious germs. The more general applications of germicides, antiseptics, and thorough cleanliness in the treatment and prevention of all contagious diseases which is now the rule, will surely have a beneficial effect in guarding the profession against danger from this