for instance, states represented by Dr. Minor-will ultimately lead to public education which will inform the general public and this will lead to a general education. I will say in conclusion that this should be largely a matter of congressional legislation. There is no quarantine, inter-state quarantine, against this disease, and, so far as I know, it is not in the power of the legislature to regulate this question in so far as inter-state emigration of the inhabitants of the several states is concerned. Consequently, it should be of a national scope in so far as the provision of sanatoria for the purpose of treating tubercular cases are concerned. And ultimately. in my judgment, the United States government should establish somewhere in the United States, where experience shows the best and most suitable and favorable climate, a system of treatment of this discase for those unable to go; and in the course of time the units of usefulness in the individua', in the diminution of morality, would so add to the commercial units as to pay the United States ten fold for the amount of money expended apparently for 1umanity, but in reality in the interest of the great and lendid national potency of cur country.

Dr. Thigpen: I will detain you only a few minutes as it is growing late.

In the first place, every citizen should know of the universality of tuberculosis. I believe that all of us have it in one way or another.

I did not have the opportunity of hearing but one of the papers, that of Dr. Minor, which was very instructive, as I was unfortunately called out.

'One avenue of tubercular infection, one which I think is sometimes ove look 1, is the tonsils.

I do not agree with the last speaker that it is a question for the United States Government to settle. It is a question for the doctors in every state to handle through their representative, whom they send to make our laws; and they should have local bills enacted at home for the protection and care of the poor. The poor people are the patients we have to look out for. The people who have means can look out for themselves; but the poor need, and should demand, the attention of every state.

Another thing of most importance is the early recognition of the disease. My experience teaches me that the best esults of course are obtained by its early recognition; and the secret of this is a thorough examination of the patient.

It is the duty of every medical man to pay more attention to this subject.

Dr. McWhorter: I will not consume much of the valuable time of this Association. Governor Cunningham remarked, and I will comment on that-because I wish to add one iuea --that this infection comes from the outside, and I wish to add to this, that it comes from an individual of the same species that becomes infected. It is well known, from the latest investigations, that every place where a consumptive patient has been sick or died, is a focus. We should have prompt extirpation of this disease. In India, where formerly they had bubonic plague, a doctor had recently to travel six week, in British India to hunt up a case in order to examine it. It is our duty to apply to legislative bodies for assistance in combating this scourge of the human race. Some gentleman may say that this is not feasible, but I will remind you that the appropriations have increased from eleven hundred to twentyeight hundred thousand in the past eighteen years. Suppose we used ten, fifty or one hundred thousand for the care and study of this scourge. Would it not be entirely reasonable?

Dr. M. S. Davie, Jr.: I have listened with very keen appreciation to the masterly presentation of this subject, and I feel that it would be immodest in me to conceive that I may add anything to what has been said. I wish particularly in just one moment to stress one or two points which I conceive to be very important in this connection. First, the tuberculosis type or types should be carefully studied by us all, and next, we should try to acquaint ourselves with information necessary for the carly recognition of this trouble. Next, when we recognize it early we should tell frankly the patient what his condition is, and try, to the best of our ability, to educate him thoroughly as to what his personal duty is in this matter. Education is the one preeminent hope for the solution of this question, and in doing this there are many methods. It is well, and I would like to be thoroughly understood in this connection, to save money to educate the Chinaman, I approve of that, my church alone sends a missionary for this purpose, but it would also be wise to have some general plan for raising money to keep at home to fight this great white plague.

Dr. Minor: Let me thank Mr. Smith and Dr. Jones for two papers that it was my privilege to listen to. I enjoyed the layman's paper of Mr. Smith most heartily; knowing his doctor-Bonifay-well, I took all the more pleasure in listening how thoroughly he had been trained. I cannot enter into many points of his paper, or Dr. Jones', which I would so gladly do. I will only dwell on a few points as to what you gentlemen in this state can do. Devote yourselves to the education of the masses, circulation of pamphlets, use of newspapers, and have popular lectures. Tubercular exhibitions were given in Baltimore a year ago. A realization by the people of what tuberculosis is, is better than anything I have seen. You must resist the habit of spitting—again and again I have seen gentlemen here spitting on the floor, and if the doctors do it,what are the public going to do? If you cannot learn never to spit unless you have a proper place to spit, how can you go to the public and tell them not to spit? It is necessary to cure your own bad habits before you go out and preach to others. Now as to dispensaries, no one is better informed on the subject of running dispensaries than Dr. Otis, from Boston. I am speaking of the poor. You doctors can handle the middle class and well to do; it is for the poor that dispensaries are necessary, in order to send to the dwellings of the poor to teach them how to carry out hygiene. Next, as to free sanitariums for hopeless cases, they should be near your towns. Hopeless cases should be separated from hopeful cases. Free sanitariums where the hopeless cases may live for they are the children of the State until death puts an end to their existence and to their danger to other people. For light cases, a place at Citronelle or some other location, or up in the hills-Huntsville, for instance. But that is not the end, you send your patient to the sanitarium for two or three months, then he goes back to the cellar where he comes from, where twelve or fourteen spit on the floors, where the food is improper, and what happens? He is bound to relapse, he must relapse and your money be thrown away. Therefore, gentlemen, either by the French idea, by life and work on the farms to pay for their keep by the work they do, or by getting philanthrophists to build proper tenaments, and when they come back they come to proper locations. They must have a proper place to go then you are reaching what you are aiming at. There must be some arrangement of city or State aid to the poor people-I am talking again of the absolutely poor. Further, a most important question, the

disinfection of the hovels where the tuberculosis cases die. Dr. Bragg in New York, in Cherry Street and Cherry Bend, in New York, where death after death has occurred, thirty or forty cases in one house, states that the house must be torn down or disinfected after each case. You can make laws, and you must make laws, but remember no law is stronger than the sentiment behind the law; all law is the manifestation of the will of the people, and if they do not know they have no will, and, gentlemen, they must know.

Dr. Cunningham: I rise to a question of privilege. The remarks of Dr. Thigpen conveyed the idea of something I did not intend to say. I thought I said ultimately it would be a matter of national legislation, but at present it should consist of law making bodies of the State and county, city, etc.

A CHOICE OF METHODS IN REMOVING UTERINE FIBRO-MYOMA.

BY LEROY BROUN, M. D., OF NEW YORK, N. Y.

Up to not a very late date, the teaching has been that fibroid tumors of the uterus are inoffensive, benign growths, rarely giving rise to any serious trouble other than of hemorrhage, and in which the menopause gave complete relief from all resulting symptoms and inconveniences.

Little by little it dawned upon those coming frequently in contact with such conditions that the menopause was in such matters not always the haven we had been taught to expect. In tumors where the fibrous tissue predominates, making the hard variety, a contraction and shrinking in size is at times noticed after the cessation of the menstruation; but in those having the muscular elements predominating, constituting the myomatous type, as also in the fibrocystic tumors and edematous tumors, the cessation of the growth does not take place at the menopause.

We know also that the menopause does not come on in the presence of these growths as early as normally; in fact, the cessation of menstruation is ordinarily delayed from five to ten years. Bishop mentions an instance in his own practice of a patient who, though sixty, was still regular.

In the progress of the growth of the tumor, disturbances in its circulation are not uncommon; especially is this true of such tumors as have extended beyond the pelvic limits. As a result of this disturbance in its circulation, adhesions of the uterine mass to the adjacent organs frequently result, rendering its removal when necessary from urgent causes, more dangerous to the patient.

During the course of the development of myomatous tumors, they extend at times between the folds of the broad ligament dissecting up the pelvic peritoneum. The tumor, being solid, does not give as an ovarian cyst would do, and whether the development is under the peritoneum or intrapelvic, it at times becomes wedged between the bony boundaries, and pressing on the ureters, causes a pyonephrosis-a degeneration of the kidneys and ultimate death. When the uterus is the seat of a fibro-myomatous growth we do not find that this is always the extent of the disease existing with the pelvic organs.

There is commonly associated with such growths inflammatory states of the tubo-ovarian adnexa of one or both sides. Such complications, when going on to a purulent condition, endanger within themselves, the life of the patient.

The long continued drain through the profuse hemorrhages attendant upon a majority of fibroid tumors so deplete and weaken the physical state of the patient as to frequently be the indirect cause of her death through some intercurrent disease.

Fibroid tumors also at times, during some period of their existence, undergo a necrotic change. Especially is this true of the submucous variety and was also not an uncommon sequel of the electrical treatment by puncture of some years past. The sloughing of these 'tumors caused by an interference in their circulation is one of the gravest complications that can arise in connection with their presence, rendering a fatal termination positive unless relief is obtained, and magnifying at the time of the operation the danger of their removal. Another form of degeneration of these tumors is the sarcomatous changes known to take place among them.

Fibroid tumors may remain quiescent for a time and afterwards begin to rapidly increase in size-becoming fibrocystic