flagrant transgressions of the limits of the art of surgery. It is not unusual for one operator to exhibit from five to six normal ovaries as the result of half a day's work. All kinds of excuses are made for this kind of surgery. The ovaries are too large, cirrhotic, cystic, or perchance a ruptured Graafiian follicle is discovered, when he consoles himself that he has removed an apoplectic ovary. Where is this wholesale unsexing of our female population going to end? The beginning of the end has come. The army of women minus their essential organs of generation is beginning to raise its voice against such mutilating work. The number of women who willingly sacrifice their ovaries to restore their shattered health without securing the expected relief has increased to an alarming extent. This sad experience has made the gynecologists more desperate and bold. They have been importuned by their castrated, tubeless patients to such an extent that the art of surgery was again resorted to. The uterus, which heretofore had been comparatively safe, was now selected as the offending body, and vaginal hysterectomy became at once a popular operation. Many atrophic uteri remaining after removal of their appendages have been removed in a vain hope of securing permanent relief. Vaginal hysterectomy for diseases other than carcinoma is now at its height. The uterus is being removed for hypertrophy, endometritis, flexion, version and minute myofibromata. This important organ is no longer safe if it is in the vicinity of a pelvic abscess. Perchance a healthy uterus is removed under the pretense of securing a more direct route to a focus or foci of pelvic inflammation. It is needless to say that most of the surgeons who clamor for the removal of the uterus through the vagina for insignificant affections or inflammatory lesions of adjacent parts, do so by the use of compression forceps. It is no great surgical feat to squeeze out an inflamed or displaced uterus between compression forceps. It is difficult to say where this rage for the removal of the female sexual organs will end or what organ will be the next battle ground for the aggressive gynecologist. The clitoris, the vagina, the cervix uteri, the ovaries, the Fallopian tubes, the uterus and its ligaments have successively passed through a trying ordeal of the furor operativus. What the next fad will be is impossible to foretell. As one operation after another is falling into a well-deserved desuetude new ones will have to be devised to gratify the whims of the patients and the ambitions of the gynecologist. I have portrayed to you only a few of the excesses of the art of surgery as applied to the female organs of generation, but enough has been said to show you that it is time to call a halt. Further depredations can best be

Let

avoided by the general practitioners to whom most of the patients apply for relief. them do their duty toward their patients. Many of the minor affections of the uterus and its appendages are within the reach of intelligent general and local treatment without a recourse to the knife. If gynecology is to live and become a real benefit to women suffering from pelvic disease, it must become more conservative. We all appreciate what surgery has done in prolonging life and in mitigating suffering in the treatment of ovarian cysts and the removal of the uterus, the seat of symptom-producing myofibromata. What I am objecting to, and on good ground, is the indiscriminate operating upon the female organs of generation for imaginary or insignificant affections. This is an evil that must be apparent to all and that the leaders of gynecology must assist us to suppress.

I cannot dismiss the subject of genital surgery without making a strong plea in favor of conservatism in the treatment of prostatic hypertrophy. A few years ago J. W. White made a series of experiments on dogs which proved that the testicles possessed an influence which, to a certain degree, controlled the nutrition of the prostate gland. His experiments were made on dogs, the animals being vigorous and in full possession of their sexual power. He found that castration was constantly followed by progressive atrophy of the prostate gland. At that time he timidly suggested that castration in cases of prostatic hypertrophy might possibly prove to be a valuable surgical resource in the treatment of uniary obstruction due to such a cause. About the same time Ramm gave the result of his clinical experience, covering about the same ground, urging the utility of castration as a legitimate surgical procedure in the treatment of non-malignant obstructive enlargement of the prostate, a condition so frequently met with in men advanced in years. You are familiar with the subsequent history of this operation. Numerous operations have been performed in different countries which appear to support the claims made for it by both of these investigators. The operation has been modified in substituting for the castration section or resection of the vas deferens, and recently neurectomy of the spermatic nerves; both of these procedures are said to produce the same curative effect as castration. A sufficient clinical material has accumulated to prove that these different procedures frequently result in diminution in the size of the prostate and that the symptoms caused by the obstruction often diminish or disappear.

I can readily understand in what manner emasculation in young animals and young and middle-aged men should be followed by atrophy of the healthy prostate gland.

Cas

tration of women during active sexual life will bring about atrophy of the uterus as a constant result. Clinical experience has also shown that the anticipated menopause effected by castration has a decided effect on the myomatous uterus. But who would think of castrating a woman who has reached the menopause for such an indication? It is very difficult to understand how castration or its substitutes performed on men advanced in years, with atrophic dormant testicles should exert such a positive influence upon an organ, the seat of senile affection And yet, the fact remains that many reliable men have observed such results, and we can no longer doubt

them

What I fear, and the reason I allude to this subject, is this, that castration of aged men for hypertrophy of the prostate, when this operation becomes common property and is endorsed by surgeons who stand high in the estimation of the profession, will be misapplied in the same way, fortunately, probably to a lesser extent than the removal of normal ovaries. Men will be castrated for stone in the bladder, chronic cystitis and malignant disease of the bladder. It is not always easy nor possible to make a positive differential diagnosis between simple hypertrophy of the prostate and some of the conditions which simulate so closely. In doubtful cases it appears to me it would certainly be advisable to make the diagnosis sure by a supra-pubic cystotomy before resorting to a mutilating operation, rather than remove the testicles and later discover a tubercular bladder or encysted stone or malignant disease of the bladder or prostate. Castration is such an easy operation that every tyro in surgery will be tempted to perform it upon willing subjects suffering from obscure affections of the bladder, complicating hypertrophy of the prostate gland. The RammWhite operation deserves a fair trial at the hands of competent surgeons, in well-selected cases, but I apprehend evil in the future, not so much from the proper use as the abuse of this procedure. In short, it is probable that this new surgical resource, which has not yet passed the trial stage of a legitimate established. surgical procedure, will on a smaller scale become a repetition of the unenviable history of castration of the opposite sex. We have every reason to believe that so far the apparently successful cases have found their way into current medical literature, while the cases in which the operation has proved a failure, with few exceptions, have for apparent reasons not been published.

Gentlemen: It has been my purpose to call your attention in the brief time allotted to the delivery of this address to some of the limits of the art of surgery and to a few of the most flagrant prevalent trespasses of its legitimate

limits by undiscriminating surgeons. I wish time would permit me to say something of the too frequent recourse to the recently revived operation of symphyseotomy and the unwarranted procedure known as Porro's operation, except in cases in which the uterus is the seat of a life-threatening affection, some of the evil results following the too frequent performance of ventro-fixation of the retroverted uterus, and many other topics in general surgery and gynecology to which no allusion has been made, where the limits of the art of surgery have been ignored, and too often reckless operating has disgraced the fair fame and reputation of our noble profession. Let us have in the future more of the nil nocere in place of the furor operativus. I have written and delivered this address with malice toward none, in the interest of the suffering portion of our population, for the true advancement of the science and art of surgery, and as a plea for recognition of the good work done by the great mass and backbone of our profession, the modest, toiling, inadequately remunerated general practitioner.-Journal' of American Medical Association.

(429) Changes in the Spinal Cord After Amputation of Extremities.

Grigoriew (Zeit. f. Heilk., vol. xv, p. 75) investigated 2 cases of amputation of the arm, 2 of amputation of the thigh, and I of amputation of the leg. The period elapsing between operation and death varied from twenty years to I year. The results of his investigations agree with those of the greater number of authorities, and are collected by the author in the following summary: In all cases excepting that in which one year elapsed before death, deviations from the normal appearance of the cord were noticed; in all cases they were analogous, affected the corresponding portions of the cord, and consisted in a simple atrophy of certain portions of the grey and white substance differing in the cases only by the degree of development. The simple atrophy of the nervous elements of the cord was greater as the period elapsing between amputation and death was greater, less as it was less; while in the case in which the period was only one year, atrophy was completely wanting. With reference to the relative time before the separate paths and portions of the cord became degenerated, the author found. his cases in agreement with those of other authors, and with those obtained by experiment on animals, namely, that the atrophic phenomena appear earlier and are more marked in the sensory than the motor areas of the cord.-British Medical Journal.

Miscellany.

Traumatic Neurasthenia.

At a recent meeting of the New York Neurological Society Dr. C. E. Nammack presented a patient, a policeman, who, on October 12, 1892, had attempted to stop three runaway horses, attached to a steam fire engine, in the Centennial parade. He was successful in this, but although not physically injured, he received a profound psychic shock. One week later it became necessary for him to seek medical advice, for the relief of pains in his chest. On the advice of Dr. C. L. Dana he went abroad, and remained there from June, 1894, to October, 1895. He had been perfectly well. up to the time of this accident, and his family and personal history were excellent. He remained on police duty for some time, but found himself unable to attend to his work, even though his promotion to the rank of roundsman had rendered this less monotonous than formerly. The first symptoms noticed were diminished power of persistent application and nervous irritability. Mental exaltation then became marked, and insomnia became most distressing. Hyperæsthesia and paræsthesia were noticed. The principal subjective symptoms were pain over the heart and dyspnoea, on exertion; profuse sweating and insomnia. Examination recently showed the pain and temperature senses normal, tactile sensibility impaired, and hyperæsthesia wanting. Both visual fields showed the shifting type of contraction. Color perception was fairly good. There was no motor weakness of the eyes and no abnormal pupillary reaction. Smell and taste were not affected; station and gait were good; there was some tremor of the hands. The knee jerks were slightly exaggerated. The heart action was weak and greatly accelerated by walking; there was no enlargement of the heart or valvular disease. Slight irritation of the skin led to persistent redness. His weight had fallen from 220 to 175 pounds. Micturition was not vigorously performed. The urine was normal. The sexual desire was weak, although the power was good. The diagnosis in this case, the speaker said, lay between traumatic neurasthenia, traumatic hysteria and simulation. The last was excluded by the absence of motive, of striking symptoms and of efforts to exaggerate slight symptoms. Hysteria was excluded by the absence of anæsthesia, contractures, spasms, etc., and of paroxysmal phenomena. The patient had had the benefit of skilful treatment, and improvement had been slow but steady. Apparently, hydro therapy had benefited the

patient the most. The case was interesting, as being free from the usual complications arising from prospective lawsuits.

Dr. C. L. Dana said that when he saw this case he made the diagnosis of traumatic neurasthenia. The case was an interesting and typical one, and was chiefly of importance on account of the absence of the complications referred to.

Dr. Nammack, in closing, said that formerly considerable stress had been laid upon the condition of the visual fields as a differential point between traumatic neurasthenia and hysteria, but that now this had been pretty much abandoned.—Journal of Nervous and Mental Diseases.

Roentgen Rays in Internal Medicine.

Huber, of Leyden's clinic (Deut. med. Woch., March 19, 1896), remarks that in various swellings of the joints it may be impossible to ascertain by palpation whether the changes lie in the joint ends, in the cartilages, or in the soft parts. Case I: A man, aged 31, had a third attack of rheumatism. He had also had several attacks of gonorrhoea, from one of which he was still suffering. The photograph showed distinctly the swelling of the soft parts about the metacarpo-phalangeal joints of the middle and index fingers, and also about the first phalangeal joints of the second and especially the third fingers. No change was visible in the bones. Case II: A woman, aged 41, had suffered from chronic rheumatism for two years. At first it was limited to the small joints of the hands; later the elbow, shoulder, knee and ankle-joints were affected. Here the photograph showed that, although the rheumatism had existed for two years, there were no anatomical changes in the bones of the hands. Under treatment she improved considerably. Case III: A man, aged 49, had suffered for three or four years from painful swellings in the fingers, due to gout. The photograph showed lateral outgrowths and irregular thickenings in the ends of the bones. In the terminal phalanges a streaky appearance was visible, due in all probability to the deposit of lime salts. Case IV: A girl who had a poisoned wound of her hand three months previously. had a thickening about and loss of movement in the first phalangeal joint. The photograph explained the failure of past methods of treatment and the need of surgical assistance. The last photograph was from a patient who had suffered from gout for thirtyeight years previously. It showed (a) large gouty nodules beneath the skin, and apparently in connection with the joints. These deposits of uric acid allow the rays to pass through fairly well. (b) Great changes and destruction in the joints, and (c) destruction of the bone.

In the terminal phalanx of the ring finger it would appear as if there were a cavity surrounded by a thin wall only, the cavity being probably filled with uric acid. The removal of the uric acid in this case, either by absorption or otherwise, could only render a hitherto useful hand quite useless.-British Medical Journal.

The Fees of Medical Witnesses in Great Britain.

In Scotland, medical witnesses receive two guineas for each day they are cited to appear in the circuit court of the town in which they are residing and three guineas if the court is held at a distance. There are also allowances for traveling and other expenses. In England and Wales the fee is one guinea per diem, one round trip railway fare, and an allowance of two shillings per night. If the court is held in the city in which the witness resides, there are no allowances beyond the guinea a day. The association of police surgeons of Great Britain and Ireland is agitating the question of demanding larger fees for witnesses. It recently requested the home secretary to receive a delegation to confer with him on the desirability of revising and increasing the present scale of fees, but he declined to discuss the question, seeming to think that $5 a day was good enough pay for a docter.-Medical Record.

One of the interesting characters of the fourteenth century was the sergeant surgeon of Edward III., in 1346, John of Arden. gives a "Description of ye qualites which ought to be in ye surgeon that performeth any operation in chirurgery:

"First, that he be devout. Secondlie, charitable to ye poor. Thirdly, to use few words. Fourthly, to avoid drunkenness. Fifthly, to be chaste both in words and gestures, as well as to fear ye not.

Sixthly, not to undertake an incurable disease."-Medical News.

We have received the following from the secretary of the Marion-Sims College of Medicine of St. Louis: Whereas, Dr. I. N. Love has found it incumbent on him to sever his connection with the Marion-Sims College of Medicine, the members of the faculty of that institution embrace this occasion to express their appreciation of his past services, and to extend to him their hope that in all his future connections he will find both pleasure and profit.

C. Barek.

R. C. Atkinson.
B. M. Hypes.

Committee.

Notices and Reviews.

Obstetric Accidents, Emergencies and Operations. By L. Ch. Boisliniere, A. M., M. D.. LL. D., Philadelphia: W. B. Saunders, 1896.

The author sets forth in his preface that "this book is not a treatise on midwifery nor a manual of obstetrics," but that "it is intended for the use of the practitioner, who, when away from home, has not the opportunity of consulting a library or of calling a friend in consultation." The work is far from being what the author intended. In the first place, it contains too much that belongs more properly to a treatise or manual, and which would be of little value or interest to one seeking help in an emergency. This unnecessary padding makes the volume too bulky to be conveniently used as a working guide. On the other hand, to one requiring assistance, when away from library and friends, the book would prove, in most instances, a disappointment. There is a serious lack of explicitness in giving the details of treatment, whether operative or otherwise, and the author's meaning is not always clear. The avowed object of the work is lost sight of at times, as, for instance, when the writer insists that where surgical anesthesia is necessary "chloroform must be administered by a reliable medical assistant," and when he urges that in all bloody operations one or two able col

leagues be called in consultation. In the

treatment of abortion one is advised to do nothing aside from the use of ergot and the tampon, until "bad symptoms" show themselves, because under certain conditions the ovum or placenta may be retained for months or years without danger. According to the author, incomplete perineal lacerations, that is, those beginning at the vulva and not involving the anal splincter, "do not require any particular treatment, as they heal spontaneously," which is quite at variance with the teachings of the majority of obstetricians. The author emphatically declares that the killing of an unborn child, in order to save the mother's life, is never justifiable, at any stage of uterogestation. He deplores the wanton "slaughter of the innocents" in cases of uncontrolable vomiting of pregnancy, and in cases of tribal or abdominal gestation.

The book is well printed and is profusely illustrated, to a large extent with Dr. Dickin

son's beautiful cuts, reproduced from the American Text Book of Obstetrics.

L. H. P.

BOOKS AND PAMPHLETS RECEIVED.

"The Technics of the Trial Case; or, Subjective Optemetry," by A. Edward Davis, A. M., M. D. Reprinted from the New York Medical Journal for June 20, 1896.

"Fetal Hiccough," by Jos. B. DeLee, M. D. Reprinted from The Chicago Medical Recorder, August, 1895.

"Three Clinical Obstetrical Studies," by Jos. B. DeLee, M. D. Reprinted from The Chicago Medical Recorder, May, 1896.

"Salivary Calculi," by Gustav Fütterer, M. D. Reprinted from Medicine. Geo. S. Davis, publisher, July, 1896.

"A New Method of Treating Pneumothorax," by Gustav Fütterer, M. D. Reprinted from Medicine, June, 1896.

"Sponge Grafting in the Orbit for Support of Artificial Eye," by E. Oliver Belt, M. D., of Washington, D. C. Reprinted from The Medical News, June 27, 1896.

"The Diagnosis of Hysteria," by Hugh T. Patrick, M. D. Reprinted from the New York Medical Journal for February 15 and 22, 1896.

"The Conservative Use of the Stomach Tube in the Treatment of Gastric Diseases," by J. M. G. Carter, M. D. Reprinted from the Journal of the American Medical Association, June 15, 1895.

"Is the Disturbed Equilibrium of the Eye Muscles a Cause of Headaches and Other Reflex Neurosis?" by F. C. Hotz, M. D. Reprinted from the Chicago Medical Recorder, April, 1896.

"Ulcer of the Stomach," by J. M. G. Carter, M. D., Waukegan, Ill. Reprinted from International Clinics, Vol. IV, Fifth Series.

"Conservative Surgical Treatment of Para and Peri-Uterine Septic Diseases," by Fernand Henrotin, M. D. Reprinted from the American Gynæcological and Obstetrical Journal for June, 1895.

"Hypnotism," by Hugh T. Patrick, M. D. Reprinted from International Clinics, Vol. IV, Fifth Series.

"Sarcoma of the Choroid, Glioma of the Retina, and New Formed Blood Vessels in the Vitreous," by L. Webster Fox, M. D. Reprint from the Ophthalmic Record, Vol. 5, No. 8.

"Hydro-Galvanism of the Urethra," by Robert Newman, M. D., New York. Reprinted from Transactions of Electro-Therapeutic Association, 1895.

"The Extension Corset and Its Indications," by Alex. C. Wiener, M. D. Reprinted from

the Journal of the American Medical Association, April 25, 1896.

"Present Status of Operative Treatment for Bladder-Stone," by Arthur Dean Bevan, M. D. Reprinted from Medicine, May, 1896.

"The Development of the Test Card," by Dr. Frederick K. Smith. Reprinted from the Cleveland Medical Gazette, June, 1896.

"Diagnosis of Hystero-Epilepsy," by Hugh T. Patrick, M. D. Reprinted from the North American Practitioner, July, 1896.

"The Experience of Several Physicians with Sero-Therapy in Tuberculosis," by Paul Paquin, M. D. Reprinted from the Journal of the American Medical Association, August 15, 1896.

"Tumors of the Eyeball," by William H. Wilder, M. D. Reprinted from the Journal of the American Medical Association, April 27, 1895.

"Paralysis of the Ocular Muscles," by William H. Wilder, M. D. Reprinted from the Chicago Medical Recorder, July, 1896.

A physician is an angel when employed, but a devil when one must pay him.-German.

I had reasoned myself into an opinion that the use of physicians, unless in some acute disease, was a venture, and that their greatest practicers practiced least upon themselves.Sir W. Temple.

FOR SALE.

PRACTICE FOR SALE:-I offer for sale my practice in the County seat of one of the best counties in Iowa. Have been here for twelve years; am surgeon of the leading road entering the town; am medical examiner for six life insurance companies, etc. I simply require that my successor buy my office fixtures, mostly new-worth $700. Purchaser must be reliable physician with few years' practice. Address "Z. V.," care RAILWAY SURGEON, Chicago.

Desiring to remove to the Pacific Coast, I offer my well-established practice of over 20 years to any physician who will purchase my real estate, situated in one of the most beautiful and thriving towns in Southern Michigan, and surrounded by a very rich farming country. The town is intersected by two important railroads. for one of which the subscriber is surgeon. The real estate consists of a fine brick house of eight rooms and two fine offices besides, attached to, and a part of, the residence. A fine well of the purest water, two cisterns, waterworks, etc. Fine garden filled with choice fruit in bearing, peaches, pears and apricots and small fruits, raspberries. currants, etc. Fine barn and other outbuildings, comparatively new and in the very best condition, all offered with the practice and goodwill at a very low figure for cash. Address "MACK, Surgeon," care RAILWAY SURGEON, Monadnock Block Chicago, Ill.

By reason of failing health, physician wishes to dispose of real estate and practice. Practice amounts to nearly $4,000 per year. No charges except for real estate. Address WM. D. B. AINEY, Montrose, Pa.

Desiring to remove to a warmer climate, owing to poor health. I offer my well-established practice of 11 years to any physician who will purchase my real estate: situated in one of the most thriving towns in the Platte Valley, in Central Nebraska, on main line of Union Pacific R. R., on which road I am the assistant surgeon.

The real estate consists of 2 lots "on corner," on which there is a fine artistic "modern" frame house, 8 rooms; stable 20x30, wind mill. tower and 30-barrel tank: nice blue grass lawn. trees and fine garden (all new); and all offered with my $5,000 practice and good will, at a very low figure. A part cash, balance on time. A very thickly populated country. Address BOVINF," care RAILWAY SURGEON, Monadnock Block, Chicago, Ill