by a digital examination, which represented the only positive and final method. Hence, in any given case, if there was difficulty or disturbance of micturition attended with a sense of fulness in the rectum, we were justified to make a digital examination to discover the connection, and this either during pregnancy or labor, and especially so during pregnancy. During labor it would certainly be discovered. Such examination brought to our knowledge the exact conditions leading to retention of urine. As to treatment: Suppose the state of affairs had been discovered at eight months; chloroform might have been administered and the impacted mass dislodged, or else enemata might have been resorted to to soften and gradually remove it. He did not believe that, in his case, enemata would have succeeded, for even after the mass was broken up the removal of the fragments by the finger would have been very painful, and could not have been accomplished without chloroform; so that he would advocate the latter procedure in all such cases. If the mass was soft and boggy, enemata would suffice. He preferred small quantities of water with glycerine or sweet oil, and had seen successive injections of six ounces gradually and effectually empty the rectum. He advised a small injection at night to be retained until next morning, to be then followed by repeated small injections. In pregnancy there was no doubt as to the proper procedure. If we found rectal accumulations before labor, they should be removed by enemata; but when labor set in and the rectum contained a hard mass sufficiently large to push the uterus up and preventing descent of the child, we must dislodge it by mechanical means. Had his patient believed herself to be in labor, she would have called him in sooner and would have been relieved sooner. The next question was, as these masses might be large and hard enough to prevent micturition, what would be the effect of failure to discover the cause, if by the use of the catheter we did not empty the bladder, and thought that there was no more urine in it? Might not a mistake and neglect result in the causation of cystitis or pyelitis, or other renal trouble?

In conclusion, he said that while the subject introduced might seem trivial to older practitioners, yet it could not be so to the young men of the profession, who might be misled by failure of catheterization or by the statement of the patient that she was not in labor.

DR. KING inquired as to the amount of fecal matter removed. (Dr. Busey said it would represent at least one pint.) Dr. King, continuing, said fecal impaction, whether occurring in men or women, was an interesting subject. In a discussion published in the AMER. JOUR. OF OBSTETRICS were given some remarkable cases. Thus one patient had not defecated for six months; others had gone from two to three months; some only evacuated the bowels two or three times a year. The late Dr. Hall, of this city, related a case of obstinate obstruction. The subject was a military gen

One day

tleman who boarded at the same house with Dr. Hall.
the colonel, looking very melancholy, came to Dr. Hall and told
him that his bowels had not been moved for three months. The
doctor would hardly believe him, but ordered some compound ca-
thartic pills which proved ineffectual.
thartics, all to no purpose. Examination showed that the rectum
He then gave stronger ca-
was occupied by a fecal mass of strong hardness. The doctor

went to work and broke off as much as he could from day to day,
the patient's wife standing by and holding a plate for the recep-
tion of the fragments. On the nineteenth day she inquired of the
doctor whether this was ever going to end? Finally all the mass
was removed.
was informed that he had been constipated during last winter, he
Dr. King saw a gentleman a few days ago, and
did not know how long, and even now he did not have a stool for
twenty-five to thirty days. To return to Dr. Busey's case: He had
never seen anything like it where the whole pelvis was filled with
fecal matter, although all of us met with accumulations of feces
more or less in quantity.

DR. G. W. JOHNSTON Said that Dr. J. B. Hunter had reported a case where a fecal accumulation had been mistaken for an ovarian tumor. As to Dr. Busey's case, fecal impaction was more or less common, but it was uncommon as a complication of labor, and still more so as a positive impediment to the birth of the child. Rouyer (Gaz. Hebdom., 1862) gave the history of a multipara who had never had any trouble at the birth of her children. In her last labor the head was arrested at the superior strait; the forceps was applied, and it required the force of three men to extract the child. The head was greatly bruised. In the delivery the rectovaginal septum was torn through in two places. The cause of the dystocia was a fecal impaction which persisted for one month after labor and resisted all enemata. Finally an abscess formed in the perineum, requiring surgical interference; some feces were removed with a spoon, and the woman died thirty-six hours after the operation.

In the same article Rouyer mentioned a case to which Fournier was called in consultation by three students who, for five days, had tried to deliver a woman, 22 years of age, who had been constipated for five days. Fournier advised injections, but they could not find an anus; the latter was imperforate and the rectum opened into the vagina. It was punctured, and by injections they removed an immense mass of feces containing cherry stones. After this spontaneous delivery took place.

Pregnancy favored fecal accumulation and impaction, and they in turn might prove an obstacle to delivery. Even when delivery was possible, traumatic injuries were done the recto-vaginal septum from pressure of the child's head on one side and the fecal tumor on the other.

DR. BROMWELL was glad to have been a witness at so interesting a case as that reported by Dr. Busey, and could bear testimony to the skill displayed in the recognition of the trouble, and in the effectual manner of relief. He thought the quantity of fecal matter removed was nearer a quart than a pint. Its character showed that it had been in the rectum for some time, for it was of calcareous hardness. He agreed with Dr. Johnston that the literature on the subject was scant. Dr. Bromwell had a case of fecal impaction (not in pregnancy) in a lady which was mistaken for a

fibroid, although she had a fibroid also. She had a regular stool every day, there being a central passage through the mass permitting passage of fecal matter from above. Ordinary enemata having failed, he tried cathartics, finally ox-gall by enema, which caused terrible straining without dislodging the mass. He then took a Sims' depressor and succeeded in removing the mass piecemeal in three days.

DR. BUSEY, in closing, said he was indebted to Dr. Johnston for a presentation of the cases, which showed that they were even more dangerous than he had anticipated, especially when the forceps were applied before the fecal mass was dislodged. He had not thought that such cases could occur, inasmuch as examination would show the impaction. One symptom he had omitted to mention-the odor of the finger after coming in contact with the fecal mass. The danger shown in Dr. Johnston's cases, especially the rupture of the vagino-rectal septum, from compression between the head and the fecal mass, made the subject still more interesting.

TRANSACTIONS OF THE GYNECOLOGICAL SOCIETY OF CHICAGO.

Meeting, Friday, June 18th, 1886.

The President, DANIEL T. NELSON, M.D., in the Chair.

DR. W. W. JAGGARD exhibited

A GRAVID UTERUS WITH ADNEXA, CORRESPONDING TO THE SIXTH

MONTH.

The material was placed at his disposal through the courtesy of Dr. H. H. Frothingham, one of the resident obstetricians of Cook County Hospital.

The patient, 30 years old, multipara, came under observation May 17th, 1886. While sitting on a chair in the ward, she began to show signs of asphyxia. She was immediately put to bed, but died within five minutes of the beginning of the attack.

Autopsy made after forty-eight hours showed some congestion of envelopes of brain and at posterior margin of tentorium cerebelli two small, round, firm tumors intimately attached to the dura mater and pressing upon cerebellum at posterior internal angle of each hemisphere. Tumors are each about the size of a filbert, upon section presenting a grayish firm surface at periphery, and a disintegrated portion at the centre. Cerebellum.-Soft and pale throughout, arbor vitæ appearance almost entirely disappeared. No trace of hemorrhage or embolism discovered. Ventricles of cerebrum contained little fluid.

(Tumors referred for microscopical examination.)

Abdomen.-Peritoneum apparently normal. Gravid uterus with fundus extending to the level of the umbilicus. Large corpus luteum in left ovary. Upon opening the uterus, a male fetus, in the embryonal position, was found. Placenta separated from the uterus by its own weight and without any effort to detach it. Dr. Jaggard desired to call attention to the condition of the cervix. The cervix is a funnel-shaped object, the neck of which measures 4 cm. in length; thickness of wall, 2 cm. The upper expanded portion measures 1.5 cm. in length; thickness of the wall 1.5 cm. The mucous membrane lining this funnel-shaped cervical canal differs in its macroscopic characters from the mucous membrane lining the uterine cavity. The cavity of the cervix is filled with a white coagulated secretion. The insertion of the membranes forms a circle around the upper expanded portion of the cervix, about 7 cm. in diameter, corresponding to the site of several large veins in the muscular substance of the uterus, and the insertion of the peritoneum externally. At this point, the muscular substance of the uterine wall becomes thinner. The average thickness of the muscular wall of the uterus is 1 cm.; that of the cervix 1.5 to 2 cm. Total length of the uterus, 17 cm. The macroscopical characters of the preparation seemed to sustain the position assumed by Bandl, Kuestner, and Carl Braun, recently opposed with considerable force by M. Hofmeier. Dr. John Bartlett, a distinguished Fellow of the Society, read a paper entitled 1 66 The Cervix Uteri Before, During, and After Labor," July 14th, 1873, before the Chicago Medical Society (several years prior to the appearance of Bandl's classical monograph upon the same subject) from which the following extract is made:

Early in pregnancy the neck of the uterus is called upon to supply its quota to the enlarging body. Speaking somewhat figuratively, as ring after ring of tissue is demanded from the upper part of the cervix, the preparatory development in the remaining portion is such that the length of the neck is not apparently impaired, so that what remains of it as late as two weeks before labor has been mistaken for the entire infraand supra-vaginal cervix, whilst the loss by the continual transfer from the upper portions of the neck to the uterine walls has entirely escaped notice. That circle of the neck which corresponds at the time of an examination to the limits of its expansion, is regarded by writers as the os internum. The os internum is, of course, as before labor, above the attachment of the vagina, and, near term, far removed from the examining finger. The apparent constriction taken for it is simply that point in the cervical walls marking the constantly decreasing line of demarcation between the expanded and yet unexpanded portions of the neck."

DR. A. REEVES JACKSON, in beginning the discussion on Dr. Parkes' paper on the treatment of uterine fibroids by ergot, said: "I was very much pleased to hear the reading of Dr. Parkes paper. I commenced using ergot in the treatment of fibroids in June, 1873. I had used it in eight cases at the time Dr. Byford read his paper based on 103 observations gathered from various

1 The Chicago Medical Journal, October, 1873.

persons in this country. I was extremely pleased with the result; two of the patients seemed to be practically cured-that is to say, while there could be distinguished some remaining enlargement of the uterus, the symptoms that were referable to the presence of the tumor were entirely removed, and the patients suffered no inconvenience from the bulk of the uterus. In nearly every case there was improvement. I continued to use it for several years, but have not used it lately-I do not know why. The cases that have been published by those who use it extensively have all shown favorable results except those of Martin, of Berlin, and perhaps two or three others. There seems to be no reason to doubt that ergot, whether given hypodermically, by the mouth, or rectum, does have some controlling influence on the development of uterine myomata, checking the growth or lessening the size of the tumor. Indeed there is reason to believe that it is one of the very best means of dealing with these tumors. I have used the remedy in perhaps thirty cases. I do not know just what the ratio of success was. In about three-fourths of these cases there was benefit. Sometimes the good effect did not consist in diminution of the size of the neoplasm, but was from improvement in the general health of the patient. I was very glad to hear of the almost phenomenal success that followed the practice of Dr. Parkes. In some of the cases he relates the patients were, however, evidently in great jeopardy from the sloughing of the mass, and the difficulty of getting it away before septicemic symptoms came on. There is great danger unquestionably in having a sloughing fibroid retained within the uterus. The treatment by ergot should be accompanied by dilatation of the cervix, so that the mass, when separated from the wall of the uterus, may escape readily. This would lessen that danger. In some cases, death has occurred very soon after the stinking discharge appears. Nevertheless, the treatment by ergot is very much less dangerous than any of our surgical methods of dealing with uterine fibroids.

THE PRESIDENT.-Have you kept records of any of your cases? DR. JACKSON.-Yes; and I shall be glad, if the interest continues, to report them in detail. I kept accurate notes of the first cases, so far as I had charge of the patients. Some of them occurred in the Woman's Hospital, and the patients would go away, and we did not always have means of ascertaining the final results. But of others, occurring in private practice, I can give accurate details.

DR. H. T. BYFORD.-I made the assertion that there was no danger of a sloughing of the tumor when it is not situated so that it can be expelled by way of the vagina. This was based on the fact that, unless submucous, it cannot be firmly enough compressed. I have reported a case of fibroid tumor of the vagina, whose thick pedicle was gradually cut through by daily tightening a fine wire about it; when the wire had cut through the pedicle, it was found to have reattached itself, and retained its vitality, showing that tumors of this nature require very little nourishment to keep them from undergoing sloughing. The cases on record are very few in which subperitoneal growths have sloughed from the use of ergot.

DR. W. W. JAGGARD said, with reference to priority in the use of ergot in the treatment of uterine fibroids, that Hildebrandt, of

1 Chicago Medical Journal and Examiner, August, 1885.