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near the mucous membrane, is the kind that I think may almost certainly be expelled. If you find a case of symmetrical development, where the uterus seems near its normal shape, no matter how big, so it is normal in shape, oval, or globular, without any large projections standing out in various directions, feeling somewhat elastic to the touch, and attended with hemorrhage, you may be pretty sure you can expel the tumor by commencing with small doses of ergot and increasing them in size, and then when the pains begin, not to stop them. The presence of severe pains frightens a great many men from finishing what they have begun. If I were to try to explain this operation, I would say when ergot is given in this way, after a while the tumor becomes starved, the supply is cut off so there is not blood enough to support it, and very soon it dies in consequence of the strangling process. When it dies there is, at the same time, gangrene of the mucous membrane covering it; then it becomes a foreign body and you cannot keep the uterus from expelling it. The expulsion is a consequence of this starvation and killing process in the tumor. As to the action of ergot in tumors that are not submucous, of course I know that tumors not submucous cannot be expelled. There is what is called the interstitial tumor, developed in the central stratum of the fibrous walls of the uterus; these are the proper subjects of the Hildebrandt process for atrophization. Then with reference to the effect of ergot upon subperitoneal tumors. I have often been asked the question, Can ergot affect the subperitoneal tumors? I think they are frequently starved out and cured; when not too near the peritoneum there is no danger of their becoming detached and putrid in the peritoneal cavity, because the action is from the tumor. In the submucous tumor, the contractions are all towards it and none from it. There is one circumstance to be taken in connection with these tumors and the action of ergot upon them, that has not been sufficiently considered. A large proportion of them growing to any considerable size contract attachments to the peritoneal membrane, the intestines, omentum, or the walls of the abdomen, and in making this attachment they get a new supply of blood, which makes the life of the tumor more tenacious than it would be otherwise. This very process of adhesion to the walls of the abdomen is, more than any other, the cause of their great size and the change from a fibrous to a fibro-cystic tumor. We need not expect such tumors to be affected by ergot. There are a good many other things that interfere with the successful use of ergot, of which I cannot now speak. I am grateful to my western associates who have assisted me by facts and experiments on this subject. If you go to the eastern part of the United States they will tell you that ergot is of no use in the treatment of fibrous tumors, or it is too dangerous; the patient cannot live under the pains of expulsion, etc.; but if these same gentlemen had a patient in labor they would urge the the pains instead of stopping them. Most physicians who do not believe in the efficacy of ergot, use Hildebrandt's method pretty much altogether, which produces tonic contraction of the fibres of the uterus, but does not go to the extent of causing expulsive pains. Then, again, there is too great apprehension on the part of the profession generally of the dangerous poison of ergot. I do not know whether the history we have of the poisonous influence of ergot in producing nervous diseases, gangrene, and so on, is true; whether the observations that led to that teaching were correct at

one time or not, but I know that, after the use of ergot persistently for two or three years in the same case, I have never seen any evil influence produced by it, unless it is in cases where the violent action of the uterus would be regarded as such. I have purposely avoided saying anything about the modus operandi of ergot in causing contractions in the uterine fibres, because that is now sufficiently understood by the profession. But, Mr. President, I feel that I have occupied too much of the valuable time of the Society already, and will say no more.

A STUDY OF THE CAUSE AND TREATMENT OF PELVIC HEMATOCELES.'

The discussion of Dr. Byford's paper was deferred until the next regular meeting.

TRANSACTIONS OF THE OBSTETRICAL SOCIETY OF LONDON.

Stated Meeting, June 2d, 1886.

The President, DR. POTTER, in the Chair.

The following specimens were shown:

1. Fibroids in Twin Pregnancy, by Dr. John Phillips.

2. Fetus and Placenta from Extrauterine Gestation Removed by Abdominal Section, by Dr. Herman.

3. Ovarian Tumor and Fibro-Myoma Uteri Removed at the same Operation, by Mr. Knowsley Thornton.

Papers:

NOTE ON THE ARTIFICIAL PRODUCTION OF SO-CALLED

VARIX.

"LYMPHATIC

By DR. F. H. CHAMPNEYS.-The object of the author was to determine whether so-called "lymphatic varices" could not be produced at will by the simple expedient of cupping striæ in the skin which were not edematous. If this produced appearances which could not be distinguished from so-called "lymphatic varices," it would tend to prove that these are really due to general lymphatic edema, showing most plainly over the least supported parts of the skin, and not to any peculiar arrangement of lymphatics, nor to obstruction of any particular lymphatic trunks.

This was proved to be the case.

The author concludes that "lymphatic varix" is a misleading expression.

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DR. HERMAN said that Dr. Champneys had spoken in his paper of lymphatic edema," and of "edema" in his remarks. He asked whether the alternative mode of expression was simply for

1 See original article in next number.

brevity or whether it illustrated his view as to the nature of the fluid filling the cracks. He believed with many others that in phlegmasia dolens there was not simply edema from venous obstruction, but there was obstruction in the lymphatic system of the limb. There was little direct proof of this, but there were strong arguments from analogy in its favor. Dr. Duncan's case was important, for, if the fluid in the varicose skin-cracks were lymph, it furnished some direct evidence that there was obstruction to the return of the lymph from the limb. Did Dr. Champneys consider that his experiments had any bearing on this question? When he spoke of "edema" did he mean the swelling that resulted from altered pressure relations in the capillaries, or did he mean by "lymphatic edema" that the fluid had been exuded from the lymphatic vessels ?

DR. M. HANDFIELD-JONES called Dr. Champneys' attention to three cases of dilatation of lymphatic radicles which were in St. Mary's Hospital, and were published in the Lancet, August 7th, 1875. They closely resembled that of Dr. M. Duncan. Mere edema was not sufficient to produce the appearances described. Some active pathological condition attacked the small spaces from which the lymphatic vessels started, and spread thence along the larger canals. It was noteworthy that, considering the frequency of edema of the lower limbs, the appearances described in the cases referred to were rare.

DR. CHAMPNEYS said that Dr. Griffith had misunderstood the

gist of his paper. It was an argument that the so-called "lymphatic edema" was not a special affection of lymphatic vessels, but was merely a general edema, showing most plainly at the weakest parts of the skin. Dr. M. Duncan (from whom Dr. Griffith also differed) had expressed his opinion in the words quoted from his paper, and Dr. Champneys had endeavored to prove by experiment the correctness of this opinion. Therefore Dr. Griffith agreed with Dr. Duncan and Dr. Champneys. To Dr. Herman Dr. Champneys replied that he meant ordinary edema, and not any special affection of the lymphatic vessels.

No report of Dr. Griffith's remarks was received before the report of the meeting was sent to the journals.

NOTE ON ONE OF THE CAUSES OF DIFFICULTY IN TURNING; WITH REMARKS ON THE PRACTICE OF AMPUTATING THE PROCIDENT ARM.

By DR. G. ERNEST HERMAN.-The author describes difficulty in turning due to impaction of the point of the shoulder below the imperfectly dilated internal'os. In these cases there is no great difficulty in seizing the lower extremity, but when this has been done, the condition described prevents the child from rotating. The proper way to overcome the difficulty is to press the point of the shoulder towards the middle line of the cervical canal, and thus disengage and raise the shoulder. When this is done the child is easily turned. The author then refers to the writings of those who have advocated amputation of the arm in cases of transverse presentation which cannot be turned, on the ground that turning becomes easy when this has been done. He believes that these cases were of the kind now described by him, and that the amputation of the arm was effective by removing the resistance offered by the im

pacted shoulder. But he did not think amputation of the arm was proper in such cases, for the child could be turned if the point of the shoulder was disengaged in the manner he had described, and if the child were dead, decapitation was better than amputation of the arm followed by turning.

DR. GALABIN did not think that the internal arm could prevent the shoulder being pushed directly upwards. It might, however, prevent its ascent when the attempt was made to turn as described by Dr. Herman, by acting on both poles of the fetus at once, for this would move the shoulders not only upward, but also outward, and it would be more likely to be resisted by the projecting ring. He had never had occasion either to cut off the arm or push the shoulder, and he had only once met with a case in which it was impossible to turn, and he had to decapitate. In this case a shoulder had been mistaken for a breech, and expectant treatment continued for two days. He believed that there was no case in the records of Guy's Hospital Charity in which turning was impossible, and alternative embryotomy became necessary. Where it was necessary to act on both poles of the fetus, he would make the action alternately, pulling down a leg and pushing up a shoulder.

He asked if Dr. Herman had been always successful with his method, or whether embryotomy was still necessary sometimes? DRS. BOXALL, CHAMPNEYS, PLAYFAIR, CLEVELAND, and the PRESIDENT also made remarks, and Dr. Herman in reply said that he did not assert that the condition described in his paper was the cause of difficulty in every case, but that on the contrary he thought it an occasional and rare source of difficulty.

There was in these cases a little difficulty in bringing down the foot, but much in turning the child; while where the uterus was contracted tonically round the child there was difficulty in getting the foot. He agreed with Dr. Galabin, and had pointed out in his paper that the difficulty was augmented by pushing up the shoulder while pulling down the leg. The defined swelling of the shoulder which was present showed that it had been encircled for a long time. He had felt the contracted ring above the shoulder. He adopted in turning the plan advocated before the Society in a valuable paper by Dr. Galabin, i. e., he seized the most easily accessible foot.

Attempts at turning had been made under anesthesia in one of his cases for three-quarters of an hour; in the second, anesthesia was not employed, and he did not remember as to the third.

FOUR CASES OF SPURIOUS HERMAPHRODITISM IN ONE FAMILY.

BY DR. JOHN PHILLIPS.-The author gave the family history; out of nine pregnancies the fourth, sixth, eighth, and ninth were hermaphrodites. Fright during the third month of pregnancy in mother's opinion caused the first. None of them survived more than a few days, and the author had an opportunity of post-mortem examination; he laid the results before the Society with all the more important parts dissected out. The family antecedents were very carefully gone into, many of them being personally examined. Several defects, such as hernia and the like, had been discovered. A genealogical tree was appended. The author gave

an historical view of the whole subject. There appeared two causes at work on the mother's side in the production of this deformity. (1) The initial fright which she received when pregnant with the first. (2) The continued dread and mental distress

which ensued on her bearing a deformed child.

Conclusions: (1) A hernial or other weakness present in one parent, acting as a predisposing cause, any deep maternal impression received about the third month might induce some impediment to the proper differentiation of the urogenital system. (2) That a distinct tendency towards bearing hermaphrodites might be developed in a mother who had already borne one.

DR. M. HANDFIELD-JONES asked as to the relative frequency of sterility in these spurious hermaphrodites. It was a law of evolution that in hermaphrodites one set of organs atrophied in proportion to the development of the other; and, so in cases with a large clitoris, imperfect uterus and ovaries might be expected.

DR. CLEVELAND mentioned that he had a patient with only one testicle descended, who was the father of a large family, none of

whom were deformed.

DRS. JOHN WILLIAMS, WILCOX, CHAMPNEYS, and GALABIN also made remarks.

DR. JOHN PHILLIPS in reply said that he thought specimens of spurious male or female hermaphroditism were not uncommon, but that four in one family was unique. The father was the elder of the two parents, but his exact age he could not remember. He could not throw any light on Dr. Handfield-Jones' queries.

TRANSACTIONS OF THE FIRST MEET-
ING OF THE GERMAN GYNECO-
LOGICAL ASSOCIATION.

HELD AT MUNICH, JUNE 17TH, 18TH, AND 19TH, 1886.
(Concluded from p. 1001.)

Third Day-Morning Session.

President, DR. WINCKEL.

DR. SCHAUTA read a paper on

THE OPERATION FOR RECTO-VAGINAL FISTULÆ,

He first discussed the methods used in the treatment of these conditions: freshening from the vagina or rectum, division of the recto-vaginal septum below the fistula, and perineoplasty. These fistulæ are said to be more difficult to cure than vesico-vag inal

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