upwards of two hundred pounds, had borne several large children. In this labor she was attended by a midwife; after waiting fortyeight hours and seeing that the progress was slow, the latter sent for a physician, who succeeded in bringing down a foot. He then sent for a colleague, and together they extracted a leg. Dr. Morrill was then called and delivered a dead child, the weight of which, as carefully taken by him in the presence of his confréres, was as before stated.

THE PRESIDENT remarked that a German physician in the city had assured him that he had delivered a child weighing eighteen pounds. The largest child on record, weighing twenty-three pounds, was borne by Anna Swan, the giantess.

FETUS PAPYRACEUS.

DR. MCLEAN reported the following case: After a normal labor, he delivered a child weighing about ten and one-half or eleven pounds. The uterus remained large, and on examination some body could apparently be felt in addition to the placenta. By expression the latter was expelled, and with it a second amniotic sac, containing an anencephalic fetus, about four months old, completely flattened. The pregnancy had been perfectly normal in spite of the presence of the second fetus.

THE PRESIDENT remarked that such cases as the one reported had sometimes given rise to the suspicion of superfecundation. He asked regarding the appearance of the placenta.

DR. MCLEAN said that the half opposite to the flattened fetus had undergone extensive fatty degeneration.

THE PRESIDENT thought that this arrest of growth of one fetus was not uncommon in twin-pregnancies.

CASE OF PREMATURE DEVELOPMENT IN A BOY.

DR. SIMS related the case of a boy, three and one-half years of age, who had been brought to him, because his relatives thought that there was something peculiar about the child's sexual organs. The boy was as large as a child of seven (he weighed fifteen pounds when born), and had a penis and testicles as fully developed as those of an adult while the pubes were covered with a thick growth of hair which began to appear when he was eleven months old. The child was semi-idiotic, acted very much like an animal, especially when he was alarmed, and laughed with a peculiarly deep chest-tone. When he cried, the cry resembled the bellowing of a calf. He had constant erections and masturbated frequently, but had no seminal emissions. He had no inclination for the opposite sex. [The case will be reported in full in a future number of this Journal.]

DR. JACOBI Said that he had seen a few cases of premature development. From the general description of the boy and the peculiarities in the configuration of the cranial and facial bones, he inferred that he was a crétin. The sexual organs were often

prematurely developed in this class, masturbation being one of the first symptoms of sexual precocity, which often accompanied the early growth of hair on the genitals. He recalled a medicolegal case, in which a girl seven years of age had accused a schoolmaster of rape. She described the process of sexual intercourse so exactly that it seemed remarkable how she could have learned about such matters. On examining her external genitals, Dr. Jacobi found that the parts were intact, in fact, coition would have been a physical impossibility. There was hair on the mons which, with the labia majora, was large and well developed. This was a case of premature development of the imagination together with the sexual organs.

CASE OF MULTIPLE NEUROMATA OF THE ABDOMINAL WALL, FOLLOWING LAPAROTOMY.

DR. SIMS related the subsequent history of a case described at a former meeting (January 19th, 1886). He had then described the development of numerous painful nodules in the subcutaneous adipose tissue of the abdomen after laparotomy. These were excised, and had been submitted to different microscopists for examination, their reports conflicting. Dr. Sims had accepted the opinion of one gentleman that the growths were neuromata, but another pathologist had recently affirmed that they presented the minute structure of sarcomata. From the clinical history of the patient, he was inclined to believe that the tumors were not malignant. After removing the nodules, others made their appearance, and these were in turn excised until the patient's abdomen presented a deep cut or gully, extending entirely across the body, from one lower rib to the opposite one. This wound healed by granulation, and the patient was relieved of the old pain, but there still remained a number of small fibrous bands that extended between the old median incision and the superficial transverse one, about a quarter of an inch apart. These caused unpleasant dragging sensations, until they were divided under cocaine-anesthesia, when the patient was entirely relieved.

DR. JACOBI said that about twelve or fifteen similar cases were on record. Circumscribed collections of fat in the subcutaneous tissue might cause the same symptoms as neuromata, and hence might be classed with those growths; both were doubtless due to some inflammation of the peripheral nerves. The sections of the nodules doscribed by Dr. Sims, as examined by the speaker, had consisted almost entirely of dense fibrous tissue.

DR. SIMS remarked that one microscopist had found numbers of round and giant cells in a few sections.

DR. COE said that he had examined a large number of sections, and had found no appearances sufficient to justify the diagnosis of malignant disease. He had stated in his report that the growths were neuromata. He had been shown sections prepared by the gentleman to whom Dr. Sims had alluded, which certainly did suggest sarcoma.

DR. JACOBI, who, with Dr. T. A. Emmet, had seen the patient in consultation, called attention to the fact that her child had con

genital heart-disease. Could there be some connection between the peculiar tendency of the mother to neuritis and the cardiac trouble in the infant? The disease-mitral insufficiency, with resulting compensatory hypertrophy-was rare in such a young child.

CASE OF OVARIOTOMY DURING PREGNANCY-RECOVERY WITHOUT INTERFERENCE WITH THE PREGNANCY.

THE PRESIDENT reported the following case: Six weeks ago, he was called to Yonkers to see a patient with supposed ovarian tumor. She had borne four children, the last one ten months before. After the birth of the last child, the menstrual flow appeared twice, and then failed to return. Soon after she began to vomit excessively. The abdomen increased in size rapidly, so that the attending physician decided to tap her; this he did, withdrawing four gallons of a dark fluid, a specimen of which was sent to the President, who examined it microscopically, and found that it contained ovarian corpuscles, so that the probable diagnosis of ovarian cyst was made. On examining the patient, he detected a large fluctuating tumor, filling both iliac regions, and extending upwards as far as the diaphragm. The cervix uteri was suspiciously soft, the vaginal mucous membrane presented a marked bluish discoloration, and ballottement was obscurely felt on bimanual examination. These signs, when considered in connection with the fact that menstruation had been absent for four months, appeared to justify the diagnosis of pregnancy, complicated with ovarian cyst. The patient was advised to wait until she had grown stronger and the tumor had begun to fill again. Two weeks later, she had improved so much that she came to the speaker's office, but one week after the vomiting began again, and the tumor grew so rapidly that an immediate operation was advised. This was performed four weeks before, the family physician, Dr. Benedict, and Drs. Warren, Grandin, and Wells assisting. The growth proved to be a multilocular ovarian cyst (weighing twenty-five pounds), with a considerable number of fresh adhesions to the anterior parietes, which bled profusely on being separated, so that the operation was retarded to fifty minutes. The tumor grew from the left side by a long pedicle; the uterus, which was enlarged to the usual size at the fifth month of pregnancy, was left undisturbed. The patient made a good recovery, the temperature not exceeding 99.5° F. A few hours after the operation, the vomiting recommenced, and threatened to exhaust the patient. Two days later, the speaker saw the patient, and found her much prostrated. Gastric nutrition was at once stopped, rectal alimentation alone ordered, and the cervix was dilated by the finger, morphine being at the same time injected over the epigastrium. In a few hours the nausea and vomiting ceased, the stomach soon retained food, and convalescence was uninterrupted. The patient was then walking about, and the pregnancy was pro

gressing normally; there was no reason why she should not go on to the full term.

DR. WYLIE thought that the dilatation of the cervix undoubtedly cured the vomiting. He had never known this operation to fail in such cases, nor had he ever seen abortion produced by dilatation, provided that the finger or instrument was carried up to, but not through the os internum.

TRANSACTIONS OF THE OBSTETRICAL SOCIETY OF PHILADELPHIA.

Stated Meeting, October 7th, 1886.

The President, B. F. BAER, M.D., in the Chair.

RUPTURED FALLOPIAN PREGNANCY, LEFT SIDE.

DR. JOSEPH PRICE exhibited the ovary and distended tube which had burst spontaneously. No fetus was discovered; a very free hemorrhage into the peritoneal cavity had occurred. In the vast majority of cases, the rupture is fatal. The cause of death is invariably hemorrhage.

Dr. Price also exhibited specimens from a case of

DOUBLE PYO-SALPINX WITH CYST OF THE RIGHT BROAD LIGAMENT AND ABSCESS OF THE OVARY OF THE SAME SIDE.

The specimen consisted of both Fallopian tubes and ovaries, and was a good example of pyo-salpinx, both tubes being closed at the ends and distended with pus. The right tube was long and very much distended and with a large abscess of the ovary and a cyst of the ovary as large as a base-ball occupied the whole of the right side of the pelvic cavity, where the entire mass was firmly bound down and gave rise to great suffering.

The diagnosis in this class of cases is either made or it is not made. He is quite sure Mr. Tait before proceeding to an operation is fairly certain of his diagnosis, and this generally presents but little difficulty. It is true that he operates early, as soon as he recognizes dangerous troubles. Dr. Price feels certain that delay with us is accountable for the large death rate. Dr. Mundé says of Mr. Tait, "Now his wonderful dexterity and tactile sense come into play, for with these fingers he at once makes the diagnosis which he appears to pride himself on not attempting to make with accuracy in those cases demanding removal of the uterine appendages, the so-called 'Tait's operation,' except through the abdominal incision.”

While at Birmingham, recently, he visited regularly his large public clinic, and watched carefully his rapid examination; he cited one case to illustrate the fact that Mr. Tait made his diagnosis through the vagina. After passing a number of cases, displacements, etc., which he did not think of sufficient importance to ask us to examine, he came to one and kindly asked us to examine and express an opinion. Dr. Price examined and found the physical characteristics of pus. Mr. T.'s reply was "quite right." The patient was at once sent to Spark Hill for operation. One tube was found full of pus, the other partially filled and the ovaries cystic. This case illustrates that Tait does not guess at conditions and resort to abdominal section for diagnostic purposes. A world of mischief has already come of such statements. Of course, there are exceptional cases demanding exploratory incision. Tait says: "Save when the seat of such organic disease as will explain genuine suffering, the uterine appendages ought not to be removed, and that those who attribute all the pelvic aches and ails of women to. the ovaries and tubes, and rush in to remove them, are dangerous people."

DR. LONGAKER considered Case 1st one of tubal pregnancy. Recurring attacks of peritonitis should direct attention to the probability of pyo-salpinx. The condition should be easily recognized, but is sometimes overlooked.

DR. HOWARD A. KELLY remarked that, in view of the increasing number of cases of hemato-salpinx which we were now meeting, it was of the utmost importance that all those which come under our immediate notice should receive a more rigid examination, and elaborate attention should be directed to the clinical history. He believed positive diagnostic signs would be discovered which will make our interference more a matter of scientific certainty. Dr. Kelly was not speaking of those cases of a minor degree of tubal apoplexy or hemorrhage symptomatic of a grave dyscrasia, but of those in which, owing either to a closure of an outlet or to disease of the mucous membrane of the tubes or grave local circulatory disturbance, a mass coliected, forming a sausage-like tumor, producing various symptoms, some of which are common to pyo-salpinx. There is always great local tenderness and often masses of exudate embedding and obscuring the original tumor, and in cases of rupture often a peritonitis as rapidly fatal as in pus-cases.

The suspicion that a tubal pregnancy lies at the bottom of the explanation in all these cases is negatived by the fact that a majority of the cases are hemato-salpinx of both tubes.

A very important symptom which I learn was present in Dr. Price's case was also prominent in my own case, that is a stillicidium of bloody grumous material per uterus and vaginam, which is regarded by the patient as a prolonged menstrual period. This undoubtedly flows from the tube, and is altogether analogous to the free purulent discharge from the tubes of pyo-salpinx which he had seen. He intends, in his next case of this kind, to catheterize the tube and dilate and endeavor to relieve his case of hematoor pyo-salpinx in this way if the discharge exists in sufficient quantity to lead him to suspect a patulous uterine orifice.