46 to 51. Not until four and five years after the operation does this figure sink to 35 per cent, and only in a minor degree because relapses occurred more frequently in the later years, but rather because in these years the indications for the operation were extended by us. For a careful examination of the cases shows that in only four instances after the supra-vaginal amputation did local relapses occur later than one year subsequent to the operation; in these cases, too, the local condition appeared rather suspicious even before the end of the year, so that the conclusion is admissible that those patients whose local condition offers nothing of a doubtful character after the lapse of a year may be considered definitely cured. All relapses which occurred after the end of one year (altogether five) were quite independent of the uterus, as was shown in several cases by the autopsy. Of those treated by the total extirpation, one-half of the cases (seven out of fourteen) showed relapses in the second year. Nevertheless, after two years, out of 25 operated upon, 6, or 24 per cent, were still healthy, thus justifying the total extirpation under all circumstances; for the patients treated in that way could not have been operated upon in any other manner.

At all events, from the figures obtained it appears that partial extirpation in cases of epithelioma of the cervix is sufficient to effect a radical cure; and, on the other hand, that vaginal hysterectomy has become an indispensable auxiliary, permitting the operative treatment of carcinoma of the cervix after other methods are no longer sufficient.

In order to place in the right light the greater danger of the partial as compared with the total extirpation of the uterus, which Duevelius had particularly emphasized, I shall use for my statistics the operations performed until the end of 1885. Between October 1st, 1878, and January 1st, 1886, there were performed at our clinic 118 partial extirpations of the uterus (22 of them by myself, with one death), altogether with 10 deaths, or 8.5 per cent; the last 56 with 3 deaths. During the same time, 48 total extirpations were performed (14 by myself, with 2 deaths), altogether with 12 deaths, or 25 per cent; the last 20 with 4 deaths.

These figures likewise show that under equal conditions the total extirpation is always the graver operation, and therefore not to be undertaken unless necessity compels.

But the whole anatomical view of the question respecting carcinoma of the uterus, as founded in the paper by Ruge and Veit some years ago, has found a novel and very valuable support

by this clinical experience. On the other hand it shows, besides, that if cervical carcinoma is operated upon at all early, it offers a prognosis as regards radical cure which is as good as that of carcinoma in general. The settlement of this question appears of special importance with reference to the doctrine which is particularly prevalent in America, namely, to abstain from any operative treatment of uterine carcinoma.

BERLIN, February, 1886.

TRANSACTIONS OF THE OBSTETRICAL SOCIETY OF NEW YORK.

REPORTED BY THE SECRETARY, DR. H. C. COE.

Stated Meeting, February 2d, 1886.

DR. H. T. HANKS, Vice-President, in the Chair.

A SPECIMEN OF SUPPOSED FLESHY MOLE.

DR. GILLETTE exhibited a round, fleshy mass, the size of an orange, that had been expelled from the uterus of a lady whom he had attended in consultation. The history of the case was briefly stated. The patient, who lived in Elizabeth, N. J., was a multipara who had borne three children. She became pregnant for the fourth time last spring and aborted in August. Her attendant was positive that the entire placenta had been expelled with the fetus. Instead of convalescing in the usual manner, she suffered from a constant oozing of blood that proved a serious drain upon her vital powers. Her physician, thinking that a portion of the placenta might possibly be retained within the uterine cavity, dilated the os internum with sponge-tents and used the curette thoroughly, but removed nothing. The uterus appeared to be of normal depth. Dr. Gillette was called in consultation, and found the patient in fair condition in spite of the constant loss of blood. As the os had been dilated previous to his arrival, he introduced a curette into the cavity to the depth of four and onehalf inches, and scraped the interior vigorously, but obtained nothing save a small quantity of granular débris. He naturally supposed that the condition was one of subinvolution with fungous endometritis. During the night following the operation, the patient had expulsive pains and finally discharged the body which he had presented. When examined immediately after its expulsion, the remains of an amniotic sac were visible at the lower part of the mass. If the curette had entered this cavity, there would have been some clue to the true condition. On section, the body appeared to be of a soft, spongy

character, which to the speaker suggested hypertrophied placental tissue. The specimen was of interest not only from its rarity, but because it suggested the question, "Was it the remains of a second conception, and consequently was the case one of superfetation?" Considering the fact that the placenta had been carefully examined by a competent observer and had been found intact, Dr. Gillette said that he was inclined to give an affirmative answer to the question. He acknowledged that he had not had the least suspicion of the true condition of affairs, and had positively committed himself to a wrong diagnosis.

[The specimen was referred to Dr. Coe for microscopical examination. He reported as follows: "Numerous sections were examined and compared, with a view to discovering remains of chorionic villi, the presence of which, according to all authorities, alone establishes the positive diagnosis of fleshy mole. A careful search failed to reveal any appearances that could suggest such villi. The sections presented uniformly a loose myxomatous tissue, disposed in the form of trabeculæ, which were filled with decolorized blood-corpuscles inclosed in networks of fibrin, and fatty degenerated and pigmented cells of an epithelioid type. Scattered throughout the sections were blood-clots that had apparently become partially organized, and also collections of pigment. In some places there were bundles of connective tissue, in others limited areas showing hyaline degeneration. There was no trace of newlyformed vessels.

Considering the microscopical appearances of the specimen, the diagnosis lies between fibro-myxoma, angioma, retained placenta, and so-called fleshy mole (Fleischmole, mola carnosa).

The first may be eliminated from the small amount of fibrous tissue and the presence of numerous epithelioid cells; simple retained placenta is excluded from the entire absence of chorionic villi, while organized retained placenta, or fleshy mole, is rendered somewhat doubtful for the same reason. However, the fact that the tissue is largely myxomatous and that the fatty-degenerated cells are those peculiar to the placenta, the presence of organized blood-clots and of spots of hyaline degeneration-all conspire to render this diagnosis a probable one. Angioma of the uterus has been reported by Klob ("Path. Anat. d. weibl. Geschlechtsorgane"), who describes under the name of "cavernous ectasia" a spongy mass, two centimetres in diameter, which he found adherent to the posterior wall of the uterine cavity. Its microscopical appearances were quite similar to those of the present specimen. He explains the origin of the growth as consequent upon the non-involution, and subsequent telangiectatic transformation, of the wall at the point of placental attachment. Savage (“Female Pelv. Organs ") refers to a similar angiomatous growth.

It will be seen that the character of the mass is by no means clear. Histologically, it may be called a myxo-angioma; that it

is the remains of a placenta that has undergone carnification cannot be positively affirmed, because of the complete absence of chorionic villi which have nearly always been found in such cases.]

DR. BYRNE asked how such a large mass had been overlooked during the operation of curettirg, and also how there could have existed such a discrepancy between the two measurements of the uterine cavity.

DR. GILLETTE said that the attending physician in introducing his curette had doubtless encountered the lower part of the mole directly, and had thus failed to discover the true depth of the cavity, while he himself, by keeping the instrument close to the uterine wall, had pushed it past the mass, and thus reached the fundus. If the mole represented the product of a second conception, what had become of the corresponding fetus ?

DR. HANKS suggested that the original condition may have been one of twin-pregnancy with separate placentæ, one fetus having died and become absorbed, while its placenta remained and became hypertrophied, so as to form a mole.

DR. GILLETTE said that this theory had occurred to him as being a very plausible one. Although his obstetrical experience had been large, this was the first case of the kind that he had ever encountered, so that he did not feel competent to explain it.

DR. HANKS thought that the speaker's frank acknowledgment of his failure to discover the foreign body within the uterus ought to be an encouragement to those who with far less experience had been so unfortunate as to overlook the presence of early pregnancy, and to pass instruments into the cavity.

A PUERPERAL FEVER MICROBE AND ITS HABITAT IN NEW YORK.

DR. EMIL NOEGGERATH read a paper on this subject [which will be published in the May number of this JOURNAL], a brief abstract of which is as follows:

The reader introduced his subject by describing at length a case of puerperal fever of a remittent type, which occurred in a patient whose confinement was effected under the most stringent antiseptic precautions. Her surroundings were considered to be favorable in every respect. There was a dressing-closet communicating with the lying-in chamber; in order to eliminate every source of infection, the reader plugged up all the holes in the stationary basin.

A few days after her confinement (which was perfectly normal) the patient had a chill, and developed a high temperature, which was controlled by appropriate treatment. There was a foul discharge from the uterus, which ceased after the administration of injections. From the symptoms, the reader inferred that the condition in this case was not septicemia, but sapremia. The question was, What was its origin? On examining microscopically the lochial discharge and a decomposed clot that had been expelled from the uterine cavity, he found a bacterium with certain very marked characteristics. This appeared as two ob

long bodies separated by a constriction. On removing the rubber corks from the overflow-pipe of the basin, and examining the scrapings from their under surfaces, the identical microbes were discovered, a direct relation being thus established between the emanations from the pipes and the sapremic condition of the patient. Now, as the basin had been sealed up before the labor began, and no discharges from the patient, or, in fact, fluids of any kind had been poured into it, the inference was that the bacteria must have been present in the air contained within the pipes long before they entered the genital tract of the puerperal wo

man.

The reader did not pretend to be able to trace the sequence, but he thought that the practical deduction was sufficiently evident, viz.: that we ought never to select as a lying-in room any chamber that communicated with a bath-room or dressing-closet, because although the plumbing might be perfect from the standpoint of the sanitary engineer, this was no security against the presence of dangerous germs.

After the reading of the paper, a number of cultures were shown, both in test-tubes and on potato. The reader called attention to the fact that the saprophytic character of the microbe was shown by the highly offensive odor to which it gave rise. Microscopical preparations of bacteria from the water-pipes, lochial secretions, and decomposed blood-clot were then demonstrated.

DR. COE mentioned an obscure case of puerperal fever in regard to which he had been consulted the same evening. The symptoms were somewhat similar to those described by the reader, and the patient's environment was much the same. Every precaution had been taken in the conduct of the case, and it was difficult to assume the presence of septic infection. He thought that Dr. Noeggerath's discovery might throw light upon many of those cases of post-partum elevation of temperature in which the element of sepsis could be excluded.

DR. HANKS recalled a case similar to the one reported by the reader of the paper, in which thorough antiseptic precautions had been observed, and yet he had had trouble. It was rather disheartening to think that, after all the care that was employed in one's confinement cases, such unseen and dangerous influences might be at work to defeat his plans.

DR. NOEGGERATH compared the bacterium of puerperal, or sapremic fever to the specific microbe of diphtheria; they were alike in this, that they remained at the infected spot, and did not spread throughout the system. In this respect bacteria differed from cocci, since the latter were prone to form metastasis. Was there a septic, as well as a sapremic, bacterium of puerperal fever? This question he was not yet prepared to answer. A syringeful of gelatin containing the sapremic microbe could be injected into the peritoneal cavity of a rabbit without causing any symptoms whatever, proving that there was no septic element in this form of germ. There might be serious symptoms with a considerable elevation of temperature, but the patients would recover as long as the condition remained one of sapremia.