supported by any kind of evidence. The influence of the operation is, that by removal of the ovaries and tubes, chiefly the tubes, according to my own experience, the menstruation is arrested, and the moment menstruation is arrested, the whole contents of the pelvis are put at rest, and the tumor disappears or diminishes in size.

Towards the conclusion of the paper, Dr. Bigelow says that "the operation of oophorectomy (by which, I presume, he means removal of the ovaries and tubes) is very often an extremely difficult one, more difficult than hysterectomy, and in other hands than those of Mr. Tait has not given brilliant results." I can only say that if this is really true, and I very much doubt it, it must have been Dr. Bigelow's misfortune to see the operation performed by most bungling operators. Hysterectomy is the most ghastly, serious, and difficult operation in the whole realm of abdominal surgery, and that removal of the uterine appendages for myoma is not a difficult operation in skilled hands is proved by the fact that, in the table to which I allude (see British Medical Journal, Aug. 15th, 1885), I published fifty-eight consecutive cases without a death, and within that series there was not a single incomplete operation. I have not, at the present moment, leisure to take out my statistics since then, but I believe that, since that paper was published, I could double the number of cases performed, with only one death and without a single incomplete operation; that is to say, the mortality is less than two per cent, and the operation so relatively simple that I never leave it incomplete. Let me say, finally, that no kind of argument can be based on such statistics as have been published concerning this and other similar operations in America and Germany. For instance, the mortality of Agnew's table is not the mortality of the operation, but the mortality of some thirty or forty operators, most of whose efforts were simply murderous. It is not the mortality of the operation, but the mortality of the surgeon, and it is only of a piece with Dr. Bigelow's want of information on the subject that he should seriously advance any argument from such a mass of disasters as that table represents. My experience, as I have already said, shows that the operation is, indeed, "a radical one, and not palliative;" it is a radical cure, as the lives of my patients after the operation, in some cases, now extend to ten or twelve years, and they remain in perfect health.

The conclusion of Dr. Bigelow's paper is a most glaring example of putting the cart before the horse. He says: "Hysterectomy is a dangerous operation, but a radical one. Do the general

mortality statistics favor one above the other? If the percentage be equal, there can be no question of choice." Hysterectomy, I say, is a dangerous operation, so dangerous that Dr. Bigelow has not accepted my challenge, made on September 19th, 1885, to let us know what the real mortality of hysterectomy in Berlin is. I am informed by trustworthy German and American visitors that it runs between forty and sixty per cent. If this is so, then the proceeding ought to be stopped by legal interference. If it is not so, then we ought to be put in possession of what the facts really are, but neither Dr. Bigelow nor his friends will ever venture upon the publication of statistics, as is the habit and custom in England, where every case is set down in detail in its order, authenticated by name and age in such a way that there can be no possible dispute as to its occurrence or result. Until this is done, nothing but condemnation can be meted out to the work of the German surgeons. I have shown that my mortality of removal of the appendages is less than two per cent. The best mortality yet published of hysterectomy is by Dr. Keith, and that is about twelve per cent, to which rate, I think, I have brought my own at the present moment. There is, therefore, no choice between the operations; and I always think that if the operations of removal of the appendages were performed early, and before the tumors were allowed to grow to such a size as to make their removal a matter of necessity, there would be no need for hysterectomy at all, and the mortality of this terrible disease would be brought down to a percentage infinitely less than scarlet fever or measles, I am, sir, yours, etc.,

BIRMINGHAM, March, 1886.

LAWSON TAIT.

TRANSACTIONS OF THE OBSTETRICAL SOCIETY OF NEW YORK.

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

Stated Meeting, March 2d, 1886.

The President, DR. PAUL F. MUNDÉ, in the Chair.

AN AXIS-TRACTION ATTACHMENT APPLICABLE TO ANY VARIETY OF

FORCEPS.

DR. BROOKS H. WELLS (present by invitation) showed an ingenious device of his own, by means of which an ordinary pair of obstetrical forceps can be converted into axis-traction forceps. It consisted

essentially of a traction-rod, at the end of which was a notched hook which fitted into the angle made by the divergence of the blades, and was provided with a transverse handle. From this rod arose a movable arm with a clamp which grasped firmly the handles of the forceps, and held them at any desired distance from the traction-rod, thus allowing the line of traction to be adjusted to the varying pelvic curves of different forceps.

The instrument was designed to be attached after the forceps were applied and locked. The speaker showed a pair of Tarnier's forceps for the purpose of comparison.

THE PRESIDENT called attention to the difference between the axis-traction attachments in the two forceps shown. In the Tarnier variety traction was exerted in a line with the blades, whereas with Dr. Wells' arrangement the force was applied at the lock. DR. WELLS admitted that the point of attachment was different, but he thought that the line of traction was the same.

DR. GRANDIN thought that the tendency of the traction with Dr. Wells' attachment would be to pull the blades off from the head. The instrument was certainly less complicated than that of Tarnier, and possessed the special advantage that it could be used with whatever forceps with which the operator was already familiar.

A SPECIMEN OF OVARIAN CYST SHOWING UNUSUAL DISTENTION AND CALCAREOUS DEGENERATION OF THE LINING MEMBRANE-OPERATION-DEATH.

DR. NILSEN exhibited the specimen which consisted of two portions of a cyst, one of which was removed by laparotomy, the other after death. The sac contained forty-seven and a half pounds of fluid. It was found to be universally adherent at the time of operation, so that a part only was excised, the edges of the remaining portion being stitched into the abdominal wound. The patient had albuminuria before the operation, and died of uremia on the fifteenth day following it. The adherent cyst was removed with difficulty at the autopsy, only by tearing away the coils of intestine with which it was surrounded.

DR. GRANDIN asked if the patient had organic disease of the kidneys. The speaker replied in the affirmative. "Why then was the operation performed?" asked the former gentleman.

DR. NILSEN replied that the object aimed at was simply to relieve the extreme distention of the abdomen, which occasioned great distress.

DR. WARD asked if he understood the speaker to say that the patient had been tapped.

DR. NILSEN said that she was not tapped except at the time of the operation.

A SPECIMEN OF EPITHELIOMA OF THE FEMALE BLADDER-DEATH FROM PROBABLE PULMONARY METASTASIS.

THE PRESIDENT showed a bladder from which he had removed with the curette a mass of cancerous material which was presented to the Society at a previous meeting (January 5th). The operation was performed for the relief of distressing symptoms (hematuria and frequent micturition), and to that extent it was perfectly successful. The patient lived for four or five weeks after the operation, and died with symptoms of pulmonary metastasis. The speaker demonstrated the fact that no permanent lesion of the vesical wall had resulted from the scraping. Another interesting feature in the specimen was the presence of a small friable thread, which possibly represented the encysted ligature, remaining after an operation for the removal of an ovarian tumor, which had been performed by Prof. Taufer, of Pesth, two years before.

A SPECIMEN OF VILLOUS CANCER OF THE CERVIX AND BODY OF THE UTERUS, OCCURRING SIMULTANEOUSLY WITH A SUBMUCOUS FIBROIDOPERATION BY CURETTE-DEATH FROM PULMONARY EMBOLISM.

THE PRESIDENT exhibited a second specimen, possessing considerable interest. The history of the patient from whom it was removed after death was briefly this: She came to the speaker's office three weeks before, having been sent to him by her attendant, who had made the diagnosis of epithelioma of the cervix. She was a nullipara, forty-five years of age, and since August had suffered with severe hemorrhages, which recurred at irregular intervals, being sometimes slight and at other times profuse. Of

late she had begun to have an extremely offensive discharge from the vagina. On examination, the lips of the portio vaginalis felt normal, but protruding from the os externum was a friable mass which broke down under the finger and bled easily. The fundus was enlarged and felt hard, as if from the presence of a fibroid. It was at first thought that the tumor was a sloughing fibroid, but this diagnosis was rejected, because the sound entered the centre of the mass, and did not pass on one side of it, as it would have done if the growth had been an intrauterine polypus. Depth of uterine cavity, four inches. The condition was recognized as a rare one, namely, epithelioma arising within the cervical canal,

Combined fibroid and epithelioma.

Median section.

Front view.

Fibroid at fundus.

Body of uterus showing epithelioma. On left side adhesion detached showing extension of epithelioma.

but not involving the vaginal covering of the cervix. The patient was advised to enter the hospital, simply to have the sloughing mass removed. Both her husband and herself were assured that the operation was not a dangerous one.

The cervical canal was first thoroughly curretted, and then the finger was passed into the uterine cavity, malignant disease of the latter being discovered, as well as the presence of a subperitoneal fibroid at the fundus. The uterus itself was fixed and the entire organ had a firmer consistence than normal, as if it was infiltrated. The uterine cavity was curetted, and the uterus was washed out with a solution of corrosive sublimate. Pledgets of cotton saturated with chloride of zinc were next applied to the cervical canal (the uterine cavity being packed with iodoform gauze), and these were retained in position with vaginal tampons, the upper layer being covered with iodoform, while the lower ones were soaked in