pole of the eye toward the nose, producing a divergent squint and fixing the eye in this position. Whether there is a piece of bone driven into the orbit pressing upon the optic nerve producing the atrophy, or whether there is a fracture extending into the optic foramen, it is impossible for us to tell, but the changes in the nerve head are very decided. The nerve is white and the blood-vessels are all contracted. The man did not have a perception of light in that eye, and under these circumstances I do not see how relief of pressure from the orbit would restore the integrity of the nerve, and if the atrophy is due to a fracture into the foramen then an operation would do absolutely no good. I think it is rather fortunate that the man has atrophy of the optic nerve with an eye placed in the position as it is, otherwise he would have a very disagreeable, uncomfortable, and inoperable diplopia. I do not believe the injury will have any effect upon the opposite eye.

Cancer of the Cervix; Fibroma of the Uterus. Dr. L. S. McMurtry: The first specimen is a uterus removed per vaginam, the cervix being the seat of cancer, and is one of the cases that come to us in condition for operation with some hope of permanent cure. I believe scarcely ten per cent of cases of cancer of the uterus fall into the physician's hands in time for any operation to be done with the hope of a radical cure, and I believe it is positively detrimental to the patient's welfare to operate in those cases where there is infiltration of the bladder and rectum and the lateral pelvic spaces; by operating in such cases we simply open lymphatic channels and encourage dissemination of the disease.

The woman in this case was thirty-seven years of age, and the disease had been in progress for a few months. The hemorrhage was persistent and excessive, and it will be observed that the disease has established itself in the interior of the cervix, and the lips have not become destroyed. There was just beginning to be a proliferation from the interior of the lower lip. The specimen illustrates how easy it is to separate the cervix from the body of the uterus; how the cervix and the corpus are really developed from separate and distinct centers, and are, as it were, two distinct organs.

It will be observed that the disease has infiltrated the cervix well up to the margin of the corpus, but has not invaded the latter. The operation was performed day before yesterday. I removed both ovaries and both tubes. The patient is doing well, and promises to make a prompt recovery.

The second specimen is a fibroma of the uterus. I present it to the society to illustrate one important point. It must be remembered that our real knowledge of fibroid tumors of the uterus is young; the evolution of the operative treatment of these growths has been a matter of the past four or five years, and I take it we have much yet to learn about the histological pathology of uterine fibromata. Here is a comparatively small fibroid tumor of the uterus from which the woman came near losing her life. She has been in bed three months with peritonitis of active and extensive character. The uterine appendages (especially from hydro- and pyo-salpinx) are very commonly involved with fibroid tumors as a complication. In this case the structures of the pelvis were matted together-absolutely packedover the whole floor of the pelvis. Examination from above simply demonstrated that the intestines were matted down all over the front of the pelvis and could not be pushed out of the way after elevating the pelvis-they were adherent. The woman has had an elevated temperature-rapid pulse; she has had typical pelvic peritonitis, extending in recurring attacks into the upper abdomen. I was unable to determine just when I had entered the abdominal cavity, because in cutting down I found the parietal peritoneum adherent to the visceral peritoneum; separating the intestinal adhesions all the way down I stripped the small intestine for a considerable distance from its mesentery. After getting down to the tumor in the pelvis, every thing was found adherent and had to be stripped loose. I made a slit in the capsule at one point and stripped the structures away at the expense of the tumor in order to liberate the intestine which was so intimately associated with it. I never succeeded in finding the uterine appendages; they were disintegrated; every thing was separated close to the capsule and the tumor removed, and drainage established to the floor of the pelvis. There was a large amount of serum and numerous flakes of lymph in the peritoneum. The bowel injuries were repaired. It is one of those cases of fibroid tumor of the uterus of comparatively small size associated with inflammatory disease of the uterine appendages, with pelvic peritonitis extending to the general peritoneum.

If this operation had been attempted from below, the tumor could scarcely have been removed in any way except by morcelment, because the adhesions were so dense that the tumor had to be dissected out.

The case is most interesting, as illustrating the complications these tumors may present, which we formerly regarded as universally benign.

and simple. The operation was performed in my clinic at the Hospital College of Medicine and the patient has made an easy recovery.

Discussion. Dr. W. L. Rodman: What per cent of cases of cancer of the uterus, in your experience, have been in the negro race?

Dr. L. S. McMurtry: I can not tell exactly without looking up my notes. I can, at the moment, recall but one case of cancer of the uterus that I have operated upon in the negro; but I have seen quite a number of cases in an advanced stage in the negro race.

Dr. W. L. Rodman: The specimens presented by Dr. McMurtry are both interesting, and I am glad he has shown them to us. Both cases were operated upon as they should have been, and I believe in the cancerous case he has a good chance of a radical cure.

I asked Dr. McMurtry the question as to the relative frequancy of cancer in the negro race, because at the present time I have been collecting data on this subject. I must say that I was surprised to find the profession to a certain extent is in error, I think, as to the relative frequency of cancer of the uterus in the negro race. We know as a general thing the black race is immune, relatively speaking, to cancerous disease in many parts of the body; but it will be found on close investigation that this immunity does not exist as far as the uterus is concerned; they are quite as liable to cancer of the uterus as the white race-indeed it would seem a little more so. This is not only true of the uterus, but also of the mammary gland; negroes have cancer of the mammary very much more frequently than is generally supposed. The statistics of Billings in his recent Census Report show that quite as many negro women die of cancer of the breast and uterus as in the white race. It may be that the negro is a little more liable to sarcoma than the white race, and as nearly all of these malignant growths are classed as "cancerous" rather than accurate diagnoses made, this may have some bearing upon the question; it is only in the best hospitals that you find the distinction made between sarcoma and carcinoma. It is certainly true that negroes suffer from malignant disease of the uterus and breast nearly or quite as often as the white race.

Dr. T. S. Bullock: I see no reason why the woman from whom Dr. McMurtry removed the cancerous breast has not an excellent chance for a recurrence of the disease.

Dr. H. A. Cottell: I have seen one case of cancer of the uterus in the negro; my attention was not called to it until the disease had

advanced beyond surgical reach. The first case of malignant disease, however, that I ever saw was a very large epithelioma of the buttock of a very black negro woman. It was removed at the clinic of the University of Louisville by Dr. Yandell, the first operation I ever saw him perform. The tumor was enormous and covered the greater part of the area of one buttock. Since that time I have seen very little of malignant disease in the negro. At least I have seen very little carcinoma; I think they are quite as liable to sarcoma as others.

I see no reason why a distinction should not always be made between carcinoma and sarcoma. It seems to me in collecting statistics upon that subject there would be a great deal of confusion if you do not make the distinction, since they are undoubtedly separate and distinct diseases.

Dr. Wm. Bailey: I do not desire to speak from a surgical standpoint, but in this connection want to mention an experience that occurred in connection with a fibroid tumor of the uterus in a lady of this city twenty-five years ago, in which a peculiar phenomenon was observed, in that there was an aneurismal manifestation at the neck of the uterus in connection with several fibroids; it was demonstrable to the touch; and also with the double aural stethoscope I could get the phenomenon of aneurism very distinctly. And incidentally or casually I observed from the pen of Spencer Wells the same phenomenon described, and had the pleasure of receiving from him a letter in regard to the matter in response to my inquiry.

The patient was operated upon by Dr. Atlee, of Philadelphia, who came here for the purpose, and the woman died upon the operatingtable. Three or four fibroid tumors were removed through the abdominal wall, when, either from loss of blood or from the anesthetic, or perhaps from both combined, the woman, having been under the influence of chloroform for quite a while, died on the table.

Dr. Turner Anderson: I do not know that Dr. Rodman's observations agree with my experience in regard to malignant disease in negroes; I have not seen many cases of cancer of the uterus in negro women in comparison to whites. The pure blooded African seems to me to enjoy an immunity from malignant disease of both the breast and uterus. That has been my personal observation. I am quite sure I can not recall more than a few cases of cancerous disease of the breast or uterus occurring in the black race. I have seen a few cases in mixed breeds, but it seems to me that even there they have enjoyed

an immunity that does not exist in the Caucasian. I am a little surprised at Dr. Rodman's statement; I thought there was a consensus of opinion that the North American negroes enjoyed immunity from malignant disease of the uterus and breast. I can not recall a single case of cancer of the uterus in the full-blooded African. We all recognize that the North American negro has a special predilection for fibroid tumors; they are very common; we all look for and expect them to develop, but this has never seemed to be true with carcinomatous disease.

Dr. L. S. McMurtry: I am glad that Dr. Rodman has gone in such a thorough and systematic manner into the investigation of this subject, and think it has an extremely practical as well as a very interesting side scientifically. And I must say that my observations are in accord with what Dr. Anderson has stated. I have not seen a single case of cancer of the breast in the negro. Of course I have lived and practiced in Kentucky all my professional life, and still I recognize from the manner in which Dr. Rodman has gone about this investigation, that his opinion upon the subject, having gleaned data from so many sources, will be more valuable as a result of his researches than almost any isolated opinion would be. Fibroid tumors are so common in the negro race, that when I was a student in New Orleans, where post-mortem examinations are made every morning and many of the subjects are negroes, I remember it was very commonly remarked by the pathologist that we could scarcely make a post-mortem on a negro woman but we would find a fibroid tumor of the uterus; some of them were small, producing no symptoms perhaps during life, but nearly always present. Ovarian tumors are more rare in the negro race, still they are not uncommon. I have operated upon a number of negro women for ovarian cysts, but I think they are less frequent in the negro race than in the Caucasian. But as to malignant disease of the uterus, I have seen a number of cases in negroes that were advanced beyond operative interference. I think sarcoma of the uterus is more common in the negro. Cancer of the breast, I was under the impression, was very rare indeed in the negro race.

Dr. W. L. Rodman: I was certainly under the same impression up to a year or two ago at any rate. Those of you who remember the paper I read at Baltimore three years ago will recall the fact that I took the ground then that the negro was relatively immune from cancer of the breast; but even then I had seen three such cases. A more careful