MINUTES OF THE SECTION

ON

OBSTETRICS AND DISEASES OF WOMEN AND

CHILDREN.

TUESDAY, May 4, 1875.

Dr. W. H. BYFORD, of Illinois, presiding.

Dr. M. P. WRIGHT, of Ohio, presented the cadaver of an infant, the last of a series of cases, which had occurred in his service in the obstetrical wards of the Cincinnati General Hospital, during the past two years. He denominated the disease "black color" or "pigmentation," and desired information in regard to its nature and treatment, stating that he had searched in vain for the reports. any similar cases. He exhibited a dissection of the kidneys. Dr. CHADWICK, of Massachusetts, called attention to the fact that similar cases had occurred in the obstetrical wards of the Massachusetts General Hospital, a report of which might be found in a recent number of the Boston Medical and Surgical Journal.

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Dr. Wright was requested to furnish a full report, in writing, of his cases for reference to the Committee of Publication.

Dr. S. C. BUSEY, of D. C., presented a paper entitled Congenital Occlusion and Dilatation of Lymphatic Channels, which was referred to the Committee of Publication.

Dr. NATHAN ALLEN, of Massachusetts, read a paper entitled Normal Standard of Women for Propagation, which was referred to the Committee of Publication.

Dr. W. H. BYFORD presiding.

WEDNESDAY, May 5.

The Chairman called attention to the provision of the regula tions, which required the submission of all papers read before the Section to a special committee for careful examination, and, on motion of Dr. CHADWICK, the motion referring the papers read the day previously was reconsidered, and the papers were referred to a special committee consisting of Drs. BYFORD, PARVIN, JEN KS, CHADWICK, and the Secretary.

The Section refused to permit Dr. SELL to read his paper entitled Obstetrics in Vienna, because the greater portion of it had been published in a journal.

Dr. JOHN MORRIS, of Maryland, submitted his report on Pessaries, which was read and referred to the Special Committee for examination.

THURSDAY, May 6.

Section met at 3 P. M., Dr. BYFORD presiding.

Dr. WARNER, of Massachusetts, asked permission to withdraw his paper entitled The Connection of the Hepatic Functions with Uterine Hyperæmia, Fluxion, and Inflammation, and to have leave to present it at the next meeting. Permission granted.

The address of the Chairman was referred to the Committee of Publication, with the recommendation that it be published in the Transactions.

On motion of Dr. CHADWICK the Section tendered its thanks to Dr. BYFORD for his very able and interesting address.

The report of Dr. A. S. HEATON, of Michigan, On Retroversion of the Uterus during Pregnancy, was read and referred to the Special Committee for examination.

The paper by Dr. J. H. THOMPSON, of D. C., entitled Three Cases of Myo-Fibromata or Fibroid Tumors of the Uterus treated by Ergot, was read and referred to the Special Committee.

The paper by Dr. JOSHUA P. ALLEN, of Philadelphia, entitled Phlebitis following the Hypodermic Use of Ergot in the Treatment of a Fibroid Tumor of the Uterus, was referred to the Special Committee for examination.

On motion of Dr. T. PARVIN, of Indiana, the Chairman and Secretary of this Section for the ensuing year were directed to solicit contributions of papers to be submitted at the meeting to be held in 1876.

A vote of thanks was tendered to the officers of the Section.

The Secretary regrets that, in consequence of the failure to obtain a competent reporter for this Section, he cannot submit to the Publication Committee a synopsis of the instructive and interesting debates which took place during the sessions.

S. C. BUSEY, M.D.,

Secretary.

W. H. BYFORD, M.D.,

Chairman.

ADDRESS IN OBSTETRICS, DISEASES OF WOMEN

AND CHILDREN.

BY WM. H. BYFORD, A.M., M.D.

MR. PRESIDENT AND GENTLEMEN: The great extent, varied character, and rapid advancement of the subjects connected with the department of practical medicine represented by the Section of Obstetrics and Diseases of Women and Children render a complete and profitable annual resumé of progress a very difficult if not an impracticable undertaking in the time allotted to this address. I hope, therefore, to be pardoned for selecting some one subject for more extended consideration and research than could be embraced in so short a general summary. This course will, I believe, permit of an accumulation of facts from which important inferences may be drawn that will serve as a basis for the formation of rules to guide us in the practice of our art.

This brief introduction will enable me, without further apology or loss of time, to invite your attention to the Treatment of Fibrous Tumors of the Uterus by Ergot, the subject which I have chosen for my address.

It is a very short time since all forms of fibrous tumors of the uterus, except the polypoid variety, were considered entirely beyond the reach of legitimate medicine or surgery. Recent writers, with very few exceptions, teach the entire inefficiency of any form of treatment for the cure of intramural fibrous tumors of the uterus except by enucleation, and that this operation is so dangerous and difficult as not to be thought of except in desperate conditions. All who have been under the necessity of performing this hazardous operation will readily concur with the teachers in the cautionary precept that this must be a last resort of surgery, instead of a chosen means of relief.

To the advantage of the medicinal treatment of these tumors we may justly say, that it is not a final venture, but a safe means,

which can be employed before dangerous symptoms present themselves, and thus save patients from the inconveniences and perils of a resort to surgery. Even in extremities, we are encouraged to hope and believe that the dangerous symptoms which have hitherto been considered as calling for surgical interference may be removed, so that we can wait in safety for the further and more curative effects of the same remedies. On account of the safety of this treatment, all cases, both trivial and grave, will be included in the field of its usefulness.

Experimental therapeutics has taught us that ergot and some other medicines exert a special influence on the unstriped muscular fibres. This property is not confined to ergot and belladonna, the popular medicines now used for this purpose. It is also possessed by quinia, some preparations of lead, alum, bromine, and iodine in a high degree, and by most of the astringents.

Remembering the double system of unstriped fibres entering into the composition of the uterine tissues, we can easily understand how much more efficiently these agents may be made to act upon the uterus than upon any other organ. While the unstriped fibres form the muscular structure of the walls of the uterus they also enter into the composition of the arterial tubes supplying blood to its substance.

Both ergot and belladonna act upon the uterine walls in a threefold manner, and cause a diminution in the flow of blood to the morbid as well as to the healthy tissues in the uterine structure. First the calibre of the arterial tubes is diminished by the contraction of the muscular fibres which enter into their composition. Second: the arterioles are diminished in size by compression from the contraction of the uterine muscular fibres which surround them. Third: these vessels are distorted and drawn in diverse directions by both the contraction and compression, and hence are rendered less fit for sanguineous conduits.

Another consideration of prime importance is that, under the influence of these medicines, the nutrition of fibrous tumors is interfered with, not only from diminution of blood in their tissues, but also from compression of their substance by the proper fibres of the uterus, and are therefore made more susceptible to the process of disintegration and absorption.

If we are correct in the histology and pathology of the parts in question, and in the therapeutical action of ergot and the other medicines mentioned, then we have just grounds upon which to