several small tumors, Owing to the number

birth. It contained within its walls from the size of a pea to a hen's egg. of abnormal growths scattered through the substance of the womb, it was decided that the whole of the organ, down to the cervix, must be removed. After applying the rubber tube, which included the left ovary, and carrying it low down on the neck of the womb, an incision was made through the organ from before backwards so as to divide it through the whole of the body, exposing its cavity. This was found lengthened and enlarged, and its mucous membrane inflamed. The left ovary was ligatured at this stage, and then the left half of the uterus cut away. This was done by making the incision through the peritoneum higher than on the inner part, so that it left a stump representing an inverted cone, its apex being the cervical canal at its upper part. The ligated ovary was cut away with the scissors, and the uterine stump closely stitched with strong silk. A large number of deep and superficial sutures were introduced. The right half of the womb was then removed, and managed in the same way. On this side some difficulty was experienced in bringing the peritoneal flaps together, but it was finally accomplished. On removing the tube, considerable hemorrhage occurred, but more sutures finally controlled it. The uterine arteries were ligatured by taking deep stitches on each side, and tying below the cut surfaces. In this case a drainage-tube was introduced; a pair of strong forceps being forced through the peritoneum in Douglas's cul-de-sac, into the vagina, and a rubber drainage-tube drawn back through the opening made by the forceps.

The

The operation was completed as in the other cases. patient was reported restless. Then unfavorable symptoms occurred. She died on the sixth day.

CASE 4. Ovarian cyst. The patient was about the size of a woman at full term. Incision from umbilicus to pubis. No delay on account of superficial hemorrhage. The knife was thrust into the cyst, and its contents rapidly evacuated. The assistant made pressure on the abdominal walls, so

as to force the fluid out, and at the same time press the tumor against the edges of the opening, thus preventing its contents from escaping into the peritoneal cavity. After the sac was partially emptied, it was drawn out, and a long broad pedicle exposed: this was ligatured in four parts, and the tumor cut away with the scissors. This was all done in seven minutes. A sponge on a holder was passed in three or four times, and the external wound closed. The patient was washed off, and ready for the dressings, inside of twenty minutes. Patient made a rapid recovery.

CASE 5. — Ovarian cyst, left side; about the size of a fœtal head. It did not present at the abdominal wound; but the hand of the operator, passed in and behind it, brought a large portion of it out; and, as there was some delay in handing a knife, the forefinger was thrust through a thin portion of the wall of the cyst, thus evacuating its contents without much ceremony. At the same time pressure and traction were made from behind, with the hand in the abdominal cavity. The pedicle was very short and thick, and it was quite difficult to pass the needle with the ligatures below the cyst-wall. It was ligated in several parts. In cutting away the cyst, it appeared as though a portion of its wall were left on the pedicle. On examination, the right ovary was found to be diseased; and a portion of its substance was removed, and the wound stitched together. Rapid recovery.

A band

CASE 6. Two small cysts of the right broad ligament, with adhesions to the uterus, bowels, and omentum. of omentum was ligatured and cut. Other adhesions were broken away with the fingers. The cysts were brought out, and the broad ligament ligatured toward the womb, and along its broad attachment below. This was done in sections. No hemorrhage after the cysts were removed.

CASE 7. Multilocular cyst of right ovary, four inches in diameter. There were no adhesions, but the tumor was so firmly impacted in the pelvis as to require considerable effort to disengage it. This was done by the assistant passing his finger into the vagina, and pressing against it from below.

The pedicle was very short; and, in cutting away the tumor, a portion of the sac remained on the stump. This was dissected off, and the peritoneum stitched over the end of the stump. In this case there was quite a quantity of fluid in the abdominal cavity, and the bowels were red and congested.

CASE 8. An enlargement of the right ovary to about the size of a hen's egg, with inflammatory products around it. In Douglas's cul-de-sac was a pus-cavity. A drainage-tube was inserted through the vagina, as described in a previous case. The pus-cavity was thoroughly washed out with a five-per-cent solution of carbolic acid. The ovary was ligated and removed without difficulty. This patient had suffered extremely for a number of months, and was thin and debilitated.

CASE 9. Myoma or fibro-myoma. The patient was about as large as a woman at the sixth month. The tumor had an irregular outline. Quite a depression could be felt in the median line, from before backwards. Its longest diameter was from side to side. Its attachment was on the right side, and it was diagnosed as coming from the right ovary and broad ligament. This diagnosis was not corrected till after the tumor was removed, and it was found to contain the cavity of the uterus. The explanation of the mistake was, that a tumor behind and to the left had all the characteristics of the fundus of the uterus.

This tumor could not be removed, as the mistake was not discovered till the part removed was carefully examined some time after the operation. A little more care, and the use of the sound, would have prevented this mistake. It would be well to say here that Dr. Martin avoids the use of the sound as much as possible, and especially on cases for immediate operation.

The supposed pedicle was two inches thick, and was said to be attached to the bladder. Several ligatures were passed through this pedicle, and then the tumor was cut away by making flaps, as previously described. The flaps, however, were rather short, and some difficulty was experienced in

making them cover the stump. Over fifty sutures were put in.

CASE 10. A small right ovarian cyst. There was considerable hemorrhage from the abdominal incision, which required a number of ligatures. With the thick spray, and the poor light in the room, it was impossible to see into the abdominal cavity. The operator himself could not see much. In fact, a large part of his work in the abdomen is done by the sense of touch, and not of sight. Extensive adhesions were broken up with the hand. A portion of omentum was tied in two places, and cut between; then a portion of what was said to be a cyst-wall was removed with the hand.

Quite profuse hemorrhage followed these manipulations. The remaining portion of the cyst, or degenerated ovary, was drawn out so as to be seen, and ligatured, and the diseased portion cut away with the scissors. In this case the usual precautions for controlling all hemorrhage, before closing the abdomen, were not adopted.

CASE II.This was so nearly like Case 10, that it is not necessary to report it.

The result in the last few cases is not given, on account of coming so near the close of the course; but we were informed later, that nine out of the eleven cases recovered. I have the impression that the second fatal case was No. 10.

XII.

REPORT OF THE COMMITTEE ON A STATE HOMOEOPATHIC INSANE HOSPITAL.

YOUR Committee have twice reported progress, which reports are to be found in the Society's publications for the years 1882 and 1883.

Their labors as a committee having been completed, they desire to make this their final report.

Appointed as a committee of the Society, with full powers, at the Annual Meeting in April, 1881, the members sought to acquaint themselves with the wants of the community and the profession in this matter, and to ascertain the most effective method of accomplishing it.

In the fall of 1881 they sent blank petitions to all the homœopathic physicians in the State, requesting them to procure the signatures of the most prominent citizens in their vicinity, asking the State to provide homœopathic treatment for the insane under its charge who may desire such medical treatment, or for whom it may be desired by responsible friends. Of the five hundred physicians to whom the blanks were sent, some sixty responded, and the names of about seven thousand prominent citizens were appended to the petitions as presented. In addition, many members of both branches. of the Legislature were advised with by our friends, and a generally favorable opinion secured as to the justice and propriety of our petition.

A hearing, as already reported, was held by the Committee on Public Charitable Institutions, who made a favorable re