Date. 24 from whooping-cough, 20 from cerebro-spinal meningitis, 13 from measles, eight from malarial and remittent fevers, seven from erysipelas, one each from pleurisy and small-pox. Scarlet fever, diphtheria, and croup have varied a little each week for the past month, but without any great change. From cerebro-spinal meningitis there has been a progressively increasing mortality; from erysipelas decreasing. The deaths from measles are double the number for the previous week, but not so many as two weeks ago. In typhoid fever there is an increase over the previous two weeks, making the deaths nearly the same as three weeks ago. Whooping cough has been increasing for the past three weeks. The deaths from "zymotic " and chronic pulmonary diseases are more than for any other of the past four weeks; from acute pulmonary diseases less. The total mortality is somewhat more than for the previous week. From bronchitis, 18 deaths were reported in New York, nine in Brooklyn, four in Boston, two in Philadelphia, Chicago, and Fall River, one in Cincinnati, New Haven, Nashville, Cambridge, Salem, and Holyoke. From typhoid fever, seven in Philadelphia, five in Chicago, three in Boston, two in New York and Providence, one in St. Louis, Cincinnati, District of Columbia, Cleveland, Buffalo, New Haven, Nashville, and Fall River. From whoopingcough, eight in New York, three in Philadelphia, Brooklyn, St. Louis, and Cleveland, one in Baltimore, Boston, Cincinnati, and Newburyport. From cerebro-spinal meningitis, six in New York, three in Buffalo, two in Philadelphia, Cincinnati, Lynn, and Salem, one in Chicago, St. Louis, and Worcester. From measles, five in Cleveland, three in New York and Pittsburgh, one in District of Columbia and Worcester. From erysipelas, two in Buffalo, one in New York, Philadelphia, Brooklyn, St. Louis, and District of Columbia. From malarial, remittent, and typho-malarial fevers, three in New York, two in Brooklyn and St. Louis, one in District of Columbia. From bilious fever, one in Baltimore. From small-pox, one in New York. The weather was generally reported fine, clear, unusually hot for the first part of the week, and on the lakes changeable, the meteorological record for the week in Boston (latitude 42o 21', longitude 71° 4') being as follows: State of Rainfall. Weather.1 7 A. M. 2 P. M. 1 O.; cloudy; C., clear; F., fair; G., fog; H., hazy; S., smoky; R., rain; T., threatening. For the week ending May 10th, in 149 German cities and towns, with an estimated population of 7,573,964, the death-rate was 28.3, an increase of 1.2 from the previous week. Pulmonary diseases, typhus fever, and relapsing fever were somewhat more prevalent; diphtheria, whooping-cough, and diarrhoeal diseases were very fatal; measles, scarlet fever, and typhoid fever had diminished in fatality. Four thousand one hundred and fifteen deaths were reported: 643 from pulmonary consumption, 514 from acute diseases of the respiratory organs, 217 from diarrhoeal diseases, 140 from diphtheria and croup, 55 from whooping-cough, 48 from typhoid fever, 46 from scarlet fever, 33 from measles, 25 from puerperal fever, 10 from typhus fever, two from small-pox (Ratibor and Cologne), one from hydrophobia (Posen). The death-rates ranged from 15.6 in Carlsruhe to 42.7 in Posen. Königsberg 28.9; Dantzic 27.6; Breslau 34.1; Munich, 42.3; Dresden 23.0; Cassel 25.7; Berlin 26.2; Leipsic 23.6; Hamburg 30.1; Hanover 24.4; Bremen 19.6; Cologne 31.9; Frankfort-on-theMain 31.8; Strasburg 29.8; Darmstadt 17.9. Also for the same week the rates were for Vienna 33.1; Prague 47.0; Geneva 36.7; Basel 34.1; Paris 29.4; Christiania 16.1. For the week ending May 17th, in the 20 English cities and towns having an estimated population of 7,383,999, the death-rate was 22.4, the same as for the previous week; the mortality from pulmonary diseases, measles, and whooping cough continued to decline; there was some increase in fever, diphtheria, and scarlet fever, not great. Three thousand one hundred and seventy-four deaths were reported: 355 from diseases of the respiratory organs, 106 from whooping-cough, 85 from scarlet fever, 72 from measles, 43 from fever, 29 from diarrhoea, 17 from diphtheria, six from small-pox (in London). The death-rates ranged from 15 in Portsmouth to 26.3 in Newcastle-upon-Tyne; 21.1 London; 15.8 Brighton; 22.9 Bristol; 21.5 Birmingham; 23.3 Liverpool; 26.2 Manchester. In Edinburgh the death-rate was 19, in Glasgow 22, in Dublin 33 (small-pox about the same). Fevers are less fatal in Turkey and Russia. Several of the governments of Europe have removed all restrictions upon trade with the places in Europe where the plague prevailed or was suspected of possible occurrence. THE following extract of an act of Congress approved June 2, 1879, entitled An Act to Prevent the Introduction of Contagious or Infectious Diseases into the United States, is hereby published for the information of all concerned: "SEC. 9. So much of the Act entitled An Act to Prevent the Introduction of Contagious or Infectious Diseases into the United States, approved April 29, 1878, as requires consular officers or other representatives of the United States at foreign ports to report the sanitary condition of and the departure of vessels from such ports to the supervising surgeon-general of the marine hospital service; and so much of said act as requires the surgeon-general of the marine hospital service to frame rules and regulations, and to execute said act, and to give notice to federal and state officers of the approach of infected vessels, and furnish said officers with weekly abstracts of consular sanitary reports, and all other acts and parts of acts inconsistent with the provisions of this act, be, and the same are hereby, repealed." By direction of the secretary of the treasurery, J. B. HAMILTON, Surgeon-General United States Marine Hospital Service. THE AMERICAN NEUROLOGICAL ASSOCIATION will hold its fifth annual meeting in New York city on Wednesday, June 18th, which will continue three days. BOOKS AND PAMPHLETS RECEIVED. - Fistula, Hæmorrhoids, Painful Ulcer, Stricture, Prolapsus, and other Diseases of the Rectum, their Diagnosis and Treatment. By William Allingham. Third edition, partly rewritten. Philadelphia Lindsay and Blakiston. 1879. Dr. G. Beck's Therapeutischer Almanach. Bern. 1879. A Compendium of the Principles and Practice of Medicine. For the Use of Students and Practitioners. By Stephen H. Potter, M. D. Second Edition. Hamilton, Ohio. 1879. Annual Address on the Relation of Neurasthenia to Diseases of the Womb. By Willa m Goodell, M. A., M. D. Philadelphia, Pa. Reprint from Vol. III. Gynecological Transactions. 1879. Transactions of the American Gynecological Society. Vol. III., for the Year 1878. Boston Houghton, Osgood & Co. The Riverside Press, Cambridge. 1879. Lectures on Electricity in its Relations to Medicine and Surgery. By A. D. Rockwell, A. M., M. D. New York: William Wood & Co. 1879. Handbook of Diagnosis and Treatment of Diseases of the Throat and Nasal Cavities. By Carl Seiler, M. D. With Thirty-Five Illustrations. Philadelphia: Henry C. Lea. 1879. The Channing Home. Report No. 11. 1879. Thirty-Third Annual Announcement of Starling Medical College, Columbus, Ohio. Inhalations in the Treatment of Pulmonary Diseases.' By F. H. Davis, M. D. Chicago, Ill. 1879. Photographic Illustrations of Skin Diseases. By George Henry Fox, A. M., M. D. Forty-Eight Colored Plates taken from Life. Parts 1 and 2. New York: E. B. Treat. (From Shumway & Co., 21 Bromfield Street, Boston.) THE BOSTON * JUL 79 MEDICAL AND SURGICAL JOURNAL. VOL. C.-THURSDAY, JUNE 19, 1879. — NO. 25. THE EXTIRPATION OF THE OVARIES FOR SOME OF THE DISORDERS OF MENSTRUAL LIFE.1 BY WILLIAM GOODELL, A. M., M. D., Clinical Professor of Diseases of Women, University of Pennsylvania, etc. CASE I. My first case was that of a maiden lady, aged thirty-three, who had for many years been a great sufferer. She was never wholly free from pain, but one week before each monthly period this pain began to increase, and steadily grew worse, until it became unbearable. The menstrual flux then appeared, but with no abatement of her sufferings. It lasted fully a week, and was always profuse, sometimes alarmingly so. Then followed a week of gradual lessening of all these distressing symptoms. Thus three weeks out of every four were virtually spent by her in bed, and the remaining time was not long enough for her to recruit her powers and husband her strength for the next encounter with her monthly foe. Worn out by loss of blood and by her acute pains, which were deemed nervous, she consulted Dr. S. Weir Mitchell. He at once discovered an abdominal tumor, and asked me to see her. The lady was pale, thin, and bloodless, with a face furrowed by acute suffering. I found a virginal cervix lodged on the symphysis pubis, and a sharply anteflexed womb imbedded in the hilus of a large and kidney-shaped fibroid tumor. Although the sound gave a measurement of but three inches, the tumor dipped down to the bottom of Douglas's pouch, and reached up to a point two fingers' breadth above the navel and to its left. The fibroid was plainly subperitoneal, and not amenable to treatment per vaginam. Thereafter Dr. Mitchell and I met frequently, and did all that we could to alleviate the pain and lessen the bleeding, but without any success whatever. She grew rapidly worse, and it was finally decided to extirpate the womb. While waiting for the hot weather to pass by, I came across a successful case of the same nature cured by Trenholme, of Montreal, by the removal of both ovaries. We therefore determined to try this operation before resorting to the major one, and she gave us no peace until the day was fixed upon. Accordingly, on October 4, 1 Abstract of a paper read before the Pennsylvania State Medical Society. 1877, with the aid of Drs. S. Weir Mitchell, John Ashhurst, Charles T. Hunter, B. F. Baer, and W. H. Heath, I removed both ovaries by the vaginal incision. The hemorrhage was very trifling during the operation; no vessel needed tying, and not a suture was put into the vaginal wound. The right ovary looked healthy, but the left contained a small cyst. The immediate effect on the lady was most remarkable. From that day she lost all those pains and aches which had imbittered her menstrual and intermenstrual life, and they have never returned. The large fibroid tumor also rapidly lessened in size, until, six months later, it was no larger than a horse-chestnut. At that size it has since remained, but is giving her no trouble whatever. From being a bedridden invalid she now takes charge of her mother's house, and is able to do many other things beside. Last evening, Dr. John Ashhurst casually informed me that, with a friend of his, she had a few days ago walked four miles into the country after wild flowers. Her menses have never returned, but their absence has not made any appreciable effect upon her appearance or upon her character. She is just the same in these respects as she was before the operation. In addition to this case I have collected in my work on Gynecology1 eleven others, making twelve in all, in which the operation of spaying was performed for fibroid tumor of the womb. Of these, three proved fatal, but in each of them the ovaries were removed by the more hazardous abdominal incision. In one, operated on by Hegar, of Freiburg, the tumor grew smaller for five months, and the menstrual flux was absent; then a hæmorrhage took place, and an increase in the growth was observed, but unfortunately the patient was soon after lost sight of. In the remaining eight, including my own case, convalescence was uninterrupted, the menopause was established, the tumor be came smaller, and the women were virtually cured. Now I do not by any manner of means propose the removal of the ovaries as the sole means of curing a troublesome fibroid tumor of the womb. Whenever one so bulges into the cavity of the womb as to be reachable it ought to be enucleated. In this manner I have removed several interstitial fibroid tumors, one of them weighing twenty ounces. Then again we must not forget the incision of the capsule, the hypodermic use of ergotine, and other means devised for the treatment of these growths. But whenever the tumor is irremediable by such means I believe spaying to be a perfectly legitimate operation, and one which will be found very successful. CASE II. This was an unmarried lady of twenty-seven, who had great hæmorrhage at her menstrual periods and exquisite suffering, not only at these times, but for a week before and after. Her physician 1 Lessons in Gynæcology, page 275. any called me in to see her several times, but I was powerless to do good whatever. Her troubles seemed to start from turgid and neuralgic ovaries, for the womb showed no lesion whatever, and the pains radiated from each ovarian region. She had violent headaches, great emaciation, weighing sixty-seven pounds only, and exhibited mental disturbances which threatened insanity. I finally recommended the rest cure, but this did her very little good, although she was under the skillful supervision of Dr. S. Weir Mitchell, and fattened up to eightythree pounds. It was the worst case but one of pernicious menstruation that I have ever seen. Finally, after due deliberation, the removal of the ovaries was decided upon by us, and proposed to her. She at once consented, and I performed the operation per vaginam, being aided by her physician and by two other medical friends. One stalk was tied with silk, the other with gut; this latter broke, and that stalk was then crushed off with the écraseur. Her recovery was a slow one, being retarded by a small pelvic abscess, which burst through the incision, and discharged the knot of the silk ligature. Menstruation did not return, and she became wonderfully better, so much so as to astonish her friends, who were all ignorant of the nature of the operation. The secret has been well kept; her father, the other members of her family, and the servants in the house are to this day unaware of what took place. Beside her mother and the physicians present no other soul knows that she is without ovaries. Nor is the slightest change of voice, of appearance, or of character perceptible. She mingles in society, and is just as womanly and as womanish as she was before the operation. She has simply reached the climacteric somewhat abruptly, as Kœberlé calls it. Not long ago her physician informed me that "she deemed herself perfectly well, and had told him that he need never call again as a physician, but as a friend." She has a large circle of friends, many of whom have complimented me on the successful issue of my treatment, and have asked questions so hard to parry that I trust the recording angel has dropped a tear over each entry of my answers. CASE III. This was a married lady, aged thirty-seven, and the mother of three children, the youngest ten years old. She must have sustained some injury from the birth of this last child, for she never conceived again, and was never well afterwards. Agonizing pelvic pains at first ushered in the monthly periods, then kept up for some time afterwards, and finally never left her. She now became bedridden and an opium eater. Early in May, 1878, I was called in to see her by her physician, Dr. A. C. Deakyne, who had faithfully attended her for two years, and had exhausted every means known to medicine. A more wretched creature I never saw. She was reduced to skin and bones, and bore on her face the lines and furrows of the keenest anguish. The womb was in its place, and presented no other lesion than a slight |