APPENDIX-Section on Gynecology. UTERUS, WITH ITS CONTAINED FIBROID, RE- By J. B. STINSON, M. D., SHERMAN, TEXAS. EXPLANATION OF FIGURES.-I. Incision made through fundus and tumor. 2. Substance of tumor. 3. Right ovary. 4. Uterovaginal attachment. 5. Tumor presenting at os, which is considerably dilated. 6. Thin edge of os. 7. Left ovary. 8. Uterine wall. Miss S. B., aged 30, came under my care in November, 1884. She stated that, for five years previously, she had suffered from profuse menstruation at times, Uterus and its Contained Fibroid Removed-J. B. Stinson, M. D., Sherman, and frequent neuralgic pains, and bearing down sensations in her pelvis. At times, there was also a frequent desire to urinate. At the time she came under observation, she was very anæmic and much exsanguinated. She had been prescribed for, for her frequent floodings, but no uterine examination had ever been made. Upon examination, an immense fibroid mass was found filling up the uterus, which was as large as if six months pregnant, and extending as high as the umbilicus. The os uteri was dilated, perhaps an inch and a half in diameter, and, to the touch, the tumor had very much the feeling of the advancing fœtal head in normal labor. Upon digital examination, the finger could be inserted between the presenting mass and the thin edge of the os, on the right side, as far as the finger would reach. The part thus capable of being explored was about one inch wide by three deep, on the left side of the uterine cavity. Throughout the rest of the cavity, the tumor was thor oughly adherent to the uterine walls. I advised a tonic course of treatment, to repair the wasted tissues, and then to have the tumor removed; the hemorrhage, meantime, to be controlled by ergot and ergotine. This course was immediately resorted to. The Christmas. following, she, with her father's family, removed to the country, and I did not see her again until the July following, when I was called to see her, in consultation with Drs. Devine and Simmons, of Whitemound, in this county. I found her no better than in the November previous. She was now in such a hopeless condition APPENDIX-Section on Gynecology. that any operative procedure would have been utterly futile, and she was left to her fate, and died three days afterward. The family kindly granted a post-mortem examination, with the privilege of removing the tumor for preservation. The uterus and contained fibroid. weighed 54 pounds. The specimen shows, when closely examined, that it would have been a difficult task to have removed it, and, if it could have been peeled from the uterine wall, it would have required forceps for its delivery, so closely was the pelvic cavity filled with it. Laceration of the Perineum in Labor-J. M. Fort, M. D., Paris, Texas. FREQUENCY OF LACERATION OF THE PERINEUM IN LABOR. By J. M. FORT, M. D., PARIS, TEXAS. The interest manifested in the consideration of every medical subject should be commensurate with its practical importance. The frequency or infrequency of laceration of the perineum in the act of parturition is a question which cannot fail to interest every practicing physician-for every practitioner of medicine is also an obstetrician. In the presentation of this subject for your consideration, I shall endeavor, in the first place, to be brief; and, secondly, I shall endeavor to show, from reliable statistics, that this accident of labor does not occur as frequently in the practice of our own physicians as it does in the great hospitals or lying-in institutions in this and foreign countries. Our German brethren-so far as my reading extends -have furnishsd us with more statistics upon this subject than I have been able to find elsewhere. APPENDIX-Section on Gynæcology. the result of his observation, puts the per cent of ruptures at 20. Spiegelberg, in a series of 3,000 cases, puts the proportion of lacerations at 31⁄2 per cent. Litzmann, in a series of 4,316 multiparæ cases, reports 496 ruptures, or 111⁄2 per cent. Preiter, in his primiparæ cases, gives the per cent of ruptures at 88.4; Winckel gives the per cent at 82; Schroeder, at 34-5 Olshausen, at 21.1 per cent. Our leading obstetricians in the United States fail to give us any statistics upon the subject. Prof. H. T. Byford places the general average of ruptures at one in every five or six cases of labor, or at a per cent of from 16 to 20. All writers upon the subject speak of it as an accident of frequent occurrence; but there seems to be a reluctance on the part of most physicians to speak out upon the subject, especially to discuss the cases which may have occurred in their own practice. I do not claim for our practicing physicians any superiority of knowledge or tact in the management of their obstetric cases; and yet the conviction has been forced upon my mind that laceration of the perineum, to a greater degree than rupture of the fourchette-which occurs in all primiparæ—and slight cracks or fissures of a superficial character is of comparatively rare occurrence in the practice of the physicians of this State. With the view of getting some reliable data upon Montford gives an average of 22 per cent of lacerations in a series of 1,105 cases of labor. Winckel, as |