blood vessels. He concludes his paper as follows:

dence, or due simply to the general dis

turbance of nutrition.

in our research in this direction, that the etiology of many of our cataract cases which are now obscure, may be cleared up and better understood. I would suggest that the eyes be tested for their visual acuteness, at regular intervals; the interior of the eye should also be examined to determine if cataract be present, and as to how far the sight is affected by it, and if other causes are present, how far the impairment of vision is due to them; the careful supervision of the patient for any symptoms which point to impairment of circulation and digestion. The interest of the patient demands this supervision, for by it we will become more familiar with the nature, prevention and removal of the general conditions which may be the cause of the formation of cataract. As before stated, in all cases of incipient cataract, careful analysis of the urine should be made at different intervals. Though we may not have proven a direct connection between general disease and the formation of cataract, yet it can not be denied the existence of a predisposing cause in all diseases where there is impairment of nutrition and lessened vitality.

DISCUSSION.

Dr. E. Oliver Belt said Dr. Dufour's paper was a very interesting one, still he could not but believe that general disease had very little to do with the formation of cataract, Diabetes and rachitis did have some influence but malaria, influenza, typhoid fever, etc., were extremely rare as causes. One per cent was about all that could be traced to the influence of diabetes, and only about six per cent to albumenuria, so that it appeared that these diseases had very little to do with the formation of cataract. other diseases cataract is found so rarely that it may have been a mere coinci

In

occur.

In

produced convulsions, as in ergotism, and in certain diseases as rachitis in which convulsions frequently The formation of cataract is usually attributed to some disturbance of the nu trition of the lens, further than this we are still in the dark as to the cause. diabetes some think it is due to extraction of water from the lens by the sugar in the surrounding fluids, as it is found. by experiment that if a clear lens is immersed in a sugar solution it will become opaque, however very little sugar has been found in the aqueous of patients suffering with diabetes, so the truth of this theory has not been verified.

Dr. Dufour, in closing the discussion, said he had not much more to add to his paper. His idea in bringing the matter before the society was to gain the cooperation of the general practitioner in order that the disease might be taken in its incipiency. As Dr. Belt had said we were not always certain as to the cause of cataract, but we did know that it was due in some way to disturbances of nutrition. The hope of treatment in the beginning when there was a slight opacity of the lens, was to adopt some method to prevent the formation of the cataract, give the patient good vision, and still leave the lens in place. It was only by the co-operation of the general practitioner, however, that this could be accomplished. He did not mean to assert positively that there was any direct dependence of cataract upon general diseases, but he did believe there was some influence of the one upon the other, and the best way to counteract this was by co-operation with the general practitioner, as suggested in the paper just read.

The President asked Dr. Dufour if he did not think it was the man who adjusted the first pair of glasses-in other words the oculist-and not the general practitioner who had the best chance of discovering and treating cataract in its incipiency?

Dr. Dufour replied that that was so to

a certain extent, but he was sorry to say that in the large cities it was not the oculist but the optician, who had no qualifications whatever, who generally adjusted the first glasses.

MEETING OF MARCH 18, 1896. Dr. S. C. Busey, President, in the Chair.

The following Pathological Specimens were presented by Dr. J. Wesley Bovee: 1. Parovarian cyst.

2. Ruptured tubal pregnancy.

left side and laid on that side, principally, even after the abdomen was opened. It was only after the normal tube and ovary were found on the left side that I found it to be a tumor of the right parovarium. The patient is practically out of all danger.

2. A young colored woman who had had a child three years ago after a normal labor, enjoyed good health previous to about the middle of December, 1895, and menstruated last December 12th, of that year. Then vague pelvic pains and

Dr. Bovee read the following reports of the cases:

I. A white woman, single, 27 years of age was seen in consultation March 4th. Her menses began at fifteen and have all the time been irregular, sometimes being absent for three months at a time; though during the past year have been quite regular, scant and painful.

The last period occurred one week ago. Five years ago she was injured by falling backward partly off a horse and has had occasional pain through the abdomen since. One year ago first noticed an enlargement of the abdomen and thought she was getting fleshy. This chagrined her very much and she remained at home more than was her custom. The abdomen has rapidly increased and recently the circumference has increased at the rate of two inches per month. She entered Providence Hospital March 9th, and on the eleventh I removed a right par-ovarian cyst weighing thirteen pounds. The ovary of that side is practically normal and the tube is quite a remarkable affair, being sixteen inches in length as it is spread out over the cyst. The opposite appendage being normal was not disturbed. A peculiar feature of the case was that the growth appeared to spring from the

minating in a severe attack January 20th last. The menses had now been absent forty-four days and as the pelvic pain was extremely severe and accompanied with the passage of a large blood-clot from the vagina, she thought she had had an abortion. However, as she was feeling much better two days later, she got up and was about the house. But the pain and flow continued and she applied for treatment at the out-door department of Columbia Hospital, February 17th. There an examination was made and a fluctuating mass was found behind the uterus. She was advised to enter the hospital at once but returned home and resumed her household duties. On February 27th she was attacked with sudden, severe pain in the lower part of the abdomen, followed by repeated attacks of syncope. She remained in bed, attended by Dr. C. Marshall until her coming to the hospital the second of March.

On admission: The flow has continued since the abortion. since the abortion. The bowels have not moved since the 28th ult., and she complains of very severe pain through the abdomen. She was very feeble, unable to walk, the extremities were cold and she seemed nearly exsanguinated. There was slight œdema of the legs and the abdomen was very much distended

by fluid and gas. The mucous membranes of the lips, tongue, conjunctivæ and vagina were very pale. No glandular enlargements were noted. The urine. had a specific gravity of 1,024 and contained albumen and pus; the pulse was very feeble and the temperature was subnormal.

A diagnosis of probable ruptured tubal pregnancy was made, so that when the abdomen was opened, March 5th, 1896, we were not at all surprised by the pouring out of a large quantity of black, semi-solid blood as soon as the peritoneum was incised. By passing my fingers downward, the top of the slightly enlarged uterus was easily felt and recognized and the right appendage, other than a few adhesions of the ovary, was found to be normal and not removed. The ovary contained a corpus luteum. The left Fallopian tube was much lengthened and its first two or three inches was apparently normal. It, however, continued around backward, much as does the round ligament in front, and ended in a sac attached to the rectum, the uterus being free from the sac. This sac had ruptured and, lying partly in and partly out of it, were the foetal membranes, the fœtus and a large mass of blood clots. The ovary of this side was apparently normal and contained no corpus luteum. The foetus was of about six weeks gestation. The appendage was removed and the abdomen flushed with hot water, large clots being washed out of it, even from behind the liver and near the spleen. No drainage was used and the wound was closed with kangaroo tendon, buried both subperitoneally and subcutaneously. 1500 C. C. of normal salt solution was thrown under the skin and she made a complete recovery.

3. Sarah W, colored, single; 39 years of age, was admitted to Columbia Hospital January 11th, last, complaining

of pain through the lower part of the abdomen. She had missed two menstrual periods. Previous to the absence of it the flow was regular, painful and very profuse, lasting about two weeks and containing large clots. An examination shewed the uterus extending to above the umbilicus and containing a number of fibroids, there being one large one low in the pelvis, in front of the cervix. The body of the organ was suspiciously soft and this, together with the history of amenorrhoea, warranted a diagnosis of pregnancy.

A consultation was held and the decision that hysterectomy was advisable was reached. To this the patient consented but later changed her mind about it and left the hospital January 21st.

She was readmitted the 12th inst, and the uterus was still further enlarged and softer and the menstrual flow had not re

appeared. She was now four months pregnant and the large fibroid was still in the pelvis. She had returned for the operation, which was done March 16th. Abdominal hysterectomy was done and the specimen shows the fibroids in the main part of the uterus and the one mentioned as filling the pelvis. The woman stood the operation well and her pulse has never reached 100 since the operation. To-day she is perfectly comforta

ble.

DISCUSSION.

Dr. Jos. Taber Johnson said he had had the pleasure of seeing Dr. Bovee remove the larger tumor containing the fœtus. It seemed as if such cases were more frequent than was formerly supposed to be the case, for this was the

third one which had come to his notice within a short while. He himself had reported a case to the Society last week in which the women had been in the fifth month of pregnancy with a large tumor by the side of the uterus and another low down in the pelvis. Then came Dr. Bovee's case, just reported and he un

derstood that Dr. Fry had operated upon a similar case to-day. He thought that gynecologists who were also obstetricians were taking the ground that the greater safety of the woman was conserved by removing the tumor, uterus and all. The operation was a severe one, but it was far safer to perform it than allow the pregnancy to continue so long that a miscarriage might be provoked by the growth of the tumor with the consequent danger of a severe hemorrhage. This danger was so great and the impossibility of the birth of the child later on by the natural channels so evident that this operation was becoming one of selection now, and the good results obtained in these cases seemed to demonstrate the wisdom of performing it. It might not be such a triumph of surgery or obstetrics as it would be if the pregnancy could have been allowed to go on and a Porro operation done, thereby saving the child, but the sufferings were so great in these cases that it seemed justifiable to do the operation at an earlier stage.

With regard to the case of ruptured tubal pregnancy, he said they seemed to be much more frequent than formerly, if we could judge by the frequency with which they were now reported. The numerous successful operations recently performed seemed to emphasize the fact that these cases could be saved if the operation was done before the dangers became too great from hemorrhage or consequent septicæmia.

Dr. I. S. Stone said the cases were all extremely interesting, especially the one of fibroids complicating pregnancy. He wanted to add to the three cases recorded by Dr. Johnson two others which had recently been operated on, one by Dr. Kelley at Garfield Hospital and the other by himself. He had performed the operation on a woman who appeared to be about 55 years of age, so that the idea of pregnancy was not even suspected until the tumor, weighing 18 pounds, was removed. There were fearful mesenteric adhesions in this case so that she bled a great deal rendering it impossible to do as complete an operation as could. have been wished. The patient died.

He had also recently opened the abdomen of a woman under very similar circumstances. She had been bleeding for the last six months, and according to her own account had had the tumor for five months. She insisted that she was not pregnant. This case showed how unsafe it was to depend upon a patient's own statements regarding pregnancy. She was put upon the operating table and an incision made. A fibroid was found very much smaller than in Dr. Bovee's case, but, like his, situated on the left side. After discovering the existence of pregnancy he thought it only just both to the mother and foetus to let the pregnancy continue and later do a Porro or Cæsarean section, preferably the former, by means of a wire clamp. He hoped that the patient would consent to remain under observation. She was doing nicely since the operation. He believed it would be better to allow the pregnancy to continue two or three months longer and then operate.

Dr. Bovee, in closing the discussion, said that there was an element in Dr. Stone's case, which was wanting in his; that was an ignorance of the existence of pregnancy. Dr. Stone might have been justified in closing the abdomen of his second patient and allowing the pregnancy to continue if he was sure she could be kept under observation, but if not the case might give much trouble later on. The state of the woman's own feelings might be an index in such cases, so that if she desired to have children the pregnancy might be allowed to continue and an attempt made to save the child by a Porro operation, otherwise he thought it would be wiser to remove it at once. Moreover, he thought that if she continued to bleed as she had done for six months past she would not be in condition for a Porro operation when the time came. His own patient had been to eight or nine different physicians in regard to having the operation done since he had first seen her and then came back to him deciding to have it done. He had thought it wiser to do it at this time rather than wait for the full time of pregnancy.

REPORTS OF EIGHT CASES OF HYSTEREC

TOMY WITH SPECIMENS.

Dr. Joseph Taber Johnson presented a group of specimens, all of which had involved hysterectomy. Two were vaginal hysterectomies for cancer of the uterus and one for intra uterine fibroid, and five were supra-vaginal hysterectomies for uterine fibroids. The group of vaginal hysterectomies occurred in women about the time of the menapause. They all presented about the same symptoms and the same indications for operations. Two were done at Columbia Hospital on the same day. The third was done in Dr. Johnson's private. sanatorium. These three uteri were removed with clamps instead of ligatures. They all made an unusually rapid convalescence, the two at Columbia Hospital being up on the tenth day, walking about at the end of two weeks and going home feeling very well at the end of the third week. The lady in my hospital had been weakened by previous hemorrhages, and her convalescence was two weeks longer, when she drove with her husband to her home eight miles in the country.

Case four was a large uterine fibroid removed from a patient, in Dr. Johnson's sanatorium, who was at the same time five months pregnant. She came from Falls Church in Virginia, being sent by Dr. Talbott of that place. Mrs. B. had been seven months married and while she had been aware that she was not altogether well, she did not know that she had a fibroid tumor. Along with the first symptoms of pregnancy there was an unusually rapid enlargement of the abdomen and during the past two months the increase in size had been altogether upon the right side. Constant pain and pressure symptoms, indigestion and inability to walk, induced her to consult Dr. Talbott, who at the end of the fifth month brought her to

Washington.
Washington. Her symptoms had now

become so painful that she was practically a bed-ridden invalid. When her condition, and the risks and dangers of an operation were fully explained to herself and her husband, they both at once decided in favor of an operation which was performed early in March resulting in the removal of the specimen here exhibited, consisting of a six-pound fibroid tumor growing from the side of the uterus, which was enlarged sufficiently to contain a five months fœtus. This was practically a Porro operation. Dr. Johnson regretted that he could not allow this patient to go on to the viability of the child, but he doubted if the patient would have survived her distressing symptoms a month longer. The patient. made an excellent recovery and returned to her home a month after the operation.

The fifth case was Miss X, white, single, age about 35, had been suffering from the effects of a bleeding fibroid for many months. She was exceedingly nervous, exhausted and at the time of the operation called herself a physical and nervous wreck. For the few days preceding her entering the sanatorium she fainted several times from loss of blood, being compelled to remain flat in bed with only a very thin pillow under her head. She was carried down stairs. in her own house and upstairs in the sanatorium. As soon as preparation could be made, supra-vaginal hysterectomy was done by the Baer method and the tumor removed, here exhibited. She has since made a fairly good recovery and returned to her home. It will probably be a year before she recovers from her loss of blood, neurasthenia and indigestion, which preceeded her operation.

The sixth and eighth cases were all supra-vaginal hysterectomies by the Baer method done mostly for pain and