The adhesions were quite extensive about base of tumor and involving the round ligaments, which were ligated with a mass of adhesive membrane and divided; the neck of the uterus was now reached, a double armed suture needle was passed through the neck of the uterus and tied each way, round ligaments ligated, and brought through the abdominal incision, ligatures to the neck were crowded down into the cervical canal with the finger, and left to pass down into the vagina to serve the double purpose of drainage and convenience of removing, and from the thickness of the uterine neck supposed they would remain a long time; one taken away January 26, 1881, and the second one February 15, 1881; from this time all discharge ceased, pain and heat of back passed off, which had been almost constant from the time of the operation, soon passed off and is now well, and feeling much better than for the last two years previous to the removal of the uterus. Considerable blood was lost in the operation; dilute Curbolic acid was used as a styptic to check the oozing of blood and cleanse the abdominal cavity; wound dressed with deep seated quill and superficial sutures, adhesive straps and bandages. Pulse after operation, 54; at evening, 60.

Second day. Pulse, 69; temperature, 97.

Third day. Pulse, 68; temperature, 973. Nausea and eructations of gas-some pain.

Fourth day. Pulse, 90; temperature, 982. Less nausea until well, soreness and pain less, urine passed natural.

Fifth day. Pulse, 96; temperature, 983.

Sixth day. Pulse, 82; temperature, 99. Bowels tympanitic, little soreness.

Seventh day. Pulse, 80, and intermitting; temperature, above normal; bowels less bloated or sore, restless part of the night.

Eighth day. Pulse, 92; not intermitting; temperature, 98. Rested well through night, little pain and soreness, some tympanitis.

Ninth day. Pulse, 80; temperature, 983. Tongue heavily coated, with thirst.

Tenth day. Pulse, 90; temperature, 994. Bowels moved in night by assistance of an enema, very copious movements-but little pain-removed deep seated sutures, wound nearly closed.

Eleventh day. Pulse, 86; temperature, 100. Coat on tongue softening, pain and heat of head, restless night, two voluntary motions of bowels in latter part of night, feverish.

Twelfth day. Pulse, 86; temperature, 993. Less fever, no pain of head, tongue cleaning, bowels tympanitic with soreness and tenderness.

Thirteenth day. Pulse, 80; temperature, 99. Fever nearly gone, tongue cleaning, passed a very good night.

Fourteenth day. Pulse, 76; temperature, 100%. Had a restless night, pain through loins and hips, notice a decreasing pulse with an increase of temperature; removed superficial sutures, wound entirely healed.

Fifteenth day. Pulse, 80; temperature, 99. Bloody, offensive mattery discharge from vagina through night.

Sixteenth day. Pulse, 80; temperature, 98. But little vaginal discharge, fever less, tympanitis and soreness of bowels nearly gone.

Seventeenth day. Pulse, 80; temperature,

above normal, vaginal discharge and bad odor less, bowels moved by an enema. Nineteenth day. Pulse, 74; temperature, 983. Natural motion of bowels.

Twenty-first day. Pulse, 82; temperature, 983. Slight heat, no pain, no bloating of bowels.

Twenty-third day. Pulse, 68; temperature, 97. Decrease both in pulse and temperature, hands and feet cold, more free and offensive discharge.

Twenty-fifth day. Pulse, 78; temperature, 97. Mattery discharge continues, no soreness.

Twenty-seventh day. Pulse, 72; temperature, 98. Head hot and painful, hands and feet cold, no motion of bowels for six days, saw too much company yesterday, seems worried.

Thirtieth day. Pulse, 76; temperature, 973. Surface cool, heat of head less, bowels moved twice last twenty-four hours.

Thirty-fourth day. Pulse, 60; temperature, 983. Appetite good, bowels constipated. Discharged a substance resembling partly decayed flesh and very offensive; little discharge to-day. Thirty-seventh day. Pulse, 72; temperature normal, sitting up an hour or two each day, bowels constipated, requiring enemas.

SECTIONAL MEETING.

DISCUSSION.

DR. WM. OWENS: I would like to inquire to what extent Ergot has been used, and by what process, to arrest the progress of hyperplasia in fibroids, and to what extent it has been used by the homoeopathic profes

I have an interesting case in regard to its use hypodermically, if it has not been used, with your permission I will offer some suggestions in regard to it. It is well known that Prof. Hildebrandt, of Konigsburg, first suggested the use of Ergotine in the treatment of uterine fibroids. He reported some cases where he had remarkable success in using it internally and also hypodermically. Some years ago I had a case which seemed, in my opinion, to be of that nature; it had developed very slowly through the course of some six or eight years, until the tumor appeared midway between the pubis and umbilicus. She was unwilling to submit to a very thorough examination. She was a school teacher. She thought it would be impossible to submit to an operation, and thought she would rather die. I resorted to the use of the hypodermic injection, using Squibb's fluid extract of Ergot, diluted one-half with water. I used that over the pubic region about the centre of the tumor. After using it a few times I insisted upon an examination, and I detected the uterus pressed far back in the Douglas cul-de-sac; there was a tumor presenting between the cervix and the bladder, which was large and hard. At this time she thought it was getting better, but she was not sure. I made an exploration with the trocar and drew off a portion of bloody water, which was all I could get. The trocar penetrated the tumor two inches. There was no unusual discharge following the use of the trocar. I would say that she had been subject to uterine hæmorrhages of a very severe character, for five years previous to this time. I continued my hypodermic injections every four weeks. In one year the measurements around the abdomen in the median line at the umbilicus and pubis were reduced four inches. I gave her no further hypodermic injection, and in three years from that time no tumor could be detected. The young lady attended to her duties constantly and is alive and well to-day. She is better and stronger than she has been for twelve years. She is a single lady, and is now thirty-five

years of age. This case I regarded as a case of uterine fibroid proper, in fact involving the uterine walls.

DR. ORMES: Posteriorly?

DR. OWENS: No, sir. I think involving the walls in the anterior portion. Another case, which was certainly a sub-mural fibroid, came under my notice, where I was called in consultation. The patient was a married woman without children. This trouble had been going on for ten or twelve years. I found her abdomen very greatly enlarged; the os had dilated until the finger could be introduced to the internal os. The sound could be passed into the internal os and passing behind the tumor circumscribe a space of nine inches in length from the external os. The sound was introduced until we had about an inch and a half of the handle left. We passed and swept around this tumor and found that it was free from any adhesions posteriorly; that it was confined entirely to the anterior walls and seemed to be sub-mural. In this case also we used the hypodermic syringe. I had one made on purpose with a long needle. The needle was four inches in length. I injected thirty drops of a solution containing equal parts of water and Squibb's fluid extract of Ergot into the tumor at this time. At this time the case was left in the hands of the attending physician, who continued to treat it once a month for fifteen months afterwards. The tumor entirely disappeared, and she became regular in her menstruation, and is as well and healthy a woman to-day as any woman can be. She lives in Ohio, and the name of the patient and her location can be given whenever it is necessary. Another lady who came to this same physician for treatment measured fifty-seven inches around the abdomen. I saw the case in consultation, and can testify to the measurement. The hypodermic syringe was used as in the first case, over the pubic region. This woman had been the mother of several children. DR. GROSVENOR: What was the character of the tumor?

DR. OWENS: That we could not determine.

DR. GROSVENOR: Intramural or in the uterus?

DR. OWENS: I thought it was sub-serous. In this case there was a sub-serous tumor. The abdomen was very much distended; it was difficult to tell just where it did originate or what particular type it had. The uterus was entirely occluded; we could not pass a sound into it beyond the internal os. I regarded it as a sub-serous tumor pressing upon the anterior walls of the uterus until they had been entirely obliterated. The attempt to pass the sound around in any direction was quite painful. In fact we could determine nothing positively by the finger in regard to it. The treatment was kept up, and the measurement reduced to twenty-nine inches.

She went home apparently well, or rather very much better, for she is not well yet. This was within the last three years. I take it, it will be some time before she will be entirely cured. The fourth case was one in which we had a complication of a fibroid and cystic tumor, evidently the result of some injury to the patient; she thought she had received an injury from which a cyst was developed. This was undoubtedly a sub-serous tumor. When I first saw her she was twenty-eight years old, had had one child, and had been married six years. She had frequent and profuse hæmorrhages; these large hæmorrhages usually mark this class of cases. When

I first saw her I made up my diagnosis, which was confirmed by the judgment of two other physicians, that we had a sub-serous tumor. She would not submit to hypodermic injections or operations; she said she would just as soon die as to submit to anything of the kind. Two or three, perhaps four months, passed along. The size of the tumor increased and seemed to project from the right side of the uterus towards the left side of the umbilicus. It was hard and very firm, and we all thought it a sub-serous fibroid. About four months later, it was noticed that a small protuberance had formed on the right side of this tumor, about the right cornu of the uterus, and at the time that it was supposed to have bursted or collapsed it had attained the size of a goose egg. Three months from the time the tumor was discovered she took a long walk, and used a considerable amount of exertion climbing a hill; she came home with evident indications of peritonitis, and died three days afterwards. We were permitted to have an examination of the tumor after death, and what we supposed to be a fibroid remained; the projection or protuberance had disappeared. I might mention two or three other cases of similar character, but none in which the hypodermic syringe was used so successfully. I have a case under treatment now, probably involving the walls of the uterus, where I am using the hypodermic syringe.

DR. D. B. WHITTIER: I would like to inquire of Dr. Owens if he believes that the cure in the first case cited was due to the use of the hypodermic injections of Ergot?

DR. OWENS: I will say that I have reason to believe that the Ergot was the cause of the cure. I believe that these cases of recovery, so far as they have recovered, are due to the use of Ergotine used hypodermically and otherwise. These cases were reported verbally in the Ohio State Society and have been under observation ever since. The patients are well to-day. DR. WHITTIER: Were not the intervals between the injections too long?