for their appearance there, and, as Dr. Macdonald has said, when the gall-bladder is distended we expect it to attach itself near the umbilicus, especially in women, and in that event, the cyst being opened up, its cavity will be directed upward and not downward toward the symphysis, a point of value in determining what we are dealing with.

Dr Vander Veer alluded to one symptom which I have found to be present throughout almost every case I have examined. It was conspicuous in his case. The young lady could not ride a horse on account of a recurring fainting sensation.

Dr. Ill uses a very appropriate, although somewhat commercial, term to describe the character or manner of evacuation of the bladder by instalments. This certainly would be a very characteristic symptom of urachal cysts having vesical connection, and could only be mistaken for hydronephrosis that occurs in the course of distended kidney due to distortion or displacement.

Dr. McMurtry, in his inimitable and very eloquent way, described the sentiments that impelled me to remove the cyst. There it lay, easily detached, just at the point of my finger, and I could not resist the temptation to remove it. I knew the danger. I do not believe I could resist the temptation again. The sac was easily detached. Had it been one of those thick, inflamed sacs that Mr. Tait speaks of; had it dipped down in the pelvis and separated the peritoneum from the vessel, I should not have attempted it, but should have incised and drained it. Dr. Reed's plan, which was so successful, to detach the peritoneum, to close over the raw surface, is adding a little more risk to the case, and if we have a large area I would not think of doing so.

The pathology of these tumors is very different. If we have a vesical connection, either by a cord or the patent end of the urachus, then we have to deal with that connection. It is a part of the technique that has been brought out by Dr. Ill, and it must be treated as any other hollow viscus, inverted, and closed with sutures.

As to the danger of sepsis, I try to be aseptic at all times. I did not contaminate the denuded surface with the escaping fluid; not one drop of it got between the cyst-wall and parietes, and I tried to be as clean as possible. If sepsis caused gangrene and not starvation, then it would be all right to have left this big flap of peritoneum. On that point one surgeon in removing a large sarcoma on the abdominal wall took away an immense area of the abdominal parietes, and then looking at the peritoneum feared to leave it, and took out a large area and left the surface raw. The patient got well.

CONSERVATION OF THE OVARY.

BY B. SHERWOOD-DUNN, M.D.,

BOSTON.

PROFESSOR BROWN-SÉQUARD believed and taught as a principle of physiology that every gland, whether or not provided with excretive ducts, gives to the blood a certain useful principle, the absence of which is felt and made apparent after its extirpation or the destruction or modification of its functional activity by disease.

The importance of this theory, if it be based upon a fact, cannot be overestimated; and if its truth be proven and generally accepted, will certainly have a modifying influence upon the frequency with which the ovaries have been, and in some localities are, extirpated.

The recent publication of researches made by Mond and Chrobak, of Vienna; Jayle and Lissac, of Paris; Mainzer, of Berlin, and Muret, of Lausanne, has given definite form to certain ideas that I conceived upon this subject, born of a series of observations taken in my hospital service at Paris, of a variety of troubles and functional disturbances which more or less constantly follow as a result of double oöphorectomy.

These various troubles and functional derangements, which are constant though variable in degree, in women who have had the menopause anticipated by castration, form to my mind one of the strongest arguments in support of the glandular theory.

From observations made upon 100 cases operated upon in Broca and St. Louis Hospitals, at Paris, I found that where the woman Prematurely lost both ovaries, 78 per cent. subsequently

had

suffered a notable loss of memory; 60 per cent. were troubled with flashes of heat and vertigo; 50 per cent. confessed to a change in their character, having become more irritable, less patient, and some of them so changed as to give way to violent and irresponsi

ble fits of temper; 42 per cent. suffered more or less from mental depression, and 10 per cent. were so depressed as to verge upon melancholia. In 75 per cent. there was a diminution in sexual desire, and some of these claimed they experienced no sexual pleasure; 13 per cent. were not relieved of the pain from which they suffered; 35 per cent. increased in weight, and some became abnormally fat. Some complained of a diminution in the power of vision; 12 per cent. noted a change in the tone of their voice to a heavier, more masculine quality. Some 15 per cent. suffered from irregular attacks of minor skin affections; 25 per cent. had severe headaches, as a rule increased in intensity at the catamenial period. Equally as many complained of nightmare, more or less constant, while about 5 per cent. suffered from insomnia. In a few cases there existed a sexual hyper-excitability not present prior to the castration. I particularly noted a few cases presenting chiefly gastric reflexes, where, without any premonitory symptoms or apparent cause, the stomach would reject food, or refuse to prepare it for intestinal digestion, and the consequent distress following the fermentation compelled the patient to seek relief.

It should be noted that, usually, these troubles were more marked in women under thirty or thirty-three years of age.

The modification in the memory in the foregoing was in many cases very remarkable. As a rule, the patient could recall incidents and details of their experience which occurred at times previous to the date of their operation, but at the time of interrogation they complained of inability to recall matters of importance of recent occurrence, and in starting to do a certain thing would forget their intention before arriving to its accomplishment, or would forget in the midst of a narrative the point they commenced to relate, etc. In the observations of Dr. Jayle,' he has found this loss existing in two cases in which ten years have expired since their operation.

I think the weight of opinion now supports the view that a simple hysterectomy which leaves the ovary in place is followed by much less functional disturbance than the removal of the ovaries and the leaving of the uterus.

The thesis of M. Claret, Paris, 1896, and a memoir published

1 Revue de Gynécologie, Paris, Mai, Juin, 1897.

by M. Glaveck,1 1889, give some conclusive data to the effect that, following a simple hysterectomy not comprising the ovaries, these organs do not rapidly atrophy, as has been generally thought; and it is reasonable to suppose that the happy modification of reflex disturbance, where the ovaries are left after hysterectomy, is due to the continuance of their functional activity and the resultant action upon the general system of the normal effect of their secretion. I have been favorably disposed to the hypothesis advanced by Brown-Séquard for some time, and the results of experiments made with ovarian substance, or powdered ovary, in patients who have lost both ovaries, or were suffering from troubles which in a greater or less measure were due to a diseased condition of the ovary (dysmenorrhea, amenorrhea, anemia, neuralgia, etc), seem to support this theory.

The fact that in many notable instances following double oophorectomy the subject has been restored to the very best condition of health by the operation does not militate against the truth of the theory of the secretive function of these organs, but to my mind is rather in its favor.

After years of slow degenerescence, or of rapid disease, which may so change the character of the secreted elements as to be harmful in their influence upon the general system, it would seem possible and even probable that the effect of their ablation would be permanently beneficial. For, as the first effort of nature is to resist and repair, it is but natural that she should welcome the loss of an organ which, by the perversion of its natural function, destroys instead of preserves.

Being persuaded that the ovary is as much a secretory gland as is the thyroid, I believe that the troubles observed following their ablation are due to the consequent loss of their secretion to the economy, and I have been led to this opinion by the following accumulated evidence:

1. Statistics show functional troubles to be more constant and intense in women who have lost both ovaries by operative interference.

2. That there is little if any modification of these disturbances where the uterus is left and both ovaries are removed.

1 Arch. f. Gynäk., Bd. xxxv. p. 1.

3. That these troubles are notably less where the uterus is removed and the ovaries are left in situ.

4. By the favorable results of the experiments of Jayle, Mainzer, Mond, Chrobak, Muret, as well as my own, in the administration of ovarian substance or powdered ovary to patients who suffered from various forms of disturbance more or less intense following double oophorectomy, and equally those suffering from functional difficulties due to ovarian disease.

The first three of these facts have been before me for some years, but the fourth-the therapeutic effect of the ovary given in different forms-is new. I have administered it only in three cases, and I consider the data of only one of these worthy of your serious attention; but this one goes far to substantiate the more extended and valuable reports published by the distinguished men already mentioned, and makes me hopeful that this treatment may prove valuable in some cases where it has seemed impossible to obtain any amelioration.

In the observations of the authorities mentioned use was made of (1) the ovary in its natural state; (2) the desiccated and powdered organ; (3) glycerin extract of the ovary; (4) liquid extract of the ovary prepared after the method of Brown-Séquard and preserved in sealed tubes.

The first form presents two objections: difficulty of obtaining the fresh organ, and greater difficulty in getting the patient to take it.

The second form, of powder, has been the one most favored by all, and has given as good results as the administration of the hashed fresh ovary, or of the glycerin extract, or the hypodermic injection of liquid extract prepared after the method of BrownSéquard.

I have so far used only the powder and the tablets, the latter in only one case, which did not respond as quickly as the others, and I soon changed to the powder; but I would not say that one is better than the other, as I have not given the tablets a fair trial neither can I expect such good fortune as that the good effects observed in my three cases will continue in those that may follow.

CASE I. was a young married woman, no children, aged twentyfour years, who had suffered great pain at each recurring menstrual