which the physician has to deal; and now and then cases arise in which the attendant's ingenuity is severely taxed as to the choice of remedies to be used continuously during gestation. As soon as the hypertrophic condition of the uterus begins there is a divergence of blood from the intestinal tract, and, for that matter, from the general economy, to the uterus, which is now called upon to sustain a new being. The nervous energies are also directed toward this organ from the general system, and, as a consequence, an atonic condition follows which, if not met therapeutically, may result in a disordered and demoralized nervous system.

Once a disordered and deranged nervous system is developed, a deranged and disordered mentality is apt to follow. Evil forebodings, hallucinations, dread of the pangs of labor, etc.—often helped on and assisted by the awful stories of unfortunate terminations in the person of some acquaintance, as related by some kind (?) lady friend-are but the danger-signals to warn us of what the results might be if the condition is not met promptly and in a decisive manner. Is it not, then, our duty to build up the now overtaxed nervous system, in order that, when the ordeal appears through which the individual is about to pass, nature may accomplish her purpose in a physiologically satisfactory manner?

After a faithful trial of strychnine in combination with iron or the bitter vegetable tonics, I found it was followed with unsatisfactory results in many cases. It occurred to me that free phosphorus, the well-known nerve tonic, would probably, if combined with iron, answer the purpose. In this, however, I was disappointed, and was compelled to abandon its use on account of the derangement of the stomach it almost always produced. The eructations of gases impregnated with the phosphorus is another and a serious objection offered by the patient. Still, not wishing to abandon the use of a remedy which I regarded as theoretically of value, I began the use of the chemical union of phosphorus and strychnine as prepared by Merck; and later, at my request, Parke, Davis & Co., of Detroit, prepared for me the gelatin-coated pill of the phosphate of strychnine, each containing one-one-hundredth of a grain. (I have found that this size is the most convenient, as the dose can be increased by directing the patient to double the number in order to get the fiftieth, or to take four pills if it is desirable to give the one-twenty-fifth of a grain.)

The following observations have been made by me in the use of phosphate of strychnine during the gestation of weak and debilitated patients: A good appetite and good assimilation are obtained in the general weakness and debility of the anemic, constipation is relieved, and, in short, the patient is built up and placed in a good condition to pass through the ordeal of labor; the uterus contracts promptly after the third stage of labor, and the use of ergot is entirely dispensed with. In this connection I wish to say that it has now been five years since I have used any ergot in my obstetrical practice. If I find it necessary to use the forceps the patient is given a hypodermatic injection of one-thirtieth of a grain of sulphate or phosphate of strychnine as soon as the anesthetic is commenced, but no ergot is ever used. I have also observed that after the continuous use of the phosphate of strychnine the uterus contracts promptly after the second stage of labor; and in many cases the application of Credé's method of expression of the placenta is not needed to bring it away, and no post-partum hemorrhages have occurred. The often-observed chilliness or rigors, which in the majority of cases follow labor, have been noticed in but few cases. This rigor, so common after labor, regarding which but little can be found in the text-books, is nothing more nor less than surgical shock. This is obviated by the prophylactic-strychnine.

I have used strychnine for some time in my abdominal surgery for the purpose of preventing shock and to control the pulse in the operations, and in this way was led to its use in obstetrics.

In closing, I wish to say that, as phosphorus and strychnine are remedies used in the treatment of rhachitis with good results, would it not be the remedy during the gestation of the rhachitic fetus? The phosphate of strychnine I have found to act better as a laxative than either the sulphate or nitrate.

DISCUSSION.

DR. JOHN M. DUFF, of Pittsburg.-Mr. President: I desire to add my testimony to the effectiveness of strychnine during pregnancy. I have used it for a long time. I have employed it continuously in the hospital with which I am connected, as do my colleagues. Three or four years ago I wrote an article on this subject, an abstract of which was published in the Therapeutic Gazette. Dr. Hall, of Wheaton,

Texas, published an article at the same time on the same subject. The California Medical Journal had an editorial upon the subject, commenting on the fact that we should have both written at the same time, without any knowledge of each other, on the same subject. Since then I have corroborated my former opinions on the subject, and I think those who use strychnine faithfully will find all that has been said in its favor is correct. I have no hesitancy in saying that with the judicious use of strychnine the indications for instrumental delivery will be far less frequent, and ergot will only occasionally be called for during or after the third stage of labor. It reduces the number of abortions, and especially premature deliveries, by giving tone to the uterine muscles and nerves, as well as by its general tonic influence. It improves the appetite and digestion, keeps the bowels soluble, prevents insomnia, regulates the circulation, and in the weak insures a more rapid and less painful labor. After its use after-pains are not so frequent, and the danger of post-partum hemorrhage is greatly reduced. That it is constant in its action, and that benign results follow its administration in every case, I cannot claim, as I have occasionally given it when it completely failed to produce desired results, and I am not unmindful of the fact that I have seen apparent evil results from its administration in a few cases. The treatment is not suggested as routine, but as indicated in each given case, for every case in the hands of the scientific obstetrician is treated of itself, by itself, and for itself. My observations warrant me in making the broad assertion that with the judicious administration of strychnine prior to labor the cases in which ergot will be indicated after the third stage of labor will be very rare. The action of strychnine is effective and prompt.

DR. DORSETT (closing the discussion).—I have very little to add, except to say that possibly in my paper I did not lay enough stress upon the advantage of the phosphate over the sulphate of strychnine. I will say, in addition, I have found it a very much better laxative than the sulphate of strychnine; and I also wish to remark that it is common practice in the West for general practitioners to place their patients upon the well-known aloin, strychnine, and belladonna pill, and I only speak of this to condemn it, because in a number of instances I have noticed a deficiency in the secretion of milk after the aloin, strychnine, and belladonna pill has been continued during the latter months of gestation. Possibly its discontinuance after the sixth month may make some difference; but where it is persisted in for over nine months, I am satisfied I have observed a deficiency in milk secretion, and patients have complained that they had not sufficient milk to sustain the life of the child, and a wet-nurse had to be resorted to.

THE FATE OF OVARIES IN CONNECTION WITH RETROVERSION AND RETROFLEXION

My subject does not include those less frequent instances of ovarian descensus that occur without backward deflexion of the longitudinal uterine axis, primarily from pathologic processes that have either increased their weight or have left their ligamentary supports relaxed or elongated, so that one or both ovaries drop downward and inward into the median line of the pelvic canal temporarily or permanently, even while the uterus remains in normal position. I desire, with your indulgence, to call your attention to only one, but mechanically the most prolific, cause of descensus ovariorum. I would remind my hearers of the hidden trap for ovaries that is created by a thoroughly retroverted uterus, and of the traumata that ovaries experience in the majority of instances, to a variable degree, in their helpless association with it.

While these evils are fragmentarily alluded to by a number of authors under the objectionable term of "prolapse of ovaries," their pathological dignity is, to my mind, nowhere fully set forth. It is insufficiently appreciated by gynecologists, and scarcely at all by probably the majority of general practitioners. From this and similarly obscure but no less objective causes there arises still a great hardship to a multitude of suffering, enfeebled, and neurotic women. I need not comment upon the number of such who are maltreated by constitutional remedies upon erroneous diagnoses, nor upon the number of them who might be saved from a partial or total castration if a permanent restoration to normal position and mobility were or had been secured at an earlier date. Again, another motive comes to me in this connection when I read in a book as prominent and recent as the American Text-book of Gyne

cology,' a statement which is practically absurd-i. e., “In retroversion the ovary usually lies in front of the uterus" (!). This is almost impossible, and I have never found it so in the absence of neoplasms. Some truth, however, is contained in the author's next declaration, "but it sometimes lies beneath that organ in the cul-de-sac."

We are at this time concerned only with flexions and versions of the uterus within an approximately median antero-posterior plane of the pelvis. In order to define and to speak about retroversion of the uterus we need to consider briefly what is the normal position. We must understand clearly the proper bearing or effect of intra-abdominal forces upon the uterus and its adjacent organs in normal position, in order to appreciate that these very potent forces are made to do a work of destruction when the uterus departs from its normal anterior range of mobility within the plane spoken of. This means the entire range of anteversion or any forward inclination of the long uterine axis which will form a sufficient angle with the perpendicular line of the body to enable the consensus or aggregate downward impulse of intra-abdominal pressure to impinge upon the posterior aspect of the fundus sufficiently to move it forward, and not backward, during straining efforts when the body is in an erect posture and when the bladder and rectum are not temporarily distended; and it implies such patency of the uterine supports that they will restore it to its normal anterior confines when it has been temporarily or physiologically tipped over backward by a full bladder or rectum, or by both. The one substantial support of the ovary, which holds when the other attachments readily yield, is the utero-ovarian ligament. This, according to Luschka,2 is a firm one of organized muscle whose fibres are continuous chiefly with those in the posterior uterine wall. He says it is given off at the junction of the upper and middle third of the uterus, is five millimetres thick at its outer, the thinner, end, is covered with peritoneum, and has an average length of two and eight-tenths centimetres. The other supports are its hilum, a cup- or slit-like socket on the upper or posterior peritoneal blade of the broad ligament, into which the straight and thinner border is received this stem of the ovary conveys its nerves and relatively large blood vessels; and, finally, the outer elastic, web-like structure, composed of connective tissue