Full text of "Ernst Mueller Collection 1911-"

See other formats

6^^3T

jtueR ^06/

J^j-

>o c

ÖOÖQ

■olJer 1

Joseph Müllar

^eb. 30 Mai 1862 zu Mansbach
^est. 2I.K0V. 1925 zu Schmalkulden

Todes Urkunde

II ame

T^olf Müller Schuiimacher ,g8st . in einem Alter von 63 Jahren 10 M naten

zu Mansbach am c2»März lo75

Heirats Urkunde

Trauungs

Jahr Monat Tag
1842 April 28

K arjie , S t and . Aiter

der neuen Eheleute

^v-i-iX^ -'ni

Wolf Müller, / Wittwer,\A/ar mit Galle? gebr •Imssbaum \

(hier verheiratet. /

Est er Spier 22 Jare alt, ledig - ^. SO.G-^^M ^^ Q^t^W

^^^mmmm*iKmf*^nm9m'^ *m^^^ »^wy^^acöag '

Vor-u.Zanaae , Stand der beiderseitigen Eltern der

Sheleute

"Leiser Müller war Lehrer in Uerleshuusen

die Mutter, Morle? Müller, Beide in iierleshc^usen gestorb

^der Vater Abraham Spier, Hände Ismann, die Mutter Dijia
{gebr. Katz aus Oersfeld?

'leiser Müller, Vorsänger aus Mansbach geb 6.5.1758
Moria 2. Ehe bürdig aus Heinrichs gpb. lij.8.1783

Wolf Müller geb 24. 10 •1811

//U^^(^ ^

Zeugnis

der

PryfyoiigsK@[mimissi@o zy WOrzbyr

über die

ärztliche Vorprüfung des Studierenden der Medizin

Herrn

Demselben ist bei der mit ihm nach der Prüfungsordnung vom 28. Mai 1901
abgehaltenen Vorprüfung

1. in der Anatomie die Zensur:

2. , ,, Physiologie

3. ,, „ Physik

4. „ ,, Chemie

5. „ ,, Zoologie

6. ,, ,» Botanik

f»

»♦

»t

»*

<f^ f^

■^A

»» ♦»

»I

»»

«>

>»

somit die Gesamtzensur

erteilt worden.

r I

WÜRZBURG, den ^l

.Der Vorsitzende der Prüfunqskommission,

1 i

AP"

Würzburg,MLZ^^Mddi^(::!ß^fi?v?,

J^rung von üntsrtranken u. Aschaffefläurg

■^ '' J\^Kammer des Jnnern.

* 17 tc

rg.

ßl^^

h/.

/^^li^J>Ia>:immansAZnivGr9ität Würzburg.

Kollegienbuch

des

Stiilfsrenilen der 'JllhOi/C^Th

Herrn

%!^nd.. c^iMi,

ana

^Wneiheili^iW

Vorschriften

die Inscriptions- und Honorarbefreiung betreffend.

Die Inscn|»ti()ii bcpiniit im Wintersemester am lö. Oktober,
im Sominerseinester am If). April und dauert bis 15. JMoveillber
bezw. 15. Hai.

Die Inscrii)tion geschieht in der Weise, daß der Studierende
sich eigenhändig in die auf tiem Inscriptionsbureau oder bei dem
eiu/ehien Do/cutoii aufliegenden Tnscriptionslisten einzeichnet, so-
dann dein Ltiivorsitäts-(^uiistor das N'erzeichnis der eingeschriebenen
Vorlesungen nebst Kollegienbuch — beide gleichlautend ausgefüllt
— übergibt und die festgesetzten Honorare entrichtet.

Die InMoription g^ilt als vollxogen erst dann,
wenn das Honorar bezahlt und amtliche Bestätigung hierüber im
Kollegienbuche erteilt ist.

V^on der Honorarbezahlung befreite Studierende haben in
gleicher Weise Verzeichnis und Kollegiet)buch ausgefüllt dem IJniv.-
Quästorate innerhalb dCP Obigen Krifit zur amtlichen Be-
scheinigung der Inscription vorzulegen.

Xichtbeaclitans; vorntehender VorMchrIften
Kicht die Mtreiciiaii{>; im ^tlartrii^elbache nach
Mich.

Hiebei wird darauf aufmerksam gemacht, daß <iie aufliegen-
den Inscri[)tionslisten (iffentliche Urkunden sind und die Einzeich-
nung in dieselben zur Annahme und Honorierung der betr. Vor-
lesung ver[)flichtet, gleichviel ob die inscribierte Vorlesung auch
besucht wird oder nicht. Die Zurückziehung einer Unterschrift ist
nur während des vorgeschriebenen Tnscriptionstermins und auch
hier nur mit Zustimmung des betr. Dozenten gestattet.

Die Ver|)flichtung zur Honorierung der betr. Vorlesung, für
welche sich der Studierende eingezeichnet hat, bleibt auch bestehen
selbst für den Fall, daß wegen 2s'ichteinhaltung der Bestitnmungen
in den Jt^ij 22 und 23 der Satzungeti die Streichung des Tnscribierten
erfolgen müßte und eine Bescheinigung der Vorlesung in dem Ab-
gangszeugnisse nicht möglich wäre.

Andererseits kann durch eine Bescheinigung über gehörte
Vorlesungei nur auf Grund der Einzeichnuug in die Inscriptions-
listen erfolgen.

Die gänzliche oder teilweise Honorarbefreiung- ist isowotll
(Kirch den Nachweis der l>Ürfti{;keit als aucli den der
Wärdigkeit des Gesuchstellcrs bedingt.

Die Dürftiiskeit ist bei der erstmaligen Aiuneldung durch
ein von der zuständigen lleimatbehörde ausgestelltes und von der
einschlägigen Verwaltungsbehörde (Bez. - Amt, Landrat etc.) und
Steuerbehörde beglaubigtes Vermögenszeugnis nachzuweisen.

Dieses Zeugnis muß ersehen lassen :

1) Namen, Geburtsort, Heimat (Wohnort der Eltern) des
Kandidaten,

2) Stand und Gewerbe der Eltern.

3) ob Vater und Mutter noch leben,

4) Zahl, Alter und Stellung der noch lebenden Geschwister,
und ob sie versorgt sind oder nicht,

5) den Betrag des Vermögens der Eltern und des selbstän-
digen Vermögens des Kandidaten, soweit es amtlich zu
ermitteln oder sonst bekannt ist.

6) das Einkommen der Eltern und die (Quellen desselben,

7) den Betrag und die (Tattung der Steuern, welche der
Studierende oder dessen Eltern zu entrichten haben,

8) den Betrag der Schulden des Studierenden oder seiner
Eltern,

9) die (Quellen und Hilfsmittel, durch welche der Kandidat
bisher sich erhalten und seine Studienkosten bestritten
hat, sowie den Betrag seines aus diesen Quellen flies-
senden Einkommens, insbes. der Unterstützungen aus
öffentlichen und Privatmitteln.

Unvollständige, Husweichende oder unwahre
Ang:aben in dem Zeag;niM(«e haben die AbweiMong
des Gesaehes zur Folg;e.

Im Falle wiederholter Bewerbung genügt eine Bescheinigung
der zuständigen Behörde darüber, daß eine Aenderung in den Ver-
mögensverhältnissen nicht eingetreten ist.

Der Nachweis der Würdigkeit wird angebracht durch ein
Zeugnis über tadellose Führung und durch ein Zeugnis über be-
friedigenden Studienerfolg.

Zu letzterem Behufe sind bei der Meldung im ersten Studien-
jahre das Gymnasialreifezeugnis oder das sonstige Reifezeugnis zum
akademischen Studium vorzulegen.

Bei wiederholter B<'werbung bezw. bei Bewerbung in späteren
Semestern ist die Würdigkeit durch Vorlage von Zeugnissen über
tadellose Führung sowie über die bestandene Stipendium- bezw.
sonstige gleichwertige J*rnfung (ärztliche Vorprüfung etc.) nach-
zuweisen.

Stipendienprüfungen werden nur einmal im Jahre und zwar
jeweilig im Sommersemester abgehalten. Hicbei ist jeiler Sti|)endien-
bewerber aus drei Fächern zu prüfen, über welche er Im TOraus-
geffÄnS«*"**"» WinterNeniester ordentliche Vorlesungen
im Sinne des § 27 <ier L'niversitäts-Satzungen gehört hat. Kol-
legien, welche wöchentlich 8 Stunden bezw. 12 Stunden gelesen
werden, sind hiobei doppelt bezw. dreifach zu rechnen, so daß z.
B. ein Bewerber, welcher ein wöchentlich 12 stündiges Kolleg ge-
hört hat, nur aus diesem einen Fache zu prüfen ist.

Es müssen sonach Studierende, welche sich um Stipendien
bewerben oder Honorarerlass anstreben wollen, ihr Studium im
Wintersemester so einrichten, daß Sie den obigen Anforderungen
genügen können.

J)io zu Beginn des Wintersemesters ausgesprochene Honorar-
befreiung gilt für das ganze Studienjahr, die zu Beginn des Som-
mersomesters ausgesprochene nur für das betreffende Sommer-
semester.

Die an die Honorarienkommission zu richtenden Gesuche um
Honorarbefreiung haben in Kürz? den bisherigen Studiengang und
Angabe der allenfalls bisher gewährten Honorarnachlässe zu ent-
halten und sind mit den erforderlichen Belegen bei Ver-
nieulnng: der Xichtberneksichtigung - Winter-
»eniester b!« läns^^ttenM 8. Xovember, im Honimer-
Senienter bi» iäni^stens 8. Mai — bei dem k. L'niv.-
(^uästorate einzureichen.

J't^i^i-fSemesier 191 /

Bezeichnung der belegten p^^^^ ^^^ Dozenten
Vorlesungen. i

a^.

1^:^..

'-£a.

^p^H^ ^.^:^H^^-<^

^<^^^..J^./

vta^, .kß^.^.

^f ^^J^. ^JLQ^!^^^^

s , ■ - ^-

-J^äAtIv^

i?-W>'<*«.-**-«' E

Honorarpflichtigkeit

HoMorar-
betraf

Itfk. I PfK^

<6*

yi^j'lf

•"nlSUfJ." ' Bescheinigung der Dozenten

(nicht vorgeschrieben)

Qaittors

Mk. I Pfg.

tf/r

M^}iL. Semester \9\^//i^

Bezeichnung der belegten i j^amen der Dozenten
Vorlesungen.

^r^^^^

/^ (^^

Honorarpflichtigkeit

Honorar- || Ouittung des || Bescheinigung der Dozenten

betrag i Quästors , , . i v

" " (nicht vorgeschneuen)

PfK II Mk. I Pfg,

■!*«S1

.Ui;Ji4----Semester 191 ^/f.}

Bezeichnung der belegten
Vorlesungen

Damen der Dozenten

.'OM.-IM^M^

.AA<?i'.0

.i...

j-^'ii.....y^^

Xy^y^oX' \Ji\im/fJL.

^mL%.^..S(^^ .

.'.M..^..Ji/i

..^.Jt....^.M^.

J.■^^^.WA^ v]4^(>l*^

Honorarpflichtigkeit

Honorar-
betrM

'"oiSJH)»' 1 Bescheinigung der Dozenten

' (nicht vorgeschrieben)

ci • Semester 191 A

Bezeichnung der belegten
Vorlesungen.

Tlamen der Dozenten

I^_A

Honorarpflichtigkeit

Honorar-
betrag

'"oIa?ort" Bescheinigung der Dozenten

(nicht vorgeschrieben)

^^^^'^T!!''?^'*^ ^'i'r*^

KA.I^.'fU.Mu.

^^ ■ — -^ -

Honorarpflichtig

SemesU

5r 191

kftit ^

1
1

Bezeichnung der belegten
Vorlesungen.

Hamen der Dozenten

Honorar-
bitrag

Quittung des
Quistors

Bescheinigung der Dozenten

(nicht vorgeschrieben)

Mk. 1 Pffe-

Mk. 1 Pfg.

..,.. ...^...v....

•

Praktikantenschein.

«» r»r-» «I

Dem Kandidaten der Medizin

t€^^ ^.y'//l^

aus t'^^i^^yupt

<^^^c>Ce^.^x^ wird hiermit bescheinigt, daß er nach voll-

ständig bestandener ärztUcher Vorprüfung im ''i<!<!^^i>i^,,^^ X^^^

vom

Z/.>^ ^^^^'Ä. 1^^/^bis zum ^'^ dC^-^^' \/^f^

an der ohrenärztlichen Klinik als Praktikant regelmäßig teilgenommen hat.

München, den

ten

^Y.-

19 />^

Der Direhtor der otiatrischen Klinik und Poliklinik.

^ t I

l t^

No.

//f3

Praktikantenschein.

Dem Kandidaten der Medizin {Vv»4- MaIWu.

aus

(äcli^^cJ^oJUk^^A/"

vollständig bestandener ärztlicher Vorprüfung im ^^^»vua^M^- Halbjahr 19m

wird hiermit bescheinigt, dass er nach

cSo.

vom

1^ teil (Law^ bis zum jAten j^ü \g\ Lj. an der

chirurgischen Klinik als Praktikant regelmässig teilgenommen hat.

MÜNCHEN, den X^^n juü iQi ^

Direktor der chirurgischen Klinik.

> t

ftn^tyift

etäbt. itranken^aud Mn^en tink» bet ti\ax.

aeuflnM.

(5» totrb bietmlt bepätlgt, baB ^err CJtnjl KütCcr bom
18. ^eaember 1913 bi* 4. snärj 1914 auf bet ♦itutoifji^en
Kbteilttng aU (JoaFfiftent tätiö toar.
SHln^en, ben 5. mx% 1914

9et Oberatat:

gUr bie Kl$tiökeit bet tlbf(ttlft:

>:;^-«v^-^-r/..'^V>*-^t-^;^...^i^^^

Inskription Nr. ^oQ
Geburten gehoben : V

H. S. Journal Nr.:

i^^^^^^^W

Praktikantenschein.

Dem Kandidaten der Medizin \X^Afi^..X'^iL^^&M/..

aus

.Q^v^>n<:aXI>l^<^^

wird hiemit bescheinigt, dass er nach

vollständig bestandener Vorprüfung im C^/wwwt^ - Halbjahr 19 l^t

vom 1 ? ten ßk^iA/iX

\ ten (Ww^ 191H

191 H

bis zum

an der geburtshilflich-gynäkolo-

gischen Klinik als Praktikant regelmässig teilgenommen und ^ Kreissende

in Gegenwart des Assistenzarztes selbständig entbunden hat.

München, den \ tjn CUv^u^/yt 19/ If

Der Direktor der KgL Frauenklinik

AI l"ir,H'l

^iäbt. «^ranßen^auö ^ünc^en finßö öer S^far.

cugnis.

€& tpirb I^ierburi^ beftätigt, 6<3§

f)crr 6inA^ 'M3^t

r>om

i^itn jbtAJL/^^

UA^

... 19 /l^ bis. k ten ^im..

19'1>+

auf ber ÜklMMAAA^^^^^ Abteilung als CoAA^t^>^'^..

tatig wav.

München, ben i^ i^ M.^i

"«

Dorftetjcnbes Zeugnis lüitb f)ierinit amtlid) teftätigt

Der J8)bcrar5t:

^ranßenl^auö -pireRtion.

V 20. (Wa. 2) 17. XII. 07. 1000.

eugnis

ü6er die Teilnaßme an den 3Präpaner-%l6ungen

6ei der

%lnivevsUät Tjüüvzdurg.

SDem Studierenden der SÜedizin iKerrn

aus

wird ßiemit ßescßeinigt, daß er im

Winter-malöjadr 191i^^ vom 25. 0/cio6er 6is 2l- ''" ^^.^U^r^^c^^^^—an dem
2. 3fCurs der anatomischen S^räparier-'Zlöungen regelmäßig teilgenommen ßat.

%Uürz6urg, den ^4-^

191 5

•^■(/ xn>^

Zur Beachtung: Gegenwärtiges Zeugnis ist aufzubewahren, weil
öasselbe gemäß § 22 öer Prüfungsordnung für Arzte öem
seinerzeitigen Gesuche um Zulassung zur ärztlichen
Prüfung wieöer beizufügen ist.

^> O

c^e^

-^^'^

'^ /^^y^T^^j^^.^^AZ^'^:^ fX^ ^^«J-^ -^ -^t

P-

r -y^G-^^-iT r

'•-*^^ at*J^

*^^9/Z^ ^StA^ ^^<r<^^/**<y ^*0 ^^c^^e^e^

^»^»-.i»^ C^e^

^a^.

''"ö^*-^ <Ä^ -.'^^ ^^ic-<,^t

Ä-C-^

^^^^^ ^a^^^Ä^^^^^^i^

/^^ni

-t

yV^ ^^/^

/>^yr-

7.^

• ^—

^^^^'»^ ^

^^^

Z^"

'^^^^:e^

'^'^

äI-,^

^^-.^^

^ ^^iL_ -^

^::i2n^

^f^J

Sd?malfak\Mi, 5cn .^....._l£'?^ \9_/^

'""''^''^ Der Stabtfetretär.

^^ t^ -^^^-^/^i*<^/^fi<^^^^!^

/y ■ :#^ ^^^^

eugws

über die ^eifnaßme an den CSräparier^Q^bungen

bei der

QJniverßtät ^ürzhurg.

CDem oftudierenden der Hl^dizin ^errn

aus ^.<:^^^<-*<^-^^«-«^^*-<'«-«^^^ wird ßiemit befcßeinigt, daß er

im ^inter^JfafbJaßr 191i \ll vom 25. Okiober bis If *ii. /t'^4s£r-^^
an dem A OQirs der anafomifcßen ^räparier-üibungen regefmäßfg
feifgenommen ßat.

^ürzburg, den 2^ ''" Y-^^-^C^^ /p/ ^.

^10 *^«^*/^^^^^^^»^*^^*^»^/^^ ^^t-^^^^^^^^.^^^'^^^^cr

^ >'*-

**^0<

-**»-*'»lt-*'^i»-<*^

ugnis

über die Teifnaßme an den pßysiofogiscßen ü/bangen bei der

llnwersifäf zu ^ürzhurg.

Dem Studierenden der ^ediz,

9ferrn uty^^t/^/

aus

wird bescheinigt, dass er

(TTii^pf^^d —' ^afbjaßr 79/ J

vom

bis

fen

Xf'- 6c^rxy

ft<

an den pßgsiofogiscßen

iibungen regefmässig teifgenommen hat.

Würzbarg, den ^^J'" /x^ti/U jgjJ

ty.

t^ e^

-**»-

"N I , -

w I 8

. 97-:.

^-^ea^^^^^^Jj"^

.■<^o^ii^^Jec^aA^f^e^,am^i^»^/^^ U(m^^^

ytm/yc/e

f /f

(/l

'f//u/^^^/?y

! N

^) v .;^^-^^*-^;. /f^/^>^^'//>i^//^^^^

"Ä^^/.^^/ "^TJ^^^-^- jm

j!^*-^^^^^*'^*y^SC*'1'*^ ^«^^»y^^»^B>t<t4*<44^^#>^' ^»-^ fc;?--»«-»V%^i^ «^^^/^*.^:^g-#<»?<*^^».»<^

►/

-»:»?-*'«'*^-»f^^^r^,^-«-.r^i5r^^*^,^-r*'<l^J

•^^^^

M !

V'O

m^m^

nbtv bie fcUnntiitie an bem dfcmifdieit ^rithtiltunt fttt* Pebi|itt(r

bei ber

Pnitteffttat ftt $UU

1^» 1^ ji »«^

2)em (Stubierenben ber Webtain J^yi/n/>i f f^iiAÄ^JiX

aug U(:Ji/niCLZ^ wirb {)termit befrf)emiöt, bag er im

an beni cf)emifd)en ^^raftifuni für ^Jlcbiginer regelmä^ia teilgenommen t)at.

ii«l, ben ...>^- ten ^^oU 19^5

(Unterf(i)rift be§ Seiter§ ber Übungen.)

(^eglaubignnö burcf) ben ^ireftor be§ 3nftitut§, fofern berfclbe nirf)t felbft fieiter

ber Übungen gemefen ift.)

<i i

<yzaSitKanien:>crietn.

^^etn (^anc/tola^en c/ez ^/Cec/tcn

wtn

aui>

"WA^^osPiioXh/A/

Cx^nj^'Vfiu^

fDtra ntemt^ nedcnetnta^, c/ot^ er,

naon t>o/fö^änc/ta oeo^anc/ener äzti&Hcnet ZC/oti>rüruna, tm W. (^Tiaioianr /P'/S/fu

t>om

OJMoW

79 \^ ^t<> <&um (o ^^« WX^

/9^H

an aer (^vüntK^ der ^L^n€/e^'K^an/cnetten a/c^ J^taK^mant zeae/tnäß>ta ^euae-

nofnmen

nat.

^/lünc^en, den G ^^^ ^^Aj^. 79 \^

<Oer J/orc>ianol äez S. <==2tnivez:>iMh'(^utnc/erKt^

Nr. 19. 2000. 11 11. 11.50.

No. /W.

Praktikantenschein.

Dem Kandidaten der Medizin ||uittM. iMA/yT'.

aus

^CA/^vwoXk.o^M^

wird hiermit bescheinigt, daß er nach vollständig

bestandener ärztlicher Vorprüfung, im (wa^X^X^. Halbjahr \9\'iy^i^

vom <ü l '*'"

c>W<?W.

bis zum I '«"

./^Haw...

an der

'AÄji^i/icI^iJtM/'. Klinik

als Praktikant

regelmässig teilgenommen hat.

München, den

ten

Mm^..

Direktor der X- .-6MÜM^r^\i4

191*^

Klinik

l s

No. ^i

Praktikantenschein.

« !

:=aK:

aus

Dem Kandidaten der Medizin

Mm^KidhA

izin HilM .MiiMiAÄM:!:::

wird hiermit bescheinigt, daß er nach vollständig
bestandener ärztlicher Vorprüfung, im S^ß'iM^iMlA^

Halbjahr 191

vom

ten

Äuüi

bis zum V" ^e"

ImIi

an der I. Medizinischen Klinik als Praktikant regelmäßig teilgenommen hat

München, den Vv »•«

huk

191

J/.

cy\Aii

Direktor der I. Medizinischen Kli

\' 1

^•'>

No..

Praktikantenschein.

Dem Kandidaten der Medizin

izin ....m//ijri.&

aus Je /? /yi€t l /f{X/€%€ ^'f^xxA hiermit bescheinigt, daß er nach voll-

ständig bestandener ärztlicher Vorprüfung im

/:^^/r^ Halbjahr 19

vom

bis z^xTR.^ ^^-MrCl.^U:.. .

* X

19 /</

an der ¥^, U< tl^^/'WC^/O^/r j>^/ U ^^^ Poliklinik als Praktikant

regelmässig teilgenommen hat.

München, den 7 i/^^ .<./..</<. ..

der Kgl.

Der Direktor

' Poliklinik:

> 1

Zeugnis.

Dass der Kandidat der Medizin

Herr

iv {iH^<^

e^i^

am praktischen Unterrichte in der Impftechnik teilgenommen und die zur Aus-
übung der Impfung erforderlichen technischen Fertigkeiten erlangt hat, wird
hiemit bescheinigt, zugleich wird bestätigt, dass er mehr als zwei öffentlichen
Impfungs- und Wiederimpfungsterminen beigewohnt und sich die erforder-
lichen Kenntnisse über Gewinnung und Erhaltung der Lymphe erworben hat.

MÜNCHEN,

l. /i/l

r^ '

No. 31. 2000. IV. t3. 9.80

No.

Praktikantenschein.

Dem Kandidaten der Medizin .&l^>i J^

aus

.0 C>VM4^^

wird hiermit bescheinigt, daß er nach vollständig

bestandener ärztlicher Vorprüfung, im <^r^ :^:^^rHU^ - Halbjahr 191 K

vom

^'^■■•'*" .örd/tA^. bis zum 3.0 ...ten ^^^ j^ji^

der f^'^l^.l^ . -...udi^'l^U^

1i\

Klinik als Praktikant

regelmässig teilgenommen hat.

München, den 3? '«n ^AjJÜCf, 191 if

Direktor der

s!^Af)jA^

(>W%___^

•.„^^.-^

qJ ia 4/iÄu Mten^e/iet^t.

.^^f-'/r/ ^Itz-zitrur/tz-Zen f/e? ,^,^c<^rÄ^.

^^(^jn^ c:yL(^f^^?^

^'22i^l/£m^...

€i-fy:^

kl\^../^^f^ct(:/ Afe'fi^r?€/ /f^Jr/?^f^^/. r/r/JJ er 97^(7c/^

^(^

^ / / y

/S. .^yjruä-/ /ß...

f7 n-

c/e^f. ^yjYc^^^^^^^^^^^'^ (^.yhu9^r/^ t7U

^a^/t^c/'?^/' ^ ec/e/^/ ? dxj /^ /er^/ye,

e^/7 o--^// iy/^ e^t'

Ary/.

äi^t, €/ein£. (t,. /^ J^

M)e^ M)tiemol äet (zXd^tm.

^jingtift,

<lUrtiTi,ben 2Ci. 3«finAtl916

24« Migup 1915 6i« 10« :^t|ember 1915 ouf ber inneren flMeituno B
bed ue[tuno0(o|aiet tee !r4enr a^tan t)nt«

JBei)cnbelt r^erben auf bcr : bteitunfl n ü^öeuaatifecr, ^aocn-,
Sata- unb etof f;ae4'f eUranfec^ ettBevben i!^ ber ftation bie aanfe
;^nf ekt icti^abteiluna angegUet^ert •

•• tot bie: bie :tene eine* ttf f irenjarjt c* un: au!<y feit-
^.elfe bi: Söctretutto bee orbinierenben HtjteÄ ber ctatinn Hbet*
n€A;iaen maifen, ^v >at feine GteCCe ioiet ßeiBiffcniöft« en unb
|ut>frläf i ift-cn cife auigefUitt

te^Caullgt

G<)t^rar3t .

^B$* 3t« 3e(r
otb. Ktit ber inneren "tat, JB
IJef^nnBCagnrett 2.

lUtigkeit ber -nbr^cift:

»tfibttft.

jaanbftbetrg aS*19»li« 1017

Cert cönb. nel^. 3tnfi mutx au» otJmaClalb^n ip bom 21. 3an.l910
bi» 21. 11, 1917 In ber mlCita^ir^en a^^atflö eine» 3*lböllf »atate»
anbem meiner lieltung unt etjtet Cten PÄbtlf^fn Htanlien^auf e atft
petlDerttetenber nff l[*er.$aTät ouf ber ^DlruraU^^en etatloa tötla
fler^efen.

fterr ljmct<rr t^ai ar. bet ^en?ältiöunß be» InfnCße befi frleoe»

, , ^ flrofen operotlben

ouf ba« 5tTonft^*niiuu^ eUr^töu enbcn »J.ctcrlat» In UtilerT Tefler unb

ftelglger !:elfc tcUoenoBuien. tlu»ocrüret mit einet teilten fluf-
fof funo-^cobc^ teitnlfCor: öefi^lö unb einen für feine Jungen Z<i%xt
bemerUendbcrteu erm eii i'lltenr tat er fH In ben i^m infolge ber
3eltbert)attnlf fe früfticltiü Übertraoencn :;if tUtenkreU f^ned eln-
ßeorbeltet unb ble für Un »Unflße üttge fe^r au feinem BorteiC
üuÄgenuft. S6cl unferem tögll*en 3uf CBiiienorbelt en konnte \^ a»i«
bübon ttbcraeugen^ bag er bon Beginn feine» Stubium« on mit Örünb-
tit^feelt/ ^Slfer unb Irfotg gearbeitet t^at, fo traten befonber»
gute anatowlf»$e Renntnirfe a^ Tage, d» Ift mir eine Jreube geteeftn
au fe'oen auf iretcjen guten Beben ble \\d) bei ber Unterfudfung bon
-?ranhcn unb a<^**»c^nfCÄ au»o^?^^K^«n Oj)'»rot l onen ergebenben Semon*
jlratUnen bei Um fleten. :3c} (abe bemgeadß Sertn Äülter annd^fl
nCelnere r;inürlffe unter meiner «ufflc^t maejen Caffen, in bet
testen 3elt bin itj Infolge meiner auf ue^rere ö«|arette berteiCten
^Stigbelt bcau übergegangen, ibn felbfiänblg bor ft^btrere o^^etatibe
«Aufgaben ju feCt en, ble er immer ju metner 3uf rlebcn^elt IHt^
S)ur« petlge« (tublun In feiner freien 3eit in ftevr «mit er iamier
be,Uebt geteefen, fi<t toif f enfcjaft tl« fottaubltben unb ßüAen am»-
aufüClen, ü)ie 2:ecfmlk ber nobernen GunbbetjanbCung be^etrf^te er
boUftänblg* i

S)ut<J feinen offenen unb geraben (J^l^arakter fötale hux^ ein
freunbtlc^e» unb entgcgenkowmcnbe» Kefen tat Jerr fetter fl« ble
6t)m)?attien ber ^tranken unb «erh:unbeten aC» au< bie meinige in
bot lern 5<ate erteorbent 3# konn i^n für fpater a(» Äffipenaorgt
befonber» auf euner ♦iturgifdSien Ctatlpn toarm emj^fe^Cen. -t t* ^

<. V

>t<^^

?ll4tlgkelt

fctitift:

gea* ^r. ^eCke»Uaub
Äeltenber »tat be» Stabt* Äranken^aufe«.

Jlr;tlid)e jOrttfungshtmitniffton

Berlin.

Berlin, ^e^

^em .s^aiibibaten bei* ^})iebi^ui

löivb. t)ienmt befcf)eini(^t, ban er H^t -ifiL.i^jditCuov Doi iuUtid)en jUnifunc^g^

QV5tha)ei\ 'iUnifung (u'fittbot uwb bicfo uoi'in!*t'

tomtuiffiou 'Berlin

boonbüt 1)0 (nm ipUb.

Ter Sefrctäv t)cv ^Prüfuugt^toiuimffiou.

'niiif!ia::lrr-i.ri.'il.eain§cni

tarken-^nnf , d^h.lö. Harz 2918,

Besehe int

n g

-■■'"■ j'"-

gfi ioird hiermtt bescheinigt, dass der Feldhilf 3

^jorzt Ernst Müller Ceiegenheit hatte die Vorle-

sungen der Köntgl, Universität Berlin U Winter
Semester 1917/18 regelmässig t'{ besuchen»

Markendori , .

bei ;^/

der üntörsohilXt

Stabr» und BegisJient samt

lÄutiudr^u. stell veitr.Aijutant

•«MMm

K02:iiGLic:i:

PRl^DRlGH-:71LH:^LivIS-ü:JiV-.RSlTAJr

3erL in , de

Ss wird hierdurch bescheinigt, dass der Studierende
der Medizin Herr (Ä-t^ JOU'&S^

ans !^np/7/ikaMm^ j<W^^ ^/^^^am U. Jjm'^m/fr i9i;^

auf der hiesi^-en Universität immatr iknlier t v/orden ist^
und dass er derselben noch anp-ehört.

am
bisher

Ferner wird bescheinif^l , das? er in

die ärztliche Vorprüfung bestanden,
Semester, einschliesslich /i^4r7i/w kli-

nischer Semester, Vorlesungen belegt hat
' ^ J Der Rektor

'V.J^>C;:^

Besehe ini<^un^.

i^A-y^^\yJ^

Ovv^^

3^rc'ie;it);M ci'cr

<^h

•v H r, •* o

•>• t, o. 1. t

iLJLJ_il_?„L±_L

crr O

> V «1

:r:t t

Ar»

3 '-- .r

aM» j

)n'n r

r-» ^ »*-,,>•

a r)at Vit/) i-, ßerbf. 1918

et^ja ein ':3x ert c( ] al)r vertreten, '^r l)at e5 i)ar3'l3rx:'; ncrTraubcu

ficf tc5 s?>ertva.icn bcr 3af 1 c:at cu

gu icii:Ov c)j

f r

Oll .ii

-v>^* i

i ; X ; e ^ c a

t« ,-.4 X

t)crfel)en banU ber reichen -^tcbl-

iulfcV.'.'. v^cuut -ai ijc^ '\b(tx 'o\e ?i' becfl^

^r. ^^ 0 c t t c r

)U5t

Tre

Yere

•&2?

^r^£^^^^^^~y*;*t--;^

■MlMMMMaiiMMaiMMMMl

«««yi

MhM«

rtIM

-I^^^f- *^

prof. Dr. mti. p. Straßmann

Sprfdijril: 4 7,-6 Ulir mitx Otmnftap

ßrrliit «.»». 6, 28,7,19.

Jd(t)iiinanii|lr. IK
frrnftjr. Amt iloröfit 1690

Merrn

Dr. jfied. Ernst Müller

Krankenhaus Treuen'bricken

Sehr geehrter Merr Kollege^

Gernp Ibtn ich her ei t Ihnf>n
Gelegenheit an meiner Klinik su gynäkologischer
ferüollkonjJiniing f,il Tjieten. Es kann sich frei^
lieh vorerst nur um. eine Volontärstelle auf
3 Monate ah l.Des.l.^. (ohne irgendwelche fer^
günstigung ) handeln.

Mäheres wurde ich gern Rundlich rAt Ihnen
in T.einer Sprechstunde tägl. von 4i-6 Uhr
(ausser Donnerstags) hesprechen.
Das Zeugnis schicke ich anhei zurück.

Mit kollegialem Gruss
ih7\ gans er^gekener

-.-«««' II imil IMBIiHWlIHllWI ■■! I

atß CVcf.luCiri für nfercii-, 4aCl^ u, :^cf cr.^ra;:hici tcn cn bcr tciu
pattc :.cfevt;clu:ari;it tatii hin, ein bcit UOcv ben 'i>ur4f4iiilt
OeOcntcÄ : iffcn xi. ;.;5nncn in :cv -würt^nooCoölc anöccl^nct; er öc-
^cvrfni bie r^e^n Ih bcr i an^nöci'aol) ie aul» unter er fc^herenben t.er-
?j;;Ctni ffcn; cn:>viluri;ne.cale C^crc t lon-in auegi» führen ^Jc;r Ujvx tcUec
t;clrc r,cleccnl?clt acö<^^vi:. uuC i:; Ui icvtiil: bcr Ctoöcopic unb
r.Unc!copic !uv..lcs er tjröf^eu^ ^7cf4i .. :1^i« "airac bcr "dt :?ftnb einer

Oes.: ""r. Turc^-cr^t

Gut blc r:i<>tlo'i-it
"i^ax l=:bfgrift:

""'nbiirc

Die ^imraitsfaj)e.

v\ni

PROF. O. WITZEL

OBHBIMKR MKDIZINALHAT

DÜSSELDORF,

1 MOORKNSTRASSK
TKLKFON 7700

ii/e/h^a 044^ it4*i i^X-Ä^ywv ^'ku (^U4t /«y /,iu4.

Je44i M^ ^^^^ 4^-^^UuH ^4^'^.^ ^^^^ rv/^^
'{fu'rUc.^ ^,^ UH4^ «Tä^ÄV^ ä^>^^^ >i,J^

«H

1023
433

UNIVERSITÄT MÜNCHEN

ZEUGNIS
ZUM ABGANGE VON DER UNIVERSITÄT.

' )

Herr Errist J L 11 CT

aus Schmal ii aide n

geboren zm S C h i'l a 1 h a 1 d 6 n

ist vom 23.0Ktöber 1913 bis zun, Ende des oOuüfierhalb Jahres 1917

als Studierender der Medizin

t ■

an der hiesigen Universität immatrikuliert und auf die im angehefteten
Kollegienbuch verzeichneten Vorlesungen inskribiert gewesen.

Über seine Führung während dieser Zeit ist Nachteiliges nicht zu
bemerken.

Zur Bestätigung dessen ist dieses Zeugnis unter dem Universitäts-
siegel ausgefertigt und von dem derzeitigen Rektor und dem Syndikus
der Universität eigenhändig unterzeichnet worden.

München, den 2, Dezember 1911^;-

Der derzeitige Rektor

z;^^;

Gebühr 4 Mk.

Der Syndikus:

Universität München.

Kollcgiciibuch

für

Herrn stud. .,v\^x^ UiM/)l Mm^....

Die Titel der Vorlesungen sind im genauen voll-
ständigen Wortlaut einzutragen, wie er im V^orlesungs-
Verzaichnis aufgeführt ist.

f^ei Bestellung eines Abgangs-Zeugnisses sowie
bei der Anmeldung zu einer Stipendien-Prüfung ist das
Kollegienbuch der Universitäts-Kanzlei vorzulegen.

I. Inskriptions-Bestimmungen für die Universität München.

Die Inskription geschieht in folgender Weise:

1. Der Studierende trägt in sein Kollegienbuch und in ein von
ihm unterfertigtes Inskriptionsverzeichnis jede Vorlesung
mit der im Vorlesungsverzeichnis angegebenen Bezeichnung
und mit dem Namen des Dozenten ein; die Inskriptions-
verzeichnisse werden bei der Anmeldung zur Immatriku-
lation und bei der Matrikelerneuerung ausgegeben;

2. er übergibt sodann Kollegienbuch und Inskriptionsver-
zeichnis gleichzeitig mit dem Kollegienhonorar oder dem
Nachweis über Honorarbefreiung dem Quästor; auch für
publice gehaltene Vorlesungen ist Kollegienbuch und
Inskriptionsverzeichnis zu übergeben ;

3. eine Quittung über den einbezahlten Gesamtbetrag erhält
er sofort, das Kollegienbuch mit den Bestätigungen der
Quästur und der Kanzlei über die vollzogene Inskription
erhält er möglichst innerhalb der Inskriptionsfrist zurück.

Eine Vorlesung gilt als belegt erst dann, wenn sie im Kol-
legienbuch vorgetragen und dem Vortrag der Stempel der Quästur
und der Kanzlei beigefügt ist.

Andere Vorlesungen werden nicht in das Abgangszeugnis
aufgenommen, auch nicht, wenn sie publice gehalten wurden.

Bei Vorlesungen, bei denen der Eintritt nur gegen besonderen
Ausweis gestattet ist, oder bei denen den Hörern bestimmte Plätze
zugeteilt sind, oder bei denen der Aufruf der Hörer nach einer
bestimmten Reihenfolge erfolgt, werden Hörsaalkarten, gegebenen-
falls mit Platznummer ausgegeben.

Die Ausgabe der Hörsaalkarten und die Nummer der Karten
richtet sich nach dem Eintrag in die über die V^orlesung geführte
Hörsaalliste. Die Hörsaallisten liegen vom 15. Oktober bis
15. November und vom 15. April bis 15. Mai in der Quästur
oder in dem betreffenden Institute auf.

Für die Einzeichnung von Ausländern in die
sind die etwa bestehenden besonderen Vorschriften

Die Annahme der Hörsaalkarte verpflichtet zur Inskription
(Ziff. 1), wenn die Karte nicht bis zum 8. Mai bezw. 8. November
wieder zurückgegeben wird.

Die Frist für die Einreichung der Inskriptionsverzeichnissc
und die Bezahlung des Kollegienhonorars auf der Quästur (Ziff. 2)
beginnt im Wintersemester am 15. Oktober, im Sommersemester
am 15. April und dauert bis 15. November bezw. 15. Mai (§ 25
Abs. I der Satzungen).

Eine spätere Einreichung und Bezahlung findet nur ausnahms-
weise mit besonderer Genehmigung des Rektors statt, wenn ein
ausreichender Entschuldigungsgrui d nachgewiesen wird. Jedoch
ist auch dann, von besonders berücksichtigungswürdigen Fällen
abgesehen, der letzte November und der letzte Mai der äussersle
Termin (§ 25 Abs. II der Satzungen).

II. Bestimmungen über Honorarbefreiung.

Die Bestimmungen über Honorarbefreiung finden Anwendung
auf landesangehörige Studierende und auf Studierende solcher
deutscher Bundesstaaten, die Gegenseitigkeit üben.

Ueber Gesuche um Honorarbefreiung entscheidet eine eigene
Kommission (Honorarienkon mission), die aus dem Rektor und aus
einem von jeder Fakultät (Fakultätssektion) aus ihrer Mitte ab-
zuordnenden Mitgliede besteht.

Die Honorarbefreiung ist durch die Dürftigkeit und Würdig-
keit des Studierenden bedingt.

Gänzliche Honorarbefreiung wird nur bei voller Mittellosigkeit,
teilweise Befreiung dann gewählt, wenn zwar volle Mittellosigkeit

Hörsaallisten
massgebend.

nicht nachgewiesen ist, die Verhältnisse des Studierenden aber
eine billige Berücksichtigung erheischen.

Für die Höhe des Nachlasses ist der Grad nicht nur der
Dürftigkeit, sondern auch der Würdigkeit massgebend.

Die Dürftigkeit wird durch ein von der zuständigen Behörde
in gehöriger Form ausgestelltes Vermögenszeugnis nachgewiesen.

Das Zeugnis muss enthalten.

1. Namen und Geburtsort des Studierenden,

2. Wohnort und Beruf der Eltern und die Angabe, ob Vater
und Mutter noch leben.

3. Zahl, Alter und Stellung der lebenden Geschwister, sowie
die Angabe, ob sie versorgt sind oder nicht,

4. den Betrag des Vermögens der Eltern und des selbstän-
digen Vermögens des Studierenden, soweit es amtlich zu
ermitteln oder sonst bekannt ist,

5. das Einkommen der Eltern und dessen Quellen,

6. den Betrag und die Gattung der Steuern, die der Studie-
rende oder seine Eltern zu entrichten haben,

7. den Betrag von Schulden des Studierenden oder seiner Eltern,

8. die Quellen und Hilfsmittel, durch die der Studierende sich
bisher erhalten und seine Studienkosten bestritten hat
sowie den Betrag seines aus diesen Quellen fliessenden
Einkommens, insbesondere der Unterstützungen aus öffent-
lichen und Privatmitteln.

Im Falle wiederholter Bewerbung genügt eine Bescheinigung
der zuständigen Behörde darüber, dass eine Änderung in den Ver-
mögensverhältnissen nicht eingetreten ist.

Die Würdigkeit wird nachgewiesen durch ein Zeugnis über
tadellose Führung und ein Zeugnis über befriedigenden Studienerfolg.

Der Studienerfolg wird beurteilt bei der Meldung im ersten
Studienjahre nach dem Reifezeugnisse, bei späteren Meldungen
nach dem Zeugnis über die Stipendien- oder eine sonstige gleich-
wertige Prüfung (ärztliche Vorprüfung usw.).

Ob an Stelle solcher Prüfungszeugnisse auch Zeugnisse über
die tätige Anteilnahme an Seminaren, Praktiken oder Injtituts-
übungen treten können oder neben ihnen vorzulegen sind, wird
yon der einschlägigen Fakultät bestimmt.

Hält die Honorarienkommission nähere Aufschlüsse für wün-
schenswert, so wird der Vorstand den Studierenden vor sich rufen,
um Aufklärungen von ihm zu verlangen.

Ein Gesuch um Honorarbefreiung, für das die Unterlagen in
unvollständiger, ausweichender oder unwahrer Art erbracht werden,
wird abgewiesen.

Ein Studierender, der gegenüber der Ho.iorarienkommission
unwahre Angaben macht, hat ausserdem disziplinares Einschreiten
zu gewähren.

Gesuche um Honorarbefreiung sind mit den erforderlichen
Nachweisen bei Vermeidung des Ausschlusses innerhalb der von
der Honorarienkommission bekannt gegebenen Frist einzureichen.

Die zu Beginn des Wintersemesters ausgesprochene Ho.iorar-
befreiung gilt in der Regel für das ganze Studienjahr, die zu Be-
ginn des Sommersemesters ausgesprochene ausschliesslich für dieses
Sommersemester.

Gegen die Entscheidungen der Honorarienkommission findet
Berufung nicht statt.

Die Gesuche um Honorarbefreiung haben in Kürze den bisherigen
Studiengang und Angabe der allenfalls bisher gewährten Honorar-
nachlässe zu enthalten und sind mit den erforderlichen Belegen bei
Vermeidung der Nichtberüclcsichtigung — im Wintersemester
bis längstens 30. Oktober, im Sommer-Semester bis längstens
30. April — schriftlich bei dem Univ. Quästorate einzureichen.

Angabe der Honorarpflicht : ^o^i, ' ,ob frei, '/s, 'k. »/», -/•, oder ganz)

Bezeichnung der belegten Vorlesungen

im vollständigen ^Vortlaut

Semester 19 A^

'/\if

o^ouoAiM^l^- Yj^^ri<?Lc\A^U, ^w(Jl

Zahl

der
wöchentl
Stunden

-C\A\M^A\^^

in.

U(AiAUlAlLAUAAvUiAVVV«t. \vi. aJ^i CIxaA^^

|/l'ltuv>wtvtu,4tt jit^vniy)^ /4/iA/

7 ■ L O 0

"^^Ujo^

J'i^A^.\M/ihJlQ^^hluiAJ^

j2/wwv?Ci

c5a«<4iv^J/Jf

Namen der Dozenten

in alphabetischer
Reihenfolge

J}^

Bezahlt

Einbezahlter

Honorar-Betrag

inkl. Dienergeld,

Praktik -Beitrag

u. Instit -Gebühr

^1 '-

4 ^b 50

[UnrZüiMirrHunchenl "

Bescheinigung der Dozenten

(nicht vorgeschtieben)

Angabe der Honorarpflicht (ob frei, »/b, «/.., '-., Vi oder ganz)

Bezeichnung der belegten Vorlesungen

im vollständigen VST'ortlaut

Zahl

der
wöchenti
Stunden

Namen der Dozenleo

in alphabetischer
Reihenfolge

Einbezahlter

Honorar-Betrag

inkl. Dienergeld,

Praktik.-Beitrag

u. Instit.-Gebülir

Bescheioigang der Dozenten

(nicht vorgeschrieben)

Angabe der Honorarpflicht:

Bezeichnung der belegten Vorlesungen

im vollständigen Wortlaut

l^ßl" Semester 19^ 14/15

Sormer - Semester 1915

J^inter - Semester l^lo/ 16

Somaer - Semester 1916

Winter - Semester 1916/17

.Somaer - Semester 1917 :

beurlaubt; stund im Heere.

^sT^

(ob frei, V»» '^Z^» ^\^^ ^1^ oder ganzi

der

wöchentÜ

Stunder

Namen der Dozenten

in alphabetischer
Reihenfolge

Einbezahlter

Honorar-Betrag

inkl. Dienergeld,

Pralttik.-Beitrag

u. Instit-Gebühr

Bescheinigung der Dozenten

(nicht vorgeschrieben)

Angabe der Honorarpflicht:

Bezeichnung der belegten Vorlesungen

im vollständigen Wortlaut

-Semester 19

(ob frei, »/s ''h, »/s, 'h oder ganz)

Zahl f
der
wöchentl.
Stunden

Namen der Dozenten

in alphabetischer
Reihenfolge

Einbezahlter
Honorar-Betrag
inkl. Dienergeld,
Praktik.-Beitrag
u. Instit-Gebühr

tM*

Bescheioigung der Dozenten

(nicht vorgoihrieben)

-- 4

VI Vt

■■«■•■■■■R

J>14tiijLt

üanbd^era a.b.C •^10.1117

terr conb, mcb. Mnr Tülttx flu# t^naCkcrben ip bo£ 21. 3an»16
Mi 21. 11. 1917 \r\ y>^x m» nt:^rU'«T> (T^ctce eine« : eCb(|it f larat«*
an b«« :nelner .'2eltunö untetftlCtcn räbtif^ten Prenhenftcur^ «t«
ne( (bf ctrete.ibci i-^f firenjarat au( r>$x i^itut^if '.en etotion tätlQ

auf brt^ .eionUcn^aw!» einrtöi'i«nb«n otaM« ot^eratioen ^oteriaCl in
äuSer,'^ xt^^i unb fCcigijjex elf« t ?l C^enomfen. nu#cerUret j^it etiet
Cel4t«n i^uf farrunc«^Qabe, teAuifd^ew defti« unb eine» für feine
Junöcn 'jatyce bemeirtten*fcetten ecn^e:^ HCCtn bot et fl4 In bew Ibw
infoCo? bev 3«itt)^t^>uCtnif f e ftUbicitlo 'Ibi^rt casenen ^fCltJttn-
krei« f't^ncCC einj^eoTbeitftt unb bi« fit i^u gUnriQe P.a^^ fe^t 0U
feine»' :jortei( ausgenützt, ^ei anfcreai tagilcf^tt Cufa:«. cnat^eitÄn
Uonnte i* '^\^') ^a^i>r\ U^ctjcuoen, baC er bon ^ealnw feine» rtubiuw*
an 3tit (5rUnbCii^l?eit, 'HTer unb CxfoCo ßeocbcHft i^ct, fo traten
befonberö oute anctoulf.:»c lienrtniffe gu ':raoe' ^''ft IP wir eine Hteube
aeb^cfen gi; ffiien aiif retten ble fi* beV br. '!nt difui^uny t)oti Uranien
unb ^cricinfciir, «nÄocfUl; rtcr ü^ci öf • iwiei. aißcbei.btn ^ewonprationen
bei Ur. flc(cp. ;':(^ {)at(> beagc^-St ^crvn V'Mi ex f.ui\öe!jr fetclnete
ßiiurlffe ur.tcr meiner ^iuffUt roden teffen, in bet testen /Jeit
bin M infoCi^c rf.einer auf mebtere loecrttte betteilten iStiotieit
b03U übetgecan^en^ ibn feCbpanbig bot fiffcefete «^etati^e rufgaben

|u. [eUen, bie er intnet |u meiner 3ttf tiebenbeit i'6?%

. lttT4 /etiaei

ttubium in feiner freien 3eit ip 4etr PUder i

it.Atx bei^rebt ge^efen

fi« teiffenf(;afft(i(t^ fottaubitben unb i:ilAen aul|ufiiuen. ^ie te«ni&
ber »obernen lunbbe^onbtttnß bebertf^te et bocrpdnbio.

ut« feinen offenen unb oereben '^^ctckter foteie but*

ein

freunbCi^e» unb ent oefienkamenbei tiefen (at fietr IKllCet fi* b*a
einmbat^ieen ber tranken unb ^etfcunteten aU au« ble «einioc in
bödem .ait erteotben. 3« kann i^n fUr fbäter aC« Äffipeniatit
befonber« auf einer d&itatoifc^en Ctßtion aarm evipfeb(en.

Hf^x bic .'^i(bllnUeii
.^T^r- ^^^ ^it>f4tift:

gef« ^t* SeCkefka»!»
^eitenbec nx%i be* Stöbt. 5^ranken^aufei.

L ^

Harburg, den 28. 4. 33.

fferr Dr.-Sm.-it M U 1 J mr

war in der Zeit von Januar bis April "
1915 mit mir bei R. I. R. 270 im SchUthngraben an der Westfront. Das Regi»
ment hielt dwi Abschnitt bdsetst, westlich von Nesle bei den Dörfern Chilly
und Hallu. Meine Kompagnie , welcher Herr Dr. Ernst Müller als Unterargt zugeteilt
worden ujar,lag etuxx 200 m dem französischen Schütsengrahen gegenüber. Die Krx^ *
te mussten damals auf besonderen Befehl stets mit in vorderster Linie sein.
Herr Dr. Müller, als Arxt von 1/ 270, Es war Herrn Dr. Müller erlaubt worden,
sich einen eigenen unterstand xu bauen. Da dieser Unverstand Jedoch verschie=
dene Male von den Franxpsen zusammengeschossen wurde , nahm ich Herrn Dr. Müller
«( in meinen Unterstqnd . Ich hatte daher vollauf Gelegenheit, Herrn Dr. Mül^
1er als mensch, als krzt und als Soldat kennen und schätzen zu lernen. Nach dem
Kriege wurde siitens eines Militärlazarettes bei mir angefragt, ( wenn ich nicht
irre, war es LucXenuxilde ,Job Herr Dr. Müller würdig sei , das E. K. zu erhalten.
Ich habe damals meiner Entrüstung Ausdruck gegeben, dass Herr. Dr. Füller die^ |

se Auszeichnung nicht schon 1919 erhalten habe, und ihm zur Verleihung des S. K.
vorgeschlagen* Ich führte damqls an, wie Herr Dr. Müller bei einem kleinen Few
erÜberfall , wobei wir den ersten Verwundeten hatten, durch sein entschlossenes

Eingreifen die Stimmung der Mannschaften wiedrr auffrischte . Wie ich von Re^
gJ^entskameradan damals gehört habe , hat er sich auch bei dem Durchbruch von
Qorlice stets als tüchtiger Soldat und Arzt geXzeigt.Ich persönlich erinnere
mich gern seiner als eines bescheidenen, vornehmen Menschen.

^ut^i S 6Uip^^^^

kgl. preuss. Hauptmann d. R. a. D.
damaliger dberleutnaf bei I / 270.

>(rf&^ -nxy<^<ü '^^ey^a^tc^ ^1^[^£a.^^ >

ll/J jyc/ ,^>C^*l'^ •

- ><./

(fi,f,V-c,:r.

yvxA-^ a: /

16763

•V'll

Israelitische Gemeinde

Schmalkalden

9 Ifei

1933

Schmalkalden, den 19

Au33Ug aus den Gcburts-Heirato- Sc Sterbe-Rexcister der
israelitischen ^remeinde Schir.- Ikalden.

"betrifft Eltern, Gro33Gltern, UrgroGseltern des 2U Sclirnalk.-lder
Geborenen, jetzt in Nürnbcre \'7ohnhaf ten Herrn Dr. ned, Krnst
Müller, c^boren am 26 Febru- r 1893.

1. Eltern:

Va.ter: Josef Müller, ceb» zu Mansbach ,
Mutter: Klara Mi"41er geb. Mand-l,^eb. am 26 Juni 1865
in Schirialkalden.

2. Grosseltern: Liebm,-nn Mandel, -eb. am 26 März 1826 zu Schmcalkalden.

Fanni,geb. Eckrnann, ^eb. am. 26 August 1844 zu Schmalkalden.

3. Urgrosseltern. Liebmann lviandel,ceb. zu Schmalkalden, am? I>e.3embar 1784

gestorben am. 26 ITovemiber 1825 ' v

Klara, ;:eb. Levi, gest. am 3o M-irz 1859.

Der Synagogen-Aeltestr

Sgn. Aöw, St0ll0 III. A. K.
San i t ä t a a m t
No. 1819. /

Berlin W.:^5,dm 20. Juli 1920.
Potadameratraße 56.

BESCHEINIGUNG.

Dem praktiachm Arst Harm Dr. ERNST
M U E L L E B wird auf aainan WUNSCH baaohainigt. daß er

9. 8. 1914 ala Kriagafraiwilligar bat

dar 2. Komp. Erm. Batl. Jnf. Be^t. 83 aingatratan iat.

Durch Verfügung daa a tallvart raten ten öenaralkdo.
XI. A. K. vom 4. 1. 15 IVb No. 1012 iat er xum Sanitätaanit
III. A. K. veraatzt uncTu^tar ihm, Dianet getan bia zum 28,
2. 1919, dem Tage aeinar Entlaaaung aua dem Heere.

Gemäß Verfügung dea atellvertretenten General^
Kommandoa XI. A. K. uorn ü. 9. 14 IVb No. ÄMMM/ 7142, be-
atätigt durch Verfügung dea Kriega-Miniateriuma vom 28.9.
1914 No. 3569/9. 14 M. A. iat er zum Feldunterarzt , durch
A. K.O. vom 26. 1. 1917 zum Feldhilf aarzt ernannt worden.

Der Voratand:

gebortn am Z*^ ten Z"^^^-. 18 /^'* )u

:5u^maiiu*v;;»v

^t:ci§ toirb hiermit be^ufS ftanbeÄamtUc^cn SlufgebotS

bcf (peinigt, bafe^^ÄT' felbc feit

m M £ ^^

l^icrfelbft roo^n^aft

z. ^

Sc^mallialben, ben

192

ie ^olijeioettDaltung*

Polizeidirektion Nürnberg-Fürth .

Nürnberg, den.

./^:.(^^...192b^

Leumundszeugnis.

Auf Grund der Erhebungen wird hiermit bestätigt, daß über den
Leumund de s Px.Ä.aenÄrz.t.e.a

.?.?.?.?.?!^...?!.^j.....^M.*....?.?.?.st M

geboren am .26^1eferay.r...l893 zu ..SchraÄlkÄldfin.^.

.P.?:eußis.cher.

Staat sangehöriger , .m^.

ouch^jji politischer Bezieh^mg

Nacht elllge^s hier nicht bekannt ist.

Geb. Reg. Nr.

390

Gebühr RJf ?.!.§.4 bezahlt.

6971.

Form. Nr. 823. H. 11.XII.30/5000 .

K'.

K.B.

^Mv^/

7i ^

M ...45, b„ 1S9,

■JBOi^i^aUiJMMH«

2)iß€cl)i[>cit nmjtch^nbör ^ferfigurtg,

Siccjcini vj li::*) llnlerfcbrift

triiö li:i:.if bourFu4I^ct.

«öu®berfcoiilieu u. iWittelf ranb

Kammer tes 3nncf'"
3. 81.

%^^«^«,.1?....RM.^ Ptg, Siaatsgobührtn

r IT ?^-^--. # Züsdilaa'

'- « -..••- 0 Volimaditsttmpfl

**" ly i, 2usdila(t

^■•r-r,,,,,^,. ^ ,y< — ,1 Postgebtthratv ^

#••*

V'^<.!C .

"«.•^^t v

ArzfliJier BezirksYerein
Nürnberg

Bankkonto :
Darmstädter- und Nationalbank Nürnberg

Postsctieckkonto : Amt Nürnberg Nr. 5305.

Fernsprecher 21291

Nürnberg I, den 21.X.1 933 .

Adlerstraße 15, SchlieBfach

B e 3 t ä t i g u n g

Herr Dr. Ernst M ü 1 1 e r ist als Facharzt für Chirurgie
unl Geburtshilfe seit November 1920 in Nürnberg niedergelassen;
während seiner 13 Jährigen ärstl .Tätigkeit in Nürnberg ist vorn be-
ruflichen Standpunkt aus nie etwas an seiner Praxusführung zu bean^
standen gewesen, noch sonst etwas ehrenrühriges gegen ihn vorgelegen.
Auch als Kassenarzt hat er niemals zu irgend einer Beanstaniung Ver-
anlassung gegeben.

AerHlwher Bezlr7:sverein

(x^yU^'uf^

?*,• J. .-■.>, -.«t, <^-<'-',r :••■-.*** ->- ■■•>'■■ - *-^- -II '■ --,f --iTfttfctrt"

Abschrift.

Bescheinigung»

Herr Dr Ernst Müller, geb. am 26.2.93, hat sich im
Jahre 1921 in Nürnberg als Facharzt für Chirurgie und Frauenkrank-
heiten niedergelassen. Mit seiner Niederlassung wurde Herr Dr Müller
Mitglied des ärztlichen Bezirksvereins Nürnberg, also des Standesvereins
der Nürnberger Ärzte, u, der Krankenkussenabteilung des späteren
kassenärztlichen Vereins Nürnberg. Der Unterfertigte war bis Ende
März d. J. ärztlicher Geschäftsführer der genannten Vereine.
Herr Dr iviüller war immer ein einwandfreier, standestreuer Kollege
u. hat sich durch seine grossen Kenntnisse, durch seinen grossen
Pleiss, durch seine grosse Gewissenhaftigkeit u. durch seine stete
Hilfsbereitschaft bei Tag u. bei Nacht einen grossen Kreis von
Patienten in allen Schichten der Bevölkerung erworben.

Nürnberg, 23. 10.33

San. Rat Dr Steinheimer.

Gesch. Reg. Nr. 1736.
Die Echtheit vorstehender Unterschrift des Herrn
Sanitätsrats Dr Ludwig Steinheimer in Nürnberg,
Bucherstrasse 20a, wird hiermit beglaubugt.
Nürnberg, den dreiundzwanzigsten-23» Oktober 1955-

neunzehnhundert dreiunddrei ssig-.

Bayerisches Notariat
Nürnberg II

Wittmann
Notar.

Abschrift.

Pr. Ministerium
des Inneren.

Nachdem der Kandidat der Medizin Ernst Müller aus Schmalkalden
am 27. November 1918 die ärztliche Prüfung vor der Prüfungskommission
in Berlin mit der Zensur "gut" bestanden hat und der von ihm geleistete
Kriegsdienst auf das Praktische Jahr angerechnet worden ist, wird ihm
hierdurch die

Approbation als Arzt
mit der Geltung vom 27. November 1918 ab für das Gebiet des Deutschen
Reiches gemäss § 29 der Reichsgewerbeordnung erteilt.

Berlin, den 17. Dezember 1918.

Ministerium des Innern.
Im Auftrage.
Kirchner

Approbation
für
Ernst Müller
als Arzt.

Ä. 18650.

Stempel: 1,50 M.
Nr. 618.

Docjiel^enbc nbfdjrlft flimmt mit &er Urf^rift üfcmhu

/f1^ )

../T.i:, nbtcilung 96.

1^.-»

'^'4i^

.^SlMi^ Jnstizobsrsekrgtär

Die üS^lffMIfllü Unterj^nft bes

Utfunbsbeamtcn bec gefcf^ä^sfjcllc öes
ilmtsgeric^ts In vilfLL[/kt/....mx^

Berlin, h^.MuA^±^^mm /w

2)cr ^Imtsgen^ntsptaflbent

Gesehen nx Eeglaubigurg der
/7V"i stehenden UntefiClitift

Berlin, d^n'^ ^euJih /pj

di3 Deutgjdaea R^ula.

[ulUag:

Reimke

1052.108

Abschrift.

1912/15

OBERREALSCHÜLE zu SGHMALKALDEN.

ZEUGNIS der REIFE.

Ernet Müller
geboren den 26. Februar 1893 zu Schmalkalden, Kreis Herrschaft
Schmalkalden jüdischer Konfession, Sohn des Drogisten Joseph Müller
zu Schmalkalden
war 9 Jahre auf der Oberrealschule und zwar 2 Jahre in Prima.

I. Betragen und Pleiss:

1# Betragen: gut

2. Fleiss:

sehr gut

Er wurde von der mündlichen
Prüfung befreit.

II. Kenntnisse und Fertigkeiten

1. Religionslehre: (Auf der Schule wird jüd. Religionsunterricht

nicht erteilt.)

2. Deutsch: genügend.

Französisch:

gut.

Englisch:

gut.

Geschichte:

gut.

Erdkunde :

genügend

Mathematik:

gut.

Physik:

gut.

Chemie :

gut.. :

.Naturgeschicht

e :

.Turnen:

genügend

12 . Freihandzeichnen : gut .
13« Linearzeichnen:

14 «Singen:

15 .Handschrift : genügend

f M

V*»

Die unterzeichnete Prüfungskommission hat ihm demnach, da er Jetzt
die hiesige Oberrealschule verläset, um Medizin zu studieren, das

Zeugnis der Reife
zuerkannt und entlässt ihn mit den besten Wünschen für seine Zukunft.
Sohmalkalden, den 23. März 1911.

Königl. Provinzial-Schul-
Kollegium. Cassel.

Königliche Prüfungskommission:

Th. Kaiser,

Kaestler

Homburg

Schmidt,

Heyfelder,

Dr Amelung

Henkel,

Dt Kreiten

Jäckel

Königlicher Kommissar.

Vertreter des Kuratoriums

Direktor.

Oberlehrer.

Oberlehrer
Oberlehrer
Zeichenlehrer
Ramb.

Er hat an dem den drei obei-sten Klassen der Oberrealsohule ange«
gliederten wahlfreien Unterricht im Lateinischen mit befriedigendem
Erfolg teilgenommen.

Schmalkalden, 23- März 1911.

Oberrealschule
Sohmalkalden.

Homburg
Oberrealschuldirektor.

norftehcnbc nb[cl;jnff pimiitt mit Öcr Urfd?nft üBeref

ereilt

."VC"«

- »1

^^. ^JW-^^i^^-'w^Ur /fß f

• *^*"r j ' •>'

Länm., i(c»,.,

•,ai)ir ^

mam

jetzt
as

Lkunf t .

••»•*••••••

Jnstizobsrsskrttir

ange-
lndem

Urlunbsbeamtcn &et(Q<5cf*äftspcne {«s

Jltntsgcri^ts lrt...„.i^£<tÄä^. ipir&

hiermit bcglaubtgi y^ ^ y^^Jj

Salin, ^^cJjLJ£^±Sd^^^ ^^'^'^^

Der 21mtsgejfwfoisprafib«nt

Gesehen rar Ccslaubigurg der
Z^;^ glebenden Unterüchriit.

Berlin, den-/^ kiftUMäik/flj,

Das Auswärtige Amt
des Deutspten Reichs.

ftebnkfi ^

^'^'^^■f^'^

Gesch. Rag. Nr. 1736.

'^$p( y^fZ- i-h/ ^^® Bolitlieit vorstehender Unterschrift des
^J ,P^*f>f^''-^OuaQXxn Sanitätsrats Br« Ludwig Steinheii

^^^^t^^<M--A

■> m e r ^ in Niirnherg, Buoherstrasse 20 a,

wird hiermit heglauhigt.
*v/^*^lirnl)erg,den dreiandzwanzigsten-23. Oktoher 1933-

<^'

neaazehnhundertdreiuiiddreissig-*

Die Echtheit der vorstehenden Name nsunters ehr ift des

bayerischen Notars Justizrats Wj ttmann am Notariate
Nürnberg II wird hiermit mit dem Beifügen beglaubigt, dass
der Genannte zur Vornahme der vorstehenden Beurkunding berech-
tigt und diese den hier geltenden Lanäesgesetzea gemäß erfolgt
ist •

N ü r n b e r g , den 51. Oktober 1953.

Der Präsident
des Landgerichts Kürnberg = Fürth :

^^e^\

A/ mi.Geb.f-Begl. N"^
^ RM.Geb.f.Zeugti.
_/^RM.205S Zuschlag

Sa.^/£HM.

f<r^^^^'}[$fj

Nachdem der Kandidat der Medizin Ernst Müller
aus Schr/ial Halden am 27. November ims die är rötliche Prüfimg
vor der PrüßjngskomMission in Berlin mit der Zensur
"gut'' bestanden hat und der von ihm geleistete Kriegs-
dienst aU'f das Praktische tfahr angerechnet worden istj
wird ihm hierdurch die

Approbation als A r x t
mit der Geltung vom 27. November 1918 ah ß'lr das Gebiet
des Deutschen Reiches geniäß f 29 der Bei chsgewerbe Ordnung
erteilt.

B e r 1 i n, den 17. Dezember 1918.

i'-

Ministerium des Jnnern
t/m Auftrage.

Approbation

f'ir
Ernst Müll
als Arzt.
M. 18850.

Gesehen zur ßegfatiblgiicg der
2*^« stehendeu Unterachiift.
Berlin, den ^ fe^e^t^^^ /^3S.

Das Auswärtige,s^grtp^j : j,50 #.
cka DeutsQ^n Reichs.

rag: Nr. GIB.

^R\X0^

^^k^i^

VISTO EN ESTE C0N8ULAD0 OET ESPAKA
CUENP P^A MC*WZAR Ir* FIR

AäJLv

tUN.

Ytlm^Mk. DE ia2^

V"^^^ David Carreffo

IDERECHOS CONSULARES ESPANOLES

^/////^

^^.^^

i^..;

t. *..L

T^.^

Z<jUj Jrxü^köJ DijX.-4J.tj.Ai

^■J

! ^

ü ;/lio: it :.:iv ocncer

'JLic ir: tu c^rtifr tlii.t 3:R.ZjI;T . YLU^R,. .J..713 rarl

.Yenuc,ilev' Ycri- ^I ,: .^•/v^' " "'

b:ib:*-^ c-l ': ^tliGi:^ frc: T934-I94I,

Wiiile here lie direc-lscd r. ^^necoloGical-ouftetr^-cal Clinic. ^.i i

ef^tii.ation lie v/ds one of tlic bert .T3-neccl():-:icts jnd üü..tetricians
in Athens. I considor iiii. an ercellani: phynician and ourjjcon. 1
iiave had t/tj.c opoortmiity to follor' Lie üi)cr^:.tiüns and !iave .':een

er-'cellent r(=r--ultr .

ü.

l.erber of tLe Acadeny /'"^^^J^^^^^^ >

Ciiairran of the T.yprer.e ::Blt:L Council L.nd

Ir-ofei'üoT of t].r : ndical Tacult^^ in tliB T'i

Vcliens.

iverc

■r»o - T-^'-

Athens , Z^ th C e p tenber 1146.

YgrpacKt iB HtX Vi i55>5e

Verzeichnis iJber die gebrauchte

Praxis- und Kl inikeinpichtung
des Herrn Dp.B.Mü] ] er,
Nürnberg, Linlenaststr. 14

3 ärztliche Apparate mit allem Zubehör
(Röntgen- Dyathermie-Hoch f'requenz)
1 Operationstisch urid 1 Untersuchungs-
tisch mit 7ubehöp
1 Vepbandsstof f-Stepilisatop
1 Tnstpumentenkochep mit Z^behöp
1 intbindunf skoff ep komplett (äpztl .Ge^rauchs-
bestecke)

gyn'kol. und chipuperische Instrumente
i Schpeibtisch
i4 Stühle
1 Anzahl Lampen
1 Schreibmaschine *
eine gposse Anzahl med, Lehpbücher
i6 Schpänke
i3 Tische
5 Waschständep

2 ^app9?eils m^dical s avec aprDartprance

(Röntgen , Dyathf>pmle,Hochf p9quenze

1 table '1*op^patiors et ä*eramin?.tions

avec appaptenance

1 appapeil h Stöpiüser los bandages

un noT^bre des appareils et

ins' ruments
m^dicals

1 table ii ßcripe

14 chaisp>3

plusieures lampes

1 machine k ecrire

un grand rombpe de liv.ros m^dicals

16 armoires

13 tabl PS

5 cuvettes

eine grosse Anzahl Porzellan-Email- und ^^ grand nombre de tasses, de peans
Qlasschalen und Flaschen ©"^ bonteil l'^s

2 Waagen % balances

Wasche:

Cg jpationswäsche, Bett-Ktlchen-u.BadewäscWe '^^ grand nombre dn linr^e

Wäsche für den Arzt und die Schwester

SäT0.ingswäsche

K]inikgeschirr,E3Sbestecke& Qeräte -^^s Num6reB»ses outiTs et des vaissaux

Küchengerate ur. '!!. div, Harsl aMunaji^gegenstände P^ur la clinique

16 Patientenbetten, komplett ig ]its co^plets pour d^s -alaips

2 Sauglmgsbetten n 2 n n n n petit enfants

lö Nachttische -"it den dazu gehöriger Lamnen 15 t^.bles de nuit aviec df>s lamüPi
und Spiegel. et aes rairroirs

Spiegi
4 Bett-Tische

1 Suspen sionsgcpu st

2 Untersichungs-Khaiselongues

4 lits conibiti^ avec d«^s tables
un echafand a Suspension

2 chaiselonf'Ues pour i^examiant ion

Haoh der glaubhaften Erklärung der Prau Liselotte Müller ,
wohnhaft in Nürnberg sind die im Yerxeldhnis aufgeführten Gegenstände
gebraucht. Dieselben hatte seither ihr Ehemann, Herr Dr. Ernst Müller
während seines hiesigen Aufenthaltes in seinem Gewerbebetriebe als Frauen-
arzt in Benützung. Herr Dr. Müller ist nach Athen übersiedelt. Dort
sollen die Gegenstände ihm in seinem Gewerbebetriebe zum eigenen Gebrauch»

dienen*

2&SEP.1934

Nömbcrg, den

Polizeidireition Hümberg^FWJi

ICE.

*^el),-Ret. Hl.

\^^.\.

X*euuiUr

wf — ■ mm

^•

<4i

GRIECHISCHES KONSULAT
ZU WÜRZBURG

WÖRZBURG. DEN

JULIUSPROMENAOE 66
FERNRUF 4002

^^ ( r

( CK

(/^

i^<^i r

//:

•^

( Ux

ö rc r^

fiCT^ ^fr^c/TA:: Clc^yL^

f^ c Y ^r/üo yy^c;^rJuct^cy- rr^^^t^^c

y^ r ( ^x^ '/^^ ^ ^\r ^^

£-7 ^

a"\jt

o/^

r <A

fc^-^ '>>7 r ^<b^ /r

t, •

^<.

7 f ^ J

< 0--U

f \

c *^

U.,.,^^^ 4" £y- ^<^/,

/^ ^/^^ ^«*-v * / ^ ^

cn;^

\c r/^c

.^.

£^\J

v?V rj <r*.' • */,

^>\;\ ^/^ ^^ ^. ^ 1

^ c ^t \ o rrc ^

ÄÄ

-^^

^Vir

v^.

yo •/c^ /r-r/^^ ^^

/T^,

^ Tükr ^c ^A

^/''"^ ^

r ^^.

^ -\j

-^,

.v> 'r

{}vos^r

^ c ^Cu r^ ^^ ^ ^

'^<y.

/^ fcc»: u /-

y r fyr^

rjt^Sj'X/'

c .>

-tv

' «^-^ <^/- «,-4',

e »^^ c>i/ ^ ^~ /"cTv ^ J ' >-t/<^Af ^ <:o

'\yZf

A7S^/^ /^

Cäc^£

c CiC<^ i/ r^^-^

^^ ly

^<i-

v/ ^^

«P

^^( 5 )^/

^r^ /-TT^/ r^

^ ^ <^^ '*^->^ /> ^>fc

TsK

Tl<h, ■*.*l»-><i-^

I " — - — — '
Die€cl)il>c!t nm(tcF)^n5^r »Fertigung,
SiccjcIiD .3 »i::^ llulerfcbcift

'21«sbad?, ^c:l. ^.;.^^./:'.^^.^.';.^9 .:'.:'•

n:v3tcrung
nonObfcfroiiken u. Ütittelfranft

Kammer bet 3nne»-*
9. II.

- ^>;

r; -i

«•*•

'?.... '^

%,.««.,.^....RM.r> Pfg. Staatsgcbührta

IT -^•— » Zuschlag

« V Vollmachtsttmpfl

, ^ ^ Zuschlag

"" .^» n y— .> PostgebQhrgn z^//

■MMHiP

■MHI

Polize-direktion Nürnberg-Fürth. Nürnberg, den /^- J^'^^y^ \<^:^

Leumundszeugnis.

Auf Grund der Erh^bunge ^. wi rd htprnlt bestätigt, daß über den
Leumund des PrÄU.enar:^te3

Herrn Dr, .od. ?]rr.st ^! Uli , r,

geboren am '^^ ,^o\.r\v..r 1^33 zu Schi..ai :Mi>^ei.,
..preußlsclier Staatsangehöriger. ' *^v "

... X « . .

^ach in i>olitii:c:ier Losiclr-j^j

NaohtPlllges Tiler nicht bekannt ist.

K.E.

Geb . Reg . Nr ^2.9 1^ ^^ ^^' '

Gebühr Kf^ ^..»§.4 bezahlt.

6371.

Abschrift
T-b.::r.:l/6 Eni/.7g.

Bayer. Land es Siedlung

..: . .j^'Srtir^ für Ausv/andererberatung

in Verbindung mit dem
Deutschen Ausland-Institut Stutt;::art

tlünciien, den 5. Juni 1934.
Eanalstr.29/lII

./^

Herr Dr. Ernst 1:1 ü 1 1 e r, Frauenarzt, wohnhaft in
llürnberr, Lindenaststr .37, hat hier glaubhaft gemacht, daf3 er die
ernsthafte Absicht hat, mit seiner Familie - Ehefrau vuid zwei mi>i-
d erjährigen Hindern - nach

Griechenland
auszuwandern, da ei' als Ilichtarier seine Existenz nicht aufrecht
erhalten kann, obgleich als IZri^steilnehmer zu den Ilrankenkassen
zugelassen.

nachdem seine vielfachen Bemühungen um Gründung einer
neuen Existenz - zuerst in Palästina, dann in Spanien, - infolge
unüberwindlicher Schwierigkeiten gescheitert sind, bietet sich
ihm jetzt Gelegenheit, zusammen mit einem früheren griechischen
Studienkollegen die Errichtung einer Privatklinik in Athen zu be-
treiben.

Voraussetzung hierfür ist die Ablegung des griechischen
Staatsexamens, die erst nach zwei Jahren möglich ist, und ferner
die Beibringung eines größeren Kapitals zur Erriclitung der Klinik.
Hierfür und für den Lebensunterhalt der vierköpfigen Familie wäh-
rend der liwei Jahre, wo noch kein Verdienst anfällt, bittet der
Antragsteller um die Freigabe von PJ{ 50.000.-.

Unter den gegebenen Verhältnissen begutachte ich den An-
trag v;ie folgt :

VJi 20.000.- i.Vi*. Reichsmark zwanzigtausend in bar

PJ; 30*000.- i.V/. Reichsmark dreißigtausend in V/aren
- deutschen Materialien und Einrichtungen für die Klinik -, wobei
für letztere die Gev/ährung einer längeren Bezugsfrist befürwortet
wird.

Ferner wird mit Rücksicht auf die Dringlichkeit des Vor-
habens empfohlen dem Antragsteller einen Betrag von ^% 15.000.- in
bar (von den beantragten VJi 20.000.-) vorläufig gelegentlich seiner
bevorstehenden Auswanderung zu genehmigen.

Herr Dr. Müller hat den Krieg als Freiwilliger an der
Front unter Auszeichnung mitgemacht und sich hierbei Beschädigungen
zugezogen, durch die er in seiner körperlichen Betätigung behindert

ist. Sein Gesuch verdient deshalb besondere Berücksichtigung. Auch
v/ird durch seinen V/egzug von Nürnberg eine bedeutende Praxis für

J' /

flHC

16763

- 2 -

«•

einen arischen Facharzt frei. Schließlich dürfte die Errichtung
einer guten Fachklinik unter deutscher Leitung in Griechenland
dem Ansehen des Deutschtums dort förderlich sein. j

Die beiden früher ausgestellten Bescheinigungen vom 5.10.33
Tgb. Nr. 22/10 Em und vom 20.12.33 Tgb.. Ilr. 102/10 Em./v/a. ver=
lieren hiermit ihre Gültigkeit.

Der Devisenbewirtschaftungsstelle sind vorzulegen;

polizeiliche Dauerabmeldung
Einreisesichtvermerk für Griechenland
Unbedenklichkeitsbescheinigung des Finanzamte
Verzeichnis des in- und ausländischen Ver-
mögens .

Bayer. Landessiedlung
Abteilung für Auswandererberatung
gez. Engelhardt

""i-'^nts

Phof. BERNHARD ZONDEK

JUKUHAIL.1CM

ROO'HflOHILD HADAHSAH
ONIVKR«lTY HOSPITAL.

Ji^;^ ^jV^j: ^y'^ij.

TO WHOM IT MAY CONCERN

THIS IS TO CERTIFY thet Doctor ERNEST MYLLER
from NEW YORK is known to me for ebout 30 years. I know
th&t he got hls educetion st the Feul Stressmenn Gynecologicsl
snd Obste^tricel Hospitel of the Berlin üniversity.

Doctor Myller wss later a well known gyneoologist
find obstetricifcn et Nuremberg in Gerraöny, fend since the time
of the Nazi regime he has been working in Athens (Greece)
where he had a Gynecölogical and Obstetrical Clinic of his
own. I know that Doctor Myller had an outstending reputation
in Athens.

I can recommend Doctor Myller warmly es a man
of excellent character, as a very reliable physician, and
8 well trained gyneoologist and obstetrician.

Bernhard Zondek.

Jerusalem, September 22, 1946.

Dr. Ernest Myller,
Gynecologist, 60

Dr. Ernelii' Myller. sixty, a
gynecologret and obstetrician
with Offices at 65 E. 76th St..
died yesterday of a heart attack
at his home, 450 E. 63d St. He
was on the staff of the Post-
Graduate and Madison Hospitals.

In 1933 Dr. Myller, chief gyne-
cologist. and surgeon at the
Marthaheim Hospital in Num-
3^rg, Germany, was driven out
^f the country by the Nazis. He
went to Athens where. within a
year, he had passed the Greek
medical examinations, though
he had not known the language
before his flight from Germany.

For seven years he was head
of a private hospital in Athens.
In 1941, when the Nazis invaded
Greece, Dr. Myller was rescuec
with his family by the British
Navy. He had been in the United
States for twelve years.

Dr. Myller had designed in
struments used in the detectio.,
of Cancer in the Uterus and ap-
paratus used for the eure of
sterility.

Surviving are his wife, Mrs.
Liselotte Myller, and a son,
Ralph Myller. Another son, Lt.
Ulrich Myller. was killed in
action in Korea.

l ror<^

'^ssiona

I (^erfiriccue^

m^J

?<;>ä>^^>sit%>s»^^<;>&L*^^^«»tj<;>s^^^

MEMBERSHIP CERTinCATE

31f ^ Ammrati S^ort^tg tot tift ^tulug ot ^t^rtlttg

QII|tH \B to (Ef rttf 9 //m/

ERNEST MYLLER, M.D,

^ a/i

S^;^ciate ^ytiefiive)^ c-f tJ/ie Soln

^oeietii

mr^ /he .ytm/u

^Mfu^/, /€r^ we uea)^ e/esüinaie^/ m

^m,

kermn,

arul i^ euliued lo ali t/te /i^tllmeS e/ Sac/t ^yitemmi^Mi/L

^£&Tk^0t,:^====J(3,

SECRETARY

^^.9.

PRESIDENT

(g&t3C>Sit54>&^^^>«>J^^«t%^«>:5C>&^^^^

EeNIKON & KAHOAIITPIAKON nANEnilTHMION
' Ae H N QN

•AciO.

H KOIMHTEIA
THl IATPIKH2 ZXOAHZ

17(^0)1,

249

AiAcTtX. 1071

'Ev 'A9r|vaic; xf]
t4

15 M«fou

.193

E N A ß I K T I K 0 N

iJlp^

K.EPNEJITOi: I.kYüAEP ^k 2:pt.XK4XTev tKearr] etöCHipnq tyi 15r
'ATtpiAicu 1935 Tf|v bno TfT^v nnven inTT]p.inK'^v v6}i'nv 6p i^c p,£vT]V *

*0 KoojifjTmp.

'C rp^uliHTeCq. I

Dem Kandiddten der Medizin, Herrn Ernst Müller aus
Sehmalkalden itTh. wird hiejnit auf Antrag bestätigt,
daß derselbe die ärztliohe Vorprüfung am 17. 7. 1913
mit der Gesamtnote I- sehr gut Bestanden hiiit.

V/ürzburg, den 17. November 1916,
K. Universitäts-Syndikat.

Vir

um ornatissimum

/sr^j^^-^rr^^iA/^^*^'/^;?:^^

€ivibu8 Vniversitatis litterariae Fridericae Ouilelmae
legitime adncriptum nomen apud facultatem medicam

rite professum esse testamur.

Berolini, \.X u

mens.

anni MDCCCCXVIL

Decanus et Professores

ordinis medicorum

Yniversitatis Fridericae

Gruilelmae.

-■al^

n o

i'jM "»'wi iimn' iwj

♦

J > .-,

^öuigl^cli Bajor/sc/,

(^^'1(5)^

^:/.

Ci^ '

ganjs

it-,-v

nijui^

-<*-»*^

.?c^^f?M^c-i^

,.*\,^ ^^^^*^*^M^M^m^*^*'^<^i^^ ä:W^

^."»a^

;d;

^^^/C^

Würzb unj , ^^ //• -:^/^A

iLüUUj

;jy^

UiiivprsitatsRoklor:

Fiiiversitäts ■ Swdikus ?

0 9

vt*/'

i.iiii vh'd.^.r}; Viirz'^u-

"U-|

^6&z^ei^/?//t/j

--»w^ -»^u^*^ ^X^ 4*vr^ med. Ernst M ü 1 .1 er

rv^ S c h m a 1 k a 1 d e rw-*'-^;^^-,^^^^^*-*^^-

«*-♦*-

^^<

{>97?

ed^e^

.S..S.U9il....

,. esteclog.i.e.

.W,.S..19.X1/.12

.Qr.g.sjii.sc.he. Chemie.
Physik

Botanik

Anatomie .1...

.Präp.arie.rüb.unge.n . I ..Kurs

Wlirzburg.,. .den. 11 .April . .1.91.2.

K...U.niYe.r3itäts.-. Syndikat..

Prof .Dr.Sobotta

„ Suchner
Wien

„ Kraus

Sehul.tze

St Öhr

cAT/n-ie^ii^^.''

<L>^.S9^e^^^'^^^^?^a .äi^ ^>^^

^^iTX^^n^.

■ • ■

■

•••• ••• •..<

•

L .1 Ul .1»— ifMW

c7e^ne4!),^e^.

fLM^y?^€yr^^n/^^^.^^ j^€^t^//^^fa^i^

IIP ■ _L : —1

- -'

•

• •

Kurze Übersicht über anorganische und organische Chemie bei

Prof .Dr. Feist

Muskelphysi ologi e bei Prot . Dr.Dethe

Hinsichtlich

I ■ ,■' <• < ,1

■^
^

r'^^^O //^^-n^A'y^'r'V// t^t/j ^tt^y t^-M yt^^*^iyf^ t

ft-^^^-^iJ^'/ ^'-^</ />^CtM.^-^^n/^*-^ito

■*-»-*- /-

*-*-

-p.^ /--i^^-^M^-i

^4^/

<«;

C^C'^'t-^ u

•t-f'

-*-'t'-t-^ /^/-*-*-^/'A-«< ca-C*^)»-*^-*«'/'*' A-i/'5^-*^*-»-lMf- ■f^-ft'<l C>X--*-^ * *-> /^ *' ■

Qy/Ze/j Jn-t^f^ A /.

C ltt^i.i^/t /9 tir

y.W

H--

(Scbüf^rcn 6 J(

r^^^y/,t.y/>/

•tM-t'-t'^t'

clt±.u.ujri -/cP /X.

"W^

jy"jjP

at--ff.

^n Koücgicnl^onorarcn fiub bcm ßcrrn acftunbct

JL, njorüber berfelbe ^t\\ potfdjriftsmä^tijeu Hemers ansaeftellt hjxi.

Der Srfjulöner ift i>cri.>flii-htct, por Ablauf doh ö 3<^^*"^" "'•^'^ feiucni ^b^jaiu\c roii Mcfer Unioeri'ität
ber 5onoiarieufrebit PciiDaltuu^ ober bcm Heftor x>o'\\ [cinent Jlufciitl^alt ZTaitrid^t 311 oiebcii,

Dtcicnitje 3el^örbe, bei ipcldjcr ^iiifteUuttij ober Zlieberlajfinitj bes

l^errn _.^ erfolt^t, «rtrtr erfudji, in (Seniäßbcit

ber (^trfularücrorbmijii^-«^«t-Trrt5Ftobcr I82h tinb bcr ^liirhtlarrcrorbinMiij poiii
1879 bcjii Kcftor baron IHitteiluno, .511 macbcn.

wmw^mmmms^mmmmmm-wmm^mm^Msmwmmsmmm',

||n||l"!|||ni|||M|||M|||ii|||ni||!n||iM|||ii|j||M||||M|||i.||||i||||ii|||ii|||ii|||M!]||i||^^

'1l(l||tt||j]!M|||ll|j|ll|||IM|||"||!"|!|Mt|||il|];'"

|iir!||ii||M ij|i'ijiii|||Mj;i'ii|r

t»-..' <

QVOD FELIX FAYSTTMQVE SIT

VNIVERSITATIS LITTERARIAE

FRIDERICAE GVILELMAE

R F.CTO R I'] M A G NJ FIGO

REINOLDO

B E R G

THEOLOGIAE DOCTORE NEC NON IVRIS VTRIVSQVE ET PHILOSOPHIAE HONORIS CAVSA DOCTORE IN HAC VNIVERSITATE PROFESSORE 1>VBIJC0 ORI)IN\RJ()
AVGVSTISSIMO BORVSSORVM REGl AB INTIMIS CONSISTORII CONSILIIS SOCIETATIS LITTERARIAE GOTTINGENSIS SOCIO EPISTVLARI ORDINE CRVCIS EERREVE TN
SECVNDA CLASSE ALBO NIGRO IN VINCVLO CRVCEQVE PRO BELLI ADMINICVLIS PRAEBITA DECORATO ORDINIS REGII AQVILAE RVBRAE L\ QVARTA CLASSK

ORDINISQVE REGII CORONAE IN TERTIA CLASSE EQVITE

EX DECEETO GEATIOSI MEDICOEVM OIIDINIS

PßOJIOTOß LEGITIME COKSTITVTVS

GVILELMVS

HIS

MEDICINAE ET CHIRVRGIAE DOCTOR IN HAC VNIVERSITATE PROFESSOR PVBLICVS ORDINARIVS REGI A CONSILIIS MKDICIS INTIMIS CLINICI MFDICI IN RFCIO
CARITATIS NOSOCOMIO DIRECTOR ORDINIS CRVCIS FERREAE IN PRIMA ET SECVNDA CLASSE ORDINVM RHOIORVM ET AQVILAE RVBRAE ET CORONAE IN TFI'TIA

CLASSE MVLTORVMQVE ALIORVM ORDINVM A GEBMANARVM NATIONVM PRINCIPIBVS MANDATORVM EQVES

FACVLTATIS MEDIPAE H. T. DECANVS

VlllO CMISSIMO

; ERNESTOlMVELLER ':

»»t^Pl.»*-.*!^ .•-•J 4 - -'*!- ■^■"

-«.-IJ . t\i*-..

v»»ei»^

L'jww->,'.<fv F,:^ y».»w»'- vwvyA "y.ptW'' :*=

•! '■■^'. ;;/^"v -r; ^j".

DISSBRTATIONEM LAVDABILEM LINGVA GERMANICA SCRIPTAM

INSCJlirTAM

ÜBER DIE TORSION DES SAMENSTRANGS

AVCTORITATE ORDINIS EDIDIT

D O C T O R I S M E D I C I N A E

IMMVMTATES ET PJU\'lLE(iIA OllNAMENTA ET HONOßES

DJE XVII. M. lANVAIill A. MDCCCCXIX

i;iTK CONTVLIT

COLLATAQVE

P\ |]li( 0 IIOC DJPLOMATE

3IEDIC01IVM OIIDIISUS OBSlliN ATIONE COMPEOBATO

DECLAIIAVIT

i-i

/m^Ow Iav

tAvV-

tA ^

"J'Uvvl-

^ /\M^^O/u*j/

•<VW^

&1- Xu>w

CtvX

AW^v-^—«-^^

/Vt^ '

-i'Vi: ^^^'"^

^¥

BEROLINI

TYPIS KXPKESSIT ARTHVRVS SCHOLEM

Porftcljfnbe nbWjrift fn-nmt mit b« Urldjrift übe«m.

-.«vs Urfun^sb.-cv-, et icc 0cfd;äfts51:Üe be3
'•■-ßmtf9erid;is -^^M^^^^' Bbtcluna 96.

."«■«M

,;jru"5!)5n?ti'«tlr

ilmt^Acrt'i- '5 tn ^:^/fLC<C:.iZi....xm^

Der 21mtsgcrid?tsj?räftbent

rcs-^V-lSi/^x

•!7' >.

^Ä^: >

/ }

CcGc''.n T'.x CeglatiWgarg der
/<^/>^-- ste'iandea Uaterschriit.

I r^3 Ausv/ärtigeAmt
d.i Deuten Reichs,

Rc!e&3

(^^a:II A D^cunof,itJ

QVOD FELIX FAVSTVMQVE SIT

VNIVERSITATIS LITTERARIAE

3RICAE GVILELMAE

RECTOKE M AGNI FIGO

EINOLDO

SEEBERÜ

IHEOLOGIAE DOCTORE NEC NON IVRIS VTRIVSQVE ET PHILOSOPHIAE HONORIS CAVSA DOCTORE IN lIAC VNl\ EIlSITxVTr: PROFESSORE PV15LICO ORDINARIO
AVGVSTISSIMO BORVSSORVM REGI AB lUTIMIS CONSISTORII CONSILIIS SOCIKT-itxo r-ia«?orvAxi.t^« <,c-.^rx.oT;.,4sis 80Cl() ELM8TVLAUI ORDINE CRVCIS FERREAE IX
SECVNDA CLASSE ALBO NIORO IN viNCvrP -^^«^^»^^ ^'^^'"«^^^-^ ^^^^^'^^^^^^ PRAEBITA • DKCORATO t^UDlNIS REGII VOVILAE RVBRAF IN OVARTA TF A^ST?

S ORDINISQVE REGII CORONAE IN TERTIA CLASSE EOVITE ^ ev r^x/i v>i.H.^.^i.

EX DECEETO GKATIOSI MEDICORVM OEDINLS

PEOMOTOß LEGITIME CONSTITVTVS

GVILELMVS

HIS

FAOVLTATIS MEDICAE H. T. DECANVS

VIKO CLAßISSIMO

ERNESTO MYE

xL R

HASSO-NASSOVIENSI

-■•■■»■«-•x * /*</

» »»1» A n nv T /i A

IUI

'ÖSTQVAM COLLOQViVM SVSTlNVlTj

DISSERTATIQNEM LAVDABILEM LINGVA GERMANICA SCIIIPTAM

INSCRIPTAM

ÜBER DIE TORSION DES SAMENSTRANGS

AVCTORITATE ORDINIS EDIDIT

DOCTORIS MEDICINAE

IMMVNITATES ET PßlVILEGIA ORNAMENTA ET HONORES

DIE XVII. M. JANVAIUI A. MDCCCCXIX |

IIITE CONTVLIT

COLLATAQVE

PVBLICO HOC DIPLOMATE

JllEDiooRVM ORDINIS OBSIGNATIONE COjlPßOBATO

DECLARA VIT -

t-.

i. /. ^

-c^f^-i^i^

ft/4. —

/^^/

fjifM

e^-

•t

Gesehen rT Bcgiatitfgiing dcr^

/1n^ stehenden Unterschrift. f

Ber!in, den //T i^^l,^,^.,^^ )^.

Das Auswärtige Amt /

cLs Deutscfasn Reichs. I

BEROLINI

TYPIS EXPBESSIT AETHYEVS SCHOLEM

^^J/^^'^

Reimke

mmm

QVOD FELIX FAVSTVMQVE SIT
AVSPICllS ET AVCTORl 1 ATE A\ GX STISSIMl AC POTENTISSIMl DOMINI

G V 1 L E 1

I.VIPF.RATORIS GERMANOKVM BORVSSIAK REGIS

RIX TORE

ALBRKCHTO PENCK

PFIILOSOPHIAE DOCTOKt: KT OKDINIS FHILOSüPHOKUM PROFESSOHE PVBL. ORD.

Studiosns

data dextra iurisiurandi loco legibus magistratibusqiie acaderaicis fidem oboedientiam reverentiam pollicitus
numero civium Vniversitatis Fridericae Guilelmae Berolinensis legitime adscriptus est Cuius rei testes hasce

Utteras sigillo Vniversitatis miiiiitas et Rectoris manu snbscriptas accepit

/^^

/C ■

1). Herolini (I. yf ^>^. mens.

Miini MDCCCCXVII.

c:^/

^emMte'?/

W.S. 1912/13

S.S. 1913

<^/

(j/€inenmm/i:-^ety ^':/^?iedi^ym^eny

PräparierUbungen II. Kurs
Physiologie

Zoologie

Topographische Anatosiie
Anatomisches Repetitorium
Physiologische Chemie
Physiologie

Topogrsiphische Anatomie
Physiologische Übungen

Zoologie
Mikroskopischer Kurs

.J^>•-x

>^Ät^1

'-^^^

Dr.Schultze
„ von Frey

Boveri
Sobotta
Lubosch
Ackermann

„ von Frey

♦»

Sobotta

„ von Frey
„ Boveri
^ Schultze

b(em£^y^y

r^^

ue'n^n^ml^^a:!<^^y /{^

'.^}zen^

]sir. j ^r-

^öniM^icli Bayer/ sc7,e

> ; • V «-^

#m*-n''

,-*yr#^,'«*< **-»-*-

^/rK/7^ <^

^t^^ cX^**f-'*^M^v^^m'f»-i^f'^tr'' 0^^'K^

O^^on-i^ i4J^e>c^o/^^-'>^n^

«.^«(?.«

^« *-*'#'*-*<:

^M^* '«iC^*-«*-^^

*-**!^»^-»-4«'^*-#* ^^^^^''^^■m^^* *^f i^

« #-* --«*^*«-<

-#*^^ j^t^ -**-*^ // -«

f/^^y y y

-t^lfi «/;»*-»^<«-**

riiivcrsiläls-Rckloi*:

'i^

riilvcrsititKSMidikiist

(Ji/,:^-^ i.//.

«M

OUOD BONUM FORTÜiNATUMQUE ESSE lUBEAT

DEUS OPTIMUS MAXIiMUS
REGNANTE

AÜGUSTISSIMO AC POTENTISSIMO REGE AC DOMINO

DOMINO

OTTONE

REGE BAVARIAE

SUB SERENISSIMO ET POTENTISSIMO DOMINO

DOMINO

LUITPOLDO

PRINCIPE BAVARIAE REGIO

REGNl BAVARIAE PROCURATORE

CORAM

ALMAE HUIUS REGIAE UNIVERSITATIS

RECTORE MAGNIFICO

GEORGIO DE SCHANZ

nOCTORE RERUM POLITICARUM PROFESSORE ORDINARIO OECONOMIAE PUBLICAE CONSILIARIO REGNI BAVARIAE

EQUITE ORDINIS CORONAE BAVARICAE ET ORDINIS S. MICHAELIS CL. III.

XA^n e4tu/i.. ..JlaM^.. fc£m. oMa^Pc

(y^t/H^

STUDIOSUS

/m^(>UfC^

DEXTRA FIDEQUE DATA

IN J.EGES MAGISTRATUSQUE ACADEMICOS OBSEQUIUM PIETATEM REVERENTIAM POLLICITUS
EQUES HONESTATEM VITAE MORUMQUE DILIGENTER ESSE SECTATURUM PROUT INGENUUM DEGET AC LIBERALEM lUVENEM

NUMERO CIVIUM ACADEMIAE JULIO-MAXIMILIANAE LEGITIME ADSCRIPTUS

TESTES EIUS REI HASCE LITERAS SIGILLO UNIVERSITATIS MUNITAS
MANUQUE RECTORIS SUBSCRIPTAS ACCEPIT.

wircebuhgi die xjoZ'.iiensis^^^^ anni mdccccxi.

Jh//>rt/^4

^e>^^

Bi-^v^ J^Utc//^^ 6^cM'a^

IderO

Ct/a/i

' : ,uaiii,a»«r!»Ä*^«-

4?l //^/

Ai^ <Zc^<>-^-^-^£pyA.

^^^€€^ A^v^^

^- ^

^^^(^-

^^u^^^^ /^^

J-^-*^^ i^^i:>^r'>ir> ^

President
RUDOLF NISSEN

116 East 58th Street

Vice- President
JOSEPH BERBERICH

Recording Secretary
LOTHAR KALINOWSKY

Corresponding Secretary

WALTER M. FÜRST

121 East 6 Ist Str^H

Assistant Secretary
HELEN O. CURTH

Treasurer

ARON GOLDSCHMIDT

12 East 88th Street

Assistant Treasurer

ERNEST GOLD

Archiüisl-Historian
FELIX JACOBI

Subalf Utrrlfom iMpöiral &onrti|

in tljr Olilii of Nrm flnrk

Founded 1660
Incorpnratecl 1867

Committee on Admission

CHARLES GOTTLIEB

ARTHUR ISRAEL OSCAR ULRICH

Program Committee

W. V. BERGER HANS R. SIELMAN

ARTHUR SONNENFELD

Publishing Committee

FRANZ GROEDEL BRUNO KISCH
MAX MILLER

Legal Counsel

ALBERT HIRST. Eiq.

51 Chambers Street

New York Academy of Medicine Building
Fifth Avenue at I03rd Street

Telephone. At water 9-4700

Regulär Monthly Meeting

Monday, January 6th, 1947

6:30 P.M. Sharp

/. Executive Session.

Report o( the outgoing President.

//. Scientific Session,

a) Demonstration:

Ernest Myller — Problems in the Therapy
of Sterility. ( 1 0 min.)

b) Papers of the Evening :

1 . Ernest Gold — Surgical Trealment of
Hyperparathyroidism. (20 min.)

2. Alexandra Adler — Neuroses in Child-
hood. (20 min.)

Recommended for Election:

Louis Adler, 61 West 74t h Street

Joshua Breuer. 851 West 18 Ist Street

Aladar Parkas. 133 East 58th Street

Kurt F. Fraenkel, 270 Fort Washington Avenue

Hilde Lachmann Mosse. 108-25 72nd Avenue,

Forest Hills, L. 1.

Herman Moses. 262 West I07th Street
Ludwig Schwarzschild, 514 West End Avenue
Henry Leonhard Wittner, 200 Central Park South

///. Executive Session.

IV. Collation.

Applied for Membership
See encloaed LA*t

_«.:

(Stfr (Summanairaltli of masaactiuartts

Board of Registration in Medicine
State House. Boston

♦ »»

Application and Fee Received

ADMIT APPLICANT, NUMBER ) J o^ ö ö . TO

MAR 10 11 VZ 13 1942
EXAMINATION AT 9.30 A.M., •^'*'^. "^V "^ *

IN THE AUDITORIUM, STATE HOUSE, BOSTON.

N. B. — Bring Fountain Pen

Admission Card and Numbered

PHOTOGRAPH. H . Qu i mby G|^lupe^ WI . D.

2ra—(b) -1-41-479«

Im (a)— 9-41— 7327

)Uor^

-f

vA,-vj;uII^

Cert. No. ..^:?^.t39

BOARD OF REGISTRATION IN MEDICINE

STATE HOUSE

TEMPORARY CERTIFICATE

M«n -|*^ 10/0

having been examined (^1 !...". l.rlJs.ZL., and found quaUfied by

this Board, has been registered as a qualified physician, as provided by the
laws of the Commonwealth.

This certificate must be exchanged for an engrossed certificate with-
in one year as it will become void at the expiration of that time. When the
engrossed certificate is ready, word will be sent to you from this office that
the exchange can be made.

Secretary

1135 <Pai& c/tvtnut

j^iAx, yoxi, jvy 1012 s

^ , Mfvu^

0^4^

n^ju)

^A-vu^ ■

P Mi^ ^

/1^

/^<

£^

/yie^

/2 /

^ f^

Sd>.>^

ORTHO RESEARCH FOUNDATION

RARITAN, NEW JERSEY

May 5, 1953

Dr« !• C* Rubin
911 Park Avenue
New York. N. Y.

Dear Doctor Rubin:

We are enclosing two copies of your
paper as corrected to the best of our knowledge«
Possibly Dr« Myller would like one of these«

May we take this opportunity of
thanking you for your painstaking efforts on behalf

of Salpix?

We have sent a large amount of Salpix

out and are having very favorable connient8<

Kindest regards«

tu V« Chapple« M« D«

Sincerely,

yj^

^/H»^

Director of Clinical Research

encl«

WA.

f'' I' ll')l'.' II';'

Mjp^jn^j

excellent visualization
simplified technique

noni('f'ii''iri(ig and nontoKu
painless

no damage to tissues
systemically safe

'.v»ii:)("'io|iil)h .\ad cibso ,

no danger of oil embolization

no radiopaque residue

no foreign body granulomata

new

!' n ( i <'/'!

II '/>;)■

i 1 i / j

iVtVt'ClKBl

CONTRAST MEDIUM

O r (f (h G

Ortho Pharmaceutical Corporation

for safer hysterosalpingography

CONTRAST MEDIUM

Salpix contrast medium makes available for the first time for
hysterosalpingography a radiopaque substance thot

is nonirritating

is painless

leaves no radiopaque residue

permits adäquate visualization
of the Uterus and tubes safely

Although long proposed as an extremely valuable diagnostic procedura'
hysterosalpingography has not met with general acceptance because of the
pathological and morbid sequelae so frequently found with the use of
hitherto available contrast media.^'*

Neither the "interrupted fractional injection"technique proposed by Hyams^
nor the 24-hour postinjection film, common with iodized oils, is necessary
with Salpix contrast medium.

Salpix contrast medium combines the blood extender polyvinylpyrrolidone^
with sodium acetrizoate. RV.R is stable,' nonantigenic and possesses certain
choracteristics similar to human serum albumin^° which assert a protective
action diverting excretion of toxic dyes and other toxins through the kidney
rather than the liver." Sodium acetrizoate contains 65.8% iodine per mole-
cule of the Compound and thus possesses a high degree of radiopacity. It is
water-soluble/^ stoble, and does not release any free iodine.

methods of use

hysterosalpingography

Standard gynecological procedures are followed, with the
important exception that 24-hour postinjection films,
common with iodized oils, are not necessary'^ followlng
the use of Salpix contrast medium because
of its ability to pass through the finest tubal lumen.

QS an aid to diagnosis of uterine pothology

Rubin'^ observed that diagnosis of uterine pothology is greatly aided
if excess Salpix contrast medium is withdrawn from the Uterus
via the introducing cannula. This is due to the property which Salpix
contrast medium possesses of coating the uterine wall with a fine
film of the radiopaque medium.

indications for hysterosalpingography

I Determination of tubal patency.

2 Mechanical release of tubal obstruction.

O Diagnosis of molformations of the Uterus or failopian tubes.

4 Postoperative visualization of tubal piastic surgery.

5 A diagnostic procedure as an aid in the detection of uterine
and tubal pothology.

controindicotions to hysterosalpingography

I Presence of severe vaginal or cervical infections.

2 Existing or recent pelvic infection.

3 Pregnancy.

«-.

Saüfk

M T.M.

CONTRAST MEDIUM

for safer hysterosalpingography

available

Package of 6 individual rubber-capped sterile vials,
each vial filled to deliver 6 cc. Salpix contrast medium.

bibliography

I.Rubin, I. C: Röntgendiagnostik der Uterustumoren mit Hilfe von Intrauterinen Collargoliniektionen
Zentralbl. f. Gynäk. 38:658, 1914.

2. Wharton, L. R.: Gynecology with a Section on Femole Urology, Philadelphia, W. B. Saunders Company,
1943. r- /'

3. Bloomfield, A.: Six Cases of Venous Intravasation following Intrauterine Lipiodol Iniection, J. Obst &
Gynaec. Brit. Emp. 53:345, 1946.

4. Brown, W. E.; Jennings, A. F., and Bradbury, J. T.: The Absorption of Radiopaque Substances Used in
Hysterosalpingography, Am. J. Obst. & Gynec. 58:1041, 1949.

5. Eisen, D., and Goldstein, J.: Lipiodol Intravasation during Uterosalpingography with Pulmonary Com-
plications, Radiology 45:603, 1945.

6. Holm Nielsln, R: Injuries Caused by Hysterosalpingography, Acta obst. et gynec. Scandinav. 26:565,
1946.

7. Hyams, M. N.: Uterosalpingography by Interrupted Fractional Injections, Surg., Gynec. & Obst 60-224
1935. . . ,

8. Reppe, W.; Schuster, C, and Hartman, A.: Polymerie N-Vinyl Lactams and Process of Producing Same.
Bibliographical list published by General Aniline & Film Corporation, New York, March, 1951.

9. Schildknecht, C. E.; Kinney, P. W., Stecker, M. L.: Periston Type Polyvinylpyrrolidone: Report on Physical
Properties, P B Report 96884, Office of Technical Services, United States Department of Commerce.

10. Bennhold, H., and Schubert, R.: Investigation of the Possible "Vehicie Function" of the Plasma Substi-
tute Periston, Ztschr. f. d. ges. exper. Med. 173:722, 1944.

11. Schubert, R.; New Method for Detoxication by Infusion of Low Molecular Fractions of Kollidon: Pre-
liminary Report, Deutsche med. Wchnschr. 7Z:55\, 1948.

12. Neuhaus, D. R.; Christman, A. A., and Lewis, H. B.: Biochemical Studies on Urokon (sodium 2,4,6-
triiodo-3-acetylaminobenzoate), a New Pyelographie Medium, J, Lab. & Clin. Med. 35:43, 1950.

13. Rubin, I. C; Myller, E., and Hartman, C. G.: Solpix: A New Approoch to the Ideal Radiopaque Medium
for Uterosalpingography, Fertil. & Steril., in press.

14. Rubin, I. C: Personal eommunication.

Ortho

Ortho Pharmaceutical Corporation

Roriton, New Jersey

L-12Ö

■«■NW

Printed in USA.

Salplx: A New Approach to the Ideal X-ray Opaque

Medium for Uterosalplngography

I, C> Rubin, M,D,, F.k.C.S., Emest Myller, M.D. and Carl Q. Hartman, PhoD

(

Ever slnce the first attempts were made to vlsuallze the uterine cavlty
(hysterography) and the lumen of the f alloplan tubea (salplngography)
by roeans of Intrauterine collargol Injectlon reported Independently by
Wm.^Cary and I. C. Rubin In 19l4, raany Improvements have been advocated,
Beglnnlng wlth dlfferent Solutions contalnlng halogen salts [Rubin (24)j
Kennedy, (lla^ IIb)] there followed the development of lodlzed olls, of
whlch Llplodol Is representatlve of the entlre group of substances com-
blnlng lodlne wlth olls of varlous klnds . Llplodol was flrst proposed
by Slcard and Porestier (37) for general use and by Heuser (lO) for ap-
pllcatlon In gynecology (3, 8, 13, l4, 32, 35, 36, 40) •

When the organlc lodlne-contalnlng Compounds such as Uroselectan,
Hippuran and Diodrast were developed for urologlcal x-ray dlagnosls,
many gynecologlsts soon adopted these In thelr original form or In some
modlflcatlon thereof (ll, 12, l6, 23, 30). The newer contrast media
comblne a water-soluble organlc lodlne Compound wlth a vehlcle to en-
hance the vlscoslty. Among these comblnatlons may be mentloned Sklodan
comblned wlth acacla and Rayopaque wlth polyvlnyl alcohol^ most recently
carboxyraethyl-cellulose and dextran have been employed to Increase the
vlscoslty In thls raanner, the last-named especlally In Sweden and
Swltzerland. These contrast media have all had the same objectlvej
namely, to avold leavlng oll resldue In the female genital tract.

( lodlzed olls have been employed many tlmes by two of the present authors

untll the deleterlous effects of the olls were dlscovered In 1927 (25,
26) . The harmful results of lodlzed oll comblnatlons as used In the
Investlgatlon of sterlllty may be summarlzed as follows?

- 2 -

(

1) Retentlon In obstructed f alloplan tubes . If the tubes have been non-
patulous, no apparent damage Is suffered by the patlent. If, however,
the tubes have been partlally patent, the lodlzed oil Is trapped by
vlrtue of Its vlscosity, Its very slow absorptlon and fallure to mix
with the tubal secretlons. Retained for varylng lengths of time wlthln
the constrlcted lumen, the oll may, and actually does, set up a forelgn
body reaction leading to granuloma formatlon and complete tubal ob-
structlon. The first Observation of such oll retentlon In the falloplan
tubes was reported by Rubin In 1927 (25) and publlshed in 1928 (26).
Other reports of tubal Irritation soon followed (Ries (22); Novak (l8,
19); Rubin (27, 31, 32).

2) Multiple cyst formatlon. A second undeslrable sequel of the intra-
uterine injection of iodized oil is the long periods of time that
spillage Into the peritoneal cavity remain (4, 7, 17, 31, 32), setting
up multiple cyst formations, which it is well to avoid even though such
peritoneal reaction may not interfere with conception.

Many gynecologists do not favor, or are unenthusiastic conceming, the
use of iodized oil for salpingography, fearing inJury to the cilia.

3) Oil embolism. Of less frequent occurrence (l), but more serious
when it occurs, is the intravasation of iodized oil into the uterine
veins and thence into the systemic circulation (l, 2, 6, 21, 42). Also
to be reckoned with is the introduction of the oil into the myometrium,
especially in cases of adenomyosis where the iodized oil remains for

a long time, with or without inciting inflammatory processes .

These clinical and pathological observations have led to renewed ef-
forts at making available an x-ray opaque substance which has the
following properties: l) it should be dense enough to cast clean
shadowsf 2) it should pass through the fallopian tubes slowly enough

- 3 -

(

to be fllmedj 3) It should be sufflclently vlscous so that strlctures
of the tubal lumen may be accurately vlsuallzed; 4) and flnally the
materlal Injected should be resorbed wlthln a few hours, leavlng no
trace behlnd, elther in the tubes or in the peritoneal cavlty, yet of-
ferlng the possibillty of raaklng a complete and positive dlagnosls In a
relative ly short tlme. In thls connectlon the now well-known fact need
hardly be mentloned that when lodlzed olls are used, a 24-hour film Is
Indispensable to establlsh tubal non-patency or hlgh-grade tubal strlc-
tures.

(

The four crlterla have been fully met In Salplx.

Descrlptlon
The present paper deals wlth an x-ray opaque medium, Salplx, which is
a comblnation of a Solution of polyvlnylpyrrolldone (PVP), basls of a
well-known blood extender, to which has been added Sodium Acetrizoate
CMalllnrVrpodt) The widely used blood Substitute PVP (9) has been
selected as a suitable agent to impart to the acetrizoate, a Compound
of high x-ray opacity, the needed viscostiy and tissue adhesiveness .
Sodium Acetrizoate has a high iodine content (65.8j6) as may be seen
from the following formulas

Chemically thia Compound is described as sodium 3-acetylamino-2-4-6-

triiodobenzoate .

Salplx is an amber colored raixturei Its viscoslty at 37^C is approx-
imately 200 centipolse. It contains 3^^ Sodium Acetrizoate. It is
Stahle on storage at 50^C for 6 months, and will permlt autoclaving

- 4 -

(

wlthout loss of Its deslrable propertles . It Is subjected to the usual
Controls for sterlllty and pyrogenlclty.

Historie Note
It Is of Interest to recall that the flrst trlals wlth uterlne Injec-
tlon of x-ray opaque substances were made upon the human female on
purely emplrlcal grounds . Cary^s flrst Injectlons of Collargol were
made wlthout prior anlmal experlmentatlon and Rubin had made only ana-
tomlcal studles and Injectlons of Collargol In the rabblt before ap-
plylng the method cllnlcally. Soon after. In preparatlon of the cllnlcal
use of oxygen Insufflatlon through the uterus, Rubin Injected the dog's
veln wlth an amount of oxygen equal to that recoramended for the cllnlcal
dlagnosis of tubal patency»

In retrospect there Is no doubt that the new venture was concerned only
wlth the anatomlcal feaslblllty and the physlcal reallzablllty of the
x-ray opaque agent. Untoward effects were only appreclated after some
cllnlcal trlal wlth varlous substances eraployed In hysterosalplngography.

(

Thls early emplrlcal method has slnce been abandoned and replaced by
scientific experlmental controls whlch were Instltuted for example in
the case of viscorayopaque (Rayopaque) . Thls substance appeared to
satlsfy the deslderata of vlscosity as well as non-resldue, but proved
to have Irritant action, in many cases for some mlnutes and occaslonally
longer. As the manufacture of thls product was dlscontlnued, the op-
portunlty proferred by the Ortho Research Foundation was welcoraed to
develop another x-ray opaque substance havlng the same deslrable
prlnclples of Rayopaque minus its disadvantages . The blood Substitute
polyvinylpyrrolidone as the viscoslty-renderlng vehicle for the or-
ganlc iodine component acetrizoate has been subjected to modern ex-
perlmental controls to determine their deslrablllty for cllnlcal trlal

- 5 -

as follows:

(

The Questlon of Toxiclty of PVP and

Since the non-toxlclty of each coraponent of Salplx has been amply
demonstrated (9, 12), and It mlght have been assumed that the combina-
tlon of the two to be also non-toxlc, nevertheless thls was not taken
for granted. Special tests were therefore made to study thls new con-
trast medium, Salplx, for posslble Irritation and toxiclty. These tests
conslsted of Injectlng It Into monkeys, rabblts, dogs and rats, In-
travenously, Intraperltoneally by dlrect abdominal puncture and by way
of the Uterus, also subcutaneously and by gavage . The tests are pre-
sented In outline as follows s

Summary of Experiments wlth Monkeys

Thlrty experlments were made on 13 monkeys; of these anlraals two were
used 4 tlmes; two 3 tlmes; four twlce and 8 but once . In all ex-
perlments x-ray fllms were taken.

Three monkeys recelved each 5 cc . of Salplx Intravenously; none showed
the sllghtest reactlon or Symptom. In 5 experlments the uterus was
entered and Injected froro below by the technlques of Rubin and Morse
(29)j 6 tlmes the uterus was Injected successfully from wlthout. I.e.
through the abdominal wall, because the approach from below Is some-
tlraes extreraely dlfflcult. Three tlmes a laparotomy was done and the
Uterus Injected. Nlne Intraperitoneal Injectlons were made to test
toxiclty and rate of absorptlon. In 4, the vaglna only was Injected.
None of the 13 monkeys showed the least sign of Irritation or toxiclty.

Absence of Toxiclty In Dogs and Rabblts

A dog was Injected subcutaneously wlth 5 cc. of Salplx . At autopsy
the next day, no sign of Irritation was dlscernable at the Injected

6 -

(

area. Another dog received subcutaneously 2 cc, of Salplx in each of
these reglons: right and left scapula and rlght and left gluteal
reglons; no reactlon was noted. A thlrd dog llcked the slte of injec«
tlon of 5 cc. of Salplx frora tlme to tlme for about an hour, otherwlse
showing no Symptoms •

Pour rabblts injected with 5 cc. of Salplx Intravenously showed no
Symptoms of dlscomfort or Irritation whatever. A flfth rabblt was
treated as follows: 5 cc. of Salplx was Injected Intravenously; 5
minutes later, the rlght renal pelvls and ureter and left renal pelvls
were vlsuallzed on the x-ray film; the llver was mottled, the lobules
belng outllned. After 30 minutes there were the same flndlngs, much
materlal showing In the bladder. In 50 minutes, both Ureters were
vlsuallzed, the bladder seen to be dllated and füll of Salplx. In 80
minutes another Intravascular Injectlon of 2.5 cc. of Salplx was made.
The flndlngs were the same as before. No Symptoms appeared.

Rate of Absorption of Salplx

After Intravenous Injectlon of ^ cc. in_ rabblts the materlal was
vlslble only In the bladder one hour later.

After Intravenous Injectlon In monkeys t

No. 29 - 1/18/52 - 5 cc. - In one hour all Salplx In bladder
No. 26 - 1/23/52 - Same In 75 minutes.

(

After Intraperitoneal Injectlon In monkeys (^ to 5 cc.)?

No. 2 - 1/18/52 - 3 cc. - In one hour, none In body cavlty, all In
bladder.

No. 11 - 1/28/52 . 5 cc. - Same as #2.

No. 8 - 1/29/52 - 5 cc. - In one hour falnt streaks of Salplx appeared

In abdominal cavlty, bladder shadow showing large fllllng.

- 7 -

No. 30 - 2/5/52 - 3 cc. - In 80 mlnutes all In bladder. In 2k hours
none left In bladder.

No, 8 - 2/5/52 - 3 cc. - In 30 mlnutes none vlslble in abdomen, bladder
fllled wlth Salpix. In 23 hours, none anywhere.

Injectlon of uterus of inonkeys ( 3. cc . ) :

No. 21 - 11/19/51 - In 90 mlnutes slight resldue in uterus, most in
bladder.

No. 8 - 1/28/52 - Uterus fllled, spillage through tube into body cavity
In one hour abdominal cavity clear, uterlne outline good, rauch Salpix
in bladder.

No. 20 - 2/5/52 - 3 cc. by mistake into pelvis] then 2.3 cc. into
Uterus. In 24 hours no Salpix left anywhere.

No. 24 - 2/5/52 - 3 cc. injected into uterus, with escape into peri-
toneal cavity through oviduct. In 2 hours all absorbed frora abdominal
cavity. In 24 hours all Salpix had disappeared from body.

No. 21 - 3A/52 - Uterus injected. Escape into peritoneal cavity
30 mlnutes uterlne lumen well outlined, no Salpix visible in body
cavity.

(

Summary of Toxicity Experiments

The observations derived from animal experiments with Salpix may be
summarized as follows:

1) After intravenous injectlon, Salpix rapidly leaves the blood stream
via the kidneys. It remains in the uterlne lumen of the monkey up to
one or two hours for reasons stated below, but spillage into the peri-
toneal cavity is eliminated within an hour.

2) The longer retention of Salpix in the monkey uterus as compared with
the human uterus requires a note of explanatlon. In the macaque
species there is in the region of the cervix uteri a colliculus which
pushes the cervical lumen dorsally, like a ball valve, rendering the
( . already narrow passage circuitous and the emptying of the uterus more
difficult. It is apparent, too, that because of the obstructing col-
liculus, Insertion of a cannula frora below is practically impossible

- 8 -

(

wlthout surgery. The surglcal technlque to overcome the cervical ob-
structlon to a uterina cannula was developed by Rubin and Morse (29) o
It consists of cutting through the lateral cervix walls and bypassing
the colliculus. By pulling apart the cervical lips, the uterine cannula
can then be directly inserted into the uterus and injection success«
fully acconrplished. That the colliculus blocks the discharge of
uterine contents has been repeatedly observed by one of the authors
(C.G.H.) who noted that the monkey uterus is much slower to expel its
Contents (a small dead erabryo, for example) than is the case in the
human being. In a few clinical cases with cervical Stenosis Salpix
was retained within the uterus for about a half-hour before it was
evacuated.

3) As Salpix can safely be injected intravenously, its accidental
entry into the blood stream during and after uterosalpingography is
unattended or followed by harmful results which are, unfortunately,
sometimes noted after intravasation of oil into the uterine vein
causing fat embolism.

Clinical Observations and Evaluation

■ m'f

Salpix has been employed by the senior author in uterotubal injection
on over 350 patients. The clinical use of Salpix has in his hands
been more satiafactory than that of previously available opaque
substances. Practically none of the patients experienced the mild to
severe abdominal pain which attends or follows injection of iodized oils
and Solutions of organic iodine Compounds hitherto used, including
Rayopaque. It has been a pleasant experience to see the patients
leave the office without the slightest discomfort after injection of
Salpix, When other iodated Compounds were used it was necessary to
premedicate the patients because many complained of pelvic pains and

- 9

(

other signs of peritoneal Irritation lasting from a few minutes some-
times to a few hours . Although no permanent sequellae were noted
after other water soluble contrast media, the immediate reactlon after
injection was a disadvantage that needed to be overcome.

These observations have raised the questlon of what accounts for the
absence of subjective discomfort after Salpix. The explanation ap-
pears to be the followingi Schubert (3^) has shown that PVP reduces
toxicity of varlous Compounds, In the case of toxlc dyes, he observes
PVP serves to work the dyes out of blood plasma and tissues and to
dlvert them from the liver to the kldneys, hence hastening their
excretion, thus actlng much like human albumln binding. The Virtual
non-existence of toxicity of Salpix may be due to the protective
action of PVP as well as to its rapid absorption and excretion -«
rapid enough to reduce irritation; slow enough to enable the ex-
amining physician to make a concluslve diagnosis of intrauterine
lesions and of tubal patency or non-patency. It is also true that
sodium acetrizoate is stable and gives off no free iodine, which would
of course, cause peritoneal Irritation.

(

Hysterosalpingography has been employed to determine radiographically
the proximal first point of tubal obstruction in cases which were pre-
viously demonstrated by uterotubal insufflation to have non-patent
tubes and where surgical restoration was contemplated. In this con-
nection it should again be eraphasized what has been called attention
to many tlmes before by the senior author that for the determination
of tubal patency, non-patency and partial patency, reliance may be
placed first and foremost upon uterotubal insufflation. For those
who prefer to resort to hysterosalpingography as a method of diag-
noslng tubal patency, the use of Salpix serves to reduce the hazards

10 -

and sequellae of x-ray opaque fluide to a mlnlraum. That Is the Chief
^ vlrtue of thls new medium. It Is taken for granted that the physlclan
employlng Salplx, llke many other slmllar contrast media, will have
famlllarlzed hlmself wlth the Interpretation of the radlographlc
plctures, the detalls of whlch cannot be entered Into here.»

Although the major Interest In Salplx Is Its usefulness In detectlng
Iraportant Intrauterine leslons such as polypl, submucous myomas, and
cervlcal strlctures as well as In pre- and post-menopausal perlods, the
presence of endometrlal Carcinoma, thls new contrast medium, Salplx,
demonstrates at least as well as any of the lodlzed olls hltherto
extenslvely employed for hysterosalplngography wlthout sharing thelr
dlsadvantages (32) • These condltlons have become well known, thanks
to Innumerable reports from all parts of the world . What Is not ap«
f preclated Is the value of routlne hysterography as a preoperatlve
dlagnostlc measure In myomectomy and even more Importantly In the
dlagnosls of endometrlal Carcinoma. The former will presently be dls-
cussed In a forthcomlng monograph; the latter was flrst suggested In a
dlscusslon of Sheffey»s paper on mallgnancy subsequent to Irradiation
of the Uterus for benign condltlons at the 1942 meetlng of the
American Gynecologlcal Society and has recently been the subject of a
special communlcatlon at the Congress at Morocco In April 1952. Slnce
then, several cases have been encountered, one of whlch Is recorded
he re wlth.

♦ For the reader who deslres detalled Information on thls partlcular
subject, reference may be made to a volume on ÜTEROTÜBAL INSUFFLATION,
publlshed In 1947. UTEROTUBAL INSUFFLATION by I . C. Rubin. Publlshed
by C. V. Mosby Co., St. Louis, 1947.

(

- 11 -

(

Gase Report: Mrs. E. G., 43 years old, a nulllpara and nulligravida
consulted one of the present authors (l.C.R.) November l4, 1952, with
the complalnt of bleedlng on and off for the past year, after a two-
year perlod of amenorrhea, whlch she considered to be her menopauseo
On physlcal examinatlon, her uterus was found not to be appreciably
enlarged, but a small amount of dark somewhat clotted blood escaped
at the cervix. Several days later, when she was not bleedlng, a
hysterogram showed raany small irregulär fllllng defects along the
rlght border of the uterlne cavlty and especlally abiindant In the
lower uterlne segraent (Fig. l) . The plcture was strongly suggestive
of Carcinoma, but a positive diagnosis could not be raade on account
of the possible presence of blood clots. A suction endometrial
biopsy was, therefore, done immediately following the hysterogram.
The material submitted was hydrolized. A second endometrial biopsy
was reported as Carcinoma. The patient was operated upon by Mr. V, B.
Green-Arraytage in London, England, December 12, 1952. A total
hysterectomy with bilateral salpingoophorectoray was done for en-
dometrial Carcinoma (Pig 2).

Of especial interest in this case is that two vaginal smears taken
in New York City and examined at a Cancer detection center were re-
ported negative and third vaginal smear taken in London was also
reported negative. Purthermore, as the first endometrial biopsy was
not conclusive, a second one was insisted upon because of the appear-
ance of the hysterogram. The value of x-ray visualization with
Salpix in this particular case needs no further comment except to
emphasize the fact that by its aid the entire conf iguration of the
uterine cavity is visualized and not only those areas which happen
to be within the ränge of the suction curet.

- 12 -

SummaiTy

(

A new water soluble x-ray opaque medium has been descrlbed composed
of polyvlnylpyrrolldone (PVP) wlth Sodlum Acetrlzoate and designated
Salplx.* Thls has the deslred propertles of radlopaclty and vlscoslty -
whlch are best sulted for hysterosalplngography. Sharing the advantages
of lodlzed olls and none of thelr dlsadvantages, thls new contrast
medium Is also superlor to the other water soluble comblnatlons of
lodlne wlth vlscoslty- Increaslng substances because Its use Is un-
attended or followed by pelvlc Irritation, Salplx possesses perfect
tolerability, A special advantage over lodlzed olls is the pos-
slbillty of diagnosing tubal obstruction from one x-ray exposure,
avolding the expense and inconvenience to the patlent of a second
exposure withln 24 hours as is necessary where lodlzed oll is usedo
Another advantage is that withln one or at most two hours It is
absorbed, leavlng no trace thereafter, in contrast to lodlzed olls
whlch are frequently trapped at constrlcted polnts in the tubal lumen,
hence causlng forelgn body granuloraa and total obstruction where only
partlal and reroedlable obstruction was present before the hystero-
salp Ingograph. Adequate experlmental evldence and cllnlcal experlence
in over 350 cases in whlch Salplx was used have deroonstrated its
nearest approach to the ideal x-ray contrast medium for use in
hysterography per se and for hysterosalplngography.

♦ Developed by the Ortho Research Foundation, Rarltan, N. J

Figiire 1

ffl»

Blbllography

1) Bank, J., Compllcatlons of hysterosalplngography. Acta Obstet, et Qynec
( Scand, 29t383-399> 1950.

2) Bloomfleld, Alice, Slx cases of venous Intravasatlon followlng Intrau-

terine Llplodol Injectlons, J. Obstet. & Qynaec. Brlt. Empire,
53? 3^5-3^6, 1946.

3) Brandt, P. and J. Dubols, Concluslon d'une serle de 200 hysterosalpin-

graphles practlques pour sterlllt^. Bull. Soc • Qyn^c. et Obstet.
1949. I. P.349.

4) Brown, Willis E., Agnes P. Jennlngs and J. T. Bradbury, The absorptlon

of radlopaque substances In hysterosalplngography. Am. J. Obstet. &
Gynec, 58:1041-1052, 1949.

(

5) Gary, W. H., Note on deterralnatlon of patency of falloplan tubes by the

use of collargol and the x-ray shadow. Am. J. Obstet. 69:462-464, 1914

6) Eiser, D. and J. Goldstein, Llplodol Intravasatlon durlng uterosalpln-

gography, Radio logy, 45:603, 1945.

7) Plnkbelner, Hans, Hysterosalplngography wlth oll or watersoluble con-

trast media, D. med. Wchnschr., 77:1627-1630, 1952.

8) Prazler, C. H., The use of lodlzed rapeseed oll (camplodol) for roent-

genographlc exploratlon. Am. Surg., 89:801, 1929.

9) General Anlllne and Pllm Corp. P.V.P. (Polyvlnylpyrrolldone) (Book)

New York, 1954.

10) Heuser, C, Llplodol In the dlagnosls of pregnancy, Lancet, 2:4, 1925j

Brlt. J. Radlology 31:110, 1926.

11) Jefferlss, Derek, Hysterosalplngography employlng a watersoluble con-

trast medium, J. Obstet. & Gynec. Brlt. Empire, 55:271^ 1940.

(

IIa) Kennedy, W. T., A method of keeplng falloplan tubes open. Am. J. Obstet.
k Oynec, 3^607, 1922,

IIb) Kennedy, W. T., Radlography of closed falloplan tubes. Am. J. Obstet,
& Qynec, 6:12, 1923.

12) Malllnckrodt Chemical Works, "Professional Information", Sterile Sol-

13) Mathieu, Albert, Hysterosalpingography by means of iodized rapeseed

oil. Am. J. Surg., 14:63^-636, 1931.

14) Mathieu, Albert, Lipiodol as a diagnostic aid in fibromata of female

genital tract. Am. J. Surg., 6:720, 1929.

15) Morse, A. H. and I. C. Rubin, The pharmacodynamic effects of certain

oxytocics upon tubal contractions in the rhesus monkey, Surg. Oynec.
& Obstet., 71:620-623, Nov. 1940.

16) Neuhaus, Dorothy, Adam J. Chris tman and Howard B. Lewis, Evaluation

of some iodine-containing organic Compounds as x-ray contrast media,
Proc. Soc. Exp. Biol. Med., 78:313-317, 1951.

17) Nielsen, Pool Holm, Injuries caused by hysterosalpingography. Acta

Obstet, k Gynec. Scand., 26:265,19^6.

18) Novak, J., Salpingographie oder Tiibendürchblasüng, Zbl. f. Qynak.,

54:3013, 1930.

19) Novak, J., Salpingographie und IßbendSrchblasÄng, Zbl. f. Oynak, 55sl449-

1450, 1931.

^0) Palmer, Allan, Lipiodol "P" for use in hysterosalpingography, Pert.
k Steril., 3^210-216, May-June, 1952.

(

- 3 -

21) Platt, Arnold, Intravasatlon of Llplodol durlng uterosalplngography,

Ohio Med. J,, 43:821, 19^7.

22) Ries, E., Effect of Llplodol Injectlon on the tubes. Am. J. Obstet. 8c

Qynec, 17:728, 1929.

23) Robecchl, E. and A. Tettl, The use of water-soluble vlscous contrast

media for hysterosalplngography, Minerva gln/c, 4:l47-153> 1952|
Abst. In J. Obstet. & Qynec. Brit. Emp. 59:#1564, p.917, Dec. 1952.

24) Rubin, I. C, Roentgen dlagnosls of tumor wlth the ald of Intrauterine

collargol Injectlons, Zbl. f. Gynak., 38:658-660, 1914.

25) Rubin, I. C.,.Thlrteenth Meeting of the Radio loglcal Soc. of North

Am., Dec. 1, 1927.

26) Rubin, I. C, Diagnostic use of Intrauterine lodlzed oll Injectlon

comblned wlth the x-rays as compared to peruterlne carbon dloxlde
Insufflatlon, Radlology, 11:115> 1928.

27) Rubin, I. C, Subphrenlc collectlon of Llplodol followlng Injectlon

Into the falloplan tube. Wlth observatlons on reverse gravltatlon
of pelvlc exudates and the genlto-phrenlc Syndrome In women. Am. J.
Obstet. & Qynec, 31:230, 1936.

28) Rubin, I. C, Retention of Llplodol In falloplan tubes wlth special

reference to accluslve effect In cases of permeable strlcture, N. Y,
State J. Med., 36:1089> 1936.

29) Rubin, I. C. and A. H. Morse, Comparatlve value of radlopaque sub-

stances used In uterosalplngography. Am. J. Roentgenology, 4ls527, 1939

30) Rubin, I.e., Use of soluble x-ray opaque media In gynecology. Med. Rec .

152:212-216, 1940.

(

. 4 .

31) Rubin, I. C, Discusslon to Lewis C. Scheffey's papers Mallgnancy

subsequent to Irradiation of the Uterus for benign conditions.
Trans-Am, Qynec. Soc, 67:313^ 1942.

32) Rubin, I. C, Utero tubal insuff lation, Mosby, St. Louis, 19^7.

33) Rubin, I. C, Comparison of carbon dioxide and opaque media in the

diagnosis of tubal patency, Pert. and Sterility, 3tl79> 1952.

34) Schubert, Ren^, Ne^ie Wege der Entgiftung durch Infusion niedermolekularen

Kollidonfraktionen, D. Med. Wchnschr., 73:551-553, 1948.

35) Seyraour, Prances I., The importance of diagnostic uterosalpingography

in gynecology. Med. Woman's J., Sept. 1939«

36) Seymour, Prances I., A simple method of tubal insufflation treatment

for sterility. Med. Woman»s J., May 3, 1938.

37) Sicard, J. A. and J. Porestier, lodized oil as contrast medium in

radioscopy. Bull, et mem Soc. med d höp de Paris, 46:463, 1922.

38) Sicard, J. A. and D»Oran Solal, Accidents consecutifs au injection in-

trauterine de Lipiodol, Bull, et M^m. Soc. Nat. de Chir., 54:1423, 1928.

39) Weir, William C. and David R. Weir, Theröipeutic value of salpingograms

in infertility, Pert. & Sterility, 2:5l4, 1951.

40) Weisman, Abner I., Incidence of residual intraperitoneal iodochlorol

after hysterosalpingography, Pert. & Sterility, 3^290, 1952.

(

4l) White, Margaret Moore, Erro^te in technique and Interpretation of hyster-
osalpingography and tubal insufflation, J. Obstet. & Gynaec. Brit»
Emp., 58:573-582, 1951.

42) Williauis, E. R., Venous intravasation during uterosalpingography, Brit.
J. Radiology, 17:13, 1944.

Pnjo<yiant

FIRST WORLD CONGRESS

ON
FERTILITY AND STERILITY

HENRY HUDSON HOTEL
NEW YORK CITY
MAY 25-31, 1953

I.F.A.

Sponsored by
The International Fertility Association

and
The American Society for the Study of Sterility

P^uoanjcun

FIRST WORLD CONGRESS

ON
FERTILITY AND STERILITY

HENRY HUDSON HOTEL
NEW YORK CITY
MAY 25-31, 1953

I \

I.F.A.

Sponsored by
The International Fertility Association

and
The American Society for the Study of Sterility

OFFICERS
American Society for the Study of Sterility

President, Irving F. Stein
Vice-President, John O. Haman
Secretary, Walter W. Williams
Treasurer, Carl Johnson
Ass't Secretary, Herbert H. Thomas

Directors

M. Edward Davis
S. Leon Israel
Lewis Michelson
W. T. Pommerenke
Somers H. Sturgis
B. Bernard Weinstein

OFFICERS
International Fertility Association

President, B. Bernard Weinstein

Vice-President, A. Campos da Paz Jr.

Secretary-General, Carlos D. Guerrero

Assoc. Sec'y General, Abner I. Weisman

and

Honorary and Active Vice-Presidents
National Secretaries of each Nation

CONGRESS COMMITTEES

PROGRAM COMMITTEE
Co-Chairmen:

A. Campos da Paz, Jr., Rio de Janeiro, Brazil.

S. Leon Israel, Philadelphia, Pa.
Sub-Chairman:

M. G. Fincher, Ithaca, N. Y.

COMMITTEE ON ARRANGEMENTS

Chairman:

Abner I. Weisman, New York, N. Y.
Chairmen of Subcommittees:

Banquet: John O. Haman, San Francisco, Calif.

Scientific Exhibits: Charles M. McLane, New York, N. Y.

Clinics in New York: Clair E. Folsome, New York, N. Y.;
Abraham Stone, New York, N. Y.

Reception: Samuel L. Siegler, Brooklyn, N. Y.

Welcome: J. P. Greenhill, Chicago, 111.

Registration: Carl Johnson, New Haven, Conn.; Herbert
Thomas, Birmingham, Ala.

Motion Pictures: Daniel B. Roth, Teaneck, N. J.

Public Relations: Somers H. Sturgis, Boston, Mass.

Inaugural: A. Campos da Paz, Jr., Rio de Janeiro, Brazil.

Information: Walter W. Williams, Springfield, Mass.

Language Interpretation: Rita S. Finkler, Newark, N. J.

Women Physicians: Sophia J. Kleegman, New York, N. Y.

Latin-American Night: Aberlardo Salas G., Monterrey, Mexico

Physicians' Wives: Mrs. Martin L. Stone, New York, N. Y.

Chief Interpreter: Mrs. Dolores Dove, New York, N. Y.

LIAISON COMMITTEE

Chairman:
W. T. Pommerenke, Rochester, N. Y.

WORLD CONGRESS COMMITTEE OF THE
I.F.A. AND A.S.S.S.

B. Bernard Weinstein, New Orleans, La., President, I.F.A.

Irving F. Stein, Chicago, 111., President, A.S.S.S.

Carlos D. Guerrero, Mexico, D.F., Secretary-General, I.F.A.

Walter W. Williams, Springfield, Mass., Secretary, A.S.S.S.

CONTINENTAL COMMITTEE

Henri Bayle, Paris, France, representing Europe.

W. T. Pommerenke, Rochester, N. Y., representing North

America.
Edmundo Murray, Buenos Aires, Argentina representing

South America.
Samuel Rozin, Jerusalem, Israel, representing Asia.
Bryan C. Murless, Durban, South Africa, representing Africa.
H. Pellew, Adelaide, Australia, represenüng Australia.

THE FIRST WORLD CONGRESS
ON FERTILITY AND STERIUTY

It was with a good deal of doubt and misgivings that a small
eroup of men gathered together in a room in the Gloria Hotel in
Rio de Janeiro, Brazil, and agreed'that an international meeting
on fertility and sterility should be held in New York City during
the last week of May, 1953. They realized that their embryonic
Society was without funds, that the world had not been organized
in the field of fertility and sterility, and that language barriers
were sure to cause trouble. Yet, on October 18, 1951, these men
had a vision. They simply knew that, come May, 1953, the world
leaders in fertility and sterility would get to New York somehow.
They knew that the First World Congress on Fertility and Sterility
just had to come soon-and why not as soon as was possible? Why
delay?

The organizing committee of the International Fertility Asso-
ciation got underway and elicited the aid of the American Society
for the Study of Sterility. The latter Organization, though still
young and toddling, at least had some 200 members at the time.
The planning, thinking and activities of the two societies merged
for the Congress. Things had to be done-and done fast. They
had but a year and a half to plan for a world-wide meeting.

All the struggles, heartaches and sleepless nights due to uncer-
tainties have come and gone. The First World Congress on Fer-
tility and Sterility is an accomplished fact. Now, we no longer need
hold our breath-the success of the Congress is certain.

Never before in history have so many world leaders in repro-
duction gathered together under one roof. Never before has any
such equally ambitious program been planned for a First Interna-
tional Meeting. Actually, the Congress will hear 189 reports from
investigators from every corner of the earth. Discussors number
in the hundreds. And, never before, for any specialty international
meeting on reproduction have almost a thousand scientists regis-
tered and paid for their reservations in advance!

We have made mistakes-the Congress will have its flaws-our
planning could have been improved in spots-but in the final
analysis, we know that you will have been pleased to be a part of
this first history-making congress.

We are happy to have been of service to our fellow colleagues
of the world and to the people of the world.

The Organizing Committee

A. Campos da Paz, Rio de Janeiro
S. Leon Israel, Philadelphia
Abner I. Weisman, New York City

SPECIAL RECEPTION FOR DISTINGUISHED
INTERNATIONAL GUESTS

Latin — American Night
(La Noche Latino-Americana)

BALLROOM-HENRY HUDSON HOTEL
New York City

Sunday, May 24, 1953, 8:30 P.M.

tendered by the members of the

AMERICAN SOCIETY FOR THE STUDY OF STERILITY

and the

INTERNATIONAL FERTILITY ASSOCIATION

GUEST-CHAIRMAN, ABELARDO SALAS C, M.D.

Monterrey, Mexico

Dress — Typical Native Costume
(Latin American)

By Invitation

Music by Maurice Wolfsie and his Latin-American orchestra

Sponsored by

The International Fertility Association
The American Society for the Study of Sterility

Chairman, Dr. A. Campos da Paz Jr.
Rio de Janeiro, Brazil

Addresses of Welcome:

Dr. Irving F. Stein, President,

The American Society for the Study of Sterility

Dr. B. Bernard Weinstein, President,
The International Fertility Association

Dr. Walter W. Williams, Secretary,

The American Society for the Study of Sterility

Dr. Carlos D. Guerrero, Secretary-General,
The International Fertility Association

Order of Business:

The Roll Call of NATIONS

The Roll Call of OFFICIAL SCIENTIFIC
REPRESENTATIVES

The Roll Call of NATIONAL SECRETARIES of the IFA

PURPOSE, AIMS AND RESOLUTIONS OF THE
CONGRESS

OFFICIAL PROGRAM

FIRST WORLD CONGRESS ON FERTILITY AND STERILITY

Tuesday Morning, May 26, 1953, 8:30 A.M.

Section ll-"CUNICAL ASPECTS OF OVARIAN PHYSIOLOGY"

(Ballroom— Room A)

Honoray Chairman: JUAN CARLOS AHUMADA, Titular
Professor of Gynecology, University of Buenos Aires; Chief of
the Gynecology Service, Hospital of Clinicas, Buenos Aires,
Argentina

Chairman: ERNST NAVRATIL, Graz, Austria

Vice-Chairmen: FERNANDO DE ALMEIDA, Lisbon, Portugal

B. BELONOSCHKIN, Stockholm, Sweden
AMERICO STABILE, Montevideo, Uruguay

Honorary Secretary: OSCAR AGUERO, Caracas, Venezuela

Secretary: HERMAN I. KANTOR, Dallas, Texas, U. S. A.

1. The Value of Vaginal Smears in Sterility

INES L. C. DE ALLENDE, Chief of the Endocrinology Divi-
sion, Mercedes and Martin Ferreyra Institute of Medical
Investigation, Cördoba, Argentina

Discussants: AMELIA ERNST, Santiago, Chile
DIB GEBARA, Rio de Janeiro, Brazil
EPHRAIM SHORR, New York, N. Y.

2. Hypertrophy of the Theca Cells and Sterility

AXEL WESTMAN, Professor of Obstetrics and Gynecology
and Director of the Department of Women's Diseases,
Caroline Institute, Stockholm, Sweden

Discussant: CARL G. HARTMAN, Raritan, N. J., U. S. A.

3. Time of Ovulation in the Menstrual Cycle

PABLO E. BORRAS, Ex-Professor of Gynecology in the Litoral

University and Chief of the Gynecology Service of the Spanish

Hospital, Rosario, Argentina

and
RAFAEL M. PINEDA, Assistant Chief of the Gynecology

Service of the Spanish Hospital, Rosario, Argentina
Discussants: PER BERGMAN, Malmo, Sweden

CARL G. HARTMAN, Raritan, N. J., U. S. A.

A. WOLF NETTO, Rio de Janeiro, Brazil

4. Ovulation Timing

HERMANN KNAUSS, Head of the Department of Gynecology
and Obstetrics in Wien-Lainz, Vienna, Austria

5. Ovulation at or Near the Menopause

ALBERT SHARMAN, Consulting Obstetrician and Gyne-
cologist, Royal Samaritan Hospital for Women; Lecturer,
Clinical Gynecology, University of Glasgow, Glasgow, Scot-
land

6. The Incidence of Ovulation After Ectopic Pregnancy as De-

termined by Endometrial Biopsy
ALVIN M. SIEGLER, From the Department of Obstetrics
and Gynecology, State University of New York at New York
City, College of Medicine; and Kings County Hospital,
Brooklyn, New York

7. Conception During the Safe Period

CARLOS COLMEIRO-LAFORET, Gynecologist and Oste-
trician to the Vigo Hospital, Vigo, Spain

8. Induced Ovulation and Studies on Superfetation in Pregnant
Rabbits

M. SAN MARTIN, Chief of the Joint Laboratory of Genetics
and Reproduction, National University of San Marcos, Lima,
Peru

8:30 A.M.

Section lll-"CLINICAL ASPECTS OF SPERMATOGENESIS"

(Tudor Room— Room B)

Honorary Chairmnn: EDUARDO CASTRO, Clinical Professor
of Urology, National University of Mexico, Chief Urologist
Juärez and Spanish Hospitals, Mexico, D.F.

Chairman: FRED A. SIMMONS, Boston, Mass., U. S. A.

Vice-Chairmen: RAYMOND GROSS, Dublin, Ireland

LEOPOLDO E. LOPEZ, Caracas, Venezuela
JAMES K. L. CHOY, Topeka, Kansas, U. S. A.

Honorary Secretary: ROBERT S. HOTCHKISS, New York, N. Y.

Secretary: PAUL L. GETZOFF, New Orleans, La., U. S. A.

I. Aspects and Prospects of Quantitative Studies on Spermato-
genesis
EDWARD C. ROOSEN-RUNGE, Department of Anatomy.

University of Washington School of Medicine, Seattle,

Washington, U. S. A.

Discussants: WILLIAM H. MASTERS, St. Louis, Missouri,

U. S. A.

FRANCISCO VALDES DE VALLINA, Mexico, D.F.

2. The Endocrine Control of Spermatogenesis

EARL T. ENGLE, Professor of Anatomy, Columbia University,
College of Physicians and Surgeons, New York, N. Y.

Discussants: THALES MARTIN, Rio de Janeiro, Brazil
R. MORICARD, Paris, France
WARREN O. NELSON, Iowa City, Iowa, U. S. A.

3. Pre-adolescent Hypogonadism and Infertility: A Histologie
Study of the Maldevelopment

CHARLES W. CHARNY, Associate in Urology, Albert
Einstein Medical Center; Associate in Urology, Hahneman
Hospital, Philadelphia, Pa., U. S. A. and ALFRED S.
CONSTON and DAVID S. MERANZE, Philadelphia, Pa.,
U. S. A.

Discussants: ADIB ANTONIO COURI, Rio de Janeiro, Brazil
ROBERT VARGAS ZALAZAR, Santiago, Chile
R. PALMER HOWARD, Oklahoma City, Oklahoma, U.S.A.

4. Occupation and Male Fertility: Relation of Occupation to
Lowered Fertility and Infertility

EDUARDO CASTRO, Clinical Professor of Urology, National
University of Mexico, Mexico, D.F.

Discussants: LEOPOLDO E. LOPEZ, Caracas, Venezuela
WALTER W. WILLIAMS, Springfield, Mass., U. S. A.

5. Aspermatogenesis in the Guinea Pig Induced by a Single
Injection of Homologous Testicular Material Combined with
Paraffin Oil and Killed Mycobacteria

JULES FREUND, M. M. LIPTON and G. E. THOMPSON,
Division of Applied Immunology, The Public Health Re-
search Institute of the City of New York, New York, N. Y.

6. The Influence of Orchitis Parotidea on Spermatogenesis
ERIC NORDLANDER, Lecturer, University, Caroline Insti-
tute; Director of Laboratory for Male Fertility Research,
Hospital of the Caroline Institute, Stockholm, Sweden

7. Testicular Biopsy in Some Developmental Abnormalities of
Puberty

D. ANDREANI, M. MONICELLI, and C. CONTI, General
Medical Clinic of the University of Pisa, Pisa, Italy

8. Study of the Morphological and Histochemical Changes Pro-
duced by Estrogens on Adult Human Testes

FELIPE A. DE LA BALZE, Associate Professor, School of
Medicine, University of Buenos Aires, Argentina; and R. E.
MANCINI, G. E. BUR, and JUAN IRAZU, of the School
of Medicine, University of Buenos Aires, Buenos Aires,
Argentina

TUESDA Y

8:30 A.M.

Secfion lll-A-"SPECIAL GENERAL SESSION ON STERILITY"

(Terrace Room— Room E)

Honorary Chairman: EDMA ABOUCHDID, Department of
Gynecology and Obstetrics, American Hospital, Beirut,
Lebanon

Chairman: INES L. C. DE ALLENDE, Cordoba, Argentina

Vice-Chairmen: RONALD M. ALDER, Melbourne, Australia

SAMUEL LETENDRE, Montreal, Canada
LUIS TIRADO VELEZ, Medellin, Colombia

Honorary Secretary: DANIEL TREVINO G., Monterrey, Mexico

Secretary: JOHN M. CANNIS, Plainfield, N. J., U. S. A.

1. Investigation of the Married Couple in a Sterility Clinic in
Adelaide, Australia

HENRY EDWIN PELLEW, Hon. Gynecologist at Royal Ade-
laide Hospital; Hon. Obstetrician at Queen Victoria Mater-
nity Hospital, Adelaide, Australia

2. Simultaneous Recording of Uterine and Tubal Contractility
and of Uterotubal Insufflation

AMERICO STABILE, H. ALVAREZ and R. CALDEYRO-
BARCIA, From the Departments of Obstetrics and Gynecol-
ogy and of Physiology, of the Faculty of Medicine, Monte-
video, Uruguay

3. Rebound Phenomen in the Female

ADIB ANTONIO COURI, Urologist of the Institute of Gyne-
cology, Rio de Janeiro, Brazil

4. Post-Coital Examination of the Vaginal Contents

LUIS RODRIGUEZ VILLA, Professor of Clinical Pathology
in the Graduate School of the National University of Mexico,
Mexico, D.E.

5. An Analysis of 475 Basal Temperature Curves in Gynecological
Gases in Haiti

YVONNE Y. G. SYLVAIN, Hospital of St. Francis De Sales,
Port-Au-Prince, Haiti

6. Sterility and Functional Anovulatory Metrorrhagia Improved
by Diathermie Coagulation of the Endometrium

SERGIO FUENSALIDA, University of Chile, Santiago, Chile

■

7. The Value of Electro-Uterography in Infertility Gases
KURT SOKOL, Bremen, Germany

8. Frequency of Anovulatory Cycles in the Peruvian Woman
Complaining of Sterility

JORGE ASCENZO C, Chief of the Consultorio-Service of
Sterility in the Lozada Clinic, Lima, Peru

— Consecutive Translation During this Session —

Transactions may be ordered at the Congress at the pre-
publication price of $21.00. Only a limited edition will be
published. Be sure to order your copy now. Since meetings
are being held simultaneously, it will be physically im-
possible to hear everything that is being presented at the
Congress.

1:30 P.M.

Section IV-"FACTORS INFLUENCiNG SPERM-EGG UNION"

(Ballroom— Room A)

Honorary Chairman: R. MORIGARD, Director of the Hormone
Laboratory of the School of Special Studies, and of the Labora-
tory of the Gynecological Clinic of the Faculty of Medicine,
Paris, France

Chairman: WILLIAM H. PERLOFF, Philadelphia, Pa., U. S. A.

Vice-Chairmen: EDMA ABOUCHDID, Beirut, Lebanon

RODOLFO ARROYO LLANO, Monterrey,

Mexico
MAXIM ILO TERRAN VALLS, San Jose, Costa
Rica

Honorary Secretary: J. LAMBILLON, Leopoldville, Belgian
Congo

Secretary: MELVIN R. COHEN, Chicago, 111., U. S. A.

1. A Possible Role of Follicular Fluid in Human Fertility and
Infertility

RAPHAEL KURZROK, LEO WILSON, both of the
Morrisania City Hospital, and CHARLES H. BIRNBERG,
Brooklyn Jewish Hospital, New York, N. Y.

Discussants: P. M. F. BISHOP, London, England
KARL BURGER, Murzburg, Germany
EDMOND J. FARRIS, Philadelphia, Pa., U. S. A.

2. Further Studies of the Potential Oxide-Reduction in Tubal
Fecondation; Applications to Sterility by the Study of the
Reduction of Methylene Blue by Human Spermatozoa

RENE MORIGARD, Director of the Hormone Laboratory of
the School of Special Studies; and Director of the Laboratory
of the Gynecological Clinic of the Faculty of Medicine, Paris,
France

Discussants: W. T. POMMERENKE, Rochester, N. Y., U. S. A.
G. HELLINGA, Amsterdam, Netherlands

3. Peritoneal Factor in Sterility

EDMUNDO G. MURRAY, Docente Libre in Gynecology,
University of Buenos Aires; President of the Argentine
Society for the Study of Sterility, Buenos Aires, Argentina

Discussants: AFRANIO A. MATOS, Rio de Janeiro, Brazil
IRVING F. STEIN, Chicago, 111., U. S. A.
DELFINO GALLO, Guadalajara, Mexico

. «

4. Spermigration in the Female Genital Tract

EDUARDO BUNSTER M., Professor of Gynecology, Uni-
versity of Chile; Chairman of the Chilean Obstetrical and
Gynecological Society; and CARLOS LUND, and RENATO
BENEZET, both of the Gynecological Section of the Hospital
del Salvador, Santiago, Chile

3:45 P.M.

Sectio.^ V-"ENDOCRINE FACTORS"
(Ballroom— Room A)

Honorary Chairman: SUBODH MITRA, Professor-in-charge,
Department of Obstetrics and Gynecology, R. G. Kar Medical
College; Director of the Chittaranjan Cancer Hospital, Cal-
cutta, India

Chairman: E. C. HAMBLEN, Durham, N. C, U. S. A.

Vice-Chairmen: JOSEPH G. ASHERMAN, Tel-Aviv, Israel

MAURICIO TEICHHOLZ, Rio de Janeiro,

Brazil
G. TESAURO, Naples, Italy

Honorary Secretary: KANJI KIKA, Sendai, Japan

Secretary: IRVING I. KURLAND, Brooklyn, N. Y., U. S. A.

1. Influence of Vitamin E on the Placenta

B. S. TEN BERGE and RICHARD POLAK, Department of
Gynecology and Obstetrics, State University, Groningen,
Netherlands

Discussants: U. J. SALMON, New York, N. Y.
EVAN V. SHUTE, London, Canada

2. The Value of Hormone-Analysis in Male and Female Sterility
L. I. SWAAB, Leader of Central Sterility Clinic of N.V.S.H.;

Consulting Gynecologist, C.I.Z. Hospital, Amsterdam,
Netherlands

3. Artificial endometrial cycles in the Ovariectomized Woman:
Criteria of Relative Estrogenic Excess

JACQUES FERIN, Lecturer at the University of Louvain,
Louvain, Belgium

4. Congenital Sexual Anomalies

W. O. THOMPSON, Clinical Professor of Medicine, University
of Illinois College of Medicine, Chicago, 111., U. S. A.

5. Observations on the Incidence of Congenital Anomalies and
Their Prevention

EVAN B. SHUTE, Medical Director of the Shute Institute,
London, Canada

6. The Role of the Prostate Gland in Hormone Stimulation
JOSE ALVAREZ LLERENA, Department of Urology, Mexico,

D.F.

7. Contribution to the Treatment of Sterility by Hormonal Pelvic
Vaccination

ARMANDO NASCIMIENTO, JR., Rio de Janeiro, Brazil

We are grateful to the International Business Machines
Co., for their very kind Cooperation and their generosity

in making available the hearing devices.

TUESDAY

1:30 P.M.

Section VI-"PATTERNS AND EVALUATION OF SEMEN"

(Tudor Room— Room B)

Honorary Chairman: WALTER W. WILLIAMS, Clinical Gene-
ticist, Springfield Hospital, Springfield, Mass.; Secretary,
American Society for the Study of Sterility, Springfield, Mass.,
U. S. A.

Chairman: CHARLES W. CHARNY, Philadelphia, Pa., U. S. A.

Vice-Chairmen: ERIC NORDLANDER, Stockholm, Sweden

SERIF CANGA, Ankara, Turkey
BASIL MAROULIS, Athens, Greece

Honorary Secretary: LUIS RODRIGUEZ VILLA, Mexico, D.F.

Secretary: ARTHUR A. ROTH, Cleveland, Ohio, U. S. A.

1. An Analysis of Human Male Fertility

JOHN MACLEOD, Associate Professor of Anatomy, Cornell

University Medical College, New York, N. Y.
Discussant: EDUARDO CASTRO, Mexico, D.F.

2. Fluctuating Male Fertility

RAYMOND G. GROSS, Physician in Charge, Infertility Clinic,
Rotunda Hospital; Gynecologist, Bon Secour Hospital,
Dublin, Ireland

Discussants: CHARLES W. CHARNY, Philadelphia, Pa..

U. S. A.

RUY GOYANNA, Rio de Janeiro, Brazil

3. Electronmicroscopy of Human Spermatozoa

MEYER D. SCHNALL, Gynecology Department, Mount Sinai

Hospital, New York, N. Y.
Discussant: RICHARDT H. HAMMEN, Copenhagen, Den-

mark

4. The Value of Urethrography in the Study of Male Fertility
and Sterility

M. LEOPOLD BRODNY, Urologist to the Fertility Clinic of
Beth Israel Hospital, Boston, Mass., U. S. A.

Discussant: OCTACILIO GUALBERTO, Rio de Janeiro,
Brazil

5. Evaluation of Different Seminal Patterns: their Relation to
Clinical and Laboratory Data; their Significance with Regard
to Therapy

G. HELLINGA, Endocrinologist of the Ned. Herv. Diaconessen
Inrichting, Amsterdam, Netherlands

TUESDA Y

6. Hyaluronidase in Sterility

MICHEL TURPAULT, Vice-President of the French Gyne-
cological Society, Paris, France

7. The Differentiation Between Lack of Motility and Necro-
spermia in Human Spermatozoa; Relation to Fertility

NORBERT KLUEKEN, From the Dermatological Clinic of
the University of Cologne, Krefeld, Germany

8. The Enzymatic Aspect of Male Human Fertility

LOUIS J. CELLA, JR., From the Department of Surgery,
Rhode Island Hospital, Providcnce, Rhode Island, U. S. A.

8:30 P.M.

Section VII-"CLINICAL RECOGNITION OF OVULATION"

(Baliroom— Room A)

Honorary Chairman: H. DE WATTEVILLE, Professor of Gyne-
cology and Obstetrics, Faculty of Medicine of Geneva, Geneva,
Switzerland

Chairman: JUAN WOOD, Santiago, Chile

Vice-Chairmen: ERNESTO DE ARAGON. Havana, Cuba

NORMANDO ARENAS, Buenos Aires,

Argentina
EVAN V. SHUTE, London, Ontario

Honorary Secretary: ELIPHALET WEIZBARD, Rishon-Le-Zion,
Israel

Secretary: LEONARD F. CINER, New York, N. Y.

1. Changes in Respiratory Physiology as a Criterion of Ovulation

W. T. POMMERENKE, R. L. GOODLAND, and J. G.
REYNOLDS, University of Rochester School of Medicine
and Dentistry, Rochestcr, N. Y., U. S. A.

Discussants: CARLOS NOUEL, Caracas, Venezuela
SOMERS H. STURGIS, Boston, Mass., U. S. A.
JOSE MEDINA, Sao Paulo, Brazil
ALICE NETTER LAMBERT, Paris, France

2. Culdoscopy in the Diagnosis of Ovulation and Ovum Migration

ALBERT DECKER, Clinical Professor of Gynecology and
Obstetrics, New York Polyclinic Medical School and Hos-
pital; Associate Clinical Professor of Gynecology and Ob
stetrics, New York Medical College, New York, N. Y.

TÜESDA y

Discussants: RAOUL PALMER, Paris, France
JOHN ROCK, Boston, Mass., U. S. A.
MANUEL URRUTIA RUIZ, Mexico, D.F.

3. The Accuracy of Endometrial. Dating: A Correlation of
Endometrial Dating with Basal Body lempcrature and Menses
ROBERT W. NOYES and JOHN O. HAMAN, From the

Department of Obstetrics and Gynecology, Stanford Uni-
versity School of Medicine, San Francisco, Cal., U. S. A.
Discussants: CHAUNCEY J. PATTEE, Montreal, Canada
SAMUEL L. SIEGLER, Brooklyn, New York
ALEJANDRO POU-DE-SAN 11 AGO, Montevideo, Uruguay
G. TESAURO, Naples, Italy

4. Hormone Effects on Basal Body Tcmperaturcs and Menstrual
Patterns

ROBERT M. PERLMAN, Director, Institute of Endocrinology
and Gerontology, San Francisco, Cal., U. S. A.

Discussants: M. EDWARD DAVIS, Chicago, 111., U. S. A.
S. LEON ISRAEL, Philadelphia, Pa., U. S. A.

5. Correlation Between Vaginal Cytology and Basal Tempera tures
During the Menstrual Cycle

INES L. C. DE ALLENDE and O. ORIAS, The Mercedes and
Martin Ferreyra Institute of Medical Research, Cordoba,
Argentina

6. The Value of Basal Temperatures and Colpocyclogram in the
Diagnosis of Ovulation

HECTOR ROCAMORA and F. LEON BLANCO, University
of Havana, Havana, Cuba

Visit the Technical Exhibits on the Second Floor

WEDNESDAY

8:30 A.M.

Section VIII-"TREATMENT OF ANOVULATION"
(Ballroom— Room A)

Honorary Chairman: S. R. M. REYNOLDS, Department of
Embryology, Carnegie Institution of Washington, Baltimore,
Md., U. S. A.

Chairman: SOMERS H. STURGIS, Boston, Mass., U. S. A.

Vice-Chairmen: ZARE ARSLANIAN, Aleppo, Syria

C. L. JHAVERl, Bombay, India
HALIT KAMGOZEN, Ankara, Turkey

Honorary Secretary: LYMAN W. MASON, Denver, Colorado,
U. S. A.

Secretary: THOMAS D. EFSTATION, Tiffin, Ohio, U. S. A.

1. The Treatment of Female and Male Infertility by X-Ray
Therapy

IRA I. KAPLAN, Clinical Professor of Radiology, N.Y.U.—

Bellevue Medical Center, New York, N. Y.
Discussant: CHARLES MAZER, Philadelphia, Pa., U. S. A.

2. Further Studies on the Hormonal Changes Following Low
Dosage Irradiation of Pituitary and Ovaries in Avulatory
Women

ABRAHAM E. RAKOFF, Clinical Professor of Obstetric and
Gynecologic Endocrinology, Jefferson Medical College,
Philadelphia, Pa., U. S. A.

3. X-Ray Therapy in the Treatment of the Menstrual Anovula-
tory Cycle

ADOLFO JASSIN, Chief of Gynecology of the Regional's In-
stitute of Endocrinology, Buenos Aires, Argentina

4. Anovulatory Cycles and Stimulant Roentgen therapy in 100
Peruvian Sterile Couples

JORGE ASCENZO, Chief of the Sterility Consultorio of the
Lozada Clinic of Lima; Assistant Professor and Chief of
Clinic of the Maternity School of Lima, Lima, Peru

5. Induction of Ovulation in Hirsute, Amenorrheic Women
ROBERT G. GREENBLATT, Professor of Endocrinology,

Medical College of Georgia, Augusta, Ga., U. S. A.

6. The Gonadotropins in the Treatment of the Anovulatory Cycle
CESAR A. BREA, Professor of Gynecology, University of

Buenos Aires, Buenos Aires, Argentina

WEDNESDAY

8:30 A.M.

Section IX-"MALE THERAPEUTIC ASPECTS"
(Tudor Room— Room B)

Honorary Chairman: LEWIS MICHELSON, Emeritus Associate
Professor of Clinical Urology, Stanford University School of
Medicine, San Francisco, Cal., U. S. A.

Chairman: M. LEOPOLD BRODNY, Boston, Mass., U. S. A.

Vice-Chairmen: VICTOR CONILL SERRA, Barcelona, Spain

G. HELLINGA, Amsterdam, Netherlands
RICHARDT HAMMEN, Copenhagen,
Denmark

Honorary Secretary: M. CARDIA, Lisbon, Portugal

Secretary: LOUIS PORTNOY, New York, N. Y.

1. Diagnosis of the Blockage of the Epidiymal Canal, the Vas
and Ejaculatory Ducts

ARMANDO TRABUCCO, Alvear Polyclinic of Buenos Aires,

Argentina
Discussants: VINCENT J. O'CONOR, Chicago, 111., U. S. A.

A. FIGUEIREDO BAENA, Rio de Janeiro, Brazil

2. Surgical Correction of Male Sterility

VINCENT J. O'CONOR, Professor and Head of the Depart-
ment of Urology, Northwestern University Medical School,
Chicago, 111., U. S. A.

Discussants: ROBERT S. HOTCHKISS, New York, N. Y.
LEWIS MICHELSON, San Francisco, California

3. Human Male Sterility due to Brucellosis: A Clinical, Histo-
logical and Hormonal Study in 16 Cases

FELIPE A. DE LA BALZE, Associate Professor, School of
Medicine, University of Buenos Aires; and R. E. MANCINI,
F. ARRILLAGA. G. E. BUR and E. A. MOLINELLI, of
the School of Medicine, University of Buenos Aires, Ar-
gentina

4. Therapeutic Experiences in the Treatment of Delayed Male
Puberty

D. ANDREANI, and C. CONTI, Clinica Medica, University
of Pisa, Pisa, Italy

5. Testosterone Therapy in Male Infertility: Effect of Local
Implantation and Intramuscular Injection
RICHARDT HAMMEN, Copenhagen, Denmark

WEDN ESDAY

6. The End Results of Testostcrone Therapy (Rebound Phenom-
enon) as Observed by the Gynecologist

MORTIMER S. WEINSTEIN, Clinical Assistant Visiting
Gynecologist and Obstetrician, Metropolitan Hospital, New
York, N. Y.

7. Incidcnce of the Male Factor as the Cause of Marital Sterility
in Peru

JORGE ASCENZO, Chief of the Consultorio-Service, Clinica
Lozada, Lima, Peru

1:30 P.M.

Section IX-A-*'SPECIAL MOTION PICTURE SESSION OF NEW
DIAGNOSTIC TECHNIQUES AND TREATMENT*'

(Ballroom— Room A)

1:30 P.M.

•RECENT ADVANCES IN DIAGNOSIS AND THERAPY OF

INFERTILITY"

(Ballroom Foyers)

An opportunity is offered on this afternoon to visit the scientific
exhibits of the Congress at leisure and to discuss particular aspects
of each exhibit with demonstrators at the exhibit Stands.

1:30 P.M.

"NEW INSTRUMENTS, BOOKS, MEDICAMENTS AND
PHARMACEUTICALS IN STERILITY PRACTICE"

(Second Floor Corridors)

An opportunity to visit with the technical exhibitors who are
displaying the latcst apparatuscs, technical aids, drugs and other
items related to sterility practice, is provided. It is suggested that
adequate time be allotted from your busy schedule at the Congress
to visit these technical shows to be informed of the latest advances
from the technical aspect of sterility and fertility. These exhibitors
have been carefully selected and invited to participate in the
Congress, so that you may see, collected together, in a few moments,
what would take hours of visiting elsewhere.

WEDNESDAY NIGHT

8:30 P.M.

Section X-"THE HOSTILE CERVIX"
(Ballroom— Room A)

Honorary Chairman: W. T. POMMERENKE, Associate Professor
of Obstetrics and Gynecology, University of Rochester School
of Medicine and Dentistry, Rochester, N. Y.; National Secretary
for the United States of America to the International Fertility
Association

Chairman: J. P. GREENHILL, Chicago, 111., U. S. A.

Vice-Chairman: J. FERIN, Louvain, Belgium

DEBORA JOFFE, Johannesburg, Union of

South Africa
G. L M. SWYER, London, England

Honorary Secretary: DELFINO GALLO, Guadalajara, Mexico

Secretary: WILLIAM T. BLACK, Memphis, Tenn., U. S. A.

1. The Role of Endocervicitis in Sterility

RANDOLPH GEPFERT, Assistant Professor of Clinical Ob-
stetrics and Gynecology, Cornell University Medical College;
Associate Attending Obstetrician and Gynecologist, New
York Lying-In Hospital

Discussants: DONATO RAMIREZ, Mexico, D.E.
MARGARET MOORE WHITE, London, England

2. Surgical Treatment of Cervical Sterility

RAUL M. CHEVALIER, Chief of the Sterility Center, Faculty
of Medical Sciences of Buenos Aires; Attending Physician,
Hospital of Clinicas, Buenos Aires, Argentina: and JOSE
M.E. MEZZADRA, Associate Professor of Gynecology, Uni-
versity of Buenos Aires; Sub-Chief of the Sterility Center,
Faculty of Medical Sciences, Buenos Aires, Argentina

Discussants: LUIS GOMEZ-DAZA, Mexico, D.E.
JULIO M. MORALES, Asuncion, Paraguay
AURELIO MONTEIRO, Rio de Janeiro, Brazil

3. Post-Coital Examination: Its Value and Interpretation
RAOUL PALMER, Chief of Gynevology, Faculty of Medicine,

Paris, France: and ELISABETH PALMER, Paris, France
Discussants: JOSE GONZALEZ GUERRERO, San Salvador,
El Salvador
JOSE NEMIROVSKY, San Paulo, Brazil
LUIS RODRIGUEZ VILLA, Mexico, D.F.

WEDNESDAY NIGHT

4. The Crystallization Phenomena of the Cervical Mucus: Obser-
vations with the Phase Contrast Microscope

A. CAMPOS DA PAZ JR., Vice-President of the International
Fertility Association, President of the Brazilian Society for the
Study of Sterility, Rio de Janeiro, Brazil: and L. COSTA
LIMA, Titular Member of the Brazilian Society for the Study
of Sterility, Rio de Janeiro, Brazil

Discussants: B. BELONOSCHKIN, Stockholm, Sweden
FRANCE MORICARD, Paris, France
MAXWELL ROLAND, New York, N. Y.

5. Our Experience with the Crystallization Test of the Cervical
Mucus

CARLOS NOUEL, Assistant Professor of Clinical Obstetrics,
Central University of Venezuela, Caracas, Venezuela

6. Contribution to the Study of the Cervical Mucus in Sterility

R. GANDOLFO HERRERA, Professor of Gynecology, Uni-
versities of Buenos Airts and Eva Peron; and VICENTE
LUIS BEARZI, Head of Sterility Center of Eva Peron Uni-
versity, Head of Gynecology Service of Phthisiology Institute,
Buenos Aires, Argentina

7. Some Results in Cervical Mucus Crystallization

ALEJANDRO POU-DE-SANTIAGO, Assistant at the Gyne-
cology and Obstetric Clinica, Gynecologist of the Institute
of Endocrinology, Montevideo, Uruguay

8. Cytologie Cycle of the Endocervical Mucus

AMALIA ERNST, and ALBERTO GUZMAN, From the De-
partment of Obstetrics and Gynecology, University of Chile,
Santiago, Chile

9. Spermatic Findings in the Post-coital Cervical Contents

LUIS RODRIGUEZ VILLA, Professor of Clinical Pathology
of the Post-Graduate School of the National University of
Mexico, Mexico, D.E.

IHURSDAY

8:30 A.M.

Section XI-"BLOOD INCOMPATIBIUTY AND FERTILITY'*

(Ballroom— Room A)

Honorary Chairman: EDWIN M. ROBERTSON, Professor and
Head of the Department of Obstetrics and Gynecology, School
of Medicine, Queen's University, Kingston, Ontario, Canada

Chairman: CARL E. JOHNSON, New Haven, Conn., U.S.A.

Vice-Chairmen: JORGE ASCENZO, Lima, Peru

LORNA LLOYD-GREEN, Melbourne, Australia
ABELARDO SALAS G., Monterrey, Mexico

Honorary Secretary: MAKOTO TAYA, Tokyo, Japan

Secretary: RICHARD A. STREET JR., Vicksburg, Miss., U. S. A.

1. Treatment of the Pregnant Woman "Iso-sensitized" to the Rh
Factors

MANUEL LUIS PEREZ, Professor of Clinical Obstetrics of
the School of Medicine, University of Buenos Aires, Argentina

Discussants: OSCAR AGUERO, Caracas, Venezuela
J. MILTON SINGLETON, Kansas City, Mo., U.S.A.
RAUL BRIQUET, San Paulo, Brazil

2. Is there a relationship Between Spontaneous Abortion and
Blood Factors?

HARRY WALLERSTEIN, Attending in Hematology, Jewish
Memorial Hospital; Consultant Hematologist, Morrisania
City Hospital, New York, N. Y.

3. A-B-O Blood Croups and Rh Subtypes in Sensitized and Non-
Sensitized Rh-negative Pregnant Women
ALEXANDER S. WIENER, Division of Immunohematology

of the Jewish Hospital o£ Brooklyn, N. Y.; RAFFAELE
NAPPI, the Clinica Ostetrica e Ginecologia Universita di
Napoli (Direttore, Prof. G. Tesauro); and EVE B. GOR-
DON, of the Serological Laboratory of the Office of the Chief
Medical Examiner of the City of New York

4. Rh Factor and Double Fetal Malformations

JACOBO ROSENVASSER and MIGUEL MARGULIES,
Buenos Aires, Argentina

THURSDAY

10:45 A.M.

Section XII-"PERINATAL MORTAUTY"
(Ballroom— Room A)

Honorary Chairman: EDMUNDO MURRAY, Docent Libre in
Gynecology, University of Buenos Aires; President, Argentine
Society for the Study of Sterility, Buenos Aires, Argentina

Chairman: SAMUEL M. DODEK, Washington, D. C, U.S.A.

Vice-Chairmen: RONALD M. ALDER, Melbourne, Australia

RODULFO CAMERO, Bogota, Colombia
LIVIA ESCALONA, Caracas, Venezuela

Honorary Secretary: J. LAVERGNE, Panama City, Panama

Secretary: S. S. ROSENFELD, New York, N. Y.

1. Causes of Perinatal Deaths

PEDRO A. GUTIERREZ ALFARO, Ministro de Sanidad y
Asistencia Publica, Republic of Venezuela; Chief Obstetri-
cian, Concepciön Palacios Maternity, Caracas, Venezuela

Discussant: JORGE ASCENZO, Lima, Peru

2. Perinatal Death

J. M. MONIZ ARAGAO, Hospital Pro Matre, Rio de Janeiro,
Brazil, H. FRANC DE FARIA, Rio de Janeiro, Brazil

3. Mortality in Prematurity

GUILHERME DE FREITAS PENTEADO and LUIZ
ALFREDO CORREA DA COSTA, Rio de Janeiro, Brazil

4. Fetal Morbidity and Mortality in Obstetrical Analgesia: A
Study of the Relative Value of the Combination of Mepiridine
(Demerol), Scopolamine, "Trilene" and Pudendal Block

LUIZ DE FREITAS GUIMARAESE, JR, Head of the Obstet-
rical and Gynecological Department of the Polyclinic Hos-
pital of Botafogo, Rio de Janeiro, Brazil

5. Social Factors Causing Prematurity

S. DEXEUS FONT, Director of the Provincial Maternity Hos-
pital of Barcelona, Barcelona, Spain

IHURSDAY

8:30 A.M.

Section XIII-"PELVIC TUBERCULOSIS AND INFERTIUTY"

(Tudor Room— Room B)

Honorary Chairman: l. C. RUBIN, Consulting Gynecologist
Mount Sinai Hospital, New York, N. Y.

Chairman: ALBERT SHARMAN, Glasgow, Scotland

Vice-Chairmen: TOMAS ARMSTRONG, Havana, Cuba

GUSTAVO ISAZA MEJIA, Medellin, Colombia
OSBERTO ROSALES M., Guatemala City,
Guatemala

Honorary Secretary: JUAN A. NUNEZ, Colon, Panama

Secretary: CHARLES R. FREED, Denver, Colorado, U.S.A.

1. The Importance of the Specific Cultures of Uterine and Vaginal
Discharges in the Detection of Genital Tuberculosis in Sterile
Women

L HALBRECHT, Director, Maternity Hospital, Hadera, Israel;
Chairman, Board of Directors Postgraduate Medical School
of the Kupat Holim, Hadera, Israel

Discussants: I. C. RUBIN, New York, N. Y.

MARGARET MOORE WHITE, London, England

2. The Diagnosis of Tubal Tuberculosis with Special Reference
to X-Ray Diagnosis

SAMUEL ROZIN, Consultant, Obstetrical and Gynecological
Department, Hadassah University Hospital, Jerusalem, Israel

Discussants: ARIS TOBULO CARRIZO, Panama City, Pan-
ama
KANJI KIKA, Sendai, Japan
JUAN WOOD, Santiago, Chile

3. Tuberculosis of the Female Genitalia Related to Fertility

KANJI KIKA, Assistant Professor of Obstetrics and Gynecology,
School of Medicine, Sendai, Honshu, Japan

Discussant: GEORGE BLINICK, New York, N. Y.

4. The Problem of Sterility in Female Genital Tuberculosis
ARTURO ACHARD, Docent Libre in Gynecology and Obstet-
rics of the Faculty of Medicine; Medical Chief of the Service
of Gynecology and Obstetrics for Tuberculosis, Montevideo,
Uruguay

THURSDAY

5. The Diagnosis of Tubal Tuberculosis

MARGARET MOORE WHITE, Gynecologist to Fertility De-
partment, Royal Free Hospital, London, England

6. The Non-Surgical Treatment of Pelvic Tuberculosis
LINTON MORRIS SNAITH, Senior Obstetrician and Gyne-
cologist, Newcastle General Hospital; Lecturer in the De-
partment of Obstetrics and Gynecology, King's College,
University of Durham, Newcastle, England

1:30 P.M.
Section XIV-"DIAGNOSIS OF FALLOPIAN TUBE OCCLUSION"

(Ballroom^Room A)

Honorary Chairman: ARNALDO DE MORAES, Professor of
Gynecology and Head of the Department, University of Brazil;
Director, Institute of Endocrine Gynecology, Rio de Janeiro,
Brazil

Chairman: PENDLETON TOMPKINS, San Francisco, Cal.,
U. S. A.

Vice-Chairmen: FRANCISCO LUQUE, Madrid, Spain

JULIO M. MORALES, Asuncion, Paraguay
CARLOS NOUEL, Caracas, Venezuela

Honorary Secretary: ARISTOBULO CARRIZO V., Panama City,
Panama

Secretary: GEORGE SPECK, Arlington, Va., U. S. A.

1. Interpretation of Manometric Oscillation Observed During
Uterotubal Insufflation

AMERICO STABILE, Titular Professor of Obstetrics and
Gynecology of the Faculty of Medicine, Montevideo, Uruguay

Discussants: L. BONNET, Paris, France
EDUARDO BUNSTER, Santiago, Chile
I. C. RUBIN, New York, N. Y.

2. Tubo-ovarian Physiology: Further Observations by Culdotomy
JOSEPH B. DOYLE, Department of Obstetrics, Tufts Medical

School, Boston, Mass., U. S. A.
Discussants: CHARLES L. BUXTON, New York, N. Y.
AXEL WESTMAN, Stockholm, Sweden

IHURSDAY

3. Uterotubal Dynamics

CARLOS D. GUERRERO, Professor of Gynecology, Medical
and Postgraduate Schools, National University of Mexico;
Gynecologist in Charge of Fertility Clinic, Hospital of Gyne-
cology in the "Mexican Institute of Social Security"— Mexico,
D.F.

Discussants: CLARICE AMARAL FERREIRA, Rio de Ja-
neiro, Brazil
PEDRO A. FIGUEROA CASAS, Rosario, Argentina
J. P. GREENHILL, Chicago, 111., U. S. A.

4. The Volumetrie Index of Uterotubal Insufflation

OSCAR BLANCHARD, Associate Professor of Clinical Gyne-
cology, University of Buenos Aires; Chief of the Gynecology
Clinic of the J. Fernandez Polyclinic Hospital, Buenos Aires,
Argentina; and RAUL PARKS, Buenos Aires, Argentina

Discussants: I. C. RUBIN, New York, N. Y.
CLAUDE BECLERE, Paris, France

5. Applications of an Experimental Study for the Interpretation
of the Tracings of Kymographic Insufflation

LOUIS BONNET, Former Chief of the Clinic of the Faculty
of Medicine, Paris, France

6. Uterotubal Insufflation in Normal and Induced Cycles

EDUARDO BUNSTER and LILA CORONEL, Gynecology
Clinic, Salvador Hospital, Santiago, Chile

7. Pathology of Tubal Occlusion

EDMUNDO G. MURRAY, Docente Libre in Gynecology,
University of Buenos Aires; President of the Argentine So-
ciety for the Study of Sterility, Buenos Aires, Argentina

8. A New Method of Exploring the Function of the Fallopian
Tubes

VICTOR CONILL-SERRA, Associate Professor of Obstetrics
and Gynecology of the Faculty of Medicine of Barcelona,
Barcelona, Spain

9. Contribution to the Diagnosis of Tubal Occlusion
ALCIDES SENRA and ALTAMIRO VIANA, Rio de Janeiro,

Brazil

THURSDAY

1:30 P.M.

Section XV-'TROBLEMS IN REPRODUCTION" (Animal)

(Tudor Room— Room B)

Honorary Chairman: M. G. FINCHER, Department of Medicine
and übstetrics, New York State Veterinary College, Cornell
University, Ithaca, N. Y., U, S. A.

Chdinmm: JOHN MACLEOD, New York, N. Y.

V ke-Cliair man : \NTON\0 MIES FILHO, Campo Grande,

Brazil

Honorary Secretary: L. V. D. SLUIS, Leeuwarden, Netherlands

Secretary: C. A. V. BARKER, Giiclph, Ontario, Canada

THURSDAY

6. Low Ternperature Storage of Bull Semen in England

L. E. ROWSON, Cambridge and District Cattle Breeders Ltd.,
The Gravel Pits, Cambridge, England

7. Studies with Frozen Semen in the United States

E. L. WILLETT and HENRY DÜNN, American Foundation
for the Study of Genetics, Madison, Wisconsin

Discussants for Papers 6 and 7:

J. A. HENDERSON, Guelph, Ontario. Canada
JOHN MACLEOD, New York, N. Y.

Program to be continued tomorrow morning

1. Canine and Bovine Ovarian Neoplasms

KENNETH McENTEE, Department of Pathology, New York
State Veterinary College, Ithaca, N. Y.; and C. P. ZEPP JR.,
Zepp Animal Hospital, New York, N. Y.

Discussant: PETER OLAFSON, Ithaca. N. Y.

2. Testicular Biopsies (lllustrated with film)

C. A. V. BARKER, Ontario Veterinary College, Guelph, On-
tario, Canada
Discussant: S. J. ROBERTS, Ithaca, N. Y.

3. The Quality of Semen of Bulls in Relation to the Number of
Ejaculations

VICENTE DE PAULO GRACA and ANTONIO MIES
FILHO, Institute of Zootechnics, of the Ministry of Agri-
culture, Campo Grande, Brazil

Discussant: R. W. BRA I TON, Ithaca, N. Y.

4. Factors of Male Fertility and Actual Methods for its Objective
Estimation

T. BONADONNA, Professor and Director of the "Lazzaro
Spallanzani" Institute for Artificial Insemination, Milan,
Italy

5. Occurrence of Bovine Venereal Trichomoniasis in Bulls Em-
ployed in Artificial Insemination

DAVID E. BARTLETT, American Breeders Service, Chicago,
111., U. S. A.

Discussant: WAYNE BINNS, Logan, Utah
30

Official Banquet, Thursday Evening May 28th, 1953.
Tickets may be obtained now at the Registration desk.

Dress Optional

Hot^l Commodore
Grand Ball Room

THURSDAY NIGHT

FRIDAY

OFFICIAL BANQUET

GRAND BALL ROOM-HOTEL COMMODORE

NEW YORK CITY

Thursday, May 28, 1953, 7 P.M.

JOHN O. HAMAN, M.D.
Chairman, Sub-committee for the Banquet

JOHN MacLEOD, Ph.D.

Suh-Chairman

GUESTS

DR. PEDRO A. GUTIERREZ ALFARO

Ministro de Sanidad and Asistencia Publica

Republic of Venezuela

DR. JOHN F. MAHONEY

Commissioner of Flealth of the City of New York

DR. MARCUS D. KOGEL
Commissioner of Hospitals of the City of New York

Music by Leo Dryer
and his orchestra

Dress Optional

8:30 A.M.
Section XVI-"PROBLEMS IN REPRODUCTION" (Animal)

This Section is a continuation of Section XV
begun on the previous day. The same Board
of Officers will continue to conduct this session.

(Tudor Room— Room B)

1. Experiences With Sterility in Cattle

L. V. D. SLUIS, Health Service for Cattle, Leeuwarden, Nether-
lands
Discussant: S. J. ROBERTS, Ithaca, N. Y.

2. Mucus

H. E. KINGMAN, Wyoming Hereford Ranch, Cheyenne,

Wyoming, U. S. A.
General Discussion

3. The Association of Vibrio Fetus Infection in Cattle with Infer-
tility

J. R. LAWSON, Ministry of Agriculture and Fisheries, Veter-
inary Laboratory, Waybridge, England

4. The Diagnosis of Bovine Vibriosis

D. E. HUGHES and H. L. GILMAN, Department of Bac-
teriology, New York State Veterinary College, Cornell Uni-
versity, Ithaca, N. Y.

Discussants for Papers 3 and 4:

KENNETH McENTEE, Ithaca, N. Y.

A. H. FRANK, Beltsville, Maryland, U. S. A.

General Discussion

Closing and Summation of Program

8:30 A.M.

Section XVII-"TREATMENT OF DISORDERED AND
OCCLUDED FALLOPIAN TUBES**

(Ballroom— Room A)

Honorary Chairman: JUAN JOSE CROTTOGINI, Professor of
Gynecology and Obstetrics, Faculty of Medicine, Montevideo,
Uruguay

Chairman: B. BERNARD WEINSTEIN, New Orleans, La.,

U.S.A.

FRIDA Y

Vice-Chairmen: ALVARO DE AQUINO SALLES, Rio de Janei-
ro, Brazil
EDUARDO BUNSTER, Santiago, Chile
RAUL CHEVALIER, Buenos Aires, Argentina

Honorary Secretary: DARIO SIERRA, Medellin, Colombia

Secretary: JOSEPH N. SEITCHIK, Philadelphia, Pa., U.S.A.

1. The Value of Insufflation in the Diagnosis and Therapy of
Sterility

MARIOS TRITOFTIDES, Obstetrical and Gynecological
Surgical Clinic, Limassol, Cyprus

2. The Value of Uterotubal Insufflation in the Treatment of Tubal
Obstruction to Uvular Migration

I. C. RUBIN, Consulting Gynecologist, Mount Sinai Hospital,
New York, N. Y.

Discussants: F. MORICARD, Paris, France
DONATO RAMIREZ, Mexico, D.E.
ERNEST NAVRATIL, Vienna, Austria
PENDLETON TOMPKINS, San Francisco, Cal., U. S. A.

3. Pregnancy in Sterility Gases Following Gombined Gas-Oil-Gas
(Gynographic Survey) into the Uterotubal Tract Instillations

ABNER I. WEISMAN, Gynecologist and Obstetrician to the
Metropolitan Hospital, Associate in Gynecology and Ob-
stetrics, New York Medical College, Flower and Fifth Avenue
Hospitals.

Discussants: NORMANDO ARENAS, Buenos Aires, Argentina
JOSE GONZALEZ GUERRERO, San Salvador, El Salvador
ALLAN PALMER, San Francisco, Cal., U.S.A.

4. "Ethiodan"— as a Contrast Medium for Uterosalpingography

MARGARET HADLEY JACKSON, Medical Officer to the
Infertility Clinic of Exeter, Devon, England

5. The Use of a Radiopaque and Bacteriostatic Mixture for X-Ray
diagnosis in the Study of Female Sterility

ANTONIO KARCZMAR, Member of the Staff, American-
British Cowdray Hospital, Mexico, D.F.

6. Polyethylene in Tuboplastic Procedures

JOHN ROCK, Senior Surgeon and Director of Fertility and
Endocrine Clinic, Free Hospital for Women; Clinical Pro-
fessor of Gynecology, Harvard Medical School, Boston, Mass.,
U.S.A.; and WILLIAM J. MULLIGAN and CHARLES
EASTERDAY, Associate Surgeons, Free Hospital for Women,
Boston, Mass., U.S.A.

FRIDAY

Discussants: LOUIS M. HELLMAN, New York, N. Y.
MARIO A. CASTALLO, Philadelphia, Pa.
ABNER I. WEISMAN, New York, N. Y.

7. A New and Efficient Technic of Partial Salpibgectomy in the

Cure of Sterility
MANUEL B. RODRIGUEZ LOPEZ, Professor of Clinical Gy-
necology and Obstetrics, Faculty of Medicine, Montevideo,
Uruguay

8. Results of Tubal Surgery in 200 cases of Closure

RAOUL PALM ER, Chief of Gynecology, Faculty of Medicine,
Paris, France

9. Plastic Rings to Retain the Patency of a Newly Formed Tubal
Ostium

EDWARD KAHN, Chief of the Sterility Clinic, Department of
Obstetrics and Gynecology, Sydenham Hospital, New York,

N. Y.

1:30 P.M.

Section XVIII-"UTERINE AND PELVIC PHYSIO-PATHOLOGY"

(Ballroom— Room A)

Honorary Chairman: CLAUDE BECLERE, Ancien Chief of
Gynecology Clinic of the Faculty of Medicine, Paris, France

Chairman: MANUEL B. RODRIGUEZ LOPEZ, Montevideo,
Uruguay

Vice-Chairmen: JOSE MEDINA, San Paulo, Brazil

PETER BISHOP, London, England
EDWIN M. ROBERTSON, Kingston, Ontario,
Canada

Honorary Secretary: CARLOS COLMEIRO LAFORET, Vigo,

Spain

Secretary: CHARLES O. McCORMICK, Indianapolis, Indiana,
U. S. A.

1. Physiopathology of Nidation

OCTAVIO RODRIGUES LIMA, Professor of Obstetrics, Uni-
versity of Brazil, Rio de Janeiro

Discussants: I. HALBRECHT, Hadera, Israel
HECTOR ROCAMORA, Havana, Cuba
CHARLES STEVENSON, Detroit, Michigan, U. S. A.

FRIDAY

2. Observations on the Origin and Specific Function of the Histio-
cytes in the F'emale Genital Tract

GEORGE N. PAPANICOLAOU, Department of Anatomy.
Cornell University Medical College, New York, N. Y.

Discussant: JOHN W. HUFFMAN, Chicago, 111., U. S. A.

3. Pelvic Congestion and Fertility

JUAN JOSE CROTTOGINI, Professor of Obstetrics and
Gynecology, Faculty of Medicine, Montevideo, Uruguay

Discussants: EDUARDO BUNSTER, Santiago, Chile
HOWARD C. TAYLOR, New York, N. Y.
RAFAEL SALINAS RIVERO, Monterrey, Mexico

4. Studies of the Contractility of the Pregnant Uterus

H. ALVAREZ, Associate Professor of Obstetrics and Gyne-
cology, Faculty of Medicine; Head of the Department of
Obstetrics and Gynecology, Hospital Pasteur, Montevideo,
Uruguay: and R. CALDEYRO-BARCIA, Associate Professor
of Physiology, Faculty of Medicine, Montevideo, Uruguay

Discussants: CARL T. JAVERT, New York, N. Y.
J. LAVERGNE, Panama City, Panama

5. Comparative Study on Phosphatases and Glycogen in the
Human Uterine Mucus

FRANCE MARIE MORICARD, In Charge of Endocrine Con-
sultation of the Gynecology Clinic, Hopital Broca, Paris,
France

Discussants: VICTOR CONHILL SERRA, Barcelona, Spain
W. T. POMMERNKE, Rochester, N. Y.
AMALIA ERNST, Santiago, Chile
ROBERTO VAZQUEZ PALLARES, Guadalajara, Mexico

6. Studies on the Metrial Gland

BRUNO ALIPIO LOBO, Professor of Histology and Embry-
ology, Rural University of Brazil, Rio de Janeiro, Brazil

Discussants: GABRIEL ALVAREZ, Mexico, D.E.

GILBERT DOUGLAS, Birmingham, Alabama, U. S. A.

7. Effect of Presacral Nerve Excitation on the Contractility of the
Human Uterus

R. CALDEYRO-BARCIA, and H. ALVAREZ, Faculty of
Medicine, Montevideo, Uruguay

FRIDAY

1:30 P.M.

Section XIX-"PSYCHOGENIC ASPECTS OF THE
INFERTILE COUPLE"

(Tudor Room— Room B)

Honorary Chairman: ANTONIO CLAVERO NUNEZ, Director
of the Spanish Revista of Obstetrics and Gynecology; Mater-
nölogo de la Sanidad Nacional, Barcelona, Spain

Chairman: ALAN F. GUTTMACHER, New York

Vice-Chairman: PEDRO FIGUEROA CASAS, Rosario, Argentina

YVONNE Y.G. SYLVAIN, Port-Au-Prince, Haita
EDMA ABOUCHDID, Lebanon, Syria

Honorary Secretary: RAFAELE NAPPI, Naples, Italy

Secretary: J. JAY ROMMER, Newark, N. J., U.S.A.

L A Tubal Factor in Functional Sterility of Women

BORIS B. RUBENSTEIN, Michael Reese Hospital, Chicago,

IlL, U.S.A.
Discussants: ANTONIO CLAVERO NUNEZ, Barcelona.

Spain

OSBERTO ROSALES M., Guatemala City, Guatemala

A. HERBERT MARBACH, Philadelphia, Pa., U.S.A.

2. A Psychodynamic Approach to the Study of Infertility

E. S. C. FORD, Instructor in Psychiatry; I. FORMAN, Asso-
ciate Professor of Obstetrics and Gynecology; J. R. WILL-
SON, Professor and Head of the Department of Obstetrics
and Gynecology and with the collaboration of other workers
of the Temple University Hospital, Philadelphia, Pa.

3. Psychogenic Factors in Sterility

IRVING C. FISCHER, Mount Sinai Hospital, New York, N. Y.

4. Fear and Voluntary Sterility Following Cesarean Operation
SANTIAGO DEXEUS FONT, Director of the Provincial Ma-

ternity Hospital, Barcelona, Spain

5. Psychogenic Amenorrhoea

JOSE NEMIROVSKY, Gynecologist and Obstetrician, San
Paulo, Brazil

FRIDAY

8:30 P.M.
Section XX-"HUMAN ARTIFiCIAL INSEMINATION'*

(Ballroom—Room A)

Honorary Chairman: ABRAHAM STONE, Director, Margaret
Sanger Research Bureau, New York, N. Y.

Chairman: KARL BURGER, Wurzberg, Germany

Vice-Chairmen: A. CLAVERO NUNEZ, Barcelona, Spain

K. ANDO, Tokyo, Japan

MARGARET HADLEY JACKSON, Crediton,
Devon, England

Honorary Secretary: WILSON G. McKAY, Oshawa, Ontario,
Canada

Secretary: DANIEL B. ROTH, Teaneck, N. J., U.S.A.

1. Legal Aspects of Artificial Insemination

SIDNEY B. SCHATKIN, Assistant Corporation Counsel, City
of New York

Discussant: NICOLAO DINO DE CASTRO COSTA, Rio de
Janeiro, Brazil

2. Therapeutic Donor Insemination

SOPHIA J. KLEEGMAN, Associate Clinical Professor, Obstet-
rics and Gynecology, N. Y. University College of Medicine,
New York, N. Y.

Discussants: ERNESTO R. DeARAGON, Havana, Cuba
I. HALBRECHT, Hadera, Israel
PAUL TOPKINS, New York, N. Y.
MANUEL MATEOS FOURNIER, Mexico, D.E.

3. Retention of Fertilization Capacity of Human Spermatozoa
Stored at Low Temperature with Antibiotics

ALVARO DE AQUINO SALLES, Director of the Clinical
Division of the Institute of Gynecology of the University of
Brazil; and MARIO A. DE CENZO, Chief of the Laboratory
Staff of the Polyclinic of Botafogo, Rio de Janeiro, Brazil

Discussants: EDMOND J. FARRIS, Philadelphia, Pa.
CARL G. HARTMAN, Raritan, N. J.
ABNER I. WEISMAN, New York

FRIDAY

4. The Day of Ovulation as Indicated by 66 Conceptions FoUow-
ing Artificial Insemination

DOUGLAS P. MURPHY, University of Pennsylvania; and
EDMOND J. FARRIS, The Wistra Institute of Anatomy,
Philadelphia, Pa.

Discussants: LOUIS L. FREIDMAN, St. Paul, Minn., U.S.A.
DANIEL B. ROTH, Teaneck, N. J., U. S. A.

5. The General Situation of Artificial Insemination at the Clinic
of the Keio University Hospital, Tokyo, Japan
KAKUICHI ANDO, Director of the Gynecology and Obstetrics

Department, Keio University School of Medicine, Tokyo,
Japan

6. Fertility as Evaluated by Artificial Insemination
SHELDON PAYNE and ROBERT F. SKEELS, Shelton Clinic,

Los Angeles, Cal.

SATURDAY

8:30 A.M.

Section XXI-"DIAGNOSIS AND TREATMENT OF STERIUTY

OF UTERINE ORIGIN**

(Ballroom—Room A)

Honorary Chairman: ERNESTO R. DE ARAGON, Professor of
Obstetrics and Gynecology, National University of Havana,
Havana, Cuba

Chairman: LINTON MORRIS SNAITH, Newcastle, England
Vice-Chairmen: ALFONSO ALVAREZ-BRAVO, Mexico, D.F.

R. MORICARD, Paris, France

LESLIE W. GLEADELL, Melbourne, Australia

Honorary Secretary: ALEJANDRO POU-DE-SANTIAGO, Mon-
tevideo, Uruguay

Secretary: FRANCIS M. INGERSOLL, Boston, Mass., U. S. A.

1. Hypoplasia of the Uterus: Diagnosis and Treatment

JUAN CARLOS AHUMADA, Titular Professor of Gynecol^
ogy, University of Buenos Aires; Chief of the Gynecology
Service Hospital of Clinicas, Buenos Aires, Argentina: and
RAUL M. CHEVALIER, Chief of the Sterility Center,
Buenos Aires, Argentina

Discussant: JOSE MEDINA, San Paulo, Brazil

2. A Preliminary Series of Gases of Uterine Hypoplasia Treated
by Local Injection of an Estrogen Emulsion

CEDRIC LANE-ROBERTS, Gynecologist to Philip Hill Par-
enthood Centre, Royal Northern Hospital, London, England

Discussant: KARL J. KARNAKY, Houston, Texas

S. A Method of Studying the Uterine Canal by Hysteroscopic
Examination

W. B. NORMENT, Surgeon, Wesley Long Hospital, Greens-
boro, N. C., U. S. A.

Discussant: MAXWELL B. ROLAND, New York, N. Y.

4. Hysterography in the Diagnosis of Sterility

CLAUDE BECLERE, Ancien Chief of the Gynecology Clinic,
Faculty of Medicine, Paris, France

Discussants: JOSE NEMIROVSKY, San Paulo, Brazil
ABNER I. WEISMAN, New York, N. Y.

SATURDAY

5. Fibromyomata Uteri and Sterility

ALFONSO ALVAREZ-BRAVO, Professor of Clinical Abdom-
inal Surgery, University of Mexico School of Medicine; Chair-
man of the Gynecological Department of the Spanish Hos-
pital of Mexico, Mexico, D.F.

Discussants: JUAN JOSE CROTTOGINI, Montevideo, Uru-
guay

LICINIO DUTRA, San Paulo, Brazil
EDWARD SOLOMONS, Dublin, Ireland

6. Results of the Strassman Metroplasty in Habitual Abortion
due to Congenital Malformation

JOSEPH A. SCHOCKAERT, Professor of Gynecology and Ob-
stetrics, University of Louvain, Louvain, Belgium
Discussant: ERWIN O. STRASSMAN, Houston, Texas

7. Endometrial Aspiration Smears in the Study of Infertility
GEORGE H. ROMBERG, Director of Fertility Clinic, Gyne-

cologic Outpatient Department, Hospital for Joint Diseases,
New York, N. Y.

8. The Role of Genital Displacement in Female Sterility
FRANCISCO LUQUE, Madrid, Spain

8:30 A.M.

Section XXII-"PROBLEMS OF CHILD ADOPTION**

(Tudor Room— Room B)

Honorary Chairman: KAKUICHI ANDO, Director of the De-
partment of Gynecology and Obstetrics, Keio University School
of Medicine, Tokyo, Japan

Chairman: J. GARCIA ORCOYEN, Madrid, Spain

Vice-Chairmen: A. MOURAO FILHO, Rio de Janeiro, Brazil

DAPHNE CHUN, Hong Kong, China

ARTHUR APARICIO JARAMILLO, Bogota,
Colombia

Honorary Secretary: ARTURO ACH ARD, Montevideo, Uruguay
Secretary: DANIEL B. ROTH, Teaneck, N. J., U.S.A.

1. Introductory Remarks

ABNER I. WEISMAN, Chairman, Committee on Arrange-
ments, World Congress

SATURDAY

2. Indications for Child Adoption

HANS LEHFELDT, Lenox Hill Hospital and Beth David Hos-
pital, New York, N. Y.

3. The Role of the Recognized Adoption Agency in Child Adop-
tion

FLORENCE G. BROWN, Executive Director, Free Synagogue
Child Adoption Committee, New York, N. Y.

4. The Role of the Physician in Child Adoptions

FRED B. KYGER, Chief Obstetrician, Fairmount Maternity
Hospital, Kansas City, Mo., U.S.A.

5. Child Adoption froni the Viewpoint of a Psychiatrist
WILLIAM E. SORREL, Associate Attending Neuropsychiatrist
and Chief of Clinical Psychiatry, Jewish Memorial Hospital,

New York, N. Y.

6. Child Adoption in China

DAPHNE CHUN, Queen Mary Hospital, Hong Kong

7. Fertility After Child Adoption

WILLIAM S. KROGER, Assistant Clinical Professor of Ob-
stetrics and Gynecology, Chicago Medical School, Chicago,
111., U.S.A.

8. Adoption or Donor Artificial Insemination?

MARGARET HADLEY JACKSON, Medical Officer to Infer-
tility Clinic at the Royal Devon and Excter Hospital, Crediton,
Devon, England

1:30 P.M.

Section XXIII-"THREATENED AND HABITUAL ABORTION**

(Ballroom— Room A)

Honorary Chairmen: OCTAVIO RODGRIGUES LIMA, Pro-
fessor of Obstetrics, University of Brazil, Rio de Janeiro, Brazil

Chairman: I. HALBRECHT, Hadera, Israel

Vice-Chairmen: EDWARD SOLOMONS, Dublin, Ireland

FRANCE MARIE MORICARD, Paris, France
TOMAS ARMSTRON, Havana, Cuba

Honorary Secretary: JOSE GONZALEZ GUERRERO, San Sal-
vador, El Salvador

Secretary: M. M. BRAUNSTEIN, Montreal, Canada
42

SAIUROAY

1. The Effect of Artificial Abortion on Fertility

JOSEPH G. ASHERMAN, Director, Women's Hospital Tel-
Aviv, Israel

Discussants: ARTHUR FIRST, Philadelphia, Pa.
KATHLEEN M. D. HARDING, London, England

2. Treatment of Habitual Abortion

JORGE DE REZENDE, Professor of Obstetrics, School of Medi-
cine and Surgery, Rio de Janeiro, Brazil

Discussants: HERBERT S. KUPPERMAN, New York, N. Y.
LINTON MORRIS SNAITH, Newcastle, England
GUILLERMO VAUTRIN, Havana, Cuba

3. Pregnancy Complicating Diabetes

PRISCILLA WHITE, Physician, New England Deaconess Hos-
pital, Boston, Mass., U.S.A.

Discussants: EDWARD C. HUGHES, Syracuse, New York
ARMINDO DE OLIVEIRA SARMENTO, Rio de Janeiro,

Brazil
FLA VIA MIGUEZ DE MELLO, Rio de Janeiro, Brazil

4. The Cervix in Habitual Abortion

J. GARCIA ORCOYEN, Professor of Gynecology, University

of Madrid, Madrid, Spain
Discussants: FERNANDO DE ALMEIDA, Lisbon, Portugal

A. F. LASH, Chicago, 111., U.S.A.

JULIO ORTIZ PEREZ, Havana, Cuba

JOSE G. MARTINEZ, Monterrey, Mexico

5. Treatment o£ Premature Labor

MANUEL B. RODRIGUEZ LOPEZ, Professor of Obstetrics
and Gynecology, Faculty of Medicine, Montevideo, Uruguay

Discussants: A. GUIMARAES FILHO, Rio de Janeiro, Brazil
MARTIN GARRIGA ROCA, Madrid, Spain

6. Role of Congenital Uterine Malformations and of Acquired
Deformities of the Uterine Cavity in the Pathogenesis of Female
Infertility (Habitual Abortion)

I. HALBRECHT, Director of Hadera Hospital, Hadera, Israel
Discussants: I. C. RUBIN, New York, N. Y.

MARGARET MOORE WHITE, London, England

7. Vulvar Fluorescence in the Diagnosis and Treatment of Threat-
ened Abortion

M. SYDNEY MARGOLESE, Clinical Instructor, Department
of Medicine, University of California, Los Angeles, Cal.,
U.S.A.

Discussant: PAUL H. FRIED, Philadelphia, Pa., U.S.A.

SATURDAY

8 Premature Labor

SUBODH MITRA, Professorin-Charge of Department of Ob-
stetrics and Gynecology, R. G. Kar Medical College, Calcutta,
India

9. Role of Extra-Human Factors in Human Fertility

JOSE RAMIREZ-OLIVELLA, Professor of Obstetrics, Uni-
versity of Havana, Havana, Cuba

10. Comparative Study of the Value of Diethylstilbestrol and
Progesterone in the Treatment of Threatened Abortion
LUIZ CASTELAZO AYALA, Mexico, D.F.

1:30 P.M.
Section XXIV-"REPORTS FROM INFERTIUTY CLINICS"

(Tudor Room— Room B)

Honorary Chairman: PEDRO A. GUTIERREZ ALFARO, Minis-
tro de Sanidad y Asistencia Publica, Caracas, Venezuela

Chairman: KATHLEEN M. D. HARDING, London, England

Vice-Chairmen: EDMUNDO G. MURRAY, Buenos Aires, Argen-
tina
JUAN WOOD, Santiago, Chile
L. I. SWAAB, Amsterdam, Netherlands

Honorary Secretary: ORLANDO BAIOCCHI, Rio de Janeiro,
Brazil

Secretary: ANNA K. DANIELS, New York, N. Y.

1. The Outcome of Pregnancy in Women Attending an Infertility
Clinic
GERALD I. M. SWYER, Consultant Endocrinologist to the

Obstetric Department, University College Hospital, London,

England

Discussants: ALVARO DE AQUINO SALLES, Rio de Janeiro,
Brazil

CARL JOHNSON, New Haven, Conn., U. S. A.
B. BERNARD WEINSTEIN, New Orleans, La., U. S. A.

SATURDAY

2. Evaluation of Therapy in 500 Childless Wives

V. H. TURNER and C. D. DAVIS, Department of Obstetrics
and Gynecology, School of Medicine, Duke University, Dur-
ham, N. C, U. S. A.

Discussant: CLAIR E. FOLSOME, New York, N. Y.

3. Infertility: Clinical Impressions Obtained from a Review of
1000 Cases

ROBERT B. WILSON, Section of Obstetrics and Gynecology,
Mayo Clinic, Rochester, Minnesota, U. S. A.

Discussant: G. E. SEEGAR-JONES, Baltimore, Md., U. S. A.

4. Medical Treatment in Pregnancy Following Sterility

CLAUDE BECLERE, Ancien Chief, Gynecology Clinic of the
Faculty of Medicine, Paris, France

5. The Problem of Sterility in Turkey: Statistics and Studies Based
on the Etiology, Diagnosis and Treatment

SERIF CANGA, Professor of Obstetrics and Gynecology, Medi-
cal School of Ankara University, Ankara, Turkey

6. Certain Aspects of Fertility and Sterility in Muselman Women
of North Africa

HENRI FULCONIS, Clinic of Obstetrics and Gynecology,
Algiers, Algeria

7. An Analysis of Accidental Pregnancies Occurring During In-
fertility Studies

DAVID R. WEIR AND ASSOCIATES, Maternal Health Asso
ciation of Cleveland, Ohio

8. Sterility and Fertility Problems in Syria
ZARE ARSLANIAN, Aleppo, Syria

SUN DAY

2 P.M.

Section XXV-*'THE CLOSING SESSION"

(Ballroom— Room A)

Resolutions

Awards

Awarding of Diplomas to Members of the
International Fertility Association

Introduction of New Members of the American Society

for the Study of Sterility

The Roll Call of Nations

Final Summation of the Congress

SCIENTIFIC MOTION PICTURES

Monday, May 25th through Friday, May 29th

Daniel B. Roth, M.D., Chairman
Teaneck, N. J.

John Cannis, M.D.

Giro Tarta, M.D.

Raul Ortiz de la Pena, M.D.

A. R. Abarbanel

Assistant Professor of Obstetrics and Gynecology, College of
Medical Evangelists, Los Angeles, California, U. S. A.

MYOMECTOMY AND MYOMETRIAL
RECONSTRUCTION

Louis B. Bachrach

Associate in Urology, Prince Georges General Hospital,

Cheverly, Md., U. S. A.
Visiting Urologist, George Washington University Hospital,

Washington, D. C, U. S. A.

VASO EPIDIDYMOSTOMY FOR OBSTRUCTIVE

IN FERTILITY
CONGENITAL BILATERAL ATRESL\

C. A. V. Barker

Associate Professor, Department of Medicine and Surgery,
Division of Animal Reproduction, Ontario Veterinary College,

Guelph, Ontario, Canada

TESTiCULAR BIOPSY TECHNICS IN BULLS

Adib Antonio Couri
Institute of Biology, Rio de Janeiro, Brazil

OFFICE TECHNIC OF TESTICULAR BIOPSY

Joseph B. Doyle

Assistant Clinical Professor of Obstetrics, Tufts Medical School,

Boston, Mass., U. S. A.

OBSERVATION OF THE HUMAN TUBO OVARIAN

MECHANISM WITH THE PELVISCOPE

AUTONOMIC UTEROTUBAL DENERVATION

Carlos D. Guerrero

Clinical Professor Obstetrics and Gynecology, National University

Schools of Medicine, Mexico, D.F.

ESTERILIDAD POR MIOMA CAVITARIO Y
MIOMECTOMIA A TRAVES DE HISTEROTOMIA

(Cavitary Uterine Myoma and Myomectomy
through Hysterotomy)

I i.

Jane E. Hodgson

Ancker Hospital, St. Paul, Minnesota, U. S. A.

THE RANA PIPIENS FROG TEST FOR PREGNANCY

Francis M. Ingersoll

Assistant Surgeon, Massachusetts General Hospital,

Boston, Mass., U. S. A.

STEIN-LEVENTHAL SYNDROME

Antonio Karczmar
Medical Staff, The American-British Cowdray Hospital,

Mexico, D.F.

THE USE OF A RADIOPAQUE AND BACTERIOSTATIC

MIXTURE L-E (LIPIODOL F.-ETHER) FOR

HYSTEROGRAPHY AND HYSTEROSALPINGOGRAPHY

A. Lopez de Nava
Chief of the Gynecological and Obstetrical Department of the

Navy Hospital, Mexico, D.F.
Professor of Obstetrics, National University of Mexico School of

Medicine, Mexico, D.F.
A GASE OF DOUBLE UTERUS AND DOUBLE VAGINA-

STRASSMANN'S OPERATION

Maurice Mayer

Department of Gynecology, Hospital of St. Antoine, Paris, France

TUBOPLASTY: TECHNIC OF UTEROTUBAL

IMPLANTATION

Rene Moricard

Directeur du Laboratoire d'Hormonologie de l'Ecole des Hautes

Etudes de l'Universite de Paris, Paris, France

FONCTION MEIOGENE DU LIQUIDE FOLLICULAIRE

ET RECHERCHES SUR LA FECONDATION

(A quantitative study by hormone micro-injection into the ovarian

follicle of a meiogenic function of the follicular liquid:

Problems of human application)

Edgar da Rosa Ribeiro, Rio de Janeiro, Brazil

NUEVO MODELO DE APARATO PARA
HISTEROSALPINGOGRAFIA

(A New Apparatus for Hysterosalpingography)

TECNICA DE ANASTOMOSIS TUBARIA

(Technic of Tubal Anastamosis)

George H. Romberg

Medical Staff, White Plains Hospital, White Plains, N. Y., U. S. A.

ENDOMETRIAL ASPIRATION TECHNIC

Schering Corporation, Bloomfield, N. J., U. S. A.

PHYSIOLOGY OF NORMAL MENSTRUATION

(English and Spanish)

MALE SEX HORMONE

(English and Spanish)

Dr. Shirodkar

Professor of Obstetrics and Gynecology, Grant Medical College

Bombay, India

DIRECT VISION TUBAL PATENCY TEST AND
TECHNIQUE OF UTEROTUBAL IMPLANTATION

Abraham Stone

Director, Fertility Service, Margaret Sanger Research Bureau,

New York, N. Y., U. S. A.

BIOLOGY OF CONCEPTION

Transactions may be ordered at the Congress at the pre-
publication price of $21.00. Only a limited edition will be
published. Be sure to order your copy nofw. Since meetings
are being held simultaneously, it will be physically im-
possible to hear everything that is being presented at the
Congress.

SCIENTIFIC EXHIBITS

Chairman: Charles m. mclane
Sub-Chairmen: Edward c. hughes and rita s. finkler

Ballroom Foyer

A NEW IMPROVED X-RAY OPAQUE MASS FOR
HYSTEROSALPINGOGRAPHY

I. C. RUBIN, M.D.

ERNEST MYLLER, M.D.

CARL G. HARTMAN, PH.D.

New York City, N. Y. and Raritan, N. J.
SOME INTERESTING UTEROTUBAL RADIOGRAPHS

CERIF CANGA, M.D.

University of Ankara, Ankara, Turkey
INVESTIGATION OF TUBAL PHYSIOLOGY

AMERICO STABILE, M.D.

Facultad de Medicina, Montevideo, Uruguay

A NEW NON-BIOLOGICAL PREGNANCY TEST

HOWARD W. JONES, JR., M.D.
G. E. S. JONES, M.D.

Baltimore, Maryland

A FIFTEEN YEAR STUDY OF STERILITY

JUAN WOOD, M.D.
AMALIA ERNST^ M.D,

University of Chile, Santiago, Chile

PRE-COLOMBIAN CENTRAL AND SOUTH AMERICAN

FERTILITY SYMBOLS: PRIMITIVE AFRICAN AND

OCEANIQUE SEXUAL SYMBOLS

ABNER I. WEISMAN, M.D.
JULIUS CARLEBACH

New York City, N. Y.

THE CYTOLOGIC APPROACH TO

GYNECOLOGIC DISORDERS

EMANUEL L. HECHT, M.D.
WILLIAM E. STUDDIFORD, M.D.

New York University — Bellevue Medical Center

University Hospital
New York City, N. Y.

A SIMPLE TEST FOR THE DETERMINATION OF

PREGNANCY AND OVULATION USING

CERVICAL MUCUS SECRETION

MAXWELL ROLAND, M.D.

Queens General Hospital, New York City, N. Y.

CERVICAL MUCUS "SPINNBARKEIT" TEST

FOR OVULATION

U. J. SALMON, M.D.

New York City, N. Y.

USE OF RADIOPAQUE AND BACTERIOSTATIC

MEDIUM (LIPIODOL-E7 HER MEDIUM) IN

GYNECOLOGICAL X-RAY DIAGNOSIS

ANTONIO KARCZMAR, M.D.

American-British Cowdray Hospital, Mexico, D.E.
USE OF THE PELVISCOPE IN CULDOTOMY

JOSEPH B. DOYLE, M.D.

Department of Obstetrics, Tufts Medical School

Boston, Mass.

A STUDY OF THE POST-OVULATORY PHASE OF

THE MENSTRUAL CYCLE IN RELATION TO AGE:

THE LENGTH OF THE PREMENSTRUAL PHASE

R. F. VOLLMAN, M.D.

Geneva, Switzerland, and New York, N. Y.

PELVIC PHOTOSCOPY DURING THE OVARIAN CYCLE

MELVIN R. COHEN, M.D.
HENRY S. GUTERMAN, M.D.

Michael Reese Hospital, Chicago, 111.

"POLYETHYLENE INTUBATED SALPINGOPLASTY"
A NEWER APPROACH TO CLOSED TUBE STERILITY

MARIO A. CASTALLO, M.D.
AMOS S. WAINER, M.D.

Jefferson Medical College, Philadelphia, Pa.

ELECTRONMICROSCOPIC AND PHASE MISCROSCOPIC
STUDY OF HUMAN SPERMATOZOA

MEYER D. SCHNALL, M.D.

Mount Sinai Hospital, New York, N. Y.

CULDOSCOPIC DIAGNOSIS OF GYNECOLOGIC DISEASE

ALBERT DECKER, M.D.

New York Medical College

MARTIN J. CLYMAN, M.D.

New York City, N. Y.

A METHOD OF STUDYING THE UTERINE CANAL
BY HYSTEROSCOPIC EXAMINATION

W. B. NORMENT, M.D.

Wesley Long Hospital, Greensboro, N. C.
TESTICULAR BIOPSY

FRED A. SIMMONS, M.D.

Harvard Medical School, Boston, Mass.
TUBAL INSUFFLATION

LOUIS BONNET, M.D.

Paris, France

NORMAL AND ABNORMAL DEVELOPMENT

OF THE HUMAN EMBRYO

Medical Museum, Armed Forces Institute of Pathology

Washington, D. C.

PATHOLOGY OF TUBAL OCCLUSION

EDMUNDO G. MURRAY, M.D.

Telömaco Susini Institute of Pathology School of Medicine,

University of Buenos Aires
Buenos Aires, Argentina

THE CAUSE OF MANOMETRIC OSCILLATIONS
DURING UTEROTUBAL INSUFFLATION

EDUARDO BUNSTER, M.D.

Hospital del Salvador, Santiago-de-Chile, Chile, S. A.

LA MATURATION OVULAIRE, LA FECONDATION

ET L'EXPLORATION CYTO-HORMONALE

(MUQUEUSE UTERINE HUMAINE)

R. MORICARD, M.D.
F. MORICARD, M.D.

Hospital Broca, Paris, France

THE CRYSTALLIZATION TEST OF THE
CERVICAL MUCUS

ARTHUR CAMPOS DA PAZ, M.D.
LUIS DA COSTA LIMA, M.D.
ORLANDO BAIOCCHI, M.D.

Rio de Janeiro, Brazil

25
26
27

FETAL SALVAGE PROGRAM:
PRECONCEPTIONAL THERAPY

E. C. HUGHES, M.D.

F. J. SCHOENECK, M.D.

C. W. LLOYD, M.D.

A. W. VAN NESS, M.D.

Department of Photography

Department of Obstetrics, State University of New York

State University of New York Medical Center at Syracuse

College of Medicine, Syracuse, N. Y.

ABNORMAL OVULATION

WALTER W. WILLIAMS, M.D.

Springfield, Mass.

A NEW APPARATUS FOR INTRAUTERINE
INSTILLATION OF SEMEN IN ARTIFICIAL

INSEMINATION

DELFINO GALLO, M.D.

Guadalajara, Jal., Mexico

FEMALE STERILITY: ENDOCRINE FACTORS

RITA S. FINKLER, M.D.
SYLVIA F. BECKER, M.D.

Beth Israel Hospital, Newark, N. J.

STUDIES ON THE CONTRACTILITY OF THE
HUMAN PREGNANT UTERUS

H. ALVAREZ, M.D.
R. CALDEYRO-BARCIA, M.D.

Facultad de Medicina, Montevideo, Uruguay

WOMEN'S ENTERTAINMENT

(Headquarters— Georgian Lounge— Henry Hudson Hotel)
Registration Fee $10.00 It pays to register and go to everything

Registration fee includes cost of all events and bus transporta-
tion (banquet not included). Non-registrants will be expected to
pay the listed fee for each event. Tickets must be obtained for
all admissions.

Free tickets for many Radio and Television shows will be avail-
able all week. Simply ask us for them.

The Women's Headquarters Lx)unge will be open all week for
your pleasure and comfort and the Hostess on duty will be happy
to serve you. All information and tickets for the various functions
will be available at the WOMEN'S REGISTRATION D£SK
(2nd floor-Henry Hudson Hotel) or in the WOMEN'S HEAD-
QUARTERS LOUNGE (Georgian Room) at the same hotel.

EVENTS
SUNDAY May 24

Advance registration all day Sunday. It is expected that all

the women will register.

MONDAY May 25th

Registration all day Monday. 8:30 P.M.— Ladies are invited
to attend the Inaugural Session of the Congress in the Ball-
room of the Henry Hudson Hotel. Please wear your badge
to gain admittance to meeting.

FASHION SHOW - LUNCHEON

TUESDAY May 26th

12:30 P.M. Fashion show sponsored by Saks Fifth Avenue and
luncheon in the Ballroom of the Hotel Pierre at 6 Ist Street
and Fifth Avenue. Commentary by Miss Nola Luxford,
Fashion Coordinator, Hotel Pierre. Spanish and French trans-
lators will be present through the courtesy of Saks Fifth
Avenue.

—Fee to non-registrants $5.00

BOAT TRIP

WEDNESDAY May 27th

1:15 P.M. Buses will leave the Henry Hudson Hotel promptly
for the Circle Line pier located at 43rd Street and the Hudson
River. The boat trip around Manhattan is a must for visitors
to New York. The trip takes three hours. Buses will meet the
boat and return to the hotel at the end of the trip. This
event is OPEN TO MEN.

—Fee to non-registrants $3.00 including bus transportation

^::

LEVER HOUSE TOUR - BEAUTY DEMONSTRATION

THURSDAY May 28th

9:30 A.M, Buses will leave the Henry Hudson Hotel for a tour
of Lever House. Fhis edifice is one of the most modern build-
ings in the City of New York. A demonstration on "make-up"
and Souvenirs for all who attend. Lever House is located on
Park Avenue at 53rd Street.

—Fee to non-registrants $1.00 includes transportation

A limited number of hairdresser appointments can be made
at Antoines of Sakes Fifth Avenue for Thursday afternoon.
All requests must be made by Monday at 5 P.M.
7:30 P.M. Official Banquet of the Congress at the Commodore
Hotel. (Reservations should be made at the Main Registra-
tion Desk.)

BUS TOUR
FRIDAY May 29th

2:30 P.M. Buses will leave the Henry Hudson Hotel promptly
for a Grand Tour of New York. Many of the wonders of New
York will be pointed out on this trip, with special emphasis
on the UN buildings. The visit and view from the top of
the Empire State Building will be of special interest to all.
The trip lasts three hours. Tour notes will be printed in
Spanish and English and will be distributed to all.

—Fee to non-registrants $4.00

SATURDAY May 30th

8:30 A.M. The ladies are invited to attend the Scientific Ses-
sion of the Congress on Child Adoption on Saturday morning.
Please wear your badge to gain admittance to meeting in the
Tudor Room (Room B) second floor of the Henry Hudson
Hotel.

SUNDAY May 31 st

2:00 P.M. The ladies are cordially invited to attend the
Closing Session of the Congress.

Booth 24 -
Booth 25
Booth 26
Booth 27
Booth 28
Booth 29
Booth 30
Booth 3 1
Booth 32
Booth 33
Booth 34
Booth 35
Booth 36
Booth 37
Booth 38
Booth 39
Booth 40
Booth 41

TECHNICAL EXHIBITORS

(Second Floor Corridors)

The Purdue Frederick Company

Campbell Associates

The Grafax Company

Westwood Pharmaceutical Corporation

Encyclopedia Americana

Clay Adams Company

Milex Products

Kidde Manufacturing Corp.

Cameron Surgical Specialty Company

Goodman-Kleiner Company

- International Fertility Association

- American Society for the Study of Sterility

- World Congress on Fertility and Sterility

- American Cystoscope Makers, Inc.

- "Teaching Clinics in New York"

- Ortho Pharmaceutical Corporation

- "Distinguished Books"

- E. Fougera and Company

SOCIETIES AND INSTITUTIONS OFFICIALLY
REPRESENTED AT THE CONGRESS

STERILITY SOCIETIES

American Society for the Study of Sterility

Argentine Society for the Study of Sterility
(Dr. Edmundo G. Murray and others)

Brazilian Society for the Study of Sterility
(Dr. A. Campos da Paz)

British Society for the Study of Fertility

Canadian Committee for the Study of Sterility

Cuban Society for the Study of Sterility

French Society for the Study of Sterility

Mexican Association for the Study of Sterility

Monterrey Society for the Study of Sterility

New York Fertility Society

Spanish Society for the Study of Sterility
(Dr. A. Clavero Nunez)

Uruguayan Society for the Study of Sterility

(Drs. Manuel Rodriguez Lopez and Arturo Achard)

Venezuelan Society for the Study of Sterility

MEDICAL SOCIETIES

6©

American Medical Association

(dR. PAUL M. WERNERJ

Editorial Board of Obstetricia

y Ginecologia

Latino- Americana
(dr. jacobo rosenvasser)

Gynecological Society of Israel

(dr. JOSEPH G. ASHERMAN)

Italian Endocrine Society
(dr. d. andreani)

Kupat Holim of Israel
(dr. I. halbrecht)

N.S.V.H.— Netherland Society

of Sexual Reform
(dr. l. l swaab)

Science Council of Japan
(dr. kakuichi ando)

Sociedad Chilena de

Obstetricia and Ginecologia

(drs. EDUARDO BUNSTER, JUAN
WOOD AND AMALIA ERNST)

Sociedad de Obstetricia y
Ginecologia de Rosario
(Argentina)

(drs. PABLO BORRAS AND
PEDRO FIGUEROA CASAS)

Soci^t^ Francaise de
Gynecologie

(drs. RAOUL PALMER AND
MICHEL TURPAULT'i

UNIVERSITIES

American University at

Beirut, Lebanon
(dr. edma abouchdid)

Faculty of Mediane,
Montevideo, Uruguay

(dRS. MANUEL B. RODRIGUEZ LOPEZ
AND ARTURO ACHARD)

Rutgers University,
College of Pharmacy

(DAVID FROST)

University of Barcelona

(dr. VICTOR CONHILL-SERRA)

University of Chile

(drs. eduardo bunster, amalia

ERNST and JUAN WOOD)

University of Buenos Aires

(dr. JUAN CARLOS AHUMADA)

University of Guadalajara
(dr. delfino gallo)

University of Hong Kong
(dr. daphne chun)

University of Paraguay
(drs. julio morales and
eusebio villamayer)

University of Salonica,
at Athens

(dr. KONSTANTINE VLACHOS)

GOVERNMENT AGENCIES

Republic of Argentina
(Ministro de Salud)
(dr. adolfo jassin)

Republic of Brazil
Department of Agriculture

(dr. ANTONIO MIES FILHO)

Republic of Brazil
(dr. a. campos da paz)

Republic of Costa Rica
(dr. m. teran valls)

Republic of El Salvador

(drs. JOSE GONZALEZ GUERRERO,
NARCISO DIAZ BAZAN
SALVADOR BATISTA MENA)

Greek Ministry of Agriculture

(dr. KONSTANTINE VLACHOS)

Italian Government

(dr. GIUSEPPE TESAURO)

Mexican Navy

(dr. LOPEZ DE NAVA)

Republic of Portugal
(Ministerio do Ultramar)

(dr. PEDRO MONJARDINO)

Sweden (Royal Ministry for
Foreign Affairs)

(drs. AXEL WESTMAN AND
ERIC NORDLÄNDER)

Uruguay (Government and

Faculty of Medicine)
(dr. americo stabile)

Venezuela

(dr. CARLOS NOUEL)

]

PROGRAM COMMITTEE
Chairman: a. campos da paz

S. LEON ISRAEL

Sub-Chairmen: m. g. fincher

BANQUET COMMITTEE

Chairman: john o. haman
Sub-Chairman: john macleod

WELCOME COMMITTEE
Chairman: j. p. greenhill

M. LEOPOLD BRODNY
ADOLFO JASSIN
E. CABEAUX

MARTIN L. STONE
RAUL ORTIZ DE LA PENA
RAFFAELE NAPPI

RECEPTION COMMITTEE

Chairman: samuel l. sikgler

Sub-Chairman: Charles h. birnberg

Sub-Chairman: abelardo salas g.

ROBERT S. HOTCHKISS
CHARLES M. MC LANE
UDALL J. SALMON
I. C. RUBIN
CHARLES L. BUXTON
ALBERT DECKER
LOUIS M. HELLMAN
SOPHIA J. KLEEGMAN
RAPHAEL KURZROK
JOHN MACLEOD
ABRAHAM STONE
M. LEOPOLD BRODNY
LEONARD F. CINER
ANNA K. DANIELS
ERALE T. ENGEL
CLAIR E. FOLSOME
RANDOLPH GEPFERT
JOSEPH GOLDZIEHER

ARTHUR V. GREELEY
EDWARD KAHN
HERBERT S. KUPPERMAN
J. IRVING KUSHNER
MAXWELL ROLAND
S. S. ROSEN FELD
DANIEL B. ROTH
MEYER D. SCHNALL
PAUL TOPKINS
LEO WILSON
LAWRENCE Q. CRAWLEY
IRVING C. FISCHER
SHERWIN A. KAUFMAN
IRVING I. KURLAND
LOUIS PORTNOY
GEORGE H. ROMBERG
MARTIN L. STONE

COMMITTEE FOR LATIN-AMERICAN NIGHT

Chairman: abelardo salas g.

Argentina— ADOLFO jassin Guatemala— osberto rosales m.

Brazil-ALVARO de aquino salles Mexico— carlos d. guerrero

Chile— JUAN WOOD
Columbia— RODULFO camero

Cuba— HECTOR ROCAMORA

El Salvador— JOSE Gonzales

GUERRERO

Costa Rica— M. teran valls

Peru— JORGE ASCENZO c.

Panama— A. carrizo
Paraguay— juLio morales
Haiti— YVONNE sylvain
Uruguay— A. pou-de-santiago
Venezuela— CARLOS nouel

NOTES

COMMITTEE ON SCIENTIFIC EXHIBITS

Chairmen: Charles m. mclane

Sub-Chairmen: edward c. hughes

RITA FINKLER

COMMITTEE ON MOTION PICTURES
Chairman: daniel b. roth

JOHN CANNIS CIRO TARTA

RAUL ORTIZ DE LA PENA

WOMEN'S CONVENTION COMMITTEE
MRS. MARTIN L. STONE, Chairman

NEW YORK CITY

MRS. G. PAPANICOLAOU
MRS. M. ROLAND
MRS. G. ROMBERG
MRS. I. C. RUBIN
MRS. M. SAGARRA
MRS. M. SCHNALL
MRS. S. L. SIEGLER
MRS. H. THOMAS
MRS. A. WEISMAN
MRS. W. W. WILLIAMS

WOMEN'S HEADQUARTERS LOUNGE— GEORGIAN LOUNGE
HENRY HUDSON HOTEL

MRS.

. COHEN

MRS.

CHARNY

MRS.

DONNENFELD

MRS.

FISCHER

MRS.

FOLSOME

MRS.

GUTTMACHER

MRS.

HOTCHKISS

MRS.

L. ISRAEL

MRS.

KAHN

MRS.

MC LANE

WE ARE GRATEFUL TO THE FOLLOWING
SPONSORING COMMERCIAL CONCERNS

CIBA PHARMACEUTICAL PRODUCTS, INC.
INTERNATIONAL BUSINESS MACHINES, INC.
SCHERING CORPORATION
THE UPJOHN COMPANY

NEW YORK UNIVERSITY POST -GRADUATE MEDICAL SCHOOL

Departments of
Obstetrics, Qynecology and Urology

COURSE NO. 564-A - INFERTILITY
December 8 through iO, 1952

UNDER THE DIRECTION OF DR. LOCKE L. MACKENZIE AND DR. ROBERT S. HOTCHK I SS

Tuition: $^0 •

ALL SESSIONS IN ERDMANN AUDITORIUM. UNIVERSITY HOSPITAL

303 EAST 20TH STREET N.Y.C. (UNLESS OTHERWISE NOTE)

MONDAY. DEC. 8

8:45 9: 15 a.m.
477 First Avenue

9:15 - 10:00 a.m.

10:00 - 11:00

11: 00 a.m. - 12 noon

12:00 - 1: 00 p m.
l: 00 - 2: 00 p.m.

2:00 - 3:00 p.m.
GYN Clinic

3:00 - 4:00 p.m.

4:00 5:00 p.m.

5:00 - 6:00 p.m.

TUESDAY. DEC. 9
9:00 - 10:00 a.m.

10: 00 - 11:00 a.m.

11:00 a.m. - 12:00 noon

12:00 - 1:00 p.m

Regi st rat ion

Introductory Lecture
Dr. Locke L. Mackenzie

Physiolop^y of Ovulation
Dr. Maxwell Roland

Physiology of Menstruation
Dr. Theodore Neustaedter

Lunch Hour

Technique of Tubal Insufflation
Dr. Ernest Myller ^y

Performance of Tubal Insufflation
Dr . Maxwe l l Roland

Fundamental Con si derations of the
Anatomy and Physiology of the Male
Genital System

Dr. Robert S. Hotchkiss

Hi Story Taking and Physical Examination
in the Male

Dr. Robert 5. Hotchkiss

Cervical Incompatibi li ty
Dr. Locke L. Mackenzie

Physiology of Ferti li zation and
Nidation

Dr. Maxwell Roland

Other Endocrine Factors Involved in
Infertility

Dr. Theodore Neustaedter

Uterine Malposi tions, Fibroids,
Ovarian Cysts and Cervical pathology
as Factors in Infertility
Dr. jyaZter T. Dannreuther

Lunch Hour

Inferti lity

Page 2

)

TUESDAY. DEC. 9 ( coTit inued)
1: 00 2:00 p.m.

2:00 - 5:00 p.m.

GYN Cytology Laboratory

5:00 - 6:00 p

WEDNESDAY. DEC. 10
9:00 10:00 a.m.

10:00 awm. - 1:00 p.m.
GYN Cytology Laboratory

1: 00 - 2:00 p.m.

2: 00 - 3: 00 p-m.
GYN Clinic

3: 00 - 4: 00 p.m.

4:00 - 4:30 p.m

4:30 p.m

Technique of Artificial Insemination
Dr. Locke L* Mackenzie

Techniques and Interpretation of
Semen Analysis
Drs. John MacLeod, Robert Hotchkiss
and John Silberblatt

Motion Picture on Semen Analysis
Dr. Robert S. Hotchkiss

Methods of Determination of the Time
of Ovulation
Dr , Locke L. Mackenzie

Cytology of the Menstrual Cycle
Dr. E. Lawrence Hecht

Lunch Hour

Performance of Hystero- salpingography
Dr. Mortimer N. Hyams

Surgery of Occluded Fallopian Tubes
Dr. Locke L. Mackenzie

Surgery of Male in Infertility
Dr. Robert S. Hotchkiss

Bound Table Discussion

New York University - Bellevue Medical Center
University Hospital
303 E. 20th Street

New York

Department of Gynecology

Staff Conference

Wednecday, December 15 f 19^0

Doctor W.T.Dannreuther, Executive Officer

tophitheatre "»" at i(^:00 p.n*

1. Introduction of a New
Instrument

2. Report of a Gase of
Puberty Bleeding

3. Presentation of a Gase
of Papillomata of the
Bladder

4^ Presentation of a Gase
of Mesenteric Thrombosis
Complicating Pregnancy

5, Report on Ectopic Pregnancy

Doctor Ernest l^ller

Doctor Theodore Neustaedter

Doctor Robert Gushing

Doctor Henry MacDuff

Doctor Michael Jordan

AMERICAN BOARD DF DBSTETRICS AND GYNECDLDGY

Dr. Walter T. Dannreuther, New York. PraideiM
Dr. Joseph L. Baer, Chicago, III., Vice President
Dr. L. E. Phaneuf, Boston, Mass., Vice President
Dr. Paul Titus, Pittsburgh, Pa., Secretary-Treasurer
Dr. E. A. Schumann, Philadelphia. Pa.
Dr. L. A. Emue, San Francisco, Calif.
Dr. Norman F. Miller, Ann Arbor, Mich.
Dr. Willard R. Cooke. Galveston. Texas.
Dr. f. Bayard Carter, Durham, N. C.

f AGS \
AAOG&AS

\ AMA ;

OFFICE OP THE SECRETARY-TREASURER

DR. PAUL TITUS

1015 HiGHLAND Building

Pittsburgh, Pa.

October 2, 1947.

TO APPLICANTS OP THE AMERICAN BOARD OF OBSTBTRICS AND QYNECOLOGY:

It is noted from your application for admission to the exam-
inations of the Board that you are of foreign birth, and I regret to
advise you that it will be necessary for you to furnish us with a not-
arized Statement regarding your citizenship in either the United States
or Canada, since the Board has a ruling that it cannot accept for ad-
mission to exaraination any oandidate who is not a füll Citizen of either
the United States or Canada.

This ruling beoame effective at the olose of the annual
meeting of the Board on June 9, 1942, and applies to all applications
received in this office after that date regardless of the date on which
the original inquiry regarding application was made.

I would suggest that you have prepared by a notary public a
Statement that he has seen your papers and that they are in Order, at-
testing to your füll citizenship in the United States or Canada, or if
your citizenship was attained through your parents' papers when you
were a minor, attested proof of this. Do not send citizenship papers«

We regret greatly that it is necessary to write you about
this matter, but it is required that we have such Information for our
permanent files«

Yours very truly,

PTiA

AMERICAN BOARD DF DBSTETRICS AND GYNECDLDGY

Walter T. Dannrbuthbii, M. D„ New York. Prtsident

Joseph L. Babr. M, D., Chicago, Iu... Vice President

Ludwig A. Emoe, M. D., San Francisco, Calif., Vice President

Paul Trrus, M. D., Ptttsburgh, Pa., Secretary-Trtaturer

NoRUAN F. MnxER, M. D., Ann Arbor, Mich.

Willard R. Cooks, M, D.. Galvbston, Texas.

F. Bayard Carter. M. D., Durham, N. C.

Edward A. Schumann, M. D., Philadblthia, Pa.

Robert L. Faulkner, M. D., Clbvbland, Ohio.

OFFICE OF THE SECRETART-TREA8URER

PAULTITUS, M.D.

1015 Highland Building

PiTTSBUROH 6, Fa.

April 27, 1948,

Dear Doctor Myller:

The Credentials Committee of this Board directs me to inform you
that you are eligible for admission to the Part I examination of this Board to
be held in 19U9, or at ary regularly scheduled Part I examination within three
years of the date of filing your application.

Part I -

The examinations of the Board consist of two parts:

(a) Written examination, to be held on the first Friday of each
February in various cities of the United States and Canada»
Arrangements will be made for you to report for the Part I
written examination at or near your place of residence»

(b) Under a recent change in regulations; case report s to be reviewed
should be scnt to the Office of the Secretary as soon as
possible after receipt of this notice of eligibility. In making
acknowledgment of this notice, the Secretary should be notified
of the apprjximate date on which the case reports may be expected»
This date should not be more than thirty (30) days after the date
of the eligibility notice, and none may be submitted after the
date of the scheduled Part I examination in Februaiy except by
special arrangement. Candidates cannot proceed to Part II examina-
tions until c\fter Part I has been successfully conqpleted.

Part II - - An oral-clinical and pathology examination, following completion

of the Part I examination at a subsequent meeting of the entire
Board. This examination is usually held immediately prior to, and
at the place of , the annual Convention of the American Medical
Association, but may be scheduled elsewhere«

Information as t o the dates and exact location of these examinations
will be published in State medical Journals and The Journal of the American
Medical Association» Notices will be sent you well in advance of the examination
dates»

Your examination fee of $»85 «00 is now due« Please make your check
payal>le io the American Board of Obstetrics and Gynecology.

Ernest Myller, M. D. ,

875 Park Avenue,

New York 21, New York.

pVadf JUL 1 7 194a

Veiy trjüy yours, ^ .

Paul Titus, M. D.
S ec re tary-T re as urer

AMERICAN BOARD DF DBSTETRICS AND GYNECDLOGY

Walte» T. Dannreitthek. M. D„ New York, President
Joseph L. Baer. M, D., Chicago. Iu... Vice President
Norman F. Miller, M. D., Ann Arbor, Mich., Vice President
Paul Trrui. M. D., Ptttsburoh, Pa., Secretary-Treasurer
WaLARD R. CooKE. M. D., Galveston, Texas.
F. Batard Carter, M. D., Durham, N. C.
Robert L. Faulkner, M. D., Cleveland, Ohio.
Daniel G. Morton, M. D., San Francisco, Calu.
R. A. Kimbrouch, Jr., M. D., Philadelphia, Pa.

r AGS \,
,AAOG&AS
\ AMÄ /

OFRCE OF THE SECRETARY-TREASURER

PAULTITUS, M.D.

1015 HiGHLAND Building

Pittsburgh6, Pa.

April 1, 1949.

Ernest Myller, M. D,,

875 Park Avenue,

New York 21, New York.

Dear Doctor Myller:

The American Board of Obstetrics and Gynecology
directs me to inform you, which I do with pleasure, that
you have attained a satisfactory grade in your written
examination and in your case histories,

You are now eligible for the final examination,
Part II (oral and pathology) which will be held at the
Hotel Shoreland, Chicago, Illinois, May 8 to 14 inclusive,
1949, Notice of your examination assignment, from which
you will have dates for making hotel reservations , is
either enclosed herewith or will be forwarded to you soon«

Very truly yours,

. ; ^^ -

Paul Titus, lU ^. ,
Secretary*

PTadf

AMERICAN BOARD DF OBSTETRICS AND GYNECDLDGY

Waltb» T. Dannmuthe», M. D„ New York, Praident
Joseph L. Baem. M, D., CmcAOO. lu... Vice President
NoEMAN F. Miller. M. D.. Ann Arbor, Mich.. Vice President
Paul Tirut. M. D., Pittsburoh, Fa., Secretary-Treasurer
Willard R. Cooke. M. D., GALVEtroN, Texas.
F. Batard Carter. M. D., Durham. N. C.
Robert L. Faulkner. M. D., Clevbland, Ohio.
Daniel G. Morton, M. D., San Francisco, Caue.
R. A. KiuBROUGH. Jr., M. D.. Philadelphia, Pa.

f AGS ^^,

AAOG&AS,
. AMA /

OinCE OP THE SECRETARY-TREASURER

PAULTITUS, M.D.

1015 HiGHLAND Building

Pittsburoh 6, Pa.

May 19, 1949*

Emest Myller, M, D. ,

875 Park Avenue,

New York 21, New York.

Dear Doctor Myller?

The American Board of Obstetrics and Gynecology directs rae to
inform you, which I do with pleasure, that you have successfully passed
the examinations for certification«

Please fill out and retum the enclosed slip to this office so that
your certificate may be properly inscribed. The certificate will be
forwarded to you within the next fev/ months.

In giving us the infonnation for yoiir certificate and for yovir listing
with the Board, will you advise us if you maintain more than one office,
and wish more than one listing in the geographical list of Diplomates« TUTe
will appreciate also if you will advise this office promptly at any time
that your address is changed.

It is the sincere hope of the entire Board that you will continue
your active interest in the work of the Board, and your suggestions will
be welcome at all times«

Cordial^Ly yours,

Paul Titus, M. 1).,
Secretary.

PTadf

encl - certificate slip

•^

Tbl. PLAZA 5-1274

UNITED STATES A INTERNATIONAL
PATENTS ft TRADE MARKS

registered

ARMAND E. MESTERN

PATENT ATTORNEY

565 FIFTH AVENUE

New York 17. N. Y.

Dr. Ernest MyLLer,
875 Park Avenue,
New York, N.Y.

Sept. 16, L949

re:lnsuff lation Cannula

Dear Dr. Ilyller:

I have pleasure to enclose the document
relatlng to the patent issued in the above matter,

The number of the patent is:

2^480,041,

The j^atent Is dated:
August 23, 1949

The term of the patent is 17 yeare from

the Said date. The patented artioles should be marked;
U.S.Patent 2,480,041.

Please acknowledge recei^^t and oblige

AEM/APA
enc.

tV.^.'W'j«-

,^. ^- -^

No./

Massachusetts

Board of Registration in Medicine

As a means of identifying applicanta to
practice mediciiie, two unmounted finished
photographs (not proofs), 3^x4%, of each
applicant must be furnished, one of which
shall be certified by the Dean of the Medical
College (see note) which he attended and t^e
other shall be marked with the niimber assign-
ed to the candidate and shall be returned to
him with his card of admission. Each ap-
plicant must bring the returned pho-
tograph to the Board of Examiners on
the morning on which he takes his
first examination; otherwise the ap-
plicant will not be admitted to the ex-
amination. Cap and gown photographs
and snapshots are not accepted.

Photograph to be presented at each ex-
amination by displaying same upon table when
writing.

This blank should be pasted on the un-
mounted photograph which is to be returned
to the applicant with the card of admission.

^•. \

DR. ERNEST MYLLER

Am 23. Oktober starb im 60.
Lebensjahr infolge einer Herz-
attacke der bekannte Gynäkologe
Dr. Ernst Myller, der in New
York am Madison Avenue und
University Hospital tätig war. In
Schmalkalden geboren, studierte
er Medizin an der Univerlität von
Berlin und wirkte bis zur Macht-
übernahme der Nazis an einem
Spital in Nürnberg. Danach wan-
derte er nach Griechenland aus,
wo er in Athen ein Spital grün-
dete, dem er sieben Jahre lan^
vorstand.

Neben seiner ausserordentlich
erfolgreichen medizinischen Wf-
tigkeit — er war Arzt der ameri-
kanischen und britischen Bot-

schaft und des Königs von Grie-
chenland — stellte er sich nach
Kriegsausbruch den Alliierten zur
Verfügung und arbeitete für das
British Intelligence Service. Als
die Deutschen 1941 in Griechen-
land einfielen, evakuierten die
Engländer Dr. Myller und seine
FamlM^ auf einem britischen

Kreuzer. Dr. Myller ging nach
den Vereinigten Staaten und liess
sich in New York nieder.

Er hat zahlreiche wissenschaft-
liche Arbeiten auf gynäkologi-
schem Gebiet veröffentlicht und
auch Instrumente entworfen, da-
runter solche zur Feststellung
von Gebärmutterkrebs. Er war
Sekretär der Rudolf Virchow Mc-
«»1 Society und Chairm«in der
onference of the Obstetrical
oard of Madison Avenue Hospi-
Tal sowie Mitglied verschiedener^
wissenschaftlicher Verein! jungen.
Dank seiner grossen Hilfsbe-
reitschaft, Liebenswürdigkeit und
Pcscheidenheit erfreute sich Dr.
Myller besonderer Beliebtheit bei
allen, die ihn kannten. Er wird
von seiner Frau, Liselotte, und
einem Sohn, Ralph, überlebt. Sein
zweiter Sohn, Lieutenant Ulrich
Myller, ist vor drei Monaten in
Korea gefallen.

Ittjprinted liom NEW YORK STATE JOURNAL OF MEDICINE, Vol. 50, No. 3, Feb. 1, 1950

Co})yrig}it 1950 l)y the Medical Society of the State of New York and reprinted by permission of the

A CERVICAL "SCRAPER"

Ernest Myller, M.D., New York City

{From the Universüy Hospital, New York Universüy-Bellevue Medical Center)

PAPANICOLAOU'S detection of exfoliated
Cancer cells in the vaginal smear has added
greatly to the early recognition of malignant dis-
ease. The present method of scraping the cer-
vical canal in order to obtain a greater concen-
tration of Cancer cells, and especially more cells
from the cervical epithelium, is considered an
improvement over the simple vaginal smear.
The important region to be investigated is the
junctional region between the columnar cell
epithelium and the squamous cell epithelium,
since the majority of cervical Cancers originate in
that area. The detection of Cancer of the cervix
and the fundus at the earliest possible moment
will increase the curability of this disease to a
considerable degree. The well-founded assump-
tion that a noninvasive Carcinoma may be present
intraepithelially for many years without any
Symptoms and without progress justifies an
examination of every adult woman by the vaginal
smear method or with a cervical scraping, or
both.

A simple instrument, the cervical "scraper,"
facilitates obtaining satisfactory specimens with
every routine vaginal examination . * This instru-
ment consists of a small metal cone attached to a
handle (Fig. 1). On both sides of the cone there
is a fin (Fig. 2) . These two fins converge on the
top of the cone. The free sides of the fins are rec-
tangular but not sharp. When used properly
no trauma occurs; only epithelial cells will be
scraped off. Satisfactory smears can be obtained
by an examiner without previous experience.

Fig. 2.

Fig. 3.

-Ä

Fig. 1.

After exposure of the cervij^ with a speculum,
the cone is inserted into the cervical canal and
rotated once or twice with very slight pressure
(Fig. 3). Occasionally, suspicious areas outside
the canal should also be scraped off with the top
of the instrument where the two fins join. The
epithelial cells will adhere to the fins, and the

material thus obtained is transferred to glass
slides by smearing it from the fins directly on
the slides. The slides are immediately immersed
in the fixative Solution.

The conical shape of the cervical "scraper"
prevents its deviation from the longitudinal axis
of the cervical canal; the scraper is bound to
come in contact with the epithelial junction line
whether the cervix is small or large.

The cervical * 'scraper" is easily sterilized and
can be used repeatedly to obtain cells from the
cervix. In comparing smears taken with this
scraper and with disposable wooden spatulas, it
appears that more sheets of well-preserved cervi-
cal cells are obtained with the former with little
or no bleeding. The instrument penetrates as
easily into the nonparous cervical os as into a
lacerated, diseased cervical canal.

* Manufactured and diatributed by United Surgical Supply
Co., 160 East 56 th Street, New York City.

ao4

"■■i.

.-»•\

I-e ; Dr Sl^Oi^'r LYLliSR .

?o ;/lioi. it i.ay concern.

Avenue, llev^ York 2I,::»Y. ,v;as est^blis}.ed in Athens fron 1 934-1 941,
Vhile here he^ directed a ^n^cGloGical-obstetrical Clinic.;,
estiration ho \ms one. of the best {^^necolo^ists and obstetrlclans
in Athens. I consider liir. an ercellant physician and sur^eon; I
liave liad the opoortuuity to follor liic Operations and have seen
eycellent reGults.

1mm

i 'q;

.OaLU ^

I. erber of tKe Agadex-iy /'"Athens ,
Cliaiman of the Syprer.e IDsltli Council and
Pi-ofensor o^f the l'edical 7aculty in thB^l'niversit:
of Athens; >

Athens, 30 th GeptCL.ber Iö46.

O
u

Reprinted, with additions, from The Journal of the American Medical
Asswialion. June 21, 1952, Vol. 149, pp. 757 and 758

CONTROL OF POSTPARTUM HEMORRHAGE

Ernest Myller, M.D., New York

Hemorrhage is one of the most frequent causes of
Postpartum death. Statistics being reliable only from
larger Hospitals, we may assume that many Postpartum
deaths are either unreported or designated otherwise.
In a report from the Mayo Clinic,' the incidence of
death from hemorrhage is 0.491 per 1,000 births, an
average of 1 case per 2,000 deliveries. Postpartum hem-
orrhage in a large Brooklyn hospital caused death in 34
of 37 cases of obstetric fatality. It can only be conjectured
how many more occur in institutions with lower Stand-
ards.

There are Standard methods of treating postpartum
hemorrhage. It must be assumed from the poor results
reported that they are not always successful. The usual
routine procedure is to endeavor to find out whether the
Uterus is empty or to establish other causes for the bleed-
ing. By the time the examination is completed, the hem-
orrhage may become alarming. Posterior pituitary
(Pituitrin*) or ergot is given intravenously, the uterus is
massaged, and in many cases valuable time is lost. Intra-
uterine packing is resorted to, which stops the bleeding
for the moment. Blood transfusions are started. After a
Short time the bleeding may start again, seeping through
the packing. Removal and reapplication of packing does
not necessarily stop the bleeding and, in spite of con-
comitant transfusions, the patient may rapidly become
moribund. It is the belief of Douglass - that when the
first uterine packing is not successful, the uterus is prob-
ably ruptured. If such is the case, a second packing is

From the Department of Obstetrics and Gynecology, New York Uni-
versity Medical College.

1. Hunt, A. B.: Massive Obstetric Hemorrhage Rcquiring Hysterec-
tomy. Am. J. Obst. & Gynec. 49:246-252 (Feb.) 1945.

2. Douglass, L. H., in discussion of Beacham, W. D., and Beacham,
D. W.: Rupture of the Uterus, Am. J. Obst. & Gynec. 61 : 824-837 (April)
1951.

definitely contraindicated. Greenhill ' also advised
against packing the Uterus a second tinie, recommending
immediate hysterectomy as the safer procedure.

Postpartum hemorrhage can be controUed, no matter
what its cause, by a method described many years ago by
Logothetopoulos in Athens.' His method involves a type
of packing that he originally used after clamp hysterecto-
mies. It was inserted into the pelvis after the Uterus was
taken out, allowing immediate removal of the clamps
without any loss of blood. Logothetopoulos applied the
same principle of hemostasis to control of bleeding from
the Postpartum uterus after considerable experience in
his surgical cases had proved it efficient. He called the
procedure ''traction packing."

METHOD

A doubly folded quadrangular piece of gauze 36 in. (91 cm.)
Square and a gauze roll 4 in. (10 cm.) wide and 16 yd. (15 m.)
long are required. The Operator grasps the cervix with one or
several tenaciilum forceps and brings it down well to the level of
the Vulva. The blades of a vaginal speculum are helpful in
spreading the cervical canal apart. The center of the quad-
rangular piecc of gauze is inserted into the Uterus by means of
a sponge forceps. In contrast to the conventional method, it is
not necessary to reach the fundus with this packing.

The four corners of the quadrangular piece of gauze protrud-
ing from the uterus are spread apart. The Operator then packs
the long Strip of gauze into the gauze sack situated in the uterus.
Carefully done, this produces a large round ball inside of the
Uterus. The size of this ball is always the same, being deter-
mined by the uniform amount of gauze strip used. Thus the
whole procedure bccomes automatic and not subject to indi-
vidual alterations, an important point in an Operation when
time means everything.

The four corners of the quadrangular piece of gauze are
grasped in one band and pulled downward. The blood supply of
the Uterus is cut off and bleeding ceases at once. In order to
maintain the downward traction, the gauze stem is run through
a thick ring pessary, and the pessary is pushed upward against
the Vulva, which is protected by a piece of gauze. The ring is
fixed in its position with a clamp.

3. Greenhill. J. P.: in Yearbook of Obstetrics and Gynecology, Chi-
cago, The Yearbook Publishers, Inc., 1950, p. 241.

4. Logotiietopulos, K.: Gynäknelogische Chirurgie, Berlin, Julius
Springer, 1939

Conventional packing is an attempt to compress the
open sinuses and blood vessels in the wall of the bleeding
Uterus. To be sure, the packing itself may produce a
contraction, and only in such cases will it be effective.

Fig. 1. — Insertion of the quadrangular piece of gauze into the uterine
cavity.

Fig. 2. — Spreading the quadrangular gauze and filling it with a gauze
Strip.

On the other hand, traction compresses the uterine ves-
sels against the pelvic wall, interrupting the blood flow
to the Uterus completely. If the uterus is atonic, there
is in addition to this hemostatic efl'ect the oxytocic

Fig. 3. — Downward traction applied to four corners of the quadrangular
piece of gauze.

Fig. 4. — The stem of gauze pulled through a ring pessary

eflfect of anemia, which is produced by compression of
the arteries. Furthermore, it is possible that pressure
upon Frankenhauser's ganglion stimulates the uterine
muscle to contract by way of the autonomic nerves. It
is obvious that the cause of the bleeding does not in-
fluence the effectiveness of this packing. Wherever the
bleeding comes from, it will be stopped. This packing is
inserted with relative ease, far more readily than a con-
ventional packing, with no need to fill the uterine cavity
completely, and the procedure is rapid and precise.

Fig. 5. — Packing in situ and maintenance of traction by application of
a strong clamp.

This packing is indicated only in cases of severe hem-
orrhage, after simpler procedures have been attempted
and the vagina and cervix examined as possible sources
of bleeding. Its purpose is to control bleeding immedi-
ately and to eliminate anxiety and haste. Once accom-
plished, additional measures such as transfusion and con-
sultation may be obtained in leisure. As the patient's
condition improves with or without transfusion, the sub-
sequent procedure depends upon diagnosis. If the Uterus
is atonic and the bleeding has stopped entirely, the pres-
sure is released by opening the clamp. After a short while
the internal strip of gauze may be gradually removed,

followed by the quadrangular piece of gauze, which may
take out with it pieces of membrane left behind. The
removal of the packing is almost painless.

If the hemorrhage has occurred after a difficult forceps
delivery, a version, or in a case in which a cesarean
section has been done previously, the possibility of a
ruptured Uterus must be considered. In this instance the
packing may enter the abdominal cavity through the tear
in the uterus, intentionally or by chance. No härm can
be done by the possible additional trauma to the uterine
wall, since it will be necessary to remove the uterus any-

Fig. 6. — Compression of the hypogastric vessels when traction is
applied to the gauze packing.

way. Once in place, traction packing allows time for
carefui preoperative preparation. There is no urgency
for any operative Intervention while the patient is in
shock. Her chances for recovery after hysterectomy or
more conservative procedures are much improved.

According to Greenhill, the mortality rate of uterine
rupture is 58%. A very recent report from the Harlem
Hospital ^ gives the mortality rate as 57.1%. Consider-
ing the excellent facilities and expert attention in this
hospital, it may be assumed that in less well-equipped

5. Posner, L. B.; Smith, D. F., and Trambert, H. L.: 14-Year Survey
of Parturient Ruptured Uterus at Harlem Hospital, New York J. Med.
51:641-644 (March) 1951.

institutions the mortality rate may be much higher. With
successful hemostasis and eliminated urgency, with time
to recover from shock, mortality rates should be con-
siderably reduced. Posner and his co-workers •' stated,
"Immediate transfusion and laparotomy, regardless of
the degree of shock, is the surgical treatment of rupture
of the Uterus." Speaking of mortality, they add that with
adcquatc blood transfusion and present-day antibiotics
all natients might have survived. All these ends can be
realized with traction packing; there is no need of im-
mediate Operation "regardless of the degree of shock."
Actual experience with this packing is limited. Logo-
thctopoulos has used it in only about 10 cases of Post-
partum hemorrhage, but has had excellent results in all.
This packing procedure was studied in cadavers at the
University of Athens." The packing was inserted in the
manner described, followed by traction. A dye was in-
jected into the carotid artery under pressure and there-
after the pelvic organs were examined. All blood vessels
except the uterine arteries were filled with the dye. It
was interesting to note that the Ureters were not com-
pressed; they could be flushed through from above with
very slight pressure.

SUMMARV

There are few new methods available to reduce the
mortality rate of Postpartum hemorrhage. Blood trans-
fusion is often unsuccessfui because hemostasis is diffi-
cult. Operations are often done with the patient in shock.
Traction packing controls all Postpartum bleeding im-
mediately and therefore should reduce the mortality rate.

65 E. 76th St.

6. Christopulos. C: Anatomische Ergebnisse der Biutstillungsmethode
nach Logothetopulcs, Zeniralbl. f. Gynäk. 57: 807-809 (April) 1933

PrinteJ and Published in the United States of America

NEW YORK UNIVERSITY-BELLEVUE MEDICAL CENTER

OF NEW YORK UNIVERSITY

UNIVERSITY HOSPITAL

(FORMERLY NEW YORK POST-GRADUATE HOSPITAL)
303 HAST TWENTIETH STREET NEW YORK 3. N.Y.

EDWARD M. BERNECKER. M.D., Administrator

GRamercy 7-2000

March 2A, 1953

Ernest IfyHer, M.D.
6$ East 76th Street
New York, New Yerk

Dear Doctor ^fjrller«

Thank you very imich for submltting the questions fer the exaMination
•f the fereign physicians this Coming Friday. I hope you will not feel
disturlbed that I have not used them. Macy nore were received than could be
used and those whose were not selected there^y escape the onerous task of
correcting the papers. I shall file your letter for possible later examination.

Miss Eskin has broijght to vay attention that the present Committee of
three, to review requests for performing therapeutic alwrtions in this hospital,
has served for over a year and should be changed, Consequently, I have asked
Doctor Locke L. Macke nzie to serve as chaiman of this Special Committee and I
wonder if you will be wiUing to be one of the other two meabers. The duties
are not very heavy. They consist of reviewing the histories of an average 4-5
cases on whom members of the staff wish to perfora therapeutic abortions, and
either approving or disapproving them for this procedure. As you know, this is
carried out anonymously and the decision is cownunicated to the attending surgeon
\mder ny name« I hope you will be willing to undertake this task.

Sincerely yours,

Gray H. Twombly, M.D.

Assoclate Director

Department of Obstetrids and Gynecology

GHT :nse

NEW YORK UNIVERSITY

WASHINGTON SQUARE
NEW YORK 3. N.Y.

OFFICE OF THE VICE CHANCELLOR
AND SECRETARY

18 June, 1953

Ify dear Doctor Hsrller:

Tou are hereby advised that the Council of New York
University has approved and confirmed the action of the Board of
Trustes s of the New York Üniversity-Bellevue Medical Center in
appointing you to the paxt time staff of the College of Medicine
for the year beginning Jrxly 1, 1953 with the title of Glinical
Instructor in Obste trics and Gynecology.

Very truly yours.

Vice Chancellor
, and Secretary

Dr« Emest >^ller
450 East 63d Street
New Tork 21, New York

NEW YORK UNIVERSITY

WASHINGTON SQUARE
NEW YORK 3, N.Y.

OFFICE OF THE VICE CHANCELLOR
AND SECRETARY

15 June, 1950

}fy dear Doctor ><5rller:

lou are hereby adviaed that the Council of
New York üniversity, at a meeting held May 22, 1950, approved
and confinned the action of the Board of Trustees of the
New Yoric Üniversity-Bellevue Medical Center is appointing you
to the part tiae staff of the Post-Graduate Medical School for
the acadeaic year 1950-1951, beginning September 1, 1950, with
the title of Clinical Instructor in Obetetrios and Gynecology«

Very truly yours,

■Xv^^^-w^-^^ö-^

Vice Chancellor
and Secretary

Dr. Emest Hyller
88-35 Elfflhurst Avenue
Elohurst, New York

•. R. 40I

city of new york
Department of Hospitals

i \

HARLEM HOSPITAL

136TH STREET AND LENOX AVENUE

NEW YORK SO, N. Y.

May 16,1952

Dr.Emest I^ller

65 East 76th, Street,

New York,N.Y.

Dear Doctor I^ller:

I wish to thank you on behalf of the
Obstetrical Staff for your excellent presentation on
uterina packing, at oiir last monthly Conference,

With best wishes, I am,

y yoixrs.

ACP/M

A.Charles Posner, M.D, "^^^

Director of Obstetrics

NEW YORK POST-GRADUATE MEDICAL SCHOOL AND HOSPITAL

a03 EAST 20TH STREET, AT SECOND AVENUE
NEW YORK. 3. N. Y.

OUT-PATIENT DEPARTMENT

GRamercy 8-7080

January 2B, I^^^?

To Whnm It ?/iav Cancern:

Dr. Ernest Myller has beer, ass^ciated with th? Gynecological
Staff of the P'^st Graduate Hospital for the past 5 years,

During the past 4 years he has been associated with my clinic«
I have found him to be competent and skillful in Gynecological
diagnosis and treatment.

He has an agreeable personality and works well with the
other raembers of the staff.

DR ROBERT J LOWRIE

I40 EAST FIFTY-FOURTH STREET

NEW YORK 22, N.Y.

November 29, 1950

Dr. Emest ^^yller
65 East 76th Street
New York, N.Y.

Dear Doctor Ä^ller:

RE: Offering technic of biopsy of
the cervix by l^ller*s Cervical Scraper
in Lowrie's GYNECOLOGY

I have read with Interest your article on the Cervical Scraper
in the February Ist, 1950 issue of the New York State Journal of Medicine.
We are now reading galley proofs of our forthcoming two volume work
in gynecology and we have a chapter (Äevoted to Methods of Biopsy in volume
II which is on gynecologic surgery.

We are anxious to have our work up to .the minute so to speak,
and for this reason we would like to include a picture of yoim Instrument
with the Script in the form of a legend. At this late date trith the type of
the book about half set up in print, we are more or less limited to
making any additions in the form of legends. In our work we are using
the legends pretty much exclusively to describe technic and we find it
to be very satisfactory.

On the Chance that you would give us consent to reproduce your
technic with your figures 2 and 3, I have prepared the enclosed material.
If you give us consent for reproduction, then will you i.iake any corrections
in pencil and return your corrected sheet to me. Do you have the original
illustrations of figures 2 and 3, If not, we could get permission from the
manufacturer to loan the electros or cuts to our publisher.

Because of the proximity of the date of publication, we should
appreciate an early reply from you, and would thank you for such Coopera-
tion as you may see fit to extend. Could you spare us two reprints.

Robert J . Lowrie \
Editor-in-chief -^

P.S. Our publisher is Charles C. Thomas, 321 East Lawrence Avenue, Springfield,
Illinois. In our two volume work there are 66 contributors from 30 medical
schools in the United States, Canada and England. Volume II is devoted to
Gynecologic Surgery. As of this date over half of the galley proofs are
corrected.

JAMES F. McKERNON, M.D.
Honorarv President

ARTHUR F. CHACE, M.D.
Pretident

EDGAR H. BOLES
VicB'President

WILLIAM V. GRIFFIN
Vice-President

DAVE H. MORRIS
Vice-President

ALLEN WARDWELL
Vice-Preaident

ROBERT E. ALLEN
Treaturer

GEORGE A. VONDERMUHLL

Secretary

HELEN L. WATTS
Assistant Secretary

NEW YORK POST-GRADUATE MEDICAL SCHOOL AND HOSPITAL

505 EA8T 20th STREET, at SECOND AVENUE

NEW YORK

June 23, 19A3

Dear Doctor ^Jy-ller:

I have the honor to advise you that, on the nomination
of the MedicuL Board, you have been appointed by the Board of

Directors of the New York Poöt-Graduate Medicul School and
Hospital to be

Junior Assistant Gynecologist to the Dispensary.

This appointment takes effect as of May i, 19^43,
and will remain effective at the pleasure of the Board of Directors
until further notice« It is a temporary appointment until six
months after the war ends, at which time it may be made peniianent.

By authority of the Board of Directors,

George A. Vonderaiuhll
Secretary

(

Dr. Ernest lyjyller
UO East 6lst Street
New York, N.Y.

COLUMBIA UNIVCRSITY
NEW YORK POST-GRADUATE MEDICAL SCHOOL
303 EA8T 20TH STREET
NEW YORK

OFriCC OP THC DIRECTOR

Oc tober U, 19^2

^ (

Dr. Emest MJyller
^0 East 6l8t Street
New York

Dear Doctor Myller:

It gives me pleasure to inforia you that upon the
recommendation of Dr. Walter T. Darmreuther, Executive
Officer of the Department of Gynecology, you have been
appointed Provisional Assistant to the Dispensary in that
department for a period of six months, beginning November
1, 19^2,

A copy of our Directory of the Staff is being sent

to you under separate cover

THRiom

Very truly yours,

Thomas H. Busseil, M.D.
Assistant Director

PHONI TRaffolgcr 9-1100

MADISON AVENUE HOSPITAL
30 EAST 76th STREH
NEW YORK 21, N. Y.

Dr. E. Myller
65 R. 76 St,
New York City

Dear Doctor:

The Obstetrical Department of the Madison Avenue Hospital
cordially invites you to attend its regulär quarterly
DIMN^:3^ MSFTINH to be held on the 15th floor of the hcspital
at 8 P.y.. on V^^olnesJay, June lOth 1953,

PROGRA.M
Maternal and fetal death statistics for the past three months

SCIENTIFIC PROORAli!

!• Carcinoma In Situ In Pregnancy,

Ernest Myller,M.D.

2, IJterovaginal Extirpation For Procidentia,

(Motion picture) Charles H,Thom,M.D.

Dinner: 8 P.M.
R.S.V.P.

Sinoerely yours.

^y4/y^ ^^^^^^^-^-^ty ^J>^

Geza Weitzner, M.D.

NEW YORK UNIVERSITY

WASHINGTON SQUARE
NEW YORK 3, N.Y.

OFFICE OF THE VICE CHANCELLOR
AND SECRETARY

10 Jiine, 19^9

}fy dear Doctor Myller:

You are hereby advised that the Council of
New York üniversity, at a meeting held May 23, 19^9, approved
and confirmed the recommendation of the Board of Trustees of
the New York Üniversity-Bellevue Medical Center that you be
appointed to the staff of the Post-Graduate Medical School
for the academic year 1949-1950, beginning September 1, 194-9,
with the title of Clinical Instructor in Obstetrics and

Gynecology,

Very truly yours,

Dr. Ernest Myller
88-35 Elmhurst Avenue
Elmhurst, New York

Vice Chancellor
and Secretary

4f-ail>fe«ä«»t'lll>lll 'in ■»■

NEW YORK UNIVERSITY

WASHINGTON SQUARE
NEW YORK 3, N.Y.

OFFICE OP THE VICE CHANCELLOR
AND SECRETARY

20 June, 1952

Ify dear Doctor Myller:

You are hereby advised that the Counoil of New York
University, at a meeting held May 26 ^ 1952, approved and confirmed
the aotion of the Board of Trustees of the New York University-
Bellevue Medlcal Center in appointing you to the part time staff of
tho Post-Graduate Medioal ßohool for the year beginning July 1, 1952,
with the title of Instructor in Clinical Obstetrics and üynecology*

The period of this appointment has heen made ooterminus
with the fiscal year of the Medioal Center and thus overlaps the months
of July and August, 1952 inoluded in your current term of servioe.

Very truly yours,

Vioe Chanoellor
and Score tary

Dr. Emest i^yller
450 East 63d Street
New York 21, New York

.wiimwm**^

V .'. W

NEW YORK UNIVERSITY-BELLEVUE MEDICAL CENTER

OF NEW YORK UNIVERSITY

477 FIRST AVENUE, NEW YORK 16, N.Y.

OREGON 9-3200

BOARD OF TRUSTEES

WINTHROP ROCKEFELLER. Chairman

F. ABBOT GOODHUE. Vict Chairman

LAWRENCE C. MARSHALL. Treaturer

HARRIS A. DÜNN. Stcrttary

GEORGE A. BROWNELL

JAMES M. CECIL

NEVIL FORD

BERNARD F. GIMBEL

CHARLES C. HARRIS

O. V. W. HAWKINS

RUSH H. KRESS

SAMUEL D. LEIDESDORF

CHARLES S. McVEIGH

BAYARD F. POPE

HERBERT L. SPENCER

July 3, 1953

EXECUTIVE OFFICBRS

EDWIN A. SALMON. Dirrcfor

DONAL SHEEHAN. M.D.. Attociatt Dirtctor

CURRIER MCEWEN, M.D.. Dtm

College of Medicin»
ROBERT BOGGS. M.D.. Dean

Pott-Craduate Medical School
EDWARD M. BERNECKER. M.D.

Hospital Adminiitrator
EDGAR S. TILTON, Exteutivt Stcrttary

Dear Doctor >tyller:

Yoiu are hereby advised that the Board of Trustees at
a meeting held in June 1953 approved and conf irmed your re-
appointment to the University Hospital staf f as hereinafter
set forth: /

Title: Assistant Attending Obstetrician euad Gynecologist
Period: Effective Jiüy 1, 1953

It is understood that all staff appointments shall
be for periods not in excess of one year, and shall terminate
on June 30th of each year thereafter following the commence-
ment of Service under the appointment, provided however, that
all such appointments shall be subject to the right of the
Board of Trustees to aodify or cancel the terms of service at
any time in the event that conditions make such action desir-
able, the decision of the Board as to the desirability of such
action being final,

Sincerely yours,

/ ÄAAy^ 66cA^/ÖXc-X.t^

SecÄtary
Board oä Trustees

Doctor Emest Ntyller
450 East 63rd Street
New York 21, New York

ORTHO RESEARCH FOUNDATION

RARITAN, NEW JERSEY

December 11, 1952

Dr. Emest Myller
65 East 76th Street
New York 21, New York

Dear Dr. Myller:

Thank« for the reprlnt. The technlque is clever; and if it is as
effective as a first eid, as I think it is, should be widely adopted,

We will be delayed for a couple of weeks in getting out the next batch
of Salpix. Just made up a batch; but, altho\jgh the vials are auto-
claved, sterility tests have to be made, This takree 2 weeks,

December 23 to January 3 I shall be in Texas,

With greetings to the epproaching Holiday Season and Best Wishes for
the New Year,

Sinc^rely,

Carl ö, Hartman
Assoclate Birector

CGHtdf

fiudolf Virrlfant i^rbiral i^orirtg in tl|p Olttg of S^rw forb

president
Dr. Max Jessner
870 fifth avenue

cor. 8ecretary
Dr. Ernst M. Rosenbaum

B WEST 86th STREET

trea8urer
Dr. Arnold T. Benfey

so PARK TERRACE WEST

DeoQxnber 5# 195^

Dr» Emest Myll«r
63 Bast 76th Stret%
New ^ork City

Dear Dr. Mylleri

I am happy to inform you that at the last meetlng
of the Rudolf Virohow Medioal Society, you were
eleoted Corresponding Secretary»

Sinoeroly yours.

UU^ ,

emr/aw

Ernst M* RosenbauA, M«D»
Cor« Secretary

ALL PRESrNTATIOlC OPJ^N TO GrilTTAL riSCUBSION

NTW YORK ÜNirRSITY - DriX'VUT MFDICrX CENTTR
Univeroity Hospital
303 r.20th Street
New York

Depertnent of Obstetrics
and Gynccolocy

Staff Confrrencc
Wednesdoy, Mnrch 18, 1953

1* Service Report of Gouverneur

Hospital

2 t f^crvice Report of Üniversity
Hospital

3t Carcinona in Situ Associated
with Pregnancy

Anphitheatre "B" at 4*00 p^n.

Doctor Gray H# Twonbly, Preöiding

Doctor Franklin Reyner

Doctor Arthur Porvey

Doctor Ernest Ifrller

•

NEW YORK UNIVERSITY POST- GRADUATE MEDICAL SCHOOL
Departments of Obstetrics and Gynecology and Urology

COURSE NO 564 A INFERTILITY

December iO through 12. 1951

UNDER THE DIRECTION OF DR. LOCKE L MACKENZIE AND DR. S. HOTCHK'SS

Tui tion $^0

GIVEN AT THE UNIVERSITY HOSPITAL. 303 EAST 20TH STREET. N.Y C

Monday , Dec. iO
8 ö 45 - 9:15 a, m .
477 First Avenue

Regi str ation

9: 15 - 10^00 a.m.
Erdmann Auditorium

Introductory Lecture
Dr. Locke L. Mackenzie

10:00 - 11:00 a.m.
Erdmann Auditorium

Physiology of Ovulation
Dr. Maxwell Roland

11:00 a.m. - 12:00 noon
Er dm an Auditorium

physiology of Menstruation
Dr. Theodore Neust aedter

12:00 - 1:00 p.m.

Lunch Hour

V^'

1>00 2:00 p.m.
rdmann Auditorium

2:00 - 3:00 p.m.
GYN Clinic

Technicfue of Tub al Insuffl ation
Dr s Ernest Myller

Performance of Tub al Insufflation
Dr. Maxwell Roland

3.00 ' 4:00 p.m.
Erdmann Auditorium

4 00 5 00 p.m.
Erdmann Auditorium

Fundamental Consider ations of the
Anatomy and Physiology of the Male
Genital System

Dr. Robert S. Hotchkiss

Hi Story Taki ng and Physical Examination
in the Male

Dr. Robert S. Hotchkiss

5;00 ^ 6 00 p.m.
Erdmann Auditorium

Tuesday , Dec . ü
9^00 - 10:00 a.m.
Amph. B

10 00 ' 11:00 a.m.
Amph. B

1] 00 a.m, - 12 00 noon
Amph. B

Cervical Incomp atibi lit y
Dr. Locke L. Mackenzie

Physiology of Fertili zati on and
Ni dati on

Dr. Maxwell Roland

Other Endocrine Factors Involved in
Inf er ti 1 i ty

Dr. Theodore Neustäedter

Uterine Malposi tions. Fibroids,
Ovarian Cysts and Cervica^ Pathology
as Factors in Infertility
Dr. Walter T. Dannreuther

12 00 1.00 p,m.

Lunch Hour

Inferti lity

Page 2

Tuesday, Dec. H (continued)
1:00 - 2:00 p.m.
Erdmann Auditorium

Technique of Artificial Insemination
Dr. Locke L. Macken zie

2:00 - 5:00 p.m.

GYN Cytology Laboratory

Techniques and Interpretation of
Semen Analysi s

Dr. John MacLeod

Dr. Bobert Hotchkiss

Dr. John Silberblatt

5:00 - 6:00 p.m.
Erdmann Auditorium

Motion Picture on Semen Analysis
Dr. Robert S. Hotchkiss

Wednesday, Dec i2
9:00 - 10:00 a.ra.
Erdmann Auditorium

10:00 a.m. - 1:00 p.m.
GYN Cytology Laboratory

1:00 - 2:00 p.m.

2:Oo - 3 «00 p.m.
GYN Clinic

3:00 - 4:00 p.m.
Erdmann Auditorium

Methods of Determination of the Time
of Ovulation

Dr. Locke L. Macken zie

Cytology of the Menstrual Cycle
Dr. E. Lawrence Hecht

Lunch Hour

Performance of Hystero- salpingogr aphy
Dr. Mortimer N. Hyams

Surgery of Occluded Fal lopi an Tubes
Dr. Locke L. Macken zie

4:00 - 4: 30 p.m.
Erdmann Auditorium

Surgery of Male in Infertility
Dr. Robert S, Hotchkiss

4:30 p.m.

Round Table Discussion

NEW YORK UNIVERSITY-BELLEVUE MEDICAL CENTER

OP NEW YORK UNIVERSITY

UNIVERSITY HOSPITAL

(PORMERLY NEW YORK P05T-GRADUATE HOSPITAL)
303 EAST TWENTIETH STREET, NEW YORK 3. N.Y.

GRAMERCY 7-2000

Dccember 3, 1951

Ernest >fyller, M.D.
65 East 76th Street
New York, New York

Dear ^octor JfyUer:

On Monday, December lOth, between 1-2 p.m., I have

schedTiled you for a talk on the Technique of Tubal Insufflation

here, in the Erdmann Auditorium, I hope you will be able to

discuss it at this time.

Sincerely,

jv^^—

Locke L.^ckenzie, M.D,

Acting Chairman

Department of Obstetrics and Gynecology

EDITOR
AUSTIN SMITH. MD.

AssociATc Editors
Johnson F. Hammond, M.d.

GEORGE HALPERIN, M.D.

(Zilie Sauntal nf Ü}t
Ameriran Meixtul Aaaortattan

535 Nnrll? flfarfaorti »trtti
(Stlirago 10

In your reply pleaie
refer to these initialf

JFH

March 5, 1952

Dr. Ernest Myller
65 East 76th Street
New York 21, New York

Dear Doctor Myller:

In preparing your paper entitled "Control
of Postpartum Hemorrhage" for the printer, attention
has been called to the number of illustratlons and
we believe that figures 5 and 6 are sufflclent as
illustratlons. With your perraission the remaining
illustratlons will be omitted from THE JOURNAL, but,
if you desire, they may be included in your reprints
at your expense.

Sincerely yours,

JFH : ad

[mond, M.D,
Isociate Editor

' j'

IA/>\JC-^

«f^

j^i u ^xJ y-^' " '^^^ ^-7 J3L ^^

/^<-

■>:-»»V«IP.IWJ>..l<«aL«

NEW YORK UNIVERSITY

WASHINGTON SQUARE
NEW YORK 3, N.Y.

OFFICE OF THE VICE CHANCELLOR
AND SECRETARY

31 October, 1951

]Ay dear Doctor Wbrller:

You are hereby advised that the Council of
New York University, at a meeting held October 22, 1951,
approved and confirmed the recommendation of the Board
of Trustees of the New York Üniversity-Bellevue Medical
Center that your title be changed f rom Clinical Instructor
to Instructor in Clinical Obste trics and Qynecology, as

of September 1, 1951.

Very truly

Vice Chancellor
and Secretaiy

Dr. Emest Myller
^50 East 63 Street
New York 21, New York

NEW YORK UNIVERSITY-BELLEVUE MEDICAL CENTER

OF NEW YORK UNIVERSITY

477 FIRST AVENUE, NEW YORK 16. N.Y.

OREGON 9-3200

BOARD OF TRUSTEES

WINTHROP ROCKEFELLER, Chairman

SAMUEL A. BROWN. M.D.. Vic* -Chairman

LEROY E. KIMBALL. Secrttary-Tttaturtr

GEORGE A. BROWNELL

HARRY WOODBURN CHASE

HARRIS A. DÜNN

NEVIL FORD

F. ABBOT GO<X)HUE

CHARLES C. HARRIS

O. V. W. HAWKINS

RUSH H. KRESS

SAMUEL D. LEIDESDORF

CHARLES S. MCVEICH

BAYARD POPE

JOHN M. SCHIFF

OFFICERS OF ADMINISTRATION

FDWIN A. SALMON. Director
DONAL SHEEHAN. M.D.. Chairman

Scientific Committm
CURRIER MCEWEN. M.D.. Dean

Colligt of Medicint
ROBERT BOGGS. M.D.. Dean

Pott-Craduate Medical School
EDWARD M. BERNECKER. M.D.

Hospital Adminittrator
EDGAR S. TILTON. ExtcutttH Seccttarg

October 22, 1951

Dear Doctor llyller:

You are hereby advised that the Board of Truste es at
a meeting held October 16, 1951 approved and conf iraied your
Promotion to the ühiversity Hospital staf f as hereinaf ter
set forth:

Title: Assistant Attending Obstetrician and Gynecologist
Period: Effect! ve September 1, 1951

It is understood that all staff appointments shall
be f or perials not in excess of one year, and shall terminate
on August 31s t of each year thereafter following the commence-
ment of service under the appointment, provlded however, that
ail such appointments shall be subject to the right of the
Board of Trustees to modify or cancel the terms of Service at
any time in the event that conditions make such action desir-
able, the decision of the Board as to the desirability of such
action being final.

Sincerely yours.

Secrel^ry-Treasurer
(100 Washington Square East)

Doctor Emest Myller
63 East 76th Street
New York 21, New York

THE YEAR BOOM PU B IIS HERS, IN C,

PUBLISHERS TO THE MEDICAL AND DENTAL PROFESSIONS • 200 EAST ILLINOIS STREET • CHICAGO 11, ILLINOIS

July 8, 1952

Ernest Myller, M. D.
65 East 7^h Street
New York, New York

In reply please refer to Code G ^03

Dear Dr. ^fyller:

Dr, J. P. Greenhlll, the editor of the Year Book of Obstettics and
Gynecology, has selected your article, Control of Postpartum Hemor-
rhage, from the June 21, 1952 issue €f the Journal of the American
Medical Association, to be abstracted for the 1952 Year Book. He
has also asked thät we reproduce Figures 1 and 2 which appeared with
the article.

Will you please send us the original drawings of these lllustrations,
or glossy prlnts thereof ? We shall be glad to retum them as soon
as the book Is published, and, of course, we shall give füll credit
to both you and the Journal.

The manuscript for this Year Book will be sent to the typesetter in
the near future and we are now makiing the engravings for the book.
Will you, therefore, please send us the drawings or photographs by
retum mall, or let us know when we may expect to receive them?

Sincerely yours,

THE YEAR BOOK PUBLISHERS, Inc.

FW/bba

"^/l-#-<^€.^-C^

(^ xxJUaJ^^oJiJI

Frances Wetherhold v
Managing Editor (Year Books)

~:«H!«4;:'3Ki«%«^<« >Wä«Maüa^yHI

MUk-'

EDITOR
AUSTIN SMITH.

M.O.

ASSOCIATE EDITORS

Johnson F. Hammono, M.D.

GEORGE HAL.PERIN, M.O.

J51|0 Journal of tl\t
Amf rtran Meixtul Aßanriatinn

535 Norttf Bfarborn »trrrt
(Stfiradii 10

ARTICI.es ,\RE ACCEPTED FOR I'UBI.ICA-
TION ON COMirnON THAT TIIKY AkF.
(ONTKll'.l'TKl) SOI. Kl. Y TO TM IS JOIKNAL.

In your reply pleaie |
refer to these inltlali i

A5:gc

November 9, 1951

Dr. Erneet Myller
65 Bast 76th Street
New York 21, N. Y.

Dear Doctor Myiler:

Your paper entitled "Control of Postparttun Hemorrha^e" ha«
"been accepted as a clinical note for publication In The Journal
of the American Medical Association, suhject to slight editorial
modification and subject to a delay in piablication due to a
large hacklog in Communications. The paper is also accepted wlth
the tinderstanding that it is contributed solely to this Journal.

A proof will be sent to you before publication.

Very truly yours.

JOÜRHAL AMERICAN MEDICAL ASSOCIATION

.«j«i8i«!iM»«a>>i- «Wim,««»

CITY OF HEW YOHK
STATE OF HSr TOM

coüHTi of net: 10»

On thi» day personally app0?:red before M

HAUS D. FROEHLICH
restdlng et 111 - 10, 76th Read, Forest Hills, N.Y«, who after
belnf: dtily swom, deposes and 8ay»|

Th»t he Is thoroughly ft-imllifc^r wlth the ^glish and
Greek langw^gesf

Thftt he personally nade the at'acbed translation amA
hereby certlfies to tbe best of bis knowledge and bellt^f that
It Is fi true Tersion of the original docuaent written in the
Greek language»

^a,.^*^ y. /fe^^^^^

Svom to before ae the *otary Fublie
on this 13th day of ^oremhmr 1941

URrvf'HSiTi or a

DIRflCTOR OF MEDICAL rCIDOL

Ati^iand^ May 15, 19t5

File No S49A071

CHR'^IFTCATS

Dr« HN^T J. I^ELLFil, doctor of aeaiclne, iTTAdUf.ted fr«i
the Uttiversity of Berlin^ bom at SofaMalkaldaiiy Gernany

PASSED KITH HORORS
2^ cxrjalnation bcld in accordance with the laws of thlf
^nirersity aa of '^pril 15, 1956 imd is hcreby j^r^ntod &

LICfUSE TO FR/CTICE WlDICIlfl

in Gr«^ce And hold gorei

it poaitions«

Sgdl (illegible) Dircctor
■ ■ 8«cr«tAry

S • a 1

CITY OF NEW YORK )
STATE OF NEW YORK )
COUNTY OF NEW YORK)

SS:

On this day personally appeared before me

who, after being duly sworn, deposes and says:

That she (he) is a professional translator

of the English, OiiWMI^ «•••

languages,

employed by the National Refugee Service, Inc., 165 West A6 Street,

New York, N.Y.;

That she (he) has personally made the

attached translation(s) and hereby certifies to the best of her
(his) knowledge and belief that it is (they are) a true version(s)
of the original document(s) written in the

language(s) •

ma/l \ U

Swom to before me, the Notary Public
on thi§/l^ day of Mtf wismc , 19^1

KOTAllT PÜBUC. W..tcb^t- CO.
r,^ r. (M\;'8No.975Reg.^o.3L597

Ji.Y.Co.ClV'sN-

Term

-^78a-7/a

iatüm

JSäSL

i.^52«ioe

19I):^A9

^ AT SCIB-.LK

li-TURITY CF-:?iriCATg

Ernst Müller
tom Fcbrunry 1^6, 1893 nt 3cbanlkald«a> Dia tri et estiite ScbiMilkald«!
of Jöwish f^iith, eKm of tho drugri^t Joseph liuell«r of ^hsalkald«»
ti%tiSd«d 9 jtk^r^ tb& Obf^rrealsotaule^ 2 tharr^of ths hi^^JH^t gr dm {?riw)

l ,C9R^*\^g^ ^,n<^ PU^^^®»

1) Oaciductt food

2) Dollgencei very pood

Ba «M «SBtiqpt froiB tb" oral nxtmini^tion

1) RaLigioo (lo Je^sh reIlgi<}o 1 Mons arr> giip«i ut the school)

2) OersHttit f^ir
5) Fr^^chi good
4} EhgUahl gCKxi
5) HlfJtoryt fooA
•) Qeogrt pl^jyi fair
7) & tliM&tlosi good
•) Fbersioat fOOd

9) Cheal^tryi coo4

10) Patxiral historyi'—

11) Othba tlott fair

12} fraalMd dr .ringt fOod
13) Unmor draMngt
14} Singingt ~—
IS) Ifeadknitia«* tmiw

« 2 «

TlM imderslgned Board of Bx^mlnera theroforo gr nts Ma m
MATOHITY CEnriflCATE
•ince hß is leavlnf )±3 Oberreulsch Xa to study ■•dicltt« and diamisse j
tdm with the bo^t wisbea for his futurc*

SchiÄlkrlden, M^rcb 25^ 1911

Boyal Provincial
School Board« Cassol

Royjil Bo-ird of fxaaliier»
Si^iature^ of ex'minmrs Md ter^chers

Um att«id«d the optional Lntin lesson« teld in

eoocectlon «Ith tho three higbeat

of th^: Ob raalacbula

with satisfectory rc'sul^^a«

SobMÜUwldMi» Marob 22, 1911

Blr^etor of the ^^rrorlschule

Vha fthw» ffipiiiture is eartifiad oorrect

Barlin "ov^ftber iX), 1953

agd« BrcmadM Ol&Tk of the ^ourt

"^ abov9 Signa tiire is eirtlfiad oorreot

Berlia^ ^armber 20> 1953

s^d» Block OouDty Court ?r sidaat

The abovo 8l|^t«r« ia oertified corract
Barlia, Boir««bw 21, 19if
•gd« Ballte ForaigD ^ffloa

Seala

WÜERZBÜRG

LEAVIÄG CERTIFICATE

ITI

ERlfST MUrLLER of Sobaialkaldoii, bon at ScbKlkalden
tHi» enrolled froa April 29^ 1911 to dntm^ h& a Student of

mediclno
at thiB ^iv rsltjf and reglnt red diAr to tho lacturüf? deai^aV-d
kttTttlD'^fter«

C«3Cöming kils cc«iduct nothln^: derog<3tory haa böoa rfjported durlag
thiß period»

IH t;IT«ESS WIERJO? this certlflc te hasJ betwi isoued and the
««fil of the Univt^r^lty and the pisraottel signeture of the actlng rector
1^ the önlvcralty «yndlc affix»d th^reto»

7.burSf April 11, 1911

üniv raltQT ^ctopt Bg}i. Prof« Dr# K»B» Lel^aann
^alvoraity Syndlot srdm illerible

Sefil
» 17882

HQ^mf

1911

Unter xm2/in2

Oat^ology
Orgnalc ofae»l3tr]r

Botiioy

Jnatoay I

Dl^^sectloo laboratoT7, courii« X

iMTsburg^ April U, 1912

3mX

B« Onire jity Sindyc
s^m illaglbl«

w c

RECTOR AHD SEH ATI

OF -^W HOTAL CIIFJSTäH äLBEFCIIT ÜWIWrr.ITr AT Ktt

MfUtf ko^ tids loarlng certificate that llr, EHH^T M U E L L E 1

born at Scimalkalden 8on of tb^ drugglst «X« Iflller, prepared for

«Cfedewic Studios at the Oberreal schule at Schnalkp.ldfln^

ime Bstrlciilfited wlth us on th^: strength of a Icaving certificate

frcan the üniveraity l^vTEburg, on %i'll ^, 1012 and de-fot^d hi»»elf

to th*^ otuciy of a e d i c 1 n e«

^rinf: bis 8 aontha stay t thln UntT^-rsity, b duly regiaterad to

the lectures h-^rr-in ^f tor spocifiod, Gn<l in ccord^nce ^Ith certiflc tea

•ubaittedy aal gave notice#

.affiäJl

i.^!SLl.^k

Systa»:tlc anf.tomy of the fauar.n body II

a) Mcxvous 3y: ten
^rr^ctlcal coxirse in chtjiistry for

•edicul students
Short surv^y on inorgaaic and organlc ch«Äistry
Physiolory of thß »uaclea

Oa»cemini: hl« ccaiduct at trie ünlversity nothinp derogatory ha.
reported«

Iss\a0d by tte aoting Rr.ctor^ Signature aad seol affix«d«
*lol, iugUi3t 2^^ 1912

09(M

Seril

9(^ ille|ible

S(*d» Werner
%iv*:rslty Secr<?tary

Bmm on
Mit^xst Ip 1912

Mo 945

TOTAL BAVaRIAK JULIUS M/^XIMILIAR ÜNIV ^::iTI immZBÖHO

L^iVniG CTa^mnCATt

Vr» Imst II € 1 1 e r of Scbaalkaldeiif bom at Sch»<ilkald«i
«Ätridilated at t'rds ^Iversity fro« ^ctobtir lö, 191* to dfite

as e Student of

e d i c i n

and duly ref^ist^red to tlr» lectures br*r(3lnftfter speclfi^d»
Conc?mlng bis conrKirit durin thi3 p riod oothia^! d ror tory < ^3 b«4

peported^

IN riTR'^S^* irmOF thlö certiflcf.t« te«

iatwd and tbe

• ftl of thß **nivF?rslty axtd thc; personal sif?:n«ture.^ of the actlng ri*ctor
and the univ(?r«lty aiyndic nfflxed therrto#

Hueraburp:! AurtiEst 13, 1913

Seal

üniv r-Jlty Rector
ngd« Prof« Dr. ^. Hei»

üniversity ^yndic
Hgdm liucller

S«aie3te(r

DeBlgnatioo of Lecture

flntcr 1912A»»

1915

MaMctlon exerciaea ^d oourse

FbQraiaOLogy
Zooloj^

Topographie i^atosf
Bapetition cotirsa in anntoay
Fby3iolofic chfiÄistry

Phorsiolofgr
^opogrepidc an^toagr
Ixerciaaa in p^^iolo
^^loty

in »icroscopy

CEHTIFIC/TE
by thi
Botxrö of ^*aiii*.tr» at Ihieraburg

on the
»«Kilcal prelljilnary ©x'^min tlan of th*
Student of »edicine Mr# " PJIfrr MOFLLIl of ^ctaMÜLkAld«

IHHH»«^»HNHHHi>

Th- follofwinp m rkn wem giv»?n »vUi ßft*3r tha
prellalnary ex-^idBatlon htdd in accor<i«nce with the i*xr*ialn blon
or(5cr of Ity 28, 1901«

1} In anfttooy

ii) In Physlology

5) In Pborrsics

4) In Cb^alstry

5) In Zoology
t) In Botany

thu@ the avBrage rating

» TRI GOOD *

lUersburpi JTuly 17, 1915

^1* ohalmeii of tho bo rd of exa«in&rs

a&rk

very good

Vf?ry px>o<l

T ry f:ood

good

▼«ry cx>od

good

tigd* %derlflfi
Seal

Lee'.llait^d
VsersbuTf , Mowmävr 20, 1955

»t of fct«'rftrft^en aiKl Aschaffenburg

Obwiber for Intt^mal Affalrs

Seal

»g^i# 111^ 'fl

1025/482

ÜNIVFRSITT

ü K I C H

ÄRTIFTCATE
WHöl LK/VIHG THE ÜNIVKRSITI

Mr. Ernst 1 Ä 1 1 e r, of Schnalknlden^ bom -t Sctanalkadc»

was matrtculat©d at tlds lÄalTerslty froa October 28, 1915 tvirourh the

end of the suauaer »«laster 1917 as t^tudent of nedlcine

and rec;lstered to the lectures desit-nated In tl» at^^^ched coller:^» book»

Concemtng hls conducts during this period nothing derogatory
has b#en reported»

IN fflTHESS WHERBOy this certificate ht s l>e«i isBued and the
university seal^ as well as the personal si^riatureM of the actinr rector
and syndic of the uniwersity affixed thereto»

Munich, Deceaber 5, 1917

The acting Rector
sgd, 0* ^eigl

StAl

The ^dic
8^d« Dr« linh&user

Propaedeutic gynecologic clinic

Thftrapeutics of internal diseases

Pain preventlon in surgery and practicel
•zorcieee

Surgical propaedftutiis (aiirgical diagnoiia
and sur^cal therapeutic», exerciaef)

ItMÜcnl clinic for beginners

M^^tal diaeaaaa

dlnio and polyclinic of pediatz*ic diseaaea
indudinf^ phyaiology and pathologj
ef na'^rition in infanta* aga

4
X

i
t

•urgloal clinlc

Obstetrtc pynecologic clinic with clinlcal and
polydini al obstetrlc observ^tions and
exercises in touch e»i»inrationa

Otlatric clinlc (with otoicopy)

Ixercise» in dißgnoaifl on polyclinicol patient«

Rhino - laryngolof:ic clinic

ThÄoretic and pr-:tctic/.a racclncition cours«

Clinic for Syphilis and dematolordc diseAsa«

■edical clinic for advrmced t^tudanta

Intubatic»! and tr.xcheotoay

Winter se«ester 1914/1915
Sianer Semester 1915
hinter seaisster 1916/1916
Siawer aeaester 1916
Winter ae«ester 1916/1917
*^iairaer »eraester 1917

Fage 2
^m-H r>fir wi

1
2

1
2
6

Isare of abaonc«! i» the aroy«

seala

IE R7CT0H iND SERATI

0f WR »TAL mmnm wiLmw mny^nsin at beblik

ctrtlfy W thia le^ivlnp' certlficßto thot Ir. imtST 1 ü E L L I R
bom at Sohi&Lkaldfifi in RetfMB-JlasMiiy ton of the Mrohuit MUer
«a« preparod for acadeeic £^tudi69 at the Ob^rrealschul« at dalaaXkfldea
and waa w^tilculated wlth u» ob the strcn^h of a 1©^ ving certtficata
froa the öiiiverslty Munich on ^or «her Z2, 1117 ßad rcna^inad hara

as a sttident of

»adlclna

until the and of the sumer seedster I918»

Durlng the tlae he nttendad this yniversity he duly raglsterod to
thö Iftoturea «pecified in t^ie att&ched liw^tt

fepariJMBtal pharsaoelog/
Forcaisic aadicina
TopograpMc anat<Mgr

II Syer SeaePter 193^

iadic^il poXydinle
Obatetidc igmacologic clinic
Piychiatrio clinic
dftrgioal clinic
Ophtbidaie diaic

Couraa in patholofic anatomy and ext^rctaaa
Couraa in »icroacopy In p/tthoIo|ic faistdlogy
in pathology on fresh praparr.tiana

Fft« staap

After the candidate of »«dicixitt
IfMST MUELLER of Scbnalkaldon has passed hls
nedioal examinatlon before the board of ezaainers at
Berlin with the aark • g o o d • and hls war serYlcef
hflid been t&ken account of in sterd of the obllratory
pr»ctical interne yertTp ha is hereby granted •

UCmSS AS FBISICIAll
valid froa the Äoveaber 27, 1918 and for the territory
of the Geraan Raich In .iccordanoa with Par 29 of the Reichs

ordar«

Barlln, Daceaber 17^ 1916

Seal

Mlnlstry of Interior

By Order
agd# lircfaner

Seen for Terificetiwa of
abore aign^tura
Bariin, »oveabar 7, 1955

Saal

The Foreign Office of
t\m ^eraan Reich
agd« Reiaka

L I C E H S E
for
Imet ■ fl 1 1 e r
aa pligriician

\:iii THir. jxüix To kappin e.'^g

IN TKi. rmiiDHlCH-WI'.ULliftS

ü';ivi:-.:'iTy m b, i^iii

üfKicr the »ftgnificont EectoraLiTi of Roinold v^'e'3b9rg, Doctor of

Thoo ogyp Doctor h»c. of Luw and Philo-jophy, Public ?r"»res3or

In orülnary nt thia Unlv^a-sity, ♦

by Order of th*^j ßraciouii Tj^culty of Medien«,

Wilhelm Kia, duly comaip.'^on^'d Pr motori Doctor of i'^^iclne ^nd
Surgery, Public Professor in Orcim;ry t;t ^hia Univsrsity, •

Dei.n ^ro tsa. o* thc Fuculty of MrJicine,

ha« löwfully conforrod u^on the eio^t la^.med

Km3t li u a 1 1 a r

of hes?en-^^e.3niiu,

a raetUcal pr^ictitioner,

tlie prero^atlves und Privileges, tbo de^xeo and tho honors of

DOCTOr. OF l!KDICINi:

lifter he pes.-^ed the ortl exufcüntition and / :'t«r hie praia^ivorthy
th<98i8| »ritten In th^ Gerausn lunfutfe ' n leiiring the tiüe*
•UJeber die Tor»ion des Saa^nstrenga* y^&s pr ntof* with tlm sporoval
of th« Fsculty«

This i7th «lay of J^nuary 1919t

m f ITNEf^ W? K;trX)F TIII-^ V^L^J^ \h\r BEt:N IF^^UED üfIDEi; THii ?EAL
OT^ Tfil FACULTT.

Th'^' £enuinen«S8 of th# (0^&l)

oi^n tur« o^ the Hector

of thÄ l'niv^^raity o'' **er~.in

ia hireby certifiod,

Berlin, J^oveubei' 9, 1923.

The Prusaifoi ^^inister of ßcienc«,
Art and Public Educationt
Byt 8g • Or. Amk«l.

( 8<i8l)

»8719

8^c, HiSf -*«ftn pro toa,
The ''or^jgoing aiiü. tui*e hes b'^en ftffixed
by th« Dettn of the l&culty of ^'«tiicin«
fet th>tt tim«^ Prcfeflsor D-* Hls»
Berlin, Koveaber 6, 1833 • the Etctort
(s^ül of the Unlveraity) sgd.illegible

8aen for certificution of th« feforog ng

sirnüture«

Bariin, Uoveiibor 16, 19S5» The Foralfn Offica

of the Cleim&n Reicht
Byt s^-d, ille^flble. (ge&l)

♦ Tr&nsltitor*ö notat further titla» 0E;itted»

MEMBERSHIP DIRECTORY
for 1954

THE AMERICAN SOCIETY

for the

STUDY OF STERILITY

OFFICERS AND DIRECTORS

1953-1954

B. BERNARD WEINSTEIN
President

ROBERT HOTCHKISS
Vice-President

HERBERT H. THOMAS
Secretary

CARL E. JOHNSON
TreaBurer

BOARD OF DIRECTORS

S. Leon Israel 1954

Myron G. Fincher _ 1954

Somers H. Sturgis — 1956

J. P. Greenhill - 1955

Willis E. Brown _ 1966

Pendieton Tonripkins 1966

FAST PRESIDENTS

Walter W. Williams 1944-1947

Lyman W. Mason 1948-1949

Lewis Michelson „.1950-1951

Fred A. Simmons 1951-1952

Irvin F. Stein _ 1952-1953

ROSTER OF MEMBERS

HONORART MEMBERS

HAMBLEN, EDWIN C, M.D.

Endocrine Division, Duke Hospital, Durham. N. C.
HARTMAN, CARL G.. M.D.

Ortho Research Foundation, Raritan, N. J.

LANE-ROBERTS. CEDRIC S., M.D.

The Mill House, Tewin, Harts. England

PAPANICOLAOU, GEORGE N., M.D.
1300 York Ave., New York. N. Y.

RUBIN, ISIDOR, C. M.D.

911 Park Ave., New York, N. Y.

8TONE, ABRAHAM. M.D.

40 Park Ave., New York 16, N. Y.

FELLOWS

BROWN, WILLIS E., M.D.

University of Arkansas, Little Rock, Ark.

CHARNY, CHARLES W., M.D.

2039 DeLancey PL, Philadelphia 8. Pa.

DABNEY, MARYE Y., M.D.

2300 Highland Ave., Birmingham. Ala.
DAVIS, M. EDWARD, M.D.

5841 Maryland Ave., Chicago 37, III.
DOUGLAS, GILBERT F., M.D.

1923 So. 14th Ave., Birmingham, Ala.

GLASS, SAMUEL JR.. M.D.

860 No. Bedford Dr., Beverly Hills, Calif.
GREENHILL, J. P., M.D.

65 E. Washington Blvd., Chicago. 111.
GUERRERO. CARLOS D., M.D.

Miguel Schulz 19, Mexico City, Mexico
GUTTMACHER, ALAN F., M.D.

Mt. Sinai Hospital, New York City, N. Y.

HAMAN, JOHN O., M.D.

490 Post St.. San Francisco 2, Calif.
HOTCHKISS. ROBERT S., M.D.

66 E. 66th St.. New York 21. N. Y.

ISRAEL, S. LEON. M.D.

2116 Spruce St., Philadelphia 3, Pa.

MacLEOD, JOHN, Ph.D.

CorneU Univ. Medical College, 1300 York Ave.,

New York. N. Y.
MASON, LYMAN W., M. D.

1214 Republic Bldg., Denver, Colo.
MAZER, CHARLES. M.D.

2047 Spruce St., Philadelphia 3. Pa.
McLANE, CHARLES M., M.D.

960 Park Ave.. New York 28. N. Y.
MEIGS. JOE V., M.D.

Vincent Memorial Hospital, Boston, Mas».
MICHELSON, LEWIS. M.D.

490 Post St., San Francisco 2, Calif.

POMMERENKE, W. T.. M.D.

Univ. of Rochester Medical Center, Rochester,
N. Y.

RAKOFF, ABRAHAM E.. M.D.

269 So. 19th St.. Philadelphia 3. Pa.
ROBERSTON. EDWIN M., F.R.C.O.G.

Kingston General Hospital, Kingston, Ontario,

Canada
ROCK, JOHN, M.D.

32 Cumberland Ave., Brookline, Mass.

SALMON. UDALL J., M.D.

875 Fifth Ave., New York 21, N. Y.
SIMMONS. FRED A.. M.D.

330 Dartmouth St., Boston, Mass.
STEIN, IRVING F.. M.D.

80 N. Michigan Ave., Chicago 2, 111.
STURGIS. SOMERS H., M.D.

721 Huntington Ave., Boston, Mass.

TOMPKINS, PENDLETON, M.D.

450 Sutter St., San Francisco, Calif.

WEINSTEIN, B. B., M.D.

1421 Delachaise St., New Orleans 15, La.
WEISMAN, ABNER I., M.D.

1160 Fifth Ave., New York 29, N. Y.
WILLIAMS, WALTER W., M.D.

20 Magrnolia Terrace. Springfield, Mass.

ACTIVE

ALVAREZ-BRAVO, ALFONSO, M.D.

Plaza de la Republica 7, 40 Piso, Mexico 1, D. F.

BELDING. DAVID L.. M.D.

215 Main St., Hingham, Mass.

BICKERS. WILLIAM, M.D.

412 Med. Arts Bldg., Richmond. Va.
BIRNBERG. CHARLES H., M.D.

191 Ocean Ave., Brooklyn, New York
BLANDAU, RICHARD J.. M.D.

6531 37th St., N.E., Seattle. Wash.
BRODNY, M. LEOPOLD. M.D.

636 Beacon St., Boston 16, Mass.
BURKE, JOHN E.. M.D.

86 Lincoln St., Framingham, Mass.
BUXTON, CHARLES L.. M.D.

Yale University Medical School, New Haven, Conn.

CARTER, BAYARD. M.D.

Duke University Hospital, Durham, N. C.
CASTRO, EDUARDO, M.D.

Uruguay 90, Mexico 2, D. F., Mexico
COHEN, MELVIN R., M.D.

80 No. Michigan Ave.. Chicago, 111.
CROSSEN. ROBERT J.. M.D.

901 University Club Bldg.. 607 N. Grand Ave.,

St. Louis. Mo.

DECKER. ALBERT. M.D.

10 W. 74th St.. New York. N. Y.
DODGE. EVA F., M.D.

University of Arkansas. 2124 W. llth St.. Little

Rock, Ark.
DOYLE. JOSEPH B.. M.D.

66 Bay State Rd., Boston, Mass.

FARRIS, EDMOND J.. Ph.D.

The Wistar Institute. 36th and Woodland Ave..

Philadelphia, Pa.
FINCHER, MYRON G.. D.V.M.

New York State Veterinary College, Cornell Uni-
versity, Ithaca, N. Y.
FINKLER, RITA S.. M.D.

86 Leslie St.. Newark 8. N. J.
FISTER. GEORGE M., M.D.

886 24th St.. Ogden. Utah
FOLSOME, CLAIR E.. M.D.

1249 Fifth Ave., New York 29, N. Y.
FRIED, PAUL H., M.D.

1812 Spruce St.. Philadelphia 3, Pa.
FREIDMAN, LOUIS L., M.D.

817 Lowry Medical Arts Bldg., St. Paul 2. Mlnn.

GALLO. DELFINO, M.D.

Justo Sierra 888, Guadalajara, Mexico
GETZOFF, PAUL L., M.D.

400 Medical Arts Bldg.. New Orleans 16. La.
GOLDZIEHER, JOSEPH. M.D.

1188 Medical Arts Bldg.. San Antonio, Texas

GRAY, LAMAN A.. M.D.

408 Heybum Bld»., Louisville 2, Ky.
GREENBLATT, R. B.. M.D.

Medical ColleRe of Georgia, Augusta, Ga.

HARTNETT, LEO J.. M.D.

422 Missouri Theatre Bldfir., St. Louis 3, Mo.
HELLER, CARL G.. M.D.

Univ. of Oretron Medical School. Portland. Ore.
HELLMAN. LOUIS M.. M.D.

Helen Street, Greenvale, L. L, N. Y.
HOWARD, R. PALMER

Oklahoma Med. Research Inst. & Hospital

825 N.E. 13th Street. Oklahoma City, Okla.
HUDGINS. ARCHIBALD P., M.D.

403 Professional Bldg., Charleston. W. Va.
HUGHES, EDWARD C. M.D.

713 E. Genessee Street, Syracuse, N. Y.

INGERSOLL, FRANCIS M., M.D.
264 Beacon St., Boston. Maas.

JOHNSON, CARL E., M.D.

364 Oak Street. New Haven 11, Conn.
JONES, G. E. SEGAR. M.D.

110-111 Medical Arts Bldg., Baltimore, Md.

KANTOR. HERMAN L. M.D.

3534 Maple Ave., Dallas, Texas
KLEEGMAN, SOPHIA J., M.D.

59 E. 54th Street. New York, N. Y.
KURZROK, RAPHAEL, M.D.

1016 Fifth Ave., New York, N. Y.

MACK, HAROLD C. M.D.

3001 W. Grand BIvd.. Detroit, Mich.
MARBACH. A. HERBERT, M.D.

Suite 1201, Medical Tower, Philadelphia 3, Pa.
MASTERS, WILLIAM H., M.D.

630 S. Kings Highway. St. Louis, Mo.
MULLIGAN, WILLIAM J.. M.D.

32 Cumberland Ave., B»-ookline 46, Mass.

NELSON. WARREN O., Ph.D.

State Univ. of Iowa, College of Medicine, Iowa
City, la.

PAGE, ERNEST, M.D.

3031 Telegraph Ave., Berkeley, Calif.
PALMER, ALLAN, M.D.

2107 Van Ness Ave., San Francisco, Calif.
PAYNE, SHELDON, M.D.

921 Westwood Blvd., Los Angeles, Calif.
PERLOFF, WM. H., M.D.

1930 Chestnut St., Philadelphia, Pa.

POLLAK, OTAKER J., M.D.
P.O. Box 228, Dover, Del.

REIFENSTEIN, EDWARD C, JR., M.D.

27 Hawthorne Ave., Bloomfield, N. J.
ROMMER. J. JAY, M.D.

26 Ingraham Place, Newark, N. J.
ROTH. ARTHUR A., M.D.

1021 Prospect Ave., Cleveland, O.
RUBENSTEIN, BORIS B., M.D.

185 N. Wabash Ave., Chicago. 111.
RUTHERFORD, ROBERT N., M.D.

707 Broadway, Seattle, Wash.

SHIELDS. FRANCES E., M.D.

New Haven Professional Bldg., 462 Jefferson St..

Monterey, Calif.
SHUTE. EVAN V., M.D.

10 Grand Ave., London, Ontario. Canada
SILBERNAGEL, WYNNE M., M.D.

9 Buttles Ave., Columbus 12, O.
SINGLETON, J. MILTON, M.D.

315 Nichols Rd., Kansas City, Mo.
STUERMER, VIRGINIA M., M.D.

2900 Vine St., Lincoln 3, Neb.

THOMAS, HERBERT H., M.D.

920 So. 19th St., Birmingham, Ala.
THOMPSON, WILLARD O., M.D.

700 N. Michigan Ave., Chicago 11, 111.
TURNER, VIOLET H.. M.D.

Duke Hospital, Durham, N. C.
TYLER, EDWARD T., M.D.

10911 Weybum Ave., Los Angeles 24, Calif.

VOLLMER, ALBERT M., M.D.

384 Post St., San Francisco, Calif.

WEED, JOHN C, M.D.

Ochsner Clinic, Prytania and Aline St»., New

Orleans 15, La.
WEIR, DAVID R., M.D.

2102 Abington Rd., Cleveland 6, Ohio
WEIR, WILLIAM C, M.D.

10515 Carnegie Ave.. Cleveland. Ohio
WHITELAW, M. JAMES, M.D.

655 Sutter St., San Francisco, Calif.

ASSOCIATE MEMBERS

ABRAMSON, DANIEL, M.D.

127 Bay State Rd., Boston, Mass.

ALBERT, A., M.D.
102-110 Second Ave.

S.W., Rochester, Minn.
9

ALBERT. LOUIS. M.D.

476 Commonwealth Ave.. Boston. Mass.
ANDERSON. HARLEY. M.D.

1107 Medical Arts Bldg.. Omaha. Neb.
ANDROS. GEORGE J.. M.D.

420 W. Ottawa St., LansinR. Mich.
ANGELUCCI. HELEN M.. M.D.

136 S. 16th St., Philadelphia, Pa.
ARNHEIM, FLAK K., M.D.

8612 Fifth Ave., Pittsburgh 13, Pa.
ARZAC, J. P.. M.D.

Monte Libano 340. Mexico City. Mexico
AUGUST. RALPH V.. M.D.

72 Broadway. Muskegon Heights. Mich.
AUSLANDER. HAROLD P., M.D.

2840 Coral Way, Miami Beach. Fla.

BANKS. A. LAWRENCE, M.D.

707 Broadway, Seattle 22. Wash.
BARKER, C.A.V., D.V.M.. M.Sc. D.V.Sc.

Dept. of Medicine and Sur^ery

Ontario Veterinary Collesre, Guelph. Ont., Canada
BELT, ELMER. M.D.

1893 Wilshire Blvd.. Los Angeles. Calif.
BEHRMAN. SAMUEL J.. M.D.

617 E. Liberty St., Ann Arbor, Mich.
BENESOHN. SOL, M.D.

66 E. Washington, Chicago, III.
BENJAMIN. JOHN. M.D.

Strong Memorial Hosp.. Rochester. N. Y.
BENNETT, ALWNE E., M.D.

808 Republic Bldg., Cleveland 16. Ohio
BERLIN. ALLEN. M.D.

722 Macabees Bldg.. Detroit 2, Mich.
BERMAN. ROBERT. M.D.

299 Clinton Ave.. Newark. N. J.
BISKIND. GERSON R., M.D.

460 Sutter St., No. 1489, San Francisco 8. Calif.
BISKIND. MORTON S.. M.D.

Westport. Conn.
BLACK. WILLIAM T.. M.D.

899 Madison Ave.. Memphis. Tenn.
BRAND. ELLIOTT. M.D.

146 Sherman Ave., New Haven. Conn.
BRANNON. ROBERT M., M.D.

2121 Highland Ave., Birmingham, Ala.
BRANSCOMB. LOUISE. M.D.

1026 Woodward Bldg., Birmingham, Ala.
BROWN. HUNTER M.. M.D.

1922 lOth Ave., S., Birmingham. Ala.
BUERGER, CLAUDE L., JR., M.D.

1466 Springhill Ave.. Mobile 17, AU.
BYRON, CHARLES, M.D.

346 Schermerhorn St., Brooklyn, N. Y.

CANNIS, JOHN P.. M.D.

926 Park Ave.. Plainfield, N.J.
CANTOR, EDWARD B.. M.D.

4849 Van Nuys Blvd.. Sherman Oaks. Calif.
CARLSON. HJALMAR. M.D.

1816 Professional Bldg.. Kansas City, Mo.
CARRABBA, SALVATORE, M.D.

179 Allyn St., Hartford, Conn.
CASTALLO, MARIO A., M.D.

1621 Spruce St.. Philadelphia. Pa.
CHAPPELL, AMEY, M.D.

79.5 Peachtree St., N.E., Atlanta. Ga.
CHIDESTER, AUGUSTUS B., M.D.

120 Genesee St., Auburn, N. Y.
CHRISMAN, R. B., JR.. M.D.

701 du Pont Bldg., Miami, Fla.
CINER. LEONARD F., M.D.

68 East 79th, New York, N. Y.
CLINE, WADE, M.D.

2018 15th Ave.. S.. Birmingham, Ala.
COCHRANE, CLELAND, M.D.

701 N. Peninsula Dr., Daytona Beach. Fla.
CORCORAN, MICHAEL A., M.D.

689 Asylum Ave., Hartford, Conn.
CORTESE, THOMAS A., M.D.

4.35 South East St. Indianapolis, Ind.
COULTON, DONALD, M.D.

326 State St., Bangor, Me.
CRAWLEY, LAWRENCE Q.. M.D.

101 East 89th St.. New York 28, N. Y.
CRISTOL, DAVID S., M.D.

255 S. 17th St.. Philadelphia 3, Pa.
CRUTCHER, H. K., M.D.

1511 N. Beckley, Dallas, Tex.

DANFORTH, DAVID, M.D.

636 Church St., Evanston, 111.
DANIELS. ANNA KLEEGMAN, M.D.

322 W. 72nd St.. New York 23, N. Y.
DAVIS, JULIUS T., M.D.

4414 Magnolia St., New Orleans, La.
DE CARLE. DONALD W., M.D.

2000 Van Ness, San Francisco, Calif.
DICKERSON. DONALD L.. M.D.

107 N. Franklin St., Danville, III.
DIETER, DONALD D., M.D.

416 So. Santa Fe, Salina, Kans.
DIPPEL, LOUIS A., M.D.

309 Hermann Professional Bldg., Houston 5, Tex.
DOBSON, CATHERINE L., M.D.

25 E. Washington St., Chicago 2, 111.
DODEK, SAMUEL M., M.D.

1730 Eye St., Washington, D. C.
DOUGLAS, JOSEPH W., M.D.

1900 North Palafox St., Pensacola. Fla.

EFSTATION. THOMAS D.. M.D.

84 W. Market St., Tiffin, Ohio
EMMONS, CARL W., M.D.

Women'8 Clinic, 2495 Center St., Salem, Ore.
ENGLE, EARL T., Ph.D.

630 W. 168th St.. New York, N. Y.
EPPERSON, JOHN W. W., M.D.

West Grand Blvd. and Hamilton Ave.. Detroit,

Mich.
ESSIN, EMMETT, JR., M.D.

109 N. Walnut, Sherman, Tex.

FELDMAN, HAROLD, M.D.

131 Linwood, Buffalo, N. Y.
FINEGOLD, W. J., M.D.

3500 Fifth Ave., Pittsburgh 13. Pa.
FIRST, ARTHUR. M.D.

1714 Spruce St., Philadelphia. Pa.
FISCHER, IRVING C. M.D.

15 E. 7l8t St.. New York. N, Y.
FLUHMAN, C. FREDERIC, M.D.

656 Sutter St., San Francisco. Calif.
FOGEL, JULIUS, M.D.

1723 M. St.. N.W.. WashinKton. D. C.
FOND. MORRIS S.. M.D.

1272 Grand Concourse, Bronx 66, N. Y.
FORMAN, ISADOR, M.D.

802 S. 19th St., Philadelphia 3, Pa.
FORMAN, RICHARD C, M.D.

427 Biltmore Way, Coral Gables, Fla.
FORTIER, QUINCY E., M.D.

2232 Seabury Ave., Minneapolis, Minn.
FRANK, RICHARD, M.D.

109 N. Wabash Ave., Chicagro, 111.
FRAZIER, WILLIAM HARVEY, M.D.

1681 Paulsen, Medical & Dental Bldg., Spokane,

Wash.
FREED, CHARLES R., M.D.

1809 E. 18th Ave., Denver 6, Colo.
FREEDMAN, HENRY, M.D.

9 Pierre Pont St., Brooklyn, N. Y.
FROSH, ALVIN J., M.D.

2222 E. 18th Ave., Denver, Colo.
FROST, INGLIS F., M.D.

181 South St.. Morristown, N. J.

GARRETT. SHERMAN S.. M.D.

209 West Park. Champaifirn, 111.
GARBER. STANLEY T.. M.D.

104 Wm. Howard Taft Rd., Cincinnati 19, Ohio
GARSKE, GEORGE LEO, M.D.

322 Doctors Blds:.. 90 S. Ninth St., Minneapolis 2,

Minn.
GEPFERT. RANDOLPH, M.D.

71 E. 77th St., New York, N. Y.

GERSH, ISADORE, M.D.

242 Metropolitan Bldg., Denver, Colo.
GODFRIED, MILTON S., M.D.

86 Trumbull St., New Haven, Conn.
GOLDFARB, ALVIN, M.D.

1 East 72nd St., New York, N. Y.
GOLDMAN, DANIEL W., M.D.

601 Medical Arts BldR., New Orleans 16, La.
GOLDNER. HARRY. M.D.

1815 llth Ave., S., Birmingham, Ala.
GONZALEZ-GUERRERO, JOSE, M.D.

Calle Arce, Apts. Transito No. 4,

San Salvador, El Salvador, Central America
GOODMAN, LEON J., M.D.

729 Pine St., Macon, Ga.
GORBEA. RICARDO L., M.D.

894 West End Ave.. New York. N. Y.
GREENE, LAURENCE F., M.D.

Mayo Clinic, Rochester, Minn.
GREELEY, ARTHUR V., M.D.

960 Park Ave., New York 28, N. Y.
GUERRA, A. SALAS, M.D.

Padremier 1043 Pte., Monterrey, Mexico
GUERRIERO, WILLIAM F., M.D.

3207 Turtle Creek Blvd., Dallas 4, Tex.

HADDEN, DAVID RODNEY, M.D.

2680 Bancoft Way, Berkeley 4, Calif.
HAHN. GEORGE A.. M.D.

265 S. 17th St.. Philadelphia. Pa.
HANGE. B. M.. M.D.

62 N. Third St.. Easton, Pa.
HARRIS. JOSEPH M., M.D.

183 S. Lasky Dr., Beverly Hills, Calif.
HARSH, JOHN F., MD.

920 S. 19th St., Birmingham, Ala.
HECKEL, GEORGE P., M.D.

Strons: Memorial Hospital, 260 Crittenden Blvd.,

Rochester, N. Y.
HECKEL, NORRIS J., M.D.

122 S. Michigan Ave., Chicago, 111.
HENKIN, ALLEN E., M.D.

Suite 804, Farrasrut Med. Bldg.,

900 17th St., N.W., Washington 6. D. C.
HEPBURN. ROBERT HOUGHTON, M.D.

85 Jefferson St., Hartford, Conn.
HERROLD, RUSSELL D., M.D.

6 N. Michigan, Chicago, 111.
HINMAN, FRANK. JR.. M.D.

Univ. of California Hospital. San Francisco, Calif.
HODGSON, JANE E., M.D.

611 Lowary Medical Arts Bldg., St. Paul, Minn.
HOFFMAN. KATHRYN E., M.D.

685 Schofield Bldg., Cleveland. Ohio

HOLLANDER. ARTHUR. M.D.

1695 Grand Concourse, New York. N. Y.
HOWARD. FREDERICK S.. M.D.

655 Sutter St., San Francisco. Calif.
HOWARD. LAWRENCE L., M.D.

1220 Central Ave., Great Falls, Mont.
HUFFMAN. JOHN W., M.D.

670 N. Michigan Ave.. Chicago, 111.
HULME, HAROLD B.. M.D.

411 First National Bank, Boise, Id.
HUNTER, G. WILSON. M.D.

Fargo Clinic. Fargo. N. D.

JACOBSON. CHARLES E.. M.D.

50 Farmington Ave.. Hartford. Conn.
JENNINGS, ANGES F.. M.D.

231 Grand Ave.. South San Francisco, Calif.
JINKINS, J. L., M.D.

906 22nd St., Galveston, Tex.
JOHNSON. C. GORDON, M.D.

3636 St. Charles Ave.. New Orleans. La.
JONES, W. NICHOLSON. M.D.

2154 Highland Ave.. Birmingham. Ala.

KAHN, EDWARD, M.D.

213-16 85th Ave., Queens Village. N. Y.
KAIN, HELEN G., M.D.

1801 Eye Street, N.W.. Washington, D. C.
KARNAKY, KARL JOHN. M.D.

329 Medical Arts Bldg., Houston 2. Tex.
KAUFMAN. SHERWIN A.. M.D.

935 Park Ave.. New York 28. N. Y.
KERNODLE, JOHN ROBERT. M.D.

Kernodle Clinic. Burlington. N. C.
KESHIN. JESSE G., M.D.

610 West llOth St., New York. N. Y.
KINGMAN, H. E.. D.V.M.

Wyoming Hereford Ranch, Cheyenne. Wyo.
KIRKENDALL, HENRY L.. M.D.

50 Elm St.. Worcester. Mass.
KLEIN, JOSEPH. M.D.

80 Farminghton Ave.. Hartford. Conn.
KOHN. ANTHONY, MD.

111 Carlton Ave.. Islip Terrace. L. I., N. Y.
KRAMER. MILTON, M.D.

1263 President St., Brooklyn 13. N. Y.
KREBS, O. S.. M.D.

3720 Washington Blvd., St. Louis, Mo.
KUPPERMAN, HERBERT S., M.D.

477 Ist Ave.. New York 16. N. Y.
KURLAND. IRVING I.. M.D.

1265 President St.. Brooklyn 13, N. Y.
KURZROK. LAWRENCE. M.D.

969 Park Ave., New York, N. Y,

KUSHNER, J.
1840 Grand

IRVING. M.D.
Concourse. New

York, N. Y.

LANGSTON. HENRY J.. M.D.

Main St. and Jefferson Ave., Danville, Va.
LATTUADA. HENRY P.. M.D.

101 W. North St.. Danville, 111.
LEARY. DEBORAH, M.D.

School of Medicine, Univ. of North Carolina

Chapel Hill. N. C.
LEIBOLD. GEORGE. M.D.

818 Cedar Ave.. Pittsburgh, Pa.
LENNOX, ARTHUR L., M.D.

1838 Parkwood Ave.. Toledo. Ohio
LEVENTHAL, MICHAEL. M.D.

109 N. Wabash St., Chicago, 111.
LORIMER. ROBERT. M.D.

148 State St., Portland, Me.
LUCAS, J. F., M.D.

501 W. Washington St., Greenwood. Miss.
LUKEMAN. H. J., M.D.

285 Casa Linda Plaza, Dallas 18, Tex.
LYON. ROBERT A.. M.D.

2533 Ocean Ave.. San Francisco. Calif.

MARGOLESE, M.S.. M.D.

436 N. Roxbury Dr.. Beverly Hills. Calif.
MARSH. EARLE M.. M.D.

490 Post St.. San Francisco 2. Calif.
MASSEY. WARREN E.. M.D.

1538 Medical Arts Bldg., Dallas, Tex.
MATSNER, ERIC M.. M.D.

450 N. Bedford Dr.. Beverly Hills, Calif.
McCALL. MILTON L.. M.D.

Louisiana State Univ.. New Orleans, La.
McCORMICK. CHARLES O.. JR.. M.D.

3843 Central Ave., Indianapolis, Ind.
McDONOUGH. JOHN J.. M.D.

11 Central Square. Youngston. Ohio
McENTEE. KENNETH. D.V.M.

New York State Veterinary College at Cornell

Univ., Ithaca. N. Y.
MENCARO. WILLIAM JOSEPH. M.D.

505 15th. Moline, 111.
MENDEL, EVRI B., M.D.

3702 Worth, Dallas, Tex.
MEZER, JACOB. M.D.

The Lister Bldg.. 475 Commonwealth Ave..

Boston, Mass.
MILLEN, ROBERT S.

Westbury, N. Y.
MITCHELL, GEORGE J., M.D.

1322 Springhill Ave., Mobile, Ala.
MITCHELL, GEORGE W., JR.. M.D.

30 Bennet St., Boston. Mass.

MONTGOMERY. JOHN B.. M.D.

1930 Chestnut St., Philadelphia, Pa.
MORGENSTERN, MATES, M.D.

127 LivingTston Ave., New Brunswick, N. J.
MORSE, WALTER 8., M.D.

3411 Montrose Blvd.. Houston 6, Tex.
MYLKS, G. W.. JR.. M.D.

122 Wellington St., Kini^ston, Ontario, Canada.
MYLLER, ERNEST, M.D.

66 E. 76th St., New York, N. Y.

NATHANSON, ESTHER A., M.D.

2535 Massachusetts Ave., N.W., Washington 8, D. C.
NISWANDER, KENNETH. M.D.

412 Linwood Ave., Buffalo, N. Y.
NORWOOD, G. E., M.D.

1406 S. San Marino Ave, San Marino 9, Calif.
NYDA. MORTON J., M.D.

666 Sutter St., San Francisco, Calif.

OGLE, LUTHER CURTIS, M.D.

188 S. Bellevue St., Suite 306, Memphis, Tenn.

PARKS, THOMAS J.. M.D.

47 E. 63rd St., New York 21, N. Y.
PATTEE. CHAUNCEY J., M.D.

1390 Sherbrooke St., W., Montreal, Canada
PEARSE. RICHARD L., M.D.

604 W.. Chapel Hill. Durham, N. C.
PERLMAN, ROBERT M., M.D.

999 Sutter St., San Francisco. Calif.
PERSALL. JOHN T., M.D.

302 S.F.C. Bldfi:., Auffusta. Ga.
PETERS, WILLIAM A.. JR., M.D.

206 S. Road St., Elizabeth City, N. C.
PEVEN, PHILIP S., M.D.

18709 Meyers Rd., Detroit 36, Mich.
PLATZ, CAROL. M.D.

1368 Kelly Rd.. Detroit 24. Mich.
PORTNOY, LOUIS, M.D.

28 W. llth St., New York 11, N. Y.
POWELL, NORBORNE B.. M.D.

801 Hermann Professional Bldfi:.. Houston 26, Tex.

RAND. ANNA T., M.D.

1801 Emerson St., N.W., Washington, D. C.
RENNIE, S.W., M.D.

1201 Delaware Ave., Wilminarton, Del.
RIESER, CHARLES, M.D.

819 Cypress St., N. E., Atlanta, Ga.
RIEMENSCHNEIDER. E., M.D.

1000 2nd National Bldfir., Akron, Ohio
ROBERTSON. JARRETT. M.D.

609 Medical Arts Bldg., Birmingham, Ala.

ROGERS, JOSEPH. M.D.

171 Harrison Ave., Boston, Mass.
ROLAND, MAXWELL, M.D.

11420 Queens Blvd.. Forest Hills. N. Y.
ROMBERG. GEORGE H.. M.D.

145 Maple Ave., White Plains, N. Y.
ROMBERGER. FLOYD T., JR.. M.D.

3440 No. Meridian St., Indianapolis, Ind.
ROSENBLUM. GORDON. M.D.

6333 Wilshire Blvd.. Los Angeles 48, Calif.
ROSENFELD. S. S., M.D.

1882 Grand Concourse, New York, N. Y.
ROTH, DANIEL B.. M.D.

886 Garrison Ave.. Teaneck, N. J.
ROTHMAN. EMIL. M.D.

722 Maccabees Bldg.. Detroit. Mich.
RUSSELL. MURRAY, M.D.

8820 Wilshire Blvd., Beverly Hills, Calif.

SAPHIRSTEIN, HYMAN, M.D.

479 Beacon St.. Boston, Mass.
SCHAEFFER. FRANCES C, M.D.
26 N. Eight St., AUentown. Pa.
SCHINFELD. LOUIS. M.D.

256 S. 17th St., Philadelphia, Pa.
SCHNALL, MEYER D., M.D.

130 E. 67th St., New York, N. Y.
SCHRÄM, E. L. R., M.D.

604 Wellington St., London, Ontario, Canada.
SCHULTZ, JOHN M., M.D.

604 Huntington Bldg., Miami 82, Fla.
SCOTT, JOSEPH W., M.D.

742 Dupont Bldg.. Miami, Fla.
SEIBEL. DAVID. M.D.

University Hospital. Minneapolis, Minn.
SEITCHIK. JOSEPH N.. M.D.

230 N. Broad St.. Philadelphia. Pa.
SELTZER, LEO MAURICE. M.D.

1205 Quarrier St., Charleston. W. Va.
SHIMMERLIK. LUCH. M.D.

155 E. 73rd St., New York. N. Y.
SIEGLER. ALVIN M.. M.D.

706 Eastem Parkway, Brooklyn, N. Y.
SILTON, MAURICE Z., M.D.

5720 Wilshire Blvd.. Los Aengeles 36, Calif.
SIMMONS. RAYMOND. M.D.

37-39 N. Goodman St.. Rochester, N. Y.
SINCLAIR. A. B.. M.D.

4711 Central St.. Kansas City. Mo.
SKEELS. ROBERT. M.D.

921 Westwood Blvd.. Los Angeles. Calif.
SMITH. SAMUEL W.. M.D.

6638 Telegraph Ave.. Oakland. Calif.
SNOW, LUCILLE H., M.D.

686 Church St., Wilmette. 111.

SORDO-NORIEGA, ANTONIO, M.D.

Vallarta No. 16, Mexico City, Mexico.
SORY, J. R., M.D.

535 S. Flagler Dr., West Palm Beach, Fla.
SPECK, GEORGE, M.D.

2808 S. Randolph St., Arlingrton 6, Va.
SPICER, ROBERT T., M.D,

Dean, School of Medicine, University of Miami,

Coral Gables, Fla.
STEIN, ANNA A., M.D.

55 Forest Ave., Staten Island 1, N. Y.
STEINBERG. WERNER, M.D.

35 Gesner St., I^inden, N. J.
STEINER, MELVIN D.. M.D.

209 Medical Arts Bldg., New Orleans. La.
STEPHENSON. GATTON A., M.D.

92 Amherst St., Garden City, L. I.. N. Y.
STEVENSON, CHARLES, M.D.

1405 Kales Bldg., Detroit 26, Mich.
STOLLMAN. BERNARD, M.D.

8220 Wilshire Blvd.. Beverly Hills, Calif.
STONE. BARTLETT H.. M.D.

1101 Beacon Street. Brookline 46, Mass.
STONE, MARTIN L., M.D.

New York Medical College, Fifth Ave. at 106th

St., New York 29. N. Y.
STRASSMANN. ERWIN O.. M.D.

1405 Hermann Prof. Bldg., Houston 2. Tex.
STREET. R. A.. JR., M.D.

The Street Clinic, Vicksburg, Miss.
SUGGS, WILLIAM D., M.D.

Monument Ave. and Lombardy St., Richmond, Va.

TAFEEN. CARL H., M.D.

9 Pierre Pont St., Brooklyn, N. Y.
TANZ, ALFRED, M.D.

288 Crown St., Brooklyn, N. Y.
TARTA. GIRO, M.D.

654 E. 18th St., Paterson, N. J.
TAYMOR, MELVIN L., M.D.

330 Darthmouth St., Boston, Mass.
TIETZE, CHRISTOPHER. M.D.

2532 Holmes Run Dr., Falls Church, Va.
THOMAS, LEON B., M.D.

1206 S. llth St., Tacoma, Wash.
TOPKINS, PAUL, M.D.

1141 Eastern Parkway, Brooklyn. N. Y.
TRUEX. S. ALLEN. M.D.

Truex Clinic, Jackson. Tenn.
TRYTHALL, S. W., M.D.

13300 Livernois Ave., Detroit 4. Mich.

VANN. FELIX H.. M.D.

242 Engle St., Englewood, N. J.

VON FOHLE. K. C. M.D.
1010 Banks. Houston, Tex.

WAINER, AMOS SHEPARD. M.D.

1621 Spnice St., Philadelphia 8, Pa.
WALLIN. S. P.. M.D.

2615 Capital Ave.. Cheyenne, Wyo.
WARE. H. HUDNALL, JR., M.D.

816 W. Franklin St.. Richmond, Va.
WARD, ELIZABETH, M.D.

140 Roseville Ave., Newark, N. J.
WARD. MILDRED E.. M.D.

59 E. 54th St.. New York, N. Y.
WARREN, BERNICE. M.D.

4100 West McNichols Rd., Detroit, Mich.
WATERS. H. W., M.D.

730 Adams Ave., MontKomery, Ala.
WATSON, BLAKE H., M.D.

10962 LeConte Ave.. Los Angeles 24. Calif.

Beverly Hills. Calif.
WEBER, LENNARD L., M.D.

255 S. I7th St., Philadelphia. Pa.
WEIL. ALVEN M.. M.D.

1030 Ist Natl. Tower, Akron. Ohio.
WEINSTEIN. DAVID. M.D.

234 S. Main St.. Opelousas, La.
WEINSTEIN, MORTIMER. M.D.

1160 Fifth Ave., New York. N. Y.
WELD, STANLEY B., M.D.

85 Jefferson St., Hartford. Conn.
WELDON. JOSEPH. M.D.

461 Government St.. Mobile. Ala.
WEXLER. DAVID J.. M.D.

111 Carlton Ave.. Islip Terrace. Long Island, N. Y.
WIENER, WILLIAM B., M.D.

653 N. State St., Jackson. Miss.
WILLIAMS. GEORGE A.. M.D.

710 Peachtree St., N.E.. Atlanta, Ga.
WILSON. LEO. M.D.

400 West End Ave., New York. N. Y.
WILSON, ROBERT B., MD.

102-110 Second Ave., S.W.. Rochester, Minn.
WIMPFHEIMER, SEYMOUR, M.D.

1100 Park Ave.. New York 28. N. Y.
WINEBERG. ANAH CECELIA. M.D.

3120 Webster St., Oakland 9, Calif.
WOLLMAN. LEO. M.D.

2802 Mermaid Ave., Brooklyn. N. Y.
WORD. BUFORD, M.D.

2205 Highland Ave., Birmingham, Ala.

YOUNG, RAYMOND L.. M.D.

241 Washington Ave.. SanU Fe, N. M.

ZELLERMAYER. J.. M.D.

609 Professional Bldgr,, Kansas City, Mo.
ZETTELMAN. HENRY J., M.D.

1432 Aeburgr Ave.. Evanston, 111.

CORRESPONDING MEMBERS

AHUMADA, JUAN C, M.D.

Charcas 2346, Buenos Aires, South America
ASHERMAN, JOSEPH G., M.D.

29 Idelson St.. Tel-Aviv. Israel
AVERILL, L. C. L.. M.D.

83 Bealey Ave., Christchurch. N. Z.

BAYLE. HENRI, M.D.

193 Boulevard St. Germain, Paris, France
BECLERE, CLAUDE. M.D.

23. Rue d'Artois. Paris (Seme), France
BERGE. TEN, M.D.

Academisch Ziekenhuis, Groningen. Netherlands
BETTINOTTI, ALBERTO, M.D.

Rivere Indarte 21, Buenos Aires. South America
BOTTELLA-LLUSIA, JOSE. M.D.

Velazquez 83, Madrid, Spain
BREA. CESAR A., M.D.

Santa Fe 1391, Buenos Aires, Argentina

CARRIZO, ARISTOBULO, M.D.

Centro Medico Box 1615, Panama, Panama
CHEVALIER, PAOUL M.

Sante Fe 1707, Buenos Aires, Argentina

DA PAZ FIHLO, A. CAMPOS, M.D.

Rua Sao Jose, No. 50 40qandar

Rio de Janeiro, Brazil
DE ANDRADE, CLAUDIO, M.D.

Baras Jaguerico, 275, Rio de Janeiro. Brazil
DE LA BALZE, FELIPE, M.D.

1083 Parana St., Buenos Aires, Argentina
DE BARROS, PAULO, M.D.

Rue Alcindo Guanabara, Rio de Janeiro, Brazil
DE MORAES, ARNALDO. M.D.

Caixa Postal No. 1289. Rio de Janeiro. Brazil
DE MUYLDER. EDGARD, M.D.

Avenue General de Gaulle 36. Brüssels. Belgium
DE REZENDE. JORGE. M.D.

92, Rua Xavier Da Silveira. Rio de Janeiro. Brazil
DE WATTEVILLE. HUBERT. M.D.

6, Rue Charles Bonnet. Geneva. Switzerland
DI PAOLA. GUILLERMO. M.D.

Vidt 2061, Buenos Aires, Argentina

GRANT. ALAN, M.D.

147 Macquarie St., Sydney, Australia

HAMMEN, RICHARDT H.. M.D.

Jarmersgade 2. Copenhagen, Denmark
HERRERA, ROBERTO GANDOLFO. M.D.

1592 San Juan St., Buenos Aires. Argentina, S. A.

JOEL, CHARLES A., M.D.

4, Zvishapira St., Tel Aviv, Israel

LAGERLOF. PROF. NILS

Royal Veterinary College, Experimental Faltet,

Stockholm. Sweden
LOPEZ, MANUEL B.. M.D.

Calle Yi. 1219. Montevideo, Uruguay
LOUYOT, JEAN, M.D.

25 Baron Louis St., Nancy, France

MADSEN, VALDEMAR, M.D.

16 Juliane Maries Ves, Copenhagen, Denmark
MEZZADRA, JOSE MARIA E.. M.D.

Pampa 2540, Buenos Aires, Argentina, S. A.
MORI-CHAVEZ, PABLO. M.D.

Negreiros 563, Lima, Peru, S. A.
MURRAY, EDMUNDO G.. M.D.

Ayacucho 1376. Buenos Aires, Argentina

NOBILE. TIMETEO. M.D.

Via Sabaudia 14, Torino, Italy
NORDLANDER, ERIC. M.D.

Grev Turegatan 86, Stockholm, Sweden
NOUEL, CARLOS. M.D.

Avenida Buenos Aires, Caracas. Venezuela, S. A.
NUNEZ, ANTONIO CLAVERO, M.D.

Gran Via Fernando el Catolico 27, pral., Valencia.

Spain

PALMER, RAOUL, M.D.
3 Rue Octave Feuillet. Paris, France
PENA. DE LA, ALFONSO
Padilla 22, Madrid, Spain

RABAU. ERWIN. M.D.

8 Megidoser. Tel Aviv, Israel
RAO, B. K., M.D.

S-K Connaright Place, New Delhi, India
RYDBERG. ERIK. M.D.

Juliane Mariesvej 18, Copenhagen, Denmark

SHARMAN, ALBERT, M.D.

19 Kelvin Crt., Glasgow, Scotland
SOLOMONS, EDWARD, M.D.

80 Fitzwilliams PI., Dublin, Ireland

TRABUCCO, ARMANDO E.. MD.

Rivadavia 1917, Buenos Aires, Argentina, S. A.

VANDEVELDE. PETER. M.D.

108, Ave. J. Van Ryswyck, Antwerp, Belffium
VERAIN. MARCEL, M.D.

68 bia Rue de la Commandier, Nancy, France

YOUNG, DONALD. M.D.

50 Rodney St.. Liverpool, Lancashire, England

GEOGRAPHICAL INDEX

ALABAMA

Brannon, Robert M.
Branscomb. Louise
Brown. Hunter
Buerger, Claude L.
Cline, Wade
Dabney, Marye Y.
Douglas, Gilbert F.
Goldner, Harry
Harsh, John F.
Jones, W. Nicholson
Mitchell, George J.
Robertson, Jarrett
Thomas, Herbert H.
Waters, H. W.
Weldon, Joseph
Word, Buford

ARKANSAS

Brown, Willis E.
Dodge, Eva F.

CALIFORNIA

LOS ANGELES and
BEVERLY HILLS

Belt, Eimer
Glass, Samuel J.
Harris, Joseph
Margolese, M. S.
Matsner, Eric M.
Payne, Sheldon
Rosenblum, Gordon
Russell, Murray
Silton, Maurice Z.
Skeels, Robert
Stollman, Bernard
Tyler, Edward T.
Watson, Blake H.

SAN FRANCISCO and
BERKELEY

Biskind, Gerson R.
de Carlo, Donald W.
Fluhman, C. Frederic
Hadden, David Rodney
Haman, John O.
Hinman, Frank. Jr.

Howard, Frederick S.
Jennings, Agnes F.
Lyon, Robert A.
Marsh, Earle M.
Michelson, Lewis
Myda, Morton
Palmer. Allan
Page. Ernest
Perlman. Robert M.
Tompkins. Pendieton
Vollmer. Albert M.
Whitelaw, Maurice J.

OTHER CITIES

Cantor. Edward
Norwood. G. E.
Shields. Frances E.
Smith. Samuel W.
Wineberg. Anah C.

COLORADO

Freed. Charles
Frosh. Alvin J.
Gersh. Isadore
Mason, Lyman M.

CONNECTICUT

Biskind, Morton
Brand, EUiott
Carrabba, Salvatore
Corcoran, Michael A.
Goldfried, Milton S.
Jacobson, Charles E.
Johnson, Carl E.
Klein, Joseph
Hepbum, Robert H.
Weld. Stanley B.

DELAWARE

Pollak, Otakar J.
Rennie, S. W.

DIST. OF COLUMBIA

Dodek, Samuel M.
Fogel, Julius
Henkln, Allen E.
Nathanson, Esther A.
Rand, Anna T.
Kain, Helen G.

FLORIDA

Anslander, Harold P.
Chrisman, R. B.
Coehrane. Cleland
Doufirlas. Joseph W.
Forman, Richard C.
Sory, J. R.
Schultz, John M.
Spicer, Robert

GEORGIA

Chappell, Amey
Goodman, Leon J.
Greenblatt, R. B.
Persall, John T.
Rieser, Charles
Williama, Georsre A.

IDAHO

Hulme. Harold B.

ILLINOIS

CHICAGO

Benesohn, Sol.
Cohen, Melvin R.
Davis, M. Edward
Dobson, Catherine L.
Frank, Richard
Greenhill, J. P.
Heckel, Norris J.
HeiTold, Russell D.
Huffman, John W.
Leventhal, Michael
Rubenstein, Boris B.
Stein, Irvinjf F.
Thompson, Willard O.

OTHER CITIES

Danforth, David
Dickerson, Donald L.
Garrett, Sherman S.
Lattuada, Henry P.
Mencarrow, William J.
Snow, Lucille
Zettelman, Henry J.

INDIANA

Cortese, Thomas A.
McCormick, C. C, Jr.
Romberfirer, Floyd T.,
Jr.

IOWA

Nelson, Warren
Stuermer, Virginia M.

KANSAS

Dieter. Donald D.

KENTUCKY

Gray, Laman A.

LOUISIANA

Davis, Julius
Getzoff , Paul L.
Goldman, Daniel W.
Johnson, C. Gordon
McCall, Milton L.
Steiner, Melvin D.
Weed, John C.
Weinstein, B. B.
Weinstein, David

MAINE

Coulton, Donald
Lorimer, Robert

MARYLAND

Jones, G. E. Segar

MASSACHUSETTS

BOSTON and
BROOKLINE

Abramson, Daniel

Albert, Louis

Brodny, M. Leopold

Doyle, Joseph B.

Ingersoll, Francis M.

Mezer, Jacob

MeiRS. Joe V.

Mitchell, Georife W.

Mulliean, William J.

Rock, John

Rogers, Joseph

Saphirstein, Hjnnan

Simmons, Fred A., Jr.

Stone, Bartlett

Sturgis, Somers H.

Taymor, Melvin L.

OTHER CITIES

Beldinsr, David L.
Burke, John E.
Kirkendall, Henry L.
WiUiams, Walter W.

MICHIGAN

Andres, George J.
August, Ralph V.
Behrman, Samuel J.
Berlin, Allen
Mack, Harold C.
Peven, Philip S.
Platz, Carol
Rothman, Emil
Stevenson, Charles
Trythall, S. W.
Warren, Bemice

MINNESOTA

Albert, A.
Fortier, Quincy E.
Freidman, Louis L.
Garske, George Leo
Green, Lawrence
Hodgson, Jane E.
Seibel, David
Wilson, Robert B.

MISSISSIPPI

Lucas, J. F.
Street, R. A., Jr.
Wiener. William B.

MISSOURI

Carlson, Hjalmar
Crossen, Robert J.
Hartnett, Leo J.
Krebs, O. S.
Masters, William H.
Singleton, J. Milton
Zellermayer, J.

MONTANA

Howard, Lawrence L.

NEBRASKA

Anderson, Harley
Stuermer, Virginia M.

NEW JERSEY

Finklcr, Rita S.
Berman, Robert
Cannis, John P.
Hartman, Carl G.
Frost, Inglis F.
Morgenstern, Mates
Rommer, J. Jay
Roth, Daniel B.

Steinberg. Werner
Tarta, Giro
Vann, Felix H.
Ward, Elizabeth
Reifenstein. E. C, Jr.

NEW MEXICO

Young, Raymond L.

NEW YORK

NEW YORK CITY and
BROOKLYN

Byron, Charles
Chidester, Augustus B.
Buxton, Charles L.
einer. Leonard F.
Crawley, Lawrence O.
Daniels, Anna K.
Decker, Albert
Engle, Earl T.
Fischer, Irving C.
Folsome, Clair E.
Freedman, Henry
Gepfert, Randolph
Gorbea. Ricardo L.
Goldfarb, Alvin
Greeley, Arthur V.
Guttmacher, Alan F.
Hollander, Arthur
Hotchkiss, Robert S.
Kaufman, Sherwin A.
Keshin, Jesse G.
Kleegman, Sophia J.
Kramer, Milton
Kupperman, Hebert S.
Kurland, Irving I.
Kurzrok, Lawrence
Kurzrok, Raphael
Kushner, J. Irving
MacLeod, John
McLane, Charles M.
Milien, Robert S.
Myller, Emest
Papanicolaou, G. N.
Parks, Thomas
Portnoy, Louis
Rosenfeld, S. S.
Rubin, Isidor C.
Salmon. Udall J.
Schnall, Meyer D.
Shimmerlik, Lucy
Sicgler, Alvin M.
Stein, Anna A.
Stone. Abraham

Stone, Martin L.
Tafeen, Carl H.
Tanz, Alfred
Topkins, Paul
Ward, Mildred E.
Weinstein, Mortimer
Weisman, Abner I.
Wexler, David J.
Wilson, Leo
Wimpfheimer, Seymour
Wollman, Leo

OTHER CITIES

Benjamin, John
Birnberg, Charles H.
Feldman, Harold
Fincher, Myron G.
Fond, Morris S.
Heckel, George P.
Hellman, Louis M.
Hughes, Edward C.
Kahn, Edward
Kohn, Anthony
McEntee, Kenneth
Niswander, Kenneth
Pommerenke, W. T,
Roland, Maxwell
Romberg, George H.
Simmons, Raymond
Stephenson, (iatton A.

NORTH CAROLINA

Carter, Bayard
Hamblen, Edwin C.
Kernodle, John Robert
Leary, Deborah
Pearse, Richard L.
Peters, William A.
Turner, Violet H.

NORTH DAKOTA

Hunter. G. Wilson

OHIO

Bennett, Alwne E.
Efstation, Thomas D.
Garber, Stanley
Hoffman, Kathryn E.
Lennox, Arthur L.
McDonough, John J.
Roth, Arthur A.
Silbernagel, Wynne M.
Weil, Alven M.
Weir, David R.
Weir. William C.

OKLAHOMA

Howard, R. Palmer

OREGON

Heller, Carl G.
Emmons, Carl W.

PENNSYLVANIA

PHILADELPHIA

Angelucci, Helen M.
Castallo, Mario A.
Charny, Charles
Cristol, Davis S.
F'arris, Edmond J.
First, Arthur
Forman, Isador
Fried, Paul H.
Hahn, George A.
Israel, S. Leon
Marbach, A. Herbort
Mazer, Charles
Montgomery, John B.
Perloff, Wm. H.
Rakoff, Abraham E.
Schinfeld. Louis
Seitchik, Joseph N.
Wainer, Arnos Shepard
Weber, Lennard L.

OTHER CITIES

Arnheim, Falk K.
Finegold, W. J.
Hance, B. M.
Leibold, George
Schaeffer, Frances C.

TENNESSEE

Black, William T.
Ogle, Luther Curtis
Truex, Allen

TEXAS

Crutcher, H. K.
Dippel, A. Louis
Eßsin, Emmett
Guerriero, William F.
Jinkins, J. L.
Kantor, Herman I.
Karnaky, Karl John
Lukeman, H. J.
Massey, Warren E.
Mendel, Evri B.
Morse, Walter S.

Powell. Norbome B.
Strasmann, Erwin O.
Von Pohle, K. C.
Goldzier, Joseph

UTAH

Fister, George M.

VIRGINIA

Bickers, William
Längsten, Henry J.
Speck, George
Suggs. WiUiam D.
Tietze, Christopher
Ware. H. H.. Jr.

WASHINGTON

Banks, Lawrence
Blandau, Richard J.
Frazier, William H.
Rutherford, Robert N.
Thomas, Leon B.

WEST VIRGINIA

Hudgins, Archibald P.
Seltzer. Leo Maurice

WYOMING

Kingman, H. E.
Wallin, S. P.

ARGENTINA

Ahumada, Juan C.
Bettinotti, Alberto
Chevalier, Raul M.
Brea, Cesar A.
de la Balze, Felipe
di Paola, GuUermo
Herrera, Roberto G.
Mezzadra, Jose M. E.
Murray, Edmundo G.
Trabucco. Armande E.

AUSTRALIA

Grant. Alan

BRAZIL

da Paz Fllho. A. C.
de Andrade, Claudio
de Barros, Paulo
de Moraes, Amaldo
de Rezende, Jorge

BELGIUM

DeMuylder, Eduard
Vandevelde, Peter

CANADA

Barker, C. A. V.
Mylks, G. W., Jr.
Pattee, Chauncey J.
Roberston, Edwin M.
Schräm, E. L. R.
Shute. Evan V.

DENMARK

Mammen, Rlchardt H.
Madsen, Valdemar
Rydberg, Erik

ENGLAND

Lane-Roberts, Cedric S.
Young, Donald

FRANCE

Bayle, Henri
Beclere, Claude
Louyot, Jean
Palmer, Raoul
Verain, Marcel

INDIA

Rao, B. K.

IRELAND

Solomons, Edward

ISRAEL

Asherman, Joseph G.
Joel. Charles A.
Rabau, Erwin

ITALY

Nobile, Timoteo

MEXICO

Alvarez, Bravo. Alfonso
Arzac, Jose P.
Castro, Eduarde
Gallo, Delfino
Guerrero, Carlos D.
Guerra, Salas
Sordo-Moriega, Antonio
Young, Raymond L.

NETHERLANDS

Rerge, Ten

NEW ZEALAND

AveriM. L. C. L.

PANAMA

Carrizo, Aristobulo

PERU

Muri-Chavez, Pablo

SALVADOR

Guerrero, Jose G.

SCOTLAND

Sharman, Albert

SPAIN

Butelhi-Iilusia. Jose
Nuni'z, Antonio C.
•ic la Pcna. Alfnnso

SWEDEN

T,affcrl<)f, NÜH
Nordländer, Eric

S WITZERLAND

De Watteville, Hubert

URUGUAY

Lopez, Manuel B.

VENEZUELA

Nouel, Carlos

CITY OF NEW YORK

DEPARTMENT OF HOSPITALS

125 WORTH STREET

NEW YORK 13. N. Y.

MARCUS D. KOGEL. M. D.
COMMISSIONER

Dr« Em est Mylier
65 East 7mh Street
Wew iork City

December 5, 1955

•. n. 402

[

Dear I^octor Mylier:

On the recommendatioE of
the Medical Board of Gouverneur Hospital,
you are promoted to Associate Visit icg
ObstetriciäD-GyDecologist, affective
September 9, 1955.

itruly yours.

MDK:din8

f, M.D.
Commis sloner

«-•*.i-»-rf(is*i^««iw^«SfC-J«^je>*»'i:*j'«t«i*3*:^swp-'- .-rai^-'-r^ - -■■a"t^»-<Wn» ■•^wtfe-«*»»-^.- -. ■• -.*"«<*:-'

AMERICAN ACADEMY OF OBSTETRICS AND GYNECOLOGY

Office of C. Paul Hodgkinson, M.D., Secretary

116 South Michigan Avenue

Chicago 3, Illinois

September l8, 1953

Ernest Myller, M.D.
65 East 76th Street
New York 21, New York

Dear Doctor Myller:

It gives me great pleasure to inform you that the Executive
Board of the American Academy of Obstetrics and Gynecology
has elected you a Fellow of the Academy.

This election is contingent, of course, upon receipt of your
check for $50 in payment of your initiation fee of $25 and
your 1953 dues $25.

It is hoped that your participation in the Academy and its
activities will be a continuing source of mutual advantage
and pleasure.

I look forward to seeing you at Coming meetings.

Very sincerely yoin*s.

^.c£

CPH:ac

C. Paul Hodgkinson'T^M.D.
Secretary

PRESIDENT

Robert A. Kimbrouch, Je., MD.
807 Spnice Street
Philadelphia 7, Pennsylvania

IMMEDI ATE FAST PRESIDENT

Carl P. Huber, M.D.
1040 West Michigan Street
Indianapolis 7, Indiana

IST VICE PRESIDENT
Howard Stearns, M.D.
833 S. W. Eleventh Ave.
Portland S, Oregon

2ND VICE PRESIDENT

Joe Vincent Meios, M.D.
Vincent Memorial Hospital
Boston, Massachusetts

PRESIDENT ELECT

Bayard Carter, M.D.
Duke Hospital
Durham, North Carolina

TREASURER

Herbert E. Schmifz, M.D.
55 E. Washington Street
Chicago 2, Illinois

SECRETARY

Ci -Paul Hodckinson, M.D.

17546 Meadowood, Lathrup Village
Birmingharn, Michigan

ASSISTANT SECRETARY
: Charles D. Kxmbaix, M.D.
734 Broadway
Seattle 22, Washington

Chairwnn of Districi I

Samuel B. KnutwooD, M.D.
1180 Beacon Street
Brookline 46, Massachusetts

Chairman of Districi V

Allan C. Barnes, MJ>.

2065 Adelbert Road
Cleveland 6, Ohio

Chairman of District JI

Edward C. Httches, M.D.
713 E. Genescc Street
Syracuse 2, New York

Chairman of District VI

John I. Brewer, M.D.
104 S. Michigan
Chicago 3, Illinois

Chairman of District III

JoiiN B. Montgomery, M.D.
1930 Chestnut Street
Philadelphia 3, Pennsylvania

Chairman of District VII

Wllllxm f. Mengert, M.D.
2211 Oak Lawn
Dallas 4, Texas

Chairman of District IV
John Parks, M.D.
901 23rd Street, N.W.
Washington 7, D. C.

Chairman of District VIII .
R. Glenn Craig, M.D.
490 Post Street
San Francisco 2, California

EXECUTIVE SECRETARY, Mr. Donald F. Richardson, 116 South Michigan, Chicago 3, Illinois

NEW YORK UNI VERSITY- BELLEVUE MEDICAL CENTER

OF NEW YORK UNIVERSITY

477 FIRST AVENUE. NEW YORK 16, N.Y.

OREGON 9-3200

BOARD OF TRUSTEES

WINTHROP ROCKEFELLER. Chairman

SAMUEL A. BROWN, M.D.. Vict-Chairman

LEROY E. KIMBALL. Secrttary-Tctaiurtr

GEORGE A. BROWNELL

HARRY WOODBURN CHASE

HARRIS A, DÜNN

NEVIL FORD

F. ABBOT GOODHUE

CHARLES C. HARRIS

O. V. W. HAWKINS

RUSH H. KRESS

SAMUEL D. LEIDESDORF

CHARLES S. MCVEIGH

BAYARD POPE

JOHN M. SCHIFF

June 29, 1951

OFFICERS OF ADMINISTRATION

EDWIN A. SALMON. Dirtctor
DONAL SHEEHAN. M.D., Chairman

Scientific Committte
CURRIER MCEWEN. M.D.. Dtm

College of Medicine
ROBERT ßOGGS, M.EX. Dean

Post-Craduate Mediail Scboot
EDWARD M. BERN ECKER. M.D.

Hospital Administrator
EDGAR S, TILTON. Executiut Secrelary

Dear Doctor Myller:

You are hereby advised that the Board of Trustees at
a meeting held June 19, 1951 approved and confinned your re-
appointment to the University Hospital staff as hereinafter
set forth:

Title: Assistant In Obstetrics and Gynecology
Period: Effectivc September 1, 1951

It is understocd that all staff appointments shall
be for periods not in excess of one year, and shall terminate
on August .?lst of each year thereafter following the commence-
ment of service linder the appointment, orovided however, that

all such appointments shall be subject to the right of the
Board of Trustees to modify or cancel the terms of service at
any time in the event that conditions make such action desir-
able, the decision of the Board as to the desirability of such
action being final.

Sincerely yours.

Secretary-Treasurer
(100 Washington Souare Eest)

Doctor Emest Myller
65 East 76th Street
New York 21, New York

...t^^sdima

NEW YORK UNIVERSITY-BELLEVUE MEDICAL CENTER

OF NEW YORK UNIVERSITY

477 FIRST AVENUE, NEW YORK 16. N.Y.

OREGON 9-3200

BOARD OF TRUSTEES

WINTHROP ROCKEFELLER. Chairman

SAMUEL A. BROWN. M.D.. Vice-Chairman

LEROY E. KIMBALL, Secrelary-Treaturtr

GEORGE A. BROWNELL

HARRY WOODBURN CHASE

HARRIS A. DÜNN

NEVIL FORD

F. ABBOT GOODHUE

CHARLES C. HARRIS

O. V. W. HAWKINS

RUSH H. KRESS

SAMUEL D. LEIDESDORF

CHARLES S. MCVEIGH

BAYARD POPE

JOHN M. SCHIFF

June 9, 1950

OFFICERS OF ADMINISTRATION

EDWIN A. SALMON. Director
DONAL SHEEHAN. M.D., Chairman

Scientific Committee
CURRIER MCEWEN, MD., Dean

College of Medicine
ROBERT BOGGS, M.D., Dean

Post-Graduate Medical School
EDWARD M. BERNECKER, M.D., Hoipital Administrator
EDGAR S. TILTON, Executive Secretary

Dear Dr, Fyllert

You are hereby advised that the Board of Trustees at
a meeting held May 9, 1950 approved and confirmed your
appointment to the University Hospital staff as hereinafter
set forth:

Title: Assistant In Obstetrics and Gynecology
Period: Effective September 1, 1950

It is understood that all staff appointments shall
be for periods not in exe es s of one year, and shall terminate
on August 31st of each year thereafter following the coramence-
ment of service under the appointment, provided however, that
all such appointments shall be subject to the right of the
Board of Trustees to raodify or cancel the terms of service at
any time in the event that conditions make such action desir-
able, the decision of the Board as to the desirability of such
action being final.

Sincerely yours.

S^retary-Treasurer
(lOp^ashington Square East)

Dr. Ernst J-tyll^r

875 Park Avenue

New York 21, New York

....,j^j^y.uit.],ijmi.iiiMi

*K— 40t

CITY OF NEW YORK
DEPARTMENT OF HOSPITALS

125 WORTH STREET
NEW YORK 13. N. Y.

MARCUS D. KOGCL. M. D.
COMMiaaiONCR

April 28, 1960

Dr. Eroest *Äyller
66 East 76th Street
üew York 21, N.Y,

Dear i^octor Myller:

On the recoEoaendation of
the Medlcal Board of Gouverneur fioßpital,
you are hereby appointed Assistant
^isiting Obßtetrician-Gynecologist,
effective April 3rr^950.

llDK:dil8

New York Post-Graduate Medical School and Hospital

303 EAST TWENTIETH STREET
NEW YORK 3. N.Y.

Department of Gynecology
Office of the Executive Officer

Janu-ry 12, 1949

Emest ^5ylle^, M.D,
875 Park Avenue
New York, Nev; York

Dear Doctor >6rller:

Some time in the near future I trust that you will receive
an appointment as Assistant in Obste tri es and Gynecology to the
lÄiiversity Hospital, as there will be no further Dispensary
appointments,

The assigninents are made by the Chairman of each Department
and the assignment will be to the Clinic as heretofore, It does
not carry with it the privilege of admitting private patients to
the hospital itself •

Very truly yours,

Walter ?• Dannreuther, M.D.

Chairman

Department of Obstetrics and Gynecology

WTDinse

.Jl

THE UNIVERSITY OF THE STATE OF NEW YORK

THE STATE EDUCATiON DEPARTMENT

ALBANY

BUREAU OF QUALIFYING CERTIFICATE8
HORACE L. FIBLD. CHIEF

Novenbor 18, 1941

Dr. Ernst MyUer
383 West End Avenue
New York, Nev; York

Dear Sir or Madam:

itten examlnatlon
.ers wlth a mark
lat you may be ex-

You passed y,o
In Engllsh for fcireij
sufflclently hlgh\si^
cused from trylng tkhe^xdral examlnatlon.

You may ^se thls letter as evldence
that you have^afssed the complete examlna-
tlon lir\BnK^ for forelgners conducted
by thls \eiR^tment In October, 1941.

(•

Very truly yours

3/ /"^

CPN : AC

Chief

2Cn^^c^ ^:^S^^^><^ '^^^^J-'^^^üy^^^^^'K^ ^^^^^^>i^^^ -^^^^^ y^^-^^^c^^

0^3

1« Hut ±B the dtfliiitioii of postparttai

2» Ifitbod« of rae«0uriQg blood iMt

3« Ite iaportmoe of olinieal sigas of hcmorzlMgo

4* ÜMMiMity of oerrieal inepoetioii

5« Todtaiiquo of pooking tlio vagiiMif eoxidx end Uterus , and indioatioiui fbr

6« Obqrtoeie«

7# luftudoBs ineludiig Intrrrenous pitoitrln

8« T^ranofasions

9« ReohoclciBg

lO, ^jratoroetoRQr • do not weit too loog

Sbould bo glTon I7 a »omber of the Obatetrioal and Qjrnaoologioal Dapartoiaat*

AMERICAN BOARD DF DBSTETRICS AND GYNECDLDGY

Waltb» T. Dannrbuthe*. M. D„ Niw York, President
JosBPH L. Babr. M, D., Chicago, lu... Vice President

Paul Trrus. M. D., PrmBUROH. Pa., Secretary-Treaturer

NoRUAN F. Miller, M. D., Ann Arbor, Mich.
Willard R. Cookb, M, D.. Galveiton, Texas.
F. Batard Carter, M. D., Duhham, N. C.

Ludwig A. Emgb. M, D., San Francisco. Calif., Vice President
Edward A. Schumann, M. D., Philadelphia, Pa.
Robert L. Faulkner, M. D., Cleveland, Ohio.

/ AGS ^
AAOG&AS
AMA :

OFnCE OF THE SECRETARY-TREASURER

PAUL TITUS, M.D.

1015 HiGHLAhiD Building

PlTTSBUROH (6), Fa.

October 2, 1947.

Emest Myller, M. D. ,

875 Park Avenue,

New York 21, New York,

Dear Dr, Myller:

You made no reply to question
#11 in your application and it is essential
for our Gredentials Committee to have this
Information. It is belng attached below and
I would appreciate your early attention to
this matter»

Yery^Tuly—^f-ows ,

Paul Tltus, M. D.

PT/adf

Dx. Erneßt Hyllei?
65 Eae-b "76tli Street
Hew iork 21, 5- !•

iuj^.^

iLOCtmimaaare. ■ umMi

Ernest Myller, M.D., Cor. Secretary

Rudolf Virchow Medical Society

64 East 76th Street

New York 21, New York

i l

THE RUDOLF VIRCHOW MEDICAL SOCIETY
IN THE CITY OF NEW YORK

THE MEDICAL CIRCLE

THE AMERICAN SOCIETY OF
EUROPEAN CHEMISTS AND PHARMACISTS

request fhe pleasure of your presence at a

SPECIAL MEETING

in honor of the EIGHTIETH BIRTHDAY of

PROFESSOR OTTO LOEWI

Tuesday evening, June 2nd, 1953
at 8 o'clock sharp

to be held at the

ACADEMY OF MEDICINE

Hosack Hall

2 East I03rd Street

New York City

Fellcitations will be conveyed by
PAUL H. HOCH

The Rudolf Virchow Medical Society

JOSEF NOVAK

The Medical Circle

HERMANN F. MARK

The American Society of European Chennists and Pharmacists

cuRRiER McEwen

Dean, New York University College of Medicine

ERNST NAVRATIL

Professor of Gynecology, Universi+y of Graz, Austria

McKEEN cattell

Professor of Pharmacology, Cornell University Medical College

Past President, The American Society for Pharmacology and

Experimental Therapeutics

ALEXANDER T. MARTIN

President, New York Academy of Medicine

HORACE W. STUNKARD

Chairman, Department of Biology, New York University
Past President, New York Academy of Sciences

OTTO KRAYER

Professor of Pharmacology, Harvard University

ERNST P. PICK

Clinical Professor of Pharmacology, Colunnbia University

Formerly Professor of Pharmacology and Director of the

Pharmacological Institute, University of Vienna

■■»'

mmmmmm

ADDRESSES
will be dellvered by

CHARLES H. BEST

Professor of Physiology, University of Toronto

CARL F. CORI

Professor of Biological Chemistry, Washington University, St. Louis

SEVERO OCHOA

Professor of Pharmacology. New York University College of Medicine

Chalrman:
PAUL H. HOCH

A Receptlon will be held after the Ceremonies in the

Presidents' Gallery
Refreshments will be served. Dress Optional.

RHODE ISLAND HOSPITAL

S93 EOOY STREET, PROVIDENCE, R. I.

Ouvix, ^rOj l<^5'i.

Dear Doctor:

entitled

I have read with great interest your article

as published in N. CX. l4f .66, , ~3"u,vcc a\ ^ V C| 3 ';^

I shall appreciate it very much if you would

be kind enough to forward to me ö H-d- .

reprint/ of same.

J) ^Cl-hJc Aji/Uf/ "7^t<j6 f-^^ ^^-^^rtCCJLß^^ ^

'Sincerely,

George W. Water man, M. I>.
Chief, Department of Gynecology

Doctor L C. Rubin
911 Park Avenue
New York 21. N.Y.

BUtterfield 8-1980

Jeruary 19,1955

My dear Mrs^ Myller:

I have had a rec^uebt frou the
Mericen Society for the Study of Steril ity
to v<rite an obituary notice in the Fertility
and bterility Journal for Doctor Myller. Ifl'ould
you be good enough to let me have a copy of the
notice tixfit appeerec in the paper ehortly after
his pai^sing?

Incidentflly the enclosed is what
I collected froni Mme. Alexis Kyrou who v/as here
recently. Sho needs? an Operation but prefers to
have it done in Greece where sne says it will cost
her less.

Best regerds to you and your son.

Sincerely yoars,

iVr&« Emest Myller
450 Eaeb 63 rd Street
New York City

BUtteHield 8-5929

ERNEST mVlLER, M. D.

65 EAST 76th STREET

New Y«*k 21, N. Y.

FOR PROFESSIONAL SERVICES

mmatk

•mm*

Cyclo gesterine tablets. (Upjohn)
3 tablets for 10 days

NEW YORK UNIVERSITY-BELLEVUE MEDICAL CENTER

OF NEW YORK UNIVERSITY

POST-GRADUATE MEDICAL SCHOOL

303 HAST 20TH STREET. NEW YORK 3. N. Y.

July 21, 1953

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

GOUVERNEUR HObPITAL
621 Water Street
NEW YORK 2, N.T.

GRAMERCY 7-2000

Ernest Myller, M.D.
65 E 76th Street
New York City

Dear Dr. Myller:

I shall appreciate your attending V^edn^sday dftemooii st CouveiTieur
Eosiit.-! fcr t,he present.

I have already written conceming the matter which we discussed at the
telephone. This is in the hands of Dr. Studdiford and I hope and believe we
will have favorable reply shortly.

Sinceroly yours,

Locke L. Mackenzie, M.D.

Dr.xM/rj

mtummmm

Conclusions

Tlie importaiicc ul' ccrvifai obturation in tlie piocedure ot' iitorotubal
iiisufiflation and liysterüsal{)ingo«»rai)hy lia« been cinphasized. Desidcrata ot' the
ideal uterina cannula are :

1. Paiiiless applieation uiiaccoinpanied by trainna.

2. Airti<2jht ciosuro oi* the eervical eaiial.

JJ. Mainteiianee of the normal anatomical position ot" the utcriis.

A new cannula with inflatable balloon l'or cervical obtunition has beon
desci'ibed.

References

1. Personal coiniiiunieHtion. Acknowledginent is lierevvitli iiiado t<» H. h. Stout, M.D., f<»r

liis kiiidness in lettin^ us see his instrununit.
'2. Decker, Alhort: Am. .). Obst. & Gynkc. 54: 1077, 11)47.
;?. Kubin, I. (\: Am. .1. Obst. & Gyxkc. 45: 41'.). 1!)4:?.

CEUVICAL OBTIIKATIOX WITIl

INFLATABLE (^VXXFLA IN

UTEHOTriJAL IXSrFFLATlOX

ÄND IIYSTEKOSALPINGOGRAIMIY

I. C. RUBIX, M.Ü., F.A.C.S.

and

KKXKSST MYLLEK, M.D.

New York, N. Y.

Heprinted from

AMKKICA.N .FOUKNAF. OF OliSTKTHKS

AXF) (}VXE('()I.()(JV

St. liüuis

Vol.

.)<•, Xo. <i, Page« lü77-l(),s:2, I>e<-etnlM'r,
1948

( l'rint«'(l in the r. .S. A. i

CERVICAL OBTURATION WITH INFLATABLE CANNULA IN
ÜTEROTUBAL INSUFFLATION AND HYSTEROSALPINGOGRAPHY

T. r. Rriu\,M.D., F.A.(\S., and Eknest Myij.kk, M.D., Nkw Vohk, N. V.

CKHViCAL obturatioii is ot' major iniportaiu-e in the teehnical pi-occdurc
of uterotubal insuftlation and hystero*?raphy. Re«j;nrgitati()n of ('(>_• iüt^;
or oil Icads 1o unroliable estimation oi" the pressure eini)l()yed, and not inlic-
(pieiitlv to wronjy interi)rotation as to tii})al ])ateney. ()l)turati()n is usimlly
seeured by i)resNin«»- a r\il)ber oi* metal acorn aj^ainst llie eei'vieal os. Tbis is
easily aeconipüshed in tlie i)resenee of a round and well-sbaped external orifiee.
Ilovvever, il* tlie external os is irre«>ular in eontour as in hieeratioiis and eversioiis.
exeessive |)ressure inust be exerted t)y tlie aeorn in order to prevent U'aka^c
of the eontrast medium or of (H). «jas as the ease may be. To prevenl
re<iur^itation the eervix inust be «^rasped tirndy with a tenaeuhun foreeps
exertinii>' eounter ])ressure. In this maneuver, the uterus is either pushed up-
ward Ol- dravvn down. To keep the balanee by equal push and pull is some-
linies diftieull. The anatomie chan^re in position may oeeasionally be suffieienl
t<» sinudale closure of the tubes by eausinji: artiticial kinks at the uterotubal
junetion or ])v artifieallv stretchiu"; adhesions which do not otherwise obstruel
the tubal lumen when tho normal position of the uterus is undisturl)ed. The
cannula devised bv Colvin with sercw tips of various sizes, later modified by
nud«»ins, affords ti«iht ohturation l)Ut involves a eertain amount of trauma
whieh theoretically may predispose to embolization.

After manv vears experienec with hvsterosali)in«»:o«i;rapiiy and uteiolubal
insufflation the ])rerequisites of an ideal uterine eannula appear to be the fol-

lowni«:

1. Its applieation should be painless and unaeeompanied by trauma.

2. It must provide airtight ohturation of the cervical canal.

3. It should maintain the normal anatomical position of the uterus.

The cannula presented in this paper has been devised with these desiderata
in view. It is based on a rather old device, namely, the use of an intlatable
rubber bulb in order to change the diameter of a rv/u\ instrument. Nitze,
the inventor of the cystoscope, made use of this prineiple for a ureteral
catheter. in 1883, a United States |)atent was «iranted to Henry E. Finney
for an instrument based on the samo prineiple for ''the treatment of the male
Urethra." Ahout twelve years ago, one of us (LCR.) construeted a cannula
similar in prineiple to the one about to be described. Dr. R. B. Stout had the
same idea, except that he placed the rubber balloon within the uterine cavity.'
Deckel-,^ in a recent puI)lication, also recommends insertinj? the rubbei* balloon
surrounding the cannula tip into the uterine eavity. This prineiple has been
employed by one of us in study ing the differential between uterine and tubal
contractions during uterotubal insufflation.^

The present cannula (Fig. 1) has developed out of a simple model whicli
we have used since 1946 in 175 eases for eervical obturation. The eannula has
the Ienj»th and dianieter of an ordinary uterine sound. It consists of two
inetal Channels, one of whieh is very narrow and ends aboiit 2 cm. hehind the
ti}) of the Instrument. Its opening is eovered hy a thin, elastic rubber tube, 2
lo 8 cm. long, which is tied at each end to the shaft of the instrument l)y
snrgical silk.*

ViK. 1.— Cannula assonibled roady for- use witli levolvin« «lisi-, hubs foi- sviin^e an«!
inanometer connections and inflatable tip (letter B below letter C not visible), (a). Rubber
tubing distended. (ft). Extension tip for instMtion into uterin»' ravitv.

The instrument can be inserted easily into any eervical canal which admits
a uterine sound. In most cases it is not necessary to grasp the cervix with
a tenaculum forceps. The latter can be removed as soon as the rubber-covered
tip has been inserted inside the eervical canal. In certain cases, e.g., Stenosis
of the internal os, it niay be desirable to insert the cannula with its tip in the
uterine cavity. For such imri)ose the short ti]) (T) (Fig. 1) may be rei)bu-e(l
by a h)nger one (T,) (Fig. 1). Preliminary dilatation, when desn-abie, shouM
not be done just before the injection of contrast media or before insufiHation.
So far it has been ])ossible in our cases to introduce the cannula in eervical
Stenosis after the latter was passed by a uterine sound.

The cannula is inserted with the revolving disc D in the position that
presents the engraved letter B (bulb on the disc) (Fig. 1) opposite a fixed
uidicator. Through hub A, which fits the J.uer syringe, 1 to 3 c.c. of water oi-
air are injected and thus the rubber tube at the end of the instrument becomes
distended (Fig. la). With a little experience one can soon feel whether the
bulb IS sufficiently expanded. If one is interested in checking the pressure in the
inflated balloon, he need only turn the disc to T, remove the syringe, and attach
a manometer to hub A. On turning the disc back to B, the pressure within the
'•^^^^>c^' balloon will be prom])tly indicated on the numometer. It is to be noted

i:. r.6 7treef.^Te"wVork'^?^^^^ '^ ""^^^ ^"^ clistributed by United Surgical Supply Co.. lüO

that if less than 1 c.c. of air or water is used to inflate the balloon, the pressure
readings in the balloon may not be accurate. \ow the disc is turned to the i)osi-
tion marked by the letter C (elosed) and the instrument is ready for the pro-
cedure.

Ms^.

■*^v*: r* -^jiu^ -rmm-

Vig. 2.— Inflatable cannula flUed with diodrast obturatin^ the eervical canal. Note that it Ks
pyriform or acorn in shape as compared to the oval-shaped inflated cannula outside of the body.

The disc is now turned to the position X (== x-ray) thus eonneeting hub A
directly wäth the tip of the instrument inside the eervical can^l, or to tip T;.
in the uterine cavity. A Luer syringe containing the contrast medium is
connected to hub A and the medium is injected into tiie iiterus and the x-ray
exposure follows. For fractional injection of contrast medium, the disc is
turned to position C after the first fraction is introduced. Ilands and syringe
may now be removed because the expanded bulb retains the cannula in situ.*
By turning the disc back to position X the second fractional injection can be
made, and if need be, a third or fourth.

When the kymograph is employed it is connected to hub A and the disc is
turned to position X. The insufflation test can be carried out with a 20 c.c.

•A special clatnp adaptable to any vasinal speculuin has been devised to keep the ean-
nula in the horizontal position.

Luer syrin<?e attached to Imb A. The diso is turned to position R (= Kubiii
tost) whicli oiia])los us to nioasui'o tlie oxortod i)rossui'e ])y conneeting tho man-
ometer to hui) B. In tlie siniplified test, 20 c.c. of carbon dioxide injected by
a syriiige is sufficicnt beeause of thc coniplete elosure ot" the cervix without aiiy
leakago. A suddon fall of inaiionictrio pressure is indieative of tubal pateney.
If Shoulder pains result they are minimal.*

By inflating the rubber bulb with an a(|ueous contrast medium (e.«»;.
diodrast) one eaii easily demoustrate the relation of the bulb to the cervieal
canal (Fig. 2). In order to notc the distensibility of the intracervieal balloon
and any changes that the eervieal walls might exert upon it, another cannula
with the balloon filled with an ecpial amoiuit of diodrast was exposed at the
same time on the same x-ray film, The shape of the balloon inside the cervix
may be eompared to the external ballocm in Fig. 2. In Fig. 3, water has re-
placed the diodrast and is therefore invisible, while the uterine cavity is
Seen filled with contrast medium. Ineidentally, the cervieal balloon reveals a
configuration whicli does not couforiii to what one notes in conventional draw-
ings of the cervieal canal beeause of distention by the rubber balloon. The
cervieal canal appears, from our study, to yield readily to a greater degree of
dilatation than has hitherto been realizcd.f

Owing to rigid walls, some cervices were found to resist balloon distention
with 2 to 3 c.c. of water. Nevertheless, good olituration could be obtained with
less filling. If the rubber ])art of the insti'ument is not iuserted deep enough
into the cervieal canal the balloon may liulge Ihi'ough the extei-nal os. IIow-
ever, this does not prevent airtight elosure. Sliould the rubber bulb be pushed
out entirely from the cervix it mav be reiuserted and kei)t in place by grasi)ing
the anterior lip of the cervix with a tenaculum forceps. In several cases the
cervix was found transformed into a shallow cone. Airtight elosure could
be obtained in these cases by advaucing the ex])anded rubber bulb into the
cone while the cervix was held in ])lace })y a tenaculum force]is.

The present caninila has the advantage over the ordinary cannula with an
acorn tip in that it brings a lai-ger area of the endocervix in contact with
the acorn. Jlence, the pressure recpiired to obturate the cervix is less. As
this pressuie is not only directed upwai'd, bul upon all sides, dislocation of the
cervix does not as a rule result.

The pressure within the rubber balloon automaticallv predetermines the
maximum pressure which is intended to be used for the insufflation test or
salpingography. If, for example in the bulb is 250 mm. Hg and the pressure
used during insufflation or sali)ingography is higher, no matter how little this
may be, there is prompt esca])e of the gas, or oil from the cervix. The same
physical law operates here as in measuring blood ])ressure. If the blood pressure
exceeds the pressure in the armcuff, tlie i)ulse wave immediately returns.
The balloon in the present cannula thus forms a desirable safety valve which
automatically prevents an undue increase of pressure inside tlie uterus.

This feature of the instrument is of importance for salpingography.
Usually a contrast medium is used wbich has a certain viscosity. "^ Pressure
determinations when lii)iodol or other viscous fluid is used are iiot accurate
beeause of the considerable friction inside the small lumen of the cannula
where a rapid decrease of i)i'essure takes ])lace with each progressive centimeter
of the lumen. When the constrast medium enters the uterine cavitv the

JV^^*l ^^^}°^ author dpes not recommend or employ the use of the syringe for inject

inpT

CJOz into the Uterus for testing tubal pateney, pref erring insufflation by means of the aut'omatiV
Siphon Mieter with kyn.ograph. The ptisc-nt cannula is adniirably adapted for this apparatis

future^ public^a°tk)n.''*' *'^^'''*'*'"^' °^ *^^ ^^^"'^'^ »"^*^'' various condltions will be the ba.sls of a

pressure hievitably falls. If tuhal ohstruction is encountered there is a gradual
increase of pressure inside the uterus until it equals that which is exerted by
the syringe. Before this point is reached a high j)ressure may be exerted
through the syringe which is not usually appreciated by the Operator unless
he uses a manometer. The rubber balloon afVoids safety beeause when the
pressure exceeds that within the bulb, the oil ('S('a|)es k (mce through the
external cervieal os.

Fig. 3. — Inflatable cannula filled with water (therefore invisible by x-ray) obturating
tho cervieal canal. The contrast medium (rayopaque) demonstrates the uterine cavity. The
rubber balloon distended by diodrast is seen below outside of the body for purpose of comparison.

The Instrument can be sterilized by boiling. The rubber bulb can stand
boiling many times; its cost, however, is so small that it may readily be replaced
for each test, We have found it practical to fiU the })ulb before inserting the
cannula in order to note whether it is watertight. However, should the
rubber break it is immediately a])preciated by the drop in resistance. The
water escapes through the external os and does no harni. It is particularly to
be noted that the Operation of the cannula is exceedingly simple, and after some
little experience, requires a minimum of time.

;^cM^ 1^^. W^^l^^"^^

^X^-^

!AM^

(^j^^

fr.li

K11M

CvWvv

1^1

BULLETIN

THE AMERICAN BOARD

OBSTETRICS AND
GYNECOLOGY

/ AGS ^„
AAOG&AS
k AMA /

ElGHTEENTH ISSUE

June, 1947

OFFICE:

1015 Highland Building

PnrsBURGH (6), Pa.

PAUL TITUS, M.D., Secretary

The American Board

Obstetrics and Gynecology, Inc.

DIRECTORS
President
Walter T. Dannreuther. M.D., New York CSity
A. A. O. G. and A. S.

Vice'President

Joseph L. Baer, M.D., Chicago, Illinois

A. G. S.

Vice'President
Ludwig A. Emge, M.D., San Francisco, Calif.
Section on O. and G.. A. M. A.

SecretaryTreasurer
Paul Titus. M.D.. Pittsburgh, Pennsylvania
A. A. O. G. and A. S.

Memher Executive Committee

Norman F. Miller, M.D., Ann Arbor, Mich.

Section on O. and G., A. M. A.

Edward A. Schumann, M.D., Philadelphia, Pa.

Norman F. Miller. MD., Ann Arbor, Michigan

A. G. S.

' Willard R. Cooke. M.D., Galveston, Texas
A. A. O. G. and A. S.

F. Bayard Carter. M.D., Durham, N. C.
Section on O. tf G., A. M. A.

Robert L. Faulkner, M.D., Cleveland. Ohio

A. G. S.

Reed B. Dawson, Esq., New York City

Counsel

Former Directors of the Board

F. L. Adair, M.D., Chicago, 111.

E. D. Plass, M.D., Iowa City, Iowa.

G. D. Royston, M.D., St. Louis, Mo.

J. C. Litzenberg, M.D., Minneapolis, Minn.
R. D. Mussey, M.D., Rochester, Minn.
E. A. Schumann, M.D., Philadelphia, Pa.
Norris W. Vaux, M.D., Philadelphia, Pa.
L. E. Phaneuf, M.D., Boston, Mass.

Associate Examiners Who Have Served
With the Board

W. T. Black, M.D., Memphis, Tenn. (Dcceased)

L. A. Calkins, M.D., Kansas City, Mo.

S. A. Chalfant, M.D., Pittsburgh, Pa. (Dcceascd)

C. G. Collins, M.D., New Orleans, La.

S. A. Cosgrove, M.D., Jersey City, N. J.

W. C. Danforth, M.D., Evanston, 111.

W. J. Dieckmann, M.D., Chicago, 111.

N. J. Eastman, M.D., Baltimore, Md.

J. R. Eisaman, M.D., Pittsburgh, Pa.

Frederick H. Falls, MD., Chicago, 111.

R. L. Faulkner, MD., Cleveland, Ohio.

J. W. Harris, M.D., Madison, Wis.

W. P. Healy, MD., New York Qty.

H. Close Hesseltine, M.D., Chicago, 111.

James E. King, M.D., Buffalo, N. Y. (Deccased)

C. B. Lull, M.D., Philadelphia, Pa.

Harvey B. Matthews, M.D., Brooklyn, N. Y.

James R. McCord, M.D., Atlanta, Ga.

L. G. McNeile, M.D., Los Angeles, Calif. (Deceased)

Emil Novak, M.D., Baltimore, Md.

John L. Parks, M.D., Washington, D. C.

W. T. Pride, M.D., Memphis, Tenn.

L. M. Randall, M.D., Rochester, Minn.

G. D. Royston, M.D., St. Louis, Mo.

H. E. Schmitz, M.D., Chicago, 111.

Otto H. Schwarz, M.D., St. Louis, Mo.

Ward F. Seeley, M.D., Detroit, Mich.

N. W. Vaux, M.D., Philadelphia, Pa.

W. H. Vogt, M.D., St Louis, Mo. (Dcceascd)

W. H. Weir, M.D., Cleveland, Ohio.

THE AMERICAN BOARD OF
OBSTETRICS AND GYNECOLOGY

ORGANIZATION

In 1930 the American Asscx:iation of Obstetri'
cians, Gynecologists, and Abdominal Surgeons,
the American Gynecological Society, and the See
tion on Obstetrics and Gynecology of the Amef
ican Medical Association, each elected three Fei'
lows to constitute the American Board of Obstet'
rics and Gynecology.

Dr. Walter T. Dannreuther of New York, Dr.
Paul Titus of Pittsburgh, and Dr. Grandison D.
Royston of St. Louis were appointed to represent
the American Association of Obstetricians, Gyne'
cologists, and Abdominal Surgeons; Dr. Jennings
C. Lit2;enberg of MinneapoHs, Dr. Joseph L. Baer
of Chicago, and Dr. E. A. Schumann of Phila'
delphia were appointed to represent the Ameri'
can Gynecological Society; Dr. Fred L. Adair of
Chicago, Dr. R. D. Mussey of Rochester, Minn.,
and Dr. E. D. Plass of Iowa City, Iowa, were
appointed to represent the Section on Obstetrics,
Gynecology, and Abdominal Syrgery of the
American Medical Association. Since formation
of the Board several of the original members have
resigned and others have been duly appointed to
fiU their places.

The Board was incorporated, organized and held
its first meeting in September 1930. At that time
the ByLaws were adopted and provisions were
made by resolutions for its proper functioning.

This Board had been in the process of organiza'
tion since 1927 and put into action a determ/ned
effort on the part of these three national organi«
zations to improve the Standards of practice of
obstetrics and gynecology.

PURPOSES OF THE BOARD

First: To elevate the Standards and advance the
cause of obstetrics and gynecology.

Second: To determine the competence of prac
titioners professing to be specialists in obstetrics
and gynecology.

Third: To arrange, control, and conduct exam'
inations to test the qualifications of voluntary
candidates appearing before the Board for certi'
fication as specialists in obstetrics and gynecology.

Fourth : To grant and issue certificates of quali'
fication as specialists in the field of obstetrics and
gynecology to candidates successful in demon'
strating their proficiency.

Fifth: To serve the public, hospitals and the
medical schools by preparing lists of speciaHsts
certified by the Board.

These activities proceed from the certificate of in'
Corporation in which it is stated that "the natura
of the business and the objects or purposes prcK
posed to be transacted, promoted and carried on
by it" are as follows:

"To encourage the study, improve
the practice, and advance the cause
of obstetrics and gynecology, sub'
jects which should be inseparably
interwoven; and to grant and to
issue to physicians duly licensed by
law, certificates or other equivalent
recognition of special knowledge in
obstetrics and gynecology."

VALUE OF CERTIFICATES

The national obstetrical and gynecological or'
ganizations, which have participated in the for'
mation of the Board and are Sponsoring its activi'
ties, as well as other societies, attach considerable
importance to its certificate. Both the medical and
the lay public, including hospital directors, have
come to utilize the certificate from this Board
freely as a means of determining who are well
grounded as speciaHsts in obstetrics and gync
cology.

Lists of those holding certificates from this Board
and limiting their practice to obstetrics and
gynecology are published in the Directory of
Medical Specialists; similar lists are published by
the American Journal of Obstetrics and Gync
cology, and also appear in the American Medical
Directory. This latter indicates Diplomates of this
and other Boards by means of numerical Symbols

dppearing in the Biographie records, but does not
gi\e such special recognition to Diplomates who
are not members of the American Medical Asso'
ciation.

Each certificate granted or issued does not of it'
seif confer or purport to confer upon any per'
son any degree or legal qualifications, privileges or
license to practice obstetrics or gynecology, nor
does the Board intend in any way to interfere
with or limit the professional activities of any
duly licensed physician. Its chief aim is to stand'
ardize qualification for specialists in obstetrics and
gynecology, and to certify as specialists those who
voluntarily appear before the Board for such rec'
ognition and certification, according to its reguk'
tions and requirements.

This Board does not subscribe to any hospital rule
that certification is to be required for medical
appointments especially in ranks lower than Chief
or Senior Staff of hospitals, or Associate Profes'
sorship in Schools of Medicine, for the obvious
reason that such appointments constitute desirable
specialist training.

Even though certification or its füll equivalent
may be considered a desirable requisite to appoint'
ment in key positions, as on the Senior or Chief
Staff, particularly of hospitals expecting to con'
duct approved Services for training of residents,
it was never intended by this Board that certifica'
tion should be required by any hospital as a pre'
requisite to appointment, especially in such lesser
positions.

REVOCATION OF CERTIFICATES

Each Certificate of Qualification may be revoked
by this Board in the event that:

1. Any representation or Statement made
to the Board or to any of its representatives
by the physician so certified, including the
Statements contained in his application for
certification, shall have been false or inten'
tionally misleading.

2. The physician so certified shall not in
fact have been eligible to receive certifica'
tion, irrespective of whether or not the facts
constituting such ineHgibility were known to

or could have been ascertained by this Board,
its members, directors, examiners, officers or
agents at or before the time of issuance of
such Certificate of Qualification.

3. Any rule governing examination for
certification shall have been violated by the
physician so certified and the fact of such
violation shall not have been ascertained
until after the issuance of the Certificate of
Qualification.

4. The physician so certified shall fail to
abide by the regulations governing the limi'
tation of his practice to the specialty of
obstetrics and gynecology.

5. The physician so certified shall violate
the Standards of ethical practice of medicine
then accepted by organized medicine in the
locality in which he shall be practicing, and,
without limitation of the foregoing, the for'
feiture, revocation or Suspension of his li'
cense to practice medicine, or the expulsion
from, or Suspension from the rights and priv
ileges of membership in, the American Med'
icaä Association or any State or county so'
ciety affiliated therewith, any recognized
Canadian medical society, the American As'
sociation of Obstetricians, Gynecologists
and Abdominal Surgeons or the American
Gynecological Society shall be conclusive evi'
dence of a violation of such Standards of
ethical practice of medicine.

6. The physician so certified shall fail to
comply with or violate, or the issuance or
receipt by him of such Certificate of QuaH'
fication shall have been contrary to or in
violation of , the Certificate of Incorporation,
the By-Laws or the Rules and Regulations of
this Board.

Upon revocation of any Certificate of QuaHfica'
tion by this Board as aforesaid, the holder therc'
of shall retum his Certificate of Qualification and
all other evidence of certification to the Secretary
of the Board and his name shall be removed from
the list of Certificate holders of this Board.

PREREQUISITES TO ELIGIBILITY

Each applicant before he may become eligible to
receive such certificate or other evidence of recog'
nition :

1. Must have had conferred upon him a
degree in medicine by an Institution of learn-
ing approved by the Advisory Board for
Medical Specialties and the Council on Med'
ical Education and Hospitals of the Amer'
ican Medical Association.

2. Must establish in a manner satisfactory
to the Board of Directors th'at he is a physi'
cian duly Hcensed to practice medicine, and

(a) That he is of high ethical and
professional Standing.

(b) That he has received adequate
training in both obstetrics and gynecol'
ogy as a specialty. Training in one
branch only is not acceptable.

3. Must make application for investigation
of his credentials and a survey of his char'
acter.

4. Must assure the Board that he is limit'
ing his practice to obstetrics and/or gyne'
cology and that he intends to continue to
do so, except for military duties, having
limited for at least six (6) months before
making application (except for active mili'
tary duty).

5. Must have membership in the American
Medical Association, or membership in such
Canadian or other medical societies as are
recognized for this purpose by the Council
on Medical Education and Hospitals of the
American Medical Association. (Membership
in the AMA or equivalent society member'
ship is waived, temporarily, for men in the
Army or Navy, especially for those who
proceeded directly or almost so from hospital
Services into Army or Navy Services, upon
a Statement of intention to join promptly
upon retum to civilian practice.)

6. This Board will not accept appli'
cants for examination who are not füll citi'

zens of the United States or of Canada,
though they be residents of either country.
Foreign born applicants must have been cer'
tified by either the National Board of Medi'
cal Examiners or licensed to practice medi'
eine in the United States or Canada by a
State or Provincial Board of Licensure.
Notarized Statements, not original Citizen'
ship papers, must be fumished when the ap'
plication is filed attesting to the fact of füll
citizenship in the United States or Canada,
if the applicant is foreign born. Further,
there will be required a probationary period
of at least three (3) years from the date of
licensure in the practice of medicine in these
countries before such a candidate may be
admitted to examination.

7. The Board accepts the fifth or "intern"
medical school year required at some schools
in lieu of the usual fifth or intern "clinical
training" year following graduation. As a
Substitute for special training, service with
a qualified obstetrician'gynecologist precep'
tor, preferably one who has been certified by
the Board, may be acceptable. The exact time
basis for this has not been specified, and
each case must be reviewed and decided in'
dividually by the Credentials Committee
after the application is submitted in the
regulär manner. The time allowance for this
type of training will vary with the amount
of work done with the preceptor. Opportun'
ity for personal responsibility during this
period of training is essential.

8. The Board conformed with the gen'
eral acceleration in programs in medical edu'
cation in that it will accept a period of nine
"accelerated" months as an academic year in
satisfying our requirement for each of three
years of residency training. Such allowances
can be made only for Services during the
wartime period of the official "accelerated
program" and are not made for Services bc
fore 1944 or after the discontinuance of this
acceleration in 1946.

9. The period of special training should
emphasize the relation of the basic sciences,

anatomy, pathology, physiology, biochemis'
try, and bacteriology, to the application of
surgical principles which are fundamental in
all branches of surgery. In addition, the can'
didate must understand and be trained in the
following subjects, viz., the care of emer'
gencies, shock, hemorrhage, blood replacc
ment, electrolyte and fluid balance, protein
and nitrogen balance, choice of anesthetics,
chemotherapy, acidosis, and alkalosis, narco'
tics and hypnotics, wound healing, etc.

10. Credit for graduate courses in the basic
Sciences which involve laboratory and didac
tic teaching rather than clinical experience
or opportunities will be given credit for the
time spent up to a maximum period of not
more than six months regardless of the dura'
tion of the course.

11. An acceptable residency is one which
has been approved by the Council on Medi'
cal Education and Hospitals of the American
Medical Association jointly with this Board.

12. The Board has ruled that physicians
who accept male patients in their private or
other practice, for operative or other care,
cannot be regarded as specialists in obstetrics
and gynecology, except by special ruling
when this is related to active military duty.

13. This Board deprecates engagement in
fields of practice other than that in which
candidates profess to be specialists. The
Board does not exclude from examination,
however, obstetricians and/or gynecologists
who practice abdominal surgery and urology
in the female, as well as breast surgery, be'
cause of the correlation of these activities.

Military Service or any other similar patriotic
Service, such as work with Selective Service
Boards, etc., have not been construed as nou'
limitation of practice in violation of the
Board regulätions.

REQUIREMENTS

The requirements for all candidates will be uni'
form as foUows:

1. Completion of at least one (1) year

intern service in a hospital approved by
the Council on Medical Education and HoS'
pitals of the A. M. A. (This need not be a
general rotating internship, although this
latter is preferred.)

(A second year general internship is to be
considered as one of a candidate's years of
practice. No credit will be given toward spe'
cial training during a second year general
internship.)

2. A minimum of scven (7) years of prac
tice after the intern year, including at least
three (3) years of residency training in ap'
proved institutions, or adequate preceptor'
ship training as a formal assistant, prefer'
ably füll time, in approved institutions or
with recognized specialists in obstetrics and/
or gynecology satisfactory to the Board of
Directors.

This Board, in Cooperation with the Council
on Medical Education and Hospitals of the
American Medical Association, surveys in'
stitutions providing acceptable residencies in
obstetrics and gynecology.

The American Board of Obstetrics and Gync
cology establishes herewith requirements for
its approval of a residency in a hospital de'
partment or service :

1. The Chief of the Active Visiting Staff of
the Department must be certified by this
Board with at least one other of his subordi'
nates, the remaining members of the Staff
must be otherwise acceptably qualified to
teach and to practice obstetrics-gynecology.

2. In instances where the Services of obstet'
rics'gynecology are not combined but are
separate in any given hospital, the Chief of
each such service and at least one of his sub'
ordinates must be certified.

3. If obstetrics and gynecology are not com'
bined in one department, approval can be
granted only if arrangements are made for
some degree of rotation of residents between
both Services.

4. If gynecology is classified in the given
hospital as a subdivision or subservice of

surgery, approval cannot be granted for resi'
dency training in gynecx)logy.

5. Exceptions to the foregoing, in respect
to the certified Status of Chiefs of Service
and others as outHned above, can be made
only by unanimous assent of the Committee
on Postgraduale Survey, for adequate and
justifiable reasons. As examples of the latter,
the degree of F.A.C.S. in obstetrics'gync
cology might be accepted in Heu of one of
the two required certifications if the general
reputation of the person concerned is known
to the Committee as national or sectional in
scope, or a professorial rank without certifi'
cation might be acceptable.

6. It should be recalled by all concerned
that credits for graduate training may be ob'
tai nable for residency or assistantship service
in hospitals not ofEcially approved for resi-
dency training. Each such case must be indi'
vidually considered, and credits will be largc
ly dependent upon the teaching qualifications
of those in charge of the service, and the clin'
ical facilities of the hospital in question.

Lists of formally approved institutions for
special residency training appear regularly
in certain issues of the Journal of the A.
M. A. Detailed information about any of
these can be obtained by applying to the
A. M. A.

It is possible for candidates trained in some
unclassified or as yet unapproved hospitals
to obtain credit for this training if properly
supervised. Each such case must be consid'
ered on its own merits.

Candidates should ofFer as Sponsors or refer'
ences, two Diplomates of this Board with
whom they are presently in contact, rather
than men under whom they served as resi'
dents only.

APPLICATION AND FEES

Application must be made on a special blank
which will be furnished by the Secretary's Office,
1015 Highland Building, Pittsburgh (6), Pa., and
must be forwarded with the other required crc
dentials and the application fee to the Secre'

; .

tary's Office at least ninety (90) days prior to
the scheduled date of the examinations.

Application fee « $ 1 5 .00

Make checks payable to American Board of

Obstetrics and Gynecology, Not returnable.
(Applications will not be considered for
Classification and action by the Credentials
Committee unless accompanied by the appli'
cation fee.)

Examination fee _ $85.00

(Payable when the candidate is notified of
acceptance for examination. Not returnable
after the candidate has been officially ac
cepted by the Credentials Committee and
notified to report for examination.)

Total fee $100.00

The fees have been carefully computed on a
basis of cost of examinations and are used en'
tirely for administrative expenses. Examiners
serve without compensation other than actual
expenses.

Many prospectve candidates write the Secretary's
O&ce outlining in their letters their training quali'
fications and asking informally if they are eligible.
Any candidate should be able to make a fair
estimate of his eligibility after studying this Bul'
letin.

The Secretary cannot and will not make any
eligibility rulings. These are made only by the
Credentials Committee after reviewing those ap'
plications only, which are made on the special
form provided for this purpose, and submitted
to the Secretary with the candidate's applica*
tion fee.

All candidates must comply with Board regula'
tions in eflFect for the year in which the exam'
ination is taken, regardless of when the original
application was filed.

Applicants declared ineligible for admission to
examination may reopen their applications within
two (2) years of the filing date without payment
of an additional application fee.

Applicants declared eligible but who fail to exer'
eise the examination privilege within three (3)
years of the date of filing the application are re'

quired to file a new application and to pay a new
application fee.

An applicant in military Service during the war'
time national emergency and assigned to work in
general surgery under conditions acceptable to the
Credentials Committee may receive credit up to
a maximum of six (6) months applicable toward
his three (3) required years of specialty training.
The additional time may be applied toward the
years of practice requirement.

An applicant servmg under military Orders in an
Army or a Navy hospital in an obstetrical and/or
gynecological Service under supervision will be
given the same credit as if he were working under
a preceptor, since most of these departments are
supervised by men who are Diplomates of this
Board or who are recognized obstetrician'gync
cologists. He may obtain füll residency credit if
such hospital is ofiicially approved and listed for
residency training in this specialty.

Additional time in military service with any type
of general medical assignment may be applied
toward the Board's years of practice requirement.
The Credentials Committee of the Board will rc
view and give consideration to each individual

Upon notice of acceptance for admission to
examination, examination fee is due and also case
records which should be shipped by the candidate
to the Secretary's Office as soon as possible and
not later than the date of the Part I written
examination.

The candidate should make immediate acknowl'
edgment of his notice of acceptance at which
time he will notify the Secretary's Office approxi'
mately when to expect his case reports.

EXAMINATIONS

Part I examinations are scheduled annually for
the first Friday in February. Grades cannot
usually be mailed from the Secretary's Office un'
til after April first following the examination.
Arrangements will be made for candidates to
report in any convenient city where there may
be a Diplomate of this Board to conduct or to
supervise the written examination which will be

sent out from the Board's Office under sealed
Cover.

Special arrangement will be made through senior
officers for conducting the written portion of the
Part I examination for men in military service.
Such candidates are requested to keep the Secre'
tary's Office informed at all times of changes in
their mailing addresses.

All applicants accepted for examination will be
required to obtain a passing grade in both the
written examination and a review of case reports
(Part I), before becoming eligible for the oral'
clinical and pathology examinations (Part II).
The passing grade for the written examination
and case reports is 75 per cent. A candidate
whose grade in either or both falls below 75 per
cent is conditioned.

Re-examination for the removal of conditions in
Part I may be taken after one year but within
three years after the first failure, without pay
ment of an additional fee.

Candidates who successfully complete the Part

I examination proceed automatically to the Part

II examination held later in the year.

Candidates appearing for rcexamination under
a new application after two previous failures will
not be required, if they have passed all or part
of the Part I examinations on their first applica'
tion, to repeat such examination items already
successfully cleared.

After two ineligibility or postponement rulings
on any candidate's application, an entirely new
application form must be submitted (with or
without fee, according to current requirements)
in Order to bring data down to date. The essen'
tial feature of this should be evidence of addi'
tional training and experience.

All original Group A candidates, who have al'
lowed three years or more to elapse without tak'
ing examinations, and who care to apply again,
must do so on the regulär current basis. If ac'
cepted, they will now be subject to Part I and
Part II examinations.

Former Group A candidates appearing for rc
examination after first failure in Part II are not
required to take the Part I examination.

Part I

Examination consists of :

1. A comprehensive written examination,
conducted annually, including questions on
both obstetrics and gynecology and related
basic Sciences.

2. The filing of twentyfive (25) obstetrical
and gynecological case reports, in Condensed
form. Five (5) cases may concern major ill'
nesses, not necessarily operative. These must
be cases for which the candidate was per'
sonally responsible.

3. The written examination will be limited
to a maximum period of three hours.

(For details regarding Case Reports see next
page) .

Part II

The oral'clinical and pathology examinations
given all candidates are conducted by the entire
Board and the Associate Examiners usually near
the time and place of the annual meeting of
one or more of the national societies represented
on this Board, usually that of the American Medi'
cal Association. Advance announcements of ex'
amination dates and place will be made in med'
ical Journals throughout the country.

Examination consists of :

1. Oral examination before two to four ex-
aminers.

An endeavor is made to adapt the details of
the oral examination to each candidate's ex'
perience and practice. The examination is
particularly directed to ascertain his famil'
iarity with recent obstetrical and gynecologi'
cal literature, the related basic sciences, the
breadth of his clinical experience, and his
general qualifications as a specialist in obstet'
rics and gynecology.

2. Pathology examination.

The candidate is expected to identify and to
discuss several obstetrical and gynecological
pathologic specimens and sections.

Examiners report orally upon each candidate to
the assembled Board, after which the results of
their investigations are considered jointly by the

11»

entire Board and Associate Examiners. After a
general consideration of the details of the candi'
date's oral and pathology examinations, including
a review of his capability and general adaptabil'
ity, the candidate is passed or failed by the entire
Board.

The final action of the Board is based upon the
candidate's ethical and professional record, train'
ing and attainments, as well as on the results of
his formal examination.

No conditions are given in Part II of the
examination. When a candidate fails in Part II of
the examination, he is not required to repeat
Part I, but to take a re-examination in the oral'
clinical and pathology portions only. One re-ex'
amination may be taken within three (3) yearsof
the original examination or first failure without
reapphcation or payment of an additional fee.

The candidate may reappear at the examination
following the one failed by him. In applying for
reappearance he should outline additional train'
ing or experience acquired in the interim. The
Board may, at its discretion, deny the candidate
the privilege of rcexamination.

Failure to exercise the privilege of rcexamination
within three (3) years, entails the filing of a
new application with the usual application and
examination fees.

After two failures in either Part I or Part II on
the first application, the candidate may reapply
and be readmitted to examinations once only.
Exceptions to this ruling can be made only by ac
tion of the entire Board in annual Session, usually
to be based upon evidence of additional training
and experience sufficient to Warrant such action.

CASE REPORTS

Case reports are to be sent by the candidate to
the Secretary as soon as possible after receiving
notification of eligibility, and not later than the
date of the Part I written examination.

Twentyfive (25) important obstetrical and gyne'
cological case reports, in Condensed form, are
required. Five (5) cases may concern major ill'
nesses, not necessarily operative. These reports
must include a variety of material rather than a

number of cases of one type and must be cases
treated within four (4) years of the date of the
candidate's application. The number of cases from
one's residency Service should not be more than
half the total number.

These reports are not to be copied verbatim
from hospital records, but must be sufficiently
complete so that the Examiners can evaluate the
judgment of the candidate in bis choice of
procedure.

Candidate should indicate on each case record
whether this is from his residency Service or from
his private practice and all records failing to have
this information will be considered unacceptable.

These reports should be prepared in Condensed
form in Une with the foUowing items:

1. Heading each separate case report must
be the hospital number and date, name
of the hospital at which the patient was
operated, with all pertinent dates, together
with the candidate's name or identifiable in'
itials, name of each patient, name of oper'
ator (candidate). The case reports should
be given sequence numbers from 1 to 25 and
must specify whether from residency service
or from private practice.

2. (a) Preoperative diagnosis and basis for
this, in brief .

(b) Postoperative diagnosis, based on
findings.

3. Nature of Operation, omitting descrip'
tive technical details, but including pathol'
ogist's findings on tissue removed.

4. Critical summary or analysis of each
case, with critical deductions derived from
correctness or incorrectness of diagnosis, op'
erative findings, postoperative course, and
from final results on discharge from hospital
and at six months ''followup" examination.

5. Histories must be typewritten on stand'
ard size paper, Sj/z x 11 inches, and must
be assembled by individual cases.

6. Reports must not be bound with any
form of binding other than light weight
paper folders or covers.

7. Two (2) separate verified index lists of
case reports must be made for each indi'
vidual hospital at which Operations were per'
formed. AU verifications must be formally
signed by the responsible hospital official,
attesting in each instance that the candidate
was the Operator and must State:

Sequence numbers of case reports.
Candidate's name at head of each page.
Name and address of hospital.
Whether from residency service or from

private practice.
Patients' names or identifiable initials.
Patients' admission numbers.
Date of each patient's admission.
Date of each patient's Operation.
Date of each patient's discharge.

The critical summary or analysis which must bc
prepared for each case must include:

1. An account of the candidate's personal
observations of the case both prior to and
subsequent to Operation.

2. The basis for the diagnosis.

3. The facts that determined the course of
treatment. Details of operative technic should
not be included.

4. Critical conclusions to be drawn from
the outcome of the case.

Case reports which do not include such discus*
sion and comments will not be reviewed or
graded by the Examiners.

Obstetrical case reports should show:

(a) Date of first prenatal visit and any
special features bearing on the case.

(b) The weight and condition of the child
at birth and at time of discharge from the
hospital.

Obstetrical reports which do not include pelvic

measurements either by calipers and, as indi'

cated, by X'ray pelvimetry, will be considered
incompletc.

For lists of certificate holders of this, as othcr

Boards, consult the Directory of Medical Speci'
alists Certified by American Boards (1946).

Communications should be addressed to the Secrctary:

DR. PAUL TITUS
1015 Highland Building, Pittsburgh (6), Pa.

Make checks payable to the American Board of
Obstetrics and Gynecology.

ADVISORY BOARD FOR MEDICAL
SPECIALTIES

Organized in 1933'34 to coordinate graduate education
and certification of medical specialists in the United
States and Canada.

This Board holds active membersbip in the
Advisory Board for Medical Specialists and re'
ports directly to its member groups and functions
in close Cooperation with the Council on Medical
Education and Hospitals of the American Medi'
cal Assodation.

ÜFFICERS AND EXECUTIVE COMMITTEE

RoBiN C. BuERKi, M.D., President
Philadelphia, Pa.

L. R. Chandler, M.D., Vice President
San Francisco, CaHf.

B. R. KiRKLiN, M.D., Secretary-Treasurer
Rochester, Minn.

Victor Johnson, M.D.
Chicago, 111.

Conrad Berens, M.D.
New York, N. Y.

Member Organizations

The Association of American Medical Colleobs

The American Hospital Assgoation

The Federation of State Medical Boards
OF the U. S. A.

The National Board of Medical Examiners

The American Board of Ophthalmology

The American Board of Otolaryngology

The American Board of Obstetrics and
Gynecology

The American Board of Dermatology
and Syphilology

The American Board of Pediatrics

The American Board of Psychiatry and
Neurology

The American Board of Radiology

The American Board of Orthopaedic Surgery

The American Board of Urology

The American Board of Internal Medicine

The American Board of Pathology

The American Board of Surgery

The American Board of Neurological Surgery

The American Board of Anesthesiology

The American Board of Plastic Surgery

The American Board of Physical Medicine

DIRECTORY OF MEDICAL SPECIALISTS

Publication Office

210 East Ohio Street, Chicago, 11, Illinois

The Joint Directory of Medical Specialists certified by
the fiftcen special Boards was first published in 1940 by
the Advisory Board for Medical Specialties; a second
edition appeared in February, 1942; and a third edition
in 1946. The third edition of the Directory referred to
above is published by the A. N. Marquis Company,
210 East Ohio Street, Chicago, 11, Illinois. List price
is $10.30. Between editions frequent Bulletins are to bc
issued to Directory subscribers, listing new names as
thcy are certified up to the time of issuance of the
succeeding Directory.

25 years ago Rubin a4troduced a nethod

• • • ••

With noinal patency the -^aspressure rises
to 70rnm and falls to ^0 mm, Conf irmation
by Shoulder pain, Refewed pain*

Indication. it sho'.a.d be the first test aftei
the husjands Genen h:is been exair.inned.

Contra indlcations; " ELeeding

Purulent discharge
Recent infla^iiriations

Large timiors

Sermons cardiac disease

Bleeding on incertion o:

cannula
Pregnancy

Apparatiis used.

Garbondioxyd super ior to air,
Deccription of apparatus
Use of s^nringe
CaniiUlas,

Time for test#

Eadonetriuin has least thichness

no dnnger of endoi.ietriosis

no interf erence with pregnancy

The test:

Testing of apparatus
Placing od patient
Decinfection
Edrection of canal

exar-ination

sounding, better not

Stenosis of internal os

Don^t dilate

Cervix:

Insertion ^d.th pressure
Graspinf of cervix
nislocation possible
\^ere is the tip of tto cannula?

Injection of gas or opening of jalve^
riatch for escape at cervix - ^

Auscultation

Pressure,

Ainount of gas. Rate of flow.

Patient sits up. Shoulderpain.

If streng, let h-r lay

do- n.

Interpretation :

ilanometer, KymograpB
Shoiolderpain
delayed«

••miltHä immn »•■nnNiiWiwitiKnilfc i

If closed:
200 :m
Don»t exceed. Experiments.

If gas pnsses at looinri and higher
partial block.
May be caiised by spasme or ty
adheslons.

Location of pain glve hint of locatlon
of blockage.
medlcation.

00? SHWX %u

CNSPWMfei^raM akoN«^'«!« S4

Ftfteo Photogrtph Hei«

NEW YORK UNIVERSITY POST-GRADUATE MEDICAl; SCHOOL

477 FIRST AVENUE, NEW YORK 16, N. Y.

APPLICATION FOR ADMiSSION TO POSTGRADUATE COURSES

Last Name First Name MiddleName

Permanent Address

Present Address Telephone No.

Age Sex Citizenship Marital Status

Attended Medical School from To Degrec

HOSPITAL INTERNSHIPS OR RESIDENCIES:
(1)

(Name of Hospital)

(City)
(City)

(State)
(State)

From
From
From

To
To
To

(2)
(3)

(Name of Hospital) (City) (State)

State below the nature of each of the internships or residencies (/.^., whether rotating, medical or surgical) :
(1). (2) (3)

PREVIOUS GRADUATE OR POSTGRADUATE MEDICAL STUDY:

(Subject)
(Subject)

(School)
(School)

From
From
From

To
To
To

Licenscd to practice medicine in {state) (k^'*) License No.

Type of Practice {inäicate whether gener al, including obstetrks and pediatrics, or confined to a specialty) :

Of what professional organizations are you a member?

PRESENT HOSPITAL AFFILIATIONS:

(Hospital)

(City)

(Appointment and Service)

(Hospital) (City) (Appointment and Service)

Military Service {with dates and brief indication of type of professional experience)

Date Appointed
Date Appointed

Specialty Board certification

(Date) (Board)

Other evidence of specialist qualifications {membership in special academies, Colleges, etc.)

Scientific Publications {use reverse of this blank or an attachment if necessary)

1 HEREBY APPLY FOR ADMISSION TO THE FOLLOWING COURSES:

No , Subject Beginning

No Subject Beginning

Date

Approved

(Signatare of Applicant)

>^* J-^tk-iW.* -J^-lJ-^'l. ,'- I.' ■■ » '— ^"

VOL. LH., NO. 25

MAY P>, 19 52

COURSES FOR PHYSICIANS

POST-6RADUATE

MEDIC AL SCHO OL

71ST SESSION

1952-1953

NOTICE

The procedures of admission, the program of Instruction, including
degree requirements, the schedule of fees, and the personnel of the
teaching staff and their respective assignments announced in this bul-
letin are subject to such changes, at any time, as may be deemed neces-
sary or advisable by the administration. Any course of Instruction may
be discontinued before completion if the administration deems such
discontinuance for the best interests of the University. Upon discon-
tinuance, the University will refund to students in good Standing all
fees for Instruction in such course.

NEW YORK UNIVERSITY

POST-6RADUATE
MEDICAL SCHOOL

NEW YORK UNIVERSITY BULLETIN

Vol. LH, No. 25

May 19, 1952

Published weekly from December, for forty-five consecutive weeks, by
New York University, Main Building, 100 Washington Square Hast,
New York 3, N.Y. Re-entered as second-class matter December 5,
1951, at the Post Office at New York, N.Y., under the Act of August
24, 1912. Acceptance for mailing at special rate of postage provlded
for in Section 1 103, Act of October 3, 1917, authorized June 17, 1924.

1952-1953

A Unit of New York University-Bellevue Medical Center
477 FIRST AVENUE • NEW YORK 16 • NEW YORK

The teaching program is carried out in the lahoratories and
Conference rooms of the University and in the following hospitals.

Beekman-Downtown Hospital

Bellevue Hospital

Beth Israel Hospital

Goldwater Memorial Hospital

Gouverneur Hospital

Irvington House

Lenox Hill Hospital

New York Eye and Ear Infirmary

New York State Rehabilitation Hospital

St. Vincent's Hospital

University Hospital

Willard Parker Hospital

OFFICERS OF ADMINISTRATION

Robert Boggs, A.B., M.D.,C.M. [McGill], Dean

Clarence E. de la Chapelle, B.S. (Med.), M.D., Associate Dean

C. Travers Stepita, M.S., M.D., Associate Dean (Foreign Student Affairs)

Frode Jensen, A.B., M.D., Associate Dean
Katherine L. Stevens, Recorder

PROFESSORS EMERITI

Walter T. Dannreuther, M.D., Obstetrics and Gynecology

Austin Flint, A.M. (Hon.), M.D., Obstetrics

Howard Fox, A.B., M.D., Sc.D. (Hon.), Dermatology and Syphilology

Emanuel D. Friedman, B.S., M.D., Neurology

Charles Gottlieb, M.D., Radiology

Daniel B. Kirby, A.B., A.M., M.D., LL.D., Ophthalmology

Arthur Krida, M.D., Orthopedic Surgery

Walter G. Lough, B.S., M.D., Medicine

George Miller MacKee, M.D., Dermatology and Syphilology

Alfred T. Osgood, A.B., M.D., Vrology

Charles Hendee Smith, B.S., M.D., Pediatrics

« J

CALENDAR OF COURSES
1952-1953

CALENDAR OF COURSES, 1952-1953 (continueä)

DATE

COURSE

DATE COURSE

July

1 Dermatology and Syphilology
Medicine

7 Medicine
14 Medicine

Medicine
Ophthalmology
Ophthalmology
Physical Medicine and
Rehabilitation
21 Medicine

Ophthalmology
Ophthalmology

Sepiember

2 Anesthesiology
Anesthesiology
Obstetrics and Gynecology

8 Medicine
Pediatrics
Surgery

9 Surgery
11 Medicine

15 Obstetrics and Gynecology
Obstetrics and Gynecology
Otolaryngology
Otolaryngology
Pediatrics

Radiology

16 Pathology

17 Pathology

22 Dermatology and Syphilology

Medicine

Ophthalmology

Pediatrics

Physical Medicine and
Rehabilitation

Psychiatry and Neurology

Psychiatry and Neurology
29 Comprehensive Medicine

Anatomy

Ahatomy

Anatomy

Anesthesiology

Forensic Medicine

Industrial Medicine

Medicine

Ophthalmology

Otolaryngology

Pathology

Physical Medicine and
Rehabilitation

Psychiatry and Neurology

NUMBER DATE

COURSE

NUMBER

525-A
5429-A
5414-A
5424-A
5430-A

579-A
5710-A

731 1-A

5422-A
571 1-A
5713-A

-A
-A
-A

-A
A
A

513-A

512-A

734-

5427-

614-

663-

6610-

5433-

563-A

566-A

591-A

592-A

618-A

652-A

442-A

44 1-A

524-A

5420-A

5714-A

6110-A

7310-A

647-A

648-A

740-A

41 1-A

413-

414-

514-

531

481
5429-

576-

593-

596-
591 1-A

443-A

■A

-A

■A

Ocloher

1 Dermatology and Syphilology

Radiology
3 Radiology

6 Medicine
Medicine
Neurosurgery
Obstetrics and Gynecology
Pediatrics

7 Obstetrics and Gynecology
Obstetrics and Gynecology

13 Medicine

Obstetrics and Gynecology
Orthopedic Surgery

14 Obstetrics and Gynecology

20 Physical Medicine and

Rehabilitation

21 Radiology
27 Medicine

Medicine

Obstetrics and Gynecology

Ophthalmology

'J^ovember

3 Ophthalmology

Otolaryngology

Pediatrics
10 Medicine

Medicine

Ophthalmology

Otolaryngology

Surgery

Urology
17 Medicine

Medicine
24 Otolaryngology

Becember

1 Surgery

8 Industrial Medicine

Obstetrics and Gynecology

Otolaryngology

Surgery

Jauuary

5 Anatomy

Anatomy

Anatomy
738-A Anesthesiology

645-A Orthopedic Surgery

649-A Orthopedic Surgery

525-A
65 1-A
651-B

546-A
5434-A
551-A
561-A
612-A
567-A
568-A
542 1-A
560-A
582-A
569-A

7312-A
655-A

5424-B

5435-A

562-A

574-A

577-A

597-A

61 1-A

5414-B

5415-A

5422-B

575-A

578-A

594-A

661 1-A

674-A

5418-A

5423-A

598-A

664-A

484-A
564-A
599-A
666-A

412-A
413-A
415-A
416-A
512-B
581-A
583-A

January (cont'd)

Radiology

Surgery

Urology

Otolaryngology

Preventive Medicine

Psychiatry and Neurology

8 Pathology
12 Medicine

Neurosurgery

Pediatrics

Physical Medicine and

Rehabilitation
Physical Medicine and

Rehabilitation
Psychiatry and Neurology

19 Dermatology and Syphilology
Ophthalmology
Ophthalmology
Otolaryngology
Pediatrics

Physical Medicine and

Rehabilitation
Surgery

20 Pathology

26 Ophthalmology
Ophthalmology
Surgery

28 Medicine

29 Radiology

lebruary

2 Anesthesiology

Industrial Medicine

Medicine

Surgery
5 Medicine

9 Otolaryngology
16 Radiology

18 Medicine

23 Medicine

Obstetrics and Gynecology

Ophthalmology

24 Obstetrics and Gynecology

21arch

2 Industrial Medicine

Medicine
9 Medicine

Ophthalmology

NUMBER

DATE COURSE

Pediatrics

653-A

Medicine

665-A

Ophthalmology

66 1-A

Pathology

672-A

Microbiology

5910-A

Obstetrics and Gynecology

735-A

Obstetrics and Gynecology

64 1-A

Ophthalmology

644-A

Surgery

444-A

Anatomy

5436-A

Anatomy

552-A

Anatomy

617-A

Medicine
Ophthalmology

738-B

Surgery

7310-B

ri\

643-A

Pediatrics

522-A

Pediatrics

579-B

Surgery

5710-B

Pediatrics

595-A

Medicine

613-A

Medicine
Medicine

7312-B

Medicine

660-A

Obstetrics and Gynecology

441-B

Medicine

5711-B

Medicine

5713-B

Medicine

662-A

Obstetrics and Gynecology

5426-A

Obstetrics and Gynecology

654-A

Medicine
Medicine
Medicine

Medicine

510-A

Medicine

482-A

Medicine

5427-B

Medicine

668-A

Physical Medicine and

5433-B

Rehabilitation

594-B

652-B

'May

543 1-A

5420-B

562-B

11
18

Anesthesiology
Dermatology and Syphilology
Medicine

575-B

578-B

lune

569-B

Medicine
Medicme
Neurosurgery

483-A

Orthopedic Surgery

5428-A

Radiology

5416-A

Medicine

571-A

Medicine

NUMBER

614-B
5415-B
572-A
442-B
432-A
563-B
566-B
574-B
667-A
411-B
413-C
414-B
5423-B
573-A
661-B

619-A
615-A
669-A
616-A
54 1-A
547-A
548-A
549-A
561-B
542-A
546-B

5413-A
567-B
568-B
545-A

5410-A

541 1-A
544-A
544-B
543-A

5412-A

7312-C

5 1 2-C

523-A
5432-A

5419-A

542 1-B

553-A

582-B

656-A

5418-B

5425-A

ANATOMY

College of Mediane

Donal Sheehan, b.s., m.s., m.b.,ch.b., m.d., sc.d. [Man-
chester], Professor and Chairman of the Department
Louis L. Bergmann, m.d., Associate Professor
Pinckney J. Harman, b.s., m.s., ph.d., Associate Professor
Joseph Pick, m.d. [vienna], Associate Professor
Benjamin G. P. Shafiroff, m.d., Associate Professor of

Clinical Surgery (Assigned to Anatomy)
Joseph M. Odiorne, b.s., a.m., ph.d., Assistant Professor
Louis M. Rosati, b.s., m.d., Assistant Professor of Clini-
cal Surgery (Assigned to Anatomy)

The foUowing courses may be taken füll time by
special arrangement on a prorata basis of $100.00 per
month.
41 1-A. ANATOMY OF THE HEAD AND NECK

A twelve weeks' course, 1 to 5 p.m., Mondays,
Wednesdays, and Fridays, September 29 through
Decembcr 19, 1952. Designed for graduate students
iuterested in the fields of ophthalmology, otorhino-
laryngology, or gcncral or thoracic surgery. The fas-
cial planes of the neck and their continuities are inten-
sively studied. The surgical anatomy of the thyroid
gland, parathyroid glands, pharynx, and larynx are
dissected in detail. Other special studies involve the
recurrent laryngeal nerves, the superior laryngeal
nerves, the sympathetic nervous System, and the caro-
tid sinus mechanism. Surgical aspects are considered
in relation to practical anatomy.

Given under the direction of Dr. Benjamin G. P.
Shafiroff. Tuition $90.00.

This course is repeated as 4 1 1 -B, March 30 through
June 19, 1953.

412-A. ANATOMY OF THE THORAX AND ITS
VISCERA

A twelve weeks' course, 1 to 5 p.m., Mondays,
Wednesdays, and Fridays, January 5 through March
27, 1953. It is designed primarily for the thoracic or
general surgeon or internist. The thoracic bony cage
is completely dissected. The anatomy of the lung is
studied in detail especially from the Standpoint of
bronchovascular segments. The mediastinum is care-
fuUy investigated. The cardiovascular structures are
studied with recent developments in cardiac surgery.
Congenital anomalies are considered. The surgical
anatomy of the esophagus, autonomic nervous system,
and lymphatic system are included.

Given under the direction of Dr. Benjamin G. P.
ShafirofT. Tuition $90.00.

Seelig Freund, b.s., m.d., Instructor in Surgery (Assigned

to Anatomy)
May B. Hollinshead, a.b., ph.d., Instructor
Maude V. Vance, a.b., m.d., Instructor
Harold S. Auerhan, a.b., m.d., Assistant
Henry Huber, a.b., m.d., Assistant
Quan Y. Kau, a.b., m.d., Assistant
Eugene P. Liston, a.b., m.d., Assistant
Bernard O. Nemoitin, a.b., a.m., m.d., Assistant
Marvin P. Rhodes, a.b., m.d., Assistant
Morton Roberts, a.b., m.d., Assistant
Henry L Scheer, b.s., m.d., Assistant

413-A. ANATOMY OF THE ABDOMEN

A twelve weeks' course, 1 to 5 p.m., Mondays,
Wednesdays, and Fridays, September 29 through
December 19, 1952. A dissection course of the entire
abdomen and pelvis. Variational anatomy is particu-
larly stressed. All organs are studied from the surgical
Standpoint. The genitourinary system and viscera of
pelvis are included. The surgical anatomy of hernia is

stressed.

Given under the direction of Dr. Benjamin G. P.

Shafiroff. Tuition $90.00.

This course is repeated as 413-B, January 5
through March 27, 1953, and as 413-C, March 30
through June 19, 1953.

414-A. ANATOMY OF THE FEMALE PELVIS

A twelve weeks' course, 1 to 5 p.m., Mondays,
Wednesdays, and Fridays, September 29 through
December 19, 1952. It is a practical dissection course
of the female pelvis. The pelvic fascia and their practi-
cal applications are stressed. The perineum is dis-
sected in detail. All the pelvic viscera and their
surgical relationships are correlated. The pelvic auto-
nomic System is dissected.

Given under the direction of Dr. Benjamin G. P.
Shafiroff. Tuition $90.00.

This course is repeated as 414-B, March 30
through June 19, 1953.

415-A. ANATOMY OF THE GENITOURINARY
SYSTEM

A twelve weeks' course, 1 to 5 p.m., Mondays,
Wednesdays, and Fridays, January 5 through March
27, 1953. It Combines the general features of 413 and
414.

Given under the direction of Dr. Benjamin G. P.
Shafiroff. Tuition $90.00.

416-A. ANATOMY OF THE MUSCULOSKELE-
TAL SYSTEM

A twelve weeks' course, 1 to 5 p.m., Mondays,
Wednesdays, and Fridays, January 5 through March
27, 1953. It is a general dissection course of the mus-

culoskeletal system involving the upper and lower
extremities, the muscles of the back, and their neuro-
vascular structures.

Given under the direction of Dr. Benjamin G. P.
Shafiroff. Tuition $90.00.

'--^

wfw*-

Instruction in Applied Anatomy

ANESTHESIOLOGY

Emery A. Rovenstine, a.b.. m.d.. sc.d. (hon.), Professor

and Chairman of the Department
Raphael W. Robertazzi, b.s., dot. med. chir. [naples],

Professor of Clinical A nesthesia
Seymour Goldenberg, a.b., m.d., Associate Professor of

Clinical A nesthesia
Louis R. Orkin, a.b., m.d., Assistant Professor
Solomon G. Hershey, e.s., m.d., Clinical Professor

513-A. ANESTHESIOLOGY (GRADUATE
COURSE)

The Instruction, largely clinical, with special
classes, demonstrations, Conferences, etc., occupies
the Student füll time during one calendar year, begin-
ning September 2, 1952. Intensive didactic, seminar,
and laboratory study in the basic medical sciences as
applied to anesthesia is included. The major subjects
are anatomy, physiology, pharmacology, pathology,
biochemistry and biophysics, experimental anesthesia,
inhalation thcrapy, and toxicology.

Students who satisfactorily complete the first year
of work may continue their training in residence for a
minimum of one year. The residency must be ap-
proved by the Post-Graduate Medical School. It offers
the Student an opportunity to undertake individual
original investigation in some phase of clinical experi-
mental anesthesia.

Given under the direction of Professor Emery A.
Rovenstine. Maximum class 6. Tuition $700.00.
(Enrollment after September 2, 1952, by arrange-
ment. )

510-A. ANESTHESIOLOGY:
ENDOTRACHEAL AND RELATED METHODS

A one-week, full-time course, February 2 through
7, 1953, covering the principles and clinical practices
of endotracheal procedures including operating-room
bronchoscopy. Two hours daily are given to didactic
Instruction, the remainder of the time to supervised
clinical work. Only those actively engagcd in clinical
anesthesiology are accepted.

Given under the direction of Professor Emery A.
Rovenstine. Maximum class 4. Tuition $75.00.

511-A. ANESTHESIOLOGY (FOR
SPECIALISTS)

An intensive refresher course of two weeks' dura-
tion beginning on any Monday (September through
June). The present practices in general, regional,
intravenous, and rectal anesthesia are presented from
the theoretical and clinical Standpoints.

M.D., Associate Clinical

Donald L. Burdick, b.s., a.m.,

Professor
Charles L. Burstein, b.s., m.d. [paris], Associate Clinical

Professor
Jack Milowsky, s.S., m.d., Associate Clinical Professor
James Marin, a.b., m.d., Assistant Clinical Professor
D. Jeanne Richardson, b.s., m.d., Assistant Clinical Pro-
fessor

Given under the direction of Professor Emery A.
Rovenstine. Maximum class 2. Tuition $150.00.

512-A. REGIONAL ANESTHESIOLOGY

An intensive two-week course in regional anes-
thesia, including therapeutic nerve blocking. The
entire'day is utilized to present the subject by cadaver
dissection, lectures, clinical demonstration, and prac-
tice. September 2 through 13, 1952.

Given under the direction of Professor Emery A.
Rovenstine. Maximum class 16. Tuition $200.00.

This course is repeated as 512-B, January 5
through 16, 1953, and as 512-C, May 11 through 22,
1953.
514-A. ANESTHESIOLOGY

A full-time course of twelve weeks' duration, Sep-
tember 29 through December 19, 1952. One half of
the student's day is occupied live days weekly with
assigned exercises in classrooms and laboratories
covering the fundamental sciences of physiology,
pharmacology, therapeutics, anatomy, pathology,
toxicology, physics, and chemistry in their relation to
anesthesiology. Practical supervised instruction m
clinical anesthesia and its related practices occupies
the remainder of the student^s day.

A Student may arrange to take the first, second,
and/or third sessions of the course. The clinical
instruction given mornings is consistent throughout
the course. Afternoons:

Part I-September 29 through October 24, 1952.
Didactic instruction in the fundamental sciences in
their relation to anesthesiology.

Part Il-October 27 through November 21, 1952.
Didactic instruction in clinical anesthesiology.

Part III-November 24 through December 19,
1952. Didactic instruction in subjects related to the
clinical practice of anesthesiology. Inhalational and
parenteral therapy, management of comatose states,
etc.

A practical knowledge of modern anesthesia is a
prerequisite. Given under the direction of Professor
Emery A. Rovenstine. Maximum class 24. Tuition
$300.00. (Any four weeks $125.00.)

1«?^

• •

•

•l

Practical Demonitration of Modern Anesthesia

CHEMISTRY

DERMATOLOGY AND SYPHILOLOGY

CHEMISTRY

College of Mediane

DERMATOLOGY AND SYPHILOLOGY

R. Keith Cannan, b.s., m.s., sc.d. [london], Professor

and Chairman of the Department
Isidor Greenwald, a.b., ph.d., Professor
Milton Levy, e.s., ph.d., Associate Professor
Maxwell Schubert, a.b.. a.m., ph.d., Adjunct Associate

Professor (Assigned to Mediane)
Albert S. Keston, a.b., m.s. ph.d., Assistant Professor
Robert C. Warner, b.s., m.s., ph.d., Assistant Professor
Hildegard Wilson, a.b., a.m., ph.d., Assistant Professor

(Assigned to Mediane)
Mary E. Dumm, a.b., a.m., ph.d., Adjunct Assistant Pro-
fessor (Assigned to Mediane)
Walton B. Geiger, a.b., ph.d., Adjunct Assistant Professor
(Assigned to Medicine)

Integration of Clinicol Problems with Loborotory Techniques

ä0^.

lone Weber, b.s., a.m., ph.d., Adjunct Assistant Professor

Mary E. Carsten, a.b., m.s., ph.d., Fellow

Joseph Dancis, a.b., m.d., Fellow

Seymour Ehrenpreis, b.s., Fellow

Jacques R. Fresco, a.b., m.s., Fellow

Cliflford Jackson, b.s., m.s., Fellow

Kenneth C. Leibman, b.s., m.s., Fellow

Joseph Lospalluto, b.s., Fellow

Evelyn Slobodiansky, a.b., m.s., ph.d., Fellow

The members of the department take part in the basic
science instruction in the courses offered by the clinical
departments.

Marion B. Sulzberger, m.d. [zurich], Professor and
Chairman of the Department

Frank C. Combes, m.d., Professor

Evan W. Thomas, a.b., m.d., Professor of Clinical Medi-
cine (Assigned to Syphilology)

Franz Herrmann, m.d. [Frankfurt], Associate Professor

Rudolf L. Baer, m.d. [Frankfurt], Associate Professor
of Clinical Dermatology and Syphilology

David Bloom, m.d. [bern], Associate Professor of Clini-
cal Dermatology and Syphilology

Maurice J. Costello, b.s., m.d., Associate Professor of
Clinical Dermatology and Syphilology

Max Jessner, m.d. [koenigsberg], Associate Professor of
Clinical Dermatology and Syphilology

> ■ U ^

Frances Pascher, m.d., Associate Professor of Clinical
Dermatology and Syphilology

Charles R. Rein, b.s., m.d., Associate Professor of Clini-
cal Dermatology and Syphilology

Herman Sharlit, a.b., b.s., m.d., Associate Professor of
Clinical Dermatology and Syphilology

Nathan Sobel, m.d., Associate Professor of Clinical Der-
matology and Syphilology

Jesse A. Tolmach, m.d., Associate Professor of Clinical
Dermatology and Syphilology

Jack Wolf, A.B., M.D., Associate Professor of Clinical

Dermatology and Syphilology
Morris Leider, a.b., m.d., Assistant Professor

Practical Instruction in Examination Technique of Skin

DERMATOLOGY AND SYPHILOLOGY

Gerald Flaum, a.b., m.d., med.sc.d., Assistant Professor

of Clinical Medicine (Assigned to Syphilology)
Louis Schwartz, a.b., m.d.. Adjimct Clinical Professor
David B. Ball in, m.d.. Associate Clinical Professor
Else Ann Barthel, b.s., m.d.. Associate Clinical Professor
Hans H. Biberstein, m.d. [Breslau], Associate Clinical

Professor
Orlando Canizares, doc. univ. [med. fac, paris], Asso-
ciate Clinical Professor
William Director, m.d.. Associate Clinical Professor
Samuel B. Frank, a.b.. m.d., Associate Clinical Professor
Andrew G. Franks, b.s., m.d., ll.b.. Associate Clinical

Professor
Herman Goodman, b.s.. m.d.. Associate Clinical Pro-
fessor
Irving N. Holtzman, m.d.. Associate Clinical Professor
Arthur B. Hyman, m.b., b.s. [london], Associate Clinical

Professor
Samuel Irgang, m.d.. Associate Clinical Professor
Paul R. Kline, m.d., Associate Clinical Professor
William Leifer, m.d., Associate Clinical Professor
John F. Mahoney, m.d., Associate Clinical Professor
H. Victor Mendelsohn, m.d.. Associate Clinical Professor
Joseph L. Morse, m.d., Associate Clinical Professor
Emanuel Muskatblit, physician [odessa], Associate Clin-
ical Professor
Ernst W. Nathan, m.d. [giessen], Associate Clinical Pro-
fessor
Frederick Reiss, m.d. [Budapest], Associate Clinical

Professor
Timothy J. Riordan, m.d.. Associate Clinical Professor
Gdali Rubin, m.d. [paris], Associate Clinical Professor
Lionel C. Rubin, a.b.. m.d.. Associate Clinical Professor
Herman H. Sawicky, b.s., m.d. [Edinburgh], Associate

Clinical Professor
Charles F. Sims, a.b., m.d., Associate Clinical Professor
Howard T. Behrman, a.b., m.d., Assistant Clinical Pro-
fessor
Frank E. Gross, m.d., med.sc.m., Assistant Clinical Pro-
fessor
Lopo de Mello, m.d., Assistant Clinical Professor
Richard Emmet, a.b., m.d., Assistant Clinical Professor
Alexander A. Fisher, a.b., m.d., Assistant Clinical Pro-
fessor
John Garb, m.d.. Assistant Clinical Professor
Thomas N. Graham, m.d., Assistant Clinical Prof essor
Joseph Hahn, b.s.. m.d., Assistant Clinical Professor
Delmas K. Kitchen, a.b. (chem.), b.s. (med.), m.d.,

Assistant Clinical Professor
Ralph L Kreisberg, b.s. (med.), m.d., Assistant Clinical

Professor
Emory Ladany, m.d. [Budapest], Assistant Clinical Pro-
fessor
Simeon E. Landy, a.b., Assistant Clinical Professor
Juan Larralde, m.d. [paris], med.sc.d. [univ. central,

VENEZUELA], Assistant Clinical Professor
Charles S. Miller, a.b., m.d., Assistant Clinical Professor
Abraham J. Orfuss, b.s., m.d., Assistent Clinical Professor
Julius H. Pollock, B.S., m.d., Assistant Clinical Professor
Morris J. Rothstein, b.s., yi.n., Assistant Clinical Professor

Ludwig Schwarzschild, m.d. [wuerzburg], Assistant

Clinical Professor
Mabel G. Silverberg, a.b., m.d., Assistant Clinical Pro-
fessor
Jacob Skeer, m.d., Assistant Clinical Professor
Jacob Wachtel, m.d., Assistant Clinical Professor
Jacob A. Goldberg, a.b., a.m., ph.d., Lecturer
Theodore Rosenthal, b.s., m.d., Lecturer
Joseph R. Klaar, m.d. [vienna], Instructor
Ludwig S. Kleeberg, m.d. [jena], Instructor
Ludwig W. Loewenstein, m.d. [cologne], Instructor
Nathan Pensky, a.b., m.d., Instructor
Max Wolf, M.D. [vienna], Instructor
Isidor Apfelberg, m.d., Instructor in Clinical Dermatol-

ogy and Syphilology
Benjamin Bender, b.s., m.d., Instructor in Clinical Der-

matology and Syphilology
Vagharshag Boghosian, m.d. [beyrouth], Instructor in

Clinical Dermatology and Syphilology
Max Braitman, b.s., m.d., Instructor in Clinical Derma-
tology and Syphilology
Theodore H. Finkle, a.b., m.d., Instructor in Clinical Der-
matology and Syphilology
Abraham J. Gewirtz, b.s., m.d. [laval], Instructor in

Clinical Dermatology and Syphilology
John Groopman, b.s., m.d., Instructor in Clinical Derma-
tology and Syphilology
Ernest L. Kadisch, m.d. [freiburg], Instructor in Clini-
cal Dermatology and Syphilology
Kate Freeman Miller, a.b., m.d., Instructor in Clinical

Dermatology and Syphilology
Helen Neave, a.b., m.d., Instructor in Clinical Dermatol-
ogy and Syphilology
Laurence L. Palitz, a.b., ph.d., m.d., Instructor in Clinical

Dermatology and Syphilology
Morris M. Reschke, m.d. [berlin], Instructor in Clinical

Dermatology and Syphilology
Sidney J. Robbins, b.s., m.d. [vienna], Instructor in Clini-
cal Dermatology and Syphilology
Ernst Rosenbaum, m.d. [Breslau], Instructor in Clinical

Dermatology and Syphilology
Walter F. Rosenberg, m.d. [Heidelberg], Instructor in

Clinical Dermatology and Syphilology
Gerald A. Spencer, b.s.; doc. univ. [med. fac, lyon],

Instructor in Clinical Dermatology and Syphilology
Louis H. Tobin, m.d., Instructor in Clinical Dermatology

and Syphilology
Henry R. Corwin, a.b., m.d., Clinical Instructor
Benjamin D. Erger, m.d., Clinical Instructor
Hans Field, m.d., Clinical Instructor
John Heinlein, m.d., Clinical Instructor
Edward G. Jeruss, b.s., m.d., Clinical Instructor
Norman B. Kanof, a.b., m.d., med.sc.d. (derm.), Clini-
cal Instructor
George H. Kostant, a.b., m.d., Clinical Instructor
Irving L. Milberg, a.b., m.d., Clinical Instructor
Julius L. Rosenfeld, m.d.,c.m. [dalhousie], Clinical In-
structor
Jessie Rubin, a.b., m.d. [Lausanne], Clinical Instructor

i«i#jijWipi.T'

DERMATOLOGY AND SYPHILOLOGY

Joseph J. Sher, b.s., m.d., Clinical Instructor in Radiology
(Assigned to Dermatology)

Hilda G. Straker, a.b., m.d., Clinical Instructor

Victor H. Witten, b.s., m.d., Clinical Instructor

Harold L. Adler, b.s., m.d., Assistant in Clinical Derma-
tology and Syphilology

Arthur Back, m.d., Assistant in Clinical Dermatology
and Syphilology

Earle Brauer, m.d., Assistant in Clinical Dermatology
and Syphilology

Elfriede W. Ehrenreich, m.d., Assistant in Clinical Der-
matology and Syphilology

William Eller, m.d., Assistant in Clinical Dermatology
and Syphilology

Martin Fischer, m.d., Assistant in Clinical Dermatology
and Syphilology

Dorothy Fisher, a.b., m.d., Assistant in Clinical Derma-
tology and Syphilology

Harold Glick, m.d., Assistant in Clinical Dermatology
and Syphilology

Morton Kulick, b.s., m.d., Assistant in Clinical Dermatol-
ogy and Syphilology

Rene Leviticus, m.d., Assistant in Clinical Dermatology
and Syphilology

Irwin L Lubowe, a.b., m.d., Assistant in Clinical Derma-
tology and Syphilology

Irving E. Marks, m.d., Assistant in Clinical Dermatology
and Syphilology

Martin G. Marmon, a.b., m.d., Assistant in Clinical Der-
matology and Syphilology

Frederick R. Mebel, a.b., m.d., Assistant in Clinical Der-
matology and Syphilology
■ Adrian Neumann, m.d., Assistant in Clinical Dermatol-
ogy and Syphilology

Leo Orris, a.b., m.s.(pub.health),m.d., Assistant in
Clinical Dermatology and Syphilology

George Popkin, m.d., Assistant in Clinical Dermatology
and Syphilology

Milton S. Ross, b.s., m.d.. Assistant in Clinical Derma-
tology and Syphilology

Adolph S. Sternberg, m.d. Ifreiburg], Assistant in Clin-
ical Dermatology and Syphilology

Jules E. Vandow, m.d., Assistant in Clinical Dermatology
and Syphilology

Harold S. Appell, m.d.. Fellow

Alexander Borota, m.d. [Budapest]. Fellow

Olga-Sophie Dobkevitch-Morrill, m.d. [paris], Fellow

Ruth W. Piccagli, m.d. [frankfurtI, Fellow

Philip H. Prose, b.s., m.d. Ilausanne], Fellow

Norman Goldfarb, m.d.. Assistant in Clinical Dermatol-
ogy and Syphilology

So!t mon Goldman, b.s.. m.d., Assistant in Clinical Der-
matology and Syphilology

Otto B. Hitschmann, m.d. Ivienna], Assistant in Clinical
Dermatology and Syphilology

Beatrice Kalish, a.b., m.d.. Assistant in Clinical Derma-
tology and Syphilology

Leonard V. Kornblee, a.b.. m.d., Assistant in Clinical
Dermatology and Syphilology

525-A. DERMATOLOGY AND SYPHILOLOGY
(GRADUATE COURSE)

A full-time course of one calendar year, October 1 ,
1952, through September 30, 1953. (This course may
be entered July 1, 1952.) Covers the basic science
aspects of the specialty and consists of didactic lec-
tures as well as practical and laboratory exercises in
histopathology, mycology, bacteriology, physiology,
heniatology, allergy and immunology, serology, radio-
active isotopes, radiation and other physical therapy,
and other basic fields as applied to the skin and its dis-
eases and to venereal diseases. The facilities of the
Skin and Cancer Unit, University Hospital, Bellevue
Hospital, Willard Parker Hospital, and the other affili-
ated hospitals are utilized. This course should be taken
in conjunction with a two-year residency or in con-
junction with a combined fellowship and preceptee
training program to comprise a füll three-year training
period.

A limited number of scholarships are available.

Given under the direction of Professor Marion B.
Sulzberger. Tuition $700.00.

521-A. AN INTENSIVE AND COMPREHEN-
SIVE REVIEW IN DERMATOLOGICAL HISTO-
PATHOLOGY

A full-time intensive course of five days' duration
consisting of a series of lectures, illustrated by micro-
scopic slides. A complete review of both the normal
histology of the skin and the essential histopathology
of diseases of the skin. Includes study at the micro-
scope and slides representing common and unusual
microscopic features of dermatoses. The dates of this
course will precede that of the examination by the spe-
cialty board and will be announced in American medi-
cal Journals.

Given under the direction of Professor Marion B.
Sulzberger. Maximum class 20. Tuition $75.00.

522-A. SEMINAR IN DERMATOLOGY AND
SYPHILOLOGY

A full-time intensive course of five days' duration,
January 19 through 23, 1953, consisting of illustrated
lectures and demonstrations of patients and methods.
The latest accepted methods used in the diagnosis and

ifw^rj^^s.i-ataitfi^'ifaf

(■ta

DERMATOLOGY AND SYPHILOLOGY

FORENSIC MEDICINE

therapy of the following dcrmatoses are included: pre-
cancers and Cancers of thc skin; acne vulgaris; various
forms of cczema; industrial dcrmatoses; warts; scars
and birthmarks; fungus infcctions; bactcrial infections
of the skin; psoriasis; liehen planus; allergic dcrma-
toses, including various forms of cczema, hives, drug
reactions, etc.; baldncss and excessive hair; syphilis in
all stagcs, including discussion of Serologie changes.
The usc of special modalities is dctailed, including:
ACTH and Cortisone; other hormones; vitamins; anti-
biotics; antihistaminics; and radioactive agents.

Given undcr the direction of Professor Marion B.
Sulzberger. Maximum class 20. Tuition $75.00.

523-A. SYMPOSIUM ON DERMATOLOGY
AND SYPHILOLOGY (FOR DERMATOLO-
GISTS)

A full-time course of five days' duration, May 18
through 22, 1953, consisting of a survey and critical
evaluation of recent advanecs and research in dcrma-
tology and syphilology, including such subjccts as ra-
dioactive isotopes, grenz-ray and thorium-X therapy;
ACTH. Cortisone, and other new drugs and hormones;
drug eruptions; new methods of treatment of common
skin diseases; new causes for industrial dcrmatoses;
the prcsent concept of cczema; management of benign
and of dangerous nevi; diagnosis and management of
Syphilis, lymphohlastomas. allergic skin diseases, fun-
gus diseases; selected rare conditions; and the psy-
chosomatic aspects of dermatology. Demonstration of
patients and application of new techniques are
included.

Given under the direction of Professor Marion B.
Sulzberticr. Maximum class 20. Tuition $85.00.

524-A. DERMATOLOGY AND SYPHILOLOGY
IN INFANTS AND CHILDREN

An intensive full-time review course of five days'
duration, September 22 through 26, 1952. Includes
clinical scssions and demonstration of patients to-
gether with the application of modern diagnostic and

therapeutic modalities, iilustration of the common and
rare skin diseases, illustrated lectures covering the dif-
ferential diagnosis, causes and newest forms of treat-
ment of nevi, tumors, warts, allergies, eczemas,
urticarias, pyodermas, drug eruptions, acnes, psoria-
sis, and other skin diseases as they occur in the young.
Given under the direction of Professor Marion B.
Sulzberger. Tuition $75.00.

482-A. OCCUPATIONAL DERMATOSES (IN
CONJUNCTION WITH THE DEPARTMENT OF
INDUSTRIAL MEDICINE)

A two-week, part-time course given under the
direction of Dr. William Leifer (see page 16).

735-A. TROPICAL MEDICINE

Lectures on tropical fungus diseases given by mem-
bcrs of the department in conjunction with the above
listed course (see page 63).

SHORT-TERM AND PRACTICAL COURSES IN
DERMATOLOGY AND SYPHILOLOGY

Part-time and full-time courses ranging from one
weck to one year are available by arrangement, on a
prorata basis of $125.00 per month, füll time.

The applicant may select Instruction in one or more
of the subdivisions of the specialty, including derma-
tologic allergy; histopathology; mycology; dermatolo-
gic hematology; photography; dermatologic therapy;
dcrmatologic surgery; physical therapy — radiation
therapy, use of isotopes and thorium X; venereal dis-
eases and serology.

Opportunities may be made available for qualified
students to work on original laboratory and clinical
research projects under the supervision of staff
members.

A prospectus may be obtained by writing to the
Oflice of the Dean, Post-Graduate Medical School,
477 First Avenue, New York 16, N.Y.

FORENSIC MEDICINE

Harrison S. Martland, a.b., m.d., Professor and Chairman

of the Department
Thomas A. Gonzales, m.d., Professor
Milton Helpern, b.s., m.d., Associate Professor
Rudolf M. Paltauf, m.d. [vienna], Assistant Professor

531-A. FORENSIC MEDICINE (GRADUATE
COURSE)

Opportunity is provided for a few physicians to
undertake advanced training in the field of forensic
medicine. This study Covers a period of not less than
one academic year, füll time, or an equivalent period
on a part-time basis, beginning September 29, 1952.

The course is given in the laboratories of the Chief
Medical Examiner and the Toxicologist of the City of
New York. Students work both in the laboratory and
in the field and may undertake independent research.
The first part of the period of study is spent chiefly in
the basic medical sciences as related to forensic medi-
cine; the latter is largely given over to applied work in
the necropsy room, the toxicological laboratory, the
field, and the courts.

Given under the direction of Professor Harrison S.
Martland. Tuition $700.00.

532-A. FORENSIC MEDICINE

Postgraduate courses of varying duration are of-
fered in forensic medicine, on the prorata basis of
$100.00 per month, füll time.

533-A. TOXICOLOGY (DATES BY
ARRANGEMENT)

Section I. Three months. Introduction to Toxicological
Procedures and Analysis for Gaseous Poisons.

Methods and proctocol in the toxicological laboratory;
collection of the samples for toxicological analysis;
appropriate organs for particular toxicological analyses;
information needed by the toxicologist prior to the analy-
sis; relation between the pathologist and the toxicologist;
handling evidence and establishing the chain of evidence;
general procedures in toxicological analysis; qualitative
and quantitative analysis for gaseous poisons. Tuition
$300.00.

Section IL Three months. Analysis for Volatile Poisons.
Methods for the detection of volatile poisons isolated
from tissue and body fluids by steam distillation. Empha-
sis is placed on the qualitative methods for the identifica-
tion of the wide variety of volatiles. Quantitative methods
are considered only for the more common substances
such as the alcohols, Cyanide, phenols, halogenated
hydrocarbons, and commercial hydrocarbon mixtures.
Tuition $300.00.

Alexander S. Wiener, a.b., m.d., Assistant Professor
Alexander O. Gettler, b.s., a.m., ph.d., ll.d., Lecturer

(Toxicology)
Charles J. Umberger, B.s., ph.d., Lecturer

Section III. Six months. Inorganic Poisons.
Subsection 1. Three months. Metallic Poisons.

The period is devoted exciusively to learning the prin-
ciples and manipulative techniques and plate interpreta-
tion of spectrographic analysis. A study is made of the
characteristic spectra of all the toxic metals. Tuition
$300.00.

Subsection 2. Three months. Quantitative Analysis of the
Metals and Analysis of the Nonmetallic Inorganic
Poisons.

Preparation of biological samples for inorganic metal
and nonmetal analysis and quantitative chemical methods
for the common metal poisons. Qualitative and quantita-
tive analysis for the inorganic nonmetallic poisons, such
as phosphorus, fluorides, borates, nitrites, nitrates, and
chlorates is also studied.

Tuition $300.

For füll six months, tuition $500.00.

Section IV. Nine months. The Nonvolatile Organic
Poisons.

Subsection 1. Three months. Fundamental Techniques
for the Analysis of Nonvolatile Organic Poisons.

The period is devoted to the study of procedures for
the isolation and purification of the organic drugs from
tissue and body fluids, the development of micro-manipu-
lative techniques which include micro-sublimation, mi-
cro-manipulation, micro-melting points, the essentials of
chemical microscopy, and carbon, hydrogen, and molecu-
lar weight determinations.

Subsection 2. Three months. Detection of the Acid-Type
Nonvolatile Organic Poisons.

The period covers the detection of the acid-type drugs
with special attention to the barbiturates.

Subsection 3. Three months. Detection of the Basic-Type
Nonvolatile Organic Poisons.

This period is devoted to methods for the detection
and determination of the basic-type drugs, such as the
narcotics, local anesthetics, antihistamines, etc.

Tuition for nine months $700.00.

Section V. Three months. Application of Instrumentation
to Toxicological Analysis.

Essentials of infrared and ultraviolet spectrophotome-
try, high voltage technique in spectrographic analysis,
special applications of conductometric and electrometric
methods. Special procedures in forensic medicine, such
as the comparison of physical evidence, detection of pow-
der, determination of entrance and exit wounds. Tuition
$300.00.

INDUSTRIAL MEDICINE

Anthony J. Lanza, m.d.. Professor and Chairman of the

Department
David H. Goldstein, a.b., m.d.. med.sc.d., Associate

Professor
Merril Eisenbud, b.s. (elec. engr.). Associate Professor

(Industrial Hyfiiene)
Norton Nelson, a.b., ph.d., Associate Professor
Herman N. Eisen, a.b., m.d., Assistant Professor
Sidney Laskin, a.b., Assistant Professor
Edward D. Palmes, b.s., m.s., ph.d., Assistant Professor
William E. Smith, a.b., m.d., Assistant Professor
Edgar Mayer, a.b., m.d., Clinical Professor
Ronald F. Buchan, a.b., m.d.,c.m. [mcgillI, Associate

Clinical Professor
Leonard Greenburg, c.e. (sanitary engr.), ph.d., m.d.,

Associate Clinical Professor
Joseph P. Holt, B.S., M.S., ph.d., m.d., Associate Clinical

Professor
Willard F. Machle, b.s., m.d.. Associate Clinical Professor

481-A. INDUSTRIAL MEDICINE (GRADUATE
COURSE)

A full-timc course of one calcndar year beginning
September 29, 1952, in industrial mcdieinc and indus-
trial hygiene givcn in the Institute of Industrial Medi-
cine and the College of Engineering. Under a
co-operative agreement with the College of Engineer-
ing, this course is ofTered jointly to physicians and
engineers. It comprises nine months of class and lab-
oratory work and three months of in-plant vvork. The
course includes the following:

A. For physicians and engineers jointly

Epidemiology, preventive medicine, and bio-
statistics including Statistical procedures and
analysis; the relationship of environmental
conditions in work places to health and dis-
ease; workmen's compcnsation and legal
aspects.

B. For physicians

Organization, administration, and economics
of an industrial medical department; occupa-
tional diseases; roentgenology with particular
reference to pulmonary diseases; psychiatry,
geriatrics, and industrial relations; rehabilita-
tion.

C. For engineers

Air conditioning, control of atmospheric pol-
lution, disposal of industrial wastes; methods
of sampling and analysis; illumination stand-

Robert C. Page, a.b., m.b.. m.d., Associate Clinical Pro-
fessor
George M. Saunders, a.b., m.d., Associate Clinical Pro-

fessor
Frank R. Ferlaino, b.s., m.s., m.d., Assistant Clinical

Professor
Frank P. Guidotti, m.d. [naples], Assistant Clinical Pro-
fessor
Ralph F. Schneider, B.s., m.d., Assistant Clinical Pro-
fessor
Barnett S. Fox, Lecturer

Nathan Van Hendricks, b.engr., ch.e., Lecturer
Henry D. Sayer, Lecturer
Royd R. Sayers, a.b., a.m., m.d., Lecturer
Edward J. Stieglitz, b.s., m.s., m.d., Lecturer
Arthur J. Vorwald, a.b., ph.d., m.d., ll.d., sc.d.(hon.),

Lecturer
George W. Wright, b.s., m.d., Lecturer
Bernhard Altshuler, b.s. (engr.physics), Instructor
Lawrence F. Dieringer, b.s. (chem.engr.), Instructor
(Industrial Hygiene)

ards and designs; accident and fire prevention;
Physiologie effects of toxic substances and
their maximum allowable concentrations. In-
plant work is in approved industrial medical
departments or approved industrial-hygiene
laboratories.
The institute maintains three laboratories for re-
search and teaching-industrial toxicology, industrial
physiology, and industrial hygiene. Students partici-
pate in the work of these three laboratories.

Given under the direction of Professor Anthony J.
Lanza. Tuition $700.00.

482-A. OCCUPATIONAL DERMATOSES

A five-day, full-time course, February 2 through 6,
1953, in the diagnosis, treatment, and prevention of
occupational derniatoses.

Given under the direction of Dr. William Leifer.
Tuition $50.00.

483-A. INDUSTRIAL MEDICINE

An intensive three months' course in industrial
medicine to be given March 2 through May 29, 1953.
Designed for industrial physicians who wish to be-
come conversant with the more recent developments
in industrial medicine, cspecially in its preventive
aspects.

Given under the direction of Professor Anthony J.
Lanza. Maximum class 25. Tuition $300.00.

INDUSTRIAL MEDICINE

484-A. MEDICAL ASPECTS OF COMPENSA-
TION

A one-week course, December 8 through 13, 1952,
given in co-operation with the American Academy of
Compcnsation Medicine, covering the compcnsation
aspects of the various medical spccialtics by specialists
in cach field.

Givcn under the direction of Professor Anthony J.
Lanza in association with Dr. William B. Rawls of the
American Academy of Compcnsation Medicine. Tui-
tion $50.00. For mcmbcrs of the Academy, tuition
$25.00.

5432-A. PULMONARY DISEASES IN RELA-
TION TO INDUSTRY

A full-time course of five days' duration, May 18
through 22, 1953, for the purpose of giving the
matriculate a practical approach to the problems of

industry in relation to thoracic disease. To this end, a
brief background of pathoiogy and physiology is the
basis for the presentations on the various illnesses and
occupational diseases that are encountered. Emphasis
is placed on treatment and rehabilitation, problems of
extreme importance to the industrial physician. Some
of the legal aspects of compensabie disease are
touched. Ample opportunity is presented for forum
discussion.

Given under the direction of Dr. David Ulmar. Tui-
tion $50.00.

Short courses in various specialties of industrial
medicine, including the pneumoconioses at the Sara-
nac Laboratory, Saranac Lake, New York, are oflFered
by special arrangement on a prorata basis of $100.00
per month, füll time.

Courses in industrial hygiene engineering are given
in co-operation with the College of Engineering. For
further information consult the Graduate Division
bulletin of the College.

MEDICINE

Charles F. Wilkinson, Jr., b.s.(chem.engr.), m.d., Pro-
fessor and Chairman of the Department
Clarence E. de la Chapelle, b.s. (med.), m.d., Professor
Charles A. Poindexter, b.s., m.d., m.s., Professor
A. Wilbur Duryee, b.s., m.d., Professor of Clinical Medi-

cine
Charles H. Nammack, a.b., m.d., Professor of Clinical

Medicine
Will C. Spain, a.b., m.d., Professor of Clinical Medicine
Maurice Bruger, b.s., m.s., m.d.,c.m. [mcgill], Associate

Professor
J. Scott Butterworth, b.s., m.s., m.d., med.sc.d., Associate

Professor
Raymond S. Jackson, m.d., Associate Professor
Benjamin I. Ashe, b.s., m.d., Associate Professor of Clin-
ical Medicine
Irving Graef, a.b., m.d., Associate Professor of Clinical

Medicine
Robert McGrath, b.s., m.d., Associate Professor of Clin-
ical Medicine
Lester J. Unger, a.b., a.m., m.d., Associate Professor of

Clinical Medicine
Laurence G. Wesson, Jr., a.b., m.d., Assistant Professor
Charles A. R. Connor, a.b.. m.d., med.sc.d., Assistant

Professor of Clinical Medicine
Maximilian Fabrykant, m.d. [charles un;v., prague],

Assistant Professor of Clinical Medicine
J. Russell Twiss, a.b., m.d., Assistant Professor of Clin-
ical Medicine
Arthur M. Fishberg, a.b., m.d., Clinical Professor
Edgar A. Lawrence, b.s. [mcgill], m.d., Clinical Pro-
fessor
Henry A. Rafsky, m.d., Clinical Professor
Emanuel Appelbaum, a.b., m.d., Associate Clinical Pro-
fessor
Joseph Eideisberg, m.d., Associate Clinical Professor
Abner M. Fuchs, m.d., Associate Clinical Professor
Clarence C. Füller, b.s., m.d., Associate Clinical Professor
Eimer S. Gais, b.s. (med.), m.d., Associate Clinical Pro-
fessor
Richard E. Gordon, m.d.. Associate Clinical Professor
Carl H. Greene, a.b., ph.d., m.d., Associate Clinical Pro-
fessor
Edward F. Härtung, a.b., m.d., Associate Clinical Pro-
fessor
Max-Wilhelm Johannsen, m.d., Associate Clinical Pro-
fessor
S. Edward King, b.s., m.d., m.s.p.h., Associate Clinical

Professor
Arnold Koffler, m.d., Associate Clinical Professor
Lawrence Meyers, b.s., a.m., m.d., Associate Clinical

Professor
Jack Nelson, b.s., m.d., Associate Clinical Professor
Elliot Oppenheim, m.d. [Edinburgh], Associate Clinical

Professor
Edward H. Reisner, Jr., a.b., m.d., Associate Clinical

Professor
Matthew Shapiro, m.d., Associate Clinical Professor
Harry A. Solomon, m.d., Associate Clinical Professor

Saul Solomon, a.b., m.d.,c.m. [mcgill], Associate Clin-
ical Professor
Otto Steinbrocker, b.s., m.d., Associate Clinical Professor
Max Trubek, a.b., m.d., Associate Clinical Professor
David Ulmar, a.b., m.d., Associate Clinical Professor
Harry Vesell, a.b., m.d., Associate Clinical Professor
Michael Weingarten, m.d., Associate Clinical Professor
Hyman Alexander, b.s., m.d., Assistant Clinical Professor
Frances L. Bailen-Rose, b.s., m.d., Assistant Clinical Pro-
fessor
Z. Taylor Bercovitz, b.s., m.s., ph.d., m.d., Assistant

Clinical Professor
Louis F. Bishop, Jr., ph.b., m.d., Assistant Clinical Pro-
fessor
Edwin Boros, m.d., Assistant Clinical Professor
Maurice R. Chassin, a.b., m.d., Assistant Clinical Pro-
fessor
Abraham W. Freireich, b.s., m.d., Assistant Clinical

Professor
Maxwell L. Gelfand, b.s., m.d., Assistant Clinical Pro-
fessor
Samuel U. Greenberg, a.b., m.d., Assistant Clinical Pro-
fessor
Frode Jensen, a.b., m.d., Assistant Clinical Professor
Mennasch Kalkstein, b.s.; m.b.,ch.b. [st. Andrews], As-
sistant Clinical Professor
Winifred C. Loughlin, a.b., m.d., Assistant Clinical Pro-
fessor
George C. McEachern, a.b., m.d., Assistant Clinical Pro-
fessor
Jerome A. Marks, a.b., m.d., Assistant Clinical Professor
George Pollack, m.d. [London], Assistant Clinical Pro-
fessor
Anna R. Spiegelman, a.b., m.d., Assistant Clinical Pro-
fessor
John J. Thorpe, b.s., m.d.. Assistant Clinical Professor
Leo Weiner, b.s.; m.d. [vienna], Assistant Clinical Pro-
fessor
William J. Welch, a.b., m.d., Assistant Clinical Professor
Paul K. Boyer, a.b., m.d., med.sc.d., Instructor
Irwin R. Cohen, m.d., Instructor
Joseph Kovacs, a.b., m.d. [Budapest], Instructor
Teresa McGovern, b.s., m.s., m.d., Instructor
Lawrence R. Prouty, b.s.(biochem.), m.d., Instructor
Ralph I. Alford, a.b., m.d., Instructor in Clinical Medi-
cine
Michael S. Bruno, a.b., m.d., Instructor in Clinical Medi-
cine
Herbert A. Dann, a.b., m.d., Instructor in Clinical Medi-
cine
Alfred D. Dennison, Jr., a.b., m.d., Instructor in Clinical

Medicine
Helen S. Haskell, a.b., a.m., m.d., Instructor in Clinical

Medicine
Jacob Heyman, a.b., m.d., Instructor in Clinical Medicine
Delavan V. Holman, a.b., m.d., Instructor in Clinical

Medicine
Sidney I. Kreps, a.b., m.d., Instructor in Clinical Medi-
cine

MEDICINE

William S. Ling, a.b., m.d., Instructor in Clinical Medi-
cine
James Tesler, m.d., m.s. (med.), Instructor in Clinical

Medicine
Allan R. Aronson, b.s., m.d., Clinical Instructor
Shepard G. Aronson, a.b., m.d., Clinical Instructor
Harry Bartfeld, m.d., Clinical Instructor
William V. Berger, m.d., Clinical Instructor
Audrie L. Bobb, a.b., m.s., m.d., Clinical Instructor
Ralph G. Bonime, b.s., m.d., Clinical Instructor
Joel J. Brenner, b.s.; a.b., m.b.,ch.b., a.m. [oxon.], Clini-
cal Instructor
Leonard B. Burness, B.s., m.d., Clinical Instructor
ClifTord Cohen, a.b., m.d., Clinical Instructor
John Staige Davis, Jr., m.d., Clinical Instructor
Ned Doscher, b.s., m.d., Clinical Instructor
Alfred Gabel, m.d., Clinical Instructor
Thomas H. Gleeson, m.d. [Toronto], Clinical Instructor
Herbert Greenfield, a.b., m.d., Clinical Instructor
Stanley Isenberg, a.b., m.d., Clinical Instructor
Mildred E. Kamner, a.b., a.m., ph.d., m.d., Clinical In-
structor
Theodore Kaplan, m.d., Clinical Instructor
Benjamin M. Kaufman, m.d., Clinical Instructor
Paul Kuhn, m.d., Clinical Instructor
Harry G. Kupperman, a.b., m.d., Clinical Instructor
Robert S. Levin, m.d., Clinical Instructor
Harold J. Livingston, a.b., m.d., Clinical Instructor
Morton F. Mark, a.b., m.d., Clinical Instructor
Richard S. Marton, m.d., Clinical Instructor
Murray L. Maurer, b.s.; m.d. [basel], Clinical Instructor
Morris O. Pearlmutter, a.b., m.d., Clinical Instructor
Albert A. Pollack, a.b., m.d., m.s. (med.), Clinical In-
structor
Isador Ripps, b.s., m.d., Clinical Instructor
Dino Sandroni, b.s., m.d., Clinical Instructor
Philip M. Schulman, b.s., m.d., Clinical Instructor
M. Stephen Schwartz, a.b., a.m., m.d,, Clinical Instructor
Myron F. Sesit, a.b., b.s., m.d., Clinical Instructor
Walter C. Spiess, Jr., m.d., Clinical Instructor
James M. Tarsy, m.d. [Bologna], Clinical Instructor
John V. Waller, a.b., m.d., Clinical Instructor
William Wolins, m.d., Clinical Instructor
ehester B. Allen, Jr., a.b., m.d., Assistant
Harry Blutman, m.d., Assistant
George Bruzza, a.b., m.d., Assistant
Lisgar B. Eckardt, a.b., a.m., ph.d., m.d., Assistant

Irving A. Glass, a.b., m.d., Assistant
Hazel Isenberg, Assistant (Hematology)
Leopold C. Lazarowitz, m.d. [warsaw], Assistant
Francis A. Pflum, b.s., m.d., Assistant
Francis T. Rogliano, b.s., m.d., Assistant
Sheldon Schwartz, b.s., m.d., Assistant
Margaret Strauss-Ballard, a.b., m.s., Assistant (Allergy)
Stanley J. Wittenberg, s.S., m.d., Assistant
Stewart F. Alexander, a.b., m.d., Clinical Assistant
Samuel H. Belgorod, a.b., m.d., Clinical Assistant
Graham L. Bennett, a.b., m.d., Clinical Assistant
Carlos Bertran, a.b., m.d., Clinical Assistant
Herbert R. Blain, b.s.; m.d. [Edinburgh], Clinical Assist-
ant
Neal S. Bricker, a.b., m.d., Clinical Assistant
Earl B. Brown, b.s., m.d., Clinical Assistant
Robert L. Cella, a.b., m.d., Clinical Assistant
Theodore Cohen, m.d., Clinical Assistant
Leonard Felder, a.b., m.d., Clinical Assistant
Benjamin S. Fishman, a.b.; m.d. [london], Clinical

Assistant
J. Wilfrid Forster, m.d. [queen's univ., Kingston], Clin-
ical Assistant
Morton Glen, a.b., m.d., Clinical Assistant
Louis W. Granirer, a.b., m.d., Clinical Assistant
Edwin A. Henck, m.d., Clinical Assistant
Edwin H. Kaufman, b.s., m.d., Clinical Assistant
Max S. Königsberg, b.s.; m.d. [Hamburg], Clinical As-
sistant
Frederick O. Kraus, b.s., m.d., Clinical Assistant
Samuel B. Levy, b.s., m.d., Clinical Assistant
Günther Lomnitz, m.d. [Frankfurt], Clinical Assistant
John McGaley, m.d., Clinical Assistant
Louis Mamelok, a.b., m.d., Clinical Assistant
Richard E. Passenger, b.s., m.d., Clinical Assistant
Andrew B. Paul, m.d. [Budapest], Clinical Assistant
Jacob Prager, m.d., Clinical Assistant
Richard B. Quan, m.d., Clinical Assistant
Edward H. Roston, a.b., m.d., Clinical Assistant
Harry Shilkret, b.s., m.d., Clinical Assistant
Max A. Sklar, b.s., m.d., Clinical Assistant
William A. Tansey, a.b., m.d., Clinical Assistant
Arthur R. Thomas, a.b., m.d., Clinical Assistant
Hobart H. Todd, b.s., m.s., m.d., Clinical Assistant
Aaron Weiner, m.d. [milan], Clinical Assistant
John Winslow, a.b., m.d., Clinical Assistant
Anne B. Wright, a.b., m.d., Clinical Assistant

5429-A. INTERNAL MEDICINE (GRADUATE
COURSE)

A full-time course of one academic or one calendar
year with daily exercises Mondays through Fridays, 9
a.m. to 5 p.m., beginning September 29, 1952. (This
course may be entered July 1, 1952.) The training in
internal medicine includes special consideration of the
various subdivisions, such as cardiovascular diseases,
allergy, metabolic disturbances, pulmonary diseases,

etc. In addition, the technical disciplines of bacteriol-
ogy, biochemistry, physiology, pathology, and phar-
macology are elaborated in relation to clinical
medicine. Students come in contact with patients on
the medical Services of Bellevue Hospital, University
Hospital, and Willard Parker Hospital (Tuberculosis
Division ) . They participate in Conferences, seminars,
and other forms of instruction. Assignments are also
made to the various specialty clinics in Bellevue Hos-
pital. Problems pertaining to the medical sciences as

MEDICINE

applied to clinical medicine are developed under the
guidance of a member of the department of medicine
and in conjunction with other departments according
to the nature of the problem. Through the various
clinical facilities enlarged experience is made available
particularly in the practical matters of diagnosis and
treatment.

Given under the direction of Professor Charles F.
Wilkinson, Jr. Tuition $700.00.

541-A. SEMINAR IN INTERNAL MEDICINE
A fuU-time, eight weeks* course, April 13 through
June 5, 1953, consisting of a survey of the field of
internal medicine by means of lectures and case dem-
onstrations in the various medical specialties. The
program is composed of the part-time courses 542-A,
543-A, 544-A, 544-B, 545-A, 546-B, 547-A, 548-A,
549-A, 5410-A, 541 1-A, 5412-A, 5413-A (de-
scribed below), weekly one-hour lectures on an
evaluation of modern therapeutics, and weekly staff
Conferences.

Given under the direction of Professor Charles F.
Wilkinson, Jr. Maximum class 20. Tuition $250.00.

542-A. ARTHRITIS AND ALLIED RHEU-
MATIC DISORDERS

A part-time course of eight sessions, 9 a.m. to 12
m., Tuesdays, April 14 through June 2, 1953, consist-
ing of a systematic survey of arthritis and rheumatic
diseases. Special attention is given to current diagnos-
tic procedures and advances in therapy.

Given under the direction of Dr. Edward F. Här-
tung. Tuition $50.00.

543-A. ALLERGY

A part-time course of eight sessions, 2 to 4 p.m.,
Fridays, April 17 through June 5, 1953. Consists of a
discussion of the fundamentals of allergy together
with a description of the diagnosis and treatment of its
various clinical forms, combined with the demonstra-
tion of cases.

Given under the direction of Dr. W. C. Spain. Tui-
tion $40.00.

544-A. CARDIOLOGY

A part-time course of eight sessions, 2 to 5 p.m.,
Thursdays, April 16 through June 4, 1953.

Designed as a review course for physicians doing
general practice or internal medicine. As far as pos-
sible, emphasis is placed on clinical cardiology and
an attempt is made to review all the major forms of
heart disease with discussion of modern trends in

treatment and demonstration of patients. Many teach-
ing aids are used such as the electron vectroscope (see
page 63) with stethoscopic amplification and the
fluoro-demonstrator. The former Instrument enables
each member of the class to listen to each patient and
at the same time to see the simultaneous electrocardio-
gram or stethogram of the patient. The fluoro-demon-
strator is an apparatus for teaching large groups the
fundamentals of cardiac fluoroscopy without some of
the drawbacks of the darkroom. This equipment,
designed exclusively for teaching, has been developed
in this laboratory.

Given under the direction of Drs. Charles A.
Poindexter and J. Scott Butterworth. Maximum class
40. Tuition $75.00.
544-B. CLINICAL ELECTROCARDIOGRAPHY

A part-time course of eight sessions, 12:30 to 2
p.m., Thursdays, April 16 through June 4, 1953, deal-
ing with modern electrocardiography and stressing the
basic electrophysiology of the heart rather than pat-
tern diagnosis. Extremity potentials, unipolar leads,
and esophageal leads are fully covered. An introduc-
tion to vectrocardiography is also included. The elec-
tron vectroscope is frequently used (see page 63)
rather than placing too much emphasis on slides.

Given under the direction of Dr. Charles A. Poin-
dexter. Tuition $40.00.

545-A. NORMAL AND PATHOLOGICAL
PHYSIOLOGY: FUNCTION AL AND CHEMI-
CAL ASPECTS

A part-time course of eight sessions, 9 to 11 a.m.,
Wednesdays, April 15 through June 3, 1953. A lec-
ture course presenting a rapid review of the normal
and pathological physiology of those Systems of par-
ticular importance in internal medicine. The clinical
value, indications, and interpretations of functional
and Chemical tests designed to reveal disturbed physi-
ology are discussed. Does not include actual demon-
strations of chemical technique but the importance of
laboratory data in diagnosis is stressed.

Given under the direction of Dr. Maurice Bruger.
Tuition $40.00.

546-A. CLINICAL HEMATOLOGY

A part-time course of ten sessions, 9 to 11 a.m.,
Mondays, October 6 through December 8, 1952.
Consists of a discussion of the techniques used in
hematology, with the Interpretation of hematological
laboratory data. The pathogenesis, symptomatology,
and treatment of the anemias, polycythemia, disorders
of the white cells, spieen and lymph nodes, and the

MEDICINE

hemorrhagic diatheses are reviewed. The use of folic
acid, Vitamin B12, nitrogen mustards, radioactive
phosphorus, urethane, folic-acid antagonists, and
pituitary and adrenal hormones is considered, as well
as the use of blood and blood Substitutes and the clini-
cal importance of the Rh factor.

Given under the direction of Dr. Edward H. Reis-
ner, Jr. Tuition $40.00.

This course is repeated as 546-B, in sixteen ses-
sions, 12 m. to 1 p.m., Tuesdays and 9 a.m. to 10:30
a.m., Thursdays, April 14 through June 4, 1953.

547-A. PROBLEMS IN DIAGNOSIS

A part-time course of eight sessions, 9 to 11:45
a.m., Mondays, April 13 through June 1, 1953, con-
sisting of case teaching with special emphasis on dis-
ease Seen in office and hospital practice. The history,
interpretation of physical findings, X-ray, and labora-
tory analyses are included in the discussion of differ-
ential diagnosis. A part of each Session is devoted to
the examination of patients by the matriculates.

Given under the direction of Dr. Matthew Shapiro.
Maximum class 20. Tuition $35.00.

548-A. ACUTE AND CHRONIC DISEASES OF
THE CHEST

A part-time course of eight sessions, 2 to 4 p.m.,
Mondays, April 13 through June 1, 1953, consisting
of diagnosis and treatment, practical discussion and
demonstration of acute and chronic pulmonary dis-
eases, correlation of X-ray findings with clinical stud-
ies, and fluoroscopy.

Given under the direction of Dr. David Ulmar.
Maximum class 20. Tuition $35.00.

549-A. ENDOCRINOLOGY

A part-time course of twenty-four sessions, Mon-
days, 12 m. to 1 p.m., Thursdays, 10:30 to 11:30
a.m., and Fridays, 9 to 10 a.m., April 13 through June
5, 1953. Surveys the fields of endocrinology and Cov-
ers a comprehensive review of the recent develop-
ments in the diagnosis and treatment of diseases of the
thyroid, parathyroid, adrenal, pituitary, gonads, and
the everyday and emergency management of the dia-
betic patient.

Given under the direction of Dr. Benjamin I. Ashe,
assisted by the staff. Tuition $40.00.

5410-A. DISEASES OF THE LIVER AND BILI-
ARY TRAGT

A part-time course of eight sessions, 1 1 a.m. to 1
p.m., Wednesdays, April 15 through June 3, 1953,

consisting of recent advances in the diagnosis and
medical management of functional and organic disor-
ders of the liver and biliary tract; technique and Inter-
pretation of biliary drainage; pancreatic function
tests; liver function tests; surgical indications.

Given under the direction of Dr. J. Russell Twiss.
Tuition $35.00.

541 1-A. GASTROENTEROLOGY

A part-time course of eight sessions, 2 to 5 p.m.,
Wednesdays, April 15 through June 3, 1953, consist-
ing of diagnosis and treatment of diseases of the
esophagus and stomach, with particular attention to
peptic ulcer; gastroscopic examinations; diseases of
the large and small intestines, with particular attention
to ulcerative Colitis; sigmoidoscopic examinations;
correlation of X-ray findings with clinical studies.

Given under the direction of Dr. Clarence C. Füller.
Tuition $40.00.

5412-A. NEPHRITIS AND HYPERTENSION

A part-time course of eight sessions, 9 a.m. to 1
p.m., Fridays, April 17 through June 5, 1953. A com-
prehensive but concise presentation of recent develop-
ments and current concepts in the diagnosis and
treatment of the nephritides and vascular hyperten-
sion. Basic pathologic physiology is applied to the
management of clinical problems. Biochemical and
body electrolytic disturbances in renal disease are con-
sidered in relation to actual therapeutic problems. A
demonstration and discussion of hemodialysis (artifi-
cial kidney) in the treatment of anuria is included.
The relationships of the various specialties to hyper-
tension and nephritis are discussed by the individual
departments in an informal clinical review.

Given under the direction of Dr. S. Edward King.
Tuition $30.00.

5413-A. PERIPHERAL VASCULAR DISEASES

A part-time course of eight sessions, 2 to 4 p.m.,
Tuesdays, April 14 through June 2, 1953. Consists of
the use and interpretation of methods of diagnosis and
treatment of diseases of the vascular System, including
thromboangiitis obliterans, Raynaud's disease, and
arteriosclerosis.

Given under the direction of Dr. A. Wilbur Duryee.
Maximum class 30. Tuition $40.00.

5414-A. ARTHRITIS AND ALLIED RHEU-
MATIC DISORDERS

A full-time course of two weeks' duration, July 7
through 18, 1952. The first week Covers the funda-
mental concepts of anatomy, physiology, and path-

MEDICINE

ology necessary for a basic understanding of the
subject, together with a detailed exposition of the main
disease entities and their treatment, including rheuma-
toid arthritis, Osteoarthritis, specific infectional arthn-
tis, gout, acute rheumatic fever, and fibrositis. The
second week affords a survey of the most recent
advances in this field, and to this end the staflf of the
entire Center has been drawn upon Uberally. During
the entire two-week period the Student has actual con-
tact with the arthritic patient and observes and partici-
pates in all forms of therapy.

Given under the direction of Dr. Edward F. Här-
tung. Tuition $125.00.

This course is repeated as 5414-B, November 10
through 21, 1952. (To be offered in July 1953 also.)

5415-A. ALLERG Y

A full-time course of two weeks' duration, Novem-
ber 10 through 21, 1952, consisting of morning
sessions devoted to laboratory instruction in the
preparation and standardization of protein extracts,
while afternoon sessions in the large outpatient clinic
deal with the diagnosis and treatment of asthma, hay
fever, and other allergic diseases, the technique of skin
tests and hyposensitization, and the role of focal infec-
tions in allergy.

Given under the direction of Dr. W. C. Spain.
Maximum class 12. Tuition $200.00.

This course is repeated as 5415-B, March 16
through 27, 1953.

54 1 6-A. ACUTE AND CHRONIC PULMONARY
DISEASES

A full-time course of five days' duration, March 9
through 13, 1953, consisting of diagnosis and treat-
ment; practical discussion and demonstration of acute
and chronic pulmonary diseases; correlation of X-ray
findings with clinical studies; fluoroscopy. Lectures
and bedside teaching.

Given under the direction of Dr. David Ulmar.
Maximum class 15. Tuition $45.00.

5418-A. PERIPHERAL VASCULAR DISEASES
A full-time course of five days' duration, November
17 through 21, 1952, consisting of differential diag-
nosis; the use and Interpretation of diagnostic methods
including the oscillometer, nerve block, hot-water
Immersion tests and surface-temperature studies,
arteriography; the medical and surgical treatment of
diseases of the peripheral vascular system including
thromboangiitis obliterans, Raynaud's disease, sclero-
derma, and arteriosclerosis; venous and lymphatic

pathology; surgical aspects of vascular diseases; and
demonstration of apparatus. Case studies are stressed
throughout the course.

Given under the direction of Dr. A. Wilbur Duryee.
Maximum class 30. Tuition $50.00.

This course is repeated as 541 8-B, June 22 through
26, 1953.

541 9-A. SYMPOSIUM ON INTERNAL MEDI-
CINE

A full-time course of ten days' duration, June 15
through 26, 1953. Registrations are accepted for the
entire ten days or for either the first or second five-day

period.

Offers the Internist and general practitioner a con-
cise review of present-day therapy in the field of inter-
nal medicine. Indications and contraindications in the
use of the newer drugs are discussed. Presentations
include the following topics: cardiovascular disease,
antibiotics, hematology, arthritis, hypertension, nutri-
tion, diabetes, renal disease, gastroenterology, and
endocrinology. Lectures are given on the present
Status of radioactive isotopes in the treatment of
malignant disease, fluid balance in health and disease,
and the newer antihistamine drugs in allergic diseases.

Given under the direction of Professor Charles F.
Wilkinson, Jr. Tuition for five days $50.00; ten days
$90.00.

5420-A. NORMAL AND PATHOLOGICAL
PHYSIOLOGY: FUNCTION AL AND CHEMI-
CAL ASPECTS

A full-time course of ten days' duration, September

22 through October 3, 1952. A lecture course pre-

sented as a review of normal and pathological physi-

ology of those Systems of particular importance in

internal medicine. Discussions include fat, protein,

and carbohydrate metabolism, respiratory physiology,

hematopoietic system, the vitamins, bile physiology,

the functional testing of the stomach, pancreas and

liver, the endocrine glands, Phosphatase metabolism,

cerebrospinal fluid chemistry, mineral metabolism,

cardiac physiology, blood volume, water balance, and

acid-base metabolism. The clinical value, indications,

and Interpretation of functional and chemical tests

designed to reveal disturbed physiology are discussed.

Does not include actual demonstrations of chemical

technique but the importance of laboratory data in

diagnosis is stressed.

Given under the direction of Dr. Maurice Bruger.
Tuition $100.00.

This course is repeated as 5420-B, February 23
through March 6, 1953.

MEDICINE

542 1-A. GASTROENTEROLOGY

A full-time course of five days' duration, October
13 through 17, 1952, covering diseases of the esopha-
gus, stomach, rectum, liver, biliary tract, and
pancreas, with special reference to diagnosis and
treatment. Gastroscopy, sigmoidoscopy, and duode-
nal drainage are demonstrated and their significance
discussed. The newer methods of treatment are
presented.

Given under the direction of Dr. Clarence C. Füller.
Maximum class 40. Tuition $45.00.

This course is repeated as 542 1-B, June 15 through
19, 1953.

5422-A. ENDOCRINOLOGY

A full-time course of five days' duration, July 21
through 25, 1952. Surveys the field of endocrinology
and Covers a comprehensive review of the recent
developments in the diagnosis and treatment of dis-
eases of the thyroid, parathyroid, adrenal, pituitary,
gonads, and the everyday and emergency management
of the diabetic patient. These are discussed under the
headings: the detection of diabetes and its differential
diagnosis, the objectives to be attained by therapy, the
criteria for good control, the use of diets and how
much can be accomplished by their use, when and how
to use the various types of insulin, the management of
emergencies including ketosis and coma, the detection
and management of hypoglycemia, and complications
and intercurrent problems in the course of diabetes
and their management by modern methods.

Disorders of the thyroid gland are discussed along
the following lines: diagnostic laboratory procedures,
such as protein-bound iodine, radioactive iodine
uptake, and basal metabolism; diagnosis and treat-
ment of toxic goiter; diagnosis and treatment of hypo-
thyroidism; selection of cases for surgery, the types
and incidence of complications following thyroidec-
tomy.

The course considers the other glands of internal
secretion— the pituitary, the adrenals, parathyroids,
ovaries, and testes and includes a discussion of the
hormones, their physiology, the more important clini-
cal Syndromes, and their diagnosis and treatment.

Given under the direction of Dr. Benjamin I. Ashe,
assisted by the staff. Tuition $50.00.

This course is repeated as 5422-B, November 10
through 14, 1952. (To be offered in July 1953 also.)

5423-A. ELECTROCARDIOGRAPHY

A full-time course of five days' duration, Novem-
ber 17 through 21, 1952, dealing with modern

electrocardiography and stressing the basic electro-
physiology of the heart rather than pattern diagnosis.
Extremity potentials, unipolar and esophageal leads
are fully covered. An introduction to vectrocardi-
ography will also be included. The electron vectro-
scope is used (see page 63).

Given under the direction of Dr. Charles A. Poin-
dexter. Tuition $75.00.

This course is repeated as 5423-B, March 30
through April 3, 1953.

5424-A. NEPHRITIS AND HYPERTENSION

A five-day, full-time course, July 14 through 18,
1952. A comprehensive review of recent develop-
ments in renal diseases and vascular hypertension.
Essential physiologic advances, including renal clear-
ance methods and electrolytic disturbances in renal
disease, are presented. A demonstration of hemodialy-
sis (artificial kidney) is given. Most types of renal dis-
ease, including glomerular nephritis, the nephroses,
acute renal insufticiency (lower nephron nephritis),
Pyelonephritis, and renal vascular lesions associated
with pregnancy, are covered.

Psychiatric, endocrine, and urologic factors in
hypertension are considered, as well as cardiac, cere-
bral, and renal complications. The general manage-
ment of hypertension, including the indications for
sympathectomy is reviewed. Major emphasis through-
out is placed upon practical clinical methods of diag-
nosis and treatment.

Members of the departments of surgery, urology,
psychiatry and neurology, and ophthalmology present
the various specialties in their relationship to renal
and hypertensive vascular disease. Lectures are sup-
plemented by demonstrations, ward-case presenta-
tions, and round-table Conferences.

Given under the direction of Dr. S. Edward King.
Tuition $50.00.

This course is repeated as 5424-B, October 27
through 31, 1952. (To be offered in July 1953 also.)

5425-A. CARDIOLOGY

A full-time, four weeks' comprehensive course,
June 29 through July 24, 1953. An attempt is made to
summarize the basic knowledge and the recent ad-
vances in cardiology in regard to diagnosis and treat-
ment. Electrocardiography is an integral part of the
course and emphasis is placed on the modern electro-
physiology of the heart. Subjects such as extremity
Potentials, esophageal leads, unipolar leads, and
exploratory leads are fully discussed, and the electron
vectroscope is used to demonstrate to the entire group
electrocardiograms from test subjects and patients.

tili ImiS^^''^-^^ ..--.— .^m^^^m

MEDICINE

Auscultation of the heart is studied under ideal condi-
tions by use of the electronic stethoscope whereby
each Student and the instructors listen at the same time
to each patient through individual electronic stetho-
scopes. The electrocardiogram or stethogram of the
patient can be visualized on the electron vectroscope
at the same time. The fluoro-demonstrator is available
for the teaching of cardiac fluoroscopy. The electron
vectroscope (see page 63), the multiple electronic
stethoscopes, the fluoro-demonstrator, and other de-
vices have all been developed in this laboratory to
improve the teaching of cardiology by audio-visual
methods.

Given under the direction of Drs. Charles A.
Poindexter and J. Scott Butterworth. Maximum class
40. Tuition $250.00.

5426-A. GERIATRICS

A three-day, fuU-time course, January 28, 29, and
30, 1953, designed to familiarize physicians with the
broader aspects of the care of elderly patients. It is
realized that geriatrics is not a true specialty and,
therefore, the subject matter is presented from a point

The Electron Vectroscope Visuolly Records the Sound» of the Living Heart

of view that encompasses the medical and surgical
subspecialties as well as the psychosomatic and reha-
bilitation aspects. Emphasis is placed on the diagnosis
and treatment of diseases commonly associated with
aging as well as the altered physiological and meta-
bolic conditions found in this older group.

Given under the direction of Professor Charles F.
Wilkinson, Jr. Tuition $30.00.

5427-A. AUSCULTATION OF THE HEART

A three-day, full-time course, September 8 through
10, 1952, designed to stress the types of heart disease
where important findings are present on physical diag-
nosis and to present auscultatory findings. Numerous
audio-visual aids have been developed in the labora-
tory which are particularly useful in the teaching of
auscultation. These include the electron vectroscope
(see page 63 ) , and the use of tape recordings for illus-
trating unusual sounds.

Given under the direction of Dr. J. Scott Butter-
worth. Tuition $50.00.

This course is repeated as 5427-B, February 2
through 4, 1953.

^^ ^ ji

MEDICINE

5428-A. INTERNAL MEDICINE

Instruction is given five momings a week, March 2
through 27, 1953, for four weeks. Designed for physi-
cians in general practice who wish a practical review
of recent advances in diagnosis and treatment.
Instruction is given to small groups at the bedside by a
member of the staff, usually a specialist in the field
which is the subject of discussion. Once each week
members of the course attend a clinical pathological
Conference.

Given under the direction of Dr. Charles H. Nam-
mack. Maximum class 12. Tuition $100.00.

5430-A. REVIEW COURSE IN GENERAL
MEDICINE

A full-time course of ten days' duration, Mondays
through Fridays, July 14 through 25, 1952, making a
total of sixty hours of instruction. Designed especially
for members of the American Academy of General
Practice but other physicians are eligible to attend. It
includes the main features of internal medicine and its
subdivisions, as well as dermatology and syphilology,

pediatrics, neuropsychiatry, physical medicine, and
the diagnosis and pre- and postoperative care of surgi-
cal conditions. Instruction is given in Bellevue Hospi-
tal by means of ward rounds, Conferences, seminars,
and clinics.

Given under the direction of Professor Charles F.
Wilkinson, Jr. Maximum class 50. Tuition $100.00.
(To be offered in July 1953 also.)

543 1-A. ACTH AND CORTISONE

A full-time course of three days' duration, February
18, 19, and 20, 1953. An intensive discussion course
in the use and relationship of ACTH, Cortisone, and
other adrenal Steroids to many of the phases of medi-
cine, making use of the clinical facilities of the Medi-
cal Center.

Given under the direction of Professor Charles F.
Wilkinson, Jr. Tuition $35.00.

5432-A. PULMONARY DISEASES IN RELA-
TION TO INDUSTRY

A full-time course of five days' duration, May 18
through 22, 1953, for the purpose of giving the

Bedside Teaching Is Constantly Emphasized

■fL

%,.

MEDICINE

matriculate a practical approach to the problems of
industry in relation to thoracic disease. To this end, a
brief background of pathology and physiology is the
basis for the presentations on the various illnesses and
occupational diseases that are encountered. Emphasis
is placed on treatment and rehabiiitation, problems of
extreme importance to the industrial physician. Some
of the legal aspects of compensable disease are
touched. Ample opportunity is presented for forum
discussion.

Given under the direction of Dr. David Ulmar. Tui-
tion $50.00.

5433-A. FLUOROSCOPY OF THE HEART

A two-day, full-time course, September 1 1 and 12,
1952, dealing primarily with examination of the heart
by fluoroscopic methods. The techniques of making
accurate orthodiagrams are described and illustrated.
Various types of Chamber abnormalities are discussed
and, in addition, procedures such as roentgenkymog-
raphy, electrokymography, and angiocardiography
are given special attention. For a description of some
of the equipment used in this course, see the special
section on audio-visual aids (page 63).

Given under the direction of Drs. Charles A.
Poindexter and J. Scott Butterworth. Tuition $30.00.

This course is repeated as 5433-B, February 5 and
6, 1953.

5434-A. CONGENITAL HEART DISEASE

A three-day, fuli-time course, October 6 through 8,
1952, designed to give a survey of congenital heart
disease. It takes up the common and some of the more
unusual types of congenital cardiac malformations
and includes discussions and illustrations of the vari-
ous types of procedures used in arriving at diagnosis.
These procedures include cardiac catheterization with
pressure readings, oxygen Contents, studies, and elec-
trocardiograms from inside the heart as well as angio-
cardiography. For a description of some of the
equipment used in this course, see the special section
on audio-visual aids (page 63).

Given under the direction of Dr. Charles A. Poin-
dexter. Tuition $40.00.

5435-A. RHEUMATIC HEART DISEASE

A three-day, full-time course, October 27 through
29, 1952, organized to give a general review of rheu-
matic heart disease with emphasis on the newer meth-
ods of diagnosis and therapy. All types of rheumatic
lesions from acute rheumatic fever to the end result of
rheumatic valvulär disease are discussed. For a
description of some of the special equipment used in
this course, see the section on audio-visual aids (page
63).

Given under the direction of Dr. Charles A. Poin-
dexter. Tuition $40.00.

5436-A. DEGENERATIVE HEART DISEASE

A three-day, full-time course, January 12 through
14, 1953. Concerning degenerative heart disease in
general, the material consists of diseases of a degen-
erative nature which affect the coronary arteries and
the myocardium. This includes arteriosclerosis of the
coronary vessels and hypertensive heart disease. Spe-
cial attention is given to more recent concepts of diag-
nosis and treatment of the degenerative diseases. For
a description of the special methods used in teaching,
see the section on audio-visual aids (page 63).

Given under the direction of Dr. Charles A. Poin-
dexter. Tuition $40.00

740-A. COMPREHENSIVE MEDICINE FOR
FOREIGN PHYSICIANS

One academic year of full-time study, Mondays
through Fridays from 9 a.m. to 5 p.m., September 29,
1952, through June 19, 1953. A comprehensive course
in American medicine for graduates of foreign medi-
cal schools desiring to practice in this country. Condi-
tional admission to the examinations of one of the
State or National Boards of Medical Examiners is a
prereqidsite for admission. (All departments partici-
pate in this course.) Further information may be
obtained from the Office of the Dean, Post-Graduate
Medical School, 477 First Avenue, New York 16,
N.Y.

MICROBIOLOGY

College of Medicine

Colin M. MacLeod, m.d.,c.m. [mcgill], Professor and

Chairman of the Department
Alwin M. Pappenheimer, Jr., b.s., ph.d., Professor
Mark H. Adams, a.b., ph.d., Associate Professor
James E. Ziegler, Jr., a.b., m.d., Associate Professor
Alan W. Bernheimer, B.s., a.m., ph.d., Assistant Professor

432-A. VIRUSES AND VIRUS DISEASES

A full-time course of seven weeks' duration, 9 a.m.
to 5 p.m., Mondays through Fridays, March 23
through May 9, 1953. Half of the time devoted to lab-
oratory exercises, the remainder to lectures, Seminars,
and Conferences. No other work should be undertaken
as it is anticipated that the füll time of the Student will
be occupied by this course. Designed to acquaint

L. Royal Christensen, B.s., ph.d.. Assistant Professor
Efraim Racker, m.d. [vienna], Assistant Professor
NormaC. Styron, a.b., b.s., m.s., Instructor
Benjamin Mandel, B.s., m.s., ph.d., Assistant
Walter L. Barksdale, Fellow
Odd A. Wager, m.d. [helsinkiI, Fellow

advanced students with techniques currently used in
virus research and with recent advances in our knowl-
edge of virus infections, using both bacterial and ani-
mal viruses as illustrative materials. Prerequisite: a
working knowledge of bacteriological techniques.
Further details may be obtained on request.

Given under the direction of Professor Colin M.
MacLeod. Maximum class 16. Tuition $21 1.00.

A Modern Microbiology Laboratory

\ •'■

« #-'« arm

*-^ >0t

"V'

«II

n^j

.►

NEUROSURGERY

OBSTETRICS AND GYNECOLOGY

NEUROSURGERY

OBSTETRICS AND GYNECOLOGY

Thomas I. Hoen, a.b.. m.d., Professor and Chairman of
the Department

Francis A. Echlin, m.d.,c.m. [mcgill]; med.sc.d.; m.sc.
[mcgill], Associate Professor

James T. Daniels, m.d., Associate Professor of Clinical
Neurosurgery

Irving S. Cooper, a.b., m.d., m.s., ph.d., Assistant Pro-
fessor

551-A. THE INTERVERTEBRAL DISO

A full-time course of five days' duration, October 6
through 10, 1952. An intensive study of the problems
of intervertebral disc disease. Consists of lectures,
clinical, pathological, and X-ray demonstrations. For
qualified neuro-, general, and orthopedic surgeons.

Given under the direction of Professor Thomas I.
Hoen. Maximum class 10. Tuition $60.00.

552-A. DIAGNOSIS AND TREATMENT OF
PERIPHERAL NERVE INJURIES

A full-time course of five days' duration, January
12 through 16, 1953. Lectures, case presentations,
and study of pathologic material, including demon-

Stanley Stellar, a.b., m.d., Assistant Professor

Thomas Q. Garvey, Jr., b.s., m.d., Assistant Professor of
Clinical Neurosurgery

J. Arthur MacLean, m.d., Assistant Professor of Clinical
Neurosurgery

Leo M. Davidoflf, m.d., Clinical Professor

Carlos Guillermo de Gutierrez-Mahoney, a.b., m.d., Clin-
ical Professor

stration and Instruction in electrodiagnostic methods.
Surgical treatment is given in considerable detail with
demonstrations in animals, and clinical material if

available.

Given under the direction of Professor Thomas I.
Hoen. Maximum class 10. Tuition $90.00.

553-A. TRAUMA OF CENTRAL NERVOUS
SYSTEM

A full-time course of six days' duration, June 15
through 20, 1953, for general surgeons. Consists of
lectures, presentation of pathologic material, clinical
Conferences, and attendance at Operations.

Given under the direction of Professor Thomas I.
Hoen. Maximum class 15. Tuition $75.00.

Professor and Chairman of Department (to be an-

nounced)
Locke L. Mackenzie, a.b., m.d., Associate Professor
Mortimer N. Hyams, m.d., Associate Professor of Clin-
ical Obstetrics and Gynecology
Michael J. Jordan, b.s., m.d., Associate Professor of

Clinical Obstetrics and Gynecology
Theodore Neustaedter, m.d., Associate Professor of Clin-
ical Obstetrics and Gynecology
E. Lawrence Hecht, b.s., m.d., Assistant Professor of

Clinical Obstetrics and Gynecology
Henry C. Falk, m.d., Clinical Professor
Salvatore di Palma, m.d., Associate Clinical Professor
Adolph Jacoby, m.d., Associate Clinical Professor
Isador W. Kahn, m.d., Associate Clinical Professor
John A. Kelly, m.d., Associate Clinical Professor
Gerard L. Moench, m.d., Associate Clinical Professor
Benjamin Rabbiner, m.d., Associate Clinical Professor
Samuel Schmerzler, m.d., Associate Clinical Professor
Joseph N. Tesi, m.d. [florence], Associate Clinical Pro-
fessor
George Blinick, b.s., m.d., Assistant Clinical Professor
Matthew Di Giorgi, m.d., Assistant Clinical Professor
Emanuel M. Wainess, m.d., Assistant Clinical Professor
Ben B. Wetchler, b.s., m.d., m.s., Assistant Clinical Pro-
fessor
Martin J. Clyman, b.s., m.d., Instructor
Benedict B. Benigno, B.s. (biolggy), m.d., Instructor in

Clinical Obstetrics and Gynecology
John C. DuBois, a.b., m.d., Instructor in Clinical Obstet-
rics and Gynecology
G. Thurman Fulmer, b.s., m.d., Instructor in Clinical

Obstetrics and Gynecology
Louis Gordon, m.d., Instructor in Clinical Obstetrics and

Gynecology
Morton K. Hertz, m.d., Instructor in Clinical Obstetrics

and Gynecology
Peter La Mariana, B.s., m.d., Instructor in Clinical Obstet-
rics and Gynecology

560-A. GYNECOLOGICAL MALIGNANCY

A full-time ten-day course, October 1 3 through 24,
1952. Designed for specialists in obstetrics and gyne-
cology only. The anatomy of the female pelvis is dis-
cussed with particular attention to considerations
affecting the spread of malignant disease, including
lectures on embryology and pathology, as well as lec-
tures and laboratory werk on exfoliative cytology in
the diagnosis of the malignancy. The newer chemical
tests for Carcinoma are discussed; the diagnosis, diflfer-
ential diagnosis, and treatment, both surgical and by
radioactive energy. It also includes a discussion of the
fundamental concepts of radiant energy, the atomic
structure of matter, and the interreaction of radiant

John Messina, m.d. [naples], Instructor in Clinical Ob-
stetrics and Gynecology

Ernest Myller, m.d. [berlin; Athens], Instructor in Clin-
ical Obstetrics and Gynecology

Gottfried Neumann, m.d. [Leipzig], Instructor in Clinical
Obstetrics and Gynecology

Anna Earl Purdy, a.b., m.d., Instructor in Clinical Ob-
stetrics and Gynecology

Maxwell Schräm, b.s. (med.), m.d., Instructor in Clinical

Obstetrics and Gynecology
Ethel Torten Sokal, m.d. [lwow], Instructor in Clinical

Obstetrics and Gynecology

Anna A. Stein, m.d., Instructor in Clinical Obstetrics and
Gynecology

David L. Bobker, b.s., Clinical Instructor
Robert M. Cushing, b.s., m.d,, Clinical Instructor
Jacob Donshik, b.s., m.d., Clinical Instructor
Phyllis DeVit Gallaher, m.d., Clinical Instructor
Stefano Miele, m.d. [naples], Clinical Instructor
Milton H. Miller, m.d., Clinical Instructor
Charles R. Moog, b.s., m.d., Clinical Instructor
John E. O'Connor, a.b., m.d., Clinical Instructor
William B. Quinn, b.s., m.d., Clinical Instructor
Samuel Ratowsky, b.s., m.d., Clinical Instructor
Nathan E. Ross, b.s., m.d., Clinical Instructor
Herbert Z. Teichner, m.d. [naples], Clinical Instructor
Alfred Widetsky, b.s., m.d., Clinical Instructor
Frederick S. Kinder, a.b., m.d., Assistant
Robert H. Berman, ph.b., m.d., Clinical Assistant
Morris I. Eisenstein, m.d., Clinical Assistant
Charles H. Immordino, b.s., m.d., Clinical Assistant

Helen Z. Jern, physician [moscovv], a.m., Clinical As-
sistant

Edward R. Laus, m.d.. Clinical Assistant
Maxwell Roland, a.b., m.d. [lwsanne], Clinical Assistant
Raymond W. Sass, b.s., m.d., Clinical Assistant
Feliciano J. Scire, m.d. [naples], Clinical Assistant

energy with tissue, both physical and biological, and
it Covers practica] considerations and dosage in X-ray
and radium therapy. The diagnosis and surgery of
Carcinoma of the breast as well as urological complica-
tions are covered also.

Given under the direction of Dr. Locke L. Mac-
kenzie. Tuition $150.00.

561-A. SEMINAR IN GYNECOLOGY

A full-time course of four weeks' duration, October
6 through November 1, 1952. Clinical lectures (illus-
trated with lantern slides, anatomical specimens, and
motion pictures), clinics, and ward rounds provide
systematic Instruction in gynecological pathology,
diagnosis and office treatment, cystoscopy and endo-

OBSTETRICS AND GYNECQLOGY

OBSTETRICS AND GYNECOLOGY

scopy, vaginal and endometrial cytology, and gyne-
cological endocrinology.

Given under the direction of Professor Emeritus
Walter T. Dannreuther. Maximum class 6. Tuition

$150.00.

This course is repeated as 561-B, April 13 through

May 9, 1953.

562-A. GYNECOLOGY: DIAGNOSIS AND OF-
FICE TREATMENT

A part-time course of ten sessions, 10 a.m. to 12
m., Mondays, Wednesdays, and Fridays, October 27
through November 17, 1952.

Given under the direction of Dr. Matthew
Di Giorgi. Maximum class 6. Tuition $50.00.

This course is repeated as 562-B, February 23
through March 16, 1953.

563-A. GYNECOLOGY: DIAGNOSIS AND OF-
FICE TREATMENT

A part-time course of fifteen sessions, 2 to 4 p.m.,
Mondays, Wednesdays, and Fridays, September 15
through October 17, 1952.

Given under the direction of Dr. Mortimer N.
Hyams. Maximum class 6. Tuition $75.00.

This course is repeated as 563-B, March 23
through April 24, 1953.

Both of the above courses are presented by demon-
strations, lantern slides, and practical application.
Opportunity is given to examine a large number of
patients and to develop diagnostic ability. Course 563
also includes electrotherapy as it applies to gynecol-
ogy, methods of conization of the uterine cervix,
uterosalpingography, sterilization by coagulation of
the uterine cornu, and transuterine insufflation.

564-A. INFERTILITY

A three-day, full-time course given jointly by the
department of urology and the department of obstet-
rics and gynecology, December 8 through 10, 1952.
Problems of steril ity are presented as related to both
husband and wife. Methods of diagnosis and treat-
ment are presented by lectures, outpatient demonstra-
tions, and laboratory techniques.

Tuition $40.00.

566-A. CYSTOSCOPY AND ENDOSCOPY

A part-time course of fifteen sessions, 10 a.m. to 12
m., Mondays, Wednesdays, and Fridays, September
15 through October 17, 1952.

Essentially practical and includes the following sub-

jects: review of anatomy of the urinary tract, tech-
nique of cystoscopy and endoscopy, use of water
dilatation cystoscope, examination of bladder for vari-
ous pathological conditions, ureteral catheterization
and passage of bougie, irrigation of renal pelvis, pye-
lography and intravenous urography, examination
and treatment of Urethra with both air and water dila-
tation, fulguration of bladder growths, and indigocar-
min and phenolsulphonphthalein tests.

Given under the direction of Dr. Samuel Schmerz-
ler. Maximum class 6, Tuition $75.00.

This course is repeated as 566-B, March 23
through April 24, 1953.

567-A. GYNECOLOGICAL ENDOCRINOLOGY

A part-time course of twenty-four sessions, 10 a.m.
to 12 m., Tuesdays, Thursdays, and Saturdays, Octo-
ber 7 through December 6, 1952. Consists of the rela-
tion of the endocrine glands and their hormones to
physical development, menstrual derangements, ste-
rility, and menopausal disturbances; the clinical appli-
cation of organotherapy. An adequate knowledge of
biological chemistry, histopathology, and the physi-
ology of the female pelvic organs is required for
admission to this course because laboratory proce-
dures are correlated with the daily clinical work.
Applicants are admitted only after an interview with
the instructor in charge. This class is invited to attend
Dr. Mackenzie's lecture on vaginal smears, Tuesdays.

Given under the direction of Dr. Theodore Neu-
staedter. Maximum class 4. Tuition $125.00.

This course is repeated as 567-B, April 14 through
June 6, 1953.

568-A. VAGINAL CYTOLOGY (FOR
SPECIALISTS)

A part-time course of sixteen sessions, 12 m. to 1
p.m., Tuesdays, and 9 a.m. to 12 m., Thursdays,
October 7 through December 4, 1952. Consists of lec-
tures and laboratory periods dealing with the tech-
nique of taking, preparing, and examining vaginal
smears. Subjects of study include the normal vaginal
cells, changes observed during the menstrual cycle,
the amenorrheas, pregnancy, the menopause, and
other physiological and pathological gynecological
conditions, as well as the diagnosis of malignancy of
the genital tract.

Given under the direction of Dr. E. Lawrence
Hecht. Maximum class 6. Tuition $100.00.

This course is repeated as 568-B, April 14 through
June 4, 1953.

569-A. SURGICAL ANATOMY AS APPLIED
TO GYNECOLOGY: CAD AVER

A part-time course of twelve sessions, 11 a.m. to
12:30 p.m., Tuesdays, Thursdays, and Saturdays,
October 14 through November 1 1 , 1952, consisting of
the surgical anatomy of the following Operations con-
sidered in detail, illustrated by lantern slides and
blackboard drawings, as well as by dissection:

1 . Anterior vaginal wall

a) Relaxed bladder sphincter

b) Vesicovaginal fistula

c) Repair of cystocele

2. Postvaginal wall

a) Simple perineorrhaphy

b) Perineorrhaphy with torn anal sphincter

c) Postcolpotomy

3. Diagnostic curettage with Insertion of intra-

uterine pessary

4. Repair of lacerated cervix

5. Operations for retro-displaced Uterus (choice

of technique)

6. Operations on broad ligaments, tubes, and

ovaries

7. Choice of a complete or supracervical hyster-

ectomy

8. Operations for gynecological ureteral injuries

9. Repair of gynecological intestinal injuries

10. Bladder and sigmoid

1 1 . Hemorroidectomy
Restricted to surgeons.

Given under the direction of Dr. Salvatore di
Palma. Maximum class 6. Tuition $175.00.

This course is repeated as 569-B, February 24
through March 21, 1953.

734 A. GYNECOLOGY (FOR SPECIALISTS)

Covers a sixteen-week period, September 2 through
December 19, 1952. The matriculant's time is fuUy
occupied from 8:30 a.m. to 12m., Mondays through
Fridays, and from 1 : 30 to 4 p.m. on Wednesdays. Ses-
sions are assigned to ward rounds, lectures, and clini-
cal and laboratory demonstrations. Throughout the
course, emphasis is directed toward the commonly
encountered diseases as well as presentation of the
recent advances in gynecology.

Among the subjects covered in discussion are the
diagnosis and treatment of abnormal uterine bleeding,
gonorrhea, and postabortal infection, radium and
X-ray in gynecology, newer concepts in the manage-
ment of Carcinoma of the cervix and fundus of the
Uterus (including reference to the vaginal smear as a
method of diagnosis), and sterility in the female. Time
is devoted to a study of the endopelvic fascia in rela-
tion to Prolapse and its surgical treatment. The clinical
management of tumors of the Uterus and ovary are
reviewed. Finally, there are demonstrations of the
common procedures in ofifice gynecology.

Ward rounds emphasize differential diagnosis and
Problems in the preoperative and postoperative care
of the patient. A clinical pathological Conference is
held weekly and includes case teaching, differential
diagnosis, and pathology in relation to the clinical
picture.

The course is given at Beth Israel Hospital under
the direction of Dr. Henry C. Falk. Maximum class 6.
Tuition $250.00.

This course is repeated as 734-B (dates to be
announced).

■ I ^

OBSTETRICS AND GYNECOLOGY

scopy, vaginal and endometrial cytology, and gyne-
cological endocrinology.

Given under the direction of Professor Emeritus
Walter T. Dannreuther. Maximum class 6. Tuition

$150.00.

This course is repeated as 561-B, April 13 through

May 9, 1953.

562-A. GYNECOLOGY: DIAGNOSIS AND OF-
FICE TREATMENT

A part-time course of ten sessions, 10 a.m. to 12
m., Mondays, Wednesdays, and Fridays, October 27
through November 17, 1952.

Given under the direction of Dr. Matthew
Di Giorgi. Maximum class 6. Tuition $50.00.

This course is repeated as 562-B, February 23
through March 16, 1953.

563-A. GYNECOLOGY: DIAGNOSIS AND OF-
FICE TREATMENT

A part-time course of fifteen sessions, 2 to 4 p.m.,
Mondays, Wednesdays, and Fridays, September 15
through October 17, 1952.

Given under the direction of Dr. Mortimer N.
Hyams. Maximum class 6. Tuition $75.00.

This course is repeated as 563-B, March 23
through April 24, 1953.

Roth of the above courses are presented by demon-
strations, lantern slides, and practical application.
Opportunity is given to examine a large number of
patients and to develop diagnostic ability. Course 563
also includes electrotherapy as it applies to gynecol-
ogy, methods of conization of the uterine cervix,
uterosalpingography, sterilization by coagulation of
the uterine cornu, and transuterine insuflflation.

564-A. INFERTILITY

A three-day, full-time course given jointly by the
department of urology and the department of obstet-
rics and gynecology, December 8 through 10, 1952.
Problems of sterility are presented as related to both
husband and wife. Methods of diagnosis and treat-
ment are presented by lectures, outpatient demonstra-
tions, and laboratory techniques.

Tuition $40.00.

566-A. CYSTOSCOPY AND ENDOSCOPY

A part-time course of fifteen sessions, 10 a.m. to 12
m., Mondays, Wednesdays, and Fridays, September
15 through October 17, 1952.

Essentially practical and includes the following sub-

jects: review of anatomy of the urinary tract, tech-
nique of cystoscopy and endoscopy, use of water
dilatation cystoscope, examination of bladder for vari-
ous pathological conditions, ureteral catheterization
and passage of bougie, Irrigation of renal pelvis, pye-
lography and intravenous urography, examination
and treatment of Urethra with both air and water dila-
tation, fulguration of bladder growths, and indigocar-
min and phenolsulphonphthalein tests.

Given under the direction of Dr. Samuel Schmerz-
ler. Maximum class 6, Tuition $75.00.

This course is repeated as 566-B, March 23
through April 24, 1953.

567-A. GYNECOLOGICAL ENDOCRINOLOGY

Given under the direction of Dr. Theodore Neu-
staedter. Maximum class 4. Tuition $125.00.

This course is repeated as 567-B, April 14 through
June 6, 1953.

568-A. VAGINAL CYTOLOGY (FOR
SPECIALISTS)

Given under the direction of Dr. E. Lawrence
Hecht. Maximum class 6. Tuition $100.00.

This course is repeated as 568-B, April 14 through
June 4, 1953.

OBSTETRICS AND GYNECOLOGY

569-A. SURGICAL ANATOMY AS APPLIED
TO GYNECOLOGY: CADAVER

A part-time course of twelve sessions, 11 a.m. to
12:30 p.m., Tuesdays, Thursdays, and Saturdays,
October 14 through November 11, 1952, consistingof
the surgical anatomy of the following Operations con-
sidered in detail, illustrated by lantern slides and
blackboard drawings, as well as by dissection:

1. Anterior vaginal wall

a) Relaxed bladder sphincter

b) Vesicovaginal fistula

c) Repair of cystocele

2. Postvaginal wall

a) Simple perineorrhaphy

b) Perineorrhaphy with torn anal sphincter

c) Postcolpotomy

3. Diagnostic curettage with Insertion of intra-

uterine pessary

4. Repair of lacerated cervix

5. Operations for retro-displaced Uterus (choice

of technique)

6. Operations on broad ligaments, tubes, and

ovaries

7. Choice of a complete or supracervical hyster-

ectomy

8. Operations for gynecological ureteral injuries

9. Repair of gynecological intestinal injuries

10. Bladder and sigmoid

1 1 . Hemorroidectomy
Restricted to surgeons.

Given under the direction of Dr. Salvatore di
Palma. Maximum class 6. Tuition $175.00.

This course is repeated as 569-B, February 24
through March 21, 1953.

734-A. GYNECOLOGY (FOR SPECIALISTS)

Covers a sixteen-week period, September 2 through
December 19, 1952. The matriculant's time is fully
occupied from 8:30 a.m. to 12 m., Mondays through
Fridays, and from 1 : 30 to 4 p.m. on Wednesdays. Ses-
sions are assigned to ward rounds, lectures, and clini-
cal and laboratory demonstrations. Throughout the
course, emphasis is directed toward the commonly
encountered diseases as well as presentation of the
recent advances in gynecology.

Among the subjects covered in discussion are the
diagnosis and treatment of abnormal uterine bleeding,
gonorrhea, and postabortal infection, radium and
X-ray in gynecology, newer concepts in the manage-
ment of Carcinoma of the cervix and fundus of the
Uterus (including reference to the vaginal smear as a
method of diagnosis ) , and sterility in the female. Time
is devoted to a study of the endopelvic fascia in rela-
tion to Prolapse and its surgical treatment. The clinical
management of tumors of the Uterus and ovary are
reviewed. Finally, there are demonstrations of the
common procedures in office gynecology.

The course is given at Beth Israel Hospital under
the direction of Dr. Henry C. Falk. Maximum class 6.
Tuition $250.00.

This course is repeated as 734-B (dates to be
announced).

■•^

OPHTHALMOLOGY

A. Gerard DeVoe, a.b., m.d., med.sc.d., Professor and

Chairman of the Department
Rudolf Aebli, a.b., m.d., Professor of Clinical Ophthal-

mology
Conrad Berens, m.d., Professor of Clinical Ophthal-

mology
George N. Wise, b.s., m.d., med.sc.d., Assistant Professor
Girolamo Bonaccolto, m.d. [rome], Clinical Professor
Truman L. Boyes, m.d. [Toronto], Clinical Professor
Harold W. Brown, b.s., m.d., Clinical Professor
W. Guernsey Frey, Jr., a.b., m.d., Clinical Professor
Wendel! L. Hughes, m.d. [western ontario], Clinical

Professor
Raymond E. Meek, b.s.(med.), m.d., Clinical Professor
R. Townley Paton, b.s., m.d., Clinical Professor
Brittain F. Payne, a.b., m.d., Clinical Professor
James W. Smith, m.d., Clinical Professor
Ervin A. Tusak, m.d. [german univ., prague], Clinical

Professor
Walter S. Atkinson, m.d.,c.m. [mcgill], Associate Clin-
ical Professor
Isadore Givner, b.s.(med.), m.d., Associate Clinical

Professor
Alfred Kestenbaum, m.d. [vienna], Associate Clinical

Professor
Domenico Cappetta, m.d. [florence], Assistant Clinical

Professor
Max Chamlin, a.b., m.d., Assistant Clinical Professor
Gerald E. Fonda, b.s., m.d., Assistant Clinical Professor
Sidney A. Fox, a.b., m.d., m.s. (Ophthal.), Assistant

Clinical Professor
Bernard Fread, b.s., m.d., Assistant Clinical Professor
James M. Houlahan, a.b., m.d., Assistant Clinical Pro-
fessor

576-A. OPHTHALMOLOGY (GRADUATE
COURSE)

A nine months' course, September 29, 1952,
through June 19, 1953, in the basic sciences as applied
to ophthalmology, the successful completion of which
is to be followed by a residency in a hospital approved
by the school.

Given under the direction of Professor A. Gerard
DeVoe. Tuition $700.00.

571-A. MOTOR ANOMALIES OF THE EYE
(Part I) (FOR SPECIALISTS)

A full-time course of six days' duration, March 9
through 14, 1953. The course is made as practical as
possible, and the relation of the muscle balance to
refraction is always considered in the prescribing of
glasses. Anatomy of the ocular muscles, nerve supply,
action of individual muscles, anomalies of associated

Abraham L. Kornzweig, a.b., m.d.. Assistant Clinical

Professor
Arthur Linksz, m.d. [kiel], med.sc.d. [pecs], Assistant

Clinical Professor
Hunter H. Romaine, m.d., Assistant Clinical Professor
Anthony A. Scimeca, m.d., Assistant Clinical Professor
Byron C. Smith, b.s., m.d., Assistant Clinical Professor
Frederick H. Theodore, a.b., m.d., Assistant Clinical Pro-
fessor
Goodwin M. Breinin, B.s., a.m., m.d., Instructor
J. Gordon Cole, b.s., m.b.. m.d., Instructor
Frank H. Constantine, a.b., m.d.. Instructor
William L. Donnelly, m.d., Instructor
A. Marvin Gillman, a.b.. m.s.(pub.health), m.d.. In-
structor
Louis J. Girard, a.b., m.d., Instructor
Bernard Kronenberg, b.s., m.d. [bern], Instructor
Joseph H. Krug, a.b., m.d., Instructor
Walter J. Mäher, m.d., Instructor
Alfred Weintraub, m.d. [vienna], Instructor
Leon M. Weiss, b.s., m.d., Instructor
Joshua Zuckerman, b.s., m.d.,c.m. [mcgill], Instructor
Irwin J. Cohen, a.b., m.d., Clinical Instructor
William J. Garvin, Clinical Instructor
Richard W. Greene, m.d., Clinical Instructor
Gerald B. Kara, a.b., m.d., Clinical Instructor
Francis C. Keil, Jr., a.b., m.d.. med.sc.d.. Clinical In-
structor
Jesse W. Overton, b.s., m.d., Clinical Instructor
Bernard A. Roberts, b.s., m.d., Clinical Instructor
Chih Chiang Teng, m.d. [Shanghai], Clinical Instructor
Bernard M. Teschner, a.b., m.d., Clinical Instructor
Howard K. Weisberg, m.d., Clinical Instructor
Helena Fedukowicz, physician [jekaterinoslaw],
Fellow

movements, anomalies of convergence, of divergence,
and of sursumvergence. Gase demonstrations foUow
the lectures.

Given under the direction of Dr. Harold W. Brown.
Tuition $90.00.

572-A. MOTOR ANOMALIES OF THE EYE
(Part H) (FOR SPECIALISTS)

A full-time course of five days' duration, March 16
through 20, 1953. A continuation of 571-A, with
drills in making tests and examination of patients for
diagnosis. The question of treatment, both operative
and nonoperative, and the use and limitations of each
are considered. Open only to those who have taken
571-A.

A set or box of prisms is required and must be fur-
nished by the Student.

Given under the direction of Dr. Harold W. Brown.
Tuition $75.00.

OPHTHALMOLOGY

573-A. OPHTHALMIC PLASTIC SURGERY
(FOR SPECIALISTS)

A part-time course of five days' duration, 2 to 5
p.m., March 30 through April 3, 1953. This course
Covers the essentials of Ophthalmie plastic surgery for
the practicing ophthalmologist. Special emphasis is
laid on the more common fundamental procedures
peculiar to lid surgery. These include such minor sur-
gery as tarsorrhaphy, canthoplasty, excision and
repair of lid margin lesions as well as the usual classi-
cal procedures for the correction of ptosis, ectropion,
entropion, socket lesions, etc. Instruction is by lecture
and demonstration. The Steps in the various tech-
niques are systematically outlined and the choice of
the suitable technique for various clinical conditions
is considered.

Given under the direction of Dr. Sydney A. Fox.
Tuition $75.00.

574-A. SURGERY OF THE EYE (FOR
SPECIALISTS)

A full-time course of six days' duration, October 27
through November 1, 1952, consisting of lectures on
cataract surgery, glaucoma surgery, ocular muscle
surgery, ptosis surgery, surgical treatment of retinal
detachment, corneal transplantation, and plastic sur-
gery of the eye. Practical work on technique of eye
Operations on the cadaver. Operative clinics at the
University Hospital, Bellevue Hospital, and Lenox
Hill Hospital.

Given under the direction of Dr. Rudolf Aebli.
Maximum class 11. Tuition $100.00.

This course is repeated as 574-B, March 23
through 28, 1953.

575-A. DIFFERENTIAL DIAGNOSIS WITH
THE SLIT LAMP (FOR SPECIALISTS)

A part-time course of five days' duration, 9 a.m. to
1 p.m., November 10 through 14, 1952, consisting of
differential diagnosis of diseases of the anterior Seg-
ment of the eyeball and of the different mediums of
the eye. Includes a thorough demonstration of the
principles of Illumination by means of the^ slit lamp.
The important elementary lesions of the conjunctiva,
Cornea, iris, lens, and vitreous are analyzed and illus-
trated by means of slides and presentation of cases.
The diflferential diagnosis of pathological lesions of
these structures is stressed.

Given under the direction of Dr. Girolamo Bonac-
colto. Maximum class 12. Tuition $75.00.

This course is repeated as 575-B, February 23
through 27, 1953.

577-A. EXTERNAL DISEASES OF THE EYE
(FOR SPECIALISTS)

A part-time course of five days' duration, 2 to 5
p.m., November 3 through 7, 1952. Consists of clini-
cal differential diagnosis of types of Conjunctivitis.
Office procedures are demonstrated as an aid in differ-
ential diagnosis. The clinical types of bacterial, virus,
and allergic inflammations of the outer eye are pre-
sented with lectures, photographs, and clinical
demonstrations.

Given under the direction of Dr. Frederick Theo-
dore. Tuition $75.00.

578-A. OCULAR EXPRESSIONS OF SYSTEMIC
DISEASE

A part-time course, five days, 2 to 5 p.m., Novem-
ber 10 through 14, 1952. Covers clinical and
pathological changes associated with diabetes, hyper-
tension, nephritis, thyroid dysfunction, blood dyscra-
sias, and optic-nerve diseases. Some associated eye
and skin evidences of systemic diseases are discussed.
These include lupus erythematosus, dermatomyositis,
sarcoid, brucellosis, and the phakomatoses.

Given under the direction of Dr. Isadore Givner.
Tuition $50.00.

This course is repeated as 578-B, February 23
through 27, 1953.

579-A. NEURO-OPHTHALMOLOGY

A part-time course of five days' duration, 9 a.m. to
12m., July 14 through 18, 1952. Consists of a review
of the anatomy of the nerve fibers, instrumental and
noninstrumental perimetry, Classification and signifi-
cance of field defects, optic atrophy, chiasmal Syn-
dromes, and pupillary reactions. Discussion of the
types of nuclear and peripheral abducenspalsy,
diverse forms of gaze palsy (supranuclear palsy),
nystagmus, vertigo, and convergence disturbances. A
Short review of cerebro-ocular diseases and functional
disturbances of the eye is given.

Given under the direction of Dr. Alfred Kesten-
baum. Tuition $50.00.

This course is repeated as 579-B, January 19
through 23, 1953.

5710-A. PERIMETRY

A part-time course of five days' duration, 2 to 5
p.m., July 14 through 18, 1952. An intensive review
of methods in the practical use of the perimeter and
tangent screen. Emphasis is laid on the detection of
minimal defects in the visual fields produced by early

..■^■.■..a.t^..-^=^-^^^^..*^.«*n.:-»^

OPHTHALMOLOGY

ORTHOPEDIC SURGERY

lesions, both ocular and intracranial. The differential
diagnosis of papiiledema, optic neuritis, and various
congenital and developmental anomalies of the disc
are considered, making use of the tangent screen.

Typical field defects produced by classical intra-
cranial lesions, especially tumors, are demonstrated.
Their interpretive value in relation to site of lesion,
localizing or lateralizing value, and other clinical
interpretations is covered. Methods of recording find-
ings and transposing them to the chart are reviewed.
Further attention is paid to the quality of defective
fields and methods of recording such qualities. Em-
phasis is placed on the follow-up of visual fields in
brain tumor cases being treated with radiotherapy.

Given under the direction of Dr. Max Chamlin.
Tuition $50.00.

This course is repeated as 5710-B, January 19
through23, 1953.

571 1-A. OPHTHALMOSCOPY

A part-time course of five days' duration, 9 a.m. to
12 m., July 21 through 25, 1952. A study of ophthal-
moscopic diseases of the vitreous, retina, choroid, and
optic nerve. Congenital anomalies and traumatic fun-
dus changes. Manifestations of general diseases in the
eye grounds. Ophthalmoscopic case presentations.
Students are required to bring their own ophthalmo-
scopes.

Given under the direction of Dr. George N. Wise.
Tuition $50.00.

Practical Instruction in Ophthalmology

This course is repeated as 571 1-B, January 26
through 30, 1953.

5713-A. OCULAR THERAPEUTICS

A part-time course of five days' duration, 1 to 4
p.m., July 21 through 25, 1952, which reviews current
methods of therapy in ocular diseases. Although
emphasis is placed on medical treatment, indication
for surgical Intervention is also discussed. Particular
attention is directed to the antibiotics, adrenocortico-
tropic hormones, and the newer antiglaucomatous
drugs.

Given under the direction of Dr. A. Gerard DeVoe.
Tuition $50.00.

This course is repeated as 5713-B, January 26
through 30, 1953.

5714-A. HISTOPATHOLOGY

A part-time course of six days' duration, 1 to 4
p.m., September 22 through 27, 1952. Consists of lec-
tures, demonstrations, and microscopic study of intra-
ocular inflammations, pyogenic, nonspecific, specific
granulomas, tumors of the eye and adnexae, path-
ology of glaucoma, pathology of trauma and compli-
cations following intraocular surgery, pathology of the
eye in systemic disease states. All this to be introduced
with a lecture on general principles of Ophthalmie
pathology and a System for reading Ophthalmie
pathology slides.

Given under the direction of Dr. A. Marvin Gill-
man. Tuition $100.00.

ORTHOPEDIC SURGERY

I
V

LV ^^

Walter A. L. Thompson, m.d., Professor and Chairman

of the Department
George Anapol, m.d., Professor of Clinical Orthopedic

Surgery
John C. McCauley, Jr., b.s., m.d., Associate Professor
M. Beckett Howorth, b.s., m.d., med.sc.d., Clinical Pro-
fessor
William H. Irish, m.d., Clinical Professor
Ernst W. Bergmann, m.d. [erlangen], Associate Clinical

Professor
William A. Walker, a.b., m.d., Associate Clinical Pro-
fessor
Joseph Buchman, b.s., m.d., Assistant Clinical Professor
Alvin Hulnick, a.b., m.d., Assistant Clinical Professor
Samuel H. Nickerson, b.s., m.d., cm. [mcgill], Assistant

Clinical Professor
Antonio J. Pisani, B.s., m.d., Assistant Clinical Professor
Robert L. Preston, B.s., m.d., Assistant Clinical Professor
Mario E. Stella, B.s., m.d., Assistant Clinical Professor

Postgraduate courses of varying duration may be
undertaken by special arrangement on a prorata basis
of $100.00 per month, füll time.

58 1-A. BASIC SCIENCES AS RELATED TO
ORTHOPEDIC SURGERY (GRADUATE
COURSE)

A full-time course of six months' duration, January
5 through June 19, 1953, for orthopedic surgeons who
intend to achieve American Board certification. The
course includes anatomical dissection, pathology,
physiology, biochemistry, microbiology, and pharma-
cology. The study of bone tumors is under the direc-
tion of Dr. Bradley L. Coley. Conferences correlating
the basic sciences with clinical orthopedics are held
under the direction of Dr. M. Beckett Howorth.

Given under the direction of Professor Walter A. L.
Thompson. Maximum class 20. Tuition $450.00.

582-A. ORTHOPEDICS IN GENERAL
PRACTICE

A full-time course of five days' duration, October
13 through 17, 1952. A review of orthopedic condi-
tions encountered in general practice. Common errors
made in the treatment of fractures is included. Instruc-
tion is given in Bellevue and University Hospitals by
means of ward rounds and Conferences and clinics.
Extensive clinical material makes possible the presen-
tation of the course by practical demonstrations.

Given under the direction of Professor Walter A. L.
Thompson. Maximum class 20. Tuition $75.00.

This course is repeated as 582-B, June 15 through
19, 1953.

David M. Bosworth, a.b., m.d., Lecturer

George D. Appold, B.s., m.d., Instructor

Alvin M. Arkin, b.s., m.d., m.s., Instructor

Arthur I. Blieden, b.s., m.b., m.d., Instructor

Irving V. Glick, a.b., m.d., Instructor

Constantine L. Jeannopoulos, a.b., m.d. [rome], In-
structor

Albert J. Schein, b.s., m.d., Instructor

John P. Stump, a.b., m.d., Instructor

Harry Weiner, m.d., Instructor

H. Leslie Wenger, d.s. (med.), m.d., Instructor

Edward J. Haboush, b.s. (med.), m.d., Instructor in Clini-
cal Orthopedic Surgery

Albert B. Accettola, b.s., m.d., Assistant

Emanuel Blumenfeld, b.s., m.d., Assistant

Maccabae Boorstein, b.s., m.d., Assistant

Robert M. Richman, a.b., m.d., Assistant

John T. Croft, m.d., Assistant in Clinical Orthopedic
Surgery

583-A. ANATOMY FOR ORTHOPEDIC
SURGEONS

A full-time course of five days' duration, January 5
through 9, 1953, providing the students with the
opportunity to personally dissect the extremities and
the spine. The instruction is given by qualified ortho-
pedic surgeons actively engaged in clinical work and
particularly experienced in anatomy.

Given under the direction of Dr. Alvin Hulnick.
Maximum class 20. Tuition $90.00.

Correlation of Diagnostic ond Therapeutic Procedures

in Children's Orthopedics

. J\

-Si

: y^

OTORHINOLARYNGOLOGY

John F. Daly, a.b., m.d., Professor and Chairman of the

Department
James B. Shannon, m.d., Professor of Clinical Otorhino-

laryngology
Joseph L. Goldman, a.b., m.d., Associate Professor of

Clinical Otorhinolaryngology
William Wallace Morrison, m.d. [western ontario],

Associate Professor of Clinical Otorhinolaryngology
Paul S. Seager, a.b., m.d., Associate Professor of Clinical

Otorhinolaryngology
John C. Cardona, a.b., m.d., Assistant Professor of Clin-
ical Otorhinolaryngology
Daniel S. Cunning, m.d., Clinical Professor
Andrew A. Eggston, b.s., m.d., Clinical Prof essor of Path-

ology (Otorhinolaryngology)
J. Swift Hanley, a.b., m.d.,c.m. [queen's univ., Kings-
ton], Clinical Professor
Girard F. Oberrender, b.s., m.d., Clinical Professor
Greydon G. Boyd, a.b., b.s., m.d., Associate Clinical Pro-
fessor
Virginius B. Hirst, b.s., m.d., Associate Clinical Professor
Earl F. Limbach, a.b., m.d., Associate Clinical Professor
William B. Allan, b.s., m.d., Assistant Clinical Professor
Miles Atkinson, m.b.,b.s. [London], Assistant Clinical

Professor
Richard J. Bellucci, b.s., m.s., m.d., Assistant Clinical

Professor
David Bernstein, b.s., m.d., Assistant Clinical Professor
John A. Cinelli, a.b., m.d. [rome], Assistant Clinical Pro-
fessor
Ward C. Denison, m.d., Assistant Cliniral Professor
Charles W. Depping, m.d., Assistant Clinical Professor
David \. Frank, m.d., Assistant Clinical Professor
Leopold L Glushak, m.b.,ch.b. [Glasgow], Assistant

Clinical Professor
Joseph H. Hersh, b.s., m.d., Assistant Clinical Professor

593-A. BASIC SCIENCES OF OTORHINO-
LARYNGOLOGY (GRADUATE COURSE)

A full-time course of nine months' duration, Sep-
tember 29, 1952, through June 19, 1953, designed
particularly for those who intend to specialize in
otorhinolaryngology and who will complete their
training with a residency. Emphasis is placed on the
basic sciences and the allied clinical subjects of
otorhinolaryngology, such as allergy, neurology, dis-
eases of the ehest, bronchoscopy, and head and neck
surgery. These are covered in detail in their relation-
ship to Problems of otorhinolaryngology. The course
is planned to give the Student a firm foundation in the
basic sciences, the fundamentals of diagnosis, and a
broad outlook on ear, nose, and throat problems that
arise in other clinical fields.

Given under the direction of Professor John F.
Daly. Tuition $700.00.

William J. Hochbaum, a.b., m.d., Assistant Clinical Pro-
fessor
Alexander F. Laszlo, m.d. [Budapest], Assistant Clinical

Professor
Anthony Nigro, m.d., Assistant Clinical Professor
Max Rabbiner, b.s.(med.), m.d., Assistant Clinical Pro-
fessor
Max L. Som, b.s., m.d., Assistant Clinical Professor
Darrell G. Voorhees, b.s., m.d., Assistant Clinical Pro-
fessor
Ernest A. WeymuUer, b.s., m.d., Assistant Clinical Pro-
fessor
Joseph E. Zbar, a.b., m.d.,c.m. [queen's univ., Kings-
ton], Assistant Clinical Professor
Walter A. Petryshyn, a.b., m.d., Instructor in Clinical

Otolaryngology
Murray Abrams, b.s., m.d., Clinical Instructor
Godfrey E. Arnold, m.d. [vienna], Clinical Instructor
Mark H. Barnes, a.b., m.d., Clinical Instructor
Louis F. Castaldo, b.s., m.d., Clinical Instructor
James V. Conway, a.b., m.d., Clinical Instructor
Rector T. Davol, a.b., m.d., Clinical Instructor
Louise Fischer, b.s., m.d., Clinical Instructor
Joseph Freeman, a.b., m.d., Clinical Instructor
Otto Gambacorta, a.b., m.d., Clinical Instructor
Edward S. Orzac, m.d., Clinical Instructor
Ralph Peimer, a.b., m.d., Clinical Instructor
Alan A. Scheer, m.d., Clinical Instructor
Francis S. Weinstein, b.s., m.d., Clinical Instructor
Joseph P. Connolly, b.s., m.d., Clinical Assistant
Samuel Eisenberg, b.s., m.d. [vienna], Clinical Assistant
Seymour Jacobson, a.b., m.d., Clinical Assistant
Saul C. Newman, b.s., m.d., Clinical Assistant
Frank J. Riccio, b.s., m.d. [rome], Clinical Assistant
Morris M. Rossman, a.b., m.d. [rome], Clinical Assistant
Francis Kwok, m.d. [st. john's univ., Shanghai],
Fellow

591-A. INTENSIVE COURSE IN BASIC
SCIENCES

An intensive ten-day course in basic sciences—
including embryology, anatomy, physiology, bacteri-
ology, principles of operative surgery, and audiology—
9 a.m. to 1 p.m., September 15 through 26, 1952.

Given under the direction of Professor John F.
Daly. Maximum class 12. Tuition $100.00.

This course will be repeated in the spring of 1953.

592-A. HISTOPATHOLOGY OF THE EAR,
NOSE, AND THROAT

An intensive review of histology and the general
and special pathology of the ear, nose, throat, and
head and neck. Material is covered using microscopic
slides, demonstrations, lectures, and specimens. The
clinical course of the common pathological processes
is discussed. Given for a ten-day period, 2 to 5 p.m.,

Practkol Instruction in the Ute of the Bronchoscop«

OTORHINOLARYNGOLOGY

PATHOLOGY

September 15 through 26, 1952.

Given under the direction of Dr. Andrew A. Egg-
ston and staflf. Maximum class 12. Tuition $100.00.

This course will be repeated in the spring of 1953.

594-A. ENDAURAL SURGERY

A full-time course of ten days' duration, November
10 through 21, 1952. The anatomy of the temporal
bone is presented and the technique of endaural sur-
gery is taught using cadaver material. The indications
for temporal bone surgery are discussed in lectures
and Seminars.

Given under the direction of Professor John F.
Daly. Maximum class 7. Tuition $150.00.

This course will be repeated as 594-B, February 9
through 20, 1953.

595-A. ADVANCED BRONCHOESOPHA-
GOLOGY AND LARYNGOLOGY

The presentation of recent advances in the manage-
ment of diseases of the larynx, esophagus, and
tracheobronchial tree. Current trends and new tech-
niques are presented in seminars and demonstrations.
Subjccts covered include: Suspension laryngoscopy,
pediatric bronchoscopy, and voice and Speech prob-
lems, as well as an intensive review of the diseases
commonly seen by the endoscopist. A full-time course
of five days' duration, January 19 through 23, 1953.

Given under the direction of Professor John F.
Daly. Maximum class 12. Tuition $100.00.

596-A. ANATOMY OF THE HEAD, NECK, AND
THORAX FOR OTOLARYNGOLOGISTS

A part-time six weeks' course giving complete ana-
tomical dissection of the head and neck and thorax,
supplemented with lectures, demonstrations, and dis-
cussion groups. Given 9 a.m. to 12 m., Mondays
through Fridays, September 29 through November 7,
1952.

Given under the direction of Professor John F.
Daly. Tuition $125.00.

597-A. NEUROANATOMY, NEUROPHYSI-
OLOGY, AND NEURO-OTOLOGY

A five-day course, full-time, November 3 through
7, 1952. The neuroanatomy of the cranial nerves and
their principle pathways is presented. Physiology of
vestibulär apparatus-hearing, voice, and speech, plus
their clinical application— is covered.

Given under the direction of Professor John F.
Daly. Tuition $75.00.

598-A. PATHOLOGY OF THE HEAD AND
NECK

This course of four weeks' duration is given 9 a.m.
to 12 m., November 24 through December 19, 1952.
It Covers a complete review of general pathology and
its application to ear, nose, and throat problems. Par-
ticular attention is given to normal histology of the
nose, sinuses, Upper digestive and respiratory tracts,
and histopathology of the temporal bone. Consider-
able time is spent on pathology of tumors of the head
and neck that fall within the realm of the specialty of
otolaryngology. The students are given training in
slide diagnosis with unknown material.

Given under the direction of Professor John F.
Daly. Tuition $125.00.

599-A. ALLERGY FOR OTOLARYNGOLO-
GISTS

Principles and practical methods of treatment for
allergic diseases of the Upper respiratory tract are pre-
sented in lectures and clinical demonstrations. A five-
day, full-time course, December 8 through 12, 1952.

Given under the direction of Professor John F.
Daly and Dr. Will Cook Spain. Tuition $75.00.

5910-A. SURGERY OF THE HEAD AND NECK

The modern surgical procedures in the head and
neck region covered in lectures and on the cadaver.
Surgery of the nose, paranasal sinuses, oral cavity, and
salivary glands. Basic procedures in neck surgery cov-
ering laryngectomy, laryngofissure, cysts of neck,
arytenoidectomy, diverticulum, and neck dissection
are included. A ten-day, full-time course, January 5
through 16, 1953.

Given under the direction of Professor John F.
Daly. Maximum class 8. Tuition $200.00.

591 1-A. ADVANCED SURGERY OF THE NECK

Principles of block dissections of the neck and its
variations for the qualified laryngeal surgeon. Supra-
omohyoid, complete radical neck, bilateral and uni-
lateral radical neck dissection in continuity with
laryngectomy and pharyngectomy. A ten-day, full-
time course, September 29 through October 10, 1952.

Given under the direction of Professor John F.
Daly. Maximum class 4. Tuition $250.00.

PATHOLOGY

College of Medicine

William C. Von Glahn, b.s., m.d., Professor and Chair-

man of the Department
Maurice N. Richter, b.s., m.d., Professor
Sigmund L. Wilens, s.S., m.d., Professor
John W. Hall, e.s., m.d., Associate Professor
Lewis D. Stevenson, a.b., m.d., cm. [queen's univ.,

KINGSTON], Associate Professor of Neuro pathology
Stanley Gross, B.s., m.d., Assistant Professor
Adolf Hochwald, m.d. [masaryk univ.], Assistant Pro-
fessor
Leon Sokoloflf, a.b., m.d., Assistant Professor
William Antopol, b.s., m.d., Clinical Prof essor
Andrew A. Eggston, b.s., m.d., Clinical Professor (Oto-
rhinolaryngology)

441-A. GYNECOLOGICAL PATHOLOGY
(FOR SPECIALISTS)

A part-time course of sixteen sessions, 1 1 a.m. to 1
p.m., Wednesdays, September 17 through December
31, 1952. Consists of a systematic review of the
pathology of the more common gynecological condi-
tions, presented by lectures, demonstrations, and
microscopic study. The correlation of clinical and
pathological features is emphasized. (442-A is a pre-
requisite for this course.)

Given under the direction of Dr. Maxwell J. Fein.
Maximum class 16. Tuition $100.00.

This course is repeated as 44 1 -B, 2 : 30 to 4 : 30 p.m.,
Tuesdays and Thursdays, January 20 through March
17, 1953.

442-A. SURGICAL PATHOLOGY
(FOR SPECIALISTS)

A part-time course of thirty sessions, 2:30 to 4:30
p.m., Tuesdays and Thursdays, September 16 through
January 13, 1953. Designed for surgeons and patholo-
gists. Consists of the study of important pathological
conditions with particular reference to those of inter-
est in general surgery. Instruction is by lectures, dem-
onstrations, and the study of gross and microscopic
preparations. Material from the operating rooms of
the University Hospital is available for demonstra-
tions of gross specimens, and prepared slides illustrate
microscopic changes. The pathological changes are
correlated with clinical findings whenever possible.

Given under the direction of Dr. Maxwell J. Fein.
Maximum class 16. Tuition $200.00.

This course is repeated as 442-B, March 17 through
June 25, 1953.

Maxwell J. Fein, m.d., Clinical Professor

Norman S. Cooper, a.b., m.d., Instructor; Dean W.

Horace Hoskins Fellow in Comparative Pathology
Antonio Rottino, b.s., m.d., Instructor
Harry D. Bucalo, Jr., m.d., Assistant
Barbara S. Ferguson, a.b., m.d., Assistant
*Sidney Z. Gellman, m.d., Assistant
Ruth Güssen, a.b., m.d., Assistant
William J. Hutchins, B.s., m.s., m.d., Assistant
Robert T. McCIuskey, a.b., m.d., Assistant
Gloria A. Rudisch, Assistant
Harry H. Stumpf, a.b., m.d., Assistant

*Leave of absence, military service.

443-A. PRINCIPLES OF PATHOLOGY

Review of principles of general pathology with
study of the characteristic lesions found in various dis-
eases. Conducted with lectures and demonstrations of
gross material and histologic preparations. Especial
emphasis on correlation of clinical and pathologic fea-
tures. Twenty-four sessions, 1 to 4 p.m., Mondays and
Wednesdays, September 29 through December 17,
1952. Given for students in the graduate courses, but
open to others providing Space permits.

Given under the direction of Professor William C.
Von Glahn. Tuition $100.00.

444-A. SPECIAL PATHOLOGY FOR
SURGEONS

Prerequisite: Course no. 443-A, Principles of
Pathology. Presentation of material that is of interest
to the general surgeon, consisting of gross specimens
and histologic preparations with correlation of clinical
and pathologic aspects. Twenty-four sessions, Thurs-
days, 1 to 4 p.m., January 8 through June 18, 1953.

Given under the direction of Professor William C.
Von Glahn. Tuition $125.00.

Surgical Pathology Taught by Class Demonstration

and Individual Observation

- I

PEDIATRICS

Adolph G. DeSanctis, m.d., Professor and Chairman

of the Department
Leslie O. Ashton, b.s., m.d., Professor of CUnical Pedi-

atrics
Rosa Lee Nemir, a.b., m.d., Associate Professor
John Dorsey Craig, d.s., m.d., Associate Professor of

CUnical Pediatrics
D. William Scotti, m.d., Associate Professor of CUnical

Pediatrics
Beatrice Bergman, m.d., Assistant Professor of CUnical

Pediatrics
Oliver L. Stringfield, s.S., m.d., Assistant Professor of

CUnical Pediatrics
Julian Rogatz, m.d., Associate CUnical Professor
Frederick Castrovinci, a.b., a.m., m.d., Assistant CUn-
ical Professor
Robert Chobot, a.b., m.d., Assistant CUnical Professor
Edward M. DiTolla, m.d., Assistant CUnical Professor
Daniel J. Dolan, a.b., m.d., Assistant CUnical Professor
Louis Hodes, b.s., m.d., a.m., Assistant CUnical Pro-
fessor
Vincent de Paul Larkin, a.b., m.d., Assistant CUnical

Professor
Martin M. Maliner, m.d., Assistant CUnical Professor
Benjamin Silberg, m.d., Assistant CUnical Professor
Irwin F. Sobel, a.b., m.d., Assistant CUnical Professor
Edward T. Wilkes, b.s., m.d., Assistant CUnical Pro-
fessor
Oscar Bodansky, a.b., a.m., ph.d., m.d., Lecturer
* Robert J. Waldron, a.b., m.d., Instructor
Philip S. Chasin, b.s.; m.d. [Düsseldorf], Instructor in

CUnical Pediatrics
Francis C. DeLorenzo, b.s., m.d., Instructor in CUnical

Pediatrics
Joseph Di Leo, m.d. [Bologna], Instructor in CUnical

Pediatrics
Peter A. Perillo, a.b., m.d., Instructor in CUnical Pedia-
trics

6110-A. PEDIATRICS (GRADUATE COURSE)

A full-time course of nine or twelve months' dura-
tion, beginning September 22, 1 952, covering not only
experience in the care of infants and children but also
lectures in the basic sciences, microbiology, chemistry,
and physiology. Pediatric experience is obtained on
the wards of the University Hospital as well as in Chil-
dren's Medical Service, Bellevue, St. Vincent's, and
Memorial Hospitals, and Irvington House for Cardiac
Children, where, in addition to the usual pediatric
Problems, specialties such as tuberculosis, cardiology,
allergy, tumors, care of the newborn, etc., may be
studied. The well-baby clinic furnishes experience
with the Problems of infant feeding and immunization,
and experience in the appraisal of growth and devel-

George E. Pittinos, a.b., m.d., Instructor in CUnical

Pediatrics
Joseph F. Raflfetto, a.b., m.d., Instructor in CUnical

Pediatrics
Alfred B. Amier, m.d. [Lausanne], CUnical Instructor
Sol D. Amsterdam, b.s., a.m., m.d. [Lausanne], CUnical

Instructor
*Noah Barysh, b.s., m.d., CUnical Instructor
Nathan Cabot, s.S., m.d., CUnical Instructor
Marie L. Cote, a.b., m.d., CUnical Instructor
James Dick, a.b., m.d., CUnical Instructor
Harold S. Douglas, m.d., CUnical Instructor
Sol N. Keen, b.s., m.d., CUnical Instructor
Thomas F. X. Lenihan, a.b., m.d., CUnical Instructor
Harold R. Mancusi-Ungaro, a.b., m.d., CUnical In-
structor
William P. Riley, b.s., m.d., CUnical Instructor
Flora F. Silberbush, m.d. [basel], CUnical Instructor
Pasquale A. Statile, b.s., m.d., CUnical Instructor
Harold D. Dundy, b.s., m.d., Assistant
James J. Farley, m.d., Assistant
Vincent J. Felitti, a.b. (med.), m.d., Assistant
B. Winston Jarvis, b.s., m.d., Assistant
ehester H. Myron, a.b., m.d., Assistant
Italo Palmieri, m.d., Assistant
Frank A. Delaney, ph.b., a.m., CUnical Assistant

(Speech)
Vincent J. Fiocco, b.s., m.d., CUnical Assistant
Bernard Greenberg, b.s., m.d., CUnical Assistant
Rafael R. Muniz, b.s., m.d., CUnical Assistant
A. Downey Osborn, b.s.; m.b.,ch.b. [Edinburgh], CUni-
cal Assistant
Lewis J. Schloss, a.b., m.d., CUnical Assistant
Lawrence M. Shapiro, a.b., m.d., CUnical Assistant
Brona Szuldberg, m.d. [warsaw], CUnical Assistant
Martin Turkish, b.s., m.d., CUnical Assistant
Irving H. Uvitsky, m.d., CUnical Assistant
*Leave of absence.

opment is obtained in a developmental clinic. Oppor-
tunities are given to attend seminars, Conferences, and
lectures in the department, including those on child
psychiatry. Extensive experience in the reading of
X-rays in children is furnished and supervised by both
clinicians and radiologists.

Given under the direction of Dr. Rosa Lee Nemir.
Maximum class 12. Tuition $700.00.

611-A. CLINICAL PEDIATRICS

A ten-week, part-time course of thirty sessions, 9
a.m. to 1 p.m., Mondays, Wednesdays, and Fridays,
November 3, 1952, through January 16, 1953,
designed for the general practitioner or pediatrician
who can devote only part of his time each week to
refresher studies. Consists of didactic lectures, bedside

.>ter

PEDIATRICS

rounds, clinical Conferences, case demonstrations, and
active participation in the various specialty clinics. All
basic pediatric problems are reviewed. Special empha-
sis is placed on normal development in infancy and
childhood, infant care and feeding (including the pre-
mature), chemo- and antibiotic therapy, pediatric
endocrinology, preventive pediatrics, pediatric X-ray
diagnosis, and the management of acute and chronic
illnesses.

Given under the direction of Professor Adolph G.
DeSanctis. Tuition $125.00.

612-A. CLINICAL PEDIATRICS

A full-time course of four weeks' duration, October
6 through 31, 1952. A review of clinical pediatrics
including ward rounds, clinical Conferences, and case
demonstrations in special clinics dealing with cardi-
ology, allergy, endocrinology, ehest diseases, and
Speech defects. Clinical lectures on neurological,
orthopedic, urological, surgical, and otolaryngological
conditions are given by specialists in these fields.
Recent developments in antibiotic therapy, infant
nutrition, and infectious and metabolic diseases are
discussed. The practical application of these develop-
ments is stressed from the viewpoint of the general
practitioner as well as the pediatrician. Active partici-
pation on the wards and in the clinics of the University
Hospital is included in the program for each physician
enrolled in this course. Each participating physician is
assigned to examine patients on admission to the hos-
pital, to perform diagnostic and therapeutic proce-
dures as indicated, and to follow the progress of
individual patients.

Given under the direction of Professor Adolph G.
DeSanctis. Maximum class 16. Tuition $150.00.

613-A. PEDIATRIC REFRESHER COURSE

A full-time course of two weeks' duration, January
19 through 31, 1953. A variety of common pediatric
Problems are presented in clinical lectures and Confer-
ences. Specialists in the various phases of pediatrics
conduct ward rounds and present interesting cases.
Recent developments are presented along with basic
considerations.

Given under the direction of Professor Adolph G.
DeSanctis. Tuition $100.00.

614-A. REVIEW OF CLINICAL PEDIATRICS

A full-time course of six days' duration, September
8 through 13,1 952, consisting of a review of the prac-
tical Problems encountered in pediatric practice.
Clinical lectures, Conferences, ward rounds, and case
demonstrations are given by specialists in the various

phases of pediatrics. Special emphasis is placed on
infant feeding, preventive pediatrics, chemotherapy,
cardiology, and care of the premature infant.

Given under the direction of Professor Adolph G.
DeSanctis. Maximum class 40. Tuition $50.00.

This course is repeated as 614-B, March 9 through
14, 1953.

615-A. PRACTICAL PEDIATRIC
ENDOCRINOLOGY

A part-time course of ten sessions, 1 0 a.m. to 12m.,
Thursdays, April 2 through June 4, 1953, in the basic
principles and clinical applications of the most recent
advances in pediatric endocrinology. Consists of
didactic lectures, case demonstrations, and Confer-
ences. Patients are presented and, whenever neces-
sary, additional material is presented in detail with the
use of lantern slides and photographs. In each instance
the practical aspects of pediatric endocrinology are
stressed. An organized system of diagnosis and man-
agement is offered. Designed for pediatricians but,
enrollment permitting, is available to general
practitioners.

Given under the direction of Dr. Beatrice Bergman.
Tuition $50.00.

616-A. PEDIATRIC ALLERGY

A part-time course of ten sess"ons, 9:30 a.m. to
12:30 p.m., Tuesdays, April 7 through June 9, 1953.
Consists of didactic lectures, ca.«? dernonstrations,
clinical Conferences, and active participation in the
Pediatric Allergy Clinic of the University Hospital. All
Problems commonly encountered in allergic children
are discussed in detail. Special emphasis is placed on
the management of hay fever, eczema, asthma, gas-
trointestinal allergies, practical experience with skin
testing and other diagnostic techniques, drug allergies,
and the use of the new antihistaminic preparations.
Designed for pediatricians but, enrollment permitting,
is available to general practitioners.

Given under the direction of Dr. Robert Chobot.
Tuition $60.00.

617-A. COMMUNICABLE DISEASES

An intensive full-time course of five days' duration,
January 12 through 16, 1953, in the basic and practi-
cal aspects of the common communicable diseases.
The Problems encountered are discussed by outstand-
ing authorities in lectures, and the participating physi-
cian actively engages in the examination of patients at
the Willard Parker Hospital for Contagious Diseases.
Basic diagnostic and therapeutic principles are em-

^11 »»■III I )ll~

PEDIATRICS

PHARMACOLOGY

phasized. A summary of present aspects of tubercu-
losis as it is encountered in children is also included.
Given under the direction of Dr. John Dorsey
Craig. Tuition $50.00.

618-A. PEDIATRIC CARDIOLOGY

A full-time course of five days' duration, September
15 through 19, 1952. Offers an intensive review of the
most recent advances in pediatric cardiology including
rheumatic fever, rheumatic heart disease, and con-
genital heart disease. The various diagnostic proce-
dures are included, such as electrocardiography,
fluoroscopy, cardiac visualization, and venous cathe-
terization. An attempt is made to present the most
practical and most modern means of treating the vari-
ous cardiac problems as they arise.

Given under the direction of Dr. Martin M.
Maliner. Maximum class 30. Tuition $50.00.

619-A. PEDIATRIC CARDIOLOGY

A part-time course of ten sessions, Wednesdays, 9
a.m. to 12 m., April 1 through June 3, 1953. Consists

of didactic lectures, case demonstrations and Confer-
ences, and active participation in the Pediatric
Cardiac Clinic of the University Hospital. Special
emphasis is placed on the basic considerations of
pediatric cardiology. Among the numerous topics
considered are rheumatic fever, congenital heart dis-
orders, fluoroscopic and X-ray examination of the
normal and pathological heart (including cardiac
visualization with contrast mediums and venous
catheterization ) , normal and abnormal electrocardio-
grams, acute infections as related to pediatric cardi-
ology, surgical correction of congenital anomalies,
anesthesia in cardiac children, and the newer drugs
used in the therapy of cardiac disorders. Ample
opportunity is offered to study actual cases in the
Pediatric Cardiac Clinic. Diagnosis and surgical treat-
ment of congenital cardiac disease is included. De-
signed for pediatricians but, enroUment permitting, is
available to general practitioners.

Given under the direction of Dr. Martin M.
Maliner. Tuition $60.00.

PHARMACOLOGY

College of Me die ine

X*-

Severe Ochoa, m.d. [madrid], Professor and Chairman

of the Department
Otto Loewi, M.D. [STRASBOURG], sc.d.(hon.), Research

Professor
Richard C. de Bodo, m.d. [Budapest], Associate Pro-
fessor
Seymour Korkes, m.d., Assistant Professor
Sarah Ratner, a.b., a.m., ph.d., Assistant Professor
Seymour Kaufman, b.s., m.s., ph.d., Instructor
Joseph R. Stern, a.b., a.m., m.d. [Toronto], Instructor
Minor J. Coon, a.b., ph.d., Fellow
Osvaldo Cori, med. cir. [chile], Fellow

Issac Harary, a.b. [western ontario], Fellow
Saul R. Korey, m.d., Fellow
Nathan Lane, a.b., m.d., Fellow
Dorothy Newmeyer, b.s., m.s., ph.d., Fellow
Marvin W. Sinkoff, a.b., m.d., Fellow
Harold J. Strecker, b.s., ph.d.. Fellow
Wolf Vishniac, a.b., m.s., ph.d., Fellow
Israel Zelitch, b.s., m.s., ph.d., Fellow

The members of the department take part in the basic
science instruction in the courses oflfered by the clinical
departments.

Modern Clinical Investigation

Care of the Premoture Infant

""-^

I
•■ I

PHYSICAL MEDICINE AND REHABILITATION

College of Medicine

Howard A. Rusk, a.b., m.d., sc.d.(hon.), ll.d., Pro-
fessor and Chairman of the Department

George G. Deaver, b.p.e., m.d., Professor of Clinical
Rehabilitation

Donald A. Covalt, b.s., m.d., Associate Professor of
Rehabilitation

Hans Kraus, m.d. [vienna], Associate Professor of Clin-
ical Physical Medicine and Rehabilitation

Joseph Moldaver, m.d., Associate Professor of Clinical
Physical Medicine and Rehabilitation

Edward W. Lowman, b.s., m.d., m.s.(med.), Assistant
Professor

Allen S. Russek, a.b., l.r.c.p.s. [Edinburgh, Glasgow],
Assistant Professor

Joseph G. Benton, a.b., m.s., ph.d., m.d., Adjunct Assist-
ant Professor

Michael M. Dacso, m.d. [Budapest], Assistant Professor
of Clinical Physical Medicine and Rehabilitation

Edward E. Gordon, a.b., m.d., Assistant Professor of
Clinical Physical Medicine and Rehabilitation

Bruce B. Grynbaum, m.d., Assistant Professor of Clinical
Physical Medicine and Rehabilitation

Eugene J. Taylor, b.s.(educ.), a.m., Assistant Professor
of Clinical Physical Medicine and Rehabilitation

Samuel E. Bilik, m.d., Associate Clinical Professor

John D. Currence, b.s., m.d., Associate Clinical Professor

Arthur S. Abramson, b.s., m.d.,c.m. [mcgill], Assistant
Clinical Professor

Harold Brandaleone, b.s., m.d., med.sc.d., Assistant
Clinical Professor of Medicine {Assigned to Rehabili-
tation)

Leo Dobrin, a.b., m.d., Instructor

Dominic A. Donio, b.s., m.d., Instructor

Vera S. Emanuel, a.b. [south africa], m.d.,ch.b. [wit-

watersrand], Instructor in Pediatrics (Assigned to
Physical Medicine and Rehabilitation)

Gerald J. Friedman, b.s., m.d., Instructor

Irving M. Friedman, a.b., m.s., Instructor

Morris Grayson, b.s.; m.d. [Lausanne], Instructor in
Psychiatry (Assigned to Physical Medicine and Reha-
bilitation)

Edith L. Kristeller, m.d., Instructor

Edward J. Lorenze, m.d., Instructor

Morton Marks, a.b., m.d., Instructor in Neurology (As-
signed to Physical Medicine and Rehabilitation)

Michael Miller, B.s., m.d., Instructor

Eugene Moskowitz, b.s.; m.d. [basel], Instructor

Herbert F. Mulholland, b.s., m.d., Instructor

Seymour H. Rinzler, a.b., m.d., Instructor

Samuel S. Sverdlik, b.s., m.d., Instructor

Henry Viscardi, Jr., B.s., ll.b., Instructor

Lawrence H. Wisham, B.s., m.d., Instructor

William Woolner, a.b., m.d., Instructor

Joseph Levi, b.s., a.m., ph.d., Clinical Instructor in Med-
ical Psychology (Assigned to Physical Medicine and
Rehabilitation)

Henry Brown, b.s., m.d., Assistant

Klaas Smidt, m.d. [leiden], Assistant

Muriel R. Benton, a.b., m.d., Clinical Assistant in Psy-
chiatry (Assigned to Physical Medicine and Rehabili-
tation)

Stanley Berenstein, b.s., m.d., Fellow

Anthony L. Brittis, a.b., m.d., Fellow

Karl E. Carlson, a.b., m.d., Fellow

A. Bernice Clark, a.b., m.d., Fellow

Anna Kara, m.d. [Montreal], Fellow

Philip R. Lee, a.b., m.d., Fellow

Judith Rosenschein, a.b., m.d., Fellow

Given under the direction of Professor Howard A.
Rusk and staff.

This course is repeated as 7310-B, January 12
through February 6, 1953. Fee $100.00.

731 1-A. PHYSICAL MEDICINE AND
REHABILITATION

An intensive ten-day course for specialists in physi-
cal medicine and rehabilitation, July 14 through 25,
1952. Includes methods for evaluation and practical
training of patients with physical disabiiities.

Given under the direction of Professor Howard A.
Rusk and staff. Tuition $75.00.

7312-A. SEMINAR ON THE REHABILITA-
TION OF CHILDREN

An intensive full-time, five-day course, October 20
through 24, 1952, for general practitioners and pedia-
tricians. Designed to give a picture, through lectures,
demonstrations, clinics, and Conferences, of the Organ-
ization, administration, Integration, equipment, the-
ory, and practice of a pediatric rehabihtation service.

Given under the direction of Professor Howard A.
Rusk and staff. Tuition $40.00.

This course is repeated as 7312-B, January 19
through 23, 1953, and as 7312-C, April 20 through
24, 1953.

Rehabilitation

^«4

,:' \

^*Ni>i^^taM|

"^'

738-A. PHYSICAL MEDICINE AND REHA-
BILITATION (GRADUATE COURSE)

A nine-month, full-time course, September 29,
1952, through June 19, 1953. Didactic and practical
Instruction in the evaluation and treatment of physical
disabiiities by physical, psychosocial, and vocational-
rehabilitation procedures, the uses of the physical mo-
dalities, and the therapy of the "third phase" of med-
ical care. The clinical aspects of rehabilitation and
physical medicine as they relate to internal medicine,
surgery, and other specialties are presented in didactic
lectures, seminars, and clinical demonstrations.

Given at Bellevue Hospital, University Hospital,
and at the Institute of Physical Medicine and Rehabil-
itation under the direction of Professor Howard A.
Rusk. This course is repeated as 738-B, January 12
through October 10, 1953. Tuition $700.00.

739-A. PHYSICAL MEDICINE AND
REHABILITATION

A twelve- or twenty-four-week course at Bellevue
Hospital, University Hospital, and the Institute of
Physical Medicine and Rehabilitation. Arranged by
interview.

Given under the direction of Professor Howard A.
Rusk and staff. Tuition $200.00 for twelve weeks;
$400.00 for twenty-four weeks.

7310-A. PHYSICAL MEDICINE AND
REHABILITATION

A four-week, full-time course for specialists in
physical medicine and rehabilitation, September 22
through October 17, 1952. Includes advanced meth-
ods of diagnosis, evaluation, practical training meth-
ods, and program planning in hospital practice.

■/i'v

•' y

»*»^s«!»

/Tl

^^>3i,

*)■ .-*s&-

^- ■ .-T

« w *• * ""«^ •»■

PHYSIOLOGY

College of Medicine

Homer W. Smith, a.b., sc.d., m.s.(hon.), Professor and

Chairman of the Department
W. Parker Anslow, Jr., b.s., ph.d., Associate Professor
ehester W. Hampel, a.b., a.m., ph.d., Associate Professor
Samuel Standard, m.d., Lecturer
E. Lovell Becker, a.b., m.d., Instructor
Preston G. McLean, m.d., Instructor
Lot B. Page, m.d., Instructor

Metabolism Studies in Applied Physiology

■^m..

John C. Scott-Baker, m.b.,b.s.[london], Instructor
Himansu S. Chakravarti, m.b., b.s., m.d. [calcutta],

Fellow
Alfred P. Fishman, a.b., m.s., m.d., Fellow
Feiice Martignomi, m.d. [pavia], Fellow
George A. Zak, Fellow

Course Nos. 545-A and 5420-A & B, Normal and
Pathological Physiology: Functional and Chemical
Aspects (see pages 20 and 22).

■ ■^BjJJ'''^'?-'-" '^ "

/»•*

•* '- j '. *

PREVENTIVE MEDICINE

College of Medicine

Henry E. Meleney, a.b., m.d., Hermann M. Biggs Pro-
fessor and Chairman of the Department
Donald Mainland, m.b.,ch.b., sc.d. [Edinburgh], Pro-
fessor (Medical Statistics)
Harry Most, b.s., m.d., med.sc.d., Professor {Tropical

Medicine)
Jacob H. Landes, m.d., m.p.h., Assistant Professor
Donald V. Moore, a.b., a.m., ph.d., Assistant Professor
Ray E. Trussell, a.b., m.d., m.p.h., Clinical Professor
Abraham Stone, b.s., m.d., Associate Clinical Professor
Arthur B. Robins, a.b., m.d., med.sc.d., d.p.h., Assistant
Clinical Professor

735-A. TROPICAL MEDICINE

A full-time intensive course, in tropical and para-
sitic diseases, of seven weeks' duration, January 5
through February 20, 1953. Consists of lectures, labo-
ratory exercises, and clinical demonstrations covering
etiological agents, arthropod vectors, pathology, diag-
nosis, treatment, and prevention. The diseases cov-

Jacques M. May, b.s. [sorbonne], m.d. [paris], Lecturer
(Geographical Medicine)

Jack H. Sandground, b.s., m.s. [south africa], sc.d.,
Lecturer

Arthur Schindelheim, d.d.s., Lecturer

George Simon, m.d., Lecturer

Harry Strusser, d.d.s., m.s. ( pub. health), L^cmrer

Frederik Van Assendelft, physician [Amsterdam], Lec-
turer (Tropical Medicine)

Louis Weiner, e.e., Lecturer

Lee F. Herrera, b.s., Instructor (Medical Statistics)

Florence E. Ritner, Instructor (Social Service)

Frances T. Poe, a.b., a.m., m.s., Assistant (Social Service)

ered include infections caused by viruses, rickettsias,
bacteria, fungi, spirochetes, protozoa, and helminthes;
also nutritional diseases, tropical ophthalmology,
dermatology, and sanitation, and physiological prob-
lems of the tropics.

Given under the direction of Dr. Harry Most and
staff. Tuition $300.00.

Laboratory Exercise in Tropica! Medicine (Schistosomiasis)

«^s#

^ 1 ■

< *■»-

V N

«y

PSYCHIATRY AND NEUROLOGY

College of Me die ine

S. Bernard Wortis, a.b., m.d., Lucius N. Littauer Pro-
fessor of Psychiatry, Professor of Neurology and
Chairman of the Department

Psychiatry

Morris Herman, b.s., m.d., Menas S. Gregory Professor
of Clinical Psychiatry

Lauretta Bender, s.S., a.m., m.d., Professor of Clinical
Psychiatry

Lewis L Sharp, s.S., m.d.,c.m. [mcgill], Associate Pro-
fessor of Clinical Psychiatry

Marvin Stern, d.s., m.d., Assistant Professor

Hans L. Teuber, ph.d., Assistant Professor ( Experi-
ment al Psychology)

John Frosch, s.S.; m.d. [bern], Assistant Professor of
Clinical Psychiatry

James F. Garrett, a.b., a.m., ph.d., Assistant Professor
of Clinical Psychology (Assigned to Physical Medi-
cine and Rehabilitation)

Florence Halpern, a.b., a.m., ph.d., Assistant Professor
of Clinical Psychology

Thomas K. Davis, a.b., m.d., Clinical Professor of
Neuropsychiatry

Louis Hausman, a.b., m.d., Clinical Professor of Neuro-
psychiatry

Philip R. Lehrman, m.d., Clinical Professor

Benjamin Apfelberg, m.d., Associate Clinical Professor

John H. Taterka, m.d. [Breslau], Associate Clinical
Professor

David Wechsler, a.b., a.m., ph.d., Associate Clinical
Professor of Medical Psychology

Gustav Bychowski, m.d. [Zürich], Assistant Clinical
Professor

David J. Impastato, a.b., m.d., Assistant Clinical Pro-
fessor

Sidney Klein, b.s., m.d., Assistant Clinical Professor

Meyer H. Maskin, a.b., m.b., m.d., Assistant Clinical
Professor

Bela Mittelmann, m.d. [german univ., prague], Assist-
ant Clinical Professor
Joseph W. Owen, m.d., Assistant Clinical Professor
Arnold Z. Pfeffer, b.s., m.s., m.d., Assistant Clinical
Professor

Charles B. Thompson, a.b., m.d., Assistant Clinical
Professor

Helen Thompson, a.b.. a.m., ph.d., Assistant Clinical
Professor of Medical Psychology (Assigned to Pedi-
atrics)

Joseph Wortis, a.b.; m.d. [vienna], Assistant Clinical
Professor

Zuleika Yarrell, m.d., Assistant Clinical Professor
Frances C. Macgregor, a.b., a.m., Research Associate in
Sociology (Psychiatry)

Elsa Bay, b.s., Instructor (Psychiatric Social Work)

Morris Grayson, b.s.; m.d. [Lausanne], Instructor (As-
signed to Physical Mediane and Rehabilitation)
Ruth M. McGuire, b.s., m.s., Instructor in Psychiatric

Social Work
Sadi Oppenheim, a.b., a.m., Instructor in Medical Psy-
chology
Earle Saxe, b.s., m.d., Instructor
Isidor Bernstein, a.b., m.d., Clinical Instructor
Saul H. Fisher, b.s., m.d., Clinical Instructor
L Peter Glauber, m.d., Clinical Instructor
Daniel L. Goldstein, b.s., m.d., Clinical Instructor
Joseph Levi, b.s., a.m., ph.d., Clinical Instructor in
Medical Psychology (Assigned to Physical Medicine
and Rehabilitation)
Joseph H. Merin, b.s., m.d., Clinical Instructor
Emanuel Messinger, a.b., m.d., Clinical Instructor
Edith Nachmansohn, m.d. [berlin], Clinical Instructor
Leo L. Orenstein, b.s., m.d., Clinical Instructor
Lilly Ottenheimer, Clinical Instructor
Selig J. Ross, B.S., m.d., Clinical Instructor
Dora Schaffer, m.d. [berlin], Clinical Instructor
Howard H. Schlossman, m.d., Clinical Instructor
Rubin L. Siegel, b.s., Clinical Instructor
Archie Silver, b.s., m.d., Clinical Instructor
Kona Simon, b.s., m.d. [vienna], Clinical Instructor
Alexander Thomas, b.s., m.d., Clinical Instructor
Montague Ullman, b.s., m.d., Clinical Instructor
B. Frank Vogel, b.s., m.d. [paris], Clinical Instructor
Theodore S. Weiss, m.d., Clinical Instructor
Paul Zimmering, a.b., m.b.,ch.b. [Bristol], Clinical

Instructor
Marvin L. Blumberg, a.b., m.d., Assistant
John A. Frank, b.s., m.d., Assistant
Irving L. Bauer, a.b., m.d., Clinical Assistant
Muriel R. Benton, a.b., m.d., Clinical Assistant (As-
signed to Physical Medicine and Rehabilitation)
Seymour Berg, a.b., m.d., Clinical Assistant
Albert Bryt, m.d. [paris], Clinical Assistant
John R. Gates, Jr., b.s., m.d., Clinical Assistant
Abraham S. Effron, a.b., m.b. [belfast], Clinical

Assistant
Aaron Esman, m.d., Clinical Assistant
Charlotte Feibel, Clinical Assistant in Medical Psy-
chology
Barbara Fish, m.d., Clinical Assistant
Alfred M. Freedman, a.b., m.b., m.d., Clinical Assistant
David B. Friedman, a.b., m.d., Clinical Assistant
*Herman P. Gladstone, a.b., m.d., Clinical Assistant
Harry Kosovsky, a.b., m.d., Clinical Assistant
Malvina W. Kremer, a.b., a.m., m.d., Clinical Assistant
John J. Macbride, a.b., m.d., Clinical Assistant
Warren J. Muhlfelder, m.d. [basel], Clinical Assistant

irr^cif^^y».'' ^^

PSYCHIATRY AND NEUROLOGY

Alfred H. Rifkin, b.s., m.d., Clinical Assistant

Joseph E. Rubinstein, a.b., m.d.,c.m. [mcgill], Clinical

Assistant
John B. Scanlan, b.s., m.d., Clinical Assistant
Bernard H. Shulman, a.b., m.d. [Edinburgh], Clinical

Assistant
Leonard R. Sillman, b.s., m.d., Clinical Assistant
Sylvia B. Simon, a.b., m.d. [vienna], Clinical Assistant
Harry F. Tashman, m.d., Clinical Assistant
James M. Toolan, a.b., m.d., Clinical Assistant
George J. Weinstein, m.d., Clinical Assistant
Herbert Wieder, b.s., m.d., Clinical Assistant
Edith Wladkowsky, b.s., Clinical Assistant in Medical

Psychology
Arthur Zitrin, b.s., m.s., m.d., Clinical Assistant
Dorothy Colodny, a.b., a.m., m.d., Fellow
Paul Dince, m.d., Fellow
Richard C. Robertiello, a.b., m.d., Fellow
Jerome Silverman, a.b., m.d., Fellow

Neurology
Samuel Brock, m.d., Professor
Morris B. Bender, b.s., m.d., Professor of Clinical

Neurology
Bernhard Dattner, J.D., m.d. [vienna], Clinical Professor
Alexandra Adler, m.d. [vienna], Assistant Clinical Pro-
fessor
David J. Flicker, b.s., m.d., Assistant Clinical Professor
Israel S. Freiman, b.s., m.d., Assistant Clinical Pro-
fessor

645-A. NEUROLOGY (GRADUATE COURSE)

Training in neurology is given starting September
29, 1952. This program for qualified physicians in-
cludes residency training in neurology and in the
neurological aspects of medicine. Includes ( 1 ) clinical
neurology, (2) the basic neurologic sciences (neu-
roanatomy, neurophysiology ) , (3) measurement
methods in neurology— including X-ray diagnosis,
neuro-ophthalmology, and psychometric testing
methods, (4) child neurology, (5) techniques and
methods of examination and treatment, (6) rehabili-
tation procedures for neurologic disabilities. Partici-
pation is required in case presentations, seminars,
clinical Conferences, and survey of pertinent literature.
Each candidate is required to participate in some clini-
cal or laboratory investigation. The course is designed
to Cover one academic year; however, two additional
years devoted to a neurologic residency in an ap-
proved hospital is recommended.

Given at Bellevue Hospital, University Hospital,
and Goldwater Memorial Hospital under the direction
of Professor S. Bernard Wortis. Tuition $700.00.

Max Helfand, m.d., Assistant Clinical Professor
Ira S. Ross, a.b., m.d., Assistant Clinical Professor
Morton Marks, a.b., m.d., Instructor (Assigned to Phys-
ical Medicine and Rehabilitation)
Morton Nathanson, a.b., m.d., Instructor
Alvin Robins, m.d., Instructor
Ernest V. Altman, Clinical Instructor
Francis C. Ansanelli, b.s., m.d., Clinical Instructor
Thomas E. Bamford, Jr., a.b., m.d., med.sc.d., Clinical

Instructor
George S. Cattanach, a.b., m.d., Clinical Instructor
Lawrence H. Gahagan, b.s., a.m., ph.d., m.d., Clinical

Instructor
Lawrence I. Kaplan, a.b., m.d., Clinical Instructor
Joachim Luwisch, m.d. [erlangen], Clinical Instructor
Russell G. Mac Robert, m.d. [western ontario,

TORONTO], Clinical Instructor
Arthur W. Schappell, a.b.(chem.), m.d., Clinical

Instructor
Mortimer F. Shapiro, a.b., m.d., Clinical Instructor
John L. Simon, a.b., m.d., Clinical Instructor
Joseph A. Winn, m.d. [charles univ., prague], Clinical

Instructor
Philip S. Bergman, a.b., m.d., Assistant
Gustave G. Gordon, m.d. [bern], Clinical Assistant
Martin A. Green, b.s., m.d., Clinical Assistant
Elias Savitsky, b.s., m.d., Clinical Assistant
Walter Sencer, b.s., m.d., Fellow
♦Leave of absence, military service.

649-A. PSYCHIATRY (GRADUATE COURSE)

Training in psychiatry is given September 29, 1952,
through June 19, 1953. This program for qualified
physicians includes residency training in psychiatry
and in the psychodynamic aspects of medicine. Inr
cludes study pf (1) clinical psychiatry, (2) the basic
Psychiatric sciences (study of the social, cultural, en-
vironmental, and personal psychodynamic factors in
health and illness), (3) the basic neurologic sciences,
(4) psychosomatics, (5) measurement methods in
psychiatry (both psychologic and physiologic ) , (6)
child psychiatry, (7) techniques and methodology of
interview and therapy, (8) medicolegal aspects of
psychiatry. Participation is required in case presenta-
tions, Seminars, clinical Conferences, and survey of
pertinent literature. Each candidate is required to par-
ticipate in some clinical or laboratory investigation.
This is a full-time course designed to cover one aca-
demic year; however, two additional years devoted to
a Psychiatric residency in an approved hospital is
recommended under the direction of Professor S. Ber-
nard Wortis. Tuition $700.00.

PSYCHIATRY AND NEUROLOGY

641-A. PSYCHIATRIC AND NEUROLOGIC
PROBLEMS IN GENERAL PRACTICE

A part-time course of three weeks' duration, 9 a.m.
to 12 m., Mondays through Saturdays, January 5
through 24, 1953. Covers the common Psychiatric
Problems seen in general practice. Problems of etiol-
ogy, diagnosis, and methods of management and treat-
ment are stressed.

Given under the direction of Professor S. Bernard
Wortis. Maximum class 12. Tuition $100.00.

642-A. ELECTROENCEPHALOGRAPHY

A part-time course of eight weeks' duration, four
hours each day, by arrangement, Mondays through
Saturdays. Instruction in the general principles of
electroencephalography in general medical, Psychi-
atric, and neurologic disorders. The Student partici-
pates in the recording and reading of electroen-
cephalographic tests.

Maximum class 6. Tuition $300.00.

643-A. TREATMENT METHODS IN
PSYCHIATRY

A part-time course of eight weeks' duration, 9 a.m.
to 12 m., Mondays through Saturdays, January 12
through March 7, 1953. Includes instruction in, and
critical review of, the physiologic, pharmacologic,
electrical, and psychodynamic treatment methods.
Open only to physicians who have had previous medi-
cal and Psychiatric training acceptable to the depart-
ment of psychiatry.

Given under the direction of Professor S. Bernard
Wortis. Tuition $250.00.

644-A. NEUROANATOMY AND NEUROPHYS-
lOLOGY

A part-time basic science course of twelve weeks'
duration on the structure and function of the nervous
System. The course is held three mornings a week, by
arrangement, 8:30 a.m. to 12 m., September 22
through December 13, 1952.

Given under the direction of Professor S. Bernard
Wortis. Maximum class 30. Tuition $250.00.

646-A. PSYCHIATRY IN THE PRACTICE OF
MEDICINE AND PEDIATRICS

A full-time, three months' course in psychiatry for
internists and pediatricians^ Additional basic three
months' periods of continued and advanced work can
be arranged. The subjects covered include etiology,
symptomatology, dynamics, and therapy in behavior
disorders, neuroses, psychoses, and organic brain dis-
eases in children and adolescents. In addition to lec-
tures and seminars, there is daily practical work with
patients. Intended to give the intemist and pediatri-
cian an orientation to Psychiatric problems in their
respective fields. Enrollment on various dates by ar-
rangement.

Tuition $300.00 for each three months' period.

647-A. PSYCHIATRY AND NEUROLOGY

A twelve-week, full-time course, September 22
through December 13, 1952, in psychiatry and
neurology. The subjects covered include clinical psy-
chiatry, clinical neurology, therapy, psychosomatic
Problems, neuroanatomy, neurophysiology, neuro-
pathology, X-ray diagnosis, electroencephalography,
and other related subjects.

Early application, on a special and regulär form
for registration, is recommended because of the lim-
itr-d enrollment that can be accommodated. Preference
L given to applicants who have had previous approved
Psychiatric and neurologic training.

Tuition $300.00.

648-A. PSYCHOLOGY AND
PSYCHODYNAMICS

A three months', part-time course, hours by ar-
rangement, Mondays through Saturdays, Septem-
ber 22 through December 13, 1952, in the structure
and development of normal personality; the theory
and use of psychometric testing methods; and study
of the interrelations of sociology, cultural anthropol-
ogy, social work, religion, and the law with psychi-
atry. Medical and social psychology are considered
from the psychodynamic and physiologic aspects.

Given under the direction of Professor S. Bernard
Wortis. Maximum class 6. Tuition $200.00.

Clats In Neurology— Emphasis Is Placed
on Visual Aids in All Departments

MimSm

mgT

RADIOLOGY

Professor and Chairman of the Department (to be
announced)

Milton Friedman, m.d., Associate Professor oj Clinical
Radiology

Maxwell H. Poppel, m.d., Associate Professor af Clinical
Radiology

Ira I. Kaplan, b.s., m.d., Clinical Professor

Henry K. Taylor, m.d., Clinical Professor

Arthur J. Bendick, m.d., Associate Clinical Professor

Francis H. Ghiselin, a.b., m.d., Associate Clinical Pro-
fessor

George P. Robb, a.b., m.d., Associate Clinical Professor
Sidney Rubenfeld, b.s., m.d., Associate Clinical Pro-
fessor

Francis F. Ruzicka, Jr., a.b., m.d., Associate Clinical
Professor

C. Wadsworth Schwartz, ph.b., m.d., Associate Clinical

Professor
Samuel L. Beranbaum, a.b., m.d. [Toronto], Assistant

Clinical Professor

Alexander J. S. Chilko, m.d. [Budapest], Assistant Clin-
ical Professor

Harold G. Jacobson, b.s., m.b., m.d., Assistant Clinical
Professor

Morris Kaplan, m.d., Assistant Clinical Professor {Radia-
tion Therapy)

Bernard Kurz, m.d., Assistant Clinical Professor

651-A. DIAGNOSTIC RADIOLOGY FOR GEN-
ERAL PRACTITIONERS

A part-time course of thirty-two weeks' duration,
8 to 10 p.m., Wednesdays, October 1, 1952, tlirough
JVIay 6, 1953. Emphasis is placed on the diagnosis of
diseases of the heart, lungs, stomach, kidneys, and
bones.

Maximum class 20. Tuition $100.00.
This course is repeated as 651-B, 2 to 4 p.m., Fri-
days, October 3, 1952, through May 8, 1953.

652-A. DIAGNOSTIC RADIOLOGY

A part-time course of twelve weeks' duration, 4 to
6 p.m., Mondays, Wednesdays, and Fridays, Septem-
ber 15 through December 5, 1952. Designed for the
general practitioner in medicine. Consists of lectures,
practica] demonstrations, and Conferences covering
the physical principles underlying roentgenology,
basic normal X-ray anatomy, the principles and prac-
tice of fluoroscopy, and the application of X-ray diag-
nosis to the study of fractures, bone lesions, diseases
of the joints, lungs, heart, brain, gastrointestiml tract,
gall bladder, urinary tract, and the mastoid and
sinuses.

Frederick H. McKee, a.b., m.d., Assistant Clinical Pro-
fessor (Radiation Therapy)

Rieva Rosh, physician [kharkov], Assistant Clinical
Professor

Irving Schwartz, b.s., m.d., Assistant Clinical Professor

Jesse D. Stark, a.b., m.d., Assistant Clinical Professor

Eimer M. Claiborne, m.d., Lecturer

Edgar N. Grisewood, a.b., a.m., Lecturer in Radiology
(X-Ray Physics)

Hans R. Sielman, m.d. [munich], Lecturer

Anthony A. Blasi, a.b.; m.d. [rome], Instructor

Stanley H. Craig, b.s.; m.d. [basel], Instructor

Lawrence A. Davis, a.b., m.d., Instructor

Lewis J. Friedman, m.d., Instructor

Samuel T. Herstone, a.b., m.d., Instructor

Howard J. Hutter, m.d., Instructor

Max Miller, b.s., m.d. [vienna], med.sc.m., Instructor

Eleanor Oshry, b.s. (physics), Instructor (Radiological
Physics)

Herbert S. Sharlin, a.b., m.d., Instructor

Harry Weaver, a.b., m.d., Instructor

Constantino Zaino, b.s., m.d., Instructor

Joseph Zausner, b.s.; m.d. [vienna], Instructor

Alfred J. Bernstein, b.s.; m.b.,ch.b. [st. Andrews], Clini-
cal Instructor

Abraham Geffen, a.b., m.d., Clinical Instructor

Joseph J. Sher, b.s., m.d., Clinical Instructor (Derma-
tology)

Maximum class 20. Tuition $100.00.
This course is repeated as 652-B, February 16
through May 8, 1953.

653-A. RADIOLOGY, BASIC SCIENCES

A full-time course of nine months' duration, Sep-
tember 29, 1952, through June 19, 1953. Includes
anatomy, radiophysics, biochemistry, physiology, bac-
teriology, pathology, and the principles and applica-
tion of radiobiology.

Given under the direction of Dr. Milton Friedman.
Tuition $700.00.

654-A. RADIOBIOLOGY

A part-time course of twenty sessions, 5 to 7 p.m.,
Thursdays, January 29 through June 11, 1953. Open
to postgraduate students in radiation therapy and also
to practicing radiologists.

Consists of lectures and seminars and is designed
to bridge the gap between radiation physics and clin-
ical radiation therapy, by giving the Student a back-
ground of the biological as well as physical effects of
irradiation. After a review of the biological, physical,

chemical, and histological effects of radiation on
tissue, the application of these basic phenomena to
practica] radiation therapy is discussed. Radiation
genetics, recovery phenomena, time-dose studies, and
gamma roentgen dosage System for radium therapy
are reviewed. Problems are assigned which entail
directed outside reading to amplify the lectures.

Given under the direction of Dr. Milton Friedman.
Maximum class 20. Tuition $75.00.

655-A. RADIOPHYSICS

A part-time course of fifteen sessions, 9 to 10:30
a.m., Tuesdays, October 21, 1952, through Febru-
ary 3, 1953, consisting of didactic lectures and prac-
tica] demonstrations. Includes a consideration of the

basic concepts of electricity, magnetism, radiation;
the production and measurement of X rays; natural
and artificial radioactivity, including dosage deter-
minations.

Given under the direction of Dr. Milton Friedman.
Maximum class 20. Tuition $75.00.

656-A. DIAGNOSTIC RADIOLOGY

An intensive five-day course, füll time, June 15
through 19, 1953, consisting of lectures, practical
demonstrations, and Conferences covering X-ray diag-
nosis, diseases of the heart, lungs, and gastrointestinal,
urinary, and biliary tracts.

Tuition $50.00.

Practica! Seminar in Radiology

SURGERY

J. William Hinton, m.d., Professor and Chairman of the

Department
L. Corsan Reid, m.d.,c.m. [mcgill], Professor of Ex-

peri mental Surgery
R. Franklin Carter, b.s., m.d., Professor of Clinical

Siir^ery
Robert H. Kennedy, a.b., m.d., Professor of Clinical

Surgery
Arthur S. McQuillan, a.b., m.d., Professor of Clinical

Surgery

Herbert Willy Meyer, a.b., m.d., Professor of Clinical
Surgery

Walter W. Fischer, m.d., Associate Professor of Clinical
Surgery

S. Arthur Localio, a.b., m.d., med.sc.d., Associate Pro-
fessor of Clinical Surgery

Jere W. Lord, Jr., a.b., m.d., Associate Professor of
Clinical Surgery

Louis R. Slattery, a.b., m.d., Associate Professor of Clin-
ical Surgery

Robert T. Crowley, m.d., m.s. (surgery), med.sc.m.,
Assistant Professor of Clinical Surgery

David Lyall, b.s., m.d., Assistant Professor of Clinical
Surgery

Charles G. Neumann, a.b., m.d., Assistant Professor of
Clinical Surgery

Louis M. Rosati, b.s., m.d., Assistant Professor of Clin-
ical Surgery

George M. Saypol, b.s., m.d., Assistant Professor of

Clinical Surgery
Alexander Zimany, a.b., m.d., Assistant Professor of

Clinical Surgery

Philip A. Zoller, m.d., Assistant Professor of Clinical

Surgery
Bradley L. Coley, a.b., m.d., Clinical Professor
Lester Blum, a.b., m.d., Associate Clinical Professor
Lester Breidenbach, b.s., m.d., Associate Clinical Pro-
fessor

Harold E. Clark, a.b., m.d., Associate Clinical Professor

665-A. SURGERY (GRADUATE COURSE)

Designed for one academic year, September 29,
1952, through June 19, 1953, of fuU-time study to
precede or follow two or more years of surgical resi-
dency in an approved hospital. In this course approxi-
mately three quarters of the time is devoted to basic
sciences while the remainder is alloted to clinical sub-
jects. The basic sciences include anatomy, physiology,
biochemistry, bacteriology, pharmacology, surgical
pathology, and experimental surgery. Clinical teach-
ing is correlated with the basic sciences and is con-
ducted as informal round-table Conferences. These
Conferences are devoted to general surgery, tumor

Norman L. Higinbotham, m.d.,c.m. [mcgill], Asso-
ciate Clinical Professor

Miguel Grausman Elias, B.s., m.d., Associate Clinical
Professor

Walter D. Ludlum, Jr., a.b., m.d., Associate Clinical
Professor

Sigmund Mage, a.b., b.s., m.d., Associate Clinical Pro-
fessor

Herbert F. Newman, a.b., m.d., Associate Clinical Pro-
fessor

* Robert T. Findlay, m.d., Assistant Clinical Professor
William T. Medl, a.b., m.d., Assistant Clinical Professor
William Batiuchok, a.b., m.d., Instructor

Frank S. Butler, a.b., m.d., Instructor
Jameson L. Chassin, b.s., m.d., Instructor
Donald A. Davis, b.s., m.d., Instructor
Stephen L. Gumport, a.b., m.d., Instructor
Hector A. McDougall, b.s., m.d.,c.m. [mcgill],

Instructor
Carl S. Oakman, a.b., m.d., Instructor
Carl W. Roessel, a.b., m.d., Instructor
Charles F. Schetlin, a.b., m.d., Instructor
Reynold E. Church, b.s., m.d., Clinical Instructor
Lee Gillette, a.b., m.d., Clinical Instructor
Gabriel P. Seley, m.d., Clinical Instructor
Meyer M. Stone, ch.e., m.d., Clinical Instructor
Louis Venet, b.s., m.d., Clinical Instructor
Harry Chasserot, a.b., m.d., Assistant
Frederick W. Finn, b.s., m.d., Assistant
James K. Keeley, a.b., m.d., m.s. (surgery), Assistant
Rockwood Keith, b.s., m.d., m.s. (med.), med.sc.d.,

Assistant
Jane A. La Fetra, b.s. (med. tech.), Assistant
Graham C. Newbury, m.d., Assistant
Caspare A. Salvia, a.b., m.d., Assistant
Hugh E. Stephenson, Jr., b.s., m.d., Assistant

* Peter William Stone, m.d., Assistant
Harry B. Underwood, b.s., m.d., Assistant
Jerrold von Wedel, m.d., Assistant

*Leave of absence, armed forces.

surgery, pediatric surgery and the surgery of trauma.
Diagnostic roentgenology is given as part of the
course. Library periods are assigned for study of
surgical literature.

Given under the direction of Professor J. William
Hinton. Tuition $700.00.

660-A. ANATOMY AND PHYSIOLOGY OF
THE AUTONOM IC NERVOUS SYSTEM AND
THEIR CLINICAL APPLICATION

A full-time, one-week course, January 19 through
24, 1952, devoted to the anatomy and physiology of
the autonomic nervous System. Anatomical demon-

mtm

li^^Mto

SURGERY

strations and prosections are correlated with lectures
and Conferences. The diagnostic, therapeutic, and
surgical procedures performed upon the autonomic
nervous system for pathologic processes are thor-
oughly covered as well as the relation of the autonomic
nervous system to anesthetic, endocrinologic, and psy-
chosomatic problems.

Given under the direction of Professor J. William
Hinton and Dr. Joseph Pick of the department of
anatomy. Maximum class 12. Tuition $150.00.

661-A. REVIEW OF GENERAL SURGERY
(FOR SPECIALISTS)

A full-time course of four weeks' duration for
qualified surgeons, September 29 through October 25,

1952. Provides advanced Instruction in general sur-
gery by means of demonstrations, lectures, and a
review of applied surgical anatomy on the cadaver.
Special measures employed in the preoperative and
postoperative care of patients are emphasized in clin-
ical demonstrations and lectures by specialists from
the medical, surgical, and laboratory staffs. Differen-
tial diagnosis and treatment are discussed and demon-
strated in specialty clinics for the management of
diseases of the thyroid, stomach, colon and rectum,
biliary tract, pancreas, thorax, and cardiovascular
System. Similar clinical demonstrations are given by
the Tumor Service for diseases of the breast, tumors
of the head and neck, and malignant melanoma.
Physiological and biochemical aspects of surgical
practice are stressed and use of antibiotics discussed.

Given under the direction of Professor J. William
Hinton. Maximum class 20. Tuition $300.00.

This course is repeated as 661-B, March 30 through
April 25, 1953.

662-A. BASIC PROBLEMS IN CANCER THER-
APY (FOR SURGEONS)

A full-time course of twelve days' duration for
qualified surgeons, January 26 through February 7,

1953, on the basic problems of Cancer therapy. Early
diagnosis and modern methods of surgical therapy
are discussed in didactic lectures and case demonstra-
tions. The operative technique of block lymph-node
dissections and radical surgery for Cancer of the head,
neck, thorax, breast, abdomen, and extremities is
stressed in cadaver demonstrations.

Given under the direction of Dr. Herbert Willy
Meyer. Maximum class 20. Tuition $200.00.

663-A. RECENT ADVANCES IN SURGERY

A full-time course of two weeks' duration, Septem-
ber 8 through 20, 1952, consisting of didactic lectures

and demonstrations that cover the recent advances in
general surgery stressing physiological and biochem-
ical considerations. Emphasis is placed on recent
advances in surgery of the thyroid, thorax, and cardio-
vascular System, including portal hypertension and
cirrhosis of the liver. The physiological background
of gastric surgery and vagotomy in the management
of peptic ulcer is stressed, as well as the biochemical
and physiological advances related to surgery of the
intestines, biliary tract, and pancreas. The extended
concepts of Cancer surgery and lymphatic drainage are
covered from the pathological and anatomical stand-
points. The diseases of the autonomic nervous system
are covered and the physiological basis of surgical
procedures on this system emphasized.

Given under the direction of Professor J. William
Hinton. Tuition $200.00.

664-A. TRAUMA (EXCLUDING FRACTURES)
(FOR SURGEONS)

A full-time course of five and one-half days' dura-
tion, December 1 through 6, 1952. Emphasis is placed
on training in the correct methods of suturing tendons,
nerves, blood vessels, and intestines, and in the prepa-
ration and application of skin grafts and flaps in the
surgical laboratory. In preparation for this, the morn-
ings are spent in presentations of the indications for
and value of these procedures.

Given under the direction of Dr. Robert H. Ken-
nedy. Maximum class 30. Tuition $125.00.

666-A. DIAGNOSIS AND TREATMENT OF
TRAUMA

A full-time course of six days' duration, Decem-
ber 8 through 13, 1952. Planned for those physicians
who are now, or expect to be, concerned with indus-
trial or civilian injuries of all types. It is also aimed
at preparing physicians for better care of injury in the
event of civilian disaster. An intensive course of lec-
tures and demonstrations on the care and treatment
of the injured. Case demonstrations and ward rounds
are held at Beekman-Downtown, Bellevue, Univer-
sity, and Gouverneur Hospitals.

Given under the direction of Dr. Robert H. Ken-
nedy. Maximum class 20. Tuition $90.00.

667-A. SURGERY OF THE HAND

A full-time course of six days' duration, March 23
through 28, 1953. Considers the anatomy and physi-
ology of the band. A series of lectures and demonstra-
tions based on the practical clinical viewpoint toward
management, soft-tissue defects, fractures, infections,
burns, crush injuries, tendon repair, grafts and trans-

— "^

SURGERY

plants, vasomotor and tropic lesions, rehabilitation
and reconstruction. Given at Beekman-Downtown,
Gouverneur, Bellevue, and University Hospitals.

Given under the direction of Dr. Robert H. Ken-
nedy. Maximum class 20. Tuition $90.00.

668-A. DIAGNOSIS AND TREATMENT OF
FRACTURES AND DISLOCATIONS

A full-time course of two weeks' duration, Febru-
ary 2 through 14, 1953. Consists of review of current
methods of diagnosis and treatment, lectures, demon-
strations, ward rounds, and ambulatory clinics at
Beekman-Downtown, Gouverneur, and Bellevue Hos-
pitals. Includes presence at one or more bone Opera-
tions.

Given under the direction of Dr. Robert H. Ken-
nedy. Maximum class 20. Tuition $125.00.

669-A. SURGERY OF TRAUMA

A part-time course of ten sessions, 1 to 5 p.m.,
Thursdays, April 2 through June 4, 1953, covering
the field of trauma. Ward rounds, clinical demonstra-
tions, follow-up clinics, round-table discussions, and
lectures. Includes presence at one or more bone Opera-
tions. Given at Beekman-Downtown and Bellevue
Hospitals.

Given under the direction of Dr. Robert H. Ken-
nedy. Maximum class 20. Tuition $100.00.

Physicians Learning Surgical Technique in the Laboratory

6610-A. TRAUMA OF THE GENITOURINARY
SYSTEM

A part-time course of six sessions, 2 to 4 p.m.,
Tuesdays, September 9 through October 14, 1952.
Consists of lectures and demonstrations covering the
field of genitourinary trauma. A review is made of the
essential anatomy, abnormal physiology and path-
ology, diflferential diagnosis, and the principles of
treatment. Particular emphasis is placed on the meth-
ods of examination, including a discussion of the
investigation of the acutely injured patient at the bed-
side. An evaluation of the various injuries as related
to workmen's compensation is made also. Given at
Beekman-Downtown Hospital.

Given under the direction of Dr. Robert H. Ken-
nedy. Tuition $50.00.

661 1-A. PITFALLS IN INTERNAL FIXATION
OF FRACTURES (SPECIALISTS)

A full-time course of six days' duration, Novem-
ber 10 through 15, 1952. A series of lectures and
demonstrations on the physical, chemical, and physi-
ological characteristics of bone plates and screws;
errors in their manufacture and in technique of appli-
cation; intramedullary fixation and hip nailing. There
are also Operations and case demonstrations. Given
at Beekman-Downtown Hospital.

Given under the direction of Dr. Robert H. Ken-
nedy. Maximum class 20. Tuition $90.00.

UROLOGY

Robert S. Hotchkiss, B.s., m.d., Professor and Chairman

of the Department
Meredith F. Campbell, b.s., m.s., m.d., Professor
William Delzell, a.b., m.d., Professor of Clinical Urology
C. Travers Stepita, m.d., m.s., Professor of Clinical

Vrolofiy
Herbert Brendler, a.b., m.d., Assistant Professor
Thomas F. Howley, a.b., m.d., Associate Clinical Pro-
fessor
Herbert R. Kenyon, a.b., m.d., Associate Clinical Pro-
fessor
Dean Makowski, a.b., m.d., Associate Clinical Professor
Maximilian M. Nemser, m.d., Associate Clinical Pro-
fessor
George W. Slaughter, a.b., m.d., Associate Clinical Pro-
fessor
Seymour F. Wilhelm, b.s., m.d., Associate Clinical Pro-
fessor

John L. Alley, a.b., m.d.. Assistant Clinical Professor
Alvin C. Drummond, a.b., m.s., m.d., Assistant Clinical

Professor
Gaetano J. Mecca, m.d., Assistant Clinical Professor
Harry R. Newman, m.d. [Toronto], m.s., Assistant Clin-
ical Professor
Bernard D. Pinck, a.b.. m.d., Assistant Clinical Professor
Alien Abrahams, b.s.. m.d.. Instriictor
Joseph H. Marvin, b.s., b.s.s.. a.m., m.d., Instructor
Samuel S. Newman, m.d., Instructor
Lazarus A. Orkin, B.s., m.d., Instructor
John M. Silberblatt, a.b.. m.d., Instructor
Gustav Friedmann, m.d., Clinical Instructor
Ira J. Holzman, a.b., m.d., Clinical Instructor
Sol S. Katz, M.D. [LAUSANNE], CHnical Instructor
Robert E. Lucey, m.d., Clinical Instructor
Noah Meyerson, m.d.. Clinical Instructor
Irving M. Schneider, b.s.. m.d.. Clinical Instructor

Postgraduate study of varying duration may be
undertaken by special arrangement on a prorata basis
of $200.00 per month, füll time.

672-A. UROLOGY (GRADUATE COURSE)

A full-time course of one academic year, Septem-
ber 29, 1952, through June 19, 1953, designed par-
ticularly for those who intend to specialize in urology
and who will complete their training with a residency.
Major emphasis is placed on the basic sciences, includ-
ing anatomy, biochemistry, bacteriology, and pathol-
ogy. Application of the clinical science study is pre-
sented by means of cadaver and experimental surgery,
as well as by staff Conferences and round-table discus-
sions. The allied clinical subjects, such as anesthesiol-
ogy, medicine, general surgery, gynecology, and pedi-
atrics, are presented by specialists in the respective
fields. The purpose of the course is to give the Student
a firm foundation in the basic sciences as well as the
fundamentals of diagnosis and clinical management
of Urologie Problems. In exceptional circumstances,
the applicant may elect to pursue this course over a
three-year period. The first year he may be in attend-
ance for the first trimester (September to December).
The second year he may progress to the second trimes-
ter (January to March), and in the third year may
complete the last trimester (April to June).

Given under the direction of Professor Robert S.
Hotchkiss. Tuition $700.00.

67 1-A. ADVANCED COURSE IN UROLOGY
(FOR SPECIALISTS)

A full-time course of four weeks' duration, to be
held in May or June (dates to be announced later).

All surgical operative procedures are reviewed on the
cadaver and in operative clinics with ward rounds for
Instruction in preoperative and postoperative care.
Advanced instruction in cystoscopic and urethro-
scopic diagnosis and treatment in urography is given
in the outpatient department. The newer aspects of
correlated subjects such as anesthesiology, cardiovas-
cular disease, microbiology, and renal physiology are
presented. Topics related to recent advances in
urology are reviewed.

Given under the direction of Professor Robert S.
Hotchkiss. Tuition $175.00.

564-A. INFERTILITY

A three-day, full-time course given jointly by the
department of urology and the department of obste-
trics and gynecology, December 8 through 10, 1952.
Problems of sterility are presented as related to both
husband and wife. Methods of diagnosis and treatment
are presented by lectures, outpatient demonstrations,
and laboratory techniques.

Tuition $40.00.

674-A. REFRESHER COURSE IN BASIC
UROLOGY

A one-week, full-time course, November 10
through 15, 1952, devoted to anatomical-surgical
demonstrations on the cadaver. A review of embry-
ology, pathology, and physiology of the genitourinary
System.

Given under the direction of Professor Robert S.
Hotchkiss. Tuition $60.00.

1^-^

General Information

POST-GRADUATE MEDICAL SCHOOL

The New York University Post-Graduate Medical
School was founded on December 1, 1947, through
the consolidation of the New York Post-Graduate
Medical School and the Postgraduale Division of the
College of Medicine.

The New York Post-Graduate Medical School
and Hospital was incorporated in 1882 and chartered
by the State in 1886. The College of Medicine of New
York University oflfered postgraduate studies first in
1914 and, because of the large number of physician
veterans interested in retraining, organized the Post-
graduate Division of the College of Medicine in 1945.
This was made possible through a three-year grant
from the W. K. Kellogg Foundation.

The Consolidated Post-Graduate Medical School
through its clinical Services offers courses in practi-
cally all fields of medicine and surgery for the general
practitioner and the specialist.

The present greatly expanded program has been
made possible through the generosity of the Samuel H.
Kress Foundation, which has made a substantial con-
tribution for a ten-year period for the support of the
Post-Graduate Medical School.

The following hospitals participate in the graduate
and postgraduate program of the school:

Bellevue Hospital, the oldest of 26 municipal hos-
pitals owned and operated by the Department of Hos-
pitals of New York City, was founded in 1736 and
was given its present name in 1816. It accommodates
over 3,000 patients, primarily those with acute disease.
Yearly admissions average 65,000. The hospital is
organized in four divisions, the fourth being the teach-
ing division of the Post-Graduate Medical School.

Beekman-Downtown Hospital, a voluntary hospital
of 180 beds, is known for its large number of admis-
sions of patients with acute surgical conditions, par-
ticularly of traumatic origin.

Beth Israel Hospital, a voluntary Institution of 382
beds and 80 bassinets.

Goldwater Memorial Hospital for Chronic Dis-
eases. The New York University Division has 750
beds divided among medical, surgical, neurological,
and research Services.

Gouverneur Hospital, a municipal hospital of 200
beds.

Irvington House, a voluntary hospital of 103 beds
located at Irvington-on-Hudson, New York. The
Institution specializes in the care of children with rheu-
matic fever and rheumatic heart disease.

Lenox Hill Hospital, a voluntary hospital of 600
beds.

A'^H' York Eye and Ear Infirmary, a voluntary hos-
pital, was the first Institution established in this coun-
ery limited to diseases of the eye, ear, nose, and throat.
It has 171 beds in addition to a very large outpatient
Service.

New York State Rehabilitation Hospital, at Haver-
straw, New York, is a specialty hospital of 300 beds,
which is limited to the care of children and adults with
orthopedic conditions, as well as poliomyelitis.

St. Vincent's Hospital is a voluntary hospital of 544
beds. An extensive building program will increase its
capacity to 626 beds.

University Hospital, formerly the New York Post-
Graduate Hospital, has been an integral part of the
Medical Center since December 1, 1947. It has 406
beds.

Willard Parker Hospital, a municipal Institution of
433 beds, is limited to the treatment of contagious dis-
ease. In addition to the usual contagious diseases,
there are available 100 beds for the care and study of
patients with pulmonary tuberculosis.

The number of beds directly affiliated with the
Medical Center totals approximately 6,500.

NEW YORK UNIVERSITY-BELLEVUE MEDICAL CENTER

New York University established the Medical Cen-
ter in 1948 in order to carry out an expanded pro-
gram of medical education, research, and patient care.
The Medical Center includes the College of Medicine,
the Post-Graduate Medical School, and the twenty-
three hospitals in which the clinical part of the pro-
gram of the two schools is carried out. All the hospitals
are operated by outside agencies, either municipal or

voluntary, except the University Hospital, which is
owned and operated by the University. By far the
largest part of the clinical program is in Bellevue
Hospital, in which the University has operated its
teaching and research programs for over a Century.
Through the facilities of the Medical Center, the
University is now able to offer to students— undergrad-
uate, graduate, and postgraduate— and to research
workers one of the finest opportunities now available.

IMM

General Information

REGIONAL HOSPITAL PLAN

The REGIONAL HOSPITAL PLAN provides to
nonteaching hospitals in suburban and rural areas
association with the teaching and research staffs of
the Medical Center. Resident physicians of these
affiliated hospitals have the privilege of spending an
academic year in a graduate course at the center, with
the tuition waived subject to the rules and regulations
governing the Regional Plan.

The objective of the Regional Hospital Plan is the
improvement of the medical care in the communities
served by the hospitals. It also provides a distinct
broadening of the opportunities for postgraduate edu-
cation to the practicing physicians in these areas.

The Regional Hospital Plan is supporteä by a grant
from the W. K. Kellogg Foundation.

Participating hospitals as of April 1, 1952, are:
Easton Hospital, Easton, Pennsylvania
Fitkin Memorial Hospital, Neptune, New Jersey
Grasslands Hospital, Valhalla, New York
Greenwich Hospital, Greenwich, Connecticut

Hunterdon Medical Center, Flemington,

New Jersey*
Meadowbrook Hospital, Hempstead, New York
Monmouth Memorial Hospital, Long Branch,

New Jersey
Mountainside Hospital, Montclair, New Jersey
New Rochelle Hospital, New Rochelle,

New York
Overlook Hospital, Summit, New Jersey
St. Luke's Hospital, Newburgh, New York
St. Vincent's Hospital, Bridgeport, Connecticut
Vassar Brothers Hospital, Poughkeepsie,

New York

*Under construction.

The Regional Hospital Plan of the Medical Center
is administered by the Division of Affiliated and
Regional Hospitals of which Associate Dean Clarence
E. de la Chapelle and Associate Dean Frode Jensen
are in Charge.

Physicians from 27 Foreign Countries, 45 States, and 2 Territories
Studied Last Year in the Post-Graduate Medical School

är' j(f«''^ä;n

,.t^i^^l0^^7^^.^

^* ^

•^!

^■1^

General Information

POSTGRADUATE COURSES

The school offers numerous postgraduate courses
on a part-time or full-time basis in the various fields
of medicine and surgery. These courses are designed
to meet the needs of physicians in practice whether
specialists or general practitioners. Whenever pos-
sible, the school will endeavor to establish courses for
special groups. The minimum requirements for admis-
sion to these courses are :

1. Graduation from a medical College, or its
equivalent, approved by the Post-Graduate Medical
School.

2. Completion of an internship of at least one year
(or nine months of the accelerated wartime schedule)
in a hospital approved by the Post-Graduate Medical
School, except in the case of foreign students who will
be required to have an equivalent amount of hospital
experience.

All applications and inquiries concerning admission
should be addressed to the Office of the Dean, Post-
Graduate Medical School, 477 First Avenue, New
York 16, N.Y.

NEW YORK UNIVERSITY • POST-GRADUATE MEDICAL SCHOOL

477 Jirst Avenue • ?^ew Jork i6 • "New Jork

APPLICATION FOR POST-GRADUATE COURSES

Last Name.

.First Name.

.Middle Name.

Permanent Address.

Age

Attended.

.Sex.

.Citizenship.

(City)
Marital Status.

(State)

.Medical School from.

.to.

.Degree.

HOSPITAL INTERNSHIPS OR RESIDENCIES:

0)-

(Name of Hospital)
(2).

(City)

(State)

.from.
.from.

.to.
.to.

(Name of Hospital) (City) (State)

State below the nature of each of the internships or residencies (i.e., whether rotating, medical, or surgical):

' ^~~~ (2) _ J(Use back for additional data)

PREVIOUS GRADUATE OR POSTGRADUATE MEDICAL STUDY (List on back)

Licensed to practice medicine in (state). ___^

Professional organizations or specialty board certification.

.(year).

.License No.

PRESENT HOSPITAL AFFILIATION.
Type of Practice

(Hospital)

(City)

(State)

(DateApp'd)

(Service)

Military Service (list on back with dates and brief indication of type of professional experience):

I HEREBY APPLY FOR ADMISSION TO THE FOLLOWING COURSES:

^o __ Subject.

No._

.Beginning.

.Subject-

Date.

.Beginning.

Approved-

(Signatur e of Applicant)

GRADUATE COURSES

Graduate courses of one year's duration at the
Post-Graduate Medical School are offered to provide
advanced training in medicine and surgery and also
in the medical and surgical specialties. They may be
taken as part of a residency training program or in
preparation for examinations of the various specialty
boards. The minimum requirements for admission to
these courses are :

1 . Graduation from a medical College approved by
the Post-Graduate Medical School or the Council on
Medical Education and Hospitals of the American
Medical Association

2. Completion of an internship of at least one year
in a hospital approved by the Post-Graduate Medical
School or, in the case of foreign students, an equiva-
lent amount of hospital training

3. Approval by the head of the department in
which the course is to be given

It is not possible for the committee on admissions
to interview all candidates for admission to these
studies. However, candidates may be requested to
appear before the committee.

Examinations, either written or oral or both, are
required of Student physicians before completion of
the graduate courses.

The regulations governing examinations are sub-
ject to change at any time.

A certificate will be granted to those physicians who
have fulfilled all the requisites of a graduate course
of study, including the successful passing of required
examinations. (5^^page62)

NEW YORK UNIVERSITY • POST-GRADUATE MEDICAL SCHOOL

477 7irst Jvenue • Tiew Jork 16 • T^ew york

APPLICATION FOR GRADUATE COURSE

Last Name.

.First Name.

.Middle Name.

Permanent Address

A ge Sex.

.Citizenship.

(City)
Marital Status.

(State)

A ttended-

.Medical School from.

.to.

.Degree.

HOSPITAL INTERNSHIPS OR RESIDENCIES (Indicate whether rotating, medical, surgical, etc.):
fj) from- . to

(Name of Hospital)
(2).

(City)

(State)

(Name of Hospital)
(3)

(City)

(State)

.from.

)

.from.

to.

.to.

Type.

-Type.

(Name of Hospital) (City) (State)

PRESENT HOSPITAL AFFILIATION:

from.

(Name of Hospital) (City) (State)

If in practice, indicate whether general or confined to a specialty.

Licensed

.to.

-Type.

Year.

1 HEREBY APPLY FOR ADMISSION TO THE FOLLOWING COURSE:

No.

.Subject.

. Beginn ing.

Date.

Approved.

The applicant must Supplement this form with: (I) transcript
of medical College record; (2) certification of hospital intern-
ship (and residency); (3) three letters of recommendation from
qualified physicians; (4) applicant's photograph; (5) applicant

(Signature of Applicant)

for the course in surgery must furnish written assurance of a
residency or appointment to the attending staff of an approved
hospital following completion of the course.

General Information

he graduate courses are:

Number

Page

Anesthesiology

513-A

Dermatology and Syphi ology

525-A

Forcnsic Medicine

531-A

Industrial Medicine

481-A

Medicine

5429-A

Neurology

645-A

Ophthalmology

576-A

General Information

Orthopedic Surgery

Otorhinolaryngology

Pediatrics

Physical Medicine and

Rehabilitation
Psychiatry
Surgery
Urology

Number

Page

581-A

593-A

6110-A

738-A

649-A

665-A

672-A

DEGREES

Master of Science

This degree in a designated clinical field, e.g., M.S.
(in Ophthalmology), M.S. (in Dermatology and
Syphilology), etc., may be awarded after the candi-
datc has fulfillcd the following requirements:

1. He must be or have been registered as a gradu-
ate Student for one year in the school subsequent to
1951 when this degree was approved by the Univer-
sity.

2. He must give evidence of at least two additional
yearsof graduate training beyond the internship. Grad-
uate training other than that obtained at the school
must be in hospitals or institutions approved by the
faculty. A fellowship or preceptorship may be ac-
ceptcd in lieu of a residency but prior approval must
be obtained by the faculty.

3. He must submit an acceptablc thesis following
completion of thrce years of graduate work. However,
ycarly registration is necessary until the candidate has
submittcd his thesis. This thesis may represent labora-
tory or clinical invcstigation. Before the candidate is
recommcnded for the degree, his thesis must be
approved by a committee of readers appointed by the
dean.

The matriculation fee is $6.00 per year except for
the one year spent in a graduate course at the school
No credit will be allowed by the University toward a
doctorate in philosophy for work done in satisfying
the requirements of the Master of Science degree.

Doctor of Medical Science (Med.Sc.D.)

A physician regularly matriculated in the Post-
Graduate Medical School may, in exceptional circum-
stances, be recommendcd as a candidate for the degree
of Doctor of Medical Science (Med.Sc.D.) Such a
Student, if enrolled in one of the graduate studies
must not only satisfactorily complete the special
requirements of the course including examinations but

must also show unusual professional ability and excep-
tional academic attainments. Other candidates, espe-
cially those participating in full-time research in a
precljnical and/or clinical department, may at the
completion of at least one year of such work be recom-
mcnded by the department head as a candidate for
the advanced degree. In the event that a candidate is
approved, he will be required to meet the following
regulations:

He shall spend at least three years in graduate study,
of which at least one year shall be at the Post-Gradu-
ate Medical School.

A Student must maintain his matriculation in the
Post-Graduate Medical School throughout the period
of his candidacy for the degree. A matriculation fee
of $6.00 is payable each year.

A preliminary examination, conducted at least one
year before the time the candidate will apply for the
degree, is designed to demonstrate a comprehensive
and accurate knowledge of the preclinical sciences as
requisite for mastery of his special field. This examina-
tion will be both oral and written. If the candidate
successfully passes this examination, he will be per-
mitted to continue his graduate work including inde-
pendent invcstigation and the preparation of his
thesis. It is expected that the preparation of an ac-
ceptablc thesis will usualiy require not less than an
academic year. The thesis must conform to regulations
printed in a separate pamphlet obtainable from the
dean's ofhce.

The final examination is a defense of the thesis.
The chairman of the examining board will submit to
the dean, as soon as possible after the examination,
the opinion of the committee as a whole regarding
the candidate's qualifications for the degree.

No candidate will be recommcnded for a degree
until the graduation fee and all other required fees
have been paid. These fees are due and payable on or
before May 15.

AUDIO-VISUAL METHODS AND AIDS USED BY THE DIVISION OF CARDIOLOGY

The division of cardiology has developed, during
the last several years, certain audio-visual methods
that have special application in the teaching of cardio-
vascular diseases.

The first of these is the fluoro-demonstrator, which
is a device using heart modeis and allows visualization
of the Silhouette of the heart in all positions. This Sil-
houette has all the appearances of the heart under
the fluoroscope with the exception of pulsating
motion.

The classroom is equipped with ultraviolct light,
known as "black light," which allows the use of fluo-
rescent paints and chalks that stand out brilliantly with
the room darkened for viewing X rays, lantern slides,
or oscilloscopes.

The Educational Electron Cardioscope uses a

sixteen-inch, television-type tube on which the instan-
taneous electrocardiogram, stethocardiogram, or bal-
listocardiogram may be shown. Thus, it is possible to
do much of the teaching of electrocardiography and
stethocardiography directly from patients without the
use of slides. The Educational Electron Cardioscope is
also equipped with a special sound Channel, and each
seat is wired so that the individual Student, by using
an electronic stethoscope, may hear the sounds and
murmurs from the patient's heart as he would through
his own stethoscope.

Inasmuch as suitable cases are not always available
for demonstration, a special tape recorder for heart
sounds has been developed, and a large library of
these recordings is available for the demonstration of
all types of auscultatory phenomenon.

DISCIPLINE

In Order to safeguard its ideals of scholarship, char-
acter, and personal behavior, the University reserves,
and the Student concedes to the University, the right
to require the withdrawal of any Student at any time
for any reason deemed sufficient to it. A prorata return
of fees will be made if further attendance of any Stu-

dent is prohibited before the end of a course for which
such Student has paid his fees.

The University reserves the right to withhold all
injormation about the record of any Student who is
in arrears in the payment of fees or other obligations.

REGISTRATION

All students must register in person at the office
of the dean before attending any course. Payment of
tuition must be made at the time of registration.

To make a definite reservation, a deposit may be
required in advance of the opening date of a course.
This deposit will not be returned if the applicant fails

to attend; however, he may attend a course within this
or the following academic year, and the original
deposit will be credited. No refund will be made to a
Student who fails to complete the course in which he
has enrolled (except in case of serious illness of the
Student).

VETERANS

Veterans who plan to use the educational benefits
of Public Law 346 must secure from the Veterans
Administration a Certificate of Eligibility and Entitle-
ment. Veterans who have previously used benefits at
another Institution must obtain a Supplemental Cer-
tificate of Eligibility. In either case, the certificate
must be presented at the time of registration or the
Student will be held responsible for the fees. Refunds
will be made from the effective date of the certificate.

It is to be noted that the name of New York University,
the name and dates of the course must appear on the
certificate.

Recipients of New York State War Service Scholar-
ships should present, at the time of registration, evi-
dence of the award from the New York State Educa-
tion Department authorizing use of the scholarship at
New York University.

mf^

General Information

BOOKS AND SUPPLIES

In some of the courses, certain books and Instru-
ments are required; in others, they are merely recom-
mended. Students are advised to avail themselves of

the Service offered by the Center bookroom since it
offers the advantage of lower prices. The bookroom
is in the Twenty-sixth Street building.

FOREIGN STUDENTS

Students from abroad should consult the office of
the dean concerning admission and course offerings.
Such applicants must have achieved superior records
and have sufficient proficiency in English to enable
them to profit from their educational experience in the
United States. A written application, including a com-
plete chronological outline of education abroad,
together with füll educational credentials in the orig-

inal and authorized or notarized translations thereof,
constitutes the first step in the admission process. If
approved, certificates of admission will be forwarded
so that the necessary arrangements may be made
through the office of the American consul. A registra-
tion fee of $50.00 per academic year is required of a
foreign Student undertaking recommended postgrad-
uate work outside of the school.

STUDENT HEALTH SERVICE

The physicians of the Student Health Service are
available for consultation by physicians enrolled in
the Post-Graduate Medical School who may become
ill.

The Student Health Service is located in the ad-
ministration building of the Post-Graduate Medical

School at 477 First Avenue. Office hours are from
12:30 to 1:30 p.m., Mondays through Fridays. Pro-
vision can be made for caring for emergencies occur-
ring at other hours by telephoning Oregon 9-3200,
Extension 389.

LIBRARY

The library of the Medical Center, located in the
Twenty-eighth Street building, is the consolidation of
the libraries of the College of Medicine and the New
York Post-Graduate Medical School.

The library contains Standard textbooks and mono-
graphs in all fields of medicine, and about 375 differ-

ent periodicals including foreign ones, are received
regularly. The library has about 59,000 volumes.

A reading room is maintained in the Post-Graduate
Medical School building. This room contains text-
books and recent periodicals.

THE TEACHING STAFF

The list of members of each department was accu- Because appointments were not complete at that time,
rate at the time this announcement went to press. some of the lists are subject to change.

OFFICERS OF ADMINISTRATION OF THE UNIVERSITY

Henry T. Heald, B.S. in C.E., M.S. in C.E., D. Engr., LL.D., Chancellor

Harry Woodburn Chase, A.B., A.M., Ph.D., L.H.D., Litt.D., LL.D., Chancellor Emeritus

Frank Leo Howley, B.S., LL.D., Vice Chancellor for University Development

LeRoy Elwood Kimball, A.B., A.M., LL.D., Vice Chancellor and Comptroller

Harold Oliver Voorhis, B.S., A.M., LL.D., Vice Chancellor and Secretary

*Rufus Daniel Smith, A.B., A.M., LL.D., Provost

Thomas Clark Pollock, A.B., A.M., Ph.D., Litt.D., Acting Provost

Elwood Curt Kastner, B.S., LL.D., Registrar; Supervisor of Admissions

Wesley Raymond Hendershot, B.C.S., Bursar

Ernest Leopold Hettich, A.B., A.M., Ph.D., Director of the Libraries

Ralph W. Sockman, A.B., A.M., Ph.D., D.D., S.T.D., L.H.D., Litt.D., LL.D., University Chaplain

♦On leave of absence to March 1, 1952

OFFICERS OF ADMINISTRATION OF THE

MEDICAL CENTER

Edwin A. Salmon, Director

Donal Sheehan, M.S., M.B.,Ch.B. [Manchester], M.D., Sc.D., Associate Director

Currier McEwen, B.S., M.D., Sc.D. (Hon.), Dean, College of Medicine

Robert Boggs, A.B., M.D.,C.M. [McGill], Dean, Post-Graduate Medical School

Edwin M. Bernecker, M.D., Hospital Administrator

Edgar S. Tilton, A.B., Executive Secretary

-J*V

INDEX

Administration, ofücers of : school, 3; University, 65

Admission, 60, 61

Anatomy, 6-7

Anesthesiology, 8

Application forms, 60, 61

Audio-visual methods and aids, 63

Books and supplies, 64

Calendar of courses, 4-5

Chemistry, 10

Degrees: Doctor of Medical Science, 62; Master of

Science, 62
Dermatology and syphilology, 11-14
Discipline, 63
Foreign students, 64
Forensic medicine, 15
General information, 58-64
Graduate courses, 61, 62
Gynecology, 29-3 1

Hospitals affiliated with the Medical Center, 2, 58
Industrial medicine, 16-17
Library, 64
Medicine, 18-26
Microbiology, 27
Neurology, 48-50
Neurosurgery, 28

New York University— Bellevue Medical Center, 58

Obstetrics and Gynecology, 29-31

Ophthalmology, 32-34

Orthopedic surgery, 35

Otorhinolaryngology, 36-38

Pathology, 39

Pediatrics, 40-42

Pharmacology, 43

Physical medicine and rehabilitation, 44-45

Physiology, 46

Post-Graduate Medical School, 58

Postgraduate courses, 60

Preventive medicine, 47

Professors emeriti, 3

Psychiatry and neurology, 48-50

Radiology, 52-53

Regional Hospital plan, 59

Registration, 63

Rehabilitation, 44-45

Student health service, 64

Surgery, 54-56

Syphilology, 11-14

Urology, 57

Veterans, 63

■,i

Fortschritte / Advances / Progrfes

Antibiotica et Chemotherapia. Fortschritte / Advances / Progr^s. Hgb.
von / edited by / dirig6 par H. Bloch, O. Gsell und E. Langer.
Vol. 1:X + 378 p., 113 flg., 1 färb. Taf., 1954. . . . sFr. 52.—

Fortschritte der Augenheilkunde / Advances in Ophthalmology / Progre«

en Ophthalmology. Hgb. von / edited by / dirig6 par E. B. Streiff.
Vol. 1: Xfl + 291 p., 1952. (Bibl. Ophthal, fasc. 36.) . . sFr. 39.50
Vol. 2; VIII + 333 p., 28 fig., 1953. (Bibl. Ophthal, fasc. 38.) sFr. 39.50
Vol. 3: VIII 4- 336 p., 1954. (Bibl. Ophthal, fasc. 39.) . sFr. 39.50
Vol. 4: ca. 350 p., ca. 50 fig., 1954. In Vorbereitung

Fortschritte der Biochemie 1938-1947.

Von F. Haurowitz. VIII + 364 p., 5 fig., 1948 . . . sFr. 41.60

Fortschritte der Geburtshilfe und Gynäkologie.

Vol. 1 : Mit Beiträgen v. W. Neuweiler, P. Jung u. O. Käser.

88 p., 4 fig., 1950. (Bibliotheca Gynaecologica fasc. 9). . sFr. 9.35

Vol. 2: Mit Beiträgen von A. Reist und H. Hosemann. 149 p.,

25 fig., 1951. (Bibliotheca Gynaecologica fasc. 10.) . . sFr. 18.70

Fortschritte der Hals- Nasen- und Ohrenheilkunde / Advances in Oto-
Rhino-Laryngologie / Progres en Oto-Rhino-Laryngologie.
Hgb. von / edited by / dirige par L. Rüedi.
Vol. 1: Mit Beiträgen von M.Arslan, L. B. W. Jongkees
und E. Wodak. VIII + 263 p., 49 fig., 1953. (Bibliotheca

Oto-Rhino-Laryngologica fasc. 1.) sFr. 36. —

Vol. 2: Mit Beiträgen v. F. Altmann u. K. Graf. VH-274 p.,

40 fig., 1955 sFr. 36.—

Fortschritte der Tuberkuloseforschung / Advances in Tuberculosis
Research / Progres de TExploration de la Tuberculose.

Hgb. von / edited by / dirig6 par H. Birkhäuser und H. Bloch.
Vol. 1/2: IV+446 p., 5 fig., 1948. (Bibl. Tuberc. fasc. 1-2.) sFr. 52.—
Vol. 3: IV + 307 p., 13 fig., 1950. (Bibl. Tubcrc. fasc. 3.) . sFr. 39.50
Vol. 4: 308 p., 59 fig., 1951. (Bibl. Tuberc. fasc. 5.) . . sFr. 43.70
Vol. 5: VIII + 370 p., 79 fig.,. 1952. (Bibl. Tuberc. fasc. 6.) sFr. 46.80
Vol. 6: ca. 250 p., ca. 120 fig., 1954. (Bibl. Tuberc. fasc. 9.) sFr. 32.—

Progress in AUergy / Fortschritte der Allergielehre.

Edited by / hgb. von P. Kallös.

Fo/. /; 400 p., 38 fig., 1939 VergrifTen

Vol. 2: VIII + 356 p., 50 fig., 37 tab., 1949 .... sFr. 37.45

Vol. 3: VIII + 572 p., 82 fig., 61 tab., 1 col. plate, 1952 . sFr. 68.65

Vol. 4: VIII + 520 p., 149 fig., 63 tab., 1954 .... sFr. 68.65

Wiederherstellungschirurgie und Traumatologie / Reconstruction Sur-
gery and Traumatology / Chirurgie Reparatrice et Traumatologie.

Jahrbuch / Annual Survey / Annuaire. Hgb. von / edited by / dirig6
par M. Lange.

Fo/./: VIII + 260 p., 101 fig., 1953 sFr. 36.—

Fo/. 2: IV + 244 p., 129 fig., 1954 sFr. 36.—

BASEL (Schweiz)

S. KARGER

NEW YORK

Proceedings
of the

Rudolf Virchow
Medical Society

in the City of New York

Volume XII
1953

Edited by the Rjblication Committee
Hans Behrendt / Joseph Berberigh

HAR KaLIND^SKY

BASLE (Switzcrland) S. KARGER Publishcrs NEW YORK

Antibiotica et Chemotherapia

Fortschritte / Advances / Progres

Herausgegeben von — edited by — dirig6 par

H. BLOCH O. GSELL E. LANGER

New York Basel Berlin

VOL. 1

X + 378 p., 113 fig., 1954. sFr. 52.—

INDEX

Die neuere Entwicklung der Antibiotica als Arzneimittel.
Von J. BÜCHI, Zürich.

Die Behandlung der Endocarditis lenta mit Antibiotica.
Von H. BARTELHEIMER und W. ENGERT, Berlin.
Sulfonamide Combinations.
By S. HELANDER, Stockholm.

Les accidents provoqu^s par les Antibiotiques.
Par P. RENTCHNICK, Gen^ve.

Antibiotica und Pilrerkrankungen der Haut und Schleimhaut.
Von H. GRIMMER, Berlin.

Pilzerkrankungen der inneren Organe als Folge von Behandlung

mit Antibiotica, unter besonderer Berücksichtigung des

Respirationstraktes. Von T. WEGMANN, Zürich.

Wirkung der Antibiotica, insbesondere des Penicillin, auf das

vegetative Nervensystem und das Endocrinum.

Von W. BLAICH, Münster.

Antibiotica in der Pädiatrie. Von E. ROSSI, Zürich.

Medizinische Monatsschrift, Heft 9, 1954: «Die Absicht der Heraus-
geber des vorliegenden Werkes, eine in Form eines Jahrbuches in
Slf. '^'n ^'n? -jfderkehrende Übersicht über den Stand der
antibaktenellen Behandlung zu schafTen, wird nicht nur von den
Kennern des Fachgebietes, die ja selbst vor einer kaum zu bewältigen-
den Literaturanhaufung stehen, sondern vor allem von den Ärzten
die am Krankenbett stehen und täglich zu antibiotischen Mitteln grei-
fen müssen, ehrhch begrüßt werden. Schon der erste hier vorliegende
Band bringt eine Anzahl vielversprechender Einzeldarstellungen aus
der Feder hervorragender Sachkenner.»

BASEL (Schweiz)

S. KARGER

NEW YORK

's
l

Proceedings
of the

Redolf Virchoiv
Medical Society

in the City of New York

Volume XII
1953

Edited by the Publication Committee

Hans Behrendt Joseph Berberich

Lothar Kalinowsky

BASLE (Switzerland) S. KARGER Publishers NEW YORK

All rights, including that of translation into foreign languages, reserved.
Photomechanic reproduction (photocopy, microcopy) of this book or part of it without special permission

of the publishers is prohibited.

Printed in Switzerland by Buchdruckerei Zur Neuen Aargauer Zeitung, Aarau.

CONTENTS

MEETING OF JANUARY 5th

Aesthetic Considerations in Reconstructive Plastic Surgery
Gustave Aufricht

Treatment of Hypertension with Ganglionic Blocking Agents
Paul H. Kuhn

Discussion: Emil Glass

MEETING OF FEBRUARY 2nd

Insecticides 15

Ludwig Teleky

Lead Poisoning in Children 21

Frederick G. Zak

Ambulatory Anticoagulant Therapy. An Evaluation of a 4 Years
Experience (Manuscript not received)
Kurt Lange

MEETING OF MARCH 2nd

Selected Legal Topics 22

Albert Hirst

Psychiatric Aspects of Criminal Behavior 35

Leo L. Orenstein

MEETING OF APRIL 6th

Symposium on Ulcerative Colitis

Medical Aspects 37

Charles L Krieger

Surgical Aspects 45

Helmuth Nathan

III

Psychiatric Aspects ^^

Bernhard C. Meyer (by invitation)

Pathologie Aspects (Manuscript not received)
Max Wachstein

MEETING OF MAY 4th

Demonstrations:

Newer Techniques in Cineplastic Amputations 52

Ernst W. Bergmann

Pulmonary Sarcoidosis 54

F. C. Burgheim
Acute Mesenteric Vascular Occlusion Following Mumps ... 56

Wolf Elkan
Craniopharyngeomas in Children and Adults and their Operative
Treatment by the Transphenoidal Method
(Manuscript not received)

Oscar Hirsch (by invitation)

Treatment of Excessive Smoking by Hypnosis 60

Edith Klemperer

Cancer of the Lungs and Lobectorny 62

Richard Lewin

Myocardial Infarction in a 24 Year old Boy 66

Rudolf A. Stern

Bovine Tuberculosis of the Kidney 69

Alfred Zinner

MEETING OF OCTOBER 5th

Supervoltage Roentgen Therapy 73

F. C. Burgheim

The Physical Aspects of Radioactive Cobalt Therapy . ... 11
Lillian E. Jacobson (by invitation)

The Diagnostic and Therapeutic Uses of Radioactive lodine . . 89
Martin Perlmutter (by invitation)

MEETING OF November 2nd

The KimmelstieUWilson Syndrome and its Clinical Variants . . 91
Harold Rifkin (by invitation)

Medical Management of Peripheral Vascular Diseases in Diabetes 95
Heinz I. Lippmann

Surgical Management of Peripheral Vascular Diseases
Samuel Silbert (by invitation)

Ocular Manifestations in Protracted Diabetes

Georges Kleefeld (by invitation)

Insulin Management of Diabetes

Martin G. Goldner

MEETING OF DECEMBER 7th

Superfical Ulceration of the Urethral Meatus in Male Children
Paul Freud

Some Non-Tuberculous Chest Diseases in Children
Helene Eliasberg

Apocrine Sweat Glands and Sexual Development
H. Behrendt

Discussion: H. Vollmer

103
104
107

Obituaries

Presidents of the Rudolf Virchow Medical Society
Members of the Rudolf Virchow Medical Society

113
115
121
121

124
127
128

AESTHETIC CONSIDERATIONS
IN RECONSTRUCTIVE PLASTIC SURGERY

Gustave Aufright

The plastic surgeon deals with the reconstruction and repair of
defects and deformities mostly on the surface of the body. The defects
may be acquired by trauma, such as war injuries, automobile acci-
dents, bums, etc., or caused by pathologic conditions, such as neo-
plasm, or infectious diseases (lues, tuberculosis, etc.) or they may be
congenital such as hare lip, congenital absence of ear, syndactylia,
extensive nevi, etc. The condition actually is a surgical problem and
the reason for the plastic surgeon's interest and aptitude to deal with
these reconstructions is not only his experience with transplantation
for replacing tissue losses but his special training and attention to the
aesthetic details and accuracy. From the plastic surgeon's i>oint of
view it is not sufficient to close the defect or cover it with a skin graft
or Aap. The reconstructed part has to be re-built to normal contours
and the transplant should be as good a match as possible to the
original, in thickness, texture, color, hairiness, etc. The scars with the
neighboring region should be placed as inconspicuously as possible.
Attention must be paid also not to cause unsightly secondary dis-
figurement at the place of the donor site. The plastic surgeon always
keej>s before his eyes the aesthetic requisites of reconstruction.

( Illustrated with slides and film. )

1«

TREATMENT OF HYPERTENSION WITH
GANGLIONIC BLOCKING AGENTS

Paul H. Kuhn

A physician who is called upon to treat a hypertensive patient
would do well to be guided by the foUowing known facts which have
emerged from the wealth of clinical experience and experimental work
in the field of hypertension.

1 ) Many cases of essential hypertension follow a benign course.

2) The etiology of essential hypertension is not yet clearly under-
stood. There are probably several factors, neurogenic, humoral,
endocrine, infectious, etc., which in combination lead to the
development of what is known as essential hypertension. The
clinical features of this entity do not disclose in which proportion
these factors bear upon the etiology of the disease.

3 ) The height of the diastolic blood pressure is directly related to the
amount of resistance encountered by the blood flow within the
narrowed lumina of the smaller arteries and arterioles.

4) The prognosis dep>ends upon the elevation of the patient's dia-
stolic blood pressure.

The logical deductions from these facts are as foUows: There is
no etiological treatment of this disease. The patients do well for many
years on a conservative regime, such as physical and mental rest,
reassurance by the physician, moderation in their living habits, and
mild sedation. Only a small percentage of patients show either disturb-
ing subjective Symptoms or alarming objective findings that are suf-
ficiently serious to Warrant drastic therapeutic measures; and even
in those cases, the physician should give his patients the benefit of a

prolonged rest and thorough clinical Observation before rushing them
into a theraj>eutic adventure, which, like surgical intervention, is
irreversible and which, like drug treatment, may be hazardous.

Contemplation of more drastic therapeutic measures at once
raises the question as to which hypertensive patients should be sub-
jected to more aggressive methods of treatment and which method is
the most desirable for the individual case.

Pickering ( 1 ) and others have shown that a patient with a per-
manently elevated diastolic blood pressure above 140 mm. Hg is in the
danger zone and the benign course of his disease may, at any time,
change into the malignant phase. Hemiplegie death occurs twice as
often in the group with pressure above 200/120 as in that with pres-
sure of 180/110 (Beckman, 2). There are patients with disturbing
and, at times, disabling manifestations of intractable headaches, diz-
ziness, vertigo, breathlessness, repeated epistaxis, recurrent pulmonary
edema and serious visual disturbances caused by rapidly deteriorating
fundus changes exceeding Grade 2 of Keith's and Wagener's Classifi-
cation. Last, but not least, there are the toxemias of pregnancy, which,
at times, can be classified as hypertensive emergencies. All these
patients need sj>ecial consideration.

True, some of these cases at times have reacted favorably to
sodium restriction in their diet and/or to sodium and protein restriction
(rice diet Kempner). However, in time, these strict and unpalatable
diets become so monotonous that the patients resent them and finally
refuse to continue with the dietary regime, even though they are con-
vinced of its value.

Surgical sympathectomy has been of benefit to some patients
whereas others have had relapses of their hypertensive disease after an
Operation, and some have not reacted at all to surgical intervention.
Unfortunately, there is no method known to insure that only those
patients will be operated upon who will respond to operative treat-
ment.

E. V. Allen (3) writcs: "It is, therefore, logical to believe that, if
the problem of essential hypertension is solved, it will be solved by
medical measures." If the blocking of the transmission of nervous Im-
pulses decreases the tonus of the smaller blood vessels and lowers the

Table 1

Criteria for Effectiveness of Hypotensive Drugs

(Edward D. Preis, Medical Clinics of America, 32, 5. Sept. 1948)

1 ) Agent should lower blood pressure significantly in a fair proportion of patients.

2) Hypotensive eflFect should be accomplished without serious detriment to the

patient.

3) Hypotensive response should be accompanied by clinical indication of arrest or
preferably reversal of the disease (symptomatic relief, reduction in cardiac
size, Clearing of neuroretinitis, etc.).

4) Drug should have a duration action of at least 8 hours.

5) Satisfactory drug should be efFective by mouth or at least subcutaneous in-
jection.

resistance to the blood flow, the blood pressure logically will fall, and
secondary organic changes, like retinitis, cardiac hypertrophy, etc.,
will disappear. TJiis has been proved to be the case after surgical
sympathectomy and there is no reason to assume that "chemical sym-
pathectomy" cannot do the same thing. In the last few years, old drugs
have been re-examined for their pressure-reducing qualities and new
drugs have been designed for this purpose. The drugs now at our
disposal can be conveniently divided as follows:

1 ) Drugs whose action is not due to any reversal of vascular changes.

2) Drugs whose primary action is upon the sympathetic and para-
sympathetic nervous System (adrenergic and sympatholytic drugs).

3) Drugs which interrupt the transmission of nervous impulses from
the central nervous System to the periphery at the level of the
ganglionic Synapse (ganglionic blocking drugs).

The selection of the most suitable drug for the individual patient
has already become a serious problem due to the list of "efTective"
drugs provided by the busy pharmaceutical industries. A few basic
principles of drug treatment, first formulated by Freis (4), will help to
make a selection (Table 1 , 2, 3 ) . Points 4 and 5 of Table 3 need partic-
ular emphasis. A duration of drug action of about 8 hours is important
either to minimize the danger of infection from too frequent injections,
or its interference with digestion and proper resorption of the drug by
oral administration. Effectiveness by mouth, or at least by subcutan-
eous injection, which the patient can be trained to give himself, makes

Table 2
Indications for the Use of Hexamethonium in Hypertensives

1) Persistent elevation of the diastolic blood pressure above 140 mm. Hg whilc
patient is at complete rest and thoroughly relaxed and after conservativc
measures, such as bed rest, sedation, sodium restriction, rice diet and psycho-
therapy have been proven unsuccessful.

2) Severe and disturbing clinical manifestations, such as intractable headaches,
dizziness, vertigo, breathlessness, pulmonary edema, repeated epistaxis and
serious visual disturbanccs caused by rapidly deteriorating fundus findings
exceeding Grade 2 of Keith's and Wagener's Classification.

3) Toxemia in pregnancy and eclampsia.

Contraindications for the Use of Hexamethonium in Hypertensives

1) Impaired renal function (azotemia).

2) Recent blood losses.

3) Advanced coronary artery disease and cerebral thrombosis.

4) Persistent constipation, not yielding to proper management.

Table 3
Action of Hexamethonium Chloride

1 ) Inhibits or blocks the transmission of nervous impulses through the sympathetic
and parasympathetic ganglia.

2) Produces reduction of blood pressure in hypertensive patients by removal of
the abnormal vasoconstrictor tone. Effect obtained varies considerably, cor-
responding to the relative proportions of neurogenic and humoral components
of the raised blood pressure.

3) Reduces bleeding during surgical Operations by reducing or abolishing sym-
pathetic tone and pooling of blood in the vessels of a dependent part of the
body.

4) Depresses the volume and acidity of the gastric secretion and motality.

5) Causes dilatation of the pupils and dryness of the mouth (atropine-like cffect).

the procedure itself independent of the physician's personal attendance,
and contributes to the willingness of the patient to cooperate.

Our own experience has been restricted to the administration of
one of the ganglionic blocking agents, the hexamethonium chloride
(Methium). This should not be construed as a discrimination of other
drugs. After searching the literature on these preparations and after
having had a few preliminary experiences of our own with some of
these drugs, Methium seemed the most suitable drug for our purpose,
and, despite certain undisputed disadvantages, the most promising
one for a prolonged treatment of essential hypertension. This drug did

Table 4
Toxic Reactions of Hexamethonium

All toxic reactions can be traced to the blocking action of Hexamethonium
upon the autonomous nervous System:

1 ) Postural hypotension — > faintness -> vertigo -» syncope

2) Atonia of the guts, causing constipation and a condition resembling paralytic
ileus

3) Nausea, vomiting, diarrhea

4) Blurred vision, dryness of the mouth

5) Paralysis of the bladder with urinary retention.

6) Decrease in libido.

not seem too hazardous, provided a rather strict routine was followed
during its administration, the details of which will be discussed. The
convenient oral route of application is especially controversial and
needs further study.

The Hexamethoniums, one of which is Methium (Hexamethon-
ium Chloride), are powerful hypotensive drugs, effective by the par-
enteral, as well as the oral route. One of their so-called disadvantages
is the poor, irregulär and erratic absorption from the intestinal tract.
When the urinary excretion is used as an index of the amount of the
dose absorbed, absorption ranges from 5-10 %. This index corres-
ponds with the clinical Observation that roughly ten times more of the
drug must be given by mouth to obtain the same efifect as with par-
enteral dosage ( Paton and Zaimis, 5 ) . For this reason, as well as the
risk created by the irregulär absorption of the drug, the oral admin-
istration has been termed unsatisfactory by many observers (Graham
and Campbell, 6; M. L. Rosenheim, 7, and others). We disagree on
the basis of our experience. The so-called poor absorption rate is an
advantage, rather than a disadvantage, of the drug, provided a regulär
absorption of the 5-10 % from the intestinal tract can be achieved
with a strict and proper regime. With the absorption rate regulated,
the "poor" absorption prevents, rather than creates, overdosage and
toxic side eflfects. It should be kept in mind that the action of Hexa-
methonium is considerably enhanced by a salt poor diet, and a smaller
dosage of the drug can be given to patients following this dietary
regime, which also tends to minimize the toxic side efTects and has
become an integral part of our therapeutic measures.

Table 3 gives a clear outline of the action of Methium, and
Table 4 explains its possible toxic reactions which can be traced to
ganghonic blocking action. Blurred vision and dryness of the mouth
are the usual side efTects of the drug and, as a rule, are not particularly
bothersome. Decrease of libido has been observed more in the male
than in the female patient, catching the patient by surprise, but is of
no significance as it is a transitory Symptom, disappearing immediately
with the cessation of the medication. Postural hypotension is a desir-
able effect of the drug, rather than a toxic side efTect. Atonia of the
guts, together with its result constipation and paralytic ileus, seem to
be features which can be avoided, and paralysis of the bladder has
fortunately never occurred in our series.

Before reporting our own results, it may prove of value to discuss
briefly the contraindications to the use of Methium in hypertensive
patients. Hexamethonium is excreted as an unchanged compwDund
solely by the kidneys and it is therefore only logical to postulate that
the kidney function should be intact, or at least not damaged, to an
extent as to interfere with the elimination of the drug from the blood.
An undue increase of the blood level will naturally create the danger of
toxic reactions. Elevated blood levels may also be due to a stepped-up
resorption from the intestinal tract in cases of constipation, when the
drug remains in the guts for too long a period of time. Therefore, the
digestive functions of the patient need special attention, and chroni-
cally constipated patients not responding to proper management in
their pre-treatment period are better excluded from the oral admin-
istration of Methium, as furthermore the drug lowers the blood pres-
sure and slows down the blood flow. This increases the danger of
thrombosis and, in cases of advanced coronary or cerebral thrombosis,
or recent and extensive blood losses, makes the use of Hexamethonium
inadvisable.

We have thus far employed Methium in 22 selected cases. The
first patient began to take the drug in April, 1952, which makes the
Observation period rather short and the number of cases studied not
large enough to give a fair Impression as to the effectiveness, or failure,
of the drug. This report is, therefore, a preliminary one. Its findings
are of necessity highly subjective and its deductions may prove to be

premature and in need of correction in many of its ramifications. There
is one point, however, which should be stressed in view of a few recent
very antagonistic reports: Due to the fact that we were extremely care-
ful in the selection of our cases and followed a very strict routine, we
did not run into any serious trouble, discontinuing the treatment in
several cases, where we were not certain that the routine we prescribed
was followed by the patient in its minute detail. The foUowing case
reports will illustrate certain points of our hypothesis:

F. S., a 42 year old male clerk, was first seen at the office on April 21, 1952.
For many years he had been suffering from "migraine headaches", which had
disappeared spontaneously. In December, 1951, he feit light headed and, at times,
dizzy, and visited his physician for a general examination. He was told that his
blood pressure was considerably elevated and that he should take things easy and
stop Smoking 80 cigarettes a day. There was a family history of hypertension and
both parents died from cerebral accidents at the age of 62 and 52 respectively.
On April 20, 1952, he sufFered a sudden severe epistaxis, which lasted for several
hours and was stopped by tamponade of the nose. He was told by the attending
physician that his blood pressure needed immediate treatment. The patient was
66/2 inches tall and weighed (stripped) 175 Ibs. The face was flushed and a
slight dyspnea on exertion, as well as orthopnea, were present. Fundi showed
Grade H hypertensive changcs but no blurring of the discs. The enlargement of
the heart was very marked and extended to the lef t anterior axillary line ; a systolic
murmur was audible over the entire precordium, His blood pressure was 240/160.
The EGG showed a sinus tachycardia and marked left ventricular strain. The
urine had a specific gravity of 1.018 and did not contain any albumin, sugar or
urobihnogen. He was hospitalized and his basic blood pressure was established at
230/140. Further course and medication are shown in Fig. 1. His blood pressure
slowly receded and the patient feit well and was discharged from the hospital on
May 12, 1952, with a blood pressure of 140/95 and a weight loss of 10 Ibs. His
maintenance dose at that time was 2 grams a day, divided into 4 doses of 500 mg.
each. He has continued this dosage ever since, with no toxic side effects what-
soever, and has not lost a single day of work. His blood pressure now ranges
between 160-170 over 100-110. He has had no recurrence of his epistaxis. X-ray
examination on December 20^^ showed marked reduction of the size of his heart.
The EGG revealed a slurring of his heart rate, a lowering of the voltage, and a
diminution of the left ventricular strain. There were no changes in the condition
of the fundi.

E. B., a 57 year old housewife, was seen first in consultation on June 16,
1952. She was a known hypertensive for the past 10 years and had several mild
cerebral vascular accidents. She complained of severe headaches, extreme general
weakness, dizzy spells, shaking of the right hand (which interfered with writing
and needlework) nycturia, and dyspnea on exertion. Her last cerebral accident a
few weeks prior to the examination was coupled with vertigo. She collapsed early
in the moming in the bathroom and Struck her head against the wash basin,
suffering several lacerations of the scalp which required hospital treatment. She

had been digitalized for several years and receivcd Veratrite while in the hospital
but without much relief. There also was a family history of hypertension. Both
parents and one sister died from cerebral accident and coronary occlusion respec-
tively. She was 64/2 inches tall and weighed (stripped) 157 pounds. She had a
slightly flushed face and mild cyanosis of the lips, but no dyspnea or orthopnea.
There were minor varicosities of both legs but no pretibial edema. The heart was
not enlarged, the heart sounds were distant and poor, and the second aortic sound
was accentuated. A systolic murmur could be heard over the aortic area. The
blood pressure was 190/110 and the EGG showed left axis deviation and left
ventricular strain. There was slight posturing of the pronated forearm and fist-
making was not as facile with the right as with the left hand. On Walking there
was a tendency towards diminished automatic swinging of the right arm, and a
fine tremor of the right hand was present. The face was slightly set and the left
Corner of the mouth was somewhat lower than the right. Fundi showed AV
nicking but no blurring of the discs. Urine analysis revealed a specific gravity of
1.010, no albumin, sugar or urobilinogen. Blood count and Sedimentation rate
were normal. PSP showed a total elimination of 63 % of the dye, and the highest
concentration of the urine was only 1.015. A diagnosis of essential hypertension
and hypertensive encephalopathy was made and the patient was hospitalized.
Under bed rest, salt-poor diet, and sedation, her systolic blood pressure receded
to 170, but the diastolic remained unchanged and her complaints continued. On
June 19, 1952, she was put on 500 mg. of Methium and the blood pressure
promptly dropped. On June 27^^^ a slight rise was again noticed and the dose of
Methium was increased to 750 mg. On June 28**^, her Standing blood pressure
had fallen to 130/80, she had no headaches any more and asked to be discharged
in the care of her local physician. When I saw the patient again on July 10*^^ she
had been kept on a maintenance dose of 750 mg. of Methium and her blood
pressure was 150/90. Her general condition was very satisfactory. There was no
headache, no dizziness, the weakness had disappeared and the shaking of her hand
was no longer noticeable. She claimcd that she was able to write and crochet
again and that she had no more dyspnea. Her maintenance dose was again in-
creased to 825 mg. of Methium daily and she was again seen on August 27^,
when all subjective Symptoms had practically disappeared and her blood pressure
was 120/70. Ever since she is continuing her maintenance dose, her blood pressure
does not change and she is feeling well.

E. G., a 62 year oid hospital administrator, was first examined on May 21,
1952. His hypertension was discovered quite accidentally 5 years ago, when he
applied for a life insurance poiicy. In September, 1950, he had a mild cerebral
accident while riding in a subway and had to be hospitalized. He was treated
with bed rest, diet, sedation and injections of an unknown drug. He did not
improve and complained of dizziness, grogginess, fatigue, tremor of both hands,
constant "funny feeling*' in the head, and palpitations. He had stopped smoking
5 years ago on the advice of his physician and lives a very quiet life.

He was 65 inches tall and weighed (stripped) 135 Ibs. He had a rigidity
of facial expression and a very slow gait. There was edema of both legs and a
rather coarse tremor of both hands. The fundi showed blurring of both discs, in-
creased arteriolar reflexes and AV nicking, but no old or fresh hemorrhages. The
heart was not enlarged, but the second aortic sound was accentuated and a rather

harsh systolic murmur could be heard over the entire precordium. Blood pressure
was 195/100 The urine concentrated to 1.023 and showed a faint trace of albu-
min. PSP showed a 60 % excretion in the first hour, and the Urea Nitrogen was
14 3 mg.% Blood count and Sedimentation rate were normal.

As this patient was a hospital administrator, he was not hospitalized but
was Seen daily at the hospital. From May 21^t until July lOth, he was kept on a
salt-poor diet, vitamins and sedation. His blood pressure went up to 210/1 lU and
his condition remained unchanged. Following the administration of 500 mgs of
Methium in four divided doses, his blood pressure came down to 180/90. When
we increased the dose to 750 mg., he first feit rather well, but on August ^t, he
complained of weakness and a feeling of faintness, as well as a slight nausea,
dryness in the mouth, and blurred vision. His blood pressure was 120/70. It was
assumed that his maintenance dose was probably too high and it was agam reduced
to 500 mg. in four divided doses. On August 8th, there were no subjective com-
plaints and the blood pressure had risen to 140/98 and he feit very well. On
August 19th, his blood pressure was 132/94 and on September 2nd, it was 140/98.
The patient spontaneously claimed that he had not feit as well in many years, he
went to work every day despite the unusual summer heat. On October 15th, he
complained of nervousness, palpitations, and giddiness, his blood pressure was
170/98, and his physical findings were satisfactory. He claimed that he was
nervous because his sistcr-in-law had been attacked and robbed in the apartment
house in which he and his wife were living, that he was in constant fear it could
happen again, and could happen to him. Ever since, his systolic pressure has been
higher, but the diastolic pressure remains at a level slightly below 100 mm. Hg.

J. H., a 65 year old French seamstress and war bride of World War I, was
known to me since June, 1940, when she visited my oflfice with complaints of
occipital headaches, dizziness, insomnia and a choking Sensation in her head. She
had always been emotionally unstable. Her weight at that time was 145 Ibs., and
her blood pressure 170/90. In the 12 years I have observed the patient, her
weight increased to 157 Ibs., and the blood pressure to 260/140. She had a mild
coronary occlusion in March, 1948, which left her with a moderate myocardial
damage causing occasional premature beats, which, at times, became the source
of highly emotional complaints. Her heart became enlarged in 1948 and a harsh
systolic aortic murmur developed that was audible over the entire precordium.
In September, 1951, she had a cerebral accident which, after a few days of a
complete right-sided hemiparalysis, left her with a certain spasticity and weakness
of that side of the body. Her blood pressure remained elevated (250/140) and
she complained bitterly of dizziness, severe headaches, and blurring of her vision.
The slightest effort, as climbing one short flight of stairs up to her room in the
slums, left her shortwinded and exhausted for a long period of time. She always
lived very irregularly, smoked excessively and ate poorly balanced meals. In the
hope of getting some relief from her distressing Symptoms, she agreed to cooperate
in this new treatment. I should have known that a person accustomed to such an
irregulär mode of life would be uncooperative. She was briefed and put on 500 mg.
of Methium on July 27, 1952. The initial response was favorable. By August 12^^,
her blood pressure had fallen to 180/110. She feit considerably better, her head-
aches had disappeared, she could walk better and climb the flight of stairs to
her room without difficulties. However, she resented the strict diet, the laxatives,

and many of the rules and regulations. When the dose of Methium was increased
to 625 mg. on August 20*^, her blood pressure feil to 160/104 and the patient
feit lightheaded, faint, and complained of palpitations. When the dose was
reduced to 500 mg. the blood pressure went up and the readings became irregulär.
She conceded that she did not adhere to the regimen "too" strictly, and we thought
it better to take her off the drug before dangerous reaction would occur.

In the foregoing discussion, we have stressed repeatedly the point
that success or fall uro of treatment with ganghonic blcx:king drugs
may very well be determined by the way in which cases are selected
for this kind of therapy. Indication and contraindication for the use
of hexamethonine in the individual patient can best be established by
hospital Observation. We are not satisfied - as many physicians are -
with data obtained during ambulatory examinations. Each patient
should be hospitalized for diagnostic work-up, proper briefing, and
Observation of the initial response to therapy.

Basic blood pressure must be established by instituting bed rest,
salt-poor diet and sedation. Kidney function is ascertained by clearance
and excretion tests, and the condition of the myocardium is properly
evaluated.

Special attention should be paid to the regulating of bowel func-
tion. Mild saline laxatives should be administered routinely.

Patients whose constipation cannot be overcome are better re-
jected as poor risks. Among other things, the hospitalization period
gives the patient an opportunity to receive some valuable hints from
the dietitian in regard to the salt-poor diet which is an integral part
of the entire therapeutic regimen.

Proper Instruction and briefing of the patient is part of initia-
ting the treatment. He has to be told in detail, what he has to expect,
what the "normal" reactions to the drug may be, and how he can
minimize or overcome them. The toxic reactions should be explained
to him and he should be informed that he must contact his physician
promptly each time he has a new reaction. Under no circumstances
should he ever increase, decrease, or stop his medication without in-
forming the physician as particularly severe kidney reactions have
been observed after sudden withdrawal of the drug.

The so-called postural hypotension, meaning the drop of blood
pressure in a Standing position, is a desired effect of the ganglionic-

2 Virchow Society, Vol. 12 (1953)

blocking drugs and not a manifestation of toxicity. It is the most
sensitive indicator of proper dosage.

When the Standing blood pressure is charted graphically, the
development of tolcrance or toxicity becomes evident immediately.
In the latter case, the curve drops abruptly even before clinical Sym-
ptoms appear, and in the former case, it increases slowly. The drop
calls for an immediate reduction of the dose, and the rise for its in-
crease. A dosage schedule, based on the evaluation of the Standing
blood pressure, safeguards the regulation of the drug therapy. It is
inadvisable to foUow rigid dose schedules as each and every case
requires individual handling. It is always well to remember that
hypertension is an adaptation Syndrome, and that the body has made
its adjustment to the altered physiological State of the vascular System
over a period of many years. Therefore, it should, and will, take time
for the body to re-adjust itself to lower blood pressure levels. For this
reason, and in order to avoid serious side effects, the blood pressure
should be reduced slowly over a period of many weeks. Relief from
distressing Symptoms, and the slow improvement with the disap-
pearance of physical signs, are more impK)rtant than the establishment
of ideal blood pressure values. The smallest dose which can keep the
blood pressure on an even level should be accepted as a maintenance
dose.

The administration schedule of the drug also needs careful
watching. The drug should be given on a fasting stomach at least
4 hours after the previous meal, and about 1 hour before the follow-
ing meal, in order to obtain better resorption from the intestinal tract.
As poor and irregulär absorption is one of the pitfalls of oral adminis-
tration, optimal conditions for the resorption of the drug should always
be established. Also sudden discontinuation of the agent should be
avoided, as cases have been repoited in which a sudden withdrawal
has caused serious kidney disturbances.

In case of serious complications, such as vertigo, giddiness, severe
constipation, paralytic ileus, or retention of urine, the dose should
be reduced immediately and antidotes be given at once: UrochoHn
and Neostigmin in paralytic ileus and urinary retention, and Neo-
synephrin in severe hypotensive states.

Our ex{>erience with oral medication of a ganglionic blocking
agent (Methium) in 22 consecutive cases of essential hypertension
can be summarized as foUows:

The ganglionic blocking agents are powerful drugs, and their
employment in hypertension has many pitfalls. However, with proper
selection of cases and proper regard to technical requirements good
clinical results can be obtained at not too great a risk.

The drug therapy in essential hypertension is in its infancy;
better and less toxic agents will doubtlessly be available in the near
future.

REFERENCES

1. Pickering, G. W: The pathogenesis of malignant hypertension. Circulation 6,
599-610, 1952.

2. Beckman, H.: Pharmacology in clinical practice, p. 19&-203. W. B. Saunders,
Philadelphia 1952.

3. Allen, E.V.: Symposium on the treatment of hypertension. Proc. Mayo Clin.

27, M'6-M\, 1952.

4. Preis, E. D.: Recent advances in the medical treatment of essential hyper-
tension with particular reference to drugs. Med. Clin. N. Amer. 52, 1247-1258,

1948.

5. Paton, W. D. M. and E. J. Zaimis: Actions and clinical assessment of drugs,
which produce neuromuscular block. Lancet 2, 568-570, 1950.

6. Graham, J. G. and A. Campbell: Absorption of Hexamethonium. Brit. med.
J. /, 1514-1515, 1951.

7. Rosenheim, M. L.: Medical treatment of hypertension. (Proc. roy. Soc. Med.)
Lancet 7, 492-493, 1952.

DISCUSSION
Emil Glass

I would like to emphasize the importance of the ganglionic
blocking in the treatment of certain diseases. Years ago I introduced
a method of blocking the ganglion sphenopalatinum by means of
Isophenal (Doppler) for the treatment of headache due to spasm of
the small vessels. Doppler was the first to introduce the so-called
sympathicodiaphteresis; he used it as a Substitute for the Leriche opera-

tion to relieve the vascular spasm affecting the testicle. Blocking of
the nasal sympathetic pathways may check severe headache, for
instance of premenstrual headache. According to FHess, the blocking
is achieved by cautherization of the tuberculum of the nasal septum
or of the anterior portion of the middle turbinate. Ruskin obtained
good therapeutic results in the treatment of backache by blocking the
nasal ganglion in this vvay. The attempt seems justified to apply this
method to the treatment of hypertension in lieu of the heroic surgical
procedures presently used. The technique of the blocking method
is simple, there is no risk involved, no pain and no side efTects. I had
good results with this method in some cases of Buerger's disease.

INSECTICIDES

Ludwig Teleky

Devastation by insects and other animal pests is an old story and
so is the fight against it. In the second book of Moses we read that
God sent over the Egyptians a cloud of stinging flies, grasshoppers and
house vermin. The Suggestion that fruit trees be treated with sulphur
or tar vapors was made already 200 years before Christ. Since those
antique ages man has made himself master of vast areas of the earth
and tumed them to his own purposes: agriculture, cattlebreeding,
forestry. The gravity of pest devastation and man's struggle against
it have accordingly intensified. Sixty kinds of insects cause damage in
the United States estimated at a yearly total of 1 1 ,600,000,000. In
the fight against pests we consume, yearly, sixty-six million kilograms
of lead and calcium arsenate, twenty-two million kilograms of DDT,
and smaller quantities of many other substances.

Both World wars added streng impetus to man's endeavor to find
and test the efficacy of insecticides. In the last few years nearly five
thousand substances have been tried out on insects and rodents. The
Problems involved are not simple; diflerent insecticides must be used
against difTerent insects, for diflerent plants, soils and seasons. For
example: one animal may react to a poison quite differently from
another animal - which indicates also how wrong it is to apply to
human beings the results of animal experiments. In this connection
let me mention a new rodenticide: a-N aphthylthiurea, "Antu". This
kills norway rats and dogs but has practically no efTect on mice or
squirrels.

We cannot speak here of the various properties and peculiarities
of diflerent insecticides, but we should mention the amazing fact that

certain insects build up resistance to particular poisons, an immunity
that persists for generations. Thus in the United States generations of
flies have now acquired resistance against DDT.

In addition to the older poisons, such as the arsenates and hydro-
cvanic acid, there are the new contact insecticides, which kill by con-
tact alone. These may be grouped as follows:

Halogenated hydrocarbons, including DDT, Chlordan,

Benzenehexachloride
Organic phosphates: Parathion, TEPP

We have further:

Organic sulphur Compounds
Organic materials such as nicotine
Organic mercury Compounds
Lead arsenates, etc.

It should be emphasized here that every insecticide has several com-
mercial names, adopted by various firms and changing with the times.

We shall speak here only of a few of the most important insecti-
cides and their danger to human beings - the factory workers who
produce them, and the farmers who apply them. - We will leam how
to protect them and how to treat poisonings.

Hydrocyanic Acid: Extremely dangerous. It can penetrate a thin
wall, adheres to clothing and textiles. After it has been used as insecti-
cide or rodenticide, rooms and textiles which have come in contact
with it must be thoroughly aired for at least twenty-four hours. This
poison is taken in by respiration and through the skin; it quickly
causes unconsciousness, coma, death. The Reichsgesundheitsamt re-
commended a treatment as early as 1942, which has since been im-
proved upon by Chen and Rose ( 1 ) . First, Inhalation of amylnitrite
from broken phials, then intravenous injection of 2.5-5 cm^ of a 3 %
sodium nitrite Solution; instantly thereafter, with the same needle,
25-50 cm^ of a 50 % sodium thiosulfate Solution. If necessary, repeat
one hour later, in any case two hours later. The patient has to be
observed for 24^8 hours and if necessary be treated again.

Organic Mercury Compounds. Commercial names: Ceresan,
Germisan, Upsulan, etc. The clinical picture difTers from that of mer-
cury poisoning. There is little or no saHvation or tremor, but we find
vasomotoric disorders, hypoaesthesia in the lower extremities and
j>sychic disturbanccs.

Example: Two girls are working in a storehouse 15 feet away from some
piles of dicthylene mercury. After 3 months of working they fall ill with gastric
and nervous disturbanccs. In spite of treatment with BAL death occurs 6 wceks
later.

Contact Insecticides. According to Lehman (2) their relative
toxicity for human beings is as follows:

DDT

Chlordan

Methoxy chlor

1/24

Parathion

TEPP

125

The most frequently used of these substances is DDT. It is supp-
lied as a talcum powder containing 2-10 % DDT, and as a spraying
liquid containing 6 % DDT in kerosene. Commercial names: Gesarol,
Neocid, Duclid, etc. Up to 1951 there were 66 reported poisonings
(one fatal) among agricultural workers, 263 poisonings (9 fatal) by
accidental intake, and 22 poisonings by wilful intake, with 3 deaths.

Light cases bring on loss of appetite, gastric Symptoms, buming
of the eyes, dryness of the pharynx and irritability. Cases are reported
among workers foUowing a single exposure to heavy dust clouds, as
well as foUowing prolonged lighter contact, e.g., after an ovemight
stay in freshly and too heavily dusted rooms.

Klingemann ( 3 ) reports on a man who inhaled heavy clouds of
dust for two or three hours and took in large quantities through his
greased skin. He developed gastric Symptoms, paraesthesia, paresis
and albuminuria. Recovery was very slow. There are also chronic
cases. Stone and Gladstone (4) report disturbances of speech, vision
and locomotion after 4 years of constant exposure. Hertel (5) reports
the fatal outcome of such a chronic case.

'•

For his protection the worker should have a respirator (tested
by the United States Department of Agriculture) and natural rubber
gloves. The workers should be shifted every two to four weeks; they
should not engage in this kind of work for any length of time. Stone
and Gladstone tried their patient with 400 mg. of nicotinic acid daily
for 3 davs, then injected 1 50 mg. of thiamin daily for 6 days.

Chlordan, called "Velsicol 1068", is absorbed by the skin. Reports
on poisoning are few and not entirely clear. Symptoms seem to be
vertigo, irritability, tremor.

Benzenehexachloride and Pentachlorphenol (Baader and Bauer,
6) are skin irritants, the latter also causing bronchitis and neuralgia.
Dichlorhenzol ("Globol") was formerly believed to be innocuous, but
on one occasion four persons who had been treating clothes against
moths with this substance lost consciousness, showed a weak pulse,
excitation, then vomiting ( 7 ) .

Organic Phosphorus Compounds. They are far more dangerous
than the halogenated hydrocarbons; Parat hion is the most widely
used. The record on Parathion (called "E 605" or "Thiophos")
up to the year 1950 shows 198 reported poisonings, including 7 fatal
and 40 of serious nature. Of these cases 112 were farm workers (in-
cluding 2 pilots), with 3 fataUties and 25 serious consequences. Para-
thion is a black-brown, oily liquid which is used in the United States
as a 1-2 % powder with talcum or as a 0.06 % emulsion. Parathion
inactivates the enzyme choHnesterase. Parathion is taken in through
the skin and by respiration.

Case reports. A man working without a respirator feil ill at noon of the first
day with vertigo, fainting, abdominal pains, vomiting, convulsions.

A man who sprayed himself with Parathion failed to get cleaned properly.
8 hours later there was nausea and tremor. Improvement set in after administra-
tion of atropine, but death occurred 21 hours later (8).

Another worker after being severely soiled with Parathion died within
15 hours.

But we have also reports indicating a more cumulative poisoning:

A man worked for two weeks, 5 days a week, Alling spray apparatus. He feil
ill, but recovered. A month later he started on the same kind of work again and
died on the second day of the renewed contact.

An entomologist worked for 4 months ofT and on with Parathion. One day
he failed to use a respirator; after a few hours of working he died.

To summarize, poisoning begins with nausea, vomiting, abdomi-
nal pains, salivation, and myosis (eye disturbances may cause acci-
dents among pilots spreading the substance from a plane), increase
in blood pressure, oppression, bronchitis with heavy secretion, muscle
spasms, tremor, restlessness; eventually, Stupor, confusion, convulsions
and death may occur. Fatal outcome has been observed from one to
2 1 hours f ollowing the exposure and from one to 1 3 hours after the
appearance of the first Symptoms.

The American Cyanamid Co., which produces Thiopos (Para-
thion) in the United States, recommends the f ollowing Prophylaxis:
Avoid Inspiration and contact with skin ; for this purpose use approved
respirator and gloves of natural rubber, cover every part of skin.
After work wash face, arms, hands and all soiled parts carefully. It is
best to take a bath and clean the whole body thoroughly. When Symp-
toms appear, call the doctor, but even before his arrival, if there is
disturbed vision, abdominal pain, oppression, take two tablets of
atropine, 0.6 mg. each. If the physician finds hyperhydrosis, myosis,
lacrimation, salivation, he is to give 1.30-1.95 mg. atropine intra-
venously every hour until dilation of the pupils occurs or until 19.5 mg.
have been given. Give no morphine ! If there is bronchial stasis apply
"postural drainage", if necessary artificial respiration. The acute
danger persists from 24 to 48 hours. A man who has once been poi-
soned should not work with Parathion again.

A sensitive test for Parathion poisoning is the determination of
Cholinesterase in red cells and plasma. A good method of detecting an
impending poisoning would be the continuous control of the concen-
tration of this enzyme. The first determinations must be made before
the worker Starts handling organic phosphates, in order to obtain his
normal choHnesterase values. Weekly examinations should be made
thereafter. Upon the first appreciable drop of one of the Cholinesterase
below the mean normal, the worker should be immediately removed
from all possible contact with Parathion until a subsequent check
indicates the retum to normal values. Gariik (9) applied this method
with excellent results. However, the method is rather involved and
requires facilities not readily obtainable in rural surroundings.
TEPP is even more dangerous than Parathion.

In my opinion such extremely dangerous substances as the
organic phosphates should not be used at all. The use of insecticides
in general requires govemment regulation so that potential damage
may be minimized and substances too perilous to man can be removed

from the market.

REFERENCES

1. Chen, K. K. and C. L. Rose: J. Amer. med. Ass. 149, 113, 1952.

2. Lehman, A.: Pests and their Control. July 17, 1949.

3. Klingemann: Ärztl. Wschr. 1949, p. 465.

4. Stone, T. T. and L. Gladstone: J. Amer. med. Ass. 145, 1342, 1951.

5. Hertel, H.: Dtsch. Arch. klin. Med. 199, 256, 1952.

6. Baader, E. W. and H. J. Bauer: Ind. J. Surg. 20, 286, 1951.

7. Robber, H.: in Sammlung von Vergiftungsfällen. 1928.

8. Bidstrup, P. L.: Brit. Med. J. 2, 548, 1950.

9. Industr. Hyg. Newsletter 10, No. 9, 1950.

LEAD POISONING IN CHILDREN

Frederick G. Zak

A fatal case of lead encephalopathy in a child with pica is pre-
sented. The diagnosis was not suspected clinically and based on the
presence of acid-fast nuclear inclusion bodies in kidney and liver.
Typical microscopic changes of the brain and a significant increase
of lead in this organ corroborated this.

The differential diagnoses are discussed from the Standpoints of
the clinician and the pathologist.

SELECTED LEGAL TOPICS
Albert Hirst

I accept, with thanks, your invitation to discuss with you tonight
certain legal subjects which may be of practical interest to you. I shall
touch upon these topics:

I. The unpleasant possibility that a physician may be sued both
for malpractice and for breach of contract.

II. Some legal aspects of the physician's duty to keep confiden-
tial bis patient's Communications.

III. Certain provisions of the Penal Law of interest to physicians.

IV. Certain aspects of the law of Intestacy and Wills.

We all realize the high Obligation we owe to those who come to
US for professional help ; we realize that we owe them the highest duty,
unflagging zeal and attention to their needs; we have no sympathy
for the man who, careless of his professional Standards, injures those
who come to him and has to respond in damages for wrongs he has
inflicted.

What concerns us, however, is the possibility, unfortunately not
so remote, of the professional man being victimized by the crank or
the crook.

Now, what I wanted to bring out in this part of my discussion
is the even more unpleasant f act that that crank or crook has the oppor-
tunity of attacking a physician in two different ways. He may claim
"malpractice". That term has been defined in Isenstein v. Malcomson,
227, App. Div., 66, 236 N. Y. S. 641, 643, where the court said that

it has been "used to indicate a corrupt or culpably incompetent prac-
titioner of either law or medicine".

Now, in an action for malpractice, your defense can show that
the methods which you used to treat the patient were the Standard
methods recognized by the profcssion, that you used due care and
that the unsatisfactory result was not your fault.

Insurance companies make readily available to reputable physi-
cians policies under which, in case of an action for malpractice, the
insurance Company bears the entire expense of the defense and in
case of an adverse outcome, pays the judgment that the patient may
recover.

I take it that so far I have told you nothing new. What I wanted
to point out under this heading is the possibility, well established in
our law, of an action by that same crank or crook not only for mal-
practice, but in addition, on a theory of a breach of contract. Thus,
one of our courts stated (Frankel v. Wolper, 181 App. Div. 485, 169
N.Y. S. 15, 17):

"I should say, that where a physician, with whatever prudence, agrees that
his treatment will eure, and it does not, the patient is absolved from payment,
may recover advances, may recover expenditures necessitated for nurses and medi-
cines, and maybe for something eise."

To make things worse, under our law, an action for malpractice must

be commenced within two years after the act of malpractice has been

committed. If not commenced within that period, it is forever barred.

A Claim for breach of contract, however, may be asserted any time

within six years.

Let me give you the facts in Conklin v. Draper, 229 App. Div. 227, 241
N. Y. S. 529, aff'd. 254 N. Y. 620. In that case, plaintiff was operated for appen-
dicitis. The surgeon left an arterial forceps in the abdominal cavity. The error
was discovered after the two years had elapsed during which an action for mal-
practice could be commenced, but the court permitted the plaintiflf to sue for
a breach of the contract which the defendants had made that the Operation "will
eure". Significantly enough the defendants were the surgeon who performed the
Operation, as well as the general practitioner who had assisted in the pre- and
postoperational care.

In another case*, the defendant had attempted to remove a cataract. The
Operation was unsuccessful. The patient sued, claiming that insufficient anesthesia

♦ Colvin V. Smith, 94 N. Y. S. 2^ 98, aff'd. 276 App. Div. 9, 92 N. Y. S. 2d
794, 275 App. Div. 1018, 91 N. Y. S. 2d 713.

was given ; because of that insuf ficiency, the patient moved the eye during the
Operation, which resulted in injuries. She sued the doctor in two separate actions,
in each case claiming $ 20,000, one action for malpractice and the other one for
breach of contract to eure. The courts held that she was entitled to maintain
both cases.

Let me stress the difficulties these defendant physicians were
subjected to in cases where the patient claims that a contract was
broken. You, as a physician, may know that a promise that your
"treatment will eure" would be ridiculous. As a matter of fact, you
may have wamed your patient that the possibility of success of the
treatment is slight; you may even have discouraged continuance of
the treatment. Just the same, the patient can come into court and claim
that within the secrecy of your consultation room a conversation had
taken place completely contrary to what actually was said; you will
find yourself in the highly undesirable and dangerous position that
there will be one person's word against the other's, with a jury left free
to speculate whether to believe the patient or the physician, one of
them obviously lying.

This Situation is made all the more serious by the fact that you
cannot obtain insurance to protect you against claims for breach of
contract. Obviously, no insurer can undertake to protect a physician
who, for all he knows, may have been making extravagant promises
in Order to attract business.

One consolation only can I offer - the damages recoverable in
an action for breach of contract are likely to be considerably less than
those in a malpractice action. Just the same, to be compelled to repay
all fees received from the patient, to pay him for his expenditures for
nurses and medicine, is an unpleasant possibiüty.

I can only rctommend extreme care in predicting the outcome
of treatments, by a physician or by a surgeon; to try, if possible, to
have this type of conversation in the presence of a friendly witness,
such as your nurse; and wherever possible, to obtain the patient's
signed Statement showing that no agreement was made that your
"treatment will eure".

The physician's duty to keep confidential what the patient has
told him is too well known to call for discussion. What we shall discuss
tonight are rather the exceptions to the rule :

1. No duty to keep disclosures confidential exists where the
relationship is not that of physician and patient. If, for instance, a
person sues an accident and health insurance Company for disability
benefits, or has been injured in an automobile accident and is suing
in negligence, the defendant may arrange with you to examine the
plaintifT ; in that case, of course, you are perf ectly free to disclose to the
defendant not only your findings upon the examination, but whatever
the plaintiff may have told you. You are not plaintiff's physician.

2. Your patient may authorize you to disclose your medical
findings, including the medical history which he gave you, to another
party; you may have treated a plaintifT whose medical Status is now
involved in litigation. Now, in any such Situation, when your patient
authorizes you to disclose your medical record to an outsider, it is
advisable that you do not act, except upon your patient's written
authorization. If you act under such a written authorization, it is
essential that you insist that the writing be delivered to you and that
you retain it in your files so that at any time in the future, you can
protect yourself against any possible claims that your disclosures were
not authorized.

3. You may be called to court as a witness. Such a call may come
in two different forms: a) you may appear in court by arrangement,
or b) you may appear under subpoena compelling you to attend. If
you are subpoenaed, you are entitled to only the statutory witness fee
which is trifling. It is quite proper, however, for you, whether you
appear voluntarily or under the compulsion of a subpoena, to accept
from the party that calls you to court, in addition to the witness fee,
adequate compensation for your loss of time.

If you appear as a witness, whether voluntsuily or under sub-
poena, the protection of your patient's confidential communication

has passed out of your hands. As a witness in court, it is your duty to
answer all questions asked of you; it is up to the lawyer and not to you
to object to questions if he considers that they call improperly for
disclosure of confidential information. You can never be criticized for
answering freely any question you are asked in court or in any judi-
cial proceeding.

There is one additional bit of information that I would Hke to
leave with you - certain matters that you personally, may consider
confidential are not confidential as a matter of law. Even over objec-
tion, I can force you to disclose the dates when a person consulted
you; I can also force you to answer the question whether on these
occasions the person was well or sick. I cannot go further, but I can
go that far. These questions you may safely answer to a stranger even
though he does not have your patient's authorization.

III.

In this discussion, I shall confine myself to the Penal Law of tliis
State; I take it that everyone in this audience is more or less familiär
with his duties and liabiUties under the United States Food and Drugs
Act or the provisions of Federal law dealing with narcotics; as to nar-
cotics, these are regulated by Federal and by State law ; none of these
matters shall I discuss tonight.

Again I shall confine myself to telling what the law is; this,
I take it, is not the time and place to discuss what the law ought to be.

1. Adultery is defined in § 100 of the Penal Law to be: "Adultery
is the sexual intercourse of two persons, either of whom is married to
a third person". It is a misdemeanor. It is punishable by imprison-
ment up to six months or by a fine of ? 250. The possibility of pro-
secution for adultery is extremely slight. The type of evidence which
is ample in an action for divorce is not sufficient in a criminal pro-
secution. l'here, the district attorney would have to prove "beyond
a reasonable doubt" that intercourse actually took place. The mere
finding of the parties alone in a hotel room, for instance, would not
be sufficient.

2. Abortion.

"§ 80. Definition and punishment of abortion

A person who, with intent thereby to procure the miscarriage of a woman,
unless the same is necessary to preserve the life of the woman, or of the child with
which she is pregnant, either:

1. Prescribes, supplies, or administers to a woman, whether pregnant or
not, or advises or causes a woman to take any medicine, drug, or substance; or,

2. Uses, or causes to be used, any instrument or other means,

Is guilty of abortion, and is punishable by imprisonment in a State prison
for not more than four years, or in a county jail for not more than one year."

"§ 81. Killing of child in attempting miscarriage

A pregnant woman, who takes any medicine, drug, or substance, or uses or
submits to the use of any instrument or other means, with intent thereby to pro-
duce her own miscarriage, unless the same is necessary to preserve her life, or
that of the child whereof she is pregnant, is punishable by imprisonment for not
less than one year, nor more than four years."

"§ 81-a. Witnesses' Privileges
A female who has violated section eighty-a of this article or who has com-
mitted an attempt to violate such section shall not be excused from attending and
testifying or producing any evidence, documentary or otherwise, in any investi-
gation or trial relating to violations of sections eighty, eighty-one, eighty-two, ten
hundred and fifty, or eleven hundred and forty-two of this chapter, or an attempt
to commit any such violation, upon the ground or for the reason that the testi-
mony or evidence, documentary or otherwise, required of her, may tend to con-
vict her of a crime or to subject her to a penalty or forfeiture; but no such female
shall be prosecuted or subjected to any such penalty or forfeiture for or on account
of any transaction, matter or thing conceming which she is compelled, af ter having
claimed her privilege against self-incrimination, to testify or produce evidence,
documentary or otherwise, and no testimony so given or produced shall be received
against her upon any criminal investigation, proceeding or trial*".

"§ 82. Selling drugs or instruments to procure a miscarriage
A person who manufactures, gives or sells an instrument, a medicine or
drug, or any other substance, with intent that the same may be unlawfuUy used
in procuring the miscarriage of a woman, is guilty of a felony."

"§1050. Manslaughter in first degree

Such homicide is manslaughter in the first degree, when committed without
a design to effect death:

« « *

The wilful killing of an unbom quick child, by any injury conmiitted upon
the person of the mother of such child, is manslaughter in the first degree.

A person who provides, supplies, or administers to a woman, whether pre-
gnant or not, or who prescribes for, or advises or procures a woman to take any
medicine, drug, or substance, or who uses or employs, or causes to be used or

« In other words, the female may freely testify against the accused physician.

3 Virchow Society, Vol. 12 (1953)

employed, any Instrument or other nieans, with intent thereby to procure thc
miscarriage of a woman, unless the same is necessary to preserve her life, m case
the death of the woman, or of any quick child of which she is pregnant, is thereby
produced, is guilty of manslaughter in the first degree."

You will notice that § 80 defines the crime of abortion to be
procuring "the miscarriage of a woman, unless the same is necessary
to preserve the life of the woman, or of the child with which she is
pregnant". I hardly need mention to this audience the well known
practice that a surgeon before performing an abortion will have the
case diagnosed by one, or preferably more than one, independent
physicians and that he will not operate unless they certify in writing
that the Operation is necessary for the preservation of hfe.

3. Contraceptives. The law applicable to the use of contraceptives
is found in §§ 1 142, 1 142-a and 11 45 of the Penal Law. They read:

"§ 1142. Indecent articles

A person who sells, lends, gives away, or in any manner exhibits or ofFers
to seil, lend or give away, or has in his possession with intent to seil, lend or give
away, or advertises, or offers for sale, loan or distribution, any Instrument or
article, or any recipe, drug or medicine for the prevention of conception, or for
causing unlawful abortion, or purporting to be for the prevention of conception,
or for causing unlawful abortion, or advertises, or holds out representations that
it can be so used or applied, or any such description as will be calculated to lead
another to so use or apply any such article, recipe, drug, medicine or instrument,
or who writes or prints or causes to be written or printed, a card, circular,
Pamphlet, advertisement or notice of any kind, or gives information orally, stating
when, where, how, of whom, or by what means such an instrument, article,
recipe, drug or medicine can be purchased or obtained, or who manufactures any
such instrument, article, recipe, drug or medicine, is guilty of a misdemeanor,
and shall be liable to the same penalties as provided in section eleven hundred
and forty-one of this chapter."

§ 1 142-a. Advertisements relating to certain diseases prohibited. Whoever
publishes, delivers or distributes or causes to be published, delivered or distributed
in any manner whatsoever an advertisement concerning a venereal disease, lost
manhood, lost vitality, impotency, sexual weakness, seminal emissions, varicocele,
self-abuse or excessive sexual indulgence whether described by such names, words,
terms or phrases, or by any other names, words, terms or phrases, calculated or
intended to convey to the reader the idea that any of said diseases, infirmities,
disabilities, conditions, or habits are meant or referred to, and calling attention
to a medicine, article or preparation that may be used therefor or to a person
or persons from whom or an oflFice or place at which information, treatment or
adyice relating to such disease, infirmity, habit or condition may be obtained, is
guilty of a misdemeanor and upon conviction thereof shall be punished by im-

prisonment for not more than six months, or by a fine of not less than fifty doUars
nor more than five hundred doUars, or by both such fine and imprisonment. This
section, however, shall "not apply to didactic or scientific treatises which do not
advertise or call attention to any person or persons from whom or any ofTice or
place at which information, treatment or advice may be obtained, nor shall it
apply to advertisements or notices issued by an incorporated hospital, or by a
licensed dispensary, duly certified by the local board of health as a venereal
disease clinic, or by a municipal board or department of health or by the depart-
ment of health of the State of New York".

"§ 1145, Physicians' instruments

An article or instrument, used or applied by physicians lawfully practising,
or by their direction or prescription, for the eure or prevention of disease, is not
an article of indecent or immoral nature or use, within this article. The supplying
of such articles to such physicians or by their direction or prescription, is not an
offense under this article."

Our highest court, the Court of Appeals, has said in People
V. Sanger, 222 N. Y. 192, 194, 195, after quoting § 1 145, that:

"This exception in behalf of physicians docs not pcrmit advertisements
regarding such matters, nor promiscuous advice to patients irrespective of their
condition, but it is broad enough to protect the physician who in good faith
gives such help or advice to a married person to eure or prevent disease. 'Disease,'
by Webster's International Dictionary, is defined to bc, 'an alteration in the State
of the body, or of some of its organs, interrupting or disturbing the Performance
of the vital functions, and causing or threatening pain and sickness; illness; sick-
ness; disorder.'

The protection thus afforded the physician would also extend to thc
druggist, or vendor, acting upon the physician's prescription or order*".

It may also be of interest for you to know that in the case of
Barretta v. Barretta 46 N. Y. S. 2^ 261, a wife sued her husband for
Separation. He defended on the ground that the wife had refused any
sexual relations with the husband unless he would use a contraceptive.
The judge said:

"A wife who demands benefits under the marriage contract must provc
that she is willing to discharge her obligations under it. The rcfusal of a wife
without adequate excuse to have ordinary marriage relations with her husband
strikes at the basic obligations of the marriage contract. Here she seeks the benefits
of that contract while violating one of the fundamental obligations of it. Our law
does not permit her to recover. Mirizio v. Mirizio, 242 N. Y. 74, 150 N. E. 605,
44 A. L. R. 714; Downes v. Downes, 225 App. Div. 886, 233 N. Y. S. 39."

The court refused to allow any alimony to the wife.

* In other words, only if you honestly belle ve that contraceptives are needed
to eure or prevent disease may you prescribe them.

4. Rape. Rape in the ordinary sense, is defined m § 2010 and
we shall not discuss it herein. I point out to you, however the follow-
ing definition of rape in the second degree as found m § 2010 of the
Penal Law.

"A person of the age of twenty-one years or over who perpetrates an act of
sexual k^tercourse with a female, not his wife, ander the age of eighteen years,
unde drcurstances not amounting to rape in the first degree, - ^-Ity «f ^^^^^
in the second degree, and punishable with impnsonment for not more thai. ten

^'^"'a person who perpetrates an act of sexual intercourse with a female, not
his wife, under the age of eighteen years, under circumstances not amountmg to
rape in (he first degree or rape in the second degree is guilty of a misdemeanor ** .

The very serious aspect of rape in the second degree, or, as it is
often called statutory rape, is that the crime is conunitted and the
defendant is guilty even though he did not know the age of the female
and, as a matter of fact, was misinformed by her as to her true age.
I quote the following from People v. Marks 146 App. Div. 11, 130
N. Y. S. 524, 525 where the Appellate Division said of § 2010:

"By that enactment, and the statutory provisions from which it was taken,
the Legislature in its wisdom determined to make the crime dependent upon the
age of the female, and thereby intercourse with a female the day before she attairis
the age of 18 years, if not under circumstances constituting the crime of rape m
the first degree, is a fclony; but it would not be a crime at all, unless under an-
other Statute relating to adultery, if the intercourse took place the day after.

The manifest purpose of this legislation was to protect the morals of young
girls; and, to render the enactment efTective, neither the consent, nor the previous
unchastity of the girl, nor her representations nor information derived from others
as to her age, nor her appearance with lespect to age is a defense to a prosecution,
but such facts may doubtless be taken into consideration by the court in passing
sentence* * *."

5. Crime against nature; sodomy. § 690 of the Penal Law pro-
vides, in part:

"A person who carnally knows any male or female person by the anus or
by or with the mouth against the will and without the consent of such other
person; or,

« « * «

5. When such other person is, at the time, unconscious of the nature of
the act, and this is known to the defendant ; or when such other person is in the
custody of the law, or of any officer thereof, or in any place of lawful detention,
temporary or permanent; or, a person who carnally knows in any manner any

animal or bird; or attempts sexual intercourse with a dead body, is guilty of
sodomy in the first degree and is punishable with imprisonment for not more than
twenty years or with imprisonment for an indeterminate term the minimum of
which shall be one day and the maximum of which shall be the duration of his
natural life.

A person twenty-one years of age or over who carnally knows by the anus
or by or wäth the mouth any male or female person under the age of eighteen
years, under circumstances not amounting to sodomy in the first degree is guilty
of sodomy in the second degree and punishable with imprisonment for not more
than ten years.

A person who carnally knows any male or female person by the anus or by
or with the mouth under circumstances not amounting to sodomy in the first
degree or sodomy in the second degree is guilty of a misdemeanor." ♦ * ♦ ♦

In concluding our discussion of the Penal Law, may we point

out:

1 . In cases of rape and crime against nature, the slightest sexual
Penetration is sufficient to complete the crime.

2. In any prosecution for adultery, for rape or for crime against
nature, no conviction can be had on the uncorroborated testimony of
the complaining witness.

3. In so far as any complaint against a physician is concemed for
any violation of the Penal Law, we should realize that entrapment is
perfectly legal. In other words, the unknown patient who comes to
you may be a detective trying to entrap you into a violation of law.

IV.

In this final part of my talk, I propose to discuss a matter that
concems you, not in your capacity as physicians, but as family men.
I would like to call to your attention certain aspects in which our
System differs from the legal Systems used on the Continent of Europe.

1 . It is my understanding that in European countries where the
civil or Roman law prevails, wills can be made very informally. For
instance, I understand that, over there, if you write out your will with
your own hand and sign it, it is perfectly good. Such a will has no
eflect whatever in this State. Here, while the law does not require
that the will must be prepared by a lawyer, it does require certain
formalities in its execution. The testator must sign the will at the end,

he must do so in the presence of at least two witnesses to whom he
must declare that he is signing his wUl and he must ask them to sign
as witnesses. The witnesses must see him sign and they must sign in
his presence and in the presence of each other. A will not so executed
is not a will.

2. Again, I understand that under European Systems, regardless
of your intentions, your wife and children each are entitled to a cer-
tain minimum share in what you leave at death. In this State, on the
other hand, the only person who can insist on a certain minimum
share, with exceptions not important to us tonight, is the widow or
the widower; children have no claim of inheritance that a parcnt
must respect. You are perfectly free, for no reason whatever, to dis-
inherit some or all of your children.

3. It is my impression that in Europe, the heirs quite informally
take over what has been left to them and that they do so directly.
That is not our System. A person appointed by the court, which is,
incidentally, called the Surrogate's Court, handles all the affairs of
the deceased; collects the assets, pays the debts, prepares tax retums,
pays the income and inheritance taxes, and after all that is done,
distributes the balance of the estate to those entitled thereto. If you
die leaving a will in which you appoint a person to handle your
aflPairs, the person is called an "executor"; if you die without a will,
the person appointed to handle your affairs is called an "admini-
strator".

Both executors and administrators are entitled to certain com-
pensation which is regulated by law. Their function is important. It is
important, therefore, for you to decide by your will who should handle
your estate because otherwise, the Surrogate will select an administra-
tor under certain impersonal rules that the law lays down.

Another important fact for you to know is that your executor
acts without fumishing a surety Company bond. An administrator
must fumish such a bond. The premium for a bond is high and the
expense is considerable. Thus, the simplest kind of will naming an
executor is likely to save your family quite a good deal of money.

4. I do not know what provisions Continental laws make for the
protection of the property of minors. In this State, the protection of
minors' property il very rigid. If you die intestate and your inf ant child
becomes entitled to an inheritance, it will be entrusted to a court
appointed guardian. The guardian usually is the child's parent, but
again must furnish an expensive surety Company bond for the pro-
tection of the minor. This bond must be renewed every year during
minority. The minor's funds, be they capital or income, cannot be
expended without court approval. If the inf ant is to be supported
out of what you left him, a lawyer must be hired every year to file an
accounting; if any money is to be used for the infant's education,
maintenance and support, the Surrogate must authorize the expen-
diture in advance.

While these rigid rules are effective in protecting minors' funds
from conversion and theft, they are very burdensome. You may, how-
ever, in your will, dispense with all of these safeguards. You can do
that in a variety of ways; if your property is not large in amount,
it may be wise to leave everything to your widow and nothing to your
children, trusting to the mother to take care of her own children ; or,
you may leave some money to your children giving your widow or
other relatives füll authority to spend it on behalf of the child as they
deem best.

5. In more substantial estates, a device, which I understand is
unknown on the Continent, but in common use in this country is the
creation of a trust. By this device, you take away the bürden of
management of investments from your wife and children and entrust
it either to competent friends or to a trust Company. In certain cases,
the device has also substantial tax advantages.

6. In every estate beyond the smallest, we are seriously concemed
with tax Problems; income taxes as well as inheritance taxes, have
to be considered and considerable savings can be efTected by using
proper measures. If you make no will, you cannot do that.

7. Finally, may I say that we here in this country use life in-
surance f ar more extensively than do Europeans. We use it to provide
guaranteed and frequently income tax free incomes for our widows

and orphans; to pay the mortgage on the home; to pay estate taxes;
to provide College funds for the children. Life Insurance here is abso-
lutely safe; life Insurance companies do not fall. They meet their
obligations promptly.

It is customary when one prepares one's will at the same time to
make certain agreements with the life insurance companies about the
method of their paying the death benefits. The disposition of your life
insurance and of the rest of what you leave are intimately related
and should be considered together.

These matters are of special importance to the family of pro-
fessional people who are not usually included among the beneficiaries
of the social security System.

In Conclusion

It is difficult for a lawyer to guess how much of legal subjects
physicians will know. I cannot flatter myself that I have told you
much that is new to you. I hope, however, that I have succeeded in
stimulating your thinking in one or the other respect. In any event,
let me thank you for the patience with which you have listened.

PSYCHIATRIC ASPECTS OF CRIMINAL

BEHAVIOR

Leo L. Orenstein

What is criminal in human behavior is defined by legal rather
than medical criteria, and depends on social and cultural deter-
minants. Human behavior, whether criminal, or otherwise falls within
the province of Psychiatric investigation. The psychiatrist must con-
cem himself with the careful examination of the criminal, that is the
conscious manifestations and unconscious motivations observable 3nd
discemable in those accused and convicted of crime. By definition
one is a criminal after apprehension and conviction only. This does
not mean that so called asocial tendencies are Umited to those adjudi-
cated in our courts of law ; nor does it f ollow that adjudication always
proves beyond any doubt that the subject is a criminal.

Evidence has been collected and recorded in the literature
(Borchard; Orenstein) indicating that innocent people may at times
be convicted on charges of criminal acts. While this occurs in-
frequently, it does occur, and is most likely to happen in instances
involving moral and ideological issues. It is our opinion that Psychia-
tric investigations may prove very helpful in clarifying existing con-
fusions, and this efTort could be even more productive if our laws were
permissive or helpful in subjecting complaining witnesses to Psychiatric
examinations, just as they are conceming the accused.

Since the responsibility of the psychiatrist is to investigate the
criminal and not the crime, he must leave the latter to bis associates
in the legal and police professions. It remains the obUgation of the
psychiatrist to evaluate the person of the criminal, make a diagnosis,
establish legal responsibility, and report the same. It remains for the

court and juries to determine the legal meaning and relevance of the
medical facts presented by the psychiatrist.

Crimes are commitled by psychotic and mentally defective per-
sons. However, the majority of criminals are legally responsible for
their acts, even though many show evidence of major disturbance m
their character structure. It should be kept in mind that in some,
neurotic traits are acted out in such ways as to lead to serious conflict
with the law. The periodic appearance of headlines concerning the
criminal who is insane is less threatening to our public safety and
welfare than such headlines might imply. Sex crimes particularly
attract much attention, and even though 17 states have enacted
special legislation to deal with sex offenders, the basic question in this
area is far from resolved.

There is much opportunity, challenging though it may be, for
the psychiatrist in the field of penolog>^ This should, and ultimately
may broaden its horizons in the direction of rehabilitation and even
therapy in a f ulier medical sense.

In our approach to the therapeutic and preventive aspects of
crime cognizance has to be taken of practica! limitations. It is useless
to become preoccupied with theories unless they are practica], laws
unless they are meaningful, and ideas unless they are workable. The
psychiatrist interestcd in crime realizes the limitations relative to all
other phenomena in nature, and does not anticipate Utopian Solu-
tions. However as a physician cognizant of the great strides made in
this field, and the many more challenging possibilities for the future,
the psychiatrist readily accepts bis Obligation to participate in a for-
ward moving rather than Status quo medical and social effort.

MEDICAL ASPECTS OF ULCERATIVE COLITIS

Charles I. Krieger

Ulcerative Colitis, also known as Colitis gravis, was described by
Wilke and Moxon as a separate disease entity as far back as 1875.
But it was only after Worid War I that chronic ulcerative Colitis was
recognized as one among various other diseases of the colon associated
with ulcer formation. Subsequently, the diflerential diagnostic criteria
were established. However, there are still a few who consider chronic
ulcerative Colitis and chronic dysentery to be of common origin.

We know acute forms of the disease with sudden onset, high
fever, Woody and mucous stools. On proctoscopy, there are ulcerative
processes which look very similar to those seen in acute dysentery.
Since this type of ulcerative Colitis gives all the Symptoms of an acute
infectious disease of the large bowel, considerable efTorts have been
made to identify a specific organism as the etiologic agent (Bargen).
The results were not conclusive and it is the present consensus that
the bacterial flora is non-specific and plays no role in the etiology of
the inflammatory process. The same holds true for certain viruses iso-
lated from the mucosa. However, such secondary infections lead to
further damage of the intestinal wall and contribute to the seriousness
of the process.

Allergy, imbalance of the autonomous nervous System, and nutri-
tional deficiencies have also attracted attention as potential etiologic
factors. All 3 have been shown to effect experimental changes (blood
and lymph supply) in the colon similar to those associated with
ulcerative Colitis.

Ver>' much emphasis has been placed lately on the psychologic
aspects which will be discussed by Dr. Meyer. In my own opinion,

there can be no doubt that in ulcerative Colitis, as in peptic ulcer,
"stress" plays an important part in producing localized lesions, pro-
vided the person is prone to such a psychosomatic reaction. If we
accept ulcerative Colitis as a disease of stress in persons with neurotic
traits, there is still the problem of what the mechanism of the reaction
may be both as to localization and pathogenesis of the intestinal lesions.

The importance of the psychogenic factor in the clinical picture
of the disease is almost generally accepted. An ailment causing dis-
ability for a long period of time involving remissions and relapses,
puts a tremendous strain on the paticnt. Altemating disappointment,
and optimism, periods of pain, disturbed nights, loss of weight,
inability to lead a normal social Hfe - all this may imperil the balance
even of well adjusted persons.

In Order to establish a diagnosis we have to rule out a number
of related conditions. Bacillary dysentery, acute and chronic forms of
amebic Colitis, an irritable colon, tuberculosis, regional ileitis, nutri-
tional deficiency, primary congenital polyposis of the colon, and
lymphogranuloma venerium are the most important diseases which
should be considered.

The onset of ulcerative Colitis is gradual, sometimes acute, very
rarely fulminating. According to Palmer, 97 % of the cases show
rectal involvement on proctoscopy. The Observation of 2000 cases by
Sloan, Bargen and Gage showed clearly that the most frequent type
of disease involves the rectum and to a greater or lesser extent the
entire colon. The milder form progresses slowly from the rectum to
the sigmoid and colon. The process may be continuous for many
years, heal and show relapses with further progress proximally. It is
important to note that there is no direct correlation between the
extent of the lesion and the clinical Symptoms. Patients with extensive
lesions of the rectum and sigmoid may complain of constipation, com-
bined with some tenesm and expulsion of mucus with or without
blood. On the other hand a process identified by proctoscopy and
x-ray examination as relatively mild may produce violent pain and
tenesm, as well as loose and bloody stools. We have seen cases with
only a few loose bowel movements, which showed extensive polypoid

changes. The severest forms of the disease, with narrowing, scar for-
mation and polypoid changes throughout the whole colon occasionally
go into complete remission with formed, regulär bowel movements
and with little pain. Time does not i>ermit to describe in detail the
different proctoscopic pictures at the various stages of the disease.
However, I may assure you that protoscopy in the hands of the
experienced physician will almost always establish the diagnosis, the
type, and the stage of the disease.

The two most frequent complications are stricture (in about
10%) and polypoid changes (in almost 20% of the cases). Most of
the strictures are localized in the rectum and sigmoid; they do not
interfere with the transport of fecal material. It must be kept in mind
that ulcerative Colitis may be a complication of primary [X)lyposis of
the Colon.

As to the relationship between chronic ulcerative Colitis and
Cancer, recent reports show that Carcinoma occurs more frequently in
patients with ulcerative Colitis than in the average population ( Kasich,
Weingarten and Brown: in 7 of 143 cases = 4.9%; Kiefer, Eytinge
and Johnson: in 10 of 226 surgical cases = 4.4%, and in 9 of 458
non-surgical cases=2%; Lyons and Garlock: in 9 of 226 surgical
cases = 3.9 %). These figures alone are not alarming wouldn't it be
for the fact that observed malignancies concemed relatively youthful
patients, that multiple foci were present and that the tumors were
highly malignant and metastasized frequently. Alvarez has stressed
these points. The factors of age and of duration of the disease should,
therefore, be taken into consideration when the indication of surgery
comes up.

That ulcerative Colitis during its prolonged course impairs the
balance of fluid, electrolytes, and nitrogen, and causes nutritional de-
ficiency and anemia is not surprising. The severest cases show extreme
loss of weight and complete emaciation, a picture of pity and sorrow.
What happens to metabolism and nutrition in milder cases when
they extend over years is not yet sufficiently known. From a paper of
Posey and Bargen it would app>ear that severe metabolic derange-
ments may be presented at a time when the disease still causes rela-

tively mild Symptoms. Such frequently described signs as glossitis,
cheilosis, and raw beef tongue are commonly interpreted as vitamin
deficiency.

Impairment of adrenocortical function is suggested by the fre-
quently diminished urinary excretion of 17-Ketosteroids and increased
excretion of corticosteroids. The Sedimentation rate is increased in
Proportion to the severity of the disease. Leucocytosis is missing even
in severe cases. Defective intestinal absorption due to abnormally fast
passage of food prevents utilization of part of the food intake. Nitrogen
balance becomes negative (Sappington and Bockus), calcium loss
causes demineralization of bones. A significant potassium deficiency
was reported by Smith, Pollard and Bolt, but not confirmed by others.
Our own observations revealed quite frequently low serum potassium,
low Chlorides and low sodium, sometimes combined with metabolic
alkalosis. Hypoproteinemia is frequently present. Patients in the State
of malnutrition usually have very low BUN. This might be due in
part to an inability to synthesize protein and this, in tum, might be
the result of diminished production of those corticosteroids which are
needed for the anabolism of protein.

Hepatic disturbances in ulcerative Colitis are frequently men-
tioned in the literature, but their significance and origin has still to be
explained. Fatty Infiltration or cirrhosis of the liver are common
findings. The question of liver damage has been recently investigated
by Kleckner, Stauffer, Bargen and Dockerty by combined use of
hepatic function tests and needle biopsy. The findings in 32 cases
were as follows: Normal: 5 cases; fatty Infiltration: 9 cases; pericho-
langitis: 3 cases; p>ericholangitis with stasis of bile: 3 cases; diffuse
hepatitis: 2 cases; necrosis: 1 case; cirrhosis: 6 cases; metastatic
Carcinoma: 3 cases.

In 6 patients who had no clinical or laboratory evidence of
hepatic dysfunction, only 2 had normal findings on biopsy. This con-
firms the commonly held view that liver damage is a f requent attribute
of ulcerative Colitis.

That renal changes may develop on the same basis seems possible.
Jensen, Baggenstoss and Bargen's postmortem studies of 64 cases

revealed that glomerular tuft proliferation was present in 70 % of the
patients and most pronounced in the active cases. Tubulär degenera-
tion and necrosis were found in 23 %, acute Pyelonephritis in 6.7 %,
renal calculus in one case. Compared with other severe chronic diseases
of various kinds, chronic ulcerative Colitis showed the highest inci-
dence of renal damage, a fact which should reflect uf>on the indication
of surgery.

The therapy of ulcerative Colitis is one of the most difTicult and
complex Problems. The character and the features of the disease are
of such a diversity that we have to ad just the management to the
ever-changing clinical Situation. To retain the confidence of the
patient and his family during the prolonged course of the ailment is
a task very hard to achieve. On the other band, the results may be
less satisfactory if the patient has not complete confidence and is not
willing to cooperate to the füllest extent. I can give you only an out-
line of the most important therapeutic procedures.

There has always been the general tendency towards an undue
restriction of the diet, emanating from the idea that a non-residue
diet is required by the presence of inflammatory intestinal lesions. Such
a diet must become harmful if given for a prolonged period of time.
The proper regimen should supply plenty of protein ( at least 120 g. )
and as many additional calories as the patient tolerates, restricting
the total amount of fat. The tolerance for milk is generally poor.
Fruits are valuable, but are apt to produce diarrhea in many cases.
Fresh orange juice is preferable because it is rieh in potassium.
Replacement of water, electrolytes and nitrogen is of great importance.
Blood transfusions are often needed to restore volume and protein
level of the vascular compartment. Frequent blood counts and serum
analysis for electrolytes must supply the criteria upon which the
amount and kind of parenteral fluid therapy depends. The necessity
of vitamin replacement is understood.

As to medication, anti-spasmodics are very valuable. Opium and
its derivatives should be given with caution. When the first sulfa drugs
became available, expectations were high. Today we know that only
preparations which largely escaf>e absorption from the intestinal tract

have beneficial effect. Sulfathalidine (Phthalysulfathiazole) and Sul-
fasuxidine (Succinylsulfathiazole) are the preparations of choice.
They act primarily on the gram-negative flora of the intestines. Their
therapeutic vaJue in ulcerative coUtis is not uniform. Patients with
acute exacerbations may benefit temporarily from the medication, for
instance, prior to surgery. The latest addition to these drugs is azul-
fidine, suggested by Svartz in Stockholm in 1940. It is gradually
decomposed in the body to 5-AminosaUcyHc acid and Sulfapyridine.
To reduce the incidence and severity of side eflects, the well known
precautions must be observed and one should control the Output and
composition of urine as well as the blood count. As a whole, the value
of sulfa drugs in the treatment of the acute and chronic phases of the
disease is very limited.

Equally disappointing are the results obtained with antibiotics.
There is no doubt that the bacterial flora can be influenced, even
selectively, by the various preparations, when administered orally or
parenterally. However, this effect is short and soon the bacterial count
retums to or exceeds its original level. The antibiotics are valuable
only in the acute flare-up and in the pre-operative management. The
evaluation of the various antibiotics with respect to these two indi-
cations is still incomplete.

Finally, we have to discuss the therapeutic value of ACTH and
Cortisone. The observations gathered thus far cover a period of not
more than 3 years, but give sufficient proof that the beginning of a
new area in the treatment of ulcerative Colitis is at band. A critical
analysis of the available studies indicates that the majority of observers
consider ACTH or Cortisone as an eflective remedy at one time or
the other. A few authors disagree and discourage the use of either
one (Rosmiller, Brown and Ecker, Redish). Our own experience
correlates well with that of Wirts-Carrol and Kirsner- Palmer who are
convinced that ACTH is very valuable as an adjunct in the treatment
of idiopathic ulcerative Colitis. I feel that ACTH should be given a
trial whenever the clinical condition Warrants it, but that such a
treatment requires hospitalization under any circumstances. I would
not use these potent substances in mild cases unless all the other
methods of internal therapy have failed. Patients who have a recur-

rence and are in good nutritional condition should not be subjected
to ACTH injections and their potential side effects. Patients who have
their first attack and show fulminating Symptoms should receive an
early course of treatment with ACTH. Quick response and complete
restoration of the mucosa has been reported not infrequently. We had
always thought that the anatomic lesions as seen on proctoscopy could
hardh vanish as the result of any therapeutic procedure in so short a
time. Yet, their rapid disappearance during administration of ACTH
is a matter of record. Additional improvements consist in the decline of
fever, and the number of bowel movements, the restoration of electro-
lyte balance, an increase in blood formation, gain in weight, and
return of appetite. Furthermore, the patient will usually develop the
euphoria that is so well known as a result of ACTH administration.
If one observes such a drastic change in a severely ill patient, extreme
caution is indicated not to overrate the significance of such an appa-
rent improvemeiit On the other band, to bring about a remission by
use of ACTH is an achievement that should not be underrated. It
even seems as if we can sustain such remissions and prevent recurrences
from getting out of control.

The risks and benefits of prolonged endocrine therapy with
ACTH or Cortisone are not yet fully understood. Among the known
complications are masked Perforation of peptic ulcer and ulcerating
areas of the colon, the development of psychosis, and the production
of hyperadrenocorticism.

Whether ACl H or Cortisone is of greater efficiency in these
therapeutic endeavors, has not yet been decided. I have seen patients
who did not respond to ACTH but improved with Cortisone, and vice
versa. The quiekest response is achieved by intravenous administration
of ACTH. Most authors feel that sulfa drugs or antibiotics should be
given in addition to ACTH whenever the danger of suppurative
complications is threatening.

Treatment with ACTH or Cortisone may also alter the surgical
aspects of the disease. When we consider that the mortality rate in
emergency Operations is 50 7r and in properly selected cases only 9 %
(Bargen), attempts are justified to overcome emergency situations by

4 Viichow Society, Vol. 12 (1953)

means of endocrine thcrapy and to postpone surgery until the patient's
condition is under reasonablc control.

The foregoing discussion did not conceal my somewhat rcserved
attitude with respect to the ultimate fate of patients suffering from
this dreadful disease. There is, however, no doubt that the chances
for recovery are considerably greater today than 10 years ago. New
discoveries in the field of metaboHsm, drug therapy and endocrine
control have been applied to the treatment of ulcerative Colitis and,
in combination with psychotherapy, have resulted in an entirely new
pattem of medical management of the disease. The prospect of
reducing the need for surgery has increased considerably, and if the
surgeon is called upon to step in, the chances are today that he will
take over many more good than bad surgical risks.

SURGICAL ASPECTS OF ULCERATIVE COLITIS

Helml'th Nathan

The ways of trcating a disease of unknown etiology cannot be
but solely empiric. Often the procedures will be palliative only. Among
the etiologic factors which are assumed to play a role in the develop-
ment of ulcerative Colitis are infection, nutritional deficiency, allergy
and psychosomatic reactions. Unfortunately, one rarely eures the
existing disease by eliminating one or the other of these factors. Ul-
cerative Colitis is a dreadful disease; it occurs frequently in young
people who are in the prime of their life and above average intelli-
gence. Almy states that the condition is apt to produce inflammations
as huge as any observed in clinical medicine. Bacon compares it with
a third degree burn of the colon, with severe secondary infection and
coating of the mucosa with fecal purulent poultice. Ulcerative Colitis
Starts usually in the rectum, proceeds to the sigmoid and ultimately
involves the upper part of the colon and cecum. In a number of
cases the process will pass the barrier of the ileocecal valve, and then
we face the even more frightening disease of ileocohtis. In a smaller
percentage of cases the disease Starts off in the proximal part of the
Colon, and recently a number of cases have been reported where the
colon was involved only secondarily as a result of an extending regional
ileitis. I have seen a bov of 4 vears who was afflicted with the disease,
and there are reports on ulcerative Colitis in the newborn. The disease
is rarely seen in the aged.

Obscure in its etiology, uncertain in its prognosis, fluctuant in
its remissions, the condition poses a difficult problem from the thera-
peutic viewpoint. It can be controlled without surgery in about 60 to
S5^/c, but as Jordan and Kiefer have stated, a eure is possible only

Acute exacerbation
Multiple remissions
Uncontrolled, continuous diarrhca
UncontroUcd hcmorrhage

(chronic, acute)
Perforation (chronic, acute)
Perirectal abscess

Indications for Surgery

Anorectal fistulae

Obstruction (chronic, acute)

Pseudopolyposis

Malignant degeneration

Arthritis

Gangrenous pyodermy

Rigid-pipelike rectum and sigmoid

by surgical removal of the colon. We have heard Dr. Krieger's pre-
sentation of current mcdical aspects. The optimism which followed
the introduction of ACTH and Cortisone has received severe setbacks.
More and more cases of ACTH-treated patients are reported in whom
Short improvement was followed by severe bleeding and Perforation.
Such occurrences are especialh dangerous because they are often
masked by the apparent well-being of the patient. Cooperation of
family physician and surgeon is indispensable not only before but also
after surgical intervention. Once it has been decided to resort to sur-
gery, repair and maintenance of electrolyte and fluid balance has to
be attended to, antibiotic therapy must be initiated and proper psycho-
logic care must be provided. Dr. Crohns opinion regarding psycho-
therapy is outdated; he niaintained that a psychiatrist on the bedside
of such a seriously ill patient is a wastage of time, energy, good thought
and money. Not only the psychiatrist, but also the physician and the
surgeon should take time out to give the patient mental comfort and
confidence.

Surgical treatment must be fluctuant, both in its indication and
in its technical procedures. Without going into details I shall first give
you a brief outline of the indications for surgery as I see them from
my relatively conservative point of view.

Early surgery seems to be indicated in all cases of the f ulminating
type ; their mortality is very high with any kind of therapy, even with
surgery. Catell and Cave had a mortality ranging from 53 to 75%.
No wonder that Cave suggested recently an earher and more radical
application of surgery in these and other forms of ulcerative Colitis.

Surgical Procedures

Indirect
Vagotomy

subdiaphragmatic

supradiaphragmatic
Pelvic neurectomy

sympathetic

parasynipathetic
Lumbodorsal sympathectoniy

Direct
Shortcircuiting

ileostomy

cecostomy

ileosigmoidostomy
Eliminating

colectomy

one-two-multiple stage
partial-subtotal-total

one + two team

Howard Lilienthal performed surgery in ulcerative Colitis already
in 1901 ; he used a multiple stage procedure with good results. If the
mortality of ulcerative Colitis is still high, we have to blame that at
least partly on an unduly conservative attitude towards the indication
for surgery. In the series of cases shown on the chart the mortality
is high in both the medically and surgically treated patients. But if
we consider that onlv the most severe cases came to surger) and that
total colectomies show even better results than the combination of
all availablc medical methods, advocation of early surgery seems to be
justified. Only in one group of cases is utmost conservatism indicated,
that is, in young children. Their mortality is terrifically high.

Operative procedures include 3 methods. The first, uses the in-
direct approach and is aimed at eliminating the nervous Impulses
and thereby changing the pattem of intestinal motility. Dennis, Torek
and others advise vagotomy, either supra- or subdiaphragmatic. Since
the vagus supplics only the right side of the colon, Hinton, Frykman
and others have sugc^ested to remove the autonomous presacral and
pelvic parasympathetic ganglia. Vagotomy as advocated by Dennis
has not been accepted as an eflective method of treatment since it
leads only to temporary improvement which takes place so often spon-
taneously in the course of the disease. Hinton's procedure (exposure
of the ganglia by incision of the peritoneum on the sacrum) involves
some postoperative complications (temporary disturbances in voiding
and ejaculation) and is not yet recommended for general use, although
it certainly represents one of the most promising approaches to the

Problem. These rncthods, howcver, do not eliminate the potential
development of Cancer which occurs tvvice as frequently in patients
with ulcerative Colitis than in the average population and is often
especially malignant.

The second category of methods is designed to establish short
circuits: Ileostomy, cecostomy and ileosigmoidostomy. Their aim is to
put the diseased colon at rest. After ileostom), whether done as a
double loop or closed and open end procedure, the mortality rate is
18 to 21 7r. Dehydration, perforation, Peritonitis and severe bleeding
from the colon are among the sequelae. Improvements are only tem-
porary, if they occur at all, and the re-anastomosis with the sigmoid
usually causes a flare-up of the disease. Under these circumstances,
the rule has been generally accepted: Once an ileostomy, always a
colectomy.

Paradox as it might appcar, patients in whom ileostomy failed
are doing well on colectomy. This Operation can be done in one, two
or multiple stages, as partial, subtotal or total colectomy. In the one
stage Performance of subtotal colectomy, combined with immediate
abdcmino-perineal resection, two surgical teams may take part, one
doing the perineal and the other the abdominal Operation. The most
modern and most successful Operation is the one-stage immediate
ileostomy with subtotal colectomy, followed within one to three months
by the abdomino-perineal resection. Bacon, Gavon and Miller and
his associates have introduced this new courageous approach into ihc
surgery of ulcerative Colitis. Figure 1 shows the amount of colon
removed during one of these Operations (details of the technique are
given). The patients recover amazingly fast and may return in about
two months to their occupational and social activities. This adjust-
ment has lost much of its hardships thanks to the Rutzen bag which
can bc worn almost unnoticed under any kind of clothing (ladies'
evening dress). The question may be asked whether abdominal ileo-
stomy could not be circumvented altogether? Ravitch has suggested
an ano-ileostomy as an alternative procedure in the treatment of Poly-
posis but not in ulcerative Colitis. Recently organized ileostomy clubs
ofTer unique opportunities for patients with ulcerative Colitis to join
in their efforts of adjustmcnt, to discuss their problems of rehabili-

Fig. 1. Terminal Ileum and Colon to be removed in one stagc.

tation, to give and receive encouragement in battling against technical
difficulties and mental strain caused bv the dreadful disease.

I want to show you briefly two of our patients who were operated
on recently. Both have total colectomies; one had a perforation, the
other one a prolonged bleeding of such severity that we could hardly
pour blood in as fast as he was losing it. That they are both living
happily and doing füll work now is sufficient proof for the fallacy of
the old saying, "The patient is too sick to be operated on". Instead,
we must have the courage to say, "He is too sick not to be operated on."

PSYCHIATRIC ASPECTS OF ULCERATIVE

COLITIS

Bernhard C. Meyer

The attention of the psychiatrist to the problem of chronic
ulcerative coHtis embraces three phases:

1. Psychologie factors playing an etiologic or contributan' role in
the genesis of the illness.

2. Psychologie reactions to the illness.

3. Psychiatric manifestations associated with improvement or eure
of the disease.

Of these three aspects of the problem the second, the psychic
reactions of the patient to the physical illness, is so patent as to tend
to overshadow the other two. Psychiatric and psychologic investiga-
tions, however, have shown that the pre-colitic personality of patients
with chronic ulcerative Colitis tends toward a certain type, charac-
terizable as narcissistic, passive, vulnerable, infantile, dependent and
repressed. Equally typical is the denial of emotional conflict and a
rather vigorous defense, occasionally assuming hostile or paranoid
proportions, against attempted penetration of this denial. Acute onset
of the colitic Syndrome often follows psychic trauma, especially the loss
of a so-called "key person" from the life of the patient. Similarly,
severe electrolyte disturbances in the ileostomy patient not infrequently
occur after emotional disturbances, often of a seemingly minor degree.
With the disease established the Colitis patient tends toward a regres-
sive preoccupation with the condition and its manifestations, exhibit-
ing an abandonment of the fastidiousness and nicety so characteristic
of the pre-colitic personality to a degree reminiscent of the coprophilic

behavior of severely regressed State hospital inmates. This finding is
in keeping with other indications that the ulcerative Colitis patient is
often but delicately defended against an underlying psychosis. Inju-
dicious psychologic probing has not infrequently unfolded severely
psychotic productions and behavior. This impression of an underlying
psychotic pattern is confirmed in Rorschach and other psychologic
studies. In not a few instances a reciprocal relation between psychosis
and Colitis has been observed : the outbreak of a frank psychosis being
accompanied by a disappearance of the colitic Syndrome. Such
occurrences as well as the reverse suggest that the Colitis may serve a
defensive purpose, protecting the individual against psychotic break-
down. Somatic conditions as well as psychotic episodes, e.g. asthma,
have also been known to "replace" the Colitis. In other instances Coli-
tis and psychosis occur concomitantly. Psychiatric treatment encoura-
ging the production of repressed and phantasy material is often hazar-
dous and may lead to psychotic upheaval. Most observers agree that
the most effective therapeutic Psychiatric tool is the establishment of
a warm human relationship between doctor and patient, supplying to
the latter a replica of the "lost" "key individual" in the person of the
physician, whether Internist, surgeon or psychiatrist.

4* Virchow Society, Vol. 12 (1953)

NEWER TECHNIQUES IN CINEPLASTIC

AMPUTATIONS

Ernst W. Bergmann

Cineplastic procedures have made slow headway in this country,
yet the field of application should grow considering the ever increasing
number of industrial and traffic accidents.

The principle of cinetization is to make use of certain muscles
for purposes of activating an artificial hand or hook.

The initiative in transforming an arm stump into something
more useful was taken by the Italians, but their method of forming
tendon loops at the stump end proved not very successful and has not
many advocates.

Sauerbruch's muscle canal Operation is far more satisfactory. It
uses a skin tube which is fashioned from a pedicle skin Aap by sewing it
inside out. This tube is passed through a tunnel in the muscle belly
and it moves with the contracting muscle. It is this movement which
is utiHzed to activate an artificial hand.

The operative technique as originally developed by Sauerbruch,
has been modified by Lebsche und by Spitder as follows:

1. Canalization of the forearm muscles has more or less been given
up even in stumps having the necessary length as stipulated in
previous pap>ers.

2. As a rule, the canalizadon is applied to the biceps alone. The idea
of a double motor, that is the addition of a triceps tunnel for anta-
gonistic action has been given up, leaving this action to a spring
in the terminal device.

3. The skin tube is made considerably wider.

4. The biceps tendon is severed from its distal attachment, so that it
no longer flexcs the elbow, a function which is left to the brachialis
alone.

5. In Short arm stumps the method can be very successfully applied
to the pectoralis muscle. This is in obvious contrast to what Sauer-
bruch and later Nissen and myself have said on sundry occasions.
Lebsche's pectoralis tunnel has proven a most valuable procedure.
( Demonstration of two patients with biceps tunnels. )

PULMONARY SARCOIDOSIS
F. C. Burgheim

Since roentgen examinations of the ehest have beeome a routine
offiee proeedure, I should like to demonstrate a ease whieh might
easily be mistaken for tubereulosis or malignant tumor, the two con-
ditions doctors are mostly concemed with. I also want to show this
case of pulmonary sarcoidosis or Boeck's sarcoid in order to impress
on you the most characteristic pattem of this disease.

Slide No. 1. This is the so-called sarcoid type (Garland) of
bilateral, symmetrical enlargement of the peribronchial lymph nodes,
while the paratracheal lymph nodes are involved only on the right
side. Coarse lymphatic markings radiating toward the periphery and
several small areas of pulmonary infiltration are also noted. - The
patient, a young, healthy-looking man, active in all kinds of sports,
was much surprised when he was rejected by the Army in 1942 after
a routine ehest film had been taken. I saw him a few days later in a
very depressed mood, as he had been told that he was suffering from
advanced tubereulosis.

However, this initial diagnosis was wrong, based solely on an
erroneous interpretation of the X-ray film. The "sarcoid type" of pul-
monary lymphadenopathy, the excellent general condition of the pa-
tient who had no cough, no dyspnoe and no fever, his negative Sputum
and negative tuberculin test, a normal blood Sedimentation rate and,
finally, the clinical course disclosed the identity of the disease: sar-
coidosis.

Slide No. 2: Seven years later - I omit the films taken in the
meantime -, without any treatment or change in the patient's daily
habits, we find a marked improvement indicating that the condition

had been stationary for many years. This is also a characteristic
finding in this disease. Sputum and other tests remained negative.

Slide No. 3: This film, taken more than 10 years since the disease
was discovered, reveals further improvement: the coarse striations
and the enlarged paratracheal lymph nodes on the right side have
disappeared.

Slide No. 4: The last film was made only /2 year later. The pa-
tient had just been treated at a hospital with a total of 550 mg. Corti-
sone for an allergic j>enicillin reaction. It is remarkable that this
relatively small dose of Cortisone has produced an immediate, though
slight Clearing of the lesions. Such efTects of Cortisone have been de-
scribed in the literature following intensive treatment, and I believe
that this also confirms our diagnosis.

Time does not permit to go into details of this interesting disease,
originally described as skin lesion. We know that it may occur in any
part and tissue of the body and that its course may be as variable as
its manifestations. Since this is not my first Observation of this kind
I would hke to emphasize once more that the bilateral and symmetri-
cal hilar lymphadenopathy in an apparently healty person is suggestive
of pulmonary sarcoidosis.

ACUTE MESENTERIC VASCULAR
OCCLUSION FOLLOWING MUMPS

Wolf Elkan

Acute mesenteric vascular occlusion still remains one of the most
serious surgical catastrophes with a mortality of 90-95 % according
to recent comprehensive reviews of the literature. Ficarra in 1944
collected 569 cases with 35 survivals, a mortality of 94%. McClena-
han and Fisher in 1948 collected 616 cases with a mortality of 93 %,
Whittaker and Pemberton at the Mayo Clinic in 1938 reported
3 survivals in 60 cases, a total mortality rate of 95 % . The actual
mortality may even be higher since not all cases are correctly diagnosed
preoperatively, many patients come to the hospital in moribund con-
dition and often no autopsy is performed. The reasons for this high
mortality are twof old : First, the rare incidence of the condition which
ranges between 0.02% and 0.05% of all hospital admissions. Se-
condly the diagnosis is very difficult to make because Mesenteric Vas-
cular occlusion has no typical clinical picture. The onset may be in-
sidious, subacute or fulminating. The pre-operative diagnoses in most
reported cases have been gastroenteritis, Cholecystitis, acute pancrea-
titis, atypical pneumonia, lead poisoning, appendicitis, intestinal ob-
struction, volvulus, paralytic ileus, renal colic, perforated ulcer, Car-
cinoma divcrticulitis, etc.

Since the picture is often uncertain, much time is spent with
diagnostic procedures. Mortality rises with every hour that passes
between onset of the disease and surgical Intervention. Death occurs
both from shock due to the loss of blood volume caused by tremendous
outpouring of blood into the intestinal lumen and peritoneum as well
as from toxemia caused by gangrenous intestines.

Often Operation is refused by the surgeon on account of the
patient's poor condition. This is definitely wrong inasmuch as failure
to operate will lead to certain death while surgery gives the patient
his only chance for survival.

Many times, resection is not done because too much of the
intestine appears to be involved. This is equally wrong since a number
of cases have been reported where almost all of the small intestines
had been resected leaving as little as 17 cm., 20 cm., and 45 cm. of
ileum and one case where even the ascending and one half of the
transverse colon had to be resected with subsequent survival of the
patient. Massive involvement, therefore, is no contraindication for
resection since, here again, failure to resect will lead to the death of
the patient.

Symptom atology: The onset is frequently insidious with vague
abdominal pains, indigestion, belching and vomiting for one to seven
days; then the temperature rises up to about 101, the pulse becomes
very rapid and the WBC generally is found between 20 and 30,000
with a high difTerential count.

Abdominal distention sets in but true rigidity is often absent.
A typical Symptom is very severe pain, out of all proportion to the
physical findings. Blood tests show hemo-concentration ; X-rays fre-
quently show dilated loops which extend down to the splenic flexure
suggesting intestinal obstruction. Barium, however, if given by enema
passes freely beyond this point, a diagnostic sign which has been
described by Harrington. The overall clinical picture has been
described as a composite of internal hemorrhage and intestinal ob-
struction.

The etiology of this condition may be classified as follows:

1. Mechanical causes: a) adhesions, b) volvulus, c) Strangulation,
d) pressure of adjacent tumors and e) portal stasis.

2. Traumatic causes: a) trauma of the abdomen and b) tearing of
the mesentery.

3. Blood dyscrasias: a) polycythemia vera and b) splenic anemia.

4. Infections: a) appendicitis, b) pelvic inflammation, c) Chole-
cystitis, d) f>eritonitis, e) diverticulitis and f) thrombophlebitis.

5. Cardiac causes (for the arterial type): a) auricular fibrillation
and b) rheumatic heart disease.

6. Miscellaneous causes: a) periarteritis nodosa, b) mesenteric
thrombosis following lumbar sympathectomy or procaine block
of the lumbar chain (Laufmann and Scheinberg, Bauer) and
c) obesity.

7. Unknown causes: In a very large number of cases, thrombosis
of the mesenteric vein must come under the etiologic heading of
primary venous thrombosis or "Mesenteric vascular thrombosis
without apparent cause". Since it seems unlikely that a condition
of such gravity should develop by itself and for no reason whatso-
ever, it must be assumed that in those cases a causative factor
does actually exist but has not become apparent to the chnician.
Such cases ränge between 35 and 40 % in recent computations
of the hterature.

In the following case report, a new etiology is described which
I have not found anywhere in the international Hterature up to the
present date. It is a case of acute surperior mesenteric vein thrombosis
following acute pancreatitis after mumps.

The patient, a 32 year old male with a non-contributory past medical history
suffered from an attack of mumps, on May 9, 51. He received two injections of
immune serum globulin on May 9 and 11, and 5 mg. of diethylstill-bestrol daily
to prevent Orchitis, and improved. Two weeks later he suflfered from pain in the
left hypochondriurn and back, indigestion, belching and feeling of fullness; he
passed soapsy stools. His spermatic cords were tender to the touch. The diagnosis
of pancreatitis following mumps was made. He was treated with bed rest and a
fat free diet. His pain and temperature increased and he was hospitalized on
May 31, 51. His weight at that time was 195 Ibs., temp. 100.2, pulse 90, respiration
20, BP 125/80. He had slight tenderness in the LUQ. RBC 5/2 million hemo-
globin 110 % indicating hemo-concentration; WEG 16,100, poly 83 %, Stab forms
12%, lymphs 3%, monos 2%. The urine was essentially negative. He was
treated with intravenous fluids and penicillin and improved. Two days later he
suddenly coUapsed. His temperature rose to 103.4, pulse to 136. He assumed an
ashen gray color and was covered with cold Perspiration. His BP feil to 90/60
while his abdomen became distended and no peristalsis could be heard.

In spite of his precarious condition, immediate surgery was decided upon,
on the assumption that a perforative hemorrhagic pancreatitis had occurred. On
opening the abdomen about 2000 cm^ of dark sanguinous fluid was aspirated. In
the LUQ a convolut of distended gangrenous intestine was found beginning about
30 cm. below the ligament Treitz and extending for about 180 cm. The entire

involved intestine was rapidly rese( tt-d and a side to sidc anastaniosis was done,
with about 20 cm"'* of overlap to safcguard against advancing marginal thrombosis.
During the Operation the patient wrnt into derp sho( k and became mori-
bund and received last rites. About V:« of the Operation was carricd out without
anesthesia, carrying the patient on oxygcn and blood transfusions only. The post-
operative coursc was cxtremely stormy with a temperature rise to 106, abscnt
pulse and BP, and heart rate of 180. The patient was treated with blood trans-
fusions, parental fluids, vitamins and anticoagulants; using heparin intravcnously
for the first 48 hrs., and following with dicumarol thereafter. He received anti-
biotics and Cortisone to overconie what appeared to be adrenal exhaustion. After
the first critical days the patient had an uneventful recovery, except for what
appeared to be a thrombotic episode on the 10»^ postoperative day. This, how-
ever, was overcome with anticoagulants. It was found at this point that the com-
bination of heparin and dicumarol will in rare instances be antagonistic instead
of symbiotic and dicumarol alone was given from then on with good rcsults.

The patient was allowed out of bed on the 15'^ postoperative day and dis-
charged from the hospital on the 21**' postoperative day in excellent condition. He
has been well now for two years.

It is suggestcd that the entity of mesenteric vascular occlusion be
kept in mind in all cases of unexplained intra-abdominal conditions
and that surgical intervention be not delaycd by protracted diagnostic
procedures.

This case as well as othcr cases in the hterature prove that surgery
must be done regardless of the apparent hopelcssness of the patient's
condition since failure to operate will Icad to certain death. Intestinal
resection must be done as widely as possible regardless of the extent
of involvement.

TREATMENT OF EXCESSIVE SMOKING

BY HY PN OS IS

Edith Klemperer

Patient started smoking at 13 years and immediately smoked
2-3 packages daily, but took only a few puffs with each cigarette.
A few months later, he smoked all cigarettes to the end. He is now
44 years old, is bored with his occupation (pressing clothes) and
abets smoking. In 1949, diabetes, claudicatio intermittens, and a
questionable Buerger's disease were diagnosed. Pulse of dorsalis pedis
and tibialis were not palpable. After Walking one or two blocks he
had to stop because of pains in calves. He had no relief f rom his com-
plaints after he had received 30-40 injections, and was told to stop
smoking. However, "I just have to smoke" was his reply. Since a
stomach ulcer wa.s detected 4 months ago, he keeps to a diet and
takes pills to combat the pain.

He was first seen on March 4, a Wednesday and was told that
hypnoanalysis would be preferablc to hypnosis in his particular case.
All analytic endeavors failed, however, because of the patient's Op-
position. Hypnosis could be easily induced. He received the conven-
tional soothing suggestions, some of negative nature (that he would
not want to smoke) some of pasitive (that he would feel fine without
smoking). Scheduled for another session on Saturday, March 7, he
phoned saying that he had no desire any longer to smoke and would
not return for treatment. Sunday he took up smoking again, under
the following circumstances. Although he had no urge to smoke, not
even in the smoker's lounge, his girl friend happened to ask him (in
the Cafeteria) to buy her a pack of cigarettes and to light one for her.
When he did so, she refused to smoke it. Left with the lighted cigarette,

he didn't want to waste it and did smoke it. This started him on the
old road.

He gave me this story on March 16, when he returned to see me.
His stomach was fine and he no longer needed pills. He said that his
legs were better. Hc was again hypnotized and got some additional
suggestions. This time he stayed away from smoking for only two days.

He came again to see me on April 7. His stomach did not cause
any discomfort, the condition of his legs was unchanged. When asked
what kind of taste he disliked most, he named camphorated oil and
"tasty" gasoline. In hypnosis, the suggestions were made that a ciga-
rette would burn his fingers and that its taste would be like that of
camphorated oil and "tasty'' gasoline. When he returned on April 16,
he reported not to havr smoked thus far and to feel well. "There is a
wonderful change with my stomach, I have no pains, I don't want
to smoke". The same suggestions as made in the preceding hypnosis
were repeated at this session.

Patient abstained from smoking for 1 7 days, until April 24. On
this day, while he was eating in a restaurant, his bottom plate broke.
He feit very upset and embarrassed and took to smoking again. But
he threw the cigarette away after a few pufTs because he did not
"get any pleasure out of it". W^hen he was seen on April 29, he had
smoked only 2 packages and 6 cigarettes in these 5 days, about as
manv as he used to smoke formerlv in one dav. He was able to eat
spicy food, his appetite had improved, he was gaining weight. Follow-
ing the renewed treatment by hypnosis he surrendered cigarettes and
matches and voiced his Intention to see his physician in order to ask
him for injections. He was not heard from since. It may be assumed
that his habit was bioken. It is of interest that there were no untoward
signs of abstinence at any time.

CANCER OF THE LUNGS AND LOBECTOMY

R. Lewin

l'he incidence of malignant tumors of the lung has steadily in-
creascd in recent years. A broad program is needed to combat ihis
form of malignancy at every level of medical service. The practitioner
can participate in this program elTectively and should make every
effort to do so. A review of my own cases observed from an early
stage through the critical phases of the disease may give you a reahstic
picture of its common course and of the problems concerning early
diagnosis and surgical inter\'ention.

The diagnostic difficulties are in no way an obstacle which
cannot be overcome, as I have shown on a previous occasion. This
should again be demonstrated today by two case histories. In both
patients the presence of a bronchogenic Carcinoma with abscess for-
mation, as originally suggested by the X-ray appearance of the lesions,
was not confirmed by the outcome. The lesions disappeared comple-
tely with antibiotic therapy and turned out to be lung abscesses.
Another point seems worth while mentioning. While every unex-
plained pulmonary lesion in an adult patient should be looked upon
as potentially malign, onc should never fail to include tuberculosis
into the differential diagnostic considerations. This is illustrated by
the following case of a 50 \ear old white male patient. He was ad-
mitted to one of the hospitals for Cancer and allied diseases because
a ehest film had disclosed the presence of lesions of potentially malig-
nant character ^film). However, the pulmonary findings turned out
to be of tuberculosis naturc. A ehest film taken 15 months later, while
the patient was still under treatment, showed that most of the ab-

normal densities seen at the first film had undergone calcification
conforming to the patterns of healing of pulmonary tuberculosis.

I shall now discuss the history and films of a number of patients
whom I saw durine the last few vears in mv office.

The first and oldest patient, a man of 83 years, had a history
of persistent coughing and hemoptoe. X-ray examination revealed a
density in the lower lobe of the left lung. This proved to be a growing
tumor. Local and general Symptoms were mild and there was not
much suflering. Progressive heart failurc led to death.

The second case concerns a man agcd 77 who for several years
was suflering from hypertension, chronic bronchitis, and mild asth-
matic manifestations. Frequently performed fluoroscopic examinations
did not reveal anything suggestive of tumor. Then followed a short
feverish sickness diagnosed as virus pneumonia. A large density in the
left lung was found- with the characteristic appearance of a malignant
process. The patients advanced age and the fixed hypertension ruled
out any surgical Intervention. He was treated symptomatically and
lived with relatively little discomfort for several months.

The next case is that of a woman in her 60's who had been
treated for lymphatic leucemia over a period of many years. She
suddenly showed a density in her right lung. Papanicolou was nega-
tive. Radioactive phosphorus, nitrogen mustard and X-ray radiation
failed to have any beneficial results. Finally, bronchoscopic examina-
tion revealed that the pulmonary' lesion was not of leucemic nature,
but a bronchogenic Carcinoma.

The next case was seen first when he had an acute coronar\'
occlusion in 1948. He continued to have precordial pain on effort
and had a second infarct in 1950. A few months later he underwent
a successful gall bladder Operation. About a year ago he took sick
with fever and persistent coughing. My diagnosis was virus pneu-
monia. When the patient failed to improve, ehest X-rays were taken
which showed a diffuse infiltration of the right lower lobe. By broncho-
scopy (visualization and biops\ ) and examination of the pleural
exsudate, this infiltration was established as a bronchogenic Carcinoma.
Since surgery could not be considered because of the cardiac Status,
X-ray treatment was initiated, but failed to prevent rapid deterioration.

Under similar circumstances I lost 4 other patients with pul-
monary mali.i^nancies because surgical treatment was precluded.

M n ■JuMK.n» liß a ■

Fig. 1

The last case of this group looked much more promising when
I saw him first in September, 1952 and I trusted that my ardent
efforts in early Cancer detection would be finally rewarded. This man
was 57 years old and complaining about a distressing cough for some
time. Like most of the patients reported on tonight, he was an excessive
smoker and he attributed the coughing to this fact. On X-ray examina-
tion ( Fig. 1 ) it became evident that he had a pulmonary tumor show-
ing as a circumscribed oval shadow in the periphery of the right lower
lebe. Lobectomy was performed. The anatomic diagnosis was squam-
ous cell Carcinoma. There was good reason to hope that surgery at this
early stage would result in a complete eure. But his well being was
only of Short duration. Soon, the patient's condition worsened and the
appearance of metastatic brain lesions once more turned our hopes
into disappointment. Whether total pneumonectomy could have pre-
vented this outcome is a ver\' important question. From recent dis-
cussions of this problcm I have gained the impression that pneumon-
ectomy must be considered the superior method of treatment.

When one's own efTorts in the management of malignant lung
tumors bring nothing but failure and disappointment, one will readily
understand why a campaign is being waged with the aim of improving
early detection of lung Cancer. W e have to detect the disease in its
\'ery early stage when the patient is still symptomless and feels not
yet impelled to ask for medical advice on his own initiative. Periodical
examinations of all persons over 40 or better over 30 years of age is
the safest prophylactic measure. This sounds Utopie but could be done
through a program of public education with teeth in it ! Such a pro-
gram must alert patients and physicians alike. Periodic X-ray ex-
amination of the ehest must become a matter of routine. Kxisting
Cancer detection centers cannot do the Job alone. PLvery practitioner is
needed for the realization of a program of this magnitude. Many more
opportunities must be provided for Instruction in the recent methods
of detection. Medical and clinical societies should participate in these
efTorts. When everv doctor's office will function as a Cancer detection
Center, it may well be that Cancer of the lung is controlled and cured
some day.

MYOCARDIAL INFARCTION IN A
24 YEAR OLD BOY

Rudolf A. Stern

This report concerns the case of a \ oung Iranian graduate Student
who has been undcr my care since July 1948. The past history is not
contributory except for the fact that he has been of asthenic habitus,
got easily exhausted from his work and was advised to have regulär
checkups. The last one, on March 31, 1952, did not reveal any ab-
normal findings.

On Ma\ 19, 1952, he phoned my office asking for an appoint-
ment the same day because of unbearable headache of three davs
duration. Whcn 1 saw him, hc looked extremely pale and shaky. His
temperature was normal, and no signs of infection could be found.
His pulse was 60, and regulär, his blood pressure 75/60. (Previous
readings were reported as 120/70.) No cardiac murmurs were heard
and no pulmonar\ rales. On fluoroscopy, the diaphragm moved
freely and the lung fields were clear. The heart appeared small but
of normal configuration. The aortic arch was normal, Holzknecht
free. A ehest film revealed a drop heart but no pathology. The ECG
showed regulär sinus rhythm, a rate of 60, and a conduction lime of
0.18. QRS measured 0.05, showed low voltage in Lead 1, and in-
version in all ehest leads. ST was slighdy depressed in CF 5, but
normal in the Standard leads. T was also normal in the Standard
leads, but negative in all ehest leads. The abdomen was soft and not
tender. Urinalysis was normal. The white count was 13.000, the ESR
16 mm/one hour.

Although the electrocardiographic findings did not signify the
66

presence of an acute infarction*, I feit strongly they warranted my
decision to treat this condition as an acute coronary. Only then, on
intense questioning, the patient supplied additional data of the histo* ,
headache that had developed during the last three days and was
left-sided (face and cranium), ehest pain radiating to the left Shoulder
(it Started soon after he had lifted a very heavy intrument).

I prescribed bed rest and phenobarbital. Four days later, the
blood count was normal, while ESR had risen to 33 mm/one hour.
ECG now showed the waxing and waving of T waves characteristic
of myocardial infarction in its early stage. At strict bed rest the patient
made a quick recovery. The pain subsided after a few days, the blood
pressure retumed gradually to normal. The temperature remained
always normal. On June 6th, ESR was 14, and 9 on June 20. An
ECG taken on June 25*^ showed satisfactory stabilization : QRS as
well as T had become upright in lead CF 4 and 5, while all waves
were inverted in CF 2.

Thereafter, the patient was allowed to increase his activities
gradually. No signs or Symptoms of any recurrence were noticed, and
on August 1, 1952 he started a six weeks vacation. When he retumed,
he feit perfectly well. Since all findings were normal, he was allowed
to resume his work, with the stipulation that he must strictly avoid
any kind of strain and abstain from smoking (he used to smoke a
pack a day prior to his illness) . He has been seen at monthly intervals
and has remained free from any signs and Symptoms of pathology. As
of today, he has completed his Ph. D. thesis and is working as a
research assistant.

I believe that the presumptive diagnosis of myocardial infarction
was confirmed by the course of the disease. This is a rare illness in a
youth of 24 years. However, Yater and coworkers (2) could report
on 255 such cases (between 18 and 30 years old) who were observed
in the armed Services during World War H. All these men had been
subjected to extremely strenuous activities.

* The absence of characteristic findings in the ECG during the evolution
of myocardial infarction has also been reported by Katz (1). His patient wn«
30 years old.

5 Virchow Society, Vol. 12 (1953)

I want to emphasize the following points: Acute coronary in older
persons is occasionally masked by various Symptoms such as indiges-
tion, severe tooth ache, headache etc. If younger persons are stricken,
they have almost always typical angina and are in severe shock. The
foregoing account demonstrates that even in young patients the
characteristic clinical manifestations of acute coronary may be absent.
Under such circumstances, the nature of the disease has to be suspected
in Order to be diagnosed.

REFERENCES

1. Katz, L. N.: Electrocardiographic Interpretation, p.
Philadelphia 1946.

2. Yater, W. M., etc.: Amer. Heart J. 36, 334, 1948.

84, Lea and Febiger,

BOVINE TUBERCULOSIS OF THE KIDNEY

Alfred Zinner

I would Hke to report the case of W. M., a 30 year old white
male who consulted me because of an urologic condition of 3 years
duration. The first abnormal sign he had noticed was heavy cloudiness
of his urine. There was no increased frequency of urination and no
burning Sensation. His physician referred him to a hospital for dia-
gnostic work-up. Upon completion of all test procedures (cystoscopy,
intravenous and retrograd pyelography) he was discharged with the
diagnosis of chronic cystitis. The guinea pig test was negative. Three
years later he was referred to me.

He appeared well nourished and did not seem to be scriously ill.
On examination there was no costo-lumbar tenderness, and no en-
larged kidney was palpable. The prostate was enlarged and some hard
but not tender nodules were present. The very cloudy urine contained
albumen (H — |-), numerous W. B. C. and some R. B. C. Numerous
tubercle bacilli could be demonstrated in the stained sediment. The
intravenous pyelogram revealed excretion of diodrast on both sides
at normal rate and good concentration. While the left pelvis and the
left Ureter appeared normal, the calices of the right kidney were
somewhat blunt and the right Ureter was dilated to the width of a
finger and completely atonic in its entire length.

I was afraid that there might be no eure anymore, considering
the long duration of the tuberculous infection. On ureteral catheteri-
zation, however, normal urine was obtained from the left kidney,
whereas urine from the right kidney contained pus and Koch bazilli.
On cystoscopy, the bladder capacity was found to be normal, there
was no ulceration, and indigo-carmine was excreted on both sides at

normal rate and concentration. There seemed to be no doubt about
the presence of surgical tuberculosis of one kidney; the absence of
bladder Symptoms, however, and more so the negative guinea-pig test
were puzzling. Then I learned that the man was a butcher and the
diagnosis of bovine tuberculosis of the right kidney seemed probable.
Consequently, nephrectomy was performed on January 5, 1945.
The surface of the kidney was studded with numerous isolated and
conglomerate tubercles. The upper and middle calyx showed only
mild excavation. There was only slight caseous necrosis. The specimen
was taken immediately to the laboratory and both guinea-pigs and
rabbits were inoculated with fresh material (Dr. G. Schwartzmann).*
The guinea-pigs remained healthy, but the rabbits developed an in-

fection.

To corroborate the diagnosis, a patch test with human tuberculin
and an intracutaneous test with bovine tuberculin (1 : 10,000) was
performed with the patient. The patch was negative, the bovine
tuberculin produced a severe local reaction.

During the 7 years foUowing the Operation the patient has been
treated in various hospitals with streptomycin, PAS, and more re-
cently with isoniacid. Although he looks very healthv, the urine still
contains tubercle bacilli.

There are 4 known types of tubercle bacilli: human, bovine,
avian, and "cold-blooded". According to Topley and Wilson (13),
only the first two types are found in the naturally occurring tuberculous
infection of man. This is not correct. Loewenstein has published 3
cases of kidney tuberculosis in which the organisms were identified
as those of the avian strain. Lederer has contributed another such case.
However, these are rare exceptions.

Some remarks may be in order as to the methods of diflerentia-
tion. Smith (12), Dorset (4), and Huserang (7) claim that bovine
tubercle bacilli tend to remain short and plump, whereas those of the
human type are slender. However, the majority of investigators do
not believe that morphologic diflerences constitute a satisfactory dia-
gnostic criterium. All agree that the growth of the human strain sur-
passes that of the bovine typye on all media. For this reason the human

* This is the first rcported dircct inoculation of kidney tissue.

type is designated as eugone, the bovine as dysgone. On media con-
taining glycerol, the human bacilli show a thick, confluent growth,
the bovine type grows poorly if at all. The human strain often pro-
duces a pigment of yellow or orange color, the bovine type does not
(Griffith and Stanley [6]).

Koch himself held ( 1901 ) that bovine tubercle baciUi were virtu-
ally non-pathogenic for man, but had to admit later ( 1908) that man
might be infected. He maintained, however, that "bovine" infection
would rarely lead to the development of a serious tuberculous disease.
We now know better. Tuberculosis of the cervical glands in children
is caused by bovine bacilli in 58-85 % of the cases below five years
of age, and in nearly 50 % of those 5-14 years old. Primary abdominal
tuberculosis is almost invariably due to the bovine type. As to genito-
urinary tuberculosis, the bovine type has been found in 15 % of the
cases (Gervais, 5), and in 33 % of the patients with renal tuberculosis
(Band 1).

There can be no doubt that tubercle bacilli of both the bovine
and human type, if they are sufficiently virulent, may produce infec-
tions in guinea-pigs as well as in rabbits. However, bovine bacilli of
low virulence infect rabbits much more readily than the organisms of
any other strain (Villemin). Smith (12) states that "tuberculous virus
of bovine origin possesses an exalted virulence for rabbits". Conse-
quently, the rabbit test is generally considered as a reliable aid in
determining the type of tubercle bacilli found in human tuberculous
disease. It has long been known that the organisms found in renal
tuberculosis are characterized by their low virulence (15). This ex-
plains why many cases of kidney tuberculosis verified at Operation or
autopsy, have not been diagnosed by means of the guinea-pig test
(2,3,9,14).

In conclusion, it may be stated:

1 . Renal tuberculosis can be diagnosed in 94 % of the cases f rom
the urinary Sediment - {xjsitive findings on the stained ( Ziehl-Neelson )
smear (Hottinger, 8).

2. A negative guinea-pig test is not conclusive. Inoculation of
rabbits is required in order to confirm or rule out infection with bovine
bacilli.

3. The use of antibiotics does not assure sterilization of the urinary
tract or the eure of advanced kidney tuberculosis. Strictly unilaterad
destructive (surgical) renal tuberculosis is best treated by nephrectomy.
Postoperative treatment should include administration of PAS and
streptomycin (Latimer et al., 10).

REFERENCES

1.
2.
3.
4.
5.
6.
7.
8.
9.

Ind. Bull. 52.

Band, D.: Edinb. med. J. 42, 162, 1935.

Blatt: Z. Urol. 19, 321, 1925.

Boeckel: Tuberculose renale. Chapelot, Paris 1912.

Dorset, M.: Wash. Gov. Printing Office, 1904, Bureau Anim.

Gervais: Le bacille au type bovine. Lille 1937.

Grifßh and Stanley: Edinb. med. J. 39, 173, 1931.

Huserang, A.: Tuberculose humaine. These, Paris 1940.

Hottinger: Z. Krankh. Harn-Sexualorgane 8, 178, 1916.

Hyman, A. and L. T. Mann: J. Amer. med. Ass. 76, 1012, 1921.

10. Lattimer et al.: J. Urol. 67, 750, 1952.

11. Legeu, J.D.: J. Urol. 17, 154, 1922.
Smith, T.: J. exp. Med. 5, 451, 1898.

Topley and Wilson: The principles of bacteriology. 2"^ ed. Arnold, London
1936.

Wildbolz, H.: Die Tuberkulose der Harnorgane. Handb. der Urologie, Bd. 4,
1927.
Pels'Leusden: Arch. klin. Chir. 95, 245, 1935.

12
13

SUPERVOLTAGE ROENTGEN THERAPY

F. C. Burgheim

Supervoltage roentgen therapy represents one of the recent ad-
vances in the field of therapeutic radiology. The term "suj>ervoltage"
should not suggest any relationship to a superman's machine with
su{>erefTects. It simply conveys the fact that voltages above the con-
ventional 200,000 limit are employed. It would be more precise to
speak of radiation therapy with voltages above 200 Kv, as suggested
some years ago in editorials of leading radiologic Journals. However,
I shall continue in using the less cumbersome and generally preferred
term "supervoltage" until a better one is proposed.

What was the reason for building su{>ervoltage machines? Roent-
gen therapy reached the highest peak in its short history when in the
1920's Regaud and Coutard reported about their new method, with
which they had successfully treated cases of advanced Cancer of the
larynx. They were able to demonstrate that a much higher total dose
could be given - without causing serious damage - when the Single
dose which produced a skin erythema and had been the limiting factor
heretofore was divided in several smaller, daily doses. This discovery
led to an almost revolutionary development in radiation therapy. The
skin and, consequently, deep-seated tumors could be subjected now
to doses capable of killing tumor cells, doses no radiologist had ever
dared to dream of .

Once the divided-dose or protracted fractional method was est-
ablished, further improvement in the treatment of radioresistant car-
cinomas was expected from more fK>werful X-ray apparatus. It was
hoped that their harder radiation would provide for greater penetra-
tion and an increase of the depth dose, i.e. the dose measured at the

depth of the tumor (which is, of course, smaller than the dose im-
pinging on the skin). It could also be expected that the potential
specific effcct of a shorter wave length (between 1 and 2 million volts,
i.e. in the ränge of radium) would imitate the favorable action of
radium.

Since the construction of roentgen apparatus with voltages above
the conventional 200 Kv. was only a physical engineering problem,
it could soon be carried out in this country. I had the privilege of
working with onc of the first 1 million volt macliines ever built (at
the Columbia-Presbyterian Medical Center). It was a big, inflexible
apparatus, causing many inconveniences, headaches and frustrating
delays in its use for Cancer therapy. Compared with it the new 2 mil-
lion volt machine I am using now for the same purposes at the Hospital
for Joint Diseases seems to be one of the miracles of our technical age :
a flexible, adjustable apparatus that can be handled almost as easily
as the smaller conventional units.

On the basis of this experience I believe that supervoltage radia-
tion is distinctly superior to that of 200 Kv. in the treatment of malig-
nant disease. One of the advantages is the increase in depth dose.
Although this increase is only moderate per field, in combination
with the use of multiple portals it leads to a considerable gain. This
is particularly valuable in the treatment of deep-seated lesions in
obese patients or in situations which require the Irradiation of small
areas with only one field available. Another advantage (that came
rather unexpected and was somewhat puzzling) is the fact that we
can apply a dose to the skin that is still larger than that permissible
with 200 Kv. under strict Observation of the described Coutard prin-
ciple. And a greater surf ace dose means a f urther increase in the dose
that becomes eflfective in the neoplasm. Today, the explanation of
this phenomenon is well known. Without going into physical details,
I will say only this: the so-called back-scatter, i. e. the scattering of
softer rays back toward the skin during the passage of the supervoltage
rays through the tissues, is negligible in comparison with the back-
scatter at 200 Kv. Furthermore, supervoltage rays have their greatest
intensity at 3 mm. beneath the skin and not at the skin surface as
with lower voltages. In view of theses different biologic actions we have

to look out for danger signals in other parts of the body such as
ihe subcutancous tissues and mucous membranes. However, if we
stricdy adhere to the principles laid down by Regaud and Coutard
and administer each irradiation at a slow rate, no severe damage to
any tissue will occur. I mention this because some radiologists make
up their own modifications of the protracted fractional technique in
Order to save time. This willful deviation from the established technical
rules may bring injury and discomfort to the patient and will certainly
be avoided by those who appreciate fuUy the fundamentals of the bio-
logic process involved.

I should like to report on the successful treatment of such radio-
resistant tumors as Carcinoma of the bladder, lungs, esophagus and
Uterus; none of them received additional therapy, especially not ra-
dium treatment. Although tumor doses exceeding 6000 roentgen
Units (i.e. the lethal dose for Cancer cells) were delivered in certain
instances, the reactions of skin and mucous membranes were noticeably
milder than those described by others. No subcutancous or muscular
fibrosis was observed during the years following the irradiation. l'he
patients stayed rather comfortable throughout the course of treat-
ments. I venture the opinion that the slow, protracted application of
small intensities and moderate daily doses causes only little damage
to the vascular-connective tissues, so that the normal cells of the tumor
bed do not lose what Ewing once called their "power of adaptation".
The highly gratifying results obtained in our series of malignancies
seem to confirm the correctness of our method.

I must also State the important fact that, owing to the mentioned
lack of back-scatter, we can now irradiate through fields that have
been previously treated with the conventional 200 Kv. An increasing
number of patients are being referred nowadays to institutions equip-
ped with supervoltage machines because previously applied ordinary
deep X-ray treatment did not result in complete sterilization of the
tumor or could not prevent local recurrences.

Another important point is that large areas can be irradiated.
This simplifies the technical procedure and guarantees a more homo-
geneous penetration not only into all portions of the tumor but also
into the adjacent tissues and lymph nodes. This could never be

G Virchow Socii'ty. Vol. 12 (195:})

achieved by the niost skilful arrangement of multiple portals. Super-
voltage Irradiation with only one large anterior and one posterior field
is indicated, for instance, in Cancer of the uterus and prostate. When
still larger fields have to be exposed - as in all thase desperate cases
where tumor metastases have spread to almost every part of the body -
irradiation of the whole body in one exposure ( teleroentgen therapy)
may be of benefit. Such a treatment when given with supervohage
machines requires only very short exposures, while it takes hours to
achieve the same effect with 200 Kv. radiation. These spray irradia-
tions with very small doses, applied daily, and combined with local
treatment (small fields, higher doses) can be applied for many weeks
and often lead to astonishing palliative results. It is certainly worth
while trying this method. Detrimental efTects upon the blood frequently
observed upon teleroentgen therapy with lower voltages, were absent
or negligible in my patients who received supervoltage teleroentgen
therapy.

Time does not permit to discuss a number of other characteristic
difTerences between supervoltage and conventional roentgen therapy.
However, a most recent advance in this field cannot be omitted: the
combination of supervoltage with rotation therapy. This new tech-
nique makes it possible to deliver a homogeneous high dose to the
tumor and, if necessary, to regional lymph nodes, while the skin and
other tissues receive a considerably smaller dose. After precise measure-
ments have been taken with a body contourometer and the neoplasm
is properly localized, the patient is placed on a rotation platform in
such a Position that the tumor forms the center of rotation. For pur-
poses of adjusting the position to minute details, it is very helpful to
employ a light beam corresponding to the central ray and to take films
with the supervoltage machine while the patient is set up for the
irradiation. This technique is recommended for the treatment of
gynecologic tumors, Cancers of the rectum, bladder, stomach, eso-
phagus, mediastinum, bronchial carcinomas, and tumors of the
pharynx, brain, and spine. (Slides were shown illustrating the proce-
dure in general and its application in individual cases.)

THE PHYSICAL ASPECTS OF RADIOACTIVE

COBALT THERAPY

LiM-iAN E. Jacobson

This atomic age, with its creation of radioactive Clements woi th
far more than gold, can rightfully be called the fulfilment of the
alchemist's dream.

Until recently, only comparatively small amounts of radioactive
material were produced for peace time use. However, with the produc-
tion of radioactive Cobalt 60, the picture has changcd. In each Cobalt
Beam Therapy Machine the radioactivity of the metallic cobalt ex-
ceeds all the medically used radium in the whole world.

The principle of making atoms radioactive is simple. Small
nuclear particles called neutrons are "shot" at the atoms of an dement.
Here and there a neutron strikes the nucleus and is there incorporated
to form an unstable atom which at some time in the future will break
up, giving out radiations, in other words, it will be radioactive.

The Cobalt used in the Cobalt Beam Therapy Machine at Monie-
fiore Haspital was niade radioactive by placing thin discs or wafers of
metallic Co59 in the path of slow neutrons in the nuclear reactor or
atomic pile at Chalk Ri\ er, Canada. Some of the atoms of stable Co39
capture a neutron, become heavier, and change into unstable Co60.
These wafers are left in the atomic pile for about six months. The
source of radiation consists of seventeen thin discs placed one on top
of another in an air tight steel Container. The composite forms a
cylinder like a pill box, one inch in diameter and one half inch thick.

In Order to protect personnel, the cobalt is placed in a lead in steel
drum about two feet in diameter and four feet high. The cobalt in

this form is used in the same manncr as a supervoltage X-ray tube.
Supervoltagc refers to voltages above 2,000,000.

»ifflSSC

Fig. 1

The cobalt is housed in the center of the Container shown in
Figure 1 . The head weighs 4000 pounds but can easilv be positioned
by a push of the control buttons, which causes it to ride up or down
or to pivot around the axis, rotating from the vertical to ten degrees
above the horizontal. The mechanism is finely controUed despite its
weight.

Hoiiow coi|^Hi>o«r

UCHT SOUICf SWElOtNC

DOM!

'■*- HIAO CHCOMI TIMM

••- SOUICI HOUSINO

MIMARY DIArNtACM

urra HOUSINO

VARIAUf TREATMINI
Ot^TANCf CONTKOl \

- lOWII HOUSINO

ADJUSTAIlf OIAPHIAOM —
ONf ONIT ASSiMtlT O»
OfPOSING «lOCKS SHOWN

^^AffRTUIE CONTIOl HANOliS
-SHOWN fO* OUT Of rOSiTION

IXAPNtAOM »OTTOM COVft

Fig. 2

Figure 2 shows the cross section of the drum. In front of the
source is a hollow cone containing mercury which absorbs the radiation
when the machinc is not in use. The mercury is pumped out by remote
control from the control room when a patient is to be treated. If the
power should fail or the outsidc door be opened, the mercury runs
back into the cone by gravity, so that the machine falls safe. The size
of the field is varied by moving the lead blocks which act as a dia-
phragm.

The room in which the Cobalt Beam Therapy Machinc was
placed, see Figure 3, is well suited for this purpose. The outside wall
for four and a half feet is below ground level and faces a garden which
is not used. The beam is directed toward this wall or the floor, which
is direcdy on the ground. Wherc the direct beam might strike it, the
outside wall was built up to a thickness of three feet of concrete on the
inside. This is sufficient to attenuate the direct beam to below the
tolerance levels of 6.25 mr/hr. All the other walls were filled in to
a thickness of twelve inches, which is sufficient to reduce the scattered
radiation in all directions below the tolerance level. The ceiling was
found by a boring to be eighteen inches thick with eleven inches of
concrete. Nothing was added.

Floor Plan of Cobalt and Adjolning Rooms

Garden

Window

100 cm

Hall

7 In Steel SMIng Door

Fig. 3

The Observation window from the control room to the therapy
room is very interesting in that it is made of a special lead oxide glass,
whose index of refraction is higher than that of any other glass hereto-
fore made, so that even through an eight by eight inch window almost

the entire treatment room is visible. The window is two inches thick
and gives the protection of one inch of lead.

A Steel sliding door permits entrance from the hall to the Cobalt
room.

Under the most adverse operating conditions, after very careful
measurements, the strav radiation was found to be well below the
permissible amount in all places except through the steel door. This
has been remedied by the construction of a barrier wall perpendicular
to the wall containg the door, as can be seen in Figure 3.

mr/hr at Wall in Control Room, Beam Vertical

200^

^ I50V l

% lOO

0.05

50 100 150 200 250
DIstance along Floor, Cm.

Fig. 4

The stray radiation measurements in the control room can best
be shown by lines drawn through points where the stray radiation as
measured with a survey meter is the same. These lines are called
isostrays and are shown in Figure 4, when the beam is directed verti-
cally düwnward. The stray radiation at ehest level nexi to the wall of
the control room is .2 mr/hr., at foot level .5 mr/hr. When the beam is
directed horizontally, as in Figure 5, the stray radiation is less, about
.05 mr/hr. were the technician sits.

The personnel operating the Cobalt unit have been monitored
continuously by film badges and pocket dosimeters. The pocket dosi-
meters are read at the beginning and at the end of the day and in-
dicate that about 1 mr is received. This is approximately the natural
leakage of the Instrument. In a two-week period the film badges have

received less than a measurabJe amount which is less than 20 mr. So
the Operation of a Cobalt unit is as safe as that of a well protected
X-rav machine.

mr/hr at Wall of Control Room^ Beam Horizontal

250

200

-o 150

too

50
0

50 100 150 200 250
Distance along Floor, Cm.

Fig. 5

Cobalt has distinct advantages over conventional X-rays in the
200 to 400 kv. ränge. Cobalt gives off gamma rays which are more
penetrating than those of radium and equivaient in penetration to
X-ravs from a 3 MEV. X-rav machine.

In comparing Cobalt and 400 kv. radiation, one finds that for
400 kv., thirty-nine percent of the surface dose reaches a depth of
10 cm. foi a 10 X 10 cm. field, and for cobalt radiation fifty-six per-
cent. If one wanted to give a dose of 100 r to a tumor at that depth
256 r of 400 kv. X-rays would have to be given to the skin but only
179 r of Co60 radiation. Thus, for equal doses to the tumor, the skin
and underlying tissues are spared with Co60 radiation. If the tumor
is treated from several ports, the skin effect with Cobalt ceases to be
the limiting factor as it has been with conventional X-rays.

When the tumor receives the same dose with conventional radiat-
ion as with Cobalt, the underlying healthy tissue receives a much
greater dose, and therefore the systemic reaction is greater. Figures 6
and 7 illustrate this point. If the tumor receives 5000 r with Cobalt,
the skin at the ports of entry receives 4000 r and most of the under-

DISTRIBUTION OF D0SA6E WITH 200 KV
hvl 1.25mm Cu, 50cm T.S.D., THREE 7X15 FIELDS

Ca of Lung, Postoperative

Posteriof

rsoor

7500r

rsoor
Anterior Fig. 6

DISTRIBUTION OF DOS ACE WITH Co 60
80cm S.S.D. THREE 7X13 FIELDS

Ca of Lung, Postoperative

Posterior

Anterior Fig. 7

Fig. 8

hing tissue 3500 r. Whilc with 200 kv., the skin and a large portion
of the underlying tissues would recei\e 6500 to 7500 r. This dose is
bcvond tolerance and therefore, it is impossible to deliver a dose of
5000 r to this tumor from three ports with 200 kv. X-rays. Large doses
not possible heretofore havc been given to some patients with very
little radiation sickness.

There is a great deal more scatter with conventional X-rays than
with Cobalt or supervoltage, which increases the volume of tissue
irradiated with conventional X-ray.

Even when equal doses are gi\'en to the skin, the efTect on the
skin is far less with Cobalt than with conventional X-rays. Only mild
erythemas and bronzing were obtained with large fields and doses as
high as 5500 r to 6000 r at 4 mm. below the upper surface of the skin
where the maximum is received with our set-up, and doses of 4500 to
5000 r to the skin. Of course, one may question whether or not some
difTerential action appears at a depth between conventional and super-

voltage radiation. This is still a moot question which necds further
investigation.

Cobalt radiation penetrates bone almost as easily as soft tissue,
whereas conventional X-rays arc absorbed more by bone. Therefore,
Cobalt can be used to treat a tumor underlying normal bone with less
efTect to bone than with regulär X-rays.

'■S^j'T!''^'!

Fig. 9

The Cobalt Beam Therapy Machine and the roc^m protection for
it are more expensive than a conventional X-ray installation, but
considerably less expensive than supervoltage equipment and housing.

Fig. 10

One must takc into account the decay of Cobalt 60. In five years
half of it disintegrates and therefore, its activity is reduced to half of
its original valuc. Whcn the times of treatment become too long, the
existing Cobalt source can be exchanged for one of high specific
activity. Since one pays for the r Output of a source, the cost of the new
one is the difTerence between its price and that allowed for the activity
of the old one. The old source is placed back into the pile, reactivated,
and used over again. Whether this replacement is more expensive than
the replacement of supervoltage X-ray tubes remains to be seen.

For the radiation to be most efTective and do the least damage to
healthy tissue, the rays must bc so directed that they always strike the
tumor from several ports of entry. A great deal of attention is given
to the exact location of the tumor within the patient. After the tumor
has been located on the X-ray film or by fluoroscopic examination, the
following procedure occurs in all head, neck, and ehest lesions which
can be treated in the erect position. A light plaster of Paris cast is made
of the portion of the body containing the lesion. Special lead markers

are placed on the cast anteriorly, posteriorly, and laterally. The patient
is again placed in the cast and X-rayed in the same position as he is
to be treated. An AP and a lateral film are taken. On thcse films the
radiologist marks the lesion that he wants treated. See Figure 8. From
the Identification of the markers on the cast with the correction for
distortion, the physicist locates two pcrpendicular axes through the
Center of the lesion as is seen in Figure 9.

Fig. 11

The contour of the cross section through the center of the lesion
of the body with the cast is drawn on tracing paper. By applying
isodose curves from various angles, he finds the most efficient way to

get a uniform radiation field for the lesion, with a minimum of damage
to important structures such as eyes, and spinal cord. The centers of the
ports of entry and exit are then marked on the cast. Each tiine the
patient is treated, he wears the cast, and the machine is so positioned
that the lucite cone fits into the center of the port of entry and the
back pointer fits into the center of the exit port, as is seen in Figure 10.
This means that the beam always is angled exactly in the same direct-
ion. By using the Cobalt source as a diagnostic X-ray tube, wc have
devised a way of taking films to verify that the tumor is being irradiated

as planned.

To get a minimum skin effect Cobalt can be used with a rotating
platform as shown in Figure 1 1 . Rotation is used where the lesion is
located more or less in the central axis of the patient. The patient is
so positioned that the center of the tumor is at the center of rotation.
Sometinies instead of having a complete revolution, the palient is
moved back and forth through a sector of an arc.

As a physicist, I dare not discuss results. However, this I can say,
that if thcre is such a thing as a cancercidal dose, in most cases it can
be delivered to any part of the bod\ without undue skin eflects, normal
tissuc efTects, or radiation sickness.

Excellent radiotherapy can be given without Cobalt or super-
voltage. However, both of these, when used judiciously, are very good
tools with which to do a better Job.

Lillian E. Jacobson, Radiation Physicist
Montefiore Hospital
210th Street and Gun Hill Road
New York 67, N. Y.

THE DIAGNOSTIC AND THERAPEUTIC USES
OF RADIOACTIVE lODINE

Martin Perlmutter

Radioactive lodine - P-*^ - is useful clinically becausc of its
following properties:

1 . It is so powerful that therapeutic doses are exceedingly dilute,
in fact so dilute that the Solutions are odorless, tastless, and will not
cause reactions in patients who are unable to take Lugols Solution.

2. Practicallv all of the iodide is either retained bv the thvroid

' 4 4

gland or excreted in the urine.

3. The beta rays which destroy cells can penetrate only 2 mm.
deep; as a result only the thyroid gland can be damaged.

4. The gamma rays which do not destroy cells, penetrate into far
more distant tissues and are useful for detection of thyroid tissue.

5. The half-life of V''^ is eight days - short enough to prevent
damage through Irradiation, and long enough to preserve the isotope's
potency during its transport through the body.

Application of V'-^^ for diagnostic purposes permits:

1 . to assay the avidity of the th) roid gland for iodine. This test of
thyroid function is not reliable when iodides (or various other drugs)
have been administered prior to the Performance of the test.

2. to make the diagnosis of thyroiditis and thyrotoxicosis factitia.

3. to localize thyroid tissue even at sites remote from the neck.

4. to detect functioning metastases of Cancer of the thyroid.

5. to diflerentiate benign from potentially malignant isolated
nudules.

. . r. utsftfw yvrr^-ijvf: thvT<iid Xirnui' and ihuh r*r>^'-^^ thf: paütni
1^ ^nHb'.Toic fia^u Gravc' divrav: and l<^xi( nrxiular ^riiei .

2- 1€ tksr-To^ ibmiid cancCT Dwu* afv:r ablati'jn 'i Üie tbyroid
and |>r*rparai'i^ ic aanuniriraiiou <A thiouracil ; .

;>. IC mouu: b>prrwh^T<jidisnri in nevereh ill cardiac paüenu tn
dwilr•>^inr yar. d liKtir n'/niia) tbyroid jrland and thub k/wering ihc

T//£ KIMMELSTIEL-WILSON SYNDROME
AND ITS CLINICAL VARIANTS

Harold Rifkin

In 1936 Kimmelstiel and Wilson described characteristic post-
mortem findings in the kidneys of 8 patients, seven of them known
diabetics. The clinical records revealed that all these diabetic patienls
had albuminuria, hypertension, edema, and azotemia. Numerous
reports have appeared attesting to the clinical importance of this Syn-
drome. Although originally considered to be a disease of middle-aged
and elderly diabetics, this so-called "complication" of diabetes is now
known to occur also in children and adolescents whose diabetes has
been manifest for at least ten ycai-s. The gravity of this Syndrome is
emphasized by reports that diabetic nephropathy takes first place as
the cause of death in patients who had diabetes for twenty years or
longer.

The fully developed Syndrome include^ retinopathy, proteinuria,
hypertension, nephrotic and/or cardiac edema, and azotemia, in asso-
ciation with mild or severe diabetes. Occasionally, a patient may be
observed from the onset of his diabetes through the various stages of
the complicating Syndrome. More frequently, however, time of onset
and rate of the syndrome's progression are not known when the
condition is diagnosed. There seems to be no doubt that the renal
lesion is just one manifestation of the widespread angiopathic changes
that develop in the course of the diabetic metaboHc disorder. In a
large group of patients studied at Montefiore Hospital we could
observe the foUowing clinical variants of the Syndrome:

1. Diabetes mellitus, hypertensive disease, edema, proteinuria, and
retinopathy; this represents the fuU-blown Syndrome.

7 Virchow Society, Vol. 12 (1953)

2. Mild diabetes mellitus, retinopathy, peripheral vascular disease,
and proteinuria with or without hypertension or renal insufficiency.

3. Diabetes mellitus, hypertensive disease with or without cardiac
failure, and proteinuria.

4. Diabetes melütus, arteriosclerotic heart disease, congestive failure,
proteinuria, and retinopathy.

5. Renal insufficiency and/or edema of undetermined etiology in a
latent diabetic patient with some other major illness.

6. Nephrotic Syndrome in a juvenile diabetic with retinopathy, with
or without hypertension or renal impairment (in their early stages) .

7. Diabetes mellitus, peripheral neuropathy, retinopathy and prot-
einuria.

All available data indicate that there is no correlation between
the incidence of the Syndrome and the patients' age or sex or the in-
tensity of the diabetic disorder. Evidently, the most important etiologic
f actor is the duration of the diabetes. The earliest observed appearance
of renal lesions is 8 years after the onset of manifest diabetes.

I should like to discuss briefly the clinical and postmortem find-
ings in a recent series of 21 patients, from 45 to 65 years old. The
diabetes was mild, moderate or severe. All patients had hypertension,
with the exception of two in whom autopsy disclosed extensive
myocardial infarction. A constant finding was the characteristic retinal
microaneurysms of diabetes, in addition to extensive retinal hemorrh-
ages and exudates. Edema was noted in approximately 75 % of the
patients. No correlation could be established between the severity of
the edema and the degree of hypoalbuminemia. In the older age group
edema was chiefly due to congestive heart failure while nephrotic
edema prevailed in the younger patients. A moderate to severe anemia,
and azotemia was an almost constant feature.

The prognosis is poor regardless of the clinical picture. The aver-
age life expectancy foliowing the onset of the Syndrome is 6 to 7 years,
with a ränge of 2-13 years. Uremia, myocardial infarction, and acute
cardiac failure are the most frequent causes of death. Renal pathology
consisted of afferent and efferent arteriolosclerosis and intercapillary
glomerulosclerosis of varying degrees.

Differential diagnostic considerations must take into account the
patient's age. In the young diabetic, the nephrotic or hypertensive
stages of chronic glomerulonephritis as well as chronic Pyelonephritis
offer the chief diagnostic difficulties. In the elderly diabetic patient,
co-existent hypertensive or arteriosclerotic renal disease with or without
congestive heart failure, chronic Pyelonephritis, and renal amyloidosis
(tuberculosis!) have to be considered.

In our experience the diagnosis of the Kimmelstiel-Wilson Syn-
drome is greally aided by these test procedures: 1 . Examination of the
urinary sediment for anisotropic material, i.e. doubly refractile lipoid
droplets enclosed in epithelial cells or casts. Under ordinary light, they
appear yellowish-black ; under polarized light, they can be easily
recognized as the well known maltese crosses. The amount of aniso-
tropic material present in the urine varies from day to day. The lipoid
droplets are best demonstrated in fresh, acid urine, but are difficult to
find in poorly preserved alkaline samples. Needless to say that these
elements are significant of the K.-W. Syndrome only when other dis-
eases are ruled out as the potential cause of "lipoid" excretion in the
urine, particularly chronic glomerulonephritis in cases of young dia-
betics. If red blood cells and hemoglobin casts are found, one should
consider the presence of the K.-W. Syndrome as extremely unlikely.

2. Electrophoretic analysis of plasma and urinary proteins. The
K.-W. Syndrome shows the foliowing pattem in the serum: a low
albumin, an elevated alpha-2 and beta globulin, and a normal ganmia
globulin. The urinary pattem signifies the preponderance of albumin
and alpha- 1 globulin, with normal i.e. small amounts of the beta and
gamma globulin f ractions. In contrast, patients with nephrotic glomer-
ulonephritis have a serum pattern characterized by abnormally low
gamma globulin. In renal amyloidosis, ganmia globulin is increased
in serum and urine. Normal alpha-2 globulin and elevated beta
globulin is the serum pattem found in diabetics with hypertensive or
arteriosclerotic heart disease. Whether the elevated serum alpha-2
globulin in patients with Kimmelstiel-Wilson Syndrome is simply the
result of mesenchymal injury and prolonged proteinuria or represents
an abnormality that is specifically associated with diabetic glomerulo-
sclerosis, cannot be determined at present.

Renal clearance tests have proved to be of no value in the dia-

gnosis of the K.-W. Syndrome. , , ^ t

Finally, renal biopsy as recendy recommended by Iverson et al.
may prove to be an invaluable aid in diagnosis ^ . . ^

Disturbances of lipid metabolism as well as alteraüons m the
metabolism of complex mucopolysaccharides may be involved in the
pathogenesis of the Syndrome. Elevated levels of cholesterol and
phospholipids as well as marked elevation of the Sf 12-20 class of
lipoproteins have been found in the blood of patients presentmg the
Syndrome. Furthermore, complex carbohydrate substances have been
demonstrated histologically in the hyaUne material of the retmal and
renal lesions. That the deposition of this material might be due to an
abnormally high concentration of circulating glycoproteins, as sug-
gested previously, is indicated by our recent studies. Total serum Poly-
saccharides bound to protein and glucosamine, were found to be in-
creased only in those diabeüc patients who showed retinopathy, neuro-
pathy or the fully developed K.-W. Syndrome. In the absence of
degenerative vascular disease, neither diabetics nor non-diabetic
patients, with or without arteriosclerotic disease, exhibited these
Chemical abnormalities. Renal insufficiency cannot be the sole cause
of these abnormal levels of glycoprotein.

Our preliminary studies on the relationship between glycoproteins
and lipoproteins in the serum of Kimmelstiel-Wilson patients indicate
that the increases in alpha-2 globulin and complex carbohydrates run
parallel.

MEDICAL MANAGEMENT OF PERIPHERAL
VASCULAR DISEASES IN DIABETES

Heinz I. Lippmann

With few exceptions occlusive arterial disease in diabetic patients
is due to arteriosclerosis. Since the etiology of arteriosclerosis is not yet
known, no causal treatment exists at present. Medical management is,
therefore, confined to the therapy of Symptoms. Accordingly, the dis-
cussion tonight will deal with the treatment of conditions which re-
present the most frequently seen manifestations of peripheral vascular
disease in diabetic patients:

1. UncompHcated arteriosclerosis obliterans.

2. Infections (local, septic).

3. Ulcerations.

4. Gangrene.

Time does not permit to consider diabetic neuropathies, acute
arterial occlusion, venous and lymph vessel diseases, and the pre- and
postoperative medical care.

1, UncompHcated arteriosclerosis obliterans (ASO) (Table 1)

The Cardinal Symptom is intermittent claudication. Objective
sings are blanching on elevation and rubor in dependency, absent
pulses on f oot and leg, and abnormal oscillometric and thermometric *
findings, particularly following posterior tibial nerve block with pro-
cain or intraarterial injection of small amounts of priscoline. Other
diagnostic methods such as plethysmography, calorimetry, arterio-

* A reliable pocket-size skin thermometer is supplied by Marcks, Ltd., London.

Manifestations:

Table 1

Arteriosclerosis Obliterans

(Intimal thickcning, thrombotic occlusion)

Intermittent claudication.
Blanching on elevation, rubor on dependency.
Absent pulses (palpation, oscillometry) .
Low skin temperature after vasodilatation.

Medical management: Protection from heat or trauma.

Exercise - No smoking - Cleanliness - Avoidance of
hypoglycemia, of acidosis - Oral vasodilators

Of douhtful value.

Sympathetic blockade - Vitamins (A, C, E)
Intra-arterial vasodilators.

graphy and radioactive soduim clearances are procedures not feasible

for office use.

Arteriosclerosis, at least in the diabetic, is basically a progressive
disease. However, ASO may become stationary for many years. The
formation of collateral vessels which is the rule in untreated cases, may
be enhanced by muscular exercise. Walking (but not beyond the
onset of intermittent claudication) is the best therapeutic procedure
known at present. Oral vasodilators are commonly given in these
cases, but it is doubtful whether any medication, oral or parenteral, is
of actual help. The same is true for all physiotherapeutic procedures
known to me. Sympathetic nerve blocking and lumbar sympathectomy
have been ineffective in the many patients I have had an opportunity
to observe. I feel certain that favorable reports conceming sympa-
thectomy ( 1 ) and intraarterial therapy (2) for intermittent claudica-
tion will not stand the test of time.

The main efTorts in the management of ASO in the diabetic must
be directed towards Prophylaxis. Mechanical and thermal trauma to
the involved limb must be carefully avoided. Still, in more than 50 %
of our hospital patients minor bums were responsible for gangrene
of feet or legs. It is clearly the medical profession's responsibility that
patients realize the danger of applying direct heat to limbs showing
signs of impaired circulation. Proper hygiene should include a daily
foot bath in lukewarm soap water and application of mineral oil or
lanolin to the skin. The patient should have his toenails clipj>ed, but

should not do it himself . If trauma occurs, he should consult his phy-
sician without delay.

Some measure of protection may be obtained by lumbar sympa-
thectomy (3) or intraarterial vasodilator therapy (4) in ASO in
diabetics.

In Order to bring home to every patient the nature of ASO and
the importance of prophylaxis, I have found it expedient to band out
typewritten instructions, adapted to the patient's educational back-
ground .

No patients with ASO should be permitted to smoke. In hitherto
unpublished follow-up studies on 400 patients observed over more
than 10 years, and on another series of 250 patients followed over
shorter periods of time, the f oUowing was found : In either group the
smokers showed a statistically significant higher incidence of clinical
deterioration than the non-smokers. ITiere was no smoker among
those who improved, subjectively or objectively. It is often said that
nicotin excercises its damaging effect by causing vasoconstriction. I
believe that additional factors are involved in the deleterious action of
tobacco.

Hypoglycemic episodes should not be permitted to occur in a
diabetic with ASO. I have the records of 12 such patients in whom
hypoglycemia was followed by complete occlusion of the major leg
arteries and distal gangrene. The occurrence of coronary thrombosis
during hypoglycemia is common knowledge ( 5 ) . We fear overdosage
of insulin more than occasional hyperglycemia in diabetics with ASO.
I give these patients the minimum dose of insulin compatible with
adequate nutrition. They should spill traces of sugar in the urine.
The other extreme, acidosis must be avoided as well.

2. Infections (Table 2)

The "uncontrolled" diabetic tends to develop infections. When
excessive foot Perspiration causes the skin to macerate, an intractable
epidermophytotic infection may become amenable to treatment after
sympathetic blockade or lumbar sympathectomy.

Table 2
Infections

Superficial infections
e.g. Epidermophytosis

Pyogenic inf.

Deep infections
e.g. Abscess, tendon inf.
Phlegmone, osteomyel.

Septic infections
e.g. S.B.E. (carditis or angiitis)
Septic thrombophleb.

In all cases

Management

Fungicides - No penicillin - occasionally
sympathetic blockade - Hygiene

Antibiotics - wet dressings, lukewarm -
I & D (e.g. paronycchia)

Antibiotics - surgical management as in
non-p.v.d. (Culture sensitivity not helpful)

Antibiotics (Culture sensitivity helpful)

Diabetic control

Vigorous vasodilatation deleterious if

circulation is good (skin maceration).

In the treatment of pyogenic infections, antibiotic sensitivity tests
in bacterial cultures have not been helpful in the choice of the Opti-
mum dose or the appropriate antibiotic. Penicillin continues to be an
cfifective agent in many cases. High antibiotic concentrations in in-
fected tissues may be obtained by intraarterial administration (6).
Howevcr, I do not believe that the clinical results after systemic ad-
ministration are inferior. Apparently, an Optimum tissue concentration
of an antibiotic can be obtained by intramuscular injection, or by oral
administration.

Intraarterial vasodilator therapy for diabetic infections should
not be instituted in the presence of an adequate circulation. I have
observed local peripheral edema, skin maceration and spread of the
infection in several such cases.

3. Ulcerations (Table 3)

Treatment depends on the location and type of the ulcer, whether
it is arterial or venous in origin, clean, infected or gangrenous, acute
or chronic.

Subungual epidermophytotic ulcers occur frequently in diabetics.
If a small triangulär wedge is clipped into the nail, pus will often

Location
Subungual

Digits

Over digit joints

Plantar (balls) Callus

Lower leg (later.)
Legs or thighs

Table 3
Ulcerations

Usual cavise Management

Fungus - mixed inf. Relieve nail pressure

Trauma - arterial ins. i.a. vasodilators - sedation

antibiotics

Osteomyelitis? (X-ray) Local amputation - transmetatarsal

amputation

Careful debridement, pressure
rehef, - antibiotics - vasodilators

Sedation - dilators

Arteriolosclerosis *
Venous stasis *

Supportive therapy (Unna boot,
Ace supportive bandage, etc.)

* Lues, squamous cell Ca.

empty under pressure; at a later date, more nail plate may be removed,
carefuUy avoiding trauma to the edges and the base. Removal of an
ingrown nail is an operating room procedure in these cases, and should
be done with chisel and drill from above; dystrophic thickened nail
should be thinned down with a drill file. These techniques must be
learned and whether an ulcer will heal or spread depends more on the
manner of manipulating these Instruments than the procedure used.
The general rule is to do as little as possible.

4. Gangrene (Table 4)

All factoi^ which contribute to the development of gangrene,
namely ischemia, infection, trauma, pain and the general Status of the
patient deserve equal therapeutic attention.

Intraarterial vasodilator therapy, judiciously applied, has provcn
valuable in the treatment of diabetic gangrene ( 7 ) . Intraarterial in-
jection of vasodilators * is indicated only for the rehef of ischemia.
There is some evidence that the formation of collaterals and cutaneous
blood flow may be enhanced by a round-the-clock injection schedule,

* Sustained vasodilatation is difficult to obtain with histamin, and its appli-
cation is too cumbersome for general use.

Digits (toes, fingers) Foot,

For the purpose of
Prevention of spreading

Control of pain

Control of infection

Demarcation

Improvement of ischemia

Promotion of healing after
demarcation

Table 4
Gangrene
Leg, Heel, Localised skin areas, Massive gangrene

Medical management

Thcrapeutic measurc
Relief of local pressure - rest -? other
General sedation - intraarterial procain
Antibiotics (systemic)

Preservation of body heat (cotton packing)
Optimum moisture (bland ointments) -

Intraarterial vasodilators

Positive N-balance (nutrition, activity)
Control of anemia (Fe, liver, transfusion)

Granulation Tocopherols (systemic)
Epithelization Vitamins A and D (local)
Contraction unknown

especially when combined with reflex heat (8). The amount of vaso
dilator injected is kept short of causing systemic reactions.

Buerger's exercises or the oscillating bed are often used. The value
of these passive exercises has been questioned recently ( 9 ) .

The control of pain is of utmost importance, since pain produces
vasoconstriction and interferes in many ways with the general condi-
tion of the patient. Narcotics are freely used if necessary and without
fear of addiction. Procain injected intraarterially has proven valuable
in some cases, but may cause vasoconstriction, thereby offsetting the
analgesic effect.

Any damage to the involved limbs must be avoided. Regulär ex-
ercise should be given to all major joints. To prevent flexion con-
tractures, removable plaster Splints must be applied in somes cases.
All patients with gangrene have bed rest or wheelchair privileges as
long as the progress of demarcation is not entirely satisfactory. A
cradle should protect the foot. A foam rubber cushion should be
placed under the leg, but the heel should not touch the mattress and
the bed should be raised in such a way that the limb is kept level and
is not elevated.

100

When demarcation is complete, formation of granulation tissue
may be speeded up by oral administration of vitamin E ( alpha-toco-
pherol). Unpublished observations suggest that its stimulating effect
corresponds with its concentration in the blood. The blood level can
be raised by oral, rarely by parenteral administration.

Epithelization is enhanced by topical application of vitamin A
and D or by ultraviolet irradiation. There is no known measure that
would enhance wound contraction, the third known mechanism of
wound closure.

In conclusion it can be said that the paramount task of the medi-
cal management is to prevent damage to a limb with poor circulation.
The general condition of the patient must be watched continually.
Antibiotics are given when needed. Intraarterial administration of
vasodilators and analgesics offers promising results. The use of nerve-
blocking procedures is occasionally indicated. To evaluate all these
moddities, a thorough knowledge of the natural course of untreated
occlusive arterial disease is indispensable.

Nature is kind, whether the physician interferes or not. In my
experience, about three quarters of the patients who develop a throm-
botic occlusion of a sclerotic femoral artery will get away without the
loss of the limb or even parts thereof. Many more patients with oc-
clusive arterial disease die with their feet on than with their feet off
and can be managed conservatively. Many limbs can be saved by
medical means, even when ulcerations or gangrene give rise to addit-
ional hazards.

Every patient in need of a major amputation is a living symbol
of our failure. However, even then his chances to resume a useful life
in Society are not at an end. We have today in our midst one of the
pioneers of conservative surgery for peripheral vascular diseases. Dr.
S. Silbert's own presentation will bear better witness to his achieve-
ments than any words.

A diabetic patient's chance, then, to maintain his working capa-
city has improved through the years. Let us work for better chances for
the patient of the future.

101

REFERENCES

1. De Bakey, M. E., O. Creech and J. P. Woodhall: Evaluation of Sympathec-
tomy in Arteriosclerotic Peripheral Vascular Disease. J. Amer. med. Ass. 144,

1227, 1950. . ^.

2. Mufson, I.: A New Treatment for the Relief of Oblitcrative Diseases of Peri-
pheral Arteries. Ann. intern. Med. 29, 903, 1948.

3. Edwards, E. A. and C. Crane: Lumbar Sympathectomy for Arteriosclerosis of
Lower Extremities. New Engl. J. Med. 244, 199, 1951.

4. Lippmann, H. L: Unpublished observations.

5. Gilbert, R. A. and J. W. Goldzieher: The Mechanism and Prevention of
Cardiovascular Changes Due to Insulin. Ann. intern. Med. 25, 928, 1946.

6. Glasser, S. T., J. Herriin jr. and B. Pollock: Intra-arterial Injection of Peni-
cillin for Infections of the Extremities. J. Amer. med. Ass. 128, 798, 1945.

7. Lippmann, H. L: Intraarterial Priscoline Therapy for Peripheral Vascular
Disturbances. Angiology 3, 69, 1952.

8. Kappert, A.: Zur Behandlung mit intraarteriellen Injektionen. Helv. med.
Acta m', 25, 1947.

9. Wisham, L. H., A. S. Abramson and A. Ebel: Value of Exercise in Peripheral
Arterial Disease. J. Amer. med. Asso. 153, 10, 1953.

102

SURGICAL MANAGEMENT OF
PERIPHERAL VASCULAR DISEASES

Samuel Silbert

Five levels of amputation should be considered in patients with
gangrene of the toes or foot. Amputation of a gangrenous toe fre-
quently results in a gangrenous wound, and is usually not advisable.
On the contrary if there is ulceration of a Single toe, with or without
osteomyehtis, amputation of such a toe usually heals by primary union
and saves many weeks of disabiUty. When gangrene involves two or
more toes, a transmetatarsal amputation should usually be done.
About 65 % of such amputations result in good healing. The great
advantage of a successful transmetatarsal amputation is that a pro-
thesis is not needed. When gangrene extends beyond the toes to in-
volve the foot, and when there is gangrene of the heel, a mid-leg
amputation should be done, saving the knee Joint. The advantages of
mid-leg amputation are: reduced operative mortality, improved out-
look for rehabilitation and absence of f>ersistent pain in the stump. In
patients who are veiy toxic, it is frequently desirable to do a preUmin-
ary quick guillotine amputation just above the ankle in order to remove
the gangrenous or infected foot. The general condition of the patient
usually improves rapidly following this simple procedure, and se-
condary amputation through the mid-leg can then be done safely.
Mid-thigh amputation is reserved for the sj>ecial case where gangrene
extends almost to the knee Joint, or where there has been insufficient
time for development of coUateral circulation to the midleg following
an acute femoral artery closure.

103

OCULAR MANIFESTATIONS IN PROTRACTED

DIABETES

Georges Kleefeld

Diabetes per se is one of the worst enemies of the eye. Cure and
maybe, someday, prevention of this disease will be a boon for

humanity.

Thus the physician should be trained for the detection of the
earliest signs of eye changes at a time when still some therapeutic
measures might be considered.

Forty years ago, people were not routinely examined for gly-
cosuria. The ophthalmologists were practically the only ones who
were trained in the use of the ophthalmoscope, and capable of making
the diagnosis of "diabetic retinitis", as this condition was called at

that time.

Today, every physician knows and possesses this instrument for
gazing at the fundus of the eye. The general practitioner has to be
familiär with the ophthalmoscope because he is the one who has to
see the first signs of a retinopathy. And he has to perform the ophthal-
moscopy without artificial dilatation of the pupil, because instilHng
any kind of mydriatic can lead to the development of glaucoma, and,
positively, he should not take any chance. It is our belief that the physi-
cian who takes care of a diabetic case has the same responsibiUty when
it comes to the detection of acidosis or to the detection of the first
appearances of diabetic retinopathy. The ophthalmologists will be
always very happy to discuss these findings with the general practi-
tioner who detected them. Once the diagnosis of retinopathy is firmly
established, a steady Cooperation of general practitioner, laboratory
and ophthalmologist will be required.

104

A routine examination of a diabetic should not bypass the ex-
temal aspect of the eyes, nor should the interrogatory fail to include
some very important points: whether the eyes are painful ( Symptom
of a possible iritis-glaucoma) ; whether the vision is faihng (iritis -
cataract - retinopathy ) ; whether there is double vision ( involvement
of eye-muscles) ; whether some days the vision is better than others
( swelhng of the lens going parallely with the variations of glycemia ) .

The present concept in the evolution of diabetic retinopathy can
be deducted from papers issued by the English School (Ballantyne)
and Johns Hopkins University (Friedenwald, Becker). The first ap-
pearance is a change in the veins of the retina. They lose their tonus,
become irregularly enlarged. Their irregulär shape contrasts with the
regulär pattem of the arteries. Friedenwald insists upon the presence
of microaneurysms in the macular region as the forerunner of a dia-
betic retinopathy. These microameurysms are fairly well pathogno-
monic of that condition. Later on appear the hemorrhages, varying in
aspect according to their locations in the retina. Roundish yellowish
exudates develop in the same region ; they coalesce and form irregulär
scalloped masses, which contain frequently cholesterol crystals.

If the disease takes on a malignant character, hemorrhages spread
into the vitreous body, and lead to proliferant retinitis with secondary
incurable detachment of the degenerated retina, and blindness.

How Stands the problem of diabetes as connected with ophthal-
mology? Diabetes Mellitus in the past was synonymous of glycosuria.
This simplified concept is no longer accepted. Aglycosuria in diabetics
does not bring about either the disappearance or even the arrest of
the "so-called" diabetic eye lesions. The factor "sugar" is not the only
one which has to be considered in the genesis of the eye changes.

It seems fairly well established that these changes occur only in
protracted cases. All of the old diabetics are not necessarily Ophthal-
mologie cases. One should not forget that most of the old diabetics
show sclerosis of the blood vessels; whether the diabetic disorder leads
to this sclerosis or whether there is a concomitance of diabetes and
sclerosis is hard to say.

In the Kimmelstiel-Wilson disease corpuscles are found in the
kidneys which show microaneurysms very similar in apf>earance to

105

those observed as a forerunner of diabetic retinopathy. By injecting
rabbits with alloxan and corticotropin Becker and Friedenwald suc-
ceeded in producing renal and retinal lesions resembling those observed
in man. These experiments as well as studies on diabetics have led
them to conclude that there might be some logic in treating diabetic
retinopathy by adrenalectomy.

Recently, Peiner and Waldman have explored and advocated
the treatment of diabetic retinopathy with testosterone and estrogens.
These hormones are considered as antagonizing the action of corticch
tropin.

Researches pertaining to the use of Cortisone and cortisone-like
substances in ophthalmology started with a systemic administration of
these hormones. Later on, Cortisone and hydrocortisone were appüed
topically in the conjunctival sac or undemeath the conjunctiva. At
present we know that Cortisone therapy may lead to glycosuria. Treat-
ing eye conditions with these hormones may thus lead to glucosuria.
Cortisone instilled in the conjunctival sac may pass through the tear
duct and into the circulation. In particular, with the so-called "local
drip Cortisone treatment" (1 or 1.5 cc. of a 2J/2 % Solution of Cortisone
in two minutes) the potentially absorbed amount of Cortisone is not
negligible, especially if this administration is repeated a few times
daily. It is obvious that any Cortisone treatment of eye conditons will
require the constant supervision by the general practitioner. We say,
"any Cortisone treatment", this means general as well as local. It can
happen that a diabetic suffering from episcleritis requires topical
Cortisone, or that a patient who has contracted an acute choroiditis is
a diabetic. The close collaboration of intemist and ophthalmologist is
the best safeguard against eye complications in diabetes.

106

INSULIN MANAGEMENT OF DIABETES

Martin G. Goldner

Insulin management permits the diabetic patient to maintain or
to re-establish optimal nutritional Status with a minimal degree of
hyperglycemia and glycosuria. Since maintenance of such optimal
nutritional Status must be the therapeutic aim in diabetes mellitus, as
long as a eure is not yet at hand, it follows that every diabetic patient
who is unable to do so by dietary means alone, should be placed on
insulin management. It also follows that insulin management is related
more directly to the patient's nutritional requirements than to the
severity of the diabetes, which is difficult to define and which may
depend on many other factors in addition to insuHn deficiency.

Insulin management Starts with dietary management. Optimal
nutrition for the diabetic patient is the same as optimal nutrition for
the non-diabetic. That is to say, that the diabetic organism has the
same energy requirement as the non-diabetic and is subject to the same
hazards of undernutrition and overfeeding. It is not possible in this
context to evaluate critically the dangers of obesity ; it may suf fice to
say that a diabetic patient should never be obese. A few words, how-
ever, should be said about under-nutrition in diabetes. Under-
nutrition was unavoidable in the pre-insulin era. Then, its dangers
were obscured by the short life span of the diabetic patient. Since the
advent of insulin, the life expectancy of the diabetic has become almost
the same as that of the non-diabetic. It is, therefore, mandatory to
provide for optimal nutrition in the management of all diabetic
patients, children as well as adults. By meeting this requirement one
will promote physical health and resistance, secure normal rate of

107

8 Virchow Society, Vol. 12 (1953)

growth and development, and may ward off the onset of degenerative
diseases threatening the diabetic most seriously in the presence of mal-
nutrition.

The proper diet should be as similar to a normal regimen as pos-
sible: with regard to caloric value, to content of vitamins, minerals,
etc., and to relative distribution of the nutrients. It should be cal-
culated in relation to ideal weight for sex and age. If placed on such
a diet (provided that insulin administration is adequate), the under-
nourished patient will gain, the obese patient will gradually lose until
they reach and maintain the desired weight. This procedure may be
more time consumjng than the temporary use of reducing or high
caloric diets with subsequent placement on maintenance diet; but it
has the advantage that diet and insulin can be adjusted at once. For
the average adult, such a diet will provide about 2500 calories and
will contain 250 g. of carbohydrates, 100 g. of protein, and 100 g.
of fat. Experience has shown that the best results are obtained when
such a diet is administered in 4 meals (breakfast, lunch, supper, and
bedtime feeding) and when 2/5 of the allotted carbohydrates are of-
fered for breakfast, and 1/5 for each of the other meals.

Only the mild diabetic (adult) will tolerate this kind of diet
without receiving insulin. All other diabetics need Substitution therapy
with insulin. They include the following groups: 1) all diabetic
children; 2) adults who cannot adjust to the above maintenance diet;
3) all cases of diabetes complicated by infection, surgical disease,
pregnancy, diabetic acidosis and coma.

Insulin management Starts after the patient has been placed on
his proper diet. Insulin is adjusted to the diet, not the diet to an arbi-
trär)' amount of insulin! The proper dose should be the minimal
amount of insulin which will lower the hyperglycemia to almost nor-
mal levels and decrease the glycosuria to a trace, without eliminating
it entirely. The choice of this minimal effective dose is intended not
only to prevent hypoglycemic reactions but also to prevent further
depression of the remaining insulin producing power of the pancreas.
It is rather well established that excessive exogenous insulin depresses
endogenous insulin production.

108

Two types of insulin are presently at our disposal for insulin
management: the slow-acting (long-lasting) and rapid-acting (short-
lasting) preparations. The slow-acting are Protamine Zinc InsuHn and
Globin Insulin or NPH (Neutral Protamine Hagedom); they are
gradually absorbed over periods of 18 hours (NPH) to 36 hours
(PZI) and have correspondingly prolonged action curves. They reach
their maximal effect a few hours after injection. They are usually
given once daily - NPH may sometimes be given twice a day, at
12 hours interval. If spaced properly, two consecutive doses may
overlap in their action, the slow, incoming effect of the new dose
being superimposed on the waning effect of the preceding dose. This
permits a sustained suppression of the fasting diabetic hyperglycemia.
The steady rate of absorption does, of course, not adequately check
the rise of the blood sugar that foUows intake of food. Nevertheless, in
many instances when depression of the fasting level suffices to prevent
excessive postprandial hyperglycemia, diabetes may be satisfactorily
controlled by the use of slow-acting Insulins alone.

However, in some forms of diabetes, particularly in children, the
amount of slow-acting insulin required for adequate control during
the period of food intake would precipitate hypoglycemia during the
physiological fast at night time. In these cases, slow-acting insuhn is
administered in smaller doses to guarantee a "basic" sustained anti-
glycemic action. This must be supplemented by doses of rapid-acting
insuhn, either regulär insulin, crystalline insulin or insulin derived
from insuhn zinc crystals. They all reach the peak of their effective-
ness in less than 30 minutes after injection and have exhausted
their action after 3-4 hours. They are added usually to the basic in-
suhn prior to breakfast (which should have the greatest carbohydrate
content). If NPH insulin is used as basic insuhn, the supplementary
dose of rapid-acting insulin and one dose of NPH can easily be mixed
and injected through the same syringe. This should not be done,
however, with PZI because this preparation contains an excess of
Protamine and any admixed rapid-acting insuhn will be precipitated
and converted into an insulin with long-lasting effect.

More than 90 % of all diebetics can be controlled in this fashion.
Only in the rare instance of the so-called briddle diabetes more than

109

one supplementär)' dose of rapid-acting Insulin may be required, for
instance, prior to each of the 3 or 4 daily meals. Occasionally, even
2 doses of NPH may have to be administered.

Now a Word about the dosage. The dose required in the individ-
ual Gase cannot be calculated from a simple formula. The rule that
one Unit of insulin permits the utilization of 2 g. of sugar is more often
wrong than right. In most instances, one has to find the adequate dose
by trial and error. Since insulin management is not an emergency
procedure (with the exception of coma), there is always ample time
to increase a small initial dose until the minimal effective dose is found.
The initial dose should generally not be higher than 20 units of slow-
acting insulin or 10 to 15 units of rapid-acting insulin. Then, 5 to
10 units are added at intervals of one or several days until urinalysis
indicates that the minimal efiective dose has been reached. This
method may be time consuming, but is certainly safer than to give an
arbitrary large dose initially and decrease it gradually until the mini-
mal eflective dose has been reached. The dose contained in a single
injection should not exceed 80 units, except in the treatment of coma
or insulin insensitivity. Slow-acting insulin needs time to estabHsh its
füll effect. One will do best to give the same dose for 2 or 3 days
before increasing it. Throughout the period of adjustment, urine
should be examined for sugar ( qualitatively before each meal and,
quantitatively in the 24 hour specimen ) . The f ollow-up of f asting and
preprandial blood sugar levels is less essential than the urinalysis. When
the 24 hour Output of glucose is less than 10 g., and when the degree
of glycosuria is minimal throughout the day, the adjustment can
be considered as satisfactory. If the glycosuria is heavy in only one of
the composite urine specimens of the 24 hour output and absent in the
others, the f ood distribution should be changed rather than the dosage
of insulin or the caloric content of the diet. For instance, some of the
carbohydrates are taken away from the meal preceding the heavy
glycosuria, added to another meal or distributed over those meals
following which the urine was found to be free or almost free of sugar.

When diet and insulin requirement have been properly establish-
ed, maintenance of control is the next task. On the suggested ade-
quate diet, the patient has seldom the desire to cheat; this ehminates

110

one great hazard. In addition, the patient must be instructed how to
administer his insulin, not to inject it permanendy at the same site,
lest he may develop granulomata from which insulin is poorly ab-
sorbed. He has to know not only the prescribed dose of insulin, but
also how to measure it.

He should be familiär with the various strengths of insulin pre-
parations and learn to calculate the prescribed units from preparations
which contain 40, 80 or 100 units in 1 cc. He also should be given
an identification card, such as is issued by the American Diabetes
Association, which identifies him as a diabetic patient and indicates
the amount of insulin and the diet he is taking. Furthermore, he must
know that even if he feels not well and is unable to eat his füll diet, he
has to take his füll dose of insulin. Any intercurrent illness is apt to
increase the insulin requirement or to decrease insulin sensitivity. Thus,
in spite of decreased food intake, the same amount of insulin or even
more, is needed. Omission of insulin because of an upset stomach or
another minor illness is the most common cause of diabetic coma.
Finally, the patient must be instructed about the Symptoms of insulin
reactions and how to take care of them. He must know that he should
seek the advice of his physician at regulär intervals and whenever the
control of his disease becomes deficient, even if he himself was able
to adjust the immediate derangement.

These are the basic problems of insulin management; time does
not permit to discuss special as{>ects, such as switching from one type
of insuHn to another, insulin management of surgical complications,
the management of diabetic coma, or the rare instances of insulin
allergv' and insulin insensitivity. These, however, are situations which
commonly require hospitalization, while the basic establishment and
maintenance of insulin therapy is a matter of office practice.

One more thought in closing; insuHn therapy is Substitution
therapy. It has been tremendously successful. Nevertheless, it is not the
ideal therapy. Insulin is secreted in constantly changing amounts into
the portal System and reaches the periphery only after having passed
the liver where it most likely exerts some of its effect or where it is
altered. What we are doing, with insuhn administration, is to Substitute
rather crudely subcutaneous injections for this internal secretion.

111

This may account for some of the difficulties in Insulin manage-
ment. It may also account for the fact that we have to use far larger
doses of insulin than those known to be secreted under physiologic

conditions.

Administration of insulin is the best therapy of diabetes today.
Our goal, however, is not Substitution but eure and prevention. This
is what present research in diabetes is striving for.

112

SUPERFICIAL ULCERATION OF THE
URETHRAL MEATUS IN MALE CHILDREN

Paul Freud

Superficial ulceration of the meatus in male infants and young
boys is not generally recognized as a definite entity, in spite of its fre-
quent occurrence.

The lesion consists of a superficial ulcer on the periphery of the
meatus, cracking its labia to a width and depth of 1 to 3 mm. The
ulceration always remains localized, sparing the inner surfaces of the
Urethra. There is no urethral discharge. Crust formation leads readily
to temporary obstruction of the Urethra and incomplete emptying of
the bladder (divided stream or dribble). When the scabs come off,
the first drop of urine touching the surf ace of the ulcer causes intense
pain, and the children retain urine until an overflowing bladder
enforces voiding. The condition does not cause fever. As soon as the
scab peals off, bleeding occurs. Bright bloody Spots on the diapers are
frequently the first Symptom that alarms the parents. Secretion on the
surf ace of the ulcer soon Starts again, leading to formation of new
obstructing crusts, bleeding and difficulty in voiding. This vicious
cycle may come to a halt, eventually, w^hen the ulcer heals spontane-
ously and leaves only small constricting scars. After a pause, the
lesion reappears and, if not treated, heals again with scar formation
and intensification of the stricture. Any stricture located at the orifice
or higher up W\\\ eventually lead to urinary retention, with all its
dangers of pressure damage and infection.

Our experience based on the treatment of numerous cases shows
that the disorder occurs only in circumcised children or when a wide
prepuce leaves the tip of the meatus exposed to Irritation.

113

However, development of the lesion is always conditioned by a
congenitally tight meatus (anterior-posterior diameter less than
3 mm.) and the presence of a rash (ammonia dermatitis) or Herpes.
They narrow the tight meatal opening still further (inflammatory
swelling ) .

Treatment consists of :

1. Installation of 1 drop of a 2 % novocain Solution on the surface
of the ulcer (relief of pain on voiding).

2. Use of non-volatile antiseptics directed against the action of bact.
ammoniagenes; impregnation of diapers and topical application
( ointment ) .

3. Repeated dilatation of the meatus in cases of moderate constriction ;
meatomy and dilatations in cases of "pin point" meatus.

114

SOME NON-TUBERCULOUS CHEST DISEASES

IN CHILDREN

Helene Eliasberg

From the great variety of lung diseases in childhood I have chosen
a group which has in common abnormal airspaces within or around
the lungs. To be more specific I am going to discuss the occurrence of
cysts, emphysema, abscesses and pneumothorax in infants and
children.

Cysts

Lungcysts may be found at all ages; sometimes they are discovered
by routine ehest X-rays without having caused any Symptoms. They
may be single or multiple, but are usually located in one lobe. Some
cysts are filled with mucoid fluid, secreted by the mucous glands in
the Hning of the wall; most cysts are airfilled. The fluid cysts are more
or less Stahle in size and do not cause respiratory disturbances. Air-
cysts may communicate with a bronchus and if a check valve mechan-
ism develops, they may enlarge to enormous proportions and cause
serious displacement of the mediastinum and heart. They may burst
and produce a tensionpneumothorax, or they may compress the ad-
jacent lung tissue with ensuing cyanosis and severe respiratory and
circulatory distress rcquiring emergency Operations. Besides these
complications, caused by mechanical forces, infection is a great hazard
in pulmonary cysts, more so in older children than in infants. These
dangers inherent in pulmonary cysts are the reason why many p)edi-
atricians and surgeons favor early Operation. After several bouts of
infection have produced adhesions, purulent exudate within the cyst
and blurring of the lobar demarcations, the Operation becomes more

115

difficult. Total pneumonectomy may be necessary instead of a seg-
mental resection or lobectomy. Even if some of the patients escape all
these complications, it seems to me of importance to restore the f unc-
tion of at least part of their lung rather than to maintain a functionless
cystbearing lobe (which compresses the adjacent lobes). Early lob-
ectomy is tolerated remarkably well by infants. The remaining lobes
expand well and fill the entire pleural cavity. The youngest baby that
ever underwent a successful lobectomy was operated on the 7th day of
its life by Whitesell and White. A total pneumonectomy was even
performed on a 3 weeks old baby who had a large cyst in the upper
lobe. The results were excellent (Gross).

There are, however, other observers who advocate watchful
waiting instead of immediate surgical intervention (Vollmer, Caffey).
CaiTey reported recently on 13 cases of lung cysts in infants under
6 months of age. Only 2 had to be operated on because of massive
pulmonary emphysema. In the remaining infants the cystic lesions
disappeared spontaneously after months or years.

Another controversy concerns the question whether the cysts are
congenital (intrauterine error in the embryonic development of the
lungbuds) or acquired (early postnatal mechanical origin). Some
cysts found in stillborns and newboms at autopsy and birth, respec-
tively, are undoubtedly of congenital nature. On the other band, Caf-
fey, Convey, Rappaport and Meyer believe that most lung cysts are of
acquired origin even when bronchial epithelial lining, muscle and
cartilage are found in their wall. CafTey bases bis opinion on 5000
autopsies of newboms at Babies Hospital. The question is by no
means theoretical since many surgeons insist that prognosis and therapy
of congenital and acquired cysts are entirely different. Congenital cysts
should be removed on account of the potential dangers mentioned
above, whereas acquired cysts could be watched and rarely need Oper-
ation. Acquired cysts usually can be traced back to a pulmonary in-
fection, a factor which plays no etiologic role in the formation of the
congenital cyst.

116

Emphysema

Emphysema occurs in 2 forms, the compensatory and the ob-
structive. Anatomically, the compensatory form is no true emphysema,
but a reversible volumen pulmonum auctum: there is an increase in
air content due to hyperventilatory function of a lobe or lung compen-
sating for an atelectatic lobe. Clinically, one finds in addition to the
atelectatic lung portion an enlarged size of part or whole of the remain-
ing lung. On X-ray examination, the lung appears overaerated, the
intercostal Spaces are widened, the diaphragm is depressed, the medi-
astinum shifted to the opposite side. All these changes are more marked
on inspiration. This type of emphysema is frequently seen in atel-
ectasis of the newbom or following aspiration of foreign bodies if it
results in total bronchial obstruction.

While compensatory emphysema is the beneficial result of a
Physiologie adjustment, the obstructive emphysema is a pathologic
condition due to check valve type of bronchial obstruction. The over-
aeration can be regional, lobar or may involve an entire lung. The
X-ray findings are very similar to those seen in compensatory emphy-
sema, except for the absence of atelectasis in other parts of the lung.
For the differentiation of the 2 types, fluoroscopy is of greater hclp
than the film, unless one can be sure to get 2 exposures, one in in-
spiration, the other in expiration - a difficult task to achieve in
children.

Cases of obstructive lobar emphysema not due to demonstrable
compression of any kind may require thoracotomy and lobectomy. This
proved to be a life saving procedure in cases of emphysema that tumed
out to be the result of vascular and other anomalies. Regional ob-
structive emphysema due to a check valve mechanism in a small
bronchus has been known as an important manifestation of pulmon-
ary pathology since its first description by Caffey. Such an obstruction
may occur in the course of a pneumonia and may result in the forma-
tion of large tension cysts. Anatomically, they represent a gross disten-
tion of alveoH, small bronchioli or bronchi, yet without much destruc-
tion of lung parenchyma. The cysts may be Single or multiple; they
are air-filled and contain only a small amount of fluid, if any. They

117

are called pneumatocele. It is most characteristic that they easily
undergo Variation in size and that they have the tendency to disappear
spontaneously. Though their appearance during the course of pneu-
monia may suggest the diagnosis of a lung abscess, the differentiation
is not too difficult. In contrast to the abscess, the cyst develops witliout
serious Symptoms: there is no fever, no leucocytosis, no abnormal type
of respiration, and no interference with the child's general condition.
In fact, I believe that the development of a pneumatocele might ver)'
easily escape recognition unless serial X-rays are taken. After the
pneumonia has cleared up, these cysts may pei-sist for several months.
When they disappear eventually they leave no residues; the lung tissue
shows a completely normal structure. That the pneumatocele is actually
due to a bronchial check valve obstruction has been confirmed by the
finding of raised gas pressure within the cyst. In rare cases of very high
pressure in a superficially located pneumatocele, an air bleb may burst
and produce interstitial emphysema or pneumothorax. It is the rule,
however, that the regional obstructive emphysema disappears with the
Clearing of bronchial obstruction, without any therapy. It is inter-
esting that in the majority of the reported cases the bacteriological
examination revealed an infection with staphylococcus hemolyticus
aureus.

In the following films I will demonstrate some of the diagnostic
difficulties relating to cysts. Diffuse bilateral obstructive emphysema
due to bronchospasm and check valve occlusion of small bronchioli
is the main feature of bronchial asthma, at least in children. There-
fore, whcezing is very often diagnosed as bronchial asthma. However,
one should always bear in mind that asthma is a bilateral condition.
Unilateral conditions, e.g., one-sided bulge or lag, combined with
wheezing, predominantly present over one lung have to be carefully
studied until the cause of the obstruction is found.

Lung Abscess

The counterpart of the transient cysts in regional obstructive
emphysema are the permanent cavities as seen in pulmonary abscesses.
Here, severe tissue destruction takes place, either in pyogenic non-

118

resolving pneumonic infiltrations, in necrotizing infarcts or in caseous
tuberculous infiltrations. Bronchiectatic cavities also tend to develop
abscesses, especially after prolonged Stagnation of purulent exudate.

An incipient pneumonic pulmonary abscess may present a diffi-
cult diagnostic problem. With a rise of temperature, high leucocytosis
and the signs of severe illness, it is not always possible to establish the
diagnosis, even if one suspects abscess formation. If one goes in with
a needle, one will hardly hit a deep seated small abscess, and X-rays
will not reveal anything but a definite pulmonary shadow in this early
phase. With progressing necrosis and liquefaction the pulmonary
shadow becomes less dense in the center. Eventually, when communi-
cation with the bronchus is established and air enters the cavity of the
abscess, the X-ray findings become characteristic : fluid-air level within
a cavity that is surrounded by a broad ring of infiltrated lung tissue.
By contrast, pleural empyema leads to displacement of heart and
mediastinum away from fluid shadow or empyema. However, to make
things more difficult, it is by no means rare that one has to deal with
simultaneously existing empyema and lung abscess.

Like pneumonia, lung abscesses in childhood are f requently caused
by aspiration of foreign bodies, especially grains carrying bacteria and
fungi. Pulmonary abscesses following tonsillectomy have fortunately
become rather rare, thanks to the prophylactic use of antibiotics and
sulfadrugs, proper postural drainage and suction during Operation.

Spontaneous Pneumothorax

So called spontaneous pneumothorax is not infrequent in child-
hood. One may find it already in the newbom. Here, it is usually due
to rupture of an emphysematous bleb in compensatory as well as in
obstructive emphysema. However, obstructive emphysema is more
likely to cause rupture and subsequent pneumothorax because the
check valve mechanism induces steadily rising pressure. The prognosis
of this condition in the newbom is better than one would expect. As
soon as the intraluminal bronchial obstruction is released the emphy-
sema disappears and the pneumothorax is quickly absorbed. This form
of neonatal pneumothorax is usually discovered only by X-ray. In

119

older children, congenital bullae or blebs, trauma, tracheotomy and
tuberculosis are the main causes of pneumothorax. Clinically, there is
sudden pain in one side of the ehest, severe dyspnoe, cyanosis or shock;
occasionally, when the amount of air escaping into the pleural cavity
remains small, only slight discomfort may be feit. The involved side is
bulging and lagging in respiratory expansion. The radiologic signs are:
collapse of the lung towards the pulmonary root ; if adhesions exist the
collapse is not complete and the fibrous Strands extending from the
lung surface to the parietal wall cause sharp, irregulär, angular con-
tours of the coUapsed lung, over which the pleural lining is visible.
The airspace surrounding the lung does not show any pulmonary
markings, as seen in emphysema.

If the intrapleural pressure is elevated, the intercostal Spaces are
markedly widened, the diaphragm depressed, the mediastinum and
heart displaced to the opposite side. Sometimes fluid appears (serous
fluid, blood or pus) and produces the characteristic horizontal air-
fluid line. The presence of a valvulär mechanism at the tear leads to
the development of a tension pneumothorax, with herniation into the
mediastinum and the opposite pleural cavity, causing extreme dyspnoa
and cyanosis.

Such paüents have to be treated with conti nued closed aspiration
by airsealtubing through a thoracocentesis. If there is no emergency,
the pneumothorax is best left alone, permitting spontaneous ab-
sorption.

In conclusion I would like to stress the following points: In any
patient presenting Symptoms of respiratory distress the diagnosis and
prognosis should be firmly established. Whether the management
should be conservative or surgical will depend on the results of serial
X-ray examinations, bronchoscopy and bacteriological and clinical
studies. The age of the patient is not a contraindication, neither for
bronchoscopy nor for surgery.

120

APOCRINE SWEAT GLANDS AND SEXUAL

DEVELOPMENT

H. Behrendt

The pH on the surface of the axilla was tested colorimetrically in
502 boys of various maturity groups, including preadolescents and
adolescents. The results can be summarized as foUows:

1 . The acidity on the surface of the axillary vault decreases consider-
ably when the apocrine sweat glands in that area supply "alkaüne"
sweat.

2. The axillary vault pH indicates the presence or absence of apo-
crine sweat production.

3. The activation of apocrine sweat glands coincides with one of the
phases of sexual maturation in boys.

4. The frequency distribution of pH readings on the axillary vault
among boys of diflerent sexual maturity shows a steady increase in
the number of "positive apocrine" readings from preadolescence
through maturation.

This shift of pH from acid to neutral or alkaline values (on the
axillary vault) is one of the chemical signs of sexual maturation.

DISCUSSION
H. Vollmer

Dr. Freud's paper is of practical importance. Due to their locali-
zation, these lesions cause undue concem to parents and at times
puzzle the physician. As a rule, they yield readily to treatment with
indifferent ointments and control of ammonia formation. The most

121

common mistake is overtreatment which adds a therapeutic to ihe
etiologic irritant, aggravating the condition. Antibiotic ointmenls may
cause sensitization and their use should be restricted to cases in which
secondary infection is obvious or bacteriologically proven. I wonder
whether local application of hydrocortisone should be tried to avoid
swelling, fibrosis and scaring. It is not for me to decide whether pedi-
atricians or urologists are right with their etiologic concepts. Do we
have valid Standards as to normal size of the urethral meatus during
infancy? Personally I have difficulties in understanding why a slight,
functionally insignificant narrowing should cause such ulcerations.
Most pediatricians agree that narrowing is the result rather than the
cause of these lesions.

Dr. Behrendt, in his modesty, told me that he is going to present
"an insignificant physiologic contribution". A study of such thorough-
ness is always significant, particularly if it concems puberty, a period
so long neglected by both intemists and pediatricians. To take care of
this age period is so to say the great finale of the pediatrician's job.
Physiologic studies are basic in opening a new field to our understand-
ing. Practical appHcation of such knowledge will follow in due time.

Sweating can be caused experimentally by hypothalamic Stimu-
lation. Puberty is believed by many to be initiated by hypothalamus-
pituitary mechanisms. It is therefore no surprise that puberty is ac-
companied by changes in sweat composition. The acidity of other
secretions such as vaginal secretions is changed in the opposite direc-
tion. Besides the acidity, there may be other changes not yet under-
stood which explain the spontaneous eure of tinea capitis at the age of
puberty. To speak of another age period: Why does Leiner's disease
clear up spontaneously at the age of 3 months? We don't know. Dr.
Behrendt opened an important new field for study and we all hope he
continues his work.

Dr. Eliasberg together with Neuland in 1920 made an essendal
contribution by their classic description of epituberculosis. Today Dr.
Eliasberg presented interesting ehest conditions which attracted in-
creasing attention in recent years. If I may add an early own Obser-
vation: In 1927 I described a 6 year old girl with a pulmonary cavity
and an air-fluid level. In spite of negative tuberculin tests, Finkdstein

122

wamed against my conservative attitude and thought this cavity to be
tuberculous. The child did well without any treatment. Re-examin-
ation 21 years later revealed that this cavity had persisted without any
change. The course was asymptomatic. Emphysematous cavity was the
most probable diagnosis. This case was one of the first described in the
Uterature with the longest foUow-up period. It teaches that not all
emphysematous cavities disappear spontaneously and that, never-
theless, a conservative attitude is to be recommended.

May I re-emphasize the importance of tuberculin tests for differ-
ential diagnosis. Their importance increased with the decrease of
positive reactors in the population. When Pirquet described his cutane-
ous test 50 years ago, neariy 100 % of the Vienna population of
military age was tuberculin positive. Therefore, the test was not of
great diagnostic help except in early childhood. The Situation today
and in the United States is entirely different. In recent years, among
all admissions to Babies Hospital from birth to puberty only 3 % posi-
tive reactors were found. It is obvious that under these circumstances
a positive tuberculin test assumes a much greater significance.

Dr. EHasberg's excellent presentation deserves a more competent
discussion than I can offer. We are fortunate in having with us Dr.
John Caffey of Babies Hospital, our great expert in pediatric roent-
genology. Dr. Caffey graciously agreed to discuss Dr. EHasberg's paper.

123

9 Virchow Society, Vol. 12 (1953,

OBITUARIES
Read by Paul Hoch

Dr. Hedwig Zweig
Dr. Hedwig Zweig was graduated in 1922 from Breslau. She was
then Assistant at the Pediatric Clinic with Professor Stolte at Breslau.
Later she was Assistant of Professor L. F. Meyer at Berlin. For four-
teen years she practised as a pediatrician in Gleiwitz. In 1940 she
went to Shanghai and worked at the American Mission Hospital with
Chinese war orphans. In 1941 she came to New York and became
assistant of Dr. Herman Schwartz. Dr. Zweig was on the staff of the
Pediatric Department of Beth Israel Hospital and was a Pediatrician
to the Health Department of the City of New York. Wherever she
worked she devoted herseif wholeheartedly to her patients and was
mach beloved and respected by her co-workers.

Dr. Rudolph Hoeber

was bom in Stettin in 1873. He studied medicine in Erlangen, Frei-
burg and Berlin. He received his doctor's degree in Erlangen in 1897.
In 1898 he became Privatdozent for Physiology in Zürich. In 1909 he
went to Kiel where he became füll professor of Physiology in 1915. He
made outstanding contributions to physiology. His book "The Physi-
cal Chemistry of Cells and Tissues" which appeared in 1902 was a
fundamental work in this field. Later he wrote his textbook on
physiolog)' which was widely used and esteemed. He also wrote "The
Physical Chemical Investigative Methods of the Animal Cells and
Tissues" in which he summarized the great progress made in this
branch of science. His many publications dealt mainly with physics
and chemistry as applied to physiology.

Dr. Max Einhorn

Dr. Max Einhorn was an outstanding gastroenterologist who
died at the age of 9 1 . He was Consulting physician to the Lenox Hill
Hospital who gave that Institution the Max and Flora Einhorn Build-
ing and donated funds for awards to care for patients with gastro-
enterological ailments. He was on the faculty of the Post-Graduate
Medical School from 1889 to 1922 when he became emeritus profes-

124

sor of medicine. Dr. Einhorn invented the stomach bücket, a method
of transillumination of the stomach, a duodenal tube for diagnosis and
treatment of intestinal disease, a pyloric dilator catheter for infants,
and a fermentation saccharometer. He was the author of "Diseases of
the Stomach" which appeared first in 1896, "Diseases of the In-
testines", in 1900, "Practical Problems of Diet and Nutrition", in
1905, "Lectures on Diabetes", in 1914, and the "Duodenal Tube and
Its Possibilities", in 1920. Dr. Einhorn who retired about fifteen years
ago remained active until shortly before his death. For his outstanding
achievements in medicine he held honorary degrees of the University
of Tokyo. He was a member of most of the American national so-
cieties in medicine and was honorary member of the medical society
of Munich, and of the Parisian, Japanese, and Belgian gastroenter-
ological associations. With Dr. Einhorn's passing the Rudolph Vir-
chow Society lost one of its most respected members.

Dr. Julius Fuchs

Dr. Julius Fuchs died at the age of 65, August 15, 1953. Dr.
Fuchs was an intemationally known orthopedic surgeon and founder
of the treatment method, orthokinetics. He was bom in Baden,
Germany and received his medical degree at the University of Heidel-
berg in 1913. He was Chief Orthopedic Surgeon of the Veterans
Hospital in Baden, Germany until 1920 when he founded his own
orthopedic Institute in Baden-Baden. It was here he developed liis
technique of orthokinetics which used flexible devices instead of rigid,
plastic casts to brace orthopedic injuries, and thus allow limb motion.
He came to the United States in 1 940 where he continued his experi-
ments. He wrote many textbooks and articles on orthopedics in both
English and German. His latest was "Principles of Orthokinetics",
published in 1 95 1 .

Dr. E. David Friedman

Dr. E. David Friedman was born in New York City, attended
C.C.N.Y., and received his Medical Degree from New York University
in 1907, after which he did post-graduate work at the Universities of
Vienna and Berlin. He held numerous important staff appointments
in New York hospitals. He was visiting neuropsychiatrist of the Gold-

125

water Memorial Hospital, Chief of the Neurological Service of Belle-
vue Hospital, Director of the Neurological Service of Beth Israel
Hospital, and many others. He was Professor of Neurology at New
York University from which position he retired in 1947. He continued
his numerous activities in the field of neurology after his retirement.
In 1949 he received the Townsend Harris Medal from City College
for outstanding post-graduate achievement in "some significant field
of human endeavor". He was President of the Park Avenue Syna-
gogue and had been actively interested in many Jewish educational
organizations. He was an outstanding neurologist with a great clinical
knowledge. He was recognized as an outstanding teacher and his
kindly and understanding personality made him much loved by his

students and patients.

Dr. Ernest Myller

was bom in Schmalkalden 60 years ago. He graduated from the Uni-
versity of Beriin in 1918. By the eariy 30's he had become chief gyne-
cologist and head of a hospital in Nuremberg. After the rise of Hitler
to power in 1933 Dr. Myller and his family were forced to flee to
Greece. There he passed the medical examinations and opened a
private hospital in Athens which he headed for the next 7 years. When
the war began Dr. Myller undertook secret work in Greece for the
British Intelligence and in 1941 when the Gcrmans invaded Greece
he and his family were evacuated from Greece. He then came to New
York and resumed his medical practice. At his death he was Chairman
of the Conference of the obstetrical board at Madison Avenue Hospi-
tal, assistant attending gynecologist at University Hospital, a member
of the county, State and national medical societies, and a diplomat of
the American Board of Obstetrics and Gynecology. He was an author
of a number of scientific publications in the field of gynecology and a
designer of instruments used in the field of sterility and for the detec-
tion of Cancer of the Uterus. For several years he was also the cor-
responding secretary of the Rudolf Virchow Medical Society. In him
we lose a very highly esteemed colleague and one of the most efficient
and conscientious officers of the Society. We were all very shaken by
his sudden passing and I am sure that it will be difficult to replace him.
We will all cherish his memory.

126

PRESIDENTS OF THE RUDOLF VIRCHOW

MEDICAL SOCIETY

*Carl A. Krog .
*Emil Gruening .
*Carl A. T. Krog
*Felix Nordemann
*Carl Heitzmann
^Leonard Weber
*Henry J. Garrigues
*Abraham Jacobi
*Carl Heitzmann
*Joseph W. Gleitsmann

* Willy Meyer
*Wolif Freudenthal
*Herman Klotz .
*George W. Jacoby
*Hermann J. Boldt
*/• 'S- Schmitt
*Carl Beck .
*Franz Torek
*Carl E. Pfeister
*Gustav Seeligmann
*Wolß Freudenthal
*Hermann J. Boldt

Rudolf Denig .
*Hermann Fischer
*Ernst Danziger .
*Thomas Scholz .

Carl Eggers
*Ludwig Oulmann

Arthur Stein

Alfred Plaut

Gerhard L. Moensch

Paul K. Sauer .

Robert Muller .
*George Mannheimer
^Franz M. Groedel

Charles Gottlieb

Rudolf Nissen .

Joseph Berberich

Kurt Goldstein .

Max Jessner

Herbert Elias

Paul Hoch .

* Deceased

. 1876-1877

. 1878-1879

1880-1881

1882-1883-1884

1885-1886

1887-1888

1888-1890

1891

1892

1893-1894

1895-1896

1897-1898

1899-1900

1901-1902

1903-1904

1905-1906

. 1907-1908

1909-1910

. 1911-1912

1913-1914

1915-1916

1917

1918-1919-1920

1921-1922

1923-1924

1925-1926

. 1926-1927

1928-1929

1930-1931

1932-1933

1934-1935

1936-1937

1938-1939

1940-1941-1942

1943-1944

. 1945-1946

1947

1948-1949

1950

1951

1952

1953

127

MEMBERS OF THE RUDOLF VIRCHOW
MEDICAL SOCIETY

HONORARY MEMBERS

Casper, Leopold (1945)

213 West 75th Street, N.Y.C.
Denig, Rudolf (1897)

56 East 58th Street, N.Y.C.
Einhorn, Max ( 1886)

20 East 63rd Street, N.Y.C.
Einstein, Albert ( 1941 )

Princeton, New Jersey
Hoeber, Rudolf (1943)

Philadelphia, Pa.
Joslin, Elliot (1950)

81 Bay State Road, Boston, Mass.
Lieberthal, David (1944)

104 South Michigan Blvd.,

Chicago, 111.

Loewi, Otto (1943)

155 East 93rd Street, N.Y.C.

MagnuS'Levy, Adolf (1941)

121 West 105th Street, N.Y.C.
Meirowsky, Emil (1941)

1040-1232 West Michigan Street,

Indianapolis, Ind.
Neuberg, Carl (1947)

99 Livingston Avenue,

Brooklyn, N.Y.
Nissen, Rudolf (1941)

Bürgerspital Basel, Schweiz
Oppenheimer, B.S. (1950)

124 East eist Street, N.Y.C.
Pick,Ernest P. (1942)

19 East 98th Street, N.Y.C.
Schick, Bela (1925)

17 East 84th Street, N.Y.C.
Sondern, Frederick E. (1892)

180 West 58th Street, N.Y.C.

CORRESPONDING MEMBERS

Kleeberg, Julius (1950)

Hadassah Hospital, Jerusalem, Israel
Liefmann, Emil (1950)

105 Grüneburgweg

Frankfurt a. M., Germany
Siegrist, Henry A. (1940)

Casa Serena

Pura, Ticino, Switzerland

Thannhauser, Sigfried

New England Center Hospital,
Corner Harrison Ave, and
Benett Street, Boston, Mass.

Zondek, Bernhard (1950)
Jerusalem, Israel

MEMBERS

Abraham, E. G. (1948)
993 Park Avenue, N.Y. C.

Adelsberger, Lucie (1949)

200 Central Park South, N.Y.C.

Adler, Alexandra (1946)
32 East 39th Street, N.Y.C.

Adler, Louis (1947)

61 West 74th Street, N.Y.C.

128

Adlersberg, D. (1936)

136 East 64th Street, N.Y.C.
AI den, Maurice (1946)

1610 University Ave., Bronx, N.Y.
Alexander, Hugo ( 1944)

35-06 94th Street, Jackson Hcights,

L. I., N.Y.
Ambinder, Nathan (1949)

1212Fifth Avenue, N.Y.C.

Ansfanger, Ludwig Anger (1946)

35-30 8 Ist Street, Jackson Hcights,

L.I., N.Y.
Apton, Adolph N. (1936)

911 Park Avenue, N.Y.C.
Aron, Frederick Simon (1946)

101 West 80th Street, N.Y.C.
Arons, Isidore (1946)

57 West 57th Street, N.Y.C.
Auerbach, Liese (1943)

155 West 7 Ist Street, N.Y.C.
Aufricht, Gustave (1927)

103 East 86th Street, N.Y.C.
Auslaender, Jacob (1931)

286 West 86th Street, N.Y.C.
Bachenheimer, Max (1945)

398 East 152nd Street, Bronx, N.Y.
Bader, Edwin (1949)

42-20 Kissena Boulevard,

Flushing, L.I., N.Y.
Baer, Heinrich H. (1952)

101 West 126th Street, N.Y.C.
Baer, Richard (1948)

103 East 86th Street, N.Y.C.
Ball, Erna (1954)

87-02 166th Street, Jamaica, N.Y.
Bamberger, Ernest H. (1927)

140 West 86th Street, N.Y.C.
Bardach, Kurt Arthur (1947)

2 West 88th Street, N.Y.C.
Bardeleben, Walther (1946)

645 West End Avenue, N.Y.C.
Bash, Eric A. (1949)

28-18 36th Avenue,

Long Island City, N.Y.
Batzdorf, Erwin E. (1942)

865 Park Avenue, N.Y.C.
Baum, Samuel (1945)

200 West 58th Street, N.Y.C.
Beckhard, Erwin (1947)

87-40 Elmhurst Avenue,

Elmhurst, L.I., N.Y.
Behrend,H.J. (1941)

470 West End Avenue, N.Y.C.
Behrendt, Hans (1941)

1165 Park Avenue, N.Y.C.
Be jach, Hans (1948)

99 Warren Street, N.Y.C.
Benfey, Arnold T. (1944)

50 Park Terrace West, N.Y. C.
Benjamin, Harry (1918)

728 Park Avenue, N.Y.C.

Berberich, Joseph ( 1941 )
784 Park Avenue, N.Y.C.

Berger, W. V. (1942)

38 East 73rd Street, N.Y.C.

Bergmann, Ernst W. (1941)
955 Park Avenue, N.Y.C.

Bergmann, Fanny (1947)
41-58 74th Street,
Jackson Heights, L.I., N.Y.

Bernstein, Eug. Traugott (1941)

100 Central Park South, N.Y.C.

Biber stein, Erna (1951)

667 Madison Avenue, N.Y.C.

Biber stein, Hans H. ( 1941 )
667 Madison Avenue, N.Y.C.

Blasi, Anthony Albert (1945)
25 East Broad Street,
Mt. Vemon, N.Y.

Bleyer, Leon

St. Josephs Hospital
Providence, R.I.

Bloch, Rudolf G. (1953)
5 East 73rd Street, N.Y.C.

Blum, Joseph (1953)

106 East 85th Street, N.Y.C.

Blum, Theodor (1914)

101 East 79th Street, N.YC.
Blume, Hans L. W. (1945)

20 West 77th Street, N.Y.C.
Blumenthal, Ernest Joseph (1946)

118-14 83rd Avenue,

Kew Gardens, L.I., N.Y.
Boenheim, Flora (1948)

1175 Park Avenue, N.Y.C.
Boernstein, Walter (1949)

4 East 95th Street, N.Y.C.
Bonis, Alexander (1949)

145 East 54th Street, N.Y.C.
Borchardt, Paul Robert (1947)

2383 Walton Ave., Bronx, N.Y.
Brandt, Frederick C. (1948)

57 West 57th Street, N.Y.C.
Braude, Eugene (1946)

44 Bennett Avenue, N.Y.C.
Braun, Martin (1952)

366 Willis Ave., Bronx, N.Y.
Breuer, Joshua (1947)

461 Ft. Washington Avenue, N.Y.C.
Brinitzer, Hans F. (1940)

5 West 86th Street, N.Y.C.

129

Brodnitz, Friedrich S. (1943)

667 Madison Avenue, N.Y.C.
Brunell, Ernst Ludwig (1947)

35-55 73rd Street,

Jackson Heights, L.I., N.Y.
Buchbinder, Selma (1947)

295 Harvard Avenue,

Rockville Centre, N.Y.
Bucky, Gustav (1939)

5 East 76th Street, N.Y.C.
Buechler, Erich (1945)

420 East 86th Street, N.Y.C.
Burgheim, Fred C. (1939)

897 Park Avenue, N.Y.C.
Caan, Paul (1951)

545 West End Avenue, N.Y.C.
C aminer, Eric (1944)

2720 Broadway, N.Y.C.
Casper, Wolf gang A. (1939)

25 Central Avenue,

St. George, Staten Island, N.Y.
Cohn, Felix (1951)

215 West 105th Street, N. Y. C.
Dallas, Arthur (1939)

200 Central Park South, N.Y.C.
Dann, Richard (1943)

37-20 Bist Street,

Jackson Heights, L.I., N.Y.
Dessauer, Morris (1946)

57 West 58th Street, N.Y.C.
Dessauer, Stephanie (1944)

1094 Greene Avenue,

Brooklyn, N.Y.
Deutschberger, Otto (1949)

27 West 86th Street, N.Y.C.
Domarus, Eilhard von (1946)

865 Park Avenue, N.Y.C.
Durham, Felix O. (1941)

829 Park Avenue, N.Y.C.
Duschak, Ernest T. (1941)

25 Central Park West, N.Y.C.
Edkins, Walter E. (1940)

112-50 78th Avenue,

Forest Hills, L.I., N.Y.
Ehrenreich, Max (1941)

350 East 77th Street, N.Y.C.
Ehrmann, Rudolf R. (1942)

568 Park Avenue, N.Y.C.
Eilbott, Wilhelm (1943)

755 West End Avenue, N.Y.C.
Einstein, Fritz I. ( 1951 )

570 West 183rd Street, N.Y. C.

Einstein, Gustav (1939)

1175 Park Avenue, N.Y.C.
Elias, Ada (1952)

433 West End Avenue, N.Y.C.
Elias, Gunter M. (1948)

865 West End Avenue, N.Y.C.
Elias, Herbert (1941)

21 East 79th Street, N.Y.C.
Elias, Kurt (1951)

3455 Steuben Avenue,

Bronx 67, N.Y.C.
Eliasberg, Helene (1941)

65 East 96th Street, N.Y.C.
Eliasberg, Wladimir (1941)

151 Central Park West, N.Y.C.
Eliassow, Alfred (1946)

83-80 118 Street,

Kew Gardens, L.I., N.Y.
Elkan, Wolf (1947)

120 Central Park South, N.Y.C.
Eiston, Anny (1949)

242 East 15th Street, N.Y.C.
Engel, Hermann (1951)

1143 Fifth Avenue, N.Y.C.
Engelmann, Curt (1938)

667 Madison Avenue, N.Y.C.
Erlanger, Gustav (1949)

20 West 77th Street, N.Y.C.
Fabian, Helen ]. (1945)

57 West 57th Street, N.Y.C.
Falkson, Kurt Ferdinand (1951)

225 West 86th Street, N.Y.C.
Faltitschek, Josef (1949)

27 West 72nd Street, N.Y.C.
Farmer, Laurence (1951)

993 Park Avenue, N.Y.C.
Farkas, Aladar (1947)

133 East 58th Street, N.Y.C.
Feibes, Henry (1941)

1855 Monroe Ave., Bronx, N.Y.
Feigenheimer, Erwin (1949)

281 Covert Street, Brooklyn, N.Y.
Felden, Botho F. (1927)

38 East 85th Street, N.Y.C.
Ferrington, Elizabeth (1946)

Laboratory Service

Veterans Administration Hospital

Jackson, Mississippi
Fink, Heinrich Louis (1951)

2889 Briggs Ave., Bronx, N.Y.
Fischer, Martin (1951)

250 West 103rd Street, N.Y.C.

130

Fischer, Martin (1953)
176 Atlantic Avenue,
Lynbrook, N.Y.

Flake, Minna Margareta (1947)
161 West 86th Street, N.Y.C.

Flehinger, Benno (1945)

760 West End Avenue, N.Y.C.
Fliegel, Otto (1951)

29 West 64th Street, N.Y.C.
Forchheimer, Ludwig (1949)

52 East 68th Street, N.Y.C.
Fraenkel, Kurt F. (1947)

270 Fort Washington Ave., N.Y.C.
Frankel, Walter (1949)

85 Manor Drive, Newark, N. J.
Frankley, Greta (1947)

350 Central Park West, N.Y.C.
Freud, Frederick (1946)

103 East 86th Street, N.Y.C.
Freud, Paul (1940)

106-15 Queens Boulevard,

Forest Hills, L.I., N.Y.
Freudenthal, Siegmund (1946)

230 West 79th Street, N.Y.C.
Freund, Kate M. (1945)

115 East 89th Street, N.Y.C.
Friedemann, Max W. (1944)

251 Central Park West, N.Y.C.
Friedman, Geo. Alexander (1947)

133 East 58th Street, N.Y.C.
Friedman, Jechiel M. (1949)

166 Bayard Street,

Brooklyn 22, N.Y.

Froeschels, Emil (1941)

133 East 58th Street, N.Y.C.

Fryth, Walter B. (1946)

328 West 86th Street, N.Y.C.

Fuchs, Bert (1945)

412 West llOth Street, N.Y.C.

Fuchs, Felix (1947)

46 East 80th Street, N.Y.C.

Gans, Harry (1946)

141 West 73rd Street, N.Y.C.

Gerst, Ernst S. (1944)

34-43 89th Street,

Jackson Heights, L.I., N.Y.
Gersuny, Otto (1950)

625 Park Avenue, N.Y.C.
Glaubach, Susi (1944)

520 East 12th Street, N.Y.C.

Gluck, Annemarie Schmitz (1941)

1239 Madison Avenue, N.Y.C.
Gold, Ernest (1943)

1 1 1 East 80th Street, N.Y.C.
Goldbloom, Allen A. (1950)

2 East 95th Street, N.Y.C.
Goldman, Walter (1941)

1040 Park Avenue, N.Y. C.
Goldner, Martin G. (1951)

327 Central Park West, N.Y.C.
Goldschmidt, Aron (1939)

12 East 88th Street, N.Y.C.
Goldschmidt, Max (1943)

116 East 63rd Street, N.Y.C.
Goldschmitt, Solomon (1950)

333 Central Park West, N.Y.C.
Goldstein, Eli (1945)

150 East 94th Street, N.Y.C.
Goldstein, Kurt (1945)

1148 Fifth Avenue, N.Y.C.
Goldzieher, Max (1945)

104 East 40th Street, N.Y.C.
Gottlieb, Charles ]. (1940)

101 East 81st Street, N.Y.C.
Gottschalk, Nora (1946)

215 East 164th Street, Bronx, N.Y.
Gould, Werner (1951)

219 Passaic Street, Hackensack, N.J.
Grafenberg, Ernest (1944)

865 Park Avenue, N.Y.C.
Graff,HildigardK. (1945)

314 Parsons Drive

Syracuse 4, N.Y.
Graubard, David ]. (1951)

1082 Park Avenue, N.Y.C.
Graupner, Frank H. (1945)

57 West 57th Street, N.Y.C.
Griesman, Bruno L. (1938)

47 East 61 Street, N.Y.C.
Grossmann, Friederick W. (1953)

20 Sherman Avenue, N.Y. C.
Grossmann, Herbert O. (1946)

500 West End Avenue, N.Y.C.
Gruenthal, Max (1947)

25 West 8 Ist Street, N.Y.C.
Gudemann, Joseph (1945)

567 West 170th Street, N.Y.C.
Gundelfinger, Ernst (1943)

152 West 58th Street, N.Y.C.
Gurewitch, Vladimir (1943)

1165 Park Avenue, N.Y.C.

131

Gutmann, Max (1950)

1816 Madison Street,

Brooklyn, N.Y.
Haas, Alfred (1941)

143 East 88th Street, N.Y.C.
Hammerschlag, Ernst ( 1942)

109 East 81st Street, N.Y.C.
Hammerschlag, Fred G. (1948)

247 Cornwall Avenue,

Valley Stream, L.I., N.Y.
Handzel, Valerie (1950)

15 West 84th Street, N.Y.C.
Hass, Julius (1942)

17 East 82nd Street, N.Y.C.
Haymann, Hermann (1951)

102 East 22nd Street, N.Y.C.
Hecht, Sigmund (1949)

47 Arden Street, N.Y.C.
Heiman, Marcel (1949)

1148 Fifth Avenue, N.Y.C.
Heine, Ludwig (1940)

117-05 84th Ave, Richmond Hill,

L.I., N.Y.
Heinemann, Charlotte (1954)

601 West 174th Street, N.Y.C.
Heinemann, Walter (1939)

680 West End Avenue, N.Y.C.
Heller, William (1941)

200 Central Park South, N.Y.C.
Hermann, Franz (1944)

58 West 90th Street, N.Y.C.
Hertz, Arthur (1946)

114 East 54th Street, N.Y.C.
Hess, Leo (1944)

210 West lOlst Street, N.Y.C.
Hesse, Hans (1946)

412 Audubon Avenue, N.Y.C.
Heymann, Hans (1941)

140 West 58th Street, N.Y.C.
Hirsch, Hans G. (1943)

333 West End Avenue, N.Y.C.
Hirsch, Sophie B. Glaser (1949)

262 Central Park West, N.Y.C.
Hirschfeld, Hans (1948)

350 Central Park West, N.Y.C.
Hirschfeld, Kurt Emil (1946)

1410 Grand Concourse, Bronx, N.Y.
Hirschhorn, Max Leo (1951)

560 1-1 3 th Avenue, Brooklyn, N.Y.
Hirschowitz, Martin (1947)

371 Fort Washington Avenue,

N.Y.C.
Hoch, Paul (1940)

1165 Park Avenue, N.Y.C.

132

Hochstetter, Werner (1945)

1 1 East 68th Street, N.Y.C.
Hoff mann, Karl F. (1926)

108 East 86th Street, N.Y.C.
Ho ff mann, Margot (1947)

1409 Fulton Avenue, Bronx, N.Y.
Horowitz, Isaac (1943)

128 Central Park South, N.Y.C.
Hülse, Wilfred (1938)

110 West 96th Street, N.Y.C.
Icken, Ralph, L. (1953)

25-98, 36th Street, Astoria, L. I.

N.Y.

Isaak, Ludwig (1941)

45 East 85th Street, N.Y.C.
Isler, Leopold (1947)

120 West 70th Street, N.Y.C.
Israel, Arthur (1944)

155 East 72nd Street, N.Y.C.
Jacobson, Moritz (1951)

207 West 106th Street, N. Y. C.
Jacoby, Max (1948)

315 Central Park West, N.Y.C.
Jarecki, Max M. (1947)

905 Bergh Street, Asbury Park, N.J.
J essner, Max (1945)

870 Fifth Avenue, N.Y.C.

Jolowicz, Ernst (1949)

147 West 50th Street, N.Y.C.
Jordan, Henry H. (1946)

110 East 93rd Street, N.Y.C.
Julius, Fred Siegfried (1946)

227 Central Park West, N.Y.C.
Jüngster, Max (1946)

320 West 90th Street, N.Y.C.
Jurasz, Anthony (1953)

80-20 Broadway, Elmhurst, N.Y.
Kalinowsky, Lothar B. (1943)

115 East 82nd Street, N.Y.C.
Kallmann, Franz (1949)

959 Madison Avenue, N.Y.C.
Kaminsky, Anatol (1948)

433 West 34th Street, N.Y.C.
Kamnitzer, Siegbert (1946)

115 West 73rd Street, N.Y.C.
Kaskel, Ernst (1943)

520 West llOth Street, N.Y.C.
Katzenstein, Abraham A. (1948)

140 West 86th Street, N.Y.C.
Katzenstein, Margarete H. (1943)

514 West End Avenue, N.Y.C.

Kauf er, George (1951)

771 Seventh Avenue, N.Y.C.

Kautzky, Karl (1942)

440 West End Avenue, N.Y.C.

Kautz, Friedrich G. (1940)
784 Park Avenue, N.Y.C.

Kent, Charles (1950)
80-09 35th Avenue,
Jackson Heights, L.I., N.Y.

Kestenbaum, Alfred (1940)
470 Park Avenue, N.Y.C.

Kilman, Martin (1949)

118 East 54th Street, N.Y.C.

Kirschner, Max (1945)
109-20 Queens Boulevard,
Forest Hills, L.I, N.Y.

Kisch, Bruno (1941)

845 West End Avenue, N.Y.C.

Kiwi, Hans S. (1942)

305 East 88th Street, N.Y.C.

Klaar, Joseph (1942)

1239 Madison Avenue, N.Y.C.
Klaften, Emanuel (1947)

333 Central Park West, N.Y.C.
Kleeberg, Ludwig S. (1943)

2 East 95th Street, N.Y.C.
Kleemann, Erich Emanuel (1946)

680 West End Avenue, N.Y.C.
Klein, George (1943)

10 East 85th Street, N.Y.C.
Klein, Martin (1944)

574 West End Avenue, N.Y.C.
Klein, Paul (1951)

46 East 80th Street, N.Y. C.
Klein, Siegfried B. (1944)

784 Park Avenue, N.Y.C.
Klemper er, Edith (1945)

315 East 77th Street, N.Y.C.
Klinger, Oskar (1952)

850 Park Avenue, N.Y.C.
Kochmann, Alfred (1948)

667 Madison Avenue, N.Y.C.
Kolton, Hermann (1941)

250 West 94th Street, N.Y.C.
Kornitzer, Ernst (1941)

1239 Madison Avenue, N.Y.C.
Krieger, Charles L (1941)

6 East 85th Street, N.Y.C.
Kriss, Bruno Reginald (1946)

970 Park Avenue, N.Y.C.

Kristeller, Leo (1941)

20 Seaman Avenue, N.Y.C.
Kran, Theodor (1946)

1628 University Avenue,

Bronx, N.Y.
Kroner, Jacques (1949)

333 Central Park West, N.Y.C.
Kroner, Karl (1948)

17 Morsemere Place

Yonkers, N.Y.
Krueger, Erich (1938)

Veterans Hospital,

Kingsbridge Road, Bronx, N.Y.
Kuhn, Paul H. (1940)

103 East 75th Street, N.Y.C.
Kurcer, Mendel (1945)

85-15 139th Street,

Jamaica, L.I., N.Y.
Lange, Hanna S. (1946)

110-45 Queens Boulevard,

Forest Hills, L.I., N.Y.
Lange, Kurt (1942)

116 Central Park South, N.Y.C.
Langstadt, Arthur (1946)

1165 Park Avenue, N.Y.C.
Lax, Henry (1943)

160 East 72nd Street, N.Y.C.
Layton, George A. (1946)

114 East 54th Street, N.Y.C.
Lefferts, David (1945)

230 West 79th Street, N.Y.C.
Lehfeldt,Hans M. (1945)

784 Park Avenue, N.Y.C.
Lehndorff, Heinrich (1941)

650 Main Street,

New Rochelle, N.Y.
Lehr, David (1953)

Flower Hospital,

Fifth Avenue and 105th Street,

New York City
Leiner, George (1949)

105 East 74th Street, N.Y.C.
Leipziger, Hans (1945)

558 West 164th Street, N.Y.C.
Lemos, Anita De (1946)

435 West 119th Street, N.Y.C.
Lendl, Wilhelmina (1941)

P.O.B. 706, Rome, N.Y.
Leopold, Harald (1942)

9 East 78th Street, N.Y.C.
Levi, Julius ( 1950)

140 East 2nd Street, N.Y.C.

133

Levi,Max (1948)

200 Central Park South, N.Y.C.

Lewi, Maurice J. (1928)

53 East 124th Street, N.Y.C.

Lewin, Richard (1944)

46 Fort Washington Ave., N.Y.C.

Lewinski, Moritz (1944)

875 West End Avenue, N.Y.C.

Lewy, Robert (1945)
91 Tulip Avenue,
Floral Park, L.I., N.Y.

Liehmann, George H. (1946)
32 West 82nd Street, N.Y.C.

Lippmann, H. (1942)

1192 Park Avenue, N.Y.C.

Lister, Jacob (1947)

1675 Grd. Concourse, Bronx, N.Y.

Loewenstein, L. W. (1938)
125 East 72nd Street, N.Y.C.

Loewy, Paul (1942)

440 West End Avenue, N.Y.C.

Lowenstein, Otto (1941)
865 Park Avenue, N.Y.C.

Lowenthal, Adolf (1941)

230 West 105th Street, N.Y.C.

Lubliner, Ruth (1952)
3439 Knox Place, N.Y.C.

Lussheimer, Paul (1949)

411 West End Avenue, N.Y.C.
Lust, Franz J. (1941)

17 East 89th Street, N.Y.C.
Maier, Bert ha Spiegel (1946)

1685 Morris Avenue, Bronx, N.Y.
Maier, Max (1946)

216 West 89th Street, N.Y.C.

Mandelbaum, Recka (1943)

701 West 175th Street, N.Y.C.
Mandl, Gustav (1943)

43-08 41st Street,

Long Island City, L.I., N.Y.
Mannheim, Hans L. (1941)

784 Park Avenue, N.Y.C.
Marcus, Howard H. (1953)

200 Central Park South, N.Y.C.
Mark, Bruno (1944)

179 East 79th Street, N.Y.C.
Markham, Paul R. (1941)

34-20 83rd Street,

Jackson Heights, L.I., N.Y.

134

Markus, Nathan H. (1945)

50 West 96th Street, N.Y.C.
Mayer, Ida (1948)

336 Central Park West, N.Y.C.
Mayer, Paul J. (1945)

203 West 90th Street, N.Y.C.
Mayer, William (1942)

115 East 116th Street, N.Y.C.
Meinrath, Hans (1946)

75-14 Austin Street,

Forest Hills, L.I., N.Y.

Metzger, Emy A. (1944)

1172 Park Avenue, N.Y. C.
Metzger, Ernst (1939)

118 East 93rd Street, N.Y.C.
Meyer, George M. (1945)

4915 Broadway, N.Y.C.
Meyer, Max (1942)

645 West End Avenue, N.Y.C.
Meyer, Selma (1941)

84-51 Beverly Road,

Kew Gardens, L.I., N.Y.
Miller, Max (1943)

829 Park Avenue, N.Y.C.
Mohr, Jacob (1947)

780 West End Avenue, N.Y.C.
Moller, Raphael (1946)

600 West 169th Street, N.Y.C.
Mosbacher, Emil (1949)

200 Central Park South, N.Y.C.
Moser, Hanna Melzer ( 1952)

844 Carleton Road, Westfield, N.J.
Moses, Herman (1947)

262 West 107th Street, N.Y.C.
Mosse, Carl Emil

1 38-69 A Jewel Avenue,

Flushing 67, N.Y.
Mosse, Eric (1938)

57 West 57th Street, N.Y.C.
Muehsam, Edward (1945)

3 East 74th Street, N.Y.C.
Mueller,ErnstF. (1935)

784 Park Avenue, N.Y.C.
Muller-Deham, Albert (1941)

243 Riverside Drive, N.Y.C.
Musa, George (1936)

50 East 7 Ist Street, N.Y.C.
Naegele, Alice (1950)

725 West 184th Street, N.Y.C.
Nahm, Eric (1941)

799 Park Avenue, N.Y.C.

Narath, Peter A. (1939)

State Road,

Yorktown Heights, N.Y.
Nathan, Ernest (1941)

133 East 58th Street, N.Y.C.
Nathan, Helmuth (1938)

667 Madison Avenue, N.Y.C.
Nathorff,Eric (1941)

30 West 70th Street, N.Y.C.
Nauenberg, Erna de (1951)

1107 Fifth Avenue, N.Y. C.
Neub erger, Siegfried (1946)

590 Bedford Avenue, Brooklyn, N.Y.
Neuburger, Joseph (1950)

542 West 112th Street, N.Y.C.
Neugarten, Ludwig (1934)

952 Fifth Avenue, N.Y.C.
Neuhaus, Fritz (1945)

715 West 175th Street, N.Y.C.
Neumann, Edith A. (1944)

83-44 Lefferts Boulevard,

Kew Gardens, L.I., N.Y.
Neumann, Gottfried (1950)

950 Park Avenue, N.Y.C.
Neumann, Rudolf (1948)

83-44 Lefferts Boulevard,

Kew Gardens, L.I., N.Y.
Neustadt, Adolph (1946)

3900 Greystone Ave., Bronx, N.Y.
New, Arthur (1944)

129 West llOth Street, N.Y.C.
Niemann, Walter (1930)

Jericho Turnpike, Hillside Boulev.,

New Hyde Park, N.Y.
Norris, Paul F. (1953)

37-32 79th Street,

Jackson Heights, L.L, N.Y.
Novak, Josef (1945)

865 Park Ave., N.Y.C.
Nussbaum, William (1949)

82-31 Austin Street,

Kew Gardens, L.L, N.Y.
Ochs, Isaak Julius (1946)

215 West 98th Street, N.Y.C.
Offenbacher, Richard (1949)

13 20-5 Ist Street, Brooklyn, N.Y.
Olnink,Ignatius Nie. W. (1942)

435 East 57th Street, N.Y.C.
Oppenheim, Henry (1947)

41-96 Gleane Street,

Elmhurst, L.L, N.Y.
Oppenheimer, Helmuth Ernst (1946)

865 Park Avenue, N.Y.C.

Ottenheimer, Lilly C. (1945)
36 East 68th Street, N.Y.C.

Ottenheimer, Julius G. (1945)
114 East84th Street, N.Y.C.

Palmer, Herbert J. (1944)
170 East 77th Street, N.Y.C.

Paltauf, Rudolf (1935)

344 West 72nd Street, N.Y.C.

Pasch kis, Rudolf (1942)

133 East 58th Street, N.Y.C.

Peller, Sigismund (1949)
164 East 81st Street, N.Y.C.

Perez, Willy M. (1939)

57 West 57th Street, N.Y.C.

Perls, Walter L. (1945)

525 West End Avenue, N.Y.C.
Pflaum, Alfred (1947)

225 West 7 Ist Street, N.Y.C.
Pick, Paul (1952)

983 Park Avenue, N.Y.C.
Pineas, Herman O. (1949)

1225 Park Avenue, N.Y.C.
Pollak, Richard (1946)

27 West 72nd Street, N.Y.C.
Preminger, Max ( 1944)

Pemberton Road, New Lisbon, N.J.

Prihram, Bruno O. C. (1947)

910 Fifth Avenue, N.Y.C.
Proskauer, Arthur (1948)

69-40 108th Street,

Forest Hills, L. L, N.Y.
Rachmann, Walter (1946)

200 Bennett Avenue, N.Y.C.
Rapp, Menny (1940)

515 West End Avenue, N.Y.C.
Reis, Julius (1946)

245 Fort Washington Ave., N.Y.C.
Reissner, Albert (1943)

93 Eighth Avenue,

Brooklyn, N.Y.
Riesenfeld, Fritz D. (1947)

50 West 72nd Street, N.Y.C.
Robbins, Sidney (1947)

30 East 60th Street, N.Y.C.
Roos, Nathan (1946)

454 Fort Washington Ave., N.Y.C.
Rosenbaum, Ernst (1945)

5 West 86th Street, N.Y.C.
Rosenberg, Arthur (1945)

238 Fort Washington Ave., N.Y.C.

135

Rosenberg, Dora (1946)

53-75 65th Place, Maspeth, N.Y.
Roseno, Alfred (1940)

950 Park Avenue, N.Y.C.
Rosenow, Anna (1946)

371 Fort Washington Ave., N.Y.C.
Rosenow, George (1943)

944 Fifth Avenue, N.Y.C.
Ross, Alfred (1940)

20-35 Seagist Avenue,

Far Rockaway, L. I., N.Y.
Rothmann, Eva (1947)

1 148 Fifth Avenue, N.Y.C.
Rubin, I.e. (1940)

911 Park Avenue, N.Y.C.
Sachs, Henry B. (1948)

145 Vermilyea Avenue, N.Y.C.
Sachs, Louis (1941)

1 16 East 58th Street, N.Y.C.
Saiten, Rudolf (1942)

955 Park Avenue, N.Y.C.
Samson, Joseph W. (1944)

775 Riverside Drive, N.Y.C.
Samuel, Arthur (1944)

12 Dongan Place, N.Y.C.
Samuels, Saul (1948)

151 East 83rd Street, N.Y.C.
Sand, Herman (1951)

1158 Boynton Ave., Bronx, N.Y.
Schachter, Franz (1947)

963 Avenue St. John, Bronx, N.Y.
Schaefer, Erich (1944)

53 Main Street, Canton, N.Y.
Schalscha, Kurt (1952)

667 Madison Avenue, N.Y.C.
Schauder, Herman (1947)

4 East 95th Street, N.Y.C.

Scheyer, Hans E. (1945)

61 Elm Street, Potsdam, N.Y.
Schindler, Richard (1942)

360 Central Park Ave., N.Y.C.
Schlesinger, Benno (1944)

108 West 85th Street, N.Y.C.
Schmidt, Robert M. (1943)

108-24 7 Ist Street, Forest Hills,

L.L, N.Y.
Schnebel, Emil (1942)

103 Thayer Street, N.Y.C.
Schnerb, Godschau (1947)

717 West 177th Street, N.Y.C.
Schoenfeld, Siegfried (1939)

200 Central Park South, N.Y.C.

136

Schomberg, Ernest (1950)

466 West 13 Ist Street, N.Y.C.

Schwarz, Eugene E. (1952)

65 East 76th Street, N.Y.C.
Schwarz, Gottwald (1949)

63 East 84th Street, N.Y.C.
Schwarzbart, Irma Julia (1946)

110-35 72nd Avenue

Forest Hills, L.L, N.Y.
Schwarzmann, Emil (1942)

133 East 58th Street, N.Y.C.
Schwarzschild, Ludwig (1947)

514 West End Avenue, N.Y.C.
Schweitzer, Ernst E. (1953)

133 East 40th Street, N.Y.C.
Seidemann, Herta (1951)

1349 Lexington Ave., N.Y.C.
Seidenberg, Leopold (1941)

200 Central Park South, N.Y.C.
Selig, Rudolf (1941)

56 East 87th Street, N.Y.C.
Seligmann, Fred S. (1948)

501 32nd Street, Union City, N.J.
Senator, Hans (1941)

115-55 77th Avenue,

Forest Hills, L.L, N.Y.

Sichell, Jane (1952)

666 West End Avenue, N.Y.C.
Sichell, Max Josef (1946)

666 West End Avenue, N.Y.C.
Siegel, Erich (1942)

151 West 86th Street, N.Y.C.
Sielman, Hans R. (1941)

105 East 74th Street, N.Y.C.
Silbermann, Maximilian (1948)

893 Park Avenue, N.Y.C.
Simon, Arthur F. (1939)

86-10 34th Avenue,

Jackson Heights, L.L, N.Y.
Simon, Eugene (1949)

315 West 106th Street, N.Y.C.
Singer, Rudolf (1941)

1100 Park Avenue, N.Y.C.

Sonnenfeld, Anni (1951)

116 East 58th Street, N.Y.C.
Sonnenfeld, Arthur (1944)

116 East 58th Street, N.Y.C.
Spaeth, Kurth (1944)

562 West 148th Street, N.Y.C.

Stein, George (1952)

730 Fifth Avenue, N.Y.C.

Steinhardt, Max (1946)

2980 Valentine Avenue,

Bronx, N.Y.
Stern, Rudolf A. (1941)

1150 Fifth Avenue, N.Y.C.
Sternberg, Adolph S. (1947)

853 Seventh Avenue, N.Y.C.
Stone, Paul (1947)

47-02 Skillman Avenue,

Long Island City, L.L, N.Y.
Strauss, Elizabeth (1945)

315 Central Park West, N.Y.C.
Strauss, Hans (1940)

315 Central Park West, N.Y.C.
Sulzberger, Marion B. (1931)

999 Fifth Avenue, N.Y.C.
Sundheimer, Martin (1951)

70 Cortlandt Ave., New Rochelle,

N.Y.
Swienty, Wilhelm (1947)

50 West 72nd Street, N.Y.C.
Tater ka, Henry M. (1947)

325 West End Avenue, N.Y.C.
Teichner, Herbert (1951)

195 Genesee Street, Geneva, N.Y.
Teleky, Ludwig (1948)

96 Wadsworth Terrace, N.Y.C.
Torner, Joseph (1944)

402 Clinton Avenue, Albany, N.Y.
Trautman, Edgar (1941)

57 East 88th Street, N.Y.C.
Trefousse, George L. (1947)

241 Central Park West, N.Y.C.
Tr eitel, Emil (1944)

57-26 6 Ist Street, Maspeth, N.Y.
Tuch, Richard (1949)

189 Sherman Avenue, N.Y.C.
Ullman, Walther Hans (1951)

115 West 86th Street, N.Y.C.
Ulrich, Oscar (1939)

27 West 86th Street, N.Y.C.
Violin, Edward (1950)

57 East 88th Street, N.Y.C.
Vogl, Alfred (1942)

1165 Park Avenue, N.Y.C.
Vollmer, Hermann (1939)

25 Central Park West, N.Y.C.
Wachen, Robert (1947)

60-52 Palmetto Street,

Ridgewood, L.L, N.Y.

Wachstein, Max (1952)

St. Catherines Hospital,

Brooklyn, N.Y.
Wagner, Martin (1950)

215 West 88th Street, N.Y.C.
Wahl, Stephen (1948)

14 East 90th Street, N.Y.C.
Waitzf eider, Walter (1952)

229 West 78th Street, N.Y.C.
Waltuch, Max (1949)

119 East 84th Street, N.Y.C.
Weichsel, Manfred (1947)

47-07 41st Street,

Sunnyside, L.L, N.Y.
Weil, Rudolf (1944)

230 Central Park South, N.Y.C.
Weinberg, Frederick S. (1942)

375 Riverside Drive, N.Y.C.
Weiner, Ernst B. (1942)

133 East 58th Street, N.Y.C.
Weisenbeck, Max (1943)

East Avenue, Onondage Hill, N.Y.
Weiss, Frederick A. (1943)

1 1 Riverside Drive, N.Y.C.
Weiss, Harry (1946)

75 Fort Washington Avenue, N.Y.C.
Weiss, Herrman (1944)

300 Madison Ave., Madison, N.J.
Weiss, Samuel (1917)

146 Central Park West, N.Y.C.
Wendel, Gustav (1946)

43-10 44th Street,

Long Island, L.L, N.Y.
Wertheim, Frederick Max ( 1946)

143 West 96th Street, N.Y.C.
Winkler, Günther E. (1948)

30 Central Park South, N.Y.C.
Wolf, Max (1941)

969 Park Avenue, N.Y.C.
Wolf, Günther E. (1944)

Box A 241, Camarillo, Calif.
Wolfsen, Martin Richard (1947)

65 Central Park West, N.Y.C.
Zak, Frederick Gerard (1951)

25 East 94th Street, N.Y.C.
Ziegler, Joseph (1950)

510 Madison Avenue, N.Y.C.
Zinner, Alfred (1944)

17 East 82nd Street, N.Y.C.

137

ASSOCIATE MEMBERS

Molitor, Hans (1936)

Merck Institute, Rahway, N.J.

Schleger, Fred (1942)

108 East 79th Street, N.Y.C.

INACTIVE MEMBERS

Alexander, Berthold

Mt. Sinai Hospital, Chicago 8, 111.
Colmers, Franz A. (1938)

3 East 74th Street, N.Y. C.
Feldstein, Zama (1913)

62 West 82nd Street, N.Y.C.
Fuld, Ernest M. (1951)

1125 Grand Concourse, Bronx, N. Y.
Glas, Emil

101 East 74th Street, N.Y.C.
Gordon, Irving (1945)

200 West 20th Street, N.Y.C.
Kreuder, Henry (1902)

635 Riverside Drive, N.Y. C.
Kruna, Richard 5. ( 1 94 1 )

50 North Broadway,

White Plains, N.Y.
Kutner, Reynold (1949)

47 Fort Washington Ave., N.Y.
Mannheimer, Jacob (1941)

1125 Grand Concourse, Bronx N Y
Plaut, Alfred (1929)

Armed Forces Institute

of Pathology, Washington, D.C.

138

Prinz, Leopold (1949)

143 West 96th Street, N.Y.C.
Schapiro, Bernard

Jerusalem, Israel

Seligmann, Albert (1946)
41 Forest Avenue,
Silverlake, L.I., N.Y.

Sellings, William (1942)

837 N. La Jolla Avenue,

Los Angeles, Calif.
Steffens, William (1894)

300 Convent Avenue, N.Y.C.
Strauss,Max (1941)

200 Central Park South,

New York City

Wiener, Joseph Charles (1946)
84-09 Talbot Street,
Kew Gardens, L.I., N.Y.

Wolf, Heinrich
85 Fifth Ave., N.Y.C.

Zuerndorf er, Louis (1952)

915 Brückner Blvd. Bronx, N.Y.

ATLAS DER SYSTEMATISCHEN

ANATOMIE DES MENSCHEN

VON PROF. DR. MED. ET PHIL.

GERHARD WOLF-HEIDEGGER

BASEL

Band 1 Skeletsystem-Knochenverbindungcn- Muskulatur

IV -f- 218 S.. 347 gröfiteils mehrfarb. Abb., 1944, sFr. 32.—

Band 2 Eingeweide - Haut/Sinnesorgane

Erscheint 1955

Bands Periphere Nerven und Gefäße - Zentralnervensystem

(Darstellung der Nerven und Cefäfie auf einem Bild)
Erscheint 1955

Jeder Band enthält ca. 350 mehrfarbige Abbildungen auf ca. 250 Seiten.

Preis pro Band sFr. 32. —

Auf einen ausführlichen Text wurde verzichtet, so dai der Atlas neben jedem

beliebigen Lehrbuch verwendet werden kann.
Verlangen Sie den Spezialprospekt mit Probetafeln.

Aus den ersten Urteilen:

«...Was den neuen Atlas von G. Wolf- Heidegger betrifft, so kann ich wohl sagen,
dafi die Abbildungen ausgezeichnet sind, und ich selbstverständlich gerne meinen
Studenten diesen mich sehr interessierenden Atlas empfehlen werde...» W. K.
«... Für die Studenten sind die Abbildungen gerade deswegen von ganz beson-
derem didaktischen Wert, weil die Linienführung der Umrisse und das Relief
der Formen einfach sind, und der Blick nicht durch Darstellung nebensächlicher
Einzelheiten verwirrt wird ...» W. B.

«... I was tremendously impressed with the excellence of the plates, the remark-
able cleamess of presentation, the fine paper and good formet. 1 shall certainly
recommend this book very highly to my students and professional confreres...»

O. S.
«... Un coup d*OBil aux 6dbantillons des illustrations que vous avez unis k votre
lettre suffit pour se rendre compte du soin avec lequel les pr^parations ont htk
cboisies et les fignres exdcut^es; la valeur didactique de votre oeuvre est hors
de discussion ...» R. A

BASEL (Schweiz)

S. KARGER

NEW YORK

The Journal of the American Medical Profession

Ky-

Mechanotherapy of Impotene
Artificiai Inseminatio
After Effects of Impotene

Obesity
Sociaiization in Britain
From the Secretary of Defense

Medical Book News
Contemporary Progress

Editorlols
Contents Pages 7a, 9a

Vol. 77

May 1949

No. 5

of nausea and vomiting while taking
dienestrol; this occurred on a dosage of
0.5 mg. daily; after stopping treatment for
a week, it was begun again with a dosage
of 0.3 mg. daily without further signs
of toxicity. Only 2 patients had with-
drawal bleeding; one of these was a cas-
trate twenty-seven years of age, who had
shown withdrawal bleeding with other
types of estrogen therapy. By giving
dienestrol in intermittent courses of twenty
days with ten-day intervals, withdrawal
bleeding simulating normal menstrual
periods was obtained. The other patient
was sixty-three years of age and showed
slight bleedmg (Spotting) for a day after
voluntarily discontinuing treatment for a
week.

COMMENT

Judging front the author's clinical evalua-
tion dienestrol is "just another" estrogenic
hormone. We have had no expertence with
this particular hormone but apparently it is
potent (even when taken by mouth) and has
yery jew side effects. Given a potent prepara-
tion that can be given by mouth there is
little choice in the muUitude of estrogenic
hormones available. H.B.M,

Vaginal Cytology of Postmeno-
pausal Women

J. R. Kernodle and W. K. Cuyler
(Southern Medical Journal, 41:861, 869,
Oct. 1948) report a study of the cytology
of 415 sets of vaginal and cervical smears
from postmenopausal women-; 70 of these
smears came from women with malig-
nant lesions of the genital organs. These
smears were classified according to Papani-
colaou and Traut with several Subtypes
created by the authors to define the cytology
more acurately. One of the Subtypes,
AMA (atrophic menopause, acidophilic),
has been the subject of a special study.
In the group of 257 patients without
malignant lesions, the average age was
53.2 years; the menopause was spontaneous
in 207 cases, and surgical in 50 cases;
68 patients had had postmenopausal
bleeding. Type II smears (atypical epithe-
lial cells, but not malignant) were
found in 80.5 per cent of the patients.

238

Repeat smears were made in some cases
(a total of 345 smears); in these smears,
subtype R (regressive) was most fre-
quently found.' Trichomonas vaginalis
was associated most frequently with sub-
type R. Chronic Cervicitis was present m
more than one-third of the patients and
was associated most frequently with Sub-
types R and AMA. In the malignant
group, subtype R was associated most fre-
quently with malignancy, and subtype
AMA was least frequently found. A
special study of subtype AMA was made
in the vaginal smears of 68 post-meno-
pausal women. These smears show various
types of basal cells, including normal basal
cells, but all are acidophilic, most of the
cells' are smaller than normal, and some
show various stages of necrocytosis. These
smears were not frequently associated
with malignancy. They represent an "ac-
centuated degeneration," which is prob-
ably secondary to an endogenous hormonal
imbalance; although sometimes associated
with infection, infection was not present
in the majority of cases showing this type
of smear.

Com ME NT

Vaginal cytology in postmenopausal jvomen
is destined to become a routine procedure.
Indeed, it may be said to be "just that" right
nojv. Any such patient coming to the ofßce
for a general check-up has not had a cornplete
examination unless vaginal cytology is in-
cluded. The authors have classified smears
according to Papanicolaou and Trout and
have created, for the sake of accuracy, several
Subtypes. At least two of these Subtypes have
received special study. One could be definitely
said to be non-malignant, whereas the other
was just as surely malignant. If you are in-
terested in vaginal cytology read this article
— yes, study it. Remember! early diagnosis is
still the only hope for a positive eure of
Cancer. H.B.M.

The Treatment of Uterine Fibroids

F. L. Payne (Surgical Clinics of North
America, Dec. 1948:1455) states that since
uterine fibroids may give rise to no Symp-
toms and have "a very low potential" for
malignant degeneration, a diagnosis of
uterine myoma is not necessarily an indi-
cation for active treatment. If a diagnosis
of a fibroid tumor is definitely established

MEDICAL TIMES, MAY. 1949

in a woman approaching the menopause,
the patient is kept under Observation with-
out treatment as long as there are no
Symptoms and the tumor does not exceed
the size of a three months' pre.cnancy.
The same is true of a woman "past the
menopause, if the tumor is small and there
are no Symptoms; such women should be
Seen at least every six months, and treat-
ment instituted if pain or bleeding devel-
ops. Some younger women with very small
hbroids may also be kept under Observa-
tion if they desire to have a child prior
to surgical treatment. In some patients
approaching the menopause, who have a
small uterine fibroid, with menorrhagia
the only Symptom, androgen therapy is of
value to control the bleeding; androgen
therapy must be used with care in order
to avoid untoward reactions. It may also be
used occasionally in younger women with
small fibroids who wish to defer Opera-
tion for a time. Radium has been used
in the treatment of uterine fibroids in the
author's clinic since 1912; and has been
found to be indicated in about 20 per
cent of cases. It is used chiefly in women
approaching the menopause, who have rela-
tively small uterine fibroids with abnormal
bleeding; after a diagnostic curettage an
intrauterine application of a menopausal
dose of radium is given. It is also em-
ployed occasionally in younger women
with abnormal bleeding and small uterine
fibroids; in some of these cases Operation
can be deferred, and in others, the ab-
normal bleeding is controlled without Op-
eration. X-ray therapy may be used for
the control of bleeding when radium or
immediate Operation is contraindicated; in
some cases marked regression of the tumor
results. Myomectomy is indicated in
about 10 to 15 per cent of cases of uter-
ine fibroids, chiefly in young women in
the childbearing period. Hysterectomy is
the Operation of choice in most cases of
uterine fibroids. Vaginal hysterectomy is
done only when the uterus is slightly en-
larged and there is no adnexal disease.
Abdominal hysterectomy is usually the
method of choice; the author does not per-
form total hysterectomy routinely, but
prefers it to supravaginal hysterectomy if

MEDICAL TIMES, MAY. 1949

the general condition of the patient per-
mits and benign cervical disease is present.
Any healthy ovarian tissue is conserved.

COMMENT

IVe have taught and practiced for many
years that "all fibroids need to be watched
but not all fibroids need to be treated." We
have "watched" fibroids that gave no clinical
Symptoms and did not suddenly change in
stze, consistency or sensitivity (5-10 years or
longer) before instituting active treatment.
Of course, the size and multiplicity of fibroids
are always important. We can see no härm
m such management and in not a few cases
great good is accomplished by preserving the
childbearing (also the menstrual) function
as long as it is feasible to do so. As the author
States, fibroids have "a very low potential"
for malignant changes and if under constant
conttnuous Observation (peivic examination
every 3-6 months, more often if indicated)
there is very little risk from this angle of the
Problem, We can agree 100 per cent with
the plan of active treatment that the author
advocates. It is conservative, withoui too much
risk to the patient, and it is reasonable, par-
ttcularly if the patient is in the childbearing
age and is married or expects to get married.
It requires more "guts" to be intelligently
conservative than it does to be immediately
radtcal. H.B.M.

Cervical Obturation with Inflatabie
Cannuia in Uterotubal InsufRation
and Hysterosalpingograpiiy

I. C. Rubin and Ernest Myller (Amer-
ican Journal of Obstetrics and Gynecology,
56:1077, Dec. 1948) describe a cannuia
with an inflatabie rubber bulb used for
obturation of the cervical canal during
uterotubal insufl^ation or hysterosalpin-
gography. This instrument can be in-
serted into any cervical canal that admits
a uterine sound. The rubber bulb can be
inflated with an aqueous contrast medium,
so that the relation of the bulb to the
cervical canal can be demonstrated. The
advantages of this type of cannuia are:
It provides airtight closure of the cervical
canal, which is essential for either utero-
tubal insufflation or hysterosalpingography ;
its application is painless and it causes no
trauma; it maintains the normal anatomi-
cal Position of the uterus. Another ad-
vantage of this cannuia is that the pressure

239

within the rubber bulb determines the
maximum pressure that can be used for
tubal insufflation or hysterosalpingography,
for if the pressure used in either of these
procedures exceeds that in the rubber bulb,
there is prompt escape of the gas or the
opaque medium from the cervix. Thus the
rubber bulb of the cannula acts as "a
desirable safety valve" which prevents un-
due mcrease of pressure within the uterus.

Com ME NT
Everybody who has ever done the Rubin

test for patency of the fallopian tubes or
hysterosalpingography knows that cervical
obturation is of major importance. Regurgita-
tion of CO2 gas or oil leads to failure of these
tests, The authors have derised a cannula
with an inflatable bulb which can be inflated
after passage through the cervical canal into
the uterine cavity and by downward traction
affords an affective means of plugging the
internal cervical os, It works. We have had
no personal experience but have seen Dr.
Rubin demonstrate this cannula and it cer-
tainly has every advantage over all other
methods of cervical obturation that we know
about. If you perform the Rubin test get one
of these cannulas. You will never regret it.

OBSTETRICS

Rh Sensitization in a Primipara
Caused by Intramuscular
Injection of Human Serum

J. Thornton Wallace and associates
(American Journal of Obstetrics and Gyne-
cology, 56:1163, Dec. 1948) report a
case in which an Rh-negative woman in
her first pregnancy showed Rh antibodies
in the serum from the seventh week of
pregnancy, which suddenly rose to a high
titer in the thirty-second week. The hus-
band was Rh-positive, and presumably
heterozygous for the Rh factor. In this
case there was no history of blood trans-
fusions or injections of whole blood at
any time in the patient's life, but there
was a history of intramuscular injections
of pooled adult serum as a prophylactic
measure against poliomyelitis when the pa-
tient was eight years of age. At the time
when the Rh antibody titer rose suddenly,
a cesarean section was done in the hope
of preventing severe erythroblastosis fetalis
in the infant. Although an exchange
transfusion was begun shortly after birth,
the infant died on the second day; autopsy
showed the typical pathological changes
of erythroblastosis fetalis. The mother
made a good recovery, but experience in
similar cases indicates that it is doubtful
if the Rh antibody in her serum will fall
sufficiently to enable her to have a viable
Rh-positive infant. As the husband is
heterozygous, there is a possibility of an

240

Rh-negative infant which would not be
erythroblastotic. It is now generally recog-
nized that transfusions or even intra-
muscular injections of Rh-positive blood in
Rh-negative individuals cause Rh sensitiza-
tion more frequently than pregnancy with
Rh-positive fetuses. This case shows that
the injection of serum or plasma into Rh-
negative women may also cause Rh sensi-
tization, and that careful inquiry should be
made in regard to such injections in taking
the obstetric histories of Rh-negative
women.

COMMENT

The authors report a case of Rh sensitiza-
tion in a Primipara caused by the intra-
muscular injection of human serum years
previously. This case report, among other
things, brings out three points that should
always be kept in mind by the accoucheur,
viz^: (1) that cesarean section performed some
weeks before term may not keep the baby
from dying of erythroblastosis: (2) that an
exchange transfusion does not always save an
erythroblastotic baby; and (3) that the mere
injection of serum or plasma into Rh-negative
women may cause Rh sensitization and that a
careful inquiry into the past history regarding
injections and/or transfusions should always
be undertaken. Take warning and "save face"
when handling Rh-negative women, H.B.M.

The Treatment of Eclampsia by
Means of Regional Nerve Block

F. E. Whitacre and associates (Southern
Medical Journal, 41:920, Oct. 1948) re-

MEDICAL TIMES, MAY. 1949

port that they nave used regional nerve
block in the treatment of their most se-
vere cases of eclampsia with good results.
Restlessness is controlled with the sedative
drugs commonly used; and hypertonic in-
travenous glucose is given, in addition
to the regional nerve block. In the typical
case reported, 8 cc. of "metycaine" in 1.5
per Cent Solution was first introduced into
the sacral canal; as this produced no evi-
dence of spinal anesthesia, an initial dose
of 22 cc. of the "metycaine" Solution was
given and a segmental level of cutaneous
anesthesia was maintained between thoracic
8 and 10, by giving 20 cc. of the "mety-
caine" Solution every forty-five minutes.
The blood pressure feil gradually. The
regional nerve block was maintained and
the blood pressure controlled for thirty-
six hours, during which time a few uterine
.contractions occurred. As it became in-
creasingly difficult to maintain the regional
nerve block, labor was induced by artificial
rupture of the membranes, and a satisfac-
tory nerve block to control hypertension
and to relieve the pain of labor was main-
tained by introducing the "metycaine" So-
lution into the subarachnoid Space, above
the third lumbar interspace, in a dosagc
of 1 to 2 cc. every hour. The nerve block
was continued for twenty-four hours after
deljvery, and there was no rise in blood
pressure. Both the mother and her in-
fant were discharged in good condition.
Recently, in cases in which regional nerve
block has been used to control blood
pressure and increase the urine volume,
intravenous injection of mannitol in dis-
tilled water has been employed every four
hours, in addition to 5 to 10 per cent glu-
cose Solution, as necessary to produce effec-
tive diuresis and dehydration.

COMMENT

We, of course, have no specific treatment
for the toxemias of pregnancy, including
eclampsia. Therefore any adjunct to the com-
monly employed treatment of eclampsia ts
acceptabte. The one case reportd by the
authors naturally does not establish the trust-
worthiness of regional nerve block. On the
other hand, the %asic principles involved are
sound and, under proper auspices, this method
should prove of very great value. We have

MEDICAL TIMES, MAY, 1949

not personally employed the method but can
see no reason for not using regional nerve
block if the occasion arises. Go ahead and
try it! Be sure you know the technic or, better
still, have a qualified anesthetist per form the
f^iock. H.B.M.

Decidual Bleeding in Pregnancy

H. A. Power (Atnerican Journal of Ob-
stetrics and Gynecology, 56:743, Oct.
1948) reports 13 cases in which vaginal
bleeding ocairred in the first four and
one-half to five months of pregnancy and
was not due to premature Separation or low
Implantation of the placenta. The bleed-
ing varied in amount, and in 4 cases was
accompanied by cramps; all of these 4
patients abortcd four to six weeks after
the onset of Symptoms, but in one in-
stance the child was viable (seven months)
and survived. In the other 9 cases the
bleeding ceased and the pregnancy pro-
gressed to term or near term and all the
infants survived. One of the patients was
fully ambulatory, 5 were on bcd rest, and
7 were kept in bed and given estrogen
and progesterone therapy. In all cases,
areas of decidual degeneration were found
after delivery, the degeneration being most
extensive in those cases in which preg-
nancy terminated early. No evidence of
subplacental hematoma or of gross patho-
logical changes in the placenta was found
in any case. In one case there was an
apparent cervical polyp, which was found
to consist of degenerated decidua. These
findings indicate that bleeding in early
pregnancy may result from degeneratin^
decidual tissue; in such cases, the bleed-
ing gradually ceases, as a rule, and preg-
nancy progresses normally under con-
servative treatment; the value of endocrine
therapy was not dearly demonstrated in
this series. The final diagnosis depends
upon examination of any tissue passed
and inspection of the placenta and mem-
branes following delivery.

COMMFNT .

Decidual bleeding in pregnancy is a real
pathological entity. Clinically the diagnosis
is difficult to make. Micro scopically it is easy.
Not infrequently a diagnosis of threatened or

241

INDEX NUMBER

tn^Ä^J

Borden's prescrlpiion specialties are flexihly adapiable to cope effecitvely
xcHn ihe sharplif increasea number of your infani jeeaiug prohiems.

BIOLAC-a complete Infant formula (only
vitamimC supplementation needed) for infants
deprived of mother's milk.

DRYCO-a powdered, high-protein, low-fat,
moaerate carbohydrate milk f ood ideally suited
for all formulas.

BETA'LACTOSE-an exceptionally palatable,
highly soluble milk sugar for formula modi-
fication.

MULL-SOY-a hypo-allergenic emulsified soy
food for infants and adults allergic to milk
proteins. The 1:1 Standard dilution approxi-
mates cow's milk in fat, protein, carbohydrate
and mineral content.

K LI M -a spray-dried whole milk with soft curd
properties essential,in Infant feeding and
special diets. Particularly valuable when avail-
ability or safety of fre* milk is uncertain.

TiorJcn prcscrlptlon proancts are avaiiahie ai oll Jrug stores.
Cowplete professional informniion niay he ohialned on rennest.

*«Miur»»

""fv^ BORDEN'S PRESCRiPTiöN PRODITÜTS DIVISION

fe^^^

350 MADISON AVENUE. NEW YORK Un'^^Y;

<
Vi

AMERICAN JOURNAL

OBSTETRICS AND
GYNECOLOGY

Vol. 56

December, 1948

No. 6

Editor
GEORGE W. KOSMAK

Associate Editors
HOWARD C. TAYLOR, JR. WILLIAM J. DIECKMANN

OFFICIAL ORGAN

THU AMERICAN GYNECOLOGICAL SOCIETY
THE AMERICAN ASSOCIATION OF OBSTETRICIANS, GYNECOLOGISTS,

AND ABDOMINAL SURGKONS

NEW YORK OBSTETRICAL SOCIETY; OBSTETRICAL SOCIETY OF PHILADELPHIA

BROOKLYN GYNECOLOGICAL SOCIETY; ST. LOUIS GYNECOLOGICAL SOCIETY

NEW ORLEANS GYNECOLOGICAL AND OBSTETRK^AL SOCIETY

BALTIMORE ^i^STETRICAL AND GYNECOLOGICAL SOCIETY

CHICAGO GYNECOLOGICAL SOCIETY; CINCINNATI OBSTETRIC SOCIETY

CENTRAL ASSOCIATION OF OBSTETRICIANS AND GYNE(X)L()GJSTS

AMERICAN BOARD OF OBSTETRICS AND GYNECOLOGY

WAHINGTON GYNECOLOGICAL SOCIETY

PITTSBURGH OBSTETRICAL AND GYNECOLOGICAL SOCIETY

OBSTETRICAL SOCIETY OF BOSTON

LOUISVILLE OBSTETRICAL AND GYNECOLOGICAL SOCIETY

SOUTH ATLANTIC ASSOCIATION OF OBSTETRICIANS AND (}YNECOLO(JlSTS

SEATTLE GYNECOLOGICAL SOCIETY

SOCIETY OF OBSTETRICIANS AND GYNECOLOGISTS OF CANADA

ALABAMA ASSOCIATION OF OBSTETRICIANS AND GYNECOLOGISTS

AKRON OBSTETRICAL AND GYNECOLOGICAL SOCIETY

KANSAS CITY OBSTETRICAL AND GYNECOLOGICAL SOCIETY

CENTRAL NEW YORK ASSOCIATION OF GYNECOLOGISTS AND OBSTETRICIANS

NEW JERSEY OBSTETRICAL AND GYNECOLOGICAL SOCIETY

PUBLISHED BT THE C. V. MOSBY COMPANY, 3207 WASHINGTON BLVD., ST. LOUIS 3, U. S. A.

TABLE OF CONTENTS ON PAGE 6

'j.

CONTENTS FOR DECEMBER, 1948

Original Communications

The Role of Surgery in the Treatment of Carcinoma of the Cervix.

Charles D. Read. M.D., London, England ^"^^

Newer Concepts of Menstruation. Irwin H. Kaiser, M.D., Baltimore, ^^^^

Leiomyosarcoma'of the Uterus. G. Hamilton Davis M.D., John S.

Howe, M.D., and Willard G. French, M.D., Brooklyn, N. Y. 1048

Endometriosis as a Cause of Ileal Obstruction, Paul E. McGuff, M.D
John M. Waugh. M.D., Malcolm B. Dockerty, M.D., and Lawrence
M. Randall, M.D., Rochester, Mmn. J"^^

Acute Hydramnios. Paul F. Mueller, M.D., New York, N. Y. ---:-- 1069

Cervical Obturation With Inflatable Cannula in Uterotubal Insufflation
and Hysterosalpingography. I. C. Rubm, M.D., F.A.C.S., and
Ernest Myller, M.D., New York, N. Y. 1077

The Diagnosis of Genital Malignancy by Vaginal Smears. John R.
Kernodle, M.D., W. Kenneth Cuyler, Ph.D.. and Walter L.
Thomas, M.D., Durham, N. C. 1083

A Critical Survey of the Questionable Pelvis. H. Hoffman Groskloss,
M.D., F.A.C.S., Owen F. Robbins, M.D., and John T. Moehn,
M.D.,' Minneapolis, Minn. 10^0

Techniques for Isolation, Maintenance, and Mass Culture of Döderlein's

Bacillus. Eleanor L. Gilmore, M.S., Raritan, N. J. 1104

A Comparative Study of the Efficacy of Certain Drugs in Promoting
Evacuation of the Female Bladder Following Gynecologic Opera-
tions. Charles Lintgen, M.D., Philadelphia, Pa. 1112

Simultaneous Intrauterine and Extrauterine Pregnancy. Robert W.

DeVoe, M.D., and Joseph Hyde Pratt, M.D., Rochester, Mmn. 1119

Habitual Abortion. Roscoe L. Wall, Jr., M.D., and Arthur T. Hertig,

M.D., Boston, Mass. 1127

Necropsy Findings in Patients With Carcinoma of the Cervix. Alex-
ander Brunschwig, M.D., and Virginia Pierce, M.D., New York,
N. Y 1134

Cystoscopy and Pyelography Following Paravesical Extraperitoneal

Cesarean Section. Edith K. Mangone, M.D., Jersey City, N. J. 1138

The Bacteriology of Fallopian Tubes Removed at Operation. Marie

L. Koch, M.S., Baltimore, Md. 1142

Pyeloureteral Dilatation of Pregnancy After Death of the Fetus. G.
van Wagenen, Ph.D., and Ralph H. Jenkins, M.D., New Haven,
Conn. 1146

A Statistical Report of 1,771 Cases of Hysterectomy. W. C. Weir,

M.D., Cleveland, Ohio 1151

The Rate of Renewal in Woman of the Water and Sodium of the
Amniotic Fluid as Determined by Tracer Techniques. G. J. Vos-
burgh, M.D., L. B. Flexner, M.D., D. B. Cowie, Ph.D., L. M.
Hellman, M.D., N. K. Proctor, and W. S. Wilde, Ph.D., Balti-
more, Md. 1156

An Investigation Into the Incidence of Abortion in Baltimore.

Christopher Tietze, M.D., Baltimore, Md. 1160

Rh Sensitization in a Primipara Caused by Intramuscular Injection
of Human Serum Resulting in Fatal Erythroblastosis. J. Thorn-
ton Wallace, M.D., F.A.C.S.. Alexander Wiener, M.D., F.A.C.P.,
and Margaret H. Doyle, M.D., Brooklyn, N. Y. 1163

Sulfadiazine Concentration in the Blood and Lochia. Bruce P. Zummo,

M.D., and Louis Rudolph, M.D., Chicago, 111. 1168

A Full-Term Live Tubal Pregnancy. Julian W. Ross, M.D., and

Leroy R. Weekes, M.D., Washington, D. C. 1170

Pregnancy Complicated by Subarachnoid Hemorrhage. M. Garber,

M.D., F.A.C.S., and R. R. Maier, M.D., Cleveland, Ohio 1174

Kidney Function in the Fetus. Samuel T. Thierstein, M.D., Fred D.

Coleman, M.D., and Frank H. Tanner, M.D., Lincoln, Neb. 1178

{Continued on page 8)

Page 6

Am. J. Obst. & Gynec.

CERVICAL OBTURATION WITH INFLATABLE CANNULA IN
UTEROTUBAL INSUFFLATION AND HYSTEROSALPINGOGRAPHY

I. C. Rubin, M.D., F.A.C.S., and Ernest Myller, M.l)., New York, N. V.

CERVICAL obturation is of major importance in the technical procedure "
of uterotubal insufflation and hysterography. Regurgitation of CO2 gas
or oil leads to unreliable estimation of the pressure employed, and not infre-
quently to wrong interpretation as to tubal patency. Obturation is usually
secured by pressing a rubber or metal acorn against the cervical os. This is
easily accomplished in the presence of a round and well-shaped external orifice.
However, if the external os is irregulär in contour as in lacerations and eversions,
excessive pressure must be exerted by the acorn in order to prevent leakage.
of the contrast medium or of CO2 gas as the case may be. To prevent
regurgitation the cervix must be grasped firmly with a tenaculum forceps
exerting counter pressure. In this maneuver, the uterus is either pushed up-
ward or drawn down. To keep the balance by equal push and pull is some-
times difficult. The anatomic change in position may occasionally be sufficient
to simulate closure of the tubes by causing artificial kinks at the uterotubal
junction or by artifically stretching adhesions whieh do not otherwise obstruct
the tubal lumen when the normal position of the uterus is undisturbed. The
cannula devised by Colvin with screw tips of various sizes, later modified by
Hudgins, affords tight obturation but involves a certain amount of trauma
which theoretically may predispose to embolization.

• After many years experience with hysterosalpingography and uterotubal
insufflation the prerequisites of an ideal uterine cannula appear to be the fol-
lowing :

1. Its application should be painless and unaccompanied by trauma.

2. It must provide airtight obturation of the cervical canal.

3. It should maintain the normal anatomieal position of the uterus.

The cannula presented in this paper has been devised with these desiderata
in view It is based on a rather old device, namely, the use of an mflatable
rubber bulb in order to change the diameter of a rigid Instrument. Nitze,
the inventor of the cystoscope, made use of this principle for a ureteral
eatheter. In 1883, a United States patent was granted to Henry E.Finney
for an Instrument based on the same principle for ' ' the treatment of the ma e
Urethra." About twelve years ago, one of us (.J-^-R-) construct^ed a cannula
similar in principle to the one about to be described. Dr. R B. Stout had the
same idea, except that he placed the rubber balloon withm the uterine cavity.
Decker,^ in a recent publication, also recommends insertmg the rubber balloon
surrounding the cannula tip into the uterine cavity. This principle has been
employed by one of us in studying the differential between uterine and tubal
contractions during uterotubal insufflation.^

1077

1078

KUBIN AND MVLLKK

Am. J. Obst. &Gyne(
December, 194K

The present oannula (Fi}?. 1) has develoiwd out of a simple model whieh

we liave used smce 1946 in 17,5 eases tor cervieal obtunition. Tiie eannula ha.

the lensth and dianicter- c.f a.i „.•diiui.y „terine s«un.i. Jt .onsists of two

meta (- liannels, one .,f whieh is very nai-r„w and eiid.s al).)ut 2 em hehind fTe

ip üt the instruinent. Its openinfj is eovered by a thin, elastie rubber tube 2

s«ri,^Tsilk"'' " "* '"*' "' """'^ ""' '" '''' ''''"'' "*■ '^' i-fu'-ent by

tubing distemied. ,b). Extension tip fo? in5."?ron intoTterim' ca^it"? ^""^'''^- <«)• R"bber

a ute'i'jne" oaür^irilit l'f^'l '"'% '"*" "">' "'''''''' ™»'^' -hieb admits

a tenaeulum i^ree>,s Th ^' ", ""' ""''•T'''' *« S™**!' »^e eervix with
tir! V, T P'^^eps 1 In lattei- can l)e reinoved a.s soou as the rul)})er-eovPie<l

ot the iiiternal os, it may be desii-able to iiisert the eani.iiln witt,' ft V; • !t
liten.ie cavity. F«,- sueh p„,|,„se the sh,„t t , rT/ ■ " ^ ■ i " '!' ^
bv a h)n<>-er öiie (T 1 ( Fi,, n p. r ■ V-, ' '• * '^- '' '"'''y ''e repUieed

«„/i 1 " /,'. ' *f- ^'- ' """""aiy dilatation, when desirable xlmnM
not be done jU8t betöre the injeetion of eontrast media «r efore h suffl
•So far it has beeii po.ssil)le in oui- eases tn intr,„ln„„ ti.„ „ ? usufflat on
Stenosis after the latter was passed iV a merine so.S """"''' '" '''''"''^

The cannida is inserted with the revolvino- AW« n ;., ti.
presents the engraved letter li (b,dl, on the dise (l-t / Position hat
indieator. Throufjh hui, A, whieh fits e uer ^^rii.le 1 uU^T^'f ^^^'*^
air are injeeted and thus fl e rubber tube .the en 1 nt^'th * '• °* T"*'"' •""
disteiided (Fi..- 1«) Wi l, ., i/tu • * *"*" "«ti'U'nent beeoiiies

II, 1 r.ffi • ^;i "^^ V , "''*♦'«" exi)enenee one can soon feel whether the

Intüjted^ba"?;::; 'L^;^Ä ;■ :x!ii::T;'za::l;:' ''-■ ^--^ ^

a manometer to hub A. On' turninl t he disL" ba'e^ "A 'e' ^Si^ withtn the
rubber halhu.n will be pron.ptly indieated on the manometer. THs toÜe notl^l

B. 56 Ireef"" "viVo^rN." y.'"''"'" "^ '"'"" "'"' '"-'tributed by United Surgical Supply Co.. MO

Volume 56
Niimber 6

INFLATABLE CANNULA FOR CEHVICAL OBTURATION

1079

that it* less than 1 c.c. of air or water is used to inflatr the halloon, the i)ressiire
readin^-s in the halloon may not he acenrate. Xow the dise is turned to the Posi-
tion marked hy the letter (' (elosed) and the instnmieiit is ready for the pro-
cedure.

Fig. 2.— Inflatable eannula fllled with diodrast obturating the cervical canal. Note that itis
pyriform or acorn in shape as compared to the oval-shaped inflated eannula outside of the Dody.

The dise is now turned to the position X (= x-ray) thus eonneeting huh A
directly with the tip of the instrument inside the eervieal eanal, or to tip T2
in the' uterine eavity. A Luer syrin«e eontaininj? the eontrast medium is
connected to hui) A and the medium is injeeted into the uterus and the x-ray
exposure follows. For fractional injeetion of eontrast medium, the (hse is
turned to position C after the first fraetion is introdueed. Hands and synnge
may now be removed because the expanded bulb retains the eannula in situ.*
By'turninj? the dise hack to i)osition X the second fractional injeetion can be
made, and if need be, a third or fourth.

When the kymooraph is employed it is connected to hub A and the disc is
turned to position X. The insufflätion test can be carried out with a 20 c.c.

^ special clanip adaptable to any vaginal speeuluni has been devised to keep the ean-
nula in the horizontal position.

1080

RUBIN AND MYLLEK

Am. J. Obst. & Gynec.
December, 1948

Luer syringe attached to hub A. The disc is turned to position R (= Rubin
test) which enables us to mea.sure the exertcd pressure by connectmg the man-
ometer to hub B. In the simplified test, 20 c.c. of carbon dioxide injected by
a syringe is sufficient because of the complete closure of the cervix without any
leakage. A sudden fall of manometric pressure is indicative of tubal patency.
If Shoulder pains result they are minimal.*

By inflating the rubber bulb with an aciueous eontrast medium (e.g.
diodrast) one oan easily demonstrate the relation of the bulb to the cervical
canal (Fig. 2). In order to note the distensibility of the intracervical balloon
and any changes that the cervical walls might exert upon it, another cannula
with the balloon filled with an equal amount of diodrast was exposed at the
same time on the same x-ray film. The shape of the balloon inside the cervix
may be compared to the external balloon in Fig. 2. In Fig. 3, water has re-
placed the diodrast and is therefore invisible, while the uterine cavity is
Seen filled with eontrast medium. Incidentally, the cervical balloon reveals a
configuration which does not conform to what one notes in conventional draw-
ings of the cervical canal because of distention by the rubber balloon. The
cervical canal appears, from our study, to yield readily to a greater degree of
dilatation than has hitherto been realized.f

Owing to rigid walls, some cervices were found to resist balloon distention
with 2 to 3 c.c. of water. Nevertheless, good obturation could be obtained with
less Alling. If the rubber part of the instnunent is not inserted deep enough
into the cervical canal the balloon mav bulge through the external os. How-
ever, this does not prevent airtight closure. Should the rubber bulb be pushed
out entirely from the cervix it mav be reinserted and kept in place by grasping
the anterior lip of the cervix with a tenaculum forceps. In several cases the
cervix was found transformed into a shallow cone. Airtight closure could
be obtained in these cases by advancing the expanded rubber bulb into the
cone while the cervix was held in place by a tenaculum forceps.

The present cannula has the advantage over the ordinary cannula with an
acorn tip in that it brings a larger area of the endocervix in contact with
the acorn. Hence, the pressure required to obturate the cervix is less. As
this pressure is not only directed upward, but upon all sides, dislocation of the
cervix does not as a rule result.

The pressure within the rubber balloon automatically predetermines the
maximum pressure which is intended to be used for the insufflation test or
salpingography. If, for example in the bulb is 250 mm. Hg and the pressure
used during insufflation or salpingography is higher, no matter how little this
may be, there is prompt escape of the gas, or oil from the cervix. The same
physical law operates here as in measuring blood pressure. If the blood pressure
exceeds the pressure in the armcufP, the pulse wave immediately returns.
The balloon in the present cannula thus forms a desirable safety valve which
automatically prevents an undue increase of pressure inside the uterus.

This feature of the Instrument is of importance for salpingography.
Usually a eontrast medium is used which has a certain viscosity. Pressure
determinations when lipiodol or other viscous fluid is used are not accurate
because of the considerable friction inside the small lumen of the cannula
where a rapid decrease of pressure takes place with each progressive centimeter
of the lumen. When the constrast medium enters the uterine cavity the

•The senior author does not recommend or employ the use of the syringe for injecting
CO2 into the uterus for testingr tubal patency, preferring insufflation by means of the automatic
Siphon meter with Icymograph. The present cannula is adniirably adapted for this apparatus.

tThis poInt of elasticity of the cervix under various condltions will be the basis of a
future publication.

Volume 56
Number 6

INFLATABLE CANNULA FOR CERVICAL OBTURATION

1081

pressure inevitably falls. If tubal obstruction is encountered there is a gradual
increase of pressure inside the uterus until it equals that which is exerted by
the syringe. Before this point is reached a high pressure may be exerted
through the syringe which is not usually appreciated by the Operator unless
he uses a manometer. The rubber balloon afPords safety because when the
pressure exceeds that within the bulb, the oil escapes at once through the
external cervical os.

Fis 3 — Inflatable cannula filled with water (therefore invisible by x-ray) obturating
tho cerifcal canal The eontrast medium (rayopaque) demonstrates the Sterine cavity. The
rubber baUoorSistendedby diodrast is seen below outside of the body for purpose of comparison.

The Instrument can be sterilized by boiling The rubber biilb jan stand
boiling many times; its cost, however, is so small that it may readily be replaced
for efch test. We'have found it practical to ^^^he bulb before mser mg the
cannula in order to note whether it is watertight however should the
rubber break it is immediately appreciated by the drop ^^^ .f^f^ance^ ,J^^
water escapes through the external os and does no härm. It is particularly to
b^ noted that the Operation of the cannula is exceedingly simple, and after some
little experience, requires a minimum of time.

1082

RUBIN AND MYLLER

Am. J. Obst. & Gynec.
December, 1948

Conclusions

The importaiiee of eervieal ()l)tiiratiüM in tlie proeedure of uterotubal
insuftlation and hysterosalpinjjfo^raphy has heen emphasized. Desiderata of the
ideal uterine eaiinula are :

1. Painless applieation unaeeompanied hy traiima.

2. Airti«>ht elosure of the cervieal eaiial.

3. Maintenanee of the normal anatomieal i)().siti()n of the utenis.

A new eaniiula with inflatable balloon for eervieal ol)tin*ation has been
described.

References

1. Personal coniinunication. Acknovvledgnient is herewith niade to K. H. 8toiit MI) for

his kindness in lettin^ us see hi.s instrunient. » - • v

2. Decker, Alhert: Am. .T. Ohst. & Ctynec. 54: 1077, 1947.

3. Rubin, I. (\: Am. .1. Okst. & (iwv.c. 45: 411), 1948.

NEW .^ YORK

Keralb<ga6^arr(bune

New York QCT 2 4 1953

Dr. Ernest Myller,
Gynecolo^Sl, 60

Dr. Ernest Myller. sixty, a
gynecologist and obstetrician
with Offices at 65 E. 76th St..
died yesterday of a heart attack
at his home, 450 E. 63d St. He
was on the staff of the Post-
Graduate and Madison Hospitals.

In 1933 Dr. Myller. chief gyne-
cologist, and surgeon at the
Marthaheim Hospital in Nürn-
berg, Germany, was driven out
of the country by the Nazis. He
went to Athens where, within a
year, he had passed the Greek
medical examinations, though
he had not known the language
before his flight from Germany.

For seven years he was head
of a private hospital in Athens.
In 1941, when the Nazis invaded
Greece, Dr. Myller was rescued
with his family by the British
Navy. He had been in the United
States for twelve years.

Dr. Myller had designed In-')
struments used in the detection,
of Cancer in the Uterus and ap-
paratus used for the eure of
sterility.

Surviving are his wife. Mrs.
Liselotte Myller, and a son,
Ralph Myller. Another son. Lt.
Ulrich Myller, was killed in
action in Korea.

J\R [OWC Collect Jon wlffi

>^(Lt'<

Ofl

Ann

M im

Ae/Ie.

Her 3

^r Cöl/ec-^h/j

Ernst Müller, M.D.

Ernst Müller was bom of February 26, 1893 in Schmalkalden, Thüringen, Germany.
Schmalkalden, was a small town of approximately 10,00() inhabitants, including a few Jewish
families.

Emst's parents were Joseph and Clara who owned and operated a Pharmacy called Germania
Drogerie, which was located on the main Square of town in a house flanked by the hotel and
the church. The living quarters were above the störe.

After completing high school (Gymnasium), Ernst left to study medicine, and attended the
Universities in München, Kiel, Berlin and Würzburg where he joined a Jewish fratemity called
Veda. Throughout his life he stayed in contact with bis fratemity "brothers". While in Berlin
he decided to specialize in gynecology, obstetrics and surgery and intemed at the clinic of Dr.
Strassman.

In World War I, he served as an army doctor at several military hospitals as well as at the
front, where he was wounded several times and was decorated with the iron cross. After the
war, he settled in Nürnberg where his practice gradually flourished, as did his excellent reputa-
tion . He was 32 years old when he met the 19 year old Liselotte at a party. She was the
daughter of Marta and Stefan Hirschmann, the director of the Bayerische Hypotheken &
Wechsel Bank in Nürnberg.

Liselotte and Ernst were married in 1926 and had two sons, Rolf bom in 1926 and Ulrich four
and a half years later. The were a happy family who lived in a beautiful town house, content
and prosperous, sharing their many interests and hobbies.

Then came the catastrophe: — Hitler!

In 1934 the Müller family escaped to Greece, where Emst had to take and passed the medical
licensing examination in Greek, before establishing a successful practice. The family acquired
Greek citizenship and in the process the name Müller was changed to Myller. In 1941 they
were forced to flee the Nazi invaders, this time ending up in America. In New York, after a
long and hard struggle, Emst built up his third successful career before he died at the age of
60. Ulrich, his younger son was killed in 1953 in the Korean war.

Rolf became an architect, married Lois Westerdahl, a lovely New York girl, and they have
iwwonderful daughters, Elise and Corinne. Liselotte married Ely Jacques Kahan, the New
York architect, 10 years after Emst's death.

For more Information on Emst Müller's life, please read Liselotte's Memoirs, which she wrote
in 1970 under the name of Kahn, her second husband. A copy of her memoirs can be found in
the archives of the Leo Baeck Institute in New York City.

^mm

^mmm>

^cv

r^^ /V.c^

AR /mnri

MB ^ZO

: NEW YORK TIMES, SATURDAY. OCTOBER 24,

DR. ERNEST MYLLER,
GYNECOLOGIST, 60

Staff Aide of 2 Hospitals Here

Who Headed Institutions in

Germany and Greece Dies

Dr. Emest Myller, gynecologist
and obstetrician on the staffs of
the Madison Avenue and Univer-
sity Hospitals, died of a heart at-
tack early yesterday at his home,
450 East Sixty-third Street. His
age was 60.

Dr. Myller had headed hospitals
in his native Germany and in
Greece before Coming to this coun-
try as a refugee from the Nazi»
wtlve year» ago. He wa» ttm
JUMil^ of a jiiwnber of scientific
p2^ners in the field of gyneco^gy,
•nd V^» 4esig?ier q^^ msiinisamt^
uatd m th* ii«iu ot sberiU^y a^
fior tli« d^^eetion ©< eancer of tne
Uterus,

At his death he was secretary
of the Rudolf Virchow Medical
Society and chairman of the Con-
ference of the obstetrical board at
Madison Avenue Hospital. He also
was an assistant attending gyne-
cologist at University Hospital, a
member of the county, State and
national medical societies, and a
diplomat of the American Board
of Obstetrics and Gynecology.

Born in the health resort village
of Schmalkalden at the foot of the
Thuringian Forest in former Prus-
sian Saxony, Dr. Myller was grad-
uated from the medical school at
the University of Berlin in 1918.
By the early Thirties he had be-
come Chief gynecologist and
surgeon and head of a hospital in
Nuremburg.

After the rise of Hitler to power
in 1933, Dr. Myller and his family
were forced to flee to Greece be-
cause they were Jewish. There he
mastered the Greek language,
passed the medical examinations
within a year, and opened a small
private hospital in Athens, which
he headed f or the next seven years.
When the war began Dr. Myller
undertook secret work in Greece
for British intelligence, and in 1941,
when the Germans invaded Greece,
he and his family were evacuated
from the country on a British naval
vessel. Within a year he came to
this country and settled in New
York, where he resumed his medi-
C8Ä practice.

Dr. Myller is survived by his
widow, Liselotte, and a son Ralph.
His younger son, Lieut. Ulrich
Myller, was killed in Korea three
months ago.

E
d
ii
B

V
V

3-
a
c

t
T
r
F
F

r
c
t
1
f
t

i-
s
i
I

f
t

Dr. Ernest Myller

(

)

NA 95098

3K<5.

M-4

E A A H r^j

zj». r~i

OKPATIA

X^+,

. 0-.;\!-.iaN

iKTTü'.TOirT 6ti

MK|<v^_iW ^V V^^tlV

VTliy/.iHtZ " \\i /.TTV, t U . I L . i

• / ll< V

/l43ry

ftlili OK.;» ^ov Cn t'\(4>\ H V i|u. IUMM

(W J f (,

X'U Wio^ Y^*' • '1^^ ^^'^ ^

' ff *f loM'C/r^ tWn'

A .V

jv C/^ütoetut Xj (U' j]

•ü Lv'U A^HQTIp: 'S» T- ■

//-

MiHmMfM«

^ätkm

mmmmmmtmutim

CITY OF NEW YORK

DEPARTMENT OF HEALTH

BUREAU OF RECORDS AND STATISTICS

Borough of

MANHATTAN

New York. N Y.

NOV-5 1953

Below it a photoitatic copy of o certificate on file in the Bureau of Rocordt
and Statiitici of tho Department of Health of the City of New York.

nivi$'o;i if atCORrs
DrpARTrzNr cf h-/. th

ßORruGflCrflAmTfAN
FI LED

y^i CGI ?3 Ai'l 11 ; 5

fllrrttfirat^ nf i^aUy

Certificate No.

1. NAME OF
DECEASED

(Trimt »r Typtvril*)

PERSONAL PARTICULARS

( I It he A"<J >" *y f-Hiural Dirrrtor)

t^^ff?^- "~ ^j'^^

Fir>t Namr

MkMIc Nunc

Las« Nun«

|2 USUAL RESIDENCE: (a) Stau

(b) <•<>.

aiul Zollt ^r^ .Jm[... ,

No.-4<Ä? dr..r. Jb. $ä>. —::£...„

' (H IM rural atta.aivt Imaliom)

MEDICAL CERTIFICATE OF DEATH

( To be fllfJiH by Ihr l'hyiiciam)

1% PLACK Or DEATH:

..Ä..#*<.,"^./f4^

(Hl

^ dt IM rtiral ar,a,af,, „„,

(e) I.msth ot midrnrr or «lajr in rily o(
■Nrw York ininirilialrly (irior lo drath

\i SINOLR. MARRIED, WIDOWED,'
OR UIVORCKD iu>:t, »Hi- u-orä}

U PATK OF
HIKTH OP
UKCKDKNT

(Month)

(Dar)

(Year)

I a. Uiual Occupatio!! (Kind o( work donc durii

lifr, cvcn i( ttuttt/f
b. Kin4 oi Butin««a or In4ualr]r

U LESS thM 1 dar.

kra/iri"

lurinc moil Qf/<Mrki^
lairjr in which ifiit work wai

(a) NKU YORK CITY: (b) Boroufh

or Intlitulion '..."...^....T...r*1^..'.. ~..Z... .. .^T.

(II MW ■■ htMpitml «r iNirtViittoN, fit-* ttVtrt *i^ kümbtt.)

(d) If in hci>|iital, fivc Ward No. ^
(Uonth) (Uay)

U DATE AND
HOUR OP
DEATH

^_ (Year) | (llout)

!• COLOR OB RAC« iTT Appromi».!« A«.

J!^k^

don«

l? SOCIAL SKCURITY NO

BIRTHFLACK

(Statt or Forrign Coufitry)

OP WHAT COUNTRY WAS^
DKCKASKH A CITIZKN
AT TIMK OF OKATII?

loa WAS OKCKASKO FA.
IN UNITKO STATKS
AKMi:n FOHCKS'

kl NAMK OF
FATHKH OP

ni.(. r.ni.N

\i maii>i:n n
OF Mein

OF PICK

17 SEX

-^•^

20 I HERKBY CERTIFY that (I attetuW thc d«r«5v,I)»
i»..tiiT ■■i....;n;.- „t «l;. :^..;....: riii llii ilmi udj'

tr.mi Cf'/ji 19 . to J^«y- ^^ * 19 ^i

-!• w

aiid laM saw h »'«ü alive at U 4M on 0*rfi irlt " \9/i

1 fiirtlwr urtify ttut death iO^^ H O f cauiwl. directly
i>r iiiilirciily by accidt-iit. honiicidr, suicidr. acute or ilirotiic
|H.iv.iimK. «>r in any siispicious or unusual maiincr. aiid that it
was duc to NATURAL CAUSKS n».)re fully dcscribc«! in the
tiMifuIrntial mcthcal rcj«)« fiW »ith tlie l)e)>artnicm uf Health.

* ( >>■(! Q<tt us>tit tktt d» mat »ffly.

t .Sri- ^tst iMStiHiliom vm »rtvr». vf ctrlifcatt.

Witiifss niy haiul thi» '^J <Uy of L^^JT^ "ffV. "%» 19 wT^

li; OF INFI

roNs

IIP V^ DKCFASED AnDREfiS_^ /^ ^^"^ x*Ar 1/ J

rmaiion

jr-^ ' -• y^ ^ l4<Ci,ocatiui#(Citv~To«n or CWin(\ »Bil Sl»I«) Mc^jJatr

fu kl AI Ol RKORDS .AND SrATLSlICS ^ DEPARTMENT OF HEALTII O TY OF NE^ YORK

c^rtlfy tSa» ♦ ••■ ^orcOv

CARL L. tRHAKi)T

/ U\_

WARNING DO NOT ACCfPT THIS TRANSCRIPT UNLbSS
SEAL CF THE DEPARTMENT OF HEalTH IS AFFIXED ThEREON
DUCTION OF THIS TRANSCRIPT IS r "^HiBiTED

REPRO-

NOTICE; In Ijjuing tfii$ t'on^crlpt cf thc Rt^'J
the City of New York doos r^o^ ccrtify to tho tr^«-
OS no Inquiry at to tho foctj ha$ boen p'ovid.d by lo*

■ • ■^t» Todo th. <■, >>

r\ä J.S4M tA^-Wt

riy» i

ORIGINAL

TO BE GIVEN TO
THE PERSON NATURALIZED

.^//^////%/ '^^gggo

No. 6 669 586

'M^

Male

Grreek

////

AfU:

,fy4;^//4/J^M/J'jM!^//y^^^^ /^A/V//iilV /^/ ////'.

ATES OF AMERICA ( po.

S'/f//ffft///r o/V/oMt/

\ '^^j^M^^^^HS

UNITED STATES OF AMERICA v j-j..
EASXERN J}ISTIIICT OFHEW YO.RK \

/Jd^4y£^i/>f/^^^. //m//f//¥ >/5wV^ ..^^Disüict-::-^::::"- ----.- VWs^

-The'United States -"

;!. ^Februar y Ig.igTJT

Brooklyn-- —

ERNEST MXLLER

M^i^JitZ/ri^^d gg-35 Elmhurst Avenue, Elmhurst, New ^Qj;^ .>

y/yyj/yJ^ February /^^^^m^^^^^K^^^^^W/^^

forty seven jm///j^yM^\ Ai//f^n/Jl^/»/^^/^^

/i^y/ 8eventy first

Qefik/

-U. S. District-

Of^uri.

^ppMJi/ Qp;ik.

^¥F-'*Cj3

■)■ \M^*^.^ \M uv> ■ x>%^^is >l\\x^v %Lr\ä g CvT^j

.^^ifiTt'X V.

v' X - « 1 V

.Uin.i.li.ii..i.M;tni..] ..i-i.»iHHrta

Di« chirurgische Therapie des Vorfalles der Genital organe

durch sutfuiidüle Uterusamputation.

Von
Prof • Dr. Konstantin Logotlietopiilos, Direktor der I Frauen-
klinik in Athen.

Die chirur^-ische Therapie des Vorfalls der Geni-
tal organe besteht, wie "bekannt:
1.) in der Wiederherstellung des muskulösen Eeckenhodens

mit der herausnähme des infolge des Vorfalls überflüssi-
gen Teiles der vorderen imd hinteren vaginalen Wand und
2.) in der Wiederaufrichtung des Uterus in Anteflexions-
Stellung*

Das Verfahren ist leicht bei Vorfall

der

Scheide

mit leichter nach hinten und unten Verlagerving des Uterus.
Bei diesen Fällen genügt die vordere und hintere Vaginal-
plastik mit der Aufrichtung des Uterus durch Verkürzung
der ligg. rotiinda nach irgend einer der zahlreichen Metho-
den zur Erreichung eines guten und dauernden Resultates.
Bei dem parziellen oder totalen Vorfall des Uterus aber,
mit oder ohne Verlängerung der Portio verlangt die Therapie
einen erweiterten chiriirgischen Eingriff, der oft das Deben
der Trau gefährdet. Das Prinzip der Operation ist auch bei
diesen Fällen im allgemeinen das gleiche, d.h. Bildung eines
starken muskulösen Beckenbodens und i^ef estigung des Uterus
in Anteflexions Stellung. Da aber die Verkürzung der ligg.
rotunda in diesen Fällen sich als ungenügend erwiesen hat,
wird der Uterus direkt auf die Bauchwand genäht, am besten
nach der ihethode von Kocher. Durch diese Methode wird der
Uterus eher nach oben gezogen als in Anteflexions st eilung
gebracht. Trotz dieser Befestigxing kommt es oft vor, dass er
durch Dehnxing der Verwachsungen wieder nach unten verlagert
wird. Die zwischen Uterus und Bauchwand entstandenen Taschen-
bild\mgen haben oft eine Darmverschlingung zur Folge. Eine
gute iiixethode, die ich auch früher oft angewandt habe, ist
die VaginifiJtation nach Schauta-^ertheim. Durch diese
Operation in Kombination mit der vorderen und hinteren
vaginalen Plastik und die Bildung eines starken Perineums
durch die Levatorennaht wird nicht nur eine feste muskulöse
Basis gebildet, sondern auch der Uterus in Aneflexionsstell\ing
befestigt, gleichzeitig wird die Blase nach oben verlagert
und ruht nunmehr aizf der hinteren Uteruswand. Zur Vermei-
dung von Rezidiven empfiehlt Wertheim die Verkürzung der
ligg» sacrouterina durch Naht. Diese Operation gestaltet
die Prognose noch schwerer. Wertheim selbst hat von 252 auf
diese Weise operierten Fällen 16 verloren. Statt dieser
Originalmethode ist die Modifikation nach Kielland vorzuzieh-
en. Durch diese Operation wird der zwischen Corpus und Cervix

mmmm

tss.

-2-

uteri vorhandene V/inkel aiifgehoten und die Gervix wird
dadurch auf die hintere Vaginalaxe verlagert. Die Vagini-
fixation nach Schauta-Wertheim mit oder ohne die Modifizier-
rung nach Elielland habe ich in der letzten Zeit wegen der
relativ grossen Mortalität und wegen der nicht seltenen Re-
zidiven verlassen. Ebenso wende ich aus dem gleichen Grunde
nicht mehr die vaginale Total extirpation an, die ebenso gute
statische Resultate iibt, aber doch einen grösseren Eingriff \
darstellt, sondern begnüge mich mit der Abtragung des gan- ^
zen unteren Teiles des Uterus im Zusammenhang mit der Bildung q
einer engeren Vagina und eines starken -t^erineums. Die Ope-
ration ist leicht auszuführen und hat mir bis jetzt die
besten Resultate gegeben» Sie ist im Prinzip der hohen
Portioamputation ähnlich, mit dem Unterschied, dass der Ute-
rus viel weiter oben bis zum Fundus abgetragen wird, wofür
ich den i^ahmen subfundale Uterusamputation vorschlage.

Die Operation wird auf folgende Weise ausgeführt:
die Portio wird mit Kugelzangen gefasst und stark nach ab-
wärts gezogen. Nun wird die Scheidewand in ihrer ganzen Dicke
mit einer kräftigen gebogenen Schere ¥2 cm. oberhalb des
Überganges der Scheide in die Portioschleimhaut zirkulär
umschnitten und teils stumpf, teils mit der Schere etwas
nach oben prepariert. Die Blasenwand wird jetzt nach oben
zu abgespannt und mit kleinen Schnitten die nun deutlich
sichtbar werdenden vesicocervikalcn Bindeglied stränge ge-
trennt und dadiirch die Blase von ihren festeren Verbindungen
mit der ^ervix losgelöst. Die Blase wird nun mit dem Pinger
nach oben geschoben. Nachdem auch die seitlichen Blasen-
partien nach oben und nach der ^eite geschoben werden sind,
legen wir das vordere Vaginal Spekulum unter die Blase und
bringen sie und die Ureteren auf diese Heise ausserhalb
des Operationsgebietes. Das nun deutlich sichtbare Perito-
neum wird mit einer Pinzette gefasst und mit einem Scheren-
schlag geöffnet \ind die Öffnung nach beiden Seiten erwei-
tert. Das so geöffnete Peritoneum zieht sich von selbst
oder mit Nachhilfe des Pingers durch das Abwärtsziehen des
Uterus zurück und wird mit einigen Nähten auf die vordere
Uteruswand 2 t/2 - 3 cm. unterhalb der Fundus ob er fläche be-
festigt. Die Scheide wird dann auf beiden Seiten hochgescho—
ben, nachdem die Utering efässe mit Klemmen gefasst und unter-
bunden worden sinf . Die Portio wird stark nach vorne ge-
zogen, das Douglasperitoneum geöffnet, nach oben geschoben
und auf die untere Uteruswand und in der gleichen Höhe
mit dem Blasenperitoneum mit einigen Nähten befestigt.
Der nun freiliegende Uterus wird direkt unterhalb der
Peritonealnähte mit dem ^esser oder mit der Schere abge-
tragen. Die Uteruswunde «vird nach der Methode von Sturm-
dorf mit der Vaginalwandung bedeckt. Bei kleinen atrophischen

._ "Tr iirifc'' -^T-^"""-"-^"-" •— ^'

-3--

ynd>ntiiAA-

uteri verzichte ich auf die Öffnung des Peritoneiims, das-
selbe wird möglichst hoch geholieliezi und der Uterus direkt
unterhalb der Ins ertionsst eile des Peritoneums abgetragen.
Anschliessend wird die vordere und hintere Vaginal plastik
und die Bildung eines festen Beckenbodens vorgenommen.

Auf diese Weise habe ich selbst im ganzen 71
Fälle operiert, ZOio davon waren äusserst herxint er gekommen
als Folge der schlechten Ernährungsverhältnisse, die seit
^ Jahren in G-riechenland herrschen. Ein Beweis, dass die
mangelhafte Konstitution in der Äetiologie des Prolapsus
eine grosse Rolle spielt.

Eine eingehende Beschreibung aller einschlägigen
Krankengeschichten an dieser Stelle wäre wohl zu weit-
gehend, sie wird übrigens von meinem Assistenten Dr.
Galanopoulos an anderem Ort veröffentlicht werden. Hier
möchte ich nur noch kixrz über die Resultate berichten.

Von den 71 Fällen hatten 27 einen partiellen und
44 einen totalen Uterusprolaps.

Der Uterus war in Mittelstellxmg bei 44 Fällen,
in Retroflexio bei 36 iind in anteflektierten Stellung
bei 11. Bei 64 Fällen wurde allgemeine Aethernarkose an-
gewandt, bei 7 Evipan-Na. und bei einem Lokalanästhesie.
Die Dauer der Operation war im Mittel 29 Minuten. Die
Länge der Uterushöhle schwauikte zwischen 4 und 15 cm#

Von diesen Fällen sind zwei, gerade die letzten,
gestorben. Der eine an septischer Urämie und der andere an
Embolie.

Nachiint ersucht wurden: 2 Fälle nach 3 Monaten, 4
Fälle nach einem Jahr (weitere 5 Fälle nur durch briefli-
che Anfrage). Ein zweites Mal kamen hiervon 20 Fälle nach
18 Monaten zur Nachuntersuchung.

Was die subjektiven Beschwerden betrifft, klagte
von den mindestens 6 Monate danach untersuchten Fällen
keine mehr über Zug oder Druck nach unten, 6 klagten über
Kreuzschmerzen, 3 über Schmerzen beim Goitus, 5 hatten
psychische Erscheinungen, alle Patientinnen waren voll
arbeitsfähig.

Die Menstruation war normal bei 23, 8 hatten
Amenorhoe wegen Unterernährung, 9 Oligomenorhoe mid 24
AI t ersamenorho e .

Die objektive Untersuchung ergab bei 5 leichte

-4-

Inversion der vorderen Vaginalwand ohne subjektive Be-
schwerden» Alle anderen ohne "besonderen Befund.

Die zweite Untersuchung "bei 20 Kranken 10 Mo-
nate nach der Operation ergab folgendes: keine Patientin
klagte über irgendwelche Beschwerden. 2 klagten über Kreuz-
schmerzen, 1 über Beschwerden in der Miktion. Alle waren
arbeitsfähig. Bei keiner trat Gravidität ein.

Die objektive Untersuchung ergab bei einer eine
leichte Inversion der vorderen Vaginalwand, sonst bei allen
keinen besonderen Befund.

l±e aus dem Vorhergehenden sich ergibt, sind die
Resultate dieser Operation so günstige (ich habe bis jetzt
keine Rezidive beobachtet »nd ausser den beiden angeführten,
nicht auf die Art der Operation zurückzuführenden Fällen,
kein weiterer Todesfall); dass dieser Eingriff momentan in
meiner Klinik bei grossen Utcrusprolapsen die Operation
der Waiil darstellt. ]

Der Vorteil der Operation ist, dass die Ausführung
leicht ist, die Cxefahr äusserst gering, da man mit der ^
Peritonealhöhle gar nicht in Berührung kommt, und bei
jxingen Frauen bleibt die i'eriode erhalten.

'-^^

Therapie der atonischen Blutxing nach der ^eburt der

i;lS25Gi&ji

von

Prof. Dr» Konstantin Logothetopulos, Vorstand der I.
Universitätsfrauenklinik in Athen»

Eine der "bis jetzt noch nicht ganz gelösten Fra-
gen in der Geburtshilfe ist die Bekämpfung der atonischen
Blutung nach der Geburt der Plazenta* Trotz allen bis jetzt
bekannten Mitteln geht Immer noch eine Anzahl von jungen,
blühenden Frauen zu Grtinde. Nur derjenige der solche Eälle
niite^^lebt hat, ist im Stande, die Tragik eines solchen Todes
zu beurteilen. Mit Recht sagt Labhardt '•er habe das "^efühl,
man könnte sich in einen Todesfall durch Eklampsie oder
Plazenta praevia viel eher fügen als in einen durch Atonic
veranlasst en#"

Alle die bis jetzt angegebenen Blutstillungsmittel
Bind \insicher und die direkt durch Druck oder Zug auf die
Blutgefässe wirkenden Methoden schliessen grosse Gefahren in
sich» Es wäre zu weitgehend, wenn ich alle diese Methoden
und die Wirkung demselben kritisiere, es steht ausführlich
in allen Lehrbüchern der Geburtshilfe»

Man rechnet jetzt auf eine Sterblichkeit an ato-
nischer Blutung nach der Geburt von 0,05/^* Grosse Blutver-
luste aber schädigen den Gesamtorganismus und schränken sei-
ne Abwehrkräfte gegen Infektion ein» Wenn man also auch die
Fälle mit dazurechnet, die infolge des Blutverlustes an
Infektion sterben, wird die Mottalitätsziff er sicher grösser
sein»

Seit ich meine Blutstillungsmethode ft^ Notfälle
bei gynäkologischen Operationen angewandt habe/ dachte ich
diese Methode auch in der Geburtshilfe bei atopischen
Blutungen anzuwenden» Trotzdem aber so viele Jahre vergangen
sind, ist mir keine Gelegenheit geboten worden, bis ich vor
zwei Jahren in meiner Klinik eine Patientin vorfand, die
fortwährend blutete, trotzdem bei ihr Blutstillungsmittal
und eine starke Uterus tamponade angewandt worden waren»
Ich habe sofort aus dem Uterus die Gaze entfernt und meinen
Tampon eingeführt» Die Blutung sisticrte sofort» Seit
diesem Fall wurde in meiner Klinik die Methode noch sechs-
mal angewandt mit promptem Erfolg.

Sie wird auf folgende Weise ausgeführt: Die Pa-

~2-

^am

ctUl

^(tC^3

^aUA

ti entin wird auf ^ucrbett gelagert, die äusseren Genitalien
werden gesäubert, die Scheide desinfiziert und die Blase
durch den Katheter entleert • Nach Einlegung de» vorderen
und hinteren Vaginal Spekulums werden die Muttermundlippen
mit Kugelzangen hoch gefasst und die Portio fest nach unten
gezogen. Dann werden die Vaginal Spekula in den Uterus ein-
geführt, so dass der Muttermund weit offen gehalten wird#
Darauf nimmt man ein quadratisches Gazestück, dessen Mitte
mit einer Icngen anatomischen Pinzette oder mit einem
Stopfer in den Uterus eingeführt wird» Nachdem die heraus-
hängenÄto Zipfel der Gaze von dem Assistenten auseinander-
gehalten werden, wird ein langer Gazestreifen in den
Uterus eingeführte und gleichmässig nach allen Richtungen
verteilt, so dass ein Kindskopf j^rosses kugelförmiges Gebilde
darin entsteht« Die vier Zipfel der äusseren qLuadratischen
Gaze, sowie das heraushängende Ende des Streifens, welches
zu unterscheiden etwas länger sein muss als die vier Zipfel,
werden mit der rechten Hand gefasst und fest nach unten
gezogen, bis der kugelige Tampon in das kleine Becken ein-
tritt und auf die Uteringefässe einen Druck ausüben kann.f-
Man zieht dann die 5 heraushängenden Zipfel durch ein grosses
Ringpessar, das man mit der linken /iand fest z^Z^"^ d©^
unteren Teil der Symphyse, die absteigende Schambeiiiäste
und den Beckenboden anpresst, viährend die rechte Hand mit
aller Kraft an den Zipfeln zieht^ Zur Vermeidung von Nekrosen,
die durch zu starken Druck auf die Vulva entstehen könnten,
lege ich zwischen Pessar und Vulva auf beide Seiten des
Tamponstieles einen kleinen Wattebausch. Nun leg* ein
Assistent eine starke Klemme vor dem Pessar, dass das sich
nun zwischen Vulva und dieser Klemme befindet-f Die Blutung
nach Einlegen des Tampons hört mit aller Sicherheit sofort
auf, wie aus den Fällen über die ich gleich berichten werde
zu ersehen ist» Bei allen Fällen wurde der TamJJon nach 5
Stunden entfernt, um die Gefahr der Infektion infolge langen
Liegens der Gaze im Uterus zu v ermüden» Man ksuin ev» die-
selbe noch früher herausnehmen, wenn der Uterus sich in-
zwischen gut kontrahiert hat» Ausser der prompten Wirkung des
Tampons infolge des ausgeübten Druckes auf die Uteringe-
fässe, besitzt er auch die Vorteile der gewöhnlichen Tampona-
de, d»h» er ruft einen starken ^ontraiktionsreiz auf den Uterus
hervor und beim Entfernen der Gaze werden Eihautf etzen und
Blutkoagula mit entfernt» Die Nachteile der gewöhnlichen
Tamponade fallen hier zum grossen Teil weg:

1» Die Durchführung dauert nicht lange, da nicht die
ganze Uterushöhle mit Gaze gefüllt wird» Selbstverständlich
muss der ^ampon sterilisiert in einer Büchse immer bereit
stehen»

2» Schädigungsmöglichkeit kommt nicht vor, da der Zipfel
der ^uadratgaze nicht bis zum Fundus Uteri eingeführt zu
werden braucht»

3» Die Infektionsgefahr ist äusserst gering, da nur die

-3-

erste Gaze Direkt mit den Uteruswari düngen in Berührung
koioiat*

4.
weg#

Die Schnierzhaftigkeit bei entfernung der Gaze fällt hier

Die nach Einführung des Tampons bemerkbare Zu-
sammen Ziehung des Uterus ist nicht nur auf den ausgeübten
Reiz, sondern auch auf die durch die Absperrung bedingte
Anaemi e des Organs wie es auch bei der Drosselung der Blu-
zufuhr durch die Aortenkompression der Fall ist* Vielleicht
auch durch den ausgeübten Druck auf dma Ganglion von
Fr ankenhäus er •

Was die Indikationsstellung betrifft, bin ich
der -Ansicht, dass man mit der Anv/endung des Tampons nicht
lange v/artet. Man kann ja im voraus nicht wissen, bis zu
welchem Grade die Patientin eine Elutimg vertragen kann»
Wenn man sich über die Intaktheit der Plazenta überzeugt
hat und die Blutung nach kräftiger Massage des Uterus und
Einspritzung von Blutstillungsmitteln fortdauert, bereitet
man die Patientin zur Einlegung äes Tampons vor» Inzwischen
kann man eine heissc vaginale oder Uterus spühlung vorneiimen.
Bleibt der Erfolg aus, wendet iftan gleich den Tampon an,
indem man auf alle anderen bekannten Blutstillungsiüethoden
verzichtet»

Die »"irkung ist so prompt xind sicher, dass ich
es nunmehr als einen Kunsti^ehler betrachte, wenn eine
Patientin an atonisoher Blutung nach der Geburt stirbt»

Die in meiner Klinik beobachteten Fälle sind
folgende:

Fall 1) Protokoll Nr. 557A941. Frau K.K., 27jährige Ipara*
Letzte Menses am 10»5*194-0» Aufnaiime in unserer
Klinik 12 »2 »1941, 6h» Gebxirtshilflicher Befund:
Fundus uteri 2 1/2 Finger breit unterhalb des Pros,
xiph. I Schädellase, Schädel im Beckeneingang beweg-
lich» Herztöne (-}• Beckendurchmesser: 23, 25, 29,
18» Vaginal: Muttermand handteil ergross von Plazenta^ev
gewebe überdeckt, ziemlich starke Blutung. Allge-
meiner Zustand schlecht. Puls 130, Temperatur 36,8.
Mit Rücksicht auf das Fehlen der kindlichen Herztöne
und des allgemeinen Zustandes der Graviden entschliess*
man sich zur Uterusentleerung per vias naturalis»
7h» Nach vorheriger Durchbohrung der Plazenta wurde
der vordere Fuss gefasst und gewendet. 7h»15» Sponta-
Entwicklung des Kindes» Die Plazenta wurde unmittelbar
nach der Entwicklung der Frucht manual gelöst» Die
Blutung dauert fort trotz der Verabreichung der

t4-

Fall 2)

Fall 3)

gewöJfinlichen ELutstillungsinittel. Auch die Uterus-
Bcheidentamponade nach Bumm brachte Äicht den
gewünschten Erfolg. Deshalb wurde sie entfernt und
statt ihrer mein Tampon eingeführt, worauf die BIut
tÄng prompt aufhörte und der ^terus sich stark kon-
trahierte* Obwohl der Erfolg der Blutstillung durch
den Tampon in diesem Fall auffallend war, ist die Pati-
entin 1/2 Stunde später wegen vorangegangenem grossen
Blutverlustes ad exitum gekommen.

Erotok. Nr. 608/1941. Frau K.D., 30jährige Ipara.
Letzte Menses am 27#4.1940. 22h. 15.2*194l, Wehen-
beginn. 9h. 10, 16.2.1941, Aufnahme in unserer Klinik.
Geburtshilflicher Befund bei der Aufnahme: Fundus
uteri 3 Finger breit unterhalb des Proc. xiph., I
Schädellage, Schädel im Becken eingetreten, Herztöne
( + ). 4h. 16.2.1941 Blaseilsprung. 9h. 30 Spontangeburt
einer männlichen 3200 g. schweren und 50 cm. langen
Frucht aus H.H.H. 9h. 45 'Spontane Placentaausstossung.
Unmittelbar nach der PlacentaaBsstossung trat eine
ziemlich starke Blutung auf, die auf die gewöhnlichen
Blutstillungsmittel (Pituinal, Gynergen, Uterusmassage)
nicht aufhört. Puls 130. 12h. Anhalten der Blutung.
Puls 150. Allgemeiner Zustand schlecht. Mit lücksicht
darauf entscliliesst man sich zu meiner Uterustamponade.
Prompte Blutstillung. 17h. Entfernung des Tampons.
Keine Nachblutxmg. Uterus stark kontrahiert. 26,2.1941
Nach normalem V/ochenbettverlauf wurde die Wöchnerin
gesund entlassen.

Protok. Nr. 624/1941. Frau Z.A., 233ährig, II Gravi-
dität, I Partus. Letzte Menses am 5#5»1940. 16.2.1941,
20k. Wehenbeginn. 17#2#194l, 5h. 10, Axifnahme in unse-
rer Klinik. Geburtshilflicher Befund: Fundus uteri
4 Finger breit unterhalb des Proc. xiph. I Schädellage,
Schädel im Becken eingetreten, Herztöne (+). Normale
Beckenverhältnisse. , 5h30' Blasensprung. 6h. 5 'Mutter-
mund verstrichen, Blase gesprungen, Schädel eingetre-
ten, Pfeilnaht/ schräg, kleine Fontanelle links vorne.
Herztöne verlangsamt, 80 in der Minute. Mit Rücksicht
darauf entschliesst man sich zur sofortigen Geburts-
beendi^ung. 6h. lO' Anlegen der Zange und Extraktion
einer 2200 g. schweren und 49 cm. langen weiblichen
lebenden Frucht. 6h. 25' Spontane Placentaausstossung.
Unmittelbar nachher trat eine starke Blutung auf, die
durch die gewöhnlichen Blutstillungsmittel nicht zu
beeinflussen ist. Puls 140, allgemeiner Zustand
schlecht. 7h. Tamponeinführung, worauf die Blutxing
prompt steht und der Uterus sich stark kontrahiert.'
12h. Tamponentfernung. Kefine Nachblutung. Puls 110,
allgemeiner Zustand gut. 26.2.1941, Entlassung nach

-5-

Fall 4)

Fall 5)

normalem '<Yochenbettverlauf •

Protok* Nr. 832/1941. Frau E.L., 20jährige Ipara*
Letzte Menses am 45*5 »1940. 2*3.1941, 19h. Wehen-
beginn. 3.3.1941, 19h. Aufnahme in unserer Klinik.
Geburtshilflicher Befund: Fundus uteri 2 Finger
breit unterhalb des Proc. xiph., I Schödellage, Schä-
del mit mittlerem Segment ins Becken ragend. Herz-
töne ^•). 2.3.1941, 20h. Blasensprung. 3.3.1941,
21h. 5, Muttermund verstrichen. Blase gesprungen,
Schädel in Beckenmitte, Pfeilnaht q.uer, kleine Fon-
tanelle links. Beckendurchmesser: 23,26,30,17.
Temperatur 39 • Puls 95 • Mit Rücksicht auf das Fehlen
der kindlichen Plerztöne und der Temperatur Steigerung
entschliesst man sich zur Baseothripsie. 21h. 30'
Anlegen des Braxin' sehen Kranioklastes womit eine
männliche 2600 g. schwere tote Frucht entwickelt
wurde. 21h. 40' Spontane Placentaausstossiing. Unmit- *
telbar nachher trat eine massig starke Blutung auf
die die gewöhnlichen Blutstillungsmittel keine #ir-
kiing haben. Puls 130, allgeiaeiner Zustand nicht gut.
22h. Tamponeinführung. Aufhören der Blutung, Uterus
stark kontrahiert. 24h. Keine Blutung, allgemeiner
Zustand wesentlich gebessert, Puls 110.2h., 4.3.1941
Tamponentfernung. Keine Nachblutung. Uterus stark
kontrahiert. 10.3.1941 Entlassung nach normalem
V/ochenbettverlauf .

Protok. Nr. 1364/1941. Frau E.A., 30nährige Ipara.
Letzte Menses nicht erinnerlich. 10.4.191, 22h. 30'
Wehenbeginn. 11,4.41, 11h. Aufnahme in unserer Klinik.
Geburtshilflicher Befund: Grav, Mens. IX, Fundus
uteri 3 Finger breit imt erhalb des Proc. xiph. I
Schädellage, Schädel im Becken fast eingetreten.
Herztöne 1+), frühBBitigBr Blasensprung. I4h.15
Muttermund verstrichen. Blase gesprungen. Schädel
eingetreten, Pfeilnaht schräg, kleine Fontanelle
links vorne. Herztöne stark beschleunigt. Mit Rück-
sicht darauf entschliesst man sich zur ^eburtsbefen-
digung. 14h. 25' Anlegen der Zange. Entwicklung einer
männlichen 3300 g. schweren und 50 cm. langen leben-
den "^rucht. 14h. 30' Spontane Placentaausstossung.
Unmittelbar nachher trat eine massig starke Blutung

auf, auf die die gewöhnlichen Blutstillungsmittel
keine vVirkung haben. Puls 130. Ohnmachtsanfälle.
15h. Tamponeinführung. Aufhören der Blutung, Uterus
stark kontrahiert. Puls 100. Allgemeiner Zustand
wesentlich gebessert. 17.4.41, Entlassung nach Fie-
berfreiem Wochenbettverlauf.

-6-

Fall 6)

Fall 7)

Protok* Nr* 1780/1943. Frau P.T*, 22jährige Ipara.
Letzte Menses am 18.11»1942» Die «VöcJuierin wurde zu
Hause entbunden (Forceps), sie suchte aber unsere
Klinik auf wegen der bestehenden Blutung die unmittel-
bar nach der Placentaausstossung auftrat. Puls 120»
Temperatur 37 8 • Allgemeiner Zustand relativ gut.
Die vorgenommene Uterus aus tastung ergab dass der Ute-^
rus leer war. Die Revision des Oenitalschlauahes wies
einen doppelseitigen Muttermund und Scheidenrids auf,
die durch einige Catgutnähte versorgt wurden. Trotz-
dem hielt die Blutung noch an. Puls 150, Ohnmächte-
anfalle. Da die gewöhnlichen Blutstillungsmittel die
bestehende Blutung nicht beeinflussen konnten, ent-^ohlo
schloss man sich zur Tampon einfiihrung. Sofort nack
der Tamponeinführung hörte die Blutung auf. Der Uterus
kontrahierte sich gut und der allgemeine Zustand dBr
Patientin besserte sich ziinehmend. Fünf Stunden später
wurde der Tampon entfernt, und 10 Tage nach der
Tamponeinführung verliess die Wöchnerin gesund unsere
Klinik.

Protok. Hr. 1664/1943. Frau A.P», 24 jahrige Ifara.
Letzte Menses am 11.11.1943. 21.8»1943, 5h. 30
V/ehenbeginn. 9h. 30' Aufnahme in unserer Klinik.
Geburtshilflicher Befund: Fundus Uteri 2 Finger
breit unterhalb des Proc. xiph.* I Schädellage^ Schä-
del fast eingetreten, Herztöne (+)• 15h. Blasensprung.
I6h. Spontangeburt einer lebenden, weiblichen 3250 g.
schweren und 50 cm. langen Frucht aus H.H.H. I6hl5'
Spontane Placentaausstossung. Unmittelbar nachher
trat eine ziemlich starke Blutung auf, auf die die
gewöhnlichen Blutstillungsmittel keine .Virkung hatten.
Puls 160, Ohnmachtsanfälle. 17h. Tamponeinführung,
worauf die Blutung prompt stand und der Uterus sich
stark kontrahierte. 22h. Tamponentfernung. Keine Nach—
blutxing. Uterus stark kontrahiert. Puls 120, allge-
meiner Zustand bedeutend gebessert. 2»9»43, Entlassung
nach fieberfreiem V/och enb et tverlaxif.

Nachdiesen glänzenden Resultaten kann ich jetzt mit
Freuden hier das gleiche sagen, was ich für die Blutstillung
bei gynäkologischen Operationen gesagt habe, dass nämlich
mein Tampon bei richtiger Anwendung auch bei schwer zu stil-
lenden atonischen lutungen nach der Geburt der Placenta eine
sichere und nie versagende Hilfe bietet.

XJiAAry^

5'D-

-^ . GW> 4'j -

AAAtH^k,

iqo-

\n -

i')'i%

oe-vo^

5S\.'\

M-W(lvW^

l^i

■yo

Q^l . 1^

_ JAaaA^ \ L

(id. ^

(0 '
lS-0

STD

J u

Mr^

Ji\^ (Aly^ 1/^V^

l 15"

lt. licOc-QW vWU, ■J>0\^

\ *

1 1

To^^OuM.

>lMg

A>C»^<

-60

1^;^-

M^- 10. X.aA'w«*^-

Zl.S\)

ZG8.5P

-O-

— H—

— r—

'MÜB

Vä

<\\h is

10"

I-

* 15!

Jl i

^UL'v^'. U- 2.. Uvk. /f -

^voj^o ^ L&wAa

lÜ

_ J l

_ -^ ^ -a«^

JH^fc*^? J

IJt, ll^jUt- \U*U»v CAi«.iv,

XGS so

I2H + 2S.".-« '- ^ LV^.SD l^^^-.ll

OJUcUWc^ &s.u.x;nL V^f^.rO

4 ' «

4^ 1-

315 -

i^w^

$^L.li

1 — r

m- H. ^

i-i-.s:^

^ il?-

1 — r

•-\r

m^t.sx

.^AÄA^vO^a • tWi M C<im4iLA |feS -

."i'U.MA^xtv

Ul^

n^q^H(\. ^^Vvi C\auam. ) A>

j 11

/^M-^

\lßA/VV

-eAi/t\ 2)"*

^.Hxt^l, 41

-4- ^,

i=V

, ^a.^^.HPi H«>^-

l\,-ICAA,|l)U/o_J.

Vau

liL^

1 11

l -.

1 — t

1 ir

■^.1^)H^ "1% n>u^jju^ D.S.

k Mftc\^<-H:%

.iO

li')S«>

1 h

1 N-

J L

l^b^O

rfcvi-u

Üi^'Y^ ^ . - -

rw^j ji^ro 11 c«u,X^ ilH

35-
5t)

^^^

ifeS-

n.t^

Jj_üt4JtV3. I^y»^

— /

Ü.

-■UoJ- "^ t^^__CAW^U, U^Aa^uA ^

Ifll^l

K 15-

K ^

■^ h

Oi.

31^.^

iti>v.iS',so »1» UmJUc-

VAAAi^A-tci, A'»**^^^^

GiO.^

i 1-

• *^-. .*^.

J u.

( 16

[\ßyW-

11 c'u«<JIa. »**<t

6 ^^oouv ^UUCIOU/Ö

^ — \

-UajL'vw )

'S -

ä;i.w-

rö3.^^

■ f

1 — i-

(

vtvv

• 1

12* c(u**U.«« ^ Vr

zri-

i vmx alJU ä ,st 4»

-i

^. l\-

A 1.

"~n —

n^.^i^

^i.vHi^ /tev'liUv.

\^ 9M|'

^J^/<^A V

(\/>^i

J,t '^^^^i^^ (CAM'Jtß^ ) Ojjs^/^

V('

■hZ

\ — \

A^ CßAA/Ot.

l^iS

ly^i/rV Müu.'occiys J. '/;fe^h j;^ i-5^2. -

CUvJ^ i J

'VVA/J>>.

Vc^^-'^'

M-

■i h

rnr

^64^(44^

a^^^^,..,^^^^

«Vz^ S*^rt<f. <»y''^ ^y

c3^^^;,i>* ^^?^ Oi^^

/•

^ct

^' ■ .,*^ /<^^^^ ^''*^

l^i^(^^^

i^U/U^

• ^

/^ -/

€^ ^

^ «Ä-r

--H^^

^^^ ^ ^^--^rÄ W4^-M^

-UhU^ ^'^'-^^ i.^'«<^*^

4^.

ü^U/"*^^

/}ß^i/C(^

^^^/f^ ^^^

.<'<^

...^/l^ ^-^t4^if-^ ^

^f ^

^Ä^ -/^ (/^"^^ '^^ e(.^p^9f^^

/.^^ ^^^f^^-^-^^

H^<yU ^'^^^

i/d^^^^.

UNITED STATES PATENT OFFICE.

ETHELBEKT KEAVLEY, OK K08THKRN, SASKATCHEWAN, CANADA.

CURETTE.

No. 839,641.

Speciflcation of Letters Patent. Patented Dec. 25, 1906.

Application filed December 21, 1905. Serial No. 292,747.

•

2'o (ül ii'fionh it iHdif roricern:

Be it known that I, Eni elbkrt Keavley, a
su})jort of tlie Kin^ of Groat Britain, and a
residcMit of Kosthern, in tho Provinoe of Sas-
5 katchewan and Dominion of Canada, have in-
vented a new and lin])roved Curette, of
whicli tlie followin^ is a lull, clear, and exact
dcscription.

The invention rehites to uterine curettes,

10 ])iit niay he likewise adapted for ciiretting in
siir<!;ical work.

Tlie piirpose of the invention is to so coii-
struct the nistruinent that it will he of niod-
erately soft or seinipliahle inaterial, i)refer-

15 ahly riihher, and so that one sliank and lian-
dle can he conveniently and accuratel}' litted
to dilferent sizes of the instruinent, and, fur-
ther, to provide an instruinent that inay he
safely inserted without iniury to tJie neck of

20 the woinh and whicli will act to effectively
reinove placenta or other fetal matter and
suhstances without laceiatin*^ ui iiillaiiiiii<i^
intra-iiterine tissue and without dan<i^er of
])ro(lucinf^ new lesions and which will be in

25 all respects inuch su])erior to metal instrii-
inents now^ used for the purpose or the liiigei-
of the Operator.

The invention consists in the novel con-
struction and combination of the several

30 parts, as will he hereinafter fully set forth,
and pointed out in the claims.

Keference is to behad to the accompanying
drawings, forming a part of this speciiication,
in which similar characters of reference indi-

35 cate corresponding parts in all the iigures.

Figure 1 is a perspective view of the instru-
inent complete. Fig. 2 is a horizontal scc-
tion through the instrument, the shank of
the handle and the hlade appearing in side

40 elevation. Fig. 3 is a view similar to that
shown in Fig. 2, showing a slight change in
the concavity thereof ; and Fig. 4 is a perspec-
tive view of the blade-section of the snanK.
The instruinent A is provided with a re-

45 movable shank B, having an attached or in-
tegral handle B', which is usually Hat, as illus-
trated, and at the outer end of said shank a
collar 10 is formed, and a hlade 11 extends
outw^ard froin the shank adjacent to said col-

50 lar, forniing a Shoulder 12 at what may be
ternied the ''front" face of the hlade, as is
shown in Figs. 2 and 3, and, as is illustrated
in Fig. 4, the longitudinal edges of the blade
taper inward in direction of the shank, ren-

5 5 dering said blade widest at its outer end.

The instruinent A is inade of moderately-
soft rubber or an equivtilent seiiiiplastic ina-
terial and is somewhat sj)oon-shaped in gen-
eral conto ur, The instrument is of greatest
breadth and depth at its outer end and of 6c
least such dimensions at its inner end, which
is circuilar in cross-section. The back 13 of
the instrument is convexed, and the outer
end 14 is rounded off, while the front face 15
is concaved, the convex and the concave sur- 65
face meeting at an acute angle, as clearly
shown in Fig. 3, and it may be liere remarked
that the longitudinal tapei* of the entire in-
strument is quite gradual.

A concavity 16 is produced in the front 70
face 15 of the instrument, which concavity is
Segment al in the cross-section of the instru-
ment and gradually diminishes in depth in
direction of its innt^r end, thereby forming
side marginal lips 17, continuous with an 75
outer end marginal lip IT*", the said lips
forming the scraping edge of tlu curette. 1
desire it to be understood that the instru-
ment A mav be ihade in dilferent sizes, and
the concavity 16 may be made deeper or 80
shallower than shown, and shorter or longer,
as demanded by the Service required of
thein.

All sizes of the instrument are provided
with a longitudinal slot 18, which extends 85
outward from a circular opening 19 in its in-
ner end. The slot 18 terminates sliort of the
outer end of the instrument and is practically
on a liiie dravvn about centrally and longitudi-
nally through the instruinent, as is shown in 90
Figs. 2 and 3. The slot 18 receives the blade
11 and the circular opening 19 the onter end
of the shank B and its collar 10. The blade
11 does not extend to the outer (^nd of the
body of the instrument, in order that the 95
flexibility of the instruinent shall not be in-
terfered with at such point, and the blade
11 is oÜ'set to the rear in order that it will not
be too close to the inner end portion of the
concavity 16 and yet permit the shank to sus- 100
tain a central position relative to the instru-
ment.

The rul)ber instrument is far superior to
steel, as the moderately-soft rubber will not
lacerate the inflamed intra-uterine tissue and 105
thus produce a new lesion through w liich tlie
geims would still fürt her invade said tissues.
It is superior to the iinger because longer, and
by its use all parts of the uterine cavity are
easily accessible. Again, when using the uo

830,641

finj^er it is necessary to dopress the inllaiiied
Uterus a^ainst the iiii<;er, and such pressure
call be eniployed only wheii usm«^ an anes-
thetic, if niuch tenderness be ])resent. The
pressure apphed to the uterus throu^^h the
abdominal treatnient aggravates the pain
and produces a further extension uf tlie in-
llainiuation. Furtherniore, all risk of per-
forating the softened uterine tissue is very
greatly reduced, if not absolutely abolished.

Having thus described niy invention, I
claini as iiew and desire to secure l)y Letters
Patent —

1. A curette coniprising a rigid shank pro-
15 vided with a llattened and wiclened end, and
with an annular Hange at the junction of the
shank and ihe ilaliened poriiori, and a body
portion of flexible niaterial having a slot for
receiving the flattened end, and an annular
groove for receiving the Hange, said body
portion being provided with a concavity hav-
ing a scraping edge for the j)urpose set forth.

2. A curette coniprising a rigid shank, and
a flexible body portion, said body portion
having in the siüe thereof a concavity pro- 25
vided with a scra])ing edge for the pur])ose
set forth.

3. A curette coniprising a rigid shank, and
a flexible body portion or blade provided in
one of its faces with a concavity, the sur- 30
faces of the concavity and the body portion
nieeting at an acute angle to form an edge
for the purpose set forth.

4. A curette coniprising a rigid shank, and

a blade having a flexible edge for the purpose 35
set forth.

In testimony whereof 1 have signed my
name to this speciiication in the presence of
twu suusci'ibiiig wiiiicööco.

ETllELBEKT iiEAVLEY.

Witnesses:

Susan Ckaig,
G. A. McHuGH.

DEUTSCHESjRElCH

AUSGEGEBEN
AM 3. NOVEMBER 1933

REICHSPATE^TAMT

PATENTSCHRIFT

--JVr 362^97 -

KLASSE 30 a 4'^UPPE 11

APR 14 1923
^' Patent Q^'

Dr. Paul Klaac in Wien.

Gegen Perforationen sichernde Cürette.
Patentiert im Deutsclien Reicfce vom 27. April 1921 ab.

Für diese Anmeldung ist ^emaa dem Inionsvertrinc vom :. Juni lyii die Priorität auf (Jrund
der Anmeldung in Österreich von^ i8. Januar 1921 beansprucht.

^ Die bisher in der Fniucnheilkunde verwen-
deten Instrumente zur Entfernung von
Kesten, die bei vorzeitigen oder normal ver-
^laufenden Geburten in der Gebärmutter zu-
5 rückbleiben, sowie zu anderen therapeutischen

Zwecken, wie etwa Auskratzungen der Ciebär-
(mittersclilcinihaut wegen Entzündungen usw.,
laben in bezug auf ihre Verwendung verschie-^
Icne Nachteile.
So besteht stets die Gefahr, daß bei der Be-^ 10

7
i

/
I

I' *

^■^

i?'i?^''"i^'^sTB"w;"- •

3e2W7

»5

nutzung der bekannten Cüretten bei EinfuhT
rung in die Gebärmutter, selbst wenn dies
unter Führung der Finger geschieht, die Wan^
düng der Gebärmutter durchstoßen wird; denn
die Wandung des Organs hat infolge der vcr^
schiedenen abnormalen Veränderungen keinen
großen Widerstand. Demzufolge kann man
mit den derzeit gebräuchlichen Cüretten
tiefer eindringen, was die Perforation der
\^andung und damit gefährliche Folgen und
selbst den Tod der Patientin zur Folge haben
kann.

Es muß deshalb vor Einführung der
Cürette mit Hilfe eines Meßinstrumentes
(graduierte Sonde) die Tiefe der Gebärmutter
festgestellt werden. Trotzdem ist aber für
den Operateur, kein Mittel gegeben, ein zu
tiefes Eindringen mit der Cürette beim nach-
folgenden Arbeiten hintanzuhalten, weil er
t)ei der Auskratzung oder Abschabung wieder-
holt sehr verschieden große Widerstände zu
überwinden hat und daher das Gefühl für ein
2U tiefes Eindringen bzw. Durchstoßen zu-
folge der Weichheit der Wandung naturgemäß
verliert.

Das den Gegenstand der vorliegenden Er-
ng bildende Instrument beseitigt die ge-
Nachteile und schließt jede Gefahr
Benutzung dadurch aus, daß eine
irgendeiner der bekannten Aus-
mit einer gleichzeitig das Ein-
^ enzendcn Stellvorrichtung in
gebracht ist, wobei der Abstand
dem arbeitenden Kopfstück der
ürtd dem an den Scheidenteil der Ge-
:er anstoßenden Teil der Stellvorrich-
der jeweils durch die Sonde fest-
Eindringungstiefe jederzeit vorher
werden kann.
Zeichnung veranschaulicht in Abb. i
firette, in Abb. 2 die an dem Cüretten-
angebrachte Stellvorrichtung. Die Abb. 3
4 stellen das gebrauchsfertige eingestellte
Instrument in zwei zueinander rechtwinkligen
Ansichten dar, wobei in Abb. 4 ein Hohl-
körper gezeigt ist, in welchen das Instrument
auf eine begrenzte Tiefe eingefiäirt erscheint.
Die Cürette a hat die gebräuchliche Form
und einen stumpfen oder scharfen Kopf teil;
sie ist zwecks Einsetzens in ihren Griff b mit
einem Vierkant a versehen und wird durdl,
eine Schraube c in der Hülse des Griffes fest-
grfialten. Die mit der Cürette in Verbindung
zu bringer*de Stellvorrichtung besteht aus
einem Rohr d zur Aufnahme des Cüretten-

stieles, der als Führung für die an ihm
schieblwre Stellvorrichtung dient, ru w<
Zweck das Rohr d eine nach hinten re
Schlitzführung f besitzt, die an einem
kel ^ an der Griffhülse sich führt und njittel^
einer Stellschraube h am Griff h festgi '
werden kann.

Das vordere Ende dea Rohres d tri
|)lattenförmiges Querstück i, welches,
Abb. 4 zu ersehen, infolge seiner Brei
dehnung am Eintritt in den verengten ,
artigen Scheidenteil der Gebärmutter."
hindert ist, wogegen das Kopf stuck
Teil des Stieles der Cürette, der at
Rohr d der Stellvorriditung vorst«
gehindert durch den Scheidenteil hfinc
die Gebärnnitterhöhlung eingeführt
kann.

Nachdem mittels der Sonde die T«
Körperhöhlung, in welcher die Auskrj
vorgenommen werden soll, bestimmt w^
ist, wird die Cürette in dem Rohr dcf
Vorrichtung auf die an der Sondensl
mittelte Länge eingestellt und die St<
richtung am Cürettengriff mittds
Schraube h festgestellt Nunmehr ii
Abstand zwischen dem Cürettenkopf«
der Querplatte » gleich der zulässigen
dringungstiefe des Instrumentes g(
und dieser Abstand bleibt nach der diti
Querplatte begrenzten Einführung
der ganzen Dauer der Arbeit unvi
aufrechterhalten, so daß ein sicheres
des Operateurs gewährleistet ersehe'*»*
der Widerstand, den die Querplatte _..
Scheidenteil der Gebärmutter findet, e'
bedeutender ist, so erscheint dadurcÜ
tiefes Eindringen der Cürette aiit

Da das Instrimient leicht zerle^)ar U
die sorgfältige Reinigimg ebenso leidÄ
rasche Austausch der Cüretten vorg<
werden.

Patent- An SPRUCH

Gegen Perforationen sichei
gekennzeichnet durch eine
tung, die aus einem an dem
stiel verschiebbaren und am Gri
rette feststellbaren Rohr bestellt, lin-
dem Cürettenkopf zugekehrten ^'
Querstück angebracht ist, welche* ...
führung der auf die Tiefendisti
behandelnden Körperhöhle aus
Vorrichtung vorragenden Cürette^

M*.j.

Ahh

./'■

Hiereu 1 Blatt Zeichnungen.

1 1' ■ ■ilTiilnlJia.iMii^ifiimiiilHollMiTii

iiiilMrif iM

K£:puBLiQte Fii\NgArsB.

MINISTKÜi: DU commerce: et de L'INDUSTRIE.
ÜiRKCTIOiN DE LA PROPtlETE INDUSTRIELLE.

■»♦<r-f

BREVE T DmIvENTION.

Gr. 19. —ia. 1.

r 734.439

Curette pour räclages ut^rins.

M. Adam Maksymiuan PAPKE n'sidanlcii Poloyne.

Demand6 le 17 mars 1932, ä 14*» 34" ä Paris.
Dt'livn'; le i'^aoiit i()39. — Pi^bli^ le 9i oclobre tgSa.

I^|)«'nian<le de brevel d^pos^een Polognc le i6 j^in 1981. — D<^lai*alion du deposanl.)

Oll siil ([n'''!! iii«'<1fH-i!i(» cliinirirical«' on
(>t fmuH'iiiiiH'iit <>l.li<i('. ."1 hl >-uit(' «riiii no-
cuiicluMiHMit. <!(' f:iii'(' UM ciirj'ttüjic «Ic \'n\v-
i'U- iMMir ('II ('liiiiiiicr Ics «IrUris nliiccntjiiros,
\ ccttc »''liiiiiiiMtioii rtaiit i»i:iti(iu<''C'( le plus
Hiuvciit cji j(;irtic M l;i iiuiiii et cn partic a
J'aidc «l*u|^«' ciin^ttc a iikiik-Iu' raide. ccllcM-i
«'taut iii«li.>iK'iisal>l<' tfUHcs Ics fois i\\w los
<i(']ii-is |»la<'('iitair('s adlirrcut cucorc fortc-

,Q iiiciil aux pariiis de Tutorus.

l/<'iiijd(ii de la curette a iiiau(die raidc
• ti'diiiaiie a riiKMtnveiiiciit dtuTasidinicr
:\>M'y. suiiveiit iles lesioiis des pands de Tute-
ni> fataleiiieut raniollies au i'ours de Tac-

l5 <''U(du'iueiit.

l.a pre-scnte inveiiti(ui a pour ohjet nnc
'U rotte (d)viant a (-«'t incoiivenient (»t ro-
1! anpialde eii ce (pi'cdle peilt otro entiero-
iiH'ut ronfeniioe <laiis lu uiaiii du uiedeoin

20 <'ii du (diinir<jieii au niouieiit uu <dle est
introdiiite daus Tutorus do rao^^-oiioliee.

Cettc iiouvelie curette constitue im inatru-
nieiit moiiis daiif::ereux que le?^ curette.s 0111-
p]oye<^s jus(pi'a prescait et periuet <1e siip-

2 0 prijiier les diverse?^ (Operations iiiaimelk^
buivie.s d'uu curettag<' iiistruin(»ntaire neees-
.sitees auterieureiiient et de reduire le ra-
ola^<' di*s |»an)is iiteriiios a uiio nperatu'ii
iiuuuiolle uni(jue .saus les Ulessor.

|l)ans le de^t^in aniiexe : 3o

Fig. 1 est une vuo de cote de la iiouvelle
(11 rotte;

V\iX. 2 on <»st la vue de face.

;i/instruinent se comiMwe (l'une curette
j ropreniont dite 3 jx)ur raclage uterina, Z%
f.xoe sur iin manche recourbe court 4 con-
stitue par un metal ou une matiere assez
flaxible j)our etre cint-ree et adaptee a la
inain de l'operateur. Ce manche 4 est ter-
inine par un renflc»ment arnmdi 5 destine ä &o
vebir b*aj)puyer contre le centre du creux
nesa main {wnir assurer la fixite de l'instru-
ment au cours du curettage.

te manche 4 eöt relie par un petit pont
2 a un anneau 1 destine ä s'enfiler sur le 45
doigt median de Toperateur. Une fois Tan-
nejiu 1 maintenu de cette fa^on, le renfle-
miit 5 correspond au centre du creux de la
miiiii tandis que les bouts de« doigts sont
po^es en dehors du bord superieur de la 5o
curette 3.

iLa technique du curettage effectue ä
Taide de cet instrument perraet de decoUer
le^iresidus placentaires qui adherent forte-
mffit aux parois de l'uterus et qu'on ne 55
jx^rrait decoller ä la main. Corame lee
]'(.Äts des doigts se trouvent au-dessus de

•iutree coustituant la curette pro-

Prix du fascicuTe J 5 francs.

0 c

.1 D

[734.439] —

prement dite, IIb controleut tactilement Hi
tin d^bris placentaire quelconque adhere
aux papoiß de rut^nw.

En outre, le curettage op^re ä Taide de

o cet inatrument donne k Top^rateur une phw
grande aüret^, en ce sens qu'en oontrolant
par le boot de ses doigts le mouveniPiit dp
la curette, il evite de bleaser les parois ra-
mollies de Tutenw, tout eii alliant 1«» avaii-

o lages du curettage manuel et du curetta^e
inatnunentaira

Curette pour raclages uterinF, remarqua-

ble en ee quVll«. sc vuni\>c,M' ,l'u,.(. curpttc
proprenicnt dite prolonpeant in, mam-ho re- iS
ccuirbe tennine a hui pxtn'init«' lihro par un
renflomeiit arrondi, cc manche otjint avan-
tageuaement flexible p^mr sc rourber et
arwez c-oiirt [Knir Hro lo«r,' (•(.rupl^tcniont
dans la niain cn iiM'mc tfinps (juf la curette 20
au manche ('taut {»rpfprablciiMMit rclip par
un petit pont im aiinpau .s'nitiJant siir un
doigt de r«q>erateur.

ADiM Maksymiuan PAPEK.

Par pr«rv*Uoa i

Mavltadlt.

NJUMMilaHiliiiil

fiiäimmlimmämmämäämäiiiii^^

lÄTpiKOI ZYAACrO^

*i i&EllTION TMTÖTHTQI^

Ai'IIf')v 'AdiO,

llbä

1""

AE 625 1 5

}

'Apiö,npa)T. ^J/^

BE3AI22IS

C^ 9

0 ' laTp 0 x6(; 2l5/\> oyoc *Aör|Vü)v ßeßatoT,ftTi o* laTpöc;

^ I

__Ta api,0M.öv 2047^

'Ev'Aafjvatc T^T^ SS'QxTüjßpCou 1937

d^N'

Abb, 15 - BlutstillungstnethodTe nach Logothetopoulos bei atonischer
Blutung nach der Geburt der Plazenta.

Sonderabdruck aus dem Zentralblatt für Gynäkologie 1933 Nr. 14

Aus dem Anatomischen Institut in Athen
Direktor: Prof. Dr. G. Sklawunos

Anatomische Ergebnisse der Blutstillungsmethode

nach Logothetopulos'

Von Dr. Ch. Christopulos,

Assistenzarzt an der Gynäkologischen Universitätsklinik in Athen

Als vor 2 Jahren der Professor der Anatomie in Athen, G. Sklawunos, bei
einer Operation die Blutstillungsmethode nach Logothetopulos anwenden sah,
fand er es zweckmäßig, diese Methode einem Studium zu unterwerfen und sie auch
an Leichen anzuwenden. Darauf wurde ein Assistenzarzt der Gynäkologischen
Klinik, Dr. Ch. Christ opu los, beauftragt, diese Untersuchungen im Anatomischen
Institut unter Aufsicht von Prof. Dr. G. Sklawunos auszuführen.

Diese anatomischen Untersuchungen bezwecken einerseits die Feststellung
der Art der Wirkung des Zugtampons, andererseits die Bestimmung der Lage und
des Verhältnisses desselben zu den Organen des Beckens. Die Untersuchungen
wurden bei fünf einbalsamierten Leichen ausgeführt. Es wurden 3mal vaginale
und 2mal abdominale Totalexstirpationen vorgenommen. Es muß hier betont
werden, daß sowohl die abdominale, wie auch die vaginale Anwendung der Tam-
ponade und der Zug der Gazezipfel bei allen Fällen genau so ausgeführt wurde
wie bei Lebenden.

Bei allen Fällen wurde die Einspritzung von Farbstoff in die Carotis den
2. — 3. Tag nach Anwendung des Tampons vorgenommen. Die Eröffnung der
Leichen wurde am 8.— 12. Tag gemacht; die Beckenhöhle wurde freigelegt durch
einen Längsschnitt in der Mitte und zwei anderen senkrecht auf dem ersteren
verlaufend.

I.Fall. Abdominale Totalexstirpation des Uterus mit Hinterlassung der
Adnexe. Die A. uterinae werden nicht unterbunden. Die Eröffnung des Leibes
erfolgte den 8. Tag nach der mit der Operation verbundenen Tamponade. Nach
Freilegung der Beckenhöhle sehen wir das Netz auf den Därmen liegen und die-
selben wieder auf dem obersten Teil des Tampons. Nach Verschiebung der Darm-
schlingen nach aufwärts sehen wir, daß der oberste Teil des Tampons 4 cm nach
vorn oberhalb der Symphyse reicht, hinten in der Höhe des III. Sakralwirbels
und seitlich in der Höhe der Linea innominata und im Verhältnis zu den Iliacal-
gefäßen 3 cm unterhalb der Teilung der Iliaca comunis.

Der Douglas'sche Raum ist trotz des starken Zuges der Gazestreifen hinten
frei, so daß man leicht mit dem Finger bis zum Beckenbogen kommen kann. Das
Sigmoideum sowie das Rektum sind in ihrem ganzen Lauf vollkommen frei.

Der größte Druck wird außer auf die seitlichen Beckenwände hauptsächlich
auf das Trigonum urogenitale ausgeübt. Der rechte Eileiterstumpf wird gedrückt,
der linke liegt höher und ist infolgedessen frei. Wir nehmen den Tampon heraus
und sehen, daß die Höhle, in welcher der Tampon lag, umgeben wird von der
Blase, dem Mastdarm und dem Trigonum urogenitale, welches nach vorn und
unten leicht verschoben ist.

» Vortrag, gehalten von Prof. Dr. K. Logothetopulos in der Gynäkologischen Gesell-
schaft in Wien am 20. XII. 1932.

807

»>■#■

Zentralblatt für Gynäkologie 1933 Nr. 14

Wir tasten die Höhle aus und finden, daß sie als feste Unterlage die innere
Fläche des Os ischii hat. Darauf schreiten wir zur anatomischen Präparierung
der Gefäße des kleinen Beckens. Zu diesem Zweck spalten wir das Becken in der
Schamfuge. Nach der Freilegung der Gefäße der linken Beckenhälfte sehen wir,
daß alle Äste der Arteria hypogastrica von Farbstoff gefüllt sind. Wir verfolgen
speziell die Arteria uterina, welche bei der Operation nicht unterbunden wurde.
Dieselbe ist oberhalb der Schnittstelle in einer Länge von 2 cm frei von Farbstoff.
Daraus schließen wir, daß gerade auf diese Stelle der Tampon einen großen Druck
ausübt. Aus den Kapillargefäßen merkt man keinen Austritt von Farbstoff.

2. Fall. Vor der Operation und Anwendung der Tamponade und 6 Tage nach
der Einbalsamierung der Leiche wurden die Gefäße mit einer Lösung von Sproz.
Natrium citricum durchgespült, um dieselben von eventuell vorhandenen Throm-
ben zu befreien. Die Operation bestand in der vaginalen Totalexstirpation des
Uterus mit Hinterlassung der Adnexe. Bei der Anlegung des Tampons wurden die
Stümpfe der Eileiter etwas heruntergezogen, die Klemmen sind jedoch entfernt
worden, ohne die Gefäße zu unterbinden, die Arteriae uterinae sind durchschnitten
worden, ohne überhaupt angefaßt zu werden.

Die Eröffnung der Leiche wurde am 8. Tage vorgenommen, nach der Ein-
spritzung des Farbstoffes durch Herausschneiden der ganzen vorderen Bauch-
wand. Das Netz und die Därme liegen auf dem Tampon, genau wie in dem 1. Fall.
Ein Stück von dem Dünndarm liegt hinter dem Tampon tief im Douglas'schen
Raum. Nach Herausziehen der Därme sieht man den Tampon, der eine ovale
Form hat und dessen Oberfläche etwas unregelmäßig ist. Die Harnblase ist leer
und liegt auf dem Tampon. Rechts hat das parietale Blatt des Peritoneums wegen
des Zuges des Adnexstumpfes nach unten eine Falte gebildet, welche ungefähr
im V. Lendenwirbel anfängt. Links sieht man nur die Falte des Lig. latum. Beider-
seits sitzen die abdominalen Teile der Eileiter auf den Seitenflächen des Tampons.
Der Stumpf aber des Eileiters liegt unter dem Druck des Tampons.

Wir wollen feststellen, inwiefern die Tamponade drückend auf die Ureteren
wirkt, zu dem Zweck legen wir den linken Ureter vollkommen frei und eröffnen
ihn etwas über seiner Kreuzungsstelle mit den Iliacalgefäßen. An der Eröffnungs-
stelle spritzen wir unter schwachem Druck mit einer Spritze etwas Wasser ein.
Das Wasser tritt ungehindert in die Blase ein. Bei der Füllung der Blase wird die
Dehnung derselben nach oben nicht gehindert, nur ein leichter Druck der gefüllten
Blase wird im unteren Teil derselben bemerkt, und zwar nur, wenn die in die Blase
eingelaufene Flüssigkeit 300 g überschreitet.

Wir vergrößern den Zug der Gazezipfel, die vor der Scheide liegen, auf das
höchste und führen auf die gleiche Weise Flüssigkeit in den rechten Ureter ein. Trotz
des großen Zuges wird bei dem Durchlaufen der Flüssigkeit durch den Ureter kein
Hindernis bemerkbar. Nach Einlaufen von 200 g Flüssigkeit in die Blase drücken
wir auf dieselbe, worauf die Flüssigkeit sich durch die Harnröhre entleert. Daraus
schließen wir, daß trotz des starken Zuges kein Druck auf den ganzen Verlauf
der Urethra ausgeübt wird. Der Tampon wird entfernt, wir präparieren die Gefäße
des Beckens und finden, daß die A. uterinae 3 cm lang oberhalb des Schnittes
keinen Farbstoff enthält.

3. Fall. Vaginale Totalexstirpation des Uterus ohne die Adnexe. Es wurde
kein Gefäß unterbunden. Folgende Tamponade. In diesem Fall wollten wir den
Druck feststellen, unter welchem der Farbstoff aus der Spritze in die Carotis ein-
drang. Zu diesem Zweck vereinigten wir den einen Teil der T-förmigen Röhre

808

'4«n

'«1

Christopulos, Anatomische Ergebnisse der Blutstillungsmethode

mit der Carotis, den anderen Teil mit der Spritze, die Farbstoff enthielt, und den
dritten Teil mit einem Quecksilbermanometer. Dieser Teil wird mit einer Klemme
geschlossen gehalten. Sobald wir anfangen den Farbstoff einzuspritzen, nehmen
wir die Druckklemme weg und lassen den Farbstoff mit dem Manometer in Be-
rührung kommen. Der Druck steigt dauernd, und erst nachdem er 750 mm über-
schritten hat, zeigt sich der Farbstoff in den Beckengefäßen. Am 8. Tag nach der
Einspritzung des Farbstoffes wird die Leiche geöffnet. Nach dem Herausziehen
der Därme sehen wir die leere Blase auf dem Tampon liegen, genau wie bei den
vorher beschriebenen Fällen.

Der Tampon wird herausgenommen und man sieht auf seinen seitlichen
Flächen die Abdrücke, die die gedrückten Adnexen hinterlassen haben.

Die Stümpfe der Eileiter befinden sich auf den seitlichen Wänden des kleinen
Beckens. Wegen des nach unten gedrängten Beckenbogens ist der Scheidenstumpf
nach unten zusammengefaltet, ein Zeichen des ausgeübten Druckes des Tampon-
halses. Nach dem Durchspalten des Beckens werden die Gefäße präpariert und
wir bemerken, daß trotz des verhältnismäßig kleinen Druckes, unter welchem der
Farbstoff eingespritzt wurde, alle Äste der Hypogastrica gefüllt sind.

Wir verfolgen die Aa. uterinae und präparieren sie sorgfältig. 3 cm von der
Schnittstelle befindet sich wegen des auf diese Stelle ausgeübten Druckes kein
Farbstoff. Ebenfalls befindet sich kein Farbstoff in den Kapillargefäßen der Um-
gebung. Auf die Harnröhre, Blase und den Mastdarm ist kein Druck aus-
geübt worden.

4. Fall. Vaginale Totalexstirpation des Uterus. Kein Gefäß ist unterbunden.
Tamponade. — Bei der Eröffnung der Leiche durch Mittel- und Querschnitt be-
finden sich die Grenzen des Tampons etwas höher als bei den bis jetzt beschriebenen
Fällen. Die Harnblase ist leicht nach rechts verschoben. Der herausgenommene
Tampon hat wie gewöhnlich eine ovale Form. Der Grenzunterschied derselben
ist auf den gefüllten Mastdarm zurückzuführen. Das Becken wird gespalten und
wir bemerken, daß trotz des gefüllten Mastdarms wenig Druck auf ihn ausgeübt wird.

Beide Eileiterstümpfe sind auf die seitlichen Beckenwände gedrückt. Wir
präparieren die linke Beckenhälfte. Wir sehen, daß die A. uterina in der Länge
von 2 cm vom Schnitt aus ohne Farbstoff ist.

5. Fall. Abdominale Totalexstirpation des Uterus ohne die Adnexe. Unter-
bunden sind nur die Adnexstümpfe. Die Grenzen des Tampons sind genau wie
bei den anderen beschriebenen Fällen. Die unterbundenen Stümpfe liegen hoch
und werden nicht von dem Tampon gepreßt. Blase und Mastdarm sowie Sigmoideum
sind frei. Der Scheidenstumpf ist wegen des auf ihn ausgeübten Druckes zusammen-
gefaltet. Die Präparierung der Gefäße zeigt, daß alle Farbstoff enthalten, außer
an der gedrückten Stelle der Aa. uterinae.

Aus den beschriebenen anatomischen Untersuchungen ergibt sich, daß die
Blutstillung durch die Tamponade nach Logothetopulos vollkommen sicher ist,
und wie sich auch klinisch nachweisen läßt, wird auf kein anderes Organ ein
irgendwie schädlicher Druck ausgeübt.

Die Nekrosen der Gewebe sind leicht zu vermeiden durch das Abnehmen
der vor dem Pessar liegenden Klemme, 8 Stunden nach der Operation, wodurch
der Druck aufhört.

Damit auch kein Druck auf die Blase ausgeübt wird, führt man während
der 2 ersten Tage einen Dauerkatheter ein, damit die Blase dauernd leer ist.

809

AI nipOOAOI THS XKIPOYPriKHi:

AOrO-TAMIION KAI ANAIMAKTOXl KAIilAPIKH TOMH

Mia vta mc6o5o(; tniaxiataq, tuv aipoppayiüv Rata Td<; iyxcipr\ati^
'Yno ToO K, K. AOrOOETOnOYAOY, t. KoöiiynTOÖ toG navtiriaTTiMiou

El<; 5uok6X.ouc;, I5lqc KoXTtiKÖtq £yxEipViO£i(;,
6uvaTöv vd öX.io6f|Of) fj dmoXlvcjoK; dryyElou
Tivöt; Kai v<k Crnoxcapfjop toüto npöq töv au-
VEKTiKÖv loTöv, Y] bwatöv TÖ aii.*oppooOv dty
YEiov vdt \ii\ Elvai Ttpooixöv npöq oüA,A.t)4;iv,
fj äXXoTE ävcKa Tou EüöpO-mou xdv Iotöjv vä
ÖuoxEpaivtovioi al dcnoXivcJofiq Kai <b<; Ik
ToüTou vä \ii] EUloxETai f| al^oppayiCK

£[<; ToiaOxac; ■ntpi-TTTwotn;, äXXoTE, iJcmo'
6cToüvTo XofiiÖEq Eiq xö al^dtooov (i^poq, oi'i-
TiVEq TiapE^EVov ^Til 48 üpoiq, [li] oüoriq Ka-
TopOoTriq Tijq aliiooTaoiac; öi' äXXou xpöiiou.
El«; &KKaq nöXiv "nEpmTclKJEic;, \ii] oüotic; bv-
vaXTJq Tiic; aluooTaoiaq 5iä 1011061 Tf)OE(o<; Xa-
C16g>v, f|vaYKa^6^E6a vdt iipoa(püyo}\itv Etq
Tfjv XaiiapoTO|ifiv Tipö<; dva^fj-rnaiv lou al-
VioppooüvToq ÄyyFlou Kai dcnoXtvuaiv xoO-

TOU.

Etq Td«; TtEpiTTtöoEiq TaüTaq ^()Kxpliö^o^EV
drttö TToXXüiv dTcJv lölav n^9oöov, Tf|v ö-riolav
6 KaSiiyiiTfic; ti^q ruvaiKoXoyiaq ^.v Halle
Nürenberger «inEKöcXEOE A ö y o • t a n-
n 6 V .

'Eitl tou otiueIou toütou ö Eric Weber-
el^ TÖ ßiSXlov TOU (1). Ivd itEpiypdjiiEi Tfjv
aliiooTaTiKT|v neu Taütriv ii^Oo&ov ^etttohe-
pci<;, yp&<pu Tdt t{,f\q: «npoocjniKuic;, A^' ö-

TOU yVtdpi^OllEV TfjV TEXVlKf]V TaÜTTlV, oüöäito-

TE nX^ov Eoxontv Tt|v dtvdyKTiv vdt ^yuaTa/vEi-
v|)a)|iEV aluooTaTiKfiv Xa4i5a Kaxä Tfjv ^yx^l-
pifoiv, £ti bt TrrpioaöTcpov vdt npoSünEV £(<;
XaTtapoTonfiv TTpac; drv'ai;nTTioiv alpoppooCvroc;
dtyyflou»

'EnioTiq ö iv Biiwr\ KaBriyiiTfiq pQ^I Wer
per »1^'^« ToO Julius Sederl (2) irtpiypäccpov.
TEc; Eiq TÖ VEOJOti ^köoGev ßiSXiov twv tiq 6
ocXISok; het' eikövojv Tfjv ^e8o&öv hou, ypdt-
^ouv tni TOU ocCiToO aimslou Tdt ti,r\c: «"OXwv
TÜV BuOKOXlÖV TOUTCJV dcTtTiXXdtyriuEv ofjjAEpov
5idt TTiq ^Ev<*^o<t)uoG<; ix£665ou toO "EXXrjvoq
FuvaiKoXöyou K tjvoxavTlvou AoyoeEToiioOXou.
'H |iE6o5oq aüTTi ^löcq ämTp^nEi TxdvTOTE koi
eI<; öXa«; Täq ■hepitttcöoek; vdt oTa^aTr|0£onEV
EVTöq ÖXlycjv Xetctcüv Ti]q cjpaq ndcoav aijiop-
paytocv dcoit>aX.Cüq. Aäov iräq x^ipo^^PVÖ«;, ö-
oTiq G^Xei ^v itdori f)p£(il<jc vä ^kteXeoq koi
&(JOKoXov ETI tyxElpTloiv, vä yvcjpi^T) tf\v yit-
O060V TaüTtiv».

'H ii^6o5oq dKTEXEiTai xaTd töv dnöXou-
6ov Tpöitov: nXTjpoG|iEV KaXcjq odKKOv ek te-
Tpoycjvou Y<5t^^<; 5iä ^anpäq XüjpiBoq yd^riq
oüTwq, tJoTE va oxnM<*'^iö9B a<|><xipiKÖ(; öyKoq

viaq TOU TETpaycjvou yd^n«;, cbq kai tö H£«
Ta^u ToüTtjv dKpov Ttic; Xupiboq yä^rjq, ö-
TiEp Tipö«; öidKpioiv bto\ vä Etvai KaTd Ti

^aKpÖTEpOV TCJV TfOOdpCJV äKpuv, OUXA^a^'

6dvo(icv öyioü 5iä ^idq dyKiaTpoipdpou (iilXriq
"^o^ Ammoi»' ^^ ö6nyoönEV, ^Exd Tfiv di|Kxi-
psoiv TTjq nf)Tpaq. dnö Tirjq KOiXiaKT]«; koiXö-
TT^TOc; biä (lEOOu Toü KöXitou npöq Td ^^CJ yEV-
vriTiKd öpyava. "O ß0T]6öq ouXXaixftdvEi toö-
Ta Kai ^Xkei lox^pw«; ixpäq Td KdTcj (x^xP*^*^
oO Tö o<jK3tipiKÖv Tannöv eIoeXGh Elq Tf]V t-
Xdooova txüeXov Kai &uvT]6g vd doKrjoQ ni£-
oiv im Ttöv dyyfiwv. Tö toioutov ^TxiTuyxä-
vtTai Kai 61' Eioayuyiiq 6id tou koXeoO \k<x-
Kpdq KupTrj«; al^ooTaTiKnc; XaSiboq, i^Tiq d^a
dtva<t>avfj eIq t^v ntpiTovaiKfiv KOiXöTiiTa 61-
cvoiyETai Kai ouXXajiidVEi Td eI<; aüTfjv eI-
oayönFva dKpKx xou Tannöv Kai 2Xkei itpöc;
Td E^u. Ka6' öv xP^vov ö ßorieö«; ^Xkei, ö

KaiaapiKri Topii. Aiavoi^K kdiXiokuv
TOixcopdTuv Kai MnTpaq

ttEplnou KE<paXrj<; ä^6püou. Tö ^^yE9o<; tou
Tc^itöv E^apT&Tai iK Ttiq 6£oE(oq tou al^iop-
poouVToc; dyyEiou, Efvai 6^ Töaov uEyaXuTE-
pov, öoov ItEpiOOÖTEpOV ATt^x^i TÖ dyyEiov d-
nö TOU nucXiKoO ^öd^ouc;. Tdw; Täoaapaq yu-

(1) Eric Weber : Techniques chirurgi'
coies vaginales. Editeur Baillöre et Fils, Po-
'is 1948.

(2) Univ. Prof. P. Werner, Dr. J. Sede'i:
Die Vaginalen - Bauchhoelen Operotionet-
Wien 1952. Urban und Schworzenberg.

cHAIOI>

Eicraywyn toü Ta^irbv meto xfiv ä^aipE-
aiv TOÜ CM^PÜou.

Xcipoupyöq cnoSoTieEi Tti^i^tüv ^k tüv dvcj Kai
5iaKpaTtov tö TajiTtöv ßadEuq ivtöq x^q iiut-

XOU HEXPiq ÖTOU TOUTO T£X£lCi>q OTEpECoOrj. Tö

ToioüTov iftiTuyxdVETai (bq diKOXoOetoq: "EX-
KO(iEv Tä ä^u TOÜ koXeoO KpE^d^EVa dKpa
ToG Tannöv 6id ^äoou fevöq ^lEydXou 6aKTuX.i-
oEi5ouq TTEoaou öv üOouiiev 5id TT\q dpioTE-
pdq x^iP<^<; ^"i foö alSolou. ivü f| ÖE^id x^iP
jiETd ÖuvdnEcjq CXkei Td dKpa Tfjq ydt4n<;. *A-
KoXoOGcjq dXXoq ßoT]9öq tottoOexeI laxupdv
Xafilöa drKpiSüq npö tou ^ieooou, öaTiq f\br\
EÜploKETai nETa^u alöolou Kai Xaftl6oq 'H
aliioppayla ditloxETai ndpauta, nETd Tf|v dt-
KpiSrj ä^Kxpnoytjv xoG xanTiöv. önÖTE 5uvdnE-
9a vd £^aKoXou9f]Oü)nEV Tfjv iyY^eipi\a\.v tv
n&ar\ t\P£\iiq.

npöq äitioxEaiv aliioppaylaq ^irl KoXniKüv
^yXtipnoEwv ävEpyoGiiEV KaTd Töv aöTöv xpö-
Ttov, (iE Tf|v 6ia(^opd(v öixcoq öTi npöTov Elod-

yCUEV Töv KEVÖV OdKKOV 6lä H^OOU TOU KOX-

•niKou TpaünotToq ^iTöq Ti^q TtEpiTova'iKfjq Koi-
XöTpxoq, 6iä oteiXeoO f[ ^aKpdcq dtvotToniKiiq
XaSi5oq Kai dKoXo06ü)q nX^poü^iEV töv oäK-
Kov bid ^axpäq Xu>pi5oq ydijriq. 'Ek Tiap^ \-
XfiXou Ötov vd npoo^x<^^^^ iv<* ^ Xioplq ku-
Tav^jiETai lootxEpuq npöq öXac^ Tdq 5ieu9üv»
OEiq ^vTöq XTiq nuEXiKijq KOiXöxi^xoq. oöxioq cj-
OTE ö ■nXtipio9Elq odKKOq vä npooXdaT] Tf|v
H0p(|)f|v nfjKuToq (griechenpiiz), ^^ tö «vöiia-
o£ ö KaOTiyTiTfiq tv AEnplg (SeHheim)- npöq
äno<puyt|v VEKpüoEcov, aiTiVEq 6uvaTöv vd
TtpoKXn9oöv (bq iK Tijq loxupäq mäottaq toO
nEoooü inl TOU alöolou, Toiio9£Toü|iEv ^Exa^u
TiEooou Kai alöolou Kax* d^^öxspa xd nA-d-
yia ToO (iloxou tou Tanitöv (iixpöv oTpc.>(ia
^ä|i£aKoq. Aid töv ocötöv Xöyov f| npö toO
TitoooO Toiio9ETounävT) XaSlq ditKzipcixai |i£-
Tä 8 üpaq. Plötq ö(i(>>q nEpaiT^pu x^ipi<'l**<i
änl TOU TtEooou ÖEOv vd dTtoq)£üyTiTai, A^ax-
pou^^vou TOU teXeutoIou jiETä 24 cjpaq. 'Atiö
xr^q TplTTiq f|(iäpaq dpxö^E9a d«|>aipoüvTEq
Tfjv £oü>T£piKf)y Xb>pl6a yd^ijq (i^XP^ '^'i^J "^t**
TiTTjq fm^paq, Ahötc d<|>aipoOtiEV (boaüxbiq Kai
Tfjv ^^(oTEpiKfjv yd^av tou Taniiöv.

"Iva öiantoTuSg fj ^v^pyEia toO xPloi^o-
Tioiouii£\ou TojiTiöv d^' ftvöq Kai Iva naOopi-

oG^ f| 6£oiq aüTou iv ax^oti npöq Td öpya\a

Ttjq nUEXou dcp' tTEpou, Tfj 0TtOÖEl£;El TOU Ka-

ÖTjyriToü r. £ KXaftoOvou Kai 6nö Tf|V KaGobfj-
yTjoiv TOÜ I6I0U, ^yävovTo etq tö i\ 'A9ri-
vaiq 'AvaToiitiov imö toO N. XpioTonoüXou
LpEuvai dnl 5 nTtondxtov (3) 'Eydvovxo Tpti<;
KcXniKai Kai öuo KOiXiaKal OoXEpEKTo^al,
Ka9' äq i<pr\p[iöaQr] tö Tafinöv dKpificJq dx;
ini ijcjoiiq yuvaiKÖq, äveu dnoXivüoEojq Tcov
HTjTpialcjv dcyyElcjv. AOo Eioq TpEiq fjjx^paq
HETd Tfjv äcpapnoyriv tou Ta^irtöv 6vTipYfi9r\
EVEoiq xP'^^oxiKriq tlq ttjv KapwTiöa, daKT]9fi-
OTjq niEOECoq ^ityaXuXEpaq xijq (puaioXoyiKriQ
•ni^aECjq toü aKuaToq. MEtd 1 5 fjUEpaq finTj-
KoXoü9iiO£v fj öidvoi^iq Tfjq KoiXlaq tcjv nTto«

^dTGJV, blE1TlOTCJ9TJ bt ÖTl TÖOOV TÖ dnEu9i»«

an^vov, öoov Kai f| oüpoSöxoq KüoTiq jicTd

TWV OÜpTJTTJpCJV EKFlVXO E^(o9l ToG UTTÖ nlEOlV

eOpiOKOn^vou TtFÖiou, dmoKXEioGelaTjq oütgj
olaobfinoTE ßXdSrjq aüTcJv, npäypa önfp Kai.
5iä Trjq KXiviKiiq TiEipaq exei änob£ix9ti. 'floaü«
xcjq öiemoT(i9Tj öTi ol loTol n^pi^ twv öia-
tiitjGeiocjv Kai ^ifj dnoXiva>9Eioti)v nijTpialiov
dprnpiQV nap^jiEivav <5tV£u xP"o'^i'^'l<i ÖiaXü-
atutq, npäyiia Tö ÖTto'iov drroötiKVÜEi tö <k»
a<pci\i(; Tfjq dpTTjpiaKfjq aliiooTaolaq.

'E^EXäXEoa |iet' ^niTuxlaq KoXniKdq Kai
KOiXiaKdq EyxEiptjotiq Etq Täq iiEyaXuT^pa«;
riavEiticrXTjmaKdq KXiviKdq Tfjq EüpünTjq dvEii
dnoXiv^oFcoq KaTd xdq KOiXiaKdq öcTEpEKTo-
Hdq Töv jiTjTpialcov dcyyElcov, KaTd bt TdQ
KoXniKdq ^yxEipfjoEiq dtVEu denoXivüoEtjq oübE-
vöq dyyEiou. Iva dnobEl^cj Tfjv ^v^pyEiorv toü
Tannöv. np^itEi ö^coq vd tovIocjuev ^VTaü9a
ÖTl Tö Tannöv Ö^ov vä xP1<''t'0''^oin'^0'i jiövov
Elq nEpiTtTiijoEiq dvdyKrjq. ^nl al^oppaylaq
fjTiq Korx' dXXov xpötiov oOööXtoq f\ büay(^tp(ji<^
inloxETai, önöTc toGto nap^x^i ßE&alav ßo«
fjÖEiav.

"ETäpa nEplnTcootq ^ijKiPuoytiq Tou Ta^inöv
Elvai i\ äirioxeoiq xfjq aiiioppaylaq ^lETd Töv
ToKETöv, EVEKa dcTovlaq Tfjq ^ifjTpaq nETd Tfjv
^KSoXfjv ToG TtXaKoövToq. itpäyua tö öiroiov
dGECopEiTo ^EXPi to05e ^v iK TCOV dXüTOJV npo-
•XTindTuv Tijq /vkxuuTiKijq.

*H tijKxpjioyfj TOU TajiTtöv Elq Tdq ToiaüTa«;
nEpimoHJEiq ^KXEA.Eixai Kaxd xöv fe^ijq xpö-
nov: 'H do9Evfjq xoTiv.6EXEixai tni xijq nXa-
ylaq nXEupdq Tijq KXivrjq oüTcoq, 6ote Td l-
axlot vd npo^xo"^. Tä d^uTEpiKd yE\'VTjTiKdc
öpyava Ka9api^ovTai, ö KoXEöq dnooTEipoü-
Tai Kai fj oOpoböxoq KÜoTiq KEvouTai 8id Ka-
9ETfipoq. Mexö Tfjv TcmoÖETTjaiv Eüptcov 5ia-
oToXäojv ^v TU) KöXno) ouXXanSdvojiEv 5i* dy-
KioTpoEiÖüv XaSlbojv TÖ TipöoGiov Kai tö önl-
o9iov x^i^o^ "^oö auxevoq Kai ^Xkojiev TaüTa
loxupwq Tipöq xd Kdxo) Elxa ElodyouEV Toüq
KoXnobiaoToXEiq ivröq Tijq KOiXöTTjxoq Tijq
jirjTpaq oüTcjq, üote Tö otö^iov aüTfjq vd Öl«

'\oxvpct 2X^1 q ToG TopiTOv npoq xd kÄ-
TM Kai dcpaipEoiq toü nXaKoOvToq.

aoTaXfj Eup^toq, "Ev ouvEXElg TipofialvouEV
Elq Tfjv ä«|Kxpiioyf|v tou Tannöv, ü>q tö toi-
outov npäTToiiEv Kaxd Tdq KoXniKdq öoTspEK«
Tojidq iv nEpiTtTtöoEi aljioppaylaq. Eladyo|iEV

ItpcÖTOV TÖV KEVÖV odKKOV Elq TtjV KOlXÖTTjTa

xfjq nnxpaq bid oxeiXeou V\ ^laKpäq dvocTO|ii»
Kijq XaSlboq Kai dKoXoüGtoq nXTjpounEV TöV
odKKOV öid jiaKpäq Xcopiboq yd^tj«;' '£•' ^'^'

(3) N. Christopoulos : Anatomische Er-
gebnisse der Blutstillunqsmethode nach
Loqothetopoulos. Zbl. Gynaekologie. 1933,
iNo. 14.

699

METPHTHZ
TON ANEZEON MAI

'H v^a ivTUTrcjaiaKr) dpEpiKaviKri l^to-
pcoic; tfi/ai ^iia auoKtur] 5id Tf|c; ötroi-
aq KaTapcTpÖTai 6 6a6^6q tuv dveaeuv
eiq TÜq ÖTToiaq ^H tvaq ävöpWTroq.

'H auoKiur], öttcj^ TrepiypOK^eTai dtc-
Xw(; eiq £va ttepioöiköv xfiq Ncaq 'Yöp-
Kriq, cTvai ^iriPTMCvri eiq 6Ep^iö^ieTpov Kai
L/ypöncTpow Kai ÖTov ol ÖciKTai dp^oTt-
pcov auiXTxipouv tiq t6 T5iov anMCiov, tö-
te f\ dtveaic; etvai -rrXripnq. Ol 6t?KTai toü
6epjiO|ieTpou Kai üypoiJEtpou Kivoüvrai ^-
"iri Midq -rrXaKÖq pe ^covaq xPWMCXTiaTdq
— dpuöpdv, Kuavfjv, TTpaalvr|v Kai KiTpi-

vnv.

'H dpxn ToO iQi[iou ÖTTcoq at Iva irr\-
(JT][iov yeüpa ÖiirAa diTO Iva Kupiov irpt-
TTEi vd KdÖETai KOI pia Kupla, 9d irpt-
TTCi vd dva^rjTnön tiq tov l4ov aiwva,
ÖTTOTc ol 5üo au^uyoi ^Tpcoyav dirö tö

VßlOV TTldTO Kai ixpr]Oi\iOT[0\QUV TÖ Tl6l-

ov TTOTrjpi 6id vd ttivouv.

MIA ZXE^ON RANAKEIA

TO XAQPIOYXON MArNH2:iON

*H dirXoüaTdTn XPHorx; toü.

paXXfjXou 6£ov vot npoo^x^k^^v» 'f^« ^ Xcjpiq
KOTavE^tTai laontpcdc; -npöc; öXaq xdq 6ieu-
ölvoek; ivTöq ttjc; unTpiKiriq koiXött|To<;, Iva
6 nXiiptoetlc; oükkoc; TtpoaXd^o "^^ '^XTW^^ V^^'
KUToq Kai KaTd xfiv gX^iv iif] ^^^XBxi npöq Tdc
t^cj. ElTa öianEpünEV rd öcxpa tüv yaC,uiV
6id ^Eoou 5aKTDX(OEi6o0q iteoooO, töv önolov
«üöoüuev 6id TTjq dpioTtpäq X^ip6<; ^'"^ "^oö
alöoiou, ivü f| 5E^i(k x*^^P 2Xkei loxupciiq Tdt
öKpo Ttiiv ya^wv. 'AKoXoOScoq 6 ßoiieoq toito-
ÖETfi laxupdcv Xa&L5a dKpiScöq npö toü nto-
ooo, ÖOTiq f\br] EOpioKETai jitto^u al5oiou xai
XaCiSoq. 'H aluoppayia H£Td ifjv TonoetTT]-
Oiv TOü Tatinöv äixiaxtTai ndpauTa.

*0 KaöriYTiTfiq TTiq A' MaituTiKfiq Kai fu-
\aiKoXoyiKifjq KXiviKiiq toO navEiiiaTimlou Ti^q
Bi^WTiq TqssIIo Antoine, elq tö Biologie
und Pathologie des Weibes (4) öiartpayiia-
Tku6|i£Voq Tö Qi^ia töjv pfj^Euv Tf\q lifjTpaq
(Tötioq IX, atXlq 389—623) ypd«|>ci Td i^r^q
oxETiKÖJq \ii TT^v ÖEpaiTElcrv TÖV Capeiuv ne-
piTnwotcov pfi^Ewq Triq jifiTpaq, KaO' dq nepi-
riwoEiq f| äyxElpiioiq biv Elvai SuvaTöv vd
tEXtoBfi d^^otuq Ttpöq änlaxEoiv Trjq tocjTtpi-
Kiriq al^oppayiaq: «"Höri itiaTEüu ÖTi ty[^o\it.v
tv [iiaov, TÖ ÖTTolov Elq ToiaüTaq ßapEiaq dc-
iXEX-rtioTiKdq KaTaoTdoEiq, KaöioTö BuvaTf)v
Tfjv ^ETa(|>opdv TT^q doBEVoOq Elq Noookohei-
ov npöq iyxElPTioiv. Tö \iiaov toöto Elvai tö
TanTTÖv KOTdc AoyoÖETÖTtouXov. Nojll^CJ, ÖTl Tö
TaniTÖv ^flioriq Kai Etq TtEpiTtTwoEiq pri^Eiov
Tf)q ^f]Tpaq öüvaTai vd npootpipw ä^aipETiKdq
CmnpEolaq Tö Tannöv biov vd ^<|Kxp^ö^TiTai
diJ^ocjq, wq Kai Elq Tdq KoXniKdq iyxfipf]0Eiq
f| iv&o^TiTpiKCüq (Eiq x<*Xapdv iif|Tpav) V\ öid
\iiaou TOÜ prjynaToq Elq Tf)v nEpiTovaiKf|v
KOiXÖTTiTo. Aid Tliq iipapnoynq ToO Tannöv
iTiloxETai f\ al^oppayla KEpauvoSÖXuq, itpä-
•y^a Tö öitoiov 6i" oüÖEVöq dA.Xou ouvTripriTi-
KoG UEODU Etvai KaTopecjTöv. ndq öoTiq dita^
tüptQr\ tlq ToiaüTTiv S^oiv, 50voTai vd Cmo-
Xoyla]], Tl aimalVEi toüto 6id töv x^>^Po^P*
•yöv».

Utpaiitpoi ö Antoine WEpiypdi^ci XtnTo-
^cpüq Ttiv £(^apnoyfiv toG Ta^nov Trapaö^Tuv
Kai ElKövaq Ik toü ßi«A.ioo (iou «Gynaekolo-
C sehe Chirurgie». Iuviotcjuev öeev. Iva Td
oid tt)v ä4>ap(ioytiv TOÜ Tairnöv xP^^üÖt) El-
vai Elq ■nütvTaq Toüq toKETouq Ik tcov npoTt-
puiv {Toiiia Kai dTitaTEiptj^^va tvTÖq iiETaA.-
Xivou 6oxEiou. 'H iv^pytia Elvai Töaov dnE-
ooq Kai do^Xfiq. Xöyu) Tfjq \ii\ Eloxojp^iaEcjq
nX^ov aijiotToq ävTöq Ttiq nfjTpaq. «q Ik Ti^q
oujimtoECjq tojv ^r^Tpialcov dyytlcjv üixö toij
Ta^iTiöv ^m TiiJv ToixtoiidTujv Ti^q Ttu^Xou, üote
ndq äuEpxö^Evoq ÖdvaToq iE, al|ioppaylaq, l-
VEKa dTovlaq Ti^q jif)Tpaq, 5^ov vd 8EtjpfiTai
(bq douyxwpiTov 0<|>dXiia toü laTpoö.

EIZ TO EnOMENON: Tö T^Xoq

(4) Seitz ■ Amreich : Biologie und Pa-
thologie des Weibes. Bond IX, Geburts-
hifte (3), von Prof. Tassilo Antoine : Ute-
rusruptur, 1950. Urban und Schwarzen-
berq.

700

npeTTEi KOcvEiq vd ^TTavaXajjßävi;! auxva
TÖq M^yti^a«; dXT^eEiaq, ötov ö KÖopoq 6ev
TÖq rrpooExti öaov dpKEi. Kai ttpettei vd
öpoXoynawviEv öti etteito dTTÖ töv öopu-
6ov TTou EyivEv dXIyov rrpö foO TroXE^ou
IjETd Tdq dvaKOivwCTEiq tou fdXXou Kaör^-
yriToG NTEXfiTTE 5id Td ahia Triq kotq-
TrXriKTiKfiq 6ia5öa£uq toG KapKivou KaTÖ
Td teXeutoTc ETri, öXoq ö KÖa^oq ^Xnanö-
vnoE Tdq au^Coi^Xdq tou.

Tpcbyo^Ev KQTd Td TEXeurala eth dXd-
ti « pacpivapiGMEvo >, 5r|Xa6n TeXEicoq d-
TTriXXaypEvov öttö tö x^t-^ptoOxov ^ayvn-

(TIOV, TÖ OTTOuSaiOTaTOV aLKTTOTIKÖV TOü,

TpcbyouEv Td ßpaapEva XaxaviKd teXeicoc;
OTEyvd, ivd Td Kupia auoTaTiKd tou, tq
äXoTa Kai metQ^G aÜTcov toc toü ^ayvQ-
oiou, (pEuyouv [xi tö vEpö tou ßpao■^lOu,
xprici MOTTO ioümev Xoycp thc dvayKaaTiKnq
EVTaQEcoq Tcöv KaXXiEpyEiuv, yEwpyiKd
TTpoiövTa EaTEpHMEva tcov dXoTcov toü pa-
yvnoiou Kai tüv dXXcov petoXXwv. Elvai
6e töc dXaTa aürd dirapaiTriTa ox' pövov
5id thv irpöXriipiv toü KapKivou, dXXd^ yE-
viKcbq 5id thv EÜpu6pov, KovoviKnv Kai Ka-
Xnv XeiTOupyiav toü öpyavianoü.

*H diTouaia tou payvriaiou Kupicoq dirö
Tf|v öiaTpocpnv paq, eTvqi d^opun irXEtaTcov
öpyaviKcov öioaapaxwv. 'O NteXptte tö e-
XEi dTToSEi^Ei [xi TrXEToTa TTEipaMaTd tou.
'E-rrfipE, TT. X-, TTOvTiKoOq Kai Toüq piiCTOÜq
ÜTTEÖaXE a£ 6iaiTav ÖTrnXXayMEvriv ^vte-
},Ci<; payvriaiou, Touq di öcXXouq jiiaouq

TOÜq £TpE(|)£ pE TpÖ<t)ipa^ TTEptEXOVTa^ dpKE-

TÖv ÖTTÖ TÖ dXaq aÜTOü. Tö dTroTEXECTiaa
i'lTO ÖTI pETÖc MEpiKdq £65opd6aq ol TpE-
(pc[\€.vo\ xwpk potyvriaiov TrovriKoi Trpoa-
EÖXfdnaav diTÖ KapKlvov, tv&i oi dXXoi m-
aoi Sev ^Traöav tittote. PlEpav Tnq tSioTr)-
Toq tou Taurriq tö payvricriov ^EKOupd^ei
TÖV Koupaapcvov 6pyc^'\cfyi6v, KOTaTTpaO-

VEI TÖ VEÜpa, TOVOJVEi TOÜq lOTOÜq, TTOPE-
XEI El'q TÖV dvOpCJTTüV TÖ OOpOlüV EKEiVO ai-

aörjua Tiiq EÜ<popiaq Kai Triq aiaioÖo^iaq,
TÖV KÖpvEi iKOvöv vö KOTaÖdXXri MEyuXaq
TTpooTTaSEiaq, t^acpaviCEi thv kotutttcooiv
Tcöv n9iKwv, liJUX'Kcbv Kai ocopaiiKÜv tou
5uvdpEcov.

'E^ dXXou, ÖEppaTiKai, dpöpiTiKoi, pEu-
poTiKoi TTa6naEiq, pETpiKai dvcopaXiai,
EVTEpiKoi 6iaTapaxai, TraönoEiq toü nTra-
Toq, TTpoXap6dvovTai, ßEXTicbvovToi Kai
auxvcioTaTa ÖEpaTiEuovTai 5id Tnq Eiaayco-
ynq x^P'oGxoü payvriaiou Eiq töv öpya-
vioijöv, Fevikwtepov n KaTdoTaaiq Tf|q ü-
yEiaq tcov i^XiKicopEVcov OTÖpcov PeXtiuve-
Tai TToXü p£ THV TrpöaXriipiv x^wP'oGxou
payvriaiou. 'H sXXEiiiJiq toü petcXXou toü-
TOu dTTÖ TÖV öpyaviapöv ottoteXeI ^vav d-
TTÖ TOÜq KupicjTEpouq TTapdyovToq twv ko
Kcbv TOÜ ynpaToq.

KavTovTd 5riXa5n tö x^wp'oGxov payvri-
aiov CTXEÖöv TTovdKEia, Koi päXioTa Euöri-
vcotötti. ripdypaTi n Tipri tou Eiq tö (pap-
pOKEla eIvoi ttoXü piKpd.

Atv Eivai dvdyKri vd TTpoa(})üyr) KOvEiq
Eic TO oxETiKd OTTEOiaXiTE. 'E^ dXXou 5i-
d(t)opa lapaTiKC ü6aTa ttoü KUKXo(popoüv

El'q TÖ EpTTÖplOV TTEpiEXOUV pETO^O TÜV

dXXcov X PICT ip COT dTcov dXdTcov Kai dXarar
payvrialou.

EüpiCTKEi öpcoq KCVEiq x^wpioüxov pa-
yvrjQiov « xüpa » Eiq öXa tö (pap^aKEiQ.
Kai pia KouTaXid toü yXuKoü kuÖe T]\ii-
pav, Eiq ÖTToiavÖnTTOTE copav, eIvoi dpKcTr\.
'H dXdxiOTa dXXcooTE SuadpEaioq yEÜaic
TOU £^a<t)avi^ETai p£ piaö TTOTripi vEpö, Ei'q

TÖ ÖTToIov TÖ x^copioüxov payvriaiov eTvqi
^^aipETiKd EÜSidXuTov. 0d sXsyE koveis;
ÖTI Sev TTpETTEi vd ÜTTdpx':! (5a'6pcoTToq ttoü
öd auvETrXripcovEv riSri tqv i'iXiKiav Tqq aco-
poTiKriq TOU dvaTTTÜ^Ecoq, rrou vd pn Tralp«
vri x^wP'oüxo/ payvncTiov.

TA HAEKTPONIA EN TH HPAEEI

PVeMIIlI THI TPOXAIAZ AI' HAEKTPONIKQN EFKEOAAQN

'EvTÖq öXiyuv ^twv n Tawq koi pn^wv,
«palvETai ÖTI Öev 6d üirdpxouv ttXeov Tpoxo-
vöpoi eiq Tdq 'HvcopEvaq floXiTEiaq. 'OXai
al TToXeiq TrapayyeXXouv n5ri koi ^TriSupoüv
vd ^^oöiaaSouv pe rjXEKTpiKOuq iyKt^dXouq,
ol ÖTToToi ^aivETai öti Xuouv koto töv Iko-

VOTrOirjTIKUTtpOV ÖuvaTOV TpÖTTOV TO TTpößXr]-

pa Triq KUKXo^opiaq tqv auTOKivnTcov kc»
TÜV TTE^wv. 'lÖicoq elq Tnv 'ApepiKiiv, Trap'

ÖXoV TÖ TCpdOTIOV Ö61KÖV ÖIKTUOV, T*) KUkXo-

^opia elq Tdq TröXeiq eTvai öuoxEpcaTdTr)
elq «piapevaq wpaq Tqq npepaq. Ol öönyoi

TQV OÜTOKlvnTCOV TTpETTEI vd i^OUV 'I661OV

ÜTTOpovnv ÖTOV dvapev ouv Triaco öttö dTeXeiw-
Touq aeipdq Tpoxo^öpcov, ävayKd^ovTai 6c
vd KivoOvTai TToXu 6paöÜTepa Kai drrö aü-
Touq dKÖpn Touq Tteijoüq,

Aid vd Xüaouv t6 TrpööXripa auTO, ol 'A-
pepiKavoi iaKc^Bncrav vd KaTa^üyouv elq l-
va d^aipETiKuq ^^utttipetiköv daTuvopiKÖv
Tfjq Tpoxofiaq, 6 ÖTToToq, xwpiq piaööv, öd
öieudüvi] Tf|v KUKXo^opiav drrö 6d6ouq pepi-
KÜv iKaTOCTopeTpcov i/no Tf|v öco^aXTOv. flpo-
KEiTci TTEpi ivöq... »"iXcKTpoviKoO iyKE^dXou,
dTTÖ ^KEivouq TTOÜ diTEÖe i xönt^ov TÖaov XPH"
aipoi eiq 5ia^6pouq dXXouq TopeTq.

Eiq pcpiKdq dpepiKcviKdq iröXeiq XPHO''"
poTToioOvTai fi5n ol dyKE^aXoi aÜTol Ttiq
Tpoxaiaq. Td dTTOTEXcapaTo eTvai iKTTXqKTi-
Kd. AiaoTaupcocEiq ttou i^aivovTo diTÖ i-
TÜv TTpowpiapevai vd yivtovTai tottoi d^o-
PHTou auvcoaTiapoO Tpoxo<^öpcjv, 6I5ouv ai-
^viöicoq elq Touq auTOKivriTicidq dTriaTeü-
Touq EUKoXiaq 6ia6daECoq. Tö TrXeov ktuttti-
TÖv TTapoÖEiypo TTapexci tö XoualriT flXalnv
Triq N. 'YöpKriq, tö anpETov örrou öiaaTau-
poÜTai f\ Mairjv iTprjriT \ii Tqv OüecTaeaTEp
"AÖEviou Kai TÖ Nöp8 MTTp6vTyouair|. Mia
^TTiTpoTrfi prixaviKQv cTxev eupci Tcp 1937 cbq
pövqv Xüffiv TOü TTpo6XripaTo? rrj? kükXo^o-

piaq elq ttjv SiacTaüpcoaiv aÜTiiv, thv ko-
TCOKeu^v LTTToyelcov anpdyycov, al ÖTroIai o-
pcjq ed ^aTolxiCav Trepi Td 2.000.00Ü 5oX-
Xdpia. X»dpiq elq töv 'jXcKTpoviKÖv eyKccpaXov
^öaTTavnönoav pövov 1.000 öoXXdpia, ör|X.
50o ^Twv piaöoi iv6(; daTu^üXaKoq Tf|q Tpo-
xaiaq.ZriPt'WTEOv öti elq tö Xquöit DXairiv
drrriaxoXoGvTo pEXPt ToüSe 5 — 6 Tpoxovöpoi
ol öttoToi f\br[ KoöiaTavTai TrepiTTot.

'0 i'iXcKTpoviKÖq iyKE^aXoq Triq Tpoxaiaq
eTvai d^eüpeaiq twv Xevpu X6ou, Xdppu Oü-
TXko^ Kai T^cbv MtropKep. 'H pnxavn auTr\,
TOTTo6ETOupEvr| üttö Tqv da(|>aXTOv Eiq tt^v 5ia-
OTaüpuaiv 6ÜO n ttepioctotepcov ööikcöv dpTq-
piwv Kai auvSuaapEvri pe auoTripa <}»coTeivü)v
anpoTcov ürrepdvco rfiq da^dXTOu, ^ttikoivco-
vc? pe dXXa pnxQtvnpaTa, ttou eüpIaKovTai
TToXu TTpö TT^q 6iaaTaup6aecoq Kai KOTaypd-
^ouv ÖXa Td öeSopEva, öaov d(t)opgc töv dpi-
6p6v Kai Tf)v CTiypfiv SieXcuaexoq tüv Tpo-
xoiföpcov, dTToaT^Xouv 5e Td SeSopeva aÜTd
elq TÖV KevTpiKÖv dyKE^aXov. 'O /iXeKTpovi«
KÖq £yK£<|>aXoq dvaXap6dvei vd aTapaT^aq
Tqv KUKXoifopiav Trpöq piav Xeto^öpov, vd t-
TTiTpeipi] Tqv KUKXo^opiav Trpöq dXXqv, vd 4»
TTiTpEi|)i;i Tqv 6io5ov elq Touq TTC^oüq kXtt.
'OXa yivovToi p^ Toanv TaxÜTr|Ta, wotc 6
Xpövoq aToöpeüoecoq TTcpiopi^eTai elq tö b

XdxiCTTOV.

KaTd Trjv öidpKEiav TcXcuTaiaq £tti-
ÖEi^ecoq 6p£TavviKÜ)v dppdTcov pdxn«; koi
dXXcov TEÖcopaKiCTpEvcov öxnP<iTcov etq tö
MTTÖÖivyKTov TOU NTÖpaeT Tqq M. BpeTav-
viaq ^Kape Tf|v ^p^dviaiv tou kqI tö
TcXeuToiou tüttou CpETavviKÖv dppa pd-
xriq «KevTripicov III>.

«HA10£»

AI nPOOAOIJTHiJ XEIPO YPriKHi:

AOrO-TAMnOX KAI ANAIMAKTOX: KAIIIAPIKH TOMH

Mio vca Mc6o5oc iiriaxcacwq t6v alMoppoyiuv koto toc iyxeipnvcK
'Yuö Tou K. K. A0r06ET0n0YA0Y, KodnYlTOu toö flavc-iriaTnMiou
'AvaKoivuaiq Iv tq 'loTpoxcipoupyiKÜ 'Eraiptty 'ABnvüv.

ß'.

"HSn eiaepx6|ie6a eiq tö Kupiov Oepia
inq dvoKoivwaeoc; ^aq, TOi/reaTiv £iq thv
t6 TrpcjTOv TTpoÄirrTTiKwq ecpapfjioynv toü
Ta\nxö\> tTTi KaiaapiKHq TojinQ.

H KaiaapiKn To^rj >^'''o yvwaTn 6tt6
ToOq dpxaioTdTouq xpövouq elq touq dp-
xalouq AiyuTTTiouq, "EXAn^cxQ Kai PcoiJiai-
cuq. 'Ev TouTOiq ai pexP' tovaÖe övaKoivü-
atiq £Tri toü Seiiaioq toOtou elvai d6e-
6aioi, KaTaTToXEjinÖE'ö'ai uttö ttoXAwv ou-
Tcoq, coaTE ouÖettote öeAei ETTEÄeo öiaÄEu-
Kovaiq TOÜ xpov'ou Triq dirapxHQ ^HQ ^Y"
Xtipi'iaEwc; TQÜTnq. 'Ev fEp^aviot n irpwTri
ßEÖaicoÖEiaa KaioapiKn To^ir^ E^eTEXEOÖn
Otto toü Troutmann tw 1610. T6 Tpaü^jia
Triq pHTpaq öev auv£ppd<pn, dXAd jiövov tö
KOiAiaKd ToixcbiiaTa ouvEirTÖxöncrav. *H
yuvr) aTTEÖicoaE thv 25riv njiEpav fjiETd Tr|v
£YX£iP1<^'^ KaTd THv EyEpaiv aüTriq ek T^q
KÄivnq/ TÖ dz TEKvov iC,r]ae. m^xP' toO 9ou
ETOuq Triq i'iXiKiaq tou. 'E-rrianq "rriSavoAo-
YEiTai ÖTi ö £^ 'EAÖETiaq xotpoöoaKoq
Jacob Nufer e^eteXeoew diriTuxwq Trjv £y-
xetpio^'v ToÜTrik^ £TTi Tnq auCüyou tou.

'H KaiaapiKn TO|jr|, ek toü Aotiv/ikoö
Sectio coesoria, (pEpEi tö övo|ia aOrf|q oü-
xi 61ÖT1 öl' aÜTnq ^YEvvnBn ö 'louXioq
KaToap, Ka9' öaov tö toioutov eTvoi Xiav
d^EÖaiov, oÜTE öiÖTi x\ iyxEipnc^iq aÜTri £-
CeteäeIto üttö T(I)v Pcopaicov. Tö uiöavwTE-
po\/ eIvxji, KOTd Trjv yvwijnv öXcov twv auy-
YPCXcpEOV, ÖTi ö öpoq ouToq TrpoEpxETai ek
TOÜ XocTiviKoü caedere = köttteiv, ÖECopEi-
Tci bi WC yAwcTCTiKÖq TTXsovaatJiöq, Ka8' ö-
oov r) Ae^ic section, wq Kai i^i Ae^'Q caede-
re Exouv Tpv aÜTÖv anpotaiav.

Tö 1844 ö £K KoTTEYXöcyn^ Kayser
irapouaiaaE CTTaTioTiKriv, 61' r,q v\ ek Ti^q
£Vx£ipncT£coq TOÜTr^q evri^ÖTriq twv yuvai-
Kwv dvnpxETo Ei'q 62%, 6 öe ÖdvaToq Eurip-
X£TO ÖT£ }i£v £^ d<p66vou aliioppayiaq, ötp
6t Ik AoijiW^Ewq. 'H övriTÖTnq riXaTTcbSn
vüv KOTaTTÄriKTiKwq, a<p' Evöq ^k Triq üttö
TOÜ Kroenig Kai Sellheim EiaaxÖEiariq Tpa-
XnAiKriq Tonnq Kai d(t>' ^T^pou 6id Triq "^e-
AeiOTTOinaEwq üttö toü Saenger Triq auppa-
<priq Tnq lipTpaq.

"Ektote, 15 ia Se |i£Td thv dvaKdXu«4jiv
TWV dvTi6ioTiKwv (pappdKwv, euE^ETdöriaav
ai EvÖEt^Eiq Triq £Yxe'Pnc7£wq TaÜTriq etti

TrÄEioTWV MOtlEUTlKWV ^TriTrXOKWV.

'Oaov dcpopQC Eiq töv/ tpöttov thc ^ktej

>£CTEWq Tric EYXEipnCTEWq n TO^n ETti TOÜ

owiiaToq Triq M^'^'P^'^» H KoXouuEvn <^KAaa-
o-iKH KaiaapiKn tomh» ^X^\ n5n ^yKOTa-
XEKpön, EVEKa Tnq aitioppayiaq nTiq ^ttep-
XETOi KaTd Tnv 6iaT0Mnv TWV/ -irayEwv toi-
yw^dTwv TOÜ CTWMaToq Tnq ijinTpaq, wq Kai

^K TOÜ KlVÖOvOÜTnq JiETETTElTa TrpOKXnOEWq

CTujjKpüaEwv nETa^ü Tnq oüXnq Kai twv dvTEpi
Kwv ^Mkwv. 'O Sellheim ^TÖviaE Toüq kiv
ßüvouq, oüq ^vexei i^l ÖiaTo^n toü Toixwiaa-
Toq TOÜ awpaToq Tnq unTpaq, Ka6' öaov
ÖaOvSnTTOTE CTTEpEd Kai dv TEXEaSn '^ Od-

(pn, KOTd Tnv TraXivÖpöunaiv Tnq unTpoq
Td pdmiaTa yaAapoGvTai Kai tö Tpaüpa
KaSiorduEvov öiaitEpaTÖv auvETrdyETai tte-
pITOVITlöa. WC EK Tnq £^ö5ou ÜYpwv fK
Tric unTpiKnq KOiAÖTnToq. Tö ToioÜTOv crij-
veteXeoev waTE vd TTpoTinoTai tö Tpax»T
AiKÖv T^niia Tnq unTpaq, öttep sTvai Xe-
TTTOTEpov Kai 5id Tnq Eiq 6üo OTpwjiaTa
pa(t>nq koi Tnq ^-rriKaXüUJEwq toü auppa-
(pEVToq TpaÜMOtToq üirö toü TtEpiTOvaiou
Ttiq KÜCTTEwq KOÖiaTaTai dSiaTTEpaTov
*H ^vSoTTEpiTovaiKn TpaynXiKn n laÖ^iKn
KaiaapiKn TO|jn öttoteXe? KaTd Tdq aTa-
TiOTiKdq TWV Winter Kai Noujoks Td 80%
TWV ^kteXouüevwv KaiaapiKwv to^wv. Td
irpoTEpnnaTa Tnq Topnq TaÜTnq ^vavTi yr\(;
TraXaidc KXaaoiKtiq KaiaapiKnq Topnq tt-
vai TrXElaTa : 'O kivÖuvoc Tnc ttepitovIt«-
5oc ETvai piKpÖTEpoq, ai aiuoppayiai Ka-
Td TTiv 6iaT0|jnv toü XetttoG TOiywiaaToq
TOÜ aüyevoq iAdx'C7Tai, Td ainäaaovia

«HAIOI.

dyyda diroXivoüvrai eüxtpCic,, i^ 5£ x^^d-
poxriq TWV pa(pwv toü Tpaü^JlaTo^ eveko
Tf|q aü^ojiEiwaEwq toü Tjirmonoq toütüu
Tnq lirjTpaq, wq tö toioütov aupöolvEi Eiq

TÖ GWlia, dTT0<p£ÜY£Ta» CTXEÖÖV iravTOTC.

'Ek Tnc auyKaXü^iEwq toOtou uttö ttepito-
vaiou dTTocpEÜyovra» Etrianq Kai auii(})üa£iq
Tnq oüXnq pETd twv evtepikwv iXiKwv. 'H
iaSiiiKii öiaTcpn Tnq pnTpaq cuveteXeoe
KOTd TTpwTov Xöyov eIq Tnv TEpaaTiav 6i-
aöoaiv Tnq KaiaapiKnc TO^nq.

'EkeIvo tö öttoTov Ev6ia(p£pEi ^vToüöa n*
pdq Elvai vd d^ETdawuEv Td aiTia toü 6a-
vdTou KOTd TÖq KaiaapiKdq Topidq. Ka-
Td Tiiv aToTioTiKriv TWV Winter Kai Nou-
joks ai aiuoppayiai irai^ouv onucxvTiKÖw
pöXov KaTd Tnv KaiaapiKnv Toprjv. floX-
Xai TTEpiTTTwaEiq öavdTou xotpaKTnpiCö^t-
vai wq KapSiaKoi f\ KUKXo<popiKai dvETrdp-
KEiai öcpEiXovTai dacpaAwq Eiq Tnv Kard
Tnv KaiaapiKnv To^nv ETTEpxopEvnv ai-j
^jioppayiav. 'ETrianq yvwOToü övToq öti f\
Xoijiw^iq £ÜX£P£CTTEpov TTpoa6dXXEi ^^n«*-
TXnu£vaq yuvaiKoq, ö dpiS^öq twv ettep-
XCMEvwv SavdTwv 6d r^To oaijKbc ^ikpöte-
poq, Edv KaTd Tnv ^yxEipncriv 5ev Eirnpxe-
To aiMoppayia. Ai aipioppayiai KaTd Tn*»
KaiaopiKiiv Toprjv öcpEiXovTai kotq kovö-
va Eic Tnv dSpdvEiav Ttiq jiiiipaq, nT.q
TrapaTnPEiTai ouvnÖEOTEpov fi eiq dXXaq
MaieuTiKdq ETTEpGdaEiq. "EvEKa toü Xöyou

TOÜTOU dlTOCpEÜyETai ÜTTÖ TTOXXWV /j ^YX^j'
pnaiq TTpö Tnq Evdp^Ewq twv w6ivwv Ttiq
lirjTpaq, KaiTOi eIvoi dTTOÖEÖEiyiJiEvov öt»
öaov TTEpiaaÖTEpoc; xpovoq rrapEpxeTai d-
TTÖ Ttiq £vdp^£wq toü toketoü, töqov Ufc-
yaXuTEpoq KaölaTonrai ö Kivöuvoq Tnq Xoi-
uw^Ew^. MEydXnv ^TTianq ön^aaiav exouv
ai ai|ioppayiai ai TrpoEpxöpEvai ek twv
oüXwv Tnq pnTpaq twv ö<peiXoiJ£vwv £{q
TTponynöe'caq KaiaapiKdq Topdq. floXXd-
Kiq EIQ Tdq ToiauToq irepiTTTwoeiq, I5ia ^'
dv n drroKÖXXnaiq toü TrXaKoüvroq irape-
xn SuaxEPEiaq, EvÖEiKvuTai 1^ E^aipEcriq
Tnq MnTpaq irpöq 5idawaiv Tnq yuvaiKÖq.
Aipoppayiai dva^EpovTai Errianq £VEKa6i-
aaxiaEwq Tnq pnTpaq KOTd Tnv ^^oSov toO
^^6püou, I6iqt KOTd Tnv EyKapaiav Kcrrd
Ffannenstiel öiaTopnv, ÖTTÖTav StTvorröv vd
Tpwöoüv ai unTpicxIai dpTnpiai.

'EvSiacpEpooaa elvai i\ dvoKoivwaiq foü

Charles Gordon, Brooklyn, N.Y. eIc Tnv

'ApEpiKaviKnv 'EToipiav MaieuTnpwv — fu-

vaiKoXöywv Kai XEipoupywv eiq Hot

Springs, Virginia, 6, 7 Koi 8 ItTTTEijiöpiou

1951. OÜToq dvacpEpEi Tnv crTocTiaTiKnvTOÖ

Dieckmann tw 1950 ^tti 242 öovotwv Ik

KaiaapiKnq TOiinq. *Ek Ttiq OTcmoTiKiiq

TaÜTnq E^dyETai öti 69 TTEpiTrrwaeiq ütte-

Kuujav ^K XoiMw^ewq, eiq 15 6e i^ aCrrwv

ÜTTnp^e ao6apd aiMoppayia, 34 ttepitttw-

OEiq KaSapwq dTTÖ ai|ioppayiav, 7 dTTÖ

eyxEipnTiKÖv shok. Eiq 31 TrepnrTwaeiq

ao6apd aipoppayia auveTeXeaev eiq 9a-

vdTouq dTTo6o6evTac : eiq KopöioKÖv voan-

na 2, Eiq EKXapipiav 2, Ei'q dn6oXnv 3, eiq

dTuxnuaTa Korrd Tnv ^ETdyyiaiv Kai dve-

TrdpKEiav vE(j)pwv 1 0 Kai eIq liöXuvaiv 1 2.

I AoMÖdvovTEc; TaÜTa ütt* 6<1jiv ßAETtoiJEw

j ÖTToIav anuaaiav Eye« A dTTwXsia aTiiaToq

i Kcrrd Tnv KaiaapiKnv TOlinv. *0 Gordon

I tovICei oTi n OvnaiMÖTnq Kord Toüq toke-

Toüc Süvorrai vd ^XocTTwSn £ti ttXeov^ 6:d

I Tnq dvayvwpiaEwc toü yeyovoTOc toütou.

I ETuai EÜTuxnq Siöti eiq i\xi |tuxev ö

; KXnpoq vd Xüaw tö aoßapöv toüto Cfyrr]-

j \ia 5i' dTrXouaTdTnq Me665ou, 61' ^c Ka-

' TOp9oÜTai A teXeiwc dvaiiiOfKToq SiE^ayu-

yn Tnq ^YxEipnaewc TaÜTnq. 'H doappoyii

Tnq me865ou ToÜTnq yivETai wq Kai elc

Tdq KoiXiaKdq üaTEpEKTopdc ^v ttepiittq-

aEi aipopcayiaq, nTiq Kar' dXXov toöttov

oüSöXwc n 5uaxEpwc ^Tri^axEtai, d)C dvw-

TEpw dvE(|)EpOM£v. nXnpoüuev KaXwc crcK-

Kov ^K TETpaywvou yd^nc 6id uaKpdq Xco-

oiSoc ydfnc, oütwc wäre vd cryrwicniuB^

(jKXnpps aipaipiKÖq öyKoq, üxtiJ^otoq iin«

KuToq, TTepiTTOu K£(j>aXnq t^tpOou, iva ^r^
KaTd Tnv iaxupdv äX^iw irpöq Td KdTco t'
^EXÖn trpöq Td eCw. Td Teaaapa OKpa Tnq
TETpaywvou ydCn<;, w<; ><ai n u£Ta^ü toü-
Twv CKpa Tnq Xwpi6oq, yd^n^, n^iq irpöt;
ÖidKpiaiv ÖEov va elvai KOTd ti ^OKpoTe-
pa TWV dXXwv, auXXau6dvoM£v öpoü 61a
pidq ayKiOTpo(pöpou^ unXnq toü Amonn,
nv öSnyoü^Ev duö Tiiq T0^lnQ toü Mn^ptKOu
ToixwMaToq 6id uioov toü köXttou upoc;
Td E^w yEwnTiKd opyava, d<poü TTpony^v^-
liEvwq d^aydyoiiEv tö £|i6puov, *0 ßon6oq
auXXa^ödvEi Td OKpa TaÜTa koi eXkei »-
axupwq TTpöq Td KdTw P£XP'<; ou tö aipai-
piKÖv Ta^TTÖv £(a£X6i;i eiq Trjv ^Xdaao'.a
ttüeXov Kai 5uvn9n vd doKrjao meaiv ^rri
TWV pnTpiaiwv dyyEiwv. Tö toioütov ^tti-
TuyxdvcTai^ Kai oid Tnq eiaaywynq pa-
Kpdc KupTnq ailioaTaTiKnq Xaöiöoq, htk;
d^ia dva(t)avn Eiq Tnv KOiXÖTnTa Tfjq ^irj«
Tpaq 6iavoiy£Tai Kai auXXapödvEi Td ei«;
aCrrnv eiaayÖMEva dKpa toü Taiarröv, oti«
va Kai eXkei rrpöq Td £^w, Kaö' Öv xPO^ov
ö ßon6öq eXkei iaxupwq Td dKpa toü tcm-
TTÖv, TTpo6aivo|iEv EIC Triv dcpaipEOiv toO
TTXaKoüvTOq Kai Eiq Tnv auppa<pnv toü im-
TpiKoü Tpaüpiaroq. MeTd TaÜTa EKTeXoüuev
yiaXd^eiq Tiiq jjinTpaq rrpöq rrpÖKXnaiv a^j-
aToXwv aürnq, iviaxüovTeq TaÜTcq öi' ivt"
OEwq TriTouiTpivnq Kai TTEpaivojiEv ttjv £y
XEipnoiv 5id auppacpfjq twv KoiXiaKwv toi-
XWudTwv.

'E^£TeXeaa|iEv ji£XP« Toü5e öktw Kai-
aapiKdq Topdq, £(q dq i(pnPJi6oa|iev Tnv
liE6o6ov ToÜTnv jieT'^ ^^aipETiKiiq ^ttitux»'
at;. 'Etti to ßotaEi Triq Treipaq fiv Eaxnt^ot-
TiaapEv, T^ ^KTEXEaiq Triq EyxeipnoEwq koI
T^ Eiaaywyn toO TajiTTÖv 5eov vd yiveTa»
Korrd TÖv dKÖXouöov Tpörrov. Aiavoiyo|jEv
Td KoiXiaKd TOixwMOrra 5i' dTTinnKOuq to-
(ific Kai d(i>oü eiaaydyouev tiq Tnv tteoi-
TovaiKnv KOiXÖTnTa ^eydXa arrXnvia, npö^
cTro<puynv EiapEÜaEwq eiq TaCrrnv Evapviou
üypoü, 5iavoiyop£v Trjv pnTpav «pEpovreq
eyKapaiav TO^nv eiq tö dvwTepov Tianpa
TOÜ aüxevoq. Eito CTuXXaii6dvou£v tö ki-
TWTEpov \iiv XE^^oq TOÜ TpaüuaToq 5i* dy-
KioTpoEiöwv Xa6i6wv, tö 6e dvwTepov 5id
6iaaToXEwq Kai SiavoiyoMev toüto eupewq,
6<poij 3e6aiwq TTponyoupevwq ExopEv Trpo-
6r\ Eiq Tnv ^^aywynv toü ^|i6püou. Metä
Taüra 6iox£teüom£v Td cKpa Tnq YotCn*^
6td TOÜ koXeoü Trpöc fd e^w, ivd 6e ö &o-
nööq 2Xk£i TaÜTa Iaxupwq, uTro6onöoü|i£v
6id Tiiq xEipöq Tnv eTaoöov toü TaiiTTÖy eIi;
Trjv KOiXÖTnTa Tnq unTpaq. *Edv i\ lanTpa
EXT) auoToXfi KaXwq Kai biv ürrdpxEi kiv-
6uvoq SEUTEpoyEvoüq aiiiopporyiaq, £vE<ct
dToviaq Tnq lanTpaq^ tö TajiTTÖv Süvonrai
vd d<paipe9n dpEawq^ METd Tnv ^yyEipnoiv
'Ev ^vorvTia TTEpiTTTwoEi £<j)apii6<^oiiev ^töv*
Treaaöv Kai Tr|v Xa6i6a, wq tö toioütov
TTpdTTOtJiev KaTd Tdq aijioppayiaq ^ tvEKa
dToviaq Tnq pnTpaq uETd töv toketov. 'Ev
ToiaCnr} TTEpnrrciaei 1^ d<;>aipeaiq tou Tau-
TTÖv TeXelTai meto 2 — 3 wpaq. 'H oixrro-
Xn TWV jinTpiKwv ToixtoMaTwv uETd Tnv ei-
aaywyn V TOÜ Tay-TTÖv ETTEpxETai eüyepecTTe-
pov, oü Movov eveKa toü i< ToCrrou ^"^^0"
XOMEvou ipe9iaiioG,^dXXd Kai Iveko Tnq ^»c
Triq aupTTiEaEwq twv pnTpiaiwv dpTripioy
ETTEpxonEVTiq dvaiuioq TOÜ öpydyoü, cbq t6
toioütov auMÖaivei Kai KOTd tfjv au^TTte-
aiv Triq dooTtiq. E(c toüto tTrianc auvTe-
Xei Kai T*! 5id tou touttöv cruiiTTieaiQ twv
yayyXiwv toö Fronkenhoeuser.

AtnovönTov eTvai 6ti ttpö Tnq ^yxEipn-
aEwq 6eov vd ÜTtdpX!! TrpoxEtpov tqhuöv

dTTEOTeipWMEVOV.

TeXoq, lTri9üMOU|iEv vd Toviacoiaev 6ti fj
PE9o5oq auTn eTvai TÖaov diTOTeXEauccTi-
Kn, wäre -n-daa KaiaapiKn Topfi eiq t6 p^X-
Xov 6d TeXnTai dvaipdKTwq, ^Xorrouvi^vTiq
oÜTO Tnq 6vno-iu6TnToq twv yuvaiKÖv Ka-
rd Tdc dyxEipnaeiq TaCrraq eiq tö iXdx«-
otov. K. AOrOOETOnOYAOI

737

XAPTOrPA^ErTAT 0A0KAHP02 H PA A ATA
ME 17 MEPAAA EIAIKA AEPOnAANA

T6 'EBviKov r£coypa<|>iK6v 'IvcttitoCtov
•XT\^ PaXXiaq Sia vä KaTopTian äKpi-
ÖEaTOtTouq xopTaq öXwv tqv faXXi-
KÜv TTcpioxüv itpuSIaae mc cISikö Mnxovnua-
la ScKO CTTTCt depoTrXdva koi lioxicrc Tri*"
xapToypd(pr|0'iv tuv au(i(puva iit tcxq veaq
diraiTTiati^ TTJq yccoypafpiKnc itnaTHMnc
'O iayüuv arwitqov i-rriariMO«; xotpTn«; TnQ
roAXioq, 6 ÖTToioq cTxt auvxaxön M^ 6aatv
Taq TpiycovopETpiKdq KOI Td<; iraXaioTcpac

ßapoiicTpiKotq ji£865ou^, Biv SuvoTai irXeow
vä iCuirnpcTnatl TÖq ötvdyKoq iroXXüv ÜTrn-

pEaiÜV, TToXü TTCpiaCTOTEpOV 6c TflV ÖCpOTTO-

p(av ^v öijiEi ytviKtüfftMq töv auyKoivtoviwv
MC TTupauXoKiviiTa Kai iXiKO-rrTEpa. *H vca
xapT07päq)riaiq irap' öXov Öt« 5tv Elvai Ini-
TTOvoq.-^TTwq i\ TraXaid, 6id Tnv öttoiow 6
TOTToypdipo^ fJTO üiTOxpcu^Evoq vd dvepxETOi
MC irXfiÖoq 6apfuv öpydvww ^lt^rpT\atuiCi t\c,
Sua-rrpoaiTa ffiiMEio — d-n-aiTei iv toütoi? no- |

Xüpnvov Ipyaalav Kai ttpoctektiküv 2Xey-
xov Twv öpwv TTTriaEMc; KaTÖ Tnv iitoiav
XoM6dvovTai ai dcpoiixoTOYpacpiat .

Mexp» anjiEpov Exti xapToypa<|>n8n tö tv
TpiTov Trjq faXXiac;. 'H dvuTEpco <t>UTOYpa-
(pia Seikvüci t6 ^auTEpiKOv £vöc: in tüv 17
yaXXihüv depoTrXdvuv xapTOYpa(t>nCTttoq koB'
r]v ffTiyjin*' ol ^iTi6aivovTEq aüioO ^Xeyxouv
xd \xr]xavT\\iaja aÜToiiÖTOu XnOiECOc dEpo(pw-
Toypaiptwv.

738

«HAIOZ»

BAIIAEION THI EAAAAOI

YnOYPfEION KPATIKH2 YflEINHI KAI ANTIAHH^EOI •

AieuÖuvoij

rpaqjelov -

•Ev 'A0i]vc:i5 vfi

16/10/3t

=- o

> H

tl IT

5 w

2 'o
5 c

4
•4

A n 0 *!^ A £ I Z

«M

I) T^v and 26/6/35 aJTnöwv toü taxpoO h. * .pv^cvou *^6\Kcp
\kzxi xQv JtpocT)pTTj[i£vwv taÖT^ 6tH tuo\cYT)TtH(2v attou^i^vou T^v
XOp^YTjGiv iöcCas; ^etxoupY^as Zetpoü.üYtH?fe-ruv.4t»oXoYi'HTI^

2)'2^\^ UTi*apC^IJ«72 •.^•ava9opi?v toO *^YCtovotiu*iOÜ I^vxpou

* AtxtHoßotwxCa^ tr£x5 TOÜ auv?imievou Ta!?rp axctinoö 6eXtCou

cni&eupi^aeiag*

3)l'^v uii*apC^l686 £•?• Y^^iii^Teuaiv to3 */ivu)TaTOu '^y^^^ovo^^^-

HüU ü^ßouX^JU aTt09' iVD^i^voü uiicp x?5^ x^^^Y^'-cu)? t?5? avt*)T£piL

iZil 4) Tas ötiT^'ct^ TOiJ 16 IS *IavouapCou 1926 InTeXecTixot
li^iaTay\JL:j^xo^ xoO ilo^io^xtKoO Atax<Yl^axos •fiepf t5pu|i(5xwv
üYittv?!^ Haf taxptnfjs evY^vtt*

A U 0 9 L L I Z 0 11 S N,
XopTiYotJiiev ets x6v atxoüvxa '^I^pvfoxov : öXXep aöciav
^öguatmg naC KzixoopyCa^ evxafJ^ hiC cztC ti^s o5o0 AountavoO
15 Xc tpoupY infj^ ruvatHoXoYtK?J^-MateüxtH?I^ Ai.vtxf{^#

'O •X^üUOüpY^s;

. „MS-. Mii*'»**^««

iaMmnMMMMII

■MB;

i
i

(

: )

I I' (Fortsetzung auf Seite 36)

Statt dieser Originalmethode ist die Modifikation nach Kielland
vorzuziehen. Durch diese Operation wird der zwischen Corpus und Cervix
uteri vorhandene Winkel aufgehoben und die Cervix dadurch auf die hin--
tere Vaginalaxe verlagert.

Die Vagini fixation nach Sohauta-^Wertheim mit oder ohne Modifizier
rung nach Kielland habe ich in der lezten Zeit wegen der relativlt^großen
Mortalität und wegen der nicht seltenen Rezidiven verlassen. Ebenso wäHde
ich aus dem gleichen Grunde nicht mehr die vaginale Total ext irpation an,
die ebenso gute statt sMsohe Resultate gibt, aber doch einen größeren Ein--
griff darstellt, sondern begnüge mich mit der Abtragung des ganzen unteren
Teiles des Uterus im Zusammenhang mit der Bildung einer engeren Vagina und
eines starken Perineums. Die Operation ist leicht auszuführen und hat mir
bis Jetzt die besten Resultate gegeben. Si€ ist im Prinzip der hohen Portio
amputatiom ähnlich, mit dem Unterschied, daß der Uterus viel weiter oben bis
zum Fundus abgetragen wird,wofür ich vorschlage fJf^ÄJwfaie Uterusam^utation.

Die Operation wird auf folgende Weise ausgeführt: Die Portio wird
mit Kugelzangen gefaßt und stark nach abwärts gezogen. Nun wird die Scheide^
wand in ihrer ganzen Dicke mit einer kräftigen gebogenen Schere l/2cm. ober-
halb des Überga7iges der Scheiden in die Portioschleimhaut zirkulär umschni-
tten und teils stumpf , teils mit der Schere etwas nach oben präpariA. Die
Blasenwand wird Jetzt nach oben zu abgespannt und mit$ /kleinen Schnitten di$^
nun deutlich sichtbar werdenden vesicocervihalen Bindegliedstränge getrennt
und dadurch die Blase von ihren festeren Verbindungen mit der Cervix loage--
löst. Die Blase wird dann mit dem Finger nach oben geschoben. Nachdem auch
die seitlichen Blasenpartien nach oben und nach derSeiiif geschoben worden
sind, legen wir das vordere Vaginalspäkulum unter die Blase und iringen sie
und die Wticä^äA Ureteren auf diese Weise außerhalb des Operationsgebietes.
Das nun deutlich sichtbare Peritoneum^ wird mit einer Pinzette gefaßt und
mit einem Scherenschlag geöffnet und die Öffnung nach beiden Seiten erweiJ*
tert(Abb.71,75,76,77). Das so ^0öffnet^ Peritoneum zieht sich von selbst o-
der mit Nachhilfe des Fingers durch das Abwärtsziehen des Uterus zurück und
wird mit einigen Nähten auf die vordere Uteruswand 0^^ 3V2-3 cm. unterhalb
der Fundusoberfläche befestigt. Die Scheide wird dann auf beiden Seiten
hochgeschoben, nachdem die Uteringefäße mit Klemmen gefaßt und unterbunden
worden sind. Die Portio wird stark nach vorne gezogen, das Douglas Perito-
neum geöffnet, nach oben geschoben und auf die hintere Uteruswand und in deX
gleichen Höhe mit dem Blasenperitoneum mit einigen Nähten befestigt. Der
nun freiliegende Uterus wird direkt unterhalb der Peritoneal nähte mit dem

Messer oder mit der Schere abgetragen. Die Uteruswunde wird nach der Metho-
de von StuiOndorf mit der ^aginalwandung bedeckt.

4 .^ X ^JL .

:5SS3B3SSK

'n^'-^

'"^ f

>^3*

Bei kleinen atrophischen Uteri verzichte ich auf die Eröffnung des Pfrito--
neums, dasselbe wird möglichst hoch geschoben und der Uterus direkt unterhalb
der Insertionsätelle des Peritoneums abgetragen. Anschließend wird die vordere
und hintere Vaginalplastik und dte Bildung eines festen Beckenbodens vorgenom-
Tfienm

Die Resultate der Operation sind so günstig, daß dieser Eingriff in meiner
Klinik bei großen Uterusprolapsen die Operation der Wahl darstellt. Ich habe
bis Jetzt bei 81 Fällen die Sich selbst operiett habe nur ein Rezidiv des
Scheidenvorfalles beobachtet, so daß eine Wiederholung der plastischen Opera--
tion der Scheide notwendig wurde. Die B*» Todesfälle die vomommen sind/nicht
auf die Art der Operation zurückzufuhren, da die eine an Embolie und die. zwei-
te an septischer Urämie ^AfNt starb. Es handelte sich bei beiden um sehr herun-
tergekommene Patient inen.

Der Vorteil der Operation ist, daß die Ausführung leicht ist und die Gefahr
äußert gering, da man S4Ää* der Peritonealhöhle gar nicht in Berührung kommt.

Bei jungen Frauen beste^fein i;eiterer Vorteil daß die Menstruation erhalten
bleibt.

-«MMMMaHMBl

Obwohl die erste Auflage von längerer Zeit vergriffen war, ist es
nicht möglich gewesen die zweite erscheinen zu lassen.

Bei der zweiten Auflage sind zwei neue Methoden hinzugefügt worden.
Die erste betrifft die Geburtshilfe; es handelt sich um die Therapie der
atonischen Blutungen nach der Geburt der Plazenta.

Die zweite ist die subfundale Uterusamputation bei Prolapsen und bei Me-
trorrhagien.

Da ich durch diese Methode bessere Reim^ltate erreicht habe, werde
ich nicht mehr die sagitale ITterusamputati on beschreiben.

Athen den,

K. L0G0THET0PUL03 .

— ^(

i\o

/ l^

4^>

Zentralblatt für Gynäkologie

Gegründet von H. FRITSCH. Herausgegeben von Geh. Med.- Rat Prof. Dr.
^V. STOECKEL, Berlin. Jährlich 52 Hefte. 1940 im 64. Jahrgang, gr.8».

Viertel) ährlidi RM. 14.60

Als einzige Wochenschrift In der deutschen Frauenheilkunde und Oeburtsiillfe ist das Zentralblatt eine Zeitschrift de»
praktischen Frauenarztes. Die 62 abjreschlossenc n Jahrgänge sind in der ganr '»-ont die Annalen einer entscheidenden
Entwicklung, anderste, gebend oder nehmend, immer aber tätigen Anteil hatt» So wie sie mit ihren Beiträgen auf manch
einem Gebiet dem Stand der Zei-* wegweisend vorauseilte, hatte sie auch 1 funktionellen Denken, seinen Anbruch früh
erkennend, die Bahn In die Frauenheilkunde geebnet. Neue,vorwärtS8türmeiide Fragengruppen, Hormonforschung, Diätetik,
Erbbiologie, Bäder- und Kümakundf, wurde offenen Blicks und frei von theoretischer Spekulation untersucht, wie es über-
haupt das Kennzeichen des Zentralblattes ist, frühzeitig aus dem erst Werdenden, noch Fließenden das für den Praktiker
Verwendbare sorgsam herauszuarbeiten. Besonders anreg-jnde und lehrreiche Fälle werden kasuistisch erfaßt und für weitere
Verwertung der Erfahrungen festgehalten. Dem berechti-^ten Streben des Frauenarztes nach einer Weitung des Blicks über
das engere Fachgebiet hinaus dienen Beiträge aus Nachbarfächern. Laufend erscheinen Sitzungsberichte der verschiedenen
Gesellschaften; und Einzelreferate, auf die der umsieht ge Arzt weder verzichten kann noch will, unterrichten über die

Arbeit anderer Fachotgane in zeitsparender Form.

Gynäkologisdie Operationen

Von Prof. Dr. F. von MIKULICZ-RADECKI, Direktor der Univ.-Frauen-

klinik, Königsberg i. Pr. VI, 132 Seiten mit 146 meist farbigen Abbildungen.

1933. 4*. Geb. RM. 19.50

(Erweiterter Sonderdruik aus Bier- Braun- Kümmelt, Chirurgische Operationslehre, 6. Aufl.,
Band IV, herausgegeben von F. Sauerbruch und V.Schmieden)

Zeitschrift für Geburtshilfe: In diesem Werk erfährt die Operationstechnik der Stoeckel sehen Schule eine ganz hervorragende
Darstellung. Die vaginalen Methode\i, die an dieser Klinik in besonderem Maße gepflegt werden, sind in Wort und Bild
so klar und verständlich geschildert, daß auch der vaginal nicht sehr geübte Gynäkologe sicher großen Nutzen aus dem
Studium dieser Operationslehre ziehen wird. Es besteht für den operierenden Arzt die Gefahr, in seiner Methodik zu er-
starren und Ich halte das Buch des Verfassers gerade darum für so wertvoll, weil es den Operateuren anderer Schulen die

eigene Technik so klar und bis in alle Einzelheiten darstellt.

Die Praxis dt^r Ster ilisierungsoperationen

Von Prof. Dr. K. H. BAUER, Direktor der Chir. Univ.- Klinik, Breslau, und

Prof. Dr. F. von MIKULICZ-RADLCKI, Direktor der Univ.-Frauenklinik,

Königsberg i. Pr. VI, 1 76 Seiten mit Ql Abbildungen. I936. gr.8°.

RM. 15.40, geb. RM. 17.—

Berichte Ober die gesamte Gynäkologie: Die Verfasser geben Jedem Operateur, der sich mit den Problemen der Sterilisierung
zu befassen hat, wertvolle Hinweise in die Hand. Ganz besonders sind die Indikationsstellung zur Sterilisierunf sowie
alle sich an diese anknüpfenden Fragen sowohl Juristischer als auch medizinischer Natur und die bisher auf diesem un-
geheuerwichtigen Gebiet gesammelten Erfahrungen herausf^estellt. Welt über den Rahmen eines Nachschlagewerkes hinaus
gibt es Jedem den Anreiz, etwa bestehende Unklarheiten zu beseitigen. Die Vor- und Nachteile aller bisherigen Sterilisierungs-
methoden sind kritisch behandelt. Ein anschauliches Bildmaterial begleitet den Text ; alles in allem, endlich das Standardwerk.

"' Schmidt v. Elmendorf

Deutsches Gynäkologen-Verzeidmis

Wissensdiaftlidier Werdegang und wissensdiaftlidies Sdiaffen deutsdier
Gynäkologen. Herausgegeben von Geh. Med.- Rat Prof. Dr. W. STOECKEL,
Berlin. Bearbeitet von Dr. F. M1CHEI.SSON, Sdiömberg im Sdiwarzwald.

2. Auflage. XII, 581 Seiten. 1939- gr.8«.
Geb. RM. 28.—. Für Mitgl. d. Deutsdien Gesellsdi. f. Gynäkologie RM. 24.80

Das „Deutsche Oynäkologen-Ver: elchnis" bietet die genauen Anschriften der arischen, deutschsprachigen Gynäkologen des
In- und Auslandes. Doch ist dieses Werk mehr als nur ein zuverlässiges „Adreßbuch", es enthält weiter den beruflichen
Werdegang dieser Gynäkologen und ihre wissenschaftlichen Arbeiten in Büchern und Zeitschriften. Die Gynäkologen der
Ostmark und des Sudetengaues vurden g-eichfalis mit aut'genommen. Die Aufgliederung des reichhaltigen ^toff es nach

verschiedenen sachlichen Gesichtspunkten gewährleistet, alle gewünschten Auskünfte rasch zu find
Ein ausführliches Probeheft sende ich Ihnen gern kostenfrei

iTn.

JOHANN AMBRO SIUS BARTH / VERLAG / LEIPZIG

KONSTANTIN LOGOTHETOPULOS

I.-

GYNÄKOLOGISCHE

CHIRURGIE

«r> •>

JOHANN AMBROSIÜS BARTH /VERLAG / LEIPZIG

r t

' f'

[

VORWORT J^,H Oi-Utti Ä^uL._L^^:

Die Herausgabe einer neuen in deutscher Sprache geschriebenen gynäkologischen
Operationslehre hieße ,, Eulen nach Athen tragen", da ja schon eine große Anzahl
schöner, allen Anforderungen Rechnung tragender deutscher Werke vorhanden ist.
Aber jeder Chirurg weiß, wie lehrreich und vorteilhaft es ist, andere erfahrene Of)era-
teure bei ihrer Arbeit zu beobachten, um dadurch sein eigenes Können, besonders hin-
sichtlich der Technik, zu erweitern. Ein solches direktes Beobachten wird nun oft aus
äußeren Gründen nicht möglich sein, und man muß zu Ersatzmitteln greifen, zu Be-
schreibungen und Abbildungen, wie wir sie in den bekannten Operationslehren und in
den Fachzeitschriften finden. Mancher Operateur hält die Veröffentlichung von tech-
nischen Kleinigkeiten für überflüssig, obwohl gerade durch solche Angaben die Aus-
führung der bekannten typischen 0})erationen erleichtert wird. In diesem Buch will
ich die in meiner Klinik in Gebrauch befindlichen und bewährten Oi)erationen, sowohl
typischer Art wie auch von mir angegebene Modifikationen und eigene Methoden aus-
führlich beschreiben. Ich gehe jedoch auf Operationen, die in allen Kliniken in gleicher
Art und Weise, sowie auf solche, die in unserer Klinik selten ausgeführt werden, wie
z. B. die erweiterte abdominale Uterusexstirpation, nicht näher ein, da sie ja in allen
Operationslehren ins einzelne gehend abgehandelt sind.

Besonderen Wert habe ich auf die genaue Schilderung der vaginalen Operationen
gelegt, die meines Erachtens heute nicht mehr gebührende Berücksichtigung bei der
Ausbildung junger Gynäkologen finden, obwohl nur der Gynäkologe, der die vaginale
Technik voll und ganz beherrscht, die richtige Indikation stellen kann, ob vaginal oder
abdominal vorgegangen werden soll, und alle Vorteile des vaginalen Weges gebührend
zu schätzen weiß. Es dürfte nicht vorkommen, daß die einzige Indikation zum abdomi-
nalen Vorgehen die mangelnde Erfahrung und ungenügende Technik im vaginalen
Operieren ist. Man darf auch nicht vergessen, daß dem im vaginalen Operieren Geübten
seine subtilere Technik beim abdominalen Vorgehen sehr zustatten kommt.

Ich habe ferner vermieden, auf Indikationsstellung einzelner Operationen näher
einzugehen, da das dem Zweck dieses Buches nicht entsprechen würde und da in fast
allen Lehrbüchern genügend genaue Erörterungen vorhanden sind. Aus dem gleichen
Grunde vermeide ich Beschreibung der Operations Vorbereitung, der Asepsis, sowie der
Nachbehandlung und der Narkose.

Den größten Wert legte ich auf die sorgfältige Ausführung der Abbildungen, die
unter Zuhilfenahme von während der Operation angefertigter Skizzen und Photo-
graphien von Frau Margarete We n d 1 a n d unter meiner Kontrolle gezeichnet wurden.
Für ihre unermüdliche, gewissenhafte Arbeit spreche ich der Künstlerin, die sich
mehrere Monate in Athen aufhalten mußte, auch an dieser Stelle meinen Dank aus.

Athen, August 1939

K. LOGOTHETOPÜLOS

\'\

INHALT

Allgemeiner Teil Seite

1. Mittel zur Blutstillung 1

2. Blutstillungsmethode für Notfälle nach Logothetopulos 5

3. Laparatomie ^^

a) Lagerung der Patientin ^ 1

b) Der Medianschnitt ^^

c) Suprasymphysärer Querschnitt nach Pfannenstiel 15

d ) Bauchdeckennaht ^ ^

e) Erleichterung der Appendektomie beiLängs- und Querschnitt nach Logothetopulos 16

f) Freilegung des Operationsgebietes durch Abstopfen der Darmschlingen 17

g) Peritonisierung und Drainage der Bauchhöhle 19

4. Vaginale Operationen 1^

a) Colpocoeliotomia anterior 23

b) Colpocoeliotomia posterior "3

Spezieller Teil

I. Chirurgische Behandlung der Lageanomalien des Uterus 24

A. Retroversioflexio uteri 24

1. Fixation der Lig. rotunda 24

a) Operation nach Alexander- Adams 24

b) Operation nach Olshausen 24

c) Operation nach Doleris 25

d) Operation nach Webster-Baldy 25

2. Abdominale Vesikof ixation 25

3. Verkürzung der Ligamenta rotunda mit gleichzeitiger Vesicof ixatio
uteri nach Logothetopulos 26

4. Direkte Befestigung des Uterus an den Bauchdecken 27

B. Descensus und Prolapsus vaginae 27

1. Vordere Kolporraphie 27

2. Hintere Kolporraphie und Perineoplastik 29

3. Operation des veralteten kompletten Dammrisses 32

C. Descensus und Prolapsus uteri 35

L Interpositio uteri vesicovaginalis 35

II. Operationen an der Vulva ^^

1. Exstirpation der Bartholinischen Drüse 36

2. Carcinoma vulvae

III. Vaginale Operationen am Uterus

1. Ausschabung des Uterus

Komplikationen bei der Ausschabung *^

2. Operation alter Zervixrisse. a) nach Roser-Emmet. b) nach Sturmdorff 45

3. Diszision der Cervix nach Pozzi ^^

4 yinitiflllii iitiiii^<il'» Uii'iiiiiii vj-tinn vor d b r #«ii c i 4€r a.u s 46

VI Inlmlt

Seite

5. D io vaginalo Totaloxst iri)ation dos UtoruH ^^

a) Vaginale Totalcxstirpation mit Spaltung der vorderen Uteruswand 55

b) Vaginale Totalexstirpation des Uterus mit Spaltung dvr vorderen und hinteren
Uteruswand 5o

6. Vaginale Operationen bei Uterus myomatosus 56

a) Gestielte submuköse Myom(> (Polypen) ^"

b) Vaginale Enukleation von Myomknoten 56

c ) Vaginale Utorusexstiri)ation bei Uterus myomatosus 56

7. Erweiterte vaginale Operation des Carcinoma colli uteri 60

8. Abdominale Operationen am Uterus ^^

a) Das gestielte subseröse Myom ^3

b) Die Enukleation der Myome ^'^

c ) Die abdominale sagittale Uterusresektion ^'^

d) Die supravaginale Uterusexstirpation 6ö

e) Die abdominale Totalexstirpation des Uterus 71

9. Die Ovariektomie 74

a) Die abdominale Ovariektomie 74

b) Die vaginale Ovariektomie 78

10. Entzündliche Adnexerkrankungen 79

a) Abdominale Operation der entzimdlichen Adnexerkrankungen 80

b) Vaginale Operation der entzimdliehen Adnexerkrankungen 83

11. Craviditas extrauterina 86

12. Die chirurgische Behandlung der Parametritis 88

Die Behandlung der chronischen Parametritis durch künstliche Abszeßbildung nach

Logothetopulos 89

13. Die zirkumskripte Stenose der Scheide 93

14. Die totale Atresie der Scheide — 93

Häniatokolj)os und Hämatometra 93

15. Die Bildung einer künstlichen Scheide 93

16. Die Blasenscheidenf istel 94

Blasenscheidenfistel mit Zerstörung des Sphincter vesicae und der Harnröhre 100

17. Die Rektovaginalfistel 103

Sachverzeichnis 105

ALLGEMEINER TEIL

Vor Ausführung einer jeden Ojieration hat der Operateur genau abzuwägen, ob
die Größe und die Gefälirlichkeit eines Eingriffes dem beabsichtigten Zweck entspricht
und vor allen Dingen der Patientin Nutzen bringen wird.

Vorbedingung für einen günstigen Verlauf einer jeden Oi)eration ist die genaue
Befolgung aller Regeln der Asepsis. Um aber ein gutes Resultat zu erhalten, um nach
Möglichkeit alle Gefahren auszuschalten, muß der operierende Arzt operative Begabung,
also Gewandtheit und Technik besitzen. Diese Eigenschaften sind unerläßlich, um eine
genügende Schnelligkeit beim Operieren zu erreichen, denn je kürzer die Operations-
dauer, um so besser sind die Resultate infolge geringerer Narkosedauer, kleineren
Operationschocks und, wie experimentell nachgewiesen ist, geringere Verunreinigung
des Operationsfeldes mit Mikroben. Es bedarf nicht der Erwähnung, daß die Schnellig-
keit nicht auf Kosten der Blutstillung und der Asepsis erzielt werden darf. Unter
.,asei)tisch operieren'' versteht man natürlich nicht nur Verwendung sterilisierter In-
strumente, Tücher, Handschuhe usw., sondern hauptsächlich das Vermeiden der Über-
tragung von infektiösen Keimen durch sinnlose und unvorsichtige Mani[)ulationen von
infizierten Gebieten auf keimfreie während der Operation, wie z. B. bei der Eröffnung
der Scheide, des keimhaltigen Uterus oder eitriger Adnextumoren.

Das wirklich schnelle Operieren wird nicht durch bloße Fingerfertigkeit erreicht,
sondern vor allen Dingen durch systematische, zweckentsprechende Bewegungen unter
Vermeidung unnützer Wiederholungen, was nur bei genauer Kenntnis der Operations-
anatomie und persönlicher Erfahrung möglich ist,

1. Mittel zur Blutstillung

Immer muß der größte Wert auf genaueste Blutstillung bei der Operation gelegt
werden. Große Blutverluste schädigen den Gesamtorganismus und schränken seine
Abwehrkräfte gegen Infektion ein. Blutansammlungen in der Bauchhöhle können zur
Vereiterung führen, Hämatome der Bauebdecken verhindern oft die prima intentio
der Operationswunden. Kapillare Blutungen stehen meist von selbst und bedürfen
keiner besonderen Beachtung, solche stärkeren Grades werden durch leichten Druck
mit einer Gazekompresse zum Stehen gebracht. Kleinere Gefäße können mit einer
Klemme gefaßt werden, die nach einiger Zeit ohne Unterbindung wieder entfernt
werden kann. Man verwende immer das dünnste, eben noch ausreichende Katgut
zur Unterbindung, um die Resorption zu erleichtern. Bei den meisten gynäkologischen
Operationen fassen wir mit größeren, starken Klemmen mehrere Gefäße zusammen
mit dem sie umgebenden Bindegewebe (Abb. 1—4). Viele Chirurgen lehnen diese Art
der Unterbindung ab, da sie der Meinung sind, daß dadurch Gewebsnekrosen entstehen,
die Infektionen begünstigen. Das ist jedoch nicht richtig, da einwandfrei erwiesen ist,
daß trotz der starken Schnürung die Stümpfe noch genügend ernährt werden. Die
Schürzung des ersten Knotens soll geschehen, während der Assistent die Klemme lang-
sam und vorsichtig öffnet, wenn nötig mit beiden Händen, so daß der Faden langsam
in die Klemmfurche hineinrutscht. Hierauf macht man den zweiten und bei Katgut
auch noch einen dritten Knoten. Einen Fehler, den ich immer wieder bei jungen

Allgcmoinor Teil

1. Mittel zur Blutstillung

AsHistenten bemerke, möchte ich noch erwähnen. Sie stecken während der Unter-
bindung die Finger in die Löcher der Klemme und erschweren dadurch dem Operateur
die Arbeit, weil während der Ausführung der verschiedenen Unterbindungsmanöver
die Klemme nach allen Richtungen leicht beweghch sein muß; ist das nicht der Fall,
SU ist besonders in der Tiefe die Unterbindung kaum möglich. Erst nn letzten

Abb. 1.

Abb. 2.

Abb. 3. Abb. 4.

Abb. 1 — 4. Anlegung von Massenligaturen

Augenblick, wenn die Klemme geöffnet werden soll, führt man Daumen und
Zeigefinger in die Ringe ein. Die Methode der Blutstillung nach Doyen und
Tuffier, bei der mittels starker, kurzer Klemmen ein sehr starker Druck 2 Minuten
lang auf die Gefäße ausgeübt wird, die dadurch ohne Unterbindung geschlossen werden
sollen, ist wegen der Gefahr postoperativer Blutung wieder verlassen worden. Macht
bei vaginalen Operationen die Unterbindung von Gefäßen in großer Tiefe Schwierig-
keiten, so kann im Notfall die das Gefäß fassende Klemme für 2 — 3 Tage in der Wunde
liegen bleiben. Im allgemeinen steht dann beim Abnehmen der Klemme aber die Blu-
tung. Da das nicht immer der Fall ist, das Liegenbleiben der Klemme Schmerzen und

Abb. 5. Fübrungssonde nach Amann

Unannehmlichkeiten sowie Nekrose der Stümpfe mit erschwerter Wundheilung ver-
ursacht, so ist nach MögUchkeit stets die Unterbindung zu erstreben. J)iffuse Blutungen
werden durch Umstechung zum Stehen gebracht, oder man tam])oniert die blutende
Stelle mit Gaze, setzt die Oi)eration fort und entfernt den Tam[)on wieder am Schlüsse
der Operation. Sollte es dann trotzdem noch weiter bluten, so können wir erneut tam-
ponieren und den Gazestreifen zwecks Ableitung des Wundsekrets nach außen leiten.
Das geschieht besonders einfach bei der Totalexstirpation des Uterus, bei der wir die
tamponierende Gaze mittels der Amannschen Führungssonde (Abb. 5) durch das
Scheidenloch nach außen führen. Bleibt der Uterus erhalten oder amputieren wir
supravaginal, so wird
der Streifen durch
ein zu diesem Zweck
angelegtes Loch im
hinteren Scheidenge-
wölbe nach außen ge-
leitet und dann die
Bauchhöhle geschlos-
sen. Zuweilen gelingt
aber die Blutstillung
mit einfacher Tam-
ponade nicht, sei es,
daß die blutende
Fläche zu groß ist
oder daß eine erhöhte
Blutungsbereitschaft
des Körpers besteht.

In solchen Fällen, ebenso wenn Fassen und Unterbinden des Gefäßes mißlingt,
wird die Tamponade nach Mikulicz empfohlen. Dieses Verfahren ist recht brauch-
bar, jedoch muß man mit die Rekonvaleszenz verlängernden Sekundärinfektio-
nen rechnen, und falls es sich um die Tamponade durch eine Bauchwunde handelt,
ist die Gefahr eines postoperativen Narbenbruches sehr groß. Außerdem versagt die
Methode bei starken arteriellen Blutungen häufig vollkommen. Von lokal zu ver-
wendenden blutstillenden Mitteln machen wir keinen Gebrauch, ebenso verzichten wir
auf den Thermokauter, weil der sich bildende Schorf leicht Anlaß zu Infektionen gibt
und die Bildung von Adhäsionen begünstigt. Die Unterbindung der Arteriae hypo-
gastricae zur Bekäm])fung abundanter Blutungen kommt für meine Klinik seit Ein-
führung meiner Blutstillungsmethode nicht mehr in Frage. Sie wird noch von ver-
schiedenen Operateuren prophylaktisch vor Ausführung der eigentlichen Operation
zur Vermeidung starker Blutverluste ausgeführt, ist jedoch durchaus kein harmloser
Eingriff, wie folgendes Vorkommnis zeigt. In meiner Klinik wurde von einem sehr
bekannten ausländischen Gynäkologen eine abdominale Wertheimsche Operation
lege artis ausgeführt, und zwar mit vorhergehender Unterbindung beider Art. hypo-
gastricae. Die Bauchhöhle wurde offen gelassen und die große Wundhöhle mit Gaze
austamponiert. 20 Tage nach der Operation bemerkte man Urinabgang aus der Scheide.
Die Untersuchung zeigte eine Nekrose der Blasenwand, und das nekrotische Stück
konnte von oben aus in toto entfernt werden. Nach 2 V2 Monaten wurde die enorme
Blasenscheiden, jfistel" (Fehlen des ganzen Blasenfundus und der hinteren Blasen-
wand!) unter Benutzung der vorderen Rektalwand als Ersatz für die fehlenden Blasen-
teile von mir geschlossen.

4 Allgemcinor Teil

Um bei starken Blutungen das blutende Gefäß leichter auffinden zu können,
drückt man mit dem Finger unter Zuhilfenahme einer Kompresse die Aorta fest gegen
die Wirbelsäule, wodurch eine provisorische Blutstillung zustande kommt, die das
Fassen der Gefäße ermöglicht.

Abb. 6. Fixierung des vor der Vulva liegenden Wattebausches
mittels eines um die Scliulter gelegten Verbandes

Der Momburgsche Schlauch sowie die Vorrichtungen zur Aortenkompression
von Riediger und Sehrt sind nicht ungefährlich und werden von uns nur im äußer-
sten Notfall in der Geburtshilfe angewandt.

Bei Blutungen, die zuweilen nach Operationen an der Vagina oder an den äußeren
Genitalien auftreten und die meist auf Frühresor})tion von Katgutunterbindungen
zurückzuführen sind, kann eine Scheidentamponade den ganzen Erfolg einer Operation,
z. B. einer Plastik, in Frage stellen. Folgendes Verfahren hat mir stets gute Dienste
geleistet: Ich befestige einen vor den äußeren Genitalien liegenden Wattebausch
mit Hilfe einer Binde, die man zuerst zirkulär um die Hüften anlegt. Von hinten geht
man dann zwischen den Schenkeln nach vorn und über die Schultern und wiederholt

2. Blutstillungsmethodo für Notfälle nach Logothetopulos 5

diese Tour mehrmals, auf diese Weise einen starken Druck auf die äußeren Genitalien
ausübend. Aus Abb. 6 ist dieser Verband leichter verständlich wie aus einer genauen
Beschreibung.

2. Blutstillungsmethode für Notfälle nach Logothetopulos

[Von Nürnberger^) ,, Logotampon", von Sellheim^) ,, Griechenpilz" genannt.]

Um die Tampondrainage von den Bauchdecken aus zu vermeiden und eine erfolg-
reiche Tamponade durch die Scheide ausführen zu können, habe ich eine besondere

'^imy-'-^::m5!isSi,

We^^Oaa/.

Abb. 7. Blutstillungsmethode nach Logothetopulos.
Einführung des Tampons in das Scheidenlumen nach der Exstirpation des Uterus

Methode erdacht, die imstande ist, jede, auch die stärkste arterielle Blutung zu
stillen. Sie ist nur für den Notfall gedacht und hat sich in zahlreichen Fällen seit vielen
Jahren glänzend bewährt. Ich gehe in folgender Weise vor:

Ich fülle einen aus einem quadratischen Gazestück bestehenden Beutel fest mit
einem langen Gazestreifen aus, so daß ein etwa kindskopfgroßes, kugelförmiges Ge-
bilde entsteht. Die Größe des Tampons hängt von der Lage des blutenden Gefäßes
ab, sie muß um so größer sein, je weiter das Gefäß vom Beckenboden entfernt ist.
Die vier Zipfel der äußeren, quadratischen Gaze sowie das heraushängende Ende des

1) Zbl. Gynäk. 1926, Nr. 50, 3202.

2) Zbl. Gynäk. 1930 Nr. 21, 1318.

Allgcnnoinor T(m'1

2. Blutstillungsmothode für Notfällo nach Logothotopulos

T ^ ----«■'

Abb. 8. mnt»iillii>grTrffiiii(iliuitf

ScliematisclK^ Darstellung (l('s Vorganges in Abb. 7

Abb. 0.

lw^^<>i,Kn||npii \f\M Star-
ker Zug nach abwärts bis
zum Eintritt des Tampons
ins kleine Becken

^HHH

Abb. 13. Blutstilluugs-
methode nach Logothe-
topulos bei v^aginalen
Operationen. Ausstopfen
des leer eingefü hrten Gaze -
beuteis mit dem Streifen

Abb. 14. Hhitntillimjrnmrthnda itirifrh

K. Richtige Lage des
Tampons. Schematische Darstellung

Allgomoinor T(mI

fülle. Hierbei muß man darauf achten, daß der Streifen gleichmäßig nach allen Seiten
in die Beckenhöhle verteilt wird, so daß der gefüllte Beutel die Form eines Pilzes
annimmt (Abb. 14).

Zur Vermeidung von Nekrosen, die durch zu starken Druck des Pessars auf die
Vulva entstehen könnten, lege ich zwischen Pessar und Vulva auf beide Seiten des
Tamponstieles einen kleinen Wattebausch. Aus dem gleichen Grunde wird die vor
dem Pessar liegende Klemme nach 8 Stunden entfernt. Jede weitere Manipulation
an der Gaze muß man aber vermeiden, weshalb man das Pessar am besten noch einen
weiteren Tag liegen läßt. Am 3. Tag fängt man an, den inneren Streifen nach und nach
herauszuziehen, und am 5. Tag entfernt man auch die äußere quadratische Umhüllungs-
gaze des Tampons.

Einerseits um zu bestimmen, wie der Tampon wirkt, andererseits um seine genaue
Lage zu den Organen des Beckens festzustellen, wurden im hiesigen Anatomischen
Institut von Christo pulos unter der Leitung von Sclavunos Untersuchungen an
der Leiche angestellt i) . Es wurde einwandfrei festgestellt, daß Darm, Blase und
Ureteren außerhalb des unter Druck gesetzten Gebietes liegen und jede Schädigung
ausgeschlossen ist, was auch mit den klinischen Erfahrungen übereinstimmt.^) Ferner
blieb die Umgebung der durchschnittenen und nicht unterbundenen Art. uterinae
vollkommen frei von Farblösungen, die unter hohem Druck in die Karotiden ein-
gespritzt wurden. Beweis für die Sicherheit der arteriellen Blutstillung.

Auch bei postoi)erativen Blutungen war mir der Tampon zu wiederholten Malen
von größtem Nutzen. In solchen Fällen ap{)liziere ich den Tampon nach Wieder-
eröffnung der genähten Scheidenwände und des Peritoneums von der Scheide aus,
gleichgültig, ob vaginal oder abdominal operiert worden war. Bekommt der Tampon
die richtige Größe, d. h. füllt er das kleine Becken genügend aus, so steht die Blutung
in allen Fällen prompt.

Bei heruntergekommenen Patientinnen und komplizierten Bauchoperationen ver-
zichte ich, besonders dann, wenn eine Scheidendrainage notwendig wird, auf die Unter-
bindung der in der Tiefe liegenden, schwer erreichbaren Gefäße und lege den Tampon
ein, worauf die angelegten Klenmien wieder entfernt werden, bevor der Tampon end-
gültig in seiner Lage befestigt ist, in dem Augenblick also, in welchem der Assistent
den Tampon nach unten zieht. Ich sehe nicht ein, warum das Leben der Patientin
gefährdet werden soll, nur weil man die Blutstillung durch Unterbindung aller Gefäße
oder die genaue Peritonisation erreichen will, wodurch die Dauer der Operation erheb-
lich verlängert wird. Wer einmal die Anwendung des Tampons erlernt hat, wird seinen
Wert immer höher schätzen : er wird merken, mit welcher Ruhe und Sicherheit er jede,
auch die schwerste gynäkologische Operation ausführen kann, wenn er das Gefühl hat,
jeder unvorhergesehenen Blutung mit Leichtigkeit Herr zu werden.

Ich habe vaginale und abdominale Uterusexstirpationen in den größten Kliniken
Europas mit Erfolg ausgeführt (Paris: J. L. Faure; Leipzig: Sellheim; Wien:
Halban ; Berlin: Stöckel; Halle: Nürnberger), ohne ein einziges Gefäß zu unter-
binden und ohne eine Klemme zu hinterlassen, um die Wirkung des Tampons zu zeigen.
Aus diesem Grunde glaubten einige Kollegen, daß ich meine Blutstillung als Methode
der Wahl betrachte. Daß das nicht der Fall ist, habe ich in den vorstehenden Aus-
führungen dargelegt. Ich betone nochmals, daß mein Tampon nur im Falle der Not
bei anders nicht oder nur schwer zu stillenden Blutungen angewandt werden soll,
dann aber eine sichere, nie versagende Hilfe bietet.

1) Zbl. Gynäk. 1933, Nr. 14, 807.

2) Küstner, Zbl. Gynäk. 1933, Nr. 13, 773.

2. BUitstillungs;motho(lo für Notfälle nach Logothetopulos

Abb. 10. iHUtstülungsmethode nach L.og<>t-hetopulo.s. Tampon in situ

Abb. 11. DdntatittHngHinethodi
nach Logothetopiilos.
Starkes Anziehen der durch ein
Ringpessar gezogenen Tanipon-
zipfel nach unten. Die andere
Hand drückt gleichzeitig das
Pessar kräftig gegen die Vulva

Allgomoinor Teil

Streifens, das zur Unterscheidung etwas länger sein muß als die vier Zipfel, fasse ich
nun zusammen mit einer Amannschen Führungssonde und führe sie von der Bauch-
höhle aus durch die Scheide nach außen (Abb. 7 und 8), wo sie ein Assistent faßt
und kräftig nach unten zieht, bis der kugelige Tamj)on ins kleine Becken eintritt und
auf die Beckengefäße einen Druck ausüben kann (Abb. 9). Während der Assistent

zieht, hilft der Operateur von
oben durch Druck nach und
hält den Tampon so lange
tief im kleinen Becken fest,
bis er endgültig befestigt ist
(Abb. 10). Das geschieht auf
folgende Weise : Man zieht die
5 aus der Scheide herausragen-
den Zipfel der Gaze durch ein
großes Ringpessar, das man
mit der linken Hand fest
gegen den unteren Teil der
Symj)hyse, die absteigenden
Schambeinäste und den Bek-
kenboden anjireßt, während
die rechte Hand mit aller
Kraft an den Zipfeln zieht
(Abb. 11). Nun legt ein an-
derer Assistent eine starke
Klemme direkt vor das Pes-
sar, das sich nun zwischen
Vulva und dieser Klemme
befindet (Abb. 12). Selbst-
verständlich muß ein vor
der Operation vorbereiteter
Tampon steril vorrätig ge-
halten werden. Ich rate je-
doch immer, noch einen
zweiten gebrauchsfertiger^
Tam})on in Reserve zu hal-
ten, so daß beim unrichtigen
Einlegen der schlechtsitzende
Tampon sofort durch einen
neuen ersetzt werden kann. Damit der Stiel des Tampons dünner wird und
leichter herausgeleitet werden kann, schneidet man die sich beim Füllen des
Beutels auf den Seiten bildenden überflüssigen Falten ab. Jede Blutung steht
nach korrektem Einlegen des Tampons sofort, und man kann die Operation in
aller Ruhe fortsetzen. Der Beutel wird von den oberen Teilen der Bauchhöhle
abgeschlossen, indem man das Blasenperitoneum mit dem Rektum oder auch
der Flexur vernäht, was in den meisten Fällen leicht gelingt.

Um Blutungen bei vaginalen Operationen zu stillen, gehe ich auf die gleiche Weise
vor, nur mit dem Unterschied, daß ich zuerst den leeren Beutel durch die Scheiden-
wunde mit einem Stopfer (Abb. 13) oder mit einer langen anatomischen Pinzette in die
Bauchhöhle einführe, und dann erst den Beutel fest mit dem langen Gazestreifen aus-

Abb. 12.

Das Pessar wird diircli eine starke Kleinme in seiner Lage

gehalten. Schutz der Vulva durch eine untergelegte Oazelage

t seilt 21. i^ ,^t, linln Fall von Ulnarielühmmung

ieobaohft nab«. Infolge DruoHes deä Armes auf

tischea.

der Länge nach den Kör-

beobachtet werden. Bei
der Beckenhochlagerung
(Trendelenburg) müs-
sen die Schulterstützen
sehr gut anliegen. Die
Beine werden gespreizt am
Tisch befestigt, so daß im
Bedarfsfall leicht Mani-
pulationen an der Vagina
oder Blase vorgenommen

werden können (AW^T^lIQ-
Der Narkotiseur soll nicht
durch besondere Vorrich-
tungen von den Vorgängen
im Operationsgebiet ab-
getrennt sein, damit er die
Bauchatmung genau sehen
und die Tiefe der Narkose
nach dem Fortgang der
Operation regeln kann,
während dem Oj)erateur
die Kontrolle der Narkose

ermöglicht ist. Der rechtshändige Operateur steht auf der linken Seite der Patientin,
um leichter mit der rechten Hand in der Bauchhöhle manipulieren zu können. Ihm
gegenüber stehen die Assistenten, und rechts und etwas hinter ihm die Operations-
schwester. Der Instrumententisch soll möglichst nahe beim Operateur sein, damit er in
der Lage ist, sich im Bedarfsfalle die Instrumente selbst auszusuchen oder zu nehmen.
Die von manchen Operateuren benutzten kleinen 0])erationsbretter auf Brust
oder Bauch der Patientin halte ich für überflüssig, ja sogar für störend. Man
stellt besser hinter dem Assistenten noch einen kleinen Instrumententisch auf, auf
den man einige Kocher, Scheren usw. legt. Hier in Griechenland können wir auf
künsthche Lichtquellen fast verzichten, da das natürUche Licht jeder Kunstbeleuchtung
überlegen ist, auf die wir nur nachts angewiesen sind ; um zu grelles Licht zu vermeiden,
müssen die Fenster des Operationssaales nach Norden zu liegen.

Logothetopulos, Gynäkologische Chirurgie *

■\

-^ A \ •^'

l '«9 5 V3 » 0 '^ \ .r'

"' .■.

^< — — ,», »» .

5 aus der Scheide herausragen-
den Zipfel der Gaze durch ein
großes Ringpessar, das man
mit der hnken Hand fest
gegen den unteren Teil der
Sym])hyse, die absteigenden
Schambeinäste und den Bek-
kenboden an])reßt, während
die rechte Hand mit aller
Kraft an den Zipfeln zieht
(Abb. 11). Nun legt ein an-
derer Assistent eine starke
Klemme direkt vor das Pes-
sar, das sich nun zwischen
Vulva und dieser Klemme
befindet (Abb. 12). Selbst-
verständlich muß ein vor
der Operation vorbereiteter
Tampon steril vorrätig ge-
halten werden. Ich rate je-
doch immer, noch einen
zweiten gebrauchsfertiger^
Tampon in Reserve zu hal-
ten, so daß beim unrichtigen
Einlegen der schlechtsitzende
Tampon sofort durch einen
neuen ersetzt werden kann. Damit der Stiel des Tampons dünner wird und
leichter herausgeleitet werden kann, schneidet man die sich beim Füllen des
Beutels auf den Seiten bildenden überflüssigen Falten ab. Jede Blutung steht
nach korrektem Einlegen des Tampons sofort, und man kann die Operation in
aller Ruhe fortsetzen. Der Beutel wird von den oberen Teilen der Bauchhöhle
abgeschlossen, indem man das Blasenperitoneum mit dem Rektum oder auch
der Flexur vernäht, was in den meisten Fällen leicht gelingt.

Um Blutungen bei vaginalen Oi)erationen zu stillen, gehe ich auf die gleiche Weise
vor, nur mit dem Unterschied, daß ich zuerst den leeren Beutel durch die Scheiden-
wunde mit einem Stopfer (Abb. 13) oder mit einer langen anatomischen Pinzette in die
Bauchhöhle einführe, und dann erst den Beutel fest mit dem langen Gazestreifen aus-

Abb. 12. Htotafe^ui^Miif t hnrtr nuntT i4 rij[|i< hnfapiiLn
Das Pessar wird durch eine starke Klemme in seiner Lage
gehalten. Schutz der Vulva durch eine untergelegte Gazelage

(

3. Laparotomie

3. Laparotomie
a) La^tTuii«: der Patientin
Die Lagerung der Patienten soll so sein, daß weder der Operateur noch die Assi-
stenten in ihrer Arbeit behindert werden, auch darf für die Patientin keinerlei Schaden
entstehen, wie z. B. Radialislähmung durch Druck des Nerven auf die ungei)olsterte
Tischkante und dgl. Ich
vermeide das, indem ich
die Arme mit Hilfe einer
unter dem Körper durch-
geführten Binde so be-
festige, daß sie gestreckt
der Länge nach den Kör-
})er der Patientin berührend^ g»»
Der Puls kann vom Nar-
kotiseur an der Karotis
beobachtet werden. Bei
der Beckenhochlagerung
(Trendelenburg) müs-
sen die Schulterstützen
sehr gut anliegen. Die
Beine werden gespreizt am
Tisch befestigt, so daß im
Bedarfsfall leicht Mani-
pulationen an der Vagina
oder Blase vorgenommen
werden können (Ab^r=?53-
Der Narkotiseur soll nicht
durch besondere Vorrich-
tungen von den Vorgängen
im Operationsgebiet ab-
getrennt sein, damit er die
Bauchatmung genau sehen
und die Tiefe der Narkose
nach dem Fortgang der
Operation regeln kann,
während dem Oi)erateur
die Kontrolle der Narkose

ermöglicht ist. Der rechtshändige Operateur steht auf der linken Seite der Patientin,
um leichter mit der rechten Hand in der Bauchliöhle manipulieren zu können. Ihm
gegenüber stehen die Assistenten, und rechts und etwas hinter ihm die Operations-
schwester. Der Instrumententisch soll mögUchst nahe beim Operateur sein, damit er in
der Lage ist, sich im Bedarfsfalle die Instrumente selbst auszusuchen oder zu nehmen.
Die von manchen Operateuren benutzten kleinen Operationsbretter auf Brust
oder Bauch der Patientin halte ich für überflüssig, ja sogar für störend. Man
stellt besser hinter dem Assistenten noch einen kleinen Instrumententisch auf, auf
den man einige Kocher, Scheren usw. legt. Hier in Griechenland können wir auf
künstliche Lichtquellen fast verzichten, da das natürliche Licht jeder Kunstbeleuchtung
überlegen ist, auf die wir nur nachts angewiesen sind ; um zu grelles Licht zu vermeiden,
müssen die Fenster des Operationssaales nach Norden zu liegen.

Logothetopulos, Gynäkologisclie Chirurgie

Allgomeinor T(ül

Abb. 16. Einlegen des Bauchdcckenhaltcrs nach Logothetopulos

Abb. 17. Einlegen des Baiichdeckenhalters nach I»ofK>t'li»topiil€m. Spreizen der Blätter

3. Laparotomie

Die bei Lai)arotoniien gebräuchlichen Instrumente sind in meiner Klinik die in
deutschen gynäkologischen Küniken allgemein üblichen. Spezielle Instrumente werde
ich besonders erwähnen. Große Erleichterung beim Nähen der Bauchdecken bietet
die Reverdinnadel, von der man eine stark und eine schwach gebogene vorrätig hält.
Ihre subtile Bauart verlangt sorgfältige
Pflege, damit sie stets gebrauchsfertig bleibt.
Sie wird in Frankreich fast ausschließlich
zum Nähen benutzt.

Von der Firma Stiefenhofer in München
wurde ein selbsthaltendes vierblättriges
Spekulum nach meinen Angaben hergestellt
(Abb. 16 — 17), dessen Anwendung sehr be-
quem ist, und das den großen Vorteil
hat, auch bei kleinen Bauchschnitten beste
Zugänglichkeit des 0})erationsgebietes zu
erreichen. Die Blätter des Halters werden
in zwei Größen hergestellt, entsprechend
der verschiedenen Dicke der Bauchdecken.
Sie sind leicht auswechselbar. Nach Eröff-
nung des Bauches zieht man zunächst mit
gewöhnlichen Spekula die Bauchdecken
auseinander, worauf das selbsthaltende Spe-
kulum leicht eingelegt werden kann.

b) Der Medianschnitt

Er fängt oberhalb der Symphyse an
und wird genau in der Mittellinie senkrecht
nach oben geführt, soweit es die Operation
erfordert. Wir suchen mit nicht zu großen
Schnitten auszukommen und beginnen stets
mit einem kleinen Schnitt, der je nach
Bedarf verlängert werden kann. Durch
Spaltung der Haut nach abwärts über die
Symphyse wird bei fetten Frauen das Ope-
rationsgebiet zugänglicher^). Eine Verlänge-
rung nach oben über den Nabel hinaus
kommt nur ausnahmsweise für ganz große
Tumoren in Frage. Haut und Unterhaut-
zellgewebe spalten wir bis auf die Aponeurose

mit dem Messer. Diese selbst wird von einem kleinen Einschnitt aus mit der Schere
gespalten und hierauf die beiden M. recti mit der geschlossenen Schere und den
Fingern voneinander getrennt (Abb. 18). Jetzt führen wir zwei Bauchspekula ein und
lassen sie vom Assistenten halten. Das Peritoneum wird mit zwei Pinzetten gefaßt,
hochgehoben und durch Hineinstechen mit der geschlossenen stumpfen Schere eröffnet
(Abb. 19), also nicht unter Verwendung schneidender Instrumente^). Durch das ent-
standene Loch dringt Luft in die Bauchhöhle und der Darm fällt zurück, worauf
das Bauchfell leicht mit der Schere ganz eröffnet werden kann (Abb. 20). Bei diesem

Abb. 18. Bauchdeckenlängsschnitt.
Stumpfe Trennung der Mm. recti

1) Kuhlenkampf, Zbl. Chir. 1924, Nr. 30.

2) Zbl. Gynäk. 1933, Nr. 15.

Abb. 19. Eröffnung dos Peritoneum nach Logothetopulos. Anhebung des Peritoneum
mittels zweier Pinzetten und Durehstechung mit der geschlossenen Schere

Abb. 20. Erweiterung der Peritonealöffnung mit der Schere

3. Laparotomie

Vorgehen ist eine Verletzung des Darmes unmöglich, da im Augenhlick der Durch-
bohrung der Darm zurückweicht und nicht verletzt werden kann, selbst wenn eine
Schlinge versehentlich mit der Pinzette mitgefaßt sein sollte. Vorteile des Median-
schnittes sind sein blutloser Verlauf, Fehlen von Funktionsstörungen an Muskeln und
Nerven und die Möglichkeit, ihn beliebig nach oben zu vergrößern.

e) Suprasymphysärcr Querschnitt nach Pfannenstiel

Wir durchschneiden mit dem Messer die Haut und das Unterhautzellgewebe
2— 3 cm oberhalb der Symphyse in querer Richtung in einer Länge von 5 — 20 cm
und mehr, je nach Art der Operation und Dicke der Bauchdecken. So wie beim Median-
schnitt machen wir zuerst einen kleinen Einschnitt in die Faszie mit dem Messer und
vergrößern ihn dann mit der Schere in querer Richtung. Faszie und Muskeln werden
in der Mitte, wo sie in festem Zusammenhang stehen, mit der Schere voneinander
getrennt, was durch Anheben der Faszie mit den Fingern erleichtert wird. Diese Ab-
trennung muß in möglichst großer Ausdehnung mit Hilfe eines Tupfers ausgeführt
werden, damit das Operationsgebiet zugängUcher wird. Die Mm. recti werden, wie
beim Längsschnitt, mit der geschlossenen Schere und den Fingern stumpf auseinander-
gedrängt, das Peritoneum in oben beschriebener Weise eröffnet und mein selbsthalten-
des Spekulum eingeführt, durch das die Öffnung stark erweitert werden kann

(Abb. 16—17).

d) Bauchdeckennaht

Sie wird in horizontaler Lage ausgeführt, nachdem man sich überzeugt hat, daß
die Darmschlingen sich in ihrer normalen Lage befinden, und nachdem man das Netz
mit der Hand symphysenwärts gezogen hat, so daß der Bauchinhalt gut bedeckt wird.
Wir nähen schrittweise, zuerst das Peritoneum, dann die Mm. recti, deren Ränder beim
Längsschnitt von der Aponeurose frei gemacht werden, hierauf die Faszie und zuletzt

- Durchgreifend«' Seidonnaht

- Gaze rolle

- M i (• h (• 1 seht' Klammer

- Fasziennaht

Peritoneainaht

Abb. 2L Schematische Darstellung unserer Bauchdeckennaht

Unterhautzellgewebe und Haut. Für diese Etagennaht wird Katgut verwendet, da
im Falle einer Eiterung bei Seidennähten die ganze Wunde eröffnet werden müßte,
um alle Seidennähte zu entfernen, die andernfalls zu Fistelbildung Veranlassung
geben könnten. Beim Längsschnitt legen wir durchgreifende Seidennähte nach Voll-
endung der Peritoneainaht durch Haut, Faszie und Muskulatur, dann wird die Faszie
fortlaufend mit Katgut genäht, die Haut mit Michelschen Klammern geschlossen
und zuletzt die durchgreifenden Seidennähte über einer längs der Wunde gelegten
Gazerolle geknüpft (Abb. 21). Halb an führt die durchgreifenden Nähte nur durch
Haut und Faszie, J. L. Faure auch durch das Peritoneum.

.«>— ir >— •■

Allgemcinor Teil

3. Laparotomie

Sehr gute Resultate ergibt die Amannsche Naht, bei der die durchgreifenden
Nähte so gelegt werden, daß die entsprechenden Schichten der Bauchwand zur Ver-
einigung kommen. Nach der Naht des Peritoneum mit fortlaufendem Katgutfaden
führen wir einen festen Seiden- oder Zwirnfaden mit einer 6-7 cm langen leicht
gebogenen Nadel oder besser noch mit Reverdin durch die Bauchdecken der einen Seite,
d. h. durch Haut, Faszie und Muskel, dann nur durch Muskel und Faszie der anderen
Seite und kehren wieder auf die erste Seite zurück, wo wir die Faszie allem fassen.

Abb. 22. BaiicluU'ekcnnaht nach Amann

Abb. 23. Hauchdcekcnnalit nach Amann.
Knoten von ']v zwei benachbarten Nähten über Gazetupfern

Abb. 23.

Hierauf führen wir den Faden durch Faszie und Haut der andern Seite wieder heraus.
Die herausragenden Fäden werden fest angezogen und je zwei derselben Seite über
einem Tupfer verknotet (Abb. 22—23).

Die Naht des Schnittes nach Pfannenstiel erfolgt ebenfalls etagenweise, indem
man zuerst Peritoneum, dann die Mm. recti, die Faszie, das subkutane Zellgewebe
und die Haut näht. Bei diesem Schnitt halten wir die durchgreifenden Nähte für
überflüssig, jedoch müssen wegen der Gefahr der Bildung von Hämatomen auch die
kleineren Gefäße sorgfältig unterbunden werden.

Die Entstehung von Bauchbrüchen kann nur durch exakte etagenweise Bauch-
deckennaht vermieden werden, aber nicht durch das ständige Tragen von Bauch-
binden, die, im Gegensatz zu früheren Ansichten, keinen wesentlichen Einfluß auf die
Hernienbildung haben.

e) Erlciehtcruns: der Appendektomie bei Länjrs- und Qiierselinitt naeh Lojjothctopiilos

Wir suchen bei jeder Laparatomie wegen Erkrankung der Genitalien die Appen-
dix auf und entfernen sie, falls sie pathologische Veränderungen aufweist. Meist kann
das leicht durch den vorhandenen Längs- oder Querschnitt geschehen. In Fällen aber,
in denen das Herausziehen des Blinddarmes vor die Bauchwunde Verwachsungen

halber Schwierigkeiten bietet, sind wir gezwungen, den anfänglichen Schnitt zu ver-
größern oder den rechten geraden Bauchmuskel (juer zu durchschneiden, um den
Wurmfortsatz herausholen zu können. Um dies unphysiologische Vorgehen zu ver-
meiden, verlege ich den Schnitt auf folgende Weise |)ararektal.

Nach Beendigung der gynäkologischen Operation entferne ich die Bauchdecken-
halter und befreie den rechten M. rectus in möglichst großer Ausdehnung von seinem
hinteren und vorderen Faszienblatt, wie das auch bei Lennardschem Schnitt

Blinil-
(lariii

Abb. 24. Verlagerung des M. rectus nach links
zwecks Freilegung des Ileozökalgebietes nach Logothetopulos

geschieht. Man setzt zwei Bauchdeckenhalter ein und zieht den freigemachten
Muskel stark nach links, die übrigen Schichten der rechten Bauchdeckenhälfte,
d. h. Haut, Faszie und Peritoneum nach der entgegengesetzten Seite, also nach
rechts (Abb. 24). Nach Beendigung der Aj)pendektomie nehme ich die Bauch-
deckenhalter heraus, bringe das Peritoneum unterhalb vom rechten M. rectus
wieder an seinen Platz und schließe die Bauchdecken etagenweise.

f) Freilejfun^^ des Operationsgebietes durch Abstopfen der Dannschlingeii

Ein Haupterfordernis zum Gelingen einer O]^eration ist die einwandfreie Ab-
trennung der Genitalorgane vom übrigen Bauchraum, besonders wenn es sich um
Eingriffe in infiziertem Gebiet handelt. Wir legen in Trendelenburgscher Lagerung
gefaltete Gazekompressen von etwa 20 cm Breite und 80 cm Länge ein, von denen
gewöhnlich 1—2 Stück zur vollkommenen Deckung ausreichend sind. Unsere Technik
der Einlegung ist folgende : Wir fassen eine Kompresse mit der rechten Hand in der
Mitte und schieben damit die in der Medianlinie vordringenden Darmschhngen nach

Allgemeiner T(m1

dem Diaphragma zu zurück. Die Kompresse wird dann mit der linken Hand in ihrer
Lage festgehalten und mit der rechten Hand die seitlichen Kompressenteile auf die
übrigen Darmschlingen gedeckt (Abb. 25). Auf die gleiche Weise wird die zweite
und nötigenfalls dritte Kom])res8e eingeführt. Ich halte die Abdeckung auf diese
Weise für sehr wichtig, da z. B. beim Platzen einer eiterhaltigen Geschwulst die
infektiösen Massen nur die zuletzt eingeführte Kompresse verunreinigen können, die
während der Operation leicht gewechselt werden kann. Die Zurückdrängung der

Abb. 25. Freilegiing des Operationsgebietes durch Abstopfung der Darmschlingen.

Die linke Hand hält die Mitte der eingeführten Gazekompresse fest, während die

rechte Hand die Darmschlingen mit der Gaze bedeckt

Därme macht Schwierigkeiten, wenn wegen zu oberflächlicher Narkose keine gute
Entspannung der Bauchmuskulatur eintritt, so daß die Eingeweide immer wieder
nach außen gepreßt werden. In einem solchen Falle warten wir ruhig ab, bis tiefe
Narkose eingetreten ist und bedecken in der Zwischenzeit die Wunde mit einem sterilen
Tuch. Gut eingelegte Kompressen erleichtern die Operation außerordentlich und
machen alle zum Zurückhalten der Därme konstruierten Instrumente überflüssig.
Preßt die Patientin, so hält man die Kompressen mit der Hand zurück, bis wieder
ruhige Atmung eingetreten ist. Die Kompressen sollen nicht aus der Wunde heraus-
ragen, um eine Behinderung des Operateurs zu vermeiden, sie werden aber genau
gezählt, damit keine in der Bauchhöhle zurückbleiben kann. Auf jeden Fall wird vor
Schluß des Peritoneums nochmals gründlich kontrolliert, so daß jeder Zweifel aus-
geschlossen ist. Nach der Eröffnung der Bauchhöhle haben alle kleinen Tupfer und
Kompressen dem Operationsgebiet fern zu bleiben, und zum Tupfen werden nur
Stieltupfer verwendet.

4. Vaginale Operationen
fl) Peritonisiorunj^ und Drainap:o der Bauclihöhlo

{

Jede Wundfläche im Bauche muß mit Peritoneum bedeckt werden, da wir im
Peritoneum dank seiner bakteriziden Kraft ein vorzügliches Mittel gegen Infektion
haben. Große Operationsstüm})fe, die zur Infektionsquelle werden könnten, werden
am besten extraperitoneal gelagert. Die sorgfältige Peritonisierung bildet den besten
Schutz gegen Verwachsungen mit den Nachbarorganen und somit auch vor dem post-
operativen Ileus (Qu^nu und Beutner). Bei den meisten typischen Operationen
gelingt die Peritonisierung leicht, macht jedoch zuweilen große Schwierigkeiten, wenn
es an Peritoneum fehlt, das man dann nehmen muß, wo immer man es findet. Für
solche Fälle bedient man sich vorteilhaft der Amannschen Methode, bei der Sigmoid
oder höher gelegene Teile des Rektums mit dem Blasenperitoneum vernäht werden.
Sorgfältige Peritonisierung und Blutstillung machen eine Drainage meist überflüssig.
Wegen der in bezug auf Asepsis immer etwas unsicheren Verhältnisse bei abdominalen
Karzinomoperationen empfiehlt J. L. Faure in jedem Falle Offenlassen des Bauches
und Mikulicz -Tamponade. Nach meinen Erfahrungen wird dadurch jedoch die
Mortalitätsziffer auch nicht besser. Deshalb vermeiden wir priiizipiell die Drainage
nach oben, und nur wenn es unumgänglich notwendig ist, drainieren wir nach der
Scheide zu und schließen die Bauchdecken vollkommen.

4. Vaginale Operationen

Die Instrumente, die wir bei vaginalen Oi)erationen gebrauchen, sind im all-
gemeinen die gleichen wie die bei Laparatomien üblichen, mit Ausnahme der Bauch-
spekula, an deren Stelle wir Scheidenspekula gebrauchen. Die Firma Stiefenhofer
hat nach meinen Angaben ein spezielles Spekulum angefertigt (Abb. 26), das von den
sonst gebräuchhchen sich dadurch unterscheidet, daß der eine Seitenflügel nach oben
in Form eines Ohres verlängert ist, das zur Ausübung eines Druckes auf die seitliche
Scheidenwand beim SchuchaVdt- Schnitt dient. Dadurch wird eine sehr gute Blut-
stillung erzielt, so daß man nur wenige Unterbindungen braucht und viel Zeit gewinnt.

Sehr wichtig ist die Lagerung der Patientin auf dem Operationstisch. Sie liegt
auf dem Rücken mit abduzierten und in der Hüfte und Knie gebeugten Beinen, das
Gesäß den Tischrand etwas überragend. Damit sie während der Operation unveränder-
lich festliegt, verwendet man Schulterstützen, und die Beine werden in ihrer Lage
durch gerade Eisenstäbe unter den Knieen zurückgehalten. Um jede Störung der
Assistenten zu vermeiden, sind die Stäbe nicht senkrecht, sondern stark schräg geneigt
zum Operationstisch und nach dem Kopfe der Patientin zu angebracht (Abb. 27).
Dadurch kommen die Beine der Patientin auf die Rücken der Assistenten zu liegen.
Die Hände der Frau werden gekreuzt auf der Brust befestigt. Im Gegensatz zur
Laparatomie brauchen wir bei größeren Vaginaloperationen stets zwei Assistenten,
da keins der bis jetzt angegebenen selbsthaltenden Spekula einen Assistenten zu er-
setzen vermag. Der erste Assistent stellt sich auf der rechten Seite der Patientin auf,
um seine rechte Hand besser benutzen zu können. Der links stehende erleichtert sich
das Halten des vorderen Blattes, wenn er seine Hand auf die Symphyse stützt (Abb. 28),
dabei aber darauf achtet, daß er mit dem Ellbogen keinen Druck auf das Abdomen
der Frau ausübt und die freie Atmung dadurch behindert. Die Tischplatte soll mög-
lichst hoch sein, damit die Assistenten durch zu starkes Bücken nicht unnötig ermüdet
werden. Der Operateur setzt sich vor die Vulva der Kranken; rechts und mög-
Uchst nahe von ihm steht der Instrumententisch und hinter diesem die Operations-
schwester.

Allgemeinor Teil

4. Vaginalci Operationen

Abb. 26. Vaginalspekulum für den Schuchardtschen Schnitt nach Logothetopulos

Abb. 27. Lagerung der

Patientin bei vaginalen

Operationen

Um den After und die unige})enden Partien <rut abzudecken, wird das sterile Tuch
mit einer Kugelzange oberhalb der Analöffnung und mit zwei Tucbklemmen seitlich
an den Gesäßbacken befestigt (Abb. 29).

Die Scheidenspekula geben gewöhnlich genügend Raum zur Einführung der
Instrumente und der Finger, handelt es sich jedoch lun größere Tumoren bei enger

vWV.

Abb. 28. Haltung des vorderen Scheidenspiegels.
Die Hand des Assistenten stützt sich auf die Symphyse

Vagina, z. B. bei Nulliparen, so muß man eine Spaltung des Beckenbodens und der
Scheide vornehmen (Schuchardt- Schnitt). Dadurch gewinnt man soviel Raum, um
nicht nur die Finger, sondern nötigenfalls auch die ganze Hand einführen zu können. Wir
kommen stets mit dem einseitigen, auf der linken Seite der Patientin ausgeführten
Schnitt aus und konnten bisher den von Stöckel empfohlenen zweiten Schnitt auf
der rechten Seite auch bei Totalexstirpation wegen Karzinom entbehren. Nach Unter-
bindung der größeren, hauptsächhch oben gelegenen Gefäße bedecken wir die Wunde
mit einer kleinen Gazekompresse und führen unser Spezialspekulum ein, das den Ein-
schnitt vor Verschmutzung schützt und gleichzeitig blutstillend wirkt (Abb. 26).

Allgemoiner Teil

Die Eröffnung der Bauchhöhle von der Scheide aus kann durch die vordere oder
durch die hintere Kolpotomie geschehen. Bei Operationen an Uterus oder Adnexen
wenden wir die vordere Kolpoköliotomie an, da sie am besten die Vorwälzung des
Uterus ermöglicht. Die hintere Kolpoköliotomie dient zur Eröffnung von Douglas-
abszessen und nur ganz ausnahmsweise in besonderen Fällen zu Operationen an Uterus
oder Adnexen. Zur korrekten Ausführung der vorderen oder hinteren Kolpotomie
muß man sich die anatomischen Verhältnisse stets genau vor Augen halten.

Abb. 29. Abdeckung des Operationsgebietes

Die Blase ist mit dem Uterus an der vorderen Wand der Zervix durch lockeres
Bindegewebe verbunden, so daß bei normalen Verhältnissen die Ablösung der beiden
Organe voneinander in der Mitte sehr leicht mit dem Finger geschelien kann (Abb. 76).
Hierauf kommen die seitlichen Partien zu Gesicht, wo Blase und Uterus wesentlich
fester miteinander verbunden sind, so daß wir von der Schere Gebrauch machen
müssen. Beim Herunterziehen des Uterus folgt die Blase mit und wird ebenfalls ver-
lagert, wobei sie eine Falte bildet. Dagegen bleibt die vordere Bauchfellfalte (Plica
vesico-uterina), die bei normaler Lage der Genitalorgane bis zum inneren Muttermund
reicht und 2 cm vom vorderen Scheidengewölbe entfernt ist, beim Herabziehen des
Uterus in ihrer Lage, so daß ihre Entfernung vom Scheidengewölbe nunmehr etwa
4 cm beträgt. Das Douglasperitoneum reicht bis dicht an die Scheide, mit der es
durch lockeres Bindegwebe verbunden ist. Beim Herabziehen des Uterus folgt es
deshalb nur teilweise nach, so daß man es beim Eröffnen der Scheide erst in einer Tiefe
von etwa 2 cm auffindet.

4. Vaginale Operationen

a) Colpoeooliotuinia anterior

Nach Entfaltung der Scheide und Einstellung der Portio mittels der Si)ekula
fassen wir die vordere Muttermundslippe mit einer Kugelzange und ziehen sie nach der
Vulva zu und etwas dammwärts. Wir spalten die vordere Vaginal wand mit dem
Messer in der Medianlinie, und zwar beginnt der Schnitt 2 cm unterhalb der Urethra
und reicht bis zur Portio herab. An Stelle dieses Schnittes kann man je nach Lage des
Falles einen quergelegenen oder einen T-förmigen anwenden. Der Quer- oder ]3ogen-
schnitt muß an der Blasen-Cervixgrenze angelegt werden, im allgemeinen 1 V2— 2 cm
oberhalb des Muttermundes. Jeder dieser Schnitte muß unter allen Umständen bis
zu dem unterhalb der Vaginalwandung liegenden Bindegewebe geführt werden, da
nur dann Blase und Scheidenwand leicht voneinander getrennt werden können. Nach
Spaltung der Scheidenwand in der Mittellinie fassen wir beiderseitig die Wundränder
mit je einer Kocherklemme und beginnen die Ablösung nach beiden Seiten zu mit
der Schere auf eine Entfernung von etwa 2 cm. Die Ablösung der Blase sowie der
weitere Verlauf der Operation wird bei der vaginalen Uterusexstirpation beschrieben.

b) Colpocoeliotoinia posterior

Infolge der einfachen anatomischen Verhältnisse ist sie leichter als die vordere
ausführbar. Das Peritoneum reicht herab bis zur Scheidenwand, und die Ablösung

der Blase fällt fort.

Man entfaltet die Vagina mit Hilfe der Spekula, stellt die Portio ein und faßt die
hintere Muttermundslippe mit einer Kugelzange, die stark nach außen und symphysen-
wärts angezogen wird, nachdem man das störende vordere Spekulum entfernt hat.
Nun wird die hintere Vaginalwand dicht unterhalb der Portio quer gespalten und damit
gleichzeitig das Peritoneum eröffnet.

Vor jedem weiteren Eingriff wird aus diagnostischen Gründen eine eingehende
Austastung des kleinen Beckens von der Operationswunde aus vorgenommen. Wenn
eine Drainage sich als überflüssig erweist, wird nach Beendigung der Operation Peri-
toneum und Scheidenwandung mit Katgut geschlossen.

SPEZIELLER TEIL

I. Chirurgische Behandlung der Lageanomalien des Uterus

A. Ketrovorsiofloxio uteri

1. Fixation dor Li??, rotimda
a) Operation nach Alexander- Adams

Der erste, der an die Ersetzung der Pessarbehandlung bei Retroflexioversio uteri
durch eine Oi)eration gedacht hat, war Alquier, der im Jahre 1840 in der franzö-
sischen Akademie vorschlug, durch Verkürzung der Lig. rotunda eine Reposition des
Uterus zu erzielen. Tatsächlich ausgeführt wurde diese Operation aber erst durch zwei
englische Chirurgen, Alexander und Adams, im Jahre 1881.

Es ist bei der Ausführung dieser Operation wichtig, sich an ganz bestimmte
Regeln zu halten, ohne die man auf Schwierigkeiten stößt. Um die Lig. rotunda im
Leistenkanal leicht auffinden zu können, muß der 4—6 cm lange Hautschnitt, der
am Tuberculum j)ubicum beginnt und })arallel und etwas oberhalb des Poupart sehen
Bandes verläuft, bis zur oberflächlichen Faszie geführt werden, die man dann mit
einem Tupfer von dem daraufliegenden Fett reinigt, bis sie weißschimmernd erscheint.
Jetzt wird in der Gegend des äußeren Leistenringes der Im lach sehe Fettpfropf
sichtbar, der besonders bei fetten Patientinnen das Lig. rotundum verdeckt. Hier
wird das Ligament aufgesucht, mit einer stumpfen Klemme gefaßt und nun erst die
Faszie eröffnet. Vor Auffindung des Bandes darf man die Faszie keinesfalls eröffnen.
Nach Spaltung der Faszie wird das Band leicht nach auswärts gezogen und längs
seines ganzen Verlaufes im Leistenkanal freipräpariert. Man muß es recht vorsichtig
behandeln, da es besonders bei Nullipara in seinen distalen Abschnitten oft sehr dünn
und zerreißlich ist.

Der Processus vaginalis peritonei wird mit einem Tupfer zurückgeschoben oder
besser mit der Schere eröffnet, damit man sich durch Einführung des Fingers in die
Bauchhöhle über den genauen Zustand der inneren Organe orientieren kann. Hierauf
wird das Peritoneum wieder geschlossen, und das Ligament mit einigen Nähten am
Poupart sehen Bande befestigt, wobei man darauf achten muß, es nicht ganz in die
Naht zu nehmen, um Nekrosen zu vermeiden. Der überflüssige Teil des runden Bandes
wird unterbunden und weggeschnitten. Man schließt die Bauchdecken im Sinne der
Bassinischen Operation.

Wenn man das Band nicht finden sollte, was, wenn auch recht selten, selbst bei
Einhaltung obiger Regeln vorkommen kann, so erweitert man den Schnitt und sucht
es direkt an seinem Ursprung an der Uteruskante auf.

b) Operation nach Olshausen

Anheftung der Ligamenta rotunda in der Nähe ihres Ursprungs am Uterus an
die Bauchdecken. Je eine mit Katgut oder dünner Seide armierte Nadel wird auf

A. Retroversioflexio uteri

beiden Seiten durch Faszie, Muskel und Peritoneum hindurchgeführt, das Ligament
durchstochen und dann wieder nach außen zurückgeleitet. Nach Schluß der Bauch-
wunde werden vor der Hautnaht die Fäden jederseits geknüpft.

e) Operation naeh Doleris

Eröffnung des Bauches mit Quer- oder Längsschnitt. Eine mit Seide armierte
Dechampsnadel wird unterhalb des Lig. rotundum in einer Entfernung von 3 cm von
der Uteruskante durch das Lig. latum geführt, und auf gleiche Weise auch das Ligament
der anderen Seite angeschlungen. Mit einer stumpfen Klennne werden dann beiderseits
etwas oberhalb der Symphyse und etwa 2 cm von der Mittellinie entfernt Muskel
und Peritoneum durchstoßen und die Ligamentschleifen durch die beiden Öffnungen
hindurchgezogen. Peritoneum und Muskel werden vereinigt und darüber die beiden
Bänder untereinander und mit dem Muskel vernäht. Zur größeren Sicherheit kann
man bei der Fasziennaht noch die Bänder mitfassen, und sie so auf der Rückseite der
Faszie mit befestigen.

Diese beiden letzten Methoden haben den Nachteil, daß zwischen Bauchwand
und Uterus Darmschlingen eintreten können, und daß auf diese Weise ein Strangula-
tionsileus entstehen kann. Abgesehen davon ist aber auch die Lage des Uterus anormal
hoch, und seine ])hysiologische Beweglichkeit ist sehr verringert.

Um diese Nachteile zu vermeiden, hat man empfohlen, die Ligamente auf die
vordere (Polk, Menge, Dudley, Latzko) oder besser auf die hintere (Webster,
Baldy) Wand des Uterus aufzunähen.

d) Operation naeh Webster-Baldy

Nach Eröffnung der Bauchhöhle werden die Ligamenta rotunda beiderseits
mittels einer Dechampsnadel und Faden in einer Entfernung von etwa 3 cm von der
Uteruskante umfaßt und hochgezogen. Dann durchsticht man jederseits die Meso-
salpinx mit einer Klemme (Pean), zieht mit ihrer Hilfe die Ligamentschleifen durch
die Mesosalpinx hindurch und befestigt sie mit einigen Katgut- oder Seidenfäden auf
der hinteren Uterusfläche. Man achte darauf, die Tuben nicht abzuknicken, wodurch
ein Hindernis für die Konzeption geschaffen würde.

2. Abdominale Vesikofixatioa

Die von Werth im Jahre 1884 angegebene Methode, die auch heute noch zahl-
reiche Anhänger hat, beruht auf der Verödung des vorderen Douglasschen Raumes
(Cavum vesicouterinum), um dadurch den von vorn und oben wirksamen intra-
abdominellen Druck auszuschalten. Der dann nur noch vorhandene Druck von hinten
und oben auf die Uterusrückfläche drängt den Uterus in Anteversioflexionstellung.
Nach Halban geht man folgendermaßen vor:

Eine mit einem längeren Katgutfaden versehene Nadel wird am Fundus uteri
knapp oberhalb der Tubeninsertionsstelle eingestochen ; sie nimmt durch wiederholte
Einstiche das ganze Peritoneum der vorderen Uterusfläche und der hinteren Blasen -
wand mit und wird knapp oberhalb des Blasenscheitels wieder ausgestochen (Tabaks-
beutelnaht). Das gleiche geschieht symmetrisch mit einer zweiten Naht auf der anderen
Seite. Die Enden beider Fäden werden verknotet, so daß der Uterusfundus auf den
Blasenscheitel zu liegen kommt, und das Cavum vesicouterinum verödet wird.

Speziollor Tcül / I. Chirurgischo Beliandlung der Lageanomalien

B. Descensus und Prolapsus vaginae

3. Verkürzung der Ligamenta rotunda mit gleichzeitiger Vesicofixatio uteri

nach Logothetopulos

Um die Excavatio vesicouterina zu
veröden und gleichzeitig direkt den Uterus
in Anteversioflexio zu halten, vernähe ich
zunächst entsprechend der Methode von
Baldy-Webster die Ligamenta rotunda
auf der hinteren Fläche des Uterus mit
einigen Nähten und fixiere dann die Blase
mit Knopfnähten auf die dem Fundus
zunächstliegenden Teile dieser Bänder
(Abb. 30, 31 und 32). Diese Methode ist
seit längerer Zeit für mich die Methode
der Wahl, da durch sie der Uterus eine
dopj^elte Sicherung seiner Lage erhält,
die der normalen weitgehend ähnelt.

Wichtig ist, daß bei der Ver-
nähung der Ligamenta rotunda auf der
Rückseite des Uterus nur die hinteren
Schenkel dieser Bänder zur Verwendung
kommen, damit ihre vorderen Teile, mit
denen später die Blase vereinigt wird,
dies ohne Spannung zulassen.

Der Vorteil der Operation liegt
darin, daß die Blase ihre volle Be-
weglichkeit beibehält, und Nachunter-

Ahb. 30. Verkürzung der Lig. rotunda mit gleich-
zeitiger Vesicofixatio uteri nach Logotlieto-
pulos. Der um das Lig. rotun(him gelegt(^
Faden wird mittels einer Klemme durch die
Mesosalpinx hindurchgezogen

Abb. 3L Verkürzung der Lig. rotunda mit
gleichzeitiger Vesicofixatio uteri nflehLofio
tlioljujitilo.s. Vernähung der Blase mit
den auf der Hinterwand des Uterus ver-
einigten Lig. rotunda

Abb. 32. Verkürzung der Lig. rotunda mit
gleichzeitiger Vesicofixatio nach Logothe-
tv^MUos. Die Blase ist mit vier Knopf-
nähten an den Lig. rotunda befestigt

suchungen ergaben, daß niemals Blasenstörungen auftraten, auch nicht bei Fällen,
bei denen es zu einer Gravidität gekommen war. Rezidive wurden bei weit über
hundert von mir oder meinen Assistenten operierten Fällen nicht beobachtet.

4. Direkte Befestifjiing des Uterus an den Bauehdeeken

Die Ventrofixation nach Leopold -Czerny, bei der man die mit einem Faden
armierte Nadel durch Faszie, Muskulatur und Peritoneum der einen Seite führt, den
Uterus faßt und durch die entsprechenden Schichten der anderen Seite wieder heraus-
kommt, kann nur bei Frauen, die nicht mehr gebärfähig sind oder gleichzeitig sterili-
siert werden sollen, angewandt werden. Bei Uterusvorfällen ist die Methode jedoch
wertvoll und wird häufig benutzt. Eine noch zuverlässigere Anheftung des Uterus an die
Bauchdecken für solche Fälle erreicht man aber mit der Koch ersehen Exohystero-
pexie, die folgendermaßen ausgeführt wird:

Nach Eröffnung der Bauchhöhle wird der Uterus mit einer Kugelzange gefaßt
und nach außen gezogen, worauf wir das Peritoneum derart an die hintere und vordere
Uterusfläche annähen, daß der Uterus extrai)eritoneal zu liegen kommt. Bei der
Bauchdeckennaht durchsticht man den Uterus mit zwei stärkeren Fäden gleichzeitig
mit der Faszie und knotet dieselben nach der Fasziennaht.

B. Descensus und Prolapsus vaginae
1. Vordere Kolporraphie

Nach Einführung des hinteren Scheidenspekulum wird die vordere Vaginalwand
genau in der Mittellinie, etwa 1 cm oberhalb des Mutter nmndes gefaßt und herab-
gezogen; mit einer zweiten Kugelzange faßt man die Vaginalwand dicht unterhalb

Abb. 33. Vordere Kolporraphie. Beginn der
Abtragung des ovalen Scheidenlappens

Logothetopulos, Gynäkologische Chirurgie

Abb. 34. Vordere Kolporraphie. Fassen der
Scheidenwundränder mit Kocherklemmen und
scharfe Ablösung der Scheidenwand von ihrer

Unterlage

2g SpezioUcr Teil / I. Cliirurgischo Behandlung der Lag(^anomalien

der Urethralöffnung und zieht sie nach aufwärts. Bei der so gespannten Vaginalwand
wird direkt oberhalb der unteren Kugelzange ein kleiner Einschnitt mit der Schere
durch die ganze Dicke der Schleimhaut gemacht, die Schleimhautränder mit einer
Pi.izctte gefaßt und mit der Schere auf der linken Seite von unten nach oben ein bis
zur oberen Kugelzange reichender bogenförmiger Schnitt geführt (Abb. 33—36).
Die Vaginalwand wird von diesem Schnitt aus nach hnks zu abpräpariert und ein

Abb. 35. Vordere Kolporraphie. Die Ab-
lösung des Scheidenlappens wird stumpf
mit einem Tupfer fortgesetzt

Abb. 36. Vordere Kolporraphie. Die Ablösung
des vorderen Lappens ist beendet. Die fort-
laufende Naht faßt die Blasenwandung mit

ovaler La])i)en herausgeschnitten, dessen Größe von der Ausdehnung des Vorfalles
abhängt. Man achte darauf, daß die Wundränder einander ohne Spannung genähert
werden können und berechne auch danach die Größe des wegzunehmenden Lappens.
Arbeitet man in der richtigen Schicht, so ist es ein leichtes, den Lappen mit einem
Tupfer abzulösen, indem man die Wundränder mit einer oder zwei Kocherklemmen
faßt und über den Finger herüberstülpt. Die Vereinigung der Wundränder geschieht
mit fortlaufender Naht, die man unten, d. h. an der Zervix, beginnt. Wenn man die
Naht breit anlegt und gleichzeitig etwas von der Blasenwand mitfaßt, erübrigt
sich eine Sonderraffung der Blase, falls es sich nur um einen kleinen Prolaps
handelt (Abb. 36). Bei größeren Zystozelen jedoch führe ich eine Extraraffung
der Blase aus.

13. Descensus und Prolapsus vaginae

äd

Ist die erste Naht an der Portio gelegt, so wird die untere Kugelzange entfernt,
und der Assistent "ieht nur an dem Faden, so daß beim Weiternähen die l\)rti() von
selbst schrittweise in ihre alte Lage zurückkehrt. Handelt es sich um einen sehr großen
Vorfall, bei dem die (höße des Lapi)ens zuvor schwer festzulegen ist, so beginnt man
die Plastik zweckmäßig mit einem großen medianen Längsschnitt, von dem aus die
Scheidenwand in oben geschilderter Weise nach beiden Seiten abgelöst wird. Dann
wird die Blase in die Höhe geschoben und mit einer Tabaksbeutelnaht gerafft. Die
sich spannenden Blasenschenkel werden nur durchgeschnitten, wenn eine Portioampu-
tation wegen Elongatio notwendig ist. Eine Blutstillung erübrigt sich bei kleinen
Prolapsen meist, da die Blutung aus den Wundränderii bei der Naht zu stehen pflegt,
bei größeren Vorfällen jedoch ist es sicherer, blutende Gefäße zu fassen und zu unter-
binden.

2. Hintere Kolporraphie und Perineoplastik

Die Raffung der hinteren Scheidenwand muß stets mit der Bildung eines neuen
festen Dammes zugleich geschehen. Der Erfolg der O])eration ist weitgehend von der
Höhe dieses neuen Dammes abhängig sowie von der Weite des entstehenden Scheiden-
rohres, das auf keinen Fall zu Kohabitationsschwierigkeiten Veraidassung geben darf.
Fällt der neugebildete Damm zu niedrig aus, so ist das Ergebnis wenig vom Zustande
vor der 0])eration verschieden, und die Patientin leidet weiter unter ihren Beschwerden.
Wir legen deshalb von vornherein die Höhe des zu bildenden Dammes fest durch
Bestimmung der Punkte, die nach ihrer Vereinigung die Stelle des früheren Frenulum
einnehmen werden, und die im allgemeinen den unteren Enden der kleinen Labien ent-
sprechen. Ein dritter Punkt in der Medianlinie der vorgefallenen hinteren Scheidenwand
entspricht dem oberen Ende des zu resezierenden Scheidenla])pens; seine Lage ist
abhängig von der Größe des Vorfalles, und wir legen ihn am besten erst endgültig
während des Ablösens des La})pens fest. Die Wahl dieser drei Punkte kann nicht nach
bestimmten Regeln erfolgen, sondern ist in der Hauptsache von der operativen Er-
fahrung abhängig.

Wir gehen folgendermaßen vor: Die zwei seitlichen, unterhalb der kleinen Labien
liegenden Stellen werden mit je einer Kugelzange gefaßt und vom Assistenten leicht
nach der Seite und nach oben zu angezogen, so daß die Dammhaut sich linienförmig
anspannt. Genau an der Grenze von Haut und Schleimhaut werden die beiden seithch
festgelegten Punkte mit der Schere durch einen Schnitt vereinigt, der nach unten zu
leicht bogenförmig verläuft (Abb. 37). Man faßt dann den Scheidenwundrand in der
Mitte mit zwei Kochern und beginnt von hier aus die Abi)räparierung der hinteren
Scheidenwand vom Rektum, was mit Schere und Tupfer sehr leicht geschieht, wenn man
sich wie bei der vorderen Kolporraphie in der richtigen Schicht befindet (Abb. 38—39).
Man kontrolhert mit dem Finger in der Vagina, wie hoch man die Ablösung fortsetzen
darf und bezeichnet sich schließlich den obersten Punkt mit einer Kocherklemme, von der
aus man nach beiden Seiten in Richtung der seitlichen Kugelzangen die Scheidenwand
abträgt. Die Kocher klemme wird von der Wundseite des Lappens aus angesetzt
(Abb. 40). Zieht man diese Klemme kräftig nach abwärts, so bilden sich zwei im
spitzen Winkel zueinander verlaufende Wundränder, die man mit fortlaufenden
Nähten vereinigt (Abb. 41—42). Die neue, verengte Scheide ist nun gebildet, und wir
kommen zum für den Erfolg wichtigsten Teil der Operation, zur Levatornaht. Mit
einer großen, kräftigen Nadel führt man, weit ausholend, einen starken Katgutfaden
durch das Spatium pararectale von außen nach innen auf der linken Seite um den
deutUch fühlbaren Levator herum. Das gleiche Manöver wird mit demselben Faden

Bü

^p<>zi('ll«T Teil / I. Chirurgische Behandhing der Lageanomalien

B. Descensus und Prolapsus vaginae

Abb. 37. Hintore Kolporraphie.
Schnitt an der Haut-Schleiinhautgrenze

Abb. 38. Hintere Kolporraphie. Scharfes
Abpräparieren der mit den Fingern vor-
gestülpten Scheidenwandung. Das Rektum
wölbt sich untc^rhalb der Schere vor

Abb. 39. Hintere Kolporraphie. Weiteres
stumpf (^s Abschieben der von den Fingern der
linken Hand vorgestülpten Scheidenwandung

Abb. 40. Hintere Kolporraphie. Fassen des
obersten Punktes des Scheidenlappens von der
Wundseite her, Zug nach abwärts und Abtra-
gung in der vorgezeichneten Linie mit der Schere

Abb. 4L Hintere Kolporraphie. Beginn
der fortlaufenden Naht auf der linken Seite

Abb. 42. Hintere Kolporraphie. Linke Nahthälfto
beendet. Beginn der fortlaufenden Naht rechts

Abb. 43. Hintere Kolporraphie. Scheidennaht beendet. Vereinigung der Levatoren unter Schutz

des Darmes mit dem Finger

32 Sp(./.icH.T Teil / I. riiiiurKischo nclinn.Ihing der Lageanomalien

in unifrekehrter Richtung auf der rechten Seite vorgenommen, und nachdem man
drei bis vier solcl.e Nähte gelegt hat. werden sie geknüpft. Man schützt das Rektum
beim Anlegen dieser Nähte, indem man es mit dem Hnken Zeigefinger nach oben und
hinten zu fortschiebt (Abb. 43). Seine Verletzung könnte zu unangenehmer l.stel-
bildung Veranlassung geben. Den Schluß der Operation bildet die Hautnaht der
Dammwunde, die wir mit Katgut ausführen. t^ ■ . i

Bei allen i)lastischen Operationen müssen im Interesse des guten Enderfolges
alle Nähte weit durchgreifend, die Schleimhaut min.lestens V2 cm vom Wundrande
entfernt durchdringend, angelegt werden, so daß die Wundflächen breit aneinander
zu liegen kommen, und um Nekrosen zu vermeiden, soll der Abstand der emzelnen
Nähte voneinander mindestens 1 cm betragen.

In den ersten Tagen nach der Or)eration binden wir die Beine der Patientm
zusanmien. Ein Dauerkatheter wird bei uns nie eingelegt, Tmd nur in seltenen Fällen
ist Katheterismus nach der Operation erforderlich.

3. Operation des veralteten kompletten Dammrisses

Nach Ausschneidung des narbigen Gewebes wird der Mastdarm in ausgiebiger
Weise von der Scheidenwand abgelöst, mit feiner Knopf- oder fortlaufender Seiden-
naht ohne Mitfassen der Darmsehleimhaut genäht und nach sorgfältiger Freilegung

B. DescensuB und Prolapsus vaginae

Abb. 44.

Abb. 45.

Abb. 44. Totaler Dammriß. — Abb. 45. Operation des totalen Dammrisses nach Logo thetopu los.
Das Operationsgebiet ist mit Kugelzangen freigelegt. Schnittfidirung durch starke Linien markiert

? ■

Abb. 46.

Abb. 46. Operation des totalen Datninrisses im^
ln^ffmiAmät^^r^. Darm- und Spliinkternaht
beendet. Die aufwärts freipräpari<Mte Darin-
wandung ist mit zwei Kocherklt«mmen gefaßt
und in einer Falte abgehoben. Die oberste hält
die Scheidenschleimhaut nach oben

Abb. 47. Operation des totalen Dammrisses
L'jg"*lB*topntn • Die herabgezogene Darmfalte
deckt die Darmnaht und wird mit einigen Nähten
auf dem Sphinkter befestigt

Abb. 48. Operation des totalen Dammrisses nach

Ltjgothetopnfos. Die herabgezogene und auf

dem Si)hinkter befestigte Darmfalte deckt die

Darmnaht vollkommen ab

^»^^Ct4t^'

Abb. 47.

Abb. 48.

34 Speziollor T.-il / I. CliiiiiigiKclio R,.lmnillung der Lageanomalicn

die Si.hinkterenenden wieder mit feinen Seidennähten vereinigt. Es folgt die Naht
der Scheidenwundränder mit Katgut, die Naht der Levatoren und die Hautnaht,
wie wir es eingeliend bei der I)animi)la8tik geschildert haben.

Trotz sorgfältiger Technik wird wohl jeder Operateur bei dieser Operation Miß-
erfolge gehabt haben, die ihn zur Wiederholung des Eingriffes zwangen. Ich verwende
seit längerer Zeit eine eigene Methode, die bisher in jedem Falle einen vollen Erfolg
ergab und daher für uns die Methode der Wahl geworden ist.

C. Descensus und Prolapsus uteri

Vagiiiahvaiid

KolpopiTineo-
plastik

Darmfalte

Darmnaht

AV)b. 49. OiKM-ation dos totaUm Damm-
risses n«»c]x;~"fe o fg cH h e V&fi^r^^ s . Sche-
matische Darstellung der Oi)eration

Ich beginne die Oi^eration in der gewöhnlichen Weise mit Abtrennung des Narben-
gewebes, löse dann aber den Mastdarm von der Scheidenwand weit nach oben zu ab,
so daß es nach der Darm- und Sphinkternaht ohne Schwierigkeit möglich ist, eine
Falte der Rektumwand von den höher gelegenen Teilen nach abwärts als Deckung
über die Darmnaht zu ziehen, was ohne Spannung geschehen muß. Diese Falte wird
auf dem Si)hinkter mit einigen Knopfnähten befestigt, worauf die Operation in der
gewöhnlichen Weise beendet wird (Abb. 44 — 50).

Die vom Rektum aus deutlich fühlbare Tasche macht den Patientinnen in keiner
Weise Beschwerden, wie man vielleicht annehmen könnte, und der postoperative Ver-
lauf unterscheidet sich in nichts von demjenigen, wie wir ihn bei der übUchen Methode
gewöhnt sind. Nach kurzer Zeit verschwindet die Tasche wieder, indem sich die Falte
nach oben in ihre normale Lage zurückzieht.

Die Vorbereitung zur Operation muß sorgfältig sein. Man führt einige Tage mit
einem beliebigen Mittel ab, gibt am Vorabend der Operation ein Reinigungsklysma und
Opiumtropfen und nur eine leichte, wenig Stuhl bildende Kost. Durch geeignete Diät
sorgen wir dafür, daß erst am 6. Tage nach der Operation Stuhl erfolgt. Wir geben

^ i

an diesem Tage Rizinusöl und gleichzeitig ein (Mklysma. Um den Abgang von
Blähungen zu erleichtern, legt man zweckmäßig gleich nach der Oi)eration ein Darm-
rohr ein.

Wir haben eine große Zahl kompletter Dammrisse nach dieser Methode operiert
und stets eine prima intentio und völlige Kontinenz erreicht.

C. Descensus und Prolapsus uteri

', S. /^3

Unter Berücksichtigung der Ätiologie der Erkrankung müssen bei einer erfolg-
versprechenden Operation zwei ganz verschiedene pathologische Zustände beseitigt
werden. Die Operation gliedert sich in folgende Abschnitte:

1. Wiederherstellung des Beckenbodens mit Beseitigung der überschüssigen
vorderen und hinteren Vaginal wandteile und

2. Befestigung des retroflektierten Uterus in normaler Lage.

Handelt es sich um einen leichten Deszensus des Uterus mit Vorfall der Scheiden-
wände, so kommt man in der Regel mit vorderer und hinterer Kolpora])hie, Damm-
plastik und Reposition des Uterus nach Verkürzung der Lig. rotunda zum Ziel. Der
Eingriff wird größer und komplizierter, wenn es sich um einen stärker deszendierten
Uterus oder um einen vollständigen Vorfall desselben mit Elongation des distalen
Uterusabschnittes handelt, aber auch hier bleibt das Prinzip die Wiederherstellung
des Beckenbodens und die Fixierung des Uterus in Anteversioflexio. Die hierzu er-
sonnenen Methoden und Modifikationen sind zahllos, nicht alle jedoch sind im End-
erfolg befriedigend, andere wieder gefährden das Leben der Patientin. Bei solchen
schweren Fällen ist die einfache Verkürzung der Ligamenta rotunda nicht ausreichend,
und an ihre Stelle müssen Verfahren treten, die den Uterus fest in Anteversioflexio -
Stellung befestigen . DieKocherscheHysteropexie bringt den Uterus in eine stark
elevierte Stellung und gibt durch die außerordentlich feste Lagerung des Uterus inner-
halb der Bauchdecken gute Resultate. Trotzdem sehen wir auch hier Rezidive, wobei
die Verwachsungen zwischen Uterus und Bauchwand bandförmig ausgezogen werden,
so daß sie eine Gefahr für die Darmschlingen bilden.

J I Interpositio uteri vesico vaginalis

Diese von Wert heim angegebene und von Schauta modifizierte Operation
stützt sich auf die Freundsche Kolpohysteropexie, die heute nicht mehr angewandt
wird Bei der S c h a u t a - W e r t h e i m sehen Interposition wird der Uterus als lebendes
Pessar benutzt, das zur Zurückhaltung der prolabierten Blase dient, die auf seine

Rückwand zu liegen kommt.

Der Operationsvorgang ist folgender: Die Portio wird mit zwei Kugelzaiigen
angehakt und kräftig nach abwärts gezogen. Nun wird genau wie bei der vorderen
Kolporraphie ein ellipsenförmiges Stück aus der vorderen Scheidenwand heraus-
genommen, dessen Größe von dem Grade des Vorfalles, aber auch von der Größe des
zu interponierenden Uteruskörpers abhängig ist. Die Blase wird vom Collum uteri
mit der Schere abgetrennt und dann mit dem Finger stumpf nach oben abgeschoben
wobei die seitlich von der Blase zum Uterus ziehenden festeren Bindegewebsbundel
(Blasenschenkel) nach Möglichkeit geschont werden. Die Blase wird vom Assistenten
mit dem vorderen Spekulum gut zurückgehalten und dadurch vor Verletzungen
geschützt. Nach Eröffnung des Peritoneum wird der Uterus genau wie bei der

Spezieller Teil / II. Operationen an der Vulva

vaginalen Kxstirf)ation hervorgewälzt, jedoch mit Vorsicht, um unnötige Zerfetzungen
des Gewehes zu vermeiden, die zu Wundstörungen Veranlassung geben könnten.
Befindet sich die Frau noch im gebärfähigen Alter, so muß unbedingt die Sterilisierung
vorgenommen werden, die wir meist nach der Madlenerschen Methode ausführen.
Dann wird die Bauchhöhle wieder geschlossen, indem wir das Blasenperitoneum mit
zwei bis drei Katgutkno])fnähten in Höhe des inneren Muttermundes der hinteren
Uterusfläche aufnähen. Der Uterus wird nun wieder zurückgeschoben und über ihm
die Scheidenwundränder mit fortlaufender Katgutnaht möglichst spannungslos ver-
einigt. Damit das möglich ist, muß von vornherein bei der Exstirpation des Scheiden-
lappens auf die Größe des zu interponierenden Uterus Rücksicht genommen werden,
wie oben bereits erwähnt wurde. Läßt sich die Naht nicht ohne Spannung ausführen,
so ist es besser, die Wundränder mit der Uterusvorderfläche zu vernähen und auf ihre
Vereinigung zu verzichten/ Ein zu g»'oßer, metritisch veränderter Uterus kann auch
vor dem Einnähen durch Ugittale Resektion in beliebiger Weise verkleinert werden,
in der Art, wie ich es als 8])ezielle Methode bei starken Menorhagieen angegeben habe
(tt. S:46). )Die von Wertheim vorgeschlagene Verkürzung der Ligamenta sacro-
' uterina, die wohl geeignet erscheint die Operationsresultate zu verbessern, wenden
wir nicht an, da dadurch die Prognose der Operation erheblich verschlechtert wird,
wie schon aus Wertheims eigener Statistik hervorgeht (auf 262 Fälle 16 Todes-
fälle!). Vor Beginn der Operation empfiehlt es sich, die Größe des Uterus mit der
Sonde zu bestimmen und nötigenfalls eine Amputation des elongierten Teils der Portio

^v-^^X

jrer

vorzunehmen.

Die Schau ta- Wertheim sehe Operation ist zweifellos die erfolgsichera*^ Pro-
lapsoperation, erfordert aber große Erfahrung und spezielle vaginale Technik. Auch
bei den besten Operateuren bleibt die Mortalität hoch, nach Reifferscheidt3,4bis ^
7,5«/o, was bei der relativen Harmlosigkeit des zu beseitigenden Leidens zu viel ist. T^
Aus dies^ GrundeXzieh^ ich. jetzt bei älterensFrauen te vagina^ Totalexstii4;)atian
mi^ vQrdei^r und hint

.X..VV.V.. Kol^ori^iTihi^ und\DdlmmplasM^^ daNjie t)ax^erresültat\
geiku so gUt\ind wi^bei jede^ari^ere\Me\hod^, die PtogHose qu^d\vitVm jedKch

II. Operationen an der Vulva

L Exstirpation der Bartholinischen Drüse

In besonderen Fällen chronischer Entzündung führen wir die radikale Operation
aus, d. h. wir entfernen die gesamte Drüse zusammen mit ihrem Ausführungsgang in

folgender Weise:

Schnitt durch die Haut in Länge der Zystenoberfläche an der Grenze von großen
und kleinen Schamlippen in Längsrichtung. Der Zystenbalg wird teils stumpf, teils
mit der Schere herauspräpariert und entfernt, die ziemlich stark blutenden Gefäße
gefaßt und unterbunden, und die Wunde schichtweise vernäht. Ein kleiner ableitender
Gazestreifen muß in den meisten Fällen eingelegt werden. Bei der Präparation der
Zyste ist große Vorsicht geboten, um ein Platzen derselben zu vermeiden. Es erschwert
die weitere radikale Entfernung des Balges ungemein, da sich die Grenzen zum be-
nachbarten Gew^ebe nicht mehr darstellen lassen. Wir helfen uns in einem solchen
Falle, indem wir die Zyste ganz entleeren, sie mit physiologischer Kochsalzlösung sauber
spülen und dann den ganzen Balg mit einem Gazestreifen bis ungefähr zur früheren
Größe wieder auffüllen. Auf diese Weise kann man sehr bequem die Operation zu Ende
führen und mit Sicherheit den ganzen Balg entfernen (Abb. 51—53).

Abb. 51. H a r t h o 1 i n i sehe Zyste

Abb . 52 . Operation der B a r t h o 1 i n i sc heii

Zyste. Die beim Freipräparieren geplatzte

Zyste wird mit Claze ausgestopft

Abb. 53 . Operation der B a r t h o l i n i sehen

Zyste, Herauspräparieren der mit Oazo

ausgestopften Zyste

Abb. 51.

Abb. 52.

Abb. 53.

t t

Spozioller Teil / II. Opcrationpn an der Vulva

2. Carcinoma vulvae

Bei überhaupt nocii angreifbarem Kar/.inom der Vulva ziehen wir che Operation
der Strahlenbehandlung vor. da <lur<h .liese wohl der primäre Tumor günstig bee.n ußt
winl die Wirkung auf die karzinomatösen Drüsen dagegen zumindestens zweifelhaft
bleibt Aus diesem Grunde kann eine kombinierte Behandlung gute Erfolge geben,
d h. man bestrahlt den primären Tumor und exstirpiert nachträglich die Drusen.

Ich führe die Operation in zwei Sitzungen aus, um Infektionen nach Möglich-
keit zu vermeiden. Zuerst wird der primäre Tumor exstirpiert, und nach Heilung der
Wunde wird in einem zweiten Eingriff <lie Vulvektomie und die Drüsenexstirpation
vorgenommen, d. h. die radikale Operation. Die Lymphbahnen, die von der Glans
clitoridis ausgehen, schlagen zwei verschiedene Wege ein : der eine endet m den tiefen
In^uinaldrüsen und im Ganglion internus retrocruralis (kruraler Weg), und der andere
lauft dem Lig. rotundum entlang zum Ganglion retrocruralis externus und endet oft in
den Inguinaldrüsen. Deshalb genügt es beim Sitz des Karzinoms in der Gegend des Vesti-
bulum im Zusammenhang mit der Vulvektomie auf beiden Seiten die Inguinaldrüsen
samt dem subkutanen Fettgewebe zu entfernen, während beim Khtoriskarzmom

Abb. 54. Radikaloperation des Vulvakarzinoms.

Die punktierte Linie markiert den Hautschnitt

zur Entfernung des Tumors

Abb. 55. Radikaloperation des Vulvakarzinoms.
Der primäre Tumor ist entfernt

2. Carcinoma vulvae

Abb. 56. Abb. 57. Radikaloperation des Vulvakarzinoms. Schnittfühnnig

Abb. 56. Radikaloperation des Vuh akarzinoms.
Schematische Darstellung der Naht nach Kntfernung des primären Tumors

unbedingt noch die Iliakalgegend ausgeräumt werden muß. Die Operation verläuft

auf folgende Weise:

In der ersten Sitzung exstiri)ieren wir, wenn keine Bestrahlung vorherging, den
Tumor durch Umschneidung im Gesunden (Abb. 54 und 55) und Vernähung der
Wunde mit Knopfnähten (Abb. 56). Erst nach vollständiger Heilung der Wunde folgt
in zweiter Sitzung die Radikaloperation.

Der Hautschnitt verläuft von der rechten Spina iliaca ant. sup. bogenförmig
in die rechte Kruralgegend, von hier in einem weiten Bogen durch den Mons veneris
oberhalb der Klitoris nach der linken Kruralgegend, um dann an der linken Spina
ihaca ant. sup. zu enden (Abb. 57). Von der Mitte des quer über die Klitoris ver-
laufenden Schnittes geht dann ein gerader Schnitt nach abwärts bis zur Vulva, die
zirkulär umschnitten wird (Abb. 57).

Wir bevorzugen diese bogenförmigen Schnitte, weil die von Rupprecht an-
gegebenen seitlich vom Mons veneris und parallel zur V. saphena verlaufenden leicht

zu Nekrosen führen können.

Wir beginnen mit der Exstirj)ation der Iliakaldrüsen. die wir intra- oder extra-
peritoneal vornehmen können, und die keine nennenswerten Schwierigkeiten bietet.
Die Ausräumung der inguinalen Drüsenpakete muß en bloc erfolgen, da man nur so
wirklich alle Drüsen entfernen kann. Zu diesem Zweck muß man von unten nach oben
zu fortschreitend die Aponeurose der Muskeln des Scar paschen Dreiecks abpräpa-
rieren, wobei man sich immer hinter der Vena saphena magna hält, die man gleich
nach genügend weiter Ablösung der Haut möglichst tief unten zwischen zwei Ligaturen
durchtrennt. Geht man von hier nach oben zu weiter, so trifft man auf folgende zu
unterbindende Gefäße: Aa. und Vv. pudendae ext., Aa. und Vv. circumfl. ilium superf.

Art. cplKastrU'a supcrflc.

V. saphena magna

III. Vaginale Operationen. 1. Ausschabung dos Uterus

Rosen-

inüllcrsche

Drüse

A. u. V.pu-
dcnta ext.

Margo falci
fornüs

M. pecti-
neua

y'e^Ut^a/.

M. sartorius

V. fenioralis V. sai)li('na magna

Abb. 58. Radikaloperation des Vulvakarzinoms. Ausräumung der rechten Inguinalgegend. Das
Unterhautzellgewebe mit Fascien, Muse, sartorius und Pectineus ist teilweise abgelöst und wird

hochgehalten

Abb. 59. Radikaloperation des Vulvakarzinoms. Photographie der bei der Radikaloperati

exstirpierten Gewebsteile

lon

und schließlich ganz oben die A. und V. epigastr. superfic. Die Vena saphena magna
muß zum zweiten Male dicht an ihrer Einmündungssteile in die Femoralis unterbunden
und durchtrennt werden. Wie schon erwähnt, muß man die Aponeurose des M. sar-

torius und pectineus mitentfernen,
weil nur in dieser Schicht die Aus-
räumung leicht und wirklich voll-
kommen vonstatten geht. Die unter
dem Po upart sehen Bande liegende
R o s e n m ü 1 1 e r sehe Drüse darf nicht
vergessen werden. Nachdem die
Ausräumung auf beiden Seiten be-
endet ist, wird die Vulva im Zu-
sammenhang mit dem oberhalb
von ihr befindlichen, die beiden
Drüsen pakete verbindenden Unter-
hautzellgewebe entfernt (Abb. 58
und 60).

Die früher geradezu trostlosen
Dauerresultate haben sich durch
dieses radikale Vorgehen wesentlich
gebessert, so daß Rupj)recht bei
25 operierten Fällen 4()o/o Dauer-
heilungen aufweisen kann.

Wir bestrahlen alle operierten
Fälle nach. Die inoperablen Vulva-
karzinome werden sofort der Be-
strahlung unterzogen.

Abb. 60. Radikaloperation des Vulvakarzinoms.

Schematische Darstellung der Naht nach X'oll-

endung des Eingriffes

III. Vaginale Operationen am Uterus

1. Ausschabung des Uterus

Bei der gynäkologischen Ausschabung fassen wir die Portio mit ein oder besser
mit zwei Kugelzangen an der vorderen Li])pe und ziehen sie nach abwärts und außen.
Dann führen wir in das Kavum eine biegsame Uterussonde ein, der wir eine ent-
sprechende Form geben. Die vorhergegangene bimanuelle Untersuchung hat uns
bereits über Größe und Lage des Uterus informiert, und die Handhabung der Sonde
muß unter Berücksichtigung dieser Verhältnisse mit großer Vorsicht geschehen, um
Verletzungen mit Sicherheit zu vermeiden. Man versuche nicht die Sonde mit Gewalt
einzuführen, wenn sich irgendwelche Schwierigkeiten zeigen, sondern man verschiebe
die Operation auf den nächsten Tag, wo man dann meist zum Ziele kommt. Die Son-
dierung unterrichtet uns genau über Größe und Verlauf der Uterushöhle und darf nie
unterlassen werden. Nach Erweiterung des Zervikalkanals mit einigen Hegarstiften
oder sonstigen Diktatoren schaben wir ohne große Kraftanwendung die Gebärmutter-
höhle mit einer scharfen Kürette aus.

Handelt es sich um einen Abortus, so erweitern wir stärker, entsprechend der
Zeit der Schwangerschaft und der Größe der Abortreste. In den ersten 3—4 Schwanger-
schaftsmonaten benutze ich zur Entleerung stumpfe Küretten. Sind noch große
Plazentarstücke oder der Fötus zu entfernen, so nehme ich die Wintersche Abort-
zange oder die große Bummsche Kürette. Die Ausräumung mit dem Finger halte ich
für viel schwieriger und unzweckmäßiger, und die GefährUchkeit des Eingriffes wird

t t

Spozi(^ller Toil / III. Vaginale Operationen am Uterus

1. AuHschaliimg des Uterus

auf diese Weise auch nicht herabgesetzt, wie viele Statistiken beweisen. Hat sich der
Uterus gut kontrahiert, so kann man mit entsprechender Vorsicht und ohne Kraft
auch eine größere scharfe Kürette benutzen, um die letzen Plazentarstückchen zu
entfernen, worauf ich großen Wert lege, weil dadurch den Patientinnen Schmerzen
und Blutungen nach dem Eingriff erspart bleiben. Nach völliger Entleerung des
Uterus wische ich das Kavum lediglich mit Jodtinktur aus und verzichte auf
Spülung und Tamponade. Die Blutung steht in jedem Falle, wenn der Uterus tat-
sächlich keine Abortreste mehr enthcält. Man erleichtert sich die ganze Operation
durch vorhergehende Sekale- oder Pituitrinin jektion, wodurch die Uterushöhle kleiner
und die Wandung härter wird. Eine leichte Scheidentamponade, die wir nach der
Operation machen, wird am nächsten Tage wieder entfernt.

Komplikationen bei der Ausschabung

Die Verhütung einer Infektion liegt meistens nicht in den Händen des Opera-
teurs, sondern hängt vom mehr oder weniger aseptischen Zustand des Uterusinhaltes
ab. Den besten Schutz zu ihrer Vermeidung bildet die sorgfältige, restlose Entleerung
des Uterus unter Beachtung aller aseptischen Kautelen.

Ganz im Gegensatz hierzu bildet die Perforation des Uterus eine KompHkation,
die meistens zu Lasten des operierenden Arztes geht, wenn auch zuzugeben ist, daß
in manchen, besonders unglückhch gelagerten Fällen die weiche, fast unfühlbare

Abb. 61. Doppelte Perforation des graviden Uterus (M. V.). Der zerfetzte Fötus ist durch die
große Perforation aus dem Uterus ausgetreten. In der kleinen, am Fundus uteri liegenden Öffnung

sieht man das in den Uterus hineingezogene Netz

Wandung der schwangeren Gebärnmtter ohne jedes Verschulden bei ganz korrek-
tem Vorgehen durchbohrt werden kann. Schon gleich zu Beginn des Eingriffes
kann eine Perforation des Uterus mit der Sonde vorkommen. Häufiger sind
Verletzungen der Zervix durch zu forziertes Diktieren mit den Hegarstiften,
wobei häufig der Kürette ein falscher Weg gebahnt wird. Die schwersten Ver-
letzungen sieht man nach fehlerhaftem Gebrauch der Winterschen Zange, besonders
wenn die zuerst gesetzte Perforation nicht sofort bemerkt und durch das entstandene
Loch Darmschlingen oder Netz in die Scheide und nach außen gezogen wird. Bei
einem in meine Klinik gebrachten und von mir operierten Fall war der 5 Monate
alte, halbzerstückelte Fötus durch eine große Perforationsöffnung in die Bauchhöhle
geschlüpft, und durch eine zweite Öffnung hing ein großes Netzstück in die Vagina.
Abdominale Uterusexstiri)ation mit Ausgang in Heilung (Abb. 61). Um Unheil zu
verhüten, muß das wirklich wertvolle Instrument von Winter in folgender Weise

Abb. 62. Operative Behandlung des Abortus. Die Wintersche Abortzange wird unter Kontrolle

der äußeren Hand bis zum Fundus eingeführt

Logothotdpulos. GyuäkoloKischf Chirurgie

Speziolh^r Teil / III. Vaginalo Operationen am Uterus

Abb. 63. Operative
Behandlung des
Abortus. Die Abort-
zange wird etwas
zurückgezogen und
geöffnet

2. Operation alter Zervixrisse

Abb. 63.

Abb. 64. Operative
Behandlung des
Abortus. Ein ab-
gelöstes Plazenta -
stück wird unter
Drehung der Abort-
zange nach außen
gezogen

angewandt werden: Die linke Hand umfaßt den Fundus uteri und fühlt so selir
deutlich die ohne Druck bis ganz nach oben eingeführte geschlossene Zange (Abb. 62),
die jetzt ein wenig zurückgezogen und nun erst geöffnet wird (Abb. 63). Im Uterus
befindliche Stücke der Plazenta oder des Fötus legen sich ganz von selbst zwischen
die Löffel der Zange, die lediglich geschlossen zu werden braucht, ohne eine andere
vorhergehende Bewegung. So vermeidet man mit Sicherheit das gefährliche Fassen
der weichen Uteruswand. Führt man beim Herausziehen der Plazenta mit der
Abortzange eine drehende Bewegung nach einer Seite hin aus (Abb. 64), so gehngt
es sehr oft, die ganze Plazenta in toto herauszubef ordern.

Hat man die Gewißheit oder auch nur den Verdacht perforiert zu haben, so stellt
man jede weitere intrauterine Manii)ulation sofort ein. Bei gynäkologischen Fällen
pflegt dieses Mißgeschick ohne ernste Folgen zu bleiben, und wir können uns darauf
beschränken, Bettruhe zu verordnen und eine Eisblase aufzulegen. Zeigen sich jedoch
peritonitische Erscheinungen, so ist die Laparotomie unvermeidbar. Wir führen sie
sofort aus, wenn die Perforation sich gelegentlich einer Abortausräumung ereignete.
Man fährt am sichersten mit der Exstirpation des verletzten Uterus, kann sich aber
ausnahmsweise mit der Naht der Perforationsstelle begnügen, wenn man der Asepsis
des Operateurs, der die Ausräumung des Uterus vorgenommen hat, sicher ist und
es sich um einen wahrscheinlich bakterienfreien Uterus gehandelt hat (Schwanger-
schaftsunterbrechung).

2. Operation alter Zervixrisse

Die bei der Geburt entstehenden Zervixrisse mit ihren späteren Ektropien machen
zuweilen erhebliche Beschwerden, so daß die operative Wiederherstellung normaler
Verhältnisse angezeigt ist. Wir verwenden je nach dem Grad der Einrisse folgende
Methoden :

a) nach Roser-Emmet:

Exzision der Narben, vollständige Anfrischung der Lappenränder. Bei der Naht
des Risses muß man sich bemühen, den oberen Wundwinkel gut mitzufassen, da Nach-
blutungen aus dieser Stelle nicht selten sind;

b) nach Sturmdorff:

Diese ganz ausgezeichnete Resultate ergebende Methode verwenden wir nicht nur
bei Zervixrissen größeren Umfanges, sondern auch bei sehr hartnäckigen Katarrhen
mit Erosionsbildung, wobei die ganze Zervixschleimhaut durch Scheidenschleimhaut
ersetzt wird. Man schneidet mit einem sehr scharfen, schlanken Messer ein kegel-
förmiges Stück aus der Portio, dessen Basis die ganze Portio umkreist, dessen Spitze
in Höhe des inneren Muttermundes liegt. In diesem Kegel ist somit die ganze Unter-
fläche der Portio und die Zervixschleimhaut enthalten. Nun sticht man mit einer
starken, scharf gekrümmten Nadel, die mit einem sehr kräftigen Katgutfaden armiert
ist, in Höhe des inneren Muttermundes durch die Scheidenschleimhaut in den Zervikal-
kanal und führt die Nadel durch das Orificium ext. heraus. Nachdem man die
Scheidenwand in der Mitte und oberhalb des Wundrandes mit der Nadel gefaßt hat,
kehrt man auf dem gleichen Weg durch den Zervikalkanal zurück und durchsticht
die Portio von innen nach außen etwa in 1 cm Entfernung seitlich von der Ein-
stichöffnung. Beim Knoten der beiden Fadenenden wird die Schleimhaut tief in den
Zervikalkanal hineingezogen und tritt an Stelle der exzidierten Innenfläche. Das gleiche
Manöver wiederholt man in entsprechender Weise auf der Rückseite der Portio. Wenn
nötig werden die schlitzförmigen Wunden auf beiden Seiten noch mit einigen Nähten
verschlossen.

Abb. 64.

! / '

Spezieller Teil / III. Vaginale Operationen am Uterus

3. Diszision der Cervix nach Pozzi

Die in seltenen Fällen Sterilität verursachenden Stenosen des äußeren Mutter-
mundes können durch Einlegen von Laminaria oder durch Dilatation mit Hegar-
stiften meist nicht dauernd beseitigt werden, im Gegenteil, es treten infolge der ent-
standenen kleinen Verletzungen zuweilen sogar noch narbige Verengerungen zur
primären Stenose hinzu. Wir führen mit gutem Enderfolg hier die Stomatoplastik
nach Pozzi aus, bei der die Zervix quer gespalten wird, so daß je zwei in der Mitte
in Berührung stehende Wundflächen entstehen. Entsprechend dem Grade der Ver-
engerung schneidet man aus diesen Flächen je einen kleinen Keil heraus und vepaht
die Wundränder mit Katgut (Abb. 65—67).

4. rartielte Hasittale Uterusresektion -nm-4«t Seheide fm>

Bei Blutungen, die weder mit Bestrahlungen, noch mit Uterusexstirpatimi^be-
handelt werden können, weil die Menstruation erhalten bleiben soll, wende ich folgMidee

Ausfülirung/iner vorderen KolpocoeUotomie. Nachdem der Fundus uteri aus der
CoeliotomieÖff^g herausgewälzt ist, fassen wir ihn beiderseits neben den Ansatz-
stellen der Li^^)tunda i^lt je einer Kugelzange und führen nahezu parallel zur Uterus-
kante undAon ihr^^a 2 cm entfernt, Hnks und rechts einen Längsschnitt bis zum
inneren/Lttermund:^ s^aß ein keilförmiges Stück des Korpus entfernt wird, dessen
Basis/em Fundu/und dess>u. Spitze dem Isthmus entspricht (Abb. 68). Die Blutung
hier/ei ist sehr Zring, da der Mittelteil des Uterus gefäßarm ist. Einzelunterbindungen
sind nicht no^endig, und man kann sofort mit der Naht beginnen, die man zwecks
leichterer Adaption der beiden Hälften zweckmäßigerweise am Fundus anfängt
(Abb. 69 /nd 70). Sind alle Knopfnähte hinten und vorn gelegt, so heftet man mit
einigen Wichen das Blasenperitoneum genau so wie bei der Interpositio uteri \inögUchst
tief de/hinteren Uteruswand an und schließt dann die Scheidenwunde. Da der Zweck
dieser Operation die Erhaltung einer normalen Menstruation ist, so darf sie nur bei
funktionstüchtigen Ovarien ausgeführt werden.

5. Die vaginale Totale xstirpation des Uterus

Wir führen sie in unkomplizierten Fällen, bei freibeweglichem und nicht be-
sonders großem Uterus in folgender Weise aus :

Nach Entfaltung der Scheide mittels Spekula fassen wir die Portio mit zwei oder
vier einzähnigen Kugelzangen und ziehen sie nach abwärts. Nun wird die Scheiden-
wand in ihrer ganzen Dicke mit einer kräftigen gebogenen Schere etwa V2 cm oberhalb
des Überganges der Scheiden- in die Portioschleimhaut zirkulär umschnitten (Abb. 71),
und teils stumpf, teils mit der Schere etwas nach oben zu abpräpariert. Ist der Uterus-
inhalt nicht sicher aseptisch, so fassen wir beide MuttermundsUppen mit Kugelzangen zu-
sammen und vernähen nach zirkulärer Umschneidung der Portio die vordere und die
hintere Vaginalwunde mit Knopfnähten, so daß der Muttermund vollkommen ver-
deckt ist (Abb. 72—74).

Bei enger Scheide kann man die Öffnung durch Hinzufügen zweier 1—2 cm langer
Schnitte senkrecht zum Wundrand auf beiden Seiten leicht erweitern. Die Blasen-
wandung wird jetzt mit der Pinzette nach oben zu angespannt und mit kleinen Schnitten
die nun deutlich sichtbar werdenden vesikozervikalen Bindegewebsstränge durchtrennt,
und dadurch die Blase von ihren festeren Verbindungen mit der Zervix losgelöst
(Abb. 75). Zum weiteren Abschieben der Blase verwenden wir nur den Finger, da

3. Die Diszision der Cervix nach Pozzi

Abb. 65. Zervixspaltiing nach Pozzi.
Markierung der Sehnittfühnnig

Abb. 66. Zervixspaltiing nach Pozzi. Aus
der Wundfläche der linktm S(Mte wird ein
keilförmiges Stück herausgeschnitten. Rechts
werden die Wundränder nach der Heraus-
nahme des Keils wieder vereinigt

Abb. 67. Zervixspaltung nach Pozzi.
Die Operation ist beendet

Abb. 68. Väjmiale a»0ttÄle Utepsrttesektion

nach' L^othWp^ los. '^^A»<(lem hervor-

ga^fsMen Ute^svwird eiö*eH(örmige8\^tück

/ r »x^erau^g^JB^nittei

v>'^

/ ,0

V'lb

rr^

f u

SpozioUor Teil / III. Vaginale Oporationün am Utorus

5. Dio vaginalem Totalrxstirpation des Utorus

Fundus
uteri

Abb. 69. Vaginale sagjXÜale Uterusresektion
nach Logothetj>f{ulos. Vereinigung der
Wundflächeja^^ler Vorderseite des Uterus
mit Einzelnähten

\
Abb. 70. Vaginale sagittale^t^ferusresektion
nach Logothetopukj.»: Vereinigung der
Wundflächen auf d^ßi<Hinterseite des Uterus.
Der zuerst am' Fundus angelegte Faden
dient als Zügel

beim Gebrauch von Tupfer oder Gazestückchen die Peritonealfalte zu leicht mit nach
oben geht (Abb.>^).V^Man verhütet auch so am besten ein Einreißen der Blasen-
wandung, wenn Infiltrationen oder Verwachsungen bestehen, die nötigenfalls, wie es
bei karzinomatösen Uteri häufig vorkommt, mit Pinzette und Schere scharf abpräpa-
riert werden müssen. Nachdem auch die seitlichen Blasen])artieen mit beiden Zeige-
fingern gut nach oben und nach der Seite geschoben worden sind (Abb. "^ /legen wir
das vordere Blatt des Spekulums unter die Blase und bringen sie und die Ureteren
auf diese Weise außerhalb des Operationsgebietes. Das an seiner weißen, glänzenden
Farbe erkennbare Peritoneum, das nun deutlich sichtbar ist, wird mit der Pinzette
angehoben, mit einem Scherenschlag eröffnet, und die Öffnung nach beiden Seiten
erweitert (Abb. 77): Man entfernt das vordere Spekulum und führt ein breiteres Blatt
in die Peritonealöffnung ein. Der Assistent zieht dieses Spekulum kräftig symphysen-
wärts und macht so die vordere Uteruswand zugängig, die mit einer doppelzähnigen
Kugel- oder besser Krallenzange gefaßt und nach abwärts gezogen wird, während man
mit der anderen Hand die Portio in die Scheide zurückschiebt (Abby^TÄ). Das oberhalb
der Kugel zange sichtbar werdende Uterusstück wird mit einer zweiten Kugelzange
gefaßt, nach abwärts gezogen und die erste Zange entfernt. So klettern wir nach und
nach an der vorderen Uteruswand bis zum Fundus in die Höhe, der schließlich vor der
Vulva erscheint (Abb^l&J: Bei größeren Uteri erleichtert man sich das Vorwälzen des
Fundus, indem man mit den Zangen nicht die Mitte, sondern die seitlichen Teile faßt
und nun zuerst das linke, dann das rechte Hörn entwickelt. Wenn man jetzt die Portio
an den Kugelzangen oder am Zügel wieder nach außen zieht, liegt der ganze Uterus

ht^a^Um^

Abb. lir-. Vaginale» Uterusexstirpation. Die

Vaghialschleimhaut wird mit der gebogenen

Schere zirkulär umschnitten

Abb. ^%. Vaginale Uterusexstirpation bei in-
fektiösem Inhalt. Nach Zusammenfassen der
vorderen und hinteren Muttermundlippe mit
Kugelzangen wird die Schleimhaut zirkulär

umschnitten

Abb. TS,. Vaginale Uterusexstirpation bei

infektiösem Inhalt. Vernähung des vorderen

vind hinteren Schleimhautlappens

Abb. J?4? Vaginale Uterusexstirpation bei
infektiösem Inhalt. Anlegen der letzten

Knopfnaht

Spozi(>llor Toi) / III. Vaginale Operationen am Uterus

5. Die vaginale Totalexstirpation des Uterus

Cn-

Cyi

a) Seitlicher Einschnitt in die Scheide

Abb. l-ffT- Vaginale Uterusexstirpation. Er-
weiterung des Zirkulärsehnittes durch kleine
Längsschnitte bei{lers(nts. Die Blase wird von
ihren festeren Verbindungen mit der Zervix
.. scharf abgelöst

Abb. 787" Vaginale Uterust^xstirpation. Der mit
durch die Peritonealöffnung nach außen gezogen

Abb. 76. Vaginale Uterusexstirpation. Die
Blase wird mit dem Finger hochgeschoben

Abb. 77.- Vaginale Uterusexstirpation. Die

Blase wird mit dem vorderen Vaginal-

spekulum zurückgehalten und die Peri-

tonealfalte eröffnet

einer Krallenzange gefaßte Fundus uteri wird
unter gleichzeitigem Zurückschieben der Portio

vor der Vulva (Abb;^. Durch Einführen einer großen, mit einem Faden versehenen
Kompresse in die Bauchhöhle werden die Darmschlingen am Vorfallen verhindert.
Wcährend der Uterus stark nach rechts gezogen wird, faßt man mit einer starken
Klemme etwa 1 cm vom Uterus entfernt, das linke Lig. rotundum, die Tube und das
Lig. ovarii proprii unter sorgfältiger Kontrolle des Fingers und des Auges, um
das Mitfassen eines anderen Organes zu verhindern. Die gefaßten Teile werden
dicht am Uterus mit der Schere durchschnitten. Unter ständigem Zug des Uterus
nach rechts w ird jetzt mit einer zweiten Klemme von unten her die linke Arteria uterina
und das Lig. sacrouterinum gefaßt und mit der Schere dicht am Uterus durch -
trennt.

Die gleichen Manöver werden unter Zug des Uterus nach links auf der rechten
Seite ausgeführt (Abb.'»t). Das Seitenspekulum befindet sich immer auf der Seite, an
der der Operateur gerade arbeitet. Wichtig ist, sich immer dicht am Uterus zu
halten, um mit Sicherheit jede Verletzung des Ureters zu vermeiden. Bei glatten
Fällen kann die ganze Absetzung des Uterus bis zu dieser Phase in IV2— ^ Minuten
ausgeführt werden.

Abb..7^ (Unterschrift s. S. 50)

Abb. 7fr-(Unterschrift s. S. 50)

[

Abb. 7^ Vaginale Uterusexstirpation. Der
Fundus uteri ist nach außen gewälzt

Mycini-
knotfii

Abb.-ÄOr Vaginale Uterusexstirpation. Auch
die Portio ist jetzt hervorgezogen, so
daß der ganze Uterus vor der Vulva liegt

Sp(3zii)llor Teil / 111. Vaginalt? Op(>ratioiien am Uterus

Ablj. "RTT Vaginale Uterusexstir -
pation. Fundus uteri und Portio
werden kräftig nach links gezogen.
Die Ligg. lata, die Tuben und die
Ligg. ov. propr. sind zwischen
Klemmen durchschnitten. Das

rechte Parametrium mit den Uterin -
gefäßen ist von imten gefaßt

Abb. 88». Vaginale Uterusexstir-

pation. Die Klemmen werden

durch Unterbindungen ersetzt

#^*e^:W^t

6. Vaginale Totalexstirpation

Abb. '8*r Vaginale Uterusexstirpation.
Schluß des Peritonevnns und der Scheide.
Die Nähte fassen die Unterbindungs-
stümpfe mit

Abb. 84-. Vaginale Uterusexstirpation.
Durch die Nahtführung wird erreicht,
(laß die Stümpfe extraperitonc^al,
aber von der Scheidenschleimhaut
bedeckt, gelagert werden

Es folgt die Umstechung der in den Klemmen liegenden Bündel. Wir beginnen
mit der am leichtest versorgbaren Klemme, hinter der wir das gefaßte Gewebe durch-
stechen und den starken Katgutfaden erst oberhalb und dann unterhalb der Klemme
knoten, wobei man sehr darauf achten muß, daß der Faden wirklich um die Klemmen-
spitze herumgelegt wird (Abb^^). Der Assistent öffnet die Klemme während des
Zuziehens des Knotens sehr langsam, ohne die Stellung derselben zu verändern. Er
läßt den Faden sozusagen in die Quetschfurche hineinrutschen. Nachdem alle Klemmen
durch Unterbindungen ersetzt worden sind, entfernt man die in der Bauchhöhle
befindliche Kompresse in leichter Beckenhochlagerung unter Zurückhaltung sich etwa
vordrängender Darmschlingen mit einem Stieltupfer. Beim langsamen Zurückziehen
des vorderen Seitenspekulums, nötigenfalls in leichter Beckenhochlagerung, um die
Darmschlingen außer Sicht zu bringen, erscheint das Peritoneum, das man mit dem
Scheidenwundrand zusammen in eine Klemme faßt. Ebenso verfährt man mit dem
Douglasperitoneum, das beim langsamen Zurückziehen des hinteren Spekulums sicht-
bar wird. Mit einzelnen Knopfnähten oder mittels Tabaksbeutelnaht, die durch
Scheidenwand, Peritoneum und Stümpfe geht, wird die Vagina geschlossen, so daß
die Stümpfe außerhalb der Bauchhöhle zu liegen kommen (Abb. ^. Ich trachte aber,
sie möglichst mit der Scheide zu decken, da sonst Tubengranulome entstehen, die für
die Patientin lästig sein können (Blutungen, Ausfluß) (Abb.-S^). Vor der Entlassung
kontrolliere ich deshalb immer die Scheidenwunde und zerstöre gegebenenfalls Granu-
lationen mit dem Galvanokauter.

/ 7;

f %o

SpcziclltM- Tt^il / 111. Vaginahi Opcrationon am Uterus

Abb. ^ 5 ^

Abb.

8«^ ^3

Abb. "H^ Vaginale Uterusexstirpation
durch Spaltung der vorderen Uterus -
wand. Die Blase ist abgelöst und
wird vorn vorderen Vaginalspekulum
hochgehalten

Abb. 86. Vaginale Uterusexstirpation
durch Spaltung der vorderen Uterus-
wand. Das vordere Vaginalblatt liegt
in der Peritonealöfinung und hält die
Blase zurück. Die vordere Zervixwand
ist gespalten

Abb. "^^Z^. Vaginale Uterusexstirpation
durch Spaltung der vorderen Uterus-
wand. Die mit Krallenzangen gt^faßten
Uteruswundränder werden auseinander
und nach abwärts gezogen. Die vordere
Uteruswand wird weiter nach oben zu
gespalten

r^Kl

Abb. 8\ %],

ö. Die vaginale Totaloxstirpation dos Uterus

Abb. *i^ Vaginale Uterusexstirpation
(lurcb Spaltung der vorderen Uterus-
wand. Nach weiterer Spaltung erscheint
der Fundus uteri und wird mit einer
Krallenzange gefaßt

a) Vaginale Totalexstirpation mit Spaltuiift der vordor.'ii l toriiswaiul

Ist der zu exstirpierende Uterus erheblich vergrößert oder bestehen Verwachsungen
und Infiltrationen, so kann das Hervorwälzen Schwierigkeiten machen, die wir m
folgender Weise umgehen : Der Anfang der Operation verläuft wie bei der gewöhnhchen
Totalexstirpation, also Hervorziehen der Portio, Umschnei(hmg der Vag.nalwand,
Ablösen der Blase und Einführen des vorderen Blattes unter diese. Nacli Entfernung
der vorderen Kugelzangen von der Portio spalten wir die vordere Uteruswand mit einer
geraden Schere, deren eine Branche wir in das Kavum einführen, genau m <ler Mittel-
- /- linie (Abb 85 undto). Um bei diesen meist komi)lizierteren Fällen mehr Raum zu
-'^^^ -<^-\aben, ersetzen wir gern die Kugelzangen an der Portio durch starke Seidenfä.len
Bei der Spaltung wird das Peritoneum ganz von selbst eröffnet, und wir fuhren sofort
ein Spekulum in die Bauchhöhle ein, durch das die Blase nach oben gehalten wird
Hierauf werden die Uteruswundränder beiderseits mit Krallenzangen gefaßt und
nach unten gezogen (Abbfszj, gleichzeitig aber die gespaltene Portio in die Sc^lieide
zurückgeschoben. Unter stetigem Nachfassen mit den Krallenzangen wir.l die Uterus-
wandung bis hinauf zum Fundus gespalten, der schließlich vor der Vulva erscheint
(Abb. kji Jetzt wird die Portio wieder herausgezogen, und die Oi.erat.on in genau
der oben geschilderten Weise zu Ende geführt.

b) Vaginale Totalexstirpation des Iter.is mit Spaltung der vorderen und hinteren l teruswand

Wir wenden diese von Müller angegebene Methode hauptsächlich dann an, wenn
es sich um Uteri handelt, die infolge entzündlicher Adnexerkrankungen gleichsam
im Parametrium eingemauert erscheinen. Man «i.altet den Uterus vollkommen in

r /-»

Spezioller Teil / III. Vaginale Operationen am Uterus

6. Vaginale Operationen bei Uterus myomatosus

»I

zwei Hälften, die nacheinander exstirpiert werden, und zwar schiebt man die eine Hälfte
während der Entfernung der anderen wieder in die Bauchhöhle zurück, um möglichst
viel Raum zu haben. Die Hauptschwierigkeit dieser Operation liegt im Vermeiden
von Verletzungen der Ureteren und der Blase, die sich der Verwachsungen wegen nur
schwer abschieben läßt.

6. Vaginale Operationen bei Uterus myomatosus

a) Gestielte submuköse Myome (Polypen)

Die in die Scheide hineinragenden oder schon vor der Vulva erscheinenden sub-
mukösen gestielten Myome (Abb.^-jSl^ fassen wir mit einer Krallenzange und drehen
sie ab, oder, falls das nicht gelingt, schneiden wir den Stiel an seiner Abgangsstelle
mit der Schere durch. Liegt diese Stelle hoch oben, so müssen wir zuerst die vordere
Zervix wand spalten, den Stiel abtragen und nun die Zervix wieder vernähen (Abb,
Eine erhebhche Blutung pflegt nicht zu entstehen, sie läßt sich fast immer durch eine
leichte Uterustamponade stillen. Diese einfache Entfernung der myomatösen Polypen
führen wir nur ungern aus, da der Enderfolg oft nicht befriedigend ist. Man ist nicht
vor Rezidiven sicher, die oft infizierten Tumoren machen Entzündungserscheinungen
in der Umgebung, und das Fieber bleibt nach der Operation weiter bestehen. In allen
diesen Fällen schließen wir deswegen an die Abtragung des Polypen die Uterus-
exstirpation an.

b) Vaginale Enukleation von Myomknoten

Wir wenden dieses Vorgehen nur bei kleinen Tumoren und auch da nur ausnahms-
weise an, da für konservative Myomoperationen der abdominale Weg vorzuziehen ist.
Der Uterus wird in der gleichen Weise vorgewälzt, wie wir es bei der vaginalen Exstir-
pation geschildert haben, und dann die Enukleation der Knoten wie bei der abdominalen
Operation ausgeführt (siehe S. 64).

c) Vaginale Uterusexstirpation bei Uterus myomatosus

Es ist möglich, vaginal sehr große Myome zu entfernen, wenn man sich durch einen
S c hu char dt- Schnitt Raum schafft und die Uterusspaltung nach Doyen ausführt.
Wir ziehen aber doch den abdominalen Weg vor, da man unerwarteterweise oft den
Uterus erhalten kann, was sich vor der Operation nicht mit Sicherheit sagen läßt.
Auch bei sehr großen Tumoren, die nicht ins kleine Becken hineinpassen, oder beim
Bestehen starker Adhäsionen, verzichten wir auf das vaginale Vorgehen.

Haben wir uns für die vaginale Operation entschlossen, so versuchen wir den
gespaltenen Uterus hervorzuwälzen ; mißlingt das bei zu großen Geschwülsten, so
zerstückeln wir den Tumor (Morcellement nach Pean), eine bei richtiger Technik
durchaus nicht schwierige und elegante Operation. Ich beginne mit der Spaltung der
vorderen Uteruswand, soweit sie ausführbar ist, und ziehe dann die Wundränder
mit Krallenzangen stark nach außen. Der Tumor wird mit einer Krallenzange oder
mit dem Myombohrer gefaßt und mit dem Segondschen Messer (Abb.f^ ein kegel- f t^
förmiges Stück herausgeschnitten. Bevor ich dasselbe aber ganz abtrage, fasse ich
den Resttumor von neuem, um zu verhüten, daß er sich wieder zurückzieht (Abb. ^^f ^ ^
undf^Ss^. Oft läßt sich auch ein großer Knoten im ganzen aus seinem Bett heraus-
schälen (Abb.l^ und man arbeitet sich auf diese oder auf obige Art langsam bis

Abb. 9^$£

Abb. Ä^ Großer, in die Scheide geborener Polyp (submuköses
Myom). Er ist mit einer Krallenzange gefaßt und wird durch

Abtlrehen entfernt

Abb. 9a^ Gestieltes submuköses Myom. Spaltung der vorderen
Zervixwand zwecks Freilegung der Ansatzstelle des Stiels

Abb. ^^ &■?.

Spozioller T(nl / III. Vaginalo Oporationen am Uterus

6. Vaginalem Oporationon bei Uterus myomatosus

■I

Abb. yl. Vaginalo Exstirpation des
myomatösen Uterus durch Zerstücke-
lung. Die im Bild sichtbaren Fäden
liegen an der in die Scheide zurück-
geschobenen, gespaltenen Portio. Aus
der mit einer Krallenzange gefaßten
vorderen Uteruswand wird mit einem
Messer ein keilförmiges Stück heraus-
geschnitten

Abb.'"fl'3T Vaginale Exstirpation des
myomatösen Uterus durch Zerstücke-
lung. Aus der gefaßten und stark
nacii abwärts gezogenen Uteruswand
wird mit dem Messer ein weiteres
Stück herausgeschnitten

Abb. ^^ Vaginale Exstirpation des
myomatösen Uterus durch Zerstücke-
lung. Vor der Abtragung des keil-
förmigen Stückes wird die Uterus-
schnittfläche erneut mit Krallen-
zangen gefaßt

Logothetopulos, Gynäkologische Chirurgie

Abb. -^h- Vaginale Exstirpation des
myomatösen Uterus durch Zer-
stückelung. Nach Abtragung der
zwei ersten Stücke wird die Uterus-
wand an der linken Seite stark nach
abwärts gezogen und seitlich eben-
falls ein Stück herausgeschnitten.
Vor der vollständigen Abtragung ist
an die rechte Uterushälfte eine andere
Krallenzange angesetzt worden

Vf:>

Spezieller Teil / III. Vaginale Operationen am Uterus

^tu^U^ .

-tjiyi|iy^»5

Kill großer

Abb. mr Vaginale P^xstirpation des myomatösen Uterus durch Zerstückelung.

Myomknoten wird aus seinem Bett herausgeschält

zum Fundus vorwärts (Abb.'»^, indem man immer wieder neue Teile der Uterus-
wandung nach abwärts zieht, bis der ganze Uterus als große längliche Masse vor der
Vulva erscheint (Abb. '^V Nun kann die Exstirpation zu Ende geführt werden,
so wie sie bereits geschildert wurde. Es ist ratsam, beim Morcellement sich
stets in der Mitte des Tumors zu halten, um die seitlich hegenden großen Gefäße
zu vermeiden. Man verhütet das zu häufige Abreißen der Krallenzangen und
unliebsame Verzögerungen der Operation, wenn man sich den Tumor von oben
her ins Becken hineinpressen läßt. Das bildet gleichzeitig den besten Schutz gegen
ein ungewolltes Abreißen und Zurückbleiben gestielter subseröser Myome in der

Bauchhöhle.

Die von D öder lein empfohlene Spaltung der hinteren Uterus wand wende ich
nur bei Myomen an, die hinter dem Uterus und tief im kleinen Becken sitzen.

7. Erweiterte vaginale Operation des Carcinoma colli uteri

Diese Operation bezweckt die Entfernung eines möghchst großen Teils der Para-
metrien im Zusammenhang mit dem Uterus nach Freilegung der Ureteren. Sie wurde
von Schauta systematisch ausgearbeitet, aber erst durch den von Schuchardt
eingeführten paravaginalen Erweiterungsschnitt wurde ein erfolgsicheres Arbeiten
ermöglicht. Wir beschränken uns auf die Wiedergabe der in unserer Klinik gebräuch-

7. Erweiterte vaginale Operation des Carcinoma colli uteri

fil

Wfr. Vagii

Abb. 8^ Vaginale Exstirpation des myomatösen Uterus durch Zerstück(>lung. Ein sehr großes,

verjauchtes Myom wird durch Zerstückelung entfernt. Der größte Teil des Tumors ist bereits

abgetragen, und der Uterus ist mit einem Rest des Myoms vor die Vulva gezogen

heben Technik, die in einzelnen Punkten von dem in den verschiedenen Operations-
lehren geschilderten Verfahren abweicht^).

Die mit scharfen Klemmen gefaßte Scheidenwand wird zirkulär umschnitten
(Abb/^ und mit der gebogenen Schere ringsum von dem darunter liegenden Binde-
gewebe abgelöst. Die Entfernung des Schnittes von der Portio richtet sich ganz nach
dem vorliegenden Fall, muß aber jedenfalls so bemessen sein, daß die karzinomatösen

1) Pankow, Die Therapie des Uteruskarzinoms. — Handbvich der Gynäkologie von
Stöckel. VI. Band, 2. Heft, S. 410. — Mikulicz-Radecki, Gynäkologische Operationen.
Verlag Johann Ambrosius Barth, 1933. — Peham- Amreich, Gynäkologische Operationen.
Verlag Karger, 1930.

Spezieller Teil / III. Vaginale Operationen am Uterus

r^^

r^n

Massen vollständig von der zu bildenden Scheidenmanschette bedeckt werden können.
Wir legen über die Portio einen mit Jodtinktur getränkten Gazebausch und vernähen
über demselben mit nahe beieinander liegenden starken Seidennähten die vordere
und hintere Scheidenwand (AhhJ^, so daß ein Austritt von infektiösem Material
oder karzinomatösen Keimen mit Sicherheit verhindert wird. Handschuh- und In-
strumentenwechsel. Nach Anlegung eines ausgiebigen Schuchardtschnittes wird das
von mir angegebene, bereits früher beschriebene hintere Spekulum (Abb. 26) und die

8. Abdominale Operationen am Uterus

Abb. *^ Erweiterte vaginale Uterusexstir-
pation bei Portiokarzinom. Die Scheiden-
wand wird mit vier scharfen Klemmen ge-
faßt und zirkulär umschnitten

Abb. ö^. Erweiterte vaginale Uterusexstir-
pation bei Portiokarzinom. Die vordere und
hintere Vaginalwand wird miteinander ver-
näht, nachdem vor die Portio ein mit Tct.
Jodi getränkter Gazebausch gelegt wurde

beiden Seitenspekula eingesetzt, und die mit einer Kocherklemme zusammengefaßten
Seidenfäden werden stark nach abwärts gezogen. Die nun folgende Ablösung der
Blase muß sehr vorsichtig erfolgen, da beim Vorhandensein von Infiltrationen Einrisse
sehr leicht möghch sind. Wir benutzen die Schere (Abb/l^, lösen die Blase aber
nicht so weit wie bei der einfachen Uterusexstirpation ab, sondern nur bis zum Abgang
der Ureteren, die beim Vorliegen von parametranen Infiltrationen unter allen Um-
ständen zu Gesicht kommen müssen. Nur in den leider nicht allzu häufigen frühen
Stadien, bei denen die Parametrien noch ganz frei sind, können wir auf das Aufsuchen
der Ureteren verzichten und sie einfach mit der Blase nach oben abschieben (Abb."^).
Besteht über die Lage der Ureteren kein Zweifel mehr, so werden sie zusammen mit
der Blase mit dem vorderen Spekulum nach oben gehalten und das Parametrium
sorgfältig weiter stumpf mit dem Finger freipräpariert (Abb: 1^). Die Uteringefäße

werden zwischen zwei Klemmen durchtrennt (Abb. liöj). Nachdem das Parametrium

auch von der anderen Seite in gleicher Weise freigelegt worden ist, eröffnen wir die

vordere Peritonealfalte und das Peritoneum des Do u gl asschen Raumes. Jetzt legen

wir möglichst große Partien des Bindegewebes mit dem Finger frei, was infolge der

vorgehenden Ligatur der Uteringefäße ohne wesentliche Blutung möglich ist. Nachdem

der Uterus wie bei der einfachen Exstirpation mit Kugelzangen gefaßt und sein Fundus

nach außen gestülpt worden ist (Abb. 1"(^ werden die noch übrigen Gefäße durch

/Oo

Abb. ^^T~ Erweiterte vaginale Uterusexstirpation bei Portiokarzmom. Dw Blase wu-d mit dt'U b ingcrn

nach oben zurückgeschoben, wodurch die Ureteren aus dem Operationsgebiet entfernt werden

Anlegen großer Klemmen an beide Seiten des Lig. latum und an die Adnexe gesichert,
und der Uterus mit den Adnexen abgetragen. Die Operation wird mit der Naht des
Peritoneums und der Scheide beendet, ganz in gleicher Weise wie bei der einfachen
Kolpohysterektomie. Drainage oder meine Blutstillungsmethode wird nur angewandt,
wenn sich keine genügende Blutstillung erzielen läßt, wie es bei vorgeschrittenen Fällen

möglich sein kann.

8. Abdominale Operationen am Uterus

a) Das gestielte subseröse Myom

Nach Eröffnung der Bauchhöhle wird der Stiel des Tumors einfach unterbunden
und durchschnitten. Falls es sich um einen breitbasig aufsitzenden Stiel handelt,
schneiden wir ihn keilförmig aus der Uteruswandung heraus und vernähen mit einigen
Einzelnähten die Wunde. In jedem Falle folgt eine genaue Untersuchung des Uterus
auf Myomknoten, die wir alle zu entfernen pflegen, auch wenn es sich um sehr kleine
Geschwülste handelt.

Spezieller Teil / HT. Vaginale Operationen am Uterus

Abb. iiMT Erweiterte vagmale Uterusexstir-

pation bei Portiokarzinom. Ablösung der

Blase mit Schere und Pinzette

8. Abdominale Operationen am Uterus

Abb. %OTr Erweiterte vaginale Uterusexstirpation bei
Portiokarzinom. Das link(^ Param(»trium wird mit dem

Finger freigelegt

b) Die Enukleation der Myome

Man versteht hierunter die Aushülsung der subserösen und interstitiellen Myome
aus ihrer bindegewebigen Kapsel unter Erhaltung des Uterus. Ich wende diese Methode
nur ausnahmsweise an, weil es in dem zur Myombildung disponierten Uterus doch
häufig zur Wiederentwicklung von Tumoren kommt, und weil die Prognose dieser an
sich zwar einfachen Operation in bezug auf Mortalität und Morbidität nicht besser ist
wie die der totalen oder subtotalen Uterusexstirpation.

Man macht über dem Tumor einen Einschnitt, der die Kapsel eröffnet und schält
den Knoten stumpf oder mit der Schere aus seinem Bett heraus. Nachdem alles über-
flüssige Gewebe abgetragen worden ist, vernäht man die Wunde schichtweise von
innen nach außen fortschreitend, sorgfältig darauf achtend, daß keine toten Räume
entstehen, die zu Sekretverhaltung mit ihren Folgen Veranlassung geben könnten.

(^-4Ufc_alulonnnflil(> Bagittak Uteritsf^sektion

Es handelt sich im Prinzip um die gleiche Operation, wie wir sie vaginal bereits
geschildert haben"^(s^S. 60).

Nach der Resektion>d«^^^ilförmigen StücI^ö»'"k%iB dem mit zwei Kugelzangen
seitlich gefaßten Uterus,,(m)b/l04^,^erden''^ Wundr^der miteinander vernäht,
und die jetzt einaml^ stark genähe^^ Ligg. lata zur Peritonisierung benutzt.
Wir vernähen die^Mesosalpinx, das Meso vadium und nötigenfatl« auch die Tuben auf
der RückseitC/d^ Uterus miteinander (Abb. 105). Zur Deckung der Vorderseite steht

Urotor

Durclitrciinte

UtfrliiKt'fäUo

Abb. i^öST Erweiterte vaginale Uterusexstir-
pation bei Portiokarzinom. Der linke Ureter
liegt frei. Die linken Uteringefäße sind mit
Klemmen gefaßt

llufjC^/

Abb. ifiS; Erweiterte vaginale Uterusexstir-
pation bei Portiokarzinom. Der Uterus ist vor
die Vulva g(>zogen imd an die linken Adnexe
eine Klemme gelegt

^'e^iSut/^

Abb. )p4. Abdor/inale Lgittal/ UterusWktion nach Lbgothe/opulos. Die Uteruskanten
sind mit KugelzanLn ge(aßt. Alls dem Corpus ute/i wird e^ keilförmiges Stvi6k herau^eschnitten

Spezieller Teil / III. Vagiim!«' Oi^erationen am Uterus

4bb. 105.

Abdominale sagittale Uterusresektion nach Log>y4<lietopulos. Peritonisierung der
vernähten Hinterwand imter Verwendung des Lig. iHtiun und der Tuben

''Abb. 106. Abdominale sagittale Uterusresektion nach Logothetojv^^ilos. Die vorderen Wund-

nähte/werden mit Blasenperitoneum gedeckt.

uns das Blasenperitorfeum in beliebigem Umfange zur Verfügfing. Nach seiner Ab-
lösung vom Uter>i^wird es mit dem oberen freien Ra|>el^der vereinigten Ligamente
und eventuell u^ den Tuben vernäht (Abb. 106). B^allen itt^inen so operierten Fällen
war das E;?^bnis ausgezeichnet, insofern, als>„;dtirch die Erhaltung eines Teiles der
Uterusscnleimhaut die Menstruation in normalem Umfange bestehen blieb.

^ Ö) Dio suprava^inalc Uteruscxstirpation

Die Bauchhöhle wird mit einem Medianschnitt oder dem Pf an nenstie Ischen
Querschnitt eröffnet, den wir aber nur benutzen, wenn der Tumor den Nabel nicht
überragt. Man könnte natürlich auch noch größere Myome mit dem Querschnitt
entfernen und zwar mittels Zerstückelung (Morcellement), da jedoch bei eventueller
Eröffnung des Cavum uteri die Asepsis nicht unbedingt gewährleistet ist, so ziehen wir
den Längsschnitt vor, der sich nötigenfalls beliebig verlängern läßt.

Nachdem der Uterus mit der Krallenzange oder dem Myombohrer (Doyen)
gefaßt und herausgezogen worden ist, beginne ich mit der Abtrennung der rechten
Adnexe auf folgende Weise: Ich durchbohre mit dem rechten Mittelfinger das Lig.
latum unterhalb des Ansatzes des Lig. rotundum an den Uterus und ziehe die auf
dem Finger liegenden Gebilde (Lig. rotundum, Lig. ovarii proprium und Tube)
nach lateralwärts. Nun gehe ich mit dem Zeigefinger der anderen Hand in das Loch
im Lig. latum ein und entfalte die Ligamentblätter bis herab zur Blase, wobei gleich-
zeitig die Übergangsfalte in ihren seitlichen Partieen vom Uterus abgelöst wird
(Abb.ln^. Jetzt durch trenne ich die auf dem Finger liegenden Gewebe zwischen
zwei Klemmen (AbblJO^; liegt jedoch das Lig. rotundum von der Tube etwas weiter
entfernt, wie man es bei Myomen des öfteren findet, so wird es isoliert unterbunden.
Der bereits abgelöste Teil des Blasenperitoneums wird mit einer Pinzette gefaßt und
quer bis zur linken Uteruskante hinüber durchschnitten. Im Gegensatz zur Total-

8. Abdominale Operationen am Uterus

10 b

exstirpation braucht bei der supravaginalen Amputation des Uterus die Blase nur ganz
wenig nach unten zu abgeschoben zu werden. Nun wird der Uterus stark nach außen
und links gezogen, das rechte Parametrium mit den Uteringefäßen mit einer gebogenen
Klennne gefaßt und durchtrennt, wobei man sich dicht an der Uteruskante zu halten
hat, um den Ureter mit Sicherheit zu schonen [khhf\m^. Unter ständigem Zug am /
Myombohrer wird jetzt mit einer kräftigen Schere der Uterus oberhalb der Zervix ^ . . y
quer durchschnitten (Abby/^&#), worauf man die im linken Parametrium verlaufenden ^ / O ^
Uteringefäße zu Gesicht bekommt. Man faßt sie mit einer Klemme und durch- ^^ / O S
schneidet sie (Abb/Siic). Endlich wird von oben her das Hnke Lig. latum unter
Zurücklassung der Adnexe mit ein oder zwei Klemmen gefaßt und der Uterus ab-
getragen. Auf diese Weise läßt sich bei einiger Übung die ganze Operation bis zu
diesem Punkte in 2 — 3 Minuten ausführen.

7{uittl.4n/

V£vrT

Abb idä^r. Supravaginale Uterusexstirpation. Der Uterus ist mit einer Krallenzange gefaßt und
stark nacb außen und links gezogen. Das rechte Lig. latum wird mit dem Mittelfinger durchbohrt
und die auf demselben liegenden Gebilde (Lig. rotundum, Lig. ovarii proprium und Tube) stark
lateralwärts gezogen. Der linke Zeigefinger entfaltet das linke Lig. latum bis zur Blase herab und

löst die seitlichen Blasenpartien vom Uterus ab

Spoziollor Teil / III. Vaginale Oporationon am Uterus

8. Abdominale Operationen am Uterus

1^
Abb. 4#H-. Supravaginale Uterusexstirpation. Tube, Lig. rotundum und Lig. o\ am propruim

werden mit Klemmen gefaßt

Abb. rRjSupravaginaleUterusoxHtirpati()n. DerUteriiswinl
stark naeh oben und links gezogen und gleiehzeitig mit den
gefaßten Gefäßen oberhalb der Zervix (luer durehsehnitten

^j^^r

Abb. 1^. Supravaginale Uterusexstirpation. Die Blase ist bis zur linken Uteruskante abgelöst

und wird mit einem Stieltupfer nach unten gehalten. Das rechte Parametrium mit den darin

befindlichen Uteringefäßen ist mit einer gebogenen Klemme gefaßt

Abb 1\1 Supravaginale Uterusexstirpation. Der Uterus ist quer durehtrennt. Die zu Gesicht
gekommenen linken Uteringefäße wurden mit einer Klemme gefaßt und durchschnitten

Spezieller Teil / III. Vaginale Operationen am Uterus

f')b

Abb. i42. Supravaginale Uterii.sexstirpation. Vordere und hintere Zerv^xwand werden mit-
einander vernäht

\ü

Abb. KQ, Supravaginale Uterusexstirpation. Peritonisierung durch Vernähen des Blasen- mit
dem Douglasperitoneum unter gleichzeitigem Einstülpen der Adnexstümpfe

8. Abdominale Operationen am Uterus

/U /j-^

r^o

Durch Vernähen der vorderen und liinteren Hälfte der Zervix mit einigen Knopf-
nähten stillt man die geringe Blutung aus der Uterusw unde, num ersetzt die Klennnen
durch Ligaturen und beendet die Operation mit der exakten Peritonisierung^ Abb. tt^

V/'und Vi^

Die supravaginale Amputation wird von mir und wohl von den meisten anderen
Operateuren in einfachen Fällen als Methode der Wahl angesehen, da sie schneller
auszuführen ist und nach der Sammelstatistik von Albrecht i) eine geringere
MortaUtät aufweist wie die Totalexstirpation.

Die Stumpf exsudate, die die Morbidität der su[)ravaginalen Amputation stark
belasten, gehen unter konservativer Therapie fast immer zurück. Die an der zurück-
gelassenen Zervix möglicherweise auftretenden Karzinome sind an Zahl sehr gering
(0,32— 0,380/o), so daß auch sie die Gesamtmortahtät der su[)ravaginalen Operation
nicht wesentlich erhöhen.

e) Die abdoniiiiaU' Totalexstirpation des Uterus

Nach gründlicher Desinfektion stopfen wir die Scheide mit einem Gazestreifen
aus, der zur Aufsaugung der aus der Zervix während der Operation austretenden
Sekrete dient. Sein Ende muß weit aus der Vulva herausragen, damit der Tampon
jederzeit von einer Hilfs])erson entfernt werden kann.

Der Beginn ist der gleiche wie bei der supravaginalen Exstirpation des Uterus.
Fassen des Uterus mit einer Krallenzange oder mit dem Myombohrer, Herausziehen
vor die Bauchwunde und Abtrennung desselben von den rechten Adnexen in der oben
beschriebenen Weise (Abb.jW^^ Nun aber ist es wichtig, daß die Blase besonders in
ihren seitlichen Teilen gut nach unten abgeschoben wird, so daß die obere Scheiden -

])artie frei liegt (Abb^^44^>/3 d

Das Parametrium mit den darin liegenden Gefäßen wird möglichst dicht am
Uterus gefaßt und durchtrennt. Der Ureter ist nicht gefährdet, wenn man zuvor die
Blase gut abgeschoben hat und wenn man sich immer nahe der Uteruskante hält.
In gleicher Weise werden die linken Adnexe und Uteringefäße gefaßt. Während der
Uterus dann kräftig symphysenwärts gezogen wird, durchtrenne ich mit der Schere
das Douglasperitoneum quer und schiebe mit einem Tupfer den Mastdarm etwas nach
unten zu. Der Uterus wird wieder kranial wärts gezogen, und während der Assistent
die Blase mit einem Stieltupfer gut nach abwärts hält, spalte ich mit dem Messer,
dessen Schneide blasenwärts sieht, die vordere Zervixwand in der Medianlinie und ver-
längere den Schnitt, bis die Vagina genügend eröffnet ist, nach unten zu (Abb/K4).
Bestehen Zweifel über die Lage der Zervix, so bringt der tastende Finger sofort Klar-
heit. Nachdem die bei der Vorbereitung eingelegte Gaze von einer Hilfsperson von
unten herausgezogen worden ist, fasse ich die Scheidenwundränder unterhalb der
Portio mit zwei Faßzangen, ziehe sie auseinander und führe einen Stieltupfer in
das Scheidenlumen ein, der den Austritt von Scheidensekret verhindert. Die mit
einer doppelzähnigen Kugelzange an der hinteren Lippe gefaßte Portio wird aus der
Scheidenöffnung heraus und stark nach oben gezogen und nun mit der Schere die ^ /

Scheide zirkulär durchtrennt (Abb>H^ und fW). Der in der Scheide befindliche ^ (0 f // /^
Stieltupfer wird vorsichtig entfernt und, nachdem man den vorderen und hinteren
Scheidenwundrand mit einer Kocherklemme fixiert hat, durch einen Gazestreifen ersetzt ^ ' .
(Abb^li^. Man führt ihn mit einer Führungssonde (s. S. 3) ein und schneidet ihn,
sobald sein unteres Ende in der Vulva erschienen ist, dicht über dem abdominalen

fin

1) Halban-Seitz, Bd. IV, 480.

Spoziollor Teil / III. Vaginale Operationen am Uterus

8. Abdoniinah^ Operationen am Uterus

Yu^Mi^

Abb. IW, Abdominale Totalexstirpation des Uterus. Das Lig. latum und die Uteringefäße sind
zwischen den Klemmen durchschnitten. Während die weit nach unten zu abgeschobene Blase
gut mit einem Tupfer zurückgehalten wird, wird das Messer mit nach vorn gerichteter Schneide

in d(>n unteren Teil der Scheid(niwand eingestochen

Ende der Vagina ab. Dieser Streifen dient als Drainage. Blutungen aus dem Scheiden-
wundrand werden durch Umstechungen gestillt, alle Klemmen durch Unterbindungen
ersetzt und das gesamte Operationsgebiet auf Bluttrockenheit untersucht. Die Vagina
wird mit einer fortlaufenden Naht verschlossen, wobei man die Schleimhaut am besten
nicht mitfaßt. Erst wenn jede Blutung steht, peritonisieren wir durch Versenken der
Stümpfe und durch Vernähen des Blasenperitoneums mit dem des Rektum.

Die geschilderte Operation gestaltet sich nur bei unkompHzierten Fällen in dieser
typischen Weise. Sind Verwachsungen vorhanden, so müssen sie zuvor präparatorisch
mit Pinzette und Schere gelöst werden, ehe man die Exstirpation des Tumors vor-
nimmt. Bei intraligamentärer Entwicklung des Myoms spaltet man das Lig. latum
zwischen Lig. rotundum und Tube und löst den Tumor vorsichtig aus der Ligament-
umhüllung aus. Man hat sich hierbei ganz besonders vor Verletzungen des Ureters
zu hüten, der häufig durch den Tumor verlagert ist und am besten in seinem ganzen
Beckenteil vor Fortsetzung der Operation isoliert wird.

Abb. Tlfr. Abdojninale Totalexstirpation des
Uterus. Die vordere Zervixwand und der obere
Teil der Vagina sind mit dem Messer gespalten.
Die hint(»re Muttermundslippe ist mit einer
Faf3zange gefaßt. In die Vagina ist ein ge-
stielter Tupfer eingeführt

/ 9
Abb. tW: Abdominale Totah'xstirpation des
Uterus. l)i»> vordere \'aginalwand wird mit
einer Klemme angezogen. Unü'r starkem Zug
an der Portio wird die hintere Vaginalwand
dicht unterhalb der Portio durchschnitten

'//i»^

Abb H^ Abdominale Totalexstirpation des Uterus. Der Uterus ist entfernt. Die vaginalen
Wundränder sind mit Klemmen gefaßt und in das Vaginallumen ist em Cazestreifen emgetuhrt.
Die Vagina wird mit Nähten geschlossen, die die Schleimhaut nicht mitfassen. Kinstulpen der

Stiunpfe bei der Peritonisic^rung

Die oft sehr schwierige Exstirpation zervikaler Myomknoten, die die Blase zuweilen
hoch nach oben verschieben, kann man sich erleichtern dadurch, daß man einen zweiten
Myombohrer in den tief liegenden Tumor einsetzt und ihn damit nach oben zieht.
Gelingtauch das nicht, weil etwa der Knoten fest im Becken eingekeilt ist, so kommt
man zum Ziel, wenn man die Myomkapsel einschneidet und den Tumor enukleiert.

Spezieller Teil / III. Vaginale Operationen am Uterus

Sind gleichzeitig entzündliche Adnextumoren vorhanden, so werden sie zunächst
in oben beschriebener Weise freipräpariert und nötigenfalls entfernt, und dann erst
geht man an die Exstirpation des Uterus heran. In solchen nicht sicher aseptischen
Fällen lasse ich die Scheide offen und drainiere mit einem Gazestreifen durch dieselbe.
Die Bauchdecken schließe ich dagegen immer in bekannter Weise.

9. Die Ovariektomie

Diese Operation (nicht ganz zutreffend als ,,Ovariotomie" bezeichnet) wurde
zuerst im Jahre 1809 von Ephraim Mac Dowell (USA.) ohne Narkose bei einer
Negerin ausgeführt und zwar mit vollem Erfolg, womit der Siegeszug der zunächst
mit enormer Mortalität belasteten Bauchchirurgie begann. Die Herausnahme eines
einfachen Ovarialtumors ist ein so einfacher Eingriff, daß er mit Recht als Anfänger-
operation betrachtet werden kann, aber häufig finden sich Verwachsungen und andere
Kom})likationen, die das Können eines erfahrenen Operateurs erfordern.

Im allgemeinen bevorzugen wir bei der Ovariektomie die Laparatomie, da sich
oft über die freie Beweglichkeit des Tumors oder seine intraligamentäre Entwicklung
vor der Operation kein klares Bild gewinnen läßt. Man kann so oft den Uterus erhalten,
w^ährend man beim vaginalen Vorgehen gezwungen ist, ihn mit zu entfernen, wenn es
sich um einigermaßen komplizierte Fälle handelt. Haben wir es mit nicht ganz kleinen
Tumoren zu tun, so muß man sie beim vaginalen Operieren eröffnen, was bei infiziertem
Inhalt oder bei Malignität eine erhebliche Verschlechterung der Prognose bedeutet.
Nur bei sehr fetten Frauen, oder wenn sowieso eine vaginale Operation vorgenommen
werden muß (Prolaps oder dgl.), gehen wir Ovarialtumoren vaginal an, aber auch
dann nicht, wenn es sich um maligne Tumoren oder um irgendwie komplizierte Fälle
handelt.

a) Die abdominale Ovariektomie

Wir verwenden im allgemeinen den medianen Längsschnitt, der bei freien zysti-
schen Tumoren sehr klein angelegt und im Bedarfsfall beliebig nach oben verlängert
werden kann. Der Pf annenstielsche Querschnitt hat nur den Vorteil des ästhetisch
besseren Aussehens und kann bei einfachen Tumoren natürlich ohne Schwierigkeit

benutzt werden.

Nach Eröffnung des Peritoneums orientieren wir uns über Sitz, Größe und freie
Beweglichkeit des Tumors und trachten möglichst immer danach, ganz besonders
aber, wenn es sich um maligne Tumoren oder um solche mit verdächtigem Inhalt
handelt, ihn uneröffnet zu entfernen, nötigenfalls mit Erweiterung des anfänglichen
Bauchschnittes. Wir führen die Hand in die Bauchhöhle ein, umgreifen den Tumor
und wälzen ihn vor die Bauchdecken, nachdem etwa vorhandene Verwachsungen
stumpf oder scharf gelöst wurden. Der Stiel wird nach vorhergehendem Fassen mit
Klemmen vom Uterus abgetrennt, unterbunden und peritonisiert. Man kann sich die
Exstirpation eines Tumors durch eine kleine Bauchöffnung durch folgenden Kunst-
griff sehr erleichtern: Nach Eröffnung der Bauchhöhle legen wir den Tumorstiel frei
und durchtrennen ihn zwischen zwei Klemmen, so daß er sich frei in der Bauchhöhle
befindet. Zieht nun der Assistent die Spekula gut auseinander, so gelingt es über-
raschend leicht, den an der Klemme gefaßten Tumor durch den kleinen Bauchschnitt
zu „entbinden"!). Sind die zystischen Tumoren bestimmt gutartig und ihr Inhalt
zweifellos aseptisch, was man an der Transparenz der Wandung meist recht gut erkennen

1) Beschrieben in meinem Lehrbuch der Gynäkologie II. Band, 1928. Halle, Buchdruckerei
des Waisenhauses.

ö. Die Ovariektomie

//•L
Abb. 118. Ovarektomie. Eröffnung der Zyste mit dem Messer. Der Zysteninhalt fließt aus

Abb. (t^ Ovarektomie. Die Zystenwand ist an der geöffneten Stelle mit einer Klemme gefaßt

und nach außen gezogen

Logothetopulos, Gynäkologische Chirurgie

i(h

llH

Spezieller Teil / III. Vaginale Operationen am Uterus

Abb. 12(^. Ovariektoniie. Die gänzlich außerhalb der Bauchhöhle gebrachte Zyste wird vom

Uterus abgetrennt

kann, so ist die Eröffnung und Entleerung der Zyste vor der Entfernung zweckmäßig.
Nach Eröffnung des Peritoneums stellt sich die Zyste meist von selbst in die Wunde
ein, nötigenfalls helfen wir durch leichten Druck auf die Bauchdecken oberhalb der
Schnittwunde nach. Nun gehen wir von der Trendelen burgschen Beckenhoch-
lagerung zu einer Tieflagerung des Beckens über, um das Eindringen von Flüssigkeit
in die Bauchhöhle zu erschweren, und eröffnen mit dem Messer die Zyste (Abb/^4i^.
Die Verwendung eines Troikarts ist überflüssig, da die unter Druck stehende Flüssig-
keit im Strahl herausfließt. Mit einigen Klemmen fassen wir sofort die Zystenwand
an der Schnittstelle und ziehen sie langsam entsprechend der fortschreitenden Ent-
leerung nach außen (Abb. 11^), fassen gegebenenfalls mit anderen Klemmen nach,
bis wir den Stiel erreichen und nach vorhergehendem Abklemmen unterbinden und
abtragen können (Abb. 120)^ Man verwendet zur Unterbindung starkes Katgut und
durchsticht den Stiel, da ein Abgleiten der Ligatur verhängnisvolle Folgen haben
könnte. Liegt eine Stieldrehung vor, so bringen wir sie vor Anlegung der Klemmen durch
Drehung des Stieles in entgegengesetzte Richtung zum Verschwinden. Wir decken
den Stumpf stets sorgfältig mit Peritoneum, haben jedoch beim gelegentlichen Unter-
lassen der Peritonisierung zwecks Zeitersparnis keinerlei nachteilige Folgen bemerkt.
Intraligamentär entwickelte Tumoren können wegen der meist bestehenden
Verlagerung der Nachbarorgane dem Operateur große Schwierigkeiten bereiten, und
nur durch sorgfältigste Orientierung gelingt es, Verletzungen der Blase, des Darmes

9. Die Ovariektomie

Darin

Appcndict'S
t'piploicea

Abb 1-21T Ovariektoniie. Die dünnen Wände einer ^r^platzten Zj'.^te werden mit Klemmen ent-
faltet, und nach vollständiger Entleerung des InhaUvs wird die Höhlung mit Gaze ausgestopft

///-

Darm

Ahh M4 Ovari.-ktomie. Die Zystenöffm.ng ist mit einer fortlaufenden Naht geHchlossen. Die
i,^z ^i Oa,e ausgef 1 te Zyste kann nun'' wie ein solider Tumor gehamlhabt, d. h. m,t emer

KrallenLrK.-äßf >•»<' "«^1^ ''"ß™ S«-^"«™ ^^"•'^"- Mit Pinzette und Schere werden d.e \ er-
Krallt nzangt 8^^^^^^^^^^^ ^^,^ u^,.„, „„^ jjetz von der Zystenwandung abgelost

fll <

7g Spezieller Teil / lU. Vaginulr (),,...alion.... an. Uteru«

und besonders des Ureters zu vermeiden. Ir. einen nieir.er Fälle finul ich den Ureter
"17 Mitte der Vorderwand einer großen intraligan.entärer. Zyste verlaufend! D.e
wichtigste Regel bei der Operation dieser Turnorer, ist immer an den L reter zu denken
und ihn bei irgendwelchen Unklarheiten in. ganzen gefährdeten Bezirk freizulegen.
Kein Gewebsstrang darf abgeklemmt oder gar durchschn.tten werden, ohne daß man
sich über seine Natur absolut im klaren ist, wrul mar. schheße den Bauch nicht, bevor
man sieh nicht von der Unversehrtheit der Ureteren ü»)erzeugt hat.

Die oft umfangreichen Verwachsungen der Zysten mit der peritonealen Umgebung
erfordern sehr vorsichtiges Vorgehen. Schon bei Kröffmu.g der Pentonealhöhe kann
die mit dem Peritoneum parietale verbackene Zystenwand durchtrennt werden, em
zum mindesten unangenehmes Ereignis, falls es sich um infizierte oder maligne Tumoren
handelt Die Verwachsungen mit den Darmschlingen, Netz und I^eckenwand können
im allgemeinen mit der Hand stumpf abgelöst werden, zuweilen jedoch ist sorgfaltige
Präparation mit Pinzette und Schere notwendig, wobei gefäßführende Stränge zuvor
abgeklemmt werden müssen. Gelegentliche Verletzungen des Darmes müssen sorg-
fältig unter Vermeidung jeder Stenosierung des Lumens vernäht werden, auch wenn
es sieh nur um Serosadefekte handelt.

Trotz aller Vorsicht reißt beim Lösen von Verwachsungen die Zystenwand leicht
ein wodurch die weitere Abpräparierung des nun schlaffen Sackes sehr wesentlich
erschwert wird In solchen Fällen wende ich eine Methode an, die ich seinerzeit für
die Exstirpation der Zvsten der Bartholinischen Drüse beschrieben habe. Wir
tupfen die Zyste nach Möglichkeit trocken und stopfen sie dann fest mit Gazestücken
aus (\bb./f5+): die Öffnung wird mit einigen Stichen wieder vernäht, und nun läßt
sich der gazegefüllte Sack ganz wie ein solider TumorJ^ehandeln, mit Krallenzangen
fassen, freipräparieren und nach außen ziehen (Abb-i^Sj:

Bösartige Ovarialtumoren sind meistens doppelseitig und oft sekundär entstanden.
Deshalb ist auch beim Fehlen sichtbarer Veränderungen stets auch das Ovarium der
anscheinend gesunden Seite mitzuentfernen und regelmäßig die gesamten Bauchorgane
nach dem Primärtumor abzusuchen.

b) Die vaginale Ovariektomie

Atlee (Amerika) hat im Jahre 1854 zuerst und durch Zufall diese Operation aus-
geführt, planmäßig durchdacht und in die Tat umgesetzt wurde sie aber erst im
Jahre 1870 durch Gaillard-Thomas, und der Vorkämpfer der vaginalen Operations-
methoden. Dührsen. hat sie nach gründlicher Ausarbeitung zu weiterer Verbreitung

gebracht.

Nach der Eröffnung der Bauchhöhle, dem Sitz des Tumors entsprechend durch
vordere oder hintere Kolpotomie. fassen wir den Tumor mit Muzeuxzangen. eröffnen
ilin mit Messer oder Troikart und lassen den Inhalt abfließen. Hierauf ziehen wir die
Zvste unter mehrmaligem Nachfassen mit Klemmen nach abwärts, bis der Stiel
erscheint, den wir nach vorhergehendem Abklemmen abtragen und unterbinden.

Nicht ganz leicht ist die vaginale Entfernung multilokularer Zysten, die eine
nach der andern eröffnet werden müssen, wobei man sich sehr vor Verletzungen von
Darmschlingen hüten muß. Am besten zieht man sich den Uteruskörper wie bei der
vacnnalen Totalexstirpation nach außen, durchtreimt den Tumorstiel zwischen zwei
Klemmen und zieht nun am Stiel die Zyste nach abwärts. Man eröffnet nun die
jeweils in der Kolpotomieöffnung erscheinende Zyste, entleert sie, faßt mit Klemmen
nach und brmgt sich so die nächste zu Gesicht, bis der ganze Tumor entfernt ist.

10. Entzündliche Adnexerkrankungen

•

10. Entzündliche Adnexerkrankungen

Bei der Häufigkeit ihres Vorkommens, der langen Erkrankungsdauer und damit
verbundenem Siechtum bilden die entzündlichen Erkrankungen der Adnexe trotz aller
Fortschritte in der Behandlung nach wie vor eine ausge8[)rochene Crux medicorum.
Glücklicherweise ist das Leben der Frauen in der Mehrzahl der Fälle nicht bedroht,
und wir können durch frühzeitige Anwendung aller modernen konservativen Mittel
meistens ernstere Komplikationen verhüten. Es gelingt, durch strenge Bettruhe und
Anwendung des Eisbeutels die akuten Erscheinungen zum Rückgang zu bringen,
und man sieht immer wieder mit Verwunderung, wie selbst sehr große Tumoren ver-
schwinden. Die dann noch verbleibenden Reste der Entzündung kommen zur Resor])-
tion durch Anwendung von Mitteln, die eine lokale Hyperämie erzeugen, angefangen
von den altbewährten heißen Sitzbädern bis zur Kurzwellenbehandlung, von der
Terpentininjektion bis zur Hormontherapie. Das eine Mal sind die Behandlungs-
methoden, das andere Mal die Geduld des Arztes, am häufigsten jedoch die Geduld
der Patientin zuerst erschöpft. Es taucht die Frage der Operation auf, und wir müssen
zugeben, daß in einer nicht unbeträchtlichen Zahl von Fällen nur durch diese eine
Radikalheilung zu erreichen ist.

Die an sich zweckmäßigste Operationsmethode, die Exstirpation des Uterus mit-
samt den Adnexen, die am sichersten zum Erfolg führt, bringt letzten Endes dem
Operateur wenig Dank ein, da die meist noch im zeugungsfähigen Alter stehenden
Frauen später schwer unter Ausfallserscheinungen zu leiden haben. Wir gehen deshalb
an unserer Klinik möglichst konservativ vor und erhalten den Frauen zumindestens
die Eierstöcke. Nur beim abdominalen Vorgehen läßt sich exakt beurteilen, was
erhalten werden kann und was im Interesse des Enderfolges exstirpiert werden muß.
Auch die für den Erfolg so wichtige Blutstillung und die peinliche Peritonisierung
läßt sich nur von oben ausführen, so daß wir den für ungefährUcher geltenden vagi-
nalen Weg in den letzten Jahren nur noch ausnahmsweise anwenden.

Ganz im Gegensatz hierzu operiere ich ausschließlich vaginal in den schweren
Fällen, bei denen von vornherein nur die Exstirpation des Uterus und der erkrankten
Adnexe in Frage kommt. Trotz aller modernen Laboratoriumsuntersuchungen (Leuko-
zytenzählung, Blutbild, Senkungsgeschwindigkeit usw.) sind wir auch heute nicht
in der Lage, mit aller Bestimmtheit vor der Operation den Grad der Infektiosität des
zu erwartenden Eiters zu erkennen, und schon aus diesem Grunde sind unsere Resultate
beim vaginalen Vorgehen lebenssicherer. Eine absolute Indikation für die vagmale
Operation stellen für mich jene Fälle dar, bei denen die Frau, durch monatelanges
Fieber geschwächt, eine Laparotomie nicht überstehen, und entweder am Eingriff
als solchem oder an einer Peritonitis zugrunde gehen würde. Auch vorhergegangene
Operationen, bei denen vaginal oder abdominal Abszesse eröffnet wurden, und die
Fisteln hinterlassen haben, zwingen uns den vaginalen Weg auf. Ein Schuchardt-
scher Schnitt und die vorhergehende Exstirpation des Uterus gibt mir immer eine
ausgezeichnete Übersicht des Operationsgebietes, so daß die Operation genau so klar
und planmäßig verläuft wie bei der Laparotomie. Die anscheinend bestehende Gefahr
der Darmverletzung ist nicht sehr erheblich, da nur die Verwachsungen der Adnexe
mit der Beckenwand stumpf mit der Hand gelöst werden, worauf sich die Tumoren
mit den Darmschlingen zusammen tiefer ziehen und unter Leitung des Auges mit der
Schere sauber voneinander trennen lassen. Bei all diesen Manipulationen bleibt man
außerhalb der freien Bauchhöhle, da die oberhalb der Eitersäcke von miteinander
verwachsenen Darmschlingen gebildete Schutzdecke in den meisten Fällen mcht
zerstört zu werden braucht ; ein unschätzbarer Vorteil des vaginalen Weges !

Spezieller Teil / III. Vaginale Operationen am Uterus

a) Abdoininalf Operation der entzüiullielien AdnexerkraiikmiKen
Die Sciiwierigkeit der Exstirpation entzündlicher Adnextumoren per laparatomiam
steht im direkten Verhältnis zum Grade der vorhandenen Adhäsionen. Wir erott.ten
vorsichtig die Bauchhöhle möglichst an einer Stelle, die frei von Verwachsungen ist
ziehen den mit einer Kugelzange gefaßten Uterus leicht mit der linken Hand nach
außen und versuche.., mit der anderen Hand vorsichtig die Verwachsungen zu losen.
Jede Gewaltanwendung ist zu vermeiden und bei der geringsten Schwiengkeit setzen
wir die Ablösung mit der Schere unter Leitung des Auges fort, wobei die Blutung nur
gering ist und meist durch leichten Druck provisorisch eingelegter Kompressen zum
Stehen kommt. Sind die Adnexe völlig frei, so wird das Lig. infund.bulo pelv.cum
und das Lig. ovarü proj.rium nach vorherigem Fassen mit Klemmen durchschnitten
und unterbunden, während man das Ostium uterinum der Tube am besten keilförmig
aus dem Uterus heraussehneidet. Das Lig. latum wird einfach durchtrennt, die geringe
Blutung kommt bei der Peritonisierung zum Stehen. Die Gefäßstün,,.fe werden sorg-

fältig versenkt. , ,

Bei stärkeren Verwachsungen wählen wir den umgekehrten Weg. Wir durcli-
trennen den uterinen Teil der Tube zwischen zwei Klemmen und lösen mit der Hand
die Adhäsionen, während wir an der Tube einen stetigen Zug von median nach lateral-

f/Ml^^«M/

!/>

Abb. +33. Abdominale Operation der Adnextumoren. Der Uterus ist mit einer Krallenzange gefaßt
und nach links und außen gezogen. Auf der Hand liegt der abgelöste rechtsseitige Adnextumor

10. Entziuidliche Adnexerkrankungen

wcärts ausüben. Auch hierbei werden festere Stränge scharf durchtrennt. Entstehen
auf der Uterusoberfläche größere Defekte, so werden sie zweckmäßig mit dem Blasen-
peritoneum gedeckt. Man durchtrennt es an seiner Übergangsstelle zum Uterus mit
der Schere, schiebt die Blase etwas mit einem Tupfer zurück und kaim nun leicht
den Peritoneallappen an der Uterusrückfläche annähen (Lie])mann).

Bei ausgedehnteren Prozessen muß außer den Adnexen auch der Uterus ganz oder
partiell entfernt werden (Totalexstirpation, Amputatio supravaginalis oder Defundatio
uteri nach Beuttner).

Am empfehlenswertesten ist die Totalexstirpation, weil sie eine ausgezeichnete
Drainage nach der Scheide zu ermöglicht und weil die so unangenehmen, schwer
zugängUchen Stumpfexsudate der supra vaginalen Amputation vermieden werden.

Nach Eröffnung der Bauchhöhle finden wir in schweren Fällen das kleine Becken
mit einer formlosen Masse ausgefüllt, die zunächst eine Orientierung unmöglich scheinen
läßt. Die Genitalorgane sind mit Netz und Darmschlingen bedeckt, und nur durch
geduldige, langsam in die Tiefe vordringende Präparation gelingt es, teils scharf,
teils stumpf, die Adhäsionen zu beseitigen und schließlich den Uterus mit einer Krallen-
zange zu fassen. Wir ziehen ihn kräftig nach außen zu und stopfen die Bauchhöhle
mit Kompressen besonders sorgfältig ab wegen der steten Gefahr des Platzens eiter-

¥u(^S^^.

Abb. ^ Abdominale Operation der Adnextumoren. Die linken Adnexe sind ebenfalls mit der

Hand abgelöst worden

I i

n<}'f/'^

g2 . Spezieller Teil / III. Vaginale Operationen am Uterus

haltieer Tumoren. Nun erst gehen wir mit der freien Hand, während die andere einen
ständigen Zug nach oben am Uterus ausübt, zwisclien 4\nnor und Beckenwand m
den Douglasschen Raum und versuchen, so wie wir es bei der manuellen 1 lazentar-
lösung zu machen gewohnt sind, durch langsames Vordringen «^^^11^^^^. v'"
Tumor unzerstückelt in die Hohlhand zu bekommen (Abb./f^ und 1^ Auch hierbei
sind stärkere Verwachsungen mit der Schere scharf zu durchtrennen Ist der Tumor
intraligamentär entwickelt, so suchen wir den stark gefährdeten Ureter hoch oben
auf und verfolgen ihn während des Freimachen« des Tumors bis zur Blase hinab.
Das von vielen Operateuren geübte Entleeren der Eitersäcke durch Punktion
lehnen wir ab, da hierdurch die Infektionsgefahr nur unwesentlich verringert wird,
die Auslösung der Tumoren dagegen sich bedeutend schwieriger vornehmen laßt. Da
wir die freie Bauchhöhle zuvor gut abgedeckt haben, so ist das Platzen der Eitersacke
während der Operation, das sich in der Tat oft nicht vermeiden läßt, nicht allzu
bedeutungsvoll, besonders wenn es sich um den meist sterilen gonorrhoischen Eiter
handelt Da wir jedoch eine sekundäre Infektion mit Bact. coli, mit Staphylo- oder
Streptokokken niemals mit Sicherheit ausschließen können, so muß jeder ausfließende
Eiter aufs Sorgfältigste mit Tupfern und Gazekompressen aufgefangen und weg-
getupft werden, die Abdeckkompressen ersetzen wir durch frische, und erst nachdem
wir auch die Handschuhe gewechselt haben, fahren wir mit der Operation fort.

Darmverletzungen können vorkommen auch ohne Schuld des Operateurs, da die
mit dem Tumor verbackene SchHnge an der Verwachsungsstelle nekrotisch geworden
sein kann. Man vernäht die Öffnung mit zweifacher Lembertnaht möglichst senkrecht
zum Darm verlauf, um Stenosen zu vermeiden.

Gewöhnhch nehmen wir die Exstirpation des Uterus erst nach der Ablösung der
Tumoren vor. Handelt es sich jedoch um sehr schwierige Fälle mit stärksten Ver-
wachsungen, so exstirpieren wir nach vorhergehender Medianspaltung zuerst den
Uterus und lösen dann die Adnexe aus ihren Verklebungen aus (Methode von
J. L. Faure). Die Technik ist folgende:

Wir fassen den Uterus auf beiden Seiten des Fundus mit zwei kräftigen Kugel-
zangen und spalten ihn mit einer geraden Schere median bis herab zur Portio. Mit einer
weiteren Kugelzange fassen wir nun den tiefsten Punkt der einen gespaltenen Uterus-
hälfte und schneiden mit kleinen Scherenschnitten die Zervix vom Scheidengewölbe
ab, wobei die Uterina sichtbar wird. Nach ihrer Unterbindung lassen sich die Adnexe
überraschend leicht unter fortwährendem Zug an den Uterusklemmen teils scharf,
teils stumpf von median nach lateral fortschreitend, exstirpieren. In gleicher Weise
wird dann die andere Uterushälfte mit den Adnexen entfernt. Diese Methode ziehen
wir der in gleicher Weise ausführbaren supravaginalen Amputation vor, bei der nach
Spaltung des Uterus bis zum Isthmus die Zervix mit einer gebogenen Schere quer
durchtrennt wird, wonach die Exstirpation der Adnexe in oben geschilderter Weise
folgt. Selbstverständlich muß vor Spaltung des Uterus die Blase nach vorhergehender
querer Durchtrennung des Blasenperitoneums nach abwärts geschoben werden, und
zwar möglichst tief bei der totalen, in geringerem Maße bei der supravaginalen Ampu-
tation.

Sehr empfehlenswert ist in schwierigen Fällen auch die Methode von Kelly.
Wir beginnen auf der wahrscheinhch leichteren Seite mit der Ablösung der Adnexe
und Durchtrennung des Lig. latum. Das Blasenperitoneum wird jetzt quer durch-
trennt und die Blase mit einem Stieltupfer weit nach abwärts geschoben. Nun fassen
wir die sichtbar werdende Uterina mit einer langen Klemme und durchtrennen mit
Messer oder Schere den Uterus supravaginal in der Isthmusgegend. Wir ziehen ihn

10. Entzündliche Adnexerkrankuiigen

kräftig nach der anderen Seite und unterbinden auch hier die Uterina, worauf die
Adnexe wieder von median nach lateral zu ausgelöst werden.

Wir vernähen, gleichgültig nach welcher Methode wir vorgegangen sind, am
Schlüsse die vordere und hintere Scheidenwand miteinander, respektiv bei su])ra-
vaginaler Amputation vorderen und hinteren Teil des Zervixstumpfes. Hierauf folgt
sorgfältige Peritonisierung durch Vereinigung des Blasen- mit dem Rektumperitoneum
und Einstülpung der Unterbindungsstümpfe. Ist Drainage erforderlich, so erfolgt sie
entweder durch die Scheidenöffnung oder bei supravaginaler Amputation durch ein zu
diesem Zweck im hinteren Scheidengewölbe angelegtes Loch. Bei schwer stillbaren
Blutungen legen wir, besonders wenn durch die Scheide drainiert werden muß, mit
promptem Erfolg meinen Blutstillungstampon ein (s. S. 19).

b) Vaginale Operation der entzündlichen Adnexerkrankungen
Die vaginale Exstirpation des Uterus bei entzündlichen Adnexerkrankungen mit
nachfolgender Eröffnung der Eitersäcke ist zuerst von Pean ausgeführt worden, der
dadurch eine gute Drainage nach der Scheide zu erzielen wollte. Da die Resultate nicht
ermutigend waren, wurde diese Methode bald wieder verlassen, und man ging dazu
über die Totalexstirpation des Uterus samt der Adnexe zu machen.

Wir gehen in folgender Weise vor: .^ ^'

Anlegung eines Schuchardtschnittes, der die Operation sehr erleichtert, und Exstir-
pation des Uterus in bereits beschriebener Weise. Gleich nach der V^rwä^^^^g .^f
Uterus führen wir eine mit einem Faden versehene große Kompresse in die Bauchhohle
ein Sind sehr starke Verwachsungen und Infiltrationen vorhanden, so macht das
Herauswälzen des Uterus manchmal Schwierigkeiten, deren man Herr wird nach Spal^
tung der vorderen Uteruswand (Doyen) oder der vorderen und hinteren Uterusuand
(nach Müller). Döderlein empfiehlt die Spaltung der ^-^-^ ^terus^^^^^^^
Vorwälzen des Corpus uteri durch das hintere Scheidengewölbe -;!^ Vorgehen das be-
sonders bei retroflektiert liegendem Uterus angezeigt erscheint. ^^^^'^^ ^^^'^^^
leichtere Fälle, so kann die Exstirpation der Adnexe zusammen mit dem ^^^"^^^^^^
oder nicht gespaltenen Uterus leicht vorgenommen werden. Bei schwereren Ver
wachsungen jedoch ziehen wir die vorhergehende Entfernung des Uterus vor, wobei
Tr VernSun^ von Verletzungen des Ureters die Klammen dicht an d^e ^^^^^^^
herangelegt werden müssen. Jetzt können wir die Adnexe entfernen^ E ^^^-^^^^^^
bMung der Gefäße und nach Entfernung der großen Kompresse, Schluß der Bauch-
höhle falls keine Drainage erforderlich ist.

Diese Operation konnte man bis jetzt nur in den Fallen ausfuhren, in denen sicn
die ^ZoTT^^i^^ untersten Teil des kleinen Beckens befanden, wogegen man
teiti nach^ben reichende Konglomerate nicht anzugehen wagte -.^^^^^^^^
lichkeit einer exakten Blutstillung und der vermeinthchen Gefahr von Nebenver

'''Toreinigen Jahren sah ich mich gezwungen eine Patientin mit äußerst schwerer
AdnexerkranLig zu operieren. Die Tumoren überragten die Beckeneingangsebene
f:^^:^^. m'onatelanges Fieber gänzlich herabgekommene ^^^^^^^^^
u • -u Ti^firiH^n von Ta2 zu Tag. Notgedrungen versuchte ich die Fatientin

pLi^er Darmsehlingen entleerte sich massenhaft stinkender Eiter, so daß ich auf eine
rSeOprition verzichten mußte und nach ausgiebiger Drainage die Bauchhoh e
^r^^tl.. jammervolle Zustand der Frau besserte sich nicht, und so ent-
rchtß ich m ch 50 Tage „ach dem ersten Eingriff Uterus und Adnexe vaginal zu ent-

öl

-' ■-■■'-'— ^-

Spezieller Teil / III. Vaginale Operationen am Uterus

D ärm-
st'Illingen

Adnex-
tuinor

Abb. hSÄ». Vaginale Exstirpation von Adnextiunoren nach Logothetopulos. Nach vaginaler

Exstirpation des Uterus löst die ganz in die Bauchhöhle eingc^fiihrte linke Hand die linken Adnexe

von den deckenden DarmschlingcMi luid Netz ab," während gltMchzeitig die rechte Hand die mit

den Klemmen gefaßten Adnexstinnpfe leicht nach abwärts zieht

fernen, mit dem Erfolg, daß die Frau gesund die Klinik verlassen konnte^). In der
Folge habe ich noch 23 gleichartige Fälle operiert, von denen zwei ad exituni kamen,
die eine an Peritonitis, die andere infolge Gangrän des Schuchardtschen Schnittes,
der während der Operation von dem sehr virulenten Eiter infiziert worden war. Es
handelte sich durchweg um außerordentlich schwere, infektiöse Fälle, bei denen eine
Laparatoniie wenig Erfolg versprach. Die meisten dieser Patientinnen waren schon
monatelang in verschiedenen hiesigen chirurgisch -gynäkologischen Kliniken auf alle
erdenkhche Weise behandelt worden und wurden speziell zu dieser Operation an mich
überwiesen.

1) Zbl. Gynäk. 1933, Nr. 14.

10. Entzündliche Adnexcrkrankungcn

Meine O|)erationsmethode unterscheidet sich im wesentlichen von den bisher ge-
bräuchUchen dadurch, daß ich mich nicht mit der Ablösung der Adnextumoren mit
1 — 2 Fingern begnüge, was nur bei ganz tief unten im Becken liegenden Konglomeraten
)glich ist, sondern daß ich 4 Finger oder sogar die ganze Hand in die Beckenhöhle

1 9

^mO^

Abb m. Vagmale Exstirpation von Adnextumoren nach Logothetopulos. Die abgelösten
und nach außen gebracliten link(>n Adnexe liegen auf der Hand

einführe wodurch ich auch noch so hoch liegende Tumoren abschälen und exstirpieren
kann. Dasselbe Vorgehen wurde nach mir noch von Bucura em]>fohleni).

Der Verlauf der Operation ist folgender:

Großer einseitiger Schuchardtschnitt mittels Galvano- oder Thennokauter aus-
geführt um die Infektion der Wundflächen möghchst zu erschweren Nach der m
oben beschriebener Weise vorgenommenen Uterusexstirpation entferne ich dte Sc^den^
Spekula, führe die ganze Hand in die Beckenhöhle em und begmne mit der Ablösung
der Tun oren. Ich gehe in gleicher Weise vor, als ob es sich um eine manuelle Plazentar-
tung handeln würde, d. h., ich suche eine Stelle auf, von der aus ich am leichtesten

T) Bucu7a, Veit-Stoeckel, Handb. d. Geb., III. Aufl., Bd. VIH, S. 278.

I I

n Killte

Spezieller Teil / III. Vaginale Operationen am Uterus

zwischen Tumor und Beckenwand eindringen kann, und von hier aus löse ich schritt-
weise vorwärtstastend die Verwachsungen und ziehe den Tumor möghchst unzer-
stückelt herab, was natürlich nicht immer gelingt (Abb-ff^- m). Meistens kommt es
zum Platzen des Eitersackes, und ich fasse dann die schlaffen Wandungen mit l^aß-
zangen und erleichtere mir durch Zug nach abwärts die weitere Ausschalung. Um eine
Verletzung des die freie Bauchhöhle abschließenden, von verbackenen Darmschlingen
gebildeten Daches oberhalb der Tumormassen zu vermeiden, bemühe ich mich, mit
der Hand stets in Berührung mit der obersten Kuppe des Tumors zu bleiben. Sollte
die Hand trotzdem einmal mit der freien Bauchhöhle in Verbindung treten, so hat
das meiner Erfahrung nach auch keine unangenehmen Folgen. Um den Eiter wahrend
der Operation leichter nach außen abfließen zu lassen, finden alle Manipulationen bei
leichter Beckentieflagerung statt. Mit auffallender Leichtigkeit lassen sich die Ver-
wachsungen lösen, viel leichter sogar wie bei der Laparatomie. Die Blutstillung ge-
schieht in der gewöhnlichen Weise durch Fassen der Gefäße und nachfolgender Unter-
bindung, aber es ist sehr interessant, daß die Blutung im allgemeinen nur sehr gering
ist so daß ich in einem Fall weder eine Unterbindung zu machen, noch meinen blut-
stillenden Tampon anzuwenden brauchte und nur einen einfachen Mikulicz sehen
Tampon einlegte. Natürlich verwende ich mit Vorliebe meinen blutstillenden Tampon,
wenn die Blutung erheblich ist und sonst nicht gestillt werden kann, da ja in jedem
Fall eine Drainage notwendig ist. Unerwarteterweise findet man nicht die größten
Schwierigkeiten bei der Lösung der Adnexe, sondern bei der Uterusexstirpation, da
das Corpus uteri zuweilen gleichsam in Adhäsionen eingemauert ist und seiner Dislo-
kation hartnäckigsten Widerstand entgegensetzt. Ich betone nochmals, daß die Ein-
führung der ganzen Hand einen wesentHchen Bestandteil meiner Technik bildet, da
nur so ein genaues Abtasten aller Organe mit feinstem Gefühl möglich ist, wie es mit
einzelnen Fingern niemals erreicht werden kann. Ohne Schwierigkeit kann man be-
urteilen, welche Verwachsungen stumpf gelöst, welche mit der Schere unter Leitung
des Auges durchtrennt werden müssen. Sind Verwachsungen zwischen Darm und
Adnexen vorhanden, so zieht man einfach die adhärente Schlinge mit dem Tumor
zusammen nach unten, wo sie dann mit der Schere abgetrennt werden kann. In einem
Fall konnte ich auf diese Weise sogar ein großes Stück nekrotischen Dünndarms resezieren.
Ich bin sicher, daß diese Operation, die viel schwieriger aussieht, als sie in der Tat
ist, von jedem mit der vaginalen Technik vertrautem Gynäkologen ausgeführt werden
kann und, wie ich hoffe, auch ausgeführt werden wird, da sie in gewissen Fällen die
einzige Möglichkeit zur Rettung eines menschlichen Lebens darstellt.

11. Oraviditas extrauterina

Die Behandlung der extrauterinen Schwangerschaft ist stets eine operative,
worüber wohl kaum Meinungsverschiedenheiten bestehen dürften. Wir stehen auf dem
Standpunkt, daß auch die Zeit der Schwangerschaft bei der Indikation zur Operation
keine Rolle spielt, und daß bei vorgeschrittenen, bereits in der zweiten Hälfte befind-
lichen Schwangerschaften der Gedanke, vielleicht doch noch ein lebendes Kind zu
erhalten, uns nicht dazu verleiten darf von diesem Grundsatze abzugehen. Je weiter
die Gravidität fortgeschritten ist, um so größer ist die Gefährlichkeit der Operation
durch immer massigere Entwicklung der Gefäße der Plazenta und Ausbildung vaskula-
risierter Adhäsionen. Ganz abgesehen davon weisen die extrauterin bis zum Schwanger-
schaftsende ausgetragenen Kinder so häufig Mißbildungen (über SO^/o) auf, daß es uns
durchaus problematisch erscheint, ob wir ihretwegen eine gesunde Frau den ernstesten
Gefahren aussetzen dürfen.

11. Graviditas extrauterina

Im allgemeinen ist die Operation der Extrauteringravidität der ersten Monate
leicht. Man kann gewisse Fälle vaginal angehen; wir bevorzugen aher die Laparatomie
der größeren Übersichtlichkeit und der Blutersparnis halber. Sofort nach Eröffnung
der Bauchhöhle gehen wir mit der ganzen Hand in die Tiefe und suchen die erkrankte
Tube nach außen zu bringen, wobei wir uns bei blutgefüllter Bauchhöhle meist durch
das Gefühl leiten lassen müssen. Die gegebenenfalls bestehende Blutung wird augen-
blicklich mittels zweier Klemmen, von denen die eine an der Uteruskante, die andere
am Lig. infundibulopelvicum sitzt, provisorisch gestillt, worauf uns die genaue Be-
sichtigung erkennen läßt, ob vielleicht ein Teil der Tube erhalten werden kann. Das
Ovar suchen wir auf alle Fälle zurückzulassen. Die Exstirpation der Tube wird in
gleicher Weise vorgenommen, wie es bei den entzündlichen Adnexerkrankungen ge-
schildert wurde (Abb."^6^ Sind bereits starke Verwachsungen vorhanden, so ziehen / ^^
wir den mit einer Kugelzange gefaßten Uterus nach außen und erleichtern uns so die
Orientierung. Die Ablösung einer in vorgeschrittenen Fällen vorhandenen binde-
gewebigen Kapsel von den umgebenden Darmschlingen und vom Netz kann außer-
ordentlich schwierig, ja unmöglich sein, so daß wir notgedrungen Teile derselben zu-
rücklassen müssen. Den Schluß der Operation bildet regelmäßig die Inspektion der
Adnexe der anderen Seite, die selbst beim Vorhandensein entzündlicher Ver-
änderungen möglichst schonend behandelt werden müssen im Interesse der Erhaltung
der Fertilität. In veralteten Fällen mit ausgedehnter bindegewebiger Organisation der
Blutmassen können wir gezwungen sein den Uterus mitzuentfernen, wobei wir auf die
Erhaltung wenigstens eines Ovars bedacht sind. Infizierte oder auch nur infektions-
verdächtige Fälle werden durch das hintere Scheidengewölbe drainiert; ganz ausnahms-
weise, wenn besondere Umstände es erfordern, drainieren wir durch die Bauchdecken.
Die infizierte retrouterine Hämatocele (Fieber, Leukozytose, Erhöhung der Blutkörper-
chensenkungsgeschwindigkeit) eröffnen wir nur durch die hintere Kolpotomie, entfernen
die Blutkoagula und drainieren. Ist eine peritubare Hämatozele von unten nicht zu
erreichen, so'entfernen wir durch Laparatomie den Fruchtsack und legen einen Mikulicz-

tampon ein.

Befinden sich größere Blutmengen in der Bauchhöhle, so entfernen wir sie mit der
Hand und mit Kompressen so gut wie mögUch, wobei eine geringe Tieflagerung des
Beckens von Nutzen ist. Zurückbleibende Reste werden ohne Schaden resorbiert.
Über die Zweckmäßigkeit der Wiederinfusion des aus der Bauchhöhle entfernten Blutes
(nach Thiese) sind die Meinungen sehr geteilt. In sehr ausgebluteten Fällen ist die
Ausführung der Bluttransfusion von einem geeigneten Spender unbedingt ungefähr-
licher und erfolgreicher. In den meisten Fällen sind wir mit intravenösen Kochsalz-
infusionen und analeptischen Mitteln gut ausgekommen. Es versteht sich von selbst,
daß alle blutdrucksteigernde Maßnahmen erst nach der endgültigen Blutstillung vor-
genommen werden dürfen.

Die Operation der extrauterinen Schwangerschaft der letzten Monate kann ganz
außerordentliche Schwierigkeiten bereiten. Als das ideale Verfahren ist immer die völ-
lige Entfernung des Fruchtsackes anzusehen. Aber wenn sich d.e Plazenta zwischen
den Darmschlingen, am Netz oder gar noch weiter oben (z. B. an der Leber) emgemstet
hat, kann auch dem wagemutigsten Operateur nur dringend geraten werden, semem
verständlichen Wunsch auf radikales Vorgehen nicht nachzugeben, -"dern s.ch mrt
der Entfernung der Frucht unter Zurücklassung von Teilen des Fruchtsackes zu be-
g^^ge^ rbe'sonders von französischen Autoren empfohlene Methode der Einnähung
Sruchtsackes in die Bauchdecken, seine Eröffnung und Entfernung der Fruch^ nut
Zurücklassen der Plazenta kann wegen der großen Gefahr einer Infektion und Nach

yy Speziellor Teil / IH. Vaginah« Operationen am Uterus

X i ^« TT-öii^^n Uann die vorgehende Unter-

blutuni; nicht L^utgeheißen werden. In manchen fallen kann a e g

hat sich der blutstillende Tampon von Logothetopulos Ak leoe

12. Die chirurgische Itchandluiif; der l'arami'tritis

Bei Vereiterung des extraperitoneal liegenden Bindegewebes des Icleinen Beckens
eröffnet lan, sobaH eine umsiriebene ^i-ansarnndung naohwe.s^ar^^^^^^^^
die hintere oder durch die vordere Kolpotomie je nach <len. ^f ."^^ '^j^;- j^^™;^'';^"
Eiterabfluü zu erleichtern, erweitern wir nut -"-^0-;-"«^ ""^'^;, ';,f^; '^^ .
offnunsr cehen mit 2 Fingern in <Ue Abs/.elJhöhle en, und durchtrennen die meist vor
otlnung, genen »HU - 1 ^ ., ^ . ,, • ,.,, „:„„ einzige Eiterhöhle mit glatten

handenen bindegewebigen Septen, so daß sich eine einzige , Jl

Wänden bildet. Diese drainieren wir nach Abfluß des Eiters mit Jodoformgaze, ver
m^dt aber jede Spülung mit desinfizierenden Flüssigkeiten, - ^ ^^^'^ -;-
infektiösem Material in die vielleicht zufällig eröffnete freie Ba«.|hhohle mit S cheiheit
zu verhüten. Nach 48 Stunden ersetzen wir die Gaze durch ein Drainrohr und können
ietzt ohne Bedenken die Abszeßhöhle auss[)ülen.

^Abszesse der seitUchen Beckenwand, die wir von unten nich erreichen können^
eröffnen wir von einem 5-6 cm langen Schnitte aus, den wir d.cht oberhalb und
Irallel zum Poupartschen Band anlegen. Wir durchtrennen Haut Unterhautzell-
ZZ und Faszie scharf, arbeiten uns stumpf mit Finger und gesch ossener Schere
durch die Muskulatur und setzen Spekula ein. Unter Lösung etwaiger Verwachsungen
gehen wir stumpf mit dem Finger extraperitoneal der Beckenwand folgend ni che lief
Ms wir auf Eiter treffen. Wir erweitern den Zugang zur Abszeßhohle gehen mit
2 Fingern in dieselbe und verwandeln die zerklüftete Höhlung in einen glattwandigen
Rauni, indem wir genau wie beim vaginalen Vorgehen die bindegewebigen Septen
durchtrennen. Blutungen stehen immer durch einfache Tami)onade der Hohh^ng mi
Jodoformgaze, die auch hier nach 48 Stunden durch ein Drain ersetzt wird. Die jetzt
empfehlenswerten Spülungen machen wir mit einem Rüekflußkatheter und verwenden
hierzu 2o/oiges Wasserstoffsuperoxyd.

So leicht die Behandlung des parametritischen Abszesses ist, um so größere An-
forderungen an unser therapeutisches Können stellt die chronische, fibröse Form

der Parametritis.

Die (Jrundlage der bisherigen Therapie bildete in erster Linie die Anwendung von
Wärme in ihren verschiedenen Formen, wie Sitzbäder, Scheiden- und Darmspulungen,
Lichtbäder Moorbäder und neuerdings auch die Kurzwellenbehandlung, die der
Diathermie gegenüber wohl einen Fortschritt bedeutet, aber bei den hier uns interes-
sierenden Fällen doch keine solchen Erfolge aufweist, wie sie es bei den entzundhchen
Adnexerkrankungen in geradezu spezifischer Weise tut. Bei genügend langer Dauer
der Behandlung erreicht man mit all diesen Mitteln in einer erheblichen Anzahl von
Fällen eine wesentliche Besserung des subjektiven Befindens und auch der objektive
Befund wird günstig beeinflußt, so daß ein solcher konservativer Versuch in jedem
Falle gerechtfertigt ist. Nun gibt es leider eine nicht geringe Zahl von Parametritiden,
die nur sehr wenig oder auch gar nicht von all diesen Maßnahmen beeinflußt werden,
Fälle, bei denen das parametritische Gewebe in eine steinharte Masse umgewandelt ist,
die jedem therapeutischem Angriff widersteht. Man versuchte in solchen verzweifelten
Fällen chirurgisch vorzugehen, aber die vorgeschlagenen Operationsmethoden sind
wieder verlassen worden, entweder weil sie gar zu heroisch waren und praktisch deshalb
nicht verwendet werden konnten, oder weil sie nicht eingreifend genug zu keinem
Erfolge führten. Hierher gehört die Exstirpation der Ligamenta lata, eventuell in Ver-

12. Die chirurgische Behandlung der Parametriti>

bindung mit der Uterussuspension (Veit, Martin usw.), die trotz der günstigen Er-
gebnisse, wie sie Warnekross in 14 Fällen erzielte, bei der Mehrzahl der ()|)erateure
sich nicht hat durchsetzen können. Die von den Franzosen angewandte Totalexstir-
])ation des Uterus samt der Adnexe, womögUch noch mit der Herausnahme eines
Teiles des ])arametritischen Gewebes, ist in ihren Endresultaten sehr wenig ermutigend,
und da bei sehr gründlichem Vorgehen Nebenverletzungen der Blase und des Harn-
leiters häufig vorkommen, so hat diese Methode nur spärliche Anhänger gefunden.
Der Vollständigkeit halber erwähne ich noch die Eingriffe am Beckensymphatikus
(Latarjet, Röchet), die auf die Gewebsveränderungen nur geringe Einwirkungen
zeigen, jedoch die Schmerzen günstig beeinflussen können.

Die Behandlung: der ehroniseheii Parametritis dureh künstliehe Abszeßbildun)

naeh Logothetopulos

Da die exsudative Form der Parametritis, der parametritische Abszeß also, durch
Eröffnung des Eiterherdes und Entleerung leicht zur Heilung zu bringen ist, ganz im
Gegensatz zur plastischen, fibrösen Form der Parametritis, so lag der Gedanke nahe,
diese letzte in die abszedierende Form umzuwandeln und dann in der vielfach be-
währten Art weiterzubehandeln.

Als geeignetes Mittel hierzu wählten wir die Injektion von Terpentinöl, dessen
abszeßbildende Eigenschaft ja bekannt ist, und mit der wir so glänzende Resultate
erzielten, daß wir sie in allen solchen, allerdings nicht häufigen Fällen mit gleichbleiben-
dem Erfolg anwandten.

Die einfache Technik erleichtert man sich sehr durch Verwendung einer speziellen
Spritze aus Metall, bei der die Nadel mittels Bajonettverschluß festgehalten wird
(Abb. t^. Der erforderliche Druck ist für die üblichen Rekordspritzen viel zu hoch, >
so daß die Flüssigkeit zwischen Konus und Nadel herausläuft oder der Glaszylinder

platzt. • r 1 i-

TechnikderOperation: Nach Einführung der Scheidenspekula und Desinfektion

der Scheidenschleimhaut injizieren wir möglichst zentral in das verhärtete parametri-
tische Gewebe an zwei oder drei ein wenig auseinanderliegenden Punkten je 2—3 ccm
Terpentinöl Die zu injizierende Menge muß natürlich der Ausdehnung des infiltrierten
Bezirkes entsprechen und wird je nachdem kleiner oder größer gewählt, soll aber nach
Möglichkeit 6 ccm nicht überschreiten, obgleich wir ohne jeden Schaden auch schon
größere Dosen verabreicht haben. Handelt es sich um eine vordere Parametritis, dann
muß zuerst nach Durchtrennung der vorderen Scheidenwand die Blase stumpf ab-
geschoben werden, wonach man ohne Gefahr der Blasenverletzung die Injektion vor-
nehmen kann. Bei mehr nach den Bauchdecken zu entwicke ten Infiltraten durch-
trennt man in oben beschriebener Weise Haut, Faszie und Muskulatur und spritzt
das Terpentinöl direkt in das harte Exsudat ein.

In den folgenden Tagen kommt es zu mäßigen Temperatursteigerungen und Ver-
mehrung der Leukozyten als Begleiterscheinung des sich bildenden Abszesses. So ort
nl der Injektion t'eten starke Schmerzen auf, so ^^^^^ J^^^^^T^^
vor Beginn der Operation eine Morphiumspritze verabreicht, die unte Um tanden
ILerholt werden' muß. Irgendwelche Komphkationen seitens der ^^.^^^^^

Organe oder des Peritoneums wurden von uns in ^^^-'^}^'\\'^'^^^^^
aseptischen Kautelen entnommene Abszeßeiter erweist sich bei bakteriologischer

Untersuchung als steril.

1) Z. Geburtsh. Bd. 104, 1937.

/<!/

Spezieller Teil / III. Vaginale Operationen am Uterus

frA

j/t^a^^a^

"IX

bb Wl Die Behandlung der chronischen Parametritis durch künstliche Abszeßbildung nach
ogoth^lopulos. Einspritzung von Terpentinöl in die fibrinösen Massen des Parametrium .

Links Metallspritze mit Bajonettverschluß

Abb. 1
L

Die Eröffnung des Abszesses nehmen wir 48 Stunden nach der Injektion vor,
obwohl auch schon vor Ablauf dieser Zeit einmal eine genügende Einschmelzung ein-
\ 1^ getreten sein kann (Abb. 12R— ia2). Nach der Inzision kommt es zur Absonderung
einer mehr oder weniger großen Menge eines dickflüssigen, mit nekrotischen Gewebs-
fetzen untermengten Eiters. Bei Einführung des Fingers in die Abszeßhöhle fühlt
man leicht zerdrückbare, bröckhche Massen, die wir entfernen, um eine große einheit-
liche Höhle zu schaffen, die mit Gazestreifen drainiert wird, genau so als wenn es sich

12. Die chirurgische Behandlung der Paramt^tritis

\ )

I "^

\t^

Abb. 128. Die Behandlung der chronischen Parametritis durch künstliche Abszeßbildung iBIPh

I/o^f><.h€^top.ut«7X Schematische Darstellung. Di(> Pfeile geben die Richtung an, in (ler die

Nadel bei der Injektion in die fibrösen, parametritischen Massen vorg(>schobcn wird

jtflllllllllllllllWiDIIDIIIIIIIIIII

Abb 129. Die Behandlung der chronischen Parametritis durch künstliche Abszeßbildung nach
LogotketopuW«. Schematische Darstellung der vereiterten fibrösen parametritischen Massen.

Die Pfeile zeigen die Richtung der Kolpotomiewunde

Logothetopulos, Gynäkologische Chirurgie

Sp(3ziüllor Teil / III. Vaginale Operationen am Uterus

Abb. fm^ Die BebaiuiUmg der cbronischen
Paramt^tritis durch kiinstliche Abszeßbildung
nauik-Xugotlu'topuloH. Eröffnung des ge-
bildeten Abszesses dvncb hintere Kolpotomie
mit dem Thermokauter

IIb

Abb. J>h Die Behandlung der chronischen
Parametritis durch kiuistliche Abszeßbildung
naeh -fc»^«4h^ta^UrWs. Erweiterung der
Kolpotomiewunch^ mit der Kornzange. Aus
der Öffnung fließt dickflüssiger Eiter

Abb. ^82. Die Behandlung der chro-
nischenParametritis durch künstliclu^
Abszeßbildung rtwoh ho p a t-kett) -
.^■i«^ Mit dem in die Abszeß -
höhle eingefidirten Fingt^r wtu-den
die bröckeligen Massen (mtfernt, die
Septen durchtrennt und so eine ein-
heitliche Höhle hergestellt

13. Stenose der Scheide / 14. Atresie der Scheide / 15. Bildung einer künstlichen Scheide 98

um einen gewöhnlichen parametritischen Abszeß handehi würde. Man ist immer wieder
erstaunt, wie die harten Massen, die nur mit Mühe von der Nadel durchbohrt werden
konnten, jetzt nach der Einschmelzung mit Leichtigkeit mit dem Finger zerdrückt
werden können. Die Nachbehandlung unterscheidet sich in keiner Weise von der-
jenigen anderer parametritischer Abszesse.

Das Endergebnis ist überraschend gut. Die monatelang von großen Schmerzen
gequälten Kranken werden mit einem Schlage schmerzfrei, die derben fibrösen Massen
verschwinden, und der Tastbefund wird meistens nach einigen Wochen nahezu normal.
Bei einem Falle mit starker Stenose des Darmes wurde sofort nach der Abszeßeröffnung
die Darmentleerung wieder beschwerdefrei, und die zuvor von Zeit zu Zeit auftretenden
Ileuserscheinungen konnten nicht mehr beobachtet werden.

13. Die zirkumskripte Stenose der Scheide,

wie sie nicht allzu selten nach Geburts- oder Kohabitationsverletzungen beobachtet
wird, ist häufig durch Dilatation allein nicht zu beheben, und wir gehen dann fol-
gendermaßen vor:

Nach Einstellung der Stenose mittels Spekula faßt man die Scheidenwand unter-
halb der Verengung mit Kugelzangen und spannt sie durch Zug nach unten und außen
gut an. Nun spaltet man die narbig veränderte Stelle in der Medianlinie und näht
diesen Längsschnitt in (juerer Richtung zusammen. Die Länge des Schnittes wird
durch den Grad der Stenosierung bestimmt. Die gleiche Plastik führt man daim auf
der Hinterwand aus, wonach die Scheide mit Gaze gut austamponiert wird.

14. Die totale Atresie der Scheide

infolge Verwachsung der Scheiden wände ist nicht leicht zu beseitigen, wenn man ein
wirklich funktionstüchtiges Organ herstellen will. Von einem Querschnitt über den
Damm aus arbeitet man sich stumpf mit dem Finger und der Schere zwischen Rektum
und Blase in die Höhe, bis man intakte Vaginalschleimhaut oder die Portio erreicht.
Man zieht die Schleimhautränder nach unten bis es gelingt, sie mit erhaltenen Scheiden-
resten weiter unten zu vereinigen oder sie zirkulär in den Introitus einzunähen. Bei
sehr unübersichtlichen Fällen kann es nötig werden, die Operation durch Laparatomie
zu beginnen und dann vaginal fortzufahren, um mit Sicherheit Blasen- und Darm-
verletzungen zu vermeiden.

"Dpi

Hämatokolpos und Hämatoinetra

infolge angeborener oder erworbener Hymenal- oder Scheidenatresie genügt die ein-
fache Eröffnung des Verschlusses mit nachfolgender Tamponade und nötigenfalls
Bougiebehandlung, um eine erneute Stenose zu verhindern. Besteht neben der Häma-
tometra noch eine Hämatosalpinx, so ist diese Behandlung auf keinen Fall erlaubt,
da es zu leicht zu einer Verjauchung des Tubeninhaltes mit nachfolgender Peritonitis
kommen kann. Man exstir})iert am besten durch Laparatomie die erweiterten Tuben
oder macht bei sterilem Inhalt eine Salpingostomie, wenn auf Konzeption Wert gelegt
wird. Sind Veränderungen vorhanden, die eine normale Genitalfunktion ausschließen,
so kann man den Uterus entfernen unter Zurücklassung der Ovarien.

15. Die Bildung einer künstlichen Scheide

Noch vor nicht allzulanger Zeit wurde diese Operation von namhaften Autoren
abgelehnt, wenn sich durch sie nicht Schwangerschaft und Geburt ermöglichen ließet).

1) Franz, Gynäk. Operat.

Spcziollor Toil / III. Vaginale Operationen am Uterus

'll

16. Die Blasenscheidenfistel

1)5

Das ist nur in ganz seltenen Fällen zu erwarten, weil sich neben der Mißbildung der
Scheide fast immer auch Veränderungen der inneren Organe nachweisen lassen. Wir
halten uns nicht für berechtigt, eine Frau zurückzuweisen, die sich durch einen opera-
tiven Eingriff einen Glückszuwachs verspricht und oft genug sich nur durch die Ope-
ration vom Suizid zurückhalten läßt. Diese Nachgiebigkeit fällt uns um so leichter,
als die modernen Operationsmethoden der künsthchen Scheidenbildung nur mit emer
ganz geringen Morbidität und fast gar keiner Mortalität belastet sind, ganz im Gegen-
satz zu den früheren Eingriffen mit Verwendung einer Dünndarmschhnge (Haeber-
lein, Mori, Baldwin) oder eines Teiles des Mastdarms (Schubert).

Die von Vi^agner-Kirschner angegebene Methode, bei der der zwischen Blase
und Mastdarm angelegte scheidenförmige Kanal unter Zuhilfenahme einer Prothese
mit einigen großen Epidermislappen ausgekleidet wird, hat den großen Vorzug der
völligen Ungefährlichkeit und scheint in ihren Enderfolgen den früheren Methoden
gleichwertig zu sein. Technisch nicht ganz einfach ist allerdings die Entnahme der
Lappen aus der Oberschenkelhaut.

Andere benutzen als Schrittmacher für die Epithelisierung des gebildeten Kanals
heteroplastische Materialien, so z. B. Eihaut oder Vernix caseosa, ebenfalls mit gutem

Enderfolg (Burger).

Den Gipfel der Einfachheit erreichte aber Gambarow^), der von einem kleinen
Querschnitt aus stumpf den Kanal zwischen Blase und Mastdarm anlegte und ihn
tamponierte. Dieser mit Bougies und später durch natürlichen Gebrauch offengehaltene
Kanal war nach wenigen Monaten mit einer festen Epithelschicht ausgekleidet und
allen Anforderungen an eine Scheide gewachsen.

16. Die Blasenscheidenfistel

Wenn wir die nicht sehr häufigen Fälle von Fistelentstehung infolge Durchbruch
maligner Tumoren außer acht lassen, so haben wir es mit 2 Arten von Fisteln zu tun,
mit den j)ostpartalen und den postoperativen, deren operative Beseitigung mit zu den
dankbarsten Aufgaben des chirurgisch tätigen Arztes gehört. Allerdings sei hier be-
tont, daß die Operation der Blasenscheidenfistel zu den schwierigsten Eingriffen zu
zählen ist, die beste operative Technik und größte Erfahrung verlangt, da jede Fistel
individuell behandelt sein will, entsprechend der fast unbegrenzten Mannigfaltigkeit,
mit der sie in Erscheinung zu treten pflegen.

Auch heute noch gibt es in Griechenland zahlreiche Dörfer und Inseln, schwer
erreichbar und fern von gut eingerichteten Kliniken gelegen, wo die Entbindungen
ohne oder mit zu später ärztUcher Hilfe vor sich gehen müssen. Beweis hierfür sind
die vielen Fisteln, die wir hier zu sehen bekommen, und die entweder durch Nekrose
der allzulange zwischen Kopf und Becken gequetschten Weichteile entstanden sind,
oder traumatisch durch geburtshilfliche Eingriffe unter unzureichenden äußeren Be-
dingungen.

Die gelegentlich gynäkologischer Operationen, besonders nach der totalen Uterus-
exstirpation auftretenden Fisteln sind hierzulande in kleinerer Zahl zu beobachten
und, wenn sie durch direkte Verletzungen entstanden sind, meist ziemlich leicht zu
beseitigen, ganz im Gegensatz zu den durch Nekrose sekundär in Erscheinung tretenden
Fisteln, bei denen zuweilen große Teile der Blasenwand zu Verlust gegangen sind
(s. den S. 3 beschriebenen Fall). Solche Defekte sehen wir besonders nach der Wert-
heimschen Totalexstirpation auftreten, bei der die zahlreichen Unterbindungen die
Ernährung der Blase gefährden. Es sei hier daran erinnert, daß die Art. vesicalis,

1) Zbl. Gynäk. 1933, Nr. 43.

die den Blasengrund versorgt, aus der Art. hypogastrica stammt, und daß der Ramus
cervicovaginalis der Art. uterina Äste zum mittleren Harnröhrenabschnitt schickt.
Nicht selten gehen auch kräftige Äste der Art. uterina direkt zur Blasen wand.

Eine während der Operation entstandene Blasenverletzung muß unter allen Um-
ständen wieder durch sorgfältigste Naht geschlossen werden, bei Laparatomien am
besten sofort, bei vaginalen Operationen erst nach Beendigung des Eingriffes, da nach
der Entfernung der Instrumente und eventuell des Uterus die Zugängigkeit und Über-
sicht in der Scheide eine bessere ist. Man spannt die Blasen wunde mittels zweier Kugel-
zangen an und näht sie fortlaufend mit Katgut, ohne die Schleimhaut mitzufassen.
Darüber kommt eine zweite fortlaufende Katgutnaht oder Einzelnähte, die das Blasen-
gewebe möglichst breit fassen sollen. Bei vaginalen Operationen versuche man die
Blasennähte mit Peritoneum zu decken, was bei der Laparatomie ja selbstverständlich
ist. Man vermeide aber die Anwendung einer Tamponade, sei es zur Blutstillung oder
zur Vorbeugung von Infektionen, da meiner Erfahrung nach hierdurch die Heilung
der Blasenwunde in Frage gestellt wird. Wenn irgend möglich soll die Scheide voll-
kommen geschlossen werden, wie es auch Stoeckel ausdrückhch verlangt. Auch
wenn die Naht gut gelungen ist, legen wir einen Dauerkatheter für 8 — 10 Tage ein,
und auf diese Weise haben wir stets eine Fistelbildung verhüten können.

Wird die Blasenverletzung nicht während der Operation erkannt oder entsteht
einige Tage nach dem Eingriff eine Fistel durch Nekrose, so legt man einen Dauer-
katheter ein, und man sieht nicht allzuselten einen spontanen Verschluß eintreten.
In anderen Fällen erreicht man nur eine Verkleinerung der Fistel, wodurch die s[)ätere
Operation sehr erleichtert wird. Die Fisteln, die sich nicht in kurzer Zeit nach der
Operation, bei der sie entstanden sind, schließen, zeigen nur eine geringe Neigung zur
Spontanheilung und müssen fast immer operativ beseitigt werden.

Über 100 Operationsmethoden sind seit den Zeiten Simons, Lambells und
Sims', den hauptsächlichen Begründern der Fisteloperation, angegeben worden. Sie
sind größtenteils nur noch von historischem Interesse; ich verweise auf die meister-
hafte Darstellung Stoeckels im Veit-Stoeckelschem Handbuch X. Band, II. Teil
und beschränke mich hier auf die Beschreibung der von mir geübten Art der Fistel-
operation, wie ich sie auf Grund einer Erfahrung bei 89 meist äußerst schweren Fällen
ausgearbeitet habe. Ich stehe auf dem Standpunkt, daß jede Blasenscheidenfistel vaginal
operiert werden muß und geheilt werden kann, unter der Voraussetzung, daß der
Operateur die Technik der vaginalen Operationen voll und ganz beherrscht. Ist das
nicht der Fall, so tut er besser daran, die Kranke in seinem und in ihrem Interesse an
einen erfahrenen Operateur zu überweisen, weil jede mißglückte Operation wertvolles
Gewebe zerstört und die nachfolgenden Eingriffe nur schwieriger macht. Freilich gibt
es kleine, gut zugängliche Fisteln, die ohne große Schwierigkeit durch jede beliebige
Methode geschlossen werden können, die Erfolgsaussichten werden aber sofort
schlechter, wenn wir uns jenen meist nach Nekrosen auftretenden Fällen gegenüber
sehen, bei' denen die Fistelränder unregelmäßig gezackt, hart und mit den darunter
liegenden Geweben und dem Knochen verwachsen sind, wenn große Defekte der
Blase und der Harnröhre bestehen oder schon bei der Untersuchung der Finger statt
der Vagina einen narbigen Trichter vorfindet, der Portio und Fistel verbirgt.

Von Wichtigkeit ist die Wahl des Operationstermins. Fisteln, die sich nicht spontan
schließen, dürfen nicht vor Ablauf von 2—3 Monaten nach ihrer Entstehung operiert
werden. Besonders bei den durch Nekrose hervogerufenen Fisteln muß man das Ab-
stoßen der toten Gewebsteile und die Erholung der geschädigten Partien geduldig
abwarten, und man benutzt diese Zeit, um die Frauen für die Operation vorzubereiten.

9ß Spozioller Teil / III. Vaginale Operationen am Uterus

So behandelt man eine etwa bestehende Zystitis oder Pyehtis durch Blasenspülungen
mit leicht desinfizierenden Mitteln, wobei die in die Scheide abHi^ßende Spulflussig-
keit gleichzeitig eine günstige Einwirkung auf die infizierte Scheidenschleimhaut hat,
und gibt nötigenfalls intravenöse Zylotropininjektionen. Die durch die standige Be-
netzung mit Urin entstehenden Ekzeme, Pyodermien und Furunkulosen bilden eine
Gefahr für den aseptischen Operationsverlauf. Die Kranken müssen zu größter Sauber-
keit angehalten werden. Tägliche Sitzbäder oder auch die von Latzko empfohlenen
medikamentösen Dauerbäder helfen zur Beseitigung der Hautinfektionen. Nach dem
Bade werden die äußeren Genitalien mit Zinkpasta vor der erneuten Benetzung mit
Urin geschützt. In gewissen Abständen findet eine Behandlung der Scheidenschleim-
haut statt. Man entfernt abgestoßene Gewebsteile oder in der Fistelumgebung befind-
liche Inkrustationen, granulierende Wunden werden geätzt oder mit Jodtinktur be-
strichen, und man nimmt nicht resorbierte Fäden heraus, die vielleicht von einer vor-
hergegangenen Oi)eration zurückgeblieben sind.

Die früher oft benutzten, schmerzhaften Methoden zur unblutigen Erweiterung
der narbig verengten Vagina sind jetzt zugunsten des Schuchardtschen Schnittes
vollkommen verlassen worden, der bei richtiger Anwendung auch ganz hoch sitzende
Fisteln bei enger Vagina zugängig macht und die Verwendung besonders langer Spezial-
instrumente, wie sie ehemals im Gebrauch waren, erübrigt. Wir kommen mit den
gewöhnHchen, bei vaginalen Operationen gebräuchlichen Instrumenten aus. Wert
legen wir auf die Verwendung kleiner, stark gekrümmter, kräftiger Nadeln, die sich
im Nadelhalter in jeder Richtung festklemmen lassen und sich nicht verdrehen. Als
Nahtmaterial verwende ich für die Blase dünnes und für die Scheidenschleimhaut
dickeres Katgut. Lassen sich die Scheidenwundränder nicht ohne Spannung zusammen-
bringen, so nehme ich ausnahmsweise Seide. Für die Blase kommt unresorbierbares
Nahtmaterial in keinem Fall in Frage, da es zuweilen ins Blaseninnere hineinwandert
und dann Veranlassung zu Steinbildung geben kann. Ist die Blasenwand gut mobilisiert
und lassen sich die Wundränder ohne Spannung aneinander bringen, so heilt die Fistel
mit jedem Nahtmaterial. Wichtig und für den Erfolg ausschlaggebend ist es, mög-
lichst breite Wundflächen miteinander in Berührung zu bringen, und es ist gleich-
gültig, ob man ein- oder mehrschichtig näht, weil es auf dasselbe herauskommt
wenn man mit einer Naht oder mit zwei Nähten die gleiche Fläche der Blase zu-
sammenbringt. Ich bevorzuge im allgemeinen die Zweietagennaht, bei der ich die
Blase und die Scheide mit je einer Naht schließe. Nur wenn sehr große Blasen-
flächen zur Verfügung stehen, lege ich noch eine zweite Blasennaht an. Die Gewebe
heilen, wie immer in der Chirurgie, am besten, wenn sie möglichst wenig geschädigt
werden, und das ist der Fall bei Verwendung von möglichst wenig Nähten. Die Blasen-
schleimhaut fasse ich nicht mit, obwohl Stoeckel davon keine Nachteile gesehen hat.
Da der 10 — 15 mm lange Blasenteil des Ureters nach dem Durchtritt durch die Musku-
latur unter der Schleimhaut verläuft, so vermeidet man ihn am besten, wenn man die
Nähte nur durch die Muskulatur legt.

Die Patientin wird wie zu einer Vaginaloperation gelagert, doch achten wir mit
besonderer Sorgfalt darauf, daß der Steiß die Tischkante überragt, und daß die Beine
gut gespreizt sind. Leichte Beckenhochlagerung erleichtert die Zugängigkeit.

Als Narkotikum verwende ich wie bei allen Vaginaloperationen Evipan und komme
damit auch bei länger dauernden Eingriffen meistens aus ohne oder nur mit geringem
Zusatz von Äther.

Den Fistelverschluß nur durch Anfrischung und Naht führe ich nicht aus, wenn
man auch in einfach gelagerten Fällen damit zum Ziel kommen kann. Wir haben in

16. Die Blasenseheidenfistül

'.17

der Fistel plastik nach Aufteilung des Fistelkanals (Dedoublement) eine so sichere
Methode, daß wir auf sie auch bei unkomplizierten Fällen nicht verzichten wollen.
Sie ist für mich die Methode der Wahl, und ich führe sie folgendermaßen aus:

Nach Ausführung des Schuchardtschnittes und Einsetzen der Spekula orientiere
ich mich zuerst über Lage, Größe und Beschaffenheit der Fistel, indem ich die um-
gebende Vaginalwand mit Kugelzangen fasse und auseinanderziehe. In anderen Fällen
wieder gehngt die Freilegung einfach durch Nachabwärtsziehen der Portio mit einer
Kugelzange. Ich suche nun die am leichtesten verschiebliche Stelle der Fistelumgebung
auf und beginne mit einem spitzen, scharfen Messer am Fistel rand die Ablösung der
Scheiden- von der Blasenwand. Sobald ich einen genügend großen Teil der die Fistel
umgebenden Blasenwand freiprä[)ariert habe, lege ich die erste Naht möglichst weit
durchgreifend an und knüi)fe sie (Abby i^S=und \^. Sie wird als Zügel benutzt und vom
Assistenten gut nach abwärts gezogen, wonach die platzraubenden Kugelzangen ent-
fernt werden können. Nun präpariere ich mit Messer oder Schere eine weiteres Stück
der Blasenwand frei, lege sofort die zweite Naht an, die wieder nach unten gezogen wird.
Nachdem der erste Faden abgeschnitten worden ist, lege ich wieder ein neues Stück
der Blasenwand frei, lege den dritten Faden und fahre so fort, bis die ganze Fistel
geschlossen ist. Diese Art zu operieren hat den großen Vorteil, daß man durch keine
raumbeengenden Instrumente behindert wird, und daß durch das Ablösen und sofortige
Vernähen nur kleiner Blasenteile die so störende Blutung auf ein Mindestmaß beschränkt
bleibt. Die vielfach empfohlenen Adrenalininjektionen, die die Heilung ungünstig be-
einflussen, sind hierdurch überflüssig geworden. In welcher Weise man anfrischt, hori-
zontal, schräg oder sagittal hängt ausschließlich von der Art der Fistel und der Richtung
der größten Gewebsspannung ab, nach der sich auch die Naht zu richten hat. So kann man
gezwungen sein, die gleiche Fistel in mehreren Richtungen zu nähen (Abb. 138 und 131))-
Nach Beendigung der Blasennaht wird die Blase mit verdünnter, sterilisierter
Milch gefüllt, nachdem man zuvor die Scheide mit Gaze austamponiert hat zur Ver-
meidung von Täuschungen durch etwa von der Urethra in die Tiefe zurücklaufende
Flüssigkeit. Nach Entfernung des Katheters und der Gaze kontrolliert man, ob Milch
zwischen den Nähten heraussickert. Ist das der Fall, so schließt man die betreffende
Stelle mit einer Naht. Die Operation wird beendet mit der Vereinigung der Scheiden-
wundränder durch Knopfnähte, wobei man zu erreichen sucht (obwohl ich es nicht für
unbedingt notwendig halte), daß die beiden Nahtreihen nicht übereinander fallen.

Bei Fällen mit besonders starker Spannung der Gewebe kann man mit Nutzen
von der Füthschen Modifikation der Gewebsspaltung Gebrauch machen. Man um-
schneidet die Fistel in etwa V2 cm Entfernung von ihrem Rand, so daß ein ringförmiges
Stück der Vaginalwand stehen bleibt, das nicht mit in die Naht genommen wird, so
daß es sich beim Knüpfen der Fäden nach der Blase zu umkrempelt.

Wieder andere Fälle mit großen Blasendefekten und starker narbiger Fixation
des Fistelrandes können uns zur Exstirpation des Uterus zwingen. Danach kann die
Blase leicht in großer Ausdehnung freigelegt werden, und wir haben reichlich Peri-
toneum zur Nahtsicherung zur Verfügung, eventuell unter Benutzung der Rektumwand
(Latzko) oder sogar der Ligg. lata.

Mit großem Vorteil kann man den Uterus zur Unterpolsterung der Fisteln ver-
wenden (metroplastische Operation), am besten durch die Interposition des Corpus
nach A.Freund. Bei in der Nähe der Zervix liegenden Fisteln kann man diese nach
vorheriger Mobilisierung zur Deckung benützen (Küstner-Wolkowitsch), in
schwierigen Fällen erst nach Unterbindung der Parametrien vom Douglas her
(Küstner, Rübsamen, Latzko).

n?/

t i

Spoziollor Teil / III. Vaginale Operationen am Uterus

16. Die Blasenscheid(aifi.st(4

Abb. tS^ Große Blasen- Schoidenfistel. Sie

ist zum Teil von der faltigen vordc^ren

Vaginalwand bedeckt

Abb. 1S4.* Große Blasen - Scheidenfistel.
Operation durch Dedoublement. Die Blase
ist in großer Ausdehnung rings um die Fistel
freipräpariert und die eine Hälfte der Nähte
in schräger Richtung angelegt. (Am Fistel-
rand ist ein Stück der Scheidenwand
stehengeblieben )

Abb. >ä+r Große Blasen - Scheidenfistel.
Operation durch Dedoublement. Ein Teil
der Blasenwand ist von der Scheidenwand
freipräpariert. Die erste Naht ist angelegt

Abb. l>8ö» Operation einer großen Blasen-
scheidenfistel. Die Blase ist in großer Aus-
dehnung freipräpariert und in schräger Rich-
tung mit Knopf nähten vernäht. Darüber
wird die Blasenwand mit einer weiteren
Nahtreihe vereinigt

.-vi

Abb IS^ Große Blasen- Scheidenfistel. Operation durch Dedoublement. NachdiMu alle
Blasennähte geknüpft sind, werden die Scheidenwundränder mit Knoptnahten vereinigt unter

Mitfassen der Blasenwand

Abb ta&. Operation einer großen T? lasen -
Scheidenfistel. Die Blase ist in großer Aus-
dehnung freipräpariert und die eine Haltte
der Nähte in sagittaler und die andere
Hälfte in querer Richtung angelegt

Abb. ra^ Operation einer großen Blasen-

scheidenfistel. Nach Anknüpfen der queren

Nahtreihen wird die Vagina vernäht unter

Mitfassen der Blasenwände

1 00

SpozioUcr Teil / III. Vaginalo Operationen am Uterus

Blascnseheidciifistol mit Zerstörung des Sphincter vesicae und der Harnröhre

Man kann wohl sagen, daß heute jede Blasenscheidenfistel, bei der die Urethra
nicht beschädigt ist, von wenigen Ausnahmen abgesehen, heilbar ist. Leider werden
die Erfolge weniger sicher, wenn der Sphinkter und die Harnröhre beteiligt sind, da
ja nun die Beseitigung der Fistel nicht genügt, sondern auch ein funktionsfähiger
Schließmuskel hergestellt werden muß, um die willkürliche Zurückhaltung des
Urins zu ermöglichen. Das ist keine leichte Aufgabe trotz der mannigfaltigen,
geistreichen Operationsmethoden die besonders in den letzten Jahren angegeben worden
sind. Ich habe 89 Blasenscheidenfisteln selbst operiert, darunter 62 Fälle ohne Urethral-
verletzung. Von diesen zum Teil sehr großen Fisteln wurden 90«/o geheilt, und zwar
meistens bereits mit der ersten Operation. Bei einigen besonders umfangreichen
Fisteln mußte eine Nachoperation vorgenommen werden, die dann zu vollkommener
Heilung führte. Von den ungeheilten Fällen hätte bestimmt noch der größte Teil
geschlossen werden können, wenn sich die Patientinnen nicht einer zweiten Ope-
ration entzogen hätten. Von den 27 Fällen mit vollständig oder teilweise fehlender
Urethra konnten bei der Entlassung 24 den Urin über 2 Stunden willkürlich

zurückhalten^).

Für die Herstellung des Sphinkter kann jedes in der Nähe des Trigonum vesicae
liegende funktionstüchtige Muskelgewebe herangezogen werden, da nach Latzko so-
wohl die glatte als auch die quergestreifte Muskulatur sich schnell den Verhältnissen
anpaßt und den willkürhchen Verschluß der Blase ermögUcht. Ist die Urethra erhalten,
so genügt es meistens nach Verschluß der Fistel die erhaltenen seitlichen Teile
des Sphinkters und des umliegenden Gewebes durch Quernähte zu vereinigen. Fehlt
sie jedoch teilweise oder ganz, so muß der aus angrenzenden Gewebsteilen hergestellte,
sie ersetzende Kanal eine Muskelunterjiolsterung erhalten, die die Arbeit des Sphinkters
zu übernehmen hat. Die zunächst mittels Katheter offengehaltene künsthche Harn-
röhre zeigt nach nicht allzulanger Zeit eine Auskleidung mit Blasenepithel (Latzko)
und ist nun wirklich zu einer Urethra geworden. Zur muskulären Unterpolsterung
kann man den Fundus oder die Zervix der Gebärmutter oder quergestreifte Muskulatur
(Bulbo- oder Ischiokavernosus, die Levatoren oder auch die Pyramidales) benutzen,
die freipräpariert und mit Nähten unterhalb der neugebildeten Urethra vereinigt
werden. Meistens haben jedoch die vorderen Teile des Bulbo- und Ischiocavernosus
und der Levatorschenkel durch narbige Veränderungen viel von ihrer Elastizität ein-
gebüßt und ihr Abstand ist durch die nach schweren Geburten des öfteren zu beob-
achtende Diastase der Symphyse vergrößert, so daß eine Vereinigung in der Mittel-
linie nur unter starker Spannung möglich ist. Die Folge ist ein Mißlingen der Plastik
infolge Durchschneiden der Nähte oder Nekrose des anämischen Gewebes. Die von
A. Franz angegebene Methode der Verwendung der Levatoren, bei der zwei Muskel-
streifen freipräpariert und mit ihrem hinteren Ende unter der Urethra vereinigt
werden, zeigt bessere Resultate. Martins läßt die freigelegten Muskelbäuche im
Zusammenhang und vernäht sie in der Mittellinie. Ebenfalls von Martins stammt
die Verwendung eines gestielten Fettmuskellappens, der den Bulbocavernosus enthält,
und dessen Basis der ernährenden Gefäße und Nerven halber hinten liegt. Dieser
Lappen wird um den Blasenhals herumgeführt und an der entgegengesetzten Seite
fixiert. Ich habe diese Methode bei einer sehr großen Fistel und ganz fehlender Urethra
mit bestem Erfolg ausgeführt.

1) Über 50 der genannten Fälle hat mein Schüler Antonopulos ausführlich berichtet.
(Congres Frangais de Chirurgie, 1932; Cinquante cas de fistules vesico-vaginales traites par la
voie vaginale.)

16. Die Blasonschoidenfistel

101

Die Goebel-Stoeckelsche Pyramidalisplastik, bei der zwei die Mm. pyramidales
enthaltende Aponeurosenstreifen aus der Rektusscheide hinter der Symphyse hindurch-
gezogen und unter dem Blasenhals vereinigt werden, ist sehr oft mit Erfolg ausgeführt
worden. Ein Nachteil dieser Methode ist die leicht auftretende Nekrose der Lapjien,
die nicht sehr gut ernährt sind.

Fistrl

>f/Äii?2W^

Abb. 14^^ Sehr große Blasensch(>idenfistel mit Fehlen der ganzen Urethra und der

vorderen Vaginalwand

Die Benutzung des interponierten Uterus bei Defekten der Urethra hat uns nicht
befriedigt, ebensowenig die Heranziehung der Portio, die meistens viel zu schwer
bewegUch ist. Sie kann aber mit Erfolg unseren Zwecken auf die von mir angegebene
und unten beschriebene Weise dienstbar gemacht werden, wenn große Defekte der
Urethra und der vorderen Scheidenwand uns zwingen, nach ,,lastischem Materia
Umschau zu halten. Antonopulos hat auf dem Pariser Chirurgenkongreß 1932
auch über diese Methode berichtet.

Nach Verschluß der Blasenfistel und Bildung einer künstlichen Harnrohre aus
dem umgebenden Gewebe wird die Portio mit 2 Kugelzangen nach unten gezogen und
in frontaler Richtung gespalten. Von der Vorderfläche der vorderen Lippe wird
mit dem Messer die Schleimhaut entfernt, und die so angefnschte Flache mit
einigen durch die seitlichen Wundränder geführten Nähten auf der neugebildeten
Urethra befestigt. Die Portioschnittflächen werden wie bei der Diszision wieder

102

Spozieller Toil / III. Vaginale Operationen am Uterus

Abb. liu Sehr große Blasenscheidenfistel
mit Fehlen der ganzen Uretlira und der
vorderen Seheidenwand. Em kleiner Teil
der Blasenwand ist freij^räpariert und die
erste Naht angelegt

Abb. 142, Sehr große Blasenscheidenfistel
mit Fehlen der ganzen Urethra und der
vorderen Scheidenwand. Die Fistel wird
fortschreitend freipräpariert und der jeweils
freigelegte Teil sofort mit Knopfnähten ver-
schlossen. Die prolabierte Blasenschleimhaut
wird mit einem Stieltupfer zurückgehalten

\'hy

ut//aü>t/

Abb. I^Ö". Sehr große l^lasenscheidenfistel mit Fehlen der ganzen Urethra und der vorderen
Scheidenwand. Die ganze Fistel ist geschlossen mit Ausnahme einer kleinen Öffnung, die als Urethra
dienen soll. Die Schleimhaut der vorderen Muttermundslippe wird mit dem Messer abgetragen

17. Die Rektovaginalfistel

103

Abb. \^¥. Sehr große Blasenscheidenfistel
mit Fehlen der ganzen Urethra und der
vorderen Scheidenwand. Die Muttermunds-
lippen werden mit Kugelzangen aus(Mnander-
gehalten imd die ganze Zervix in (querer
Richtung gespalten

r^1

Abb. 145. Sehr großt> Blasenscheidenfistel
mit Fehlen d(M- ganzen Urethra und der
vordt^ren Vaginal wand. Die g(>spaltene
vordere Mutterinundslippe d«'ekt die ganze
Fistel bis zur Urethra und wird seitlich mit
den Seheidenwmidrändern vernäht. Die
Wundränder d(u- hinteren Mutti'rnumdslippo
werden mit Knopfnähten vereinigt

mit einigen Katgutnähten geschlossen. Das Herabziehen der gespaltenen Portio . ^^ /

gelingt überraschend leicht, während der Uterus fast in seiner alten Lage bleibt / / J / '

(Abb. 140—145).

Ich habe nach dieser Methode sehr schwere Fälle mit vollem Erfolg operiert.

17. Die Rektovaginalfistel

Im Gegensatz zu den Blasenscheidenfisteln spielt bei den rektovaginalen Kommu-
nikationen, die allermeist intra partum zustande kommen, die Drucknekrose keine
Rolle, und zwar deshalb, weil der kindliche Schädel an dieser Stelle des Beckens keinen
knöchernen Gegenpart findet, gegen den er Mastdarm und Scheide anpressen könnte.
Die Entstehung dieser Verletzungen ist auf Überdehnung des rektovaginalen Dia-
phragma und schließlichem Einriß desselben beim Durchtritt des kindlichen Kopfes
zurückzuführen, oder, weniger häufig, auf direkte Zerreißungen mit geburtshilflichen
Instrumenten. Nicht selten sehen wir Mastdarm Verletzungen nach vaginalen oder
abdominalen Totalexstirpationen, nach hinterer Kolpotomie und Kolporrhaphie usw.
mit späterer Kommunikation zwischen Rektum und Scheide. Weniger häufig, aber
um so gefährlicher wegen der Infektion, entstehen Mastdarm -Scheidenrisse nach
Pfählungs- und Kohabitationsverletzungen. Die geburtshilflich entstandenen Fisteln -

104

Spezieller Teil / ITT. Vaginale Operationen am Uteru.^

befinden sich meistens im mittleren und unteren Drittel der Scheide, während die
postoperativen vorwiegend im oberen Drittel auftreten.

Bei der großen Neigung der rekto-vaginalen Fisteln zur Selbstheilung sind wir
verpflichtet stets eine Wartezeit von einigen Monaten vor der operativen Inangriff-
nahme verstreichen zu lassen, die wir mit unterstützenden Maßnahmen zur Heilung
ausfüllen. Wir lassen vaginale Spülungen mit leicht antiseptischen Mitteln machen,
sorgen für angehaltenen Stuhl durch geeignete Diät und geringe Opiumgaben und
legen nötigenfalls ein Darmrohr ein, um den physiologischen Abgang der Darmgase
zu erleichtern. Wir haben nach dieser Behandlung Selbstheilung von Fisteln beobach-
tet, die für 2 Finger durchgängig waren. Kommt es zu keinem vollkommenen Schluß,
so ist die erreichte Verkleinerung für die nachfolgende Operation nur vorteilhaft.

Kleine Fisteln können wir in Art der Blasenfisteln operieren. Wir umschneiden
die Öffnung zirkulär und lösen die Scheidenwand teils stumpf, teils scharf vom Mast-
darm ab bis sich die Fistelränder ohne Spannung mit Knopfnähten oder fortlaufender
feiner Seidennaht, die die Schleimhaut nicht mitfassen darf, vereinigen lassen. Da-
rüber wird die Scheidenwunde mit kräftigen Katgutnähten geschlossen. Die Nach-
behandlung besteht in der Verhinderung des Stuhlganges bis etwa zum 6. Tage
durch entsprechende Kost und kleine Opiumgaben, dann Verabfolgung eines kräftigen
Abführmittels und Erleichterung des ersten Stuhles durch ein Ölklysma.

Größere Fisteln werden stets durch Spaltung des ganzen Dammes und des zwischen
ihm und der Fistel liegenden Gewebes in einen kompletten Dammriß verwandelt,
dessen Operation in oben geschilderter Weise nach meiner Methode (s. S. 32) vor-
genommen wird. Die Sicherung der Darmnaht mit der Mastdarmfalte hat uns in allen
Fällen eine vollständige Heilung gebracht, so daß wir auf alle anderen Methoden ver-
zichten zu können glauben. Theoretisch denkbar wäre es, daß die von uns früher oft
benutzte Segondsche Methode bei ausgedehnter Mastdarmzerstörung ausnahmsweise
in Anwendung kommen müßte. Nach Dilatation des Sphinkter wird das Rektum
oberhalb der beschädigten Stelle zirkulär durchschnitten, mobihsiert und nach Ent-
fernung des peripheren Teiles des Mastdarms durch den Sphinkter gezogen und
zirkulär am Analring befestigt. Vorbedingung für den Erfolg ist, daß diese Naht
ohne jede Spannung vor sich geht.

Sehr hochsitzende Fisteln müssen durch einen Schuchardtschnitt zugängig ge-
macht werden. Wir operieren sie in gleicher Weise wie die Blasenfisteln. Sobald ein
Stück der Darmwand durch Umschneidung und Abpräparieren freigemacht worden
ist, legen wir sofort die erste Naht, präparieren weiter, legen die zweite Naht und so
fort (s. S. 98). Die lang gelassenen Fäden dienen als Zügel und machen raumbeengende
Instrumente überflüssig. Eine in der Tiefe schwer zu stillende Blutung wird verhindert
durch die blutstillende Wirkung der keine Darmteile fassenden Einzelnähte.

SACHVERZEICHNIS

Abdeckung des OptM-ationsgebietes 22 (Abb.).
Abdominale Operation der entzüncilieht^n Adnex -
erkmnkungen 80 ff.

— Operationen am Uterus ö3ff.

— Ovariektomie 74 ff.

— sagittale Uterusresektion 64.

— Totalexstirpation des Uterus 71 ff.

— Vesikofixation nach Halban 25.
Abortus, scim^ operative Heliandlung 43 (Abb.).
Abortzange, Wintersche 41, 43 (Abb.).
Abstopf en der Darmschlingen zur Freilegung

des Operationsgebietes 17 ff., 18 (Abb.).
Adnexerkrankungen, entzündliche 79 ff.

, ihre abdominale Operation 80ff.

, ihre vagimile Operation 83 ff.

Aortenkompression, Momburgsche 4.

— von Riediger und Sehrt 4.
Appendektomie, i)n-e Erleichterung bei Längs-
und Querschnitt nach Logothetopulos Iß.

Asepsis 1.

Atresie der Scheide, totale 93.

Ausschabung des Uterus 41 f.

— , Komplikationen bei der 42 ff.

Barthol in ische Drüse, ihre Exstirpation 36.

— Zyste 37 (Abb.).
Bauchdeckenhalter 12 (Abb.).
Bauchdeckennaht 15 f.

— nach Amann 16 (Abb.).

Bauchhöhle, ihre Peritonisierung und Drainage

19.
Beckenhochlagerung nach Trendelenburg II,

17.
Befestigung des Uterus an den Bauchdecken 27.
Blasenscheidenfistel 94ff.

— mit Zerstörung des Sphincter vesicae und
der Harnröhre 99 ff.

Blutstillung Iff.

— nach Doyen und Tuffier 2.
Blutstillungsmethode für Notfälle nach Logo-
thetopulos 5ff.

Carcinoma colli uteri, erweiterte vaginale Ope-
ration des 60ff.

— vulvae 38 f.

Cervix, ihre Diszision nach Pozzi 46.
Colpocoeliotomia anterior 23.

— posterior 23.

Dammriß, kompletter 32 f.
Dedoublement 99 (Abb.).
Defundatio uteri nach Beuttner 81.
Descensus und Prolapsus uteri 35 f.

— — — vaginae 27 ff.

Diszision der Cervix nach Pozzi 46.
Drainage der Bauchhöhle 19.

Elongatio 29.

Entzündliche Adnexerkrankungen 79.

, ihre abdominale Operation 80 ff.

, ihre vaginale Operation 83 ff.

Enukleation der Myome 64.

— , vaginale, von Myomknoten 56.

Erweiterte vaginale Operation dt^s Carcinoma

colli uteri 60ff.
Exohysteropcxie, Kochcrsche 27.
Exstirpation des Uterus nach J. L.Faure 82.

nach Kelly 82.

Extrauterine Schwangerschaft 86 f.

Fixation der Lig. rotunda 24 f.
Führimgssonde 7 1 .
— , Amannsche 3, 8.

firav'iditas extrauterina 86 f.
Orieehenpilz 5.

Hämatokolpos und Hämatometra 93.

Infektion 42.

Interpositio uteri vesicovaginalis 35 f.
Interposition, Schau ta- Wertheim sehe 35.
Intraligamentäre Kntwicklung des Myoms 72.
— Tumoren 76.

Klitoriskarzinom 38.

Koch ersehe Exohystc^ropexie 27.

Kolpohysteropexie, Freund sehe 35.

Kolporraphie, hintere 29 ff.

- — , vordere 27 f.

Kolpotomie 22.

Kom])likationen bei der Ausschabung 42 ff.

Künstliche Scheide 93 f.

Lageanomalien des Uterus 24ff.

Lagerung der Patientin bei Laparotomie 1 1 ff.

bei vaginalen Operationen 20 (Abb.).

Laparotomie 1 1 f f .
Lennard scher Schnitt 17.
Ligamenta rotunda, ihre Fixation 24 f.

, ihre Verkürzung 25 f.

Logotampone 5.

; Massenligaturen 2 (Abb.).
Medianschnitt 13 f.
Mikulicz -Tamponade 19.
Morcellement 66.

— nach Pean 56.
Myom, gestieltes subseröses 63.
— , seine intraligamentäre Entwicklung 72.
Myome, gestielte submuköse 56.
— , ihre Enukleation 64.
Myomknoten, zervikaler 73.

Operation alter Zervixrisse nach Roser-Em-

met 45.

— nach Sturmdorff 45.

■ — , erweiterte vaginale des Carcinoma colli uteri

60ff.

— nach Alexander-Adams 24.

— nach Doleris 25.

— nach Olshausen 24.

— nach Webster- Baldy 25.
Operationen, abdominale, am Uterus 63 ff.

— an der Vulva 36ff.
— , vaginale 19 ff.

I I

106

Sachvorzoichnis

Operationen, vaginale, am Uterus 41 ff.

. , bei Uterus niyomatosus 56ff.

, Lagerung der Patientin bei 20 (Abb.).

Operationsgebiet, seine Abdeckung 22 (Abb.).
— , seine Freilegung durcb Abstopfen der

Darmschlingen 1 7 ff .
Ovariektomie 74 ff.
— , abdominale 74ff.
— , vaginale 78.

Parametritis, chronische, ihre Behandlung nach

Logothetopulos 89ff.
Perforation 42.
Perineoplastik 29 ff.
Peritonealnaht nach J. L. Faure 15.

— nach Halban 15.

Peritoneum, Eröffnung des — nach Logo-
thetopulos 14 (Abh.).
Peritonisierung der 15auchhöhle 19.

— nach Amann 19.
Plica vesico-uterina 22.
Polypen 56.
Portioamputation 29.

Prolapsus und Descensus viteri 35 f.

— vaginae 27 ff.

Pyramidalisplast ik, Goobel-Stoeckelsche

101.

Rektovaginalfistel 103 f.
Retroversioflexio uteri 24ff.

Searpasches Dreieck 39.
Scheide, künstliche 93 f.
Seheidenatresie, totale 93.
Scheidenspekula 21.
Scheidenstenose, zirkumskripte 93.
Schuchardt- Schnitt 19, 20 (Abb.), 21.
Spaltung der vorderen Uteruswand 55.

und hinteren Uteruswand 55 f.

Spekulum, vierblättriges 13.

Stenose der Scheide, zirkumskrij^te 93.

Suprasymphysärer Querschnitt nach Pf annen-

stiel 15.
Supravaginale Uterusexstirpation 66 ff.

Tamponade nach Mikulicz 3.

Totalexstirpation, abdominale, des Uterus 71 ff.

- — ; vaginale, des Uterus 46 ff., 55.

Trendelenburgsche Lagerung 11, 17.

Tubengranulome 53.

Tuchklemmtni 2 1 .

Tumoren, intraligamentäre 76.

. t

Uterus, abdominale Operationen am 63 ff.

Totalexstirpation des 71 ff.

— , Ausschabung des 41 f.

— , Lageanomalien des 24 ff.

myomatosus, vaginale Operationen bei

56 ff. , , , ,
seine Befestigung an den Bauchdecken

^* vaginale Operationen am 4Ut.

■ ] — Totalexstirpation des 46 ff.

Uterusexstirpation, supravaginale 66 ff.

, vaginale, bei Uterus myomatosus 56 ff.

^n,|ai.>4'>J?^ä^n***^^H^^'«^*'' '^
— , ^..^^ vO^S^^^^^ *'^ mime ans U\
Uteruswand, hintere, Spaltung nach Döderlein-

83.

nach Müller 83.

— , Spaltung der vorderen 55.

der vorderen und hinteren 55 f.

— , vordere, Spaltung nach Doyen 83.

Vaginale Enukleation von Myomknoten 56.

. Exstirpation von Adnextumorcn nach Logo-
thetopulos 84 (Abb.).

Operation der entzündlichen Adnexerkran-

kungen nach Pean 83 ff.

— Operationen 19ff.
am Uterus 41 ff.

_ — bei Uterus myomatosus 56 ff.

— Ovariektomie 78.

— Totalexstirpation des Uterus 46 ff., 55.

Uterusexstirpation bei Uterus myomatosus

56ff.

Vaginalspekulum für den Schuchardt sehen
Schnitt nach Logothetopulos 20 (Abb.).

Ventrofixation nach Leopold -Gz erny 27.

Verkürzung der Ligamenta rotunda mit gleich-
zeitiger Vesicofixatio uteri nach Logo-
thetopulos 25f.

Vesicofixatio uteri 25 f.

Vesikofixation, abdominale, nach Halban 25.

Vulva, Operationen an der 36 ff.

Vulvektomie 38.

Webster-Baldy-Methode zur Verkürzung der
Ligamenta rotunda 25 f.

Zervikaler Myomknoten 73.
Zervixrisse, Operation alter, nach Roser-Em-
met 45.

nach Sturmdorff 45.

Zystozelen 28.

Druck von Metzger & Wittig in Leipzig

1 1^

>
O

KQNITANTINOY AOrOIETOnOYAOY

rYNAIKOAOriKH XEIPOYPFIKH

^ ,

EKAOTHi APTYPHI nAnAZHZHZ akaahmiaz 7<

Ae H N A I i 950

rYNAIKOAOriKH XEIPOYPFIKH

'Ynö

KidvoTavTlvou AoYoOcTonoüXou

KaöriYnToO toO naveniOTniJiou

'Enirljjou Ai56KTopoq toö PlavcniOTnM'ou toO Moväxou

M^Aou^ TH^ reppaviKÖ^ 'AKaSrjM'a? OuoioÖKpöv

li'

■^^

'i^

META 147 EIKONON EN TO» KEIMENOi

^ 950

EKAOTHI APTYPHI nAriAZHIHI AKAAHMIAI 76. - A0HNAI

nPOAOrOI AEYTEPAZ EKAOZEQZ

To avä x^iQ«? ^Qyov el88 t^ jiqcotov tö qpox; xaict t6 1939, exSoöfcv yzQ-
^lavioTi ()jiö Toij ev AeiiJ^it? exSoTixov oixoi^ «Ambrosius Barfh». 'H hxh<; SieiCa?
8|dvib]öi(; if](; jTQcoTr]? Tavirjc 8x86öeo)^ f>iaQT\jQei xr]v e-upievT] i'jioSox^v f)? eiD^e
pietali) Tcbv Ei8ixa)v toö Sieö'vovg EJiiöTrjjxovixov xoojiov. 'H djtö jio^Xov a/eSia,
^ojievri 8e\JT8Qa exSooig ujiö xov 8iQT]pievoDex8oTixoi) cixo-u Sev pjcQaYM^axojtoiri'Oii-
evexa XY\q xaiaaTQoqpfji; ai^Toi) xaxd ttjv 8idQX8iav xov noMiiov,

'H sie, |evr]v Y^wööav 8t][ioöi8vöi5 toij ovyyQayinaxoq toijtod öqpeC^etai et?
TO oTi ^lövov ovTO) fJTO SiJvaTÖv vd Xdßcoöiv 8iJQ8lav 8i8dvf] 8id8oöiv af Im' efiov
ejiiTeuxö'eiöai xQOJiojioiriöeig (OQiafAevcov BYxeiQ^j^ecov, (bg xai ai f|neT8Qai v^ai xal

JIQCDTOTVJIOI X8lQ0VQY'^Ctl ^8'&o8oi. "OtI 6 OXOnOC, 01JT0(; eJl8T8lix'&T] djro8ElXVT58Tai

8x xibv KolXanX(bv 8T]fioöi8i)^dTa)v xfi? 8ie'&vo'ug ßißXioYQaq)ia(;, evöa YiV8Tai ^v(pr]'
fxog piveCa twv pi8d68(ov ^ou, d)? 8i(; Td BiSixd X8(pd^aia dvaq)8Q8xai.

Eig TT]v jittQoijöttv 8x8oöiv jigoöexeöi^öav Svo exi fA8do8oi jiov. 'H jxCa e^
aiJTcbv dvaqpeQeTtti ei? tt]V Mai8\)TixT]v xal dq)0Qd 8ig tö jiexQi toij88 dXDTov
t,r\x i(]\La xfii; ejiiöxeaecag aipiOQQOYCag xf\c, jxrjxQag, oqpedopievTi? etg dxoviav xf\q
[ir\xQa<; fi8xd tt]v 8xßoXr)v xoi3 jr^axoi3vxo<;. 'H 88\)TeQa elvai r\ \)n e^iov yXr\Q^loa

« v Jl o Jl v d ^ 8 V i X ö s d X Q 0) T T] Q i a ö ji ö g T f] 5 JlTjTQag».

'Ai^fivai, 'lavompiog 1950

K. AOroeETOnOYA02

npoAoroz npQTHz ekaoieqz

'H 8x8oaig 8vög veou Big y^QM-^^^^^'^ yXoiooav Y^vaixoA.oYixo'u eYX8iQT]Tixoij
öDYYQ^^i^iaxo? Qä 8Ö80)Q8ixo öxi «qpEQEi yXama ei? 'Aörivag», xad' oöov f\br\
{jjidpxEi \iEyaq dQiO|,i6<; xoiouxcdv yeQ\iaviy.(bv ovyyQa\i\iax(dv dvxajioxgivo^iEVOov
e'k; 6?ia(; xäq djiaixriöEic. 'AW Exaaxo; x^iQODQYog yvcoqC^ei jtoöov eIvoi 8i8axTi-
xöv xal d)q)£^inov vd jiaQaxoXoDÖrj ällovc, 8^ji8iQOug lEiQOVQyovq xaxd xö 8qyov
avxwv, Tva ovxco 8uq\jvt] xaq YVoaaEi«; a-uxcii, ibiq. oaov dqpOQQl ei? xf]V x8XVixt]V.
'H xoiavxTi a^i8öo? jiaQaxoA,oijöiiöi(; Sev 8lvai jidvxox8 8waxTi 8V8xa 8iaq)ÖQa)v
JlÖYCOv xal ouxco dvaY>cd^8xai xiq TiQoq dvaji>.TiQCOöiv amf\q vd xaxaqpBiJYH ei? jie-
QiYQaq)d? xal dji8txoviöeic, äq dvBVQioxofxev 8lg xd YVCOGxd Tßxvixd öXJYYQat^^a'ca
xal 81? xd ejiiöXTifiOVixd :n;EQio8ixd. 'AxQißcb? f| 8t]pioöi8uöl? xoiouxcov xexvixcov
JCe;ixo[XEQ8ia)v 8i8vxo>Li)vei aii^iavxixä)? xf]v exxeXeöiv x(bv yvcoöxcov xdjiixcov 8Y-
X8iQr|öecov. Ei$ xö ßißXiov touxo ejiidufio) vd ji8QiYQd\l)co 8ie|o8ixa)? xd? ei? xfjv

K^Livixnv (iOD ecpaQuo^onEva; xal Soxii^aoöeioag syiEiQr]xixäg usUbovq, xoaov
xägxvmHäg ooov xal x&g vmbzi^^iGaq {.ji' inov XQononoinasiq, &g xal xäq iUag
HEVobovq \iov.

Ah Xznxoloyib dg eyxtiQr\aev;, auive? exteXoCvtai et? 6;Las xhg xlmxäg
xaxä TÖv auTÖv toÖjtov, &q ml et? inzivag, aTtive? ExteXovvtai o;ravto? et? t^
rmsTegav xAtvixnv, (b? «jtl ;iaoa8EiYnaTi elvai f| eöpeia xodtaxfi wtEQ8XT0(in (')
xa# oaov jtEgi avtr)? neavuaxEiiovTai XEJitojiEorös jidvTa ta SiÖaxt.xä fvxsiQn'
Tixa ouYYQ<innaTa. -ISiaiTeeav annaoiav äji^Scoaa ei? x^v jiEeiYQatpV x(bv koX-
mxcüv EYXEitWv, auivE? xaxd t^ YVWRV ^ov öev Xanßdvovxat dgxExd (,n
oi|)iv, (0? agno^Et, xaxd x^v sxjtaiÖEwiv veagöiv YwaixoXoYcov. Elvai Yvcoaxöv
oxi ^dvov 6 YwaixoXÖYog 6 xaxexcov xeXei'co? xf)v xoXa.xnv xexvixf,v Suvaxai
va dExü riiv ÖQ^V 6'v8ei|iv, Edv f, iyyßQmg bioy vd xE^fixai xoX^nxÄg ^ xo.;iia-
x(Ds. Movov o{ixoe YVcoQfCei vd ExxijiS öeövrco? jtdvxa xd jcXEOVExxnnaxa xtj? xoX-
Jtixfjg 68oü Non^Co) 6x1 8ev ejrtxQCTExat vd e;nXanßdvExai xig YUvatxo;LoYUti; ey-
XEionoscüs 8id ifis xodiaxfie 68oC xal ndvov ineibi] bh xaxEXEi x^v xexvixfjv tcdv
xoXjiixmv EYXEiQTiOEov, atxivEs Elvai dotYxei'ro? dxivSi.vdTfQai. 'Qoa<>x<£g 8eov
väm Xt)anovti xis öxi ot f|axrifi£vot ei? xdg xoXjtixd? EYXB.QfioE.e TtQooaQiidt^ovv
naXvxeQov x^ ^Ejtxfiv xexv.x^iv avixröv et? xdg 8td xfj? xodiaxf]? 68oö byxeiq^oei?.

AjieqpuYov waauxco? vd zlötlQu, üg xb Mna xmv ev8ei|£cov xöJv eyxeiqti-
OEcov, xad- ooov xö xoioöxov 8ev U ävxamxQivexo zig xöv axo;iöv xoü ßißXiov
xouTou xal Sidxi oxe86v ei? oXa xd 8i8axxixd at)YYQd(inaxa mdQxouv doxovvxco?
axeißEt? CTEiriYTiaEi?. Atd xöv aüxöv Xoyov änicpvyov xal xfjv ^rEoiYgatp^v xfj?
:xoOEYXeieT)xixfi? jtagaoxEvfj?, xf)? dar]^\>iag, Tf)? ^xtxByl^lQ^xly.r\g dYa)Yf)g xal xfj?
vaQxcDOEO)?. 'Anebmaa n^yiax^v ar^aaiav ei? x^iv dxQißfi xal ctiheXti exxeXeoiv
xcov Eixdvcov, attivs? EiEXE^Eödrioav u;rö xov e'XeyxÖv ^ot) i,;rö xfjs eni xovxa> ei?
AOtiva? dqp.xOEions >iVQiag MagyaQixag Wendland, xf) ßo»,0ei'9 axE8.aYoan(idxa)v
xal qpwxoYeaqptröv, aixivE? eXr\(f>^aay xaxd xijv 8idQX£iav xröv EYXEiQrjaEwv. üpö?
xV xaXXixExvt8a, rix.; ÖjrEXQEcoOr) vd jxaQanei'vT) km jioXXok fifjva? ei? xd? 'aI^-
va?, EX(podC(D xal evxaüöa xd? EÜxagioxi'a? (iov 8td x^v dxoveaoxov xal e^weC-
8r)xov EQYaoiav auxt]?.

'Adfivai, AÖYOvaTo; 1939

K. AOrO0ETOnOYAO2

1. TVmeienotvt«ü,„vexo>eYXataXeLVei ;.o6 toXXoO, evexa t<öv xaX«xeD<»v dwoxeXeouärnw
auva «apexs. n .vpeta hoU..^ ioxees.xo^n xaxd ÄA«„,« -«.„„«,„, x„(xoc aüx^Telvtr tvarZo
XeQEOTEQa IT15 >toiXiaxf\q. , « wi vtj^vixco^ eivai öuo-

2«nlralbta(t fu«r Oyna«kol09l.- 1940 N. ). w. Sto«<k«l, Berlin.

Yvo.aeco; xov ß.ß (ov dvxa„,ßdvcx„t x., öx. 6 o.YYpacp.v, .po^px.ra. ^x x^J Y.o.av. n a^o-

»EtopTiöx, 0,5 ;tXovxtO|iü; xt)? lexvtxn; ei? SmxöXots- :teoi;txc6oeis

eis olovs TOvs yvyaixoXöyovs. ff " "

8<hw.l.,r ««dlxlni^h. Wo.h.n,chrl«-Heft ,2, .940, «,ö Hu.«y, Aa.au.

_ Elvat Uay M^a^igov vä Aa^ßdvn n? Yvfiatv xAv I8(c«v meöoS^v l^ttSe^icov xe.Qovo-
Yu,v xa. 0,; xotovxo« 8eov vä dccognOfi dva,,p.aßr,T^xo,s 6 Sta-O.vxf,? x,k nave..axrm.«x?;
rvv«..oXoYtx,5 KXcv.xns tÄv 'Ad,vä,v. d,; xovxo .pox^nxec d^eoo,; «x xov nooxn^evov ßt-
PXtov. Xa.p«, 8,oxt oovyyQamk ho..]nxu IS.atxEOc»; .I5 xd? xoXmKdg «YX^OWets, Suaico?

080V ov8e:toxe da a;xoxeXsan aoßagöv dvx.;,eöoo,;cov xij? el8tx6xr,xo?. 2v^q,<ovä, cboavxcoc
n90?xasa^o,|,E,;xovAoYO,W;covXov, oxi8ev^;ttxee;t£xai vd decoorjxai A? ev8«^s Xa;xa-
Qoro^ns „ „Yvoia xi); exxeXeascos tu? ^YX^PPoeo,? 8.d xn; xoX;tixüs oSoü. El; xö ßcßXiov ;t6ot-
Ypacpovxm 8.a(poooi xetpovoYixal l;te^ßdoEic, exxeXEOÖEio«, x6 ;tOüixov {.^ö xov AoYO»Eto-
^ovXov. 0 ovnQacpev; sioEexetat xal d, xd; jt.xooxepa, XE^^xonepEtas xüs x^xvcxi);, «xo.ßöis
öe xovxo a;t0TeXEi xo ;teOöov xov ;xeaYnaxixä.s Äpaiov ßißXiov t,exd xÄv Xan;iocüv etxövojv.
^ JilS Tovi Tzeneigafihovs yvvaocoXSyovi robg ivdia,peeoßivovi d,ä xt,v ytwowy.xÄv t£-
Xnxriv avviazätai zo egyov zovzo 'dtaizegcos.

Oebufthllf. und IFrau.nh«lliund. - 2 Jg. Heft 4, .940, i'it, .0« L 8.Hx, xaftnYr,ToC toO Have-
niottiltiou xti5 *oavx(poi5oit|S.

MexaE^ dXXwv 6 Seitz Yodcpet : UagaxnQEl xis ei; xö ßißXiov ,t6oov 6 avYYpaq,nV
itgooTOftet ooßaoAs xal a«vex«>s vd xtXe. 0:101,^00 ^nv X£.poveYixf,v xexvixfiv xai ;x6aov atoftd-
T*",,?" ,"''"^'"''' ^« 8'«8«"tl Et; ulYav xvxXov td d;toxeXEonaxd xov. 'I8tmxEpav o«ua-
amv 8i8Et 0 AoYO&Ex6;tovXo;, xai 8ixa£o)s, eI? xd; xoX^tud; EYXEionoet;. 'H ovxvf, Eq,ao^oY^
Ttov xoX;xix(ov «YXEien^Ecov d;taXXäcoei xd; Ywalxa; xoöv dva^tocptüxicov EvoxXt)ndxü)v xi); Xa-
naooxonn; xai xov ueYoXvxEpov xtv8uvov. Mei' e{iyvo)hoovvii4 9d d;to8Exdovv ;ioXXoi xi> Xe-
JttonEof) XEpiYpacpTiv tüs afnooxaxixfi? avxov n£a68ov.

7o ßißXlov &d naoAaxt, d; nävza xuQovQy^v f.eydXai inrjQeaiai, 6 de mwioauivos
XeiQOvgyoi &a. uxpeXrj»/} ex zovzov fteydXcui.

Klinisch« Woch»n$thrlff-Heft 12, 1940, «aö ioü v. laschke, xa*r,vnxoö loö nave«ioii„i(ou loö Giessen.

Tö ßißXiov Tov Yvwoxov avYYpa(j)^o)s, xaixot :TEOiXanßdvei n6vov 104 0EXi8a; nexd ttüv
e^atoExixüv Elx6va,v, exei xazaTjXrixz.xws nXaiowv TteQiex&fievov, xaööaov o.'.xo; xaxopöcivEi
vd ;teoiYpd(pn xaxd xoö;tov ovvxonov xal E^xpivfi Tf|V XEipovpYixnv xexvixi'iv. Bob n6.vzv,v

O TlETiei

gajuivog x^igovgyo? Xaußdvmv yvcöaiv io)v eHTi^ejuevcüy h reo ßißkicp '^eXet jusydXcog

1 «M

Deutsche medizinische Wocliensclirift— utco Eymer, xa^nY^l^o^ ^^^ Ilavertiötiifiiou lou Movdxou.

*0 ovyygacpevq :t£QiyQdcpBi xatd tqojiov avvTO(iov xai avvaQjiaanxov, ei^ 86xijiov ypp-
HavixTjv ykihooav, xäq ev ifj KXivixfj xov ovvi]^coq, IxTeXoupievag ey/eipTiöeig. 'H jreQiYpacpf)
öwoöfuetai VKO KolvnX^bibv dQiöTorexvixwv eixövojv.

Meyac dpi^iüoe twv Kegiygacpo^iivcov xeiQO'^'i>Yi>«wv hf^oöcov eivai öXoyq nQcoxoxvjioq
rj d^TOteXet OEigdv litxQOiEQCüv r\ [ieyalvxeQoyv nagaXXayibv itQOvcptoxanevoiv eYXeiQnoecov.
Aiav hbiarpigövoai elvai al jueyakönvooi alaoaiaiixal avtov jii€»'>odoi. 'Qg ejriöeltog vei-
QOVQybq JtQOTifia 6 ovYYQatpevg xaq kyxEiQ\]Geiq 8id ifig xoXÄixn? obov.

T6 elq ixdoxtjv oeXida ttqcototvjiov xovto ovyyQa.u/na, x6 ojioiov iygdcpr] äjio Tigayjua
xixöv «.maitre^, ovvioxäxai ^egjuöxaxa etg xov eidixov yvvaixoXöyov.

Zentralorgan fOr die gesamte Chirurgie- vjtö Schenk, xadrivTiToö tov navejiioiTijiiou xfiq UQdyaq.

"Ev öXoyq elaiygTixov ovyyQa\ina, ev t^ oitoicp jr£QiYQdq)Oviai öwto^cos Jtai xadagÄg
al öjrovÖaioTeoai täv YwaixoXoYixoJv Eyx,eiQr\oF.(oy Im tfi ^don jtaQaoTanxwv eixovcov, ai
ojioiai exTeXoiivTai etg ttiv xXivixfiv xov ai-YYQatpecog. IlXfiv xov Ytvixov nepovg, tu ojioiov
jreQiFXEiXiav dHioAoyoi^g öö^iytag, t6 elöixov ^FQog dtpopd dq ^8Yav dpu^^ov T(>ojiojioiri0ecov
xai Flg löiag xov ovyyQaq>Ewq xeiQOupYixdg [ieöööot^g, ecp' ÖXcov twv yvcüötcov YwaixoXoYixwv
eYXeigiiGecov, >^ai?' ov t^c^ttov £^g ovdh äXXo ovyyga^^ia avvavxcbvxat, jidvrote iLxetd Xetttohe-
QOvg^jtEQiYQacp^g rfig xtiQOi-QYixfig lexvixfig xal Td)v XeÄXOneQEiaiv avTng, ^e JiQoajrdOpiav odv-
Tow8DO£(og TOD XQovov xx)q exTeXeoecog.

T6 öVYYQa^^ia TOiJTO JiapovöidCa //eya^?;)' jr^wrort;7r/av xal ngodidei ßa^eiag Im
oxrj^ovcxag yvchoecg xov ovyygacpicg^ 8t6 elvat d|iov lötatTepag jrQoaoxfig tx ^igovq täv vst-
pot'QYwv xai Twv yuvaixoXoycov.

Die medizinische Weit-BeUin, Nr. 21/40, vno BcKeimann, xa^,vnxov roO navs..axr,^.'ou xov BspoX.'vou.
'A;r6 Tfig djTo^i^Ecog to^ eiötxot. YwaixoXoYoi. n e^cpdviaig toC ßißXioi. ösov vd xaioe-
ua.^T] x^otcog Xoycp xo. WetMsvtxoC, xaoaxr.lpog xai xfig ^xe^oSufic IS.OTWg to.
9 /.,^a.oi ,..ae.oAo,o. ö^rarxa. i^ avxov rd drxXrjao.r ÖMy.axa ovrxeXovrxa lg X
xeXeioTioirjaiv xfjg xexvixfjg xwv. ^

lentraibiatt für Chirurgie -Heft 15, 1940, vno Gohrbandt, Berlin.

'0 Gohrbandt dvacpepcov rdg ^e^obovq xal xdg TQO;ro;roirioag tm tc5v lytno^a.o^v
xaTaXriYa xapaxTTiQiaTixwg etg xd 8|f]g : t^i twv EYXeiQTiaewv

Ol' fiovov eig xcv didaoxöjuevov dXXd yal i^/'r tA« A.a ' , , ,

Münchner medizlnith« Wo<hens<hrl«- «nö Woltor Reeh.

'O et? TOV? eiStxotis XeiQOvoYixov'; xvxXonc tfic Fmi.nvf«. v

*Aya(p8pü) lvTav{>a növov xV vjt6 tov ovyYoatp^cog ijiivondeloav ja^öoSov at^o<JTaolas, t^v
VTio xou Sellheim «IXXiivixog \ivKr\q» xXri^eioav, üx; xai Tf|v deoa;i£iav Tife Xpoviag TiapanTi-
TQIT180Q 8id Tfig xexvTjTfig djtooTT^jiaTOjxoiTJoecog. Td ßißXlov änoxtkeX iiaiQexixov ßo^^fia
did xov U€ xrjv x^iQovgyixrjv äaxoXovjuevov yvvaixoXöyov,

Der Chlrung— Heft 11, 1940, vn6 Herold, xa^yiixoö toö novenioTtiniou x^q 'liyaq.

Elq xb ßißXiov TOV «FvvatxoXoYix^ XeipovoYixf)» 0 avYYOaq>cv'g nzQiyQd(pE\. avyx6\i(dq
xai n8Td JioXvjxXridwv xaXXixexvixwv elx6va)v xdg ojrovÖaiOTepag lYXeipriTixdg avTOv \iE&6^ovq.
'H JcepiYQacpri xwv öiacpop^DV (pdo€a)v xriq kyxtiQr\öEO)q elvai öacpecTaTT) ovxcoq, &ax2 näq xiq
övvaTai 8vxepsöxaxa vd JxapaxoXovdiioti xavxag.

T6 ßißXiov Jtapexei oeipdv ev8iacp8pova<ov vjto8ei|6cov, wg f\ vn avTOv djto jxaxpov
Xpövov Icpopjio^ojAevTi alpiooTaTixfi H^^oöog. Td ßißXlov avviaräxai iv^igficog etg ndvxa x^i-
govgyov.

rENIKON MEPOI

TIqo jtdoTis lyxHQr\o?wq 6 x^iQOvgyoq Seov va OTadMion IjiaxQißcog, läv xb ueycOo?
Hai ol xivÖDvoi Tf)g eyxeiQTiöewg dvTajioxQivcoviai Jigbg xoy ejriSicüxd^evov oxojiöv xai xv-
Qicog edv f\ eyx^iQ^ölq \xe\Xi(\ vd oxpeXriötl Tf)v itdoxovaav.

Aid TT)v e{)voixTiv i^eXi^iv otaaöriJiOTe Eyx^iQr\oeo)q nQoanaixfXxai f\ dxQißr)5 TnQT]öis
JidvTCOv Tcov xavovcüv xr\<; äor]\^iaq. Aid vd ejiUEVxOfi (Vw? fi'voixov djtOTFXEOna xai vd djio-
xXt-iöOoiiv xard t6 ömatov ot xivÖvvoi, 8eov 6 xeiQOvgyöc vd exTl X^^QOVQyixbv räXavTOv,
TlTOi ejiiÖEiiOTTiTa xai TexvixTjv IxavoTnia. AI löioTriTe? amai elvat djraQaiTT]TOi, iva 6 x^i-
QOVQyoq xexTTiTai ejiaQKfj TaxuTT]Ta xard Tf)v eYXeiQTloiv, xai>' öoov ooov f^QaxvxsQa glvai f\
öidpxeia xr\g eYxeiQrjöea)? toöov xoXvtfqov elvai to d^oieXeopia, Coq ex xr\q ^ixpotegag ftiaQxeia?
Tfjc vapxwaECog, ttj; jiixpoTFQag eYXeiQTirixfj? xaiauXTi^i«? xa(, ^q n£iQa\iaxixCoq exfi djtoSei-
X^f), Tfjg mxooTeQag övoröcoQFVGecog nixQoßicov ejtl xov Iyxeiqtiiixov jieöiov.

Elvai jiEQiTTov vd JiagaTTiOTiöcopiev ön Öeov vd \xr] ejiiöiojXTjiai xaxvxr]q dq ßdgoq xr\q
aluoaxaoiaq xai xr\q äoy\\^iaq.

Aid xriq ex(pQdö£(og «döTiJirog EyxeiQriai?» Ivvoovuev ßeßaiojg ov |x6vov tt)V xQT]öi^o-
TioiTiöiv djroöTeiQCDOevTCOv eQyaXeicov, oOoviwv, xei^oxticdv xXji., dXXd xvpicog xr]v djiocpvy^r
xr\q \iExaq)OQäq xaid tiiv eYXeiQT]öiv Xoimoyovcüv xoxxwv, öi'doxojicov xai djipooexTCOv xe^pi-
a^üiv, djco fAstioXva^evov Tcebiov nqbq dör|JiTOv toiovtov, wq ejil TrapaÖEiYnan xaid tt)v 8id-
voi|iv TOiJ xoXeov, xr\q nixQoßioq)6QOv xoiXottiios xf\q \ir\XQaq r\ Jivo)bovq oyxov twv e|aQTT]-
lAdicov.

T6 vd xeiQOVQYÜ ti? taxecog Elvai jiQdypiaTi djiotEXeopia ov piovov 8axTuXixfig liiiöe-
liOTTiTog, dXXd xvQicog ovoxi]\iaiix(i)\ xai öxojii'hcov xivriö£0)v, ^iet' äKOq)vyr\q EJcavaXriii^ecoc
dvcoqjEXtüV TOioiJTCOV, ojiEQ Eivai övvttTOv vd xaTOQi>a)dü |,j6vov 8id xf\q dxgißovg yvcoaecas xr\q
eyxeiQTiTtxfig dvaio^ixTis xai xY\q JigoöCDJiixfis jiEigag.

1. M^oa np6c; alMÖoTooiv.

MeYdXri oT]piaoia 8eov vd 8i8TiTai jidviotE ei? ttiv dxgißEOTdiTiv ainooraoiv xard it|v
^YXeigriöiv. *H ^lEYdXri djicoXeia aipiaTog ßXdjitei tov öXov ogYavio^iov xai jiegiogi^ei xaq
ä\ivyxixixq aiJtoi) 8vvd^ei5 xaid xr\q Xoinw^ecog. SvXXoytj ai^aTOg eviog XY\q jtEgiTOvaixfj? xot-
X6tt]T05 8uvaTai vd xaiaXrili] elq 8iajiVT]öiv, t6 ai^dTcopia 8e twv xoiXiaxwv TOixcöjidxwv Jia-
gaxcoXuei xi]V xard Jigwrov axojiov ejiovXcoöiv toi) eyxfiQtitixoi) tgavpiatog.

*H Tgixoei8fi(; atpioggayia EJiiaxEiai ouvridco? dcp' mvxf\q xai 8ev djiaiTei i8iav Tivd negi.
|Avav, xoiovTT] öncog uEYaXvtegov ßadpiov ejiioxfxai 8t'eXa(pgdg Jiiföeo)? 8id oreXriviou yö^t]?. Td
jAixgoTEga ayveia övXXapißdvovtai 8i' aipiootaTixwv Xaßi8cov, aixiveg piEtd iiva xgovov, dvev
Ji£gi8£G£Cü?, dq)aigoi5vTai. XgT]öinojroiov|uiEV jidvtOTE XEJtTOtaTOv ^(üCxov gdnna xardXX'nXov 8i'
djioXivcoöiv, iva xadiöTatai e{)X£gri5 f\ djioggoqpTioig avtov'. Elq xaq JiXEiOTa? twv YVvaixoXoyi-
xü)v eYXeJ-O^oecav GuXXapißdvovtai 8id piEYaXvTEgov loxt'gaiv Xaßi8cüv n:Xeiova dyYf ici ojaoO
jAfrd Toi5 JiEgißdXXovTog avid övvexTixoij iötoi> (eIk. 1 — 4). FIoXXol xeiQODgYol djioggijitovv
Tf|v n£{>o8ov TavTiiv xr\q djtoXivcooEü)?, 8i6ti vopiiLOvv oti ovto) jrgoxaXElxai vexgcoöi? täv
töTwv, EiJvooC'oa TTiv Xoi^a)|iv. T6 toioitov öpio)? o{>86Xcü5 elvai 8gd6v, xad' ooov exet dvav-
TiggriTü)^ d:io8Eix^fi, öti jiagd ttjv loxvgdv ;t£giöq)iY|iv id xoXoßcünata £|axoXouOo\}v vd ige-
rpcovtai Ijiagxwg. *0 nQihxoq xojißog 8eov vd Yivritai xad' ov XQOVov 6 ßoTiOog dvoiyei ßga-
Sfcog xai jtgooEXTixwg ifiv Xaß(8a, ev dvdyxti 8i' d^iq)OT£gcL)v twv XEiQtr>v cvtcog, dSoie i6
gd^ixa ßga8Eü)g vd öXiöi^aivt] evto^ XY\q vko xY\q XaßiSoi; aximaiiadEiOT]? Evto^fig. 'AxoXovdcoq
ExieXoiJjiev tov 8£\5Tegov xo^ißov xai Ijii XQTi^Ji^ojioirioECog ^(üixov gd^naiog ejii jiXeov eva

igiTOv xoußov. 'EjtuHpiü) evrai^öa va dvacpegco ev ovpdXna, t6 ojioIov jiaQetriQiiöa ejtaveiXiiH-
jiEvco^ Aq veoi'5 ßoiiOoijg. Ka{>' ov X0<^vov exTF^eiiai f| djioXivcoöK;, eiöciyovv xovq ho.v.xvXovq
evTO; TCüv xqixcov ttj? Xaßifto^ xai övöXfOaivoDv ovtcü t6 Fyyov xov XfiQO^QYO^. öiott elvai
dvavxalov xaid x\\v exreXeoiv tu)v Öiacpopcov xeiQiöjxöjv nQoq jiFQiötaiv tva in Xaßf) pisraxivf)-
Tat E^x^Qü)? TiQoq oXa? tu; Öievduvaeig. 'Ev evavTUJi jieQiJCTcaoei ^ djioXivoxJig, löiqielg Toßddog,

Eix. 1-4. — neQidsaigudyysiüiv.

xa^AOTaTai Svotxeqti? eav \i}] äbvvaxo(;. Movov xa{>' ov XQOvov jTQOxeiTai vd fiiavoivfi Jtpog
dcpaiQeaiv -n Xaßii, Eioavei 6 ß()T]&6g tov dvTixeiQa xai tov ^pöov ödxTvXov evTog täv xqixcov
TTJs XaßiÖo^.

•H |i,Edo8o5 al\iOoxdoEoyq xaxä Doyen xai Tuffier, xa^' fiv doxEiTai hC laxvQwv
ßgaxEiwv Xaßi8cov löXi'OOTdtn mzaiq biagxEiaq 2 Xejctwv ejci twv dyYficov, d'Tua oiJto) dvev
djioXivwöEwg djiorpQdööOVTai, ex^i £YxaTaXei(p^fi, EVExa tov xivöwov tt)? HETEYXeiQTlTixfi?
aijAOQQaYia?. 'Edv x\ djioXivcoöig aYYeicov ei; \iiya ßddog xaTa xaq xoXjrixdg EYXeipriöEig eji-
(paviCll ftvöXEQEia?, Eivai öwaTov ev dvdYxn vd EYxaTaXEicpOfi ejii tojiou y\ G-uXXa^ßdvovöa t6
dYYeiov Xaßi? e;ii 2—3 x^ii^ac,. TevucÖs xatd ttjv dcpaipeöiv xr\q XaßiSog Öev {xpiOTOTai jiXeov
al^OQQttYia. 'Ejieiöt) ojAcog t6 toioijtov ouöoXcog ovußaivEi jidvTOTE, in 8e JiaQanovT) ttj; XaßiÖog

/>v

.jtQOxaXEi oXyo? xai SuadpEOTa evoxXnnaTa, o)? xai vexQcaoiv tAv xoXoßco^dTCOv iTticpepovoav

ÖVOXeQEiaV XQTU TTJV EäOvXcOÖIV, iTClölOmOpiEV XOTU TO ÖVVQTOV JldVTOTE xx\\ dÄoXivcooiv. Tf)v

5idxvT0v ai^OQQaYiov xaTUJtavouEv Öid QanudTwv «JiEQirtdQOECD?» r\ ;iconaTit;onev 8id ydCM<;
TTjV aljAopQOOiiaav x^pav, ouvexiCo^ev Se thv EYXeiQT]aiv xai dqpaiQoOjAEv tov THü\x(xxio\koy xqtu
t6 Ttegaq Tfig EYXEiQt'iöECO?. 'Edv Jiagd TavTa l^axüX^uOf) fj al^oppaYia, öwd^ieda vd jccohoti-
öcoM-ev ex veov xai vd Öiaßißdocouev Tr)v XcopiSa Ya'Cil? J^Qo; ^d e|a), TCQoq tov oxojiov Tiapo-
XETeuoeo)? twv exxpipidxcov toij TQavVa^os« T6 toioijtov ejtiTVYXavETai evxepa)? ISiQt xoTd ttiv
oXixriv vöTEQEXTOHTiv, xttd' Tiv öiaßißd^ouEV TTJV JiwjAaTitovaav Xa)Qi8a YciCnS ^Ü ßoii^FiQi
Tf)s dYxiöTQOcpoQOv nnXT]? TOV Ainaiin (elx. 5) 8id ttj? ö^n? to\5 xoXeov Jigo? tu e^ü). 'Edv ^
^ATlTQa exet öiUTTioiiOfi ti Mveto un:eoxoXjtixfi vöTeoexTGun, öiaßißdCeTUi ^ Xa)gi5 hC bnr\(;hm-
voiYEiarig jigog tovto
xaTd TOV ojtiödiov 06-
Xov TOvxoXeov xai dxo-

XovO-O)? xXeiETUI f\ JCE

QiTOva'ixT) xoiXoTTi;. 'E-

VIOTE OJACOg 8ev EJtlTVY"

XdvETai fi ainooTaoig
8id TOV djtXov 7co)(Aa

TlöpiOV, 81TE filOTl X\ ut-

pidaaovaa §-Tt(pdvEia eI-
vai JioXv HEYdXr), eite
öioTi v(piOTaTai jiQo8id-
^Eaig TOV OQYaviGnov
Jtpog atnoQQUYiav. Etg
TOiavTag jTEQiJiTcaaEig,
0)5 xai OTUv fj avXXiT
y^vq xai djtoXiva)ois tov
UYYEiov djiOTVYXave i,

ovviöTdTai 6 jicofAUTiöM-og xuT« Mikulicz. Trjv piedoSov xavxx\v xaid xavova djiocpEV
YOjiEV, xaO' ooov uvtti e^l loxvgdg dgTTiQiaxfii; alpiogpaYiag dÄOTVYXdvEi JiXifigflDs.
MEiovEXTnua Tfi? he{>68ov TavTTi? Eivai xai 6 xiv8vvo? EjiiYEvovg pioXvVaecog, fiTig jia-
gaTEiVEi Tf|v dvdÖQtoöiv, wg xai n MfTEYXfiQTiTmj xoiXoxtiXti Aev nETaxeigiCopiEda atno-
OTUTixd q)dgnaxa, woavTcog djioqjEVYopiEv Tf|v 8id tov dEgnoxavTfjgog xavTTigiaoiv tov
aiiioggoovvTog aYYeiov, xai^' öaov x\ hC aiTOv 8Tl^llOvgY0v^lEVTl Eoxdga eiix^Qw^ JtgoxaXEt Xoi-
ji(o|Eig xai EvvoEi TOV öXT]uaTiau6v övpiqjvoECOv. *H djioXivcoGig twv egü) Xuyovicov dgTTigiüiv
Jigög xaTajtoXEjiTiöiv dcpOovov ainogguYia? 8£v Eivai ei? XQn^iv jiXeov eI? tt)v xXivixtiv jaov,
djto Tri; ecpagnoYfjg Trj; finETEga; he068ov ainoaTdoEO);. 'H drtoXivcaoi; EVEgYEiTai vjio 8ia(p6-
gcöv xeigovgYwv Jigoq)üXaxTix(j5; kqo xxy; exTeXEöEco; tov xvgiov |.i£gov; ttj; eyxeiQ^oeco;, jigog
djrocpvYi'iV piEYdXr]; UTioXeia; ainuTo;, oi'86Xfji); opicog avxx\ slvat djioXvTco; dßXaßrj;, w; f\ dxö-
XovOo; JtEgiJiTCüöic djioÖEixvvEi. El; Tr)v xXivixrjv piov eIeteXeöOt) piET'dgioTT]; TEXvixfi; xoiXiaxf)
voTEgEXTOur) xuto Wercheim vjto YvcodTOTdTOv xeiQO^QYO^ dXXoSaJtov. METd JigoriYTideiaav
djioXivcüöiv dnqpOTEgcov twv eocd XaYOvicov dgTTigiwv, f| xoiXiaxfi xoiXotti; jiagE^EivEV dvoixTTj
xai in TgavMaTtxf) ejiiq)dvtia EJicüpiaTiöOri 8id ödxxov Mikulicz. Eixoaiv ^nega; ^lETd ttjv ey*
XEigiiöiv jiagETTigriOTi £|o8o; ovgcov d^o tov xoXeov. 'H eIetuoi; d;te8£i|E vExgcooiv tov toixco-
HUTO; tfj; ovgo86xov xvcteco;, öqpEiXofiEvriv ei; ttjv uTeXfi aipidTWoiv xr\q ovgo86xov xvoTECog
evExa rf); djioXivojaEO); twv eöo) XuYOvicav dgrngiwv. MeTd tivu xQOvov EJiriX^EV djiojTTCOots
TOV VExgcodfiVTo; TpirinaTo; ex twv dv(o. 2 V2 nrjva; piETd TUVTa t6 vn:EgnEY£dE; xvötioxoX-
jiixov övgiYYiov (djicoXEia oXoxXrigov tov jivOuevo; xul tov o.tiöOiov TOixw^iaTo; xx\q xvoTECog)
övv£xXe{g{>i) vji' E^iov 8id XQi1öi^o;ioi/|öeco; tov jrgoö{>iov TOix^naTo; tov d;iT]vOvöfA£vov Jigog

Elx. 5. — 'AyxiaxQotpoQOi /*^Xrj tov Amanh,

dvajiXnQüXJiv Tov lUeiJtovTOs toixoVatos xx\<; xuörecog, imxzvx^zia'(\q ovtco teXeta^

«i^^ojiev

'EjiI laxvQas atiioogayia? jtQog dvevQcaiv xai djioXivcoaiv xov alpioQQoovvTO? dwetov
•V 8id Tov öaxTvXov Tf)v doQTTjv lox-UQü)? IjtI TTJs ajiovövXixfjs öttiXtis XQTioinojioiouv-

Elx. 6.—

^VfAJiieois xov jiQo xov alöolov rono&etrj&evrog oyxov ßd/xßaxog
öl* ijiidiafiov :iSQißäXlovvog lovg at/iovs.

TES ajiXnyiov yd^T]?. o{5tco 5e Iji^gxeiat JiOOoa)()iva)g atjiOöTaaig, ^\nq evxEQaivei t^v ovXXntl^iv
Tov ayveiov.

'0 IXaanxos acoXfiv toi) Momburg öyq xai rd urixavTinara xov Riediger xai Sehrt
8ey Elvai dxivövv«. ^Ek\ al^oggayiag, fing evioie E^repxeiai ^si' iyXBiQTiaEig xaid rov xo-
Aeov n xaia la e|an6Qixd yevvTixixd öpyava xai fing xatd lo jiXelöiov ocpeiXetai elg nQcbi^oy
a;iopoo(pnaiv Ca)ixÄv panjidicov. ;üo6g d^tocpuy^v to(5 xoX;nxoi5 ^rcojxanano^, 6aiig dd ^eon
EV «ncpißoXcp ro oXov d;roTEXEa^.a ifig EyxEipriOEcog, a)g en\ naQabeiy^axi ^dg :cXaanxfig,
iqxxQjAO^o) mv axoXov{^ov fAEdoöov EJtiTnxojg :

Gynecologie et Obstetrique XXIII Nr. 3, Mars 1931.

■^

r\r

, '^,''''^f "f^ ^Y^^^ ßd^ßaxog g;tl rdiv l|a)TEpixa)v yEVvnnxaiv ÖQydva)v xai jiieCo) loCiov
öia imviag E;n8Ea^ov. fing xatd ;reüirov ;rEQißdXXEi tt|v öacpvv. 'Ex tcov omnbzy cpEQEiai
TOTE avTTi jiEta^i^ Ta)v jiTiQÄv .TQog Td TtQoao) xai {,;tEQdva) TÄv dSjicov xai lÄavaXanßdvfrai
fi JiEQicpoQa aurfig jioXXdxig. oSote vd JiooxXndii ovno laxuQd JtiEoig l;il ic5v I5o)ieoix(Lv yev-
VTiTixov OQydvcov. Elg iriv eIx. 6 yivEiai e^qeoteqov xaiaXriTTog 6 ^JiiÖEOjiog o^og.

2, AlMooTQTiKh M^öoöoq «clq nepinruGCiq dv6YKn<;» kotö AoYOÖCTÖnouAov

KaTä Nürnberger (») «Logotampon». Kotä Sollhoim (') «Grtochonpih» (iAAqviKÖ^ puiu|0

övopoodcioo.

"Iva djiocpEvx^fi 6 TtapoxETEDTixög Jtw^ano^og 8id töjv xoiXiaxwv Toixw^dnov xai xaTaarfi
Svvaifi i?l Icpapjioyf) djtOTeXEa^anxov Jicopianö^ov 8td tovxoXEoOjÄEvonaa iÖiav ^eOoSov. fing
ElvailxavnvdxaTajiauGfloiavöiijtOTE, xai tV tax^pordtTiv eti, dottipiaxTiv atnoopayiav. *H n€-

£■/;«. 7.—AlfioaxaxiHr] fie&odog xaxa AoYO^tx6novXor .
Elaaycoyi} xov ßvoftaxos ngos xov xoXjxixov avXov, /xsxä xrjv e^aigeaiv xijg firjxgag.

Oo8og avTT] EJtFvofiaT) 8id rr|v TEpiJitcoaiv novov dvdyxT]g xai djtE8eixOTi ti8t| djco jioXXo)v hwv
elg (üpiafAEvag JtepiJtnoaeig dpioTTi. 'Evepyd) wq dxoXov^cog : ÜXripw xaXü>g odxxov ^x TEipa'
ycovixoij TE^iaxlov yd^rig 8id ^axpdg Xa)pi8og yd^Tjg^ovxwg, (ügte vd oxTmaTiö^fi oqjaipixog
oyxog nzQiKOv xecpaXfjg Jtai86g. To ^Aeyedog toi" ßmnarog e|apTdTai Ix tfig ^fOECog rov atfiop

1. Zbl. Gynäk. 1926 Nr. 50, 3202

2. Zbl. Gynäk. 1930 Nr. 21, 1318.

EU. 8.
AifioaiaxixT} fxi^-
Sog xatd Aoyo'&e'
TÖnovXov. 2xr}(j,a
xixrf jiaQaaxaai? tcov
TsXotfjLfvmv sig rrjv

slx, 7.

Elx. lO.—Al^otaxiHti fxi^odog xaxä Aoyo&eTÖnovXoy. Bvafia e<paQ(Aoa^iv .

Elx. ll.'AlfXooxaxixi] /iie&odog xa-
xä Aoyo^exÖJtovXov, 'lax^gä eX-
^t? TiQog xä xdxcD xwv diaßcßa-
a^vxcov dia. fieoov daxivXioeibovg
neoaov xQaajisöcov xov ßva^axog^
*H äXXrj x^''Q ^t^C*« xavxoXQoycog
xovjcsaaov la^vgcög im xov aidoiov.

Elx, 9.—Ai/M)oxaxixrj fXE&oöog xaxä AoYO&ex6novXov.
'JaxvQä n^ig xfjg yd^rjg jiQog xä xdxco ^sxQi xfjg etaodov xov ßva/mxog ivxog x^g eXdooovog nvekov.

QOOVVTO^ dweiov. tooov jiEvaXvTEQOv Oöov ÄFQioaoTEQOv djiexei t6 dyYs^^^v olko xov jiveXixov
S8d(pov5. Td xEOöaQU xQdo JteSa xr\q l|a)TfQixfi? YaC^I? wg xai lo neia^i) tovtcov xQepidpievov
dxQOv rfi; XcüqiÖo; ya^il?» o^^Q ^Q0(; ÖidxQioiv 8eov vd elvai xatd xi piaxpotegov twv xeood-
Qcov xQaojieÖcov, avXXanßdvo) ojiov 8id \iiäq äy-KioTQOcpoQov uriXTig tov Amann, f{y oötiyo)

djio TTJ; xoiXiaxTJg xoi'k6xr\xoq 8id
^eoov Tov xoXeoiJ nQoq xä I|ü) y^v-
VHTixd ÖQYCiva (elx. 7 xai 8). *0
ßoT]^6c ovXXapißdvet tavia xai eX-
xet löXVQcog JiQog td xato) ^exQi
ov t6 öq)atQix6v ßvo|ia eioeXötl ^k
TTjv eXdoaova jt\j£Xov xai öwi^dii vd
döxriöti jtieoiv IjcI tojv ayydinv
(elx. 9). T6 TOiovTOv ejtiTVYXaverat
xai 8i' etaaYCOYTJg 8id xov xoXeov
HaxQd? ainooTanxfjg XaßiSog, fin?
dpia dvaqpavf) et? iriv jiegiTOvaixriv
xoiXoTTjTa SiavoiYEiai xai ovk'ka\x.-
ßdvei id eis a^Jtfiv EiaaYoneva dxpa
Tov n(l^\kaxoq xai eXxEi Jtpög xd £|co.
Ka\^' ov xQovov 6 ßoT]{>6s eXxei, 6

XElQOVQYOg VJloßOTldEl JllE^COV EX

Twv dvü) xai öiaxparwv t6 ßvö^ia
ßa^ECog EVTOg tt)? jii'eXox) hexqi ov

TOVTO TeXeICOS GTEQECoOf] (dx 10),

T6 TOiovTOv £jiiTUYX«VETai (o? dxo-
Xov'dcog : "EXxojAEV xa 5 e'Hco tov
xoXeov xQEndjiEva xQdöJiEÖa YdC"»!?
8id piEöou evog piEYaXov SaxTvXiOEi-
8oi's TCfööOi!, ov wdovpiEV 8id Tfjg
dpiöTEgd; XciQ^S eJtl tov xdico
XEiXovg ifjg inßi'tf]? avn(pvöEa)?,
Tc5v xaTiovTCüv x\^iy.(by xXd8a)v xai
TOV jivfXixov £8d(pov5, evcp in 8E|id
XEiQ fiEi^' ^Xt]s tf)s 8vvdn£a)5 eXxE«
Td xQda.iEÖa (etx. 11), 'AxoXov^cog,
dXXog ßori^og TOJtoDETei loxvpdv
XaßiSa dxQißcög jiqo tov jieöoov, ooTig r\^y\ EiigioxETai piETaHv alSoiov xai Xaßi8og (elx. 12) ^
AvTOvoTiTOv Eivai OTi jiQÖ xx\q EYXeiQilöswg 8eov vd v.idgxTl JtQOXEiQOv ETOipiov daTjJiTOv
ßvGjia. 2vnßovXEva) Iv TOVTOig jtovtote vd 8iaTTiQfiTai ev eq)£8Q£iQL xai £v 8€vteqov etoim-Ov
^Qo? XQTJoiv ßvöua, wote ejii jat) OQbx\q TOJiodeTiiöECog tov jiqcotov ßvonatog vd 8vvdnEda
vd t6 dvTixaTaaTTiacouEV dpiEacog 8i' evog veov. ''Iva 6 m'öxog tov ßvafiaTOg xaTaGT-ß Xejitote-
Qog xai iva 8vvaTai vd öiaßißd^Erai evxeqeöxeqov, djroxojiTOiiEv Tag öXTinaTi^opiEvag piETd ttjv
jiXriQWöiv TOV ödxxov e.tI twv JiXaYicov jtEQiTTdg JiTVxdg. 'H ainogpaYia EJciaxETai jtdgavTa
jiETd Triv dxQißfi EcpapnOYnv tov ßvojiaTOg, ojiOTav 8vvdn£^a vd llaxoXovOriocouEv Tf|v eyXEI"
QTioiv £v jidofl fiQEniQi. *0 ödxxog djcopiovovTai djco Trjs dvcüTEpag pioipag xy\q jiEQiTOvaixrig
xoiXoTTiTOg, a^f"" ov t6 jiEQiTOvaiov TTJs xvoTEOjg öVQpacpf) JTQog t6 djievOvaM,£vov fi xal JlQOg

t6 aiY^AOElSEg, OJIEQ XOTd t6 JiXeiöTOV EJllTVYXdvETai El'xEQWC.

ÜQoq EJtiaxEöiv ai^OQpaYiag ejii xoXjiixwv eyxeiqtiöecov eveqyo) xaTd tov avrov tqo
äov, jiE Tfjv 8ia(poQdv ojicog oti jtQoiTov fladYO) tov xevov ödxxov 8id piEoov tov xoXjiixov
Toa\VaTog EVTOg Tfig JCEQiTOvaixfig xoiXottitos 8id öteiXeov (elx. 13) r\ 8id iiaxpag dvaTOnixYJg Xa-

EIh. 12. — AlfioatatiHT) fdi&odos xaxä AoYo^ezÖJtovXov.
'O Jieoaog diatTjQeTzai elg xrjv ^iaiv xov dt' laxvgäg Xaßidog.
IjQodoniois xov aidoiov diä ydC^g xojio^ezij&eiarjg xdxco xov Jieaoov.

Elx. 13. — Alfiootaxixi) fxs-
^odog xaxd Aoyo'&tx6nov
Äov, Eni xoXjiixMV eyiEigi)'
aetov. niriQWötg xov elaa-
xMvxog XEVOV ex yd^rig ödx-
xov did iatgidog ydCijs.

K. Aoyo^sxojiQvXqv, fvyaixoXoyixri XeiQOVQYtMrj

Elx. 14. — Alfxooxaxixf] fxf^odog
xaxä AoYo^etönovXov. *0q^
jojfO^exTjaig xov ßvofiaxog, SxH'
fuxxiHr) dvajtaQdaxaaig.

ßi8oc xal dxoXovdcog 7tXT)ga> tov odxxov 8iu piaxQu? XcooiSog yd'Qriq. 'Ex jrapaXXriXou Seov va
JtQOöfXCüuev iva f) Xcogi? loopiEQojg xaTavenT]Tai nQoq ö\aq mg biEv^vvoei; evTOg xr\q JiveXixfjg
xoiX6tt]tos OVTC05, <waTe 6 ^iXiipcoOeig adxxog va jtpoaXdßti Tr)v piOQcpTjv ^vxriTog (e^«. 14),

TLQoq äno(pvyr]v vexgcooecov ainveg Swarov vd 7CQOxXT]^oa5v wq ex xr\q loxvQag mi-
aecog to\5 kböoov zkI tov aiSoiov, tojcgöetü) pieia^v neooov xal aiöoiov xai' dpicpoTega td
JiXdvia TOiJ niaxou tov ßvapiaTog jiixQOv otgcäna ßdpißaxog. Aid tov aiiTOV Xoyov 1^ jiqo Toi3
maaov TOjrodeTODuevT) Xaßig dqpaiQeitai nerd 8 wpag.

Ildg 6\i(oq TteoaiTepo) xeiQiapiog ejil xf[q yaC,r\<; 7] xov mooov 8eov vd djtO(pevYT)Tai,
acpaiQOv^evov toij TeXevTaiov jxeTd 24dSQag. 'Ajto xriq xQixr]qf\\iBQaq äQx6[i£^a dcpaipovvTeg ttjv
EocoTfQixfiv XcoQi8a yd^Tig jxexQi Tfjg 7iE\xKX't]q ^piegag, ojiote dqpaiQOv^iev woavxünq xal t^v
l^coTeQixTjv JtEQixaXvjtTixTiv yd^av xov ßvo\iaxoq.

"Iva SiajtiaTCüdfi äcp' hbq [ikv f\ evEQyeia xov ßvo[iaxoq xal dqp' eteqov iva xa^opi-
öOfi dxpißwg f) ^Eaig ai)To€» ev oxboei TiQoq xä ÖQyava ttj? jiueXov, Tfj {'jio8Ei|ei tov F. ZxXa-
ßovvov xal vjto TTiv oÖTiYiav tov löiov eyevovto eI? t6 ev 'A^fivaig 'AvaTOjiEiov i'jto tov
N. XgrjaroTiovXov (1) EQEVvai ejii jtevte JiTcopiaTCOv. 'EyevovTO 3 xoXjiixai xal övoxoiXiaxal vote-
QEXTOM,ai, xa^' äq Eq)r]Qn6o&r\ 6 7ia)naxia\i6q dxQißd)? xaTdTovdvco TiEQiYQaipEVTaTQOJiov, T.e. wg
Ijtl CwöTi? yvvaixoq, dvEv EjtiÖEaECog twv piTiTQiaicüv dQTTiQiwv. 2—3 miBQaq [lexä xr\v Ecpap-
jiOYnv TOV jccojxaTia^ov EVTiQYn^T] EVEois XQoaTixfis elq tt)v xaQCOTiöa, äoKr]Moy]q piEYaXvTEQag
TCiEOECog djto xriq cpva loXoyixriq mioecoq xov aluaxoq. METd 15 fwxBgaq eyeveto fj öidvoiHig xriq
xoiXtag Tü)v TTTCo^idtcüv, Ei fiq SiEmaTcoOn oti Toaov t6 d.iEvdva^iEvov, ooov xal ^ xvoTig xal ot
oypnTfipEg exEivTO e'Icoi^i tov {jko jiiEöiv EVQiöxon^vov jtESiov. djioxXEionevTi; ovTO) otua-
öfiJtOTE ßXdßris avToiv. öyq x6 toiovtov xal 8id Tfjg xXivixfj; jiEipag h^i djroÖEix&fi.
yaavxwq SiEJiioTco^n 6'ti ot torol tzeqiI tcov öiaTa^EioÄv xal jifj djtoXivco&Eioaiv unTQiaicov
aoTTiQKov JtaQFjxEivav d'vEV XQcoaTixfJs 8iaXvaEco?, tov^' Öueq djioÖEixvvEi t6 döcpaXEg ttic
aQTTiQiaxfig al\ioaxdo£(i)q.

. /OjAOicos i^l ^iETEYXBlQrlTlX(ov atjxoQoaYidiv t6 ßva^xa vtctjoIev d;roTEXEa^aTixcoTaTOv.

avEV ÖE avTOv da rmrjv vjioxQEOn^vog vd JtQoßd) Eiq Tf|v h veov 8idvoi'£iv xriq xoiXtag nobq
avEVQEaLV xal d^oXivcoaiv tov atjxOQQoovvTOs aYYeiov. ^et' d^cpißoXov d^iOTEXEOfxaTog. '0
Weber ei; to ßißXiov tov («). ev cJ ^rEQiYQdcpei XE^rTOfxEQO)? t^v atnoataTixTiv mov jxeöoSov
e.-.i TOV ari^Etov TOVTOv YQdcpEt Td EEfig : «nQoaco^rixoig dcp' c'tov Yvcopi^o^Ev t^v TEXvtxfjv
mvTTiv. ov8e:roTE :tXEOv stxouEV dvdYxriv vd E^ at^oaTaTtxr,v Xaßtöa xaTd ttiv

BYXeiQTiaiv, ETt 8e oXlyoteqov vd :rQoßa,^EV dq t^v Xa^rapoTOji^v :tp6, dva^T^Tnoiv al^oppo-
ovvTO,^aYYetov>> HEcpap^OY^TOvßva,aTO,El,Toiav^^^ .Epi.TcoaEtg. eI'te xocXtaxoT/eL
xoX.txc., EYEVETO f) EYXBtp,atg. TEXElTat öyq dxoXovdo), : AtavotYO.Ev Td avppacpEVTa xoX:rtxd
TOtxo^aTa .q xai TO .Epuovatov xal Ecpap^ö^o^Ev tov .co^aTta.ov d), xal xaTd Tdg xoX-

ny eXaaaova :tveXov xat Ecpap^oadfi xaXÄ,, ^ «l.oppaYta eI, :rdaag Tdg ^rEpt^TlaEt
EJiiöXETai da(paXc5g. ^ s v«s ^itpiJirwoEig

va.poa.cov anetcov xal i^ap.öCco tö ß,5o.„. AI roxoO«r,Maa. Xaß(8s, dxoatovTTZ

0..P exs. .ev«X,v a^^aatav e , X(av l|r,v.X.^eva, dpoa,arov5. Aev lvvo<J 8.a.i vr6^;x vst
vevera. , co, rr,, app<oa.ov e 5 xo.avxas .sp...d.ae^ 8cd xfi; .„p„,d„,a,s .f), Le ojlc
evexonj^Xs^povs d.oXtvuioscos xcöv dw^tcov x«i xü^ dxp.ßoC^ .epuova.o.XaaxSr

I. Anatomische Ergebnisse der Blutstillungsmethode nach I^<,„fi,.t , ,,
Christopoulos. Zbl. Gynäk. 1933 Nr. U. I^gothetopulos. Von Dr. C.

2. Eric Weber. Techniques chimrgicales Vaginales. Editeurs Balliere et Fils. Paris 1948.

JlTCOOEig

'ExEivog oöTig d7ta| 2q)TipnooE t6 ßvöpia Od ileTipiTiöe tt^v d|iav avTOv. 0d jrapeTifi-
pT]öE |AETd ji6öT)g fipEjAiag xal dacpaXEiag ijiiXanßdvETai xal Tfjg 8voxepEOTEpag Iti YwaixoXo
Yix^g EYXBiQtiaEcog, OTav Ix twv nipOTepcov Elvai ßfißaiog oti Svvarai evxepwg vd yivn xvpiog
0iaa8Tiji0TE djipoojCTOv at^xoppaYiag.

'E^ETEXEoa piET'EJiiTvxiag xoXjcixdg xal xoiXiaxdg E/xeipTioEig slg Tdg piEYaXvTEpag jiavejiiOTTi-
M-taxdgxXivixdgTfigEvpwjtYig, IlapiöioDv J. L. Faure, AEiii^iag Seilheim, Biewrig Halban, Be-
poXivov Stoeckel, XdXXe Nürnberger, (bgxal eigTriv KcuvoTavTivovjioXiv, xXivixt) 2Yovp8aiov,
dvEV djinhvwaECog xaTd Tdg Xa/tapOTOpidg twv uriTpiaicov dpTTipKüv, xaTd 8e Tdg xoXjiixdg ey-
XeipriöEig ovSsvog dYY^iov, iva djto8£i|co xr\v IvEpYeiav tov ßvonaTog. 'Ex tov yeYOvoTOg tov-
Tov övvd8EXipoL TivEg £v6niaav oti i>£fopcü Triv n£i>o86v piov TavTTiv wg tov yevixov TpOTtOV
ai|AOöTaöiag. "Oii t6 toiovtov ov8öXo)g eivai dXiiOEg dv£jiTv|a rfit] £v TOig jipoiiYOviiEVOig.
Tovi^co xal jidXiv oti tÖ ßvajxa 8eov vd XQilcJipiojtoifiTai Elg jtepiJtTcooEig piovov dvdYXTig eni
aijAoppaYia; titi; xot' dXXov TpoKOv ovSoXcog ti 8vaxepü)g ejrioxexai, ojcote tovto jiapExei
ßeßaiav ßorj^Eiav.

Ai|i6oTaoiq mctci t6v tokctöv ciq nepinTuociq äroviaq rnq M^Tpaq ^tih T^v iK6oA^v tou
nAaKoüvToq, Karä AoyodcTÖnouAov (*).

"Ev EX Twv M-BXQi tov8e dXvTCOv n:poßXTindTODv EV TU MaiEVTixü r|T0 fi £jtiax£Oig TY^g

ai^oppaYiag EVExa aTOviag Tfjg ^rjTpag jiETd ttiv ExßoXfjv Toij jiXaxovvTog. Ilap* oXa Ta lAEXPi

TOv8e YVfooTd iiEaa, dpxETog dpidnog VEapcov Ywaixöjv djioOvriaxEi. Movov Ixeivog ööTig

jiaoEaTn £tg TOiavTag ji£pi:tTü)a£ig Eivai eig ^eöiv vd xpivfl ttjv TpaYixoTTiTa Evog toiovtov

OavaTOv.

IldvTa Td jAEXQi tov8e YVCOöTd [lioa ainoöTdöECog jAETd tov toxetov, Td JtEpiYQa^po-
jiEva Eig Tidvia Td piaiEVTixd ovYY^oinnaTa, Elvai dßEßaia. 'H h TOig jtpOTiYOV|.ievoig JiEpiYQa-
cpBioa ainoöTaTixTi jAE^oSog, tov xa(^' eX^iv jtconaTiopiov, Ecpapjxoa^Eiöa xal EJtl ai|A0ppaYiag
evExa OTOvia? Tfjg ^iriTpag pitTd tov toketov eäetvxev djroXvTCOg. T6 toiovtov djr£8£ixOT] InXxfi
ßdöEi jioXXwv jtEpiJiTCüöECOv EV Tcp Aripioaiti) MaiEVTTiQi(() xaTu TOV XQOvov xr\q vn e^iov 8iev-

dvVOECOg TOVTOV.

*H EcpappiOYTi TOV jtcopiaTianov tovtov EXTEXfiTai o)g dxoXovdcog :
*H dppcoaxog TOJtodETEiTai ejcI Trig jtXaYiag JiXEVpdg Tfjg xXivT]g ovTCog, wote Td loxia
vd jtpOEXOVV, Td E^cüTEpixd YBVvr]Tixd opYava xadapi^ovTai, 6 xoXEog djrooTEipovTai xal i\
ovpoSoxog xvöTig xEvovTai 8id xa&ETfjpog. METd ttiv tohioöettioiv EvpEwv 8iaaToXEa)v ev T(p
xoXew övXXapißdvouEv 8i' dYxioTpOEiSwv XaßiScov t6 Äp6ö{>iov xal ökio{>iov xeiXog T^g |iriTpag
xal EXxopiEV TavTTiv löxvpwc Jtpog tu xaTco. Eha eIcoyouev Tovg xoXjtoSiaoToXEig IvTog Tfjg
xoiXoTTiTOg TTic \ir\xQaq ovTCog, oSote t6 OTOfAiov avTrig vd 8iavoiYti £Vp£a)g. 'Ev övv£X£i(? Jtpo-
ßaivojiEV Eig TOV jcconaTianov, wg t6 toiovtov irpaTTOpiEv xaTd Tdg xoXjcixdg EYXBienöEig ev Jie-
QiJiTcoaEi ai^oppaYiag (elx. 13).

T6 xvpiwTEpov öTiM-eiov TTig EcpapnOYfig tov jtwpiaTiopiov Elvai f\ 6pioi6fAOpq)og xalxad*
oXag Tdg SiEvdvvöEig EioaYCOYTi Tfjg XcopiSog Yd^rig ovTCog, wote 6 axT]naTiC6^EVog ocpaipixog
ÖYxog EVTÖg TYJg ^TlTpag vd M-f) I^EpXTiTai Jipog Td e|ü) xaTd Tnv löx^^pdv eX|iv avTOV (elx. 11).
'U dq)aip£Oig tov jtwuaTog YiveTai ^lETd n:dpo8ov 3—4 wpwv. dq)OV dcpaipEöcopiEV jipcüTOv xi\v Xo3-
Qi8a Yd^Tig xal TEXEVTaicog ttiv TETpaYWVov Yd^av. 'H d(paipEöig övvaTai vd övvteXeoOü xal
EVCopiTEpov, Eqp' OGOv f\ \ir\xQa EV Tcp |i£TaH\) EXei xaXwg ovoxakf\.

'0 jicajKXTiönog ovTog £vex£i xal tu JiXEOVEXTTi^iaTa tov xoivov K(d\xaxio\iOv XY\q ^nxpag,
TOVTEöTi jtpoxaXEi loxvpöv ovöToXixov EpEÜiönov xr\q ^iriTpag xal xaTd tt]V dcpaipEOiv ovjAJia-
paavpovTtti Tvxöv vjioX£iq)devTa T^ii^iaTa v^ievcov xal Opöjißoi ainaTog. Td jAEiovEXTii^aTa tov

1. 'H ^ledoSog autri dvEXoivwdri vn" i\io\} xaxoniv jtoooxXTjoecog eig xd IlavejtiöXTijiia Bievrng,
Movdxou, BbqoUvov xal KieA.ou X(p 19J3. 'ExaoaxxriQia^ 8e vnb xcov elöixwv xa^v^ltÄv (bg x6 tavyb
%o\} KoX6\i^o\i*. 'Ynb xoö A.IJafi^iovxr) dvexoivcoö>ii elg xö 12o Congres Francjais de Gynecologie Mont»
pellier, Mai 1948.

xoivov jicoiiatiapiov xara \ikya \iiQoq Ssv vcpiOTanai, 6i6ti : 1) *H ^q)aQiAOYT) ovvTeXeiTat eig
mxQov xoovixov öidöTTina, xaOöoov ^ eiöavonevT] ya?« 8ev jiXtiqoI e| oXokXtiqOij tt]v ^iiTQav

MtjTQinia dßTt]pia

Elx. 15.-ÄtfxoaxaXixri fxe^do? iv nsQiTtrcooec dxovlag xfjg /i^rp«? furä xijy ixßok^v xov TtXaxovyxoe,

xaxä Aoyo'&eTÖnovXov,

2) BXdßai Tri? m^^aq (bidxQy\öiq) 8ev EJieQXOviai, öiori i^ eioavonevi) yatia 8ev l|ixveiTai ^e-
XQi xov nv^^ivog. 3) '0 x(v8vvoc if)? ^oXvvoeog. xaT'dvTideoiv jcgog tov öi^vtIOti Jiconatiajiöv,

etvai jiTi^afAivcJ?, xad' ooov m-ovov ^ jiqwtt] y(k,a xov l|o)teoixo\) odxxov EQXfTat ?lq lnaq>i\v
\i£xä Tü)v TOixcündTCov xr\q [ir\xQaq. 4) T6 jiQOxaXov^evov dXyo? xatd t^v dcpaigeoiv tri? Y«"
^T]S TOV xoivov jico|AaTionoi) IxXeijifi TeXeio)?.

*H ouöToXr] XY\q \ir\XQaq f| EJteQXopievTi neTot ttjv eioavcoYTiv tov 7Hi)\xaxoq öcpeiXcTai ov
piovov elg tov ex tovtov epe^tanov, aXka xai e\q xr\v Ix xf\q av\imioE(i)q twv lAriTgiaicov do*
TT]Qtü)v ejieQX0nevT]v dvaipiiav to\5 OQydyov, wg t6 toiovtov ovjißaivei xal xaTot ttiv av\inUoiy
xr\q doQTfi?. "locog 8e xal et? ttjv övhtiIeöiv tov yciYyXiov tov F'rankenhäuser.

"Ooov dcpcgd eI? ttiv ev8Ei|iv xr\q k(paQ\ioyY\q, öeov vd \ir\ dva^lEvco^iev IjiI jioXvv xqo*
vov. Aev 8vvdnEda vd yvcoqi^cduev ex twv jiqoteqcov piEXOi Jtoiov ßaöjAOv al\xoQQayiav 8vva-
TQi vd dvEX^Ti ^ dpocooTog. 'Edv JieiodwuEV oti 6 jtXaxov? eItjX^ev £| öXoxXrJQOv xal 8ev
Exovöi jtapanEivEi ujroXEijifiaTa avTOv, f\ 8e ainoppayia, itagd xaq laxvpd? ^aXd^Ei? xr\q jiTi-
TQa; xal TTiv xOTJöiv atnoöTaTixwv cpapnuxcov, E^axoXov^Ei, tote jioOETOijidCo^EV Tf|v dpoco-
OTOV 8id Tf|v ecpapnoYTiv tov jio)naTiö|iOV. 'Ev T(T) HETa|v SvvdpiEda vd lq)aQ^6oa)^iEV xoX-
jiixov 11 xal uTiTQiaiov Oeq^iov 8iaxXvön6v. 'Edv jcagd TavTa 8ev IjceXOti ^6 djtOTEXeoiia

l(paQ|i6^0HEV dvEV XQOVOTQlßT]? TOV JtCOlxaTlöJAOV.

SvviOTWUEV ödEv ivaTd 8id tov jiconaTionov XQe«'0)8Ti Elvai ei? jrdvTa? tov? toxetov?
Ix Twv jtqotIocov ETOijAa xal djiEOTEioco^eva evto? piETaXXivov xvtiov.

•H IvEQYEia Elvai toöov dnEoo? xal dacpaXii?. Ix ttj? m EloxcognöECO? jcXIov at^aTO?
eI? Tiiv niiTpav 0)? Ix Tri? av|A:iiEaEü)? twv piriTQiaicov dQTr]Qic5v vjio tov jtco^iaTO? IjiI twv
TOixcojidTcov Tri? jiveXov. ö5öt£ Tiäg eneQyo^ievoq Mvarog e^ al,uoggayiag , hexa äxoviag xfjg
fiTjtQag, diov vä ^ecogrjzai elg x6 i^^g d)g äovyxcoQrjxov a<pdk^a xov laxgov.

*0 Iv Bievvti Ka^riYTiTn? Antoine avvioTd t6v xad' eX|iv K(i)[iaxia\ibw xal eI? jce-
QirtTCüOEi? öXixfi? fi xal neoixri? Qr\l£oyq xr\q \iY\xQaq xaTd tov toxetov ^lexQi xfi? lxrEXIoEa)?Tfis
zyXBiQr\OB(oq, ojieq öecoqovuev Xiav öp^ov.

3. AanapOTopfj.

o) TonodiTn#iq Tqq 6pp6oTou.

•H TOJtodETTiöi? Tri? dQ00)öTOv 8eov vd YivTiTai ovTO)?, aSöTE ovTE 6 xziQOvgybq ovte ot
ßoii^^ol vd jtapaxcoXvcovTai xaTd t6 eqyov avTwv, 8eov 8' wöavTCO? vd jifi jcQOxaXfiTai xdxco-
01? Ijil Tfi? dQQCoaTov, o)? £n:l jraQaSEiYiAavi jiagdXvoi? twv dvco dxQcov, EVExa jtiEöECO? tov
wXevixov vevQOv IjiI* tov xeiXov? Tri? TQaJtE'CTi?, o)? t6 toiovtov jiaQETTigTiaa el? liiav JceQiJiTO)-
oiv. IIqo? djiocpvYTiv TOVTOv, |jtEi8fi xoTd t6 jtXelöTOv djio Tri? djtoipEO)? TavTr]? Td ottioi'
YuaTa TCüV ßpaxiövcov Ijtl jiXeiötcov xziQOVQyiKOiV TQaJiE^wv Elvai eXaTTü)^iaTlxd, övviötcü Triv
oTEoecoaiv twv dvco dxgcov 8i' evo? |jii8eönov cpEQopievov xaTCodEV tov xoo^AOV ovtco?,^ wote
TavTa vd lipdjiTCOVTat Iv IxTdoEi xaTd |Afixo? twv jiXaYicov jiXevqwv tov ow^aTO? t^? aQQd^oxov.^
•H Oeöi? avTTi JTOO? TOVTOi? ü)? Ix Tri? \^n ^TQoeloxfi? Tü)v dYxojvcov TÜ? TQajiE^Ti? 8ev jraQEvoxXEi
TOV XEiQOvgyby xal tov? ßon^ov? eI? t6 sgyov tcov. KaTd t6 xexXijxevov e:iiJiE8ov Trende-
lenburg Td öTTiQiYHaTa twv oSucov Seov vd Elvai xaXw? TOJioOETr]|Aeva, Td 81 xoto) dxpa gte-
QEOvvTai Ijil Tfi? TQajte^T]? Iv djtaYCOYli ovtcd?, wote Iv jieqijitwöei dvaYxri? vd IxTeXÄvTai
EVXEQü)? xeiQionol xaTd tov xoXeov r\ ttjv ovoo86xov xvötiv.

•0 vaQxo)Tr)? 8eov xaTd ttjv Yvcopiriv piov vd \xr] djionovovTai 8i' eiSixov jtQOJtETdöjia-
TO? djto TOV lYXeiQTlTixoi» Jie8iov xaTd Triv 8idQXEiav Tri? lYXeiQnoECO?, Iva ovtoc 8vvaTai yd
jragaxoXovdfi ^nv xoiXiaxfiv dvajrvoriv xal vd qvOuiCtI xov ßaa^iöv Tri? vapxwoEO)? xaid Triy
IIeXi^iv Tri? IyXeiqtiöeco?, ovtco 81 vd 8iEvxoXvvnTai xal 6 eXeyxo? xfi? vaQxcüöEü)? vjio tov

XEIQOVQYOV. ^ ^ « s^'

'0 Se^ioxeiq xnQOVQybq loxaxai nagä xb dpiOTEQOV jiXaYtov Tri? agpcüOTOv, iva övva-
Tai EvxeQü)? vd IxteXÜ tov? xeiQionov? 8id Tri? öe^td? xsiQoq Ivto? Tfi? JiEQiTOvaCxfi? xoi-

X6tt]to?. ^

01 ßoTi^ol löTavTai evavTi avTOv, 8E|id 8e xal oXiYOv ojiiodev avTOv f\ d8EX<pri ßoT]-

xVoq fi ivxeiQtCovaa xä lQYa;ieia. 'H igane^a tcüv ^yaXEicov vu e{>Q(oxTiTai nXr\oiov xov X£f
QOUQYOWTO?. iva o^itos öi^vatai xal 6 l'öiog v' dvaCiitfi xal Xanßdvn m dvayxaia Ig-
yaXeia. T6 vno jtoXXwv ejil xov dcoQuxo? TOjioOeiou^evov ToajiECiöiov Jtpog evajt6{}eöiv IpYa-
Xeicov decüQü) ov piovov JteQiTTOv dXXct xal ü)? jiapaxoXuov id? eAEudega? xivrioeis loy xeiQOVQ-
Yov. 'Avt' avTOv TOJio{>eTOV(iev, ojiioOev lOiJ ßoTi{>ov. ev ejrl JtXeov xQaKsQibioy EQYaXEicov,
Ijil ToO onoiov TOjtodETOviiEV Xaßifta? tivd? Kocher, \i^aXi8ia xXjt.

El? TTiv 'EXXdöa övvdnEda oxeööv v' djiO(puYO)|X£V t6 te/vtitov cpo)?. öioci t6 cpvoixov
q>o)q VTiEQEXEt oloüöfiJioie TEXvriTOii loiouiov, ei? o piovov mxä xi]v vvxxa äyayxaQ6\x£^a vd
xaiacpEUYCOHEV. Iloog djroipvYriv IxdaußcoTixoi) (pcoTO? 8eov rd jiagddvQa XY\q aldovari? eyxei-
QTiöECöv vd xeivtat ngoq ßoQpav. Td xaid Tf)v XajiaQOToufiv XQTi^mojioiou^Eva EQYaXEia ei?
TTjv xXivixfiv nov Elvai Yevixü)? idouvridTi twv YwaixoXoYixujv xXivixdiv ttj? FEQ^avia?. 6d
dvatpEQO) novov löiaiTEpco? Eiöixd nva EQYaXEia. Mayd'kcoq öievxoXvvei xaid xi]v Qaq)r\v twv
xoiXiaxd)v TOixcofidTCOv f\ ßfXovri Reverdin, xoriöipiojioiovpiEV öe ^Aiav xvqttiv xai jxiav vjio-
xiJQTOV. "EvExa xr\q XEKxr\q xataöXEvfis xr\q ßEXovT]? djiaiTEirai £jii|Li£Xf|g jrEQiJtoiTiöi? Iva slvai Jidv-
TOTE xatdXXriXo? jiQog XQTJöiv. 'Ev FaXXiQC XQilöipiojioiEUai avxr] djioxXEioTixwg 8i' öXag xäq
Qacpdq. 'Yjiö xov oixov Stiefenhofer Toi3 Movdyov xaiECXEmöÖT] xatd xäq vtcoöeiIei? \xov
OLVx6\iaxog TEtpdcp'uXXog öiaoToXEV? (elx. 16—17), oöTig evxeqo)? IqpaQi^oCETai xal exei t6
^AEYa jtXEOVEXTTipia vd xa^iötgi jtpooiTCüTaTOv t6 EYXtiQilTixov jieÖiov, 8id x\\q EVpEiag öiavoi-
Ieco? twv xoiXiaxüiv TOixcoiidTcov xal ejiI hixqu? eti TOjirj?. Td qpuXXa atTOiJ xaraöXEi^d^ovTai
eI? Ovo öidqpopa jaeye^T] iva Eq^apno^coviai dvaXoYCo; tov jidxovg tojv xoiXiaxwv roi-
Xcopidtov. TaOia EimöXcog öuvavrai vd EvaXXdööco^rai. Mtid tt|v 8idvoi|iv Tf]g xoiXiag djid-
YOUEV djc' dXXrjXcov td xoiXiaxd TOixcopiara 8id owridcov SioötoXecdv, IlIeO' o slvai övvarov
EiJXEQüig vd TOjiodETTidfi 6 avx6\k(xxoq öiacToXEV?.

6') 'H M^oq TO|j^.

hvxt\ dpXETai dvo) xr\q •nßiXTJg ovjxcpvaECog xal qpEQETai dxpißo)? ejcI xx\q \x.icix\q yQa\i\Jix\q
Ev^ECO? jTQÖg id dvo), El? pif)xog dvdXoYOv ttj? EVXeiQ^löEcog. . •

FEVixcog jioioiJUEda £va()5iv xx\q EYXEigTiGECo? 8id mxQ«? TO^rj?, ring ev dvaYxt] 8\3vaTai vd
e;iiHT]XDvOxi. 'EjiI Jtaxvadpxojv Yi'vaixwv, 8i' ejtipiTixv'VöEü)? irpog td xdio) x\\qxo\xx\q xovhi^-
\xaxoq, dxQißw? dvco xx\q inßtxfis avucpi'aEcog, xadiötatai JtQOöiTWTEQOv tö £YXeiQT)Tix6v

TCEÖlOV (0-

'ElaiQETixa)? EJii Xiav ev^eye^cov oyxcdv d^raiTEiTai EJiipirixvvöi? ttj? xo\kx\q jAEXpi dvco
xov 6|A(paXo{i. AiaTEjivouEv to ÖEQ^a xal tov vjtoöoqiov ovvextixov Iötov 8id toij naxaiQiov
\kiXQi x^q dÄOVEVQ(6öE(oc;. "En avxii\q eveqyeit«l piixQd Tonf) 5id xov naxaipiov, x\xiq 8jriHT]xv-
VEtai 8id TOV ipaXiöiou xal dxoXovaco? djioxü)Qit;oviai Ölk dXXriXojv oi oqOoI xoiXiaxoi \ivzq
Sid TOV xXeiotov ol^aXiSiov xal 8id twv öaxTvXcov (eix. 18).

EladYOjAEV hvo djiaYCOYd d'YxiöTQa. d'Tiva dvaXapißdvEi vd xpaTÜ 6 ßoT]Oü?. T6 jtEQiTO-
vaiov öuXXafißdvETai 8id 8vo xeiqovqyixwv Xaßiöcov. avu^povrai xal öiavoiYETai 8i' Ejxßv^i-
öE(o? TOV dxQOv TOV xXeiötoi' d^ßXEO? \i;aXifiiov (ein 19), i^toi dvEV Tfjg xgriainojioiiiöEO)?
TE[xv6vT(ov £QYaXEiü)v. Aid xr\q br]\iiovQy'n^doy]q 6jir\q EioEQXETai aTHOGipaipixog driQ Eig ttjv
jiEOiTOvaixTiv xoiXoTTiTa xal at ivTspixal eXixec vjtoxcopovv, pieO' o EvxEpwg t6 jiEpiTOVaiov
öiavoiYETai teXeico? 8id tov xi^aXiSiov (eU. 20). KaTd tov X£iQio|x6v tovtov eIvoi dövvaTog
6 TpavjiaTiö^og tov IvTEpov, öioti xaTd tt)v öidTpnaiv tov jcEpiTOvaiov t6 evtepov vtioxcoqei
xal ÖEV Elvai övvaTOv vd Tpau^aTiöf^fi xal dv eti evtepixt) eXiI l\ djtpoaEiiag eIxe övXXTitpdfj
8id Tfig Xaßiöog. üpoTEpri^aTa Tfjg ^Eong TO^ifig Elvai ^ dv£v ai^oppaYiag EXTEXEöig, ^ m
£JiaxoXovdT]oig Xeitovpyixwv öiaTapaxdiv xaTd Tovg ^ivg xal td VEvpa xal ^ övvaTOTTig Tfig
xaTd ßovXrioiv 8Jti|iT]xvvoecog av>rf)g jipog Td dvco.

1. Kuhlen Kampf Zbl. Chir. 1924, No 30.

EU. 16.-To7io&ixriaiS xov xodiaxov diaaxoUtos naxä üoyo^erÖJtovXov.

£U 17.-^7 OTio^exrjois tov xo

diaxov diaaxoXeoiS xaxä Aoyo^sxönovXoy,

Anayoyfri x&v cpvXXmv,

AittTenvopiev 8id to\3 naxaiQiov t6 öegpia xal tov övvextixov iötov 2—3 exar. avco tri^
flßixfjg ov\x(pvoE(oq elq ^ifixos 5-20 exar. xai jiXeov dvaXoycog tov e iSov? tri? eYXeiQ^oeco? xal
TOiJ ndxovq twv xoiXiaxwv toixcomcitcov. 'Qg xai Ijil piEan? Toptfig eveQyov^ev xat' doxa; \ii-

xgdv TopiTjv 6id tov piaxaiQiov IjiI Tfjs djiovev-
Q(l)omq xal ueyE^vvouev dxoXov{^(05 xavn\y 8id
TOV \i^aXi8iov eYxa()öia)5. 'H djtovevQCOoi; ixal
ol pivec djioxoQiCovTai an dXXiiXwv 8id tov
\|)aXi8iov xQTd t6 [leoov evOa EVQiöxovTai eig
öTfvfiv övvdtcpeiav, ojceq EVxeQaivcTai 8i' dvv-
il^cüöEwg TTJ? djiovEVQwoECog vjio Tcov 8axTvXtov.
*0 änoxo)Qio[ibq ovTog Seov vd EXTEXfiTai 5id
ToXvjtiov yd'C,'t]q El? oaov t6 övvaTOV uEyaXvTE-
gav EXTaoiv, iva t6 Eyxeit^il^i'tov mhiov xaTacTÜ
ÄQOoiTCOTEQOv. Ol oqOoi [xvsq djcoxcöQiCovTai
d^ißXECü? an dXXrjXcov 8id tov xXEtOTOv H^aXt-
öiov xal Twv SaxTvXcov o)? xal £;tl \iior\q X0[ir\q,
t6 jiEQiTOvaiov SiavoiYETai xal EiactVEiai 6
in^AETEQOc avTopiaTog öiaoToXEvg, 8i' ov f\ xot-
XiaxT) 8idvoi|i5 5vvaTai piEYdXco; vd Öieu-
Qvvdfi (eix. 16 — 17).

S) Pa(p4 TWY KOlAlOKUV TOIXU|läTUV.

AvTT] EXTEXfiiTai Eig OQi^ovTiav ÖEaiv, dq)0\)

JTQÖTEQOV ßEßaiCOdcü^lEV OTl Ol EVTEQlXai eXiXE?

fcVQiGxovTOi Eig TTiv q)VGioXoYixfiv avTwv Oeöiv
xal dcpov eXEco^iev 8id Tfjg x^iQ^S ^o IjiijiXovv
jiQog TTjv xoTEvOvvaiv \r\q fjßixfjg ovncpvoEü);
ovTcog, dSöTE al EVTEpixal eXixe; xaXü)(; vd ,xa-
XvcpOovv vjco TpvTOv. SvQQctJiTOUEv 8ia8oxixco5
jiQWTOv t6 JiEQitovaiov, dxoXovOcüQ TOv; öpdovg
\kvq, ü)v al jiapvqpdl ejiI ^ieötis tohtj? eXeij^e-
Qovvtai djto TTJ; djtovEVQcaoEO);, vTCEgdvco öe
TOVTCOv TT)v djiovEVQCOöiv xal teXo^ tov VJtOÖO-
Qiov oi^vEXTixov löTOv xai t6 ÖEppia. Aid ttjv
xoTd öTpcopiaTa TOiavTT)v Qaq)T|v XQ^löipiouotov-

JiEV ^(üixOV Qd|ajAa, xaö' OOOV EV JtEQlJtTCÜOEl

öiajiVTiaEcog Ejci nETa|ivcov gaiAjidTcov Öeov vd
ÖiavoiYÜ t6 oXov Tgavpia, jipog dqpaiQEaiv twv
EX \kzxä\'nq oaMJAaTCOv, UTiva dXXcoq Elvai SvvaTOv vd JiQoxaXEaovv oupiYYia. 'EtiI Ijupifixo-u;
xo\kx\q 8ia7i£Qü)jii-v gd^iüaTa Ix jiETd?T)c, piETd ttjv jiXtiqii avQgatpriv tov TiEpiTOvaiov, 8id tov
hiQ\kaxoq xx\q djtovEVQwoEco? xal twv nvd)v, dxoXovdcog öVQpdjtTOUEV Trjv djiovEvpcaoiv 8id
övvEXoC'? pa(pfis EX Cw'ixov pd^piaros, övyxXeio^ev t6 ÖEp^ia 8i' oyxttipcov Michel xal teXo;
tt^^aTi^o^AEV Td Ix \izxd\'(\q 8ia;iEpaöd£VTa pdn^aTa vjtEpdvo) Ivo? xvXivöpov Ix Yd^ilS tojtoOe-
TOvjiEvov xaTd ^yjxog tov Tpav^aTog (eIx. 21). '0 Halban 8iajtEpa Td pdn^iaTa piovov 8id
M.EÖ0V tov ÖEp^aTO? xal Tfjg djtovEvpwoEcog, 6 J. L. Faure xal 8id ueoov tov jiEpiTOvaiov.
"ApiöTa djiOTEXEafAaTa .TapEXEt f) pacpf) Amann, xaO' fiv Td öiajiEpco^Eva papipiaTa tojioöe-
ToiivTai ovto)?, wöte a! dvTiöTOixoi oTißdÖE? TOV xoiXiaxov Tor/conaTO? EpxovTai E15 Ijiaqjfiv.
Metu TTiv ovYxXEiaiv tov jiEQiTOvaiov, 8id ovvEXOvs pacpfis CWtxov pd^^iaTOg, 8ia;r£pa)ji£v lo^v

Elx. 18. — Msarj tofiTj t<ov xoikiaxMv lotpfto-

fidtOiV. 'AjlOXCOOlOfiOS XÜJV OQ&cäv xot-

kiaxcöv fxvwv.

': f.-

Fix ig-Aiävoi^i; lov neoixovaiov xaia Aoyo^tzdnovXov . 'Avvyj<oaic xov negnovaiov
' ' diä ovo x^^QOVQyix'üyv Xaßidiov xai ÖidiQnoig öiä xov xkeiaxov y^aktdiov.

. .ijtf-"" . *.,... ....*•■*/*-*.'

£1^ 20. — AievQvvoig xov JisQixovaixov ävoiyiwxoQ ^la xov xpaXidiov,

06v l-K \X£xdlr\<; Qd\i\ia 8ia piia? vjtox\5gTOv ßeXovri? \ir\yiOvq 6—7 exar. ^ xaXXiTeQOV 5ia ßeXo-
VT]S Reverdin 8id jaegov täv xoiXiaxwv TOixwpidTcov tov evo? nXayiov, r\xoi 8td toxi ÖEQ^xa-
TO?, TTJ? djtoveuoü)oeco5 xal toxi uvo?, dxoXoudü)? öe 8id xov \ivbq xai tfis ajtovevQCoaeo)? tov
It^OOu jiXaYiou. 'EjiavepxöpieOa ?x veov elc t6 dpxixov jtXdYiov, xaö* o ÖiajieQWjAEV 6id Tfjs

:l^

-i^.. ■

J?/x. 21. — SpifJUttixT] Tiagdaiaoiq. Ttjg ^fiexegag Qaq^rjs
i(wv HOiXiaxuiv toix(o/ndicov.

ßeX6vT]5 \i6vov xiyv djcovevpcoaiv, ev avvexEiq. 8e öia^eQüiuEV t6 Qd\x\ia ex vtov 8id if]? d^o-
y£VQ(X)OEoyq xal xov' Segnarog tov ereQCv jcXaYiov. Td jiQoexovra Qd\i[i(xxa eiriÖEVOuev loxv-
00)5 xal dvd bvo XY\q avxY\q TcXBVQäq ejtI hbq xoXvTiiov (eix. 22 — 23).

EtM, 22. — Pa<prj x<ov xodiax&v xoixoifxaxoiv xaxä Amann.

Elx. 23.
Elx. 23.-~Pa(prj x&v xodiaxäfv xoixco/mxxojv xaxä Amann.

'H Qa^pT) xr\q tojatI; xaid Pfanenstiel exTeXeiTai woavTcog xaid oxQ6\iaxa. Kard xav-
TTiv avQQdnxoiiEv jiQüiTOv t6 jteQiTOvaiov, dxoXovdcog tovc OQ&ovq \ivq, ttiv djcoveuQcooiv.
Tov \)jio86qiov avvexTtxov larov xal t6 öepua.

Katd Tf|v TO^fiv TavTTiv ^ecüQOl}^iev wg tzeqixxgl xd ueydXa Siajispco^eva gdupiaTa,
öcpeiXoiiev ojacos, evexa tov xivövvov xY\g b7]\xiovQyiaq al\iax(o\idx(dv , vd djioXivovuev ertinEXw?

xal td mxQOTEQa eri dyyeia. *H ^Ti^iovQyia xoiXiox/]Xti? Suvatai v' äno(f>tv'/ßxi M-O"
vov öl' dxQißoi'? xatu öT()Ji)|iaTa Qacpri;, (n%i bk 8id tf)? eq)aQpiOYn(; xoiXiOEmftEOjiOv, ovtivo?.
dvTii^ETQ)? TtQoq TiQoyEv^axF.Qaq dvTiXrixi^EK;, f| pifi eqpaQ^iOYT) ovÖe^Cav ovöiwSti ^niöga
öiv exEi ü)5 ngbq x\\v brwiiovQyiaw xiiXwv.

c') AicuK6Auvoiq TJi^ cl^aipcocuq Tqq OKoAiiKoeiSoG^ dno<puocuq In) iiioi\q Koi Iyk^P^'^^
TOiaiiq KOTci AoyodcTonouAov.

'Ava^TiTOiinev ejtl Kdoy\q XajiaoOTO^fi?, eveQYOi^nEVT]? 8id jiddT]Oiv tü)V yevvtitixwv öq-
YavcDV, TTlv öX(jüXT]X0Et8f] dji6q)voiv xal E^aiQot'uev tavT-nv ev fl Jieqijitwöei £nq)avi^Ei jiaüo-

~»*wj^

ßl^_ 24. — Msxax6jitoig xov ogdov fxvos noos xä dgiotsgä ngog
xdlvii>iv T/)? eihoxv<pkixf}g xoiQag, xaxä AoYo^exönovlov.

ano

XoYtxäc dXXoKOons. TötoioCtov hUttxai xatu to jiktatov vu slvat ^^mQk 810. ins near,«
S lYxaöoC«? tonüs. 'E«l ;reotnT«.aecov Stto,;, x«»' a? 6 l^eXxt^ano? rov xvcpXoC ^exot m- xoi-
Xtaxov teavt»ato? evexa av^cpvaecov enq>avtCet oxextxäs St^oxeoeCa;, v^toxoeov^ed« va J«m_r,-
^vvcoiisv tfiv dextxnv Tonnv li vü Siax^ptocouev eYxaooiO); töv 8e|wv oo»ov xo^iaxov i^vv,
Jva o«xü3 SvvndüijiEV xal elavcivcoiiev tfiv axco^rixoetSfi drtöqjvotv. Hoo; «;io(pi.Y{lv tovtov
usTaxo^xr^o) Tfiv xo^rlV «apooftixö,? «L« dxoXovaa.; : Met« «pcitcootv ifis YVvmxoXovixj,? ey-
loViaecos, äjio^axovWo) töv xoataxöv S.aoxoXea xal d^Xevöeo.o xov 8eHiov oo»ov_ ^vv ei;
Lov TÖ 8,)vax6v ^«'^^«^«v ^xxaaiv dirö xov ö:tta»(ov xal npoofttov ;r8xaXov xr,S «t,xt,?
avxov 0,; lö XO.OVXOV Ylvexat xal xatü xf,v xo^f,v xoö Lennard. Eiadyco 8vo a^iaytoY« «Yxt-
cxoa xal llxü) xov d;xeXEVÖEO(oflEvta nvv loxvO".? JiQo; x« doioxeed, tö? U v^ioXotnov? oxi-
ßd8a; xoü 8e?ioü fmla«; xoü xciXiaxoC xoixoV«tos, iixoi xö Sep^a. xfiv d«ove«o»aiv xai xo
ntpixövaiov, itpö? x6 dvxi»EX0v jiXöyiov, hr\Uhx\ itpö; xd 8E|iä (ei'x. 24).

MExd xö Jirgas xü; axwXnxoEiSExxonfi; dcpaipw xd ditaYCOY« dYxioxQa. I^tavatpepo) gl?
Ti,v alaiv xot, xö jiEottdvaiov xdxoj xoü 8e5ioü öpftoö wvö; xal ovyxXeCo) xd xoiXiaxa TOtX<«-
Haxa xaxd axot6(iaxa.

ä3

OT) 'AnoK^Au^PK; ToO iyx^tpi\tmov ncStou ^tit no|ioTid|Jou tuv ivTcpikov ^AtKuv kot&
Aoyodc T^nötf Ao V.

npo; IjtiTvxiav tf)? eyxeiQiloecas djiaiTFtxat jigcDTiöTCü? iva ejiinEX(og djionovoivtai id
yevvTixixu opyava änb xf\q vjtoXoijiov jifpiTOvaixfi? xoiX6ttito5. Ibiq. ecp' öoov jigöxeiiai jieqI
ijie^ßdoecos ejii ^oXvvöevTog ji£5iov. Elq Xiav xExXijiEvov ^jiCtteSov Trendelenburg EiadvouEV
jiivxcüOeiaav öOovtiv Ix ydCris JiXdtov? 20 Ixar. xal nnxovg SOIxaT., e| covot^viiOcos 1^2Tefid-
Xia ijtagxoi'v öid ifiv lEXEiav EJiixdXvxpiv twv evteqixwv eXixcov. *H texvix^ ifis Ton:o»eTTiaEüJs

^ix. 25.-'^;roxaAt;v;<? rov iyxeiQtjTixov jiediov öt' anofxov<bae<og x&v hxepix&v
eXiHa>y xarä AoYo^,r6novXov. 'H dgcaregä x^Iq >cgareT loxvga., ,6 i^ioov rn,
etoax^eiorjg o^yrjg in ydCvs, hw r) de^ca x^Iq xaXvnxn dcä rrj, ydCrjg ras hxe-

Qixäg iXixag.

TÄv to 8tdx^,8E|t«, XBtQ6, x6 ^Eaov

fxLc IT ^"7""^^^'^^\^;« --^^ -^ -QoßaXXo^oa, xar« x^v .eo.v VQa^.^v IvrEptxd,
eXixas ^oog lo öiacppay^xa. AxoXoi^ao,; xparEtiai araaepoi, ^ ödovr] 8td tfis doiaiEodc vei-
Qo, st, xriv Osatv a.x^, xal 8td xri, ÖEltd, xetgo, xo.oÖExowxat x« .Xdyta ^Epr, xf), Ö06vr,c
6711 xü)v vjtoXoijicov iXixcov {elx. 25). ^^uuvtis

, ^ 'OMOia), EladYExai xal ^ 8e,,xeq« xal h dvdYxn f) rpixr] oOovr, ex ydCns. GECopo) xf,v
loiavxnv E;rixaXx,^|;iv o), Xtav ox^otcoör,. ötöxt d^' Ivog d;to.^ovvxat al ^vxEptxal eXixec xaxd
xov xaXuxEQOv XPO.OV xal dcp' Ixeqo. ev .Ept.xcoaEt p^iEco, ;.va,8o., ÖYxo.. a! .oX.o^axtxal
owca. Epxovxac eI, l.acp^v ,6vov ^Exd xf), XEXEvxata, EtoaxOEto,, 6U.r,,^ fjn, LaxaT Z-
Qcog va avxixaxaoxaOi, xaxd xr,v ötdpxEiav xfi, EYXEip/iaEcog. 'H d;rco^^ai, xcov EvxEptxÄv iXi-
xa)v E^cpavtCet 8.axEpEta,. Icp'Saov evex« Xtav E.t.oXata, vapxcoaEco, 8ev I.EpxExat XEXEta xa-
Xapcoat, xcov xoiXtaxcuv ^voiv. 6;röxExd EvxEpa cbaovvxai ex veox, :tp6,xde|co. 'Evxota.5xt, ^rEQc-
^xcooEt ava^Evo».Ev np^^cog ,EXpt o^ iTtEXO, ßa^Ela vdpxcoot,. xaXv.xovxE, xaxd x6v ^Exa^i,
XQOvov xo xpav^a 8i d;tEaxEipa)^EVT,s o^ovr,,. AI xaXoig xo:todExr,dEtaat ödovai EtaEpaivovv

l^aiQEXixws XTiv lYXeiQT]oiv xal xadioxovv TiEpixxd ajravxa xd Jipog diKoOrioiv xwv Ivx^pcov
v>Jto8Eix^evxa EpYaXEia. AI öOövai 8£0v vd \jli\ jipOEXOvv xov xpavjAaxog Iva jatj jtapaxcöXvovv
xov xeiOOvpYOv, dpiOjioiJvxai 8' avxai EJiaxpißw?, iva jat) xaxd xijxtiv jiapapiEivtl xig Ivxo? xx\<;
jiEpixovaixfis xoiX6xT]xo5. 'Ev jidati JiEpiJtxcüOEi jipo xfig ovyxXeioeü), xoii jiEpixovaiov licava-
Xa^ßdvojiEV xov eXeyxov djtal exi jtpooExxixwg 8i' EloaYcoYf]; xfjs xeiQO? e^S ^^iv jrgpixovaixTiv
xoiXoxTixa, iva djtoxXEioOü Tidoa dnq)ißoXia.

MExd xTjv 8idvoi|iv xf)? xciXiaxf)? xoiXoxtixo, Seov vd djionaxp\3va)vxai djto xov lyxei-
pT]xixoi) jie8iov jtdvxa xd piixpd xoXvjiia xal xd ojiXrivia, Jtpo? djioojioyYioiv Se XOti^iJaO"
jioioiJvxai növov xoXvjiia ovYxpaxovpiEva vjio Xaßi8o5 xal oi«xl jiXeov xovj Ivog IxdoxOxE.

5') ncpiTOvaionAaoTiK^ kqi napoxereuoK; inq KoiAiavi^q K0iA6Ti|Toq.

'ExdaxTi xpav^axixf] EJiicpdvEine Ivxog xr\<^ xoiXia; 8eov vd xaXvjrxY]xai 8id jiEpixovaiov,
xaO^' oaov x6 Jiepixovaiov Evexa xx\q uixpoßiöxxovov loxvoq auxou eIvüi £|oxov ^eöov xaxd xf]?
Xoin(6|Ea)?. Td Fviieye^il xoXoßco^iaxa, driva eivai 8uvaT6v vd djioxEXEaouv jinYHv XoipküIecd?,
xojio^EXOiivxai xaxd Jipoxi|iTiaiv E^CDJCEpixovaixu)?. *H EJiijiEXfj? jiepixovaio;iXaoxixf| iipooxa-
XEUEi dptaxa diio xwv au^cpuaECOv jipo, xd JtapaxElviEva öpyava, o)? xal drto xov ,|i£XEYXE''Qil'
xixov eIXeov (Quenu xal Beutner). El? xd; niXeioxa; xvjiixdq EYXeiQnoeiS evxEpü)^ Ijtixvyxd-
VExai f[ jtEpixovaiojiXaaxixii, evioxe 0^(05 Eixqpavi^ovxai {AtydXai 8vöxepeiai ejiI EXXEiii^ECog jie-
pixovaiov, ojiEp EV xoiavx(] .lEpiaxcooEi 8£0v vd dvajtXiipovxcxi vtco opoyövov jtapaxEi^EVOv 6p-
ydvov. EI5 xoiavxag jiepiJiTWöEi; £q)apn6^onEV EJtwqpEXü), xx\y n£\>o8ov xov Amann, xa&' fiv
x6 öiYiAOEi8E5 y\ xö dvwxEpov x^f^iia xov opdov EvxEpov övppdnxExai jipog x6 jiEpixovaiov xfis
ovpo86xov xvöXEO),. 'H EjnpiEXf]; jiEoixovaiojiXaoxixTi xal y\ alpiooxaoi? xaOioxovv 7iEpixxT]v
xaxd x6 jiXeIgxov xrjv jiapoxEXEvoiv.

'Ejtl dM.q)iß6Xü)v övvOyixwv, oöov dq)0p^ eI? xtiv döTixiJiav xaxd xtjv xoiXiaxf]v EYXeipil-
aiv xoi5 xapxivov, 6 J. L. Faure övvioxd eI; Jidca; xd; jiepiJixwöEi? xtiv \kr\ ovykXeioiv xfjc,
xoiXiag xal xov Jicojiaxionov xaxd Mikulicz. SvpKpwvo); Jipo; xt|v jiEtpav jiov o^w; 8ev
EXaxxovxai 8id xovxov x6 Jioooaxov xr\q Ovtixoxtixo;. "EvExa xovxov djioqpEVYOjiEV xaxd xavova
x^v jiapoxexEVöiv 8id xwv xoiXiaxwv xoixcopidxcov xal jiapoxEXEVouEV Jtpog xov xoXeov övy*
xXeiovxe; xeXeico; xd xotXiaxd xoixwuaxa.

4. KoAniKol ^Yxcipriociq.

Td IpYaXEia, dxiva ^iExaxelpl^6^iE^a xaxd xdc xoXnixd? lnL^iQ\\oty<;, elvai hf yi\zi xd
avxd jipo; xd XQTiaijAOJioiovuEva xal xaxd xfiv Xajiapoxo|iiiv, llaiQEOEi xwv djiaYcoYwv dyxi-
oxpcüv, dvxl xü)v 6jto(<ji)v nExaxeipiWM.e^a xoXjtixov; 8iaöToX£i;. '0 olxo? Stiefenhofer Iv
Movdxcp xaxEaxEvaoE xaxd xdg vjro8Ei|£i? nov eISixov 8iaaxoXEa (ein. 26), oaxi; 8ia(pEpEi xwv
piEXpi xov8e ev XQr\OEi, xa»* oxi x6 ev JiXaYiov jixEpvyiov EjrijATixvvExat jipo; xd dvco vjio jiop-
(pTjv ü)Xiov. OJtEp XQT1ÖIM.EVEI iva döxfi n:iEöiv ejiI xov jiXaYiov xoXjtixov xoixwjiaxo; xaxd xtjv
xojiTiv Schuchardt. Ai' avxou EÄixVYxdvExai dpioxT] aljAOoxaai; ovxco;, oSoxe xa^ioxovxai
dvaYxaXai oXiYioxai djtoXivomEig xEp8i';onEvov, ovxco dpxExov XQOvov.

*H xojio^EXTiöi? xr\q dppcoöxov £:il xr\q x^iQOVQyiyiXiq xpaÄECr]? slvai d|ia JioXXfi; Jipo-
ooxriq. 'H dppcoaxo; xOTto^EXEixai v-^xico; \i?. xd öxeXt] eI; djiaYCOY^ xal xd^i^v xaxd ^ x^v
xax' laxiov xal xtjv xaxd yovv dpöpcooiv, Ivcp ol y^ovxoI jipoEXOvv xr\q xeiQOvpYixfj; xpaucCil?.
"Iva f\ dppcoaxo; xaxd xfiv SidpxEiav xfj; meiQr\OE(xig :lapa^4Elvtl oxa^EQibq dxivnxoc XQUomo-
jioiovuEV öXTlp(Y^AaTa ^aiv w^cov, al 8£ xvfi^ial xpaxovvxai Jipog xd Öjiiöcd jiovincog 8id jAExaX-
Xivcov El8ixä)v pdß8a)v xojtodExovpiEvcüv vjio xd YÖvaxa. "Iva d:ioq)£VYT]xai ola8Vi;iox£ IvoxXn«
öis xü)v ßoTiddiv, al pdß8oi 8eov vd m^ elvai xddtxoi dXXd toxvpo); xExXi^iEvai Jipo; xtiv x^i-
povpYixV TQdKElav xal nQoq xtiv xaxEV^woiv xfi? xE(paXfi? xfj; dppcoöxov (elx. 27). O^o)
al xvfinai xfig dppc^axov xEivxai sk\ xa)v vcoxcov xa)v ßoTiOoiv. AI xelQzq xf^q yvvaiyibq oiEpe^
ovvxai EJil xov dcüpaxo; Eöxavpco^AEvai.

Eix. 26. — KoXmxog diaoxokevg d

m xriv xofifjv Schuchardt xaza Aoyo'O'exdnovXoy.

EU. 27. — Tojto^B

TTjoig xrjg olqqcooxov

sJii xokmx&v iy^^ei-

Qijcfecov.

•Ev dvTideaei jiqo? triv XanapoTOji^v e:ti ueYaXvTepcov xoXtiixcov lYXciQnöecov ?xo^€V
dvdYXT]V 8^0 ß0T]»ü)v jidvTOTE. xaO' ooov o{,8els EK Td)v liEXOi lOvSe nooTQ^evTcov xoXjio5ux-
OToXecov elvai Swaiöv vd dvtixaTaoTrioti Iva ßondov. '0 JigcoTOs ßonOo; TOTroOeTelrai el? t6
88|i6v ^JiXdYiov Tfi? doQcooTov, tva Suvatai vd XQTiainojioifj xaXXitPQOv rnv 8e|idv avrov
XEioa. 'O doiöTEQd laidjAEvos ÖiEvxoXvvEtai xaid Tr,v ovYxpdTTioiv toxi jioooÖiov xoXuoöia-

.4 X^'-

{kOUm/

Eix. 28. — ZvyxQOitTjötg xov nQoa&iov xoXjiodiaaxoXeoig. *H x^'^Q
xov ßorj&ov oxrjQiCexai mi xfjg^ßixfjg avfiq)vö9we.

axoUioq otav öTTigi^tl ^^v 8e|idv xov xeiQ« e^i ^ns ^ßi^n? av|i(p\jaEa)s fe^x. 2^^. Oviog
ojiCDS Seov vd JtQOöEXl] tva m döxfi jiieoiv tiva öid to^ aYxcovo? avioii ejiI xr\q xoiXiaq xY\q
Yvvaixog xal jcaQaxcoXvt] ovtcö ttiv IXEuOEQav avrfj? dvajivoriv. 'H xeiQovqyixti TganE^a 8eov
vd Eivai oöov TÖ övvaiov vipiiXoTEQOv, iva oi ßoii^ol pifi vjroßdXXcüvtai ei? xojtcooiv daxojicog.
Evexa löxvgag xd\i'\\;e(oq xov xoquov avtwv. *0 x^iQOVQybq xadritai jiqo tov alöoiov xr\q Ywai-
xos, 8£|id 8e xal oaov t6 öuvarov jiXriöiov aitioij TOJiodETEiTai f\xQ(XTieC,a twv EQYaXeiwv, ojti-
adev 58 tavTiig lotarai rj d8£Xq)f| ^ EYXeiQi^ovoa id EQYaXEia.

"Iva IjiixaXvcp^ii xaXws 6 JtpcoxToe xai fl jieqi avtov xchga oxEQeovxai x6 djiEOieiQCDjiE-
vov odoviov 8i' ö8ovTü)Tfis Xaßiöo? xatd i6 ÖEQpia dvco xov öaxtvXiov xal 8id ovo Xoßiöcoy
exaieocoOEV xatd it)v jtQoexovöav £jtiq)dveiav iwv yXovtwv (elx. 29).

Ol xoXjtoSiaöToXeT? owri^a)? fiTiniouQYOvv dpxeTOv xwqov tcqo? eiaaYO)Y^v tcov epYa-
XeCcoy xai räiv 6axTÜXa)v, jiQOxeinevou o^icog Jtepl piEYa^i^tepov o'yxcov ejil otevov xoXeov 0)5
l«i droxcov, Seov vd IxteXw^ev tV xo\k\\\ täv huwv toC) jtEQiveov xai tov xoXeov (xard
Schuchard), Aid tauiTis 5TmiovQYOii|iEv Ijtaoxf] x<a>0Ov, oSöte vd SuvdnE^a vd EiaaYaYcouEV
ov fiovov TOV5 öaxryXovg dXX' ev jieqijitwöei dvdyxn? xai oXoxXtiqov xx\v xeipa. 'Apxou^eda

JldVTOTE de, TT)V HOv67rXEV()OV £711 TOV dpiöTEOOV JtXttYlOl' TT]? aQQ(l)GXOV §XTeX0V^£VT1V TOpiTlV,

fjSvvTidTmEV ÖE vd ditotpvYcouEv HE/Qi xovhz xx\v ovox(x^z\oo.\ VKO xov Stöckcl ÖEUTEpav ro-
»A^v Ejil TOii ÖE^ioi» jiXaYiov xai ItiX EV'pEiag eti uöTEgeKTOnrj? EVExa xapxivw^aTog. Met' d;to-

Ein. 29.~

Zregscoaig xwv ojzXrjvi'cov ijil ^coIticxmv iyxeiQtjaecov

Xtvcomv TCOV ^EYaXvtEpcov. x^pico, Toiv .p6, Td .goaco XEt^.EV0)v «yy^Ccov. xaX^:rTOUEV t6
rpa..a 6ca ,1X00. o.X.vio. Yd^,. xai EtodYC.EV tov ^.etepov öiaaToxl. ooTirZTaTE^^a
TTlv rOMTiv a;.o Tn^ QVKavaeco, xai Ta.TOXpövcog IvepyeI at^xooTaTixdi, fe.',.. 2^; ^

H öiayoil.g Tfi5 ;tEpiTOvaixfi, xoiXoTnTog d:rc, tov xoXEoi5 ftvvaTai vd Yivri 8id Tri^
:i^ooOia, , 8.d Tn. ö.ia^ia, xoX.OTO.f],. 'E.l EYXstp,^aEO>v xaTd t^v ^Ar^JT^Loxl
.«T« i<pap,oSo,ev T^v .poa^iav xoX.oto^^v. öioti avT, e JpaivEi ^pioT« t^v 5t'
avT,, xaTaa.aaiv tov .vO,Evo, Tfi, ,^Tpa,. 'H 6.iaOia xoX.oxoixL,^ LeIt«? .pt
ötavoiiiv Ta,v d.oaTp.dTcov tov AovyXaaEiov xc^pov xd .övov 6X., E|aipETixai, EriprE-
va, .Ep..Tcoae^ 8.' lYx-priaEi, M .,,, ,,,,,„, ^ ,^, e^apT,.dTcov. HpogöpO^v Ixt xro^ t^
.TJr:vl5;^^^^^^^ xoX.oxoiX.OTO.,, 5E0V vd Exco^Ev .dvTOTE .p6 ocpL.oiv Td, dvaTo-

'H ovpoööxos xvaTig avvÖEETat .ETd ttj, .i^Tpag xaTd t6 ;tp6a^tov Tofxcü.a tov Tpa^

Xn^ov 8id xaXapov ovvextixov Iotov ovto),, oSote IäI cpvoioXoYtxdiv axeafcov f) djioxöXXriöi,
Tü)v 8vo opYdvwv OLK dXXnXü)v TEXEiTai Evxepü), xard t6 ueoov 8id Ton öaxTvXou (etx. 78).
OvTO) YivovTai lnqpavfi Td JiXaYia TurinaTa, EvOa fj ovpoftöxog xvacig xai o TpdxTiXo,
ovvÖEOvTai jioXv OTEpEcoTEpov jtpo, dXXtiXa OVTO),, &OXB vjioxpEOvjAEda vd XQTlöinOTioiTiocouev
t6 \i;aXi8iov. KaTd xr\y eX^iv jipog Td xaTCO xr\; \iY\xQaq f\ ovpoöoxo, xvoTig avvaxoXovOEi Jiap-

EXTOJll^O^EVT], aXT^aTl^OHEVT), OVTÜ) JtTVXfj,. 'AvTl^ETO), f\ JlpOödia JTEplTOVaixfl JlTVXf) (XVOTIO-
IlTJTplxri JlTVXn), ^Tl, EJCI (pVöloXoYlxfi, OeGECO, Tü)V YEVVTITIXWV OpYttVCOV E|lXV£lTai HEXpl TOV

£00) |j,riTp«xoi5 aTopiiov xai djiEXEi olko tov ;rpoo^iov xoXjiixov doXov 2 Ix., xaTd tt)v :rp6,
id xdT(ü eX|iv TTJ, UTiTpas jiapauEVEi ei, ttjv avTTiv Oeqiv ovto),, wote fj djtooTaai, avTf],dji6
TOV xoXjtixov {>6Xov tivai jiEpijiov 4 Ix. T6 jiEpiTOvaiov tov AovYXaoEiov l^ixvEiTai hXtioie-

ÖTttTa Jipo, TOV XOXeÖv, [i£^* OV ÖW^EETttl öld XöXapOV GVVEXTIXOV toTOV. ''EvEXa TOVTOV XOTd
TTJV £X|lV Tf), .TlTpa, JlpO, Td XO'tO) t6 ÄEpiTOVaiOV T0i5 AoVYXaaElOvdxoXov^El Iv .EpEl OVTCD,,

üSaTE xaTd xx\v Sidvoi^iv tov öjcigOiov OöXov tov xoXeov dvEVplGXOpiEV tovto jAoXi, eI, ßd^o,

2 Ix. JlEplTlOV.

a') ripoodia KoAnoKoiAioTO|i^.

METd TTiv djraYWYnv twv xoXtiixwv TOixco.dTCOv 8id tc5v xoXjioSiaGToXECov xai Tfjv djio-
xdXvil^iv TOV TpaxriXov GvXXapißdvouEv t6 jrp6ai>iov TpaxriXixov xeTXo, 81' aYxiGTpcoTfig Xaßi8o;

xai eXxO^AEV TOfTO KQO TOV ai8oiOV xai XOTOTI JtpO, TrjV XaTEV^VVGlV tov JlEpiVEOU. AtaTEpiVÜ-

M-Ev t6 JtpoGOiov xoXjiixov TOix(ona 8id tov piaxaipiov xaTd xr\v [iiar\v Ypanpiriv, ttj, xo\x\;
dpxo.EVT], dxpißo), 2 EX. xdTü) Tri, oupn^pa, xai e^ixvov.evti, jcpo, tu xaTü) HEXpi Trj, ev8o-
xoXEixn, pioipa, TOV TpaxnXov. 'AvtI th, TOpifj, TavTi], 8vvdjA£da, dvaXoYO), tt], jiepijitcügeco,,
vd EcpapnoGcopiEv TopiYiv q;£oo.LiEvnv EYxaoaio), fi TOiauTHV oxnpiaTO, T. 'H EYxap Gia y\ to|oei-
8f|, TO.T) 8eov vd (pepTiTai xard xä ooiaxuaTECO, xai TpaxnXov xaTd Yevixov xavova 1 V2 — 2 Ix.

dvCO TOV TpaXnXlXOV GTO.IOI). 'ExdGTTl TÜ)V TOflWV TOVTCOV £V ndotl -^EpiJlTCOGEl 8e0V vd EVEp-
YHTai JAEXpl TOV GVVEXTIXOV IgtOV TOU XElfi^VOV VKO TO XoXjllXOV TOlXCDJAa, SlOTl TOTE ,6vOV

eIvoi SvvaTOv vd djtoxcopiGOxi ^ xvgti, djro tov xoXtiixov TOixwpiaTa, evxpQw,. METd tov
8ixaG.6v TOV xoXjiixov TOixwaaTO, xaTd Tf)v piEGTiv Ypapi|iAnv ovXXanßdvouEv l'xaOTOv Tpavpia-
Tixov xeiXo, 8id XaßiScov Kocher xai daxo^e^a Trj, djtoxoXXriGEco, jcpo, ä\icp6xEQa xä jiXdyia
8id TOV \iJaXi8iov jiEXpt djroaTdGEO), 2 ex. JiEpijrov. 'H drcoxoXXriGi, xr\q xvgteü), xai f\ jTEpat-
TEpo) eIeXi^i, Tri, EYXeiQnöEO), \Vt JtEpiYpaqjfi xard xr\v xoXjtixfjv vGTEpEXTOjirjv.

6'> 'Oniodfa KoAnoKoiAioTopn*

AVTT] EVEXU TÜ)V djlXoVGTEpCOV dvaTOHlXüiv GVvOtIXWV EXTEXElTai E{«XEp£GT£pOV fl f) Jlp G-

dia, xa^' 600V TO jtEpiTOvaiov E|ixvEiTai Jipo, Td xotco jAexpi tov xoXjtixov doXov, in 8£ ovpo-
86x0, xvGTi, 8EV dTtoxcopi^ETai. 'ArtdyoiiEv Td xoXjtixd TOcxconaTa 8id xoXjto8iaGToXEa)v, d:ro-
xaXvÄTOjiEv TOV TpdxriXov xai GvXXa.ßdvofXEv t6 on:LG^iov TpaxT]Xix6v tslloq 81' dYxiGTpcoTf),
Xaßi8o,, fiv E'Xxo.ev loxvpo), jipo, ttjv e|o8ov tov xoXEoi5 xai jtpo, tt|v xaTEV&vvoiv xr\q fjßi-
xfi, Gv^iq)VGEa), dcpov djtonaxpvvopiEV tov :Tapaxa)XvovTa Trjv xdd£X|iv JcpOGdiov xoX3Co8ia-
GToXsa. 'AxoXou^o); 8iaT£.uvouEv t6 ojiig^iov xoX.ixov TOixfopia EYxapGico, axpißw, xaTco tov
dvaGÄOG^EVTO, TpaxnXov, 8iavoiYopiEvov ovico TavTOXpovco, tov jtEpuovaiov. lipo oiaG8rin:i)TE
jiEpaiTEpco ETTEpißaGEO),, ;rpoßaivo|HEv Jipoc 8iaYva)GTix6v oxojiov ei, XEjrTOjiEpfi \i)TiXdq)T]Giv Tf),
iXdnGOvo, jiveXov djco tov eyxeiPtitixov Tpaupiaro,. 'Edv f) 8iaGCoXTiva)Gi, ^Ecopridfi JiEpiTTrj,
piETd TO jiEpa, Tfi, EYXeiQnoECD, gvyxXeio.ev t6 jiEpiTOvatov xai t6 xoXjiixov TOixcona 8td ^Wi-
x(ov pamidTcov.

K. Aoyo^etojiovlov, FvvaixoXoyixi] XeiQOVQytxij

EIAIKON MEPOr

I. XcipoupYiKn Oepancfa töy ävüpäAov 0€O€üy if\q linipag.

A'. OniZOI4 KAIZIZ KAI KAMMHZ THZ MHTPAZ

1. Zrcp^uoic; töv OTpOYYÜAov ouvö^opov

O) 'EyxcfpHOiq Karä Alexander- Adami.

npwTO? 6 Alquier ecxecpOri va avTixaraöTrioti rfiv 8ia toxi mooov {>EQajieiav Tr\q
bmo&iaq xd^oi^eo)? xai xXioEMq ifie \ir\XQOiq bC EyxEiQr\OEü)g.

^ Omoq xfxrd t6 hoq 1840 ejtQoieivEV dq TrjvraUixfiv 'Axabr][iiav x}]v ejiitfi'Hiv ävaxdlEoyq
TmmrQaqbia ßQaxvvoEißqxibv oxQoyyvXm' ovvbEo\iwv. H Eyi^\Qr]oiq 0^0)? avTT] llereXeö^T] t6
JCQa)Tovi)ji6 8uo''AYYXo)vxeiQOi)()Ya)v,ToO Alexander xai toi' Adams, xaiot t6 FioglSSl. Kaia
TT|V8XTeXeaiVTfi?6YXeiQnafa)?TaiJTTi?Elvai d;raQairT)TOv Iva TTiQcoiiev (i)Qio\ihovq xavovaq, ävev

T(ÜV ÖKOicüV TlQOOXQOVOliEV dq bvOXEQEiaq. "Iva öl'VTlOwpiEV EVxdXo)? Vd dvEVQroi^EV TOt'; ÖTQOYYV-

\ovq ovvbioiiovq hxbq xov (ioi.ßwvixoi) koqov, Seov f] lour) xov ÖEQpiaroc, \xr\xovq 4— G Ix., vd äg-
XTirai änb xov ^ßixoii cpviiaxoq xal vd jroQEUTiTai jtagaUiiXa),- xai oaiyov dva) xov novnaQxdov avv
bionov, vd EtaxcoQfi be \xexqi xr\q lmnoXr\q äKOvevQO)aeo)q. TaiWnv dxoXovOojg xaOaQiCouEv
&nb xov In avxr\q xei^evod Unovq bm xoXvkiov hexqi annEioii, woie vd cpaivTirai Aeux/i,
ör(Xf3ovöa. Ovx(o xa^ioxaxai l^cpavE? xard rfiv xwgav toC- eHo) ßovßcovixof- atopiiov t6 Xijrd)-
8e? EVßoXov Tof. Imlach. Ötzeq Im naxvoaQxcov Ibiq. Yi^vaixd)v xaXvxxei xbv oxQoyyvXov övv
bEO\xov. 'EvTavda dva^TiTEirai 6 öuvÖeöho?. avXXapißdvEiai ovioq bC d^ißXEia? Xaßiöo? xal
dxoXouOo)? öiavoiYEtai f) änovEVQmaiq. Uqo xr\q dvEVQEaECog xov ovvbioiiov beov vd pir^i
ÖiaxwQi'CTlTai f] äKOvevQOioiq. Mexä xy]v 8idvoi|iv rn; drtOVEVQwaEO); EvxeQCü? E'XxETai 6 auv
bsoiioq KQoq xä £|a) xal dn:oipaovrai xard pifixog if]? oXt]? ai-ioi) öiaöpo^ific djio toi- ßoi^ßco-
vixoii TiOQOv. Ol xeiQiö^iol xaid tov ouvÖEOfiOv öeov vd Yivcüvrai ^Etd liEYaXrig .TQOöoxfjc,
ÖiOTi o{>TO? Ibiq. Im dioxcov. xard rriv e|o) av^tov ^oigav Elvai jioXu XEJiTog xal Ei.apv.Trog.'
'H ;iQoßdXXovaa jiEQiTOvaür) mv^r] djrcoi^Eiroi ftid roXi^Jiiou ti xdXXiov fiiavniYErai 8td
TOi~ xpaXiöioi^ Iva ödviiOw^ev vd TTQOoavaToXiöOoinEV öid x^q FiaaYCOYn? xov ÖaxTrXoi. hxbq
xriq xoiXiaxfl; xoiXottito;. Öyq Kgbq xi]v äxQißrt xaxdoxaaiv twv Eaco y£vvtitix(I,v ÖpYavcov
'AxoXoi)d(o? öiJY>tXEiETai ex veov t6 jtEQitovaiov xal GTEOEOviai 8id tivcov Qa|nndTO)v 6 ovv-
bEüiiOq ijil Tou UovjtaQXEiov övvbEGixov. Aeov ofico; vd 8i8nrai rtonao^n iva pif) at'UJtEQiXan"
ßdvTiTai 6 ötQOYYvXog auvÖEO^iog £| 6XoxXiiqov dq rf|v pacpnv jtqos ditocpuYnv VExpwaecog rov-
rov. T6 JcXeovdCov T^fjjxa roii ötqoyyi^Xod ovvbeo\xov d^oXivoi^Tai xal d;toxö;rTETai. Td xoi-
Xiaxd TOixoVara öVYxXEiovtai 6)q xal xaid xi]v EYXetQTiaiv x^m xard Bassini. 'Edv ^ dveij-
QEGiq Twv GTQOYYt'Xcüv öi^vÖFCTjicov Öev xaraGtfi öt'vaTn, lot-d^ ojteq, xaiTOi ttoXu ajcavico? xa^
hu xr\Q^üB(ßq ETI Tojv dva) xavovcov Si^varov vd auußfj, Sievouvo^ev r^ lon^v xal dvaJyiTOv-
^xev xovxovq an EvMaq xard iriv Excpvaiv aucwv jiagd t6 xEgag Tr\q \iY\TQaq.

6) 'Eyxcfpqoiq Korh Olthauten.

^ nQOor\\coaiq itQbq xä xoiXiaxd TOixwjxara rcov GTQOYYacov gvvSeg^wv n:XriGiov xr\c Ix-
(puGFcog T(ov EX XY\q [ir\xQaq.

BeXovti cpEQOi^Ga Ccoixov od^^xa ?^ Xejittiv nEra^av 8ia;tEQd kq>' exdoxov nlayiov xhv
djiovEVQcoGiv Tü)v Xo|d)v, Tof) OQ^oii xoiXiaxoC ^ivbq xal t6 JtEQiTovaiov. 8iaTQv,;rd dxoXovdo)?

i?5

TOV öTQOYYuXov gijv8eg^*ov xal 8iexßdXX£Tai avTn ex veov 8id xov aurov jiXaYiov xoiXiaxov
TOixwfAaToe ngbq xä e^co.

METd THv guykXeigiv Tojv xoiXtaxtov roix(ondTa)v xal Jtpo xr\q oacpriq roi' Sep^aTO?
d^^ari^ovrai Td pd^naTa etiI IxdaTOD jiXaYiou.

Y') 'EYXcipnoK nara Dolerit.

AidvoiHii; XY\q xoiXia? bC lyxaQo'mq r\ xard [iY\noq xo[ir\q. BeXovt) Dechamps piETd
gd^noToc nET«Eivov 8iajrEodTai xotco xov oxQoyyvlov gvv8eohod, ei? djiooTaGiv 3 ex. djio
TOI) xhXod; rf)? ^»iTQa;, 8id hegov tou jiXarEO? gi'v8£oho\). Kard tov auTOv tqojtov 8ia7iEQ(xiai
Qdma 8id TOU jtX (teo; ouv8ha^ou tou eteoou ^XaYiou. 'AxoXoin^co? SiarpuTidTai 8i' dußXeia?
Xaßiöo; xar' duqpoTEpa Td JiXaYia. oXi'yov uvw xr\q f]ßiyS]q (5V\iq)VOE(oq xal JüEpijrou 2 ex. djio
Tri? jiEGTig YQafX^n;, 6 opOo? \xvq xal to jtEpuovaiov xal 8id piEGOu t(T)v 2 ojicov eXxovrai jipo?
Td E^o) ai dyxuXai t(7)v GTOoyyuXoav ouv8eowcov. T6 JtEpiTOvaiov xal oi pivEg ouvEvouvTai
xal ujiEpdvQ) Touüfov GuppdTiTOVTai Ol 8uo guv8eghoi TiQbq dXXiiXou? xal Jipo? tov? [ivq. Ylgbq
jifcYoXuTEpav dGcpdXEiav ftuvdpiEOa xard Tf)v ga(pi]v xr\q d.-iovEvpcoGECü? vd GvXXdßcouEV xalrou?
Guv8£G^ou? xal OUT03 vd jrpoGriXo)oconEv Touioug eäI Tri? ojiiodio? EJiKpavEia? ttj? djcovEvpa)-
OEO)?. 'AntpoTEpai ai TEXEUTaiai auToi Meöo8oi e'xouv t6 HEiovexirma, oti Elvai SuvaTov vd
ujieioeXOouv EVTEpixai eXixe? ^ETa|u xoiXiaxoT* TOixoHiaTO? xal piriTpac, outo) bk vd 8Tinioup.
Yrii>ii eiXeo? El d.ToqppdHEO)?. ÜXt^v toutou o^q)? r] Oegi? tt)? unTpa? Eivai IgaipETixo)? uH'TiXt]
xal :rEpiopi"C£T(u xard jioXi' f] rpuoioXoYixfi xivtitixott]? ai'Tri?.

riooq d7to(puYf)v TOI' M,EiovEXTnMaTO? TOUTOU, guvegt/]Oti Iva Ol GUV8£OHOI GuppdjiTCüv-
Tai Fjtl TOU jTpooOiou (Polk. Menge) xtX. fi xdXXiov ejil tou ÖjüigOiou TOixco^aTO? Tfjg \xr\-
xgaq (Webster— Baldy).

5) 'EYXeipnoK; KOTci Webster - Baldy.

MfTd Tr)v 8idvoraiv xr\q xoiXiaxfi? xoiXottito? GvXXanßdvovTai ExaTEpwdEV ol GTpoYYi'Xot
ouv8egm.oi 8id ßEXovr,? I^echamps xal pdiLiuaTo; ei? djiOGTaoiv 3 ex. djto tou xeiXou? ttj? n/)-
Tpa? xal dvEXxovrai. 'AxoXouOo)? Siarpu.TwuEv exaTEpcoOEV t6 nfGOGaXn:iYYiov 8id Xußi8o?
(Pean) xai eXxo^iev 8id raiTri? xd? aYxuXa? twv GTpOYYuXcov guvSeghcov 8id piEGOu tou pie-
ooGaXjiiYYiou xal jipooriXwvopiEv raura? 8id tivcov CroCxcov ti \XExaE,ivo)v panndrcov £n:l ttj?
ojTiof^ia? ETTicpavEiac tt'i? uiiTpoc. npOGFXOUEv opiü)? Iva [xi] ujiOGTouv Gi'iYxanH^iv ai goXtiiy-
Ye?, OTE 8Ti!J,ioupY£iTai xcoXupia GuXXriii^EO)?.

2. KoiAiOK^ KuoTionn^ia.

'H xmb xov Werth xard t6 1384 u;ro8Eixv*>ETGa n£0o8o?, fin? xal GTipiEpov eti e'xei
Euapii>^ou? 6n-a8oi'c, GrTipi'CETai Eni xx]q eSacpaviGECo? tou n:poo{>iou AouYXaoEiou x^pou (xu-
GTio^iTiToixou xoXjtüVwto?) jtoo? tov Gxojiov i'va £|ou8ETEpo)df) f\ EX T(uv jtpoGa) xal UVO)

IGXt'pd £v80X0lXiaX)l TTIEOI?. 'H {»qplGTaHEVTl o{^EV JtlEGI? £X TWV OTtlGO) Xttl dvO) EJll TT)? OJll-

GvHa? EJTKpavEi'o? Tri? ^n^pa? (uOfi Tf)v urirpav ei? jipoG&iav xXioiv xal xani^iv.

Kard tov Halban jipoßaivofiEv o)? dxoXouOco? : BeXovt] cpEpouoa i^iaxpov ^wixoV
Qd[ina 8iaTpuJi« tov jruO|iEva ttI? i-inTpa? dxpiß(oc ryo) XY\q Oegeo)? ttj? ExcpuoEO)? tti? odX-
jiiYYo;* auTT] 8i' EJiavaXafißavonEv(ov vu|e(üv GuXXa^ißdvEi to jiEpiTOvaiov Tri? .tpooOia? eiti-
qpavEia? rfi? mirpa? xal £v guvexeiq: tou o.tiGiXou TOixoHiaro? Tri? xugtew? xal 8i£xßdXXETai
ex VEOu dvco Tri? xopu(pri? Tri? xugtew? (paqpf) xan;vo{>uXaxo?). To af'TO EVEpYEiTai au^piETpixco?
8id SEUTEpa? ga^)r\q km xov EXEgov nXayiov. Td dxpa dpKpoTEpcov Td>v papinaTCOv aM-piaTi^ov-

Tai OUTO)?, WGTE 6 JlUl>uf)V TH? ^TITpa? EJClxdf^TlTai EJll Tri? XOpU(pfi? Tri? XUOTEO)?, OJtOTE TO XV-
0TlOHT]TplX0V XoXjKO^a E^OuSETEQOUTai,

3. Bpdxuvoiq tüv oTpoyyüAov ouvö^omuv |jct6 TaÜTOxp6vou KuoTionq^iaq

in\ Tnq pr|Tpa<; kqtö AoyodCTonouAov.

npog elovSerepcDaiv toi5 xvaTionTiTpuoiJ
xo^Ttcopiarog xal xavxo'iQOVioq Siaxparrjaecog
Tri; |Li»lTQa5 8igÄOoaf>iavxXiaiv xal xd|Li\i^iv, ovq-
QaTtTQ) KEQiKOv xatu iHv piF{)o8ov Baldy -
Webster tou; arooYYi''Xovc; övvöeopKn'; ejil ttj?
imiaDiaq FjricpavKi«; tTi; ^i/iTQag bid tivwv
Qa.uLidrfJüv xai uxoAoi'Owg ovQydjiTa) Tr)v xv-
oTiv fti' dn:X(Jüv Qoqpüjv ejri to€) T^irjuaro; tdiv
arooYYi'Xo)v öiJvfieapifov Tn>v dva8iJiX(joi>8vr(ov
Lt\ xov 6n:iööioi) TOixoonarog toO jn^dpievog
rng migag (el>t. SO, 31, 82). 'H MeOoöo?
ai'Tr) Fivai ij jLiovr] itqp' f]ud)v Ecpaono'Co^FVTi
d.-ü6 .ToAXoii xonvoit, x«0-' ogov 8id rai'TTig ^
liinTp« diioxTd 8i;iAfiv eHaofpdXiöiv ific Oeöeco;
ai'rfic, )]Tig ei\ai .-raQ:^nrp8Qi); jigog Tr)v cpvöio-
?.OYixriv. 'EvÖEixvvTai iva xard tt)v ovpoacpfiv
Ttov aTQOYYV'^.a)v m-vSea^cov f.tI rf)? o.TiöOia;
ejtKpavfciog Tri(; lu/joag avQQd;rro)VTai iliovov rd
o.TiaOia axeXri Tri? dYxi'XTi? t(T)v ai'v5ea|iiO)v tou-
ro)v, iva rd TrpoaOia öxeXri, pieO' d)v (3Qa8u-
TFQOv oi'vdÄTETai r^ v.voxiq, jtaQaneivovv dvev
rdaecog.

T6 :rkovexTTiM,a xr\q eYXeiQriöea); eVxeiTai
El? t6 OTi in xuoTig öiaiTiQEi Tf|v öXtiv ai)Tf)g

Ä^f«. SO—Bgä/waic: tmv argoyyvXcov owd^o/nwv

fietä xavxoxQovov fcvoiiojirj^ia? l^l Tfjg

firjXQag xaxä Aoyo&erönovXov,

Eix. Sl. — BQdxwoig x(bv oxooyyvXcov owSs-
oftcov fxexä xavxoxQovov xvmiojii^^iag im xng
fiTjXQag xaia. Aoyo-d'tx67tovXov. IvQoacph rfig
xvaxeojg im xGiv ovvdeMfxoiv in! rofi djii-
a^iov xoixoifAaxog xrjg fii]XQag oxgoyyidcov

OVvÖEOf4.COV,

Eix. 32. — Boäxvvaig rcDv oxgoyyvkcov avv
öeofiojv fisxa xavxoxQOvov yvaicojirj^iag im
r^i^ Mxoag xaxh Aoyoß'exdjtovXov. 'H xv-
nxig Ex^t axsQsw^ im xibv oxQoyyvXcov ovv
öeofxüjv öia xeoodQcov dnlibv Qaixfxdxoyv.

-jM-»— ■•'■-

♦ 37

4. "Apeoo^ oTcp^ooic; xfiq m^tpoc; inl tuv koiAiokuv tcixumAtuy.

'H xoiXiojtrilia xard Lejpold - Czerny, xaf>' r\\ ÖiajieQwpiev xx\\ (pspovoav t6 gd^na
ßeX6vr]v 8id xx\q, d^iovei-oürneco; tü)v javcüv xal tou irepiTovaiov xov Ivo? jtXaYiov. oDXXanßd-

VOUEV TflV JATlTQaV Xol ftlExßdXXoUEV ^X VeOD Öld Td)V dvTlörOl'xCÜV OTlßd8tOV xov ETEQOl' nkii-

Yiou. AuTTi Efpae^ü^Eiai \x6\ov IjiI Yi^vaixojv evqiöxohevcov eig ifjv xXinaxTriQiov i'iXixiav,
fi sdv atitai vjtoßXrif^üiöiv ei? texvixyiv oteiqcüöiv.

'EjiI jcQOjtrwoEcov Tri? ^^nTga? f| ueOo^o? Elvai jioXvtiho? xal ovxvd Ecpappio^eTai. 'Ejii
TOiovTO)v fVf»; JiFgiTiTWöEO V EJtiTi^YXdvouEv dxonn doqpaXEöTEQav :rQoariXa)öiv tn? piriToa? ejii
Td)v xoiXiaxd)v TOixcondTCov 8iu ttj? E|a)i3öTEQo;tTi|ia? xaTd Kocher, fixi? ^xTEXEirai o)? dxo-
XoiJi*>co? :

Metu öidvoi'^iv iT)? xoiXiaxfi? xoiXottito? öi'XXanßdvETat f| nr'iTQa 8i' arxiarpcoTfi? Xa-
ßi8o? xal EXxEtai iroo? td e^co, dxoXoudw? avopdjiTETat t6 toixixov jTEQiTovaiov Ijtl ifj? om-
öOi'a? xal rtQOö^ia? E.^KpavEia? ifj? ^iriipa? ovtü)?, wöte \\ \i<\xQa TO^odETEirai £|ü)jiEQiTovai-
xw?. Kard tyiv gaqpfjv tcüv xoiXiaxwv TOixcDudroov 8iajt£Qü)nev 8uo loxvQoiEya pan^ata ßid
tn? M-riiQu? xal öid ir)? djiovEDQcaaEO)? tcuv Xo^wv ExaiEpcoOEV, driva dpinaTiCouev pitid x\\y
Qaq)f)v tF]? djtovEVQcoöEco?.

B. XAAAPnZIZ KAI nPOnTftZIZ TOY KOAEOY.

1. ripoodia KoAnoppa(pn*

METd TT|v eiaaYO)Ynv Toa') ojtiöOiov xoXÄo8iaoToXeü)? ovXXanßdvouev 8i' dYxioTQCoifi?
Xaßi8o? t6 jTQoai^iov x'-Xtiixov toixojna dxgißd)? fi? x\\\ ^eotiv YQa|Linriv, 1 ex. jceqijiod dvw

Eix. 33. — Hgoo&la xoLtooQatp/j . ^Evag^cg d:joxco-
Qiajuov xov did axixxrjg ygafjifjirjg xa&ogia&ivxo;
iXXeni'Osidovg xoimxov xgt][xvov.

Eix. 34. — flgooOia xoX.togoafpt] . ^vXXrjtpig xov
xoXjicxou xgavfxaxog dia kaßiöoiv Kocher >tal
ajioxöXXrjOtq xov xoXtiixov xoiXMfiaiog djto xov
VJioatgcofiaxog did xov xpakidiov.

xov atojxiOD Tfj? ^Tirga? xai eXxo^ev touto kqoc, xa xato). Smlhvui)aq uY/aoTQwtfi? Aaß.'Öog
m^Uajißdvo^Fv Tu xoXjtikov toi'xw^a axoißoj? xctto tov axo\ivov tf]? ovqtiOqo; xai axopiFV
TOUTO jtpog Tci dvo). 'Ejii Tou retvo^evou ovtco xoXjiixoi' TOixcoMaros rpeQoufc'v dxpiPoj? avco
Tfis xatWTeQa; (xyKiüXQonr\q Xaßifiog hixquv Sta toi* y\mhhwv T.^^fjv xaO" 67ov tu ivuiyoc, toi-

».■!*fä-

At;;. 3ü.—nQon^ia xoXjiooQacpij. 7/ UTioy.oL

/.rjoig tov Hokjiixov xorj/wov ovi.i7iA,jQopjai

dfißXeojg ^t' ivog xohmlov.

hi^t. .ij.- nooox%'a y.olnoQoufp,) 'H ajioxöL
Anoig Toc jioooUlov xor^Hvor tyj-i n€Qax(o{>ri
H oweyjii garpri^ av/.ÄafAßdrn x6 xoiywfm

xoX^txot, tmxo.Mato,, at,XXa,ßc<vottev tö ovo, xpaa^t^Sov S,« xe.Qoveytxr,? XalifSo; xai cp.<pn-
^.v 8w Toy n-aXtStov To|o«8r, tOMf,v ln\ rov öetoreeov ^c^aytot, sx töv xoiro) ;roöc tä /v,o
HEXQi T11C avcoTfpa; aYxioipwtns XüßiSo? ff/«. 33— H6). ' '

'Ex Tf,; to^fis taürns ^rapaaxemCfTat ;rQÖ5 t« dpiaTfe« (rof, xnom'ovov) to xoX;tixov
to.xo,,.« xai s^te^vEtat _EXA8t,^OEt8n= xen.vdg, ovr.vog tö (xeraK' ^iagtatat Ix tri, fxräa-o.c
xn? :roo^t(«aecos Aeov o^co? r« toat,iattx,', xa'X„ vä SüvavTat v,i nlr^a.ä^ovy n^b, äU.C
ayev T„a«o; .^Xoy.Conevot, ;.o6; tovto ro,', ^.yfliov, roO exrenvo^evov xo.^vov. 'eV^'c-ovI.
Ya,o,ei>a a; xnv ao^toCo.,a„v ot.ßdfia dv«. .,',xep^, v« ü^oxoU,',o«mev tov xpn^vöv 8t«t roXv-
;t.oy, ote ayXXoKßavouev t« tpav^atix« xeiXn 8.« ^l,üs fj Si'o Xaß.'Sa.v Kocher, «c d<p,lvo,tfv
V« e.oX.a0„ao.v 1.1 rruv SaxxvXcov T,-,, äpiorepü, xe.pö,. 'H avWva,o„ T,r>v xpa^lZv
Xakcov vmrm 8tä ovv.xovc pa.,.,,, f,g lvap|., yfvnat fx xo.v xdxa,, üx.n <5.ö xov xpax.Ko,,
tn? nnxo«;. Oxav „ paq,,, ;ipoanXr,atdi;n evpäav £;rtcpävEcav xä,v ^xaxfpcoÖEV xpriuvojv xai
xa^xoxpovy); avXXr,<pOn <i ^x.xn xoO rcxco^axo^ xr^ x.^axeco;. .,ptxxeÜH ^ iS.acx'o« ax.po,'-
xvcoot; ro. xoa<«Maxos avx%, E,p' öoov ;xp6xaxac ;t.oi ^txp«? ;xpo.xo)OEa)s (^l>c. 36) 'Eni
jiev«Ai.x.pa,v KvaxtoxnXülv exxeXÄ tStatxepav ct,pp(xva)otv rov totxoVaxo; xf,s xi-oxeoi' Metu

Tr)v TOJioi^eTTicTiv Trjg jiqojtt]; Qafpri? xaTa tov TpdxilXov dq)aiO£TTai t\ xatcatepa dYxiöTQcoiTi
Xaßig xai 6 ßoriOo; eXxEi novov t6 panpia ovtco;, (oöte xaTa Tr)v jitpaiTepü) guqpfjv 6 TQaXTiXog
avTopidTCö^ ejiavfQXETai ßaOnTjSov et? ttjv (pDaioXoyixTiv avTOii {>eöiv. npoxeinevou Jiepl n€-
YiXrig JiQOjtTcaöeo);, xai>' r\v elvai fiuoxeoe; vd xaOoQiöcopiFV ex tcüv jipOTeQcav to piEvedo; xov
xQT]nvov. uQXÖneda Tric JiXaoTixfi? qjtQOVTe; pieya^iiv neariv ejcipirixTi tohi')v, dqp' fi? djioxoXXd)-
piEV TO xoXjiixov Toixo)|,ia ngoq dpiqpOTtQa tu ii'Kdyia o)? avo). 'AxoXoudo)? djKoOovuev ttjv
xi'öTiv TiQoq xä äv(o xai övqqixvov^ifv to xoix(x)\ia avxY\q 8iu Qatpn? xa:ivodi'«Xaxu5. Td exa-
TepcüOev Teivoneva gxeXt] XY\q xuötecü; ftiaTepivovTat novov eqp' ooov elvai dvaYxaio; 6 dxQü)-
TTipiaono; TOP TQaxnXou EVExu EJCiUYixuvoEü); auToO. 'H ainooTaaig jieqitteuei xaTU to jiXei-
öTOv EJil nixQ(jL)v jiQOjiTcoöEcov, xttd' oöov f\ aiuOQQaYia ex tü)v xQav\xaxix(x)V /eiXecov eniaxE-
Tai 8id TTi; Qaq)fis. £Jti uEYaXx'TeQcov ö\x(og TiponiTcoöEcav elvai döq)aXEöT£QOv vd ovXXanßdvcov-
Tai Td ainoQQOorivTa dYY^i« xcn vd djioXivwvTai.

2. 'Oniodia KoAnoppa<pn kq) nepiveonAaoTiKri*

'H ovQoixvo)ai(; tov bnia^iov xoXniixov Tor/capiaTOg öeov jidvTOTE vd avv8vd^T)Tai pierd
Tri? SnniovQYia; tvo; veov tö/vpov jieqiveov. To dn:0T£Xeö|ia Tf^c lyx'£iQr]OE(aq E^agTaTai d;io-
XuTO); ex tov» vii^ovg tou veov toutov JteoivFOv, o); xai xY\q EupUTi^To; tov öXri^aTiConEvov xoX-
jTixov auXov. 'Ev ovSeuia olio); tieq i^itcooei vd övöxepaivTiTai x] owovoia EVExa vjifpßoXixfi?
GrEVoOöEO); TOV xoXhov. 'Edv TO veo8tiiiiov9yi1^£V TifpiVEOv Elvai Xöpiil^ov, TO djiOTEXföixa oXi-
Yov SiaipepEi co; .-tqo; tt]v Jtpo tt]? eYXeiQ'I^Ew; xaTdoTaoiv, ^ Ö'dQQwaTog vjtoqpepei JiepaiTepca ex
Tfüv avTwv evoxXrmaTO^v. "Evexa tovtov xaf>OQiI^O|LiEV ex tü)v jiqoteqcov to vi^^o; tov jrpog bj]-
piiovpYiav jiEpiveov 8id xaOopionov tcov cnineiov (uiva piETd ttjv övvevü)oiv Xanßdvovv tvjv
f^eaiv TOU ojttaO^iov övv8eö|i,ov twv M-eYdXcov xeiXecov, Td ojiota ev y^vei dvTioTOixovv Jipog td
ojiiodia dxpa xmv nixpaiv xei^e^v. "Ev TpiTOv örmpiov ejii xr\q \xiar\q yQa\i\XY[q xov jcpojti-

JITOVTO? ÖJIIÖ^IOV XoXjTIXOV TOlXWpiaTOg dvTlGTOlXEl JlpO; TO dvO) dxpOV TOV Jipo; £XT0nf|V

xoXjiixov xpTifxvov. To vy^oq xov cn^iEiOü tovtov e^apTdTai ex tov pieYe^ovg xr\q jiQonxd)0£(oq
xai xa^opi^ETai xaTd itpOTipiTiöiv xaTu ttjv d;iox6XXT]aiv tov xpripivoi'. 'H ^xXoytj twv Tpjcav
TOVTCuv OTipieicov ÖEV Eivai övvaTov vd opioOfl 8id xavovcav, dXX' E^apTdToi xvpicoq ex Tri; :tei-
pag TOV xeiQOVQYOv. IIpoßaivojiEv Eig Trjv djrox6XXr]öiv (b? dxoXov{>a)g :

Td exjiTeooM*}Ev 8vo aT]H8ia, Td xeiiiiEva xaTCü twv piixpwv xsi^ewv, övXXapißdvovTai 8i'
dYxiaTpcoTwv Xaßiöcov xai eXxovTai kXacpQwq vjio twv ßoriOcüV jxQcq xa. nXdYioi xai uvco ovTCog,
03ÖTE TO ÖEpixa TOV jiEpiVEOv SiaTEivETai öXTinaTi'Cov EYxapoiav jiTVxrjv. 'Axpißw? xaTd Td opia
ÖEpi-iaTO; xai ßXEvoYOvov <pepeTai Topif] 8id li^aXiöiov djio XY\q \xiaq XaßiSog jcpog xr\v dXXT]v,
fiTig Eivai eXaq)pu)g To|oEi8f); piE t»)v xvpTOTtiTa jipo«; Td ojiiao) (elx. 37). SvXXa^ißdvo^ev
dxoXov^coq TO Tpav^iOTixov x^l^^^OQ xov xoXäixov TOixoV«TO; xaTd x6 nEaov 8id 8\)0 Xaßifta)v
Kocher xai dpxopiEOa djto ttj; öeoeco; TavTTi; Tri; djtoxoXXr'iöE«; tov ojiig^iov xoXjiixov toi-
XüVato; d;i6 tov djiEVÖvojievov, TOv{f' OTtEp EvxepeöTaTa EJiiTVYXav^Tai 8id \i)aXi8iov xai
ToXvÄiov Ecp' OGOV EvoiGxopiEÖa Ei; Triv dpuo^ovGav 0Tißd8a, w; xai EJti jiqogOio; xoXjiop-
pacpfi; (du. 38 — 39). 'EXeyxo^ev 8id tov EiGaYO^svov evto; tov xoXeoij 8axTvXov jaexqi
.TOiov vil^ov; 8E0V vd eäexteivo^iev Tfjv drtoxoXXTiGiv xai GvXXapißdvopiev to dvcoTOTOv
xoXjtixov Gripieiov 8id XaßiSo; Kocher, e| ov or^Eiov te.uvo|,iev t6 xoXjiixov TOtxwpia
xaT' dpicpoTEpa Td jiXaYict jxe xaTPvOvvoiv :cp6; rd; exaü£pfjöi>EV aYxiGTpcoTd; XaßiSa;. *H Xaßi^
Kojher TOJco^ETETTai e^i Tri; ^<^f»> TpavpiaTixfi; E.Tiqpaveia; tov xpTipivov (elx 40). 'Edv eX^O)-
piEV laxv^d); TrV Xaßi8a ravTriv jioo; Td xaTCO, tote GxripiaTi'CovTai exotepcoOev 8vo vji' oEEiav
Ycoviav dcpiGTapiEva TyavpiaTixd X^i^^l. otTiva Gvppd.TTO^iEv jcpo; dXXr]>a 8id gvvexov; pacpri;
(eiy. 41 — 42). '0 veo; gtevodOeI; xoXeo; e'xei :tXeov oxrmaTiof>r|, ÄpoßaivopiEv 8e i]hr] ei; to
ovGio)8fc; 8id TrjV ejiitvxicxv xf\q EYX^iOnoEOj; |.iEpo;, 8r]Xa8f) Triv pacpi^v toöv dveXxTripcDV ^vcüv.
Aid piEYaXTi; iGXvpd; ßeXovri; xai iGXvpov ^o)ixov papipiOT'^; 8ia;iEp(üpiev tov Jiapaopöixov
IGTOV TOV dpiGTEpov rtXttYiov xi\q Y'wvaiKÖ; ex twv £|(o Jipög Td ego) xai uxoXovdo); tov aa-

Jöv äxQMv xwv x^i^ecov Öia äyxiaxQOitÖJv
Aaßidcov xai zo^oecdijg rofiij xurä tä ooia Sig.
jf fMxxos i xal lß?.svoy6vov.

Eix. SS.— *07iinHa xoXjioggnqpt]. JJagaaxevr/
diä tpaXiöiov tov diä xov öaxxvkov äraaxoa-

axQa-

(fevios xolmxov^ xoixw^mroi. 16 antv^vaixk
vov JiooßdUei xdxcü xov ifaXidiov

Eix. 39.~''Oma&ia xokjioQQatpi). rtegans-

QOi öid xokvTxiov Jiagaoxtvtj xov dmatga-

fphxog öiä xüv daxTv;.tov xijs dgioxegäg

^eifidg xokjiixov joi^cofxazog.

tix. 40- Omo&ia xohtoggatp^. ^vklritpig
xov avuixatov onfiBiov xov xokmxov xgrjfxvov
a;ro T^<r xgavfiaxixrjg avxov ijinpaveiag diä
/.aßidog Kocher, Ik^ig ngog xd xdxo} xai
ajtOHOJtti avxov did y;ahöiov xatd xijv o»^«t-

TOV

Elx. 41. — 'O.iia&ia xoXn tooarpt] . ^Exio/nij
xoknixov xoixco/iiaxo:; xal Fv/g^ig xijg nvvexovg
gaqptjs xaxä xodgiaxegov jxkdyiov.

'CnicOia xo/.nogf^aqri, 'H ga<pi] xov dgt-
tv .ikayiov i.iegaxcoi^r]. "Erag^ig

EU. 42. — 'C:

oiegov nAayiov inegaxcbi>r). 'Erag^i
xijg ovyexoig ga(pfjg de^id.

..A^fi"*^^^., .^..f,^^

Elx. 43,'—'0ma{^ia xoXjioggacpq. 'H gatpij xov xoXeov l^egaxcö&r). 2vgga<pr) xüv ävekxx^goyv />tv(äy

f^etd, ngoaxaoiag xov ivxioov vno xov öaxxvXov^

(pCoq \i^T]Xa(poitnEvov rtvt^.xrriga \ivv. '0 avxbq x^iO^^pioi; eKTcXeiTai 5td XY\q avTri? ßs^ovii? xal
Qd\i\xaToq xar' dvTiihtov ftuvOuvGiv ejil xov fieHioi} nlaylov xr\q Yi'vatxo? xal äcpov TOJtof>e-
TTiöCopiev 3—4 TOtavia Qd[i\iaxa dpinaTiCopiev laura. IlQOöTaTEUOUEV tu a.mv^vo[iEvov xatd
tnv TOTToOfTiiötv Td)v QU[i[idxa,v TovTCüv aKOiDovvxtg 8id tox» dgiöTegoi' fteixTOi' ngog xu. dvco
xal üÄiöü) ff^x. 4.!/^

Eis Jtdöa^ Tag nXaaTixug eYXeiQ^oei; Jigog l;riTea^|iv xaXo€' temxoi) djTOTeXe 0^.0105 Öeov
rd Qd|.iLiaTa vd övXXa^ißdvoiJv ei'Qeiav [ioiQuv lOTof), vd ftiaÄFpoi'v 8e tov ßXevoydvov rovXdxi-
öTCV Va ^->t- djTO TO)v XPiXetov TOV TQau|.iaTog oi'Twg, ü3öTe ai TQai)[xaTixai ejiiq)dveiai vd £q-
XcovTai ?lq ei'peiav ejTa(pf)v nguq dXAiiXa; "Iva äKO(pEvyi]xai V£XQ(OGig öeov f] djioaTaaig twv
ji8HOvo)nevo3v Qa^^i'tTWV dn;' dXXr'iXwv vd elvai TOi'XdxiöTOv 1 exaTOOTOiiETQOv.

Kard xdq Jiowra; i^piepag fXfcTd tj'iv 8YXe*0n<'iv jtqoöeyyi'Copiev jiQog äXl^laq 81' ejTiöe-
o\iOv xäc KVY\iiaq xr\q doQWOTOu. Oi'ÖejtOTe rojtoOeTeiTai ucp' fipiwv \x6vi\ioq xaderfiQ xal pio-
vov et; TieQiJTTCjoaeig laxovQiag xaOeTTiQid'Cojxev ttjv xl'ötiv pieTd t^v EYXeiQriGiv.

3. 'Eyxeipnociq jf[q naAaiäq öAiKnq pn^eoq toü nepiveou.

Met' exTO!j,v|v tou ovKd)bovq loxov aHOxoAXdTai «QxoiivTcog to dÄet'öt'ö|jevov djto TOii
xnAjcixoT' TOixoVaTOc, oi'QodjiTeTai 8e t6 priY^A« 8id XejiTrii; 8iaxojTT0nevt)c r\ övvexovg ex pie.
td^T)? oacpnc, uveu öuXX»)\|jeo); toü evTtQixov (iXevoYovov ujto xov Qd\.i\iaioq, Her' ejrineXfj 8e
äKO\\fiXii)aiv övvEvot'VTai xal Td jTFQaTa to-D o(.piyxxv\Qoq ex veov jtqo; äXh]ht 8id XejiTCüv ex
HeTd|tig oa|.i|Lidüa)v. 'Ejiaxo?,oiJ»>eT Qocpj'i t(T)v xoüöjreSrov tov xoLtixov TQavjiaTOg jrgog dX^TiXa
8id ^'i)ixu)v Qaa;adT(")v, v) na;p»i tiov dvFXxTi'ioo)v piuajv xal f) oarp») tov 8eQ|iaT0c, ö)q TavTa

yy^ifti 'j-^^^-»V--n-»

7v^

EU. 44.

Klx, 45.

Elx. 44. ^ 'Ohxn p^l^s; tov nsotvUv.~Ki>c 15 -'Eyyf.lo^^a,, xrj, 6XiySj, g/^^,co, tov mgnoviov xam
AoyoitexoJiovXov. lo eyxsimjtixov tihÖiov ^xei Fxjirvyßrj de' dyy.imocoTÖÖv kaßiöoiv. *H die{'^vrac r/Tc

xo^r^g oijfieiovzai öiä naieiag yQa^i/nfjg.

.^K.

• -j »>

EtH. 40.

Eix. 46.— 'Eyxeiytiaig n/s' oXiHt^ (t/jgeujg lor .ttoi-
veov xam Aoyo^exdnovXov 7/ oiqyq lov iyugov xai
TOV aqpiyxii/fws f-^ei Jisgazw^ . To 7tur>aaxet'aoi>h
■^'jogza äyu) xoi/Mfia zov fvifqov exti ovUt^tpi^,) öiä
lafiiöuiv Kocher xai exei vjisyeo»,) fig .iiv/t'/v. 7/
avcomzt) Xaßig xgazei z6^ xoXjiixOv zoi'xcofi'u mjog

xä ärco.

EU. 47.— Eyxeigf]aig zrjg S^tx,-); g^^.oig zor .ifoi.
veov xazu Aoyo^ez6novXov. 'H xm%lxvai)eioa er-
rrmxij jixvjjq xaki Jiiei zi,v Fvxeo:xl,r oatpijv xai nooa-
xoaaiui öia zivuiv ga^ifxäzoiv fni ,o' a<r>yxzrfQog

Eix 4H.~'Eyxtiot)oig zr/g oi/x^s ofll^o)- zov neo,-

veov^ xazu Aoyo^erdjiovXov 7/ xai>s).xvaJelaa

Fni zor ofpiyxzijQo^ fvzeoixt/ jztvxii F.iixalvnzei r-

leioig zijv h'zeoixtjv gafpi]%\

'i^^Vm^i)*^';

EU. 47,

EU. 48,

JieQi£YC>a\i)aiLiev Xejitoueqio; xata t^v jieQivgojcXaoTixriv. tlaga Trjv ejitpieXfi texviXTiv f\
ky/i£{Qr]aiq avxy] djiOTDYX«vti jroUdxcg ovtü)?, woie 6 xeiQOVQyo? dvayxd^eTai vd ejiava-
Xdßn Tijv eJiFußitöiv.

'Ajio naxg )r' xqovod yor]a\[ionoiu) i6iav neOoSov, r\xtq piexQi tov5e ef^ jidoaq xäq ne-
QiKxdmiK; I.K.I .laQeoxEv dpiGiu d^OTEXEopiaTa xai evtxa toütod eyfveto piEOoöog exXoYn?
fi|iu)v. 'AQXOnai in; £YX>-iQnöeco; u); öwn^^ü); öi' dn:oxü)QLö|ioiJ t)ü oi'XwSov? löroü, äno-

Elx 49—''Eyx^iQr}Oi<:tfig6Xixfjg Qr)^EOis xov tisqi-
veou xata. Aoyo&evdnovXov. Ef^fjfxaiixij jiaQaara-

Elx. 50. — *£yx€iQr]Oig r^s 6?.ixijg Qrj^ecog xov ns-

Qivitv xata AoYO&eTÖJiovXov. Zxt](xaiixi] Tiagä-

oxaaig xiig eyxsiQtjascog.

xoXXoj hk dxoXovOa)^ tu CiiibvOvo[itvov uno xov xoXjiixov xo\i(x)[iaxcq dQxoiJVTcog n^go? t« dvcD

01)1035, WöTE ^iETU Ty)V Qaq)>)V TOV EVTEQOU XUl TOV Oipi YXtflQOg VU f IVai ftl^VaTOV dvEV ftl'ö/FQEl'ag

vd xaOEXxuöwpiEV Jixvir]v xov TOixa)|.iarog tou dÄE\)i>L'aM.FVOv ex xr\q dvwTfpa? ^OlQag aiTOi)
TiQoq £;iixdXv\i;iv X)]q hx?Qixr\q Qaq)r\q. 'H nxvxr] avxj] GTEQEOviai Ijii xov oq)iyyixr\QO<; ävev
idöECog 8id tlvwv .ue^ovouevcüv Qaq){T)V. ^eO' o f) fyifiQj\oiq djiojTFQaTomai xatd tov öt'vrjÖT]
T q6 jüov (elx. 44 — 50).

'0 djio xov OQ^ov (Taqpd); xl^riXacpwnEvoc; OvXa^ öev jTpoxaXEi eii; id? aQQWöTOVi; Ivo-
xXr'mata, w? m\)a\Cüq \h\ f)ftwaTÖTi(;vd vom'Gti, xai \\ f.iET£YXF'QTiTixfi e|EXi|i; xat' ovhkv 8ia-
(pFQEt ttI; xard tuc ev xotigei ufOoftovg. Metu (3Qaxvv XQOvov 6 Oi'XaE E|aq)av((;£Tai, o.iote ^
Jiri'xf] ujtoxcoQEi ÄQog rd dvoj ei^ t))v (puGioXoYuriv avxx\q Oeoiv.

'H JiQO.TapaoxEuri öid inv EYXeiprioiv ^eov vd Elvai LiiheX»!?. AiftopiFv EJti xivaq y\\iz-
Qdq JTQü x\\q EYXFigr]ö£a)(; vjiaxiixuv cpaQuaxov, eveqyovuev xurd xx\v jiqoiiyovhevtiv EG^Epav
Tri? EYXeiQnöEO)? xaOaoT xov xXiJG|ia xai x^QnYO'"M.£v GTaYOva; ojiiou, LTLTQEJtoiiEv ht EXacpgdv
TQ0(pnv öimiouQYOUGav oXiY« xo.-igava. Aid xy\q ÖEOUGri; öiaiTTi; JIQooexouev iva EJtaxoXo'uOnGtl
t6 JiQWTOv xEvcoGi? xttTd i\\\ i^^v f^Egav HETd Tf)v FYXeiQntJiv. XoQTiYof'UEv xttTd TTiv nUFpav
TauTHV xixivov eXaiov xul TaviTOxoovo); eveq/ovuev i'jioxXvghov eXaiovxov. IIqoc öiEt'xoXvvoiv
Tri? e|ö8ov twv dEpicov TOJcodETOvuEv ?Mvq \x^xä xo nioaq xy\q eyxeiQtioeco? ooAy\\a Ivteqov
xaTd t6 ttÄEvi^vGfAevov,

' k

■*

♦ <

"ExonEV xeiQOVQYnGEi uEYttv dQi{>nov oXixwv qti|fo)v tov JiEQiveov XGTd Tfjv meOoöov
TauTT]v xai e'xoiaev ettituxei JtdvroTE nEtd tvjv jtqwttiv lyx^iQy\aiy teXeCov EYxpdTe av tov
o(^iyyixx\{joq.

r. nrnziz kai nponrnziz thz mhtpaz

"ExovTE? VK ö\|^Ei Trjv aiTioXoYiav Tri? JtaOrioefD?, Jipo? ejiitei'^iv eYXeiQ*n^ixo^' aTtOTE«
XEG^aTO? 8E0V vd xaTajtoXEnnGCouEv 8uo oXw? Siacpopoi»; jraOoXoYixdg xaTaGTdoEig. 'H ^yxei-
pY]Oi? 8iaipEiTai ovx(a Eig Td? dxoXou^ov? xoTd x^pav EÄE^ißdoEig :

1) 'AjioxaTdoTttGiv TOij jiveXixov E^dcpoi'g ^aet' dcpaipEOEü)? Toii jiXEOvdsOvrog jrpoo^iov
xai onio^vov xoXtiixoi) toixcohoto?.

2) Movijxov jtpOGriXcooiv tri? Jipo? Td ojcigcd xExa^piEvtii; unTpag ei? (puGioXoYixf|v Oeoiv.

npOXEl|XEV01) JtEpl mxpdg JlTWGEfü; Tri? ^>1Tpa? JlETd ÄQOJrTCOGECO? TOV XOXjllXOlJ TOIXW-

^aTO? EJiiTDYXdvo^iEv ixavo.T[Oir]Tixov djroT£XEO|ia Öid Tri? JtpooOia? xai öjiiGf^iac xoXjioppaipfi?,
jüXaGTixfi? Toi5 ÄEpivEOD xai dvaid^EO)? tT]? n/]Tpa? ftid ßgaxvvGto)? tcüv OTpOYYvXwv gdv8^-
G|A03V. 'H EYXEi'onoi? xadi'oTaTai HEYaXvTFpa xai £7iin:Xoxa)TEpa etii piEpixil? ri oXtxri? jrpoÄTü)-

GECO? Tri? JA>irpa? HETd EJTlUTlxr'VGEa)? TOV xdTO) flUlGEO? a\Tf]?. 'AXXd xai eI? TlV ;tEQ{:iT(0OlV

Tai'»TT)v 8E0V jidvTO)? vd djiOKaTaGTaOf) t6 ^vfXixov FÖaqpr? xai vd GT-pEwOfi f| jiiiTpo el?
jipOGÖiav xXiGiv xai xdiivpiv. AI :nrp6? tovto £;iivoT]OEiGai ueOoöoi xai Tpojiojion'iGEi? Eivoi
JioXvdpid^oi, ÖEV Elvai oaco? JtuGai ixavojioniTixai o)? jtqo? t6 teXixov djiOTEXEGua, aXXai öe
jidXiv 8iaxiv8iJVFV0\iv t>iv l;o)f)v Tri? dppü)GTOv. 'Ejii toiovtow ßapFuov jrEpiJiTcaGFrov öev
E.-tapxEL 1^ djiXn ßpdxvvGi; xCd\ gtpoyyvX(ov gwöeg^küv, dXX' dvT' avTri? öcpEi'XopiEv vd ecpapno-
GO)^EV EYXeipriTixd? ueOoöoh?, autVE? ;rpoGr]Xo)vovv xaX(ü? ttiv piriTpav ei? Oeoiv jtpoGOiac
xXiGEO)? xai xdpiii^Eü)?. 'H VGTEpojiiilia xaTd Kocher cpspEi tiiv uriTpav ei? jioXv {)\i)T)X-nv Oeoiv
xai ÖiÖEt xaXd djTOTEXEGnaTa 8id ttI? e|aipETixd)? GTaOfpdc TojroÖETriGEa)? TavTT]? evto? twv
xoiXiaxwv TOixco|idTO)v. 'AXXd xai 8id Tri? ^ieOoSov TavTT^? jrapaTripovvToi vjioTpoÄai, xaO'd?
al av^q)UGFi? nETa|i) nrJTpa? xai xoiXiaxov TOixoVato? 6iaTEivovTai vjio ^optprjv 8eGni5cüv,
aiTiVE? öriniovpYOvv xivÖvvov EiGXCopiioEco? EVTCpixcüV eXixcüv.

a) napivdcoi^ Ti|q M^Tpa^ mcto^ü kuotcos Kai koAcoü.

*H {).^o8ElxOElGa vno xov Wertlielm xai TpojiOÄOiriOETGa vjio tov Schauta eyxf'Qti-
01? GTTipi^ETai EJti xr\q xoXjiovoTEoojiri^ia? xard Freund, i]ti? vvv ftfv eIvui hXeov ev XQ^tJf'^.
KaTd Tfiv jiapEvOEGiv xaTd Schauta - Wertheim xpil^ipiöjioiETTai w? «^d)v äeggo?» f\ \k<\XQa,
fiTi? dvEXxvEi Jtpo? Td dvo) xai Öjüigo) Triv jipojiijtTovoav xvgtiv, OTTipi^opiEvriv etiI Tri? ojii-
oOia? avTri? £;iiq)avEia?.

*H EYXFipTiGi? EXTEXEiTai (0? dxoXovOo)? : '0 TpdxTiXo? GvXXafißdvETai hC dYxiGTpo)Td)V
Xaßi8(ov xai E'XxETai iGxa'pw? nohq xa xaTW. 'AxoXovOw? axpißd)?, d)? xard thv TipooDiav

XoXjlOppaqprjv, ^KTE^lV£Tal EXXFtll^OElftE? TF^ldxiOV £X TOV JlpOoOlOV XOXjllXOV TOlXCOJAaTO?, OVTLVO?

t6 heyeOo? E^apTUTai ex lov ßaOnov Tri? Jtpojitcügeco? xai £x tov ^ieyeOov? tov jiapEVTiOf
HEvov oco^aTO? Tri? ^il^pa?. 'H ovpoSoxo? xügti? d^oxcopi^Eiat dmj tov Tpax^Xov Tri? ^niga?
8id TOV \|)aXi8iov xai Eha djicoOEiTat ;igö? Td dvo) diißXeü)? 8id tov 8axTi'Xov, xaO' ov XQO-
vov al TEivonEvai xaid Td JcXotYia Tri? ovpo86xov xvgteco? :rp6? tov TodxriXov loxvpoTEpai Öe-
g^iiSe? GVVEXTixoij iGTOV (gxeXti ^n? xuoTEü)?) JipocpvXaGGOVTai xard t6 övvaTOv. 'H xvoti?
8iaxpaTEiTai Jipo? Td Öjiigü) väo tov ßoT]Oov xaXd)? 8id tov jigooiXov 8iaGToX£a)? xai jrgoo-
TaTtVETai ovTW djio TOV TpavpiaTiGnov. iMETd Tfjv 8idvoi|iv TOV .TFpiTOvaiov To Gw^a Tri? nrj-
Tpa? dvaoTpEcpETai npo? Td Jipdoco, o)? to toiovtov axpißto? YiVETat xaTd ttjv xoXjiixtjv vote-

pEXTOJXriv, JtdvTCO? OUCÜ? HETd JüpOGOXfi?, l'va djlOipEVXOoVV JCEplTiai OVvOXaGEl? TWV lGTd)V,

aiTiVE? SvvaTov vd jrpoxaXEOf vv 8iaTapaxd? xaTd x\\\ ejtovXcüoiv. 'Edv \\ yvvx\ EupioxETai eI?
fjXixiav ixavrjv jtqoc TEXvojioir]öiv 8eov dÄapaiTrJTca? vd ÄgoßdipiEv ei? ttjv öTEiycaoiv, x\\ xqt«

t6 jrXeloTOv exreXovuev xara xx\v \jiibohov tov Madiener. 'AxoXoijOa)? ovyyldo\i?v tfiv Jtepi-

TOvaixTiv xoiXoTTira. öuooajtTOvre; hm 8i)0 ihfxqi tqkov ^Wixwv paiLipiofTCov t6 jteQiTOvaiov xr\Q,

xvdTeü)? KQOQ, xr\v ojriöOiav 8;ri(pdveiav rn; n/)TQa?, kutu to ijiljog Toi3 eaa)|LiTirQixov oxo\i{ov,

H ^riToa dxoXouOwg dTtwOeTrat tiqo; rot Öjiiöo), epiTTQOöOfcv fi'avTf); avpodotTOvrai jtapdXXiiXa

TU Toai»(iaTix« xeiXT] toiI xoXeoi) fiia Oiiv^-foxx; ex Cfoixwv ganndtTCOv Qacpfi?, av^v rdöEfo;. "Iva

TO TOiODTOv xaraorfi fii^varov, 6eov xard rnv exrofifiv toi? xoXtuxou xpriuvoii vd lr\^^\\ ex tcüv

^Oorepcov {»ji* mi^tv t6 ixeYef^og Tfjq jraoFVTiOepievrc ^iiiipa; o); dvroTepo) nSri dvacpepouev 'Edv

1) oa(pr) Toiv xoX;rixa)v xoaon;e5a)v 5fcv nlvai önvfuov va y[vx[ dvei) tdaecog, eiv«i jcQOTipiOTeQOv

ojtfo; TU TQan^arixd -/fiXt] oDpoaipTDv rjti rn; TiooaOia; ejutpaveiag Tri; l^^'lTpa? xai jiaQa-

Xei:pdfj 1^ jtQoaevYioig auT(ov jTQO^d'UriXa. Aiav eVveOTig, evexa utitqitiSo? dXXoiwöelöa

^riTQa^ ftuvarai o)oaijrü); jtqo in; Qarpn; Seovro); vd 0!.iix9vvf>fj i^i' oßeXiaia; ö(pr]voei8ov?

exTo^fjg (eIx. ^ 0—72), Tr]v JiQOTaOriaav \'äo toi' Wertlieim ßodxi'vaiv twv leQOnriTQixfliv

awSeofiCüv, fing o)? vjioöTiiQi^Frai ßeXTtwvei rd EVX^iQriTtxd änox^Uanaxa, hh e(pac)^6Co^lev

xa»' oaov 8id xavxr]^ y\ jiooYvcoaig Tri? hx^iQr\oeo)q L-rißaQuvETai eHaiQenxoK, o)? t6 toioi'tov

JtQOxujTTet ex Tivü)v OTaTiaTixwv aiTOiJ toutov tou Wertheim (ejii 262 JieQiJiTWGecov 16 JieQi-

JiTcoaeig {^avdxov). Uqo ttj; evdoieco; rfig eYXeiQrioeco; xa{>OQi^eTai to ueYe^o? Trjg \iArQaq 8id

TTJ? M-TiTQOjiriAri; xai ev jteQiTtTcooei ev8e(|eü); exTeXeirai «-(OfOTrioiaano? xov ^m[i^xvv-

OevTOc xnY\\iaxoq xov TQax/iXon.

'H EYXe.iOTiai^ Scliauta - Wert heim eivru ävancpißohoq doipaXnq wg jtqo? to d^ore-
Xea^o, dn:aiT£T oucog ^eYdXr.v jreToav x«i ei8ixmv tfxvixtiv t(ov xo?.jiix(T)v FjrF|A(3dae(ov. 'H Ovt)
(TifiOTT)? >Taoaii8VFi ueycHit] xcxi 8l' doiaTOv; eri Xfioovovoi'g, xurd tov Keifferscheid 3,4 piexQi
7.5 7„,jT()aoöTovo;tFo Flvai ^iFYa fv axFöPi jcqo; tiV GoßaporriTa ttj; hqo; OegaTieiav jta{>TiöFO)g.
'AvTi Tfig 3TQ(OT0Ti'jrov TauTTi; ^FiV)8ou jiQOTLuriTFa elvai f) u/io tov Kielland yfvojlifvti tqojio-
:toiTiöi;.Aid Tfjg eYXfio)iaFto;TauTri?aiOFTai f] ^sTa^u öcoiaxüo; xai tq xxnXou öxrmaTi'Cojxevri yw-
via Tri; M-^iyontc^xai oitw 6 rodxnXo; ^i^Taco.iiCerai ;co,\; to 6;r(af>iov xoXttixov toi'xcüm«.

nXrjv Tcoy ^Fi>o8fov toi-twv e;ri n^ixiconevcov Yi'vaixüjv öuviöTdrai r^ xoXjtixfi oXixr]
ijöTFQFXTOpiri ^FTd JinoölHctq xai ö;TioOiag xoX;rooQarp?i; y^a\ jiAaaTixf); tov jiepiVFOu. xaO'
ÖGOv Td ^i6vl^a djcoTeXeönaTa eivai e| l'aov xaXd öaov xai fjii oiaoftnjroTF dXXr); jxe^oöov, r^
TiQOYvomi; 6^10); oaov dqpoQd elq xovq xivSuvov; Tri; >r\^ Flvai waavTWc ßapeia.

6) YnonuSpcviKi^ uOTcpcKTopn »caTci AoYodcr6nouAov (')

Tr)v Vagfinifikation xaTd Schauta - Wertheim ^iPtd ri dvFv tqoäojiouigfco; xard
Kielland e'xo) eYKaraXFUl^Fi evexa rfi; gxetix(o; tiFYdXri; OvnTornTo; J); dvcoTepco epoii^r)
xui Twv o{ixi G.TQVuov u;c0TO07E(l)v. "Evexa Tü)v aÖTcov XoYfDv 8ev eKüFAfl) ttXfov xai rriv xoXjti •
x^v VGTFQexTO^riv, f'iTig xaiTOi Tiaor/ei xaXd Grarixd d^tOTeXFo^aTa. d.^OTFXFi ßapeiav xeiQOVo-
Yixriv ^^iTFMßaGiv. Elq TOiauTa; jüfoijitcügfi; iiEOiOQi^n^ai Fi; t^v exTopiriv oXoxXt'iqoi. tov
xaTWTFQOv TJi)l^xaTo; Tri; ^nTQa; ev Gvvövaa^co ^isTd rii; xoXTtOQoacpri; xai tov axri^iaTiG^ov'
iGXVQOv jTFQiveov. 'H cxteXfoi; Tn; eYXeiQnGF(o; Tavrri; elvai Xi'av evxeQ^; xai ^o\ jrapeGxev
apiGTa a;roTFXeGuaTa. 'H FYXF^griGi; avrr, elvai itapencpegn; noo; rnv iMi'nXfiv rpaxriXoTOnnv.
He Tny öiaqpopdv oti 8fv irepiopiCo^ai et; tiiv eKTon>> piovov tov TpaxnXov. dXXd eKTe|.iva3
xai TO G(b[ia Tri; unrpa; fxexpi tov jcvO^hvo; avTrl;. 'Q; fx tovtov (ov6|.iaoa rriv eYXtipT]oiv
TavTT]V vJiOTivd'fiEvixrjv vßTfoey.Tourjy.

'H eYXeipriGt; exreXeiTai w; dxoXor'.{>ü); : SvXXa^ßdvo^ev öi dYxiGT00ei8d>v Xaßi8o)v
TOV Tpdxr.Xov Tfi; ^rirpa; xai eXxo^ev tovtov iGXvpd>; ;tp6; Td xarco. 'AxoXovOco; 8i' igxij-
pa; xi^pTfi; li^aXiöo; reuvotxev to TOixco^a tov xoXfou xvxXoTepfo; xai xa{>' ÖXov to Trdxo;
avTOi- V, ix. dvcoOev Tri; ^FraßaGFCo; tov xoXttixov ßXFvoYOvov fi; tov Tpaxr]Xixöv toiovtov
cI); ivepYOiiMev xai xard rfiv xoXjiixriv vGrepexro^ulv. Elra (m^ov^iFv rriv o{,po86xov

hTr^v ^hybov xamy^v e^eiAsaa e.-rixuxö); xat6:ttv ;cgooxX)ioEa); et; tag nave^rioxri^ttaxd;
KAivixas BievvTi;, BegoXivou, Movdxou xai KieXou xcö 1943.

#■><

0 * , *%

»il

x\5oTiv Ttpo; Td avo) 8id toXvjtiov vjioßoTi&oi'VTe; tov d:toxo)pionov Tavrn; dTto tov
jAvVxov iGTOv Tfi; li^xQaq 8id mxpfov To^cüv 8id Tfi; H>aXi8o;. MFrd tov djtoxtopiGMOv xai
Tnv Jipo; Td dvo) d7ro)OTioiv xai tcüv JiXaYiwv TfiTiMarcov tm; xvgtfü);, eiGaYO^iev tov äpogOiov
xoXjioSiaGToXea xarwOev rfi; xvGTew; xai qpepouev ovtco Tavn.v o); xai tov; ovpnTrlpa; exTo;
tov» xeiQOvpYixov jte8iov. To \\br] xaraordv e^(pave; JiepiTovaiov GvXXanßdvoMev 8id xeiQOvg
YiXTi; Xaßiöo;^ öiavoi^YO^ev 8id rfi; ii-aXi8o; xai evpvvofiev to dvoiYna ;rp6; ducpoTeg« rd
^XaYia (ety. 73, 77, 7H, 79). To ovt«) SiavoiYev Jteoirovaiov HFTarojciCeTai avTO|idTü); fi tu
ßorideK? xov öaxrvXov ;tp6; Td «v(0. Jr; ex rrl; fXEfco; tm; io')Tpa; ;rp6; rd xaro). Elia 8i'
evuov pacpcov Gvppd:iT0nev to ÄPpiTOvaiov 6;ri tov m,OGt^iov ToixoVaro; Tri; ^inTpa; 2 ^', Ix.
xarcoOi Tri; liricpaveia; tov TrvO.uevo; Tfi; ^iiTp«;. Merd Tavra d^cpdrepa rd TtXdyia (b; xai to
o;tiGOiov TOix(ojia tov xoXeov (?).^ouvTai ;rp6; Td dvco. ^eO' o GvXXanßdvo^ev rd; MnTpiaia;
apTngia; 8ia XaßiScov xai d;ioXivovnev ravTa;' eXxonev elra tov rpdxriXov ;tpo; Td xaro) xai
TipoGco, ftiavoiYO^ev xai GvppdjtTO^ev to JiepiTovaiov tov AovYXaGeiov xo)oov :to6; to bm-
Gi^iov To.xfoixa Tfi; [xnrpa; avTiGTOi/o); :tpo; to vijio; Tri; tipogOio; pacpfi; tov TrepiTOvaiov.
H OVTCO dTieXFvOepovfXFvn ^ir]Tpa exre^vFrai 8id tov naxaip'ov 2 xil, xaTorOi rfi; :repiTO.
vaixfi; gacpn;. 'H Tpav^iariKf] ejiirpdvFia tov vjtoXeijtonevov Turinaro; Tri; ^^irpa; xaXvjtTerai
8id Tü)v xoXtiixcov TOixrofxdTCüv xard rrV ^leOoftov tov Sturmdorf (eIx. 6;')— HO).

Ei; 7tepi.TT0)GEi; dcpocpixri; ^i^rpa; :rFp-opi:öuef>a fI; Tpv jipo; Td dvr.) anM^oiv xov

Eiy. 54. — Pc^iHtj tyieior^nig rov xaoxlvov xov

aidoiov. 'H oxixii] yoajiiuij Öiayoäqpei lijv to^o/v

tov deQfxaxog jiQog i^aigeaiv xov öyxov.

£lx. 55, — PiCiHt] iyx^i'oijaig xov xagxtvov xov
aifioiov. *0 ^loojxoJiaOtjg oyxog f^^t i^nioei^^.

Ein. ol.—Bao^)Xiv£iog Hvaxig.

Ein. 52.— '*EyxsiQi)oiixfic:Bao&o).ivFlov xvoxeux;

xaxÖL Aoyod'exdnovXov. 'H diaQgrjx^eioa xvaxig

jikrjQovxai diä j'aC^s.

Eix. 53. — *EyXEiQr]oig xt']g Bao&okivei'ov >iv-
oxecos. Exxofit] xfjg MrjQovg ydCrjS xroTcW»

Etx. 51.

--■ ■■;A>:-- ■■".■■■ ■■/■-■.*'ÄS' W^'-'- ■" '.'■■. V -■'"^

■/4;^^'Är/,r.7».v'ifc-ips%-.'».'T-7'

Ein. 52,

EU 53.

jtEQixovaiov avev 8iavoi|ecos tovtov xal fxT^nvofiev t6 xdtcöOi tov jtepiTOvaCov tufina ttjc

'H ^YXeipiloig TiQuaii^ETai 5ia tyj? ixTeXeoecD? rng Jigoo^iag xal oniaOiag xoXjioQpa-
(pfi$ xal Tov öXTmaiia^ioi) loxvgov jteQivEOv /'«^x. 39—43).

Td dTtOTeXpanara ttj? eYXeiQncieco? Ta\rcTi? vjifiolav looov Evdotota, xa^' öoov ou8e-
M.iav vjiOTQOjifiv JcaQETfiOTioa. oSote \v\ Ecpapno^Erai avTT] vjcp' V^veI; jtctoag rag jtEQiJtTCü-

Elx. 56

EU 57.—PiCiyii fyxeiQT)oig xov xaQxivov xov atdolov. *H tpogä n}ff xofo'jg.

Eix. 56. — Pi^ixt] eyxeioTjais xov xagxivov xov aldoiov.
2x*}fii.xixt) m.oiniai.g xfj; oafpfjg fusxä xtjv i^aiQsaiv xov JiQcaxojta&ovg oyxov.

OK? jiQOjiTOJOECOv nFydXov ßaOnov. 'EEEtfXEaa 6 l'öio? 81 xommaq eyxeiqViöei?, xatd to jiXeI-
öTOv de, Yi'valxag jaeycIXti? ^Xixiag xai Aiav xaraßEßXiiHEvag. Oi etceX^ovte? Öijo Odvaioi ov-
ÖE^iiav öXFöiv eIxov jtqo; t6 eI8o? tTi; byX^i^iiöeo)?, xa^oöov 6 eI? o)q)EiXETO dq E^ßoXriv xal
6 ETEQog El? öTiJtTixfiv ovpaijiiav. T6 jtQOöov TT]? zyx^iQx\oz(üq owiaTarai eI? t6 öu fj exteXe-
01? Elvai Ei'XFQri; xal 6 xivftuvo? eXocxiöto?, xaOooov ovöoXcü? Epxopie^)« ei? E^acpriv ^erd
tf]? jiEQiTOvaixfj? xoiXoTTiTO?. 'Ejil jiXeov Öe eI? VEapd? Yvvaixa? SiaTTipEltai y\ l\k\ky\voq pvoig.

II. 'EYX€lpnO€IC KOTGI TÖ OfSoTOY.
1. 'EKTopfi Toö BapöoAivelou äö^voq kotö Aoyo8cT6nouAov.

Ek ElSlxd? JtEQlJlTWOEl? XQOVia? (pXEYM-Ovfj? EVEQYOVpiEV TT)V Ql^txfjV EYXeiQ^ölV, TOV-

TEoriv EHaiQOTjpiEv Tov oXov dÖEva o^ioO piETd xov ExcpoQTiTixoi) jiOQOv, 0)? dxoXovdo)? :

TonT) TOV ÖEQuato? xuid nfjxo? TTJ? EJiKpavEia? TTJc BagdoXiVEiov xuoTECo? xaid td
OQia xov piEYdXou xal piixpov xei^ov?. *H BagdoXivEio? xvori? djroxcoQi^ETai dußXEco? fi 8id
TOV \|)aXi8ioiJ xal ElaigEirai, id iöxvqü)? ainooQOOvvTa dYYci« ovXXanßdvovTai xal djioXi-
vovviai, TO 8e TpaiJ^a ovQgdjtTETai xaTd onßdöag. El? Td? n;XEiOTa? jieqijitwoei? 8eov vd
TOjtoOETfJTai piixpd jraQOXETEVTixf] XcoqI? YdC^l? KaTo x\\v jtaQajxEVTjv ttj? BapOcXivEiov xv-
OTECO? djcaiTEiToi uEYdXt] JtQOöOXT) JiQo? djiO(pv«YT)v TTJ? otÜecü? avTT)?. T6 TOiovTOv 5vox£Qaivei

K. Aoyo'^BXonQ V X 0 Vy rvvaixoXoytx^ XetQovQyixrj

noXy ifiv mQaixEQO) qi^ixt)v exTOMr)v ifj? xd\^r]q, xa^* ooov xa OQia TiQoq lov YeiTVict^ovra
toTov 5ev elvai nUov bvvaxbv va öiaxpivwvTai. Ugbq SievxoXvvöiv ifj? ^yxeiQYio^coq xavxr]q
loxecpdTifAEv TT|v dxoXouOov nEi'^oSov. AiavoiyouEv ttjv xuöTiv, jiXuvoiiEv Em\xeX(bq 8id cpvoio
Xoyixoi} dXatouxov ÖiaXiJ^aTo; ttjv xoiX6iT]Ta aiiif)? xal dxoXovOcü; JiXriQOvuev TavTTjv 8id
X(OQiboqjdtr\q \iexqi oxf5öv tou dpxixoi) uEyedov? avxriq. Aid Tf)? oOrco HETaTQOjrfis xov xv
OTixoiJ oYxov El? ov^jravfi öuvcfneOa dvEtco? vd djüOTtEQaTCüocouEv t^v EYXeiQTiöiv xal jaet'
daqpaXEias vd E|atQEö(onEV t6 oXov TCixco^a xr\q xvatECOs (c^x. 61—53).

2. KapKivopa tou aiöoiou.

. rEVixü); Ejtl EyxeiQr]oi[xov xaQxivconato? toi5 ai5oiou jiqoti^o) ttiv EYXeiQTioiv tng
dxTivoOEQa;tEia5, xaO' ogov 8td tqijtti? i^rTiOEd^ETai nev xaXaic 6 jtQcorojradns ÖYxog. f) |;ri-
öpaais 6ji(o? tri? dxtivoßoXia; Ijii idiv xaQxivcojiaTcoöüiv YaYYXi'cov jcaga^EVEi EtaEti To{.Xa'xi-
öTOv ancpiößnrnai^o?. "EvExa toi^tov i^ öDvÖEÖmoMEvn ^rpajiEia bvvazai vd öcoon xnXd d;to-
TEXEönara, ÖTiXaSi^i dxnvoßoXoi-^Ev tov ÄQCoiojraOfi o'yxov xal e^aipo^MEV dxoXovOco? td Yct-
YXia. ExteXo) t^v EYXeiQriaiv Eiq bvo (2) XQOvovq. l'va aKOcpvyo, xaid lo övvatov ifiv XoiVco-
^iv. Kara izQioxov klaiQ.lxai 6 :rga)To;raö^; 6'yxo; xal jaetu ifiv OEQa:t£iav rov ipamaroc
e^nxEtgEtiai Etc ÖE.TEpav E;tE^ßaatv ^ alöotExro^r, xal ^ t|atpEaig ro^v YavYX.'cov. ro^rEartv ^
QtCtxn^EYXBip^at,. Td XEMcpixd dYY^I« d'rtva E^op^x^vrat gx x^q ßaXdvov rrjc xXEtroptöo, dxo-
Xov^ovv bvo biacpoQOv; obovq : ^ ^t« xaraX^YBi ei, rd xard ßd.^o, ßovßcvixd YdYY^ia xal

z\q xd YaYYXia xaro) toi» jtoujiaQTEiov ovvSeöhov xal rd uTipiala YaYY^i«. fl 8e dXXri JiOQei'»E-
tai xard \ix\v.oq tü)v otqoyyuXcov övv8£öficov xal xuTaXriYei öuvi'i^ü)? eI? rd dvo) rov jtovjiag-
TEiOD auvÖEOfAOu EJitTtoXf]? ßoußcüvixd YdYYXia. ''EvExa toutod Ejtl xapxivou £8Qal;onEvov
xard TTiv xwpav rov» jtpoSonou dQXEi l'va ^lEid rnv alSoiExroni^v, Iv ovwvfjiiii. ExrajAOUv xai'

Elx. Ö9. — Pi^ixij Fyx-iQtjoii xov xanyJvov tou alSoiov. <PcoxoyQa<pia zöiv e^ai-
08{}£viu)v iaxiüv xaiä xi]v gi^ixijv fy^^iotjaiv.

kf'Kk«*- -1

dnrp;)TFoa tu JiXaYia tu ßnvßcovixä Y^^YYXta oi^ov hftu tov v;ro8oQior) XiÄw8oi<g iotov,
ETI xaoxivdMiüTPc 8eTfi? x}.EiT<:Qi8cg 8rov djtoQaiT/iTO)? vd fHaiQEOovv xal Td EiXEaxd Y«YYXia.
*H EYXeiQTiaK; exTEXtiTai (oq dxoXouOoj? :

KaTd tr)v :iQa)Tir]v owESgiav E£ai-
OoniAHV, Euv 8ev .-T00TiY»iv>i1 dxTivoÜEQa-
jtEia, TOV ÖYxov 8id JtepiTopifjg vyiov;
lOToxt (e^H. 54-— 55) xal 8id ouQoatpfig
xov Tpai'fiaTog 8id hehovcohevcov QO(pü)v
(ely.. 56). Metu thv teXeiov OtpaTiEiav
TOU ToaiVatog £n:axoXoi)i^£i ei, SEVTfpav
övvE8Qiav 1^ QiCixTn eYXEiQTipi?-

*H TOjif) T0\5 8EQnaT0, qjEOErai ex xx\q
bz%iaq .TQOödiov dvco XaYOviov dxdvdr],
to|o£i8(j5, jtQo, TTJV 8E|idv piTiQiaiav xw-

paV, EXEldEV 8£ El, Etipl) t6|0V 8ld piEGOU
TOV £(pT]ßaiOV l'JlEpdvO) TT), xXElTOpl8o,

Jipo, Trjv dpiöTEpdv jiTipiaiav x^'^QOtv, iva
xaTaXfild et, TTjv dpiGTEpdv ^poo^iav
dvo) Xayoviov dxav^av (elx. 57), 'Ex tov
^Eoou xx\q dx^EiöT], dvco tt), xXEiTopi8o,
T0|0£l801), Topifj, qpEpETai ößfXiaico, pf'-
dEia xo\ix\ jtpo, Td xdTü) fiEXpi tov ai
8oiov ojiEp jiEoiTEpivETai xvxXixoj, (elx.

57). ITpOTipKnUEV TTIV T0|0El8fi Tai'TTlV

T0|iriv, 8i6ti y\ VKO tov Rupprecht Eix. 60.—PtCtxr]eyxei()r]oigxovxagxivovxovaidoiov.^xV'
VJl08Elxf>Eiaa. f) cpEponEVr) 7iapa;iXEV0(0, ^"''''''^ ara:xaodaxaa,, xrj, oa^rj, V"« t^v äjxonsQdxooiv

TOV EqpTipaiov xai JiapaXXriXco, jtpo,

TTiv aaqpTivfi cpXfißa, Eivai 8vvaT6v vd jrpoxaAEan v£xpo)oiv. 'ApxopiEOa 8id ttj, E|aip£OEa), twv
EiXeoxwv yciyyXiwv, ttjv o^oiav 8vvd^£da vd evepymöcouev £v8o- r\ £|a);iEpiT0vaixü), xal fiTi,
8EV EfAcpavi^Ei dlioXoYOv, 8vaxEp£ia,. 'H Exxai^dpioi, ttj, nd^Ti, twv ßovßcovixwv YaYYXio)v
8E0V vd £V£pYn>'>fi ^v övv6X(p, SioTi piovov ovTCO Elvai SvvaTOv JtpaYpiaTixü), vd E^aiQEÖovv
TidvTa Td YdYY>-ia. üpo, tovto o^eiXo^ev vd JiaQaöXEvdacofiEv ex tü)V xdio) jiqo^ id dvco

•

ßaf>|.iT)86v TTiv jiFQiTOviav t(j5v \iv(iiv xov TQiYO)vov xQV Scarpa, o;tiö\>ev xr\c, ojtoia? evQi-
axETai r\ ^ei^o)v oacpTivf)? (pXeij), r\v \x.?.xa e^ttoxf) djioxöXXTiGiv tov öeQpiaTog, ooov t6 Swatov
:ieQi(pe()ixü')TFQOv, öiarepivouEV neTa|v fivo djioXivcoöecov. 'Ajto xov gtiheiov tovtox^ jrQoxo)-
QOWTfc? iiQO<; xa dv(D övv«VTa)H8v ru dxoXouOu jiQog aÄoXivwoiv dyYEia : "EEco ai8oiixT)v dpiT]-
Qiav xai rpXeßa, eniiJioXfjg :i8QiaÄO)|Li8VT]V Xayoviov dQTi]Qiav xai qpXeßa, xat icXog oXfO? jr^og
TU d'vcü 87ti7roXfj? ejiivdörQiov dQTTiQiav xai q)X8ßa.

H ^iEi^cov aa(privT)? rpXeij^ 8eov Ix vt'oi^ vd djtoAivoOfj xai vd djioxojifj JiXriaiov xov
anjieiov Tfj? 8iaßoXfi; aiTfj; 8i; Trjv nT]Qiaiav (pX8ß(x. 'Qg dvcoTFQO) FXexOr), öfov vd anvocpai-
Qeocofiev njv Ä8QiT0viav toi" Qaimxov xai xrevirou nt^og, xai>' ooov piovov ftid ifig ^EaioFaewg
TTig öTißdöog xavxK\q, T8X8iTai in exxaOaQioig Qil;ix(7jg xai e\Xf(ia)g.

lo xei^evov vko tov 7üoi;7idQT8iov auvSeönov yd^^iov rou Roseiiniüller ösov vd ^t)
7taQaXeiq)0fi 'A^oi> jieQaTCoOfi i'l exxaOdoiaig xot' d[X(p6T8oa id JtXdyia raaioeirai t6 aiftoiov
ey öiJV8X8ia H8ra toi» evQiaxo^ievo'u i'jreodvco auToiJ ijjtoöoQiou öijvfxtixoij Igxov toD ai'vfiFovio;
Tdg 8xar8Qa)f>ev döevixdg fxdCag (eix. 58 xai 60).

Td jiQwr.v Tiolv ÖuGdoeGTa |Liovi[ia djiOTtXeafiaTa eßpAricuOTiauv ovGiwftcoc 8id iTig qi-
Cixfjg TauTTig eYX£iQi1ö8a)g oi^rcog, dSore o Rnpprecht ejri 25 ey/.nQTiOfiGd.v jr8QiJitü)Geo)v
JtapovGid'Cei 40% novijxoi-g IdaEig. 'AxTivoßoXof'ixev iraGa; rd; 8YXe«QTli^eiaag jTFQijrTomeig
|ieT8YXeiQTiTixwg. Td ht) 8YXeiQ»lGifia xaQxivaV«ta toi. uiÖoioij ujtoßdUovTai d|iEGO)g F(r
dxTtvoßoXiav.

. KoAniKoi eYX€ipno€is eni in? pnrpas.

1. 'Anö^eoK; rnq p^Tpa<;.

^ Kaid tfiv Yx^vaixoXoyixrV djtöEsö.v o.AXanßävouEv xov lodxnXov 8id n„<g ü uäXXov

5vo aYXiatocoTüiv Xaßi8ü)v d;tö loC :tooa»(ov xb(Xo,,s xai axonEv tovtov :tt)ö? x« xdto. xai eto)

AxoXovfta,? dadYO^EV et; xf|v xotWx„xa xfjs ^,|xoa; svxa^^xov miQomh^^, ü^^, KQOobiho-

ixev avaXoYWs xüs ÖEaeco? xfj? ^t,^r^.as xf,v «o^ö^ovrav Hoo<pr',v. 'H .Teo„vn»fToa äv^^ituooc

e;«aai; Ey.ei „8n xaxato.-xiaei ^n«? ;r8ol xov ^eyeSov; xalxns »eofo,; xfi? u,)xea;. '0 xamauöc

xri; nnxQo^riXn? Scov vd y^v« ^exü (iEYdXr,; :t(>oao-/ri,s, d(pov Xr,cp()or,v in' ö^iv «J ayf^Etc

avxat tva ^ex« ßeßaiöx„xo? d;to.pevxOoi-v xoan.ax,ano,'. Aev d^xo.-tE.eoVsOa vd E!oaY«Y»uPv

ßiaiw; x,,v ^r,Xr,v, oxav Ettqp„v(tExai o?«8,i;xoxe hvoxi^ua, Ü}X «vaßdXXo^EV x,> E;tEMßaa,v 8tu

xnv EironEvriv „jtFoav, ottÖxe E;nxvYXdvon6V xaxd xö ^XEiorov xö jxoOoiVevov 'H |«xao.- 8td

xn; ^riXr,? nlyo>foo.l ^jxd; dxotß.ö; n.^X xoT, ,xeye»o,.; xai xn; ;xopE>a; xfi; juixgtxfj; xoaö-

xov Hegar T, uXXcov Staoxokcüv a;xoS60n£v xnv firixp.x.iv xoiXox.ixu 8i' ö^eoc Eeoxoov dvpv
aaxMaEco,- .oxvgdg Suva^Erog. 'Edv .poxE.xa. :xEpl ExßoXr,;, fi.aaxEXXo^EV xöv xpdx.Xov e?c ue-
yaXvxEpov ßa,Vov ayaXoYCo; xov ^r,vo; x% xvr,aEa,g xai xov .eyeOov? xo> v.oXEt,^dra.v xSc
sxßoXn?. Kax« xov; 3-4 «pa)xovs ^.|va; xf,; xv^oeco; ^ExaxEtglto^ac d^tßXEa lior^a 8td xi
EXXEVcatv Eav xpoxE.xa. vd dq>a.gE»ovv dxö^, ^syaXvxEga x^n^ax« ;xXaxovvxo; f) la&oL
xoxE xonat^o.TOta. xf,v Xaß!8a xov Winter |^ x6 (.EY« |Eaxgov xov Bumm. Tf,v iXTZ
xov 8axxvXov ÖEcp«. .oXy 8vaXE0EoxEp«v x«l ovxl axo..,coxEp«v. oi 8e Ix xf,, l^H^Z
xavx„S x.vSvvot ov8oXa); sXaxxovvxat, ,ö,- ;toXXai oxax.ax,xal «;ro8Euvvovv. "Oxav J l" ^a
exet xaXo,, avoxaXfi 8vvd,E»« vd ^ExaxE.ptaOÄ.sv ,Exd x% .poar,xovar„ .dvxoxE .poooxn"
xa. avEv ßcag .EYaXvxEpov oEv ^Eaxpov, Iva d.o.axpvvo.^ev xd xEXEVxata xE^dxca .Xaxovvxo/
E.t xovxov «.o8t8o, ^EYaX,v ..^aaiav, 8.öx. al :cdoxova«t d.aXXdaaovxac xfov .ova)v xai
x«,v a.^.oppaYta,v ,Exa xnv e.E^ßaacv. Msxd xf,v xeXe,„v exxevcoo.v .fj, ,yixoa, i-x„XE(,pa> xTv
xoiXoxnxa avxnc 8.« ßa^^axo; la,8£ov xai d:xo,pEvva) xnv ;xXva.v xai xöv ;laxtauov 'H
mnoppaYia xaxa;xavEt et; ;xnaav wpi;tx»atv, Eq,' Saov ^ n,'|xpa to«yk«xi 8ev Lt^VE. ^1^"
v.oXEtM.a.a .pov. "H oXr,>E,ß„a., EvxEpaivExa. 8cd xn, Ix uov^lUcov ivr;:ripYox°!

Vrig T) v;ioq)voiVT]g, 8i* ü)v f| xoiXoTTig Tfig ^ilTQag G^ixQvvETai xai t6 tcixca^a avTfjg xa{>i-
GTaTai GxXriQÖTFQOv. '0 xaXapog xoXjiixog jKonaTiGnog, OGTig piETd ttjv eYXeiQilöiv evepYeiTai,
dqjaiQEiTai Tf]v ejccnevriv iQntQav.

'EnmAoKai Karci Tijv dnö^coiv.

'H JiQOcpüXalig UÄO Tfig koi^uco^eu)^ bh e|aQTdTai xard t6 jtXeloTGV Ix twv xeiOi^ncüV
xov XHiQOVQyou dXX' ex tt); xard t6 ndXXov r\ tittov dGnn;TOXJ xaraöTdoFcog to\» jieQiexonevov
TYJg nr'iToag. 1 fjv xaXuTeoav aGqpdXeiuv jiQog djtocpvY^v TauTTig Jiapexei t^ ejnnEXrig, dvev imo-
Xei^^dTwv, xevcooig xr\q \ir\XQaq \i^xu. TTiQiiGecog öX(x)v tojv xavovcov Tf^g aGTiiplag. "OXcDg dvTi*
\>Fra)g fj didzgrj'ii ; Tr\:; iir'iTQag 8r]HiovoYFi EÄiJiXoxriv, ring xaTd i6 jiXfigtov ejußaQV'vet tov
'j(,'-{QOVi)yov iriTjdv, uv xai 6[ioXoYOiMiFv;j)g eig nvag löiaiiFQcog dti'XFig JiFQiJiTo'iGFig, to |iaX-

Elx. Ol. —/\iji/ifj didtorjacg iyxv/twvog ^^tgag (5ov /ntjvog). To xaiaxsi.iaxtn{^h efißovov i^fjA&sv oltio

XTJs fXi]XQaq eh ttjV xoiXiav diä xf}<; fie'/d?.t]g 6nt]i Öiutq/joeco^. Kaxä xi/v iA.iy.odv ojiijv it]V EVQinxofievr]v

xaxd xov Ttv&füva xfjg fi/jxgag jiaQaxrjQsi xi; xö ivxdg xijg fxrjxoag eXxvo&kv enijikovv.

daxov oxeSov nt) aiGOriTov Toixcoua Tfig eYxi'novog uriToag elvai SvvaTov vd SiaTgTif^ü, dvev
Ttvog (maiTiOTTiTog aiJTOi) xai fjii oXcog dv^joyov TFXvixfjg. Ovto) dpia tfi evdolei Tfjg ejiepißd-
08ü)g elvai övvaTOv vd 8iaTQTii>xi ^ M-^lTpa 8id tng |.iTiTO0nriXT]g. Evxvotfqoi eivai oi Tgavua-
TiG|ioi TOV TQaxriXot» evExa ßiaiag 8iaGToXfig 8id tcov xtiquov tgv He^ar, ojiote SiÖFTai eig
TO HeGTQOv eGcpaXpievri xaTeu»>i^vGig. Tovg ßapuTegoi^g TQav[xaTio.uoug jtaQaTTiOEi Tig m"' eGcpaX-
lAevTiv XQT]öi|iOÄOiT]oiv Tfjg Xaßiöog Winter, iöi'q: otav f| doxi^('>? jrQOxXriOEiGa ÖiaTQiiGig öev
Yivii dpiEGCog dvTiXr]7tTf] xai 8id xx\<; jiQOxXridEiGTig OTcf^g eXxdgöovv JCQog tov xoXe(v xai e'Ico
O.VX0V svTEQixai E'Xixsg Ti £Äin:Xovy. Eig |iiav nETaq)EQOElGav Eig ttiv xXivix/jV \kov xai vk
l\kOv EYXEigT]9eioav jieqijttcogiv to finLT8piaxiGv)EV eVßgvov bov ji-nvog wXiGdiiGe 8id neGOu
tfjg fiEYdXrjg ojtfjg Tfjg öiaTgriGecüg jigog ttjv xoiXiaxT|v v.o\Xdxr\xa xai öid [kioov jxidg h^vxi

aii^^mrmmmam»

vkinmtm^mmma

QCtq 6KY\q EXQE\iaxo [iiya Tepiaxiov ejiikIoov eviog toxi xoXeoi'. koiXiaxi) iJöTeQFKro|iT) [ifi^ djio*
Xi\lE(i)q Eiq l'aaiv (elx. (U).

npog djioqpDYnv dTvxnM-aTOg 8eov vd 7Qr)öiuo;ioif]TaiT6 d|i6/\oYOv rcp övti eQYaXeiov xov

Winter wg dxoXovdcü? : 'H dpiöTEgd xeiQ TiepißdUei tov :iu{>neva rng |LiT|TQag, ojtore aw)

aio^dvetai oacpoig tt|v Xaßi5a eiaaYOfxevrjv xXeiaTnvdvev mkouoq \iin^i xov KV^\x.ivoQ,(elx. 62).

H Xußig dxoXoui^co; djio roD jiui>nevo; üXlyov d;roöüpETai xai totf t6 jiqüjtov dvoiYetai

(ey. 63). Ta evoioxo^ev« sv tfi n^to? tE^dz.« toü «XaHOPvto^ ^ tof, ^Mßpvov eta^ovovtai

TOS x,5 ,,rpas. Eav xara tnv i^aycoyr^y rov .XaxoCvro, 8.« tn? Xaßt8os .goa8a,ao)iv "ic
avTnv :.eo.otpo,ptxr,v xtvr,atv ^tqo; rö gv ^.Wvtov (eU 64) eMrvyxdvera. avv,«arara <) e|„-
Ya>Y1 tov. nXaxo.vtos sv x,^ avvoXcp. Ot xeteto^oi oi)Toi i;xavaXa^ßdvovTai j^expi d^aieeaeo.«

£i*x. 63.--*Eyx'£iQT]tixi} OsganBia tijg ixßoXijg. 'H Xaßig anoavQexai xaxd xi nai diavoiyexai.

Elx. 64. — 'EfX'^^QTI^^^h ^fffct-^*'« ^fjg ixßoXrjg. T6 djioxolXrj^ev tfitjfia nkaxovviog sXxexai TiQog xä £$(0

iv(^ ovoxQi(pexai ff kaßig Winter,

• t

toij 6Xou jiXaxoOvtog, ojtöre ^(papnö^opiev ttiv djioEeöiv XY\q firjt^ag. H ovoxo'kr] tAv int)-
tQiaiü)v TOtxa)|idio)v änoxeXn djioöeiHiv xr\q reÄeia? exxEvwoEOjg tri? firiTQag. 'Edv ti^ e'xn Tr|v
ßeßaiOTTita f) xai jxovov irjv ujioipiav ort öiFTpriae to roixwna, tote öiaxojiTEi Jidpavia otov-
SrjjcoTe JieQaiTfQO) evftopiriTQiov xeipit^nov. El? Y^'vaixoXoyiKUs djio^eoeig, t6 toioi5tov äxvxrwia
ov\r]&0)g 8ev exei öoßapdc; ovvtJieia?, öwd^ieöa 6e vd dpxEöO^oiiLiev dq x)\v ovoxaaiv dvajiav-
oeoiq £iq xr]v xXivtiv xai Triv TOjtodETTjaiv xi'^öTECDg Jidyou ejti xr\g xotXia;. 'Edv epiqpaviödovv
JcegiTOvaixd cpaiv6\ieva t) ä\XEOoq XajraQOTOf.iTi dn:oßaiV£i dvajioqpEVXTog. 'Edv i^ 8jdrQT)öi5 ^Yf"
VETO x<iTa TT]v dcpaiQEaiv vnohinndxoiy exßoXfjg £XTeAoi»nEv dpiEoa)? XajrupOTO|xriv. ITqo? piEya-
AvTEpav äaq.d'keiav eveQyovjiev ttiv E|aiQEaiv Tr\q XQav[iaxio{^eiori(; \i\]XQac, bwd[Hi&a ö[io)q
XQT e|aig£aiv vd dQxea^copiev EI5 Tr)v Qaq)r)v tt]? X^Qa? ttj? ÖioTQriöECo;, tdv el'piEi'^a ßeßaiot
^TEQi xf\q äoY\\i)iaq xov xeiqovqyoi', ooiiq £|eTeXEae Trjv djr6|£öiv ttI; [i\]XQaq xai edv jigoxEiTai
negi [ir\xQaq [lex' doriJüTOv jre(>i£XOfievou (öiaxojif] xvr\o£0)q).

2. 'Eyxeipnoiq naAaiQv pq^euv toü TpaxnAou.

Ai TtQOxaXoiVevai xaTa tov toxetov Qr\leiq xov xQai}]lov \x^xd xu)v EJiaxüXot'{>ovvTa)v

lxTQOjria)V ÖTmiOVQVOW EVIOTE EVTOVOVg EVOXXIIÖEI? OUTOIS.WöTEEVÖElXVVTaif) EYXeiQTiTixii änO'

Eix. 05 xai 66.—

'ErxeiQrjoc, ^aXaca, Q^^eco, r^v r^a^^Xöv rfi, l^r)^Qa, xaxa Sturmdorf.

a) Kajd Rozer-Emmet : 'ExTo^n toiv ox',Xaiv, TEXEta VEapo^rotnoig to^v vecXeov KaTd
pv pa^,v T,, pnleco; 5eov vd a.XXa^ßdvco.Ev xaXa>, Tnv «vco va>v(„; t 0 Tpa^^a^^^^ ZI

or«ac «„ö XOX.L xo o^r^ot "h^^^^^^^^ " ''"'^"'"^ ^'"°^'^°^ """"*'-

Ä?

£'/x. G7. — Aiatofii] 10V ioa/ij}.i>v y.uiä Hozzi.
dia atixtr}^ youfifii}<; ujittx6yi:fig xfjs <po()äi

Ki/i (JS. — Aiatofu/ lor lou/i/kov aaiä Pozzi,
^Ex xtjq zoavuauxri<g enKfaveiag xov dgiaisgov
nkayioxi ixiijixvsTui aq?tjvoeid€s xe^iä'iiov, d<|(ä
TO xgavfiaxixu X^^^l A*^^« '^»' e^aigeaiv n^f
cKftjvos (ivgodnTovxac fx veov.

'^mv*m$mm!^-^^at^-^

'>it*i/^4»t

Eix. 69. — diato^tj TOV xga/jj/.ov xaxä Pozzi.

Eix. 70. — KoXjiixi) oßs/.iaia exiofiij xf.itjfAaxos

xijc fii^xgag xaxä Aoyo'&eidnovXoy. 'Ex xfjg

dvaoxQaq>eiorjS :jxQ6g xä Txgoaco firfxgas i^ai-

Qeixai otprjvoetdkg xtfid^iov^

TEjiaxiov, o^Tivog f\ ßctoi^ xaiaXanßcivei ty\v oXr]v xoXeixT)v fiotpav, f\ fie xOQvqpT) (^vtiotoixei

elg t6 vx^oq xov eoo) uritpixoi) oxo\iiov. Ovico et? tov xcuvov rovtov JCfpiXanßdveTai fi oXt]

xdTO) ejTKpdvfia rrjg evÖoxoXeixfj? pioipa? toi) xQaxr\\ov xai 6 8v8cTQaxr)Xix6g ßXevoyovog. Ai'

loxvpa? o^Eiag Xiav xt'orfi? ßeX6vT)g 8iajteQd)[A€v djio tov xoXjiixgv ßXevoyovov 8id [iiaov xov

jcaxovg toO TQaxTiXixov TCixcopiaTog jiQoq xov avXov, tlq xo v\\)oq xov eoco ixtitqixov otohiov

Jiaxi^ Cö)ixüv pdu^ia xai oÖTiYovpiev toi'to jiQoq xä tqü) tov utitqixov öto^iov. 'AxoXovdox; äcp' oZ

ovXXaßa)f.iev 8id xr\<; uvx\\(; ßeXovTi; tov xoXjtixov ßXevoYOvnv xotu Tf)v neoTjV YQöMPi'nv vJieQdvco

tov TQttXTiXixov TQaxVoTO?, ejiiöTQEcponfv öiajiEQwvTEg xttT' (ivTiÜETOv xaTEVi^vvöiv, iJtoi d^OTOli

^vöoTQaxTiXixov aiXov (jiapd ttiv 7CQ(0TT)y f|o8ov ty]? ßgXovrig) 8id \iioov xov ndxovq xov tqq-

XilXixov TOixoVaTog tiqü; tov vjreoüev xoXjiixüv ßXEvoyovov" i^ ßeXovT] l'^egxETai et; djioaTa-

01 V 1 exQT. jrXaviwg xr\c, dRr\q xr\q ngjjxriq Q«qpTi?. KaTa tov d^naTiopiov Td)v 8vo dxpcov toi»

pannaTO? eXxETut 6 xoXjrixog ßXevoyövog löXVQwg jigoq tov tquxtiXixov avXov xai dvTixaOiöTd

Ti]V exTUTideiGav eowTEQixfiv avTov EjitqpdvEiav. T6 ai'TO L-tavaXanßdvofiEV ev dvaXoyit? ejti

XY\q bmo^iaq [loigaq xov 8iaTan8VTOs TQaxriXoi'- Kut' dpicpoTEga Ta ^Xavia Ta oxiano£i8fi Tgav.

^QTa ovyxXEiovTai 8id tivcov xoivwv gacpwv (elx 65-66).

3. AiQTOMn Toö TpaxnAou kotq Pozzi.

H öTEvcoai? TOV e'Io) ixTiTQixov oTO^iiov 10 n:(joxaXovGa tXq xivaq jTEQiJtTCüaEig öteiqcoöiv
Sev 8vvaTai ^ovijxcog vd dEpaÄEvöfi 8i' d(5ay(üyx\q Xanivapiag x\ 8i« 8taöToXfi; 8id twv xt)-
Qiü)v TOV Hegar, TovvavTiov 8id twv jtooxaXovuEvcov nixpoiv TQav|.iaTio^wv eviote EJtiJCQOa-

Tl^EVTQl^ EIS TT> JlOCOTOJia^fj GTEVCOOIV OiUcüSeI? ÖTEVCOÖEig. ElC TOlüVTa? JlEQlJlTCOaEl? EXTE-

XovuEV EJiiTvxd)? TT]v öTo^aTOÄXaöTiKT)v. xttcd Pozzi, xaO' fiv 6 TQdxriXo? TE^iVETal EYxapöico?
ovTfog, oSöTE Srmioi'QYovvTai 8vo TQfxv^aTlxal ejiicpdvEiai övvEXopiEvai xaTa t6 M^aov. 'Ava-
Xoyco? TOV ßa^^ov Tf|C öTEvwoEwg fxtehvouev ll exdöTTig Tpav^aTixT]? EJitcpavEia; dvd £v ^il-
XQov xa)V0Ei8£s TEMdxiov xai öVQQdjiTOUEV Td TQavMaTixd xdlx) xy\q EXTOpifJs JtQÖg dXXrjXa
8id Ccüixov gdnnaTO^ {eIk. 67—69).

4. I^nvociönq tKTo\xi\ TpniJOToq Tnq PHTpaq Korä AoyoÖCTonouAov.

'E;rl atuopQaYid)v veqqwv yi'vaixoiv, xad' aq hkv Elvat 8vvaT6v vd E(paQ^Oöi*>ii axTi-
voßoXia Ti voTEOEXTO^ii, EVExa xr^q dvdYxn? 8iaTnQriöEC0s x^q E^nnvov pvoECog. Etpap^otouEV
T»]v axoXovdov jA£{>o8ov :

^ 'ExteXov^ev ;rpooöiav xoX:roxoiXiOTo^riv. 'Acp' o{5 6 ttvO^tiv Tric m,Tp«s 8,d ttj? an-

onnsTrKxotXiOTO^fis-dvaaTpacpii xai EXxvaör, irpo,^ tu E|a). GvUa^^ßdvo^Ev tovtov xaT' d^-

q)OTEpa TU ;rXaYia jtXiigiov x^q ExcpvGECo? tcLv acpoYYvXcov gvv8eghcov 8i' aYxiGTponcüV Xaßi-

8a,v xai q)Epo^Ev irapaXX/iXa)^ ;rpo5 Td ;rXdYia ^dlx^ x^q ,^^xQaq xai nq änooxaciv 2 Ix, ;rE-

pi:TOv^ä:r^ avToiv apiGrEpd xai 8£|id £:ri^ifixEi, TO^d, ^Expi tov egco ^r^Tpuov GTO^fov o^^TCog.

(oaTE EXTE^VETai EX TOV Gco^iaTO? xcovoeiSe? TE^dxiov, o^^Tivo? ^ ßdoig dvTiGTOiXEi eIc t6v nvl

fXEva xui , xOQ.cp^ etc tov IgO^ov f./.. r^^y. 'H at.uoppaYi'a xaT' avTr,v Elvai "^axiGTr^,

xa{> oaov f, ^egt, ^olpa xr^q ^^xgaq Elvat :rTCOxn dq äyyeXa. ME^xova)^iEv«t d;toXivc6GEi, 8£V

£tvai a;rapatTnTOi, :rpoßatvoM£V 8e duEoco, Eig Tr)v pacp^v dpxo.Evoi d.TO tov ^rv^Mevo, ngbq

xaXXiTEpav :rpoGap^xoYnv T(Lv8vonu(GECOvr^^;< 71-72j Mexä thv TO^roÖETrjGtv SXcov tcov paq)d>v

^iE^ovco^Evo), xaTa Tnv o;ttG^<>(av xai .poG^Xav E:rtcpdvEiav :rpoo,Xc6vo,Ev 8td tivcov pa(pd,v t6

^•piTOvaiov Tns xvGTEcog, a>g xai xaTd t^v xvgtioxoX.ix^v .«qevOegiv xr^q ^r^xgaq. dq ogov

t SvvaTOv xaTcoTEpov G,^Elov TOV 6.1G01OV TOtxc;i,aTO, xr,q ^r,.gaq xal gvyxXeio,ev dxoXov-

^coq xo XOX.IXOV Tpav.a E.Eiöf, axo.6, xr^q EYXe.priGEco, TavT,, Elvai ^ 8iaT.ip,Gi, cpvGio-

XoYix,,^ E.,,vo,pvGia,. ÖEOv avT, vd EXTEX^Tai ,6vov 1.1 cpvoioXoYixo,, XEuovpYOvadiv

D. 'Ynonud^icviK^ ^ktom^ rnq pn^pac; kqt6 AoyodcTÖnouAov.

'AvtI Xr\q |.Ie{>680V XY\q O(pY]V0£l8oV5 IxTOJifJS E^ETeXeOO Eig TlVa? TtEplJlTCÜGEig TTlV VJIO-

jivO^EvixTjv 6XT0jxT)v xr[q utiTpas piETd £|aip£Tixov djtOTEXEonaTOs. Ka^' oaov eI; Jidoag ids
JtepiJtTWOEig TavTa; xaT(op^d)f>T] r\ 8iaTT'ipT)ois xr\q eh^t'ivov pvoEcog het* oXiytic d:tü)XEiag
aijAaTOg. 'Qg ex tovtov JipoTipKo t»iv pi£0o8ov TavTtiv Elg jiEpiJiTd>aEi(; al^oppaYiojv, xaö' äq
jrapd Tdq ETtavEiXi^fAHEvag djio^EOEig 8ev EjiEpXETai t6 dÄ<^TEXEG|ia, f| 8£ dxTivoßoXia xal fj
dqpaipEGig xr\q \x{\xQ(xq dvT£v8EixvvTai EVExa tov vEapov x7]q f|Xixiag twv Ywaixdiv.

*H £YXeiQT]öig exteXeItoi d)C ÄEpiEYpdcpri avTTi f\q xäq jrpojiTCüOEig xf\q i^riTpas.

6. KoAniKi'i 6AiKf| uoTCpCKTOMn*

'ExteXovuev TauTTiv Eig djiXdg jiepiJTTWGEig EJil ■nivi(]xr\q xal ovxl ^^aipETixüjg \i^yaXx]q
HrJTpag wg dxoXovOwg :

MsTd £x;iTv|iv TOV xoXeov 8id xoXiioSiaGToXECüv ovXXafißdvojAEv tov tqoxtiXov 8id 8vo
fl TEOGapwv novo8ovTiX(ji)v Xaß{8a)v xol eXxo^ev tovtov Jipog Td xotü). 'AxoXovdcog tejavo^iev
jcEpiqpEpixwg TO xoXjiixov TOixcopia xaf)"' öXov avTOv t6 jrdxog 8i' loxvpov xvpTOv \i)aXi8iov,
Va ex. jiEpfjiov dvo) xr\q nETaßanxfig ^üjvng tov xoXjiixov jigbq tov TpaxTiXixov ßXEvoYOvov
(elx. 73)^ EiTa djtoxoXXd^uev t6 xoXjiixov TOi'xfjDi-ia öXiyov Jtpoc Td dv(ü, ev piEpei dpßXecog, ev
fiEpEi 8id TOV \|;aXi8iov. 'Edv to jifqiexopifvov Tf]g piriTpog 8£V Elvai djioXvTO^g doTiTiTOv, ovX-
XapißdvopiEv dpupoTEpa Td yj^ili] xov xqux^Xov 8i' dyxiGTpcüTcäv Xaßi8ü)v xal ^lEid JiEpiqpEpixcüv
oiq dvcö jcEpl TOV TodxTiXov T0(.ia)V, ovQpdjiTOpiEv TO jTpooOiov JTpög TO ojiiodiov xoXjiixov
TOiX(0|ia 8id nEiiovco^iPvcov pacpcJlJv ovTcog, üSgie t6 utitqixov üx6\.i\.o\ gvyxoXvjitetoi teXeicü?
(ein. 74—76),

'E;il GTEVov xoXeov SiEi'pvvo^iEv avTov Evx£p<»ic 8id 8vo TO^aiv xaTd Td 8uo avTOv
jiXaYia nr'ixovg 1 — 2 Ix. T6 TOixcona Tfji; xvgteo); dvlXxETai dxoXovOcog 8id xenjovpYixfj;
Xaßi8og xal 8id piixpcov Topicov SiaTEHvovTai at xvoTiOTpaxTiXixal 8£oni8Eg, oatpcäg Siaxpivo-

piEVai, OVTO) 81 fj Xl'GTl? dTttXEvflEpOVTai dÄO TOJV OTEppCüV .TpOOqJVaeCOV aVTTJg HETO TOV Tpa-

XnXov (ely.. 77). TLobq irepaiTEpo) d^üiOiioiv xr\q xvGTECog X0'^löl^lO7lOlov^^Ev piovov tov 8dxTV-
Xov, xaO' ogov ejiI XQrpipiOÄOu'iGEOog toXvjiiov r\ TEpiaxiov YdC^i? f\ JtEpiTOva'Cxri jttvxti Et'xö-
\ioq GVUJiapaovpETai Jipoi; Td dvo) (e'x. 78). 'Ajioq)£VY<^Mev ovtco ttjv pn|iv tov TOixcopiaTOg
xr\q xvGTECog, ev jt£QL;iid)OEi O[i0}q vjidp'^ecog 8iT]0T'iöewv ti GVH(pvGEü)V, Mq xb toiovtov owt)-
Oco; GvpißaivEi ejiI xaQxiva)|iaTa)8ovg [.niTpag, f) xvgtk; 8i-ov jiovtote v' djioxa^pi'Cetai 8id xr\q
Xaßi8o(; xal Toi5 \|jaXi8iov. 'Acp' ov djtcoO/iGcouEV xaXd)g Tiobq xä dvco xal .pog Td jiXdyia 8i'
dpicpoTEpcDV Tüjv 8eixt(Lv xul Ty]v jiXuYiav pioTpav xr\q xvGTto)? (elx 101) EiGayopiEV tov jrpo-
odiov xoX7to8iaGToX£a xaTCO xf\q xvgteo)? xal cpEpojAEV ovtco tt)v xvgtiv xal tov? ovpTiTfipag
EXTog TOV £YX£ip'nTixov ÄEÖiov. T6 jiEpiTOvaiov dvayvcopi^cVevov 8id tov Xevxov xal gtiXjivov
XpwnaTog, ojiEp Ti8Ti oaopibq 8iaq)aiv£Tai, dvvipovTai 8id xeiQOi'PYix^i? Xaßi8og, 8iavoiYeTai
8id Topiris TOV \ljaXi8iov, 8iEvpvvonEVT]s Eha xi\q bnY\q ngbq dpicpoTEpa Td JiXaYia (s^^- 79).
'AjiopiaxpvvopiEv TOV jrpoG^iov xoX;io8iaoToX£a xal EiGayopiEv EvpvTEpov toiovtov Ivrog tov
jrepiTOvaixov dvoiYnaTOi;. 'O ßor^Oog eXxei tov xoX7io8iaGToXea iGXvpdx; Jtpog tt^v ^ßixTjv
Gvpitp^^oiv, djioxoXvÄTOjiEvov OVTO) TOV jipooOiov TOixcopiaTOs Tri? l^ilTQai;, ojtEp ovXXonßdvETai
8id 8vo8ovTi,xfjs r\ jroXvoSovTixfjg XaßiÖog xal l'XxETai Tigbq xä xoto), £V(p 8id xr\q äXk^q xei-
Qoq djTcodEiTai 6 TpdxilXo? jipog tov ÖjtigOiov OoXov tov xoXeov (ely,. 80). To dvo) xr\q äyy.i'
OTpcoTTJ? Xaßi8os xaOiGTdpicvov opaTOv Tpifina tti; ^r|Tpa; ovXXapißdvETOi 8id 8£VTepa5 dYxi-
GTpWTfis Xaßi8r)s, l'XxETai Jipo? Td KaTco xal dTiopiaxpvvETai f\ no(ßxr\ Xaßig. Ovtü) 8id tojio-
dETTioECog dXXE:taUT)Xo3v Xaßi8a)v dvappixcopiEda öXiYOv xot' ÖXiyov ejii tov jiQOodiov toixco-
M-OTO; xr\q ^rJTpag \isxQi lov vipov; tov jiv{>pi£vog, ögti? teXo^ E^Kpavi^ETai ngb xov ai8oiov
(eix. 81). 'Ek\ EvpiEYE^ov; piiiTpag 8ievxoXvvohev ttiv xaTaojraGiv tov jiv^hevo?, ovXXajißd.
vovTE? 8id Td)v Xaßi8ü)v ovxl t6 ^iegov dXXd Td jiXdyia T^rinaTa avTOv. Ovtco JiQoßdXXei

TiocüTOv TO dgiötepov, uxoXouOco; be c6 8e|iov xepac. *Eav \\hr] eXIca^EV lov rpdxriXov 8ia tü)v
äyxiafQ(xix(i)v Aoßiftwv fx veou tiqck; tu f'^o), fi o>.t] [ir\TQa ^Fpeiai jtqo toC» aiÖoiotj (elx. 82).
Ai' tiöaYioYn? f-vro^ xx\<; TiFpiTOvauf]; xoiXoTTiTog ineYaXric oOovt]; ya^^z öuyxQaTOiJuevri? 8id
Qd^inatog, :raQ8HJTofti"c;ET«i ^ -nQonxiüovz tcov evTFQix(I)V eXixcov, xaO' ov •/Q'^vov ^ uriTQa eXxf-
Tui lox^Qo); ^C>^^? Td fte^id, nüXXanßdvouev 8i' loxi'od? Xaßifto? ei? «jioöTaaiv 1 Ix. jiegijiou
ano xx\q \ir[XQiX(; tov doiOTFQov oxQoyyvAov öüvöeöpiov, Tr)v adXjiiYY« xö'i tov i'Öiov öuvöeopiov
Tfjq a)Oi>rix)i?, vkq tov dxoißr) FXfyXf^v tTi? dcpfic x«i Tf)? 6()daeo);, i'va ttJioqpuYW^ev Tr)v övX.

A7;«. i 1 .--KoAjiiaii ußs/.ijLia t>:iouii i^u/jf iu-
ra^ tf/g ^rjumq y.axa AoyoO^txöncvXov. 2*'o-

Qa(pti xwv T()avfiazi;<(hv Liicpavciojv loü om-
oOiov xoixo\naxog Öiä fUfioyco/aroiv oatfwv.

Ein. l^i.—KvX.iixi] oiiUiuiu rxiofiij xfiijumos
^'l> .«','*,>a>'' >i(^i(i Aoyo^exonovkov. l'voQuq>t}
xwv xfjur^uxiy.Cv ejii(pavEi(bv xov .t(Jor.i>lov roi-
X^niaxo;: r?),- fujrQas. T6 .-xoibxov xaru xov :jv&-

XnxKiv uXXot, ttvo? ooYuvov. Tu ovXXwfHvta e^c.gr.'mcau tafT« fium^vovtat 8iü toD Wt-
8to„ axpcßu.; ^«ea t.V ^ntpav. Atä c.v.xov; eX^ecog xns ^nto«; ^gö? t« Ss^ta o.XXa^ßdvo-
Jt.v ex Ta.v xaTa> 8t« Se.repas tox^oü; J.aßiSo; rf,v äoiOTeeüv ,.r,tp,a(„v äprr,o(av xai töv
lEOOHTitguov oyv8£onov xai ftta«^vo^i.v ravta 8.« toü y-aXtSfot, dxe.ßö,? ;ta9Öt ifiv nr'itoav
• ^ üt «VTOi xaetatxol EHTfXovvtai 8i' gXlECo; tfi; n.'ite«? ;toös x« «piotfp« E;tl tox, SeE.oC
TÜaywv (elx. 83). . ^

'O jiXdyio; xoXjioSiaatoXEV? E{ofaxETai ;tdvt..TE im xov jtXavfo,,, xad' 8 dxQißtöc 6
XEtpoyoYü? EeYdSetai. Elvai d,tüeaü„tov iVa (i,', ä.TO^axQiW.ir«! tig djtö rne u^roac wöc
aocpaXn a^xocpoY^v Teax,ttar,anoC toC ote„Tfipos. 'E;ti d;tXä,v ;rEQi;ctcoaECüv slvat Swatov fi
oX^ ElaipEai? r,|5 untpas räyi xfj? q,daE«s xaOxr,s v« 8iaoxEon 1 '1.-2 Unxä. 'AxoXov»Et «
öia ßEXovyis a;toX>vü.oii tÄv ovXXn<pOEVxcov 8.« töiv Xaß(8ü>v xoXoßa,j.dxa,v. 'AoyöuEÖa d;t6
xns Ex,XE0EoxEQov ^pocufj? X«ß(8o;. S.tc&Ev x.^ 6;to(as 8taxg.;rA^Ev 8ui x%"ßsXövr,, xö
ovXXtkp^ev xoXoßcotta xal dji^axftoMEV xö ioxvpov ^oucv ^d^^a ;,eä,xov .-.pös xö avw xal
«HoXou&ü.; ;t0os xo xdxo) xn; Xaß(8os, 8eov 8e v« :.pooExa)HEv l8tmxEea.s I'va xö pd^ua axpaY"
naxvx«>s^ «ptßdXXn xö axpov xf,; XaßCSog f./«. S4;. '0 ßor,{>ös SmvoiYEi Tr,v Xaßi8a xad' 6v
Xeovov exxeXeixoi, ;toXv ßpaSECOs, 6 xd^ßog, xcoplg vd nExaßdXi, x^iv deo.v avxns 'A(p,',vEi

ßi

.■

Eix. 73.--Kok:iixij i'oieosxtofit'j. Tö y.oX.tty.dv
toi^cof^a te/nvexai Jif^oiqyeoixtog diä xov xvoxov

tfakidiov.

Elx. 74.— Ko'/.n xi] voxFoexiofiij tm m,niixov ne
Qiexof.dYOV Ttji; fitjXQn^. Mexa xtjv ovXXr]-tpiv lov
:iooodiov xal onini^iov XQax'jXixov yeiXovs öi*
ayxioxQioxviv Aaßidcov, xtuvexai JieQi<pe£ixwg x6

^ii^ki.'Mmitmi:-''ty~ '

Eix, 75, — Kolnixi) voxEor.xxo^t] r.-xl ot]nxixov Tf-

QiFyofiEvov lijg fi/jxgas . ^VQoatpij xov jioon&iov xal

dma&iov xQ)]fivov xovjkoXjiixov loi^wiiaxog.

Eix. IC). — KoXjiixi] voxEQExxofii] inl or]7ixixov

:iEoiExof.iEvov xijg /x^xoag. Tono&Etrjani x^g xeXsv-

xaiag f^EfxovwfiEVTjg Qaqjrjg.

ovxioq eljtetv t6 odnna va öXiaÖTiofl Ivto? xr\<; jiqoxXtiOeioti? §x Tr\q oDvdXiapeo)? avXaxo^.
'Aq)' otj dvTixaraöTaOovv oXai ai Xaß(8e? 8i' djioXivcoöECov, anoavQO\iE\ ek\ netgiü)? xexXi-
pievoi' ejiiJieöOD ifj; TQajie^T]? Tf)v eioax^eToav Ivtcx; tt]? xoiXiag odovriv ya^'r]^, än(o&ovvx€q
öid ToXvjiioi» xpaTOvuevOD {.»äo XaßiÖo? id? tvxov jrQoßaXXovöa? evregixd; eXixac. Aid ßpa-
bfiaq dtpaigeoecog tov jiqoööiov xoXjioöiaoToXeco?, Iv dvaYKfl 8h, ejti hetqiw^ xexXihevo-u km-
JI880V, iva al evTEQixal eXixe? \xi] d)oi jiXeov opatai, jrpoßdXXEi t6 jtEpiTovaiov, ojieq avXXapi-
ßdvopiEV 6\iov \x£iä To{) xoXjtixoi} TOixwpiaTO^ 8id piidg Xaßi8o5. T6 avxn jigdTTO^iEV xal xatd
xo JiEQiTOvaiov xov AovyXaoeiov, Ötifq xatd tiiv dcpafgeoiv xov omo^iov xoX:io8iaGToXECO(;

LX.

Ko^-Jitx't] voxenEXTOjxr}. H xvotti ä.ioji^elxai
:iQ6g la ävM diä xov fiaxivkov.

E^X. ll. — KoXjiixi] itaieQexrojiO]. 'Eji^xxan'g xfj<;
jxsQKpSQixfjg xofifjs diä /ntxowv xo/ncöv xaxä xä
ovo nkdyia. *H xvaxig elsv&eoovxai ano xü)v
otSQQWv Jtgoaqpvaeiov fiexä xov XQaxr)?,ov. *H im
xrjs slxövog iyxagoia ygaiuf^i] arjfieioT xijv nXa-
yiav xofj,i]v sjii xov xohov.

xadiöTttTai oQaiov. Aid i^EpiovcopiEvcov Qacpwv r\ 8id Qacpf)? xaarvoduXaxog, firi? SieQ^ei^ai 8id
Tov xoXjiixoi) TOixwnaTO?, xov jiEQiTOvaiOD xai Tcav xoXoßwptdrcov, ouyxXEiETai 6 xoXEog ovtco?,
dSöTE xä xoXoßaVata naQa[iivov\ ixxbq xr\q .TEgiTOvaixfjg xoiXoTTiTOg (elx. 85), npooEXOijev
opico? iva xaXvjüTCOUEV lai^ta xatd t6 8\.'vaT6v 8id xov xoXjiixov TOixaV«TO(;, xad' oaov dXXcog
8T]niovQYOiivTai xoxxioVara twv öaXjiiYY^v, driva öi^v/idco? jiQOxaXovv evoxXriaEig £i? ttjv
ctQQcoaTOv (ainOQQaYiai, exxQiöig) (eix. 86). ''EvExa toijtod jtqo Tfjg EYxaraX£i\l)£a)^ xvic, xXivi-
xfj^ VJio xf\q äQQ(ßaxov eabyx^Jaev JidvioiE lo xoXtiixov TQavjia xal xaTaarQeq)opiEV xä xv^ov
ävanxvx^iyxa. xoxxKopiaTa 8id xov YotXßavoxai^rfioog.

o') KoAniKf^ üoTCpCKTO|jJ^ pcTä 5iaTO|jnq tou npoodiou TCixoparoq Trjq pn^pa^.

'Edv f) TüQog egaipEaiv [ir\TQa elvai uEYaXvTgpa xov q)VöioXoYixoi) r\ uq)iöTavTai ov\i-
(pvoHq xal SiTiOrjoEig, f\ jzQoq xä jrQoaco dvaoTpocpr) xr\q \ir\XQaq 8ajvaTÖv vd JüQOxaXEOtl 8vöX£-
QEia?, id; onoiag jraQaxdnjCTO|LiEV wg dxoXou^o)? :

'H^Evag^ig xr\g eyxBiQr\öEü)(; 8i£HdY£Tai wg.xai xatd ttiv auvrjOri oXixtjv voTEpExropiiiv,

TlTOi xaOeXxuöig to\5 tpaxriXov, JtEpKpEpixT) xo\i^ xov xoXjiixov roixconatog, djioxoXXriöig XY\q
xuoTFCog xal EloaYWYn tov jtpoodiov xoX7io8iaoToXEa)g xdtcoOi a\rxr\q. Msid ^ETatojiioiv twv
dvxioTptoTüiv Xaßi8a)v xov jrpooOiov xeiXovg xov TgaxnXou ^pog td jiXaYia 8taTPnvo^EV t6
Jtpoodiov TOixco^a Tfjg ^Tirpog dxpißcag xatd t^v piEoiiv Yga^nriv 81' Ev{>Eog \paXi8i()V, ovxivog
TÖ Ev öxeXog EiodYOUEV mog tfig xoiXoiTiTog Tfjg pniigag (etx. 87—88).

Ilpog djioxTTioiv EJiapxovg x^gov Eig ndXXov EJtiJtXoxovg jTFgiJiTCooEig dvTixadiöTO)HEV
idg dYxiargwidg XaßiSag xov xQaxr\lov 81' loxvgwv HEta^ivcDv panndrcüv. Kard tt|v 8iaT0^fiv
xov TpaxrjXov 8iavoiY£Tai xal t6 jcEpiiovaiov, ueO' o EtödvopiEv tov jtpoof^iov xoXTtiöiaoro-

Eix. 79. — KoXjiixt] vaxsQEXxofi/j. 'H xvaxig avyxoa- Etx. 80. — KoXnixrj vaxegexxoftrj. *0 avXXi](p&€tg dta

xeitai ngog xä äv(o diä xov jiqoo&iov xoXjiodiaoioXeoig fnäg jioXvodovxixijg XaßlAog jtv&fiijv xfjg fijjxgng lA-

xai Tj TiSQixovai'xr) jixvxfj diavoiysxai. xsxai dia /lifoov xov jiegixovai'xov dvoiy/xaxog Ttgog

xä f^oi diä avyxQOVov äjto)&i^ae(Oi xov x^a^i^kov tiqo^

xä dniow.

Ua EVTog Tfig JiEpiTOvaixfig xoiXotTiTog, 8i' ov öVYXpaTEiiai jrpog td otvo) y\ xvoiig. 'AxoXov-
Ocog öDXXajißdvovTai td Tpavpiatixd x^iXt] xx\q uritpag xatd id 8i'0 jiXdtYia 8id jioXvoSovtixwv
Xaßi8a)v xal eXxovtoi jtpog id xdico (el^ 89), xaO' 6v XQOvov 6 8iaTapi£ig TpdxT]Xog djrwf^El-
tai Jtpog t6 ßddog Toi5 xoXeoi5. Aid 8ia8oxix(i)v ov'XXriii^ECOv vko aYxiöTpcoitöv Xaßi8a)v 8ia-
TEHVETOi to TOixcona rfjg uriipag piEXpi xov nv^\iEvoq, ootig TEXog jipoßdXXEi jrpo tov ai8oiov
(elx. 90). *'H8ti E'XxETai ex \iov 6 TpdxilXog jtpog xä l\iü xal fi £YXeiQi1<JiS dÄOJiEpaiovTai
dxpißüig xaid tov dvco JtEpiYpaq)6nEvov Tpojiov.

6') KoAniK^ 6AiK^ uorcpcKTopjj hih Topf)^ tou npoodfou xai 6:Tiodiou Toix6|iaTo<; Ti|^ p^rpaq.

'Ecpappio^ofAEv TT)v n£i^o8ov TaiJTTiv {)jio8EixÖ£Töav VJIO TOV Müller xvpio^g, ÖTav jrpo
XEirai JtEpi \ix\XQO.q YJTig, Evexa <pXEYH0va)8(ji)v dXXoiwoECOv twv t|apTT]|;idTCOv xal tov Jtapa-
HT)Tpiov I^Kpavi^Exai wg EVTEixioÖEioa evTog aitüiv. AiaTEM-'vouEv ttjv uriTpav XEXEicog Eig 8vo

in -f^rfilMi 1^ iTTI i fc'liaMilTrfl iT "1

^HioT). d'tiva t6 h ^aetu t6 aXXo d(paiQovvTai. llQoq f^oixovo^riöiv xaid t6 Swaiov zvqv
TfQov x(A>QOu d;i(oOEirai to ev fifiiau Jtgog Tf)v jiEQiTOvaixriv xoi?.6TTjra xai>' öv xpovov eEai-
qfTtui t6 etepov fipiiav.

'H xvQicoTfocx negipiva xard i\\v lyt^\Q\\(5y.v taiTTiv elvai vd ano(pvy(i)\iiv xQavymxi-
(inov; Tcjv ov()T)Tr)Q03v xttl x\\q xuöTFO);, T)Ti5 evtxa T(iüV orpicpi''oeü)v (.(tru ftvö/foeia? djro)

^eiToi JTpog TU dvco.

7. KoAniKol ^YXCipno€«<; ^"* MüO|iaTWÖouq pHTpa^.

• . • ■ t

o') Mioxv>TCi ufTo6AcvoY6vii pu^para (noAuno5cq7. ■[

Td TiQf ßdXXovTu evTOc Tov xoXjtov r\ xai E^Kpavitofifva jtqo tov ai8oiOD tJJtoßXevo-
yovia liio/cüTa \jiV[l)\k(xxa (eiy.. Ol) ovXk'^[i^ivo\i£v 8id :roXaK)8ovTixn? Xaßiöo; xal Gvorpecpo-

£■«< Sl. — KoX.iixij vatF.QFXToat). 'O .tv&iujv xfjg
fir}zoag s^^i dvaotoaqrt'/ jiQog tä .^oöofo.

Elx. S2. — Kol7n.y.i]^ vmeQExTOfii]. '0 todxrjXog t^3
tjdr] o^uoUog tkxvo^,-] jigog za e^co aStr], ojoxe' ^
6Xi] }ii]xoa xsl rat ,t^ö tov aiöoiov.

Mey avza n nv tö toioCtov 8ev ^Mxvyxdwxai Siateuvonsv Siü iov^\>aXibiov tov niazov xaT(i
tnv f,x(pvaiv;,a,'TOv. "Edv to annsTov tiis h<pvoemi tov n(axot. ev,e(a.etai toXv ^tpö? to ßddo;
tn? Mutp.xn? KOtXotnto;, SiavoLYOUEv tö ;tooa»wv toa/.nUxöv tolxo.n« xal «jicxö^touEV tov
^loxov, axoXovfto,; 8e ov(.c.«^tonev Ix veov tÖv tQcixriXnv (u'x .92;. 'ElmoEtixT, aitioQonyia
bev ema.^ßa,vEi, ^ mxga bi toiavtn l.iiaxEta. ozeSÖv :t(ivtot£ bC eXacppov ^tconattonov

tns untQo;

^ Aev IxteXov^ev Ei-xaeiat«.« tfiv d;cX,> ta«tnv lEaceEa.v tov ^t.a)n«to)8ot>s nolvKobog,
öuni totEXtxov a;totEXEo^a 8ev Elvat cwn»co? !xavo;.ocr,tu6v. Aev äa.p«X.CÖ^iE»a d;rö tn;
v'^oteo^tns, Eav 8e o oyxos, 0,5 ow,',»»; f^ll (^oXw^fj, .Tpoxakttai ,pXEYfiOvcü8„; E^EgyaoCa

Elx. SB. — KoXjtixi] vaiEoexrofArj, *0
Ttv^firjv tijg fi^iQag xai 6 xoäxqkog eX-
xovxai laxvocog jigog xä aQiaxsod.
'O nXaxbg ovvÖBa/iiog^ ai odXmyyEg xal
Ol iSioi avvdsofiot. xfjg MO&rjxrjg s^ovr
diaxafiij fXBxa^v ovo aifiooxaxixi7)v
Xaßidcov To de^iov jiaga^rjxQiov fisxä
X€ov firjxocalcov dyyeiuiv F-^ei ovXXt]-
(p&fj ix xa)v xdxo}.

Elx. S4. — KoXjtixrj vaxegex'

xofiri. AI Xaßideg dvxixa^l-

ojavtai $1* änoXtvcüoswv.

K. ' Ä9yo^exono v X o v^ rvvaixoXoytxri XetQOVQyixij

ek ta nsQil xal 6 nvQExbq l|axoXovdei Inl ^axpov nerd tfiv eYXeiQTiöiv. "EvExa tovtov et^
jrXEiGTo; jreQiJiTCoaeig jaet' dqpaiQEoiv to€- jcoXvnobog IvEQYof'^EV £jiijiqoö{>£tü)5 rriv i'GTEOEXTOjinv.

6') KoAniKJj iKHUpnvioiq |iuo|jaT65ous dyKOu.

'EcpaQiiolonEw Tf)v n^OoÖov rauTTiv ^ovov Ijil piixpaiv oyxcov, dUd xai tote eti xqt'
ElaiQEaiv. xa^' oöov 8id xäq ovvximxixuq hx^iQriaeiq twv pivconaTcov jrpoTi^wuev Tf|v xoi-

•--V"^-

Eix. S5.~Kohtixr] voieQ€XTour). ZvvxXpin,^

avXkaf4avovv Hat rä ä:tohvco&evxa LI- 'T r^f^'^^^^ 9<^9^olv ijtnvyxdvLc Iva

ßco/nma. f« >^oloßoifxaxa rojto^etrj^ovv juev i^cons-

• . e^^omiPicöff, xaXvcp&ovvÖB öiä xov xoX-

niHov zoixcofiaxos.

S.r J.r.n tz£z: .tätä rr- 'r --' <— «-

OYxo« (OS i^t, xüiXiaxiov ^YXeiorjatcov (ßX. aeX. 73).
y > KoAm.4 6oTep,KTOMik <„i müumotüBo«, p^rpa,.

Doyen, npoa^öi^sv oV«; xatd xavöva tf,v xoZlr^r. I ""7°' '"" '**^^^°« "««

' ■ ii

LI f ?}

tu. d7.

Ein, 66,

Elx. 87.'—KoXniXTj voregexrofir] dta xo-
fifjg xov ngoodiov xoiXMfxaxog xfjg (ArixQaq,
*H xvaxig ansxokkrf&ri xai avyxgaisTxai
JtQog xä ävco vno xov jiQoa&iov xüXtio-
diaaxoXfcog.

Eix, S8.— KoXjiixrj vaxegexxojbiij diä xo-
f^^S xov Jiooa&iov xoixwfiaxoq. *0 71q6-
oviog xoXnodianxoXevi; erst xono^exn^n
evxog lov avoiyfjiaxog xov negixovaiov xai
ovyxQaxst xtjv xvaxiv Jioog xä ävco.

Elx. 80, — KoX^iixij vaxsQexxojurj diä xo-
fifjg xov Jiooa^iov lot^fo/uixog. *0 tiqSo'
^log xoXnoöiaaxoXevg ^X^^ xo:^o&Exrj^
ivxog xov ävoiyfxaxog xov jiegcxovaiov xai
avyxgaxei xijv xvaxiv ngog xä ävco T6
TTQÖa^iov xoixcofiu xov xQax^^kov sxsi
diaxa/MJ,

Elx, S9.

etvat övvatov. xat eXko^ev t,^ tpav^ar..« x^ar, 8t« noXvo8oyx,J^

VOd,p. 'to^tl"' ^- ^""''^'^*''^^ ^''^«»"' ^« axo^patcöfi &; üSr, „6x„ dvcoTlpo, nepte-
YOa<pr, Aeoy iva ,<ata tov tE^axta^ov nf, napExxXtvtouEV xfis ^eo„s voa^nfic tov ovxov tva

aaaYxtcTea.atv tu.v ;roXvo8ovTtxäiv Xaß(8<ov xal xfiv 8vadpEaTov ^„pätaatv t^? EYXEtpncEcoc

ZiZZToZ: ""^"n^ ^^" '^""^ ''' '"' "^" ■-'^»^ - ^-»^'^^ "-'^- T? o rrv

xaTToZ ' ' '^^-^ -^eav da^dXEtav M xvx6v dvE.tOv^.xov ä.oa.aotv öyxov
ZlZt7Zr-Z'^: r^'r'''"- ^^""^"^"^ ^^^«^ ^^^ .epttovaCx% xo^Xot^to, T6v
u6vov ^V ' » '" ^'"""'^"^ ^°' °"'''*'°« '^"^e"'«^' TOiXoVatos s^ap^o^^ev

8. Edpcra KoAn.Ki^ *yxeipno.<; toö KapK.vüpaTo*: toö rpox/jAou Tn<; n^Tpa«;

xa Z srfr. - '" «vag,Ep<o^EV tf,v tEXv.x.'.v. fit.; dxoXovÖECta. eI, t^ xXtvtxiiv ^ol

X oo^vcxr " "' "" '"""" '"' ^'^ ^''''"'•' ^"« ö^«*epo,Eva, eI, tu 8.dq,oo„
/eiooi'QYtxu öi.'YY()api^aTa. h' v«

rov «H dirr "" - ""-"''"' '^"^'ötovx.xXtx.ö^a.öxov v.„xe.,evov oJexLov

xToxIvZrsr V ■" -"'"' f '''"" ''^'^"^^'^''^' "«^^ ^" v.oXoytCEx„. oCxco,, SotE at

xapxivwnaiojöEi? (la^ai vu eIvoi 8vvatöv vd xaXumftnriv rclcf,>, . < . ^

xoX^tixü? :tEpixEtpt8os. '««Avcpöow teXeico? vno ms 6„niovpYov^Evt,s

ovoodlZl^r''^''' '"'-"'" '-""'^"^ "•^"'''"^ ^"^^^ ^'«P^«''^^ 8td ßaV^atos la,8(ov xal

.apE^.o8c^r,ta. aaq,aXä,s ^ E>8oc xapxtvco^arcoSäiv ovotÄv n Xot^oyLcov ,txpoöta,v 'TxXav^

d 8e uExIvaT' ' ""^-S-"-^-^ ^"•- ^''V, <o; x„i 6 .pocöto, xal .Xdyto, xotoi3xo .
'IxoXoX riZr ''^''?'^'*^^^" «'l^°ß'S°^ Kocher JXxovxac taxopö., .po^ xd xdxco

8^ tili - ' ' '"'"'""' '^^^'^ ""'^^- Xer,at^o.o.oC^EV xo ^aXWtov (sU 103),

Jvov'x ^or''''^ "" ''""' '''''"'• '""' "-ü^ -XnslxepExxo.^;. dXXd
dvaxourxS r„L - M '• °'""? '"' "«^«^'''^^"''i^ »"lOnoecos 8eov vd d.oxaXv,p»ofiv Se-
rn «to^tx^S ;xap„axE.ns.Movov E^l xov;xpo,t(xo„ axa8(o., 8t,axvxc5s ovxi xöaov avxvoC

?Ä M x" '''"'"' ""' '' -co*nac»,EV ai.ov; .po^ xd dvco .exd xf), xvaxEC«
otot^! xfit'" '"^^T*""!"^^ ,"«' ''«'°« ^« «vco d.c6ar,a.v xcöv oipr,xnp<ov. avyxpaxovvxa
ZZrl '^^^r,yo- »*"« trisxuaxEcos 8td xov .poaöto. xoX.oS.aoxoXeco? xal :rapa-

axE„aCovxat .EpauEpo, E.t^EXö.^ xd .ap„^,ixp,a d^ßXEco^ 8.d xoC Saxx^o. (eU 103).

Ta ^nxptata «vveta 8taxE^vovxai ^Exa|{, 8uo Xaß(8a,v (eU 104). 'Aq>' o7. x6 naoa-
,,tptov xax„ xo EXEpov .XdYtov d,EXEv9Epa>0fi xaxd xöv avxöv xpo.v. sL^vomev x^v

ooov xo 8t,vaxov EvpvxEpav ^o.pav ovvExxtxoC iaxov 8.d xov Saxx^ov, S^Ep cvvxEXEtxat dvEV
M ""' «;^°ö'^«V_-S. EVExa xfis .por,y,»E(ar,s d.oX.vc/.aecos röiv ^,xpta(a,v dv^EZ

x«t eX^ecs avxr,« .po« xa E|a, ^^/«. 105) «oq,aX(Csx„t f) al^öaxaats tAv vnoAot^a,v dYY«a)v sTd

To:i:o{>8TTiöeco5 ^eyccXcov XaßiScov xat' dpicporeoa Vd jiXdYia toi5 jiXat^o? owb^opiov xai twV
6|aQTTmdTcov xal elaiQeiTai ^ \iy\xQo. nerd twv k\aQxr\\idx(fi\ . 'H eYXeiQiloi? JiepaTOVTai 8id

%;f'-::* .v-' w.'-^^-^-iW'.i^v :,";\:V'\.,-,''"' ■■'■^'jM

EiV .92 — Minxroxov {•jToß?.£voy6v:oy fivoj^a zlm-

To/o/ ^ xoi'r Jioooi^iov toixcojuaxog zov Tpa;f///ti'

.ijo^ u.ioxnXvt^uv rrjs ix(proewc: lov fiioyov.

Elx. 9L — Miyag noXvjiovg e^w&t]ß€ig ixxog xov

xohov (vnoßlevoyoviov /nvco/naj. Ovxog exei avX-

Xf](p&fj diä TioXvodovxixtjg XaßiÖog xal i^aigeixai

diä ovoxQO(pfjq.

xr\q Qaqpfjg tov jtepiTOvaioD xai xov xoXeov axpißw? o)? xal xatd ttiv djiXfiv xoXjtixtiv vöiepex-
TOjAriv. 'Ecpapixöco^AEv Äagoxerevaiv fi tov i^pietepov xad' 6X|iv Jiconatiönov. ev iregurTwoei
\k\\ ejTiTevxOeiöTi? ejraQxov? aijioöTdöecog, wg t6 toiovtov ovußaivei ;toXXdxig l;ii jiqoxexcoqti-
nevcov jreQiJTTcoGecov.

9. KoiAiQKai ^YXeipnocK; iit\ ir\^ MH^paq.

a') Ih |jioxot6v änoppoyöviov puu|ja.

Metd TTiv 8idvoi|iv ttj^ JceQiTOvaixfj? xoiXottito^ JteQiSevttai an\(hc, 6 \iiatoq toii oYxou
xal öiateM-veTai. IlQOxeijAevov JteQi \iioxov e'xovtog eupelav ßdaiv, exTEpivouev tovTOv acprivOEi-
8ü)S ex xov ni\xQiyiov TOixwjiatog xal ovQQdnxo\xEv xb xQav\x(x 8id Ttvcov nefAOvcünevcov gacpwv.

i?tx. Ö5. — KoXjxixr] i^aigeai; xFjg /avco/na-
TOiöovg fxt'jxfxxg Öiä xaxaisfiaxta/xov. Tä
öiaxoivöfxsva sig xijv elxöva Qdfxuaxa i;xovv
xono&Exri&i) im xov dixctox/ivxog igu^ij-
kov oaxig eyßi d.TCod/yi?// noog xo ßdi^og
xov xoXeou. 'Ex xov ojiia&iov xoixcöf^axog
jfjg firixQag, avXka^ßavo^hov dia :joIvo-
dovxixfjg kaßidog, ixxFfivsxai öiä (xaxo-t-
Qiov aqprjvoEidig xefidxtov.

Elx. 94. — KoXjiixr} i^aigeaig xfjg fivco-
fiaxoiöovg fujxoag Öiä xaxaxE^ajiOfiov,
JJqo xfjg exxofifjg xov aqirjvoecdorg xfitj^ia-
xog avXXa/ußdvovxai zd xgavfxaxixd x^^^Xr]
xfjg (xfixQag ix viov dtd nvXvoöovtixwv
Xaßidcov,

»V.

Xsj^^ii^'

EiH. .vj. — Kokjiiicij i^aiQEOig xfjg /uvcojuaxcbSovg
fu'jToag diä rsjuaxiojuov. 'Ex xov /ArjxQtxoö loc-
X'Jy^axog^ x6 otioTov avv£^.i](pi^t] xai ekxsxai ia^v-
o(ö; .TfOOs xä xdxo), ixxe/uvexai Öiä xov fiayat-
Qiov jteya^ xsfAdyiov.

Elx. OG.—KolTiixr} fiaioenig xi]g /uvcj^ia
icodovg fii'jXQag Siä xaxuxe/xaxio^iov. Meta
ri/v ixxofiijv xCov ovo txowioiv xFjuaxi(oy
fXxexai ro [irjxoixov xoixoinu xov doinx-oov
TiXayiov loxvQtbg jtgog xä xdxoi xai fW-
^vexai öfioiwg xE^idxtov i| avxov. TIqo xrjg
i'l okoxX^Qov dTioxoji^g xo:xo^Exeixai jio-
Ivodovxixi] laßig xaxd x6 dgioxegdv tj/tu^id-
Qiov xfjg fi/jXQas.

El? kdoxr]V JiEQimcdaiv ^jiaxoXoij^el Xejitoueq^,; llhaaiq tn; ^ntpa? JiQoq dvevpEoiv 5XXa)v
jivcünaTCOÖwv OYXCüv, o'vq dcpaiQoi'UEv. xai uv eii jiQoxeiTai keq\ aiüv \iixqG)v toioutü^v.

6') 'H ^KHUpnvioiq iiuoMäTOV.

Aid TavTTi? evvoovfAEv x\]v djtoqpXoujüöiv xiov vtoqqoyovicov xai ftiapieocov \iVM\idx(x)y
djTOTfi? \yd)bovq avTwv xdx^? ^etd 5iaTTiQ)]ö80)? tf)? \i}]XQaq. 'ExreAovutv tr^v ^eOoöov tqvttiv
^ovov xat' eHaiQEaiv. xaO' oaov e;ii roiaurri; \iniQaq nuq exfi n:Qo8id»eoiv et; vfveoiv pivo)-
^idTa)v öuv/ido}? 6|e?aööovTai ex veoi) lUKoiiarwöei; öyxoi xai ftiori f\ nQnyvcooic, tf)? tocag

'l'""| '~ jl I ^ IHIll I ^ MIMMBIWI I II I

A'tx. 97. — KoXnixi) e^aiQsaig xfjg [ivoifiaxioöovg fxrjxgag diu

xaxax€f4axio/nov. "Ev aQxexov fxsye&ovg ^ivwfxa ixjtVQfjvi-

Cexai ex xov xocxcöfiaxog xrjg fit'jXQag.

d^Afi; xa^' lai^Trjv eyxi^iQrioEwq, 8ev eIvoi xaXXiieQa xr\q, oXixrj? ti v(poXixfi? voTFQEXTOnfi?
oöov äcpOQq. £i; xrjv {>viiGinoTi]Ta xai Tr)v voGTigotriTa. ^Fpopisv Ejii tou o'yxoii tohtiv. r\xiq
öiavoiYEi TTiv xdil^av, xai djtoqpXoiov^iEv tov ü'yxov dn(3X£cog fi 8iu tov xi^aXiÖiou djto xr\g xoitt|?
avTOv. 'Aqp' ov d(paiQ8i)fi aKaq 6 :rXEOvdJ;(ov latog, öVQodjiTOUEV t6 TQavpia xatd oxQ(i)\iaxa
EX Tüjv eaco Jtpoc rd £|o), jtqoöexovte? L-iaxQißd)? tva piii ÖTnaiODQYnTai xOjQOq, ooxiq Od fi5v-
vaio vd öDVTEXEGtl Eig xaTaxQaTTi'Tiv ExxQindrcov piETd Xüjy £jrc(xoXoin^ö)v avxwv.

Y') 'H än& ii\q Koikiaq OfpnvociSfjq cktomh Tqq PH^paq Karä AoYodcTÖnouAov.

npoxEiToi xar' dpxriv jieqi xr\q avxr\q EYX^iQriöEa)? iiv if]hx\ JtEQiEYQaiiJauEV xatd xäq
xoXjiixdg EY'/.fiQ^Wei?- MEtd TTiv EKTOpiTiv ncpiivoEiSoi'^ TEpiaxioi^ EX Tri? pinTQag,
f\xiq e'xe' övXXriqpOf] xaid td bvo nldyia 8id bvo dYxiöTQCDTojv Xaßiöcov (eix 106), ovq^^ö,-

•t— ■••••

:iTOvtai tot TpaviAttTixa xellif] jiQoq d'XXriXa. Äia xy]v jcepitovaixV lmyiö\.v\^iv XQ^^\J^OTCOt*'
ovvtai ol .-iXaiei? övvÖeöhoi, ouivt? ipepovrai jtXtiöiov dXXrjXwv.

2vt>^dÄT0H£v t6 \ieoooalmyyiov, xb ntöocoO/ixiov xai ev ävdyK]\ xai x^v odXmyya
xov hbqn'kayiov injbq x6 eiegov eäi xn? OTiöOiag e;ii(paveia? XY\q [ir\XQag (elx. 107), Uqqq
e;iixdAv\i)iv x^q, jißOöOia; IjiiqpavEia? exouev eii; rriv 8idf>£öiv i^iag ejiaQKF) fXTaoiv jiepirovaiov

•.'

£/«. 98.—KoXmxr} e^aigeoig xfjg fiV(Ofiaz(odovg firjiQag dtä xaiaxsfxanouov

Msya xEfiaxiov ajioovvte»eifievov ftvMfxaiog i^aiositai dia y.aTaiefiaxiauov T6

fieyakvxsQOv fiSQog xov öyxov exet Ijdt] i^aiQE&iJ xai ^ fiyjiQa /nexä xov vjioXoi-

jiov xov fiVMfiaxog exet iXxva&rj tiqo xov aldoiov.

xal xuatew;. T6 jtepiTOvaiov xr\q Ei'oeco; djtoxoXXrn^eiOTis d;i6 xr\q [i^XQUc, ofipoSoxov
xuarecog avQodKxexai ngbq xb eXeu^epov dvco xeiXo? taiv ODvevcoöevTwv jTXarecov öuvöeöpicov
xal ev dvdYxn jtqo^ rd; odlmyyaq (elx. 108), El? xdq lYXeiQr]öeiöas oCtco ^neifpaq tiepittto)-
GEi? TO d;^OTeXeö^ia {.jrf]p|ev g|aipETOv, wöxe 8id tf)? öiaTripTiaeo)? Tni^^atog xov ßXEVovovov
TTJg jATiTpag iq EV^T)Vog pvoig jrape^Etve (pvöioXoyixii.

6') 'H 6ncpKoÄniK4 60TcpcicTo|j4. •

*H xoiXiaxY] xoiXoTTig öiavoiYetai 8iu \ifO\\q xo\kx\q r\ hC Eyxapoias lo^ifig xatd
Pfannenstiel, fiv oncog EXTeXor^ev novov eqj' ooov 6 öyxrg 8ev i'.iEpßftivEi tov önqpaXov. 0d
fi8vvd|i8Öa ßEßuicü^ vu f|aip20ü)H£v xal ni'wpiaTa ueydXov ^Eye^oug 8id x\\q ev^tapöiag xo\kx\^
8id TEnaxianou (morcelement), e;tEi8r] c^'«)? xatd t»iv Sidvoi^iv x\\q, xoiXoTTiiog tng unipag

*.•"

üBt**. >%:-*»:. A^ftV*.'^!;» .>-*f

Ä"*«. 99. — EvQEia xoknixii voxsQexiojiui /;t< xao-
xtvw^axog xov xgaxrikov xfjg fxr'jiQag. 16 xokjtikov
xoixiofia ovXXafjßdverai «Im 4 ayxioxQwxiöv ka-
ßiduiv xai XF/Livetai JteQiqpsgixiJög.

hix. 100. — EvQiea xoXjiixrj vaxsQEXxo^ij tni xao-
xirwfiaxo; xov xguyif/.ov xfjg ^t]X(jag. T6 ngoa&iov
xai ojiio^iov xokmxov xoixw^a ovQQajixovxai noog
aXXr]Xa atp* cv 7ioor}yovixiv<og xoTto&extj&tj Jigit
xov xgaxtjXov xe/ndxiov ydi^rjg ifxßgaxev diä ßdfi-
ßaxog loidiov.

bh elvai bvvaxbv vd TTipT]dfi in djtoXurog dariil^ia, TipOTipiüiuEv xr]v \iEor]\ Tonr^v, ^tig Iv
dvdYxn öwaiai dgxoxjvxoq vd ejiexraöfi. 'Acp' ou avXXricpöfj 6 Jivduriv xr\q \ir\XQa<; 8id jtoXvo-
SovTixfj? XaßiSog f\ 8iu xov EXJtcünaTioTfjpog (Doyen) xal EXxuööfi jipog rd e|ü), dpxoneöa
xov djioxcopiGnov Twv ÖE^cov ElapTTindTCüv d)g dxoXovdcüg :

AiaTpvjTÄpiEV 8id TOii he^iov \ieoov SaxiuXov tov jrXatvv ovvöeohov xdio) Trjg Ixcpv-
OECo; tov öTpoYY^Xou avv8ea|iO\j jiapd ttjv uriTQav xal eXxofAEV Td km xov öaxTvXov xei^eva
e|apTri^AaTa (atpoYYvXog ovvSeo^og, i8iog öiWöfönog ttjc (bodriXTic xal od^myl) jipög to
JiXdYiov jiveXixov tcixco^q. EloEpxdnEOa dxoXovOo)? 8id toö Seixtoi) xr\q dXXrig XEiQoq jiFTa|\)
Twv JtETdXXcov 'ov 6^a)v\5nov JiXaTEog awSEa^ov xal djioxoipi^ofiEv Td jieTaXa aitov dji' dX-
XriXcov ngbq xd xaTco ^lexQt tri? ovpo86xo\) xvoTECog, ev(p TavTOXpövo); fj xvoTio^riTpixTi itTian
TOV jTEpiTOvaiov djioxoXXdTai xaTd t6 jcXaYiov ai'Tfjs djto Tfjg Mn^pag (eix, 109),

AiaTE^vojiev dxoXoüOa)? xd E^ixadripieva ejtI tov SaxTvXov E^apTTinaTa ^Eta|v 8vo Xa-
ßi8a)v (dx. 110). 'Edv o\nüq 6 öTpoYY\5Xog ovvÖEöpio; exEi oXiYOv djtonaxpvvdfj djio tfig ad^-

^lYYo;, o)? t6 toioOtov ovvavTc? u? ovxvclxie ?;rl MVWMaiCüv. a-^c^ivcvMtv Tortcv iSiaiTSQto??
T6 djTOxoXXridev fifin T^fj^a tof- jiegiTOvaioij Trjq ximeco? avXXaMßdverai 8id xeiQOfQYixfjg Xa-
ßi8o?xcK 8iaT£jiV8Tai eYxaQoio)? nexQi xov dgiöugov xeOvOi^,- tf]? nfitpae. 'Ev dvuOEOEi Ttpo?
Tfiv oXixfiv eiaiQEöiv xam iriv t'jieQxoX;iixT|v vöTeQexTOjii^v f] ovqoöoxo? xvöti? 8eov vd djio)-
Onrai ^ovov ÖXiyov Ttgog td xdio). 'H |x/)Toa neid TaxJra eXxerai Iöx^qo)? itpo? id e'io) xal
agiöTj-Qd. t6 öeiiov Jtaoa(ifiTQiov ^erd rdiv unipiaicov ayve^cov a^)XXa^ißdve^al 8i' toxi^od?
amoatar.xri? xvQifig Xaßiöog xal öiat^^veiai :rXr|öiov rov xe(Xoi,g 1% ^^Toa;. tva fi£T' dacpa-

rcuv avo. o aota«po; .Xatv, oM,.,o, ö.ä ^ta- ?) 8,5o Xaß(8cov xal exxB;v,rT uZa uj
a«^;t.puaMßavoneva)v töiv iEapTr^drcov. Oöt« ^ SXr, Ivvetonaic u.rri rivTr- ^'''^" '"'
8VV.0V vä l.e.e.., .^.p. .oO o,.,o. .o..ovl.6: 2-^U:i^irZ,S^Z. ZI
c».ov .po, to o,.adcov xofxco.a .o« tp„x,iXov 8.d uvcov .e.ovco^evcov .a^VcLT^
Xa.,p„ „..oppavta i. xov rpav^aro; x% .rirp«,. 'Avtt.aa.oroivte, eka trifSac sf'Xo
Xtvcoo^cov .epa.vo,ev xny svxs(p,acv 8c' e..,eAo«, ..puov„.o.Xaonx% (e.'«' luZ lim
H ujiepxoXjtixn vatepextonT] dtcopettat v;t' ?noü wc xai Wo tmv Tl.f„.,. •'■ii
Xe.po.pv.v el, d.X., .sp^xcoa., cb, ...080, Ix^o^^: 8c6u exTZ: ^4 Txaxf xl
oxax.axcx,v xo. Albrecht Jx« ^upox^pav öv,a.,dx,x„ xi); ÖX.xn. fiax.pexxo Jf^^x^x vi SpT
^axa xcov xoXoßco,„xcov «x.va e..ß„p^vo.v x^v voa,p6x,xa x% i.spxox'.xü, Wp x 0^5

r I

yjtoxwQOvv 8id avvTTiOYiTixfi? öeoaJiEiag oxeSov jidvTore. 'H avdnxvlic, xaQxivcönaTCOv ejti rov
IvajcojiEivavTO? xQaxhlov elvai o;iavia (0.32-0.38 "/o). Ovi^s, wgtf aviT] ftev av|dvei alo^r]-
TW? TT)v YevixTiv OvTjoinoTTiTa tri? i7ieQxoX:tixfi$ byxeiq/iöeco;.

C) KoiAiaK^ 6AlKfi UOTCpCKTOp^.

Meid ejtineXfi dÄoXujiavaiv tov xoXfov jtconaTiCo^ev tovtov 8id XcoqiSo? Ya?T]5. iVig
XQTlCTl^lEVEl JtQo; djtOQQOcptiaiv Twv ExxQindtwv, icüv £|EQXOHevü)v EX Tov TQaxnXov xatd Tf)V
EYxeiQTlöiv. T6 dxQov ai'rfi? 8£ov vd jiQoßdfXti doxeid cEcü toi" xoXeov, iva avin övraiai vd
dq)aiQEdÜ evJXEQcog fi? oiavöiijrOTe ötiyhtiv v>(p' evo^ ßondov.

'H evapHig rfj? EYXEiQiiaEa)? TeXEiTai roc xai xatd xtV vjtFpxdX^iix^v f»OTEQEXTO^r'iv. Ii'X-
XtiTpig TTJ? jATlToag 8id jioXvoöovTixri? Xaßi8o? Ti8id xov zv.i,(i)\iaxioxr\Qoq, ^'X^ic x\]<; [vr\xQaq jioog

iS"/;«. iöJ?. - Evosla xoXjiixij vategexiofiij eni xaQXi-
vcoßatog tov x^ax^^ov tfjg fii)xoaq. 'Ajiox6kXi]acg irjg
xvaxecogdid yjakidiov xai dvaxo/nixffg laßiöog.

Elx. 103. — EvoeXa xoXnixi] vateQSxxo/at] eni xaoxivcaf^axog xov xoa-
X'jXov xijg fxrjxQug. T6 dgioxegov jiunafii^XQiov naQaoxevdCexai dtd xov

daxxvkov.

TO xoiXiaxov Tpav^ia xal djicxcopiapiog avxriq «J^o t(^)v 8£|id)v E\aQxy\\xdx(xi\ o)? dvco (elx. 109).
Elvai opio)? djtaQaiTTiTOv l'va n xvgti? djtwdii&fi xaXo);, :tQO^ td xatco, 18 i(? xatd xa jiXaYia
avxr\q ovccd^, oSote vd djtoxaXuq^Ofj y\ xdico pioipa tov xoXeov (elx. 116).

T6 jiapanrirQiov HEtd töjv ev avT^ Eupiöxo^Evcov aYYCiwv ovXXapißdvETai 8aov t6 hv-
Tov jtXtigiov TT]? UTiTpa? xal 8iaT£nvETai. '0 of'pr]Tf)p 8ev 8iaTp£X£i xiv8i)vov Ecp' oaov JtooY]-
YovjiEVCog T^ ovpo86xo5 xvarig exei xaXw? dji(o{>Tiöfi xal Icp' üöov 8£V drtOnaxpvvojAEOa djro
xov xz\Xov(; TTJ? uritpag. Kaid tov avTOv xpojtov öuXXapißdvovTai Td dpioTEpd ££apTTinaTa
xal Td piTiTpiaia dYYeict- 'Ev(p in pt^Tpa E'XxETai tote iGX'upa)? Jipog tiV ÖievOvvoiv xr\q fjßixfj?
avucpvoEcog 8iaT£^von£v EYxapGicog 8id tov \|;aXt8io'u t6 jtEpiTOvaiov tov AovYXaoeiov xal
djtco^ounev 8id ToXvJtiov t6 dn:£v^ujnEvov öXCyov Jipog Td xdTco. *H ^ATiTpa sXxeTai Ix v^ov

I ^W'll

Eix. 104. — EvQsta xoXmxi] voregexro/ni] ijii xag-

Hivcofiaxos lov TQaxrjXov xt/g fitjtgag. '0 aoiozegog

ovQTjxrjQ ix^i üev&€Qco&tj. Tä dgioxegä iut]XQiaTa

dyyeia e^ow avUtj(p^ Siä kaßiöcov.

nobq xbv ö^cpaXov xai ?vq) 6 ßonOo? xparei xaXa,? jtqo? m xdico triv ovqoöÖxovxvötiv 5ia lo-
XvÄioi) 8.«xQaroi,^EVov i.:r6 X«ß(8og. ömtenvouEv öidiov jiaxaipiov t6 jtQOodiov coi'xcoua lov
TQaxnXov xata xi?)v m80iiv yqomm^v xal eji.nr.xvvoMev iriv iom^v jrQfg la xdio) M^aPi o{, Äia-
votYn EJiagxÄ? 6 xoXeos (£.'«. ii^;. Ev dt^icplßoX,'(? J)g :rQ65 tnv Oeöiv tov rpaxnXov xaOoÖT,-
YovueOa tl^nXacpoivT.s 8i« to^ öaxivXov. 'Acpo^ dcpa.QEOfJ ex tcüv xdto) v;t6 iivo; ßor^Oüv f,
YaCa, fi TOjiodETTiOEioa xatd rriv JTQOjraQaoxEDnv. ovAXöMßuvonFv t« Tpavuarixa x^'^r] tou
xoXeoi^ xdto) TOV TQaxnXixov öTojiioi, 8i« 8vodYx.öTQa)Td,vXoßi8a)v. eXxo^xev lavia. djronaxQU-
vo^xEV d^' dXXiiXccv xai dcayo^ev hxcq rov avXov xov xoXfov toXi-ttiov öiaxQarorwEvov vno

Eix. 105 — EvQeTaxokjiixr) vaxegexxofxt] im xagxiväi-
fiazog xov xgnxTJXov xrjg ßi^xgag. *H fii^XQU exet eXxvo^
jioo xov aiöoiov xai elg xä dgiaxegä i^aQxijfuxxa ex^i
xcno&exrj^ XaßCg,

^rW^

Eix. 107. — *H dno ttjg xoiXiaq dßeXiaia txxofiij firjxoixov xoi-

XÖifxaxog xaxd Aoyo-&ex6novXov, IhoixovaiojiÄaoiixij xov ovg-

ga(pevxos ojtia^iov xoixcöiiiaxog öia xoi}oi^o7iou)oeoig xatv jiXa-

xsoiv ovvöeofiwv xai xcöv aaXjityyojv.

Eix. lOS - 'H dno rjjg xoiXiag oßehala exxofii] ftrjXQixov

xoixtö^iaxo^ xaxd. Aoyo^erönovXov . Td gd/nfiaxa xov Jtgoo-

&iov fiT}xgixov xoixiöfiaxog xakrjixovxai Sid xov unxpixov

xgaoTiedov xov negixovaiov.

Eix. 106. — 'H djio xij? xodiag oßeXiaia ixxofiij fxrjxgixov xoixo'yfzaxos xaxd

Aoyo-d'ex6novXoy, Td Z^/A»y ^ijs ju^xgag exovv avXkrjq)^ di* dyxioxgwxwv

Xaßiöoiv. "Ex xov o(üfiaxog xrjs firjXQag e^aigeXxai aqnjvoeideg xfi^fia.

XaßiSog, ojTEQ 7iaQE\niobit,Ei tt]v £|o8ov xoX;rixo)v ExxQipidicov KQÖq ttjv xoiXiav. '0 tqqxiiXo^
ovXXanßavo^Evo? dxoXoi^Ocoi; xatu t6 ojiioOiov Xf^^^? avioii 8id 8iio8oviixfi? XaßiSo? eXxetqi
8id \iiaov rri; ojif]? tov xoXeov ngbq xr\\ jtEpiTOvaixriv xoiXoTTiTa xai loxvoo)? jtqoc xä avco
dxoXovdcog bi öiaTEuvfTai fiid tov ij^aXiöiov 6 xoXeo? jrEQifpEQixo)? (eix. 117 — 118). T6 evto?
xov xoXeov f i'Qiöx6nevo\ toXvjtiov djro^axQVVETai \k^xa jtqoooxiI? dqjov avXXTjqpOfi t6 äq6o{>iov
Y.a\ ojTiöOiov TQavjiaTixov x^^^oi; tov xoXeov öict Xaßi8(ov Kocher xai dvTixaOioTaTai 8id Xo)-
Qi8o? yaC,r\q (dx. 119) r\y ftiaßißdtionEV jrpog tov xoXeov 8id Tri? aYxiGTpocpoQOv utiXtii; (ßX. eix. 5)
zvbvq 8e piöXi? dvaqpavri jtqo tov aiöoiov t6 xaTCo avxfiQ d'xQOv, djioxÖJiTOuev tqvttiv
dxQißw? avo) tov xoiXiaxov jiEpaToq tov xoXeov. 'H Xcüqi? avtri W^^^\^^^^^ nQoq jtagoxe-
TEvaiv. 'H ainOQpaYia ex twv TpaviiOTixcöv x^i^^wv tov xoXeov EjriaxEtai 8t' djioXtvcooecov
8id ßEXövT)?. At Xaßi8Eg dvTixadiöTavTai v.tto djroXivomECüv xai lo oXov lYXeiQ'H^ixov äe8iov
tX£YX£"fCti ü)5 jTQog TT)v aipidöraöiv. '0 xoXeo? ovYxXEiETai 8id övvexov? paq^fj?, xad'fiv 8eov ei
8vvaT0v vd \kx\ övXXapißdvTiTai 6 ßXEVOYOvcg avTOv. METd tt^v teXeiov ai^ioöTcioiv FVEQYOvntv

TTIV JlEQlTOVaiOJlXaöTlXTlV HEt' EVTacpiOöJiOV T(üV XoXoßcOndTCÜV 8ld ÖVQOCtCpfi? TOV JlEQlTOVaiOV

TTJ? xvöTecog JTQO? To jTEQiTOvaiov TOV djr£vOvG|ievov. *H JiEQiYQacpEiöa ^vxeiQTiois IxTEXElTai

piOVOV EJTl Ol'xl EJllJtXoXCOV JlEQl JITO)Ö£0)V XOTQ TÜV IVJCIXOV TOVTOV TQOJTOV. *Ev JI£QIJIT(00£1

ovjAqJvaECOv 8eov vd Xvdovv avTOi jrgoTiYOviiEVü)? 8id JtopaaxEvfjc;, Tfj ßori^Eiq: x^iQf^i^'OYiXT]?
Xaßi8og xai \paXi8iov jtplv x\ Ägoßw^Ev tiq Tfjv slaiptöiv tov o'yxov. j '

'Ejtl £v8oövv8EöpiixTis dvajiTvlFO)? pivwpiaTOc; TEpivopiEv TOV jiXoTVv ovv8eöm,ov nETa|v
tov ötqoyy^Xov öwSea^iOv xai xx\q aakmyyoc, xai djioxoXXw^EV n-goöexTixü)? tov Syxov dno

'ktUm ihlMMr.'*"

«M

••>"

xov XEQißctXXovTOc QVTOv JtXateo^ avv8£ö|.iov. 'löiaiiepa jrgoaoxr) djtaiTEiTai tvo piT) TQCo^fi
6 oiipriTTiQ, OöTic oi^vri\*>ü)$ e'x'^i lAETaTOÄiöOyj vno tov oyxov. Elvat jiqotihothqov jiqIv ti äqo"
XfopYiocouev 81? THv evXfiQilöiv vu d.ionovcoocofitv ai'TOv xaO' öXtiv x\\v jiveXixiiv avTOv 5ia-
ÖQO^riv. AuvctpieOa vd ef'xepdvcDuev Tf)v eviore X(av öi^oxFQn eEaipeciv [.ivcDnaTCoSwv öyxcov

tAx. lOi). — 'YjjeQxo/.nixij vazeQextofa]. 'H fn'jToa i^^^ ovkktjrpi^ij diä jitXvoöovTixfjq Xaßidog xal iXxetat
lo)[VQ(üg .i()6g xa i^(o xai äoiorsod. 'Ode^iog .T/aris- ovvdea^Os Öiaiovjiäxui diä rov jueoov daxxvkov xal xäsjii-
xa&i^fieva in* avxov e^aoitj^axa (otgoyyvlog ovvdea/nog, idiog ovvSeoftog xrjg woi'^tjxrjg xai odlmy^) skxovxai
taxvQ(bg TiQog lä TtXayia. 'O dgioxegog deixxrjg ajioxwoli^Ei xa jxexaXa xov dgioxegov TtXaxeog ovvÖeo^ov f^^XQi
XTJg xvatecog :jQ6g xä xdxco xal djioxoXXä xdg JiXayiag fioigag xijg xvotscog dno tfjg /nijxQag,

TOiJ TQaxTJXov, oiTiveg öivriOco? än(x){^ovv ttiv "kvotiv jigog id dvco, edv £loaydyco\XE\ eva öeij-
TfQOv exTtcüjxaTiöTTJQa evTog TOiJ o'yxov, OGxiq elvai 8oq)Tiv(ü|ievog nq xb ßd{^oq xr\q iiviXov, xai
eX|co|X8V TOiiTOv TiQoq TU dvco. 'Edv t6 TOioiJTOv Öev ejriTuxU. e^8i8r) locog 6 ö'yxog tivai xa^ri-
Xa)|.ievog evxbq xriqnveXov, xaTOQ0a)vo|i8v t6toio\)tov, edv 8iavoi|ü)|X8V Tr)vxd\pavToiJ ^ludjjAaTO?
xal exjivQTiviacopiev tov oyxov. 'E:tl vndg'^ECüq ex jiaQaXXrjXov cpXeY^ovcDÖüiv 8|aQTYinaTixd)V
OYxcov, Jiapaoxem^opiev tovtod? jiq6t8QOv xaTd tov r\br\ jieQiYQaqpevTO toÖ.t;ov xal ev dvaYxtl
llaiQOvpiev, dxoXov^cog 8e JtQOXcoQOiinev eig rrjv e|aiQeoiv xr\q [ir\xQaq. Eig TOiavTa? oiixl dacpa-
Xibq äor\Rxovq JtfQiTtTcoaeig drprivopiEV tov xoXeov dvoixTov xal 7üaQ0X8TeiJ0|xev 8id XcDQiöog yci-
^T)g 8id \xE00v TOVTOv, avYxXeiovTeg jtdvTOTe Td xoiXtaxd TOixoVata.

EU HO -'Y.isoxolx.xli voi-'OFy.joH;,. 7/ od/.T/;„^ o axooyyvkog arrdeofiog xal 6 l'diog orv^en/^og x^g ojo-

i/t'jHijg Piovv (wkX>j(fi>fj htd kaßiöcov.

Eix. 111. — *YjieQxok:iixtj vaxeoExxojiv). 7/ xvoxig P^ei djioxokkrj&fj /tiexQi tov dgiaxeoov x^i^ovg xrjg fi^xgag

xal xoaxelxai :iq6 gxd xdxto 8t* evog xokvjiiov avkkrjcp^hiog vjio dyxiaxQcoxrjg kaßidog.To de^iov JiaQafi^XQtov

fisxä x(bv evQiaxofievoiv ivxog avxov fifjxgiatcov dyysioiv fx^i ovkkt](p&fj dtä (itäg xvQxrjg kaßidog.

K. Äoyo^sxonovkov, rvvaiHokoyixr] XeiQovQyixtj Q

.t.y

Ely. 112.—

Yjieoy.oXnixi} vorEoey.TOj.ii). 'H fit'jtoa fly.etai Inyvgw^ jiQog tä avwxai doiOTFgä xal tavxoj^oo-
v(og XE^vExai ftetä röJv ov}.h](f^tvT(jnv dyy£i'(ov uvo) rov rgayi^/.oi'.

J£lx. IIB.—

'Y^spxoXmxi] voxEOEy.ioui]. '// unxoa Vipi A»«^«..*~ ' ' «. , «. ,

EU. 114.—

YjxEQXoATfixrj vaxEQexxo^n). Tb JxgöaOiov xal ojxio&iov xoij^oyfia xov XQa)^t}?,ov oi'QQä.^xoviai

jiQOS äV.rjka,

T-'

Elx. 115. — 'YjxEoxoXTXiXfj roxEOExxofU). ITEoixovaioTiXaoxiXfj diä ovgQaqpfjg lov Txegixovatov ta/^ xüöwcof ueta,
Tov AovyXaoEiov jxeqixovqiov fiExä xavxo-^QOvov Fvxafpiaofiov xiäv i^ßoxr^ftaxi^icöv xokoßo}fid%<av.

10. 'H UOdnKCKTOMn

Tov xatGt t6 hoq 1809 imb xov Ephraim Mac Dowell (U. S. A.) ävEv vaQxcooew; e^l jiia?
ai^iojciöo? xal naXiata neiu xaXov djtOTeXEOnaTOc, oiko) öe riQX'oev ri Xa^iJiQa ^ JteQioSog xr\<;
XEiQOVQyiKr\(; irig xoiXia«;, dQXixwg ejtißaQvvaEiaa vko \xEydlj\q dynoi\x6xr]xoq. 'H IHaiQEöig

£'/x. iiö. — KoiXiaxrj oXixt] e^atgeaig xf]g fi)'jtgag. *0 :iXaxvg arvÖEn^tog xai ra f.irjt;}iaTa dyyeia e^ovv dia^co-
Qcad^rj liieza^v Öi'o Aaßiöwv. *Ev<o i] xvöxk; dico^rj^siaa jto/.v .loog xä xdito xgaieixai xaXwg fii'' kvog xoXv-
jiiov, ifißv&iCexai x6 ^ayaioiov exov xo o^v fxsoog ai'xov Foxna/nfierov jiQog xä Jioooio ivxog xov dvwxsQov Tfin-

fxaxog xov xoXtiixov xoijrcö/naxog.

hbq oiTiXov öyxoi» xr\q Coo^r\xr]q elvai roaov £i»XfQn? eTfußaGi?, wöte Öixaicog va ^ecogfitai
ü)? eyxeiQiloi? twv doxagicov, Iviote o'ncog dvEVQioxovToi ovnqpuoEig xal d'XXai IjriJiXoxai,
aixiveq djtaitovv iriv ixavotriTa hbq JiEJtEiQanEvOD xeiQOHQyoi). TEVcxcög JiQOTtjiwpiev ttjv Xa-
jiagoTOHTiv 8id tfiv EHaiQEaiv rcäv oyxfov xr\q (ooOrjxTi?, xa^' öaov owri^oDg 8ev ÖDvdpiEOa vd
EXü)jA£v oaqpfi Eixova jiqo xr\q Eyi£iQr\Ge(ßq tzeqX xr\q xivtitixottito^ xov öyxov r\ xr\q ev8oauv8e-
G\iixr\q amov dva7tTv|EC0?. Ovtco 8i»vdnE0a vd 8iaTTiQrioo)|iEV triv uriigav, ivcT) e:ii xoXjtixf]?
EJtEfxßdöEO)g dvavxa^o^iEi^a vd d(paiQ£acon£v xal launiv, Ihiq. etti Erti.TXoxcov tivcov jtEQiJiKO-
aEü)v. 'Eqp' oöov 8ev jtQOXEiTai äeqi [iixqov öyxov EiiiEOa {ijioxqecohevoi vd SiavoiHcoiiev tou-
Tov xaid T^iv xoXjrixriv LiEjxßaoiv, tovO' ojteq ejti ^em-oXi'ojievoij jieqiexohevov r\ ejil xaxori-
&ovq öyxov £JiißaQVV8i_ £|ai$ETixd)s tfiv jiqoyvcooiv. Movov Eni Xiav jraxi^odQxov yvvaixcov y\

.3^^!^r^

; ^^01^

j^§

.><«»*!5%-v '

-1

^^t

^, ".dii^rr^'^

w^^k.' -^ ^^^S^P^^^k

^^r

l^w

^^^^^^BWV-

•

jz m i

F •<.

. ■„ ^^B \ *

Elx. 117. — KoiXiaxi] oXixt/ i':^aiQeaig xT/g fii'jxoag.
'16 TiQooüiov zol^cofia xov xQax'jXov xai x6 dvcoie-
govxfifjfxa xov xoXeov e^ow Öiavoiyij dtä xov f^u-
yaiQiov . T6 ojiia&iov -/e^X^og xov xoaxr'jXov ex^i ovX-
X.rjq>^tj dl' dyxioxQ'jixrjg XußiSog. 'Eviog xov xo'
Xeov eX6i elaax^fj xoXvjxiov öiaxgaxovfisvov t'.TO

Xaßidog.

Elx. HS. — KoiXiax'f] oXixij i^aigeaig xfjg ^it'jxgag.
T6 no6a{^iov xoX:iix6v loixo^fia iX.xexai diu f.itäg
Xaßidog. 'l'.TÖ Ioxvqvlv fX^iv xov xgaxtjXov diaxi-
fivsxac x6 dnio^iov xoXjiixov xot^oi^a dxgißcjg
xdxco xov xgaxt'iXov,

Elx. 119. — KoiXiaxr] oXixij i^aigeaig xrjg fxjjxgag. 'H fii)xoa ex^i- dcpaigFOr^. Id xoX.iixd xoav/Mxixa x^^Xt]
exovv ovXXfjqp&rj Öid XaßiSojv xai ivxog xov avXov xov xoXeov ex^i elaax^q X.cogig ydCt]g. '0 xoXeog ovyxXeU-
xat diä oa<f(av ai'xiveg öev avXX.a(xßdvovv xov ßXevoyovov. 'Evxa<piaa^6g xwv xoXoßiofmxoiv xarä xtjv nsQixo-

vaionXaaxixf]V.

Edv EVExa äyXr\q ahiac evSeixvutcxi in exteXeöi? xoXjtixfji; EJiEußdöEwg (jTQojtTWöi? xtX.) XEiQOi^g-
YOV'uev ö'yxou? T(ov (LoOrixwv xoXjrixd)?, dXXd xal tote ^ovov euv jigoxEiTai jieqi xaXori(^cov

OYXCOV fl JtEQl 6TCCL)ö8TijlOT£ fif] EJTlJlXoxCOV HIEQlJtTWaECOg.

a') KoiAiaxfl uo^f|KCKTO|j^.

" 'EtpaQuo^ouev yevixü)? ttiv \iioi]V Topiiiv, titi? ejii eXgvöepcov xvötixwv oyxcov exieXet-
rai dQXi>iü)? ^AlXQd, gjiexTetvonevr] ev dvdvxn JtQÖ? tu dvd). 'H eyrngoia to^t) Pfannenstiel
EXei piovov t6 TiXeovexTTina xa^Xitepa^ aiödTiTixfig E^icpavioewq, exTeXeitai 8e ejii ^iixpaiv oy-
xo)v, Xf*>Qk vd e7iiq)8Qt] övoxeQeictc;.

Meiü Tf)v 8idvoi|iv toO negirovaiou nQOoavaxohl6\ie&a jieqI tri? ^töECO?, tov ^ieYe^o^'?
xai rfi; xivTiTixoTTirog roO o'ykou, nQ0OEX0\iEv öncog öX^oc; löiaireQO)?, orav .^goxeirai jieqi oy-
xcov xaxOTiOcov, Ti Jiepi toioijtcov piEid vkokxov jteqifxoixevod, oitive? öeov vu £|aiQa)VTai dvEV
8iavoi|EC0s, EV dvdYxti 8i' EJiExrdöEO)? xr\q dQXixrj? xjiXiaxf); TO|ific. EiodYOiiEV ttiv xeToa Iv-
Tog Tfjg jiEQiTOvaixfi? xoiAottito?, öi^XXapißdvofxev tov oyxov xal qpEQOjiEV ai'TOv jiqo twv xoi-
XiaxÄv toixwfidTCDV. dcpov jiQOTiYOvpiEVog Xi^öco^ev iKpiötaiiEvag tdxov öv^qpVöEi? d^ßXEwg fi
8id Toi5 \i)aXi8iov. 'O ^ilöXOS, M-e^d .tqotiyo'uiievtiv guXXti\|)lv 8id XaßiScov, d^oxcogiCEiai djto
Tfig nrJTQfxg, «jtoXivoiJTai xal xaXujitETai 8id jiEQiTOvaiou. Ai)vd^Eda ^EYaXcog vd ÖievkoXwcojxev
ttiv £|aiOEöiv Evog oyxov 8id \ieoov i^ixQdg io\iY\q tt)? xoiXiag 8id tov EEng xeiQi-öjioC' : METd
8idvoi|iv Tfjg jtEQiTOvaixfig xoiXoTTiTog eXeu^eqoi'uev tov [lioxov toij öyxoi; xal öiaTEM-vojXEv
TOiiTOV HETa|v 8\J0 Xaßiöcov ovTcog, wöte 6 öyxog :^aQa^EVEl eXe^jOeqo? EVTOg xriq xoiXiaxfjg xoi-
XoTrjTog. 'AxoXoL'Oü)? 6 ßori^og eXxei xovq ÖiaöToXEig loxvQchq olk dXXrjXcov xal oXiyov jiQog Td
dvo), oi^rco 8£ LtiTUY;KdvETai EVXEQEOTaTa f\ E^aYWYn tou o'yxod xal 8id ^iixydg xoiXtaxfjg to-
pifig, 8id TTJg 8id tov \iio%ov JtQog Td fl(0 eXIecd? ai'TOv. 'Edv 6 xdötixoc öyxoc; jiETd ßEßaiOTT]-
Tog {>£ü)QEiTai wg xaXori&rig xal t6 jieqiexohevov aitTOii dvanq)iß6Xa)g äor]Kxov, TOi'd' Öjieq bv-
vdpiE^a xaTd t6 jtXeTgtov EitxoXcog vd SiaÄiOTWöcauEV ex Trig8ia(pavEiag tov TOixwnaTO?, Elvai
axojiinoc 1^ 8idvoiHig xal f\ xEVCDoig Tfjg xvoTECog kqo xr\q £|aiQ£ö£0)c avTng. MfTd xr\y 8idvoi-
i^iv TOV jiEQiTOvaiov f\ xvoTig avTOfidTCog jiQoßdXXEi xard t6 jiXeiotov Eig t6 eyxeiqtitixov jte-
8iov, EV ävdyyiw 8e vJioßoTidovpiEv tovto 8t' tXaq)Qdg jiiEGECüg tcov xoiXiaxwv TOixconaTcav,
dvcüdEV TTig Topifjg. 'AxoXovdcog piETaßdXXopiEV to ejiijceöov Tiig dpQcoaTOv djio E^ixXiVEg Tren-
delenburg £ig ÄQOxXiVEg, xal 8iaTQV3Tä)H£v TT)v xvöTiv 8id fxaxaiQiov (eix. 120). *H XQ^jcrig
Tfjg ßEX6vT]g jiagaxEVTrioEo^g slvai jtEQiTTti, 8i6ti to vko jiieaiv EUQiax6|iEvov vyQov exqeei wg
d^o jTi8axog. Aid XaßiScov övXXajißdvofXEV d|,i£öO)g t6 Toixa)|.ia Tf)g xvöTEOjg xaTd xr]v xd)Qav
TTig Tonfjg xal eXxo^ev tovttiv ßgaSECog JtQog Td eEco, evcTj ovyXQOvfog TfXEiTai f\ ßadpiiaia xe-
vcoöig TavTTig (eix. 121). 'AxoXovOwg övXXanßdvouev tjiv kvgxlv bC dXXcov XaßiScov, HEXQt ov
(pddöaipiEV TOV [iioiov xal 8vvtiO(üH£V, [iexu gvXX'hiI^iv avTOv 8id XaßiSog, vd dn;ox6i|JO)HEV
(elx. 122). XQT]öi|jion:oioi5nEV jigog djioXivcoöiv iöxvqov Qcoixov gdufia xal 8ia7r£QÜ)|X£v 8id
Trjg ßEXovTig tov [x'w/iov, 8i6ti y\ öXiöOiiaig tov gdn^aTOg Tf)g djioXivwöEcog 8vvaTai vd EXTl
öXEOgia dn:oT£X£G|iaTa. 'E:il GvoTQOcpfig tov piioxov eEaXEitpouev Tavtr^v 8i' dvTii^ETOv gtqo-
(pf|g Toi5 öyxov jiqo Tfig Tojio^ETi'iGEcog twv XaßiSrov. 'EjiixaXvjiTOUEv t6 xoX6ßco|j,a jT;dv-
TOTE EjrinEXwg 8id jtEpiiovjtiov xaiTOi 8£v EXopiEv jtaQatriQiiGEi ^elovextixov djiOTEXEopia Ix Ttig
jiaQaX£iiiJEa)gEigTivag JiEQiJiTcooEig 8i'olxovoniav XQOvovTfjq JieQiTOvaiojiXaGTixfig. 'Ev8oövv8e-
GM-ixcog dvajiTVGoo^iEVOi öyxoi SvvavTai vd jrgoxaXEoovv SvGXEQEiag Eig tov XEiQOvgyov EVExa
jiaQEXTOJiioECog xaTd t6 jiXeigtov tcöv yEiTOvixoJv OQydvcov, [.lövov bk 8id jtqooextixov jtQOoa-
vaToXiG|xov EJtiTvyxdvouEv vd djtoipVYa)|j,£v TQai'|iaTiG|i6vTr]g xvoTEtog, Toi3 EVTEpovxal i8iQt tov
ovQTiTTiQog.Eig Tiva; tcov jteqljitcjogewv piov evqov tov oi'QT]TriQa jtoqevouevov xaTd t6 ueöov TTJg
jiQOG^iag EjricpavEiag piidg uEydXiig £v8oGvv8£GjAixfig xi'GT£0)g. Kavwv xaTd tt)v EyxEipTiaiv tcov
Ev8oovv8Eanixwv oyxcov Eivai jtdvtOTE vd e'xwiiev vk^ üi|;ei tov ovpriTriQa, ejiI olaG8Tin:oTE 8£
dn(pißoXiag vd djioxaXv;iTa)^iEV tovtov xa^' öXov t6 £;iixiv8vvov Eyx8iQT|Tix6v Ä£8iov. Aeov vd
piT) GvXXaiißdvYiTai 8id Xaßiöog ov8e vd SiaTEpivTiTai oiab/iJiOTE ÖEG^iig lotov, xo^giq vd Eivai
Tig djtoXvTCog ßEßaiog äeqI TYJg cpvGEcog avTfig xal vd [li] xXEiriTai »i xoiXia, jiglv ti jiEiodfi
jieqI Tiig dxEQaioTTiTOg twv ovqtitiiqcov. Ai GVVT]Ocog IxTETa^Evai GVfitpvoEig tcov xvgtixcöv oy-
xcov JiQog TOV ÖQoycjvov töjv yEiTOvixcöv öpydvcov djraiTOvv ^£ydX1lv jigoGOxriv. KaTd ttjv
8idvoi|iv ETI Tfig JiEQiTCvaixfig xoiX6Tr]Tog £ivai ftvvaTov vd 8iaTQTiO'n to TOixo)na Tfig xvöteco^
Edv TOVTO ;tQoaxoXXTi{>fi ejtI tov toixixov jiEQiTOvaiov, Tovd' ojiEQ Xiav 8vödöEaT0v, Icp' ÖöOV

MfV^m^UI ■' t I

£i>c. 120.— *fJo^TjxexTOfii]. Aiävoi^iq xrj? xvaxewg diä xovjiaxatQlov. To neQi€X<^ftevov xijg xvöt€(og ixQesi

El>c- 121.— 'Qo&n>iexto[xii. To xoixcofia xf-jg xvaxecog exei ovUr)<p&r) xaxä x6 öiavoiyev ar}fieiov diä /.aßlöog

xai eXxsxai :iQ6g xä ävoi.

'i-- ■■■ - - -' •• ' ° ■

JiQOxeiTai jieqI \k£[ioXva\iiy(ov r\ xaxOTidcov oy^cov. Ai ov[i(pvoEiq xov kmn'koov xai toii nvAi-
xov xOiX(i)\xaxoq \xBxa, x(b\ ivTeQiXü>v eXixcov "kvovxai GDvriOa)^ dfißXFCOg 6iu xr\(; xhqoi;. 'Eviote
6Vü)5 elvai äydyy.t] vd jtaQaöHevaa&ovv £Ki[ieX(i)q biä xi]q x^'iQO^QYix^? XaßiÖo; xai xov li^a-
Xifiiov, ojiOTE ex TO)v jiQOTEpcov Seov vtt öi)XXanßdvTiTai exdoTTi Öeöfil; ÄFptf'xouöa ayvei«. Td
Tvxov tgavuaia xov hxsQOv öeov vd ovQodjrrcüvtai ejiipitXd); xai av eii jigoxeiTai jieqi i^at'-
HctTCOv Tov OQOYÖvoD, \ik Jictoav jiQOöOxf.v JTQog djioqpi^Y^v öTtvwöEO)? Tov avXov. riap oativ
tnv JtQOooxT|V xard xr\v djiox6XXT)aiv tcov övficpuöfccov jioUdxig öiaoQrjyvi'Tai t6 TOixcana xy\q
xiJöTECog, ojiotav r'i jieQaitEQca jtaQaoxevri tov xaXapoiJ jtXeov adxKOv ovoiiobwq övoxEQaive-
tai. Eig TOiavtag JiFQiJiTWöeig xQ^Iöim-o^oio) ueOoöov f]v e//i) TiÖt) .-reop/n.iii'ti 8id ttiv e|aiQe-

Elx.l2k—'üo^xexxofxri.T6xoix(onaxf}gx{,axe(og?X^^ovXXri(p&r^ xaxä x6 diavoiyev öTjfuTov 8ia Xaßidog

xai sXx^xai Jigog xä e^cj.

öiv Twv xvöTECOv Td)v ßaQ^oXiVEicov d8evo3v. 'Ajroan:oYYi'Conev 8id ajrXnvia)v xard t6 Swatov
TTiv xoiXoTTiTa xr\q xvaxecüq xai jiXtiqoi'uev lauTriv dxoXovi^cog xaXcog 8id Xa)Qi8os yoCt]? (el^.
123)' avQQdjiTOjiEV ex veov ifiv to^tiv xov xoiyßymxoq 8id gan^drcov xai ovxo^ netaßdXXojiev
Tov jtXTiocoOevra 8id Yd^ri? ödxxov ei? Gt^njcaYn ö'yxov, ov auXXajißdvojiev 8id jioXi.o8ovtixü)v
Xaßi8a)v, djieXevOeoovpiev xai eXxopiev jtgog rd e|a) ^ef;« i54).

Ol xaxoT^öeis ÖYxoi tri? (oo{>i^xii? elvai xatd t6 jiXeiarov d^cpoTegojcXeuQoi. dvajciiJö-
aovtai 8e avvndco? 8evreQ0;iaaü)g. "Evexa toutov xai Im dTioo^öia? eri xaracpavcav dXXoico-
öecüv 8eov vd elaigw^ev xai xx\v d)0^)^xTiv xov qpaivojievixo)? vYioii; jiXaYtou xai vd eietdCco^ev
^ieOo8lxd)g ÖXa td opyava xy\<; xoiXiag Jtpög dveupeaiv tov jrpcoTOjtaaovg o'yxov.
6') KoAniK^ 6odqKCKTOM^.

' '9 Atlee rAiieQixfJs) eEeteXeoe lo itpÄTOv xatd lo 1854 oXco? Ti^x«fa); i^v eYXei'onoiv
tavTTiv. o Caillard - Thomas öjico? ^e^oSixoig eQYaaOelg dveaxeuaae lai^mv t6 kqC^xov xard

Elx. 123. — ^üo&ijxsxxo^tj xaxä Aoyo'^srojxovXov, Tu hjiiä xai^^oiiaxa Qrfx^eiar]^ xvoxBJnq dtaxHtoytat Sia
Xaßiticof X li jii^iä XE/.eiav xh'.oniv xou :isoiExoasvov n\r)oovxai t) xoikoirjg avxqg diu, ydC'l-i.

Elx. 124. — *Qo&t]XFxxofiij xaxä Aoyo&ezdnovXov. T6 ävoiyfia xfji; xvaxecog c^^t avyxaXv(p&rj 8iä avyexovg

Qaq>i}g, t) jtXrjQco&etoa diä ydCr]g xvnxcg övvaxai vä &e(OQt]&fj nXeov wg ovfiTxayrjg oyxog, dr^laötj vd avX).t]<p^f]

öiä TioXvoöovxixijg Xaßidog xai vä eXxvo^ij ngog xä e^co. Ai' dxo/xixrjg Xaßidog xai xpaXiöiov dnox^^QiCovxa^

ai av/Aifvasis zov toixcofuixog t^£ xvaxecos dno xov ivxeQov nal xov eniTiXöov.

<»<■■

OÄ^--'^^ ^^33ivan

t6 ETOg 1870, 6 8e jiqcotojioqo? twv xoXäixc5v evxeiQiltixcav piedoöcov Dührsen \xExä pi^ixTiv
ImlEQyaoiav, öiefiooev avinv evqijteqov. Meid triv 8idvoi|iv xY\q JieQiTOvaixfi? xoiXottitos 8id
jiQoadia? Ti öjiiodia; xo\nOTO\XY\q, ävaUyoyq xr\q f^eoecog xov oyxov, ouXXa^ßdvo|xev tov öyxov
8i' dyxiöTQCDTwv Xaßiöwv, Siavoivouev tovtov 8iu tov piaxaipiou ii Tfjs ßeXovT]? jtapaxevTfi-
aeco; xal dqjnvouev vd exoeuot] t6 keqiexoiievov . 'AxoXouOco? eXxojiev ttiv xuötiv JtQog td
xctTü) jAE dXXEJcdXXriXov ö^jXXrixi^iv 8id Xaßiöcov piEXQt o{> dvacpavfi 6 niöxo?, ov jxEtd jiqotiyti-
dEioav öUvdXi\piv 8id Xaßiöog djioxojttouEV xal djioXivovtirv. 'H dqpaiQEOi? djto xov xoXeov
jioXdxwqwv xvötecov 8ev Elvai tooov e\%£Qy\(;, 8i6ti jiqejiei vd öiavoiyovv fj jiia xoiXoTTig jiEüd
TY|v dXXriv, ojtOTE öuvatov vd tqo3{>ovv evteqixqi eXixEg. "EXxouev jiqo? toito t6 ow^a xr\q
\ir\xQaq o)? EJti xoXtuxtj? aJOTEOEXiopif]? TiQoq xä eHü), SiaTEnvojAEV tov iiiöxov to\5 oyxoi^ jAETaHv
8uo Xaßiöcov xai eXko^ev dxoXouOwg Ix tov higxov tov öyxov nQog xä xaTCO, öiavoiyo^EV eItu
TTjv enq)avi^on£VT]v xaTd t6 dvoiyna ttj? xoXjcoTO^ifig xuotiv, xEvovpiEV tüvtiiv, GvXXa^ßdvo^iEV
8id Xaßi8a)v xal l'XxofiEV iiQoq xd s|ü) ttjv ETtonEviiv T0iauTT]v, £jiavaXa}ißdvovT£s t6 uvto jae-
XQi ov dq)aiQEdfi £| oXoxXrjpov 6 07x05.

11. 0AcYKiov6öci(; nadnociq t6v e^apTnM<^'rov

Ai (pX£Ypiovc68£i; jiadriöEi? twv £|aQTrmdTCOv w? ex xY\g övxvottito^ xr\g ^axgdg 8iaQ-
XEiag xY\q jiai^TiaEco; xal ttj^ övvoSevovöt]? TavTa; xaxE^iag, Jtag' öXag xäq JiQOoSovg Elg Triv ^e-
QttjiEVTixriv, rpEQovv Eig 8voxEQii ^Eöiv TOV laTOüv. EvTVXwg in ^^^ "^^"^ Y^^ctixü)V Eig xäq jiXei-
GTag TCüv JtEQiÄTCoöEcov 8EV djiEiXEiTaL xal 8vvdn£^a 81' EYxaipov EqjaQuoYTJg öXcov tcüv veco-
TEQCOv övvTTiQTiTixcäv piEöcov vd dÄoq)VYO)H£V xaTd t6 jiXeIotov öoßagdg EJiiJtXoxdg. Ai' avaxt]-
Qäq xaTaxXiOECog xal EcpaQ^iOYTig xvöteccx; jiaYOv r\ xoQTiYTloECog jtevixiXXivt]? xXjt. Eivat 8vvaT6v
vd vjcoxcoQrjaovv Td ö|£a q)aiv6^Eva xal jiaQaTTiQEi xiq JtoXXdxig het' extiXtiEeco? Kcbq E^aqpavi-
^ovTQi xal Xiav evheye^ei? eti oyxoi Td n:aQanFV0VTa vjtoXEinjAaTa xr\q <pXEYpiovfig djtOQQoqpüiv-
tai 81' £q)aQHOYng [lEacöV dTiva jigoxaXovv xOTiiy.r\v vjiEQainiav, dpxopiEvoi 8£ djio Td jtaXaio-
Oev £XTino)HEva d£Q|iu £8Q6XovTQa xaraXriYOM-EV £15 Tfjv 8id ßgciXECOV xv^ctTCOv dEpajtEiav xal
djio xäq EVEOEig XY\q TEQFßivö^ivT]^ Eiq TT]v OQnovoOeQajTEiav. "AX^OTE piEV E^avTXEiTai in öEigd

TCüV dEQa.TEVTlXWV H£&68a)V dVEV djlOTEXEöHaTOg, OTE ExXeiTIEl f\ VJlOpiOvf) TOV laTQOij, ÖVVr]

dEöTttTa 6\xoiq xal xvpiwg in V7iO|iovf] xr\q dpQCooTOv. ITqoxvjitei ovtcd t6 jipoßXiina xr\q byX^I'
griöECog xal oqpEiXopiEV vd jraoaSEXi^wpiev oti elq £va dpxETOv dpiOfiov jt£Qi:TTO)öEa)v fAOvov 8id
TavTTig 8vvdn£&a vd £n:iTvxcü[AEV Triv pi^ixfjv deoajTEiav. 'H pidXXov öKOJCi^og £YXeiQi1T^i>tYi j^£-
do8og, TiTOi f\ £|aiQEöig xriq \ir\XQaq \iexa twv £EaoTT]ndTa)v, j]xiq döqpaXcog «ye'' fk djiOTEXE-
öjxa 8ev ixovojioiEi evteXei tov xeiQO^QYOv, 8i6ti ai xaTUTO tiXeIotov Eig ttjv YevETriaiov jtEQio-
8ov EVQiaxopiEvai Y'^vaixEg vjtoqpEpovv ßgaSvTEQOv jioXv ex xXimqxttiqixwv 8iaTa(jaxa).v"EvExa
TOVTOv EinEda oaov t6 8vvaT0v ovvTTiQ'nTixoi E15 rf)v xXivix/]v [laq xal £v jieqi.dtooöei £yiEiQr\-
CEoaq 8iaTTioovn£v tovXcixiötov Tag cooi^^xag tojv yvvaixcjüv. Movov xard ttjv xoiXiaxr]v EJtEji-
ßaoiv 8vvaTai Tig EJiaxQißwg vd xgiv(i, ti Elvai Swotov vd 8iaTT]QT]0fj xal ti Seov vd £|aiQFdfi,
tva t6 teXixov djtOTfXEöna Elvai xaXov. 'Opioicog f] ainoöTaGig, I^Tig Elvai togov d;raQaiTT]Tog
8id t6 djiOTEXEGna xal in XEJtTOUEQTig jiEQiTOvaiojtXaGTixrj, Eivat 8vvaT6v vd exteXeg^ovv ^aovov
EX Tüivdvcü, 81' 6 IjIOVOV xaT' E^aiQEGiv Eqpapnö^ouEV ttiv ^ecoqovhevtiv ü)g dxiv8vvov xoXtiixtiv
686v xaTd Td TEXEVTaia ett].

"OXo)g dvTi^ETCog XEiQOvgyG) djroxXEiOTixojg xoXjrixcog Tag ßapEiag JiEpiJiTcoGEig, xaO'
ag EX Ttüv jiQOTEpcüv Ti^ETai CriTTina dcpaipEGFwg Tfig uriTpog xal twv jiaoxovTCOv £|opTr]jid-
Tcov. Ilap' öXag Tdg VECOTEpag EpYaoTTipiaxdi, E^ETdoEig (dpidjiriGig Xevxwv aijioocpaipicüv, al-
^aToXoYixT) eix(OV, TaxvTTig xadi^nGECog xXji.) 8£V EipiEÖa xal vvv eti £ig Oeoiv vd Yvo)pi^o)^EV
^lETd ßEßaiOTTiTOg Jipo Trjg syxEiQr\OE(x)q tov ßa^piov Tfjg To|ix6TT]Tog tov jivov xal o)g ex tovtov
Td djiOTEX£G|xaTa f]\i(i)V xatd xr]v xoXjtixrjv iJ,£&o8ov Elvai aGqpaXsGTEpa ogov dqpopa Eig ttiv

^(OTIV TTig dpQüJGTOV. 'AjloXvTOV £v8£l|lV 8ld TT|V XOX;ilXl]V EJlEußaoiV JiapEXOVV 81' EHE EXElVai

Clt,jiEQiÄT(6G£i$ xad' dg f\ Jtda^^ovGa, £tT]G&Evr]piEVTi vjio jivqetoö ejtI nfivag, 8£V 8vvaTai vd

dvEX^fi ttiv Xa7rapaT0HT)v xal fiTig ^d tito ÖvvaTov vd djio^dvti xaTd thv IjiEußaoiv r) fvExa
M.ET£YX£ipTlTixng Jt£piTOviTi8og. 'ÜGauTCog piETd EYXEiQnoEig, xa»' ag 8itivoiyti djiGOTT^a xoXjii-
xd)g ti xoiXiaxwc xal napE^EivE GVpiYYiov, dvoYxa^onE&a vd öxoXovOtiocouev ttjv xoX;rixnv
686v. *H TO^XT] Schuchard xal 1^ JiponYTiÜEioa dcpaipEGig Tfjg ^iirpag ejtitpejiei Eig f\\iäq Jidv-

TOTE l^aipETlXTlV IjllOXOJTTlGlV TOV EYXElpTlTlXOU JtE8l0V OVTWC, (SöT£ r\ EYXElQT]Oig EXTEXElTai dxpl-

ßwg xal jA£do8ixwg wg xatd ttjv XajiapoTOHTjv. *0 vjidpxcov q)aivonEvixü)g xiv8vvog TpavjAari-
G|.iov TOV EVTEpov 8EV filvai TOOOV Goßapog, xaO' ÖGOv al av|Li(pvoEig tojv E^apTTmaTcov piETd
TOV jcvfcXixov TOixcojiaTOg XvovTai djißXECDg xal EVXfpwg 8id Tilg xeiqoc, ojiote ot oyxoi o^ov \iexa
Ttüv EVTEpixcüV eXixcov fiXxovTai jTpog TdxdTco xal djioxwpi^ovTai 8id tov \l;aXi8iov dji' dXXriXcDV
jipOGEXTixojg vjio TTjv xado8TiYT]Giv TOV ö(pOaXnov. Kad' oXovg Tovg X£ipiö|Liovg TOVTOvg ^pYO-
^OfiEOa €|o} TTJg IXEvOfpag jiEpiTOvaixfig xoiXoTTiTog, xaO' ogov t6 oXTmaTiCopiEvov vjtepdvcü
Tü)V Jiva)8d)v odxxcov jipogtotevtixov EJiixdXvnna vjco twv Gvnq)von£va)v Jipog dXXqXag evte-
pixcüv eXixwv, Eig Tdg jiXEiGTog jtEpijiTWGEig "Sev Elvai ä\dyxr\ vd 8iappaYfi, okeq ßEßaicog
djtOTEXEi dvEXTiHT]TOv jipOTEpT]|ia TTJg xoXjiixfjg 680V.

a) KoiAioKJt lyxcfpnoK; tüv fpAcYMOvuSöv 6ykuv tüv il[opTqtiäTuv.

'H 8vGX£p£ia Tfig E^aipEGECDg q)XEYHOV(o8a)v o'yxcdv Toiv £capTT]ndT(üv 8id XajiapoTOnfig
Eivai dvdXoYOg Tipog Tdg vq)iOTajA£vag GvnqpvGEig. AiavoiYO^Ev jrpooEXTixwg xr\v JtepiTOva'ixfiv
xoiXoTTiTa xaTd t6 8vvaT6v Eig gt]|aeiov ojiEp Elvai eXevöepov Gvuq)voEü)g, eäxouev tt|v ovXXt]-
q)Ö£iGav jiTiTpav 8id .ToXvo8ovTixfig Xaßi8og EXaqppcag 8id Tfjg dpiGTEpdg XsiQoq nQoq xu £|a)
xal JipoGJiaOov^iEV vd Xvgco^ev 8id Tfjg iTfpag XsiQoq JipOGEXTixwg Tdg Gvn(p\3GEig. Aeov vd
djioqjEVYcoiXEV ttjv dGxijoiv ßiag, km IXaxiGCTig bk 8vGX£pEiag GVVEX^CoMfv ttjv d^oxoXXTiGiv 8id
TOV i|^aXi8iov VJIO tt^v xado8TiYTiöiv Toi5 6(pöaX|,iov, ojiote f\ ai^ioppaYia Elvai ^xixpd xal xaTd
t6 jiXeIötov EJtiGXETai 81' IXacppdg jiiEGECog 8id ojiXtivicüv £iGaY0|>i^vü)v jrpoocopivwg. 'Edv Td
llapTTinaTa Elvai TEXEiwg iXEVÖEpa, tote ü xpE|xaGTf)p Gvv8EGHog xal 6 i8iog GVv8£G^og Tfjg
wo^TlxTig piETd gvXXtii^iv 8id Xaßi8a)v 8iaT£|AvovTai xal djioXivoiJvTai, £V(p t6 ^TiTpooDaycoyixov
OTOfxiov TTJg odXjiiYYO? Jttt^d JipoTiHTjGiv EXTEjAVETai o(pTivoEi8ü)g djio Tfig UTiTpa?. *0 JtXaTvg gvv-
8£G|xog djiXtog 8iaTE|AV£Tai, 1^ 8£ nixpd £| avTOv aifioppoia IjiiGXETai 8id Tfig jiEpiTOvaiojiXaoTi-
xfjg. Td xoXoßcopiaTa twv dYY£iwv £VTaq)id'CovTai EJitnEXwg.

'Ejtl IGXVptOV GV^q)VG£a)V ExXeYO^EV TTjV dvTlOETOV 686v. AiaTEJiVOUEV t6 nT]Tpix6v

Tpifipia TTJg odXjriYYog ^aetu^v 8vo Xaßi8ü)v xal djioxoXAwuEv 8id Tfjg XFi-Qog tdg Gv^KpvGEig
xaO' ov XQovov eXxouev GTaOepwg xr]v odXKiyya ex Tfjg fA£OT|g YQCtpinfig jrpog Td JiXdY««-
'O^oicog 8iaTEHVopiEV 81 d tov \|;aXi8iov Tdg iGXvpoTEpag ovpiq)VG£ig. 'Edv ejiI Tfjg £jiiq)avE(ag
Tfig \ir\XQaq jipoExXTif^Ti \iEydX'r\ xiq djttoXEia öppoYOvov IjiixaXvjiTETai avxj] xaTaXXriXcog 8id
TOV jiEpiTOvaiov Tfig xvGTECog. ripog tovto 8iaT£}>ivo|A£v t6 jiEpiTOvuiov xaTd t6 GiiHEiov Tfig
dvaxduxiJECog avTOv ek\ xr\q piriTpac, drtojö^oi'UEV ttjv xvgtiv oXiyov 8id toXvjiiov xal ovto) 8v-
vduEÖ^a vd GvppdipcojiEv EvXEpwg t6 jiEpiTOvaixov xpdGJte8ov ejiI Tfig ojitodiag EJiicpavEiag T^g
UTiTpag (Liepniann).

'EjtI dXXoicoGECOv pidXXov EXTfivopiEvcav 8eov vd dqpaipfiTai jiXf]v twv lEapTTindTCov xdl
in uriTpa iiEpixwc fi oXixwg (oXixf) dtpaipEGig, vjiepxoXicixfi vgtepexto^iii, ti JivdnEvixf) vGTEpE-
xTOnf) xaTd Beuttner).

HpoTi^iOTEpa Eivai fi oXixf) E^aipEGig, Sioti d<p' Ivog ejiitpejtei E^aipETixTjv jiapoxe-
TEVGiv Jipog TOV xoXeov xal d(p' eteoov djtoqpEvyovTai Td 8vGdp£or« xal 8voxepwg OEpajiEvo-
HEva £5i8p(onaTa tojv xoXoßcopidTCOv Tfig ujt£pxo?v;iixfig vGTEpEXTOwng MtTd Tnv 8idvoi5iv Eig
ßapEiag jiepiJiTWGEig EvpiGxopiEv ttiv sXaGGOva jiueXov KEjrXTipcjatiEVTiv vjto dpiopqpov ndl^T]g xal
TiTig dpxixajg xa^iord dSvvaTOv tov .tpooavuToXiGjiov. Td Y£VVT]Tixd öpYava xaXvjiTOVTai vjio
EÄiJiXoov xal £VTEpixa)v eXixü)v,j.iövov 8e8i' vjiopiovTiTixwg xal ßpa8£a)g EXTEXovjxEVTig EigTO ßd-
Oog jiapaGXEvfig xaTOpi^oupiev vd d^oxcapiGCopiEV Tdg Gvpi(pvGEig £v piepEi 8id \l^aXi8iov, £v he-
p£i d|LißX£ü)g, xal TEXog vd ovXXdßcouEv tiiv n^Tpav 8id jroXvo8ovTixfig Xaßi8og. "EXxouev Tav-
TTjv iGXvpwg Jtpög Td e^o) xal djiop,ovovnEV ttjv jrEpiTOva'ixfiv xoiXoTTjTa 81' ödovwv Xiav nqo-

.. — — . liiillMllg iMiil 1 • ihllMMITIB J

äi

aexTixü)^, evExa xov vq)ioTa[ihov jravrOTe xiv8uvou xr\q Qii|eü)? jivcoSfov o'yxcdv. Nvv Iv^ f\
dpioiegd xe'iQ eXxei t))v iurjvpav öTai*>FQüJ? Jtpo? ta £|a), £iödYO|Liev t^jv 8e|iav xelga |ieTa|i)
oyxou xai jiveXixou Toixw^atog flg tov AouvAdaeiov x<jiH>^^v >tai jrQOöJiadoC'jiev, ü)? ouvrjdcog
TO TOiovTov JüpdiTOfiEv EÄi ftaxTuXixfig d.-ioxoXXncEW^ Tof> 7TXaxoi5vTcg 8iu ßpaSeia? jrQoajf>T)-
öf 0); TOV Xfc'Xovg tTic d'xpac x^'Q^^'^vd GnUdßüJutv hilg xov xoiXod ttis JtaXd|Lirig tov dxEQaiov
oyxov (tiy.. 123 — l'Jd). Ai loxi'Qai öi'jirpiöfi? hiov xai EVTavda vd öiaTeVvcovTai 8iu vpaXi-
6iov. 'Euv 6 ö'yxo; e'xfci dvajiTvxi^n evfioöeonixo);, dvu'^TjTOviLiev oaov t6 övvaTcv vii»T)Xd tov
()\'Q)]Tr,Qa OöTig öutTQr/tH xivftuvüv xui 7caQaxoXoL'i)ov|.itv toitcv JTpog tu xdTCO fxeXQi Tric xu-

//g/f^t^^t^

Etx. 125. — Kodiaxi] hnlgnais x&v öyxoiv xa>v f^nnrr^nAT,^., *ii ' ■

tT]/iiaxixog oyxog.

cov X.POVPVCOV .eva.a,v .ä.v .vco8ä.v -xx.v 8.^ .„p„xsv.^o..,;8.rfn S;» „0x^128^0-
Tn? Xo.,co|sa.s aa,,«vTC05 IXaTtovxac, ?v^ tovvavn'ov ^ ä.o^acoa.; xov Syxou Lav W
.«vuxas 8vax.pa„s, 'E.«8,-, ex x«.v .po«p»v exo,.v d.o^ovcoaa xaXu,, ^ ^Xav 2-

xov x,io„ oxBtpov xaxäxö ;xXEtaxov ,cxpo6[a,v. 'E.a8n oVoK oisLr. T "."'""^T''
xXnocü^ev nsxü ßeßac6x„xo5 SevxepoJftfi Xo(a«Ecv 8td xir . S^-vaxov vä d:to-

..WXXO.V. 8.0V vd d.o.0Y;,.,: ,zt. 'Lttr :r„r;s:x i

IxQeov Jt\5ov, vd dvTlxaalOTü)^iEV xä<; o^6va<; äno\xovo)oi(dq 8id vecov xai dcpov dXXa|opiEV xei'
QOXTia vd ODVExtöcopiEv ttV EYXEiOTloiv. Elvai ^vvqtov vd EJtioviißü Toai'naTia^og tov evteqov
xai dv£\) iijiaiTiOTiiTog tov xeiQOVqyov, ei? jieqi;ito)öeis xa{>' (iq fxu vEXQwdfi fj ov\npvO[ievr\
HETd tov o'yxov eXi| xai xard i6 oimETov t^c; ov^tpOoEO); avTfi;.

2vQod7iTOHEv Tf|v ojifiv TOV EVTEQOv 8id 8i7rXf]^ OCKprig xQTu Lenibert eI 8vvarov xoTd
TOV EYxdQoiov d^ova avTOv ngbq djtocpvYrjv otevwöeco?. 2vvni>ü)(; jiQoßuivo^EV ^Iq xr]v E^aiQE-
atv xr\q \ir\^Qaq, |iETd Tfjv djroxoXXTiaiv tcov Öyxcov. 'Edv ('hko? jiQoxEiiai jifqi Xiav 8vaxF0(i)V

JIEQ171T0)Ö£03V JAETtt GTEQQCÖV ÖV|iqpl')OE(0V, d(paiQOVU£V TT^V piriTQaV ^IFTU ÄO0l]YOVJieV0V SlXaG^lOV

avTYi? xoTd Tf]v |iEöT]v YPö^H^V xai d;ioxoXXo)HEV dxoXovf>a)g td £|aQTrinaTa d;iö tu.; ov^icpu-
gek; avTwv (n£0o8o? J. L Faurc) 'H texv.xt] eIvui in dx6Xov{>05 :

^i/c^'^iü,'

Elx. 126. — Kodiaxi) eyxeiQr]öi<; xmv oyxcov x(bv r^agxrj^dxojv. 7d dgtnxeoa i^anxj/xaxa ?xovv dnoxoXXr]{^Pj

ofAoicog did xfjg x^^Q^^-

2vXXanßdvo|jiEV ttjv n^Tpav xot' d^q)6TEQa Td JiXaYia tov tivOjaevo; 8id 8vo Igxvqü)v
7ioXvo8ovTix(ov Xaßi8cov xai tepivouev tuvttiv xaTd Triv \xioy\v YOa^^nv 8i' pMioq >ijaXi8iov
\xiXQi TOV TpaxnXov. 'AxoXovdaig GvXXajißdvo|üiEV 8i' dXXri«; jioXvo8ovTixfi; Xaßi8o5 to xaroWa-
Tov ormEiov TOV Evo? fjnioEo; TTJ? UTiTpa? xai dJCOo:la)^EV 8id liixQwv Topidiv tov ^iJaXi8iov
TOV TpdxTiXov djTO TOV doXov TOV xoXeov, ojiOTE Y^VETOi xaTttcpavT)? f| piTiTQiaia dpTTiQia. Meto
xr\v djtoXivcoGiv TavTTis 8vvdpi£i^a vd djioxoXXrJGWfiEv Td EgapTn^aTa Xiav evxeqws eXxovte? ov-
VEXW? Tag Xaßi8a5 xr\q \ir\XQaq, äqoxcdqovvte? oiXXote 8id to\~ \paXi8iov, oiXXote 8e d^ßX^o)?, djro
xr\q \iEar\q yQa\i\ir\q ngbq xä jiXaYia. KoTd tov avrov tqojiov £|aiQ£iTai dxoXovdco? t6 eteqov
Yipiiav xr\q \ir\xQaq [x^xa twv £|aQTT]ndTCOv. ITpOTipicö^EV Trjv piEdo8ov TavTTiv xr[q VJiEQXoXjtixrjg
vcTEpEKTOpifig opioicog exteXovhevtiv, xttd' r\y ^A£cd TOV 8ixaapi6v xr\q \ir\XQaq \iixQi xov loOnoCj

öiaienveTai EyxaQoUoq 6 TQdxriXo<; öia xi'qtoi) \paAi8iov, pie^' o IjraxoXouOEi f\ e^aipecig tcüv
tE,aQzir\\idx(i)v wg ävay.

Evvontov elvai ori ^em 7C()0T]YTif>eTöav iynaQüiay ftiaTOHT]v xov jiegiTOvaiov ir\q xvöteüx;
xai TiQO xov Öixaonov xr\q \ir\XQaq fteov v« djta){>Tii>fi f\ xvonq nQoq td xcxtco xoi 8f] ooov to
övvQTOv jiEOioaoTfQOv ejii xr\q oXixfj;, dX\yMXfQov hk e:ii rfic i'äfqxoXjiixyji; voTfQFXTOfxric.

Elg ÖvoxoXovg KfQiiix(i)öEiq öDviöTUTai wöauTw; f| neOoöog toij Kelly. Kaxu xavx)]v
äQiont^a biä rng äjioxoKlr\oe(üq tojv f^aQTTHidToav xai xr\q ^iax()\if\q xov .iXareoc om-fteönou
xatd TO jiXdYiov, ovTivog tviv dTToxoXXTiaiv OewQovuEv fvyjEoeox?Qav. AiatejivonFV 6Yxaonia)c
TO TtepiTOvaiov xr\q xuotfü)? xai iL-ta)i>ornEv thv xvötiv ftid toXvjiioii, ooov to öuvotov jiqoc
Tr)v i^ßiXT)v ov\npvoiv. 2i»XXaLißdvonFv dxoXom^o); tiV d.^oxaXi'fpOfToav HT]TQirxiav aQTTiQiav
ftid jiaxpdg Xaßiöog xai 8iaTepivo|a,ev biu xov uayrngiov 1) i|)aXi8ioi) ti^v |.ir)TQav vjieqxoXjiixu)?
XQTd Tf)v Y.^QUv Tou icT^nou. "EXxopiev eTtcx TauTr|v laiVQ{i)q ngoz to dXXo jtXdyiov, djioXivou-
\LZv xai Tvjv erepav liTjTOiaiav apTTioiav xai djioxoXXoiiev tu e|aQTnia,aTa jrdXiv ex xr\q \iEor\c
yQa\i[xr\q Jipög T'i JiXdyia. SvoodjtTO^ev ev t^Xfi, dve|aQTTiT(o;; XY\q f.iEi>o8ov fiv fixoXovOrioa^iFv.
ngbq dXXriXa to jigoadiov xai ojiio^iov xoX:tix6v Tor/w^ia, ek\ 8e vmQy.oXmxr\q vöTFQEXTOHTii;
TO jtQOöf^iov xai ojtioi^iov Tfxfi^a toi) TQaxriXixoi» xoXoßw^aTog. 'AxoXoi'OeI ejiiHEXfig jteqito-
vaiojcXaaTixrj 8id ovQQacpr\q xov jiEOiTOvaioi^ xrl^ xijoteo)? TCQoq xb xov aKEV^vö\xivov xai
evTaq)iaa|Li6g to)v xoXoß(ondTü)v tcov d7ioXivü)OF0)v. 'Edv xaf^iöTaTai f\ jtapoxeTEi'GK; djiayai
TT^Tog, öiEVEQYEiTai avxx] r\ 8id TOtJ dvoLYiLiaTog Tov' xoXeou r] Kaxä triv {);tEQxoX:iixTiv v'ote-
QEXTOHTiv, 8i' bKr\q öiavoiYOnevTig ngbq tovto y.axä tov 67iiai)iov xoXtiixov OoXov.

'Edv f| ejtiaxEOig t^; aiMOpoayia; enqjjtvd^ei ftuo^eosia;, i5ig ev jteoiJiTOJOEi jiaooxETEV-
a£CD5 ngbq xov xoXeov, eqpapno^ouEV xr]\ |ie9o56v uou ainooidaeo)? [iz dixeaov dn;OTEXeaM.a.

6') KoAniKJ^ ^vxcfplOK töv ^Acym^vuSöv nad^ocuv tüv iCapTqM^TUV

*H xoXjtix^ e|aiQ60Lg xr\q \ir\xQaq slq q)XeY[iovo)8Eig JtaO-riaEig taiv elagTrinaTCov, |1£t' ejta-
xoXovOovaav 8idvoi|iv twv Jtuü)8c5v ödxxwv, eleTEXeödri to jigcaTOv {i^o to\j Pean, ejil oxojrcp
xaXf)? JtaQOxeTEvaFCög ngbq tov xoXeov. 'Ejiei8f) Td dn;oTeXeöLiaTa 8ev f|öav evdaQQUVTixd eYxa-
TEXeiq)0-Ti xai JidXiv f\ ^6^0805 avxr\ xai EJcavfjX^EV y\ xoATrixf) oXixf) dcpaiQEöig xr\q uriTQag piETd
TÜ)V E^apTTinaTcov.

rigoßatvouEv coq dxoXoij^cog :

To\ir\ Schuchard, r\xiq Eux^gaivEi Xiav tv)v Eyxei'grioiv xai EHaigpöi; xr\q \ir\xQaq y.axä
TOV 11811 jiegiYpacpEVTa Tgojiov.

'AiiEöCog pisTd T»iv dvaöTgofpfjv Tri; ^^Ifga? Jtgog Td jiooöcü eiadYOUEv ueydXTiv oOovtiv
«psgo-uaav gdmj,a evTog xr\q xoiXiaxfjg xoiXottito?. 'Ev 7i-Qi7ixci>GEi löxt'pcov ov^KpuaEWV xai 81-
Ti&rioscov f\ dvaoTgoqpfi xr\q ptriTgag E!jiq)avi'CEi eviote 8voxEgEia;, äq vjiEgvixwpiEV 8id tov
Sixaanoij toi' Jigoa^ioi) TOixoVaTog 1 Doyen) ti rov jigoöOion xai ottiö^iov xoiX(x)\iaxoq avxr\q
(Müller). 'O Döderlein övviöTa tov ftr/aanov toij ön;iai>iou toix'oucxto; xr\q [ir\xQaq xai ttV
avaoTgoq)fiv tou o(i)\iaxoq xv\q \ir\xQaq 8id tov ojtiöOiou xoXjrixov OoXov', ueOoSo; titi; ev8Ei-
xvurai Ibiq. ejiI OÄio^iag xdpixliecog Trjg nr)Tgag. IIooxeiixevod jregl änXo)v jrEgin:To)aEa)v elvai
SuvaTOV vd Yivn ^ e|aig£aig T(j5v e|agryindTO)v ojxou \i':xä xriq 8ixaai^eiarig ti ^iri M-n^Q«? e^'x^'
Q'^q. 'EjiI loivoibv ouiAqpuaE'jav 6.iiJi); n:03TL.u otiev Tnv jrgoriY''>iJH^vr]v e;aig£öiv xr\q \ir\xQaq,
xa^' fiv, :xQbq djiocpvYriv Tgav|iaTionoi3 tov ovgTiTrjgo;, 8eov aiXaßiSE; vd TO;tot>fcT(jL)VTai dxgi-
ßo)? Jtagd Td X^^Xti Trj; iiriTga;. 'AxoXou^oag 8\JvdLiei^a vd dq)atgEö(oiXEv Td E^agTrinaTa. 'Ejia-
xoXou^Ei f| djroXivcDOig tcov aYYeicov xai nETd ttiv dqpafgEOiv xr\q [lEydXriq öOovTiq gvyxXeiöi?
xr\q JtEpiTOvaixrig xoiXoTTiTog, £q)' ojov 8£v vqpiOTaTai dvaYxri JcagoxETEVOEcag. 'H eyX^^Q'Höi?
avTTi £i£T£XEiTO djio JtoXXoO XQOVOTj Eiq xaq JCEguiTcooEig xai>' äq ol oyxoi EvgiöxovTO elq xr\v
xaTCOTEpav piovov pioTgav xr\q iXdöoovog jiueXoi», evcT) avTi^ETog ejtI öyxcov oitive? e^eteivovto
Xiav Jipo? rd dvco 8£v eTxe ToXpiridfi 'n IjiEußaoig, EVExa xoij d8uvdT0ii Trj; dxpißovg al|xoöTd
OECog xai roxi vjidpxoviog xiv8ijvod Tpav^iaTianov twv JtapaxEinEVcov öpYavcov.

npo 6Tc5v,f|vaYxdo^Tiv vd xeipovpY^^Jö) appcooTOv [ik ElaipETixd)? ßageiav E5upTTiM'aTiTi8a.

laa

i"'^*'"*"

Ol (pXeYJiov(o8eig öyxoi vjiEpsßaivov ttjv £iöo8ov xY\q jtveXgv. f\ be xaidöTGOis xr\q l^aipeTixo)?
E^TivTXrmEVTig dppwGTOv, l'vExa TOii GvvEXovg jrvpEToa», 8iapxEGavTog eäI jroXXuv; ^fjvag, Lie-
8£ivo\5io änb fmgaq £?g ^^Fpav. niE^OMEVOg vnb xr\q dvaYxri? EJiEXFipnoa vd aomo) tt|V dgpü)-
OTOv 8id Xa^apoTO^fic;, dXX' dnEGwg piETd Tf|V 8idvoi5iv xr\q jifpiTOvuixfi? xoiXoTTiTog xai tt|V

djlOXOXXllGlV TWV EVTEgiXOüV EAIXCOV £|£XEVCL)dTl El? JlOOOTTlTa JIUOV SvOOG^lOV OVXiOq, WGTE VJIE*

XPEO)0tiv vd £YxaTaX£i>a) thv oxEipiv x\]q pi'Cixfic; EYXeipnGEO); xai xaTOJtiv EvgEiag jiapoxETEU-
oecoc, E-TavE/tXEioa xr]v jiEpiTova'ixTiv xo XorriTa. 'H d'^ioOp/ivriTOg xaTdoraGig xr\q dppü)OTOv 8ev
£ßEXrio)f>Ti xai ovTO) djTEcpdöioa 50 ^tiEpa; n^rd tov jtgoTTiv eTtFußaoiv vd dq)aig£Oü) Triv fi^r
Toav xai Td E^agTiiiiaTa xoXiüixd)? piE to djion'XEona üti i"i yvvr\ n8vvrii>Ti vd £YxaTaXEi>n t»iv
xXivtxfjv vyir\q (').

'AxoXoij/>(o- EXFigiupYTifToi 23 eti 6.uoia; jtEgnT.oaEi;, £| (ov 2 d.T«=ßia)Gav, f\ [xia EVExa
7tEoiTOviTi8og. f] dXXTi EVExa YWYYpaivT]- xr\q Tonfi; Scliuchardt, Tirig e^oX^vOti xaTd tiiv 8idg-
xEiav xr\q Eyi£iQr\oE(oq vko xov Xiav XoipiOYOvov kvov. 'EirpoxEiTO xard xavova ÄEpl £Paip£Tixa)g
ßapEiwv GTiJiTixcov nEgurTwoECov, EJTi T(7)v OÄOicov f] Xa.iapOTOUTi 8£v Od eIxev djTOTEXEOHa. Ai
äXeIgtoi t(T)v dppwoTon tovküv EvgfoxovTO TJSii ejt) nfjvac t\q 8ia(pögovc Tdiv IvTavOa X£igoi'g-
YiX(I)V-YVvaixoXoYixd)V xXivixwv \mb \)Fga:TEiav, oiav8/i;roTE 8\JvaTai xig vd q^avTaGÖfj 'ooi'Xcpa-
n(8ai xai .-ievixiXXlvti 8tv lÄfipxov ttiv ejtoxtiv exeivtiv), djiEGTdXriGav 8£ £!8ix(ü; Jigo? EjiE 8id
Tiiv EYXejgrioiv TauTTiv. 'H EYXeipriTixf) avTTi HE{>o8og 8ia(jigei ovoicüSü)? twv uXXote £q)ag|A0-
Co^AEVwv, xa{>' ÖGOv 8ev dgxovjxai ei; ttV djtoxoXXriGiv twv EHaoTTipiatixcav 0Yxa)v 81' evo; ti
8vo 8axTrXo)v, tovO' ojrFg rlvai 8inaT6v ^lovov en\ o'yxcüv oitive; xEivTai dq ttiv xaTO)TdTTiv
^olgav Tri; JiveXou, dXX' oti EiodYw evto; ttk -tveXixTi; xoiXottitoc tov; 4 SaxTuXov; ti xai
oXoxXrigov Trjv xeIqu, 81' f); ovt(jd 8vvanai vd aÄOtpXoiomü) xalE^aigEGO) öyxov; XEipiEvovg flq
TTIV dvcoTttTTiv |ioIpav Tfi; jiveXov. To toiovtov 8£v f|TO SvvQTOv vd exTEXEodfi JlpOTEpOV, \Ki\
ovGTi; YvcoGTTi; TTi; inpiETEpa; ainoGTaTixfi; piE^oSov. *H i8ia ueOgöo? GWEaiTidii H£Td lavTa
xai vjTü Toi5 Bucura(2).

'H EYXeiQTlöig EXTEXciTai wq dxoXov^co; :

MovojiXEVpo; piEYdXri toilit) Schucliart 8id YöXßavo - OEp^oxavTTJgo; jipo; jipo-
(pvXa|iv xaTd to 8vvaTov tcov ToavuaTixwv ErticpavEiaiv änb xr\q Xoihü>|eo);. METd ttjv v'OTEpE-
XTOfxriv, evEpYOvuEVTiv xard tov dvo) jr£piYpaq)£VTa Tpojiov, d.Topiaxgvva) tov; xoX;ro8iaGroX£ig
xol EiGaYfo oXoxXrigov TTIV Xf^Q« £vto; ttj; xoXjrixfi; xoiXottito; xaldpxo|.iai xr\q djioxoXXriGEcog
T(Jüv ÖYXCOV. npoßaivco uiq xai xaTd ttiv djioxoXXrjGiv tov jiXaxovvTo; 8id tti; x^ipo;, 8TiXa8Ti
ävaC,y\xG) ev gtiheTov e^ ov EVXFpEGTEpov 8vva^iai vd eigSvoco itAExaEv tov o'yxov xai tov toixw-
^QTo; TTJ; jiveXov xai ex tov orijxEiov tovtov djioxoXXo) ßai>HTi86v, \i^TiXaq)ü)v Td; ovficpvGEic
xai xa^EXxvcüv toi' o'yxov xaTd to 8vvar6v aTEndxiGTOv, ojiEg ßeßaico; 8£v EJiiTVYXdvETai jidv-
TOTE (elx. 127 — 128). KoTd to tcXfIgtov E^pgxETai Qr\E,iq xov :ivü)8ov; odxxov, ojiote ovXXapi-
ßdvo) 81' iGXvgwv Xaßi8o)v Td ;iXa8apd TOixwpiaTa avTOv xai 81' eX^eco? avTcov Jigo; Td xotü)
BvyßQaivd) xy]v .tEpauEga) djioxoAXTjGiv. lipo; dn:ocpvY»lv ttj; öiaojiaGECog ttj; d(popiGTixfi; Qo')-
vri;, TiTi; e'xei 8ri|LiiovpYT]0fi vnb xibv gvyxoXXtjOeigiov evteqix(üv eXi'xoov VÄEpdvco tcöv (pXey^o-
vü)8d)v o'yxwv xai fiTi; e'xei djioxXEiGEi ttjv heyuXtiv jrEgiTOva'Cxfiv xoiXoTTiTa, irpoG-iaOco jidv-
TOTE 6ji(o; EiipiGXETai 1^ x^'Q pio^' £1; EJtacpfjv jtpo; ttjv dvcoTaTTiv pioipav xov o'yxov. 'Edv jiapd
TavTa f\ X£ig eXO^i tic E^acpriv jrgo; ttjv fiXEvÖEgav jiEgiTOva'ixfiv xoiXorriTa, xö xoiovtov 8£V
e'xei 8vGdg£GTa djiOTEXeGnaTa, o); ex jiEigac Yvcogil^o). "Iva SievxoXvvOfi ti Expot) tov jitjgv :ip6;
Td EXTo; xatd ttjv 8idgxEiav ttj; ly'/jE.iQY\öEK% JcdvTc; oi XEipiG^iol exTEXovvTai eI; £Xa<pp6v
jcpoxXivE; £7i:ijie8ov. Ai Gvpicpt'GEi; XvovTai |,iet^ extiXtixtixti; EvxoXia; xai 8fi EVxoXcoTEpov ti
xaTd TTIV XajiagoTOpiTiv. 'H ainoGTOGi; YiVETai o); oiv/iOco; 8id GvXXri\|;£ü); tcov üyyeicov xai
dxoXovdov djioXivcoGEco; avTcov, dXXd ;iapa86|co; f\ aipioppaYia Y£vixü); Elvai piixpd, oSgte ei;
jxiav jiEpiJiTCOGiv 8EV expTiGinojtoiTiGa ovrE djioXivcoGEi; oute tov ai|iOGxaTixöv Jico^aTiGnov

1. Zbl. Gynäk. 1933 No 14.

2. Bucura Veit-Stöckel Handb. F. Gyn. III Aufl. Bd, VIII S. 278.

^ ■ nt;uiii;r7 RpftrtUDc Yonaiuojioiü xata «(jOTintioiv

töv at^oatartxöv «co^atio^öv nou iv «piJiTcooei ai^opeav «s. xa» oo ^ ' J'

jttmogi; elvoi avayxaia xal f^ napoxeievoi?. Uaeaöot», otv „viroa- xaO'

x«xd t^v dnox6XX,mv röiv S|ap...ci.cov. dU« ,äUov x«xd xnv «<?-;-; ^JJ^^^^ .^^^

jiQos lä i^o) tovg atXh]rp&Evmq diä kaßiÖMV e^aortjuanxov^ ixinyovg.

ajiOTeXet ovoiäSf? ueqo; ttj? TF/vr/fj? \.yo\\ xai>' oaov m,6vov ovto) elvai ftwatri ^ axoißfig
xai aacprig 'vJJTiXctcp'naK; 6X(0V kuv OQYcitvwv, tovO' ojieo öev f:iiTVYX«vFTai Si' öXiY03V 8axiuXfOv.
Ei'XeQwg Swctuf^ct vd extihtjöwhfv jiofa; GijpicpuaEK; öiwa^Ei^a vu Xuötofiev unßXFCog xal Jioia^
va 8iaxa)Qiö(0H£v 8id xov y^akihvov v'Jio x\\v y{a^oh{\^T[Ovv xov öqpöaXfAoO. 'Ejti iicpioTajievcöv
öVjiq)i5oFa)v ^eTa|i) evTEQCov xal F|aQTT]ndTa)v, eXxopiEv djtXd)^ irjv oiJ^i(p\jo^evT]v eXixa b\kOV
pierd T9V oyxov JtQÖg id e|a), otiotf givai Suvarov aviai vd d.TOxo)Qiöi^a)öi 8id toC i^jaXi-

hiov. EI5 jA(av jtEQijtTcoaiv fi8vvri{>Tiv naXiaia xat' auTOv t6v tpoTtov vd l^aiQicua ncya ^piTi^a
VEXQW^evTog XejiTOv mepov. Elpiai ßeßaio? ön f\ lyx^{Qx\(ii<; cvkx\, r\x\.<; (paivetai jioXv 8voxe-
Oeatepa r\ öaov elvai de, xx\v JtoavM'^TixoTriia, elvai övvqtov vd exTgXfjtai vjio jiaviog y^"
vaixoXoYov xatexovro? xx\yf xoXjiixtiv texvix^v xai o)? IX:tiC(0 M EXTEXfjrai, Sioti djiOTeXei
avTT] eI^ (opiopiEvag rt£Qi7tro30Ei? Tf|v n6vT]v SwarÖTTiTa Siaocoaeco; piid; dvi^QWJiivTig vjtdi^lecDg.

12. 'E^up/JTpioc; KÜnoiq

H dEpajtEia TTJg E|a)HT)TQiov xDi^öEa)? eIvoi jictviotE XEiQO'UQYiXTi, ooov dq)ogd 8e zlq
TOVTO ÖEOv vd |if) {xpioTatai öixoYVcon'ia. <I)qovoi'uev öti xal 6 Xpovog ovfiEHiav ijiiÖpaoiv
exei Eni Tf)5 ev8ei|eco? ttj? £YXe>Qi1O€(0? xal oti eI? jfQOXEXOogimEVTiv xvt]oiv xal av (xvxt\ eti

/j? .{

EIh. 128. — KoXjzixrj E^aiQBOig x(ov i^aoTT]f.iatix(Jbv oyxmv xara Aoyo&erSnovXoy. Tä anoxo).lr\^hta xal
jigog xä e^co klxva^evta aQiaxe^ä e^aQxr'ijuaxa ijiixdi^rjvxai ini xfjg xsioog,

öiaTQEXH xal t6 öeuteqov finiov, f\ axEii^ig oti jiiOavü)? 8\Jvd|>iEda vd excö^ev Cwv eußpvov 8eov
iva n^ djio|iaxQiJvti fliAct? d;t6 töv ßaoixov toijtov xavova. "Oaov JCEpiaoÖTEgov exei Ttpoxo)-
pTIOEi f\ xuTjöig, Toaov HEyaXuTEpoc; eIvoi 6 xivÖvvo^ rfj? BYXeipilöECog, EVExa ddpoa? dvajtTiJ
Iecüq Tüiv aYYCiwv xov jiXaxovvio? xal örmiovpYiag wpYavcofiEvwv ovpKpiJöECOv. IIXtiv tovtov
rd xaTd t6 Tsp^ rfjs xvtioewj; £|aipo\jpiEva Ejißpva Ejxq)avi^ovv ovxvdxi? Sia^apiiav (dvo) twv

JT. yloj'otl^ffToaovioVj /Yvaixoio^tx^ XstQovQfiici]

SÄ

30°/«), üSoTE vevtxco? elvai Xiav jiQoßXrinaTixov, eav jcgenei evexa toii Xoyov xomov vd zxM-
Tcopiev vyiä Ywalxa el? tovj? aoßaQCOTCiTOv^ xovxovq xivöuvovg.

revixcüs f) lYXeiQTlöic ifj^ elwuTitpiov xDTiöECDg xard xovq ngdnov:; \xr\vag elvai evxe-
QY\q. IleQiJiTcoafK; xiveq bvvavxai vu xeiQOvpYTiOoiiv xai 8id TTJg xoXjiixfis oöoi». llQOxi\iw\i£v
xr]v XajiaQOTOpifiv evexa xr\q xaXXiTepag ejiioxojtiioecog xai nixpoieQa? djrwXeiag ainaro?. "Ajia.
TÜ 8iavoi|ei xr\(; xoiXia? eloavouev 6X6xXt)QOv tfiv xeIqu vaxä ßctOo? xai JtQoajtaOov^ev vd (pe-
QCDiAfeV JiQO? td e^cü ifiv Jidöxoi^öov GdXÄiYY«. ev jiEQiJiTcoöei 8e xa^' r[V r] jifQiTOvaixT) xoiXo-
TTis elvai JiejrXiiQco^evT] aiuaio^, oftriYO^neda xaxa t6 TiXeToTOv 8id xi]q ä(pr\q. 'Y(piGT(ijAevT]
Tvxov al\ioQQayia ERioxExai jiqoocoqivü)? 8id bvo Xaßi8a)v, TOJtoOeTOv^ievTis xr^q mdt, jiOQd tö
XelXo; xr\q \xr\XQaq, xr\q dXXric 8e xarcü tov xoepiaarriQog ovyUo[kOv, [leXQi ov 8id xnq e/cioxojin-
0£(i)q dvTiXT]q)da)fAev oti Swa^e^a vd 8iaTTiQT'|öa)nev \ieQoq xY\q odXmyyoq. 'Ev jcdöfl jieQiJiTCOöei-
jEQOGjra^ovuev vd 8iaTTiC)Tiaü)nev Tf|v wodrixTiv. 'H eHaipEöK; xr\q odlKiyyoq exTeXelrai Coq xai
Eni Twv q)XeY^ovoj8ü>v jiaöriöecov (etx. 82). 'YcpiGTa^evcov loxvQUdV ov^i(pvo£a)\ e|dYoiLiev xr\v
ovXXTiq)0£TGav 8i* dYxiOTQCOTri? XaßiSoc; firiToav jtqo^ xä e'Hco xai nQOoavaxohl6[i£{>a ovtco et"
XeoeGTEQOv. 'H djtoxoXXriGis xr\q iva)8ov5 xdipri? JiaXaidg e|a)HT]TQion xin^ecog, GxrinaTi-
t,0[ie\r]q vko tü)v yEixviaC,6^x(üy IvreQixwv eXixcov xai xov ejiijrXöov, 8iVaTai vd jrpoxa-
Xeoti pieYdXag 8vGxeQeia?, jioXXdxi? 8e xadiGiatai dömaro^ ovxcoq, &oxe dvaYxa^opie^a vd ly-
xataXeiil^copiEV x\xr\\iaxa avxr]q. T6 nsgaq xr\q EyxEiQr\OE(x)q dTroreXei xard xavova in eHiGxojiTj-
01$ Tü)v elaQTTindTCüv xov kxEQOv n'Kayiov, driva xai ejtl vjtdplECO? eii \xr\ ovoKobujv qpXeYliO-
vcoScov dXXoiomecov 8eov et 8vvaT6v vd 8iaipuXd|(ü^Ev ngbq xov gxoäov 8iaTriQiiGeü)$ xr\q yo-
vifioiTiTO?. Eiq JtaXaidg jcepiTctcoGeis ^iet' exTETapiEvcov ÖQyavcoGewv roxi ;te7rT]YÖT0g aipiaTO?
dvaYxa^OfxeOa jtoXXdxig vd d^paigeocoiiev xai avxi]v triv |,ir)TQav (ppovii'^cviec iva 8iaTT)Q'nd'n
TOvXdxiGTOv f\ \iia 6)0&r\y.r\. MeiioXi^Gpievai r\ vkokxoi pioXuvGeco^ KEQinxiboEiq JiaQoxeiEuov-
rai 8id xov OoXov xov xoXeov, eig oXcog 8e e|aiQETixd$ jiEQiJiTcoGEig 7ragoxETei5o|,iEV 8id xwv
xoiXiaxüiv TOiXü^naTCOv. T6 pioXvvdev oniGdopiTirgiov aindrcona (jivQetog, ujiepXevxoxvrcoöig,
au^TiGig xr\q xaxvxii]X0q xadi^i^Geco? xwv ep^Opaiv atnoGcpaipicov) 8iav'0iY0HEV piovov 8i' ojii-
oö-iag xoXjtOTOjifig, dqpaipoi'uev rd JiriYfAaTa aipiarog xxl JtapoxEievonev. 'Edv 8id iY\q xoXjti-
xf)s 68oii 8ev 8vvdneda vd q)OdGCünev t6 jiepiaYO^YiHOV aijxdTco^ia, dqpaipov^ev 8id Xajiapo-
xo[ir\q Tov e|ißpvix6v Gaxxov xai eq)apn6'^0|i,ev ejtijicofxaTio^iov xard Mikulicz.

'Ejii VJidpEecDQ jiEYdXri; jiggottito? aipiaio^ ev rfi JTEpiTOvaixf) xoiXottiti dq)aipovuev
TOiJTO 8id XY\q jraXdnT]? xai gjtXtivicöv, ogov t6 8vvaT6v EJiijiEXd)^, totoioijtov 8'e{)xepaiveTai 8i'
eXacppw? jcpoxXivovg e;iiJie8ov xr\q dppcoGTOu. 'EYxaraXeKpdevTa {»TtoXeinpiaia djtoppoqxjävrai
ävev ßXdßris tiv6$. *Qq ngbq ttjv GxojtifAOTTiTa xr\q ejtaveYX^Gecog tov ainaio? tov GvXXeyevTO?
ex xf\q JtepiTOva'ixf)$ xoiXoTtiTog (xaTd Thiese) ai Yvwnai 8iiGTavTai. Et; Xiav eHaipeTOvg Jie"
piJtT(üoei$ in pi€TdYYiöi5 aiVaTog jcapd Tivog xaTaXXriXou 86tou eivai dxivSvvoTepa xai djio-
TEXeGpiaTixcoTEpa. El; Td; jtXeiGTa; jtEpiJtTWGeis eGXOfiev xaXd djiOTeXeGpiaTa 8i' ev8o(pXeßiot)
eYX^öeco? dXoTOuxov 6ppoi3 xai dvaXriJiTixwv oxevaanaTcov. Ai'tovotitov eivai oti djravTa Td
jtpo? ai)|TiGiv xr\q jiieGecog tov aijxaTOc pieoa 8eov t6 7ipü)T0v vd ecpapno^covTai jicTd ttiv te-
Xeiav ainoGTaoiv.

'H EyxEiQr\oiq xr\q E|ü)jATiTpiov xvnaeco? twv TEXevTaicov \iy]Wibv elvai 8vvaT6v vd eiuicpa-
viot] oXcog e'^aipeTixag 8uGxepEia5 'Qq Ibiddbj] pie^oSov 8eov jidvTOTe vd ^ecopwiLiev ttjv te-
Xeiav dcpaipeGiv tov enßpvixo\5 goxxov. 'Edv ö\i(oq 6 JiXaxov? e'xei EYxaTaGTaö^fj pieTa^v tc5v
evTepixcov eXixcov, Toi5 cjhäXogv r\ itQoq xä dvco (o)$ ki JiapaSEiYM-aTi xaTd t6 fijtap) Gvußov
XevojAev xai tov ^dXXov ToXiiripöv xeiQovpYov vd pif) ejii8iojxn piCixriv eYXEipT]Giv, dXXd vd jie-
piopi^TiTai elq tt]v dcpaipEGiv tov xvriixaTo; xai ttiv eyxaTaXeiil^iv x\iy]\idx(i)v xov eiAßpvixov
Gdxxov. Aev ejri8oxi^dCoMev ttiv 18 1(? vjto TdXXcov övyYQacpecöv owiGTco^ievTiv ueö"o8ov tt}?
QayY\q xov e^ßpvixov Gaxxov Jtpo; Td xoiXiaxd TOixcofxoTa, tt)v 8idvoi|iv xai e|aipeoiv tov
xvTinaTog xai eYxaTaXeixpiv tov jiXaxovvTo;, evexa twv jAEYdXcov xiv8vva)v ttj^ Xoin(6|eo)$ xai
Tr\<; \xBXBy%eiQTf\xixr\^ ()i!|iOQpaYia$. Ei$ Tivag jtepiTtTcoGEis evöeixwTai ^ !x twv ngoxigayv

K : 1.

Ji .ft

djtoXivcooi? XY\q eaco Xayoviov dpxTipiag (Amann). Et; dXXa^ jiepiJtTwaeig djieSeix^T] 6 f\\iix£'
Qoq atjiOGTaTixos JicopaTiGuog d)q oa)Tfipio$.

13. *H xopoupyiK^ dcpancia rnc; napaMn'>'piTiöo<;.

EjiI 8iajrvTiGea)5 tov gvvextixov Igtov xr\q eXaGoovo? jtvIXov tov xeipievov ?|Q)jie-
ptTOvaixdx;, d^eocog oyq yivei Fyibii]koq JtepiYpajtTog gvXXoyt] jivov, 8iavoiYOnev TavTTiv 8i' 6jri«
a^iaq r\ JipoGdiug xoXTtoxopifi;, dvaXoYcag xY\q e8pa? TavTTig. Ilpog 8ievx6Xvvoiv xr\q ixpoii?
TOV jivov ftiEi'pvvouev dpißXecos tfiv Topifiv EiGdYOVTE? atjiOGTaTixTiv Xaßi8a xai 8iavoiYOVTe5
TavTTiv. Mexd if)v 8iEvpvvoiv eiödYOUEv 8vo 8axTvXov; evTo; tti; xoiX6tt]to5 to\5 djcoGTTinaTO^
xai 8iaxa)pil;ojiev Td vjcdpxovTa xaTd t6 jcXeigtov SiaqppaYpiaTa gvvextixoD Igtov, oxTinaTi^o-
^levTi? ovTO) eviaiac; xoiXottito; iietu Xeicov TOixcoMaTCOv. MeTd tt)v expo^v tov jtvov Jtapoxe-
TEVo^Ev TavTT]v 8id yd'C,j]q ia)8o(popniov, djtoqpevYO^ev o\icoq jiXvgiv 8i' dvTiGT]:iTixov vypov
Iva ^aet' doqpaXEia; djioxXe(oo)nev elGpoTjv ioyovcov ovgiwv evTO? ttj; tvxov 8iavoiYeiGT)$ eXev-
i^epa; Jifpuovaixf)? xoiXottito;. MeTd 48 wpa; dvTixaihoToinev ttjv yd^av 8id jiapoxETevTixov
oo)Xf]vo$, ojtOTe 8vvdpiEda jiXeov ävEv ev8oiaonov vd djiojiXvvcouev t^v jtvcoSti xoiX^TTiTa. 'A-
n:ooTTi^aTa tov jiXoyiov xoiXiaxov TOixconaTog d'Tiva 8ev 8vvdfie^a vd q)Mo(xi\iEV ?x tov xoX-
jcov 8iavoiYOHEV 8id xo[ir\q nr\xovq 5—6 ex., fiv cpepopiev dxpißw? vjiepdvo) xai jtupaXXTjXü);
TCQoq TOV Jiovn;dpTEiov ovvSeGjiov. AiaTeiavopiev t6 8epjia, tov vjio86piov gvvextixov igtov
xai TT)v dÄOvei^pfüöiv, Jipoxo)pov|iEv dfxßXeo)? 8id tov 8axTvXov xai tov xXeiGTOv ij^aXiSiov 8id
HEGOv Twv [ivCjy xai tojigOetov^ev tov; 8iaGToXEi(;. AiaXi')0VTeg Tdg tvxov vq)iOTaneva(; ovnq)VGei5
:ipoxo)QOV|iEV dpißXeco? 8id tov SaxTvXov dxoXovdovvTEg E^cojiepiTOvaixwg t6 TOi'xcona XY\q nvE-
Xov ngbq xb ßdOog nexpi ov GvvavTiiocouev Jivov. Aievpvvopiev ttjv eioo8ov Jtpo^ ttiv jivw8t]
xoiXoTTiTa EiGdYOVTE? 2 SaxTvXcvg evTOc avxr\q xai piETaßdXXonev ttjv dvwjiaXov xoiX6TT]Ta eI;
o^aXifiv, 8iaxo)pii;ovTEc dxpißd)g wg xai xaTd tt)v xoXjrixfjv IjieiiißaGiv Td ex GvvexTixov Igtov
8iaq)pdYM'CtTa. *H aipioppaYia ejiiGxeTai jtdvTOxe 8i' djiXov jicopiaTiGnov xr\q xoiXottito; 8id
Yd^Tig lco8oqiopjAiov, iiv dvTixadioTwuev onoicog 8id Ga)Xf]Vog pieTd 48 cogaq xai exTeXovpiev
jiXvGeig 8id xadeTfjpog 8ijtXov pEV|iaT0$ xqtioi^^J^oiovvtes Jtpog tovto 2*/o vji£po|ei8iov tov
vSpoYovov.

"Ooov evxfpT)? elvai f\ OepajtPia tov jiapapiiiTpixov djtOGTTinaTog tooov SvGxepeGTepa
clvai f\ depajieia xr\q XQOviag Ivcodovg jnoQq)fjg r^g TtaQajurjTgirtdog.

BaGig xr\q nexpi T0v8e depajteiag fJTO xaTa jrpwTOv Xoyov t^ ecpapnoyT) OeppiOTTiTog Eiq
xdq biacpOQOvq avxr\q noQcpdq, titoi e8poXovTpa)v, JiXvGecov xoXeoij xai dnevdvGpievov, q)CüTO-
XovTpcov, lXvoXovTpa)v xai TcXevTauo; xY\q 8id ßpaxecov xvpidTCOv Oepajieiag, r\xiq djiOTeXel
jipdo8ov evavTi xr\q bia^EQ\xiaq.

Td djcoceXeGnaTa 8id TavTr^c elg xdq ev8ia(pepovaa$ f\\idq ivTav^a jiepiJTTCooeig 8ev
elvai TOGOv evvoixd, oaq xb toiovtov ovpißaivei xaTd xdq (pXeYH0va)8ei$ Jiadifioeig twv §|apTTi*
^AttTCOv öXcoq t8iaiTepco$. 'EjiI dpxovvTco? piaxpdg 8iapxEia5 OEpajieiag xaTopdovpiev 8i' öXcov
Twv neocov TOVTCDv Eiq pieyav dpiO^ov jiepiJCTCooecDv alodT|TTiv vjioxwpTioiv twv vjioxeipievi-
xü)v evoxXTi^iaTCOv xai twv dvTixeinevixwv evpTijidTCOv ovTCog, oSoTe f) toiovtti ovvttjptitix^
depajieia ^jtißdXXfTai Eiq ixdoTTiv jiepiJiTWGiv. Avgtvxw; vjrdpxei ovxl nixpog dpidjiog jtapa-
jATiTpiTiScov, aiTivEs eXdxiGTu ?! ov86Xa)g ejiTiped^ovTai vjro twv \xeo(ov tovtcüv, jiepijrrwGeig
xa^' dq 6 TtapapiTiTpixog lOTog Exet |ieTaßXT]^f] Eiq GxXT]pdv pid^av, r\xiq 8ev vjioxcopei el^
olav8TijiOTe d^epajiEVTixf)v dYwyTiv.

Etg xdq djiEXjiiGTixdg TavTag niepiJiTcoGeig e:texeipT)Gdv Tiveg va Ijiejißoirv xeioovpyi-
xa)$, dXXd al vji' avTwv jipoTadEiGai eYXEiQiTr''>tal nedo8oi lYxo"^£Xei{pdT)Gav ex veov eiTe
8i6ti avTai fJGav Xiav ToXpiTipal xai jipaxTixo); evexa tovtov dvecpdpuoGTOi, eiTe 8i6ti ö)q
dvejiapxeig Eiq ov8ev djiOTeXeoua fiyaYOv. 'EvTavOa dvTixei f| ?|aipeoi$ twv JiXaTecov ovv8e-
G^icDv, ev ovvaqpeiQL neTd tü)v Gvv8eGna)v etapTTioecog xr\q \ir\XQaq (Veit, Martin xtX.), T[xiq
jiapd Td evvotxd djiOTeXeGjiaTa. wq 6 Warnekros 8id 14 JieoiJtTcaoei.^ dvecpeoev, 8ev xaTü)Q-

100

öco^ri vd lmy.Q(xxr\Gy\ a)? piedoSo? 8id tovg jtXeiatov? x^iQO^QYOvg. *H iijto tojv FdXXcov
eqpapno^o^evTi 6Xixt| llaiQeaig rrj? nn^Qa? fieid twv e|aQTrindTCüv, et övvatov i^ei' dcpaipeaeco^
TurinaTOs ex tov jiaQainTiTQixoiJ Iötov, eivai fXdxiöra evOapQDVTixT) w? jtQO? rö teXixov avTfjs
djroreXeana, xa^' öoov ejti oiCixfis ejteMßdoeo); öx)vri{>a)? öi^ußaivouv XQ(xv[iaxa zni rfig xv-
oxadic; xal toO ovQiiTfJQog. Ourcüg t^ piedoSo^ amr[ evqev EXaxiOTOug ^ovov öjiaöoijg.

Ilpog Gt'fAjrXriQcaöiv toi) ^epiaTog dvacpepca dxopiT) xal tag IjtepißdöEig Ijti roii oi^imia-
driTtxoiJ vet'Qixoi» ovoxr\\iaxoq xr\q nviXov (Latarjet, Röchet), auive? eXaxiöTTiv piovov ejciöpa-
oiv e'xovv £jc' ai»Td)v rwv dXXoicoaecog, auive? ofiwg öiH'avrai vd ejtTipedaovv evvoixü)? ro d^yog.

Ocpancfa Ti|q xpoviaq napoMnTpiTiSoq 5ici tcx^htoö änooTHMoroq kotci AoyodcTÖnouAov.

'EjteiÖT) in eliÖQCOnatixf) nogcpr) xr\q KaQa\xif]XQixiboq, t'itoi t6 jiaQauT]TQix6v änoGxrwxa,
EVXEQCjq {^egaiiBvexai 8id ir\q öiavoilecog xal xtvcoGKcag xr\q KVißbovq löiiag xat' dvriO^eGiv
TiQoq TTiv jiXaöTtxf)v ivcoÖT] ^OQqpTjv xY\q jiaQa\xr]XQixiboq, EoxBip^r]\xEV vd ineraßdAXcouev xr]v le-
Xeviaiav eig Jivo')8ri HOQq)r)v xal dxoXoijdcog vd {^EQUjievo(a\xev xavxr]v 8id xr\q ovvY\dovq pie-
^68ou. 'Qq xardXXTjXov neoov 6|eXe|anev ttiv evföiv TFQevßivOeXaiOD, o^nvog f\ ibi6xy]q jigbq
JtQOorjXcoöiv änooxrwiaxoq elvai ti8ti yvojaxr] xal 8i' f)? ecxo^ev togov Xaimipd djcoreXeG^aTa
dSöTE exQr]oi\i07ioir\oa\xEv xavxy\v Eiq ndoaq xäq xoiavxaq, ovy} ovxvdq, 7iEQiJixdi)0Eiq jtdvroTF
[lExä xov aiJTOi) änoxEXEayiaxoq.

*H djiXf) Texvixf) 8ievxoXvv6Tai Xiav 8id xr\q iQi(]oi\xonoir\oEa)q 6t8ixf)g \XEX(xXXivr\q
ovQiyyoq eig !iv TOÄG^exeiTai iq ßsXovTi GraOepa)? (elx. 129). 'H djiaiTOVjievTi J^ieoig 8id xhq
ovv\\^E^q ovQiy^aq eivai jioXi) mpr]Xri ovtco?, wGie t6 {»yqov ex/eerai jigog rd e|a) \xExa\v xy\q
ovQiyyoq xal tfig ßeXovng r\ 6 x'dXivog xi'XivSpog 8iaQQriYvi'rai.

TexvixYj jfjg iyxeigrjoeayg : Merd xr\v E[oayioyi]v ro)v xoX7ro8LaoToXea)v xal tt)v djio-
Xv^avöiv TOi) roixco^aTog xov xoXeoii evie^ev ei 8vvar6v Eiq x6 xevtqov tov oxlr\Qov loxov
xov 7iaQa\xr]XQ\ov Eiq 2 rj 3 oXiyov an dXXfiXcov djtexovra GT^eia 2—3 x.ex. rcQeßiv&eXaiov.
*H Tigbq EVEöiv K0o6xr]q jiqekei ßfcßaicog vd dvTajtoxQiVTiTai jipo; xr\v exraGiv ifjg 8iTi^TiLie-
vif]q xcogag xal dvaXoywg XQiloifiO.TOieirai ^ixpd r\ \xEydly] JtOGorr]?, 8eov oVcog vd ^t) vjtepßai-
vco^iev xaid To 8vvaT6v td 6 x.lx., xairoi ixQTiGifxojroiriGaMev xal f-ievaXmepag eti 86geic
dvEU ßXdßTis Tivoc. 'Etil JipoGOiag ;tapaM-r)TQiri8o; 8fov 7iQor]yov\iEvo)q jueid Siaropiriv xov
KQOoriov xoXjcixoii TOtxw^aio? vd djicoi^TiOfi dußXfü)? in xuorig, ojioie 8DvdneOa vd evepyii-
GWUEV Tr)V EVEGiv dvFi' xiv8iJvoi) Tpav^aTio^iov xr\q Kvoxeoiq. 'Em jroi^naEco; E^EXixOeiang
TiQoq xä xoiXiaxd TOixdj^ara 8la^e^vo^lEv xard rov d'vw JiFpiYOacpevra toojeov t6 ftmurt r^v
artOVEupcoGiv xai xovq \ivq xai evie^ev ajt Evdeiag to TEQEßiv{>£Xaiov evto? xov oxXy]Qov
ElibQißiiaxoq. Katd xäq molovdovq mieoag ^apaiTipEiTai MEtpia v\l)(ooiq xr\q OEpjxoxpaoiac
xal aulnotg xov äQid\iOv twv XEVxd)v ai^AOGqpatpiow, Eiq hbr\X(ooiv xov oxnmTi'QonEvov djto-
oxr\mxoq. 'Auegco? jxEtd rfiv evegiv t^qpavi'Covtai iGXi'pol jruvv,i oi^tco;, oSgte Elvai GxoTr.nnv
TiÖTi Jipo TTi; evaplEco; xr]q EJTE^xßaGEO)? va evegy^uev evegiv ^ioptpivrig, fiv ev dvdYxri en:a-
vaXanßdvofiev ßpa8\jT£pov.

Elq^ ovSE^iav jiepiJiTWGiv JiapEiripiiOTiGav EJiijtXoxal vcp' f^^uiv ex [lEQovq twv veito-

VIXWV ÖpYttVCOV r\ xov JTEQlTOVaiOV.

Gecopo) :tEpitr6v vd tovigo) gviavOa öri .Tpo rfjg evegeco? 6 XEiQOvgybq Seov vd elvai
anolvxo^q ßEßaiog Öti jipoxEiiai jcEpl 7iagaiir]xgixiboq, iixoi JiEpi bir]^öE(oq xov e^wkeoixo
vaixd)? XEi^ievoij gi^vextixou Igtov xal oi^xl nEg\ El(xgxy]naxi>iov Öyxod. 'Ev rfi TeXe^rai
piJtTcoöei 1^ evEGig TOI- xeoEßivOEXaiov ov ^ovov Eiq ovbh ^eXei gi^vteXegei dXX' aGcraX'''^ v"
ejiiSEivooon TTiv xatdomGiv. ' ^ ^^^

T6 döfiJiTCog ex toxi aKOoxmcxxoq XritpOev ttvov d:i()8EixvuETa( xatd r^v .nv^.ß i
Ycxnv elExaGiv co, G.Elpov. T^v 8.dvo.|.v xov ä.ooxA.axoq ^vepyov.ev 48 Zc^m^Z
evEGiv, xaiTOi r)8Ti ^QO irig nagobov xov xgovov tovtoi. elvai 8i;vuov vd L ''T

Kaid xnv ötdvoiltv e;.aHoXovOEt Ixpof, ^Eydl^q l) ^,,^,^, ^^^ .^^^^^ ^tox.ppEvcto.

101

nvov dvanE^iiYiiEvov ^Etd TEpiaxiwv VExpconevov lotov. Katd it|v ttoaYCüYr)v toij 8axTvXov
Eiq TTiv xoiXoTT]Ta xov djiooTnuaTog aiGOavouEÖa jiaX^axdg xal ev^pvjiTOvg ^d^ag, dg djicpia-
xpuvojAEV xal ovTO) 8T]niovpYOV|i£v Eviaiav xoiXöttira, fiv JiapoxEtEvouev Öid ic^axiov y6)i,x\q
d)g dv ejtpdxEiTO jiipl oi'vrjOovg jrapanT]Tpixov dKOox\\\kaxoq.

/e^ä^W^ .

Eix. 129.

^9.— H ^eoansia t>/s yoovia^ ^i'Äivdov^ JiaQa^urjzniriSo^ 8ia ^lexaxQom'is ek Tsyvrjtov an6atr]^ia xaxä
€z6novXov. "Eveaig tsgFßtv&eXaiov ivtog r>/,- Ivcödovs ndCr]s lov JiaQafirjtoiov. ds^iä r] etdcHtj fxe-

Met' EXJiXrilEcot, ßXE^opiEV jidvTOTE oti ai GxXriQai av^tai nd^ai ag piErd tOGTig 8t'ox£-
peiag f|8vvd^eOa vd 8ia:repdGcopi£v 8id Trjg ßEXovng, vvv ^lEtd ttiv Tfi|iv Ei'xepwg 8\JvavTai 8id
Tü)v 8axTijXcov vd ovvdXißovv. 'H nETEYXeiQT]Tixf| dycoYTi ot)86Xcog 8iaq)epEi Tfjg twv aXXcov
jiapa|iT]Tpixa)v djrooTrindTCOv. T6 teXixov djiCTEXEG^ia Eivai IxjiXt)xtix6v. At Tupawov^iEvai

102

Eix. 130. — 'H ^egansla trjg XQo^^*^^ ^vXcödovg Jiagafitjrohcöog diä rsxvr^xfjg /netaxgoTifjg eig d7i6axf]fia xatä
Aoyo'O'eTdnovXov. ^Xlf*(^yxv nagäataaig. Td ßeXr] ösixvvow rrjv xaxsv^vvaiv ngog xrjv onoiav Jigocj^eixat

ri ßeXovr] xatä xrjv ey^yoiv ivxog xfjg tvcodovg jiaQafiriXQixfjg fid^ijg.

Elx. 131 -'H&eganeia xrjg XQOViag ^vXcodovgjxaga^ritgixcdog diä fx^tatgom'}^ etg tsxvrjxov ä:t6oxnua xaxh

trjv xaxev^vaiv xfjg xobtoxo/4fjg. f l •> ^^^»vr

103

Elx. 132, — *H ^eganeia xfjg XQ^^^^^ ^vXiodovg
JiagafxrfxglxiSog dia ^sxaxgojiijg elg xnxvtjxov ojro
axr]fia xaxä Aoyoß'SxdnovXov. Ainvoi^ig xov
axfjf^oixia&evxog d.ioatt'juaxog di' onco&lag xoItio-
xofifjg xal &sQfAoxavxijgoi.

Eix. 133. — 'H ^egansia xrjg XQ^^^^^ ^vlcödovg
jiaga/urjxgitidog diä fiexaxgojtPjg stg xexvfjtov dno'
axrifxa xaxä AoyoS'eTdTtovXov. Aievgvvaig xov
xgavfiaxog xijg xoXjioxofiijg üiä fiiäg XaßiSog. *Eh
xfjg ojtfjg geei jxaxvggmaxov nvov.

Elx. 134. — *H ^F.gajteia t/yc X?ov/a? ^vkcodovg 7tagafir]xgixi6og diä fuxaxgojtfjg elg xsxvrjxov dnoaxrjfia ^xaxä

A9YO^sx6jtovXov.Aiä xiöv iviog x^g jivcodovg xodoxrjxog eloax&svxcov daxxvkcov d^ofxaxgvvovxai al sv^gv-

nxoi fiäCai, xaxaaxgetpovxai xä diorpQay^axa xai ovxco örjfAiovgyelxai {xia iviaia xoiXöxrjs,

104

Im nfivag vnh Iöxvqwv jiovcdv ao^evet? dn:aXXaöaovTai an^oco? towü)V. ai oxXnpal lv(ü8ei(;

/ naCai elacpaviCovrai xai TU eleraoTixa evjQn^iaia pietd iivag eßöo^idSag xatd t6 JiXeiöTOv

elvai oxt86v (pvaioXoyixd. 'Ejii md? jteoiJCTCOöeo)? iietd ueydXT]? aTevwoecos tov eviepov, djAe-

00)? nerd tfiv 8idvoi|iv xov am^ox^wiaxoc, xateöm f| xevcoöis xov hiegov ex veov dvd)8vvo5.

ÖEV JlttQETTlQfldTlOaV hk Ttt djüO XaigOV El? XaiQOV JIQOTEQOV 8^i(paVl'(;Ö|Aeva ÖD|iJlT(6-

9 * Mr

fiata eIXeotj.

14. 'H öoKTuAioeiö^q orivooic; toü koAcoö.

'H 8axTvXiOEi8fi? otevcooi? tov xoXeov, r\Tiq jiaQaTTiQEiTai oiV ojiavio)? jaetq tgav^a-
tiönov? evExa toxetcöv fi auvo^öia;, bvyaxbv ovvr\&wq vd ^EQajievOü ^i6vov 8td xeiQOVQYt^tfi?
IjtEußdaEO)?, 8i' o jcQoßaivo|iEv o)? dxoXoijffa)? :

MEtd djtoxdXvipiv TOii aiEVwpiaTog 8id xoXn;o8iaaToXEü)v, ovXXa^xßdvouEV t6 xoXjiixov
Toixcona xdTO) ttj? ötevcooeco? 8i' dYxtöTQCOTd)v Xaßiöcov xal teivojaev tovto xaXcog Öi'eXIecos
TiQoq td xdTO) xal E|a). 'AxoXovdo)? SiatEnvouEV ifiv ovXcoÖti noipav avTOV xard ifiv ixeötiv
YQaii^ifiv xr\g jtQOo^ia? 7rEQiq)£(>Eia? xal öVQQaJiTOjAEV t6 ejüi^tixe? rpavjia xatd tov eYxaQatov
d|ova xov xoXeov. T6 \ir\xoq xr\q xo\ir\(; xadopi^Etai ex tov ßa\^nov xr\q gtevcoöeo)?. Tt^v avTf)v
jrXaöTixfiv exTeXovuEV dxoXovOco? ejil xr\q ngoö^iaq jiEQiq)EQEia? xov oxBvd^\iaxo<;, [ie{^' o ticü-
littTi^ETai xaXwg 6 xoXeo? 8id ya^ilS- ■*

15. *H öAiKH ärpHoia tou koAcoü.

*H oXixf) dTQTiota TOV xoXeoij evexa avuqpi'oecov tcov xoXjiixwv TOcxw^dTCOv 8ev elvai
evxeoe? vd OeQajtevOfi edv jrpaYUaTixd)? OeXo(.iev vd djioxaTaoTriocüuev xaTdXXriXov jiqo? Xet-
xovgyiav oqy«vov. MeTd eYxaQoiav TOnf)v xatd t6 dvo) oqiov to\3 jtepiveov jtpoxcoQOv^ev d^-
ßXecog öid toxj öaxTvXov xal \paXi8iov nETa^i; oq^ov xal xvöteo)? jrpog Td dvo) ^lexpi ov
(pO^dacDpiEv El? iJYie? xoXjiixov TCixcopia xal et? tov TpdxTiXov. "EXxopiev Td xQdajieöa Toi5 xoX-
niTiov ToixwjAaTO? Jtpo? Td xotco liexQi ov xaTOpi^cüöcopiev vd evcoöcouev TavTa jiETd twv vjto-
XetJtopievcov xaTCOTepcov toiovtcüv r\ vd ovgQd\|Ja)|iev TavTa jiEptqjEgixo)? jiqo? ttiv eiaoöov
TOV xoXeov.

'EjiI 8voxeQü)V jteQiJiTcaaecov ÖvvaTov vd jiagaöTfi ävdyKt] iva äQXio(X)\iev ttjv eYXei'
Qrjaiv 8id XajcaQ0T0|i,fi? xal vd avvexiocauev TavTT]v dxoXovdcD? xoXjcixco?, iva \iexä ßeßaiOTT]-
TO? drtoq)VYö)!iev TpavpiaTiönov? ttj? xvcteo)? xal tov evTegov.

'EjtI atnaTOxoXjiov r\ ai|iaTOuiiTga? evExa ovyy^vov? r\ ejcixTTiTOv aTgrioia? tov vjae-
vo? f) Toi5 xoXeov, dgxovueOa ei? ttjv djiXfjv ftiaTO^iTiv tov SiaqpgdYjxaTO? xal. tov jrco^aTiöiiov
xal evegYOvpiev SiaöToXriv 8id xiipicov iva djioqpVYf'^piEv veav öTevcoaiv. 'Edv ovvvjidgxil neTd
TT)? ai^iaTopiriTga? xal ainaroadXÄiYl, tote f\ i>egajreia avTT] ov86Xco? ejiiTgejieTai, 8i6ti y\ 8ia-
Tonf) EVxoXcü? 8vvaTai vd EJUcpEgi) djTOövvf>EGiv tov jTEpiEXOMEvov TT)? ödXjiiYYO? M'C'f' ejia-
xoXovOovoTi? :rEgiTOviTi8o?. 'E^aigorpiev xaTd jrgoTinnGiv 8id XajragoTOnf]? Td? 8ia)YXü)|ieva?
ödXjtiYY«? ^ exTeXov^iEv GaXjiiYYOöTopiiav ejiI oTEigov JisgiEXOfXEVov avTcöv, edv ßEßaio)? djio-
ßXejio^iev et? ovXXrixpiv. 'Ev jiegiÄTcoöei dXXoiwGecüv aiTive? djioxXeiovv Tfjv qjvoioXoYixriv
YevvTiTixTiv XeiTOvgYiav Swa^eOa vd dqpatgeGCouev Trjv pifiTgav juegiGw^ovTe? Td? wodrixa?.

16. 'H önMioupyia TCxvnTOü koAcoO.

Ilgo ovxl \iaxQov xgovov f] EYXeigriGi? avTT] e'xev djiogQicpdfi vjio twv Yva)aT0T£Q0)v ejit-
0TT]M,6v(üv, 8i6n 8i' avTfi? 8ev tito Swutt) xvtjgi? xal toxetö?. Avtt) iiovov et? oXa)?yjjra-
via? jiegiJCTCüGei? eivai 8vvaTri, 8i6Tt Gxe86v jidvTOTe JiXrjv xfj? 8iauagTia? tov xoXeov ovvv-
j^dgxo^'v xal dXXoiwGei? twv eoco YevvT]Tixü)v opYdvcov. Aev voni^opiev öti ertiTgejteTai et? fwiCiq

105

vd djtoji^iijtco^ev Ywaixa titi? 8id Tri? c'YXeiQn^fw? SvvaTOv vd xaTaoTxi eirvxr')?. ovxvoTOTa
8e 8id TT]? EYXeigrioew? vd djiOTganfj djio ttjv avTOXTOviav. 'H \';ioxa)gT]oi? f|uü)v avTT] yive-
rai evxegcGTcgov xa{>6G0v ai veouegai xeignvgYixai n£i>o8()t 8rmiovgYia? xoXeov Ijiißagv-
vovTai HE ^Aixgdv ^ovov voGT]g6TT]Ta xal nEt\)v8fniu? öxe8üv aviioinoTTiTO?, ev dvri{>eoei jrgo?
Td? JigoYEVEGTEga? EYXFigriTixd? ^AEf>68ov? xQtig nojtouiGEW? eXixo? tov Xejitov IvTEgov
(Haeberlein, Mori, Baldwin) ii r^/maTo? tov djiEvOvGjxEvov (Schubert).

•H TigoTaOeiGa vjio TOV Wagner - Kirschner he0o8o?, xa.')' nv 6 8tmiovgYovnFvo?
.liETali) xvoTecü? xal djrEv^vapiEvov vro piogcpriv xoXeov ai-Xo; ejüevSOprai 8id XQT[(5i\i07iOir\-
aeo)? jrgoöeTtxov \kx\xav{\\xaxoc vjto MeYttXojv tÄi8Fo^ixo)v Xcogiöcov, e'xei t6 piEYa TrgoTegrj^a
TOV oXq)? dxiv8vvov xal qpaivETai vd tlvai iootiho? w? jigo? Td TeXixd aÄGteXeoLiaTa Jtgo?
Td? jrgoYeveoTega? jiedö8ov?. Texvixw? 8ev Elvai to) ovti tooov Euxegn? ^ Xt1i1;i? e;ri8epMixü>v
Xa)gi8(ov ex tou SegfxaTO? tov mipov. "AXXoi xptigiuoäoiovv ü)? ÄgoSgopiov 8id t»|v dvdjiXa-
Giv TOV e;ii{>T]Xiov tov 8ri^iU)vpYTii>evT0? ai'Xou eregojiXuoTixd noGxeünaTa, ji.x- d^iviov,
GfifiY^a eußgvixov, wGavto)? \xk xaXd TtXixd d;ioTi-Xeö|iata (Burj^er).

'ÄJiXovoTdTiiv ^eöoöov expriöino^oiriOEv 6 Gambarow ('), ooti? [aetu mxpdv EYxapoiav
8iaT0^riv £8TmiovgYnae 8i' dußXeia? djioxoXXnGeo)? HETa;u xÜGrecoc xal djrsv^vonEvov avXov
xal EJico^dTiöEv avTOv. '0 avXo? ovro?, ooti? 8iET»ipni>Ti dvoixro? 8id xrjpicov xal dxoXovdco?
8id TTJ? ovvovoia?, EJiExaXvcpOn |iet' oXiyov? tirlvac 8td GTißd8o? oTEpEov eäiOtiXiov xal 8if.
jrXdo&Tj El? xardXXT]Xov xoXeov.

17. Td KuoTiOKoAniKä oupiyyia.

'Edv ElaipeowjiEv rd? \i^ ovxvd? jtEpiJiTü)0£i? 8TiniovpYia? ovpiYYiov evexa pn^ecü?
xaxori^cov öyxwv exojiev 8vo ei8(jüV ovpiYYia, Td inetd toxetov xal Td nETEYXeipriTixd, f\ xeipovp-
Yix^ depajteia twv ojioiwv elvai epYov ixavov xeipovpYov. Aeov önco? vd TOvioOf] Öti ^ ky-
XeipT]oi? Twv xvoTioxoXjitxdiv ovgiYY'wv ovYxaraXeYEtai piETa^v t<ov 8vGxegeGTdTa)v eirepißd-
oecov xal fin? djiaiTei dgioTTiv eYXeigr)Tixf)v lexvixriv xal heyigttiv ÄEigav, xat^' ooov exa-
OTOv ovgiYYiov 8£Ov vd OEgajiEviiTai xut' i8iov Tg6;iov dvaXoYCO? xy\; jioixiXXovoti? uogcpfj?
VJtO TTjV OTioiav ExaoTOv EM-vpavi^ETai.

AvoTVXw? xal orinEpov eti vjidpxovv ei? ttiv *EXXd8a jioXXd x^gia xal vfiooi pieTa
Svoxepeia? ejtixoivwvovvxa xal xeipieva ^laxpdv wpYavwpiEvcov xXivixwv, evda oi TOxeTol yi-
vovTai dvev taTpixfj? tivo? ßoriOeia? ti koXv xaOvorEpr,OE(oT)? Toiavtri?.

'A7i68ei|i? tovtov eIvoi tu .^oXXu ovgiYYia uTiva owridco? ßXEJio^Ev xai Td ojioia
jigoxaXovvTat eite ex VExpo')Ge(o? to)v Gvvf>Xißon£vcov e;ii piaxpov xo^vov naXaxwv piopiojv,
^eTa|v xeq)aXfl? xal jiveXov, eI'te ex tpaunaTO? evexa naievTixf)? ETiEußdoecü? YevopievT)? vjio,
8vo|[ievei? ovvf>rixa?. Td e^qpavi'Cone^ a e;c' evxaipiQt Y^^vaixoXoYixöiv ejreußdoecav ovgiYYia, t8iQL
\iE&^ oXixiV i'GTEpexTO|iriv, TiapaTTipovvTai et? ttjv 'EXXd8a et? nixpotEpov dpuVov, otav 86
TavTa TipoxaXovvTai 8i' dpieocDV Tpav^iaTiopiojv, OFpajievovrai xatd t6 .iXeTotov evxepo)?, öXco?
dvtiOETCO? Jigo? Td 8ei'TEp0Yevfi ovpiYYi«, evexa vexpwoeoj?, ei? d eviote IXX^ijiei \iiya piEpo?
tov TOix^naTO? Tri? xvgteo^? (ßXEjre x\]v et? Tf)v oeX. 110 ÄEpiYpa(ponevT]v jiepiätü3giv). Toiav-
TT]v xaTaoTpocpriv tov Toixcopiaio? ÄapatripovpiEv t8iQt piEtd Trjv 6Xixr]v vgtepexto^ativ xaxd
Wertheim, xad'fiv ai jtoXXal d:ioXivo')GFi? jrapaßXdÄiovv trjv xavovixriv jrapoxnv ai^aTO? eI?
Triv xvoTiv. "A? v:to^vriGa)|i£v ejil Tfi evxaipia on f\ xvoTixr) dpTripia, fin? X<^^C>TiYei aipia et? tov
jtv^Heva Tri? xvGtea)?, jtpoepxerai ex if]? eoco XaYOviov dpTripia? xal oti 6 tpaxiiXoxoXjiixo?
xXdSo? Tfi? jir]Tpiaia? dpTTipia? xogriYeT xXa8iGxov? ei? tiiv pieoriv noipav tt]? ovpridpa?. Ovxl
OJtavico? pieYaXvTepoi xXdSoi Tri? ^rixpiaia? dpTr]pin? jiopevovTai olk evöeio? eI? t6 Toixcopia

tf]? XVOTEO)?.

T6 jipoxaXovjievov tvxov xard Tr)v 8idpx€iav Tri? eYXeipiioeco? Tpavpia Tri? xvoTeco? 8eov
djtapaiTr)TCü? vd ovppdjiTEtai 8i' ejiineXov? paqpfi? ejil XajiagoTOnid)V xaTd Jigotipirioiv evOv?
dpieöcoc, ejil xoXjiixwv 8' ejiepißdoecov neTd t6 Jiepa? Tri? eYXeiprioeo)?, xa&' ooov jietd Trjv d<pa(-

1. Zbl. Gynaek. No 43

rJ^S

106

QEOtv taiv ^QvaXeicDV xai h^exo[iiv(oq xr\q liTiTpa^ elvai EvxzQiaxcQOi ot IvSoxoXitixoi X€iQiö\i6i.
Tfivouev t6 Tpavua tfi? ximiea)? ftiu 2 dYxiöTQOjTcov Xaßiöcov xal öi^opdjiTOjiEv toxjto 5id
ovvexov? oa<PT)? Ix ^(o'ixov Qa^naioq, x^pk vu övXXan(3dvo)|iev tov ßXevoyovov avifi?. ''Yjifq-
dcv xr\q JH^djirig IxTeXovpiEv öemepav ovvexfi ix ^(oixoiJ gdnnatog pa(pr|v, fi TOTtoOetov^itv
anXäq Qacpd?, aitive? 8eov va nvXXanßdvoDv ooov to ftuvarov mQioooxEQOv TOixo)|ia tri? xu-
öTfcag. 'Ejii xoXjcixmv 6YXEiQriöeo)v jTpOöJtaOovuev vd xaXvJiTCOuev td^ pacpdg i% xvöteo); 8id
jigpiiovaiov, TOvO' ojiep xatd xäq XaTtapOTOM-dg elvai aviovoriTOv. 'Ajio(p£VYOM€v ei bvvaxbv
TTiv icpapnoYTiv jicojiaTiönov eI'te jtqo? ainoöiaoiv eite jiqo; djtoqpi^YTiv Xoiji(ü|Ea)?, xa{>' ooov,
d)5 noi djif5Ei|£v f\ jitTpa piov, bia-nv^Evexai 8i' aiTOV i^ ejtouXcoöi? xov xQav\xaxo<; xr\q xv-

OTECOg. El SUVQTOV ÖEOV vd OVYxXElTlTai 6 XoXcOg TeXeUOi;, Wg TO TOIOVTOV 6 StOeckel TOVl^El.

Kai 8jri EJticvxov? eri paqpf]? tottoOetcvuev \i6vi[iov xaÖETfjpa ejti 8—10 f\\xEQaq xai oijto)
f|8vvriOT]piEv vd ä7io(pvy(i)\i£v jrdvTOTE ttjv ex veov ÖTipiioi'QYiav öi'piYYif>^- 'Edv 6 Tpav^aii'
a\ibq xr\q xvgteü)? Öev yivw dviiX-riTiTO? xatd tt)v ftidpxEiav xr\c, kyx'£iQY\0£(oq f\ ebif][iiovQyr\{^'\]
övpiYYiov evExa VExpcoöEco? öXiY«^ 'HM-ep«? M-"« ^^Hv EJtE^ßaoiv, thäo^etoviliev ^övip-ov xade-
ifjpa, ovTü) ÖE JiapaTTipoi5jAEV vd IjiEpXEtai ov'xl tÖöov öJtavicog avi6\iaxoq oi^y^^Xeiöi? tov ov-
piYYiov- El? dXXa? 7iEpiJüTü)aEig EJiirvYXdvopiEv piovov öm'xpvvaiv avTOV, 8i' f)? öiEvxoXvvEtai
jidXv f\ ^aeXXovtixti EYXEipTiai?.

SvpiYYio dtiva ÖEV ejiovXoiivTai evto? ßpaxeo? xQOvoi» djio xr\q EYXeiQ^öEO)? xa^* r\v
ÄpoexXridTioav öeixvvow eXüxiöttiv [xovov idoiv jrpog aiTOfiatov l'aaiv xai jrpejiEt, öxe86v Jidv-
TOTE, vd OEpajiEvcoviai XEiQOupYixw?-

IIXeov t(j5v 100 EYXeipTiTixüiv jxeOoöcov e'xouv Ttpoiai^f) djto xr\q knoxr\q xov Simons,
Lambells xai Sims, ttov xi'picov i8pDTc5v xr\q JiXaGTixfig twv övpiYY^ö^v. Avrai elvai xaid t6
jrXEiaTOv lOTOpixtü? piovov EvÖiaqpEpovöai. IlapajiEHjra) ei? xr\v £pi7rEpiöTaTü)HEVT]V jtEpiYpaqjTiv
xov Stöckel El? TÖ ovyyQa[i[ia Veit Stöcke! X toho?, [legoq II xai nEptopi^onai eviavi^a et?
Tf)v JiEpiYpacpTjv xr\q vjc' e[iov £(papuo^on£VT|S TEXvixfig xata ttjv jtXaoTixfiv tü>v öXjpiYYicöV O)?
EX« xavxr\v ^Kflegyao^j] ejii tfi ßdoEi jtEipa? 89 jiEpiJiTcooECov, xard t6 jrXEiaTOv ElaipETixwg
ooßapcov.

'E^i^iEV(0 El? TTiv dpxr)v OTi jiäv xuonoxoXjtuov ovpiYYiov Svvaiai vd ^EpaTtEVÖü xard
xavova xai öeov vd xeipovpYfiTai 8id xr\g xoXjrixfig 68ov, viib xr\v jipoüjioOEöiv oti 6 xeiQovgybq
xatEXEi teXeio)? xr\v texvixtiv twv xoXjiixcov £yxeiPtiöeo)v. 'Edv t6 lOioiitov Öev övußaivEi jtQO-
Ti^iOTEpov Eivai vd jrapaÄEnii^tl ttjv do^evri, ^Qoq xb öDurpEpov tou xai t6 övpiqpEpov a-urfig, el^;
dXXov JiEJiEipaixEvovxeipovpYOv, xad'oöov ndaa aÄOTVxor'aa EYXeipTiGi? xataatpEqjEi JtoXiJTifiOv
löTOv xai xa^iOTd xaq ejtaxoXoD^ovoaq EjiEpißdöEig eti 8i'öXEp£öT£pa?. 'AacpaXcög vjidpxouv
fiixpd EVxoXcog Tcpooitd ovpiYYt«, dtiva avEV jjEYdXrig övoxEpEiag öuvavtai vd ODppatpoiiv 8i'
olaoÖTiJiOTE JipoTi^cüjAEVT]? ueOööou, dXXu Td TfXixd djioTEXEönata Elvai Xiav ö-uanEvri oadxi?
EvpiaxofAEda jipo ovpiYYiwv JipoxXri^EVTov ixetü vExpcoGiv. El? tavia id xeiXt] Eivai dvco^iaXa.
oxXripd xai ov[i(pvovxai ngbq tov väoxei^evov iotov xai t6 Ögtovv, w? xai Ejil H£ydXy]q djico-

XE(as loTOV TT)? XVOTECOs Xal TT)? 0VpT)dQa? fl EUV 6 ödxTvXo? XOTd TTIV E^ETttGlY dvTl XOV XO"

Xeov ovvavTd oijXo)8ti XoavoEiöf) xoiXoTTiTa. fiTi? djroxpujtTEi tov TpdxT)Xov xal t6 GvpiYYiov.
MEYdXriv GJiovöaiOTTiTa exei f\ exXoYr) tov xqÖvov xr\q EYXeipriöECü?. 2vpiYYta d'Tiva
ÖEV EJiovXovvTai avxo[idxü)q öeov vd \ir] xeipovpYwvTai jipo Tfi? Jtapoöov 2—3 pirivcav djco xriq
l^cpavioECO? avTwv. "Ibiq. ejiI GvpiYYicov jrpoxXT)dEVTa)v RVExa VExpcooEO)? öeov vd dvanEvwpiev
ME^' vjiojAOvfi? TTJV djtojiTCOGiv Tü)v vExpcoi^EVTcov TpiTipidTcov iGTwv xal xr]v dva'CcooY6vT]oiv Tri?
ßXaßEioTi? Xfopa?. XpTiGijiOjtoiovixEv TOV XQOvov TOVTOv, Iva Jipo;iapaGXEvdoa)LiEv xr\v äo&evi]
8id TT)v EYXEipTiöiv. Omca ÖEpaÄEVOfiEV ttiv tvxov vjidpxonoav xvGTiTiöa r\ jcvEXiTiSa 8id nXv'
oeo)? TYJ? xuGTECO? 8i' IXocppü)? dvTiGTi:jtTixü)v öiaXvpiaTfüv, ojTÖTE TO pEov El? TOV xoXjtov 8id:
Xvjia 6JCi8pQi TavToxpovco? ewoCxw? ejtI tov qpXEYnaivovTO? ßXEVOYOvov tov xoXeov. 'EjüI nv-

OETOV IxTeXoVJAEV £v80(pXEßl0V? EVEGEl? GvXOTpOJllVT]?. Td TüpOxaXovHEVa EVEXa 8iaßpOXfi? VJIQ

Tü)V ovQü)v Ix^E^ara, 7rvo8Ep^iTi8£? xal 8oi^itiv(ogei? djiOTEXovv xivövvov 8id ttjv doriJiTOv
I|eXi?iv Tri? hx^iQr\OE(oq. AI dG^EVEi? 8eov vd Tripovv heyigttiv xadapiOTtita. Td ^^Epfiöio

ISpoXovTpa t) Td owiGTCü^Eva 6^1010)? vjio Toi5 Latzko lapiaTixa XovTpd SiapxEia? ovvreXovv cl?
TTjv dEpajiEiav twv 8Ep|.iaTixa)v Xoino)H£a)v. Meto t6 Xovcpov td ^co YevvT]Tixd SpYava Jipocpv-
XdöoovTai 5i' aXotcpfi? \l)Fv8apYvpov djio Tri? ex veov 8iaßpoxfi? twv ovpcov.

Kad* ü)pioji£va xpovixd 8iaGTri^aTa IxteXovuev dEpajieiav tov xoXjiixov ßXevoYOvov*
djüOnaxQvvofiEv djiojiEGOVTo T^ri^iaTa igtwv ti ovYxpi|AaTa evpioxonEva jtcpl Tr|v Jiepi<|)£peiav
TOV ovpiYYiov. *H Gapxoq)vo\Ga TpavuaTixrj £Jii(pdv£ia xavTripid^ETai r\ i;caXEi(p£Tai 8id ßd^i-
M-aTO? la)8iov. 'Acpaipov^Ev Td ni\ djiopppoq)Tid£VTa pdjipiaTa, d'Tiva jiidavcj? Ixovv Jiapaneivet
ex jiid? JiQOTiYridEiöri? ^YXeipTioEco?.

AI XPi1Gi(i03TOiov^£vai jipOTEpov ö8vvTipai heOo8oi jtpo? dvaijiaxTOv Sievpvvaiv tov ov-
Xü)8ü)? eoTEvcopiEvov xoXeov exovv \]br\ teXeico? avTixaTaGTa^fi vjio Tf)? TOjifi? Schuchard,
fiTi? öp^üi^ EXTEXovpiEvrj xa&iGTd EVXEpfi Tr)v jrpOGEYYioiv xal ei? öXü)? v\i;TiXd xei|ieva ovpiYY^I
Ejcl oTEvov xoXeov xal xaöiGTOvv jiEpiTTriv TTIV xonoiv jxaxpcäv El8ixa)v epYaXeicüv o)? tg to^-
avTa ixPTiöinojioiovvTO dXXoTe. 'ApxovpiEda ei? Td gwiiOti EpYaXfiia Td xpTiainojioiovpiEva xot^
Td? xoXjiixd? EYXCIP^IOEI?.

'A:io8i8on£v d|iav eI? t^v xptioi^o;ioit]Giv juxpcöv JioXv xvpTwv iGXVpwv ß»XoW5v, at-
Tive? ovXXaußdvovTai OTadEpo)? vjio tov ßEXovoxoTOxov jipr ? oiav8Ti7toTE xatevdvvGiv xal 8ev
jiEpiGTpeq)OVTat. Xprioinoiroico 8id xr\v xvötiv Xejitov ^cüXxov pdnjAa, 8id 8e t6 xoXjttxov toi-
Xco^ia jiaxv toiovtov. 'Edv Td Tpav^ioTixd xeiXk] tov xoXeov ovimcXTiGid^ovv piovov xaTOTiiv Td-
GEO)? ^iETaxeipiConai llaipETixo)? Tf)v |ieTa|av. Aid ttjv xvotiv et? ov8EjAiav jiEpijiTcootv Ijiitpejie-
Taipdmia \xr] djioppoq)CL)|Aevov. xa^' öoovtovto eviote 8iEiG8vei evtö? Tri? x\5oteo)? xal 8vvaTai
vd 8tihioupytigi] XiOov. 'Edv t6 Tolxcojia Tri? xvgtecd? exw xaXü>? xiVTiTOjiGirjOr) xal TdTpavpiaTi-
xd x^iXt] npOGJiXTioid^ovv dvEv xdoeodq ngbq dXXT]Xa, t6 GvpiYYiov dEpaÄEVETOi 8i' oIovStijiote ei-
8ov? paqjfi?. Elvai ovgicüSe? xal gtim-ovtixov 8id t6 d^OTeXEGna vd cpepcouEv eIc ejiaq)r|v 8oov
TO 8vvaT6v EvpEia? TpavjxaTixd? £niq)avEia?, Elvai 8e d8idq)opov edv GvppdjiTCopiEv et? ^iiav f\
dXX.EJtaXXriXov? GTißd8a?, 8i6ti xaTaXrivojiEV ei? t6 olvxo, Edv jipOGEYYiocouEv 8i* Ivo? fj 8id 8vo
pannaTCOv Td? avTd? EJiKpavEia? Tri? xvgteco?.

IIpoTino) YEVixü)? TTIV paqpriv eI? 8vo GTpcopiaTa, xad' t^v gvyxXivcoto TOixco^a ttj? xv-
gteco? xal TOV xoXeov 8id nEpiovcDpiEvcov papipidTCOv. Movov OTav exw^iev eI? ttjv 8id&eGiv [laq
HEYdXa? EJiKpavEia? ttj? xvgteco?, tojioOetü) piiav eti 8EVT£pav paqprjv avrfi?. Ol loTol kjiov
XovvTai, wq jidvTOTe eI? ttjv xeipovpYixrjv, xaXXiTEpov otuv Tpav^iaTi^covTai ogov t6 8vvaT6v
öXiYcoTEpov, TO toiovtov 8e GvpißaivEi OTQV n£TaxEipi^ü)pie^a ogov t6 8vvaT6v öXiYcoTEpa pd^-
^aTa. Aev ovXXa^ßdvco tov ßXEvoYOvov xY\q xvgteco?, dv xal 6 Stöckel 8£v ÖECöpEi t6 toiovtov
(o? nEiovexTixov. 'EtieiSt) f] evöoxvGTixr) pioipa tov ovpriTfipo?, ^nxov? 10 — IöxiXiogt., \iexä

TTJV EloSvGlV El? TOV (XVIXOV X^'^^Va Tri? XVOTEO)?, JtOpEVETai VJIO TOV ßXEVOYOVOV, d.-lOipEVYO"

fAEV TavTT^v xaXXiTEpov Edv 8iajr£pü)H£v xa pd^piaTa piovov 8id Toi5 pivixov xixwvo? Tri? xvoTeo)?.

*H dppcooTO? TOjioOETEiTai 0)? xal xaTd Td? xoXjiixd? EYXeipi1<JeiS» jrpOGEXOfAEV ö[i(oq
i8iatT£pco? iva x] EÖpa nQoixxi xov xeiXov? Tri? tpoäeI^ii? xai iva oi uTipol elvai ei? TeXeiav
ujiaYCOYriv. T6 eXacppov xExXipiEvov £ji;in:£8ov EvxfpaivEi tov? xeipiöpiov?. *Q? vapxcoTixov he-
TaxEipt^opiEda, ü)? El? n:dGa? Td? xoXjtixd? EYXeipilöEi?, t6 Evipan xal dpxovpiai et? tovto xal
Et? Td? ueyaXvTEpa? eti 8iapxeia? EYXeipilöEi? xaTdTO jiXeTgtov, dvEV f\ piövov \ik [iixpdv Jipoo-
OrixTiv aldepo?.

Aev exTeXü) tt|V gvyxXeigiv GVpiYYiov 8id VEapo^roiriGeü)? piovov xal paq)fi? xal et? d;cXd?
Iti jtepiJTTCOGEi? xaO^' a? Elvai 8vvaT6v vd e^iTvxw toiovtov. "Exopiev togov aGcpaXfi ne^o8ov
El? Tf|v jrXaoTixriv Td)v GvpiYY^^v 8id ftixoG^iov tov xvgtioxoXjiixov 8iaq)pdYHaT0? (dedouble-
ment), oSgte 8ev irapaiTOv^itda aircri? xal ejil pir] e^iJiXoxcov eTi jiEpiJiTcooeoov. Avtti elvai 8i'
e|j,e v\ neOoöo? exXoYri? xal ecpappio^o) TavTriv oj? dxoXovdco? : MeTd tt|v exTeXeGiv Tri? topifi?
Schuchardt xal Tr]v tottoOettjoiv tü)v xoX^oStaGToXEcov, jipooavaToXi^o^ai xaTd jcpwTOv co?
Jipo? Tr|v Oegiv, t6 pieyeOo? xal ttjv GVGTaaiv tov GvpiYYiov, dxoXovöco? 8e ovXXajißdvCo 8i'
dYxiGTpcoTwv Xaßi8cov t6 jtepi| xoXjilxov T0ix(0|ia xal djidYfo tovto. ET? Tiva? JcepiJiTcoGei?
TO GvpiYYiov Y^VETai jtpooiTov djiXd)? 8id Tri? Jipo? Td xdTco eX^eco? tov TpaxrjXov 8i' dYxi-

— --■■— -^■- — --- -■-*-T|-gHf — - ■" ■■ --• ■-— ^■-

JOS

fm. "''i,^^

EIh, 135. — Meya xoXtioxv mxhv avoiyyiov. 'Ejii-

xakvnxexM iv fiegsi vjio tfjg :tivxf}^ toü Jiooo-

^iov xoXtiihov zocxcofiaiug.

Eix. 136.— Meya xvatioxokTiixov ovQiyyiov. ^Ey-
j^slotjocg diä xr/g fisäoSov zov Öiyaofiov. T/uijfxa xov
xoixdifxaxos xijg xvoxecog ex^i d:;ioxoXkr)&rj dad
xov xoXmxov ioix<o/^axog. T6 jiqcöxov gdfi^ia
eX^t xono^exr]^f\ .

Elx. 137. — Meya xvaxtoxoXjiixov ovgtyyiov. 'H
xvaxig exei JiaQaaxevaodij eig fieydkrjv sxxaaiv
Ttegi^ xov ovgtyyiov xa'i x6 ijfxiov xwv Qaqfüöv
ex^i xoTto^exT]^ xaxd xov ko^ov ä^ova avxov.
('Em xov ;i;«/Apvff xov ovgtyyiov ex^i JiaQafielvsi
Xoj^lg xqXsiixov xoix(ofiaxog) .

Elx. 138. — Msya xvoxioxoXjiixov ovglyyiov. 'H
xvniig k'xsc Jiagaoxevao^ elg fieydXrjV exraoiv
xai eyei ovgga(pii 8id jus /novo) /nevojv gafijudxojv
xaxa xov ko^ov ä^ova. *Yjiegdvo) avxcbv avggd-
nxexai ro xvaxixov xolxoj^a did ngoo&exov osi-
Qäg Qaf/,izdxo)v ,

109

Eix. 139. — Meya xvaxioxok:iix6v ovglyyiov. Mexd dfi/naxia/nov okuiv xtLv gofifidrwy tfjg xiouojg oigQamovxai
xä xQavfiaxixd x^^^^ ^^^ xokeov öcd ^e^ovoifüvoiv gafifidzaiv xd, onoTa ovkkoftßdvovv xal xd xolxcofia xfjg xvoxefOf.

Elx. 140. — Meya xvoxinxokriixov ovglyyiov. 'H
xvöxig ex^i Jtagaoxevaoi^fj elg ^ieydkr)v exzaniv
xal xo tjfxiov xcöv gafif^idxoiv ex^^ xo.Toi^exr]&i]
xaxd xov oßekiaTov ä^ova, x6 de akko fjfiiav'.xaxd
xov eyxdgaiov.

Elx. 141. — Meya xvaxioxokjiixov m^glyyiov. Me-
xd xov dpipiaxiapiov x&v gafijudxcov xaxd xov ey-
xdgaiov d^ova ovggdjixo/xev xov xokeov avkkafj.'
ßdvovxeg xal xo xolx^yfia xfjg xvaxewg.

110

axQ(üXx\<; Xaßiöog. 'Ava^riTü) dxoXovdco; t^v eiaepeaTEQOv neraxivouiievTiv Moiv ttj? JiEOicpe-
Oeia? Tov avoiYYiov xal aoxo^at Jtaod t6 t^vXoc, xov ö-uqiyYiov tt)? dÄOxoXXriGeo)? tov xoXjii-
xov &no xov xvOTixoiJ toixwhqto? öi' oxi\ix\QOV xal tehvovto? MaxaiQiov. 'A(pov JtaQaaxevdoco
doxovvTCO(; ji^y« Mepoc tov irepi t6 ovqiyyiov xvotixov roixwnaTO?, TOjiodeTO) t6 jtQWTOv pd^^a
oiiXXaMßdvcov r?öov to övvatov \izyakvx^QO\ (nepcg xov xoiX(X)\kaxoq xal djijiaTitco romo (elx. 135-
136). Xonoi^iOÄOiü) TO Qd\im TotJTO TiQog fX|iv, eXxETai U imo xov ßoT]Oov laxvQO)?, nQoq xä
xdtco, ÖJTÖTE öwavtai vd dtpaipE^orv ai xaTaXapißdvovaai x<>>QOv äyynoxQayxai XaßiÖE?. Eha
JtaQaaxEDd^cü 8id tov \xfixayQiov f) i[>aXiMoD evqv T|xfina xov xuötixov TOlxa)^xaTO?, TOjrodeTü)
ä\iiao)q TO Öevteoov gdnna. ojiep xal JidXiv E'XxEtai jrpog tu xoto), dqpoi' djtoxojiii t6 jiqätov
pd^ina, JtaQaoxEvd^fjD ^x veov dXXo Tpifina tov xvaTixov Tor/conarog, tojig^eto) t6 tqitov QdjA^a
ml llaxoXonfto) jispaiTEpco, jiEXpi o{> ovYxXEiodfj t6 oXov avQi-^yiov. V xQonoq ovxoq xr\q EYXei-
QY\oBOiq exEt To jieYa jtpoTEQTina oti Öev jtapEUJtoöi^eTai Tig vko twv epYaXFicov aTiva jtEpiOQi*
Couv TOV xwQOV xal oTt öidtfii; djtoxoXXriaECog xal TfjgdpiEaovavpoacpfig ^ixpwv ^aovov TjiTi^d-
Tcov TT)? xvaTECog jtEQtOQi'CETai xol f| rtaQEvoxXovöa ainoQpaYia ei? t6 EXdxiaTOv.

AI jioXXdxig avaTaÖEtoai hiöEiq dÖQEvaUvT)?, aiTivcg EjrTiQEa^ovv övö^evü); xr\v zkov-

XcüOlV, xaT£OTT)OaV OVTCO JlEQlTTai.

KaTd Tiva Tpojtov vEapoicoiEi xiq, OQi^ovxtwq, Xo^wg ti oßfiXiaicog. £|aQTdTat djioxXEi-
oiixGiq ix xr\q [iOQcpr\q xov ovQiyyiov xol xr\q Opaecog Tfjg \.iEyioxy]q tooeo)? tü)v Iotwv, dvaXo-
Ywg Tr\q ojTOiag totioOetoviiev ttjv Qacpr'iv. Outo3 etpiEOa :iioXXdxi? t'jioxQECopiEVOt vd oi'QQdjiTO)
^EV To avTO Gvgiyyiov xaxä biacpoQOvq uHovag (ely. 137-141).

Msxä xr\y djrojreodTcaöiv xr\q Qacprig xr\q y.voxE(Dq jiXtiqoxjuev TavTrjv 8i' dpaicüOevTOg
djtEöTEiQCDHEvOD YaXaxTog, dq)Oii jcQOriYOt'^fvcog JtconaTiöcouEV tov xoXeov biä ydC,if\q iva djiocpu-
YCopiEv JiaQajiXdvTioiv, evexo tvxov djio xr\q ovQ\\{)Qaq EXQtovTog jiQOg to ßdüog xov xoXeoxJ Ya-
XaxTog. Meto xr\v äcpaigsoiv xov xadETf.gog xal Tfjg yaCr]q, eXeyxojaev Idv dvaßXvI^Ei YdXa 8id
I^Eaou Twv Qa\i\idxwv. 'Edv to toiovtov Gi'ußaivEi övyxXeiouev to vexq(jo{>£V otiheIov 8i' Evog
QdptfxaTog. 'H £YXt«piloig jtfgaToijTai 8iu Trig övyQaq)f)g tojv TpavuaTixüjv xeiXecov toi? xoXeov
8id ^AE^lOva)^Evcüv panndTCOv, ejiiöicoxouev 8' iva piT] ai'n.iiJiTOvv jtQog dXXriXag ai 8i)0 OEipal
paiAnaTCüv (dv xal 8ev Oecoqü) to toio\)tov (bg d^oX^tcog dvaYxaTov\

'E;ii TTEpiTTTCoaECov iiet' £|aiQETixrig loxi'pdg TaoECog tcov iotü)V 8vvdjA£0a vd EcpaQuooco-
jiEv TTjv TQOJiojioiTiöiv T0\3 8ixaauoi} xaTd Fütli. TE^lvo^lfv to xoXjiixov TOixw^ia jieqI to ov
QiYYiov Eig d^ööTaciv V> L\i. djto tov x^iXovg tov ovTcog, oSöte vd n:aQa[AEivti 8axTvXiO£i8Eg
TEjidxtov TOV xoXjtixov TOixüVctTog, ojtEQ 8ev övXXapißdvETai xaTd xr\v gacpriv ovTCog, oSote
TOVTO xaTd TOV d^naTionov tcov gannaTCOV dvaaTQ£(p£Tai jipog to eöcoteqixov Tfig xvöTECog.

"'AXXai jtdXiv JtEQiJiTCOOEig ^lETd \i£yd'k'r\q djicoXEiag xvötixov TOixco^aTOg xal |jI£t' lox^-
pag ovXa)8ovg TipooTiXcoaEcog twv xfiXecov tov övpiYY^ov 8vvaT6v vd pidg dvaYxdoovv vd dq)ai-
pEöa)(i£v TT|v jiTiTpav. 'Ev TOiavTti jtEpiJtTWGEi 8vvdn£Öa vd jrapaöXEvdaco|iEv tt)v xvgtiv ev-
XEp(og Eig HEYdXriv EXTaotv, EXovTEg ovtco Eig ttjv 8idOEaiv piag dpxETOV jtepiTovaiov Jtpog £|a-
öq)dXiöiv TTig pacpfig, ev dvdYxti 8id XQiloipiojioiriöEcog tov TOixoanaTog tov öpOov (Latzko) r\
xal T(üv jtXaTEcov ovv8£a|ia)v.

Avvd^iE^a ETtiTvxcüg vd XQX]Oi\iOKOir[0(i)\iEV ttjv pi/iTpav wg vjioaTiipiYna twv övpiYYiö>v
fUTiTpojiXaoTixT) EYXeiQTiöig), xaTd :tpOTiHT]öiv 8id Tfjg jiapEV^EOECog tov öcopiaTOg xaTd A.
f'reund.

'EjiI ovpiYYicov XEinEvcov jiXtiöiov tov TpaxriXov 8vvdM.£Öa vd XQx\oi\ionoiY\0(i)\iBV xov-
TOV jtpog IjtixdXvii^iv jAETd jipOTiYT]0£iaav xivriTOjtoiTiaiv (Küstner - Wolkowitsch), £ig ßa-
pEiag8e jcepuiToSoEig piETd jipotjyovm-evtiv djtoXivcooiv twv Jiapa|j,TiTpio}v (Küstner, Pübsamen,
Latzko).

KuOTiOKpAniKÖv ouplYYiov iicTä KaraoTpotpii^ toG otpiyKTnpo^ riiq KuoTcoq ko) Tiiq oupndpo^

Avvd|A£da vd eI'jccouev oti oiov8riJrOT£ avpiYYiov Icp' ogov f\ ovpy)dpa vtpioTaTai eivai
Swaiöv orj^epov vd OEpajiEvdfj, jtXriv eXuxiötcov llaipEOECov. AvoTvxwg rd djiOTEXEopiaTa

111

clvai öXiYWTEpov doq)aXfi ^«v 6 o(piYXT?|p xal f\ ovpiiOpa exovv waaikcog xaTaotpaq)fi, xa^
ooov h TOiavTti JiEpiJiTcooEi f\ depajiEia tov ovpiYYiov 8£v dpxEi, dXX* o^eiXo^ev vd djioxa'
TaoTTioco^Ev xal öipiYXTTipa txavöv jipog XpiTovpYiav, iva ovtü) IjiavacpEpcouEv t^v Ixovöidv
EYxpdTEiav Tü)v ovpcov. To TOIOVTOV 8£v Elvai e'pyov EX'XEpfg Jiapd Tdg TioixiXag 6vq)veig iy-

Eix. 142. — Kvaxioxokmxov avgiyyiov e^aigexixov fisye&ovt; fisx* iXXelyjeioi; dkoxXtJQov tiji ovQi^^Qai xai toö

jiQoa&iov xokjiixov xoix(öfiaxos.

XEipiiTixdg |i£0^68ovg aiTiVEg e'xovv jtpoTadfj i8iql xaTd to TEXEVTata txr\. *'Exco 6 i8iog xei
povpYTJöEi 89 ovpiYYici xvoTioxoXjTixd, ix iovtcdv 62 JiEpiJtToiöEig dvEV TpavuaTtopiov Tfjg ov-
pridpag. 'Ex tü)v xaTd to jiXeTotov JtoXv ^leYdXcov tovtcov ovptYYiö)v £d£paj[fcvOT]aav Td90®/o
xal 8ri duEöcog jAETd xr]v jip(OTT]v lyx'£'^Q'f\oiy. Eig Tiva ttoXv evjieyeOt) ovpiYYi« fivaYxdoO'nuEV
vd EjravaXdßcüuEv ttjv EyxEipriaiv, fiTig xal £jt£q)£p£ to teXixov djrOTEXEojia.

'Ex Td)v \ii\ dEpajtEv^Eiowv jtEpiJiTcoaEcov \xiyaq dpiOfiog Od f|8vvaT0 vd OEpajtEvOfi,
edv at Jidöxovoai 5£v fipvovvTO 8£VTEpav eyxeiptiöiv. 'Ex xcüv 27 JCEpiitTCOoEcov ^lETd oXixfig r\
jAEpixfig xaTaöTpoq)f)g Tfjg ovpridpag, xaTEOTT] 8vvaT6v a! 24 xaTd t^jv e|o8ov ix tov Noöoxo-
jiEiov vd ovYxpaTOvv Ixovoicog Td ovpa IjtI 2 xal jtXeov ojpag(*).

Aid TTjv djioxaTdoiaöiv tov GcpiYXTfjpog 8vvdpiEda vd xqtigipioäoiiigcouev olovSriJiOTE
jivixov Igtov ixavov jtpog Xeitovpyiov, xei^evov ttXtigiov tov TpiYWvov Tfjg xvoTEwg, ijiEi8fj

1. 'Eni 50 T(5v dvaq)eQOnevcov JieQinrcooewv dvexoi'vcooe 8i8|o8ix(5g 6 fiaOTjxiig ^.ou 'AvxoovonouXog
(Congres Franipaise Chirurgie 1932 Cinquante cas des fistnies vesico - vaginales traites par la voic
va:ginale).

112

El^ 243 ^KvöX'oxoXntxov ovoiyyiov flaipsnxov

yai tov nooa&lov xoXjiihov xottM^arog. tyxei-^
gnoi, xarä AoYo^erdnovXov. Mihqov xm^a xov
xLcofiaxo, rfj, xvöxew, ex^c naoaöxsvaa^ xac

Elx 144--KvöxcoxoXmx6v avgfYrcov ßacQsrixov

aw^ um ^r ^, r ovyxgaxeixai Tigog xa
ßkevoyovog xtjg xvoxecog oj a

Fix 245 —KvaxioxoXmxov avQiyyiov i^aigsxixov ^isyi&ovc ,ufr' msiy'€(og oloxktjoov tfjg ovgrj^Qag xal
ngo'a&iov xokmxov xoa<öaaxog. 'En^io^o^f >^«^« Aoyo^Bx6novXov. T6 ovQiyYcov iv avvöXco exs^ ^C';7„i
i^cpEöBi uiäg uLXQäg dm-jg, fjxcg fxiXXec vä xomievoj^ d>g ovqt^&qü. «O ßXsvoyovog xov TiQoa^iov x^^^ovg xov
^ XQaxrjXov ixxe(Mvexai diä xov inaxaioiov.

xov

113

xaia TOV Latzko tooov ai Xeiai ooov xai at VQM^^wTtti niüxal Tveg xax^coq jtoooao^oCov-
rai JtQoq xa<; a'uvd/ixag xal evx^Qaivovv xr\v eKcn'oiav eyyiQuxfiav xr\q yivoxvioq.

'Euv f\ ovQ)\(^Qa biaxt^Q^lxai dpxel xatu to jiXelaTov \i^xä xi]v ai'OQucpriv xov avQiy-
Yioi' va öVveva)ao)HHv xä vjioXeiJioneva nkdyia T^TUiata tov afpiYXTfiQo^ xal to\j ÄFQißdXXov-
xoq lOTOv <^i' eYxa()oi(ov gaqxov. 'Fa\v l)\i(i)c, eXXfiJiti avTi) fv fXFQfi r\ et ^XoxXv.qov, tote fieov
6 veo8T]Hioi'QY'n^^^''? ^^ "f^^^v JTaQ(txeiM.Fvo)v iokov jtoo»; avTixaTdtOTaoiv Tng oi'Q/iO(.)a^ o(oXtiv
va b'xt] ni'ixov v7t()i^F|ia, omQ Oa ftuvuKxi vu ((vnxfacxoTi'iön t6 F07OV tov ocpiYXTrioo^.

Elx. 144.—Kvaitoxo/.nixöv cvnr/yiov i^uiosxi-
xov fieyti^ovg /,isi* W.Eiy'ewg oXoxXijoov xtjg oi'-
pvd'oag >cai xov nQoo&tov xoXjuxov xoiy/hfiaiog.

'Eyxei'JV"^'^ xara Aoyo'&exonovXov. /« F"'-'/
xov foayvXov ä.idyoyiai nji' dX/JjXcov fitd fioro-

(oaxy^'

Sovxixüiv Xaßl^oiv xal öiaiff-ivexai 6 xtjdxyXog
-yxaooloig xa&" oXov x6 fxijxog xov avXov avxov.

fyxa

Elx. 145.—'KvciTioxo/..iixoyovoiyyicv e^aioruxov
fisyti^'ovg fui' FkXettff(og oXox/./'joov t//c ovgt)
^pag xai xov nQoni^lov xo'/.mxov ioLX''>lif^to^.
Eyyfloyrii^ y-ntd Aoyo-O'exdjxovXov. '/'«> a.io-
axinOkv 7i()6n\}ioy %ti'f-oi xov inait'iXov xa/.v.xxei
6//txX)joov xo avngaqph avgiyyiov füXQ'- ")? ovot]-
&gag xal ovQoänieiai exnxfgwi^fv noog xa xgav-
fiaxixn ;tf«7//"ror' xoXeov. Tu xoav/iaxixct ;r/-/Af;
TO? d.tio&iov xQaxr]Xixov XFiXovg nvgodnxovxai
öiä fi£fAOVO)uevo}V ga(pa)V.

•H dQXixü)? ftid xüi^ettIqo? ftiaTiiQOvnFVTi ftiaßaTi] TFXvrjTri ovQM^Qa ftTroxTa ^lETa 017.1
^axQov xoövov FÄFv8v(Tiv fE ^niHX'wv ttI? xugtfo; (Latzko) xal ^FTaöXTl^aT(•CETal oiTO^
jtQaY^AaTixo)g et? ovQriOQav. 'Q? ^A^'Vxov v^oOfh« 5vvdiXEfta vd XQrioiH07ioiiiöO)^tv tov m'O-
jxeva ri tov TQaxriXov xr\Q n^Tpa^ ti YQan^^o^TOv nvv (ßoXßo - fi laxio • aTiQaYY«')?^^!. tov? dvF>-
xTfiga? 11 TOV? JiVQa^iOEifiEi? \xrq) oÜtive? :rooaoxFvdCovTai xal ovQQa.TTOVTai 8id gan^iaTCov
xdTCO xn? VEo8nuiovQYnf>Eiöri? ovQriOQa?. KaTu to jiAfTotov xä iroca{>ia x^ymixa cov ßoXßov
xal löXto - oriQayyiohovq xal t(ov oxfX(1^v t^ov dvEXxTnQOW v^pfoTavTai FXdTTO)öiv tti? eXaoTi-
xoTTiTO? avTd)v FVFxa of'XcoSmv dXXoio^OFCov, fi 8e djtoaTaoi? avTwv avEdvei FVExa (VaaTdoFCü?
Tn? fißixri? avn(pi'(TE(0?. i^ti? TtapaTTipFiTai (tvvti{)eötfqov IjtI 8voX£Q(nv toxftcov oi'tco?.^ ojöte
övVEVOöi? avTwv xaTd tt|V ueötiv yQcmir]v Flvai ftvvaTT) ^lovov iiETd toxvQdv Taa.v. To ajro-
teXEöna Elvai djiOTVXia ttj? jiXaaTixfjg FVFxa 8iaT0^fi? T(0v iotäv v:i6 t(T)V Qa[i\idxiov ^ vf-
XQCooei? Twv dvainixcöv toiovtcüv.
K. Aoyo^€X07iovXov, VvvaiHoXoyixi] Xscgovgyixrj

114

'H .^ooiaOeioa vjio tov A. Franz ^ei*>o8og ific XQy\oi\xonoir\GZ(a<; xwv dvEXxTT^pcov,
xaO' r\y .^aQüoxEvdCovTal hvo öeoniöe; nvö?, o)v la ojiiödia nzQaxa ouvevovviai vno Tr)v ot>-
pi'lOpav. -lo^EXEi xaXXiTtga d.-iOTt/io^aTa. *0 Martius xaiaXeiJiei xovq JiapaöxevaodevTag \iv<;
öi»VTiv(Ofi£vov; ^£Trt;v' tü)v xal övpQciÄTei tov'tov; xard it]v jieöT)V yQ(i\Ji\jix\\ (vjio ttjv otjpr)-
dpav). 'QoavTCog 6 Martius xQT]ainoj[oi£i eV^ioxov xcjimvov h. Unovq xal pivog oong jreoi-
XanßdvEi Tov ßoXßoöTiQaYYO)8Ti, ovtivo? f] ßdöi; evexa tüjv TQO(po(p6QO)v dyYeiwv xal vevpcüv
8eov vct öiairiQTiTai.

'O xQimvog ovTo; TO.ToOeiFiTai liioX TOV ai'Xfva rrjg xuoiewg xal aTFpEOVTai xard t6
dvTii^fTOv jiXdYiov avTOv. 'F]|eTeXeöa iriv faeOoÖov tauTiiv jier'aQiaTOv djiOTeXeojiaTog elg evqvj
avQiYYiov nEtd reXEiag eXXEitj^Eajg Trjg org/jöpac.

ecp-nonoadi) vji' l\iOv dTiOTEXEG^aTixo); ÄoXXdxig. MfiovExirma tfig ueöoÖov tavTTjg slvai fi

EÄEQXOpiEVT) EVIOTE VEXQCOOig TWV XQTmvd)V, OlTlVEg hk\ TQECpOViai JldvrOTE dQXOUVTCOg.

.|ii^ r.vAiiA lu viAciuiwv .ujAu uuoxuAiwg ^tiuxivtiiui. uvTog ü^o^c xaiJiGTarai evxqtiöüoc uet
djiOTEXfa^aTog xard tov vk k\iov vKohnixihia xaTCOTEQO) J[FoiYQa(püfAEVOv tqojiov Eig jteqi-
jiTomEi; HEYdXt]; xaTaoTQOcpfig Trig ovo/n^oag xal toO äqogOiov xoXjtixov TOixco^aTOg, xad' dg
dvaYxa^onEOa vd dva^iiTriGW^Ev löTOvg .Toog -lAaöTixr'iv.

'O 'AvT0)v6.'üOvXog dvEXOlVWGEV Eig t6 SV'VEÖQIOV TO)V XElQOlfQYÄV TWY naQlölO)V TOO

1932 xal Trjv ^lEdoöcv TavTTiv.

METd TTiv ovoQa(pr]v TOV GvoiYYiov Tilg xvoTEcog xal ttjv ÖTmiovpYiav TEXVT|Tfig o{.g/i-
^pag ex xov :iEpißdXXovTog igtov. eXxETai 6 TpdxriXog ;rp6g Ta xaTCO 8id 2 dYxiGTpü)T(ov Xaßi-
6(ov xal öiaTE^vETai EYxapGicog. 'Ex T^g :iooGÖiag EirupavE.'ag tov ;tpoGdiov xeiXovg dcpaipEi-
Tai o ßXEVOYOvog 8id tov naxaipiov xal ii vEaoo.TOinOElGa ovto) EiricpdvEia .TpoötjXovrai 8id
Ttv(ov pacpo^v öta^repcojxEvcov 8td to.v ;rXaYi'o)v xeiAEcov T^g Tpav^aTtx^g l;rt(pavEiag E;rl Tric
VEo5r),mvoYriOEtG,g ovp.Opag. A! E.tcpdvEcat ex Tng ötaTO^ng lov xpaxnXov Gx,pptxvovvTat
öia rng öia.TEpaio)GEO)g ^coixo.v oan^dTcov cog ejtI Tr^g :rXaGrixfig Kaxd Pozzi (dx 67-69) 'O
x«{>.XxvG^o, TOV 5txaG.^EVT0g TpaxnXov E.uvYxdvETat EVxrpcLg. hG, f, ^^rpa .apaMEV^t Elg
TTiv apxiXTiv avTfig öegiv (elx. 242—147). * ' »* « v y Mtvti tig

18. Tä opOoKoAniKä ouplyyia.

ra. E'. vtxojlVJtL^^^ " X--OXOX,,,, ,,,,,^,,^ ,, opOoxoX.txd ro.avr« 8ev öcpE^ov-

Oov. 'H ^..tovpYfa TO^pav.aT.G, r tIov Ö^EZrX '^^''

:tixov öiarpodYMaTog xal Iv tfL .Ir r t '^, '!"^ ''^ ^^^ i'/iepöidraGiv tov opdoxoX-

ßooov, a.:;oi' ;ov^.T lg T V d '\i^^ T' ^!^^' "^^^ '^^'^^ ^^^ '^^^«^^^ -^ ^^■
v(a>g .apaT,po4v ^0«;«::;^^ n^zfir^ ^"^"^r^^ ^^^^^^-^- ^^^ -«-

vaTEoexTo,nv, ^et' o.tG^^av xoX.oto2 xa " 7 '"" "^""^^ ^ '^"^^^«^^^ ^^^^^

X.V6VV6TEP0V EVExa T,g Xo...,..g C pYo ^^^^^^^^^ ^ ^^ ^-^-^^ov dXX' e. I.-

XiG^ov fi T9av^aTlG^ov ex GvvovGiac tH ^ " "^''^^^ " ^^^^«^' '^«^«^^v 6ßE-

ovvovGtag. la GvptYYta Ta 8,^tovpY,ÖEVTa eh toxetov l&pdSovTat

115

xatd TO jiXeIotov Etg t6 hegov y\ xaTd)Ttpov xpfTOv tov xohov, evaj xa n^TEYX^ipriTixd Enq)a-
vi^ovTai xvpicog Eig t6 dvwTepov TpiTTipiopiov.

"EvExa Tfjg piEYiöTtig TdGewg tü)v öp{)oxoXjnxd)v GvpiYY*wv ^pog avT6^iaT0v Taoiv, Seov
vd \XY\ Tcpoßaivopiev etg Ti]v EYXfiQilöiv d}i£Ga)g, dXXd vd dq)i')Vü)HfV vd jraptXi^n öidoTiipia
dpxETwv nr|Vd)v, xa{>'o öidoTTina eq)ao!ioCojAev ovvTTipi]Tixd piEGa OepajiFiag. 'ExteXovuev xoX-
jtixovg ftiaxXvojxovg ^cTd iXaqppojv dvTioiiJiTixojv öiaXvnaTwv, piepinvojvTeg ftid Tdg xavovixdg
xEvaWeig Tfjg dppcoGTOv bC EiSixTig öiaiTTjg xal xöpTiY»'löEö)g EXaqppwv ojiioux*^^'^« xal tojtoOe-
TOvvTEg £v dvaYXfl GwXrjva tov eviepov :rp6g ftieuxoXvvGiv Tf^g q)vo loXoYixfig Egofiov t(ov ue-
püov. napFTTipriGapiEV ^ETd TTjv i>FpajiFiav TavTi^v avTOnaTOv laaiv GVpiYYi<'>v, d'Tiva TjGav
ftiaßaTd Eig 8vo ftaxTvXovg. 'Edv ouTca 6ev xuTaXr'ili] to gvqiyy^^v Elg TeXixi)v gvyxXfioiv, y]
ETiiTEVxi^Eiöa ofAixpvvöig avTOv f ivai evvoixfj ftid tt)v ejiaxoXovOovoav eyxeiQtiöiv. AvvdneOa
vd xeiQovpYdipiev piixod öpi^oxoXÄixd GupiYY^^ <^? xal td xvoTioxoXjiixd TOiavTa.

nEpiTEuvopiEV TO aTopiiov jiEpKpFpixcog xai djioxoXXcöuEV TO xoXäixov TOi'xcona £V HEpEl
d^ßXecog ev jiEpei 8e 8id TEpivovTog opYctvov diio tov TOixaVaTog tov evteqov fxe'xpi orineiov,
oSgte vd Eivai övvaTOV vd ovv£vo)i}(jl)oi td x^iXi] tov ovpiYYi^^ dvEi' TOGtog 8id nFM-ovcofiEvcov
Qa\x[idx(jdv r\ GVVEXOvg XEJiTf)g paqpfig, i]Tig öeov vd \ii] Oiyh tov ßXevoYOvov tov IvTepov.
"Av(0&i avcYJg GVYxXeieTai t6 xoXtiixov TOixcopia 8t' loxvpcuv (Aenova)nevü)v ^o)ixd)V pannaTcov-
*H ueT£YXEipi1"C'-x>] OEpajiEia ovvioTaTai elg t7]v Jiapaxd)XvGiv xr\q XEva)GEa)g nexpi JifpiJrov T^g
6T)g ^^AFpag 8i' dvaXoY^v SiaiTTjg xal x^QT1Yi^iocO)g h'xqcüv Sogecov Öä{ov, dxoXovdcog 8id 8iev-
xoXvvoECog TTig jipwTrig xevwGECog 8id x^O'OY^löEwg iGXvpov xaOapTixov xal 8id xXvG^aTog

£Xatovx*>i^'-

MEYaXvTEpa ovpiYYioi 8£0v vd ^lETaTpejKOVTai Elg TeXeiav pnHiv tov jiepiveov 8id Toiifjg-

TOV oXov IvTEpov xal Toij vjidpxovTog igtov (,iETa|v EVTepov xal GVpiYY^f)"^* H eyx^ 'Qil^i? evFpYEi
Tai xaTdTOv jiEpiYpaipEVTa dva)TEpa) Tpöjiov, Gvnq)tt)va)g Jipog tt^v n£0o86v jxov (ßX.elx. 44 — 48)
*H £^aGq)dXiGig Trig EVTEpixfig pacpfig 8id JCTVxrjg tov djiEvOvojiEvov e8a)X£v elg Vdg elg oXag
rdg JTepiÄTWGEig TeXeiav i'aGiv, cogte TtiGTEi^opiev oti 8\'vdnef>a vd :iapaiTT)\)(jL)nev änb jid^a^
Tdg dXXag piedoSovg. 0d f|8vvaT6 Tig vd Gxeqpdfj Tt]v xaT' e^aipEGiv £q)apnoYT]v Tfig ne068ov
TOV Segond, i^v ^n^Ig jrpoTEpov ovxvd f|tT£Xov|X£v elg EXTETapievag xaTaGTQoq)dg tov djievOv-
onevov. MeTd tyjv 8iaT0nriv tov G^piYXTripog 8laT£^ivo|A£V tu djiEvOvGpiEVOv jiEpicpEpixwg dva)
Tng xaTEGTpaiinevrig Xmqgl^, xivriTOJioieiTai xal nerd ttjv ucpaipeGiv tov jieoKpfpixoi» x\ir\\xa-
Tog TOV djiEvdvGpiEVOv, E^eXxETai 8id iifgov tov GcpiYXTnpog xal GTFpFOJtoiEiTai 8id pacpöjv JTFpi-
q)EpiX(I)g xaTd tov SaxTvXiov. Iloog ejcitev^iv xaXov djiOTeXEGnaTog ÄQOVJioOEGig elvai l'va f\
pacpT) avTTjYiVETai d'vEV Tivog TaGewg tcov iötojv. ^vpiYYi« xeiuEva jioXv jrpog Td dv(o 8vvavTai
vd xaTaoTOvv jipoaiTd 8id Tng TO^fig Schuchardt. XEipovpYOvpiev TavTa ü)g xal Td xvanoxoX-
jiixd GvpiYYia- "Ana (bg T^ifina rov TOixwpiaTog tov evTepov 8id jiepKpEpixfig Tonfjg xal d;io-
xoXXrioECog :tapaGX£vaG\>fi, tojtoOetovuev d^iEGog ttiv jrptoTTiv pacpriv, x.o.x. Td pd^i^iaTO 8ia-
TTipovjAEva ^axpd xptigi^evovv wg piEGa EX^ecog xal xaOiGTOVv jtepiTTd Td epYaXeia, aTiva
:i£piopi^ovv TOV XibQOv. AljxopQaYia xaTd ßdf^og, riTig 8vGXepd)g eniGXETai, jrapaxo)XveTat
8id Tfig alnooTaTixng 8pdGea)g twv nenovco^evwv pacpwv, auivEg 8£V GvXXaMßdvovv TOixw^ia
TOV evTEpov.

f I

nEPIEX0M6NÄ

TENIKON MEPOI

i, Meoa npoq aip6oTaoiv 2eX. 9

2. Ai^ooTOTiKi^ |jcdo5oq «ciq ncpinruaciq ävaYKriq» Karoi AoyodtTÖirouAov • 13

Ai^ioöTttoig \iexä xov toxeiov c'k; Tiegi-^ttooei? uxovia«; tTj^ [ir\XQd(; \texui xi]\ exßoXf^v

xoö jiXaxoövtoi^, xaxd AoYOÖ-ETTÖÜioü^wOv '. . . . » . 19

3. AanipOTOMn ............'.'>' 21

a) TonioO-EXTiöi? xf\q uqqmoxov ................. » 21

ß) MeoT) xOjAT) > 22

y) 'YjiEQTißixfi EvxttQoia xo\i)] xaxd Pfannensfeld » 24

6) PatjpT] xdiv xoiXiaxdiv xoixcofxdxrov » 24

e) AiEuxoXuvöi? xf]g E|aiyeöEa)g xf)«; oxcDXrjXOEiSou^ djioqJuoEO)? Erti piEöiiq xol eyxay-

aiaq xojxfic, xaxu AoyoO'EXÖJXOuXov . . . ... * 27

T) * Anox.ä\v\^iq xov eyyeiQ^xiKov jxeÖiou 8id rt(o^axiö^.oü xwv £vxE^)iX(Jöv fXixwv

xaxd AoYOÖ-EXcmouXov » 28

^) ÜEyixovaioniXaoxiX)] xai kolq^x^isvök; xi\q xoiXiaxfjc; xoiX6xr\xoq » 29

4. KoXniKai eyxcipnocK» • * 29

a) n()OÖ^ia xoXrxoxoiXioxofiT) » 33

ß) 'OjtioO'ia xoX7t:oxoiXioxop,i| '. . » 33

EIAIKON MEPOI

I. XeipoupYiKh öcpaneia röv ävüpaAüv Ococüy Tfiq piiTpaq.
A' 'OTtiaSia kXIoic; Kai Kd|i4;iq ttjc; ^f|Tpaq.

1. Zrcpeuoiq tüv arpo^^iükuv ouv5eo|juv

a) 'EYxeiO^loi«; xaxd Alexander— Adams . . .

ß) 'EyxeiQTi]aiq xaxd Olshaiisen

Y) 'EyxeiQIIö''? xaxd Doleris

8) 'EYxe^ö^löi? xaxd Webster, Baldy

2. KoiAioKfi KUOTionn^ia

3. BpoxuvoK; töv orpoyYuAuv ouvöcopuv pcTCi rauroxpovou KUOTionq^ioq

cni Tnq \ir\Tpaq kqtci AoyodcTonouAov

4. "A^itaoq OTCpcuoiq rn; pnTpaq cni tüv koiAioküv ToixupäTWV ....

B' XaXdpcoaic; Kai irpÖTtTCoaiq tou koXeou.

1. npoodia KoAnoppCi(pf|

2. 'Oniodia KoAnoppacpn kqi nepiveonXaoriKri

3. 'Evxcipnoi^ Tnq noAaiäq oAiKnq pi^^cuq tou ncpivcou

V ntcoaic; Kai itpÖTtTcoaic; Tfjq iifixpaq.

riapevdcoiq Tqq \»i\Tpaq pcra^u KUOTCoq Koi koAcoö
'Ynonud|jcviKf| uoicpcKTopfi Karä AoyOdcTonouAov

II. 'EYX^ipnoci? KQTä Tö a(5oTov.

1. 'EKTopn TOU BapdoAivciou äScvoq

2. KapKivuija toü aiSoiou . . .

hl. KoXniKai 'Eyxcipnoeiq em iriq pnipaq.

1. 'Ano^coi«; Ti\q PHTpaq

'EjimXoxai xaxd xriv d;i6^£oiv

118

2. 'Eyxc'pnoK naAaiöv p^^cuv toö Tpax^^oü . . . . ^ • • • • • •

5. AiQTopJi TOü rpax^Aou Korä Porzi J a ' x I

4. XqM|voei«*iq intou^ Tu^paToq Ti|«; n^rpaf; narä AoYoa«T6noüAoY ...»

5. 'YnonüdMCViKfi Iktom^ th«; m^tP««; •'«to AovodcTÖnouAoY »

6. KoAniKfi 6AiKn üotcpcktom^

a) KoXnixn 6Xixn voteeExxonTi jiEta Siaxojifig lov ngoö^Xou xoixfofiaios xti? ^ntcas

ß) KoXnixn 6kxT, {»öiEQOxio^n ^eid biaxoiinq xov nQoa^iov xal bma^iov ioixo)|ia-

xo? xfig ^r'ixga?

7. KoAiiiKal iYXCipnoci^ inl iiuumcitoSous M^Tpa^

a) Miöxwxöv unioß/levoYovtov ftucopia

ß) KoXnixq ixnuQr\viaiq ^uw^axcoSoug oyxou

y) KoXjiixti uoxeyFXXonT) im ^uwpiaxwSoug ^»1^0«? * *

8. iupcia KoAnwi^ uoTcpcitTOiiii *nl kopkivomoto«; toü rpax^Aow tik M^rpoq »

9. KoiAioKai ^yXCipHOCiq cni T^q lihrpaq *

a) Miöxcoxov vKOQQoyoviov piuco^a

ß) 'ExjiuQTJvioig lAucojidxcov

V) 'H djio XY\q xoiXiaq öcptivoeiÖT]? exxojiTi xfjg nnxüa? KOTCI AOYOdCTÖnOüAoV

8) 'YnegxoXrtixn voxevjexxonri

e) KoiXiaxT] oXixt] voxeoexxonn

10. 'AoOqKCKTOM'Jk

a) KoiXiaxT) wo^iixexxofATi * •

ß) KoXjiixt] (boO-TixexxonTi

11. ♦AcYMOvuSciq nadnociq Töv t^apTiiliATOv »

tt) KoiXiaxn eyx^iimaiq xwv cpA,eYHOVoD8wv o^x^v xwv e|agxTijidx(Dv »

ß) KoXnixf) ey/ieiQy\aiq xwv (pXevuovcoÖwv ;ia^öe(ov xwv llaexr^axcov, xaxd AoYO-

dcT6nouAov *

12. 'E(u|inTpioq Kuq9i; *

13. XcipoupYiKfi dcpaneia rnq napapHTP*"*«^ *

Be^janeia xf\g XQovta? jtaQafinxQixiSog 8id ngoxXnoeto? xexviixoö djiGoxT^axo? xaxd

AoYodcT6nouAov *

14. Aa«TuAioci5rjq OTCVuoiq tou KoAtoO ^

15. 'OAiKJ^ äTpqoJa toü koAcou *

16. Ai||jioupYia tcx^htou koAcoö *

17. KtfOTiOKoAniKä oupi'Yyia *

18. 'OpdoKoAniKä oupiyYia. 'EYXCVnoiS koto AoYodcTÖnowAor »

56
58
58
59
53
62

63
64
64
64
66
69
70
70
73
73
75
77
84
86
88
90
91

94
97
99

100
104
104
104
105
110

Gase S. K., 48 years old, gravida v, para iv; craniotomy; and an angioma of the
skull removed six months ago. Became pregnant, last period occurring on Dec. 20,
1937; an x-ray abortion was performed. p]ntered hospital bleeding profusely. Uterus
the size of a three and one-half months' gestation and contained a number of sub-
serous fibroids; cervix patulous; adnexa not palpable. Bleeding continued despite
oxytocics, and a dilatation and curettage were performed. This revealed a sub-
mucous fibroid on the right posterolateral wall of the uterus, confirmed by a clinical
hysterogram, hippuran and CO^, Fig. 5, B.

Gase P. B., 25 years old, single, gravida 0, para 0; menorrhagia for the past eight
to nine months, flow increased from five to six to twelve to thirteen days. Uterus
the size of a three months' gestation, smooth in contour, mobile; cervix firm, closed;
adnexa negative. Clinical hysterogram (hippuran and GO,) showed the presence ot
a submueous mvoma (Fig. (), B). Myoniectomy was performed; one large fibroid re-
moved from tlie left uterine wall. The postoperative injection of hippuran and
CO showed a return to the triangulär form of the uterine cavity (Fig. 6, D).

Gase C. S., 43 years old, married 9 years, gravida 0, para 0; menses normal until
one year ago; since then has had menorrhagia and dysmenorrhea ; flow eight to
ten days with raany dots. Uterus enlarged to size of a seven to eight weeks' gesta-
tion and slightly irregulär; cervix softened and external os slightly dilated; adnexa
negative. The lower pole of the intrauterine tumor was just palpable to finger
tip. Glinical hysterogram not necessary but done for purposes of demonstration and
contrast (Fig. 8, B). Vaginal hysterotomy and removal of a submueous fibroid the
size of a large plum (Fig. 7, C).

Gase M. E., 44 years old, gravida vi, para v; menorrhagia of one year 's duration.
Uterus enlarged to the size of an eight weeks' gestation due to a number of small
myomas in the right uterine wall. Gurettage: uterine cavity symmetrical showing
no submueous tumors. Glinical hysterogram, hippuran and G0„ showed moderately
dilated triangulär uterine cavity, no submueous myoma.

Gase T. B., 49 years old, gravida ii, para ii; menorrhagia lor past year. Blood
pressure 200/100. Pelvic examination: cervix hypertrophied ; uterus enlarged to the
size of a two to two and one-half months' gestation; adnexa not palpable. Clinical
hysterogram, hippuran and CO,, showed the uterine cavity dilated but not encroaehed
upon by any tumor (Figs. 10, A and B). Gurettage and radium, 1,500 mc. hours.
Gase F. W., 29 years old, single, nulligravida ; profuse regulär periods ; increasing
size of abdomen and metrorrhagia of three weeks' duration on two occasions. Uterus
found enlarged to the size of five months' gestation, firm and tender. Clinical
hysterogram, hippuran and CO,, showed a markedly dilated, irregulär uterine cavity
on one side suggestive of a submueous myoma (Fig. 10, B) which was defimtely
proved after the injection of GO.. (Fig. 10, C). A single large fibroid was removed
without entering the endometrial cavity although the fibroid encroaehed upon the
entire left side of the cavity. A hysterogram with hippuran and GO, after the Opera-
tion showed the endometrial cavity of triangulär configuration (Fig. 10, D) and
after CO, injection (Fig. 10, iJ).

SUMMARY

The presence of submueous myomas can be diagnosticated roentgeno-
logically by the intrauterine injection of hippuran followed by CO2.
Neither by itself is adequate for this purpose. The hippuran is used
in concentrations of 80 to 100 per cent wliich, when expelled from the
uterine cavity, leaves a crystalline deposit on the uterine mucosa and the
mucosa covering the submueous tumor. The injection of CO2 serves as
a transparent contrast to the densely opaciue hippuran outline. Both
media are innocuous, each being well tolerated by the organism. There
are no irritation and no residue or foreign body reaction. In selected
cases where recognition of submueous myoma is important from the
viewpoint of the choice of therapy, this method appears to be serviceable.

X-RAY DEIMONSTRATION OF

SUBMUCOUS IVn^OMAS BY

COMBINED USE OF HIPPURAN

AND CO2 INJECTION

I. G. RUBIN, M.D., F.A.G.S.

New York, N. Y.

From the Gynecological Service and the X-Ray
Department of Mount Sinai Hospital

Reprinted from

AMERICAN JOURNAL

OBSTETRICS AND GYNECOLOGY

St. Louis

Vol. 37, No. 1, Pages 75-85, January, 1939
(Printed in the U, S. A.)

;

X-RAY DEMONSTRATION OF SUBMUCOUS MYOMAS BY
COMBINED USE OF HIPPURAN AND CO2 INJECTION*

I. C. Rubin, M.D, F.A.C.S., New York, N. Y.

(From the Gynecological Service and the X-ray Department of Mount Sinai Hospital)

INTRAUTERINE injection of radio-opaque solutions for the specific
purpose of demonstrating submucous myomas began with coUargol
in 1914. t Since then other forms of colloidal silver and halogen salts
have been employed. These have eventually been supplanted by iodized
oils and at present lipiodol is most commonly preferred.

Two techniques are in vogue. One is the fractional and the other
the evacuation method. The first consists of introducing 2 c.e. of lipiodol
and making the x-ray exposure. This is followed by 4 or 5 successive
films each after 4, 6, 8, and 10 c.c. have been introduced into the uterine
cavity. The second method consists of filming the filled uterus at its
maximum capacity and again as soon as the lipiodol has been evacuated.

Each of these methods gives telltale pictures in a certain percentage
of cases, visualizing submucous myomas and other growths which pro-
trude into the uterine cavity. Both have the disadvantage of allowing
the oil to pass through the Fallopian tubes and of entering the peritoneal
cavity. This drawback may to a certain extent be avoided by Controlling
the injection with the fluoroscope. The injection is discontinued the
moment the uterine cavity is seen to be filled or the oil is seen entering
the tubes. The fractional method necessitates multiple exposures which
must be considered in relation to the examiner and the patient.

I have sought to avoid the escape into the peritoneal cavity by in-
troducing into the uterus a thin rubber balloon ( Condom or Penrose
tubing), coated with lipiodol on its outer and inner surfaces. Air
injected into the balloon served as contrast. Unfortunately the inflated
balloon does not adapt itself to the configuration of the uterine cavity,
being limited largely by its molded form. Another device which I
tried was to introduce a gelatin capsule containing ether after the
lipiodol was evacuated, the expanding ether vapor liberated from the
dissolved capsule serving to distend the uterine cavity. Neither of these
methods has been found satisfactory. The introduction of a foreign
body in addition to the lipiodol is not practical, occasioning, as it does,
added trauma. Although the diagnosis of submucous myomas is impor-
tant in selected cases, the method employed must be considered in rela-
tion to its safety, feasibility and simplicity.

•These illustrations were demonstrated at the scientific exhibit at the meeting of
the American Gynecological Society, at Asheville, N. C, May 30, 1938.

In this work I had the valuable assistance of my Resident, Dr. Arthur H. Davids,
who made the routine injections.

tRöntgendiagnostik der Uterustumoren mit Hilfe von intrauterinen CoUargolinjek-
tionen, Zentralbl. f. Gynäk., No. 18, 1914.

These conditions appear to be met by adopting the group of organic
iodides such as uroselectan, skiodan, diodrast and hippuran, which have
been utilized in excretory urography. They have the virtue of rapid
absorption. They are nonirritant and are well tolerated by the blood
stream. Their elimination by the kidneys is rapid and unaccompanied
or followed by harmful lesions.

For intrauterine use the amount of the organic iodide employed is
not enough as a rule to visualize the urinary tract. The Solution may,
however, when the Fallopian tubes are freely patent entcr the peri-
toneal cavity from which it is rapidly resorbed and soon appears in
the kidney pelves, Ureters, and bladder. As this occurs well after the
uterographs have been obtained, they öfter no eonfusion.

Of the substances mentioned, hippuran has so far been used for our
present purposes although it is quite ])ossible that the others may yield
equally good results. It is available in crystalline i)owder and can
be made up into 100 per cent Solution, in which State it can be kept at
a moderately warm temperature. When cooled it crystallizes, requiring
heating before the injection. In this Saturation it remains a clear Solu-
tion for a half hour or somewhat longer. Wcakcr solutions were first
used and although shadowgraphs were obtained tliey were not as satis-
factory as the 100 per cent Solution (1 gm. of hippuran to 1 c.e. of dis-
tilled water).

The hippuran is introduced into the uterine cavity by moans of a
20 c.c. syringe and uterine cannula, both of which are kept warm. An
x-ray exposure is made at the point when the uterine cavity is filled.
As a rule, from 5 to 10 or 15 c.c. are needed in fibromyomatous uteri
under pressures varying between 40 mm. Hg and 150 mm. Hg.

After the x-ray exposure is made the hipi)uran is witlidrawn into
the syringe and the cannula is removed. It is well to allow two or
three minutes for the uterus to empty itself. The Solution is aspirated
and whatever amount remains is expelled. Another syringe filled with
20 c.c. CO2 is now attached to a clean cannula, 1 or 2 c.c. being dis-
charged into sterile fluid in order to displace the air contained in the
uterine cannula. The cannula is introduced into the uterine cavity and
the CO2 is injected until a sense of resistance is reached which is similar
to that experienced during the injection of hippuran. At this point
an x-ray exposure is made. (A bullet forceps grasps the anterior cervix
lip and the cannula is introduced so tliat its tip is just above the internal
OS, the rubber or metal acorn engaging the external os to prevent re-
gurgitation. )

A manometer, indispensable when lipiodol is used, is not required
with hippuran. I have first insufflated the uterus with CO2 in order
to determine the initial pressure rise necessary to force the CO2 through
the uterotubal junction, using this pressure as a guide in injecting the
Solution. The latter was also injected by the graduated force of the
CO2 delivered from an insufflation apparatus both for the practical con-
trol of the pressure as well as to observe differences in pressure between

the fluid and CO^. In tliis iiianeiiver il is onl.v necessary to hold tlie
graduated ^Iühh tiibe containing- the radio-opaciue lluid above the level
of the body.

It was found that the pressures reached by the aciueous Solutions ex-
ceeded to some extent tliose reached by the ('Oa. These were not as
great as when lipiodol was used. Hence the manometer was found dis-
pensable and in the last injeetions we have resorted to manual injection
of hippuran depending ui)on tlie filling Sensation imparted to the band.

RESULTS

The liippuran shadovv by itself may not present the slightest indication of an
intrauterine tumor. This may be seen in Fig. Ij A, Case E. C, where the hippuran
hysterogram of the specinien showed an irregulär cavity, the outline of submueous
myonuis definitely appearing in the hysterogram following the intrauterine injection
of CO, (Fig. 1,'li).

In Fig. 2, A, Case B. H., a single submueous myoma was not diagnosable by the
hippuran hysterogram. It was beautifully outlined in the CO, contrast film (Fig.
2, B).

The same negative finding was secn in Fig. 3, A, Case M. M., where neither in
the clinical hysterogram, by using hippuran 100 per cent nor in the specimen was a
diagnosis possible of a submueous myoma (Fig. 3, B). The outline of the submueous
tumor showed up definitely in the clinical hysterogram after CO, (Fig. 3, B), and
it was also demonstrable in the specimen by the aid of CO, (Fig. 3, D).

Fig. 4, A, Case I. G., presents an irregulär sliadow with the hippuran, whereas
the contrast aflforded by CO, shows definite Protrusion into the uterine cavity (Fig.
4, B). Uterus opened up showing the submueous myoma, C.

Fig. 5, A, Case S. K., shows no special deviation froni the normal triangulär
shape of the uterine cavity by hippuran, whereas the submueous nature of the tumor
is shown in the hysterogram with CO, (Fig. 5, B).

When a crescentic shadow is obtained by the hippuran alone, it is strongly pre-
sumptive evidence of a submueous myoma (Fig. (5, A). In such cases the contrast

Fig. 2. — Case B. H. A, Hysterogram with hippuran 100 per cent Solution nhows a
dilated uterine cavity but no niarked sugscstion of the presence of a submueous
myoma. B. Hysteroaerograni v^ith CO- injected after hippuran shows a solitary sub-
mueous flbroid which may be seen in Fig. 2, C. C, Uterus cut open showing a solitary
subnmeous flbroid visualized in Fig. 2, B.

given by the CO, hysterogram is particularly striking, as can be seen in Fig. C, B^
Gase P. B. In this case the submueous myoma was removed by abdominal
myomectomy after which the hysterogram, Fig. 6, C, showed the return to the
more or less triangulär configuration of the uterine cavity (Fig. G, E) and is
prettily demonstrated in the CO, hysterogram, Fig. 6, E. Another Illustration
of the return to the triangulär shape of the uterine cavity after a myomectomy
is seen in Figs. 10, A, 10, B, 10, C, and 10, 2> (Case F. W.)/

Fig. 7, A, Case C. S., illustrates a submueous myoma in the process of being ex-
truded. The hysterogram with hippuran is not characteristic whereas the CO, hystero-
gram shows the lower pole of the tumor protruding into the cavity of the uterus
near the internal os.

Fig. 4. — Gase I. G. A, Clinical hysterogram with hippuran 100 per cent Solution
shows an irregulär shadow not particularly diagnostic of a submucous flbroid. B,
Clinical hysteroaerogram with CO2 injected after hippuran shows the submucous flbroid
projecting into the uterine cavity as seen in the specimen (Fig. 4, C). C, Uterus cut
open showing the solitary submucous flbroid.

Fig. 3.— Gase M. M. A, Clinical hyterogram with hippuran 100 per cent Solution
shows a dilated cavity without any deflnite indication of a submucous flbroid. B,
Clinical hysteroaerogram with GO2 injected after hippuran shows the uterine cavity
to be deflnitely encroached upon by a submucous myoma. C, Hysterogram of extir-
pated Uterus with hippuran 100 per cent Solution ; no indication of a submucous flbroid.
D, Hysteroaerogram of extirpated Uterus with CO2 after hippuran shows the solitary
submucous flbroid practically as it appears in Fig. 3, E. E, Uterus cut open shows
the submucous flbroid visualized in hysteroaerogram, Fig. 3, D.

Fig. 5.— Gase S. K. A, Clinical hysterogram with hippuran 100 per cent Solution
shows a dilated triangulär uterine cavity; no Suggestion of a submucous flbroid.
B, Clinical hysteroaerogram with CO2 injection after hippuran shows the submucous
flbroid.

When no submucous iiiyoma is present despite the inultiplicity of the tumors,
the uterine cavity may be typically triangulär as in Fig. 8, A and B, Gase M. E.,
where the cavity is only moderately dilated; or Fig. 9, Ä and B, Case T. B., where
the cavity is very markedly dilated without any protrusion into it of any of the
fibroids. The CO^ x-ray eontrast film, hovvever, demonstrates this characteristically
as may be seen in Figs. 9, B and 10, B. Solutions in the strengths employed for
intravenous or retrograde urography are not quite strong enough to leave a deposit

Fig. 6. — Case P. B. A, Clinical hysterogram w^ith hippuran 100 per cent Solution
Shows a dilated crescentic uterine cavity suggestive of submucous niyoma. The tubes
have been entered by the hippuran. B, Clinical hysteroaerogram with CO2 injeetion
after hippuran shows the submucous nature of the tumor. The tubes are still seen
to be fllled. C, After myomectomy. Clinical hysterogram using hippuran 100 per cent
Solution showing a triangulär uterine cavity. D, After myomectomy. Clinical
hysteroaerogram after CO2 injeetion shows a triangulär uterine cavity; no Pro-
trusion into it.

upon the uterine mucosa to serve as eontrast with COj. We found that strengths of
80 per cent and upward gave better results. CO^ is preferable to air because it avoids
all possibility of embolism, being absorbed by an equal quantity of blood, wliile air
and its other components, oxygen and nitrogen, are relatively insoluble.

The indications for the use of x-ray and radio-opaciue media and CO2
for the demonstration of submucous myoma may be brieliy given :

1. When it is important to avoid a laparotomy for fibroids as in the
case of obese individuals and in systemic disease, in which circumstances
x-ray and radium therapy are usually preferred. If a submucous myoma
is positivcly knovvn to be present, surgical removal is indicated despite
the increased risk to the otherwise handicapped patient.

2. When considering myomectomy in younger individuals who are
sterile and desire children, or when menstruation is to be conserved.

Fig 7._Case CS. A, Clinicnl hysterogram with li ppuran 1(K) per cent Solution
showing an irregulär cavity without characteristic signs. B, Clinical hysteroaerogram
with CO2 injected after hippuran showing the submucous character of the tumor.
C, Extirpated uterus cut open showing the submucous niyoma.

the knowledge of the presence of a submucous myoma will enablc the
surgeon to deal adequately with the coiidition, adopting suitable vaginal
or laparotomy technique, or a combination of the two.

The cases in whicli hippuran and CO2 werc employed are the follow-
ing:

Case E. C, 52 years old, gravida ii, para ii; menorrhagia for two years, flow
increasing from three- to an eight-day flow with clots. Uterus enlarged to the size of
a four months' gestation. Hysterectomy and bilateral salpingo-oophorectoray.
Specimen injected with hippuran and COj showed multiple submucous fibroids (Figs.
1, A and 1, B).

Gase B. H., 42 years old, gravida ii, para ii; coraplained of menorrhagia of one
year's duration and severe dysmenorrhea, periods lasting six to seven days instead
of three to four. Uterus enlarged to size of a two and one-half months' gestation;
cervix normal; adnexa not palpable. Hysterectomy. Specimen revealed by hippuran
and COj a Single plum-sized submucous fibroid on a sessile pedicle (Fig. 2, C).

Gase M. M., 47 years old, gravida iii, para iii; menorrhagia and dysmenorrhea for
the past four to five months, periods increased from four to eight days, the flow being

Fig. 8. — Case M. E, A, Clinical hysterogram with hippuran 100 per cent Solution
showing a somewhat dilated cavity with no Suggestion of submucous myoma. B,
Clinical hysteroaerogram after CO2 injection shows a triangulär cavity with no en-
croachment.

Fig. 9. — Case T. B. A, Clinical hysterogram with hippuran 100 per cent Solution
showing a widely dilated irregulär uterine cavity. B, Clinical hysteroaerogram with
CO2 injected after hippuran showing no encroachment upon the uterine cavity.

profuse. Uterus enlarged to the size of a ten to eleven weeks' gestation; adnexa
not palpable; cervix normal. Clinical hysterogram, hippuran and COj, showed a
submucous myoma. Hysterectomy and bilateral salpingo-oophorectomy. Specimen
showed a uterus enlarged to a three months' pregnancy, containing one large sub-
mucous fibroid and a few intramural fibroids (Fig. 3, D).

Case I. G., 43 years old, gravida ii, para ii; for past six months severe menstrual
bleeding with passage of clots. Uterus uniformly enlarged to the size of a three

months' gestation. Clinical hysterogram, hippuran and CO^, showed the presence of
a large submucous myoma, Fig. 4, B (specimen), which was confirmed by the opened
specimen.

Fig. 10. — Case F. W. A, Fiat plate showing faint outline of enlarged uterus In
relation to pelvis. B, Clinical hysterogram with hippuran 100 per cent Solution show-
ing a widely dilated irregulär uterine cavity without any deflnite sign of submucous
encroachment. C. Clinical hysteroaerogram with CO2 injected after hippuran show-
ing the submucous character of the fibroid. D, After myomectomy. Clinical hystero-
gram with hippuran 100 per cent Solution showing widely dilated uterine cavity of
triangulär shape. E, After myomectomy. Clinical hysteroaerogram with CO2 in-
jected after hippuran showing a widely dilated uterine cavity; no submucous en-
croachment

\' \(Fort8et2ung au^ Seite lO^l --^"

•'d2^?!}?^ff?£-^52*r2'?f ^5?-55^ g^^^'^cÄer Blutuhg^ nach

^/ne der ^^^ jetzt noch nicht gam gelösten Fragen in der Geburtshilfe
ist die Bekämpfung der atonischen Blutung nach der Geburt der Plazenta.Trote
allen bis Jetzt bekannten Mitteln geht immer noch eine Anzahl von Jungenpl
blühenden Frauen zu Grunde. Nur derjenige der solche Fälle miterlebt hat, "" .
ist im Stande, die Tragik eines solchen Todes zu beurteilen. Mit Recht sagt
Labhardt "er habe das Gefühl, man könnte sich An einen Todes/all durch Ek-»
lampsie oder Plazenta pcaevia viel eher fügen als in einen durch Atonie
veranlassten. "

Alle die bis Jetzt angegebenen Blutstillungsmittel sind unsicher und i

die direkt durch Druck oder Zug auf die Blutgefässe wirkende Methoden
schli essen grosse Gefahren in sich. Es wäre zu weit gehend, wenn ich alle
diese Methoden und die Wirkung derselben kritisierendes steht ausführlich
in allen Lehrbüchern der Gpurtshilfe.

Mann rechnet Jetzt auf eine Sterblichkeit an atonischer Blutung nach
der Geburt M von 0,05%. Grosse Blutverluste aber schädigen den Gesamtorga-
nismus und schränken seine Abwehrkräfte gegen Infektion ein. Wenn mann also
auch die Fälle mit dazurechnet , di e infolge des Blutverlustes an Infektion
sterben, wird die Mortalitätsziffer 9^ sicher grösser sein.

Seit ich meine Blutstillungsmethode für Notfälle bei gynäkologischen ^

■V

Operationen angewandt habe, dachte ich diese Methode auch in der Geburtshilfe
bei atonischen Blutungen anzuwenden. Trotzdem aber so viele Jahre vergangen
sind, ist mir keine Gelegenheit geboten worden, bis ich vor dJS^ Jahren in dWi-iW
meiner Klinik eine Patientin vorfand, die fortwährend blutete, trotzdem bei ihr
Blutstillungsmittel und eine starke Jterustamponade angewandt worden waren.
Ich habe sofort aus dem Uterus die Gaze entfernt und meinen Tampon eigeführt.
Seit diesem Fall wurde in meiner Klinik die Methode öffters mit promptem Fr-
folg angewandt.

Sie wird auf folgende V/eise ausgeführt : Die Patientin wird auf Querbett
gelagert, die äusseren Genitalien werden gesäubert , die Scheide desinfiziert
und die Blase durch den Katheter entleert. Nach Einlegung de^ vorderen und
hinteren Vag inalspekulwni^ werden die Muttermundlippen mit Kugelzangen hoch
gefasst und die fortio fest nach unten gezogen. Dann werden die Vaginalspeku--
la in den Uterus eingeräVBit,so dass der Muttermund weit offen gehalten wird.
Darauf nimmt man ein quadratisches Gasestück, dessen MitteM mit einer langen
anatomiMchen Pinzette oder mit einem Stopfer in den Uterus eingeführt wird.
Nachdem die heraushängenden Zipfel der Gaze von dem Assistenten auseinander^

gehalten werden, wird ein Itinger Gaaestreifen in den Uterus eingeführt und

f •-

-^-

gleiohmä88ig nach allen Riohtungtn verteilt, ao dasa ein Kindskopf grosses
kugelförmigea Gebilde darin entsteht (Abb. 13'^ 15) .Der Zug und die Befestigung
des Tampons wird wie bei den gj/näkologisohen Operationen angeführt (Abb. Q*-*! 2) .

Nach 5 Stunden wird df% Tampon entfernt, um die Gefahr der Infektion infolge
langen Liegens der Gaze im Uterus zu vermeiden. Man kann iM dieselbe noch
früher herausnehmen,wenn der Uterus sich inzwischen gut Kontrahiert hat.

Ausser der prompten iVirkung des Tampons infolge des ausgeübten Druckes auf
die Ut er ingefdiße, besitzt er auch die Vorteile der gewöhnlichen Tamponade, d.h.
er ruft einen starken Kontrakt iosreiz auf den Uterus hervor und Entfernen der
Gaze werden Eihautfetzen und Blutkoagula mit entfernt. Die Nachteile der ge-
wönliohen Tamponade fallen hier zum großen Teil weg:

1.) Die Durchführung dauert nicht lange, da nicht die ganze Uterushöle mit
Gaze gefüllt wird. Selbstverständlich muß der Tampon sterilisiert in
einer Büchse immer bereit stehen.

2.) Schädigungsmöglichkeit kommt nicht vor, da der Zipfel der Quadratgaze
nicht bis zum Fundus Uteri eingeführt zu werden braucht.

3.) Die Infektionsgefahr ist äußerst gering, da nur die erste Gaze direkt
mit den Uteruswandungen in Berührung kommt »

4.) Die Schmerzhaft igkeit bei Entfernung der Gaze fällt hier weg.
Die nach Einführung des Tampons bememare Zusammenziehung des Uteras ist
nicht nur auf den ausgeübten Reiz, sondern auch auf die durch die Absperrung
bidingte Anämie des Organs wie es auch bei der Drosselung der Blutzufuhr durdk^
die Aortakompression der Fall isir. Vielleicht auch durch den ausgeübten Druck
auf das Ganglion von Frankenhäuser.

Was die Indikationsstellung betrifft, bin ich der Ansicht, daß man mit der
Anwendung des Tampons nicht zu lange wartet. Man kann Ja im voraus nicht j$i
wissen, bis zu welchem Grade die Patientin eine Blutung vertragen kann. :Venn
man sich über die Intaktheit der Plazenta überzeugt hat und die Blutung nach
Kräftiger Massage des Uterus und Einspritzung von Blutstillungsmitteln fort"
dauert , bereitet man die Patienti^i zur Einlegung des Tampons vor. Inzwischen
kann man eine heiße vagtnale oder Uterusspül lung vornehmen. Bleibt der Erfolg
aus, wendet man den Tampon an, indem man auf alle anderen bekannten Blutstill^
ungsmethoden verzichtet.

Die fUfirkung ist so promt und sicher, daß ich ms nunmehr als einen Kunst
fehler betrachte, wenn eine Patientin an atonischer Blutung stirbt.

maomgt VtfiJüm^ K»0«

±Q the xaost fj^wmaat

Qf poatHPortUDi dmXtu Statist!«

hedsxQ PftHahlo ooly firoci largcsor hoopltolB^ ve nust assisso that nmgr pogfc-*
nslal dirths ronoln eitbw UMwyorted or are nthwnrtio rtiiiciiiiinfL Ih a
r^«rt fiPOD the Ui^^ CSLlnlo (1)^ the Ineldnt of death Srm hmaanAmQß
ia aa hl^ aa 0*4S1 poor tiwiL^viTid Urthat an avoraoo of one oaaa p» tup

delivoxloe«

in a large J3tockl^n locpltal

asxiaed death in 34 out of 37 caeos« Uo oan only oonjootur« oa to bov mteh
hi^er f^talitioa ooour in inErtitutiOMl vith lomoir steasdarda«

9168*6 aro stoadaxd xoetbods of treating poet^portei hmcrsimgßB^ Va
mst aagine ftou the jpoar roaulta x«portod that thflor ara not vuxy suooao»
ful« Wo zoutiaeZy endwvor to find \jfaatli«r tfaa uteoma Is «aprtQr or aatab»
lish other oauses f or the l]OL0oding» Q$r tho tiine the ecoBzuination le occv»

• Ktoitrin is givw Intara^

XxLetedt '^o liGnonHbau has beooDa
'vonoualjr^ the xxtorac Is xaaMBead isnd ^ in noat oaaoa^ vnlxialxLo tiino is
lost» Cbe resorts to Intxmrtorine paoiking« iMoh atope the liLeadlnc Tor
tlia MMBt« HLood tronsfiisloiu: aro startod« Aftor a ohort vMle the IxLee-
ding starte Q^odn$ aaiplng throu^i the paddng. Ose raoonml and reivpUr-
oatiaa of It öo&b not stop the hLeadbic tmd^ in «pit oof ooneapialt«t
transfosicna^ the pati<mt goea douohill mpld3y« It io the bellef of
Oou^Laa (6) that ubm the fijrst ut«rtaa paoking ia not oucoessfciLt

are poratakKly dealing %dth a nqpturad xitaania« If suoli is tlie casa^ a
aooond paaldng ia definitoly contraindlcated« Qreenliill (2) also adtlaad
agdaat paoldag the uterus a awond tlxae» iwwmiwHng inaadlate hyatap»
6gtflifBr as the safte prooadora»

HmtpcTttm hamrxboQQ oaxL be oontroUed^ xKurnttior ttet it« oausa» tj
»Mthod daaorlbtd imqr ymn Bgo l^ J3t. K. Logothetopoulos in küham Ü)#
Hls nethod inmlTOs a certaln packlag liildh ha oorlglaally uoed ajpter qI&bi».
hystereotoGBdes« It \ms inserted Into the paLrls aftar the utaoraa ina tric»
ottt olloidnc the Imaidlata r«icrml of the olaq?8 wlthout any losa of Uüood,
J^m Zo^thetppoiilos a|]pliod the aasie princdpla q£ hamoetaala f er tha
trol of bleadixig firom the pos-^jartim utorus aiter oonsideraliLe CQqpariesioa
In hls surgLcal cases had prov^d It efflcieaxt. Dt. Logothetopoulos oallad
the procedicre "Tiuctian paddiig«.

A doohly f olded quadrangular pleoe of gauze 36»l5r S^j^kad a gaofa
rdUL 4>" vlda and 16 yaarda long ara raqiürod«

Äe Operator ßraaps the oamdx wlth one or several tenaculxon forocpa
brlngs It doun mll to the leval of the vul-wa« tte Hades of a TUgtnal

opening

of the quadraagtOar pioce of catiae Iß Insartad Into the uterua \^ ruwi^i
of a sponge f orcepa» In contrast to the ooBfontlanal methodi it is not
naoaeaaiy to reaoh the fundus idth this packlng,(Flg.l).

The f otip oomere of the quadrangular place of gauae prottidlnc froa
the Uterus are spread apart. The opiMtor thm paoka into tha gram sae
sltuated In tlie trtwroa, the long strlp of gauaa piraviously tn^f.4flfit^, a
fully dcsie thls jproducaa a large round hall Insldo of the Uterus. 7ha «i
of this ball is altaQrs the s jae, belng detoinalned Igr the unlfona azaouat
of gause Strip uaad« Thus the liiole procedura becanos autoiaatio and not
subjact to Indivldcial alterations, an Jaiportaiit point In an ogi^tlon,
►e tiiar »hbis ovoi7thlng.(Flg.2).

ur niaoa

blaadlng

•>

Ih Order to madixtain tho äoMamrd traoücn^ tha gisoze B%m Is rw
throu^ a thiok rlxig pooKuy, thitfHHÜ^ puahed i:^}.iard a^painst tbe vulm,
%ihiola is protootod l]|^ a pieca ocf @nw«(Flg«4)«

Th© ring Is fiaced Ih its positicm vdth a claiap.(Flß,5)«
liio conventicQial pocklng aXtesi^tü to cocqpireaa the opmx simisMi and
U.ood VBssolo in the voll of the bleadlfig utoxns* Tb be surOj tho paoking
Itself niay produce a contractioni and only üä mich oasaa «<ti it be e£f<»#»
tiV0« Ob the other hand^ txaction pBcHiig coczpowNiM tha utoorlne rmwAB
against the pelvic vall^ interrcqpting the blood flov to the titorua oobw
pletely»(Flg«6}» In the case of an atonio xxterus^ ve have in addition to
thia haDOstatic offoct, the as^toeic effeot of anoalat \Moh is prodnoad
bjr the ooEproGsion of the ai-toriee« Purthonaore, it is poooihLe th^t pre»-
aure upcn foankenhauser'a gangllon stlmulates the irterine musol^ to ocav-
tvact bf7 \my of the autonociio nerrM» It is obvious that the oaiase of
the hleedlng does not Influenoe tlio effectiveness of this packing.

yherevor the bleeding

frcm, it will liiili^iaa, Inserted with re-

lative eaae^ far inore readily thon a convontional padking, vith no neod
to cQLplotel^ f iU the utorinc cavilgr, the procedore is rapid and prMlaa«

laadlMS to say, this paoking is indioated only In seratre oases of
hflDoniiage^ afteor simpler procedixres have been attenptod and tho vagÜHt

and ccflpvix

as possible sources of blaeding« Its porpose is tfaa

Ixiaediato control of bleeding ond the elisdnatlon of anzietgr and haste«
Ghoe accoziiplishod the additional maasures aucli aa tnoiafusion and oon-
sultation oan bo obtained in Xbisure*

As the patient's condition improves idth or without transfusicsit the
aubeeqiient procodure dependa vpaa oar diacnosis« If ve aro dealing %ritli

silc trbexv0 and the bl6«disg ha« ctopped enürely tha prm&orm ig r^
I lo^ opening the olas))* After a short \Aiile the internal etrip of
ea& be gradaally renoted^ foUInjed }j^ the quadran{rular piooo odT
0sxmm, vhich will take out idth It amll ploces of iwobranes left befalzid«
The reKioval of the packing Is practlcally polnless.

If the hanoniiace has occurod after a difflcult forcope, a Terci«
or in a case, powviously sectioncd, v;e must consldor the possiblllty of
a rqptured utoruc. In suoh a oaae the packlng may entor the abdcaninal
eavlty throu^ the tear in the uterue, intentionaUQr or tjr ohance, No
harn can be done hßr the possible additlonal tzutna to tlie uterine \jb11,
elnce tlie utoms will probably have to be rosaoved«

Chce In place, traotion pacldng allox;s tline for oareful pre-operative
preparation, There la no in'cenpy for any operative interventicai while
the patieat is in ehock« Iler ohances for recovery after hysterectony or
a lore oonservative prooodure are rtuch Inproved*

Accordlnß to are«xhill the zaortality *ate of uterine ngyture is 5S%.
A vory reo nt report firoti the Harlam Ilospital U) ßivos tlie Liortality
rato of 57.1%. Conoidearing the excollent facillties and eapert attenticn
in tliis hospital, we can assnne that in lesser inetitutiona tho nortality
rate may be nuch hicher« With succecsful hedostasis and eüjalnated urgmoy.

with tlre to
reduced»

froc shook^ nortality ratea ehould be considorably

Posner and his oo-ivorkers (4) aays^Ij^aiiedinte transfusion and lapam-
toBy, regardleae of the degree of shock, is tlie surgic^JL troatcient of
rqpture of the uterus.« Speaklng of oarlality, they add,«that \dLth ade-
fOate blood and prenont-day anti-bdotics all cases nay have survlved#*
All these desiderata oan be realized with our traotion paoking« There la

-5-

HO neod of Imriedlato opcmtion "r9garda.os8 of the d^ret of AmIu"

It is advisabLe tliat gauae axui strip are kept rea^ for use, with
Bpecific Instructions, imderstood Ijy' ^t loast Oiie Beciber of the staff.

Actiml exporlance uith thls pcwklng is litiited« Dr. LocothetopouLofl
fat0 ixoed it in about 10 casos ot Postpartum hemorrhngo and had esceÜBbint
residts in all«

Study of this if\^^^c ^ oadavers Das done at the Iltiiviersity of
Athens (5). 1!he pcwking was insortod uitli Danner above described and
fol2]bi>»d Ij^ traction. A äy^ was injoctod into the carotic artery under

pp©G stire and

th pelvic Organs were explored« All blood vesseLs

except the uterine arteriös \;ero filled with the ^» It was intoreating
to note that the uretero were not coopresaedf they could be fLushod
tbrou^ froci above eran uith very slight pressure«

Qooeluaions
ThoTO are no nethods available to reduco the nortality rate of
poatgpartuni haiorriiace. KLood(||Jimofiißion is ofton unouccosaful because
hoMBtajsis is difficult« Operations are dono under condition of sliock«
Ti^ction paclcing controls all pootportuni bLeeding iionediately and tliere-
foro shouLd reduce the nortality rate iinneacurably.

-^^fa»ture^

1. Hunt O'ayo dinlc) Am^J.ObGtAßrn. 4912^^6-252 Feb.1945

2. Qreenhlll, OammxtB page 241« learbook 1950
3» K^Logothotopouloa, (%ai. ohirurgie, 1939«

4^ Posner, anith, TSambert. New York State J. of Med. Vol.51,no5,rarch 5L

5. Oh. Oariatopoulos, Zentralblatt für Q^ru 1933, No. 14^

6. Beaohain and DeaohaBi (niscussion) Abu J*Obßt.ß:Gyn#Vol6l,IIo4,Ap(r.l951.

Therapie der atoniscKen Blutuüg nach der "-»eburt der

kX az eut a •

von

Prof • Dr. iionßtantiii LOt^othetopuloB, Vorstand der I.
Universit:iui.;frauenkliaik in Athen.

^iAe der lio jetzt noch nicht jan« :;clöcten ira-
^en in der Geburtshilfe ist die lekämpfiing der atoniachen
Llutung nach der Geburt der rlazenta» Trotz ollen biß jetzt
bekannten Mitteln ^^i^iti immer noch eine Anzahl von jun^^^en,
blühenden irauen zu .runde* liur derjenige der solche P-^lle
;ai beliebt hut, ist iia ütande^ die Tragik eines solchen Todes
zu beurteilen» üit Recht sa^jt Labhardt "er habe das ^efühl,
man könnte L^icii in eiuen 2odosfai:. durch Ekla:üpsie oder
Ilaseiita , •• evia viel ener fü^en alc in einen durch Atonie

veranlaL^B t:..«

Alle die bis jetzt angegebenen TautBtillu. littel
sind unsio:.er und die direkt dui^ch Druck oder Zug auf die
IlutgefäSDe wirkenden ^dethoden sciilieoscn ^Tosce Gefahren in
sich» i-B v;äre zu \vcitßehend| wenn ich alle diese Methoden
und die '.7irkung dei^öelben kritisiere^ es stellt ausfülirlich
in allen Lehrbüchern der vioburtoiiilf e#

dSLa rechnet jetzt auf eine ^terblicLkoit mi ato-
nischer lilutmi. i.KJ:. der ^-eburt von ü,ü5/-» Oroüse Ilutver-
luste aber sc adi,::cn (loa GesaiiitorraniDiäUs und sclir.aiken sei-
ne Abv/ehrkräfte ,:e^eix Infektion ein» .exin man also auch die
- ..lle mit dazurcchnet, die infolge des IlutverlustsB an
Infektion sterben, wird die ...üttalitätssiff er nicher grösser
seiiu

üeit ich meine lautstillungsnicthode für Notfälle
bei gynokologi sehen üi^erationen angewandt nabd/ dachte ich
•liese iviethode auch ii. der Cebui'tshilf c bei atoMschen
.lutuiven anzuwenden. Trotzdeiü aber so viele Jahre ver;:angen
sind, ist mir keine .ele^eniieit ,eboten worden, bis ich vor
zwei Jaliren in -:.eintT Klinik eine latientin vorfand, die
fortwlüirend blutete, trotzdeiu Lei iixr KLutstillungsmittBl
und eine starke Dtei ü.ötaiüi)onade angewandt worden waren*
Ich habe sofort aus Iqixl Uterus die Gaze entfernt und meinen
Tainpon eingeführt • de Hlutung sistierte sofort, ^eit
diesem Fall wux^de in meiner Klinik die Methode noch sechs-
mal angewandt mit promptem Erfolg»

Sie wird auf fol^i^eaäe .eise ausgeführt: i3ie Pa-

(7/ .^ /'i^/t^^W^^'^^ "^^ 4i.^^a^/M^

-2-

tiexitiii wird auf ^uerbett .^^'^t ^^^ äusseren Goiiitalieii

vv erden gesäubert, die ocaeidc j^;;..ii:ii ziert und die .laee
duroll den iLatiieter cmtLeert. . aon J^iul 3^ ;:;uiir: doH vorderen
und hinteren Va^^inal Spekulums . en die >uut ter:aundlippen
iiiit Kugel«an en hoch i^efasst "ond die Portio f eot nach unten
r:ro an» UaiiCL v/erden die Y^ -laalsi^ekula in den Uterus ei-.i-

v«*i

rt, so dasB de^ iuUttoa..^.uid weit offen ^^einalten /?ird«

i^arauf niuiat inaii ein quadratisches Gazestücki deecen ^itte
mit einer 1 r ' *. aaatoiaisclien ^inzette odex^ mit einem
iitopf er in deu ütei-'us ei Cührt wird# Naolideu die heraus-
h uiÄön Ziif el dör Gaze von dem ü-bsi Stent au : lei*-

:,teii werrien, v,ird ein laujer Gazestreif e^i in aen
Uterus eiu^je.: ihrt und ^^leiohmäßai^ nach allen Ixichtun^en
verteilt, so iaöc ein Kindskopf , rosoee ku^:ellöri:iige8 Gebilde
darin entstellt J^:ie vier Zipfel der äueeeren q.uadrati sehen
Graze, cowie das^^iaeraushan^^ende -^inde des ^itreifens, welcheo
EU unterBcheiden etwas l.inger sein iuuas als die vier Zipfel,
werden mit dci' rechten Hand rcfasst und fest nach imten
^•ezoi^en, bis de* ku^yjli.^e Tampon in das kleine i-ecken ein-
tritt und auf die UterinjefäsGO ein: iruok ausäben kann*
Mail zieht danii die 5 herai len Zipfel durch ein ,'rrossee

Ringpessar, dac ruan mit der linken '^*and fest en den'

unteren Teil d ^ _ yse, die abctei^^ende üc ..eiibäste

Und den Beckenboden anpresst, mrälirend die rechte iland mit
aller Kraft an den Zipfeln sieht^ Zur Vermeidung von Nekroß«n,
die durca zu starken Druck auf aie Vulva entstehen könnten,
' ^ e ich z'.vischen Pesear und \^ulva auf beide .reiben deü
^cuuponstieles einen kleinen Vattebausch» lun le;* ein
Aösistanx eine starke kleiüiae vor dem r , i«:rr^d:.o sich

nun ZY/i3onen Vulva i;mu liasor iil 0 befind:^!, y, Jie Blutung
nach Einle,-en des Tami^ons hört mix aller oicnej ^t sofort
uf, wie aus den r^^llex. aber die ich gleicn berichten werde

^S ^,f

ZU erselien ist« ei allen iallen wurde dei -auigon nach 5
stunden entfernt, um die Gefaixr der Infektion infolge langen
Lie^ens der Gaze im Otcrus zu vermeiden» kan kann ev. die-
selbe noch früher herausnehmen, vvemi der Uterue sich in-
zwischen 5Ut kontrahiert hat» Ausser der proüipten ^Virkung des
ü-ampons infolge des ausgeübten x;ruckes auf die Iterinr-o-
fcisfce, besitzt er auch die Vorteile der ^e " nlioLon lam
de, d.h» er ruft einen starken •^ontraktiOüSi eiz au'^

pona-

^^11 Uterus

hervor und beim x>ntf ernen der ;aze werden hihautf etzen und
Bluthoa^:ula mit entfernt. Die liach teile der gewöimlichen
lamponade fallen hier zum rossen Teil w«gj

1 • Jie Durchführun:; dauert nicht lange, da nicht die
f-anze Uterushöhle mit .aze gefallt .vird» Gelbstverstlindlich
musß der lampon sterilisiert in einer hUchso imraer bereit
acehen»

2« Schädigungsmagliohkeit kommt nicht vor, da der Zipfel

der ^uadratjaze nicht bis zum Fundus Uteri ein^ofahrt zu
werden braucht •

3» Die Infektionr '^ahr ist äusserst gering, da nur die

-3-

k l .

4» -^ie ^c

i direkt mit den Utcruswa..duzij:en in

iiiang

;:■ ,f ti, iiQiti bei ontf ernuiig der Gaze füllt J-i

.V ■äz •

2.ie , .vi ,a-u.v- des youa ueuiorkoure üu-

saui^cnziehuii, des Uterus ißt riiclxt xiur auf da:a ausgeübt®:!
Reia, sondern auch auf dio durcl. die Absperrung teain,>e
iüiaemie des ui-aris wie us auo. ^ :x der f «f ««l'^%Jer ^lu
zufuhr durch die Aortorikompresßioxi der iall ist. Vielleic
auch duroh de/i aus,-euttcn Ji'uck auf das uanglion von
x'T Ojik enhaus •" i' •

Was die ludilcaiionscte Im' betrifft, bin ich
cier ^nsiul't. --ss mau mit der An.vonauaij des Ta-apons nicht zu
ionr-8 wartet, -aa ■ : ja im voraus nicht .vissen, Mn zu
■ Icnem Grale die .atientin eine lutun- vertra-en ka.in.
'an man sica über die Intaktheit der irlazenta ä±0Tzan;^
y ■ und iie lutun- nach kräf ticer :.ar.sa/e des Lterus und
'.iacpritzui. • von lutstillun-saitteln fortdai< ; t, ■ :-oitoT
man die ratientln zur ^inle-un.3 des Taapons vor. Inz./isc i
iL ?i.e heiD.e va inale oder üterusspühlung vornehmen.
leiLt der .r-füli-' aus, .vsnJet ir.a.i gleich den J-ampon an,
iilti na^ au? alle anderen belca.mten autstilUmgo .ethoden

verzic:: t et . . , . , j„v-

jie "irkuij-' ist so proüii^t ujid sicner, aabu icn
CS nunmehr als einen .unctfealer betrachte, wean eine
ratieatin an atonißc sr ilutua- uach der .ebui. sti. ct.

ie in meiiit;^' Klinik beobachteten Fälle sind

iül,,e:.de:

Pall 1) Irotokoll Jr. 557Ay^l* ^-^ ^f-> aTjähri^c Ipara*
Letzte ..eno^^^ oü 10.5*1940. Aufnai^e in uiißcror
Klimik 12*2*194'I, 6h. ( eburtßhilflicaer lefiind:
i'miduö uteri 2 1/2 li.i.or breit unterhalb des rros^
xiph. I 3oh.:aella-e, ^c .cl im reckenei ^ bewe-

lieh, nerztrjne (-}• LeckendurchJieB'ccr: 2ö, o, ^^J,
18. Va inal: i^utterüiÄnd handtellei\.rüöB von ^lazenta-
^ewebe'iiberdookt; ziemlioh B^arke Blutung, /vllge-
mtlner Zuöt.id schlecht, Puls 1:^0, Temperatur 36,8.

': auf das i'ehlen der kindlichen Herztöne
: .einen Zu&tandes der Graviden entechlieLL

Uterus entleerung per vias naturalis.
leri^er jurchbohrun,^ der ^lajseiita wurde
•ust ' -ef asst und gewendet» 7h.15» i3ponta-
les Kindes. Die Plazenta wurde unmittelbcii
Wicklung der irucht r^jinual jelött. Die

.,dt .:Uokßic;
unu les all
man sich zuj
7h. ..ü,ch VC.
der vordere
Ent^vioklun
nach der ü*ii

Blutung dauert fort trotz der ^erabreiaxmn - der

t4-

Fall 2>

.all 3)

irwöiuilicUen i2LutßtillaL ittel» Auch dio Uterus-
bciieidentaüiiJOuade nacii Bux^iu. bracute üiont den
Äewunacliten i^rfolg. Dosnalb wui^de Dxe antierut und
statt ihrer mein lam,>on ein, - Ihrt, wora lie IIut
t^i"- prompt aufhörte uiid der ^terus sicn stark korx-
traiiierte. Obwü/.! der erfolg der Llutstillun^ durch ^
den ^ci:apon in diesem rall auffallend war, ie die i-aui-
entin 1/2 stunde spater we/en voran^set'fixi-ena.i gronsen
J31utv3i-liißtes aa exitim ^^ekoimaen»

Broto:;* -.r. 5üB/l94U irauiv.iv, ÖOjohri ..' Ipara.

Letz. unses a^ 2/.4*1940. 22h. 15*2.19^f1, ehen-

be^diii.. 9h*10, 16.2.1941, Aufnaiuie in unserer Klinik.
Geburtoliilflichoi i^^efund "bei der Aufna^uua: mdus
uteri 3 finv^'er breit unterhalb des Iroc. xiiu., I
Scheid öllareV Schädel im i3ecken eingetreten, Herztöne
(•f ]. • 16.2.1941 iilasetispruxi,,. 9h#'t50 opontan^^eburt
einer u^^JUilio/jen 32üü *. scUweren und ">0 cm. langen
j7p^Q-^ .ix.].. 9n.4':;'.^j:'üntane rlacentaausstossun^«

UniuitGöli -Ol. der naceutaausatossun ; trat eine

aiemlioh s .e ilutun^^ auf, die auf dia jewöhnliohen
viutsoillu .^.littel (xituinal, G^/norcen, UterusmasBage)
nicht aufhört. i.'ulö 1oü. 12h. /uihalten der llutung.
Puls 130# All -emeiner Zubtand sculeclit. ..it Rücksicht
darauf entschließst iiian sich zu ineiuer üterustamponade.
Prompte hlutstillimg* 17h. liiitf ernuiig deo Tampons.
Keine Laohblutun^-. Ute.us stark kontraliiort. 26,2.1941
■;acn noru^aleiu =VochenDettv erlauf wurde die ./öchnerin
gesund entlasi;en.

x^rotok. jr. 624/1941 • i^'rau Z.A., 233a.ua.:, II .rayi--
dität, X ...artuß» Letzte i^enses am 5#5«1940. Ib. 2.19^1 1
20h. ..ehe.ibe-in:t. 17.2.1941, 5h. 10, Aufnahme iu uiise-
ror iQinik. eburtshilflioher Befund: uadus uteri
4 i'inger breit unterhalb des rroc. xi^, .. I bchj.dellage,
Jchädel im Bocken eingetreten, Herztöne ( + )• .:ormale
l5eckenverhältni3Be. 5h:50'£lasensprung. 6h. b ..utter-

Vi/

nd vex*atrichen, ülas
ten, rfeilaaiit/ sciira-,
..erztöne verla. it,
darauf entscliliüust .man

jesü"-'^

beendic.n

6h. 10 Anlc

unf:en, Jchudel cingetre-
Sleiue i^ontanelle links vorne.-
in der .»linute. .üt Rückeicht
ich zur sofortigen Geburts-
, ier Zan^re mid :tatrai:tion
einer 22«^ . -chweren und 49 cm. lan. 3n v/eiblichen
lebenden i'rüclix. 6h.21)' spontane Placentaausstoüsung.
Unmittelbar nacnner trat eine starke mutung avf, die
dui^ch die gewö^'riliohen Bluts tilluncsmittel nicht zu
beeinflussen ibt. Puls 140, allgemeiner 2iUBtand
schlecht. 7h. Tampon einfüiirung, worauf die Ilutur.v'^
prompt steht vxii der Uterus sich stark kontrahieia.
12h.^Tamponentf ernuii^:. Kefine ilachblutun -. xuIg 110,
allgemeiner

Zu£;tand

gut.

26 .2 • 1 941 , l:ln clasBung naoh

'■«'■-

*Aüi • *<.-*i- "^^

vvj,.» c;...L.u w t V c.*- ici *►<-*. •

1 4) irruöüic»

ijali 5;

.«to^ 4Mk#

..L

7n f-i"". 1

n y^i.*i

am Sc

»-> v^

taiiclle i:
der iÄ.iiJiiilxc

-«Uli

iaäii/il i Oiie
wur * 211 *

telt;ar rn'*-
die die ,,;:.
kr.r. ■ !

2 2 i • • •

küü -dert. I0«i5»19'^1

-'-k*^

,17-

. i, ui.. :^:>. -it i:UckGioht oui das ir'ehleri

t eine
t

tote Frucht
ijoa teü ' ' »- o en t riau n b to •: urifi •

Tic^"'^^ lau.ötiiiuii ---^1 ^ (■:;.

. öxen der ^li

' ..': ' "■ UtU;r •,

it, .. ulG 11 ^2xi#, ^♦^♦i^^rl

j. tlutuii. ; • l t e. ütark
j... cuiig nach nc:i eiu

Lt-
Ir-
, Uterus

':H>4/1 .^41 »

jJ!i # 4.i • I

xro üOii • • ^ . . . - , _ , ^ ^

Letzte .»^e. -^lich^ eri^^-ierlic--» 10«4.j. ;'i| .^c:u»öw

iri-i* ll^4#4l, 11 . -J r. .e in wiDorer i^liru...
Gefcurti. -li .. \i : ler ; , n\z. _ ,

uteri o i'in breit Uivt . . ■. ^roc. xi].L» i

wchildella. -, v;:...:u:l iiü -. ociiieü faßt ei .retexi|
Herztöne C + ii -^' B^lttz^v ilaciencpru..^ • i't'i-.i^

^.utteriuUüd vc ^ ':riC4ie:i| i-lar-^ -es^iru:-- • ->. iel

eia^'etreten, .^clln: " 3önr_..,, kleiue oataxiell©
liiiicß vorne» .oi-ztü. -;tar/: bescnleui.! t. dt rUck-
öicht .;• d en:. schliefst iiiL,i i^Lo.\ zur -eourtsbeto-
di-;Ui., • •

■ ieiieii
den •*^ruolit#
Ijiiini itelbar

.1 aer Zaii^a.
> uiid 5v

ei - i

^Oi

au I' I uu.i
keiri.e

wesentliC'

1 ■ •:.;■■ alic' z...
... ^ s 1 t

. * i d^

iert» ula 1v. .• a11
^>'t. 17*4.41, ..

lUt.. Ci.i.i

eiixer
. lebert-

lut

Utr

- i: <ip>-'i' -irföjii-:'.

-.„iÄ^WriW;

-6-

xaii v>;

irotoK.»

Letale

bar u. .
Temperatui

/ tiv^y' 1

. /de:' :ia Hut--

laaenc- :^: aiif t

» All reiner .-utaix^ .

iJie voj\jC;aQ.ii .eiia Ut er- .vwiatj tastung ei .,
rus ie-r war# Die i:eviiiio:i deB •:}eiiit • "^

■f^y

einej. doi j:elt;eit1 -

die durch oiai^

dem hielt die j^iutuü^

anfalle. ciie

besteh- lutua^; ..

schlosL .. : ich zur

der TaiapoiiuiixJLuüruii^^.

kontraliiürto eich ^:ut unö de^' ^^llrer^^

iatieiitiii "^»^«^uerto r-^'"' srniv,. cnd* 1 w....

wurde " ■ pon e^x--. t, la^d IC Ta^^e

TaiiipOii^xaiu- verlj.c.i.,ü die Vöchneri::

Klini....

•'ttenai- "^ '^ind ^
uUiiJ.ate vgx'Uorf:.t

. tilTi
t ^fteir\flu^Be/i !
onei

lie KLuliw

lauc-ee ?/ies

"^l ide auf,
Ci^, Trota-

1 dir

^l nack
-• er Uterus
^'^' uund dBr
^iden si^äter

i"^ er

l V

«^

e Ipara«

~..i<.

'^jetzU. : 1].1 -1 ra* 21.8.194: . :

t^t .. .„.''' ix; ■ .

Gebur . ilflici^ev ^..: ^ . ^...-.ß Miori '

"breit uii.,... J'?b t-oo* xiph>. I Cc .., -

del faßt ei.;*^.,<iu.. v;.i.;..v, r^itöxie (4-;, 1^. , --..^

16h. 3poxilaai^:eI'iii*t ei.iw lel<exidea, vieill ,.i^..^ii t-^^^., ^,_,.
bchwereii ^ i 50 c;;.» '^an - - ^.^ - ^ ^. >- t.^. ^ ^ I6iil5'
.:: montane ^ lacoi.tuaueutoi^. • xi^Miücfelbar r

trat eiiio aie:-ill . ^k« iauuv: •: '", a^ ;i.ü aie

Villi ^ ^ Liili Ittel iceiiic tea«

irula 1/ , .. .- , • v/h. :. _ !^

./i.'rrijf dit- : jjr... _ ü e'. . .1 d: . 3 oi'o^

. .. iiOiit;'c.-i ;. ?:.:h» Tamu0i*6:iufer.j .. . .liu.e Naol:.-

blutmag» Dt- ^ .,.. _ ...iert, rul^ V . -je-

neinor Suct-"''*'^ bodeut^- 'jst^ert. 2.^. ^ ^tlaoeung

iiach fiebor-^i %^iai .-/oc u.*.-^uuve.rlauf .

i ' ü hier daö :;lt:io' .^ ..u < ,
bc^ .olo „ ^ioiieji

mein rai. . ■•.. 3i i : ., -^r ^i

1 itOai- "^1

Sic : aie ve}^..a , 11 T

LCii 1

oei Cü.

;r Geluiä .
: etet.

l'lutstiTl^

aine

JL.D. 1907

Ifff Oec, f«?7-|cce<M«/. im No¥., 1908
DMPLETE SPECIFIC ATION.

(#tttieiii«ii, j««tidiiif at Salt Lak«
oltbe tJni4<jd:$iaiei of A»«riea, di

iu.vt:uu.ufi jb&d in wbai manner the same k
-''' <}escrilb«0 and a&certained in and by tbe

*ennc

uu. uu»i«:incai luäirumeiii ui uovei aud
r^.^tu ^reianfter aod thown in the

ombodying the inTenticm, sliowing
nd having the handle in section

baving th« iiterotoiue ccmtrtctcd; and,
in» iiandl« on tlie lia« s — « of Fig. 2.
'^ ■■" sbeatk '1, a handle 2, at one end of said
^^'te eua theredf. The uteroloine 3 is
loop ^rm and fiexihle, one edge being
^rbn) matteo* fron tha menthnme or iining
Th# ttterotome or scraper 3 may be
^Htbin the tvbe or «heath 1 or maj
feto in any manner.
^ngtb and the handle 2 at one end
laviicpd t^iereto, and taid handle may be
lay be preferred, aocordin^ to the make
4 4 (merates thitmgh a guide b nenr the
|e ««nd oppotite to that provided
ectad pocatiag morementt

ay oons ei warn in whieh eaie

4ce opi»4Mi»iie sutat of the g^e, therehy
lud 4.

roTided, one of said levert

ipfint portion of the handle

w^ith the il^ 6. A

^veri and slft4idapted

ÄBsre

i » poftiob /j
üerel> ' Mme

Wmii. «#'

':^>^^j^::,,'^m^i^^^^

I J

I c

NO 281701.— A.D. 1907.

Moormeütei-'a Improvemems in and rtlaiing to Uterine Cnrdtea,

limit, which is when the slide (> is f the upper end of the guule 7, stop Shoulders
bemg provided at each end of the iuide to limit the movemeuts of the slide und
tue cooi>erating parts. 11

When it is necessary to applyJ the Instrument, pressure is exertwl upon
the button 9, thereby moving thel ro<l 4 within the tube or «heuth an<l <on-
tracting the uterotome or scraper.f. as indicated in Fig. 2, thereby iHTmittini?
Of the ready introiluetion of the same into the uterus and throuirh the cervix
after which the pressure may be rel<jase<l fn)m the button 9 moro or less to i>ern»it
the uterotome to expand to the i-^quire<l size, after which the instrument is
manipulated in the well-known maliner to remove the morbid matter ])r(Hlucine 10
endometritis Preliminary to the jlemoval of the instrument, the button 9 is
agam pressed unon to contract thfj uterotome to its smallest size so that the
Instrument may be withdrawn with ease and without producing anv unuecessarv
pain er inconvenience to the patient. ^

_ Having now particularly desorib^d and ascertaine<l the nature of my inven-
I Claim is-" '' "»anuer the saiiie is to be i>erforme<l, I declare thut what

fJffl/""/u " H!^";'"^ ^^'^^^'^ comprising a hollow tube in which slides a ro<l
htted ^ith a blade which can be a^vancecl or retire<l by means of toffgle-levers
arrangecl within the handle of saiil hollow tube and actuate<l to anv de^sired
extent by pressing ujwn a button proje<ting from the haiidle.
„ Ti .\",,''*f?°!/^"^^**^ accordiiig to (Maim 1, characterize<l bv the fact that
a shde IS h te<l to the inner end of the rod and is guided in the handle to i,,^.
vent lateral movement of the blade and also by the fact that the blade is
expansible so that by withdrawing it into the hollow tube, it can be mad« 25
smaller and vice versa. |j *"««-«

i- 15

Dated this 31st day of Dec. 1967.

. 1

D. MADDISON & Co.,
Civil Engineers,
Agents für Applicant.

Bwihill: Printed for Hi» Majesty's Sttti^nery Office, by Love & Malcom»,

ou, Ltd.— 1908.

I
I

aimmmmmmtimimmmmmmmmmmimmmmmmmmmmm

äbm

nHgttummmmiiammimimmmmmmmm
1

I C

I D

4^^G

EAAHNIKH AHMOKPATIA

EOHMEPIS TH2 KYBEPNHEEÖ2

*BJv 'A'&'Tjvaig zu 29 'larovaglovl^t^^li

'ÄQL^fiög (pvXXov H

YnOYPrEION EEQTEPiKQN

A'.a AtaTavy.^TO? aro 15 lÄVOjapiou 1935 sy.^oOevxcK; sv
'AOy;v;(?. TTpoxiaet toj £~t twv *K^toT£p'.7.wv Tzo'jpvo'j, dr,^£-
vvtoptaOr; 6 x. Sontino Maiiro, (o? II poisvo? xy);; IxaXta^^
£v llaxpa'.^. ;A£xa Sjxai'.o^ojia; £rt xcöv Nopiwv "Axab? y.stl
"HX'.$o?, Apy.Äcfa?, A'.xwXi'a; y.a'. iV/.3:pv;v:a;, Aa/.ojvb;

A(
'A6r

YVwp

xaXtDii; £v 0£jjaAov!XY;

'O 'YjtouoYO?
n. TSAAi^APHS

♦

YnOYPrEION AIKAIOIYNHI

A'.a A'axa7;j.axo; ar& 18 'lavcrjapt'oj 1935, ix^oOsvxo; £v

'AOr.vat?, zpoxajs'. xcü irs xr,? Ar/.atoJuvTj? T-cjpvoO iizr).-

Xivr,, Tf, atxr,3£'. xOJ. s^- 'wv avaxptx.y.cöv xaOr;/,:vx(i)v 6 äva»-

y.p tXYi? xoy 13ou xv.T(i;jLaxc? xoü 11 Ar,:j.:j.£A:',osiy.£'Ou 'A6r,VG)v

HXta? X. p£;jL-c'j.

Ai' ojAOtoj xr,? auxY;? ypovo\o'{>.OL^, sy.^oOevxo? ev 'AOVivat;,
rpoxajfit xov auxoj TzoypYOj xac !J.£xa vvwjjLoSoxYjjtv xoü At-
ocxrjcxoü i^upL^ojAtcj xoO T-C'jpYa-o;) Aty.atcjjvr,;, ^'.wpijOr,
£i$iy6g ä;i.'.j8o? l'zoÖYixotpjXa^ xapa xw £ts'.y.(ö ä:J.('j6(;) Ttto-
0r(y.O9'jAax£up Kpojrta? 6 Xpfjjxog Ar,;j.r,xp:ou Fxcx:?, S'./.r;-
vopo?, y.£y.xr,;jL£vc^ y.at xa Aotza v6;j.t;j.a -ixpojovxa.

Ai' aTTO^aTscov xoü i'i x-^? Aty.a'.&juvr,? Tzo'jpYoG a7:o 22
'lavoüapfo'j 1935 /at uz* aptO;j.ou; :

5854, axr.XXavr, ix xwv xa0r,x6vx6)v tou 6 "Iwavvr,; Ko/-
xtvaxr,?, ü'07pa;j.,xax£u? a' xa^£(i);. £xt ;j.'.56ä> rpo^^'^^-cibiq
E'.pr,vo$ty£tO'j ^i' xac£(üg zapa xw EtpT,voctx£:co Kajx£AXt0J
KtJ7a:xoj y.Ät "koavvr,; Pouvapr^?, •koYp^;j.;j.ax£'j? a' xaHcO)?
::apa xw ^lxatJ|J.axo$^•A£'!tp llaxpcöv w? ju;j.zAr(pcojavx£? xo
65ov eTO? xf,; Y;Ar/.[a? xwv.

3718, 5tfc)?t70r, $txoAa6o? ::apa xw Eipr,voB'.x£'w Aujir,; 6
navav'.wxr,? lzupt$wvo? M'pou^G?, iy^v azoA'JxViptov i^xo-
Aapx£''o'J y-3£t xa Aotra vo^tiJLa zpoaovxa.

2573, £vfiV£xo a-o5£y.xY) y; iv. xoJ £~a7vrA;j.axo; xoO $'.xo-
Xa6ou :x3paf':r,Jt? xo-j 7:apa xw Etpvootx£'(p T^O'j;j.£ py.wv xot-
ouxou 'AOavaitou K. Koyy.tvEArj.

'A-r;XXaYr,Tav 4y. xf,? y-r,p£j(a; Xovw 6p'!cu f/Atxia? oi :

I. notvixot xXr,XY;p£?*

1) 'Avay.p''T£G); 'Ap£tou Oavoj r£wpYio? Tavxtvaxr,?. 2)
'Avaxp:5£G)? nXr/iX'f;,£X£to2tx£iou Tpt7:6A£W(; FfiwpY. N. Tla-
voTcouAo;, 3) Eijav^sAta; npoxoBty.cov Tpi-oAEw? FfitopYto?
n. XapaA3;j.x6::ouXo? xal 4) EbaYYsAta? nXr/j.:;.£X£to$i-
xwv 0£<jjaAovtxr,? Kwv. Aayy.a^.

II. "E.jiv.t70o'. $tiy.a^xtxot y.Ar,xf,p£?'

1) 'Avaxptj£(o? 'Ecp£X£-ou NaurXi'ou 6 Ntx. Xtvo?. 2) 'A-
vaxp(T£(i)? np(oxo$ty.£fo'j KaXatxwv Xp. KuSiXo? xat 'Av-
Bp£a? 2xaaivo(xr,?, 3) 'AvaxptJ£6)? ^Xr/;J.li.£X£50^y£(o•J Xa-
v:(i)v Ntx. Tjovxo;. 4) "Avaxpt^Jfiwq nXY;[AiJ.£iX£io$'.x£ioj B6-

Xcu, Kü)v, Mo^^apr,?, 5) 'Avat/ptjEtog nXY;;jL;jL£X£'.o$ty.£to,> Kap-
Sixty;? II av. "Ay.p'.66;. 6) 'Avay.p'T£(ü? irAr/tJL;jL£X£'.o$ty,£ oj
Ks^^XXv.fviag EuayveXo? M-Ey.axwpo;, 7) Etja^Y^Ata^ 'E-
9£xwv Kpir-xr,? Mäpxo; il aTxacaxr,?, 8) EtjavvcXfa; 11Xy;;x-
;j.2X£tcB'//.ä)v Kj7:aptjj'!aQ i^-jp. N'.xoXo-ojXo;. 9) lv!ia77£-
Xt'a? II AY;;j.[jL£X£to$tx(I>v NauTrXtoj 'E;jl;j,. HsG^üjpc'OjXoq, 10)
EtjavvsX a? U Ar,;j.ji£X£'.C(C'./ä)v Ka>a.j.ü)v ZJ9. Zacpstpozoj-
Xo?, 11) E'.c;aYY£X(a; ^!Xr,;jL;J.iX£'.o^.y.cöv KscpaXXr.v.'a? Ntx.
Pa^xoTTOjXo;, 12) EbaYYsXta; lIXr,;i.;j.£A£to$ty.ä>v Tp'.xxa-
X(ov PfiCüpY- AY;;jir,xp6-ojXo?, 13) EtjaYYsXta; lIXr,;jL;jL£X£'.c-
$'.y,(öv PoXou Avx. X:x^r,Y£wpY 0'> xal Nty.. Ilazacr,;jLr,xptoj,
14) EtjaYYsXfa; nXri;jL;j,£X£to^.y,wv p£Ou;j.vr,^ "HXta? 'Axo-
aToXo'j, 15) EtjaYY*X(a? lIXr,;j.;jL£A£'.oo'.y.(öv 'IIpay.A£:ou lo).
21]jX'.66;. 16) EtjaYYsXia? nXr,!jL;j.£X£to$'.y(öv Po^o-y;; P£ü)pY.
XpLCTOXOc^r^i;.

IIxa'.Tjiaxo$ti/,£twv
17) KapBfxjr^; 'Iw. 17 a::ay.to7xa?, 18 'ApYCJXoXfcj Ktov.
A£xopaxO(;, 19) 'HX'.$o<; PstopY- Av^pio-ouXo?. 20) Tptx-
xaXtov FfiwpY. i^xojpvapa?. 21) lUXoj N'.x. IlaY^'-^'^^^i 22)
Aapf^r,; Kwv. BaxaXoY'.avvr,?, 23) i^'.xüwvo? 11 av. KsXXäpr,;.
Etpr,vo$'.y,£t(ov
24) Majjr.xo? Avx. MaxOatou, 25) OtxaXt^oj Bajt'X.
Mwy.ay.oQ. 26) Kap^ipL^Ay;? 'Av$p. Kc';j.r£a?. 27) Kapuxat-
vr,; FswpY- Aapixporo'jXo?, 28) Ku^Jir,^ 'xAae^. 'AX£$avBpt5r,;,
29) A'j'/.^rq Nty.. F£(i)pY''o"j, 30) Na^oj Ito. AaYapäg, 31)
<I>oX£Yav$poj F£ü>pY. Zfi-axo?, 32) 'l£pa-£xpa? P£(opY. Ma-
O'.oj^ai/.r^;, 33) Motpwv *Ap. Tjov^t;;, 34) BaXxr,; Iw. Pr,-
Ya;, 35) "Apxr,? Kwv. Mrouvxa;, 30) BojXyäp£X"oj F£iopY.
Hazay.wax^g. 37) Aijy.a^o; Koiv. Kov.Japr,;, 38) 'AtTioX-
X(i)vt(ov 'Av$p. woX^axo?, 39) llpovvwv Ka;/,rtTjr,- i^£ptäxc?,
40) lÜafjLat'wv ^£6aTxtavo? BtoXaxo;, 41) MjO'j;j.vr,; KX£av-
Or,; Xax^Y5Xpr,:7xou, 42) OtxuXoj Ar.^i.. iIxpa66Xa'.txo?, 43)
ZaYO?*? EupjT. IIarax£';j.ü)vo?, 4U Awp'.iwv r£a)pY. Pa-
9x6-0'/ao?, 45) 'AX'.x'.avGü A. Xp'.JXo^o-jXiaxr,;. 46) Xtopa;
^9:r/.t(,)v IwafjCp Aa[JLavaxr<(S.

III. KXr,xf,p£; äxpoaxr^piwv.
1 ) 'E9£T£tou NajTwXiou BaitX. i^appf,;.

ripO)X03tX£fo)V'

2) Tp'.x6X£(i)? Nr/.. A'.y^vy;; X3i Euccyy- "AOavajOTOuXo;,
3) MtxjXr^vr,; "AvSpEac; Bay.aXavxwvr.^, 4) Xav'ov Yli'po^
Nty.oXou^cfxr,?, 5) Aaptjr,? Eütx. Ilaxptapyia;, 6) Bfiua-
Xvtxr,? Fpr,Y. MtaouXr,^, 7) Fp£6£vö)v BaitX. MoX-6a?, 8)
Uxzpd^ 'AXfii. Ta'.:j.7:i$r^? xai F£copY. K£vxpo;. -avT£^ tj'^-
-Xr,pwTavx£g x6 65ov i'xo; xf^; YjXtxta? xwv.

2540, azr.XXaY'r- *'-öyo> opfou Y;Xr/.ia?, r/. X£ xr,; £;x'iJ.(jOoj
u~r,p£jta(; zapa xw nxa'Tj.axo5ty.£:w 'AvBptxTatvr.? xat xr;;
atJLCjOo'j ~apa xw npwxo$'.y,£U;) Ivjzap'.TTca; 6 $'.y.ajx'.y.o;
vXTiXTtp 0£6$(i)po; F. KoXoxojpo;. w; 'k£p6a; xo 70ov £X0<;
xy;; yjX'jx.''.X(; xOu.

1255, £Y£V£xc a'-o$£XTY; r; h. xy;; urr.p£r'ac; rapatxY;Ti?

xoO £v xf( z£p'.9£p£ta xo'j np6)xoB'.y,£'!ou 'HXfi'a; »uitOo'j Bt-

y.ajxtxoü y.Xr^XYjpo; 'AOavajfoj üx£9avozouXou.

'O *Ywtoi»oYo?
Zn. T^.AIAi^OYPOS

1 1

^■iJi^ <n-^^;..- -a-„L - kil». .

EtoMEPIi: TMS RYBEPNHSI'Oi: (TEYXOi! TPJTON)

f •

Aiöqücook; ^juaQjtj^evojv.

«') AiopOoyiat i] l^ €JfaXu.evou /etpovpaipou rsptAr/j/t? xtji;
utt' ap'.Ö. 39712 axo 8 X\j^(0'j7'0'j 1934 'rxojpYty,f(; azo^a-
TEüx; SrjpLOstsuOsiar,; ei? to ur' aptO. 85)1934 9üXXov 'Eifr,!!..
Ku6epvi5^£(og (Teü/o? F') xspt ärovc^ixfj? jjLYjvta'ou e7:t36;i.a-
T0(; et(; t6v KtTJfffsXia lIp(oTo5ty,ü)v ^upoj 'I(ijavvr,v Kü)V-
(jTavTi'vo'j, ojov a^opa to ';:0'aciv ei? o ävsp^sTat tojto {xr^vtatw?
ex. TO'j e<79aX|JL£vou 250 sl? to 6p6ov 350.

ß') A'.opOo'Jxai y; s^ ij^aXiJLsvcj X£'P07P^9ö'«> xsprAr,<]^i? xf^f;
utt' aptO. 95665)34 axo 11 lavojaptou 1935 rzo'jpftxt;?
a7:09aj£w? 5r,;j,oj'.£'jO£''jY;? et; t6 bz' iptO. 4)19815 <p6XXov
'E9y;|jl. K'j6£pvr,ar£'(i); (Tfix/o; F' ) 7:£pt 5topt7;xoO 5ixa^Ttr/.(7)v
Ypa(p£(j)v ß' TaH£(i)? £70v a9opa Tt)v Fpaj/,'j.aT£iav -ap' y; £to-
xoOfiTtiOY) 6 erifjxwv 'Avaarraito«; K£9aVAr,v6g £/, toü £J9aX-
[j.£vou zapa Tti rpa:j,;jLaT£(a tou nTaij;j.aT05t*/£fou 'AOr,v(ov
et; TO opOov (crapa t-^ Fp3;jtjJLaT£ia toj flpoTO^ixeiou 'A-

('Ey. Tou Txo'jpveto'j A'.y,atoiJVY;;)

NOMAPXIA ATTIKOnOIÜTIAS

Ata T'^c uz' a;tO. 580 ty;; 16 'lavouaptou 1935 azc-

9aT£0)? Tou NcfASPc^ou 'A-xiy.oSci'.wtfa; äv£T£ÖY;jav xa xaOr,-

xovxa Xr^c'.apxou £v xy; KoivoTrjt Ko-JXOuSaO'jvtov et; xo>

Fpa^xjxaxia xy;; Kotv6xY;xo(; Kwv. 'A9£VxouXy]v.

'O No^oLQxn?
K. KAAAMAPA2

NOMAPXIA EBPOr

Ata XYJ; uz' apt8. 13994 z. e. aTr09a:rew; xou Ncpiapyvj

"^^E^poD 5!V£X£0r,73tv fa y.OfOiTiXOvxa xou Xr.^tapxou xf,; Kotvo-

xr.xo; Sxspvag et; xov yotvoxty.ov Fpa;j/;.ax£a BaatX£tOv Ha-

::aöavaafciy izt pir/^taia a!A0t6Y) 20 o)o kz\ toi> [JLr,vtattu cfp^a-

vixoij pLtcrOou auxou.

'O Nondoxil?
HP nARABANAillAAHS

NOMAPXIA TPIKKAAON

AiÄ xy;; uz aptO. 16775 arö 11 lav&japtou 1935 axooa-

c£0); TO'J No;j.apxou Tpty.y.aXwv, avexeOr.^av xa xxÖY^(y,ov':'y

ToG Arj|tap)jcv xy;; KotvoxYjXo; AtozpaTTOu £t; xov T^y/i-

<^'^ih auxr,; Bwfiav MTrtxov ext atiot^f^ hri zphc^ xa 20(,)o

iz\ xou opvavtiv.oj pLtjOcG 7i>xoü.

'O No^iaoxris
X. niniAIAFKAS

NOMAPXIA AITÜAOAKAPNANIAS

Ata XYJ; U7c' aptO. 31572 izo 15-1-1 935 azo9aJ£(o; xoj
NotJLapxoy AiTwXcaxapvavia; av£X£6r,ffav xa xaOr,/,ovxa /r-
ctap^ou xYj; Kotv6TY;xo; nXaxavoj - Na-jzr/.xta; £'; xov
Fecopvtov N. Oty,ov6pLOu iz\ [i,r,vtata a;jL0t6YJ 2px. 80 zXY;p(i)X£a
£x toü Kotvoxtxoü TatxetO'j nXaxavou avxt xo5 IlpoeipO'j xyj;
i$taq| Kotvoxr.xo; xäuxy;;, [jly) 3'jva;jL£vou va h.xtXirrt xa avw-

xepfe) xaÖY^xovxa.

'O N(Hiaox«v AiEir^irvTT);
A. AHMHTPAKOnOYAOS

NOMAPXIA KOZANH^

Ata xYJ; uz aptÖ. 14214 r. e. aro9aa£(i); xou Notiapx^n
KoJ^avY); av£X£6r,<Tav xa xaör^xovxa Xr^^tap^oj ev xy^ Kotvoxr^xt
AouxpO'5 £i; xov Euay. Nxapf^v iz\ drolir,[;.t(Off£t Bpa^. 100
yYjvtatw;.

Ata xy;; uz' aptO. 22126 r. e. azo^oi^zt^q xoü NojAapxoj
Ko!^avY;; av£X€Or,<jav xa xaOY^y.cvxa XY;^tapxo'J ev x-J y.otvoxrjt
Kovxo6o'jvtou et; xov Ntx. Ilazaxwjxav ext axo^iYjijLtwjet §p.
20 o)o ext xoD (Jitj^oü xou w; xotvox. Ypa;jL[jiaxe{i);.

Ata x-^; yx' aptO. 22472 x. e. axo9a^e(i); toü Na[jLapxoi>
Ko^^avY;«^ av£X£Or,aav xa xaOii/ovxa Xr^^tapxou sv x^i xotv6xr,x;
i^xapxou et; xov N. HaxaxwTxav ext axol^YjjAKOJet Stpa^SAciv
20 o)o exi XOJ [xtjOoü xou w; xoivox. YpaptiAaxew;.

Ata xf,; ux' aptO. 22286 x. e. axo9a<jeü); xoü No^iap^ou
Ko^avr,; ävexfiOr^crav xa xaOr/AOvxa Xr^^tap^ou ev x^ xotvoxYjxt
TxY-Xtou et; xov 'A6. iltJepaSr^ ext axo^^r^pitcoaet Bpaxixdiv
20 o)o £xt xou pitjO^u xou (o; xoivox. YpaixpLaxew;.

Ata xf^; ux' a^tO. 18980 'x. e'. ax09aT£(i); xoü Nc|Aapxou
Ko!^avr;; av£X£Or,Tav xa xaOr,xovxa Xr^^iap'/ou ev x-y; xotvoxr^xt
■AuYepYj; et; tov F. Ar^.uLr^x'piaSr^v ext axo^^r^fAtwiet Spa/ULciv
20 o)o ext xoü [AtjO-oü xou w; xotvox. YP^tl-J^piaxeo);.

'O No^doXTJ?
A. 2XINA2

NOMAPXIA ^eiÜTIAO^QKIAOS

Ata TYJ; ux' aptO. 16784 x. e- axo9ao'£(i); xoü No(JLap5(ou
<l>0iü>xt$C9ü)xt5o; dvexe$r,Tav xa xaOVixovxa xoü Xr^^tap/ou X'^;
Koi'^xr.xo; 'Aj^XaJtou et; xov NtxoXaov Kou[jLxapav ext T-jj ve-

V0[JLt7|XeV1() ä[JL0t6YJ.

Ata xf,; üx' iptO. 698 e. e. ax09aa'£ü); xoü No[JLap5(Ou ^tw-
xt5o9ü)xfBo; aviXEÖr^jav xa xaOr,xovxa xoü XY;^tapyau xYJ«; Kot-
voxYjxo; ToXo9(J)vo; et; xov 'AOavajtov KouXavxt^Yjv ext xj
V£vopi.tj'JLevT(3 a;jL0t6Y).

Ata xy;; ux' aptO. 93 e. e. ax09aje(«); xoü auxoü Nojiapxou
dvexe()Y;^av xa xaOi^^xovxa xoü Xr^^tapyou x^; Kotvoxrjo; Ka-
ax£X£iou £t; xov Ilava^tt^xr^v IlaxavtxoXaou ext tq vevo-
fjLtapievY; apiotS^.

*0 NondoxTic
N. riFANTES

NOMAPXIA KABAAAAS

Ata x^; ux' apiO. 270 xyj; 12r<; 'lavouaptou 1935 ax09a-
cr£(d; xoü No[jLapxou Ka^aXXa; av£xeOr,^av xd x,aOY;xovxa Xt^-
Stopyou xapa xw Xr^^tapyeto) xf^; Kotv6xY;xo; Kapuavtj; ei?' xov
rpa!JL!j.axea xaüxr,; NtxoXaov IlaxavtxoXaou ext [XYjvtKXta d-
[LOiixi 6pt<70r<Jo;jLi€VY; üxo xoü Kotvoxtxoü xauxr,; SujiSouXtou xat
[/.Tt 5uvapL£vr, va uz-ptfi fd 20o)o xoü [xr^vtatou ixtorOoü xou-

Ata xf<; ux' dptO. 305 xy;; 14 'lavouaptou 1935 axo9a!j£(o;
xoü Nofxdpyou Ka6dXXa; dv£X£OY;jav xa xaOn^xovxa Xr<5'«p-
you xapd xtp Xr,rtapX£iou x'^c,* Ko'.v6xy;xo; 'EXato^toptou £t;
xov Fpa-jLjjtaxia xauxr^; EücrpfeXov Apo^ov ixt ptr^vta a d[JLo -
6y} 6ptaOr,ao[jL£vr, üxo xoü Kotvoxtxoü xaüxr,; Su|jL6ouXtou xat
\i4ri 5uva,u.evY3 vd üxep6f, xa 20o)o xoü [Jir^^taiou pit^Öoü xou.

Atd xy;; ux' dptf;*. 442 xy;; 17 'lavouaptou 1935 dxo9ao'£<i);
xoü Nopiapyou Ka6aXXa; dvex£0Y;(7av xd xaOi^xovxa XY;^tdpyou
xapd xw Xr,^tapy£ttp xf,; Kotv6xr,xo; AuXy;; et; xy;v Fpa[/,|j.a'
xea xauxr,; "Avvav S. PtavveXY; exl pir^vtata duLOiS^] 6pt(jör,^o-
jjievYj üxo xoü Kotvoxtxoü xauxr^; SupLcouXtou r/iat [jly; ^uvaiJievY)
vd Üx£p6y; xd 20o)o xoü jjir^vtaiou .ULtaÖoü xöu.

'O Nopdoxil?
r. PENTHS

YnOYPrEION ESQTEPIKQN

Atd xoü axo 26 'lavouaptou 1935 FI. Ataxd-fiaxo;, ex-
coOevxo; ev 'AÖr.vat;, xpoxda-ei xoü ext xwv 'Ecwxeptxcov
Txoupvcü, evexp'OY; y; dxoxxr^Ji; xy;; 'EXXY;vtxf<; töa^eveia;
xapd xoü £vr,Xtxcu dXXo$3)xoü Fex6dpx Bü)|i.a Tepl^tav, cy;-

■MHi

E^HMEPIS THS KrBEPNIISEQS (TETXOS TPITON)

XcojavTog ty;v xepl toutou OeXr^aiv to'j tg) Ar/jACipytp Kspy.y-
pottcov.

At
ev

:\ta jo'j aro 22 'lavouaptou 1935 AtaiaYiJLaTo;, iy.BoOsvTO? ^
'AOiivat;, xpotaast tou ext twv 'l^^wTEptxxwv T-ojpy&j. f «-

APXHfEION AITYNOMIAI HOAEQN
Ata TT)? Ox' ap'O. 913 »T> 5501 ;3 «ro 23 'lavouaptou «. «.

^({-ajitü; TOÜ "Apyr.voü xf,? 'A7T.»voj,ia? lloXswv xaxa xo

axo9aa£(o? to-j Ttto'jpyo-j twv 'EjwTsp'.xwiV, exBoOst^r,;; 5'j-
va|j,£t TO'j apOpoJ 37 zap. 3 toü xwJtxozotr.OevTo; u::' aptO.
4952 v6{A0u y.at aTY;pt^o:j.£vr,? st? YVio;j.o$6Tr,Ttv toü zapa t(T)
auTw 'TTOupYSttp i^!4;.6ouXtO'j 'lOa^sveta? 7:ph^ t)V aj;jL9wv5{
xat To 'Txo'jpYsTov twv 'E^wrsptxwv, azs^r^^^axo oxt 6 'la-
X(o6o? Y] Zax 'Apiap toj XatiJ. aze^aXs tt)v *EXXr,vtxY;v tOa-
Ysvstav a'j[jL9wv6)? tw apOpto 23 xou 'A^xf/oj Nopiou, w? expo-
TcOTTOtr^OT] »Bta xoü jxovoy apOpou xoü No|jlou 120 xr,q 31 As-
xs;jL6ptou 1913)2 'lavouaptou 1914.

At' 6|j.ota? i^r' aptO. 75012)144 xt;? auxf,? Y;|jL£po;jLr,vta;,
£y.BoO£t<7Y;? $jva[jL£t xoG apOpOy 37 -ap. 3 xoj y,(o5ixo7:'Otr,6£v-
xo<; ux' aptO. 4952 voijlou xai axr,ptI^o[JL£vr,q £t? Yvcj;j.j$6xr,!j'.v
XOJ xapa xcp auxw 'TxoupYetto Su;j,8o'jXtO'j 'iGayivsta? xpo;
Yjv (Ji>|jL9(i)V£t xai xo 'Txo'jpYsIov xwv 'E^wxEptxwv, ax£9r,vaxo
oxt 0 'Aptax£t5r,? NtxoXaoj ]waxpa6£Xa(; xaxEJxr, "EXXyjv
xYjv 1)14 N)6ptou 1913 xaxa xo apOpov 4 '^<; SuvOVjxrj? xwv
'AOr^vwv.

At' 6;j-ota; ux' aptO. 1772)150 xf,? auxYJ; YjixspopLYjvta?,
e/;5o6£(aY;(; Buva;jL£i xoj apOpou 37 xap. 3 xoü X(oBtxoxotr,öev-
xo? ux' dptO. 4952 v-6|jlou xat jxr,piI^o;jL£vr,(; eti; YV(o;jLo56xr,a'.v
xou xapa xü> auxqi) 'TxoupYstw S'ji:JL6ouXtou 'lOaY£V£ta(; xpo?
TQV ffU'iJL^wvEt xat xo 'Txo'jpY£tov xöiv 'E^wxfiptxwv, aXiCpiivaxo
oxt 6 'l6)avvr,<; MtyatjX Bo^'-ax^^OYAOu xaxsjxr, "EXXr.v xy;v
23)7)1930 crujjL^wvw? xw apOptp 28 iBa?. 2 Ttj? S'JiA6ay£(>)?
xy;(; 'A^xtSpa? xou 1930.

'O 'YjtovoY^?

r. XASiPos

zl<(5^i?o)o/? TjuaQirjjuSvcov.

'Ev XYJ ux' dptO. 704)419 axo 19 Aexeix^ptou 1934 axo-
9aj£i XOJ Txo'jpYOJ xwv 'Eiwxsptxwv St' r,q ix^pr^^T^^T^ €xt-
^OfjLa 5o)o £xi XOJ apyjxoj ;j.ta6oj 12 YP^t^swv a' xa|£w;
x^? Xwpo^yXaxf,; xal xyj? oxotac; x£ptXr,t^t? £Br,;jLoat£'j6r, et?
xo i^x' ap'8. 1 (xejyo? F' ) xf,? 4r<? 'lavouaptoj 1935, 9uX-
Xov xrj? 'E9r/a.£pt5o(; xf<? Kj6£pvr,(7£w? £xt9£povxat at e^f,?
BiopOwaet?. ^ ^ 1 T^'' l»|«

1) AtopOouxat xo ex(ovj[j.ov xoj •^pa(^i(^z 'Iwavvoj BXayw-
ptxY5 xou SxuptSwvoi; zlq xb xpaYl^axtxbv 'Iwavvr^v Bpaywpi-
xr^v xou Sxupt'Bwvo?.

2) AtopOouxat xb exwvujxov xoü Yp3t9£to? TTavaYtwxou Mou-
pexa et? xb xpaYlxaxtxbv ITavaYiwxou Mxoupexa.

3) AtopOouxat xb ezwvupiov.xoü yP^^s«^? Kwvjxavxivou Aou-
i;.avaxou et? xb xpaYlJ^aft'/'bv Kwvjxavxt'vou AouiAa'Bavou.

4) 'Extar,? BtopOoüxai xb bvoixaxsxwvui-^ov xoü yP^^^w? 'A-
Oavaaiou ÄhXtBtovYj xoü riauXou £{? xb xpaY;j.axtxbv 'AOa-
vaatav MeXtBwvtj xoü IlauXou.

('Ex xoü 'TroupYSioj 'Et(.)X£P'.x(ov)

AHMAPXIA AOHNÜN

Ata xf^? axb 19 A£X£!x8ptou 1934 axo9aa£G)? xf^? Ar.ixap-
^taxTJ? 'Extxpox^? ax£XuOr;^av Xoy^ xaxapYTG^sü)? OiaEW?
at xaOaptaxptat xou Ar/^AOu 'EXfiVY; PexfixaYV-ou xat 2o9:a

FtavvoxouXou, Xo^w B' £YxaxaX£:<J^£to? 0£J£(o? ot vsxpoOaxxai
N. SxapKToxouXo? y,at K. Tupouxr,?, 5id xtj? axb 24 Noctx-
6ptou X. €. axo9a(j£(i)? auxYj?.

CYjtoYCacpT;)

apY'2(?.

Ata x^? üx' aptO. 112 9. 1769)6 axb 18)1)35 ax09dae(i)?
xoü auToü AcyYJYOJ, TXY;pt!ioy.£vr,? et? xb apOpov 33 xoü v6|Jlou
4971 X7' ;j.£xa auy.^tovov ^('^6yxry xy;? 'AvwxaxY;? 'TYStovo|Ai-
|X'?;? Ajxjvo;j.txY;? 'Extxpoxf,? äxoXusxat xoü .'Aaxuvo*JLtxoü
Iwy.axo? $ta XoYCu? uYst'a? 6 ajx)Xa| 1709 'Exa[A£tvü)vB6-
xouXo? 2Lxup. xoü r£wpY!Ou.

Ata x^? üx' ap'.O. 783 9. 1750)5 axb 18-1-35 axo9acr£(o?
xoü^aÜTOÜ "Apyr,Yoü Txr.pt^casvr,? £t? xb apOpov 33 xoü v6|xou
4971 xat [;.£xa cru:JL9(,)vov y^bi'^r,^^ xt;? 'Avwxaxr,? TYfitovopit-
XYJ? Aaxuvo^txf,? 'E'xtxpoxY;? azoXuexat xoü 'Aaxuvopitxoü
Iwaaxo? Jia Xoyou? ÜYSta? b ajx'j9. 1750 Kaxtpx^-rj? ^r^T^'
xp'.o? xoü riav.

I. KQX2TANTINOY

ynoyprEioN nÄiflEiÄj_i(Äi ePHiKEyninTüN

Ata Aiaxcr;tJiixo? £x5oO£vto? ev 'AOi^vai? X'yj 31 A£X£'tX-
6piou X. e. xaxa xoü? x£t;ji£vou? v6;j.ou? xat xf^ xpoxaset xoü
'TxoupYOÜ xwv 0pY;jx£'j|JLaxü)v ixat IlatSita? axY;pt!io;jL£Vir; et?
dx69ajiv x^? 'laxptxY]? SyoXf^? xoü 'EOvixoü xat KaxoJ:-
axptaxoü nav5xtJXY;;jLtou 'AOr.vwv, StopfJ^sxat extixeXYjXY;? xoü
epYaaxYjptou xtj? Oepjxeuxtxtj? ev xy] 'laxpex-fl ^X^''^*?) '^^
'EOvtxoü y,at Kaxo5taxptaxcü Ilavextjxr/^xtou 'AOr^vwv 6
FewpYto? Tptavxa9jXXt5r,? BtBaxxwp xtj? 'laxptxf^? i::\ Or)-
xeta xea^dpwv exwv xat ext ßaO;xü) xat pitjOci T[j.Y;tJL7xapyou
6' xct^ect)?.

A'/ üxo'jpY'.xt;? xpa^sw? ux' aptO. 77093 xr;? 5 'lavoua-
ptcu e. £.. xaxa xb '^jTOpov 19 xoü 0iT:h 12 "lavouapfcu 1934
AtaxaYi^axo? «xept xwv dxoJoywv xoXtxtxwv cr.y-oafwv üxaX-
Xr^Xcov», xb apOp. 2 xoü vopiou 4596 «xfipt tspoxY;püx(ov, xr.v
üx' apiO. 259 £. e., xpoxajiv xrj? I. Suv6-ou xf,? 'ExxXr,ita?
xf,? 'EXXaBo?, yopTr;Y£i'fat et? xbv ext ^aO;jLw ehr^'^TtZOu lepo-
xr,puxa xf^? 'lepa? Mr,xpox6X£(i)? ZaxuvOou, NtxoXaov 'A-
SoüpTjV, £x.'5o;j.a tjov xpb? 'xb ti'X'.rj xt;? 2ia90pa? xoü apytxoü
t/.tjOoü xoü ^aO;jioü xou xat xoü dpytxoü pitjOoü xoü a;jL£7w?
avwxepou ßaO;xoü xoü x;j.Y;aaxapyou ^' xa^£ü)?, Y-xot £x 5pay.

xptaxo7.'(i)v (300) ^*r,via'(oc, w? <ju;jLxXY;p(OTavxa üxepxevxa-
ex^ €ÜBbxt;j.ov üxr,p£5'av £v xcp aüxq) ^aO;jxp xat xbv zph^
xpoaY^Y'O'^ äxatxouaevov ypovov.

Ata xpac£(o? xcü TxoupYOÜ IlatBsia? xat 0pr,T/£uu.ax(,)v
üx' aptO. 3686 xf,? 17 'lavouaptou e. e., xaxa xa? xst-isva?
$taxa?ei?, avaxaXetxat y; üx' äptO. 3686 Yj;j.£X£pa Ttpact? £X-
$O'0£Tja xy;v 20 'lavouaptou 1933 y.at Sr/tJLOJteuOetja xy^v 27
xoü aüxoü [Jir;vb? et? xb üx' aptO. 8 9ÜXX0V xYJ; 'E9r,;x£pi5o?
x^? Ku6£pvr,a£ü)? x£pt avaxXY;a£(o? xf^? üx' ap:0. 19674 xoü
1906 Y;u£X£pa? xpa^EW? x£pt axoXüj£(i)? X6y(!> crxpax£Ü7£(o?
xoü Sr;^o5t5ajxaXou Sxaüpou Koü6£Xa, £x xoü or/ACxtxoü ayo-
Xfi.'ou MfiYaXr,? Mavxtv£ta?-Aax(ovixY;?, Exavepyoixlvr,? xaü-
xr,? £v icyut.

A'.' üxoupY'.x^? xpacsw? üx' ap:'0. 72600 xy;? 8 'lavoua-
ptou £. s. xaxa xb «pOpov 7 xoü voülou 41 53 x,aj xy]V' xeoc-
Xa!JL8avo:j.£vr,v et? xb üx' dptO. 101 e. e. x;a/xtxbv xoü 'Ex-
xaiBeuxtxcü Su;j.6ouXtou xpoxaj'v xou, ;;,£xa-:tOsx'xt Xoy« ^c-
i$''at? Saxdvai? b IlavaY. Kap-vx^iC^;? 5r,;j,C3t5d-

). •

VT,

»»

y.at

asiOi

Henorrhage is nou the leadinc caiice of ins.tenirJ. death in i.he Ifoited
States, having displaced infection and toxerda in that categoiy, The
hemorrhages of pre^nancy have cone to occupy first place simply by fai-
linA to decrease as imch as ha.ve the other two principal causes of na-
temel de!:.th«

This failiire is serious, because the prevention of henorrhage death

is the responsibilifer of the doctor, and of the hospital, and because
bleedin^' is a preventable cause of death, or, better, it should be.
Outside factors, such as the devclopment of nore effective antibiotics
and iinproved living Standards, ^^ j^^^ contributed to the better sta-
tistics for sepsis and toxenia.

Before 1935, matemal mortality frorri blood loss had not decreased
for tuenty years, despite the use of transfusions. Qnly dinring the past
fifteen years, vdtli the advent of blood banics and nore available labora-
tory facilities, as well as broader understanding of the causes of
henorrhage and its treatnent, has death fron bleeding partially curbed,
decreasing by 59/^ fron 1939 to 194-0, Although there uere probably sone
fortunate, v/ell staffed institutions with large s-rvices that did not
have a henorrhagic death for this period, such was not the case for the

country at large.

In 194.vC henorrhage acconnted for 33 JS of all natemal deaths,

in actual figures about 4 henorrhagic deaths per 10.000 live births,
A further analysis indicates tliat of these 1,400 wonen dying fron he-
norrhage, about one third wre nonv/hite, A nonwhite nother's death v/as no re
than 3 times hi.^her as that for a white nother. Obstetric henorrhage,
an inclTisive terai for Postpartum henorrhage, placenta previa, and
abruptio placentae, and including traurna and shock, shoiild hs.ve been

-2-

more e':*fectivly curbed*

Shock, the usual cause of death fron blood loss, is accentmted by
such matemal complications as aneinia, trauma, prolonged labor, and to-
xemia of prernancy. Death from hemorrhacic shock , however, is preventabLe.
In obstretrics, the usml story is not that ofl fierce and uncontrolled
hemorlihage for a fcw ninutes and thon Gudden der.th. Hather, the course
of events is one of steady moderate bleeding over a period of several
hours ending in shock and death, because no one became alarmed early
enough. Accordinc to one study, the average tine between delivery and
death was as long as five hours and t.jenty ninutes. . Too often obstetri^

bleeding is allcn/ed to continue until shock is irreversible and blood-
transf Urions are useless,

l'fothers die in several other \JB.ys as a result o§ blood loss. They
may become so ireakened that they succumb to infections, uhich otherwise

they would easily overcome, Accidents occur in best staffed hospitals
in spite of all precautions in typing and cross matching, and occasionally
patients die fron inconpatible blood. The so called ciish cyndrom in
obstetric patients is now fully recognized. It is a cause of death uhich
may follow henorrliagic shock. In this Syndrom the pathologic lesion
CLllegedly occurs in the renal cortex, and during the ensuingchangcs
in the parenchyn of the kidney, death occurs in a few ueeks post partum
from anuria and nitro gen retention»

Even if a patient survives a severe hemorrhage, she r.iay die from
its effects years aftenmrds. Sheehan, ivrho has perf -nned an unusual
niüTiber of autopsies of fatal obstetric shock, has found, that the patient
who survived a severe episod of shock for a day or so , 'jould develop
an infarction of the pitu^tary gland. "itr. refemnce to tMs last finding
t\ is author correlated hei lorrhaf^ic shock v/ith acute necrosis of the

- 3 «

anterior pitiiitar^r gland and subsequ-nt chronic pituitary ddicoasG.

In Shechan's syndror. the patient progressively develops weakness^loss

of libido , anenorrhoa , depilation of piibic and aaillary hn.ir, general

atrophy, astlienia , hypothyroidicn, and debility, with ultimate coitä

and doath 466 _ ensiiinr yoars aftcr the initial obstctric shock.
Exarrmation of the pituitar:^^ giand in such cases discloses fibrotic

reolacenent of over threo ouaterdpf the anterior portion, Althourh

^Ypatient^ have been reported \d.th Shechan,s Syndrom, probably mny go

"unrecognized.

^*Y ^ Aa.^^^^ t

Uterine ble<:-ding aftor delivery is controlled by periodic uterine
contractionc, retractions of muscel f ihres, and the clotting nechanisrne,
The uterine contractions can be naintained for a fex; rdniites by the
Ilse of oxytocics, b-t certainly not perrianeBtly. T he second uiechanisme,
retradtion, especially of the innemost muscuLar layers jr.st beneath
the decidiia , caiises a gradiial muscular closure of the lar-e siniises
of the uterine iiall so that, :;hen the tie norr.irj. pueiperal Uterus is
not contracting, bleeding is controlled. See-^lngly , both precipifous
and prolongued labours interfere i/ith retraction, and atonic her.imorrhage
may f ollow.

In the final analjrsis , the control of bleeding rests in the for-
mation, naintenance, and Organization of throinb^y at the placental side.
Any disturbance in this mechanisii can produce an ohnomal loss of blood.
In rare cases delayed heiiorrhage twelve to tv/enttour hour,': after deliveiy
may indicatc abnormalities in the clotting nechanisn. If othor causes
of bleeding are surely elL^dnated correction of the clotting inechanlsin
sl ould be tried by idrainistering internus cn-lary protamln sulfate 50 to
loo mg. and toluidine blue 25o mg intravenously . l^ether the bleeding
factor in the blood ic heparin or heparinlike, specific or nonspecific

^u ^

Is Icirgcly of acadomic interest, for the proper uso of thic method v;ill
saTe lives in these not too froquent cases»

Gases of afibrinogenpnia have occxn'ed follovdng obstetric hemorrhage

The blood of these patients doos not clotp and theye are ixsinlly los^

imless purified fibrinösen or several hundred cc of j«Citrated • can be

tem "the third sta.^e of labor" be replacod by the {Hacental starre "

or that v;e enploy\he "fonrth str.ge" sinco nost diffic'-iltieG vdth henw

oiTliages occm* after the delivery of the placenta that means after the

tiiird stage of labor. Tlie physiolory of the picental stage is in Short

the follo'./ing: the placenta separates in a fevj ninutcs in r.ost cases

and does so irrespective of OB^ripsiös- ^ergotrate or pituitrine«

ELoodloss hov;ever, is most effectively reduced by the coiibined use of

slov; delivery and intravenous oxiloeics adrainistered diiring the very

last moinents of the Gecond stage of Irbor. This met]-iOd favors natural

expi^ision of the Infant bjr the utems.often atonic and depressed by

the analgesic and anesthetic agents aboundantly employed in i^iodcm

obstotrics«

It is agreed upon to spealc of postpartim henorrhare if the hlood
loss exceeds 500 cc, but iit is rather unpredictable \.7ith vjhat ainount
of blood loss a real danger begins, Generally spcalcing, a woraan in labor
can bear \d.th coiaparative inpunity a blood loss uhich would seriously
endanger the lifei of a streng man. This is probably due to the fact ^WMrtr
that a considerable increase of the anount of blood occurs during preg-
nancy. In any event, the effect of hemorrhage idll also depend on the
general Constitution of the pa.tient, the Status of her blood, as revealcd
by the erythrocyte count, cell volume and hemoglobin content at the time

-5-

of adüdssion to the labor room, as well as to the actual anoimt lost«

Thus, a wonan already exhaiisted \tj a long labor or weakenod by aa antecedent
disease may die after a rolatively small loss of blood, which wotad not
effct considerably another wornan, As a nile, the loss of a moderate anoimt
of blood is not attended by serioiis Symptoms; but v;hen the hemorrhage |
becoms profuse other synotons appear and make the picttire quite diffcront.
The pulse becones rapid, compressible, the face becones palll«t and assime
a äiTGCwn. appearance, while at the sarne time she may conplain of disturbed
Vision , chilliness and shortness of breath« This already is a very serious
synpton and idth th^ appearance of air himger the patient usuall^^ passes
into -unconsciousness before the fatal temination« . ,
The diagnosis of postpartuiii henorrliage is not difficult,*^ v/e have in
nind the possibility of a concealed bleeding. In these not to frequent
cases the bleedinr occurs into the uterine limen or, in the case of
traun€fc in the para uterine tissues. We nust state, hoi;ever, that such a
concealed henorrhage should not remain unnoticed by a watchful attending.
Even if routine preca tions are neglected, the first indication of the
condition nay be afforded by the pale and haggard appearance of the patiBnt.
The cliange in blood pressure and the increased size of the utenis, v;hich
has a doughy consistency, should lead very quickly to a right diagnosis»
The decision conceming the proper treatment of a postpartuiri hemorrhage
depends Ujon the reco;iiition of the source of bleeding. This differential
diagnosisiiS is of the utmost inportance, and it should be atten|fefcr{a, "to
come to decision as qick as possible. If the bleeding commences imnediat-
ly after the birth ^of the child, it is due either to tears of the geni-
tal tract, or to partial Separation of the placenta, If the latter is
the case, the bleeding stops temporarely after massage or kneadlng of
the utenis, but it recurs as soon che uterus is allowed to relax#

-6-

If 176 have no succecs vrith these manipulations the bleeding usuidly comcs
from a tear . A definite dlagnosis, hov/ever is possible only after the
placenta is coÄetely expelled or removed. Qn the other hand, if a
henorrhace persJ^s after tte reinoval of the placebta and tlie abdominal
palpation shows that the uterus is f imly contracted, we probably have to
deal \d.th a tear in the birth caiial, and all oiir endeavor nust be direo-
ted to fing the place of this traiJiii^ The f irst place to lock f or is
the episiotoiny incision. It is siorprising in hov; iriany cases a episio-
toiny wound can give rise to extensive bleeding. Vei^^ often the episioto-
my was done to early and ims allo\jed to bleed in the erronnous assuüw-
ption that this tiny trickle of blood \rovld not amoimt to a real blood

loGS» • • • sonething about episiotoi.'iy

The inspection of the vaginal \-ra.lls is of iinportance especially after
forceps deliveries when there ^-rcis a rotating movenent done v/ith the
instnment. This tends to shear off the lateral vjalls of the vagina and
ver;- severe bleeding inay occur. It is ali/ays essential to grasp the
uppemost angel of the tear and begin seidjig dov;n\7ard, using a large
needle and goinf throuf-h the entire thickness of the wall» The cervix
can be brought into viev by pressin'.' dovm the fimdus of the uteriis towards
the Vulva, and if this falls, the cervix lias to he exposed by laeans of
a speculmi and grasped with a tenaciiliEi forceps. Acain it is essential
to Start at the highest end of the tear. Qnce the bleeding point is
found, we can usiially proceed \n.thout too great a haste« ELood replace-
ment has to be started as soon as possible.

If , hov;ever, the uterus does not contract after the expulsion
of the placenta, or if renains so only so long as imssage is kept up, ,the
c^5ise of the bleeding iniist be soiight for either in atony or in the reten-
tion of a placental cotyledo. By carofiiL inspection of the placenta

) 1

-7-
v/hich absolutely has to be clone as a matter of routine, iie can find \dth

certaintj uhether^is a pieco of the afterbirth Eiisslnc, or \jhether we
havo left beliind a siiccenttiriate lobe. A p*ure, prinaiy atony is not too
frequent, and consequentlv this diacnosis should be done only after the
exclusion of cvery other TX)ssibi ity, Thcre is a definite trend towards
more active treatrient in the case of retained placenta. We don't wait an;^'-
riore for man.y hoi-rs, anxiously uatchinc whether there will be bleedin^,
and we don't resor-''. to saline injections into the cord, but we thinlc
thao active manaconent is the "est, As I have mentioned before, the Se-
paration of the placenta is a natter of minutes. In sone hospitals Pi-
tuitrin is injectefi intravenously as spon as the shc)i?ldei5 of the baby
(B^delivered. Tlie placenta vdll be separated at once and pronptly exptiLsed^
If this injection is done sifter con^lcte celiver^;- of the l^aby, th re is
a groat possibility that cervi:: contracts before the placenta has tdjiie
to pass the extemal os» Tliis increascs the blood loss considerably,
Therefor the pitiiitrin injection should be done jtiBt before the baby is
doli ve red or after the ilacenta is expelled. Generally, our liinit in
v/aitin^; for the placenta is about twenty rdnutes. After this tiiie 11t dt
the placenta will be removed inantially if active bleeding is pre ent.
We insert the freshly desinfected and oLoved band high up into the uteru s
and tr^^ to get hold of the codyledo or the entire placenta as the case
may be. It is ver^^ essential to h-^ve a good anesthesia and an assistent,
vho pushes the uterus against the band inside the uterus, if you cannot
accomplish this yourself. The band in the uterus acts as irritator,
causing contractions. After separatinr ^ the retained portion of the
placenta , the hajid should be withdraim gradually, a.Tlowing the uterus
to contractu It secms that tliis active proceduTe doej. not materially in-
crease morbidity by bacterial Invasion. We resort in all those cases to

I
l

-8-
liber^J. ncdication witli antibiotics and we rarely soe any rise of

temperature during the Puerperium,

As to the causes of Postpartum henorrh-ge, predisposing factors
nay initiate a sequents of events uhich caa be avoided, We can say that
the treatment of Postpartum hemorrhage already starts durlng pregnancy.
An adequate prenatal history, Including a history of previous puerperal
hemorrhage, is sufficient 60 place the physician on guard, The earljr
recognition and treatment of ^ anemla is good insui*ance against KLeeding
accidents« Like\d.se, dietary instruction and other aspects of inteeligent
prenatal care ^sdll strengthen matemal defenses against blood loss, Preci-
pitous labour or inert ia itüI v/am the physician of the danger of hemor^
rhage , as well as v/ill multiple pregnancy, hydramnios, lar^ie babies,
inother words everything v±iich expands the uterus in an anusual manner.
Difficult operative deliveries should alv/ays be regarded \r±th suspicion
conceming the Postpartum period« Let uc remem.ber the frequency of in-
juries to the soft parts, which are only obvious, if bleeding occurs
vhich force ud to exanine the birth canal in order to find the source
of it. The inf luencc of a deep anesthesia upon bleeding after dellvery
of the baby can not be oversmphasized. Those who employ local anesthesi§.
such as pudendal block or similar procedures, will agree that even in
the case of a bleeding incident post partum, the blood loss usually is

not so excessive as after use of a general anesthesia.

Prophylaxis against hemorrhage might include the routine typing

of all obstetric patie ts. It gives you a real piece of mind to know
OH

that you able to peif om a bloodtransfusion without dangerous delay.
In raost institutions typing for the Bh factor is also dobe routinely.
Supportive measures include intravenous saline, plasma, 20^ glucose etc,
but only as stopgaps. Such agents will raise the bloodpressure and coni-

-9^

bat shock only \jhile ruiming into the veln.
All patients in hemorrhagic shock shoiild receilfe './hole blood , usimlly

at least 1000 cc,

because the amo-unt of bloodlass is always

"underestimated, Don»t fordet to asstire qidte from the bcginning suffi-
cient help, because we never know ^ftiat v/ill liappen in the next nonent.
V/ith inassive henorrhage, large transfusions imder press-ure may be neces-
sary. In fact, intraarterial bloodtransfusions have been used on hypo-
tensive patients after massive henorrhage idth encoiuftging resiats,
l'forphine should be adininistered for restlessnes, and oxygen r.aay be use-
fiil in conbatting cerebral hypoxia, The headdown position is advantagous
in such cases.

I did not teil you very much about the uterine packing, but I
vdll do it now, describing a new method, which even is not yet published

hre in this country. I thing you nay interested in it and glife me a few
more minutes to explain this procedura,

I Start vd.th a very short description of what is practi-
caliy alv/ays done as soon as the doctor recognizes that he is dealing
idth a hemoritege, in other words a short resumee of what :7e have
already heard.

Reprinted, with additions, from The Journal of ihe American Medical
Association, June 21, 1952. Vol. 149, pp. 757 and 75H

CONTROL OF POSTPARTUM HEMORRHAGE

Ernest Myller, M.D., New York

Hemorrhage is one of the most frequent causes of
Postpartum death. Statistics being reliable only from
larger Hospitals, we may assume that many Postpartum
deaths are either unreported or designated otherwise.
In a report from the Mayo Clinic,' the incidence of
death from hemorrhage is 0.491 per 1,000 births, an
average of 1 case per 2,000 deliveries. Postpartum hem-
orrhage in a large Brooklyn hospital caused death in 34
of 37 cases of obstetric fataHty. It can only be conjectured
how many more occur in institutions with lower Stand-
ards.

There are Standard methods of treating postpartum
hemorrhage. It must be assumed from the poor results
reported that they are not always successful. The usual
routine procedure is to endeavor to find out whether the
Uterus is empty or to establish other causes for the bleed-
ing. By the time the examination is completed, the hem-
orrhage may become alarming. Posterior pituitary
(Pituitrin") or ergot is given intravenously, the Uterus is
massaged, and in many cases valuable time is lost. Intra-
uterine packing is resorted to, which stops the bleeding
for the moment. Blood transfusions are started. After a
Short time the bleeding may Start again, seeping through
the packing. Removal and reapplication of packing does
not necessarily stop the bleeding and, in spite of con-
comitant transfusions, the patient may rapidly become
moribund. It is the belief of Douglass - that when the
first uterine packing is not successful, the Uterus is prob-
ably ruptured. If such is the case, a second packing is

From the Department of Obstetrics and Gynecology, New York Uni-
versity Medical College. •

1. Hunt, A. B.: Massive Obstetric Hemorrhage Rcquiring Hysterec-
tomy. Am. J. Obst. & Gynec. 49: 246-252 (Feb.) 1945.

2. Douglass, L. H., in discussion of Beacham, W. D., and Beacham,
D. W.: Rupture of the Uterus, Am. J. Obst. & Gynec. 61: 824-837 (April)
1951.

HHHHi

definitely contraindicated. Greenhill ^ also advised
against packing the uterus a second time, recommending
immediate hysterectomy as the safer procedure.

Postpartum hemorrhage can be controlled, no matter
what its cause, by a method described many years ago by
Logothetopoulos in Athens.* His method involves a type
of packing that he originally used after clamp hysterecto-
mies. It was inserted into the pelvis after the uterus was
taken out, ailowing immediate removal of the clamps
without any loss of blood. Logothetopoulos applied the
same principle of hemostasis to control of bleeding from
the Postpartum uterus after considerable experience in
his surgical cases had proved it efficient. He called the
procedure "traction packing."

METHOD

A doiibly folded quadrangular piece of gauze 36 in. (91 cm.)
Square and a gauze roll 4 in. (10 cm.) vvide and 16 yd. (15 m.)
long are required. The Operator grasps the cervix with one er
several tenaculum forceps and brings it down well to the level of
the Vulva. The blades of a vaginal speculum are helpful in
spreading the cervical canal apart. The center of the quad-
rangular piece of gauze is inserted into the uterus by means of
a spongc forceps. In contrast to the conventional method, it is
not necessary to reach the fundus with this packing.

The four corners of the quadrangular piece of gauze protrud-
ing from the uterus are spread apart. The Operator then packs
the long Strip of gauze into the gauze sack situated in the uterus.
Carefully done, this produces a large round ball inside of the
Uterus. The size of this ball is always the same, being deter-
mined by the uniform amount of gauze strip used. Thus the
whole procedure becomes automatic and not subject to indi-
vidual allerations, an important point in an Operation when
time means everything.

The four corners of the quadrangular piece of gauze are
grasped in one band and pulled dov/nward. The blood supply of
the Uterus is cut off and bleeding ceases at once. In order to
maintain the downward traction, the gauze stem is run through
a thick ring pessary, and the pessary is pushed upward against
the Vulva, which is protected by a piece of gauze. The ring is
fixed in its position with. a ciamp.

3. Greenhill, J. P.: in Yearbook of Obstetrics and Gynecology, Chi-
cago, The Yearbook Publishers, Inc., 1950, p. 241.

4. Logothetopulos, K.: Gynäknelogische Chirurgie, Berlin, Julius
Springer, 1939

Fig. 1.— Insertion of the quadrangular piece of gauze into the uterina
cavity.

Fig. 2. — Spreading the quadrangular gauze and Alling it with a gauze
Strip.

On the other band, traction compresses the uterine ves-
sels against the pelvic wall, interrupting the blood flow
to the Uterus completely. If the uterus is atonic, there
is in addition to this hemostatic effect the oxytocic

Fig. 3. — Downward traction applied to four corners of the quadrangular
piece of gauze.

Fig. 4. — The stem of gauze pulled through a ring pessary

Fig. 5. — Packing in situ and maintenance of traction by application of
a strong clamp.

This packing is indicated only in cases of severe hem-
orrhage, after simpler procedures have been attempted
and the vagina and cervix examined as possible sources
of bleeding. Its purpose is to control bleeding immedi-
ately and to eliminate anxiety and haste. Once accom-
plished, additional measures such as transfusion and con-
sultation may be obtained in leisure. As the patient's
condition improves with or without transfusion, the sub-
sequent procedure depends upon diagnosis. If the Uterus
is atonic and the bleeding has stopped entirely, the pres-
sure is released by opening the clamp, After a short while
the internal strip of gauze may be gradually removed,

followed by Ihe quadrangular piece of gauze, which may
take out with it pieces of membrane left behind. The
removal of the packing is almost painless.

If the hemorrhage has occurred after a difficult forceps
deüvery, a version, or in a case in which a cesarean
section has been done previously, the possibility of a
ruptured Uterus must be considered. In this instance the
packing may enter the abdominal cavity through the tear
in the uterus, intentionally or by chance. No härm can
be done by the possible additional trauma to the uterine
wall, since it will be necessary to remove the uterus any-

Fig. 6. — Compression of the hypogastric vessels when traction is
applied to the gauze packing.

way. Once in place, traction packing allows time for
careful preoperative preparation. There is no urgency
for any operative Intervention while the patient is in
shock. Her chances for recovery after hysterectomy or
more conservative procedures are much improved.

According to Greenhill, the mortality rate of uterine
rupture is 58%. A very recent report from the Harlem
Hospital •' gives the mortality rate as 57.1%. Consider-
ing the excellent facilities and expert attention in this
Hospital, it may be assumed that in less well-equipped

5. Posner, L. B.; Smith, D. F., and Trambert, H. L.: 14-Year Survey
of Parturient Ruptured Uterus at Harlem Hospital, New York J. Med
51:641-644 (March) 1951.

institutions the mortality rate may be much higher. With
successful hemostasis and eliminated urgency, with time
to recover from shock, mortality rates should be con-
siderably reduced. Posner and his co-workers ' stated,
"Immediate transfusion and laparotomy, regardless of
the degree of shock, is the surgical treatnient of rupture
of the Uterus." Speaking of mortality, they add that with
adcquate blood transfusion and present-day antibiotics
all patients might have survived. All these ends can be
realized with traction packing; there is no need of im-
mediate Operation "regardless of the degree of shock."
Actual experience with this packing is limited. Logo-
thetopoulos has used it in only about 10 cases of Post-
partum hemorrhage, but has had excellent results in all.
This packing procedure was studied in cadavers at the
University of Athens." The packing was inserted in the
manner described, followed by traction. A dye was in-
jected into the carotid artery under pressure and therc-
after the pelvic organs were examined. All blood vesseis
except the uterine arteries were filled with the dye. It
was interestins to note that the Ureters were not com-
pressed; they could be fiushed through from above with
very slight pressure.

SUMMARY

There are few new methods available to reduce the
mortality rate of Postpartum hemorrhage. Blood trans-
fusion is often unsuccessfui becausc hemostasis is difli-
cult. Operations are often done with the patient in shock.
Traction packing controls all Postpartum bleeding im-
mediately and therefore should reduce the mortality rate.

65 E. 76th St.

6. Christopulos, C: Anatomische Ergebnisse der Biutstiilunusmethode
nach Logothetopulcs, Zeniraibl. f. Gynük. 57: «07-809 (April) 1933

Printed and Published in the United States of America

Prof. BKRNHARI) ZONDKK

RO'rHHCHILU HAHAHSAIl ITNIVKRBITY HOSPITAI.

JEKUHALBM

July 10, 1941.

Daar CoUee^ue,

I have knofm Dr. Brnst iLiller f or
20 years« He l8 an able gynecologist and had a
large practice is Germany (Nurenburg) and later
in Athens»

It woidd be very kind of you to

help Dr. Miller.

Sincerely yours.

Department of State
Washington, D, C.
September 25, 1941

Dear Dr. and Mrs» Mullers

Your letters from the Kawsar, malled at Pernambuco on the
17th, came today and Mrs« Foster and I are overjoyed to know
that you have safely reached thls hemlsphere and will soon
be in the United States» We have had no woivi of you slnce
your cable of June 7, telllng us thd visas had been Issued,
and had become increaslngly concerned about you« There seemed
to be absolutely no "way to find out what had happened to you
and we had almost given you up for lost, I oannot teil you
how relieved and happy your letter has made us»

I can imagine what a terrlble time you have had» Surely
the worst of your troubles are now behlnd you» It will be
difficult, of course, to try to start afresh in the United
States, and there may be hard years ahead. But nothing will
compare with what you have been through during the past year.
Besides ourselves, there are many people here who are anxious
to help you» I think especially of the Shears CE wrote to them
today about yovr letters) but there are also the Russells,
the G-ordons, and I am sure many more Americans who knew and
liked you in Athens» Mrs» Foster and I are ■«■■■■■■ hoplng
very much that you will not fall to keep in frequent touch
with US as soon as you land euid thereafter; we want to hear
of any way you think we can help you; we want you to call upon
US for any assistance we may be able to give. I shall make
inquiries at once regarding the laws of the various states
as to the practice of medicine by aliens. Unfortunately, it
appears that there are very few states where aliens can
practice, and as you doubtless know it takes five years to
become naturalized as an American Citizen» 1*11 write you in
a few days about the state laws» Meanwhile, I cannot help
feeling that the main thing is that you and your family are
safely here» State medical laws should be a little thing to
worry about after what you have been through»

Yoxir money reached me safely and is in my bank In Phila-
delphia in my name » The original amount was iffFV*TW $3,187»46,
as received by the New York bank (Credit Suisse, 30 Plne
Street) and as you will see from the attached letter the bank
deducted $15.36 for cables and oost of license. The money
is in a so-called "frozen" account and cannot be paid to me
or anyone eise until a license is obtained» I believe there
will be no difficulty in obtaining a license, at least to
pay out a certain amount per month, and I shall apply for
the license as soon as I know you have arrived in the United
States» In any case, I can advanoe you any sum you llke from
my own funds, regardless of your deposit in my name» Please
let me know at once how much you need»

- 2 -

I gather from your letter that you plan to go strllght
from New York to Vleveland. If by any Chance Jou decide to
go through Washington, don't forget that we v/ould be delighted
to see you and to have a vi alt from you« I am glad you have
decided not to stop In New York, whlch Is so füll of refugees
these days that I am told it is eabtra difficult for any Single
refugee to make his way. I think you are wise to push westwards
and to seek a part of the country where there are proportionately
fewer refugees — and fewer doctors as well. Of course, when we
find out what the state medical laws are we shall have to be
guided by them In your choice of where to live.

This letter is meant for both of you from both of us~
and it carries our thankfulness for your escape and all cur
best wishes for security and health and happiness in your
future lives in the United States»

Ever sincerely,

Lä^/\>U^

P. S, I am mailing the original of this letter to Cleveland
and a copy to the boat, though I doubt if the latter will
reach you.

CITY OF NEW YORK )
STATE OF NEW YORK ) SS:
COUNTY OF NEW YORK)

On this day personally appeared before me

•fttt In tmA

who, after being duly sworn, deposes and says:

That she (he) is a professional translator
of the English, 0«MWt •♦«• languages,

employed by the National Refugee Service, Inc., 165 West A^ Street,

New York, N.Y.;

That she (he) has personally made the

attached translation(s) and hereby certifies to the best of her
(his) knowledge and belief that it is (they are) a true version(s)
of the original document(s) written in the

language(s) •

X.J/ 1/ (//,nJ

Swom to before me, the Notary Public
on this/^ day of ^^ 9»m , 19^1

MüTaR^' PU-Hi^A^. vv e=^tchester Co.
jj.Y.Co.Clk'sKo.975Keg.No.3C59*?

Term Uxpires ^•Llrcb 30, 1943

-^78a-7/a

ij^^^^f ■ ■'-^fmmx<v>^s'-::.,!i^mMm^'rrmc^*, --/; :^^: --■■

COPI

1452. loe

I9i:2A3

^ArmilTl arenncATE

Irnst Mfill^r

bom Fetoruiry :^, 1893 at Schaalkaldon^ Dia tri et ««t^ite Schaalkald«
of Jevl3h f'lth, öon of th« drug-ict Joseph Ihieller of Schaalkaldsü
fttteaded 9 y^f^rs the ObcrreMlschule^ 2 ther^^f the hl he st ßr de (Frl»)

l) Conducti food

fi) DiJ.ig<mcet very pood He t.ss «xempt froo the orrl ox^Blnatian

1) Religion (Bo JeiTlsh rf?ligion 1 ssons tire given at tto »cjiool)

2) Gervtat f^lr
S) Froiichi good

4) •dfUslit good

5) HlMtoryt good

6) Geo^aphsn fair

7) Ä the« tic3t goot?
# noralcst good

9) Chemistryi good

10) Ratural historyt —

11)

ticsi f»»ir

12) 'rMhA&d dr ^^Ingl good

13) Linec^ dr&ftlngt

14) SinglBgt

15) Bandwritiag« fWLr

- 2 -

Tli» uiid«r9i^ed loard of IgDoünera therefore gr nts hla a

ÄATOHITY CERTIFICATE
since he Is Umring -«ds Oberrealach !• to atiidy «•dlclne and diaalsse»
bis wlth the best wi«lies for his füture*

Scinalk/ Iden, March 23, 1911

Royal ProvinclÄl
School Board« Cassel

^ayml Bo^rd of Isßydnert
SjL^aatupes of exaain^rs and te
He attended the optional Latin lassoni bald in
connection with thc three hip:he»t gradaa of tht Ob realscbiaa
wlth satiöf.tctory resulta«

3obBalkald«n|» Marcb 25, 1911
ÜMilaurg
•iractor of tbe ^rrealaelula

Mie r'bore aigncnture iö oartified correct

•arlln "oT^jaber 20, 19S5

Bgd. Breimeqke Clerk of the ^ourt

The abovg sign/iture ia cartified correct

Berlin, «ovenber 20, 1935

sp^iU Block Co«ity ^ourt Pr .sidont

^e abo^ aign<ature is cartified correct
Berlin, ioipcaibar El, 19H
Bgd. MmUkm Foreign ^ffica

ROTAL BIV RIAH JULIOS «AXWIUA« UlilV 3111
■OERZBURO

MAViHO C!:htific;.te

llr. EBIST WOfUjOl of SchBaikalden, bort» at Sol»nlkalden
m« «irolled fro« April M, 19U to d«U, aa a studont of

Bsdicln«
•t thlB «nlT rslty and rnpristfir^ duly to tiw lectiires deslj^at'd

Conceming ido conduct nothlnt: derogatory ha.'? been r^ported chiring

thl» period»

lü FITNESS IUERFOy this certiflc t« hao beim Ismied and the
Äe.^l of the ünlv'-rstty and the personal Signatare of the actimr rector
iwkS the Onlverslty syndic effixed ther^to.

lüerzburgt April 11 t 1912

üniY T:i%7 Äectort sga^ Prof* 0r. t.B. Lehiann

^nlvursity Syndiot s-d, iUecible

K 17662

Semester

^ctur^

19U

fint T 19U2A912

Osteology
Or^nlc cbeiftistry
PhQFSica
Botijay

Attatoay I

0ls»ecticm laboratory, court:?« 1

Ittenburg, ^vM U, 191^

K. Oniv« -ity Sindyc
sp:d# illagil^t

V E

RECTOR AÄD

S I B A T E

0? THF HDYüL C11RI3TAH äLBKECHT ÜKIV^ i.:^?! AT KIO,

certify by tbls learlng cartlflcato thßt Uv. KRHST M ü E L L E R
liwm ftt Sctaalkalden son of the druggiat J» Iffiller^ prepared for
ac demlc 3tudies at the Oberreolachule at SobMalkalden^
was mi?triculated wlth us on tl^ strength of a leevln^ certlflcota
tnm the ünlv^^rsity Wu^^rzburg, on Aprli 26, 1912 and de-voted hlaaalf

to the study of

e d 1 c 1 n e«

^Hirlng his 6 aottths stay :t thiü ünivvTSity, he duly reglit«r«d to

the löctures hr^reln'ifter specified, and in ccorciMioe with certiflc tes

suteitted, ßnd gave notlce«

ijffrn st^FT^ m^

Syöteau'itlc anf:to«y of the baea body II

a) Mpi^vouB flty te«
Practical course in cht»lstry for

■edical students
Short surrey on inorganic and org^nlc ch<?aistry
Physiolory of the auedee

Conceming hi» conduct at the üniveralty nothln^: dei^ogatory ha^ beeo

reported«

Issued hy the aotlng llfctor« Signature ond seal af fiztKl»

^el, August 22, 1912

Seal

8gd. ille^ble

9(^0 Wenier
ünlv^^r^lty Secrot.ary

taie on

lEUgust 1, 1912

Mo 945

HOTAL BAVARIAN JULIUS M/HMIUAl ÜMIVERSITI TOERlBÖRß

Lri^VING CS.mFICi.TF

■r» Ernst Miller of Schnalkaldent bona at SclÄMlkcild«
•&Ö antrtculated at this ^Ivorsity froa ^ctober 18, 191^- to df.te

as e Student of

■ edicino

and duly reg! 3t red to the Icctures hercinafter spocifitd»
Concc^ming hl3 conduct durin- this p rlod no^hlnp d rop^^tory haa bei

reported»

IN riTN^S'' mwOT thl? certific'te hps b«eo issued an-] tb»
3 1 of the nivBrslty f^nd the persomil sign^ture? of the acting rector
and the universlty atyndic fiffixed thereto#

^erzbuTf?, Au^nist 13, 1915

«Ml

Üniv«?r3lty Rector
Sjprd. Prof. Dr. ^ . Hehn

Unlvc-ralty %nf?lc
•fd« B3ueller

Scaaeiitar

Desiptiatloo of Lecture

Winter 1912^915

1915

DisifK^tion exercises 2nd oour9«
Phorsiology

XooXocf

Topographie äoutomy
S0p«tltion cottre# in ^nxitoay
Pfagrtiologic chöÄlstry

Pborsielogy

^opogrmphxc a&^^tosy

Bxereis«« in phQrsiolo^

2ooloty

Course in «icroacopy

4
3

CITHTIFTC/

\ of ^ Bin- rß üt luer«burg

on the
«ödical prellnlnory exaröln^^tlon of thm
Student of »ediclne Mr. ' PJIST II ü E L L E B of SehaulkKlden

The followinf' » rks wera giren Ydm after the
pr«linlnnry ex'ad.n«tion heJLd in accord«nce with tliß exriain tlon

Order of »ay 23, 1901»

1) In anatoay

Z) In Pl^ßiology

5) In Pl]Qrj?lca

4) In CboÄlstry

5) In Zoology

6) In Botany
thus tlie avwrage rating

the mark

Tery good
▼ery p:ood
▼ ry f^ood
good

▼ery f^od
good

» r;Rl GOOD ••

luerftburgB July 17, 1918

Tb« cbairMm of the ba^rd of exaidiiers

sgd* %derl«l
Seal

Leg<^li»ed
1Ner«bun», Howaiber 20, 195S
OoTfsrawwit of Htttf rfr?:nk^ts and Aschwffenburg
Clammbmr for lKt»^mal Affaip«

10^V483

ÜWIVFHSITY

n N I C H

CKirriFTn^TF

IiE.\VIirG 7HK UKIVKHSITI

Ir» fcttot » Ä 1 X e r> of SeteOkaldeo, tom t Schß^ilk Ideo

was Bi^* tricuiated at tlils ünlvorsity froa October 28, 1913 tJirough thtt

«nd of the suMier aosester 1917 as i^tudent of »«dlcln«

cnd re^ifjtered to th» lectures deaifiiatcd in tb^ att^ched colle^y^ book»

Conceming hia conduct« durlnr this p^riod nothlnf' derog^tory
h&3 be<^ reported»

IN T^TRESS t^HIRBOf thls certificate h a l>€en is^nied ttid tht
imivor^'lty seal, bb wöU aa tlie personal si^ifaturen of th^» r^otini: rector
«Id syndic of the imiverslty affixed thoreto*

■Kmich, Deceaber 5, 1917

Th^^ n^cting fUctor
sgd« 0. Igl

sEa

»awiiiKiiimiti

Propnedmitlc gynacolof^ic clinic
TtaftTiqiKmt.ios of internal diseaa««
Paln prevQotion in lur^cry an ' pr cticsl
•K^rcises

pro^aod^oitltfs (aur^iccil diagnoais
tmd sur^cal therapeutics, exercisea)
■•dior.1 clinic for beginners
K'^tal diseaMis

Clinic tind polyolinic o^" pediatric di3et.ae«
includinf^ pllfBlolo^ and petknilogy
of «u'rition in inf«^ts» age

4
1

ffnf^. itv Munlcb

X 8Q||€3ter 1914

Surglcal clinlc

Obstetrlc gynecolopic clinlc with clinlcnl md
polyclini al obstetrlc obaerv^tions and
exercl««» in touch exaiEin?>tlon8

Oti^xtrlc clinlc (with otoscopy)

ExerciBe» in dia^oais on polycllnic*a patienta

Rhino - laryngolo^ic dinic

Theoretic &nd preictical ▼^ccinütlon course

Clinlc for Syphilis ^m I derma tolof^ic dicea^jef

i^edical clinlc for adv?mced -tudents

Intubiition md tr-cheotony

Fnge t

fBüftter

SiflBier
t»inter

Summer
Unter
ler

«eaestsr
»emester
Semester
Semester
Semester
Semester

1^4^915

1915
1915/1916

1916

1916A^1'7

1917

of absoncsj in the aray»

smals

IE BFCTOR AND lEiATE
«R MTAL FlIEDRICH flLiilLM ÜIIVIllSITI AT BCBLIM

certlfy by this le< vlnp certificate that Mr« HÜIST i ü 1 t L E R
bom at Scbsalkaldca in He«M»«llatMU^ mm of thf^ ■•rohant Mfiller

vat prtipared for a

c studiaa at the Obt^rrealachule at Scbnalk^ Id»

frw the tfeivftrsity lonich «i Mor-mber ZZ^ 1917 and re»ftined here

as a Student of

aedicine

\uitil the ead of the auMier soKeatar 1918»

DuriBg the tiaa he attended this university he duly registered to
the lecturea apecifled in the attached li^tt

JSSm

^flkm^VLm Qt l<^v}^w?

l
s
s

Winter Seaester 1917A911

Istperiaental phamacology
Forenslc nedicine
tapographic anatovy

|T Sipmer Sanester 1916

ledical polyolinie

Obstetrlc gyaeoologic dinic

Psychiatric clinic

Sirglcal dinic

Ophthalmie clinic

Course in pathologic anatony aad exerciaea

Course in aicrosoopy in patholo|ic histologsr

Course in pathology on fresh preparatioiii

'•• ttaap

After thm oandidate of sedicin«
rigiST I U E L L £ H of Sdnalkaldon has pasoed bis
»•dio^ ©xaalnatlon before the board of oxaminers at
Berlin rith the aark • g o o d • lad hiß war aendoet
bad bean taken account of in stm^d of tho oKLiftatory
pr?icticiil interne ye ir^ he is hereb^ gr^mted a

LICINSE AS PHTSICIÜ
valid froa the Sovomber 27, 1918 and for the territory
of tho Qeraan Reich in « cconlanoe vith ?ar 29 of the Reichs
trede order«

Berlin» I>ec^ber 17» 1918

Seal

KiaiatTy of Interior

^y Order
agd« Kircteier

Seen for Terificetlo« of
abeve alfanture
Berlin» loTittber 7» 1955

•eel

The Foreign Office of
tbe ^^enMOi Beleb

agd« Reii^e

L I C E N S E
for
Imst ■ fl 1 1 e r
aa pb^sioian

IN TE: FllIEnUCH-WI LK!1I«S

rnivririTY in r hlii

ünnar tlie maeniflcont R#ctorship of Reinold S^eberg, Doctor of

Theo ogy, Doctor h.c, of Law and Philosophy, Public ?rof««sop

in ordinär/ »t thi« University, •

by ord^r of the gracious Faculty of M^jdiclne,

Wllhel« His, duly coamis.^ion'^ Pr raotort Doctor of Medicine and
Surgery, Public Pr rfossor in Ordinary at thio Uni^versity, •

DeiiH pro teia. of the Faculty of Medicin«,

haß It^wfully conforr«d U'^on the raof^t l«j.m«d

Ernst M u e 1 1 • r
of Hes8en--^^&3aau^

^ aedic&l practltioner,

th« prerogatives und Privileges, tbe de^-ree and tho honors of

DOCTOR OF SiKDICINE

«fter h« pG5:^ed the oml etaü^lntticai and aftor bis pr&isfcvcithy
thftßia, writtftn in the Germ*ia Iw^n^uiige tn bearing the tiil«»
"U«ber die Torsion de» Sattenstrangs" was pr.nt'id with thö approval
of the F?.culty«

Thie 17th day of January 1919.

IN rrniEff^ m^ERBOF THI'^ DIPLOI^A HAf BEEN If^f^üED ÜMDEK THE SFAL
Of TH2 fACüLTTt

•gd, Hist r^ean pro tm,
Thö forfigoing »i£7iatui*e has be«n afrixed
by the hmtin of the Faculty of *^*^icine
ftt th^,t time, Profeagor D; • His.
Berlin, Noveruber 6, 19B5» The Hectori
(•eal of the University) »gd.iliegible

The genuinenesa of the C*«^}

aign ture of the Äector

of the ^*niv>raity of **erlin

ia h*ir«by cirtified,

Berlin, HoTaii^ber 9, 1955,

The Prusüian **inlster of Science,
Art and Public Eciuc&tiont
Byt ag« . Dr. 2unkel.

(•eal)

5£3719^

•e«a for certificätion of the efon^oiaf
8i£Tiature,

B«rlin, Soveaber 16, 19i^ö« The Foreif:n Office

of the Geit&an Reicht
Byt agd. illet-ible. faeal)

♦ franeittor^a notet fUrther titlea oaitted.

CITY OF nm YORK

coüNTY or Nr; tork

)

On thi.' duy personfdly app«'^^ red before ae

HAIIS D. FROEHLICH
resldlag et Ul - 10, 7cth Road, Forest Hills, N.I., who after
beinft <3uly swom, deposes and sryst

Th«t he Is thorougbly f«.»ilif:r frith the li^glish and
Greek langU' ge^f

That he persooally »od« the at ichtd tmaslrition «i
hereby certifiea to the best of hls knoidodg« 6ad ball f that
It i8 ?? true Version of the origüifil doc^iaent Witten in the
Qreek iMfiiafe*

to befope Be the ^otf ly Public
on thiv* 13th day of ^oTcnber 1941

OTIVt^R^nT OF ATHUIS
DIRECTOR 0? KPICAL dOIDOL

AtiMBS^ hy 15^ IMS

flle Ho 249A071

OIRTIFICITE

Dr, ^ST J. KÜEXLER^ doctor of «edlcine, gradu t^ tram
the ünivoralty of Berlin, born at SchafOk adf», C^xwny

PASSK) WITH HC^ORS
üxx exrjiination held In accordaxice wlth tho 1&W3 of thi»
Universlty aa of April 15, 1935 tmd !• h«rel]y fffWtac a

LKOTTSE TD PRACTICB »IDICIHI
in Or««w Rftd hold govenuiÄit ppiltlons.

/-'

Sgdt (Uleglbl«) Ülrector

S« a l

No. 839,641.

«--

PATENTED DEC. 25, 1906.
E. REAVLET.
CÜRETTE.

AFFLIOATIOI FILEO BEO. 81. 1906.

"Eäg-I.

-zB

WfTNESSES:

-:ß

INVENTUR
BY

ATTORNEYS

TW MOitmt* pmTmm» eo., WAMHiHo-nm, b. c.

May 24, 1949.

J. E. AYRE

CERVICAL SCRAPBR
Filed Oct. 1, 1947

MUf.£

/A'

■m

-\2.

2,471,088

z^ y )^,

m^f.Q

t-^\

JErj0.3

Wlg.O!

SQUAMO'COLUMNAR
JUNCTI0N(9)

GLANDULÄR EPTHEUUM(tO)

■NULLIPAROUS TYPE
OF CEPVIX

Mig.5

PAROUSyLACERATED
OR ERODED
CERVIX

INVENTOR.

JAMBS ERNEST AYRE

^^Xl^rrJ^^ A^^^^L^l^

ATTORNEY

Patented May 24, 1949

2,471,088

UNITED STATES PATENT OFFICE

2,471,088

CERVICAL SCRAPER

James Ernest Ayre, Mount Royal, Quebec, Can-
ada, assi^nor to Clay-Adams Company, Inc., a
Corporation of New York

Application October 1, 1947, Serial No. 777.218

1 Claim. (Cl. 128—304)

My present Invention relates in general to an
improved and novel scraper for use in "spatula
cytology technique " and more speciflcally to an
improved scraper for use in selective cytology
employed in the diagnosis of any accessible sur- •'
face Cancer.

The selective cytology technique was developed
in a search for 9 method of studying evldence
of Cancer growth in the cells which become
earliest involved in cervical Cancer. The squa- ^:>
mous cells encircling tho tiny cervical opening
at the squamo-columnar junction constitute a
key point of origin for Cancer more frequently
than any other Single focus in the female body.
The scraper test offers a technique providing 1-»
"surface biopsy" information of these cells prior
to their actual desouamation. The idea Is to
detect evidence of the earliest cell change in
malignsncy ard of precancerous cell changes.
It must be emphssized that the surgical biopsy 2i}
is dependent for success upon the lesion being
visualiy demonstrable. Numerous cases have
been encountered where a Single biopsy missed
the growth while repeat sections revealed a small
Cancer. By study of cells in selective cytology 25
smears, morphoiogic changes have been identi-
fied believed to constitute a precancer cell-com-
plex. Through early diagnosis of Cancer by
routin e cytology tests, death from Cancer of the
cervix should become highly preventable. Gü

One of the important objects of my present
Invention is to provide a novel and improved
scraper of pr.rt-cular advantage in the selective
method for obtaining "sin-face biopsy" from the
squamo-columnar junction of the cervix, and of 35
general advantage in the diagnosis of any ac-
cessible surface Cancer, e. g., tongue, lip, throat,
skin and vulva.

Another Import ant object of my invention is to
provide a cervical scraper which is generally ^0
elongated In configuration and possesses a degree
of flexibiMty. the scraper having one end thereof
constructed to take a smear of a nulliparous type
of cervix, vhile the opposite end is constructed
to be adapted for a parous or eroded type of 45
cervix.

A m.ore specific object of my invention is to
provide a thin elongated scraper, one end thereof
having the form of a broad blade of uniform
width, while the opposite end generally has a pair 50
of divergent protuberances whereby one of them
functions as a pivot for the other as it is rotated
during gentle scraping of the entire squamo-col-
umnar junction throughout its circumference.

Still other objects of my invention will appear 55

as this description proceeds, it being emphasized
that my present scraper is extremely economical
in manufacture thereby to make entirely prac-
tical a simple Office test for uterine Cancer diag-
nosis.

In the drawing:

Fig. 1 is a füll size front view of a scraper con-
structed in accordance with my invention;

Fig. 2 is a section taken along line 2 — 2 of Pig.

1 lookins: in the dlrection of the arrows;

Pig. 3 is an end view of the spatula viewed from
the blade end;

Pig. 4 shov/s the manner of using the hook end
of the scraper; and

Pig. 5 illustrates the use of the broad blade end
of the scraper.

Referring now to the accompanying drawing,
the scraper is generaHy of the configuration
r'epicted in Fig. 1. The intermediate section f of
the elongated scraper is a narrow thin strip of
generally rectangular shape. One end of the
strip \ is formed into a broad blade or paddle

2 whose sides are parallel, and whose leading
edge 3 is arcuate. The opposite end 4 of the
strip I is essentially heart-shaped in that it com-
prises a pair of divergent protuberances or
rounded peaks 5 and S. The protuberance 6 is
larger than its mate, and extends beyond it. The
arcuate Valley or concavity 7 between the peaks
or convex sections 5 and 6 functions as a scraping
edge. The concave and convex sections 7 and 6
function as a scraping edge. The entire strip is
made of thin wood. but may be pressed from a
plastic material, or a nulp material such as card-
board. The scraper may, also be made of metal.
The scraper is dispcsable after use for obtaining
a surface biopsy. It will be noted that the edges
of the section 4 are roimded. The width of blade
2 is somewhat less than the width of section 4.

The method of t.?king a cervical smear for se-
lective cytology requires first the adequate ex-
posure of the cervix with a bivalve speculum.
The mucus present at the external os is aspirated
using a small glass pipette, or it may be wiped
off with a cotton swab and discarded. In all cases
we take both the external os smear by aspiration
and the scraper smear for selectivlty. In these
cases the aspirated mucus is placed on a slide for
the usual staining procedure, preceding the tak-
ing of the scraper test. Following the removal
of excess mucus, the squamo-columnar junction
is viwsualized. The precise method of taking the
scraper test will vary according to the type of
cervix, e. g., the presence of extensive lacerations
or erosions will modify the procedure.

«*

mmt

2,471,088

A nulliparous or healthy-appearing cervix
showing the squamo-columnar junction just out-
side the circle of the cervical opening may readily
be approached by simply placing the end 4 of
the scraper gently against the cervical opening. ^
Reference is made to Pig. 4 which shows the man-
ner of using the section 4 for a nulliparous type
of cervix. The extensive peak 6 ^is gently poßi-
tioned, as shown, against the cervical opening 8.
While held in this position a rotary movement, jq
indicated by the circular arrow, permits light
scraping of the entire squamo-columnar junction
9 throughout its circumference. By rotating the
scraper the entire circumference of this cancer
Zone may be "surface biopsied." The cells shed
from this key point show the earliest indication
of incipient Carcinoma bef ore any lesion may be
recognized by the naked eye. Thie hook end 4 is
not suitable for cervices with long erosions, a& the :
scraping might miss the isquamous tissue, obtain- ^^
ing a "surf ace biopsy" of glandulär tissue only.

PaFOUs cervices more commonly exhibit a larger
Portion of the reddish glandulär cervical epi-
thelium, with or without an erosion, eversion or
laceration. For cervices of this type the scraper .^^
test is taken by scraping along the squamo-col-
umnar-margin at the most suspicious area with
the other end 2 of the< scraper. This is shown
in ügsö.which depicts the manner of using the
end 2. The vscraper is rotated in the direction of 3^)
thearrow% Whether the secretion is derived as
shown in Pig. 4 or Pig. 5 it is spread over a glass
slide, and then processed to preserve in a glycerine
media for 7-14 days so as to submitto any special -

ized cytological laboratory for experienced inter-
pretation.

In summary, from a cytological study of over
3000 cases, by the use of cervical cytology tests
in general and the scraper technique in particular,
death from Carcinoma of the cervix could poten-
tially become highly preventable. It would ap-
pear that «by routine cervical cytology tests with
a scraper of the present type it becomes more
practical and easier to take advantage of the
lif6-saving possibilities offered by cytology.

What I Claim is:

A cervical scraper consisting of an elongated
stripi one end of the strip being generally triangu-
lär and having a pair of unsymmetrical convex
end sections connected by a section of concave
configuration, one of said convex sections being
substäntfally longer than the other, and said
longef section being adapted to enter the cervical
opening and f unction as ^'a pivot, the shorter sec-
tion functioning as a rotatable wing relative to
said pivot, said concnve section being adapted to
scrape^celis from the squamo-columnar junction
in response to rotation o£ the scraper about the
pivot afforded by said longer section.

JAMES ERNEST AYRE.

REFERENCES CITED

The föllowlng references are of record in the
ü\e of thts patent:

Catalog of George Pilling & Son Co. of Phila-
delphia, published in 1921, page 122. (Copy in
Division 56.)

Ilt^printed from NEW YORK STATE JOURNAL OF MEDICINE, Vol. 50, No. 3, Feb. 1, 1950

A CERVICAL "SCRAPER"

Ernest Myller, M.D., New York City

iFrom the University Hospital, New York Univeraity-Bellevue Medical Center)

PAPANICOLAOU'S detection of exfoliated
Cancer cells in the vaginal smear has added
greatly to the early recognition of malignant dis-
ease. The present method of scraping the cer-
vical canal in order to obtain a greater concen-
tration of Cancer cells, and especially more cells
from the cervical epithelium, is considered an
improvement over the simple vaginal smear,
The important region to be investigated is the
junctional region between the columnar cell
epithelium and the squamous cell epithelium,
since the majority of cervical Cancers originate in
that area. The detection of cancer of the cervix
and the fundus at the earliest possible moment
will increase the curability of this disease to a
considerable degree. The well-founded assump-
tion that a noninvasive Carcinoma may be present
intraepithelially for many years without any
Symptoms and without progress justifies an
examination of every adult woman by the vaginal
smear method or with a cervical scraping, or
both.

A simple Instrument, the cer\4cal "scraper,"
facilitates obtaining satisfactory specimens with
every routine vaginal examination . * This Instru-
ment consists of a small metal cone attached to a
handle (Fig. 1). On both sides of the cone there
is a fin (Fig. 2) . These two fins converge on the
top of the cone. The free sides of the fins are rec-
tangular but not sharp. When used properly
no trauma occurs; only epithelial cells will be
scraped off. Satisfactory smears can be obtained
by an examiner without pre\'ious experience.

Fig. 1.

After exposure of the cervux with a speculum,
the cone is inserted into the cervical canal and
rotated once or twice with very slight pressure
(Fig. 3). Occasionally, suspicious areas outside
the canal should also be scraped off with the top
of the instrument where the two fins join. The
epithelial cells will adhere to the fins, and the

Fig. 2.

Fig. 3.

material thus obtained is transferred to glass
südes by smearing it from the fins directly on
the südes. The slides are immediately immersed
in the fixative Solution.

The cervical "scraper" is easily sterilized and
can be used repeatedly to obtain cells from the
cervix. In comparing smears taken with this
scraper and with disposable wooden spatulas, it
appears that more sheets of well-preserved cervi-
cal cells are obtained with the former with little
or no bleeding. The instrument penetrates as
easily into the nonparous cervical os as into a
lacerated, diseased cervical canal.

♦ Manufactured and distributed by United Surgical Supply
Co., 160 East 56th Street, New York City.

304

lUipriiited fiom NEW YORK STATE JOURNAL OF MEDICINE, Vol. 50, No. 3, Feb. 1, 1950

A CERVICAL "SCRAPER"

Ernest Myller, M.D., New York City

{JFrom the Universüy Hospital, New York Univeraüy-Bellevue Medical Center)

PAPANICOLAOU'S detection of exfoHated
canoer cells in the vaginal smear has added
greatly to the early recognition of malignant dis-
ease. The present method of scraping the cer-
vical canal in order to obtain a greater concen-
tration of Cancer cells, and especially more cells
from the cervical epithelium, is considered an
improY uient over the simple vaginal smear.
Tho important region to be investigated is the
junctional region between the columnar cell
epithelium and the squamous cell epithelium,
since the majority of cervical Cancers originate in
that area. The detection of Cancer of the cervix
and the fundus at the earliest possible moment
will increase the curability of this disease to a
considerable degree. The well-founded assump-
tion that a noninvasive Carcinoma may be present
intraepitheüally for many years without any
Symptoms and without progress justifies an
examination of every adult woman by the vaginal
smear method or with a cervical scraping, or
both.

Fig. 1.

After exposure of the cervix with a speculum,
the cone is inserted into the cervical canal and
rotated once or twice with very slight pressure
(Fig. 3). Occasionally, suspicious areas outside
the canal should also be scraped off with the top
of the instrument where the two fins join. The
epithelial cells wdll adhere to the fins, and the

Fig. 2.

Fig. 3.

material thus obtained is transferred to glass
slides by smearing it from the fins directly on
the slides. The slides are immediately immersed
in the fixative Solution.

* Manufactured and distributed by United Surgical Supply
Co., 160 East 56th Street, New York City.

304

Conclusions

Till.' importaiice ol" corvical ()l)türatioii in llie proccdurc ol' utcrotubal
iiisufüatiüii and hysterosali)iiij»ü<»rapliy lia.s been c'!ni)ha.sizt'd. Dcsiderata of thc
ideal uterine cannula are :

1. I*ainless application uiiacconipaiiied hy trauiiia.

2. Airti<^]it elosure of the eervical canal.

3. Maintonanee of tho normal anatoniical position of llic nlci'us.

A new cnnniila witli inflatablo balloon foi* eervical obluratioii lias Ix-en

deseribed.

References

1. PersoiiJil coiiiiiiuiiicatioii. Ackiiowk'dj^niK'iit is herewitli iiuul»' to \\. H. Sloiil, iM.D., h)r

liis kiiuliioss in lettiii^ iis see Iiis iiistniineiit.
L'. Decker, All)ort: Am. .1. Obst. & Gynec. 54: 1077, 11*47.
:\. Kubin. I. ('.: Am. .1. Ohst. & (Jynkc. 45: 41!>. I!)j:'..

CKKVK'AL OirrrHATlOX WITll

IXFLATAHLK CANNTLA IN

ITEROTriJAL IXSrFFLATlON

AM) HVSTF:K()SAL1MX(}()(}KA1MIV

I. C. RUBIX, M.D., F.A.C.S.

and

KKXKST MVLLHK, M.D.

New York, N. Y.

Keprinted fntin

A.MKincA.N .»OTKNAI. OP OP-STKIKK "S

AND (iVXK('()L()(}V

St. Louis

Vol. .')(•). X... (i. Paoes 1()77-1(I.SL', December,

1948

( l'rint.ij in tlir l'. S. A. >

CERVIOAL OBTURATION WITH INFLATABLE CANNULA IN
ÜTEROTUBAL INSUFFLATION AND HYSTEROSALPINGOGRAPHY

I. (\ RiBiN, M.I)., F.A.(\S., AND Ernkst Myi.lkr, M.l)., Nkw Vohk. X. V.

CKIiV'K'AL ohturatiüii is of major iniportanee in the teehnical i)r()ee(linT
Ol* uterotubal iiisuflflatioii and hysterograpliy. Uej>;iirgitation of (M)., gas
or oil leads 1o unreliable estimation of the pressure eniployed, and not int're-
(|uently to wrong Interpretation as to tubal i)ateney. ()l)turation is usiuilly
secured ])y pressing a rul)l)er or metal acorn against the cervical os. Tliis is
easily aceomplished in the i)resenee o!* a round and \vell-shai)ed external orifiee.
ilowever, if the external os is irreguhir in eontour as in hieerations and eversions,
exeessive pressure nuist be exerted by the aeorn in order to prevent leakage
oi* tlie eontrast medium or of COo gas as the ease may be. To prevenl
regurgitation the eervix nuist l)e grasped finnly vvith a tenaculum foireps
exerting eounter pressure. In this maneuver, the uterus is either pushed up-
ward Ol- drawn down. To keep the balance by equal push and pull is some-
times (litTioull. The anatomic change in position may oeeasionally be sufficienl
lo simubite elosure of the tubes by eausing artificial kinks at the uterot ubal
Junction or by artifieally stretehing adhesions which do not othervvise obstruel
the tubal lumen when the nornud position of the uterus is undisturbed. The
canmda devised by Colvin with serew tips of vai-ious sizes, later moditied by
lludgins, affords tight obturation but involves a eertain aniount of trauma
which theoretieally may predispose to embolization.

After many years experienee with hysterosalpingography and uterot ubal
insufHation the prere(|uisites of an ideal uterine eannula ap]>ear to be the fol-
lowing :

1. Its application should be painless and unaceoiupanied by trauma.

2. It must provide airtight obturation of the cervical canal.

3. It should maintain the normal anatomieal position of the uterus.

The cannula presented in this paper has been devised with these desiderata
in view. It is based on a rather old deviee, namely, the iise of an inflatable
rubber bulb in order to change the diameter of a rigid Instrument. Nitze,
the inventor of the cystoseope, made use of this prineiple for a ureteral
catheter. In 1883, a United States patent was granted to Ileiu-y K. Finney
for an Instrument based on the same prineiple for "the treatment of the male
Urethra." About twelve years ago, one of us (I.C.R.) constructed a cannula
similar in prineiple to the one about to be described. Dr. R. B. Stout had the
same idea, except that he placed the rubber balloon within the uterine cavity.'
Decker,^ in a recent publication, also recommends inserting the rubbei* balloon
surrounding the cannula tip into the uterine cavity. This prineiple has been
employed by one of us in studying the differential hetween uterine and tubal
contractions during uterotubal insuflflation.^

The present cannula (Fig. 1) has developed out of a simple inodel wliieli
we linv(» iised since 1946 in 175 eases lor eervieal ()l)turati()n. The eanmila has
Ihe h'iijith and dianieter of an ordinary uterine sound. It consists ot* two
metal eliannels, one of whieh is very narrow and ends a])()ut 2 eni. hehind th<'
tip of the Instrument. Its opeinn^- is eovered l)y a thin, ehistie rui)ber tuhe, 2
to 8 eni. lonj»', whieh is tie(i at eaeh end to the shaft of the instrument hy
siu'«ii('}d silk.*

FiK. 1. — C'aniiuhi asst-nibled it-adv for iise witli revolvinj; ilisc. hubs for' sviinm' an.l
manometer connections aml inflatable tip (letter B below letter C not visible). (a). Rubber
tubitiK (listonded. (h). Extension tip for inseition into uterina oavitv.

The instrument ean be inserted easilv into anv eervieal eanal wiiich admits
a uterine sound. In most eases it is not nece^ssaiy to grasp the eervix with
a tenaeulum foreeps. The latter ean he removed as so(m as the ruhher-eovered
tip lins heen inserted inside the eervieal eannl. In eertnin eases, e.*»., Stenosis
of Ihe internal os, it may he desirahle to insert the eannula with its tij) in the
uterine eavity. Foi* sueh imrpose the short tip (T) (Fi^. 1) may be repbieed
hy a lonj^er one (T,) (Fi«»-. 1). Preliminary dilatation, when desirabie, sbould
not be done just before the injeetion of eontrast media or before insufflation.
So far it has heen possible in our eases to introduee the eannula in eervieal
Stenosis after the latter was i)assed by a uterine sound.

The cannula is inserted with the revolvin«? dise D in the position thal
presents the en«?raved letter H (bulb on the dise) (Fi^. 1) opi)osite a fixed
indieator. Throujih hub A, whieh fits the liUer syrinjye, 1 to 8 e.e. of w^ater or
air are injeeted and thus the rubber tube at the end of the instrument l)eeomes
distended (Fijr. 1«). With a little experienee one ean soon feel whethej- the
bull) is sufheiently ex])anded. If one is interested m eheekin<>- the pressure in the
inllated balloon, he need only turn the dise to (\ remove the svrin^e, and attaeh
a nuuiometer to hub A. On turnino- the dise baek to B, the pressure within the
»•itbber balloon will be ])romptly indieated on the nuuiometer. It is to be noted

I' -.. *J*^^ cannula presented horo is ma.le and distributed by United Surpical Supply Co IfiO
I'.. ;>() .str«'t't, Aew 1 ork, N. Y. r-r- .7 ,

that if less than 1 e.e. of air or water is used to inflate the balloon, the pi'essure
rea(lin«»:s in the balloon may not be aeeurate. \ow the dise is turned to the Posi-
tion marked by the letter T (elosed) and the instrument is ready t*or the pro-
<'(Mlui'e.

Fit;. '-. — Inflatable cannula flUed with diodrast obturating the eervieal canal. Note that it is
pyriform or aeorn in shape as compared to the oval-shaped inflated cannula outside of the body.

The dise is now turned to the i)ositioii X (= x-ray) thus eonnecting hub A
directl}' with the tij) of the instrument inside the eervieal eanal, or to tip T_.
in the uterine eavity. A Luer syringe eontaining the eontrast medium is
eonnected to hub A and the medium is injeeted into the uterus and the x-ray
exposure follows. For fraetional injeetion of eontrast medium, the dise is
turned to position C after the first fraetion is introdueed. Hands and sy ringe
may now be removed because the expanded bulb retains the eannula in situ.*
By turning the dise hack to ])osition X the second fraetional injeetion ean be
made, and if need be, a third or fourth.

When the kymograjdi is employed it is eonnected to hub A and the dise is
turned to position X. The insufflation test ean be earried out with a 20 o.e.

*A .special clanip adaptable to any vasinal specuhnn has been devised to keep the can-
nula in the horizontal position.

I.uer syringe attached to hub A. The disc is turned to position R (== Rubin
fest) whieh cnnblos us to moasure thc exortod prossiire ])y eonnecting tlio man-
ometer to hub B. In the simplified test, 20 c.c. ot* carbon dioxide injected l)y
a syringe is sufficient because of tlie c()mi)leto elosine ot' the cervix without an\
leaka^e. A sudden fall oi' maiioiiietric ])ressure is indieative of tubal i)ateney.
If Shoulder pains result they are minimal.*

By inflating the rubber bulb with an a(iueous contrast medium (e.«»-.
diodrast) one can easilv domonstrate the relation of the bulb to the cervieal
canal (Fig. 2). In order to note the distensibility of the intracervical balloon
and any changes that the cervieal walls might exert upon it, another eannula
with the balloon filled with an e(iual amount of diodrast was exposed at the
same time on the same x-ray film. The shape of the balloon inside the cervix
may be compared to the external balloon in Fig. 2. In Fig. 3, water has re-
placed the diodrast and is therofore invisible, while the uterine cavity is
Seen filled with contrast medium. Incidentally, the cervieal balloon reveals a
configuration whieh does not conform to what one notes in conventional draw-
ings of the cervieal canal because of distention by the rubber balloon. The
cervieal canal appears, from our study, to yield readily to a greater degree of
dilatation than has hitherto been realized.f

Owing to rigid walls, some cervices were found to resist balloon distention
with 2 to 3 c.c. of water. Nevertheless, good obturation could be obtained with
less filling. If the rubber part of the instrumcnt is not inserted deep enougli
into the cervieal canal the balloon may Imlge through the external os. IIow-
ever, this does not prevent airtight closure. Should the rubber bulb be pushed
out entirely from the- cervix it mav be reinserted and kept in place by grasping
the anterior lip of the cervix with a tenaculum forceps. In several cases the
cervix w^as found transformed into a shallow cone. Airtight closure could
be obtained in these cases by advancing the expanded rubber bulb into the
cone while the cervix w^as held in i)lace by a tenaculum forcei)s.

The present cannida has the advantage over the ordinary eannula with an
acorn tip in that it brings a larger area of the endocervix in contact with
the acorn. Hence, the pressure required to obturate the cervix is less. As
this pressure is not only directed u])ward, but upcm all sides, dislocation of the
cervix does not as a rule result.

The pressure withhi the rubber balloon automatically predetermines the
maximum pressure whieh is intended to be used for the insufflation test or
salpingography. If, for example in the bulb is 250 mm. Hg and the pressure
used during insufflation or salpingography is higher, no matter how little this
may be, there is prompt escape of the gas, or oil from the cervix. The same
physical law operates here as in measuring blood pressure. If the blood pressure
exceeds the pressure in the armcuff, tlie ])ulse wave immediately returns.
The balloon in the present eannula thus forms a desirable safety valve whieh
automatically prevents an undue increase of pressure inside the uterus.

This feature of the Instrument is of importance for salpingography.
üsually a contrast medium is used whieh has a certain viscosity. Pressure
determinations when lipiodol or other viscous fluid is used are not accurate
because of the considerable friction inside the small lumen of the eannula
where a rapid decrease of pressure takes place with each progressive centimeter
of the lumen. When the constrast medium enters the uterine cavity the

•The senior author does not recommend or employ the use of the syringe for Injectinj?
CO2 into the uterus for testing tubal patency, preferring insufflation by means of the automatic
Siphon nieter with kyniograph. The present eannula is adinirably adapted for this apparatus.

tThis point of elasticity of the cervix under various conditions will be the basls of a
future publication.

pressure inevitably falls. If tubal obstniction is encountered there is a grachial
increase of pressure inside the uterus until it e(iuals that whieh is exert ed by
the syringe. Before this i)oint is reaclied a high pressure may be exerted
through the syringe whieh is not usually api)reciated bv the Operator uidess
he uses a manometer. The rubber balloon affords salVtv because when the
pressure exceeds that within the bulb, the oil escapes at once through the
external cervieal os.

Fig. 3. — Inflatable eannula filled with water (theiefore invisible by x-ray) obturatlng
the cervieal canal. The contrast medium (rayopaque) demonstrates the uterine cavity. The
rubber balloon distended by diodrast is .seen below outside of the body for purpose of comparison.

The Instrument ean be sterilized by boiling. The rubber bulb ean stand
boiling many times; its cost, however, is so small that it may readily be replaced
for each test. We have found it practical to tili the bull) before inserting the
eannula in order to note whether it is watertight. However, should the
rubber break it is immediately appreeiated by the drop in resistance. The
water escapes through the external os and does no harin. Ft is particularly to
be noted that the Operation of the eannula is exceedingly sim])le, and after soine
little experience, requires a minimum of time.

?i-»jV--,T^3-^OT*-'TT"''5'^ ' «1 -'•■wr-y'— ^sf," ^wr™

■' "'^pe'ä'~'•">■ •" ■■"»'(?5_?' frp'r

for safer hysterosalpingography

Sa^k

CONTRAST MEDIUM

Salpix contrast medium makes available for the first time for
hysterosalpingography o radiopaque substance that

is nonirritating

is painless

leaves no radiopaque residue

permits adequate visualizotion
of the Uterus and tubes safely

Although long proposed as an extremely valuable diagnostic procedure/
hysterosalpingography has not met with general acceptance because of the
pathological and morbid sequelae so frequently found with the use of
hitherto available contrast medio.^'*

Neither the 'Interrupted fractionol injection^technique proposed by Hyams''
nor the 24-hour postinjection film, common with iodized oils, is necessary
with Salpix contrast medium.

Salpix contrast medium combines the blood extender polyvinylpyrrolidone«
with sodium acetrizoate. RV.R is stable/ nonantigenic and possesses certain
characteristics similar to human serum albumin^° which assert a protective
action diverting excretion of toxic dyes and other toxins through the kidney
rather than the liver.^' Sodium acetrizoate contains 65.8% iodine per mole-
cule of the Compound and thus possesses a high degree of radiopacity. It is
water-soiuble/^ stable, and does not release any free iodine.

methods of use

hysterosalpingography

as an aid to diagnosis of uterine pothology

Rubin'^ observed that diagnosis of uterine pothology is greotly aided
if excess Salpix contrast medium is withdrawn from the uterus
via the introducing cannula. This is due to the property which Salpix
contrast medium possesses of coating the uterine wall with a fine
film of the radiopaque medium.

indications for hysterosalpingography

I Determination of tubol potency.

2 Mechanical releose of tubal obstruction.

3 Diagnosis of maiformations of the Uterus or fallopian tubes.

4 Postoperative visualization of tubal plastic surgery.

5 A diagnostic procedure as an aid in the detection of uferine
and tubal pothology.

contraindications to hysterosalpingography

1 Presence of severe vaginal or cervical infections.

2 Existing or recent pelvic infection.

3 Pregnancy.

Sa^lx

CONTRAST MEDIUM

for safer hysterosalpingography

available

Package of 6 individual rubber-capped sterile vials,
each vial filled to deliver 6 cc. Salpix contrast medium.

bibliography

1. Rubin, I. C: Röntgendiagnostik der Uterustumoren mit Hilfe von Intrauterinen Collargolinjelctionen,
Zentralbl. f. Gynäk. 38:658, 1914.

2. Wharton, L R.: Gynecology with a Section on Female Urology, Philadelphia, W. B. Saunders Company,
1943.

3. Bloomfield, A.: Six Cases of Venous Intravasation following Intrauterine Lipiodol Injection, J. Obst. &
Gynoec. Brit. Emp. 53:345, 1946.

4. Brown, W. E.; Jennings, A, F., and Bradbury, J. T.: The Absorption of Radiopaque Substances Used in
Hysterosalpingography, Am. J. Obst. & Gynec. 58:1041, 1949.

5. Eisen, D., and Goldstein, J.: Lipiodol Intravasation during Uterosalpingography with Pulmonary Com-
plications, Radiology 45:603, 1945.

6. Holm Nielsln, P.: Injuries Caused by Hysterosalpingography, Acta obst. et gynec. Scandinav. 26:565,
1946.

7. Hyams, M. N.: Uterosalpingography by Interrupted Fractional Injections, Surg., Gynec. & Obst. 60:224,
1935.

8. Reppe, W.; Schuster, C, and Hartman, A.: Polymerie N-Vinyl Lactams and Process of Producing Same.
Bibliographical list published by General Aniline & Film Corporation, New York, March, 1951.

10. Bennhold, H., and Schubert, R.: Investigation of the Possible "Vehicie Function" of the Plasma Substi-
tute Periston, Ztschr. f. d. ges. exper. Med. 173:722, 1944.

11. Schubert, R.; New Method for Detoxication by Infusion of Low Molecular Fractions of Kollidon: Pre-
liminary Report, Deutsche med. Wchnschr. 73:551, 1948.

12. Neuhaus, D. R.; Christman, A. A., and Lewis, H. B.: Biochemical Studies on Urokon (sodium 2,4,6-
triiodo-3-acetylaminobenzoate), a New Pyelographie Medium, J. Lab. & Clin. Med. 35:43, 1950.

13. Rubin, I. C; Myller, E., and Hartman, C. G.: Salpix: A New Approach to the Ideal Radiopaque Medium
for Uterosalpingography, Fertil. & Steril., in press.

14. Rubin, I. C: Personal communication.

Ortho

Ortho Pharmaceutical Corporation

Raritan, New Jersey

L-126

Printed in U.S.A.

Reprinted, with additums. from The Journal of the American Medical
Association, June 21, 1952, Vol. 149, pp. 757 and 75H

CONTROL OF POSTPARTLM HEMORRHAGE

Ernest Myller, M.D., New York

Hemorrhage is one of the most frequent causes of
Postpartum death. Statistics being reliable only from
larger hospitals, we may assume that many Postpartum
deaths are either unreported or designated otherwise.
In a report from the Mayo CHnic,' the incidence of
death from hemorrhage is 0.491 per 1,000 births, an
average of 1 case per 2,000 deliveries. Postpartum hem-
orrhage in a large Brooklyn hospital caused death in 34
of 37 cases of obstetric fatality. It can only be conjectured
how many more occur in institutions with lower Stand-
ards.

There are Standard methods of treating postpartum
hemorrhage. It must be assumed from the poor results
reported that they are not always successful. The usual
routine procedure is to endeavor to find out whether the
Uterus is empty or to establish other causes for the bleed-
ing. By the time the examination is completed, the hem-
orrhage may become alarming. Posterior pituitary
(Pituitrin") or ergot is givcn intravenously, the Uterus is
massaged, and in many cases valuable time is lost. Intra-
uterine packing is resorted to, which stops the bleeding
for the moment. Blood transfusions are started. After a
Short time the bleeding may start again, seeping through
the packing. Removal and reapplication of packing does
not necessarily stop the bleeding and, in spite of con-
comitant transfusions, the patient may rapidly become
moribund. It is the belief of Douglass - that when the
first uterine packing is not successful, the Uterus is prob-
ably ruptured. If such is the case, a second packing is

From the Department of Obstetrics and Gynecology, New York Uni-
versity Medical College.

1. Hunt, A. B.: Massive Obstetric Hemorrhage Rcquiring Hysterec-
tomy. Am. J. Obst. & Gynec. 49:246-252 (Feb.) 1945.

2. Douglass. L. H.. in discussion of Beacham, W. D.. and Beacham,
D. W.: Rupture of the Uterus, Am. J. Obst. & Gynec. 61: 824-837 (April)
1951.

4_-

definitely contraindicated. Greenhill • also advised
against packing the Uterus a second time, recommending
immediate hysterectomy as the safer procedure.

Postpartum hemorrhage can be controlled, no matter
what its cause, by a method described many years ago by
Logothetopoulos in Athens.' His method involves a type
of packing that he originally used after clamp hysterecto-
mies. It was inserted into the pelvis after the uterus was
taken out, allowing immediate removal of the clamps
without any loss of blood. Logothetopoulos apphed the
same principle of hemostasis to control of bleeding from
the Postpartum uterus after considerable experience in
his surgical cases had proved it efticient. He called the
procedure "traction packing."

METHOD

A doubly folded quadrangular piece of gauze 36 in. (91 cm.)
Square and a gauze roll 4 in. (10 cm.) wide and 16 yd. (15 m.)
long are required. The Operator grasps the cervix with one or
several tenaculum forceps and brings it down well to the level of
the Vulva. The blades of a vaginal speculum are helpfui in
spreading the cervical canal apart. The center of the quad-
rangular piece of gauze is inserted into the uterus by means of
a sponge forceps. In contrast to the conventional method, it is
not necessary to reach the fundus with this packing.

The four corners of the quadrangular piece of gauze protrud-
ing from the uterus are spread apart. The Operator then packs
the long Strip of gauze into the gauze sack situated in the uterus.
Carefully done, this produces a large round ball inside of the
Uterus. The size of this ball is always the same, being deter-
mined by the uniform amount of gauze strip used. Thus the
whole procedure becomes automatic and not subject to indi-
vidual alterations, an important point in an Operation when
time means everything.

3. Greenhill, J. P.: in Yearbook of Obstetrics, and Gynecology, Chi-
cago, The Yearbook Pubiishers, Inc., 1950, p. 241.

4. Logothetopulos, K.: Gynäknelogische Chirurgie, Berlin, Julius
Springer, 1939

Fig. I.— Insertion of the quadrangular piece of gauze into the uterine
cavity.

P'g- 2. — Spreading the quadrangular gauze and filling it with a gauze
Strip.

JL.

"V*

Fig. 3. — Downward traction applied to four corners of the quadrangular
piece of gauze.

Fig. 4. — The stem of gauze pulled through a ring pessary

effect of anemia, which is produced by compression of
the arteries. Furthermore, it is possible that pressure
upon Fraiikenhauser's ganglion stimulates the uterine
muscle to contract by way of the autonomic nerves. It
is obvious that the cause of the bleeding does not in-
fluence the effectiveness of this packing. Wherever the
bleeding comes from, it will be stopped. This packing is
inserted with relative ease, far more readily than a con-
ventional packing, with no need to fill the uterine cavity
completely, and the procedure is rapid and precise.

Fig. 5. — Packing in situ and maintenance of traction by application of
a strong clamp.

followed by the quadrangular piece of gauze, which may
take out with it pieces of membrane left behind. The
renioval of the packing is almost painless.

If the hemorrhage has occurred after a difficult forceps
delivery, a version, or in a case in which a cesarean
section has been done previously, the possibility of a
ruptured Uterus must be considered. In this instance the
packing may enter the abdominal cavity through the tear
in the Uterus, intentionally or by chance. No härm can
be done by the possible additional trauma to the uterine
wall, since it will be necessary to remove the Uterus any-

Fig. 6. — Compression of the hypogastric vessels when traction is
applied to the gauze packing.

way. Once in place, traction packing allows time for
careful preoperative preparation. There is no urgency
for any operative intervention while the patient is in
shock. Her chances for recovery after hysterectomy or
more conservative procedures are much improved.

According to Greenhill, the mortality rate of uterine
rupture is 58%. A very recent report from the Harlem
Hospital "' gives the mortality rate as 57.1%. Consider-
ing the excellent facilities and expert attention in this
Hospital, it may be assumed that in less well-equipped

5. Posner, L. B.; Smith, D. F., and Trambert, H. L.: 14-Year Survey
of Parturient Ruptured Uterus at Harlem Hospital, New York J. Med.
51:641-644 (March) 1951.

(

institutions the mortality rate may be much higher. With
successful hemostasis and eliminated urgency, with time
to recover from shock, mortality rates should be con-
siderably reduced. Posner and his co-workers ' stated,
'immediate transfusion and laparotomy, regardless of
the degree of shock, is the surgical treatment of rupture
of the Uterus." Speaking of mortality, they add that with
adcquate blood transfusion and present-day antibiotics
all natients might have survived. All these ends can be
rcalized with traction packing; there is no need of im-
mediate Operation "regardless of the degree of shock."
Actual experience with this packing is limited. Logo-
thctopoulos has used it in only about 10 cases of Post-
partum hemorrhage, but has had excellent results in all.
This packing procedure was studied in cadavers at the
Univcrsity of Athens." The packing was inserted in the
manncr described, followed by traction. A dye was in-
jccted into the carotid artery under pressure and therc-
after the pelvic organs were examined. All blood vessels
except the uterine arteries were filled with the dye. It
was interesting to note that the Ureters were not com-
pressed; they could be flushed through from above with
very slight pressure.

SUMMARY

There are few new methods available to reduce the
mortality rate of postpartum hemorrhage. Blood trans-
fusion is often unsuccessful because hemostasis is diffi-
cult. Operations are often done with the patient in shock.
Traction packing controls all postpartum bleeding im-
mediately and therefore should reduce the mortality rate.

65 E. 76th St.

6. Christopulos, C: Anatomische Ergebnisse der Blutstillungsmethode
nach Logothetopulcs. Zentralbl. f. Gynäk. 57: 807-809 (April) 193^

Printed and Published in the United States of America

Sonderabdruck aus dem Zentralblatt für Gynäkologie 1933 Nr. 14

Aus dem Anatomischen Institut in Athen
Direktor: Prof. Dr. G. Sklawunos

Anatomische Ergebnisse der Blutstillungsmethode

nach Logothetopulos^

Von Dr. Gh. Christopulos,
Assistenzarzt an der Gynäkologischen Universitätsklinik in Athen

Als vor 2 Jahren der Professor der Anatomie in Athen, G. Sklawunos, bei
einer Operation die Blutstillungsmethode nach Logothetopulos anwenden sah,
fand er es zweckmäßig, diese Methode einem Studium zu unterwerfen und sie auch
an Leichen anzuwenden. Darauf wurde ein Assistenzarzt der Gynäkologischen
Klinik, Dr. Ch. Christopulos, beauftragt, diese Untersuchungen im Anatomischen
Institut unter Aufsicht von Prof. Dr. G. Sklawunos auszuführen.

1 Vortrag, gehalten von Prof. Dr. K. Logothetopulos in der Gynäkologischen Gesell-
schaft in Wien am 20. XII. 1932.

807

Zentralblatt für Gynäkologie 1933 Nr. 14

Wir tasten die Höhle aus und finden, daß sie als feste Unterlage die innere
Fläche des Os ischii hat. Darauf schreiten wir zur anatomischen Präparierung
der üefäße des kleinen Beckens. Zu diesem Zweck spalten wir das Becken in der
Schamfuge. Nach der Freilegung der üefäße der linken Beckenhälfte sehen wir,
daß alle Äste der Arteria hypogastrica von Farbstoff gefüllt sind. Wir verfolgen
speziell die Arteria uterina, welche bei der Operation nicht unterbunden wurde.
Dieselbe ist oberhalb der Schnittstelle in einer Länge von 2 cm frei von Farbstoff.
Daraus schließen wir, daß gerade auf diese Stelle der Tampon einen großen Druck
ausübt. Aus den Kapillargefäßen merkt man keinen Austritt von Farbstoff.

2. Fall. Vor der Operation und Anwendung der Tamponade und 6 Tage nach
der Einbalsamierung der Leiche wurden die Gefäße mit einer Lösung von 3proz.
Natrium citricum durchgespült, um dieselben von eventuell vorhandenen Throm-
ben zu befreien. Die Operation bestand in der vaginalen Totalexstirpation des
Uterus mit Hinterlassung der Adnexe. Bei der Anlegung des Tampons wurden die
Stümpfe der Eileiter etwas heruntergezogen, die Klemmen sind jedoch entfernt
worden, ohne die Gefäße zu unterbinden, die Arteriae uterinae sind durchschnitten
worden, ohne überhaupt angefaßt zu werden.

808

(

Christopulos, Anatomische Ergebnisse der Blutstillungsmethode

mit der Carotis, den anderen Teil mit der Spritze, die Farbstoff enthielt, und den
dritten Teil mit einem Quecksilbermanometer. Dieser Teil wird mit einer Klenmie
geschlossen gehalten. Sobald wir anfangen den Farbstoff einzuspritzen, nehmen
wir die Druckklemme weg und lassen den Farbstoff mit dem Manometer in Be-
rührung kommen. Der Druck steigt dauernd, und erst nachdem er 750 mm über-
schritten hat, zeigt sich der Farbstoff in den Beckengefäßen. Am 8. Tag nach der
Einspritzung des Farbstoffes wird die Leiche geöffnet. Nach dem Herausziehen
der Därme sehen wir die leere Blase auf dem Tampon liegen, genau wie bei den
vorher beschriebenen Fällen.

Der Tampon wird herausgenommen und man sieht auf seinen seitlichen
Flächen die Abdrücke, die die gedrückten Adnexen hinterlassen haben.

Die Nekrosen der Gewebe sind leicht zu vermeiden durch das Abnehmen
der vor dem Pessar liegenden Klemme, 8 Stunden nach der Operation, wodurch
der Druck aufhört.

Damit auch kein Druck auf die Blase ausgeübt wird, führt man während
der 2 ersten Tage einen Dauerkatheter ein, damit die Blase dauernd leer ist.

809

BULLETIN OF TFIE UNIVERSITY HOSPITAL

to the pelvic cavity, especially the sacral coiitour. If the Symphysis
pubis outline^s well, oiie may ohtain, by scale ineasurement, the
anteroposterior diameter of the pelvic inlet.

The simple anteroposterior flat film, so often employed by many
hospitals, is iisiially deluding and therefore pernicious. Much more
reliance can be placed upon the lateral film. However, the additional
flat film is useful in obtaining a complete coneept of the fetal presen-
tation in a few cases, especially in transverse presentations, where
Version and extraction Operation is often necessary. This previonsly
obtained knowledge immeasnrably facilitates the Operation in that
the precise location of the feet in relation to the fetal spine is then
known.

BIBLIOGRAPHY

1. Fabrt-'s Obstetriqiic, Cilhert, A., and Fournier, L.: Paris, 1915, pp. 512-522.

2. Comniandcur et al.: La Pratique de l'Art des Accoucheinents, Vohime II, pp. 197-200,
A.sstdin et Ilou/ian, Paris, 1915.

3 Johnson, C. H.: Mensuration and locali/.ation hv nu-ans of tlu' roentKen rav. Radiolojiy
8: 51«, 1927. k . k7

4. Hanson. S.: A nt'w pclvinietcr (or tlu' nieasuremt-nt o! tlu- bispinous diameter. Am. I.
Ölst. & Ciynec. 19: 124, 19.30.

5. C'aldwi'll, \V. E., and Moloy, 11. C: Anatomical variations in lemale pelvis and their
etfect in lahor with su^Kested Classification. Am. J. Obst. & Gynec. 26: 479, 1933.

ß. Hodui's, P. C, and Lcdoiix, A. C: Rocntyen rav pelvimetry; a simnlified stereoroent-
«('no«rapliic ntethod. Am. J. Hocntycnol. and Radinm rherapy 27: 83, 1932.

7. Caldwell, W. E., Moloy, H. C, and D'Esopo, D. A.: Further studies on the pelvic
architecture Am. J. Obst. & Gynec. 28: 482, 1934.

8. Caldwell, W. E., Moloy, H. C., and D'Esopo. D. A.: A roentKenoloßic study of the
nn'chanism of ennayement of the fetal head. Am. J. Obst. & Gynec. 28: 824, 1934.

9. Snow, W., and Powell, C. B.: Roentprn visuali/.ation of the placenta. Am. I. Roentijenol.
«c Rad. Ther. 31: 37, 1934.

10. Caldwell, W. E., Moloy, 11. C., and D'Esopo, D. A.: Further studies on the mechanism
of labor. Am. J. Obst. *c Gynec. 30: 763, 1935.

11. Schumann, E. A.: The size and shape of the iielvic inlet as determined bv direct
measurement. Am. J. Obst. 6: Gynec. 32: 832, 1936.

12. Ball, Robert P.: Roentuen pelvimetr>' and fetal cephalometry. Sura., Gynec. & Obst.
62: 798, 1936.

13. Tornin. R., Holmes. L. P., and Hamilton, W. F.: A roentKen pelvimeter simplifying
'Ihonis' method. Radiolo«y 31: 584, 1938.

14. Snow, W., and Rosensohn, M.: Roentjjenolonic visuali/.ation of the soft tissues in
prennancy. Am. J. Roentuenol. and Radium Therapy 42: 709, 1939.

15. Snow. W.: Vistiali/.ation of soft tissues of advanced pregnancy in normal and abnormal
premiancies. New York State J. Med. 39: 20.50, 1939.

16. Tori>in, Richard, and Holmes, L. P.: Pelvic inlet Variation in 400 Nejjro women.
Am. .1. Obst. 6r Gynec. 38: 594. 1939.

17. Dippel, A. L., and Brown, W. H.: RoentKen visuali/.ation of the placenta by 80*^1
tissue technic. Am. J. Obst. & Gynec. 40: 986, 1940.

18. Brown, W. H., and Dippel, A. L.: The uses and limitations of so*^! tissue roentKeno-
jirapbv in placenta previa and in certain other obstetrical conditions. Bidl. Johns Hopkins
Hosp. 66: 90, 1940.

19. Thoius, H., and Godfried, M. S.: Suboccipito-breKmatic circimnference. Am. }. Obst.
«c Gynec. 39: 841, 1940.

20. VVarren, Cora: Radioyraphic technic involved in pelvimetrv. The X-ray Technician.
12: 52. 1940.

21. Dippel, A. L.. and Brown. W. H.: Direct visuali/.ation of the placenta by .soft
tisstie roent^enouraphy. New Enjiland J. Med. 223: 316, 1940.

22. Hodtres, P. C.. and Dipjiel. A. L.: The use of X-rav in obstetrical diagnosis, with
particular relerence to pelvimetry and fetometry. Internat. Abstr. of Surj?. 70: 421, 1940.

23. Torpin. Richard: Poenttren pelvimetrv in labor bv the pelvic inlet grid method.
Am. J. RoentKcnol. and Riuliimi Therapy 47: 717, 1942.

24. Torpin. Richard, and Holmes. L. P.: The influence of the placental site upon fetal
Präsentation. Am. J. Obst. & Gnec. 46: 268, 1943.

2.5. Tornin. Richard: The influence of placental site on fetal presentation. J. A. M. A.
127: 442, 1945.

26. Thoms, H.: The Ohstetric Pelvis. The Williams & Wilkins Company, 1935, Balti-
n^.ore, Md.

BULLETIN

OF THE

UNIVERSITY HOSPITAL

(Affiliated with the University of Georgia School of Medicine)

Vol. 7

Aiigii.sta, Georgia, March, 1948

No. 1

ROENTGENPELVIMETRY IN LABOR BY THE GRID METHOD
AND BY THE LATERAL SOFT TLSSUE TECHNIC

By RICHARD TORPIX, M. D."
Instructions for use of Torpin-Thoins RocntgcnpeKiint-ter.

Fig. 1

This device,'' developed at the Uni\ersity Hospital for siilgle. film acciirate
measurement of the most important ohstetrical distances within the pelvic ca\ ity,
must be used with a degree of technic necessary with all special instruments.

The advocacy of this method casts no reflectioi^s upon others,
some of which are more exact and therefore more scientific. Their
complexitv, however, militates against their practicality, in most
cases, for routine use. These include the triangulation methods of
Johnson," Hodges," " Ball," etc., and the Stereoroentgenographic
method perfected by Caldwell, Moloy, and D'Esopo. ' ' ' *"

•Professor and Chairman, Department of Obstetrics and Gynecology, University of Georgia

School of Medicine, Anyiista, Georgia

■■■■■■

2 BULLETIN OF TUE UNIVERSITY HOSPITAL

The Problems of the grid method and their simple Solutions are
set forth in the following outline:

A decade of study has been devoted to ascertaining the basic
crucial dimensions of the female pelvic cavity in regard to their
clinical application in labor. These may be reduced to the following:
size and shape of the obstetrical pelvic inlet and of the width of the
ischial spines. The width of the ischial spines, also, is in direct
relation to the width of the outlet because both are almost invariably
associated. A narrow midpelvis usually denotes a narrow outlet
and vice versa. It is reasonable to suspect that the contour of the
sacral curve would be of importance. However, in a conscientious
study of several thousand labors in Caucasian and Negro women,
there was no specific case in which a correlation could be demon-
strated between inward curving of the sacrum and dystocia. In a
few instances an inward pointed and ankylosed coccyx has tem-
porarily held up delivery.

The exact size and shape of the inlet and the relative widths of
the ischial spines are simultaneously obtained by use of this instru-
ment which facilitates the application of the grid method, previously
developed by Thoms" and shown by Schumann," to be accurate to
within 2 mm., if proper attention to details is observed. For clinical
purposes, accuracy to 5 mm. (i. e. approximately 5 per cent error) is
satisfactory.

While attention to details in the set up is not very important
in case the pelvis is of adecjuate size, these features should be observed
routinelv because thev become essential in the smaller and borderline
examples.

Study of the appended wash drawings, Fig. 2, 3, 4, of the pelvic
inlet reveals that the forward or backward tilting of the pelvis, during
the film exposure, is significant. It is desirable to have a film which
shows a clear posterior aspect of the pelvic inlet. If the position is
correct as in Fig. 3, the upper part of the sacral portion of the ca\'ity
wall forms a perpendicular line, which is desirable. If the tilting is
too far forward, as in Fig. 2, the promontory of the sacrum shows
up in the film in a disturbing manner, and the ischial spines theu
appear too far posterior and the two rami of the pubic bones show
separately in the film. This causes an artificial aberration which
may be wrongly interpreted in the reading of the film. When the
tilting is too far posterior as in Fig. 4, the various componeat parts of
the sacrum show, and it is then difficult to outline, in the film the
posterior termination of the obstetrical conjugate upon which the
anteroposterior diameter depends. One also notes that when the
tilting of the pelvis is accurate as in Fig. 3, a line drawn between the

BULLETIN OF THE UNIVERSITY HOSPITAL

Fig. 2

Fig. 3

anterior superior spines of the ilium bisects the pelvic cavity, and
that the lower rami of the pubic bones are hidden by the upper rami.
The method of obtaining the film, as in Fig. 3, is shown under
positioning of the patient.

BULLETIN OF TUE UNIVERSITY HOSPITAL

BULLETIN OF THE UNIVERSITY HOSPITAL

tinct. Here it may be necessary to iise others. If so it is quite well
to draw a line across the back between the iliac crests. The
point at vvhich the line crosses the spinal colunin is in the neighbor-
hood of the posterior end of Baudelocciue's dianieter, which pre-
sumably and usually does lie in or near the plane of the obstetrical
conjugate. The posterior extremity of this is ordinarily the inter-
space between the fonrth and fifth hnnbar spines.

(2) The de vice, Fig. 1, is placed npon the X-ray table and, in
most types of tables, 22 inches wide, is automatically centered froni
side to side. The patient then sits upon the frame, Fig. 6, with her
buttocks against the lower part of the backrest, which should lean
back approximately 30" from the perpendicular. The posterior marker
then is applied at the ink mark over her Imnbar region. The anterior
marker support is pnshed, in its slot, back as far as it will go toward
the patient. The loosened marker is then fixed in position against

Fig. 4

POSITIONING OF THE PATIENT

(1) With the patient standing on the floor, and her sacral region
exposed, an ink line is drawn at the apex of the rhomboid of Michaelis,
as illustrated. Fig. 5. In obese patients, these landmarks are indis-

Fig. 5

Fig. 6

the skin over the pubic bone 1 cm. below its apex. Proper adjust-
ment of the front marker is more important than that in the rear.
At eight months pregnancy or near term, the patient is instrncted
to take a deep breath and relax her abdominal wall muscles so that
by pressing inward, the fingers of the obstetrician may palpate the
apex of the pubic bone. Only by this method, can one be sure of
the proper adjustment of the marker, which should be against the
pubic bone and 1 cm. below the top margin. After both markers
are adjusted, it is necessary to see that the level of the posterior one
is approximately 1 cm. above that of the anterior. If such is found

BULLETIN OF TUE UNIVERSITY HOSPITAL

not to be the case, then both markers should be loosened and the back
rest adjusted forward if the posterior one is relatively too low; or
the back rest is adjusted backward if the posterior marker is relatively
too high, after which the markers are readjusted. Only by such
adjustment can the technician be certain of obtaining a proper film
of the pelvic inlet, as in Figure 3 instead of an incorrect one
as in Figures 2 or 4.

(3) A Bucky diaphragni is employed and casette with 8 x 10-inch
film. This size film is adec|uate since all that is desired, is an outline
of the pelvic inlet and the ischial spines, and this region lies directly
over the center of the film. The employment of a larger film entails
waste, more space for storage, and the films are less easily manipulated
in any subsequent study.

(4) Centerin g the X-ray tube with a 5" cone over the center
of the pelvic inlet is accomplished by focusing it over a line drawn
between the anterior superior iliac spines. The tube casette distance
recommended is 32 inches.

RADIOGRAPHIC TECHNIC
Tube casette distance, 32 inches. (30 to 36 inches, Thoms".)
Bucky Diaphragm, 5-inch cone.
Milliamperage, 50.
K. V. P., 85.

Exposure time for 6 to 7 months pregnancy, 7 to 9 seconds.
Exposure time for 8 to 9 months pregnancy, 10 to 12 seconds.

If the tube is of a different calibration, the voltage, amperage
and time may be varied to obtain the similar milliampere seconds.
This is a rather heavy dosage and should not be repeated.
Consequently it is best to use care in all details so as to make only
one exposure. As an alternative, the film could be made before
pregnancy, or at three months pregnancy with a marked reduction
in total M. A. S.

INTERPRETATION OF THE FILM

The film may be read by the roentgenologist and the report
presented to the obstetrician. In order to save delay in certain cases,
it is wise for the obstetrician to be able to read the film directly,
and it is better for him to do so in all cases.

BULLETIN OF TUE UNIVERSITY HOSPITAL 7

There are four essential factors to note: (1) size of inlet in centi-
meters, (2) shape of inlet, (3) relative width of the ischial spines,
(4) presentation cephalic or breech ,etc.

(1) Size of inlet.

This is recorded by counting the dots between the posterior
border of the Symphysis pubis and the center of the pro-
montory or the sacral contour of the image of the pelvic
inlet; and for the transverse diameter by counting the dots
transversely across the widest diameter of the inlet.

(2) Shape of inlet.

For the purpose of Classification and of some small practical
value in certain instances, it is useful to state the facts in
regard to the contour of the pelvic cavity in the terms of
the primary Classification of Caldwell, Moloy and D'Esopo
as illustrated.

Gynecoid,
Female Type

Anthrupoid,
Type

Android
Male Tendency

Platypelloid,
Fiat Pelvis

Fig. 7

If one wishes to use Thoms Classification, the following
illustrations Fig. 8 reveal the essential contours of the
inlet:

Brachypellic

Mesatipellic

Dolichopellic

Platypellif

Fig. 8

For the sake of consistency, differentiation of platypelloid
type from gynecoid type has been postulated as follows:
If the transverse diameter is more than 3 cm. greater than

8 BULLETIN OF TUE UNIVERSITY HOSPITAL

the A. P. diameter, the type has been recorded as platy-
pelloid or platypellic (Thoins).

(3) Relative width of ischial spines.

Of iitmost importance in the interpretation is consideration
of the midpelvis, hecause in this portion the contraction is
i often productive of dystocia, especially if the fetal head
piesents occiput posteriorly. The ischial spines are shown
in the film as lateral triangulär projections froni each side,
into the image of the inlet. The measurenient between these
points is relative only in this film, but with experience one
can determine cjuite well midpelvic contraction. Narrowing
of the spines as seen in the film is of more importance in
case the whole pelvic cavity is relatively narrow, especially
in the anthropoid and android types. In any doubtful case,
the exact distance between the spines may be determined
by direct measurement on the patient, by use of Hanson's
rectovaginal internal pelvimeter/

(4) Fetal presentation.

At eight months or term pregnancy, the head shows as a
circular or oval outline in or overlapping the image of the
pelvic inlet. The more nearly circular the head image is,
the more flexed is the head, and usually the deeper it is
in the pelvic canal.

Sometimes one is able to differentiate the occiput in the
oval images, but usually not. If the presentation is breech,
the hip bones or femurs are seen and not the cranium.
In a few cases, diagnosis of anencephalus has been made
from this type of film. Usually the whole outline of the fetal
cranimn is framed well within the pelvic inlet image. In
such cases there can be no question of any dystocia occurring
at the inlet.

Completed Report

The record of the film then should contain the follow-
ing information: Classification type of pelvis; anteroposterior
and transverse diameters of the inlet; relative width of the
ischial spines (wide, relatively narrow, or narrow as the case
may be); and the fetal presentation. As an illustration, the
final report may read: type of pelvis, gynecoid; A. P. diameter
of inlet, 11 cm.; transverse diameter, 13 cm.; midpelvis wide;
cephalic presentation, fetal head well framed in pelvic inlet
image. Prognosis (if desired) no question of any pelvic
dystocia.

Signed:

BULLETIN OF TUE UNIVERSITY HOSPITAL

If the obstetrician is able to shovv the film to the patient and
interpret these facts to her, the psychological effect upon her is
pronounced. Since the vast majority of pelves are normal, the news
that the patient receives is usually good news and aids in buoying
her mental approach to labor. This often proves to be one of the
major factors in niaking it a normal procedure. In addition, the
use of exact factors determined by roentgenography permits the
obstetrician knovvledge of the case in hand, that eliminates much of
the uncertainty, and he may then direct bis attention to maintaining
a normal physiology of labor as elsewhere described.' ' In our large
series, most of the patients with inlet A. P. diameters of 9 cm. or
more, have delivered spontaneously due care having been taken to
insure physiological normal labor by fluid intake, correction of anemia
and by proper sedation with especial attention to control of the
uterine contractions. In addition there should be knowledge as to
the midpelvis, and the distance between the ischial spines ought to
be at least 9 cm. Usually a woman with a contracted pelvis delivers
a small fetus, but this is not always the case. In the series of spon-
taneous labors with contracted pelves, there were many in which
the diameters of the presenting fetal cranium were within a few
millimeters of the shortest diameters of the mother's pelvic cavity.

THE LATERAL SOFT TISSUE FILM

As an adjunct to the grid film view of the inlet, reliable additional
information may be derived from the lateral soft tissue film.'
In some cases, this information is invaluable, especially in malpre-
sentation, as transverse lie, brow, etc. Some obstetricians favor limit-
ing X-ray studies to lateral films, but from this no adequate informa-
tion can be obtained as to the width of the pelvis at the inlet or at
the midpelvic oiitlet region, nor can the contour of the inlet be noted;
and it is upon this latter factor that the classifications are based.
The lateral film indisputably reveals the presentation of the fetus
and relation to engagement including the variety of position of the
presenting part, and the attitude of the fetus. Thus, only, can one be
certain in all cases as to occiput anterior, lateral, or occiput posterior
presentation. The contour of the sacrum is shown if the technic
of the filming has been adequate. This information, while theoreti-
cally good, is in my opinion of doubtfid practical value. The
obstetrical conjugate should be available from the lateral film, but
one objection is that the anterior delimitation is not well shown since
the Symphysis pubis delineates poorly. The location of the placenta
is well shown in approximately 80% of cases and more often than that
if the technic is carefully performed. It is possible that by taking
the lateral view with the patient standing with her abdomen supported
employing a specially constructed X-ray machine, more uniformity

BULLETIN OF THE UNIVERSITY HOSPITAL

and accuracy woiild be obtainable. When the patient lies on her
side, her uterus has a tendency to fall toward the plane of the table
and this causes some distortion, unless corrected by special pillows.

Fig. 9

The simplest form of fetal roentgencephalometry is that obtained
by an isometric scale placed over the fetal head at the time of making
the lateral film. Such may be attached by an abdominal belt as
illustrated, Fig. 9, but the technic of application should be done by the
obstetrician if the results are to be at all reliable. In 67 per cent of five
hundred such measurements, the error was no more than 5 per cent.
Many of these, in routine cases, were left to the various X-ray tech-
nicians who had often not been especially trained and in some of these
cases the error became 20 per cent — far too much for reliance. How
ever, the grid inethod of inlet pelvimetry, if done at the eighth month,
presents a good estimate of the relative size of the fetal head and,
of conrse, if the head is as low as engagement, its measurement is
then (|uite precise.

TECHNIC OF THE LATERAL SOFT TISSUE FILM

Tube casette distance: 36 inches.

4 mm. aluminum, shielding the uterus and fetus above the pelvic
inlet region.

Biicky diaphragm: 14 x 17 inch film.

«^¥

BULLETIN OF THE UNIVERSITY HOSPITAL

Voltage: 68 to 70.

Milliamperage: 100.

10 cm. lead scale attached to mother's abdomen longitudinally
and at level with the fetal head.

Time for term pregnancy: 2 to 2V2 seconds, depending upon size
of patient.

Position of the patient: lying upon the X-ray table with her
right side down and her Shoulders far hack to the edge of the table
with her pelvis lying over the middle of the table, as illustrated,
Fig. 9. The technician should try to visualize the 30 x 20 cm. ovoid
uterus so that it lies longitudinally over the 14 x 17 inch film. The
tube is focused directly over the center of the film and on a level
with a line a few centimeters above the iliac crests.

READING THE LATERAL SOFT TISSUE FILM

If appropriate technic has been utilized, the image of the uterus
should be seen in the upper portion of the film with the image of
the sacrum (lateral \'iew) directly below. In cephalic or breech
presentations, the image of the fetus should lie almost longitudinally.
The placenta attached, as a rule, to the anterior or posterior wall of
the fundus uteri, thereby usually causes a heavy shadow between
the uterine wall and the fetus; sometimes there is evidence of calcified
particles. Ordinarily this shadow is higher in the fundus, but in
placenta previa it may be so low that it displaces the fetal head or
other presenting part. With careful technic and proper study, this
film becomes much more important in diagnosis of placenta previa
than the technic in which the urinary hladder is partially filled with
radiopacjue fluid; since the hladder technic could possibly reveal only
those 50 per cent or less of placentas on the anterior wall. The chief
merit of the lateral soft tissue film seems to lie in its information
in regard to the fetus in labor. These facts are the exact presentation,
variety of position, attitude of the fetus, and descent of the presenting
part, and these are all conclusively revealed.

It has been shown ("' ') that the site of the placenta has consider-
able effect upon the fetal presentation. When the placenta is located
upon the posterior wall of the fundus, there is increased tendency for
the fetal presentation to be occiput anterior; and when the placenta
is upon the anterior wall, there is increased tendency for occiput
posterior presentation. In fact, this probably is the chief etiologic
factor in occiput posterior presentation which occurs originally in
approximately 20 per cent of all cephalic presentations. Roughly 40
per cent are occiput anterior and the remaining 40 per cent occiput
transverse (or lateral). Substantial information is presented in regard

1
4

Reprinted from

The American Journal of Roentgenology and Radium Therapy

Vol. XLVII, Xo. 5, May, 1942

ROENTGEN PELVIMETRY IN LABOR BY THE
PELVIC INLET GRID METHOü*

Ry RICHARD TORPIN, M.D.

AUGUSTA, GEORGIA

^T^HIS Study was conducted in associa-
^ tion with theohstetricdelivery oF 1,420
women, 510 white and 910 negro. Ahout
two-thirds were home deliveries, but patho-
logic conditions were taken care of in the
hospital where 138 had pelvic measure-
inents made during labor. 'I'his was a single
view of the inlet showing the outhne of fetal
head generally franied within that of the
pelvic inlet, since the patient is in a semi-
sitting Position when the film is exposed,

inlet with transverse diameter less or no
more than equal to the anteroposterior
diameter; (c) android (male type) inlet
with triangulär contour wider in the poste-
rior third and narrow anteriorl\ . In some
cases the ischial spines protrude inward and
show in the film; (d) platypelloid (flat pel-
vis) in which the anteroposterior diameter
is shorter by 3 cm. or morc than the trans-
verse diameter. Other characteristics of the
four types may be noted by palpating the

Fig. I

and the fetal head has a tendency to sink
into the true pelvis.

Thf. resulting 8 by 10 inch film, made
with the device previously described,^
illustrated in Figure i,shows (i) the outline
of the pelvic inlet and its diameter in centi-
meters directly by counting the dots be-
tween two points; (2) the contour of the in-
let, and this is important in the pelvic
Classification into the four groups of Cald-
well, Moloy and D'Esopo,^ who amplified
the older Classification of the anthropolo-
gists, Weber, Stein and others. These« types
are {a) gynecoid (female type) symmetrical,
oval pelvic inlet with transverse diameter
up to 3 cm. longer than the anteroposterior
diameter; {b) anthropoid — round or oval

contour of the sacrum which mav bend
rather forward, especi-!' i.
type. By palpatin'. ih K,chi
the tuberosities s.rrowness o.

may be identi'"
poid or andr(y
study these r
have less ettVei
shortening of th.

Midroid
'nd

thro-
n this

frequently v
ves. Howev :^;.
types of peives seem to
^n labor than does the
"nie conjugate (the an-
teroposterior 'amL.er of the inlet). Of
course the efi' is greater if there is an as-
sociated narro\ ransverse diameter.

tt r^f I

TL MNIQUE

The number of patie.ü., ir
this series is shown in Table i,

Among the 1,420 deliveries occurred 24

group m

* Fron! the Department ofObstetrics and Gynecology, University of Georgia School of Medicine, Augusta, Georgia.

t i

7i8

Richard Torpin

May, 1941

forceps Operations in which the pelvis had
roentgen studies, and this included almost
all forceps cases. This reveals a forceps in-
cidence of not over 3 per cent and corre-
sponds well with the more or less ideal rate
in vogue at the Grady Hospital in Atlanta.
Since 16 of the forceps deliveries were in

negro. There were 3 low forceps deliveries
in white women and 5 in negro women. In
5 cases of forceps delivery there was a nar-
row outlet as shown by the shortening of
distance between the ischial spines seen in
the pelvic inlet film and by rectal palpation.
Ten of the 24 women who had to be deli-

Table I

Gynecoid

lotals

Conjugate vera in cm.
White

8-9

9-10
3

lO-II

11-12
20

12-13
10

^3-H
I

14-15

Negro

Anthropoid

Conjugate vera in cm.
White

Negro

8-9

9-10

lo-ii

11-12

12-13

13-H

14-15

Android

Conjugate vera in cm.
Wählte

Negro

8-9

9-10
I

la-ii
I

1 1-12
4

12-13
I

13-14

14-15
I

Platypelloid

Conjugate vera in cm.
White

Negro

8-9
I

9-10

lO-II

11-12

i2-n

^3~H

14-15

Nägele

Conjugate vera in cm.
White

Negro

8-9

9-10

lO-II

II-T2

12-13

13-14

14 15

(White 57 pkis Negro 81)

138

negro women, the incidence is the same as
in white women, identical rules as to neces-
sity of application being used in both cases.
Table i shows a higher incidence of con-
tracted pelves in negro women. It seems,
however, that the negro newborn's head is
softer and molds more than that of the
white infant. The mid forceps incidence was
16 to low forceps 8. Five of the mid forceps
dehveries were in white women and 11 in

vered by forceps had normal size pelves, 2
of these being justo major 12 by 13 cm.;
one of these had a 9 pound, 4 ounce baby
and the other, 7 pounds 12 ounces.

Among the 24 operative deliveries re-
quiting forceps, 17 of the pelves were gyne-
coid in type, 3 were anthropoid — all negro,
3 android or tendency to android — 2 white
and I negro, and i Nägele pelvis in «c negro
woman.

Vol. 47, No. 5

Roentgen Pelvimetry in Labor

719

Experience teaches one to suspect diffi-
culty in labor in the short obese type of pa-
tient, so-called dystrophia dystocia Syn-
drome, and one gathers from the literature
that these patients have a tendency to con-
tracted pelves of android or anthropoid
types. In this group there were 8 such pa-
tients delivered in the hospital, 4 white and
4 negro. All but one had gynecoid type
pelves; contraction below 10 cm. antero-
posterior in 2, slight contraction 10-1 1 cm.
anteroposterior in 3, large gynecoid pelvis
in one and a contracted android type in one
negro.

Of these 8 patients, 4 delivered spon-
taneously — i negro, contracted gynecoid; i
negro, slightly contracted gynecoid in 113
hours; i white woman of 235 pounds weight
with justo major gynecoid pelvis in 3^
hours, and i negro whose slightly contrac-
ted pelvis had a tendency to android type
and a narrow outlet. There were 2 mid for-
ceps, I white gynecoid slightly contracted
and I white normal size gynecoid type.
There was i cesarean section in a white
woman with a slightly contracted gynecoid
pelvis who had a thirty hour labor test.
There was i craniotomy in a negro with a
contracted gynecoid pelvis who had a large
baby weighing more than 8 pounds.

In this series it is feit that no woman or
Infant was neglected in giving each mother,
under amnesia, füll opportunity to com-
plete the labor spontaneously. The craniot-
omy cases were neglected before admis-
sion.

INDIVIDUAL DESCRIPTION OF LABOR
IN EACH GASE ILLUSTRATED

The case histories correspond in number
to the pelvic outlines shown in Figures 2,
3, 4 and 5.

Case i. White primipara, aged eighteen; con-
tracted gynecoid pelvis; anteroposterior 9.25 cm.,
transverse 11 cm. Labor 8 hr. test followed by low
cervical cesarean section, Weight of infant 5 Ib. 1 1| oz.

Case 2. Negro primipara, aged fifteen; contracted
gynecoid pelvis; anteroposterior 9.25 cm., transverse
10.25 cm. Labor ist stage 17 hr., 45 min., 2nd stage
30 mir. Presentation leftoccipito-anterior, weight of
infant 3 Ib. 5 oz. The measurements of the biparietal
and suboccipital bregmatic diameters of the head of
the newborn infant were about 0.25 cm. less than

those of the pelvic inlet. One year later she dupli-
cated theproceduredelivering spontaneously an 8 Ib.

4 oz. infant after a rather longer ist stage and a 30
min. 2nd stage of labor. This proves that Xature is
able to accommodate the fetal head to a much tighter
fitting pelvis than is usual.

Case 3. Negro, para o, gravida i, aged nineteen,
toxemia of pregnancy; slightly contracted gynecoid
pelvis; anteroposterior 10 cm., transverse 1 1 cm.
Labor ist stage 22 hr., 2nd stage 2 hr. Spontaneous
delivervleft occipito-anteriorjiving infant, weight 7
Ib.

Case 4. Negro primipara, aged seventeen, obese,
eclamptic; contracted gynecoid pelvis; anteroposte-
rior 9 cm., transverse 1 1.5 cm. Labor short after two
convulsions. Spontaneous delivery of living infant
right occipito-anterior, weight of infant, 7 Ib. l oz.

Case 5. Negro primipara, aged twenty; gynecoid
pelvis; anteroposterior 11 cm., transverse 11.5 cm.
Labor ist stage ji,^ hr., 2nd stage 4 hr. 35 min. Spon-
taneous delivery left occipito-anterior, living infant,
7 Ib.

Case 6. Negro, para 7, gravida 8, aged thirty-eight,

5 living children, 1 forceps delivery; anthropoid pel-
vis, anteroposterior 1 1.5 cm., transverse 1 1 cm. Test
of labor 24 hr. then low cervical cesarean Operation
with hysterectomy, presentation left occipitoposte-
rior at Operation.

Case 7. Negro primipara, ageil eighteen; gynecoid
pelvis; anteroposterior 12 cm., transverse 12.5 cm.
Labor ist stage 48 hr. with infreqiient uterine con-
tractions, 2nd stage 2 hr. Spontaneous tlelivery, left
occipito-anterior, living infant, weight 6 Ib. 3 oz.

Case 8. Negro, para o, gravida 4; markedly con-
tracted gynecoid pelvis with prominent promontory;
anteroposterior 8.5 cm., transverse i i .5 cm. Labor 22
hr, test without engagement of the head then low
cervical cesarean section, delivery of living infant,
weight 8 Ib. 5 oz. (congenital syphilis).

Case 9. White primipara, aged twenty-thrce; gyn-
ecoid pelvis; anteroposterior 1 1.5 cm., transverse 13
cm. Labor ist stage 25 hr., 2nd stage 40 min. Spon-
taneous delivery left occipito-anterior, living infant,
weight 61b. 84 oz.

Case 10. Negro primipara, aged nineteen; gyne-
coid contracted pelvis; anteroposterior 9.5 cm., trans-
verse I 1.5 cm. Labor ist stage 3 or 4 days with infre-
quent pains, 2nd stage 32 hr. Low Kjelland forceps
delivery, right occipito-anterior, living infant,
weight 5 Ib. 14 oz.

Case ii. Negro, para 2, gravida 3, aged thirty;
gynecoid pelvis; anteroposterior 1 1.5 cm., transverse
12.25 cm. Labor ist stage 5 hr. 45 min., 2nd stage i
hr. Spontaneous delivery, left occipito-anterior, liv-
ing infant, weight 7 Ib. 7 oz.

Case 12. Negro, para 3, gravida 4, aged twenty;
gynecoid pelvis; anteroposterior 1 1.5 cm., transverse
12 cm. Transverse presentation at time of roentgen
examination. Fetus turned spontaneously and de-
livered normall y after rapid labor, left occipito-an-
terior, weight of infant 8 Ib.

720

Richard Torpin

May, 194a

Fig. 2. Pelvic outlines o( Cases i to 36.

Case 13. White, para i, gravida 2, aged twenty-
one; slightly contracted gynecoid pelvis; anteropos-
terior 10 cm., transverse 1 1.5 cm. Labor placenta pre-
via marginalis. Voorhees bag inserted into lower
uterine segment followed in i^ hr. by spontaneous

delivery living infant, right occipito-anterior, weight
6 Ib. 11^ oz.

Case 14. Negro Primipara, aged fourteen; s'ightly
contracted gynecoid pelvis; anteroposterior ;o cm.,
transverse 11.25 cm. Labor ist stage 15 hr. 20 min.,

Vol. 47, No. 5

Roentgen Pelvimetry in Labor

721

2nd stage 2 hr. 50 min. Spontaneous delivery, right
occipito-anterior, living infant, weight 6 Ib. 1 1 oz.

Case 15. Negro primipara, agetl fourteen, anemic
with phicenta previa marginalis; slight contracted
gynecoid pelvis; anteroposterior 10.5 cm., transverse
12 cm. Labor 77 hr. Right occipitoposterior rotation
135° to left occipito-anterior with spontaneous de-
livery living infant, weight 5 ib. 130z.

Case 16. White Primipara, aged sixteen; android
pelvis; anteroposterior i i cm., transverse 12 cm. La-
bor ist stage 48 hr., 2nd stage 7 hr. 31 min. Right oc-
cipitoposterior to right occipito-anterior spontaneous
delivery living infant, weight (•> Ib. 4 oz.

Case 17. Negro primipara, aged twenty-one; gyne-
coid pelvis; anteroposterior 11.75 cm., transverse 13
cm. Labor ist stage 6 hr. 30 min., 2nd stage 3 min.
Right occipito-anterior spontaneous delivery living
infant, weight 6 Ib.

Case 18. Negro, para 6, gravida 7, aged thirty;
gynecoid pelvis; anteroposterior 11.25 cm., trans-
verse 13 cm. Labor ist stage 13 hr. ^^^] min., 2nd stage
2 min. Spontaneous delivery left occipito-anterior,
living infant, weight 8 Ib. 3 oz.

Case 19. White, para 3, gravida 4, aged twenty-
two; justo major gynecoid pelvis. Labor ist stage 31
hr. 40 min., 2nd stage 2 min. Fetal head ballotable
until just before delivery. Spontaneous delivery
from complete occiput posterior presentation, living
infant, weight 7 Ib. 11.5 oz.

Case 20. White, para 2, gravida 3, aged twenty-
one; gynecoid pelvis; anteroposterior 1 1.5 cm., trans-
verse 13.5 cm. Labor ist stage 22 hr., 2nd stage few
minutes. Spontaneous delivery right occipito-ante-
rior, living infant, weight 8 Ib. 4 oz

Case 21. White primipara, aged thirty-three;
gynecoid pelvis; anteroposterior 1 1.5 cm., transverse
13.5 cm. Labor twins, female, small, both breech
spcntaneous delivery living infants, weight No. i, 4
Ib. 1 1 oz., No. 2, 4 Ib. 84 oz.

Case 22, White primipara, aged nineteen; slightly
contracted platypelloid pelvis; anteroposterior 10
cm., transverse 13 cm. Labor ist stage 152 hr., 2ntl
stage 2 hr. Spontaneous delivery, right occipito-an-
terior, living infant, weight 6 Ib. 13^} oz.

Case 23. White para 7, gravida 10, aged thirty-six;
large android pelvis; anteroposterior 14 cm,, trans-
verse 13 cm. Labor, total 3 hr.; precipitate delivery
from direct occiput posterior presentation, one living
infant, weight 9 Ib. 4 oz. One year previously she had
spontaneous delivery, from left occipito-anterior of
one living infant, weight 9 Ib. 13 oz. Total labor, 4 hr.
22 min.

Case 24. W'hite, para i, gravida 2, aged twenty-
five; gynecoid pelvis; anteroposterior 1 1.5 cm., trans-
verse 12 cm. Labor ist stage 13 hr., 2nd stage 2 hr.
47 min. Spontaneous delivery, left occipito-anterior,
living infant, weight 7 Ib. 1 1 i oz.

Cast. 25. Negro, para 2, gravida 3, aged twenty;
gynecoid pelvis; anteroposterior 11.75 cm., trans-
verse 12.75 cm. Labor ist stage 19 hr. 40 min., 2nd
stage 28 min. Spontaneous delivery.

Case 26. Negro primipara, ageil fifteen; gynecoid
pelvis; anteroposterior 11 cm., transverse 11.25 cm
Labor short, entered the hospital with the fetal head
in the perineum and spontaneously delivered a living
infant from left occipito-anterior, weight 5 Ib. 1 i oz.

Case 27. White primipara, aged nineteen; justo
major gynecoid pelvis; anteroposterior 12.5 cm.,
transverse 13 cm. Labor ist stage 31 hr. 14 min., 2nd
stage I hr. Spontaneous delivery right occipito-an-
terior living infant, 5 Ib. 3 oz.

Case 28. White primipara, aged thirty-five; slight
contracted gynecoid pelvis; anteroposterior 10 cm.,
transverse 1 1.5 cm. Labor ist stage i hr., 2nd stage 4
hr. 32 min. (left band prolapsed besicie head). Spon-
taneous delivery, right occipito-anterior living infant,
weight 7 Ib. 44 oz.

Case 29. Negro primipara, aged seventeen, mihi
toxemia; gynecoid pelvis; anteroposterior 11.5 cm.,
transverse 12.5 cm. Labor ist stage 27 hr. 15 min.,
2nd stage 3 hr. 9 min. Low forceps right occipito-an-
terior living infant, weight 7 Ib. 9 oz.

Case 30. Negro primipara, aged twenty-four,
toxemia; anthropoid pelvis; anteroposterior 11 cm.,
transverse 1 1 cm. Labor ist stage 36 hr. Cervix fully
ililated by a Voorhees bag. 2nd stage i hr. 30 min.
Mid pelvis Kjelland application of Kjelland forceps.
O.L.T. living infant, weight 7 Ib. 14 oz.

Case 31. White, para 5, gravida 6, aged twenty-
Hve; slight contracted platypelloid pelvis; anteropos-
terior 10 cm., transverse 13.5 cm. Labor ist stage 14
hr. 45 min., 2nd stage 10 min. Spontaneous delivery,
right occipito-anterior living infant, weight 8 Ib. 4 oz.

Case 32. White, para 5, gravida 6, aged thirty-two;
gynecoid pelvis; anteroposterior 10.75 cm., trans-
verse 1 2.5 cm. Labor i st stage 7 hr. 30 min , 2nd stage
30 min. Spontaneous delivery, right occipitopos-
terior to right occipito-anterior living infant, 7 Ib. 4 oz.

Case 3;^. Negro, para 5, gravida 6, aged thirty-
four; android pelvis; anteroposterior 11.25 cm.,
transverse 12 cm. Labor ist stage 10 hr., 2nd stage
25 min. Spontaneous delivery O.R.A. living infant,
weight 8 Ib.

Case 34. Negro primipara, aged fifteen; contracted
pelvis android tendency; anteroposterior 9 cm.,
transverse 10 cm. Labor ist stage 22 hr., 2nd stage
2 hr. Spontaneous delivery O.R.A. living infant,
weight 6 Ib. 8 oz.

Case ^S- Negro primipara, aged eighteen, toxemia;

gynecoid pelvis; anteroposterior 11 cm., transverse

^ 12.25 cm. Labor ist stage 15 hr. 30 min., 2nd stage

I hr. 25 min. Spontaneous delivery O.R.A. living

infant, weight 6 Ib. 12 oz.

Case 36. Negro primipara, aged eighteen; con-
tracted gynecoid pelvis; anteroposterior 9.25 cm.,
transverse 1 1 cm. Labor ist stage 19 hr. 15 min., 2nd
stage 30 min. Spontaneous delivery O.R.A. living
infant, weight 7 Ib. 4I oz.

Case 37. Negro primipara, aged thirty-two; gyne-
coid pelvis; anteroposterior 11 cm., transverse 12.75
cm. Labor, precipitant spontaneous delivery of living
infant.

722

Richard Torpin

May, 1942

Fig. 3. Pelvic outlines of Cases 37 to 72.

Case 38. White, para 2, gravida 3, aged thirty-
seven; slight contracted gynecoid pelvis; antero-
posterior 10.25 cm., transverse 12 cm. Labor ist
stage 7 hr., 2nd stage i hr. Spontaneous delivery
O.R.A. living Infant, weight 7 Ib. 2 oz.

Case 39. White, para i, gravida 2, aged nineteen,
mild toxemia; gynecoid pelvis; anteroposter or 12
cm., transverse 13 cm. Labor ist stage 6 hr. 30 min.,
2nd stage 10 min. Spontaneous delivery O.R.A.
living infant, weight 6 Ib. 7^ oz.

Vol. 47, No. 5

Roentgen Pelvimetry in Labor

723

Case 40. White Primipara, aged eighteen; gynecoid
pelvis; anteroposterior 1 1 cm., transverse 13.5 cm.
Labor ist stage 8 hr. 50 min., 2nd stage 30 min.
Spontaneous delivery O.K.A. living infant, weight
5 Ib. 12 oz.

Case 41. White, para 8, gravida 9, aged forty-
three, obese and toxemic; justo major gynecoid pel-
vis; anteroposterior 12 cm., transverse 13.5 cm.
Labor ist stage futile uterine contractions over
period of 3 days during which time she received 25
gm. MgS04 for hypertension. Innally cervix became
fully dilated and she spontaneously delivered O.L.A.
living infant, weight 9 Ib. 8 oz.

Case 42. Negro primipara, aged twenty-five, tox-
emia; contracted gynecoid pelvis; anteroposterior
9.25 cm., transverse 10.75 cm. Labor ist stage 76 hr.,
2nd stage 3 hr. Deep transverse arrest in mid pelvis
O.K.T. Kjelland application of Kjelland forceps de-
livered living infant, weight 6 Ib. 1 2 oz.

Case 43. Negro, para 2, gravida 3, aged twenty-
three; slightly contracted gynecoid pelvis; antero-
posterior 10.5 cm., transverse 12.25 cm. Labor, ist
stage 39 hr., 2nd stage 4 hr. 35 min. Low forceps de-
livery O.L.A. living infant, weight 6 Ib. 7 oz.

Case 44. White primipara, aged sixteen; gynecoid
pelvis; anteroposterior 12.0 cm., transverse 12.5 cm.
Labor, ist stage 3 hr., 2nd stage 50 min. Spontaneous
delivery O.R.A. living infant, weight 6 Ib. i oz.

Case 45. Negro primipara, aged seventeen;
slightly contracted gynecoid pelvis with prominent
promontory; anteroposterior 10 cm., transverse 12.5
cm. Labor, ist stage 24 hr., 2nd stage 1 hr. Spon-
taneous delivery O.R.A. living infant.

Case 46. White, para i, gravida 2, aged twenty-
two; slightly contracted gynecoid pelvis; antero-
posterior 10 cm., transverse 12 cm. Labor, ist stage
26 hr. 45 min., 2nd stage i min. Spontaneous delivery
O.R.P. living infant, weight 8 Ib. 4^ oz.

Case 47. Negro, para 6, gravida 7, aged thirty-
four, toxemia; justo major gynecoid pelvis; antero-
posterior 12 cm., transverse 12.5 cm. Labor, ist
stage 5 hr., 2nd stage 10 min. Spontaneous delivery
O.L.A. livinginfant, weight 9 Ib. 120z.

Case 48. Negro, para 2, gravida 3, aged twenty,
toxemia; slight contracted gynecoid pelvis; antero-
posterior 10 cm., transverse 11.5 cm. Labor, ist
stage 19 hr., 2nd stage 10 min. Spontaneous delivery
O.R.A. living infant, weight 8 Ib. 2 oz.

Case 49. White, para i, gravida 2, aged eighteen,
toxemia; gynecoid pelvis; anteroposterior 10.75 cm.,
transverse 12.5 cm. Labor, ist stage 11 hr. 15 min.,
2nd stage 27 min. Spontaneous delivery O.L.A. living
infant, weight 7 Ib. 12} oz. (ist labor 48 hr. delivered
by Kjelland forceps mid pelvis O.L.T. living infant,
weight 7 Ib. 8 oz.)

Case 50. Negro, para 4, gravida 5, aged twenty-
four; slightly contracted gynecoid pelvis; antero-
posteilor 10.5 cm., transverse 11.25 cm. Labor, ist
stage 1. hr., 2nd stage 20 min. Spontaneous delivery
O.L.A. living infant, weight 5 Ib. 13 oz.

Case 51. Negro, para 4, gravida 5, aged thirty-

four, toxemia; contracted gynecoid pelvis; antero-
posterior 9.75 cm., transverse 10.25 cm. Labor, ist
stage test ;;^^^ hr. 50 min. then low cervical cesarean
section. Letal heatl tightly fitted into pelvic brim
O.R.T. living infant, weight 8 Ib. 8 oz. (All of her
previous children were living.)

Case 52. White, para 2, gravida 3, aged twenty-
seven; large androitl pelvis; anteroposterior 1 1.5 cm.,
transverse 13 cm. Labor, ist stage 22 hr. 30 min.,
2nd stage 2 hr. 25 min. Spontaneous delivery O.L..^.
living infant, weight 8 Ib. 8» oz.

Case 53. White, para 2, gravida 3, aged twenty-
nine; slightly contracted gynecoid pelvis with promi-
nent promontory; anteroposterior 9.5 cm., trans-
verse 11.5 cm. Labor, ist stage 9 hr. 15 min., 2nd
stage 31 min. Spontaneous delivery O.L.A. living
infant, weight 9 Ib. 8 oz.

Case 54. Negro, para i, gravida 2, aged twenty-
six; android pelvis; anteroposterior 11.5 cm., trans-
verse 12.25 cm. Labor, ist stage 15 hr. 30 min., 2nd
stage 2 hr. 35 min. Spontaneous delivery O.L..A.
living infant, weight 9 Ib. 8 oz.

Case 55. Negro primipara, aged seventeen, dys-
trophia dystocia Syndrome, obese and toxemic;
slightly contracted gynecoid pelvis; anteroposterior
10 cm., transverse 11 cm. Labor, ist stage 112 hr.,
2nd stage i hr. Spontaneous delivery O.R.P. to
O.R.A. living infant, weight 6 Ib.

Case 56. White, para 2, gravida 3, aged twcnty-
one; justo major gynecoid pelvis; anteroposterior 12
cm., transverse 12.75 cm. Labor, ist stage 4 hr. 45
min., 2nd stage 15 min. Spontaneous delivery O.L.A.
living infant, weight 6 Ib. 12 oz.

Case 57. Negro, para 2, gravida 3, aged twenty;
justo major gynecoid pelvis; anteroposrerior 12.25
cm., transverse 12.75 cm. Labor, ist stage 11 hr. 40
min., 2nd stage 10 min. Spontaneous delivery O.L..A.
living infant, weight 6 Ib. 8 oz.

Case 58. White primipara, aged seventeen; gyne-
coid pelvis; anteroposterior 11.5 cm., transverse 13
cm. Labor, ist stage 19 hr. 30 min., 2nd stage 2 hr.
10 min. Spontaneous delivery O.L.A. living infant,
weight 9 Ib. 14 oz.

Case 59. White primipara, aged fifteen; gynecoid
pelvis; anteroposterior 1 1.5 cm., transverse 13.5 cm,
Labor, ist stage 10 hr., 2nd stage i hr. 10 min.
Spontaneous delivery O.L.A. living infant, weight
7 Ib. 4^ oz.

Case 60. White primipara, aged twenty-eight;
slightly contracted gynecoid pelvis; anteroposterior
IG cm., transverse 13 cm. Labor, ist stage 25 hr.
55 min., 2nd stage 39 min. Spontaneous delivery
O.L.A. living infant, weight 4 Ib. 4} oz.

Case 61. White, para i, gravida 2, aged twenty-
nine; gynecoid pelvis; anteroposterior 1 1 cm., trans-
verse 12 cm. Labor, ist stage 12 hr. 5 min., 2nd stage
I hr. 40 min. Spontaneous delivery O.L.A. living
infant, weight 10 Ib. 6| oz.

Case 62. White, para 2, gravida 3, aged nineteen,
toxemia and twins; gynecoid pelvis; anteroposterior
11.5 cm., transverse 13 cm. Labor, ist stage 17 hr.

7^4

Richard Torpin

Mav, 1942

Vol. 47, No, 5

Roentgen Pelvimetry in Labor

725

Fig. 4. Pelvic outlines of Cases 73 to 108.

5 min., 2nd stage 1 hr. Spontaneous delivery O.L.A.
living female, weight 6 Ib. 3 oz., and O.L.A. living
male, weight 6 Ib 2 oz.

Gase 63. White, para 2, gravida 3, aged twenty-
one; slightly contracted gynecoid pelvis; antero-
posterior 10.5 cm., transverse 11.5 cm. Labor, ist

stage 17 hr. 50 min., 2nd stage 2 hr. 10 min. Spon-
taneous delivery O.R.A. living infant, weight 8 Ib.
4 oz.

Gase 64. Negro primipara, aged seventeen, dys-
trophia dystocia Syndrome; contracted gynecoid pel-
vis; anteroposterior 9 cm., transverse 10.5 cm. Labor,

ist stage 63 hr., 2nd stage 2 hr. 5 min. Maternal tem-
perature 104° F., pulse 180 in spite of fluids and oxy-
gen. Dead fetiis delivered by craniotomy. Weight of
fetiis 6 Ib. 1 1 oz plus an estimated 20 per cent for
brains and blood.

Gase 65. Negro, para i, gravida 2, aged nineteen;
pelvis android tendency; anteroposterior 11.5 cm.,
transverse 12.5 cm. Labor, ist and 2nd stages 18 hr.
Spontaneous delivery Ü.L.P. to O.L.A. living infant,
weight 6 Ib. 14 oz.

Gase 66. Negro primipara, aged nineteen; anthro-
poid pelvis; anteroposterior 1 1 .5 cm., transverse 1 1 .5
cm. Labor, ist stage 15 hr., 2nd stage 4 hr. 27 min.
Kjelland mid forceps delivery O.L.T. living infant,
weight 7 Ib.

Gase 67. White primipara, aged thirty-four, short
and stout; slightly contracted gynecoid pelvis; an-
teroposterior 10 cm., transverse 12.5 cm. Labor, ist
stage 38 hr. 30 min,, 2nd stage 8 hr. 52 min. Mid
forceps delivery O.L.P. living infant, weight 7 Ib.

5 oz.

Gase 68. Negro primipara, aged sixteen; slightly
contracted gynecoid pelvis; anteroposterior 10.5 cm.,
transverse 12.5 cm. Labor, ist stage 19 hr., 2nd stage
8 hr. 18 min. Delay due to large Shoulders. Low
forceps delivery O.L.xA. living infant, weight 8 ib.

6 oz.

Gase 69. Negro primipara, aged seventeen; an-
thropoid pelvis; anteroposterior 12.25 cm., trans-
verse 12 cm. Labor, ist and 2nd stages 6 hr. Spon-
taneous delivery O.R.A. living infant, weight 6 Ib.
8 oz.

Gase 70. Negro primipara, aged twenty-one;
slightly contracted gynecoid pelvis; anteroposterior
10.5 cm., transverse 1 1.5 cm. Labor, ist stage 46 hr.,
2nd stage 2 hr. 50 min. Spontaneous delivery O.L.T.
to O.L.A. living infant, weight 7 Ib. 12 oz.

Gase 71. White primipara, aged eighteen; gyne-
coid pelvis; anteroposterior 11.5 cm,, transverse
12.75 cm. Labor, ist stage 15 hr. 12 min., 2nd stage
I hr. 16 min. Spontaneous delivery O.L.T. to O.L.A.
living infant, weight 6 Ib. 5 oz.

Gase 72. Negro, para i, gravida 2, aged twenty-
seven, toxemia; gynecoid pelvis; anteroposterior
11.75 cm., transverse 12 cm. Labor, ist stage 11 hr.
45 min., 2nd stage 8 hr. 35 min. Extension of the fetal
head, mid pelvis application of Kjelland forceps
0,R,P. to O.R.A. delivery of stil'born infant, weight
10 Ib. 3 oz. Autopsy of the fetus revealed brain in-
jury. (History of ist labor: ist stage 60 hr., 2nd stage
5 hr. 48 min. Kjelland forceps to fetal head in mid
pelvis O.L.T. delivery living infant, weight 8 Ib.
3 oz.)

Gase 73. Negro, para 3, gravida 4, aged thirty-six;
slightly contracted gynecoid pelvis; anteroposterior
10 cm., transverse 1 1.25 cm. Labor, ist stage 24 hr.,
2nd stage 15 min. Spontaneous delivery O.L.A.
livinj^ infant, weight 6 Ib, 12 oz.

Gase 74. Negro, para 4, gravida 5, aged twenty-
three, toxemia; slightly contracted gynecoid pelvis;
anteroposterior 10 cm., transverse 10.75 cm. Labor,

ist stage 2 hr. 40 min., 2nd stage 20 min. Sponta-
neous delivery O.L.A. living infant, weight 9 Ib.

1 1 oz.

Gase 75. Negro, para 4, gravida 5, ageil twenty-
seven; gynecoid pelvis; anteroposterior 1 1 cm.,
transverse 12.5 cm. Labor, ist stage 32 hr., 2nil stage
short. Spontaneous delivery living infant ().L..A.,
7 Ib. 3 oz.

Gase 76. Negro primipara, aged sixteen; con-
tracted gynecoid pelvis; anteroposterior 9 cm., trans-
verse 1 1 cm. Labor, ist stage ^];') hr., 2nil stage 1 hr.
50 min. Spontaneous delivery living infant, weight
5 Ib. 12 oz.

Gase 77. White, para o, gravida 2, aged eighteen;
justo major gynecoid pelvis; anteroposterior 12.75
cm,, transverse 13 cm. Labor, ist stage 17 hr., 2nd
stage 20 min. Spontaneous delivery O.L..^. living
infant, weight 8 Ib.

Gase 78. White primipara, aged twenty-one; gyne-
coid pelvis with android tendency; anteroposterior

12 cm., transverse 12.75 cm, Labor, ist stage 7 Hr.,
2nd stage 31 min. Spontaneous delivery O.L.A.
living infant, weight 8 Ib. 10 oz.

Gase 79. White primipara, aged eighteen; gyne-
coid pelvis; anteroposterior 1 2 cm., transverse 13 cm,
Labor, ist stage 36 hr,, 2nd stage 5 hr. 27 min. Mid
pelvis Kjelland forceps O.L.T. living infant, weight
7 Ib. 12 oz.

Gase 80. Negro primipara, aged eighteen; slightly
contracted gynecoid pelvis; anteroposterior 10.25
cm., transverse 11.75 cm. Labor, ist stage 34 hr.
30 min., 2nd stage 30 min. Spontaneous delivery
O.L.A. living infant, weight 5 Ib. 2 oz.

Gase 81. White primipara, aged fifteen; contracte 1
gynecoid pelvis; anteroposterior 9 cm., transverse
11.5 cm. Labor, ist stage 52 hr. 28 min., 2nd stage

1 hr. 56 min. Low forceps delivery O.R..-\. living
infant, weight 7 Ib. 6 oz.

Gase 82. White, para i, gravida 2, aged twenty-
one; gynecoid pelvis; anteroposterior 1 1.5 cm., trans-
verse 12.5 cm. Labor, ist stage 6 hr. 20 min,, 2nd
stage 27 min. Spontaneous delivery 0,R.A. living
infant, weight 8 Ib. 13 oz.

Gase 83. White, para 2, gravida 3, aged twenty-
one; contracted platypelloid pelvis; anteroposterior
8.75 cm., transverse 12.75 cm. Labor, 20 hr. without
engagement, then low cervical cesarean section at
which there was found a brow presentation occiput
to the right. Living infant, weight 7 Ib. 3} oz. (She
had had two previous difficult spontaneous deliveries,
both babies were small.)

Gase 84. Negro primipara, aged sixteen; gynecoid
pelvis; anteroposterior 11.5 cm., transverse 13.5 cm.
Labor, ist stage 42 hr., 2nd stage 2 hr. 40 min. Spon-
taneous delivery O.L.A. living infant, weight 5 Ib.

2 oz.

Gase 85. Negro, primipara, aged nineteen;
slightly contracted pelvis android tendency; antero-
posterior 10.5 cm., transverse 11.5 cm, Labor, ist
stage 40 hr. 20 min., 2nd stage 28 min. Spontaneous
delivery O.R..A. living infant, weight 5 Ib. 2 oz.

726

Richard Torpin

May, 1942

Case 86. Negro primipara, agetl seventeen;
slightly contracted gynecoid pelvis, android ten-
dency; anteroposterior 10 cm., transverse 12.25 cm.
Lahor, ist stage 22 hr. 45 min., 2nd stage 30 min.
Spontancous delivery O.L.A. living infant, weight

9 Ib.

Case 87. White, para i, gravida 2, aged twenty-
three; gynecoid pelvis; anteroposterior 10.5 cm.,
transverse 12.75 cm. Lahor, ist stage 6 hr. 30 min.,
2nd stage 34 min. Spontaneous delivery O.R.A. liv-
ing infant, weight 6 Ih.

Case 88. Negro primipara, aged eighteen; anthro-
poid pelvis; anteroposterior 12 cm., transverse 12 cm.
J.ahor, ist stage 36 hr. 30 min., 2nd stage 40 min.
Spontaneous delivery O.R.P. to O.R.A. living infant,
weight 7 Ib. 12 oz.

Case 89. Negro primipara, achondroplastic dwarf,
aged twenty-foiir, brought to hospital after 50 hr. of
lahor, anemic, eclamptic, neglected, and fetiis in
poor condition; large fetus and platypelloid p>elvis;
anteroposterior 8.5 cm., transverse 11. 5 cm. Delivery
by craniotomy infant, weight 8 Ib. 6 oz. plus esti-
mated 20 per cent for brains and blood. Uterus
packed, mother died on sixth day, autopsy revealed
infarct of the posterior lobe of the pituitary gland,
anemia, fatty degeneration of the liver, pulmonary
congestion and edema.

Case 90. Negro primipara, aged sixteen; gynecoid
pelvis; anteroposterior 11 cm., transverse 12 cm.
Labor, ist stage 36 hr., 2nd stage i hr. 30 min. Spon-
taneous delivery O.R.P. to O.R.A. living infant,
weight 6 Ib. 6 oz.

Case 91. Negro primipara, aged twenty-five;
gynecoid pelvis; anteroposterior 1 1 cm., transverse
11.5 cm. Labor, ist stage 30 hr., 2nd stage 2 hr.
Spontaneous delivery O.L.P to O.L.A. living infant,

weight 7 Ib. 5 oz.

Case 92. Negro primipara, aged twenty; slightly
contracted gynecoid pelvis; anteroposterior 10 cm.,
transverse 11.75 cm. Labor, ist stage 20 hr., 2nd
stage 2 hr. 15 min. Spontaneous delivery O.R.A.
living infant, weight 6 Ib. 4 oz.

Case 93. White, para 2, gravida 3, aged twenty;
gynecoid pelvis; anteroposterior 10.5 cm., transverse
12.25 cm. Labor, ist stage 12 hr. 20 min., 2nd stage
30 min. Spontaneous delivery O.L.A. living infant,
weight 6 Ib. 140z.

Case 94. White primipara, aged sixteen, short fat
type, hereditary; slightly contracted gynecoid pelvis;
anteroposterior 10.25 cm., transverse 12.75 cm.
Labor, 30 hr. test, then low cervical cesarean sec-
tion. Delivery of living infant, weight 6 Ib. 1 oz.

Case 95. Negro, para 6, gravida 7, aged twenty-
eight; gynecoid pelvis; anteroposterior 10.75 cm.,
transverse 12 cm. Labor, ist stage 23 hr., 2nd stage
25 min. Spontaneous delivery O.R.A. living infant,
weight 7 Ib. II oz.

Case 96. Negro, para 2, gravida 3, aged twenty-
seven, toxemia; slight contracted gynecoid pelvis;
anteroposterior 10 cm., transverse 10.75 cm. Labor,
ist stage 77 hr., 2nd stage 5 hr. 25 min. Mid forceps

O.R.P. Stillborn infant, weight 9 Ib. 5 oz. Autopsy:
brain injury.

Case 97. Negro, para 1, gravida 2, aged twenty-
nine; anthropoid pelvis; anteroposterior 12 cm.,
transverse 12 cm. Lahor, ist stage 48 hr., 2nd stage
30 min. Spontaneous delivery O.L.P. to O.L.A.
living infant, weight 8 Ib. 12 oz.

Case 98. Negro primipara, aged twenty; slightly
contracted gynecoid pelvis; anteroposterior 10.5 cm.,
transverse 12 cm. Labor, ist stage 79 hr. at home
with several vaginal examinations. Membrancs rup-
tured and infection of amniotic fluid, dead fetus de-
livered by craniotomy, mother died suddenly six
hours later. Autopsy: bilateral pulmonary emboli,
Streptococcus found in vaginal culture.

Case 99 Negro primipara, aged nineteen; s'ightly
contracted gynecoid pelvis; anteroposterior 9.75 cm.,
transverse 11 cm. Labor, ist stage 30 hr., 2nd stage
6 hr. Kjelland forceps delivery O.R.T. living infant
weight 5 Ib. 6 oz.

Case 100. Negro, para 2, gravida 4, aged twenty;
slightly contracted gynecoid pelvis; anteroposterior
IG cm., transverse 12.5 cm. Lahor, ist stage 56 hr.,
2nd stage 2 hr. 20 min. Spontaneous delivery O.L.A.
living infant, weight 9 Ib.

Case ioi. Negro primipara, aged sixteen; anthro-
poid pelvis; anteroposterior 12.25 cm., transverse 12
cm. Placenta previa marginalis treated by rupture of
the membranes. Labor, ist stage 12 hr. 20 min., 2nd
stage 20 min. Spontaneous delivery O.L.A. living
infant, weight 5 Ib. 4 oz.

Case 102. White primipara, aged eighteen; gyne-
coid pelvis; anteroposterior 11 cm., transverse 13.75
cm. Labor, ist stage 9 hr. 30 min., 2nd stage 1 hr.
Spontaneous delivery O R.A. living infant, 7 Ib. 6 oz.

Case 103. Negro, para 3, gravida 4, aged thirty,
toxemia; gynecoid pelvis; anteroposterior 12 cm.,
transverse 12.5 cm. Labor, ist stage 7 hr., 2nd stage
1 hr. 10 min. Breech delivery, macerated fetus,
weight 6 Ib. 2 oz.

Case 104. White, para 4, gravida 5, aged tv/ctity-
nine; malformed gynecoid pelvis; anteroposterior
11.75 cm., transverse 12.5 cm. Labor ist stage 36
hr., 2nd stage 1 hr. 10 min. Spontaneous delivery
O.L.A. living infant, weight 4 Ib. 5^ oz.

Case 105. White primipara, aged twenty; gynecoid
pelvis; anteroposterior 11.75 cm., transverse 13.25
cm. Labor, ist stage 8 hr., 2nd stage i hr. 48 min.
Spontaneous delivery O.L.A. living infant, weight
6 Ib. 10 oz.

Case 106. Negro primipara, aged sixteen, toxemia;
slightly contracted anthropoid pelvis; anteroposte-
rior 10.75 cm., transverse 10.5 cm. Labor, ist stage
12 hr. 10 min., 2nd stage 10 min. Spontaneous de-
livery O.L.A. living infant, weight 5 Ib. 4 oz.

Case 107. White primipara, aged fifteen; gynecoid
pelvis with narrow outlet; anteroposterior ii (m.,
transverse 12.25 cm. Labor, ist stage 58 hr. 5 1 .m.,
2nd stage S3 min. Low forceps delivery after rot: tion
O.R.P. to O.R.A. living infant, weight 6 Ib. 12^ oz.

Case 108. Negro primipara, aged twenty-one, tox-

VoL. 47, No. 5

Roentgen Pelvimetry in Labor

727

emia; contracted anthropoid pelvis; anteroposterior

10 cm., transverse 10 cm. Lahor, ist stage 13 hr., 2nd
stage 5 hr. 20 min. Kjelland mid forceps O.L.T.,
infant died following cerebellar injuries.

Case 109. Negro, para 2, gravida 3, aged twenty;
anthropoid pelvis; anteroposterior 1 1 cm., transverse

11 cm. Labor, ist stage 23 hr. 30 min., 2nd stage
30 min. Spontaneous delivery O.L.A. living infant,
weight 6 Ib. 6 oz.

Case 110. Negro primipara, aged seventeen, Pye-
litis of pregnancy and anemia; justo major gynecoid
pelvis; anteroposterior 12.5 cm., transverse 13 cm.
Labor, ist stage irregulär contractions for 72 hr., 2nd
stage 3 hr. Mid forceps delivery O.L.A. living infant,
weight 9 Ib. 4 oz.

Case 111. Negro primipara, aged seventeen, tox-
emia; anthropoid pelvis with narrow outlet; antero-
posterior 12 cm., transverse 12 cm. Labor, ist stage
16 hr., 2nd stage 2 hr. Spontaneous delivery O.L.A.
living infant, weight 6 Ib. 7 oz.

Case 112. White, para 4, gravida 5, aged thirty-
six; contracted android pelvis; anteroposterior 9.5
cm., transverse 12 cm. Labor, ist stage 16 hr., 2nd
stage 1 hr. Spontaneous delivery O.R.A. living in-
fant, 5 Ib. 12 oz.

Case 113. Negro primipara, aged fifteen; slightly
contracted gynecoid pelvis; anteroposterior 10.75
cm., transverse 11.75 cm. Labor, ist stage 30 hr.,
2nd stage 2 hr. plus. Mid Kjelland forceps delivery
O.L.T. living infant, weight 7 Ib. 8 oz.

Case 114. Negro, para 4, gravida 5, aged twenty-
seven, toxenia; slight contracted gynecoid pelvis;
anteroposterior 10.5 cm., transverse 1 1.75 cm. Labor,
ist stage 24 hr., 2nd stage 2 hr. Spontaneous delivery
O.R.T. to O.R.A. living infant, weight 5 Ib. 8 oz.

Case 115. Negro primipara, aged eighteen, tox-
emia; gynecoid pelvis with narrow outlet; antero-
posterior II cm., transve-se 11.75 cm. Labor, ist
stage 56 hr., 2nd stage 5 hr. 1 5 min. Kjelland applica-
tion of Kjelland for':eps O.R.P. in mid pelvis, de-
livery living infant, weight 6 Ib. 9 oz. This fetal head
rotate'' from O.L.P. to O.P. to O.R.P.

Case 116. Wählte primipara, aged twenty-six; pel-
vis tendency to android; anteroposterior 10.75 cm.,
transverse 11 cm. Labor, ist stage 14 hr., 2nd stage
21 min. Spontaneous delivery O.R.T. to O.R.A.
living infant, weight 6 Ib. 3^ oz.

Case 117. White primipara, iged seventeen, fe-
male type; pelvis android tendency, very narrow out-
let; anteroposterior 11.25 cm., transverse 11.75 cm.
Labor, ist stage 27 hr., 2nd stage 7 hr. 45 min. Mid
pelvis Kjelland application of Kjelland forceps
O.L.P. delivery of living infant, weight 6 Ib. 3 oz.,
temporary facial paralysis of fetus.

Case 118. White, para i, gravida 4, aged seven-
teen, had previous low cervical section; gynecoid
pelvis; anteroposterior 11.25 cm., transverse 13 cm
Labi»r, ist stage 18 hr. 56 min., 2nd stage i hr. Spon-
taneous delivery O.L.A. living infant, weight 7 Ib.
2| oz.

Case 119. White primipara, aged eighteen; gyne-

coid pelvis narrow outlet; anteroposterior 12 cm.,
transverse 12.25 cm. Labor, ist stage ;]3 hr. 30 min.,
2nd stage 10 min. Spontaneous delivery O.L..A. small
macerated fetus, dead for several days.

Case 120. Negro, para 4, gravida 5, aged thirty-
three; contracted pelvis android tendency; antero-
posterior 9.5 cm., transverse 1 1 cm. Lahor, ist stage
7 hr., 2nd stage 9 hr. 49 min, Dead fetus transverse
with elhow presenting, weight 7 Ib. 7 oz. deliveretl by
Version and extraction.

Case 121. Negro, para 5, gravida 6, aged thirty-
five; gynecoid pelvis; anteroposterior 10.5 cm., trans-
verse 13 cm. Labor, ist stage 13 hr., 2nd stage 52
min. Spontaneous delivery O.L.A. living infant,
weight 7 Ib. 14 oz.

Case 122. White, para 3, gravida 4, aged twenty-
four, familial obesity; justo major gynecoid pelvis
slight android tendency; anteroposterior 12.25 cm.,
transverse 14.25 cm. Labor induced, ist stage 3 hr.
30 min., 2nd stage 12 min. Spontaneous delivery
O.L.A. living infant, weight 10 Ib. ij oz,

Case 123. White primipara, aged twenty; slightly
contracted gynecoid pelvis; anteroposterior 10.25
cm., transverse 12 cm. Labor, ist stage 22 hr., 2nd
stage 6 hr. Low forceps delivery O.R.-A. living infant,
weight 9 Ib. 6 oz.

Case 124. Negro primipara, aged seventeen, tox-
emia; slightly contracted anthropoid pelvis; antero-
posterior 10.75 cm., transverse 10.75 cm. Labor, ist
stage 26 hr. 30 min., 2nd stage 2 hr. 30 min. Sponta-
neous delivery O.R.A. living infant, weight 6 Ib. i oz.
Case 125. Negro primipara, aged eighteen, tox-
emia; slightly contracted gynecoid pelvis; antero-
posterior 10.5 cm., transverse 12 cm. Labor, ist stage
10 hr. 30 min., 2nd stage i hr. Spontaneous delivery
O.R.A. living infant, weight 7 Ib. 4 oz.

Case 126. Negro, para i, gravida 2, aged nineteen;
slightly contracted gynecoid pelvis; anteroposterior
10.5 cm., transverse 12 cm. Labor, 32 hr. 10 min.,
test, head engaged, cervix dilated 4 cm. Low cervical
cesarean section, living infant, weight 7 Ib. i oz.
This patient had Postpartum eclampsia. (Her ist
labor, ist stage 32 hr. 10 min., 2nd stage 1 hr. 45 min.
Spontaneous delivery living infant, weight 7 Ib. 4 oz.)
This patient might have delivered the 2nd time with
the use of the V'oorhees bag to dilate the cervix.

Case 127. Negro primipara, aged twenty-two,
short obese type; contracted pelvis android tendency
with narrow outlet; anteroposterior 9.75 cm., trans-
verse 10.5 cm. Labor, ist stage 17 hr. 45 min., 2nd
stage I hr. 10 min. Spontaneous delivery O.R.A.
living infant, weight 7 Ib.

Case 128. Negro primipara, aged eighteen; Nägele
pelvis; anteroposterior 9.75 cm., transverse 10.5 cm.
Labor, ist stage 32 hr., 2nd stage 5 hr. 55 min. Mid
pelvis application Kjelland forceps O.L.A. delivery
living infant, weight 5 Ib. 9 oz., with fetal head
biparietal diameter 9 cm. and suboccipital bregmatic
diameter 8 cm.

Case 129. Negro, para 4, gravida 5, aged thirty-
six, diabetes and marked toxemia; contracted platy-

728

Richard Torpin

May, 1942

Fig. 5. Pelvic outlines of Cases 109 to 138.

pelloiii pelvis; anteroposterior 8.5 cm., transverse 12
cm. She had given birth to 3 babies spontaneously
weighing from 6 Ib. 1 oz. to 7 Ib. Labor, membranes
ruptured 22 Hr., head engaging, cervix dilated 4 cm.
Low cervical cesarean section delivery, living In-
fant, brow presentation, weight 9 Ib. 7 oz. The
mother died suddenly the next day, autopsy not
granted.

Gase 130, Negro, para i, gravida 2, aged thirty,
with multiple large fibromyomas; anthropoid pelvis
narrow oiitlet; anteroposterior 11 cm., transverse 11
cm. Labor, ist stage 14 hr., 2nd stage 50 min. Spon-
taneous delivery complete occiput posterior living
infant, weight 6 Ib. 3 oz.

Gase 131. White, para i, gravida 2, aged thirty-
eight, short stout; nelvis android tendency, narrow
oiitlet; anteroposterior 12.25 cm., transverse 13.25
cm, Labor, 20 hr. test then low cervical cesarean
section delivery living infant, weight 5 Ib. 8 oz.

Gase 132. Negro primipara, aged seventeen; con-
tracted gynecoid pelvis; anteroposterior 9.5 cm.,
transverse 10.75 cm. Labor, ist stage 15 hr. 30 min.,
2nd stage 2 hr. 30 min. Spontaneous delivery living
infant, weight 6 Ib. 8 oz.

Gase 133. White, para 5, gravida 6, aged thirry-
six, cardiac patient recently decompensated; 1 irge
gynecoid pelvis android tendency; anteroposterior
1 2 cm., transverse 13.5 cm. Labor, medical induction

Vol. 47, No. 5

Roentgen Pelvimetry in Labor

729

ist stage 2 hr. 30 min., 2nd stage 35 min. Sponta-
neous delivery O.L.A. living infant, weight 6 Ib. 4 oz.

Gase 134. White, para i, gravida 2, aged twenty-
nine; gynecoid pelvis; anteroposterior 1 1 cm., trans-
verse 13 cm. Outline of head hidden behind pelvic
brim. Labor, 20 hr. test, then low cervical cesarean
section delivery of living hydrocephalic infant,
weight 9 Ib. 8 oz., with extremely hard head. The
parents refused the Operation of choroid cauteriza-
tion but consented one month later when the head
hadgrown enormouslyand the Operation proved fatal.

Gase 135. White primipara, aged eighteen, dys-
trophia dystocia Syndrome with toxemia; gynecoid
pelvis; anteroposterior 11 cm., transverse 12.75 cm.
Labor, ist stage 31 hr. 24 min., 2nd stage 7 hr. 24
min. Mid pelvis Kjelland application of Kjellaml
forceps O.L.T. delivery living infant, weight 8 Ib.
i5j oz.

Gase 136. Negro primipara, aged twenty-one, tox-
emic; contracted pelvis android tendency; antero-
posterior 9 cm., transverse 1 1 .25 cm. Labor, ist stage
20 hr., 2nd stage 2 hr. 30 min. Mid pelvis Kjelland
application of Kjelland forceps O.L.T. delivery living
infant, weight 7 Ib. 15 oz. (delivery required five
45 second tractions at intervals of a minute and a
half w"th measured pull of 115 Ib. The infant, un-
injured, breathed spontaneously).

Gase 137. White primipara, aged nineteen, tox-
emia with generalized edema; pelvis android ten-
dency with narrow outlet; anteroposterior 1 1 cm.,
transverse 12 cm. Labor, ist stage 23 hr., 2nd stage
4 hr. Mid pelvis Kjelland application of Kjelland
forceps O.L.T. delivery living infant, weight 7 Ib. ^ oz.

Gase 138. Negro primipara, aged sixteen, toxemia;
anthropoid pelvis with android tendency, narrow
outlet; anteroposterior 11.25 cm., transverse 11 cm.
Labor, ist stage 7 hr., 2nd stage i hr. 55 min. Spon-
taneous delivery direct occiput posterior living in-
fant, weight 6 Ib. 12 oz.

CONCLUSIONS

An analysis of these cases shows that
while each patient in labor must still he in-
dividualized, enough information may be
obtained from the single grid film to prog-
nosticate delay definitely due to fetopelvic
disproportion. The method's freedom from
technical error, its ease oi Performance by
any technician and its economy (a single 8
by 10 inch film) Warrant its wider use not
only in private practice, but also in the
clinic, where its use in all doubtful cases
practically doubles the amount of scientific
information ordinarily available. Specifi-

callv:

(i) If there is a free space i cm. wide
between the image of the fe<-al head and

that of the pelvic inlet, there should be
no pelvic interference with labor unless the
iliac spines markedly protrude into the
pelvis as in Cases 1 17 and 130.

(2) Thoms^ and others have shown that
the length of the suboccipitobregmatic di-
ameter is very nearly equal to that of the
biparietal, while the occipitofrontal dia-
meter is much longer. There fore, for prac-
tical purposes, when the image of the fetal
head approaches the circle, it is to be as-
sumed that the view of the head is that of
marked flexion, and one can assume that it
is engaged or engaging, while if the image is
markedly oval, the head must be extended,
and one can assume that it is still floating.
A diagnosis of floating head is evident if the
borders overlap the pelvic brim in the
roentgenogram.

(3) Now if the head is thus seen to float
high, one must assume that its image is
relatively larger than actual, and tbis nuist
be taken into account in predicting the out-
come of these relatively few cases.

(4) The most important Observation
made in this study is that if the conjugata
Vera is 9 cm. or more, a test of labor should
be allowed, and in most cases the outcome
should be successful. A test of labor ordi-
narily should include uterine contractions
of forty seconds' duration recurring every
two to five minutes for twenty to twenty-
four hours. .At the end of that time, the
head should be at least in midpelvis. If not,
and if no vaginal examination has been
made, it has been shown that the lower
cesarean section Operation is quite säte.

REFERENCES

1. Torpin, R., Hoi.vtes, L. P., and FIamilton, W. F.

Roentgen pelvimeter simplifying Thoms' meth-
od. Radiologyy 1938,^?/, 584-586.

2. Gai.dwei.l, W'. K,, and Moi.ov, H. G. Anatomical

variations in female pelvis and their effect in
labor with suggested Classification. Am. J. Obst.
^G^«<?f., 1933, .?ö, 379-505.

3. Torpin, R., and Holmes, L. P. Pelvic inlet Varia-

tion in 400 Negro women. Am. J. Obst. ^Gynec.y

^939yJ^, 594-598.

4. Thoms, H., and Godfried, M. S. Suboccipito-

bregmatic circumference. Am. J. Obst. c^Gynec.^
1940, J9. 841-843.

ADDRESSES

FIRST WORLD CONGRESS

FERTILITY AND STERILITY

NEW YORK CITY

MAY 25-31, 1953

Internet Archive Audio

Featured

Top

Images

Featured

Top

Software

Featured

Top

Books

Featured

Top

Video

Featured

Top

Mobile Apps

Browser Extensions

Archive-It Subscription

Save Page Now

Full text of "Ernst Mueller Collection 1911-"

See other formats