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OBSTETRICAL TRANSACTIONS.
VOL. XLIX.
TRANSACTIONS
OK THB
OBSTETRICAL SOCIETY
LONDON.
VOL XLIX.
FOR THE YEAR 1907.
WITH A LIST OP OFFICERS, FELLOWS, ETC.,
AND GENEEAL INDEX TO VOLS. I— XLIX.
EDITED BY
HERBERT R. SPENCER, M.D.,
ROBERT BOXALL, M.D., Senior Secretary.
LONDON:
LONGMANS, GREEN, AND CO.
1908.
rUINT.n BY ADLARD AND «0N. LONPoN AND DOBKINO.
OBSTETRICAL SOCIETY OF LONDON.
OFFICERS FOR 1907
PREBIDJINT.
TICE-
PKE8IDENT8.
TBEA8UKEB.
EUITOB
OF ' TBAK8-
ACTIONS.'
HONOBABY
8ECBETARIE8.
HO^OBABT
LIBRABIAN.
SPENCER, HERBERT R., M.D.
BUTLER-SMYTHE, ALBERT C.
HANDFIELD-JONES, MONTAGU, M.D.
PHILLIPS, JOHN, M.D.
SINCLAIR, Sib WILLIAM JAPP, M.D.
(Manchester).
HERMAN, GEORGE ERNEST, M.B.
I SPENCER, HERBERT R., M.D.
r BOXALL, ROBERT, M.D.
I LEWERS, ARTHUR H. N., M.D.
EX- OFFICIO
MEMBEB8
OF COUNCIL.
OTHEB
MEMBEB8
OF COUNCIL.
I GOW, WILLIAM JOHN, M.D.
-WILLIAMS, Sib JOHN, Baet., M.D. (Trustee
and Fast President).
BLACK, J. WATT, M.D. {Trustee and Past Pre-
sident).
CHAMPNEYS, FRANCIS HENRY, M.D.
{Trustee).
GERVIS, HENRY, M.D. {Past President).
GALABIN, ALFRED LEWIS, M.D. {Past
President).
j HERMAN, G. E., M.^. {Past President).
[ DAKIN, W. R., M.D. {Ex-President).
-ANDREWS, HENRY RUSSELL, M.D.
BRIGGS, HENRY, M.B., F.R.C.S. (Liverpool).
BROOK, WILLIAM H. B., M.D. (Lincoln).
CULLINGWORTH, CHARLES JAMES, M.D.
EASTES, GEORGE, M.B., F.R.C.S.
EDEN, THOMAS W., M.D.
FAIRBAIRN, JOHN SHIELDS, M.B., B.Ch.
HELLIER, JOHN BENJAMIN, M.D. (Leeds).
HICKS, HENRY THOMAS, F.R.C.S.
, HURRY, JAMIESON BOYD, M.D. (Reading).
• KERR, JOHN MARTIN MUNRO, M.B., CM.
(Glasgow).
LOCKYER, CUTHBERT, M.D.
ROBERTS, CHARLES HUBERT, M.D.
I ROUTH, AMAND, M.D.
• SCHARLIEB, MARY ANN DACOMB, M.D.
TARGETT, JAMES HENRY, M.S., F.R.C.S.
WILLIAMSON, HERBERT, M.B.
j^ WILSON, THOxMAS, M.D. (Birmingham).
1 4— 3- G
STANDING COMMITTEES.
LIBRARY COMMITTEE.
DORAN, ALBAN, F.R.C.S.
ROBINSON, GEORGE H.DRUMMOND,M.D.
LOCKYER, CUTHBERT, M.D.
ANDREWS, H. RUSSELL, M.D.
BLACKER, G. F., M.D.
fSPENCER, H. R., M.D., President.
I HERMAN, G. E., M.B., Treasurer.
Kx-orncio.^ BOXALL, ROBERT, M.D., \ ^r o
I LEWERS, ARTHUR H. N., M.D.. ] ^^'^' '^^^*'
LGOW, WILLIAM JOHN, M.D., Hon. Lib.
EX-OFFICIO.
PUBLICATION COMMITTEE.
PHILLIPS, JOHN, M.D.
BLACKER, GEORGE FRANCIS, M.D.
CULLINGWORTH, CHARLES JAMES, M.D.
ROUTH, AMAND, M.D.
GOW, WILLIAM JOHN, M.D.
FAIRBAIRN, JOHN SHIELDS, M.B.
(-SPENCER, HERBERT R., M.D., President and
\ Editor.
) BOXALL, ROBERT, M.D.. -. ^ <,
(, LEWERS, ARTHUR H.N., M.D., f '^' ''''*
VUl
FINANCE COMMITTEE.
EX-OFFICIO.
BOULTON, PERCY, M.D.
CULLINGWORTH. CHARLES JAMES, M.D.
WILLIAMS, SiK JOHN, Bart., K.C.V.O., M.D.
BLACK, J. WATT, M.D.
CHAMPNEYS, F. H., M.D.
ROUTH, AMAND, M.D.
." SPENCER, H. R., M.D., Fregident. ,
\ HERMAN, G. E., M.B.. Treasurer.
] BOXALL, ROBERT, M.D., ) rx, .,
ClEWERS, ARTHUR H. N.,M.D.. j ^^"* '^"'''•
PATHOLOGY COMMIITEE.
GRIFFITH, W. S. A.. M.D., Chairman.
ANDREWS, HENRY RUSSELL, M.D.
BLACKER, GEORGE FRANCIS, M.D.
DORAN, ALBAN, F.R.C.S.,
EDEN, THOMAS WATTS, M.D.
FAIRBAIRN, JOHN SHIELDS. M.D.
HICKS, HENRY THOMAS, F.R.C.S.
KEEP, ARTHUR CORRIE, M.D., Secretary.
LOCKYER, CUTHBERT, M.D.
LONGRIDGE, CHARLES JOHN NEPEAN,
M.D.
MAXWELL, R. DRUMMOND, M.D.
ROBERTS. CHARLES HUBERT, M.D.
SMITH, ARTHUR LIONEL H.
SMITH, G. F. DARWALL, F.R.C.S.
SMITH, GUY BELLINGHAM, F.R.C.S.
SPENCER, HERBERT R., M.D.
STEVENS, THOMAS GEORGE, M.D.
TARGETT, JAMES HENRY, M.S.
WILLETT, JOHN ABERNETHY. M.B.
WILLIAMSON, HERBERT, M.B.
C SPENCER, H. R., M.D., President.
KX-OFFicio. \ BOXALL, ROBERT, M.D., 7 jr^^ o^^,
(LEWERS, ARTHUR H.N.,M.D., 5 ^°''- ^*''*-
LIST OF PRESIDENTS OF THE SOCIETY.
1859 EDWARD RIGBY, M.D.
1861 WILLIAM TYLEK SMITH, M.D.
1863 HENRY OLDHAM, M.D.
1865 ROBERT BARNES, M.D.
1867 JOHN HALL DAVIS, M.D.
1869 GRAILY HEWITT, M.D.
1871 JOHN BRAXTON HICKS, M.D., F.R.S.
1873 EDWARD JOHN TILT, M.D.
1875 WILLIAM OVEREND PRIESTLEY, M.D.
1877 CHARLES WEST, M.D.
1879 WILLIAM S. PLAYFAIR, M.D.
1881 J. MATTHEWS DUNCAN, M.D., F.R.S.
1883 HENRY GERVIS, M.D.
1885 JOHN BAPTISTE POTTER, M.D.
1887 JOHN WILLIAMS, M.D.
1889 ALFRED LEWIS GALABIN, M.D.
1891 JAMES WATT BLACK, M.D.-
1893 G. ERNEST HERMAN, M.B.
1895 F. H. CHAMPNEYS, M.A., M.D.
1897 CHARLES JAMES CULLINGWORTH, M.D.
1899 ALBAN DORAN, F.R.C.S.
1901 PETER HORROCKS, M.D.
1903 EDWARD MALINS, M.D.
1905 WILLIAM R. DAKIN, M.D.
1907 HERBERT R. SPENCER, M.D.
REFEREES OF PAPERS FOR THE YEAR- 1907
Appointed by the Council.
BLACK, JAMES WATT, M.D.
BLACKER, GEORGE FRANCIS, M.D.
BLAND-SUTTON, JOHN, F.R.C.S.
CHAMPNEYS, F. H., xM.A., M.D.
CULLINGWORTH, CHARLES JAMES, M.D.
DAKIN, WILLIAM RADFORD, M.D.
DORAN, ALBAN, F.R.C.S.
GALABIN, ALFRED LEWIS, M.A., M.D.
GOW, WILLIAM JOHN, M.D.
HANDFIELD-JONES, M., M.D.
HERMAN, G. ERNEST, MB.
MEREDITH, WILLIAM A.. M.B., CM.
PHILLIPS, JOHN, M.A., M.D.
ROUTH, AMAND, M.D.
SPENCER, HERBERT R., M.D.
OBSTETRICAL SOCIETY OF LONDON.
TRUSTEES OF THE SOCIETY'S PROPERTY.
Sir John Williams. Bart., K.C.V.O , M.D.
J. Watt Black, M.D.
F. H. Champneys, M.A., M.D.
HONORARY FELLOWS.
BRITISH.
Elected
1899 Hutchinson, Jonathan, F.R.C.S., F.R.S., LL.D., 15,
Cavendish square, W.
1892 Lister, The Right Honorable Lord, M.B., F.R.C.S.,
F.R.S., LL.D., 12, Park crescent, Portland place, W.
1892 Turner, Sir William, M.B., F.E.C.S., F.R.S., Principal
of the University of Edinburgh; 6, Eton terrace,
Edinburgh.
1904 "Williams, Sir John, Bart., K.C.V.O., M.D., F.R.C.P.,
Plas Llanstephan, Carmarthenshire. Council, 1875-6,
1892, 1894. Hon. Sec. 1877-9. Fice-Pres. 1880-2.
Board Exam. Midwives, 1881-2; Chairman, 1884-6.
Pres. 1887-8. Trans. 12. Trustee.
FELLOWS OK THE SOCIETY.
FOREIGN,
Elected
1899 Martin, A. E., M.D., Professor of Obstetrics and Gyuee-
cology, Greifswald. Trans. 1.
1899 Olshausen, R. M., Professor, N. Artillerieetrasse 19,
Berlin. -^
1899 PiNAED, A., Professor, 10, Rue Cambaceres, Paris.
1904 Pozzi, Samuel, M.D., 47, Avenue d'lena, Paris.
1895 VON WiwcKEL, Professor, Sonnenstrasse 16a, Munich.
ORDINARY FELLOWS
1906
Those marked thus (*) have paid the Composition Fee in lien of further
annual subscriptions.
Those marked thus (f) reside beyond the London Postal District.
The letters O.F. are prefixed to the names of the "Original Fellows" of the
Society.
Elected
1898 Aarons, S. Jervois, M.D.Edin., 14, Stratford place, W.
1900 Abbott, Hoeatio White, L.R.CP.Lond., &Q, Jackson
road, Holloway, N.
I890t AcKERLEY, Richard, M.B., B.S.Oxon., Croft House,
The Hill, Surbiton.
189 1 Adams, Charles Edmund, M.R.C.S., 227, Gipsy road, West
Norwood, S.E. CoMnc«7, 1901.
1906t Adams, Evelyn Lancelot, M.B., B.S.Lond,, 171, St.
James's road. East Croydon.
1890 Addinsell, Augustus W., M.B., C.M.Edin., M.R.C.P.,
10, Curzon street, W. Comw«7, 1898-1900. Trans. 2.
1903 Aldrich-Blake, Louisa Brandrath, M.D., M.S.Lond.,
Surgeon to the New Hospital for Women, 17, Not-
tingham place, W.
1883*tALLAN, Robert John, L.R.C.P.Ed., The Bungalow,
Dulwich hill, Sydney, New South Wales.
1906t Allan, Thomas Sprot, LR.C.P.«&;S.Edin., Q7, Pitfield
street, N.
XIV FELLOWS or THE SOCIETY.
Elected
1887 Ambrose, Robert, B.A., L.R.C.P. & S.Ed., The Mount,
Shoot-up hill, Brondesbury, N.W.
IQOlf Amsden, Walter, L.R.C.P.Lond., Seaford, Sussex.
190.5t Anderson, Daniel E., M.B.Lond., M.D.Paris, 121,
Avenue des Champs I^lysees, Paris.
1875* Anderson, John Ford, M.D.,C.M.,4 l,Belsize park, N.W.
Council, 1882. 1898-9.
1903 Anderson, Louisa Garrett, M.D., B.S.Loud., Assistant
Surgeon to the New Hospital for Women, 1 14a,
Harley street, W.
1899 Andrews, E. Collingwood, M.A., M.D.Cantab., 110,
Finchley road, South Hampstead, N.W.
1899 Andrews, Henry Russell, M.D., M.E.C. P. Lond., Assis-
tant Physician to the London Hospital, 7, Wimpole
street, W. Coimcil, \90b-7 . Trans. 2.
1906 fANKLESARiA, H. N., L.R.C.P., F.R.C.S.Edin., 12, Colaba
Causeway, Bombay, India.
1870*tApPLETON, Robert Carlisle, M.R.C.S., The Bar House,
Beverley.
1884 Appleton, Thomas A., M.R.C.S., 46, Britannia road,
Fulham, S.W.
1883t Archibald, John, M.D., Hazelden, Wimborne road,
Bournemouth.
1871 Argles, Frank, L.R.C.P. Ed., Hermon Lodge, Wanstead,
Essex, N.E. Council, 1886-7.
1906 fA-UBREY, George Ernest, M.B., B.S.Lond., Alexandra
Buildings, Hong Kong, China.
1887 Bailey, Henry Frederick, M.R.C.S., The Hollies, Lee
terrace, Lee, S.E.
1869* Bantock, George Granville, M.D., Consulting Surgeon
to the Samaritan Free Hospital ; 14, Upper Hamilton
terrace, N.W. Council, 1874-6. Trans. 2.
1886*tBARBOUR, A. H. Freeland, M.D.Edin., Lecturer on Mid-
wifery and Diseases of Women, Edinburgh Medical
School, 4, Charlotte square, Edinburgh. Council,
1898-1901. Vice-Pres. 1903-5.
1834t Ba^raclough, Robert W. S., M.D., Primrose Club, 4,
Park place, St. James's, S.W.
FELLOWS OF THE SOCIETY. XT
Elected
1896t Barrett, Sidney Edwaed, M.B., B.C. Cantab., The
Limes, Tillingham, Southminster, Essex.
1886t Ba.rrIx\gtgn, Fourness, M.B.Edin., F.RC.S.Eug., 213,
Macquarie street, Sydney, New South Wales.
1891 Barton, Edwin Alfred, L.R.C.P.Lond., 56, Kensington
Court, W.
1906 tBATTLE, Charles J., L.R.C.P., Kearsney, Stanger, Natal
South Africa.
1892 Beauchamp, Sydney, M.B., B.C.Cantab., 8,William street,
Lowndes square, S.W. Council, 1904.
1896t Belben, Frank, M.B., F.R.C.S.,RedIand8, Knyveton road,
Bournemouth.
1866*tBELCHER, Henry, M.D., 28, Cromwellroad, West Brighton.
1871 *Bell, Robert, M.D.Glasg., 1.5, Half Moon street,
May fair, W.
1906 tBELL, William Blaie, M.D., B.S., Assistant Gynaeco-
logical Surgeon to the Eoyal Infirmary, Liverpool,
7, Rodney street, Liverpool.
1889t Benson, Matthew, M.D.Brux., Wyndholme, Wigan,
1894 Berkeley, Comtns, B.A., M.B., B.C.Cantab., Physician
to Out-patients to Chelsea Hospital for Women;
53, Wimpole street, W. Council, 1902-3.
1883t Bertolacci, J. Hewetson, L.S.A., Elstead, Godalming,
Surrey.
1889t Best, William James, M.K.C.S., 1, Cambridge terrace,
Dover.
1893*tBETENS0N, William Betenson, L.R.C.P.Loud., Sussex
Lodge, Newhaven.
1894* Betenson, Woodley Daniel, L.R.C.P.Loud., 58, Lans-
downe road, Notting hill, W.
189 If Beville, Frederick Wells, L.R.C.P.Lond.
1887*tBiDEN, Charles Walter, L.R.C.P.Lond., Laxfield, Fram-
lingham.
Xn FELLOWS OF THE SOCIETY.
Elected
1879* Biggs, J. M.. M.R.C.S., L.R.C.P.Lond., Hillside, Child's
liill, N.W. Council, 1903-4.
1889t BissHopp, Francis Robert Bryant, M.A., M.B.,
B.C.Cantab., Parham House, Tunbridj,^ Wells.
1890t Black, George, M.B., B.S.Lond., The Willows, Hail-
sham, Sussex.
1868* Black, James Watt, M.A.,M.D., F.R.C. P., Obstetric Physi-
cian to the Charing Cross Hospital ; 15, Clarges street,
Piccadilly, W. Council, 1872-4. Fice-Pres. 1885-6.
Chairman, Board Exam. Midwives, 1887-90. Pres.
1891-2. Treas. 1898-1901. Trustee.
1893 Blacker, George Francis, M.D., B.S.Lond., F.R.C.S.,
Obstetric Physician to University College Hospital ;
45, Wimpole street, W. Council, 1898-1901. Board
Exam. Midwives, 1900-1. IVans. 2.
1901 Blair, G. MacLbllan, M.B., B.S., 93, Maida Vale, W.
1861*tBLAKE, Thomas William, M.D.St. And., Hurstbourne,
Bournemouth, Hants.
1888* Bland-Sutton, John, F.R.C.S., Surgeon to the Middlesex
Hospital; 47, Brook street, W. Council, 1894-5.
Trans. 5.
1902t Boardman, Edith, M.D.Brux., Hyderabad Deccan
India.
1894t BoDiLLY, Reginald Thomas H., L.R.C.P.Lond., Wood-
bury, High road. South Woodford.
1902t BoNNAR, Kathleen, L.R.C.P. and S.Edin., DiiflFerin
Hospital, Allahabad, India.
1883 BoNNEY, William Augustus, M.D., 100, Elm park gardens
Chelsea, S.W.
1900 BoNNEY, William Francis Victor, M.S., M.D.Lond.,
F.R.C. S.Eng., Lecturer on Practical Midwifery at
Middlesex Hospital; Surgeon to Out-patients, Chelsea
Hospital for Women ; 10, Devonshire street, Portland
place, W. Trans. 2.
FELLOWS OF THE SOCIETY. XVll
Elected
1894t BoRCHERDs, Walter Meent, M.R.C.S., L.U.C.P.,
Ficksburg, Orange River Colony, South Africa.
1 903 BoTT, Percival George A., L.R.C.P.Lond., 45, Cambridge
terrace, Hyde park, W.
1866* BouLTON, Peecy, M.D., Physician to the Samaritan Free
Hospital ; 15, Seymour street, Portman square, W.
(7oMn«7, 1878-80, 1885, 1896. Hon. Lib.\QS6. Hon
Sec. 1886-9. Vice-Pres. 1890-2. Board Exam.
Midwives, 1S90-1. Chairman, 1897-1900. Editor,
1894-1900. Trans. 4.
1886t BousTEAD, Robinson, M.D., B.C. Cantab., Lieutenant.
Colonel, Indian Medical Service ; c/o Messrs. H. S.
King and Co., 45, Pall Mall, S.W.
1899 Bowie, Albert W., M.B., CM. Edin., 38, Bruce Grove,
Tottenham, N.
1899t BowRiNG, Walter Andrew, F.R.C.S.Eng., The Pinea
Furze Hill, Brighton.
1884* BoxALL, Robert, M.D.Cantab., Physician and Lecturer
to the York Road (General Lying-in) Hospital;
40, Portland place, W. Council, 1888-90, 1894-5,
1899-1901. Board Exam. Midwives, 1891-3. Hon.
iz6. 1902-3. Hon.Sec.,\9QA-7. Trans. 13.
1902 Boyd, Florence Nightingale, M.D.B.rux,, L.R.C.P. and
S.L, Senior Surgeon New Hospital for Women, Lec-
turer on Gynaecology, London (Royal Free Hospital)
School of Medicine for Women ; 134, Harley street,
W. Trcms. 1.
1897 Boyd, John Stewart, L.R.C.P.Lond., Victoria House,
Custom House, E.
1884t Boys, Arthur Henry, L.R.C.P. Ed., Chequer Lawn, St.
Albans.
1880 Bhanfoot, Arthur Mudge, M.B., c/o Messrs. Woodhead
and Co., 44, Charing cross, S.W.
1887 Bridger, Adolphus Edward, M.D.Ed., 18, Portland
place. W.
VOL. xlix. h
Xviii FELLOWS OF THE SOCIETY.
Elected
1888*tBRiGGs, Henry, M.B., F.R.C.S., Surgeon to the Hospital
for Women, and Professor of Midwifery and Gynaeco-
logy, University College (Victoria University), Liver-
pool ; 3, Rodney street, Liverpool. Council, 1901-3,
1907.
1894 Brinton,Eoland Dan vers, B.A., M.D.Cantab., 8, Queen's
Gate terrace, S.W.
1892 Brodie, William Hug, M.D., C.M.Edin., F.ll.C.S.Eng.,
6, St. Stephen's road west, West Ealing, W.
1902t Brook, William Henry Beeffit, M.D., B.S., F.R.C.S.,
8, Eastgate, Lincoln. Council, 1907.
1868t Brown, Andrew, M.D. St. And., Mayfield. Royston
park, Pinner. Cownci/, 1893-4. Trans. \.
1865* Brown, D. Dyce, M.D., 29, Seymour street, Portman
square, W.
1898t Brown, Haydn, L.R.C.P.Edin., Caterham, Surrey.
1889* Brown, William Carnegie, M.D.Aber., 32, Harley street,
W.
1902 Browne, Ada Margaret, L.S.A., 64, Belsize park, N.W.
1904 Brydone, James Marr, M.B., B.C.Cantab., 16, South
Audley street, Grosvenor square, W.
l885*tBuNNY, J. Brice, L.R.C.P.Ed., Bishop's Lydeard,
Taunton.
1877t BuRD, Edward, M.D., M.C., Senior Physician to the Salop
Infirmary ; Newport House, Shrewsbury. Council,
188G-7.
1894 Bukt, Egbert Francis, M.B., C.M.Edin., 7Q, Stapleton
Hall road, Stroud Green, N.
1878 Butler-Smythe, Albert Charles, F.R. C.S.Ed,, Surgeon
to Out-patients, Samaritan Free Hospital; 76, Brook
street, Grosvenor square, W. Council, 1889-91, 1904.
Vice-Pres. 1905-7.
1887* Buxton, Dudley W., M.D.Lond., 82, Mortimer street,
Cavendish square, W.
FELLOWS OF THE SOCIETY. xix
Elected
1886t Byers, Sir John W., Kt., M.A., M.D., M.A.O. (Hon.CausS),
Professor of Midwifery and Diseases of Women and
Children at Queen's College, and Physician for Diseases
of Women to the Royal Hospital, Belfast ; Dreenagh
House, Lower crescent, Belfast. Fice-Pres. 1899-1902.
1891t Calthrop, Lionel C. Everaud, M.B.Durh., Queen
street, Droitwich, Worcestershire.
1887t Cameron, James Chalmers, M.D., Professor of Midwifery
and Diseases of Lifancy, McGili University ; 605, Dor-
chester street, Montreal.
1887t Cameron, Murdoch, M.D.Glas., Regius Professor of Mid-
wifery in the University of Glasgow, 7, Newton terrace,
Charing Cross, Glasgow. Council, 1903-5.
1903t Cameron, Samuel James Murdoch, M.B., Ch.B.Glasg.,
13, Sandyford place, Glasgow, W.
1902 Campbell, Janet, M.B., B.S.Lond., 86, Campden Hill
Court, Kensington.
1894t Campbell, John, M.A., M.D.Duhl., F.R.C.S., Crescent
House, University road, Belfast.
1888*tCAMPBELL, William Macfie, M.D. Edin., The Old House,
Grassendale, Liverpool.
1903 Chadburn, Maud Mary, M.D.Lond., Surgeon to the Out-
patient Department, New Hospital for Women; 16,
Harley street, W.
1876* Champneys, Francis Henry, M.A., M.D.Oxon., F.E.C.P.,
Physician-Accoucheur to, and Lecturer on Midwifery at,
St. Bartholomew's Hospital ; 42, Upper Brook street,
W. Council, 1880-1, 1900-1. Hon. Lib. 1882-3. Hon.
Sec. 1884-7. Vice-Pres. 1888-90. Board Exam. Mid-
wives, 1883, 1888-90; Ckairtnan, 1891-5. Editor,
1888-93. Pres. 1895-6. Treas. 1902. Trans. 16.
Trustee.
1874*tCHARLEswoRTH, James, M.D., Physician to the North
Staffordshire Infirmary; 25, Birch terrace, Hanley,
Staffordshire.
XX FELLOWS OF THE SOCIETY.
Elected
1897t CiiiNERY, Edward Fludew, F.K.C.S.Edin., Monmouth
House, Lymington, Hants.
l863*tCHiSHOLM, Edwin, M.D., 44, Roslyn gardens, Sydney,
New South Wales.
1893 Clarke, W. Bruce. F.R.C.S., Assistant Surgeon to St.
Bartholomew's Hospital, 51, Harley street, W.
1899 Clayton, Charles Hollingsworth, L.R.C.P., 10, College
terrace, Belsize park, N.W.
1903t Clayton. John Hazelwood, M.B.Lond., IG, Hagley
road, Edgbaston, Birmingham.
1906t Clifford, Harold, M.B.Lond., F.E.C.S.Edin., 15. St.
John street, Manchester.
1906 Clutterbuck, Lewis Augustus, M.D.Durh.,43, Welbeck
street, W.
1865*tCoATi:s, Charles, M.D.. Physician to tlie Bath General
and Royal United Hospitals; 10, Circus, Bath.
1875* Coffin, Richard Jas. Maitland, F.K.C.P.Ed., 94
Sinclair road. W.
1905t CoucN, Uacuel, M.B.Calc, F.R.C.S.I., 24, Chowringhi,
Calcutta, India.
I905t Collins, Victor Evelyn, M.D.Lond., Simonstown, Cape
Colony.
1888 Cooper, Peter, L.H.C.P.Lond., Stainton Lodge, 35,
Shooter's Hill road, Blackheath, S.E.
1875*tCoRDES, Aug., M.D., M.R.C.P., Consulting Accoucheur to
the " Misericorde ;" Privat Doceut for Midwifery at the
University of Geneva; 12, Rue Bellot, Geneva. TransA.
1883 *CoBNER, Cuesham, L.S.A.. 113, Mile End road, E.
1903 CoRTHORN, Alice Mary, M.B., B.S.Lond., 30, St. Mary
Abbot's terrace. Kensington.
1893 Cripps, William Harrison, F.E.C.S., Surgeon to St. Bar-
tholomew's Hospital ; 2. Stratford place, W. Trans. 2.
1889t Croft. Edward Octavius, M.D.Durh., Hon. Surgeon to
the Hospital for Women and Children ; Hon. Demon-
strator of Obstetrics to the Yorkshire College, Leeds ;
33, Park square, Leeds. Trans. 1.
FELLOWS OF THE SOCIKTY. Xxi
Elected
1881*tCROXK, Herbert Ghoege, M.B.Cantab,, Kepton, near
Burton-on-Trent.
1893 Crosby, Herbert Thomas, M.A., M.B., B.C.Cantab., 19,
Gordon square, W.C.
1895 Cross, Ernest AV., L.R.C.P.Loiid., The Limes, Wallwood
park, Leytonstoiie,
1886*tCROss, William Joseph, M.B., Horsham, Victoria, Aus-
tralia.
189St Cullex, Thomas, M.D.Toronto, Johns Hopkins Hospital,
Baltimore, U S.A.
187.5* Cullingworth, Charles James, M.D., D.C.L., LL.D.,
F.R.C.P., Consulting Obstetric Physician to St.
Thomas's Hospital; 14, Manchester square, W.
Cownd/, 1883-5, 1891-3, 1904-7. Vice-Pres. 1886-8.
Board Exam. Midwives, 1889-91. Chairman, 1895-6.
Pres. 1897-8. Trans. 14.
1905 CuRBiE, George Burnett, M.D.Aber,, St. James's
avenue, Ealing, W.
1889*tCuESETJi, Jehangir J., M.D. Brux., 77a, Gowalia Junk
road, Bombay.
1894 Cutler, Lennaru, L.E.C.P.Lond., 1, Kensington Gate,
Kensington, W. Trans. 1.
1885 Dakin, William Eadford, M.D,, B.S., F.R.C.P.,
Obstetric Physician to, and Lecturer on Midwifery at,
St. George's Hospital ; 8, Grosvenor street, W.,
Council, 1889-91. Hon. Lib. 1892-3. Hon. Sec.
1894-7. Vice-Pres. 1898-1901. Chairman, 1901-4.
Trans. 3. Pres. 1905-6,
1868 Daly, Frederick Heney, M.D., 185, Amhurst road.
Hackney Downs, N.E. Council, 1877-9. Vice-Pres.
1883-5. Trans. 2.
1901 Daly, Frederick James Purcell, L.R.C.P.Lond., 188,
Upper Clapton road, N.E.
1904t Das, Kedarnath, L.M.S., M.B.Cal., M.D.Madras, Camp-
bell Hospital, Calcutta.
XXI] FELLOWS OF THE SOCIETY.
Mlected
1893 Dauber, Johx Henry, M.A.Oxon., M.B., B.Ch.,
Phj'sician to the Hospital for Women, Solio square ;
39, Hertford street, Mayfair, W.
1906t Davidson, H. Stevenson, M.B., CIi.B.Edin., 4, Dundas
street, Edinburgh.
1892t Davis, Robert, M.R.C.S., Darrickwood, Orpington, Kent.
1891 Dawson, Ernest Rumley, L.R.C.P.Lond., 4, Grange
Park road, Leyton, E. Council, 1904-0. Trans. 1.
1889 Des VtEUX, Harold A., M.D.Brux., 214, Buckingham
gate, S.AV. Council, 1896-8.
1894 Dickinson, Thomas Vincent, M.D.Lond., M.R.C.P.,
Physician to the Italian Hospital, Queen square;
33, Sloane street, S.W. Council, 1900-2.
1894 Dickson, John William, B.A., M.B., B.C.Cantab., 42,
Hertford street, Mayfair, W.
1 907 Dodu, Stanley, M.B., B.C.Cantab., 1 1, Wimpole street.W.
1886t Donald, Archibald, M.D.Edin., M.ll.C.P., Obstetric
Physician to the Royal Infirmary, Manchester;
Honorary Surgeon to St. Mary's Hospital for Women,
Manchester; Sunnyside, Victoria park, Manchester.
Council, 1893-5. Trans. 3.
1879* DoEAN, Alban H. G., F.R.C.S., Surgeon to the Samaritan
Free Hospital ; 9, Granville place, Portman square, W.
Council, 1883-5. Hon. Lib. 1886-7. Hon. Sec. 1888-91.
Vice-Pres. 1892-4. Fres. 1899-1900. Tru7is. 24.
lS90t DocTY, Edward Henry, M.D., M.C.Cantab., F.E.C.S.
Eng., Surgeon to the Queen Victoria Hospital, La
Madeleine, Cannes ; (^Summer, 7, rue St. Roch.,
Paris).
1887 DovASTON, Milward Edmund, M.E.C.S., Hatchcroft
house, Hendon, N.W.
1899t Down, Elgar, L.R.C.P.Lond., Wingfield House, Stoke,
Devonport.
1896 DowNEs, J. Lockhart, M.B., C.M.Edin., 269, Romford
road, E.
FELLOWS OF THE SOCIETY. Xxiu
Elected
\S8-if Doyle, E. A. Gaynes, L.R.C.P., The Shrubbery, San
Fernando, Trinidad, West Indies.
1906 Drew, Douglas, B.S.,F.R.C.S.Eng., 6,\Vimpolestreet,W.
189-it Drew, Henry William, F.K.C.S., Eastgate, East Croydon.
1S83 Duncan, Alexander George, M.B., Calton House,
Amhurst park, Stamford hill, N.
1871* Eastes, George, M.B., F.R.C.S., 35, Gloucester terrace,
Hyde park, W. Council, 1878-80, 1906-7.
1883t Eccles, F. Richard, M.D., Professor of Gynaecology,
Western University ; 1, Elhvood place. Queen's avenue,
London, Ontario, Canada.
1893* Eden, Thomas Watts, M.D.Edin., M.R.C.P.Lond., Assis-
tant Obstetric Physician to, and Lecturer on Practical
Midwifery at, Charing Cross Hospital, 26, Queen
Anne street, W. Council, 1897-9, 1905-7. Board
JExam. Midwives, 1903-5. Trans. 5.
1903t Edge, Frederick, M.D.Lond., F.R.C.S.Eng.,54, Darling-
ton street, Wolverhampton.
1873*tENGELMANN, George Julius, A.M., M.D., 336, Beacon
street, Boston, Mass., U.S.A.
1907 Engineer, Sorab Kaikhoshru, M.R. C.P.Ed., L.M.&S.
Bombay, 39, Marine Lines, Fort, Bombay.
1905 English, Thomas Crisp, M.B.Lo'nd., F.R.C.S., 47,
Upper Brook street, W.
1897 Evans, Evan Laming, M.B., B.C.Cantab., F.R.C.S., 36,
Bryanston street. Great Cumberland place, W.
1875t EwAET, John Henry, M.R.C.S., L.E.C.P., Eastney,
Devonshire place, Eastbourne. Council, 1904-6.
1899 Eairbairn, John Shields, M.B., B.Ch.Oxon., Assistant
Obstetric Physician to St. Thomas's Hospital, 42,
Wimpole street, W. Council, \^Q A-7 . Board Exam.
Midwives, 1904-5. Trans. 1.
i894 Fairaveather, David, M.A., M.D., C.M.Edin., Alderman's
hill. Palmer's green, N.
XXIV FELLOWS OF THE SOCIETY.
Elected
1876t Farxcombe, Richard, M.D.Brux., 183, Belgrave road,
Balsall heath, Birmiugham.
1903t Fabncombe, William Turberville, M.D., Harbome,
Birmingham.
1869* Farquhar, William, M.D., Deputy Surgeon-General, 40,
Westbourne gardens, Bayswater, W.
1882t Farrar, Joseph, M.D., Gainsborough. Trans. 1.
1894t Fazan, Charles Herbert, L.E.C.P.Lond., Belmont,
Wadhurst, Sussex.
1868* Fegan, Richard, M.D., Westcombe park, Blackheath, S.E.
1883 Fenton, Hugh, M.D., Physician, Chelsea Hospital for
Women ; 27 George street, Hanover square, W.
1893t FiNLEY, Harry, M.D.Lond., West Malvern. Worcestershire,
1877*tFoNMARTiN, Henry de, M.D., 26, Newberry terrace,
Lower Bullar street, Nichols Town, Southampton.
1897t Fothergill, W. E., M.B., C.M.Edin., Lecturer on Mid-
wifery and Diseases of Women, Victoria University ;
Assistant Physician Northern Hospital for Women
and Children, Manchester; 13, St John Street,
Manchester.
188-4 FouRACRE, Robert Perriman, M.R.C.S., 89, Tollington
park, N.
1886t Fowler, Charles Owen, M.D., Cotford House, Thornton
heath. Council, 1901-3.
1898t Fbampton, Trevethan, M.R.C.S., F.R.C.P., 15, Bruns-
wick square, Brighton.
187o*tFRASER, Angus, M.D,, Physician and Lecturer on Clinical
Medicine to the Aberdeen Royal Infirmary ; 232, Union
street, Aberdeen. Council, 1897-1900.
1888t Feaser, James Alexander, L.R.C.P.Lond., Western
Lodge, Romford.
1902t Freeland, Arthur Raymond Stilwell, L.R.C.P.,
M.E.C.S., The Green Hall, Ashbourne, Derbyshier.
FELLOWS or THK SOCIETY. XXV
Elected
1905 Fuller, Arthur W., M.U.Edin., 32, Old Burlington
street, W.
1883* Fuller, Henry Roxburgh, M.D.Cantab., 45, Curzon
street, Mayfair, W. Council, 1893. Trans. I.
1905 Fuller, J. Reginald, M.D.Durh., 6, Crescent road,
Crouch End, N.
1886t FuRNER, WiLLouGHBY, F.R.C.S., 13, Brunswick square,
Brighton. Council, 1894-6.
1874* Galabin, Alfred Lewis, M.A., M.D., F.R.C.P., Obstetric
Physician to, and Lecturer on Midwifery at, Guy's
Hospital; 49, Wimpole street, Cavendish square, W.
Council, 1876-8. Hon. Lib. 1879. Hon. Sec. 1880-3.
Vice.Pres. 1884. Treas. 1885-8. Pres. 1889-90.
Trans. 12.
1888t Galloway, Arthur Wilton, L.E.C.P.Lond., Malverns,
Epping.
1863* Galton, JohnH., M.D., Chunam, Sylvan road, Upper Nor-
wood, S.E. Council, 1874-6, 1891-2. Fice-Pres.
1895-8.
1881 Gandy, William, M.R.C.S., Hill Top, Central hill, Nor-
wood, S.E. Council, 1897-8.
1886*tG-ARDE, Henry Croker, F.R.C.S.Edin., Maryborough,
Queensland.
1887 Gardiner, Bruce H. J., M.D., Gloucester House, Barry
road, East Dulwich, S.E.
1879 Gardner, John Twiname, 5, Embankment gardens,
Chelsea, S.W.
1872*tGARDNER, William, M.A., M.D., Professor of Gynaecology.
McGill University ; Gynaecologist to the Royal Victoria
Hospital; 109, Union avenue, Montreal, Canada.
1873*tGARTON, William, M.D., F.R.C.S., Inglewood, Aughton,
near Ormskirk.
1901 Gayer, Reginald Courtenay, L.R.C.P., 33, Stanhope
gardens, South Kensington, S.W.
XXVi FELLOWS OF THE SOCIETY.
Elected
18b9* Gell, Henry Willixgham, M.A., M.B.Oxon., 24, Palace
court, W.
1898*tGEMMELL, John Edwaed, M.B., C.M.Edin., Hon. Sur-
geon to the Hospital for Women, Liverpool ; 12, Rodney
street, Liverpool.
1859*tGERVis, Henry, M.D., F.R.C.P., Consulting Obstetric
Physician to St. Thomas's Hospital; 15, Koyal
Cresent, Bath. Council, 1864-6, 1889-91, 1893.
Hon. Sec. 1867-70. Fice-Pres. 1871-3. Treas.
1878-81. Pre*. 1S83-4. Trans. S.
1866* Gekvis, Fredeeick Heudebolrck, M.D.Brux., 1, Fellows
road, Haverstock hill, N.W. Council, 1877-9. Vice-
Pres. 1892. 3^-ans. 1.
1899t Geevis, Heney, M.A., M.B., B.C.Cantab., 74, Dyke road,
Brighton.
1883* GiBuoNs, Robert Alexander, M.D., Physician to the
Grosveuor Hospital for Women and Children ; 29,
Cadogan place, S.W. Council, 1889-90. Trans. 1.
1894 Gibson, Henry Wilkes, L.R.C.P.Lond., C, College
terrace, Fitzjohn's avenue, N.W.
1892 Giles, Arthur Edward, M.D.Loud., M.R.C.P., Physician
to Out-patieuts, Chelsea Hospital for Women; 10,
Upper Wimpole street, W. Council, 1898-1900.
Trans. 7.
I891t Gimblett, William Henry, M.D.Durh., 64, Sutherland
avenue, W.
1899t Glover, Thomas Anderson, M.D., C.M.Edin., 24, Hall-
gate, Doncaster.
1894t GoDDAKD, Charles Ernest, M.D., Wembley, Harrove.
1871 *GoDSON, Clement, M.D., CM.; 82, Brook street, W.
Council, 1876-7. Hon. Sec. 1878-81. Vice-Pres.
1882-4, Board Exam. Midwives, 1877, 1882-86.
Trans. 5.
1893t Gordon, Frederick William, L.R.C.P.Lond., Manukau
road, .\uckland, New Zealand.
FELLOWS OF THE SOCIETY. XXVU
Elected
1883 Gordon, John, M.D.. 49, Newgate street, E.G.
1869t Goss, TiiEGEKNA BiDDULPH, M.K.C.S., 1, The Circus,
Bath. Hon. Loe. Sec.
1891t GosTLiNG, William Ayton,M.D., B.S.Lond., Barningbaui,
West Worthing.
1889 GouLLET, Charles Arthur, L.R.C.P.Lond., 2, Finchley
road, N.W. Council 1902-5.
1890 Gow, William John, M.D.Loud., Physician-Accoucheur
in charge of Out-patients, St. Mary's Hospital; 27,
Weymouth street, W. Cotmcit, 1893-5-1901. Board
Exam. Mldwives, 1898-1900-1. How. Xi6., 1906-7.
Trans. 2.
lS93t GowAN, Bowie Campbell, L.R.C.P.Lond., Raven Dene,
Great Stanmore.
1907 Graham, Lewis, B.S.Lond., M.E.C.S., L.E.C.P., Hos-
pital for Women, Soho square, W.
1893 Grant, Leonard, M.U.Edin., Hillside, New Southgate, N.
1907 Gray, Aechibald Montague Henry, M.D., B.S.Lond.,
University College Hospital, W.C.
1902t Grech, Salvatoee, M.D.Malta, Professor of Obstetrics
in the University of Malta; Accoucheur and Gyiiseco-
logist and Teacher of Practical Midwifery at the
Central Civil Hospital ; 31, Strada Mezzodi, Valetta,
Malta.
1894f Green,Charles Robert Mortimer, M.D., F.R.C.S.Eng.
Lieut.-Colonel, Indian Medical Service, c/o Thomas
Cook and Sons, Ludgate Circus, E.C.
1863 *aRiPFiTH, G. de Goreequer, M.E.C.S., L.E.C.P., 34, St.
George's square, S.W. Trans. 2.
1879* Grifeith, Walter Spencer Anderson, M.D.Cantab.,
F.R.C.S., r.R.C.P., Assistant Physician-Accoucheur
to St. Bartholomew's Hospital ; 96, Harley street, W.
Council, 1886-8, 1893-5, 1901-3. Hon. Lib. 1896-7.
Board Exam. Midwives, 1887-9. Trans. 11.
XXVIU FELLOWS OF TUK SOCIETY.
Elected
1888*tGRiMSDALE, Thomas Babington, B.A., M.B.Caniab.,
Gynecological Surgeon to the Royal Infirmary, Liver-
pool, 29, Kodney street, Liverpool.
1880 Gkogono, Walter Atkins, M.R.C.S., L.E.C.P., Witham
Lodge, 171, Romford road, Stratford, E.
1896t Groves, Ernest W. Hey, M.B., B.Sc, 10, Richmond
Hill, Clifton. Trans. 1.
1894 Hamilton, Bruce, L.R.C. P. Loud., Glenbrook, 5, Crediton
road, West Hampstead, N.W.
1887t Hamilton, John, F.R.C.S.Ed., Beechhurst House, Swad-
lincote, Burton-on-Trent.
1906 Hamilton, William Gavin, Capt. LM.S., M.R.C.S.&
L.ll.C.P.ljoud., c/o Messrs. Grindlay, Groom and Co.,
Bombay.
1883* Handfield-Jones, Montagu, M.D.Loud., F.R.C.P., Pliy-
sician-Accoiioheur to, and Lecturer or Midwifery and
Diseases of Women at, St. Mary's Hospital ; 35,
Cavendish square, AV. CounciV, 1887-9, 1896-7. Board
Exam. Midicives, 1^94-6. Hon. Lib. \900-S. Hon. Sec.
1902-5. Vice.-Pres. 1906-7. Trans. 1.
1901 Handley, William Sampson, M.S., M.D.Lond.,
F.R.C.S.Eng., 77, Wimpole street, W. Council,
1905-6. Trans. 2.
1906t Harke, Sydney L., L.R.C. P., 17, Park hill road, Croydon.
1892 Harold, John, M.B.. B.Ch., B.A.O., 91, Harley street, W.
1877 Harper, Gerald S., M.B.Aber., 40, Curzon street, May-
fair, W. Council, 1894-5.
1898t Harper, John Robinson, L.E.C.P., Bear street, Barn-
staple, Devon,
1878t Harries, Thomas Davies, F.R.C.S., Grosvenor House,
Aberystwith, Cardiganshire.
1867*tHABRis, William H., M.D., Deputy Surgeon-General,
Shirley, Parklands, Surbiton.
FELLOWS OF THE SOCIETY. Xxix
Elected
1880* Harrison, Richard Charlton, M.R.C.S., L.R.C.P., 3'6,
Uxbridge road, Ealing, W.
1890t Hart, David Berry, M.D.Edin., Assistant Gynaecologist,
Royal Infirmary, Edinburgh; 13, Charlotte square,
Edinburgh. Council 1902-5.
1886t Hartley, Horace, L.R.C.P.Ed., Stone, Staffordshire.
1893 Harvey, John Jordan, L.R.C.P. & S.Edin., The Aviary,
Canning Town, E.
1880 Harvey, John Stephenson SELWYN,M.D.Durh.,M.R.C.P.,
1, Astwood road, Cromwell road, S.W.
1907 Hastings, Somerville, M.B., B.S., 35, Welbeck street.
Cavendish square, W.
1905t Haultain, Francis William NicoL,M.D.,F.R.C.P.Edin.,
12, Charlotte square, Edinburgh.
1899t Hawes, Godfrey Charles Browne, L.R.C.P., The Red
House, West road, Guildford.
1899*tHAWKEs, Claude Somerville, L.R.C.P., F.R.C.S.E.,
Glencairn, Wickham Terrace, Brisbane, Queensland.
1893t Haydon, Thomas Horatio, M.B., B.C. Cantab., 22, High
street, Marlborough.
IQOOf Hayford, Ernest James, M.D., c/o The Agent, Claude's
Ashanti Goldfields, Ltd., Cape' Coast Castle, Gold
Coast, West Africa.
1901t Hatnes, Edward James Ambrose, F.R.C.S.L, Weeta-
labah, Hay street west, Perth, Western Australia.
1907 Hedlet, John Prescott, M.B., B.C.Cantab., 11, John
street, Berkeley square, W.
1903t Heilbork, William Ernest, M.B., B.Ch. Cantab., 6,
Walmer place, Bradford, Yorks.
1892t Hellier, John Benjamin, M.D.Lond., Lecturer on Dis-
eases of Women and Children, Yorkshire College ;
Hon. Obstetric Physician to Leeds Infirmarv ; 27,
Park square, Leeds. Council, 1906-7.
XXX FELLOWS OF THE SOCIETY.
Elected
1890t Helme, T. Arthur, M.D.Edin., M.R.C.P., Hon. Surgeon
for Women to the Northern Hospital for Women and
Children, Manchester, 3, St. Peter's square, Man-
chester.
1867t Hembeough, John William, M.D.,St. Nicholas Chambers,
Newcastle-on-Tyue.
1906t Henchley, Albert Richard, M.D.Brux., L.R.C.P.&S.
Edin., 1, London road, Canterbury.
1876* Herman, George Ernest, M.B., F.R.C.P., Consulting
Obstetric Physician to the London Hospital ; 20, Harley
street. Cavendish square, W. Council, 1878-9,1898-
1901. Hon. Lib. 1880-1. lion. Sec. 1882-5. Vice-Pres.
1886-7. Board Exam. Midwives, 1886-8. Treas.
1889-92,1903-7. Pre*. 1893-4. Trana.S^.
1903 Hicks, Henry Thomas, F.R.C.S.Eug., 15, Portman
street, W. Council 1907.
1901t Hilliard, Francis PoRTEUs Tyrrell, M.A., M.B.Oxon.,
St. Giles' Hill, Winchester.
1886t Holberton, Henry Nelson, L.R.C.P.Lond., East
Molesey.
1906 Holland, Eardley L., M.B., B.S.Lond., F.R.C.S.Eng.,
Hospital for Women, Soho.
1891t HoLMAN, Robert Colgate, M.R.C.S., Whithorne House,
Midhurst, Sussex.
1864* Hood, Wharton Peter, M.D., 11, Seymour street, Port-
man square, AY.
1906 Hope, George, D.P.H., L.R.C.P., M.R.C.S.Lond.,
Beaconsfield House, 47, Uxbridge road, Hanwell, W.
1896t Hopkins, George Herbert, F.R.C.S., 3, North Quay,
Brisbane, Queensland.
1905t Hopkins, Lionel Gordon, M.D.Lond., "The Leas," West-
clifife-on-Sea, Essex.
FELLOWS OF THE SOCIETY. XXXI
Elected
1883* HoRROCKs, Peter, M.D., F.R.C.P.Lond., Obstetric Phy.
sician to Guy's Hospital ; 42, Brook street, W.
Council, \S^&-7. Hon. Lib. 1888-9. Hon. Sec.
18y0-3. Fice-Pres. 1894-6. Pres. 1901-2. Trans. 2.
1876 HoRSMAX, Godfrey Charles, L.S.A., 22, King street,
Portmaii square, W.
1 883 HosKiN, Theophilus, L.R.C.P.Lond., 1 , Amhurst park, N.
1879t Hubbard, Thomas Wells, L.R.C.P., L.R.C.S., Barming
place, Maidstone.
1901 Humphreys, Francis Rowland, L.R.C.P.Lond., 2,
Chalcot gardens, England lane. South Hampstead,
N.W.
1884*tHuRRY, Jamieson Boyd, M.D.Cantab., 43, Castle street,
Reading. Council, 1887-9, 1907. Vice.-Pres. 1897-
1900. Trans. 2.
1878*tHusBAND, \Y alter Edward, M.R.C.S., L.R.C.P., Grove
Lea, Lansdown, Bath.
1895 Huxley, Henry, L.R.C.P.Lond., 39, Leinster gardens,
Hyde park, W.
1904t Illington, Edmund Moritz, Capt. LM.S., L.R.C.P.,
c/o Surgeon-General, with the Government of Madras,
Madras.
1894t Ilott, Herbert James, M.D.Aber., 57, High street,
Bromley, Kent.
1901t Inglis, Arthur Stephen, M.D.Aber., 2, East ascent,
St. Leonards-on-sea.
1902t Inglis, John, M.D., 14, Eversfield place, St. Leonards-
on-Sea.
1907 Ingram, Percy Cecil Parker, M.B., B.S.Lond., St.
George's Infirmary, Fulham road, S.W.
1902t Ionides, Theodore Henry, M.B., B.S.Lond., 25, First
avenue, Brighton.
Xxxii FELLOWS OF THE SOCIETY.
Elected
1903 laoNsiDE, Robert Adeian, M.D., C.M.Aber., Campbell
House, Fitzjohu's avenue, N.W.
l884*tlRWiN, JoHX Arthur, M.A., M.D., 14, West Twenty-ninth
street, New York.
1904 IvENS, Mary II. Frances, M.B., M.S.Lond., Honorary
Medical Officer for the Diseases of Women, Stanley
Hospital, Liverpool, 1a, Rodney Street, Liverpool.
1897 Jager, Harold, M.B.Lond., 172, Holland park avenue,
W.
1890t James, Charles Henry, L.R.C.P.Loud., Major, Indian
Medical Service ; Patiala, Punjab, India.
1883*tJENKiNS, Edward Johnstone, M.D.Oxon., 213, Macquarie
street, Sydney.
1882*tJBNNiNGS, Charles Egerton, M.D.Durb., F.R.C.S.Eng.,
Assistant Surgeon to the North-West London Hospital ;
The Red House, Great Somerford, Wilts.
1901*tJoHNSON, Edward Angus, M.B., B.S.Melb., L.R.C.P.
Lond., "St. Catharine's" Prospect, South Australia.
1868t Jones, Evan, M.E.C.S., Ty-Mawr, Aberdare, Glamorgan-
shire. Council, 1886-8. Vice.-Fres. 1890-1.
1894 Jones, Evan, L.E.C.P.Lond., 89, Goswell road, E.C
1902t Jones, Evan James Trevor, M.D.Brux., Ty-Mawr,
Aberdare, Glamorgansbire.
lS95t Jones, George Horatio, M.R.C.S., Deddington, Oxon.
1894t Jones, John Aunallt, M.D.Durh., Heathmont, Aber-
avon, Port Talbot, Glamorganshire.
1886t Jones, William Owen, M.R.C.S., The Downs, Bowdon,
Cbeshire.
I903t Jordan, John Furneaux, M.B., F.E.C.S., Surgeon to
the Birmingham Hospital for Women, 9, Newhall
street, Birmingham.
18831 Keeling, James Hurd, M.D., 267, Glossop road, Sheffield.
FELLOWS OF THE SOCIETY. XXXlii
Elected
189fi Keep, Arthur Corrie, M.D., C.M.Edin., Surgeon to Out-
patients to the Samaritan Free Hospital ; 14,
Gloucester place, Portman square, W. Council, 1 902-4.
1894 Kellett, Alfred FeatherstoiNE, M.B., B.C.Cantab., 39,
Granville park, Blackheath, S.E.
1886 Kennedy, Alfred Edmund, L.R.C.P.Ed., Chesterton
House, Plaistow, E,
1879 Ker, Hugh Richard, L.E.C.P.Ed., Tintern, 2, Balham
hill, S.W.
1895t Kerr, John Martin Munro, M.B., C.M.Glasg.; Obstetric
Physician to the Glasgow Maternity Hospital; 28.
Berkeley terrace, Glasgow. Council, 1906-7. Trans. 2.
1907 Kerrawalla, Manecxji Piroshaw, M.D.Brux.,L.M.&S.
Bombay, 22, Oxford street, W.
1877*tKERSWiLL, John Bedford, M.R.C.P.Ed., Fairfield, St.
German's, Cornwall.
O.F.* KiALLMARK, Henry Walter, M.R.C.S., 5, Pembndge gar-
dens, Bayswater. Council, 1879-80.
1872* KiscH,ALBERT,M.R.C.S.,61,Portsdownroad,W. Council,
1896-7.
l876*tKNOTT, Charles, M.R.C.P.Ed., Liz Ville, Elm grove,
Southsea,
1889 Lake, George Robert, M.R.C.S., 177, Gloucester terrace,
Hyde park, W.
1867* Langford, Charles P., M.R.C.S., Sunnyside, Hornsey
lane, N.
1894t Lea, Arnold W. W., M.D., B.S.Lond., F.R.C.S., Lecturer
on Midwifery and Diseases of Women, Owens College,
274,Oxfordroad, Manchester. Comw«7, 1903-6. Trans.2.
1901 Leahy-Lynch, Timothy, L.R. C.P., L.M.Edin., 2, Finsbury
park road, N.
1905 Leakey, Alexander B., M.B., B.Ch.Edin., 84, Pine road,
Cricklewood, N.W.
vol. XLIX. /.
XXXIV FELLOWS OF THE SOCIETY.
Elected
1884*tLEDiARD, Henry Ambrose, M.D., 26, Lowther street,
Carlisle. Council, 1890-2. Trans. 1.
1903t Leicester, John Cyril Holdich, M.D., B.S., F.E.C.S.
Eng., Captain, Indian Medical Service, c/o Messrs.
Grindlay & Co., Calcutta. Trans. 1.
1902t Lendon, Alfred Austin, M.D.Lond., Lecturer on
Obstetrics in the University of Adelaide, North ter-
race, Adelaide, South Australia.
1897 Leslie, William Murray, M.D.Edin., 74, Cadogan
place, Belgrave square, S,W.
1900*tLEVisoN, Hugo Adolf, M.D.(Columbia Univ.), L.R.C.P.
Lond., 44, West 35th street. New York.
1885* Lewers, Arthur H, N., M.D.Lond., F.R.C.P., Obstetric
Physician to, and Lecturer on Midwifery at the
London Hospital; 43, Upper Brook street, W. Council,
1887-9, 1893, 1901-3. Board Exam. Midwives,
189.0-7. Bon. Lib. 1904-5. Hon. Sec. 1906-7.
Trans. 13.
1902 Lewis,Ernest Wool, L.R.C.P., M.E.C.S., The Hermitage,
Fulham Palace road, S.W.
1901f Littlewood, Harry, F.R.C.S,, 25, Park square, Leeds.
Trans. 1.
1894 Livermore, William Leppingwell, L.E-.C.P.Lond., 52,
Stapleton Hall road, Stroud Green, N.
1899 Lockyer, Cuthbert, M.D., B.S.Lond., E.R.C.S.. 117a,
Harley street, W. Council, 1904-7. Board Exam.
Midwives, 1905. Trans. 6.
1905t Longridge, Charles John Nepean, M.D.Vict., F.R.C.S.
Eng., 30, Wimpole street, W.
1893t Lowe, Walter George, M.D.Lond., F.R.C.S., Burton-
on-Trent.
]l878*tLYCETT, John Allan, M.D,, Consulting Gynaecologist to
the Wolverhampton and District Hospital for Women ;
•' Gatcombe," Clifton road, Tettenhail, near Wolver-
hampton.
FELLOWS OF THE SOCIETY. XXXV
Elected
1905*tLYLE, Robert Patton Ranken, M.D.Dabl., 11, Ellison
place, Newcastle-on-Tyne.
1902t Lynn, Edward, M.R.C.S., 638, Woolwich road, New
Charlton, Kent.
1890 McCann, Frederick John, M.D., C.M.Edin., F.E.C.S.
Eng., M.R.C.P., Physician to In-patients at the
Samaritan Hospital ; 5, Curzon street, Mayfair, W.
Council, 1897-8. Board Exam. Midwives^ 1904-5.
Trans. 3.
1894t McCausland, Albert Stanley, M.D.Brux., Churchill
House, Swanage.
1894t McDonnell, ^Eneas John, M.D., Ch.M.Sydney, Rath-
donnell, Toowoomba, Queensland.
1906t McIlroy, Louise, M.D., Gynsecologist to the Glasgow
Victoria Infirmary ; 26, Sandyford place, Glasgow.
Trans. 1.
1892t McKay, W. J. Stewart, M.B., M.Ch. Sydney, Australian
Club, Macquarie street, Sydney, N.S.W.
1897t McKerron, Robert Gordon, M.B.Aberd., 1, Albyn place,
Aberdeen. Trans. 2.
1900t Macan, Jameson John, M.A., M.D.Cantab., Crossgates,
Cheam, Surrey.
1893t Maclean,Ewen John, M.D., F.R.S.Edin.,M.R.C.P.Loud.,
Senior Gynaecologist to Cardiff Infirmary ; 12, Park
place, Cardiff. Council, 1900.
1899 MACLEOD, William Aitken, M.B., C.M.Edin., 9, Pern-
bridge villas, Bayswater, W.
1878*tMACNAUGHTON.JoNEs, H., M.D., M.A.O. (Hon. Causa),
F.R.C.S.I. & Edin., 131, Harley street, Cavendish
square, W. Trans. 1.
1894t McOscAR, John, L.E.C.P.Lond., Bridge House, Spring
gardens, Buxton.
1905 McQueen, Robert Martin, L.R.C.P.Lond., M.R.C.S.,
89, Eaton terrace, S.W.
XXXvi FELLOWS OF THE SOCIETY.
Elected
1899t Maguire, Geoege J., M.B., B.Ch., " Fulwood," Kew
gardens, S W. Trans. 1.
189ot Maidlow, William Harvey, M.D.Durh., F.R.C.S.Eng.
Ilminster, Somerset.
1884* Malcolm, John D., M.B., CM., Surgeon to the Samaritan
Free Hospital ; 13, Portman street, AV. CMmci7, 1894-6.
Trans. 3.
1871t*MALiN8, Edward, M.D., Consulting Obstetric Physician
to the General Hospital, Professor of Midwifery in
the University, Birmingham ; 50, Newhall street,
Birmingham. Council, 1881-3. Vice-Pres. 1884-6,
1901-2. Fres. 1903-4.
1903t Malins, Herbert, B.A.Oxon., M.B.Edin., 64, Sutherland
avenue, W.
1868*tMARCH, Henry Colley, M.D., Portisham, Dorchester.
Council, 1890-2.
1887 Mark, Leonard P., M.D.Durh., 49, Oxford terrace,
Hyde park, W.
1887t Marsh, 0. E. Bulwer, L.R. C.P.Ed., Parkdale, Clytha
park, Newport, Monmouthshire.
1905t Martex, Robert Humphrey, M.B., B.C.Cantab.,
Adelaide.
1890t Martin, Christopher, M.B., C.M.Edin., F.E.C.S.Eng.,
Surgeon to the Birmingham and Midland Hospital tor
Women; 35, George road, Edgbaston, Birmingham.
Trans. 1.
I905t Masters, Alfeed Thomas, L.S.A., Northridge,Northiam,
Sussex.
1899t Maxwell, John Preston, M.B.Lond., F.R.C.S., E.P.
Mission, Engchhun, Amoy, China. Trans. 1.
1904 Maxwell, R. Drummond, M.D.Lond., 102,Oxford gardens.
North Kensington, W.
1890 "May, Chichester Gould, M.A., M.D.Cantab., Assistant
Physician to the Grosvenor Hospital for Women and
Children ; 59, Cadogan place, S.W.
FELLOWS OF THE SOClETy. XXXVll
Elected
1884t Maynard, Edward Chaeles, L.R.C.P.Ed., 39, Wynnstay
gardens, Kensington,
1886 Mennell, Zebulon, M.R.C.S., 1, Royal crescent, Notting
hill, W.
1898 Menzies, Henrt, M.B.Cantab., 4, Ashley gardens, S.W.
1882 Meredith,William Appleton, M.B., CM., F.R.C.S.Eng.,
Surgeon to the Samaritan Free Hospital for Women
and Children; 21, Manchester square, W. Council,
1886-8. Vice.Pres. 1891-3. Trans. 3.
1893t Michie, Harry, M.B.Aber., 27, Regent street, Notting-
ham.
1875*tMiLES, Abijah J., M.D., Professor of Diseases of Women
and Children in the Cincinnati College of Medicine,
Cincinnati, Ohio, U.S.
1902 MiLLiGAN, Wyndham Anstruther, M.A., M.D.Aber.,
F.R.C.S.Edin., 68, Park street, Grosvenor square, W.
1876*tMiLLMAN, Thomas, M.D., 490, Huron street, Toronto,
Ontario, Canada.
1880*tMiLLs, Robert James, M.B., M.C., 35, Surrey street,
Norwich.
1892t Milton, Herbert M. Nelson, M.R.C.S., Kasr-el-Aini
Hospital, Cairo, Egypt.
1869*tMiNNS, Pembroke R. J. B., M.D., Thetford, Norfolk.
1903t Moore-Ede, William Edwabd, M.B., B.C.Cantab., 64,
Jesmond road, Newcastle-on-Tyne.
i859t Mooehead, John, M.D., Surgeon to the Weymouth Infir-
mary and Dispensary, Royal Bath Hotel, Bournemouth.
1895t MoRisoN, Henry Bannermann, M.B.Durh., Okehurst,
Cranleigh, Surrey.
1890 MoREis, Charles Arthur, C.V.O., M.A., M.B., M.C.
Cantab., F.R.C.S., Surgeon to the Grosvenor
Hospital for Women and Children, 28, Chester
square, S.W.
1883* MoREis, Clarke Kelly, M.R.C.S., Gordon Lodge, Charl-
ton road, Blackheath, S.E.
XXXVlll FELLOWS OF THE SOCIETY.
Elected
l»y3t Morse, Thomas Herbert, F.R.C.S., All Saints' green,
Norwich. Trans. 1.
1896 MuGFORD, Sidney Arthur, L.R.C.P., 135, Kennington
park road, S.E.
1893 MuiR, Robert Douglas, M.D., The Limes, New Cross
road, S.E.
1885 Murray-, Charles Stormont, L.R.C.S. and L.M.Ed.,
85, Gloucester place, Portman square, W.
1896t Nariman, R. T., M.D.Brux., Parsi Lying-in HospitaL
Bombay.
1902t Nariman, Temulfi Bhicafi, L.M.&E. Bombay, Bombay,
Lidia.
1892t Nash, W. Gifford, F.R.C.S., Senior Surgeon to the Bed-
ford County Hospital, Clavering House, De Parys
avenue, Bedford.
1902t Newland, H. Simpson, M.B.Adel., F.R.C.S.Eng., 12,
North terrace, Adelaide, South Australia.
1889t Newnham, William Harry Christopher, M.A.,
M.B.Cantab., Physician-Accoucheur to the Bristol
General Hospital ; Chandos Villa, Queen's road,
Clifton, Bristol.
1893t NicHOL, Frank Edward, M.A., M.B., B.C.Cantab.,
1, Ethelbert crescent, Margate.
1873t Nicholson, Arthur, M.B.Lond., 30, Brunswick square,
Brighton. Council, 1897-9.
1904t Nicholson, Haert Oliphant, M.D.Edin., 20, Manor
place, Edinburgh.
1876* Nix, Edward James, M.D., 11, Weymouth street, W.
Council, 1889-90.
1903 Nolan, William, L.E.C.P. & S.I., L.M.Dubl., 20, Talbot
road, Bayswater, W.
1903t-NoTT, Arthur Holbrook, M.B.Durh., Major, Indian
Medical Service, c/o Messrs. Grindlay & Co.,
54, Parliament street, S.W.
FELLOWS OF THE SOCIETY, XXxix
Elected
i904t Odgers, Norman Blake, M.B.,B.Ch.Oxon, F.K.C.S.Eng.,
16, Castilian street, S. Giles street, JN'orthampton.
1905 Orr, William Robert, M.D., Coolard lodge, East
Fincbley, N.
I899t OsBORN, Francis Arthur, L.R.C.P.Lond., Ennismore
House, Dover.
1877t OsTEBLOH, Paul Rudolph, M.D.Leipzic, Physician for
Diseases of Women, Diaconissen Hospital ; Wiener-
strasse 8, Dresden,
1902 OxLEY, Alfred James Rice, M.D.Dubl., 7, Courtfield
road, S.W.
1889* Page, Harry Marmaduke, M.D.Brux., F.R.C.S., 14,
Grenville place, S.W.
1877* Paramore, Richard, M.D., 2, Gordon square, W.C.
1867*tPARKs, John, M.R.C.S., Bank House, Manchester road.
Bury, Lancashire.
1887 Parsons, John Inglis, M.D.Durh., M.R.C.P., Physician
to the Chelsea Hospital for Women, 3, Queen street,
Mayfair, W. Trans. 2.
1904 Paterson, Herbert John, M.A., M.B., B.C.Cantab.,
F.R.C.S.Eng., 9, Upper Wimpole street, W.
1899 Paul, J. E., M.D., c/o Messrs. Parry and Co., 70, Grace-
church Street, E.C.
1902t Payne, Edward Marten, M.B., CM., St. John's, Rich-
mond terrace, Blackburn.
I882*tPEACEY, William, M.D., Rydal Mount, St. John's road,
Eastbourne.
1894 Peake, Solomon, M.R.C.S., 228, Goldhawk road,
Shepherd's Bush, W.
1899t Peck, Francis Samuel, M.R.C.S.Eng., Major, Indian
Medical Service ; 6, Harington street, Calcutta.
1871* Pedler, George Henry, M.R.C.S., L.E.C.P., 6, Trevor
terrace, Rutland gate, S.W. Council, 1897-8.
1 880* fPEDLE Y, Thomas Fran klin, M.D., Rangoon, India. Trans. 1 .
xl FELLOWS OF THE SOCIETY.
Elected
1898t Penny, Alfred Gervase, M.A., M.B., B.C.Cantab.
Rahere house, Clayfield, Brisbane, Queensland.
1881t Perigal, Arthur, M.D., New Barnet, Herts. Council,
1892-3.
1879*tPESiKAKA, HoRMASJi DosABHAi, 23, Homby row, Bombay.
1894 Petty, David, M.B., C.M.Edin., 148, Stamford hill, N.
1903t Philbrick, John Harold, M.B., B.Ch. Cantab, c/o
Messrs. Grindlay & Co., Calcutta.
1879 Phillips, George Kichard Turner, M.R.C.S., 33,
Beaufort gardens, S.W. Council, 1891.
1882 Phillips, John, M.A., M.D.Cantab., F.R.C.P., Professor
of Obstetric Medicine in King's College, and
Obstetric Physician to King's College Hospital ; 68,
Brook street, W. Council, 1887-9, 1893. 1906. Hon.
Lib. \894-5. Hon. Sec. 1896-9. Board £xam. Mid-
wives, 1892-4. Fice-Pres. 1900-3, 1907. Chairman
1905. Trans. 11.
1878* Philpot, Joseph Henry, M.D., 61, Chester square, S.W.
Council, 1891.
1889t Pinhorn, Richard, L.R.C.P.Lond., 5, Cambridge terrace,
Dover. Council, 1897-9.
1893 Playfair, Hugh James Moon, M.D.Lond., Assistant Phy-
sician, Hospital for Women and Children, Waterloo
road; 7, Upper Brook street, Grosvenor square, W.
Council, 1900.
1891* Pollock, William Rivers, M.D., F.R.C.P., Obstetric
Physician to the Westminster Hospital, 56, Park
street, Grosvenor square, W. Council, 1895-7, 1902-4.
Board Exam. Midwives, 1898-9. Trans. 1.
1891t Pope, Henry Sharland,M.B., B.C.Cantab., Castle Bailey,
Bridgwater.
1888* PoPHAM, Robert Brooks, F.E.C.P.Edin., L.R.C.P.Lond.,
" Endyon," 130, Argyle road. West Ealing, W
1903t Potts, William Alexander, B.A.Cantab., M.D.Edin.,
118, Hagley road, Birmingham.
FELLOWS OF THE SOCIETY. xU
Elected
1901 Powell, Llewellyn, M.B., B.C.Cantab., 58, New Caven-
dish street, W.
1886* Prangley, Henry John, L.R.C.P.Lond., Tudor House,
197, Anerley road, Anerley, S.E.
1880* Prickett, Marmaduke, M.A.Cantab., M.D., Physician to
the Samaritan Hospital ; 27, Oxford square, W.
Council, 1892.
1895 Priestley, R. C, M.A., M.B.Cantab., 81, Linden gardens,
Bayswater, W.
1905 Provis, Francis Lionel, F.E.C.S.Lond., 11, Brook
street, Hanover square, "W.
1898t PuRSLow, Charles Edwin, M.D., M.R.C.P.Lond., Hono-
rary Obstetric Officer, Queen's Hospital, Birmingham ;
192, Broad street, Birmingham.
lS76*tQuiRKE, Joseph, M.R.C.P.Ed., The Oaklands, Hunter's
road, Handsworth, Birmingham.
1878t Eawlings, John Adams, M.R.C.P.Ed., 14, Northampton
place, Swansea.
1897t Rawlings, J. D.jM.B.Lond., Rose Hill House, Dorking.
1870* Ray, Edward Reynolds, M.E.C.S., 15a, Upper Brook
street, W. Council, 1902-4.
1894t Eayner, Herbert Edward, F.E.C.S., Diamond hill,
Camberley, Surrey.
1899t Rayner, David Charles, F.E.C.S.Eng., 9, Lansdowne
place, Victoria square, Clifton, Bristol.
1860* Eayner, John, M.D., Swaledale House, Highbury quad-
rant, N.
1879 Read, Thomas Laurence, M.R.C.S., 1 1 , Petersham terrace.
Queen's gate, S.W. Council, 1892.
1905t Rees, Ehys Basil, L.S.A.Lond., Priory house, Queen's
crescent, N.W.
1879t Reid, William Loudon, M.D., Professor of Midwifery and
Diseases of Women and Children, Anderson's College ;
Physician to the Glasgow Maternity Hospital ; 7, Royal
crescent, Glasgow. Council, 1899-1901-2.
Xlii FELLOWS OF THE SOCIETY.
Elected
1893t Renshaw, Israel James Edward, F.R.C.S.Edin., 26,
Sefton road, Sale, Cheshire.
1875*tREY, EuGENio, M.D., 39, Via Cavour, Turin.
1890 Reynolds, John, M.D.Brux., 11, Brixton hill, S.W.
1905t Rice, Geokge, M.D.Durh., 46, Friar gate, Derby.
1905 RicHAKDSON, Maktin James, M.B., C.M.Edin., 47,
Gloucester place, Portman square, W.
1872*tRiCHARDS0N, William L., M.D., A.M., Professor of Obs-
tetrics in Harvard University ; Physician to the Boston
Lying-in Hospital; 225, Commonwealth avenue,
Boston, Massachusetts, U.S.
1889t Richmond, Thomas, L.R.C.P.Ed., 4, Burnbank gardens,
Glasgow.
1871* RiGDEN, Walter, M.D. St. And., 16, Thurloe place, S.W.
Council, 1882-3. Trans. 1.
1892 Roberts, Charles Hubert, M.D.Lond., F.R.C.S.Eng.,
M.E.C.P., Physician to Out-patients to Queen Char-
lotte's Hospital ; Physician to Samaritan Free Hos-
pital for Women ; 21, Welbeck street, Cavendish
square. Co?<ncz7, 1897-9, 1905-7. Board Exam. Mid^
wives, 1901. Trans. 4.
O.F.*t Roberts, David Lloyd, M.D., F.R.C.P., F.R.S.Edin.,
Consulting Obstetric Physician to the Manchester Koyal
Infirmary ; and Lecturer on Clinical Midwifery and the
Diseases of Women in Owens College; 11, St. John
street, Deansgate, Manchester. Council, 1868-70,
1880-2. Fice-Pres. 1871-2. Board Exam. Midwives,
1900-4. Trans. 5,
1867* Roberts, David W., M.D., 56, Manchester street, Man-
Chester square, W. Council, 1905.
1890t Roberts, Hugh Jones, M.R.C.S.,Llywenarth, Penygroes,
R.S.O., N. Wales.
1874* Robertson, William Borwick, M.D., St. Anne's, Thurlow
park road, West Dulwich, S.E.
FELLOWS OF THE SOCIETY. xliii
Elected
1892 Robinson, George H. Drummond, M.D., B.S.Lond.,
Assistant Obstetric Physician, West London Hospital ;
17, Seymour street, Portman square, W. Council, 1899-
1900. Board Exam. Midwives, 1898-1900. Trans. 2.
1887 Robinson, Hugh Shapter, L.R.C.P.Ed., Talfourd House,
7S, Peckliam road, Camberwell, S.E.
1876t*RoE, John Within gton, M.D., EUesmere, Salop.
1874*tRooTs, William Henry, M.R.C.S., Canbury House,
Kingston-on-Thames.
1903+ Rose, Alexander Macgregor, M.B., Ch.B., The Mess,
Prospect, Bermuda.
1904 Rose, Thomas, L.R.C.P., 60, Bloomsbury street, W.C.
1893t Rosenau, Albert, M.D., Hans Eosenau (amKxirgar-
ten), Kissiugen, Bavaria. (Winter, Winter Palace,
Monte Carlo.)
1884t Rossiteu, George Frederick, M.B., Surgeon to the
Weston-super-Mare Hospital ; Cairo Lodge, Weston-
super-Mare.
1884t Roughton, Walter, F.E.C.S., Cranborne House, New
Barnet.
1882* Rodth, Amand, M.D., B.S., F.R.C.P., Obstetric Physician
and Lecturer on Midwifery at Charing Cross Hos-
pital; 14a, Manchester square, W. Council, 1886-8,
1896-7,1907. Board Exa7n. Midwives, 1893-5. Hon.
Lib. 1898-9. Hon. Sec. 1900-3. Vice-Pres. 1904-6,
Trans. 5.
O.F.* Routh, Charles Henry Felix, M.D., Consulting Physician
to the Samaritan Free Hospital for Women and Children ;
52, Montagu square, W. Comwc?7, 1859-61. Vice-Pres.
1874-6. Tram. 13.
1 88 7*tRowE, Arthur Walton, M.D.Dur., 1 , Cecil street, Margate.
1886 Rushworth, Frank, M.D.Lond., 153, Finchley road,
South Hampstead, N.W. Council, 1905.
1886t Rdtherfoord, Henry Trotter, M.A., M.D.Cantab.,
Salisbury House, Taunton. Council, 1892-3.
Trans. 1.
Xliv FELLOWS OF THE SOCIETY.
Elected
1866*tSABOiA, Baron V, de, M.D., Director of the School of Medi-
cine, Rio de Janeiro ; 7, Rua dom Affoneo, Petropolis,
Rio Janeiro. Trans. 2,
1906 St. Johnston, Thomas Reginald, L.R.C.P., Lewisham
Infirmary, S.E.
1864*tSALTEE, John H., M.E.C.S., D'Arcy House, ToUeshunt
d'Arcy, Kelvedon, Essex. Council, 1894-6.
1868* Sams, John Sutton, M.E.C.S., St. Peter's Lodge, Eltham
road, Lee, S.E. Council, 1892.
1886*tSANDERS0N, Robert, M.B.O.xon., 56, Brunswick square,
Brighton.
1872 Sangstee, Charles, M.E.C.S., 148, Lambeth road, S.E.
1903t Savage, Smallwood, M.B.Oxon., F.R.C.S.Eng., 133,
Edmund street, Birmingham.
1890 ScHACHT, Frank Frederick, B.A., M.D.Cantab., 153,
Cromwell road, S.W.
1902 ScHARLiEB, Mary Ann Dacomb, M.D.Lond., M.S., B.S.,
Obstetric Physician to the Royal Free Hospital, and
Lecturer on Midwifery to the London School of
Medicine for Women ; 149, Harley street, W.
Council, 1905-7.
1882 Serjeant, David Maurice, M.D.,27, Peckham road, S.E.
1905 Serjeant, Edith, L. B.C. S.&P.Ediu., 27, Peckham road,
Camberwell, S.E.
1905t Serjeant, Helen Mary, L.E.C.S.&P.Edin., Babies'
Castle, Hawkhurst, Kent.
1875 Seton, David Elphinstone, M.D., 1, Emperor's gate,
S.W. Council, 1884.
1896t Sharman, Mark, M.B., C.M.Glas., Rickmansworth.
1891 Shaw-Mackenzie, John Alexander, M.D.Lond., 50,
Green street, Park lane, W.
1906t Shaw, William Fletcher, M.D.Vict., St. Mary's Hos-
pital, Manchester.
FELLOWS OF THE SOCIETY. xIt
Elected
IQOOf Shephekd, Thomas William, L.R.C.S.Edin., Castle
Hill House, Launceston.
1906 Shields, Ida Russell, M.B., B.S.Lond., Clapham
Maternity Hospital, Clapham.
1902 SiKES, Alfred Walter, M.D., B.Sc.Lond., 57, Wimpole
street, W.
1902 SiMSON, Henby J. F., M.B., F.R.C.S.Ed., 36, Grosvenor
street, W.
1888t Sinclair, Sir William Japp, M.D.Aber,, Honorary
Physician to the Southern Hospital for Women and
Children and Maternity Hospital, Manchester ; and
Professor of Obstetrics and Gynaecology, Owens
College, Manchester; Garvock House, Dudley road,
"Whalley Range, Manchester. Council, 1899-1902.
rice-Fres., 1903-7. Trans. 1.
1881t Sloan, Archibalb, M.B., 21, Elmbank street, Glasgow.
1876t Sloan, Samuel, M.D., CM., 5, Somerset place, Sauchiehall
street west, Glasgow,
1890t Sloman, Frederick, M.R.C.S., IS, Montpellier road,
Brighton.
1903 Smith, Arthur Lionel Hall, L.R.C.P., M.R.C.S.Lond.,
16, New Cavendish street, W.
1905* Smith, George Frederick Darwall, M.B.Cantab.,
B.Ch.Oxon., F.R.C.S.Eng., 30, Wimpole street, W.
1901 Smith, Guy Bellingham, M.B., B.S.Lond., F.R.C.S.,
24, St. Thomas's street, S.E. Trans. 1.
1867* Smith, Heywood, M.D., 25, Welbeck street. Cavendish
square, W. Council, 1872-5. Board Exam. Midwives,
1874-6. Trans. 6.
1875 Smith, Richard Thomas, M.D., Physician to the Hospital
for Women, Soho square ; 33, Wimpole street, W.
1886t Smith, Samuel Parsons, L.K.Q.C.P.L, Park Hyrst,
Addiscombe road, Croydon.
1899*tSMYLY, Sir William Josiah, M.D., F.R.C.P.I., 58,
Merrion square, Dublin.
xlvi FELLOWS OF THE SOCIETY.
Elected
1868* Spaull, Barnard E., M.R.C.S., L.R.C.P,, 1, Stanwick
road, West Kensington, W.
1907 Speers, William Gordon, M.R.C.S., L.R.C.P.Lond., 18,
Largo dos Guayanazes, Siio Paulo, Brazil.
1888* Spencer, Herbert R., xM.l)., B.S.Lond., F.R.C.P.,
Professor of Obstetric Medicine in University College
Hospital Medical School, Obstetric Physician to Uni-
versity College Hospital; 104, Harley street, W. Council,
1890-92. BoardExam.Midwives, 1896-7. Hon. Sec.
1898-1901. Vice-Pres., 1902-4. Editor, 1903-7.
Pres., 1907. Trans. 11.
1882* Spooner, Frederick Henry, M.D., Shameen, 33,
Pembury road. Lower Clapton, N.E.
1897 Stabb, Arthur Francis, M.B., B.C.Cantab., Assistant
Obstetric Physician to St. George's Hospital, and
Lecturer in Midwifery in the University of Cambridge ;
132, Harley street, W. Council, 1899-1901. Board
Exam. Midwives, 1903-5.
1907 Stedman, Herman, M.D.Cinc, F.R.C.S.Edin., 145, East
India road, E.
1877t Stephenson, William, M.D., Professor of Midwifery,
University of Aberdeen ; 3, Rubislaw terrace, Aberdeen.
Council, 1881-3. Vice-Pres., 1887-9. Trans. 2.
1894 Stevens, Thomas George, M.D., B.S.Lond., 8, Wey-
mouth street, W. Council, 190--3. Board Exam.
Midwives, l904<-5. Trans. 2.
1884t Stevenson, Edmond Sinclair, Knt., F.R.C.S.Ed,, Strath-
allan House, Rondebosch, Cape of Good Hope.
Trans. 2.
1875*tSTEWART, William, F.R.C.P.Ed., 26, Lethbridge road,
Southport.
1884 Stivens, Bertram H. Lyne, M.D.Brux., 107, Park
street, Grosvenor square, W.
1883 Stocks, Frederick, M.R.C.S., 421, Wandsworth road,
S.W.
1894t Stott, William Atkinson, M.B., Ch. B.Vict., L.E.C.P.
Lond., 2, Hillary place, Woodhouse lane, Leeds.
FELLOWS OP THE SOCIETY. xlvii
Elected
1898t Sturmer, Arthur James, M.E.C.S., L.R.C.P., Lieut.-
Col., c/o Messrs. Henry S. King & Co., 9, Pall Mall,
S.W. Trans. 1.
1884 Sunderland, Septimus, M.D., M.R.C.P., Physician to
the Royal Hospital for Children and Women; 11,
Cavendish place. Cavendish square, W.
1904 SwAFFiELD, Walter H., M.D., F.R.C.S.Ed., 39, Wey-
mouth street, Portland place, W.
1896 Swan, Charles Atkin, M.B., B.Ch.Oxon., 3, Chester place,
Hyde Park square, W.
1901 SwANTON, James Hutchinson, M.D., M.Ch., 40, Hariey
street, "W.
!893 SwAYNE, Francis Griffiths, M.A., M.B., B.C.Cantab.,
140, Church road, Norwood, S.E.
1892t S WAYNE, Walter Carless, M.D.Lond., Obstetric Phy-
sician, Bristol Royal Infirmary ; Professor of Mid-
wifery in University College, Bristol; Mathon house,
56, St. Paul's road, Clifton. Council, 1903-6.
1906t SwETE-EvANs, William B., M.A., M.B., B.C., Malvern
lodge, Southport.
1888* Sworn, Henry George, L.K.CIC.P. & L.M., 5, Highbury
crescent, N.
1883 Tait, Edward Sabine, M.D., 48, Highbury park, N.
Council, 1892-4. Trans. 1.
1880*tTAKAKi, Kanaheiro, F.R.C.S., 10, Nishi-Konyacho, Kio-
bashika, Tokio, Japan.
1891 Targett, James Henry, M.B., M.S.Lond., P.R.C.S.,
Obstetric Surgeon and Joint Lecturer on Midwifery
to Guy's Hospital, 19, Upper Wimpole street, W.
Council, 1895. 1906. Board Exam. Midwives^
1900-2.
1892* Tate, Walter William Hunt, M.D.Lond., Obstetric
Physician to, and Lecturer on Midwifery and the
Diseases of Women at, St. Thomas's Hospital; 32,
Queen Anne street. Cavendish square, W. Council,
1895-7. Board Exam. Midwives,\m'^-Si. Trans. 2.
xlviii FELLOWS OF THE SOCIETY
Elected
1900 Taylor, Frank Edward, M.A., M.D., F.R.C.S., Path-
ologist to Chelsea Hospital for Women ; Physician
for Diseases of Women to North-west London Hos-
pital; 11, Bentinck street, Cavendish square, W.
1890*tTAYLOR, John William, F.R.C.S., Surgeon to the
Birmingham and Midland Hospital for Women ;
Professor of Gynsecology, Birmingham University ;
22, Newhall street, Birmingham. Council, 1900-2.
Trans. 4.
1892 Taylor, William Bkamlev, M.R.C.S., 145, Denmark
hill, S.E.
I894t Tench, Montague, M.D.Bnix., L.R.C.P.Lond., Great
Dunmow, Essex.
1890t Thomas, Benjamin Wilfred, L.R.C.P.Lond., Welwyn.
1887t Thomas, William Edmund, L.R.C.P.Ed., Ashfield,
Bridgend, Glamorganshire.
1901 Thompson, Charles Herbert, M.D.Dubl., 133, Harley
street, W.
1867*tTH0MPS0N, Joseph, L.R.C.P.Lond., Surgeon to the
General Hospital and Hospital for Women, Notting-
ham ; 1, Oxford street, Nottingham. Council, 1896-8.
Trans. \.
1905 Thomson, William B,, M.D., B.Ch.Glasg., Holborn
Infirmary, Archway road, Highgate, N.,
1902 Thorne, Mary, M.D., 148, Harley street, W.
1873*tTicEHURST, Charles Sage, M.ll.C.P.Edin., Petersfield,
Hants.
I895t Tinley, William Edwin FALKiNGRiDGE,M.B.,B.S.Durh.,
Hildegard House, Whitby.
1879t TivY, William James, F.R. C.S.Ed., 5, Victoria square
Clifton, Bristol.
1886t TucKETT, Walter Reginald, M.R.C.S.,Woodhou8e Eaves,
near Loughborough.
1865* Turner, John Sidney, M.R.C.S., Stanton House, 81,
Aneriey road, Upper Norwood, S.E. Council, 1893-4.
FELLOWS OF THE SOCIETY. xlix
Elected
I891t Turner, Philip Dymock, M.D.Lond., Sudbury villa,
Ryde, Isle of Wight. Trans. 1.
1897 TwYNAM, George Edward, L.R.C.P.Lond., 2, Wetherby
place, Hereford square, South Kensington.
1S90 Tyreell, Waltee, L.R.C.P.Lond., 104, Cromwell road,
S.W.
1904t Van Buren, Asa Claude, M.B., B.S.Lond., Wray Lodge,
Chelston square, Torquay.
1903 Vaughait, Ethel May, M.D., B.S.Lond., Physician for
Diseases of Women to Out-patients, Royal Free
Hospital, and Demonstrator of Gynaecology, London
School of Medicine for Women ; 21, Upper Wirapole
street, W.
1874* Venn, Albert John, M.D., 3, Hanover court, Hanover
square, W.
1903t Vincent, George Fourquemin, F.R.C.S.Edin., Rozelle,
Maybury road, Woking.
1900* Vincent, Ralph Henry, M.D., B.S.Durh., 1, Harley
street, W.
18981 Walker, Alfred, M.D„ B.C., M.A.Cantab., Port Isaac,
North Cornwall.
l866*tWALKEE, Thomas James, M.D., Surgeon to the General
Infirmary, Peterborough ; 33, Westgate, Peterborough,
Council, 1878-80.
1901t Wallace, Arthur John, M.D.Edin., Surgeon to the
Hospital for Women, Liverpool ; 1, Gambier terrace,
Liverpool.
1870 Wallace, Frederick, M.R.C.S., L.R.C.P., Foulden
Lodge, Upper Clapton, N.E. Council, 1880-2.
1893t Walls, Willlam Kay, M.B.Lond., 14, St. John street,
Manchester.
1879*tWALTER, William, M.A., M.D., Surgeon to St. Mary's
Hospital, Manchester; 20, St. John street, Man-
Chester.
vol. lxix, ^
1 FELLOWS OF THE SOCIETY.
Elected
1867*tWALTEiis, James Hopkins, M.K.C.S., Surgeon to the Royal
Berkshire Hospital ; 15, Friar street, Reading, Berks.
Council, 1884-6. Trans. 1.
1898»tWARD, Charles, F.E.C.S.I., M.R.C.S.Eng.,Pietermaritz.
burg, Natal, S. Africa.
1898t Watson, C. R., M.D.Brux., 5, Mount Ephraim road,
Tunbridge Wells.
1894 Webb, John Curtis, M. A., M.B., B.C.Cantab., 6, Bina
gardens, S.W.
1905t Webster, CHARLEsGEOHGE,Capt. I. M.S.,L.R.C.P.&S. Ed.,
Madras.
1901 Weekes, Henry Holman, M.D.Brux., L.R.C.P.Lond.,
Crowborongh, Sussex.
1891t Wellesley- Garrett, Arthur Edward, L.R.C.S. &
L.M.Ed., 6, Grosvenor hill, Wimbledon.
1888*tWEST0N, Joseph Theophilus, M.D.Brux., care of
Messrs. Grindlay and Co., 54, Parliament street,
S.W.
1890* Wheaton, Samuel W., M.D.Lond., Physician to the Royal
Hospital for Children and Women ; 10, Rastell
avenue, Streatham hill, S.W.
1902t White, Clement, M.B., B.C.Cantab., Star hill, Eochester.
1907 White, Clifford, M.D., B.S.Lond., Queen Charlotte's
Hospital, N.W.
1903t Whitehouse, William H., M.D.Durh., Keston House,
Aston road, Birmingham.
1902|- Whitelocke, Richard Henry A., M.B., C.M.Edin., 6,
Banbury road, Oxford.
1882t Wholey, Thomas, M.B. Durh., The Lodge, Haukham,
Peveusey.
1901t WiGG, Henry Higham, M.D.Brux., L.R.C.P., F.E.C.S.
Edin., 8, North terrace, Adelaide.
1902 WiLLETT, John Abernetht, M.B.Oxon., 26, Upper
Wimpole street, W.
FELLOWS OF THE SOCIETY. ll
JElected
1903 Wflley, Florence Elizabeth, M.D., M.S., B.Sc.Lond.,
1a, Devonshire street, Portland place, W.
1904t Williams, Edward Colston, M.D., B.S.Lond., 7, Park
road, Wigan.
1899 "Williamson, Herbert, M.A., M.B,, M.R.C.P., Assistant
Obstetric Physician, Royal Hospital for Women and
Children; 84, Wimpole street, W. Council, 1907.
Trans. 3.
18981 Wilson, Claude, M.D.Edin., Belmont, Church road,
Tunbridge Wells.
1892t Wilson, Thomas, M.D., B.S.Lond., F.R.C.S., Assistant
Obstetric Physician at the General Hospital, Birming-
ham ; 87, Cornwall street, Newhall street, Birming-
ham. Council, 1906-7. Trans. 3.
1901t Wilson, Thomas George, M.B., Ch.M.Sydney, F.R.C.S.
Edin. ; 296, Ward street, North Adelaide, South
Australia.
1900t Wingate, William Warburton, M.B., B.C.Cantab., 60,
St. Andrew's street, Cambridge.
1886t Winterbottom, Arthur Thomas, L.R. C.P.Ed. , c/o H. E.
D. Pearson, Esq., King Island, Tasmania.
1877*tWiNTLE, Henry, M.B., 33, Strawberry High road,
Twickenham.
1893 Wise, Robert, M.D.Edin., 290, Ivydale road, Nunhead,
S.E.
19061 Withers, Frederick Ernest, L.R.C.P., The Manor
House, Horncastle.
I887t Withers, Robert, M.R.C.S,, Stenteford Lodge, Spencer
terrace, Lipsou road, Plymouth.
1890 Wornum, George Porter, M.R.C.S., 58, Belsize park,
Hampstead, N.W.
1904t Worthington, Richard, M.B., B.C.Cantab., Gordon
road, Lowestoft.
1876t Worts, Edwin, M.E.CS., L.R.C.P., 6, Trinity street,
Colchester.
lii FELLOWS OF THE SOCIETY.
Elected
1887t Wright, Charles James, M.R.C.S., Senior Surgeon to
the Hospital for Women and Children, Leeds ; Pro-
fessor of Midwifery to the Yorkshire College ; Lynton
Villa, Virginia road, Leeds. Council, 1903-6.
1907 Wyatt, James Montague, M.R.C.S., L.R.C.P.Lond., 15,
Routh road, "Wandsworth Common, S.W.
1888*tWYATT-SMiTH, Frank, M.B., B.C.Cantab., British Hospital,
Buenos Ayres.
1882*tYouNG, Charles Geove, M.D., Berbice, Upper Sea road,
Bexhill, Sussex.
I906t Young, Ernest Eric, M.S.Lond., North Staffordshire
Infirmary, Hartshill, Stoke-on-Trent. Trans. 1.
Number of Fellows .... 573
CONTENTS.
PAGE
List of Officers for 1907 . . . . . v
Standing Committees
vii
List of Past Pi'esidents .
ix
List of Referees of Papers for 1907
X
Trustees of the Society's Property
si
List of Honorary Fellows
xi
List of Ordinary Fellows
. xiii
Contents
liii
List of Plates .
Iviii
List of Illustrations
lix
Advertisement
Ix
January 7th, 1907—
Fibroid of Uterus with a Sarcomatous Nodule in the
centre, shown by Dr. Amand Routh
Chronic Septic Infection op the Uterus and
ITS Appendages, by Dr. Archibald Donald
The Pathology of Chronic Metritis, by Dr.
"William Fletcher Shaw
19
February 6th, 1907—
Report of the Pathology Committee on Dr. Amand
Routh's Specimen of a Fibro-myoma of the Uterus,
with a Sarcomatous Nodule in the Centre
A Villous Tumour of the Body of the Uterus in a
woman aged 84 ; Vaginal Hysterectomy ; Recovery ;
shown by Mr. J. Bland-Sutton
Pregnancy in the Right Cornu of a Fibroid Uterus,
shown by Mrs. Boyd ....
Adeno-carcinoma of the Ovary, shown by Mrs. Boyd
45
46
49
50
liv CONTENTS.
PAGE
Co-existing Tubal and Uterine Pregnancy; Abdominal
Section; subsequent delivery at term, shown by
Dr. Walter Tate . . . .51
Suppuration in Fibro-myoma Uteri following Pre-
mature Delivery; treated by Abdominal Hyste-
rectomy ; sbown by Dr. Walter Tate . . 51
Chorio-endothelioma of Uterus ; Intra-peritoneal
Haemorrhage ; Hysterectomy ; Death ; shown by
Mr. Alban Dokan for the late Dr. G. Bagot
Ferguson . . . . .57
Annual Meeting : the Audited Bepm-t of the Treasurer
(Dr. G. E. Herman) . . . .62
Report of the Honorary Librarian (Dr. W. J. Gow) . 64
Annual Address of the President (Dr. W. R. Dakin) . 66
March 6th, 1907—
Report of the Pathology Committee on Mr. Bland-
Sutton's Specimen of a Villous Tumour of Uterus
from a patient aged 84 (see p. 46) . . 93
After-history of the Case of Fibroid of Broad Ligament
associated with an Ovarian Cyst, reported in the
Forty-third Volume of the Society's ' Transactions,'
by Mr. Alban Dokan . . .94
A Case of Perithelioma of the Uterus, shown by Dr.
G. F. Darv^tall Smith . . .97
A Suppurating Fibroid Tumour of the Uterus, shown
by Dr. G. F. Blacker . . .100
A Case of Chorion-epithelioma of the Uterus : Lutein
Cysts in both Ovaries; shown by Dr. G. F. Blacker
(Plates VII— IX) . . . .104
A Case of Supposed Recurrence after Vaginal
Hysterectomy for Cancer of the Cervix, shown by
Dr. C. Hubert Roberts (Plate X) . . 114
Inaugural Address — President (Dr. H. R. Spencer) 117
April 3rd, 1907—
^Report of the Council .... 135
Report of the Pathology Committee on Mr. G. F.
Darwall Smith's Specimen of Perithelioma of the
Uterus (see p. 97) .... 136
CONTENTS. Iv
PAGE
Supposed Sarcoma of the Cervix, shown by Dr. H. R.
Andrews . . . . .137
Fibro-myomatous Uterus with a Calcified Fibroid
lying free in its cavity, shown by Dr. J. H, Dauber 139
Bilateral Primary Tuberculous Salpingitis with
Secondary Infection of the Perivascular Lymphatics
of the Uterine Wall, shown by Dr. Cuthbert
LoCKYER (Plates XI and XII) . . .141
Placentae from a case of Twins, shown by Dr. Robert
Wise ..... 147
On the advisability of Removing the Cervix
in performing hysterectomy for flbro-
MYOMATOUs Uterine Tumours, by Mr. J. D.
Malcolm ..... 148
May 1st, 1907—
Report of the Pathology Committee on Dr. H. R.
Andrews' Specimen of Supposed Sarcoma of Cervix 1G9
A Case of Intra-peritoneal Rupture of the Bladder
occurring during Labour, by Mr. C. R. Porter
(introduced by Dr. H. R. Andrews) . .170
A Uterus four years after Csesarean Section, shown
by Mr. J. Bland-Stjtton . . .174
Two Specimens from Cases of Cancer of the Cervix,
the Patients remaining free from Recurrence twenty
and eleven years respectively after Operation, shown
by Dr. Lewers .... 179
Uterus showing Villous Malignant Tumour and a
Fibroid which has undergone Sarcomatous Change,
shown by Dr. May Thorne (Plate XIII) . . 181
Malignant Vaginal Polypus secondary to an
Adrenal Tumour of the Kidney, by Mr. A lean
DOKAN (Plates XIV— XVIII) . . . 182
June 5th, 1907—
Report of the Pathology Committee on Dr. May
Thome's Specimen of Uterus showing Malignant
Villous Tumour and a Fibroid undergoing Sarco-
matous Change (see p. 181) . . . 207
Report of the Pathology Committee on Mr. Alban
Doran's Specimen of a Malignant Vaginal Polypus
secondary to an Adrenal Tumour (see p. 182) . 208
Ivi CONTENTS.
PAGK
Two Cases of Preguancy in a Rudimentary Uterine
Hoi-n, by Dr. Henry Russell Andrews . 209
Rupture of tlie Heart in a Still-born Infant, shown by
Dr. C. Nepean Longridoe . . . 21-i
Dilated Ureters in Still-born Infants, shown by Dr.
C. Nepean Longridoe . . . 215
The Pelvic Organs of a Case where Inoperable
Papilloma of the Left Ovary had been found Seven
Tears Previously, shown by Dr. Amand Routh 216
Myomatous Uterus Weighing over Seven Pounds
removed from a Woman aged 22, shown by Dr.
Herbert Spencer (Plate XIX) . . 219
Ovarian Pregnancy (.'), shown by Dr. Brigqs . 222
Early Tubal Mole, shown by Dr. Briggs . . 223
Fibroid Tissue formed around a Needle and removed
from the Left Labium Majus. shown by Dr. Briggs 223
Primary Embolic Chorion-Epithelioma of the
Vagina, by Henry Thomas Hicks (Plates XX —
XXII) . . . . .224
A Case of Chorion-epithelioma complicated
by H^mato-metra, by W. S. A. Griffith and
Herbert Williamson (Plate XXIII) . . 242
July 3rd, 1907—
Report of the Pathology Committee on Dr. H. Briggs'
Specimen of Ovarian Pregnancy (?) (see p. 222) . 256
Report of the Pathology Committee on Dr. Dauber's
Specimen of Fibro-myomatous Uterus containing
a Calcified Fibroid lying free in the Uterine Cavity
(see p. 139) . . . . .257
Report of the Pathology Committee upon Mr. H. T.
Hicks's Specimen of Primary Vaginal Embolic
Chorion-epithelioma (see p. 224). . . 257
Suppuration in an Ovarian Cyst caused by the
Bacillus typhosus, by Dr. Frank E. Taylor . 257
Two Uteri with "Fundal Ligament" after Hystero-
pexy, shown by Dr. Frank E. Taylor . . 266
Haemorrhage in Uterine Fibroid, shown by Mr. J. H.
Targett ..... 269
Malignant Disease of Cervix in One-horned Uterus,
shown by Miss Aldrich-Blake . . 270
CONTENTS. \y{{
PAGE
270
272
Skeleton of Extra-Uterine Foetus, shown by Miss
Aldrich-Blake
Two Specimens of Fibroid associated with Bleeding
after the Menopause, shown by Dr. Lewers . 271
Calcified Uterine Fibro-myoma removed Piecemeal
for HjBmorrhage fourteen years after Oophorec-
tomy, shown by Dr. Herbert R. Spencer
A Specimen of Diaphragmatic Hernia in a New-born
Baby, shown by Dr. C. Nepean Longridge . 273
Mammary Gland of New-born Infant, shown by Dr.*
C. Nepean Longridge . . 274
Myxomatous Fibroid, shown by Mrs. Scharlieb '. 274
Pension to the Secretary and Librarian, Miss Hannam, in
lieu of honorarium . . , 077
Abstract of Receipts and Payments from January— June, 1907 278
^"'^'^- • • • . . 279
Additions to Library . . ^ oqi
General Index to Transactions, vols, i— xlix .' * 295
VOL. LXIX.
PLATES*
PLATE PAGE
I-III.— The Pathology of Chronic Metritis (Dr. W
Fletcher Shaw)
IV-VI.— The Pathology of Chronic Mastitis (Dr. W
Fletcher Shaw) . . .24'
VII and VIII. — ACaseofChorion-epitheliomaof theUterus
Lutein Cysts in both Ovaries (Dr. G. F,
Blacker) . . . lOG
IX. — A Case of Chorion-epithelioma of the Uterus
Lutein Cysts in both Ovaries (Dr. G. F
Blacker) . . .110
X. — A Case of Supposed Recurrence after Vaginal
Hysterectomy for Cancer of the Cervix.
(Dr. C. Hubert Roberts) . . 114
XI and XII. — Bilateral Primary Tuberculous Salpingitis
with Secondary Infection of the Perivas-
cular Lymphatics of the Uterine Wall
(Dr. Cuthbert Lockyer) . . 142
XIII. — Uterus showing Malignant Villous Tumour
and a Fibroid which has undergone
Sarcomatous Change (Dr. May Thorne) 180
XIV. — Malignant Vaginal Polypus secondary to an
Adrenal Tumour of the Kidney (Mr.
Alban Doran) . . . 184
XV-XVII. — Malignant Vaginal Polypus secondary to an
Adrenal Tumour of the Kidney (Mr.
Alban Doran) . . . 188
XVIII. — Malignant Vaginal Poljpus secondary to an
Adrenal Tumour of the Kidney (Mr.
Alban Doran) . . . 190
XIX. — Myomatous Uterus weighing over Seven
Pounds, removed from a Woman, aged 22
(Dr. Herbert R. Spencer) . . 221
XX-XXII. — Primary Embolic Chorion-epithelioma of
the Vagina (Mr. H. T. HiCKs) . . 225
XXIII. — A Case of Chorion-epithelioma complicated
by Haematometra (Dr. W. S. A. Griffith
and Dr. H. Williamson) . . 24G
ILLUSTRATIONS.
TT PAGE
A Uterus in Sagittal Section. The cavity is dilated and
occupied by a villous tumour growing from the posterior
wall (Mr. J. Bland-Sutton) . . . .47
A Uterus in Sagittal Section which had been subjected to
Caesarean Section four years previously (Mr. J. Bland-
Sutton) 275
ADVERTISEMENT.
The Society is not as a body responsible for the facts and
opinions which ai-e advanced in the following papers and com-
munications read, nor for those contained in the abstracts of the
discussions which have occurred at the meetings during the
Session.
AGNES HANNAM,
Secretary and Librarian.
20, Hanover Square. W
JANUARY 7th, 1907.
W. R. Dakin, M.D., President, in the Chair.
Present — 26 Fellows and 2 visitors.
Books were presented by Dr. Herman, and the Staff of
Guy's Hospital.
Thomas Reginald St.Johnston, M.R.C.S., L.R.C.P.,
and William Fletcher Shaw, M.D.Vict., were admitted
Fellows of the Society.
H. N. Anklesaria, L.R.C.P., F.R.C.S.Ed. (Bombay), and
Harold Clifford, M.B.Lond. (Manchester), were declared
admitted.
The following gentlemen were elected Fellows of the
Society: Percy Cecil Parker Ingram, M.B., B.S.Lond.
(Newport, Mon.) ; and Herman Stedman, M.D.Cincinnati,
F.R.C.S.Ed.
The following gentleman was proposed for election :
Lewis Graham, B.S.Lond., M.R.C.S., L.R.C.P.
FIBROID OF UTERUS WITH A SARCOMATOUS
NODULE IN THE CENTRE.
By Dr. Amand Routh.
The specimen was removed on December 4th last,
from a lady, aged 52, who had had two children, the last
VOL. XLIX. I
2 FIBROID OF UTERUS WITH SARCOMATOUS NODULE.
sixteen years previously. Her September period was of
normal date and duration — five days. On October 3rd
hypogastric pain began, 'Mike labour pains/' but almost
continuous, starting at 6 p.m. and lasting for two hours.
These recurred every evening at the same time and lasted
for some hours. TNvice during the month slight haemor-
rhage occurred during the paroxysm of pain.
The October period lasted four days (October 16th to
20th), and was followed by increased pain, which still
recurred with absolute punctuality at 6 p.m., but lasted
three or four, or even six hours, and was uncontrolled by
drugs. She also began to lose large quantities of blood
from the uterus, large clots being passed. Her tempera-
ture never rose above 99° F.
I saw her at Newbury with Dr. Wyllie on November
1st, and found she had a fibroid uterus reaching two
inches above the pubes, and that there was much tender-
ness over the tumour on its left upper corner. Tliinking
it probable that there was a submucous fibroid or a fibroid
polypus present, I dilated up rapidly to admit my finger
but found nothing in utero. The fibroid was intra-mural,
and was mainly in the left side of the uterus.
All pain and haemorrhage ceased for four days after
the dilatation, but then the pain gradually returned. It
was found that morphia had no effect upon the severity of
the pain unless given hypodermically within the first few
minutes of the onset, which was invariably sudden, and it
was also noticed that the pains were now not so punctual,
but were postponed two or three hours beyond the twenty-
four, as if it took a longer time for the nervous energy to
accumulate.
The patient's friends were anxious to avoid hysterectomy,
so it was not till November 26th that Dr. Wyllie was
able to persuade the patient to come to a nursing home
in London. Then, curiously enough, the pains ceased for a
few days, and after a consultation with Dr. Cullingworth it
was decided to wait a week before operating. As, however,
the pains began again on the evening of the consultation.
FIBROID OP UTERUS WITH SARCOMATOUS NODULE. S
and as the patient was being worn ont by the pain and
the dread of its daily appearance, operation was agreed
upon, and supra- vaginal hysterectomy was performed on
December 4th.
On incising the fibroid after the operation, a nodule
of a soft, myeloid, homogeneous character was found in
the centre of the fibromyoma, clearly defined, apparently
not springing from the fibroid itself, but separately. Dr.
Cuthbert Lockyer, who assisted me at the operation, has
given me the following report on the specimen.
Dr. Cuthbert Lockyer's Report on Dr. Amand Eouth's
Specimen of Fibromyoma Uteri, showing Invasion
BY A Mixed-celled Sarcoma in which Multi-
nucleated GrIANT-OELLS PREDOMINATE.
The specimen consists of the body of the uterus and
the normal right appendages. The amputation of the
corpus uteri was made half an inch below the level of
the internal os. The organ measures four inches from
above down, and twelve inches in transverse circumference.
The increase in circumferential measurement is due to the
presence of an interstitial growth situated in the left
half of the uterine body. On incising 'the capsule of
uterine muscle which surrounded this growth, the former
retracted, and on cutting into the latter its surface became
convex after the manner of an ordinary fibroid. On its
cut surface, however, the growth showed two or three
circular areas of tissue totally devoid of the whorled
character of a fibroid. These areas presented a smooth,
homogeneous, glistening surface of greyish pink colour,
which appeared microscopically to be quite distinct from
the fibroid growth in which they lay embedded. Histologi-
cally, however, the demarcation is by no means definite. The
areas in question have all the characteristics of a mixed-
celled sarcoma, in which the most striking feature is the
presence of a large number of multinuclear cells, some of
4 FIBROID OF UTERUS WITH SARCOMATOUS NODULE.
which are round or oval in shape. These cells and other
malignant mesoblastic cells of smaller size and various
shapes trespass amongst^ and produce hyaline degeneration
of the fibro-muscular bundles^ and are also seen to lie
amongst the fully formed and thick-walled blood vessels of
the fibroid tumour. There is no attempt at encapsulation
of the malignant areas such as is sometimes seen when an
originally benign fibroid is invaded by a sarcoma of later
date.
There is no other growth in the wall of the uterus nor
on the mucosa, but the musculature of the organ is con-
siderably hypertrophied, the walls of the cavity being
uniformly one inch in thickness. The cavity itself is
abnormally capacious, but shows no sign of encroachment
by the tumour above described as situated in the left wall
of the uterus.
{Signed) Cuthbert Lockyer.
The specimen is of considerable interest as regards the
question of sarcoma developing in the substance of a
fibroid, but the case is also of interest from the remark-
able periodicity of the pain. Can the combined sym-
ptoms of rhythmic pain and hasmorrhage be at all diagnostic
of a malignant change occurring in a uterine fibro-
myoma ?
Dr. CuLLiNGWORTH Said that the questions raised by Dr.
Eouth's specimen were of such importance that if Dr. Routh and
Dr. Cuthbert Lockyer were willing he would suggest that the
specimen and sections be referred to the Pathology Committee for
consideration and report. The periodicity of the uterine pain
was remarkable ; personally, he had not met with a similar
experience.
Dr. Cuthbert Lockter welcomed Dr. Cvillmgworth's proposal
that the growth of the uterus shown by Dr. Koutli should be
submitted to the Pathology Committee. This was the more
necessary from the fact that Dr. Lockyer admitted that his
own report left the important question quite unanswered as to
how much of the tumom- is sarcomatous, and how far the
original fibroid is still benign. As already stated, on macro-
scopical investigation of the growth, at the time of operation,
there seemed to be no doubt that the sarcoma areas were definitely
FIBROID OF UTERUS WITH SARCOMATOUS NODULE. 5
limited and cii'cumscribed, wliilst examination of a single paraffin
section, prepared so as to include Avhat was taken to be the edge
of a sarcomatous patcli, proved that the adjacent fibro-myoma-
tous tissue was extensively invaded in a way undiscoverable by
unaided vision. Dr. Lockyer therefore undertook to cut further
sections from various parts of the fibroid, for the purpose of
deciding the important question whether or not the whole
ongmal fibroid had become the seat of secondary sarcomatous
change. That the initial tumour was a benign fibro-myoma-
tous growth seemed, in Dr. Lockyer's opinion, conclusively
proved, not only by its macroscopical characters— definite
encapsulation and convex section— but also by the presence of
definite fibro-muscular tissue and fully-fonued, thick-walled
blood-vessels seen in the microscopical section.
I%e specimen teas referred to the Pathology Comrtiittee
{see J). 45).
CHRONIC SEPTIC INFECTION OF THE UTERUS
AND ITS APPENDAGES.
By Archibald Donald, M.A., M.D., C.^f.,
aiNJ^COLOGICAL SURGEON TO THE MANCHESTER ROYAL INFIRMARY;
SURGEON TO ST. MARY's HOSPITAL, MANCHESTER.
(Received November 8th, 1906.)
{Abstract.)
The writer deals briefly with septic infection which involves
the uterine appendages as well as the uterus.
The cases in which the uterus is only involved are discussed
more fully. The clinical history and symptoms of these cases
are considered, and special attention is drawn to the discomfort
or pain which is felt in the hypogastrium or iliac regions, and
which is so characteristic of a heavy uterus.
In dealing with the pathology of chronic metritis, the great
divergencies of opinion as to the microscopic anatomy are noted.
The three main theories as to the cause of chronic metritis are
discussed, namely (I) passive congestion, (2) inflammatory
change, and (3) muscular hypertrophy.
Reasons are given why the mere alteration in position of a
healthy uterus is not likely to cause passive congestion and
chronic metritis, but it is pointed out that the treatment by
pessaries and suspension operations is founded on the assumption
that a displacement does cause these changes.
The parts played by connective tissue increase, and muscular
hypertrophy in the enlargement o^ the uterus are not as yet
definitely established and further investigations are desired.
The importance of considering the clinical history along with
the microscopic anatomy is insisted on. Four clinical types are
mentioned. The careful examination of the endometrium in
every case is also of the greatest importance.
The ti-eatment of chronic metritis is briefly considered.
INFECTION OP THE UTERUS AND ITS APPENDAGES. 7
A few introductory words to indicate tlie object and
scope of this paper will perhaps not be out of place.
In what follows I have tried to give a comprehensive,
though necessarily incomplete account of the progress and
results of certain inflammatory processes as they affect
the uterus, tubes, and ovaries. The subject is a large
one, but it seems best in the first instance to deal with it
in all its aspects, in order to avoid the purely regional
point of view. The changes produced in the uterus will
be considered more in detail.
There is no great diiference of opinion as to the clin-
ical history of chronic septic inflammation of the genital
tract, but the symptoms of the disease, especially in its
later stages, require more careful study. Good work has
been done on the pathology of chronic inflammation of
the tubes and ovaries ; but there are only a few scientific
observations on chronic inflammation of the uterus, and
we are bound to admit that many pathological points are
not yet definitely settled. Further, the failure of many
to grasp the important part that chronic uterine inflamma-
tion plays in gyngecological practice is responsible for much
in the way of treatment that is illogical and pernicious.
In dealing with the various kinds of cases, it will be
most convenient if we reverse the order in which the
infective process develops and take the more serious
cases first.
Cases in which the Inflammation Involves the Uteeine
Appendages.
The large majority of these cases begin with an acute
or subacute infection, but occasionally they are chronic
from the first. The illness generally dates from a con-
finement or an abortion, but in rare cases it may follow
some minor operation on the uterus, such as the use of
the sound. In acute infections, death may supervene
before pathological changes in the organs affected are
well marked. In the less acute infections, inflammation
8 INFECTION OF THE UTERUS AND ITS APPENDAGES.
is set up whicli spreads along the mucous surfaces and
penetrates into the tissues of the organs, and changes are
produced, which remain more or less permanent. The
process starts with an endometritis, then the mucous
membrane of the tube is affected, and this leads to a
localised peritonitis. The tubes and ovaries are thick-
ened, and may contain pus. But in the class of cases
under consideration there is merely obliteration of the
abdominal ostium of the tube, and adhesion of the tube to
the ovary. The inflammation of the pelvic peritoneum
results in adhesions ; the ovaries and tubes may be
bound together, and there may be more or less intimate
matting of these organs with intestines, omentum and
peritoneum.
The physical signs in the later stages generally consist
of a thickening, more or less definite, at the sides of the
uterus or in the pouch of Douglas. Sometimes the uterus
is bound down by adhesions, and in this way a displace-
ment is produced. The kind of displacement depends on
the part of the uterus involved. Adherent retroversion
is produced when the fundus is bound down posteriorly ;
pathological anteversion when the lower portion of the
uterus is pulled back ; and anteflexion is caused by the
contraction of adhesions which draw the middle portion of
the uterus backwards while the fundus and cervix are
free.
The symptoms in cases of this sort, when they have
passed into the chronic stage, are mainly caused by the
condition of the tubes and ovaries. As a rule the
general health is much affected. The patient is easily
tired, backache is common and also dysmenorrhcea, and
there is sterility. In the earlier stages, there may be
monorrhagia or irregular and frequent menstruation, but,
later on, the periods may become scanty. There is often
a marked change in the shape of the abdomen. The
patient complains of having lost her figure, and the abdo-
men feels and looks distended, and the muscles are rigid.
INFECTION OF THE UTERUS AND ITS APPENDAGES. 9
Cases in which the Uterus is chiefly involved-
Chronic Metritis and Endometritis.
The affection may, in tlie first instance, be acute or
sub-acute, and gradually become chronic. The uterus
may be involved in an inflammation which spreads to
the tubes and ovaries, and the inflammation in the appen-
dages may clear up, leaving the uterus alone obviously
affected. But in the majority of the cases the infection
does not travel as far as the tubes, whilst it affects
(directly or indirectly) the whole of the uterine tissue.
The mischief is mainly uterine from the first and there is
never any acute stage. It is to this class of case that I
wish particularly to direct attention.
Clinical history and symptoms. — The trouble nearly
always dates from a confinement or miscarriage, and the
history is generally as follows :
After the miscarriage or confinement the patient makes
a recovery, which may be classified as good, if careful
observations of temperature and pulse are not made. But,
if the chart is kept strictly, variations from the normal, both
in pulse and temperature, will show that convalescence has
not run an ideal course. Whether these deviations from
the normal are due to the same organisms which cause the
more acute cases, but in smaller dosage, or whether they
are due to some less noxious germs, is doubtful ; but it is
certain that cases of what may be called "slight" or
'' less severe " sepsis are not unconnnon.
As long as the patient is in bed she feels fairly well.
It is only when she begins to move about that the sym-
ptoms show themselves. She then finds that she is easily
tired, and she generally complains of pain, or it may
be only of dragging or discomfort in the hypogastrium,
or in one or both iliac regions. There is generally
some leucorrhoea in the earlier stages, and when the
periods are established they are apt to be profuse or
long-continued. The loAver part of the abdomen is some-
times distended. If the patient should become pregnant
10 INFECTION OF THE UTERUS AND ITS APPENDAGES.
again there is liability to miscarriage, and if this happens
the diseased condition is almost certain to be aggravated.
In the later stages the pain or dragging sensation in the
iliac regions is common^ and is aggravated by standing or
walking. Leucorrhoea may persist for a long period, but
this is exceptional. Sometimes haemorrhage becomes a
prominent symptom, and this is especially the case in
women over forty years of age. The hasmorrhage may be
so profuse as to seriously affect the patient^s general
health and even endanger her life.
There is one symptom to which I should like to draw
special attention, namely, the pain in the iliac region.
Pain or dragging in the iliac region is one of the
commonest symptoms in gynaecological practice, and in
my opinion is, in the large majority of cases, caused by a
heavy uterus. It is usually, but I think erroneously,
classified as ovarian. If the bulk of the uterus is greatly
increased the uterine body will fall, either forwards or
backwards, to a lower level in the pelvis than normal.
This is bound to cause a pull or strain on the broad and
round ligaments, and this pull or strain will be communicated
to the side and front of the pelvis. Those who practise
Alexander's operation rely on the round ligaments to pull
the uterus up and keep it in a position of anteversion.
It is reasonable to suppose that a heavy fundus, whether
anteverted or retroverted, will pull on the round ligaments
at their insertion in the abdominal wall. In cases of
pelvic peritonitis — where the ovaries are involved in the
inflammation — the most characteristic pain is in the back
and not in front. But although in very pronounced
retroversion or retroflexion the patient may complain of a
feeling of pressure on the rectum or perineum, the iliac
pain is much more common. It is customary, however,
to refer pain in the iliac region in women to ovarian
troubles, except in cases in which the appendix is thought
to be at fault. In the discussion on this pain, which took
place at the meeting of the British Medical Association
in 1904, the uterus was hardly mentioned and the con-
INFECTION OF THE UTEEUS AND ITS APPENDAGES. 1 1
elusion is justified that the part played by the uterus in
the production of this pain has been, to a great extent,
overlooked. And yet it is the most constant symptom of
a heavy uterus, whether that organ is retroverted or
anteverted, as anyone may easily satisfy himself by the
systematic interrogation of patients. It is aggravated or
brought on by standing, and is generally most marked
just before or at the onset of menstruation.
Physical signs. — The one thing common to all these
cases is enlargement of the body of the uterus. In some
cases the cervix is lacerated and hypertrophied, or is
thickened without obvious laceration, or shows an erosion.
On bimanual examination the body of the uterus is found
distinctly and symmetrically enlarged, and is tender to
pressure. There is either retroversion or exaggerated
anteversion, or if the isthmus of the uterus is unduly
pliant, anteflexion or retroflexion is found. The appen-
dages may be dragged down by the heavy fundus and
are then easily felt, but are not thickened or adherent.
Pathological appearances and etiology. — Within recent
years the operation of vaginal hysterectomy has been
occasionally performed in cases of chronic metritis, and a
study of the uteri thus obtained has widened our know-
ledge of the subject. In its naked-eye appearances the
chronic metritic uterus differs widely from a normal
uterus. In well-marked specimens the uterus weighs
about three times as much as the normal uterus, its walls
are about twice as thick, and there is great increase in all
the dimensions. When divided the cut surface of uterine
tissue bulges as if it had been under strain. In nearly
every case the endometrium is considerably increased in
thickness. There is no difference of opinion on these
points amongst those who have been working on the
subject, except as to the endometrium. Theilhaber
believes that thickening of the endometrium is exceptional
in chronic metritis — but Shaw, who carefull}^ examined a
much larger number of specimens, found definite thicken-
ing of the mucosa in nearly every case.
12 INFECTION OF THE UTERUS AND ITS AITENDAGES.
When we come to microscopic changes, the divergence
of opinion in more marked. Some Avriters state that
the most characteristic changes in chronic metritis are
to be found in the blood-vessels ; others think that the
connective tissue is most affected ; while others regard
the condition as primarily due to an increase in the
muscular element. The fullest account of the micro-
scopic changes in chronic metritis, and tlic one which is
based on the most copious material and careful investi-
gation, is to bo found in the paper by Dr. W. F. Shaw,
to which I would refer the members of this Society. I
may, however, mention briefly a few of Dr. Shaw's
conclusions.
He attributes the increased thickness of the uterine
walls to overgrowth of both muscle and cellular tissue —
which, in his view, are increased almost equally, but with
a very slight excess of connective tissue. He finds no
constant changes in the vessels. The endometrium was
definitely thickened in every one of twenty-five cases in
which it could be measured, with two exceptions, both of
which are easily explained.
There are three main theories as to the causation of
chronic metritis. It has been regarded as due to (1)
passive congestion ; (2) inflammatory change ; and (3)
muscular hypertrophy.
The theory of jiassive congestion as a cause of chronic
metritis may be stated thus : Under certain circum-
stances the venous circulation in the uterus is obstructed,
and this obstruction leads to dilatation of capillaries and
blood-vessels, and possibly to certain changes in the walls
of these blood-vessels. An infiltration of small cells
occurs in the neighbourhood of the vessels, and this
passes into cellular tissue so that a permanent enlarge-
ment of the uterus is thus produced.
When we come to inquire into the conditions which are
supposed to lead to this passive congestion, we find that
we are practically limited to backward displacement of
the uterus. Other conditions, such as pelvic tumours,
INFECTION OP THE UTERUS AND ITS APPENDAGES. 13
may, theoretically, cause chronic congestion of the uterus,
but the uterine condition is then only of secondary
importance. In certain cases of chronic metritis we find
the uterus in a position of retroversion or retroflexion, and
it is believed by some that these positions cause passive
congestion, which, in turn, leads to permanent changes in
the tissues of the uterus. Even if this were true it would
not account for the larger number of cases of chronic
metritis in which the uterus is anteverted, as this, the
normal position, even when exaggerated, cannot cause
obstruction to the free blood return from the uterus. But
there are reasons for believing that a mere alteration in
the position of a healthy uterus does not cause passive
congestion. The arrangement of the circulation of the
uterus, as was pointed out by Sir John Williams* many
years ago, make it exceedingly improbable that this
should occur. Then, the uterus is not always enlarged in
cases even of very marked displacement ; there may be
very pronounced and long-standing prolapse of a uterus
which is normal in size, if we except the tensile elongation
of the supra-vaginal cervix, and yet this is the case of all
others in which we would expect the blood return to be
hampered owing to the stretching of the vessels. We
find also, now and again, a uterus which has been for a
long time in a position of retroversion' and which is yet
not enlarged. Finally, if passive congestion is the cause
of chronic metritis, we should expect to find some well-
marked and characteristic changes in the blood-vessels of
uteri which had long been retroverted and were enlarged.
No such changes, however, have been proved to exist. On
the other hand. Dr. Shaw's sections show that the changes
in the vessels are variable, and do not support any such
hypothesis. The results of treatment give us another
argument against the passive congestion theory, but this
will be referred to when the treatment of chronic metritis
is discussed.
In spite of all this the theory of passive congestion has
* ' Obstet. Soc. Trans.' London, vol. xxvii foi" 1885, pp. 112-117.
14 INFECTION OF THE UTERUS AND ITS APPENDAGES.
been widely, but for the most part tacitly, adopted, and
forms the basis of most of the treatment by pessaries and
fixation operations.
There are writers who believe that the changes found
in some cases of chronic metritis are to be found chiefly
in the blood-vessels, apart from passive congestion, but as
I have stated, this cannot be accepted as a constant, or
even as a common change.
When we come to consider the remaining theories — the
theory of connective- tissue inflammation, and the theory of
muscular hypertrophy — we have to admit that at present
the position is not absolutely clear. Both theories are
a priori possible, and each has been supported by obser-
vation. According to the one, the change is to be
regarded as purely inflammatory ; according to the other
it is, in part at least, in the nature of a true hypertrophy.
This '' working hypertrophy " may be produced by an
increase in thickness of the uterine mucosa or by an
increase in the amount of connective tissue between the
muscle bundles. I believe that most cases of chronic
metritis, if carefully examined, will show both hypertrophy
of muscular tissue and increase of connective tissue.
It seems difficult to explain the divergent views of those
who have written on the pathology of chronic metritis,
as, at first sight, it seems that the question ought to be
definitely settled by the careful study of microscopic
sections. It may be that the cases from which specimens
have been obtained differ widely in their clinical history ;
and that those who hold exclusively to the connective-
tissue theory have only examined specimens which
have been obtained from uteri which have at some time
been the seat of a very acute inflammation, or in which
senile change is advanced. At the present time the
microscopic anatomy must be regarded as "sub judice." I
would suggest that in further investigations the clinical
history of each case should be carefully considered. The
neglect of this can only lead to confusion. The term
"metritis" may be a misnomer for some of the cases
INFECTION OF THE UTERUS AND ITS APPENDAGES. 15
which are grouped under this title. An investigation
into the pathology of the usual form of chronic metritis —
that is, the type in which the uterus is enlarged and the
symptoms have never been acute — is not made easier by
including cases in which there has been acute inflamma-
tion after labour, or with cases which have had a hisrh
temperature and a sharp illness after curetting, or with
cases of so-called climacteric hgemorrhage. Further, it is
highly important that the whole thickness of the body of
the uterus should be most carefully examined, and not
merely one portion. Four types of case may be dis-
tinguished clinically^ at present : 1 and 2. The two types
dealt with in this paper — i. e. those which date from a
confinement or abortion, and are either simple or compli-
cated by inflammation of the appendages. 3. The uterus
which bleeds profusely at the climacteric (this may ulti-
mately prove to belong to one of the former categories).
4. Uniform enlargement of the virginal uterus, in which
the usual sources of infection can be excluded.
Another point that calls for careful investigation in these
cases of chronic metritis is the condition of the endome-
trium. At present Ave are rather in the dark as to the
relative importance of the changes in the endometrium
and those in the mesometrium in the production of
symptoms. This is especially so in cases of profuse and
intractable haemorrhage. The theory which is involved
in the word " fibrosis," and which assumes that the
muscular tissue of the uterus is replaced by a fibrous
tissue, and that the hsemorrhage is due to want of muscular
control, is an attractive hypothesis, but it has yet to be
proved.
The diagnosis of chronic metritis is arrived at through
the clinical history and the physical signs. The one point
which I wish to emphasise here is that chronic metritis
in different stages and in varying degree is probably the
most common of all the minor gynaecological ailments.
Treatment. — If the opinions which I have expressed
as to the pathology of chronic metritis are correct, it
16 INFECTION OP THE UTERUS AND ITS APPENDAGES.
follows that all attempts to cure the condition by a mere
alteration of the position of the uterus are quite illogical.
The use of pessaries and the slinging up of the uterus by
means of operation in cases of backward displacement of
a mobile uterus is a tacit acceptance of the passive con-
gestion theory. Some who use pessaries for such cases
admit that they do not hope in this way to cure the
patient, but merely to palliate her troubles. My own
view on this point is that even where relief appears to
follow it is merely a kind of faith-healing, and that the
use of pessaries for backward displacement eventually
causes more discomfort than relief.
Others believe, however, that the maintenance of the
uterus in what they call the " proper " position brings
about a cure. The mere hanging up of the uterus by a
round ligament or fixation operation can never cause a
reduction in its size, even if it succeeds in diminishing or
altering the dragging symptoms.
The backward disjilacement of an otherwise healthy
and normal uterus produces no symptoms of any conse-
quence, and neither pessaries nor operations are required.
When the uterus is enlarged by chronic metritis the
result to be aimed at in the treatment is the reduction of
the weight of the uterus, and the cure of the tenderness —
haemorrhage, leucorrhcea, and dysmenorrhoea, if these are
present.
The means at our disposal are comparatively few.
Something can be done in the early stages by palliative
treatment ; rest in bed, frequent vaginal douching with
hot water, tonics — such as iron and strychnine — and care-
ful attention to the bowels. The only time at which
these measures are likely to be of lasting benefit is soon
after the trouble has begun. It must, however, be
remembered that in many cases the departure from the
normal is comparatively slight, and that no further treat-
ment is advisable beyond the occasional employment of
palliative measures.
In cases where we find marked enlargement of the
INFECTION OF THE UTERUS AND ITS APPENDAGES. 17
uterus, witli typical symptoms, curetting should be done.
The statement that is often seen in books, that curetting
is followed by a decrease in size of the uterus in cases of
chronic metritis, is by no means a flight of imagination.
I have accurately noted it in my own cases, and Dr.
Shaw's investigations have definitely proved that it occurs
in a large percentage. Accurate measurement is possible
only with the cavity, but careful bimanual estimation
leaves no doubt in my mind that the whole uterus is
generally diminished. The result of this reduction in
size is often to allow the retroverted uterus to return to
the normal position, but even when this does not happen
the tenderness and dragging are removed.
It is important that the operation should be carried out
with the most rigid asepsis. My own practice is to dilate,
under an anaesthetic, with finely graduated metal dilators,
to use a flushing curette, and to pack the uterine cavity
with sterilised gauze for twenty-four hours. If there is
cervical hypertrophy a wedge should be removed from
each lip of the cervix, and if there is a tendency to pro-
lapse of the vaginal walls a plastic operation on the
posterior wall adds afterwards to the patient's comfort.
It sometimes happens that a single curetting is not
sufficient, and that the operation has to be repeated before
a good result is obtained. In rare cases repeated curet-
tings fail to relieve the symptoms. Whether this is due
to a further production of diseased endometrium from the
remains of the old, or whether it is to be explained by
the condition of the mesometrium, is uncertain. My
experience leads me to favour the former view, and the
fact that these failures after curetting are comparatively
rare points to its being the correct explanation.
For really bad cases, in which there is prolonged
haemorrhage, which repeated curettings have failed to
cure, there is general agreement that vaginal hysterectomy
is justifiable.
For my part I think the operation ought to be extended
to some cases in which haemorrhage is not a very impor-
VOL. XLIX. 2
18 INFECTION OP THE UTERUS AND ITS APPENDAGES.
tant feature. There are a good many women whose
lives are rendered miserable by chronic metritis at a time
when they ought to be most active. If, in a case of this
sort, the uterus is found to be much enlarged and very
hard, and everything points to its being functionally use-
less, and no improvement is brought about by repeated
curetting, it ought to be removed. Owing to improve-
ments in technique the operation involves very little risk,
immediate or remote.
Dr. CuLLiNGWORTH suggested that Dr. Shaw's paper should
be read, and that the discussion on Dr. Donald's paper should
be postponed until the two commuuications, which were ou
closely i-elated subjects, could be considered together.
19
THE PATHOLOGY OF CHRONIC METRITIS.
By William Fletcher Shaw, M.D., Ch.B.,
HOUSE SURGEON AND RESIDENT OBSTETRICAL ASSISTANT SURGEON
ST. mart's HOSPITAL, MANCHESTER.
(Received November 9th, 1906.)
(Abstract.)
The conclusions arrived at in this paper are the result of the
examination of forty.five uteri extirpated for chronic metritis,
thirty-eight being uncomplicated cases, while seven occurred
with some concurrent pathological condition. For the purpose
of comparison twenty-three normal uteri were also examined.
Chronic metritis is a simple hypertrophy of the mesometrium
and is not a connective-tissue hyperplasia.
The percentage of connective tissue varies considerably in the
different specimens of chronic metritis, but many normal multi-
parous uteri possess an equal or even greater proportion of con-
nective tissue; the average amount in the 'specimens of chronic
metritis was only 0-8 per cent, higher than the average amount
in the normal parous uteri.
The vessel changes are variable, and, as similar affections are
as frequently found in normal uteri, they cannot be considered
as the cause of the symptoms.
Except two cases, which could be easily explained, every
specimen of uncomplicated chronic metritis also suffered from
chronic endometritis.
There is no evidence of active inflammation, as shown by
small-celled infiltration or cicatricial tissue.
Chronic metritis is a slowly progressing affection of the
uterus. It is never a primary affection, being usual secondary
to chronic endometritis, but may be associated with any pelvic
20 PATHOLOGY OF CHRONIC MISTRITIS.
oi" uterine disease leading to increased uterine contraction or
vascularity, viz. fibroids, tubo-ovarian disease, etc.
Chronic metritis occurs at a mucli earlier age than the meno-
pause, and thus proves that the climacterium is not the causal
factor.
In the early stage chronic metritis is indistinguishable clinic-
ally from chronic endometritis. At a later period the great
increase in size of the uterus may produce symptoms, i. e.
sacralgia and aching pain in the hypogastrium and iliac regions,
due to traction on the broad ligament.
The diagnosis of chronic metritis is largely dependent on the
result of treatment. In the early stage of the affection all the
symptoms disappear after dilatation and curettage of the
uterus, thus demonstrating that the endometritis is the primary
cause.
In chronic metritis and chronic endometritis local treatment
of the endometrium may fail to relieve the symptoms. This is
probably due to re-inauguration of the endometritis.
So-called " chronic metritis " is a subject which has
been clinically recognised, and of which much has been
written from early times, but it is only comparatively
recently that its pathology has been discussed on anything
like a scientific basis. However, in the vast amount of
literature on this subject there are hardly two authors who
agree as to its causation and its pathology. The reason
for these various views probably lies in the fact that only
in very recent years have uteri been extirpated for chronic
metritis, as the older writers argued from 'post-mortem uteri,
which had the same characteristics as those clinically dia-
gnosed as chronic metritis, viz. enlargement and increased
hardness, but which had often, probably, never given rise to
any symptoms during life. Even since these uteri were
extirpated the views of modern gynaecologists seem as
much at variance as those of the older writers, the most
likely -explanation being that all the writers, except
Lorentz and Theilhaber, were recording the results of
only a very small number of such uteri.
PATHOLOGY OF CHRONIC METRITIS. 21
In this paper I give tlie results of the microscopical
examination of thirty-eight uteri extirpated for chronic
metritis alone, and also seven extirpated for chronic
metritis along with some other concurrent disease ; three
had carcinoma of the cervix, two had intra-mural fibroids,
one had a tubo-ovarian abscess and one double ovarian
disease. For comparison with these I also examined twenty-
three normal uteri of various ages and the endometrium
removed by curettage in fifty cases of endometritis, the
chief object of the latter being a comparison of their
clinical histories with those of the chronic metritic uteri.
For the use of specimens I have to thank Dr. Lloyd
Roberts, Sir William Japp Sinclair, Dr. Walter, Dr. Donald,
Dr. Walls, and Dr. Arnold Lea. In the following para-
graphs dealing with changes in the blood-vessels, endome-
trium, and connective tissue, the figures are derived solely
from the thirty-eight cases of uncomplicated chronic
metritis.
Pieces were taken from several portions of each uterus
and sections cut in paraffin, so that each one included the
whole thickness of the uterine wall from peritoneum to
mucous membrane. These sections were stained with
" Yan Gieson " as being the best differential stain for
muscular and connective tissue, the connective tissue
being bright red and the muscular tissue deep yellow.
Although differing on many minor points, most authors
consider the pathology of chronic metritis to fall into one
of two groups :
(1) Changes in the vessels ;
(2) Increase of connective tissue.
(1) Changes in the Blood-vessels.
Several of the older writers considered the bleeding of
chronic metritis to be due to changes in the vessel-walls,
which they described as atheroma. Reinecke, in 1896,
and Findley, in 1905, each published four cases in which
22 PATHOLOGY OP CHRONIC METRITIS.
they considered tlie haemorrhage to be due to arterio-
sclerosis, the thickening being chiefly in the tunica media.
Theilhaber found the vessels markedly increased in all
his specimens and the walls generally thickened, but he
does not attach much importance to this.
I have investigated the condition of the blood-vessels
in the thirty-eight cases of chronic metritis, and compared
their appearance with those of normal uteri at various
ages, with the following results :
Vessels not altered . . . .15
A few vessels enlarged but walls not
thickened ..... 2
Vessels decreased in number ... 6
Vessels increased in number ... 4
A few vessels with thick tunica media
containing fibrous tissue . . . 6
A few vessels undergoing hyaline or colloid
degeneration ..... 4
A combination of the last two . . 1
38
In twenty-one — that is, 55 per cent., the vessels were
not increased in number, nor were any changes observed
in the vessel walls, but in the histories of these twenty-
one hajmorrhage was of quite as frequent occurrence as
in the other seventeen. In six instances some of the
larger arteries showed great increase in thickness of the
tunica media, the result of fibrous deposit. This is the
pathological condition to which Reinecke, Findley, etc.,
ascribe the hasmorrhage of chronic metritis. In this I
cannot agree, as I only found it occurring in a few vessels
in six specimens out of thirty-eight examined. More-
over, of these six specimens, three (Nos. 4, 10, and 18)
had no excessive haemorrhage (see PI. II, fig. 4), and I also
found this change in the vessels of many multiparous
normal uteri (see PL III, fig. 5) . In five instances the arteries
showed a homogeneous degeneration affecting the media
and adventitia. This area stained bright red with eosin.
DESCRIPTION OF PLATE I,
Illustrating Dr. Wm. Fletcher Shaw's paper on the
Pathology of Chronic Metritis.
Fio. 1. — Group of vessels from virgin iiteru8 (Case No. 37). Stained
with van Gieson.
These vessels have large lamina and narrow walls, and are surrounded
by a fair amount of connective tissue (shown black in the figure).
Outside the vessels are seen muscle bundles, with strands of connective
tissue running around the bundles and also around the individual
muscle-fibres.
This uterus was obtained from a virgin, aged 18, who died as the
result of an accident.
Fio. 2. — From Case No. 6. Stained with van Gieson.
This is the type of vessel which made some authors ascribe the bleed-
ing of chronic metritis to vessel-changes. The lumen is narrow and
the walls greatly thickened, this great increase in thickness occurring
chiefly in the tunica media and being due to a deposit of fibrous tissue,
which shows black in the photogi'aph and gives this coat its speckled
appearance. If looked at carefully a faint line of demarcation can be
seen between the narrow tunica intima and the thick tunica media. In
the section of this uterus only two vessels were thickened like this
figure, all the remainder being fairly normal, as represented in Fig. 3.
Plate I.
Obstet. Soc. Trans., Vol. XLIX.
Fig. I.
Fig 2.
Illustrating Dr. W'm. Fletcher Shaw's paper on the Pathology of Chronic Metritis.
Adlard cr> Son, Inipr.
DESCRIPTION OF PLATE II,
Illustrating Dr. Wm. Fletcher Shaw's paper on the
Pathology of Chronic Metritis.
Fig. 3. — Group of normal vessels from the same section as Fig. 2
(Case No. 6). Stained with van Gieson.
These vessels are fairly normal and correspond closely with the
vessels from a virgin uterus (Fig. 1).
Fig. 4. — Vessel showing thick tunica media due to deposit of fibrous
tissue. From Case No. 18; a uterus which had no abnormal bleeding.
Stained with haematoxylin and eosin.
Plate II.
Obstet. Soc. Trans., Vol. XLIX.
Fig. 3.
Fig. 4.
Illustrating Dr. Wm. Fletcher Sh.wv's paper on the Pathology of Chronic Metritis.
Aiilard & Son, hnpr.
DESCRIPTION OF PLATE III,
Illustrating Dr. Wm. Fletcher Shaw's paper on the
Pathology of Chronic Metritis.
Fig. 5. — Vessels showing thick tunica media due to deposit of fibrous
tissue. From a normal multiparous uterus of a woman, aged 26, with
no uterine symptoms. Stained with van Gieson.
Fia. 6. — A vessel from Case No. 7, which shows hyaline or colloid
degeneration. Stained with van Gieson.
The lumen of the vessel is narrow and is surrounded by a narrow zone
of dark, normal tissue ; the remainder of the wall is replaced by a pale,
homogeneous material. Outside the vessel wall normal, deeply-stained
mesometrium can be seen.
Plate III.
Obstet. Soc. Trans., Vol. XLIX.
Fig. 5.
Fig. 6.
Illustrating Dr. W.m. Fletcher Sh.wv's
s paper on the Pathology of Chronic Metritis.
Adlard Sf Son, Impr.
PATHOLOGY OP CHRONIC METRITIS. 23
and pale yellow with "Van Gieson/' The exact nature
of this change is not clear, but is either a hyaline or
colloid degeneration — probably colloid, as it stains a pale
yellow with "Van Gieson ^^ (see PI. Ill, fig. 6). I cannot,
however, ascribe the abnormal bleeding of chronic
metritis to this change, as three (Nos. 14, 15, and 18) of
these five specimens had no abnormal bleeding.
Anspach and Macgregor are the only authors I can find
who mention this change. Anspach described it as a peri-
arterial degeneration, which commences in the adventitia,
and finally leads to comj)lete obliteration of the vessel.
He does not name this degeneration, but states that it is
a " hyaline coloured material " when stained with eosin,
and bright yellow when stained with " Van Gieson."
Macgregor finds it in the vessels of the endometrium in
uteri which show this degeneration in the vessels of the
mesometrium. In none of my five specimens could I find
a trace of it in the vessels of the endometrium.
From these results it seems clear that the hasmorrhas-e
of chronic metritis does not depend upon changes in the
vessel-walls of the mesometrium.
The seven uteri extirpated for chronic metritis with
some concurrent disease also showed little vessel change ;
in five of them the vessels were not altered, in one the
number of vessels was increased but there were no other
changes, while only one possessed vessels with thickened
tunica media due to deposit of fibrous tissue.
(2) Changes in the Relative Amounts op Connective
Tissue and Muscular Tissue.
The most generally accepted view of the pathology of
chronic metritis is that a great increase of connective
tissue has taken place. Theilhaber considers that, not
only has the amount of connective tissue greatly increased,
but the amount of muscular tissue has actually decreased ;
this he believes to occur normally as the menopause is
24 PATHOLOGY OF CHRONIC METRITIS.
reached, and tlie excessive bleeding then commences owing
to the loss of muscular control over the vessels unless
these have proportionately contracted.
The method of estimating the amounts of connective
and muscular tissues was as follows, and was similar to
that employed by Meier, although I liad been using it
some time before I read his original paper.
The slide was put on a mechanical stage, under the
'' high power " of a microscope, and consecutive fields
estimated through the whole length of the section, from
peritoneum to endometrium. As these uteri were so thick
this generally meant forty to fifty calculations for each
section. The mean of these estimates was taken as a
fairly average estimation of that section. Each section
was calculated two to three times, and the mean of these
calculations taken as the final estimate for that section.
Finally, if more than one piece had been cut from a
uterus, the average of the results of the various sections
was taken as the estimation for the uterus. In the later
cases I only examined one piece, as I found very little
difference in the several areas from the same uterus.
Many of these calculations were made at intervals of
several months, but, with few exceptions, the estimates
for each section showed less than 5 per cent, of difference,
and very often less than 1 per cent, difference. In
estimating a section I carefully avoided seeing the former
results of that section, otherwise it would have been
almost impossible not to have been influenced by the
previous figures. The measurements of the thicknesses of
the uterine wall were made by means of a mechanical
stage on a microscope.
Forty-five uteri with chronic metritis were examined in
this way, and also, for the sake of comparison, twenty -
three uteri obtained post mortem from women of various
ages, who had not complained of any uterine symptoms
during life. Amongst these I was fortunate enough to
obtain the uterus of a virgin, aged 18, who had died
rapidly from the result of an injury to the head.
DESCRIPTION OF PLATE IV,
Illustrating Dr. Wm. Fletcher Shaw's paper on the
Pathology of Chronic Metritis.
Fm. 7. — The connective tissue seen as dense, darkly-staining strands
between the muscle bundles ; very little between the muscle fibres.
Fia. 8. — The connective tissue occurs as dense, darkly-staining strands
between the muscle bundles, and also as finer strands between the
muscle fibres.
Plate IV.
Obstet. Soc. Trans., Vol. XLIX.
Fig. 7.
Fig. 8.
Illustrating Dr. Wm. Fletcher Shaw's paper on the Pathology of Chronic Metritis.
Aillaril £^ Son, Impr.
DESCRIPTION OF PLATE Y,
Illustrating Dr. Wm. Fletcher vShaw's paper on the
Pathology of Chronic Metritis.
Fig. 9. — The connective tissue is a loose meshwork between the
muscle bundles; there is little connective tissue betrween the muscle
fibres.
Fig. 10. — The connective tissue occurs as a loose meshwork between
both the muscle bundles and the muscle fibres.
Plate V
Obstet. Soc. Trans., Vol. XLIX.
Fig. 9.
Fig. 10.
Illustrating Dr. Wm. Fletcher Sh.wv's paper on the Pathology of Chronic Metritis.
Aiilaid 8f Sor, Impr.
DESCRIPTION OF PLATE VI,
Illustrating Dr. Win. Fletcher Shaw's paper on the
Pathology of Chronic Metritis.
Fig. 11. — Section of endometrium from Case No. 33. The glands are
enlarged and increased in number, the total thickness of the endo-
metrium being much increased (compare with Fig. 12).
Fig. 12. — This shows the endometrium and part of the mesometrium
from a normal primiparous uterus, aged 32. This photograph is taken
with the same magnification as Fig. 11, and shows how much the endo-
metrium is thickened in cases of chronic metritis.
Plate VI.
Obstet. Soc. Trans., Vol. XLIX.
Fig. II.
F"lG. 12.
Illustrating Dr. \Vm. Fletcher Sh.wv's paper on the Pathology of Chronic Metritis.
Adlard &" Son, Impr.
PATHOLOGy OP CHRONrC METRITIS. 25
Meier has thoroughly worked out the musculature of
the normal uterus in a series of sixtj'^-one uteri, taken at
various ages, and has arranged them in a series of curves,
showing the percentage of connective and muscular tissues
at various ages. His first curve, containing all his uteri,
shows an3^thing but a regular gradation; his last, after
eliminating those which are least likely to be normal, i. e.
puerperal uteri, and those of women who have suffered
from wasting diseases, shows a regular increase of muscular
tissue from childhood to about twenty years of age. For
the next ten years the proportion of muscular tissue
to connective tissue remains constant. After thirty years of
age the muscular tissue progressively decreases in quantity
until old age is reached.
I have not been able to obtain sufficient adult normal
uteri to arrange in a curve, but our results for corre-
sponding uteri are sufficiently close to show that our
methods of calculating give very nearly the ti'ue propor-
tion of muscular and connective tissue.
Meier divides his specimens into eight types, according
to the arrangement of the connective tissue and muscle
fibres. These groups can all be recognised in my sections
if carefully looked for, but for practical purposes I believe
that a division into four well-defined groups is all that is
requisite :
(1) The connective tissue occurs as dense, darldy -stain-
ing strands between the muscle bundles ; there is very
little between the muscle fibres (see PL IV, fig. 7).
(2) The connective tissue occurs as dense, darkly-stain-
ing strands between the muscle bundles, but, unlike
Group 1, it also occurs in finer strands between the
muscle fibres (see PI. IV, fig. 8).
(3) The connective tissue is a loose meshicorh between
the muscle bundles, little connective tissue being present
between the muscle fibres (see PI. V, fig. 9).
(4) The connective tissue occurs as a loose meshworh
between both the muscle bundles and the muscle fibres
(see PI. V, fig. 10).
26 PATHOLOGY OF CHRONIC METRITIS.
The connective tissue is never equally distributed
through the uterine wall ; hence a section of one part
must not be taken as indicating the proportion existing
throughout the uterus. Thus, the inner third of the
uterine wall almost invariably shows a relatively small pro-
portion of connective tissue to muscle.
Lorentz has thoroughly examined nine uteri, extirpated
on account of excessive haemorrhage and with the diag-
nosis of chronic endometritis or chronic metritis. He
describes the chief pathological changes as (1) a general
increase in the size of the uterus ; (2) increase in density
of the uterus ; (3) great increase of connective tissue ; (4)
thickening of the vessel walls. He usually finds no
changes in the endometrium.
In the forty-five uteri examined by me I found the
uterus showed general enlargement, the result of hyper-
trophy of both muscular and connective-tissue elements in
the uterine wall. In a few cases only did the vessels
show marked changes. In every instance endometritis,
as shown by increased thickness of endometrium, was
present in the thirty-eight specimens of uncomplicated
chronic metritis.
Theilhaber has maintained that the characteristic
changes of chronic metritis are — a great increase of con-
nective tissue and diminished amount of muscular tissue.
He bases this opinion on the results of observations by
Meier for normal uteri, and Lorentz for uteri with chronic
metritis. My observations do not confirm this view. The
increase in size is due to a general hypertrophy of both
elements, and there is certainly no diminution in the
amount of muscular tissue.
Lorentz, in chronic metritis, places the proportion of
connective tissue at 45 per cent, to 60 per cent., average
at o0"5 per cent. My results in similar specimens varied
from 32'5 per cent, to 50 per cent., average 40*4 per cent.
In the normal uteri of parous women, Meier places the
proportion of connective tissue at 46"5 per cent., and my
own observations show a ratio of 39 "4 per cent.
PATHOLOGY OF CHRONIC METRITIS. 27
It is thus clear tliat the difference between the pro-
portion of connective tissue in normal uteri and in chronic
metritis is too slight, amounting only to 4 per cent, in
Meier and Lorentz's cases and 0*8 in mine, to account for
the great increase in thickness of the uterine wall.
Increase in size and thickness of the uterine wall is a
constant feature of chronic metritis. The dimensions of a
normal uterus may be stated as follows (Quain) : length
7'5 cm., breadth 5 cm., thickness 2'5 cm.
All my chronic metritic uteri had much thickened walls,
the least being 12 mm., the greatest 26 mm., and the
average 18'1 mm. ; while the average thickness of the
walls of the normal uteri was only 8"7 mm. These figures
were obtained after the sections were mounted, and are
therefore below the correct measurement, owing to the
shrinking of the tissues in preparation ; but as most of
the uteri were prepared in the same way the difference
between the average thicknesses of their walls will be
about correct, or will err on the side of being too small.
Now the chronic metritic uteri only show, on the average,
an increase of 0*8 per cent, (in Meier's case 4 per cent.) of
connective tissue above the normal uteri, but their walls
are, on the average, more than 100 per cent, thicker than
those of the normal uteri. To say that this great increase
in bulk is due entirely to increase of connective tissue,
and that the musculature is actually lessened in amount,
would be obviously incorrect. What has really taken
place is a general hypertrophy of the whole uterine wall,
the connective tissue having increased, in some specimens,
rather more than the muscular tissue.
Anspach, in his recent paper, also disagrees with these
results of Theilhaber, his specimens of " metrorrhagia
myopathica " showing no greater increase of connective
tissue than multiparous uteri with an equal number of
pregnancies.
Several authors consider this " fibrosis " to be due to
inflammatory changes commencing in the endometrium
and extending to the mesometriura.
28 PATHOLOGY OF CHRONIC METRITIS.
If this really was the cause then Ave should have to
form two entirely separate groups — chronic metritis
occurring- in virgins, and chronic metritis occurring after
pregnancy, as it is only in the latter that direct infection,
to cause the inflammation, could occur. In only three to
four of the uteri which I examined was there any trace of
small cell-infiltration of the connective tissue, and in none
was there anything to make us consider this the cause of
the changes.
Condition of Mucous Membrane.
Theilhaber states that thickening of the mucous mem-
brane is rarely found in chronic metritis, and when present
is simply an oedema due to venous stasis. Lorentz found
the glands increased in size or number in five out of nine
specimens. In my thirty-eight specimens I found it possible
to accurately measure the thickness of the mucosa in only
thirty-one, since some of them had been bfodly preserved,
or else only a small portion of the specimen was given to
me which did not include the whole of the mucous mem-
brane. However, in four others, sufficient mucosa was
left to show its characteristics, thus making thirty-five in
all from which definite conclusions could be drawn. Of
these thirtj^-five specimens, thirty-three showed definite
thickening of the mucosa ; in two the mucosa was of
normal or diminished depth. Of these two, one (No. 15)
had passed the menopause three years previously, and had
had no discharge of blood since, only profuse leucorrhoea;
the other (No. 24) had been curetted three times pre-
viously, and each time the mucosa had been found greatly
thickened, but unfortunately I was not able to obtain
sections from the previous curettings. The thirty-three
specimens had endometrium varying from 1'5 mm. to
5 mm.in thickness ; but besides this increased thickness
they all showed changes in the glands which distin-
guished them from the normal endometrium.
Unfortunately, almost every text-book gives a different
PATHOLOGY OF CHRONIC METRITIS. 29
classification of endometritis. Until the pathology of
endometritis is thoroughly worked out and a standard
classification adopted it is only possible to classify the
various specimens according to their most prominent
characteristics. I have divided the endometrium found
in my specimens into six classes :
(1) The glands smaller than normal 4 specimens.
(2) The glands enlarged . . 5 ,,
(3) The glands increased in number 10 „
(4) A combination of 2 and 3 . 10 ,,
(5) The stroma increased . . 3 ,,
(6) A combination of 4 and 5.3 „
This allows the specimens to be classified according to
their most prominent features. To do it more than roughly
is impossible, as the various classes merge into each other;
so much so is this that two sections hardly ever show
exactly the same features. The density of the stroma
varies very much, even in the same specimen, often being-
dense in the deeper portion of the section and loose in the
superficial. In only eight specimens did I find the stroma
less dense than normal, and in many it was denser ; but
even if the stroma were oedematous in every specimen,
venous stasis would not explain the hyperplasia of glands
found in so many instances.
These changes in the endometrium, -along with the
simple hypertrophy of the mesometrium, I find to be
the only constant changes in uteri extirpated with the
diagnosis '' chronic metritis. ^^
For the sake of comparison with these cases of chronic
metritis I tabulated the symptoms (objective and sub-
jective), and the result, after curetting of fifty cases, dia-
gnosed as chronic endometritis. Both classes of cases
complain of abnormal menstruation, intermenstrual pain,
dysmenorrhoea, and intermenstrual discharge ; in both we
find increase in the size of the uterus, flexions, and tender-
ness. These symptoms certainly occur in varying pro-
portions in the two classes of cases, but generally the
difference is too slight to enable a definite diagnosis to
30
PATHOLOGY OF CHRONIC METEITIS.
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PATHOLOGY OF CHEONIC METEITIS. 31
be made. For practical purposes I find a patient is dia-
gnosed as suffering from chronic endometritis if her sym-
ptoms are recent and the uterus is not very much enlarged ;
if the symptoms are of long duration, if the uterus is much
enlarged and hard, if haemorrhage is the chief symptom,
and especially if she has been curetted without relief, the
diagnosis is chronic metritis. Chronic endometritis thus
appears to be a precursor of chronic metritis.
That these symptoms are due to disease of the endo-
metrium is proved by the excellent results of curetting,
thirty-nine (78 per cent.) of these fifty patients reporting at
the end of six months that they were improved, and only
eleven (22 per cent.) did not feel any better. Taking the
individual symptoms separately — irregular menstruation,
intermenstrual discharge, pain, and tenderness — the results
were about the same, the effect on tenderness beino- the
most marked. Of the very large number of these patients
examined a few days after curetting, very few com-
plained of tenderness, although this was one of the most
marked features of the examination previous to operation.
At the end of six months only 8 per cent, of this series
had any tenderness.
The statement is often made that the cavity of the
uterus, in cases of chronic endometritis, is lessened after
curetting, but I do not know of any statistics on this sub-
ject. On the suggestion of Dr. Donald, I measured the
uteri of twenty-three women six months after they were
curetted for chronic endometritis, and Dr. Donald has
kindly given me two of his own private cases to bring the
number up to twenty-five. The cases were not picked in
any way. I tried to re-measure every uterus whose
measurement I had noted at the time of operation, but
could not get more than twenty-three to come back again
for examination ; either they had moved to another address
or were living too far away, or else '' had not time to
come.''^
In this list of twenty-five, twenty-two (88 per cent.)
showed diminution in length of cavity, and only three (12
32 PATHOLOGY OF CHRONIC UETKITIS.
per cent.) increase. The diminution varied from 1 in. to
5 in., the average being -^ in. That this diminution has
some definite bearing on the result is shown by the fact
that the symptoms of the three which showed increase
were not improved by the operation, while twenty-one of
the twenty-two which showed diminution of the cavity were
improved. Two of the uteri, which were increased in size,
were very difficult to examine on account of the internal os
being almost occluded, although the external os was patulous.
If the endometrium is hypertrophied from any cause,
the probability is that the uterus will endeavour to expel
it, just as it does all foreign bodies ; this would especially
occur during menstruation, when the mucous membrane
becomes more swollen, and would account for the severe
pain which most of these patients complain of at that
time. Any muscular body with increased work in
course of time hypertrophies. This occurs in the heart,
stomach, bladder, etc., and it is only reasonable to expect
it in a uterus which, for some time, has been endeavour-
ing to expel a hypertrophied mucous membrane. I have
found this to be the case in all the specimens examined
by me ; certainly most of them showed a slightly increased
percentage of connective tissue, but this was very small
compared with the great total increase in size of the
uterus — an increase which is largely made up of new
muscular tissue.
Theilhaber considers that the mesometrium is the
starting-point in so-called chronic metritis, and that the
changes, if any, in the endometrium are only secondary.
This, I consider, he deduces from insufficient data. He
divides his patients with chronic metritis into six groups :
(1) girls at puberty, (2) weak, anemic girls, (3) women at
menopause, (4) women with diseased tubes or ovaries, (5)
women with myomata, and (6) women with subinvoluted
uteri. He states that in these patients he finds atrophy
of muscle and increase of connective tissue (although
Lorentz's figures for chronic metritic uteri are not very
different from Meier's for normal uteri, if averages are
PATHOLOGY OP CHRONIC METRITIS. 33
taken), and also increased size of the vessels. The uteri
which he has examined microscopically and on which he
bases his arguments are those of Lorentz. Of these nine
specimens seven had been pregnant from three to thirteen
times, and the other two were from married nulliparous
women, aged 32 and 38 years respectively. None of
these can be taken as examples of his first two groups,
viz. girls at puberty or weak, anaemic girls. His third
class, which includes women suffering from excessive
hasmorrhage about the menopause, also occurred in my
series of cases ; but I can find no evidence to make me
suppose that the symptoms are connected with the time of
life, and are not the result of a primary endometritis, just
as in all the other specimens.
Amongst the uteri which I examined, fourteen were from
women of forty years old or more ; of these, eight definitely
dated the commencement of their symptoms from a confine-
ment or a miscarriage ; one had passed the menopause, and
had had no hemorrhage since ; one had had the heemor-
rhage for nine years, commencing when she was thirty-eight
years old ; and in another I could not obtain the date of
onset of symptoms. This only leaves three (No. 2, No. 20,
and No. 33) which might possibly be due to primary
changes in the mesometrium at the menopause, but, micro-
scopically, I find appearances similar to those occurring in
the other examples of chronic metritis ; they show no
specially high percentage of connective tissue, nor are the
vessels enlarged or thick-walled, but both have a much
thickened endometrium. Nor do Lorentz^s specimens,
except his first, appear to bear out this statement, the
other two, of more than forty years of age, having a
pregnancy about the time of, or after, the commencement
of the symptoms.
Out of twenty-three patients from whom I obtained a
definite history, fourteen dated the commencement of their
symptoms to a confinement or a miscarriage, three had
symptoms previous to the last pregnancy, and only six
had symptoms commencing at a considerable interval after
VOL. XLIX. 3
34 PATHOLOGY OF CHRONIC METRITIS.
the last delivery. This class, in which the symptoms date
from a confinement or miscarriage (Tlioilhaber's Group,
No. 6), is the one in which I find most of these patients
fall ; I also find this borne out in the histories of large
numbers of chronic endometritic patients. It is easy to
imagine an endometritis being set up after a confinement
or miscarriage, either tlirough a sliglit degree of sepsis or
from the retention of a small piece of membrane or placenta.
This is sufficient to explain the symptoms (menorrhagia,
metrorrhagia, and leucorrhoca) of these patients ; the
dysmenorrhoca is explained by the uterus contracting and
making an effort to expel the swollen endometrium during
menstruation. In process of time the contractions lead to
hypertrophy of the uterus, and so account for the enlarged,
hard uteri, and also for the constant aching pain found in
these chronic metritic patients, due to the large, heavy
uterus dragging on the broad ligaments. That the endo-
metrium is primarily at fault is proved by the results of
curetting (see pp. 31, 32). In the great majority of cases,
in a few days tenderness has disappeared and the uterus is
smaller; at a later period the uterus is found to remain
diminished in size and the symptoms have disappeared or
are improved. A certain number do not benefit from
curetting, and require a repetition of the operation ; a very
small proportion are not improved with repeated curetting,
and in these hysterectomy may be necessary. Failure of
curettage does not, however, prove that the endometrium
was not primarily at fault, since a certain amount of
endometrium must always remain behind, and may be the
starting point of a fresh endometritis. In virgins, in
whom endometritis develops without any obvious reason,
the causal element has possibly not been removed, and
consequently may again develop endometritis. The speci-
mens which I have been able to obtain, extirpated for
chronic metritis, really represent the few failures in a very
large number of patients on whom curettage was performed.
Chronic metritis may be associated with other pelvic or
uterine diseases, such as tubo-ovarian inflammation, myo-
PATHOLOGY OP CHRONIC METRITIS. 35
mata, and malignant disease of the cervix. I have examined
seven examples of this : two in which it occurred along
with small intra-mural fibroids, three with carcinoma of
the cervix, one with a pyosalpinx, and one with double
ovarian disease.
In each instance the uterus was much enlarged, globular
in shape, increased in density, and the percentage of
connective tissue was slightly increased ; in fact, the
appearances, macroscopically, were identical with those of
chronic metritis; microscopically, however, the endometrium
was not increased in thickness. These facts may be sum-
marised as follows :
Conclusions.
(1) Chronic metritis is a simple hypertrophy of the
mesometrium, and is not a connective-tissue hyperplasia.
(a) The uterus in chronic metritis is much enlarged,
the increase being in all diameters : average length of
uterus, 10"03 cm. ; average length of cavity, 8*06 cm. ;
average width, 6*04 cm. ; average thickness of wall,
2*48 cm. j average weight, 106*38 grm. The dimensions
of a normal uterus are (Quain): length, 7*5 cm.; length
of cavity, 6*39 cm. ; width, 5 cm. ; the thickness of wall,
1*25 cm.; weight, 33*41 grm.
(6) The percentage of connective tissue varies con-
siderably in the different specimens of chronic metritis,
but many normal multiparous uteri possess an equal, or
even greater, proportion of connective tissue : the average
amount in the specimens of chronic metritis was only
0*8 per cent, higher than in the normal parous uteri.
(c) The vessel changes are variable, and similar
affections are found in normal uteri.
{d) There is no evidence of active inflammation, as
shown by small-celled infiltration or cicatricial tissue.
(2) Chronic metritis is a slowly progressing affection
of the uterus. In the early stage the uterus is simply
enlarged, due to hypertrophy of the mesometrium ; at a
36 PATHOLOGY OF CHRONIC METRITIS.
later stage it tends to become denser and harder^ but
this is not due to increase of connective tissue or inflam- .
matory changes,
(3) Chronic metritis is never a primary affection. It
is usually secondary to chronic endometritis, but may be
associated with any pelvic or uterine disease leading to
increased uterine contraction or vascularity, viz. fibroids,
tubo-ovarian inflammation, carcinoma, prolapsus, etc.
The age of patients with chronic metritis varied from
twenty-three to fifty-four j-ears, the average being 38"3.
Tliis is well below the average age at which the meno-
pause occurs, and thus proves that the climacterium is not
the causal factor in the complaint.
(5) The symptoms are mainly those of the primary
disease. In the early stage chronic metritis is indis-
tinguishable from chronic endometritis. At a later period
the great increase in size of the uterus may produce
symptoms — i. e. sacralgia and aching pain in hypogastrium
and iliac regions due to traction on the broad ligaments.
(6) The diagnosis of chronic metritis is largely dependent
on the result of treatment. In the early stage of the
affection all the symptoms disappear after dilatation and
curettage of the uterus, thus demonstrating that the endo-
metritis is the primary cause.
(7) In chronic metritis and chronic endometritis local
treatment of the endometrium may fail to relieve the
symptoms. This is probably due to re-inauguration of
the endometritis.
(8) Treatment. — A few patients are relieved by general
treatment — i. e. living a simple hygienic life, Avith no very
heavy work or too long standing, but with some occupation
to prevent the patient from dwelling on her symptoms.
The bowels must act freely ; douching, also, seems to have
a beneficial effect. The great majority of the cases require
curetting, and are much improved by it (see p. 31). In
a few instances the symptoms are not relieved even by
repeated curettings ; in these cases nothing short of
hysterectomy is of any avail. This drastic measure is.
PATHOLOGY OF CHRONIC METRITIS. 37
however, only necessary in a small percentage of these
patients. At St. Mary's Hospital, in 1905, 171 patients
were curetted for chronic metritis or chronic endometritis,
while, in the same year, only five hysterectomies were
performed for these ailments.
Since writing the above paper a very important article
has appeared, by Drs. Gardner and Goodall (Brit. Med.
Journ.,' November 3rd, 1906) on " Chronic Metritis and
Arterio-sclerotic Uterus,'' based upon the examination of
nine uteri extirpated for chronic metritis.
It is satisfactory to find that the description of the
microscopic appearances which is given by the authors is
substantially the same as that which I have recorded,
although they arrive at very different conclusions. They
found hypertrophy or hyperplasia of both muscular and
fibrous tissues in seven out of these nine cases. Further,
they note the similarity of sections of chronic metritic uteri,
fibro-myomatous uteri, and uteri with disease of the
uterine adnexa. It will be remembered that in these last
two kinds of cases I found similar changes in the uterine
tissue, which I classified as " chronic metritis with some con-
current disease." So far, therefore, we are in agreement.
In the remaining two specimens the authors found
changes which, as they themselves, admit, are not
characteristic of simple chronic metritis, but which they
regard as secondary to a general arterio-sclerosis. These
changes I have not found in any of my specimens.
As regards their conclusions, they believe that the
intractable heemorrhage, which is so frequent a symptom,
is due to muscular insufficiency of the uterine tissue and
the vessel walls. They have arrived at this conclusion
because the fibrous tissue of the uterus is slightly increased
in comparison with the muscular tissue, and because they
found the adventitia of the vessels increased by a deposit
of fibrous tissue in seven cases and in some of the cases
the media of the vessels was similarly affected. But,
after most careful comparison of my sections, I have
38 PATHOLOGY OP CHRONIC METKITIS.
been able to establish no definite connection between
these altered vessels and excessive haemorrhage. Many
of the specimens in which these vessel-changes are well-
marked are normal uteri, while in other cases, in which
the haemorrhage was most pronounced and long continued,
the vessels showed none of these changes.
In discussing the changes found in the endometrium, the
authors state that they believe this affection to be primary
and due to sepsis, when it is found in what we may call
the usual type of case, but secondary to arterial changes
when it is found in their second, or arterio-sclerotic type.
How they differentiate between primary and secondary
endometritis they do not state, nor is any difference
obvious fi'om their description of the microscopical appear-
ances of their specimens. In my specimens of uncom-
plicated chronic metritis the endometrium was found
thickened in all, with the exception of two, which were
easily explained, but in every case of ^j#!complicated
chronic metritis the endometrium was of normal thickness
or thinner. But if changes in the endometrium were at
any time secondary to changes in the mesometrium they
ought to be found in the majority, at least, of cases of com-
plicated chronic metritis. Further, the explanation of all
cases of endometritis associated with chronic metritis as
being due to either sepsis or secondary to arterial changes
takes no account of the thickening of the endometrium
associated with enlargement of the body of the uterus
which is sometimes found in virgins (see Donald, ^ Journ.
of Obstet. and Gyn. of the Brit. Empire,^ 1904). Some
of the specimens which I have examined were virginal
uteri, with changes which could not be differentiated from
those found in parous uteri.
Under treatment they only consider hysterectomy after
preliminary curettage if the diagnosis is uncertain, thus
evidently drawing a hard and fast line between chronic
metritis and chronic endometritis.
They also believe that ovarian function has some power
over uterine haemorrhage, and, in support of this, quote
PATHOLOGY OF CHRONIC METRITIS. 39
one case in which menorrhagia continued for some time
after curettage, but underwent spontaneous cure in the
course of a few months. In our experience this is what
very often occurs after curettage, the patient generally
receiving more benefit from the operation after a lapse of
a few months than immediately subsequent to it.
Note. — The tables of cases are published in the ' Journ.
of Obstet. and Gyn. of the Brit. Emp./ vol. xi, February
1907, pp. 140-150.
Bibliography.
Addinsell. — Chronic Infective Metritis, Journ. of
Obstet. and Gyn. of the Brit. Emp., vol. x, 1906, p. 6.
Anspach. — Metrorrhagia Myopathica, Amer. Journ. of
Obstetrics and Diseases of Women and Children, Januarv
1906. ^'
Barbour.— Allbutt and Playfair's Svstem of Gyna3co-
logy, 1896.
Becquerel.— Traite clin. des maladies de Tuterus.
Bennet.— A Practical Treatise on Inflammation of the
Uterus and its Appendages, 1849.
Cullen. — Cancer of the Uterus and Pathology of
Diseases of the Endometrium, 1906.
Cholmogoroff.— Monats. fiir Geburts. und Gynakol ,
Bd. 11, 1900, p. 692.
De Sinety.— Manual de Gynecologie, 1879.
DoLERTs.— Metrite et fausses Metrites, 1902.
Donald. — Chronic Endometritis and Chronic Metritis
in Virgins, Journ. of Obstet. and Gyn. of the Brit. Emp
April, 1904.
FoRDYCE. — Chronic Metritis and Endometritis, Encyclo-
pEedia Medica.
Fothergill.— Some Ptecent Work on So-called Chronic
Metritis and Endometritis, and their Eelation to the
Life-history of the Uterine Muscle, Practitioner, March,
1904.
Findley. — Diagnosis of Diseases of Women, 1905.
40 PATHOLOGY OF CHRONIC METRITIS.
FiNDLEY (I^almer). — Arterio-sclerosis of the Uterus as
a Causal Factor in Uterine Haemorrhage, Amer. Journ. of
Obstet., July, 1905.
Finn. — Centralbl. fiir med. Wissensch., 1868, S. 564.
Fritsch. — Diseases of Women, 1883, pp. 151—168.
FoERSTER. — Spec. Path. Anatomic, p. 314.
Galabin. — Diseases of Women, 1903,
Walker Hall and Herxheimer. — Methods of Morbid
Histology and Clinical Pathology, 1905.
Herman. — Diseases of Women.
Hart and Barbour. — Diseases of Women.
Hektoen and Riesman. — Text-book of Pathology.
HuGUiER. — Gaz. des Hop., 1849, p. 127.
Jellett, — A Short Practice of Gynaecology, 1903.
Klebs. — Handbuch der patholog. Anatomic.
Lorentz. — Archiv fiir Gynakol., Bd. Ixx, 1903, p. 309.
Leith. — The Menopause and its Disorders, 1897.
Meier. — Archiv fiir Gynakol., Bd, Ixvi, 1902, p. 15.
Macgkegor (Jessie). — A Contribution to the Pathology
of the Endometrium, 1905.
McReynolds. — The Use and Abuse of the Curette,
Amer. Journ. of Obstet,, June, 1905,
NoNAT et Linas, — Traite pratique des maladies de
I'uterus, de ses annexes et des organes genitaux extcrnes,
1874, p. 213.
PiCHEViN ET Petit, — Gaz, Med, de Paris, 1895.
QuAiN^s Anatomy, vol. iii, part 4, p. 260.
Robertson, — Endometritis : Its Pathology and Treat-
ment, Amer, Journ. of Surgery, January, 1905,
Reinecke, — Die Sklerose der Uterinarterien und
klimakterischen Blutungen, Archiv fiir Gynakol., Bd. liii,
1897, p. 340.
ScHROEDER. — Zicmsscn's Cyclopaedia of the Practice of
Medicine, 1875, vol. x, pp. 101—139.
ScANZONi. — Die chronische Metritis, 1863.
Simpson (Sir J. Y.) — Diseases of Women, 1872.
Thomas, — Diseases of Women, 1869, p, 254,
Theilhaber. — The So-called Chronic Metritis, its Causes
PATHOLOGY OF CHRONIC METRITIS. 41
and its Symptoms, Archiv fiir Gynakol., Bd. Ixx, 1903,
p. 411.
Theilhaber. — Die Variationem im Bau des Mesometrium
und deren Einfluss auf die Eiitsteliung von Menorrliagien
und von Fluor, Archiv fiir Gynakol., Bd. Ixvi, 1902, p. 1.
Theilhaber. — Schlussfolgerungen aus den von andern
Autoren am Mesometrium blutender Frauen erliobenen
Befunden und aus unseren Untersuchungen, Archiv fiir
Gynakol., Bd. Ixvi, 1902, p. 40.
The President thanked Dr. Shaw for his valuable paper. It
was an important step towards putting the study of so-called
" metritis " on a scientific basis. Dr. Shaw had carefully con-
trolled liis observations on the diseased uteri by examining the
uteri of normal subjects, and his resulting opinion was, in conse-
quence, a safe foundation. The President used the term " so-called
metritis " because, as far as he could see, there was nothing
indicating inflammation in any of Dr. Shaw's sections or descrip-
tions. In fact, both '* metritis " and " endometritis " as used at
present by many did not necessarily mean an^'thing connected
with inflammation. These terms, however, led students and
others astray, and ought to be reserved for inflammatory pro-
cesses. He would appeal to both Dr. Donald and Dr. Shaw, as
among the pioneers in this research, not to countenance such
misuse of terms.
Dr. CuLLiNGWOETH Said that he knew Dr. Donald's paper to
be the outcome of much careful cHnical observation, of prolonged
thought, and of strong conviction. The subject was one that had
engaged the author's attention, to his (the speaker's) knowledge,
for many years. With refei-ence to Dr. Shaw's paper, he thought
the Fellows would be interested to know that it was based upon
a thesis which had been presented to the Yictoria University of
Manchester for the M.D. degree, and to which the authorities of
that University had awarded the distinction of a gold medal.
The paper represented three years' hard work. The two authors,
though both were Manchester men, had not worked in collabora-
tion, but approaching the subject independently, the one from a
clinical, the other from a pathological standpoint, they had
gradually become aware of each other's work, and of the fact that
the conclusions at which they had arrived were practically the
same.
Dr. Amand Eouth said no subject in minor gynaecology was
more perplexing than that of chronic metritis. Some patients,
with large, hard uteri, would sufl^er from menorrhagia and no
local pain, whilst others, with, apparently, a similar uterus,
42 PATHOLOGY OF CHRONIC METKITIS.
would have uo haemorrhage, but considerable pelvic discomfort.
Ciu'etting frequently relieves such patients, even when the.
scrapings are insignificant in quantity, when, in fact, an atrophic
"endometritis" has succeeded to the hypertrophic "endometritis"
which the authors appear to have mainly dealt with. Did the
authors consider all their cases to be " septic " in origin ? Were
not fe'ome of them really of the type usually known as arterio-
fibrosis of the uterus ?
Dr. Russell Andrews said that he thought that Dr.
Fletcher Shaw deserved the thanks of the meeting for his
clear demonstration of the fact that there were uo characteristic
histological changes in " chi'onic metritis." One reason why
some gynaecologists were lotli to accept chronic metritis as a
clinical entity was that the shdes and microphotographs used to
illustrate some papers on this subject showed changes in the
muscle, connective tissue, and vessel-walls, Avliich were said to
be pathognomonic of chronic metritis, thougli tliey differed in uo
way from what was seen in normal, multiparous uteri. He
thought that this was one of the most interesting points in a
very interesting demonstration.
Dr. CuTHBERT LocKYER exprcsscd his hearty appreciation of
Dr. Fletcher Shaw's admirable and i^ainstaking work upon the
much vexed question of the pathology of so-called chronic
metritis. He thought this Society owed a debt of gratitude to Dr.
Shaw for his paper and demonstration, Avhich constituted the
first really scientific attempt at evolving order out of chaos (as
far as this subject? was concerned) which had been presented for
discussion at the Obstetrical Society of London. It was true
that the Society's attention had previously been di*awn to
certain histological featiu*es in uteri said to be in a state of
" chronic metritis," but such conditions as were noted could all
be found in parous uteri devoid of such clinical symptoms as
haemorrhage and subinvolution. Dr. Shaw's demonstration was
convincing from the fact that he was careful to demonstrate the
histology of the normal side by side with that of the abnormal
uterus, and, again, his systematic three years' work embraced a
mass of material which, from its very bulk, added valuable weight
to his conclusions. It was interesting to note the luiiform
finding of concomitant mucosal hypertrophy, with similar changes
in the mesometrium. In cases the speaker had examined
hj^sterectomy had frequently followed a comparatively recent
curettage, and for this reason, probably, the specimens showed no
excess of thickness in the lining membrane of the cavmn uteri.
Dr. Lockyer was, however, quite familiar with changes in endo-
metrial scrapings, which were analogous in all the details of
hypertrophy and hyperplasia (including early fibroblastic invasion
and new vessel formation), wliich are to be found in the fibro-
muscular walls of uteri removed for haemorrhage and increased
PATHOLOGY OF CHKONIC METRITIS. 43
weight. Dr. Lockyer particularly noted that Dr. Shaw's series
of cases did not include one type of uterus in which he himself
was especially interested, and to which attention had been drawn
by Dr. Goodall at the meeting of the British Medical Association
at Toronto, in August, 1906, viz. the arterio-sclerotic uterus.
The speaker, from his own clinical and pathological experience,
agreed with Dr. Goodall that there was a type of uterine disease
which affected, primarily, the vessels of that organ— a disease
characterised by great tliickening and hyaline degeneration of
the middle coats of the vessels, together with irregular thickening
of the intima. These changes lead to actual occlusion of some
of the vessels, to compensate for which new vessels can be found
in the process of formation. Now, such uteri are found to be
associated with general cardio-vascular changes, such as are seen
in Bright's disease, and clinically give rise to intractable haemor-
rhage. If the latter be treated by curettage the scrapings are not
abundant, and are principally characterised by a fibroblastic inva-
sion, starting in the deeper layers of the miicosa and working out-
wards. This leads to fibrous tissue formation, destruction of
gland-tubes, and atrophy of the mucosa itself. Attention has been
drawn to this condition, not only by Dr. Goodall, but by Dr.
Freeland Barboiu-, in a paper entitled " Climacteric Haemorrhage
due to Sclerosis of the Uterine Vessels " ('Scottish Medical and
SurgicalJournal,' Jime, 1905), and, as this author states, the only
remedy for the haemorrhage is removal of the uterus. Dr. Lockyer
cited a similar case from his own practice, at St. Mary's Hospital,
Plaistow, and it was sui-prising to him that in such an extensive
research Dr. Shaw had not met with this condition. Dr. Lockyer
would, therefore, like to hear from Dr. Shaw whether he regarded
every case of so-called chronic metritis as of infective origin, or if
he would admit the entity of a primarily arteijio- sclerotic uterus
occurring independently of any soiu-ce of infection from without.
Dr. Fkank E. Taylor said that he had been much impressed
by two points during the routine pathological examination of a
considerable number of uteri, similar in character to those
described by Dr. Donald and Dr. Shaw, which had been removed
on account of excessive and intractable haemorrhage. The first
point was the extreme variability of the histological findings
presented by the various specimens examined, some uteri
presenting histological features which differred very slightly
from those of nomial uteri, whilst others presented most striking
changes, especially as regards the tliickness of the vessel- walls in
the myometrium. All intermediate stages were likewise observed.
The second point was the lack of a normal standard with which to
compare the conditions found in chronic metritis — as to what
amount of thickening of the vessel-walls in the myometrium
could be considered pathological, and as to the significance of the
relative proportion of fibrous to muscular tissues present, along
44 PATHOLOGY OF CHRONIC METRITIS.
with the dijBficulty of definitely ascertauiing this proportion. He
(Dr. Taylor) agreed vnth Mr. Targett that, d priori, one would
expect to find more marked changes in the endometrium than in
the myometrium in uteri causing such excessive and persistent
haemorrhage, but in the majority of the. cases examined by him
the changes in the endometrium, beyond, possibly, some hyper-
plasia, were usually not very marked, whilst the myometrium
showed more definite changes, which changes usually consisted
in great thickening of the vessel- walls. It was, he considered, an
extremely difficult matter to explain the uterine haemorrhages on the
ground of these histological findings. Both Dr. Donald and Dr.
Shaw had laid gi-eat stress on the importance of infection as a
causative factor in the etiology of chronic metritis, and had
mentioned the fi*equency with which the symptoms dated from a
confinement or miscarriage — presmnably septic. Now, gono-
coccal infection was probably as frequent as puerperal infection
of the pelvic viscera. Hence, it might have been expected, if
infection were really an important factor, that a history of gono-
coccal infection would have been present in a certain proportion
of the cases, but of such a possible origin neither Dr. Donald
nor Dr. Shaw made any mention.
FEBRUARY 6th, 1907.
W. R. Dakin, M.D., President, in the Cliair.
Present — 40 Fellows and 3 visitors.
A book was presented by Mr. J. Bland-Sntton.
George Hope, D.P.H., L.R.C.P., M.R.C.S.Lond., was
admitted a Fellow.
P. Ernest Withers, M.R.C.S., L.R.C.P. (Horncastle),
was declared admitted.
The following gentlemen were proposed for election : —
Archibald Montague Henry Gray, M.D., B.S.Lond. ; Clif-
ford White, M.D., B.S.Lond. ; and James Montague Wyatt,
M.R.C.S., L.R.C.P.Lond.
The following gentleman was elected a Fellow of the
Society :— Lewis Graham, B.S.Lond., M.R.C.S., L.R.C.P.
Report of the Pathology Committee on Dr. Amancl Routh's
Specimen of a Fihromyoma of the Uterus with a
Sarcomatous Nodule in the Centre {see p. 1).
We have examined this specimen and the microscopic
sections taken from it, and agree that the nodule is a true
giant-celled sarcoma, invading the co-existing fibromyoma.
We find no evidence of sarcomatous degeneration of the
fibromyoma. The invasion of this tumour by the sarcoma
is of quite limited extent.
{Signed) John S. Fairbaien,
CUTHBERT LOCKYER,
C. Hubert Roberts,
CoRRiE Keep,
G. Blacker, Chairman.
46 VILLOUS TUMOUR OF BODY OF UTERUS.
A VILLOUS TUMOUR OF THE BODY OF THE
UTERUS IN A WOMAN, AGED 84 ; VAGINAL
HYSTERECTOMY; RECOVERY.
By J. Bland-Sutton.
A VILLOUS tumour of the uterus is, I think, very rare,
and the interest of this report is increased from the fact
that the patient is a multipara, aged 84. Except for
a blood-stained vaginal discharge this old lady seemed
in perfect health, but the character of the discharge
made those in charge of the patient suspect that she
was the victim of cancer of the body of the uterus. In
order to establish a diagnosis the uterus was curetted,
and a microscopic examination of the scrapings caused the
pathologist to pronounce the disease to be cancerous ; but
it was thought that the patient^s advanced age contra-
indicated a radical operation.
Dr. W. A. Milligan asked me to see the patient with a
view to operation, for, notwithstanding her advanced age,
she seemed to be thoroughly capable of bearing an opera-
tion, and especially as the uterus did not appear to be
greatly enlarged. After careful consideration 1 performed
vaginal hysterectomy in September, 1906, and the opera-
tion was followed by an excellent and quick convalescence.
The uterus was hardened in a solution of formalin and
bisected (see Fig. 1) in its sagittal axis. The uterine
cavity is filled with a soft, yellowish mass, which grows
from the endometrium covering the posterior surface.
Thin sections were successfully cut in such a way as to
involve the walls of the uterus and the growth. On
microscopic examination we found that the free portion of
the tumour consists of compound villous processes covered
with columnar epithelium. Its resemblance to a villous
tumour of the bladder is complete in every particular,
except that the investing epithelium is identical with that
covering^ the normal endometrium.
VILLOUS TUMOUR OP BODY OP UTERUS.
47
We critically examined the base of the tumour and
find it consists of the peculiar cells which compose the
reticulum of the normal endometrium, and it does not
infiltrate the subjacent muscular wall of the uterus. From
Fig. 1. — A viterus in sagittal section. The cavity is dilated and
occupied by a villoxis tumour growing from the posterior wall.
From a multiparaj aged 84.
the histologic standpoint it is clearly a non-malignant
tumour.
Although I have devoted much attention to the his-
tology of uterine tumours I have only seen one other
example of a villous tumour of the corporeal endometrium.
This occurred in a multipara, aged 56, and I removed
the uterus under the impression that it was cancerous,
but in the laboratory Dr. Foulerton and myself have.
48 VILLOUS TUMOUR OF BODY OP UTERUS.
after repeated examinations of the section, been unable
to make up our minds on the question of malignancy.
This operation was performed six years ago, and, as the
woman remains in good health, it is therefore a fair
assumption that a typical villous tumour of the uterus is
not malign. Moreover, in this case the villi were long,
slender, and simple.
I believe that a typical villous tumour of the corporeal
endometrium with compound villi is a rare condition.
Dr. Am AND Routh alluded to a case of malignant papilloma
which he had shown in this Society in January, 1897 (' Obstet.
Soc. Trans.,' vol. xxxix, p. 5). The patient was aged 57, and
had metrorrhagia. Her utei-us was dilated and a soft growth
curetted away in June, 1894. This was repeated in March, 1895,
and in April, 1896. On the two previous occasions Dr. W. H.
Tate described the scrapings as benign papilloma. On the last
occasion Mr. Targett reported that the growth was a delicate
papilloma, essentially resembling the common fimbriated variety
of the urinary bladder. He added that the specimen could not
be described as mabgnant. Six mouths aftewards, as hsemor-
rhage recurred. Dr. Routh removed the uterus ^'er vaginoMi. Mr.
Targett then reported that there was distinct evidence that the
papilloma had invaded the muscle- walls, but still retained its
papillomatous type, thus differing from the columnar carcinoma
of the uterine body. Dr. Eouth believed that any new growth
occurring in the uterus, after the menopause, was apt to take on
a malignant development, and should be treated accordingly. He
was surprised, therefore, to hear that the base of the growth in
Mr. Bland- Sutton's case was not involved.
Dr. MiLLiGAN said that the clinical histoiy of the case
extended from Jidy, 1905, at which time the patient began to
suffer from a discharge, which ultimately became blood-stained.
There was never, as Mr. Bland-Sutton had said, a copious loss of
blood, the discharge all the way through being nothing more
than what could be called a blood-stained discharge. In addition
to this there was a certain amoimt of abdominal pain and back-
ache. Examination of the pelvis revealed a freely movable
uterus. The patient made an excellent recovery ofter the opera-
tion, and at the present time is remarkably well. The examination
of the ciu'ettings certainly pointed to the case as being one of
columnar-celled carcinoma of the body of the uterus. He had had
an~opportiuiity of examining Mr. Bland-Sutton's section through
the groA\^h, and certainly he could not detect any infiltration
of the muscular wall of the uterus. It is noteworthy if the
PREGNANCY IN EIGHT CORNU OF FIBROID UTERUS. 49
ease be oue of an ordiuary villous tumour, that the haemorrhage
was not more severe than it was.
Dr. Ctjthbert Lockyer : In reference to the total absence of
invasion of uterine muscle by the complicated villous adenoma
of the endometrium Dr. Cuthbert Lockyer asked Mr. Bland-Sutton
what, in his opinion, would have happened had the growth been
thoroughly curetted ? Woiild there have been a recurrence ?
The specimen was referred to the Pathology Committee.
PREGNANCY IN THE EIGHT CORNU OF A
FIBROID UTERUS.
By Mrs. Boyd.
The specimen showed a diffuse fibromyoma of the uterus
occupying the whole of the supra-vaginal portion of the
cervix and the greater part of the body, partially intra-
ligamentous and subperitoneal in its development, and
complicated by pregnancy in the right cornu of three
to four months' duration. The specimen was removed
by abdominal pan-hysterectomy, after enucleation of the
lower intra-ligamentous portion, from a patient, aged 42,
married two and a half years, without family.
On admission there was a history of four months'
amenorrhoea, the periods being replaced by slight vaginal,
blood-stained discharge, and two months' severe pain in
the abdomen, coming on in definite attacks, with frequency
of micturition, and increasing constipation.
Examination on admission showed slight haemorrhage
to be going on. A hard, ovoid tumour occupied the
centre of the abdomen, extending to a point half way
between the umbilicus and the xiphisternum. At the right
upper pole was a definitely cystic portion. Per vaginam
the cervix, much softened, was displaced to the right by
the lower pole of the hard, abdominal tumour, which
filled the pelvis. A diagnosis was made of pregnancy
complicating fibroid with impending miscarriage, and
operation was undertaken the following day.
Mrs. Boyd drew attention to the extreme thinning of
VOL. XLIX. 4
50 ADENO-CAECINOMA OF THE OVARY.
tlie uterine wall in the region of tlie right cornu, where
the ovum was developing, and compared it with a similar
specimen exhibited by her in March, 1904, where marked
thinning of the stretched uterine wall was also well seen.
In the present instance the placenta was implanted on the
area where the greatest thinning had occurred, the uterine
wall being here little more than one eighth of an inch in
thickness. She remarked on the similarity between the
risks of these cases and those of interstitial cornual preg-
nancy, and suggested that the danger of rupture of the
distended and thinned-out uterine cornu made early
operation, apart from the question of impending miscar-
riage which determined operation in this case, advisable
where the lower portion of the uterus was blocked by
fibroids, and only a small portion of the upper part of
the cavity was left available for gestation. She thought
that rupture through the placental site, with its attendant
enormous danger, might well have occurred had this case
been allowed to proceed in the hope of delivering a viable
child by Caesarian section.
Dr. Amand Eouth agreed that Mrs. Boyd's treatment had, in
this case, been the correct one, but could not agree with her
general statement tliat, 0T\ing to the risk of rupture of the uterus
from thinning of the uterine walls in these cases of pregnancy
and fibroids, hysterectomy, in the early months, was called for.
He knew of no such risk, and thought that, as a general rule,
with very few exceptions, no operation slioiild be done till fatal
viability, and that usually it was best to wait till nearly full term.
Dr. Herman asked if ruptm-e of the uterus during pregnancy
was not an extremely rare event? When investigating the
subject some years ago he had only been able to find one indu-
bitable case of ruptm-e of the uterus dm-ing pregnancy (apart
from labour and rupture of interstitial gestation sacs).
ADENO-CARCINOMA OF THE OVARY.
Shown by Mrs. Boyd.
Mrs. Boyd showed a specimen of papilliferous cystic
adeno- carcinoma of the left ovary removed from a patient
CO-EXISTING TUBAL AND UTERINE FEEGNANCY. 51
aged 54. The interest lay in the facts of the case rather
than in the specimen itself. The patient had been operated
on ten years previously in St. Bartholomew's Hospital,
where the uterus was removed by vaginal hysterectomy
for typical squamous carcinoma of the cervix. She was
admitted to the New Hospital for Women in November,
1906, with the abdomen enormously distended by ascites.
She had noticed the distension for two months, and was
otherwise in excellent health. After withdrawal of fifteen
pints of ascitic fluid by tapping, a nodular growth could
be felt adherent to the left side of the vaginal scar.
Fluid rapidly re-accumulated and the abdomen was opened,
and a cystic papilliferous tumour, of the size of an orange,
was removed ; it had to be dissected out of the vaginal
scar, in which it was firmly embedded. It proved to be
a cystic adeno-carcinoma.
Mrs. Boyd congratulated Dr. Griffith, under whose care
the patient had been ten years previously, on the success
of the vaginal hysterectomy — a cure so complete as to
alloAv the patient to develop ten years later a second
independent focus of malignant disease of a different
type. Unfortunately, no section of the early growth of
the cervix could be obtained for comparison with the
ovarian growth recently removed.
CO-EXISTING TUBAL AND UTERINE PREG-
NANCY ; ABDOMINAL SECTION ; SUB-
SEQUENT DELIVERY AT TERM.
By Waltek Tate, M.D., F.R.C.P.
Mrs. S— , aged 37, had her first and only child ten
years ago. From that time she enjoyed good health, and
had normal menstruation till February 21st, 1906, when
the last period occurred. In March she saw nothing.
During the second week in April she began to feel ill,
suffering from some pain, sickness, and diarrhoea. On
April 20th the patient had two attacks of severe pain
52 CO-EXISTING TUBAL AND UTERINE PREGNANCY.
over the lower part of the abdomen. She also had a slight
hsemorrhagic discharge, with some pain, on one or two
occasions between April 20th and 30th, when the patient
was first seen by the writer. On examination the uterus
was found to be enlarged and lying behind the pubes.
On the left side there was a firm swelling, about as big
as a duck's egg, in the situation of the left appendages
The condition was thought to be one of tubal mole, but
the patient was very anxious to avoid operation unless it
was immediately necessary.
In a case like this, when the patient had the severe
attack of pain ten days before being seen, and where, on
examination, a firm mass is found in the situation of the
appendages of one side, it may fairly be assumed that the
ovum is dead, and we have to deal with a tubal mole.
Even if further ha)morrhage does occur m such a case, it
is unlikely to be of the very severe type of intra-pentoneal
bleeding if the patient is kept absolutely at rest m bed
It was, therefore, decided that the patiert should be kept
at rest in bed, and in the event of further pain, indicatmg
recurrence of the hemorrhage occurring, abdominal section
was to be performed. The patient was kept m bed tor
three weeks, and during this time had no more pam, and
her general condition improved. A few days after
beginning to get about a little she had a return of the
pain, and a week later had another bad attack. There
had been no irregular hsemorrhagic discharge. On June
6th 1906— that is, five weeks and two days aftermy previous
visit— I again saw the patient. There was nothing' to note
specially about the general appearance and condition ot
the patient, which were quite satisfactory. The abdominal
condition, however, had altered, for there was now a well-
defined, elastic and tender swelling in the lower abdonien
on the left side, extending out to the iliac fossa. 1 er
vaginam, it was noticed that the uterus was much larger
than is usually found in cases of tubal pregnancy, and to
the left of, and continuous with it, was a swelling as large
as the closed fist in the situation of the left appendages.
CO-EXISTING TUBAL AND UTEEINE PEEGNANCY. 53
As it was evident that the return of the pain and the
increased size of the pelvic swelling were caused by further
hsemorrhage, the patient was advised to submit to operative
treatment, and on the following day laparotomy was per-
formed. When the abdomen was opened a little dark
blood was seen about the coils of intestine, contiguous to
the appendages on the left side, and an ounce or two of
dark blood was removed from the pelvis. The uterus Avas
very soft and elastic, and enlarged to the size of a three
months' pregnancy. The enlarged left appendages were
covered by adherent blood-clot, and were roofed over by
adherent omentum and some coils of bowel. The adhesions
were readily separated, and the appendages of the left side
removed. The right appendages were normal. The pelvis
was swabbed out -vvith a little normal saline solution, and
the abdomen afterwards closed.
The parts removed consisted of the Fallopian tube,
containing a tubal mole, which had probably advanced to
the eighth or ninth week. The mass was about as big
as an orange. The uterine end of the tube had a normal
appearance. The fimbriated end was contracted to the
size of a cedar pencil, and the umbilical cord was seen
issuing from this. At one part of the gestation-sac the
chorionic villi had penetrated the wall of the Fallopian
tube, and were clearly evident on the surface. On laying
open the sac by a longitudinal cut along the tube the wall
was seen to be thickened, varying from a quarter to half
an inch in thickness, owing to haemorrhage. The amniotic
sac was about two inches in diameter, and the origin of
the umbilical cord, with one and a half inches of this
structure, was seen springing from the inner surface of
the sac near the fimbriated end. There was naturally
some anxiety after the operation, lest a miscarriage of the
uterine pregnancy should occur. Fortunately this compli-
cation was avoided, and the patient made an uninterrupted
recovery.
Three weeks after the operation the uterus was found
to reach halfway between the pubes and umbilicus.
54 SUPPURATION IN FIBROMYOMA UTERI.
The patient was discharged at the end of a month, and
returned home. She had no trouble whatever during the
remaining months of pregnancy, and a living, healthy
child was born on November 30th, 1906. The confine-
ment was normal and only lasted four hours. The child,
which was a female, weighed 6^ lb.
CASE OF SUPPURATION IN FIBROMYOMA
UTERI FOLLOWING PREMATURE DELIVERY,
TREATED BY ABDOMINAL HYSTERECTOMY.
By Walter Tate, M.D., F.R.C.P.
Mrs. K — , aged 37, was married four years ago. Nine
weeks after marriage she had a miscarriage at the second
month of pregnancy, but had no complications after this.
Before her marriage a fibroid tumour of the uterus as
large as an orange had been discovered by her medical
attendant in the course of an examination for some minor
ailment. It was not causing any special symptoms. In
September, 1905, the patient again became pregnant, and
was delivered in the middle of March, 1906, of a dead
foetus at about the sixth month. Two days later she had
rigors and high fever, and apparently a parametric abscess
developed, which is said to have burst per vaginam. She
had a long, tedious convalescence, being in bed many
weeks, and in June she was sent away to Weymouth. On
returning home again in July a sinus could still be felt in
the left vaginal fornix, and the uterine fibroid was half as
large again as it was after the confinement. The patient
was better on the whole, but, as she was much troubled
Avith haemorrhoids, an operation was performed for the
removal of these. Soon after this o]3eration the temperature
beg~an to go up at night, and the tumour began to increase
more rapidly.
At the beginning of September, when the patient again
SUPPURATION IN FIBROMYOMA UTERI. 55
consulted her medical attendant, slie had been having
irregular temperature for some weeks, and was suffering
from a profuse offensive discharge from the vagina. It
was evident that the fibroid had begun to grow much
more rapidly, and on palpation the tumour was very-
tender. The patient had also lost a good deal of flesh
and looked ill. She was kept in bed for a time and hot
vaginal douching administered, but as the tumour con-
tinued to increase and the patient was steadily losing
ground, she was sent up to town with a view to operation.
On October 2nd, 1906, the patient was seen by Dr. Tate,
and looked exceedingly ill and emaciated. The expression
was anxious, and the skin had an earthy hue. The abdo-
men was occupied by a tumour as large as a seven months^
gestation. It was very tender and elastic, and fairly
mobile. On vaginal examination the cervix was felt high
up, and a portion of the tumour bulged down the anterior
fornix. Nothing could be felt of the discharging sinus
which had been observed by the medical attendant early
in August.
The appearance of the patient was very suggestive of
a malignant growth, but in view of the hectic fever
which had persisted for some weeks, and also the history
of septic trouble with abscess in the pelvis which de-
veloped during the puerperium, it seemed more than
probable that the case would prove to be one of suppura-
tion in a fibroid.
The patient was kept at rest in bed for a few days to
recover from the fatigue of the journey to town, and during
this time the irregular fever, varying between 99° F. and
102° F., persisted.
On October 7th abdominal hysterectomy was performed.
The uterus was completely removed. There was no
difficulty in the operation, and not a single adhesion in
the pelvis. This fact proves that the abscess, which
discharged jper vaginmn after the confinement, was para-
metric and not intra-peritoneal.
The uterine tumour removed was spherical in shape.
56 SUPPURATION IN PIBROMYOMA UTERI.
and tlie surface of the tumour had a yellowish-white
appearance, which was quite diiferent from what is usually
seen. The uterine canal passed upwards along the pos-
terior and left aspect of the mass. The tumour had
burrowed somewhat into the right broad ligament, but
it grew chiefly from the anterior wall of the uterus. On
carefully incising the anterior wall of the mass a large
cavity was opened up, from which was let out 3^ pints
of the most offensive pus, having a greenish -yellow
colour. Remains of fibroid growth formed a ver}'^ irre-
gular wall to this cavity, and in the centre of the cavity
was a sloughing mass of fibroid tumour about as large as
the palm of the hand, which was quite free in the cavity.
The whole inner surface of the cavity was very ragged,
and the uterine wall adjacent was ocdematous.
A cover-smear preparation was made from some of the
fluid in the interstices of the fibroid, and numerous Gram's
positive bacilli and a few streptococci were seen. All the
culture media, both aerobic and anaerobic, remained
sterile at the end of the fourth day. The cultures were
inoculated at the bedside.
The following is the report of the microscopical exa-
mination of the wall of the cavity :
"The longitudinal fasciculi (which form the investiture
of this growth) are teased asunder by an oedematous
process, which is not an unusual feature in the capsules
of interstitial growths of any size. The fibroid itself has
an area of so-called myxomatous degeneration, represented
histologically by a granular, fibrinous network, displacing
the fibromuscular bundles. The bulk of the section
shows the structure of normal looking fibromyomatous
tissue. The tumour shows no sign of pj'ogenic inflamma-
tion."
Both these reports were supplied by the Laboratories
of Pathology and Public Health.
The patient's temperature steadily fell after the opera-
tion, and by the third day it was normal. She continued
to gain strength and improved remarkably in appearance
CHOEIO-ENDOTHELIOMA OF UTEEUS. 57
during the first fortnight. At the end of this time she
began to have pain in the pelvis and some return of fever,
and six days later a tender, fluctuating swelling was
found slightly depressing the posterior vaginal wall. The
swelling was incised and a collection of pus evacuated.
After this the patient made an uninterrupted recovery.
CHOEIO-ENDOTHELIOMA OF UTERUS; INTRA-
PERITONEAL HEMORRHAGE ; HYSTEREC-
TOMY; DEATH.
By the late Dr. G. Bagot Ferguson.
[The Society cannot fail to admit how painful are the
circumstances under which this specimen is exhibited.
On September 14th, 1906, my friend and old fellow-
student, Dr. G. Bagot Ferguson, of Cheltenham, a Fellow
of this Society, sent me the specimen which I bring
forward this evening, and expressed a desire that I should
exhibit it for him at one of our meetings. Some corre-
spondence followed the receipt of the specimen, as I
considered that full particulars of the case were necessary,
and the last letter which I received from Dr. Ferguson
reached me only nine days before his terribly sudden
decease, on November 27th, when performing' an operation.
I am much indebted to Dr. Robert Kirkland, Physician to
the Cheltenham General Hospital, for kindly supplying
me with full notes of the case, which was originally under
his care in that institution, and to Mr. Shattock and Dr.
Cuthbert Lockyer for their opinion of the pathological
characters of the tumour. Alban Doran.~\
De. Kirkland's Report.
L. G — , married, aged 20, admitted into the Cheltenham
General Hospital on September 4th, 190G, under Dr.
Kirkland.
Family history unimportant.
58 CHORIO-ENDOTHELIOMA OP UTERUS.
Personal history. — The patient had always enjoyed good
health. She had been married one year. About three
months before admission she felt poorly, and consulted a
doctor, who informed her that she was suffering from
anaemia. Menstruation had ceased for three months, but
about three weeks ago she noticed a " dirty- water dis-
charo'e tinofed with blood." She stated that her abdomen
had been increasing in size for about a month. On
September 4th she was suddenly seized with severe pain
over the lower part of the abdomen, with sickness, and
her doctor advised her to seek admission into the hospital.
She was admitted under Dr. Kirkland, who saw her on
September 5th. He found her sitting up in bed with
severe dyspnoea, and pallor was very marked. Tempera-
ture 100*4° F., respiration 48, pulse 114, soft and slapping.
She complained of pain in the lower abdomen, where a
fulness could be seen extending nearly to the umbilicus.
The abdominal wall was somewhat rigid and exceedingly
tender. A large, round, and regular swelling could be
felt extending from the pelvic brim to the umbilicus, and,
laterally, more towards the right than the left. At the
right side its margin seemed well defined, and the fingers
could be insinuated between it and the iliac fossa, whilst
it was not so well defined on the left side. The percussion
note was dull over the swelling, but resonant all round.
Dulness did not change when the patient was placed on
her side. The tumour seemed movable laterally to a
slight extent. On vaginal examination the cervix felt
soft and short, the uterus was enlarged, and continuous
with the swelling on the right side. The os did not admit
the finger. There was no haemorrhage, nor any other
kind of discharge, nor any offensive odour. The pouch
of Douglas did not feel full nor boggy. A haemic murmur
could be heard over the pulmonary area. At the base of
the left lung, from beneath the heart to the spine, there
was impaired resonance Avith crepitation and faint breath-
sounds. There was neither expectoration nor haemoptysis.
The liver dulness was normal, the spleen not palpable.
CHORIO-.ENDOTHELIOMA OP UTERUS. 59
The diagnosis was pregnancy in the third or fourth
month complicated by an ovarian cyst with twisted pedicle
and intra-cystic haamorrhage. As operative interference
might be required at any moment. Dr. Gr. B. Ferguson was
asked to see her. He suggested the possibility of ectopic
gestation. Deciduoma or chorion-epithelioma was con-
sidered improbable. As there was no definite history of
abortion, and as the diagnosis was very uncertain, it was
agreed that operation should be postponed.
On September 6th the patient had less pain and distress.
On the 7th the sclerotics were noticed to be slightly tinged,
and the integuments had a generally diffused icteric tint.
On the 8th the pain again became severe, and the vomit-
ing recurred. It was found that the tumour had suddenly
increased in size, extending to an inch above the umbilicus.
There was, as throughout the patient's illness, no ha3mor-
rhage from the vagina. At a point midway between the
umbilicus and right iliac spine the maternal pulsations
could be heard distinctly simulating fcetal pulsations.
Operation was again postponed.
For a week after this examination the patient's condition
remained but little changed. The temperature, which had
fallen, never rose again to 100° F., but seldom fell below
99° F. at night. The pulse, however, remained high —
between 120 and 130.
On September 14th the patient became, if possible, more
pale, and grew extremely weak and restless, the pulse rising
to 138. As she was evidently dying it was decided to
open the abdomen at once.
Dr. G. B. Ferguson's Report.
I was asked this afternoon, September 14th, 1906, to
operate upon a young woman, aged 20, one year married,
who had symptoms of pregnancy and abdominal haemor-
rhage. I found a rough, red tumour which had originated
within the uterus, but had perforated it above and was
fungating and bleeding. The peritoneal cavity contained
60 CHORIO-ENDOTHELIOMA OF UTERUS.
mucli blood. I could find no foetus. Both ovaries were
cystic. Some omentum adhered firmly to the uterus, but
was separated and removed later. One of my colleagues
injected all the time during the operation, which lasted
half-an-hour, saline solution with 1 in 100,000 adrenalin
into the basilic vein, and warm saline was lavishly poured
into the abdominal cavity, wetting me to the skin. Soon
after I had cleared all away and sewed up the abdominal
wound the patient died.
The tumour had all the characters of a deciduoma.
Dk. Lockyer's Report of the Specimen.
The uterus is expanded and much distorted by a large,
solid, corporeal growth, which has eaten its way through
the fundus, where it presents as a red, f ungating mass.
Shreds of omentum adhere to the mass. The specimen
measures 8 in. across and 6 in. from above downwards.
As I received it the uterus was divided by an anterior
sagittal incision, exposing its cavity, which is filled as far
as the OS internum by a soft, red growth. The cervix
appears to be quite free from invasion. Above, the growth
has completely eroded the fundus, and extends for a con-
siderable distance above its limits. Posteriorly the peri-
toneal surface of the uterus is much altered by the
proximity of the tumour. In the upper half of the corpus
uteri the tumour presents posteriorly as dark-blue bosses,
covered only by peritoneum ; in the lower half the peri-
toneum and muscle of the uterine wall are normal in
appearance. Sections taken through the entire length of
the cervix and lower pole of the growth show that the
tumour invades the body of the uterus as far as the internal
OS, whilst the cervix remains healthy.
Microscopic appearances. — The tumour consists of a
combination of syncytium and its derivatives, with columns
and masses of Langhans's cells. The syncytium can be
CHORIO-ENDOTHELIOMA OF UTERUS. 61
seen invading vessels and taking the place of the endo-
thelium of their walls.
The ovaries are converted into cystic bodies, the larger
measuring 11 in. and the smaller 8 in. in circumference.
It is not clear which is the right and which the left
ovary. Two malignant nodules are attached to the larger
ovary ; one is of the size of a small Tangerine orange, and
occupies its lower pole, whilst the other nodule consists of
two lobes of the size of filberts, and lies higher up. Both
ovaries contain a number of thin-walled cysts, appearing
on the surface as semiti-ansparent bullee and dark-jDurple,
grape-like bodies. On cutting into the substance of the
larger ovary the malignant growth was found, as may be
seen on inspecting the specimen, to penetrate one of the
cysts. Both ovaries are cystic throughout ; their solid,
central core is reduced to a minimum. The largest
cysts lie towards the periphery, the smallest towards the
centre.
Microsco'pic a2)pearances. — The cysts in both ovaries are
lined with an abundance of lutein cells of the type
observed in early pregnancy. Some of the cysts have a
fibrinous investment internal to the lutein lamina ; others
have no such investment. The malignant growth is com-
posed of Langhans's cells packed into alveoli, the walls of
which are formed of syncytium.
[In conclusion, I may observe that intra-peritoneal
haemorrhage from a large uterine tumour is a rare, though
grave complication. The tumour is usually a fibroid.
The subject has been discussed by Drs. Lowers, Herbert
Spencer, and others before this Society, and more recently
by Mr. Bruce Clarke in the ' Lancet.^ "^ This case, how-
ever, for which we are indebted to our deceased colleague,
comes under a different category, as Dr. Lockyer's careful
report clearly demonstrates. — J..D.]
* " Intra-peritoneal Bleeding from a Uterine Fibroid with Acute
Distension of the Abdomen ; Abdominal Section ; Eemoval of the
Fibroid ; Recovery," ' Lancet/ January 5th, 1907, p. 8 ; -with references
to earlier cases.
62 ANNUAL MEETING.
Dr. CuTHBERT LocKTER liad practically iiotliiug to add to liis
detailed report of this growth. He liad investigated nine other
growths of similar uatiu*e, but this was the first specimen in
which an ovary was invaded by the tiimour. Ovarian metastases
were present in 5 per cent, of the recorded cases, and the same
frequency obtained for the intestines. The parametric connective
tissues were found to be the seat of new growi:li in 16 per cent,
of cases. In many instances, however, the uterus was found to
be ruptured by the primary growth, and it was just possible that
the cellular tissues became involved by direct extension in some
of these cases, just as is commonly the case with carcinoma
of the cervix. It was noteworthy that in this instance the cervix,
as is usual, escaped invasion. The ovaries were particularly
interesting, not only from the fact that in one there was a
secondary deposit, but mainly because these organs had been
transformed into compoimd lutein cystomata, and therefore
provided one more example of lutein excess accompanying
malignant overgro^vth of foetal trophoblast. It would be remem-
bered that the speaker had already published four similar
examples, and he knew of one other, but he (Dr. Lockyer) would
again draw attention to the fact that the lutein excess does not
always assume the form of a congerie of cysts, but may be
present amidst the stroma of normal-looking ovaries. As to the
mode of transference of the malignant growth to the ovary, Dr.
Lockyer di-ew attention to the fact that the growth was situated
on the pole of the ovary most remote from the hilum, and
thought that, as the omentum was adherent to the pelvic organs
and was also the seat of a large chorio-epitheliomatous mass, that
possibly the ovarian deposits sprang from cells carried from
uterus to ovary via the omentmn rather than by the anatomical
blood-vessels, which enter the hilum of the gland.
Annual Meeting.
The audited Report of the Treasurer (Dr. Gr, E.
Herman) was read.
On the motion of Dr. Amand Routh, seconded by
Dr. J. S. Faiebaien^ the Report of the Treasurer
(Dr. G. E. Herman) was received and adopted.
ANNUAL MEETING.
63
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64 ANNUAL MEETING.
Re'port of the Honorary Librarian.
The work of the Library has been carried on as usual
during the past year.
The total number of volumes in the Library amounts to
6272, of which 62 are periodicals. Of these 20 are
publications bound in two volumes annually, and the
remaining 22 in one volume annually.
During the year 39 volumes have been added, 28 of
which have been presented and 11 purchased. In
addition 240 German Inaugural Dissertations have been
purchased.
The number of Fellows visiting the library and the
number of books taken out remain about the same as
last year. William J. Gow.
The Report of the Hon. Librarian, Dr. W. J. Gow, was
received, and its adoption was moved by Mr. Alban
DoRAN, seconded by Dr. T. W. Eden, and carried.
The following Fellows were declared elected to serve
on the Council of the Society for the Session 1907 :
President. — Herbert R. Spencer, M,D.
Vice-Presidents. — Albert C. Butler-Smythe ; Montague
Handfield- Jones, M.D. ; John Phillips, M.D. ; William
Japp Sinclair, Knt., M.D. (Manchester).
Treasurer. — George Ernest Herman, M.B.
Editor of ' Transactions.' — Herbert R. Spencer, M.D.
Honorarij Secretaries. — Robert Boxall, M.D. ; Arthur
H. N. Lowers, M.D.
Honorary Librarian. — William John Gow, M.D.
Other Members of Council. — Henry Russell Andrews,
M.D. ; Henry Briggs, M.B., F.R.O.S. (Liverpool) ;
William H. B. Brook, M.D. (Lincoln) ; Charles James
Cullingworth, M.D. ; George Eastes, M.B., F.R.C.S. ;
Thomas W. Eden, M.D. ; John Shields Fairbairn, M.D.,
B.Ch. ; John Benjamin Hellier, M.D. (Leeds) ; Henry
ANNUAL MEETING, 65
Thomas Hicks, F.R.C.S. ; Jamieson Boyd Hurry, M.D.
(Reading) ; John Martin Munro Kerr, M.B., CM.
(Glasgow) ; Cuthbert Lockyer, M.D., B.S. ; Charles
Hubert Roberts, M.D. ; Amand Routh, M.D. ; Mary
Ann Daconib Scharlieb, M.D. ; James Henry Targett,
M.S., F.R.C.S. ; Herbert Williamson, M.B. ; Thomas
Wilson, M.D. (Birmingham).
Mrs. Scharlieb moved, and Mr. Butlee-Stmthe
seconded, a vote of thanks to the retiring Vice-
President, Dr. Amand Routh, and to the other retiring
members of Council, Dr. E. Rumley Dawson, Dr.
Ewart, Mr. Handley, Dr. Lea, Dr. John Phillips, and
Dr. Swayne.
The President then delivered the Annual Address.
VOL. XLIX.
66
PEESIDENT'S ANNUAL ADDRESS, 1907.
Ladies and Gentlemen, — It becomes my duty once
more to occupy your time in the recital of the progress of
our Society during a past year, both as a scientific and as
a corporate body. Looking at the subject in the latter
aspect there are great changes in prospect, and I shall
allude to this again ; but in the former we shall find, I
believe, that there is no change, for there has been no
departure from the steady determination to seek for truth
in Nature which is characteristic of this Society.
I have first to make a statement as to the number of
Fellows on our roll. We have lost by death thirteen
Fellows, of whom one. Professor Gusserow, was an
Honorary Fellow ; by resignation and erasure, I am sorry
to say, twenty-six — in all thirty-nine. We have elected
twenty-one new Fellows. Our numbers are therefore
smaller than they were last year, for then we had 595
Ordinary FelloAvs, whereas this year there are 577.
The Fellows we have lost by death since my last
address number among them some exceptionally dis-
tinguished men. Of these, the best known to the world
is Gusserow; the best known to us personally is Dr.
Hamilton Bell. To these names I deeply regret to add,
at the last moment, that of Dr. Budin.
Thomas Rutherford Adams, M.P., J.P., was born in
Ireland, and came to London to enter as a student at the
Westminster Hospital. He became House- Surgeon there,
having qualified in 1860. He took the degree of M.D.
Brussels, in 1865, after he had been in practice at Croy-
don for two years. He became a Fellow of this Society
in 1884, and was on the Council from 1894 to 1897. Dr.
Adams was one of the founders of the Croydon General
ANNUAL ADDEESS. 67
Hospital, which was about to be organised when he arrived
at Croydon, and he was one of the first members of the
medical staff. He was made public vaccinator for the
district of Croydon in 1869. Dr. Rutherford Adams was
a person of many interests outside the profession. Among
other things he was a member of the Croydon Literary
and Scientific Society, and an active Freemason. He
seemed to have been loved by both poor and rich. He
was a well-known member of the British Medical
Association. He died in the last week of 1905.
Harry Campbell Pope, M.D., B.S., F.B.C.S.~Dy. Pope
was the son of a medical man, and was born at Tring in
1849. He was at school at Haileybury, and then went to
Liverpool for his medical education. He remained there
for four years, and came up to University College Hos-
pital. He graduated as M.D. in 1878, having taken the
Fellowship of the College of Surgeons in 1876. Before
settling into practice he wasHouse-Surgeon at the Seamen's
Hospital, Greenwich, and Medical Tutor and Demonstrator
of Anatomy at the Queen's College, Birmingham. He
began private practice in Shepherd's Bush, and remained
there till his death on January 2nd, 1906. Dr. Pope
took great interest in public medical matters. He
became a Fellow of our Society in 1876, and was on the
Council from 1902 to 1904. He was also a Fellow of the
Medical Society, and of the Gynecological Society. He
helped to found the West London Medico-Chirurgical
Society, and was first Vice-President, and then President,
of that Society. He edited its ' Proceedings ' in 1895 and
1896. His contributions to medical literature included
papers on diphtheria, inguinal colotomy, diseases of the
pancreas, and the feeding of infants. He was a very
active member of the Medical Defence Union, being
Honorary Secretary for a time, and on the Council till his
death. The high esteem in which he was held by the
medical men around him is shown by the fact that he was
chosen to be the first Chairman when the Kensington
Division of the British Medical Association was instituted
68 ANNUAL ADDRESS.
in 1903. He filled the post with, much success^ and it is
no doubt greatly owing to his wise governing that this
Section is in so prosperous a condition as that in which it
now finds itself. Dr. Pope was Medical Officer to the Fire
Brigade, and was Physician to the Jewish Rescue Home.
He was at work up to the end, and was present at a meeting
of the Council of the Medical Defence Union on December
22nd, and seemed then in his usual health. He died quite
suddenly on January 2nd, aged 56.
Gelieimrath Profexsor Dr. Adolpli Gusseroic, who had
been one of our Honorary Fellows since 1895, was the
well-known Professor of Obstetrics and G-ynascology at the
University of Berlin. Professor Gusserow was the son of
a distinguished physician of that city, and was born there
in 1836. He studied in the University, and afterwards at
Wurtzburg and Prague. After passing the State exa-
mination he acted as Assistant in the University Frauen-
klinik to Edward Martin. Later on he studied in this
country under Sir James Simpson, who appears to have
exercised a great influence on his career and development,
and to have remained always one of his sincerest friends.
This friendship and esteem were evident in the address
in memory of Simpson delivered when Gusserow was
Rector of Zurich University.
On his return to G-ermany he was soon appointed
Professor of Obstetrics at Utrecht, and almost immediately
afterwards was promoted to succeed Breslau at Zurich.
He effected great improvements in the Maternity Hos-
pital, which was constructed on anything but modern
lines; and under his direction a new building was planned.
It was not, however, until he had left Zurich and was
succeeded by Frankenhauser that the Clinic was finished
and brought into use. He was made Rector of Zurich
University in 1870 — an appointment of some difficulty and
delicacy at that time, since the feeling of the University
in" the war then raging was German, while that of the
townspeople was decidedly French.
G-usserow stayed at Zurich for five years. From thence.
ANNUAL ADDRESS. 69
in 1872, he went to Strasburg — an University newly
founded after the war. He was accompanied here by
Zweifel, at that time his assistant. He left behind him
at Strasburg, as elsewhere, evidence of his energy in a
new woman^s hospital with lying-in wards.
Being now called to Berlin to take charge of the
recently instituted Charite, his great experience in
organisation enabled him to bring the Obstetrical and
Gynascological Departments of the University, and the
Clinic attached thereto, into the leading position they hold
at present. He held the Professorship till within two
years of his death, and resigned it only on account of his
failing health. Soon after his return to Berlin he had
made a most happy marriage^ and became the father of
three daughters.
Wyder, of Zurich, writing of him in the ' Monats.
f. Geb. u. Gyn.^ of April, 1906, speaks of his personal
character in the highest terms. He says : " No one will
accuse me of exaggeration when I assert that Gusserow
was an accomplished gentleman, with splendid endow-
ment of head and heart." Gusserow had the highest
possible sense of duty, and won the love of his patients,
of his colleagues, and even of candidates at examinations.
He was not a brilliant operator, and this could not be
expected in a man who did not begin to .perform major
operations till he was forty-five years of age. But as
clinical teacher he excelled all others.
He wrote very little, his principal contributions being
the section on "Die Xeubildungen des Uterus," in Billroth's
' Handbuch,^ and his "Researches on the Interchang-e of
Gases in the Foetus.^^ He edited, at first in conjunction
with Crede and later on with Leopold, the 'Archiv f.
Gyniikologie,' and he was engaged in this duty till shortly
before his death, which occurred on February 6th of last
year.
Thomas Edmonston Charles, 3LD., F.R.C.P., Deputy
Surgeon-General in the Indian Medical Service, Hon.
Physician to the King, was born in Calcutta in 1834.
70 ANNUAL ADDRESS.
He was educated at Edinburgh, and became M.D. in 1855.
He then went to India as a member of the Bengal
Medical Service. Being attached to the Bengal Fusiliers
he took part in the famous march from Dogshai to
Umballa in the 1857—1858 campaign. He served through
the siege of Delhi, and after some more fighting he
accompanied Lord Clyde and his army in the second
advance on Lucknow. Here he was in the storming
party of the Bengal Fusiliers, who took the enemy's first
position. He was afterwards in Oudh with Sir Hope
Grant, and was mentioned in despatches. He received
the Indian medal and clasps for Lucknow and Delhi.
In 1859 he was appointed Garrison Assistant-Surgeon
at Allahabad, and soon after this Professor of Midwifery
at the Bengal Medical College, a post which he filled in
the most efficient manner, and greatly advanced the
cause of medical education in India. He founded the
Eden Hospital in Calcutta, and took the greatest share in
the organising and establishing of this institution.
His health obliged him to come to Europe in 1880,
and he settled at Cannes, practising there with great
popularity and success. After six years he went to
Eome, and was attracted to the study of archasology,
becoming somewhat of an authority in this subject.
He was now again obliged by failing health to seek a
milder and more equable climate, and Falmouth was
chosen. Here he took some part in public matters, and
became Chairman of the Truro Division of the British
Medical Association. He was prevented by ill-health
alone from accepting the position of President-Elect of the
South-Eastern Branch. He died on March 2nd, aged 72.
Dr. Charles joined our Society in 1867, and was on the
Council from 1882 to 1884. Sir Joseph Fayrer, who
knew him well, says of him : " Dr. Charles was a many-
sided man. In addition to his study of archaeology
he was much interested in microscopical research, and
revised the New Sydenham Society's translation of
Marchiafava's and Bignani's work on malarial fever.
ANNUAL ADDRESS. 71
He was, so far as kis physical energy would permit, an
enthusiastic mountaineer. . . . He was a fisherman
in early life and took great interest in sport of all kinds.
. . . His great professional ability, the strenuous and
energetic manner in which he performed all his duties,
his high sense of honour, his amiable character, and his
earnest desire to be of use to everyone, not only enhanced
his value as a public servant, but endeared him to all
with whom he was associated, and especially to those
who, like the present writer, had known him throughout
his career and appreciated the sterling qualities of his
character."
Michael McWilliams Bradley, M.D., was elected a
Fellow of this Society in 1877. He was educated at
Grlasgow University, and went to practise at Jarrow-on-
Tyne in 1872. He held several public appointments,
and was on the Commission of the Peace for twenty years.
He was a Nationalist in politics, and was President of the
Wolfe Tone branch of the United Irish League. He was
on more than one occasion considered as a candidate for
a constituency in the North of Ireland. He was greatly
loved and esteemed for his genuine kindliness by all who
knew him. He contributed a paper to the ' Obstetrical
Journal ' (vol. vi) on " Post-partum Hasmorrhage, w,ith
Notes of Three Cases successfully Treated by Compression
of the Abdominal Aorta " ; and another to vol. vii of the
same journal entitled " A Contribution to Midwifery
Statistics." He died on May 2nd of last year.
Franklin Hewitt Oliver was elected a Fellow in 1888.
He was born in 1859, and died last September at the
early age of 47. He practised in Bethnal Green, and was
one of the best-known and most popular men in the district.
He was educated at Charing Cross Hospital, where he
afterwards held the post of Eesident Obstetric Officer.
Dr. Oliver held many public appointments, being for
several years Chief Surgeon to the Royal Maternity
Charity. He was at the time of his death Surgeon-
Accoucheur to the City of London Lying-in Hospital.
72 ANNUAL ADDKESS.
His last two years were however, spent on a sick-bed,
and after a life of unstinting devotion to a practice among
the poor he died, worn out with pain, which he had borne
with courage and patience.
Robert Haviilton Belt, M.A., M.B., B.C., F.R.C.8., died
in October. It is sad enough to have to record the death
of those Fellows of our Society with whom we have had
but little acquaintance, and some of whom we knew by
name only ; but in the case of Dr. Bell each of us must
feel that he has sustained a personal loss. It is a still
greater sorrow to remember that he was taken from us,
not after he had seen the fruition of a life's work and had
lived to a good old age — for these conditions to some extent
mitigate the shock of his death to a man's friends — but
when he was yet almost on the threshold of his career.
His career was certain to have been a brilliant one — his
earnestness, his energy, and his ability all assure us of
that. But there was much more than even these qualities
in him. He was a man without, I believe, a single enemy,
and that, not because of a colourless and insignificant
character, but because he was transparently honest,
because he took a broad view of life, was of a kind and
generous nature, and was free from all meanness and
petty jealousy.
Dr. Bell was born in 1871, and was educated at
Cambridge and at St. Thomas's Hospital, entering as
a student there in 1895. He was House-Physician
and Obstetric House-Physician there, having taken the
degree of M.B. in 1898. He began practice in Kensington
in 1899, but, having a strong desire to work at obstetrics,
he applied for, and was appointed to, the post of Physician
to Out-patients at the Samaritan Free Hospital. He
now took the Membership of the College of Physicians
and also the Fellowship of the College of Surgeons. The
following year found him Obstetric Tutor at his old
Hospital. In 1905 he obtained the post of Assistant
Obstetric Physician to the Great Northern Hospital, and,
the year after, the Assistant-Physiciancy to the British
ANNUAL ADDRESS. 73
Lying-in Hospital. He had become a Fellow of this
Society in 1901.
Dr. Bell's death was veiy sudden. He was at work at
St. Thomas's on October 26th, and was dead of pneumonia
on the 29th. He was, at his death, 35 years of age, and had,
as we have seen, devoted himself to the study of obstetrics
purely for only about five jeArs. When we consider the
amount of work he accomplished, not only in pathological
research and in the publication of valuable papers, but
in the numerous hospital appointments which he had
obtained in such rapid succession, we see that he had
expended more and better-directed energy in these few
years than most men are able to display in a life-time.
He had learned
" To scorn delights and live laborious days :
But the fair guerdon when we hope to find.
And think to burst out into sudden blaze,
■ Comes the blind Fury with the abhorred shears
And slits the thin-spun life."
He had distinguished himself in both literary and clinical
fields. There is no need for me to remind the Fellows of
our Society of his contributions to its * Transactions.''
These, as v^^e consider them in the order of their produc-
tion, showed an increasing acuteness of vision and power
of generalisation ; and his last paper, on a very important
question — that of the diagnosis and treatment of early
ectopic gestation — on which he was engaged at the time
of his death, illustrates his judicial faculty in a remark-
able manner. This paper shows also that he Avas a master
of good English and of clear exposition.
A writer in the ' British Medical Journal,^ one of his
colleagues at the Samaritan Free Hospital, speaks of the
deep impression made on the staff of that hospital (than
whom there are none better qualified to decide) by his judg-
ment and clinical knowledge, and says they were all of one
accord concerning his ability as an operator."* The power of
* A brass tablet to Dr. Bell's memory has been fixed in the Samaritan
Free Hospital by his medical and surgical colleagues.
74 ANNUAL ADDRESS.
teaching — a rare power — was in him highly developed. At
St. Thomas's his pupils found his interest in their work .
never failing and always discriminating. His kindness
and consideration towards his patients have been remarked
on by many who have written of him ; and I well remember
being struck with this on one occasion, in a very sad case,
while he was still in general practice in Kensington. It
was the first time I had met him, and I could not help
at once recoernisino* in him a man so kind and so self-
sacrificing that it was a privilege to know him. I can
imagine no worthier ambition for any man than that of so
li^^ng as to be cherished in the memory of his friends, as
Bell is, and ever will be.
George Bai/ot Ferguson, M.D., M.Ch., F.R.C.S., was
admitted a Fellow in 1901. He died suddenly in November
last Avhile performing an abdominal operation in the
Cheltenham Hospital.
Dr. Ferguson was educated first at Cheltenham
College, then at Oxford, and finally at St. Bartholomew's
Hospital. He became House Surgeon there, and then
went into practice at Cheltenham. He was appointed
very shortly after his arrival to a post on the honorary staff
of the Hospital, and at the time of his death was Senior
Surgeon. He had been hurriedly sent for to operate on
a case of strangulated hernia ; and while he was resecting
a piece of gangrenous intestine he suddenly fell down, and
he died very soon after. He had not been strong for
some years, and shortly before his death had suffered
from angina and other heart symptoms.
In 1901 Dr. Ferguson was President of the British
Medical Association, and delivered an address on scientific
research. He was a man of marked influence in
Cheltenham, and always exercised this in promoting the
welfare of the town and its inhabitants. It is to a great
extent by his exertions that the mineral waters of
Cheltenham have become known to the profession. He
was much valued as a consulting and operating surgeon in
the town and surrounding district. He contributed
ANNUAL ADDRESS. 75
numerous articles on surgical subjects to the medical
papers and to hospital reports.
A few weeks only before his death he sent the specimen
which we have seen this evening to Mr. Doran, who
introduced it in feeling terms ; it was the first contribu-
tion he had made to our proceedings.
miliam Travers, M.D., F.B.G.S. — Dr. Travers was a
well-known practitioner in Kensington, where he was
deservedly popular and successful. He was born in
1838. He became a student at Charing Cross Hospital,
and afterwards performed the duties of Resident Medical
Officer to that Institution for six years before beginning
private work. In 1883 he was elected Physician to the
Chelsea Hospital for Women, and held this appointment
till 1894. He was some time President of the West
London Medico-Chirurgical Society, and would have
been President of the Gynaecological Society if his
failing health had not obliged him to decline the office.
Dr. Travers suffered from increasing loss of sight towards
the close of his life, but he persevered in work till almost
the end. He died on December 17th after an attack of
pneumonia following influenza.
Dr. Travers was a man of general and widespread in-
terests, and his loss is severely felt by those who were his
patients and his friends. He had been a Fellow since 1884.
Alexander Waugh, M.B., CM., was admitted a Fellow
also in 1884. He died on December 9th, aged 66. Mr.
Waugh was educated at Bristol and St. Bartholomew's
Hospital, and qualified in 1863. He then went to practise
at Midsomer Norton, near Bath. He took a great share
in building the Cottage Hospital there, and was in every
way a benefactor to the neighbourhood. There was little
belonging to the occupations and amusements of the
country in which he was not able to take a part, and he
was loved and respected by all the country side. He was
President of the Bath and Bristol branch of the British
Medical Association in 1880.
We have also lost by death Dr. Lyons, of Thames
76 ANNUAL ADDRESS.
Ditton ; Dr. Mitchell, of St. Leonard's ; Mr. William Gill,
of Eussell Square ; and Dr. Verlcy ; but, unfortunately,
all attempts to obtain any special accounts of the lives of
these gentlemen have proved unsuccessful.
It is with the greatest regret that I add to this list
the name of Professor Budin. He died on January 22nd
from an attack of pneumonia. The time was too short
for me to prepare an adequate account of his life and most
valuable services to obstetric medicine, and I must leave
this to be done by my successor. Dr. Budin was one of
our Honorary Fellows, and was elected in 1899.
Work op the Society.
The record of the Society's work during the past year
is a very satisfactory one, as we shall see in the brief
account of it, which it is my duty to put before you.
I will group the material into: (1) papers on obstetric
subjects; (2) papers on gynaecological subjects; (3) short
communications on obstetrics; (4) the same in gynaecology;
(5) specimens.
Papers on Obstetrics.
Dr. Herman read a paper in June entitled " A Case
showing (a) Uterine Contractions without Retraction ;
(b) Prolonged High Temperature of Nervous Origin."
The author recorded a case which was interesting from
two points of view. One was the condition of the uterus
for a time during labour, in which it contracted regularly
without advance of the child, although the child was
premature and thus small, and there was no obstruction.
The other phenomenon was an event of the lying-in period.
This was unduly prolonged by raised temperature. The
woman's state was made alarming by repeated rigors,
during each of which the fever reached the neighbourhood
of 105° F.
The author considered the long standstill, in spite of
uterine contractions, to have been due to the absence of
ANNUAL ADDEESS. 77
retraction of the uterus. Retraction, however, did take
place at last. The incompleteness of the third stage seems
to be accounted for by abnormal adhesions over a small
area. After manual removal of the placenta on account
of excessive bleeding the patient was very prostrate, with
a small and quick pulse, and two pints of warm water
were injected into the rectum.
Before labour had begun, and soon after the introduction
of a bougie, she had a shivering fit, and her temperature
rose to 106*4° F. It came down in five hours after this
to 100° F., but rose again on the day following delivery
to 103° F. She had fever till the twenty-fifth day after
delivery, with rigors on the seventh, ninth, tenth, fifteenth,
eighteenth, and nineteenth days of the puerperium. In
spite of these severe symptoms the patient looked placid
and happy. Every possible source of fever seems to have
been considered and investigated according to our present
lights, but no cause could be found. The blood was sterile
on the ninth day, but the skin sloughed at the site of
puncture. She was treated with polyvalent antistrepto-
coccic serum on the eleventh day, but no appreciable effect
was produced. The injection was repeated on the nine-
teenth day after the rigor, and the temperature had fallen
next morning to 98^ F.
Dr. Herman remarked on the unusual character of the
case, and pointed out how it illustrated the difference
between contraction and retraction of the uterus, taking
the view that for more than twenty- four hours contractions
were present without any retraction, as evidenced by the
non-advance of the child. He considered that the pro-
longed high temperature with rigors was of nervous, not
hysterical, origin, and related another case which occurred
in his experience. In this there was a high temperature
for some weeks after the removal of a fibroid polypus,
without any physical sign, except a mild cystitis, to be
found. This woman was in very good condition in spite
of the pyrexia. He instanced other cases of high tem-
perature in patients of nervous and of hysterical types,
78 ANNUAL ADDRESS.
and pointed out that in all these instances, in some of
which the pyrexia lasted for weeks, there was no emacia-
tion nor enfeeblement.
The paper was well and critically discussed, and both
the points dwelt on by the author were handled very
freely. Each of the speakers who touched on the
retraction question had his own view as to how retraction
should be defined, and mistrusted all others, even including
the definitions in the English text-books. There seemed
to be no vital difference between the conceptions respec-
tively advanced by the various authorities who spoke nor
between their methods of teaching them to students. It
was agreed generally that retraction does not occur Avith-
out contraction, but on the question whether contraction
may occur without retraction — the main point of this part
of the paper — Dr. Williamson said he believed that con-
traction and retraction go hand in hand in labour (pre-
sumably normal labour), but did not say whether he thought
they might be dissociated in abnormal conditions ; and
Dr. Horrocks, who has fully dealt with this subject in an
article in the ' Journal of Obstetrics and Gynaecology ,'
January, 1902, believes that retraction — meaning, accord-
ing to his own definition, " contraction followed by relaxa-
tion (that is, the passing off of the uterine contraction)
but not by extension " — must have occurred in this case,
for there was no force present which would have extended
the uterine muscle after the contraction was over. He
believed, in fact, that each of the contractions described
by the author must have been followed by retraction.
In reference to the high temperature. Dr. Lewers
suggested uterine phlebitis as a cause, but Dr. Herman
would not agree to this for the reasons excluding sepsis
which he had stated in the paper.
In November Dr. Rivers Pollock read a paper on
" External Version, its Present Position in Obstetrics,
with a Suggestion of a New Method of Performing it.^'
Dr. Pollock described the present position of external
version in the civilised world, and discussed the question
ANNUAL ADDRESS. 79
of the proper time to perform it. He considered also the
difficulties of the operation and how to overcome them.
He believed that most important assistance was obtained
when the patient was suspended by her feet and her trunk
was rendered vertical, or as nearly so as practicable, so as
to induce disengagement of the breech, in podalic cases,
from the pelvic brim of the mother. After the disengage-
ment had been thus accomplished the breech could be
prevented from again descending into the brim by pressure
of the hand on the abdomen of the woman below the child's
breech. The patient could then be placed on her back
and the remainder of the version performed in the usual
way.
The result of inversion of the patient as afPecting the
angle made by the uterus with the horizon was discussed,
and Dr. Champneys pointed out that, to put the uterus'
upside down, the best posture was the genu-pectoral.
Dr. Pollock said he had tried that, and the breech did not
move out of the pelvis.
GYNJiCOLOGICAL PaPERS.
In January Dr. Griffith and Dr. Williamson read an
interesting and important paper on "A Case of Fibro-
myoma of the Uterus Undergoing Sarcomatous Change."
It occurred in a patient, aged 56, who suffered from
abdominal pain. She was known to have uterine fibroids,
and had been examined six years before on this account!
Nearly two months before admission into the hospital she
had begun to have the pain, with cough and night-sweats,
and she now had diarrhoea and a temperature of 101° F.
The diarrhoea soon subsided, but the temperature remained
high, and she was obviously ill. She was examined three
weeks after her admission, and there yet seemed nothino-
to connect the uterine tumour with her illness. But she
steadily got worse, and had rigors and pain in her chest.
Peptonuria had been discovered soon after her admission,
and this had suggested some necrotic change, probably in
80 ANNUAL ADDRESS.
the fibroid. A month after the examination referred to
she began to lose blood from the vagina in fairly large
quantity, and she was urged, in view of her condition, to
submit to an exploratory operation, but she refused. In
a few days she got much worse ; her pulse was 120 and
her respirations 40. There were now some signs in the
right lung, and malignant growth with secondary deposits
was suspected. Soon after this she died.
At the post-mortem examination sarcoma was found in
the lungs, and in the uterus many fibromyomata. One
of these latter showed two varieties of growth — (a) dense,
white, fibrous-looking tissue, the continuity of which was
broken by the presence of {h) masses of friable material
of a deep red or brown colour. The white part was tibro-
myoma and the brown part was sarcoma. Microscopically
the former was at one place invaded by an elongated
strand of sarcomatous cells, resembling exactly those of
the red part, and being of various sizes and shapes. Most
of them were round, some were spindle-shaped, some were
large, and contained six or eight nuclei. The authors
discussed the relations of sarcoma and fibromyoma, and
discarded the term " malignant degeneration " as inaccu-
rate and confusing. They pointed out four possible con-
ditions, each of which had been described as " malignant
degeneration." They were of opinion that this case
ought to be assigned to the group in which a sarcoma
arises de novo in a pre-existing fibromyoma, or possibly
to that in which the cells of the original fibromyoma
assume malignant characters. They further thought it
probable that the sarcoma may, in part at least, have
originated in muscle-cells. We owe the authors a good
deal for their excellent description of this case, and it
is to be hoped that more evidence as to the proneness of
fibroids to undergo malignant change may be forthcoming,
and be presented in such a form that it may be criticised.
At the meeting in March, Mr, Malcolm read a paper on
^' Peritonitis and the Staphylococcus albus." The object
of the essay was to show that the micro-organism in
ANNUAL ADDEESS. gl
question was not responsible, as had been alleged, for
certain cases of peritonitis, since it was found in many
peritoneal cavities where there was no evidence of its
presence except that of the microscope or of culture
investigations. Mr. Malcolm is well known to hold the
view that mflammation, including, of course, peritonitis
may be an aseptic process. He considered that the
evidence of Messrs. Dudgeon and Sargent as enunciated
m their work on the "Bacteriology of Peritonitis,- that,
febrile disturbances frequently found after efPusion of
blood into the peritoneal cavity are due to the presence of
this organism,- is unconvincing. He argued that a
staphylococcus which is present invariably in intra-
peritoneal blood-clot, and may exist there without pus-
formation for three months, is a different coccus from
that which produces suppuration. On this Mr. Percy
Sargent remarked that Mr. Dudgeon and he had been at
pams to demonstrate that the white staphylococcus, the
subject of this paper, was not the same as the Staphylococcus
pyogenes albus, and had never suggested that it caused
the suppuration which sometimes follows on an old pelvic
haematocele. In regard to the question of the absence of
micro-organisms in suppuration, Mr. Sargent drew a careful
distinction between the terms « aseptic - and - sterile,- as
apphed to wounds, the former meaning only the absence
ot any clinical signs of inflammatory reaction, and the
latter meaning absence of micro-organisms. He was
evidently of opinion that all cases of inflammation of the
peritoneum would eventually turn out to be due to
micro-organisms.
Mr. Malcolm's paper is full of interesting matter and
origmal ideas, and an attempt to condense it for an
occasion of this kind would not do it bare justice. I
have, therefore limited myself to giving the main points.
^ Dr. Addmsell read a paper in April with the title of
Chronic Infective Metritis." He dealt with the nature
and treatment of certain cases of uterine hemorrhage,
'Tol!xlix."''''''^^'^ "' "^"^ *^""'^ ""^ ^^^ gross lesion
6
82 ANNUAL ADDRESS.
to be found. The paper was illustrated with a large
number of lantern slides of microscopic sections taken
from uteri removed hj him in consequence of this intract-
ability. Dr. Addinsell described three stages as evidenced
by the microscope in the development of the complaint,
beginning with the usual signs of inflammation round the
blood-vessels and invading the intermuscular connective
tissue, then surrounding those mucous glands which lie
deepest in the muscular wall. After this, sclerotic changes
in the tissues, thickening of the arterial walls, chiefly in the
middle coat, and dilatation of the capillaries. The author
considered that the age of the patient had little to do
with the incidence of the disease, and that his cases
differed from those of hcemorrhage of the climacteric
period discussed by Barbour, and also from those of
arteriosclerosis described by Palmer Findle3^ The
Fellows who spoke on this paper all agreed that it
concerned a most important clinical group of cases, which
offered great difficulty in treatment. It was doubted
whether, on the evidence adduced, the cases could be
fairly ascribed to infection, for the changes found were
not in the submucous layer principally, as would be
expected on that assumption, but in the parts where the
changes due to child-bearing and presenility are found.
Dr. Blacker alluded to the success he had had in such
cases as the author described by treating them with
steam at 120° C.
At the July meeting Miss Louise Mcllroy, M.D., read
a paper on " Primary Cancer of the Ovary." As the
result of examining fifteen cases of undoubted cancer of
the ovary she had come to the conclusions given below,
which she divided into two groups :
(1) Those arrived at from the clinical stand'point. —
That primary cancer of the ovary occurs in women about
the time of the menopause or after, but is found in young
patients, causing, in the latter, cessation of menstruation.
That previous child-bearing has no influence, that pain is
not marked, that ascites is present usually, that meta-
ANNUAL ADDEESS. 83
stasis depends on the duration of the disease and the
integrity of the tumour-capsule, that the probability of
recurrence is great, and that malignancy is rarely sus-
pected before operation.
(2) Those from pathological investigations. — That both
ovaries are frequently affected, one being more advanced
than the other ; that in the early stage the capsule is firm,
but later on breaks down, and that the tumour-tissue
proliferates through it ; that germinal epithelium is absent
as a rule, and no Grraafian follicles or corpora lutea are
found ; that previous benign change in the ovary is
constant ; that the most common forms are the glandular
cystic form and the alveolar form, with connective tissue
increase ; that it begins near the surface and arises from
the follicles and from cells which have been derived from
the germ-epithelium.
The paper was highly appreciated, and Miss Mcllroy
is to be congratulated on her work. In answer to a
question she said she considered that the naked-eye
appearance of cystic growths of the ovary was of little
aid toward determining their innocence or malignity in
the majority of specimens. It would, therefore, appear
that we ought to remove all adenomatous ovarian tumours
whole, without tapping, however large they may be.
In October Mr. Eric Young described -a case of that
rare disease, primary tubercle of the cervix uteri. A
woman with no family history of tubercle began to suffer
from menorrhagia and a thick, yellow discharge, with
constant aching pains in the sacral and hypogastric
regions. There was no intermenstrual bleeding.
On examination she was slightly tender in the hypo-
gastrium and left iliac regions ; the cervix was indurated
and greatly enlarged, its surface uneven and ulcerated in
places, and in places nodular and papillary; friable no-
where. There was no sign of tubercle in the lungs.
On account of the suspicious nature of the cervix
vaginal hysterectomy was performed.
The cervix was reported on by two independent
34 ANNUAL ADDRESS.
observers. One of them stated tliat there was no miliary
tubercle, but that the specimen consisted of inflammatory
material, with here and there a giant-cell. He thought
the lesion might be of inflammatory origin. The other
reported that the area of ulceration extended, in addition
to that already described, as far up as the internal os.
He found, on microscopic examination, that many typical
tubercles were present ; in the centre were giant-cells,
some of which presented as many as fifteen or twenty
nuclei arranged round the periphery. He had no doubt
that the specimen was an example of tuberculosis of the
cerA'ix.
The author then proceeded to discuss the literature of
the subject and the difflcuhies of a clinical diagnosis.
This was a valuable paper on account of the careful
record it contained of a case of rare occurrence, of the
similarity of the disease in some respects to carcinoma,
and of the satisfactory results of treatment.
Dr. Victor Bonney read a paper in December on the
"Treatment of Ovarian Prolapse by Shortening the
Ovarian Ligament."
He considered the cases of ovarian prolapse in three
groups :
(1) Primary uncomplicated ovaHan prolapse. — In this
group he considered that the operation was indicated
where there was dyspareunia and chronic ovarian pain.
(2) Ovarian prolapse secondary to, or coincident with,
retroversion of the uterus. — In these cases, where a cure
could not be obtained by pessaries, shortening of the
ligament, combined with ventrofixation or suspension of
the uterus, was the best course.
(3) Ovarian prolapse caused by, or complicated with,
disease of the ovary or tube, with or without fixed retro-
version of the uterus. Here the author ad\ased salpin-
gectomy, combined with ventrofixation and shortening of
the ovarian ligament.
Dr. Bonney described his method of performing the
operation, which consists in pleating the ovarian ligament
ANNUAL ADDRESS. 85
by a " gathering " stitch so as to bring the ovary up
under the cornu.
This paper was discussed by several Fellows, most of
whom were not in favour of operating in such cases as the
author described in the way he recommended except under
rare circumstances.
Short Communications on Obstetric Subjects.
At the January meeting Mr. Anstruther Milligan read
a short paper on " A Case of Pyelonephritis of Pregnancy."
He related the history of a patient, who, six weeks before
her confinement, began to have symptoms of trouble in her
left loin. Her labour was normal, but three weeks after
she was admitted into the Soho Hospital, and a large
amount of pus was evacuated from the pelvis and ureter
of the left kidney. No stone or caseating matter was
found. She recovered, and had another child about fifteen
months afterwards with no return of the trouble. Mr.
Milligan then proceeded to discuss the possibility of the
pyelitis being directly due to the pregnancy, and con-
cluded that this was beyond question. He ascribed the
connection to some injury done to the ureter by compres-
sion, but was unable to state exactly how this occurred.'
In February Dr. Spencer gave an account of " A Second
Case of Abdominal Ovariotomy during Labour." The opera-
tion was complicated by extensive adhesions due to a
tapping which had been performed three weeks pre-
viously. He delivered the woman with the forceps at the
conclusion of the ovariotomy. He remarked on the un-
desirablity of tapping ovarian cysts, unless under very
exceptional circumstances, and then proceeded to consider
what courses were possible in the case of labour compli-
cated by a large ovarian tumour which did not obstruct
the pelvis. There were three alternatives, one of which
must be promptly adopted on account of the danger of
rupture of the tumour, namely :
8Q ANNUAL ADDKESS.
(1) To deliver by the natural passages, dilating the
canal if necessary, and then to perform ovariotomy.
(2) To perform ovariotomy, and leave the delivery to
nature.
(3) To perform ovariotomy at the end of the first stage
of labour, and immediately afterwards to deliver by the
forceps while the patient is under the ana3sthetic.
Of these three courses he believed that the last described
was, on the whole, the best.
In April Dr. Ewen Maclean read a short note on " A Case
of Abdominal Pregnancy, Spurious Labour at Term, Foetus
and Placenta Removed Six Months later." He related the
history of the woman's pregnancy, and described her con-
dition when she came into hospital, and the operation that
was performed. A decomposing foetus was found with a
degenerated placenta. This could not be made out to be
adherent to the sac wall, but it had probably been attached
at the inferior and anterior surfaces of the lower pole of
the sac. There was a pinhole communication between the
sac-cavity and a coil of intestine. No attempt was made
to remove the sac, as the peritoneal cavity was not opened
at any time during the operation, but it was drained. It
was impossible to be certain of the exact mode of deve-
lopment of the case ; but it could be assumed, ovarian
pregnancy being excluded, that dislocation of a tubal
pregnancy had occurred in one of the two accepted ways
at the second month, for the history and the conditions
found at the operation did not favour the theory of intra-
ligamentous development.
Dr. H. H. B. Brook recorded, in June, " Three Cases of
Glycosuria occurring in Pregnancy." By a curious co-
incidence he had had these three examples of an uncommon
disorder under his care at about the same time. They
were all nearly of the same degree of severity, as gauged
by the quantity of glucose present, viz. 10 to 12 grains to
the ounce. They were appropriately dieted, and the
sugar diminished ; but it never quite disappeared in one of
the cases, and was absent only occasionally in the others.
ANNUAL ADDRESS. 87
Dr. Brook, rightly considering that such cases are doubt-
ful as to their termination, paid much attention to them at
the time, and afterwards recorded them fully.
Dr. Nepean Longridge read a note on " Sixty-four Cases
of Contracted Pelvis," which had been delivered in Queen
Charlotte's Hospital. This was an interesting and valuable
analytical record of their treatment and its results. It
will certainly be of use to obstetricians in considering the
question of the management of contracted pelvis. The
paper is very condensed as it stands, and it would be im-
possible for me to give an adequate abstract of it for this
address. The author concludes that the treatment of this
abnormality appears to be narrowing down to two methods
of election — namely, the induction of labour and Caesarian
section ; and, speaking generally, it seems that the former
method is most satisfactory with a conjugate of over 34
inches, and the latter when it is under that measurement.
The author said he did not approve of de Ribes' bag in
induction, and Dr. Rivers Pollock and Mr. Targett spoke
in its defence.
Short Gynaecological Papers.
In May Dr. Lewers read the notes of three cases of
epithelioma of the vulva, and remarked how, as illustrated
by the first case, local recurrence after operations on
epithelioma in this part is not necessarily of fatal signifi-
cance, for the patient, after having had three operations
performed on recurrent patches, had passed five years
since the last operation without any sign of return. He
considered Paquelin's cautery a better instrument for
removal of the growth than the knife or scissors.
In July Dr. Williamson described a rare tumour of the
labium — namely adenoma. His specimen had the naked-
eje appearance of an epithelioma, but, microscopically, it
proved to be an adenoma — a diagnosis which had been
justified by no reappearance having taken place after
88 ANNUAL ADDRESS.
three years. The author alluded to the only three cases
as yet described, and discussed the origin of these
growths.
In October Dr. Eden and Mr. Lionel Provis recorded
the removal of a very large intra-ligamentous fibrocystic
tumour of the uterus. It weighed 30 lb., and was
removed by enucleation and sub-total hysterectomy. Its
growth had been very rapid, and the clinical symptoms
resembled those of an ovarian cyst. It was attached by
a distinct pedicle to the uterus.
In November Mr. Doran read a short account of a case
of myomectomy during pregnancy, followed by labour at
term, with notes of similar cases. The operation was
performed in the fourth month of the patient's first preg-
nancy. Her age was thirty-five. The operation did not
seem to unfavourably affect the pregnancy nor to increase
the perils of labour ; and it was as well borne by elderly
primigravida3 as by younger ones.
After-Histories.
Two after-histories of cases previously shown were
noted : one by Dr. Boxall, of a case of cystic fibroid with
carcinoma of the left ovary and right Fallopian tube,
which he had brought before the Society five years ago.
Dr. Boxall had recently heard from the patient that she
was perfectly well. The other was mentioned by
Dr. Hamilton Bell, and was a case, the specimen from
which was shown by Dr. Tate six months before as an
example of sarcoma of the ovary. The Pathology Com-
mittee had found no evidence of sarcomatous change in
the ovary. The woman had recently died with secondary
sarcomatous growths in various organs.
It is very obvious that the practice of recording the
after-histories of cases of which the Society has already
heard, is of the utmost value, and should be adhered to
on every possible occasion.
ANNUAL ADDRESS. 89
Specimens.
It is impossible for me to even refer to the long series
of specimens shown at meetings during the year. I
cannot, however, refrain from mentioning the specimens
shown by Dr. Cuthbert Lockyer and Dr. Blacker respec-
tively, of the imperfectly developed generative organs
removed from two epileptic subjects ; and that of fibroids
of the uterus complicated with carcinoma of the corporeal
endometrium, shown by Mr. Bland-Sutton.
Sir William Sinclair discussed the subject of sea-tangle
tents and their use, and an interesting debate followed
on the question of how far they were really useful in
gynaecological work.
It will be seen from the above short account of the
work done by the Society that there is no falling off from
the standard of previous years. Most of the important
subjects in obstetrics and gynaecology have received a
share of attention. I should like to point out that some
of the short communications — and this is true also of some
of the accounts of specimens shown — dealt with points of
great importance, and involved in their preparation a
considerable amount of work, and added much to our
knowledge of the various subjects concerned.
The discussions on papers and specimens have been as
original and independent as ever, and as free as ever from
platitudes and mere self-advertisement.
Two years ago, when casting around for a subject for
the Inaugural Address with which it is the privilege of
each President to make his appearance, I arrived at the
determination that some good might come of airing a
conviction I had as to the urgent need for reform in the
present method of teaching practical midwifery in this
country. I, therefore, discussed the matter at some
length. I was very glad to find that I had the support
of, I believe, practically all the teachers of midwifery of
London and elsewhere. In fact, I was not by any means
90 ANNUAL ADDRESS.
the first to publicly express the necessity for improve-
ment. Whether what I ventured to say was the spark
that fired the train (as I hoped it might be) I know not,
but the Fellows are, no doubt, aware that the matter is
now under consideration by both the General Medical
Council and by the Royal Colleges of Physicians and
Surgeons, and some practical result will very soon, I
hope, follow.
The agitating question of the amalgamation of our
Society with the other London medical societies into a
general academy of medicine has, as you know, been
finally settled ; and this year, almost certainly, the Obstet-
rical Society of London will cease to exist. In the name
of the Society I must heartily thank Dr. Champneys, who
has acted as our representative on the Amalgamation
Committee, for the generous devotion he has shown to
our interests, and for the sacrifice of valuable time he has
made for us, both at the meetings of the Committee and
in the intervals.
I am sure that none of us, in his anxiety to do the best
by amalgamation for the advancement of obstetric medicine,
can help feeling the sentiment of regret that a distinguished
society like ours, which has accomplished so much in its
half-century of existence, should come to the end of its
independent life, lose its honoured name, and become
merely a section of a general association of medicine. It
was, however, necessary, under the present conditions,
that this should happen, but we know that the inspiring
traditions which we have inherited will not die, and that
in the dissolution of our Society we shall show that " even
in our ashes live their wonted fires," and that the ancient
spirit ynW animate our meetings and ourselves.
We shall found another Salamis in the new country,
with Dr. Spencer as our leader. For if, by a slight
alteration, we read " Spencer " for " Teucer," then —
" Nil desperandvim Teixcro duce et auspice Teucro ;
Certus enim promisit Apollo
Ambiguam tellure nova Salamina fiituram."
ANNUAL ADDRESS. 91
But I must remember that it is not yet time to " cast a
longing, ling'ring look behind/' nor is it in my province
to compose an elegy. When the time does come for the
last words to be said in this Society I am most happy to
think they will be uttered by my distinguished successor.
In last year's address I had to record, with some
regrets, the end of the Board for the Examination of Mid-
wives, of which I was the last working Chairman. I
stand now, as it seems at present, the last President of
the Obstetrical Society who will complete the full term of
office under that title. I only trust that if, in any remote
future, the casual reader of our archives discover this, it
will not convey to him the idea that the manner in which
the duties had been performed by the last incumbent of
these two honourable offices was such as to demand their
immediate abolition. To have held the position of Presi-
dent of the leading Society devoted to the study of his
own particular branch of medicine is one of the greatest
honours, if not the greatest honour, which can befal a
man, even though he may remind himself that conspicuous
ability is not always the reason for its bestowal.
I must thank the Society for having bestowed it on me;
I must thank the Fellows for their forbearance and
support while I have enjoyed it ; and I must thank our
Senior Secretary (Dr. Boxall) for the energy he has sho^vn,
which has greatly enabled me to sustain it.
On the motion of Dr. Cullingwoeth, seconded by
Dr. Heebeet E. Spencee, a vote of thanks to the President
for his address was passed by acclamation.
MARCH 6th, 1907.
Herbert R. Spencer, M.D., President, in the Chair.
Present~52 Fellows and 4 visitors.
Books were presented by the Medical Society, St.
Bartholomew's Hospital Staff, and the Radcliffe Librarian.
Eardley L. Holland, M.B., B.S.Lond., F.R.C.S.Eng •
Percy Cecil Parker Ingram, M.B., B.S.Lond.; and Lewis
Graham, B.S.Lond., were admitted Fellows of the Society.
Charles J. Battle, M.R.C.S., L.R.C.P. (Kearsney,
Natal), was declared admitted.
The following gentlemen were elected Fellows of
the Society: Archibald Montague Henry Gray, MD
B.S.Lond.; Clifford White, M.D., B.S.Lond. ;' James
Montague Wyatt, M.R.C.S., L.R.C.P.Lond.
Report of the Pathology Committee on Mr. Bland- Sutton's
Specimen of a Villous Tumour of Uterus from a
patient aged 84 [see p. 46).
We have examined this specimen and the microscopic
sections taken from it, and agree with the exhibitor that
VOL. XLIX.
7
94 AFTEK-HISTORY OF CASE OF FIBKOID OF BEOAD LIGAMENT.
the o-rowth is a villous tumour with no evidence of malig-
nancy
{Signed) Henky Russell Andrews.
G. Blackkr.
T. W. Eden.
J. Bland-Sdtton.
IIekbekt R. Spencer.
Gorki E Keep.
W. S. A. Griffith, Chairman.
AFTER-HISTORY OF THE CASE OF FIBROID OF
BROAD LIGAMENT ASSOCIATED WITH AN
OVARIAN CYST, REPORTED IN THE FORTY-
THIRD VOLUME^ OF THE SOCIETY^S 'TRAN-
SACTIONS.'
By Alban Doran, F.R.C.S.
Four and a half years after the operation which I
reported in 1901 I removed a large cystic tumour of the
opposite ovary, which had shown no sign of disease when
inspected on the previous occasion. The second ovario-
tomy gave me an opportunity of examining the effects of
the extensive enucleation necessitated by the connections
of the two tumours already removed.
At the first operation, performed on July 18th, 1901, I
removed a thin-walled cyst of the left ovary, containing
ten pints of chocolate-coloured fluid ; it was multilocular,
and beneath and behind it lay a fibroma of the left meso-
metrium, invading the mesosalpinx. The base of the
ovarian tumour also burrowed into the mesometrium,
"dragging upwards the uterus, which bore two small
spherical fibroids posteriorly near the fundus, and also the
* P. ii60 aud PI. XIV.
AFTER-HISTOKY OF CASE OF FIBROID OF BKOAD LIGAMENT. 95
right appendages. I noted tliat " the right ovary and
tube were quite normal.^^
After clamping the ovarian pedicle I cut into the left
broad ligament, enucleated the fibroma, which weio-hed
two and a half pounds, and then ligatured the ovarian
pedicle. Much of the capsule was trimmed away • its
anterior and posterior layers were sewn over the stump
of the ovarian pedicle with a continuous No. 2 China-
twist suture. The uterus and right appendages now fell
back into the pelvis. I observed that ^^ the sigmoid
flexure lay very close to the cut edge of the capsule, but
was not kinked.^'
At the end of December, 1905, the patient was sent to
me by Mr. Meredith Townsend, of Kensington, on account
of recent abdominal distension. The patient, aged 49
did not look cachectic. A somewhat flaccid cyst occu-
pied the lower part of the abdomen, reaching three inches
above the umbilicus and downwards to the brim of the
pelvis. The uterus lay behind it and was movable.
I operated on January 9th, 1906, removing a multi-
locular cyst weighing 4 lb. 7 oz., and containing several
pints of glairy ovarian fluid. The pedicle was broad and
long. The base of the cyst, however, did not burrow
mto the broad ligament. Sections prepared from the
tumour showed glandular growth, without any trace of
malignancy.
I inspected the uterus and observed that the two little
sub-serous fibroids on its posterior aspect, near the fundus
had become much smaller. The left uterine cornu ran on
to the sigmoid flexure, which was not kinked nor other-
wise obstructed. Some lobules of fat grew close up to
the left cornu, probably derived from the sigmoid meso-
colon. I could not detect the least trace of a ligature
I searched the abdominal and pelvic cavities and could
not find any detached glandular growths or subperitoneal
tibromata. The parietal peritoneum was thickened and
highly vascular. A long piece of omentum adhered to
the uterus, but there were no other adhesions of any kind
96 AFTER-HISTORY 01-' CASE OF FIBROID OF BROAD LIGAMENT.
which was remarkable when the severity of the first opera-
tion is taken into account.
The patient was in very good health on April 1st, 1906,
four months after the operation.
Ohservationii.—Thns a cystic adenoma developed in the
right ovary, which was apparently free from any knid of
disease when I removed the left ovary subject to the same
form of new growth. The development of an ovaruxn
tumour of this kind within four years is, however, a
pathological phenomenon by no means unfamiliar to us.
Nor is it surprising that the fibroma of the broad ligament
did not recur; had I found another, I might reasonably
be accused of having overlooked it during the first opera-
tion For a broad ligament fibroma, like the example in
question, is not so probably a detached uterine tumour as
an independent new growth akin to mesenteric fibroma,
probably congenital, and nearly always of slow growth.^
When examining the parts around the uterus, as I
removed the right ovary their condition showed the advan-
tages of the practice of sewing broad ligament over the
stump of the ovarian pedicle ; for I found no adhesions
between the broad ligament and the adjacent pelvic struc-
tures, so that the second operation proved remarkably
easy.' We know how often it is far otherwise when the
ovarian pedicle formed at the first operation has been left
bare, protruding into the peritoneal cavity.
The President said he agreed that it was desirable, when
possible, to bury pedicles iu the broad ligament, but that was not
always practicable. The rate of disappearance of silk varied
much in different cases. He had seen the silk completely dis-
appear from ovarian pedicles iu three months, leaving the stump
at the cornu of the uterus smooth and quite free from adhesions.
On the other hand, he had found silk present after seven years.
Dr. Lewers said he had performed abdominal section a second
.* I have discussed this question in « Fibroid of the Broad Ligament
weighing 44Ubs." in the forty-first volume of the Society s 'Transac-
tions/ p. 173; and also in "Fibro-myoma of the Mesentery 30 lbs
with Notes on the Siu-gery of Ketro -peritoneal Tumours,' 'Brit. Med.
Journ.,' vol. ii, 1904, p. 1075.
CASE OP PEEITHELIOMA OP THE UTERUS. 97
time in the same patient in a considerable number of cases. It
was certainly not the case that the pedicle left, after removing
an ovarian tumour treated in the ordinary way, invariably con-
tracted adhesions. He had several times seen it quite free from
such adhesions.
Dr. Peter Horrocks said he had several times seen cases
where there were no adhesions over the stump after an operation
performed a considerable time previously. He mentioned a
recent case where the ovaries had been removed nine years before,
on account of a fibroid tumour. The latter, however, began to
grow and give trouble, and so was removed a week ago by pan-
hysterectomy. No adhesions were found over the stumps of the
old operation. He remembered other cases illustrating the same
fact, and he was inclined to think that the greater the degree of
asepsis the less likelihood of adhesions forming over the stump.
He also thought that if the distal end was strangulated by the
ligature being very tight adhesions were apt to form.
Mr. Alban Doran maintained that the usual practice of
leaving a ligatured pedicle bare in the peritoneum often led to
extensive, if not dangerous, adhesions. Such was his experience
of second ovariotomies on the same patients. Twenty years ago,
when thick silks were applied to thick pedicles, and the peritoneum
irritated by sponges, this complication was far more common
than it was at the present day. Dr. Horrocks had referred to a
different subject — removal of the ovaries for the " cure " of
uterine fibroids. The pedicles projecting from a big fibroid
uterus were in a position highly favourable to the development
of adhesions. Mr. Doran observed that in 1901 he noted that
two small, subperitoneal myomas projected from the fundus. In
1906 he found that they had undergone no increase or diminution
in size.
A CASE OF PERITHELIOMA OF THE UTERUS.
By G. F. Darwall Smith, M.B., F.R.C.S.
A SINGLE woman, aged 38, a parlourmaid, w^as admitted
into St. George's Hospital, under Dr. Dalcin, on July 5th,
1906, complaining of pain in the left side, and of more or
less constant bleeding from the vagina since the preceding
March. In March, 1904, she had also been under
D*r. Dakin's care, wlien double ovariotomy had been per-
98 CASE OV PERITHELIOMA OF THE UTERUS.
formed for two ovarian cysts^ one of which was suppurating.
The cysts had been reported on by Dr. Rollcston as being'
cysto-adenomabous in character. Convalescence after this
operation had been uneventful, and the patient was dis-
charged from hospital in April, 1904, apparently well.
After this operation menstruation had ceased, and
there had been no discharge of any kind noticed until the
bleeding started in March, 1906. When re-admitted to
hospital, in July, 1906, the cervix uteri was found to be
small and of normal consistence. The uterus was freely
movable, and felt somewhat unusually light. Douglas'
pouch was empty, and there was no abnormal swelling in
the pelvis.
On July 20th the uterus was curetted. The tissue
removed was declared by Dr. Rolleston to be perithelio-
matous, and is shown in one of the slides under the
microscope. Nearly the whole of this tissue is seen
to be composed of the cells of the growth. They are
slightlj'^ elongated in shape, and can be seen quite
clearly to be budding off from the poripher}' of the
smaller vessels in very many parts of the section. Some
parts of the growth are quite necrotic. In one or two
parts of the growth, which probably are the older parts
of it, the cells are almost glandular in type, but are seen
to be arranged closely about the periphery of small
vessels. Very few endometrial glands can be found in
the sections. The few that are present show some evi-
dence of proliferation of the cells lining them.
On July 31st total hj^sterectomy was performed by the
abdominal route.
The uterus so removed is only slightly enlarged. After
hardening, it measured 3 in. in length externally and
2TVin. internally. The external appearances were normal.
On slitting up the anterior wall of the uterus the cervix
appeared normal to the naked eye, but at the fundus, and
projecting downwards into the uterine cavity, was a soft,
friable growth, which was distinctl}'^ paler than the sur-
rounding mucous membrane. Under the microscope.
CASE OF PERITHELIOMA OF THE UTERUS. 99
sections taken from the site of the growth show the
origin of the growth less clearly than does the tissue
removed by the curette, but still its peritheliomatous
origin can be distinctly made out in one or two places.
Almost the entire growth is made up of cells of approxi-
mately the same character as the majority of those seen
in the curetted tissue. Scattered about here and there
are a few capillaries, but they are by no means plentiful.
Strands of elongated cells can be seen at intervals running
into the growth from the region of the uterine muscle.
These seem for the most part either to be, or to contain,
small blood-vessels. No endometrial glands have been
seen in any of the sections cut from the site of the
growth. The growth can be seen to be infiltrating the
uterine muscle at its base, and fairly numerous small
round cells are visible scattered among the muscle-fibres
for some distance towards the peritoneal surface of the
uterus. There is much less necrotic tissue to be seen in
these sections than in those from the curetting. Sections
taken from the cervix show nothins: abnormal.
If it be agreed that a perithelioma is a malignant growth
arising from the adventitia of vessels, and distinguished
by the long axes of the cells being arranged radially to
the lumen of the vessels, it is submitted that in this
growth the origin and arrangement are ef that nature.
The argument that ordinary sarcoma may show this
arrangement as the growth extends, and, hence, that this
growth may be an ordinary sarcoma, is met by the fact
that the oldest parts of the growth show the perithelio-
matous arrangement best. The oldest parts of the
growth are distinguished by (1) necrosis, (2) a less
embryonic type of cell.
I have searched through the literature of perithelioma,
but I have been unable to find any record of a case of
perithelioma of the uterus, though I believe one was
shown to the Eoyal Academy of Medicine in Ireland by
Dr. Hastings Tweedy in November last. Doubtless, how-
ever, the condition has often been seen before.
100 SUPPUEATING FIBEOID TUMOUR OF THE UTERUS.
My best thanks are due to Dr. Dakin for so kindly
allowing lue to report the case.
The specimen icas referred to the Pathology Committee
{.9ee p. 136).
Mr. Takgett agreed that the sections exhibited a malignant
o-rowth infiltrating the wall of the nterus. But he regarded it
Ss a sarcoma probably originating from the cellular stroma of
the endometrium ; whether it had begun in the sheaths or walls
of the capillary vessels did not affect the general characters of
the growth. When a sarcoma invaded a dense tissue like
uterine muscle it extended between the planes of fibres and thus
simulated the mode of infiltration of a carcinoma. A further
investigation of the specimen was desirable.
Dr. Darwall Smith, in reply, said that he had no doubt
that the specimen shown was merely a variety of sarcoma, but
that, unlike some sarcomata which had been described as commg
to have a perivascular arrangement as the growth extended, the
most clearly perivascidar part of this growth was apparently
the oldest part of the growth. He believed it was Borrmann
who had described malignant perivascular growths as bemg of
two varieties : one, the true perithelioma arising from the adveu-
titia, in which the long axes of the cells were arranged radially
to the lumen of the vessel, and this arrangement was well
marked in the present case ; and the other, which he called
periendothelioma, arising from the endothelium of the pen-
vascular Ivmphatics, in which the long axes of the cells were
parallel to' the lumen of the vessel. He was much interested to
hear of the other cases of perithelioma of the uterus which had
been mentioned.
A SUPPURATING FIBROID TUMOUR OF THE
UTERUS.
Shown by Dr. George Blacker.
^. R_^ aged 40, was admitted into the Great Northern
Hospital on April 24th, 190C, four weeks after her con-
finement. She had had five children and no miscarriages.
After the confinement, in which version had to be per-
SUPPUEATING FIBROID TUMOUR OF THE UTERUS. 101
formed on account of a shoulder presentation, she was
very ill with inflammation round the uterus. On admis-
sion the temperature was 101'4° F., the pulse rate 120;
there was considerable abdominal tenderness and a blood-
stained offensive discharge coming from the vagina. A
tender fluctuating swelling was found in the lower part of
the abdomen, reaching half-way up to the umbilicus.
The tumour was quite superficial, the skin over it was
reddened and oedematous, and it was situated in front
of the enlarged uterus, the fundus of which reached to its
upper limit. An abscess in the cellular tissue in front of
the uterus was diagnosed, and an incision was made into
the most prominent part of the tumour just above the
symphysis pubis, rather more than a pint of pus being
evacuated. The patient made an uninterrupted recovery,
and was discharged from the hospital on May 28th. At
this time the uterus was still considerably enlarged, but
this was thought to be due either to subinvolution, or to
the presence of a fibroid tumour in the uterine wall.
The patient remained well until December of the same
year, when she had what was considered to be an attack
of influenza. On January 1st, 1907, pain commenced in
the lower part of the abdomen. As the pain continued. Dr.
Rostant was called in, who informed the patient that she
had a pelvic abscess, and sent her into the hospital. On
admission the woman complained of considerable abdo-
minal pain, but the temperature was normal. Some blood-
stained discharge was present, the last period, which had
come on a week early, being just over. On examination
of the abdomen an elastic, tender, rounded, movable
tumour was found, reaching up four inches above the
pubes. The uterus, closely connected with the tumour,
was in front of and to the left of it, and the sound passed
11 cm.
The enlarged right ovary could be felt above and
separate from the main swelling. The tumour was
thought to be a suppurating cyst in the broad ligament,
and as it definitely increased in size under observation.
102 SUPPUKATINO FIBROID TUMOUR OP THE UTERUS.
and the temperature rose to 103° F., it was decided to
remove it by abdominal section. An incision was made
to one side of the old scar, and on opening the abdomen a
careful examination failed to show any sign of thickening
or induration of the cellular tissue in front of the uterus.
The tumour was found to consist of the uterus and
what was evidently an intra-ligamentary fibroid, and the
whole was removed by total hysterectomy together with
the right tube and ovary. As there was a good deal of
oozino- from the raw surface from which the tumour was
enucleated an iodoform gauze drain was introduced into
the vagina, the peritoneum sewn together over it, and the
abdomen closed. The gauze was removed on the fifth
day after the operation ; the temperature fell to normal
almost immediately, and the patient made a good
recovery.
The specimen consists of the uterus with a fibroid
tumour and the right ovary and Fallopian tube. The
tumour, measuring 10 cm. by 9 cm., is growing from the
right anterior wall of the uterus and is invading the
broad ligament, but is surrounded by a thin layer of
muscular tissue derived from the uterine wall.
The cavity of the uterus is healthy and measures 13-5
cm. On making an incision into the tumour through the
rio-ht wall of the uterus about ten ounces of pus escaped,
and the abscess cavity was found to contain a large mass
of yellow necrotic tissue. On transverse section the
cavity measures 9 cm. in length by 4 cm. across at its
widest part. Its walls are irregular and covered by an
adherent yellow slough.
Microscopic examination shows the lining of the abscess
ca\aty to be composed of typical granulation tissue.
The right Fallopian tube is shghtly thickened and its
abdominal ostium nearly closed. The right ovary is
converted into a dermoid cyst measuring 4-5 by 4 cm. in
diameter, and containing in its outer wall a small plate of
bone to which is attached a rudimentary incisor tooth.
Suppuration in a fibroid tumour is not a common form
SUPPURATING PIBKOID TUMOUE OF THE UTERUS. 103
of degeneration, and therefore this specimen is of some
interest on that account, and also as an example of a case
of anterior pelvic cellulitis. It seems probable that the
attack of pelvic cellulitis which occurred in April, 1906,
may have been the starting-point of the suppurative
process in the fibroid tumour, which no doubt was present
at that time. Unfortunately it was not possible to take
a cultivation from the pus so that the species of organism
present remains undetermined.
The President thouglit that these cases of true suppuration
were rare. He had only seen two cases. lu one the suppura-
tion was due to the presence of cancer of tlie cervix complicating
the fibroid ; in the other it was due to the presence of a gaii^
grenous polypus in the cavity, from which a large fibroid grow-
ing m the broad ligament was infected. The uterus weighed
over 14 lbs. and was removed by total abdominal hysterectomy.
In view of the fact that suppuration of fibroids was likely to
arise from infection of the cervix he thoug]it the whole of the
uterus should be removed. Infection of fibroids without sup-
puration he had frequently observed, usually after labour or
abortion.
Dr. Herman had seen one case in which an abundant dis-
charge of pus was pouring from the uterus, and there was a
fibroid Avith an irregular cavity in its interior from which pus
flowed into the uterine cavity. The patient was insane The
uterus was removed by Sir F. Treves and placed in the Museum
of the Eoyal College of Surgeons.
Dr. Peter Horrocks said he brought a large suppuratiuo-
fibroid to show at the Society last year, but owing to lack of
time it was postponed. It was a large subperitoneal fibroid
which suppurated after parturition at full term, and he was
inclined to think that the diminution of the supply of blood to
the tumour during the involuting period following parturition
had somethmg to do witli the causation of the abscess. The
centre or most ill-nourished part died, and so suppuration took
place. He mentioned another case where a lady had a laro-e
fibroid tumour for many years. She was encouraged to wait
until the change of life and not to have an operation. After
the climacteric had been reached she began to lose flesh steadily,
and the doctor found the tumour practically cystic, haviuo-"a
fluctuating feel and giving a distinct thrill. An operation was
performed and tlie uterus was removed bv supravaginal hyste-
rectomy. It was a large uterine fibroid in the walls of the
uterus, and it vras full of pus. He mentioned a similar case
104 CASE OF CHOKION-EPITHELIOMA OP THE UTERUS.
operated on nearly a month ago. He wished to point out that
the last two cases followed upon the diminished blood-supply
due to the atrophic changes of the climacteric period. Ail the
patients did well, and he would like to call attention to the
danger of using a corkscrew to draw out the fibroid when an
abscess was suspected.
Mr. Malcolm said he had shown two cases * of necrobiosis,
and had urged that the diminished blood-supply during involu-
tion was a chief cause of the change. When suppuration
occurred there must, he thought, be a further cause of mischief.
Dr. Blacker, in reply, did not think that in his case the
process of involution had had anything to do with the occur-
rence of the suppuration, as the uterus had involuted badly.
He thought, without doubt, the fibroid had become infected
from the suppurative cellulitis wliich had occurred eight months
previously. Unfortunately it had not been possible to take a
cultivation from the pus, so that the species of organism present
had not been ascertained.
A CASE OF CHORION-EPITHELIOMA OF THE
UTERUS; LUTEIN CYSTS IN BOTH OVARIES.
(With Plates VII— IX.)
By Dr. G. F. Blacker.
Mrs. A. B — , aged 46, was admitted into University
College Hospital on January 28th, 1907. She had had
five cliildron and two miscarriages, the youngest child
being seven years old. Twelve months ago she had a
period of two months' amenorrhoea, followed by haemor-
rhage lasting for three weeks and accompanied by the
passage of some clots. This bleeding was assumed, by
the medical man she called in, to be due to the onset of
the menopause, but in view of the further history of the
case no doubt she had an early miscarriage. After the
bleeding ceased the periods returned and were regular
until five weeks before her admission to the hospital.
For this length of time there liad been a slightly offensive
* ' Obstet. Trans.,' 1894, p. 200, and 1904, p. 15— the term "sloughing,"
and not " necrobiosis," was used in publisliing these cases.
CASE OF CHORION-EPITHELIOMA OF THE UTERUS. 105
blood-stained discharge from the vagina. For the past
two weeks there had been some throbbing pain in the
vagina, and she said she had been losing flesh for a month
or so past. Her bowels were moved regularly without
pain, micturition was attended with some difficulty, but
her general health had been good until the onset of the
present illness. She had, however, suffered from a
chronic winter cough for some years, and this was associated
from time to time with the expectoration of a little blood.
There was nothing of note in the family history. On
admission the patient presented a sallow and somewhat
cachectic appearance. In the lower part of the abdomen
could be felt a smooth, rounded, not tender tumour, which
was taken to be the fundus uteri. On vaginal examina-
tion the anterior and left vaginal walls were seen to be
occupied by a rounded swelling infiltrating the tissues
round the urethra and extending on to the lateral wall.
This latter portion of the tumour presented a friable and
sloughing surface. The intact mucous membrane over
the anterior part of the tumour was considerably congested,
and pressure on this area caused a good deal of pain. The
urethral orifice was displaced somewhat to the left of the
middle line, but a No. 6 gum elastic catheter was readily
passed. A similar smaller tumour occupied the right wall
of the vagina, lying in the mucous membrane and extend-
ing up into the right lateral fornix. The uterus Avas
enlarged and there was a rounded swelling in the position
of either ovary. A few days after admission the patient
coughed up a small quantity of blood. An examination
of the chest revealed slight impairment of movement on
the right side, weak breath sounds, and some coarse
rhonchi. On February 6th the vaginal growths were
excised very freely, together with the lower 2*75 cm. of
the urethra and practically the whole of the two lateral
vaginal walls, the low^er two-thirds of the anterior wall
and a part of the posterior wall. Beside the two main
tumours already described three smaller nodules of growth
were removed from the lateral and posterior vaginal walls.
lOG CASE OF CnOlUON-EPlTHELlOMA OF THK UTERUS.
The raw surfaces left were closed as far as possible by
stitching the remains of the posterior wall to the anterior,
and the stump of the urethra was brought out through a
button-hole opening in a flap drawn over it from the
anterior wall, which in its turn was stitched to the cut
edge of the mucous membrane below the clitoris. Con-
siderable difficulty was experienced in getting beyond the
limits of the growth in the right wall of the vagina, as it
extended high up into the right lateral fornix, and tlie
raw surface left in this position could not be closed, but
was plugged with iodoform gauze. The patient made a
good recovery from the operation, and was able for the
first week to retain her urine and to empty the bladder
spontaneously.
On examination under an anassthetic the body of tlie
uterus was found to be soft in consistence and considerably
enlarged; the cervix was healthy; both ovaries were cystic.
Microscopic examination of the growths removed from
the vagina showed them to be a chorion-epithelioma, and
a week later, therefore, on February loth, the uterus and
appeudages were removed by total abdominal hysterectomy.
There were slight adhesions about the ovaries, and some
little diHiculty was experienced in freeing the bladder
from the uterus, owing to the presence of a small nodule
of growth projecting from the anterior surface of the
uterus and adherent to the bladder. The latter organ
had to be dissected free, but this was done without any
injury to its walls. An iodoform gauze plug was inserted
between the cut edges of the vagina, the peritoneum sewn
together over this, and the abdomen closed without drainage.
No secondary growths were found at the time of the opera-
tion in the abdomen.
Sixteen hours after the operation the patient had a
sudden attack of abdominal pain, her pulse became small
and feeble, she became markedly blanched, and developed
some dyspnoea.
An examination of the vagina revealed the fact that
a good deal of heemorrhage was taking place from the
DESCRIPTION OF PLATE VII,
Illustrating Dr. Gr. F. Blacker's case of Chorion-epithe-
lioma of the Uterus ; Lutein Cysts in both Ovaries.
Fio. 1. — The uterus and ovaries. The anterior wall of the uterus has
been removed, sho\ving the growth almost filling the cavity. Both
ovaries are enlarged and cystic.
Fig. 2. — The right ovary laid open, showing the lutein cysts in its
interior, with haemorrhages into the interior of the cysts, into their
walls, and into the stroma of the ovary.
Plate VII.
Obstet. Soc. Trans., Vol. XLIX.
Fig. I.
Fig. 2.
Illustrating Dr. G. F. Blacker's case of Chorion-epithelioma of the Uterus
Lutein Cysts in both Ovaries.
Adlard e^ Sot}, hnpr
i
DESCRIPTION OF PLATE VIII,
Illustrating Dr. G. F. Blacker's case of Chorion-epithe-
lioma of the Uterus ; Lutein Cysts in both Ovaries.
Fig. 3. — Section of the tumour in the uterus, showing columns of
polyhedral cells with an alveolar arrangement, with a number of large
cells containing several nuclei in various parts of the section. No large
syncytial masses are to be seen.
Fia. 4. — The growth in the vagina, showing masses of protoplasm
with numerous nuclei and vacuolar spaces, together with collections of
cells derived from Langhans's layer.
Plate VIII.
Obstet. Soc. Trans., Vol. XLIX.
Fig. 3.
'f^
',^^:'*,^
''■ •- .■ *A
Fig. 4.
Illustrating Dr. G. F. Bi.ACKER's case of Chorion-epithelioma of the Uterus;
Lutein Cysts in both Ovaries.
Adiard ^ Son, Impr.
CASE OE CHORION-EPITHELIOMA OE THE UTERUS. 107
granulating surface in the right lateral fornix. This
cavity was plugged firmly with iodoform gauze under
chloroform, and the patient was transfused with one and
a half pints of saline fluid. This treatment led to a rapid
improvement in the symptoms, and no further bleeding-
occurred.
On the second and third days after the operation the
patient had a slight rigor. On the fifth day the vaginal
plug was extracted under nitrous oxide anaesthesia. On
the seventh day two more slight rigors occurred, the tempe-
rature only reaching 102° F. Since this time the patient
has made good progress, although her recovery has been
retarded by a somewhat irregular temperature, an attack
of diarrhoea, and a good deal of cough with, on two occa-
sions, the expectoration of a little blood. Examination of
the chest does not show definite signs of any growths in the
lungs, although over the scapular and axillar}'' region on the
right side there is some impaired resonance, weak breath-
sounds, and in front some fine crepitations on taking a
deep breath. The abdominal wound is soundly healed,
and the vagina is almost entirely healed. The signs in the
chest, taken together with the cough and the slight haemo-
ptysis, are very suspicious of some secondary growths in
the lungs, but, if there are any, possibly they may undergo
atrophy, as has happened in other cases where the primary
growth has been completely removed.
Unfortunately, no doubt in part as the result of the
constant coughing, the patient has lost the control over
the bladder which she had for the first week after the
second operation, and at the j)i'esent time there is almost
complete incontinence of urine.
The specunen consists of the uterus. Fallopian tubes,
ovaries, and some secondary growths removed from the
vagina.
The uterus (Fig. 1) is enlarged, measuring 10 cm. at
its widest part by 11 "5 cm. from fundus to external os.
The uterine wall, on section, varies in thickness from 1 cm,
in the left wall to 2*5 cm. in the middle of the riu'ht wall
108 CASE OF CHOKION-EPITHELIOMA OF THE UTEKDS.
of tlic body, where there is a small interstitial fibroid
1*5 cm. in diameter. A few small interstitial fibroids are
situated in the right wall of the body and one in the left.
The interior of the uterus is occupied by a growth which
is invading the uterine wall above and on the right side,
and to a lesser extent on the left side. The lower rounded
margin of the growth descends to within r75 cm. of the
internal os ; the space left is occupied by blood-clot. The
growth itself, on section, has a friable surface, and is
reddish-brown in colour, closely resembling in appearance
a mass of blood-clot, except at its site of origin in the
uterine wall, where there is a layer of tissue, yellow in
colour, softish, and rather more granular in appearance
than the uterine wall it is invading. The whole surface
of the growth presents a homogeneous appearance, and
there is no evidence of the presence of cysts or of chorionic
villi.
The cervical canal, which measures 3 cm. in length, is
healthy. Both ovaries are enlarged (t^^ig. 1), the right
one measuring o"5 cm. by 4 cm. (Fig. 2), the left 6 cm.
by 5 cm. in its widest part. They both contain a number
of cysts distributed throughout their substance, the largest
of these being 2 cm. in diameter. The outer surfaces of
the ovaries present a greyish-red appearance, and the thin-
walled cysts cause well-marked translucent projections on
the surface. A section through the right ovary (Fig. 2)
shows four cysts with well-defined walls, with a smooth inner
surface, containing a clear mucinous fluid, and showing a
considerable degree of vascularity. Several of the cysts
show haemorrhages into their interior and into the cyst
wall. In the stroma of this ovary there is a small, quite
distinct, corpus luteum 6 mm. in diameter. A section
through the left ovary presents a similar appearance,
although in this case the cysts (three in number) do not
occupy so large an area of the section. The largest cyst
in Ihis ovary shows a definite inner lining which can be
stripped away from the cyst wall. There is marked vas-
cularity of the tissues and especially of the stroma. In
CASE OP CirORION-EPITITELIOMA OP THE UTERUS. 109
some of tlie cysts the mucinous contents have coagulated into
a jelly-like mass in situ, while from others it has escaped.
Both Fallopian tubes are healthy.
The growths removed from the vagina comprise two
large tumours and three smaller ones. The largest of these,
measuring" 6'5 cm. by 4 cm., was attached to the anterior
vaginal wall, involving the inferior wall of the urethra,
and extended on to the left wall of the vagina. The latter
part of the growth had destroyed the mucous membrane
and formed an ulcerating and breaking-down mass.
Intimately united to the upper part of this tumour and
removed with it is the lower 2*75 cm. of the urethra,
which has been laid open along the middle line superiorly.
On section portions of this tumour present a greyish-
white granular appearance ; the tissue is soft and friable
and breaks down readily. A smaller growth of similar
character was removed from the left lateral wall of the
vagina above the larger tumour. An oval mass 4 cm. by
3 cm., of similar appearance on section, was removed from
the right vaginal wall and extended high up into the
right vaginal fornix, and two small tumours 1 cm. in
diameter were excised from the upper part of the posterior
wall of the vagina.
Microscopic examination of the tumour in the uterus
(Fig. 3) shows the greater part of it to be ' composed of
fibrin and blood-clot. The growth itself is made up of
branching columns of polyhedral cells with round or oval
vesicular nuclei, arranged in an alveolar manner, while
here and there are large cells containing* several nuclei.
There is an almost entire absence of any large syncytial
masses in the uterine growth, although in places strands
of syncytium are interspersed between the cell masses.
The growth in the vagina (Fig. 4), on the other hand,
contains large masses of undifferentiated protoplasm
containing numerous oval darklj^-staining nuclei and many
vacuolar spaces, as well as masses of smaller cells, evidently
derived from Langhans' laj^er of the chorionic epithelium,
which are mingled with the syncytial masses in an irregular
VOL. XLIX. 8
110 CASE OF CHORION-EPITHELIOMA OP THE UTERUS.
manner. Everywhere blood-clot and masses of fibrin are
present with the tumour elements, even penetrating between
individual cells, but there is no connective-tissue stroma.
An examination of the ovaries shows that all the cj'sts
(Fig. 5) exposed on the cut section are derived from
corpora lutea. The great majority of these cysts have no
epithelial lining, but two small cysts in tlie right ovary
have an internal lining of several layers of spherical cells.
The cysts are limited externally by a layer of fibrous
tissue derived from the stroma of the ovary ; internal to
this there is a well-marked layer of lutein cells of varying
thickness, but present without exception in some portion
of the wall of all the cysts examined, and in most of them
exceedingly well marked. With the exception of the
two small cysts already alluded to, in none of the others is
there any epithelial lining internal to the lutein laj'er,
although in many places there is a well-marked layer of
fibrin lining the inner surface of the lutein cells. In
both ovaries some lutein cells can be seen between the
cells of the stroma (Fig. C), some little distance from the
nearest cyst, but there is no general distribution of lutein
cells such as has been described in other instances.
Besides the cysts there is a well-marked corpus luteum
in the right ovary and a smaller one in the left ovary.
In some of the cysts the innermost layer of the fibrous
tissue immediately outside the lutein layer, namel}'^ the
tunica vasculosa, is extremely vascular. If the amount of
lutein tissue in the walls of the cysts be taken into
nccount there can be no doubt that there is an excess of
this tissue present in both ovaries.
This case is a good example of the simultaneous
occurrence of a chorion-epithelioma of the uterus with
lutein cysts in both ovaries. Those two conditions have
now been found present at the same time in so many
cases that such an association must be due to something
more than mere coincidence. I am, however, I must con-
fess, rather sceptical as to the truth of the hypothesis which
assumes that they stand in a definite causal relationship
DESCRIPTION OF PLATE IX,
Illustrating Dr. G. F. Black er's case of Chorion-epithe-
lioma of the Uterus ; Lutein Cysts in both Ovaries.
Fig. 5. — Section of the wall of one of the lutein cysts in the right
ovai-y, showing fibrous tissue of stroma, layer of lutein cells, and
coagvxlated contents of cyst.
Fig. 6. — A portion of the right ovary, showing lutein cells scattered
throughout the stroma.
Plate IX.
Obstet. Soc. Trans., Vol. XLIX.
Fig. 5.
Fig. 6.
Illustrating Dr. G. F. B
LACKER'S case of Chorion-epithelioma of the Uterus •
Lutein Cysts in both Ovaries. >- terus ,
Adlard ef Son.
Impr.
CASE OF CHORION-EPITHELIOMA OF THE UTERUS. Ill
to one another. That is to say that the development of a
chorion-epithelioma in the uterus is due to an excess of
lutein tissue in the ovary and an over-production of the
internal secretion of that organ. Such an excess of
lutein tissue has now been met with in so many cases of
hydatidif orm mole and chorion-epithelioma as to constitute
a most remarkable fact. If we consider, however, for a
moment the changes which occur in the uterus and in the
ovaries in these cases we cannot but be struck by the
very marked similarity between them. In the case of
the uterus we have an excessive proliferation of the
trophoblast or of the epithelium of the chorionic villi,
together with the development of cystic spaces, no doubt
due to serous transudation into the tissues of the villi.
In the ovary we have a marked proliferation of the cells
of the corpora lutea with the development of cysts,
possibly of similar origin. In both instances the tissues
chiefly affected are composed of young, rapidly-growino-
cells such as might be expected readily to respond to any
undue stimulus. It would seem probable that the cause
of the development of a chorion-epithelioma, conforming,
as it does, to the general law of carcinomatous growths in
that it affects a tissue which is already old if we consider
the total period of its growth, will be found not to differ
from the cause of a malignant growth in any other part
of the body, and that future researches will demonstrate it
to consist in some chemical change in the blood of the
patient, or in the fluids bathing the tissues of the part
affected. Further evidence in favour of such an inter-
pretation is, I think, to be found in the fact that some
excess of lutein tissue has been demonstrated to occur in
all cases of normal pregnancy, although not to such a
marked extent as in cases of hydatidiform mole or chorion-
epithelioma ; nor is this surprising when we recollect that
in cases of normal pregnancy there is no atypical pro-
liferation of the trophoblast, and therefore we would not
expect any undue development of the cells of the corpus
luteum.
112 CASE OF CnOEION-EPITHELTOMA OP THE UTEKUS.
The experiments of Friinkel and others wliich have
been brought forward to support the theory of the
important part played by the corpus luteum in presiding-
over the development of the early ovum appear to me to
be far from conclusive ; and although the development of
the trophoblast and of the cells of the corpus luteum
certainly appear to proceed 'pari pasm in these cases of
hydatidiform mole and chorion-epithelioma, yet the
assumption that the one depends upon the other seems to
me to be far from warranted. Many more cases of this
kind must be examined critically before we shall bo able
to come to any definite conclusion on this difficult subject.
In this particular case, whatever may be the true explana-
tion as to the cause, the fact remains that in the ovaries
there is a marked excess of lutein tissue, and in the uterus
there is a typical chorion-epithelioma.
PosUcript, April, 1907. — As the patient has died since
the specimen was shown it is possible to complete the
history of the case. The general weakness, which was a
marked feature from the time of the second operation,
gradually became more and more apparent, and the
patient rapidly wasted. On March 8th it was found,
owing to the constant dribbling of urine, that the capacity
of the bladder had become greatly diminished. At this
time there was very great weakness of the leg and thigh
muscles, and subsequent examination showed a well-
marked reaction of degeneration in the thigh muscles,
although the leg muscles were normal. On March 17th
a secondary growth was found present on the inner side
of the right thigh. On March 18th the growth, which
lay quite superficially under the skin and external to the
deep fascia, was removed. There was practically no
bleeding, all the vessels entering the growth appearing to
be thrombosed. A week later examination of the chest
showed definite signs (namely, impaired resonance, weak
breath sounds, and fine crepitations) pointing to the
existence of secondary growths, over the lower lobes of
both lungs, especially on the right side. On March 29th
CASE OF CHORION-EPITHELIOMA OF THE UTEECS. 113
the patient had two convulsions, with clonic and tonic
spasms, the second being followed by a semicomatose
condition which lasted some two hours, which were con-
sidered to be ura3mic in origin. On the following day
her condition was very grave, but there was no para-
lysis of the arms or legs, the cranial nerves were unaffected,
and the pupils reacted well. On April 1st the woman
gradually sank and died in a state of coma.
A post-mortem examination showed the abdominal
wound to be soundly healed ; in the remains of the vagina
there were some small nodules of growth, which showed
signs of ulceration. There were no growths in the peri-
toneum. The right ureter and the pelvis of the right
kidney contained pus. There were several small growths a
quarter to one inch in diameter in either kidney. There
was also a mass of breaking-down growth in the left
suprarenal gland. There were small nodules of secondary
growth in the liver, spleen, and scattered beneath the
mucous membrane of the small intestine. There were no
growths in the glands of the abdomen or of the chest.
Both lungs, more especially the lower lobe of the right
lung, were studded with small nodules of growth varying
from one twelfth to one inch in diameter. In the brain
there were some small growths in the left parietal and
occipital lobes. The spinal cord was healthy and there
were no growths in the bones.
Dr. Amand Eouth was glad that Dr. Blacker had operated in
tins case, for many cases had been reported Avhere permanent
recovery had followed removal of the primary uterine growth,
when the patient, judging from the symptoms and physical
signs, had secondary growths in the lungs. Could Dr. Blacker
explain these recoveries ?
The President agreed mth Dr. Blacker that lutein cysts had
no causal relation to chorion-epithelioma. In his own case
pubhshed in the ' Transactions ' in 1896, the ovaries contained
no cysts, and the single corpus luteum was solid. Dr. Blacker's
case raised several important points for discussion, especially the
presence of liaemoptysis and of secondary gro^vths in the vagina.
These growths in the vagina, which were probably embolic^liad
been found even when the uterus was healthy, and they had been
114 SUPPOSED EECUKKENCE AFTER VAGINAL HYSTERECTOMY
known to disappear spontaneously. It was therefore impoi'tant
that their presence should not be taken as a contra-indication to
operation. It was possible that a secondary growth in the lungs
might disappear in the same way.
Dr. Blacker, in repl}', said that with reference to the possi-
bility of the secondary growths in the lungs, if there were any
present, clearing up, Dr. Blacker had recorded, in the ' Trans-
actions,' vol. xlvi, p. 57, a case of choi'ion-epithelioma, in which
a secondary growth in the .vulva had sloughed out under observa-
tion, and the raw surface left had healed up entirely. Some
eight or nine cases had now been recorded in which patients had
recovered, although presenting signs of secondary growths in the
lungs, when the primary growth had been completely removed.
A CASE OF SUPPOSED RECURRENCE AFTER
VAGINAL HYSTERECTOMY FOR CANCER
OF THE CERVIX.
(With Plate X.)
Microscopic sections shown by Dr. C. Hubert Roberts.
The patient, a multipara, aged 43, was admitted to the
Samaritan Free Hospital, on October 19th, 1906, with a
history of nine months' bleeding and discharge from the
vagina, together with pain and wasting. On examination,
there was a well-marked patch of ulceration on the
posterior lip of the cervix, extending upwards as far as
the OS internum. The growth was friable and bled pro-
fusely on touch. The uterus was mobile and no thickening
could be detected in the broad ligaments. Vaginal
hysterectomy was performed on October 22nd, 1906. The
operation was difficult due to pelvic adhesions which
were probably old. Owing to slipping of a ligature on the
left broad ligament there was some severe bleeding before
it could be secured. Both broad ligaments were tied off
with silk ligatures. Those on the right side soon sloughed
away, but several on the left side remained very firm, and it
DESCRIPTION OF PLATE X,
Illustrating Dr. Hubert Roberts's case of Supposed
Recurrence after Vaginal Hysterectomy for Cancer
of the Cervix.
Fig. 1. — Section of the original growth. It is an atypical squamous-
celled carcinoma. The growth has invaded the vagiual portion as far as
the OS internum.
Fig. 2. — Section of supposed recurrence. It is not malignant. The
stroma consists mostly of fibrous tissue with large vessels (a, a). In the
centre are AveU-marked plicae (b,b) of the Fallopian tube which had been
included in the ligatures.
Plate X.
Obstet. Soc. Trans., Vol. XLIX.
Fig.
Fig. 2.
-"».ra.i„, D. H.„^„. Roe.^ss ease „, S„ppesed Ree,.„e„ee a,.e. V„,„„
Hysterectomy for Cancer of the Cervix.
Micro-photographs by Dr. Eastes.
Adiard &- Son, Imp,.
SUPPOSED KECURRENCK AFTER VAGINAL HYSTERECTOMY. 115
was decided to cut them short and leave the knots in situ.
This bears on the subsequent history of the case. In
December, 1906, two months after the operation, the
patient came back to show herself, and it was then found
that there was a suspicious patch of granulations high up
on the left side of the vagina in the region of the scar.
At the time I feared this was recurrence, and advised the
patient to come into the hospital again for operation.
iShe however refused, and went elsewhere for treatment.
On February 9th, 1907, five months after the original
operation, the patient came back to the hospital, and I
then found the mass in the roof of the vagina on the
left side had increased considerably in size and bled
freely on touch. I advised its removal, and this was
done on February 11th. The growth was of the size of a
mulberry, and seemed to have a very tough pedicle. On
cutting through this several knots of thick silk were dis-
covered embedded in thick fibrous material. No infiltration
of the vaginal scar or parametrium could be detected.
Sections of the original growth proved it to be one of
atypical squamous-celled carcinoma. The " recurrence,"
or what has been taken to be recurrence, was in no sense
malignant. It consisted of fibrous tissue covered with
granulations, the whole forming a papillomatous mass.
The stroma showed much small cell infiltration and
several thick- walled vessels. One part of the section con-
tained well-marked folds of mucous membrane which,
without any doubt were altered plicce belonging to the
Fallopian tube included in the ligature.
Dr. Roberts remarked that he thought the case one of
some interest, as, before microscopical examination, he took
the condition to be a malignant recurrence. Cases
of a similar nature had been reported by other authorities
both after vaginal hysterectomy, and the old clamp
method of abdominal hysterectomy for fibroids in which
the included tubes had subsequently given rise to curious
hasmorrhages from the stump.
Dr. Roberts reu'retted that in his case he had used such
116 SUPPOSED KECURRENCE AFTER VAGINAL HYSTERECTOMY.
thick silk and that the ligatures had been cut short, as
evidently the Fallopian tube had been included, and
subsequently given rise to the papillomatous mass arising
in the first instance from the mucosa of the tube itself.
Mr. Targett had seen several specimens of a similar kind,
which had been mistaken for nodules of recurrent growth. The
inclusion of the Fallopian tube in the scar was probably not due
to the method of vaginal hysterectomy employed, as he had seen
it after both clamp and ligature operations. The mucous mem-
brane at the cut end of the tube became irritated in the healing
vaginal wound, and produced a papillary formation.
117
INAUGURAL ADDRESS.
Ladies and Gentlemen^ — My first and pleasant duty
on occupying this Chair is to thank you for the very high
honour which you have conferred upon me by electing me
your President. It is an honour which I greatly appre-
ciate, and I will do my best to carry out the duties which
the office entails. But I am met at the very outset with
the difficulty of giving an inaugural address.
When I think of the many distinguished, learned, and
eloquent men who have held the position of President of
this Society, I am diffident of my ability to deliver an
address which shall be worthy to take its place in your
' Transactions ' beside some of the eloquent addresses of
the past.
Many of my predecessors have given brilliant and
learned inaugural addresses. I have no gift for saying-
elegant, pretty, or pleasant things. But if my remarks
have no flavour of Attic salt, they are at least not to
be taken with a grain from the cellar.' They will be
sincere, and will be directed to a few subjects which an
experience of twenty years as an obstetrician and gyna3-
cologist has convinced me are in need of consideration at
the present time if we are to carry on scientifically the
work which modern developments have rendered possible.
Perhaps I have one qualification. The Obstetrical
Society and I have grown up together. If I did not
actually " watch by its cradle," I did the next best thing
by being in the cradle with it, having come into the world
at the same time as the first volume of our ' Transactions.^
I am able to look upon our ' Transactions ^ with the
sympathy of a twin brother, as well as with that of an
Editor and President. The Society is passing through a
118 INAUGURAL ADDRESS.
critical period of its life at the age of forty-nine. It is
happily celebrating the event by receiving back into the.
family its only daughter, and it is not likely that it will
have any more offspring.
At the Inaugural Meeting of this Society in 1858, Dr.
Babington quoted a derisive remark made about the
obstetrician of his day, that " like Lord John liussell, he
would deliver a woman with child, cut a man for the
stone, or take command of the Channel Fleet," a testimony,
said Dr. Babington, to his boldness, energy, talent and
presence of mind.
Endowed with only the first of Lord John Russell's
powers, I find some diihculty in delivering an Inaugural
Address, and must claim your indulgence for its short-
comings.
I shall exercise one of the privileges of youth and address
myself mainly to the future, in which I have every con-
fidence, rather than take up your time with a consideration
of the past, which is recorded in our ' Transactions,' in our
libraries, and in our journals.
The advances made in obstetrics and gyna3cology have
been so great — indeed, so marvellous, in the lifetime of our
Society, that there is no lack of material for one who
chooses the rule of the laudator temporis acti ; the
advance has been so rapid that we have nearly attained
perfection in many of the operative procedures, such as
CiBsarean section, ovariotomy, and hysterectomy, which
were almost uniformly fatal at the time our Society was
founded. Of the graver diseases only eclampsia and
cancer and embolism baffle us, and much progress is being
made in the treatment of the two former affections. But
for many minor ailments severe operations are recom-
mended by some gyngecologists, and condemned by others,
and there are differences of opinion as to the justifiability
of methods of treatment, differences which would disap-
peaT if the facts were frankly stated and sound judgment
were brought to bear upon the consideration of those
facts. In a few directions we have advanced to certain
INAUGURAL ADDRESS. 119
knowledge, but in many others the way to triitli has been
blocked by obstructions which it is the function of
societies like this to remove.
I saw some time ago a suggestion made for a presi-
dential address to a learned society — " things we do not
know." This would be too large a subject for an
address on obstetrics and gynaecology. But some re-
marks on the principles which underlie the true advance-
ment of scientific knowledge, with illustrations of the
extent to which those principles are followed at the
present time by obstetrical and gynaecological authors,
may possibly not be unacceptable, especially to the
younger Fellows of our Society, in whose hands the future
of the Society rests.
Three hundred years ago (1605) our greatest philoso-
pher, Francis Bacon, wrote his treatise on ' The Advance-
ment of Learning.^ It contains his inductive method —
the accumulation and systematic analysis of isolated facts
to be obtained by observation and experiment — which
forms the basis of modern scientific work.
Bacon begins his treatise by mentioning three diseases
of learning, viz. 'Wain Avords," "vain matter," and
" deceit or untruth."
The first of these diseases, "vain words," occurred "when
men began to hunt more after words tlmn matter ; and
more after the choiceness of the phrase and the round
and clean composition of the sentence, and the sweet
falling of the clauses, and the varying and illustration of
their works with tropes and figures than after the weight
of matter, worth of subject, soundness of argument, life
of invention or depth of judgment." The disease of vain
words had been scoffed at by Erasmus before Bacon^s
time in a sentence which was doubtless taken to heart by
the University of London when considering the question
of compulsory Latin : " decem annos consumpsi in legendo
Cicerone " and echo answered in Greek, " o^e," — " ass " !
This disease of learning in its acute classical form is
not very prevalent amongst obstetricians and gyna3colo-
] 20 INAUGURAL ADDRESS.
gists; but in the form of logorrhouii it is still ti common
ailment. Certain writers do not indulge in the delicate
and polished kind of learning of which Bacon speaks but
run riot in words and in diffuseness of expression, so that
it is becoming impossible to keep pace with the literature
of our subject, the whole inclination and bent of the
writers, in Bacon^s phrase, being rather towards " copia ''
than weight. Diffuse writing and florid writing, which
Bacon likens to an initial letter of a book, " which
though it hath large flourishes yet it is but a letter,"
form a hindrance to the " severe inquisition of truth " in
obstetrics and gyniccology at the present day.
Bacon's second disease of learning is " vain matter,"
when persons " out of no great quantity of matter and
infinite agitation of wit, spin out unto us laborious webs
of learning, admirable for the fineness of thread and work,
but of no substance or profit." In recent years the study
of morbid specimens procured by operations has exercised
such fascination for obstetricians and gyniecologists that
this disease is less prevalent than it was, and the Fellows of
our Societ}'^, I think, are almost immune. In the weekly
press we occasionally find long unsubstantial papers which
offer to our hungry minds but a " halfpennyworth of
bread to an intolerable deal of sack."
The third disease of learning, " deceit or untruth," is
" of all the rest the foulest ; as that which doth destroy
the essential form of knowledge which is nothing but a
representation of truth ; for the truth of being and the
truth of knowing are one, difi^ering no more than the
direct beam and the beam reflected." Of this disease
there are two forms, imposture and credulity, both of
which, I fear, occur from time to time sporadically
amongst us.
Untruth occurs not in its crudest form of stating what
is not a fact but in the insidious form of omitting to
stafe all the material facts. Is it not sometimes mislead-
ing to publish cases without any after-history, when a
little inquiry might have shown that history to be un-
INAUGURAL ADDRESS. 121
favourable ? Do we not sometimes find a selected con-
secutive series of favourable cases published, whilst the
unfavourable cases preceding and following the series are
not published ? Do we not find cases of malignant
disease published within a few weeks of operation,
although they are of no special interest except from the
point of view of the possibility of cure ? Do we not find
severe abdominal and vaginal sections performed for
sundry ailments and the cases published as " cures,''
when some of them have been followed by pain and
disabilities greater than those for which the operation was
performed, of which mention should have been made in
the published accounts ? I say, of my own knowledge,
and of the knowledge of many of you, that these things
occur, and that they form a hindrance to the " glorious
inquisition of truth."
Having dealt with these three diseases of learning.
Bacon goes on to consider the " peccant humours,''
" errors," or " deficiences " of learning.
The first of these peccant humours is " the affecting
antiquity or novelty."
The modern obstetrician and gynrecologist does not
affect antiquity, and, indeed, treats it with unmerited
neglect. And yet, especially in obstetrics, the older
writers well repay perusal. From want of sufficient
acquaintance with the ancient obstetrical classics, one of
our Fellows recently described as new a method described
by Hippocrates. The Trendelenberg position was figured
by Scultetus in 1653 ; Walcher has in recent years obtained
some renown as the inventor of his " position," which was
described and figured by Scipio Mercurio in 1595 ; and in
1895 I described the operation of dividing the child's
clavicles, since called " cleidotomy," only to learn recently
that it had been described by Aetius in the sixth century,
and that Aetius had taken the operation from Philumenos.
Not only are the old classical writers neglected, but too
little heed is paid by certain gyngecologists at the present
time to the tradition of the schools handed down by the
122 INAUGURAL ADDEESS.
teachers of obstetrics and gynaecology. This neglect is
especially prevalent amongst those wlio have had no
special training at the hands of a master, and who base
their practice only on their own experience and reading.
Yet every obstetrician and gynaecologist who has experi-
ence of it knows that there is no teaching equal to that
afforded by a skilful master. The want of this opportu-
nity of receiving the tradition of the schools in gynaecology
and obstetrics has led some gynaecologists to operate on
certain cases of peritonitis and haematocele, which would
have recovered much more satisfactorily if they had been
treated conservatively, as all such cases were treated in
the days of old.
But it cannot be attributed to the modern obstetrician
and gynaecologist that he does not affect novelt}'. As it
has long ago been said that every obstetrician invents a
new forceps, so it will be said in the future that every
gynsecologist invents a new method of stitching up the
uterus or its appendages. Certainly it is only by trying
new methods that advance is made, but it is the "affrcting
novelty " that is undesirable, " the facility of credit and
accepting or admitting things weakly authorised or war-
ranted." I believe that if attention had been paid to this
Baconian warning, some of the least creditable features
in modern obstetrics and gynaecology would have been
avoided. Therefore, when new methods of treatment are
proposed, it were well to inquire what is the strength of
the author and what is the strength of the warrant. Is
the author one who by training, by experience, and by
his past record, has proved himself to be a lover of truth
and skilful in his work, and is his new method warranted
by carefully observed facts and by a sound judgment based
upon them ?
After the error of affecting antiquity or novelty, a second
error is cited, " a distrust that anything should now be
found out which the world should have missed and passed
over so long time." New methods of research have led
us to be less '' distrustful " than those who lived in Bacon's
J
TNAFGUEAL ADDRESS. 123
time, tlie most remarkable instances being the discovery of
bacterial diseases and of chorion-epithelioma ; and I think
societies like ours do mnch to preserve us from the error
(of which Bacon complains) of "too great a reverence and
a kind of adoration of the mind and understanding of man,
by means whereof men have withdrawn themselves too
much from the contemplation of Nature and the observa-
tions of experience, and have tumbled up and down in
their own reason and conceits."
To these two errors Bacon adds " impatience of doubt
and haste to assertion without due and mature suspen-
sion of judgment," and " the manner of the tradition and
delivery of knowledge which is for the most part magis-
tral and peremptory, and not ingenuous and faithful, in
a sort as may be soonest believed and not easiliost exa-
mined." I think I have met with papers on obstetrical
and gjmEecological subjects of which this could truly be
said.
Bacon advises the keeping of " registers of doubts,"
and commends them as excellent things, '' so that this
caution be used, that when they be thoroughly sifted and
brought to resolution they be from henceforth omitted,
discarded and not continued to cherish and encourage
men in doubting."
Is it not time that, if I may borrow the phrase, our
present-day " register of doubts " should have certain
items expunged from it, such as, that the aseptic method
of treatment in midwifery and gynnecology is superior to
the antiseptic method ; that the bougie method is generally
the best means known at the present time for inducing
premature labour; that in suturing the abdominal wall the
fascia should be separately stitched ; that Aveling's
repositor is the best means of reducing a chronically
inverted uterus ; and many other questions which were at
one time doubtful, but which I believe the general expe-
rience of obstetricians and gynaecologists (of this country,
at any rate) has proved to be no longer so.
The last and the greatest error of learning is the mis-
124 INAUGURAL ADDRESS.
taking the last or furtliest end of knowledge, which is
"to separate and reject vain speculations, and whatever-
is empty and void, and to preserve and augment whatever
is solid and fruitful."
This definition of the furthest end of knowledge would
form an excellent motto for a learned society.
Having dealt with the diseases and errors of learning
in general, Bacon has some shrewd remarks upon the
deficienccs of medicine in his day, a science which he
says " hath been more professed than laboured, and yet
more laboured than advanced, the labour having been in
my judgment rather in circle than in progression. For I
find much iteration, but small addition.'' Amongst the
chief deficiences he noted " the discontinuance of the
ancient and serious diligence of Hippocrates, which used
to set down a narrative of the special cases of his patients,
and how they proceeded, and how they were judged by
recovery or death.'' These histories were to be " neither
so infinite as to extend to every common case, nor so
reserved as to admit none but wonders : for many things
are new in the manner which are not new in the kind,
and if men will intend to observe they shall find much
worthy to observe."
The " history of the case," which Hippocrates and
Bacon thought so important, remains so at the present
day ; but I think the histories are not taken now as fully
as they were a quarter of a century ago by the clinical
clerks in hospitals. This is partly due to the many calls
on the time of the clinical clerks, but there is no doubt
that it is a " deficience " at the present day ; for a com-
plete history is often a partial diagnosis.
Bacon notes as a deficience amongst the doctors of his
time that "they enquire not the perfect cure of many
diseases, or extremities of diseases, but, pronouncing them
incurable, do enact a law of neglect and exempt ignorance
from discredit." Is not this the case at the present day
with those who operate only on cases of cancer in which
the uterus is freely movable ?
INAUGURAL ADDRESS. 125
He commends the union in doctors of experience and learn-
ing in the well-known passage : " they be the best physicians
which being learned incline to the traditions of experience,
or being empirics incline to the methods of learning."
If I have wearied you Avith quotations from Bacon^s
' Advancement of Learning ' my excuse must be that it is
useful, periodically, for a Society to have brought before
it those great principles in accordance with which alone is
true advance possible. They may be summed up in
careful, patient collection of facts and judicious comment
upon them. I do not know any Society which takes
more care in ascertaining its facts than ours. The
Pathology Committee, to which all doubtful specimens are
referred, is a feature of our work which might well be
imitated by other Societies. But I think that with little
effoi't the number of facts for our consideration might be
greatly increased. A suggestion which I would make to
the Fellows of our Society is that all specimens obtained
by operation and all still-born children be submitted to
examination. Specimens may now be conveniently pre-
served in a large tank in formalin solution in layers sepa-
rated by planks (a method adopted by Mr. Lawrence for
my own specimens for some years past). If this method,
of preserving and examining both macroscopically and
microscopically all operation specimens were adopted the
rate of our advance in obstetrical and gynaecological know-
ledge would be increased ! If, further, precise measurements
were given, preferably in the metric system, instead of
using such vague expressions as " fingers'-breadths," how
much would time and space be saved and accuracy in-
creased ! The value of records would be enhanced if
operators would agree as to the meaning of the term
" recovery " after operation, as, for instance, that it meant
" alive and well twenty-eight days after operation " —
whereas at the present time some operators discharge their
patients at the end of two or three weeks after an abdominal
section, and thus understate the rate of mortality by such
deaths as occur in the third or fourth week after operation.
VOL. XLIX. 9
126 INAUGURAL ADDRESS.
But if we find these errors in the statement of indivi-
dual facts how much more do we find them in those
collections and tabulations of facts which we call statistics !
Statistics have become proverbially unreliable ; one cynic
has gone so far as to define them as " lies expressed in
figures." Yet there is no reason, except the carelessness
and imposture of authors, why they should not be truths
expressed in figures, and they form the most valuable
means we have of advancing the knowledge of medicine,
for in Morgagni's words, which the ' Lancet ' reminds you
of weekly, " nulla autem est alia pro certo noscendi via,
nisi quam plurimas et morborum et dissectionum historias,
turn aliorum tum proprias, collectas habere, et inter se
comparare." How necessary is it, then, that the statistics
should be sound, unaffected by the disease of " vain words "
or " untruth," or by the peccant humour of being-
expressed " in a sort as may be soonest believed and not
easiliest examined ! "
In no disease is it of more importance that statistics
should be reliable than in the case of the treatment of
cancer of the cervix. This greatest scourge of woman is
attracting many workers, and the solution of the question
of its treatment is the goal towards which all the Fellows
of a Society like ours should strive. Yet it is " more
laboured than advanced, and the labour is rather in
circle than in progression." For what is our knoAvledge
on the subject after twenty-five years' work by hundreds
of gynaecologists on thousands of patients ? It amounts to
this : (1) That cancer of the cervix is curable in its early
stages by local removal either of the cervix by high
amputation, or of the uterus by hysterectomy ; (2) that
in somewhat advanced cases abdominal hysterectomy
permits a more extensive operation and one more in
accordance with surgical principles than is possible by the
vagina.
The first fact, the curability of cervical cancer in its
early stages, is denied by some authors, who rely only on
their own unfortunate experience. The fact of its cura-
INAUGUEAL ADDEESS. 127
bility, however, is well known to all but a few individuals
of whom some have gone so far as to give up operating
on cancer of the cervix, thus trying to " enact a lavf of
neglect and exempt ignorance from discredit"; but they
will not succeed.
The second fact is also undeniable. But this is no
reason for performing abdominal hysterectomy for all
cases of cancer of the cervix : in the early cases, espe-
cially of cancer of the portio, the vaginal operations are
certainly more suitable and have a much lower mortality.
With regard to the mortality of the abdominal operation
for cancer of the cervix, both forms of Bacon's untruth
are frequently met with — imposture on the part of the
author and credulity on the part of the reader.
I have for many years collected published statistics
of operations for cancer of the cervix, and have been sur-
prised to find how rarely the statistics were not mis-
leading.
A common way in which they are fallacious may be
illustrated by a hypothetical table :
Cases of cancer of the cervix seen . . 100
Cases of cancer operated on . . .50
No. of deaths from operation . . .10
No. of deaths from other causes within five years
of operation . . . ' . 10
No. of patients who did not reply to inquiries . 10
No. of patients with recurrence within five
years of operation . . . .15
No. of patients free from recurrence after five
years . . . . .5
Now it is clear that in this table only 10 per cent, of
the patients operated on, and 5 per cent, of those seen,
have been proved to be free from recurrence after five
years, i. e. have been proved to be " cured," to use the
conventional term. But many authors omit the cases of
deaths from operation, the cases of deaths from other
causes, and the cases of patients who do not reply to
inquiries, and give their cures as five in twenty, or 25 per
128 INAUGURAL ADDRESS.
cent. They omit these cases on the ground that it is im-
possible to say whether these cases would have had
recurrence or not. This is no doubt true ; but it is not
true to state^ as by inference these writers do, that cases
which die after operation, being probably the more
advanced cases, are no more likely to recur than those
which survive the operation, and it is not true that a
patient who is dead from recurrence is as likely to reply
to an inquiry as one who is alive and well.
This method of reckoning the percentage of cures may
have the remarkable effect of giving an operator's results
as 30 per cent, free from recurrence after three years,
and 50 per cent, free from recurrence after five years for
the same series of operations ! Indeed, it would be pos-
sible for an author using this method of computation to
claim that if oiip. patient of one hundred operated on
remained well for five years, 100 per cent, of his cases
were " cured," and yet ninety-nine out of the hundred
cases operated on may have died from the immediate
effects of the operation.
I submit that if a gynaecologist performs one hundred
hysterectomies for cancer of the cervix, and on\j ten are
known to be free from recurrence after five years, the
proper way of stating his percentage of cures is that it is
" at least ten.''
But the percentage fallacy has become so frequent since
the severer operations were introduced that, in my opinion,
no notice should be taken of results stated in percentages
unless full details are given of the figures on which those
percentages are based.
There is yet another fault in statistics of this disease
to which I must allude, which consists in the author's
giving g'reat prominence to his rate of mortality (if it is a
small one), sometimes giving it in leaded type but without
any information as to the special methods of treatment
which explain the low rate of mortality, leaving it to be
supposed that the low rate of mortality is due to his own
special skill. I think many statistics would be increased
INAUGUEAL ADDRESS. 129
in value if they gave a little less of the man and a little
more of the method.
I do not think I need apologise for drawing attention
to these faults in the statistics of cancer of the cervix
which are apt to be overlooked by gynaecologists. 1 feel
sure that advance in the treatment of this dread disease
can only take place when these errors are eliminated^ and
when the cases come for treatment in the early stages.
In order that we may get the cases early two things are
desirable, first, diffusion among women of knowledge of
the symptoms of the disease, a course which has been
adopted with good results in Germany, and which might
well be undertaken by the Royal Colleges in this country ;
and, secondly, a recognition by general practitioners, if
not by the General Medical Council, that it is a neglect
of duty to treat haemorrhage or discharge which may be
due to cancer of the uterus without making or advising a
local examination.
It might be thought that in their own interests general
practitioners would advise an examination, for by not
doing so they lay themselves open to an action at law for
negligence ; but, unfortunately, experience shows that
there are still many practitioners who prescribe medicines
and injections for uterine haemorrhages and discharges
due to cancer without making a local examination. In
some cases this would be refused by the patient ; but the
doctor should at least protect himself by advising it. I
am sure I am expressing the opinion of all gynaecologists
when I say that there is nothing sadder in our work than
to find, as we frequently do, that the cancer has been
allowed to grow beyond the possibility of removal, some-
times through feelings of false modesty on the part of the
patient, but sometimes, alas ! through the negligence or
deference of the doctor to whom she has gone for advice,
and in whom she has put her trust.
When the cases are brought to our notice in the early
stages I believe that the extended abdominal operation
will be adopted for a few cases only, that most of the
130 INAUGUIUL ADDRESS.
cases will l)e treated by the vagina by the galvano-cautery,
and I am fortified in this opinion by the fact that Werder,
one of the pioneers of the abdominal operation, has given
it up in favour of the Byrne operation with the galvano-
cautery. But this question can only be decided by the
publication of statistics free from the fallacies to which I
have alluded, and I appeal to the Fellows of this Society
to do their share in providing them.
My occupation of this Chair occurs at an eventful stage
in the history of our Society. You are aware that the
Obstetrical Society and the British Gyna3Cological Society
have agreed to amalgamate and to form the Obstetrical
and Gynfocological Section of the new Royal Society of
Medicine. This Society is in course of formation, and
will be incorporated in the course of the present year.
The union of the various medical societies of London has
been accepted by the great majority of the societies,
and I have no doubt that when it has taken place the
societies which at present refuse to join for various reasons,
which I believe are partly matters of detail and partly
groundless, will see the advantage of union and will join
the amalgamation.
I look upon this union of medical societies as a step
towards a union of far greater importance, viz., the union
of the Royal College of Physicians and the Royal College
of Surgeons of England, which was advocated by the late
Sir John Burdon Sanderson. These are the bodies which
ought to be at the head of a Royal Academy of Medicine
and Surgery. They have already co-operated in under-
taking a conjoint examination. I can see no reason why
they should not completely unite. What a library, what
a museum should we then have ! A new building would
be required in a central part of London, with library,
museum, laboratories, and meeting-room. At present the
Royal College of Surgeons^ Library and Museum is too far
away to be used as its importance deserves.
While waiting for this " consummation devoutly to be
wished,^^ we have accepted the instalment of concentration
INAUGURAL ADDRESS. 131
of work involved in the union of the Obstetrical Society of
London with the British Gynaecological Society. The
amalgamation of the two societies is a subject for con-
gratulation in the interest of obstetrics and gyneecology.
For it was clearly an anomaly that there should exist two
societies in London both dealing with the same subjects ;
and although the Obstetrical Society is bringing into the
amalgamation scheme a sum of over £4000 and a splendid
Library^ which will be shared by the present Fellows of
the Grynaecological Society, this is but a small price to pay
for the advantages of union, which is strength. For in
works for the advantage of humanity there should be no
rivalry in doing, but rivalry in doing good — " certare
ingenio, contendere nobilitate." This, the only rivalry
which is worthy of our profession, will be carried on under
the aegis of the Obstetrical and Gryngecological Section of
the new Society with an increased advantage from the
circumstance that all the serious British workers in
Obstetrics and Gynsecology will be members of the section.
I look forward to the future with the greatest confidence
that the high aims which have always guided our Society
will be continued, and the results of those aims will be
increased by the additional workers who will be added
under the new scheme.
One of the most necessary factors in successfully carry-
ing on the business of our meetings is that the rules and
customs of the Society should be conformed to, and it
will be my endeavour as President to keep this point
before you.
By way of illustration, one of the rules which is apt to
be encroached upon is that which puts a limit of half an
hour to the time during which specimens may be shown
and short communications read ; a second, which is some-
times disregarded, is that accounts of specimens exhibited
may not be read, notes only being used to refresh the
memory ; another, that a " short communication " must
not occupy more than ten minutes in reading, and must
be deposited with the secretaries at least a week before
132 INAUGURAL ADDRESS.
the meeting. There is, however, no need for a short
communication to take up so long a time as ten minutes,,
and the shorter these communications are the more time
is left for the exhibition of specimens, which often
form the most interesting part of the evening's work. I
would ask Fellows to let their communications and their
papers be as concise as possible.
The last two volumes of ' Transactions,' printed on
lighter and bulkier paper, are thicker than the previous
volumes, and the question will soon arise whether wo
should not enlarge the size of the volume ; but in the
meantime the conciseness in the papers, for which I have
appealed, would save some time for the meeting and
improve the appearance of the volume, and, I think, the
papers too.
It has been the custom, though I believe there is no
rule on the point, to announce the names of donors of
books with the titles of the books at the beginning of
each meeting. As books written in many languages are
presented to the Society, the announcement of their titles
may make a great demand on the linguistic faculty of
the honorary secretaries and on the time of the Society.
Probably most of the Fellows would derive more pleasure
and instruction from the exhibition of another specimen
than from the announcement of the titles of the gifts. I
purpose, therefore, omitting the titles while reading out the
names of the donors — pour encourager les autres — and send-
ing round the meeting-room the type-written names of the
donors and the titles. We shall thus, I think, gain a little
more time for the exhibition of specimens.
The Obstetrical Society has been distinguished in the
past for the large amount and high quality of the work
it has done in Obstetrics and G-ynaecology and there is an
assurance that this high standard will be maintained in
the excellent work done by so many of its younger
Fellows, which forms the best evidence of a Society^s
vitality.
I am happy in having to assist me two secretaries who
INAUGURAL ADDRESS. lo3
have enriched our ' Transactions ' by excellent papers.
Both of them were my fellow-students and fellow-workers
twenty-eight years ago^ and they remain fellow-students
and fellow-workers still. With their help and your kind
indulgence I hope to be able to carry out the duties of
the position which this Society has conferred upon me.
Dr. Champneys, in moving " that the best thanks of the
Society be given to Dr. Spencer for his interesting address, and
that he be asked to allow it to be published in the next volume
of ' Transactions,' " said that the Society was fortunate in having,
during the period of transition, and as last President of the
Obstetrical Society, a gentleman who had shown so much public
spirit in its affairs, and who had so abundantly identified himself
with its best work and interests. He believed that the work in
connection with the transition was proceeding well, and felt sure
that the Society would be safe in its President's hands.
135
APRIL Srd, 1907.
Heebeet R. Spencee, M.D., President^ in the Chair.
Present — 42 Fellows and 1 visitor.
A Report was presented by the Hospital Staif of the
Madras Government Maternity Hospital.
James Montague Wyatt, M.R.C.S., L.R.C.P.Lond. ;
Archibald Montague Gray, M.D., B.S.Lond. ; Clifford
White, M.D., B.S.Lond. ; and Herman Stedman, M.D.
Cincinnati, F.R.C.S.Ed., were admitted Fellows of the
Society.
The following candidates were proposed for election :
John Prescott Hedley, M.B., B.C. Cantab. ; William Gordon
Speers, M.R.C.S., L.R.C.P.Lond. (Sao Paulo, Brazil).
The Report of the Council was read as follows ; and,
on the motion of Dr. Heeman, seconded by Dr. Amand
RouTH, No. 1 was adopted, while No. 2 was put from the
Chair and adopted.
Repout of the Council.
An extraordinary meeting of the Council was held on
March 18th, 1907. The Pkesident (Dr. Herbert R.
Spencer) in the Chair.
The minutes of the last meeting were read and con-
firmed.
136 REPORT OF PATHOLOGY COMMITTEE.
The Reijort of tlie Fiiuince Committee (see Finance
Committee minute book) was read and considered.
(1) On the motion of Dr. Cullingwokth, seconded by
Dr. Eastes, it was decided to give an honorarium to Miss
Hannam of £300 (three hundred pounds).
It was decided, on the motion of Dr. Champneys,
seconded by Dr. Handfield-Jones, to give a gratuity of
£25 (twenty-five pounds) to Tatlock ; and, on tlie motion
of Dr. Champneys, seconded by Dr. Hubert Roberts, to
give a gratuity of £5 (five pounds) to Tapson.
It was decided, on the motion of Dr. Champneys,
seconded by Dr. Culling worth, to inform the Amal-
gamation Committee, in reply to its letter, that the
Society had recognised the past services of Miss Hannam,
Tatlock, and Tapson by granting the above-mentioned
sums.
(2) The following twenty Fellows were nominated to
serve with an equal number of Fellows of the Gynascologi-
cal Society on the Council of the Obstetrical and Gynajco-
logical Section of the Royal Society of Medicine : Herbert
R. Spencer, M.D. j Montagu Handfield-Jones, M.D. ; John
Phillips, M.D.; Robert Boxall, M.D.; Arthur H. N. Lewers,
M.D.; William John Gow,M.D.; Francis Henry Champneys,
M.D. ; George Ernest Herman, M.B. ; William R. Dakin,
M.D. ; Henry Russell Andrews, M.D. ; Henry Briggs,
M.B., F.R.C.S. (Liverpool) ; Charles James CuUingworth,
M.D. ; George Eastes, M.B., F.R.C.S. ; John Shields
Fairbairn, M.B. ; John M. Munro Kerr, M.B., CM.
(Glasgow); Cuthbort Lockyer, M.D.; Amand Routh, M.D.;
Mary Ann Dacoinb Scharlieb, M.D. ; Herbert Williamson,
M.B. ; Thomas Wilson, M.D. (Birmingham).
Be'port of the Pathology Committee on Mr. G. F. Darwall
Smith's Specimen of Perithelioma of the Uterus {see
~V. 97).
We have examined the specimen and the microscopic
sections taken from it, and agree that it is a type of
SUPPOSED SARCOMA OF THE CERVIX. 137
sarcoma, best described as perithelioma, for reasons given
by the exhibitor.
{Signed) H. T. Hicks.
CUTHBERT LOCKYER.
C. Nepean Longridge.
C. Hubert Roberts,
Gr. F. Darwall Smith.
CoRRiE Keep.
W. S. A. Griffith, Chairman.
SUPPOSED SARCOMA OF THE CERVIX.
Shown by Dr. Henry Russell Andrews.
L. C — , aged 35, came to the Oat-Pationt Department
at the London Hospital three weeks ago. She had had
three children and one miscarriage. For four months she
had had an offensive vaginal discharge, with occasional
bleeding. For two months she had noticed sometliing
coming down the front passage. For two weeks she had
had pain and constant bleeding. Ten years ago she had
a polypus, of the size of a fist, removed In the north of
England.
The patient was very anasmic. On examination, along,
sloughing, polypoid mass was found hanging from the
cervix. It seemed to be a greatly elongated anterior lip.
Behind this projecting polypus could be felt a rougli,
rather friable mass, apparently the posterior lip, I did
not know at all what the condition was. I admitted her
under the care of Dr. Lowers. As he had an unusually
long list of operations on his next hospital day, he asked
me to carry out the treatment of this case.
Under an anajsthetic it was found that the anterior lip
of the cervix was occupied by a large growth quite as
large as a fist. It was a firm, bluish-red, rather sloughy
138 SUPPOSED SARCOMA OP THE CERVIX.
mass, which was broken up in a peculiar way into
lobules. One long tongue of tissue, covered anteriorly by
squamous epithelium, lay in front of the main mass. The
posterior lip, which could now be felt for the first time
very high up, appeared to be normal. I thought that the
growth must be a sarcoma.
Abdominal hysterectomy seemed to be out of the ques-
tion, as the growth was septic, so I proceeded to perform
vaginal hysterectomy. The operation was laborious and
difficult, because it was impossible to open Douglas' pouch
from below, as the vagina was filled tightly by the growth.
For the same reason the original ligatures had to be
applied close to the uterus ; later, I was able to remove a
good deal of the tissue of the broad ligament on each side.
A para-vaginal incision was made. After working up
gradually on each side, I got the fundus out and then
split the uterus antero-posteriorly, and opened Douglas'
pouch from above. I did not close the peritoneal cavity
completely, as the growth was septic. The patient has
made a good recovery, and is now (two and a half weeks
after the operation) convalescent. The specimen shows
the body of the uterus unaltered, except that it contains a
small, hard, round fibroid in its posterior wall. I have
not had any sections cut from this fibroid. The posterior
lip of the cervix is healthy. From the anterior and lateral
parts of the cervix springs a large, bluish-red, lobulatcd
growth of peculiar appearance.
Microscopical sections show, I think, that the growth is
a sarcoma. In some parts the tumour is very fibrous, but
there are an extraordinary number of vessels. Dr. William
Bulloch, who kindly examined the sections, is of opinion
that the growth is a spindle-celled angeiosarcoma of high
malignancy. I hope that the specimen will be referred to
the Pathology Committee, as there may be a good deal of
difference of opinion as to the nature of the growth, at
any rate at first.
The specimen icas referred to the Pathology Committee
[see p. 169).
I
FIBROMYOMATOUS UTERUS. 139
Tlie President thought, from a short examination of the
slides, that the specimen was a degenerated myoma. He had
not seen any hirge or multinucleated cells to which he was in-
clined to attach importance in the diagnosis of sarcoma of the
uterus. The vessels appeared to be somewhat numerous, but
not more so than was sometimes observed in congested fibroids.
It was, however, clearly a case for the careful study of the
Pathology Committee.
Dr. CuTHBERT LocKYER Said he must disagree with Dr. Russell
Andrews and Dr. Williamson in their opinion that the case was
one of sarcoma. Dr. Lockyer regarded it as a fibromyoma,
blood-supply of which had undergone obstruction in the process of
extrusion. The stasis would fully account for the free interstitial
haemorrhage and for the leucocytic infiltration ; both phenomena
were most marked at the periphery of the growth, and, in the
speaker's opinion, sections taken at or near the attachment of
the uterus would give a more satisfactory picture of the time
nature of the growth. Dr. Lockyer had seen the condition
shown in Dr. Russell Andi-ews' specimen in many cases of polypi
undergoing the process of extrusion, and had always attributed
them to the combined effects of strangulation and inflammatory
reaction. In all these cases the blood-vessels are seen to be
fully formed, each vascular coat being represented, whilst in
sarcoma delicate embryonic blood- spaces abound. Dr. Lockyer,
at Dr. Russell Andrews' request, undertook to cut further
sections of the growth for the purpose of submitting them to
the Pathology Committee.
FIBROMYOMATOUS UTERUS WITH A CALCIFIED
FIBROID LYING FREE IN ITS CAVITY.
Shown by Dr. Dauber.
The patient, Mrs. L— , aged 64, was sent up to the
Hospital for Women, Soho, by Dr. North, of New South-
gate, suffering from a tumour in the abdomen, together
with a copious offensive vaginal discharge, which con-
tained, occasionally— according to the patient's statements
— " small pieces of bone."
On examination, the pelvis and abdomen, to three or
four inches above the pubes, were occupied by a hard,
irregular swelling. There was an intensely foul-smelling
140 FIBROMYOMATOUS UTERUS.
and very copious discharge from the vagina. The patient
stated that she had suffered from the tumour for thirty-two
years, but had never had the courage to submit to opera-
tion. She was induced, with difficulty, to enter the hospital.
On February 21st, 1907, Dr. Dauber operated, assisted
by Dr. Grraham, the Resident Medical Officer. A median
incision was made from the pubes to two inches above
the umbilicus, passing to the right of it. The tumour
was lobulated, being composed of many fibroids, and the
bladder was firmly adherent to the anterior surface of it,
to some three or four inches above the pubes. It was
separated with some difficulty, the broad ligaments were
rapidly clamped, divided, and dissected down until the
uterine arteries were reached, which, as soon as seen, were
ligated and the stump divided about an inch above the
external os. No pus was spilt. The cervical canal was
swabbed out with pure carbolic acid, and the stump sewn
over with continuous silk in the usual way, the broad
ligaments being closed similarly. Both ovaries and tubes
were removed as they were intimately connected with
the tumour. The abdomen was closed in three layers of
continuous silk. The operation lasted thirty-five minutes.
Recovery was uninterrupted and complete.
Directly after operation it was found that the vagina was
full of pus and that a considerable quantity had escaped
during the operation. Presumably the handling of the
tumour had squeezed the pus from the uterine cavity into
the vagina. A vaginal douche was immediately given, and
the contaminated skin cleansed. Dr. Dauber took occasion
to remark that he thought this case was one in which
subtotal was preferable to pan-hysterectomy, as it
would have been difficult, perhaps, to obviate soiling of the
peritoneum in the latter operation in view of the pus in
the vagina, whereas in subtotal hysterectomy this was
easily effected.
On opening the uterine cavity a completely calcified
fibroid, about as large as a hen's egg, was found lying
loose within it, evidently a pedunculated sub-mucous
J
BILATERAL TUBERCLILODS SALPINGITIS. 141
fibroid of long standing, which had become impregnated
witli calcareous salts in the course of long years, and
then had become detached, owing to its weight, twisting
of its pedicle or other accident.
This was a very rare condition, and the case was shown
both on account of its rarity and as a further illustration,
if that were needed, of the futility of waiting for the
menopause in cases of fibroid disease, which, far from
being a panacea, was not infrequently the starting point
of degenerative or other dangerous changes.
The specimen was referred to the Pathology Committee.
Dr. LocKYER regretted that no microscopical shdes were
forfchconiing. A doubt had been raised as to whether the cavity
in which the loose calcified body lay was really the cavum uteri.
Dr. Lockyer had no doubt that it was the cavity of the uterus,
as he fancied he could see an edge of mucous membrane still
left, but inasmuch as the canal of the cervix had not been
opened up before the specimen was hardened the only way to
settle the question was to make a section of the wall of the
caAdty in which the calcified fibroid lay.
The President said it would be interesting if the calcified
fibroid were found to be lying free in the uterine cavity ; he had
not seen, nor did he remember to have read of, a 'calcified
timiour in this situation.
In reply, Dr. Dauber still considered subtotal hysterectomy
m this case the preferable operation, as, the vaginal outlet being
small owing to senility, time would have been occupied in sewing
up the cervix, in the cleansing of the operator's hands, changing
gloves, etc., between the vaginal and abdominal operations, and
time was an important consideration in his opinion.
BILATERAL PRIMARY TUBERCULOUS SALPIN-
GITIS WITH SECONDARY INFECTION OF
THE PERIVASCULAR LYMPHATICS OF THE
UTERINE WALL.
(With Plates XI and XII.)
Shown by Dr. Cuthbert Lockyee.
The patient (M. G— ) was seen in consultation with
Mr. Sydney Wareham, F.R.C.S., on November 23rd, 1906.
VOL. XLIX. 20
142 BILATERAL TUBEECULOUS SALPINGITIS.
Her age was twenty years. She gave the following history :
In May, 190G, she had chickcnpox, and during con-
valescence was seized with acute pain in the right groin,
i. e. above Poupart's ligament. This lasted for throe
weeks. In July, 1906, the patient was again confined to
her bed with the same symptoms — severe pain in the right
iliac region. In October, 1906, she was laid up for
twenty-eight days, this time with pain in the left iliac
fossa, which soon became diffuse, radiating all over the
pelvic area and round to the sacrum. A swelling was
now detected for the first time; it lay just above Poupart's
ligament on the left side. Mr. Wareham had previously
attended the patient in 1905 for acute rheumatism. The
attack lasted from July to September; the joints involved
were both knees, ankles, wrists, and elbows. After the
rheumatism, a period of three months' amenorrhoea set in,
and a yellow vaginal discharge started which has continued
ever since. After the three months' amenorrha>a, the
periods returned very gradually to the usual type of five
or six days' loss every month. The menstrual habit was
established at the age of thirteen years; the How was
always free, three towels being used daily ; there had
been no dysmcnorrlujea.
The family history was important, the father, who was
a miller, died of phthisis, and there was consumption in
the maternal grandmother's family.
The patient herself had lost weight considerably during
her recent illnesses ; she was of the " pretty struma "
type with long eyelashes and tapering fingers. The heart
was normal. A few adventitious crepitations were occasion-
ally heard (after admission) at the right pulmonary base
in the axillary line, otherwise the lungs were normal. The
patient complained of flatulent dyspepsia. Per abdomen :
both iliac regions were very tender on palpation, but the
abdomen moved well on respiration. No tumour was felt
on~ the right side, but on the left there was a semi-
fluctuating swelling visible to ordinary inspection just
above Poupart's ligament. This swelling was nodular,
DESCRIPTION OF PLATE XI,
Illustrating Dr. Cuthbcrt Lockycr's specimen of Bilateral
Primary Tuberculous Salpingitis with Secondary
Infection of the Perivascular Lymphatics of the
Uterine Wall.
Uterus opened from behind, a, e, c. Sites of microscopical sections.
Plate XI.
Obstet. Soc. Trans., Vol. XLIX.
3 U
Q
Adlard &" 5on, /m/if.
DESCRIPTION OF PLATE XII,
Illustrating Dr. Cuthbert Lockyer's specimen of Bilateral
Primary Tuberculous Salpingitis with Secondary
Infection of the Perivascular Lymphatics of the
Uterine Wall.
Section taken through b (Plate XI), showing tubercular systems in
uterine wall.
Plate XII.
Obstet. Soc. Trans., Vol. XLIX.
Illustrating Dr. CUTHBERT Lockyer's specimen of Bilateral Primary Tuberculous
Salpingitis with Secondary Infection of the Perivascular Lymphatics of the
Uterine Wall.
Adlard & Sun, Impi .
BILATEEAL TDBEECULOUS SALPINGITIS. 143
and the visible knuckle of the same felt as if it were
immediately underneath the skin. Per vaginam the os
uteri was drawn high up and fixed. In the left fornix a
hard, tortuous, worm-like mass continuous with the nodule
visible above Poupart's ligament was easily made out.
From the physical signs and the family history the
diagnosis of tuberculous salpingitis was made.
The abdomen was opened on November 29th, 190G.
The patient was placed in the high pelvic posture. A
mesial four-inch incision was made right down to the
symphysis, and on opening the peritoneum a very flaccid
transparent cyst appeared amongst the intestines, to which
it was anchored by filmy adhesions. This proved to be
an inflammatory serous cyst, and looked like a flabby
tentacled medusa. It broke in spite of delicate handling.
It \sras eventually traced to another cyst of similar
character attached to the back of the left broad ligament,
thereby obscuring the ovary of that side from view. The
left tube was nodular, dilated, and tortuous ; it ran
around the serous cyst seen on the back of the leflji broad
ligament like a chaplet. The uterus was small, but very
adherent by filmy inflammatory bands to all adjacent
structures. As the right tube was already transformed
into a huge pyosalpinx of the ordinary banana shape, it
was decided to clear out all the pelvic genitalia en masse,
and fearing that the uterus might be involved in a
tuberculous process it was removed entire together with
the complete adnexa. The abdomen was sewn up in
three layers, and a collodion swab applied to the wound.
Mr. Wareham and Dr. Pearson (the senior house surgeon)
acted as assistants. The operation, which took forty-four
minutes to complete, was well borne by the patient, and
the recovery was afebrile and uneventful. Mr. Wareham
reports that he is giving the patient ovarian extract for
menopastic disturbance, but otherwise her health is good,
there being no sign of further tuberculous trouble so far —
i. e. four and a half months after the operation.
The interest of this case lies in its histology. In the
144 BILATERAL TUBERCULOUS SALPINGITIS.
year 1899 Mr. Targett sliowed a case of double tubercu-
lous pyosalpinx, in which he pointed out that the typical
thin-walled elongated sacs, although containing cretaceous
deposit, caseous material, or inspissated pus, may show
no histological evidence of tuberculous disease, but that
if the uterine ends of the tubes be examined, tuberculous
foci will be discovered. The cornual attachment of a
pyosalpinx has since that date been the site of election in
my routine histological examinations. In the present
case I have examined three sections of the tubes and two
of the uterus. Of the tubal sections one is taken through
the proximal caseous nodule of the left tube, one through
the cornual attachment of the same tube, whilst the third
is taken from the undilated portion of the right tube.
In the thinned-out tube wall investing the caseous nodule
there are no giant-celled systems ; they have given place
to fibrosis ; their former position is indicated by oval areas
of early fibrosis which still include a few epithelioid cells —
not enough evidence of tubercle to convince a sceptical
tyro. Ill the section of the left tube, at its fusion with
uterine muscle, beautiful giant-celled systems become
evident, whilst in the adjacent uterine muscle the spread
of the disease is most clearly shown as a round-celled
infiltration in the lymphatics amidst the muscle-bundles
breaking forth into a typical giant-celled system as
soon as a larger perivascular lymphatic is reached. A
section taken through the endometrium and adjacent
muscular strata reveals nothing abnormal beyond a some-
what hyperplastic and hypertrophical mucous membrane.
The narrow part of the right tube, one inch from the
cornu, reveals no definite tuberculous foci. (Incidentally
the uterine muscle from the region of the left cornu
shows the remains of the Wolffian tubules.) Now this
specimen is a most complete vindication of Mr. Targett's
word of warning expressed at the Obstetrical Society
eight years ago, viz. that for accurate diagnosis we must
examine the uterine ends of the tubes in tuberculous
pyosalpinx. Moreover, as regards secondary infection of
BILATERAL TUBERCULOUS SALPINGITfS. 145
the uterus it shows an absolute analogy to the spread of
cancer from ovaries to uterus. I have already shown
{' Obstet. Soc. Trans./ vol. xlvi, pp. 302, 305, 1904, Dr.
Maurice's specimen) that in the case of malignant ovaries
the cancer cells reach the uterus via the perivascular
lymphatics of the Fallopian tubes, and this is the course
taken in secondary tuberculous disease of the uterus.
Interesting as these findings are, the clinical lesson they
teach is entirely lost if we fail to see in them a clear
indication for hysterectomy in advanced cases of double
tuberculous salpingitis. This was the plea I urged in
1904, when writing on the subject of '^ carcinoma^n the
muscular wall of the uterus secondary to cancer of both
ovaries," and the same teaching is equally applicable here
where we are dealing with an advanced and spreading
tuberculous process instead of cancer. Personally I go
further and often adopt the practice of removing the
entire genitalia (total hysterectomy) for double gonor-
rhceal or puerperal pyosalpinx and double ovarian
abscess. The uterus in such cases is often a useless or
even dangerous organ, and, moreover, is so adherent to the
disorganised appendages as to make its retention a
difficult and unsatisfactory procedure. The advantages of
free vaginal drainage after its removal is another strong
inducement to carry out the radical measure which I am
here advocating.
The President thought that the results of removal of
tubercular tubes alone, without the uterus, were too good to
warrant the removal of the uterus in all cases. He mentioned
two cases, m one of which removal of the tubes was followed by
complete recovery, although the patient had tubercular disease
ot the spmal column at the time of the operation, five years ao-o •
m the other, apparently complete cure of a case of tubercle'' of
the body of the uterus liad followed curetting followed by the
apphcation of iodine and iodoform.
Mr. Malcolm tliought that possibly Dr. Lockver had not
really meant that m every case of operation for removal of
tubercular ovaries or Fallopian tubes the uterus also should be
taken away. The speaker had adopted this course on occasions
146 BILATERAL TUBERCULOUS SALPINGITIS.
however, and he believed that it was the best treatment in
selected cases.
Dr. Eden said that he considered that the operation Dr. Lockyer
had performed was qiiit« rii^ht in this particidar case. He was
not, however, prepared to admit that complete extirpation of the
uterus and its appendages was necessary in all cases of double
tubercidous salpingitis. He thought the most important point
was the condition, not of the tubes, but of the ovaries. If both
ovaries were completely disorganised the complete operation
practised by Dr. Lockyer was no doubt advisable ; the uterus
was, in all probability, fuuctioually useless without the ovaries ;
its removal did not seriously increase the severity of the operation,
while if it were left an active focus of disease might possibly be
left with it. If, hoAvever, it were possible to conserve even a
portion of one of the ovaries with the uterus, he thought it was
most important to do so, especially in young women.
Mr. Alban Doran considered that it was dangerous to leave
a ligatured bunch of tuberculous tissue on each corner of the
uterus. He had known of bad, or even fatal results often
delayed until months after the operation. On that account
amputation of the uterus, as well as the tubercidous appendages,
was advisable. We must remember the element of luck always
associated with tuberculous disease involving the peritoneum.
One bad case might recover after extensive removal of ovai'ies,
tubes, and other structures, whilst another, apparently milder,
might die after simple opening of the peritoneal cavity. There-
fore it was best to be on the safe side, and not to leave pedicles
of tuberculous appendages when it was clearly safer to amputate
the uterus.
Dr. Lockyer, in reply, thanked the Fellows of the Society for
so kindly and fully discussing his case. He would like to point
out that there was no question of tuberculosis of the endometrium ;
the uterine disease was a secondary infection of the muscular
wall due to the spread of tubercle along the lymphatics. Such a
lesion would not be benefited by curettage. Dr. Lockyer quite
agreed that hysterectomy would not be indicated for early
tuberculosis of the Fallopian tubes ; he intended his remarks to
apply to advanced cases, such as the one under discussion, where
all the pelvic organs were matted together, including the ovaries,
which, moreover, were quite disorganised.
ENTIRE FULL-TIME OVUM IN TWINS. 147
CASE OF ENTIRE FULL-TIME OVUM IN TWINS.
By Dr. Robert Wise.
Dr. Robert Wise shoAved, from a case of full-time live
twins, the second ovisac with two placenta in its walls,
the second ovum having been born entire, the cord to
the first and lower child passing from the edge of the
lower placenta in the wall of the second ovum. Both
twins are alive and full-time.
148
ON THE ADVISABILITY OF REMOVING THE
CERVIX IN PERFORMING HYST1<]RECT0MY
FOR FIBROMYOMATOUS UTERINE TUMOURS.
BY
John D. Malcolm, F.R.C.S.Eclin.,
SURGEON TO TKK SAMARITAN FREE ttOSPITAL.
{Ahdract.)
It is pointed out that after a partial hysterectomy the cervix
uteri, with its lilnod supply to some extent cut off and with its
naiTow central tube lined by mucous membrane wliich may be
chronically inflamed, offers a favourable nidus for the develop-
ment of pathogenic micro-organisms in the divided uterine
tissue, whilst the provision for drainage of discharges is im-
perfect.
Two cases are recorded in which local signs of insidious septic
change in the cervix uteri were accompanied by evidences of
irritation elsewhere, one patient suffering very severely from
phlegmasia dolens and the other from a painful cedematous
swelling in the side and in the joints. Both recovered. Notes
of a third case are given, in which, after a partial operation by
another surgeon, the cervix was found actively inflamed with a
fairly copious rauco-purulent discharge from the os and giving
rise to much irritation of the lower bowel.
A note of all the author's fatal cases of hysterectomy is given.
Excluding malignant cases (two deaths), those treated by the
old-fashioned serre-noeud (eight cases, of which six are already
published in detail) and one of enucleation of a fibroid, there
remain six deaths. In two of these, large fibroids so involved
the cervix that the greater part of it was necessarily removed ; in
one the normal uterus was partially removed, and in one it was
REMOVING THE CERVIX IN PERFORMING HYSTERECTOMY. 149
completely removed because in each case it was so incorporated
with an ovarian tumour deeply buried in the broad ligament that
its removal was easier than leaving it. These four cases died
within forty-eight hours of the operations from the severity of
the necessary procedures. In two other cases of pan-hysterec-
tomy death was due to lung complications. It is held that these
cases, although in five of the six the whole uterus was removed,
offer no guidance to treatment on the main question raised in the
paper.
The effects of the various methods on the symptoms of the
artificially induced menopause are also regarded as not giving
very satisfactory indications for treatment, — excellent results
having been obtained by all methods.
The removal of the cervix is urged on the theoretical considera-
tion that leaving it gives an increased opportunity for the
development of septic mischief, and because of the belief that
in practice the convalescence is smoother by this method.
It is therefore recommended that in performing hysterectomy
the cervix should be removed, that before operating the patient's
health should be made as good as possible, and that no woman
should be advised to retain a uterine tumour of any considerable
size, or which has become definitely prejudicial to her health.
These are the points to be attended to with a view to improving
the results of this, which is already one of our most successful
operations.
A little over twenty years ago the death-rate from the
removal of fibroid tumours of the uterus was decidedly
high, but from various causes the mortality has rapidly
diminished, and now a hysterectomy is almost, if not
quite, as safe as an ovariotomy.
Whether it is wiser to remove the cervix or to leave it
is, however, still an open question, and I therefore wish to
publish the following notes, which seem to me to support
the view that the complete operation is the better, the more
scientific, and the safer.
When the cervix is not removed the broad ligaments
are divided, the ovarian and uterine vessels are ligatured,
and the uterus is cut away about the level of the inner os,
150 EEMOVING THE CERVIX IN PERFORMING HYSTERECTOMY.
SO as to leave anterior and posterior flaps of its tissue,
which are brought together and secured in apposition by
sutures. The peritoneal edges are then adjusted so as to
cover over all the raw surfaces.
Every precaution must, of course, be taken to prevent
septic infection, and it is obvious that a special danger of
contamination exists at the point of section of the uterus.
Careful attention must also be paid to the arrest of
hoBmorrhage, which is sometimes by no means easy,
because, if myomatous growths involve the lower part of
the uterus or the cervix, the vessels are often not onlj-
enlarged, but numerous and erratic in distribution.
The difficulties of preventing a contamination of the
area of operation by the contents of the genital tract do
not vary much whether the cervix is left or taken away.
But when the cervix is left, even if the raw surfaces are
perfectly cleaned, if all parts are properly adjusted, and
if haemorrhage is satisfactorily arrested, the conditions
after the operation is finished are, in theory, particularly
unfavourable for healing.
The cervix consists of firm tissue, and the proper
securing of the vessels diminishes the supply of blood to
it. So much may this be the case that I know of an
instance in which the cervix sloughed. Fortunately it
separated without doing any harm. In the centre of the
cervix, the nourishment of which is thus interfered with,
there is a tube of mucous membrane containing many
glands, which are not infrequently in a state of chronic
inflammation, and no practicable method of cleansing can
be relied upon to make such a membrane sterile. More-
over, its cut surface is necessarily left in contact with the
raw uterine tissue, and the narrowness of the tube inter-
feres with the escape of discharges. It is obvious that
this arrangement must be favourable to the development
of noxious organisms in the injured parts and thus con-
stitutes a source of danger.
Although supra-cervical hysterectomy has proved un-
doubtedly a very successful procedure, the dangers which
REMOVING THE CERVIX IN PERFORMING HYSTERECTOMY. 151
I have pointed out must exist so long as the method is
adopted, and the following cases, although the patients
completely recovered, show that the risks directly due to
the method should not be neglected.
In the first case the patient was a nulliparous married
woman, aged 40, who had a soft fibromyoma of the uterus
rising nearly to the umbilicus. It had been known to
exist for two years and had brought about a condition
of extreme ansemia by the profuse htemorrhages which
accompanied its development. The patient had suffered
from a feverish illness attributed to tuberculosis of the
bases of both lungs in 1894, but she appeared to have
recovered completely and to be in all other respects
healthy. The tumour and the body of the uterus were
removed at the >Samaritan Free Hospital on June 23rd,
1903, the cervix being left, and there seemed to be no
reason to expect other than a good convalescence when
the patient was put back to bed. The abdominal incision
never showed any sign of irritation and there was no
evidence of peritoneal mischief at any time. Nevertheless,
the patient had the most severe and prolonged attack of
phlegmasia dolens that I have seen. From the first the
temperature was high. On the fifth day there was pain
at the base of the right lung, and, on auscultation, friction
sounds were detected both before and behind the seat of
pain. No rales or evidences of mischief within the lung
were detected, and the signs of irritation of the pleura
ceased after about a week.
On the ninth and tenth days the temperature was above
104° F. for seventeen consecutive hours, rising as high as
106*2° F. The patient was then delirious and obviouslj-
very ill, but the highest pulse was 126. The temperature
fell from 106"2° to 101° F. in seven hours. There was
no immediate explanation of the rapid fall, but about a
week later there was a slight escape from the vagina
of thick white matter, which ceased after a few hours.
When an examination was made there was always some
fulness and tenderness of the cervix. No swelling was
152 REMOVING THE CERVIX IN PERFORMING HYSTERECTOMY.
felt at any time beyond or beside the cervix, and no
appreciable discharge was noted except on the occasion
mentioned.
It was not until shortly after the pleural irritation
subsided and the temperature moderated that any sign of
mischief developed in the legs. First one and then the
other calf became swollen and painful, and then apparently
recovered. With, and following, these manifestations there
was a prolonged period of febrile temperature.
Eleven weeks after the operation the patient again
became very ill, the temperature rising nearly to 106° F.
This was followed by an enormous swelling and much
pain in the feet, logs, and thighs, the two sides being
about equally affected. There was then some evidence of
rectal and bladder irritation, but these symptoms only
lasted a few days.
At this time 10 c.c. of antistreptococcic serum were
injected subcutaneously without any very obvious effect.
A few days later there was a slight general improvement,
just as there had been before, and this marked the end of
the last acute exacerbation. The temperature remained
above normal, however, and variable, whilst the pain and
swelling subsided only very gradually, and it was not
until nineteen weeks after the operation that the patient
left the hospital.
In the summer of 1906 she looked exceedingly healthy
and said she could walk six miles without being tired.
There was still some tendency to swelling of the legs,
which was checked by means of elastic stockings. The
patient has recently developed tumours in other parts of
the body — a lipoma and a sarcoma apparently involving
three costal cartilages — but her further history has no
bearing on the subject under discussion. The uterine
tumour was not examined microscopically. I had no sus-
picion that it was other than a simple fibromyoma.
It Is, perhaps, important to state that in this case the
operation was performed during a week of excessively hot
and close weather. I was informed that about the same
EEMOVING THE CERVIX IN PERFORMING HYSTERECTOMY. 153
time, both in the Samaritan Free and in other London
hospitals, there had been cases of very high temperature
without any obvious cause, and that in one instance death
took place with an unexplained hyperpyrexia a few days
after a hysterectomy.
If my patient had died from a slightly greater absorp-
tion within three or four days of the operation, I think
that very little evidence of mischief would have been
found at a post-mortevi examination, and there might
have been no satisfactory explanation of the cause of
death.
The pleurisy, the phlegmasia, the tenderness around
the cervix, and the absence of any signs of mischief
within the peritoneal cavity or in the abdominal incision
all pointed, however, to the existence of an insidious form
of septic mischief beginning in the uterine stump.
In another case the pathological changes were very
similar.
The operation was undertaken on account of a fibro-
myoma uteri causing persistent hgemorrhages in a patient
aged 42. Only the supra-cervical parts were removed,
and at first there was no unusual symptom, the bowels
being evacuated after two days. The temperature on
the third day, instead of falling, rose to 102"2° F., and
continued at about the latter level. Nothing, except that
the cervix was somewhat swollen, was discovered to account
for the prolonged fever until the eighth day, when there
was a little purulent discharge from the vagina. Its
escape was preceded by a further rise of temperature to
103'4 F., and immediately afterwards there was a rapid fall
of three degrees. The pulse-rate kept comparatively
at a lower level than the temperature, the highest record
being 96.
The escape of pus was followed almost at once by a
slight loss of bright red blood. The hgemorrhage con-
tinued for four days, and then there was again a discharge
of yellow matter, which gradually ceased. Except that
the temperature continued to fluctuate, the patient seemed
154 REMOVING THE CEKVIX IN PERFORMING HYSTERECTOMY.
fairly well, and the pulse did not rise above 96. On the
tenth day, when the haBmorrhage had begun, 10 c.c. of
anti-streptococcic serum were injected. This treatment
did not seem to have any useful effect. The cervix became
less swollen, but a steady escape of blood was taking-
place.
On the eighteenth day the temperature rose to 105° F.,
the highest pulse- rate at this time being 100. The patient
had for some days complained of severe and increasing
pain over the liver in the mid-axillary line, and there was
considerable oedema of the subcutaneous tissues at the
seat of pain. As the patient lay on her back the centre
of this swelling was about five inches below the completely
healed puncture- wound caused by injecting the serum.
The patient was put under an anaesthetic, and an exami-
nation showed that the cervix was quite mobile, the whole
pelvic and abdominal contents seeming to be soft and
normal. An incision three inches in length was made
through the ocdematous fat on the right side down to the
fascia over the muscles, but I found no bulging or other
sign of intra-abdominal mischief. I therefore closed the
incision, and it healed by first intention. The pain ceased,
the oedema disappeared, and the temperature fell to 99"6°
F. two days later. On the third day, the twenty-first
after the hysterectomy, the temperature again rose to
104*8° F., and this was accompanied by tenderness in
many joints, particularly in the wrists and knees. Sodium
salicylate was administered and after another three days
the temperature was normal.
The vaginal discharge had ceased before this time, and
there was no discovered cause for the amelioration of
symptoms apart from the administration of the salicylate,
but the improvement was permanent.
In this case it would almost appear that the treatment
by injecting antistreptococcic serum might be held re-
sponsible for some of the unfavourable conditions which
arose. This is important, for at present it is not certain
when the method will prove beneficial, and in the fore-
EEMOVING THE CEEVIX IN PERFORMING HYSTERECTOMY. 155
going cases it was resorted to as being at least very un-
likely to do harm. In administering it every care was
taken to prevent septic contamination.
The history of this second case also strongly sujDports
the view that mischief may arise from a form of septic
infection spreading from the cervical canal. It seems
certain that a small collection of blood was retained and
became infected, the septic products partially escaped, then
a vessel bled for a few days, and the parts healed by
granulation.
Undoubtedly there was also a pathological process
affecting tissues at a distance from the seat of operation,
but there was not sufficient evidence to show whether this
was due to an infection from the injured tissues, to an
effect of the injection of serum, or to a constitutional dis-
turbance of a rheumatic nature. There was no history
of a previous rheumatic attack, although the patient had
occasionally complained of pains in her joints.
A third case, in which I did not myself perform the
operation, but which is instructive in connection with the
subject under consideration, has recently come under my
observation. The patient was brought to me by her
medical attendant thirteen months after hysterectomy had
been performed. She was aged 33. She was of a nervous
constitution, and the symptoms of the artificially induced
menopause — flushings, headaches, etc. — were severe. An
additional trouble was a considerable discharge of mucus
from the bowel, and I gathered that this had been regarded
as the chief cause of the complaints which the patient
had made since the operation. It may have been so, but
the cervix had been left in the body, and was large,
swollen, and tender. On inspection it was red and angry
in appearance around the os, from which there was a
considerable muco-purulent discharge, and this was said
to be increasing in quantity. A sound was easily passed
fully half an inch into the cervLx, but I did not think it
wise to insinuate it further.
It seemed to me that all the symptoms of the " change
156 REMOVING THE CERVIX IN TERFORMING HYSTERECTOMY.
of life " were exaggerated by the debility and irritation
induced by the cervical condition. A catarrh of the
rectum with a profuse discharge, and sometimes with
mucous casts of the intestine, is not an uncommon result
of an inflammation affecting some part of the genital
tract, and it is highly probable that the state of the bowel
and the vaginal discharge in the case under consideration
were directly due to the presence of the inflamed cervix,
and that both would have been avoided if a complete
hysterectomy had been performed. I thought that pos-
sibly a ligature was becoming loose and would be dis-
charged, and therefore palliative treatment was recoui-
nicnded for the time, but in such a case the question of
removing the cervix by a second operation might have to
be considci-ed, and conditions directed to the state of the
intestine could not, I think, prove better than palliative
until the inflammation in the cervical stump subsided. I
understand that the immediate convalescence in this case
gave rise to no anxiety.
Although such conditions as those above recorded are,
I believe, rare, nevertheless there are cases, and I have
already alluded to one, in which death follows a hyste-
rectomy a few days after the operation without any cause
being discovered, and such a fatal issue may be due to a
sepsis arising by contamination from the contents of the
cervix without any local change obvious to the naked eye
being induced.
The causes of white leg and of painful oedematous
conditions elsewhere as a consequence of an operation are
very obscure. I have seen a phlegmasia dolens arising
three weeks after a simple abdominal section, from which,
in all other respects, the patient appeared to iiiake a per-
fectly satisfactory convalescence. It is sometimes held
that an extreme degree of aneemia, which existed in the
first two cases above recorded, favours the onset of such
complications, and it might be argued that the process is
not always a septic one, although in many cases it obviously
is so. There cannot, however, be any doubt that methods
EEMOVING THE CEEVIX IN PERFORMING HYSTERECTOMY. 157
which facilitate the healing of an intra-abdominal injury
must tend to prevent the subsequent development of this
and similar complications.
It may perhaps be held that the complete removal of
the uterus only shifts the point of danger from the cervix
to the vagina, and without doubt the vagina also offers
opportunities for septic infection. Since the above was
written I have met with a very mild case of phlegmasia
dolens after a complete hysterectomy. The patient,
whose age was 39, appeared to be making a satisfactory
recovery, with the exception that the temperature during
the first three weeks, although the highest point recorded
was only 100*2°F., did not come down to normal in the
evenings. There was no other adverse sign and I thought
it well to get the patient up with a view to removing her
to the country. Accordingly on the twenty-third day
she began to move about. The temperature again rose
to 100'2°F., but the abdominal condition seemed perfect,
and there was no other indication of danger until the
thirty-fifth day, when there was a slight painful swelling
of the right leg. Two days later the temperature rose to
103*4° F., but within a week it was normal, morning and
evening, and the swelling and pain were gone. After
this the patient's progress was good, and I have recently
heard that her condition is very satisfactory.
The history of this case favours the view that anaemia
is an important predisposing cause of phlegmasia dolens,
for before the operation the patient was of extremely
unhealthy appearance. Six years earlier she had been
told that she had a tumour, but that the state of her
health was too bad to permit of operative treatment. In
1906 she came under the care of Mr. Wale, of Croydon,
who sent her to me. I had no hesitation in advising her
to take the risks of an operation as her prospects of
improvement, without this treatment, seemed very remote.
That, in such a case, everything did not progress with
complete freedom from complications does not seem to me
necessarily to indicate a fault in the method.
VOL. XLIX. 11
158 REMOVING THE CEEVIX IN PEEFOEMING HYSTEEECTOMY.
Tlie chief disadvantages of the total operation as com-
pared with the partial are that it generally takes longisr
to perform^ and that the manipulation is more difficult.
The greater time required may, however, be made up for,
to some extent, by the fact that when the cervix is left a
very exact arrest of all bleeding points should be obtained ;
whereas when it is removed if there be some oozing after
the patient is put to bed the blood escapes easily, and it
is therefore harmless. Indeed,' unless the loss is dangerous
from its quantity, a slight escape may be beneficial by
reducing local tension and by washing away infective
material.
The difficulties of manipulation are due to the great
length which the cervix occasionally attains, and to the
depth in the pelvis at which the surgeon may have to
work.
It is sometimes easier to cut away the uterus as low
down as possible, and then to seize the rest of the
cervix with a volsella and to cut it out. Mr. Bland-Sutton
recommends that only the mucous membrane and the
parts around it should be removed, a shell of cervical
tissue being left. By this plan many of the advantages
of the complete operation may be obtained, the chief of
these being the removal of the lining membrane of the
cervical canal. Mr. Bland-Sutton's method has not,
however, seemed to me easier of execution or more certain
of securing a free escape of discharges than that by which
there is a complete extirpation of the cervix. Moreover,
when this part is much elongated, and I have seen it
three inches in length, it must be very difficult to excise
the central tube, and I think it must sometimes be almost
impossible to be sure that the whole of the mucous mem-
brane has been removed.
In considering the question as to the best method of
performing an operation, the deaths immediately following
the procedures under discussion may be important. Our
President, in a former debate on this matter, quoted
statistics showing that the mortality from hysterectomy
REMOVING THE CERVIX IN PERFORMING HYSTERECTOMY. 159
was less when the cervix was taken away than when it
was left, the figures being 8*27 per cent, against 8-64 per
cent.* My own mortality would compare favourably
with either of these figures if I exclude cases operated
on by the old-fashioned serre-noeud method. I cannot
give exact details because, for a considerable period, I
left the cervix or removed it, as I thought fit at the
moment, and I find that I have not always been careful to
state which method was employed in the cases that
recovered. Statistics are, however, in my opinion, of no
value unless very large numbers are involved, and even then
they may be misleading. There are so many circumstances
besides the surgical methods that may influence the death
rate, and often there may also be a considerable range of
legitimate difference of opinion regarding the placing of
cases in a table. Moreover, bald figures may lead to
false conclusions, and a consideration of the individual
cases leads me to believe that my fatalities are of no
value in connection with the particular point raised in this
paper. I set aside cases operated on by the serre-noeud
method, from which I had eight deaths, six of which have
already been published in detail.t I also set aside two
fatal cases in which malignant tumours were removed and
in which it was, of course, right to take the cervix away if
it was possible to do so. Besides these, -I find only one
fatality from the partial operation and five from total
hysterectomy. Clearly, it might be argued from these
figures that the incomplete operation should, at least, have
a further trial, and might prove the more successful in my
hands. Moreover, in the one fatality from the incomplete
operation the body of the uterus was removed only
* ' Obstet. Soc. Trans./ 1905, p. 403.
t " Some CompHcated Cases of Abdominal Section " Case No II
' Lancet/ Jxily 18th, 1891, p. 119 ; " Ilhxstrations of Some Modes of Death'
after Ovariotomy," Cases Nos. IV and VI, 'Med.-Chir. Trans ' 1895-
" Twenty-six Cases in whicli an Abdominal Section has been Performed
a Second Time," Cases Nos. XII, XXI, and XXII, 'Med. Soc. Trans '
loyo. '
160 REMOVING THE CEEVIX IN PERFORMING HYSTERECTOMY.
because it was so closely incorporated with a deeply-
buried ovarian tumour that it was easier to excise
than to leave it. The patient died next day from the
direct effects of the operation, the duration and severity
of which would certainly not have been shortened by an
attempt to separate the uterus. As there was no tumour
in this case it might be ignored altogether, leaving my
results from the incomplete operation for removal of
fibroid tumours perfect so far as the mortality is concerned.
Of the five cases in which death followed a total
hysterectomy one might be dismissed on the same grounds,
namely, because there was no uterine tumour. The
patient was suffering from septicaemia when I removed a
large semi-solid ovarian cystoma, which was suppurating
in several places and so deeply buried in the broad
ligament that it was, again, easier to remove the uterus
than to separate it. This patient also died the day after
the operation.
In two cases in which there were large tumours, one a
cervical fibroid, the other a tumour of the uterine body as
big as a uterus in the seventh or eighth month of
gestation, the cervix was so expanded that a pan-
hysterectomy, or practically that operation, could not be
avoided. Both patients died within forty-eight hours of
the operation.
Another of these cases is interesting in connection with
the probability that a septic infection may have arisen
from the vaginal wound. The patient was aged 46, and I
removed the whole uterus and both ovaries at the Samari-
tan Free Hospital in 1898. She had frequently suffered
from bronchitis with expectoration, but immediately before
the operation there was no sign of lung mischief, except a
few crepitant rales in the left apex. After the operation
the patient was very restless from the first, the pulse was
above 120 for two days, and the temperature rose to
103"8° F. on the second evening.
There was no difficulty in getting the bowels to move,
and no evidence of peritoneal mischief at any time. On
REMOVING THE CERVIX IN PERFORMING HYSTERECTOMY. 161
the fifth day the calf of the left leg was swollen and
painful and the temperature rose to 1 04'4° F., whilst the
pulse was 150. These unfavourable symptoms moderated,
but on the sixth day the patient had a troublesome cough,
and on the ninth expectoration was profuse. She took
food well to the end and showed no signs of peritoneal
mischief, but she gradually developed a general septicaemia,
and died on the sixteenth day, the chest condition being
certainly an important cause of the fatal issue. A post-
mortem examination was not allowed.
Whether the character of the bronchitis was altered by
an infection from the contents of the genital tract, similar
to that which caused the temporary swelling in the leg,
is perhaps an open question, but it seemed to me that this
did occur.
In the last of these fatal cases death was also due to a
lung complication. Much blood was lost in separating
adhesions from which the haemorrhage could not be
arrested until the tumour had been released and removed
from the pelvis. Several pints of normal saline solution
were introduced into a vein with the most gratifying
immediate results, but loud rales were heard all over the
chest the same evening, and the patient died the next
afternoon from acute bronchitis. She had not been sub-
ject to any lung trouble before the operation. I am
inclined in this case to associate the transfusion with the
fatal issue. The method is far too active to be unasso-
ciated with dangers of its own. Its employment must, to
some extent, depend upon the anaesthetist's opinion of
the condition of the patient, and it seems to me that there
is at present a too great readiness to resort to treatment
by venous infusion. This is largely fostered, in my opinion,
by erroneous views on the condition of the blood-vessels
during severe operations.
When I add one case in which a semi-pedunculate
uterine tumour was removed from a pregnant uterus, the
operation being followed by a miscarriage and death
from septicaemia, I have mentioned every case in my
162 REMOVING THE CERVIX IN PERFORMING HYSTERECTOMY.
practice of death from operation for the removal of
uterine new growths. Of the six cases bearing on the
question raised, four died from the excessive severity of
the operation, two from lung complications, and I do not
think that any weight, either in favour of leaving or of
removing the cervix, can be attributed to these results.
Another view of the question at issue may be obtained
from a study of the remote effects of treatment. My
colleague, Mr. Alban Doran, has published the results of
a series of hysterectomies performed for fibro-myomatous
tumours, and recorded after an interval of not less than
two years (' Obstet. Soc. Trans.,' vol. xlvii, p. 363). He
was inclined to favour a partial removal, the cervix and
oven a portion of the mucous membrane of the body
of the uterus being left. By this procedure it was
suggested that a less troubled convalescence might be
obtained.
The effects of the operation upon the progress of the
" change of life " are important. But, as was pointed
out by Mrs. Stanley Boyd, in the debate on Mr. Doran's
paper, if we consider how much the troubles of the meno-
pause vary in women who have not undergone surgical
treatment and have had no recognised disease of the
genital organs, it seems to me that we ought not to lay
too much stress in regard to this matter on the results of
a series of operations, unless the indications are very
strongly in favour of one view, and this was not asserted.
Surgical treatment cannot, for example, make a neurotic
woman cease to be so, and in those rare cases in which
insanity follows an operation on the genital organs I think
there is generally a predisposition to mental disorder.
I only remember two such cases in my own practice, and
in each the patient came from an aifected stock. In fact,
when the condition of a patient after treatment is not
satisfactory it may be that the method is not in any way
at fault.
I would suggest that women who are otherwise healthy
generally make the best recoveries, both as regards the
REMOVING THE CERVIX IN PERFORMING HYSTERECTOMY. 163
immediate and tlie remote results of a hysterectomy.
One of my earliest recollections of abdominal surgery is
tlie remarkable success, as judged by the after-results, of
many cases in which the old operation, with the use of
the serre-noeud and removal of both ovaries and Fallopian
tubes, was employed. Similarly, by every modern method
or combination of methods as regards taking or leaving
the cervix and one or both ovaries, the most gratifying
after-results are common. When both ovaries have been
removed I have seen patients get well so quickly that
I am by no means persuaded that the leaving of an ovary
or part of an ovary is so important a 23oint as some
surgeons believe.
There are patients who are not so fortunate, but one of
the worst cases of nervous disturbance after a hyster-
ectomy in my practice was that of a patient aged 54 from
whom I removed a very hard fibroid tumour, which filled
the pelvis and caused much trouble from its weight, three
years after the periods ceased. The tumour was so cal-
careous that I could hardly cut it with a knife. Its re-
moval, the ovaries and cervix being left, was followed by
a perfect convalescence, so far as the surgical condition was
concerned, but for three years there was almost constant
distress, especially in warm weather, from irritation of the
skin all over the body. At the end of that time the
health of the patient began to improve, and she now says
that she is very comfortable.
From a consideration of such cases I hesitate to con-
clude that after-troubles, connected with the artificial
induction of the menopause by removal of the uterus,
should be attributed altogether to the method of operating,
and from a careful study of the whole question I have
formed the opinion that the advantages of removing the
cervix decidedly outweigh the disadvantages, both in
theory and in practice.
In theory the removal of the cervix seems to me ex-
ceedingly desirable, for the reasons which I have stated,
and in practice the patients, in my experience, recover
164 EEMOVING THK CERVIX IN PERFORMING HYSTERECTOMY,
much more smoothly and comfortably after the total
removal of the uterus.
I would, therefore, urge that in performing hysterectomy
the excision of the cervix should be undertaken whenever
there are no very special reasons against it ; that, when
time permits, the general health of the patient should be
made as satisfactory as possible before this operation is
performed ; and that no woman should be advised to
retain a fibroid tumour which has begun to have a defi-
nitely prejudicial effect upon her health, or which is of
any considerable size. These seem to me to be the chief
points to be attended to with a view to obtaining a still
further success from this which is already one of our
most satisfactory operations.
Mr. Alban Dokan admitted that Mr. Malcolm had most ably
pleaded for panhysterectomy, yet, for several reasons, in part
admitted by himself, his arguments could hardly persuade us
that the so-called " subtotal " operation ought to be abandoned.
In the first place the cervix was one important part of the pelvic
floor which should not be treated as a negligeable quantity by
the operator. We knew how safely it could be left when the
body of the uterus, badly damaged dvu*iug the removal of an
adherent ovarian tumour, had to be sacrificed. Pozzi and others
saved the cervix in many cases where the rest of the uterus was
taken away with diseased appendages, provided, of course, that
no septic condition was probable. In the second place there
was reason to believe that, in order to ensure the full benefits
which should follow the saving of more or less of the ovaries in
hysterectomy, it was advisable to leave a portion of the endo-
metrium as well ; in other words, not only the cervix, but a
little more of the uterus, should be spared. Mr. Doran had
brought forward evidence, based upon long after-histories of
sixty subtotal hysterectomies, showing the value of this practice,
and further experience had not induced him to alter his views.
Mr. Doran laid great stress on long after-histories, for a woman
convalescent from hysterectomy for fibroid was never so sure of
permanent benefit as was a patient convalescent from ovariotomy
for a non-malignant tumour. The method of Crewdson Thomas
should be applied to all series of subtotal and panhysterectomies,
and it would be instructive to hear some day of Mr. Malcolm's
results-after passing a test of that kind. Until then (if even
then) the death-knell of the subtotal method covQd not be
sounded.
REMOVING THE CERVIX IN PERFORMING HYSTERECTOMY. 165
Dr. Amand Kouth did not consider that Mr. Malcolm had
proved his contention that it was better to perform total rather
than subtotal hysterectomy in operations on uterine fibroids.
Hitherto panhysterectomy in fibro-myomatous uteri had been
urged from the point of view that the cervix was apt to become
malignant if not removed. It had not, however, been proved
that fibroids predisposed to uterine cancer, and still less had it
been shown that the cervix was especially prone to malignant
changes if fibroids were present in the uterine body. Even if
such a connection were proved it had still to be shown that
such a tendency persisted after the fibroids were removed by a
subtotal hysterectomy. To-night, however, Mr. Malcolm had
advocated the removal of the cervix " on the theoretical con-
sideration that leaving it gives an increased oj^portunity for the
development of septic mischief." Dr. Routh thought that this
was theory alone, and that the author had advanced no sufiicient
proof that the cervix was inflamed in his case, or that the auto-
toxsemia from which the patient undoubtedly suffered was of
cervical origin. He did not believe that the blood- supply of the
cervix after subtotal hysterectomy was "to some extent cut off,"
nor that the cervix tended to degenerate, and he thought the
phlegmasia and other symptoms in the author's cases were
secondary to infection of the pelvic cellular tissue. In the
absence of proof that leaving the cervix was likely to cause
mischief. Dr. Eouth thought the disadvantages of its removal
should be carefully considered. The mortality of panhysterec-
tomy was distinctly greater. Taking over 1000 cases, collected
by Pozzi, of each of these two forms of hysterectomy, he found
the percentage of mortahty of panhysterectomy was 10*4, whilst
the mortality of the subtotal oj)eration was only 7'4. The sub-
total operation could be performed more quickly, and there was
less haemorrhage, and the haemorrhage was more easily controlled.
Sepsis was much more likely to occur, with infection of ligatiu'es
and prolonged suppuration, if the vaginal canal were opened up.
The length of the vagina was maintained if the cervix was
retained, and colpocele could be avoided by drawing the stumps,
foraied by the ligation of the uterine and ovarian vessels,
together on each side. This procedure was useless in pan-
hysterectomy. There remained, too, the question of internal
secretion, and it was quite certain that such a glandular struc-
ture as the cervix must have one. If organs were to be removed
for possible dangers in the future, where is the line to be
drawn ? Following the same argimient, no one would leave a
second ovary in situ if one were being removed ; no one would
leave the appendix vermiformis if the abdomen were opened for
any cause. He was sorry that he did not think that Mr. Malcolm
had made out his case.
Mrs. Boyd used both methods for fibro-myoma, according to
166 REMOVING THE CEEVIX IN PERFORMING HYSTERECTOMY.
which seemed best suited to special conditions, and did not
speak, therefore, as a partisan of either method. She had on ,
more than one occasion seen a ceUuhtis about the stump of a
cervix left by supra- vaginal amputation, biit she had also seen
celliditis about the exposed base of the bladder, accompanied by
troublesome cystitis, in cases of panhysterectomy. She found
panliysterectomy the more troublesome operation, and agreed
with Mr. Doran that the greater interference A\dth the pelvic
floor, and the more difficult haemostasis, where the vaginal vault
was incised, wei'e points of considerable importance.
Dr. Eden said that he had performed a large number of
hysterectomies for fibro-myoma by the supra-vaginal method,
and a small number by the total method, and he was equally
satisfied with both. He was not at all convinced by Mr. Malcolm's
arguments that the total operation possessed any real advantages
over the other. Mr. Malcolm's objections to the supra-vaginal
operation were two in number : (1) the blood-supply of the
cervical stump was impaired by the operation, and it was there-
fore more liable to become infected ; (2) the mucous membrane
of the cervix was a greater soui-ce of danger than that of the
vagina. With regard to the first objection, it must be recollected
that the blood-supply of the cervix consisted of the circular artery
from the uterine and anastomosing branches from the vaginal
arteries. In the supra-vaginal operation the uterine arteries
were divided above the origin of the circular branches, while the
vaginal arteries Avere uninjured ; the blood- supply of the cervix
was therefore not affected in any way by this operation. With
regard to the second objection, he thought that bacteriology
showed the vaginal flora to be much oftener pathogenic than
those of the cervix. The clinical evidence brought forward by
Mr. Malcolm in support of his contention upon this point was
singularly unconvincing. For instance, cases of phlegmasia
occurred quite as often after a simple ovariotomy as after a pan-
hysterectomy, and the cervical stump could have nothing to do
with its causation. Again, the occurrence of localised cellulitis
around the stump after the supra-vaginal operation might be
due to faulty technique ; he had seen such cases himself, and he
explained them in that way. And lastly, he suggested that the
case in which Mr. Malcolm observed a purulent discharge from
the cervix and the rectimi thirteen mouths after supra-vaginal
hysterectomy might have been due to gonori'hoeal infection
acquired subsequent to the operation. On the whole, he was
not convinced that there was any practical advantage in the total
operation. It was argued that better drainage was obtained by
the removal of the cei*vix, but under ordinary circumstances
drainage ought not to be required ; it was much better to arrest
hsemorrhage completely before sewing over the peritoneal edges.
It certainly appeared to him that prolapse of the bladder was
REMOVING THE CEEVIX IN PEEFORMING HYSTERECTOMY. 167
more likely to occui' after tlie total operation, especially if vaginal
drainage were employed for a few days afterwards. Since it
could be more rapidly performed, lie should continue to prefer
the sub-total operation, except in special circumstances.
The President said that he had performed total abdominal
hysterectomy for fibroids to the entire exclusion of the partial
operation for the past six years, and agreed with the main con-
clusions of the author that total abdominal hysterectomy was
superior to supra- vaginal amputation, but he did not think that
Mr. Malcolm had produced much evidence of its superiority.
He (the President) had given the points of superiority of the
total operation at the Manchester meeting of the British Medical
Association, in AUbutt, Playfair, and Eden's ' System of Gyne-
cology,' and in that Society. He had not seen any evidence
brought forward which led him to modify his opinion as to the
superiority of the total operation when performed by Doyen's
method. It was superior in that it had a lower mortality (as is
shoAvn in Saenger and Herff's* extensive statistics) ; it provided
for drainage ; it gave security against injury to the bladder and
ureters and against unrecognised haemorrhage ; it removed the
cervix, which might become infected, slough, contain unrecognised
malignant disease, or develop malignant disease subsequently.
It was also less likely to be followed by intestinal obstruction if
the peritoneum were closed by a purse-string suture. He had
never seen prolapse or trouble with the bladder caused by the
operation. The bladder troubles which Mrs. Boyd had met with,
he thought, might be due to her employing gauze drainage.
Bumm had noticed these troubles after Wertheim's operation,
and attributed them to the use of gauze drainage. The President
had not employed gauze drainage after abdominal hysterectomy
for fibroids for several years past, and -knew that it was
unnecessary, and believed it to be injurious. The supposed
advantage of the internal secretion of the cervix and the slight
shoi-tening of the vagina by the removal of the ceiwix could not
be seriously set off against the above-mentioned advantages.
Their importance was disproved by the excellent results of
vaginal hysterectomy.
Mr. Malcolm, in reply, said he was quite aAvare that his
argument would not be conclusive to those who thought the
supra-cervical the better operation. He had brought forward all
the clinical evidence he possessed against the view he advocated,
as well as that in its favour. Nevertheless, he had come to a
very decided opinion, founded on the facts stated, that the com-
plete operation was the better one. Of course, it was open to
anyone to say that the complications which arose were due to
faulty technique, but every care was taken, and the two first cases
offered no difficulties of manipulation, so that he was himself
* ' Encyklopadie der Geb. und Gyn.,* 1900, pt. 2, p. 91.
168 REMOVING THE CERVIX IN PERFORMING HYSTERECTOMY.
confident that, so far as he was concerned, these cases should
have given no trouble. Moreover, as stated in the paper, there
was no mischief to be detected by manipulation around the
stump, and clear evidence of mischief in it. The idea that the
third case might be one of gonorrhoea was also possibly correct,
but the mischief was not in the vagina, except just round the os,
and there was certainly much inflammation in the cervix, whilst
the trouble dated from soon after the operation. On the whole
the evidence seemed to favour the view that a ligature was
separating. Mr. Doran had pleaded for longer after-histories.
The speaker had not tackled this extremely laboriovis investiga-
tion in a series of cases, and it might be that he heard most of
his successful operations, but he had plenty of long histories, in
which the residts were all he could hope for. He had not met
with trouble from weakness of the pelvic floor, nor from cellulitis
around the bladder. He did not pack the vagina.
169
MAY 1st, 1907.
Dr. Heebeet E. Spencer, President, in the Chair.
Present — 30 Fellows and 4 visitors.
Books were presented by the Johns Hopkins Hospital
Staff, The Medical Society, The Journal of Obstetrics and
Gynaecology of the British Empire, and a copy of a medal
by the Executive Committee of the Semmelweis Inter-
national Memorial.
The following candidates were elected Fellows of the
Society : John Prescott Hedley, M.B., B.C.Cantab. ;
William Gordon Speers, M.R.C.S., L.R.C.P.Lond. (Sito
Paulo, Brazil).
Report of the Pathology Committee on Dr. H. Russell
Andrews's Specimen of Supposed Sarcoma of Cervix
{seep. 137).
We have examined this specimen and microscopic
sections taken from various parts of the tumour (cut by
Dr. Cuthbert Lockyer specially for this Committee), and
agree that the growth is not a sarcoma, but a degenerating
fibro-myoma, the vessels of which are fully formed and
170 INTRA-PERITONEAL RUPTUEE OF THE BLADDER.
enormously dilated, due to strangulation. Some of the
sections sliow adenomatous tissue, as is frequently seen in
benign polypi.
{Signed) Herbert R. Spencer.
cuthbert lockyer.
John S. Fairbairn.
R. D. Maxwell.
A. Lionel Smith.
G. F. Darwall-Smith.
Corrie Keep.
W. S. A. Griffith, Chairman.
A CASE OF INTRA-PERITONEAL RUPTURE OF
THE BLADDER OCCURRING DURING LABOUR.
By Charles R. Porter, M.R.C.S.Eng., L.R.C.P.Lond.
(Introduced by Dr. Russell Andrews.)
The patient, M. J — , a primipara, aged 32, was seen
on January llth, 1907, as labour was supposed to have
commenced. The pains had been few in number, had
lasted only a short time, and had chiefly been felt in the
sacral region. On examination of the abdomen the child
was felt to be lying in the first vertex position ; the abdo-
men being otherwise normal, there being no evidence of
any undue distension of the bladder. There were no
pains at the time of examination. Urine had been passed,
and the bowels, which had been constipated during the
past Jortnight, had been open the day before. Per
vaginam the os uteri was the size of a threepenny-piece,
the cervix was soft and shortened ; the vertex could easily
INTEA-PEEITONEAL RUPTURE OF THE BLADDER, 171
be felt and the sutures made out. There was no indication
of any contraction of the pelvis. The membranes were
unruptured, though there was a history of " waters
running away " for the past two or three days. It should
be mentioned that the patient had been seen on January
7th on account of this symptom, and was then found to
be not in labour.
The patient was of a decidedly neurotic temperament,
and as she had slept very little the night before she was
given tr. opii iT\xx that night, but with very little effect.
She was not seen again till the morning of January 14th,
when the following history was obtained from the nurse :
The interval between January 11th and January 13th had
been practically free from real labour pains, the patient
being up and about until 8.30 p.m on the 13th, when
labour apparently started in earnest. Labour pains con-
tinued at intervals all night, increasing in severity. At
8.30 a.m. on the 14th the patient, suddenly, during a pain,
cried out that "^ something had given way inside," and
was from that moment evidently in a great deal of
general abdominal pain. At this point the nurse sent for
me, but as the house was three and a half miles away it
was 9.30 before the message was received.
When seen at 9.50 the patient was lying on her back
in bed, looking very ill indeed, calling -out from time to
time with pain, and tossing her head from side to side.
The knees were bent and the thighs were flexed upon the
abdomen. The pulse was very rapid, about 160 per minute,
and small in volume; the respirations were rapid and
shallow. The lips were dry, and the tongue furred and
somewhat dry in the centre. The abdomen was consider-
ably distended and tympanitic, especially at the epigastrium.
The pain complained of was general and continuous, and
not like labour pains. The body of the child could still
be made out, and the uterus did not appear to be tonically
contracted; slight rhythmical contractions could still be
made out. Per vaginam the head was found to be still
in the first vertex position and well down in the pehns.
172 INTRA-PERITONEAL RUPTURE OP THE BLADDER.
The OS uteri was nearly fully dilated, and the head could
be pushed up with ease, though this caused somewhat'
more pain.
As there seemed to be no obstacle to delivery except
the absence of strong uterine contractions, and taking
into consideration the serious condition of the patient,
chloroform was at once administered and delivery was
quickly and easily accomplished with forceps. The cord
was pulsating very feebly, and after a few gasps at ten-
minute intervals, the child (a well-nourished full-term
male), died in spite of artificial respiration being continued
with for nearly an hour. The placenta and membranes
were expressed after fifteen or twenty minutes, and this
was followed by somewhat severe post-partum haemorrhage,
which, however, yielded to bimanual compression of the
uterus, ergot, and a hot douche. An examination was
now made as far as possible of the uterus, but beyond a
small tear in the cervix nothing abnormal could be made
out, the uterus contracting down well after the haemor-
rhage had ceased.
After delivery the patient ceased to complain of pain
of any kind, and palpation of the abdomen did not produce
any marked discomfort. There had been and were no
symptoms referable to the bladder, and the question
seemed to be whether labour had been complicated by
perforation of the appendix or of a gastric or duodenal
ulcer. There was no previous history suggesting any of
these, and the patient had been known and treated for at
least three years prior to her pregnancy. There had
been no vomiting.
The pulse rate and respirations still continued very
rapid after delivery, but as the patient seemed much more
comfortable it was decided to leave her for the time
being with the hope that the general condition would
improve sufficiently to risk her removal to hospital. This
meant" a horsed-ambulance drive of eight and a half miles.
Her condition at 4.30 p.m. the same day was about the
same; she had not vomited, and expressed herself as
INTEA-PERITONEAL RUPTURE OP THE BLADDER. 173
feeling somewhat more comfortable. The tongue was
moist, the pulse, however, being still rapid — about 120 to
130. No urine had been passed, and as there was no
obvious distension of the bladder, and no discomfort, and
also in view of the neurotic element in the case, a catheter
was not passed.
On Januaiy 15th, at 10.30 a.m., the patient was
obviously much worse. She had been vomiting frequently
during the night. No urine had been passed.
It was decided to remove her as soon as possible to the
West Herts Infirmary, but in consequence of the distance
(the ambulance being three and a half miles from the
patient's house) the patient was not admitted until 3 p.m.
For the following notes of the subsequent treatment I
am indebted to my partner. Dr. S. A. Bontor, under whose
care she was admitted, and also to Mr. W. R. Kirkness,
the house-surgeon.
The patient's condition on admission was very grave.
The pulse was barely perceptible at the wrist, the face
was sunken and the expression anxious. The tongue
was dry and brown. The abdomen was enormously
distended and tympanitic. The respirations were rapid
and shallow. A catheter was passed and yielded about
two or three ounces of almost pure blood mixed with a
slight quantity of urine. It was decided to open the
abdomen at once. Chloroform was administered and the
abdomen opened in the middle line below the umbilicus.
On reaching the general peritoneal cavity a large quantity
of semi-serous iluid escaped; this ultimately proved to be
partly urinous. There was slight general hyperasmia
of the coats of the small intestine. The sigmoid, descend-
ing, transverse, and ascending colon were literally packed
with hard fteces. The cause of the condition was not at
first apparent as examination of the bladder did not at
first reveal any laceration. The examination of the
abdominal organs, as also the respirations of the patient,
were considerably interfered with by enormous distension
of the stomach. The abdominal incision was therefore
VOL. XLIX. 12
174 A UTERUS FOUR YEARS AFTER CESAREAN SECTION.
enlarged in the direction of the ensiform cartilage and a
small trocar was thrust into the anterior wall of the
stomach, the gas evacuated, and the puncture closed with
two Lembert sutures. Further examination then revealed
a vertical rent about one and a half inches in length in the
upper and posterior aspect of the bladder somewhat to
the right of the middle line. It was observed that this
aspect had been somewhat obscured by the introduction
of a Doyen's retractor. The edges of the rent were
ragged, but were easily approximated by two Lembert
sutures, the wall of the bladder being again invaginated
and rendered more secure by two more sutures of the
same kind. The whole peritoneal cavity was then flushed
out with hot normal saline solution and the peritoneum
cleansed with gauze swabs as far as possible. The lower
angle of the wound was drained by a large-bored rubber
tube leading down to the bladder, and the abdomen was
closed with silkworm-gut sutures.
The patient was not very markedly worse for the
operation, but in spite of all the usual means to combat
shock she never rallied, and died at 9 p.m. on the same
evening.
Unfortunately no iiost-mortem examination was allowed,
but there was no reason to believe that there was any
disease of the bladder.
A UTERUS FOUR YEARS AFTER CESAREAN
SECTION.
Shown by Mr. J. Bland-Sutton.
A WOMAN, E. C — , aged 27, well advanced in pregnancy,
was admitted into the London Hospital in October, 1902.
The pelvis was occupied by a tumour which furnished
the signs of a cervix-fibroid, and as it would clearly
A UTERUS POUR YEARS APTER CJCSAREAN SECTION.
175
obstruct the transit of the foetus^ Dr. Herman performed
Caesarean section and extracted a living female child.
The tumour was considered to be irremovable. Before
the patient left the hospital she was examined under an
anaesthetic by Mr. F. Eve, who regarded the tumour as a
fibro-sarcoma springing from the pelvic wall and adherent
to the rectum; he did not recommend an operation. This
opinion was also endorsed by Mr. Hutchinson, who
Fig. 2. — A viterus in sagittal section. It had been subjected to
Caesarean section four years previously, and the sutures used to
close the uterine incision are clearly visible on the cut surface.
happened to be present. For this information I am
indebted to the courtesy of the registrar.
In February, 1907, this patient came under my care
in the Middlesex Hospital, and I found the abdomen
occupied by a solid tumour as big as a football. This I
succeeded in removing, for it proved to be an ovarian
fibroid ; it had an adhesion to the rectum and to the back
of the uterus ; this latter organ was spread over the face
of the tumour like a pancake, and the sutures used to close
the uterus at the time of the Ca3sarean section were
visible on its anterior surface, and appeared like a series
of transverse braids on a military coat. The uterus was
176 A UTERUS FOUR YEARS AFTER CESAREAN SECTION.
detached from the tumour, but the oozing was troublesome
and it appeared safer to remove it. The injury to the
serous coat of the rectum was carefully sutured, and it
seemed prudent, as there had been some free oozing, to
drain with a narrow rubber tube. This proved a wise
precaution as some suppuration ensued, but the patient
made a satisfactory recovery. Soon after the uterus
was removed it contracted into its natural shape ; it was
then carefully hardened and bisected (Fig. 2). On
casually inspecting the cut surface it looks like a normal
uterus, and there is nothing to indicate that it had been
opened. When the cut surface is examined with a
magnifier the sutures used to close the incision are
clearly visible, and their position is indicated in the draw-
ing. A portion of the uterine wall was excised for micro-
scopic examination, and we have ascertained that the stuff
in which the sutures are embedded has the characters of
fibrous tissue. I am rather puzzled in regard to the
material of the sutures ; to the naked eye they appeared
to be catgut, but under the microscope they are seen to
be broken up into strands, and yet they do not show the
characters of silk. On application to the Registrar it has
been ascertained that Dr. Herman usually employed No.
5 Chinese silk, but in regard to this particular case there
is no mention in the notes as to the nature of the suture
material.
The specimen is interesting as demonstrating the com-
pleteness of repair in the uterine wall after Csesarean
section, but it is, of course, a question what would happen
to such a cicatrix had the uterus become gravid again,
and in relation to this matter I am able to show a uterus
from a case of repeated Csesarean section which bears on
this matter.
In May, 1905, Dr. Mulloy performed Csesarean section
on a primigravida, who had congenital absence of the
cervix uteri, the communication with the vagina being a
narrow opening barely capable of admitting a probe. The
operation was performed when the patient was in labour
A UTERUS FOUR YEARS AFTER CESAREAN SECTION. 177
and the foetus was dead when extracted. The incision in
the uterus was closed with silk sutures.
In November, 1906, the patient had again become
pregnant and was particularly anxious for a living child.
She had such a large ventral hernia that the fundus of
the uterus occupied the hernial sac. She was admitted
into the Chelsea Hospital for Women, January, 1907,
and her delivery was calculated to happen towards the
end of the month. She came into labour January 25th,
and a living, healthy, female child was extracted by
Cfesarean section. At the patient's urgent wish I removed
the uterus as she did not wish a repetition of this trouble,
and apart from this, the relation of the uterus to the enor-
mous hernial sac made this course practically a necessity.
The hysterectomy was by no means simple, as the uterus
adhered to the adjacent coils of bowel as well as the walls
of the hernial sac. The patient made an uneventful
recovery and the child has thriven.
In this instance an examination of the uterus shows a
well-marked depressed scar on the anterior wall, and on
section it was found that the uterine wall had not united
throughout its whole thickness. There are no traces of
suture material.
Cases have been reported in which patients having
survived Csesarean section and again become gravid have
sustained rupture of the uterus through yielding of the
scar. I think this specimen helps us to realise how
such an unfortunate event may come to pass.
To me it is a novelty to see a uterus four years after a
successful Ccesarean section, and it is certainly interesting
to note the complete union of the incision, which would
not be detectable to the naked eye save for its betrayal
by the unabsorbed suture material.
The President said that the first specimen exhibited by
Mr. Bland-Sutton showed the length of time which silk might
remain in the uterus. He had recently seen a patient on whom
he had performed Csesarean section on three occasions — the last
over seven years ago. The silk sutures used in closing the
uterine wound remained quiescent for nearly seven years, but a
178 A UTEKUS FOUR TEARS AFTER CJESAREAN SECTION,
few months ago, tlie patient liaving become infected with syphilis,
a small abscess formed, and, by means of a crochet-hook, one of the
sutures was removed from the resulting sinus, which then closed.
The suture appeared to be in much the same condition as when
inserted. He always used thickish silk in sewing the uterus and
on ovarian pedicles, and this was the only occasion in which he
had known such a ligature come away after operation. The sillc
suture communicated with the uterine cavity, tliough he was
always careful not to penetrate the mucous membrane in sewing
up the uteinis, and he thought it had probably become infected
from the uterus, as a result of endometritis of syphilitic or
gonoi-rhoeal origin. The President did not think it was justifiable
to remove the iiteras after Ciosarean section, or to sterilise the
patient, except where the uterus contained fil:)roi(ls, cancer, or
was damaged or infected. In the slighter forms of pelvic con-
traction, alluded to by Dr. Heywood Smith, in which a viable
child would subsequently be delivered by induction of premature
labour, patients were frequently sterilised without any sort of
justification, in his judgment.
Dr. Lewers had performed Ctcsarean section a second time in
one patient about two years after the first operation, and had an
opportunity of inspecting the site of the incision made at the
first operation. He used silkworm-gut sutures for the uterine
wound, and these could be felt almost as plainly as when first
inserted. They were embodied in organised lymph and oment^al
adhesions. As regards the justifiability of attempting to sterilise
patients during Caisarean section, in this case he had endeavoured
(at the patient's request) to sterilise her at the second operation.
He thought it best to advise the patient against such attempts at
a first Caesarean section. At a second operation it seemed much
more reasonable to make such an attempt, if the patient wished
for it. He thought, in any case, that the patient's wishes on the
matter shovild be acted upon, when all the circumstances had
been put before her.
Dr. Amand Routh considered that the patient herself, or her
husband, should decide as to whether she should run the risk of
another pregnancy and another Cesarean section, and should
therefore have the possible dangers fully explained to her.
Eui^ture of the utenas during a succeeding pregnancy and other
complications had to be faced. Sterilisation should only be
effected with the patient's consent.
Dr. Heywood Smith asked whether, in refei'ence to the im-
portant question raised by the President as to the sterilisation
of women who were the subjects of Csesarean section, such pro-
ceeding would not be justifiable in cases where there was marked
deformity of the bony pelvis, in contra-distinction to those cases
where the obstruction was due to some remarkable disease, as
for instance, a fibroid tumour of the cervix.
CANCER OP THE CERVIX. 179
Dr. Griffith had not had an opportunity of operating twice
on the same patient, though in one case his colleague, Dr. Gow,
had operated during his absence on a case on which Dr. Griffith
performed Csesarean section a year or two previously. He
informed Dr. Griffith there were no adhesions, nor any trace of
the uterine incision, nor of the sutures. Dr. Griffith was of
opinion that perfect coaptation of the cut surfaces led to perfect
union in the case of the uterus, and the absence of trouble from
sutiu-es, whilst depending on their asepticity, was also materially
influenced by the fineness of the material. For some years he
had therefore used Singer's tliread,Nos. 40 and 60, in preference
to silk for ligatures and most sutures. He entirely agreed with
the President that sterilisation in these cases was, as a rule, un-
justifiable, though in cases of large fibroids or malignant disease
there was no alternative.
TWO SPECIMENS FEOM CASES OF CANCER OF
THE CERVIX, THE PATIENTS REMAINING
FREE FROM RECURRENCE TWENTY AND
ELEVEN YEARS RESPECTIVELY AFTER OPE-
RATION.
Shown by Dr. Lewers.
Dr. Lewers showed these specimens and sections under
the microscope for the purpose of giving the after-
histories.
In the first case, one in which there was a malignant
ulcer of the vaginal portion of the cervix, the cervix was
removed by the supra- vaginal amputation on March 17th,
1887. Dr. Lewers held in his hand a letter from this
patient written in March, 1907, in which she stated she
continued quite well. The microscopical examination
showed the case to be one of squamous epithelioma. In
this case the disease appeared to be in a fairly early
stage.
In the second case, also one of squamous epithelioma of
180 CANCER OP THE CERVIX.
the cervix, the disease was in a much more advanced
stage. There was a large " cauliflower " growth of the-
cervix, and the body of the uterus was much enlarged
owing to pyometra. In this case vaginal hysterectomy
was performed on June 1st, 1895. The patient, now
being in Australia, writes to Dr. Lewers on the anniver-
sary of the operation every year, and he produced a letter
w^ritten on June 1st, 1906, eleven years after the opera-
tion, in which she reported herself as being quite well.
Full details of these cases are given in Dr. Lowers'
monograph, '' Cancer of the Uterus," pp. 96 and 131
respectively.
Dr. Lewers said these cases showed that both the
supra - vaginal amputation of the cervix and vaginal
hysterectomy could, in some cases at all events, give
as good after - results as could be wished for. Li
similar cases he still, therefore, continued to perform
vaginal hysterectomy ; at the same time he was in favour
of trjnng the more extensive operation performed by
Wertheim for cases where there was evidence that the
disease had extended moderately beyond the limits of the
uterus. Time alone could show whether such more
extensive operations, in the class of case mentioned, when
the disease had spread beyond the uterus, would be
followed by as good, or better, results than attended
supra-vaginal amputation of the cervix and vaginal
hysterectomy in the relatively earlier cases, where the
disease seemed not to have spread beyond the uterus. He
was not at present in favour of performing Wertheim's
operation as a routine treatment for every case thought
to be operable.
The President said that he had not operated on a case of
cancer of the cervix so long ago as twenty years ; but the three
cases iu which it complicated labour, which he had already
brought before the Society, remained well ten years after opera-
tion._ He agreed with Dr. Lewers as to the importance of early
operation and also as to the good results obtained in such cases
by high amputation. The modern extended abdominal hysterec-
tomy, however, permitted a clean surgical operation to be per-
DESCRIPTION OF PLATE XIII,
Illustrating Dr. May Thome's specimen of Uterus showing
Malignant Villous Tumour and a Fibroid wliich has
undergone Sarcomatous Change.
Section showing sarcomatovis change.
Plate XIII.
Obstet. Soc. Trans., Vol. XLIX.
Ilustrating Dr. M.xv Thorne's specimen of Uterus showing Malignant Villous
Tumour and a Fibroid \vhich has undergone Sarcomatous Change.
AMard Sf Son, Imfit
UTERUS SHOWING MALIGNANT VILLOUS TUMOUR. 181
formed in cases where such au operation was impossible by the
vagina. In pitblishing after-histories of cases of cancer it was
important that microscopic sections of the growi^hs should be
exhibited, as had been done in Dr. Lewers's cases and in his own.
UTERUS SHOWING MALIGNANT VILLOUS
TUMOUR AND A FIBROID WHICH HAS
UNDERGONE SARCOMATOUS CHANGE.
(With Plate XIII.)
Shown by Dr. May Thorne.
Dr. May Thorne showed a uterus removed on account
of haemorrhage from an unmarried patient, aged 61, in
whom haemorrhage occurred about ten years after the
menopause. The pathological report on the uterus by
Dr. Cuthbert Lockyer states : " The endometrial growth
takes the form of a malignant villous tumour. The latter
shows but little tendency to immediately invade the
muscle, but deep in the strata of the solid uterine wall
groups of cancer cells exist in the lymphatics. Deep in
the uterine wall there is an interstitial growth which started
as a fibroid but is now a sarcoma. This condition is con-
firmed on further examination." The uterus also contained
two small, simple fibro-myomata.
The sjpecimen was referred to the Pathology Committee.
182
MALIGNANT VAGINAL POLYPUS SECONDAEY
TO AN ADRENAL TUMOUR OF THE KIDNEY.
(With Plates XIV— XVIII.)
By Alban Doean, F.R.C.S.,
SURGEON TO. THE SAMARITAN FREE HOSPITAL.
(Eeceived April SrJ, 190Y.)
{Abstract.)
A MARRIED uniparous woman, aged 40, suffered from rigors
and sweats in September, 1906. A mass was detected in the
vagina, and a small tumour in the right iliac fossa. The vaginal
growth was a racemose body attached by a well-defined pedicle
to the lower part of the anterior wall of the vagina ; its lobules,
more or less necrosed, were shed from time to time. Three
sessile growths lay in the posterior wall, the mucosa over one
was pigmented. In November the author removed tlie abdo-
minal tumour, which proved to be a malignant adrenal growth
in the lower part of the right kidney. The patient declined to
allow a second operation for the extirpation of the vaginal
growths ; lobules of the pedunculated tumour continued to come
away. She stirvived the nephrectomy three months. After
death secondary deposits were discovered in the liver and right
lung ; their presence in the lung had been diagnosed before
death. On microscopical examination it was found that the
vaginal tumovirs, as well as the growths in the liver and lung
were of the adrenal type, and therefore secondary to the tumour
in the kidney.
In this case a pedunculated tumour developed in the vagina,
the slow, constant sloughing of its lobules probal)ly accoimting
MALIGNANT VAGINAL POLYPUS. 183
for the rigors. The tumour bore characters usually associated
with the type of new growth known to pathologists as " primary
sarcoma of the vagina in the adult" (Gow, Veit). Secondary
deposits in the lung have been recorded (Herzfeld, Bajardi) and
pigmentation has been observed (Horn, Morestin, Boldt). In the
author's case, however, sections of the lobules shed from the
pedunculated tumour showed the same structure as was seen in
sections from the renal tumour. Hence there could be no
question of coincidence of a primary vaginal sarcoma and an
adrenal tumour or " hypernephroma" of the kidney ; the latter
being, without doubt, the primary growth.
The specimen was referred to the Pathology Committee.
Inteoductory Remaeks.
Peimary sarcoma of the vagina in the adult is clinically
and pathologically a disease of high interest, about which
much has been written during the past twenty years by
many British and Foreign gynaecologists. In the course
of that same period, general surgeons and pathologists
have bestowed much attention on a far more frequent,
yet, until of late, hardly more recognised form of new
growth, " hypernephroma " or " adrenal tumour " of . the
kidney, so-called because it originates in " rests " or
tracts of tissue resembling that which makes up tlie
normal zona fasciculata of the supra-renal capsule.
I will now relate a case where a malignant pedun-
culated tumour developed in the vagina of a woman,
aged 40, some of its lobes coming away from time to
time, whilst one amongst three sessile adjacent growths
showed " pseudo-melanosis " (Horn, Morestin) of the
superjacent vaginal mucosa. All these features have
repeatedly been recorded in cases of what is specifically
known as " primary sarcoma of the vagina in the adult."
Nevertheless the tumour proved to be secondary to an
adrenal adenoma of the kidney. Nephrectomy Avas per-
formed, the patient surviving the operation for three
184 MALIGNANT VAGINAL POLYPUS.
months. After death, metastatic deposits were detected
in the liver and lung as well as the vagina.
History of the Case before Operation.
Mrs. E. H — , aged 40, was admitted into my wards in
the Samaritan Free Hospital, on November 7th, 1906.
She had been referred to me by Dr. W. T. Evans, of
Gloucester Terrace, who had detected an abdominal
tumour and a polypoid growth in the vagina.
The patient had been married for nineteen years.
Her sole pregnancy ended at term two years after her
marriage. Dr. Evans could find no history of any serious
illness since or before her confinement. Early in Sep-
tember, 1906, she complained of a " chill and tightness of
the chest." She kept in bed for a few days and felt
extremely weak when she got up. Thenceforward she
began to be troubled with profuse sweats, which, as will
be seen, continued after the operation After August,
1906, the catamenia ceased abruptly. They had pre-
viously been regular with moderate haemorrhage for
about four days.
On recovering from the " chill " the patient discovered
that the abdomen was swelling, and it slowly increased
in size.
The patient was rather thin and distinctly sallow. An
oval elastic tumour occupied the right iliac region. It
was of about the size of a cricket ball, and could be
moved laterally to the extent of two or three inches, but
could not be pushed far backwards or upwards. On
percussion there was resonance which varied from day to
day. The kidney could not be defined in the loin and
there were no enlarged glands in the inguino-femoral
region.
There was hardly any vaginal discharge. On the
posteinor commissure lay a flat nodule under an eighth of
an inch in diameter, and its surface bore papillae. A
pedunculated morbid growth of somewhat unfamiliar type
DESCRIPTION OF PLATE XIV,
Illustrating Mr. Alban Doran's paper on Malignant
Vaginal Polypus secondary to an Adrenal Tumour
of the Kidney.
Fig. 1. — The vaginal polypus. Lateral view of the largest detached
portion, natiiral size. at. Line of attachment to pedicle.
Plate XIV.
Obstet. Soc. Trans., Vol. XLIX.
Fig. I.
Illustrating Mr. Alban Doran's paper on Malignant Vaginal Polypus
secondary to an Adrenal Tuinour of the Kidnev.
Adlaid &" Srn, Impl.
MALIGNANT VAGINAL POLYPUS. 185
sprang from the mucous membrane of the vagina two
inches above the vulval orifice anteriorly and a little to
the right of the middle line. It was racemose rather
than polypoid, consisting of several out-growths varying
in shape and size ; some were like grapes, others cylin-
drical, elongated, and irregularly bent. They were for
the most part dark grey in colour. The entire growth
was attached to the vaginal wall by a stout, fleshy pedicle
about three quarters of an inch in length ; the secondary
branches of the pedicle running to each outgrowth were,
on the other hand, short, thin, and friable. Two lobules
came away after admission, before the operation. They
were sent to the College of Surgeons (PI. XIV, fig. 1). I
detected on further examination three sessile growths in
the mucous membrane of the posterior part of the vaginal
wall. The largest was about half an inch in diameter
and there was a black patch on its surface. They were
not adherent to the subjacent tissues and the rectum was
free from new growths.
The cervix appeared quite healthy and moved freely
with the rest of the uterus. There was no deposit above
the vaginal fornices, and the tumour in the right iliac fossa
could not be pushed down below the pelvic brim.
The tongue was rather raw, but not glossy ; the appetite
was bad and the bowels were neither -constipated nor
relaxed.
The patient had observed that the urine had been very
thick ever since the chill, but declared that it had never
contained blood. It was loaded with bright pink urates,
yet the specific gravity never exceeded 1022 ; about
twenty fluid ounces were passed daily; no albumen could
be detected.
The temperature fluctuated considerably during the
seven days between admission and operation. The
maximum was 102° F. (November 11th, evening), the
minimum (November 13tli, morning, before operation)
98-6° F.
The pulse was 108 on admission and never fell any
186 MALIGNANT VAGINAL POLYPUS.
lower before the operation. It was fairly full and very
soft. My clinical assistant, Major S. Colin Evans, I.M.S.,
to whom I am much indebted for help in preparing these
notes, detected a faint organic systolic murmur at the
heart's apex, but no abnormal pulmonary signs.
I diagnosed the vaginal growth as a pedunculated
sarcoma, a type noted of recent years by many writers,
some of whom have observed its tendency to undergo
necrosis, so that its lobes come away one by one. About
the tumour, in the right iliac region, I felt much less
certain ; I believed that it was either an enlarged kidney
or an ovarian dermoid held back by adhesions, and
bearing adherent intestine on its anterior surface.
The Opekation.
The operation was performed on November 13th, with
the assistance of Major S. Colin Evans and Dr. W. T.
Evans, Mr. W. S. Morley administering the anaesthetic.
My intention was to excise the vaginal growths after
removing the abdominal tumour.
When the peritoneal cavity was opened b}' a median
incision about one pint of clear ascitic lluid escaped. A
dull white tumour bearing small red, wattle-like out-
growths on its surface lay behind the ascending meso-
colon. The uterus and ovaries were normal and in no
way connected with the growth. The intestines showed
no signs of disease and there were no adhesions. I made
a longitudinal incision through the layer of peritoneum
which passed from the ascending colon on to the parietes
in the flanks, encapsuling the outer part of the tumour.
I then enucleated that part and set free the front of the
tumour without damage to the colon. The ascend-
ing mesocolon, strongly adherent to the tumour, was
torn, but without injury to its vessels, which were much
dilated. I passed my hand under the lowest and under-
most part of the tumour, which proved to be the greater
part of the right kidney, almost unchanged and rotated
MALIGNANT VAGINAL POLYPUS. 187
downwards and inwards so as to lie over the lumbar
spine. A great deal of fat was now detached from above
and behind the tumour, and much oozing ensued. The
renal vessels lay in a thin, tense band, which ran upwards
from the hilum, and looked like an old adhesion ; this
band was divided and the kidney itself set free. This
stage of the operation proved easy ; the ureter was very
thin. On the other hand, I had great difficulty in
securing vessels in the oozing surface above. I was
obliged to push up the liver, which was pale and thin
and apparently free from new growths. The gall-
bladder was slightly distended. I detached some firm
nodules, apparently glands, from the oozing tissues close
to the vena cava.
The patient's condition being very unfavourable, I did
not proceed to remove the vaginal growths, as I had
originally intended. I flushed the peritoneal cavity with
saline fluid, applied deep interrupted sutures to the
abdominal wound, poured more saline fluid into the peri-
toneal cavity, and lastly closed the abdominal incision.
I must admit that, at the conclusion of the operation, I
felt anxious about immediate results. I could not feel
certain that the tumour was not situated in the supra-renal
body itself, and when separating it from its upper con-
nections I thought of a specimen, presented by Dr. Lediard
to the museum of the Royal College of Surgeons (Pathol.
Series, No. 3514), removed from a subject after death
from Addison's disease. It reads : " A suprarenal
capsule with the adjacent vena cava . . . It is abnor-
mally close to the vena cava and compresses its own vein."
These words were my own, written after examination of
the specimen many years ago. But I have never forgotten
them, and in consequence do not feel comfortable when
operating on anything which may be the suprarenal
capsule, as anatomical relations are not always easy to
define in the course of an operation, and I know that even
during the removal of a purely renal tumour the vena
cava may be wounded.
188 malignant vaginal polypus.
The Renal Tumour.
The parts removed at tlie operation consisted oi" the
right kidney surmounted by a tuberous mass^ whicli was
separated from the kidney in front by a distinct groove
(PL XV, fig. 2), whilst posteriorly it blended with the
adjacent pole of the kidney without any visible sign of
demarcation.
The vertical measurement from the uppermost part of
the tumour to the opposite pole of the kidney was 5^
inches. The tumour alone measured 4^ inches horizon-
tally, 2 1 inches vertically, and 2 4 inches antero-posteriorly.
Its surface was somewhat tuberous and bore masses of
fat. The kidney was of about the normal size and its
capsule was not adherent.
On section the new growth was seen to invade the
substance of the kidne}'^ to a considerable extent at its
(apparent) upper pole (PI. XVI, fig. 3). A piece was cut off
the border of the kidney posteriorly where the fusion was,
as above stated, most marked, so as to include a portion
of the tumour. This piece was preserved for micro-
scopical examination. On the kidney, at the point where
the piece had been cut, an isolated tract of new growth,
with a well-defined, almost circular border, was exposed ;
it lay in the cortex of the kidney about half an inch
away from the lower limits of the tumour.
[Mr. Shattock, after carefully dissecting the prepara-
tion, has pointed out to me that the ureter lay in the
hilum anterior to the artery. I have no doubt as to the
position of the tumour when I operated ; the kidney was
displaced downwards and inwards so that it lay very
conspicuously across the lower lumbar vertebrse with its
outer, or convex border downwards. Hence the position
of the ureter would imply that the tumour had really
developed in the lower pole of the kidney (probably
movable before it became diseased), and that the organ
with the new growth had undergone rotation, bringing
the tumour and the lower pole uppermost. This fact in
DESCRIPTION OF PLATE XV,
Illustrating Mr. Alban Doran's paper on Malignant
Vaginal Polypus secondary to an Adrenal Tumour
of the Kidney.
Fig. 2. — The right kidney and tumour seen from without (anterior
aspect). The tumour seems to lie on the upper pole of the kidney, as
though it had developed in the supra- renal capsule. In reality it lies
within the lower pole, which, owing to rotation of the kidney, lay
uppermost.
Plate X\'
Obstet. Soc. Trans., Vol. XLIX.
Fig. 2.
Illustrating Mr. Albax Dokan's paper on Malignant Vaginal Polypus secondary
to an Adrenal Tumour of the Kidnev.
Adiard & Son, Impr.
DESCRIPTION OF PLATE XVI,
Illustrating Mr. Albau Doran's paper on Malignant
Vaginal Polypus secondary to an Adrenal Tumour
of the Kidney.
Fig. 3. — The right kidney and tumour, showing their cut surface.
The tumour is seen to lie within the capsule of the kidney, invading
the lower portion of that organ (see Fig. 2). It boars the naked-eye
characters of an adrenal growth.
Phitt X\'l
Obstet. Soc. Trans., Vol. XLIX.
Fig. t.
Illustrating Mr. Albax Doran's paper on Malignant Vaginal Polypus secondary
to an Adrenal Tumour of the Kidney.
Adlard & Son, Impr.
DESCRIPTION OF PLATE XVII,
Illustrating Mr. Alban Doran's paper on Malignant
Vaginal Polypus secondary to an Adrenal Tumour
of the Kidney.
Pig. 4. — Microscopical section of the renal tumour separated from the
adjacent portion of the kidney (above) by an area of fibrous tissue. The
tissue of the tiimour (below) resembles that of the zona fasciculata of
the supra-renal capsule. Low power.
Fig. 5. — The same (lower portion) under a high power. The tumour
is seen to be chiefly made up of large cells with big and well-formed
nuclei.
Plate XVII. Obstet. Soc. Trans., Vol. XLIX.
Fig. 4.
1j>-
i^^:
Fig. 5.
A-',
■ •* • V "t •
•
# (
di • A»a.
Illustrating Mr. Albax Dora.v's paper on Malignant \'aginal Polypus secondary
to an Adrenal Tumour of the Kidnev.
Adlard & Son, Impr.
MALIGNANT VAGINAL POLYPUS. 189
no ways modifies the pathological aspect o£ the case in
respect to the nature of the vaginal and visceral growths.]
The bisected tumour and kidney have been preserved,
the anterior half in the Museum of the Royal College of
Surgeons, the posterior in Dr. Cuthbert Lockyer's private
collection. The cut surface shows the yellow tissue, with
spaces filled with blood, characteristic of adrenal growths.
Microscopical appearances of the renal tumour, — I
examined, with Mr. Shattock, some sections of the
tumour at its point of junction with the kidney.
On the renal side of the section true cortical tissue
was seen, free from new growth. The tubuli uriniferi
were well-formed, bearing normal epithelium, but a
certain amount of fibrosis was present.
The kidney svibstance was separated from the new
growth by a narrow, but very distinct tract of fibrous
tissue (PI. XVII, fig. 4).
The tumour was made up of large cells with big and
well-formed nuclei (PI. XVII, fig. 5). These cells were
arranged in somewhat irregular columns strongly simula-
ting, in Mr. Shattock's opinion, the arrangement of the cells
of the zona fasciculata of the cortex in the supra-renal body.
The new growth was very vascular, especially at certain
points where groups of blood-vessels were seen, some
empty and others full of blood. There was very little
stroma so that the cells seemed to rest on the capillaries.
The Vaginal New Gtrowth.
The lobules which, as I will relate, came away after
the operation, were in a markedly necrotic condition,
unfavourable for a study of the histology of the tumour.
The two which broke off from the pedicle before the
kidney was removed were in a much less altered state,
although not absolutely free from necrotic changes.
From one lobe, oval, and half an inch in its long diameter,
some successful sections were made at the College of
Surgeons.
VOL. xlix. 13
190 MALIGNANT VAGINAL POLYPUS.
Microscopical appearances. — The tumour was made up
of large cells with big nuclei, and, as in the renal tumour,
the cells showed in many parts of the section a tendency
to a columnar arrangement (PI. XVIII, figs. 6 and 7). The
groups of cells were separated b}' connective tissue, forming
very fine lines excepting at certain points where the tissue
was much thickened by free fibrinous exudation.
Mr. Shattock considers that these appearances indi-
cated that the vaginal tumour was secondary to the
adrenal growth connected with the kidney. It had none
of the microscopical characters of a pedunculated primary
sarcoma of the vagina which it so closely resembled to
the naked eye.
I must add that near the periphery of the section,
corresponding to the surface of the tumour, was a
necrosed area separated from the unchanged tumour-
tissue by a well-marked layer of fibrin. In that area
there was much fibrinous exudation, the tumour-cells had
almost disappeared, and there was distinct small-celled
infiltration towards the free surface of the tumour.
History aftee Operation.
The patient recovered from shock sooner than I had
expected. She passed urine naturally within four hours
after the operation, and never required the catheter.
There was very little vomiting, no distension, and no
difficulty in the passage of flatus, which passed freely
within twelve hours. For a week the temperature seldom
rose above 99'2° F. and the maximum was 100*2°, and
the pulse became rather stronger and slower than before
the operation. In the course of the third week cystitis
set in, probably from discharge from the stump of the
right ureter and from irritation due to the urine, which
was as full of pink urates as before the operation, and
could not be kept clear without large doses of citrate of
potash, etc.
On November 24th the sweats, which had never entirely
DESCRIPTION OF PLATE XVIII,
Illustrating Mr. Alban Doran's paper on Malignant
Vaginal Polypus secondary to an Adrenal Tumour
of the Kidney.
Fig. 6. — Microscopical section of a lobule from a vaginal tumour. Its
tissue i-esembles that of the renal tumour (Fig. 4, lower portion), but it
is wider meshed and less distinct. Low power.
Fig. 7. — The same, under a high power. Its resemblance to the renal
tumour (Fig. 5) is evident, although its tissues are affected by necrotic
changes in its neighbourhood.
Plate XV III.
Obstet. Soc. Trans., \'ol. XLIX.
Fig. 6.
" ^^- •'. • ■■'■
'fc/-
I".«tr«i„g Mr^ Alban Dorax's paper on .Maligna,,, \-aginal Po|yp„ secondan-
to an Adrenal Tumour of the Kidney.
Adlard Sf Son, Impr.
MALIGNANT VAGINAL POLYPUS. 191
ceased, became profuse. The thorax was examined and
dulness on percussion was detected on the right side up
to the third rib. There was increased roughness of
breathing-sounds over both lungs, and crepitation at the
left apex. These symptoms disappeared within a fortnight,
but the dulness never cleared up. On December 2nd
a mass of necrosed new growth protruded from the
vagina and was easily broken off from the pedicle
without much subsequent heemorrhage. At that date
there had already been a rise of temperature for a few
days, once reaching 102° F. in the evening. This rise
was, apparently, accounted for by the development of a
tender body above the right iliac fossa, representing
inflammatory exudation around the ligatured tissues, but,
as I will endeavour to explain, it was more likely due to
another cause.
The patient, contrary to my advice, desired to go home ;
I had hoped to improve her condition so that she might be
able to bear the removal of the vaginal growths. She
was discharged on December 12th, a month after the
operation. The swelling above the right iliac fossa had
grown larger, but was distinctly less tender. As on
November 24th, there was dulness in the right mammary
line up to the third rib, without cough, heemoptysis, or
dyspnoea. The edge of the liver could be defined three
inches below the ribs in the mammary line ; it was thin,
firm, smooth and not tender. The abdomen itself was
not distended, or tender on palpation. The three growths
on the posterior wall of the vagina had not increased ; in
fact, they were necrosing. The pedunculated growth on
the anterior wall still bore several lobes. Just as when
the patient was admitted, the upper part of the vagina
was free from growths and there was hardly any vaginal
discharge. The urine was still charged with bright pink
urates ; the ropy mucus had disappeared after free
washing out of the bladder.
The patient was clearly in very weak health. I referred
her again to Dr. W. T. Evans. We both feared that she
192 MALIGNANT VAGINAL POLYPUS.
would never be in a condition which would allow of an
operation to remove the vaginal growths.
On January 2nd, 1907, Dr Evans informed me that the
patient was losing ground, and that at times she was
troubled with cough. " To-day the monthly period
began ; it is rather profuse." Considering how weak the
patient had become this return of the catamenia, after
suppression for five months, was remarkable. The
patient, notwithstanding her extreme weakness, lived until
February 8th, dying twelve weeks and three days after
the operation.
Dr. W. T. Evans was permitted to make a post-mortem
examination, and to him I am indebted for the following
report.
The body was greatly emaciated, and the skin uniformly
sallow. The abdominal icound had healed perfectly.
There was no free fluid in the peritoneal cavity or any
secondary deposits on the parietal peritoneum. The
stomach was extremely dilated, its greater curvature
almost touching the pubes. The small and large intestines
were almost empty ; the rectum contained some soft faeces.
There was no sign of obstruction or any trace of secondary
deposits. The rent in the ascending mesocolon had
closed. The structures forming and surrounding the
pedicle of the right kidney were removed for examination,
as well as an oval body, apparently an enlarged lumbar
gland above them ; the right supra-renal body could not
be distinguished. When examined no collection of pus
could be discovered in or around the pedicle, and there was
but little inflammatory effusion into its tissues though
adhesions were very dense. (The lump in the right side
had not increased since the patient left the hospital.)
The left kidney and supra-renal body showed no out-
ward sign of disease and were put aside with the spleen,
which was small and firm. The liver was large, almost
of the normal colour, but slightly mottled at certain
points. There were no inflammatory adhesions between
it and the diaphragm and viscera. Several secondary
MALIGNANT VAGINAL POLYPUS. 193
deposits were found in its substance, pale yellow, and
firmer than the hepatic tissue. One lay superficially in
the anterior jDart of the right lobe and was as big as a
filbert ; another of about the same size in the left lobe,
but it was ill-defined. Two others, well-defined, lay deep
in the substance of the right lobe. The anterior edge of
the liver and its under surface showed no signs of
secondary deposit. The gall-Madder was somewhat
distended with dark bile ; there were no calculi in its
cavity, or in the ducts.
An incision was made in the diaphragm ; the right
pleura was found to be free from adhesions and effusion,
the right lung appeared normal in consistence, but several
secondary growths, similar to those in the liver, were
found in the lower part of the inferior lobe, which,
together with the liver, was preserved for further exa-
mination."^
The uterus, ovaries and vagina were removed and pre-
served. Douglas^ pouch and the parts around it showed
no signs of any secondary growth, but soft adhesions
(not existent at the date of the operation) had formed
between several coils of small intestine and the posterior
surface of the uterus.
The preserved parts were transferred to my care and
I submitted them to Dr. Lockyer and Mr. Shattock for
microscopical examination.
The left kidney and supra-renal capsule proved to be
free from new growths or any other visible morbid
condition. The same was the case with the spleen, which,
considering the long-standing high temperature, was un-
usually small and firm. The uterus and ovaries bore no
secondary growths.
The pedunculated tumour in the vagina had almost
entirely broken down. The three sessile growths in the
posterior wall had become necrotic.
The secondary groivths. — There was some difficulty in
* The remaining thoracic viscera and the cranial cavity were not
examined ; the necropsy was made in the house where the patient died.
194 MALIGNANT VAGINAL POLYPUS.
preparing satisfactory sections of the secondary growths
in the right lung and the liver, as they were very soft:
At length some sections were successfully cut and stained ;
under the microscope they showed all the appearances
characteristic of adrenal tissue,
Ha\4ng related my case, I will now review what has
been written about connective tissue, tumours of the
vagina, and adrenal growths of the kidney.
Vaginal Fibroma and Saecoma.
Solid tumours of the vagina are not common. Richard
K. Smith published five years ago a g''Ood monograph on
fihro-myomatous tumours of the vagina. He collected
101 cases. They are nearly always single ; Straussmann
and Olenin have reported the only two authentic excep-
tions. The nature of the attachment of the growth to
the surrounding j)arts is noted in sixty-six cases ; in no
fewer than thirty-nine the tumour was said to be polypous
or pedunculated, whilst the remaining twenty-seven were
sessile. Observers, however, differ about what the Avord
'^pedunculated" may signify. The most important clinical
fact made clear by R. R. Smith is the marked tendency
of these innocent fibromas and fibro-myomas to become
necrotic, especially when they grow large. The same
change has long been known as frequent amongst malig-
nant tumours of the vagina; but Smith's evidence shows
that it is no essential proof of malignancy.
Only twelve days before I removed the kidney above
described I operated on a fibroma of the vagina. The
patient was a married woman, aged 55, who had only
once been pregnant ; her child was fourteen years of age.
She consulted me on account of a large ovarian cyst.
There was a history of suppurating femoral glands when
she was twenty-two years old. On November 1st, 1906,
I removed both ovaries for cystic tumour free from any
evidence of malignancy. The vaginal tumour, which I
had discovered when examining the patient, lay about
MALIGNANT VAGINAL POLYPUS. 195
two inches above the posterior commissure. It was per-
fectly sessile and of the shape and size of a broad bean.
The vaginal mucous membrane over it and around it was
quite health}^, but I excised the mucosa very freely ;
much bleeding ensued, easily stopped when the sutures
passed under the wound were tied. Dr. Cuthbert Lockyer
examined the growth and found that it was made up of
pure fibrous tissue. He suspected that it might be keloid
m type, an interesting point in relation to the genesis of
vaginal fibroids.
We are much more concerned at present, however,
with the only other form of vaginal growth which we
need discuss, namely, priviary sarcoma of the vagina in
the adult. The last three words are always added in
systematic works in order to distinguish this new growth
from another of a different type which develops in the
i7ifant. " Primary sarcoma " will be sufficient here to
express solely the type observed in the adult.
A great deal has been written about this primary sar-
coma, yet the disease is rare, although Meadows turned
attention to it nearly forty years ago, and since then G-ow,
Veit, Eoger Williams, Jellett and Earl, and others have
published careful analyses of collected cases inclusive of
those under their own observation. Yet Jellett and Earl,
the latest writers, could only find thirty-nine authentic
reports, less than half the total of genuine instances of
primary cancer of the Fallopian tube collected by Orthmann
and published in 1906 ; nevertheless, I believe that most
gynaecologists appear to be under the impression that
vaginal sarcoma must be much less rare. The labours of
R. R. Smith, to which I have already referred, bring up
the recorded examples of fibroma and fibro-myoma tolOl,
and it is highly probable that many other cases remain
unreported. For innocent tumours are held by many
operators as trifles not worth writing about, and on the
other hand fibroma of the vagina often gTows slowly and
gives no trouble, so that it is liable to be overlooked by
the patient, as in my own case, where, as I have explained.
196 MALIGNANT VAGINAL POLYPUS.
I discovered the vaginal tumour accidentally when
examining a woman subject to ovarian cyst. For the
above reasons we may feel sure that, in the vagina, fibroma
is commoner than sarcoma.
Veit concludes his remarks on das Sarcovi der Scheide
hei Ericachsenen by solemnly warning all future observers
who may come across sarcomatous growths in the vagina
not to be satisfied with a cursory examination of a case
hurriedly embodied in a brief clinical report, but to make
sure of the precise significance of any histological element
which they may detect — striated muscular fibre, for instance
— and above all to satisfy themselves and others as to
whether the new growth be primary or secondary. To
this view of the question we must all cordially assent, for
the collected records of primary sarcoma up to the present
date cannot as yet satisf}'' the pathologist, guide the
practitioner, or aid the operator.
Veit, I have observed, mentions striped muscle as an
element which arrests our attention. My experience
shows that it may be arrested by another highly interest-
ing tissue, the discovery leading to the important con-
clusion that the vaginal tumour is not primary. Since
very little was known about these adrenal " rests '^ until
a few years ago, I suspect that even on more than one
occasion a secondary tumour of the vagina similar to my
own may have been misinterpreted and ranked as a
primary sarcoma.
Thus Klien published as long ago as 1894 a report of
a vaginal tumour which he classified as a lymphangio-
endothelioma cavernosum hsemorrhagicum. The patient
was a multipara, aged 56. Two pedunculated, tuberous,
elastic tumours sprang from the vaginal mucous membrane,
they were very friable. Both were amputated and the
patient was discharged on the seventh day ; the after-
history was incomplete."^ The new growth was reticular
* KEen {loc. cit., p. 301) states that rectirrence took place, but at the
date on which his report was published the patient could not be persuaded
to return to hospital. The case, he said, was being closely watched. I
MALIGNANT VAGINAL POLYPUS. 197
in structure witli the meshes filled with blood. But
Neusser, amongst others, reminds us that tumours arising
in adrenal " rests " are apt to become " almost telangiec-
tatic." I cannot help thinking that Klien's tumour might
have been of that type.
I will now dwell for awhile on two clinical features
common to my case and to many examples of alleged
primary sarcoma of the vagina in the adult, namely
jpedunculation and ingmentation.
Pedunculation. — According to published reports, a large
proportion of all types of primary connective-tissue
tumours of the vagina are pedunculated. Such is the
case, we have seen, in respect to innocent tumours. The
reports of pedunculated and sessile primary sarcoma are,
I find, not highly reliable. In the first case, errors have
crept into tables and statistics. Thus Grow writes, in
describing his original case : " On the lower part of the
posterior wall is situated a small, round, sessile tumour,^'
and in that writer's tables the same case is entered under
the heading "Clinical form of growth'^ as a '^ sessile
lump." Yet in Veit's tables, widely quoted, Gow's case
(No. 14) is entered as gestielt. In the second place, as I
have already had occasion to remark, authors differ as to
what the words " pedunculated," " pediculated," " poly-
pous," and " sessile " precisely signify. - We know that
they do so when describing subserous fibroids of the
uterus. A tumour with a sharp edge overhanging a
relatively narrow attachment seems to be considered by
some as pedunculated and by others as sessile, the latter
description being the more correct. These doubtful
cases represent an intermediate stage between the
absolutely sessile growth merely projecting from the
surface of the mucosa, and the tumour with a distinct
stalk, a true pedicle in fact, undoubtedly the latter stage
cannot find any further note of it by Klien himself. Veit (' Handbuch
der Gyniikologie/ vol. i, p. 362) suspects that Klien's tumour was a
carcinoma. Klien makes no mention of any examination of the abdomen
before the removal of the tumour.
198 MALIGNANT VAGINAL POLYPUS.
of the former type. This fact was demonstrated in my
case, where the larger, older, and sloughing tumour had a-
very distinct pedicle, whilst the smaller growths were,
when I examined them, absolutely sessile. The large
tumour was racemose rather than what is understood by
polypoid. Ziegler, in his ' Pathologie,' states that vaginal
libromas, myomas, and sarcomas may be racemose as well
as polypoid. The primary sarcoma of the infant's vagina
is well knoAvn to be racemose.
The fact that this pedunculated tumour of the vagina
was secondary to an adrenal growth in the kidney shows
how careful we ought to be about exploring the patient's
abdomen and thorax and also about choosing a really
competent pathologist to examine the vaginal growth
under the microscope. I was under the impression, until
I received Dr. Lockyer's and Mr. Shattock's reports, that
there might be coincident primary vaginal sarcoma and
renal hypernephroma, the more so as when I detected
evidence of new growth in the base of the right lung I
remembered that such a complication had already been
observed in primary sarcoma of the vagina."^ The
microscope, however, showed that both the vaginal
tumour and the new growths in the lung were secondary
to the renal growth.
Pigmentation. — In this case, as I have already observed
in the clinical report, the largest of the three sessile growths
in the mucous membrane of the vagina posteriorly bore a
black patch on its surface. Unfortunately this appear-
ance was lost because the growth became sloughy before
the patient's decease. The pigmentation was very
possibly confined to the vaginal mucous membrane invest-
ing the growth. In Horn's case of primary sarcoma the
mucosa was pigmented, though the tumour itself was
free from pigment ; yet some secondary growths in the
* Herzfeld : Case where nodules of the new growth were detected in
the liHigs and pleura at the necropsy. Also Bajardi: Case where the
clinical evidence was strong, though no vost mortem was permitted.
Gow {loc. cit.) gives good abstract reports of the two cases.
MALIGNANT VAQINAL POLYPUS. 199
inguinal glands were much pigmented. Later ou pig-
mentary growths developed on the vulva^ whilst a big,
irremovable, encephaloid, abdomino-pelvic mass was found
to be free from pigment. Horn ascribed the pigmenta-
tion, Avhich was so remarkably irregular in his case,
purel}^ to haemorrhages, and gave good reasons for his
opinion. Morestin, in examining a pedunculated round-
celled sarcoma from an elderly virgin, found that some of
the cells were charged with pigment, which, like Horn,
he ascribed to blood.* My own experience shows that a
secondary adrenal tumour of the vagina may be pigmented,
and in all probability from the same cause. Pigmentation
seems to be a fascinating subject to many writers ; as for
true melanosis t I may refer the reader to my friend
Professor W. Sampson Handley^s Hunterian Lectures on
" The Pathology of Melanotic Growths in Kelation to their
Surgical Treatment," delivered last February at the Eoyal
College of Surgeons ('Lancet,' April 6th, 1907, p. 927).
There remains one more feature in my case, interesting
in respect to the vaginal tumour.
The sweats. — I have noted that the patient was
troubled with free sweats at the beginning of her illness.
They never ceased entirely and became profuse again in
the second week after the operation. At the time I
attributed the marked aggravation of- the symptom to
exudation in the stump of the pedicle, possibly to suppura-
tion. At the necropsy, however, but little evidence was
* Veit includes in his tables Parona's "melanotic spindle-celled
sarcoma/' with, reference — 'Annal. Univ. Med.-Chir. Milano,' 1887 — bnt,
like myself, was unable to obtain a copy of the original report. Most
probably Parona's case resembled those described by Horn and Morestin.
t Since the above observations Avere written I have come across a third
case, recorded by Dr. Boldt (" Primary Melanotic Sarcoma of Posterior
Vaginal Wall," with a photogravure. Eeport of a meeting of the New
York Obstetrical Society, ' Amer. Journ. Obstet.,' October, 1906, p. 550).
The patient was a nullipara, aged 37 ; the tumour was sessile and made
up of " small round-cells " ; the deeper were " laden with dark pigment."
Eapid recurrence followed removal. This case would hardly induce
Horn and Morestin to alter theii- views as to the origin of the pigment.
200 MALIGNANT VAGINAL POLYPUS.
found of inflammation, and there was no trace of pus in
tlie stump or round about it. On the other hand, there
were no inflammatory changes in the kidney which I
removed nor, as far as I am aware, does the development
of abnormal adrenal tissue cause perspirations.
The true cause of this symptom was, in all probability,
septic infection from the sloughing vaginal growths, a
complication noted by Howard Kelly in his ' Operative
Gynaecology ' (vol. i, 2nd ed., p. 332) : " There is a
great tendency in all of these tumours to undergo necrosis,
and this, together with the foul discharges, opens up an
avenue for the entrance of an infection, which in the
end often causes death." The vagina was kept as clean
as possible after the operation, but a considerable amount
of absorption was inevitable. The si3eedy removal of the
growths shortly after the nephrectomy might have given
temporary relief, but the patient would not consent to any
further operation. When I removed the kidney the
patient was in a state of collapse after I had secured the
numerous vessels divided when the upper part of the
tumour was set free. Removal of the vaginal growths,
which would have required free dissection of mucous
membrane around all of them, was, therefore, unadvisable.
Cancel' of the vagina, — A cancerous vaginal growth does
not tend to assume a polypoid form, * so that I need not
dwell on that type of tumour.
Adrenal Sarcoma or Hypernephroma of the Kidneys.
In the present case the primary seat of the new growth
was the kidney, and the structure of the new growth
resembled that of the supra-renal capsule. There were
secondary adrenal tumours in the vagina, one of which
was clinically conspicuous ; these new growths may put
us in mind of Eastwood's case of adrenal tumour of the
uterus, but in that instance the tumour was primary.
* One exceptional case has recently been reported by Dr. Macnaughton-
Jones.
MALIGNANT VAGINAL POLYPUS. 201
The above facts compel us to dwell for awhile on a very
intricate subject. Numerous monographs and essays on
adrenal tumours have been made public since that not
very remote period, the dawn of the twentieth century.
We are not concerned with certain tumours of the
supra-renal capsule itself, new growths observed in
children and associated with abnormal growth of hair and
other marked anomalies. Bulloch and Sequeira have
^^Titten much about these new growths arising in the
supra-renal capsule ; we must at the same time remember
Knowsley Thornton's case, where the patient was an adult,
a lunatic, aged 32. The face and extremities were ex-
tremely hairy. The preparation is now in the museum of
the Royal College of Surgeons (Pathol. Series 3518 E.).
In the present instance the primary growth lay, not in
the supra-renal capsule, but in the kidney, so that we
must consider adrenal tumour or hypernephroma of that
organ. The best summary by a special authority has
been drawn up by Neusser. That writer speaks of exces-
sive proliferation of circumscribed portions of supra-renal
substance, giving rise in the first instance to small tumours
resembling lipomata, which have been termed supra-renal
strumas or adenomata. " These are situated in the cortex
of the supra-renal capsule or, more frequently, in acces-
sory glands occurring in the kidney. In the latter situa-
tion the term renal adenoma or ' heterologous renal struma '
has been applied. They are small masses, varying in
size from a pin's head to a pea, yellowish-white in colour,
sharply defined and surrounded by a connective-tissue
capsule. They are histologically identical with the supra-
renal cortex, even the typical fatty infiltration of the
parenchyma being present." In addition to this for-
mation of metastases, in itself a manifestation of malig-
nancy, supra-renal strumas, after existing for a long
period of time, tend to assume malignant characters.
These malignant growths become vascular, almost telan-
giectatic. They are subject to degenerative changes, all
but exclusively fatty. HEemorrhagic cysts thus develop.
202 MALIGNANT VAGINAL POLYPUS.
I have already referred to these changes observed in
supra-renal "rests'' when commenting on Klein^s case of'
vaginal tumour. A clear general summary of the
characters of accessory adrenal tissue in the kidney will
be found in the sixth edition of Mr. Bland-Sutton's
* Tumours Innocent and Malignant,' page 111. Great
attention should be paid to that author's observations at
page 116, warning us against confusing primary tumour
of the supra-renal capsule with primary tumour of adrenal
" rests " developing in the kidney. The fallacy is due to
a very natural notion " that some of these tumours arise
in the adrenal and gradually become incorporated with
the adjacent parts of the kidney."
Such an error might readily arise from a hasty
inspection of the kidney which I removed in the case
under consideration. Anteriorly the new growth appears
to be separated from the upper pole of the kidney by a
distinct groove,"^ so that it looks like a supra-renal capsule
considerably enlarged (PI. XV, fig. 2). But posteriorly
there is no such groove, and when the cut surface of the
kidney is inspected it becomes evident that the tumour lies
inside the renal capsule, and has nothing to do with the
anatomical supra-renal capsule (PI. XVI, fig. 3). I may call
attention to Mr. Waring's very similar specimen in the
museum of St. Bartholomew's Hospital (No. 2390, G. 2),
where externally the tumour seems at first sight to lie in
the supra-renal capsule, on the top of the kidney, though
it really lies in the kidney itself.
When, however, we turn to another specimen in the
same museum (No. 2320 G.) we find a tumour of the
same type, but it lies on the lower pole of the affected
kidney.t I inverted the bottle containing this specimen,
* These remarks require modification, as far as my specimen is con-
cerned, since th.e position of the ureter was accurately defined (see above,
p. 188). There can be no doubt, however, that in Mr. Waring's specimen
the tumoui- lay in the upper pole of the kidney.
t Se^ also Fig. 6 in Ow^en Richards' "Gro^\i-hs of the Kidney and
Adrenals" ('Guy's Hospital Eeports,' vol. lix), where the tumour
occupies the lower pole (Golding- Bird's case). Richards, however, is not
absolutely certain of the nature of the tumour.
MALIGNANT VAGINAL POLYPUS. 203
when I examined it, and then it struck me how very much
the tumour resembled a diseased supra-renal capsule on
the top of the kidney. Several other instances of adrenal
tumours in the lower pole of the kidney have been
recorded (Eastwood, etc.^). They are good object lessons,
settling the once disputed question on naked-eye evidence.
For the supra-renal capsule is not in the habit of growing
on the lower pole of the kidney, and in No. 2S90 G.
" both supra-renal bodies were present in their normal
positions." On the other hand, in cases of tumour of the
supra-renal capsule itself, the kidney is as a rule quite
intact (Bulloch and Sequeira, Adams ; see also Knowsley
Thornton's specimen. Museum E.C.S., Path, series 3597 B.)
The invasion of the lung in my case is a complication
already noted in association with " hypernephroma " of
the kidney ; indeed, it is frequent, because, as Bland- Sutton
observes, the tumour is apt to invade the renal vein or its
branches. This question of the advance of the tumour
reminds ns of another subject of clinical interest. The
new growth, it has been asserted, does not tend to invade
the renal pelvis. Hence hasmaturia is said to be excep-
tional.t In one case, Mr. Waring's, which I have
already noticed, the patient, a man, aged 47, suffered
from ''painless heematuria on several occasions." On
inspecting the kidney in the Museum of St. Bartholomew's
Hospital (2930 Gc. 2) I found that the growth had replaced
not only the cortex, but also the upper pyramids, and had
reached the renal pelvis.
However, it is hardly necessary for me to dwell any
longer on adrenal tumours of the kidney, for there can be
no doubt that such was the character of the renal tumour
m my case, and that the vaginal growths were secondary
like the deposits in the liver and lung.
* An adrenal tumour may stretch the kidneys over its outer surfiice
(Fairbairn), but in that case the observer could hardly be deceived as to
the organ in which the new gro^vth had originated.
t I find that, according to Owen Richards, it is not rare, as other
writers lead us to believe (twenty-six out of forty-one cases, loc. cit ,
pp. 245, 247).
204 malignant vaginal polypus.
References.
Adams, Chas. E. — A Case of Precocious Development
associated with a Tumour of the Left Supra-renal Body.
Path. Soc. Trans., vol. Ivi (1905), p. 208.
Bulloch and Sequeira. — On the Relation of the Supra-
renal Capsules to the Sexual Organs. Ibid., p. 189, with
bibliography.
Eastwood. — The Occurrence in the Pelvis of Malignant
Tumours originating from Adrenal Remnants. Ibid., vol.
liii (1902), p. 153, with bibliography. See also Faiebairn.
— A Renal Tumour arising from Adrenal Elements. Ibid.,
p. 184.
Gow. — Primary Sarcoma of the Vagina. St. Bart's.
Hosp. Reports, vol. xxvii (1891), p. 97.
Horn. — Zur Kenntniss primaren Scheidensarcome bei
Erwachsenen. Monats. f. Greb. u. G-yn., vol. iv (1896), p.
409.
Jellett and Earl. — Primary Sarcoma of the Vagina in
an Adult, with the Notes of a Case. Journ. of Obstet.
and Gyn. of Brit. Emp., vol. v, p. 230. (With table of
thirty-nine cases and analysis.)
Klien. — Lymphangio-endothelioma cavernosum hse-
morrhagicum. Archiv f. Gynak., vol. xlvi (1894), p. 292.
MoRESTiN. — Sarcome de la parol Recto-vaginale. Bulle-
tins de la Soc. Anatom. de Paris, 1898, p. 431.
Neusser. — Diseases of the Supra-renal Capsules. Notli-
nagel's Encyclopaedia of Practical Medicine, English Edi-
tion, 1903.
Smith, R. R. — Fibro-myomatous Tumours of the Vagina.
Amer. Journ. Obstet., vol. xlv (1902), p. 145.
Veit. — Das Sarcom der Scheide bei Erwachsenen.
Handbuch der Gynakologie, vol. i (1897), p. 360.
Waring, H. J. — Descriptive List of Specimens Revised
and added to the Museum. St. Bart.'s Hosp. Reports,
voh xlii, p. 209 (No. 2390, G. 2).
Williams, W. Roger. — Sarcoma of the Vagina. Journ.
Obstet. and Gyn. Brit. Emp., vol. i (1902), p. 400.
MALIGNANT VAGINAL i'OLYrUS. 205
Dr. Beckett-Oveey (introduced by Mr. Alban Doran) de-
scribed briefly a similar case, which occurred under the care of
Dr. Hugh Phiyfair at the Metropolitan Hospital, and to -whom
he was indebted for permission to mention it. The patient, a
woman, aged 55, complained of haemorrhage from the vagina for
two months. The climacteric had occurred at 44. On examina-
tion a polypoid mass was found attached to the anterior vaginal
wall. This was removed in hospital, and a large tumour in the
right side of the abdomen was discovered. On microscopical
examination of the vaginal growth it was said, after some dis-
cussion, to be a very vascular sarcoma. The patient returned to
the hospital within two months of the removal of the growth
with a recurrence at the previous site, and it was again removed.
The patient died a month later, and on post-viortem examination
the speaker found the following conditions : The right side of
the abdomen was occupied by a large tumour which extended
into the right iliac fossa almost to Poupart's ligament. The
colon had been pushed down and surrounded the tumour on
three sides. Above it was continuous Avith the liver, although
clearly defined from the latter. On section the tumour showed
a small piece of renal substance at the upper pole, but otherwise
it was occupied by a growth measuring at its greatest about five
inches by four. The liver, which weighed nearly six pounds,
showed a large number of secondary new groTviihs varying in
size from a duck's egg to a pea. Many were softening and
breaking down, and some showed extensive haemorrhage. The
suprarenal capsule was not affected. The lungs were riddled
with a large number of small nodules, but none were degene-
rating. The vaginal wall was thickened and very dark from
haemorrhage, but showed no obvious new growth. Sections
from the various organs showed more or less typical adrenal
tissue, the most typical being that in the lungs. On comparing
the sections of the vaginal growth with these the likeness was at
once seen. There could be no doubt that the original growth
was in the kidney, and was a malignant adrenal tumour starting
in an adrenal rest. The occurrence of the tumour in the lower
part of the kidney, and the remarkable similarity of the piimary
and secondary growths to adrenal tissue, conclusively proved
this. In Mr. Waring's case, where removal of the kidney had
been performed early, the patient was alive and well. In his
case there was a distinct fibrous capsule intervening between the
growths in the supra-renal capsule and that in the kidney, and
the tumoiu- was situated in the upper pole of the kidney.
Dr. LocKYER expressed the greatest interest in Mr. Doran's
specimen of primary hypernephroma of the kidney, with secondary
deposits in the vagina, liver, lung, and omentum. He had studied
the growths most carefully from sections prepared by himself,
and quite agreed with the diagnosis arrived at by Mr. Shattock
VOL. XLIX. 14
206 MALIGNANT VAGINAL POLYPUS.
from the sections made at the College of Surgeons — viz. that the
growth in the kidney was of the nature of an adrenal inclusion.
Now, these tumours, when malignant, more frequently took oh
the form of sarcomata than carcinomata, but from the cytology
and general arrangement of the cells of this growth, shown by
Mr. Doran, Dr. Lockyer was disposed to think that it should
be classed as an adrenal carcinoma. That very day Dr. Lockyer
had, Avith the assistance of Mr. Ewan Stabb, removed a large
renal tumour, together with a (?) sarcomatous fibroid of the uterus,
and a parovarian cyst — all from the same patient. Frozen
sections had been prepared from the renal growth, which shoAved
it to be a hypernephroma, but of a totally different type to that
shown by Mr. Doran. Those who studied Mr. Doran's sections
and the sections from Dr. Lockyer's case side by side would be
struck at once by the benign character of the latter. It is
obviously an adenoma derived from adrenal tissue. This growth
had been clinically watched by Dr. Lockyer for six months,
whilst the fibroid of the uterus had been observed and measured
regularly for the past nine or ten years. The latter tumour had
decreased in size with the menopause (the patient is now aged
57 years), but she came complaining that vaginal haemorrhage
had started again, with great pelvic pain. It was then — six
months ago — ^that the renal growth was discovered, and Dr.
Lockyer feared that it might be a sarcoma secondary to this
change occurring in the shrunken fibroid ; this idea seemed the
more likely, as the upper pole of the uterine growth had become
softer than formerly. Fortunately, this was not the case, and,
whatever the nature of the uterine growth, the hypernephroma
of the kidney showed a benign structure under the microscope,
and shelled out from its capsule dui'ing operation with the
greatest ease.
Mr. Alban Doran, in reply, trusted that Dr. Beckett-Overy
would publish a full account of his important case, similar in
many respects to that which had been brought foi*ward that
evening. Mr. Bland-Sutton, in inspecting his (Mr. Doran's)
vaginal tumour, had expressed to him some suspicion that it
might, after all, have been the primary growth, or that the case
might be interpreted as a general malignant degeneration of
adrenal rests in the kidney, vagina, and elsewhere.
JUNE 5th, 1907.
Herbert R. Spencer, M.D., President, in the Chair.
Present— 51 Fellows and 4 visitors.
Books were presented by the St. Thomas's Hospital
Staff and by the Staff of the Society of the New York
Hospital.
John Prescott Hedley, M.B., B.C., was admitted a
Fellow.
The following candidates were proposed for election :
Sorab Kaikhoshru Engineer, M.K.C.P.E., L.R.C.S.B.,
L.M.&S.Bomb. (Edinburgh) ; Manecxji Piroshaw Kerra-
walla, M.D.Brux., L.M.&S.Bomb. ; Stanley Dodd, M.A.,
M.B., B.C.Cantab. ; and Somerville Hastings, M.B., B.S.
Report of the Pathology Committee on Dr. May Thome's
Specime7i of Uterus showing Malignant Villous Tumour
and a Fibroid undergoing Sarcomatous Change (see
p. 181).
We have examined this specimen and the microscopic
sections taken from it, and agree that the growth in the
wall of the uterus has the structure of a fasciculated
spindle-celled sarcoma in which there are no giant cells.
VOL. XLIX. 15
208 KEPOliT OF THE PATHOLOGY COMMITTEE.
Wu find no evidence that this growth originated in a
libro-myonia. We also agree that the villous growth is a
carcinoma of endometrium.
{Siijned^ Alban Dokan.
CUTHBEKT LOCKYEU.
G. Bellingham Smith.
Heubert li. Spencek.
J. H. Tahgett.
May Thokne.
llEKBiiiiT Williamson.
Corrie Keep.
W. S. A. CrRiFriTH, CJiainnan.
Rei^urt of the Fathology Coiuvuttee on Mr. Alban Doraii's
Specimen of a Malignant Vaginal Poly pus secondary
to an Adrenal Tuniour {see p. 182).
We have examined this specimen and the microscopic
sections taken from the vaginal polypus and the kidney,
and agree that the primary tumour is a carcinoma
originating in an adrenal rest of the kidney, and that
the vaginal poly^ius is a secondary deposit of a similar
nature.
[Signed] Alban Doran.
Cdthbert Lockyee.
G. Bellingham Smith.
J. H. Targett.
Herbert Williamson.
Corrie Keep.
W. S. A, Griffith, Chairman.
PEEGNANCT IN A RUDIMENTARY UTERINE HORN. 209
TWO CASES OF PREGNANCY IN A RUDI-
MENTARY UTERINE HORN.
By Dr. Henry Russell Andrews.
(1) Suppuration in a Pregnant Rudimentary U'jerinh
Horn Five Months after the Death op an Eight
Months' F(etus.
On October IStli, 1906, I was asked to see a patient
with severe vomiting during pregnancy, to decide whether
labour should be induced prematurely. The patient was
a primigravida, supposed to be seven calendar months
pregnant, the last period having begun on March 19th.
Before her marriage she had had two severe attacks of
vomiting lasting for several weeks, said to be due to
gastric ulcer. Towards the end of April, 1906, i.e. when
five or six weeks pregnant, she began to vomit again, and
the vomiting was so severe that she was fed ijer 7'ectum
for six weeks. During July, which she spent at the
seaside, there was no vomiting, but on her return home
the vomiting began again. She had no pain of any sort.
Before the pregnancy began, in December, 1905, she
weighed 7 st. When I saw her in October, 1906, her weight
was only 4 st. 8^ lb. She was emaciated, weak, and very
nervous. The uterus reached up to three inches above
the umbilicus. The foetal heart was heard. The foetus
seemed to be smaller than would be expected at thirty
weeks. Bimanual examination revealed nothing abnormal.
I said that induction of labour would probably kill the
patient, and that as the child was so small it would
not be likely to live. The patient was admitted into the
London Hospital on October 20th. The vomiting ceased
almost entirely from the first; on the third, fourth, and
fifth days she did not vomit at all, and after this she
vomited on an average once in every twenty -four hours. A
210 PREGNANCY IN A RUDIMENTAEY UTERINE HORN.
week after admission she was taking mince, chicken, eggs,
etc. She improved rapidly, put on one stone in weight
in a month, and returned home on November 17th. The
fcEtal heart was heard on the day before she left the
hospital. Only one vaginal examination was made, to see
whether there was any tumour in the pelvis.
I heard no more of the patient until April, 1907, when
I was told that she had not been delivered, and that she
was very ill, with a temperature of 102° F. She was
re-admitted to the hospital on April 18th, 1907, when the
following history was obtained : On November 19th, two
days after her return home, a blood-stained vaginal dis-
charge began, and she had very severe abdominal pain
coming on every five minutes for about an hour. She sent
for a doctor, who removed several pieces of what he called
" dead and bloodless placenta." As the blood-stained
discharge persisted he examined the patient under chloro-
form, but found nothing abnormal. The patient felt no
foetal movements after leaving the hospital. After a few
days the bleeding stopped, and the abdominal swelling-
began to get smaller. The vomiting ceased altogether,
and the patient began to put on flesh again. At this time
she began to suffer from fits, which her doctor believed
to be hysterical. Early in April, 1907, she became ill,
and sent for another doctor, who wrote to me about her.
For three days before admission the stools had been
extraordinarily offensive. On admission, on April 18th,
she was flushed, but looked better than when I saw her
last, and weighed 6 st. 4 lb.
Her temperature was 102° F. The abdomen contained
a rounded swelling, fixed and tender, in the middle line
reaching up to li in. above the umbilicus. A "crackle"
could be felt over it on palpation. Small, hard irregu-
larities could be felt in it.
On vaginal examination the tumour could not be
separated from the cervix. What felt like the fundus of
an unimpregnated uterus could be felt projecting from
the left side of the tumour low down.
PREGNANCY IN A RUDIMENTARY UTERINE HORN. 211
A diagnosis of suppuration in a pregnant rudimentary
horn was made^ and I proceeded to operate.
When the patient was anaesthetised a sound was passed
2^ in. into the small projection, which was taken for the
left half of the uterus.
On opening the abdomen a yellowish tumour was seen
adherent to anterior abdominal wall, omentum, sigmoid
colon and rectum. It smelt so horribly directly the
abdomen was opened that I thought that its wall must be
very thin, and packed the abdominal cavity with a sterilised
towel as well as gauze swabs. In dissecting the rectum
off the tumour the wall of the sac gave way and there
was a gush of the most horribly offensive pus. The
tumour was then brought up as much out of the abdomen
as possible and incised, the placenta and foetus and much
pus being removed. The tumour was then removed as
rapidly as possible. As it became possible to distinguish
structures the tumour seemed to be an ordinary uterus.
It was amputated at the level of the internal os so as to
get the septic mass out of the abdomen as soon as possible,
and then the cervix was removed. The pelvic cavity was
swabbed out and a large rubber drainage-tube was
inserted, one end projecting out of the abdominal wound
and the other out of the vagina. The head of the bed
was raised on blocks.
The patient made a slow but sure recovery and left the
hospital on May 24th, five weeks after the operation. In
the first fortnight after the operation she had several fits,
with rigidity and loss of power in the right arm, and loss
of consciousness. There was slight optic neuritis. Dr.
Henry Head, who kindly saw the patient, thought that
she had a septic cerebral embolus. Before she left the
hospital the right arm had regained its power, and there
had been no fits for three weeks.
The specimen shows the small uterine cavity on the left
side and the large right horn. At the operation the
right round ligament was seen coming off from the right
side of the pregnant horn, but now that the tissues have
212 PREGNANCY IN A RUDIMENTARY UTERINE HORN.
shrunk it is impossible to identify it. Both ovaries and
tubes can be seen adherent to the right horn. The
junction between the two horns is broad and thick. The
foetus, which is much decomposed, measures 17 inches in
length. There is not much left of the placenta.
My experience in this case would make me unwilling
to leave a full-term extra-uterine pregnancy alone in the
hope that no further trouble would result. I should
prefer to operate about a couple of months after the death
of the foetus. This would mean that in a certain number
of cases the operation would be performed unnecessarily,
but the operation is then not attended by much risk,
while if one waits until there are indications that suppura-
tion has occurred in the sac the danger must be increased
greatly.
(2) Rupture of a Pregnant Rudimentary Uterink Horn
AT about thk Eighth Month.
On May 6th, a primigravida, aged 32, was sent into
the London Hospital Avith a diagnosis of concealed acci-
dental haemorrhage. Her last period ended on September
5th, 1906, and she considered that she was eight months
pregnant. There were no unusual symptoms during the
pregnancy until May 5th, the day before her admission to
hospital, when at about 6 p.m. she was seized with sudden
violent abdominal pain, which became constant. During
the night and the next day she vomited frequently, and
fainted four or five times, generally as the result of sitting
up. Slight bleeding from the vagina began soon after
the onset of the pain.
When I saw her at 5.45 p.m. she was blanched, restless,
and very thirsty. The respirations were " sighing,^' the
pulse was almost imperceptible at the wrist, the heart-
beats were 140 per minute. The abdomen was distended,
tender all over. There was diminished resonance in the
flanks, but no dulness on percussion, except over a firm,
rounded tumour, which reached out of the pelvis to a point
PREGNANCY IN A RUDIMENTARY UTERINE HORN. 213
just above the umbilicus. Foetal parts were not palpable
and the fcetal heart was not heard. The whole abdomen
felt firm, as if it contained some fairly solid substance
rather than fluid.
The cervix was as soft as the normal cervix in the later
months of pregnancy. The tumour in the abdomen could
not be separated from the cervix. Continuous with tlie
cervix, and inseparable from the large tumour attached
to its left side, was a mass the size of the body of the
uterus at two months. Into this the sound was passed
3 inches.
Diagnosis. — It seemed probable that the condition was
due to the rupture of a pregnant rudimentary uterine
horn. There was no doubt that there had been severe
intra-peritoneal haemorrhage, although the condition of
the abdomen was not quite typical of recent bleeding.
Operation. — On opening the abdomen enormous clots,
practically a cast of the abdominal cavity, were removed.
The right horn of the uterus, which looked exactly like a
pregnant uterus at six months, had a small rupture at
its upper part through which placenta could be seen. As
the tumour was pulled out of the abdomen this rupture
became considerably enlarged by tearing. The right
horn was attached to the left half of the uterus by a
thin band of tissue about 2 inches broad. This band
and the broad ligament on the other side were clamped
by two pairs of forceps and the right uterine horn was
removed. The clamped tissue was then sewn o^-er, the
vessels being tied separately. The round ligament came
off the right side of the pregnant horn. The remaining
blood-clots were removed, and the abdominal cavity was
filled with saline solution.
In spite of everything that could be done the patient
died about an hour and a half after the operation.
By the time the operation v/as over the horn had almost
completely delivered the intact ovum through the renr, con-
tracting like a normal uterus. The wall of the horn was
thick muscular tissue except close by the site of rupture.
214 RITPTDRE OP THE HEART IN A STILL-BORN INFANT.
where it was so thin as to be transhicent. The fcetus
appeared to be of less than seven months' development.'
Unfortunately the right horn and the ovum were thrown
away by mistake. The left half of the uterus was removed
at the post-mortem examination. The attachments of the
right horn can be seen.
Rupture occurred unusually late in this case, as although
the foetus did not appear to be of much more than six
months' development, the history pointed to the patient's
being eight months pregnant. It was much to be regretted
that so much valuable time — nearly twenty-four hours — was
lost before she was sent to the hospital.
Miss Garrett Anderson was specially interested in the cases
reported by Dr. Andrews, because she had lately operated upon
a patient \\ath cornual pregnancy. The gestation sac lay in the
ruideveloped right liorn of a double uterus. It corresponded to
the size of a two months' pregnancy. The pregnant right horn
was closely attached from fundus downwards to the left horn,
and thick flaps of muscle had to be cut in order to separate it
from the functional and patent left side of the uterus. Mattress
sutures controlled the bleeding. The right ovary contained a
recent corpus luteum. There was no communication between
the right horn and the exterior.
RUPTURE OF THE HEART IN A STILL-BORN
INFANT.
Shown by Dr. C. Nepean Longridge.
The case was one of shoulder presentation at full time,
admitted to Queen Charlotte's Hospital with a prolapsed
and pulseless cord. Craniotomy was performed, and
powerful traction was necessary to extract the child, which
weighed 9 lb. 5 oz. without the brain. Half an ounce of
blood" was found lying free in the pei'icardial sac. There
was a rupture at the junction of the inferior vena cava
and the riorlit auricle.
DILATED URETERS IN STILL-BORN INFANTS. 215
DILATED URETERS IN STILL-BORN INFANTS.
Shown by Dr. C. Nepean Longridge.
In the last twenty autopsies on infants at Queen Char-
lotte's Hospital he had found this abnormality no less than
eight times. Six of the cases were male infants. Both
ureters were dilated in four cases, the left only in three,
and the right only in one. The specimen shown was
removed from a female infant, and was doubly interesting
on account of the fact that there was a double ureter on
each side. In most of the specimens the ureter was
dilated throughout its whole length, and in the others only
that portion which lay above the brim of the pelvis was
dilated. In no case was any stone or obstruction found
in the urinary passages. He had found great distension
of the rectum by meconium in several of the cases, and
considered that the probable explanation of the abnormality
lay m the fact that the ureters were compressed between
the full bladder and rectum.
Dr. Gray asked Dr. Longridge if he had found any atrophy in
the abdominal muscles in his cases. He (Dr. Grav) had met with
three cases m infants in which the muscular layer's of the anterior
abdominal wall were ahnost completely atrophied, and tliis was
associated with enormous dilatation of both ureters. The kidneys
were smaller than normal, and the bladder contracted and its
muscular wall much hypertrophiecl, but no obstruction to the
passage of urme could be found. A careful examination of the
cenvral nervous system had, he believed, been made and nothino-
abnormal found. The children were males ; one of them had
lived to be eight months old, but the other two only a week or
two. As far as he was aware no satisfactory explanation had
been torthcommg to explain these cases.
216 THE PELVIC ORGANS OP A CASE WHERE [NOPERARLE
THE PELVIC ORGANS OF A CASE WHERE
INOPERABLE PAPILLOMA OF THE LEFT
OVARY HAD BEEN FOUND SEVEN YEARS
PREVIOUSLY.
Shown by Dr. Amand Routh.
Dr. Amand Routh showed the pelvic organs (fibroids)
removed by laparotomy from a woman, whose abdomen
had been opened by him seven years previously, but was
closed again without anything being done owing to a
large papilloma of the left ovary which it was impossible
to remove.
The following is the history of the case.
Miss E. L — , in 1897, when aged 38, complained of
pelvic pain and of menorrhoea, and a pinky discharge
every morning on rising.
December 17th, 1898. — Left ovary is enlarged and
tender and pi'olapsed.
February 14th, 1899. — Brownish, water^'' discharge,
now almost continuous. More pelvic pain. Left ovary
larger and left Fallopian tube thought to be dilated.
February 1st, 1900. — Not seen for twelve months.
Semi-solid, though elastic mass behind uterus, extending
to sides of pelvis. Some recent pyrexia and chilliness.
Diagnosis was that of either pyosalpinx or left ovarian
growth, and as patient would not consent to abdominal
operation unless absolutely necessary, I first curetted the
uterus and then opened Douglas's pouch per vaginam,
Dr. Eden assisting me (February 8th, 1900).
We then found that the pelvis was full of a papillo-
matous mass which appeared to have invaded the cellular
tissue on the left side. The abdomen was thereupon
opened, and what appeared to be a malignant papillo-
matous mass was seen filling the pelvis. Nodules were
felt above the pelvic brim, and both these and those in
PAPILLOMA OP THE LEFT OVAEY HAD BEEN FOUND. 217
the pelvis appeared to have invaded the subperitoneal
connective tissue. The fundus uteri could be distin-
guished embedded in the growth, but the right ovary
could not be located. There were a few nodules on the
omentum and parietal peritoneum. Under these circum-
stances a diagnosis was made of a papillomatous growth
arising from the hilum of the left ovary with proliferation
into the peritoneal and sub-peritoneal connective tissue,
and it was decided to make no attempt to remove the
growth. Unfortunately no piece was removed for micro-
scopical examination.
The patient made a good recovery from the operation,
but a month afterwards, just as she was about to leave
the home, she had an attack of what was thought to be
influenza with pleurisy, and Dr. Mitchell Bruce diagnosed
an empyema on the right side. Mr. Stanley Boyd treated
this by incision and drainage. The patient made a slow
recovery and left the nursing home well on May 1st, 1900,
In June, 1901, sixteen months after the operation, she
stated that her periods had been regular, but that she
now always had a copious watery blood-stained discharge
between the periods. On bi-manual examination the
uterus was found to be distinctly enlarged but mobile,
and no traces of any pelvic grow^th could be felt, except
some induration in left broad ligament. '
In June, 1905, the uterus was much larger and nodular,
and fibroids were evidently present. As the watery
discharge continued, and there was also menorrhagia, I
explored the uterine cavity and curetted the lining mem-
brane, but only hypertrophied glandular tissue was found
(Lockyer) .
After this the fibi'oid uterus continued to enlarge, and
irregular haemorrhage became frequent, and the periods
themselves were very profuse and her general health
was getting worse.
On May 1st, 1907, therefore, I removed the uterus and
appendages, and I now show the parts removed. At the
operation there were numerous adhesions in the true
218 PELVTC ORGANS OP CASE OP INOPERABLE PAPILLOMA.
pelvis, and the general peritoneal cavity was quite shut
off from the true pelvis by universally adherent bowels
and omentum.
The left ovary was embedded in adhesions at the back
of the broad ligament and is small and cirrhotic. I
append Dr. Lockyer's report of the specimen.
Report on the Specimen.
The specimen consists of the uterus and its entire
appendages. The uterus is much distorted by the presence
of numerous fibroids, there being eight distinct and
separate tumours in its walls. None of these growths
have attained any great size, the specimen as a whole
weighing only two pounds. The largest fibroid occupies
the left anterior wall of the uterus and lies in front of, and
parallel with, the left appendages. At each cornu is
situated a subperitoneal fibroid, each growth having the
size of a small Tangerine orange. On the top of the
fundus between these two lies another smaller subperi-
toneal growth. The centre of the anterior uterine wall is
occupied by an interstitial fibroid. The cavum uteri is
opened up by two submucous growths, and finally an
interstitial growth projects from the cervix below and to
the left of the point of amputation.
The Fallopian tubes are sealed off and distended, the
left forming a thin-walled sac in its outer two thirds,
wliilst the right is thickened throughout. Both tubal sacs
on section exuded a thick, grumous material, from whicli
no organism could be grown upon any of the ordinary
culture media.
The left ovary is represented by a hard, fibrous mass
measuring 1 in. by h in. The right ovary appears normal
to the naked eje. The entire specimen in the hardened
state measures 4 in. from above down, and 5 in. from side
to side.
The right ovary measures 1 in. by f in. in its two
diameters. Its tunica and cortex are thickened ; the
MYOMATOUS UTERUS. 219
latter contains a few degenerate follicles. The stroma
presents many corpora albicantia. The vessels at the
hilum are thickened throughout, all changes pointing to
the presence of chronic oophoritis. The remains of the
left ovary contain no gland-elements. The ovarian stroma
is reduced to a minimum, being replaced to a great extent
by dense hyaline fibrous tissue. The uterine segment of
the right tube shows fibrosis and round-celled infiltration,
the fimbria are distended with leucocytes, but their
epithelium is intact. The uterine end of the left tube
shows the same inflammatory changes, but to a less degree.
CUTHBERT LOCKYBR.
I thought the specimen interesting in view of the
history of the inoperable condition found in 1900, more
especially as the left ovary, Avhich was then considered to
be the source of the papillomatous growth, is now found
to be entirely fibrous tissue with no trace of ovarian
structure.
Whether the severe illness from which she suffered
(empyema) a month after the operation had an3'thing to
do with the disappearance of the growth, or whether it is
one of those cases which so unaccountably get well after
the abdomen is opened, without anything being done, is,, of
course, doubtful. The patient is now quite well. ,
The President thought the disease might have been tubercle,
which sometimes assumed the papillary form.
MYOMATOUS UTERUS WEIGHING OVER SEVEN
POUNDS, REMOVED FROM A WOMAN AGED 22.
Shown by Dr. Herbert Spencer.
(With Plate XIX.)
The specimen was shown on account of the large size of
the tumour and the youth of the patient, and the fact
that in appearance at the operation the tumour closely
220 MYOMATOUS UTERUS.
resembled a pregnant uterus. Nine years ago he had
brought before the Society all the cases he had been able
to find recorded (forty in all) of fibro-myoma occurring in
women under twenty- five years of age, together with two
cases of his oAvn, one of which weighed 4 lb. 9| oz. Dr.
Russell Andrews had published a case of a fibro-myomatous
uterus weighing 4 lb. 5 oz. occurring (like his own) in a
Jewess, aged 20. Most of the tumours recorded, however,
were small, and it was on account of the rarity of such a
large tumour in a young subject, and its resemblance to the
pregnant uterus, that he desired to record the case. The
following are the notes :
F. G — , a Jewish virgin, aged 22, born on March 20th,
1884, as shown by her birth certificate, was seen on
December 15th, 1906. She complained of haemorrhagia,
dysmenorrhcea, and enlargement of the abdomen.
Menstruation began at the age of thirteen, and had been
regular every four weeks since. At first it lasted one
day, but for the last three years it had lasted five days,
during- the first two of which there had been pain in the
left side of the abdomen.
The patient had typhus at the age of nine, and when
she was thirteen she was treated at St. Bartholomew's
Hospital for rheumatism.
She was admitted to University College Hospital on
December 18th, 1906, and looked healthy and notansemic.
The breasts were virginal. The hymen was intact and
its opening very small, rendering examination difficult.
The abdomen was distended, measuring, 3 in. below
the umbilicus, 31 in. in girth. From the umbilicus to the
anterior superior iliac spine measured 6j in. on each side.
The distension was caused by a tumour which reached
up to 3 in. above the umbilicus and had almost the shape
and consistence of the pregnant uterus, but differed in
that the lower segment was specially prominent, that the
left cornu of the uterus felt rather harder than the rest
of the organ, and that neither ballottement nor uterine
Kouffle could be obtained. The tumour felt cystic to
Plate XIX.
Obstet. Soc. Trans., Vol. XLIX.
Illustrating Dr. Herbert Spencer's Specimen of Myomatous Uterus weighing over
Seven Pounds, removed from a Woman ag-ed 22.
Aiilaj-d &f Son, Ii>//»:
DESCRIPTION OF PLATE XIX,
Illustrating Dr. Herbert Spencer's specimen of Myomatous
Uterus weighing over Seven Pounds, removed from a
Woman aged 22.
The line of the uterine cavity is distorted by the tumour ; it may be
inferred from the position of the section of the cornu cut across at the
upper left part of the plate. Note the bulging anterior lower segment
below. The tumour has undergone mucous degeneration, especially at
its upper part.
MYOMATOUS UTERUS. 221
palpation, and gave a well-marked thrill on percussion. It
was dull on percussion. On vaginal examination the
cervix was virginal. The uterus appeared to be small ;
the tumour could not be reached. The relation of the
uterus to the tumour could not be made out without an
anesthetic, even by rectal examination. It was not
thought advisable to give an anesthetic as the case was
clearly one which required operation ; an ovarian tumour
was diagnosed.
On December 20th, 1906, Dr. Spencer operated and found
that the tumour, in its shape, and colour and consistence
closely resembled a pregnant uterus at the seventh month.
The only points in which it difPered from the pregnant
organ were in the fulness of the lower segment (which in
the pregnant uterus is usually flat), in the absence of
signs of a foetus, and in the presence of a white patch
where the tumour had pressed against the promontory,
which he had often observed in the fibroid uterus but
never m the pregnant organ. In spite of the close
simulation of the pregnant uterus he decided that the
patient could not be pregnant, as the breasts, though
having pigmented areola), were in other respects typically
virginal. He considered that the tumour was a degene-
rated fibro-myoma, and this diagnosis was confirmed on
making an incision into it.
The uterus was then removed by total abdominal
hysterectomy, the pelvic peritoneum being closed by a
purse-string suture.
The abdominal wound, sutured with buried silk (for the
fascia), and through stitches of silk-worm gut, healed by
first mtention, and the patient left the hospital quite well
on January 22nd.
On bisecting the uterus, which weighed 7 lb. 7 oz it
was found to be invaded by an intra-mural fibroid wliich
origmated m the right wall and had undergone mucous
degeneration. This degeneration was especially marked at
the upper part of the tumour, where it formed a gelatinous
layer half an inch in thickness (see plate).
222 OVARIAN PEEGNANCY.
Microscopic examination confirmed the naked-eye diag-
nosis.
OVARIAN PREGNANCY (?).
Shown by Henry Briggs, M.B., F.R.C.S.
Mrs. N — , an active, athletic woman, aged 33 ; the
mother of one child, ten years old.
Previous history good. Since the patient's only con-
finement there had been chronic retroversion of the
enlarged uterus without symptoms, with secondary sterility
for which she had often consulted her doctor, who had, at
intervals, placed a Hodge pessary, or dressed the uterus
with iodine.
History. — Menses regular ; the last period, which com-
menced on February 26th and ended on March 6th, 1907,
was of longer duration and a little more painful than usual.
Irregular bleeding ensaed on March 12th and 13th
(two days), on March 16th (one day) ; on this occasion
the hcemorrhage was accompanied by severe pain, vomiting,
and collapse ; bleeding again on March 17th, and the
following three days (four days).
Physical signs. — A fulness in the right lateral fornix was
observed on April 3rd by Dr. Matthews. The physical
signs were faint and indefinite. There was no fixation of
the uterus or its appendages.
Operation on April 8th, 1907, by a short abdominal
incision : two ounces of free, dark, intra-peritoneal fluid
blood, and the right tube and ovary were removed. The
presence of chorionic villi within the blood-clot was proved
by the microscope. The capsule of the ovary was con-
tained over the ovarian attachment of the blood-clot. The
blood-clot elsewhere was merely additional to this bursal
portion.
The specimen teas referred to the Pathology Committee
[see p. 256).
FIBROID TISSUE FORMED AROUND A NEEDLE. 223
EARLY TUBAL MOLE.
Shown by Dr. Briggs.
R. S — , aged 35, eight years married, the mother of six
children, the youngest aged 2 years.
Menstruation regular.
She was quite well until ten days after the last menstrual
period; violent pain in the left lower abdomen, local tender-
ness, a dark, blood-stained vaginal discharge and general
faintness occurred. She had four attacks of severe pain
and a continuous blood-stained discharge before the
operation of abdominal section twenty-one days later.
May, 31st, 1907.
Before operation the diagnosis of ectopic gestation
was founded on the locality and character of the pain
and on the haemorrhage, together with a fulness in the
left posterior quarter of the pelvis which pushed and
slightly fixed the uterus to the right side. One and
a half ounces of free fluid blood were present in the
peritoneal cavity. The ampullary portion, 1 in. x -|- in.,
of the left tube contained a small mole.
FIBROID TISSUE FORMED AROUND' A NEEDLE
AND REMOVED FROM THE LEFT LABIUM
MAJUS.
Shown by Dr. Briggs.
The specimen consists of an elongated mass of fibrous
and fatty tissue, 2 in. x ^ in., and in it are embedded the
two pieces of a darning-needle.
Clinical history. — The spindle-shaped tumour, reaching
1 in. below the external abdominal ring downwards in
the left labium, was said to have existed for six weeks.
The needle as its cause could not be traced.
The patient was aged 33.
VOL. XLIX. 16
224
PRIMARY EMBOLIC CHORION-EPITHELIOMA OF
THE VAGINA.
By Henry Thomas Hicks, F.R.C.S.Eng.
(Received December l7th, 1906.)
(With Plates XX-XXII.)
[Abstract.)
The paper is founded on a case of primary chorion-epithelioma
occurriug in the vagina of a woman oet. 28 years. A hydatid
mole was passed and the growth accidentally discovered about a
month later. There was no evidence of primary uterine growth.
The sections show that the growth has tho structure of a chorion-
epithelioma, but no villi are seen. Fourteen other cases have
been collected from the literature on the subject, and the
question of the degree of malignancy of this form of growth is
discussed, as well as the theories as to the origin of the vaginal
growths. The time at which the growth may appear in relation
to the gestation is also mentioned in the paper.
The patient remained free from growth for seven months after
removal of the first growth. The second grovrth was excised
without delay, but two new foci appeared qiiickly. These were
removed, but two months later the anterior vaginal wall became
rapidly infiltrated with extensive growth, and it was decided
that further operation Avould be hopeless. The patient, who up,
to this time had been comparatively well, now went downhill
with great rapidity. The growth commenced to fungate into
the vagina in many places, causing haemorrhage. The tempera-
ture rose, and signs of pulmonary trouble became evident. The
.patient died on May 8th, 1907, eleven months after the passage
of the mole.
The specimen removed at the autopsy is showu, together with
Plate XX.
Obstet. Soc. Trans., \'ol. XLIX.
c-
D-
Illustrating Mr. H. T. Hicks's paper on Primary Embolic Chorion-
epithelioma of the Vagina.
Adlatd S^ Son, hnpr.
DESCRIPTION OF PLATE XX,
Illustratnig Mr. H. T. Hicks's paper on Primary Embolic
Chorion-epithelioma of the Vagina.
A. Utervis free from growth. B. Ovaries and Fallopian tubes
C. Ureters. D. Cut edges of vaginal wall. E. Vaginal growth
F, Urethra. G. Growth involving clitoris.
Plate XXI.
Obstet. Soc. Trans., Vol. XLIX.
® © ffi ® ^ ff'
, ■« '»'
* » « ^ <» a>
* « e •
<§! ■» 5^ -
,:*
Langhans
•cells.
»"*S'^®
<?
k >*■•
^f
Syncytium.
Illustrating Mr. H. T. H.ckss paper on Primary Embolic
Chorion-epithelioma ot the Vagma.
AMard &= Son, In,
DESCRIPTION OF PLATE XXI,
Illustrating Mr. H. T. Hicks's paper on Primary Embolic
Chorion-epithelioma of the Vagina.
1. Mass of Langhans' cells. 2. Syncytium. 3. Vaginal wall. 4. Blood
and fibrin. 5. Degenerating mass of syncytium.
Plate XXI.
Obstet. Soc. Trans., Vol. XLIX.
' * * « -5 ^ ^
\i
®
® ® ®
>9.
^ V
%
I
^ .o ■ 'Wy*. * s.' !:«4 5fc ,.
ee * *^»^«^^-
>f
Illustrating Mr. H. T. Hicks's paper on Primary Embolic
Chorion-epithelioma of the Vagina.
Adlard &^ Son, Iinpr.
DESCRIPTION OF PLATE XXI,
Illustrating Mr. H. T. Hicks's paper on Primary Embolic
Chorion-epithelioma of the Vagina.
1. Mass of Langhans' cells. 2. Syncytivim. 3. Vaginal wall. 4. Blood
and fibrin. 5. Degenerating mass of syncytium.
Plate XXII.
Obstet. Soc. Trans., Vol. XLIX.
.^
'•'-.1
m
B
-/?•'
Illustrating Mr. H. T. HiCKS's paper on Primary Embolic
''chorion-epithelioma of the Vagina.
Adlard dr' Son, Ii>i/>r.
DESCRIPTION OF PLATE XXII,
Illustrating Mr. H. T. Hicks's paper on Primary Embolic
Chorion-epithelioma of the Vagina.
A. Vaginal epithelium. B. Vaginal wall. C. Syncytium. D. Langhans'
cells. E. Haemorrhage with degenerating syncytial cells. "
PRIMARY EMBOLIC CHORION-EPITHELIOMA OP VAGINA. 225
sections and drawings of the growth. Some secondary nodules
were found in the right lung.
Primary chorion-epithelioma of the vagina is of such
great interest and the recorded cases so few that I
venture to bring this case before the Society, hoping it
may help to throw some light on this rare condition. "^
E. J— aged 28, was admitted into Guy's Hospital on
July ]Oth, 1906, for pain in the left chest and dyspnoea
Previous history.—The patient was married and had
had three children and no miscarriages, and had always
had good health up to the present illness. Menstruation
had been regular and normal in amount up to seven
months before admission, since which time she has had
amenorrhoea.
On June 21st she was taken ill with shivering and was
found to have left basal pneumonia. The next day she
began to bleed from the uterus, and her medical atten-
dant sent for the assistance of the obstetric resident at
Gra/s Hospital. The cervix was dilated and a large
hydatid mole, together with a 5^ months dead, but fresh
fcetus, was cleared out of the uterine cavity. Dr Crofts'
the obstetric resident, gave the following description of
the uterine contents :
''There was a fcetus about the age of 5h months, born
dead, but m quite a fresh state and enclosed in the
amnion. That part of the placenta to which the cord
was attached appeared to be normal, but around the
periphery of this normal patch of placenta and all over
the general aspect of the chorion there was a marked
vesicular formation, which, taken as a whole, formed a
large vesicular mole. After clearing out, the uterine
cavity was found to be smooth but soft, and there was no
evidence in favour of twin pregnancy."
The dyspnoea and pyrexia "continued and the patient
was admitted into Guy's Hospital under the care of Dr.
Taylor. Empyema was diagnosed and drained The
temperature, however, rose at night for some weeks after
the operation, and Dr. Taylor thought that the pelvic
226 PRIMARY EMBOLIC CHORION-EPITHELIOMA OP VAGINA.
trouble might possibly be tlie cause of the continuous
pyrexia.
I saw the patient on July 20th, and found no evidence
of pelvic inflammation. There was a blood-stained dis-
charge of dark venous colour which the patient said had
been present since the miscarriage in June. The bleeding
was not profuse, nor did it increase on examination. The
uterus was soft and bulky, giving one the impression that
involution had been interfered with. The pyrexia had
existed for nearly a month and sub-involution was likely.
There was a soft single cyst high up in the left fornix of
the vagina of about the size of a big Tangerine orange,
and below, on the posterior wall of the vagina about two
inches from the vulva, was a small knob about the size of
a cob-nut. The upper soft cystic swelling seemed to be a
superficial vaginal cyst and was covered with unaltered
vasfinal mucous membrane. The lower swellino^ was soft
and looked bluish-purple beneath the vaginal mucous
membrane.
The question of chorion-epithelioma was raised, and
Dr. Taylor agreed to an exploration as soon as the con-
dition of the empyema would allow of it. At first the
patient did not progress very satisfactorily, owing to some
diflficult}^ in draining the pleural cavity, but the pelvic
condition became no worse. There was some slight
bleeding from the vagina during the next fortnight, and
the lower swelling increased a little in size ; the cyst
remained unaltered. On August 20th an anassthetic was
given, and the small tumour, which about doubled in size,
was removed from the vagina for examination. It was very
vascular and some lai'ge vessels in the perivaginal tissues had
to be underrun. The patient took the ansesthetic very badly.
The tumour when removed was about the size of a small
walnut, and when in situ formed a soft, well-defined swelling
placed deeply in the perivaginal tissues close against the
rectal wall, and covered on its vaginal aspect Avith normal
mucous membrane. The sections show the normal
squamous epithelium of the vagina supported by sub-
PRIMARY EMBOLIC CHORION-EPITHELIOMA OF VAGINA. 227
mucous tissue. In the deeper parts of the vaginal walls
are numerous spaces filled with a cellular growth. The
cells are of two distinct varieties. There are patches of
closely-packed cells ; each cell has a clearly defined
nucleus : these are Langhans' cells. Arranged around
each pack of Langhans' cells large quantities of syncy-
tium are seen. The syncytium is formed of large branch-
ing ribbons of multinuclear protoplasm staining deeply
with eosin. In many places the protoplasm has under-
gone vacuolation, and the characteristic oblong nuclei
of the syncytium are swollen and less deeply stained than
those seen in the syncytium which has not become vacuo-
lated.
Although as a rule the syncytium keeps to the periphery
of each pack of Langhans' cells, in many places small
pieces of irregular^ multinuclear protoplasm are mixed up
with the single nuclear cells. In the deeper parts of the
sections the growth is more abundant, and here it is em-
bedded in necrotic tissue and fibrin. There are no chorionic
villi to be seen in any of the sections, but it is quite
possible that degenerate villi may be hidden by the
ha3morrhage and necrosis, which occurs in large areas.
Many dilated venous spaces appear in the perivaginal
tissues^ and some of these are filled with masses of
syncytium ; the larger spaces contain small clumps of
Langhans' cells as well. It seems^ therefore, that the
growth spreads along the peri-vaginal venous spaces, and
the syncytium, as it were, pilots the Langhans' cells
along these paths.
September 2nd. — The patient seems very well. There
is no bleeding, and the uterus is of normal size. The
cyst in the left lateral fornix has disappeared spontaneously,
but there is a small dimple at its original site.
September 26th. — As far as clinical examination goes
the patient is quite free from growth.
October 24th. — Patient came to-day. There is no
evidence of any growth. She has had two normal
menstrual periods lasting four days on each occasion.
228 PRIMARY EMBOLIC CHORION-EPITHELIOMA OF VAGINA.
November 29tli. — Patient well and putting on weight.
There is no lia3morrhage other than a normal period, and
the local condition seems in every way satisfactory.
December 23rd. — Examination was again negative.
Further history of the case. — Vagina remained free
from growth until January 8th, 1907, when a small, soft,
but well-defined tumour, of about the size of a walnut,
was found in the lower part of the anterior vaginal wall.
In five days the tumour almost doubled in size, and it was
deemed necessary to remove it immediately.
The growth was situated deeply in the perivaginal
tissues at the vaginal outlet. In front it bulged towards
the vestibule to the right of the urethra, which was dis-
placed forwards and to the left. It was covered on its
vaginal aspect with normal rugose mucous membrane.
A transverse incision was made in front of the growth,
and the urethra Avas separated off as high as the base of
the bladder and upper limit of the tumour. The whole
width of the lower half of the anterior vaginal wall was
removed with the tumour. The growth was soft, friable,
and haemorrhagic. There was a thin, but definite capsule
on its deep aspect, but at the periphery outlying pockets
of growth could be seen in the perivaginal tissues,
especially on the right, and the vaginal wall was excised
freely in consequence of this infiltration. The cut edges
of the vagina and the urethra were brought into position
by catgut sutures. Six weeks later a soft perivaginal
swelling appeared higher up in front and on the left, which
seemed to have no connection Avitli the previous tumour,
and was covered with normal vaginal mucous membrane.
It was about the size of a walnut and was also removed,
but with considerable difficulty, owing to the close relation-
ship of the bladder and the brisk hgemorrhage Avhich
occurred at its removal.
Within three weeks another tumour appeared in the
postferior vaginal wall, below the site of the first tumour,
and the cyst, which had disappeared in August last,
refilled, and formed a soft swelling in the left lateral
PRIMARY EMBOLIC CHORION-EPITHELIOMA OP VAGINA. 229
fornix. The cyst and growth were removed on March
16th, 1907. Some thickening was noted in front beneath
the scars in the vaginal wall which was taken to be
cicatricial and inflammatory tissue, but in a few days soft
growth was found creeping forward along the vestibule to
the right of the urethra, and on further examination a
soft, diffuse infiltration was discovered in the perivaginal
tissues high up on the left in front. There was now no
definite tumour formation, but a soft growth spread along
the perivaginal tissues in a most insidious manner render-
ing further operation hopeless. Up to the middle of April
the patient^s general condition remained good, and previous
vaginal growths had given rise to no symptoms. The
growth now began to increase rapidly, running forward to
the clitoris, enlarging it to about the size of a walnut, and
the perivaginal tissues in front became boggy and swollen
by infiltrating growth. The patient did not waste much
but became very angemic, and complained of considerable
local pain. Menstruation Lad been regular up till February
last, since when there had been no loss of blood.
On April 19th hasmorrhage from the vagina set in for
the first time, and the growth was found to be fungating
through the vaginal mucous membrane on the left. The
patient went rapidly downhill, and signs of broncho-
pneumonia developed at the base of the i-ight lung, which
was taken to be due to pulmonary metastases, but there
was no hasmoptysis. The bleeding from the vagina
recurred several times, was never severe, and no doubt
much of the anaemia was due to hsemorrhage into the
growth itself.
The patient died on May 8th, 1907, eleven months
after the passage of the mole.
Report of the autopsy. — The body is not much wasted, but
very pale. There are no secondary deposits in any of
the organs except the right lung. The left lung is firmly
adherent to the parietal pleura, the adhesions being the
result of the old empyema. The left lung contains no
growth. This might be explained by the hampering
230 PKIMARY EMBOLIC CHOIMON-EPITHELIOMA OF VAGINA,
action of the pleural adhesions. In the right lung many-
small hfemorrhagic nodules are present, lying close
beneath the surface of the lung and confined to the lower
lobe. They vary in size between a bean and small nut.
Local condition. — The clitoris is the seat of a soft
haemorrhagic growth, about the size of a Tangerine
orange. Along the right side of the urethra, in the posi-
tion of the bulbous vestibuli, and to a lesser extent on the
left, soft friable growth is seen extending forw^ard from a
haemorrhagic mass in the i-ight anterior vaginal wall,
measuring 3^ x 4 in. in the vertical and transverse
diameter and 2\ in. in thickness. Higher up in the
vagina on the left is another large haemorrhagic mass
extending deeply into the cellular tissues between the
bladder and the vagina, measuring 4^ X 5 in. X 3 in. in
thickness.
The bladder and urethra were displaced forwards, but
are not infiltrated with growth, nor were their functions
interfered with during life. In three places the vaginal
mucous membrane has given way and haemorrhagic growth
is seen protruding through it. The uterus is enlarged
and its muscle soft, but neither the cervix nor the uterine
body show any sign of being, or having been, affected with
growth, and microscopical section of the muscle fails to show
any sign of new growth. The ovaries are small and contain
several small lutein cysts, and the microscopic sections show
a fairly large quantity of lutein tissue. These cells are,
however, situated mostly in close relation to the cyst walls,
and do not appear to disseminate widely into the ovarian
stroma proper. Both ureters are lifted up, and can be
seen running over the upper limit of the two vaginal
masses on their way to the bladder. The growth has not
infiltrated above the level of the ureters and the broad
ligaments are free from invasion. The inguinal, iliac,
and bronchial lymphatic glands contained no growth. At
each- of the later operations the uterine body was curetted,
but the microscopical sections failed to reveal the presence
of growth. The sections of all the tumours removed are
PRIMARY EMBOLIC CH0R10N-|:riTHEL10MA OF VAGINA. 231
alike in structure, aud are very typical examples of chorion-
epithelioma, the syncytium being greatly in excess. The
pulmonary nodules are very necrotic and hsemorrhagic,
but both varieties of cells can be seen in the sections.
Of course the greatest point of interest in this case lies
in the fact that although an intra-uterine vesicular mole
was expelled from the uterus this organ remained free from
growth, while the vagina became the seat of four separate
tumours, which appeared at diiferent times. There was
an interval of five months between the removal of the
first tumour and the appearance of the second. The
chorionic villi must have been lying latent in the peri-
vaginal tissues during this time. When they first
appeared each tumour formed a soft but well-defined
swelling in the perivaginal tissue, causing little or no local
disturbance, but as soon as recurrence and infiltration
began the rapid and treacherous manner in which the soft
growth spread in the perivaginal tissues was truly alarming.
Beyond a slight fulness the infiltration in its early stages
caused little superficial alteration either in the skin of
the vestibule or the mucous membrane of the vagina,
and it was extremely difficult to define the limits of the
affected areas until the growth had advanced considerably.
I think there can be no doubt that the growth spreads
along the perivaginal veins, because the sections taken
from the growing edges show growth creeping along the
vessels in the perivaginal tissues, and at the time of the
operations small pockets of cells were found in the
perivaginal tissues outside the definite limits of the edge
of the tumour, while the deeper portion of each tumour
had a definite capsule. I should think it was safe to
shell such tumours out of their bed when well encapsuled,
but the vaginal wall should be removed as widely as
possible at the periphery of the growth, in order to avoid
the outlying pockets in the perivaginal tissues. The
occurrence of these growths in the vagina after the
passage of the mole was so symptomless, and the infiltra-
tion so insidious, that I think a routine examination should
232 PRIMARY EMBOLIC CHORION-EPITHELIOMA OF VAGINA.
be made for some months after the passage of a mole in
every case.
With regard to the diagnosis there is no special
difficulty. In the early stages small, soft, perivaginal
tumours are liable to be overlooked, and in the later
stages the htemorrhagic infiltrating growth may simulate
haematoma. The history of a molar pregnancy and the
knowledge of the fact that these growths occur will leave
no doubt as to the nature of the case.
There are a considerable number of cases now recorded
of primary chorion-epithelioma occurring outside the
uterus, the uterus having escaped infection.
Two theories have been advanced as to the origin of
these tumours : one is that the chorionic villi migrate from
the uterus to some more or less remote part, and having
settled in the tissues the epithelium of the villi proliferates
to form a chorion-epithelioma ; the second theory is that
the intra-uterine mole is primarily malignant, but the
uterus expels it and escapes infection, the growths in
other organs being looked upon as metastases. Pick and
most authorities are in favour of the first of these theories,
and, indeed, it seems improbable that true malignant meta-
stases should form in other organs while the primary
growth is expelled from the uterus, leaving that organ free
from growth. Again, definite chorionic villi are shown in
the sections of the vaginal growths in many cases. The
myxomatous stroma of the villi with its epithelial coverings
is easily made out, which seems to suggest that the villus
has first migrated and that its epithelium proliferated to
form a groAvth which has the microscopic appearance of
chorion-epithelioma. Moreover, it is impossible to deter-
mine whether any given specimen of vesicular mole is
malignant or innocent when expelled from the uterus, and it
is difficult to imagine that a true malignant growth can escape
detection when searched for by competent pathologists.
Tliat the uterus may escape is shown in the following
cases : Marchaud records the case of a patient who died
with symptoms of cerebral tumour several months after
PRIMARY EMBOLIC CHORION-EPITHELIOMA OP VAGINA. 233
the removal of a hydatid mole. A large growth was
found in the right cerebral hemisphere and small nodules
in the lungs and kidneys. The uterus was free from
growth, the sections showing decidual remains only. There
was no vaginal growth.
A similar case is recorded by Busse, whose patient died
four months after an abortion^ uterus and vagina also
being free from growth.
Among the cases with vaginal growths, those of
Lindfors and Schmorl died, and at the autopsy no primary
growth was found in the uterine cavity in either case.
In four cases the uterus was removed during life, and
on examination no chorion -epithelioma was found. In two
cases chorionic villi with some proliferation of epithelium
were found in the uterine veins. In the remaining cases
curetting and clinical signs were relied upon to prove the
absence of a primary intra-uterine growth.
Looking at the microscopical descriptions and drawings
of the vaginal growths, we find that typical chorionic villi
were found in some parts of the nodule, while sections of
other parts showed great proliferation of the epithelium only.
I cannot detect any villous stroma in my sections ; the
growth seems to consist mainly of masses of proliferating
chorion-epithelium. In several of the recorded cases villi
were also found to be absent.
I think that the most important question which arises
is the degree of malignancy of these primary embolic
growths. Even primary uterine chorion-epithelioma,
which if not attacked early by operation is, as a rule, so
intensely malignant, sometimes behaves in a curiously
innocent manner. Noble records and gives drawings of
a case in which a great portion of a uterine chorion-
epithelioma had to be left behind because it was too
extensive for removal. The patient recovered and all
signs of the grov/th disappeared.
Secondary vaginal deposits have disappeared in the
same way after hysterectomy for primary uterine growth.
I have collected fourteen certain cases of primary
234 PEIMARY EMBOLIC CHOKION-EPITHELIOMA OF VAGINA.
vaginal growths of Avhom two died. One of them
(Schniorl) died eighteen weeks after a normal labour.
The second case (Lindfors) died nine months after a
normal labour and seven months after removal of the
vaginal nodule. In both cases secondary growths were
found in the lungs, kidney and liver, but the uterus
escaped. The other twelve cases lived, and at the time of
reporting were quite well. The nodules were removed in
all cases and a full microscopic description is given. In
the face of these results one wonders whether these
primary vaginal growths are not as a rule almost benign.
Judging from two cases recorded by Fleischmann and
Eiermann, where the vaginal growth appeared three and a
half and four years respectively after the passage of the
mole, it seems possible that migrated villi may lie dormant
for long periods before proliferation of the epithelium
occurs. It is necessary, therefore, to watch those cases
for a long time before giving a definite opinion as to the
possible occurrence of both primary and secondary
growths. That these tumours may bo very malignant is
shown in the cases of Lindfors and Schmorl and my own.
In the recorded cases of recovery the vaginal tumours
were simply excised, and no extensive local operations
were undertaken for their removal.
The growths under these circumstances can hardly be
very malignant. This question of malignancy becomes a
matter of great clinical importance, not only from the
point of view of prognosis but also from that of treat-
ment. If in any given case it can be proved that the
vaginal growth is primary the prognosis is probably good,
and hysterectomy need not be performed. If, on the
other hand, we are dealing with a vaginal nodule secon-
dary to an iutra-uterine growth, the prognosis is necessarily
bad, and the uterus must be removed at all costs. The
microscopical examination of the curettings, together with
the clinical signs and symptoms, should give reliable evi-
dence of the presence or absence of an intra-uterine growth.
Apparently the microscopical appearances of the struc-
i
PRIMARY EMBOLIC CHORION-EPITHELIOMA OF VAGINA. 235
ture of the growth does not help to decide the degree of
malignancy. As can be seen in the sections of this case
the structure of the growth is that of a typical chorion-
epithelioma. Perhaps the arrangement of the two
varieties of cells in relation to one another is more
regular than that seen in uterine growths, and syncytium
is present in larger quantities. In some of the recorded
cases typical villi with their stroma are described.
Whether the presence of these villi would help to differen-
tiate between primary and secondary vaginal growth is
an open question. The vaginal nodules most frequently
appear within two or three months after the passage of
the mole, but there are four cases recorded in which they
made their appearance while the mole was still in the
uterus, but, as has been said above, the interval may be as
long as four years. The cases which follow full-term
pregnancy seem to be more malignant than those follow-
ing moles or abortion.
With regard to the incidence of lutein tissue over-
growth in connection with primary extva-uterine chorion-
epithelioma, it is too early to give a definite opinion either
to the frequency or meaning of its occurrence until more
control work is done upon the subject of lutein tissue and
more notice is taken of the condition of the ovaries in
recording cases. In my case the ovaries are not enlarged,
but there is a considerable quantity of lutein tissue
present in the sections. The patches of lutein tissue are
mostly placed in close relation to the small blood cysts,
and there is no diffuse dissemination of lutein cells in the
ovarian stroma proper. Schickele, however, describes a
case (No. 14 in table) in which both ovaries were enlarged
to the size of the fist and contained black lutein cysts. The
uterus contained a vesicular mole, simultaneously with a
small vaginal nodule, which was removed. Hysterectomy
and ovariotomy were performed and the patient was well
six months after the operations.
There can be no doubt that trophoblastic cell prolifera-
tion is frequently associated with lutein overgrowth, but
236 PRIMAKY EMBOLIC CHORION- EPITHELIOMA OP VAGINA.
how the one is directly related to the other must be left
an open question until further work has been done upon
this most interesting subject.
It seems doubtful whether lutein overgrowth is as often
associated with primary extra-uterine chorion-epithelioma
as with intra-uterine chorion-epithelioma.
I have seen quite as much lutein tissue in two ovaries
not connected with a recent pregnancy as there is in the
ovaries in my case.
Conclusions.
(1) That these vaginal growths most often occur after
the passage of a vesicular mole, but, like intra-uterine
chorion-epithelioma, may follow abortion or full-term
pregnancy.
(2) That they may occur while the mole is still within
the uterine cavity.
(3) That they originate from the chorion-epithelium of
migratory embolic villi.
(4) That there is no evidence to show that a malignant
intra-uterine growth or a malignant mole can be expelled
from the uterus, leaving that organ free from growth and
be followed by metastases in other organs.
(5) That the growth spreads via the perivaginal venous
spaces.
(6) That there is no means of telling whether any given
mole will be followed by chorion-epithelioma.
(7) That the large quantities of syncytium seen in the
sections is very characteristic of the vaginal tumours.
I have tabulated shortly the recorded cases found in
the literature on this subject.
I have to thank Dr. Taylor for kindly allowing me to
make use of this case, and the Clinical Eesearch Association
for cutting the excellent sections of the tumours.
PRIMARY EMBOLIC CHORION-EPITHELIOMA OF VAGINA. 237
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VOL. XLIX.
17
240 PRIMAEY EMBOLIC CHORION-EPITHELIOMA OF VAGINA.
References.
Pick. — Yon der gut-und bosartigen Blasenmole. Berl.
klin. Wochenschr., 49 and 50, 1897 ; S. 1069 and 1097.
Pick. — Diskussion iiber Pick und Schmorl's Vortrage
auf der 69. Yersammlung deutscher Naturforscher und
Arzte zu Braunschweig. Centralbl. f. Gjnak., Nr. 40,
1897, S. 1217.
Pick. — Uber Metastasenbildung und Histologie der
gutartigen Blasenmole. Centralbl. f. Gynak., Nr. 40, 1897,
S. 1216.
ScHMORL. — Demonstration eines syncytialen Sclieiden-
tumors. Centralbl. f. Gynak., Nr. 40, 1897, S. 1217.
ScHLAGENHAUFER. — 2 Falle von Tumoren des Chorion-
epithcls. Wien. klin. Woclienschr., Nr. 18, 1899, S. 486.
von Guerard. — Ein selten schones Praparat von Deci-
duoma nialignnni der Cervix. Monatsschr. f. Geburtsh.
und Gynak., Bd. 10, 1899, S. 239.
ScHMiT. — Chorioepitheliale Geschwiilste der Vagina.
Wiener klin. Wochenschr., Nr. 14, 1901, S. 358.
LiNDFORS. — Zur Frage von Syncytioma malignum
vaginae post graviditatem ohne Geschwulstbildung im
Uterus (Upsala Lak Forh., Bd. 6, H, 4). Deutsches
Autoreferat in dem Centralbl. f. Gynak,, Bd. 25, Nr. 19,
1901, S. 501.
LiNDFORS. — Uber den weiteren Verlauf und den Ausgang
meines Falles von Syncytioma malignum vaginae nebst
Obductionsbefund. Centralbl. f. Gynak., Bd. 25, No. 21,
1901, S. 557.
Marchand. — iJber das maligne Chorionepitheliom nach
Mitteilung von 2 neuen Fallen. Zeitschr. f. Geb. u.
Gynak., Bd. 39, 1898, S. 173.
LiTTAUER. — Beitrag zur Frage der Malignitat des
Chorionepithels. Arch. f. Gynak., Bd. 72 (Festschrift
der-Gesellschaft), 1904, S. 295.
Zagorjanski-Kissel. — Uber das primare Chorioepi-
PRIMARY EMBOLIC CHORION-EPITHELIOMA OF VAGINA. 241
theliom ausserhalb des Bereiches der Eiansiedlung. Arch,
f. Gyniik., Bd. 67, Heft 2, 1902, S. 326.
PoTEN AND Vasmer. — Begixineiides Syncytiom mit Metas-
tasen, beobaclitet bei Blasenmolenscliwangerschaft. Arch,
f. Gynak., Bd. 61, Heft 2, 1900, S. 205.
Fleischmann. — Uber eine seltene, vom Typus abweich-
ende Form des Chorionepithelioms mit ungewohnlichem
Verlauf. Monats. f. Geburtsh. und Gynak., Bd. 17, 1903,
S. 415.
Eiermann. — Der gegenwartige Stand der Lehre vom
Deciduoma malignum. Grafe's Sammlung, Bd. 2, 1897.
Busse. — Diskussion iiber die Implantation des mensch-
lichen Eies. Greifswalder medizinischer Verein. Wiener
klin. Wochenschr., Bd. 15, Nr. 38, 1902, S. 1000.
Schickele. — Die Malignitat der Blasenmole. Arch. f.
Gynak., Bd. 78, Heft 1, 1906, S. 211.
242
A CASE OF CHORION-EPITHELIOMA COM-
PLICATED BY H^MATO-METRA.
BY
W. S. A. GrEIPFITH
AND
Herbert Williamson.
(Received April 11th, 1907.)
(With exhibition of the specimen, microscopic sections,
and a drawing.)
(With Plate XXIII.)
{Abstract.)
The case is recorded of a lady, 42 years of age, who was
delivered of a mole, probably hydatidiform, on December 30th,
1905.
The patient had borne four children, the last eight years pre-
viously ; her fifth pregnancy commenced in the early part of
June, 1905. From August to December she suffered from
numerous small vaginal haemorrhages; from November 17th
until December 29th she was under close observation, and, as no
increase in the size of the uterus occurred during this period, a
diagnosis of molar pregnancy was made, and abortion was
induced.
A mole was expelled which, in its general characters, re-
sembled a carneous mole, but upon the surface were a few
vesicles.
Three weeks later (January, 1906) the patient suffered from
persistent haemorrhage and the passage of clots ; the uterus was
explored, and a quantity of blood-clot and debris removed.
CHORION-EPITHELIOMA. 243
From this time the haemorrhage ceased excepting for the loss
of a small quantity of dark blood on February 16th, but the
uterus again enlarged, and pain was felt in the pelvis.
On March 3rd the uterus and ovaries were removed by the
abdominal route.
In November, 1906, the patient died with signs of new growth
in the lungs.
The uterine cavity was distended with fluid and clotted blood,
and the cervix completely occluded by blood-clot. A growth,
of the nature of a chorion-epithelioma, was found on the
anterior wall near the fundus, numerous lutein cysts were
present in both ovaries.
A description of the naked-eye and microscopical appear-
ances of the parts removed is given, and special attention is
drawn —
(1) To the excessive formation and wide distribution of lutein
tissues throughout the ovaries.
(2) To the support afforded by this specimen to the theory
that lutein cells may arise by modification of the
connective-tissue cells of the ovarian stroma.
(3) To the presence of a layer of necrosed tissue resem-
bHng Nitabuch's layer of canalised fibrin between the
uterine wall and tumour out-growths.
The patient from whom the specimen exhibited to-night
was removed was a lady, aged 42, who had borne four
children, the last in 1897.
Menstration commenced at the age of eleven ; the
periods were never quite regular, the intervals varying
from three to five weeks, and the bleeding was usually
profuse. In 1903, for a term of three months, menstru-
ation was suppressed ; there was no evidence of preg-
nancy, and at the end of this time the menstrual flow was
re-established and continued of the usual type until May,
1905. The last period commenced on May 20th and
ceased on May 25th, 1905 ; shortly after this pregnancy
ensued.
The pregnancy ran a course apparently normal until
August 9th ; on that date a blood-stained vaginal discharge
244 CHORION-EPITHELIOMA.
was noticed and at the same time aching pain was felt in
the pelvis over the whole area from pubes to sacrum.
Between August 9th and November 17th there were
numerous small haemorrhages, but the amount lost was
never sufficient to cause alarm.
On November 17th the patient's medical attendant, Dr.
Sharman, of Rickmansworth, brought her up to consult
Dr. Griffith. Although there had been a period of six
months' amenorrha?a, the top of the uterus was only six
inches above the pubes ; its characters, however, resembled
those found in a normal pregnancy. Dr. G-riffith
suspected that the embryo was dead, and advised a delay
of one month, and the termination of the pregnancy at
the end of that time if the uterus had not increased in
size.
The patient was seen again on December 15th, when
the following note was made : " The uterus presents no
change in size or characters, but behind it can be felt a
small tumour, probably the left ovary enlarged."
On December 29th Dr. Sharman induced abortion by
inserting a laminaria tent into the cervical canal, and on
the following day a mole w^as spontaneously expelled.
The mass presented the general characters of a carneous
mole, but Dr. Sharman noticed on the surface a few small
vesicles.
On January 2Sth, 1906, Dr. Griffith was again asked
to see the patient on account of persistent haemorrhage
and the passage of clots. The uterus was of almost the
same size as at his last examination, and the cervical
canal was patent, admitting the finger easily. Under
anaesthesia a large quantity of inoffensive blood-clot was
removed ; the uterus then contracted down well ; the
curette was introduced and " a considerable quantity of
decidua with adherent clot brought away.'^ Hasmorrhage
ceased and the patient's progress was regarded as satis-
factory until February 16th, when a small amount of
dark blood escaped ; after this date there was no further
bleeding, but aching pain in the epigastrium and hypo-
CHORION-EPITHELIOMA. 245
gastrium persisted^ and for this reason Dr. Griffith was
consulted again on February 28th. He found the uterus
as large as upon his first examination ; the fundus reached
to six inches above the pubes and the organ was unusually
broad from side to side. A diagnosis of chorion-epi-
thelioma was made ; but it was difficult to explain the fact
that for the last month there had been hsemorrhage on
one occasion only, and then slight in amount.
The patient was suffering from a troublesome cough,
and from pain in the right side of the thorax. On March
1st Dr. Garrod examined the chest, but could detect no
signs which led him to suspect the presence of new growth
in the lungs.
On March 3rd the operation of abdominal hysterectomy
was performed. When the abdomen was opened a
quantity of thin blood-stained fluid escaped ; this resembled
closely the fluid contained in the cysts of the ovaries. A
tumour which proved to be the uterus was seen rising out
of the pelvis ; its colour, size, and general characters
corresponded with those of the uterus at the end of the
fifth month of a normal gestation. The ovaries presented
a remarkable appearance : both were enlarged by the
presence of multiple cysts, and were of a curious dark
plum colour. The right was the larger of the two and
formed a tumour the size of a gooseys egg. The enlarge-
ment was due to the presence of a number of cysts, some
with serous contents, others filled with a deep red, jelly-
like material ; some of these cysts ruptured during the process
of removal. The left ovary was rather larger than a
billiard ball ; the cysts on its surface were smaller, but of
similar appearance. The uterus, together with the
uterine appendages, was removed, the vessels were
secured and the body amputated at the level of the
OS internum ; as soon as the cavity was cut across a
quantity of dark, semi-fluid blood escaped, the walls
shrinking and contracting down. The cervix was removed
separately ; a nodule was felt in the posterior vaginal
wall ; it was enucleated, but on investigation proved to be
246 CHORION-EPITHELIOMA.
a small cyst and contained no chorion-epitlieliomatous
tissue.
The patient made a good recovery : the convalescence
was interrupted by no untoward symptoms.
Immediately after removal the condition of the uterus
and cervix Avas investigated ; the cervical canal was
occluded by a quantity of coagulated blood ; a probe could
be passed without difficulty, but apparently the clot had
been sufficiently firm to prevent the escape of blood, and
to lead to distension of the cavity by haemorrhage from
the surface of the groAvth. As soon as free exit was
given the uterus contracted down, forcibly expelling a
large quantity of blood.
A puzzling feature in the clinical aspect of the case
had been the very rapid increase in size of the uterus
associated with cessation of vaginal heemorrhage. The
explanation was now quite clear ; coagulated blood had
completely occluded the cervical canal ; the haemorrhage,
previously external, had become converted into the con-
cealed variety and led to the formation of a hcemato-
metra.
We have read no account of the association of this con-
dition with chorion-epithelioma, and one of our reasons
for recording this case is to draw attention to the possibility
of such a complication. The rest of the history is soon
told. On August 18th, five months after the operation.
Dr. Sharman wrote as follows : " The condition is not
quite satisfactory, although Dr. Griffith, Dr. Garrod, and I
have been unable to find anything suggesting a recur-
rence. The patient has had a series of attacks of neuritis
and myalgia in different parts of the body, and especially
the chest, back and front, simulating pleurisy and pleuro-
dynia, at first accompanied by slight evening rise of
temperature. Recently she has been breathless with some
palpitation, but nothing definite to account for it.'^ A
fortnight later Dr. Garrod detected signs of new growth
in the lung. Death ensued in the latter half of November.
No 2^ost-mortem examination was performed.
DESCRIPTION OF PLATE XXIII,
Illustrating Dr. W. S. A. Griffith's anu Dr. Herbert
Williamson's specimen of A Case of Chorion-Epithelioma
complicated by Ha3mato-metra.
Plate XXIIl.
Obstet. Soc. Trans., V'ol. XLIX.
u
o
Q
Aiilajr/ &> Sim, /»i/»:
CHOEION- EPITHELIOMA. 247
Description of the Specimen.
After removal, fluid and clotted blood escaped and the
walls of the uterus contracted down, actively expelling
most of the clot. At the close of the operation the uterine
cavity was packed with cotton-wool soaked in a 10 per
cent, solution of formalin.
As seen at the present time the dimensions of the organ
are : Length, 8 in. ; transverse diameter at the level of the
point of entrance of the Fallopian tubes, 6^ in. ; circum-
ference at the same level, 15 in.
In appearance it resembles closel}^ a uterus enlarged by
pregnancy. The surface is smooth and peritoneum-clad
throughout the greater part of its extent; beneath the
peritoneum are numerous small dilated vessels ; the shape
is pyriform and the Fallopian tubes are attached 2
in. below the highest point of the fundus. The lower
part of the body is devoid of peritoneum on both its
anterior and posterior aspects ; from these areas the peri-
toneum has been stripped during the course of the opera-
tion. A short distance above the level of the os internum
amputation of the corpus uteri has been performed ; the
cervix was removed subsequently and the two parts have
now been stitched together as nearly as possible in their
natural position. The length of the cervix is Ij in, ;
its canal is patent, a large probe can be passed through
its whole extent. The condition of hsemato-metra did not
depend upon any structural change in the cervix, but
resulted from occlusion of the canal by blood-clot.
The posterior wall of the uterus has been removed by a
longitudinal coronal section. The cavity is greatly dilated,
the walls are thickened but unequally so, and measure | in.
in thickness at the fundus.
On the inner aspect of the anterior wall nearer to the
fundus than the cervix is an irregular area of ulceration
3 in. in length and 2 in. in breath, its long axis corre-
sponding roughly with that of the uterus. The edges
248 CHOEION-EPITHELIOMA.
of the ulcer are raised, hard, and everted ; the base is
depressed below the level of the surrounding tissues. The
ulcerated surface is covered by a number of papilla-like
projections, to which adhere portions of blood-clot and of
debris.
Nearer to the fundus, 1 in. above the upper margin
of the ulcer, are two patches of pale yellow material
resembling masses of coagulated lymph. Sections cut
through these show them to be composed of growth similar
to that which forms the floor of the ulcer.
The points of entrance of the Fallopian tubes are
situated 2 in. below the summit of the fundus. The
abdominal ostia are patent but deeply congested ; in other
respects the tubes appear to be healthy.. On the surface
of each are a number of small sessile subperitoneal cysts
(dilated lymphatics), and attached in the neighbourhood
of the infundibulum on the right side are three small
accessory tubes; two of these are fringed by miniature
fimbrias, the third is occluded at its distal extremity and
forms a small cyst (hydrosalpinx of an accessory Fallopian
tube).
Both ovaries are enlarged but have shrunken and under-
gone changes in the process of hardening. As seen imme-
diately after removal the right formed a tumour of the size
of a goose's egg, composed of a mass of thin-walled
translucent cysts; some of the cysts ruptured during
removal, their fluid contents escaping into the peritoneal
cavity. A section through the organ discloses three main
cavities filled with dark-red gelatinous material.
The left ovary is smaller — of the size of a golf ball ; its
deeply corrugated surface is raised here and there into
rounded eminences by the projection of small cysts. At
one spot on the peritoneal aspect was a small yellow plaque
measuring 1. in. in diameter and raised slightly above
the level of the surface ; this was removed for micro-
scopical examination and will be described subsequently.
On section the ovarian sti'oma is of an almost jelly-like
consistence and of a red colour.
CHOEION-EPITHELIOMA. 249
MiCEOscopicAL Examination.
Sections have been cut in such a manner as to include
the edge of the growth and a part of the adjacent uterine
wall. The growth is a typical chorion-epithelioma, com-
posed of Langhans' cells and syncytium. The fibro-mus-
cular stroma of the uterine wall is seen in part of the
section ; the tissues of which it is composed take the stain
badly, many of the nuclei are fragmentary and details of
a chromogen network cannot be determined. The fibrillte
of the muscle bundles can still be seen, but the outlines of
individual fibres are very indistinct.
The nearer Ave approach the edge of the growth the
more marked is the degeneration of the muscle, and
finally, when we reach the growing edge of the tumour
the maternal tissues are represented by an almost homo-
geneous fibrinous material comparable to Nitabuch's fibrin
layer. In it, however, we can still trace the remains of
degenerate nuclei, and scattered through it are a few
round cells, possibly of an inflammatory nature.
In the normal ovum the trophoblast exhibits destructive
properties, in virtue of which the highly differentiated
tissues of the decidua are, in its immediate neighbourhood,
reduced and converted into an almost structureless fibrin-
like mass ; the same destructive action is exhibited by the
tongue-like processes which form the vanguard of the
growth.
In a specimen of chorion-epithelioma (probably the
oldest in existence, for the patient died in the year 1872)
studied by Dr. Williamson and described in the ' Journal
of Obstetrics and Gyntecology of the British Empire,^
vol. iv, p. 306, he was able to demonstrate in the neigh-
bourhood of the tumour a number of blood-channels in
the uterine wall, and to show that around these blood-
spaces the cells which formed the outposts of the tumour
were grouped. This mode of invasion we cannot trace in
250 CHOKION-EPITHELIOMA.
the present case — we can find no constant relation between
uterine vessels and the tumour out-growths.
Cells of various forms are seen even in the deeper parts
of the uterine wall. Those of one variety are small and
possess a central vesicular nucleus surrounded by a scanty
cell substance which stains faintly with eosin. In others
the cell substance is granular and stains more deeply^ the
nuclei are denser and not clearly vesicular, in this respect
resembling the syncytium.
These various cellular elements are found in the tissues
at some considerable distance fi'om the tumour. The smaller
cells described first are most numerous ; in their characters
they differ markedly from the round cells so familiar to us
in inflammatory processes, and are evidently derivatives of
the fcetal epiblast. They are most numerous in the
neighbourhood of the vascular spaces, but are not confined
to these areas.
The tumour may be described as consisting of a sponge-
work of syncytium, the interstices of which are occupied
by large rounded or oval cells, each possessing a single
centrally-situated nucleus. Fi-om the growing edge
tongue-like processes project into the uterine stroma ; the
maternal tissues in the neighbourhood of these projections
have undergone necrosis ; they do not persist to form a
stroma for the tumour, but disappear completely, first
becoming converted into a structureless substance com-
parable to Nitabuch's layer of canalised fibrin. As the
result of the destructive action of the invading tissues
many of the processes are surrounded by spaces contain-
ing red blood-corpuscles ; it is from these vascular
channels that the growth derives its principal blood
supply.
Two distinct varieties of tissue can be recognised in
the tumour :
(1) Syncytium present in the form of irregular masses,
in the form of the so-called multi-nucleate giant-cells and
in the -form of ribbon-like strands so united as to consti-
tute a sponge-work. In the spaces of this sponge-work
CHORION-EPITHELIOMA.
251
are groups of tightly-packed cells. Between tlie masses
of syncytium on the one hand and the well-formed
discrete cells on the other all stages of gradation are
found. The protoplasm of the syncytium stains well
with eosin; it is finely granular, opaque and vacuolated.
The nuclei show no constant arrangement ; in some parts
they lie in rows, in others they are scattered irregularly
throughout the protoplasm ; in form and structure they
exhibit marked differences : some are small, round, darkly-
staining bodies, others are larger, vesicular, and possess a
distinct chromogen net-work.
(2) The Langhans' cells are rounded with a clearly
defined outline, the nuclei are large, centrally situated
and vesicular, the cell-substance is granular and vacuolated,
differing from the protoplasm of the syncytium in that it
exhibits a reteform structure and stains less deeply with
eosin.
The syncytium forms a sponge-work of interlacing
strands and in the interstices of this sponge-work lie
groups of Langhans' cells packed closely together.
Microscopical examination of the ovaries reveals :
(1) That the organs are unusually vascular.
(2) That lutein tissue is present in three situations :
(a) in the walls of the cysts ; (6) in the ovarian stroma ;
(c) on the surface of the ovary.
(3) That the stroma-cells have undetgone modifications.
The hlood-snpply of the organs is a rich one ; in addition
to well-formed vessels there are present vascular channels
possessing little more than an endothelial lining. The red,
jelly-like appearance of the ovaries is due to the presence
of blood extravasations into the oedematous stroma.
The lutein tissue. — The various cysts scattered through
the ovaries are lined by a pale yellow membrane com-
posed of lutein cells ; this membrane is thrown into wavy
folds. In most instances the lutein cells are in direct
contact with the cyst contents; occasionally a lining of
fibrinous, almost structureless, material lies within the
lutein layer. A stratum of similar material is constantly
252 CHORION-EPITHELIOMA.
to be seen in the normal corpus luteum separating the
lutein cells from the central blood-clot, and in our opinion
is to be regarded as the membrana propria of the normal
Griiffian follicle greatly hypertrophied.
The lutein tissue is formed of rounded and irregularly
shaped cells with opaque cell-substance and a centrally
situated vesicular nucleus. Karyokinetic figures are seen
in some of the nuclei and furnish evidence of rapid cell
proliferation ; such figures are rarely found in the mature
corpus luteum. Groups of lutein cells are scattered
through the stroma, and at one spot on the surface of the
left ovary a mass of the tissue projects.
We have already drawn attention to a small j-ellow
plaque -j in. in diameter attached to the surface of the
left ovary. The mass is composed of rounded cells
with a central vesicular nucleus and opaque cell-sub-
stance ; between the cells is a scanty intercellular
stroma. Three explanations of the origin of this group
of cells suggest themselves : (1) that we may have
here a " decidual nodule," one of those small masses
of decidual cells described originally by Schmorl and
Kinoshita, which are so often to be found scattered over
the peritoneum of the uterus, of Douglas's ml-de-sac, and
upon the surface of the ovaries in women dying soon
after child-birth ; (2) the nodule may represent a secon-
dary deposit of the growth ; (3) the nodule may be
composed of lutein tissue. The yellow colour of the
plaque and the characters of the cells have led us to
adopt the latter view. Dr. F. W. Andrewes and Dr.
Cuthbert Lockyer, who have been good enough to examine
the sections, agree with our conclusions.
The ovarian stroma has become modified; in many
parts it is oedematous and degenerate, the cells possess
oval or rod-shaped nuclei, and the elongated cell-processes
unite to form a network whose meshes are sometimes
occupied by red blood-corpuscles. In this degenerate
stroma are groups of lutein cells. In other places the
stroma-cells are no longer of the embryonic type, but are
CHORION-EPITHELIOMA. 253
oval or rounded, with large, clear, vesicular nuclei, some
of whicli show karyokinetic figures ; it is possible that
these may represent the earlier stages of the lutein cell,
but we possess no differential stain for lutein tissue and
therefore are not in a position to state with certainty
that these modified stroma-cells are of this nature.
In a paper read before the Obstetrical Society of
London in 1905 Dr. Cuthbert Lockyer accepted the theory
of migration of lutein cells ; there is available no positive
evidence in favour of the existence of such a phenomenon.
The origin of the lutein cell cannot be regarded as
definitely settled ; we, however, are firmly convinced that
it arises by modification of the cells of theca interna and
not from the membrana granulosa. The cells of the
theca interna are merely modified stroma cells, and we
find no difficulty whatever in believing that lutein tissue
may arise directly from the connective-tissue cells of the
ovarian stroma. The specimen before us furnishes no
clear proof of the truth of this theory, but the marked
modifications in the form of the stroma and the presence
of the groups of lutein cells scattered through it are very
suggestive.
The study of chorion-epithelioma is still in its infancy,
and it is important that every case presenting unusual
features in either its clinical or pathological aspect should
be reported. In its clinical aspect this jcase was unusual
in that a month before operation there was cessation of
vaginal hsemorrhage although the uterus continued to
enlarge.
In its pathological aspect it presents three points of
special interest :
First, in the excessive formation and wide distribution of
lutein tissue throughout the ovaries.
Secondly, in that it supports the theory that lutein cells
may arise by modification of the connective-tissue cells of
the ovarian stroma.
Thirdly, in the presence of a layer of necrosed tissue,
closely resembling Nitabuch's layer of canalised fibrin,
between the uterine wall and the tumour out-growths.
254 CHORION-EPITHELIOMA.
Dr. CuTHBERT LocKTER Congratulated Mr. Hicks and Dr.
Williamson upon their admirable reports of their two most
interesting cases. In respect of Mr. Hicks's case Dr. Lockyer
inquired if the uterine walls had been systematically examined
for areas of chorion-epithelioma ? In two cases recorded by him-
self, i. e. those of Mr. Malcolm and Dr. Oldfield, the uterine
infection might easily have been missed as tlie malignant foci
were very small and deeply seated in the utei-ine muscle ; indeed,
it was only after slicing the uterus — removed by Dr. Oldfield —
into many segments that the chorion-epitheliomatous area was
discovered. Dr. Lockyer was particularly interested in the
question of lutein excess in the ovaries in cases of vesicular mole
and chorion-epithelioma ; he had recorded four cases himself (for
one of which he was indebted to Dr. Herbert Williamson) in
Avhich there were compound lutein cystomata in association with
chorion-epithelioma, and it was with full reserve that Dr. Lockyer
drew the attention of this Society, in 1903 (four years ago), to
Pick's theory of a chorion-epitheliomatous reaction being due to
excess of lutein tissue. Dr. Lockyer pointed out then, and several
times subsequently, that this question will be settled only by the
accumulation of further cases, and in relation to this point it
interested liim to note that whilst Dr. Williamson's fresh speci-
men siipported Pick's theoiy, Mr. Hicks's i^ost-mortem material
did not. Hitherto tliere had been no case recorded where com-
pound lutein cysts liave accompanied normal gestation, whereas
whenever l)ilateral ovarian cysts have been found issociated witli
vesicular mole and chorion-epithelioma the former are always lined
by lutein tissue. As already recorded, in one of the cases of this
disease, published by Dr. Lockyer (Mr. Doran's case), there was
no lutein tissue to be found in either ovary, but the tissues were
removed post mortem after the fundus uteri had sloughed and
produced pmident peritonitis, consequently the material investi-
gated was open to criticism from a controversial point of view.
In Dr. Lockyer's opinion the interesting question of a causal
relationship existing between excess of lutein cells and chorionic
cell-proliferation still remains siih judice.
Mr. Targett thought that all cases of double lutein cystic
tumours of the ovaries should be carefully recorded. At an
operation for an ovarian cyst with pregnancy in the fourth
month he found the tumour consisted of multiple thin-walled
lutein cysts which partly ruptured on removal. Wlien the uterus
was turned aside the opposite ovary was seen to be in a similar
condition. Both tumours were removed. A fortnight later the
patient aborted ; the foetus was macerated, and the placenta was
partly composed of vesicular mole. Though the wound healed
naturally the patient remained in a weak, ancemic condition for
many weeks, but so far showed no signs of the development of
chorion-epithelioma. In view of such an occurrence he had
CHORION-EPITHELIOMA. 255
wondered whether it would not have been safer to have i*enioved
the uterus, seeing that both ovaries had been ah'eady excised.
Dr. Blacker thought these two cases of special interest,
because while one showed a definite excess of lutein tissue in
the ovary the other certainly did not. The case related by Mr.
Targett was a further proof of the now well-known fact that the
presence of a hydatidiform mole in the uterus was usually asso-
ciated with an excess of lutein tissue in the ovaries. To argue from
this, however, that the one condition depended on the other
seemed to him to be quite unwarranted. It was much more
likely that the two conditions were due to some common cause,
and this appeared the more probable when the changes which
took place were considered. In the case of the uterus there was
an excessive overgrowth cf a young and rapidly-growing tissue,
the trophoblast, with the subsequent formation of cysts, no
doubt due largely to serous transudation. In the ovary there
was also marked proliferation of a young tissue, that of the
corpus luteum, with the subsequent development of cysts no
doubt of similar origin. The close resemblance between the
changes occurring, on the one hand, in the uterus, and, on the other
hand, in the ovary, seemed to point to some common cause acting
on the two organs. If the theory that the corpus luteum pos-
sessed an internal secretion was accepted, then it was curious
that such a body derived, as it almost certainly was, from con-
nective tissue should have such a function. If this was so, then
it was unlike any other of the ductless glands in the body. Dr.
Williamson's sections from the ovaries in his case certainly favoured
the view that the cells of the corpus luteum were derived from
the stroma cells of the ovary and had a connective-tissue origin,
and the slides he had exhibited seemed to give considerable
support to the theory that the lutein cells found scattered
tlu-ovighout the stroma of the ovary really developed in situ, and
were not due to the migration of such cells from the neighboiuring
corpora lutea.
VOL. XLIX. 18
256
July 3rd, 1907.
Herbert R. Spemcek, M.D,, President, in the Chair.
Present — 29 Fellows and 6 visitors.
Books were presented by the Westminster Hospital
Staff, and Dr. Herman. ]3r. Boniiey presented a pair of
old forceps (in use prior to 1815 by Dr. William Ralfs)
with leather-covered handles.
The following gentlemen were elected Fellows of the
Society : Sorab Kaikhoshru Engineer, M.R.C.P.E.,
L.R.C.S.E., L.M.&S.Bomb., (Edinburgh) ; Manecxji
IMroshaw Kerrawalla, M.D.Brux., L.M.&S.Bomb. ;
Stanley Dodd, M.A., M.B., B.C.Cantab. ; and Somer-
ville Hastings, M.B., B.S.
Report of the Pathology Comvnttee on Dr. H. Briygfi's
Specimen of Ovarian Pregnancy (^ee p. 222) .
We have examined this specimen and the microscopic
sections taken from it, and find no certain evidence that
the imperforated ovum was developed in the ovary, and
consider that it may be a tubal abortion which has become
adherent to the ovary.
SUPPURATION IN AN OVARIAN CYST. 257
The folloiving report was made on Dr. Dauber's Speci-
men of Fihro-myomatous Uterus containing a Calcified
Fibroid lying free in the Uterine Cavity {see p. 139).
We have examined this specimen and the microscopic
sections taken from the uterus, and agree that the tumour
consists of several fibro-myomata, one of Avhich is calcified
and lies loose in a cavity, the walls of which are infiltrated
by glandular carcinoma. This cavity communicates
directly with the cervical canal and is probably the
cavity of the uterus.
The following report ivas made upon Mr. H. T. Eicks's
Specimen of Primary Vaginal Embolic Chorion-
epithelioma,
referred to the Pathology Commitee to ascertain if there
be chorion-epithelioma of the uterine body {see p. 224).
We have examined this specimen, and the microscopic
sections specially taken from the uterine wall, and find no
evidence of chorion-epithelioma of the body of the uterus.
{Signed) Alban Doran.
John H. Dauber.
H. T. Hicks.
CoRRiE Keep.
W. y. A. Griifith, Chairman.
SUPPURATION IN AN OVARIAN CYST CAUSED
BY THE BACILLUS TYPHOSUS.
By Frank E. Taylor, M.D., B.S., F.R.C.S.
The occurrence of suppuration in the contents of an
ovarian cyst is a well-recognised, though somewhat infre-
quent, complication of this neoplasm. Indeed, " at first
258 SUPPURATION IN AN OVARIAN CYST.
glance/^ as Bland-Sutton remarks, " it seems somewhat
difficult to understand how ovarian cysts should become
inflamed, enclosed as they are in air-tight cavities, and
having no communication with other organs." He further
states that " a little reflection soon reveals several sources
of infection. Of these the principal are : (1) The Fallopian
tube, (2) the intestine, (3) the vermiform appendix, and
(4) tapping."
Pfannensteil expresses the opinion that infection of
ovarian cysts usually comes from the tube or intestine, the
latter almost exclusively when the cyst is adherent to
bowel, or mere proximity suffices if this is damaged from
any cause, and that the infective agent is most seldom trans-
ported through the blood after systematic infectious diseases.
Olshausen also lays stress upon the frequency of intes-
tinal infection in suppuration of ovarian cystic neoplasms.
Menge, too, as the result of careful bacteriological
examination of many cases, believes that this is the usual
source of infection, adhesions between cyst and intestine
being almost always found. He does not, however, entirely
deny the possibility of infective micro-organisms being-
transmitted to the contents of new growths by the blood-
stream.
In one case Martin conclusively proved that infection
came directly from the intestine. A firm, flattish adhesion
from bowel to cyst was found permeated along its whole
length by Bacillus coli communis. The pyogenetic cocci
and B. coli communis are the most frequent pus-pro-
ducers in ovarian cysts. Infection with the B. tyjphosus
must necessarily be of rare occurrence, for it connotes the
occurrence of typhoid fever in a patient already possessing
an ovarian cyst. In what percentage of cases presenting
these coincident conditions ovarian cysts become infected
with the B. typhosus, and what percentage of those so
infected suppurate, we have no means of knowing.
The following case, for the clinical history of which I
am indebted to Mr. H. Speirs, house-surgeon, presents a
typical example of this condition :
SUPPUEATION IN AN OVARIAN CYST. 259
R. E. S — , IV-para^ a widow^ aged 37, was admitted
into the Chelsea Hospital for Women under the care of
Mr. J. Bland-Sutton on April 25th, 1907. She had lived
in India for the last fifteen years, and except for occasional
mild febrile attacks, which she took to be ague, and for
which she took quinine, had enjoyed good health until
April, 1906. She then had an attack of fever accompanied
by acute abdominal pain and severe diarrhoea, for which
she was admitted into the Campbellpur Hospital, India,
where she remained until August, 1906. This illness was
diagnosed and treated as typhoid fever.
Prior to the onset of this illness the patient had been
unaware of the presence of an abdominal tumour. The
menstrual function has varied considerably, having some-
times been excessive, but since the commencement of the
attack of typhoid fever in Aj)ril, 1906, there has been
complete amenorrhoea. During convalescence, Avhen the
patient had become very emaciated, her doctors discovered
a small lump in the abdomen. The tumour was extremely
mobile and free from pain and tenderness. Since then it
had gradually increased in size until her admission into
Chelsea Hospital for Women. There have never been any
symptoms referable to the tumour apart from its size and
presence. Since the attack of typhoid the patient has
been quite free from febrile attacks and has gained in
weight.
On examination the abdomen was found to be occupied
by a large tumour rising from the pelvis up to the umbilicus
mesially and to the costal margins laterally. Fluctuation
and a fluid thrill were readily obtainable. It was dull on
percussion, but a resonant colonic note was observed on the
left side, but not on the right.
Bimanual examination showed the uterus to be normal
and distinct from the tumour, which lay quite above the
fundus uteri. The diagnosis of ovarian cystoma was made.
Coeliotomy through a medium subumbilical incision was
performed on April 27th by Mr. Bland-Sutton. A large,
congested, plum-coloured, cystic swelling presented, its
260 SUPPURATION IN AN OVARIAN CYST.
anterior surface being covered like a veil by a thin sheet
of omentum, which was extensively adherent to it. There
were no other adhesions. The appearance of the tumour
suggested an ovarian cyst with twisted pedicle. It was
found to be a cyst of the left ovary, but there was no
torsion of the pedicle. It was removed entire without
difficulty. The abdomen was closed in three layers with-
out drainage. An ideal recovery followed ; the wound
healed by primary union ; the temperature never rose
above 99° F., and the patient was discharged from hospital
in excellent health on June 13th.
The structures removed consisted of the left appendages.
The Fallopian tube and mesosalpinx were somewhat
stretched and elongated, but were otherwise normal. The
ovary was replaced by a unilocular cystic tumour, about the
size of a man\s head, with some ragged omental adhesions
attached to its surface. On incision a uniform greenish-
yellow purulent fluid, free from odour, escaped, to the
amount of two-and-a-half pints.
The cyst wall was about ^ in. in thickness, and its
internal surface was rough, dark red, and necrotic-looking.
Microscopic examination showed it to consist of two layers,
an outer layer composed of fibrous tissue infiltrated Avith
small round cells, and an inner layer of diffusely-staining
necrotic tissue. Epithelial elements were wanting. No
micro-organisms could be discovered.
The purulent contents were examined microscopically in
films stained by L6ffler\s methylene blue. They con-
sisted of granular detritus in which were a few de-
generated leucocytes. No bacteria could be observed in
the films.
Cultures were at once made on agar slopes, and these
were incubated at 37° C. A sparse grey growth slowly
developed, there being very slight growth at the end of
forty-eight hours. This was found to consist of delicate
slender rods, with slightly rounded ends, which were not
very actively motile, non-spore bearing, stained readily
with the ordinary aniline dyes, and were Gram-negative.
SUPPURATION IN AN OVARIAN CYST. 261
In sub-cultures on the various media motility became very
active and typical typhoid bacilli.
The following sub-cultures were made, with the results
as stated : —
Agar streak. — Thin, translucent, shiny, spreading greyish
growths.
Gelatine streak. — Grey, glistening growth with irregular
borders, no liquefaction.
Gelatine stab. — Grrowth in depth, no liquefaction.
Potato. — White, almost invisible growth, no discolouration
of the potato.
Broth. — Growth with uniform turbidity.
Glucose agar sfah. — Growth along stab, no production of
gas.
Neutral red broth. — No change.
Litmus milk. — No coagulation, slight permanent acidity.
Lactose peptone water. — No change.
Dulcite peptone icater. — No change.
Glucose peptone water. — Acid, no gas.
Mannite peptone tcater. — Acid, no gas.
Durham's peptone icater. — No indol production.
Conradi-Drigalski plates. — Blue growth, no reddening
of medium.
Capaldi-Proskauer Medium No. I. — No growth or change
in reaction,
Capaldi-Proskauer Medium No. II. — Growth with
markedly acid reaction.
All these culture-reactions are typical of the B. typhosus
and serve to differentiate it from allied members of the
typhoid-coli group.
Agglutination tests, which are specific for the jB. typhosus,
^yeve then undertaken as follows :
A rabbit received injections of typhoid bacilli at inter-
vals until its serum would agglutinate the B. typhosus in
dilutions of 1 : 4000. This serum was also found to
agglutinate the bacilli obtained from the ovarian cyst in
dilutions of 1 : 4000. As a control, the agglutinating
power of normal rabbits^ serum was tested, and was found
262 SUPPURATION IN AN OVAEIAN CYST.
positive in dilutions of 1 : 200 but negative in dilutions of
1 : 400, i. e. to dilutions ten times stronger than that of the
treated animal producing agglutination.
Widal's reaction with the patient's serum and the typhoid
bacillus was performed : agglutination was extremely well
marked in dilutions of 1 : 100, and present, though less
perfect, in dilutions of 1 : 1000 with the time limit of one
hour.
Pfeiffer's phenomenon, i. e. the production of bacterio-
lysis in the peritoneal cavity of a guinea pig, injected
with the bacilli and with the serum of an immunised
animal, could not be obtained. This was due to want of
virulence of the bacilli, as control animals, i. e. guinea pigs
injected with the bacilli and with normal rabbits' serum,
were unaffected. For the production of this phenomenon
the use of virulent bacilli is essential, otherwise the bacilli
are destroyed in the guinea pig's peritoneal cavity.
Pfeiffer's phenomenon could, however, have been produced
in an indirect manner, even with this avirulent strain, if it
were employed for the preparation of an immune serum,
and the serum so obtained were tested along with a known
^^rulent culture of typhoid bacilli. The performance of
this indirect method Avas deemed to be unnecessary.
In this case, then, a bacillus was obtained in pure
culture from the pus of a suppurating ovarian cyst twelve
months after an attack of typhoid fever. This bacillus
has been definitely proved from a comprehensive study
of its morphological, tinctorial, cultural, and serum-aggluti-
nating properties, to be the B. typhosus. Further, the
febrile illness from which the patient suffered last year
has been definitely proved by the agglutinating powers of
her serum with typhoid bacilli to have been typhoid fever.
I consider, however, that as the bacillus isolated from
the cyst-contents was not pathogenic to guinea pigs, at
first grew feebly and slowly on agar, and at first possessed
feeble motility, and was present in such scanty numbers
that i^t could not be observed in the pus, it had almost
lost its vitality in the pus (pus possessing well-marked
SUPPURATION IN AN OVARIAN CYST. 263
bactericidal properties), and if the cyst had been allowed
to remain for some time longer its contents would have
become sterile.
It has long been a recognised clinical fact that suppu-
ration occasionally occurs in ovarian cysts after an attack
of typhoid fever, but the first to obtain typhoid-like
bacilli from the purulent contents was Worth, in 1898,
and since then eleven more cases have been recorded.
At this date, however, the methods of identifying the
JB. typhosus were unsatisfactory, and were not sufficient to
differentiate the various members of the typhoid-coli
group of bacilli. It was not until the discovery of the
specific agglutinins that the £. typhosus could be
identified with certainty, and Wallgren, in 1899, seems
to have been the first to apply sero-diagnostic methods
to the bacilli so obtained.
The difficulty of diagnosing typhoid fever from clinical
signs and symptoms is well known, and this disease has
been so closely simulated by suppurating ovarian cysts
that it has been diagnosed when this condition existed,
and the patient has been treated for typhoid fever until
the (possibly accidental) discovery of the tumour has
corrected the diagnosis. In some of the earlier recorded
cases, prior to the application of bacteriological methods,
it may have been the illness preceding the removal of a
suppurating ovarian cyst may have been of this nature
and not typhoid fever at all. Nowadays, by the applica-
tion of modern clinical methods it would be easy to
differentiate between these two conditions. Typhoid
fever would give a fall of leucocytes [i. e. leucopenia)
on blood examination, a positive diazo-reaction in the
urine, a positive Widal reaction with the patient^s scrum,
and the B. typhosus could be cultivated from the blood,
whereas in a suppurative inflammation in an ovarian cyst
there would be a rise in the number of leucocytes in the
blood [i. e. leucocytosis), a negative diazo-reaction in the
urine and a negative WidaFs reaction.
A case recorded by Lewis and Le Conte shows the
264 SUPPUEATION IN AN OVAEIAN CYST.
value of a blood examination in these conditions. A
patient with an ovarian cyst developed typhoid fever, and
this was accompanied by a lencopenia. Suppuration then
occurred in the cyst and a leucocytosis was noted. The cyst
was then tapped vaginally, reinfection from the cut surface
resulted in a relapse, and a loucopenia again resulted.
Two points of interest are suggested by a consideration
of my case, viz. : (1) Infection of the cyst contents by
means of the blood-steam ; and (2) the production of pus
by a pure typhoid infection.
In the absence of bowel adhesions the bacilli must have
been carried to the cyst by means of the blood-stream.
That typhoid bacilli may enter the circulating blood has
been proved by the employment of improved culture
media; thus Castellani obtained typhoid bacilli from the
blood by culture in twelve out of fourteen cases. On this
ground the metastatic transference of the bacilli to various
regions and organs of the body, and the occuri'ence
therein of post-typhoid suppuration is not difficult to
explain. Such suppuration has been observed, not only
in ovarian cysts, but also in the lungs, lymph-glands,
diaphragm, the salivary glands, the testis, the thyroid, the
gall-bladder, the joints, and with greatest frequency of all
in the bones as a suppurative periostitis. As regards the
production of pus by a pure typhoid infection, it was long
denied, especially by Baumgarten and Fraenkel, that the
B. typhosus was possessed of pyogenetic properties, and
that when such occurred a mixed infection was present,
suppuration being caused by the other organisms present;
or that the pus-producing organisms had been over-grown
by the B. tyj^hosus. The incorrectness of this view was
settled b}'- Kruse, who collected in Fliigge's ' Handbook '
a large series of experimental observations, by himself and
others, which have conclusively proved the possession of
pyogenetic properties by the B. typhosus.
From the bacteriological standpoint, post-typhoid sup-
puration, both in ovarian cysts and in other regions of the
body, thi'ee varieties may occur :
SUPPURATION IN AN OVARIAN CYST. 265
(1) A mixed infection, where both pyogenetic cocci and
B. typhosus are present.
(2) A secondary infection caused by invasion with pyo-
genetic cocci of the organ whose resisting power has been
lessened as the result of typhoid fever.
(3) A pure infection, caused by the B. typhosus, which
undoubtedly possesses pyogenetic properties under suitable
conditions.
The case I have just recorded provides a typical example
of the last-named variety.
The President said the Society was indebted to the author
for the very complete account and scientific investigation of this
case. He quite agreed with his opinion that most cases described
as typhoid fever complicated by ovarian tumom-s were really
suppurating ovarian tumoiu's, and that the " typhoid " fever was
due to the suppuration. He had seen a few cases of that kind.
He had, however, removed a suppurating ovarian tumour from a
patient who was suffering from typhoid fever in the opinion of
a distinguished physician. He asked Dr. Taylor whether Widal's
reaction was considered positive proof of the presence of typhoid
fever ; he knew that physicians did not regard it as such a few
years ago. He was surprised to hear that the Bacillus typhosus
could survive in ovarian fluid for twelve months, for ovarian
fluid seemed to have some influence in delaying the action of
putrefactive organisms.
Dr. C. Nepean Longeidge, referring to the latency of typhoid
bacilli in the body, said that pure cultures of typhoid bacilli had
been grown from the gall-bladder two or three years after the
original attack, and he believed he was right in saying that
cultures had been obtained from the interior of gall-stones. The
question of leucopenia was one of great interest and imj^ortance,
since the leucopenia could be demonstrated before a Widal's
reaction could be obtained, and thus assist in the early diagnosis
of typhoid fever. He remembered two cases, in one of which
bronchitis and in the other periostitis had given rise to a leucocy-
tosis in cases of typhoid, but he could not say that these compli-
cations were not due to a secondaiy infection.
Mr. Alban Doean referred to his case of perforating ulcers
of the ileum from obstruction after ovariotomy, published in the
thirtieth volume of the ' Transactions of the Pathological Society.'
A young woman, when under treatment for a condition diagnosed
as typhoid fever, was examined and an abdominal tumour was
discovered. Five weeks later a suppurating multilocular ovarian
cyst was removed. There was evidence of recent peritonitis.
266 UTERI WITH '' PUNDAL LIGAMENT " AFTER HYSTEROPEXY.
The patient died on the twelfth day. A coil of ilevim was found
obstructed by adhesions and twisted, and nearly a foot above it
was a perforating ulcer, with several others, less advanced, in its
neighbourhood. Dr. Goodhart failed to find any trace of ulcera-
tion in Peyer's patches.
Dr. Taylor said he was interested to hear the President's
experience of cases where suppurating ovarian cysts had closely
simulated typhoid fever, as he himself had no experience of such
cases, having based the remarks in his paper on this condition on
descriptions he had come across in reading the lit/erature of this
subject. As regards the value of Widal's reaction in diagnosis,
miich depended upon the technique of its performance, especially
with regard to the dilution and time limit employed. The re-
action was of extremely great value and assistance, but, like all
things human, was not absolutely infallible. Under certain con-
ditions a negative reaction might be obtained in cases of true
typhoid fever, whereas a positive I'eaction might also be obtained
lender other conditions. It was also interesting to observe that
in typhoid fever the reaction might be intermittent and present
one day and absent the next, so that a single negative reaction
was of little value. The President's suggestion of the possible
antiseptic properties of ovarian cyst fluids was new to him. In
reply to Dr. Longridge, he remarked that typhoid cholecystitis
occasionally causes tlie formation of gall-stones in which typhoid
bacilli have been found many years after typhoid fever. The
case of Drs. LeAvis and Le Conte, already quoted, went to show
that suppuration caused by a pure typhoid infection may give
rise to a leucocytosis, their results and those obtained by Dr.
Longridge in cases of suppurative typhoid periostitis being quite
in accord. Dr. Taylor confessed that he was unaware of Mr.
Doran's interesting case, as he had only looked up the literature
since the emplo3Tnent of bacteriological methods in these cases.
It Avas impossible to express an opinion on the nature of Mr.
Doran's case in the absence of any bacteriological examination,
which, however, would have been of little value in 1879, as our
knowledge of Bacillus typhosus was then very imperfect.
TWO UTERI WITH " FUNDAL LIGAMENT "
AFTER HYSTEROPEXY.
Shown by Dr. Frank E. Taylor.
CjkSE 1. — E. C — , single, aged 29, was admitted to
Chelsea Hospital for Women on November 25th, 1905,
UTEKI WITH " FUNDAL LIGAMENT " AFTER HYSTEROPEXY. 267
under the care of Dr. W. H. Fenton. She complained of
dysmenorrhoea so severe as to cause vomiting, menstrua-
tion being irregular, the loss being excessive and accom-
panied by clots ; there was also some vaginal discharge.
Menstruation had commenced at the age of twenty
and was always painful, irregular and variable in
amount from the commencement. The patient had had
gastric ulcer seven years and pleurisy two years previously
respectively.
She was an in-patient in the Women^s Hospital, Bir-
mingham, in May, 1905, where an operation said to be
curettage was performed. No improvement followed,
patient being unable to move about during menstruation
on account of severe abdominal pain.
A satisfactory pelvic examination was only possible
under ether, and this was made by Dr. Berkeley on
December 12th, 1905, when the uterus was found to be
retroflexed. Dr. Fenton performed hysteropexy on
December 8th, a satisfactory recovery followed, and the
patient was discharged on January 2nd, 1906.
Again there was no improvement, and in addition to
dysmenorrhoea patient was never free from a constant
gnawing pain in the left iliac region. The patient
accordingly went into the Radcliffe Infirmary, Oxford,
where she remained without any definite benefit for three
months. No surgical treatment seems _ to have been
undertaken there.
She returned to Chelsea for hysterectomy in March,
1907, and on March 15th supra-vaginal hysterectomy was
performed by Dr. Fenton. There was a good recovery
and patient left the hospital on April 2nd, quite relieved
of all her symptoms.
The specimen consists of the body of the uterus, slightly
uniformly enlarged, from the anterior surface of which
near the fundus springs a " fundal ligament " 1 in.
broad and 1^ in. in length.
Case 2. — E. J — , married, aged 38, was admitted into
268 UTERI WITH " FUNDAL LIGAMENT " AFTER HYSTEROPEXY.
Chelsea Hospital for Women on June 21st, 1907, nnder
Mr. Bland-Sutton's care, complaining of painful and exces-
sive menstruation. She had had two children eighteen
and a half and seventeen and a half years ago respectively
and one miscarriage fourteen years ago. Left salpingo-
oophorectomy and ventro-fixation of the uterus were per-
formed in the Middlesex Hospital in 1896. Since then
the catamenia have been very irregular or have occurred
every fortnight, lasting seven days, the loss being very
profuse and always accompanied by very severe pain.
Abdominal hysterectomy and right salpingo-oophorec-
tomy were performed on June 24th by Mr. Bland-
Sutton.
The removed uterus was slightly and uniformly en-
larged, the tip of the cervix being absent. It measured
3 in. in length and weighed 3^ oz. Attached to the
antei'ior wall just below the fundus is a " f undal ligament"
2\ in. in length and a little thicker than a goose-quill.
The ajDpendages removed showed slight chronic inflam-
matory changes, the tube and ovary being adherent to
each other, but the abdominal ostium of the tube was
patent and the ovary contained a recent corpus luteum.
The dangers of intestinal obstruction over a band caused
by such a fundal ligament is self-evident.
Dr. Drummond Eobinson remarked that a sm-gical colleague
of his had recently operated on a woman, on whom h3^steropexy
had some time pi-eviously been performed, because she had de-
veloped symptoms of acute intestinal obstruction. It was found
that a fibrous band, similar to those shown by Dr. Taylor, extended
from the fundus uteri to the abdominal scar, and in this the small
intestine had become entangled.
Mrs. Boyd asked whether the patients had been pregnant after
the suspension. Pregnancy, by dragging on and stretching of
adhesion of uterus to peritoneum of anterior abdominal Avail,
might result in the formation of such bauds. She was accustomed
to teach that methods of suspension that allowed free play for
the uterus were good for pregnancy but bad for the chances of
intestinal obstruction.
Dr. Lewees said that he generally had adopted Kelly's method
of suspending the uterus, stitching it to the peritoneum and sub-
peritoneal tissue of the abdominal wall only. The result of that
HJCMOEKHAGE IN UTEKINE FIBROID. 269
operation was to produce a band of adhesions similar to that
shown in Dr. Taylor's specimen. He had not so far met with
any bad result from the presence of such a band.
Mr. Alban Doban could readily understand hoAV obstruction
occurred after hysteropexy. In the course of an operation of
that class he had witnessed the slipping of a loop of intestine
into the space betAveen the parietes and the uterus, below the
lowest uterine suture. In order to avoid such an accident Mr.
Doran always passed a suture through the fold of peritoneum on
the inner side of each roimd ligament, fixing the two folds to
the parietal peritoneum close under the lowest uterine suture.
Dr. Taylor, in reply to Mrs. Boyd, said that neither of these
patients had been pregnant since the hysteropexy had been per-
formed. In reply to Dr Williamson he stated that he had no
definite information as to the method of performing the hystero-
pexy which had been employed in these two cases. In the first
case the method Avas probably the one employed by Dr. Fenton,
in which the peritoneum is sewn to a broad surface on the
anterior abdominal wall, as far removed from the fundus as pos-
sible. In the second case the operation had been performed in
another hospital. In Mr. Targett's cases, where Csesarian section
was necessary, no f undal ligament seems to have been present ; the
difiiculty residted from too extensive and unyielding fixation of
the uterus to the anterior abdominal wall. Dr. Taylor considered
Mr. Targett's opinion, that the normal Fallopian tube is as likely
to cause mtestinal obstruction as a fundal ligament, to be quite
erroneous. The two conditions were not parallel. A fundal
ligament forms a narrow band stretching unsupported across
the peritoneal cavity with tAvo fixed ends — one attached to the
abdominal wall, the other to the anterior aspect of the uterus,
whereas the Fallopian tube merely occupies the edge of a broad
sheet of tissue — the broad ligament — which prevents any possible
chance of bowel slipping beneath the Fallopian tube and so
becoming obstructed. Dr. Taylor also noted that Mr. Doran
fully recognised the possibility of the formation of a fundal
ligament after hysteropexy and its dangers, and A\'as pleased to
learn Mr. Doran's method of obliterating the space beneath the
attachment of the uterus to the abdominal wall, and so obviating
the possibility of subsequent intestinal obstruction.
HEMORRHAGE IN UTERINE FIBROID.
Shown by J. H. Takqett, M.S.
270 SKELETON OF EXTEA-UTERINE FCETUS.
MALIGNANT DISEASE OF CERVIX IN ONE-
HORNED UTERUS.
Shown by Miss Aldeich-Blake.
Miss Aldrich-Blake showed a uterus and appendages.
Right horn of uterus undeveloped; cervix affected by-
malignant disease ; tubes and ovaries of normal size, the
fimbriated ends of both tubes occluded. Removed from a
woman aged 32, who had been married fifteen years ;
had had one child prematurely at eight months; no other
pregnancy. The periods had begun at sixteen and been
regular, scanty, and painless.
SKELETON OF BXTRA-UT BRINE FCETUS.
Shown by Miss Axdrich-Blake.
Miss Aldeicii-Blake showed the skeleton of an extra-
uterine foetus, found lightly attached to the upper aspect
of the right tube about f in. from its fimbriated end. All
soft parts and all trace of sac or clot had been completely
absorbed. The head is missing, the remainder has shrunk
together into a small, rounded mass. Judging from the
amount of ossification rather than the size. Miss Aldrich-
Blake took it to be of between three and four months'
development. It was removed from a woman, aged 30,
who had been married ten years and had one child seven
years before the operation. There was no history of a
previous illness typical of extra-uterine gestation ; the
pregnancy seven years ago had been a normal one. An
attack of " slight peritonitis " unassociated with amenor-
rhcEa a few months after marriage marked the most pro-
bable date of the occurrence.
The President asked on what grounds the foetus was said to
be of three and a half to four months' development. The speci-
men, which consisted of a shrivelled foetus minus its head,
FIBROID ASSOCIATED WITH BLEEDING AFTER MENOPAUSE. 271
appeared to be about i in. in diameter, and the length of its
spine not more than l in. He did not think it could be of
much more than two months' development. It must be
remembered that an intra-uterine foetus of three and a half to
four months' development would measure 5 in. or 6 in. in length.
He did not think it possible that the small body shown could
represent a foetus of that length. He paid more attention to the
size of the foetus than to the degree of development of the orifice
centres, having shown many years ago how much the time of
appearance of the centres of ossification in the head of the
humerus differed from that given in the text-books of anatomy.
Dr. Lewees said that in the course of an operation for removing
a recent tubal gestation on the left side, he had found a spherical
body of the size of a large cherry attached to the right tube
among a mass of adhesions. This proved to be a foetus, and in
spite of its small size Mr. Keith, who had kindly examined the
specimen, considered it represented a foetus of between three and
four months' development.
TWO SPECIMENS OF FIBROID ASSOCIATED
WITH BLEEDING AFTER THE MENOPAUSE.
Shown by Dr. Lewers.
(1) A SECTION under the microscope of a fibroid polypus,
the size of a walnut, removed from a patient, aged 72.
A fortnight before the patient was seen she had had
some vaginal bleeding, having previously had no loss of
blood since the menopause, which occurred at about the age
of fifty. It was interesting to find that she had had a fibroid
polypus removed when she was about forty-five. On the
occurrence of the bleeding, of course, some suspicion was
raised that a malignant growth might be present, but
fortunately the result of the microscopical examination
was to show that the growth was entirely benign.
(2) A specimen of a uterus enlarged by fibroids
removed by abdominal hysterectomy from a single woman,
aged 67. The " tumour " corresponded to the size of the
pregnant uterus at the seventh month. The patient had
been known to have fibroids for at least thirty years.
VOL. XLIX, 19
272 CALCIFIED UTERINE FIBliO-MYOMA.
The menopause liad occurred, and for about uine or ten
years afterwards the patient had no symptoms at all.
Within the last three years the patient had had more
or less vaginal bleeding, at first intermittent, and after-
wards continuous and rather profuse. On examination
the specimen was seen to consist of the uterus much
enlarged by several fibroids ; one large fibroid, partly
cervical, was undergoing hyaline degeneration ; but at the
very highest part of the endometrium there was a patch
of soft growth the size of a shilling, which on micro-
scopical examination was found to be adeno-carcinoma. The
patient made an uneventful recovery after the operation,
and so far has remained well. Owing to the size of the
tumour and the great length of the, uterine cavity it
would have been practically impossible to obtain a portion
of the patch in question for examination before deciding
on hysterectomy.
CALCIFIED UTERINE FIBRO-MYOMA REMOVED
PIECEMEAL FOR HEMORRHAGE FOURTEEN
YEARS AFTER OOPHORECTOMY.
Shown by Dr. Herbert Spencer.
The tumour, of the size of a small lemon, weighing
5 oz., was removed on May 24th of this year, on
account of haemorrhage of two months' duration, probably
caused by the friction of the hard calcified lower portion
of the tumour on the endometrium, which was atrophied,
as shown by microscopic examination of portions removed
with the curette. The cervix was dilated by a laminaria
tent and the tumour found to be sessile, and the lower
end of it, which was about as big as a walnut, was of
stony hardness and irregular on the surface. The tumour
was removed piecemeal by a many-toothed volsella after
it had been enucleated from its bed with the finger. The
calcification rendered the morcellement difficult; in such
SPECIMEN OF DIAPHRAGMATIC HERNIA. 273
a case a lithotrite would probably be useful. The patient
made a painless and afebrile recovery.
The case was interesting on account of the fact that he
had performed bilateral oophorectomy on the patient in
August, 1893, on account of profound anaemia due to
haemorrhage produced by the fibro-myoma. The uterus at
that time was of the size of a large foetal head. The
uterus soon shrank to half its former bulk and all haemor-
rhage ceased after the operation. The symptoms of the
climacteric set in soon after the oophorectomy, but gave
little trouble, the patient having been in perfect health for
nearly fourteen years when the heemorrhage occurred. The
result of the oophorectomy had been very satisfactory,
but the sequel showed that it would have been better to
have removed the tumour, leaving the ovaries.
Dr. Hetwood Smith asked the President whether, in the case
he had just narrated, he had observed the size of the uterus
greatly diminished and to what, after so many years, he attri-
buted the recurrence of the gro-vsi:h and hsemorrhage.
A SPECIMEN OF DIAPHRAGMATIC HERNIA IN
A NEW-BORN BABY.
Shown by C. Nepean Longridge, M.D.
The stomach, small intestine and spleen were in the
left pleural cavity. The heart was pushed over to the
right side. The infant died about half an hour after
birth and was full time.
Mr. Eabdley Holland said that he had seen two cases of
congenital diaphragmatic hernia, which were of especial interest
because m both cases the children had survived birth for a con-
siderable length of time, though it would seem hardly possible
that an infant with such a serious malformation could exist
The first child was aged 4 months, and was admitted in a
comatose and cyanosed condition. A diagnosis of thrombosis
ot the central sinuses was hazarded. The child survived twelve
hours, and the true state of affairs was revealed bv a post-mortem
274 MYXOMATOUS FIBROID.
examination. The whole of the intestinal tract, with the excep-
tion of the stomach, the first part of the duodenum, and the
descending colon, occupied the right pleural cavity. The duo-
denum had a long mesentery. Distension of the intestmes with
gas, and the consequent embarrassment of the heart and left lung
had evidently been the cause of death. A short time afterwards
another child, aged 2 months, was admitted with signs of broncho-
pnemnonia in the left lung. Over the right side of the chest the
physical signs were vague ; there were areas of hyper-resonance
and other areas of duluess. The child survived three days. In
spite of the fact that this case was under observation for three
days, and was examined by excellent clinicians, who had the
former case fresh in their memories, it was never suspected that
the case was one of diaphragmatic hernia. A post-mortem exami-
nation revealed an exactly similar condition as in the former case.
These cases show that the diagnosis of such a condition during
life must be exceptionally difficult.
The President recalled four cases of congenital diaphragmatic
hernia he had shown to the Society with remarks on the dia-
gnosis of the condition (vol. xxxii, p. 132 ; vol. xxxiii, p. 84).
MAMMARY GLAND OF NP^W-BORN INFANT.
Shown by C. Nepean LongeidgE; M.D.
The heart of a full-time male infant. The breast was
enlarged and full of cystic spaces. Several drawings
illustrating the development of the infantile breast were
shown at the same time.
MYXOMATOUS FIBROID.
Shown by Mrs. Schaklieb^ M.D., M.S.
Mrs. L. D — , aged 26 ; married three years ; has never
been pregnant. First seen April 30th^ 1907. Periods
regular, last four to five days, flow moderate, no pain ;
bowels regular ; appetite good ; digestion good. Has
noticed some enlargement of the abdomen during the last
few months, but no symptoms whatever.
MYXOMATOUS PIBKOID. 275
On exaviination the abdomen was filled with a large
uniform tumour which yielded a sense of free fluctuation.
Diagnosis : ovarian cyst.
Operation, May 8th, 1907, under CHCI3. On open-
ing the abdomen a very pale tumour presented in the
wound ; it appeared to be a cyst and it Avas thought that
it was retro-peritoneal owing to the colour of its capsule.
It was, however, found that although the trocar entered
readily no fluid was tapped. The abdominal wound was
therefore enlarged and the abdomen thoroughly explored.
It was perfectly evident that the tumour, whatever its
nature, was behind the peritoneum, but layer after layer
of capsule was cut and stripped back without being able
to free the mass. Finally, when it was turned out it was
found that the intestines had been pushed away in every
dn-ection and that they were in no case adherent to the
tumour. The lymphatics in both broad ligaments were so
distended that they resembled large bunches of white
grapes. Both ovaries and tubes were diseased and were
removed with the tumour.
The mass was sent to Dr. Cuthbert Lockyer, who kindly
furnished the following description :
Macroscopical Repoet.
The specimen consists of the entire uterus (except per-
haps a thin shaving of the portio-vaginalis cervicis), the
appendages and a large uniformly soft growth attached to
the whole length of the anterior wall of the corpus uteri.
The uterus measures 4^ in. in length. It is a narrow,
thin, atropic organ. Its mucosa is pale and atrophied,'
the bulk of the cavity being lined by a smooth, thin,
yellowish-grey membrane.
For examination it has been opened along the whole
of its posterior free surface.
The Fallopian tubes are thinned out and stretched,
measuring 6 in. each in length. The meso-salpinges are
not opened up by the growth. The ovaries are enlarged
276 MYXOMATOUS FIBROID.
and flattened; the right measures 2| in. along its attached
border and l^ in. in vertical measurement ; the left
measures 3 in. along its attachment and 1^ in. in the
vertical. On section both organs have a pale fibrous
appearance, and are very cedematous ; no recent corpora
lutea are present, but small corpora albicantia are seen.
The right round ligament is very thin; it measures
5 in. in length; its terminal end is lost in a peritoneal
flap investing the top of the large growth. The loft
round ligament has been cut off 2 in. from the left cornu
uteri.
The tumour. — This growth is a flabby, spherical mass,
which sinks down and flattens out considerably by its own
weight when placed on a hard surface. Its circumference
measures 42 in. and it is 15 in. in its maximum dia-
meter, whilst its vertical height is 6 in. ; its weight is
23 1 lb. A shallow sulcus divides it into two portions,
and in this groove lies the uterus, whilst the appendages
pass out across the lobes on either side. Of the two
lobes the larger lies to the right and the smaller to the
left of the uterus. It has no connection whatever with
the cervix, nor with the posterior uterine wall, but it is
intimately connected with the front of the body of the
uterus ; therefore with the uterus placed in the vertical
the entire tumour lies in front of it.
The bulk of the growth presents a raw uncovered sur-
face, but the peritoneum of the fundus uteri and of the
appendages passes off on to the left lobe, covering its
upper part and also to a lesser extent over a part of the
right and larger lobe. The tumour looks as if it had
been very largely extra- or retro-peritoneal, but it had
not opened up the mesosalpinx on either side nor yet
the meso-ovarium.
The tumour cuts with a pale, glistening, cedematous sur-
face, which everywhere excludes a pale fluid^ but no
definite cysts are seen.
Histological.— The muscle has undergone myxomatous
change, and has extensively disappeared, so that in sec-
MEETING OP COUNCIL. 277
tions stained by Van Gieson's method the bulk of what
remains is fibrous tissue-bundles, the intervening muscle
being either wanting or too degenerate to take on the
yellow stain.
MEETING OF COUNCIL.
A meeting of Council was held on July 19th, 1907, at
which a letter from the Secretary of the Royal Society
of Medicine (Mr. MacAlister) was read, dated June 13th,
1907, addressed to the Secretary and Librarian (Miss
Hannam) stating that, as the Royal Society of Medicine
could not advantageously make use of part only of her
time — the conditions being such that the whole time of all
the officers and servants of the Society would be required —
it was decided to adopt the proposal of the Obstetrical
Society, and to grant her a pension of £65 a year to begin
as from 1st October next.
This pension is in lieu of the honorarium of £300 voted
by the Council and reported to the General Meeting on
April 3rd, 1907 (see p. 136).
278
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6
INDEX.
PAOB
Address (Annual) of the President {W.'R.T>akiu,'M..'D.) . QS
(Inaugural) of the new President (H. R. Spencer, M,D.) . 117
Adeno-carcinoma of the ovary (F. N. Boyd) . . 50
After-history of the case of fibroid of broad ligament asso-
ciated with an ovarian cyst reported in the forty-third
volume of the Society's ' Transactions ' (A. Doran) . 94
Aldrich-Blake (Louisa B.)j malignant disease of cervix in
one-horned uterus (shown) .... 270
skeleton of extra-uterine foetus (shown) . . 270
Anderson (L. Garrett), Remarks in discussion on H. R.
Andrews's two cases of pi-egnancy in a rudimentary
uterine horn ..... 214
Andrews (H. R.), supposed sarcoma of the cervix (shown) . 137
two cases of pregnancy in a rudimentary uterine horn . 209
MemarJts in discussion on W. F. Shaw's paper on the
pathology of chronic metritis . . .42
Baby, new-born, diaphragmatic hernia in (C. N. Longridge) . 273
Bacillus typhosus, suppuration in an ovarian cyst caused by
(F. E. Taylor) . . . . .257
Beckett-Overy (H.), BemarTcs in discussion on A. Doran's
paper on malignant vaginal polypus secondary to an
adrenal tumour of the kidney . , . 205
Blacker (G. F.), chorionepithelioma of the uterus; lutein
cysts in both ovaries .... 104
Bemarhs in reply ..... 104
suppurating fibroid tumour of the uterus (shown) . 100
BemarJcs in reply . . . . .114
■ ill discussion on W. S. A. Griffith and H.
Williamson's paper on chorionepithelioma complicated
by hsematometra ..... 254
VOL. XLIX. 20
280
INDEX.
Bladder, intva-peritoneal rupture of, occurring during labour
(C. R. Porter) ....
Bland-Sutton (J.), villous tumour of tlie body of the uterus
in a woman aged 84; vaginal liysterectomy ; recovery
uterus four years after Oaesareau section (shown)
Report of Committee
Bleeding after the menopause, fibroid associated with
(A. H. N. Lewers) ....
Boyd (F. N.), adeno-carcinoma of the ovary (shown)
pregnancy in the right cornu of a fibroid uterus (shown)
Bemarlcs in discussion on J. D. Malcolm's paper on the
advisability of removing the cervix in performing hys-
terectomy for fibro-myomatous uterine tumours
in discussion on F. E. Taylor's specimen of uteri
with " fundal ligament " after hysteropexy
BEiaas (Henry), ovarian pregnancy (shown)
early tubal mole (shown) . . . .
fibroid tissue formed around a needle and removed from
the left labium majus (shown)
Broad ligament, fibroid of, after-history (A. Doran)
170
46
174
93
271
50
49
165
268
ooo
223
223
94
Csesarean section, uterus four years after (J. Bland-Sutton) .
Cancer of the cervix, supposed recurrence after vaginal hys-
terectomy for (C. Hubert Roberts)
two specimens from cases of, the patients remaining free
from recurrence twenty and eleven years respectively
after operation (A. H. N. Lewers)
Champneys (F. H.), vote of thanks to President .
Chorio-endothelioma of uterus ; intra-peritoneal hemor-
rhage ; hysterectomy ; death (G. B. Ferguson) .
Chorionepitlielioma of the uterus; lutein cysts in both ovaries
(G. F. Blacker) .....
complicated by haematometra (W. S. A. Griffith and H.
Williamson) .....
primary embolic, of the vagina (H. T. Hicks) .
OuLLiNGWORTH (C. J.), Remarks in discussion on Amand
Routh's specimen of fibroid of uterus with a sarcoma-
tous nodule in the centre ....
• Remarhs in discussion on A. Donald's paper on chronic
septic infection of the uterus and its appendages
— :r- in discussion on W. P. Shaw's paper on the
pathology of chronic metritis
174
114
179
133
57
104
242
224
18
41
INDEX.
(i?. ±j. iaylor) . ^
281
PAGE
257
41
139
141
97
182
206
Dakin (W. R.), BemarTcs in discussion on W. F. Sbaw's paper
on the pathology of chronic metritis
Dauber (J H.), fibro-myomatous uterus with a calcified
nbroid lying free in its cavity
Remarks in reply .
Donald (Archibald), chronic septic infection of the uterus
and its appendages .
DORAN (Alban), after-hiatory of the case of fibroid' of broad
ligament associated with an ovarian cyst, reported in the
torty-third volume of the Society's ' Transactions ' 94
MemarJes in reply . , ' ^
malignant vaginal polypus secondary to an adrenal
tumour of the kidney
BemarTcs in reply . .
— in discussion on 0. Lockyer's specimen of bilateral
primary tuberculous salpingitis with secondary infection
of the perivascular lymphatics of the uterine wall ui
--i",.5«<^^fs^o^ on J. D. Malcolm's paper on the
advisability of removing the cervix in performing hyg.
terectomy for fibro-myomatous uterine tumours 165
m discussion on P. E. Taylor's case of suppuration
m an ovarian cyst caused by the Bacillus typhosus 265
~Z,'f discussion on T. E. Taylor's specimen of uteri
with fundal ligament "after hysteropexy . . 269
Eden (T. W.), BemarTcs in discussion on C. Lockyer's speci-
men of bilateral primary tuberculous salpingitis with
secondary infection of the perivascular lymphatics of the
uterine wall
■ .■ . • ' ■ .146
— m discussion on J. D. Malcolm's paper on the
advisability of removing the cervix in performing hys-
terectomy for fibro-myomatous uterine tumours ififi
ElecUonofnev,FeUou,s . . 1,45,93,169,256
Perguson (G. Bagot), chorio-endothelioma of uterus; intra-
peritoneal haemorrhage; hysterectomy; death 57
Fibro-myoma uteri; suppuration in, following premature
delivery, treated by abdominal hysterectomy (W. W. H.
• • • . . 54
282 INDEX.
PAaB
Fibro-myoma, calcified uterine, removed piecemeal for hcemor-
rbage fourteen years after oophorectomy (H. R. Spencer) 272
Foetus, extra-uterine, skeleton of (L. B. Aldi-ich-Blake) . 270
Gland, mammary, of new-born infant (C. N. Longridge) . 273
Gray (Ax'cbibald M. H.), Remarks in discussion on C. N.
Longridge's specimen of dilated ureters in stillborn
infants ...... 215
Griffith (W. S. A.), and Herbert Williamson, chorion-
epithelioma complicated by haematometra . . 242
Remarhs in discussion on J. Bland-Sutton's specimen of
a uterus four years after Ca^sarean section . . 179
Haematometra, chorionepithelioma complicated by (W. S. A.
Griffith and H. Williamson) . . . .241
Haemoi'rhage fourteen years after oophorectomy, calcified
uterine fibro-myoma removed piecemeal for (H. R.
Spencer) . . . . . .272
intra-peritoneal ; chorio-endothelioma of uterus, hys-
terectomy ; death (G. B. Ferguson ) . . .57
in uterine fibroid (J. H. Targett) . . .269
Hannam (Miss), honorarium to, voted . . . 136
pension voted in lieu of honorarium . . . 277
Heart, rupture of, in a stillborn infant (C. N. Longridge) . 214
Herman (G. Ernest), BemarJes in discussion on F. N. Boyd's
specimen of pregnancy in the right cornu of a fibroid
uterus . . . . . .50
in discussion on G. F. Blacker's specimen of sup-
purating fibroid tumour of uterus . . . 103
Hernia, diaphragmatic, in a new-born baby (0. N. Longridge) 273
Hicks (Henry Thomas), primary embolic chorionepithelioma
of the vagina ..... 224
Holland (Eardley), Remarhs in discussion on C. N. Long-
ridge's specimen of diaphragmatic hernia in a new-born
baby . . . . . .273
Honorarium to Miss Hannam, voted . . . 136
cancelled by pension .... 277
HoRROCKS (Peter), Remarks in diseussion on A. Doran's after-
history of a case of fibi'oid of broad ligament associated
with an ovarian cyst, reported in the forty-third volume
of the Society's ' Transactions ' . . .97
^ — — - in discussion on G. F. Blacker's specimen of sup-
purating fibroid tumour of uterus . . . 103
INDEX. 283
PAQB
Hysterectomy for fibromyomatous uterine tumours, advisa-
bility of removing the cervix in performing (J. D.
Malcolm) ...... 148
vaginal, for cancer of the cervix, supposed recurrence
after (C. Hubert Roberts) . . . .114
for villous tumour of tbe body of the uterus in a
woman, aged 84 ; recovery (J. Bland-Sutton) . . 46
Hysteropexy, two uteri with " fundal ligament " after (F. E.
Taylor) . . . . , .266
Infants, dilated ureters in stillborn (C. N. Longridge) . 215
Infant, new-born, mammary gland of (C. N. Longridge) . 274
Infection, chronic septic, of the uterus and its appendages
(A. Donald) . . . , . G
Kidney, adrenal tumour of, to which a malignant vaginal
polypus was secondary (A. Doran) . . . 182
Labium majus, fibroid tissue formed around a needle and
removed from the left (H. Briggs) . . . 223
Lewers (A. H. N.), two specimens from cases of cancer of
the cervix, the patients remaining free from recurrence
twenty and eleven years respectively after operation . 179
two specimens of fibroid associated with bleeding after
the menopause (shown) .... 271
Bemarhs in discussion on A. Doran's after-history of the
case of fibroid of broad ligament associated with an
ovarian cyst, reported in the forty-third volume of the
Society's 'Transactions' . . . .96
in discussion on J. Bland-Sutton's specimen of a
uterus four years after Cesarean section . . 178
in discussion on F. E. Taylor's specimen of uteri
with " fundal ligament " after hysteropexy . . 268
in discussion on L. B. Aldrich-Blake's specimen of
skeleton of extra-iiterine foetus . . . 271
Ligament, fundal, two uteri with, after hysteropexy (F. E.
Taylor) ...... 266
List of Ofiicers and Council for 1907 for the Section of
Obstetrics and Gynaecology .... 136
LocKYER (0.)j bilateral primary tuberculous salpingitis with
secondary infection of the perivascular lymphatics of the
uterine wall ..... 141
BeynarJcs in reply ..... 141
284
INDEX.
PAOB
LocKTER (C). BemnrTcs in discussion on Amaud Routli's
specimen of fibroid of uterus with a sarcomatous nodule
in the centre . . . . .4
in discussion on W. F. Shaw's paper on the patho-
logy of chronic metritis . . . .42
in discussion on J. Bland-Sutton's specimen of a
villous tumour of the body of the uterus in a woman,
aged 84 . . . . . .49
in discussion on H. R. Andrews's specimen of
supposed sarcoma of the cervix . . . 139
in discussion on J. H. Dauber's specimen of fibro-
myomatous uterus with a calcified fibroid lying free in its
cavity ...... 141
in discussion on A. Doran's paper on a malignant
vaginal polypus secondary to an adrenal tumour of the
kidney . . . . . .205
in discission on W. S. A. Griffith and H. William-
son's i)aper on chorionepitbelioma complicated by
haematometra ..... 353
Report on Amand Routh's specimen of fibro-myoma
uteri, showing invasion by a mixed-celled sarcoma in
which multi-nucleated giant cells predominate . . 3
LoNGRiDGE (C. Nepean), impture of the heart in a stillborn
infant (shown) ..... 214
dilated ureters in stillborn infants (shown) . . 215
diaphragmatic hernia in a new-born baby (shown) . 273
mammary gland of new-born infant (shown) . . 274
Bemarhs in discussion on F. E. Taylor's case of suppu-
ration in an ovarian cyst caused by the Bacillus typhosus 265
Malcolm (J. D.), on the advisability of removing the cervix
in performing hysterectomy for fibro-myomatous uterine
tumours ...... 148
BemarTxs in reply ..... 167
in discussion on G. F. Blacker's specimen of
suppurating fibroid tumour of uterus . . 104
in discussion on C. Lockyer's specimen of bilateral
primary tuberculous salpingitis with secondary infection
of the perivascular lymphatics of the uterine wall . 141
Mammary gland of new-born infant (C. N. Longridge) . 273
Menopause, fibroid associated with bleeding after the
(A. H. N. Lewers) . . . . .271
INDEX. 285
PA&B
Metritis, pathology of chronic (W. F. Shaw) . . 19
MiLLiGAN (Wyndham Anstruther), Remarks in discnssion on
J. Bland-Sutton's specimen of a villous tumour of the
body of the uterus in a woman aged 84 . . 48
Mole, early tubal (H. Briggs) .... 223
Wodule, saixomatous, in the centre of a fibroid of uterus (A.
Routh) . . . . . .1
Obstetrics and Gynaicology, Section of, of the Royal Society
of Medicine ..... 136
Oophorectomy, calcified uterine fibro-myoma removed piece-
meal for haemorrhage fourteen years after (H. R. Spencer) 272
Ovaries, lutein cysts in both, in chorionepithelioma of the
uterus (G. F. Blacker) . . . .104
Ovary, adeno-carcinoma of (F. N. Boyd) . . .50
Ovum, entire full-time, in twins (R, Wise) . . 147
Papilloma, inoperable, of the left ovary (Amand Routli) . 216
Parturition at term, in co-existing tubal and uterine pi'eg-
nancy ; abdominal section (W. W. H. Tate) . . 61
Parturition, intva-peritoneal rupture of bladder occurring
during (C. R. Porter) . . . .170
premature, suppuration in fibro-myoma uteri following,
treated by abdominal hysterectomy (W. W. H. Tate) . 54
Pathology of chronic metritis (W. F. Shaw) . . 19
Pelvis, organs of, in a case where inoperable papilloma of the
left ovary had been found seven years previously (A.
Routh) . . . . . .216
Pension to Miss Hannam .... 277
Perithelioma of the uterus (G. F. Darwall Smith) . . 97
Polypus, malignant vaginal, secondary to an adrenal tumour
of the kidney (A. Doran) .... 182
POETER (Charles R.) (introduced by Dr. Russell Andrews),
intra-peritoneal rupture of the bladder occurring during
labour . . . . . .170
Pregnancy, co-existing tubal and uterine ; abdominal section ;
subsequent delivery at term (W. W. H. Tate) . . 51
in a rudimentary uterine horn (H. R. Andrews) . 209
in the right cornu of a fibroid uterus (F. N. Boyd) . 49
ovarian (H. Briggs) .... 222
286 INDEX.
PAGE
Beport of the Council ..... 135
of the Honorary Librarian (Dr. W. J. Gow) . . 64
{audited) of the Treasurer (Dr. G. Ernest Herman) 62, 63
of the Pathology Committee on Amand Boath's specimen
of a fihro-myoma of the uterus loith a sarcomatous nodule
in the centre (see p. 1) . . . .45
on Bland- Sutton's specimen of a villous tuviour of
litems from a patient aged S4- (see p. 16) . . 93
on G. F. Darwall Smith's specimen of perithelioma
of the uterus {see p. 97) .... 136
on H. Bussell Andrews's specimen of supposed sar-
coma of cervix {seep, IZl) .... 169
on May Thome's specimen of ute^'us shoiving malig-
nant villous tumour and a fibroid undergoing sarcomatous
change {see p. 181) ..... 207
on Alban Doran's specimen of a malignant vaginal
polypus secondary to an adrenal tumour {see p. 182) . 208
on H. Briggs' 8 specimen of ovarian pregnancy . 256
on J. H. Dauber's specimen of fibro-myomatous uterus
containing a calcified fibroid lying free in the uterine
cavity ...... 257
— — on H. T. HicJcs's specimen of primary vaginal embolic
chorion epithelioma ..... 257
Roberts (C. Hubert), supposed recurrence after vaginal
hysterectomy for cancer of the cei'vix . . 114
Robinson (G. Drummond), Bemarks in discussion on F. E.
Taylor's specimen of uteri with " fundal ligament " after
hysteropexy ..... 268
RouTH (Amand), fibroid of iitevus with a sarcomatous nodule
in the centre (shown) . . . .1
pelvic organs of a case where inoperable papilloma of
the left ovary had been found seven years previously
(shown) . . . . . .216
BemarJcs in discussion on W. F. Shaw's paper on the
pathology of chronic metritis . . .41
in discussion on J. Bland- Sutton's specimen of a
villous tumour of the body of the uterus in a woman,
aged 84 . . . . . .48
in discussion on F. N. Boyd's specimen of preg-
nancy in the right eornii of a fibroid uterus . . 50
in discussion on G. F. Blacker's case of chorion-
epithelioma of the uterus ; lutein cysts in both ovaries . 113
INDEX. 287
PAGE
RouTH (Amand), ItemarTcs in discussion on J. D. Malcolm's
paper on the advisability of removing the cervix in per-
foi*ming hysterectomy for fibro-myomatous ntei'ine
tumours ...... 165
in discussion on J. Bland-Sutton's specimen of a
\iterus four years after Csesarean section . . 178
Rupture of the heart in a still-born infant (C. N. Longridge) 214
Salpingitis, bilateral primary tuberculous, with secondary
infection of the perivascular lymphatics of the uterine
wall (C. Lockyer) . . . . .141
Sarcoma, supposed of the cervix (H. R. Andrews) . . 137
SCHARLIEB (Mary A. D.), myxomatous fibroid (shown) . 274
Shaw (William F.), pathology of chronic metritis . . 19
Skeleton of extra-uterine foetus (L. B. Aldrich-Blake) . 270
Smith (G. F. Darwali), perithelioma of the uterus (shown) . 97
Bemarhs in reply ..... 100
Report of Committee .... 136
Smith (Hey wood), Remarks in discussion on J. Bland-Sutton's
specimen of a viterus four years after Cassarean section . 178
in discussion on H. R. Spencer's specimen of calci-
fied uterine fibro-myoma removed piecemeal for haemor-
rhage fourteen years after oophorectomy . . 272
Spencer (H. R.), Inaugural Address as President . . 117
myomatous uterus weighing over seven pounds removed
from a woman aged 22 . . . . 219
— — calcified uterine fibro-myoma removed piecemeal for
hsemori'hage fourteen years after oophorectomy . 272
■ Remarks in discussion on A. Doran's after-history of the
case of fibroid of broad ligament associated with an
ovarian cyst, reported in the forty-third volume of the
Society's ' Transactions ' . . . .96
in discussion on G. F. Blacker's specimen of sup-
purating fibroid tumour of uterus . . . 103
in discussion on G. F. Blacker's case of chorion-
epithelioma of the uterus ; lutein cysts in both ovaries . 113
in discussion on H. R. Andrews's specimen of sup-
posed sarcoma of the cervix .... 139
in discussion on J. H. Dfuber's specimen of fibro-
myomatous uterus with a calcified fibroid lying free in its
cavity ...... 141
288 INDEX.
PAflB
Spencer (H. R.), Remarhs in discussion on 0. Lockyer's
specimen of bilateral primary tuberculous salpingitis
witb secondary infection of the perivascular lymphatics
of the uterine wall ..... 145
in discussion on J. D. Malcolm's paper on the
advisability of removing the cervix in performing hys-
terectomy for fibro-myomatous uterine tumours . 167
in discussion on J. Bland-Sutton's specimen of a
uterus four years after Cesarean section . . 177
• in discussion on A. H. N. Lewers's specimens from
cases of cancer of the cervix, the patients remaining free
from recurrence twenty and eleven years respectively
after operation ..... 180
in discussion on F. E. Taylor's case of suppuration
in an ovarian cyst caused by the Bacillus typhosus . 265
in discussion on L. B. Aldrich-Blake's specimen of
skeleton of extra-uterine foetus . . . 270
in discussion on C. N. Longridge's specimen of
diaphragmatic hernia in a new-born baby . . 274
Suppuration in an ovarian cyst caused by the Bacillus
typhosus (F. E. Taylor) . . . .257
in fibro-myoma uteri following premature delivery, treated
by abdominal hysterectomy (W. W. H. Tate) . . 54
Taegett (J. H.), hjemorrhage in uterine fibroid (shown) . 269
Remarks in discussion on G. F. Darwall Smith's specimen
of perithelioma of the uterus .... 100
in discussion on C. H. Roberts's case of supposed
recurrence after vaginal hysterectomy for cancer of the
cervix ...... 114
in discussion on W. S. A. Griffith and H. William-
son's paper on chorionepithelioma complicated by haema-
tometra ...... 253
Tate (W. W, H.), co-existing tubal and uterine pregnancy;
abdominal section ; subsequent delivery at term . 51
suppuration in fibro-myoma utei'i following premature
delivery, treated by abdominal hysterectomy . . 54
Taylor (Frank E.), suppuration in an ovarian cyst caused by
the Bacillus typhosus .... 257
— r- Remarks in reply ..... 266
two uteri with " f undal ligament " after hysteropexy . 266
INDEX. 289
PAaa
Taylor (Frank E.), RemarJcs in i-eply . . . 269
in discussion on W. F. Shaw's paper on the patho-
logy of chronic metritis . . . ,43
Thorne (May), uterus showing malignant villous tumour and
a fibroid which has undei-gone sarcomatous change . 181
Tissue, fibroid, formed ai-ound a needle, and removed from the
left labium majus (H. Briggs) . . . 223
Tumour, adrenal, of the kidney, with malignant vaginal
polypus (A. Doran) ..... 182
fibroid, associated with bleeding after the menopause
(A. H. N. Lewers) . . . . .271
of broad ligament associated with an ovarian cyst,
reported in the forty-third volume of the Society's
'Transactions' (A. Doran) . . . .94
calcified, lying free in the cavity of a fibro-myoma-
tous uterus (J. H. Dauber) .... 139
of uterus, with a sarcomatous nodule in the centre
(A. Routh) . . . . .1
which has undergone sarcomatous change in a
iiteiiis showing malignant villous tumour (M. Thorne) . 181
of uterus, suppurating (G. F. Blacker) . . 100
myxomatous (M. A. D. Scharlieb) . . 274
of uterus, haemorrhage in (J. H. Targett) . 268
Tumours, fibro-myomatous, uterine, advisability of removing
the cervix in performing hysterectomy for (J. D. Malcolm) 148
Tumour, villous, of the body of the uterus in a woman aet. 84;
vaginal hysterectomy ; recovery (J. Bland- Sutton) . 46
malignant villous, in a uterus and a fibroid which has
undergone sarcomatous change (M. Thorne)- . . 181
Twins, entire full-time ovum in (R. Wise) . . . 147
Ureters dilated, in still-born infants (C. N. Longridge) . 215
Uteri with " f undal ligament " after hysteropexy (F. E. Taylor) 266
Uterus, ehorio-endothelioma of ; intra-peritoneal haemor-
rhage ; hysterectomy ; death (G. B. Ferguson) . . 57
ehorionepithelioma of; lutein cysts in both ovaries
(G. F. Blacker) . . . . .104
fibroid, pregnancy in the right cornu of (F. N. Boyd) . 49
fibroid of, with a sarcomatous nodule in the centre
(A. Routh) . . . . .1
suppurating fibroid tumour of (G. F. Blacker) . . 100
290
INDEX.
Uterus, fibro-myomatous, with a calcified fibroid lying free in
its cavity (J. H. Dauber) .... 139
four years after Caesarean section (J. Bland-Sutton) . 174
myomatous, weighing over seven pounds removed from
a woman, aged twenty-two (Herbert R. Spencer) . 219
one-horned, malignant disease of cervix in (L. B. Aldrich-
Blake) . . . . . .269
perithelioma of (G. F. Darwall Smith) . .97
rudimentary horn of, pregnancy in (H. R. Andrews) . 209
showing malignant villous tumour and a fibroid which
has undergone sarcomatous change (M. Thome) . 181
villous tumour of the body of, in a woman aged 84;
vaginal hysterectomy ; recovexy (J. Bland-Sutton) . 40
wall of, secondary infection of the peri-vascular lymph-
atics of in bilateral primary tuberculous salpingitis
(C. Lockyer) . . . . .141
and its appendages, chronic septic infection of (A.
Donald) . . . . . .6
■ cervix of, advisability of removing, in performing
hysterectomy for fibro-myomatous uterine tumours (J. D.
Malcolm) . . . . . .148
cervix uteri, cancer of, the patients remaining free from
recurrence twenty and eleven years respectively after
operation (A. H. N. Lewers) . . . .179
malignant disease of, in one horned (L. B.
Aldrich-Blake) ..... 270
supposed sarcoma of (H. R. Andrews) . 137
supposed recurrence after vaginal hysterec-
tomy for cancer of the cervix (C. Hubert Roberts) . 114
Vagina, primai'y embolic chorionepithelioma of (H. T. Hicks) 224
Williamson (Herbert), see W. S. A. Griffith.
Wise (Robert) entire full-time ovum in twins
147
OESTETEICAL SOCIETY.
ADDITIONS TO THE LIBRARY
BY DONATION OR PURCHASE DURING THE YEAR 1907.
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443) (Serie xv, Heft 23.) 8vo. Leipzig, 1907 Purchased.
Bar (Paul). Lecons de pathologie ob.stetricale. Deux-
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nant: their clinical characters and appropriate
treatment. 4th edition.
illust., 8vo. London, 1906 Author.
BuDiN (Pierre). The nursling: the feeding and
hygiene of premature and full-term infants.
Atithorised translation by William J. Maloney,
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ander E. Simpson, M.D., LL.D., D.Sc.
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292
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Herman (G. Ernest). Difficult labour. New edition.
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First lines in midwifery. A guide to attend-
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Author.
Ditto.
Ditto.
HOFBADER (J.). Die meuscliliche Placenta als Assimi-
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scher Vortjage, neue Folge, Nr. 454) (Serie xvi,
Heft 4.) Svo. Leipzig, 1907 Purchased.
Kroemer (Paul). Untersuchungen iiber den Bau der Jouru.Obst.
menschlichen Tube zur Kliirung der Divertikel- and Gyn.
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illust., Svo. Leipzig, 1906 Empire.
Neugebaueb (Fr. von). Zur Lehre von der Zwillings-
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das eine Ei in cavo uteri das andere extrauterin
gelagert. Kasuistik von 171 Fallen nebst zwei
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Pozzi (S.). Traite de gynecologic clinique et opera-
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RxjNGE (Max). Lehrbuch der Gvnakologie. Dritte
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SxRASSMANN (P.). Wasser und Messer in der Gyna-
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Veit (J.). Handbuch der Gyniikologie. Zweite voUig
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448. Freund, Operation einer ausgetragenen Abdominal-
schwangerscbaf t ; Versenkung d^r Placenta in die
Bauchhohle.
4.51. Strassmann, Wasser uud Messer in der Gynakologie.
454. Hofbaiier, Die menschliche Placenta als Assimila-
tionsorgan.
Winckel (Franz von). Shakespeare's Gynakologie.
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Ditto.
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TRANSACTIONS.
American Gynecological Society —
Transactions, vol. xxxi for 1906.
Svo. Phila. 1906 Society.
medical Society op London —
Transactions, vols, xxvii and xxviii, 1905.
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GENEEAL INDEX
TO THE
TRANSACTIONS
OF THE
OBSTETRICAL SOCIETY OF LONDON
VOLS. I TO XLIX
1859-1907
BY
MISS AGNES HANNAM
SKCRETAET AND LIBRARIAN OF THE OBSTETRICAL SOCIETY
Wonbon
FEINTED BY ADLARD AND SON
BAETHOLOMEW CLOSE, E.C.
1908 ^
Table of Reference to the dates of the Sessions included in
each volume of the 'Transactions':
Vol. I.
1859.
II.
1860.
III.
1861.
IV.
1862.
V.
1863.
VI.
1864.
VII.
1865.
VIII.
1866.
IX.
1867.
X.
1868.
XI.
1869.
XII.
1870.
XIII.
1871.
XIV.
1872.
XV.
1873.
XVI.
1874.
XVII.
1875.
XVIII.
1876.
XIX.
1877.
XX.
1878.
XXI.
1879.
XXII.
1880.
XXIII.
1881.
XXIV.
1882.
XXV.
1883.
Vol. XXVI.
XXVII.
XXVIII.
XXIX.
XXX.
XXXI.
XXXII.
XXXIII.
XXXIV.
XXXV.
XXXVI.
XXXVII.
XXXVIII.
XXXIX.
XL.
XLI.
XLII.
XLIII.
XLIV.
XLV.
XLVI.
XLVII.
XL VIII.
XLIX.
1884.
1885.
1886.
1887.
1888.
1889.
1890.
1891.
1892.
1893.
1894.
1895.
1896.
1897.
1898.
1899.
1900.
1901.
1902.
1903.
1904.
1905.
1906.
1907.
GENERAL INDEX
TO THE
TRANSACTIONS OF THE OBSTETRICAL SOCIETY
OF LONDON
FOR
VOLS. I— XLIX, 1859—1907.
ABDOMEN, systematic examination of, for rectifying malpositions
of the foetus in labour (A. W. Edis) . . . xiv, 331
„ macerated foetus removed two months after spurioue labour
from the cavity of (Alban Doran) . . . xlii, 8
„ palpation of the, diagnosis of placenta praeviaby (H. E. Spencer) xxxi, 203
„ retention of a foetus in, for forty-three years (R. W. Watkins) viii, 106
„ and chest, the change in size of, during the lying-in period,
and the effect of the binder upon them (G. E. Herman) . xxxii, 108
ABDOMINAL SECTION, fifteen months after conception, and eight
months after death of fcetixs (J. B. Hellier) . . xlv, 366
„ the value of, in certain cases of pelvic peritonitis (C. J.
Cullingworth) ..... xxxiv, 2o4
„ foetus, sac, and pelvic viscera from (Alban Doran) . . xxix, 491
„ followed by localised sloughing of fvindus uteri in a case of
acute septicaemia (C. J. Cullingworth) . . . xxx, 406
„ ligature discharged after (W. S. Playfair) . . . xxxiii, 386
„ in a case of extra-uterine foetation (J. B. Hicks) . . ix, 93
„ in a case of extra-uterine pregnancy (J. Braxton Hicks) . xxii, 141
„ — (J. Knowsley Thornton) . . . xxiv, 51, 81
„ — (G. E. Herman) ..... xxviii, 141
„ in the latter half of pregnancy, the child being alive in cases
of extra-uterine gestation (F. H. Champneys) . . xxix, 456
„ in a case of extra-uterine pregnancy at full term ; recovery
(J. W. Taylor) ..... xxxiii, 115
„ for removal of extra-uterine gestation (C. J. Cullingworth) . xxxv, 155
„ extra-uterine gestation (John Phillips) . . . xxxv, 162
„ (E. Sinclair Stevenson) ..... xxxv, 175
1
ABDOMINAL SECTION.
xlii, 121
xlii, 213
xlv, 144
XX vi, 268
xlviii, 137
xlvii, 181
xxxvii, 197
xlix, 51
xlii, 276
xxiii, 141
xxix, 482
ABDOMINAL SECTION (continued)—
„ performed after four or five months in a case of extra-uterine
gestation in which foetal death occurred at term after
spurious labour (John Phillips) ....
„ in a case of extra-uterine gestation in which foetal death
occurred at the eighth month after spurious labour (A
Doran) .....
„ in four cases of ruptured extra-uterine gestation occurring in
two women ; recovery (A. J. Sturmer)
„ [tubal] (Sydney Jones) ....
„ tubo-abdominal gestation at the fourth month of pregnancy
removed by (G. F. Blacker)
„ for repeated tubal pregnancy (C. E. Purslow)
„ unruptured tubal gestation removed by (W. Duncan)
„ in CO -existing tubal and uterine pregnancy ; subsequent de
livery at term (W. Tate)
„ and removal of sac in a full-term pregnancy in a rudimentary
liorn of uterus ; missed labour (five months) (J. H. Targett)
„ associated with intra-uterine pregnancy (A. L. Galabin)
„ performed during the life of the foetus at the thirty-fifth
week of gestation (John Williams) . "
„ performed eight months after death of foetus (C. J. Culling
worth) .....
„ removal of living foetus (T. E. Jessop)
„ for removal of uterus and both ovaries (Thos. Chambers)
„ for hsematosalpinx and papillomatous ovarian cyst (J
Knowsley Thornton) ....
„ chorionic villi from a tubal mole removed by (A. H. N
Lewers) .....
„ tubal mole removed by (A. H. N. Lewers) .
„ dermoid ovarian cyst impacted in the pelvis removed by,
during the ninth month of pregnancy (Thomas H. Morse) xxxviii,
„ for dermoid cyst of the ovary five years after causing ob-
struction to labour (W. W. H. Tate)
„ for removal of suppurating ovarian cyst which had obstructed
labour (W. W. H. Tate)
„ for removal of fibroid tumour of the ovary (John Williams) .
„ for removal of fibro-myoma of the right ovary (C. H. Carter) .
„ for abscess of the uterus developing during the puerperium
(A. W. W. Lea) .....
„ adeno-carcinoma of uterus and left ovary removed by (W.
Du.ncan) ......
„ fibro-cystic tumour of the uterus removed by (A. H. N.
Lewers) ......
„ two specimens of fibroid tumour removed by (G. G. Bantock)
„ five cases of fibroid tumours of the uterus removed by (G. G.
Bantock) ......
„ for removal of calcified uterine fibroids in elderly women
(W. S. A. Griffith) .....
„ Porro-Csesarean hysterectomy with retro-peritoneal treatment
of the stump in a case of fibroids obstructing labour ; with
remarks upon the relative advantages of the modern Porro
operation over the Siinger-Csesarean in most other cases
reqmring (A. Eouth) ....
„ four cases of removal of large uterine myomata by (Lawson
Tate) ......
„ see Gastrotomy, Laparotomy,
XVlll,
xxiii.
XXXVlll,
xxxvii.
480
261
12
106
78
221
xlvi, 344
xUi, 164
XXV, 35
xxix, 190
xlvi, 7
xxxix, 289
xxxvi, 270
xxiv, 91
xxiv, 301
xlviii, 17
xlii, 244
xix, 274
ABDOMINAL WALL ABORTION.
ABDOMINAL WALL, abscess in (E. J, Probyn-Williams) . xxxvi, G2
ABNORMALITY of uterus, congenital, simulating retention of
menses (J. Braxton Hicks) .... xxii, 260
„ see Fcetxis, retroflexion of. Malformations, Monsters.
ABOLITION of craniotomy from obstetric practice, in all cases
where the foetus is living and viable (W. T. Smith) . i, 21
ABORTION artificially induced, followed by peritonitis (R. Barnes) iii, 419
„ at six and a half months, with general dropsy of the foetus
(Protheroe Smith) ..... xvii, 303
„ ease of (W. S. A. Griffith) .... xxxv, 87
„ case of death following vaginal injection of acid nitrate of
mercury to produce (John Phillips) . xxxii, 308 ; xxxiii, 180
„ criminal (J. Shortt) . . . . . ix, 6
„ decidua vera and reflexa from a very early (Gr. E. Herman) . xxxii, 272
„ followed by septicoemia and fatal cardiac thrombosis (J. T.
Miisgrave) ...... xxi, 81
„ habitual (Leith Napier) .... xxxii, 389
„ htemorrhage due to retained placenta, supposed to be the
placenta of a previous (A. W. Williams) . . . viii, 317
„ showing recent placental haemorrhage (R. Wise) . . xl, 257
„ induction of, as a therapeutic measure (Sir W. O. Priestley) . xxii, 271
„ — in a patient labouring under cancerovis disease of the
uterus and rectum (F. W. Mackenzie) . . . i, 11
„ — with subsequent removal of carcinomatous cervix by supra-
vaginal amputation (A. H. N. Lowers) . . . xxx, 81
„ influence of lead-poisoning in producing (B. Baker) . . viii, 41
„ knitting-needle used to procure (W. Duncan) . . xxxiv, 223
„ missed, specimen of (G. Roper) .... xxii, 108
„ — (H. C. Pope) ..... xxiv, 139
„ — with slight cystic degeneration of the chorion (G. E.
Herman) ...... xxii, 44
„ — foetus and membranes from a case of (Alban Doran) . xxvii, 224
„ — in which an early embryo in its amniotic sac was retained
in the uterus for eight months (W. Duncan) . . xxxvii, 196
„ in which there occurred separate primary and complete ex-
pulsion of the unbroken amnion, enclosing a foetus of about
four months' gestation (Graily Hewitt) . . . xxxiii, 461
„ simple maieutic for the induction of premature' labour or
(Peter Horrocks) .... xxxviii, 168
„ notes of a case of malignant disease of the uterus with
numerous deposits in the lungs, and death following (J. D.
Malcolm) ..... xxxviii, 125
„ procured by tents of common sea tangle (W. E. Pritchard) . v, 198
„ the relation between backward displacements of the uterus
and prolonged haemorrhage after delivery and (G. E. Herman) xxxiv, 14
„ on the relation between backward displacement of the uterus,
sterility and (G. E. Herman) .... xxxiii, 499
„ retention of the ovum within the uterus and growth of mem-
branes for a period of five months after the death of the
foetus (W. Guttewitt) ..... iii, 411
„ retroflexion of the uterus as a frequent cause of (J. J. Phillips) xiv, 45
„ tetanus after (A. Wiltshire) .... xiii, 133
„ treatment of cases of, in which the placenta and membranes
are retained (Sir W. O. Priestley) . . .iii, 146
„ tubal (J. Bland-Sutton) .... xxxii, 342
„ — (W. S. Playfair) .... .xxxvii, 224
4 ABOBTION — ABSORPTION.
ABOSTION, tubal (continued) —
„ — (A. L. Galabin) . . . . . xU, 170
„ — with rupture of tube (A. Routh) . . . xliii, 294i
„ — indisputable case of complete (C. J. Cullingworth) . xxxvii, 139
,, — in which the " mole " was in process of extrusion at the
time of operation (J. Bland-Sutton)
^^ _ (J. Bland-Sutton) .....
„ — produced by bimanual examination (A. L. Galabin)
„ incomplete (L. Remfry) .....
,, — haemorrhage; operation; recovery (A. C. Butlor-Smythe) .
„ — showing intra-mural embedding of the placenta (C.
Lockyer) ......
„ twin (?) (J. C. Langmore) ....
„ report on (G. Harley and T. H. Tanner)
„ enlargements of the uterus following (T. S. Beck) .
„ twin, one emaciated and one acephalous (Clement Godson) x\
„ repeated (W. Newman) .....
„ with albiuninuria and convulsions, in six successive preg-
nancies (W. H. Broadbent) ....
„ see Miscarriage.
ABSCESS in abdominal wall (R. J. Probyn-Williams)
„ chronic, of the female urethra (G. E. Herman)
„ in a corpus luteum (J. D. Malcolm)
„ mammary, the prevention of, by the application of the principle
of rest (W. B. Woodman) ....
„ multiple, of the ovary with pyosalpinx (C. J. CuUingvvorth) .
„ of ovary (Heywood Smith) ....
„ of 'he ovary, three cases of pelvic inflammation attended with
(C. J. Cullingworth) .....
„ ovarian, ruptui-e twelve hours after labour (C. Berkeley)
„ perimetric (W. S. A. Griffith) ....
^^ _ retro-uterine (W. S. A. Griffith)
„ in placenta (R. Barnes) ....
„ in a case of puerperal septicajmia (A. Wiltshire)
„ splenic ; death on sixteenth day after delivery in case of
eclampsia; septic peritonitis (J. C. Holdich Leicester) . xlvii, 271
„ tubo-ovarian, large pyosalpinx simulating (C. J. Cullingworth) xxxiv, 437
„ — pyosalpinx simulating (C. J. Cullingworth) . xxxvii, 2
„ tubo-ovarian (W. Tate) .... xxxviii, 319, 380
„ genmne tubo-ovarian (C. J. Cullingworth) . . . xli, 39
„ of female urethra (F. C. Cory) . . . . xi, 65
„ in the uterus (W. F. Victor Bonney) . . . xlvi, 2
„ of the uterus developing during the puerperium ; i-upture into
the peritoneal cavity ; abdominal section ; recovery (A. W. W.
Lea) ...... xlvi, 7
„ and fibro-myoma (Wm. Duncan) .... xxxi, 332
„ cavity containing offensive pus in which was sarcoma of ovary
showing necrosis of central portion (W. W. H. Tate) . xli, 373
ABSENCE of nose, congenital, right palpebral fissure, and right
ear ; imperforate anus, etc. (W. Duncan) . . xxxvii, 16
„ of uterus and breasts (L. Remfry) . . xxxvii, 12
„ of the uterus and occlusion of the vagina (F. Bousquet) . xxvii, 123
ABSORPTION of fibroid tumours of the uterus, with a report of a
suspected case (Alban Doran) .... xxxv, 250
„ (?) of placenta in a case of gastrotomy for extra-uterine
gestation, in which it never came away (J. Braithwaite) . xxviii, 33
xlii,
311
xliv.
44
xlvii.
332
xxxvi.
2G1
xl,
298
xlv,
191
iv.
1.33
iv.
165
viii.
54
n, 100,
121
iii.
4U8
i.
108
xxxvi.
62
xxviii.
181
xlvii.
8
xvii.
9
xxxix.
47
xxxiv.
3
xxxvi.
277
xliv.
73
xxiv.
299
XXV,
18
viii.
149
xviii.
181
ABSORPTION ADDRESSES.
ABSORPTION (continued)—
„ of tlirombosis of the pulmonary artery in the puerperal state
(W. S. Playfair) • - . .
ACARDIACUS acephalus (AV. H. Kelson, introduced by Alban
xxvi, 162
xxxiii, 195
. xxxvi, 65
. xxxiii, 493
. xxxiii, 302
xli, 97
Doran)
ACARDIAC acephalous fcetus (G. E. Herman) .
„ amorphous fcetus (G. E. Herman for G. M. Bluett)
„ mylacephalus, see Monsters.
„ twin, mylacephalous (H. Page) .
„ from a cow (J. Bland-Sutton)
„ fcetus, see Monsters.
ACCOUCHEURS qualified for the poor (J. T. Mitchell) . . xv, 3
ACEPHALOUS FCETUS, see Monsters.
ACID nitrate of mercury, death following vaginal injection of
(John Phillips) .... .xxxiii, 180
ACOUSTIC SIGN heard after the death of the fcetus (Robert
Harvey) • . . .
Adams (William), report on F. L. Neugebauer's specimens illus
trating spondylolisthesis
Addinsell (A. W.), note on the effect of the influenza poison
upon the lying-in woman
„ case of fcetal deformity . . . .*
„ intermenstrual pain (Mittelschmerz)
„ microscopical slides from a case of intermenstrual pain
(Mittelschmerz) . . . ^
„ sections from the uterus of a bonnet monkey
„ uterus and appendages with ruptured pregnant tube
„ unusual thickening of the endometrium in case of fibroids
„ solid tumour of the ovary removed from a woman aged 36
„ tubercular uterus
„ chronic infective metritis
ADDRESS delivered at the first meeting of the Society, January
5th, 1859 (E. Rigby) . . . ^ ^
„ loyal, to the King on the death of Queen Victoria
„ — reply ....
„ to H.M. the Queen on the completion of the fiftieth year of
her reign . . . ^
„ — reply of the Home Secretary to ditto .
ADDRESSES of condolence on the death of H.E.H. the Duke of
f^^b^^y , • • . . xxvi, 85, 116
„ ot Presidents :
Rigby (E.), i, 1 ; ii, 1. Smith (W. T.). iii, 3 ; iv, 6; v, 18.
Oldham (H.), vi, 14 ; vii, 19. Barnes (R.), vii, 37 ; viii, 25 ;
IX, 18. Davis (J. H.), ix, 30; x, 14; xi, 15. Hewitt (w'
Graily), xi, 27; xii, 16; xiii, 5. Hicks (J. B.l, xiii, 27-
XIV, 25; XV, 16. Tilt (E. J.), xv, 30; xvi, 13; xvii, 24
Priestley (Sir W. O.), xvii, 36; xviii, 29; xix, 17. "West
(Charles), xix, 42; xx, 10 ; xxi, 5. Playfair (W. S.), xxi,
29; xxii, 55; xxiii, 46. Duncan (J. Matthews), xxiii, 64;'
xxiv, 32 ; XXV, 29. Gervis (Henry), xxv, 47 ; xxvi, 33 •
xxvii, 64. Potter (J. B.), xxvii, 85 ; xxviii, 52 ; xxix, 86'
WilUams (John), xxix, 99 ; xxx, 104 ; xxxi, 73. Galabin
(A. L.), XXXI, 88 ; xxxii, 86 ; xxxiii, 41 ; Black (J. Watt)
xxxm, 76; xxxiv, 33; xxxv, 47; Herman (G. Ernest)
xxi, 273
xxvi, 186
xxxv, 333
xxx vii, 204
xl, 137
xli, 3
xli, 141
xli, 172
xli, 231
xiii, 139
xlvii, 336
xlviii, 144
i, 1
xljii, 21
xliii, 143
xxix, 250
xxix, 350
6
ADDEESSES — ALLANTOIS.
ADDRESSES of Presidents (continued)—
XXXV, 3 ; xxxvi, 75 ; xxxvii, 42 ; Champneys (F. H.), xxxvii,
83; xxxviii, 60; xxxix, 56. Ctillingworth (C. J.), xxxix,
91 ; xl, 39,91 ; xli, 50. Doran (A.), xli, 107 ; xlii, 43 ; xliii,
35. HoiTOcks (P.), xliii, 79 ; xliv, 53 ; xlv, 61. Malins (E.),
xlv, 109: xlvi, 67; xlvii, 82. Dakin (W. E.), xlvii, 124;
xlviii, 51 ; xlix, 66 ; Spencer (H. K.) . . . xlLx, 117
ADENO-CARCINOMA of both ovaries (A. W. W. Lea) . . xliv, 225
„ of the ovary (F. N. Boyd) .... xlix, 50
„ of uterus and left ovary removed by abdominal section (W.
Duncan) ...... xxxix, 289
„ of the body of the uterus in an early stage, with microscopical
sections (E. W. Hey Groves) .... xlv, 138
ADENOMA (carcinoma), malignant, of the cervix uteri (F. J.
McCann) . . . . . . xl, 2
„ cystic, of the cervix (W. S. A. Griffith) . . . xxx, 4
„ of the labium (H. Williamson) .... xlviii, 235
„ unusual example of rupture of an ovarian (J. Bland-Sutton) . xli, 98
„ of the meatus virinarious externus (H. R. Spencer) . . xli, 383
„ of the portio vaginalis uteri forming a depressed sox-e or ulcer
(J. Braithwaite) ..... xxxvi, 208
„ of the uterus (T. W. Eden) .... xlii, 2
„ malignum of the body of the uterus (C. H. Roberts) . xlv, 86
ADENO-MYOMA, diffuse, of uterus (W. W. H. Tate) . . xlvi, 141
„ of the uterus (F. E. Taylor) .... xlvi, 188
„ uteri, three cases of (C. Lockyer) .... xlviii, 84
„ — polyposum benignum (F. E. Taylor) . . . xlviii, 12
ADHERENT PLACENTA, see Placenta.
.ffiTIOLOGY of gonorrhoea (Frederick J. McCann) . xxxviii, 225
„ of the sickness of pregnancy, observations on the (A. E. Giles) xxxv, 303
AFTER-HISTORIES of three cases of epithelioma of the vulva
(A. H. N. Leavers) ..... xlviii, 163
AFTER-HISTORY of " a case of cystic fibroid vnth carcinoma of
left ovary and right Fallopian tube " (brought before the
Society five years ago) (R. Boxall) . . . xlviii, 136
„ of the case of fibroid of broad ligament associated with an
ovarian cyst, reported in the forty-third volume of the
Society's ' Transactions ' (A. Doran) . . . xlix, 94
Agnew (T. W.), the forceps in certain breech presentations . xix, 217
AIR in the vagina (A. Rasch) .... xii, 281
Albany, death of H.R.H. the Duke of, addresses of condolence on xxvi,85, 116
ALBUMINURIA and convulsions during abortion in six successive
pregnancies (W. H. Broadbent) . . . i, 108
„ by hydatidiform degenei-ation of the chorion associated with
(W. B. Woodman) .... vii, 113, 117
„ see Sright's disease.
Alcock (Richard), cystic corpiis luteum . . . xliii, 208
Aldkrson (F. H.), remarks in the discussion on the use of forceps xxi, 158
Aldrich-Blake (L. B.), malignant disease of cervix in one-horned
uterus ...... xlix, 269
„ skeleton of extra-uterine fcetus .... xlix, 269
ALLANTOIS, specimen preserved in formalin of an early gestation
in both liorns of the uterus of a bitch, displaying the allantoid
vessels in their natural coloiu' (Amand Routh) . . xli, 5
AMAUROSIS AJJDREWS.
AMAUROSIS observed eight times iu succession after parturition
(H. E. Eastlake) .....
AMENORRHffiA, decidual uterine cast expelled after eight weeks,
together with an ovum of about five days' growth (W. E
Fothergill) .....
AMMONIA, injection of, into the veins in puerperal fever (W. T
Smith) .....
AMNION, foetus enclosed only in sac of (C. E. Purslow)
„ separate primaiy and complete expulsion of the unbroken,
enclosing a foetus of about four months' gestation (Graily
Hewitt) ...... xxxiii
„ retention of the cavity of, in the tube, in a tubal mole, show-
ing escape of the body of the embryo through the fimbriated
opening (J. S. Fairbairn) ....
AMPUTATION, congenital (J. Marshall)
„ of the cervix uteri (A. Meadows) ....
„ of forearm in utero (W. Gr. Hewitt)
„ supra-vaginal, for cancer, cervix uteri removed by (A. H. N.
Lewers) ..... xxxvii, 201
.. supra-vaginal, for cancer of the cervix, in which from four to
fifteen years had elapsed without reciu-rence (A. H. N. Lewers)
AMUSSAT'S OPERATION, see Colotomy.
ANEMIA and chlorosis, treatment of, with the phosphide of zinc
(J. A. Thompson) .....
„ complicated with pregnancy, iron salts in ("W. B. Woodman) .
ANJESTHESIA, local, by the ether spray, employed in the removal
of epithelioma of the cervix uteri by the ecraseur (E. Parson)
„ by mixed vapours (R. Ellis) ....
„ in midwifery (T. Skinner) ....
ANJISTHETIC properties of the bichloride of carbon (A. E. Sansom)
AN.a;STHETICS, apparatus for the self -administration of (J. M
Crombie) .....
„ value of, in midwifery (C. Kidd) .
„ in midwifery (C. Kidd) ....
„ in obstetric practice (A. E. Sansom)
ANASARCA and large placenta in a foetus (R. Boxall) .
ANATOMY, normal and pathological, of the ganglion cervicale
uteri (N. W. JastrebofE) ...
„ pathological, of erosions of the cervix uteri (A. L. Galabin)
„ — of five specimens of fibroid tumour of the ovary (J. S
Fairbairn) .....
„ of mother and foetus (H. Madge) .
„ of an infant presenting some rare deformities (C. Singer)
„ of the pelvic floor, contribution to the (G. E. Herman)
„ of the pregnant tube (H. R. Andrews)
„ and nature of two acardiac acephalic foetuses (A. Keith)
Anderson (Izett W.), notes on a Jamaica galactagogue
Andrews (H. R.), imperforate rectum and congenital prolapse of
the uterus .....
„ sarcoma of the uterus, with a microscopic section
„ rudimentary supernumerary digits
„ microscopical sections of the kidneys from a fatal case of
puerperal eclampsia (with full notes oi ;post-mortem) . xliii, 114
„ two cases of foetal ascites and oedema . . . xliii, 166
V, 79
xliii, 162
xi, 247
xli, 168
461
xliii, 211
X, 94
xi, 102
xiii, 94
xliv, 221
xvii, 57
xii, 33
ix, 47
viii, 224
iv, 116
viii, 49
xviii, 64
ii, 340
V, 125
X, 121
xlii, 98
xxiii, 266
xxii, 156
xliv, 177
viii, 348
xlvii, 250
xxxi, 263
xlv, 197
xlii, 99
xxii, 31
xlii, 169
xlii, 210
xlii, 266
8
ANDREWS ANUS.
Andrews (H. E.) continued —
„ primary melanotic sarcoma of ovary . . . xliii, 228
„ fibro-myoma of the ovary .... xliii, 231
„ congenital prolapse of the uterus associated with spina bifida xliv, 137
„ and G. Ernest Herman, contribution to the natural history of
dysmenorrhoea ..... xliv, 371
„ primary carcinoma of the Fallopian tube . . . xlv, 54
„ anatomy of the pregnant tube .... xlv, 197
„ chorio-ei^ithelioma ..... xlv, 238
„ sections showing muscular tissue in the pseudo-reflexa in
tubal pregnancy ..... xlv, 333
„ bilateral extra-uterine pregnancy . . . xlv, 461
„ uterine fibroid removed from a patient aged 20 . . . xlvii, 154
„ ruptured interstitial pregnancy .... xlvii, 259
„ fibroid showing cystic degeneration removed three weeks
after labour ...... xlviii, 247
„ large cystic fibroid ..... xlviii, 249
„ supposed endothelioma of the cervix . . . xlviii, 283
„ complete prolapse of an inverted uterus . . . xlviii, 284
„ Cffisarean section followed by removal of a fibroid which filled
the pelvic cavity . , . . . xlviii, 313
„ supposed sarcoma of the cervix .... xlix, 137
„ two cases of pregnancy in a rudimentary uterine horn . xlix, 209
Andbewes (F. W.), sections from two different cases of endosteal
sarcoma of the femur, showing syncytial structures . xlv, 237
ANENCEPHALIC DI-PROSOPIA FffiTUS, see Monsters.
ANENCEPHALOUS FffiTUS (Amand Eouth) . . . xxxv, 241
„ (H. S. Ballance) ..... xxxv, 297
„ see Monsters.
ANEURYSM of the splenic artei-y, foetal rupture of, immediately
after labour (J. D. S. Nodes and Frank Hinds) . . xlii, 305
„ traumatic, of the uterine artery (W. G. Hewitt) . . ix, 246
ANGIOMA of labium (Matthews Duncan) . . . xxvi, 118
„ of the ovaries, atrophy with collapse (cirrhosis), fibroid
degeneration and (J. Braithwaite) . . . xxxvi, 325
Anninq (G. p.), and Harry Littlewood, primary ovarian
pregnancy with ruptiu-e fourteen days after last menstruation xliii, 14
ANODYNE, extreme cold as, in the pain attendant on parturition
(J. M. Granville) . . . . • vi, 105
ANTEFLEXION OF UTERUS, sec Uterus, displacement of (ante-
flexion).
ANTISEPSIS and hygiene in fever in childbed (E. Boxall) xxxii, 219, 275
ANTISEPTIC IRRIGATION in childbed, instruments for (Graily
Hewitt) ...... xxxi, 202
ANTISEPTICS in midwifery (A. L. Qalabin) . . . xxxi, 92
„ the advantages of, in obstetric practice (Sir W. O. Priestley) . xxvii, 197
„ pellets of corrosive sublimate (F. H. Champneys) . . xxviii, 66
ANTISTREPTOCOCCIC SERUM in puerperal septicaemia (J. Walters
and A. E. Walters) . . . . . xl, 277
ANUS, atresia ani vesicalis, foetus the subject of (W. E. Dakin) . xxxii, 368
„ imperforate (A. E. Giles) .... xxxiv, 129
„ — etc., congenital absence of nose, right palpebral fissure,
and right ear (W. Duncan) . . xxxvii, 16
ANUS ATRESIA. 9
ANUS (continued) —
„ orifice of, extrusion of right arm of child through, during
labour (H. E. Eastlake) .... viii, 320
APOPLECTIC OVUM (G. E.Herman). . . . xxii^ 45
APOPLEXY of decidna (A. Routh) .... xxxii' 194
„ of the ovary, cystic dilatation without rupture (Alban Doran) xxxii,' 119
„ double ovarian, from a case of acute peritonitis (H. A. Des Voeux) xxxiv, 214
„ of the ovum (C. J. Cullingworth) . . . xxxiv, 182
„ — in a case of unruptured tubal gestation (C. J. Cullingworth) xxxiv,' 155
„ sudden seiiure terminating fatally in thirty-five hours, on the
sixth day of lying-in (R. U. West) . . . ii, 276
APOSTOLI'S METHOD in the treatment of fibroma and other
morbid conditions of the uterus (J. Inglis Parsons) . xxxiv, 22
APPENDAGES, see Uterine appendages, Wterus (and appendages).
APN(EA, cardiac, after delivery (W. S. Playfair) . . x, 21
ARM, amputation of, in pregnancy (A. Napper) . . vii, 12
ARMS, dissection of (W. L. Heath) .... xxiii, 195
„ stumps of, and deformities of lower limbs in a hydrocephalic
child (Matthews Duncan) .... xxii, 237
ARMS AND HANDS, deformity of (J. Shortt) . '. '. vi', 205
ARMSTRONG CASE, resolution of the Council on the action of a
Fellow in the. .... xxviii 1
Aemsteong (James), see BouUon, Percy.
ARTERIES, calcification of, in large fibrotic uterus (J. S. Fair-
^t"'^) • , xlvii,299
„ pulmonary, sudden death from occlusion of, seventeen days
after parturition (D. Mackinder) . . . i, 213
ARTERY, right hypogastric, absence of (A. E. Giles) . . xxxiv, 129
„ ihac, obstructed by a clot (R. Barnes) . . . xiii, 213
„ pulmonary, embolism of, after ovariotomy (E. Parson) . vii] 8
„ — fatal embolism of, nineteen days after deUvery (G. Roper) xxii 74
AsBURT (E. J.), rupture of the uterus occurring during labour . x, 40
ASCITES, with ovarian disease (G. C. P. Murray) . . v 190
„ caused by papillomatous cyst of both ovaries (Alban Doran) . xxxiv' 149
,, see Dropsy.
ASEPTIC INSTRUMENTS (P. Horrocks) . . . xxxiv, 460
„ means of keeping sponges and instruments, in the vagina
(J. Matthews Duncan) . . . , xxiv, 5
ASPHYXIA causing sudden death in a case of ovarian tumoiu-
(R. F. Battye) . . _ ^ . ii, 280
ASYMMETRY, normal, of the foetal head (A. Wiltshire) ' ." xx,' ^78
ATRESIA ani yesicalis, foetus the subject of (W. R. Dakin) . xxxii, 368
„ ot the cervix uteri, distension of uterus, and escape of menses
between the walls of the vagina (G. Lowe) . . xxix, 401
„ of the female urethra (G. E. Herman) . xxviii 267
„ vaginas, instruments for (N. Bozeman) . ' xix' 96
„ ~ case of labour Avith (Fancourt Barnes) . ." ' xxv' 99
„ -- causing retention of menses of two years' diu^ation (I. b'
*^^^^ • • • . V 162
" — ,^etainedmensesoftwoyears'durationcausedby(I.'B.Brown) iv 21
„ of the vaginal orifice of the neck of the uterus, new operation
for (V. de Saboia) . . . xvi 116
10
ATROPHY AXIAL ROTATION.
ATROPHY of chorion (G. E. Herman) . . . xxvii, 195
„ of embryo (G. E. Herman) . . . xxiii, 204, 259
„ of uterus with fibroid (F. H. Champneys) . . . xxii, 185
„ with collapse (cirrhosis), fibroid degeneration, and angioma
of the ovaries (J. Braithwaite) .... xxxvi, 325
Attill (Lombe), remarks in the discussion on the use of
forceps ...... xxi, 178
AURICLE, cervical (A. Doran) .... xxxiii, 200
AUSCULTATION as a means of diagnosis of pregnancy (E.
Copeman) . . . . . . x, 62
AUTOPSY and remarks on puerperal eclampsia (R. H. Bell) . xliv, 253
AU YARD'S COUVEUSE or nest (J. Matthews Duncan) . . xxvi, 25
AUVARD'S NIPPLE SHIELD (Clement Godson) , . xxx, 198
AvELiNG (J. H.), historical notes on displacement of the un-
impregnated uterus as a cause of displacement of the gravid
organ ...... iii, 288
„ polyptrite, a new instrument for crushing the necks of uterine
polypi . . . . . . iv, 135
„ vaginal lithotomy . . . . . v, 1
„ immediate transfusion . . . . . vi, 126
„ new hysterotome and intra-uterine spring tent . . vii, 155
„ ovariotomy in which the pedicle was tied and returned, and
the ligature removed in forty-eight hours . . vii, 229
„ the relative value of the various substances which have been
used in dilating the neck of the womb, with a plan for
deodorising sponge tents ....
„ forceps, handles curved backwards
„ new principle of treatment in prolapsus and procidentia uteri
„ gynfficometer ......
„ apparatus for immediate transfusion
„ post-mortem parturition, with references to forty-four cases .
„ best mode of opening the vein in transfusion
„ loop saw ......
„ symmetrically hypertrophied clitoris
„ report on Alfred Meadows' specimen of membrane passed in a
case of membranous dysmenorrhoja
„ presentation of a pair of forceps by . . .
„ rectal protruder, for pressing upon the posterior wall of the
vagina to protrude the rectum tlu-ough the anus for
examination ...... xviii, 83
„ ctirved needle made to revolve, for cases of vesico-vaginal
fistula ...... xix, 66
„ a repositor for inversion of the uterus . . . xx, 126
„ the curves of the midwifery forceps, their origin and uses . xx, 130
„ regulator to be used with Paquelin's cautery . . xx, 293
„ Swan's incandescent cai'bon lamp . . . xxiv, 304
„ cast of female bladder ..... xxv, 33
„ a dilator ...... xxvi, 149
„ soft myoma of the uterus showing early cystic degeneration,
removed by hysterotomy .... xxvi, 270
„ see Meadoivs {A.).
AVULSION of the uterus, post-partum (J. H. Walters) xxiv, 136 ; xxvi, 233
AXIAL ROTATION, see Rotation, axial.
ix.
264
X,
40
xi.
215
xiii.
265
xiv.
101
xiv.
240
XV,
164
XV,
221
xvi.
1
xvi.
251
xviii.
2
AXIS TEACTION FORCEPS — BARKER.
11
AXIS TRACTION FORCEPS used for delivery of a child in a case
of persistent mento-posterior position of the face (A. H. N.
Lewers) ....••
Atmakd (J. L. A.), axis pressure-binder for use during labour .
xli, 280
xxxii, 1Y3
BABY, new-born, diaphragmatic hernia in (C. N. Longridge)
Bacillus coli communis found in a case of membranous vaginitis
(T. G. Stevens) .....
„ txjphosus, suppuration in an ovarian cyst caused by (F. E.
Taylor) ......
BACK, chronic pain in (H. Gervis) . . . •
Bailey (H. W.), statistics of midwifery in the practice of, with
tables . . . . . .
„ transposition of the greater part of the abdominal viscera into
the left cavity of the thorax ....
Baker (Bekson), influence of lead-poisoning in producing abortion
and nienorrhagia .....
Ball (Ancell), treatment of moles and premature expulsion of
the foetus ......
Ballance (H. Stanley), case of anencephalic foetus
Ballard (Thomas), supposed invagination of the intestine in a
child, aged 20 months, successfully treated
„ ovary after attempt at abortion .
„ — re;port on, by Drs. Hicks and Madge
BALLS, epithelial, dermoid cyst containing a large number of
(W. F. V. Bonney)
BANDAGE after labour (A. Meadows)
Bannister (A. J.), see Meadows, A.
Bantock (G. G.), Neugebauer's vaginal speculum
„ pedicle of ovarian tumour, shomng changes caused by ligatixre
„ treatment of certain forms of menorrhagia and uterine
hsemorrhage by means of the sponge tent, with special
reference to their occurrence in women residing in tropical
climates ......
„ pathology of certain so-called unilocular ovarian cyst's
„ two-headed monster with the bodies united from the breast
downwards ......
„ uterine polypus of large size ....
„ specimens of fibroid tumour of the uterus .
„ fibroid tumour removed by abdominal section, two specimens of
„ fibroid tumours of the uterus i-emoved by abdominal section,
five cases of .
„ dermoid cyst of the right ovary ....
„ hydrosalpinx ......
„ fibroid tumours of the uterus removed by hysterectomy
„ fibroid tumours of the uterus ....
„ surgical needles and holder (Hagedorn's) .
Barber (Oliver), specimen of an anencephalic foetus .
Barbour (A. H. Fkeeland), uteri at the onset of labour and after
delivery ......
Barker (Foedyce), remarks in the discussion on puerperal fever
Barker (T. H.), annular laceration of cervix uteri
xlix, 272
xli, 228
xUx, 256
V, 76
i, 299
X, 6
viii, 41
i.
315
XXXV,
297
137
xii.
3
xii.
135
xliv.
354
vi.
125
xiii,
51
xiv.
2
xiv.
84
XV,
105
xviii.
223
xxii.
105
xxiv.
47
xxiv.
91
xxiv.
301
XXV,
38
XXV,
38
XXV,
38
xxvi.
119
xxvi.
271
xvii,
341
xxviii.
73
xvii,
222
iij
329
12
BARNES.
Barnes (Fancoubt), the indications afforded by the sphygmo-
graph in the puerperal state ....
„ model phantom for obstetric classes, designed by Budin and
Pinard ......
„ for Robert Barnes, vulcanite tubes to facilitate the injection
of perchloride of iron or iodine into the uterus
„ for C. Duncan, instrument to measure the amovintof flexion of
the uterus ......
„ spurious hermaphroditism ....
„ case of labovir with atresia vaginae
„ hypertrophied left nympha ....
„ new cephalotribe .....
Barnes (K.), some recent cases (fourteen) illustrating physiology
and treatment of placenta prtevia
„ risk to life of first and subsequent pregnancies
„ asymmetrical distortion of the pelvis, the result of unequal
length of legs . . . . .
„ indications and operations for the induction of premature
labour and for the acceleration of labour .
„ fibroid tumour springing from the posterior lip of the uterus,
causing complete prolapse and simulating inversion of the
uterus ; removal by ligature ; recovery .
„ peritonitis caused by escape of pus or putrilage from the
Fallopian tube into the abdominal cavity, following on
abortion artificially produced
„ thrombosis and embolism of lying-in women
„ broncho-pneumonia of lying-in women
„ description of a specimen of ovum in ovo .
„ fibroid tumour situated in the anterior wall of the uterus
and which obstructed laboiu-
„ association of spina bifida with hydrocephalus
„ face presentation ....
„ craniotomy forceps ....
„ spondylolisthesis, witli account of a case of pelvic contrac
tion, from this afi'ection, in which premature labour waf
induced by the author's method
„ — appendix to above memoii'
„ small fibroid tumour ....
„ piliferous cyst of ovary ....
,, address, as President . . . vii, 37 ; viii,
„ fibroid tumour removed by enucleation and excision
„ instriunent for dividing cervix ut«i-i
„ large fibroid tumours expelled spontaneously
„ third case of hydatidiform degeneration of the chorion, asso
ciated with albuminuria
„ dysmenorrhoca, metrorrhagia, ovaritis, and sterility, depend
ing upon a peculiar formation of the cervix uteri, and treat
meut by dilatation or division .
„ — appendix to above, in illustration of the behaviour of the
conical cervix with miniitc os under labour
„ varieties of form imparted to the foetal head by the various
modes of birth
„ laminaria tent introducer
„_uterus after death from a simple tapping
„ voluminous fibroid tumour from uterus
„ presidential address
„ sudden death during labour
25;
rvi,
xix,
XX,
xxiii,
xxiv,
XXV,
x.xv,
XX vi.
11,
255
229
60
177
188
99
165
27
83
311
314
107
111,
iii, 211
iii.
419
iv.
30
iv.
55
iv.
87
V,
171
V,
172
V,
173
V,
277
vi,
78
vi,
98
vi.
101
vi,
249
ix.
18
vii,
55
vii.
72
vii.
113
vii, 117
vii, 120
vii, 150
vii.
171
vii.
207
vii.
207
vii.
228
viii.
25
viii.
40
BARNES. 13
Barnes (E.) (continued) —
„ plan for cauterising cervix uteri .... viii 102
„ mummified foetus expelled after birth of full-term child '. viii] 108
„ abscess in placenta • • . . . viii' 149
„ address as President . . . . . ix' 18
„ history of preguancy complicated with smallpox . . ix' 102
„ uterus of patient after puerperal fever . . . ix' 241
„ uterus and vessels concerned in phlegmasia dolens . . x' 113
„ chorea in pregnancy . . . . . x' 147
„ new method of embryotomy . . . . xi' 126
„ head of child with Hicks's cephalotribe attached . . xi' 191
„ htemon-hage after labour . . . . xi' 219
„ improved anti-hsemorrhagic case . . . _ xii' 271
„ suture for closing the uterine wound in Ctesarean section and
for uniting uterine wound to the abdominal wall , . xii 364
„ modification of Lallemand's porte-caustique and speculum for
introducing medicated wool into vagina . . . xiii 96
„ Mr. De Berdt Hovell's uterine truss for post-partum hemor-
rhage ...... xiii, 129
„ note on tne bursting of intra-peritoneal haematocele into the
peritoneal cavity • • . . . xiii 191
„ Boddaert, of Brussels, lever • • . . xiii' 213
„ iliac artery obstructed by a clot, described by Dr. Williams, of
Truro . . . . . ' . xiii, 213
,, abstract of a memoir on osteo-malacia by Dr. Gaetano Casati,
of Milan .....' xiii, 244
„ the essential cause of dysmenorrhcea as illustrated by cases of
partial and complete retention .... xiv 108
„ fibrous tumour from anterior wall of vagina . . xiv' 309
„ modification of Nevigebauer's speculum . . . xiv' 309
„ note on the mode of dealing with the placenta where gastro-
tomy is performed in order to remove the foetus in extra-
uterine gestation • • . . . xiv 325
„ dermoid cyst ...... xv' 35
„ procidentia uteri and inversion of vagina, with hypertrophic
elongation of cervix . . . . . xv 124
„ for W. H. Kesteven, upper portion of the trunk and head of a
foetus where the arm, face, and foot had presented . xvi, 100
„ — report on ditto • • . . . xvi' 127
„ remarks in the discussion on puerperal fever . xvii, 136' 195
„ dermoid cyst containing hair and several well-developed teeth,
and a firm, jaw-shaped palate of osseous substance ' xvii, 215
„ uterus from a patient, aged 45, married, subject to eczema for
three years ...... xvii, 216
„ large conglomerate of colloid tumours grown from the omentum,
removed by gastrotomy ....
„ further history of ditto .....
„ case of labour with extreme elongation of the cervix uteri
„ report as delegate to the Philadelphia Medical Congress
„ for Dr. Bernard, apparatus for facilitating uterine injections
after labour ......
„ for Dr. Scott, pessary for prolapsus uteri .
„ fiexible galvanic stem .....
„ for Joseph B. BecTc, uterine applicator (Beefs)
„ cancer of the body of the uterus . . . .'
„ two specimens illustrating two forms or causes of intra-pelvic
blood effusions . . . . . xx 101
xvii.
216
xviii,
193
xviii.
293
xix.
2
xix.
118
xix.
119
xix.
136
xix.
136
XX,
28
14
BARNES — BECK.
Barnes (R.) continued —
„ tumour which had been protruded from the rectum during
labour ...... xxi, 28
„ Marshall's new midwifery forceps, each blade rotating on its
axis by means of a pivot joint .... xxi, 90
„ on the use of forceps and its alternatives in lingering labour . xxi, 121
„ remarks in reply ..... xxi, 238
„ on the so-called "missed labour," with a case in illustration xxiii, 81, 110
„ note on the so-called " lithopaedion," being a supplement to
the author's paper on so-called "missed labour" . . xxiii, 170
„ fibro-myoma and a new axis traction vulsellum forceps . xxv, 68
„ hffimorrhagic effusion into an ovarian cyst due to twisting of
the pedicle ...... xxv, IGO
„ on the mechanism of labour, more especially with reference
to Naegele's obliquity and the influence of the lumbo-sacral
curve ...... xxv, 258
„ ovarian tumour with twisted pedicle . . . xxvi, 59
„ cystic disease of ovary in its earliest stage . . xxvi, 157
„ glass injection tube and catheter . . . xxvi, 232
„ report on F. L. Neugebauer's specimens illustrating spondylo-
listhesis . . . ... . xxvi, 186
„ see Barnes, Fancourt.
„ see Edis, A. W.
Babtlett (Hkdlet C), lithopa?dion of fourteen years' duration
successfully removed ..... xlvi, 200
Barton (E. A.), foetus compressus .... xlv, 417
Barton (Henry T.), foetus discharged in the membranes entire
at six months and three weeks .... xxix, 189
Barton (J. Kingston), see Godson, Clement.
Bassbtt (John), cases in practice ; accidental hsemorrhage,
placenta prsevia, rupture of a varix and destruction of the
uterus ...... xiv, 58
„ on the propriety of administering iron during pregnancy as a
preventive of! post-partum haemorrhage . . . xvi. Ill
„ case of general dropsy in a foetus with hypertrophy of the
placenta ...... xix, 261
„ remarks in the discussion on the \ise of forceps . , . xxi, 192
„ see Galahin.
Batohelob (F. C), see Alban Doran.
Battet (K.), treatment of vesico- vaginal fistula by a new
method . . . . . . i, 275
Battte (R. F.), ovarian tumour, weighing 76^ oz.,in a girl, aged
12^, terminating life suddenly by asphyxia . . ii, 280
„ short examination of certain uterine affections, especially
those accompanied with leucorrhoeal discharge, in their
relations to phthisis pulmonalis . . . viii, 237
BAUDELOCftUE CEPHALOTEIBE presented to the Society by Sir
Charles Locock .....
Beach (F.), uterus and ovaries of child who died of tubercular
meningitis ......
Beale (Arthur A.), see Alhan Doran.
Beale (George B.), see Doran.
Beck (Joseph R.), see Barnes, Robert.
vii, 208
XV, 57
BECK — BITCH. 15
Beck (Snow), remarks in the discussion on puerperal fever . xvii 240
„ uterus in a case of puerperal fever . . ' vi' 186
„ puerperal fever . . . ' ' ^^^' g^
„ enlargements of the uterus which follow abortions, premature
or natural confinements ; with cases . . _ y^^j g^
„ puerperal fever, or puerperal pyemia after an alDortion • with
remarks • . . . ' • 07-
„ uterus and appendages of pregnant woman who died from
convulsions dm-ing typhus fever . . xiii 239
„ sti-ueture of the uterus and the changes the tissues undero-o
during pregnancy and after parturition . . ° xiii 290
„ pelvic haematoma or retro-uterine haematocele ; with remarks
especially as to the source of the haemorrhage . xiv 260
BECK'S UTERINE APPLICATOR (R. Barnes) . . [ xix^ 136
BED for cases of puerperal hyperpyrexia requiring continuous
application of cold (W. S. Playfair) . . . xx 171
BED-PAN, earthenware, to allow of free ablution (W. Squire) . xv' 163
BEDSORE, acute, following parturition (G. F. Blacker) . , xl,' 247
Bell (J. H.), ruptured vagina during labour ; child in abdomen
three and a half hours ; pelvic cellulitis ; recovery . iy 197
Bell (E. H.), puerperal eclampsia, with autopsy and remarks xliv' 253
„ " paratubal " hsematocele . , ' xliv' 3^2
„ cyst in connection with the right Fallopian tube, arising pro-
bably from an accessory Fallopian tube . . xlvi 21
„ torsion of the pedicle in hydrosalpinx, and other morbid con-
ditions of the Fallopian tube • . . . xlvi 152
„ on the appearance of thyroid-like structures in ovarian cysts ". xlvii' 242
„ further history of a case of degenerating fibro-myoma and
^IT^Tm^^T''^ xlviii, 199
,, see /. D. Malcolm. '
BELLADONNA, action of, upon the mammary glands (R. Marley) ii, 29
BELT, Bailey's patent abdominal (Heywood Smith) . . xix' 41
„ for use after ovariotomy (Heywood Smith) * ', xxii' 45
Bennet (Henrt), remarks in the discussion on the use of forceps xxi' 193
„ on the OS uteri internum, its anatomy, physiology and
pathology . . mrv
^ 0:1 ' • . . . . XXV, 219
Berkeley (Comyns), rupture of an ovarian abscess twelve hoiu-s
after labour ••.... xliv 73
„ spontaneous expulsion . . . * ' ^^jjy' ggo
„ parovarian cyst with twisted pedicle . '. \ xlvi' 242
BERLIN, Obstetrical and Gynaecological Society, letter from xxxix 85
„ - reply . . . . ^ ^^^.^^ ^25
Bernard (Dr.), see Barnes, Robert.
Berry (Samuel), two cases of obstrvicted labour, with remarks . vii, 261
BiBBY (S. H.), cast of antique group representing the circum-
stantials of labour in very early times . . . xvi 243
BINDER, axis pressure, for use during labour (J. L. A. Avmard") x^xii 17^
„ obstetric (H. E. Eastlake) . . . vi' ^05
„ the effect of, upon the change in size of the chest and abdo-
men during the lying-in period (G. E. Herman) . . xxxii, 108
BITCH, specimen preserved in formalin of an early gestation in
both horns of the uterus of (Amand Eouth) . . xli, 5
16
BLACK — BLADDER.
Black (J. Watt), puerperal fever and septic poisoning . xxxiii, 76
„ annual address as President . xxxiii, 76 ; xxxiv, 33 ; xxxv, 47
Blacker (G. F.), uterus with placenta praevia marginalis in situ xxxvi, 194
„ ruptiired uterus ..... xxxvi, 316
„ uterus with fibroid tumoivrs and carcinoma of the cervix
removed post mortem from a patient on whom eight years
previously the operation of oophorectomy had been per-
formed ..... xxxvii, 213
„ and T. W. P. Lawrence, a case of true unilateral hermaphro-
ditism with ovotestis occm-ring in man, \vith a summary and
criticism of the recorded cases of true hermaphroditism xxxviii, 265
„ treatment of placenta previa by Champetier de Ribes' bag . xxxix, 13S
„ case of acute bedsore follomng partiu-ition
„ fibro-adenoma removed from the cervix
„ spinal column exhibiting want of ossification in the inter-
articular portion of the lumbar vertebrae .
„ frozen sections of a iiterus at the tenth week of pregnancy,
showing haemorrhages into the placenta, decidua reflexa, and
decidua vera, from a patient who died of heart disease
„ uterus removed by vaginal hysterectomy fourteen days after
the operation of curetting and steaming had been performed
„ chorion-epithelioma of the uterus, with secondary growths in
the vagina, the lungs, and the liver
„ a case of uterus unicornis and right appendages removed
from an epileptic subject ....
„ a specimen of tubo-abdominal gestation at the fourth month
of pregnancy removed by abdominal section
„ suppiu'ating fibroid tumour of the uterus .
„ chorion-epithelioma of the uterus ; lutein cysts in both ovaries
xl, 247
xli, 374
xlii, 90
xlii, 235
xlv,
xlvi,
xlviii.
80
55
xlviii, 137
xlix, 100
xlix, 104
BLADDER, cast of membrane from female (J. H. Aveling)
„ cedar pencil, extracted from (J. J. Phillips)
„ dilatation and hypertrophy of, in a fojtus (F. A.T. O'Meara) .
„ displacement of, as a cause of tedious labour (W. H. Broad-
bent) ......
„ distension of, and ascites in a foetus, necessitating embryotomy
(A. L. Galabin) . . . . .
,, — considered as a cause of post-partum haemorrhage (J. L.
Earle) ......
,, — displacement of the uterus by (J. B. Hicks and J. F. Good-
hart) ......
„ enlarged, in a case of double pyosalpinx with secondary renal
complication (H. Macnaughton Jones)
„ exfoliation of mucous membrane of (Alban Doran) .
„ extraction of a hairpin from that of a female (P. Smith)
„ extroversion of (D. L. Koberts) ....
„ — and other malformations (H. C. Eose) .
„ — (F. H. Champneys) .....
„ female, cast of (T. Spencer Wells)
„ — exfoliation of (G. Harley) ....
„ — sho-wing the results of retention of urine after delivery (T.
Spencer Wells) .....
„ gangrene of base of (G. E. Herman)
„ — from retroversion of the gravid uterus (Ad. Easch)
„ hair-pin from, of young girl (T. C. Hayes) .
„ intra-peritoneal rupture of, occurring during labour (C. E.
Porter) ......
XXV, 33
xiv, 37
xxix, 54
v, 44
xix, 119
V, 291
xviii.
194
xxxix.
319
xxiii.
2
X,
69
xii.
361
XV,
125
xxiv.
240
iii.
417
iv.
13
iii.
354
xxix.
244
xxxi.
129
xxxv.
185
xlix, 170
BLADDER — BLAND-SUTTON.
17
V,
xli,
xxxiv,
XX,
xxxiv,
xiv,
xxxiv,
xxxiv,
xxxiv,
xxxiv,
xxxiv.
BLADDER (co^itinned)—
„ irritable, in the latter months of pregnancy (W. S. Playfair) . xiii,
„ malformation of (A. E. Giles) .... xxxiv,
„ perforation of wall of, by large foreign body in the vagina (C.
H. Carter) ...... xxii, 38
„ sloughing and separation of the mucous lining of, after delivery
by forceps in a face presentation (W. Martyn)
„ tumour closely simulating a papillomatous ovarian cystoma
attached to the front of (J. D. Malcolm) .
„ and ureters, dilatation of, from pressure, in an infant (W,
McAdam Eccles) ....
„ and urethra, female, two cases of repair of (Lawson Tait)
Blake (C. Paget), protracted gestation
Blake (J.), modification of Hodges' pessary .
Bland-Sutton (J.), ovarian dermoid
„ — infiltration of broad ligament with fat .
„ hydrosalpinx undergoing spontaneous cure
„ ovarian hydrocele containing papillomata .
„ tubal pregnancy, rupture into broad ligament
„ on a case of tubo-uterine pregnancy ; primary intra-peritoneal
rupture; recovery .... xxxvii,
„ myomata of the neck of the uterus . . . xxxix,
„ abdominal hysterectomy for myoma of the viterus ; with brief
notes of twenty-eight cases ....
„ on a case of tubo-abdominal pregnancy in which a living foetus
was extracted by coeliotomy after term, and the mother's life
preserved .....
„ on some cases of tubal pregnancy
„ ovary containing a calcareous ball^ probably a large calcified
corpus fibrosum ....
„ acardiac from a cow ....
„ unusual example of rupture of an ovarian adenoma .
., rotation and impaction of a myomatous utei'us
„ tumour of the mesometrium weighing 22 lb.
„ myomatous uterus weighing 26 lb. successfully removed
from a woman aged 74 . . . . . xli, 300
„ tubal abortion in which the " mole " was in process of extru
sion at the time of operation .... xlii,
„ gonorrhoeal pelvic peritonitis • . . . xliii,
„ tubal pregnancy diagnosed before rupture, and a case of tubal
abortion ...... xliv
„ primary cancer of the Fallopian tube . . . xliv]
„ two cases of extra-uterine gestation which went to term . xliv,
„ — illustrating changes in fibroids after the menopause . xlv,
„ ovarian dermoid with a twisted pedicle six inches in length . xlvi,
„ acvite axial rotation of a calcified fibroid of the uterus . xlvi,
„ pregnancy in a uterus with fibroids : panhysterectomy during
labour in the seventh month ....
„ tubercvilosis (probably primary) of the body of the uterus in
an adult .....
42
129
186
226
250
88
28
137
5
7
9
215
217
296
160
xxxix, 292
„ fibroids of the uterus complicated by cancer of the corporeal
endometrium ......
„ a villous tumour of the body of the uterus in a woman, aged
84 ; vaginal hysterectomy
„ uterus four years after Caesarean section .
„ see also Sutton (J. Bland).
xl,
xl,
xl,
xli,
xli,
xli,
xli.
308
313
223
97
98
296
298
xlvi,
xlvii,
xlviii.
xlix,
xlix.
311
251
44
311
316
105
147
149
238
72
140
46
174
18 BLEEDINC BOTTOMLEY.
BLEEDING after the menopause, two specimens of fibroid asso-
ciated -with (A. H. N. Lowers) .... xlix, 270
BLOOD, circulation of the, in the uterus, with some of its ana-
tomical and patholo^cal bearings (John Williams) . xxvii, 112
„ concretions in the ovary (Alban Doran) . . . xlj 214
„ intra-pelvic effusions of, two specimens illustrating two forms
or causes of (R. Barnes) .... xx, 101
„ mixture of various fluids with, in transfusion (E. A. Schafer) xxi, 316
„ right ovary and tube distended with (Wm. Duncan) . xxxii, 306
„ see Transfusion of blood.
BLOOD-SWELLING, cranial, with remarks on the nature of these
tumours (E. Rigby) . . . . . i, 231
Bluett (G. M.), case of congenital hydrocephalus complicating
labour ...... xxix, 396
„ insei-tio velamentosa ..... xxix, 511
„ and G. E. Herman, microscopical sections of tumours of foetal
membranes ...... xxix, 243
„ report on ditto by committee (A. L. Galabin, G. E. Herman,
and Alban Doran) ..... xxix, 512
„ see Herman {G. E.).
BLUNT-HOOK, considerably modified (T. Lazareivitch) . . xviii, 190
„ and sling, new form of, for assisting delivery in cases of breech
presentation (J. G. Swayne) .... xvii, 313
BODKIN nucleus of a phosphatic calculus (Amand Routh) . xxxv, 240
BONE, occipital, repoi-t of a specimen showing origin of gluteus
maximus from (L. Remfry) .... xxxvi, 227
BONES from an extra-uterine foetation which had undergone
spontaneous cure (Sir W. O. Pi-iestley) . . . xxi, 24
„ macei-ated, of a foetus from an extra-uterine gestation retained
seven years (J. D. Malcolm)
BONNET MONKEY, sections from the uterus of (A. W. Addinseil)
BoNNEY (William Francis Victor), uterus bicornis unicollis
„ solid tumour of the left ovary with an attached cyst communi-
cating with the left Fallopian tube
„ probable case of superfcetation
„ uterus and vagina with the child in situ in the second stage of
labour .....
„ dermoid cyst containing a large number of epithelial balls
„ and A. G. R. Foulerton, primary infection of the puerperal
uterus by Diplococcus pncumoniaB
„ uterine myoma undergoing red degeneration
„ abscess in the uterus .....
„ and A. G. R. Foulerton, an investigation into the causation
of puerperal infections ....
„ ruptured ovarian cyst with twisted pedicle
„ uterus removed for (?) malignant overgrowth of the endo-
metrium ......
„ treatment of ovarian prolapse by shortening the ovarian
ligament ......
BONY GIRDLE from a dermoid tumour (S. W. Wheaton)
BOSSrS DILATOR (M. Handfield-Jones)
Bcfl-OMLKT (F. C), deformed foetus ....
„ foetus compressus s. papyraceus .
xli.
223
xli.
141
xliii.
77
xliv.
92
xliv.
163
xliv.
292
xliv,
354
xlv.
128
xlv,
464
xlvi.
2
xlvii.
11
xlvii.
190
xlvii.
191
xlviii.
339
xxxv.
4
xlv.
103
xxxix.
134
xxxix.
134
ix.
12
xxi.
117
xxiii,
125
xxiiij
260
XXX,
198
xxxii.
367
xxxii.
380
xxvii.
123
xxvi,
58
xxvi.
59
xxviii.
209
BOULTON — BOYD. 19
BouLTON (P.), paraplegia occurring during pregnancy .
„ extra-iiterine foetation .....
„ case of imperforate vagina ....
„ case of conjoined twins .....
„ for James Armstrong, the alplia constant current syringe
„ calculi from a case of prolapse of the titerus and bladder
„ the purse-string suture, its use in complete rupture of the
perineum ......
BousQUET (F.), note on a case of absence of the uterus and
occlusion of the vagina ....
BoxALL (Robert), adherent placenta
„ cyst of placenta .....
„ incomplete pericardial sac, escape of heart into left plevu-al
cavity ......
„ scarlatina dtu-ing pregnancy and in the puerperal state xxx, 11, 126, 167
„ the conditions which favour mercurialism in lying-in women,
with suggestions for its prevention . . . xxx, 301-
„ pelvic liEematoma following delivery, death four hours after
labour . . . . . . xxxi, 303
„ fever in childbed. — Part I. — General hygiene and antisepsis xxxii, 219, 275
„ early placenta with localised hydatidiform degeneration . xxxiii, 494
„ ruptm-ed uterus ..... xxxiv, 11
„ placenta praevia associated with unusual size and shape of the
placenta ...... xxxiv, 464
„ fever in childbed. — Part II. — The relation of external meteoro-
logical conditions to the incidence of febrile illness in child-
bed ...... XXXV, 340
„ rapidly growing soft fibro-myoma in left broad ligament . xxxv, 410
„ uterine fibroids removed by enticleation fifteen days after
delivery ...... xxxvi, 64
„ incarcerated ovarian dermoid ; Csesarean section, and removal
of tumour at the end of the first stage of labour . . xl, 25
„ uterus with interstitial fibroid from a case of placenta preevia
centralis . . . . . . xl, 338
„ dermoid tumovirs of both ovaries ; tAvisted pedicle . . xli, 6
„ foetus with anasarca and large placenta . . . xlii, 98
„ cystic fibroid with carcinoma of left ovary and right Fallopian
tube ...... xliii, 71
„ acute inversion of the uterus ; spontaneous reposition . xlvi, 292
„ mortality in childbed both in hospital and in general practice xlvii, 196
„ extra-utei-ine gestation sac ruptured in the fifth month of
pregnancy ...... xlvii, 297
„ after-history of " a case of cystic fibroid with carcinoma of
left ovary and right Fallopian tube " (brought before the
Society five years ago) .... xlviii, 136
Boyd (Florence Nightingale), fibroma of ovary . . xliv, 176
„ two cases of abdominal hysterectomy for fibroids, complicated
by pregnancy ; with specimens .... xlvi, 106
„ necrobiotic fibroid ..... xlvi, 198
„ pregnant uterus with cancerous cervix removed by pan-
hysterectomy ..... xlvi, 345
„ fibroid of broad ligament .... xlvi, 348
„ malignant growth of cervix in a girl aged 18 . . xlvii, 313
„ pregnancy in the right cornu of a fibroid uterus . . xlix, 49
„ adeno-carcinoma of the ovary . . . xlix, 50
Boyd (Sidney), unusual case of inversion of the uterus . xlv, 170
20 BOYD — BROAD LIGAMENTS.
Boyd (Stanley), suppurating fibroid tumour of the uterus . xliii, 172
BozEMAN (N.), instruments for the operations of atresia vaginae
and vesico-vaginal fistula .... xix, 96
BRAIN from a case of puerperal septicaemia (Wm. Duncan) . xxxi, 202
J, showing thromboses in the cerebral veins and hemorrhage
into the internal capsule in a case of ingravescent hemiplegia
during pregnancy and parturition (P. Horrocks) . . xxxiii, 201
Braithwaite (James), on a new mode of treating certain cases
of reti'oflexion of unimpregnated uterus . . . xix, 122
„ on digital dilatation of the os in labour . . . xxi, 38
„ non-capsulated fibroids resembling retained placenta . xxiii, 182
„ case of gastrotomy for extra-uterine gestation in wliich the
placenta never came away .... xxviii, 33
„ adenoma of the portio vaginalis uteri, forming a depressed
sore or ulcer ...... xxxvi, 208
„ on atrophy with collapse (cirrhosis), fibroid degeneration, and
angioma of the ovaries .... xxxvi, 325
BRANDY, substitute for, in cases of exhaustion (E. Druitt) . iii, 143
Braun (Carl), blunt-pointed hook, crooked trephine and cranio-
clast ...... XV, 58
BREASTS, abscesses of, prevention of, by the application of the
principle of rest (W. B. Woodman) . . . xvii, 9
„ absence of uterus and (L. Remfry) . . xxxvii, 12
„ dark crescentic pigmentation rovind both nipples (Clement
Godson) ...... xvii, 343
„ eczema of the nipple in both (Thos. Chambers) . . xxii, 266
„ glands of, action of belladonna upon the (R. Marley) . ii, 29
„ hypertrophy of (J. A. M. Moullin) . . . xxv, 212
„ inflammation of, and milk abscess (T. W. Nunn) . . iii, 197
„ lymphangitis mammfe — an affection arising about the tenth
day of the puerperium with well-marked clinical featvues
(R. H. Vincent) ..... xliv, 158
„ supporter, linen (W. Squire) . . . . xv, 163
BREECH PRESENTATION, see Parturition.
BREISKY'S KYPHOTIC PELVIS, remarks on (F. H. Champneys) . xxiv, 242
BREPHOTOME, forceps, and blunt hook . . xxxvii, 243
Brewer (A. H.), labour complicated with an ovarian cyst . xx, 184
BRiaas (H.), chorion-epithelioma .... xlv, 239
„ primary cancer of the right Fallopian tube; right ovary
normal ...... xlvi, 60
„ ovarian pregnancy ..... xlix, 222
„ early tubal mole ..... xlix, 223
„ fibroid tissue formed around a needle and removed from the
left labium majus ..... xlix, 223
BRIGHT'S DISEASE during pregnancy (G. E. Herman)
xxix, 539 ; xxx, 478 ; xxxii, 320, 349
„ six more cases of pregnancy and labour with (G. E. Herman) . xxxvi, 9
Beoadbent (W. H.), abortion, with albuminuria and convulsions,
six successive pregnancies (under Dr. Tyler Smith) . i, 108
„ displacement of the bladder as a cause of tedious labour . v, 44
BROAD LIGAMENTS, accessory adrenal bodies in (J. H. Targett) . xxxix, 157
„ iigature and division of the upper part of both, and the result
as compared with that following removal of the uterine
appendages (L. Remfry) .... xxxvi, 202
BROAD LIGAMENTS—BROOK. 21
BROAD LIGAMENTS (coniinued)—
„ mesosigmoid, and mesocaecum, ovarian cyst which had made
its way between the layers of both (W. H. B. Brook) . xlv, 415
BROAD LIGAMENT, cancerous pelvic tiimour, commencino- in the
oitter cellular tissue of the (T. C. Hayes) . . ° xvi 102 127
„ carcinomatous tumour originating in the (T. C. Hayes) ' xvi' 101
„ cyst of (J. Knowsley Thornton) ! . ^ ' ' xxvi 55
„ — (E. Malins) .... " „„„:' goo
" - ^i^h septa (W. S. A. Griffith) . . , \ ^^.ii,' 251
"- ^'V^^^^^) , xxxiii,157
„ — (C. E. Piu-slow) ..... xli, 169
„ cyst, with torsion of the pedicle and extensive hsemorrhao'e
into the broad ligament (F. J. MeCann) . . '' xlviii 179
„ fibroid of (F. N. Boyd) . . . . .' ' xlvi' 348
„ — A^eighmg 44^ lb. (20 kils.), removed by enucleation •
recovery (Alban Doran) • . . '. xli 173
„ — associated with an ovarian cyst (A. Doran) . . xliii' 200
„ after-history of, fibroid of, associated Avith an ovarian cyst]
reported in the forty -third volume of the Society's ' Trans-
actions' (A. Doran) ..... xlix 94
„ fibroid of, weighing 4^ lb., with twisted pedicle (A. H. N.
Lewers) . . ^i- ^a*
/.I '«.,.,■ • • • . xuv, 3o4
„ hbroma of, weighing 44 lb. 8 oz., successfully removed from a
woman aged 28 (A. Doran) . xl 295
„ fibro-myoma of (W. A. Meredith) . . .* xxix, 249^ 514
„-- (M. Handfield- Jones) . . . xxxv 239
„ — large soft, weighing 14 lb. (E. Maclean) .* ' " \\ 134
„ oedematous subperitoneal fibro-myomata of uterus in, removed
by abdominal hysterectomy (C. J. Cullingworth) . . xl 302
„ degenerated fibro-myoma weighing over 17 lb. enucleated from"
nine hours before delivery at term (H. E. Spencer) .' xlvi 122
„ pedunculated fibro-myoma of, with twisted pedicle (C J
Cullingworth) . . , ' "xxxvii 222
„ hydatids of, or connected with, right (C. J. CuUingworth and
H.H. Glutton) • • . . . xlvi 254
„ infiltration of, with fat, in a case of ovarian dermoid (J Bland-
^^^^'^^^ ••.... xxxiv 7
„ left, and left Fallopian tube, sac formed by, in a case of extra-
uterine pregnancy (C. J. Cullingworth) . . xxx 480
„ large myoma of left (Wm. Duncan) . . .' xxxi' 309
„ phlegmon of the, post-mortem appearances of (A. H. N. Lewers) xxx' 7
„ rapidly growing soft (R. Boxall) ... xxxv' 410
„ rupture of tubal pregnancy into (J. Bland Sutton) . ' xxxiv' 217
Brodie (G. B.), report on C. H. Carter's specimen of six months'
fcetus which lived for twenty-one hours . . xvi 253
BROMIDE OF POTASSIUM in puerperal mania (J. B. Curgenven) ix' 155
BROMINE, cancer of the womb successfully treated by (A W
Williams) . . . . . xii 249
„ epithelioma of lip treated by injection of (A. W. Williams) xiii' 97
BRONCHO-PNEUMONIA of lying-in women (R. Barnes) . . iv^ 55
Brook (W. H. B.), primary tuberculosis of the cervix uteri for
which vaginal hysterectomy was performed . xlv 185
„ ovarian cyst which had made its way between the layers of
the mesosigmoid, both broad ligaments, and the mesoctecnm xlv 415
„ further note on a case of primary tuberculosis of cervix xlvi' 265
„ three cases of glycosuria of pregnancy . . xlviii' 192
22
BROOKES BRUNTON.
Brookes (E.), dissection and description of J. Palfrey's specimen
of monster ...... xix, 98
Brown (Andrbw), extra-uterine pregnancy ; rupture of the cyst
and death . . • • • . xi, 7
Brown (C. E.), remarks in the discussion on puerperal fever . xvii, 153
Brown (Geo. D.), malignant tumour of omentimi . . xviii, 24
Beown (I. Baker), fibrous tumour of uterus, illustrating a
siirgical operation for the cure of this affection . . i, 329
„ ruptured perinaeum, and birth of the cliild between the os
vaginae and anus . . . . . ii, 197
„ fibrous tumours of the uterus treated by surgical means . iii, 67
„ five cases of ovariotomy ..... iii, 352
„ retained menses of two years' duration caused by atresia
vaginae ; puncture of the uterus by the rectum ; recoveiy . iv, 21
„ ovariotomy, the mode of its performance and the results
obtained at the London Surgical Home . . . iv, 59
„ vesico-vaginal fistula, the mode of operating and the results
obtained in fifty-five cases at the London Surgical Home . v, 25
„ sequel to a case in vol. iv (p. 21) of the ' Transactions' of re-
tained menses of two years' duration, caused by atresia
vaginae, treated by puncture of the uterus from rectum . v, 162
„ stone in the female bladder ; vaginal lithotomy . . v, 217
„ ovarian dropsy treated by tapping and pressure ; apparent re-
covery for three and a half years j return of disease ; ovario-
tomy : recovery . . . . . v, 279
„ fibroiis tumours of the uterus, treated by surgical means . vi, 21
„ complete extirpation of the uteriis and ovaries, with large
fibrous tumours . . . . . vi, 249
„ new method of securing the pedicle in ovariotomy . . vii, 28
„ mixture of chloroform for production of anaesthesia . . vii, 208
„ child born with amputated extremities . . . viii, 102
„ use of the actual cautery in ovariotomy illustrated by eleven
cases ...... viii, 109
„ notice of the Council's recommendation of removal from the
Society of . . . . . . ix, 56
„ special meeting for considering removal from the Society of . ix, 61
BRITISH LYING-IN HOSPITAL, puei-peral fever in (W. G. Hewitt) x, 69
BRUIT, uterine, observations on the (F. H. Champneys) . xxviii, 188
Brunton (John), placenta with round tumovu"s in centre . viii, 275
„ — the subject of extreme fatty degeneration . . ix, 85
„ — with fibrinous deposits . . . . x, 20
„ presentation of right breast, followed by prolapsus of the cord
and right arm ; delivery by version . . . x, 145
„ placenta with knotted cord . . . . xi, 54
„ observations and remarks on cases of twins . . xi, 67
„ cases of twins in which, while the first child presented natur-
ally, there was placental presentation with the second . xii, 167
„ case where the entire ovum was expelled at the seventh month ;
the child I'escued alive ..... xiii, 88
„ fibrous enlargement of the uterus successfully treated by ergot
of rye ...... xiii, 282
„ remarks in the discussion on puerperal fever . . xvii, 148
„ case of extreme dropsy, fatty degeneration, and friability of
the placenta . . . ■ . . xvii, 175
„ infant suffering from double cephalhaematoma . . xx, 293
BRUNTON — CESAREAN SECTION.
23
Brunton (John) {contimied) —
„ specimen of a rare form of foetal monstrosity . . xxi, 118
„ foetal head, plaster casts of . . . . xxiii, 206
Bryant (T.), ovariotomy, with remarks . . . vi, 35
„ Caesarean section taken from the posthumous papers of the
late T. E. Bryant . . . . . vi, 197
„ fibro-cystic disease of viterus and both ovaries ; extirpation of
the whole ; recovery ..... xiv, 79
BuCKELL (Edward), specimen of transposed viscei-a from a preg-
nant woman, post-mortem Csesarean section, the child saved .
Bedin (P.), and A. Pinard, model phantom for obstetric classes
(F. Barnes) . .
BuDiN (Paul), on a diagnostic sign of vaginal haemon'hage
during partiurition .....
BuRCHELL (P. L.), turning in cases of contracted brim .
BUEMESE, midwifery among the (J. F. Pedley)
Burton (Arthur), deformed foetus .
Burton (W.), extra-uterine pregnancy
Butler-Smythe (A. C), fibro-cystic tumour of uterus .
„ dermoid cyst of the ovary
„ double pyosalpinx ....
„ dermoid cyst containing pill-like bodies
„ tubal gestation ; incomplete tubal abortion ; haemorrhage ;
operation ; recovery . . . . . xl, 298
„ carcinomatous uterus removed eighteen and a half years sub-
sequent to double ovariotomy .... xliii, 214
179
xix, 229
ix, 232
XXV, 61
. xxix, 5
xl, 217 ; xli, 339
. xxiii, 34
. xxix, 350
. xxxiii, 463
. xxxiv, 24
XXX vii, 15
CiESAEEAN SECTION (J. G. Swayne)
„ (J. B. Hicks) .
„ (H. Gibbons) .
„ (R. P. Harris) .
„ case of (J. Braxton Hicks)
„ — (C. J. CuUingworth) .
„ (A. D. Leith Napier)
„ — discussion ......
„ taken from the posthumous papers of the late T. E. Bryant
(T. Bryant) .....
„ recovery of mother ; child not viable (W. Newman) .
„ report of a case of, with remarks (D. L. Roberts)
„ in a dwarf, who died three days after from peritonitis (J
Braxton Hicks) ....
„ in 1866, subsequent natural pregnancy and delivery (W
Newman) ......
„ followed by vaginal hysterectomy for carcinoma of the cervix
complicating labour at term (J. M. Munro Kerr) .
„ in a case of epithelioma of the cervix uteri complicating preg
nancy (A. W. Edis) ....
„ for contracted pelvis (F. H. Champneys) .
„ — (C. J. CuUingworth) .
„ — (John Shaw) .....
„ in cases of contracted pelvis, based upon a series of thii-ty
cases (J. M. Munro Kerr)
„ for deformed pelvis (J. W. J. Oswald)
„ in a case of extreme distortion of the pelvis (R. Greenhalgh)
V, 84
45 ; xi, 99
xiii, 131
XV, 166
XX, 106
xxix, 252
xxxiv,, 105
xxxiv, 138
vi, 197
viii, 343
ix, 250
xxi, 253
xiv, 142
xlvii, 194
xxiv, 304
xxxi, 136
xxxiv, 89
xxxiv, 98
xlvi, 309
xvii, 378
vii, 220
24
CESAREAN SECTION — CANOEE.
xl, 25
xlviii, 240
xlviii, 313
xxix, 98
xxxi, 89
xviii, 286
xviii, 252
CJESAREAN SECTION (continued)—
„ and removal of incarcerated ovarian dermoid at the end of the
first stage of labour (R. Boxall) ....
„ and total abdominal hysterectomy for fibroids complicating
labour near term in a patient who had recovered without
operation from ruptured tubal pregnancy (H. R. Spencer)
„ followed by removal of a fibroid which filled the pelvic cavity
(H. R. Andi-ews) ....
„ fibro-myoma from (P. Horrocks) ....
„ mortality of (A. L. Galabin) ....
„ case of, on account of extensive malignant disease of the
cervix uteri (A. L. Galabin) ....
„ performed on account of cicatricial obliteration of the vagina
(A. L. Galabin) .....
„ post-moHem, in a case of transposed viscera, the child saved
(G. Buckell) . . . .
„ segment of uterus after (W. S. A. Griffith).
„ suture for closing uterine wound in, and for uniting it to the
abdominal wall (R. Barnes) ....
„ uterus after (R. Greenhalgh) ....
„ — four years after (J. Bland Sutton) . .
„ — ovaries, and tubes from a case of (C. J. CuUingworth)
„ — with kidneys and ureters, from a case of (W. Duncan)
„ ruptured uterus at term through scar of old (J. H. Targett) .
„ and craniotomy, comparative merits of (R. Greenhalgh)
,, — remarks on the relative position of (A. H. N. Lowers)
CALCAREOUS degeneration, fibroma of the ovary undergoing
(C. Hubert Roberts) .....
„ — fibrous tumour of the uterus in a state of (G. Roper)
„ — of placenta (F. H. Champneys)
„ intra-mural tumour impeding labour (Wynn Williams)
CALCIFICATION of arteries, in large fibrotic uterus (J. S. Fair-
bairn) ......
„ occurring in a fibroid of the uterus (M. Handfield-Jones)
CALCULI, UKINARY : URETHRAL.
„ — embedded in the female urethra (J. Matthews Duncan) .
„ — phosphatic, produced by retention of a Zwancke's pessary
for six years (A. L. Galabin) ....
„ — (A. Routh) .....
„ URINARY : VESICAL.
„ — multiple, the sequel of prolapsus uteri (A. L. Galabin)
„ — several from a case of old-standing prolapse (Aust Law-
rence) ......
„ — from a case of old-standing prolapse (Percy Boulton)
„ — from a case of procidentia (Aust Lawi-ence)
„ — vaginal lithotomy (I. Baker Bi'own)
„ URINARY : VESICO-VAGINAL.
„ — (Clement Godson) ....
CALCULUS, URINARY : vesical.
„ — phosphatic, and bodkin nucleus (Amand Routh) .
„ — from female (T. Spencer Wells)
Callender (G. W.), remarks in the discussion on puerperal
fever .....
Cameron (Dr.), remai-kable development of an infant .
CANCER, colloid tumours, a large conglomerate of, grown from
the omentum (R. Barnes) . . . xvii, 216 ; xviii, 193
xix.
179
xxix.
298
xii.
364
ix.
241
xlix,
174
xxxi.
308
xxxiv,
127
xlii.
242
vii.
270
xxxiv.
IGl
xxxix.
8
xix.
255
xxiv.
190
xvii.
172
xlvii.
299
xxxv.
2
xxiii,
109
xix,
201
xxvii.
3
xxii,
,106
xxxii,
,366
xxxii.
.367
XXX,
,227
V,
,217
xxvij
, 181
XXXV,
,240
iii.
.285
xvii,
, 162
xviii
, 115
DANCER.
25
CANCER (continued) —
„ primary, of the Fallopian tube, glandular strneture in the
substance of (Alban Doran) .... xxx,
„ (A. Eouth) ..... xxxi,
„ — of the Fallopian tubes, unreported case of, in 1847, with
notes on primary tubal cancer (Alban Doran) . xxxviii,
„ — of the Fallopian tube, tables of cases, reported up to
present date (April, 1898) (Alban Doran) . . xl,
„ (Alban Doran) ..... xlii,
„ (J. Bland-Sutton) .... xliv,
„ (H. E. Andrews) ..... xlv,
„ — of the right Fallopian tube; right ovary normal (H
Briggs) ...... xlvi,
„ — of the ovary (A. L. Mcllroy) .... xlviii,
„ cystic fibroid with carcinoma of left ovary and right Fallopian
tube (R. Boxall) ..... xliii, 71
„ of both ovaries primary to carcimona in the muscular wall of
the uterus (C. Lockyer) .... xlvi,
„ case of supposed, of both ovaries (J. L. Worship) . . xix,
„ of ovary extending to uterus and rectum (J. "VV. J. Oswald) . xviii,
„ extirpation of the uterus for (W. Duncan) . . xxxiii,
„ of the womb successfully treated by bromine (A. W
Williams) .....
„ of the uterus (R. Barnes)
„ — and appendages in a case of (T. C. Hayes)
„ -- with extreme degeneration without marked pain (W
Squire) .....
„ — epithelial (Clement Godson) .
„ — liistology of (A. L. Galabin) .
„ — microscopic sections of (A. H. N. Lowers)
„ — removal by Schroeder's operation (Wm. Duncan)
„ — vaginal extirpation for (A. W. Edis)
„ (A. L. Galabin) ....
„ (W. S. Playfair) ....
„ (Wm. Duncan) ....
„ — four cases of (C. J. Cullingworth)
„ — (W. S. Playfair)
„ — (J. D. Malcolm) ..... xlvii,
„ — (C. H. Roberts) ..... xlviii,
„ — fibroid tumoiirs and (Amand Routh) . . xxxviii,
„ — with fibroid tumour (A. L. Galabin) . . . xlv,
„ and fibroid in the same uterus (M. Handfield-Jones) . xlvii,
„ and fibro-myoma co-existing in the body of the iiterus (M
Handfield-Jones) ..... xlvi,
„ of the body of the uterus (A. H. N. Lewers) . . xxxiv,
„ — (M. Handfield-Jones) . . . . xl,
„ — abdominal pan -hysterectomy for (A. H. N. Lewers) . xliv,
„ — vaginal hysterectomy for (A. H. N. Lewers) . . xxxvi,
„ — simiilating fibroid in a woman, aged 86 (H. R. Spencer) . xlvi,
„ of the uterine body, illustrating the difficuly of diagnosis
between this disease and senile endometritis (G. Ernest
Herman) ...... xxxiii,
„ cylindrical or adenoid, of the body of the uterus removed by
enucleation (A. L. Galabin) .... xxviii,
„ keratinising, of the body of the viterus (A. H. N. Lewers) . xlv,
„ of the corporeal endometrium complicating a case of fibi'oids
of the uterus (J. Bland-Sutton). . . . xlviii.
XX,
XX,
xxiii,
xxviii,
xxvi,
xxvii,
xxix,
xxxi,
xxxii,
xxxii, 136, 141,
xxxix.
194
200
322
197
6
311
54
60
251
302
235
122
157
249
28
293
85
29
161
206
27
2
300
227
306
174
288
10
311
99
102
337
305
213
34
10
374
235
31
4
97
140
26 CANCER — CANCEROUS.
CANCER (continued)—
„ independent, of the body and of the cervix uteri (Amand
Eouth) ..... xxxviii, 100
„ secondary hepatic, case of pregnancy complicated by (John
Phillips) ...... xxix, 378
„ multiple medullary, complicated with (T. H. Tanner) . iv, 243
„ pelvic, pain in, and its relief by morphia, illustrated by fifty
cases (F. H. Champneys) .... xxii, 5
„ of the cervix uteri (Clement Godson) . . . xxvii, 6
„ — (P. Horrocks) ..... xxviii, 240
„ — epithelial, and its cavity (C. H. F. Routh) . . viii, 290
„ — medulhiry (F. H. Daly) . . . xvi, 122, 202
„ — clinical notes on the early course of (C. Liebman) . xvii, 6G
„ — complicating pregnancy (A. L. Galabin) . . xxiii, 186
„ — two cases of, complicating labour (G. E. Herman) . xxiv, 308
„ — extending into body of uterxis (G. E. Herman) . . xxxii, 137
„ of the cervix associated with pregnancy, abdominal hysterec-
tomy for (D. Drew) ..... xlviii, 202
„ — uterus and iliac glands removed by abdominal hysterec-
tomy for (T. "V. Dickinson) . " . . . xlviii, 15
>, — complicating labour in advanced pregnancy, the patients
remaining well eleven, eight and a half, and eight years
after high amputation of the cervix (H. R. Spencer) . xlvi, 355
„ — complicating a case of combined vaginal and abdominal
hysterectomy for a pregnancy of four and a half months (R.
Sanderson) ...... xliii, 312
„ — supposed recurrence after vaginal hysterectomy for (C.
Hubert Roberts) ..... xlix, 114
„ — two cases of, the patients remaining free from recurrence
twenty and eleven years respectively after operation (A. H.
N. Lewers) ...... xlix, 179
„ supra-vaginal amputation for (A. H. N. Lewers) . . xxxiii, 301
„ specimens of cervix uteri removed by the supra-vaginal
amputation for (A. H. N. Lewers) . . xxxvii, 201
„ of the cervix from eight cases treated by the siipra-vaginal
amputation, in which from four to fifteen years had elapsed
without recurrence (A. H. N. Lewers) . . . xliv, 221
„ of the cervix uteri complicated by pyometra (W. W. H.
Tate) ...... xxxix, 323
„ of the cervix associated with an ccdematous growth in the
fundus (C. Hubert Roberts) .... xlii, 267
„ primary, tuberculosis of the cervix simulating, treated by
vaginal hysterectomy (A. H. N. Lewers) . . . xliv, 144
„ squamous, of the cervix uteri (F. J. McCann) . . xliv, 136
„ of the cervix, two uteri removed by vaginal hysterectomy for
(A. H. N. Lewers) .... xxxviii, 164
„ see Carcinoma.
CANCEROUS disease of the genital canal, the treatment of preg-
nancy with (G. E. Herman)
„ hypertrophy of the body of the uterus (J. Matthews Duncan)
„ polypi, with microscopic sections (A. L. Galabin) .
„ tumour, pelvic, commencing in the outer cellular tissue of the
broad ligament (T. C. Hayes
„ uterus with pyometra (A. H. N. Lewers) .
„ — ^~ removed by vaginal hysterectomy (P. Horrocks)
„ (Amand Eouth) ....
„ and gravid uterus removed per vaginam (W. S. Playfair)
XX,
191
) XX.
27
XX,
82
e
cvi, 102,
127
xxxviii.
14
. xxxiv.
85
. xxxiv.
87
xxxvii.
198
CANCEROUS — CARCINOMA.
27
CANCEROUS (continued) —
„ uterus and parovarian cyst removed per vaginam (Amand
Eouth) ..... xxxvii, 8
CAPSULES, on the management of true and false, in ovariotomy
(Alban Doran) ..... xxxix, 265
CARCINOMA of the broad ligament (T. C. Hayes) . . xvi, 101
primary, of the Fallopian tube (C. J. CuUingworth . . xxxvi, 307
(C. Hubert Roberts) . . . . xl, 189
second case of (C. Hubert Roberts) . . . xli, 129
(H. R. Andrews) ..... xlv, 54
of the Fallopian tubes (C. J. CuUingworth) . . xlvii, 263
of omentum and Fallopian tube (HeyAvood Smith) . xl, 135
of left ovary and right Fallopian tube with a cystic fibroid
(R. Boxall) ...... xliii, 71
— after-history of a case of cystic fibroid with (R. Boxall) . xlviii, 136
of the ovary (W. W. H. Tate) .... xlviii, 96
— of unusual type (C. Lockyer) .... xlvi, 349
epithelial, of the ovary (C. J. CuUingworth) . . xxxii, 199
of the ovary, hsemorrhagic (C. J. CuUingAvorth) . . xxxiii, 445
primary, of both ovaries (C. Lockyer) . . . xlvi, 229
of ovary, primary solid (W. S. A. Griifith) . . xlii, 34
of uterus (W. S. Playfair) .... xxxix, 288
columnar-celled, of the uterus (C. J. CuUingworth) , xxxii, 165
primary, extirpation of the uterus for (A. H. N. Lewers) . xxx, 218
squamous-ceUed, of the uterus (C. J. CuUingworth) xxxii, 164 — 166
of the body of the uterus (W. S. Playfair) . . xii, 116
— (J. H. Targett) ..... xlii, 281
of the corpus uteri invading a myoma : hysterectomy (J. M.
Munro Kerr) ...... xlvii, 191
of the body of the uterus, with secondary growth in both
ovaries (H. T. Hicks) ..... xlviii, 196
„ primary, of the body, uterus removed by abdominal pan-
hysterectomy for (A. H. N. Lewers) . . . xliv, 290
— of the body of the uterus in which vaginal hysterectomy
was performed, etc. (A. H. N. Lewers) . . . xxxvi, 374
„ keratinising, of the body of the uterus (A. H. N. Lewers) . xlv, . 97
of body and multiple fibromata of uterus removed by abdo-
minal pan-hysterectomy (J. H. Dauber) . .' . xxxix, 321
of body of uterus, with fibro-myoma and fibroma of ovary
(W. W.H.Tate) ..... xlvi, 139
of the body in a uterus, with multiple fibroids (A. H. N.
Lewers) ...... xlvi, 266
„ of the cavity of uterus (P. Smith) . . . xii, 299
„ in the muscular wall of the uterus secondary to cancer of both
ovaries (C. Lockyer) ..... xlvi, 302
of the cervix uteri complicating pregnancy (A. L. Galabin) . xviii, 239
of the cervix complicating labour at term ; Csesarean section,
foUowed by vaginal hysterectomy (J. M. Munro Kerr) . xlvii, 194
of the cervix uteri removed by supra- vaginal amputation, -svith
previous induction of abortion (A. H. N. Lewers) . . xxx, 81
„ of cervix uteri in which the disease extended upwards into
the body (Walter W. H. Tate) . . . . xl, 258
of the cervix complicated by tubal mole (A. H. N. Lewers) . xlv, 335
of cervix uteri, with doiible salpingitis, compUcating fibro-
myoma of uterus (W. W. H. Tate) . . . xUii, 270
squamous, of cervix uteri (F. J. McCann) . . . xliv, 136
28
CAECINOMA — CAST.
xxxvii, 213
xxxviii, 102
xlviii, 181
xlvii, 338
viii, 49
xviii, 142
xi, 35
xvi, 226
xvi, 253
xxii, 34
CARCINOMA (continued) —
„ sqiiamous-celled, of the cervix uteri, in which the disease had
extended in an upward and not in a downward direction
(C. J. CuUingworth) ..... xxxiv,.136
„ of the cervix, uterus with fibroid tumours and, removed
post-mortem from a patient on Avhom eight years previously
the operation of oophorectomy had been performed (G. F.
Blacker) .....
„ uterine fibroid associated with (A. L. Galabin)
„ primary, of the vagina (F. J. McCann)
„ see Cancer.
CARCINO-SARCOMA uteri (H. E. Spencer)
CARBON, anaesthetic properties of the bichloride of (A. E
Sansom) .....
CARIES of the pelvic bones following delivery (W. S. Playfair)
Carlyle (David), casts of the head of an anencephalous foetus
with description of the labour .
Carter (C. H.), six months' fcetus which lived for twenty-one hours
„ report on ditto by committee (C. H. F. Routh and George B
Brodie) . . . . .
„ and F. H. Daly, foreign body in the vagina, removal after
four years, and after-results
„ case of large foreign body in the vagina for two years, per
forating the wall of the bladder, its removal and closure of
the fistulous opening ....
„ two cases of extra-uterine fcetation, with results
„ absence of the vagina, uterus distended by retained menstrual
fluid, operation, recovery
„ fibrous tiimour of the uterus
„ fibroid tumour of the right ovary
„ utei'ine tumoui- ....
„ cystic degeneration of subperitoneal fibroid of the uterus
„ cystic disease of both ovaries
„ double dermoid ovarian cysts
„ fibro-myoma of right ovary removed by abdominal section
„ double hydrosalpinx ....
,, epitheliomatous growth from the cervix uteri
„ ovarian cyst, partly dermoid
„ two dermoid cysts from the same patient .
„ lipoma removed from left labium majus of a woman aged 40
„ double pyosalpinx ....
„ diseased ovaries and tubes
Carter (C. M.), large fibroid tumour of uterus
CARUNCLES, urethral, structure of three different types (H
Williamson) .....
Casella (Prof.), transfusion apparatus (presented)
CASES IN PRACTICE (J. Bassett) .
„ (E. Copeman) ....
CAST of female bladder (J. H. Aveling)
„ decidual, importance of, as evidence of extra-uterine gesta
tion (W. S. A. Griffith) .... xxxvi,
„ from the uteru.s having all the characters of the decidual
jnembrane found in connection with ectopic gestation
together with a small ovarian cyst from the same case,
with microscopic sections of each (W. R. Dakin) xxxviii
xxii.
38
xxii.
160
xxii.
251
xxiv.
2
xxiv.
139
xxiv.
161
XXV,
108
XXV,
109
xxvi.
86
xxix.
190
XXX,
3
XXX,
82
xxxii.
6
xxxii.
6
xxxii.
6
xxxii.
64
xxxii.
136
xiii.
167
xlvii.
6
xvii.
45
xiv.
58
xiii.
232
XXV,
33
335
385
CAST — CHADWICK.
29
xxxiVj
251
xxxix.
260
xxvi.
232
vi.
103
xlvii.
11
iii.
424
viii,
109
xviii.
180
xix.
41
XX,
293
CAST (continued) —
„ decidual, of the uterus from a case in whicli there was no
evidence of extra-uterine gestation, with microscopic sections
(T. W. Eden) ..... xxxix, 132
„ — uterine, expelled after eight weeks' amenorrhoea, together
with an ovum of about five days' growth (W. E. Fothergill) xliii, 162
„ of the uterus (T. W. Eden) • . . . xlii' 5
CASTS, epidermic, from the vagina (J. H. Targett) . xxxvii 218
CAT, pelvis of, with bladder, uterus, and rectum in situ (H. T.
Kutherfoord) .....
„ pregnant horn from the uterus of (Robert Wise)
CATHETER, glass female (R. Barnes)
CAULIFLOWER EXCRESCENCE of the uterus (E. F. Fussell)
CAUSATION of puerperal infections, investigation into (A. G. R.
Foulerton and V. Bonney)
CAUTERISATION by electric heat in the treatment of certain dis-
eases of women (R. Ellis)
CAUTERY, actual, use of in ovariotomy (I. B. Brown) .
„ thermo-, Paquelin's, by vapour of petroleum (O. Prevot)
,, three new points for (Heywood Smith)
„ regulator to be used with (J. H. Aveling) .
CELLS, vesicular mole, showing syncytium derived from chorionic
epithelium, partially differentiated into (A. L. Oalabin)
CELLULITIS, pelvic, noted with special reference to the tempera-
tiu-e (C. J. Cullingworth) ....
CELOSOMA see Monsters.
CEPHALH-EMATOMA, double, infant suffering from (J. Brxmton)
CEPHALHiEMATOMATA, bilateral (S. W. Wheaton) .
CEPHALOTRIBE, (J. B. Hicks)
„ (J. M. Duncan) ....
„ remarks on (J. B. Hicks)
„ (G. H. Kidd) . . . . ]
„ (A. E. Martin) ....
„ Hicks's, alteration of (G. Roper) .
„ new form of (C. E. Jennings)
„ (Fancourt Barnes) ....
„ face presentation, delivery effected by (J. B. Hicks)'
„ foetus delivered by (J. B. Hicks) .
CEPHALOTRIPSY as performed at Vienna by Professor Braun (C
(J. Ritchie) .....
„ cast from the head of a child extracted by (H. Smith)
„ cast of head of child after (Heywood Smith)
„ head of child delivered by, with Hicks's instrument (R,
Barnes) ......
„ craniotomy ; Csesarean section in case of extreme distortion of
the pelvis (R. Greenhalgh)
„ three cases, report of (J. Braxton Hicks) .
„ with short remarks (J. B. Hicks) .
CEREBRAL H^IMORRHAGE, see HcEmorrhagc.
CERVIX UTERI, see Uterus (cervix of).
Chadwick (Jambs R.), election as Honorary Fellow . . xlii, 40
„ letter acknowledging election as Honorary Fellow . . xlii, 132
xlv, 240
xii, 370
XX, 293
XXXV, 6
viii, 275
xi, 42
xi, 43
xii, 1
xiv, 65
xix, 137
xxiv, 238
xxvi, 27
X, 144
xi, 1
vi, 75
xii, 134
xiii, 37
xi, 191
vii, 220
xvii, 49
XV, 41
30
CHAHBAZIAN — CHAMPNEYS.
Chahbazian (C), on the treatment of post-partiun hEemorrhage
by hypodermic injection of ergotinine
Chalmers (John), extra-nterine foetation
„ report on ditto by committee (A. L. Galabin and J. Chalmei's)
„ for Dr. McLaMrin, twin monster in its seventh month
„ hermaphrodite, genito-urinary organs of .
„ for C. Hurford, twin female monster
„ case of sptu'ioiis hermaphroditism
Chamberlen, Paul or Peter, question of portrait of .
Chambers (Thomas), uterine fibroid
„ complete inversion of uterus ....
„ retroversion of the gravid uterus ....
„ fibroid uterus ......
„ fibro-cystic disease of the uterus weighing 14 lb.
„ — report on ditto by committee (A. L. Galabin, G. E. Herman,
and T. Chambers) .....
„ two ovaries from a case of congenital inguino-ovarian hernia
(double) ; recovery .... xxi, 92, 256
„ — report on ditto by committee (John Williams and A. L.
Galabin) ......
„ fibro-cystic disease of the uterus . . .
„ — report on ditto by committee (G. G. Bantock, F. H.
Champneys, and Thomas Chambers)
„ eczema of the nipple in both breasts
„ complete extirpation of the uterus with both ovaries, weigh-
ing 10 lb. ; recovery .....
CHAMPETIEE DE RIBES' BAG, treatment of placenta praevia by
(G. F. Blacker) ..... xxxix, 138
Champneys (F. H.), uterus and neighboiiring parts from a woman
who died from the biu'sting of an aneurysm of a branch of
the pulmonary artery .....
„ on the pain in pelvic cancer and its relief by morphia, illus-
trated by fifty cases .....
,, retroflexed viterus .....
„ utertis of a woman aged 69, with large fibroid
„ incomplete rupture of vagina discovered post mortem ; death
from septicaemia .....
„ for G. C. P. Murray, calcareous degeneration of placenta
„ on the obliquely contracted pelvis of a child with left sacro-
iliac synostosis, together with remarks on the pelvis of Naegele
„ extroversion of the bladder ....
„ description of a kyphotic pelvis, with remarks on Breisky's
description ......
„ on the presstire of the femora, and its influence on the shape
of the pelvis ......
„ demonstrations illustrating the separation and expulsion from
the uterus of the placenta ....
„ the obstetrics of the kyphotic pelvis
„ — second communication ....
„ placenta succentiu-iata .....
,. ruptured uterus .....
„ for Fly Smith, pellets of corrosive sublimate
„ note on the artificial production of so-called lymphatic varix .
„ observations on the uterine bruit
„ the mechanism of the third stage of labovir : (1) the separation
of the placenta ..... xxix, 117
xxiv, 286
xviii, 67
xviii, 82
xxii, 155
. xxiv, 239
XXV, 111
XXV, 129, 162
. xvi, 245
xi, 31
. xvi, 181
. xvi, 181
. xviii, 177
XX, 32
XX, 54, 55
xxi, 269
xxii, 159
xxii, 187
xxii, 266
xxiii, 12
XX, 124
xxii.
5
xxii.
156
xxii.
185
xxiii.
10
xxiv.
190
xxiv.
191
xxiv.
240
xxiv.
242
XXV,
70
XXV,
160
XXV,
166
xxviii.
253
sxv.
214
xxvi.
329
xxviii.
66
xxviii,
144
xxviii.
188
CHAMPNEYS CHORION. 31
Champnets (F. H.), the mechanism of the third stage of labour
(continued) —
» — (2) the expulsion of the placenta . . . xxix, 151
" — (3) the separation and expulsion of the membranes . xxix, 264
„ — (4) some causes of retention of the membranes . . xxix, 317
" — (5) note on the relation between the implantation of the
placenta and the insertion of the cord . . . xxix, 337
„ mechanism of the third stage of labour ; adjourned discussion
on papers Nos. 3-5 • . . . . xxix 346
„ on primary laparotomy (that is, abdominal section in the latter
half of pregnancy, the child being alive) in cases of extra-
uterine gestation • . . . . xxix 456
„ description of a new operation for vesico-uterine fistula . xxx' 348
„ case of Caesarean section for contracted pelvis . . xxxi, 136
„ inaugural address as President . . . xxxvii' 83
„ annual address as President . . xxxviii, 60 ; xxxixi 56
CHANCEE on the cervix uteri (G. E. Herman) . . xxvii 252
„ on OS uteri (W. B. Woodman) .... vii,' 26
Chapman (W.), retention of the catamenia for more than two
years in a married woman . . , . iv 251
Chepmell (Charles), uterus from a septic case . . xxxvi, 3
CHEST and abdomen, the change in size of, during the lying-in
period, and the effect of the binder upon them (G. E. Herman) xxxii, 108
Child (Edwin), case of extra-uterine fcetation . . xviii, 119
CHILDBED, antiseptic irrigation in, instruments for (Graily
Hewitt) . . . . . . xxxi, 202
„ fever m.— Part I.— General hygiene and antisepsis (E. Boxall)
T. ^ TT m, , . . , ^^^^^> 219, 275
„ — fan 11.— 1 he relation of external meteorological conditions
to the incidence of febrile illness in childbed (R. Boxall) . xxxv, 340
„ see Fuerperium.
CHILDBIRTH, see Parturition.
CHILDKEN, temperature variations in the diseases of (W. Squire) xii 171
„ vulval discharges in (G. Drummond Robinson) . . sli^ 14
CHLORAL TREATMENT of eclampsia (P. von Seydewitz) . xii' 117
CHLORIDE of sodium, sterilised saturated solution of (H R
^P*^^°^^) xxxv, 428
CHLOROFORM for production of anaesthesia (I. B. Brown) vii 208
„ inhaler for (H. W. Liddard) . . ' ' ^vi 88
„ — pocket (J. Murray) . . . \ ! x' 95
CHLOROSIS and anaamia, treatment of, with the phosphide of zinc
(J. A. Thompson) . . . _ ^^^ 5Y
„ and menstruation, the relation between (W. Stephenson) .* xxxi', 104
CHOLERA in the newly born (J. C. Lucas) . . . xxi' 250
CHOREA with pregnancy (W. B. Woodman) . vii' iq-?
„ m pregnancy (E. Barnes) ... ^' 247
» — successfully treated by dilatation of the os uteri (W f'
Wade) . ^ ■ .. „^.
„ - (M. Handfield- Jones) ] ' ' ' ^\!J|' ^^
„ gravidarum (Fred J. McCann) . . . ^xxiii, 413,' 466
„ showing the behaviour of the pregnant uterus in (J. Braxton
„„r.^ '^ • • • • • .xxxiii,486
CHORION, atrophy of (G. E. Herman) . . . ^xvii, 195
32 CHORION — CHORION-EPITHELIOMA.
CHORION (continued) —
„ cystic degeneration of, in a case of missed abortion (G. E.
Herman) ...... xxii, 44
„ stems, hyperplasia of, with partial cystic degeneration (W. S. A.
Griffith) ...... XXX, . 82
„ cystic, hydatiform degeneration of (John Phillips) . . xxxii, 65
„ — disease of (Aust Lawrence) .... xxxii, 64
„ hydatidiform degeneration of, associated with albuminuria
(W. B. Woodman) ..... vii, 113
„ hydatidiform degeneration of preceding deciduoma malignum
without syncytium ; secondary deposits in vagina, lymphatic
glands (iliac and lumbar), and lungs (P. Horrocks) . xlv, 243
„ fibro-sarcoma of (A. L. Galabin) .... xxvii, 107
„ myxoma of, not discharged till the seventh month (C. H.
Roberts) ...... xlii, 168
„ pathology and symptoms of hydatidiform degeneration of
(Herbert Williamson) ..... xli, 303
„ villi of the, ovum expelled about the eighth week showing
(A. W. Edis) ...... xvii, 48
„ — and doubtful sarcoma, microscopical sections of uterus
showing (Leonard Remfry) . . . xxxviii, 223
„ — from a tubal mole removed by abdominal section (A. H. N.
LoAvers) ..... xxxviii, 106
CHORION-EPITHELIOMA (H. R. Andrews) . . . xlv, 238
„ (II. Briggs) ...... xlv, 239
„ (A. L. Galabin and T. G. Stevens) . . . xlv, 241
„ (J. M. Munro Kerr) ..... xlv, 244
„ (J. B. Hellier) ..... xlvii, 310
„ (John Phillips) ..... xlviii, 45
„ complicated by hrematometra (W. S. A. Griffith and H.
Williamson) ...... xlix, 241
„ with pulmonary metastases (Cuthbert Lockyer) . . xliv, 24
„ of the uterus, with secondary growths in the vagina, the
kings, and the liver (G. F. Blacker) . . . xlvi, 55
„ Avith secondary gi'owths in vagina, kidney, pancreas, lungs,
and ? lymphatic glands (C. Lockyer) . . .xlv, 245
„ malignum, with secondary growths in liver (J. H. Teacher for
Professor Sutherland and Dr. Buist) . . . xlv, 252
„ and the occurrence of chorion-epitheliomatoixs and hydatidi-
form mole-like structures in teratomata (J. H. Teacher),
adjourned discussion on ... . xlv, 303
„ (the so-called deciduoma malignum) and the occurrence of
chorion-epitheliomatous and hydatidiform mole-like struc-
tures in tumours of the testis (J. H. Teacher) . . xlv, 256
„ malignum ; primary tumour in uterus (J. II. Teacher) . xlv, 252
„ — two photographs of pelvic organs Avith primary tujnour, and
a glass tube containing a secondary nodule from the lungs
(J. H. Teacher) . . ... xlv, 253
„ uterus removed by vaginal hysterectomy, showing nodule of
(F. W. N.Haxiltain) ..... xlv, 242
„ following hydatidiform mole, in a patient with bilateral ovarian
cysts, with pathological report and references to the literature
on kindred cases (J. D. Malcolm, R. H. Bell, and C. Lockyer) xlv, 483
„ compound lutein cystomata found in association with vesicular
mole and (C. Lockyer) ..... xlvii, 157
„ of the uterus ; lutein cysts in both ovaries (G. F. Blacker) . xlix, 104
„ of the vagina, primary embolic (H. T. Hicks) . . xlix, 224
CHOROIDO-BETINITIS CELIOTOMY.
33
xxxii, 134
xvi, 223
xxxi, 311
xlvii, 108
xii, 31
xxvii, 113
xxxi, 202
i, 226
V, 58
CHOROIDO-RETINITIS, central, occurring after labour and post-
partum haemorrhage (H. Macnaughton Jones)
Churton (T.), case of recto-vaginal fistula caused by a
Zwancke's pessary retained for nearly two years
CHYLOUS CYST, large, of the mesentery (Ad. Rasch)
CHYLURIA with pregnancy (J. C. Holdich Leicester) .
CICATRICES from a burn requiring division during labour (E. F.
Willoughby) ......
CIRCULATION of blood in the uterus, with some of its anatomical
and pathological bearings (John Williams)
Clabburn (T. G.), see Playfair, W. S.
Clapham (Edward), shrivelled foetus of the fifth month utero-
gestation ......
Clarke (Eeqinald), see Phillips, John.
Clay (Charles), ovarian cyst co-existing with pregnancy, which
ruptured spontaneously ten days after labour
„ ovariotomy, statistical and practical ; also a successful case of
entire removal of uterus and its appendages
„ wire loops, horseshoe wires, etc., for coi-recting anteversion,
retroversion, obliquities, and prolapse of the vxnimpregnated
uterus . . . . .
Clbvelakd, (W. F.), infant of doubtful sex .
„ perforator of wedge-scissors construction .
„ imperforate anus in which the child lived upwards of ten
weeks without relief from the bowel after two unsuccessful
operations ......
„ apparatus for injecting ferri perchloridi
„ foetus and placenta of five months, funis knotted round neck
of child ......
„ five months foetus with intense congestion of head and neck .
„ remarks in the discussion on the use of forceps
„ thick gelatinous cord, illustrating the necessity for more than
ordinary care in tying ....
„ for G. S. Walker, large hydrencephalocele in a female child .
„ fleshy substance discharged from uterus, xxiii, 132 ; xxiv, 297 ; xxvi, 117
„ reports on ditto by committee (A. L. Galabin, John WilUams,
and W. F. Cleveland) . . . , xxiii, 181 ; xxvi, 334
„ double uterus with deciduous membrane . . . xxvi, 181
CLITORIS, elephantine development of (W. E. Eogers) . xi, 84
„ excision of, as a cure for hysteria (T. H. Tanner) . . viii, 360
„ hypertrophied nymph® and (W. Duncan) . . xxxvi, 3, 149
„ symmetrically hypertrophied (J. H. Aveling) . . xvi, 1
Clutton (H. H.), see Cullingworth, Charles J.
Coaxes (George), case of labour in a primipara suffering from
mitral stenosis ..... xxviii, 108
Coaxes (N.), prolapsus uteri in which the neck of the uterus was
partially severed by a ligature of hair which had accumu
lated around it ... .
COCCYX, outgrowth from end of (Heywood Smith)
CocKELL (F. E., jun.), foetal monstrosity
Coffin (Maixland), foetal monstrosity
C(ELI0T0M7, for extraction of a living foetus, after term in a case
of tubo-abdominal pregnancy (J. Bland-Sutton)
V,
177
ix.
29
ix.
56
ix.
203
xi.
242
xiii.
1
xvi.
2
xxi.
226
xxi,
313
xxii,
157
XV, 9
XXV, 2
XXV, 110
xxiv, 98
xl, 308
34
CCELIOTOMY — COMMITTEES.
xliv, 299
xxiii, 238
XX, 170
CCELIOTOMY (continued) —
„ anterior vaginal, anterior hysterotomy and replacement, with
recovery after failure of elastic pressure with repositors in a
case of complete inversion of uterus of seven months' dura-
tion (J. W. Taylor). . . • • •
Cole (Beverley), spring pessaries . . • •
CoLET (— ), new forceps bent as a sound for the introduction of
laminax'ia tents . . . • •
COLLAPSE (cirrhosis) atrophy Avith fibroid degeneration, and
angioma of the ovaries (J. Braithwaite) . . • xxxvi, 325
COLOTOM Y, Amussat's operation for complete obliteration of the
canal of the small intestine by fcetal peritonitis (R. Druitt) ii, 135
COLOPOTOMY, anterior (John Phillips) . . xxxviii, 213
„ hydrosalpinx and small ovarian cyst removed by anterior
(AmandRouth) . • • • . xxxviu, 185
„ cystic fibro-myoma of the uterus removed by posterior (H.
K. Spencer) . - • • " i.u\
„ posterior, for removal of dermoid cyst of ovary (A. Eouth) .
„ for removal of tubal mole (F. J. McCann) .
COMMITTEES, reports of :
on G. F. Butler Willing's specimen of five and a half months
fcBtus (Henry Savage and C. H. F. Eouth) . •
„ on C. Godson's specimen of acephalous embryo (John Williams
and C. Godson) • • • ' ,tt '
„ on T. C. Hayes' specimen of cancerous pelvic timiour (Hey-
wood Smith) . . • • ." . - i. j
on F. H. Daly's specimen of uterine tumour and attached
ovarian cyst (J. B. Potter and T. C. Hayes) . •
„ on Alfred Meadows' specimen of membrane passed in a case of
so-called membranous dysmenorrhcea (J. H. Aveling and John
Williams) . . • • i • i t J
on C. H. Carter's specimen of six months foetus which lived
for twenty-one houi-s (C. H. F. Eouth and G. B. Brodie) .
„ on W. E. Rogers' specimen of hsematocele (Heywood Smith
and W. E. Eogers) . • • .•., + '
„ on J. Ashburton Thompson's specimen of an ascitic tcetus
(John Williams and J. A. Thompson) . • _ •
„ on Frederick Wallace's specimen of uterus, left ovary, vagina,
and tumour (T. C. Hayes and J. H. Aveling) • •
„ on Frederick Wallace's case of monstrosity (J. H. Aveling and
T. C.Hayes) . • • • ^ ' -.■ . v
on A. L. Galabin's specimen of organs taken from a subject ot
extra-uterine pregnancy (W. S. Playfair, John WiUiams, and
* A. L. Galabin) . • ,:«-/• /a t"
„ on John Chalmers' specimen of extra-uterine fcetation (A. L/.
Galabin and J. Chalmers) . • • •
„ on E. Hughes' specimen of carneous mole (John Williams ana
W. B. Woodman) . • • - . * -, m r."
„ on J. Palfrey's specimen of monster (W. S. Playfair and i. C.
Hayes) . • • .'-,■■,' -i.
on A L. Galabin's specimen of a foetus m which ascites was
combined with distension of the bladder (John Williams and
A. L. Galabin) . • „ " , - •" -i. '
„ -on A. L. Galabin's case of suppuration of the uterine cavity
resulting from occlusion of the cervix (G. Roper and A. L.
Galabin) ..••••
xliii, 110
xUv, 38
xliv, 133
xvi, 97
xvi, 121
xvi, 127
202
xvi, 251
xvi, 253
xvi, 274
xvii.
66
xvii, 276
xvii, 277
xvii, 384
xviii, 82
xviii, 311
XIX,
97
xix, 120
177
COMMITTEES.
35
COMMITTEES, reports of (continued) —
„ on T. Chambers' specimen of fibro-cystic disease of the uterus
(A. L. Galabin, G. E. Herman, and T. Chambers) . . xix, 55
„ on T. Chambers' specimen of two ovaries from a case of con-
genital inguino-ovarian hernia (John Williams and A. L.
Galabin) ...... xxi, 269
„ on C. J. Cvilliugworth's specimen of fibroma of both ovaries
(J. Knowsley Thornton and Alban Doran) . . xxi, 314
„ on Heywood Smith's specimen of titerus and appendages re-
moved by hysterectomy (A. L. Galabin and John Williams) . xxii, 3
„ on Clement Godson's specimen of rupture of Fallopian tube
(John Williams, Clement Godson, and A. L. Galabin) . xxii, 82
„ on Thomas Chambers' specimen of fibro-cystic disease of the
uterus (G. G. Bantock, F. H. Champneys, and Thomas
Chambers) ...... xxii, 187
„ on Clement Godson's specimen of ruptured tubal fa3tation
(John Williams, A. L. Galabin, and Clement Godson) . xxii, 242
„ on W. F. Cleveland's specimen of fleshy substance discharged
from the uterus (A. L. Galabin, John Williams, and W. F.
Cleveland) ...... xxiii, 181
„ on Wynn Williams' specimen of fibroid tumour (Alban Doran,
Clement Godson, and F. H. Champneys) . . . xxv, 70
„ on William Duncan's specimen of hydatidiform mole (F. H.
Champneys, Alban Doran, and W. Duncan) . . xxv, 233
„ on William Duncan's specimen of ruptured ovarian cyst
(Alban Doran, W. S. Playfair, and W. Duncan).. . xxv, 234
„ on F. L. Neugebauer's specimens and photographs of spondylo-
listhesis (R. Barnes, William Adams, Noble Smith, and Alban
Doran) ...... xxvi, 186
„ on W. F. Cleveland's specimen of deciduous membrane of
pregnancy (John Williams, A. L. Galabin, and W. F. Cleveland) xxvi, 331
„ Robert Harvey's specimen of rupture of the uterus (F. H.
Champneys and Alban Doran) .... xxvii, 228
„ on E. P. Griin's specimen of supposed extra-uterine gestation
with birth through uterus (G. E. Herman and Alban Doran) xxvii, 306
„ on H. Campbell Pope's specimen of gestation in one horn of a
uterus bicornis unicollis (G. E. Herman, Alban Doran, and
W. S. A. Griffith) ..... xxviii, 72
„ on Amand Eouth's specimen of fibroid of one-horned uterus
(Alban Doran, W. S. A. Griffith, and Amand Eouth) . xxix, 57
„ on G. M. Bluett's specimen of tumours of fa3tal membranes
(A. L. Galabin, G. E. Herman, and Alban Doran) . . xxix, 512
„ on John Williams' specimen of fibroma of the ovary (A. L.
Galabin, G. E. Herman, and Alban Doran) . . xxix, 513
„ on W. A. Meredith's specimens of fibro-cystic tumour of the
ovary and fibro-myoma of the broad ligament (A. L. Galabin,
G. E. Herman, and Alban Doran) . . xxix, 513, 514
„ on J. D. Malcolm's specimen of fibroma (A. L. Galabin, G. E.
Herman, and Alban Doran) .... xxix, 515
„ on Sidney Harvey's specimen of extra-uterine gestation (J.
Braxton Hicks, Sidney Harvey, and W. S. A. Griffith) . xxx, 166
„ on P. Horrocks's specimen of inverted uterus wth fibroid
(Alban Doran and P. Hox-rocks) .... xxx, 228
„ on Aust Lawrence's specimen of an extra-uterine fcetation
(Alban Doran, G. E. Herman, and F. H. Champneys) . xxx, 302
„ on F. G. Penrose's specimen of tubo-abdominal pregnancy
(Alban Doran, G. E. Herman, and F. H. Champneys) . xxx, 303
36 COMMITTEES.
COMMITTEES, keports of (continued) —
„ on John Phillips's case of congenital sarcoma in a new-born
infant (John Phillips and Alban Doran) . . . xxx, 335
„ on John Phillips's specimen of an aborted ovum showing cysts
in the decidua vera (F. H. Champneys, John Phillips, and W.
S. A. Griffith) ..... xxxi, 161
„ on W. S. Playfair's specimen of small ovarian cyst and hsemato-
salpinx (W. S. Playfair, Alban Doran, and W. S. A. Griffith) xxxi, 162
„ on C. Stewart Pollock's specimen of ovarian dermoid from a
mare (J. Bland-Sutton, C. Stewart Pollock, and Alban Doran) xxxi, 253
„ on Alban Doran's specimen of fragment of membrane passed
from the uterus (John Williams, W. S. A. Griffith, and Alban
Doran) ...... xxxi, 310
„ on A. H. Robinson's specimen of placenta praevia (W. S. Play-
fair, F. H. Champneys, and C. J. CuUingworth) . . xxxii, 107
„ on Amand Kouth's specimen of acardiac fcetus (J. Bland-
Sutton, Amand Routh, and Alban Doran) . . xxxiii, 26
„ on W. Duncan's specimen of extirpated uterus (W. Duncan,
W. S. A. Griffith, S. W. Wheaton, and G. E Herman) . xxxiii, 161
„ on J. H. Targett's specimen of spondylolisthesis in a girl
aged 16 (J. H. Targett, A. L. Galabin, G. E. Herman, and
F. H. Champneys) ..... xxxiii, 463
„ on G. E. Herman's specimen of amorphous acardiac t^vin (G.
E. Herman, W. S. A. Griffith, Alban Doran, and J. Bland-
Sutton) ..... .xxxiv, 11
„ on Hey wood Smith's specimen of abscess of the ovary (J.
Bland-Sutton, Alban Doran, and Heywood Smith) . xxxiv, 83
„ on C. J. CuUingworth's specimen of unruptured tubal gesta-
tion with apoplexy of the ovum (.1. Bland-Sutton, C. J.
Cullingworth, Alban Doran, and William Duncan) . xxxiv, 157
„ on W. S. Playfair's specimen of haematosali^inx (W. S. Play-
fair, W. S. A. Griffith, and G. E. Herman) . . xxxiv, 467
„ on A. E. Giles's specimen of malformation of rectum and
bladder, congenital absence of both kidneys and ureters, etc.
(A. E. Giles, W. R. Dakin, and Alban Doran) . . xxxiv, 468
„ on C. J. CuUingworth's specimen of tubal gestation with
apoplectic ovum (C. J. Cullingworth, A. Doran, W. Duncan,
and J. Bland-Sutton) ..... xxxiv, 468
„ on J. R. Ratcliffe's specimen of uterus bicornis (J. H. Targett,
J. R. Ratcliffe, and A. Doran) .... xxxiv, 470
„ on A. Rasch's case of moUities ossium (A. Rasch, P. Horrocks,
R. BoxaU, and W. S. A. Griffith) . . . xxxv, 40
„ on S. W. Wheaton's specimen of dermoid tumour with bony
girdle (C. J. Cullingworth, H.R.Spencer, and S.W. Wheaton) xxxv, 41
„ on Amand Routh's specimen of fcetus sho^ving ectopia
viscerum with retroflexion (W. R. Dakin, J. H. Targett,
A. Doran, and A. Routh) .... xxxv, 102
„ on Amand Routh's specimen of anencephalic monster (A.
Routh, H. R. Spencer, and A. E. Giles) . . . xxxv, 294
„ on Amand Routh's specimen of fibi'oma spontaneously enu-
cleated (J. H. Targett, W. S. A. Griffith, and Amand Routh) xxxvi, 2
„ on William Duncan's specimen of hypertrophied vulva (P.
Horrocks, W. Duncan, and W. W. H. Tate) . . xxxvi, 150
„ on W. A. Grogono's specimen of fcetus acephalus acardiacus
~ (W. A. Groeono, J. Bland-Sutton, and A. E. Giles) . xxxvi, 185
„ on William Diincftn's specimen of tumour removed from the
abdomen (A. F. Voelcker) .... xxxvi, 265
COMMITTEES. 37
COMMITTEES, eeports op (coniimied)—
on Thomas W. Eden's specimen of tubal molo (A. Doran, T.
W. Eden, and J. Bland-Sutton) .... xxxvi, 301
on Leith Napier's specimen of deformed foetus (A. E. Giles,
W. Dakin, and L. Napier) .... xxxvi, 302
on William Duncan's specimen of double pyosalpinx (W.
Duncan, W. S. A. Griffith, and E. J. Maclean) . xxxvii, 295
on Herbert J. Ilott's specimen of foetus papyraceus (H. J. Ilott,
A. E. Giles, and A. Doran) . . . xxxvii, 16
on C. J. Cullingworth's specimen of supposed tubo-ovariau
cyst (' Transactions,' vol. xxxvii, p. 295) (W. S. A. Griffith,
C. J. CuUingworth, J. Bland-Sutton, and A. Doran) xxxviii, 4
on L. Napier's specimen of solid ovarian tumour ("Trans-
actions,' vol. xxxvii, p. 283) (J. Bland-Sutton, C. J. CuUing-
worth, L. Napier, and W. S. A. Griffith) . . xxxviii, 32
on A. H. N. Lewex's's specimen which was shoAvn as a ttibal
mole (' Transactions,' vol. xxxvii, p. 78) (J. Bland-Sutton, A.
Doran, and A. H. N. Lewers) . . . xxxviii, 87
on A. L. Galabin's specimen of extra-uterine gestation (A.
Kouth, A. Doran, A. L. Galabin, and T. W. Eden) xxxviii, 88
on A. Eouth's specimen of foetus diprosopus anencephalicus
('Transactions,' vol. xxxvii, p. 162) (W. R. Dakin, C. H.
Roberts A. E. Giles, and A. Eouth) . . xxxviii, 92
on J. Rutherford Morison's and H. R. Spencer's specimen of
deciduoma malignum and J. D. Malcolm's specimen of sar-
coma of the uterus (A. A. Kanthack, J. Bland-Sutton, J. H.
Targett, H. R. Spencer, A. Doran, T. W. Eden, and W. S. A.
Griffith) ..... xxxviii, 183
on Walter W. H. Tate's specimen of tubo-ovarian abscess
(C. H. Roberts, J. Bland-Sutton, and W. W. H. Tate) xxxviii, 380
on A. H. N. Lewers's specimen of foetus with cystic tvunour of
neck (A. Doran, A. H. N. Lewers, and J. H. Targett) . xxxix, 2
on L. Remf ry's specimen shown as chorionic villi and doubtfxil
sarcoma (A. Doran, A. A. Kanthack, J. H. Targett, L. Remfry,
J. Bland-Sutton, H. R. Spencer, T. W. Eden, and W. S. A.
Griffith) ...... xxxix, 2
on H. Macnaughton-Jones's specimen of tumovir of the ovary
(H. Macnaughton Jones, H. R. Spencer, J. H. Targett, and
T. W. Eden) . . . ... . xl, 213
on John Phillips's specimen of monstrosity resultingfrom amni-
otic adhesion to skull (John Phillips and C. Hubert Roberts) xl, 131
on Arnold W. W. Lea's specimen of tixmour expelled from
uterus during labour- at term (T. W. Eden, J. Bland-Sutton,
and A. W. W. Lea) .... . xli, 219
on Arthur Burton's specimen of deformed foetus (W. R. Dakin,
A. E. Giles, and T. W. Eden) .... xli, 340
on Amand Routh's specimen of myxo-sarcoma of the uterus
(C. H. Roberts, A. Routh, W. S. A. Griffith, H. R. Spencer,
and T. W. Eden) . . . . .xli, S70
on W. S. A. Griffith's specimen of sarcoma of the uterus (C. H.
Roberts, H. R. Spencer, W. S. A. Griffith, A. Routh, and
T. W. Eden) ...... xli, 371
on A. F. Stabb's specimen of myxofibroma (P sarcoma) of
uterus (W. Duncan, T. W. Eden, G. Drummond Robinson,
and A. F. Stabb) ..... xlii, COO
on H. R. Andrews's specimen of sarcoma of uterus (H. R.
Spencer, T. W. Eden, and H. R. Andrews) . . xlii, 265
38 COMMITTEES.
COMMITTEES, repoets of {continued) —
„ on Amand Koutli's specimen of foetus thoracopagus (A.
Eouth, and C. H. Eoberts) .... xlii, 31
COMMITTEES, pathology, reports of.
on E. O. Croft's specimen of an anomalous case of ectopic
pregnancy, probably ovarian (see ' Transactions,' vol. xlii,
p. 316) . . . . . . xliii, 24
„ on R. Boxall's specimen of cystic fibroid with carcinoma of the
left ovary and of the right Fallopian tube (J. H. Targett, C.
Lockyer, A. W. W. Lea, and R. Boxall) . . . xliii, 144
„ on A. W. W. Lea's specimen of sarcoma of the uterus and
pelvic cellular tissue (J. H. Targett, C. Lockyer, A. W. W.
Lea, and R. Boxall) ..... xliii, 145
„ on P. Horrocks's specimen of deciduoma malignum (P.
Horrocks, H. R. Spencer, A. Doran, T. W. Eden, G. B.
Smith, J. H. Targett, and W. S. A. Griffith) . . xliii, 288
„ of Teratological Conmiittee on Hugh S. Stannus's specimen of
orbital tumour in a foetus .... xliv, 91
„ on A. J. Stiu-mer's specimen of parasitic cyst of the voolva . xliv, 4
„ on H. Williamson's specimen of pregnancy in rudimentary
horn of a uterus bicornis . . . . xliv, 228
„ on W. E. Fothergill's specimen of decidual uterine cast of
seven weeks' growth, together with an oviim of about five
days' growth . . . . .xliv, 251
„ on Comyns Berkeley's specimen of ovarian abscess ruptured
diiring labour ..... xliv, 77
„ on W. F. V. Bonney's specimen of solid ovarian tumour with a
cyst attached, with the tube open . . . xliv, 93
„ on J. M. Mimro Kerr's specimen of tumour of the uterus . xliv, 130
„ on P. Horrocks's specimen of ectopic gestation . . xliv, 229
„ on W. W. H. Tate's specimen of sarcoma of the uterus (shown
May 7th, 1902) ..... xliv, 252
„ on A. H. N. Lewers's specimen of uterus removed by abdo-
minal pan-hysterectomy for primary carcinoma of the body xliv, 291
„ on F. J. McCann's specimen of " deciduoma malignum " after
the menopavise ..... xliv, 296
„ on Alban Doran's specimen of retro-peritoneal lipoma (p. 265) xliv, 310
„ on sections from the liver in R. H. Bell's case of puerperal
eclampsia (p. 253) ..... xliv, 310
„ on J. Bland- Sutton's specimen of carcinoma of Fallopian tube
and fibro-myoma of uterus .... xliv, 313
„ on J. H. Dauber's specimen of ruptvired tubal gestation . xliv, 322
„ on A. E. Giles's specimen of fibroma of the ovary . . xliv, 361
„ on W. C. Swayne's specimen of sarcoma of the body of the
uterus, with complete inversion .... xliv, 367
„ on G. F. Blacker's specimen of uterus removed by vaginal
hysterectomy ..... xlv, 85
„ on C. H. Roberts's specimen of adenoma malignum of
uterus ...... xlv, 91
„ on A. L. Galabin's specimen of hydatidiform degeneration of
the placenta and on the fcettis .... xlv, 101
„ on E. "W". Hey Groves' specimen of fibroid tumour which had
developed siibsequently to removal of both appendages . xlv, 137
„ on E. W. Hey Groves' specimen of carcinoma of the body of
tlie xiterus ...... xlv, 139
„ on specimens of chorion-epithelioma . . . xlv, 254
„ on J. B. Hellier's specimen of extra-viterine gestation . xlv, 369
COMMITTEES.
39
COMMITTEES, pathology, reports of (continued) —
on A. J. Stunner's specimen of fibro-myoma of ovary . xlv, 373
on W. A. Meredith's specimen of cervical fibroid . . xlvi, 14
on W. W. H. Tate's two specimens of diffuse adeno-myoma of
of the iiterus (p. 141) ..... xlvi, 178
on P. Horrocks's specimen of fibro-myoma of the uterus under-
going sarcomatous degeneration (p. 184) . . . xlvi, 265
on H. R. Spencer's specimen of cancer of the body of the
uterus simulating fibroid (p. 235) . . . xlvi, 265
on C. E. Purslow's specimen of cystic tumour of uterus (p.
269) ...... xlvi, 339
on C. E, Purslow's specimen of tubal mole (p. 271) . . xlvi, 340
on Frank E. Taylor's specimen of fibroma of the ovary (p.
280) ...... xM, 341
on M. Handfield-Jones's specimen of fibroid tumour of the
uterus and cystic disease of the svirrounding tissues (p. 307) xlvi, 383
on J. H. Dauber's specimen of double symmetrical cystoma of
unusual origin and connections (p. 341) . . . xlvi, 384
on F. N. Boyd's specimen of fibroma of the ovary (p. 348) . xlvi, 384
on A. E. Giles's specimen of extra-uterine gestation . . xlvii, 118
on H. Williamson's specimen of grape-like sarcoma of the
cervix uteri (p. 119) ..... xlvii, 146
on A. J. Sturmer's specimen of abdominal gestation (vol. xlvi,
p. 385) ...... xlvii, 146
on E. Hamilton Bell's microscopic sections showing the
appearance of thyroid-like structures in ovarian cysts (p. 242) xlvii, 297
on J. B. Hellier's specimen (with microscopic section) of
chorion-epithelioma ..... xlvii, 319
on F. N. Boyd's specimen (with microscopic sections) of
malignant disease of cervix, in a girl, aged 18 . . xlvii, 320
on H. E. Spencer's specimen (with niicroscopic sections) of
carcino-sarcoma uteri ..... xlvii, 352
on M. A. D. Scharlieb's specimen (Avith microscopic sections)
of endothelioma of the body of the uterus . . xlvii, 406
on W. W. H. Tate's specimen of degenerating fibro-myoma and
sarcoma of uterus ..... xlvii, 407
— (adjourned) ..... xlvii, 407
on W. W. H. Tate's specimen (with microscopic sections) of
fibro-myoma of uterus associated with a large cavity con-
taining retained menses communicating with the uterine canal xlvii, 407
on W. S. A. Griffith's and H. Williamson's specimen of fibro-
myoma of the uterus undergoing sarcomatous change (p. 22) xlviii, 72
on John Phillips's specimen (with microscopic section) of
chorion-epithelioma (p. 45) .... xlviii, 72
on A. L. Galabin's specimen of spindle-celled sarcoma of the
ovary (p. 19) . . . . . . xlviii, 72
on Mrs. Scharlieb's specimen of malignant tumour of the
uterus (p. 73) ..... xlviii, 127
on the doubtfully malignant spot in Dr. Lockyer'g specimen
of adeno-myoma of uterus (p. 94) . . . xlviii, 128
, on F. J. McCann's specimen of a hsemorrhagic broad ligament
cyst with torsion of the pedicle (p. 179) . . . xlviii, 191
on W. W. H. Tate's specimen of degenerating fibro-myoma
and sarcoma of uterus, with secondary growths in peri-
toneum, liver, lungs, and retro-peritoneal glands. (Shown
by E. Hamilton Bell.) {Vide ' Obstet. Soc. Trans.,' vol. xlvii,
1905, pp. 358, 407) . ... xlviii, 225
40 COMMITTEES — COPEMAN.
COMMITTEES, PATHOLoaT, reports op {continued) —
„ on H. Kussell Andrews's specimen and microscopic section of
endothelioma of the cervix (as described by the exhibitor)
(p. 283) . . . . . . xlviii, 802
„ on E. E. Young's microscopic section of primary tuberculosis
of the cervix uteri (p. 286) .... xlviii, 302
„ on C. Hubert Roberts's specimen of a curious case of cancer
of the uterus (p. 311) ..... xlviii, 380
„ see also Pathology Committee, p. 155.
COMMITTEES, tkratological, report of :
„ on Hugh S. Stannus's specimen of orbital tumour in a foetus . xliv, 91
CONGESTION, intense, of head and neck in a five months foitus
(W. F. Cleveland) ..... xvi, 2
CONSULTATION midwifery in private practice, statistical and
practical remarks on (E. Copeman) . . . xvi, 103
CONSTRICTOR for removal of tumoiirs of the uterus (J. Lazare-
witch) . . . . . . XV, 63
CONTRACTION of the litems (J. Matthews Duncan) . . xxviii, 91
„ irregular uterine (E. H. Trenholme) . . . xiv, 231
„ of uterus without retiaction, with prolonged high temperature
of nervous origin (G. E. Herman) . . . xlviii, 204
„ pelvic, from spondylolisthesis (R. Barnes) . . . vi, 78
,, tonic, without completeness of retraction (Matthews
Duncan) ...... xxix, 369
CONTRACTIONS of the uterus throughout pregnancy, their physio-
logical efl'octs and their value in the diagnosis of pregnancy
(J. B. llicks) ...... xiii, 216
CONTRIBUTION to the clinical knowledge of puerperal diseases
(.r. Braxton llicks) ..... xxxv, 412
CONVULSIONS and albuminuria during abortion in six successive
pregnancies (W. H. Broadbent) . . . . i, 108
„ epileptiform in the third week of the puerperal state (R. U.
West) ...... iii, 35
„ hereditary, confined to the males of a family, occurring during
infancy and at about the eighth month of intra-uterine life
(J. B. Curgenven) . . . . • ix, 116
„ puerperal, complicated with mania, apparent recovery, sudden
decease (A. Hall) . . . . • iv, 222
„ puerperal, in the ninth month of pregnancy ; delivery with
parallel forceps, child stillborn ; recovery (J. Lazarewitch) . xv, 59
„ and pelvic tumour, case of labour complicatedr by (H. M.
Madge) ...... xvii. 20
„ cases of, in the Montreal University Lying-in Hospital (D. C.
McCallum) . . . . . . xx, 43
„ see Eclampsia.
Cooke (Lotjis), uterine and extra-uterine (fimbrial) pregnancy,
progressing simultaneously to the full period of gestation ;
death ; post-mortem examination . . . v, 143
Copeman (E.), cases exemplifying some of the difficulties en-
countered in determining the existence of pregnancy, and
the value of auscultation as a means of diagnosis . . x, 62
„ imperforate hymen with retained menstrual fluid . . x, 246
„ tumours of the pelvis obstructing delivery . . xii, 313
„ cases in practice ..... xiii, 232
„ statistical and practical remarks on consultation midwifery in
private practice ..... xvi, 103
CORP CRANIOTOMY. 41
CORD, see Funis, UmhiUcal.
CoRDEs (Aug.), eases of prolapsus . . _ xyjj 53
„ letter read in the discussion on puerperal fever . ] ^ii' 217
CORNU, left uterine, sloughing fibroid of; abnormal relations
(A. Doran and C. Lockyer) . . . _ xliii 272
COEPUS FIBROSUM, large calcified, in ovary (J. Bland-Sutton) xl' 223
CORPUSLUTEUM,onthe(W.A.Popow) . . . ^^iv; 100
„ abscess m (J. D. Malcolm) . xlvii 8
„ cystic (E Alcock) . .' ; ; xliii,' 208
„ compound lutein cystomata found in association with vesicular
mole and chorio-epithelioma (C. Lockyer) . xlvii 157
„ ovarian tumour containing (A. L. Galabin) . xxxviii] 101
CORROSIVE SUBLIMATE, pellets of (F. H. Champneys). . xxviii', 66
„ irrigation, mercurialism in lying-in women undergoing (W R
^'^«") ;xxviii,281
CoET (F. C), ovum forceps. . , , vjji 5
„ abscess of female virethra . . * * ^i' 65
„ successful case of tracheotomy in croup . . * xi' 78
Cory (Robert), head said to have been ruptured by the use of
the forceps ..... xx 81
„ microscopical sections of a uterus, from a subject who died the
day menstruation commenced . . . . xx 104
„ on membranous dysmenorrhcta . . . ! xx' 113
„ uterus from a ease of severe uterine haemorrhage, and injection
of perchloride of iron . . . . - . xxi 51
COTTON-LEAP TEA as a galactagogue in Jamaica (Izett "W. Ander-
^*»'^)- • • • . ^ . . xxii, 31
COTTON- WOOL, medicated (R. Greenhalgh) . . . viii, 217
COUCH-TABLE (Robert Wise) . . . xxxvii,' 79
COUCHAID, to assist labour and economise force during parturition
(A. W. Edis). ..... xvii, 48
COUVEUSE, Auvard's, or nest (Matthews Duncan) . . xxvi, 25
COW, acardiae from (J. Bland-Sutton) . . . xli,' 97
Coward (J. W. S.), inversio uteri . . r . xii] 344
Cox (Richard), case of rupture of the uterus . . . xxviii, 225
Craddock (S.), occluded vagina after delivery, with subsequent
retention of menses ..... xiii 101
Craig (James), see Thornton (J. Knoivsley).
CRANIOTOMY (R. Druitt) . . . . . i, 81
„ abolition of, from obstetric practice, in all cases where the
foetus is living and viable (W. T. Smith) . . . i, 21
„ cephalotripsy, Caesarean section in case of extreme distortion
of the pelvis (R. Greenhalgh) .... vii, 220
„ in a ease of exhaustion and convulsions from protracted labour
.(J- T.Mitchell) . . .^ . . ^ii^368
„ in which delivery was readily effected by turning after perfora-
*l?"4„^^en instrumental extraction was found impossible
(F. W. Mackenzie) . i 267
„ methods of (A. Donald) ..'..[ xxxi' 28
„ spontaneous version after, in a case of obstructed labour f S d'.
H^°«) ' . xxvii, 293
42 CEANTOTOMY — CULLINGWORTH.
CRANIOTOMY (continued) —
„ six cases of, with remarks on the relative position of, and
Csesarean section (A. H. N. Lewers) . . . xxxiv, 161
„ forceps (R. Barnes) . . . . . v, 277
„ — (J. H. Davis) . . . . . vi, 123
„ — see also Forceps.
CRANIUM, fracture of, in a new-born child (S. W. Poole) . xx, 105
Cranny (John J.), remarks in the discussion on the use of forceps xxi, 194
Crawford (James), ovarian cyst ; uterine myoma and polypus ;
death of patient from pneumonia . . . xxxiii, 74
„ fibroma of the ovary ... . xxxvi, 190
Cripps (Harrison), abdominal hysterectomy with intra-peritoneal
treatment of the stump, with notes of eight cases . xxxviii, 41, 107
„ and Herbert Williamson, two cases involving the question
of the site of impregnation .... xlvi, 88
Croft (E. Octavius), anomalous case of ectopic pregnancy,
probably ovarian ..... xlii, 316
„ tuberculosis of cervix ..... xliv, 142
Crombie (J. M.), self -administration of anesthetics, apparatus for xviii, 64
Cronk (H. G.), see Godson, Clement.
CROUP, membranous (R. U. West) . . . . i, 53
„ successful case of tracheotomy in (F. C. Cory) . . xi, 78
CuLLiNGWORTH (C. J.), pelvic Cellulitis noted, with special re-
fei-ence to the temperature .... xii, 370
„ fibroma of both ovaries ..... xxi, 276
„ — report on ditto by committee (J. Knowsley Thornton and
Alban Doran) ..... xxi, 314
„ case of Coesarean section .... xxix, 252
„ thick-walled cyst connected with, and simulating enlarge-
ment of, the uterus .... xxx, 165, 198, 202
„ — report on ditto by committee (C. J. Cullingwoi'th, Alban
Doran, and P. Horrocks) .... xxx, 199
„ localised sloughing of fundus uteri in a case of acute septi-
caemia following abdominal section . . . xxx, 406
„ extra-uterine f cetation ; abdominal section eight months after
death of foetus ; sac formed by left Fallopian tube and left
broad ligament ; recovery .... xxx, 480
„ hsematosalpinx ..... xxxi, 226
„ — and intra-peritoneal hsematocele from rupture of a varicose
vein in the inner surface of the right Fallopian tube , xxxi, 257
„ uterus, ovaries, and tubes from a case of Csesarean section . xxxi, 308
„ case of vesico-iitero- vaginal fistula . . . xxxi, 320
„ for A. H. Robinson, uterus showing placenta praevia. . xxxii, 67
„ — report on ditto by committee (W. S. Plaj^air, F. H.
Champneys, and C. J. Cullingivorth) . . . xxxii, 107
„ uterus removed by Porro's operation . . . xxxii, 135
„ foetus and placenta from a case of extra-uterine gestation . xxxii, 135
„ cancerous uteri removed by vaginal hysterectomy . . xxxii, 136
„ foiu" cases of vaginal hysterectomy . . . xxxii, 141
„ carcinoma of the ovary ..... xxxii, 199
„ fcetus, placenta, membranes, and Fallopian tube from a case
_ of ruptured tubal gestation, complicated by a large hsemato-
salpinx on the opposite side .... xxxii, 273
„ haemorrhagic carcinoma of the ovary . . . xxxiii, 445
CULLINGWOBTH. 43
CuLLiNGwoETH (C. J.) (continued)-
„ suppurating ovarian cyst
„ a series of seven cases of pyosalpinx " " ' ^^^!"' 4^6
„ case of Cesarean section for contracted pelvis ' ' ^'''' •"' ^S
„ ruptured tubal gestation * ' ^^^^^' ^9
„ case of squamous-celled carcinoma of the cervix 'uteri in '''''''^' ^^^'
d^^^aS SSio^ ^^^^"^^^ ^" ^^ ^P--^ -d - "in^a
„ unruptiu-ed tubal gestation, with aT)or)lex'v of ^-^^^ ^,". " ^^^]'^' ^^^
„ tubal gestation with apoplekic ovSS^^ a^u^r^^^^^^^^^^ " ™' ]'!
„ two cases of pyosalpinx "lup.iuea . xxxiv, 182
„ myoma of the cervix uteri " ' ' * ^'^^^^' 219
" ^^r.W"'^'']^"^^ simulating tubo- ovarian abscess .' ' Sxiv S?
" ?n JS I abdominal section in certain cases of pdvic peri: ' ^
tonit s, based on a personal experience of fifty cases ^. • or..
„ — adjourned debate ^ ^^ • ^^^i^, 254
" TprirSiTsTo^'^ '" ^ paper 'read before the Society on ''''''' ^^^
sXlfhU'ry^rthire^^ hysterectomy, giving the Lb-
" 'h?rretZy "^ ^^'^'^ '' '''' ^'^^'^^ — -^ ^^ ^^^ominai ^^^^' ''^
" ''Z''^^''Kl-''*^'i"*'^^^*^'^i°"' in ^^hich the foetal movements ''''''''' ^^
„ large gangrenous interstitial myoma of the uterus, ' ' ''''''''■' iSo
„ three cases of pelvic inflammatL attended wTth abscess of "' '''
the ovary, with clinical remarks aoscess ot _
„ primary carcinoma of the FaUopian tube .' * ' IZ^^' f'
„ Pf .^^^jP^n^/i^^ating a tubo-ovarian abscess ' '^^^J^' ^%
" an indisputable case of complete tubal abortion xxxv ' 1 ^Q
„ diffuse (non-capsulated) myoma of uterus ' ' }^l
" ^ptdTcL^^'^'''^^-"^^^^^'^^^^^--"%^^^^ '''
" ''subjelr^^''^'^''^ ^n^aUuterinemyomaoccurringinayoung''"'''^^' ^'^
„ supposed case of tubo-ovarian cyst ' ^^vV^- 9q«^ '^^^^-■' ^^f
„ multiple fibro-myomata of the ifterus ' "^"^ ^^^ ' ^^^^^^V \
„ large fibro-cystic myoma growing from tlie cervix utPvJ ^^^v?!?. ■ 6
„ pyosalpinx, with multiple^bscesfes of the ovary 'SSx' 4?
„ maugm-al address as President ' " '^P' ^'
„ fibroma of the ovary * " * • ^xxix, 91
„ gangrene of an interstitial fibro-myoma of the uterus ' xxxj? S?
" iS"Sthfwo°' '"^^ .f'Tf ^^^"^"^ '^^^'^^^^ obstruction "''"'
and death two years after the menopause ^^^^^ ^s^
" 'SjLlt^o^tfetters ^' ^^^-^^--) --plicated by fibrol ™' '''
„ hibbographioal appendix to Annual Address • ' ■ ^1. 89
■ "mt^aSSuSi- '''^»-<-"-) --plicated- by flbrol ^'^ '"-
, codematous subperitoneal flbro-myomata if uterus in rirf,; ^'" ^^''
broad bgament removed by abdominal hysterectomy ^ ,,, 302
44
CULLINGWORTH CYST.
CuLLiNGWORTH (C. J.) (continued) —
„ genuine case of tubo-ovarian abscess
„ annual address as President ....
„ and J. S. Fairbairn, laro^e inflamed cyst (? ovarian) communi-
cating with an inflamed Fallopian tube .
„ incarcerated fibro-myoma of uterus in an unusually young
subject ......
„ and H. H. Cltttton, notes on a case of hydatids of, or con-
nected with, both ovaries, right broad ligament, liver, omen-
tum, mesentei'Y, and other parts
„ carcinoma of the Fallopian tubes
„ Pozzi medal ......
xli,
xli.
39
50
xUi, 96
xlii, 132
xlvi, 254
xlvii, 263
xlviii, 271
CULTURES, method of taking intra-uterine bacteriological
(A. W. Sikes) ..... xlv, 381
Cttratulo (J. Emilio), on the influence of the removal of the
ovaries on metabolism in connection with osteomalacia xxxviii, 17
CURETTE, for the removal of uterine fungoid granulations
(J. M. Sims) ...... vii, 72
CURETTING and steaming of uterus followed by vaginal hys-
terectomy fourteen days after (G. F. Blacker) . . xlv, 80
CuRVENQEN (J. B.), hereditary convulsions confined to the males
of a family, occurring during infancy and at about the eighth
month of intra-uterine life . . . . ix,
„ bromide of potassium in puerperal mania . . . ix,
„ hereditary twin-bearing family . . . . xi,
„ knotted cord ...... xiii.
116
155
106
187
Curtis (H. J.), "grape-like" sarcoma of tlie cervix uteri, fungat-
ing into and infiltrating the walls of the vagina, in a child,
aged 12 months ; extirpation of uterus and vagina . xlv, 320
Cutler (Lennard), kidneys from a case of eclampsia . . xxxvi, 176
„ and pROBTN-WiLLiAMS (R. J.), some observations on the tem-
perature, pulse, and respiration during labour and the
lying-in ..... xxxvii, 19, 152
CYANURIA, case of (John PhilUps) .
CYCLOPS, case of (W. J. McC. Ettles)
CYST, abdominal, in a newly-born female child (Gomer Davies)
„ large, abdominal (A. W. Williams)
„ of the broad ligament (J. Knowsley Thornton)
„ — (E. Malinsj ....
„ — -ftdth septa (W. S. A. Griffith)
„ — (W. Duncan) ....
„ — (C. E. Purslow) ....
„ — fibroid associated with an ovarian (A. Doran)
„ — with torsion of the pedicle and extensive haemorrhage
into the broad ligament (F. J. McCann)
„ chylous, of the mesentery (Ad. Rasch)
„ congenital ccelomic (C. Lockyer) .
„ dermoid (W. T. Smith) .
„ — (R. Barnes)
„— (A. W. Edis)
„ — (A. L. Galabin)
„ — two from the same patient (C. H. Carter)
xxxi, 256
xxxvi, 149
xix, 5
viii, 218
xxvi, 55
xxvi, 228
xxvii, 251
xxxiii, 157
xli, 169
xliii, 260
xlviii, 179
xxxi, 311
xliii, 7
vii, 45
XV, 35
XXV, 66
xxxiv, 441
xxxii, 6
CYST.
45
CYST, dermoid {continued) —
„ — (T. C. Hayes) ..... xxxiii, 389
„ — containing a large number of epithelial balls (W. F. Victor
Bonney) ...... xliv, 354
„ — containing hair and well-developed teeth and osseous sub-
stance (K. Barnes) ..... xvii, 215
„ — containing pill-like bodies (A. C. Butler-Smythe) xxxvii, 15
„ — suppiu-ating (Wm. Duncan) .... xxxii, 346
„ — of the pelvis, the suppuration and discharge into mucous
cavites of (G. E. Herman) .... xxvii, 254
„ — with dentigerous plate (Leith Napier) . . . xxxv, 429
„ — of ovary; post-mortem (W. B. Woodman) . . vii, 158
„ — (J. Shaw-Mackenzie) .... xxxiii, 461
„ — (A. C. Butler-Smythe) .... xxxiii, 463
„ — ovarian (J. Bland-Sutton) .... xxxiv, 5
„ — ovary containing three (S. W. Wheaton) . . xxxiii, 28
„ with infiltration of broad ligament Avith fat (J. Bland-
Sutton) ...... xxxiv, 7
„ — of ovary, with minute pedicle produced by torsion of mes-
ovarium only (A. L. Galabin) .... xlvii, 331
„ — of right ovary ; twisted pedicle (W. Duncan) . . xxxvi, 267
„ — ovarian, impacted in the pelvis, which was removed by
abdominal section during the ninth month of pregnancy
(Thomas H. Morse) .... xxxviii, 221
„ — of the ovary removed by abdominal section five years after
causing obstruction to labour (W. W. H. Tate) . . xlvi, 341
„ — incarcerated ovarian, removed diu-ing pregnancy per
vaginam (Amand Routh) . . . . xl, 217
„ — ovarian, the size of a child's head in a case of ruptured
uterus (A. H. N. Lowers) .... xlii, 95
„ — of ovary, obstructing labour- ; displacement of the tumour
from the true pelvis and extraction of the child -wdth forceps ;
removal of tumoiu- five weeks later ; recovery (J. M. Munro
Kerr) ...... xliii, 148
„ removed by posterior colpotomy (Amand Eouth) . xliv, 34
„ — in Fallopian tube (C. J. Ritchie) . . . vii, 250
„ — suppurating (A. D. Leith Napier) . . . xxxiii, 465
„ in the decidua vera, aborted ovum showing (John Phillips) xxxi, 52, 161
„ dilated tubes and cystic ovaries (early stage of tubo-ovarian)
(W. Duncan) . . . . - xxxvii, 150
„ of the Fallopian tube (A. Meadows) . . . viii, 139
„ in connection with the right Fallopian tube, arising probably
from an accessory Fallopian tube (E. Hamilton Bell) . xlvi, 21
„ from case of extra-uterine fojtation (J. Scott) . . xv, 124
„ hydatid, of the mesentery (E. Malins) . . . xxix, 245
„ hydatidiform, growing in the vulva (A. J. Sturmer) . xliii, 148
„ from the labia minora (A. Wiltshire) . . . xxiii, 206
„ of the larynx removed post mortem from an infant (A. W.
Edis) ...... xviii, 2
„ lutein, in both ovaries, in chorion-epithelioma of the uterus
(G. F. Blacker) ..... xlix, 104
„ mviltiloculai', of left ovary removed six years after removal of
right ovary (T. Spencer Wells) ....
„ — of oophoi-on (Cuthbert Lockyer)
„ myoma of utervis, weighing over 15 lb. (Alban Doran)
„ of the great omentum (Alban Doran)
ovarian (T. W. Eden)
X, 19
xlii, 37
xxxviii, 164
. xxiii, 164
. xxxv, 408
46 CYST.
CYST, ovarian (continued) —
„ — appearance of thyroid-like structures in (R. Hamilton
BeU) ....... xlvii, 242
„ — associated with a case of fibroid of broad ligament, after-
history (Alban Doran) .... xlix, 94
„ — pi-esence of sarcomatous tissue in the walls of (F. E.
Taylor) ...... xlvii, 411
„ — chronic axial rotation of an, giving rise to extreme
twisting of the elongated uterus (Thomas Wilson) . xxxix, 167
„ — ruptured, with twisted pedicle (V. Bonney) . . xlvii, 190
„ — two, removed by ovariotomy (T. Spencer Wells) . . iii, 285
„ — bilateral, in a patient with chorio-epithelioma follow-
ing hydatidiform mole (J. D. Malcolm, R. H. Bell, and C.
Lockyer) ...... xlv, 483
„ small ovarian, and hydi'osalpinx removed by anterior
colpotomy (Amand Routh) . . . xxxviii, 185
„ — with cast from the uterus having all the characters of the
decidual membrane found in connection with ectopic gesta-
tion (W. R. Dakin) .... xxxviii, 385
„ — suppuration in, caused by the Bacillus typhosus (F. E.
Taylor) . . . . . . xlix, 25(5
„ suppurating ovarian, complicating tubal pregnancy (molar)
(John Phillips) ..... xli, 384
„ obstructing labour, removed by abdominal section
eighteen mouths later (W. AV. H. Tate) . . . xlii, 164
„ attached to solid tumour of left ovary and communicating
with the left Fallopian tube (V. Bonney) . . xliv, 92
„ ovarian, which had made its way between the layers of the
meso-sigmoid, both broad ligaments, and the meso-csBCum
(W. H. B. Brook) ..... xlv, 415
„ (? ovarian) communicating with an inflamed Fallopian tube
(C. J. Cullingworth and J. S. Fairbairn) . . . xlii, 96
„ imilocular, involving both ovaries and with both Fallopian
tubes attached (J. Knowsley Thornton) . . . xxi, 119
„ unilocular ovarian, containing solid masses undergoing
necrotic change (J. S. Fairbairn) . . . xliv, 126
„ — pathology of certain so-called (G. G. Bantock) . . xv, 105
„ tubo-ovarian (W. S. A. Griffith) . . xxix, 273, 302; xxx, 3
„ — (J. Bland-Sutton) ..... xxxi, 338
^^ _ (W. C. Grigg) ..... xxxiii, 75
„ — (M. Handfield-Jones) .... xxxiv, 85
„ — large double (William Duncan) . . xxxviii, 37
„ — double pyosalpinx with (W. C. Grigg) . . . xxxiii, 75
„ — supposed case of (C. J. Cullingworth) . . xxxvii, 295
„ — supposed case of (C. J. Cullingworth) . . xxxviii, 1, 4
„ papilliferous, of the ovary (John Williams) . xxix, 247, 513
„ papillomatous ovaa-ian (J. Knowsley Thornton) . . xxvi, 4
„ — removed during the fourth month of pregnancy (W. A.
Meredith) ...... xxxii, 374
„ — of an accessory ovary (A. L. Galabin) . . . xliii, 267
„ (?) parasitic, of vulva (A. J. Sturmer) . . . xliv, 2
„ parovarian (Lawson Tait) .... xxv, 112
„ — with twisted pedicle (C. Berkeley) . . . xlyi, 242
„ — removed per vaginam (Amand Routh) . . xxxvii, 8
„ — with acute axial rotation (A. W. W. Lea) . . xxxix, 8
„ on cases of associated parovarian and vaginal, formed from a
distended Gartner's duct (Amand Routh) . . xxxvi, 152
XXX,
4
xxxii.
64
xxxii.
65
XX,
84
i.
55
xxvi.
157
XXV,
109
xxxiii.
27
CYST — DAKIN. 47
CYST (continued) —
„ of placenta (R. Boxall) ..... xxvi, 59
„ — on the fcetal siu-face of (John Williams) . . xxv, 69
„ polypiform, growing from anterior Avail of vagina, distended
by a viscid olive-colonred fluid, and projecting at os externum
vaginae. Incision, iodine injections. Subsequent removal
by wire rope ecraseur (J. H. Davis) . . . ix, 32
„ retro-peritoneal, associated with solid malignant (?) intra-
cj'stic growth (A. L. Galabin) .... xxviii, 179
„ thick-walled, connected with, and simulating enlargement of,
the iiterus (C. J. CullingAvorth) . . . xxx, 165, 198, 202
„ uterine (W. S. A. Griffith) .... xxvi, 229
„ of the vagina (M. Handfield-Jones) . . . xxxi, 129
„ — their aetiology, pathology, and treatment (Henry T.
Eutherfoord) ..... xxxiii, 354
„ removed from the vvilva (A. L. Galabin) . . . xxvi, 56
CYSTIC adenoma of the cervix (W. S. A. Griffith)
„ disease of the chorion (Aust Lawrence)
,, — hydatiform degeneration (John Phillips)
„ — of the fcetal kidney (H. Gervis)
„ — of the ovary, new method of examination of the tumour in
cases of suspected (W. G. HeAvitt)
„ — of ovary in its earliest stage (E. Barnes)
„ — of both ovaries (C. H. Carter)
„ ovary, the seat of hajmorrhage (M. Handfield-Jones)
„ degeneration, see Degeneration.
„ growths and tubal dilatation, uterine appendages showing
(T. C. Hayes). ..... xxxiii, 4
CYSTOCELE, vaginal, new operation for (E. W. Hey Groves) . xlvii, 65
CYSTOMA, compound lutein, found in association with vesicular
mole and chorion-epithelioma (C. Lockyer) . . xlvii, 157
„ double symmetrical, of unusual origin and connections (J. H.
Dauber) ...... xlvi, 341
„ ovarian, origin of, from Graafian follicles (A. L. Galabin) . xxi, 288
„ ovarian, complicating pregnancy ; infection of the cyst five
days after labour ; operation on the forty-third day ; ex-
tensive peritoneal and bowel adhesions; i-ecovery (H.
Macnaughton-Jones) ...... xlii, 140
„ papillomatous ovarian, removed after double ovariotomy
fifteen yeai-s previously (J. D. Malcolm) . . . xxxv, 36
„ double tubo-ovarian (W. Duncan) . . xxxvii, 149
„ tumour closely simulating a papillomatous ovarian, attached
to the front of the bladder and quite separate from both
ovaries (J. D. Malcolm) .... xli, 226
„ perimetric (J. H. Targett) .... xli, 343
Dakin (W. E.), on mercurialism in lying-in women undergoing
sviblimate irrigation ..... xxviii, 281
„ dissection of a fcetus, the subject of retroflexion, ectopia
viscerum, etc. ; with remarks on the frequent association of
these abnormalities, and its cause . xxxi, 308 ; xxxii, 200
„ sarcomatous uterus removed by vaginal hysterectomy . xxxii, 139
„ foetus, the subject of atresia ani vesicalis . . . xxxii, 368
„ uterus and appendages affected vrith tubercle . . xxxiii, 3
„ tetany in pregnancy . . . . . xxxiii, 163
„ sarcoma of ovary ..... xxxvi, 313
48
DAKIN DAVIS.
Dakin (W. K.) (continued) —
„ concealed accidental hemorrhage ; foetus, placenta, and
memhranes delivered entire .... xxxvi, 315
„ cast from the uterus having all the characters of the decidual
membrane found in connection with ectopic gestation
together with a small ovarian cyst from the same case with
microscopic sections of each . . . xxxviii, 385
„ uterus ruptured during imobstructed labour (with a micro-
scopic section) . . . . . xl, 29
„ uterine fibroid clinically resembling sarcoma . . xl, 32
„ fibro-myoma spontaneously enacleated during labour . xli, 105
„ inaugural address as President .... xlvii, 121;
„ annual address as President .... xlviii, 51
Daly (F. H.), advantages of the early use of the long forceps . xii, 3
„ uterus occupied by a tumour the size of a large orange, with
attached ovarian cyst ..... xvi, 122
„ report on ditto by committee (J. B. Potter and T. C. Hayes) . xvi, 202
„ large fibroid tumour in the uterus. , . . xviii, 65
„ case of inti-a-uterine tumour .... xviii, 222
„ remarks in the discussion on the use of forceps . . xxi, 227
„ extra-uterine gestation ..... xxiv, 155
„ tumoiu" expelled from the uterus after delivery . . xxviii, 170
„ and C. H. Carter, foreign body in the vagina, removal after
four years, and after-results .... xxii, 'S-i
Dauber (J. H.), carcinoma of body and multiple fibromata of
uterus removed by abdominal pan-hysterectomy . xxxix, 321
„ ruptured tubal gestation .... xliv, 321
„ double symmetrical cystoma of unusual origin and connections xlvi, 311
„ fibro-myomatous uterus with a calcified fibroid lying free in its
cavity ...... xlix, 139
Da VIES (Gomer), abdominal cyst in a newly-born female child . xix, 5
Davis (J. Hall), ovarian gestation . . . . i. 2il
„ polypus of the uterus . . . . i, 247
„ intra-uterine fibro-plastic tumour, extensively adherent,
recovered by enucleation . . . . ii, 17
,, double battledore placenta with a single umbilical cord,
connected with one child . . . . ii, 273
„ hydatid mole expelled from the uterus ijpmediately after a
living foetus and its placenta, at about six months' gestation ;
the hydatid growth being the degenerated ovum of a twin
conception ...... iii, 177
„ complete occlusion of the os uteri, with retention of menses,
after difficult labour . . . . . iv, 91
„ craniotomy forceps . . . . . vi, 123
„ fibrous tumour of the uterus attended by early pregnancy ;
retroversion of the uterus and retention of urine ; death and
decay of the foetus and subsequently of the mother from
pya;mia ...... viii, 11
„ inaugural address as President . . . . iz, 30
„ polypiform cyst growing from the anterior wall of vagina,
distended by a viscid olive-coloured fluid ; incision ; iodine
injections ; removal by wire-rope ecraseur . . ix, 32
„ large fibroid polypus pediculated at its base to posterior
margin of os uteri, its neck protruded at vulva, removed by
- the single wire ecraseixr .... ix, 152
„ annual address as President . . • . x, 14
DAVIS — DECIDUOMA.
49
Davis (J. Hall) (continued) —
„ membranes of a twin ovum of supposed ten weeks' gestation
„ intra-uterine fibroid tumour; a part removed by the single
ecraseur, the remainder strongly adherent, cut into in
different directions, and thrown off by disintegration on the
fourth day • . . . .
„ aimual address as President . . ] [
„ puerperal convulsions, illustrated by cases .
„ extra-uterine pregnancy ; the left ovary and the fimbrise of left
Fallopian tube formed the cyst Avhich had ruptui-ed, dis-
charging fojtus of eight months' growth into abdominal
_ cavity ; survival till sixth day ; necropsy
„ inversion of the uteiais after childbirth in a primipara •
amputation by ecraseur at expiration of ten montlis on
account of haemorrhage with great exhaustion
„ new vaginal speculum •...",
Davorkn (J.), see Duncan, William.
Dawson (E. Etjmlet), ruptui-e of an early (fifteenth day) tubal
gestation complicated by fibro-myomata of the uterus
„ the essential factor in the causation of sex ; a new theory of
sex • . . . .
Day (E. E.), extra-uterine fcetation, followed by intra-uterine
pregnancy ; induction of premature labour
„ adhesions between uterus and rectum, dragging down the
fundus uteri .....
Day ("W. Hankbs), case of fibroid tumour complicating delivery
X, 57
X, 227
xi, 15
xi, 268
xii, 331
xiv, 104
xvi, 98
treated by enucleation .
DEATH, causes of, in ewes, during and after parturition (J.
Hutchinson) • . . . .
xl, 155
xlii, 356
vi, 3
vi, 10
xxvii, 158
xvii, 88
DECIDUA. apoplexy of (A. Eouth) .... xxxii, 194
„ aborted ovum showing cysts in (John Phillips) . xxxi, 52,' 161
„ or fleshy substance discharged from unimpregnated half of a '
double uterus (W. F. Cleveland)
xxiii, 132, 181 ; xxiv, 297; xxvi, 117, 331
„ hypertrophy of (G. Ernest Herman) . . . xxxiii, 456
„ menstrual, passed on the first day of menstruation (A L
Galabin) . . . . .- xxi, 312
„ pieces of, illustrating the extent to which the ovum may be
occasionally interfered with without abortion occurring (W
S. Playfair) . ..... xxi, 290
„ structure of the (G. Hoggan) .... xvi 228
„ vera and reflexa from a very early abortion (G. E. Herman) xxxii^ 272
„ reflexa and decidua vera from a patient who died of heart
disease ; frozen sections of a uterus at the tenth week of
pregnancy, showing haemorrhages into the (G. F. Blacker) . xlii, 235
DECIDUOMA malignum. occurring in England (J. Rutherford
Morison) ..... xxxviii, 130
— (Herbert E. Spencer) . . . xxxviii 135
— a criticism (T. W. Eden) . . , xxxviii' 149
— addendum to paper on (T. W. Eden) . f . xxxviii,' 162
— adjourned discussion on . . . xxxviii 171
— report of Committee on specimens of . . xxxviii^ 183
— primary sarcoma of the body of the uterus, in a patient,
aged 24, treated by vaginal hysterectomy (A. H. N. Lowers), xxxix, 216
4
50
DEOIDUOMA — DEGENERATION.
xl, 113
xl, 225
xiiii, 109, 283
. xliv, 294
. xlv, 243
xlv, 245
xlv, 247, 248
. xlv, 250
. xlv, 251
. xlv, 242
DECIDUOMA malignum (continued) —
„ — (J. H. Targett) ....
„ — primary sarcoma of the body of the uterus (A. H. N
Lewers) ....
„ — (P. Horrocks)
„ — after the menopause (F. J. McCann)
„ — (T. A. Helme)
„ — (A. H. N. Lewers)
„ — (F. J. McCann)
„ — (H. R. Spencer)
„ — (A. J. Sturmer)
„ — (malignant hydatid mole) (J. B. Hellier)
„ — without syncytium ; secondary deposits in vagina, lym-
phatic glands (Uiac and lumbar), and lungs, after hydatidi-
form degeneration of tlie chorion (P. Horrocks) . . xlv, 243
„ — of uterus (J. R. Moi-ison) .... xlv, 249
„ — with secondary deposit in vagina ; lungs showing secondary
deposits (F. J. McCann) .... xlv, 248
„ — secondary growth from vagina of (J. R. Morison) . xlv, 249
„ — (so-called) and the occurrence of chorion-epitheliomatous
and hydatidiform mole-liko structures in tvunours of the
testis (J. H. Teacher) .... xlv, 256
DEFORMITY, congenital, in two children, and the natural
impressions to which the deformities were attributed (Ash-
burton Thompson) ..... xix, 94
„ curious congenital (C. H. Roberts) . . . xxxvi, 341
„ case of foetal (A. W. Addinsell) . • . xxxvii, 204
„ in an early human embryo with retroflexion, showing absence
of spinal medulla and imperfection of the vertebral column
(C. B. Lock-wood) ..... xxix, 234
„ influence of abnormal partiirition, difficult labour, premature
birth, and asphyxia neonatorum on the mental and physical
condition of the child, especially in relation to (W. J. Little) iii, 293
„ rare, in the anatomy of an infant (C, Singer) . . xlvii, 250
„ of lower limbs and stumps of arms in a hydrocephalic child
(Matthews Duncan) ..... xxii, 237
„ — dissection of ditto (W. L. Heath) . . . xxiii, 195
„ of hand and foot in a child (John Phillips) . . xxviii, 89
„ of arms and hands (J. Shortt) . . . . vi, 205
„ pelvis deformed by mollities ossium (W. S. A. Griffith) . xxvi, 230
„ see Malformations.
DEGENERATION, colloid, uterine fibroid undergoing (T. G.
Stevens) ...... xxxvi, 225
„ cystic, in large fibroid tumour of uterus (P. Horrocks) xl, 227
„ mai'ked cystic, in fibro-mj'oma of uterus removed from a
patient, aged 63, from whom both ovaries had been removed
eleven years before (W. W. H. Tate) . . . xliii, 26
„ cystic of the cervix uteri (H. Gervis) . . . xxvi, 144
„ — of chorion, in a case of missed abortion (G. E. Herman) . xxii, 44
„ — with hyperplasia of chorion stems (W. S. A. Griffith) . xxx, 82
„ — of subperitoneal fibroid of the uterus (C. H. Carter) . xxv, 108
„ — of soft myoma of the» uterus (J. H. Aveling) . . xxvi, 270
„ — umbilical cord in a state of (Clement Godson) . . xxiii, 180
,». fatty (J. Bru.nton) . . . . . ix, 85
„ fibroid, of uterus, with sub-peritoneal and interstitial fibrous
tumours, in. a state of disintegration (A. W. Edis) . . xi, 34
(W. B
DEGENERATION DEVELOPMENT.
DEGENERATION, fibroid {continued)—
" Tho%r/Br^t,^^t)---^-*rophy with collapse (cir-
, hydatid, of the ovum (F. Webb)
, hydatidiform, of the ovum (W. g! Hewitt)
' (C. H. F. Eouth) . '
, (w. A. Russell) . ■ ' •
' Voodman)'^?'""' ^''°''^*^'^ "^*^ albuminuria
. (J. Phillips) .' ■ • •
. (H. Williamson) . ' ' *
. preceding deciduoma mal'ignum witliout Wn^irf^irv,
=5-a«: ;rHS>.."r"-« ^^"^^i
myxomatoxxs, of uterine fibroids (Clement Godson) *
"^t:?^sfA FiskbbT "'"''^ '"'""'"" fibri-myoma of
red, uterine myoma undergoing (W. F. V. Bonnev) '
sarconjatous, with fibro-myoma of the uterus (? Horrocks)
- m fibro-myoma of uterus (P. Horrocks) ^ ^°"oc^s)
Ll^ ; °^ *^^ endometrium (D. C. MacCallum)
see Lalcareous degeneration.
Delbastaille's specuhun d glissQres (Alban Doran)
""^^^^llo^^^"^' '" ^'"^^^^^ ^^^^ °f unsuspected pregnancy
" ^J,f'f,°^P''^^^a/f representation; subsequent slouc^hinc and
:rof the sli^e' (rs,^^^^ ^' ''- ^^^^- -^ el^-t
„ large fibrous tumour impeding (H. M Mad^eV ^"^""^''^
" 'SL1n5" '''''"''^ """"^.^"^ ""^ ^" uterus after (J. katthews
„ sxidden and unconscious (J. Shortt)
„ see also Parturition.
51
xxxvi, 328
ix, 85
ii, 112
ii, 242
vii, 228
vii, 113, 117
xxxii, 65
xli, 303
xlv, 243
XXV, 140
xlii, 133
xlv, 464
xl, 178
xlvi, 184
xlv, 100
xxiii, 37
xxxii, 307
iv, 202
dermoid ovarian tumour
V,
186
iv.
140
xxix.
429
iv.
129
V,
42
iv.
107
iv.
210
xxxi.
86
XXXV,
429
xxiii, 16]
xxiii. 32
DENTIGEROUS bony plates from a
(Alban Doran)
„ plate with large dermoid cyst (Leith Napier)
DEPRESSION of child's head by forceps (Clement Godson^
„ of frontal bone, the result of pressure ?rom the sac -al ^ra
montory (Clement Godson) . ^ P^^'
DERMOID CYST, see Cyst.
DERMOID TUMOUR, see Tumour, Ovarian
""'' p'^eSnS ^-l' '^^'^^ ?^^"^" ^P^Pl-^ f-- a case of acute
„ placenta with hemorrhage " ' ' • -"^^^iv, 214
..and normal structure of the hu^anplaeenta(T.W.Ede„)„„vii!2t 22?
52
DEWAR — DISPROPORTION.
Dewar (John), see Godson, Clement.
DIABETES insipidus in pregnancy and labour (J. Matthews
Duncan)
„ puerperal (J. Matthews Duncan)
DIAGNOSIS of placenta prsevia by palpation of the
(U.K. Spencer) . • , . ,;r' j \
post-mortem, of a nulliparous uterus (A. Meadows)
'„ and treatment of retroflexio-versio uteri gravidi (W. J.
Sinclair) . • • • ' tt -p
DIAPHRAGM, congenital hernia through, three cases of (H. K.
Spencer) . • • •
DIAPHRAGMATIC HERNIA, congenital (A. E. Giles)
Dickinson (T. V.), uterus and iliac glands removed by abdo-
minal hysterectomy for cancer of cervix .
DICOTYLEDONOUS PLACENTA (W. T. Greene)
DIGITS, rudimentary supernumerary (H. Russell Andrews)
DILATATION of the bladder in a fffitus (F. A. T. O'Meara) .
of the cervical canal for spasmodic dysmenorrhcsa and sterility
" (C. Godson) . . • . •, ,V^''"''
„ cystic, without rupture in a case of apoplexy of the ovary
(Alban Doran) . • . •
di"-ital, of the os in labour (J. Braithwaite) •
of "the OS uteri for chorea in pregnancy (W. F. Wade)
", of the uterine canal by continuous elastic pressure (Lawson
Tait) •••••■
DILATOR (J. H. Aveling) . • • • •
Bossi's (M. Handfield- Jones) . • • •
", rapid, after Ellinger's (W. C. Grigg)
„ uterine, graduated metallic (S. Sloan)
XXIX, 308
. xxiv, 256
abdomen
. xxxi. 203
xvii, 355 ; xviii, 69
xlii, 338
xxxii, 132
xxxiv, 132
xlviii, 15
xviii, 68
xlii, 266
xxix, 54
; xxiv, 6
xxxii, 119
xxi, 38
xxii, 244
xxi, 291
xxvi, 149
xlv, 103
xvi, 248
xxviii, 114
DILATATION of bladder and ureters from pressure, in an infant
(W. McAdam Eccles) . . • • . xxxiv, ^ou
DIPHTHERIA (A. W. Williams) . •
complicating puerperal fever (R. Dnutt) . ;. ■ , , "
svmptoms simulating, in a case of pregnancy complicated by
" cancer of the cervix followed by pyemia (A. L. Galabin) .
Diplococcus pneumoniBe, primary infection of the puerperal uterus
by (A. G. R. Foulerton and W. F. Victor Bonney) .
DISCOLORATION of the skin of the forearms and hands diu-ing
pregnancy (J. G. Swayne) . • • •
DISEASES, puerperal, further contribution to the clinical know-
ledge of (J. Braxton Hicks) . • • •
DISINTEGRATION of organic tissue by high tension discharges
(J. Inglis Parsons) - • • xxxvii, 1^4
ix, 35
iii, 30
xxiii, 186
xlv, 128
iv, 18
XXXV, 412
DISLOCATION, congenital, of both hips (S. W. Poole) .
DISPLACEMENT of the bladder as a cause of tedious labour
(W. H. Broadbent) . • , • „ ' ^x, t. '
of dermoid cyst of ovary obstructing labour, from the true
" pelvis, and extraction of the child with forceps; removal of
-tumour five weeks later ; recovery (J. M. Munro Kerr)
„ of uterus, see Uterus, displacement of.
DISPROPORTION, turning in cases of (A. H. McClintoek)
xxii, 214
v, 44
xliii, 145
iv, 175
DISSECTION DOEAN.
63
xxxiv, 250
xxxii, 69
xxxiv, 184
xlix, 6
xxxi, 28
xli, 7
xliii, 180
xxi, 169
xxi, 253
DISSECTION of a malformed child (W. L. Heath) . . xxiii, 195
„ of the musclee of the female pelvis and perineum ( Alban Doran) xxviii, 274
„ of a case of spina bifida (T. W. Eden) . . . xxxv, 336
DISTENSION of vagina and uterus with muco-puriform fluid in a
child aged 7 weeks (W. McAdam Eccles) .
DivEK (Dr.), see Edis {A. W.)
DIVERTICULA, urethral (A. Routh) ....
„ Meckel's, prolapse of, forming an umbilical tumour (S. W.
Wheaton) ......
Donald (Archibald), chronic septic infection of the uterus and
its appendages .....
„ methods of craniotomy .....
„ ectopic intra-ligamentous gestation at the seventh month, in
which the foetus was extracted by vaginal incision .
„ fibroid tumoui's complicating pregnancy and labour
DoKAN (Alban), tubal gestation and the effects of chronic retro-
uterine haemorrhage .....
„ deficient development of the uterus, atresia of the os externum,
atrophy of the ovaries, insanity ....
„ pelvic viscera showing congenital communication between the
rectum and the genito-urinary tract
„ exfoliation of vesical mucous membrane
„ microscopic sections of a dermoid ovarian cyst
„ case of extreme arrest of development of the genito-urinary
tract in a female foetus .....
„ cyst of the great omentujii ....
„ twisting of pedicle in an incipient dermoid ovarian cyst
„ interstitial or tubo-uterine gestation, with notes on similar
cases in the museums of London hospitals
„ relation of prolapse of the vagina to hernia, illustrated by two
pedigrees ......
„ ruptured secondary cyst in the wall of a multilocular ovarian
tumour ......
„ specimen showing the relations to each other of inflammation
of the endometrium. Fallopian tube, ovary, and pelvic peri-
toneum ......
„ foetus and membranes from a case of missed abortion
„ malformations of the Fallopian tube . xxviii, 171 ;
„ papilloma of the I'allopian tube and the relation of hydro-
peritoneum to tubal disease . . . xxviii, 229, 243
„ dissection of the muscles of the female pelvis and perineum . xxviii, 274
„ foetus, sac, and pelvic viscera from a case of extra-uterine
pregnancy ......
„ glandular structure in the substance of a primary cancer of
the Fallopian tube .....
„ on myoma and fibro-myoma of the uterus and allied tumours
of the ovary ......
„ dissection of H. G. Trestrail's case of mylacephalus acardiac
twin, with notes on acardiac monsters in the museums of
London hospitals .....
„ for William Skene, anencephalous foetus
„ dentigerous bony plates from a dermoid ovarian tumour
„ anterior serous perimetritis simulating ovarian sarcoma when
explored by abdominal section ; recovery with disappearance
of the cyst .... xxxi, 217 ; xxxiii, 185
xxii.
79
xxiii.
2
xxiii.
105
xxiii,
107
xxiii.
164
xxiv.
133
xxiv.
227
xxvi, 88
xxvi, 118
xxvii, 164
xxvii, 224
xxix, 186
xxix, 491
xxx, 194
XXX, 410
xxxi, 4
xxxi, 52
xxxi, 86
54 DORAN.
DoRAN (Alban) (conlinucd) —
„ fibroma of the ovarian ligament .... xxxi, 200
„ fragment of membrane passed from the uterus . . xxxi, 229
,, — report on ditto by Committee (John Williams, W. S. A.
Griffith, and Alban Doran) .... xxxi, 310
„ on closure of the ostium in inflammation and allied diseases
of the Fallopian tube ..... xxxi, 344
„ apoplexy of the ovary ; cystic dilatation without rupture . xxxii, 119
„ Delbastaille's speciilum a glissieres . . . xxxii, 307
„ for Ernest Hart, ancient Greek charm from Crete representing
woman in labour ..... xxxiii, 26
„ double hsematosalpinx ; suspected early tubal gestation on
both sides ...... xxxiii, 112
„ sequel to the case of anterior serous perimetritis simvdating
ovarian sarcoma ..... x.xxiii, 185
„ congenital aiu-icular sinus ; absence of external meatus on
opposite side ; cutaneous sinus over sacrvim . . xxxiii, 199
„ cervical auricle ..... xxxiii, 200
„ for George B. Beale, fatal rupture of an ovarian cyst in an infant xx.xiv, 24
„ papillomatous cyst of both ovaries causing profuse ascitic
effusion ...... xxxiv, 149
„ on ligature of the pedicle in ovariotomy . . . xxxv, 131
„ for Arthur A. Beale,icBtus in peritoneal cavity; question of
abdominal gestation, with a summary of reported cases of
primai-y abdominal and ovarian pregnancy . . xxxv, 222
„ on the absorption of fibroid tumours of the uterus, with a
report of a suspected case .... xxxv, 250
„ for Walter Lowe and Survey Bradbury, acardiacus
mylacephalus .... xxxvii, 209
„ placental polypus .... xxxvii, 229
„ cystic myoma of uterus weighing over 15 lb. . xxxviii, 164
„ cases of fibroma of the ovary and ovarian ligament removed
by operation ; with a series of after-histories of cases
reported in the 'Transactions' since 1879 . xxxviii, 187
„ unrepoi-ted case of primary cancer of the Fallopian tubes in
1847, with notes on primary tubal canc«r . . xxxviii, 322
„ fibroma of the ovary ; impaction ; ascites ; removal . xxxix, 37
„ lipoma of the lumbar region, 44 lb. in weight, and of
twenty years' growi:h ..... xxxix, 40
„ fibroma of the abdominal wall ; increase during pregnancy . xxxix, 42
„ management of true and false capsules in ovariotomy . xxxix, 265
„ liajmorrhage from the Fallcjnan tube without evidence of
t\ibal gestation . . . . . xl, 180
„ tables of cases of primary cancer of the Fallopian tube
reported up to present date {April, 1898) . . . xl, 197
„ blood concretions in the ovary . . . . xl, 214
,, fibroma of broad ligament weighing 44 lb. 8 oz. successfully
i-emoved from a woman aged 28 . . . . xl, 295
„ sarcoma of both ovaries . . . . xl, 296
„ inaugiu'al address as President .... xli, 107
„ fibroid of the broad ligament weighing 44^ lb. (20 kilog.)
removed by enucleation ; recovery. (With table and
anal3'sis of thirty-nine cases) ..." xli, 173
„ fibroid in undeveloped cornu of an uterus unicornis ; from a
parous subject ..... xli, 295
,, double hydrosalpinx without salpingitis . . . xli, 379
„ for Professor Pawlik, photographs from a case of primary cancer
of the Fallopian tube ..... xlii, 6
DORAN — Douglas' pouch. 55
DoBAN (Alban) (continued) —
„ macerated foetus removed from the abdominal cavity two
months after spurious laboiir . . , jj.jjj g
„ annual addi-ess as President . . ' ' ^jj' 40
„ tubal mole ; fa;tus three quarters of an inch in length in
perfect preservation . . , ^2ii 134
„ extra-uterine gestation in which foetal death occurred at the
eighth month after spurious labour ; abdominal section two
months later . . _ ^^H 213
„ acute torsion of an ovarian pedicle from a case where there
was chronic torsion of the pedicle of a tumour of the
opposite ovary . . . _ ^^-j. jg
„ annual address as President . . ' xliii' "5
„ pregnant fibroid uterus removed at the fifth month'. ' xliii' 178
„ fibroid of broad ligament associated with an ovarian cyst xliii' 260
„ and CuTHBERT LocKTBE, sloughing fibroid of the left uterine ' '
cornu ; abnormal relations . . _ ^^^^^ 272
„ retro-peritoneal lipoma weighing 13 lb. 12 oz. ". ' xliv' 2G5
„ fibroma of ovary one third of an inch in diameter ." ' xliv' 173
„ pure myoma of the ovary, with a microscopic section " xliv' 168
„ pure fibroma of the ovary . . ^ ^i^^' 272
„ pregnancy after removal of both ovaries for cystic tumour . xliv, 231
„ tor F. C. Batchelor (Dunedin), primary squamous-celled
epithehoma of the body of the uterus . . xlv 374
„ pregnant fibroid uteri removed by operation .' * xlvi' 119
„ solid mesenteric tumour (fibro-myoma) weighing 30 ib. ' xlvi' 145
„ hsematoma and hsematocele ; a study of two cases of early
tubal px-egnancy • . ^. • • . . xlvi, 206
„ andH. Williamson, necrobiotic uterus associated with recent
pregnancy . . . . _ ^j^j 274
„ repeated tubal pregnancy .... ^Ivii^ 235
„ siibtotal hysterectomy ; after-histories of sixty cases xlvii 363
„ fibroma of the ovary weighing 17 lb. ; under observation
for ten years ^ • ^, • • . . xlvii, 421
„ hbro-myoma removed by abdominal myomectomy in second
month of pregnancy ; labour at term . . xlvii 426
„ myomectomy during pregnancy and labour at term in an
elderly primipara, with notes on similar cases . . xlviii 303
„ for the late Dr. G. Bagot Ferguson, chorio-endothelioma of
uterus ;intra-peritoneal haemorrhage ; hysterectomy; death xlix 57
„ atter-history of the case of fibroid of broad ligament
associated with an ovarian cyst, reported in the forty-third
volume of the Society's ' Transactions.' . . . xlix 94
„ malignant vaginal polypus secondary to an adrenal tumour of
the kidney . . . . _ xlix, 182
DOUBLE UTERUS, see Uterus, malformations of (double).
DOUCHE can (John Shaw) ....
„ new utero- vaginal (A. Wiltshire) ". [
„ the invalid's compendium (Graily Hewitt) '
„ sublimate, mercurialism in lying-in women undergoino- (W
E. Dakin) . . o & v •
„ syphon (A. W. Edis) . , \ '
„ uterine, as a therapeutic agent (W. G. Hewitt)
„ — and vaginal (A. E. Sansom) . . ]
DOUGLAS' POUCH, calcified tumovxr of uncertain origin removed
by laparotomy from (A. H. N. Lewers) . . . xlvii, 151
xxxi, 262
X, 20
XXX, 198
xxviii, 281
xxiii, 8
iv, 27
viii, 219
56 DOWN DUNCAN.
Down (J. Langdon), the obstetrical aspects of idiocy . . xviii, 296
DOYEN'S METHOD for the removal jjer vaginam of myomatous
uteri (W. J. Smyly) ..... xli, 96
Drage (Charles), extra-uterine pregnancy . . . ii, 254
Draoe (Lovell), case of rupture of the uterus . . xxviii, 2
„ fom- cases treated by electrolysis . . . xxx, 24-1, 260, 265
DRAINAGE in the treatment of suppurating ovarian cysts (J. J.
Phillips) ...... xiv, 340
Drew (Douglas), abdominal hysterectomy for cancer of the
cervix associated with pregnancy . . . xlviii, 202
DRILL- CROTCHET, description, and indications for the employ-
ment of (H. E. Eastlake) . . . . ix, 146
DROPSY extreme, Avith fatty degeneration and friability of the
placenta (J. Brunton) ..... xvii, 175
„ of foetus in a case of abortion at six and a half months
(Protheroe Smith j ..... xvii, 303
„ — case of general (Lawson Tait) .... xvii, 307
„ — complication in the delivery of (J. A. Tliorapson) . xvii, 4
„ — hypertrophy of the placenta (J. Bassett) . . xix, 261
„ — and distension of bladder in, necessitating embryotomy (A.
L. Galabin) ...... xix, 119
„ — (T. W. Eden) ..... xlv, 45
„ — and oedema (H. E. Andrews) .... xliii, 166
„ obstructing delivery in foetus with absence of urethra (T. G.
Stevens) ..... xxxvii, 5
„ ovarian (H. W. Sharpin) .... vii, 102
„ — (J. S. Turner) . . . . . x, 39
„ — treated by tapping and pressure ; apparent recovery for
three and a half years ; return of disease ; ovariotomy ;
recovery . . . . . . v, 279
„ with fibroma of the ovary ; impaction ; removal (Alban Doran) xxxix, 38
Driutt (K.), craniotomy . . . . . i, 81
„ complete obliteration of the canal of the small intestine by
foetal peritonitis ; Amussat's operation . . . ii, 135
„ effects of reckless vaccination . . . . ii, 305
„ puerperal fever complicated with diphtheria in which life Avas
saved by the sesquichloride of iron . . . iii, 30
„ substitute for brandy in cases of exhaustion . . iii, 143
„ syphilis after vaccination . . . . v, 196
Duncan (C), see Barnes, Fancourt.
Duncan (J. Matthew^s), state of the internal surface of the
uterus after delivery . . . . . iv, 107
„ cephalotribe . . . . . . xi, 42
„ long delay of labour after discharge of liquor amnii. . xiv, 216
„ spontaneous separation of placenta when it is previa . xv, 189
„ letters read in the discussion on puerperal fever . xvii, 101, 132 -
„ general cancerous hypertrophy of the body of the uterus . xx, 27
„ on traction by the lower jaw in head-last cases ; a laboratory
note ...... XX, 61
„ the revolutions of the foetal head in passing through a brim
contracted only in the conjugate diameter — laboratory note . xx, 151
„ two specimens of jjyometra .... xxi, 54
„ on expression of the cord .... xxi, 302
„ hydrocephalic child with stumps of arms and deformity of
lower limbs ...... xxii, 237
XXlUj
xxiii,
xxiii,
xxiii,
xxiii,
xxiii,
xxiii,
xxiv.
xxiv,
xxvi,
xxvi,
xxvi,
xxvii,
xxvii,
xxvii,
xxviii,
xxviii,
xxix,
xxix.
xxix, 369
DUNCAN".
Duncan (J. Matthews) (continued)—
" J i- ^' ^' ^^^^^^'^'> double ovariotomy
„ delivery m a case of double uterus
„ inaugural address as President
„ calculi embedded in female lu-ethra
„ case of phlegmasia dolens with lymphatic varix
" "LtSrnl''^ t\,ecovd as a cause of obstruction to the
natural progress of labour
„ Fallopian tube pregnancy " ' ' '
„ means of keeping sponges aseptic 'in the vagina
„ annual address as President * ^,^,-,, o.,
„ case of so-called imperforate hymen ' * ' ' ^'^^'
„ on puerperal diabetes . . * ' * ^^^^'
„ Auvard's couveuse or nest ' *
» angioma of labium ..""■•
„ on foetal revolutions . ' ' '
" Tnrb?^^'^'''*'r ?• ^""P"? °^ ^^'^ female generative organs',
including perforations, pits, and excavations
" Z It^ ?yP«^-t^-0Phy of lupus of the female generative oro-ans "
„ on the inflammations of lupus of the pudendum ° '
" oS l^^^Zf''''' ^^\^^t^^^' ^^d expansion of the utems
„ on elasticity, retraction, and polarity of the uterus .
„ on ha?morrhagic parametritis
„ on diabetes insipidus in pregnancy and labovu-
" TractSa ""^ contraction without completeness of rel
" ^'Se'StSJ^^^^ Bt^gulation of uterine fibroids
„ laceration of the vagina in labour
„ Munchmeyer's transfusion apparatus
" ^ipeciali?ofT;r T^T\«^^ «^' retroflexions of ihe foetus;
especially ot the trunk, during pregnancy
„ vote of condolence on the death of
Duncan (William), hydatidiform mole
„ large fibro-cellular tumour
„ ruptured ovarian cyst ' ' '
;: prxS'JtaSr ^^ "' '"""^"^^^ r ™«°" :
„ ovarian tumour
,, on extirpation of the entire uterus
„ hasmatocele from ruptured Graafian follicle
„ cystic ovaries removed for dysmenorrhoja
,. sloughing uterine fibroid
„ ovaries and jejunum . ' " ' *
„ secretion of milk in a new-born male child '(Hving specimen) "
„ uterus and appendages from a single woman P^'^^^en; .
„ uterus, with its contained placenta, removed from a rachitic
woman aged 30, by Porro's operation .
„ uterus, the subject of sarcoma, removed by hystereetomv with
microscopical sections . j i'cicLiuxu^,wun
„ FaUopian tube and ovary from a case of tubal gestation
:: at:n:;ice%le1oett .'^"" ^ ^^.^^ '' ^^'^^^^^'' ^^^^^^-^ •
57
6
21
64
109
132
243
263
5
29
212
256
25
118
171
139
230
310
91
115
191
308
XXX,
xxxi,
xxxii,
xxvi,
xxxii,
XXV,
XXV,
XXV,
XXV,
435
236
5
206
306
162
233
212
212
XXV,
xxvi,
xxvi,
xxvi,
xxvii, 8
xxviii,
xxviii,
xxix,
XXX,
XXX,
XXX,
234
27
186
229
i, 93
210
211
250
82
226
408
XXX, 408
xxxi,
xxxi,
xxxi,
xxxi.
165
202
202
58
DUNCAN.
Duncan (William) {continued) —
„ uterus, rectum, and left kidney of a woman who died of
Tiraemia ...... xxxi, 255
„ dermoid ovarian tumour .... xxxi, 255
„ simple ovarian cyst ..... xxxi, 255
„ large myoma of left broad ligament . . . xxxi, 309
„ hsematosalpinx and pyosalpinx .... xxxi, 332
„ hydi-osalpinx ...... xxxi, 332
„ fibro-myoma and abscess .... xxxi, 332
„ rapidly fatal cerebral haemorrhage occurring in a case of preg-
nancy complicated with multiple fibroids . . xxxii, 2
„ should pregnancy be terminated prematurely in cases of
phthisis? ...... xxxii, 7
„ right ovary and tube distended with blood . . xxxii, 306
„ uterine appendages the subject of tubercvilar deposits . xxxii, 306
„ uterus with primary cancer of the body extirpated per vaginam xxxii, 306
„ suppurating dermoid cyst .... xxxii, 346
„ ovary and tube with papilloma .... xxxii, 346
„ broad ligament cyst ..... xxxiii, 157
„ extirpation of the uterus for cancer . . . xxxiii, 157
„ report on ditto by committee (W. Dtmcan, W. S. A. Griffith,
S. W. Wheaton, and G. E. Herman) . . . xxxiii, 161
„ uterus, with kidneys and vu-eters, from a case of Csesarean
section ...... xxxiv, 127
„ knitting-needle used to procure abortion . . . xxxiv, 223
„ for H. A. Lediard, specimen of sessile fibro-myoma from the
supra- vaginal portion of cervix uteri which had obstructed
laboui*, removed by laparotomy . . . xxxv, 296
„ tubal gestation of nine weeks' duration, successfully removed
three hours after ruptiure .... xxxvi, 66
„ ruptured tubal gestation .... xxxvi, 114
„ fibroid polypus of cervix .... xxxvi, 114
„ foetus and placenta removed by laparotomy from a case of
extra-uterine gestation .... xxxvi, 146
„ gangrenous uterine fibroid removed by abdominal hyste-
rectomy ...... xxxvi, 181
„ hypertropied nymphae and clitoris . . xxxvi, 3, 149
„ cystic sarcoma of omentujn simulating ovarian tumour ; re-
moval ; recovery ..... xxxvi, 264
„ dermoid cyst of right ovary ; tmsted pedicle . . xxxvi, 267
„ ovarian tumour complicating pregnancy ; cyst ruptured
during examination ; immetliatc laparotomy; recovery . xxxvi, 312
„ for J. Davoren, a case of congenital absence of nose, right
palpebral fissure, and right ear ; imperforate anus, &c. . xxxvii, 16
„ degenerating uterine myoma . . . xxxvii, 147
„ double tubo-ovarian cystoma . . . xxxvii, 149
„ dilated tubes and cystic ovaries (early stage of tubo-ovarian
cysts) ..... xxxvii, 150
„ case of missed abortion, in which an early embryo in its
amniotic sac was retained in the uterus for eight months xxxvii, 196
„ unruptured tubal gestation removed by abdominal section xxxvii, 197
„ sloughing fibroid removed by hysterectomy . xxxvii, 197
,, for G. H. Jones, conjoined twins (thoracopagus) . xxxvii, 198
„ ruptured tubal gestation . . . xxxvii, 244
„ double pyosalpinx .... xxxvii, 245
„ — simulating extra-uterine pregnancy ; removal ; recovery xxxvii, 291
„ unruptiu-ed tubal gestation . , . xxxviii, 36
DUNCAN EAR. 59
Duncan (William) {continued) —
„ large doiible tiibo-ovarian cysts . . . xxxviii, 37
„ fibroids renaoved by the intra-abdominal method . . xxxix, 88
„ double pyosalpinx ..... xxxix, 89
„ adeno-carcinoma of uterus and left ovary removed by abdo-
minal section ..... xxxix, 289
„ uterus with submvxcous and interstitial myoma removed by
hysterectomy ..... xxxix, 290
„ multiple myxomatous polypi from cervix iiteri . . xlii, 243
J, uterus removed at full term by intra-peritoneal hysterectomy
in a case of contracted pelvis .... xliii, 9
„ multiple myxomatous polypi from the cervix uteri . . xliii, 75
„ uterine fibroids i-emoved by intra-peritoneal hysterectomy . xliii, 76
„ sarcoma of iiterus ..... xliii, 228
„ subperitoneal fibroma ..... xliii, 228
„ three months' gravid uterus removed by vaginal hysterectomy
for squamous epithelioma of cervix . , . xliv, 297
Dunn (Robert) statistics of midwifery from the records of
private practice . . . . . i, 279
„ fatal case of concealed accidental hsemorrhage occurring at
the eighth month of pregnancy .... viii, 285
„ — rupture of the uterus occvirring at the eighth month of
pregnancy . . . . . . ix, 65
DYSMENORRHCEA, essential cause of, as illustrated by cases of
partial and complete retention (Ri Barnes) . . xiv, 108
„ cystic ovaries removed for (Wm. Duncan) . . . xxviii, 211
„ mechanical (R. Greenhalgh) .... viii, 142
„ — and sterility, with a description of a new metrotome (R.
Greenhalgh) . . . . . . v, 164
„ membrane of (Wynn Williams) .... xxv, 233
„ membranous (R. Cory) ..... xx, 113
„ — membrane passed in a case of (A. Meadows) . xvi, 230, 251
„ metrorrhagia, ovaritis, and sterility, depending upon a peciiliar
formation of the cervix uteri ; and the treatment by dilata-
tion or division (R. Barnes) .... vii, 120
„ nature, cause, and treatment of (G. Hoggan) . . xvi, 250
„ on the natural history of (John Williams) . . xxiv, 103,' 141
„ contribution to the nat\u-al history of (G. Ernest Herman and
H. Russell Andrews) ..... xliv, 371
„ on the relation between backward displacements of the uterus
and (G. E. Herman) ..... xxiv, 161
„ the pathology and treatment of (John Williams) . . xix, 138
„ the relation of anteflexion of the uterus to (G. E. Herman) . xxiii, 209
„ spasmodic, the treatment of, by dilatation of the cervical canal
■ivlth graduated metallic bougies (Clement Godson) xxiii, 277 ; xxiv, 6
„ see Menstruation.
DYSPAREUNIA, see Varjinismus.
DWARF, case of Csesarean section in a, and death from peritonitis
(J. Braxton Hicks) ..... xxi, 253
EAR, right ; congenital absence of nose, right palpebral fissui'e ;
impei-forate anus, etc. (W. Duncan) . . xxxvii, 16
„ congenital aixricular sinus ; absence of external meatus on
opposite side ; cutaneous sinus over sacrum (A. Doran) . xzziii, 199
60 EARLE — 6CRASEUR.
Earle (J. Lumlet), neAv pelvimeter . . . iii, 145
„ distension of the bladder, considered as a cause of post-partum
haemoi'rhage . . . . . v, 291
Eastlake (H. E.), case in which amaurosis was observed eight
times in succession after parturition . . . v, 79
„ obstetric binder . . . . . vi, 205
„ management of third stage of labour . . . vi, 226
„ uterine therapeutics ..... viii, 6
„ case in which the right arm of the child was extruded through
the anal orifice during labour .... viii, 320
„ complete epispadias in male infant . . . ix, 63
„ indications for the employment of a di'ill-crotchet ; its special
advantages in certain forms of labour, with a description of
the instrument . . . . . ix, 116
„ child with posterior fontanelle large and quadrangular . ix, 2-43
Eaton (J. C), see Godson, Clement.
Eccles (W. McAdam), distension of vagina and ixterus with
muco-purulent fluid, accompanied by dilatation of bladder
and ureters from pressure, in a child aged 7 weeks . . xxxiv, 250
ECHINOCOCCUS (J. B. Hicks) . . . . viii, 109
ECLAMPSIA, note on the aetiology of (H. Macnaughton-Jones) . xxxix, 12
„ chloral treatment of (P. von Seydewitz) . . . xii, 117
„ in a case of erysipelas followed by premature labour (J. B.
Hurry) ...... xxxii, 309
„ kidneys from a case of (L. Cutler) . . . xxxvi, 176
„ of pregnancy, with observations on the state of the renal
function (G. E. Herman) .... xxix, 517
„ puerperal, pathology of (J. B. Hicks) . . . viii, 323
„ — pathology and treatment of, with special reference to the
use of saline transfusion (E. W. Hey Groves) . xliii, 117, 148
„ — cases of, especially illustrating the temperature and urine
in this disease (G. E. Herman) . xxxii, 17 ; xxxiii, 315
„ — the behaviour of the uterus in (J. Braxton Hicks) . xxv, 118
„ — five more cases of, especially illustrating the temperature
and urine in this disease (G. Ernest Herman) . . xxxiii, 315
„ — (Horace Savory) ..... xli, 284
„ — with a description of a five-weeks' ovum removed in a sub-
sequent pregnancy (W. S. A. Griilith and T. W. Eden) . xli, 151
„ — microscopical sections of the kidneys from a fatal case of
(H. E. Andrews) ..... xliii, 114
„ — with autopsy and remarks (E. H. Bell) . . xliv, 253
„ — treated by thyroid extract (A. J. Sturmer) . . xlvi, 126
„ — primary, pneumococcus meningitis, simulating (T. Wilson) xliv, 5
„ septic peritonitis ; splenic abscess ; death on sixteenth day
after delivery (J. C. Holdich Leicester) . . . xlvii, 271
„ with two special details of treatment (C. N. Longridge) . xlvii, 353 ^
„ see also Convulsions.
ECRASEUR (C. H. P. Eouth) ....
„ Avith single steel wire (A. Meadows)
„ single wire, for removal of fibroid polypus (J. H. Davis)
„ — intra-uterine fibroid removed by (G. C. P. Murrnyj
„ — for removal of fibroid poljqjus (A. Meadows)
„ improvement in single wire (H. Smith)
„ improvement on mode of fastening the rope in (J. B. Hicks)
„ polypus of the uterus, i-emoved by ("W. G. Hewitt) .
XV, 38
ix. 111
ix, 152
xi, 78
xi, 241
XV, 86
vii, 71
iii, 350
ECTOPIA VTSCERUM — EDIS.
61
ECTOPIA VISCERUM and retroflexion of fcetus (W. E. Dakin)
. a • J /T T T^, •„. s xxxi, 308; xxxii, 200
„ retroflexion and (John Phillips) . . . xxxiii 490
„ with retroflexion (Amand Eouth) . . ." xxxv' 102
ECTOPIC GESTATION, see Pregnancy, extra-uterine.
ECTROPION of the os uteri, case of bilateral laceration with (A
L.Galabin) ...... ^xi, 312
xxii, 268
xvii, 215
XXXV, 336
XXXV, 408
xxxvi, 6
xxxix, 132
xli, 151
xlii, 2
xlii, 5
xlv, 45
xlvi, 243
ECZEMA of the nipple in both breasts (Thos. Chambers)
„ uterus from a patient subject to, for three years (R Barnes)
Edkn (T. W.), dissection of a case of spina bifida
„ ovarian cyst ....
„ unruptured tubal gestation . . '
„ on the development and normal structure of the human
placenta . • ., • • . xxxvii, 205, 227
„ addendum to paper on deciduoma malignum . xxxviii 162
„ deciduoma malignum .- a criticism . . xxxviii' 149
„ on the structure of the ripe placenta, and the changes which
occur in placentae retained in utero after the death of the
fcetus ..... xxxviii 360
„ decidual cast of the uterus, from a case in which there was no '
evidence of extra-uterine gestation, with microscopic
sections . . . , ^
„ and W. S. A. Griffith, notes of a case of puerperal eclampsia,'
with a description of a five weeks' ovum removed in a sub-
sequent pregnancy ....
„ adenoma of the uterus . . . ,*
„ cast of the uterus ...'.*
„ case of foetal ascites . . . ' '
„ primary hydatid disease (echinococcua) of the Tallopian tube
„ and F. Lionel Pbovis, intra-ligamentous, fibro-cystic tumour
of the uterus, weighing about 30 lb., removed by enucleation
and sub-total hysterectomy . . , xlviii 264
„ tubal pregnancy with acute salpinitis . ] ,' xlviii' 272
Edis (A. W.), fibroid degeneration of uterus, with subperitoneal
and interstitial fibrous tumours, in a state of disintegration
„ four and a half months' fcetus with encephalocele
„ hydrocephalic fcetus ...'_*
„ ovarian cyst
„ abscess of ovary ; peritonitis and death
„ systematic examination of the abdomen with a view to recti-
fying malpositions of the foetus in cases of labour
„ on the necessity for caution in the employment of extra-
uterine stems ....
„ ovum expelled about the eighth week, showing the villi of the
chorion .....
„ for Dr. Diver, apparatus called the couehaid, to assist labour
and economise force during parturition .
„ india-rubber speculum trough . . \ '
„ for James Stothard, case of twins in which one died at an early
period of pregnancy . . , _ '
„ hydrocephalic foetus which had presented by the breech, and
had caused an impediment to delivery
„ case of epithelioma of the cervix uteri ; pregnancy, parturition
extraction of a living child, death of the mother, two weeks
after delivery, from pyaemia
xi, 34
xi, 173
xi, 173
xiii, 41
xiii, 99
xiv, 331
xvi, 3
xvii, 48
xvii, 48
x^ai, 49
xvii, 211
xvii, 302
xvii, 344
62 EDIS — EMBOLIA.
Edis (A. W.) (continued) —
„ specimen of cyst in the larynx removed post mortem from an
infant ...... xviii, 2
„ specimens of nulliparous and multiparous uteri, with tables of
measurements ..... xviii, 74
„ case of pyEemia with extensive purulent deposits in a new-
bom infant ...... xix, 12
„ the forceps in modern midwifery .... xix, 69
„ for Robert Barnes, modification of Tarnier's forceps . . xx, 163
„ double ovarian cysts, with fibroid of the uterus and ascitic
fluid from peritonitis ..... xx, 164
„ two placentae from cases of twins, prematurely expelled about
the fifth and sixth months . . . xx, 321, 322
„ remarks in. the discussion on the use of forceps . . xxi, 171
„ a sj'phon douche ..... xxiii, 8
„ polypi uteri ...... xxiii, 205
„ epithelioma of cervix with pregnancy . . . xxiii, 264
,. microscopical section illustrating case of malignant disease of
the cervix ...... xxiv, 298
„ epithelioma of the cervix uteri, complicating pregnancy ;
Caesarean section, recovery of mother, child living . . xxiv, 304
„ dermoid cyst ...... xxv, 66
„ arrested development of one twin ; double placenta . . xxv, 213
„ vaginal extirpation of cancerovis uterus . . . xxvii, 2
ELASTICITY of the uterus (J. Matthews Duncan) . . xxviii, 115
Elder (Gkokge), sarcoma of the ovary . . . xxv, 130
ELECTEICAL INSTRUMENTS in use in obstetric medicine (W. E.
Steavenson) ...... xxix, 298
ELECTRICAL LIGHT (Heywood Smith) . xxvii, 3
ELECTRICITY, disintegration of organic tissue by high tension
discharges (J. Inglis Parsons) . . . xxxvii, 124
ELECTROLYSIS in gynaecological practice (W. E. Steavenson,
Lovell Drage, E. A. Gibbons, and John Shaw)
„ on the induced current during parturition (W. Kilner)
ELEPHANTIASIS of the vulva (W. S. Playfair)
Elkingtok (Francis), polypus of the uterus, with clinical
observations .....
Ellington (Feancis), spontaneous inversion of the uterus
Ellis (Eichard), a rare form of twin monstrosity, Avith notes
by D. EiiBLKTON ..... vii, 160
Ellis (Egbert), cauterisation by electric heat in the treatment
of certain diseases of women .... iii, 424
„ practical inquiry into the properties of nitrate of silver, with
an account of a new instrument for its use in uterine disease iv, 116
„ ansesthesia by mixed vapours . . . . - viii, 224
„ new expanding speculum for operations on the cervix uteri . ix, 86
„ a self -retaining tenaculum for operations on the cervix uteri ix. 88
„ carbolised sponge tents. On the defects of ordinary sponge
tents and an improved method for their manufacture . ix, 121
EMBEDDING, intra-mural, of placenta shown in incomplete
-tubal abortion (C. Lockyer) .... xlv, 191
EMBOLIA in lying-in women (E. Barnes) . . . iv, 30
XXX,
xxvi.
229
93
xix.
184
i,
xix.
112
50
xxi, 74
vii, 8
EMBOLISM ENDOMETRIUM. 63
^^^°,y ^^*^^' .°^ ^^f ''^^^ ^^^"^^ ^^d pulmonary artery
nineteen years days after delivery (G. Eoper) ^
„ — ot the pulmonary artery after ovariotomy (E Parson^ '
" "^mlTmson)' ''''^'^"^. ^^^^'^^y-^^^ d^y« after 'deliver/ (h!
„ — puerperal (W. F. Wade) ' " ' ' ^^^' ^^^
' ■ ' • . vi, 255
?- bSgSTSmftr'^^' ^^- ^- ^— ) • -"i. 204, 259
"Tor^di^TS^^'itSV"''^^'^^^^^^ •™^'''
" ^^'n^;!!""-"' ^^^iotic sac retained in the uterus 'for eio-ht ^^^'^^"^
months m a ease of mixed abortion (W Duncan) " \ •• -.n.
" i:r- r'^'; and ruptux^ed tube fiom the sli ^f an old ''"' ''^
pelvic hematocele (C. J. Cullin^orth)
„ carneous mole retained m nfero five months after" death of''''''''"''
S."r^^K^^?'f-^^"^"^ ^Pitl^eliumof villi as a syncytii^
forming reticulating processes (A. L. Galabin) ^^"^^^^^"^
"Toa1n\^W^'1 ''^^^^-^^ ^^^ fimblted opening '''^' '^
shown in a tubal mole, with retention of the head ami
'"TJaTfJ jIYllL'.Sf'^^ »^ *«-'- Of t.e Wa«e; '
„ new method of (E. Barnes) . ' ' • ^^^' ^^
EMMET'S OPEEATION, or trachelo-raphe (W. S. Playfair) ' ^^' ^^^
EMOTION, strong mental, affecting pregnant women as a p^h.o ^f
Idiocy in the offspring (Sir L. MitcheH) ? ' ''^'''^ ^^
EMPYEMA in children, treatment of (W. S. Playfair)
>, ~ two forms of apparatus for use in (W. B. Woodman) * ^!' %
ENCEPHALOCELE (H. Smith) • xv, ^
„ foetus with (H. G. Times) ' " • ix, 243
„ in foetus of four and a half months (A. w' Edis^ " ' ""'"' ^^
" taSn?.fSSr/rsV4 "--^^ °^ -■" '"»— ''' ' "
"'"'fA'L.SinT*"'- ■''■■'°'" ^""•-'^°' --^-« '"'' "' "'
: SssSi;a''(''c"s;eTr"''°"^' <^- «°"-'^) ■ • -'"'SI
„ fundal (C. H. F. Eouth) ' ' * • xliii> 205
„ polyposa with blighted ovum (A. H. N Lewers) ' ' '^•".' ^^^
„ purulent senile, specimens from a case'of (a I w ' n ' ^^^'"' ^^^
» senile, difficulty"^ of diacrnS^^ betweeV fl,& Herman) xxxii, 196
cancer of the uterine bodfcTEHeT-man) '^'' ^°^
" "SSf'^ ".'^''^"^ '^'/^^^^^^ — - -embrane (A. L." "'"""^ '^
„ see Endometrium ' ' • ^cxii, 47
„ unusual thickeuiug ot in case ot fibroMs (i W. A J<ii„,„l) ; ^''J; l^
xxiv, 54
xxvi, 124
64
ENDOMETRIUM EPITHELIOMA.
ENDOMETRIUM (continued) —
„ Fallopian tube, ovary, and pelvic peritoneum, the relations to
each other of inflammation of (Alban Doran) . . xxvii, 164
„ villous degeneration of the (D. C. MacCallum) . . xxiii, 37
„ uterus removed for (?) malignant overgrowth of (V. Bonney) . xlvii, 191
„ small round-celled sarcoma of (A. L. Galabin) . . xlv, 184
ENDOTHELIOMA of uterus (M. A. D. Scharlieb) . . xlvii, 281
„ supposed, of the cervix (H. Russell Andrews) . . xlviii, 283
ENUCLEATION for removal of fibroid of the broad ligament
weigliing 44^ lb. (Alban Doran) . . . xli, 173
„ uterine fibroids removed by, fifteen days after delivery (R.
Boxall) ...... xxxvi, 64
„ spontaneous, of fibroma (Amand Routh) . . . xxxv, 409
„ for removal of large fibro-myoma of cervix, followed by vaginal
hysterectomy (W. W. H. Tate) .... xlii, 161
„ remarks on, in connection with a case of fibro-myoma of the
xiterus in a patient aged 23 (A. E. Giles) . . . xlii, 299
„ and sub-total hysterectomy for the removal of an intra-liga-
mentous, fibro-cystic tumour of the uterus weighing about
30 lb. (T. W. Eden and F. L. Provis) . . . xlviii, 264
EPILEPSY, imperfectly developed internal generative organs in
a patient subject to (C. Lockyer) . . . xlviii, 75
„ uterus unicornis and right appendages removed from a woman
subject to (G. F. Blacker) .... xlviii, 82
EPISPADIAS, complete, in male infant (H. E. Eastlake) . ix, 63
EPITHELIOMA of lip treated by injection of bromine (A. W.
Williams) ..."... xiii, 97
of the cavity of the uterus, case of extirpation for (J. Knowsley
Thornton) ...... xxv, 9
of the body of the uterus, primary squamoua-ceUed (A.
Doran) ...... xlv, 374
„ of the cervix uteri (C. H. Carter) . , xxx, 82
^^ — of the anterior lip of (A. L. Galabin) . . . xxi, 312
„ — columnar (Graily Hewitt) .... xxix, 510
— extirpation of the entire uterus for (Wm. Duncan) . xxvii, 8, 93
— foetus from a woman suffering with (Clement Godson) . xix, 40
", — and of the os (W. Newman) . . . . xvii, 213
— removed by the ecraseur, in which local anaesthesia by the
ether spray was employed (E. Parson) . . . ix, 47
— removed by ecraseur wire during pregnancy without
causing abortion (Clement Godson) . . . xxv, 18
— pregnancy, parturition, death of mother from pysemia
(A. W. Edis) ...... xvii, 344
„ — complicating pregnancy (A. L. Galabin) . . xviii, 242
^, Csesarean section (A. W. Edis) . . . xxiv, 304
][ pregnancy (C. T. Savory) .... xvii, 82
^^ _ Tvith pregnancy (A. W. Edis) . . . . xxiii, 264
of the cervix, uterus showing rapidly growing ; death from
recurrence five months after removal (C. Lockyer) . xliv, 284
„ squamous, of cervix uteri, three months' gravid uterus re-
moved by vaginal hysterectomy for (W. Duncan) . . xliv, 297
^^ _ of the cervix uteri in a very early stage (W. S. A. Griffith) xlii, 210
^^ — invading surrounding tissues like a columnar - celled
variety (W. S. A. Griffith) .... xlii, 210
— of cervix uteri ; removed in 1895 ; no recurrence in 1901
(A. H. N. Lewers) ..... xliii, 266
EPITHELIOMA EXTROVERSION. 65
EPITHELIOMA {conUmied)—
„ of vagina, primary (C. Hubert Roberts) . , xxxviii, 381
„ of the vulva, list of ovariotomies in women over 80 ; a case
aged 83, complicated by (L. Remfry) . . xxxvii, 155
„ — with after-histories (A. H. N. Lewers) . . . xlviii' 163
„ — and cyst of ovary (Heywood Smith) . . xxi, 313 ; xxiii 3
EPITHELIUM, chorionic, partially differentiated into cells, showing
syncytium derived from, in a vesicular mole (A. L. Galabin)" xlv, 240
„ ciliated, drawings of microscopic sections of a uterine polypus
shomng (H. Gervis) ..... xxviii, 240
ERGOT OF RYE for fibrous enlargement of the uterus (J. Brimton) xiii, 282
„ during labour, inquiry into effect on the life of the child
(R. U.West). ..... iii,222
„ the effect of, on the involution of the uterus (G. E. Herman
and C. O. Fowler) • . . . . xxx 85
„ liquid extract of, Martindale's (A. Wiltshire) . . xviii,' 2
ERGOTININE, the hypodermic injection of, in cases of post-partum
haemorrhage (C. Chahbazian) .... xxiv, 286
EROSIONS of the cervix ixteri, pathological anatomy of (A. L.
Galabin) ...... xxii, 156
ERYSIPELAS, symmetrical, followed by premature labour,
eclampsia post-partum (J. B. Hurry) . . . xxxii, 309
Ettles (W. J. McC), case of cyclops . . . xxxvi, 149
Eve (Fred. S.), description of a double-headed human female
monster born at the full term of gestation, shown by C.
Godson for G. E. Yarrow .... xxii 74
„ post-mortem of C. Godson's case of large encephalocele . xxii,' 132
EWES, death in, during and after partui-ition, report on certain
causes of (J. Hutchinson) .... xviii 88
EXAMINATION, bimanual, tubal abortion produced by (A. L.
Galabin) ...... xlvii, 332
EXFOLIATION of vesical mucous membrane (Alban Doran) . xxiii, 2
EXOMPHALOS, in which the gravid uterus formed the hernial
mass (G. C. P. Murray) . , . . i 77
EXPANSION of the viterus (J. Matthews Duncan) . . xxviii, 91
EXPULSION, spontaneous (C. Berkeley) . '. . xliv,' 320
EXTENSIONS of the foetus during pregnancy (J. Matthews Duncan
and J. B. Hurry) ..... xxvi, 206
EXTIRPATION of the uterus, entire (Wm. Duncan) . xxvii, 8, 93
„ — for cancer (W. Duncan) . . . .xxxiii' 157
„ — with both ovaries (Thomas Chambers) . . . xxiii] 12
„ — and ovaries with large fibrous tumotirs (I. B. Brown) . vi' 249
„ — vaginal, two cases of (A. L. Galabin) . . . xxix,' 300
„ for cancer (A. W. Edis) ..." xxvii', 2
» for primary cancer of the body (Wm. Duncan) . xxxii,' 306
„ for primary carcinoma of the body (A. H. N. Lewers) . xxx, 218
» — ill "grape-like" sarcoma of the cervdx uteri, f ungating
into and infiltrating the walls of the vagina in a child ao-ed
12 months (H. J. Curtis) . . . ° . xlv, 320
« sarcoma of the body of the uterus removed by (W. S.
Playfair) ..... xxxvii, 200
}, — see also Hysterectomy.
EXTROVERSION of the bladder (F. H. Champneys) . . xxiv, 240
5
66 EXTRUSION FALLOPIAN TUBES.
EXTEUSION, spontaneous, of a large uterine fibroid (W. S. A.
Griffith) ......
EYES, colour of, in newly-born infants (A. Wiltshire) .
XXXV, 38
XX, 79
FACE, persistent mento-posterior position of, in which the child
was delivered alive by the axis-traction forceps (A. H. N.
Lewers) ......
Fairbank (Thomas), fracture of the pelvis, with injury to the
uterus in the sixth month of pregnancy ; recovery ; death at
a subsequent delivery .....
Faiebairn (J. S.), and C. J. Cullingworth, large inflamed cyst
(? ovarian) communicating with an inflamed Fallopian tube .
„ carcinomatous tumour of ovary ....
„ tubal mole, showing escape of the body of the embryo through
the fimbriated opening, with retention of the head and
amniotic cavity in the tube . . . .
„ unilocular ovarian cyst containing solid masses undergoing
necrotic change . . . •
„ five specimens of fibroid tumour of the ovary, with observa-
tions on their pathological anatomy
„ fibroid tumour of the uterus, wholly cervical, forming an
abdominal tumour, and characterised by profuse haemorrhage
„ necrobiotic fibroid removed from a recently delivered patient,
aged 22 ..... .
„ large fibrotic uterus, with calcification of the arteries
PALLOPIAN PREGNANCY, see Pregnancy, extra-uterine,
PALLOPIAN TUBES, adherent to the opposite ovary in a case of
ovarian tumour (J. Knowsley Thornton) .
„ anatomy of the pregnaut (H. E. Andrews)
„ accessory, cyst in connection with the right, arising probably
from an (R. H. BeU) .....
„ — hydrosalpinx of an, due to twisting of the pedicle (W. S.
Handley) . • • •
„ primary cancer of, glandular structvire in the substance of a
(Alban Doran) .....
„ — (A. Routh) . . ...
„ unreported case of primary cancer of, in 1847, with notes on
primary tubal cancer (Alban Doran) . . xxiviii, 322
„ tables of cases of primary cancer of, reported up to present
date (April, 1898) (A. Doran) .
„ primary cancer of (Alban Doran)
^, _ (J. Bland-Sutton) ....
„ — of right ; right ovary normal (H. Briggs)
„ second case of primary carcinoma of (C. Hubert Roberts)
„ primary carcinoma of (C. J. Cullingworth)
^, _ (C. Hubert Roberts) ....
„ — (H. R. Andrews) ....
„ after-history of a case of cystic fibroid, with carcinoma of the
left ovary and right (R. Boxall)
„ carcinoma of (C. J. Cullingworth)
„ cystic fibroid with carcinoma of left ovary and right (R. Boxall)
„ cyst of (A. Meadows) ....
„ dermoid cyst in (C. J. Ritchie) .
„ dilatation of, uterine appendages showing cystic growths and
(T. C. Hayes) ..... xxxiii, 4
xli, 280
IX, 1
xlii, 96
xliii, 208
xliii, 211
xUv, 126
xUv, 177
xlv, 178
xlvi, 194
xlvii, 299
xxiii, 258
xlv, 197
xlvi, 21
xlv, 157
XXX, 194
xxxi, 200
xl, 197
xlii, 6
xliv, 311
xlvi, 60
xli, 129
xxxvi, 307
xl, 189
xlv, 54
xlviii, 136
xlvii, 263
xliii, 71
viii, 139
vii, 254
FALLOPIAN TUBES. 57
TALIOPIAW TUBES (continued)—
„ primary hydatid disease (echinococeus) of (T W EdAT,^ i • 0.0
« an undescnbed disease of (Lawson Tait) ^ ^ ' '^^'' ^^^
„ disease of both ; macerated fcetus (A. D. Leith Napier^ ' . "" -' !«?
" '^tX^ "^ Hemorrhage in a parovarian cyst (A,' D. Leith ''' '""
" M'Tl. W^;,"^-^ °' "act -containing a portion of the ^"-'' ''*
,. left andlettbroadligament,aacformedby,inaoaseoferfra' ^^' ®
uterine pregnancy (C. J. CuUingwortht '
„ enlarged, and cystic ovary (A. D Leith Nanieri ' ' ^^^. ••**
" "Sr^'t^r ^ * -"-"^^ ov:::L''%::t'>(X Wsley""'"'^^
" "(SXnf "" ''°"°" "'■'"■" ^"'^''IS' '"•■"l tot-tion (A. L. "'' "'
" "?£ (Aft"n So^a'r*"™ '" -«^-'-*'- »^ aUied diseases "'' "=
„ malformations of (Albau Doran) ' ' " •••,^/ ^P' 344
„ the frequency of pathological conditions of'rA TT i^T"' n ' '^^^^' ^^^
., m cases of phthisis. tubefculosTs of (P D V^fr) ^'""''^ ^^f-' l^l
" ^(l^L GaSST' Py^^^^P^^ -^^ inte;communication of "'"' '''
" XbrtT) ^'''""°" °'' ^° ^ "^^'^ ''' ^-^1- Pyo-lpinx (C. H.- ^'''' '''
" To^^CAl^ttt^; -^ ^PP-^^- of a woman who died ^'' '''
„ rupture of (Clement Godson) ' ' ' • xx, 292
„ — (J. Knowsley Thornton) ' -' ^'°^' 2, 82
„ tubal abortion with rupture of (A Eouth)' " " ^f^'' ^^^
" llf Zhr'-'^'J^^ "'"^P^ "^ *^^ b^^y °f ^^« e^bry; through ' ^^*
amniS?'c:X?r"»^' "^'' ""^"'^^^ ^' the\ead'afd
„ tuberculosis of (W. S. A. Griffith) ' " ' ^^"' ^^^
„ tuberculous disease of cervix and fW W H Tafp^ ' " ^^' ^^
" tubo-ovarian cysts (W. S. A. Griffith)" * ^^i^ 273 -^09 "" '' ^^o
■' ToS)^ '^"^:-'^ ^'^ fi°^^"^*«^ -d in two pW'dmknd'^ ^' '
„ ovarian tumour with greatly enlarged (P. HorrocksV
' Ti^amlTfc'fculf ""''' i°^^?'^) cLmSSgwithan
^^^f ^ J. CuUmgworth and J. S. Fairbaim)
' t^^Sr^h^iTeS (T^p7v^.^^Bo- elH^ -^ -'
' "^SL^rHcS-ro^^^^^^^^^^ '^^'^^^^^ ^^ libroi? tumours of the
. hypertrophy of, and cystic ovaries (John Phillips) '
, retained menses in utero and (C. H. F. Eouth) .'
xliv, 131
xxxvi, 185
xlii, 96
xliv, 92
xlii, 166
xxxi, 332
xii, 34
68
FALLOPIAN TUBES FIBRIN.
FALLOPIAN TUBES {continued)—
„ papilloma of, and the relation of hydroperitoneum to tubal
disease (Alban Doran) . . . xxviii, 229, 243
and ovaries, diseased (C. H. Carter) . . . xxxii, 136
— dilated (T. C. Hayes) .... xxxvi. 185
— and cystic ovaries (W. Duncan) . . xxxvii, 150
— distended with blood (Wm. Duncan) . . . xxxii, 306
— from a case of persistent chronic ovaritis (J. D. Malcolm) . xxviii, 278
— from a case of tubal gestation (Wm. Duncan) . . xxxi, 165
— tubercular disease of (A. W. W. Lea) . . . xlv, 133
and ovary, microscopical sections of tuberculosis of (C. H.
Roberts) ...... xlv, 92
— removed by oophorectomy (J. Knowsley Thornton) . xxiv, 137
— with papilloma (Wm. Duncan) . . . xxxii, 346
— and uterus from a case of Caesarean section (C. J. Culling-
worth) ...... xxxi, 30&
„ uterus and appendages with ruptiired pregnant (A. W.
Addinsell) ...... xli, 172
see Hiematosalpinx, Hydrosalpinx, Fyosalpinx, Salpingitis,
Uterine appendages.
FARADISATION, galactagogue properties of (T. Skinner) . v, 94
Farrar (Joseph), a new and speedy method of dilating a rigid
OS in parturition ..... xxxvi, 321
FARRE(ARCHKR),spontaneoussalivationassociatedwithpregnancy xv, 222
Farre (Arthur), remarks in the discussion on puerperal fever . xvii, 178
„ Honorary President, accepting the oflSce of . . . xvii, 302
„ a brief description of a series of casts, showing the condition
of the uterus at various periods after labour, vax-ying from
the time of delivery to fifteen days after that event . xviii, 84
FAT, infiltration of broad ligament with, in a case of ovarian
dermoid (J. Bland-Sutton) .... xxxiv, 7
„ pellets of, in a dermoid cyst (A. C. Butler-Smythe) . xxxvii, 15
FATTY CHANGES, alleged, of the uterus, sections at different
periods of the puerperium showing complete absence of
(W. S. A. Griffith) ..... xxxi, 308
FATTY DEGENERATION of placenta, see Placenta, fatty degenera-
tion of.
FEEDING BOTTLE, Marshall's patent sectional (Clement Godson) xxiii, 166
„ Perrett's (J. B. Hicks) . . . . . xi, 169
FEET, deformity of (A. E. Giles) .... xxxiv, 129
„ talipes varus of both (H. Madge) . . . ix, 158
FEMALE PRACTITIONERS, see Women.
FEMORA, the pressure of the, and its influence on the shape of
the pelvis (F. H. Champneys) .... xxv, 70
„ endosteal sarcoma of, showing syncytial structures (F. W.
Andre wes) ...... xlv, 237
FEVER, enteric, slough forming a complete cast of the vagina
from a case of (W. S. Playfair) . . . xxxviii, 33
FEVER IN CHILDBED. Part I. — General hygiene and antisepsis
(R. Boxall) . . . . . xxxii, 219, 275
„ Part II. — The relation of external meteorological conditions
to the incidence of febrile illness in childbed (R. Boxall) . xxxv, 340
FIBRIN, placenta with deposits of (J. Brunton) . . x, 20
FIBEINOUS POLYPUS FIBEO-MrOMA. 69
riBRINOUS POLYPUS (W. S. A. Griffith) . . . xxv, 165
PIBEO- ADENOMA removed from the cervix (G. F. Blacker) . xli, 374
JIBRO-CYST of ovary (W. A. Meredith) . . xxix, 248, 513
„ of the uterus (J. Knowsley Thornton) . . . xxxi, 199
riBRO-CYSTIC DISEASE of the uterus (Thos. Chambers) xxii, 159, 187
„ — (Hey wood Smith) ..... xxvi, 58
„ — weighing 14 lb. (Thos. Chambers) . . . xx, 32, 54
„ — and both ovaries ; extirpation ; recovery (T. Bryant) . xiv, 79
FIBRO-ENCHONDROMATOUS TUMOUR complicating pregnancy;
safe deliveiy (A. Wiltshire) .... xii, 376
FIBROID TUMOURS, see Tumours, fibroid.
FIBROMA (J. D. Malcolm) .... xxix, 249, 515
„ subperitoneal (W. Duncan) .... xliii, 228
„ spontaneously enucleated (Amand Eouth) . xxxv, 409 ; xxxvi] 2
„ of the abdominal wall ; increase during pregnancy (Alban
I^oran) ...... xxxix, 42
„ of broad ligament weighing 44 lb. 8 oz., successfully removed
from a woman aged 28 (Alban Doran) . . . xl, 295
„ of both ovaries (C. J. Cvillingworth) . . . xxi,' 276
„ of the ovary, sections of (H. T. Eutherfoord) . . xxxiv, 88
„ — (J. Crawford) ..... xxxvi, 190
„ (?) — (P. Horrocks) . . . . . xxxvi, 192
„ — (M. Handfield-Jones) .... xxxvi, 343
„ — undergoing calcareous degeneration (C. Hubert Eobert) . xxxix, 8
« — impaction ; ascites ; removal (Alban Doran) . . xxxix, 37
„ — (C. J. Cullingworth) ..... xxxix, 279
,, pure, of ovaiy (A. Doran) .... xliv, 172
„ of ovary one third of an inch in diameter (A. Doran) . xliv, 173
„ — (F. N. Boyd) ..... xliv, 176
„ — (A. E. Giles) ..... xHv, 360
,> — ■with fibro-myoma of uterus, and with extensive carcinoma
of body of uterus (W. W. H. Tate) . . . xlvi, 139
„ — (F. E. Taylor) ..... xlvi, 280
„ — weighing 17 lb. ; under observation for ten years (A. Doran) xlvii, 421
„ — (A. Eouth) ...... xlviii, 133
„ — and ovarian ligament removed by operation ; with a series
of after-histories of cases reported in the ' Transactions ' since
1879 (Alban Doran) . . . ,' xxxviii, 187
„ calcified ovarian (M. Handfield-Jones) . . . xlviii, 332
„ of the ovarian ligament (Alban Doran) . . . xxxi' 200
„ of the uterus (Heywood Smith) .... xxiii, 262
„ and other morbid conditions of the uterus, treated by
Apostoli's method (J. Inglis Parsons) . . . xxxiv, 22
„ uteri, small, showing sarcomatous changes (J. M. Munro Kerr) xliv, 129
„ on intermittent contractions of uterine, and in pregnancy
in relation to diagnosis (J. B. Hicks) . . . xxxvi, 188
„ multiple, of uterus, with carcinoma of body, removed by
abdominal pan-hysterectomy (J. H. Dauber) . . xxxix, 321
„ two, removed by intra-peritoneal hysterectomy (H. Mac-
naughton-Jones) ..... xxxix, 321
FIBRO-MYOMA and abscess (Wm. Duncan) , . . xxxi, 332
„ calcified uterine, removed piecemeal for haemorrhage fourteen
years after oophorectomy (H. E. Spencer) . . xlix, 271
„ subperitoneal (A. L. Galabin) .... xliii, 225
„ sessile, from the supra-vaginal jwrtion of cervix uteri which
had obsti'ucted labour (Wm. Duncan) . . . xxxv, 296
70 riBRO-MYOMA.
FIBRO-MYOMA (continued) —
„ solid mesenteric tumour, weighing 30 lb. (A. Doran) . xlvi, 145
„ spontaneously enucleated during labour (W. R. Dakin) . xli, 105
„ of broad ligament (W. A. Mere(£th) , . xxix, 249, -514
„ — (M. Handfield-Jones) .... xxxv, 239
„ — soft (R. Boxall) ..... xxxv, 410
„ and cancer co-existing in the body of the uterus (M. Handfield-
Jones) ...... xlvi, 305
„ cystic, of the uterus, removed by posterior colpotomy (H. R.
Spencer) ...... xliii, 110
„ — complicating pregnancy ; removal at four and a half months
(J. Dysart McCaw) . . . . . xl, 256
„ degenerated, weighing over 17 lb., enucleated from the broad
ligament nine hours before delivery at term (H. R. Spencer) . xlvi, 122
„ weighing 14 lb., large, soft, broad ligament (Ewen Maclean) . xl, 134
„ of uterus, oedematous subperitoneal, in right broad ligament,
removed by abdominal hysterectomy (C. J. CuUingworth) . xl, 302
„ pedunculated, of the broad ligament, with twisted pedicle
(C. J. CuUingworth) .... xxxvii, 222
„ of right ovary removed by abdominal section (C. H. Carter) . xxix, 190
„ of the ovary (H. R. Andrews) . . . , xliii, 231
„ — (A. J. Sturmer) .... xlv, 335, 370
„ of the intra-abdominal portion of the round ligament of the
uterus (H. R. Spencer) .... xlvi, 26
„ large, of cervix, removed by enucleation, followed by vaginal
hysterectomy (W. W. H. Tate) .... xlii, 161
„ of the cervix uteri removed by abdominal pan-hysterectomy
(W. A. Meredith) ..... xlvi, 12
„ of cervix treated by abdominal hysterectomy (W. W. H. Tate) xlv, 173
„ cystic, of the cervix uteri (C. H. Roberts) . . . xlii, 211
„ of uterus (R. Barnes) ..... xxv, 68
„ — (J. Knowsley Thornton) .... xxv, 67
„ — attached to fundus of an irreducible inverted uterus (P.
Horrocks) ..... xxx, 196, 228
,. — degenerating, associated with a case of hsematometra,
treated by supra-vaginal hysterectomy (W. A. Meredith) . xxix, 422
„ — from a case of Csesarean section (P. Horrocks) . . xxix, 98
„ — removed by hysterectomy (W. Walter) . . . xxvi, 326
„ — vascular (J. Knowsley Thornton) . . . xxvi, 269
„ — with axial rotation (W. A. Meredith) . . . xxx, 80
„ — removed by operation from women under twenty-five years
of age (H. R. Spencer) . . . . . xl, 228
„ — removed by operation (W. W. H. Tate) . . . xlviii, 183
„ — associated witli large cavity containing retained menses
communicating with uterine canal (W. Tate) . . xlvii, 360
„ — with extensive carcinoma of body of uterus, and fibroma of
ovary (W. W. H. Tate) .... xlri, 139
„ — showing marked cystic degeneration, removed from a
patient aged 63, from whom both ovaries had been removed
eleven years before (W. W. H. Tate) . . . xliii, 26
„ — relations of organic affections of the heart to (T. Wilson) . xlii, 176
„ — double pyosalpinx associated with (W. S. Playfair) . xxxiii, 497
„ — complicated with double salpingitis and carcinoma of cervix
(W. W. H. Tate) ..... xUii, 270
„ — gangrene of an interstitial (C. J. CuUingworth) . . xxxix, 281
„ — incarcerated, in an unusuaUy yovmg subject (C. J. Ctdling-
worth) ...... xlii, 133
i
FIBEO-MTOMA FISTULA.
71
PIBEO-MYOMA OF UTERUS (continued)—
„ — early ectopic gestation (? tubo-uterine), complicated by
(C. J. Cullingworth) ..... xxxix, 284
„ — complicating early ectopic gestation (? tubo-uterine) (C. J.
Cullingworth) . . . . . xl, 285
„ — complicating rupture of an early tubal gestation (fifteenth
day) (E. Eumley Dawson) . . . . xl, 155
„ multiple (Leith Napier) .... xxxv, 3
„ large multiple, removed by hysterectomy (A. D. Leith Napier) xxxiv, 159
„ multiple, complicating a twin pregnancy (John Phillips) . xxviii, 138
„ — of the uterus (C. J. Cullingworth) . . xxxviii, 6
„ of the uterus causing intestinal obstruction and death two
years after the menopause (C. J. Cullingworth)
„ — in a patient aged 23, with remarks on enucleation and
myomectomy (A. E. Giles)
, — pedunculated subserous, which had undergone myxomatous
and cystic degeneration (A. F. Stabb)
,; — with sarcomatous degeneration (P. Horrocks)
„ — undergoing sarcomatous degeneration (P. Horrocks)
„ — undergoing sarcomatous change (W. S. A. Griffith and H.
Williamson) .....
„ — sloughing, occurring in a patient twenty years after the
menopause (W. W. H. Tate)
„ — with sloughing of the central part shortly after delivery
(J. D. Malcobn) ....
„ -- projecting into vagina, removed by abdominal hysterectomy
iW. W. H. Tate) ....
„ aid myoma of the uterus and allied tumours of the ovary
(ilban Doran) ....
„ ani sarcoma of uterus, further history of a case of degenerat-
ii^ (E. Hamilton Bell).
„ netrobiotic uterine, occurring in pregnancy (P. E. Taylor)
„ renoved by abdominal myomectomy in second month of
pregnancy ; labour at term (A. Doran)
„ degenerating, and sarcoma of uterus (W. "W. H. Tate)
„ of Taginal wall (with microscopical slide (John Phillips)
„ of the vagina (J. M. Munro Kerr)
„ — ^anterior wall) (J. Bland-Sutton)
„ of the vestibule (J. Inglis Parsons)
„ and cystic disease co-oxisting in the same ovary (W. W. H.
Tate) .....
xxxix, 282
xlii, 299
xlii, 133
xl, 178
xlvi, 184
xlviii, 22
xl, 303
xlvi, 15
xl, 159
XXX, 410
xlviii, 199
xlvii, 333
xlvii, 426
xlvii, 358
xl, 130
xliv, 130
xli, 100
xlviii, 184
FIBEO-SAECOMA of chorion (A. L. Galabin) .
,, of the ovaries (W. A. Meredith) .
„ of the right ovary (M. Handfield- Jones)
FIBEOUS POLYPUS, see Polypus, fibrous.
FIBEOUS TUMOUES, see Tumours, fibrous.
FtELDEN (W. E.), see Galabin, A. L.
FILLET, or loop, as an obstetric aid, new modification of (E. E.
Wilmot) ......
„ steel (G. E. Sheraton) .....
FINGEES, webbed, in an infant (A. Wiltshire)
FISTULA, recto- vaginal, caused by retention of a Zwancke's pessary
(T. Churton) . ...
xlvi, 273
xxvii, 107
xxxi, 225
xxxi, 126
XV, 172
viii, 259
xii, 329
xvi, 223
72
FISTULA — FCETUS.
XXX,
348
. xxxi.
320
i.
275
e
25
vi.
107
-
. xviii.
209
) xix,
6f
xix.
9i
. xxvi,
18i
XV,
1&
XX,
170
xxi.
17
FISTULA (continued) —
„ recto- vaginal, caused by retention of a Zwancke's pessary for
six years (A. L. Galabin) .... xix, 201
„ vesico-uterine, description of a new operation for (F. H.
Chanipneys) .....
„ vesico-utero-vaginal, case of (C. J. Cullingworth)
„ vesico-vaginal treatment of, by a new method (JR.. Battey)
„ — the mode of operating, and the resvdts obtained in fifty-five
cases at the London Surgical Home
„ — new method of treating cases of (A. Meadows) .
„ — left fourteen years after lithotomj', cured by plastic opera
tions (Lawson Tait) ....
,, — cxirved needle made to revolve, for cases of (J. H. Aveling)
„ — instruments for (N. Bozeman) .
„ — caused by a calculus (Clement Godson)
„ — and recto- vaginal (T. E. Jones)
FiTZPATEiCK (J.), large uterine mole .
„ uterus with its contents at full term
FiTZPATRiCK (Thomas), early ovum, funis tightly encircling the
left thigh of foetus . . . . . x, HI
FIXATION OF UTERUS, see Uterus.
FLEXIONS OF UTERUS, see Uterus, displacements of.
FCETUS, elongation of head of, as a cause of difficulty in the appli-
cation of the ordinary forceps (W. G. Hewitt) . . iii 180
FCETAL HEAD, lateral obliquity of, in normal labour (A. L.
Galabin) ...... xvi', 283
„ normal asymmetry of (A. Wiltshire) . . . xi, 78
„ plaster casts of (J. Brunton) .... xxiii, 206
„ revolutions of, in passing through a brim contracted only in
the conjiigate diameter (J. Matthews Duncan) . . xx, 151
„ sho\ving furrowing from pressure against sacrum (G. Roper) . xxii, 84
„ varieties of form imparted to, by the various modes of birth
(E. Barnes) ...... vii, 171
FCETAL SCALP, sloughing of, as the i-esult of tedious labour (W. O.
Priestley) . , . . . . i, 323
FCETAL MONSTROSITY (Maitland Coffin) . . . xxiv, 98
„ (C. H. F. Routh) ..... xxiv, 75
„ (J. Phillips) ...... xxxix, 44
„ see also Monster.
FCETAL MOVEMENTS, on recording, by means of a gastrograph
(J. Braxton Hicks) ..... xxii, 134
FCETATION, see Pregnancy.
FCETUS, abnormal condition of, obstructing labour (J. B. Hicks) . v, 285
„ in case of abortion (Graily Hewitt) . . . xxxiii, 461
„ absence of occipital bone (R. Barnes) . . xvi, 100, 12T
„ acardiac acephalic, anatomy and nature of two (A. Keith) . xlii, 99
„ acardiac, acephalous, anencephalous, dicephalous, myla-
cephalous, etc., see also Monsters.
„ anatomical relations between mother and (H. Madge) . viii, 348
„ anencephalic, completely cleft spine associated with an un-
usual visceral malformation in (Thomas G. Stevens)
skull of an anencephalic (Amand Routh) i
xxxviii, 346
xxxvii, 219
F(ETUS.
JflETUS (continued)—
„ anencephalic (H. Macnaughton- Jones)
„ anencephalic di-prosopia, see also Monsters '
„ anencephalous (Mr. Sass)
„ — (D. Carlyle) . . ' '
„ — with spina bifida (E. Jones)
„ acephalous acardiac|(M. Handfield-Jones)
„ amorphous acardiac (G. E. Herman for G. Mallack Bluett)
„ enclosed in amniotic sac only (C. E. Purslow) ''
„ with anasarca and large placenta (E. BoxaU)
" 7SLnr>tln) ""'"'' ."' ^•'"""-""-T tract in'a female
„ ascitic, complication in the delivery of (J. A. Thomnsonl
" 'CSfdltatSr °^ «■««-<•- --=i e,n
„ ascites and 03deina of (H. R. Andrews)
„ the subject of atresia aui vesicalis (W E Dakin")
„ compressus s. papyraceus (F. C. Bottomlev) '
,, compressus (E. A. Barton)
" ^^f^ t' ^K^^- ^'^^^^ '"^"^^ ^^^^ spurious labour' in a case
itte^C^DoSn) ^^^.'^^°' ^'^r°"'^^ -^^-- tworontS
„ abdominal pregnancy secondary "to partial rupture of tubal
gestation sac; abdominal section fifteen months aftei con
ception and eight months after death of (J B HellTer)
„ death of, at end of eighth month in a case of extmuterine
prepancy and operation a month later (A E GileS
„ death of, an acoustic sign heard after the (Eobert Harvev'k '
. significance of adhesions of the wall of the gesVatio^sac to
dla?h «^h'h° ^^^^-^-^.^^^^ fetation (J. D. Malcolm
„ born dead, with knot on funis (W. Sankev)
„ deformed, with adherent placenta, intestines uncovered and
:: - (I"f wofship)^^":' "'^ ^ ^: "• "^^"^^"^ ^^^ ^^- ^- ^^is
» — (G. Boper) ..'■'•
" ~ S* n%'*!2 *T°!^ ""^ "^^'^ (^' H. N. Lewers) -.
» — (r. (-/. Bottomley) . .
, — (A. Burton) * ' *
, deformity of (A. W. Addinsell) * ' • xl, 217 ; xli, 339
, deyelopment of, to the full time in the peritoneal cavity stiu''''''^'' ^°*
TaX^faitnTai^f .^^-^"^' ^^ ^ '^ ^^ -tSpi^pfei^
, delivered by cephalotribe (J. B Hicks) " ' * ^^^^^' ^^'^
' ^CmeaS) ''''^ ^yP^'-t^r^Phy of the bladder in (F. A. T.
' tetkTfH. t" kXT'^'"^' ^""^^ '' ^'^ --^^« -d t^-e
distension of the uterus in, impeding labour (H Gervis)
dropsy of, case of general (Lawson Tait) ^ervisj
lii'^th)'^'^ of abortion at six and a half months (Protheroe
-• with hypertrophy of the placenta (J. Bassett) '
t^s. :srenrs:zir'^ ^-r^'^^^^^ ~- ^^ the
73
xlvii, 307
xi, 31
xi, 35
xi, 209
xxxiv, 84
xxxiii, 493
xli, 168
xlii, 98
xxiii, 107
xvii, 4
xix, 119
xliii, 166
xxxii, 368
xxxix, 134
xlv, 417
xlii, 213
xlv, 366
xlvii, 114
xxi, 273
xlv, 421
xi, 9
iii, 413
xiii, 53
xiii, 263
xiv, 139
. xviii, 295
xxxviii, 106
xxxix, 134
Xl, 1
xxix, 54
xxix, 189
V, 284
xvii, 307
xvii, 303
xix, 261
xix, 40
74
FCETUS.
FCETUS {continued) —
„ case of exomphalic (A. E. Giles) ....
„ extensions or retroflexions of, especially of the trunk, during
pregnancy (Matthews Duncan and J. B. Hurry)
„ extra-uterine, skeleton of (L. B. Aldrich-Blake)
„ five fcetal sacs from the peritoneal cavity of a rabbit (M
Pembrey) .....
„ five months', with intense congestion of head and neck (W,
Cleveland) .....
„ five and a half months' (Butler Willing) .
„ four and a half months', with encephalocele (A. W. Edis)
„ at fourth month enclosed in a perfect sac (H. Smith)
„ of four months' development contained within an unruptured
amnial sac with placenta praevia attached (A. D. Leith
Napier) .....
„ head of, on the occurrence in normal labour of lateral obliquity
of (A. L. Galabin) .....
„ with hernia umbilicalis congenita and spina bifida lumbo-
sacralis (Amand Routh) ....
„ hydrocephalic (A. W. Edis) ....
„ — which had presented by the breech and impeded delivery
(A. W. Edis) ......
„ — female, orbital tumour in, with tumour of cheek, mal-
development of neck, associated with hydramnios, necessitat-
ing interference with the pregnancy at the seventh month
(H. S. Stannus) .....
„ in utero, influence of maternal impressions on the (A.
Meadows) ......
„ inflammatory disease of the skin of the head and upper part
of the body of an eight months', with exudation of plastic
lymph (G. D. Gibb) .....
„ inquiry into the best mode of delivering the head of, after
perforation (J. B. Hicks) ....
„ laceration of the integument of, occurring during delivery
(R. K. Peirce) .....
„ living and viable, abolition of craniotomy from obstetric prac-
tice in all cases where (W. T. Smith)
„ living, extracted by coeliotomy after term in a case of tubo-
abdominal pregnancy (J. Bland-Sutton) .
„ malformation of (W. Sedgwick) ....
„ — (P. Horrocks) .....
„ malformed (Amand Routh) ....
„ malpositions of, in labour, systematic examination of abdomen
for rectifying (A. W. Edis) ....
„ macerated ; double tubal disease (A. D. Leith Napier)
„ — removed from the abdominal cavity two months after
spurious labour (Alban Doran) ....
„ — bones of, from an extra-uterine gestation retained seven
years (J. D. Malcolm) .....
„ partially macerated, from an extra-uterine fcetation retained
in the body about a year after its death (J. D. Malcolm)
„ matvu-ed and putrid, attempted extrusion near the umbilicus
in a case of extra-uterine gestation (A. M. Sheild) . . xxxiii, 148
„ mechanical obstruction in growth of (W. B. Owen) . . viii, 4
„ monstrous (R. Barnes) ..... vii, 227
„ miimmified, expelled after birth of full-term child (R. Barnes) viii, 108
„ myxoma in, impeding delivery (T. C. Hayes) . . xviii, 83
xxxvi, 174
xxvi, 206
xlix, 269
xl, 253
xvi, 2
xvi, 85, 97
xi, 173
xiv, 66
xxxiv, 158
xvii, 283
XXXV, 102
xi, 173
xvii, 302
xliii, 304
vii, 84
iii, 442
vi, 263
vii, 74
i, 21
xl, 308
i, 239
xxvii, 131
xxxiv, 463
xiv, 331
xxxiii, 461
xlii, 8
xli, 223
xli, 222
FCETUS. 75
rCETUS (continued)—
„ note on some difficult cases of fronto-anterior positions of the
head of (George Eoper) . . . . xl, 271
„ antero-posterior positions of the foetal head as a cause of
difficult labour (K. G. McKerron) . , . xli, 142
„ notes on a (H. S. Wilson) .... xxi, 58
„ premature expulsion of (A. Ball) . . . . i, 315
„ in peritoneal cavity, question of abdominal gestation, with a
summary of reported cases of primary abdominal and ovarian
pregnancy (Alban Doran) .... xxxv, 222
„ peritonitis of (W. A. Hunt) . . . . ix, 15
„ retained in utero for some weeks after its death and decompo-
sition (W. Newman and G. Harley) . . . ii, 251
„ retention of the ovum within the uterus, and groAvth of mem-
branes for a period of five months after the death of, in a case
of abortion (W. G. Hewitt) .... iii, 411
„ retention of, in the abdomen forty -three years (R. W. Watkins) viii, 10&
„ retained, and placenta (E. Porter) . . . xiii, 129
„ dead, retained in utero for fovir years (A. Halley) . . ix, 90
„ retroflexion of, and ectopia viscerum (W. R. Dakin) xxxi, 308 ; xxxii, 200
„ (J. Phillips) ..... xxxiii, 490
„ at seven months, illustrating celosoma with retroflexion,
meningocele, and talipes varus (Leith Napier) . . xxxvi, 116
„ retroflexion of (L. Eemfrey) .... xxxvi, 227
„ on revolutions of the (Matthews Duncan) . . . xxvi, 171
„ from a ruptured tubal fcetation (A. H. N. Lowers) . . xxviii, 207
„ sac, and pelvic viscera from a case of extra-uterine pregnancy
(Alban Doran) ..... xxix, 491
„ shrivelled, of the fifth month utero-gestation (E. Clapham) . xxxi, 202
„ six months', which lived for twenty-one hours (C. H. Carter) xvi, 226, 253
„ spontaneous evolution of, in utero ; the head changed for the
feet (E. Hodges) . . . . . ii, 303
„ stillborn, from a syphilitic patient with fatty placenta (T. C.
Hayes) ...... xvii, 275
„ structure of the ripe placenta, and the changes which occur
in placentae retained in utero after the death of (T. W. Eden) xxxviii, 360
„ teratoma of head of (Hugh S. Stannus) . . . xliv, 7S
„ thoracopagus (Amand Eouth) .... xlii, 29
„ three months', flattened and curved laterally (Heywood
Smith) . . . , . . xvi, 2
„ three quarters of an inch in length, in perfect preservation in
specimen of tubal mole (A. Doran) . . . xlii, 134
„ two, in connection with the same tube (N. J. Hay don) . v, 280
„ upper portion of trunk and head of, where the arm, face, and
foot had presented (E. Barnes) . . . xvi, 100, 127
„ extracted by vaginal incision in a case of ectopic (intra-
ligamentous) gestation at the seventh month (A. Donald) xli, 7
„ volvulus in (E. D. Maxwell) .... xlviii, 277
„ in utero, radiograph of (Heywood Smith) . . . xlviii, 44
„ with a peculiar growth from the mouth (Mr. Greives) xiv, 139, 210
„ with absence of virethra and ascites obstructing delivery
(T. G. Stevens) .... xxxvii, 5
„ with diaphragmatic hernia (H. Smith) . . . xv, 162
„ with encephalocele (H. G. Times) . . . xiii, 51
„ with outgrowth from end of coccyx (Heywood Smith) . xxv, 2
„ with rent near the anus, through which the intestines pro-
truded (H. Smith) . . . . . X, 198
76
FCETUS — FORCEPS.
JCETTJS (continued) —
„ and placenta of extra-iitei-ine gestation removed by abdominal
section (G. E. Hennan) .... xxviii, 141
,, — from a case of extra-iiterine gestation (C. J. Cullingworth) xxxii, 135
„ — removed by laparotomy from a case of extra-uterine
gestation (W. Duncan). . . . . xxxvi, 146
„ — in extra-uterine fetation (W. R. Jordan) . . xv, 124
„ — removed six months after spurious labour in a case of
abdominal pregnancy (E. J. Maclean) . . . xlviii, 129
„ — successfully removed in a case of tubal pregnancy (G. E.
Herman) ...... xxx, 123
„ — of about five months ; funis knotted round neck of child
(W. F. Cleveland) ..... xiii, 1
„ — funis obliterated by twisting (A. Rasch) . . x, 94
„ with placenta attached to the head (E. J. Tilt) . . xvi, 124
„ — attached, showing a knot in the vmibilical cord (C.
Godson) ...... XXV, 66
„ placenta, membranes, and Fallopian tube, from a case of
ruptured tubal gestation, complicated by a large haemato-
salpinx on the opposite side (C. J. Cullingworth) . . xxxii, 273
„ — and membranes delivered entire, concealed accidental
haemorrhage (W. R. Dakin) .... xxxvi, 315
„ — cord, and membranes (Robert Wise) . . xxxviii, 166
„ papyraceus (H. J. Ilott) .... xxxvii, 7
„ — (W. Rivers Pollock) . . . xxxviii, 320
„ growth of the placenta after death of, in ectopic gestation
(Lawson Tait and C. Martin) .... xxxiv, 206
„ five months, and placenta, from a case of twin pregnancy, in
which the second child was delivered alive at or near full
term, along with the dead foetus (G. G. Genge) . xxxviii, 5
„ and membranes from a case of missed abolition (Alban Doran) xxvii, 224
„ on sacs containing, and lying free in the peritoneal cavity
of a rabbit (M. S. Pembrey and G. Bellingham Smith) . xlvi, 283
„ twin, smallpox in (H. Madge) .... iii, 173
„ see Embryo.
FONTANELLE, posterior, of a child (H. E. Eastlake)
„ posterior vai-iation of the, in children (A. W. Sikes)
„ sagittal, in the heads of infants at birth (A. W. W. Lea)
FOOT and hand, deformity of, in a child (John Phillips)
FORCEPS, aseptic (P. Horrocks)
„ Aveling's, presentation of . . .
„ axis-traction, used for delivery of a child in a case of persis
t«nt mento-posterior position of the face (A. H. N. Lewers)
„ bent as a sound for the introduction of laminaria tents
(-Coley) .....
„ in breech presentations (T. W. Agnew)
„ brephotome, and blunt hook
„ craniotomy (R. Barnes) ....
„ — (J. H. Davis) ....
„ — (J. Matthews) ....
„ — new (G. Roper) ....
„ delivery bv, in face presentation in the mento-lateral position
(J. B. Hicks) .....
„ depression of child's head by (C. Godson) .
„ designed to allow the direction of traction to be that of the
axis of the pelvis (A. L. Galabin)
ix, 243
xlvi, 272
xl, 263
xxviii, 89
xxxiv, 460
xviii, 2
-xli, 280
XX,
170
xix.
217
xxxvii.
243
V,
277
vij
123
ix.
29
xix.
136
XV,
39
xxiii.
161
xix, 227
FORCEPS.
77
FOECEPS (continued)—
„ discussion on the use of, and of its alternatives in lingering
labour .... xxi, 121, 141, 171
introductory paper by Robert Barnes
remarks by W. S. Playfair
— George Kidd
— John Thorbvun
— William Stephenson
— William Newman
— Edward Malins
— F. H. Alderson
— J. Lucas Worship
— A. W. Edis .
— LombeAtthill
— A. H. McClintock
— John Bassett
— Henry Bennet
— John J. Cranny
— Henry Savage
— George Roper
— J. Braxton Hicks
— W. F. Cleveland
— F. H. Daly .
— Graily Hewitt
— J. G. Swayne
— in reply, Robei't Barnes
head said to have been ruptured by the use of (R. Cory)
long, advantages of the early use of the (F. H. Daly)
— delivery by, in labour complicated with a fibrous tumour of
uterus (W. O. Priestley)
— delivery of a very large living'child effected by (C. Waller)
in modern midwifery (A. W. Edis)
Marshall's new midwifery, each blade rotating on its axis by
means of a pivot joint (R. Barnes)
Hasland's midwifery (R. Paramore)
midwifery, the curves of, their origin and uses (J. H. Aveling)
— (J. H. Aveling)
more frequent use of, as a means of lessening both maternal
and fcetal mortality (P. H. Hai-per)
ovum (F. C. Cory)
— improvement in the joint of (Heywood Smith)
— modification of (Heywood Smith)
for removal of an ovum or retained portion of placenta (J,
Hickinbotham) ....
on rotatory action in using the (William Stephenson)
possible results of the use of ; pulsating swelling beneath a
gap or fracture of the right frontal eminence (G. E. Herman)
" rat-trap " to aid in the removal of viterine groAvths, or as
vulsella in ovariotomy (Heywood Smith) .
Tarnier's, modifications in (A. Wiltshire) .
(A. W. Edis) .....
use of, typically indicated in a case of protracted labour (G.Roper)
vnlsellum, new axis-traction (R. Barnes) .
volsella, for the soft dilated cervix (R. Wise)
with a spring racket (W. Gayton)
with simple method of increasing its compressive power (J.
Thorburn) ......
XXI
xxi, 141
xxi
xxi
xxi
xxi
xxi
xxi
xxi
xxi
xxi
xxi
xxi
xxi
xxi
xxi
xxi
xxi
xxi
xxi
xxi
xxi
xxi
XX
xii
XXI
xxix
1
viii
xxii
XX
xxi
xxii
XVI
xix
XX
XX
XXV
xliii
vi
201
121
235
141
146
150
153
155
158
159
171
178
185
192
193
194
196
201
218
226
227
229
233
238
81
3
217
309
69
90
190
130
40
142
5
46
170
22
217
190
229
223
163
75
68
233
249
xxi, 162
78
FORCEPS FUNIS.
FORCEPS (continued) —
„ and version, incarcerated ovarian dermoid ruptured during
delivery by (H. R. Spencer) , . . ,
FOEEIGN BODY (hair-pin) in bladder of young girl (T. C. Hayes).
„ in the vagina, removed after four years, and after-results
(C. H. Carter and F. H. Daly) ....
„ — large, for two years, perforating wall of bladder ; its
removal and closure of fistulous opening (C. H. Carter)
FORMALIN, specimen of an early gestation in both horns of the
uterus of a bitch, displaying the allantoid vessels in their
natural colour preserved in (Amand Routh)
FoTHBRGiLL (W. E.), decidual uterine cast expelled after eight
weeks' amenorrhoea, together with an ovum of about five
days' growth ......
FouLERTON (A. G. R.), acute general gonococcic peritonitis
„ and W. F. Victor Bonnet, primary infection of the puerperal
uterus by Diplococcxis pneumonix
„ — an investigation into the causation of puerperal infections
Fowler (Charles Owen), double monster of dicephalous type .
„ and G. E. Herman, on the effect of ergot on the involution of
the uterus ......
Fox (W. Tilbury), phlegmasia dolens
„ pathological lesion of phlegmasia dolens .
„ puerperal fever .....
„ vessels concerned in the production of phlegmasia dolens
„ imperforate rectum ; attempt at relief by operation ; death .
„ influence of mother's health on the production of rickets
FRACTURE of cranium in a new-born child (S. W. Poole)
„ of the pelvis, with injury to the uterus in the sixth month of
pregnancy ; recovery ; death occurring at a subsequent
delivery (T. Fairbank).
Freeman (H. L.), polypus uteri complicating labour removed by
ligature two days after delivery .
FRIABILITY of the placenta (J. Brunton)
FROG, oviduct of, microscopical sections of (W. S. A. Griffith)
FRONTAL BONE, depression of, in two infants (C. Godson)
FROZEN SECTIONS of a uterus at the tenth week of pregnancy
showing haemorrhages into the placenta, decidua reflexa and
decidua vera, from a patient who died of heart disease (G. F
Blacker) ....
of extra
FuLCHBR (Dr.), communicated by C. Godson, two cases
uterine f oetation
Fuller (H. Roxburgh), case of spurious labour
FUNIS, abnormal umbilical (H. Williamson) .
„ umbilical knotted, and placenta (J. A. Tapson)
„ — placenta, foetus, and membranes (R. Wise)
„ complex twistings of (M. Handfield-Jones)
,, " cork-screw " (J. G. Westmacott)
„ insertion of, and implantation of the placenta, the relation
between (F. H. Champneys)
„ insertio velamentosa (G. M. Bluett)
„ instrument for dividing (H. Smith)
„ knotted (J. B. Curgenven)
xl, 331
XXXV, 185
xxii, 34
xxii, 38
xli. 5
xliii, 162
xlvii, 185
xlv, 128
xlvii, 11
xl, 119
XXX, 85
ii, 201
ii, 222
iii, 368
iv, 144
iv. 195
iv, 260
XX, 105
ix, 1
V, 42
xvii, 175
XXX, 196
xxiii, 32
xlii, 235
xxii, 153
xxvii, 326
xliv. 141
xi, 242
xxxviii, 166
xxxi, 164
xiii, 61
xxix, 337
xxix, 511
XV, 86
xiii, 187
FUNIS GALABIN.
79
TUNIS {continued) —
„ knot in, causing death of foetus (C. Godson)
„ — on, in a case in which the foetus was born dead (W
Sankey) .....
„ prolapsed portion of, with complicated knot (H. Madge)
„ obliterated by twisting (A. Rasch)
„ on the expression of the (J. Matthews Duncan)
„ presentations (H. G. Trend)
„ prolapse of, during labour (G. Roper)
„ short, in a case of twins (J. Braxton Hicks)
„ the shortness of, as a cause of obstruction to the natural prO'
gress of laboiu- (J. Matthews Duncan)
„ thick gelatinous, illustrating the necessity for more than
ordinary care in tying (W. P. Cleveland) .
„ tightly encircling left thigh of foetus (T. Fitzpatrick)
„ vascular (erectile) tumour in the sheath of, in a newborn
infant (F. Lawton) ....
„ see Navel-ill, Umbilical cord.
FussBLL (E. F.), cauliflower excrescence of the uterus .
iii,
413
xii.
133
X,
94
xxi.
302
X,
1
xvii.
318
. xxiii.
253
. xxiii.
243
xxi.
313
X,
141
vii, 210
vi, 102
Oalabin (A. L.), case of extra-uterine pregnancy in which a com-
m\inication existed between the cyst and the uterus . xvii, 170
„ — report on ditto by committee (W. S. Playf air, John Williams,
and A. L. Galabin) ..... xvii, 384
„ on the occurrence in normal labour of lateral obliquity of the
foetal head ...... xvii, 283
„ new form of pessary for treatment of anteversion or ante-
flexion ...... xviii, 176
„ two cases of pregnancy complicated by extensive malignant
disease of the cervix uteri .... xvrii, 239
„ case of Csesarean section performed on account of cicatricial
obliteration of the vagina .... xviii, 252
„ extensive malignant disease of the cervix uteri . xviii, 286
„ foetus in which ascites was combined with distension of the
bladder, necessitating embryotomy . . . xii, 119
„ — report on ditto by committee (John Williams and A. L.
Galabin) . . . . . ' . xix, 120
„ case of suppuration of the uterine cavity resulting from occlu-
sion of the cervix ..... xLx, 176
„ — report on ditto by committee (G. Roper and A. L. Galabin) xix, 177
„ a Zwancke's pessary, retained for six years, producing recto-
vaginal and vesico-vaginal fistulse with phosphatic calculi . xix, 201
„ forceps designed to allow the direction of traction to be pre-
cisely that of the axis of the pelvis where the centre of the
head was situated . ... xix, 227
„ on the choice of the leg which should be seized in version for
presentation of the upper extremity . . . xix, 239
„ modified form of Peaslee's metrotome . . . xx, 53
„ two cancerous polypi, with microscopic sections . . xx, 82
„ myxoma of both ovaries, associated with leukaemia . . xx, 123
„ pessary for prolapse of the uterus . . . xx, 169
„ two cases of r\xpture of the vagina during labour . . xx, 295
„ microscopic sections of a medullary sarcoma o*" the cervix . xx, 323
„ ovary of a healthy woman murdered by a stau which divided
the femoral artery ..... xxi, 23
80
GALABIN.
xii,
xxi.
xxi, 312
xxi, 312
XXll,
xxii,
xxii,
xxii,
xxii.
xxui,
xxiii.
xxiii, 186
Galabin (continued) —
a Greenhalgh's pessary removed with difficulty from the
vagina ...•••
origin of ovarian cystoma from Graafian follicles, and presence
of limpid fluid in true ovarian cysts
„ microscopic section of menstrual decidua passed on the first
day of menstruation . . • • •
„ section from the anterior lip of the cervix uteri from a case of
deep bilateral laceration witli ectropion .
„ microscopic sections of the uterine mucous membrane in endo-
metritis ...■••
„ multiple vesical calculi, the sequel of prolapsus uteri
„ pathological anatomy of erosions of the cervix uteri .
„ ladies' sanitary towels . . • •
„ case of pyometra, microscopic sections of the uterine wall
" microscopic sections from Clement Godson's case of ruptured
tubal fcetation . . • • xxii, 241,
„ for John Bassett, placenta from a case of triplets . . xxin,
„ — abnormal attachment of placenta . • • xxiii,
„ case of extra-uterine, associated with intra-uterine fcetation, in
which abdominal section was performed .
„ histology of cancer of the body of the uterus
„ case of pregnancy complicated by cancer of the cervix uteri,
followed by pyaemia associated with symptoms simulating
diphtheria . . • • • •
„ periodical discharge of membrane in cervical endometritis,
microscopical sections of . • • •
„ for Alfred OilUngham, fibroid tumour of the uterus .
„ microscopic section of the septum in a doubtful case of double
vagina . • • ' vi * i.
„ retention of menstrual fluid in one half of a double uterus .
'', histological results of laceration of the cervix ; microscopic
sections shown . • • • . •
„ tumour of the placenta . . • xxiv, 241
„ the causation of lateral obliquity of the foetal head .
„ for W. E. Fielden, cyst removed from the vulva
", distension of ut<?rus from partial obstruction of cervix
„ fibro-sarcoma of chorion
„ for Leivis Jones, female twin monster
„ cancer (?) of body of uterus removed by enucleation .
',' myxo-fibroma of cervix uteri in a girl aged 17 '...,__
„ retro-peritoneal cyst associated with solid malignant (?) intra-
cystic growth . • • , " . . * ■^'^^"''
„ condition of placenta in uterus removed by Porro s operation . xxix,
„ two uteri removed by vaginal extirpation . „ ' . .
„ microscopical section of tube from an early tubal fcetation
„ case of Porro's operation
„ inaugural address as President .
„ annual address as President
„ dermoid cyst . . • • •
„ fcetation in a rudimentary horn of uterus .
„ improved sanitary towels . ' . •, '•i.!
cedematous fibroid tumour of uterus associated with preg-
" nancy . - • • • ^^T!!'
.,- extra-uterine fcetation not primarily tubal. . xxxviii,
„ intra-ligamentous gestation retained for t^-enty-one years xxxviii,
"„ tubal gestation ruptured at the sixth week . xxxvui.
49
288
47
lOti
156
188
239
242
129
130
141
161
XXIU,
xxiv,
xxiv,
xxiv,
xxiv,
. ; xxvii,
XXV,
xxvi,
xxvii,
xxvii,
xxvii,
, xxviii,
. xxviii.
xxix,
XXX,
xxxi,
xxxi,
xxxii,
xxxiv,
xxxvii,
XXX vii,
207
4
20
21
53
107
252
56
81
107
305
4
178
179
98
30O
195
57
8&
86
441
225
227
286
91
38
39
GALABIN— GANGRENOgs FIBROID.
Galabin (A. L.) (continued)—
" ZZT. iT'^Y containing: corpus luteum .
„ uterine fibroid associated with carcinoma
„ myxo-sarcoma of ui-ethra in a child
„ sarcoma of cervix uteri
„ microscopic sections of tissue removed froni f)io „f„ "
;: sffisr=' '^-'* "^ ^ pa«eur4:dTa"^^ -'«- ,
" ''the^tabe?'"""'"' "^"^"'P'" '«'• '■"^-communication of
„ sarcoma of uterus * ' " •
„ subperitoneal fibro-myoma
„ papillomatous cyst of an accessory ovary '
" fif -^ jesicular degeneration of the placenta
„ fibroid tumour of the uterus with cancer
„ thi-ee fibroid tumours of cervix uteri
,. small roimd-celled sarcoma of endometrium
„ carneous mole retained in utero five months after' H.nfi p
"Tep^/c^?----^^^^^^
„ and Thomas G Stevens, chorion-epithelioma
" 'S^of^mSltC-r "^-^'^^^^^^^ produced by to.
ovary of the same side '^'"''"''^^^ ^^^^^ (•) sarcoma of the
GALACTAGOGUE, on the use of Pnff^r, ^^ f *.'
(Izett W. Anderson) ^^tton-leaf tea as a, in Jamaica
„ uterine fibroid ..'"•• xvi, 171
GALyAIfO-CAUTEEYKl,irE(H.E. Spencer) ' '' -^".318
'''TaSc'4'^^ "'«- '-- -'—'on 0, the ^.,M .te„,s ^""' ''"
" torth)"'"''"":'" fi''--°-"7»">a of the ute'rns (C. j'. Culling; '""' '''
M of ovarian tumours from their avial r-nf of, -^U ',. , . xxxix, 281
otomy in (Lawson Tai?) rotation, successful ovari-
" Iwa^nef ^"^ ^"""" '^' ^^"^^*^' "^^^^^^ ^^ Pregnancy (J. G.
TttfnT' ''™'''' "'!"" ^^^^^^^ ^^^ ^"^-*^ <^^ (J- Eland:
6
81
xxxviii, 101
xxxviii, 102
xxxviii, 120
xxxviii, 120
xxxviii, 121
xxxix, 229
xli, 170
xlii, 173
xliii, 226
xliii, 225
xliii, 267
xlv, 100
xlv, 102
xlv, 175
xlv, 184
xlv, 240
xlv, 2^10
xlv, 241
xlv, 241
xlvii, 331
xlvii, 332
xlviii, 19
xlvi, 353
xxii, 86
XXV, 215
xxix, 244
XXV, 141
XXV, 248
xxxii, 171
82
GANT GERVIS.
Gant (F. J.), post-mortem examination of a woman at the full
period of gestation and the first stage of natural labour ;
death by accidental ha3morrhage, chietiy internally . vi, 214
GARMENT, ladies', suspender, of elastic webbing (E. J. Tilt) . xvi, 202
GARTNER'S DUCT, on cases of associated parovarian and vaginal
cysts, formed from a distended (Amand Routh) . . xxxvi, 152
GASTROGRAPH, on recording the fretal movements by means of
a (J. Braxton Hicks) ..... xxii, 134
GASTROTOMY, extra-uterine fibroid successfully removed by
(C. H. F. Eouth) . . . xvii, 216 ; xviii, 5, 145
„ for extra-uterine gestation in wliich the placenta never came
away (J. Braithwaite) ..... xxviii, 33
„ for sxipposed extra-uterine gestation (A. Meadows) . . xv, 145
„ successfully performed in extra uterine pregnancy . . xv, 130
„ for removing the foetus in extra-uterine gestation and the
mode of dealing with the placenta (R. Barnes) . . xiv, 325
„ large conglomerate of colloid tumours removed by (R. Barnes)
xvii, 216; xviii, 193
Gatton (W.), forceps with a spring racket . . . vi, 249
„ case of monstrosity ..... vii, 56
GENERATIVE ORGANS, female, hypertrophy of lupus of the
(J. Matthews Duncan) ..... xxvii, 230
„ — ulceration of lupus of the (J. Matthews Duncan) . . xxvii, 139
„ two cases of imperfectly developed internal, the patient in one
case being an epileptic subject (C. Lockyer) . . xlviii, 75
„ see Pudendum.
Genge (G. G.), five months' foetus and placenta from a case of
twin pregnancy in which the second child was delivered alive
at or near full term along with the dead foetvis . xxxviii, 5
GENITAL CANAL, cancerous disease of, in pregnancy, its treat-
ment (G. E. Herman) ....
GENITAL ORGANS, two cases of congenital malformation of (H
Macnaughton- Jones) ....
GENITO-URINARY ORGANS of a hermaphrodite (J. Chalmers)
„ spurious (J. Chalmers) ....
GENITO-URINARY TRACT in a female foetus, arrest of develop-
ment in (Alban Doran) ....
„ and the rectum, pelvic viscera showing congenital commimica-
tion between (Alban Doran) ....
Gervis (Fred. H.), report of a case of complete inversion of the
uterus occurring immediately after labour
Gebvis (H.), variety of chronic pain in the back
„ distension of the uterus in a foetus, impeding labour, with
report on specimen ....
„ distension of ureters, pelvis of kidney, etc., in an infant
„ rare form of monstrosity
„ monstrosity, one of twins, the other well formed
„ double monster ....
„_ large polypus uteri ....
„~ cases of retroversion of the gravid uterus .
„ specimen of retention of a pessary
„ case of puerperal septicfemia
XX, 191
xlii, 92
xxiv, 239
xxv, 162
xxiii, 107
xxii, 79
xvii.
278
n+Vi
V,
76
lull
V,
284
vi.
221
viii.
135
X,
113
.
X,
197
xi.
4
xvi
232,
255
xvii.
274
xviii,
160,
184
GERVIS GILLINQHAM.
83
Gebvis (H.) (continued) —
„ case of double vagina and uterus .
„ cystic disease of the fcetal kidney
„ modification of Hodge's pessary .
„ case of transverse septum in tlie vagina
„ inaugural address as President
„ specimens of myo-fibromata of the uterus
„ stibmucous fibroid of the uterus .
„ annual addi-ess as President . . . xxvi, 33 :
„ case of cystic degeneration of the cervix uteri
„ pessaries made of glycerine and gelatine .
„ drawings of microscopical sections of a uterine polypus show-
ing ciliated epithelium
„ see J. B. Hicks.
GIANT CELLS in a section of the wall of an ovarian dermoid (H.
Williamson) ......
GiBB (G. D.), case illustrating the fatal influence of grief during
the puerperal state .....
„ pelvic cellulitis after a first pregnancy, followed by suppura-
tion at back and front parts of vagina
„ inflammatory disease of the skin of the head and upper part
of the body of an eight months' foetus, with exiidation of
plastic lymph .....
XIX,
271
XX,
84
xxiii.
33
xxiv.
210
XXV,
47
XXV,
108
XXV,
161
xxvii.
64
xxvi.
144
xxviii.
163
xxviii.
240
xlvi, 299
i, 75
ii, 324
Gibbons (Henet), Csesarean section .
iii, 442
. xiii, 131
Gibbons (E. A.), case of galactorrhcBa (unilateral) . xxix, 59, 108
„ electrolysis in some chronic uterine affections, with illustra-
tive cases ..... XXX, 242, 260, 265
Giles (Arthur E.), malformation of rectum and bladder, con-
genital absence of both kidneys and ureters, imperforate
anus, absence of right hypogastric artery, and deformed feet xxxiv, 129
„ case of congenital diaphragmatic hernia . . . xxxiv, 132
„ on the lochia ...... xxxv, 190
„ the longings of pregnant women .... xxxv, 242
„ observations on the aetiology of the sickness of pregnancy . xxxv, 303
„ and R. J. Probtn Williams, a case of exophthalmic foetus . xxxvi, 174
„ temperature immediately after delivery in relation to the
duration and other characteristics of labour . , xxxvi, 238
„ uterus didelphys, with observations on the clinical importance
of this malformation .... xxxvii, 300
„ cyclical or wave theory of menstruation, with observations
on the variations in pulse and temperature in relation to
menstruation ...... xxxix, 1 15
„ molluscum fibrosum of the labium majus . . . xxxix, 231
„ and EwEN J. Maclean, two unusual cases of tubal gestation :
the one causing chronic intestinal obstruction, and accom-
panied by a hsematosalpinx of the non-gravid tube ; the other
simulating retroversion of the gravid uterus . . xxxix, 232
„ note on a case of fibro-myoma of the uterus in a patient aged
23, with remarks on enucleation and myomectomy . . xlii, 299
„ fibroma of the ovary ..... xliv, 360
„ extra-uterine pregnancy: death of foetus at end of eighth
month, and operation a month later . . . xlvii, 114
Gilford (Hastings), uterine appendages of the left side showing
evidences of the rupture of the sac of an ovarian pregnancy . xliti, 24
Gillingham (Alfred), see Qalabin, A. L.
84
GLANDS GODSON.
GLANDS of the Fallopian tubes, sections of (W. S. A. Griffith) . xxx, 195
— and their function (J. Bland-Sutton) . . xxx, 207 ; xxxii, 189
iliac, and uterus removed by abdominal hysterectomy for
cancer of cervix (T. V. Dickinson) . . . xlviii, 15
lymphatic, of the uterus, the comparative anatomy of (G.
Hoggan) ...... xxiii, 4
— chorio-epithelioma with secondary growths in vagina,
kidney, pancreas, lungs, and (C. Lockyer) . . . xlv, 245
— (iliac and lumbar), secondai-y deposits of deciduoma
malignum without syncytium in (P. Horrocks) . . xlv, 243
GLAND, mammary, of new-born infant (C. N. Longridge) . xlix, 273
GLANDULAR STRUCTURE in the substance of a primary cancer
of the Fallopian tube (Alban Doran) . . . xxx, 194
GLUTEUS MAXIMUS, remarks on foetal retroflexion : report of a
specimen showing origin of, from occipital bone (L. Eemfry) xxxvi, 227
GLYCERINE, the effect of, on the quantity of secretions poured
into the vagina (G. E. Herman) . . , . . xxx, 452
GLYCOSURIA in a patient with gangi-enous sarcoma of utei'us
i-emoved by abdominal hysterectomy (W. W. H. Tate) . xliv, 165
„ of pregnancy, three cases of (W. H. B. Brook) . . xlviii, 192
GoDDARD (Eugene), successful case of ovariotomy during preg-
nancy, with remarks on the treatment of ovarian tumours
complicating pregnancy
Xlll,
275
xiv, 137, 211
Godfrey (B.), syphilitic disease of placenta .
Godson (Charles), see Godson, Clement.
Godson (Clement), twin abortion, one emaciated and the other
without trace of head or upper extremity . . . xvi,
„ — report on ditto by committee (John Williams and Clement
Godson) ...... xvi,
„ drawing of the breasts of a girl with dark crescentic pigmenta-
tion round both nipples .... xvii,
„ midwifery statistics of thirty-five years' practice from the
records of Charles Godson .... xviii,
„ foetus from a woman at term suffering from extensive epi-
thelioma of the cervix ..... xix,
„ cases of inversion of the uterus, from notes by W. H. Maberly xix,
„ ring pessary of wood which had iDeen worn for twenty-six years xix,
„ epithelial cancer of the uterus .... xx,
„ for J. C. Eaton, double monster, a case of conjoined twins . xx,
„ dissection of . . . . . xxi, 88
„ placenta to which the umbilical vessels were peculiarly dis-
tributed (insertio velamentosa) .... xx, 324
„ polypus removed from a woman aged 60 . . . xxi, 57
„ set of pocket instruments contained within an ordinary cylin-
drical speculum ..... xxi, 90
„ for J. Kingston Barton, ruptiu-e of Fallopian tube . . xxii, 2
„ — report on ditto by committee (John Williams, Clement
Godson, and A. L. Galabin) .... xxii, 82
,,-for G. E. Yarrow, double monster . . xxii, 73, 74
„ for James Murphy, double monster . . . xxii, 109
„ removal of fibrous outgrowth from the f imdus uteri . . xxii. 111
„ large encephalocele ..... xxii, 131
100
121
343
223
40
51
203
29
171
I
GODSON GRAPPLING IRON.
85
Godson (Clement) (continued) —
„ uterus and appendages showing rupture of tubal fetation
„ — report ou ditto by committee (John Williams, A. L.
Galabin, and Clement Godson) . . . .
„ depression of the frontal bone in two infants
„ for John Dewar, interstitial fibroid causing retroflexion
„ for T. Hope r oft, Fallopian gestation
„ Leiter's temperature regulator . . . .
„ depression of child's head by forceps
„ Marshall's patent sectional feeding bottle .
„ for H. G. Cronk, a malformed heart
„ umbilical cord in a state of cystic degeneration
„ for Arnold Thomson, surgical pocket case .
„ the treatment of spasmodic dysmenorrhcea and sterility by
dilatation of the cervical canal Avith graduated metallic
bougies, with notes of five successful cases xxiii, 277
„ uterus removed by Porro's operation
„ epithelioma of cervix, removed by ecraseur wire during preg-
nancy without causing abortion ....
„ foetus with placenta attached showing a knot in the umbilical
cord ......
„ myxomatous degeneration of uterine fibroids
„ vesical calculus . . .
„ pessary for retroversion and prolapse
„ large fibrous polypiis . . . . ,
„ cancerous cervix . . . . .
„ female twin monster .....
„ case of extra-uterine foetation ....
„ Auvard's nipple shield .....
„ living female child with three lower limbs .
xxii, 186
xxii, 242
xxiii, 32
xxiii, 63
xxiii, 109
xxiii, 131
xxiii, 161
xxiii, 166
xxiii, 178
xxiii, 180
xxiii, 180
xxiv, 6
xxiv, 299
XXV, 18
XXV,
XXV,
xxvi,
xxvi,
xxvi,
xxvii,
xxviii,
xxix,
XXX,
xxxii.
66
140
181
272
328
6
68
499
198
132
GONOREHffiA, aetiology of (Frederick J. McCann)
xxxviii, 225
GooDHART (J. F.), see Hicks, J. Braxton.
Govsr (W. J.), sarcoma of the uterus removed by vaginal hysterec-
tomy ......
„ a note on vaginal secretion . . . .
„ on the relation of heart disease to menstrtiation
„ uterus from a case of Porro's operation with intra-peritoneal
treatment of the stump . . . ' .
„ cystic intra-ligamentous myoma with double uterus
GRAAFIAN FOLLICLE in pre-menstrual life, fate of ov\im and
(T. G. Stevens) .....
„ mounted specimens, showing the development and retrogres-
sive changes in (W. Hunter)
„ ovarian cystoma from (A. L. Galabin)
„ haematocele from ruptured (W. Duncan) .
Grace (Henry), Fallopian pregnancy
„ double uterus with simultaneous gestation
Granville (A. B.), phenomena, facts, and calculations connected
with the power and act of propagation in females of the
indiistrial classes in the metropolis ; derived from eleven
years' experience of two lying-in instittitions
Granville (J. M.), application of extreme cold as an anodyne in
the pain attendant on parturition
GRAPPLING IRON for use in hysterotomy (Heywood Smith)
xxxii, 374
xxxvi, 52
xxxvi, 126
xxxix, 7
xl, 134
xlv, 465
xl, 327
xxi, 288
xxviii, 210
ii, 49
iv, 138
ii, 139
vi, 105
xxii, 45
86
GRAVID UTERUS — GRIFFITH.
GEAVID UTERUS, see Uterus, gravid.
Gray (Robert), separation of the greater portion of the cervix
uteri during labour ..... xvi, 128
Greene (W. T.), remarks in the discussion on puerperal fever xvii, 253, 260
„ double or dicotyledonous placenta . . . xviii, 68
„ synopsis of one thousand five hundred consecutive labours . xix, 20-i
Greenhalgh (R.), interstitial fajtation . . . v, 154
„ treatment of mechanical dysmenorrhcea and sterility, with a
description of a new metrotome . . . . v, 164
„ diseased cervix utei-i . . . . . v, 199
„ hypertrophy of cervix removed by the wire-rope ecraseur . vi, 75
„ amputation of cervix uteri . . . . vi, 102
„ practical remarks upon the treatment of placenta prsevia,
with illustrative cases . . . . . vi, 140
„ and J. Braxton Hicks, report on tumour exhibited by Mr.
Harper . . . . . . vi, 181
„ pelvimeter . . . . . . vi, 186
„ discussion of paper on placenta praevia . . . vi, 188
„ removal of polypus ..... vii, 25
„ new form of laminaria tent .... vii, 72
„ extreme distortion of the pelvis ; craniotomy ; cephalotripsy ;
Caesarean section ..... vii, 220
„ growth from cervix uteri .... vii, 255
„ large fibrous polypus ..... vii, 256
„ comparative merits of the Caesarean operation and craniotomy
in cases of extreme distortion of the pelvis . . vii, 270
„ mechanical dysmenorrhcea .... viii, 142
„ medicated cotton wool ..... viii, 217
„ uterus after Caesarean section . . . . ix, 241
„ hypertrophied nympha . . . . . x, 57
„ elastic spring pessary for retroversion of uterus . . x, 93
„ rupture of the uterus (?), death and decomposition of the
foetus, blood poisoning ; puncture of the membranes ; re-
covery of the patient . . . . . xi, 9
„ metrometer sound ..... xiii, 169
GRIEF, fatal influence of, during the puerperal state (G. D. Gibb) i, 75
Grieves (Mr.), foetus with peculiar growth from the mouth xiv, 139, 210
Griffith (G. de G.), curious monstrosity . . . xi, 5
„ remarks in the discussion on puerperal fever . . xvii, 261
„ case of haematocephalus .... xviii, 214
Griffith (W. S. A.), uterus just before menstruation, with
microscopic sections ..... xxiv, 138
„ perimetric abscess ..... xxiv, 299
„ notes of a specimen of anteflexion of the uterus . . xxv, 3
„ specimen of a recto-uterine perimetric abscess . . xxv, 18
„ fibrinous polypus ..... xxv, 165
„ oblique rachitic pelvis ..... xxv, 232
„ uterine cyst ...... xxvi, 229
„ pelvis deformed by mollities ossium . . . xxvi, 230
„ prolapsed adherent ovaries .... xxvi, 270
„ serous periraetritis ..... xxvii, 168
„ note of a specimen of pseudo-osteo-malacic pelvis of Naegele . xxvii, 186
„ broad ligament cyst with septa .... xxvii, 251
„ extra-uterine gestation ..... xxvii, 304
„ sarcoma of vagina and uterus, secondary deposits in lungs . xxviii, 38
GRIFFITH. 87
Griffith (W. S. A.) (continued —
„ tuberculosis of Fallopian tube . . . _ xxviii 66
„ notes of a specimen of the oblique pelvis of Naegele . xxviii, 83,' 84
„ myxo-carcinoma of abdominal wall and ovaries . . xxviii' 180
„ anterior perimetritis and anterior parametritis . ." xxix' 147
„ tiibo-ovarian cysts • • . . xxix 273 ' 302
„ segment of uterus after Caesarean section . , . 'xxix' 298
„ haematoma and hsematosalpinx . . . ' xxix' 397
„ pyometra • . • • . ". .' xxix^ 398
„ specimen or tubo-ovarian cyst . . . xxx 3
„ specimen of cystic adenoma of the cervix . . , . xxx' 4
„ parametritis dextra, purulent . . . ] xxx' 5
), hyperplasia of chorion stems with partial cystic degeneration
(myxoma fibrosum of Virchow ?) . , _ .^^^ 32
„ microscopical sections of a Fallopian tube showing glands *. xxx' 195
„ — of the oviduct of the frog ... xxx' 196
„ sections of solid non-malignant tumours of the ovary and
uterus . . . . ^ xxx, 302, 409
„ acephalous acardiac monster from the museum of St. Bar-
tholomew's Hospital . . . _ xxxi 2
„ anencephalic foetus . , ' -^^^i' i qj
/,,.„. , , • • • XXXI, id-i
„ case ot retention of m*ine caused by pressure of a dermoid
ovarian cyst . . . . xxxi, 135
„ sections ot uterus at different periods of the puerperium,
showing complete absence of the alleged fatty changes '. xxxi, 308
„ case of extra-uterine gestation, the sac being situated in the
right broad ligament ; pregnancy advanced to the early part
of the fourth month . . . ^ xxxiii 126
„ case of obstructed labour, in which a large fibroma of the
ovary occupying the pelvis was mistaken for the head of an
extra-uterine foetus . . YYYii'i lAn
„-,,.• • • . XXXlll, 14U
„ specimen or double hydrosalpinx . . , xxxiii 158
„ on specimen of hsematosalpinx, shown by W. S. Playfair '. xxxiv' 467
case of galactorrhoea during a first pregnancy . ] xxxiv' 491
case of abortion . . " ^^^^' 0*7
spontaneous extrusion of a large uterine fibroid . . xxxv 38
note on the importance of a decidual cast as evidence of extra-
uterine gestation . . . _ xxxvi 335
, patient after symphysiotomy . . .- xxxvii' 13
, and T. G. Stevens, notes on the variation in height of the
fundus uteri above the symphysis during the puei-perium,
the conditions which influence this, and the practical conclu-
sions which may be drawn from such observations . xxxvii 246
, see Stabb, A. F. '
, and Arnold W. W. Lea, breech presentation with extended
l^gs •••.... xxxix 13
and T. W. Eden, notes of a case of puerperal eclampsia, with
a description of a five weeks' ovum removed in a subsequent
pregnancy . . . . . ^ ^ji^ 151
sarcoma ot the uterus . . . , ^^ 23'?
primary solid carcinoma of the ovary . . . xlii' 34
squamous-celled epithelioma invading surrounding tissues
like a columnar-celled variety . . , _ xlii 210
of the cervix uteri in a very early stage . . xlii' 210
person aged 26 ; uncertain sex .... xliii' 298
two cases of calcified uterine fibroids in elderly women removed
by abdominal section ..... xlviii 17
8S GRIFFITH — H.llMATOCELE.
Griffith (W. S. A.) (continued) —
„ and H. Williamson, fibro-myoma of the uterus undergoing
Barcomatovis change ..... xlviii, 22
— chorion-epithelioma complicated by hsematometra . xlix, 241
Grigo (W. C), hydrocephalus .... xvi, 24G
„ modification of Albert Smith's pessary by narrowing of the
shaft ...... xvi, 247
„ rapid dilator, after EUinger's .... xvi, 248
„ cyst (tubo-ovarian) ..... xxxiii, 75
„ double pyosalpinx with tubo-ovarian cysts . . xxxiii, 75
„ matted appendages ..... xxxiii, 75
„ pyosalpinx complicating pregnancy . . . xxxiii, 75
Gboqono (A. W.), see Herman, G. E.
Groves (Ernest W. Hey), pathology and treatment of puer-
peral eclampsia, with special reference to the use of saline
transfusion (with notes of two cases) . . . xliii, 117
„ adjourned discussion on. .... xliii, 148
„ fibroid tumour of uterus which developed after both ovaries
and tubes had been removed for independent disease (der-
moid cyst) . . . . . . xlv, 136
„ uterus affected with adeno-carcinoma of the body in an early
stage, with microscopical sections . . . xlv, 138
„ new operation for the cure of vaginal cystocele . . xlvii, 65
„ co-existent intra- and extra-uterine pregnancy . . xlvii, 428
Gbun (E. F.), supposed extra-uterine gestation with birth through
uterus ...... xxvii, 226
„ — report on ditto by committee (G. E. Herman and Alban
Doran) ...... xxvii, 306
" GUIDE-HOOK," a new obstetric instrument (S. Newham) . vi, 7
GYN5:C0L0GICAL PRACTICE, electrolysis in (W. E. Steaven-
son, Lovcll Drage, E. A. Gibbons, and John Shaw) . xxx, 229 — 265
GYN51C0L0GY in relation to surgery, inaugural address by Alban
Doran . . . . . . xli, 107
GYN5:C0METEE (J. H. Aveling) .... xiii, 265
Haddbn (John), see Wiltshire, Alfred.
HJEMATEMESIS in a newly-born infant (H. C. Hodges) r . xxxi, 365
H51MAT0MA and hematocele ; a study of tAvo cases of early
tubal pregnancy (A. Doran) .... xlvi, 206
„ and hsematosalpinx (\\. S. A. Griffith) . . . xxix, 397
„ pelvic, following delivery (R. Boxall) . . . xxxi, 303
„ — or I'etro-uterine ha;matoce]e, with remarks — especially as
to the soui'ce of the haimorrhage (T. S. Beck) . . xiv, 260
HiEMATOMETRA, associated with a degenerating fibro-myoma,
treated by supra-vaginal hysterectomy (W. A. Meredith) . xxix, 422
„ case of double iiterus with double, and complete absence of
the vagina (A. H. N. Lewers) . . . xxxviii, 327
„ complicating chorion-epithelioma (W. S. A. Griffith and H.
Williamson) ...... xlix, 241
H51MAT0CELE and hsematoma; a study of two cases of early
tubal pregnancy (A. Doran) .... xlvi, 206
„ oT doubtful origin (W. E. Eogers) . . xvi, 177, 274
„ from ruptiu'ed Gi-aafian follicle (Wm. Duncan) . . xxviii, 210
HJIMATOCELB H^MOERHAGE. 89
HiEMATOCELE (continued)—
„ treated by operation (John Phillips) . . . xxix, 384
„ intra-peritoneal (W. S. Playfair) . . . xxxi, 130, 162
„ — from ruptvvre of a varicose vein (C. J. Oillingworth) . xxxi, 257
„ — bursting into the peritoneal cavity (R. Barnes) . . xiii, 191
„ "paratubal" (R. H. Bell) .... xliv, 322
„ — (W. S. Handley) ..... xliv, 325
„ pelvic, with special reference to its diagnosis and treatment
(A. Meadows) .... xiii, 140, 170
„ retro-uterine (Dr. Philip) . . . . x, 57
„ — with remarks on the source of the haemorrhage (T. S.
Beck) ...... xiv, 260
„ ruptured tube and three weeks' embryo from the sac of an
old pelvic (C. J. Cullingworth) . . . xxxviii, 122
„ tubal mole with encysted (W. S. Handley). . . xliii, 255
„ uterine (H. Madge) ..... iii, 79
„ the result of malignant disease (W. S. Playfair) . . xxvi, 6
HiEMATOCEPHALUS, case of (G. de G. Griffith) . . xviii, 214
KEMATOSALPINX and hsematoma (W. S. A. Griffith) . . xxix, 397
„ (C. J. CulUngworth) ..... xxxi, 226
„ (E. Malins) ...... xxxiv, 466
„ in a chronically inflamed Fallopian tube (A. W. W. Lea) . xli, 140
„ double: suspected early tubal gestation on both sides (A.
Doran) ...... xxxiii, 112
„ hydro- (G. Ernest Herman) . . . . xxxiii, 453
„ of the non-gravid tiibe, two unusual cases of tubal gestation .-
the one caxising chronic intestinal obstruction and accom-
panied by ; the other simulating retroversion of the gravid
uterus (Arthur E. Giles and Ewen J. Maclean) . . xxxix, 232
„ an unusual case of (recurrent hsematosalpinx) (R. L. Knaggs) xxxv, 213
„ uterine appendages showing a (Amand Routh) . . xl, 306
„ and small ovarian cyst (W. S. Playfair) . . xxxi, 130, 162
„ with papillomatous ovarian cyst (J. Knowsley Thornton) . xxvi, 4
„ with hsemorrhagic and cystic ovaries (A. D. Leith Napier) . xxxiv, 439
„ complicating ovarian tumour (John Phillips) . . xxviii, 89
„ and pyosalpinx (Wm. Duncan) .... xxxi, 332
„ on the opposite side to, and complicating, a ruptured tubal
gestation (C. J. Cullingworth) . . _ - . . xxxii, 273
„ ruptured tvibal pregnancy with, of opposite side (A. H. N.
Lewers) ...... xxxix, 189
„ from rupture of a varicose vein (C. J. Cullingworth) . xxxi, 257
„ see Uterine Appendages.
HaiMORRHAGE, accidental death by (F. J. Gant) . . vi, 214
„ accidental, placenta from a case of (R. D. Muir) . . xxxv, 338
„ concealed accidental, at the latter end of pregnancy and
during labour (J. B. Hicks) . . . . ii, 53
„ fatal case of concealed accidental, occurring at the eighth
month of pregnancy (R. Dunn) .... viii, 285
„ amputation of inverted uterus, by ecraseur on accoimt of
(J. H. Davis) . . . . . . xiv, 104
„ in labour, internal and concealed, produced by early and
entirely detached placenta (J. T. Mitchell) . . viii, 282
„ concealed accidental; fa3tus, placenta, and membranes de-
livered entire (W. R. Dakin) .... xxxvi, 315
„ severe, concealed accidental, abdominal hysterectomj' for (J.
H. Targett) ...... xlvii, 147
90
HEMORRHAGE.
IX,
246
xi.
81
xxxii.
2
vi.
65
xlix.
271
xii.
271
HiEMORRHAGE (continued)—
„ fatal, from traumatic aneurysm of the uterine artery (W. G
Hewitt)
fatal in forty minutes (J. H. Houghton)
cerebral, rapidly fatal, in a case of pregnancy complicated with
multiple fibroids (Wm. Duncan)
fatal umbilical, in an infant (W. G. Hewitt)
fourteen years after oophorectomy, calcified ixterine fibre
myoma removed piecemeal for (H. R. Spencer)
improved anti-hoemoii*hagic case (R. Barnes)
into the pelvis, uterus, and ovaries from a woman who had
died from (Heywood Smith)
intra-peritoneal, chorio-endothelioma of uterus ; hysterectomy
death (G. Bagot Ferguson)
intra-venous injection of saline solution in cases of severe (P
Horrocks) ...... xxxv, 430
placenta with (H. A. Des Voeux) . . xxxvii, 9
into the placenta, decidua reflexa, and decidua vera, from a
patient who died of heart disease, frozen sections of a uterus
at the tenth week of pregnancy showing (G. F. Blacker) .
placental, abortion showing recent (R. Wise)
post-partum, cases of, in the Montreal University Lying-in
Hospital (D. C. McCallum) ....
— on plugging the uterus in severe cases of (A. H. N. Lewers) xxxii, 356
— on administering iron during pregnancy as a preventive
of (J. Bassett) . .
— apparatus for injecting the uterus in cases of (J. B. Potter)
— the treatment of, by hypodermic injection of ergotinine (C.
Chahbazian) ......
— case of central choroido-retinitis occurring after (H. Mac-
naughton-Jones) .....
— in a case of occurrence of pregnancy after the removal of
an intra-iiterine tvimour (Wynn Williams)
— uterus of a woman who died from (G. E. Harman)
— uterus and adherent placenta from patient dying of (John
Phillips) ......
— caused by peritoneal adhesions of the gravid uterus (W. G.
Hewitt) . . ^. . .
— Mr. de Berdt HoveU's uterine truss for arresting (R. Barnes)
— treatment by the intra-uterine injection of perchlorido of
iron (H. Smith)
xvii, 56
xlix, 57
xlii, 235
xl, 257
XX, 40
xvi. 111
xxi, 29
xxiv, 286
xxxii, 134
xvi, 183
XX, 2
xxxii, 195
xi, 108
xiii, 129
— distension of the bladder as a cause of (J. L. Earle)
uterine, post-partum treatment of, with perchloride of iron
(W. F. Cleveland) . . . . .
after labour (E. Barnes) . . . .
secondary puerperal (C. S. Redmond)
due to retained placenta, supposed to be the placenta of a
previous abortion (A. W. Williams)
dvu'ing convalescence after an operation for extra-uterine
foetation between the third and fourth months of gestation
(J. D. Malcolm) . . . . .
from the FaUopian tube without evidence of tubal gestation
(Alban Doran) ....
in tubal gestation .- incomplete tttbal abortion ; operation
recovery (A. C. Butler-Smythe)
diffuse meningeal, in an infant after normal labour (A. W
Sikes) . . . . .
, XV, 44, 65
v, 291
xi, 242
xi, 219
xix, 258
viii, 317
xlv, 382
xl, 180
xl, 298
xlv, 44
HiEMOB.EHAGE— HANDFIELD- JONES.
91
H^IMOREHAGE (continued) —
„ profuse, in a fibroid tumour of the uterus, wholly cervical,
forming an abdominal timiour and characterised by profuse
(J. S. Fairbairn) . . . . . xlv, 178
„ from retained placenta after abortion, terminating fatally (G.
Lowe) ...... xii, 323
„ prolonged, after delivery and abortion, the relation between,
and backward displacements of the viterus (G-. E. Herman) xxxiv, 14
„ extensive, into the broad ligament in a broad ligament cyst
with torsion of the pedicle (F. J. McCann) . . xlviii, 179
„ into the internal capsule in a case of ingravescent hemiplegia
during pi-egnancy and pai-tvirition (P. Horrocks) . . xxxiii, 201
„ cystic ovary, the seat of (M. Handfield- Jones) . . xxxiii, 27
„ calcified, after the menopause in three cases of myomatous
utei-i (H. R. Spencer) .....
„ chronic retro-uterine, the effects of, in a case of tubal gesta-
tion (Alban Doran) .....
„ uterine, and injection of perchloride of iron, uterus from a
case of (R. Cory) .....
„ — treatment of certain forms of, by means of the sponge tent,
with reference to women residing in tropical climates (G. G.
Bantock) ......
„ — mucous membrane of the uterus of an infant suffering
from (S. W. Wheaton)
„ from the uterine mucous membrane of an infant (C. H.
James) ......
„ free, intra- peritoneal, in fibro-cystic tumotir of the uterus,
laceration on its surface (A. H. N. Lewers)
„ source of, in pelvic hsematoma or retro-uterine hsematocele (T.
S. Beck) ......
„ transfusion of blood, its history and application in cases of
severe (C. Waller) .....
„ vaginal, during parturition, a diagnostic sign of (P. Bvidin) .
„ see Hsemat erne sis.
„ visceral, in stillborn children (Herbert R. Spencer) .
H.a}MOIlRHAGIC EFFUSION into an ovarian cyst due to twisting
of the pedicle (R. Barnes) ....
„ — parametritis (J. Matthews Duncan)
HEGEDORN'S SURGICAL NEEDLES and holder (G. G. Bantock) . xxvi,
Hailet (Hammett), anencephalic fcetus . . . vii,
HAIR-PIN, extraction of, from the bladder of a female (P. Smith) x, 59
„ in bladder of young girl (T. C. Hayes) . . . xxxv, 115
Hall (Archibald), puerperal convulsions complicated with
mania ; apparent recovery ; sudden decease . . iv, 222
„ monstrosity . . . . . . ix, 271
Hallbt (A.), retention in utero of the greater portion of a dead
foetus for a period of four years .
HAND and arms, deformity of (J. Shortt)
„ and foot, deformity of, in a child (John Phillips)
Handfield-Jones (M.), Porro's operation
„ case of double-bodied uterus
„ fibro-sarcoma of the right ovary .
„ vaginal cysts ....
xlviii, 333
xxi, 169
xxi, 51
xiv, 84
xxxiv, 190
xxxii, 66
xlvii, 261
xiv, 260
i, 61
xix, 232
xxxiii, 203
XXV,
xxix,
160
191
271
78
ix, 90
vi, 205
xxviii, 89
xxvii, 4
xxix, 146
xxxi, 126
xxxi, 129
92
HANDFIELD-JONES — HARRIS.
Handpield-Jones (M.) (continued) —
„ complex twistings of the funis
„ chorea in pregnancy
„ cystic ovary, the seat of haemorrhage
„ supposed myxomatous degeneration of a fibroid
„ acephalous acardiac foetus
„ tubo-ovarian cyst
„ specimen of calcification occurring in a fibroid of the uterus
„ fibro-myoma of the broad ligament
„ fibroma of ovary
„ cancer of the body of the uterus .
„ Bossi's dilator
„ two specimens of extra-uterine footation .
„ cancer and fibro-myoma coexisting in the body of the uterus
„ fibroid of the uterus with cystic degeneration of the surround
ing tissues .....
„ fibroid and cancer in the same uterus
„ myxoma of the labium majus
„ ovarian fibroma ....
Handlet (W. S.), tubal mole with encysted haematocele
„ on paratiibal hajmatocele
„ (with CuTHBERT Lockyer), Solitary interstitial fibroid
x-emoved by abdominal myomectomy
„ hydrosalpinx of an accessory Fallopian tube due to twisting
of the pedicle ....
Hanks (H.), united childi'en or double monstrosity
Hannam (Miss), honorarium in recognition of services .
„ pension to be given in lieu of honorarium .
Haedet (Robert), special position and the obstetric binder a
aids in the treatment of impeded parturition
„ abnormal gestation ....
„ acephalo-cyclopean monstrosity .
„ thx-ee cases of retroversion of uterus
Harley (G.), tubal pregnancy, with fibrous tumours of the
uterus, Avhich occiu-red in the practice of J. A. Magrath,
M.D., Kingston, Jamaica ....
„ and W. Newman, foetus retained in utero for some weeks after
its death and decomposition ....
„ and T. H. Tanner, report on a t%vin (?) abortion exhibited by
Dr. Langmore .....
„ case in which air was expelled from the vagina
Harper (P. H.) the more frequent use of the forceps as a means
of lessening both matex'nal and foetal mortality
„ ovarian (?) tumoxu', ■s\ith report by Drs. Greenhalgh and B.
Hicks ......
Harris (A.), hydx-o-encephalocele ....
„ membrane expelled from uterus a feAv days before delivery at
full term ......
„ report on above by Drs. G. Hewitt and A. Meadows .
Harris (Dr.), of Philadelphia, a x'efutation of the marvellous
account given by Px'ofessor Gardien, of Paris, in 1866, to the
effect that the Princess Pauline de Schwartzenburg was
delivered of a living foetus some time after she was burnt to
death ... . .
xxxi, 164
xxxi, 243
xxxiii, 27
xxxiii, 461
xxxiv, 84
xxxiv, 85
XXXV, 2
XXXV, 239
xxxvi, 343
xl, 34
xlv, 103
xlvi, 88
xlvi, 305
xlvi, 307
xlvii, 337
xlvii, 362
xlviii, 332
xliii, 255
xliv, 325
xlv, 51
xlv, 157
iii, 414
xlix, 136
xlix, 276
ii, 79
ii, 307
iv, 213
v, 267
i, 101
ii, 251
iv, 165
iv, 173
i, 142
vi, 181
vi, 115
vii, 47
vii, 48
xxii, 103
HAREIS — HAYES.
93
Harris (Robert P.), of Philadelphia, a plea for the practice of
symphysiotomy, based upon its record for the past eight
years ...... xxxvi, 117
„ Csesarean section ..... xv, 166
Harris (W. H.), segment of large tumour (?) ovarian . . xv, 58
Harvey (Egbert), note on an acoustic sign heard after the death
of the foetus ...... xxi, 273
„ rupture of the uterus ..... xxvii, 190
„ report on ditto by committee (F. H. Champneys and Alban
Doran) . . . . . ' . xxvii, 228
Harvey (Sidney), ruptured abdominal gestation cyst . . xxx, 2
„ report on ditto by committee (J. Braxton Hicks, Sidney
Harvey, and W. S. A. Griffith) .... xxx, 166
Haslam (W. D.), see Paramore, Richard.
Hatherley (N. C), pelvic cellulitis after second pregnancy,
followed by suppuration in left groin and left antero-superior
femoral region ..... iii, 286
Haultain (F. W. N.), uterus removed by vaginal hysterectomy,
showing nodule of chorion-epithelioma . . . xlv, 242
Haydon (N. J.), tubular fcetation Avith twins . . . v, 75
„ extra-uterine fcetation in which two foetuses were found in
connection Avdth the same tube . . . . v, 280
„ report on the specimen (W. T. Smith and J. B. Hicks) . v, 281
Hayes (T. C), removal of a Hodge's lever pessary which had
ulcerated into wall of vagina after being Avorn five years . xvi, 30
„ carcinomatous tumour originating in the broad ligament . xvi, 101
„ pelvic tumour regarded as cancerovis, commencing in the
outer ligamentous cellular tissue of the broad ligament . xvi, 102
„ report on ditto (Hey wood Smith) .... xvi, 127
„ macerated os inuominatum of case of malignant disease . xvi, 174
„ uterus and appendages from a patient who died from con-
genital heart disease . . . . . xvi, 174
„ fatty placenta from a patient Avho had in succession tAvelve
still-born children, and who suffered from frequent htemor-
rhages in her pregnancies .... xvi, 175
„ uterus and appendages connected by adhesions to the large
intestine . . . . ' . . xvii, 45
„ placental polypus ..... xvii, 177
„ fatty placenta and a still-born foetus from a syphilitic patient xvii, 275
„ for B. White, specimen of myxoma in a foetus impeding
delivery ...... xviii, 83
„ new form of tube for injecting the uterus after labour or
abortion ...... xx, 58
„ uterus and appendages enveloped in a large amount of blood-
clot and false membrane .... xx, 119
„ uterus and appendages in a case of cancer . . . xx, 293
„ anteflexed uterus .... xxii, 82 ; xxiii, 109
„ sub-peritoneal pedunculated fibroid tumoiir of the uterus xxxiii, 74
„ uterine appendages showing cystic groAvths and tubal dilata-
tion ..... xxxiii, 4, 107
two sessile fibroid polypi
an intra-uterine sessile polypus .
two dermoid cysts
large soft polypus
foreign body (hair-pin) in bladder of young girl
xxxiii, 6
xxxiii, 73
xxxiii, 389
xxxiii, 389
XXXV, 185
94
HATES — HEMIPLEGIA.
Hates (T. C.) (continued) —
„ soft fibroid tumour of uterus .... xxxv, 186
„ hydrosalpinx ...... xxxv, 410
„ dilated Fallopian tube and ovary . . . xxxvi, 185
HEAD, depression of child's, by forceps (Clement Godson) . xxiii, 161
„ antero-posterior positions of, as a cause of difficult labour (R.
G. McKerron) ..... xli, 142
„ foetal, showing furrowing from pressure against sacrum (G.
Koper) ...... xxii, 84
„ — the causation of lateral obliquity of (A. L. Galabin) . xxv, 252
„ — plaster cast of (J. Brunton) .... xxiii, 206
„ depression of frontal bone of, the result of pressure from the
sacral promontory (Clement Godson) . . . xxiii, 32
HEADS, locked, difficult labour from (H. Eaynes) . . iv, 19
Heape (Walter), the menstruation of Semnopithecus entellus . xxxvi, 213
„ menstruation and ovulation of monkeys and the human
female . . . . . xl, 161
HEART, disease of, uterus and appendages from a patient who
died of (T. C. Hayes) . . . . . xvi, 174
„ — on the relation of, to menstruation (W. J. Gow) . . xxxvi, 126
„ — frozen sections of a uterus at the tenth week of pregnancy,
showing haemorrhages into the placenta, decidua refiexa, and
docidua vera, from a patient who died of (G. F. Blacker) . xlii, 234
„ relations of organic affections of, to fibro-myoma of the uterus
(T. Wilson) ...... xlii, 176
„ fatal embolism of right side of, nineteen days after delivei-y
(G. Eoper) ...... xxi, 74
„ escape of, into left pleural cavity, through incomplete peri-
cardial sac (R. Boxall) .... xxviii, 209
„ malformed (H. Smith) ..... xii, 116
„ — (R. J. Probyn-Williams) .... xxxvi, 3
„ malformation of (Clement Godson) . . . xxiii, 178
„ from a case of puei'peral septieamia (Wm. Duncan) . xxxi, 202
„ and large vessels of a dicephalous foetus (John Phillips) . xxix, 55
„ and lungs of an infant who died when 14 days old (A. W.
Williams) . . . . . . xi, 242
„ rupture of, in a still-born infant (C. N. Longridge) . . xlix, 214
„ sounds, fcetal, muscular susurrus in relation to (J. B. Hicks) xv, 187
„ univentrictilar, of child that lived 9 months (W. S. Playfair) . xii, 163
^^ _ by Dr. Elliot (A. Wiltshire) .... xii, 164
„ see Valves.
Heath (W. Lenton), notes on the dissection of a malformed
child (see vol. xxii, p. 237) .... xxiii, 195
Heckford (N.), medullary growth in vagina of infant . . x, 224
Hellier (J. B.), decidiioma malignvim (malignant hydatid mole) xlv, 242
„ abdominal pregnancy secondary to partial ruptvire of tubal
gestation sac ; abdominal section fifteen months after con-
ception and eight months after death of foetus . . xlv, 366
„ chorion-epithelioma ..... xlvii, 310
„ see Targett, J. H.
Helsie (T. a.), deciduoma malignum . . . xlv, 243
HEMIPLEGIA occurring nine days after parturition ; death ;
partial post-mortem examination (E. F. Scougal) . . xxx, 214
HEMIPLEGIA — HERMAN.
95
HEMIPLEGIA (continued) —
„ brain showing thromboses in the cerebral veins in a case of
ingravescent (Peter Horrocks)
. xxxiii, 201
Herman (G. E.), uterus of a woman who died from post-partum
haemorrhage ......
„ unicomed uterus • • . . .
„ bicorned uterus and double vagina
„ child showing one of the possible results of the use of forceps
„ on the treatment of pregnancy complicated with cancerous
disease of the genital canal ....
„ missed abortion with slight cystic degeneration of the chorion
„ fibroid tumoui- of the vagina ....
„ specimen of apoplectic ovum ....
„ follicular hypertrophy of the cervix
„ blighted and atrophied embryo ....
„ — microscopical preparations from ditto .
„ on the relation of anteflexion of the uterus to dysmenorrhcea
„ uterine fibroid .....
„ on the relation between backward displacements of the uterus
and painful menstruation ....
„ hj'pertrophy of the placenta ....
„ two cases of labour complicated with cancer of the cervix
uteri ......
„ case of acute gangrene of the vulva in an adult, with remarks
„ inverted uterus .....
„ atrophy of chorion .....
„ chancre on the cervix uteri ....
„ on the suppuration and discharge into mucous cavities of
dermoid cysts of the pelvis ....
„ on the production of the shape of the obliqvie pelvis of
Naegele ......
„ foetus and placenta of extra-uterine gestation, removed by
XX,
XX,
XX,
XX,
XX,
XXV,
xxvii,
xxvii,
xxvii.
2
60
123
190
191
44
, 44
45
270
204
259
209
52
161
189
308
141
83
195
252
abdominal section
note on one of the catises of difficulty in turning, with remarks
on the practice of amputating the procident arm .
case of chronic abscess of the female urethra
case of lupus stricture and atresia of the female urethra
stricture of the urethra in women
and G. M. Bluett, microscopical sections of tumours of foetal
membranes . . . . ' .
— report on ditto by committee (A. L. Galabin, G. E. Herman,
and Alban Doran .....
spontaneous gangrene of upper part of vagina^ with vaginal
portion of cervix uteri and base of bladder
on delivery by the vagina in extra-uterine gestation
case of eclampsia of pregnancy with observations on the state
of the renal function .....
case of Bright's disease during pregnancy
— sequel to ditto .....
and C. Owen Fowler, on the effect of ergot on the involution
of the uterus ......
foetus and placenta successfully removed in a case of tubal
pregnancy ......
inversion of the uterus by a gangrenous fibroid
on the effect of glycerine on the quantity of secretions poured
into the vagina ....
xxvii, 254
xxviii, 6
xxviii, 141
xxviii, 150
xxviii, 181
xxviii, 267
xxix, 27
xxix, 243
xxix, 512
xxix, 244
xxix, 429
517
539
XXX, 478
XXIX
xxix
XXX, So
XXX.
XXX.
123
226
XXX, 452
96 HERMAN.
Herman (G. E.) (continued) —
„ contribution to the anatomy of the pelvic floor . . xxxi, 263
„ on the changes in the pelvic floor which accompany the
slighter degrees of prolapse .... xxxi, -276
„ cases of puerperal eclampsia, especially illustrating the tem-
perature and virine in this disease . xxxii, 17 ; xxxiii, 315
„ the change in size of the chest and abdomen during the lying-
in period, and the effect of the binder upon them . . xxxii, 108
„ case of cancer of upper part of cervix extending into body of
uterus ; vaginal hysterectomy ; recovery ; recuri-ence of
disease ; death thirteen months afterwards . . xxxii, 137
specimens from a case of purulent senile endometritis . xxxii, 196
„ decidua vera and reflexa from a very early abortion . xxxii, 272
„ tubal gestation removed before rupture . . . xxxii, 307
„ four cases of pregnancy with Bright's disease . xxxii, 320, 349
„ case of submucous fibroid presenting at the os uteri ten days
after delivery ; labour normal .... xxxiii, 30
„ cancer of the uterine body, illustrating the difficulty of dia-
gnosis between this disease and senile endometritis . xxxiii, 31
„ five more cases of puerperal eclampsia, especially illustrating
the temperature and urine in this disease . . xxxiii, 315
„ hydro-htematosalpinx ..... xxxiii, 453
„ hypertrophy of decidua ..... xxxiii, 456
„ ruptured uterus ..... xxxiii, 491
for G. Mallack Bluett, amorphous acardiac foetus . . xxxiii, 493
on the relation between backward displacement of the uterus,
sterility and abortion ..... xxxiii, 499
report on specimen of amorphous acardiac twin, shown by
him on December 2nd, 1891 (* Transactions,' vol. xxxiii,
p. 493) ...... xxxiv, 11
on the relation between backward displacements of the
uterus and prolonged haemorrhage after delivery and
abortion ...... xxxiv, 14
„ on menstruation in cases of backward displacement of the
uterus . . . . . . xxxiv, 225
„ on the frequency of the local symptoms associated with back-
ward displacement of the uterus . . . xxxv, 8
„ inaugural address as President .... xxxv. 111
„ six more cases of pregnancy and labour with Bright's
disease ...... xxxvi, 9
„ for A. W. Grogono, acephalous acardiac foetus . . xxxvi, 65
„ annual address as President .... xxxvi, 75
„ on the change in size of the cervical canal during menstrua-
tion ...... xxxvi, 250
„ annual address as President . . . xxxvii, 42
„ specimen of ectopic pregnancy going nearly to term in the
peritoneal cavity, the placenta being attached to the top of
the uterus ...... xxxix, 135
„ two cases in which life appeared to have been saved by anti-
streptococcic serum ..... xli, 346
„ on subcutaneous symphysiotomy .... xlii, 282
„ sarcoma of the stomach .... xliii, 2
„ leukfemia and pregnancy .... xliii, 234
„ and H. Russell Andrews, contribution to the natural history
-of dysmenorrhcea ..... xliv, 371
„ introduction to a discussion on ventral fixation of the viterus
and its alternatives ..... xlvii, 429
HEEMAN — HEWITT.
97
xlviii, 204
xxxvi, 272
. xxiv, 188
XXV, 129, 162
. xxviii, 158
. xxiv, 239
vii, 109
ii, 199
xlix, 272
xxxii, 132
xxxiii, 34
xxxiv, 132
xxi, 118
XXXV, 102
XV. 162
Herman (G. E.) {continued) —
„ a case slio-vving (a) uterine contraction withovit retraction,
(b) prolonged high temperature of nervous origin
„ see Wilson, H. S.
HERMAPHRODITISM, two cases of pseudo- (J. H. Targett)
„ true unilateral, with ovotestis occiurring in man, with a sum-
mary and criticism of the recorded cases of true hermaphro-
ditism (Gr. F. Blacker and T. W. P. Lawrence) . xxxviii, 265
HERMAPHRODITE, spvu-ious (Fancourt Barnes)
„ (J. Chalmers) ....
„ four cases of, in one family (John Phillips)
„ genito-urinary organs of (J. Chalmers)
HERNIA cerebri and hernia umbilicalis, with attachment of the
foetal membranes to the scalp (T. H. Tanner)
„ ?, congenital, of the liver (A. Meadows)
„ diaphragmatic, in a new-born baby (C. N. Longridge)
„ congenital diaphragmatic, three cases of (H. E. Spencer)
„ (H. R. Spencer) ....
„ (A. E. Giles) ....
„ — ventral, in a foetal monster (J. Brunton)
„ ixmbilicalis congenita and spina bifida lumbo-sacralis (Amand
Eouth) ....
„ diaphragmatic, fcetus with (H. Smith)
„ double, case of congenital inguino-ovarian, two ovaries from
(T. Chambers) .... xxi, 92, 256, 269
„ exomphalos, in which the gravid uterus formed the (G. C. P.
Murray) ......
„ of a fibro-myoma of the iiterus (J. Knowsley Thornton)
„ inguinal, of the right ovary, successfully removed (A.
Meadows) ......
„ the relation of prolapse of the vagina to (A. Doran)
„ ixmbilical (J. Thompson) ....
Hewitt (W. Graily), new method of examination of the tumour
in cases of suspected cystic disease of the ovary ; with descrip-
tion of an instrument for eifecting the same
„ hydatidif orm or vesicular mole, its nature and mode of origin
„ — degeneration of the ovum . . ., .
„ enormous fibrous tumour connected with the uterus, in the
practice of Dr. E. Uvedale "West . ' .
„ unusual elongation of the foetal head as a cause of difficulty
in the application of the ordinary forceps, with a description
of a modified form of instrument
„ polypus of the uterus, pendiilous in the vagina, removed by
the ecraseur ......
„ abortion ; retention of the ovum within the uterus and growth
of membranes for a period of five months after the death of
the fcetus ....
„ spina bifida ....
„ uterine douche as a therapeutic agent ; with exhibition of a
new instrument
„ fibrous polypus of the uterus
„ description of the conditions of the parts involved in Mr.
Marshall's case of tubal gestation
„ fatal umbilical haemorrhage in an infant .
„ apparatus for the performance of transfusion
„ Sims' modification of Chassaigrnac's ecraseur
XXV,
77
67
iii, 438
xxvi, 88
X, 9
1, oo
i,'249
ii, 112
ii, 240
iii, 180
iii, 350
iii.
411
iv.
5
1
iv,
27
^"}
123
V,
154
vi.
65
vi.
136
vi.
254
98
HEWITT HICKS.
vii.
170
viii.
137
viii.
220
viii,
221
viii.
316
ix.
55
ix.
63
3 ix.
246
3
X,
69
X,
223
xi.
27
i xi.
37
xi.
108
xii.
16
xii.
135
xii.
237
xiii.
5
xiii,
94
xiii.
103
. xvii.
156
xxi,
229
Hbwitt (W. Gbailt) {continued) —
„ anteflexion of gravid uterus
„ disease of the placenta ....
„ uterus during menstruation
„ menstruation d\iring pregnancy .
„ acephalous monstrosity ; absence of abdominal covering
„ deciduous membrane ....
„ pessary for anteflexion and version
„ traumatic aneurysm of the uterine artery ; fatal haemorrhage
„ puei-peral fever in the British Lying-in Hospital, vnth remarks
on the treatment of puei-peral fever
„ pessaries for flexions and displacements
„ inaugural address as President .
„ twins, together with secundines, from a case of hydrops amnii
,. peritoneal adhesions of the gravid uterus as a cause of post-
partum haemorrhage .
„ President's address
„ mass of hydatids expelled from uterus
„ hydatids of the uterus .
„ President's address
„ child, arm amputated in utcro
„ vomiting of pregnancy, its causes and treatment
„ remarks in the discussion on puoi'peral fever
„ — in the discussion on tlie use of forceps .
„ report on sixty-seven cases of iiterine distorsion or displace-
ment, treated during seven years at All Saints' Institution
for ladies suffering from illness . . . xxii, 173, 188
„ and A. Q. Si lcock, general and considerable congestive hyper-
trophy of the uterus with acute anteflexion and presence of
an ovai-ian cyst ..... xxv, 131
„ and S. G. Shattock, specimen of spondylolisthesis . xxvi, 149, 151
„ on the severe or so-called " uncontrollable " vomiting of preg-
nancy ..... xxvi, 273, 331
,, columnar epithelioma of cervix uteri, removed by ecraseur . xxix, 510
„ the invalid's compendium .... xxx, 198
„ instruments for antiseptic irrigation in childbed . . xxxi, 202
„ case of abortion in which there occurred separate primary and
complete expulsion of the unbroken amnion, enclosing a
fcctus of about four months' gestation . . . xxxiii, 461
., vote of condolence on death of . . . . xxxv, 336
„ see Williams, A. W.
HiCKiNBOTHAM (James), case of rupture of the uterus . . xx, 96
,, forceps for removal of an ovmn or retained portion of placenta xxi, 22
„ notes on a case of placenta praevia complicated by a largo
myoma ...... xxiii, 167
Hickman (William), two cases of inversio uteri . . xix, 49
Hicks (H. T.) and J. H. Tarqett, two cases of malignant
embryoma of the ovary. .... xlvii, 287
„ carcinoma of the body of the uterus, with secondary growth
in both ovaries ..... xlviii, 196
„ primary embolic chorion-epithelioma of the vagina . . xlix, 224
Hicks (J. Beaxton), concealed accidental haemorrhage at the
latter end of pregnancy and during labour . . ii, 53
„ new instrument for removal of uterine polypi . . iii, 346
„ five cases of vaginal closure . . . . iv, 228
„ combined external and internal version . . v, 219
HICKS.
99
Hicks (J. Braxton) contiimed—
„ combined external and internal version, appendix to ditto
" tl%^r' '>^^"'^' obstructed by abnoLal conS of
the foetiiLs, with some other points of interest
" ^ttLtl^g^W "■'. °" ^^^--^-^« of the fcBtus
„ anencephalous monster . * ' '
" ' pSforaijon ^^^ ^^'^ "^""^^ ""^ delivering the foetal head aftei-
" *w?tdarkr P'^"^^"*^*^^" i^ ^^^ mento-posterio; position;
" ^ISZT""' ?" *^'' ^'^" of 'fastening the rope in an
„ a rare form of extra-uterine foetation
„ — report on ditto by Drs. Barnes and Hicks
" Sfi,?^''''''^ ^^i^-^.^s of uterus; spontaneous sloughino- '
death from peritonitis . . "^"o^w^o .
„ polypus weighing 2| lb. .
„ echinococcus discharged from the'vao-ina
'' ^^^er^JStex?^'^^''^^'^''*'''''"^^^''*^"'^^ zinc to the canal of the
„ cephalotribe ..'_■'•
„ pathology of puerperal eclampsia . " " "
„ intermural foatation . " * '
" ^^^;:^:^<^«^-i^e fcetation treated by abdominal section ;* recovery
" '^^^^;^^«7V^?«^te™^ unobstructed labour, and an enqu?-y
as to what is intended by the terms - cessation of labouJ
pams powerless labour/' and "exhaustion." With
appendix of quotations from other writers on the subiect
„ Ccesarean section >= o^ujeou __,_„.
" 'rephStTb^'''^ ^" "^'"^^ ^"^^^'y "- ^^ff^^-ted by^ the ^ ""' '°'
V, 265
V, 285
V, 290
vi, 226
vi, 263
vii, 57
vii, 71
vii, 95
vii, 100
vii, 110
vii, 253
viii, 109
viii, 220
viii, 275
viii, 323
ix, 57
ix, 93
ix, 207
cephalotribe .
foetus delivered by cephalotribe
, remarks on the cephalotribe
„ Perrett's new feeding bottle
, pregnancy associated with ovarian cystic disease
, contribution to our knowledge of puerperal diseases, bein-
short report of eighty-nine cases, mth remarks
' enSa'rn'"' °' ^"^'•^' obstructing labour, removed by
, inaugural address
' 'ottetii TpraSs""^^"^ ^"" '^'^^^ "^^ '""'^'^'"'y ^f^-
, contractions of the uterus throiighout pregnancy, their
physiological effects and their vafue in the diagnosis of
pregnancy . . _ o"'-'^^^ uj.
, President's annual address ] ]
, fibro-cystic disease of the uterus .
anatomy of the human placenta .
President's addi-ess
wSpSition '""''•! '- '-" P--te«on in tie mento
cephalotripsy, with short remarks
""st^d^ ^^^ muscular susurrus in relation to the festal heart
report of three cases of cephalotripsy (with two casts) vvii a.o
remarks m the discussion on puerperal fever xvi, 108, 148, 195,' 209
X, 144
xi, 1
xi, 43
xi, 169
xi, 263
xii, 44
xii, 273
xiii, 27
xiii, 55
xiii, 216
xiv, 25
xiv, 66
xiv, 149
XV, 16
XV,
XV,
39
41
XV, 187
xvii, 49
100
HICKS — HODDER.
Hicks (J. Braxton) {continued) —
„ note on a dissection of a uterus, pi-egnant about three and a
half mouths, the placenta being prsevia and fibroids exten-
sively developed in the walls of the uterus . . xvii, 298
„ the utenis of Harriet Lane referred to at the ti-ial of Wain-
wrighfc, with statistics of measurements of nulliparous and
multiparous uteri ..... xviii, 70
„ and J. F. Goodhart, on the displacements of the uterus by
the distension of the bladder, as shown by experiments on
the dead body ..... xviii, 194
„ phantom employed for class purposes in midwifery . . xix, 231
„ for F. Ogston, unilateral uterus and solitary kidney with two
lu-eters ...... xxi, 57
„ remarks in the discussion on the use of forceps . . xxi, 218
„ photographs of a dwarf upon whom Caesarean section had been
performed . . . . . . xxi, 253
„ on recording the foetal movements by means of a gastrograph xxii, 134
„ case of extra-uterine foetation about the seventh month of
pregnancy ; iirgent symptoms ; removal of foetus by abdo-
minal section ; death ..... xxii, 111
„ case of congenital abnormality of the uterus simulating re-
tention of menses . . . . , xxii, 260
„ case of pregnancy with double uterus and vagina . . xxiii, 23
„ vertical septum in lower part of vagina impeding labour . xxiii, 24
„ twins, short funis in both .... xxiii, 253
„ on tlie behaviour of the uterus in puei'peral eclampsia, as
observed in two cases ..... xxv, 118
„ watch-spring Hodge pessaries .... xxx, 227
„ case of inversio uteri ; reduction ; recovery ; remarks . xxxi, 3 10
„ a case showing the behavioiu* of the pregnant uteiois in
chorea ...... xxxiii, 486
„ further contribution to the clinical knowledge of puerperal
diseases ...... xxxv, 412
„ on intermittent contractions of viterine fibromata and in preg-
nancy in relation to diagnosis .... xxxvi, 188
,, list of published writings, arranged chronologically (C. J.
CuUingworth) . . . . . xl, 102
,, see Smith, W. T.
HIGH TENSION DISCHARGES, see Electricity.
HiLLiARD (Harvey), one-headed twin monster . . xxii, 3
HiNB (S. D.), case of obstructed labour in which spontaneous
version followed an unsuccessful attempt to deliver by the
crotchet after craniotomy . . . . xxvii, 293
Hinds (Frank) and John D. S. Nodes, fatal ruptitre of an
aneuiysm of the splenic artery immediately after labour . xlii, 305
HIP-JOINT, destructive inflammation of, in a puerpei'al woman
(T. W. Nunn) . . . . . vi, 116
HIPS,-congenital dislocation of both (S. W. Poole) . . xxii, 214
HISTOLOGY of cancer of the body of the uterus (A. L. Galabin) . xxiii, 161
„ of lupus, observations and remarks on (G. Thin) . . xxvii, 315
HISTOEY, natural, of dysmenorrhcea (G. Ernest Herman and H.
Eussell Andrews) ..... xliv, 371
HoDDER (E. M.), ovariotomy .... xii, 308
HODGE S PESSARY — HOBROCKS.
101
iv.
140
xiii.
243
xiii.
263
xiv,
35
xvi.
228
xvi.
250
xxiii.
4
xvii.
218
xviii.
190
HODGE'S PESSARY, modification of (H. Gervis) . . xxiii, 33
Hodges (H. C), notes on a case of hpematemesis in a newly-born
infant ...... xxxi, 365
Hodges (Richard), hysteria simnlating in the most perfect
degree natiu-al labour . . . . . i, 339
„ spontaneous evolution of the foetus in utero, the head changed
for the feet . . . . . . ii, 303
„ presentation of the right arm and shoulder ; delivery by spon-
taneous evolution . . . . .
Hogg (F. R.), deformed foetus ....
„ — report on ditto (Drs. Aveling and Edis)
„ description of Military Lying-in Hospital, Woolwich
HoGGAN (George), the structure of the decidua
„ diagrams and microscopic specimens illvistrating the nature,
cause, and treatment of membranous dysmenorrhcea
„ the comparative anatomy of the lymphatics of the uterus
HoLMAN (C), letter read in the discussion on pvierperal fever
HOOK, blunt, of Lazarewitch, considerably modified
HopcROFT (Thomas), see Godson, Clement.
HoRSiBLOW (R. E. B.), monstrosity ....
HoRROCKs (P.), wooden ring pessary worn for six years, with the
lumen entirely filled up by deposit
„ case of rupture of the uterus and vagina .
„ placenta and membranes from a case of triplets
„ dicephalous fcetus
„ malformed fcetus
„ two cases of imperforate rectum .
„ microscopic sections of cancer of the neck of the uterus
„ large tumour at the end of the spine, supposed spina bifida .
„ fibro-myoma from a case of Csesarean section
„ specimen of chronic endometritis with microscopic sections .
„ irreducible inverted uterus with a fibro-myoma, removed by
ampvitation ...... xxx, 196
„ — report on ditto by committee (Alban Doran and P. Horrocks) xxx, 228
„ rvipture of uterus ..... xxxi, 228
„ multilocular ovarian cyst and fibroma (?) of the opposite
ovary ...... xxxiii, 200
„ brain showing thromboses in the cerebral veins and haemor-
rhage into the internal capsule in a case of ingravescent
hemiplegia during pregnancy and parturition . . xxxiii, 201
„ cancerous uterus removed by vaginal hysterectomy . xxxiv, 85
„ asceptic instruments ..... xxxiv, 460
„ transfusion apparatus ..... xjfxiv, 460
„ intra-venous injection of saline solution in cases of severe
hsemorrhage ...... xxxv, 430
„ ovarian tumour with greatly enlarged Fallopian tube . xxxvi, 185
„ large fibroid tumour of the uterus . . . xxxvi, 193
„ fibroma (?) of the ovary .... xxxvi, 192
„ large sarcoma of the ovary .... xxxvi, 192
„ simple maieutic for the induction of miscarriage or premature
labour ..... xxxviii, 168
„ fibro-myoma of the uterus with sarcomatous degeneration . xl, 178
„ large fibroid tumour of the utervis undergoing- cystic degenei'a-
tion . . . . . . xl, 227
xii, 247
. xxvi, 54
xxvi, 119, 260
. xxvi, 160
. xxvi, 326
. xxvii, 131
. xxvii, 135
xxviii, 240
xxix, 57
xxix, 98
xxix, 298
102
HOBROCKS — HYDATIDS .
HoBROCKS (P.) (continued) —
„ fibroid tumours of the uterus with great distension of the
Fallopian tubes from tubercle .... xliij 166
„ pregnant uterus and fibroid tumour removed by abdominal
hysterectomy ..... xlii, 242
„ inaugural address as President .... xliii, 79
„ deciduoma malignum .... xliii, 109 ; xliii, 283
„ annual address as President ....
„ sarcoma of ovary .....
„ tubercle of the uterus .....
„ extra-uterine fcetation .....
,, annual address as President ....
„ decidiioma malignum without syncytium ; secondary deposits
in vagina, lymphatic glands (iliac and lumbar), and lungs
after hydatidiform degeneration of the chorion
„ twin monster ......
„ fibro-myoma of the uterus undergoing sarcomatous degenera-
tion ......
„ see Stevens, T. O.
Houghton (J. H.), haemorrhage, fatal, in forty minutes
HuGHBS (K.), history of a specimen of carneousmole
„ — report on ditto by committee (John Williams and W. B.
Woodman) ......
Hunt (W. A.), foetal peritonitis {in utero)
Hunter (William), mounted specimens, showing the develop-
ment and retrogressive changes in the Graafian follicle
Huntley (E. E.), remai'ks in discussion on puei-peral fever
Hurry (J. B.),and J. Matthews Duncan, on extensions or retro-
flexions of the foetus, especially of the trunk, during preg-
nancy ......
„ case of symmetrical erysipelas, followed by premature labour ;
eclampsia on the nineteenth day post partum ; no renal dis-
ease ; recovery .....
Hutchinson (Jonathan), remarks in the discussion on puerperal
fever ......
„ report on certain causes of death in ewes during and after
partvirition, with notes on " navel-ill " in lambs
HYDATID DISEASE, primary (echinococcus), of the Fallopian
tube (T. W. Eden) .....
,, mole expelled from the uterus immediately after a living
foetus and its placenta, at about six months' gestation (J. H.
Davis) ......
„ — the degenerated ovTim of a twin conception (J. H. Davis) .
HYDATIDIFORM DEGENERATION, early placenta with localised
(E. Boxall) ...... xxxiii, 494
„ — see Degeneration.
„ mole (John Williams) ..... xvii, 2
„ — (Wm. Duncan) .... xxv, 162, 233
„ ■ — followed by chorio-epithelioma in a patient with bilateral
ovarian cysts (J. D. Malcolm, E. H. Eell, and C. Lockyer) . xlv, 483
„ vesicles attached to a portion of placenta (A. W. Williams) . x, 93
HYDATIDS in the bony pelvis (J. H. Targett) . . . xxxvi, 344
,, of the mesentery (E. Malins) .... xxix, 245
„ in omentum, simulating an ovarian tumour (W. Newman) iv, 169
xliv.
53
xliv.
94
xliv.
141
xliv.
228
xlv,
61
xlv.
243
xlvi.
183
xlvi.
184
xi,
81
xviii.
3
xviii.
311
ix.
15
xl.
,327
xvii,
,151
xxvi, 206
xxxii, 309
xvii, 116
xviii, 88
xlvi, 243
iii, 177
iii, 177
J
HYDATIDS — HYDROSALPINX.
103
HYDA.TIDS (continued) —
„ of, or connected with, both ovaries, right broad ligament, liver,
omentum, mesentery, and other parts (C. J. Cnllingworth and
H. H. Clntton) .....
„ expelled from titertis (W. G. Hewitt)
„ of the uterus (W. G. Hewitt) ....
HYDRAMNION in cases of tiniovial or homologous twins (T.
Wilson) . . . . . .
HYDRAMKIOS, orbital tumour in a hydrocephalic female foetus,
with tumour of cheek, maldevelopment of neck, associated
with (H. S. Stannus) ....
HYDRENCEPHALOCELE, large, in a female child (W. F. Cleve
land) .....
HYDROCELE of the canal of Niick containing a portion of the left
Fallopian tube (L. Eemfry)
„ ovarian, containing papillomata (J. Bland-Sutton) .
HYDROCEPHALIC head of a child (B. SpauU)
HYDROCEPHALUS (W. C. Grigg)
„ associated, and spina bifida (W. Leishman) ,
„ association of spina bifida with (E.. Barnes)
„ spina bifida followed by (D. Richards)
„ with spina bifida (R. J. Probyn- Williams) .
„ as a complication of labour (J. S. Swayne) .
„ chronic (H. Madge) ....
„ congenital, complicating labour (G. M. Bluett)
„ in fcetus which had presented by the breech and impeded
delivery (A. W. Edis) ....
„ with stumps of arms and deformity of lower limbs in a child
(J. Matthews Duncan) ....
„ — dissection of ditto (W. L. Heath)
HYDRO-ENCEPHALOCELE (A. Harris)
HYDRO-HaiMATOSALPINX (G. Ernest Herman)
HYDROMETRA in new-born children, congenital tumour at the
internal os uteri causing (H. E. Spencer) .
HYDRONEPHROSIS of the foetal kidneys ; impeding labour (H.
M. Madge) . . . . , .
„ of the left kidney (J. Sidney Ttirner) . . xxxviii, 103
HYDROPERITONEUM, the relation of, to tubal disease (Alban
Doran) ..... xxviii, 229, 243
HYDROSALPINX, removal of the uterine appendages for (Lawson
Tait) . . . . . . xxiv, 157
xlvi, 254
xii, 135
xii, 237
xli, 235
xliii, 304
xxii, 157
xl, 6
xxxiv, 215
xiii, 214
xvi, 246
V, 198
V, 172
iv, 191
xxxvi, 4
xxix, 405
v, 201
xxix, 396
xvii, 302
xxii, 237
xxiii, 195
vi, 115
xxxiii, 453
xl, 332
xi, 55
case of (G. G. Bantock)
— (Lawson Tait)
— (Wm. Dvmcan)
double (C. H. Carter)
— (W. S. A. Griffith)
— without salpingitis (A. Doran)
(T.C.Hayes) .
undergoing spontaneous cure (J. Bland-Svitton)
XXV, 38
XXV, 111
xxxi, 332
XXX, 3
xxxiii, 158
xii, 379
XXXV, 410
xxxiv, 9
and small ovarian cyst removed by anterior colpotomy (Amaud
Eouth) ..... xxxviii, 185
of an accessory Fallopian tube due to twisting of the pedicle
(W. S. Handley) ..... xlv, 157
104
HYDROSALPINX — HYSTERECTOMY.
HYDROSALPINX (continued)—
„ torsion of the pedicle in, and other morbid conditions of the
Fallopian tube (E. H. Bell) .... xZvi, 152
„ — of (H. Williamson) ..... xZvii, 5
„ see Uterine apjpendages.
HYGIENE AND ANTISEPSIS in fever in childbed (R. Boxall) xxxi/, 219, 275
HYMEN, imperforate, case of so-called (J. Matthews Duncan)
J, — with retained menstrual finid (E. Copeman)
„ obstructed labour from the presence of (S. Palmer) .
HYPERPLASIA of chorion stems with partial cystic degeneration
(myxoma fibrosum of Virchow ?) (W. S. A. Griffith)
HYPERPYREXIA, puerperal, bed for cases of, requiring con-
tinuous application of cold (W. S. Playfair)
HYPERTROPHY of the bladder in a foetus (F. A. T. O'Meara)
„ of the breasts (J. A. M. Moiillin)
„ symmetrical, of clitoris (J. H. Aveling)
„ of deeidua (G. E. Herman)
„ blighted ovum with fleshy decidual (J. Phillips)
„ Fallopian tubes and cystic ovaries (John Phillips) .
„ of labium (A. Meadows)
„ of lupus of the female generative organs (J. Matthews Duncan)
„ of left nympha (Fancom-t Barnes)
„ of the placenta (G. E. Herman) .
„ — and general dropsy in a foetus (J. Bassett)
„ of spleen and liver in a child, aged 9 (J. W. J. Oswald)
„ of the uterus with anteflexion and presence of an ovarian
cyst (Graily Hewitt and A. Q. Sileock)
„ cancerous, of the body of the uterus (J. Matthews Duncan)
„ follicular, of the cervix uteri (G. E. Herman)
HYPOSPADIAS, extreme, in a child brought up at a girls' school
as a female (H. C. Rose) ....
HYSTERECTOMY, uterus and appendages removed by (Heywood
Smith) . . . . . xxi, 313
„ in chorio-endothelioma of uterus; intra-peritoneal haemor-
rhage ; death (A. Doran for the late Br. O. Bagot Ferg^tson) .
„ for removal of fibroid tu.mours of the uterus (G. G. Bantock) .
„ for fibro-mj^omatous uterine tumours, on the advisability of
removing the cervix in performing (J. D. Malcolm)
„ for sarcoma of the uterus (Wm. Duncan) .
„ abdominal, two cases of (Lawsou Tait)
„ — for cancer of cervix, uterus and iliac glands removed by
(T. V. Dickinson) .....
„ associated with pregnancy (D. Drew)
„ — for epithelioma of the cavity (J. Knowsley Thornton)
„ — for the removal of fibroid of the uterus (G. G. Bantock) .
„ — two cases of, for fibroids, complicated by pregnancy ; with
specimens (F. N. Boyd) ....
„ — large oedematous fibroid of the uterus removed by (C. J.
Cvillingworth) .....
„ — fibroid tvimours removed by (G. G. Bantock)
„ — for large fibroid tumour (J. Knowsley Thornton)
„ — for removal of soft fibroitl tvimour of uterus (T. C. Hayes)
„ — ::^ gangrenous uterine fibi'oid (W. Duncan)
„ — case of locked fibroid treated by (W. A. Meredith)
xxiv, 212
X, 246
iv, 211
XXX, 82
XX,
171
. xxix.
54
XXV,
212
xvi,
1
XXX,
456
. xxxiii.
35
. xxxi.
332
viii.
257
1 xxvii.
230
XXV,
165
. xxiv.
189
xix.
261
. xviii.
191
a
XXV,
131
XX,
27
xxii,
270
xviii, 256
; XXii, 6
xlix, 57
xxvi, 119
xlix, 148
xxxi, 2
xxxiv, 199
xlviii, 15
xlviii, 202
XXV, 9
xxiv, 301
xlvi, 106
XXXV, 38
XXV, 38
XXV, 163
XXXV, 186
xxxvi, 181
XXX, 442
HYSTERECTOMY. 105
HYSTERECTOMY (continued)—
„ abdominal. Doyen's method, in case of large uterus with
cervical fibroid (H. E. Spencer) .... xliii, 5
„ — for removal of a decomposing fibroid tumour with micro-
cocci in its substance (S. W. Wheaton) . . . xxxiv, 187
„ — for removal of uterine fibroids and ovarian cysts (J.
Knowsley Thornton) ..... xxvi, 55
„ — for fibroid obstructing labour, uterus removed at eight and
a half months of gestation by (A. Eouth) . . xliv, 41
„ — for severe concealed accidental hemorrhage (J. H. Targett) xlvii, 147
„ — for removal of gangrenous sarcoma of uterus from a patient
suffering from glycosuria (W. W. H. Tate). . . xliv, 165
„ — sloughing fibroid removed by (W. Duncan) . . xxxvii, 197
„ — fibroids removed by intra-abdominal (W. Duncan) . xxxix, 89
„ — for removal of fibroids and large fibro-cystic tumour (J.
Knowsley Thornton) ..... xxvi, 3
„ — for removal of fibro-cystic disease (Heywood Smith) . xxvi, 58
„ — for fibro-cystic disease of the uterus (T. Chambers) xxii, 159, 187
„ — for removal of a large uterine fibro-myoma (J. Knowsley
Thornton) ...... xxv, 67
„ — for removal of fibro-myoma of uterus (W. Walter) . xxvi, 326
„ — in a case of suppuration in fibro-myoma uteri following
premature delivery (W. W. H. Tate) . . . xlix, 54
„ — for removal of vascular fibro-myoma of uterus and cystic
tumours of ovaries (J. Knowsley Thornton) . . xxvi, 269
„ — case of hsematometra associated with a degenerating fibro-
myoma, treated by (W. A. Meredith) . . . xxix, 422
„ — in two cases of fibro-myoma of cervix (W. W. H. Tate) . xlv, 173
„ — for fibro-myoma of uterus projecting into the vagina (W.
W.H.Tate) . . . . . . xl, 159
„ — for cedematous subpei'itoneal fibro-myomata of uterus in
right broad ligament (C. J. Cullingworth) . . xl, 302
„ — for myoma of the uterus : with brief notes of twenty-eight
cases (J. Bland-Sutton) .... xxxix, 292
„ — ruptured uterus treated by (John Phillips) . . xxxix, 260
„ — ruptured uterus at term through scar of old Cassarean
section (J. H. Targett) ..... xlii, 242
„ — pregnant uterus and fibroid tumour removed by (P. Hoi-rocks) xlii, 242
„ — total, and Csesarean section for fibroids complicating labour
near term in a patient who had recovered without operation
from ruptured tubal pregnancy .... xlviii, 240
„ — total, for removal of a degenerated uterine fibroid (H. R.
Spencer) . . . . . . xlv, 378
„ — uterus with fibroid tumour undergoing mucoid chano-e,
successfully removed by, with intra-peritoneal treatment of
the stump (A. H. N. Lewers) .... xlii, 94
„ — with intra-peritoneal treatment of the stump, vdt\\ notes of
eight cases (Harrison Cripps) . . . xxxviii, 41, 107
„ abdomino-vaginal, for removal of supposed myxo-sarcoma of
uterus (Amand Eouth) .... xli, 367
„ combined vaginal and abdominal, for a pregnancy of four
and a half months, complicated by cancer of the cervix
(R. Sanderson) ..... xliii, 312
„ two fibromata removed by intra-peritoneal (H. Macnaughton-
Jones) . . . . . . xxxix, 321
intraperitoneal, large multiple fibro-myoma removed by (A. D.
Leith Napier) xixiv, 159
106 HYSTERECTOMY.
HYSTERECTOMY (continued)—
„ intra-peritoneal, abdominal, uterus wdtli submucous and
interstitial myoma removed by (W. Duncan) . . xxxix, 290
„ — for removal of uterine fibroids (W. Duncan) . . xliii, 76
„ — in a case of contracted pelvis, uterus removed at full term
by (W. Duncan) ..... xliii, 9
„ Csesarean, three cases of Porro's operation, with intra-peri-
toneal treatment of the stump (H. E. Spencer) . xxxvlii, 389
„ Porro-Cgesarean, with retro-peritoneal treatment of the stump
in a. case of fibroids obstrvicting labour ; with remarks upon
the relative advantages of the modern Porro operation over
the Sanger-Csesarean in most other cases requiring abdomi-
nal section (Amand Eouth) .... xlii, 244
„ puerperal, uterus from a case of Porro's operation with intra-
peritoneal treatment of the stump (W. J. Gow) . . xxxix, 7
„ abdominal, sub-total, for removal of an intra-ligamentous,
fibro-cystic tvunour of the uterus weighing about 30 lbs. (T.
W. Eden and F. L. Provis) .... xlviii, 264
„ sub-total after-histories of sixty cases (A. Doran) . . xlvii, 363
„ supra-vaginal, monster of seventh month removed by (H.
Macnaughton-Jones) . . . . . xlvii, 302
„ vaginal, two uteri removed by (A. L. Galabin) . . xxix, 300
„ — for cancer (W. S. Playfair) .... xxxi, 227
„ — four cases of, for cancer (C. J. Cullingworth) . xxxii, 136, 141, 174
„ — vaginal, note supplementary to a paper read before the
Society on April 2nd, 1890, giving the subsequent history of
the cases (C. J. Cullingworth) .... xxxv, 25
„ — for removal of cancerous uterus (W. Duncan) . . xxvi, 27
„ — for cancer of cervix extending into body of uterus (G. E.
Herman) ...... xxxii, 137
„ supposed recxu-rence after (C. Hubert Roberts) . xlix, 114
„ — cancerous uterus removed by (P. Horrocks) . . xxxiv, 85
„ — for removal of cancerous uterus and parovarian cyst (A.
Routh) ..... xxxvii, 8
„ — cancerous uterus removed by (Amand Routh) . . xxxiv, 87
„ (R. T. Eutherfoord) .... xxxiii, 28
„ — two uteri removed by, for cancer of the cervix, the disease
being apparently at the same stage in each (A. H. N. Lewers)
xxxviii, 164
„ — for carcinoma of the corpus uteri invading a myoma (J. M.
Munro Kerr) ..... xlvii, 191
„ — carcinoma of the cervix complicating labour at term ;
Caesarean section followed by (J. M. Munro Kerr) . xlvii, 194
„ — in a case of primary carcinoma of the body of the uterus
(A. H. N". Lewers) ..... xxxvi, 374
„ — removal of three months' gravid uterus for squamous epi-
thelioma of cervix by (W. Duncan) . . . xliv, 297
„ — after removal of large fibro-myoma of the cervix by enuclea-
tion (W. W. H. Tate) ..... xlii, 161
„ — for inversion (J. A. M. Moullin) . . . xxvi, 158
„ — in a case of irreducible inverted uterus with a fibro-myoma
(P. Horrocks) .... xxx, 196, 228
„ — for malignant disease (F. A. Purcell) . . . xxvii, 5
„ — for primary malignant disease of the body (A. H. N.
-Lewers) ..... xxviii, 67, 206
,, — recovery in villous tximour of the liody of the utei'us in a
woman, aged 84 (J. Bland-Sutton) . . . xlix, 46
HYSTERECTOMY — IMPREGNATION.
107
HYSTERECTOMY (continued) —
„ vaginal, for procidentia (E. Malins) . . . xxvi, 148
„ — sarcoma of the uterus removed by (W. J. Gow) . . xxxii, 374
„ — for removal of sarcomatous tissue (W. E. Dakin) . . xxxii, 139
„ — case of primary sarcoma of the body of the uterus (" de-
ciduoma malignum ") in a patient, aged 24, treated by (A.
H. N. Lewers) ..... xxxix, 246
„ — in the puerperium for sepsis due to suppuration of myoma
(A. W. W. Lea) ..... xlvii, 1
„ — for primary tuberculosis of the cervix simulating cancer
(A. H. N. Lewers) ..... xliv, 144
„ — for primary tuberculosis of the cervix uteri (W. H. B. Brook) xlv, 185
„ — for removal of uterus, showing nodule of chorio-epi-
thelioma (F. W. N. Haultain) .... xlv, 242
„ — — fourteen days after the operation of curetting and
steaming had been performed (G F. Blacker) . . xlv, 80
„ see Extirpation, Porro's operation.
HYSTERIA, excision of the clitoris as a cure for (T. H. Tanner) . viii, 360
„ simulating in the most perfect degree natural labour (E.
Hodges) ...... i, 339
HYSTEROPEXY, two uteri with "fundal ligament" after (F. E.
Taylor) ...... xlix, 265
HYSTEROTOME, new (J. H. Aveling) ... vii, 155
HYSTEROTOMY, anterior, and anterior vaginal coeliotomy and
replacement, with recovery, for complete inversion of seven
months' duration after failure of elastic pressure with
repositors (J. W. Taylor) .... xliv, 299
„ grappling iron for use in (Heywood Smith) . . xxii, 45
„ for removal of soft myoma of the uterus (J. H. Aveling) . xxvi, 270
ICTERUS NEONATORUM (A. W. Sikes)
IDIOCY, two cases of (A. Wiltshire)
„ in children, strong mental emotion diu'ing pregnancy as a
cause of (Sir A. Mitchell) .... xxvi, 124
„ the obstetrical aspects of (J. L. Down) . . . xviii, 296
Ilott (H. J.), foetus papyraceus . . -. xxxvii, 7, 16
IMPACTION and rotation of a myomatous uterus (J. Bland-
Sutton) ......
IMPERFORATE anus, in which the child lived upwards of ten
weeks without relief from the bowel after two unsuccessful
operations (W. F. Cleveland) ....
„ anus, etc., congenital absence of nose, right palpebral fissure,
and right ear (W. Duncan)
, bowel ; operation ; death (A. Meadows)
, hymen, case of so-called (J. Matthews Duncan)
, — with retained menstrual fluid (E. Copeman)
, rectum ; attempt at relief by operation ; death (W. T. Fox)
— two cases of (P. Horrocks)
, — and congenital prolapse of the titerus (H. E. Andrews)
, vagina, congenital, four cases, and one case of congenital
phimosis occurring in the same family (H. Madge)
IMPREGNATION, effects of lactation on menstruation and
(Leonard Eemfry) .... xxxviii 22
xliv, 369
xviii, 280
xli, 296
i.x, 203
xxxvii, 16
vii, 53
xxiv, 212
X, 246
iv, 195
xxvii, 135
xlii, 169
xi, 2]3
108
IMPREGNATION — INFANT.
IMPREGNATION (continued)—
„ two cases involving the question of the site of (H. Cripps and
H. Williamson) ..... xlvi, 89
INCANDESCENT CARBON LAMP, modification of Swan's, for
gynaecological examinations and operations (J. H. Aveling) . xxiv, 301
INCARCERATION of the retro-displaced gravid uterus in three
cases, and one of extra- uterine pregnancy simulating that
condition (J. M. Munro Kerr) .... xlii, 146
INCISION, vaginal, for extraction of the foetus in a case of ectopic
(intra-ligamentous) gestation at the seventh month (A.
Donald) ...... xli, 7
INCONTINENCE OF URINE, complete, cured by ventro-fixation
of the uterus (H. Macnaughton-Jones) . . . xl, 226
INCUBATOR, Auvard's (J. Matthews Duncan) . . xxvi, 25
INDUCED CURRENT during parturition, on the benefits derived
from (W. Kilner) ..... xxvi, 1)3
INDUCTION of abortion as a therapeutic measvire (Sir W. O.
Priestley) . . . . . . xxii, 271
„ — performed in a patient labouring under cancerous disease
of the uterus and rectum ; with observations upon the justi-
fiability of the operation in such cases and the best mode of
performing it (F. AV. Mackenzie) . . . i, 11
,, of premature labour in a case of distorted pelvis (J. H.
Trouncer) . . . . . . i, 236
„ — indications and opei-ations for (R. Barnes) . . iii, 107
„ — on the methods adopted by Keiller and others for the
(J. Watt Black) ..... xxxv, 95
„ of miscarriage of premature labour, a simple maieutic for
(Peter Horrocks) .... xxxviii, 168
INDURATION, diffused subcutaneous, in an infant (A. L. Smith) xli, 103
INFANT, anatomy of, presenting some rare deformities (C.
Singer) ...... xlvii, 250
„ newly born, cases of cholera in (J. C. Lucas) . . xxi, 250
„ remarkable development of (Dr. Cameron) . . xviii, 115
„ distension of vagina and utervxs with muco-puriform fluid in
an (W. McAdam Eccles) .... xxxiv, 250
„ of doiibtful sex (W. F. Cleveland) . . . ix, 29
„ sagittal fontanelle in the heads of, at birth (A. W. W. Lea) . xl, 263
„ food (C. H. F. Routh) . . . . . ix, 29
„ newly born, case of hsematemesis in (H. C. Hodges) . xxxi, 365
„ — acute contagious pemphigus in (G. J. Maguire) . xlv, 429
„ hfemorrhage from the uterine mucoixs membrane of (C. H.
James) ...... xxxii, 06
„ diffused subcutaneous induration in (A. L. Smith) . . xli, 103
„ suffering from uterine haemorrhage, mucous membrane of
the uterus of (S. W. Wheaton) . . . xxxiv, 190
„ Mortality Committee, report of . . . . xi, 132
„ — concluding report ..... xii, 388
„ new-born, mammary gland of (C. N. Longridge) . . xlix, 273
„ still-born, dilated ui-eters in (C. N. Longridge) . . xlix, 215
„ — rupture of heart in (C. N. Longridge) . . xlix, 214
„ iiitra-uterine peritonitis in an (D. C. McCallum) . . xviii, 116
„ wdth prolapse of Meckel's diverticulum, forming an umbilical
tumour (S. W. Wheaton) .... xxxiv, 184
INFANT — INSTRUMENTS. 109
INFANT (continued)—
" luZfl^'^^ ""^ *^^ 'i^^'^"' '"^ ^ new-born (Herbert K. Spencer) xxxiv, 25
„ rules for the general management of . xii 395
„ fatal ruptiu-e of an ovarian cyst in an (Alban DoraA) " xxxiv 24.
„ syphilis in (T. H. Tanner) . . ^ " ]' .It
„ with marks and boy with webbed fingers (A. Wiltshire) ." xii^ 329
INFECTION^^chronic septic, of the uterus and its appendages
„ puerperal, investigation into the causation of (A G e' '
Foulerton and V. Bonney) . . v • • . ^^^_^
„ secondary, of the perivascular lymphatics of the uterine wall'
to bilateral primary tuberculous salpingitis (C. Lockyer) .' xlix 141
„ of the cyst five days after labour in ovarian cystoma com-
phcatmg pregnancy (H. Macnaughton-Jones) . . xlii, 140
INFECTIVE DISEASES and pyajmia, discussion on the relation of
puerperal fever to the . . . ^^ji, 90, 131, 178, 217
INFLAMMATION of the breast and milk abscess ; with analysis
ot 72 cases (T. W. Nunn) . , ■■•107
" ''JjoJ'a^jjf ^^^^P'^^ *^^®' °" closure of the ostium in (Alban '"'
„ of lupus of the pudendum (J. Matthews Duncan) \ ' xxvli' ^to
„ three cases of pelvic, attended with abscess of the ovary
with clinical remarks (C. J. CuUingworth) xxxvi 2'-7
„ uterine, diagnosis of the least known varieties of (E. J. Tilt)' xiii' iqv
„ chronic papiUary, of the vulva (Sir W. O. Priestley) . xxvi 156
INFLUENZA POISON, note on the effect of the, upon the lying-in
woman(A.W.Addinsell) . . ^ . ^ ^ . xxxv, 333
INHALER for chloroform alone or with alcohol or ether CH W
Liddard) . . , v • •
xvi.
INHIBITION OF THE UTERUS (J. Matthews Duncan) . xxviii, 91
INJECTION of saHne fluid, transfusion bottle, etc., for (H. E.
„ intra-venoiis, of saline ' solution ' in cases' of ^evQve h^mor^ ''''''^''^^^
rhage (P. Horrocks) .
„ vaginal, simple instrument for (A. Easch)* * ' ^^^^{ \^^
INJECTION TUBE, glass (E. Barnes) . ." - ' ^^^.' 233
INJURY, intra-uterine, on the head of a new-born child CW O
Jrriestley) . . _ ^ ' ' .
INSANITY in a case of deficient development of the uterus
DoraT) °^ externum, and atrophy of the ovaries {k.
" ^T'^%''\' ,T%\f'r. '^ *^^ Montreal University ' Lying-in '''''' ^^^
Hospital (D. C. McCalhun) . j j g m
„ — (Eobert Jones) . . .' ' " ^^^' ^6
INSERTIO VELAMENTOSA, placenta to which the lunbilical
vessels were peculiarly distributed (C. Godson) . xx 3'M
„ specimen of (G. M. Bluett) ^ • xx, d 4
' * ' • . xxix, oil
INSTRUMENTS, aseptic (P. Horrocks) . ^^^:' 4.^
" (N Bozem^nf ""^ ""^ ^*'''''''' ^^^'""^ ^""^ vesico-vaginal fistula
„ for dividing funis (H. Smith) .' ' ' * ^v SR
„ blunt-pointed hook, crooked trephine, cranioclast (C. Braun) xv, 58
no
INSTRUMENTS — J AGER .
INSTRUMENTS {continued)—
„ pocket, set contained within an ordinary cylindrical speculum
(C. Godson) ...... xxi,
„ received from J. Lazare witch (A. Meadows) . . xi,.
INSUFFLATOR, vaginal and uterine (H. Macnaughton-Jones) xxxvii.
INTERMENSTRUAL PAIN (Mittelschmerz) (A. W. Addinsell) .
INTESTINE, large, uterus and appendages connected by adhe-
sions to (T. C. Hayes) .....
„ supposed invagination of, in a child (T. Ballard)
„ complete obliteration of the canal of the small, by foetal peri-
tonitis (R. Druitt) .....
„ death from obstruction of (J. Knowsley Thornton) .
„ chronic obstruction of, caused by an unusual case of tubal
gestation (A. E. Giles and E. J. Maclean)
„ double obstruction of, following ovariotomy (J. H. Targett) .
„ three cases of obstruction of, following ojjerations for fibroid
tumour of uterus, with special reference to the choice of
operation (W. W. H. Tate) ....
„ small, taken from an infant (G. Roper)
^^ — loop of, found adherent to the pedicle six months after
ovariotomy (H. J. Paterson) ....
„ volvulus in a fcotiis (K. D. Maxwell)
INTRA-MURAL TUMOURS, see Tumours.
INTUSSUSCEPTION, ileo-csecal, in an infant of eight months
(H. M. Madge) .....
INVAGINATION, supposed, of the intestine in a child aged 20
months successfully treated (T. Ballard)
INVOLUTION OF THE UTERUS in the absence of the ovaries
(John Williams) ....
„ the effect of ergot on (G. E. Herman and C. O. Fowler)
IRON, the administration of, during pregnancy as a preventive
of post-partum haemorrhage (J. Bassett)
„ apparatus for injecting, in post-partum haemorrhage (W. F
Cleveland) .....
„ perchloride of, case of use of saturated solution of, in post-
pai'tum haemorrhage (G. E. Herman)
„ — intra-uterine injection of, for post-partum haemorrhage
(H. Smith) .....
„ — or iodine, tubes for injection of, into uterus (F. Barnes)
„ — injection, in a case of severe uterine haemorrhage (R. Cory)
„ sesquichloride of, in puerperal fever complicated with diph-
theria (R. Druitt) .....
„ salts in anaemia complicated with pregnancy (W. B
"Woodman) ......
IRRIGATION, antiseptic, in childbed, instruments for (Graily
Hewitt) ......
„ sublimate, mercuriaUsm in lying-in women vmdergoing (W.
R. Dakin) ....
IRRIGATOR, marine vaginal (H. Smith)
90
78
81
.xl, 137
xvii, 45
i, 137
ii, 135
xxi, 163
xxxix, 232
xl, 175
xlvi, 391
XX, 35
xlvii, 316
xlviii, 277
xvi, 219
i, 137
xxvi, 203
XXX, 85
xvi, 111
xi, 242
XX, 2
XV, 44, 65
XX,
xxi.
60
51
iii, 30
xii, 33
xxxi, 202
. xxviii, 281
xiii, 190
Jackson (J.), midwifery in the East
„ see Spencer, Heriert R.
Jager (Harold), see Phillips, John.
ii, 37
JALLAND — KERR. HI
Jalland (R.), vaginal thrombus • . . , xiv 43
James (C.H.), uterus and appendages of an infant; haemorrhao-e
from the uterine mucous membrane . . ° . xxxii, 66
James (W. Culver), anencephaloid monster . . . xxii 241
Jastreboff (N. W.), on the normal and pathological anatomy
of the ganglion cervicale uteri .... xxiii 266
Jay (F. F.), double monstrosity . . . . vi' 22''
JEJUNUM and ovaries (Wm. Dimcan) . . . xxx' 82
Jennings (C. E.), new cephalotribe . . . xxiv' 238
„ transfusion apparatus . . . . ] ^^j^j^' j^g
Jbssop (Thomas E.), case of extra-uterine gestation ; removal of
living foetus by abdominal section ; recovery of both mother
^^d'^^^ld xviii,261
Johnson (David), deformed foetus, with placenta adherent to
it, intestines uncovered and presenting, with description of
the delivery ^-^^^ 53
JOINTS, enormous enlargement of, in an infant aged five months
(A.Wiltshire) . . . _ . xx, 84
Jones (Edward), anencephalous foetus with spina bifida . xi' 209
Jones (H. Macnaughton), case of central choroido-retinitis oc-
curring after labour and post-partum htemorrhage . xxxii 134
„ vaginal and uterine polyptome . . xxxvii' 80
„ vaginal and uterine insufflator . . * xxxvii' 81
„ vaginal and uterine stem . .' ' xxxvii' 80
„ self-retaining glass retractors . . '. xxxviii' 345
„ note on the aetiology of eclampsia . . xxxix' l'>
„ case of double pyosalpinx with enlarged bladder and second- ' '
ary renal complication . . , xxxix 319
„ two fibromata removed by intra-peritoneal hysterectomy ". xxxix', 321
Jones (Lewis), see Galabin, A. L.
Jones (Robert), puerperal insanity . , , xlv *>
Jones (Sydney), for Lawson Tait, tubal foetatioa removed bv
abdominal section . . -^ ^._ • <,-,«
-J. • • . XXVl, Zoo
JONES (1. Eyton), vesico-vagiual and recto- vaginal fistula . xv,185
Jordan (W. Ross), foetus and placenta in extra-uterine foetation xv' 124
„ extra-uterine pregnancy ; gastrotomy successfully performed xv' 130
„ on a new pessary and intra-uterine stem for the relief of
flexions and displacements of the uterus . . xvi, 125
Junker (F. E.), instrument for local applications to uterus . xii,' 244
^^"fffiWs^"''^' ^'^^^^'^y ^""^ "^^^^'^ °f *^^o acardiac acephalic
.Kelson (W. H.) (introduced by Alban Doran), acardiacus
acephalus . ••• ..^^
' ■ • . xxxiii 195
Kerr (J M. Munro), three cases of incarceration of the retro-
displaced gravid uterus, and one of extra-uterine pregnancy
simulating that condition . ^ " "^ .■■ j.^.
„ dermoid cyst of ovary obstructing labour; displacement of
the tumour from the true pelvis and extraction of the child
with forceps ; removal of tumour five weeks later ; recovery xliii 145
112
KEEE — KURZ NEEDLE-HOLDER.
Kerr (J. M. Munro) {continued) —
„ small fibroma uteri showing sarcomatous changes . xliv, 129
„ fibro-myoma of the vagina .... xliv, 130
„ chorion-epithelioma ..... xlv, 244
„ certain details regarding the operation of Csesarean section in
cases of contracted pelvis, based upon a series of thirty-
cases ...... xlvi, 309
„ carcinoma of the corpus uteri invading a myoma; hys-
terectomy ...... xlvii, 191
„ carcinoma of the cervix complicating labour at term ;
Caesarean section, followed by vaginal hysterectomy . xlvii, 194
Kbsteven (W. H.), see Barnes, Boiert.
KiDD (Charles), value of anaesthetic aids in midwifery . ii, 340
„ fui-ther obsex'vations on the use of anaesthetics in midwifery v, 125
KiDD (George), remarks in the discussion on the use of forceps xxi, 141
KiDD (G. II.), cephalotribe .... xii, 1
KIDNEYS (G. C. P. Murray) .... viii, 5
KIDlfEY, accessory adrenal bodies in the broad ligaments (J. H.
Targett) . . . . . . xxxix, 157
„ adrenal tviraoui' of, malignant vaginal polypus secondary to
(A. Doran) ...... xlix, 182
„ chorio-epithelioma with secondary growths in (C. Lockyer) . xlv, 245
„ fa;tal cystic disease of (H. Gervis) . . . xx, 84
„ from a case of eclampsia (L. Cutler) . . . xxxvi, 176
„ function of, in a case of eclampsia of pregnancy (G. E.
Herman) ...... xxix, 517
„ hydronephrosis of the left (J. Sidney Turner) . xxxviii, 103
„ microscopical sections of, from a fatal case of puerperal
eclampsia (H. E. Andrews) .... xliii, 114
,, pelvis of, and ureters in an infant, distension of (H. Gervis) . vi, 221
„ fatal wasting of, in a case of prolapsus uteri (J. J. Phillips) . xii, 276
„ double pyosalpinx with enlarged bladder and secondary
complication of (H. Macnaughton-Jones) . . xxxix, 319
„ uterus and rectum from a woman who died of uraemia (Wm.
Duncan) . . . . . • xxxi, 255
„ and ureters with uterus, from a case of Caesarean section (Wm.
Duncan) ...... xxxiv, 127
„ — congenital absence of (A. E. Giles) . . . xxxiv, 129
„ solitary, with two ureters (J. Braxton Hicks) . . xxi, 57
KiLNER (Walter), upon the benefits derived from the induced
current during parturition ....
KING'S COLLEGE HOSPITAL, history of the Florence Nightingale
Lying-in Ward (C. C. Eowling) ....
Knaggs (E. Lawford), an unusual case of haematosalpinx [recur-
x*ent haematosalpinx] .....
KNITTING-NEEDLE used to procure abortion (W. Duncan)
KNOT ON FUNIS in a case in which the fcetvis was born dead
(W. Sankey) ......
KoNRAD (Mark), prolapsus of the female genital organs
KYPHOTIC PELVIS, description of a, with remarks on Breisky's
description (F. H. Champneys) .... xxiv, 242
XXV, 166 ; xxviii, 253
. xlv, 51
xxvi, 93
X, 50
xxxv, 213
xxxiv, 223
iii, 418
xiii, 251
„ the obstetrics of (F. H. Champneys)
KURZ NEEDLE-HOLDER (H. E. Spencer)
LABIA MTNOEA — LAWRENCE. 113
LABIA MINORA, cysts from (A. Wiltshire) . . . xxiii, 206
LABIUM, adenoma of (H. Williamson) . , . xlviii, 235
„ angioma of (J. Matthews Duncan) . .' .' xrvi,' 118
„ fibro-cellular tumour of (J. B. Potter) . . .' xxvi' 228
„ hypertrophy of (A. Meadows) . . . .' 'viii'257
„ lipoma removed from the left (C. H. Carter) . * xxxii,' 6
LABIUM MA JUS, fibroid tissue formed around a needle and
removed from the left (H. Briggs) . . . xlix, 223
„ — molluscum fibrosum of (A. E. Giles) . . . xxxix,' 231
» — myxoma of (M. Handfield-Jones) . . ". xlvii', 362
LABOUR, see Parturition.
LACERATION of the cervix, histological results of (A. L. Galabin) xxiv, 53
„ of the integument of the foetus occurring during delivery
(E. K. Peirce) • • . . . vii, 74
„ of the uterus (T. Radford) • . . , viii] 150
„ of the vagina in labour (J. Matthews Duncan) . . xxxi,' 236
LACTATION, effects of, on menstruation and impregnation
(L. Remfry) ..... xxxviii, 22
LALLEMAND'S PORTE-CAUSTIQUE, modification of (R. Barnes) xiii, 96
LAMBS, notes on "navel-ill" in (J. Hutchinson) . . xviii, 88
LAMINARIA spiralis, uterine tent (R. Greenhalgh) . . vii, 72
„ tents, the use of (W. Sinclair) . . . . xlviii' 185
LAMP, modification of Swan's incandescent carbon, for gynaeco-
logical examinations and operations (J. H. Aveling) . xxiv, 304
Lane (W. Arbtjthnot), what are the chief factors which deter-
mine the differences which exist in the form of the male and
female pelves? ..... xxix, 351
Langmoke (J. C), twin (?) abortion . . . . iv 133
„ — report on (G. Harley and T. H. Tanner) ." .* iv^ 155
Langstox (Thomas), monstrosity . . . . x 37
LAPAROTOMY, primary, in cases of extra-uterine gestation (F H
Champneys) • ^ -^ . • • . ' .' xxix, 456
„ m a case ot repeated ectopic gestation in the same patient
(A. H. N. Leavers) ..... ^jjj 324
„ removal of uterine fibroids by (J. Knowsley Thornton) *. xxii' 114
„ fcetiis and placenta removed by (W. Duncan) . [ xxxvi' 146
„ calcified tumour of uncertain origin removed by, from
Douglas' pouch (A. H. N. Lewers) . . ' . xlvii, 151
„ immediate, in a case of ovarian tumour (W, Duncan) ,' xxxvi' 312
„ see Abdominal section. ' ' "
LARYNX, cyst of the, removed post mortem from an infant (A. W
Edis) . ■ .,^^-- n
La WHENCE (Atjst), placenta with unusual arrangement of vessels xviii 118
„ uterus and appendages of a woman who died from rupture of
the right Fallopian tube ... xx 292
„ extra-uterine fcetation .... * ^xx' 122
„ — report by committee (Alban Doran, G. E. Herman and
F. H. Champneys) . . . . ' xxx 302
„ vesical calculi from a case of procidentia . xx.v' 227
„ sponge-tents .... ' xxxi' 333
„ cystic disease of the chorion . . * xxxii' 64
„ polypoid myoma of the uterus . . ' xxxii' 366
„ vesical calculi. . . . ". xxxiii 366
8
114
LAWRENCE LEA.
Lawrkncb (Aust) (continued) —
„ cast of a large vesical calculus .... xxxii, 366
„ note on the operation for restoring the perineal body in com-
plete rupture of the female perineum . . . xxxii, 377
„ ruptured tubal pregnancy .... xxxiv, 439
Lawrence (T. W. P.), redescription of the specimen of spondylo-
lithesis in the museum of University College . . xlii, 75
„ and G. F. Blacker, case of true unilateral hermaphroditism
wdth ovotestis occurring in man, vnth a summary and
criticism of the recorded cases of true hermaphroditism xxxviii, 265
LAWS of the Society, alteration of, respecting the Board for the
Examination of Midwives . . . xxvi, 23 ; xxvii, 58
— on the mode of election of ordinary Fellows
— respecting the eligibility of medical practitioners to the
Fellowship of the Society
xxii, 50 ;
xxii.
4
84
58
XXI,
xxix,
. xxvii,
. xxxii, 106
. xxvii, 59
xix, 16 ; xxxii, 106
xli, 48 ; xliii, 33
— respecting the ordinary meetings
, — respecting the officers of the Society
, — respecting the Society's property
, — respecting the Referees
, — respecting the duties of the Trustees
, respecting contributions of Fellows
respecting election of Fellows and papers read before the
Society ...... xliv, 51
respecting election of Officers and Council xxxvii, 288 ; xxxix, 53
— contributions of Fellows and papers read before the
Society ..... xlvi, 64, 65
Lawton (Fred.), vascular (erectile) tumour in the sheath of the
funis in a new-born infant .... vii, 210
„ — microscopical examination of the above by Dr. J. B. Hicks vii, 213
Lazarbwitch (J.), ind\iction of premature labour by injection
to the fundus of the uterus . . . . ix, 161
„ puerperal convulsions in the ninth month of pregnancy;
accouchement force ; expansion of cervix by Barnes' dilators
and incision ; delivei-y of foetus with parallel forceps ; child
stillborn ; recovery ....
„ new constrictor for removal of tumours of the uterus
„ the blunt hook of, considerably modified .
„ see Meado^vs, A.
Lea (A. W. W.), parovarian cyst with acute axial rotation
„ microscopic sections of uterine mucous membrane .
„ the sagittal fontanelle in the heads of infants at birth
„ tumour expelled from the uteriis during natural labour
„ hsematosalpinx in a chronically inflamed Fallopian tube
„ myxo-sarcoma of the vagina in a child aged two and a half
years .....
„ sarcoma of uterus ....
„ adeno-carcinoma of both ovaries .
„ tubercular disease of the Fallopian tubes and ovaries
„ abscess of the uterus developing during the puerperium
rupture into the peritoneal cavity; abdominal section
recovery ...... xlvi,
„ vaginal hysterectomy in the puerperium for sepsis due to
suppuration of myoma .... xlvii,
„ see Griffi^th, W. S. A.
XV,
59
XV,
63
xviii.
190
xxxix,
8
xxxix,
322
xl.
263
xli.
2
xli,
140
xlii.
143
xliii.
73
xliv.
225
xlv.
133
J
LEAD-POISONING — LEWERS.
115
viii, 41
xxvi, 193
xli, 276
xlvii, 108
xlvii, 271
xlvii, 321
V, 198
xvii, 101
xxiii, 131
xxxix, 87
xxxix, 125
XX, 123
xliii, 234
xiii, 213
xxvii, 298
lEAD-POISONING, influence of, in producing abortion and manor
rhagia (B. Baker) ....
Lediard (H. a.), fibro-cystic myoma of uterus ; septicaemia
„ secondary abdominal pregnancy ; septic peritonitis ; evacua
tion per rectum ; recovery
„ see Duncan, J. Matthews.
,, see Duncan, William.
Leicester (J. C. Holdich), chyluria with pregnancy .
,, eclampsia; septic peritonitis ; splenic abscess; death on six-
teenth day after delivery
„ ectopic gestation which apparently ruptured twice .
Lbishman (W.), associated hydrocephalus and spina bifida
„ remarks in the discussion on puerperal fever
LEITER'S TEMPERATURE REGULATOR (C. Godson) .
LETTER OF CONDOLENCE on the death of Sir Thomas Spencer
Wells from the " Gesellschaf t f iir Geburtshiilf e und Gyna
kologie in Berlin " .
„ reply .....
LEUKiEMIA associated with myxoma of both ovaries (A, L
Galabin) .....
„ and pregnancy (G. E. Herman) .
LEVER, Dr. Boddaert's (R. Barnes) .
Lewers (A. H. N.), double pyosalpinx with rupture of the tubes
„ uterus removed entire for primary malignant disease of the
body . . . . . . xxviii, 67
„ — microscopic sections of ditto .... xxviii 206
„ case of circumscribed sarcoma of the vagina and uterus . xxviii' 78
„ foetus from a ruptui-ed tubal fcetation . . . xxviii^ 207
„ on the frequency of pathological conditions of the Fallopian
tubes ......
„ fibroid tumours of the vagina ....
„ note on the post-mortem appearances of a phlegmon of the
broad ligament .
„ carcinomatous cervix removed (with a portion of the peri-
toneum forming Douglas' pouch) by supra- vaginal amputa-
tion, from a patient in whom abortion had been induced
at the fourth month .....
„ case of extirpation of the uterus for primary carcinoma of the
body ••-...
„ case of kipus of the vulva ....
„ three specimens showing removal of cervix uteri for malig-
nant disease ......
„ on plugging the uterus in severe cases of post-partum hsemor-
rhage, with notes of a successful case . . . xxxii, 356
„ endometritis polyposa with blighted ovum . . xxxiii, 197
„ microscopic specimens of cervix uteri removed by supra-
vaginal amputation for cancer .... xxxiii, 301
„ six cases of craniotomy, with remarks on the relative position
of craniotomy and Csesarean section
„ cancer of the body of the uterus ....
„ papillomatous ovarian cyst ....
„ case of symphysiotomy .....
„ fibro-cystic tumour of the uterus removed by abdominal
xxix, 199
xxix, 299
XXX, 7
XXX, 81
XXX, 218
xxxi, 326
xxxii, 136
xxxiv, 161
xxxiv, 213
xxxiv, 462
XXXV, 408
section
xxxvi, 270
116
LEWERS.
374
78
151
Lewers (A. H. N.) {contimied) —
„ Si, case of primary carcinoma of the body of the uterus in
which vaginal hysterectomy was performed, and more than
two years have elapsed without recurrence ; with a table of
five other cases of vaginal hysterectomy for cancer of the
body of the uterus .....
„ tubal mole removed by abdominal section . . xxxvii,
„ tubal gestation of thi'ee months operated on before ruptiu*e xxxvii,
„ specimens of cervix uteri removed by the supra-vaginal am-
putation for cancer .... xxxvii, 201
„ cancerous uterus with pyometra . . . xxxviii, 14
„ chorionic villi from a tubal mole removed by abdominal
section ..... xxxviii, 106
„ defoi'med foetus with cystic tumour of neck . xxxviii, 106
„ two uteri removed by vaginal hysterectomy for cancer of the
cervix, the disease being apparently at the same stage in
each ..... xxxviii, 164-
„ case of double uterus with double hsematometra and complete
absence of the vagina .... xxxviii, 327
„ monster, with skiagraph . . . . xxxix, 131
„ uterus removed by pan-hysterectomy . . . xxxix, 131
„ ruptured tubal pregnancy with hssmatosalpinx of opposite
side ......
„ primary sarcoma of the body of the uterus ("deciduoma
maUgnum ") in a patient twenty-four years of age, treated by
vaginal hysterectomy .....
„ primary sarcoma of the body of the uterus (deciduoma
malignum) ......
„ large solitary subperitoneal fibroid tumour of the uterus, and
litems with multiple fibroids ....
„ three uteri removed by pan-hysterectomy .
„ persistent mento-posterior position of the face, in which the
child was delivered alive by the axis-traction forceps
„ uterus with fibroid tumour vindergoing mucoid change, suc-
cessfully removed by abdominal hysterectomy with intra-
peritoneal treatment of the stump
„ ruptured uterus with dermoid ovarian cyst the size of a
child's head ......
„ repeated ectopic gestation in the same patient ; laparotomy
on each occasion .....
„ uterus with squamous epithelioma of cervix; removed in
1895 ; no recurrence in 1901 ....
„ two uteri removed by abdominal pan-hysterectomy for cancer
of the body ......
„ primary tubercixlosis of the cervix simulating cancer, and
treated by vaginal hysterectomy
„ cancer of the cervix from eight cases treated by the supra-
vaginal amputation, in which from four to fifteen years had
elapsed without recurrence ....
„ uterus removed by abdominal pan-hysterectomy for primary
carcinoma of the body ....
„ pyosalpinx with twisted pedicle ....
„ fibroid of the broad ligament weighing four and a half
pounds, with twisted pedicle ....
„ keratinising carcinoma of the body of the uterus
„ deciduoma malignum .....
„ ttibal mole complicating carcinoma of the cervix . .
xxxix, 189
xxxix, 246
xl, 225
xl, 327
xli, 275
xli, 280
xlii, 94
xlii, 95
xlii, 324
xliii, 266
xlivs 10
xliv, 144
xlix, 221
xliv, 290
xliv, 362
xliv, 364
xlv, 97
xlv, 245
xlv, 335
xvii, 66
LEWEES LITTLEWOOD. 117
Lewers (A. H. N.) (^continued)—
„ repeated ectopic gestation in the same patient . xlv 418
„ litems with carcinoma of the body and multiple fibroids ' xlvi' 266
„ pregnancy m a rudimentary uterine cornu . ' xlvii' 111
„ calcified tumour of uncertain origin removed by laparotomy
from Douglas' pouch ...."' xlvii 151
„ fibro-cystic tumour of the uterus, laceration on its surface •
tree mtra-peritoneal haemorrhage . . ' xlvii 261
„ three cases of epithelioma of the vulva, with after-histories '. xlviii' 163
„ two specimens of large uterine fibroids undergoing necro-
biosis or red degeneration . . , xlviii 173
„ tn-o specimens from cases of cancer of the cervix, the patients
remaining free from recurrence twenty and eleven years
respectively after operation . . . xlix 179
„ two specimens of fibroid associated with bleeding after the '
menopause ...... xlix, 270
LiDDARD (H. W.), inhaler for chloroform, alone or in combina-
tion with alcohol or ether . . . ^ xvi 88
LiEBMAN (Charles), clinical notes on the early course of cancer
of the cervix uteri
LIFE appeared to have been saved by antistreptococcic serum in
two cases (G. E. Herman) . . , . xli 346
LIGAMENT, round, of the uterus, fibro-myoma of the intra-abdo-
minal portion of (H. E. Spencer) . . , xlvi 26
„ see Broad Ligament. ' '
LIGATURE, changes in the pedicle of an ovarian tumour when
treated by (G. G. Bantock) . . xiv 2
„ discharged after an abdominal section (W. S. Playfkir) '. xxxiii' 386
„ of the pedicle m ovariotomy (Albau Doran) . xxxv' 131
„ and division of the upper part of both broad ligaments, and
the result as compared with that following removal of the
uterine appendages (L. Eemfry) . . . xxxvi, 202
IIP, epithelioma of, treated by injection of bromine (A W
Williams) . . . . _ ^ • ^jjj^ gy
LIPOMA removed from left labium majus (C. H. Carter) xxjiii' 6
„ of the lumbar region, four pounds in weight, and of twenty
years growth (Alban Doran) . . , \ xxxix, 40
„ retro-peritoneal, Aveighiug thirteen pounds twelve ounces (A
Doran) . t o^^
''••... xliv, 265
LIQUOR AMNII, long delay of labour after discharge of (J M
^^^"^^^) • • . ... xiv, 216
LITHOP^DION (W. J. Potts) . . . xlviii 338
„ so-caUed being a supplement to a paper on so-caUed " missed
labour (E.Barnes) . . . , j,^^-. j^q
„ of fourteen years' duration successfully removed (H C
Bartlett) . . . •; v . • ^^^. ^^
„ retained m patient for sixteen years (W. W. H. Tate) xliv' 95
LITHOTOMY, vaginal (J. H. Aveling) . ' ' v' 1
„ — for stone in the female bladder (I. Baker Brown) " v' 217
„ vesico-vaginal fistula left after, cured by plastic operation
(LawsonTait) . . . . . xviii, 209
LiTTLEwooD (H.)andG. P. Anning, primary ovarian pregnancy,
with rupture fourteen days after last menstruation . xliii, 14
118
LITTLE LOCKYER.
Little (W. J.), influence of abnormal parturition, difficult labour,
prematiu'e birth, and asphyxia neonatorum, on the mental
and physical condition of the child, especially in relation to
deformities ...... iii, 293
LIVER, cancer of, complicating pregnancy (John Phillips) . xxix, 378
„ chorionepithelioma of uterus, with secondary growths in
(G. F. Blacker) . . . " . . xlvi, 55
„ secondary growths of chorionepithelioma malignum in (J. H.
Teacher, for Prof. Sutherland and Dr. Buist) . . xlv, 252
„ congenital hernia (?) of (A. Meadows) . . . ii, 199
„ hydatids of, or connected with (C. J. Cullingvvorth and H. H.
Glutton) ...... xlvi, 254
„ hypertrophy of, in a child nine years old (J. W. J. Oswald) . xviii, 191
LOCHIA, on the (A. E. Giles) .... xxxv, 190
LocKwooD (C. B.), reti'oflexion of an early human embryo asso-
ciated with absence of the spinal medulla and imperfection
of the vertebral column .... xxix, 234
„ obliteration of the central canal of the spinal cord in an early
human embryo ..... xxx, 470
LocoCK (Sir Charles) Baudelocque cephalotribe presented by . vii, 208
„ Honorary President, allusion to the death of . . xvii, 273
LocKYER (Cdthbbrt), multilocular cyst of the oophoron . xlii, 37
„ congenital coelomic cyst .... xliii, 7
„ endometritis exfoliativa .... xliii, 205
„ and A. Doran, sloughing fibroid of the left uterine cornu ;
abnormal relations ..... xliii, 272
„ septicsemic uteri -with bacteriological investigation . xliii, 304
„ chorio-epithelioma with pulmonary metastases . . xliv, 24
„ uterus showing rapidly growing epithelioma of the cervix;
death from recurrence five months after removal . . xliv, 284
„ (with W. S. Handley), solitary interstitial fibroid removed
by abdominal myomectomy .... xlv, 51
„ incomplete tiibal abortion showing intra-mural embedding of
the placenta ...... xlv, 191
„ chorio-epithelioma with secondary growths in vagina, kidney,
pancreas, lungs, and ? lymphatic glands . . . xlv, 245
„ tubal gestation in which the ovum continiied to grow for
about four weeks after rupture, the gestation sac becoming
implanted on the omentum .... xlv, 400
„ uniovular twins ..... xlvi, 191
„ primary carcinoma of both ovaries . . . xlvi, 229
„ carcinoma in the muscular wall of the uterus secondary to
cancer of both ovaries .... xlvi, 302
„ carcinoma of the ovary of unusual type . . . xlvi, 349
„ multilobular papilloma of the urethra . . . xlvii, 122
„ the corpus luteum; compound lutein cystomata found in
association with vesicular mole and chorio-epithelioma . xlvii, 157
„ two cases of imperfectly developed internal generative organs,
the patient in one case being an epileptic subject . . xlviii, 75
„ thi'ee cases of adeno-myoma uteri . . . xlviii, 84
„ report on Amand Eouth's specimen of fibro-myoma uteri . xlix, 3
„ report on the late G. Bagot Ferguson's specimens of chorio-
endothelioma of uterus .... xlix, 60
„ bilateral primary tuberculous salpingitis, with secondary
infection of the perivascular lymphatics of the uterine wall xlix, 141
,, see Malcolm, J. D.
LONGINGS — LYIXG-IN.
119
xlvii,
xlviii,
xlix,
xlix,
xlix,
xlix,
xlvii,
XV,
xi.
353
226
214
215
272
273
316
221
177
xxix, 401
xii, 323
xiv, 283
xxi, 250
LONGINGS of pregnant women (A. E. Giles) . . , xxxv, 242
LoNGRiDGE (C. Nepean), eclampsia, with two special details of
treatment .....
„ sixty-four cases of contracted pelvis
„ loiptiire of the heart in a still-born infant .
„ dilated ureters in still-born infants
„ diaphragmatic hernia in a new-born baby .
„ mammary gland of new-born infant
LOOP of small intestine found adherent to the pedicle six month i
after ovariotomy (H. J. Paterson)
„ saw (J. H. Aveling) ....
„ whalebone, use of, in delivery (J. G. Westmacott) .
Lowe (George), case of atresia of the uterine cervical canal
distension of the utei-us; escape of the menstrual fluid
between the walls of the vagina
„ haemorrhage from retained placenta after abortion, terminat
ing fatally .....
Lowndes (F. W.), statistics of still-births
Lucas (John C), cholera in the newly born .
LUNGS, chorio-epithelioma with secondary growths in (C
Loctyer) .....
„ chorionepithelioma of viterus with secondary growths in
(G. F. Blacker) ....
„ secondary deposits of deciduoma malignum without syncy-
tium in (P. Horrocks) ....
„ showing secondary deposits of deciduoma malignum (F. J
McCann) .....
„ secondary nodule in, in a case of chorionepithelioma malignum
(J. H. Teacher) ....
„ — deposits of sarcoma in (W. S. A. Griffith)
„ notes of a case of malignant disease of the uterus with
numerous deposits in, and death following an abortion (J. D
Malcolm) .....
LUPOUS STRICTURE and atresia of the female urethra (G. E
Herman) .....
LUPUS, histological observations and remarks on (G. Thin)
„ hypertrophy of, of the female generative organs (J. Matthews
Duncanj . . . , ' .
„ inflammations of, of the pu.dendum (J. Matthews Duncan)
„ ulceration of, of the female generative organs, including per-
forations, pits, and excavations (J. Matthews Duncan)
„ of the vulva, case of (A. H. N. Lewers)
LYING-IN, see Childbed, Lying-in Women, Puerperal, Puerperium
„ Hospital (British), puerperal fever in (W. G. Hewitt)
„ — Melbourne, Australia, short account of (E,. T. Tracy)
„ — (Military) at Woolwich, account of (P. E. Hogg)
„ — University, Montreal, report of the (D. C. MacCallum)
„ hospitals, the mortality in (A. L. Galabin)
„ — in the north of Eixrope, notes of a visit to some, and on the
advantages of the antiseptic system in obstetric practice
(Sir W. O. Priestley) ..... xxvii,
„ Ward of the Cincinnati Hospital, mortality in (G. Menden-
hall) ...... xii,
„ — (Florence Nightingale), King's College Hospital, history
of (C. C. Eowling) . . . . . x.
xlv,
xlvi,
xlv,
xlv,
xlv,
xxviii.
245
55
243
24S
253
38
xxxviii, 125
xxvui,
xxvii.
xxvii,
xxvii.
XX,
xxxi.
267
315
230
310
139
326
69
349
35
35
92
197
357
50
120
LYING-IN — MCILROY.
LYING-IN {continued) —
„ woman, note on the effect of the influenza poison upon the
(A. W. Addinsell) ..... xxxv, 333
„ women, broncho-pneumonia of (R. Barnes) . . iv, . 55
„ — mercurialism in, undergoing sublimate irrigation (W. R.
Dakin) ...... xxviii, 281
„ — the conditions which favour mercurialism in, with sugges-
tions for its prevention (K. Boxall) . . . xxx, 304
„ — thrombosis and embolia of (R. Barnes) . . iv, 30
LYMPHANGITIS mammae : an affection of the breast arising
about the tenth day of the puerperium with well-marked
clinical features (R. H. Vincent) . . . xliv, 158
„ in i^elvic pathology (E. J. Tilt) .... xvi, 130
LYMPHATICS of the uterus, the comparative anatomy of (G.
Hoggan) ...... xxiii, 4
„ perivascular, of the uterine wall, bilateral primary tubercu-
lous salpingitis, with secondary infection of (C. Lockyer) . xlix, 141
LYMPHATIC VARIX, the artificial production of so-caDed (F. H.
Champneys) . . . ... . xxviii, 144
„ case of phlegmasia dolens with (J. Matthews Duncan) . xxiii, 132
Maberlet (W. H.), two specimens of placentae in which the
blood-vessels ran along the membranes for some distance
from the edge of the placenta, and then united to form the
umbilical cord ..... xix, 65
„ see Godson, Clement.
MacCallum (D. C), two cases of extra-uterine foetation . xv, 248
„ case of intra-uterine peritonitis .... xviii, 116
„ report of the University Lying-in Hospital, Montreal, from
October 1st, 1867, to October 1st, 1875 . . . xx, 35
„ description of the conjoined twins Marie-Rosa Drouin . xx, 120
„ case of villous degeneration of the endometrium . . xxiii, 37
xxxiii, 413, 466
. xxxiii, 496
xxxviii, 225
xl, 2
xl, 3
. xliv, 133
. xliv, 136
. xliv, 294
xlv, 247, 248
McCann (Frederick John), chorea gravidarum
,, tuberculoiis salpingitis
„ aetiology of gonorrhoea ....
„ malignant adenoma (carcinoma) of the cervix uteri
„ uterine myoma ....
„ tubal mole removed by colpotomy
„ squamous carcinoma of the cervix uteri
„ "deciduoma malignvim" after the menopause
„ deciduoma malignum . . . .
„ — -with secondary deposit in vagina ; lungs showing secon-
dary deposits ..... xlv, 248
,, cervical fibroid . . • • • xlviii, 178
„ broad ligament cyst with torsion of the pedicle and extensive
hemorrhage into the broad ligament . . . xlviii, 179
„ primary carcinoma of the vagina . . . xlviii, 181
„ myoma of the vagina ..... xlviii, 182
„ and W. A. Turner, on the occurrence of sugar in the urine
dm'ing the puerperal state .... xxxiv, 473
McCaw (J. Dysart), cystic fibro-myoma of the uterus complica-
ting pregnancy ; removal at four and a half months . xl, 256
McIlrot (A. Louise), primary cancer of the ovary . . xlviii, 251
MACKENZIE — MADGE.
Mackenzie (F. W.), induction of abortion in cancerous disease
ot the uterus and rectum, with observations
„ craniotomy, in which delivery was readily eiiected by turnino-'
atter perforation, when instrumental extraction was found
impossible, Avith observations upon the substitution of this
mode of delivery in certain cases
McKeown (David), the prevention of ophthalmia neonatorum
and of its ravages
Mackinder (Draper), sudden death from occlusion of the pul
monary arteries seventeen days after parturition
„ obstetrical register
McKerron (Robert G.), for William Stephenson, peculiar
mucous polypus of the cervix uteri
„ obstruction of labour by ovarian tumours in the pelvis
„ antero-posterior positions of the head as a cause of diiScult
labour
,, adjourned discussion on paper on the obstruction of labour
by ovarian tumours in the pelvis
„ suppression of urine after labour
McLaurin (Dr.), see Chalmers, John.
Maclean (Campbell), see Tilt, E. J.
Maclean (E. J.), tubo-ovarian gestation
„ large soft broad ligament iibro-myoma, weighino-' fourteen
pounds . . , o o
„ a case of abdominal pregnancy; spurious labour 'at term •
tortus and placenta removed six months later . '
„ and Arthur E. Giles, two unusual cases of tubal gestation •
the one causing chronic intestinal obstruction, and accom-
panied by a haematosalpinx of the non-gravid tube; the
other simulating retroversion of the gravid uterus
M'Clintock (A. H.), clinical memoir on turning in cases of dis-
proportion
„ remarks in the discussion on the use of forceps '.
„ motion of condolence on the death of .
Macnaughton-Jones (H.),uterinelibroidwith anomalous ovarian
tumour . . ,
.., complete incontinence of urine cured by ventro-fixation of the
uterus . . _
„ two cases of congenital malformation of the genital organs '.
„ ovarian cystoma complicating pregnancy ; infection of the
cyst five days after labour ; operation on the forty-third day ■
extensive peritoneal and bowel adhesions ; recovery [
„ monster of seventh month removed by hysterectomy
„ anencephalic foetus . . , '
Madge (H. M.), uterine hematocele .
„ smallpox in twin fcetuses . . .
„ idiopathic pericarditis in a child two and a half years old '.
„ large fibrous tumour impeding delivery .
„ chronic hydrocephalus . . . ' '
„ lesion (rupture ?) of the placenta
„ fibrous tumour of uterus
„ anatomical relations between mother and foetus
„ spina bifida, with talipes varus of both feet
„ ruptured uterus . . . * '
„ hydronephrosis of the fostal kidneys impeding labour '.
121
i, n
i, 267
xxvii, 49
i, 213
ix, 268
xxxix, 314
xxxix, 334
xli, 142
xl, 8
xliv, 97
XXXV, 106
xl, 134
xlviii, 129
xxxix, 232
iv, 175
xxi, 185
xxiii, 240
xl, 154
xl, 226
xlii, 92
xlii, 141^1
xlvii, 302
xlvii, 307
iii, 79
iii, 173
iii, 176
iv, 129
V, 201
vi, 1
viii, 105
viii, 348
ix, 158
X, 97
xi, 55
xi.
213
xii.
133
xii,
347
xiv.
227
xvi,
219
xvii,
20
122 MADGE MALCOLM.
Madge (H. M.) {continued) —
„ fotu- cases of congenital imperforate vagina, and one case of
congenital phymosis, occurring in same family
„ prolapsed portion of fiinis, with complicated knot .
„ inversio uteri ......
„ uterine fibroids complicating pregnancy .
„ case of ileo-csecal intussusception in an infant of eight
months ......
„ case of labour complicated by pelvic tumour and convulsions
Magtjire (George J.), acute contagious pemphigiis in the newly
born ...... xlv, 429
MAIEUTIC, simple, for the induction of miscarriage or premature
labour (P. Horrocks) .... xxxviii, 168
Malcolm (John D.),for J. Knowsley Thornton, ovaries and tubes
from a case of persistent chronic ovaritis . . xxviii, 278
„ — tumoi\r showing that it is, in some cases, impossible to
make a differential diagnosis between uterine and ovarian
neoplasms ...... xxix, 249
„ — report on ditto by committee (A. L. Galabin, G. E.
Herman, and Alban Doran) .... xxix, 515
„ pair of incipient ovarian cysts .... xxxiii, 29
„ papillomatous ovarian cystoma removed after double ovario-
tomy fifteen years previously .... xxxv, 36
„ uterine fibroids . . . . . xxxvi, 200
„ notes of a case of malignant disease of the iiterus with
numei'ous deposits in the lungs, and death following an
abortion ..... xxxviii, 125
„ two solid ovarian tumours . . . xxxviii, 166
„ large solid ovarian tumoui- . . . xxxviii, 167
„ solid ovarian tumour .... xxxviii, 167
„ partially macerated foitus from an extra-uterine foetation
retained in the body about a year after its death . . xii, 222
„ macerated bones of a foetus from an extra-uterine gestation
retained seven j-^ears ..... xii, 223
„ tumour closing simulating a papillomatous ovarian cystoma
attached to the front of the bladder and quite separate from
both ovaries ...... xii, 226
„ double pyosalpinx in which the tubal sacs communicated . , xlii, 10
„ operation between the third and fourth months of extra-
uterine gestation, with removal of a living foetus, and much
trouble from haemoiThage dixring convalescence . . xlv, 382
„ extra-uterine fcetation ; death after operation from septicae-
mia ; remarks on the significance of adhesions of the wall of
the gestation sac to the dead foetus . . . xlv, 421
„ sloughing of the central part of a uterine fibro-myoma shortly
after delivery ..... xlvi, 15
„ abscess in a corpus lut«um .... xlvii, 8
„ cancerous uterus ..... xlvii, 10
„ peritonitis and the Staphylococcus alius . . _ . xlviii, 97
„ on the advisability of removing the cervix in performing
hysterectomy for fibro-myomatous uterine tiimours . xlix, 148
„ E. Hamilton Bell, and Cuthbebt Lockter, chorio-epithe-
lioma following hydatidiform mole in a patient with bi-
lateral ovarian cysts, with pathological report and refer-
ences to the literature on kindred cases . . . xlv, 483
MALFORMATIONS MALIGNANT GROWTHS.
123
XVI,
viii,
xxxvi,
XXXV,
; xxix,
i,
xviii,
xxvii,
XXV,
xxxiv.
100
102
149
336
186
239
295
131
2
463
XXXV, 102
xxxix, 134
xxxix, 134
346
M.U,FORMATIONS, absence of occipital bone in a fcetus (E
Barnes) . . , ^ '
„ child born with amputated extremities (I. B. Browii)
„ ease of cyclops (W. Y. McC. Ettles)
„ dissection of a case of spina bifida (T. W. Eden)
„ of the Fallopian tube (Alban Doran) . xxviii 171
,, of the fcetus (W. Sedgwick) , . . '
„ of fcetus (G. Roper) . . , ''
>• — (P. Horrocks)
„ — outgrowth from end of coccyx (Hey wood Smith) '
>, — (Amand Routh) . . . ^ '
„ — with hernia umbilicalis congenita and spina bifida lumbo-
sacralis (Amand Routh)
„ deformed fcetus (F. C. Bottomley)
„ fcehis compressus s. papyraceus (F. 0. Bottomley)
„ in an anencephalic fcetus, completely cleft spine associated
with an unusual visceral (T. G. Stevens) . xxxviii,
„ fcetus with absence of urethra and ascites obstructino-
delivery (T. G. Stevens) . . . °xxxvii,
„ fcetus at seven months illustrating celosoma with retroflexion,
meningocele, and talipes varus (Leith Napier) . [ — -^
„ of the genital organs in a child (H. C. Rose) . \
„ — two eases of congenital (H. Macnaughton -Jones)
„ heart (R. J. Probyn-WiUiams) . . . '.
„ of heart (Clement Godson) ■ • . .
„ — of a dicephalous fcetus (John Phillips)
„ congenital diaphragmatic hernia, three cases of (H. R.
Spencer)
„ — (A. E. Giles)
„ complete epispadias in male infant (H. E. Eastlake)
„ hypospadias, extreme, in a child brought up as a female
(H. C. Rose) . . ...
,, of pelvis, induction of premature labour in a case of (J. H.
Trouncer) ..... i
» — case of Csesarean section for (J. W. J. Oswald) . . xvii[
„ living female child with three lower limbs (Clement Godson) xxxii,'
„ singular (J. Neale) ..... viii,
„ of rectum and bladder, congenital absence of both kidneys
and ureters, imperforate anus, absence of right hypogastric
artery, and deformed feet (A. E. Giles) . . . xxxiv,
,, double vagina and uterus (H. Gervis) . . . xix'
„ uterus didelphys, with observations on the clinical import-
ance of this (A. E. Giles) . . . xxxvii,
,, see Deformity, Hermajjhrodite, Monster, Spondylolisthesis.
MALIGNANT DISEASE, congenital, of the forehead and neck
(John Phillips) .... XXX, 301, 334
„ producing heematocele (W. S. Playfair) . . . xxvi, 6
„ uterus removed entire for (A. H. N. Lewers) . xxviii, 67,' 206
„ — the body of which was the seat of (Hey wood Smith) . ' xx' 4
„ of the cervix uteri (G. Roper) .... xxii^ 85
" — (A. W. Edis) ....'. xxiv', 298
" — three specimens of (A. H. N. Lewers) . . . xxxii, 136
„ — Cesarean section performed on account of (A. L. Galabin) xviii' 286
„ — two cases of pregnancy complicated by (A. L. Galabin) . xviii,' 239
,, vaginal hysterectomy for (F. A. Piu-cell) . . . xxvii, 5
MALIGNANT GROWTHS, see Tumours, malignant.
XV, 85,
xlii,
xxx\'i,
xxiii,
xxix,
xxxii,
xxxiv,
ix.
116
125
92
3
179
132
132
63
xviii, 256
236
378
132
259
129
271
301
124
MALIGNANT TUMOUE — MAXWELL.
MALIGNANT TUMOUR, see Tumours, malignant.
Malins (Edward), remai-ks in the discussion on the
forceps
„ extirpation of the uterus for procidentia
„ pyosalpinx
„ broad ligament cysts
„ double pyosalpinx
„ case of hydatids of the mesentery
„ case of extra-uterine gestation
„ haematosalpinx
„ Inaugural Address as President
„ Annual Address
MAMMA, 'glandular cystic tumour of (W. Squire)
MAMMARY GLANDS, see Breasts.
MAMMARY REGION, see Breasts.
MANIA, complicating puerperal convulsions ; apparent recovery ;
sudden decease (A. Hall) ....
MARE, cyst of the ovary of (C. S. Pollock) . . xxx
Marlet (Richard), action of belladonna upon the mammary
glands ......
„ on pertussis : its causes, symptoms, and treatment .
Marshall (John), tubal gestation ; death
„ disease of the placenta .....
„ placenta with fibrinous deposits ....
„ child born with amputated arm ....
Marshall (W. E.), see Williams, John.
Martin (A. E.), remai-ks on the pelvis collection and on pelvi-
metry in the Koyal University Maternity of Berlin
„ cephalotribe ......
Martin (Christopher), see Tait, Lawson.
Martin (L. J.), hard fibrous tumour of the ovary removed by
ovariotomy ; recovery .....
Marttn (W.), face presentation; delivery by forceps; subse-
quent sloughing and separation of the mucous lining of the
bladder and expulsion of the same
„ tedious labour ; delivery by forceps and death of the patient
on the third day, probably from thrombosis of right heart
and pulmonary arteries ....
„ extra-uterine pregnancy, terminating in sudden death
„ — report on .
„ triplets at upwards of eight months of pregnancy .
„ mp.nagement of childbed, with a view to promote successful
suckling ......
MATERNAL IMPRESSIONS to which congenital deformity of two
children was attributed (A. Thompson) .
„ case of fright by a monkey (Heywood Smith)
Mathieson (J. H.), case of extra-uterine gestation ; delivery of
living child per fagwam; removal of placenta ; recovery
Matthews (J.), new craniotomy forceps
Maxwell (James L.), notes on two fatal cases of pernicious
vomiting in pregnancy ....
use of
xxi, 155
. xxvi, 148
. xxvi, 228
. xxvi, 228
. xxvii, 137
. xxix, 245
. xxxiv, 181
. xxxiv, 466
. xlv, 109
xlvi, 67 ; xlvii, 82
iii, 213
iv,
222
234,
253
ii.
29
V,
300
V,
154
viii.
137
ix.
242
X,
94
xiv.
71
xiv.
65
xii, 302
V, 186
x, 263
xi, 57
xi, 62
xi, 208
xii, 339
xix, 94
xxii, 242
xxvi, 132
ix, 29
xliii, 288
MAXWELL — MECHANICAL ACTION.
125
Maxwell (J. Preston), on spontaneous riiptm-e of the uterus
in placenta prcevia ....
Maxwell (R. D.), volvulus in a foetus
Mayo (Charles), presentation of right shoulder and arm ; spon
taneous evolution ....
Meadows (A.), twins, one blighted, the other anencephaloixs
„ congenital hernia (?) of the liver
„ idiopathic pericarditis in a child two years old
„ ingiiinal hernia of the right ovary, successfully removed
„ monstrosity .....
„ new method of treating cases of vesico-vaginal fistula
„ bandage after labour ....
„ imperforate bowel ; operation ; death
„ monstrosity, with remarks on the influence of maternal im
pressions on the foetus in utero .
„ amputation of cervix uteri
„ intra-uterine stem ....
„ cyst of the Fallopian tube ; remarks
„ hypertrophy of labium . . . •
„ cauliflower excrescence of posterior lip
„ ecraseur with single steel wire
„ and A. J. Bannister, report on monstrosity
„ monstrosity with caudal appendage
„ uterine sound with metroscope ,
„ tumour from anterior wall of vagina
„ flexions of the uterus ....
„ medicated pessaries ....
„ new vaginal speculum ....
„ instruments received from Prof. Lazarewitch, hysteroper, two
intra-uterine stems and uterine sovind
„ amputation of cervix uteri
„ large fibroid polypus removed by single-wire ecraseur
„ two new forms of vaginal speculum
„ pelvic hsematocele, with special reference to its diagnosis and
treatment . .
„ extra-uterine gestation, with remarks on its treatment
„ probable origin of certain forms of cystic disease of the ovary
„ remarks on the treatment of some forms of extra-uterine
gestation, with a case .....
„ gastrotomy for supposed extra-uterine gestation
„ specimen of membrane passed in so-called membranous dys-
menorrhoea ......
,, — report on ditto by committee (J. H. Aveling and John
Williams) ......
„ note on the 'post-mortem diagnosis of a nulliparous uterus
xvii, 355
„ for T. N. Moore, case of Fallopian pregnancy ; rupture and
death about the fifth month
„ pessaries of xylonite
„ ovarian tumour and fibroid of uterus
„ subperitoneal uterine fibroids
„ and W. Williams and J. H. Aveling, report on a case of
extra-u.terine fcetation.
MEATUS URINARIUS EXTERNUS, adenoma of (H. R. Spencer)
MECHANICAL ACTION of pessaries (John Williams) .
xliii,
xlviii.
111,
i,
ii,
iii,
iii,
iv,
vi,
vi,
vii,
vii,
viii,
viii,
viii,
viii,
viii,
ix.
XI,
xi,
xi,
xi,
xii,
xiii, 140,
xiii,
xiv,
xivj
XV,
217
277
105
51
199
144
438
255
107
125
53
84
39
135
139
257
258
111
112
112
242
141
204
224
3
78
102
241
134
170
268
39
309
145
xvi, 230
xvi, 251
; xviii, 69
XVlll,
xxiii,
XXV,
XXV,
xiii,
xli,
xviii.
258
131
161
232
268
383
126
126 MECHANISM OF LABOUR — MEMBRANOUS CROUP.
MECHANISM OF LABOUR, more especially with reference to
Naegele's obliquity and the influence of the lumbo-sacral
curve (R. Barnes) ..... xxv, 258
„ of the third stage of (F. H. Champneys) xxix, 117, 151, 264, 317, 337, 346
MECKEL'S DIVERTICULUM, prolapse of, in an infant, forming an
vinibilical tunioiu* (S. W. Wheaton) . . . xxxiv, 184
MEDICAL CONGRESS of Philadelphia, report of delegate (R.
Barnes) ...... xix, 2
MEDICAL COUNCIL (General), direct representation of obstetrics
at . . . . . xvi, 21 ; xxiii, 46
„ resolution for a memorial to the Home Secretary, etc., for the
direct representation of obstetrics in the . . . xi, 14
„ particulars of, with text of memorial . . . xi, 123-5
MEDICAL PRACTITIONERS, alteration of the laws respecting the
eligibility of, to the Fellowship of the Society . . xxi, 4
MEDULLA, spinal, absence of (C. B. Lockwood) . . xxix, 234
MEDULLARY GROWTHS in vagina of infant (N. Heckford) . x, 224
MEETINGS, ordinary, of the Society, alteration of laws respecting
the ...... xxii, 50 ; xxix, 84
MEDIASTINUM, embryoma of anterior, in a male adult (J.
Ritchie) ...... xlv, 250
MELBOURNE (Australia) Lying-in Hospital, short account of (R.
T. Tracy) ...... xii, 349
MEMBRANE from female bladder (J. H. Aveling) . . xxv, 33
„ deciduous (W. G. Hewitt) . . . . ix, 55
„ — expelled from a double uterus (W. F. Cleveland) . xxvi, 184
„ dysmenoi-rhceal (Wynn Williams) . . . xxv, 233
„ exfoliation of vesical mucous (Alban Doran) . . xxiii, 2
„ expelled from uterus a few days before delivery at full term
(A. Harris) ...... vii, 47
„ passed in a case of membranous dysmenoiThoea (A. Meadows)
xvi, 230, 251
„ periodical discharge of, in cervical endometritis (A. L.
Galabin) ...... xxiii, 207
„ fragment of, passed from the uterus (Alban Doran) xxxi, 229, 310
„ mucous, of the uterus in endometritis (A. L. Galabin) . xxii, 47
MEMBRANES, diseased foetal, in early pregnancy (John Phillips)
xxxi, 52, 161
„ fretal, attachment of, to the scalp in case of hernia cerebri and
hernia umbilicalis (T. H. Tanner) . . . vii, 109
„ f tetus discharged in the, entire at six months and three weeks
(H. T. Barton) ..... xxix, 189
„ and fcetus from a case of missed abortion (Alban Doran) . xx\-ii, 224
„ and placentae from a case of triplets (P. Horrocks) . . xxvi, 160
„ placenta, cord, foetus, and (Robert Wise) . . xxxviii, 166
„ some causes of retention of the (F. H. Champneys) . . xxix, 317
„ separation and expulsion of the (F. H. Champneys) . . xxix, 264
„ from a ease of riiptured tubal gestation, complicated by a
large haemato-salpinx on the opposite side (C. J. Culling-
woroh) ...... xxxii, 273
„ of a twin ovum of ten weeks' gestation (J. Hall Davis) . x, 57
,, timiours of fo3tal (G. M. Bluett and G. E. Herman) xxix, 243, 512
„ see Amnion, Chorion, Dccidua.
]!SEM3RAN0US CROUP (R. U. West) . . . i, 53
MEMORIAL — MENSTRUATION.
127
MEMORIAL presented to the Genei-al Council of Medical Educa-
tion and Registration by the Council of the Obstetrical
Society of London .....
Mendenhall (George), mortality in the lying-in ward of the
Cincinnati Hospital .....
MENINGITIS, primary, pneumococcus, simulating puerperal
eclampsia (T. Wilson) . . . . .
„ tubercular, uterus and ovaries of child who died of (F. Beach)
MENINGOCELE, case of, complicating labour (S. W. Poole)
„ spinal (John Phillips) .....
,, see Malformations.
MENOPAUSE, " deciduoma malignum " after the (F. J. McCann) .
„ changes in fibroid tumours after (J. Bland-Sutton) .
„ fibroid associated with bleeding after (A. H. N. Lowers)
„ sloughing fibro-myoma of uterus occurring in a patient twenty
years after the (W. W. H. Tate)
„ fibro-myomata of the uterus causing intestinal obstruction and
death two years after the (C. J. Cullingwortli)
J, three cases of myomatous uteri bleeding after the (H. E.
Spencer) ......
MENORRHAGIA, influence of lead-poisoning in producing (B.
Baker)
„ treated by injection, or the removal of the uterine mucous
membrane by the gouge, or both means combined (C. H. F.
Eouth) ......
„ treatment of certain forms of, by means of the sponge tent,
with reference to women residing in tropical climates (G. G.
Bantock) ......
MENSES, escape of, between the walls of the vagina in a case of
atresia of the cervix uteri (G. Lowe) . . ' .
„ retained, in large cavity, communicating with uterine canal in
a case of fibro-myoma of uterus (W. W. H. Tate) .
„ — in utero and Fallopian tubes, in case of absence of vagina
(C. H. F. Routh) . . . . .
„ — of two years' duration, caused by atresia vaginae (I. B.
Brown) ......
„ — sequel to case of, caused by atresia vaginae (I. B-. Brown) .
,, retention of, after difficidt laboiu' (J. H. Davis)
„ — congenital abnormality of uterus simulating (J. Braxton
Hicks) . . . . .
„ — with distension of uterus, in a case of absence of vagina
(C. H. Carter) .....
„ — in one half of a double uterus (A. L. Galabin)
,, — for more than two years, in a married woman (W. Chap-
man) ......
„ — subsequent to case of occluded vagina after delivery (S.
Craddock) ......
MENSTRUAL FLUID, retained in a case of imperforate hymen (E.
Copeman) ......
MENSTRUATION, cyclical or wave theory, with observations on
the variations in pulse and temperature in relation to (A. E.
Giles) ......
„ on the change in size of the cervical canal during (G. E. Her-
man) ......
„ decidua passed on the first day of (A. L. Galabin)
ii.
3
xii.
357
xliv.
5
XV,
57
xix.
268
xxix.
188
xliv.
294
xlv.
105
xlix.
270
xl.
303
xxxix.
282
xlviii,
333
viii.
41
ii, 117
xiv.
84
xxix,
401
xlvii.
360
xii.
34
iv.
21
V,
162
iv.
91
xxii.
260
xxii.
251
xxiv.
21
iv,
251
xiii.
101
s.
246
xxxix.
115
xxxvi.
250
xxi.
312
128
MENSTRUATION — MESOC^CUM.
MENSTRUATION (continued)—
„ painful, on the reLation between backward displacements of
the nterus and (G. E. Herman) .... xxiv, 161
„ in cases of backward displacement of the uterus (G. E. Herman) xxxiv, S25
„ effects of lactation on impregnation and (Leonard Remfry) xxxviii, 22
„ fate of oviim and Graafian follicle prior to (T. G. Stevens) . xlv, 465
„ on the age at which it commences (W. Rigden) . . xi, 243
„ treatment of sickness in diseases of (E. J. Tilt) . . iii, 15
„ on the relation of heart disease to (W. J. Gow) . . xxxvi, 126
„ the relation of scarlatina to (R. Boxall) . . . xxx, 55
„ primary ovarian pregnancy with rupture fourteen days after
last (G. P. Anning and H. Littlewood) . . . xliii, 14
„ during pregnancy (W. G. Hewitt) . . . viii, 221
„ and pregnancy, influence of purpura haemorrhagica vipon
(John Phillips) ..... xxxiii, 390
„ uterus dviring (W. G. Hewitt) .... viii, 220
„ — just before, with microscopic sections (W. S. A. Griffith) . xxiv, 138
„ microscopical section of uterus from a subject who died the
day of commencement of (R. Cory) . . . xx, 104
„ and ovulation of monkeys and the human female (W. Heape) xl, 161
„ and chlorosis, the relation between (W. Stephenson) . xxxi, 104
„ of Semnopithecus entellus (W. Heape) . . . xxxvi, 213
MENTAL EMOTION, strong, affecting pregnant women as a cause
of idiocy in the offspring (Sir A. Mitchell)
MERCURIALISM in lying-in Avomen, the conditions which favour,
with suggestions for its prevention (R. Boxall)
„ — undergoing sublimate irrigation (W. R. Dakin) .
MERCURY, acid nitrate of, case of death following vaginal injec-
tion of (John Phillips) . . xxxii, 308 ;
„ — death following vaginal injection (J. Phillips)
„ perchloride of, pellets of (F. H. Champneys)
„ — its use as an antiseptic (A. L. Galabin)
Meredith (W. A.), large fibroid tiimour of the uterus
„ fibro-cyst of ovary
^^ — report on ditto by committee (A. L. Galabin, G. E. Herman,
and Alban Doran)
„ solid pelvic tumour
^^ — report on ditto by committee (A. L. Galabin, G. E. Herman,
and Alban Doran)
„ case of hffimatometra associated with a degenerating fibro-
myoma, treated by supra-vaginal hysterectomy
„ fibro-myomata of uterus with axial rotation of the tumours .
„ case of locked fibroid treated by supra- vaginal hysterectomy .
„ solid ttmioui'S of ovary .....
„ papillomatous ovarian cysts removed during the fourth month
of pregnancy ......
„ two cases of double ovariotomy during pregnancy .
„ fibro-myoma of the C3rvix viteri, removed by abdominal pan-
hysterectomy .....
MESENTERY, large chylous cyst of (Ad. Rasch)
„ hydatids of the (E. Malins) ....
^^ — or connected with (C. J. Cvdlingworth and H. H. Glutton)
MES0C5JCUM, ovai-ian cyst which had made its way between the
layers of the mesosigmoid, both broad ligaments, and the
(W. H. B. Brook) .....
xxvi, 124
xxx, 304
xxviii, 281
xxxiii, 180
xxxiii, 180
xxviii, 66
xxxi, 98
xxiv, 79
xxix, 248
xxix, 513
xxix, 249
xxix, 514
xxix, 422
xxx, 80
xxx, 442
xxxi, 225
xxxii, 374
xxxiv, 239
xlvi, 12
xxxi, 311
xxix, 245
xlvi, 254
xlv, 415
MESOMETEIUM MIDWIFERY. 129
MESOMETRIUM, tumour of, weighing 22 lb. (J. Bland-Sutton) . xli 298
o!l^^^^^^: J°? ^""T^. ^^^^"lents, and mesoc^eum, ovarian
B Brook? ^ "^^^ between the layers of (W. H.
MESOVARIUM, torsion of^ producing minute pedicle in dermoid
cyst ot ovary (A. L. Galabin) . f uoimoia ^^^__ ^^^
METASTASES, pulmonary, chorio-epitheUoma with (C.Lockyer) ' xHv' 24
METEOEOLOGICAL CONDITIONS, external, the relation of, to the
METRITIS, chrome infective (A. W. Addinsell) . ^Iviii 144
,, - pathology of (W. F. Shaw) . / ; " ^^^' ^^
METROMETER SOUND (R. Greenhalgh) . * " ^iii' 169
METRORRHAGIA, dysmenorrhoea, ovaritis, and sterility, depend-
ing upon a peculiar formation of the cervix uteri (R. Barnes) vii 120
METROSCOPE, uterine sound with (A. Meadows) ix ' 042
METROTOME, bilateral (R. Greenhalcrh) ' \«,
„ Peaslee's, modified form of (A. L. Galabin) ". ' ^J 53
MICROCOCCyn^the^ substance of a decomposing fibroid turnout
* " • xxxi V 1 S7
"^^ D°SitLT^ ""^ obstetrical and gynecological interest (G.
■ • • . xxxvii 263
MICROSCOPIC SECTIONS of tumour expeUed from the uterus
dimng natural labour (A. W. W. Lea) . uterus
MICROSCOPICAL SLIDES from a case of {inter-mensteual Dain
(Mittelschmerz) (A. W. AddinseU) menstrual pam
MIDWIFERY, the use of antiseptics in (A. L. Galabin) * * ^^^i 93
:: agister Llj.Xrerr^^'^ '^^=""^'" (P.Horrocks) Im', 7^9
„ among the Burmese (T. F Pedlev/ ' * ' •"' ^^
„ in the East (J. Jackson) ' ' ' ^^' ^
„ old books on, exhibition of (A. Wiltshire) ! * ' ^•' oK
" 'pLyte)"^"" '" ""* "'**''^' '^'"'*' '■*'**"« '0 C"'- S- '^' '"^
" ''S°S?riJ^ ''' *B "°^^' ''f •'«'' »' Surgeons, vote'of thanks "^ "^
„ modern, the forceps in (A. W Edis) ' ' * ^"^' ^^^
" ^(?"BameT) "^^'^^^"^ ''^''''' ^"'^""^^ *^y* ^"^^ ^«d I'i^d '''^' ^^
:: ^aSSf /r ^^ST^^ ^"'^'- ^^^^^^ ^-^^) • S S?
« — from the records of private practice (R. Dunn) ' * ]' Sq
» — m general practice (H. C. Rose) ' ' ' ..^ ?^^
„ - of thirty-five years' practice (Clement Godson) \ ' ^l^ oS
« — mprivate practice (GeorgeRigden) . xviu, 223
" 1w T^GreeTe) ^'"""""^'^^ ^"" ^"^^^^ consecutive labours "' '''
„ see also Obstetrics. ' ' ' ' • ^^' 204
xli, 2
xU, 3
0
130
MIDWIVES — MITTELSCHMEKZ.
58
78
xlvii, 80
XXXIV,
xxi,
MIDWIVES, education, examination, and registration of
xvi, 22 ; xvii, 33 ; xix, 136 ; xx, 12 ; xxiii, 75 ; xxviii, 55 ; xxxli, 87, 365
„ alteration of laws respecting the Board for the Examination
of . . . . . . xxvi, 23 ; xxvii,
„ examinations — Chart 1872 to 1904 . . . xlvii,
„ — table showing result of, for each year since institution in
1872
„ registration of, and proposal to petition for a select committee
on .
„ notice of the prospects of legislation relative to
„ rules and regulations for
MILE, effects of, when injected into the vascular system of animals
(E. A. Schiifer)
„ secretion of, in a new-born male child (W. Duncan)
„ abscess (T. W. Nunn) ....
„ see Galactorrhoea.
MiLLiGAN ("VV. A.), pyelonephritis of pregnancy
Milne (C. W.), variola in the fifth month, with consequent de
livery at full term of a dead child . .
MiLWARD (J.), cases in pi-actice : monstrosities
MISCARRIAGE at the fourth month, case in which the uterus was
plugged for haemorrhage after (A. H. N. Lewers)
„ see Abortion.
MISSED ABORTION (H. C. Pope)
„ foetus and membranes from a case of (Alban Doran)
„ case of, in which an early embryo in its amniotic sac was re^
tained in the uterus for eight months (W. Diincan)
„ see Abortion.
MISSED LABOUR, so-called, with a case in illustration (R.
Barnes) ..... xxiii, 81, 110
xl, 367
xxi, 320
XXX, 226
iu, 197
xlviii, 1
ix. 110
xiv, 140
xxxii, 356
XXIV,
xxvii.
139
224
xxxvii, 196
„ case of extra-uterine pregnancy simulating (A. Rasch)
„ (five months) ; abdominal section and removal of sac ; recovery
in a full-term pregnancy in a rudimentary horn of uterus (J.
H. Targett) ......
„ see Lithopsedion.
Mitchell (Sir Arthur), strong mental emotion affecting preg-
nant women as a cause of idiocy in the offspring
Mitchell (J. T.), some of the exigencies connected with preter-
natvu-al labour .....
„ natvu-e and treatment of puerperal peritonitis
„ early and entirely detached placenta in labour, producing
internal and concealed haemorrhage, of which the patient
died soon after delivery ....
„ ruptured uterus in about the seventh month of pregnancy
„ exhaustion and convulsions arising from protracted labour of
more than six days' duration ; craniotomy ; recovery
„ necessity of adopting laws by which the wives of the labour-
ing classes and the poor shall have secured to them in their
labours the attendance of qualified accoucheurs, female as well
as male .....
MITRAL VALVE, stenosis of, ease of labour in a primipara suffer
ingfrom (G. Coates) ....
MITTELSCHMERZ, intermenstrual pain (A. W. Addinsell)
„ microscopical slides from a case of intermenstrual pain (A. W,
Addinsell) .....
XXV. 113
xUi, 276
xxvi, 124
ii.
257
iv.
96
viii.
282
xi.
204
xii, 368
XV, a
xxviii, 108
xl, 137
xH,
MOLE — MONSTEE.
131
xviii,
xlv, 240
xlix, 223
xiii, 95
i, 249
xvii, 2
MOLE, carneous or fleshy (W. B. Woodman and E. Hughes)
„ — retained in utero five months after death of embryo show-
ing proliferation of epithelium of villi as a syncytiim form-
ing reticulating processes (A. L. Galabin)
„ early tubal (H. Briggs) . . . ^ '
„ or blighted ovum from supposed three months' preo-nancy (A
W. "Williams) . . r o j \ •
„ hydatidiform, or vesicular, its natui-e and mode of orio-in (W
Gr. Hewitt) . . . o V •
„ — case of (John Williams) , * * '
„ — (Wm. Duncan) . . [ ' ^'^^ -^g2 233
„ — foUowed by chorio-epithelioma in a patient with bilateral '
ovarian cysts (J. D. Malcolm, E. H. BeU, and C. Lockyer) xlv 483
,, malignant hydatid— deciduoma malignum (J. B. Hellier) xlv' 242
„ removed by abdominal section, chorionic villi of a tubal (A
H. N. Lewers) . . ^ ivvTHii ina
„tubal(A.H.N.Lewers). . ; ; ™J??
„ — removed by abdominal section (A. H. N. Lewers). xxxvii' 78
„ in ease of tubal abortion, in process of extrusion at the time
of operation (J. Bland-Sutton) .
„ tubal, showing escape of the body of the embryo throuc^h the
fimbriated opening, with retention of the head and amniotic
cavity in the tube (J. S. Fairbairn)
„ — with encysted hsematocele (W. S. Handley)
„ — removed by colpotomy (J. McCann)
„ — complicating carcinoma of the cervix (A. H. N. Lewers)
„ associated with (?) sarcoma of the ovary of the same side (A
L. Galabin) . . ^ '
„ — (C. E. Purslow) .'.]''
„ large uterine (T. Fitzpatrick) . . [ '
„ vesicular, and chorio-epithelioma found in association with
compound lutein cystomata (C. Lockyer) .
„ — showing syncytium derived from chorionic epithelium
partially differentiated into cells (A. L. Galabin)
» — (?) preceded by myxoma of fundus uteri : a myxoma of
chorionic viUi engrafted upon uterus (A. L. Galabin)
„ treatment of, and premature expulsion of the foetus (1
Ball) . . . _ . V- •
MOLLITIES OSSIUM : death (G. H. Pedler)
„ pelvis deformed by (W. S. A. Griffith)
MOLLITIES OSSIUM, see Osteomalacia.
MOLLUSCUM FIBROSUM, see Tumours.
MONKEYS, menstruation and ovulation of, and the human female
(W. Heape) .
MONSTER (A. Meadows) .
„ (W. Gayton) . . '
„ rare form of (H. Gervis)
„ (A. HaU) ...
„ report on (A. Meadows and A. J, Bannister)
„ with specimen (T. Langston)
„ two eases of (D. L. Eoberts)
„ curious (G. de G. Griffith)
„ (J. Oswald) .
„ (E. E. B. Horniblow) .
„ case of (F. Wallace)
xlii, 311
xliii, 211
xliii, 255
xHv, 133
xlv, 335
xlviii, 19
xlvi, 271
XX, 170
xlvii, 157
xlv, 240
xlv, 241
i, 315
xiii, 123
xxvi, 230
xvu.
xl, 161
iv, 255
vii, 56
viii, 135
ix, 271
ix, 112
X, 37
X, 269
xi, 5
xii, 115
xii, 247
176, 277
132
MONSTER.
MONSTER (continued) —
„ (C. H. F. Routh) ..... xxiv,
„ (Maitland Coffin) ..... xxiv,
„ with skiagi-aph (A. H. N. Lewers) . . . xxxix,
„ acardiac, notes on, in the museums of London hospitals (Alban
Doran) ...... xxxi,
„ acaxdiacus from a cow (J. Bland-Sutton) . . . xli,
„ amoi-phus acardiac foetus (G. E. Herman for G. M. Bluett) . xxxiii,
„ — acephalus (F. E. Cockell) .... xxv,
„ from the museum of St. Bartholomew's Hospital (W. S.
A. Griffith) ...... xxxi,
„ of six months' gestation, with rudimentary heart
(Woodley Slyman) ..... xxxi,
„ (W. H. Kelson) ..... xxxiii,
„ twin (A. Routh) ..... xxxii,
„ anatomy and nature of two acardiac acephalic fcetuses (A
Keith) . . .
„ mylacephalous acardiac twin (H. E. Trestrail)
„ — dissection of ditto (Alban Doran)
„ — acardiac twin (H. Page) . . .
„ acardiacus mylacephalus (Alban Doran)
„ acephalous (W. Graily Hewitt) . . . ,
„ — (J. Milward) .....
„ — embryo (Clement Godson)
„ — acardiac foetus (M. Handfield-Jones)
„ (G. E. Herman)
„ acephalo-cyclopean (R. Hardey) .
„ anencephalian (R. U. West)
„ anencephalous foetus (A. Meadows)
„ (H. L. Sequeira) .
„ (J. B. Hicks)
„ specimen of (O. Barber)
„ (W. Culver James)
„ (H. C. Pope)
„ with spina bifida (F. Wallace)
„ at the eighth month (H. R. Spencer)
„ (Alban Doran)
^^ (W. S. A. Griffith)
„ (A. Perigal)
„ (W. Dvmcan)
„ anencephalic fcetus (H. Hailey) .
„ (H. S. Ballance) .
„ (Amand Routh) .
,, skull of (Amand Routh)
„ — completely cleft spine associated with an unusual visceral
malformation in (T. G. Stevens) . . xxxviii,
„ di-prosopus anencephalicus (Amand Routh)
„ — di-prosopia fcetus (Amand Rovith)
„ child born Avith amputated extremities (I. B. Brown)
„ with caudal appendage (A. Meadows)
„ Cyclopean (J. A. Thompson)
„ the delivery of a (R. H. A. Schofield)
„ deformed foetus with cystic tumour of neck (A. H. N
„ foetus papyraceus (W. Rivers Pollock)
„ — — (H. J. Ilott)
„ dicephalous fcetus (P. Horrocks) .
„ (John Phillips) .
xlii,
. xxxi,
. xxxi,
. xxxiii,
xxxvii,
viii,
xiv,
xvi, 100,
. xxxiv,
. xxxvi,
iv,
ij
i)
xvu,
xxii,
xxiii,
xxiii,
XXX,
xxxi,
xxxi,
xxxi,
xxxi,
vii,
XXXV,
XXXV,
xxxvii.
xxxvui,
xxxvii,
viii,
ix,
XV,
xxi,
Lewers) xxxviii,
xxxviii,
xxxvii,
. xxvi,
. xxviii.
75
98
131
4
97
493
110
258
195
347
99
2
4
302
209
316
140
121
84
65
213
105
51
195
226
341
241
178
204
408
52
134
165
202
78
297
241
219
346
92
162
102
112
35
71
106
320
7
326
278
MONSTER — MOESE.
133
JCONSTEE (continued) —
„ dicephalous foetus, heart and large vessels of (John Phillips) . xxix, 55
„ two foetal (T. H. Tanner) . . . • ii, 247
„ foetus at seven months illustrating celosoma with retroflexion,
meningocele, and talipes varus (Leith Napier) . . xxxvi, 116
,, monstrous foetus (E. Barnes) .... vii, 227
„ foetal (John Phillips) ..... xxxix, 44
„ of seventh month removed by hysterectomy (H. Macnaughton-
Jones) ...... xlvii, 302
„ two-headed, with the bodies united from the breast downwards
(G. G. Bantock) ..... xviii, 223
„ — and three arms (J. Palfrey) . . . xix, 40, 97
double, united children (H. Hanks)
— (F. F. Jay)
— with accoimt of the delivery (W. Wills)
— (J. G. Swayne)
— (H. Gervis)
— (J. F. Rogers)
— (Clement Godson and F. S. Eve)
— (Clement Godson) ,
— (Charles Wenyon)
iii, 414
vi, 222
vii, 6
ii, 320 ; viii, 1
X, 197
xi, 128
xxii, 73, 74
. xxii, 109
xxxiii, 384
„ mechanism and management of delivery in cases of double
(W. S. Playfair) ..... viii, 300
„ conjoined twins (thoracopagus) (W. Duncan) . xxxvii, 198
„ — case of (Clement Godson) . . . xx, 171 ; xxi, 88
„ Marie- Rosa Drouin (D. C. MacCallum)
„ Rozalie and Josepha Blazet (W. S. Playfair)
„ (Percy Boidton)
„ rare form of twin (R. Ellis)
„ twin (P. Horrocks)
„ double, of dicephalous type (C. O. Fowler)
„ one of twins (H. Gervis)
,, twin, one-headed (Harvey Hilliard)
„ — in its seventh month (J. Chalmers)
„ — female (A. L. G^labin)
„ — (Clement Godson and D'Arcy Power)
„ — ischiopagus parasiticus (J. Chalmers)
„ which lived for some time after birth (W. Ross)
„ sireniform, skiagram of (Herbert Spencer)
„ living female child with three lower limbs (Clement Godson)
„ with congenital ventral hernia (J. Brunton)
„ with remarks on the influence of maternal impressions on the
foetus in utero (A. Meadows) .... vii, 84
„ resulting from amniotic adhesion to skull (John Phillips)
xl, 130 ; xxxviii, 388
MooDELLT (P. S. M.), ovariotomy . . . x, 115
MooRB (T. N.), see Meadows, A.
MoEisoN (J. Ruthbrfoed), a case of deciduoma malign mii
occurring in England .... xxxviii, 130
„ secondary growth from vagina of deciduoma malig^ixim . iJ v, 249
„ deciduoma malignum of uterus .... xlv, 249
HOBFKIA, in relief of the pain in pelvic cancer (F. H.
Champneys) ...... xxii, 5
MoESB (Thomas H.), case of dermoid ovarian cyst impacted in
the pelvis which was removed by abdominal section during
the ninth month of pregnancy . . . xxxviii, 221
XX,
120
. xxii.
265
. xxiii.
260
vii.
160
. xlvi.
183
xl.
119
X,
113
xxii.
3
xxii.
155
. xxvii.
305
. xxviii.
68
XXV,
111
ix.
31
xxxviii,
118
xxxii.
132
xxi.
118
134
MORTALITY — MYOMA.
MORTALITY in childbed both in hospital and in general practice
(E. Boxall) .....
„ in lying-in hospitals (A. L. Gralabin)
„ maternal and foetal, the more frequent use of the forceps as a
means of lessening (P. H. Harper)
„ after obstetric operations, remarks on tables of (J. B. Hicks
and J. J. Phillips) ....
„ causes of, in ovariotomy (W. T. Smith)
„ among infants, notice of the Special Committee on .
„ Report of the Infant Mortality Committee
MouLLiN (J. A. Mansell), case of extra-uterine fcetation
„ case of hypertrophy of the breasts
„ inversion of uterus ....
Mow AT (George), case of apparent absence of uterus .
MUCOUS MEMBRANE, ovarian cysts with (J. Bland-Sutton)
„ of uterus, hajmorrhage from, in an infant (C. H. James)
„ — of an infant suffering from uterine haemorrhage (S. W
Wheaton) .....
MtriB (E. D.), placenta from a case of accidental haemorrhage
MULTIPAROUS UTERUS, measui-ements of, as compared with the
xlvii,
xxxi.
196
92
i, 142
Xlll,
iii,
xi,
xi,
XXV,
XXV,
xxvi,
55
41
24
132
103
212
158
XX, 289
339
66
XXX,
xxxii.
xxxiv,
XXXV,
190
338
nulliparous (J. Braxton Hicks and A. W. Edis)
xviii, 70,
Matthews
MUNCHMEYER'S TRANSFUSION APPARATUS (J
Duncan) ......
Murphy (James), sequel to a case of ovariotomy
Murray (G. C. P.), exomphalos, in which the gi-avid uterus
formed the hernial mass ....
„ ascites with ovarian disease ....
„ fibrous tumour of the cervix uteri
„ two large kidneys .....
„ ovariotomy trocar and cannula ....
„ ulceration of os and allongement of cervix uteri
„ new pelvimeter by Dr. Byford, of Chicago .
„ peculiar knotted cord .....
„ intra-uterine fibroid removed by single-wire ecraseiir
„ specimen of fibroid uterus, showing the three forms of the
disease — subperitoneal, interstitial, and submucous
„ flexible vertebrated uterine sound
Murray (John), pocket chloroform inhaler
Murphy (J.), see Godson, Cl€'me7it.
MUSCLES of the female pelvis and perineum, dissection of (Alban
Doran) ...... xxviii, 274
„ ossification of (E. H. M. Sell) . . . . xv, 125
Musgravb (J. T.), case of abortion followed by septicaemia and
fatal cardiac thrombosis .... xxi, 81
MYO-FIBROMA of the uterus, three specimens of (H. Gervis) . xxv, 108
MYOMA, large, of left broad ligament (Wm. Duncan) . . xxxi, 309
„ uterine, four cases of removal of large, by abdominal section
(Lawson Tait) ..... xix, 274
„ — note on its pathology and treatment (Lawson Tait) . xxv, 194^
„ — and polypus, ovarian cyst (J. Crawford) . . xxxiii, 74
xxxu,
xxvii,
i,
V,
vi,
viii,
viii,
ix,
xi,
xi,
xvi,
xviii,
5
108
190
184
5
313
30
39
54
248
140
X, 95
MYOMA — MYXOMA FIBROSUM.
135
MYOMA (contimicd) —
„ uterine, abdominal hysterectomy for; with brief notes of
twenty-eight cases (J. Bland-Sutton) . . . xxxix, 292
„ — (F. J. McCann) . . . . . xl, 3
„ degenerating uterine (W. Dvmcan) . . xxxvii, 147
„ uterine, diffuse (non-caps vdated) (C. J. Cullingworth) xxxvii, 143
„ — large gangrenous interstitial (C. J. Cullingworth) . xxxvi, 268
„ — soft, showing early cystic degeneration (J. H. Aveling) . xxvi, 270
„ cystic, of uterus weighing over 15 lb. (Alban Doran) xxxviii, 164
„ cystic intra-ligamentous, with double uterus (W. J. Gow) . xl, 134
„ fibro-cystic, of the uterus (J. Knowsley Thornton) . . xxvi, 54
„ — of uterus with septicsemia (H. A. Lediard) . . xxvi, 193
„ large fibro-cystic, growing from the cervix uteri (C. J.
Ciillingvorth) .... xxxviii, 8
„ and fibro-myoma of the uterus and allied tumours of the ovary
(Alban Doran) ..... xxx, 410
„ of uterus, oedematous (W. Duncan) . . xxxvii, 148
„ (edematous (R. H. O'Callaghan) . . . xxxvii, 201
„ polypoid, of the uterus (Aust Lawrence) . . . xxxii, 366
„ submucous and interstitial, removed by hysterectomy, uterus
with (W. Duncan) ..... xxxix, 290
„ necrotic change in a small uterine, occurring in a young
siibject (C. J. Cullingworth) . . . xxxvii, 284
„ xxterine, undergoing red degeneration (W. F. V. Bonney) . xlv, 464
„ carcinoma of the corpus uteri invading, hysterectomy (J. M.
Mum-o KeiT) ..... xlvii, 191
„ of the cervix uteri (C. J. Cullingworth) . . . xxxiv, 223
„ of the neck of the uterus (J. Bland-Sutton) . . xxxix, 161
„ pure, of ovary, with a microscopic section (A. Doran) . xliv, 168
„ placenta prsevia complicated by a large (J. Hickinbotham) . xxiii, 167
„ of the vagina (F. J. McCann) .... xlviii, 182
„ vaginal hysterectomy in the puerperium for sepsis due to
suppuration of (A. W. W. Lea) .... xlvii, 1
„ see Fibro-myoma.
MYOMECTOMY, abdominal, for the removal of a solitary inter-
stitial fibroid ("W. S. Handley and C. Lockyer) . . xlv, 51
„ — in second month of pregnancy, for fibro-myoma ; labour at
term (A. Doran) . . . . . xlvii, 426
„ remarks on, in connection with a case of fibro-myoma of the
uterxis in a patient aged 23 (A. E. Giles) . . . xlii, 299
„ during pregnancy and labour at term in an elderly primipara,
with notes on similar cases (A. Doran) . . . xlviii, 303
MYXO-CARCINOMA of abdominal wall and ovaries (W. S. A.
Griffith) ...... xxviii, 180
MYXO-FIBEOMA of cervix uteri (A. L. Galabin) . . xxviii, 178
MYXOMA of the labium majus (M. Handfield-Jones) . . xlvii, 362
„ of chorion not discharged till the seventh month (C. H.
Roberts) ...... xlii, 168
„ of chorionic villi engrafted upon ut«rus ; myxoma of fundus
uteri following vesicular mole (?) (A. L. Galabin) . . xlv, 241
„ of fxmdus uteri following vesicular mole (?) a myxoma of
chorionic viUi engrafted upon uterus (A. L. Galabin) . xlv, 241
„ in a foetus impeding delivery (T. C. Hayes) . . xviii, 83
„ of both ovaries, associated with leuksemia (A. L. Galabin) . xx, 123
MYXOMA FIBROSUM of Virchow (?) (W. S. A. Griffith) . xxx, 82
136
MYXOMATOUS DEGENERATION — NECROBIOSIS.
MYXOMATOUS DEGENERATION, see Degeneration.
MYXOMATOUS GROWTH of the peritoneum ( Jolin Williams) . xxir, 93
MYXO-SARCOMA of urethra in a child (A. L. Galabin) . xxxviii, 120
„ of the uterus removed by pan-hysterectomy (Amand Routh) . xli, 139
„ — supposed, removed by abdomino-vaginal method (Amand
Routh) ...... xli, 367
„ of vagina in a child aged 2^ (A. W. W. Lea) . . xlii, 143
NAEGELE, pelvis of, remark on (P. H. Chamyneys) . . xxiv, 191
„ pelvis (J. H. Targett) ..... xli, 231
„ oblique pelvis of, on the production of the shape of (G. E.
Herman) ...... xxviii, 6
„ — notes of a specimen of (W. S. A. GriflSth) . ix\-iii, 83, 84
„ — and the influence of the lumbo-sacral curve in the mecha-
nism of labour (R. Barnes) .... xxv, 258
„ pseudo-osteo-malaeic pelvis of (W. S. A. Griffith) . . xxvii. 186
Napibb (A. D. Leith), specimen of axial rotation of a right-
sided parovarian cyst with attached right ovary and
Fallopian tube distended by haemorrhage . . xxxiv, 124
„ — of cystic ovary and enlarged tube ; abdominal section ;
history of pregnancy within two months . . xxxiv, 126
„ foetus of four months' development contained within an un-
ruptiu'ed amnial sac with placenta priBvia attached . xxxiv, 158
„ large multiple fibro-myoma removed by hysterectomy . xxxiv, 159
„ successful case of Csesarean section . . . xxxiv, 105
„ — adjourned discussion ..... xxxiv, 138
„ hiBmatosalpinx, haemorrhagic and cystic ovaries . . xxxiv, 439
„ multiple fibro-myoma ..... xxxv, 3
„ needles, needle-holder, and self -retaining speculum . . xxxv, 3
„ large dermoid cyst with dentigerous plate . . . xxxv, 429
„ solid tumour ..... xxxvii, 283
„ — tumours . . . . . xxxviii, 29
„ f cetus at seven months illustrating celosoma with retroflexion,
meningocele, and talipes varus .... xxxvi, 116
„ suppui-ating dermoid cyst .... xxxiii, 460
„ macerated foetus ; double tubal disease . . . xxxiii, 461
„ habitual abortion ..... xxxii, 389
„ case of trismus nascentium .... xix, 5
Nappkr (Albert), defective formation of skin round the umbili-
cus ; plastic operation ..... iii, 65
„ amputation of the arm in pregnancy . . . vii, 12
Nash (W. G.), needle, " gi-ip-eyed " (H. J. Paterson) . . xlvii, 250
„ repeated tubal gestation : removal of unruptui-ed tube ;
recovery ...... xlvii, 408
NAVEL, case of exomphalic foetus (A. E. Giles and R. J. Probyn-
WiUiams) ...... xxxvi, 174
NAVEL CORD of a young infant, note on a condition observed in
(John Williams) ..... xxvi, 199
NAVEL-ILL in lambs, notes on (J. Hutchinson) . . xviii, 88
Neale (J.), singula!" malformation .... viii, 259
NECROBIOSIS or red degeneration of large uterine fibroids (A. H.
N. Lewers) ...... xlviii, 173
NECROSIS — NODULE.
137
ITECROSIS of pubic bones following delivery (W. S. Playfair) . xv, 219
„ of central portion of sarcoma of ovary lying in an abscess
cavity containing offensive pus (W. W. H. Tate) . xli, 373
., of solid masses in unilocular ovarian cyst (J. S. Fairbaim) . xliv, 126
IfEEDLE, curved, made to revolve, for cases of vesico-vaginal
fistula (J. H. Aveling) ..... xix, 66
„ fibroid tissue formed around a, removed from the left labium
majus (H. Briggs) ..... xlix, 223
UEEDLE-HOLDER, Kurz (H. R. Spencer) . . . xlv, 51
„ Hagedorn's surgical (G. G. Bantock) . . . xxvi, 271
,, and self-retaining speculum (Leith Napier) . . xxxv, 3
IfEOPLASMS, uterine and ovarian, tumour showing the impossi-
bility, in some cases, to diagnose between (J. D. Malcolm) . xxix, 249
Neugkbauek (Franz Ludwig), specimens illustrating spondylolis-
thesis ...... xxvi, 84
„ — report on ditto by committee (R. Barnes, W. Adams, Noble
Smith, and Alban Doran) .... xxvi, 186
HEUEOSIS, removal of the uterine appendages in cases of func-
tional (W. S. Playfair) .... xxxiii, 7
Nbwham (Samuel), description of the "guide-hook," a new
obstetric instrument . . . . . vi, 7
Newman (W.), patient who in eighteen pregnancies gave bii-th to
only seven living children, the eleven others having been
expelled dead at various periods of gestation . . iii, 408
„ enormous development of hydatids in omentum, simulating an
ovarian tumour . . . . . iv, 169
„ Cesarean section ; recovery of mother ; child not viable . viu, 343
„ — in 1866 ; subsequent pregnancy and delivery per vias
naturales; recovery ..... xiv, 142
„ remarks in the discussion on puerperal fever . . xvii, 105
„ uterus with extensive epithelial disease of the os and cervix
uteri ...... xvii, 213
„ remarks in the discussion on the use of forceps . . xxi, 153
„ case of inversion of uterus of sixteen months' standing ; re-
placement ; recovery . . . - . . xxxi, 166
„ see Harley, G.
NIGHTDRESS for ladies during and after childbirth ( — Stewart) xvi, 87
KIPPLES, eczema of, in both breasts (Thos. Chambers) . . xxii, 266
„ three cases of three, in the human subject — one case heredi-
tary (W. B. Woodman) . . . . ix, 50
„ sore, treatment of (H. C. Rose) . . , . iv, 135
„ see Breasts.
NIPPLE SHIELD, Auvard's (Clement Godson) . . xxx, 198
„ (F. Taylor) . . . . . . iv, 228
„ and the treatment of sore nipples (H. C. Rose) . . iv, 135
NITRATE OF SILVER, properties of, with an account of a new
instrument for its use in uterine disease (R. EUis) . . iv, 116
Nodes (John D. S.) and Frank Hinds, fatal rupture of an
anevu-ysm of the splenic artery immediately after labour . xlii, 305
NODULE, sarcomatous, in the centre of a fibroid of uterus (A maud
Routh) ...... xlix, 1
138 NORTON — OLDHAM.
Norton (Selbt), teething . . . . . xi, 183
NOSE, congenital absence of, right palpebral fissure and right
ear; impei'forate anus, etc. (W. Dvmcan) . xxxvii, 16
NUCK, hydrocele of the canal of, containing a portion of the left
Fallopian tiibe (L. Eemfry) . . . . xl, 9
NULLIPAROUS UTERUS, note on the post-mortem diagnosis of (A.
Meadows) ..... xvii, 355 ; xviii, 69
„ measurements of, as compared with the miUtiparous (J.
Braxton Hicks and A. W. Edis) . . xviii, 70, 74
NuNN (T. W.), inflammation of the breast and milk abscess, with
an analysis of seventy-two cases .... iii, 197
„ desti-victive inflammation of the hip-joint in a puerperal
Avoman . . . . , . vi, 116
NYMPHA, hypertrophied (R. Greenhalgh) . . . x, 57
„ hypertrophied (Fancourt Barnes) . . . xxv, 165
„ and clitoris, hyjiertrophied (W. Duncan) . . xxxvi, 3, 149
OBLIQUITY, lateral, of the fcetal head, the causation of (A. L.
Galabin) ...... xxv, 252
„ of pelvis, see Pelvis.
OBSTETRIC binder and special position as aids in the treatment
of impeded parturition (R. Hardey) . . . ii, 79
OBSTETRICS, memorial re representation on General Medical
Council of . . . . . . xi, 124
„ anaesthetics in practice of (A. E. Sansom) . . . x, 121
„ the advantages of antiseptics in practice of (W. O. Priestley) . xxvii, 197
„ direct representation of, at the General Medical Council
xvi, 21 ; xxiii, 46
„ electrical instruments in use in (W. E. Steavenson) . xxix, 298
„ of the kyphotic pelvis (F. H. Champneys) xxv, 166; xxviii, 253
„ studies in (C. F. Ponder) .... xl, 339
„ see also Midwifery.
O'Callaghan (R. H.), cedematous myoma . . xxxvii, 201
OCCIPUT, serous tumovu- in region of (W. B. Woodman) . vii, 158
OCCLUSIGIT of the pixlmonary arteries seventeen days after
parturition (D. Mackinder) . . . . i, 213
„ complete, of the os uteri, with retention of menses after diffi-
ciilt labour (J. H. Davis) . . . . iv, 91
„ of the vagina in a case of absence of the uterus (F. Bousquet) xxvii, 123
(EDEMA of the lower half of the body, after a fall in the seventh
month of pregnancy ; premature labour ; recovery (A. Rasch) vii, 80
„ two cases of fffital ascites and (H. R. Andrews) . . xliii, 166
OFFICERS of the Society, alteration of laws respecting the
xxvii, 58 ; xxxvii, 288 ; xxxix, 53
Ogston (F.), see HicJcs, J. Braxton.
Oldham (H.), retroflexion of the gravid uterus during labour at
term . . . . . . i, 317
„ fibcoid polypus removed by Hicks' instrument . . iii, 349
„ presidental addi-ess . . . . vi, 14 ; vii, 19
„ ovarian tumour . . . . . vi, 75
o'mEARA — OSWALD. 139
O'Mbara (F. a. T.), case of dilatation and hypertrophy of the
bladder in a foetus ..... xxix, 54
OMENTUM, colloid tumours, large conglomerate of, grown from
the (R. Barnes) .... xvii, 216 ; xviii, 193
„ cyst of the great (Alban Doran) .... xxiii, 164
„ tubal gestation in which the ovum continued to grow for
about four weeks after rupture, the gestation sac becoming
implanted on (C. Lockyer) .... xlv, 400
„ hydatids in, simiilating an ovarian tiunour (W. Newman) . iv, 169
„ malignant tumour of (G. D. Bro^vn) . . . xviii, 24
„ hydatids of, or connected with (C. J. Cullingworth and H. H.
Glutton) ...... xlvi, 254
„ cystic sarcoma of, simulating ovarian tumovu- ; removal ;
recovery (W. Duncan) .... xxxvi, 264
OOPHORECTOMY, calcified uterine fibro-myoma removed piece-
meal for haemorrhage fourteen years after (H. E. Spencer) . xlix, 271
„ ovaries and Fallopian tubes removed by (J. Knowsley
Thornton) ...... xxiv, 137
„ uterus with fibroid tumours and carcinoma of the cervix
removed post mortem from a patient on whom eight years
previously had been performed the operation of (G. F.
Blacker) ..... xxxvii, 213
OOPHORITIS, see Ovaries.
OOPHORON, multilocular cyst of (Cuthbert Lockyer) . . xlii, 37
OPERATIONS, obstetric, remarks on tables of mortality after (J.
B. Hicks and J. J. Phillips) .... xiii, 55
OPHTHALMIA NEONATORUM, the prevention of, and of its
ravages (D. McKeown) .... xxvii, 49
„ — and treatment of, by Crede and others (J. Watt Black) . xxxv, 88
„ its aetiology and prevention (S. Stephenson) . . xlv, 337
OS INNOMINATUM, macerated, from case of malignant disease
(T. C. Hayes) ..... xvi, 174
OSSIFICATION, spinal column exhibiting want of, in the inter-
articular portion of the lumbar vertebrae (G. F. Blacker) . xlii, 90
OSTEOMALACIA, abstract of a memoir on, by Dr. Gaetana Casati,
of Milan (E. Barnes) . . . '. . xiii, 244
„ ovaries removed from a case of (A. Easch) . . xxxiv, 462
„ cured by excision of the ovaries (A. Easch) . . xxxv, 39
„ on the influence of the removal of the ovaries on metabolism
in connection with (J. E. Curatulo) . . xxxviii, 17
„ pelvis deformed by (W. S. A. Griffith) . . . xxvi, 230
OSTIUM, on closure of, in inflammation and allied diseases of the
Fallopian tube (Alban Doran) .... xxxi, 344
OS UTERI, occlusion of (J. H. Davis) . . . iv, 91
„ see also Uterus, os uteri.
OS VAGIN.S3, see Vagina, os vaginee.
Oswald (J.), monstrosity ..... xii, 115
Oswald (J. W. J.), case of suppurating tumour of left ovary . xvii, 168
„ — Caesarean section for deformed pelvis . . . xvii, 378
„ cancer of ovary extending to uteriis and rectum . . xviii, 122
„ case of hypertrophy of spleen and liver in a child, aged 9 . xviii, 191
„ see Routh, C. H. F.
140
OUTHWAITE OVARIES.
OuTHWAiTB (William), placenta of, double ovTun . . xxiv, 3
OVARIAN TUMOUES (P. Smith) .... xiii, 98
„ and treatment of pedicle by acu-pressure needle (A. Wilt-
shire) ...... xii, 31
„ changes in pedicle of, when treated by ligature (G. G.
Bantock) ...... xiv, 2
,, firappling ii'on for use in removal of (Heywood Smith) . xxii, 45
OVARIES, abscess of; peritonitis ; death (A. W. Edis) . . xiii, 99
„ — (Heywood Smith) ..... xxxiv, 3
„ multiple abscesses of, with pyosalpinx (C. J. Cullingworth) . xxxix, 47
„ three cases of pelvic inflammation attended with abscess of
the (C. J. Cullingworth) .... xxxvi, 277
„ inoperable papilloma of, pelvic organs of a case (A. Routh) . xlii, 216
„ absence of, note on the involution of the puei-peral uterus in
the (John Williams) ..... xxvi, 203
„ and uterus absent in tlu-ee sisters (C. E. Squarey) . . xiv, 212
„ after attempt at abortion (T. Ballard) . . . xii, 3
„ unusual example of ruptui-e of an ovarian adenoma (J. Bland-
Sutton) . . . . . . xU, 98
„ adeno-carcinoma of both (W. W. Lea) . . . xliv, 225
„ — (F. N. Boyd) ..... xUx, 50
„ removed by abdominal section, adeno-carcinoma of uterus and
left (W. Duncan) ..... xxxix, 289
„ apoplexy of, cystic dilatation without rupture (A. Doran) . xxxii, 119
„ — double, from a case of acute peritonitis (H. A. DesVoeux) . xxxiv, 214
„ atrophy of, and deficient development of the utei-us (A.
Doran) ...... xxi, 253
„ — with collapse (cirrhosis), fibroid degeneration, and angioma
of (J. Braithwaite) ..... xxxvi, 325
„ containing a calcareous ball, probably a large calcified corpus
fibrosum (J. Bland-Sutton) . . . . xl, 223
„ blood concretions in (A. Doran) . . . . xl, 214
„ cancer of, extending to uterus and rectum (J. W. J, Oswald) . xviii, 122
„ case of supposed cancer of both (J. L. Worship) . . xix, 235
„ cancer of both, primary to carcinoma in the muscular wall of
the uterus (C. Lockyer) .... xlvi, 302
„ primary cancer of (A. L. Mcllroy) . . . xlviii, 251
„ carcinoma of (C. J. Cullingworth) . . . xxxii, 199
„ — of unusual type (C. Lockyer) .... xlvi, 349
„ — (W. W. H. Tate) ..... xlviii, 96
„ primary carcinoma of both (C. Lockyer) . . . xha, 229
„ — solid (W. S. A. Griffith) .... xlii, 34
„ carcinoma of the body of the uterus with secondary growth in
both (H. T. Hicks) ..... xlviii, 196
„ — u-ith cystic fibroid (E. Boxall) .... xlviii, 136
„ — haemorrhagic (C. J. Cullingworth) . . . xxxiii, 445
„ carcinomatous tumour of (J. S. Fairbaim) . . . xliii, 208
„ chorion-epithelioma of the uterus ; lutein cysts in both (G. F.
Blacker) ...... xUx, 104
„ new method of examination of the tumour in cases of suspected
cystic disease of (W. G. Hewitt) . . . i, 55
„ cyst of, co-existing with pregnancy, which ruptured spon-
taneously ten days after labour (C. Clay) . . . i, 226
„ — (A. W. Edis) ..... xiii, 41
„ — complicating labour (A. H. Brewer) . . . xx, 184
OVARIES. 141
OVARIES (continued)—
„ cystic disease of complicating pregnancy (J. B. Hicks) xi Sfi-?
„ — probable ongin of (A. Meadows) ^ 'J' wi
„ - both (C. H. Carter) . . ' " ' ' ' ina
" in i<=s earliest stage (R. Barnes) ' * ' f^' }:2
„ (F. A. Purcell) . . ' * ^^^' ^''l
„ removed for dysmenorrhcea (W. Duncan) ' ' xx^J' 9^^
" ~ T7 ^"li liyPf trophied Fallopian tubes (John Phillips) " xSi 332
„ cystic the seat of hemorrhage (M. Handfield- Jones) ^ xSS' 27
" Thornton") ''""^"^'^^'''''"^'^'^^'''^''^P^'^^^^^
„ — (W. Duncan) '. ' ' • ^^X' J?*
„ - in connection with iiterine fibroid (F. H.' Daly) .* xvi"^' 202
" 7a" W. EdS) ''*''™'' ^""^ ^""*^" ^'"^ ^^^"^ peritonitis ' '
„ — presence of limpid fluid in (A.L. Galabin) * ' ,S' 9^
,, - in a case of hypertrophy and anteflexion of the uterus
(Graily Hewitt and A. Q. Silcock) ^^^ ,„i
,, — giving rise to a hematocele (W. Duncan) ' " ^xv^T' 9m
„ — with mucous membrane (J. Bland-Sutton) ' ' J!^' ooq
„ — and hematosalpinx (W. S. Playfair) . ' ^^y.- ^^' f^,
" - 7Pt^^ed secondary, in the waU of a multilocular tumour
or (A. Doran) . .
„ hemorrhagic and cystic (A. D. Leith Napier) ' * ^x^' III
„ cyst, pair of incipient (J. D. Malcolm) . ' Jf^Ji' 9a
" ~ "*^"°^ myoma and polypus (J. Crawford) * ' JJS!' S
„ — fatal rapture in an infant (A. Doran) . * ™i7 Ll
" ^o?an)™^' anterior serous perimetritis simulating (A.
;: ~ ^fc*?„!ii'n^X' ">' "'^^^ f^;^- f""'p=) ° ■ ^ ^
„ — uterus and appendages from patient with (P. Smith) " ^^h' f^«
„ - and enlarged tube (A. D. Leith Napier) ^ ' ^^' \fi
„ midtilocular cyst of left, removed six years after removal of '
right ovary (T. Spencer Wells) .
„ cyst, multilocular (John WilHams) " ' ^' Vt
» (W. Duncan) . ' ' ' ' ^l' jj,
„- -(J. Knowsley Thornton) \ ' ' ^^v, 212, 234
„ (w. Walter) . .... xxvi, 55
" - - and fibroma (?) of the opposite (P. Horrocks) ". * xSS' 200
„ multilocular tumour of (W. Duncan) xxxm, /oo
„ papiUomatous cysts of, removed during the foturth" month of
pregnancy (W. A. Meredith) . y " q7A
:: = %% :'f ^AtsS)"" '^""= '^'""'■' (^- i""-") : --^: ?«
" *Sr; fTll ™"^'i°f " papiUomatois ovarian cystoma ''""' ^^
?"h (X a Malc^to) °' ""^ '"^'.*^' ^-^ '"'^ -r--^ '-^ ,
„ papiUomatous accessory (A. L. Galabin) . " " „Si' |!?
„ cystoma, papillomatous, removed after double ovariotomy
fifteen years previously (J. D. Malcolm) . ^ ,,^^^ or
''TATSawS^^"'''^^'''''''^""'^''^^''^'^^*™^''^^'^^^*^^^*^
„ piliferous cyst of (R. Barnes) ." " ' • xxi, 288
„ cyst of (T. W. Eden) " * • vi, 249
' ^{V^^xT''^ ''^'*'''' ''''^^ microscopical section of same '^^' ^*
^ ' ^'^f • • • . . . xxxvi, 184
142
OVARIES.
OVARIES (continued) —
„ dilated tubes and cystic (early stage of tubo-ovarian cysts)
(W. Duncan) .... Jixxvii, 150
„ cyst of, and hydrosalpinx removed by anterior colpotomy
(Amand Eouth) .... xxxviii, 185
„ cystic (G. Drummond Eobinson) .... xxxix, 130
„ tubo-ovarian cyst (W. S. A. Griffith) . xxix, 273, 302 ; xxx, 3
„ only congested and inflamed in two cases of parovarian cyst
with twisted pedicle (H. R. Spencer) . . . xlii, 333
„ right, inguinal hernia of, successfully removed (A. Meadows) iii, 438
„ pregnancy after removal of both, for cystic tumour (A.
Doran) ...... xliv, 231
„ tumour of, complicating pregnancy; cyst ruptured during
examination ; immediate laparotomy ; recovery (W. Duncan) xxxvi, 312
unilocular, pathology of certain so-called
luiiloctdar cyst involving both, and with both Fallopian tubes
attached (J. Knowsley Thornton)
containing solid masses undergoing necrotic change (J. S.
Pairbairn) ......
dermoid cyst of right ; post-mortem (W. B. Woodman)
XV, 105
xxi, 119
xliv, 126
vii, 158
46
38
57
6
105
93
133
(J. Knowsley Thornton) . . xxiii, 104 ; xxvii,
(G. G. Bantock) ..... xxv,
(Heywood Smith) .... xxvi,
(C. H. Carter) .... xxvi, 86, xxxii,
microscopic sections of (A. Doran) . . . xxiii,
myxomatous growth of the peritoneum (John Williams)
twisting of pedicle in (A. Doran)
sarcomatous (J. Knowsley Thornton)
pressure of, causing retention of ui'ine (W. R. A. Griffith)
in a max-e (C. S. Pollock)
• containing three (S. W. Wheaton) .
(J. Mackenzie) .....
(A. C. Butler-Smythe) ...
(J. Bland-Sutton)
infiltration of broad ligament with fat (J. Bland
Sutton) ......
of right ; t\visted pedicle (W. Duncan)
impacted in the pelvis, which was I'emoved by abdo-
minal section during the ninth month of pregnancy (T. H.
Morse) ..... xxxviii, 221
of size of a child's head, in case of ruptured uterus
(A. H. N. Lewers) .....
obstructing labour ; displacement of the tixmour from the
true pelvis and extraction of the child with forceps ; removal
of tumour five weeks later ; recovery (J. M. Munro Kerr)
removed by posterior colpotomy (A. Eouth)
— — removed by abdominal section five years after causing
obstruction to labour (W. W. H. Tate)
^\T.th minute pedicle produced by torsion of mesovarium
only (A. L. Galabin) .....
— tixmour of (J. Knowsley Thornton)
bony girdle from (S. W. Wheaton) .
dentigerous bony plates from (A. Doran)
(Wm. Duncan) .....
— — (J. Bland-Sutton) ....
of both ; twisted pedicle (R. Boxall)
disease (J. L. Worship) ....
xxiv,
xxiv,
xxvii, 194
xxxi, 135
xxxi, 234, 253
xxxiii, 28
xxxiii, 461
xxxiii, 463
xxxiv, 5
xxxiv, 7
xxxvi, 267
xlii, 95
xliii.
145
xliv.
38
xlvi.
344
xlvii,
331
xxiv.
80
XXXV,
4
xxxi.
86
xxxi.
255
xxxi,
338
xli.
5
xi.
76
07AEIES.
143
OVARIES (continued)—
„ disease of, with ascites (G. C. P. Murray)
„ — complicating puerperal peritonitis, foUowed by febrile dis-
eases of the puerperal state (E. U. West) . "« uis
„ — both, the right ovary forming a communication 'with the
cscum and externaUy ; the left tumour emptying itself into
the rectum ; death, and post-mortem results (H C Rose)
" "^ t^'o cases of malignant embryomaof (H. T. Hicks and J. H^
" ~Z fi^^Y^cystic disease of uterus mistaken for (C H
Kouth) . . V . xj..
» extirpation ; recovery (T. Bryant)
„ — labour complicated with (E. T. Warn)
" — complicating pregnancy (T. Spencer Weils)
„ — (V. Saboia) . ^
" }fK "^ f^''''^ ^'^T" ^^' ^«°io^ed by ovariotomy (L. j. Martin)
„ fibroid tumour of the right (C. H. Carter) ^^r^ui)
„ removed by abdominal section (John Williams')
" ™ a papuliferous cyst (John WiUiams) . xxix 247 ^iq
„ - - five specimens of, ^dth observations on their pathological '
anatomy (J. S. Fairbairn) F " ^"logicai
„fibro-cyst of (W. A. Meredith) . \ * xxix 248^ 5^5
„ fibro-sarcoma of the right (M. Handfield-Jones) '. xxti 12fi
» (W. A. Meredith) . '' • ^^^}' ^f*
„ fibroma of, mistaken for the head of an extm-uterine foetus in ''^''''
V, 190
i, 187
ix, 44
xlvii, 287
viii, 122
xiv, 79
xi, 198
xi, 251
xii, 312
xii, 302
xxiv, 139
XXV,
a case of obstructed labour (W. S. A. Griffith)
» — (H. T. Eutherford) . .
„ fibroma of both (C. J. Cullingworth)
„ — the ligament of (A. Doran)
„ — (J. Crawford)
„ — (?) of (P. Horrocks) . ' * "
„ — (M. Handfield-Jones)
„ — and ovarian ligament removed by operation (A 'Doran^
„ — ligament of, removed by operation (A. Doran)
„ — undergoing calcareous degeneration (C. Hubert Eoberts^
„ — impaction ; ascites ; removal (A. Doran)
„ — (C. J. Cullingworth) . .
, — pure (A. Doran) .."**•
' ~ ?^®-!;^^^ ^^ ^" ^^^^ i^ diameter (A. Doran)
, — (F. N. Boyd) ^ '
, — (A. E. Giles) . ; ■ • •
' T T'*^/^i"«-™yoma of uterus with extensive carcinoma of
body of uterus (W. W. H. Tate) lunoma oi
, — (F. E. Taylor) . / '
', - (A^^o^thV ^^' '' '^'^^^''' ''^'^^^^*i<'^ ^o^ ten years (A. Doran)
, — (M. Handfield-Jones)* * * " *
' ^H^°cSe?)'' ""^ *^^ "^^*' removed by abdominal section (C.
"Doran)""^"^™^ °^ *^^ "^''''^' ^'°^ ""^^^ tumours of tlie (A.
- (A J. Sturmer) .' .' " ' ■ _
- and cystic disease co-existing in the same (W. W. H Tate) xlv? 27?
H h! auttoi)"'^'''''^ "''^' ^"'^ (^- J- Cvmingworth and "' '''
hydi-ocele of, containing'papillomata (J. Bland-Sutton) ' xxxi?' 215
pure myoma of, with a microscopic section (A. Doran) ' SI' Tfi?
myxo-carcinoma of (W. S. A. Griffith) ' •-' ^^
V v^iXlUl,!!; . , XXVlll, 180
. xxxiii, 140
. xxxiv, 88
xxi, 276
. xxxi, 200
. xxxvi, 190
. xxxvi, 192
. xxxvi, 343
XXX viii, 187
xxxviii, 8
. xxxix, 8
. xxxix, 37
. xxxix, 279
. xliv, 172
. xliv, 173
xliv, 176
xliv, 360
xlvi* 139
xlvi, 280
xlvii, 421
xlviii, 133
xlviii, 332
xxix, 190
XXX, 410
144 OVAEIES.
OVARIES {continued) —
„ myxoma of both, associated with leukaemia (A. L. Gralabin) . xx, 123
„ f ungating papillomata of both (J. Knowsley Thornton) . xxviii, 38
„ removal of both, during pregnancy (J. Knowsley Thornton)
xxvii, 46 ; xxviii, 41
„ removed from a case of osteomalacia (A. Easch) . . xxxiv, 462
„ osteomalacia cured by excision of (A. Rasch) . . xxxv, 39
„ on the influence of the removal of, on metabolism in connection
with osteomalacia (J. E. Curatulo) . . xxxviii, 17
J, acute torsion of an ovarian pedicle, from a case where there
was chronic torsion of the pedicle of a tumour of the opposite
(A. Doran) ...... xliii, 12
„ prolapsed adherent (W. S. A. Griffith) . . . xxvi, 270
„ non-malignant tumours of, sections of (W. S. A. Griffith) xxx, 302, 409
„ suppurating tumour of left (J. W. J. Oswald) . . xvii, 168
„ treatment of ovarian prolapse by shortening the ovarian liga-
ment (V. Bonney) ..... xlviii, 339
„ sarcoma of (G. Elder) ..... xxv, 130
„ — anterior serous perimetritis simulating (A. Doran)
xxxi, 217 ; xxxiii, 185
J, — both (J. A. Shaw-Mackenzie) .... xxxiv, 2
^^ _ large (?) of (P. Horrocks) .... xxxvi, 192
„ — (A. Doran) . . . . . xl, 296
„ _ (W. R. Dakin) ..... xxxvi, 313
^, — showing necrosis of central portion lying in an abscess
cavity containing offensive pus (W. W. H. Tate) . . xli, 373
„ — primary melanotic (H. E. Andrews) . . . xliii, 228
„ — (P. Horrocks) ..... xliv, 94
„ — unusual case of (J. Inglis Parsons) . . . xlv, 48
jj — associated with tubal mole of the same side (A. L.
Galabin) ...... xlviii, 19
„ tumours of, axial rotation of, leading to their strangulation
and gangrene (Lawson Tait) .... xxii, 86
jj — the right, with the Fallopian tube adherent to the opi)Osite
ovary (J. Knowsley Thornton) .... xxiii, 258
jj — complicated by a haematosalpinx (John Phillips) . . xxviii, 89
„ — with t-v\asted pedicle (R. Barnes) . . . xxvi, 59
„ — and fibroid of uterus (A. Meadows) . . . xxv, 161
„ — cystic of both (J. Knowsley Thornton) . . . xxvi, 269
„ — solid (Leith Napier) . . . . xxxviii, 29, 32
,, — removed fi-om a woman, aged 36 (A. W. AddinseU) . xlii, 139
„ acute suppiuration and sloughing of, after parturition (J. H.
Targett) . . • • . ." . xxxvii, 216
„ of a healthy woman mvu-dered by a stab which divided the
femoral artery (A. L. Galabin) . . . . xxi, 23
„ from a case of congenital inguino-ovarian hernia (T.
Chambers) ..... xxi, 92, 256, 269
„ and jejvmum (W. D\incan) .... xxx, 82
„ and FaDopian tubes, removed by oophorectomy (J. Knowsley
Thornton) . . . • • • xxiv, 137
,, — endometrium, and pelvic peritoneum, the relation to each
other of inflammation of (A. Doran) . . . xxvii, 164
,^ _ diseased (C. H. Carter) . . . . xxxii, 136
„ and Fallopian tubes, from a case of persistent chronic ovaritis
(J. D. Malcobn) ..... xxviii. 278
„ tubal gestation (W. Duncan) . . . xxxi, 165
OVARIES — OVARIOTOMY.
145
OVARIES (continued)—
„ and FaUopian tubes and uterus from a case of Csesarean sec-
tion (C. J. Cullingwoi'th) ....
„ — distended Av-ith blood (W. Duncan)
„ — with papilloma (W. Duncan) ....
„ — dUated (T. C. Hayes) ....
„ — greatly enlarged, with ttunouo.- of (P. Horrocks) .
„ — microscopical sections of tiiberculosis of (C. H. Roberts) .
„ — tubercular disease of (A. W. W. Lea)
„ — right, cystic fibroid Avdth carcinoma of left (R. Boxall)
„ normal, in primary cancer of (H. Briggs)
„ — left, solid tumour of, with an attached cyst communicating
(W. F. V. Bonney) .....
„ extirpation of both, Avith uterus (T. Chambers)
„ and uterus, extirpation of, with large fibrous tumoiu's (I. B.
Brown) ......
„ — of a child who died of tubercular meningitis (F. Beach)
„ — of a woman who had died from haemorrhage into the pelvis
(Heyv/ood Smith) .....
OVARIOTOMY (P. S. M. MoodeUy) ....
„ (E. M. Hodder) .....
„ five cases of (I. B. Brown) ....
„ the mode of its performance and the results obtained at the
London Surgical Home (I. B. Bro-\vn)
„ with cases and remarks on the different steps of the operation
and the causes of its mortality (W. T. Smith)
„ and reply to a statement respecting it made by Mr. Baker
Brown ......
„ four additional cases of (W. T. Smith)
„ statistical and practical ; also a successful case of entire
removal of the uterus and its appendages (C. Clay)
„ with remarks (T. Bryant) ....
„ eight additional cases of (W. T. Smith)
„ belt for use after (Hey^vood Smith)
„ specimen illustrating an operation for dou,ble (J. Scott)
„ — report on ditto .....
„ double (J. Matthews Dimcan) ....
„ — during pregnancy (J. Knowsley Thornton) xxvii, 46 ;
» two cases of (W. A. Meredith)
„ — carcinomatous uterus removed eighteen and a half years
subsequent to (A. C. Butler-Smythe)
„ during pregnancy, with remarks on the treatment of ovarian
tiunours complicating^pregnancy (E. Goddard)
„ performed during pregnancy, additional cases of (T. Spencer
WeUs) ......
„ double intestinal obstruction following (J. H. Targett)
„ embolism of the pulmonary artery after (E. Parson)
„ abdominal, during labom- (H. R. Spencer) .
„ during labour, in a case of incarcerated ovarian dermoid
obstructing (H. R. Spencer) ....
„ on Ligature of the pedicle in (Alban Doran)
„ new method of securing the pedicle in (I. B. Brown)
„ in which the pedicle was tied and retiu-ned, and the ligature
removed in forty-eight hovu's (J. H. Aveling)
„ loop of small intestine found adherent to the pedicle six
months after (H. J. Paterson) ....
10
xxxi.
308
xxxii.
306
xxxii.
346
xxxvi.
185
xxxvi.
185
xlv.
92
xlv.
133
xliii.
71
xlvi.
60
xliv.
92
xxiii.
12
vi.
249
XV,
57
xvii.
56
X,
115
xii.
308
iii.
352
iv, 59
iii, 41
iv.
89
iv.
141
V,
58
vi.
35
vi.
66
xxii.
45
xiii.
163
xiii,
264
xxiii.
6
xxviii.
41
xxxiv.
239
xlui.
214
xiii.
275
xix.
185
xl.
175
vii.
8
xlviii.
37
xl.
14
XXXV,
131
vii.
28
vii.
229
xlvii,
316
146 OVARIOTOMY OVUM.
OVARIOTOMY (continued)—
„ on the uianagement of true and false capsules in (Alban
Doran). ...... xxxix, 265
„ for removal of ovarian tumour (T. Spencer Wells) . iii, 214, 285
„ four additional cases of (W. T. Smith) . . . iii, 215
„ large filiroiis tumour of the ovary removed hy (L. J. Martin) . xii, 302
„ for ovarian dropsy (I. B. Brown) . . . . v, 279
„ in ovarian dropsy ; recovery (H. "W. Sharpin) . . vii, 105
„ sequel to a case of (J. Murphy) .... xxvii, 108
„ tliree successful cases of, where axial rotation of ovarian
tumours led to their strangulation and gangrene (Lawson
Tait) ...... xxii, 86
„ trocar and cannula (G. C. P. Murray) . . . viii, 313
„ use of the actual cautery in (I. B. BroAvn) . . . viii, 109
„ vaginal, for removal of small ovarian tumoui*, from a patient
who was about two months pregnant (J. W. Taylor) . xliv, 297
„ and posterior vaginal section dui-ing Labour ; ovarian tumour
obstructing delivery ; operation and delivery at one sitting ;
recovery (J. W. Taylor) .... xliv, 275
„ in women over eighty ; a case, aged 83, complicated by
epithelioma of the vulva (L. Kemfry) . . xxxvii, 155
OVARITIS, persistent, chi-onic, ovaries and tubes from (J. D.
Malcolm) ...... xxviii, 278
„ dysmenorrlicea, metrorrhagia and sterility, depending upon a
peculiar formation of the cervix uteri (K. Barnes) . . vii, 120
„ sub-acute, diagnosis of (E. J. Tilt) . . . xv, 202
OVIDUCT of the frog, microscopical sections of (W. S. A. Griffith) xxx, 196
OVOTESTIS occurring in man, true unilateral hermaphroditism
with (G. F. Blacker and T. W. P. Lawrence) . xxxviii, 265
OVULATION aud menstruation of monkeys and the human female
(W. Heape) . . . . . . xl, 161
OVUM, aborted, showing cysts in the decidua vera (John Phillips)
xxxi, 52, 161
,, — (Kobert Wise) ..... xxxix, 259
„ apoplectic (G. E. Herman) .... xxii, 45
„ — (A. Routh) ...... xxxii, 19 i
„ — in a case of unruptured tubal gestation (C. J. Culling-
worth) ..... xxxiv, 155, 182
„ blighted, protracted retention of (R. U. West) . . iv, 17
„ — report on specimen shown by Hey^vood Smith by Drs.
Meadows and Phillips ..... xii, 329
„ — (John PhiUips) ..... xxviii, 209
„ — -with fleshy decidual hypertrophy (John Phillips) . xxxiii, 35
„ — wdth endometritis polyposa (A. H. N. Lowers) . . xxxiii, 197
„ early, with funis tightly encircling the left thigh of foetus (T.
Fitzpatidck) . . . . . . x, 141
„ of about five days' growth, together with a decidual uterine
cast, expelled after eight weeks' amenorrhoea (W. E.
FothergiU) ...... xliii, 162
„ description of a five weeks', removed in a subsequent preg-
nancy in a case of puerperal eclampsia (W. S. A. Griffith and
T. W". Eden) . . . . . . xU, 151
„ on au early tubal (J. Bland-Sutton) . . . xxxvi, 195
OVUM — PAN-HYSTERECTOMY.
OVUM (contimicd)—
„ of seven months expeUed entire (iv. M Whitmav^-hV
„ containing foetus thi-ee eighths of "an inch I'ono- m <irv„•4-^,^
„ placenta of double (W. oSthwaite ^ ^^- ^™'*^^
" ""steveSf "" ^'^'^" ^ pre-menstrual life, fate of (T. G
„ in ovo (E. Barnes) . " ' '
" !;?'f^''^ ^^V*'^^' gestation, membranes of (J H Davis^
„ m twins, entu-e full-time (R. Wise) ^ ''
„ hydatidiform degeneration of (W. G. Hewitt)
" V.^- ti- r . itouth) .
" (W. A. Eussell) . ■ ■ •
» (F. Webb) . ■ • •
„ forceps (F. C. Cory) . ' ' '
.., — improvement in (H. Smith)
„ — modifications of (Heywood Smith)
Owen (W. B.), mechanical obstruction in growth of a foetus
147
xi
, 80
vi
105
xiii,
88
xvii.
48
xiij
163
. xxiv.
3
X.
. slv.
465
iv.
87
x.
57
xlix.
147
ii.
112
iij
242
vii.
228
ix.
85
viii.
5
. xxii.
46
XX,
170
viii.
4
^^^ AdiSSf'*™^^' microscopical slides from a case of (A. W.
^^Vl^^Zr™""' ""^ ""^^*^^*^^^ '^ «^^*«<="« practice (A:
Page^H.) (introduced by H. Spenceh), a mylacephalous acardiac
^^''^T.lfr^"?^-^'*"?^" '""'^^ *^^^ ^^^^^ and three arms
" lll^i'f ^" ^;^^^ ^y committee (W. S. Playfair and T. c!
„ — dissection of ditto (R. Brookes')
>, — note by J. G. Westmacott - .' ' "
^^'''hymen ''^'^' obstructed laboiu- from the presence of the
'^' (hTspTuc'^" ^'"°^"^' ^^^-- ^' P^--^^ P-^a by
^^^Si^er)''^''''';'^^'*^^"'''"^ ^'^^" secondary growths in (C.
PAN-HySTEEECTOMY, uterus removed by (A. H. N. Lewers)
" TahXmin^^rBa^X^r ^^-"^^^ ^' uterus rloved
:: tL^tTrf ^el^^eTry^H^^^^^^^^^ ^^'"''^ •
„ abdominal, for cancer of the body of uterus (A. H. N Lewersi
" i^y^A^rKewtr '' ''^'°'^ ^' '^^ ^^^^™^' -"-™^
xli, 3
X, 121
xlii, 14
. xxxiii,
xix,
xix,
xix,
xix.
,302
40
97
98
100
iv, 211
xxxi, 203
xlv,
xxxix.
xxxix,
xH,
xli,
xliv.
245
131
321
139
275
10
xliv, 290
148
PAN-HYSTERECTOMY — PARSONS.
PAN-HYSTERECTOMY {continued)—
„ uterine fibroid removed by (W. C. Swayne) . • xlv, 140
„ abdominalj for removal of fibro-myoma of the cervix uteri (W.
A Meredith) ...... xlvi, 12
„ diu'ing labour in the seventh month of a pregnancy in a
iiterus with fibroids (J. Bla.nd-Sutton) . . . xlvi, 238
„ for removal of pregnant uterus with cancerous cervix (F. N.
Boyd) ...... xlvi, 3-i5
PAPILLARY INFLAMMATION, chronic, of the vulva (W. O.
Priestley) ...... xxvi, 156
PAPILLOMA of the Fallopian tube and the relation of hydro-peri-
toneum to tubal disease (Alban Doran) . . xxviii, 229, 243
„ fungating, of both ovaries (J. Knowsley Thornton) . . xxviii, 38
„ inoperable, of the left ovary, pelvic organs from a case of (A.
Routh) ...... xlix, 216
„ of ovary and tube (W. Duncan) .... xxxii, 346
„ ovarian hydrocele containing (J. Bland-Sutton) . . xxxiv, 215
„ malignant, of iiterus (Amand Routh) . . . xxxix, 5
„ cyst of both ovaries causing profuse ascitic effusion containing
(Alban Doran) ..... xxxiv, 149
„ ovarian cyst containing (A. H. N. Lewers) . . . xxxiv, 462
„ multilobular, of the lu-etlira (C. Lockyer) . . . xlvii, 122
„ ovarian cystoma removed after double ovariotomy fifteen
years previously (J. D. Malcolm) . . . xxxv, 36
PAQUELIN'S THERMO-CAUTERY (G. Prevot) . . . xviii, 180
„ thi-ee now points for (Heywoocl Smith) . . . xix, 41
„ regulator for (J. H. Aveling) .... xx, 293
PARALYSIS, see Hemiplegia.
PARAMETRITIS, anterior, and anterior perimetritis {W. S. A.
Griffith) ...... xxix, 147
„ hajmorrhagic (J. Matthews Duncan) . . . xxix, 191
„ purulent (W. S. A. Griffith) .... xxx, 5
Paramore (Ricuakd), for W. D. Haslam, midwifery forceps . xxix, 190
PARAPLEGIA occurring dui'ing pregnancy (P. Boulton) . ix, 12
„ parturition during, with cases (Amand Routh) . . xxxix, 191
PAROVARIAN CYST (Lawson Tait) .... xxv, 112
„ axial rotation of (Leith Napier) .... xxxiv, 124
„ i-emoved per vaginam (Amand Routh) . . xxxvii, 8
„ with acute axial rotation (A. W. W. Lea) . . . xxxix, 8
„ with tmsted pedicle, two cases of, in ^^'hich the ovary only
(and not the cyst) was congested and inflamed (H. E.
Spencer) ...... xlii, 333
Parson (E.), embolism of the pulmonary artery after ovariotomy vii, 8
„ case where local anaesthesia by the ether spray was employed
in the removal of epithelioma of the cervix uteri by the
ecraseur . . . . . . ix, 47
Parsons (J. Inglis), twenty cases of fibroma and other morbid
conditions of the uterus treated by Apostoli's method . xxxiv, 22
„ the disintegration of organic tissue by high tension dis-
charges ..... xxxvii, 124
„ unusual case of sarcoma of the ovary . . . xlv, 48
„ a case of fibro-myoma of the vestibule . . . xlviii, 184
PARTURITION.
149
PARTURITION, abnormal, influence of, difficult labour, prematm-e
birth and asphyxia neonatorum on the mental and physical
condition of the child, especially in relation to deformities
(W.J. Little) . . . . ^ iii,293
„ amaui-osis observed eight times in succession after (H. E.
Eastlake) . . . . ^ v 79
„ cardiac apncea after (W. S. Playfair) . ] ! x' 21
„ application of extreme cold as an anodyne in the pain
attendant on (J. M. Granville) . . . . vi 105
„ cast of antique group representing the circumstantials of, iii
very early times (S. H. Bibby) .... xvi, 243
„ at term, degenerated fibro-myoma weighing over 17 lb.
enucleated from the broad ligament nine hovu-s before (H. E.
Spencer) ...... xlvi, 415
„ — carcinoma of the cervix complicating ; Csesarean section,
followed by vaginal hysterectomy (J. M. Munro-Kerr) '. xlvii, 194
„ — fibro-myoma removed by abdominal myomectomy in second
month of pregnancy (A. Doran) . . . xlvii, 426
„ — spiu'ious, in a case of abdominal pregnancy ; foetus and
placenta removed six months later (E. J. Maclean) . xlviii, 129
„ with atresia vaginae (Fancovirt Barnes) . . . xxv' 99
„ complicated by an ascitic fostus (J. A. Thompson) . . xvii] 4
„ axis pressure binder for use dvu-ing (J. L. A. Aymard) . xxxii' 173
„ bandage after (A. Meadows) . . . *. vi' 125
„ acute bedsore following (G. F. Blacker) . . . xl' 247
., breech presentation, new form of blimt hook and sling in cases
of (J. G. Swayne) ..... xvii, 313
„ — with extended legs (W. S. A. Griffith and Arnold W. W.
^^^) ...... xxxix, IS
„ with Bnght's disease, six more cases of pregnancy and (G. E.
Herman) ...... xxxvi 9
„ two cases of, complicated with cancer of the cervix uteri (G. E.
Herman) . . . . . . xxiv, 308
„ complicated by cancer of the cervix in advanced pregnancy,
the patients remaining well eleven, eight and a half, and
eight years after high amputation of the cervix (H. E.
Spencer) ...... xlvi, 355
„ caries of the pelvic bones following (W. S. Playfair) . xv'iii, 142
„ ancient Greek charm representing woman in (A. Doran for
Ernest Hart) ...... xxxiii, 26
„ cicatrices from a burn requiring division dui'ing (E. F.
Willoughby) . . . . . " ] ^ii, 31
„ " couchaid " to assist and economise force during (A. W. Edis) xvii, 48
„ dermoid cyst of ovary, removed by abdominal section five
years after causing obstruction to (W. W. H. Tate) . xlvi, 344
„ sudden death from occlusion of the pulmonary arteries seven-
teen days after (D. Mackinder) . . . . j 213
„ sudden death during (E. Barnes) .... viii' 40
„ — after (W. S. Playfair) .... xiii' 192
„ death during, in which in a previous pregnancy there was frac-
ture of the pelvis and injury to the uterus (T. Fairbank) . ix, 1
„ death in ewes during and after, report on certain causes of
(J. Hutchinson) • . . . . xviii 88
„ diabetes insipidus in (J. Matthews Duncan) . . xxix', 308
„ difficult, from locked heads (H. Eaynes) . . . iv' 19
» — on the management of, with a minor degree of contraction
of brim (A. B. Steele) ..... xvi 32
150
PARTURITION.
PARTURITION (continued) —
„ difficult case of, in a primipara -who, barren for thirteen years,
became pregnant after division of a deformed cervix uter
(G. Roper) .....
„ antero-posterior positions of the head as a cause of difficult
(R. G. McKerron) ....
„ digital dilatation of the os in (J. Braithwaite)
„ the relation between bactward displacements of the uterus
and prolonged ha;moiThage after abortion and (G. E
Herman) .....
„ distension of the uterus in a fcetus impeding (H. Gervis)
„ eclampsia; septic peritonitis; splenic abscess; death on the
sixteenth day after (J. C. H. Leicester) .
„ case of, with extreme elongation of the cervix uteri (R
Barnes) .....
„ fatal embolism of right heart and pulmonary artery nineteen
days after (G. Roper) ....
„ pulmonary embolism occurring twenty-four days after (H
Williamson) .....
„ ergot of rye during, effect on the life of the child (R. U. West)
„ extrusion of right arm of child through the anal orifice dviring
(H. E. Eastlake) ....
„ in face presentation, effected by the cephalotribe (J. B. Hicks)
„ — by the forceps in the mento-lateral position (J. B. Hicks)
„ in a case of deformed fasttis vnth adherent placenta and the
intestines uncovered and presenting (D. Jolmson) .
„ intra-peritoneal rupture of the bladder occurring during (C. R
Porter) .....
„ pelvic haematoma following (R. Boxall)
„ concealed accidental haemorrhage during (J. B. Hicks)
„ early and entirely detached placenta in, producing internal
and concealed haemorrliage (J. T. Mitchell)
„ haemorrhage after (R. Barnes)
„ vaginal ha^moirhage during, a diagnostic sign of (P. Budin)
„ and post-partum hiemorrhage, case of central choroido-retinitis
occvu-ring after (H. Macnaughton- Jones) .
„ diffuse meningeal haemorrhage in infant after normal (A. W
Sikes) . . . ...
„ hemiplegia occurring nine days after (E. F. Scougal)
„ ingravescent hemiplegia during (P. Horrocks)
„ impeded, treatment of, aided by special position and obstetric
binder (R. Hardey) ....
„ — in a case of hydrocephalic foetus with breech presentation
(A. W. Edis) .....
„ — by vertical septum in lower pai-t of vagina (J. Braxton
Hicks) .....
„ case of congenital hydrocephalus complicating (G. M. Bluett)
„ (J. G. Swayne) ....
„ natural, hysteria simulating in the most perfect degree (R
Hodges) .....
„ induced after full period had elapsed in pei-sistent sickness
(A. W. Williams) ....
„ on the induced ctu-rent diu-ing (W. Kilner)
„ infection of ovarian cyst complicating pregnancy five days
after (H. Macnaughton- Jones) .
„ injection of uterus after, apparatus for facilitating (R. Barnes)
„ instrument to aid the abdominal muscles in (P. Smith)
XIX,
xli,
xxi,
169
142
38
XXXIV,
V,
xlvii,
xviii,
xxi,
xlv,
iii,
viii,
XV,
xiii,
xiii,
xlix.
vm,
xi,
xix.
14
284
271
293
74
189
222
320
144
39
53
53
170
303
53
282
219
232
xxxii, 134
xlv,
XXX,
xxxiii,
xvii,
xxiii,
xxix,
xxix.
44
214
201
79
302
24
390
405
i, 339
Xll,
xxvi,
xiii,
xix,
xi,
164
93
140
118
169
PARTURITION. 151
PAETURITION (continued) —
„ two cases of inversion of the uterus after (W. T. Smith) . x, 30
„ inversion of the uterus occurring immediately after (F. H.
Gervis) ...... xvii, 278
„ laceration of the integument of the foetus oceiu-ring during
(E. K. Peii-ce) . . . . . vii, 74
„ — of the vagina during (J. Matthews Duncan) . . xxxi, 236
„ lingering, use of forceps and its alternatives in (R. Barnes) . xxi, 121
„ management of the third stage of (H. E. Eastlake) . . vi, 226
„ — with a view to promote sviccessful suckling (W. Martyn) . xii, 339
„ mechanical support diu-ing (W. Woodward) . . xi, 192
„ mechanism and management of, in cases of double monstrosity
(W. S. Playfau-) ..... viii, 300
„ the mechanism of, more especiallj^ with reference to Naegele's
obliqiiity and the influence of the lumbo-sacral curve (E.
Barnes) ...... xxv, 258
„ — of the third stage of (F. H. Champneys)
xxix, 117, 151, 264, 317, 337, 346
„ at full term, membrane expelled from uterus a few days before
(A. Harris) ...... vii, 47
„ complicated by a case of meningocele (S. W. Poole) . . xix, 265
„ missed (A. W. Williams) . . . • vi, 208
„ of double monster (W. Wills) .... vii, 6
„ myxoma in a foetus impeding (T. C. Hayes) . . xviii, 83
„ nightdress for ladies during and after ( — Stewart) . . xvi, 87
„ normal, on the occurrence of lateral obliqiiity of the foetal
head in (A. L. Galabin) .... xvii, 283
„ observations on the temperature, pulse, and respiration during
(R. J. Probyn WUliams and L. Cutler) . . xxxvii, 19, 152
„ three cases of obstructed (J. B. Hicks) . . . v, "285
„ report on one case (J. B. Hicks) . . . . v, 290
„ obstructed, from the presence of the hymen (S. Palmer) . iv, 211
„ — by fibroid tumour, situated in the anterior wall of the
uterus (R. Barnes) . . . . . v, 171
„ — (S. Berry) . . . . . - vii, 261
„ — condition of uterus in, and an inquiry as to what is intended
by the terms " cessation of laboiir pains," " powerless labour,"
and " exhaustion " (J. B. Hicks) . . . . ix, 207
„ — in which spontaneous version followed an unsuccessful
attempt to deliver by the crotchet after craniotomy (S. D.
Hine) ...... xxvii, 293
„ — in which a large fibroma of the ovary occupying the pelvis
was mistaken for the head of an extra-uterine foetus (W. S. A.
Griffith) ...... xxxiii, 140
„ obstruction of, by sessile fibro-myoma of the cervix uteri
(W. Duncan) . . . • . • xxxv, 296
„ — by ovarian tumours in the pelvis (R. G. McKerron) . xxxix, 334
„ foetus with absence of urethra and ascites obstructing (T. G.
Stevens) ..... xxxvii, 5
„ adjourned discussion on R. G. McKerron's paper on the ob-
struction of, by ovarian tumours in the pelvis . . xl, 8
„ incarcerated ovarian dermoid obstructing ovariotomy during
(H. R. Spencer) . . . . . xl, 14
„ obstructing ; manual elevation ; removal seven months
later (H. R. Spencer) . . . . . xl, 22
„ Csesarean section and removal of tumour at the end of
the first stage of (R. Boxall) . . . . xl, 25
152
PARTURITION.
PAltTUEITION (continued)—
„ suppui-ating ovarian cyst obstructing, removed by abdominal
section eighteen months later (W. W. H. Tate) . . xlii, 164
„ dermoid cyst of ovary obstructing; displacement of the
tumoiu' from the true pelvis and extraction of the child with
forcejis ; removal of tumotu' five weeks later ; recovery (J.
M. M. Kerr) ...... xliii, 145
„ uterus removed at eight and a half months of gestation by
abdominal hysterectomy for fibroid obstructing (A. Routh) . xliv, 41
„ occlusion of the os uteri, with retention of menses after diffi-
cult (J. H. Davis) . . . . . iv, 91
„ occluded vagina after, followed by subsequent retention of
menses (S. Craddock) ..... xiii, 101
,, ovarian cyst co-existing with pregnancy, which ruptured spon-
taneously ten days after (C. Clay) . . . i, 226
,, complicated with an ovarian cyst (A. H. Brewer) . . xx, 184
„ — with ovarian disease (R. T. Warn) . . . xi, 198
„ — by ovarian tumoiu- (W. S. Playfair) . . . ix, 69
„ ovarian tiunour obstructing ; posterior vaginal section and
ovariotomy during labour; operation and delivery at one
sitting ; recovery (J. W. Taylor) . " . . xliv, 275
„ a second case of abdominal ovariotomy during (H. R. Spencer) xlviii, 37
„ pain of, and anaesthetics in obstetric practice (A. E. Sansom) . x, 121
„ in the seventh month, pan-hysterectomy during (J. Bland-
Sutton) ...... xlvi, 238
„ during paraplegia, with cases (Amand Routh) . . xxxix, 191
„ complicated by acute peritonitis (without discovered cause)
(John Phillips) ..... xli, 389
„ the value of pilocarpine in (John Phillips) . . . xxx, 354
„ polypus uteri complicating (H. L. Freeman) . . v, 42
„ natural, post-mortem examination of a woman at the fii'st stage
of (F. J. Gant) . . . . • vi, 214
„ post-mortem., with references to forty -four cases (J. H. Aveling) xiv, 240
„ prematui-e followed by suppviration in fibro-myoma uteri treated
by abdominal hysterectomy (W. W. H. Tate) . . xlix, 54
„ unsuspected pregnancy and (T. H. Tanner) . . iv, 113
„ prematiu-e, induction of, in a case of distorted pelvis (J. H.
Ti'ouucer) . . . . . . i, 236
„ indications and operations for the induction of premature, and
for the acceleration of (R. Barnes) . . . iii, 107
„ induction of premature, in an extra-uterine fcetation, followed
by intra-uterine pregnancy (E. E. Day) . . . vi, 3
„ premature, induced for pelvic contraction from spondylo-
listhesis (R. Barnes) . . . . . vi, 78
„ — or natural, enlargements of the uterus following (T. S.
Beck) ...... viii, 54
,, — indviced by injection to the fundus of the uterus (J. Lazare-
witch) . . . . . . ix, 161
„ — in a case of symmetrical erysipelas, with eclampsia post-
partum (J. B. Hurry) ..... xxxii, 309
,, — induction of, on the methods adopted by Keiller and others
for the (J. Watt Black) .... xxxv, 95
„ preternatural, exigencies connected with . . . ii, 257
„ in primiparovis women late in the reproductive period of life
(G. Roper) ...... vii, 51
„ case" of, in a primipara suffering from mitral stenosis (G.
Coates) ...... xxviii, 108
PAETUEITION.
153
PARTURITION {continued) —
prolapse of the funis during (G-. Eoper)
protracted, of more than six days' diu'ation (J. T. Mitchell) .
— case of, in which the use of the forceps was typically indi-
cated (G. Eoper) .....
long delay of, after discharge of the liquor amnii (J. Matthews
Dioncan) ......
necrosis of pubic bones following (W. S. Playfair) .
a new and speedy method of dilating a rigid os in (J. Farrar) xxxvi, 321
with the parallel forceps in a case of puerperal convulsions
(J. Lazarewitch) .....
retroflexion of the gravid uterus during, at term (H. Oldham)
rupture of vagina during (J. H. Bell)
— with recovery (Heywood Smith)
— spontaneous, with recovery (A. Wiltshire)
— two cases of (A. L. Galabin) .
ruptured vagina during (T. J. Walker)
incarcerated ovarian dermoid ruptiu-ed during (H. E. Spencer)
by forceps and version, incarcerated ovarian dermoid rup'
tvu-ed during (H. E. Spencer)
fatal rupture of an aneuiysm of the splenic artery immediately
after (J. D. S. Nodes and Frank Hinds) .
large ovarian tumour ruptm-ed on the third day after (H. E
Spencer) . . . * .
rupture of an ovarian abscess twelve hours after (C. Berkeley)
— of uterus diu:ing (E. J. Asbui-y) . . .
occurring during, and after external violence (J. Phillips) xxxii, 375
uterus ruptured during unobstructed (with a microscopic sec-
tion) (W. E. Dakin) .....
utero-vaginal rupture during (A. Wiltshire)
scale for calculating onset of (W. S. Playfair)
effect of the scarlatinal poison on the course of (E. Boxall)
separation of the greater portionof cervix uteri during (E. Gray)
the shortness of the cord as a cause of obstruction to the
natural progress of (J. Matthews Duncan)
sloughing of the central part of a uterine fibro-myoma shortly
after (J. D. Malcolm) .....
spurious, macerated foetus removed from the abdominal cavity
two months after (A. Doran)
suppression of urine after (E. G. McKerron)
acute suppuration and sloughing of ovaries after (J.
Targett) .....
synopsis of 1500 consecutive cases of (W. T. Greene)
tedious, sloughing of foetal scalp, as the result of (W
Priestley) ......
— displacement of the bladder as a cause of (W. H. Broadbent)
— delivery by forceps ; death on third day from thrombosis
(W. Martyn) . . . .
temperature immediately after, in relation to the dui-ation and
other characteristics of (A. E. Giles)
case of triplets and complete placenta prsevia in which the
children were delivered alive throiigh a perforation in the
first placenta (H. E. Spencer) ....
complicated with a fibrous tumour of the uterus ; delivery by
long forceps, and subsequent removal of tumour (W. 6.
Priestley) ......
fibroid tumour complicating (W. S. Playfair) . xix, 101
xvii, 318
xii, 368
XX, 75
xiv, 216
XV, 219
XV, 59
i, 317
iv, 197
xvii, 359
xvii, 362
XX, 295
viii, 109
xl, 329
xl, 331
xlii, 305
xliii, 224
xliv, 73
40
xl, 29
xviii, 220
xxviii, 68
XXX, 68
xvi, 128
xxiii, 243
xlvi, 15
H.
O.
xlii,
xliv.
97
xxxvii, 216
xix, 204
i, 323
V, 44
X, 263
xxxvi, 238
XXXV, 107
i, 217
xxiii, 25
154
PARTURITION — PATHOLOGY.
PARTURITION (continued)—
„ fibroid twmovirs complicating pi'egnancy and (A. Donald) . xliii, 180
„ nterine fibroids removed by enucleation fifteen days after (R.
Boxall) . . . . . . xxxvi, 64
„ fibroid tumour of uterus complicating, treated by enucleation
(W. Hankes Day) ..... xxvii, 158
„ Porro-CBesarean hysterectomy witli retro-peritoneal treatment
of the stump in a case of fibroids obstructing, with remarks
upon the relative advantages of the modern Porro operation
over the Sanger-Csesarean in most other cases requiring abdo-
minal section (A. Routh) .... xlii, 244
„ complicated near term by fibroids, for which Csesarean section
and total abdominal liysterectomy had been performed in a
patient who had recovered without operation from ruptured
tubal pregnancy (H. R. Spencer) . . . xlviii, 240
„ fibroid showing cystic degeneration removed three weeks after
(H. R. Andrews) ..... xlviii, 247
„ fibro-myoma spontaneously enucleated during (W. R. Dakin) xli, 105
„ tumotu's of the pelvis obstriTcting (E. Copeman) . . xii, 313
„ complicated by pelvic tumour and convulsions (H. M. Madge) xvii, 20
„ tumour, calcareous intra-mural, impeding (Wynn Williams) . xvii, 172
„ tumour protruded from the rectum diu'ing (R. Barnes) . xxi, 28
„ — expelled from the uterus diu-ing natural (A. W. W. Lea) . xli, 2
„ after (F. H. Daly) . . . .xxviii, 170
„ submiicous fibroid presenting at the os uteri ten days after
(G. E. Herman) ..... xxxiii, 30
„ tixrning in cases of contracted brim (P. L. Bnrchell) . xxv, 61
„ difficult position of the heads during twin (T. PoUock) . iii, 103
„ changes the tissues of the txterus tindergo after (S. Beck) . xiii, 290
„ description of a series of casts shoAving the condition of the
uterus at various periods after (Arthur Farre) . . xviii, 84
„ in a case of double iiterus (J. Matthews Duncan) . . xxiii, 21
„ uterus torn out after (J. H. Walters) . . xxiv, 136 ; xxvi, 233
„ sections of uteri demonstrating the anatomical changes at the
onset of, and after delivery (A. H. F. Barbour) . . xxviii, 73
„ connected with a non-evoluted and hypertrophied state of tlie
cervix uteri (G. Roper) .... vii, 233
„ uterus and vagina with the child in situ in the second stage of
(W. P. Victor Bonney) .... xliv, 292
„ tlirough an imperforate vagina (Heywood Smith) . . xxiii, 117
„ see Delivery, Missed Labour, Placenta, Presentations, Spurious
Labour.
Pateeson (Herbert J.), a " grip-eyed " needle . . xlvii, 250
„ loop of small intestine fotmd adlierent to the pedicle six
months after ovariotomy .... xlvii, 316
„ uterus bicornis ..... xlvii, 248
„ extra-uterine gestation ; operation during the sixth month of
pregnancy ...... xlvii, 326
PATHOLOGICAL CONDITIONS of the Fallopian tubes, the frequency
of (A. H. N. Lewers) ..... xxix, 199
PATHOLOGY of chronic metritis (W. F. Shaw) . . xlix, 19
„ of putrperal eclampsia (J. B. Hicks) . . . viii, 323
„ and symptoms of hydatidiform degeneration of the chorion
(H. Williamson) ..... xli, 303
„ and" treatment of puei-peral eclampsia, with special reference to
the use of saline transfusion (with notes of two cases)
(E. W. Hey Groves) ..... xliii, 117
PATHOLOGY COMMITTEE PEDICLE.
155
XX,
xxiv,
xxviii,
xxvi.
133
46
59
PATHOLOGY COMMITTEE, reports of :
„ on Amand Routh's specimen of a fibro-myoma of the uterus with
a sarcomatous nodule in the centre (J. S. Fairbairn, C.
Lockyer, C. H. Roberts, C. Keep, and G. Blacker) . . xlix, 45
„ on J. Bland- Sutton's specimen of a villous tumour of uteriis
from a patient, aged 84 • • . . xlix 93
„ on G. F. DarwaU Smith's specimen of perithelioma of the uterus xlix,' 136
„ on H. RusseU Andrew's specimen of supposed sarcoma of
cervix . . . . . . xlix, 169
„ on May Thorne s specimen of uterus showing malignant
villous tumoiu- and a fibroid undergoing sarcomatous change xUx, 207
„ on Alban Doran's specimen of a malignant vaginal polypus
secondary to an adrenal tumour .... xlix 208
„ H. Briggs's specimen of ovarian pregnancy . . xlix' 255
„ on J. H. Dauber's specimen of fibro-myoraatous uterus con-
taining a calcified fibroid lying free in the uterine cavity . xlix, 256
„ on H. T. Hicks' specimen of primary vaginal embolic chorion-
epithelioma ...... xlix, 256
For previous Pathology Committee Reports, see Committees . 38
PATIENT after symphysiotomy (W. S. A. Griffith) . . xxxvii, 13
PEASLEE'S METROTOME, modified form of (A. L. Galabin) . xx, 53
PEDICLE, twisting of, in an incipient dermoid ovarian cyst (Alban
Doran) •••...
„ of ovarian cyst (J. Knowsley Thornton) . . xxv, 164 ;
„ in an ovarian tumour (R. Barnes)
„ of an ovarian tumour, changes in, when treated by lio-ature
(G. G. Bantock) . . . .
„ new method of securing in ovariotomy (I. B. Brown)
„ in a case of ovariotomy (J. H. Aveling)
„ on ligature of, in ovariotomy (Alban Doran)
„ fibroid, of the broad ligament, weigliing 4i lb., with twisted
(A. H. N. Lewers)
„ pedimculated fibro-myoma, of the broad ligament, with twisted
(C. J. Cullingworth) .... xxxvii, 222
„ torsion of, in a broad ligament cyst and extensive htemorrhao-e
into broad ligament (F. J. McCann) . . '^ .
„ acute torsion of an ovarian; from a case where there was
chronic torsion of the pedicle of a tumour of the opposite
ovary (A. Doran) • • . . .
„ twisted, of an ovarian dermoid six inches in length (J. Bland-
Sutton) ......
„ axial rotation of, of a right-sided parovarian cyst (Leith
Napier) •••-..
„ twisting of, in two eases of parovarian cyst, in which the
ovary only (and not the cyst) was congested and inflamed
(H. R. Spencer) ....
„ twisted, in a parovarian cyst (C. Berkeley)
„ of a hydi-osalpinx, torsion of (H. Williamson)
„ pyosalpinx with twisted (A. H. N. Lewers)
„ twisted, in dermoid cyst of right ovary (W. Duncan)
„ — in dermoid tumours of both ovaries (R. BoxaD) '.
„ — in a ruptured ovarian cyst (V. Bonney) .
„ hydrosalpinx of an accessory Fallopian tube due to twistino-
of (W. S. Handley) • . . . !
„ torsion of, in hydrosalpinx, and other morbid conditions of
the Fallopian tube (R. H. Bell) .... xlvi 152
xiv, 2
vii, 28
vii, 229
XXXV, 131
xliv, 364
xlviii, 179
xliii, 12
xlvi, 147
xxxiv, 124
xlii, 333
xlvi, 242
xlvii, 5
xliv, 362
xxxvi, 267
xli, 5
xlvii, 190
xlv, 157
156
PEDICLE — PELVIS.
r
. xlvii.
316
1
. xlvii.
331
xiii.
123
. xxix.
5
vii.
74
vii.
76
xxxvii.
15
ii.
324
. xxxi.
263
xxxi, 276
PEDICLE (continued) —
„ loop of small intestine found adlierent to, six months after
ovariotomy (H. J. Paterson)
„ minute, produced by torsion of mesovarium only in a dermoid
cyst of ovary (A. L. Galabin)
Pedleb (G. H.), deformed pelvis by mollities ossium
Pedlet (T. F.), midwifery among the Burmese
Peikce (E. K.), laceration of the integument of the foetus occur-
ring dui'ing labour ....
„ report on ditto by Drs. Harley and Meadows
PELLETS of fat in a dermoid cyst (A. C. Butler-Smythe)
PELVIC CELLULITIS after a first pregnancy, followed by siippit-
ration at back and front parts of vagina (G. D. Gibb)
PELVIC FLOOR, the anatomy of (G. E. Herman)
„ the changes in, which accompany the slighter degrees of pro-
lapse (G. E. Herman) .....
PELVIC ORGANS of a patient dying from vaginal injection of
acid nitrate of mercury to produce abortion (John Phillips)
xxxii, 308 ; xxxiii, 180
PELVIC PATHOLOGY, progress of, during the last twenty-five
years (E. J. Tilt) ....
„ lymphangitis in (E. J. Tilt)
PELVIC PERITONITIS, the value of abdominal section in certain
cases of (C. J. CulUngworth)
PELVIMETER, new (I. Lumley Earle)
„ (E. Greenhalgh) ....
„ of Dr. Byford (G. C. P. Murray) .
„ new portable, from Eiissia (Heywood Smith)
PELVIMETRY (A. E. Martin)
PELVIS, caries of the bones of the, following delivery (W. S.
Playfair) .....
„ of a cat, with bladder, uterus, and rectum in situ (H. T.
Eutherfoord) .
„ collection in the Eoyal University Maternity of Berlin (A. E,
Martin) .....
„ contracted brim of, in a minor degree, the management of
difficult laboixr with (A. B. Steele)
„ turning in cases of (P. L. Burchell) .
„ — in conjugate diameter, revolutions of the foetal head in
passing through the brim of (J. Matthews Duncan)
„ — obliquely, of a child with left sacro-iliac synostosis (F. H.
Champneys) .....
„ — case of Csesarean section for (F. H. Champneys) .
„ — Csesarean section for (C. J. Cullingworth)
„ (J. Shaw) ....
„ (Leith Napier) ....
„ — utei-us removed at full term by intra-peritoneal hysterec-
tomy in a case of (W. Duncan) .
„ — Csesarean section in cases of (J. M. Munro Kerr) .
„ — sixty-four cases of (C. N. Longridge)
„ dermoid cysts of, the suppuration and discharge into mucous
cavities of (G. E. Herman)
„ —= ovarian cyst impacted in, which was removed by abdominal
section during the ninth month of pregnancy (T. H.
Morse)
XV,
87
xvi.
130
xxxiv.
254
iii.
145
vi.
186
X,
39
xix,
41
xiv.
71
xviii.
142
xxxiv.
251
xiv.
71
xvi.
32
XXV,
61
XX,
151
xxiv.
191
xxxi.
136
xxxiv.
89
xxxiv.
98
xxxiv.
105
xliii.
9
xlvi.
309
xlviii.
226
xxvii, 254
xxxviii, 221
PELVIS — PEEFORATOE.
157
xiii, 123
xxvi, 230
xvii, 378
i, 236
ii, 314
vii, 220
vii, 270
xxviii, 274
xxix, 351
ix, 1
xxxvi, 344
xxiv, 242
XXV, 166 ; xxviii, 253
. xxiv, 191
Herman) xxviii, 6
xxviii, 83, 84
xxvii, 186
PELVIS (continued)—
„ deformed, by mollities ossiuni (G. H. Pedler)
„ (W. S. A. Griffith)
„ — case of Csesarean section for (J. W. J. Oswald)
„ distorted, induction of premature labour in a case of (J. H
Trouncer) ....
„ asymmetrical distortion of, the result of unequal length of
legs (E. Barnes)
„ extreme distortion of; craniotomy; cephalotripsy ; Csesarean
section .....
» — comparative merits of the Csesarean operation and crani
otomy in (E. Greenhalgh)
„ dissection of the muscles of the female (Alban Doran)
„ form of the male and female, Avhat are the chief factors which
determine the differences which exist in the (W. A. Lane)
„ fracture of, with injury to the uterus in the sixth month of
pregnancy (T. Fairbank)
„ hydatids in the bony (J. H. Targett)
„ kyphotic, with remarks on Breisky's description (F. H-
Champneys) ....
» — the obstetrics of (F. H. Champneys)
„ of Naegele, remarks on (F. H. Champneys).
„ — oblique, on the production of the shape of (G. E.
„ — notes of a specimen of (W. S. A. Griffith)
„ — pseudo-osteo-malacic (W. S. A. Griffith)
„ — obliquity of, and the influence of the lumbo-sacral curve in
the mechanism of labour (E. Barnes) . . . xxv, 258
„ — (J. H. Targett) ..... xli, 231
„ oblique rachitic (W. S. A. Griffith) . . . xxv, 232
„ obstruction of labour by ovarian tvimours in (E. G. McKerron) xxxix, 334
„ adjourned discussion on E. G. McKerron's paper on the
obstruction of laboiu- by ovarian tumours in . . xl, 8
„ the pressure of the femora and its influence on the shape of
the (F. H. Champneys) .... xxv, 70
„ sexual differences of the foetal (A. Thomson) . . xli, 279
„ tumom-s of, obstructing delivery (E. Copeman) . . xii, 313
„ see also Spondylolisthesis.
Pbmbret (M. S.), five foetal sacs from the peritoneal cavity of a
rabbit . . . . .' . xl, 253
„ and G. Bellingham Smith, on sacs containing foetuses and
lying free in the peritoneal cavity of a rabbit . . xlvi, 283
PEMPHIGUS, acute contagious, in the new-born (G. J. Maguire) . xlv, 429
PENCIL, cedar, extracted from the bladder of a girl (J. J.
Phillips) ...... xiv, 37
Penrose (F. G.), tubo-abdominal pregnancy . . . xxx, 124
„ — report on ditto by committee (Alban Doran, G. E. Herman,
and F. H. Champneys) ..... xxx, 303
PENSION in lieu of honorarium to Miss Hannam . . xlix, 276
PERFORATION, best mode of delivering the foetal head after (J.
B. Hicks) . . . . . . vi, 263
PERFORATOR, guarded, invented by Mr. Matthews (W. S. Play-
fair) ...... xii, 117
„ of the ordinary wedge-scissor's construction (W. F. Cleveland) ix, 56
„ protected, modifications of Oldham's and Simpson's (A.
Wiltshire) ...... xvi, 88
158 PERICAEDITIS — PERITONITIS.
PERICAEDITIS, idiopathic, in a child aged 2 (A. Meadows)
„ — in a child aged 2i (H. Madge)
PERICARDIUM, incomplete, escape of heart into left pleural cavity
(E. BoxaU) ......
Perigal (Akthur), anencephalous fa3tus
PERIMETRIC ABSCESS (W. S. Griffith)
„ retro-uterine (W. S. A. Griffith) ....
PERIMETRITIS, anterior, and anterior parametritis (W. S. A.
Griffith) ......
„ — serous, simulating ovarian sarcoma (Alban Doran)
xxxi, 217 ;
„ serous (W. S. A. Griffith) ....
„ — (J. Williams) .....
„ — case of (A. Eouth) .....
„ see also Peritoneum, pelvic.
PERINEUM, dissection of the muscles of the female (Alban
Doran) ......
,, rigid, treatment of, and the avoidance of its rupture (H. E.
TrestraU) . . . ...
„ ruptured, and birth of the child between the os vaginas and
anus (I. Baker Brown) ....
„ ruptiu-e of, complete (C. K. Thompson) . .
„ — note on the operation for restoring the perineal body in
(Aust Lawrence) ....
„ — the use of the purse-string suture in (P. Boulton)
„ prevention of (II. E. Trcstrail) . . .
„ on new methods of operation for repair of the (Lawson Tait)
PERITHELIOMA of the uterus (G. F. DarwaU-Smith) .
PERITONEUM, adliesions of the gravid utenis as a cause of post-
partum haemorrhage (W. G. Hewitt) . . . xi, 108
„ f cetus in caArity of, question of abdominal gestation, with a sum-
mary of reported cases of primary abdominal and ovarian
pregnancy (Alban Doran) .... xxxv, 222
„ myxomatous groAN'th of (J. Williams) . . . xxiv, 93
„ pelvic, endometrium, FaDopian tube, and ovary, the relation
to each other of inflammation of (Alban Doran) . . xxvii, 164
PERITONITIS in case of abscess of ovary (A. W. Edis) . . xiii, 99
„ acute general gonococcic (A. G. E. Foulerton) . . xlvii, 185
„ — double ovarian apoplexy from a case of (H. A. Des Voeux) xxxiv, 214
„ — (without discovered cause), complicating pregnancy and
laboui- (John PhUlips) . . . . . xli, 389
„ ascitic fluid from, in a case of double ovarian cysts and fibroid
of the uterus (A. W. Edis) . . . . xx, 164
„ death from, in a case of fibrous tumour of uterus (J. B. Hicks) vii, 110
„ ruptured uterus (J. T. Mitchell) . . . xi, 204
,, — of a dwarf, three days after Caesarean section (J. B'
Hicks) . . . . . • xxi, 253
„ encysted tuberculous, and its effects upon the female pelvic
viscera (J. H. Targett) .... xxxix, 126
„ foetal, complete obliteration of the canal of the small intestine
by (E. Druitt) . . . . . ii, 135
„ — (W. A. Himt) . . . . • }^.> IS
„ gonorrhoeal pelvic (J. Bland-Sutton) . . . xliii, 251
„ intra-uteriue, case of (D. C. MacCaUum) . . . xviii, 116
iii.
144
iii.
176
xxviii.
209
xxxi.
165
xxiv.
299
XXV,
18
xxix.
147
xxxiii.
185
xxvii.
168
xxvii,
169
xxviii.
131
xxviii.
274
xvii.
61
ii,
197
xix,
265
xxxii.
377
xxxii,
,380
xvii,
, 61
xxi,
,292
xlix,
, 97
PERITONITIS PESSARIES.
159
PERITONITIS (continued)—
„ its nat\ire aud treatment (J. Shaw) . . xxxvii, 10
„ pelvic, the value of abdominal section in certain cases of (C. J.
Cullingworth) ..... xxxiv, 254
„ puerperal (J. T. Mitchell) . . . . iv, 96
„ — complicated ■with ovarian disease, followed by febrile diseases
of the piierperal state, the probable consequences of infection
(R. U. West) . . . . . . i, 187
„ caused by escape of pus or putrilage from the Fallopian tube
into the abdominal cavity, following on abortion artificially
induced (R. Barnes) ....
„ septic, in secondary abdominal pregnancy (H. A. Lediard)
„ — splenic abscess ; death on sixteenth day after delivery ;
eclampsia (J. C. Holdich Leicester)
„ and the Staphylococcus alhus (J. D. Malcolm)
iii, 419
xli, 276
xlvii, 271
xlviii, 97
V, 300
PERTUSSIS ; its causes, symptoms and treatment (R. Marley)
PESSARIES, new form of, for treatment of anteversion or ante-
flexion (A. L. Galabin) .... xviii, 176
for anteflexion (W. S. Playfair) .... xv, 124
— and version (W. G. Hewitt) . . . . ix, 63
containing fluids (A. E. Sansom) . . . . x, 245
of glycerine and gelatine (H. Gervis) . . . xxvii, 163
Greenhalgh's, removed with difficulty from the vagina (A. L.
Galabin) ...... xxi, 49
Hodge's, modification of (H. Gervis) . . . xxiii, 33
(J. Blake) ..... xiv, 137
— lever, removal of, which had ulcerated into the wall of
the vagina after being worn five years (T. C. Hayes) . xvi, 30
— watch-spring (J. B. Hicks) .... xxx, 227
medicated (W. O. Priestley) .... vii, 208
— (A. Meadows) . . . . . x, 224
— in the treatment of uterine disease (T. H. Tanner) . iv, 205
mechanical action of (J. Williams) . . . xviii, 126
new (H. R. Davies) ..... xliii, 28
for prolapsus uteri (R. Barnes) .... xix, 119
— (A. L. Galabin) . . . . . xx, 169
retention of, for many years (H. Gervis) . . . xvii; 274
for retroversion and prolapse (C. Godson) . , . xxvi, 272
Albert Smith's, modification of (W. C. Grigg) . . xvi, 247
spring (Beverley Cole) ..... xxiii, 238
elastic spring (R. Greenhalgh) . . . . x, 93
vulcanite stem, shield for supporting (A. W. Williams) . xv, 246
stem, a new form of (J. G. Swayne) . . . xxiv, 220
— fiexible galvanic (R. Barnes) .... xix, 136
— intra-uterine, the necessity for caution in the employment
of (A. W. Edis) ..... xvi, 3
(C. H. F. Routh) . . . . . xi, 53
treatment of anteflexion of the uterus wthout (J. H.
Galton) ...... xvi, 171
(A. Meadows) ..... viii, 135
for the relief of flexions and displacements of the uterus
(W. R. Jordan) ..... xvi, 125
— vaginal, and uterine (H. Macnaughton- Jones) . xxxvii, 80
— spring intra-iiterine (G. Weir). . . . viii, 218
for flexions and displacements of the uterus (W. G. Hewitt) . x, 223
for treatment of flexions of the uterus (A. W. Williams) . xiv, 308
160
PESSAEIES — PHILLIPS.
PESSARIES (continued)—
,, stem, metallic, removed from a patient who had worn it for
five years and a half (W. S. Playfair)
„ — wooden ring, which had been worn for twenty-six years
(C. Godson) ......
„ worn for six years, with the lumen entirely filled up by deposit
(P. Horrocks) .....
„ Zwancke's, recto-vaginal fistula from retention of, for nearly
two years (T. Chm-ton) ....
„ — retained for six years, producing recto-vaginal and vesico-
vaginal fistulae mth phosphatic calculi (A. L. Galabin)
„ combining Zwancke's and ordinary stem (W. S. Playfair)
„ of xylonite (A. Meadows) ....
PHANTOM, model, for obstetric classes, designed by Budin and
Pinard (F. Barnes) .....
„ employed for class pm-poses in midwifery (J. B. Hicks)
Philip (Dr.), retro-uterine hsematocele
Phillips (J. J.), prolapsus uteri ending fatally by dilatation of
the ureters and wasting of the kidneys ...
„ cedar pencil extracted from the bladder
„ retro-flexion of the uterus as a frequent cause of abortion
„ treatment of suppurating ovarian cysts by drainage
„ see Hicks, J. Braxton.
Phillips (John), cliild \nth deformed hand and foot .
„ for W. S. Playfair, haematosalpinx complicating ovarian
tumour ......
„ multiple fibro-myomata complicating a twin pregnancy
„ four cases of spiu'ious hermaphroditism in one family
„ blighted ovum .....
„ case of dicephalous monstrosity ....
„ heart and large vessels of .
„ for Reginald Clarke, case of spinal meningocele
„ case of pregnancy complicated by secondary hepatic cancer .
„ — hsematocele treated by operation
„ congenital malignant disease (sarcoma) of the forehead and
neck in a new-born infant . . . xx
„ — report on ditto by committee (John Pliillips and Alban
Doran) ......
„ on the value of pilocarpine in pregnancy, laboui*, and the
lying-in state .....
„ diseased foetal membranes in early pregnancy, being an
aborted oviun showing cysts in the decidua vera
„ — report on ditto by committee (F. H. Champneys, John
Phillips, and W. S. A. Griffith) ....
„ on acute non-septic pulmonary disorders as complications of
the puerperium .....
„ blue ui-ine ; cyanuria .....
„ cystic ovaries and hypertrophied Fallopian tubes
„ cystic disease of the chorion, hydatiform degeneration
„ uterus and adherent placenta from patient dying of post-
partum haemorrhage .....
„ on a case of death f ollo^ving vaginal injection of acid nitrate of
nierciuy to produce abortion . . xxxii, 308 ; xxxiii, 180
„ ruptured uterus occui-ring diu-ing laboiu" and after external
violence ...... xxxii, 375
xxi.
50
xix.
ao3
xxvi.
54
xvi.
223
xix.
201
xiii.
2
xxiii.
131
xix.
229
xix.
231
X,
57
xii,
276
xiv.
37
xiv.
45
xiv.
340
xxviii.
89
xxviii,
89
xxviii.
138
xxviii.
158
xxviii.
209
xxviii.
278
xxix,
55
xxix.
188
xxix.
378
xxix.
384
:x, 301,
334
XXX,
335
XXX,
354
xxxi, 52
xxxi, 161
xxxi, 171
xxxi, 256
xxxi, 332
xxxii, 65
xxxii, 195
PHILLIPS — PIRIE. 161
Phillips (John) {continued) —
„ uterus and appendages from a patient dying during men-
struation from purpura hsemorrliagica (Werlhof's) . . xxxiii, 2
blighted ovum with fleshy decidual hypertrophy . . xxxiii, 35
death folio \ving vaginal injection of acid nitrate of mercury . xxxiii, 180
influence of piu'pura haemorrhagica upon menstruation and
pregnancy ...... xxxiii, 390
retroflexion and ectopia viscerum . . . xxxiii, 480
case of extra-viterine gestation in which foetal death probably
occurred at the end of the sixth month, and abdominal
section was performed two a half months later . . xxxv, 162
anterior colpotomy .... xxxviii, 213
monstrosity resulting from amniotic adhesion to skull xxxviii, 388
foetal monstrosity ..... xxxix, 44
ruptured uterus treated by abdominal hysterectomy : xxxix, 260
placenta from a case of extra-uterine f oetation ; the child at
full term, and removed five months after death , . xl, 3
fibro-myoma of vaginal wall (with microscopical slide) . xl, 130
(for Harold Jdger), monstrosity resulting from amniotic
adhesion to skull . . . . . xl, 130
ttibal pregnancy (molar) complicated by suppurating ovarian
cyst of the opposite side .... xli, 384
acute peritonitis (without discovered cause) complicating
pregnancy and laboiu* ..... xli, 389
extra-uterine gestation in which foetal death occurred at term
after spurious labour and abdominal section was perfonned
four to five months later .... xlii, 121
a case of chorion-epithelioma .... xlviii, 45
PHIMOSIS, congenital, occurring in the same family as four cases
of congenital imperforate vagina (H. M. Madge) . . xi, 213
PHLEBITIS of the umbilical vein producing pyjemia, two cases of
death in new-born infants from (G. Eoper) . . xix, 8
PHLEGMASIA ALBA DOLENS— on the common form of, after con-
finement (C. H. Eoberts) . . . xxxvii 163
„ (W. T. Fox) . . . . . ii, 201
„ with lymphatic varix (J. Matthews Duncan) . . xxiii, 132
„ pathological lesion of (W. T. Fox) . . . ii, 222
„ vessels concerned in the production of (W. T. Fox) . . iv, 144
„ uterus and vessels concerned in (R. Barnes) ' . . x, 113
„ in a case of puerperal septicasmia (A. Wiltshire) . . xviii, 181
PHLEGMON of the broad ligament, post-mortem appearances of
(A. H. N. Lowers) ..... xxx, 7
PHOTOGRAPHS from a case of primary cancer of the Fallopian
tube (Alban Doran) ..... xlii, 6
PHTHISIS pulmonalis and uterine affections (E. F. Battye) . viii, 237
„ should pregnancy be terminated prematurely in cases of ?
(W. Duncan) ..... xxxii, 7
„ tuberculosis of the Fallopian tubes and uterus in cases of (P.
D. Tiirner) ...... xli, 359
PIGMENTATION, dark crescentic, round the nipple of both breasts
(C. Godson) ...... xvii, 343
PILOCARPINE, the value of, in pregnancy, laboiu-, and the lying-
in state (John Phillips) .... xxx, 354
PiRiE (William), report on a peculiar mucous polypus of the
cervix uteri shown by R. G. McKerron . . . xxxix, 314
11
162
PLACENTA.
PLACENTA, " abdominal " pregnancy successfully treated by re-
moval of child and, three months after death of child at term
(John W. Taylor)
„ abnormal attachment of (A. L. Galabin)
„ abscess in (R. Barnes) .
„ absorption (?) of, in a case of gastrotomy from extra-uterine
gestation, in which it never came away (J. Braithwaite)
„ adherent (Wynn Williams)
„ — (R. Boxall) .....
„ — and uterus from patient dying of post-partum hsemon'hage
(John Phillips)
„ anatomy of the human (J. B. Hicks)
„ attached to head of fostus (E. J. Tilt)
„ attached to the top of the uterus in a specimen of ectopic
pregnancy going nearly to term in the peritoneal cavity (G
E. Herman) .
„ battledoor (R. U. West).
„ double battledore, with a single umbilical cord, connected with
one child (J. H. Davis). . . . .
„ two specimens of, in which the blood-vessels ran along the
membranes from the edge of the placenta and then united to
form the umbilical cord (W. H. Maberly) .
„ calcareous degeneration of (F. H. Champneys)
„ cord, foetus, and membranes (R. Wise)
„ cyst of (R. Boxall)
„ ^vith cyst on the foetal surface (John Williams)
„ partial vesicular degeneration of the (A. L. Galabin)
XXVlll,
xxiv,
xxvi,
xxxii,
xiv.
178
130
149
33
300
58
195
149
124
xxxix,
vii.
135
257
ii, 273
xix,
. xxiv,
xxxviii,
. xxvi,
XXV,
xlv,
on the development and normal struetui^e of the human (T.
W. Eden) ..... xxxvii, 205,
disease of (J. Marshall) ..... viii,
diseased, note on (Lawson Tait) .... xvii,
double (J. C. Richardson) .... viii,
— (W. G. Hewitt) ..... viii,
— or dicotyledonous (W. T. Greene) . . . xviii,
— atrophied and flattened (Heywood Smith) . . xvi,
— in a case of arrested development of one twin (A. W. Edis) xxv,
early, with localised hydatidiform degeneration (R. Boxall) . xxxiii,
expression and extraction of, on the methods adopted by
Crede and others for the (J. Watt Black) . . . xxxv,
expulsion of the (F. H. Champneys) . . . "
fatty, from a patient who had twelve still-born children and
frequent haemorrhage in her pregnancies (T. C. Hayes)
— and a still-born foetus from a sypliilitic patient (T. C. Hayes)
— degeneration and friability of the, with extreme dropsy (J.
Brunton) ......
the subject of extreme fatty degeneration (J. Brunton)
-ivith fibrinous deposits (J. Marshall)
(J. Brvmton) . . . . .
non-capsulated fibroids resembling retained (J. Braithwaite) .
frozen sections of a uterus at the tenth week of pregnancy,
from a patient who died of heart disease showing hiemor-
rhages into (G. P. Blacker) ....
and foetus of extra-uterine gestation removed by abdominal
section (G. E. Herman) .... xxviii,
-=■ funis obliterated by twisting (A. Rasch) . . x,
— of about five months, funis knotted round neck of cliild
(W. F. Cleveland) ..... xiii.
xxix.
xvi,
xvii.
xvn,
ix.
xxiii.
65
190
166
59
69
100
227
137
326
337
137
68
2
213
494
75
151
175
275
175
85
242
20
182
xlii, 235
141
94
PLACENTA. |g3
PLACEN-TA (cotiHnued)—
„ and foetus in extra-uterine fcBtation (W E Jordnti^
" lrira?f "^^ ^^"^^^^^ - ^ -- of tuba/p^'e^Lcy (a. E." ^^' '''
" Tio^rDv^Vanr'^"^ '"" ^'^"^ ^' extra-uterine gesta-' ^^'^' ^'^
» — removed six months affpr <=ni-.^-^„^ i V • ' • xxxvi, 146
abdominal pregnancy (EJ^MSlZr "^ "" " '"''' "" , ...
„ and five months' foetus, from a 'n.^a ^f +^- " • ^^^vi, 315
-hichthe second child was deU^Sed ahve"lt^nf^'^% ^^
.?thT^^ t'h the dead foetus (GG Gen^e) "^'^^ ^^' ••.
" (a JS^^nr.^^'^^' ^^^^^»^ ^ ^-^ - t^^Uilical cord^^^^"^' '
» with knotted cord (J. Brunton' ' " ' • ^^^' 66
„ and knotted cord (J. A. Tapson) " ' " • xi, 54
„ large, in a foetus .vith anasarca (R. Boxain ' ' ' f '' ^^^
„ mode of dealing with in .^aqfrnVn^'^ f^ ^' • " , • ^1". 98
in extra-uterin^e gestat?o/(E.taS£) ''""'""^ '''^ '^*^^
„ from a case of extra-uterine foetation • the"child at fnll f. ' ^^^' ^^^
(LawsonTait and C.Martin) ^ ^'^^'^P'^ gestation
„ with haemoiThage (H. A. Des Voeux) ' ' " ^^^^' ^06
" W ^""^l^ of accidental hjemorrhage (R. D Muir) ' ''^^^' o ^
» hypertrophy of (G. E. Herman) ^ ' ' ^^^^^ 338
„ — with dropsy in a foetus (J. Bassett) " " ' ^^P' ^^^
" ^a:?nYF.^'cTaVp'4?^^^^^^^ «f ^^--^^ the relation ^^ ^^^
" '"St^r' '""'"' '^°""-^ intra-mural embedding of '"''' '''
" "^tcS)^"^"'^^^ ^^*"™"^ ^^^ concealedh^morrhage (J. t! "^"' '''
» lesion (rupture ?) of the'(H. M. Mad^e) " ' ' ^'"' ^^^
„ two, and membranes from a ease of trinletsVp Tfr^y^'r^rX \ " '^i' 1
« of a double ovum (W. Outhwaite) ^ Horroeks) . xxvi, 160
» polypus of (T. C. Hayes) • ^^iv, 3
„ prolapsed (C. Smuts) . ' ' " • x^> 177
„ retained, haemorrhage due to (A. W Williams^ " * ^"' ^^°
„ — %n utero two months (J. B Walker) ' " ^"^' ^^'^
" (g" Wef ''^^^ '^'"'"^'' "^*^'' ^^-^t-"' terminating fatally ""' ''"
„ separation of the (F. H. Champneys) " ' ' ''"' ^^3
, - and expulsion of, from the uterus (F. H. Champneys) " ''^'''' ^^^
, succenturiata (F. H. Champneys) ^ ^"^ xxxvm, 360
, succenturiate, unusual form (A W Sike^s^ " * " ^^^' ^l*
, supplementary, the size of the palm of the hand (G 'jinr...^ ' ''^^■' ^^^
syphibtic disease of (B Godfrey) ^ -h-oper) . xxii, 45
from a case of triplets (A. L. Galabin) " ' xiv, 137, 211
— ruptured tubal gestation, complicated bv a Inro-a >,»«, ^. ' ^''''"' ^^^
salpinx on the opposite side (C. / CuuSgworthT^ *°" ••
tumour of (A. L. Galabin) ^ "i^ingworth) . . xxxu, 273
— from a primipara (G Roper) ' " ^^^'^' ^"^^ ' ^-'^^"' 107
xix, 256
164
PLACENTA — P r. Ayr AIR.
PLACENTA (eontmued) —
„ with round tumour in centre (J. Brunton) . . . viii, 275
„ from twins, two cases of, prematurely expelled (A. W. Edis) xx, 321, 322
„ to which the umbilical vessels were peculiarly distributed (ia-
sertio velamcntosa) (C. Godson) . . . xx, 324
„ in uterus removed by Porro's operation, condition of (A. L.
Galabin) ...... xxix, 98
„ mtli unusual arrangement of vessels (Aust Lawrence) . xviii, 118
„ unusual size and shape of (R. Boxall) . . . xxxiv, 464
„ velamentosa and an abnormally large placenta (A. F. Stabb) xxxviii, 4
PLACENTA PRiEVIA, foiu'tecn cases illustrating physiology and
treatment of (R. Barnes)
„ practical remarks iipon the treatment of (R. Greenhalgh)
„ discussion of paper on (R. Greenhalgh)
„ (G. Roper) .....
„ spontaneous separation of (J. M. Duncan) .
„ and fibroids extensively developed in the walls of the dissected
uterus pregnant about three and a half months (J. B
Hicks) .....
„ with multiple fibroids (A. Wiltshire)
„ complicated by a large myoma (J. Hickinbotham)
„ the diagnosis of, by palpation of the abdomen (H. R. Spencer)
„ uterus showing (C. J. Cullingworth)
(W. R. Pollock)
attached to an unruptured amnial sac containing a foetus of
four months' development (A. D. Leith Napier)
i, 83
vi, 14-0
vi, 188
viii, 340
XV, 189
xvii, 298
xxiii, 163
xxiii, 167
xxxi, 203
xxxii, 67, 107
XXXV, 241
xxxiv, 158
associated with unusual size and shape of the placenta (R.
Boxall) ...... xxxiv, 464
„ complete, in a case of triplets in which the children were
delivered alive through a perforation in the first placenta
(H. R. Spencer) ..... xxxv, 107
„ marginalis in situ, uterus with (G. F. Blacker) . . xxxvi, 194
„ treatment of, by Champetier de Ribes' bag (G. F. Blacker) . xxxix, 138
„ centralis, uterus with interstitial fibroid from a case of (R.
Boxall) . . . . . . xl, 338
„ spontaneoiis rupture of the uterus in (J. P. Maxwell) . xliii, 217
PLASTERS, ready-made (E. J. Tilt) . . . . v, 41
PLASTIC operation for defective formation of skin round the
umbilicus (A. Napper) ..... iii, 65
„ operations, cases of vesico-vaginal fistula left after lithotomy,
cured by (Lawson Tait) .... xviii, 209
PTiAYFAiR (W. S.), extra-uterine fcetation . . . vii, 1
„ mechanism and management of delivery in cases of double
monstrosity ...... viii, 300
„ treatment of labour complicated by ovarian tumoxir . . ix, 69
„ cardiac apncea after delivery . . . . x, 21
„ malignant disease of the uterus complicated with pregnancy . x, 58
„ absorption of fibroid tumours of the uterus , . x, 102
„ carcinoma of body of uterus .... xii, 116
„ guf.rded perforator invented by Mr. Matthews . . xii, 117
„ miiventricular heart of child that lived nine months . xii, 168
„ pessary combining Zwancke's and ordinary stem . . xii, 2
„ irritable bladder in the latter months of pregnancy . . xiii, 42
„ sudden death after delivery .... xiii, 192
,, troatment of empyema in children . . . xiv, 4
PLAYFAIR PNEUMONIA.
165
xix, 101
XV,
124
XV,
217
XV,
219
xvi, 42,
89
xvii.
200
. xviii.
142
. ; xxiii.
25
xix.
184
XX,
171
xxi.
29
xxi, 50
xxi, 290
xxii, 3
xxiii,
xxii,
xxiv,
xxvi.
46
265
54
6
162
68
xxxi, 130
Platfaik (W. S.) (continued) —
„ pessary for anteflexion .
„ malignant sarcoma of the right broad ligament
„ neci'osis of pubic bones following delivery .
„ on puerperal thrombosis
„ remarks in the discussion on puerperal fever
„ case of caries of the pelvic bones following delivery
„ on fibroid tiunour complicating delivery
„ specimen of elephantiasis of the vulva
„ for Gaillard Thomas, model of bed for cases of puerperal hyper-
pyrexia requiring continuous application of cold
„ inaugvo'al address as President
,, metallic stem pessary removed from a patient who had worn it
for five years and a half ....
„ remarks in the discussion on the use of forceps . xxi, 141, 235
„ pieces of uterine decidua illustrating the extent to which the
ovum may be occasionally interfered with without abortion
occurring ......
„ for T. G. Clahhurn, supposed super-fcetation
„ annual address as President . . . xxii, 55 :
„ the conjoined twins, Eozalie and Josepha Blazet, from Bohemia
„ notes on trachelo-raphe, or Emmet's operation
„ haematocele, the result of malignant disease
„ note on the absorption, with ultimate recovery, of thrombosis
in the pulmonary artery in the ptierperal state . . xxvi,
„ scale for calcidating onset of laboiu' . . . xxviii,
„ intra-peritoneal hsematocele, small ovarian cyst and heemato-
salpinx ......
„ — report on ditto by committee (W. S. Playfair, Alban Doran,
and W. S. A. Griffith) .....
„ intra-uterine polyptis . ...
„ cancerous uterus removed by vaginal operation
„ on removal of the uterine appendages in cases of functional
neurosis
„ ligature discharged after an abdominal section . . xxxiu,
„ double pyosalpinx, associated with fibro-myoma of utertis . xxxiii, 497
„ specimen of probable superfcetation . . . xxxiii, 496
„ supposed unruptured tubal gestation sac . . xsxiv, 28,' 465
„ — report of committee ...... xxxiv, 467
„ cancerous and gravid uterus i-emoved per vaginam . xxxvii, 198
„ sarcoma of the body of the uterus removed by vaginal extii-pa-
tion ..... xxxvii, 200
„ tubal abortion .... xxxvii, 224
„ slough forming a complete cast of the vagina, from a case of
enteric fever ..... xxxviii, 33
„ ruptured tubal gestation . . . xxxviii, 34
„ carcinoma of uterus ..... xxxix, 288
„ see Phillips, John.
PLEURAL CAVITY, left, escape of heart into, through incomplete
pericardial sac (E. Boxall) .... xxviii, 209
PLUGGING the uterus in severe cases of post-partum hasmori-hage
(A. H. N. Lewers) . . . - . . xxxii, 356
PNEUMOCOCCUS MENINGITIS, primary, simulating puerperal
eclampsia (T. Wilson) ..... xliv, 5
PNEUMONIA causing death in a case of ovarian cyst ; uterine
myoma and polypus (J. Crawford) . . . xxxiii, 74
XXXI,
xxxi,
162
132
227
7
386
166
PNEUMONIA — POLYPUS.
PNEUMONIA.(co?iHnited!)—
„ infantile interstitial (A. W. Sikes)
POCKET CASE, siu-gical (C. Godson) .
POLARITY of the uterus (J. Matthews Duncan)
Pollock (C. Stewart), cyst of the ovary of a mare
. xlvii, 74"
. xxiii, 180
. xxviii, 115
. xxxi, 234
report on ditto by committee (J. Bland-Sutton, C. Stewart
Pollock, and Alban Doran) ....
Pollock (Timothy), difficult position of the heads dui-ing twin
labour ......
xxxi, 253
iii, 103
XXXV, 241
xxxviii, 320
Pollock (W. Kivers), placenta prtevia
„ fcetus papyraceus ....
„ dermoid turaoiu' of both ovaries, with very long ovarian liga
ment on the left side . . . . . xl, 119
„ the present position of external version in obsteti*ics mth a
suggestion of a new method of performing it . . xlviii, 319
POLYPI, two sessile fibroid (T. C. Hayes) . . . xxxiii, 6
„ of the uterus, instrument for the removal of (W. T. Smith) iii, 413
„ uterine, polyptrite for crushing the necks of (J. H. Aveling) . iv, 135
POLYPTOME, vaginal and uterine (H. Macnaughton-Jones) .xxxvii, 80
POLYPTEITE, a new instrument for crushing the necks of
uterine polypi (J. H. Aveling) . . . . iv, 135
POLYPUS, adeno-myomatous, of the cervix (F. E. Taylor) . xlviii, 12
„ cancerovis, mth microscopic sections (A. L. Galabin) . xx, 82
„ peculiar cervical mucous (H. K. Spencer) . . . xli, 383
„ fibrinous (W. S. A. Griffith) .... xxv, 165
„ fibroid, attached to the fundus uteri removed by ecrasevir ;
recovery (D. L. Roberts) . . . . xi, 244
„ — of cervix (W. Duncan) .... xxxvi, 114
„ — pediculated at its base to posterior margin of os uteri, its
neck protruded at vulva, removed by the single wire ecraseur
(J. H. Davis) . . . . . . ix, 152
,, — removed by Hicks' instrument (H. Oldliam) . . iii, 349
,, — large fibrous (K. Greenhalgh) .... vii, 256
„ — (C. Godson) . . . . . xxvi, 328
„ — removal of (Heywood Smith) .... xxiii, 233
„ inti'a-uterine sessile (T. C. Hayes) . . . xxxiii, 73
„ .large-sized mucous (A. W. Williams) . . . xiv, 135
„ large soft (T. C. Hayes) ..... xxxiii, 389
,, peculiar mucous, of the cervix uteri (R. G. McKerron) . xxxix, 314
„ malignant vaginal, secondary to an adrenal tumour of the
kidney (A. Doran) ..... xlix, 182
„ multiple, myxomatous, from cervix uteri (W. Duncan) xlii, 243 ; xliii, 75
„ placental (T. C. Hayes) ..... xvii, 177
„ — (Alban Doran) .... xxxvii, 229
„ removal of (K. Greenhalgh) .... vii, 25
„ urethral, removed from a woman aged 60 (C. Godson) . xxi, 57
„ of the uterus (J. H. Davis) . . . . i, 247
„ — with clinical observations (F. Elkington) . . i, 112
„ — (A. W. Edis) ..... xxiii, 205
„ — (W. S. Playfair) ..... xxxi, 132
„ — of lai-ge size (G. G. Bantock) .... xxii, 105
„ uteri (H. Gervis) . . . . . xi, 4
„ — complicating labour, removed by ligature two days after
delivery (H. L. Freeman) . . . . v, 42
„ — large fibroid, removed by single-v.ire ecraseui- (A. Meadows) xi, 241
V,
123
iii.
346
J.
. xxviii.
240
r.
iii.
350
XXV,
138
vii.
253
xl.
339
POLYPUS POTTER. ' 167
POLYPUS (contimicd) —
„ fibrous, of the uterus (W. G. Hewitt)
„ uterine, new instrument for removal of (J. B. Hicks)
„ of uterus, drawings of microscopic sections of, showing ciliated
epithelium (H. Gervis).
„ — pendulous in the vagina removed by the ecrasetu' (W. G.
Hewitt) .....
„ adherent to the vagina (J. B. Potter)
„ weighing 2^ lb. (J. B. Hicks)
Ponder (C. F.), studies in obstetrics .
Poole (S. Wordsworth), ease of meningocele complicating
labotu- ...... xix, 265
„ case of fracture of the cranium in a noAv-born child, with a
history of the case ..... xx, 105
„ case of so-called congenital dislocation of both hips in a girl
aged 4 ..... .
Pope (H. Campbell), anencephaloid foetus
„ missed abortion .....
„ notes of a case of gestation in one horn of a uterus bicornis
unicollis
„ — refort on ditto by committee (G. E. Herman, Alban Doran,
and W. S. A. Griifith) .....
Popow (W. A.), on the corpus luteum
PORRO MEDAL and report on Porro-Caesarean section (H. E.
Spencer) ......
PORRO'S OPERATION, case of (A. L. Galabin) .
„ — (M. Handfield-Jones) ....
„ titerus removed by (C. Godson) . . . •
„ — (Heywood Smith) .....
„ — (C. J. Cullingwoiiih) . . . . .
„ condition of placenta in uterus removed by (A. L. Galabin)
„ uterus and placenta removed from a rachitic woman by (W.
Dimcan) ...... xxx, 408
„ with intra-peritoneal treatment of the stump, three cases of
(H. E. Spencer) .... xxxviii, 389
„ uterus from a case of, with intra-peritoneal treatment of the
stumj) (W. J. Gow) ..... xxxix, 7
PORRO-CESAREAN HYSTERECTOMY mth retro-peritoneal treat-
ment of the stump in a case of fibroids obstructing labour ;
with remarks upon the relative advantages of tlie modern
Pon'O operation over the Siinger-Csesarean in most other
cases requiring abdominal section (Amand Routh) . . xlii, 244
„ presentation of report on (H. K. Spencer) . . . xliv, 298
Porter (C. K.), intra-peritoneal rupttire of the bladder occiuring
dru-ing labour- ..... xlix, 170
Porter (E.), retained fcetus and placenta . . . xiii, 129
PORTIO VAGINALIS UTERI, adenoma of, forming a depressed
sore or ulcer (J. Braithwaite) .... xxxvi, 208
POST-MORTEM PARTURITION, with references to f orty-foui- cases
(J. H. Aveling) ..... xiv, 240
POTASSIUM, bromide of, in puei-peral mania (J. B. Cuigenven) . ix, 155
Potter (J. B.), ovarian tumoiu' from the body of a woman who
died from a severe burn .... xii, 246
xxii.
214
xxiii.
178
xxiv.
139
xxviii.
70
xxviii.
72
xxiv.
100
xliv.
298
xxxi
, 57
xxvii.
4
xxiv.
299
XXV,
2
xxxii.
135
xxix.
98
168 POTTEE — PREGNANCY.
Potter (J. B.) (continued) —
,, case of pregnancy complicated with malignant growths in the
vagina and i-ectum ..... xx, 110
„ pocket case containing apparatus for injecting the uterus in
cases of post-partiun haemorrhage . . . xxi, 29
„ polypxis adlierent to vagina .... xxv, 138
„ fibro-cellular tumour of labium .... xxvi, 228
„ inaugural address as President .... xxvii, 85
„ annual address as President . . xxviii, 52 ; xxix, 86
Potts ("W. J.) (introduced by Dr. Stevens), lithopaedion . xlviii, 338
Power (D'Arct), dissection of female twin monster . . xxviii, 68
POZZI MEDAL (C. J. Cvillingworth) .... xlviii, 271
PRACTICE, cases in (E. Copeman) .... xiii, 232
PEEGNANCY, abortion with albuminuria and convulsions in six
successive cases of ("W. H. Broadbent) . . . i, 108
,, abnormal (E. Hardey) . . . . • ii, 307
„ amputation of the arm in (A. Napper) . . . vii, 12
„ Bright's disease during (G. E. Herman)
xxix, 539 ; xxx, 478 ; xxxii, 320, 349
„ co-existing tubal and uterine, abdominal section ; subsequent
delivery at term (W. Tate) .... xlix, 51
„ in a radimentary uterine horn (H. E. Andrews) . . xlix, 209
„ in a woman barren for thirteen years, after bilateral division
of a deformed cervix uteri (G. Eoper) . . . xix, 169
,, in the right cornu of a fibroid utenis (F. N. Boyd) . . xlix, 49
„ in-itable bladder in the latter months of ("W. S. Plaj'fair) . xiii, 42
„ natiu-al, and delivery subsequent to Csesarean section (W.
Newman) ...... xiv, 142
„ complicated by cancer of the cervix, followed by pyaemia and
symptoms simulating diphtheria (A. L. Galabin) . . xxiii, 186
„ — with cancerous disease of the genital canal, its treatment
(G. E. Herman) . . . . . xx, 191
„ — by secondary hepatic cancer (John Phillips) . . xxix, 378
„ advanced, cancer of the cervix complicating labour in (H. E.
Spencer) ...... xlvi, 355
,, multiple medullary cancer complicated ^n-ith (T. H. Tanner) . iv, 243
„ changes the tissues of the utenis undergo during (S. Beck) . xiii, 290
„ on some changes in the uterus resulting from (John Williams) xx, 172
., chorea in (E. Barnes) . . . . . x, 147
„ — (M. Handfield-Jones) .... xxxi, 243
„ — successfully treated by dilatation of the os uteri (W. F.
Wade) ...... xxii, 244
„ — (J. B. Hicks) ..... xxxiii, 486
„ combination of chorea with (W. B. Woodman) . . xii, 102
„ -with chyhiria (J. C. Holdich Leicester) . . . xlvii, 108
„ conti-actions of the uterus throughout theii- physiological
effects and value in the diagnosis of (J. B. Hicks) . . xiii, 216
„ on intermittent contractions of uterine fibromata and in, in
relation to diagnosis (J. B. Hicks) . . . xxxvi, 188
„ cornual, at full term, removed six months after the death of
the child (C. H. Eoberts) .... xlviii, 309
,, in a rudimentary horn (L. Eemfry) . . . xxxvi, 263
,, — of uterus (A. L. Galabin) . . . xxxvii, 225
„ in aji-udimentary uterine cornu (A. H. N. Lewers) . . xlvii. 111
„ of right horn in a complete uterus bicornis (E. H. M. Sell) . xv 180
„ in one horn of a uterus bicornis unicollis (H. C. Pope) xxviii, 7u, 72
PKEGNANCY.
169
PREGNANCy (continued)—
„ dermoid ovarian cyst impacted in the pelvis wliicli was re-
moved by abdominal section during the ninth month of
(T. H. Morse) .... xxxviii, 221
„ diabetes insipidus in (J. Matthews Duncan) . . xxix, 308
„ difficulties encountered in determining the existence of, and
thevalueof auscultation as a means of diagnosis (E.Copeman) x, 62
„ discoloration of the skin of the forearms and hands diu-ing
(J. G. Swayne) .....
„ eclampsia of, with observations on the state of the renal
fxmction (G. E. Herman) ....
„ notes of a case of piierperal eclampsia, •with a description of a
five weeks' ovum removed in a subsequent (W. S. A. Griffith
and T. W. Eden)
„ h3rpertrophic elongation of the cervix uteri at the full term of
(G. Roper) ......
„ strong mental emotion affecting women during, as a cause of
idiocy in the offspring (A. Mitchell)
„ complicated by epithelioma of the cervix uteri (A. W. Edis) .
„ epithelioma of cervix with (A. W. Edis)
„ — complicated Avith (C. T. Savoiy)
„ — removed by ecraseur wire diu-ing, without causing abortion
(C. Godson) ......
„ — complicating, Csesarean section (A. W. Edis)
„ extensions or retroflexions of the fcetvis, especially of the trunk,
diu-ing (J. Matthews Duncan and J. B. Hurry)
„ fracture of the pelvis with injury to the uterus in the sixth
month of (T. Fairbank) ....
„ fibro-enchrondromatous tumour complicating; safe delivery
(A. Wiltshire) .....
„ complicated with multiple fibroids, rapidly fatal cerebral
haemorrhage in a case of (W. Duncan)
„ uterine fibroid removed during ; premature labour (J
Knowsley Thornton) .....
„ uterine fibroids complicating (H. M. Madge)
„ cedematous fibroid tumour of uterus associated with (A. L
Galabin) ..... xxxvii, 286
„ early, attended by fibrous tumour of the uterus (J. H. Davis) viii, 11
„ diseased foetal membranes in early (John Phillips} . xxxi, 52, 161
„ five months' foetus and placenta from a case of twin, in which
the second child was delivered alive at or near full term
along with the dead foetus (G. G. Genge) . . xxxviii, 5
„ fibro-myoma removed by abdominal myomectomy in the second
month of (A. Doran) ..... xlvii, 426
„ necrobiotic uterine fibro-myoma occurring in (F. E. Taylor) . xlvii, 333
„ case of galactorrhoea during a first (W. S. A. Griffith) . xxxiv, 491
„ gangrene of the thigh during the seventh month of (J. G.
Swayne) ......
„ three cases of glycosuria of (W. H. B. Brook)
„ fatal case of concealed accidental haemorrhage, occurring at
the eighth month of (R. Dunn) ....
„ concealed accidental haemorrhage at the latter end of, and
during labour (J. B. Hicks) ....
„ haemorrhage from the Fallopian tube without evidence of tubal
(Alban Doran) .....
„ abdominal hysterectomy for cancer of the cervix associated
with (D. Drew) ..... xlviii, 202
iv, 18
dx, 517
xli, 151
XV, 167
xxvi, 124
xvii, 344
xxiii, 264
xvii, 82
XXV, 18
xxiv, 304
xxvi, 206
xii, 376
xxxii, 2
xxi, 163
xiv, 227
XXV, 215
xlviii, 192
viii, 285
ii, 53
xl, 180
170
PREGNANCY.
PREGNANCY (continued)—
„ complicating two cases of abdominal hysterectomy for fibroids
(F. N. Boyd) ......
„ uterus removed at eight and a half months of, by abdominal
hysterectomy for fibroid obstructing labour (A. Routh)
„ of four and a half months, combined vaginal and abdominal
hysterectomy for, complicated by Cixncer of the cervix (R.
Sanderson) ......
„ increase duiing, in fibroma of the abdominal wall (Alban
Doran) ......
„ influence of purpura hsemorrhagica upon menstruation and
(John PhiUips) .....
„ ingravescent hemiplegia during (P. Horrocks)
„ co-existent intra- and extra-uterine (E. W. Hoy Groves)
„ on the administration of iron diu-ing, as a preventive of post-
partum haemorrhage (J. Bassett)
„ iron salts in ansemia complicated with (W. B. Woodman)
„ and labour, imsuspected (T. H. Tanner)
„ — at term, myomectomy during, in an elderly primipara, with
notes on similar cases (A. Doran)
„ — with Bright's disease, six more cases of (G. Ei Herman) .
„ — fibroid ttmioiu's complicating (A. Donald)
„ leukasmia and (G. E. Herman) ....
„ the longings of women diu-ing (A. E. Giles)
„ two cases of, complicated by extensive malignant disease of
the cervix (A. L. Galabin) ....
„ malignant disease of uterus complicating (W. S. Playfair)
„ complicated -with malignant growths in the vagina and rectum
(J. B. Potter) .....
„ membranes of a twin ovum of ten weeks (J. H. Davis)
„ menstruation during (W. G. He^vitt)
„ mole or blighted ovum from supposed three months' (A. W.
Williams) ......
„ seventh month of, cedema of the lower half of the body after a
fall in (A. Rasch) . . . . .
„ orbital tvuuour in a hydrocephalic female fa3tus, with tumour
of cheek, mal-development of neck, associated with hydi'am-
nios, necessitating interference with, at the seventh month
(H. S. Stannus) .....
„ ovarian cyst co-existing with, which ruptured spontaneously
ten days after labour (C. Clay) .
„ associated with ovarian cystic disease (J. B. Hicks) .
„ complicated by ovarian cystoma (H. Macnaughton-Jones)
„ incarcerated ovarian (dermoid) cyst, removed during (Amand
Routh) ....
„ in the middle of (H. R. Spencer)
„ removed at the fourth month of ; delivery of a living
child at temi (H. R. Spencer)
„ complicated by ovarian disease (T. Spencer Wells) .
„ tiuuoui- at about two months (J. W. Taylor) .
„ uterine appendages of the left side showing evidences of the
ruptui-e of the sac of an ovarian (H. Gilford)
„ primary ovarian, with rupture fourteen days after last meU'
struation (G. P. Arming and H. Littlewood)
„ ovarian (H. Briggs) ....
„ ovariotomy performed during, additional cases of (T. Spencer
Wells) ......
xlvi.
106
xliv.
41
xliii.
313
xxxix.
42
xxxiii.
390
xxxiii.
201
xlvii.
428
xvi.
111
xii.
33
iv.
113
xlviii.
303
xxxvi.
0
xUii,
180
xliii.
234
XXXV,
242
xviii.
239
X,
58
XX,
110
X,
57
viii.
221
xiii.
95
vii.
80
xliii, 304
i, 226
xi, 263
xlii, 140
xl, 217
xl, 259
xl, 329
xi, 251
xliv, 297
xliii, 24
xliii, 14
xlix, 222
xix, 185
PREGNANCY.
171
xli,
xxxii,
XXX,
275
41
239
231
12
286
324
389
7
354
PREGKANCY (eontinued) —
„ ovariotomy during, with remarks on the treatment of ovarian
tumoru-s complicating (E. Goddard) . . . xiii,
„ — double, during (J. Knowsley Thornton) . xxvii, 46 ; xxviii,
„ tAvo cases of (W. A. Meredith) . . . xxxiv,
„ after removal of both ovaries for cystic tumour (A. Doran) . xliv,
„ paraplegia occui-ring dui'ing (P. Boulton) . . . ix,
„ pelvic cellulitis after second, followed by suppiu*ation in left
groin and left antero-superior femoral region (N. C.
Hatherley) ...... iii,
„ first, followed by suppuration at back and front jparts of
vagina (G. D. Gibb) . . . . . ii,
„ complicated by acute peritonitis (without discovered cause)
(John PhiUips) .....
„ in cases of phthisis, should it be terminated prematurely ?
(W. Duncan) ......
„ the value of pilocarpine in (John Phillips)
„ the diagnosis of placenta prsevia by palpation of the abdomen
(H. R. Spencer) ..... xxxi, 203
„ three and a half months, with placenta prsevia and fibroids
extensivelv developed in the walls of the dissected uterus
(J. B. Hicks) ...... xvii. 298
„ jpost-mortem examination of a woman at the full period of (F
J. Gant) .....
„ protracted, case of (A. Thomson) .
„ — (C. Paget Blake) ....
„ pyelonephritis of (W. A. Milligan)
„ pyosalpinx complicating (W. C. Grigg)
„ risk to life of first and subsequent (K. Barnes)
„ rupture of the uterus, occiirring at the eight month of (E,
Dunn) .....
„ rviptured uterus in about the seventh month of, death from
peritonitis (J. T. Mitchell)
„ salivation of, successfully treated (T. Skinner)
„ spontaneous salivation associated with (A. Farr)
„ scarlatina during, and in the puerperal state (K. Boxall)
XXX, 11, 126,
„ frozen sections of a uterus at the tenth week of, showing
hsemorrhages into the placenta, decidua reflexa,-and decidua
vera, from a patient who died of heart disease (G. F.
Blacker) ...... xlii,
., complicated with smallpox (K. Barnes) . . ix,
„ — (C. W. Milne) . . . . . ix,
„ spui'ious, simulating ectopic gestation (E. S. Stevenson) . xxxii,
„ tetany in (W. K. Dakin) .... xxxiii,
„ triplets at eighth month of (W. Martyn) . . . xi,
„ twin (J. Way) ...... vii,
„ — complicated by multiple fibro-myomata (John Phillips) . xxviii,
„ double uterus with simultaneous (H. Grace) . . iv,
„ with double uterus, and vagina (J. B. Hicks) . . xxiii,
„ complicated by tumoui- of the uterus (J. L. Worship) . xiv,
„ of a uterus bicornis (J. E. Eatcliffe) . . . xxxiv,
„ unsuspected, and awkward delivery (J. Shortt) . . iv,
„ necrobiotic uterus associated with recent (A. Doran and H.
Williamson) ...... xlvi,
„ in a uterus, with fibroids ; pan-hysterectomy during labour in
the seventh month (J. Bland-Sutton) . . . xlvi.
vi,
214
. xxvii.
308
. xxxiv.
28
. xlviii.
1
. xxxiii,
75
i.
311
ix.
65
1
xi.
204
ix.
117
XV,
222
167
235
102
110
216
163
208
209
138
138
23
305
469
202
274
238
172
PREPtNANCY.
PREGNANCY (coniitiued) —
„ specimen preserved in formalin of an early, in both liorns of
the uterus of a bitch, displaying the allantoid vessels in
their natvu-al colour (Amand Routh) . . . xli,
„ early, excessive vomiting in, depending on the ii'ritation of the
gravid uterus (W. T. Smith) . . . . i,
„ vomiting of, its causes and treatment (W. G. Hewitt) . xiii,
„• — observations on the aetiology of (A. E. Giles) . . xxxv,
„ the uncontrollable vomiting of (Graily HeAvitt) . xxvi, 273,
335
103
303
331
303
288
sickness of, observations on the aetiology of (A. E. Giles) . xxxv,
two fatal cases of pernicious vomiting in (J. L. Maxwell) . xliii,
full-term, in a rudimentary horn of uterus ; missed labour
(five months) ; abdominal section and removal of sac ; re-
covery (J. H. Targett) .... xlii, 276
uterine and extra-uterine, progressing simultaneously to the
full period of gestation (L. K. Cooke)
EXTEA-UTERiNE (C. Waller)
— (C. Drage) .
— (W. Plaj-fair)
— (E. B. Truman)
— (E. Malins)
— (A. L. Galabin)
— (P. Horrocks)
— rare form of (J. B. Hicks)
— two cases of (D. C. MacCallum)
(Dr. Fulcher)
— -with operation (J. Scott)
— cyst from (J. Scott) .
— diagnosis of (L. Tait)
— the treatment of (A. L. Galabin)
— two specimens of
— bilateral (H. K. Andrews)
— unusual (H. Williamson)
— two cases of which went to term (J. Bland-Sutton)
— anomalous case, probably ovarian (E. O. Croft) .
— associated with sloughing of the abdominal wall and
attempted extrusion of a matured and putrid foetus near the
umbilicus (A. M. Shield) .... xxxiii,
— cast from the uterus having all the characters of the
decidual membrane found in connection AAith, together with
a small ovarian cyst from the same case, with microscopic
sections of each (W. E. Dakin) . . xxxviii,
— decidual cast of the ut-erus from a case in which there was
no evidence of (T. W. Eden) ....
— in which the foetus seems to have been developed to the
ivH time in the peritoneal cavity, still retaining its amniotic
covering (L. Tait) ..... xxxiv, 192
— ectopic, going nearly to term in the peritoneal cavity, the pla-
centa being attached to the top of the uterus (G. E.
Herman) .....
— note on the importance of a decidual cast as evidence of
(W. S. A. Griffith) .....
— at full term ; removal of child and placenta by abdominal
section ; recovery (J. W. Taylor)
— the sac being situated in the right broad ligament ; preg-
nancy advanced to the early part of the foiu-th month (W. S.
A. Griffith) . .... xxxiii, 126
V,
143
h
99
ii,
254
vii,
1
vii,
164
. xxxiv,
181
xxxviii.
88
xliv.
228
vii.
95
XV,
248
xxii.
153
XV,
140
XV,
124
XV,
135
. xxxi.
90
xlvi.
88
. xlv.
461
xliv.
225
xliv.
316
xlii.
316
XXXIX,
XXXIX,
XXXVl,
XXXUl,
148
385
132
135
335
115
PREGNANCY. 173
PREGNANCY (continued) —
„ extra-uterine, on primary laparotomy in cases of (F. H.
Champneys) ...... xxix, 456
„ — on delivery by the vagina in (G. E. Herman) . . xxix, 429
„ — double pyo-salpinx simulating ; removal ; recovery xxxvii, 291
„ — gastrotomy successfully performed (W. R. Jordan) . xv, 130
„ for (A. Meadows) .... xv, 145
,, — mode of dealing with placenta in gastrotomy for (R. Barnes) xiv, 325
„ — foetus and placenta in (W. R. Jordan) . . . xv, 124
,, — foetus and placenta removed by laparotomy from a case of
(W. Duncan) ...... xxxvi, 146
„ — gestation sac ruptured in the fifth month of (R. Boxall) . xlvii, 297
„ — placenta from a case of ; the child at full term and removed
five months after death (John Phillips) . . . xl, 3
„ — growth of the placenta after death of the foetus in (Lawson
Tait and C. Martin) ..... xxxiv, 206
,j — death of fcetus at the end of the eighth month, and opera-
tion a month later (A. E. Giles) .... xlvii, 114
„ — operation during the sixth month of pregnancy (H. J.
Paterson) ...... xlvii, 326
„ — not primarily tubal (A. L. Galabin) . . xxxviii, 91
„ — partially macerated fcetus from, retained in the body about
a year after its death (J. D. Malcolm) . . . xU, 222
„ — macerated bones of a fcetus from, retained seven years
(J. D. Malcolm) ..... xli, 223
„ — death after operation from septicaemia; remarks on the
significance of adhesions of the wall of the gestation sac to
the dead foetus (J. D. Malcolm) .... xlv, 421
„ — simulating a retro-flexed gravid uterus (J. M. Munro Kerr) xlii, 146
„ — in which foetal death occurred at term after spurious
labour and abdominal section was performed four to five
months later (John Phillips) .... xlii, 121
„ — in which foetal death occtirred at the eighth month after
spurious labour ; abdominal section two months later (A. Doran) xlii, 213
„ — treated by abdominal section (J. B. Hicks) . . ix, 93
„ — abdominal, removal of living fcetus by abdominal section
(T. R. Jessop) ..... xviii, 261
„ delivery of living child per vaginam; removal of pla-
centa ; recovery (J. H. Mathieson) . - . . xxvi, 132
„ in which abdominal section was perf onned during the Kf e
of the foetus at the thirty -fifth week of gestation (J. Williams) xxix, 482
„ — — case of, in which a communication existed between the
cyst and the uterus (A. L. Galabin) . . xvii, 170, 384
„ foetal bones from a case which had imdergone sponta-
neous cure (W. O. Priestley) .... xxi, 24
„ about the seventh month, removal of foetus by ab-
dominal section (J. B. Hicks) .... xxii, 141
„ two cases of, with results (C. H. Carter) . . xxii, 160
„ fcetus and placenta from (G. E. Herman) . . xxviii, 141
„ — from a case of (C. J. Cullingwoi-th) . . xxxii, 135
„ sac, and pelvic viscera from a case of, removed by
abdominal section (A. Doran) .... xxix, 491
„ four months' foetus from (A. Lawrence) . xxx, 122, 302
„ — — abdominal section eight montlis after death of fcetus
(C. J. Cullingworth) ..... xxx, 480
„ gastrotomy for, in which the placenta never came away
(J. Eraithwaite) ..... xxviii, 33
174
PREGNANCY.
PREGNANCY (continued) —
„ oxtra-uterine, abdominal, associated with intra-uterine, in
Avhich abdominal section was performed (A. L. Galabin) . xxiii, 141
„ simrdating so-called missed labour (A. Easch) . xxv, llS
„ parts illustrating (Heywood Smith) . . . xx, 5
„ removed by vaginal incision (C. Godson) . . xxix, 499
„ case of, in which the foetal movements ceased at the
end of the eighth month, and abdominal section was per-
formed four weeks later (C. J. Cullingworth) . . xxxv, 155
„ — — spurious labour at term ; foetus and placenta removed six
months later (E. J. Maclean) .... xlviii, 129
„ successfully treated by removal of child and placenta
three months after death of child at term (J. W. Taylor) . xxxix, 178
„ in which foetal death probably occurred at the end of
the sixth month, and abdominal section was performed two
and a half months later (John Phillips) . . . xxxv, 162
„ two cases of (E. S. Stevenson) . . . xxxv, 175
„ question of, in specimen of foetus in peritoneal cavity
(A. Doran) ...... xxxv, 222
„ and ovarian, summary of reported cases of primary
(A. Doran) ...... xxxv, 222
„ secondary to partial rupture of tubal gestation sac;
abdominal section fifteen months after conception and eight
months after death of foetus (J. B. Hellier) . . xlv, 366
„ (A. J. Stiu-mer) ..... xlvi, 381
„ — — section on each occasion (C. E. Purslow) . . xlvii, 185
„ — secondary abdominal ; septic peritonitis ; evacuation per
rectum ; recovery (H. A. Lediard) . . . xli, 276
„ — primary ovarian (A. W. Mayo Robson) . . . xliv, 215
„ — probably ovarian, report of committee on E. O. Croft's
specimen of an anoinalous case of . . . xliii, 24
„ — ovarian (J. H. Davis) . . . . i, 241
^, (E. ChOd) ..... xviii, 119
„ (J. Chalmers) .... xviii, 67, 82
„ — interstitial (R. Greenhalgh) . . . . v, 154
„ ruptured (H. E. Andrews) .... xlvii, 259
„ — intermural (J. B. Hicks) . . . . ix, 57
„ — intra-ligamentous, retained for twenty-one years (A. L.
Galabin) ..... xxxviii, 38
„ — (intra-ligamentous), at the seventh month, in which the
foetus was extracted by vaginal incision (A. Donald) . xli, 7
„ — Fallopian (H. Grace) . . . . ii, 49
„ — the left ovary and the fimbrias of left Fallopian tube
formed the cyst, which had ruptured, discharging the eight
months' foetus into abdominal cavity (J. H. Davis) . . xii, 331
„ — report on H. Davis's specimen of . . . xii, 367
„ — tubal, -svith fibrous tumoiu-s of the uterus (G. Harley) . i, 101
„ (J. L. Worship) . . . . . xi, 211
., — tubal, foetus and placenta successfully removed in a case
of (G. E. Herman) ..... xxx, 123
„ Fallopian tube and ovary from a case of (W. Duncan) . xxxi, 165
„ (J. S. Tiu-ner) . . . . . xvi, 30
„ (P. Boulton) ..... xxi, 117
„ (W. Burton) ..... xxiii, 34
„ (Clement Godson) .... xxiii, 109
„ (J. Matthews Duncan) .... xxiii, 263
„ (F. H. Daly) ..... xxiv, 155
xxi, 169
XXX, 195
xli, 384
xlviii, 272
PREGNANCY. 175
PREGNANCY (continued)—
„ extra-uterine, tubal, (W. S. A. Griffith) . . . xxvii, 304
„ (Leonard Eemfry) .... xxxvii, 287
» (J- Bland-Sutton) . . . xxxiii, 70 ; xl, 313
„ incomplete tubal abortion ; hsemorrhage ; operation ;
recovery (A. C. Butler- Smythe) . . . . xl 298
„ (W. G. Hewitt) . . . . . v^ 154
„ ruptured at the sixth week (A. L. Galabin) . xxxviii, 39
„ of nine weeks' duration successfully removed three hours
after rixpture (W. Duncan) .... xxxvi, 66
„ of three months operated on before rupture (A. H. N.
Lewers) ..... xxxvii, 151
„ — — two unusual cases of : the one causing chronic intestinal
obstruction, and accompanied by a hsematosalpinx of the
non-gravid tube ; the other simulating retroversion of the
gravid uterus (A. E. Giles and E. J. Maclean) . . xxxix, 232
„ case of, with notices of other cases (C. H. F. Routh) . xxi, 93
„ and the effects of chronic retro-uterine haemorrhage
(A. Doran) ......
„ microscopical section of tube from (A. L. Galabin)
„ (molar) complicated by suppurating ovarian cyst of the
opposite side (John Phillips) ....
„ with acute salpingitis (T. W. Eden) .
„ sections showing muscular tissue in the pseudo-reflexa
(H. E. Andi-ews) ..... xlv, 335
„ in which the ovum continued to grow for about four
weeks after rupttu-e, the gestation sac becoming implanted
on the omentum (C .Lockj^er) .... xlv, 400
„— ruptured tubal (W. Duncan) . . xxxvi, 114 ; xxxvii, 244
„ (W. A. Stott) ..... xxxvi, 343
„ (W. S. Playfair) .... xxxviii, 34
„ (at fourth or fifth week) ; operation ; recovery (Amand
Eouth) . . . . . . xl, 220
„ with hsematosalpinx of opposite side (A. H. N. Lewers) xxxix, 189
„ (J. H. Dauber) ..... xliv, 321
„ and death about the fifth month (A. Meadows) . xviii, 258
„ Caesarean section and total abdominal hysterectomy
for fibroids complicating labour near term in a patient who
had recovered without operation from (H. E. Spencer) . xlviii, 240
„ uterus and appendages showing (C. Godson) . xxii, 186, 242
„ foetus from (A. H. N. Lewers) . . . xxviii, 207
„ — — foetus, placenta, membranes, and Fallopian tube from a
case of, complicated by a large hsematosalpinx on the other
side (C. J. Cullingworth) .... xxxii, 273
„ (Sidney Harvey) . . . xxx, 2, 166
„ (C. .T. Cullingworth) .... xxxiv, 134
„ (A. E. A. Lawrence) .... xxxiv, 439
„ four cases of ruptured, occurring in two women ;
removal by abdominal section ; recovery (A. J. Sturmer)
„ — which apparently ruptui-ed twice (J . C. H. Leicester)
„ — ruptured, in an imperfect uterine horn (J. H. Targett)
„ — rupture of an early tubal (fifteenth day), complicated by
fibro-myomata of the uterus (E. E. Dawson)
„ removed by abdominal section (J. Knowsley Thornton)
x:
„ — (Sydney Jones) ....
„ — aboiiion (J. Bland-Sutton)
xlv.
144
xlvii.
321
xxxix.
46
xl,
155
dv, 51,
81
xxri.
268
xxxii.
342
176 PREGNANCY — PRESENTATIONS.
PREGNANCY {continued) —
„ extra-uterine, rupture of an early tubal, rupture into broad
ligament (J. Bland-Sutton) .... xxxiv, 217
„ removed before rupture (G. E. Herman) . . xxxii, 307
„ diagnosed before rupture, and a case of tubal abortion
(J. Bland-Sutton) ..... xliv, 44
„ — unruptured tubal, with apoplexy of tbe ovum (C. J. CuUing-
Avorth) ..... xxxiv, 155, 182
„ — supposed unruptured tubal (W. S. Playfair) . xxxiv, 28, 465
„ — removal of unruptured tube ; recovery (W. G. Nash) . xlvii, 408
„ — unruptured tubal (T. W. Eden) . . . xxxvi, 5
„ — — removed by abominal section (W. Duncan) . xxxvii, 197
„ (W. Duncan) .... xxxviii, 36
^^ (M. A. D. Scharlieb) .... xlvi, 54
„ — sections showing muscular tissue in the pseudo-reflexa in
(H. R. Andi-ews) ..... xlv, 333
„ — suspected early tiibal, on both sides double hajmato-salpinx
(A. Doran) ...... xxxiii, 112
„ — early tubal, with hsematoma and hsematoeele (A. Doran) . xlvi, 206
„ — operation for, between the third and fourth months of
gestation, with removal of a living foetus and much trouble
from haemorrhage during convalescence (J. D. Malcolm) . xlv, 382
„ — repeated, in the same patient ; laparotomy on each occasion
(A. H. N. Lewers) .... xlii, 324 ; xlv, 418
„ — repeated tubal (A. Doran) .... xMi, 235
„ — tubo-abdominal, at three months (F. G. Penrose). xxx, 124, 303
„ at the fourth month of pregnancy removed by abdominal
section (G. F. Blacker). .... xlviii, 137
J, in which a living foetus was extracted by coeliotomy
after term, and the mother's life preserved (J. Bland-
Sutton) . . . . . . xl, 308
„ — tubo-ovarian (J. A. M. Moullin) . . . xxv, 103
„ (E. J. Maclean) ..... xxxv, 106
^^ — interstitial or tubo-uterine, with notes on similar cases in
the museums of London hospitals (A. Doran) . . xxiv, 227
^^ — early ectopic (? tubo-uterine) complicated by fibro-myomata
of the uterus (C. J. Cullingworth) . . xxxix, 284; xl, 285
„ — tubo-iiterine ; primary intra-peritoneal rupture ; recovery
(J. Bland-Sutton) ..... xxxvii, 296
„ — tubular, with twins (N. J. Haydon) . . . v, 75
,, — case of spurious pregnancy simulating (E. S. Stevenson) . xxxii, 216
„ — supposed, with birth through uterus (E. F. Griin) xxvii, 226, 306
„ — followed by intra-uterine (E. E. Day) . . . vi, 3
,, — in which two foetuses were found in connection with the
same tube (N. J. Haydon) . . . ■ X' ^^^
„ — rupture of the cyst and death . . . . xi, 7
„ — terminating in sudden death (W. Martyn) . . xi, 57
„ — report on . . . . . . xi, 62
^^ — treatment of some forms of (A. Meadows) . . xiv, 309
„ — with remarks on its treatment (A. Meadows) . . xiii, 268
PREGNANT HORN from the uterus of a cat (Robert Wise) . xxxix, 260
PRESENTATIONS, breech, blunt hook and sling for assisting
delivery in cases of (J. G. Swayne) . . . xvii, 313
„ breech, the forceps in . . . . . xix, 217
^^ _ ^^th extended legs (W. S. A. Griffith and Arnold W. W.
Lea) ...... xxxix, 13
PRESENTATION — PR0BIN-WILLIAM8. 177
PRESExYTATION, face (R. Barnes) . . . . v, 173
„ — delivery by forceps ; subsequent sloughing and separation
of the mucous lining of the bladder and expulsion of the
same (W. Martyn) . . . . . v, 186
„ — in the mento-posterior position (J. B. Hicks) . . vii,' 57
„ — in which delivery was effected by the cephalotribe (J, B.
Hicks) . . . . . . X, 144.
„ — mento-anterior, cast of the head of a child born under,
shelving distortions of face and cranium (G. Roper) . xx, 124
„ deliveiy by the forceps in face, in the mento-lateral position
(J. B. Hicks) . . . . . . XV, 39
„ natm'ai and placental, in a case of twins (J. Brunton) . xii, 167
„ of the right arm and shoiilder ; delivery by the natural powers,
or spontaneous evolution (R. Hodges) . , . iv, 140
„ of right breast, followed by prolapsus of the cord and right
arm ; delivery by version (J. Brimton) . . . x, 145
„ of right shoulder and arm ; spontaneous evolution (C. Mayo) . iii, 105
„ funis (H. G. Trend) . . . . . x, 1
„ head-last, on traction by the lower jaw in (J. Matthews
Duncan) , . . . . . xx 61
„ of the upper extremity, on the choice of leg which shall be
seized in version for (A. L. Galabin) . . . xvs., 239
PRESSURE of the femora, and its influence on the shape of the
pelvis (F. H. Champneys) .... ixv, 70
Prbvot (Oscar), thermo-cautery, invented by Paquelin . xviii, 180
Priestlbt (W. O.), curious intra-uterine injury on the head of a
new-born child . , . . . i, 60
„ labour complicated with a fibrous tumour of the uterus;
delivery by long forceps, and subsequent removal of tumour
„ sloughing of the fcetal scalp as the result of tedious labour .
„ treatment of cases of abortion in which the placenta and mem-
branes are retained .....
„ medicated pessaries .....
„ inaugural address as President ....
„ anniial address as President . . . xviii, 29 ;
„ summary of discussion on puerperal fever (vol xvii) .
„ bones from an extra-uterine fcetation which had undergone
spontaneous cure .....
„ on the induction of abortion as a therapeutic measure
„ chronic papillary inflammation of the vulva
„ notes of a visit to some of the lying-in hospitals in the North
of Europe ; and particularly on the advantages of the anti-
septic system in obstetric practice
„ election as Honorary Fellow ....
„ letter acknowledging election as Honorary Fellow .
Peitchard (W. E.), abortion procured by tents of common sea-
tangle . . . . . . V, 198
Probtn-Williams (R. J.), malformed heart . . . xxxvi, 3
„ hydrocephalus with spina bifida .... xxxvi, 4
„ abscess in abdominal wall .... xxxvi, 62
„ and Lennard Cutler, some observations on the tempera-
ture, pulse, and respiration during laboui* and the lying-in xxxvii, 19
„ adjourned discussion .... xxxvii, 152
„ see A. E. Giles.
12
i.
217
i.
323
iii.
146
vii.
208
xvii.
36
1; xix.
17
xviii.
29
xxi.
24
xxii.
271
xxvi.
156
XX vii.
197
xlii.
40
xlii.
131
178 PEOCIDENTIA UTERI — PUERPERAL ECLAMPSIA.
PEOCIDENTIA UTERI, see Prolaps^ts uteri.
PROLAPSUS of the female genital organs (M. Konrad) . . xiii, 251
„ of the cord and right arm following presentation of the right
breast ; delivery by version (J. Brunton) . . . x, 145
„ of the funis dtiring labour (G. Roper) . . . xvii, 318
„ of ovaries, adherent (W. S. A. Griffith) . . . xxvi, 270
„ ovarian, treated by shortening the ovarian ligament (V.
Bonney) ...... xlviii, 339
„ of the pelvic floor and uterus, the changes which accom-'
pany the slighter degrees of (G. E. Herman) . . xxxi, 276
„ of Meckel's diverticulum in an infant, forming an umbilical
tumour (S. W. Wheaton) .... xxxiv, 184
„ of the vagina, the relation of, to hernia (G. E. Herman) . xxvi, 88
PROLAPSUS UTERI (J. M. Sims) . . . vii, 213, 238
„ cases of (A. Cordes) ..... xvii, 63
„ complete, caused by fibroid tumotu" springing from the pos-
terior lip of uterus (R. Barnes) .... iii, 211
„ congenital and imperforate rectum (H. K. Andrews) . xlii, 169
„ congenital, of uteriis associated with spina bifida (H. R.
Andi'ews) ...... xliv, 137
„ complete, of an inverted uterus (H. R. Andrews) . . xlviii, 284
„ and inversion of vagina, with hypertrophic elongation of
cervix (R. Barnes) ..... xv, 124
„ in which the neck of the uterus was partially severed by a
ligatui'e of hair (N. Coates) .... xv, 9
„ extirpation of uterus for (E. Malins) . . . xxvi, 148
„ pessary for (R. Barnes) ..... xix, 119
„ (A. L. Galabin) . . . . . xx, 169
„ new treatment in (J. H. Aveling) . . . xi, 215
„ vesical calculi from a case of (A. LaA^'rence) . . xxx, 227
„ ending fatally by dilatation of the iireters and wasting of the
kidneys (J. J. Phillips) .... xii, 276
„ vesical calculi, the sequel of (A. L. Galabin) . . xxii, 106
PROPAGATION, power and act of, in females of the industrial
classes in tlie metropolis ; derived from eleven years' experience
of two lying-in institutions (A. B. Granville) . . ii, 139
Propebt (Mr.), fibro-sarcoma of the right ovary . . xii, 1
PROPERTY of the Society, alteration of laws respecting the . xxxii, 106
PROTRUDER, rectal (J. H. Aveling) . . . xviii, 83
Provis (F. Lionel), see Eden, T. W.
PSEUDO-HERMAPHRODITISM, pelvic viscera showing (C. H.
Roberts) ...... xliii, 298
PUDENDUM, inflammations of lupus of the (J. Matthews Duncan) xxvii, 310
PUERPERAL CONVULSIONS ; illustrated by cases (J. H. Davis) . xi, 268
PUERPERAL DIABETES (J. Matthews Duncan) . . xxiv, 256
PUERPERAL DISEASES, short report of eighty-nine cases, with
remarks (J. B. Hicks) ..... xii, 44
,, (J. B. Hicks) adjourned discussion on . . . xii, 123
., further contribution to the clinical knowledge of (J. B.
Hicks) ...... XXXV, 412
2 uHRPEKAL ECLAMPSIA, cases of, especially illustrating the tem-
perature and urine in this disease (G. E. Herman) . . xxxii, 17
PUERPERAL ECLAMPSIA PUERPERIUM.
179
131
PUIEPERAL ECLAMPSIA (continued)—
„ five more cases of, especially illustrating the temperature and
urine in this disease (Gr. E. Herman) . . . xxxiii, 315
„ with autopsy and remarks (R. H. Bell) . . . xliv, 253
„ see Eclampsia.
PUERPERAL FEVER (W. T. Fox) .... iii, 368
„ (T. Snow Beck) . . . . . vii, 31
„ discussion on the relation of, to the infective diseases and
pysemia .... xvii, 90,
„ stimmary of discussion (W. O. Priestley) .
„ and septic poisoning, inaugural address (J. Watt Black)
„ complicated with diphtheria, in which life was saved by the
sesquichloride of iron (R. Druitt)
„ or puerperal pyemia, after an abortion (T. S. Beck) .
„ in the British Lying-in Hospital; with remarks on the
treatment of (W. G. Hewitt)
„ treated by the injection of ammonia into the veins followed by
recovery (W. T. Smith)
„ in England and Wales, undiminished mortality from, inaugural
address (C. J. Cullingworth)
„ uterus of patient after (R. Barnes)
,, see also Fever.
PUERPERAL HEMORRHAGE, secondary (C. S. Redmond)
PUERPERAL HYPERPYREXIA, bed for cases of, requiring con
tinuous application of cold (W. S. Playfair)
PUERPERAL INSANITY, cases of, in the Montreal University
Lying-in Hospital (D. C. McCallum)
„ (Robert Jones) ....
„ bromide of pota-ssium in (J. B. Curgenven)
PUERPERAL PERITONITIS (J. T. MitcheU) .
„ complicated with ovarian disease, followed by febrile diseases
of the puerperal state, the probable consequences of infection
. (R. U. West) . . . . .
PUERPERAL SEPTICaJMIA, case of (H. Gervis)
„ with abscesses, phlegmasia dolens, etc. (A. Wiltshire)
„ the clinical relation of scarlatina to (R. BoxaU)
„ uterus, heart, and brain from a case of (W. Duncan)
PUERPERAL TEMPERATURES, some observations on (E. S, Tait)
PUERPERAL THROMBOSIS (W. S. Playfair) .
PUERPERIUM, abscess of uterus developing d\xring ; rupture into
the peritoneal cavity ; abdominal section ; recovery (A. W. W.
Lea). ......
„ sudden apoplectiform seizure, terminating fatally in tliirty-
five hours, on the sixth day of the (R. U. West)
„ the change in size of the chest and abdomen during, and the
effect of the binder upon them (G. E. Herman)
„ epileptiform convulsions in the third week of (R. U. West) .
„ fatal influence of grief during (G. D. Gibb)
„ febrile diseases of, foUo^ving puerperal peritonitis complicated
with ovarian disease (R. U. West)
„ fever during the. Part II. — The relation of internal meteoro-
logical conditions to the incidence of febrile illness in child-
bed (R. Boxall) . . . . .
, 178, 217
xviii, 32
xxxiii, 76
iii, 30
ix, 275
X, 69
xi, 247
xxxix, 91
ix, 241
xix, 258
XX, 171
XX, 46
xlv, 2
ix, 155
iv, 96
i, 187
xviii, 160
xviii, 181
XXX, 126
xxxi, 202
xxvi, 8
xvi, 42, 89
xlvi, 7
ii, 276
xxxii, 108
iii, 35
i, 75
i, 187
XXXV, 340
180 PUERPKETUM PUS.
PUERPERIUM (continued) —
„ vaginal hysterectomy in, for sepsis due to suppuration of
myoma (A. W. W. Lea) .... xlvii, 1
„ destructive inflammation of hip-joint in (T. W. N\mn) . vi, 116
„ lymphangitis mammse : an affection of the breast arising about
the tenth day of (E. H. Vincent) . . . xliv, 158
„ the conditions which favour mercurialism dtu-ing the, with
suggestions for its prevention (E. Boxall) . . . xxx, 304
„ mortality in, both in hospital and in general practice (E.
Boxall) . . . . . . xlvii, 196
„ the value of pilocarpine during the (John Phillips) . . xxx, 354
„ acute non- septic pulmonary disorders as coniplications of
(John Phillips) ... . xxxi, 171
„ scarlatina during pregnancy and in the (E. Boxall) xxx, 11, 126, 167
„ effect of the scarlatinal poison on the (E. Boxall) . . xxx, 70
„ the occurrence of siigar in the urine diu-ing the (F. J. McCann
and W. A. Turner) ..... xxxiv, 473
„ the indications afforded by the sphygmograph during the
(F. Barnes) . . . ... xvi, 263
„ observations on the temperature, pulse, and respii'ation during
labour (E. J. Probyn- Williams and L. Cutler) . xxxvii, 19, 152
„ absorption of thrombosis of the pidmonary artery during the
(W. S. Playfair) ..... xxvi, 162
„ sections of uterus at different periods of the, showing complete
absence of the alleged fatty changes (W. S. A. Griffith) . xxxi, 308
„ variation in height of the fundu.s uteri above the symphysis
dvu'ing, the conditions which influence this, and the practical
conclusions which may be drawn from such observations
(T. G. Stevens and W. S. A. Griffith) . . xxxvii, 245
„ see also Childbed.
PULMONARY ARTERY, absorption of thrombosis of, in the puer-
peral state (W. S. Playfair) .... xxvi, 162
„ fatal embolism of the right heart and, nineteen days after
delivery (G. Eoper) ..... xxi, 74
PULMONARY DISORDERS, acute, non-septic, as complications of
the puerperium (John Phillips) .... xxxi, 171
PULSE and respiration during labour and the lying-in, some
observations on the temperature and (E. J. Probyn-Williams
and L. Cutler) .... xxxvii, 19, 152
„ and temperature in relation to menstruation, observations on
the variations in (A. E. Giles) .... xxxix, 115
PuRCKLL (F. A.), vaginal hysterectomy for malignant disease . xxvii, 5
PURPURA HaiMORRHAGICA, influence of, upon menstruation and
pregnancy (John Phillips) . . . xxxiii, 2, 390
PURSE-STRING SUTURE, its use in complete rupture of the peri-
nexun (P. Boulton) ..... xxxii, 380
PuRSLOw (C. E.), foetus enclosed in amniotic sac only . . xli, 168
„ cyst of the broad ligament .... xli, J 69
„ cystic tumour of uterus ..... xlvi, 269
., tubal mole . . . _ . . . xlvi, 271
„ repeated tubal preg-nancy, abdominal section on each occasion xlvii, 181
PUS, oft'ensive, in sarcoma of ovary showing necrosis of central
portion lying in an abscess cavity (W. W. H. Tate) . xli, 373
PYiEMIA — QUEEN VICTOEIA. 181
PYEMIA in a case of cancer of the cervix uteri complicating
pregnancy (A. L. Galabin) .... xxiii, 186
„ causing death in an early pregnancy, attended by fibrous
tumour of the titerus (J. H. Davis) . . . viii, 11
„ death of mother from, after parturition, in a case of epithe-
lioma of the cervix (A. W. Edis) . . . xvii, 344
„ discussion on the relation of puerperal fever to the infective
diseases and . . . xvii, 90, 131, 178, 217 ; xviii, 32
„ puerperal, or puerperal fever, after an abortion (T. S. Beck) . ix, 275
„ produced by phlebitis of the umbilical vein, tAvo cases of death
in new-born infants from (G. Roper) . . . xix, 8
„ with extensive piu'ulent deposits in a new-born infant (A. W.
Edis) ...... xix, 12
PYELONEPHRITIS of pregnancy (W. A. Milligan) . . xlviii, 1
PYOMETEA (W. S. A. Griffith) .... xxix, 398
two specimens of (J. Matthews Duncan) . . . xxi, 54
microscopic sections of utei-ine wall from a case of (A. L.
Galabin) ...... xxii, 239
cancerous uterus with (A. H. N. Lewers) . . xxxviii, 14
complicating cancer of the cervix iitei-i (W. W. H. Tate) . xxxix, 323
PYOSALPINX, cases of (Lawson Tait) . . xxv. 111, 138, 234
— (J. Knowsley Thornton) .... xxv, 139
ovaries and tiibes from a case of (E. Malins) . . xxvi, 228
removal of the uterine appendages for (Lawson Tait) . xxiv, 157
double (E. Malins) ..... xxvii, 137
— (C. H. Carter) ..... xxxii, 64
— with rupture of the tubes (A. H. N. Lewers) . . xxvii, 298
— associated with fibro-myoma of uterus (W. S. Playfair) . xxxiii, 497
— (A. C. Butler- Smy the) .... xxxiv, 24
— (W. Duncan) . . . xxxvii, 245 ; xxxix, 89
— simulating extra-uterine pregnancy ; removal ; recovery
(W. Duncan) .... xxxvii, 291
— in which the tvxbal sacs communicated (J. D. Malcolm) xlii, 10
— in which the tubes were enormously distended (C. H.
Roberts) . . . . . . xl, 121
— tuberculous, with inter-communication of the tubes (A. L.
Galabin) ...... xlii, 173
— with enlarged bladder and secondary renal cqmplication
(H. Macnaughton-Jones) .... xxxix, 319
— tuberctdous (J. H. Targett) .... xli, 341
with tubo-ovarian cysts (W. C. Grigg) . . . xxxiii, 75
two cases of double tuberculous (J. H. Targett) . . xli, 163
Tinsuspected tuberciUous salpingitis and (J. H. Targett) . xlvi, 20
a series of seven cases of (C. J. Cullingworth) . . xxxiii, 447
two cases of (C. J. Cullingworth) .... xxxiv, 219
complicating pregnancy (W. C. Grigg) . . . xxxiii, 75
simulating tvxbo-ovarian abscess (C. J. Ctillingworth)
xxxiv, 437; xxxvii, 2
with multiple abscesses of the ovary (C. J. Cullingworth) . xxxix, 47
with twisted pedicle (A. H. N. Lewers) . . . xliv, 362
and hsematosalpinx (W. Duncan) . . . xxxi, 332
see Uterine appendages.
QUEEN VICTORIA, loyal address submitted to the King on the
death of . . . . . . xliii, 21
„ — reply ...... xliii, 143
182 RABBIT REMFRT.
RABBIT, five fcetal sacs from the peritoneal cavity of (M. S.
Pembrey) ...... xl, 253
„ sacs containing foetuses and lying f i-ee in the peritoneal cavity
of (M. S. Pembrey and G. Bellingham Smith)
EADIOGRAPH of fostns in utero (Heywood Smith)
Eadford (Thomas), laceration of the uterus, with remarks
Kasch (Adolph), simple instrument for vaginal injections
„ cedema of the lower half of the body, after a fall in the seventh
month of pregnancy in premature labour ; recovery
„ vaginal drainer .....
„ f cetus and placenta ; funis obliterated by twisting
„ air in the vagma .....
„ novel way of using the uterine sound in flexions of the uterus
„ case of extra-uterine gestation simulating so-called missed
laboiu' ......
„ gangrene of the bladder from retroversion of the gravid uterus
„ case of large chylous cyst of the mesentery
„ ovaries removed from a case of osteomalacia
„ osteomalacia cui'ed by excision of the ovaries
Ratcliffe (J. R.), pregnant uterus bicornis .
Eatnes (H.), difficult labour from locked heads
RECTUM, adhesions between the uterus and, dragging down the
fundus uteri (E. E. Day)
„ cancer of ovary extending to (J. W. J. Oswald)
„ cancerous disease of, in a patient in whom abortion was
induced (F. W. Mackenzie)
„ and the genito-ui-inary tract, pelvic viscera shoAving congenital
communication between (A. Doran)
„ imperforate ; attempt at relief by operation ; death (W. T. Fox)
„ — two cases of (P. Horrocks) ....
„ — imperforate, and congenital prolapse of the uterus (H. R.
Andrews) ......
„ instrument for protruding the, by pressure on the posterior
wall of the vagina (J. H. Aveling)
„ malformation of (A. E. Giles) ....
„ malignant growth in the, complicating pregnancy (J. B.
Potter) ......
„ timiour protruded from, during laboui- (R. Barnes) .
„ viterus, and left kidney from a woman who died of ursemia
(W. Dimcan) .....
Redmond (C. Stennett), secondary puerperal htemoiThage
REFEREES, alteration of the laws respecting the
REGISTER, obstetrical (D. Mackinder)
REGULATOR, Leiter's temperature (C. Godson)
„ to be used with Paquelin's cautery (J. H. Aveling) .
RELATIONS of organic affections of the heart to fibro-myoma of
the uterus (T. Wilson)
Rkmfry (L.), blighted embryo
„ two cirrhotic and cystic ovaries, with microscopical section of
same .....
,, ligature and division of the upper part of both broad ligaments,
and~the result as compared with that foUoAving removal of
the uterine appendages
xlvi.
283
xlviii,
44
viii.
150
vi.
224
vii.
80
X,
94
X,
94
xii.
281
xiii.
247
XXV,
113
xxxi,
129
xxxi,
311
xxxiv.
462
XXXV,
39
xxxiv,
469
iv,
19
vi,
10
xviii.
122
i,
11
xxii,
79
iv.
195
XX vii.
135
xlii.
169
xviii.
83
xxxiv.
129
XX,
110
xxi.
28
xxxi.
,255
xix;
,258
xxvii,
, 59
ix.
268
xxiii,
131
XX,
,293
xlii,
,176
XXXV,
,153
xxxvi.
, 184
xxxvi.
,202
REMFRY EEVOLUTIONy. 183
Rbmfbt (L.) (continued) —
„ remarks on f cetal retroflexion ; report of a specimen showing-
origin of gluteus maximus from occipital bone . . xxxvi, 227
„ incomplete tubal abortion .... xxxvi, 261
„ gestation in a rudimentary liorn .... xxxvi, 26-3
„ ease of absence of utervis and breasts . . • xxxvu, 12
„ list of ovariotomies in women over 80. A case, aged 83, com-
plicated by epithelioma of the vulva . . xxxvu, 155
„ tubal gestation .... xxxvii, 287
„ effects of lactation on menstruation and impregnation _ xxxviii, 22
„ microscopical sections of uterus showing chorionic villi and
doubtful sarcoma .... xxxviii, 223
„ hydrocele of the canal of Niick containing a portion of the
left FaUopian tube . . . • . xl, 6
„ death of . . . . . . xl, 174
RENAL FUNCTION, see Kidneys.
REPORT of the University Lying-in Hospital, Montreal (D. C.
McCallum) . . . • • . xx, 35
REPORTS OF COMMITTEES, see Committees, reports of.
REPOSITOR for inversion of the .uterus (J. H. Aveling) . . xx, 126
REPOSITORS, failiu-e of elastic pressure vrith, in a case of complete
inversion of uterus of seven months' duration ; operation of
anterior vaginal cceliotomy, anterior hysterotomy, and re-
placement ; recovery (J. W. Taylor) . . . xliv, 299
RESPIRATION during labour and the lying-in, some observations
on the temperature, p\ilse and (R. J. Probyn-WiUiams and L.
Cutler) ..... xxxvii, 19, 152
RETENTION OF MEMBRANES, some causes of (F. H. Champneys) xxix, 337
RETINITIS, see Choroido-retinitis.
RETRACTION of the uterus (J. Matthews Duncan) . . xxviii, 115
„ tonic uterine contraction without completeness of (J. Matthews
Duncan) . . . . . • xxix, 369
„ of uterus, a case showing (a) uterine contraction without, and
(h) prolonged high temperature of nervous origin (G^. E.
Herman) ...... xlviii, 204
RETRACTORS, self-retaining glass (H. Macnaughton-J-ones) xxxviii, 345
RETROFLEXION of an early human embryo, with absence of the
spinal medulla and imperfection of the vertebral column
(C. B. Lock^vood) ..... xxix, 234
„ of the foetus during pregnancy (J. Matthews Duncan and J. B.
Hurry) ...... xx%a, 206
„ — and ectopia viscerum (W. R. Dakin) . xxxi, 308 ; xxxii, 200
„ (Amand Routh) ..... xxxy, 102
„ — at seven months, ilKistrating celosoma vnth. (Leith Napier) xxxvi, 116
„ foetal, report of a specimen showing origin of gluteus maximus
from occipital bone (L. Remfry) .... xxxvi, 227
„ of the gravid uterus diu'ing labour at term (H. Oldham) . _ i, 317
„ of uterus as a frequent cause of abortion (J. J. Phillips) . xiv, 45
„ — in a new-born child (H. R. Spencer) . . . xxxiv, 25
RETROVERSION OF UTERUS, see Uterus, displacements of (retro-
version).
REVOLUTIONS, foetal (.T. Matthews Duncan) . . . ^^-^^f'h 171
184
raCHAEDS — ROBINSOX.
EicHARDS (D.), spina bifida, followed by hydroceplialua . iv, 191
Richardson (Benjamin), remarks in the discussion on puer-
peral fever ...... xvii, 122
RiCHABDSON (J. C), double placenta, with remarks by G. Hewitt viii, 337
RICKETS, influence of the mother's health in the production of
(W. T. Fox) . . . . . . iv, 260
„ oblique rhachitic pelvis (W. S. A. Griffith) . . . xxv, 232
RiGBT (Edwaed), address at first meeting of the Society . i, 1
„ address as President . . . . i, 1 ; ii, 1
„ cranial blood swelling ; with remarks on the nature of these
tumours . . . . . . i, 231
„ address at first anniversary meeting of the Society, January
4th, 1859 . . . . . . ii, 1
RiGDEN (George), statistics of midwifery in private practice . xxiii, 151
RiGDBN (W.), age at which menstruation commences . . xi, 243
Ritchie (C. J.), cephalotripsy as performed at Vienna by Pro-
fessor Braun . . . . . . vi, 75
„ dermoid cyst in Fallopian tube .... vii, 254
Ritchie (James), embryoma of anterior mediastinum in a male
adult ...... xlv, 250
Roberts (C. H.), curious congenital deformity . . xxxvi, 341
„ on the common form of " white leg " after confinement xxxvii, 163
„ notes of a case of primary epithelioma of vagina . xxxviii, 381
„ fibroma of the ovary undergoing calcareous degeneration . xxxix, 8
„ a case of double pyosalpinx, in Avhich the tubes were enor
niously distended ....
„ a case of primary carcinoma of the Fallopian tube .
„ second case of primary carcinoma of the Fallopian tube
„ notes of a case of a large retro-peritoneal fibroid undergoing
suppiu'ation .....
„ myxoma of chorion not discharged till the seventh month
„ cystic fibro-myoma of the cervix uteri
„ cancer of the cervix associated with an adenomatous growth
in the fundus .....
„ pelvic viscera showing pseudo-hermaphroditism
„ adenoma malignum of the body of the uterus
„ microscopical sections of a case of tuberculosis of the ovary
and Fallopian tube ....
„ conaual pregnancy at full term removed six months after the
death of the child ....
„ curious case of cancer of the uterus
„ supposed recurrence after vaginal hysterectomy for cancer of
the cervix .....
Roberts (D. Lloyd), report of a case of Caesarean section, with
remarks .....
„ two cases of monstrosity
„ fibroid polypus attached to the fundus uteri removed by
ecraseur ; recovery ....
„ spina bifida .....
„ two cases of spina bifida and one of extroversion of bladder
„ notes of cases of submucous fibroid of the uterus, etc.
„ draAving of bicorned uterus with double vagina
Robinson (A. H.), see CulUngworth, C. J.
xl, 121
xl, 189
xli, 129
xli, 213
xlii, 168
xlii, 211
xlii, 267
xliii, 298
xlv, 86
xlv, 92
xlviii, 309
xlviii, 311
xUx, 114
ix, 250
X, 269
xi, 244
xi, 313
xii, 361
xiii, 309
xiii, 312
ROBINSON — ROPER.
185
EoBiNBON (G. D.), on certain micro-organisms of obstetrical and
gynsecological interest ....
„ cystic ovaries .....
„ vulval discharges in children
RoBSON (A. W. Mayo), primary ovarian gestation
EoGERS (J. F.), double monstrosity .
EoGEKS (W. R.), polypoid tumours of uterus .
„ unusual and interesting appearance of an ovum throAvn off at
the second month ....
„ elephantine development of the clitoris
„ vagina and uterus divided by septum
„ haematocele of doubtful origin
„ — repoH on ditto by committee (Heywood Smith and W. E
Rogers) .....
„ case of chronic complete inversion of the uterus, successfully
treated by sustained elastic pressure
EoPER (O.), labour in primiparous women late in the reproductive
period of life .....
„ difficult case of labour connected with a non-evoluted and
hypertrophied state of the cervix uteri
„ remarkable case of placenta prsevia
„ hypertrophic elongation of the cervix uteri at the full term
of pregnancy .....
„ on prolapse of the funis during labour
„ deformed foetus ....
„ reports of two cases of death in new-born infants from pyeomia,
produced by phlebitis of the umbilical vein
„ new craniotomy forceps ....
„ alteration of Hicks' cephalotribe .
„ a difficult case of labour in a primiparous woman, who, having
been barren for thirteen years, became pregnant after bilateral
division of a deformed cervix uteri
„ fibrous tumour of the uterus in a state of calcareous degenera-
tion ......
„ placental tumour from a primipara
„ extensively ruptured uterus
„ small intestine taken from an infant
5, case of protracted labour, in which the use of the forceps was
typically indicated ; child still-born
„ cast of the head of a child born under face presentation, show
ing distortion of face and cranium
„ some clinical remarks on a certain class of cases of anteflexion
Kxxvii,
263
xxxix.
130
xli.
14
xliv.
215
xi.
128
X,
94
xi.
80
xi.
84
xii.
297
xvi.
177
xvi, 274
xxiii, 19
vii, 51
vii, 233
viii, 340
XV, 167
xvii, 318
xviii, 295
xix, 8
xix, 136
xix, 137
xix, 169
xix.
255
xix.
256
XX,
2
XX,
35
XX, 75
XX, 124
of the uterus, with certain correlated conditions
XX, 304, 324
report of a case of fatal embolism of the right heart and pul-
monary artery nineteen days after delivery, with a few clinical
remarks ...... xxi, 74
remarks in the discussion on the use of forceps . . xxi, 201
supplementary placenta, the size of the palm of the hand . xxii, 45
cast of foetal head showing furrowing due to pressure against
the sacrum ...... xxii, 84
malignant disease of the cervix uteri . . . xxii, 85
specimen of missed abortion .... xxii, 108
report on A. L. Galabin's case of occluded cervical canal with
retention of pus in the uterine cavity . . . xix, 177
note on some difficult cases of fronto-anterior positions of the
foetal head . . . . . . xl, 271
186
EOSE — ROUTH.
EosE (H. Cooper), new description of nipple-shield and treatment
of sore nipples . . . . . iv, 135
„ disease of both ovaries, the right ovary forming a commnnica-
tion with the caecum and externally the left tumour emptying
itself into the rectum ; death, and post-inortem results . ix, 44
„ child with malformed genital organs . . xv, 85, 125
„ contribution to the statistics of midwifery in general practice xviii, 146
„ case of extreme hypospadias in a child who had been baptised,
brovight up, and ediicated at a large girls' school as a female xviii, 256
Koss (W.), cru'ious monster which lived for some time after birth ix, 31
ROTATION, axial, of ovarian tumours, leading to strangulation
and gangrene (Lawson Tait) .... xxii, 86
„ — of a right-sided parovarian cyst (Leith Napier) . . xxxiv, 124
„ chronic axial, of an ovarian cyst giving rise to extreme twist-
ing of the elongated uterus (T. Wilson) . . . xxxix, 167
„ acute axial, of parovarian cyst (A. W. W. Lea) . . xxxix, 8
„ — of a calcified fibroid of the uterus (J. Bland-Sutton) . xlvi, 149
„ of uterine tumours (W. A. Meredith) . . . xxx, 80
„ and impaction of a myomatous uterus (J. Bland-Sutton) . xli, 296
ROTATORY ACTION in the use of the forceps (W. Stephenson) . xxii, 217
Rouse (John), recovery of a still-born child ; unusvial marking of
the skin, simulating the effects of injury . . . vii, 45
RoussEL (J.), on the transfusion of blood . . . xviii, 280
EoTJTH (Amand), urethral calculus .... xxvii, 3
„ case of serous perimetritis .... xxviii, 131
„ fibroid of one-horned uterus .... xxix, 2
„ — report on, ditto by committee (Alban Doran, W. S. A.
Griffith, and Amand Routh) .... xxix,
„ primary cancer of the Fallopian tube ; recui-rence . . xxxi,
„ tu-ethral diverticula ..... xxxii,
„ apoplectic ovum ..... xxxii,
„ case of acephalous acardiac twin .... xxxii,
„ — report on, by committee (J. Bland-Sutton, Amand Kouth,
and Alban Doran) ..... xxxiii.
57
200
69
194
347
26
87
252
cancerous uterus removed by vaginal hysterectomy . . xxxiv,
ruptiu-ed uterus and vagina .... xxxiv,
malformed foetus . . . . • xxxiv, 463
foetus with hernia umbilicalis congenita and spina bifida
lumbo-sacralis (' Transactions,' vol. xxxiv, p. 463 . . xxxv, 102
anencephalic foetus ..... xxxv, 241
— report of committee ..... xxxv, 294
phosphatic calculus and bodkin nucleus . . . xxxv, 240
fibroma spontaneously enu.cleated . xxxv, 409; xxxvi, 2
on cases of associated parovarian and vaginal cysts, formed
from a distended Gartner's duct .... xxxvi, 152
cancerous uterus and parovarian cyst removed per vaginam xxxvii, 8
anencephalic di-i^rosopia foetus . . . xxxvii, 162
skull of an anencephalic foetus . . . xxxvii, 219
fibroid tiunoiu' and cancer of the utei'us . . xxxviii, 99
independent cancer of the body and of the cervix uteri xxxviii, 100
hydrosalpinx and small ovarian cyst removed by anterior
colpotomy ..... xxxviii, 185
entirely detached uterine fibroid . . . xxxviii, 388
malignant papilloma of uterus .... xxxix, 5
ROUTH.
187
EouTH (Amand) (continued) —
„ parturition during paraplegia, with cases . . . xxxix, 191
„ incarcerated ovarian (dermoid) cyst, removed during preg-
nancy per vaginam . . . . . xl, 217
„ ruptured tubal gestation (at fourth or fifth week) ; operation ;
recovery . . . . . . xl, 220
„ uterine appendages showing a haematosalpinx . . xl, 306
„ specimen preserved in formalin of an early gestation in both
horns of the uterus of a bitch, displaying the aUantoid
vessels in their natural colovu* .... xli, 5
„ myxo-sarcoma of the uterus removed by pan-hysterectomy . xli, 139
„ supposed myxo-sarcoma of the uterus removed by abdomino-
vaginal method ..... xli, 367
„ foetus thoracopagus ..... xlii, 29
„ Porro-Caesarean hysterectomy with retro-peritoneal treatment
of the stump in a case of fibroids obstructing labour ; with
remarks upon the relative advantages of the modern Porro
operation over the Sanger-Csesarean in most other cases
requiring abdominal section .... xlii, 244
„ tubal abortion with rupture of tube . . . xliii, 294
„ dermoid cyst of ovary removed by posterior colpotomy . xliv, 38
„ uterus removed at eight and a half months of gestation by
abdominal hysterectomy for fibroid obstructing labour . xliv, 41
„ Fallopian tube ruptured towards its fimbriated end in two
places ...... xliv, 131
„ fibroma of the ovary • . . . . xlviii, 133
„ fibroid of uterus with a sarcomatous nodule in the centre . xlix, 1
„ pelvic organs of a case where inoperable papilloma of the left
ovary had been found seven years previously . . xlix, 216
RouTH (C. H. F.), menoiThagia treated by injection, or the re-
moval of the uterine mucous membrane by the gouge, or both
means combined . . . . . ii, 117
hydatidiform degeneration of the ovum . . . ii, 242
fibro-cystic disease of uterus .... vii, 253
— of the uterus mistaken for ovarian disease ; attempted extir-
pation ; failure ; death by rupture of a vessel within the cyst viii, 122
new mode of treating epithelial cancer of the cervix uteri and
its cavity ...... viii, 290
samples of infants' food . . . '. . ix, 29
triplets . . . . . . ix, 156
new intra-uterine pessary . . . . xi, 53
— vesico-vaginal speculum-holder . . . xi, 125
remarkable case of absence of vagina, with retained menses in
utero and Fallopian tubes .... xii, 34
fundal endometritis ..... xii, 136
bilocular uterus ..... xii, 295
viability in a child born at five and a half months . . xiii, 132
ecraseur ...... xv, 38
use of intra-uterine stems in uterine disease . . xv, 252
remarks in the discussion on puerperal fever . . xvii, 257
on a case of extra-uterine fibroid successfully removed by
gastrotomy .... .xvii, 216; xviii, 5
addendum to ditto ..... xviii, 145
case of excessive prolongation of anterior lip of cervix . xviii, 144
on a case of extra-iiterine pregnancy, with notices of other
cases ...... xxi, 93
for J. W. J. Oswald, foetal monstrosity . . . xxiv, 75
188
EOWLIXG EUTHEEFOOED.
Rowling (C. C), the history of the Florence Nightingale Lying-
in Ward, King's College Hospital
X, 50
EUPTURE of FaUopian tubes (C. Godson) . xxii, 2, 82
„ — in a case of double pyosalpinx (A. H. N. Lewers) . xxvii, 298
„ — and tubal abortion (A. Routh) . . . xliii, 294
„ of the heart in a still-born infant (C. N. Longridge) . . xlix, 214
„ intra-peritoneal, of the bladder occurring dm-ing labom- (C. R.
Porter) ...... xlix, 170
„ partial, of tubal gestation sac in a case of secondary abdominal
pregnancj' ; abdominal section fifteen months after conception,
and eight months after death of foetus (J. B. Hellier) . xlv, 366
„ tubal gestation in which the ovum continued to grow for
about four weeks after, the gestation sac becoming im-
planted on the omentum (C. Lockyer) . . . xlv,
„ of an ovarian abscess twelve hours after labour (C. Berkeley) xliv,
„ — cyst in an infant (A. Doran) .... xxxiv,
„ of the sac of an ovarian pregnancy, evidences of, in uterine
appendages of the left side (H. Gilford) . . . xliii, 24
„ in primary ovarian pregnancy fourteen days after last men-
struation (G. P. Anning and H. Little wood)
„ of perineum, complete (C. R. Thompson) .
„ — note on the operation for restoring the perineal body in
(A. Lawrence) .....
„ — the use of the purse-string suture in (Percy Boulton)
„ prevention of (H. E. Trestrail) ....
„ of the uterus, occurring at the eighth month of pregnancy
(R. Dunn) ......
„ — (G. Roper) ......
„ — (John Williams) .....
„ — (J. Hickinbotham) .....
„ — (F. H. Champneys) ....
„ — (Robert Harvey) ....
„ — (Lovell Drage) .....
„ — (J. G. Swayne) .....
„ — (R. Cox) ......
„ — (P. Horrocks) .....
„ — (R. Boxall) .....
„ — occurring diu-ing laboui* and after external violence (John
Phillips) ...... xxxii,
„ — and vagina (A. Wiltshire) . . xviii, 220 ; xxiii,
„ (P. Horrocks) .... xxvi, 119,
„ (Amand Routh) ..... xxxiv,
„ of the uterus, four cases successfully treated by packing the
tear per vaginam with iodoform gauze (H. R. Spencer) . xlii,
„ spontaneous, of the uterus in placenta prsevia (J. P. Maxwell) xliii,
„ of vagina during labour, two cases of (A. L. Galabin) . xx,
„ — with recovery (Heywood Smith) . . . xvii,
„ — spontaneous, with recovery (A. Wiltshire) . . xvii,
„ — incomplete, death from septicaemia (F. H. Champneys) . xxiii,
RussBLL (W. A.), hydatidiform degeneration of the ovum . vii, 228
RuTHERFOORD (Henbt T.), caucerous uterus removed by vaginal
hysterectomy ; no recurrence nine months after operation . xxxiii, 28
„ cysts. of the vagina; their setiology, pathology, and treatment xxxiii, 354
„ sections of fibroma of the ovary .... xxxiv, 88
„ pelvis of a cat, with bladder, uterus, and rectum in situ . xxxiv, 251
xliii,
XXXll,
xxxii,
xvii.
IX,
XX,
XX,
XX,
. xxvi,
xxvii, 191,
. xxviii,
. xxviii,
. xxviii,
. xxxi,
xxxiv.
400
73
24
14
265
377
380
61
65
2
86
96
329
228
2
213
225
228
11
375
163
260
252
14
217
295
359
362
10
SABOTA — SARCOMA.
189
Saboia (V.). ovarian disease .... xii, 312
„ notice of a new operation performed on a lady who presented
a considerable atresia of the vaginal orifice of the neck of the
uterus ...... xvi, 116
SACRUM, foetal head showing furrowing from pressure against
(G. Roper) . ' . . . . . xxii, 84
„ cutaneous sinus over (A. Doran) .... xxxiii, 199
S.\CS, double pyosalpinx in which the tubal sacs commvinicated
(J. D. Malcohn) . . . . . . xlii, 10
„ five foetal, from the peritoneal cavity of a rabbit (M. S.
Pembrey) . . . . . . xl, 253
„ containing foetuses and lying free in the peritoneal cavity of a
rabbit (M. S. Pembrey and Gr. Bellingham Smitli) . . xlvi, 283
„ translucent, microscopical preparations from, in a case of
blighted and atrophied embryo (G. E. Herman) . . xxiii, 259
„ of an ovarian pregnancy, uterine appendages of the left side
showing evidences of the rupture of (H. Gilford) . . xliii, 24
SALICYLIC ACID, cream of, for keeping sponges and instruments
aseptic in the vagina (J. Matthews Duncan) . , xxiv, 5
SALINE SOLUTION in cases of severe haemorrhage (P. Horrocks) . xxxv, 430
„ injection of, transfusion bottle, etc., for (H. R. Spencer) . xxxv, 428
SALIVATION of pregnancy successfully treated (T. Skinner) . ix, 117
„ spontaneous, associated with pregnancy (A. Farr) . . xv, 222
SALPINGITIS, acute, in tubal pregnancy (T. W. Eden) . . xlviii, 272
„ bilateral primary tuberculous, with secondary infection of the
perivascular. lymphatics of the uterine wall (C. Loekyer) . xlix, 141
„ on clos\xre of the ostium in (A. Doran) . . . xxxi, 344
„ double, and carcinoma of cervix, fibro-myoma of uterus com-
plicated with (W. W. H. Tate) .... xliii, 270
„ double hydrosalpinx without (A. Doran) . . . xli, 379
„ tuberculous (F. J. McCann) .... xxxiii, 496
„ unsuspected tuberculous, and pyosalpinx (J. H. Targett) . xlvi, 20
„ see Fallopian tubes.
Sanderson (R.), combined vaginal and abdominal hysterectomy
for a pregnancy of four and a half months, complicated by
cancer of the cervix ..... xliii, 312
SAENGEE-C.ESAREAN SECTION, relative advantages of the
modern Porro operation in most cases requiring abdominal
section over (A. Routh) .... xlii, 244
Sanket (W.), knot on funis in a case in which the foetus was born
dead . . . . . . iii, 413
Sansom (A. E.), anaesthetic properties of the bichloride of carbon viii, 49
„ uterine and vaginal douche .... viii, 219
„ pain of parturition and anaesthetics in obstetric practice . x, 121
„ pessaries containing fluids . . . . x, 245
„ svQpho-carbolates in the treatment of certain diseases of
children ...... xii, 6
SAECOMA of the body of the uterus removed by vaginal extir-
pation (W. S. Playfair) . . . xxxvii, 200
„ primary, ("deciduoma malignum") in a patient, aged
24, treated by vaginal hysterectomy (A. H. N. Lewers) . xxxix, 246
„ (A. H. N. Lewers) . . . . xl, 225
„ with complete inversion (W. C. Swayne) . . xliv, 366
„ of cei"vix uteri (A. L. Galabin) . . . xxxviii, 120
190 SARCOMA — SASS.
SARCOMA (continued) —
„ of cervix uteri, " grape-like," fungating into and infiltrating
the walls of the vagina, in a child, aged 12 months ; extirpa-
tion of the uterus and vagina (H. J. Curtis) . . xlv, 320
„ (H. Williamson) .... xlvii, 119
„ of the cervix, medullary (A. L. Galabin) . . . xx, 323
„ — supposed (H. E. Andrews) .... 'xlix, 137
„ congenital, in a new-born infant (John Phillips) . xxx, 301, 334
„ malignant, of the riglit broad ligament (W. S. Playfair) . xv, 217
„ cystic, of omentum, simulating ovarian tumour; removal;
recovery (W. Duncan) ..... xxxvi, 264
„ doubtful, microscopical sections of uterus showing chorionic
villi and (Leonard Eemfry) . . . xxxviii, 223
„ of endometrium, small round-celled (A. L. Galabin) . . xlv, 184
„ of the femur, endosteal, showing syncytial structures (F. W.
Andrewes) ......
„ of the stomach (G. E. Herman) ....
„ of the ovary (G. Elder) .....
„ ovarian, anterior serous perimetritis simulating (A. Doran)
xxxi, 217 ;
„ primary, of both ovaries (J. A. Shaw-Mackenzie)
„ (?) large, of the ovary (P. Horrocks)
„ of ovary (W. K. Dakin) ....
„ of both ovaries (A. Doran)
„ of ovary (P. Horrocks) .....
J, — showing necrosis of central portion lying in an abscess
cavity containing offensive pus (W. Tate)
„ — primary melanotic (H. R. Andrews)
,. of the ovary, unusual (J. Inglis Parsons) . .
^\ — of the same side as a tubal mole (A. L. Galabin)
„ uterine fibroid clinically resembling (W. R. Dakin) .
„ fibro-myoraa of the uterus undergoing change like (W. S. A.
Griffith and H. Williamson) ....
„ and degenerating fibro-myoma of uterus (W. Tate) .
„ of uterus, further history of a case of degenerating fibro-myoma
and (R. Hamilton Bell) ....
„ of the uterus (W. Duncan) ....
J, — removed by vaginal hysterectomy (W. J. Gow) .
^^ — spindle-celled, removed by vaginal hysterectomy (W. R.
Dakin) ......
„ — with inversion (J. H. Targett)
„ - (W. S. A. Griffith) .....
„ — with a microscopic section (H. R. Andrews)
„ — (A. W. W. Lea) .....
„ — (A. L. Galabin) .....
„ — (W. Duncan) .....
„ gangrenous, of uterus, removed by abdominal hysterectomy
from a patient suffering from glycosuria (W. Tat«)
„ small fibroma uteri showing evidence of (J. M. Mtmro Kerr)
„ of the vagina and uterus, circiunscribed (A. H. N. Lewers)
„ — secondary deposits in lungs (W. S. A. Griffith) .
„ see Fibrosarcoma.
SARCOMATOUS DERMOID CYST of the ovary (J. Knowsley
Thornton) ...... xrvii, 194
Sass (Mr.),, anencephaloua foetus . . . xi, 31
xlv.
237
xliii.
2
XXV,
130
xxxiii.
185
xxxiv.
2
xxxvi.
192
xxxvi,
313
xl.
296
xliv.
94
xli.
373
xliii.
228
xlv.
48
xlviii.
19
xl.
32
xlviii.
22
xlvii.
358
xlviii.
199
xxxi.
2
xxxii.
374
xxxii.
139
xxxix.
285
xU,
232
xlii.
210
xliii.
73
xliii.
226
xliii.
228
xliv.
165
xliv.
129
xxviii,
78
xxviii,
38
SAVAGE SEDG WIGK.
191
Savage (Henry), remarks in the discussion on puerperal fever . xvii, 189
„ — on the use of forceps .... xxi, 196
Savoey (Charles T.), case of epithelioma of the cervix uteri com-
plicated with pregnancy ; removal of diseased portion ; sub-
sequent delivery of a healthy child ; recurring pregnancy . xvii, 82
Savory (Horace), notes on a case of puerperal eclampsia . xli, 284
SCALE for calculating onset of labour (W. S. Playfair) . . xxviii 68
SCARLATINA, the relation of, to menstruation (R. Boxall) . xxx 55
„ dm-ing pregnancy and in the puerperal state (E. Boxall) xxx, 11, 126^ 167
„ in the room during a case of persistent sickness and labovtr
(A. W. Williams) ..... xii, 164
„ the clinical relation of, to puerperal septicaemia (E. Boxall) . xxx 126
Schafer (E. a.), report of experimental inquiry instituted to
determine with what fluids and by what methods the opera-
tion of blood transfusion may best be performed, and to
ascertain the effects, immediate or remote, which result from
the operation in animals
ScHARLiEB (Mary A. D.), unruptured tubal gestation
„ endothelioma of uterus .
„ a case of unusual malignant disease of the uterus
„ myxomatous fibroid
ScHNBGiERiEF (W.), On vaginismus (dyspareunia of Barnes)
ScHOFiELD (R. H. A.), the delivery of a monster
SCHEOEDER'S OPERATION, cancerous uterus removed by (W
Duncan) .....
„ uterus removed by, for procidentia (G. Malins)
SCISSORS, angular (H. Smith) ...
„ serrated, for making smooth and definite incisions in any
tissue (Protheroe Smith)
SCOOP for removing superficial portions of malignant disease of
the cervix (Professor Simon)
Scott (John), specimen illustrating an operation for double
ovariotomy
„ — report on ditto ....
„ cyst from case of extra-uterine fcetation
„ extra-uterine fcetation, with operation
ScouGAL (E. F.), hemiplegia occurring nine days after parturi
tion ; death ; partial post-mortem examination
SECRETION OF MILK in a new-born male child (W. Duncan)
SECRETIONS, a note on vaginal (W. J. Gow) .
„ poured into the vagina, the effect of glycerine on the quantitv
of (G. E. Herman) ...
SECTION OF OBSTETRICS AND GYNAECOLOGY OF THE ROYAL
SOCIETY OF MEDICINE : nomination of first Council
SECTIONS of an adeno-myomatous polypus of the cervix CF E
Taylor) . . . . . '
„ illustrating the structure of three different types of urethral
caruncles (H. Williamson)
Sedgwick (,W.), malformation of the foetus .
xxi.
316
xlvi.
54
xlvii.
281
xlviii.
73
xlix.
273
xvi.
187
xxi.
71
xxvi.
27
xxvi.
148
xiv.
68
xvi.
180
xiv.
209
xiii.
168
xiii.
264
XV,
124
XV,
140
XXX,
214
xxx.
226
xxxvi.
52
xxx, 452
xlix, 136
xlviii, 12
xlvii, 6
i, 239
192 SELL — SHAW-MAOKENZIE.
Sell (E. H. M.), ossification of muscles . . . xv, 125
„ complete uterus bicornis, the septum extending into the one
common cervix ; pregnancy of the right horn ; turning and
extraction on account of pelvic contraction, the conjugate
diameter measuring only two and a half inches . . xv, 180
SEMNOPITHECUS ENTELLUS, menstruation of (W. Heape) . xxxvi, 213
SEPSIS, vaginal hysterectomy in the puerperium for, due to
suppuration of myoma (A. W. W. Lea) . . . xlvii, 1
SEPTIC53MLA. in a case of fibro-cystic myoma of uterus (H. A.
Lediard) ...... xxvi, 193
„ sloughing of fimdus uteri in a case of acute, following abdo-
minal section (C. J. Cullingworth) . . . xxx, 406
„ puci-peral, case of (H. tiervis) . . . xviii, 160, 184
„ — with abscesses, phlegmasia dolens, etc. (A. Wiltshire) . xviii, 181
„ — treated by anti-streptococcic serum (J. Walters and A. E.
Walters) . . . . , . xl, 277
„ — death from, in a case of incomplete rupture of the vagina
(F. H. Champneys) ..... xxiii, 10
„ — the clinical relation of scarlatina to (R. Boxall) . . xxx, 126
„ — and fatal cardiac thrombosis following a case of abortion
(J. T. Musgi-ave) ..... xxi, 81
„ — uterus, heart, and brain from a case of (W. Duncan) . xxxi, 202
„ death after operation from, in a case of extra-uterine gesta-
tion (J. D. Malcolm) ..... xlv, 421
SEPTUM, case of transverse, in the vagina (H. Gervis) . . xxiv, 210
„ vertical, in lower part of vagina, impeding labour (J. B. Hicks) xxiii, 24
„ several large thick septa in a cyst of the broad ligament (W.
S. A. Griffith) ..... xxvii, 251
Skqueira (H. L.), face monstrosity . . . . v, 195
SEROUS PERIMETRITIS, see Perimetritis.
SERUM, anti-streptococcic, appeared to have saved life in two
cases (G. E. Herman) ..... xli, 346
Severn (Walter D.), report on Heywood Smith's specimen
shown March 3rd, 1897 . . . , xl, 135
SEX, the essential factor in the causation of ; a new theory of
sex (E. R. Dawson) . . . ' . . xlii, 356
„ uncertain ; person, aged 26 (W. S. A. Griffith) . . xliii, 298
Setdevstitz (Baron P. von), chloral treatment of eclampsia . xii, 117
Sharpin (H. W.), ovarian dropsy ; ovariotomy ; recovery . vii, 105
Shattock (S. G.) and Geailt Hewitt, specimen of spondylolis-
thesis ..... xxvi, 149, 151
Shaw (H. S.), inversion of the uterus ; spontaneous reduction . x, 35
Shaw (John), the constant current in the therapeutics of
gynaecology ..... xxx, 243, 265
„ douche can ...... xxxi, 262
„ case of Caesarean section .... xxxiv, 98
„ peritonitis, its nature and treatment . . xxxvii, 10
Shaw (William F.), the pathology of chronic metritis . xlix, 19
Shaw-Mackenzie (J.), dermoid cyst of ovary . . . xxxiii, 461
„ primary sarcoma of both ovaries .... xxxiv, 2
SHEILD — SLOAN.
193
Shibld (A. Marmadukb), extra-uterine gestation associated with
sloughing of the abdominal wall, and attempted extrusion of
a matured and putrid fcetus near the umbilicus . . xxxiii, 148
Shekaton (G. E.), steel fillet .... viii, 259
„ tire-tete, or combined perforator and extractor . . ix. Ill
Shoett (John), singular case of unsuspected pregnancy and
awkward delivery . . . . . iv, 202
„ sudden and unconscious delivery . . . . iv, 210
„ medical history of women in southern India . • v, 103
„ deformity of arm and hands , . . . vi, 205
„ criminal abortion . . . . . ix, 6
SICKNESS, persistent; labour induced after full period had
elapsed, scarlatina in the room (A. W. Williams) .
„ of pregnancy, observations on the aetiology of (A. E. Giles)
„ treatment of, in uterine inflammation and diseases of men-
struation (E. J. Tilt) .....
SiKKs (A. W.), icterus neonatorum ....
„ diffuse meningeal haemorrhage in infant after normal labour .
„ method of taking intra-uterine bacteriological cultvires
„ unusual form of succenturiate placenta
„ three cases of variation of the postei'ior fontanelle in children
„ infantile interstitial pneumonia ....
SiLCOCK (A. Q.) and Grailt Hewitt, general and considerable
congestive hypertrophy of the uterus with acute anteflexion
and presence of an ovarian cyst .
Simon (Max F.), case of retroversion of the gravid womb
Simon (Professor), scoop for removing superficial portions of
malignant disease of the cervix .
Sims (J. Marion), vaginismus ...
„ new form of curette for the removal of uterine fvmgoid granu'
lations ...... vii,
„ abstract of a paper on procidentia uteri . . . vii,
„ procidentia uteri .... vii, 213,
Sims' modification of Chassaignac's ecraseur . . . vi,
Sinclair (William J.), contribution to the diagnosis- and treat
ment of retroflexio-versio uteri gravidi
„ the use of laminaria tents
Singer (Charles), anatomy of an infant presenting some rare
deformities .....
Xll,
XXXV,
iii,
xliv,
xlv,
xlv,
xlv,
xlvi,
xlvii.
XXV,
xvi.
XIV,
iii.
164
303
15
369
44
380
381
272
74
xlii,
xlviii,
xlvii,
xlix.
SKELETON of extra-uterine fojtus (L. B. Aldrich-Blake).
Skene (William), see Doran, Alhan.
SKIAGEAM of sireniform monster (Herbert Spencer) . xxxviii,
SKIN, defective formation of, round the umbilicus (A. Napper) . iii,
SKIN DISEASES, common, of cliildren (A. Wiltshire) . . xv.
Skinner (T.), anaesthesia in mid^vifery . . . iv,
„ galactagogue properties of Faradisation, with eight cases . v,
„ salivation of pregnancy successfully treated, -with a case . ix,
SKULL of an anencephalic f cetus ( Amand Eouth) . . xxxvii,
„ monstrosity resulting from amniotic adhebion to (John
Phillips) ..... .o>:xviii, 3»8 ; xl,
Sloan (Samuel), graduated melallic uterine dilators . . xxviii,
13
131
254
209
356
72
213
238
254
338
185
250
269
118
65
223
116
94
117
219
130
114
194
SLOUGH — SMITH.
SLOUGH forming a complete cast of the vagina, from a case of
enteric fever (W. S. Playfair) . . . xxxviii,
SLOUGHING of the abdominal wall and attempted extrusion of a
matiu-ed and putrid foetus near the umbilicus in a case of
extra-uterine gestation (A. M. Sheild)
„ of the central part of a uterine fibro-myoma shoi-tly after
delivery (J. D. Malcolm) ...
„ of the foetal scalp as the result of tedious labour (W. O
Priestley) .....
„ of fundus uteri, localised, in a case of acute septicaemia follow-
ing abdominal section (C. J. CvQlingworth)
Sltman (William D.), see Slyman, Woodley.
Sltman (Woodlby), for W. D. Slyman, an acephalous acardiac
monster of six months' gestation, with rudimentary heart
SMALLPOX, complicating pregnancy (K. Barnes)
„ in the fifth month, with consequent delivery at full term of a
dead child (C. W. Milne) ....
„ in twin foetuses (H. Madge) ....
Smith (A. Lionel), diffused subcutaneous induration in an infant
Smith (Fly), see Champneys, F. H.
Smith (G. F. Darwall), perithelioma of the uterus
Smith (Heywood), encephalocele
„ fcetus with rent near the anus, through which the intestines
protruded .....
„ malformed heart ....
„ cast of head after cephalotripsy . . . xii, 13
„ ovmn containing foetus three eighths of an inch long
„ marine vaginal irrigator
„ foetus at fourth month enclosed in a perfect sac
„ uterus after delivery at five months ; death from secondary
postpartum htemorrhage from carcinoma of cervix .
„ angular scissors ....
„ modification of angular scissors .
„ treatment of post-partum htemorrhage by the inti-a-uterine
injection of the perchloride of iron
„ instrument for dividing funis
„ improvement in single-^vire ecraseur
„ fcetus with diaphragmatic hernia .
„ three months' foetus flattened and curved laterally, and double
placenta atropMed and flattened
„ new "rat-trap" forceps to aid in the removal of uterine
growths, or to be used as vulsella during ovariotomy
„ uterus and ovaries of a woman who had died of haemoiThage
into the pelvis ....
„ notes of a case of ruptured vagina during labour, with re
covery .....
„ three new points for PaqueUn's petroleum cautery .
„ Bailey's new patent abdominal belt
„ new portable pelvimeter imported from Russia
„ on a case of inversion of the uterus
„ uterus, the body of which was the seat of malignant disease
„ parts illustrating extra-uterine foetation
„ forceps bent as a soxuid, for the introduction of laminaria
tents, designed by Mr. Coley
„ modification of ovum forceps
xxxiu,
.rlvi,
XXX,
XXXI,
ix,
111,
xli,
xlix,
ix,
X,
xii,
t; xiii,
xii,
xiii,
xiv,
xiv,
xiv,
xiv,
XV, 44,
XV,
XV,
XV,
33
148
15
323
406
258
102
110
173
103
97
243
198
116
37
163
190
66
67
68
103
65
86
86
162
xvi, 2
xvi, 229
xvii, 56
xvii.
359
xix.
41
xix.
41
xix.
41
xix.
57
XX,
4
XX,
5
XX,
170
XX,
170
SMITH.
195
Smith (Heywood) (continued) —
„ uterus and appendages removed by hysterectomy
„ report on ditto by committee (A. L. Galabin and John
Williams) ....
„ belt for use after ovariotomy . . . '
„ grappling iron for vise in hysterotomy or removai of lar^^-e
solid ovarian tiunours . . , °
„ improvement in the joint of his ovum forceps ." [
„ improved duck-bill speculum . . [ '
„ two photographs of a young woman whose mother Avas
frightened by a monkey . . , _
„ case of delivery through an imperforate vagina
„ removal of a large fibrous polypus . . [
„ fibroma of the uterus . . . ' "
„ f cetus with outgrowth from end of coccyx . '.
„ dermoid cyst of the ovary . . .' '
„ fibro-cystic disease of the uterus ; hysterectomy
„ new electric light ..."
„ abscess of ovary ...
„ radiograph of foetus in utero -..'.'
„ uterus removed by Porro's operation
Smith (Pbotheroe), extraction of a hairpin from the bladder of
a female by means of an instrmnent
„ pelvic band . . , ' '
„ exploring needle trocars • . .' '
„ carcinoma of cavity of utervis . . " '
„ pelvic viscera after death from spontaneous rupture of ovarian
cyst, complicated with fibroid tumour of uterus
„ ovarian tumour . . . ' '
„ uterus and appendages from above case
„ new expanding cylindrical speculum uteri .
„ pneumatic india-rubber tube for introduction of cylindrical
specula . . . _
„ newly invented serrated scissors to insure a clean cut throuo-h
any tissue . . . _ °
„ case of abortion at six and a half months mth general dronsv
of the foetus . . . . .
Smith (W. Tyler), abolition of craniotomy from obstetric practice,
m all cases where the foetus is living and viable
„ excessive vomiting in early pregnancy, depending on the
irritation of the gravid uterus .
„ inquiiy into the correctness of the doctrine of William Hunter
in regard to retroversion and retroflexion of the gravid
uterus . . . ^ °
„ inaugural address as President . .* ' a^ 3 . jV
„ ovariotomy, with cases and remarks on the different steps of '
the operation and the causes of its mortality
„ four additional cases of ovariotomy . . iii 21
„ instrument for removal of polypi of the uterus '.
„ eight additional cases of ovariotomy
„ dermoid cyst ...
„ new speculum uteri • . . .'
„ two cases of inversion of the uterus after delivery, with
remarks ...
„ puerperal fever treated by the injection of ammonia into the
veins, folloAved by recovery
xxi, 313
xxii, 3
xxii, 45
xxii, 45
xxii, 4()
xxii, 4u
xxii, 242
xxiii, 117
xxiii, 233
xxiii, 262
XXV, 2
xxvi, 57
xxvi, 58
xxvii, 3
xxxiv, 3
xlviii, 44
XXV, 2
x, 59
xi, 169
xii, 271
xii, 299
xiii, 39
xiii, 98
xiii, 126
xiii, 187
XV, 165
xvi, 180
xvii, 303
i, 21
i, 335
ii, 286
6 ; V, 18
iii, 41
5 ; iv, 141
iii, 413
vi, 66
vii, 45
viii, 101
X, 30
xi, 247
196
SMITH — SPENOER.
Smith (W. Ttleb) (continued) —
„ and J. B. Hicks, report on N. J. Haydon's specimen of extra-
uterine foetation .....
Smuts (C), curious case of prolapsed placenta
Smylt (W. J.), tliree myomatous uteri removed per vaginam by
Doyen's method .....
SOCIETIES, amalgamation of medical, special general meeting on
SOUFFLE, see Bruit.
SOUND, uterine, aseptic (P. Horrocks)
„ — flexible vertebrated (G. C. P. Mm-ray)
,, — in flexions of the uteriis (A. Rasch)
„ — with metroscope (A. Meadows)
Spaulb (B.), hydrocephalic head of a child
SPECULUM, pnetunatic india-rubber tube for introduction of
cylindrical (P. Smith) ....
„ expanding, for operations on the cervix uteri (R. Ellis)
„ modification of Neugebauer's (R. Barnes) .
„ self-retaining (Leith-Napier)
„ (H. R. Spencer) . . . .
„ holder, vesico-vaginal (C. H. P. Routh)
„ uteri (W. T. Smith) ....
„ — new expanding cylindi'ical (P. Smith) .
„ vaginal (A. Meadows) . . . . xi
„ — of Dr. Neugebauer
„ — (J. Hall Davis)
„ — ordinary cylindi'ical, set of pocket instruments contained
within (C. Godson) ....
„ — improved duck-bill (Heywood Smith) .
„ — toughened glass (A. Wiltshire)
„ a glissieres, Delbastaille's (Alban Doran) .
„ for introducing pledgets of wool into vagina (R. Barnes)
„ trough, india-rubber (A. W. Edis)
SrENCEB (Heebebt R.), uterus with sloughing fibroid .
„ an eight month anencephaUc monster
„ the diagnosis of placenta praevia by palpation of the abdomen
„ three cases of congenital diaphragmatic hernia, two being on
the right side .....
„ congenital diaphragmatic hernia ....
„ visceral haemorrhages in stiU-born children ; an analysis of 130
autopsies ; being a contribution to the study of the causation
of stillbii-th ......
„ retroflexion of the uterus in a new-born child
„ case of triplets and complete placenta prsevia in which the
children were delivered alive through a perforation in the
first placenta ...... xxxv,
„ transfusion bottle, etc., for injection of saline fluid . . xxxv,
„ speculum ..... xxxviii,
„ skiagram of sireniform monster . . . xxxviii,
„ case of deciduoma malignum . . . xxxviii,
„ three cases of Porro's operation, with intra-peritoneal treatment
of the stump
V, 281
viii, 280
xli, 96
xi, 151
XXXIV,
xviii,
xiii,
ix,
xiii,
XV,
ix,
xiv,
xxxv,
xxxviii,
xi,
viii,
xiii,
3 ; xii,
xiii,
xvi,
xxi,
xxii,
xix,
xxxii,
xiii,
xvii,
XXX,
XXX,
xxxi,
xxxii,
xxxiii.
460
140
247
242
214
165
86
309
3
117
125
101
187
134
51
98
90
46
137
307
96
49
408
408
203
132
34
XXXUl,
xxxiv.
203
25
107
428
117
118
135
xxxviii, 389
incarcerated ovarian dermoid obstructing labour ; ovariotomy
during labour . . . . . xl, 14
mautml elevation ; removal seven months later . xl, 22
in the middle of pregnancy ; manual elevation ; removal
a fortnight after delivery at term . . . xl, 259
SPENCEH — SPINA BIFIDA.
197
Spbncer (Heebekt R.) (^continued) —
„ incarcerated ovarian dermoid, removed at the foiu-th month of
pregnancy ; delivery of a living child at term . . xl, 329
„ for James Jackson, incarcerated ovarian dermoid ruptured
during delivery by forceps and version, with fatal residt . xl, 331
„ two cases of fibro-myoma of the uterus removed by operation
from women under twenty-five years of age . . xl, 228
„ thi-ee cases of congenital tumoiu" at the internal os uteri
causing hydrometra in new-born children . . . xl, 332
„ adenoma of the meatus ui-inarius externus . . . xli, 383
„ peculiar cervical mucous polypus .... xli, 383
„ four cases of rupture of the uterus successfully treated by
packing the tear per vaginam with iodoform gauze . . xlii, 14
„ two cases of parovarian cyst with twisted pedicle, in which
the ovary only (and not the cyst) was congested and
inflamed ...... xlii, 333
„ large uterus, with cervical fibroid, removed by abdominal
hysterectomy by Doyen's method . . . xliii, 5
„ cystic fibro-myoma of the uterus removed by posterior
colpotomy ...... xliii, 110
„ large ovarian tumotu' ruptui'ed on the third day after labour . xliii, 224
„ Porro medal and report on Porro-Ctesarean section . . xliv, 298
„ Kurz needle-holder ..... xlv, 51
„ deciduoma malignum ..... xlv, 250
„ degenerated uterine fibroid threatening to rupture, removed
by total abdominal hysterectomy . . . xlv, 378
„ fibro-myoma of the intra-abdominal portion of the roiind liga-
ment of the uterus ..... xlvi, 26
„ degenerated fibro-myoma weighing over 17 lb. enucleated
from the broad ligament nine hours before delivery at term . xlvi, 122
„ cancer of the body of the uterus simulating fibroid in a woman,
aged 36 ...... xlvi, 235
„ galvano-cautery knife ..... xlvi, 353
„ three cases of cancer of the cervix complicating labour in
advanced pregnancy, the patients remaining well eleven,
eight and a half, and eight years after high amputation of
the cervix ...... xlvi, 355
„ carcino-sarcoma uteri . . . ^ . . xlvii, 338
„ a second case of abdominal ovariotomy during labour . xlviii, 37
„ Csesarean section and total abdominal hysterectomy for
fibroids complicating labour near term in a patient who had
recovered without operation from rxiptured tubal pregnancy . xlviii, 240
„ three cases of myomatoiis uteri bleeding after the menopause . xlviii, 333
„ inaugural address ..... xlix, 117
„ myomatous litems weighing over 7 lb. removed from a woman,
aged 22 . . , . . . xlix, 219
„ calcified uterine fibro-myoma removed piecemeal for hsemor-
rhage fourteen years after oophorectomy . . . xlix, 271
SPHYGMOGRAPH in the puerperal state, the indications afforded
by the (Fancourt Barnes) .... xvi, 263
SPINA BIFIDA (W. G. Hewitt) . . . . iv, 5
„ (D. L. Roberts) . . . . . xi, 313
„ two cases of (D. L. Roberts) .... xii, 361
„ dissection of a case of (T. W. Eden) . . . xxxv, 336
„ associated with hydrocephalus (R. Barnes) . . v, 172
„ (W. Leishman) . . . . . v, 198
„ followed by hydrocephalus (D. Richards) . . . iv, 191
19S
SPINA BIFIDA — SQUIRE.
(Amand
of uterus (H. R.
SPI2<A EiriDA (continued) —
„ hydi'ocephahis with (R. J. Probyn-Williams) . . xxxvi,
„ in an anencephalous foetus (F. Wallace) . . . xxiii,
„ foetus anencephalus with (E. Jones) . . . xi,
„ hunbo-sacralis, and hernia umbiliealis congenita
Routh) . . .
„ in association with congenital prolapse
Andrews) ...... xliv,
„ -with talipes varus of both feet (H. Madge) . . ix,
„ supposed (P. Hon-ocks) ..... xxix,
SPINAL COLUMN exhibiting want of ossification in the inter-
articular portion of the lumbar vertebrae (G. F. Blacker) . xlii,
SPINAL CORD, obliteration of the central canal of, in an early
human embryo (C. B. Lockwood) . . . xxx,
SPINE, completely cleft, associated with an unusual visceral mal-
(P-
4
204
209
XXXV, 102
137
158
57
90
470
346
57
305
191
179
xxxvui.
formation in an anencephalic fcetus (T. G. Stevens)
„ large tumour at the end of, s\ipposed spina bifida
Horrocks) ...... xxix,
SPLEEN, fatal rupture of an aneurysm of the artery of, imme-
diately after laboiu- (J. D. S. Nodes and Frank Hinds) . xlii,
„ hypertrophy of, in a child aged 9 (J. W. J. Oswald) . . xviii,
„ enlarged wandering, forming pelvic tumours (F. E. Taylor) . xlvi,
„ wandering, simvdating an ovarian tumour and causing
retroversion of the uterus (F. E. Taylor) . . . xlvii, 70
SPONDYLOLISTHESIS, with an accoxmt of a case of pelvic contrac-
tion from this affection (R. Barnes) . . . vi,
„ appendix to above . . . . . vi,
„ specimen of, in University College Museum, with anatomical
description (Graily Hewitt .and S. G. Sliattock) . xxvi, 149,
„ specimens illustrating (F. L. Neugebauer) . . xxvi, 84,
„ in a girl aged 16 (J. H. Targett) .... xxxiii,
„ redescription of the specimen in the Museum of University
College (T. W. P. La^vrence) .... xlii,
SPONGE TENTS, aseptic (A. La^n-ence) . . . xxxi,
„ plan for deodorising (J. H. Aveling) . . . ix,
SPONGES in the vagina, means of keeping, aseptic (J. Matthews
Dimcan) ...... xxiv,
SPURIOUS LABOUR, case of (H. R. Fuller) . . . xxvii,
„ macerated fa^tus removed from the abdominal cavity two
months after (A. Doran) .... xlii,
„ extra-uterine, occurred at term after, and in which abdominal
section was performed foiu* to five months later (John
Phillips) ...... xlii,
,, — gestation in wliich foetal death occurred at the eighth
month after, abdominal section two months later (A. Doran) xlii,
Squakey (C. E.), short aecovmt of a case of tliree sisters in whom
the uterus and ovaries were absent . . . xiv,
„ causation of acquired flexions of the uterus and their path-
ology ....
„ flexible stems for flexions of the uterus
Squike (W.), glandular cystic tumour of mamma
„ puerperal temperatiu-es .
,, infantile temperature in liealth and disease
,, temperature variations in the diseases of children
„ eai'thenware bed-pan and linen breast supporter
XIV,
XV,
78
98
151
186
108
75
333
264
326
8
121
213
212
344
221
iii, 213
ix, 129, 145
X, 273
xii, 171
XV, 163
SQUIRE STEVENS. 199
Squire (W.) {coyitinued) —
„ remarks in the discussion on puerperal fever . . xvii, 148
„ cancer of the uterus, where degeneration had proceeded to its
most extreme degree Avithout marked pain . . xx, 85
„ see Buckell, Edxvard.
Stabb (A. F.), for W. S. A. Griffith, placenta velamentosa and an
abnormally large placenta . . . xxxviii, 4
„ uterus with interstitial fibroid removed from a patient aged 26 xxxix, 89
„ pedunculated subserous fibro-myoma of uterus which had
undergone myxomatous and cystic degeneration . . xlii, 1.33
Stannus (Hugh S.), orbital tiunour in a hydrocephalic female
f oetue, with tiunour of cheek, maldevelopment of neck, associ-
ated with hydramnios, necessitating interference with the
pregnancy at the seventh month . . . xliii, 304
„ teratoma of the fcetal head .... xliv, 78
Staphylococcus albus, peritonitis and (J. D. Malcolm) , . xlviii, 97
STATISTICS of midwifery practice, see Midwifery.
STEAMING and curetting of uterus followed by vaginal hysterec-
tomy fourteen days after (G. F. Blacker) . . . xlv, 80
Steavenson (W. E.), electrical instruments in use in obstetric
medicine ...... xxix, 298
„ note on the use of electrolysis in gynaecological practice xxx, 229, 260, 265
Steele (A. B.), on the management of difficult labour with a
minor degree of contraction of brim . . . xvi, 32
STEMS, flexible, for flexions of the uterus (C. E. Squarey) . xv, 221
„ intra-uterine, use of, in uterine disease (C. H. F. Routh) . xv, 252
„ see Pessaries, stem.
STENOSIS, miti"al, case of labour in a primipara sivffering from
(G. Coates) ...... xxviii, 108
Stephenson (Stdnbt), ophthalmia neonatorum, its tetiology and
prevention ...... xlv, 337
Stephenson (William), remarks in the discussion on the use of
forceps ...... xxi, 150
„ on rotatory action in vising the forceps . , . xxii, 217
„ on the relation between chlorosis and menstruation, an analysis
of two hundred and thirty -two cases . . . xxxi, 104
„ see McKerron, Robert G.
STERILITY and spasmodic dysmenoiThcea, the treatment of, by
dilatation of the cervical canal with graduated metallic
bougies (C. Godson) . . . xxiii, 277 ; xxiv, 6
„ dysmenorrhcea, metrorrhagia, ovaritis and, depending upon a
pecxUiar formation of the cervix uteri (R. Barnes) . . vii, 120
„ treatment of mechanical dysmenorrlicea and (R. Greenhalgh) v, 164
STERILITY AND ABORTION, on tlie relation between backward
displacement of the utei'us and (G. E. Herman) . . xxxiii, 499
Stevens (Thomas G.), foetus with absence of urethra and ascites
obstructing delivery .... xxx vii, 5
„ and Griffith (W. S. A.), notes on the variation in height of
the fundus uteri above the symphysis during the puerperium,
the conditions which influence this, and the practical conclu-
sions which may be drawn from such observations . xxxvii, 246
„ case of completely cleft spine associated with an unusunl
visceral malformation in an anencephalic foetus . xxxviii, 346
200
STEVENS — SUPPURATION.
Stevens (Thomas G.) {continued) —
„ for Peter Horroclcs, uterine fibroid undergoing colloid degenera-
tion .......
„ membranous vaginitis in which the Bacillus coli communis was
found ......
„ fate of the ovum and Graafian follicle in pre-menstrual life
„ see Galabin, A. L.
Stevenson (E. Sinclair), case of spurious pregnancy simulating
ectopic gestation ....
„ two cases of ectopic gestation
Stewart ( — ), legging for varicose veins
„ nightdress for ladies diu-ing and after childbirth
STILLBIRTHS, statistics of (F. W. Lo^vndes) .
„ visceral hajmorrhages at (H. R. Spencer) .
STILLBORN CHILD, recovery of, unusual marking of the skin
simulating tlie effects of injury (J. Rouse)
STILLBORN CHILDREN, registration of . .
STOMACH, sarcoma of (G. E. Herman)
Stothard (James), see Edis, A. W.
Stott (W. Atkinson), ruptured tubal pregnancy
STRANGULATION and gangrene of ovarian tumours from their
axial rotation, successful ovariotomy in (Lawson Tait)
STRICTURE of the urethra in women (G. E. Herman) .
„ — lupous (G. E. Herman)
STUDIES in obstetrics (C. F. Ponder)
Sturmer (A. J.), (?) hydatidiform cysts growing in the vulva
„ (?) parasitic cyst of the vulva
„ four cases of ruptured extra-uterine gestation occiu-ring
two women ; removal by abdominal section ; recovery
„ deciduoma malignmn ....
„ fibro-myoraa of ovary ....
„ forty-one cases of puerpeml eclampsia treated by thyroid
extract ......
„ abdominal gestation . . . . .
STYPTIC COLLOID, cure of inveterate case of ulceration of the
cervix uteri by (J. Wynne) . . . .
SUGAR in the urine during the puerperal state, the occturence of
(F. J. :\IcCaun and W. A. Tm-ner)
SULPHO-CARBOLATES in the treatment of certain diseases of
childi-en (A. E. Sansom) . . . .
SUPERFCETATION, probable CW. S. Playfair) .
,^ _ (W. F. V. Bonney) . . . . .
„ supposed (W. S. Playfair) . . . .
SUPPORT, mechanical, during labour (W. "Woodward) .
SUPPRESSION of urine after laboiu- (R. G. McKerron) .
SUPPURATION and discharge into mucous cavities of dermoid
cysts of the pelvis (G. E. Herman)
„ in fibro-myoma uteri following premature delivery, treated by
abdominal hysterectomy (W. Tate)
„ in a large retro-peritoneal fibroid (C. H. Roberts)
„ in an ovarian cyst caused by the Bacillus typhosus (F. E.
Taylor) . .
xxxvi, 225
xli, 228
xlv, 465
xxxii, 216
XXXV, 175
xvi, 88
xvi, 87
xiv, 283
xxxiii, 203
Vll,
xvi,
xliii.
45
22
2
xxxvi, 343
xxii, 86
xxix, 27
xxviii, 267
xl, 339
xliii, 148
xliv, 2
xlv, 144
xlv, 251
xlv, 335, 370
xlvi, 126
xlvi, 385
xi, 86
xxxiv, 473
XII,
6
xxxiii.
496
xliv.
163
xxii.
3
xi.
192
xliv.
97
xxvii.
254
xlix.
54
xli.
213
xlix, 256
SURPtRRY SYNCYTIUM.
201
SURGERY, inavigural addi-ess on gynaecology in relation to (A,
Doran) ...... xli, 107
SUSPENDER, ladies' garment, of elastic webbing (E. J. Tilt) . xvi, 202
SUSURRUS, musctdar, in relation to foetal heart sounds (J. B.
Hicks) . . . . . . XV, 187
Sutton (J. Bland), the glands of the Fallopian tubes and their
fvmction ...... xxx, 207
„ ovarian cysts with mucous membrane . . . xxx, 339
„ some specimens of ovarian tumouj's . . . xxxi, 333
„ uterus showing the effects of a gangrenous fibroid . . xxxii, 171
„ the glands of the Fallopian tube .... xxxii, 189
„ case of tubal abortion ..... xxxii, 342
„ a case of tubal pregnancy .... xxxiii, 70
„ on an early tubal ovum .... xxxvi, 195
„ see also Bland-Sutton, J.
SUTURE for closing the uterine wound in Cassarean section and
for uniting uterine wound to the abdominal wall (E. Barnes) xii, 364
„ the purse-string, its use in complete rupture of the perineum
(P. Boulton) ...... xxxii, 380
SwATNE (J. G.), discoloration of the skin of the forearms and
hands dtu-ing pregnancy . . . . iv, 18
„ Csesarean section . . . . . v, 84
„ double monstrosity . . . . ii, 320 ; viii, 1
„ remarks in the discussion on puerperal fever . . xvii, 154
„ on a new form of blunt hook and sling for assisting delivery
in cases of breech presentation ....
„ remarks in the discussion on the use of forceps
„ on a new form of stem pessary ....
„ gangrene of the thigh during the seventh month of pregnancy
„ cases of ruptured uterus ....
„ hydrocephalus as a complication of laboiir .
SwATNE (W. C), sarcoma of the body of the titerua with com-
plete inversion .....
„ cystic fibroid of uterus .....
„ uterine fibroid removed by pan-hysterectomy
„ fibroid of the vagina
SYMPHYSIOTOMY, case of (A. H. N. Lewers) .
„ patient after (W. S. A. Griffitli) .
„ a plea for the practice of, based upon its record for the past
eight years (R. P. Harris) ....
„ subcutaneous (G. E. Herman) ....
SYNCYTIOMA from the body of a woman who died in St. Bar-
tholomew's Hospital thirty-one years ago (H. Williamson) . xlv, 253
SYNCYTIUM derived from chorionic epithelium partially differen-
tiated into cells shown in a vesicular mole (A. L. Galabin) . xlv, 240
„ deciduoma maligniun without ; secondary deposits in vagina,
lymphatic glands (iliac and liimbar), and lungs, after
hydatidiform degeneration of the chorion (P. Horrocks) . xlv, 243
„ forming reticulating processes, carneous mole retained in utero,
five montlis after death of embryo, showing proliferation of
epithelium of villi as (A. L. Galabin) . . . xlv, 240
„ structures of, in endosteal sarcoma of the femur (F. W.
Andrewes) ...... xlv, 237
xvii.
313
xxi.
233
xxiv.
220
XXV,
215
xxviii.
213
xxix,
405
xliv.
366
xliy,
369
xlv.
140
xlv.
142
XXXV,
408
xxxvii.
13
xxxvi.
117
xlii.
282
202
SYNOSTOSIS TANNER.
SYNOSTOSIS, left sacro- iliac, in a case of obliquely contracted
peVis, with remarks on the pelvis of Naegele (F. H. Champ-
ueys) ....
SYPHILIS after vaccination (E. Druitt)
„ chancre on the cervix uteri (G. E. Herman)
„ infantile (T. H. Tanner)
„ fatty placenta and a still-born foetus from a patient
with (T. C. Hayes)
„ of placenta (B. Godfrey)
SYRINGE, the alpha constant current (P. Boulton)
xxiv, 191
V, 196
. xxvii, 252
i, 132
suffering
. xvii, 275
xiv, 137, 211
. XXX, 198
Tait (E. S.), some observations on puerperal temperatures
Tait (Lawson), reduction of chronic inversion of the uterus by
sustained pressure .....
„ instruments for the application of medicated tents to the
interior of the cervix .....
„ diagnosis of extra-uterine pregnancy
„ case of general dropsy in a fcetus . . .
„ note on a diseased pLicenta ....
„ case of vesico- vaginal fistuLa left fourteen years after lithotomy,
cured by a series of plastic operations
„ foiu- cases of removal of large uterine myomata by abdominal
section ......
„ two cases of repair of the female bladder and urethra
„ apparatus for dilating the uterine canal by continuous elastic
pressure ......
„ on new methods of operation for repair of the female perineum
„ on axial rotation of ovarian tmnours, leading to tneir strangu-
lation and gangrene ; three cases successfully treated by
immediate ovariotomy .....
„ removal of the uterine appendages, fifteen specimens of bydro-
and pyosalpinx .....
„ hydrosalpinx and pyosalpinx ....
„ parovarian cyst . . • . •
„ four cases of pyosalpinx .....
„ note on uterine myoma, its pathology and treatment
„ three cases of pyosalpinx ....
„ case of idiopathic gangrene of the uterus .
„ ail undescribed disease of the Fallopian tubes .
„ removal of appendages on account of chronic inflammatory
disease ...••■
„ case of ectopic pregnancy in which the foetus seems to have
been developed to the full time in the peritoneal cavity, still
retaining its amniotic covering ....
„ two ca^es of hysterectomy ....
„ see Jones, Sydney.
„ and Christopher Martin, note on the gro^vth of the placenta
after deatli of the fcetus in ectopic gestation
TALIPES VARUS of both feet and spina bifida (H. Madge)
„ see Malformations.
Tanner (T. H.), infantile syphilis, with remarks . •
„ two"f«:etal monsters . . . . .
„ fibrous tumour of the uterus . . ; -
„ unsuspected prepfnancy and labour . . •
xxvi, 8
xi, 174
xiv, 323
XV. 135
xvii, 307
xvii, 326
xviii, 209
xix, 274
XX, 88
xxi, 291
xxi, 292
xxii, 86
xxiv.
157
XXV,
111
XXV,
112
XXV,
138
XXV,
194
XXV,
234
XXV,
248
XXV,
249
xxix.
184
xxxiv.
192
xxxiv.
199
xxxiv.
206
ix,
158
i.
132
ii>
247
iii.
11
iv.
113
TANNER — TATE.
203
Tannee (T. H.) {continued^ —
„ tise of medicated pessaries in the treatment of uterine disease
„ multiple medullary cancer complicated with pregnancy
„ hernia cerebri and hernia umbilicaliSj with attachment of the
foetal membranes to the scalp
„ excision of the clitoris as a cure for hysteria, etc.
„ see Harley, O.
Tapson (J. A.), placenta and knotted cord
„ removal of intra-uterine tumoui-s .
Tabgett (J. H.), spondylolisthesis in a girl aged 16
„ — report on ditto by committee (J. H. Targett, Alfred 1
Galabin, G. E. Herman, and F. H. Champneys)
„ two cases of pseudo-hermapliroditism
„ hydatids in the bony pelvis
„ acute suppuration and sloughing of ovaries after parturition
„ epidermic casts from the vagina .
„ ruptured gestation in an imperfect uterine horn {Uterus
Mcornis unicollis) ....
„ encysted tubercidous peritonitis and its effects upon the female
pelvic viscera .....
„ accessory adi-enal bodies in the broad ligaments
„ sarcoma of the uterus with inversion
„ for J. B. Hellier, case of deciduoma malignum
„ double intestinal obstruction following ovariotomy .
„ report on Amand Eouth's specimen of ruptured tubal gestation
„ fibro-myoma of vagina (anterior wall)
„ two cases of double tuberculous pyosalpinx
„ Naegele pelvis .....
„ tuberculous pyosalpinx ....
„ perimetric cystoma ....
„ ruptured uterus at term tlirough scar of old Caesarean section
abdominal hysterectomy
„ full-tei-m pregnancy in a rudimentary liorn of uterus ; missed
labour (five months) ; abdominal section and removal of sac
recovery .....
„ carcinoma of the body of the uterus
„ unsuspected tuberculous salpingitis and pyosalpinx..
„ abdominal liysterectomy for severe concealed accidental haemor
rhage .....
„ and H. T. Hicks, two cases of malignant embryoma of the
ovary .....
„ haemorrhage in uterine fibroid
TARNIER'S FORCEPS, description of modification in (A. Wiltshire)
„ modification of (A. W. Edis) ....
iv,
205
iv
243
vii,
109
viii,
360
xi.
242
XV,
247
xxxiii.
108
xxxiii.
463
xxxvi.
272
XXX vi.
344
xxxvii.
216
xxxvii.
218
xxxix.
46
xxxix.
126
xxxix.
157
xxxix.
285
xl.
113
xl.
175
xl.
222
xli.
100
xli.
163
xli.
231
xli.
341
xli,
343
xlii, 242
xlii, 276
xlii, 281
xlvi, 20
xlvii, 147
xlvii, 287
xlix, 268
xix, 223
XX, 163
Tate (Waltek), tubo-ovarian abscess . . xxxviii, 319, 380
Tate (Walter W. H.), three cases of pyometra complicating cancer
of the cervix uteri .....
„ fibro-myoma of uterus projecting into vagina, removed by
abdominal hysterectomy ....
„ carcinoma of cervix uteri in which tlie disease extended
upwards into the body .....
„ case of sloughing fibro-myoma of uterus occurring in a patient
twenty years after the menopause
„ calcareous fibroid of the cervix
xxxix, 323
xl, 159
xl, 258
xl, 303
xli, 372
204
TATE TAYLOR.
Tatb (Walter W. H.) (continued) —
„ sarcoma of ovary showing necrosis of central portion lying in
an abscess cavity containing offensive pus . . xli, 373
„ large fibro-myoma of the cervix removed by enucleation,
followed by vaginal hysterectomy . . . xlii, 161
„ suppurating ovarian cyst obstructing labour, removed by
abdominal section eighteen months later . . . xlii, 164
„ fibro-myoma of uterus showing marked cystic degeneration,
removed from a patient aged 63, from whom both ovaries had
been removed eleven years before . . . xliii, 26
„ fibro-myoma of uterus complicated with double salpingitis and
carcinoma of cervix ..... xliii, 270
„ lithopsedion retained in patient for sixteen years . . xliv, 95
„ gangrenous sarcoma of uterus removed by abdominal hyste-
rectomy from a patient suffering from glycosuria . . xliv, 165
„ two eases of fibro-myoma of cervix treated by abdominal
hysterectomy ..... xlv, 173
„ tuberculous disease of cervix and Fallopian tubes . . xlvi, 138
„ fibro-myoma of uterus, with extensive carcinoma of body of
iiterus, and fibroma of ovary .... xlvi, 139
„ two cases of diffuse adeno-myoma of uterus . . xlvi, 141
„ fibro-myoma and cystic disease co-existing in the same ovary . xlvi, 273
„ dermoid cyst of the ovary removed by abdominal section five
years after causing obstruction to labour. . . xlvi, 344
„ three cases of intestinal obstruction following operations for
fibroid tumour of uterus, with special reference to the choice
of operation ...... xlvi, 391
„ degenerating fibro-myoma and sarcoma of uterus . . xlvii, 358
„ fibro-myoma of uterus, associated with large cavity containing
retained menses communicating with uterine canal . xlvii, 360
„ carcinoma of the ovary ..... xlviii, 96
„ largo fibro-myoma of uterus removed by operation . , xlviii, 183
„ co-existing tubal and uterine pregnancy ; abdominal section ;
subsequent delivery at term .... xlix, 51
„ suppuration in fibro-myoma uteri, following premature de-
livery, treated by abdominal hysterectomy . . xlix, 54
Tatlob (F.), nipple shield . . . . iv, 228
Patlor (F. E.), two cases of enlarged wandering spleen forming
pelvic tiunours ..... xlvi, 179
,, adeno-myoma of the uterus .... xlvi, 188
„ fibroma of the ovary . . . . . xlvi, 280
„ wandering spleen simulating an ovarian tumour and causing
retroversion of the uterus .... xlvii, 70
„ necrobiotic uterine fibro-myoma occurring in pregnancy . xlvii, 333
„ presence of sarcomatous tissue in the walls of ovarian cysts . xlvii, 411
„ sections of an adeno-myomatous polypus of the cervix . xlviii, 12
„ suppvu-ation in an ovarian cyst caused by the Bacillus typhosus xlix, 256
„ two uteri with " f midal ligament " after hysteropexy . xlix, 265
Taylor (John W.), extra-uterine pregnancy at full term ; removal
of child and placenta by abdominal section; recovery . xxxiii, 115
„ a second case of "abdominal" pregnancy successfully treated
by removal of child and placenta three months after death of
child at term ..... xxxix, 178
„ ovarian tiunour obstructing delivery ; posterior vaginal section
and ovariotomy dixring labour ; operation and delivery at one
sitting ; recovery .... xliv, 275
TAYLOR — TESTIS. 205
Tatlok (John W.) (continued) —
„ small ovarian tvimour removed by vaginal section from a
patient who was about two months pregnant . . xliv, 297
„ complete inversion of nteriis of seven months' duration ; failure
of elastic pressiu-e with repositors ; operation of anterior
vaginal cceliotomy, anterior hysterotomy, and replacement ;
recovery ...... xliv, 299
Teacher (J. H.), chorion-epithelioma malignum ; primary tumoiu-
in uterus ...... xlv, 252
„ for Professor Sutherland and Dr. Buist), chorion-epithelioma
malignum with secondary gro^rths in liver . . xlv, 252
„ chorion-epithelioma malignima, two photographs of pelvic
organs with primary tumoui- and a glass tube containing a
secondary nodule from the lungs . . . xlv, 253
„ — (the so-called deciduoma malignum) and the occurrence
of chorion-epitheliomatous and hydatidif orm mole-like struc-
tiu-es in tumours of the testis .... xlv, 256
„ — and the occurrence of chorion-epitheliomatous and hyda-
tidiform mole-like structiu'es in teratomata, adjourned dis-
cussion ...... xlv, 303
TEETHING (S. Norton) . . . . . xi, 183
TEMPERATURE and lurine in puerperal eclampsia (G. E. Herman)
xxxii, 17 ; xxxiii, 315
„ in a case of pelvic cellulitis (C. J. Cullingworth) . . xii, 370
„ infantile, in health and disease (W. Squire) . . x, 273
„ immediately after delivery in relation to the duration and
other characteristics of labour (A. E. Giles) . . xxxvi, 238
„ prolonged high, of nervous origin, in a case showing uterine
contraction without retraction (G. E. Herman) . . xlviii, 204
„ observations in relation to menstruation, on the variations in
pulse and (A. E. Giles). .... xxxix, 115
„ pulse, and respiration during labour and the lying-in, some
observations on (E. J. Probyn-Williams and L. Cutler) xxxvii, 19, 152
„ puerperal (W. Squire) . . . . ix, 129, 145
„ — some observations on (E. S. Tait) . . . xxvi, 8
„ regulator, Leiter's (C. Godson) .... xxiii, 131
„ variations in the diseases of children (W. Squire) .. . xii, 171
TENACULUM, self-retaining, for operations on the cervix uteri
(E. Ellis) . . . . . . ix, 88
TENTS, carbolised and defects of ordinary sponge (E. Ellis)
„ intra-uterine spring (J. H. Aveling)
„ medicated, instruments for the application to the interior of
the cervix of (L. Tait) .....
„ sponge (A. Lawrence) .....
„ of common sea-tangle, abortion procured by (W. E. Pritchard)
„ uterine, new form of laminaria (E. Greenhalgh)
„ the use of laminaria (W. Sinclair)
„ introducer, laminaria (E. Barnes)
„ uterine (A. Wiltshire) .....
TERATOMA of the fcetal head (H. S. Stannus) . . xliv, 78
„ see also Monsters.
TESTIS, chorion-epithelioma (the so-called deciduoma malignum)
and the occiiri-oncp of chorion-epitheliomatous and hyda-
tidiform mole-like structures in tumours of (J. H. Teacher) . xlv, 256
IX,
121
vii.
155
xiv.
323
xxxi.
333
V,
198
vii.
72
slviii.
185
vii.
207
viii.
149
206
TETANUS — THORNTON.
xvii, 66
xvii, 57
xix, 94
xxvii, 308
xli, 279
TENANUS after abortion (A. Wiltshire) . . . xiii, 133
„ see Trismus.
TETANY in pregnancy (W. R. Dakin) . . . xxxiii, 163
Thane (G. D.), monster ..... vii, 227
THERAPEUTICS of gynaecology, the constant cm-rent in (J.
Shaw) ..... XXX, 243, 265
„ nterine (H. E. Eastlake) .... viii, 6
Thin (George), histological observations and remarks on hipus . xxvii, 315
Thomas (Gaillard), see Playfair, W. S.
Thompson (Chas. Kobert), complete rupture of perineum . xix, 265
Thompson (Joseph), umbilical hernia . . . x, 9
Thompson (J. A.), wax model of successful vaccination with
lymi^h from a secondary vaccination . . . xiii, 94
„ desci'iption of a cyclopean monster . . . xv, 35
„ complication in the delivei-y of an ascitic foetus . . xvii, 4
„ — report on ditto by committee (John Williams and J. A.
Thompson) .....
„ note on the treatment of chlorosis and anaemia -with the phos
phide of zinc .....
„ congenital deformity in two children, and the maternal impres
sions to which the deformities were attributed
Thomson (Arnold), case of protracted pregnancy
„ see Godson, Clement.
Thomson (Arthur), sexual differences of the foetal pelvis
THORACOPAGUS, see Monsters.
THORAX, transposition of the greater part of the abdominal viscera
into the left cavity of (H. W. BaUey) . . . x, 6
Thorburn (John), remarks in the discussion on the use of forceps xxi, 146
„ midwifery forceps with simple method of increasing its com-
pressive power ..... xxi, 162
Thorns (Mat), uterus showing malignant villous tumour and a
fibroid which has imdergone sarcomatous cliange . . xlix, 181
Thornton (J. Knowslby), unilocular cyst involving both ovaries
and with both Fallopian tubes attached . . . xxi, 119
„ viterine outgrowth removed diuring pregnancy ; premature
laboiu- ; death from obstruction of intestine . . xxi, 163
„ removal of uterine fibroids by laparotomy . . . xxii, 114
„ dermoid cyst of the left ovary .... xxiii, 104
„ ovarian tumom- with the Fallopian tube adherent to the
opposite ovary ..... xxiii, 258
„ case of extra-uterine foetation removed by abdominal section xxiv, 51, 81
„ dermoid ovarian tumour .... xxiv, 80
„ ovaries and Fallopian tubes removed by oophorectomy . xxiv, 137
„ case of extirpation of uterus and appendages for epithelioma
of the cavity ...... xxv, 9
„ uterine fibro-myoma, removed by supra-vaginal hysterectomy xxv, 67
„ pyosalpinx ...... xxv, 139
„ hysterectomy for fibroid uterus .... xxv, 163
„ ovarian cyst highly congested from twisting of pedicle . xxv, 164
„ uterine fibroids and fibro-cystic tumoiir ; hj^sterectomy . xxvi, 3
„ htematosalpinx, papillomatous ovarian cyst, abdominal section xxvi, 4
„ fibro-cystic myoma of the uterus .... xxvi, 54
THOKNTON TOWELS.
207
xxvi.
55
xxvi.
269
xxviii.
41
xxvii,
194
xxviii.
38
xxxi,
198
xxxi,
199
XXXlll,
XXVI,
XIV,
Thornton (J. Knowslbt) (continued) —
„ uterine fibroids with multilocular ovarian cysts and bi-oad
ligament cyst ......
„ vascular fibro-myoma of the uterus
„ case of removal of both ovaries for dermoid cysts dtu-ing preg-
nancy .... xxvii, 46 ;
„ malignant dermoid ovarian cyst ....
„ fxingating papillomata of both ovaries
„ for James Craig, ruptured Fallopian tube .
„ two uterine fibro-cysts . . . . .
„ see Malcolm, John D.
THROMBOSIS, fatal cardiac, and septicaemia following a case of
abortion (J. T. Musgrave) ....
„ in the cerebral veins in a case of ingravescent hemiplegia
during pregnancy and parturition (P. Horrocks)
„ and embolia of lying-in women (K. Barnes) . . iv,
„ of right heart and pulmonary arteries, death from, in a case
of tedious labour (W. Martyn) . . . . x,
„ puerperal (W. S. Playfair) . . . xvi, 42,
„ of the pidmonary artery in the puerperal state, note on the
absorption of (W. S. Playfair) . . . . '
THROMBUS, vaginal (E. Jalland) ....
THYROID EXTRACT, forty-one cases of puerperal eclampsia treated
by (A. J. Sturmer) .....
Tilt (E. J.), treatment of sickness in uterine inflammation and
diseases of menstruation ....
ready-made plasters .....
extreme surgical tendencies of uterine pathologists, and on the
division of the cervix uteri ....
irritable uterus .....
diagnosis of the least known varieties of uterine inflammation
inaugural address as President ....
progress of pelvic pathology during the last twenty-five years
diagnosis of subaciite ovaritis ....
annual address as President . . . xvi, 13
for Campbell Maclean, fcetus with placenta attached to the head
lymphangitis in pelvic pathology ....
ladies' garment suspender ....
remarks in the discussion on puerperal fever
Times (H. G.), large fibrous tumoiu- of the womb
„ foetus with encephalocele ....
TIRE-TETE, or combined perforator and extractor (G. R. Sheraton)
TISSUE, fibroid, formed around a needle and removed from the
left labium majus (H. Briggs) ....
ToMLiNSON (E. S.), tuberculosis of the uterus .
TORSION, acute, of an ovarian pedicle, from a case where there
was chronic torsion of the pedicle of a tumour of the opposite
ovary (A. Doran) .....
„ of the pedicle in hydrosalpinx, and other morbid conditions of
the Fallopian tube (K. H. Bell) ....
„ of the pedicle of a hydrosalpinx (H. Williamson)
TOWELS, ladies' sanitary (A. L. Galabin)
„ improved sanitary (A. L. Gralabin)
xxi, 81
201
30
263
162
43
xlvi, 126
iii.
1^
V,
41
viii.
262
X,
199
xiii.
197
XV,
30
XV,
87
XV,
202
xvii.
24
xvi.
124
xvi.
130
xvi.
202
xvii.
204
iij
33
xiii.
51
ix.
111
xlix.
223
V,
174
xUii, 12
xlvi,
xlvii.
xxu,
xxxvii.
152
5
188
227
208
TRACH6lO-RAPH6 TROUNCER.
xxir, 54
xi, 78
XX, 61
TRACHELO - RAPHE, or Emmet's operation, notes on (W. S.
Playfair) ......
TRACHEOTOMY in croup (F. C. Cory)
TRACTION by the lower jaw in head-last cases (J. Matthews
Duncan) ......
Tracy (R. T.), short history and description of the Lying-in Hos-
pital and Infirmary at Melbourne, with some account of what
has been done in it .
TRANSFUSION apparatus, Miinchmeyer's (J. Matthews Duncan)
„ — (P. Horrocks) ....
„ — (C. E. Jennings) ....
„ — presented (Professor Casella) .
„ — for the performance of (G. Hewitt)
„ — portable (W. Walter)
„ — for immediate (J. H. Aveling) .
„ immediate (J. H. Aveling)
„ bottle, etc., for injection of saline fluid (H. R. Spencer)
„ of blood (J. Roussel) ....
„ — its history, and application in cases of severe haemorrhage
(C. Waller) .
„ best mode of opening the vein in (J. H. Aveling)
„ report of experimental inquiry instituted to determine witli
what fluids, and by what methods, the operation of, may best
be performed, and to ascertain the effects, immediate or
remote, of the opei-ation in animals (E. A. Schafer)
„ use of saline, in treatment of puei'peral eclampsia (E. W. Hey
Groves) ..... xliii, 117, 148
■A. 11,
. xxxii.
5
. xxxiv.
460
. xliii.
146
xvii.
45
vi.
136
. xxvi.
182
xiv.
101
vi,
126
. XXXV,
428
. xviii,
280
e
i.
61
XV,
164
xxi, :U6
of milk, the effects of, in animals (E. A. Schafer)
TRANSPOSITION of the greater part of the abdominal viscera into
the left cavity of the thorax (H. W. Bailey)
TREATMENT of ovarian prolapse by shortening the ovarian liga-
ment (V. Bonney) .....
TiiEND (H. G.), funis presentations ....
Trenholmb (E. H.), irregular uterine contraction
Trestrail (H. Ernest), the treatment of rigid perineum, and
the avoidance of its rupture ....
„ case of mylacephalous acardiac twin
TRIPLET FffiTUSES (J. G. Westmacott)
TRIPLETS (C. H. F. Routh) . .
„ placenta from a case of (A. L. Galabin)
„ placentae and membranes from a case of (P. Horrocks)
„ case of, and complete placenta prasvia in which the children
were delivered alive through a perforation in the first pla-
centa (H. R. Spencer) .....
„ at upwards of eight mouths of pregnancy (W. Martyn)
TRISMUS NASCENTIUM, case of (Leith Napier)
TROCAR AND CANNULA for tapping and withdramng cysts in
ovariotomy (G. C. P. Murray) . . . .
„ exploring needle (P. Smith) ....
TROUGH, india-rubber spcctdixm (A. W. Etlis) .
TbouiTcer (J. H.), induction of premature labour in a case of
distorted pelvis . , . . .
xxi, 320
X,
6
xlviii, 339
X, 1
xiv, 231
XVll,
xxxi, 2,
xiii.
61
4
95
ix, 156
xxiii, 129
xxvi, 160
XXXV, 107
xi, 208
xix, 5
viii, 313
xii, 271
xvii, 49
i, 236
TRCJMAN TUMOURS. 209
Truman (E. B.), extra-iiterine foetation . . . ^ii, 164
TEUSS, uterine (Mr. de Berdt Hovell's), for post-partum haemor-
^^ J^^°^ (^- Bai-nes) . . . ^ . , ^.jii^.g
TRUSTEES, alteration of laws respecting the duties of the xix, 16; xxxii, 106
TUBAL DISEASE, the relation of hydroperitoneum to (Alban
„see''FTllopian tubes. ' ' ' ' ^^^"i' 229, 243
TUBAL GESTATION, see Pregnancy, extra-uterine (tubal).
TUBE, glass injection (R. Barnes) . . xxvi 232
„ new form of, for injecting the uterus after labour or abortion
(T.C.Hayes) ... xx 58
„ vulcanite, to facilitate the injection of perchloride of iron or
iodine into the uterus (F. Barnes) . ^^ an
„ see Fallopian tubes. • . xx, ou
TUBERCULAR DEPOSITS, uterine appendages the subject of
a,TT.£ ''''^ • • • • • ^xxii,306
TUBERCULAR DISEASE of the Fallopian tubes and ovaries
(A. W. W. Lea) . . _ yIv i<iq
„ of uterus (S. W. Wheaton) . , [ [ ^^J^; 39
TUBERCLE, great distension of the FaUopian tubes from, in fibroid
tumours of the uterus (P. Horrocks) . vHi ifift
" — (^- vVilliamson) . . . ^^^' -.^^
„ uterus and appendages afPected with (W. R. Dakin).' ' xxxiii' 3
TUBERCULOSIS (probably primary) of the body of the uterus in
an adult (J. Bland-Sutton) . „l^- «„
„ of cervix (E. O. Croft) . ' . ] ] • X' 1I2
» — primary, of the cervix simulating cancer, and treated bv
vaginal hysterectomy (A. H. N. Lowers) . ^iw 144.
„ further note (W. H. B. Brook) " " Ji^' .,«*
„ primary, of the cervix uteri (E. E. Young) .' .' xlviii 286
» — —- /or which vaginal hysterectomy was performed TW H B
Brook) . . " 1 IS'i
„ of cervix and FaUopian tubes (W.' W. H. Tkte) " ' xlvT' 1 ^S
„ of FaUopian tube (W. S. A. Griffith) . [ ' xxvili' 66
„ of the FaUopian tubes and uterus in cases of phthisis (P D
■•burner) . . *^ V S^Q
" ^^J^l. ^ary and FaUopian tube, microscopical sections of "" ''
(C H. Roberts) . y1 oo
„ of the uterus (R. S. TomUnson) .' * ' * 1' j^f
„ — and appendages (P. D. Turner) . * " ^i{ 344
TUBO-OVARIAlf ABSCESS, see Abscess, tubo-ovarian 4^
TUBO-OVARIAN CYSTS, see Cysts, tubo-ovarian. ^
TUBO-OVARIAN GESTATION (E. J. Maclean) . . . xxxv 106
TUMOURS, adenoma of the labium (H. WUliamson) . xlviii' 235
„ — of the uterus (T. W. Eden) . ^ " LJJ' ^^o
„ — cystic, of the cervix (W. S. A. Griffith) * " xxx' 4
„ a^^^l'^of the kidney, malignant vaginal polypus secondary
„ angioma of labium (J. Matthews Duncan) . ' xxvi 118
„ calcified, of uncertain origin removed by laparotomy from
Douglas' pouch (A. H. N. Lewers) ^ xlvii 151
„ cancerous commencing in the outer cellular tissue of the broad
ligament (T. C. Hayes) . . . xvi, 101, 102, 127
14
210
TUMOURS.
TUMOURS {continued) —
„ cephalhiBinatomata, bilateral (S. W. Wheaton) . . xxxv, 6
„ — double, infant suffering from (J. Brunton) . . xx, 293
„ chorio-endothelioma of uterus ; intra-peritoneal haemorrhage ;
hysterectomy ; death (A. Doran, for the late Dr. G. Bagot
Ferguson) ...... xlix, 57
„ chorion-epithelioma of the uterus, with secondary growths in
the vagina, lungs, and the liver (G. F. Blacker) . . xlvi, 55
„ colloid, a large conglomerate of, grown from the omentum
(R. Barnes) ..... xvii, 216 ; xviii,
„ congenital, at the internal os uteri, causing hydrometra in
new-born children (H. R. Spencer)
„ — encephaloid, not impeding delivery (S. Wells)
„ cranial blood-swelling (E. Rigby)
„ cystic, in connection with the right Fallopian tube, arising
probably from an accessory Fallopian tube (R. H. Bell)
„ — of both ovaries (J. Knowsley Thornton)
„ — pregnancy after removal of both ovaries for (A. Doran)
xl,
ii.
i,
xlvi,
xxvi,
xliv,
xxxviii.
193
332
27
231
21
269
231
106
xlvii,
xlvii,
XXV,
xii,
xxix,
xxvi,
xliv,
xxxvi,
xliii,
xlviii,
of neck of uterus (A. H. N. Lewers)
erabryoma of anterior mediastinum in a male adult (J
Ritchie) ...... xlv, 250
— malignant, of the ovary (H. T. Hicks and J. H
Targett) .....
endothelioma of uterus (M. A. D. Scharlieb)
large fibro-cellular (Wm. Duncan)
fibro-enchondi-omatous complicating pregnancy ; safe delivery
(A. Wiltshire) ....
fibro-cystic, of uteriis (A. C. Butler-Smythe)
(J. Knowsley Thornton) .
(W. C. Swayne) ....
removed by abdominal section (A. H. N. Lewers)
— with carcinoma of left ovary and right Fallopian tube (R
BoxaU)
after-history of (R. Boxall)
intra-ligamentous, weighing about 30 lb., removed by
enucleation and subtotal hysterectomy (T. W. Eden and
F. L. Provis) ..... xlviii, 264
laceration on its surface ; free intra-peritoneal haemor-
rhage (A. H. N. Lewers) .... xlvii,
FIBROID, a large cystic (H. R. Andrews) . . . xlviii,
— showing cystic degeneration removed three weeks after
labour (H. R. Andrews) .... xlviii,
— (R. Barnes) . . . . . vi,
— extra-uterine, successfully removed by gastrotomy (C. H. F.
Rou^j^ .... xvii, 216 ; xviii, 5,
— expelled spontaneousl}' (R. Barnes) . . . vii,
— removed by enucleation and excision (R. Barnes) . vii,
— two cases of abdominal hysterectomy for, complicated by
pregnancy ; vfith specimens (F. N. Boyd) . . . xlvi,
— micrococci, in the substance of a decomposing (S. W.
Wheaton) ...... xxxiv,
— solitary interstitial, removed by abdominal myomectomy
(W. S. Handley and C. Lockj'er) . . . xlv,
— two cases illustrating changes in, after the menopause
(■J. Bland-Sutton) ..... xlv,
— which filled the pelvic cavity, Csesarean section followed by
removal of (H. R. Andrews) .... xlviii.
287
281
212
376
350
3
369
270
71
136
261
249
247
101
145
113
55
106
187
51
105
313
TUMOURS.
211
(A. W.
TUMOURS {continued)--
„ FIBROID (continued) —
" — unusual thickening of the endometrium
Addinsell) • . . . .
„ — complicating labour near term in a patient who had re-
covered ^vithout opei-ation from ruptured tubal pregnancy
(H. R. Spencer) • • . . .
„ — necrobiotic (F. N. Boyd) . . * *
» removed from a recently delivered patient aged 22 (J.
S. Fairbaim) .....
„ — large retro-peritoneal, undergoing suppuration (C . H. Eoberts)
„ — in undeveloped cornu of an uterus unicornis ; from a parous
xli, 231
xlviii, 240
xlvi, 198
xlvi, 194
xli, 213
subject (A. Doran)
, — sloughing, removed by hysterectomy (W. Dimcaii)
, — complicating pregnancy and labour (A. Donald) .
, — rapidly growing in a patient aged 63 (A. L. Galabin)
, — supposed myxomatous degeneration of (M. Handfield-
Jones) • • . . .
, — of broad ligament (F. N. Boyd)
, weighing 4Hb., with twisted pedicle (A. H. N.Lewers) .
, weighing 44i lb. (20 kilogrammes) removed by enuclea-
tion (A. Doran) .....
, associated with an ovarian cyst (A. Doran)
, — after-history of, associated with an ovarian cyst reported
in the forty-third volume of the Society's ' Transactions ' (A.
Doran) • . . . .
— of the cervix, calcareous (W. "W. H. Tate) '.
— calcified, lying free in the cavity of a fibro-myomatous
uterus (J. H. Dauber) ....
— two specimens of, associated with bleeding after the meno-
pause (A. H. N. Lowers) ....
— cervical (F. J. McCann) • . ! .
— polypus of cervix (W. Duncan)
— of uterus, wholly cervical, and characterised by profuse
haemorrhage (J. S. Fairbaim) ....
(A. L. Galabin) .....
removed by abdominal hysterectomy by Doyen's metliod
(H. R. Spencer) ....
— of the ovary (C. H. Carter) . . - . *
removed by abdominal section (John Williams)
with a papuliferous cyst (John Williams) . xxix, 247, 513
Avith observations on their pathological anatomy (J. S
Fairbaim) ...... xKv, 177
— of uterus (T. Chambers)
(W. B. Woodman)
(C. M. Carter) .
(T. Chambers) .
(F. H. Daly)
(A. Wiltshire) .
— — (F. H. Champneys)
(A. L. Galabin) .
(G. E. Herman) .
(W. A. Mer«. -ith)
(Wynn Will'Ams)
— — (A. Meadows)
(J. D. Malcolm) .
(J. H. Galton) .
xli, 295
xxxvii, 197
xliii, 180
xxxix, 229
xxxiii, 461
xlvi, 348
xliv, 364
xli, 173
xliii, 260
xUx, 94
xli, 372
xlix, 139
xlix, 270
xlviii, 178
xxxvi, 114
xlv, 178
xlv, 175
xliii, 5
xxiv, 139
XXV, 35
xi, 31
vii, 26
xiii, 167
xviii, 177 ; xxii, 159, 187
. xviii, 65
. xix, 119
xxii, 185
. xxiv, 4
. xxiv, 52
. xxiv, 79
XXV, 46, 70
. XXV, 161
. xxxvi, 200
. xxxvi, 318
212 TUMOURS.
TUMOURS (continued)—
„ FIBROID (continued) —
„ — of uterus, large (P. Horrocks) . . . xxxvi, 193
„ removed from a patient aged 20 (H. R. Andrews) . xlvii, 154
„ absorption of (W. S. Playfair) . . . x, 102
„ with a report of a suspected case (A. Doran ) . xxxv, 250
„ in a state of calcareous degeneration (G. Roper) . xix, 255
„ calcified (John Williams) .... xvi, 125
„ (M. Handfield-Jones) .... xxxv, 2
„ — with acute axial rotation (J. Bland-Sutton) . xlvi, 149
„ — in elderly women, removed by abdominal section
(W. S. A. Griffith), ..... xlviii, 17
„ with cancer (A. L. Galabin) . . . xlv, 102
„ — (Amand Routh) . , . xxxviii, 99
„ of the body in a woman, aged 36, simulating (H. R.
Spencer) ...... xlvi, 235
„ in the same (M. Handfield-Jones) . . xlvii, 337
„ (multiple), with carcinoma of the body (A. H. N.
Lewers) ...... xlvi, 266
„ complicated by cancer of the corporeal endometrium
(J. Bland-Sutton) ..... xlviii, 140
„ associated with carcinoma (A. L. Galabin) . xxxviii, 102
„ of the cervix removed post-mortem from a patient on
whom eight years previously the operation of oophorectomy
had been performed (G. F. Blacker) . . . xxxvii, 213
„ — — undergoing colloid degeneration (T. G. Stevens) . xxxvi, 225
„ cystic degeneration of (C. H. Carter) . . xxv, 108
„ of the surrounding tissues (M. Handfield-Jones) . xlvi, 307
„ degenerated, threatening to rupture, removed by total
abdominal hysterectomy (H. R. Spencer) . . . xlv, 378
„ myxomatous degeneration of (C. Godson) . . xxv, 140
„ entirely detached (Amand Routh) . . xxxviii, 388
„ yvith great distension of the Fallopian tubes from
tubercle (P. Horrocks) .... xlii, 166
„ removed by enucleation fifteen days after delivery (R.
Boxall) ...... xxxvi, 64
„ extirpation of uterus and both ovaries for (T.
Chambers) ...... xxiii, 12
„ and fibro-cystic tumour (J. Knowsley Thornton) xxvi, 3
„ gangrenous (J. Bland-Sutton) . . . xxxii, 171
„ inversion of uterus caused by (G. E. Herman) . xxx, 226
„ removed by abdominal hysterectomy (W. Duncan) . xxxvi, 181
„ myxomatous (M. A. D. Scharlieb) . . . xlix, 273
„ with a sarcomatous nodule in the centre (Amand Routh) xlix, 1
„ interstitial, causing retroflexion (C. God^son) . . xxiii, 63
„ removed from a patient aged 26 (A. F. Stabb) . xxxix, 89
„ from a case of placenta praevia centralis (R. Boxall). xl, 338
„ three cases of intestinal obstruction following opera-
tions for, with special reference to the choice of operation
(W. W. H. Tate) ..... xlvi, 391
„ with, undergoing mucoid change, successfully removed
by abdominal hysterectomy with intra^peritoneal treatment
of the stump (A. H. N. Lewers) .... xlii, 94
„ removed by intra-peritoneal hysterectomy (W. Duncan) xliii, 76
„ intra-uterine, intra-mural, and subperitoneal (G. G.
Bantock) . . xxiv, 47, 91, 301 ; xxv, 38: xxvi, 119
„ — removed by single-wire ecraseur (G. C. P. Murray) . li, 78
TUMOURS.
213
TUMOURS (continued)—
„ FiBKOiD (continued) —
„ — of uterus, intra-uterine, partly removed by ecraseiu-,
the remainder throwTi off by disintegration (J. H. Davis)
» fibro-plastic, extensively adherent, removed by enuclea-
tion (J. H. Davis) .....
„ removal of, and subsequent pregnancy (Wynn "Williams)
» removed by hysterectomy (J. Knowsley Thornton)
« by laparotomy (J. Knowsley Thornton)
„ suppiu-ating (Gr. F. BlacKer)
« case of locked, treated by supra-vaginal hysterectomy
(W.A.Meredith) . .
„ on locking, retroversion, and strangtdation of, in the
pelvic excavation (J. Matthews Duncan) .
., with multilocular ovarian cysts and broad-ligament
cyst (J. Knowsley Thornton) ....
» imdergoing necrobiosis or red degeneration (A. H. N.
Lewers) ......
„ obstructing labour in which Porro-Caesarean hysterec-
tomy mth retro-peritoneal treatment of the stump was per-
formed; with remarks upon the relative advantages of the
modern Porro operation over the Siinger-Caesarean in most
other cases requiring abdominal section (A. Routh)
„ uterus removed at eight and a half months of gestation
by abdominal hysterectomy for (A. Routh)
» which developed after both ovaries and tubes had been
removed for independent disease (E. W. Hey Groves)
„ removed by pan-hysterectomy (W. C. Swayne)
„ complicating pregnancy (H. M. Madge)
„ treated by enucleation (W. Hankes Day)
« multiple, fatal cerebral haemorrhage in a case of
(W. Duncan) ......
„ pan-hysterectomy during labour in the seventh
month (J. Bland-Sutton) ....
» delivery (W. S. Playfair) . . xix, 101 ;
„ pregnant about thi-ee and a half months, with placenta
prsevia (J. Braxton Hicks) ....
„ removed by operation (A. Doran)
„ removed during pregnancy; premature laboiu*; death
from obstruction of intestine (J. Knowsley Thornton)
J, expelled after delivery (F. H. Daly) .
„ — and pregnant uterus, removed by abdominal hysterectomy
(P. Horrocks) ...... ^^^, _ ^^
,, cedematous, associated with pregnancy (A. L. Galabin) xxxvii, 286
,, removed by abdominal hysterectomy (C. J. CuUing-
worth) ...... XXXV,
« multiple, with deformed fcetus (A. Wiltshire) . xxiii,
,, non - capsulated, resembling retained placenta (J.
Braithwaite) . . . . . . xxiii,
„ of one-horned (A. Routh) . . . xxix, 2,
» outgrowth from the fundus uteri (T. S. Wells) . xi,
» with attached ovarian cyst (F. H. Daly) . xvi, 122, 202
„ with double ovarian cysts and ascitic fluid from perito-
nitis (A. W. Edis) . . . . .XX, 164
« peduncvilated (W. Duncan) . , . xxvi, 186
» sloughing (W. Dimcan) .... xxix, 250
» (H. R. Spencer) . . . xxx, 408
X, 227
ii, 17
xvi, 183
XXV, 163
xxii, 114
xlix, 100
xxx, 442
xxx, 435
xxvi, 55
xlviii, 173
xlii, 244
xliv, 41
xlv, 136
xlv, 140
xiv, 227
xxvii, 158
xxxii, 2
xlvi, 238
; xxiii, 25
xvii, 298
xlvi, 119
xxi, 163
xxviii, 170
xlii, 242
38
163
182
57
73
214
TUMOUBS.
272
38
30
74
232
276
482
172
186
228
171
211
32
44
299
142
TUMOURS {continued) —
„ FIBROID {continued) —
„ — of uterus, sloughing, submucous (H. Gervis) . . xxv, 161
„ of the left uterine cornu; abnormal relations (A.
Doran and C. Lockyer) ..... xliii,
„ spontaneous extrusion of a large (W. S. A. Griffith) . xxxv,
„ submucous, presenting at the os uteri ten days after
delivery : labour normal (G. Ei-nest Herman) . . xxxiii,
„ subperitoneal pedunculated (T. C. Hayes) . . xxxiii,
„ subperitoneal (A. Meadows) . . . xxv,
„ (F. Wallace) .... xvii, 177,
„ — — showing the three forms of the disease, subperitoneal,
interstitial, and submucous (G. C. P. Miuray) . . xvi,
„ suppiu-ating (S. Boyd) .... xliii,
„ soft, removed by hysterectomy (T. C. Hayes) . . xxxv,
„ voluminous (R. Barnes) . . . . vii,
„ situated in the anterior wall, which obstructed laboui- (R.
Barnes) . . . . . . v,
„ springing from the posterior lip (R. Barnes) . . iii,
„ clinically resembling sarcoma (W. R. Dakin) . . xl,
„ — of the vagina (G. E. Herman) .... xxii,
„ (A. H. N. Lewers) .... xxix,
„ (W. C. Swayne) ..... xlv,
„ FIBROMA of the abdominal wall; increase diu'ing pregnancy
(A. Doran) ...... xxxix, 42
„ — of broad ligament weighing 44 lb. 8 oz. successfully removed
from a woman aged 28 (A. Doran) . . . xl, 295
„ — of the ovarian ligament (A. Doran) . . . xxxi, 200
„ — spontaneously enucleated (Amand Routh) . . xxxv, 409
„ — of the ovary (H. T. Rutherfoord) . . . xxxiv, 88
„ — (?) of the ovary (P. Horrocks) . . . xxxvi, 192
„ — of ovary (M. Handfield-Jones) . . . xxxvi, 343
„ (J. CraAvford) ..... xxxvi, 190
„ impaction, ascites, removal (A Doran) . . xxxix, 37
„ (C. J. CuUingworth) .... xxxix, 279
„ (F. N. Boyd) .... xliv, 176
„ (A. E. GUes) ..... xliv, 360
„ (F. E. Taylor) ..... xlvi, 280
„ pure (A. Doran) ..... xliv, 172
„ one third of an inch in diameter (A. Doran) . . xliv, 173
„ weighing 17 lb. ; xuider observation for ten years
(A. Doran) ...... xlvii, 421
„ undergoing calcareous degeneration (C. Hubert Roberts) xxxix, 8
„ — of the uterus (Heywood Smith) . . . xxiii, 262
„ on intermittent contractions of, and in pregnancy, in
relation to diagnosis (J. B. Hicks) . . . xxxvi, 188
„ multiple, with carcinoma of body, removed by abdominal
pan-hysterectomy (J. H. Dauber) . . . xxxix, 321
„ two, removed by intra-peritoneal hysterectomy (H.
Macnaughton-Jones) ..... xxxix, 321
„ FiBRO-MTOMA and abscess (W. Dimcan) . . . xxxi, 332
„ — removed by abdominal myomectomy in second month of
pi-egnancy ; labour at term (A. Doran) . . . xlvii, 426
„ — necrobiotic uterine, occurring in pregnancy (F. E. Taylor) xlvii, 333
„ — of broad ligament (W. A. Meredith) . . xxix, 249, 514
„ — — (M. Handfield-Jones) .... xxxv, 239
„ — soft, in the left broad ligament (R. Boxall) . . xxxv, 410
TUMOURS. 215
TUMOURS (continued)—
„ FiBRO-MTOMA (continued) —
„ — of the intra-abdominal portion of the round ligament of
the uterus (H. E. Spencer) .... xlvi, 26
„ — of the cervix uteri, removed by abdominal pan-hysterec-
tomy (W. A. Meredith) .... xlvi, 12
„ which had obstructed labour (W. Duncan) . . xxxv, 296
„ — cystic, of the uterus removed by posterior colpotomy
(H. E. Spencer) ..... xliii, 110
„ — solid, mesenteric, weighing" 30 lb. (A. Doran) . . xlvi, 145
„ — of right ovary removed by abdominal section (C. H. Carter) xxix, 190
„ — of ovary (A. J. Sturmer) . . . xlv, 335, 370
„ — of uterus (E. Barnes) .... xxv, 68
„ (W. Walter) ..... xxvi, 326
„ two specimens of, -with axial rotation (W. A. Meredith) xxx, 80
„ from a case of Caesarean section (P. Horrocks) . xxix, 98
„ degenerating, associated with a case of hsematometra,
treated by supra-vaginal hysterectomy (W. A. Meredith) . xxix, 422
„ attached to fundus of an irreducible inverted uterus
(P. Horrocks) .... xxx, 196, 228
„ removed by hysterectomy (J. Knowsley Thornton)
xxv, 67 ; xxvi, 269
„ on the advisability of removing the cervix in performing
hysterectomy for (J. D. Malcohn) . . . xlix, 148
„ suppuration in, following premature delivery, treated
by abdominal hysterectomy (W. Tate) . . . xlix, 54
„ causing intestinal obstruction and death two years
after the menopause (C. J. Cullingworth) . . . xxxix, 282
„ complicating early ectopic gestation (? tubo-uterine)
(C. J. Cullingworth) .... xxxix, 284 ; xl, 285
„ multiple, complicating a twin pregnancy (John Phillips) xxviii, 138
„ — (Leith Napier) .... xxxv 3
„ large, removed by hysterectomy (Leith Napier) . xxxiv, 159
„ spontaneously enucleated during labour (W. E. Dakin) xli, 105
„ gangrene of an interstitial (C. J. Cullingworth) . xxxix, 281
„ (Edematous subperitoneal, in right broad ligament
removed by abdominal hysterectomy (C. J. Cvillingworth) . xl, 302
„ — — peduncvdated, of the broad ligament, with twisted
pedicle (C J. Cullingworth) . . . xxxvii, 222
„ double pyosalpinx associated with (W. S. Playfair) . xxxiii, 497
„ sloughing, occurring in a patient twenty years after
the menopause ("W. W. H. Tate) . . . xl, 303
„ of the central part shortly after delivery (J. D.
Malcolm) . . . . /. xlvi, 15
„ undergoing sarcomatous degeneration (P. Horrocks) . xlvi, 184
„ change (W. S. A. GriiBth and H. Williamson) . xlviii, 22
„ — of the vagina (J. Bland-Sutton) . . . xli, 100
„ (J. M. Munro Kerr) .... xliv, 130
„ — of the vestibule (J. Inglis Parsons) . . . xlviii, 184
„ fibro-sarcoma of chorion (A. L. Galabin) . . . xxvii, 107
„ — of the right ovary (M. Handfield- Jones) . . xxxi, 126
„ large fibrotic, with calcification of the arteries (J. S. Fairbairn) xlvii, 299
„ piBEOUS, impeding delivery (H. M. Madge) . . iv, 129
„ — of the cervix uteri (G. C. P. Mxirray) . . . vi, 184
„ obstructing laboui-, removed by enucleation . . xii, 273
„ — of the ovary, removed by ovariotomy (L. J. Martin) . xii, 302
„ — of both ovaries (C. J. Citllingworth) . . . xxi, 276
216
TUMOURS.
XXIV,
ii.
iii,
i,
i,
TUMOURS (continued) —
,, yiBROUS (^continued) —
„ — of the uterus (C. H. Carter)
„ (H. G. Times) ....
„ (T. H. Tanner) ....
„ illustrating a sui-gical operation for the ciu-e of this
affection (I. Baker Brown)
„ tubal pregnancy with (G. Harley) .
,, (W. G. Hewitt) ....
„ spontaneous sloughing ; death from peritonitis (J. B
Hicks) .....
„ treated by siu-gical means (I. B. Brown) . iii,
„ — removal of, from fundus uteri (C. Godson)
„ — from anterior wall of vagina (R. Barnes)
„ "grape-like " sarcoma of the cervix xiteri (H. Williamson)
„ intx-a-mural calcareous, impeding labour (Wynn Williams)
„ intra-uterine, case of (F. H. Daly)
„ — i-emoval of (J. A. Tapson)
„ of labium (J. B. Potter)
„ expelled from the uterus during natiu*al laboui", along with
microscopic sections (A. W. W. Lea)
„ lipoma removed from left labium majus (C. H. Carter)
,, — of the lumbar region, 4 lb. in weight, and of twenty
years' growth (.\. Doran)
„ — retro-peritoneiil, weighing 13 lb. 12 oz. (A. Doran)
„ malignant, of omentum (G. D. Brown)
„ — groAvths in the vagina and rectum, pregnancy complicated
by (J. B. Totter) ....
„ of foital membranes (G. M. Bluett and G. E. Hei-man)
„ of the mesometrium weighing 22 lb. (J. Bland-Sutton)
„ molluscum fibrosum of the labium majus (A. E. Giles)
„ multilocuhir ovarian (John Williams)
^, _ (W. Duncan) ....
„ — ruptured secondary cyst in (A. Doran) .
„ myo-fibroma, three specimens of (H. Gervis)
„ MYOMA of left broad ligament (W. Duncan)
„ — of the uterus, its pathology and treatment (Lawson Tait)
„ four cases of removal of, by abdominal section (Lawson
Tait) ...... xix, 274
„ (F. J. McCann) . . . . . xl, 3
„ degenerating (W. Duncan) . xxxvii, 147
,, — — soft, showing early cystic degeneration (J. H. Aveling) xxvi, 270
„ - — diffuse, nou-capsulated (C. J. Cullingworth) . xxxvii, 143
„ — of cervix uteri (J. liland-Sutton) . . . xxxix, 160
„ (C. J. Cullingworth) .... xxxiv, 223
„ — — necrotic change in, occurring in a young subject (C. J.
Cullingworth) .... xxxvii, 284
„ cedematous (W. Duncan) . . . xxxvii, 148
„ (K. H. O'Callaghan) . . . xxxvii, 201
„ — — in case of placenta praevia (J. Hickinbotham) . xxiii, 166
„ fibro-cystic (J. Knowsley Thornton) . . xxvi, 54
„ sopticsemia (H. A. Lediard) . . . xxvi, 193
,, undergoing red degeneration (W. F. V. Bonney) . xlv, 464
„ — and fibro-myoma of the uterus and allied tumours of
the ovary (A. Doran) ..... xxx, 410
„ — invaded by carcinoma of the corpus uteri ; hysterectomy
(J. M. Miuu-o Ken-) ..... xlvii, 191
2
33
11
329
101
ii, 240
vii, 110
67 ; vi, 21
xxii, 111
xiv, 309
xlvii, 119
xvii, 172
xviii, 222
XV, 247
xxvi, 228
xli, 2
xxxii, 6
xxxix, 40
xliv, 265
xviii, 24
XX, 110
xxix, 243, 512
xli, 298
xxxix, 231
xxiv, 77
xxvi, 229
xxvi, 118
XXV, 108
xxxi, 309
XXV, 194
TUMOURS.
217
TUMOURS (continitsd)—
„ MYOMA {continued) —
J, — polypoid, of the uteriis (A. Lawrence) .
» (W. K. Eogers)
„ — piu-e, of the ovary, with a microscopic section (A. Doran)
„ myxo-fibroma of cervix viteri (A. L. Galabin)
„ myxoma of the labium majus (M. Handfield-Jones) .
» — of fundus uteri following vesicular mole (?) a myxoma
of chorionic villi engrafted upon uterus (A. L. Galabin)
„ shomng the impossibility, in some cases, to diagnose between
uterine and ovarian neoplasms (J. D. Malcolm)
„ orbital, in a hydrocephalic female f ojtus with tumour of cheek,
maldevelopment of neck, associated with hydi-amnios,
necessitating interference with the pregnancy at the seventh
month (H. S. Stannus).
OVARIAN (H. Oldham) .
— (A. W. Williams) .
— (P. Smith) .
— (W. H. Harris)
— (A. Meadows) .....
— axial rotation of, leading to strangulation and gangrene
(L. Tait) ......
— bilocula,ted, complicated by a hsematosalpinx (John
— weighing 76^ oz., in a girl, aged 12^, terminating life
suddenly by asphyxia ....
— with the Fallopian tube adherent to the opposite ovary (J
Knowsley Thornton) ....
— hydatids in omentum simulating (W. Newman) .
— treatment of labour complicated by (W. S. Playfair)
— obstruction of labour by (E. G. McKerron)
— adjourned discussion on K. G. McKerron's paper on the
obstruction of labour by
— removed by ovariotomy (T. Spencer Wells)
— appearance of thyroid-like structures in (E. Hamilton Bell)
— with twisted pedicle (E. Barnes)
— suppurating (J. W. J. Oswald)
xxxii,
xliv,
xxviii,
xlvii.
366
94
168
178
362
xlv, 241
xxix, 249
xliii,
vi,
X,
xiii,
XV,
XXV,
304
75
197
98
58
161
xxii, 86
xxviii, 89
ii, 280
XXlll,
ix,
xxxix,
xl,
iii,
xlvii,
xxvi,
xvii.
258
169
69
334
214
242
59
, 168
— and uterus, non-malignant, sections of (W. S. A. Griffith) xxx, 302, 409
— adenoma, unusual example of rupture of (J. Bland-Sutton) xli, 98
— anomalous, associated with uterine fibroid (H. Macnaughton-
Jfnes) . . . . . . xl, 154
— bilateral, in a patient with chorio-epithelioma follow-
ing hydatidiform mole (J. D. Malcolm, E. H. Bell, and C.
Lockyer) ...... xlv, 483
— carcinomatous (J. S. Fairbairn) . . . xliii, 208
— complicating pregnancy, cyst ruptured during examina-
tion ; immediate laparotomy ; recovery (W. Duncan) . xxxvi, 312
— containing corpus luteum (A. L. Galabin) . xxxviii, 101
— with greatly enlarged Fallopian tube (P. Horrocks) . xxxvi, 185
— hydrocele containing papillomata (J. Bland-Sutton) . xxxiv, 215
— papillomatous cyst (A. H. N. Lewers) . . . xxxiv, 462
cyst of, causing profuse ascitic effusion (A. Doran) . xxxiv, 149
cystoma, removed after double ovariotomy fifteen years
previously (J. D. Malcolm) .... xxxv, 36
closely simulating a cystoma attached to the front of
the bladder and quite separate from both ovaries (J. D.
Malcolm) ...... xli, 226
218
TUMOURS.
xliii, 224
xlv, -415
xUv, 275
xxxvi, 192 ; xliv, 94
. xxxvi, 313
xli, 373
xxxiv, 2
the walk of (F. E.
xxxvi, 264
xlvii, 411
TUMOURS (continued) —
„ OVARIAN (continued) —
„ — large, ruptured on the third day after labour (H. R.
Spencer) ......
„ — which had made its way between the layers of the meso-
sigmoid, both broad ligaments, and the meso-caecmn (W. H. B.
Brook) ......
„ — obstructing delivery; posterior vaginal section and
ovariotomy dui-ing labour ; operation and delivery at one
sitting; recovery (J. W. Taylor)
„ — sarcoma of (P. Horrocks)
„ (W. R. Dakin) .....
„ showing necrosis of central portion lying in an abscess
cavity containing offensive pus (W. W. H. Tate)
„ primary (J. A. Shaw Mackenzie)
„ — cystic, of omentum simulating ovarian ; removal ; recovery
(W. Duncan)
„ — presence of sarcomatous tissue in
Taylor)
„ — simulated by a wandering spleen, which caused retro-
version of the uterus (F. E. Taylor) . .
„ — large solid (J. D. Malcobu)
„ — solid (Leith Napier) .
„ — — with an attached cyst communicating with the left
Fallopian tube (W. F. V. Bonney)
„ removed from a woman, aged 36 (A. W. AddinseU)
„ — small, removed by vaginal section from a patient who was
about two months pi-egnant (J. W. Taylor)
„ DERMOID OVARIAN (J. Knowsley Thornton)
„ (W. Diuican)
„ some specimens of (J. Bland-Sutton)
„ dentigerous bony plates from (A. Doran)
,, — — with very long ovarian ligament on the left side (W
Rivers Pollock)
„ twisted pedicle (R. Boxall)
„ bony girdle from (S. W. Wheaton)
„ cyst (A. L. Galabin)
„ incarcerated, removed at the fouilh month of preg-
nancy ; delivery of a living child at term (H. R. Spencer)
„ ruptiu-ed during delivery by forceps and version, with
fatal result (H. R. Spencer) ....
„ Caesarean section, and removal of tumour at the end of
the first stage of of labour (R. Boxall)
„ in the middle of pregnancy ; manual elevation ; removal
a fortnight after delivery at term (H. R. Spencer) .
„ obstructing labour ; manual elevation ; removal seven
months later (H. R. Spencer) ....
„ ovariotomy during labour (H. R. Spencer)
„ — obstructing labour ; displacement of the tumour from
the true pelvis and extraction of the child with forceps;
removal of tumour five weeks later ; recovery (J. M. Munro
Kerr) ......
„ — — infiltration of broad ligament with fat (J. Bland-Siitton) xxxiv,
„ with a twdsted pedicle six inches in length (J. Bland-
Sutton) ...... xlvi, 147
r, section of the wall showing giant cells (H. Williamson) xlvi, 299
„ malignant papilloma of uterus (Amand Routh) . . xxxix, 5
xxxi, 333
. xlvii, 70
xxxviii, 166, 167
xxxviii, 29, 32
xliv, 92
xlii, 139
xliv, 297
xxiv, 80
xxxi, 255
xxxiv, 5
xxxi, 86
xl, 119
xli, 5
XXXV, 4
xxxiv, 441
xl, 329
xl, 331
xl, 25
xl, 259
xl,
xl.
xliii, 145
7
4
TUMOURS — TWINS, ABORTION.
219
TUMOURS (continued)—
„ miiltilobular papilloma of the urethra (C. Lockyer) . . xlvii, 122
„ parovarian cyst, axial rotation of (Leith Napier) . . xxxiv, 124
„ solid pelvic (W. A. Meredith) .... xxix, 249
„ pelvic, case of labour complicated by, and convulsions (H. M.
Madge) ...... xvii, 20
„ — obstructing delivery (E. Copeman) . . xii, 313
» — two cases of enlarged wandering spleen forming (F. E.
Taylor) ...... xlvi, 179
„ large pendulous uterine (E. Wise) . . . xli, 302
„ of the placenta (A. L. Galabin) . . xxiv, 241 ; xxvii, 107
j> — from a primipara (G. Eoper) .... xix, 256
„ which had been protruded from the rectum dm*ing labom- (E.
Barnes) . . . . . . xxi, 28
„ sarcoma of the uterus with inversion (J. H. Targett) . xxxix, 285
„ serous, in the occipital region (W. B. Woodman) . . vii, 158
„ solid (Leith Napier) .... xxxvii^ 283
„ large, at the end of the spine, supposed spina bifida (P.
Horrocks) ...... xxix, 57
„ of the testis, chorion-epithelioma (the so-caUed deciduoma
malignum), and the occurrence of chorion-epitheliomatous
and hydatidiform mole-like structure in (J. H. Teacher) . xlv, 256
„ tubo-ovarian cyst (M. Handfield-Jones) . . . xxxiv, 85
„ umbilical, formed by prolapse of Meckel's diverticulum (S. W.
Wheaton) ...... xxxiv, 184
„ sections illustrating the structure of three different types of
urethral cartmcles (H. Williamson) . . . xlvii, 6
„ of the uterus (C. Carter) .... xxiv, 161
„ — complicating pregnancy (J. L. Worship) . . xiv] 305
» — (C. E.Purslow) ..... xlvi, 269
„ from anterior wall of vagina (A. Meadows) . . x, 141
„ vaginal cystocele, new operation for (E. W. Hey Groves) . xlvii] 65
„ vascular (erectile), in the sheath of the funis in a new-born
infant (F. Lawton) ..... vii, 210
,. villous, of the body of the uterus, in a woman aged 84;
vaginal hysterectomy ; recovery (J. Bland-Sutton) . xlix, 46
„ — malignant, uterus showing, and a fibroid which has
undergone sarcomatous change (May Thorne) . . xlilx, 181
„ see Carcinoma, Cysts, Encephalocele, Epithelioma, Fihro-myoma,
Hxmatoma, Meningocele, Myoma, Myxoma, Papilloma, Polypus,
Sarcoma, etc.
Turner (J. S.), two specimens of ovarian dropsy . . x, 39
„ tubal pregnancy ..... xvi, 30
„ hydronephrosis of the left kidney . . xxxviii, 103
Turner (P. D.), tuberculosis of uterus and appendages . xli, 344
„ notes on tuberctdosis of the Fallopian tubes and uterus in
cases of phthisis ..... xli, 359
Turner (W. A.), see McCann, F. J.
TURNING in cases of contracted brim (P. L. Burchell) . . xxv, 61
„ in cases of disproportion (A. H. M'Clintock) . . iv, 175
„ one of the causes of difficulty in, with remarks on the practice
of amputating the procident arm (G. E. Herman) . . xxviii, 150
TWINS, ABORTION (J. C. Langmore) . • iv, 133
,, abortion of, one emaciated and one acephalous (C. Godson) x\ i, 100, 121
220 TWINS — UMBILICAL CORD.
TWINS (continued) —
„ arrested development of one (A. W. Edis) . . . xxv, 213
„ one blighted, the other anencephalous (A. Meadows) . i, 51
„ case of, in which one died at an early period of pregnancy
(A. W. Edis) ...... xvii, 211
„ conjoined, case of (Percy Boulton) . , . xxiii, 260
„ — double monster (C. Godson) . . . xx, 171 ; xxi, 88
„ — Marie-Rosa Drouin, description of (D. C. MacCallum) . xx, 120
„ — Eozalie and Josepha Blazet (W. S. Playfair) . . xxii, 265
„ — (Amand Routh) . .... xlii, 29
„ — (thoracopagus) (W. Duncan) . . . xxxvii, 198
„ entire full-time ovum in (K. Wise) . . . xlix, 147
„ tubular fojtation with (N. J. Haydon) . . . v, 75
„ short funis in both (J. B. Hicks) .... xxiii, 253
„ monster (P. Horrocks) ..... xlvi, 183
„ mylacephalous acardiac (H. Page) . . . xxxiii, 302
„ observations and remarks on cases of (J. Bnmton) . . xi, 67
„ placenta from, two cases of, prematurely expelled (A. W.
Edis) ..... XX, 321, 322
„ two cases ; the first child presented naturally, with the second
there was placental presentation (J. Brunton) . . xii, 167
„ together with secundines, from a case of hydrops amnii
(W. G. Hewitt) . . . . . xi, 37
„ unioviilar (C. Lockyer) ..... xlvi, 191
„ hydi-amnion in cases of uniovial or homologous (T. Wilson) . xli, 235
TWIN-BEARING FAMILY, hereditary (J. B. Curgenven) xi, 106
TWIN-F(ETUSES, smallpox in (H. Madge) . . . iii, 173
TWIN-LABOUR, diiHcult position of the heads during (T. Pollock) iii, 103
TWISTING of the funis (M. Handfield-Jones) . . . xxxi, 164
„ of pedicle in an incipient dermoid ovarian cyst (A. Doran) . xxiv, 133
„ — in an ovarian cyst (K. Barnes) . . . xxvi, 59
„ (J. Knowsley Thornton) . . . xxv, 164 ; xxvii, 64
„ — ^ caused by hsemorrhagic effusion into (R. Barnes) . xxv, 160
„ see Rotation.
ULCERATION of the cervix uteri, cured by the application of styp-
tic colloid (J. Wynne) . . . . . xi, 86
„ of lupus of the female degenei-ative organs, including perfora-
tions, pits, and excavations (J. Matthews Duncan) . . xxvii, 139
„ of wall of vagina caused by a pessary (T. C. Hayes) . . xvi, 30
ULCERATION (AND ULCERS), corroding, of the os uteri (John
Williams) ...... xxvi, 60
„ fiu'ther note on (John Williams) . . . xxvii, 300
UMBILICAL CORD in a state of cystic degeneration (C. Godson) xxiii, 180
„ double battledore placenta with a single, connected with one
child (J. H. Davis) . . . . • ii, 273
„ two placentae in which the blood-vessels ran along the mem-
branes for some distance from the edge of the placenta, and
then united to form the (W. H. Maberly).
„ knotted (J. Brunton) ....
„ peculiar knotted (G. C. P. MmTay)
„ knot ill, foetus with placenta attached showing (C. Godson)
„ placenta, foetus, and membranes (R. Wise)
xix.
65
xi.
54
xi.
54
. xxv.
66
xxxviii.
166
UMBILICAL VEIN — FTIlRrXE BRUIT. 221
UMBILICAL VEIN, phlebitis of, producing pysemia and death, two
cases of (G. Roper) ..... xix, 8
UMBILICUS, note on a condition observed in the navel cord of a
young infant (John Williams) .... xxvi, 199
UREMIA, uterus, rectum, and left kidney from a woman who died
from (W. Dimcan) ..... xxxi, 255
URETERS, dilated in stillborn infants (C. N. Longi-idge) . xlix, 215
„ fatal dilatation of, in case of prolapsus uteri (J. J. Pliillips) . xii, 276
„ pelvis of kidney, etc., in an infant, distension of (H. Gervis) . vi, 221
„ and bladder, dilatation of, from pressure, in an infant (W.
McAdam Eccles) ..... xxxiv, 250
„ and kidney, with uterus, from a case of Csesarean section (W.
Dimcan) ...... xxxiv, 127
„ and kidneys, congenital absence of (A. E. Giles) . . xxxiv, 129
URETHRA, female, abscess of (F. C. Cory) . . . xi, 65
„ chronic abscess of the female (G. E. Herman) . . xxviii, 181
„ calculi embedded in the female (J. Matthews Duncan) . xxiii, 109
„ in a child, myxo-sarcoma of (A. L. Galabin) . xxxviii, 120
„ diverticula of (A. Routh) .... xxxii, 69
„ absence of, in a foetus with ascites (T. G. Stevens) . .xxxvii, 5
„ lupous stricture and atresia of (G. E. Herman) . . xxviii, 267
„ multilobtdar papilloma of (C. Lockyer) . . . xlvii, 122
„ stricture of, in women (G. E. Herman) . . . xxix, 27
„ and bladder, female, two cases of repair of (Lawson Tait) . xx, 88
URINE, blue ; cyanuria (John Phillips) . . . xxxi, 256
„ complete incontinence of, cured by ventro-fixation of the
uterus (H. Macnaughton- Jones) . . . . xl, 226
„ retention of, caused by pressure of a dermoid ovarian cyst
(W. S. A. Griffith) ..... xxxi, 135
„ the occurrence of sugar in the, during the puerperal state
(F. J. McCann and W. A. Turner) . . . xxxiv, 473
„ suppression of, after labour (R. G. McKerron) . . xliv, 97
„ and temperature in puerperal eclampsia (G. E. Herman)
xxxii, 17 ; xxxiii, 315
UTERINE APPENDAGES, removal of, for chronic inflammatory
disease (Lawson Tait) . . . , . . xxix, 184
„ — for hydro- and pyosalpinx (Lawson Tait) . . xxiv, 157
„ — in cases of functional neurosis (W. S. Playfair) . . xxxiii, 7
„ right, and uterus unicornis removed from an epileptic subject
(G. F. Blacker) ..... xlviii, 82
„ fibroid tumour which had developed subsequently to removal
of both (E. W. Hey Groves) .... xlv, 136
„ showing cystic growi;hs and tubal dilatation (T. C. Hayes) xxxiii, 4, 107
„ showing a haematosalpinx (Amand Routh) . . . xl, 306
„ the subject of tubercular deposits (W. Duncan) . . xxxii, 306
„ malignant growth involving the right (C. J. CuUingworth) . xl, 6
„ matted (W. C. Grigg) ..... xxxiii, 75
„ and uterus from a single woman (W. Duncan) . . xxx, 408
„ of the left side showing evidences of the rupture of the sac of
an ovarian pregnancy (H. Gilford) . . . xliii, 24
„ see Fallopian tubes, Hsematosalpinx, Hydrosalpinx, Pyosalpinx.
UTERINE APPLICATOR, Beck's (R. Barnes) . . . xix, 136
UTERINE BRUIT, observations on the (F. H. Champneys) . xxviii, 188
222 irTERTNE CANAL — UTERUS.
UTERINE CANAL, apparatus for dilating by continuous elastic
pressure (Lawson Tait) .... xxi, 291
UTERUS, congenital abnormality of, simulating retention of
menses (J. Braxton Hicks) .... xxii, 260
„ case of missed abortion, in which an early embryo in its
amniotic sac was retained for eight months in the (W.
Duncan) ..... xxxvii, 196
„ abscess in (W. F. Victor Bonney). . . . xlvi, 2
„ — of, developing during the puerperium ; rupture into the
peritoneal cavity ; abdominal section ; recovery (A. W. W.
Lea) ...... xlvi, 7
„ absence of, and occlusion of the vagina (F. Bousquet) . xxvii, 123
„ case of apparent absence of (Gr. Mowat) . . . xx, 289
„ adeno-carcinoma of, and left ovary removed by abdominal
section (W. Duncan) ..... xxxix, 289
„ affected with adeno-carcinoma of tlie body in an early stage,
with microscopical sections (E. W. Hey Groves"^ . . xlv, 138
„ adenoma of (T. W. Eden) . . ' . . xlii, 2
„ adenoma malignum of the body of (C. H. Roberts) . . xlv, 86
„ adono-myoma of (F. E. Taylor) .... xlvi, 188
„ — two cases of diffuse (W. W. H. Tate) . . . xlvi, 141
„ — (C. Lockyer) ..... xlviii, 84
„ affections of, especially those accompanied with leucorrhceal
discharge in their relations to phthisis pulmonalis (R. F.
Battye) . . . . . . viii, 237
„ amputation of forearm in (W. G. Hewitt) . . . xiii, 94
„ traumatic aneurysm of the artery of (W. G. Hewitt) . ix, 246
„ atrophy of, with large fibroid (F. H. Champneys) . . xxii, 185
,, avulsion of, post-partum (J. H. Walters) . . xxiv, 136 ; xxvi, 233
„ of a bitch, early gestation in both horns of (A. Routh) . xli, 5
„ of a bonnet monkey, sections from (A. W. Addinsell) . xli, 141
„ after Oaesarean section (R. Greenhalgh) . . . ix, 241
„ — segment of (W. S. A. Griffith). . . . xxix, 298
„ cancer of, successfully treated by bromine (A. W. Williams) . xii, 249
„ — curious case of (C. H. Roberts) . . . xlviii, 311
„ — the body of the, histology of (A. L. Galabin) . . xxiii, 161
„ (A. H. N. Lewers) .... xxxiv, 213
„ (M. Handfield-Jones) . . . . xl, 34
„ simulating fibroid in a woman aged 36 (H. R. Spencer) . xlvi, 235
„ — the body, illustrating the difficult}' of diagnosis betrvveen
this disease and senile endometritis (G. E. Herman) . xxxiii, 31
„ cancerous disease of, in a patient in whom abortion was in-
duced (F. W. Mackenzie) . . . . i, 11
„ extirpation of, for cancer (W. Duncan) . . xxxiii, 157
„ independent cancer of the body and of the cervix (Amand
Routh) ..... xxxviii, 100
„ cancerous (Amand Routh) .... xxxiv, 87
„ — (J. D. Malcolm) ..... xlvii, 10
„ — and gTavid, removed per vaginam (W. S. Playfair) . xxxvii, 198
„ cancerous, and parovarian cyst removed per vaginam (A. Routh) xxxvii, 8
„ — removed by vaginal hysterectomy (P. Horrocks) . . xxxiv, 85
„ (H. T. Rutherfoord) .... xxxiii, 28
„ — with pyometra (A. H. N. Lewers) . . xxxviii, 14
„ appendages of, ligature and division of the upper part of both
broad ligaments, and the result as compared with that follow-
ing removal of (L. Remfry) .... xxxvi, 202
„ and appendages with ruptured pregnant tube (A. W. AddinseU) xli, 172
d
UTERTTS.
223
UTERUS (continued) —
„ cancer and fibro-myoma co-existing in the body of (M. Hand-
field-Jones) ......
„ viteri, two, removed by abdominal pan-hysterectomy for
cancer of the body (A. H. N. Lewers)
„ see also Cancer.
„ carcinoma of (W. S. Playfair) ....
„ — the body of (W. S. Playfair) ....
„ (J. H. Targett) .....
„ with secondary growth in both ovaries (H. T. Hicks) xlviii, 196
„ body of, carcinoma of, invading a myoma ; hysterectomy (J.
M. Munro Kei-r) .....
„ primary carcinoma of the body of (A. H. N. Lewers).
„ removed by abdominal pan-hysterectomy for primary car-
cinoma of the body (A. H. N. Lewers)
„ carcinoma of the cavity of (P. Smith)
„ — report on P. Smith's case ....
„ — in the muscular wall of, secondary to cancer of both
ovaries (C. Lockyer) .....
„ carcinoma, body and multiple fibromata of, removed by abdo-
minal pan-hysterectomy (J. H. Dauber) .
„ with carcinoma of the body and multiple fibroids (A. H. N.
Lewers) ......
„ keratmising carcinoma of the body (A. H. N. Lewers)
„ carcinomatous, removed eighteen and a half years subsequent
to double ovariotomy (A. C. Butler- Smythe)
„ carcino-sarcoma of (H. R. Spencer)
„ carcinoma of, see also Carcinoma.
„ cast of (T. W. Eden) .....
„ decidual cast of, from a case in which there was no evidence
of extra-vxterine gestation ; with microscopic sections (T. W.
Eden) ...... xxxix, 132
„ — expelled after eight weeks' amenorrhoea, together with an
ovum of about five days' growth (W. E. Fothergill) . xliii, 162
„ cast from, having all the characters of the decidual membrane
found in connection with ectopic gestation, together with a
small ovarian cyst from the same case, with microscopic
sections of each (W. E. Dakin) . . . xxxviii
xlvi, 305
xliv, 10
xxxix, 288
xii, 116
xlii, 281
xlvii, 191
xxxvi, 374
xliv, 290
xii, 299
xiv, 324
xlvi, 302
xxxix, 321
xlvi, 266
xlv, 97
xliii,
xlvii,
xlii.
214
338
of a cat, pregnant horn from (R. Wise) . , .
the anatomical changes in, at the onset of labour and after
delivery, sections of, demonstrating (A. H. F. Barbour)
on some changes in the, resulting from gestation (John
Williams) .....
chorion -epithelioma of; lutein cysts in both ovaries (G. F
Blacker) .....
chorion-epithelioma malignum, primary tumour in (J. H
Teacher) .....
chorion-epithelioma of, with secondary growths in the vagina
the lungs, and the liver (G. F. Blacker) .
removed by vaginal hysterectomy, showing nodule of chorio
epithelioma (F. W. N. Haultain)
the circtilation in the, with some of its anatomical and pathO'
logical bearings (John Williams)
condition of, in obstructed labour (J. B. Hicks)
— at various periods after labour, description of a series of
casts showing (A. Farre)
congestion of, relation between flexion and (John Williams)
385
xxxix, 260
xxviii, 73
XX, 172
xlix, 104
xlv, 252
xlvi, 55
xlv, 242
xxvii, 112
ix, 207
xviii, 84
xvi, 202
224
FTERUS.
91
xiii, 216
xiv, 231
xxix, 369
xlviii, 204
xlvi, 269
xlv, 80
vii, 207
xlv, 249
xxi, 253
XIV,
XV,
xxui,
XXV,
67
252
205
116
109
3
63
UTERUS (continued) —
„ contraction, inhibition, and expansion of (J. Matthews Diuican) xxviii,
„ contractions of, throughout pregnancy ; their physiological
effects and value in the diagnosis of pregnancy (J. B. Hicks)
„ irregular contraction of (E. H. Trenholme)
„ contraction, tonic, without completeness of retraction (J.
Matthews Duncan) . . . .
„ — without retraction, accompanied by prolonged high tem-
perature of nervous origin (G. E. Herman)
„ cysts of, see also Cysts.
„ cystic tumour of (C. E. Purslow) ....
„ removed by vaginal hysterectomy fourteen days after the
operation of ciu-etting and steaming had been performed
(G. F. Blacker) ....
„ after death from a simple tapping (E. Barnes)
„ deciduoma malignum of (J. E. Morison)
„ deficient development of, atresia of the os externum, atrophy
of the ovaries, insanity (A. Doran)
„ after delivery at five months (H. Smith) .
„ diseases of, use of intra-uterine stems in (C. H. F. Routh)
„ — medicated pessaries in the treatment of (T. H. Tanner)
„ — use of nitrate of silver in (E. EUis)
„ DISPLACEMENT, anteflexion of (T. C. Hayes) . xxii, 82
„ — — notes of a specimen of (W. S. A. Griffith)
„ and version of, pessary for (W. G. Hewitt)
,, clinical remarks on a certain class of cases of (G
Eoper) ..... XX, 304, 324
„ the relation of, to dysmenorrhoea (G. E. Herman) . xxiii, 209
„ treatment without intra-uterifle stem (J. H. Galton) . xvi, 171
„ pessary for (W. S. Playfair) . . . xv, 124
„ shield for supporting a vulcanite stem pessary (A. W
Williams) . . . . . . xv, 246
„ with hypertrophy and presence of an ovarian cyst
(Graily Hewitt and A. Q. Silcock) . . . xxv, 131
„ — anteflexion of, gravid (W. G. Hewitt) . . . vii, 170
„ — anteversion of, new form of pessary for (A. L. Galabin) . xviii, 176
„ — by the distension of the bladder (J. B. Hicks and J. F
Goodhart) ...... xviii, 194
„ — or distortion of, report on sixty-seven cases treated at All
Saints' Institution for Ladies (Graily Hewitt) . xxii, 173, 188
„ — on the relation between backward and painful menstrua-
tion (G. E. Herman) ..... xxiv, 161
„ — backward, menstruation in cases of (G. E. Herman) . xxxiv, 225
„ relation between, sterility and abortion (G. E. Herman) xxxiii, 499
„ and prolonged haemorrhage after delivery and abor-
tion (G. E. Herman) ..... xxxiv, 14
„ on the frequency of the local symptoms associated with
(G. E. Herman) ....
„ — flexions of (A. Meadows) ...
„ novel way of using the uterine sound in (A. Easch)
„ acqmred, their causation and pathology (C. E
Squarey) ...... xiv, 344
„ relation between congestion and (John Williams) . xvi, 202
„ instrument to measure the amount of (Fancourt Barnes) xxiii, 177
„ new pessary and intra-uterine stem for the relief of
(W. E. Jordan) ..... xvi, 125
„ — pessaries for (W. G. Hewitt) . . . . x, 223
XXXV,
XIU,
8
204
247
OTERrS.
225
UTEEUS (continued) —
„ DisPLACEMBNT {continued) —
„ — use of mre loops, horseshoe wires, etc., for correcting (C.Clay) v, 177
„ — prolapse, cases of (A. Cordes) .... xvii, 63
„ the changes in the pelvic floor which accompany the
slighter degrees of (G. E. Herman) . . . xxxi, 276
„ pessary for (R. Barnes) .... xix, 119
„ (A. L. Galabin) . . . . xx, 169
„ midtiple vesical calculi, the sequel of (A. L. Galabin) . xxii, 106
„ vesical calculi from a case of (A. Lawrence) . . xxx, 227
„ — retro-displaced gravid, thi-ee cases of incarceration of (J.
M. Muni-o Kerr) ..... xlii, 146
„ — retroflexion of (F. H. Champneys) . . . xxii, 156
„ as a frequent cause of abortion (J. J. Phillips) . xiv, 45
„ the gi'avid, during laboiu- at term (H. Oldliam) . i, 317
„ diagnosis and treatment of (W. J. Sinclair) . xlii, 338
„ from a woman who died from the bursting of an
aneiu-ysm of a branch of the pulmonary artery (F. H.
Champneys) .... • ?.^' ^^^
„ caused by an interstitial fibroid (C. Godson) . . xxiii, 63
„ the unimpregnated, a new mode of treating certain
cases of (J. Braithwaite) .... xix, 122
„ — — and ectopia viscerum (John Phillips) . . xxxiii, 490
„ of, in a new-born child (H. R. Spencer) . . xxxiv, 25
„ — retroversion (J. H. Davis) .... viii, 11
„ three cases of (R. Hardey) . . . . v, 267
„ elastic spring pessary for (R. Greenhalgh) . . x, 93
„ and prolapse of, pessary for(C. Godson) . . xxvi, 272
„ or retroflexion of the gravid (W. T. Smith) . . ii, 286
„ of the gravid (T. Chambers) . . . xvi, 181
„ (Max F. Simon) ..... xvi, 254
„ of the gravid, caused by gangrene of the bladder (A.
Easch) ...... xxxi, 129
„ (H. Gervis) . . . .xvi, 232, 255
„ tubal gestation simulating (A. E. Giles and E. J.
Maclean) ...... xxxix, 232
„ caused by a wandering spleen simulating an ovarian
tumour (F. E. Taylor) ..... xlvii, 70
„ — displacement of unimpregnated, as a cause of displacement
of the gravid organ (J. H. Aveling) . . . iii, 288
„ iNVEESioN of (J. W. S. Coward) .... xii, 344
„ — (H. M. Madge) ..... xii, 347
„ — (T. Chambers) ..... xvi, 180
„ — simulated by fibroid tumoui* (R. Barnes) . . iii, 211
„ — two cases of (W. Hickman) .... xix, 49
„ — after delivery, two cases, with remarks (W. T. Smith) . x, 30
„ — after childbirth in a primipai*a, amputation by ecraseur on
account of haemorrhage (J. H. Davis) . . . xiv,
„ — chronic, reduction by sustained pressure (L. Tait) . xi,
„ which had existed for more than five years, A\dthout
serious symptoms (W. B. Woodman) . . . ix, 52
„ successfully treated by sustained elastic pressure (W. E.
Rogers) ...... xxiii,
„ — complete, occurring immediately after labour (F. H. Gervis) xvii,
„ — by a gangrenous fibroid (G. E. Herman) . . xxx,
„ — irreducible, with a fibro-myoma removed bv amputation
(P. Horrocks) . . . ' . xxx, 196, 228
15
104
174
19
278
226
226
UTERUS.
UTERUS {continued) —
„ INVERSION {continued) —
„ — reduction (J. Braxton Hicks) .
„ — sixteen months' standing, replacement (W. Newman)
„ — repositor for (J. H. Aveling) .
„ — removal for (J. A. M. Moullin)
„ — spontaneous reduction (H. G. Shaw)
„ (F. Ellington)
„ — (C. Godson)
„ — (Heywood Smith)
„ — (G. E. Herman)
„ — the puerperal, in the absence of the ovaries (John Williams)
„ — spontaneous reposition of inverted (K. Boxall)
„ — complete, of seven months' dvu-ation ; failure of elastic
pressure with repositors ; operation of anterior vaginal coeli-
otomy, anterior hysterotomy, and replacement ; recovery
(J.W.Taylor) . . . . .
„ — acute of ; spontaneous reposition (R. Boxall)
„ — complete prolapse of (H. R. Andrews) .
„ — complete, sarcoma of the body of (W. C. Swayne)
„ — unusiuil (S. Boyd) . . . .
„ distension of, in a foitus impeding labour (H. Gervis)
„ — by retained menstrual fluid, in a case of absence of vagina
(C. H. Carter) . . . . .
„ dissection of, pregnant three and a half months, with placenta
prjevia and fibroids extensively developed in the walls of (J.
Braxton Hicks) . . . . .
„ in puerperal eclampsia, the behaviour of (J. Braxton
Hicks) . . . .
„ from a patient aged 45, married, subject to eczema for three
years (R. Barnes) . . . . .
„ elasticity, retraction, and polarity of (J. Matthews Duncan) .
„ chronic axial rotation of an ovarian cyst giving rise to extreme
tAvisting of the elongated (T. Wilson)
„ endothelioma of (M. A. D. Scharlieb)
„ removed for (?) malignant overgrowth of the endometrium
(V. Bonney) ......
„ primary squamous - celled epithelioma of the body of (A.
Doran) ......
„ enlargements of, which f oUow abortions, premature, or natural
confinements (S. Beck) . . . .
„ epithelioma of, see also Epithelioma.
„ spontaneous evolution of the fcetus in, the head changed for
the feet (R. Hodges) . . . . .
„ cauliflower excrescence of (E. F. Fussell) .
„ — of posterior lip of (A. Meadows)
„ in a case of extra-uterine pregnancy, communication between
the cyst and the (A. L. Gralabin)
„ — of puerperal fever (S. Beck)
„ — — (R. Barnes)
„ fibro-cystic disease of (C. H. F. Routh)
„ (J. B. Hicks)
„ extirpation; recovery (T. Bryant)
„ (T. Chambers) .
„ (Heywood Smith)
„ — =— mistaj^'pu for ovarian disease (C. H. F. Routh)
„ — tumour of (A. H. N. Lowers) .
xxxi, 340
xxxi, 166
XX, 126
xxvi, 158
X, 35
xix, 50
xix, 51
xix, 57
xxvii, 83
xxvi, 203
xlvi, 292
xliv, 299
xlvi, 292
xlviii, 284
xliv, 366
xlv, 170
V, 284
xxii, 251
xvii, 298
XXV, 118
xvii, 216
xxviii, 115
xxxix, 167
xlvii, 281
xlvii, 191
xlv, 374
viii, 54
ii, 303
vi, 102
viii, 258
xvii, 170, 384
vi, 186
ix, 241
vii, 253
xiv, 66
. xiv, 79
XX, 32, 54; xxii, 159, 187
. xxvi, 58
viii, 122
xlvii, 261
UTERUS.
227
UTERUS (continued) —
„ fibro-cystic tumour of, intra-ligamentous, weighing about
30 lb., removed by enucleation and subtotal hysterectomy
(T. W. Eden and F. L. Provis) ....
„ fibro-cysts of, see Fibro-cysts.
„ cystic fibroid of (W. C. Swayne) .
„ fibroid of, undergoing cystic degeneration (P. Hori'ocks)
„ — showing the three forms of the disease, subperitoneal, inter
stitial, and submucous (G. C. P. Murray) .
,, — degeneration of, with subperitoneal and interstitial fibrous
tumours (A. W. Edis) ....
„ — outgro^vth from the fundus of (T. Spencer Wells)
„ — tumoui- springing from posterior lip of (R. Barnes)
„ situated in the anterior wall of (R. Barnes) .
„ — — numerous (W. B. Woodman)
„ expelled spontaneously (J. B. Hicks)
„ (T. Chambers) ....
„ absorption of (W. S. Playfair)
„ complicating spontaneous ruptui-e of ovarian cyst (P,
Smith) .....
„ (C. M. Cai-ter) ....
„ complicating pregnancy (H. M. Madge)
„ — pregnancy in the right cornu of (F. N. Boyd)
„ — submucous (D. L. Roberts)
„ — tumour -with great distension of the Fallopian tubes
from tubercle (P. Horroeks)
„ — associated with anomalous ovarian tumour (H. MaC'
naughton-Jones) ....
„ — undergoing mucoid change, successfully removed by abdo-
minal hysterectomy with intra-peritoneal treatment of the
stump (A. H. N. Lowers) ....
„ removed at eight and a half months of gestation by
abdominal hysterectomy for fibroid obstructing labour (A.
Routh) ...... xliv, 41
„ fibroid tumour and cancer of (Amand Routh) . xxxviii, 99
„ in the same (M. Handfield-Jones) . . xlvii, 337
„ (A. L. Galabin) .... xlv, 102
„ — — and carcinoma of the cervix removed ^post-mortem from
a patient on whom eight years previously the .operation of
oophorectomy had been performed (G. F. Blacker) xxxvii, 213
„ — calcified, with acute axial rotation (J. Bland-Sutton) . xlvi, 149
„ — with cystic degeneration of the surrounding tissues
(M. Handfield-Jones) ..... xlvi, 307
„ — complicated by cancer of the coi-poreal endometrium (J.
Bland-Sutton) ..... xlviii, 140
„ — degenerated, threatening to rupture, removed by total
abdominal hysterectomy (H. R. Spencer) . . . xlv, 378
„ — tumovu- removed by pan-hysterectomy (W. C. Swayne) . xlv, 140
„ which developed after both ovaries and tubes had been
removed for independent disease (E. W. Hey Groves) . xlv, 136
„ wholly cervical, forming an abdominal tumoiu-, and
characterised by profuse haemorrhage (J. S. Fairbairn) . xlv, 178
„ intestinal obstruction following operations for (W. W.
H. Tate) ...... xlvi, 391
„ with intestinal fibroid removed from a patient aged 26 (A. F.
Stabb) ...... xxxix, 89
., — from a case of placenta praevia centralis (R. Boxall) . xl, 338
xlviii, 264
xliv, 369
xl, 227
xvi, 218
xi, 34
xi. 73
iii, 211
V, 171
vii, 26
vii, 118
xi, 31
X, 102
xiii, 39
xiii, 167
xiv, 227
xlix, 49
xiii, 309
xiii, 166
xl, 154
xiii, 94
228
UTERUS.
UTERUS (rontinued) —
„ large fibroid tumour of, iindergoing necrobiosis or red
degeneration (A. H. N. Lewers) .... xlviii, 137
„ ocdematous fibroid tumour of, associated with pregnancy (A.
L. Galabin) ...... xxxvii, 286
„ with fibroids, pregnancy in ; pan-hysterectomy during labour
in the seventh month (J. Bland-Sutton) . . . xlvi, 238
„ — — removed at the fifth month (A. Doran) . . xliii, 178
„ removed by operation (A. Doran) . . xlvi, 119
„ — with sarcomatous degeneration (P. Horrocks) . . xl, 178
„ — large solitary subperitoneal tumour of, with multiple
fibroids (A. H. N. Lowers) . . . . xl, 327
„ suppurating (S. Boyd) .... xliii, 172
„ (G. F. Blacker) .... xlix, 100
„ — with a sarcomatous nodule in the centi'S (Amand Routh) . xlix, 1
„ — see Tumours (fibroid).
„ fibroma and other morbid conditions of, treated by Apostoli's
method (J. Inglis Parsons) .... xxxiv, 22
„ — small, showing sarcomatous changes(J. M. Munro Kerr) . xliv, 129
„ — see Fibroma, Ihimours (fibroma).
„ — causing intestinal obstruction and death two years after
the menopause (C. J. Cullingworth) . . . xxxix, 282
„ — of the intra-abdominal portion of the round ligament of
(H. R. Spencer) ..... xlvi, 26
„ — relations of organic affections of the heart to (T. Wilson) . xlii, 176
„ — in a patient aged 23, with remarks on enucleation and
myomectomy (A. E. Giles) . . . . xlii, 299
„ — incarcerated, in an unusually young subject (C. J. Culling-
worth) . .....
„ — multiple (C. J. Cullingworth) . . . xxxviii
„ — pedunculated subserous, which had undergone myxomatous
and cystic degeneration (A. F. Stabb)
„ — undergoing sarcomatous degeneration (P. Horrocks)
„ — undergoing sarcomatous change (W. S. A. Griffith and
H. Williamson) .....
„ — with a calcified fibroid lying free in its cavity (J. H.
Dauber) ......
„ — sloughing of the central part of a, shortly after delivery
(J. D. Malcolm) ..... xlvi,
„ occuri-ing in a patient twenty years after the meno-
pause (W. W. H. Tate) . . . . xl, 303
„ — two cases of, removed by operation (H. K. Spencer) . xl, 228
„ — with extensive carcinoma of body of, and fibroma of ovary
(W. W. H. Tate) ..... xlvi, 139
„ — degenerating, and sarcoma of (W. W. H. Tate) . . xlvii, 358
„ further history of a case of (R. Hamilton Bell) . xlviii, 199
„ — large, removed by operation (W. W. H. Tate) . . xlviii, 183
„ — projecting into vagina, removed by abdominal hyster-
ectomy (W. W. H. Tate) . . . . xl, 159
„ — associated with large cavity containing retained menses
communicating with uterine canal (W. W. H. Tate) . xlvii, 360
„ — complicated with double salpingitis and carcinoma of
cervix (W. W. H. Tate) . . - . xliii, 270
„ — showing marked cystic degeneration, removed from a
patient aged 63, from whom both ovaries had been removed
eleven years before (W. W. H. Tate) . . . xliii, 26
,, — cystic, removed by posterior colpotomy (H. R. Spencer) . xliii, 110
xlii.
xlii,
xlvi.
132
6
133
184
xlviii, 22
139
15
xlix.
UTEROS.
229
UTEEUS (continued)—
„ fibro-myoma, cystic, complicating pregnancy ; removal at four
and a half months (J. Dysart McCaw) . . . xl, 256
„ — complicating early ectopic gestation (? tubo-uterine) (C. J.
Cullingworth) . . . . . xl, 28.j
„ mptxire of an early (fifteenth day) tubal gestation (E.
Rumley Dawson) . . . . . xl, 155
„ — (Edematous subperitoneal, in right broad ligament, removed
by abdominal hysterectomy (C. J. Cullingworth) . . xl, 302
„ gangrene of an interstitial fibro-myoma of (C. J. Cullingworth) xxxix, 281
„ early ectopic gestation (? tubo-uterine) complicated by fibro-
myomata of (C. J. Cullingworth) . . . xxxix, 284
„ fibro-myoma, see Fihro-myoma, T^iviours (fibro-myoma).
„ large fibrotic,with calcification of the arteries (J. S. Faii-bairn) xlvii, 299
„ four years after Caesarean section (J. Bland-Siitton) . . xlix, 174
„ ventral fixation of, and its alternatives (G. E. Herman) . xlvii, 429
„ notes on the variation in height of the fundus of, above the
symphysis during the puerperium, the conditions which
influence this, and the practical conclusions which may be
drawn from such observations (T. G. Stevens and W. S. A.
Griffith) ..... xxxvii, 216
„ fibrous enlargement of, successfully treated by ergot of rye
(J. Brunton) .
„ — polypus of (W. G. He\vitt)
„ — tumour of (H. G. Times)
„ (H. M. Madge) .
„ enormous, connected with (W. G. Hewitt)
„ (T. H. Tanner) .
„ treated by sui-gical means (I. B. Brown)
„ complicating labour (W. O. Priestley)
„ spontaneous sloughing; death from peritonitis (J. B
Hicks) ...... vii, 110
,, attended by early pregnancy ; retroversion of the uterus
and retention of urine ; death and decay of the foetus and
subsequently death of the mother from pyaemia (J. H. Davis) viii, 11
„ idiopathic gangrene of (Lawson Tait) . . . xxv, 248
„ fungoid granulations of, eiu-ette for removal of (J. M. Sims) . vii, 72
„ gravid, at fioll term ( — Fitzpatrick) . . . xxi, 37
„ — peritoneal adhesions as a cause of post-partum Jiasmorrhage
(W. G. Hewitt) . . . . . xi, 108
„ — excessive vomiting in early pregnancy, depending on the
irritation of (W. T. Smith) . . . . i, 335
„ — forming exomphalos (G. C. P. Murray) . . . i, 77
„ from a case of severe uterine haemorrhage and injection of
perchloride of iron (E. Cory) .... xxi, 51
„ apparatus for injecting the, in cases of post-partum haemor-
rhage (J. B. Potter) ..... xxi, 29
„ on plugging the, in severe cases of post-partum haemorrhage
(A. H. N. Lewers) ..... xxxii, 356
„ of a woman who died from post-partum haemorrhage (G. E.
Herman) ...... xx, 2
„ hydatids expelled from (W. G. Hewitt) . . . xii, 135
„ — (W. G. Hewitt) . . . . .xii, 237
„ congestive hypertrophy of, with anteflexion and presence of
an ovarian cyst (Graily Hewitt and A. Q. Silcock) . . xxv, 131
„ inflammation of, treatment of sickness in (E. J. Tilt) . iii, 15
„ injection of, after labour, apparatus for facilitating (R. Barnes) xix, 118
xiii.
282
V,
123
33
viii.
105
240
iii.
11
; vi.
21
271
230
UTEBUS.
XX, 58
XX, 63
ix, 1
xii, 244
iv, 107
X, 199
X. 231
XXX, 85
xxxiv,
viii,
xxiii.
127
150
4
UTERUS {continued)—
„ injection of, after labour or abortion, tube for (T. C. Hayes) .
„ tubes of vulcanite for the injection of perchloride of iron or
iodine into the (F. Barnes) ....
„ injury to, in the sixth month of pregnancy (T. Fairbank)
,, instrument for local applications to (F. E. Junker) .
„ internal surface of, after delivery (J. Matthews Duncan)
„ irritable (E. J. Tilt) .....
„ — discussion on .... .
„ involution of, the effect of ergot on (G. E. Herman and C. O.
Fowler) ......
„ with kidneys and ureters, from a case of Csesarean section (W.
Duncan) ......
„ laceration of (T. Radford) ....
„ lymphatics of, the comparative anatomy of (G. Hoggan)
,, MALFORMATIONS of, uterus Mcomis (H. J. Paterson)
„ — bicornis unicollis, case of gestation in one horn of (H. C.
Pope) ..... xxviii, 70,
„ (W. F. V. Bonney) .... xliii,
„ bicornis, complete, with pregnancy of tlie right horn ;
turning and extraction on account of pelvic contraction
(E. H. M. Sell) .....
„ — unicollis, pregnant (J. R. Ratcliffe)
„ and double vagina (G. E. Herman)
,, — bilocular (C. H. F. Routh) . .-. . •
„ — didelphys, with observations on the clinical importance of
this malformation (A. Giles)
., case of (M. Handfiold- Jones)
„ with double hsematometra and complete absence
the vagina (A. H. N. Lewers)
„ with cystic intra-ligamentous myoma (W. J. Gow)
,, with simultaneous gestation (H. Grace)
„ — — delivery in a case of (Matthews Duncan)
„ — — decidua or fleshy substance discharged from the unim
pregnated side of (W. F. Cleveland)
xxiii, 132, 181 ; xxiv, 297;
„ retention of menstrual fluid in one half of
Galabin) ......
„ — — and double vagina, case of (H. Gervis)
„ case of pregnancy with (J. Braxton Hicks)
„ — unicorned (G. E. Herman) ....
,, _ imilateral, and solitary kidney with two ureters (J. Braxton
Hicks) . . . _. . .
„ unicornis and right appendages removed from an epileptic
subject (G. F. Blacker) ....
„ — fibroid in undeveloped comu of (A. Doran)
„ one-horned, malignant disease of cervix in (L. B. Aldrich-Blake)
„ malignant disease of, complicated with pregnancy (W. S.
Playfair) . . . . . _ .
^^ — with numerous deposits in the lungs, and death following
an abortion (J. D. Malcolm) . . . xxxviii, 125
„ — the body (H. Smith) . . . . . xx, 4
„ diffuse (S. W. Wheaton for W. Duncan) . . xxxiii, 113
„ — unusual (M. A. D. Scharlieb) .... xlviii, 73
,, — see Malignant disease.
„ chrofiic infective metritis (A. W. Addinsell) . . xlviii, 144
„ fragment of membrane passed from (A. Doran) . xxxi, 229, SIO
xlvii, 248
XV, 180
xxxiv, 469
XX, 123
xii, 295
xxxvii, 301
xxix, 146
of
xxxviii, 327
xl, 134
IV, 138
. xxiii, 21
xxvi, 117, 184, 331
(A. L.
XXIV,
xix,
xxiii,
XX.
21
271
23
60
xxi, 57
xlviii, 82
xii, 295
xlix, 269
x, 58
CTERUS.
231
UTEBUS (^continued) — ^ , , • x •• An
„ mucous membrane of, in endometritis (A. L. Galabm) . xxu, 47
" — in an infant suffering from uterine haemorrhage (S. W.
" Wheaton) . • • ,•,,.• ^ , ,i ''^^^^' ^^^
membrane expelled from, a few days before dehvery at fuU
term (A. Harris) . • • • ' '!^-' otn
„ dui-ing menstruation (W. G. Hewitt) . . - viu, 220
„ from a subject who died the day menstruation commenced,
microscopical sections of (E. Cory) . ' ,Txr o a ' ^^' ^^^
iust before menstruation, with microscopic sections ( W. b. A.
"Griffith) . . • •..-,,,• ^^^'^^^
of a woman, aged 55, who had had two miscarriages at the
" age of 39 (F. Wallace) . . • • ^ xvii, 177, 2^6
carneous mole retained in, five months after death of embryo,
showing proliferations of epithelium of villi as a syncytium
forming reticulating processes (A. L. Galabin) . . xlv, 240
hydatid°mole expelled from, immediately after a living foetus
" and its placenta, at about six months' gestation (J. H. Davis) iii, 177
myoma of, its pathology and treatment (Lawson Tait) . xxv, 194
" _ abdominal hysterectomy for ; with brief notes of twenty-
" eight cases (J. Bland-Sutton) . . . . xxxix, 292
— cystic, weighing over 15 lb. (A. Doran) . . xxxvm, 164
" - diffuse (non-capsulated) (C. J. Cullingworth) . xxxvii, 143
" — large interstitial gangrenous (C. J. Cullingworth) . xxxvi, 268
" — submucous and interstitial, removed by hysterectomy
" (W.Duncan). . • • • ^. • xxxix, 290
— smaU, necrotic change in, occurring in a young subject
" (C. J. CulUngworth) .... ^^^}?' J^J
_ cedematous (W. Duncan) . . • ''^''Y'' 1«?
— undergoing red degeneration (W. F. V. Bonney) . xlv, 464
" — three removed yervaginaw by Doyen's method (W. J. Smyly) xli, yb
" — three cases of, with bleeding after the menopause (H. R.
" Spencer) . • • , ; " ^ ^^^"'' ^^^
— weio-hing 26 lb., successfully removed from a woman aged
" 74 (J.°Bland-Sutton) . • • ",00 ^1^' ^00
— weighing over 7 1b., removed from a woman, aged 22
(H. E. Spencer) . • • ^ • ■ ^1\^' Jl^
, — rotation and impaction of (J. Bland-Sutton) . • xli, /yb
— see also Myoma, Tumours.
" mvxoma of fundus uteri following vesicular, mole (?), a
' myxoma of chorionic vilU engrafted upon (A. L. Galabin) xlv, 241
removed bypan-hysterectomyformyxo-sarcoma(AmandEouth) xli, irfy
' supposed myxo-sarcoma of, removed by abdomino-vaginal
" method (Amand Eouth) . ■ , , -^ . xli, db7
necrobiotic, associated with recent pregnancy (A. Doran and
" H. Williamson) . • • . ." , ,/ ^1^^' ^'^
nulliparous, note on the post-mortem diagnosis ot (A.
Meadows) . • • ,, ' , . xvii, 3o5 ; xvm, 69
— and muciparous, specimens and tables of measurement ot
" (J. Braxton Hicks and A. W. Edis) . • xviii, 70. 74
instruments for operations on (Messrs. Weiss and Son) . vii, 157
" three, removed by pan-hysterectomy (A. H. N. Lewers) . xli, 2/5
„ removed by pan-hysterectomy (A. H. N. Lewers) . . xxxix. 131
!', malignant papilloma of (Amand Eouth) • ^ • . • ^^^^^> ^
removed at full term by intra-peritoneal hysterectomy in a
case of contracted pelvis (W. Duncan) . . • xhu, 9
„ perithelioma of (G. F. Darwall-Smith) . • • ^^> ^
232
UTEBUS.
xxxii, 67,
107
. xxxvi.
194
i>
112
i.
247
iii.
346
iii,
ano
xi.
4
iii,
413
X,
94
. xxiv,
at-
299
UTERUS (continued) —
„ showing placenta praevia (C. J. CuUingworth)
„ with placenta pz'isvia marginalis in situ (G. F. Blacker)
„ polypus of (F. Elkington)
„ — (J. H. Davis)
„ — (J. B. Hicks)
,, _ (W. G. Hewitt)
„ — (H. Gervis)
„ polypi of, instrument for the removal of (W. T. Smith)
„ polypoid tumour of (W. E. Rogers)
„ — see Polypus.
,, removed by Porro's operation (C. Godson) .
„ from a case of Porro's operation with intra-peritoneal treat
ment of the stump (W. J. Gow) .
„ portio vaginalis uteri, adenoma of, see Tumours.
„ ectopic pregnancy going nearly to term in the peritoneal
cavity, the placenta being attached to the top of (G. E
Herman) .....
,, pregnancy in a rudimentary horn of (11. R. Andrews)
„ pregnant, showing the behaviour of the, in chorea (J. Bi-axton
Hicks)
„ — and fibroid tumour removed by abdominal hysterectomy
(P. Horrocks)
„ flotation in a rudimentary horn of (A. L. Qalabin)
,. full-term pregnancy in a rudimentary horn of ; missed labour
(five months) ; abdominal section and removal of sac
recovery (J. H. Targett)
„ congenital prolapse of, and imperforate rectum (H. E.
Andrews) .....
„ — associated with spina bifida (H. R. Andrews)
„ puerperal, primary infection by Di2ilococcus pneumonise of
(A. G. R. Foulerton and W. F. Victor Bonney)
„ at different periods of the puerperium, showing complete
absence of the alleged fatty changes, sections of (W. S. A
Griffith) .....
„ puncture of, per rectum, in a case of retained menses (I. B
Brown) .....
„ punctiu-ed by rectum, in ease of retained menses (I. B. Bro^vn)
„ see Pyometra.
„ double pyosalpinx associated with fibro-myoma of (W. S.
Playfair) ......
„ radiograph of foetus in (Heywood Smith) .
„ removed of, see Abdominal section, Extirpation, Hysterectomy,
Porro's operation.
„ retention in, of the greater portion of a dead foetus for four
years (A. Halley) . . . . . ix,
„ retention of ovum within, in a case of abortion (W. G. Hewitt) iii, 4ll
„ RtJPTTJRK of (H. Madge) . . . . x, 97
„ — (G. Roper) . . . . . . xx, 2
„ — (John Williams) ..... xx, 86
„ — (J. Hickinbotham) ..... xx, 96
„ — (F. H. Champneys) . . . . ixvi, 329
„ — (R. Cox) ...... xxviii 225
„ — (J. G Swayne) ..... xxviii, 213
„ — (Robert Harvey) . . . . xxvii, 19], 228
„ — (Lovell Drage) ..... xxvii;, 2
„ — (P~. Horrocks) ..... xxxi, 228
xxxix, 7
xxxi.x, 135
xlix, 209
xxxiii, 486
xlii, 242
xxxvii, 225
xlii. 276
xlii, 169
xliv, 137
xlv, 128
xxxi, 30P
V, 162
iv, 21
XXXlll,
xlviii
4S7
44
90
UTERUS.
233
UTERUS (continued)—
„ EUPTURE {continued) —
„ — after external violence (John Phillips) .
„ — (R. BoxaU). ....
„ — fatal case, occurring at the eighth month of pregnancy (R
Dunn) .....
„ — in about the seventh month of pregnancy, death from peri-
tonitis (J. T. MitcheU). . ' .
„ — (?) death and decomposition of the foetus; blood poisoning
puncture of the membranes; recoveiy of the patient (E
Greenlialgh) .....
„ — occurring during labour (E. J. Asbury).
„ — (G. E. Herman) ....
„ — (G. F. Blacker) ....
„ — treated by abdominal hysterectomy (John Phillips)
„ — during unobstructed labour (udth a microscopic section)
(W. R. Dakin) ....
„ — \vith dermoid ovarian cyst the size of a child's head (A. H
N. Lewers) .....
„ — at term through scar of old Csesarean section ; abdominal
hysterectomy (J. H. Targett)
„ spontaneous rupture of, in placenta prjsvia (J. P. Maxwell)
„ four cases of rupture of, successfully treated by packing the
tear ■per vaginam with iodoform gauze (H. E. Spencer)
„ sarcoma of (W. S. A. Griffith)
„ — (A. W. W. Lea) ....
„ — (A. L. Galabin) ....
„ — with inversion (J. H. Targett)
„ — with a microscopic section (H. R. Andrews)
„ primary sarcoma ("deciduoma malig-num") in a patient, aged
24, treated by vaginal hysterectomy (A. H. N. Lewers)
„ of the body of (A. H. N. Lewers)
„ sarcoma of the body, with complete inversion (W. C. Swayne)
„ removed by vaginal extirpation (W. S. Playfau-)
„ — see also Sarcoma.
„ gangrenous sarcoma of, removed by abdominal hysterectomy
from a patient suffering from glycosuria (W. W. H. Tate)
„ showing malignant villous tumour and a fibroid which has
undergone sarcomatous change (May Tliorne)
„ frozen sections of, at the tenth week of pregnancy, showing
haemorrhages into the placenta, decidua reflexa, and decidua
vera, from a patient who died of heart disease (G. F. Blacker)
„ microscopic sections of mucous membrane of (A. W. W. Lea) .
„ — tissue removed from (A. L. Galabin)
„ microscopic sections, showing chorionic villi and doubtful
sarcoma (L. Remfry) ....
„ from a septic case (C. Chepmell) .
„ from a case of puerperal septicaemia ("W. Duncan)
„ septicsemic, with bacteriological investigation (C. Lockyer)
„ structure of, and the changes the tissues undergo diu'ing preg-
nancy and after parturition ....
„ suppuration of the cavity of, resulting from occlusion of the
cervix (A. L. Galabin) .....
„ suture for closing wound of, in Csesarean section and for uniting
wotmd to the abdominal wall (R. Barnes)
„ tubal pregnancy with fibrous tumours of (G. Harley)
„ tuberciilosis of (R. S. Tomlinson)
xxxii.
375
xxxiv.
11
ix.
65
xi.
204
xi.
9
X,
40
xxxiii.
491
xxxvi,
316
xxxix.
260
xl, 29
xlii, 95
xlii,
xliii,
xlii,
xli,
xliii,
xliii,
xxxix,
xlii,
xxxix,
xl,
xliv,
xxxvii.
242
217
14
232
73
226
285
210
246
225
366
200
xliv,
xlix,
xlii,
xxix,
xxxviii,
I
xxxviii,
. xxxvi,
. xxxi,
xliii,
xiii,
xix.
165
181
235
322
121
223
3
202
304
290
176
364
101
174
234 UTERUS.
UTERUS (continued) —
„ tuberculosis of, in cases of phthisis (P. D. Tvirner) . . xli, 359
„ tubercle of (P. Horrocks) .... xliv, 141
„ — (H. Williamson) ..... xliv, 141
„ tuberciilar (A. W. Addinsell) .... xlvii, 33i8
„ early tubercular disease of (S. W. Wheaton) . . xxxiii, 29
„ tuberculosis (probably primary) of the body of, in an adult (J.
Bland-Sutton) ..... xlvii, 72
„ tumour of, complicating pregnancy (J. L. Worship) . . xiv, 305
„ tumours, see also Tumours.
„ — removed by new constrictor (J. Lazarewitch) . . xv, 63
„ tumovir expelled from, during natural labour ( A.. W. W. Lea) xli, 2
„ body of, villous tumour of, in a woman, aged 84 ; vaginal
hysterectomy (J. Bland-Sutton) . . . xlix, 46
„ wall of, secondary infection of the perivascular lymphatics of,
to bilateral primary tuberculous salpingitis (C. Lockyer) . xlix, 141
„ with " fundal ligament " after hysteropexy (F. E. Taylor) . xlix, 265
„ witli its contents at full term (J. Fitzpatrick) . . xxi, 37
„ removed by vaginal operation (S. W. Whoaton for William
Duncan) ...... xxxiii, 113
„ and vessels concerned in phlegmasia dolens (R. Barnes) . x, 113
„ complete incontinence of urine cured by ventro-fixation of
(H. Macnaughton-Jones) . . . . xl, 226
„ CERVIX UTERI, malignant adenoma (carcinoma) of (F. J.
McCann) . . . . . . xl, 2
„ — on tlie advisability of removing, in performing hysterec-
tomy for fibro-myomatous uterine tumours (J. D. Malcolm) . xlix, 148
„ — amputation of (R. Greenhalgh) . . . vi, 102
„ (A. Meadows) .... viii, 39 ; xi, 102
„ supra-vaginal amputation for cancer (A. H. N. Lewers)
xxxiii, 301 ; xxxvii, 201
„ — atresia of, with distension of uterus, and escape of menses
between the walls of the vagina (G. Lowe) . . xxix, 401
„ of the vaginal orifice of, new operation for (V. de Saboia) xvi, 116
„ — vise of fused anhydrous sulphate of zinc to the canal of (J.
B. Hicks) ...... viii, 220
., — two uteri removed by vaginal hysterectomy for cancer of,
the disease being apparently at the same stage in each
(A. H. N. Lewers) .... xxxviii, 164
„ — thi-ee cases of pyometra complicating cancer of (W. W. H.
Tate) ...... xxxix, 323
„ — cancer of, associated with an adenomatous gi-owth in the
fundus (C. Hubert Roberts) .... xlii, 267
„ from eight cases treated by the supra-vaginal amputa-
tion, in which from four to fifteen years had elapsed without
recui-rence (A. H. N. Lewers) .... xliv, 221
„ — uterus and iliac glands removed by abdominal hysterec-
tomy for cancer of (T. V. Dickinson) . . . xlviii, 15
„ — cancer of, complicating a case of combined vaginal and
abdominal hysterectomy for a pregnancy of four and a half
months (R. Sanderson) .... xliii, 312
„ — two cases of, the patients remaining free from recurrence
twenty and eleven years respectively after operation (A. H. N.
Lewers) ...... xlix, 179
., — — supposed recun'ence after vaginal hysterectomy for
(C. Hubert Roberts) ..... xUx, 114
„ pregnant, removed by pan-hysterectomy (F. N. Boyd) . xlvi, 345
UTERUS.
235
UTEBUS (continued) —
„ CEEvix UTERI {continued) —
„ — cancer of, complicating labour in advanced pregnancy, the
patients remaining well eleven, eight and a half, and eight
years after high amputation of (H. R. Spencer) . . xlvi, 355
„ treatment of epithelial (C. H. F. Eouth) . . viii, 290
„ see also Cancer.
„ — carcinoma of, complicating labour at term ; Caesarean sec-
tion, followed by vaginal hysterectomy (J. M. Munro Kerr) . xlvii, 194
„ in which the disease extended upwards into the body
(W. W. H. Tate) . . . . . xl, 258
„ — sqviamous-celled, in which the disease had extended in an
upward and not in a do^vnward direction (C.J. Cullingworth) xxxiv, 136
„ squamous (F. J. McCann) .... xliv, 136
„ — — see also Carcinoma.
„ — chancre on (G. E. Herman) .... xxvii, 252
„ — on the change in size of the canal during menstruation
(G. E. Herman) .... xxxvi, 250
„ — cystic degeneration of (H. Gervis) . . . xxvi, 144
„ — deformed, pregnancy after bilateral division of (G. Eoper) xix, 169
„ — relative value of substances used in dilating (J. H. Aveling) ix, 264
„ — the dilatation of the canal of, for spasmodic dysmenorrhoea
and sterility (C. Godson) . . xxiii, 277 ; xxiv, 6
„ — diseased (R. Greenhalgh) . . . . v, 199
„ — malignant disease of (G. Roper) . . . xxii, 85
„ — — complicating pregnancy (A. L. Gaiabin) . . xviii, 239
„ extensive, in which Caesarean section was performed
(A. L. Gaiabin) ..... xviii, 286
„ scoop for removing superficial portions of (Professor
Simon) ...... xiv, 209
„ removal of (A. H. N. Lewers) . . . xxxii, 136
„ disease of, in one-horned (L. B. Aldrich-Blake) . xlix, 269
„ growth of, in a girl aged 18 (F. N. Boyd) . . xlvii, 313
„ — division of (E. J. Tilt) .... viii, 262
„ — extreme elongation of, in a case of labovu- (R. Barnes) . xviii, 293
„ — hypertrophic elongation of, at the full term of pregnancy
(G. Roper) . . . . . . xv, 167
„ — supposed endothelioma of (H. Russell Andrews) . . xlviii, 283
„ — epithelioma, removed by the ecraseur where local anaes-
thesia by the ether spray was employed (E. Parson) . ix, 47
„ — squamous-celled epithelioma of, in a very early stage
(W. S. A. Griffith) ..... xlii, 210
„ — with squamous epithelioma, removed in 1895 ; no recurrence
in 1901 (A. H. N. Lewers) .... xliii, 266
„ — showing rapidly growing epithelioma of; death from re-
currence five months after removal (C. Lockyer) . . xliv, 284
„ — three months' gravid, removed by vaginal hysterectomy of
cervix for squamous epithelioma (W. Duncan) . . xliv, 297
„ — epithelioma of, see Epithelioma.
„ — erosions of, pathological anatomy of (A. L. Gaiabin) . xxii, 156
„ — fibro-adenoma removed from (G . F. Blacker) . . xli, 374
„ — calcareous fibroid of (W. W. H. Tate) . . .xli, 372
„ — three fibroid tumours of (A. L. Gaiabin) . . xlv, 175
„ — large, with cervical fibroid, removed by abdominal hyste-
rectomy by Doyen's method (H. E. Spencer) . . xliii, 5
„ — fibro - myoma of, treated by abdominal hysterectomy
(W. H. H. Tate) . . . . .xlv, 173
236
UTEEUS.
UTERUS (continued) —
CERVIX UTERI {continued) —
— fibro-myoma of, removed by abdominal pan-hysterectomy
(W. A. Meredith) ..... xlvi, 12
removed by enucleation, followed by vaginal hysterec
tomy (W. W. H. Tate)
— cystic fibro-rayoma of (C. H. Roberts) .
— fibrous tumour of (G. C. P. Murray)
obstructing labour, removed by enucleation (J. B
Hicks) .....
— peculiar formation of (R. Barnes)
— ganglion cervicale uteri, the normal and pathological
anatomy of (N. W. Jastreboff) .
— gangrene of vaginal portion of (G. E. Herman) .
— growth removed from (R. Greenhalgh) .
— hypertrophy removed by the wire-rope ecraseur (R. Green
halgh) .....
— non-evoluted and lij'^pei'trophied (G. Roper)
— follicular hypertrophy of (G. E. Herman)
— instrument for dividing (R. Barnes)
— annular laceration of (T. H. Barker)
— laceration of, histological results of (A. L. Galabin)
bilateral, with ectropion, section from the anterior lip
of (A. L. Galabin) ....
— tubal mole complicating carcinoma of (A. H. N. Lowers)
— myoma of (C. J. Cullingworth)
(J. Bland-Sutton)
large fibro-cystic of (C. J. Cullingworth)
— myxo-fibroma of (A. L. Galabin)
— partial obstruction of, by distension (A. L. Galabin)
— occlusion of, with resulting suppuration of the uterine
cavity (A. L. Galabin) .
— new expanding speculum for operations on (R. Ellis)
— self -retaining tenaculum for operations on (R. Ellis)
— plan for cauterising (R. Barnes)
— sections of an adeno-myomatous polypus of (F. E. Taylor)
— peculiar mucous polypus of (R. G. McKerron)
— (H. R. Spencer)
— multiple myxomatous polypi from (W. Duncan) . xlii, 243 ; xliii,
— prolongation, excessive, of anterior lip (C. H. F. Routh) . xviii,
— rupture of, at the vaginal junction (A. Wiltshire) . xviii,
— sarcoma of (A. L. Galabin) . . . xxxviii,
— "grape-like" sarcoma f ungating into, and infiltrating
the walls of the vagina, in a cliild aged 12 months ; extir-
pation of uterus and vagina (H. J. Curtis) . . xlv,
of (H. Williamson) .... xlvii,
— supposed sarcoma of (H. R. Andrews) . . . xlix,
— separation of tlie greater portion of, dui-ing labour (R. Gray) xvi,
— trachelo-raphe or Emmet's operation, notes on (W. S.
Plaj^air) ...... xxiv,
— tuberculous' disease of, and Fallopian tubes (W. W. H. Tate) xlvi,
primary (E. E. Young) .... xlviii,
— tubercvdosis of (E. O. Croft) . . . . xliv,
— — primary, simidating cancer, and treated by vaginal
hysterectomy (A. H. N. Lewers) .... xliv, 144
-"for wliich vaginal hysterectomy was performed (W. H. B.
Brook) . . " . . . xlv, 18.5 ; xlvi, 26.5
xlii,
xlii,
vi.
Vll,
xxiii,
xxix,
vii,
vi,
vii.
xxii,
vii,
ii.
xxiv,
xxi,
xlv,
xxxiv,
xxxix,
xxxviii,
xxviii,
xxvii,
xix,
ix,
ix,
viii,
xlviii,
xxxix,
xli.
IGl
211
184
273
120
266
244
25.5
75
233
270
72
329
53
312
335
223
160
8
178
81
176
86
88
102
12
314
383
75
144
220
120
320
119
1.37
128
54
138
268
142
UTERUS.
237
XI,
xliii.
106
86
283
244
111
161
406
26
xxxiii, 30
xl, 332
xxxvi, 321
60, xxvii, 300
xxii, 244
xxi, 38
ix, 152
XXV, 219
UTERUS {continued) —
., CERVIX UTERI (continued)
„ — cystic tumour of (A. H. N. Leavers) . . xxxviii,
„ — ulceration of, ciu-ed by the application of styptic colloid
(J. Wynne) ......
„ — volsella forceps for the soft dilated (R. Wise)
„ fundus uteri, fibroid polypiis attached to (D. L. Eoberts)
„ — removal of fibrous outgrowth fi-om (C. Godson) .
„ — injection to, for induction of premature labour (J. Lazare-
witch) ......
„ — localised sloughing of, in a case of acute septicaemia follow-
ing abdominal section (C. J. Cullingworth)
„ OS TTTERi, chancre on (W. B. Woodman)
„ — submucous fibroid presenting at, ten days after delivery
(G. E. Herman) ....
„ — three cases of congenital tumour at the internal, causing
hydrometra in new-born children (H. R. Spencer) .
„ — a new and speedy method of dilating a rigid os in parturi-
tion (J. Farrar) .....
„ — corroding ulcer of (John Williams) . . xxvi,
„ — dilatation of, for chorea in pregnancy (W. F. Wade)
„ digital, in labour (J. Braithwaite) .
„ — fibroid polypus pediciuated to posterior margin of (J. H.
Davis) ......
„ — internum, its anatomy, physiology, and pathology (J. H.
Bennet) ......
„ — ulceration of, with allongement of cervix uteri (G. C. P.
MiuTay) ......
„ AND APPENDAGES, chrouic scptic infectiou of (A. Donald)
„ — connected by adhesions to the large intestine (T. C.
Hayes) ......
„ — enveloped in a large amount of blood- clot and false mem-
brane (T. C. Hayes) .....
„ — from a case of Ceesarean section (C. J. Cullingworth)
„ — epithelioma of (Heywood Smith) . . xxi, 313 ; xxii,
„ — of a woman who died from rupture of the right Fallopian
tube (Aust Lawrence) ..... xx, 292
„ — showing rupture of tubal fcetation (C. Godson) . xxii, 186, 242
„ — from a fatal case of hsemon-hage in the pelvis (Heywood
Smith) ' . . . - .
„ — from a case of haemorrhage from the uterine mucous mem-
brane in an infant (C. H. James)
„ — from a patient who died of heart disease (T. C. Hayes)
„ — removed by hystei-ectomy (H. Smith) .
„ — from patient with ovarian cyst (P. Smith)
„ — from a patient dying dui-ing menstruation from piu'pura
haemorrhagica (Werlhof ) (John Phillips) .
„ — entire removal of (C. Clay)
„ — affected with tubercle (W. E. Dakin)
„ — tuberculosis of (P. D. Tiu-ner)
„ — of pregnant woman who died from convulsions during
typhus fever (S. Beck) ....
„ — from a single woman (W. Duncan)
,, and breasts, case of absence of (L. Eemfry)
„ and iliac glands removed by abdominal hysterectomy for
cancer of cervix (T. V. Dickinson)
„ and ovaries (T. Spencer Wells)
IX,
xlix.
xvii, 45
XX, 119
xxxi, 308
3
xvii, 56
xxxii, 66
xvi, 174
xxi, 313
xiii, 126
xxxiii, 2
V, 58
xxxiii, 3
xli, 344
xiii, 239
XXX, 408
xxxvii, 12
xlviii.
238 UTERUS VAGINA.
UTEEUS (continued) —
„ and ovaries, extii-pation of, with large fibrous tiunotu-s (I. B.
Brown) . . . . . . vi, 249
„ — absent in three sisters (C. E. Squarey) . . . xiv, 212
„ — of child who died of tubercular meningitis (F. Beach) . xv, 57
„ and placenta, adherent, from patient dying of post-partum
haemorrhage (John Phillips) .... xxxii, 195
„ with its contained placenta, removed from a rachitic woman,
aged 30, by Porro's operation (W. Duncan) . . xxx, 408
„ placenta retained two months in (J. B. Walker) . . xii, 338
„ and vagina with the child in situ in the second stage of labour
(W. F. Victor Bonney) ..... xliv, 292
„ — distension of, with muco-puriform fluid, in a child aged 7
weeks (W. McAdam Eccles) .... xxxiv, 250
„ — divided by a septum (W. R. Rogers) . . . xii, 297
„ — ruptiu-e of (P. Horrocks) . . . xxvi, 119, 260
„ (A. Wiltshire) ..... xxiii, 163
„ (Amand Routh) ..... xxxiv, 252
„ and rectum, adhesions between, di-agging down the fundus
uteri (E. E. Day) . . . . . vi, 10
„ rectum, and left kidney from a woman who died of vu-aemia
(W. Duncan) ...... xxxi, 255
VACCINATION, reckless (R. Druitt) . . . • ii, 305
„ with lymph from a secondary (J. A. Thompson) . . xiii, 94
„ syphilis after (R. Druitt). . . . . v, 196
„ trwo instruments for performing (J. Whitehead) . . xiii, 188
VAGINA, absence of, uterus distended by retained menstrual fluid
(C. H. Carter) ..... xxii, 251
„ — with retained menses in utero and Fallopian tubes (C. H. F.
Routh) . . . . . . xii, 34
„ complete absence of, in a case of double uterus with double
haematometra (A. H. N. Lowers). . . xxxviii, 327
„ air expelled from (G. Harley) . . . . iv, 173
„ air in (A. Rasch) ..... xii, 281
„ atresia of, case of laboui- with (Fancourt Barnes) . . xxv, 99
„ — instruments for (N. Bozeman) . . . xix, 96
„ primary carcinoma of (F. J. McCann) . . . xlviii, 181
„ epidermic casts from (J. H. Targett) . . xxxvii, 218
„ chorion-epithelioma of uterus with secondary growths in
(G. P. Blacker) ..... xlvi, 55
„ — with secondary growths in (C. Lockyer) . . xlv, 245
„ closure of (J. B. Hicks) . . . . • iv, 228
„ cysts of (M. Handfield-Jones) .... xxxi, 129
„ — their aetiology, pathology, and treatment (H. T. Ruthcr-
foord) ...... xxxiii, 354
„ polypiform cyst, growing from anterior wall of (J. H. Davis) . ix, 32
„ deciduoma malignum with secondary deposit in, lungs showing
secondary deposits (F. J. McCann) . . . xlv, 248
„ secondary deposits of deciduoma malignum without syncytium
in, after hydatidiform degeneration of the chorion (P.
Horrocks) ...... xlv, 243
„ secondai'y gi-owth of deciduoma malignum from (J. R. Morison) xlv, 249
„ on delivery by the, in extra-uterine gestation (G. E. Herman) xxix, 429
„ double, doubtful case of (A. L. Galabin) . . . xxiv, 20
„ — and bicorned uterus (G. E. Herman) . . . xx, 123
„ — and double uterus (H. Gervis) . . . xix, 271
VAGINA.
239
VAGINA (continued) —
„ double, and double uterus, case of pregnancy with (J. B
Hicks) .....
„ primary epithelioma of (C. H. Eoberts)
„ fibroid tumour of (W. C. Swayne)
„ — see also Tumours, fibroid.
„ fibi'o-myoma of (J. Bland-Sutton).
„ — (J. M. Munro Kerr) ....
„ — wall of (with microscopical slide) (John Phillips)
„ fibrous tumoiu' from anterior wall of (K. Barnes)
„ foreign body in, removal after four years, and after-results (C
H. Carter and F. H. Daly)
„ — for two years, perforating wall of bladder, its removal and
closure of fistulous opening (C. H. Cai-ter)
„ spontaneous gangrene of upper part of (G. E. Herman)
„ the effect of glycerine on the quantity of secretions poured
into the (G. E. Herman)
„ hsemorrhage from, diiring parturition, a diagnostic sign of (P
Budin) .....
„ imperfoi-ate, case of (P. Boulton) .
„ — parturition through (Heywood Smith) .
„ incision of, for removal of extra-uterine fcetation (C. Godson)
„ of infant with medullary gi-owths (N. Heckford)
„ inversion of, with hypertrophic elongation of the cervix uteri
(R. Barnes) .....
,, laceration of, in labour (J. Matthews Duncan)
„ malignant growth in the, complicating pregnancy (J. B
Potter) .....
„ three myomatous uteri removed per vaginam by Doyen's
method (W. J. Smyly) ....
„ myoma of (F. J. McCann)
„ myxo-sarcoma of, in a child, aged 2^ (A. W. W. Lea)
„ obliteration of, cicatricial, Csesarean section on account of (A
L. Galabin) .....
„ OS vaginae and arms, ruptured perinseum and birth of child
between (I. Baker Brown)
„ occlusion of, after delivery, with subsequent retention of
menses (S. Craddock) ....
„ occlusion of, in a case of absence of the uterus (F. Bousquet)
„ pessary (Greenhalgh's) removed with difficulty ' from (A. L
Galabin) .....
„ polypus adherent to (J. B. Potter)
„ primary embolic chorion-epithelioma of (H. T. Hicks)
„ prolapse of the, the relation of, to hernia (G. E. Herman)
„ RUPTtTKB OF, diu'ing labour ; child in abdomen three and a half
hovirs ; pelvic cellulitis ; recovery (J. H. Bell)
„ (T.J.Walker) ....
„ — two cases (A. L. Galabin)
„ — death from septicaemia (F. H. Champneys)
„ — with recovery (Heywood Smith)
„ — spontaneous, with recovery (A. Wiltshire)
„ AND UTERUS, RUPTURE OF (A. Wiltshire) .
„ (P. HoiTocks) ....
„ (Amand Eouth) ....
„ — distension of, with muco-puriform fluid, in a child aged 7
weeks (W. McAdam Eccles)
„ — divided by a septum (W. E. Eogers)
xxiu,
xxxviii,
xlv,
xli,
xliv,
xl,
xiv.
23
381
142
100
130
130
309
xxii, 34
xxu,
xxix.
38
244
XXX, 452
XIX,
xxiii,
xxiii,
xxix.
XV,
xxxi.
232
125
117
499
224
124
236
XX, 110
xli,
xlviii,
xlii,
xviii.
XXI,
XXV,
xlix,
xxvi,
iv,
viii,
XX,
xxiii,
xvii,
xvii,
xxiii,
xxvi, 119,
xxxiv,
xxxiv,
xii.
96
182
143
252
197
101
123
49
138
224
88
197
109
295
10
359
362
163
260
252
250
297
240 VAGINA VBSICO-VAGINAL FISTULA.
VAGINA (continued) —
„ " grape-like " sarcoma of the cervix uteri f ungating into and
infiltrating the walls of, in a child aged 12 months ; extirpa-
tion of uterus and (H. J. Curtis) . . . xlv, 320
„ sarcoma of, see also Sarcoma.
„ secretion from (W. J. Gow) .... xxxvi, 52
„ septum in, case of transverse (H. Gervis) . . . xxiv, 210
„ — vertical, impeding labour (J. B. Hicks) . . . xxiii, 24
„ slough from a case of enteric fever, forming a complete cast
of (W. S. Playfair) .... xxxviii, 33
„ sponges in, means of keeping aseptic (J. Matthews Duncan) . xxiv, 5
„ suppuration at the back and front parts of, following pelvic
cellulitis after a first pregnancy (G. D. Gibb) . . ii, 324
„ tumour from anterior wall of (A. Meadows) . . x, 141
„ ulceration of wall of, caused by a pessary (T. C. Hayes) . xvi, 30
VAGINAL DRAINER (A. Rasch) . . . . x, 94
VAGINAL INJECTION of acid nitrate of merciury, death following
(John Phillips) ..... xxxiii, 180
VAGINAL SPECULUM, see Speculum.
VAGINISMUS (J. M. Sims) . . . . . iii, 356
„ [dyspareunia of Barnes] (W. Schnegierief ) . . xvi, 187
VAGINITIS, membranous, in which the Bacillus coli communis
was found (T. G. Stevens) . . . . xli, 228
VALVES, mitral stenosis in a primipara (G. Coates) . . xxviii, 108
VARIOLA, see Smallpox.
VASELINE, a new lubricant, specimens of (A. Wiltshire) . xviii, 176
VEINS, puerperal thrombosis (W. S. Playfair) . xvi, 42, 89
„ umbilical, phlebitis of, producing pyaemia (G. Roper) . xix. 8
„ varicose, legging for ( — Stewart) . . . xvi, 88
VENTRO-FIXATION of uterus for complete incontinence of urine
(H. Macuaughtou-Jones) . . . . xl, 226
VERSION, cases of, in the Montreal University Lying-in Hospital
(D. C. MacCallum) . . . . . xx, 40
„ combined external and internal (J. B. Hicks) . . v, 219
„ external, present position of, in obstetrics, with a suggestion
of a new method of performing it (W. R. Pollock) . . xlviii, 319
„ in cases of contracted bi-im (P. L. Burchell) . . xxv, 61
„ one of the causes of difficulty in, with remarks on the practice
of amputating the procident arm (G. E. Herman) . . xxviii, 150
„ for presentation of the upper extremity, on the choice of leg
which should be seized in (A. L. Galabin) . . xix, 239
„ spontaneous, in a case of obstructed laboxir, foUomng an
unsuccessful attempt to deliver by the crotchet after crani-
otomy (S. D. Hine) ..... xxvii, 293
„ incarcerated ovarian dermoid ruptured during delivery by
forceps and (H. R. Spencer) . . . . xl, 331
VERTEBR5;, impei-fection of, and absence of spinal medulla in an
early embrj'o (C. B. Lockwood) .... xxix, 234
„ spinal column exhibiting want of ossification in the inter-
ai-ticular portion of the lumbar (G. F. Blacker) . . xlii, 90
„ see S;^ond.ylolisthesis.
VESICO- VAGINAL FISTULA, see Fist ula, vesico- vaginal.
VIABILITY — WALKEE. 241
VIABILITY in a child born at five and a half months (C. H. F,
Eonth) ...... xiii, 132
VILLI, proliferation of epithelium of, as a syncytiiun forming
reticulating processes, shown in a carneoixs mole retained in
utero five months after death of embryo (A. L. Galabin) . xlv, 240
„ chorionic, mj'xoma of, engrafted upon uterits ; myxoma of
fundus uteri following vesicular mole ? (A. L. Galabin) . xlv, 241
Vincent (Ealph Henry), lymphangitis mammae : an affection of
the breast arising about the tenth day of the puerperium
with well-marked clinical features . . . xliv, 158
VISCERA, abdominal, transposition of greater part of, into the
left cavity of the thorax (H. W. Bailey) . . . x, 6
„ hsemoi-rhages from, in stillborn children (H. E. Spencer) . xxxiii, 203
„ pelvic, after death from spontaneous rupture of ovarian cyst,
complicated with fibroid tumour of uterus (P. Smith) . xiii, 39
„ — showing congenital communication between the rectum
and the genito-urinary tract (A. Doran) . . . xxii, 79
„ — showing pseudo-hermaphroditism (C. H. Eoberts) . xliii, 298
„ — female, encysted tuberculous peritonitis and its effects
upon (J. H. Targett) ..... xxxix, 126
„ transposed, from a pregnant woman, post-mortem Csesarean
section (E. Buckell) ..... xix, 179
VOLSELLA FORCEPS for the soft dilated cervix (E. Wise) . xliii, 233
VOLVULUS in a foetus (E. D. Maxwell) . . . xlviii, 277
VOMITING, excessive, in early pregnancy, depending on the in-ita-
tion of the gravid uterus (W. T. Smith) . . . i, 335
„ of pregnancy : its causes and treatment (W. G. Hewitt) . xiii, 103
„ — on the so-caUed vincontroUable (Graily Hewitt) '•. xxvi, 273, 331
„ — observations on the aetiology of (A. E. Giles) . . xxxv, 303
„ in pregnancy, two fatal cases of pernicious (J. L. Maxwell) . xHii, 288
VOTE OF CONDOLENCE on the death of Dr. W. M. Graily Hewitt . xxxv, 336
VULSELLUM FORCEPS, new axis-traction (E. Barnes) . . xxv, 68
VULVA, cyst removed from (A, L. Galabin) . . . xxvi, 56
„ discharges from, in children (G. D. Eobinson) . . xli, 14
„ elephantiasis of (W. S. Playfair) .... xix, 184
„ epithelioma of, with after-histories (A. H. N. Lewers) . xlviii, 163
„ fibro-myoma of the vestibule (J. Inglis Parsons) . . xlviii, 184
„ case of acute gangrene of, in an adiilt (G. E. Herman) . xxv, 141
„ hydatidiform cysts growing in (A. J. Sturmer) . . xliii, 148
„ list of ovariotomies in women over eighty. A case, aged 83,
complicated by epithelioma of the (L. Eemfry) . xxxvii, 155
„ case of lupus of (A. H. N. Lewers) . . . xxxi, 326
„ papillary inflammation of, chronic (W. 0. Priestley) . xxvi, 156
„ (?) parasitic cyst of (A. J. Sturmer) . . . . xliv, 2
„ see also Labium, Pudendum.
Wade (W. F.), puerperal embolism . . . . vi, 255
„ case of chorea in pregnancy successfully treated by dilatation
of the OS uteri ..... xxii, 244
Waits (J.), serous tumour in the occipital region . . vii, 158
Walker (G. S.), see Cleveland, W. F.
Walker (J. B.), placenta retained in utero two months . xii, 338
Walker (T. J.), ruptiu-ed vagina during labour . . viii, 109
16
242
WALLACE WEST.
xvii,
xvii,
xvii,
xvii,
xvii,
xxiii,
i,
i.
XXVI,
xxvi,
xxvi,
xxvi.
Wallace (Frederick), case of monstrosity
„ — report on ditto by committee (T. C. Hayes and J. H. Aveling)
„ uterus of a woman, aged 55, who had had two miscarriages at
the age of thirty-nine .....
„ — report on ditto by committee (T. C. Hayes and J. H. Aveling)
„ remarks in the discussion on puerperal fever
„ anencephalous foitus with spina bifida
Waller (C), transfusion of blood, its history and application in
cases of severe hamion-hage
„ extra-uterine foetation ...
„ case in which the deliveiy of a very large living child was
effected by means of the long forceps
Walter (William), portable transfusion apparatus
„ multilocular ovarian cyst
„ fibro-myoma of uterus ....
Walters (J. Hopkins), uterus torn out after delivery . xxiv, 13G
Walters (J.), and A. R. Walters, case of puerperal septicasmia
treated by anti-streptococcic serum
Warn (R. T.), labour complicated with ovarian disease .
Watkins (R. W.), retention of a fuitus in the abdomen forty
three years .....
Way (J.), twin pregnancy ....
Webb (F.), hydatid degeneration of the ovum
Weir (G.), spring intra-uterine stem
Weiss (Messrs.), case of instruments for uterine operations
Wells (T. Spencer), large congenital encephaloid tumour, not
impeding deUveiy
„ ovarian tumour removed by ovariotomy
„ stone from female bladder
„ two ovarian cysts removed by ovariotomy .
„ female bladder, showing the results of retention of urine after
delivery ....
„ cast of female bladder .
„ ovariotomy, and reply to a statement respecting it made by
Mr. Baker Brown ...
„ multilocular cyst of left ovary, removed six years after removal
of right ovary
„ fibroid outgrowth from fundus uteri
„ — report on ditto by J. B. Hicks .
„ uterus and ovaries from above case . . xi,
„ complication of pregnancy ^vith ovarian disease . . xi,
„ opening remarks and reply in the discussion on puerperal
fever ..... xvii, 90,
„ additional cases of ovariotomy performed during pregnancy . xix,
„ list of published writings, arranged chronologically (C. J
Cullingworth) ....
Wenton (Charles), double monster
West (Charles), remarks in the discussion on puerperal fever
„ inaugiu-al address as President
„ annual addi'ess as President
„ death of .
West (R. Uvedale), membranous croup
„ description of an anencephalian monster .
xl.
vin,
vii,
ix,
viii,
vii,
ii>
iii
iii.
XI,
xl,
xxxiii,
xvii,
xix,
XX, 10; xxi,
xl,
i,
i.
176
277
177
276
200
204
61
99
309
182
148
326
233
277
198
106
209
85
218
157
27
214
285
285
354
417
89
19
73
76
97
251
265
185
91
384
235
42
5
174
53
105
WEST WILLIAMS.
243
West (E. Uvedale) {continned) —
„ fatal case of puerperal peritonitis complicated with ovarian
disease, followed by febrile diseases of the puerperal state,
the probable consequences of infection . . . i, 187
„ sudden apoplectiform seizure, terminating fatally in thirty-
five hours, on the sixth day of lying-in . . . ii, 276
„ epileptiform conviolsions in the third week of the puerperal
state ...... iii, 35
„ is the ergot of rye, when administered to the mother during
labour-, dangeroiis or not to the life of the child ? . . iii, 222
„ protracted retention of blighted ovum . . . iv, 17
„ abnormal variety of the battledore placenta . . vii, 257
West (W. J.), first ovariotomist in England, portrait of . xviii, 177
Westmacott (J. G.), use of the whale-bone loop . . xi, 177
„ corkscrew funis ..... xiii, 51
„ triplet foetuses ..... xiii, 95
„ note ou J. Palfrey's specimen of monster . . . xix, 100
Wheaton (S. W.), ovary containing three dermoid cysts . xxxiii, 28
„ early tubercular disease of uterus . . . xxxiii, 29
„ for William Duncan, diffuse malignant disease of the body of
the uterus ..... xxxiii, 113, 161
„ prolapse of Meckel's diverticulum in an infant forming an
umbilical tumour ..... xxxiv, 184
„ micrococci in the substance of a decomposing fibroid tumour
removed by hysterectomy .... xxxiv, 187
„ microscopic section of the uterine mucous membrane of an
infant suffering from uterine haemorrhage . . xxxiv, 190
„ bony girdle from a dermoid tumour . . . xxxv, 4
„ — report of Committee ..... xxxv, 41
„ bilateral cephalhaematomata, cast of . . . xxxv, 6
White (B.), see Hayes, T. C.
" WHITE LEG," see Phlegmasia alba dolens.
Whitehead (J.), two instruments for performing vaccination . xiii, 188
Whitmarsh (W. M.), ovum of seven months expelled entire . vi, 105
Williams (John), calcified fibroids of uterus . . . xvi, 125
„ on the relation between congestion of the uterus and flexion
of the organ ...... xvi, 202
„ case of hydatidiform mole .... xvii, 2
„ the mechanical action of pessaries . . . xviii, 126
„ the pathology and treatment of membranous dysmeuorrhoea . xix, 138
„ for W. E. Marshall, ruptured uterus . . . xx, 86
„ on some of the changes in the uterus resulting from gesta-
tion, and on their value in the diagnosis of parity . . xx, 172
„ ovarian tumour ..... xxiv, 77
„ dermoid cyst of the ovary : myxomatous growth of the
peritoneum ...... xxiv, 93
., on the natural history of dysmenorrhuea . . xxiv, 103, 141
„ fibroid tumour of the ovary removed by abdominal section . xxv, 35
„ placenta with cyst on the fcetal surface . . . xxv, 69
„ on the con-oding ulcer of the os uteri . . . xxvi, 60
„ — further note on . . . . . xxvii, 300
„ note on a condition observed in the navel cord of a young
infant .... . xxvi, 199
244
WILLIAMS — WILLIAMSON.
Williams (John) (continued) —
„ note on the involution of the puerperal uterus in the absence
of the ovaries ..... xxvi 208
„ the circulation in the uterus, with some of its anatomical and
pathological bearings .....
„ on serous perimetritis .....
„ inaugural address as President ....
„ fibroid tumour of the ovary, with a papilliferous cyst
„ — report on ditto by committee (A. L. Galabin, G. E.
Herman, and Alban Doran) ....
„ case of extra-uterine pregnancy in which abdominal section
was performed during the life of the foetus at the thirty-fifth
week of gestation .....
„ annual address as President . . . xxx, 104
Williams (A. Wtnn), missed labour
„ large abdominal cyst ....
„ — report on ditto, by Drs. G. Hewitt and Williams .
„ haemorrhage due to retained placenta, supposed to bo the
placenta of a previous abortion .
„ diphtheria .....
„ hydatidiform vesicles attached to placenta .
„ large ovarian tumour ....
„ heart and lungs of an infant aged 14 days .
„ persistent sickness ; laboiu- induced after full period had
elapsed; scarlatina in the room .
„ cancer of the womb successfully treated by bromine.
„ mole from case of supposed three months' pregnancy
„ epithelioma of lip treated by injection of bromine .
„ large-sized miicous polypus
„ pessary for treatment of flexions of the uterus
„ shield for supporting vulcanite-stem pessary
„ intra-uterine tumour ; removal ; subsequent pregnancy
delivery by turning ; post-partum haemorrhage ; recovery
„ intra-mural calcareous tumour impeding labour
„ remarks in the discussion on puerperal fever
„ adherent placenta ....
„ two specimens of fibroid tumour of the uterus
„ — report on ditto by committee (A. Doran, C. Godson, and
F. H. Champneys) ....
„ dysmenon-hoeal membrane
„ see Meadows, A.
Williamson (Herbert), pathology and symptoms of hydatidi-
form degeneration of the chorion
„ abnormal umbilical cord ....
„ tubercle of uterus .....
„ unusual case of ectopic gestation ....
„ pulmonary embolism occurring twenty-four days after delivery
„ syncytioma from the body of a woman who died in St.
Bartholomew's Hospital thirty-one years ago . . xlv, 253
„ and Harrison Cripps, two cases involving the question of the
site of impregnation .....
„ section of the wall of an ovarian dermoid showing giant-cells
„ sections illustrating the structure of three different types of
urethral caruncles .....
„ " grape-like " sarcoma of the cervix uteri .
„ and Griffith (W. S. A.), a case of fibro-myoma of the uterus
undergoing sarcomatous change .... xlviii, 22
xxvii,
xxvii,
xxi.x,
xxix,
XXIX,
xxxi
vi
viii
viii,
viii
iXj
xi,
xii,
xii,
xiii
xiii
xiv
xiv.
XV,
xvij
xvii,
xviij
xxiv,
XXV,
XXV,
XXV,
112
169
99
247
513
482
73
208
218
278
317
35
93
197
242
164
249
95
97
135
308
246
183
172
196
300
46
70
233
xii,
xliv,
xliv,
xliv,
xlv,
xlvi,
xlvi,
xlvii,
xlvii.
303
141
141
225
189
89
299
6
119
WILLIAMSON — WISE.
245
Williamson (Herbert) (continued) —
„ a note on adenoma of the labium .... xlviii, 235
„ see Doran, Alban.
„ see Griffith, W. S. A.
Willing (G. F. Butler), five and half months' foetus . . xvi, 85
„ — repoH on ditto by committee (H. Savage and C. H. F.
Eouth) ...... xvi, 97
Willoughbt (E. F.), cicatrices from bm-n requiring division
during labour. .....
Wills (W.), double monstrosity, with accoimt of the delivery
WiLMOT (K. E.), fillet or loop as an obstetric aid, with especial
reference to a new modification of the instriuuent .
Wilson (H. S.), per G. E. Herman, notes on a foetus
Wilson (Thomas), chronic axial rotation of an ovarian cyst giving
rise to extreme tmsting of the elongated uterus
„ hydi-amnion in cases of unioval or homologous twins
„ relations of organic affections of the heart to fibro-myoma of
the uterus ......
„ primary pneumococcus meningitis simulating puerperal
eclampsia ......
Wiltshire (Alfred), new form of uterine tent
„ observations on puerperal temperatures
„ new utero-vaginal douche ....
„ ovarian tumoiu' and treatment of pedicle by acu-pressiu-e
needle ......
„ univentricular heart, by Dr. Elliot, of Carlisle
„ infant with marks and boy with webbed fingers
„ fibro-enchondi-omatous tvmiour complicating pregnancy ; safe
delivery ......
„ tetanus after abortion .....
„ common skin diseases of children .
„ protected perforators, modifications of Oldham's and Simpson's
perforators ......
„ case of spontaneous rupture of the vagina, with recovery
„ liquid extract of ergot (Martindale's)
„ specimens of vaseline, a new lubricant, and vulcanite jars for
carrying it . . . . . . xviii, 1 76
„ notes of a case of puerperal septicaemia with abscesses, dis-
organisation of the left wrist-joint, and phlegmasia dolens, in
which recovery took place ....
„ specimen of utero-vaginal rupture
„ two cases of idiocy .....
„ for John Hadden, specimen of fibroid tumour of the uterus
„ toughened glass specula ....
„ modifications in Tarnier's forceps, with extract from his letter
describing the changes ....
„ in normal asymmetry of the fcetal head, and colour of eyes in
newly-born infants ..... xx, 78
„ photograph of an infant with enormous enlargement of the
shoulder, hip, and knee-joints .... xx, 84
„ specimen of utero-vaginal ruptui-e, placenta prsevia, multiple
fibroids with deformed fcetus .... xxiii, 163
„ cysts from the labia minora .... xxiii, 206
Wise (Egbert), placenta, cord, fcetus, and membranes . xsxviii, 166
„ aborted ovum ...... xxxix, 259
xii.
31
vii.
6
XV,
172
xxi.
58
xxxix.
167
xli.
235
xlii,
176
xliv.
5
viii.
149
ix,
146
X,
20
xii.
31
xii.
164
xii.
329
xii.
376
xiii.
133
XV,
223
xvi.
88
xvii.
362
xviii.
2
XVlll,
xviii,
xviii,
xix,
xix,
181
220
280
119
137
223
246
WISE — ZINC.
Wise (Egbert) (continued) —
„ pregnant horn from tlie wtertis of a cat . . . xxxix, 260
„ abortion showing recent placental haemorrhage . . xl, 257
„ entire full-time ovum in twins .... xlix, 147
„ volseUa forceps for the soft dilated cervix . . . xliii, 233
"WOMEN in Southern India, medical history of (J. Shortt) . v, 103
„ power and act of propagation in (R. Druitt) . . ii, 139
„ special meeting relative to the admission of, to the Fellow-
ship of the Society ..... xvi, 65
„ admission of, as Fellows of the Society . . . xUv, 56
Woodman (W. Bathurst), chancre on os uteri . . vii, 26
„ numerous fibroids in a uterus , . . . vii, 26
„ combination of chorea with pregnancy . . . vii, 102
„ dermoid cyst of right ovary ; post-mortem . . . vii, 158
„ three cases of a third nipple in the hmnan subject, one case
hereditary . . . . . . ix, 50
„ chronic inversion of the uterus wliich had existed for more
than five years without serious symptoms . . . ix, 52
„ iron salts in anaemia complicated with pregnancy . . xii, 33
„ two forms of apparatus for vise in empyema of children . xv, 2
„ on the prevention of mammary abscesses by the application of
the principle of rest ..... xvii, 9
„ cameous or fleshy mole, ^\^th history of the case by R. Hughes xviii, 3
„ — report on ditto by committee (John Williams and W.
Bathui'st Woodman) ..... xviii, 311
Woodward (W.), mechanical support during labour . xi, 192
Worship (J. L.), ovarian disease . . . . xi, 76
„ extra-uterine tubal fojtation, with specimen . . xi, 211
„ deformed fcetus ..... xiv, 139
„ tumour of the uterus complicating pregnancy . . xiv, 305
„ case of supposed cancer of both ovaries . . . xix, 235
„ remarks in the discussion on the use of forceps . . xxi, 159
Wynne (James), inveterate case of ulceration of the cervix uteri
cured by the application of styptic colloid, with remarks . xi, 86
XYLONITE, pessaries of (A. Meadows) . . . xxiii, 131
Yarrow (G. E.), see Godson, Clement, and Eve, F. S.
Young (Eric Ernest), primary tuberculous diseixse of the cervix
iiteri ...... xlviii, 286
ZINC, fused anhydrous sulphate of, use of, to the canal of the
cervix uteri (J. B. Hicks) .... viii, 220
„ phosphide of, treatment of chlorosis and anaemia with (J. A.
Thompson) ...... xvii, 57
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