DR. W. H. WATHEN: Dr. Willmoth has presented the subject in a light that enables us to reason more correctly as to these neurotic disturbances. I can add nothing to the excellence of his description, and I shall only speak of the pathological troubles in the ovaries and uterus. For more than twenty years this has been a live subject with me, and I can recall many patients upon whom I have operated, or who have consulted me for troubles, reflex apparently from the ovaries and tubes. I have operated on many of them, removing the tubes and ovaries, and they have made complete recoveries and have remained well for nearly twenty years, and to-day are well. I have operated upon others, apparently more favorable cases, and they have not improved, except temporarily, and have relapsed finally into their former condition-some of them even growing worse than before the operation, and regretting that the overies had been removed. But in my earlier experience I did not understand the conditions in the ovaries that necessitated their removal; in other words, I could not appreciate the absence of all normal ovarian structure. Any experienced abdominal surgeon who has studied in life the appearance of the ovaries can with much accuracy say that the ovary has or has not normal ovarian structure, and when the ovary is removed a microscopic examination will bear out the findings of the surgeon. can judge of the condition of the ovary that I am removing, and in every case where I find in women before the climacteric one or both ovaries in which the normal structures have practically disappeared, I should certainly remove them, because they are of no value, and they are probably doing harm by the compression of the periphery of the nerves, often causing intense refiex trouble.

Now, I have noted the fact in my own work in recent years that where I have removed ovaries of this character in very nervous women, often with bad nutrition, the results have been almost universally good. It is not always true that the ovaries cause local pain; sometimes they do, but not always. The reflex symptoms are as varied as can be.

Several months ago I operated on a patient for Dr. Griffiths whose nutrition was so bad that she was apparently bloodless; her digestion. was such that she was constantly vomiting; she could digest apparently nothing. The symptoms were of a chronic indigestion. An exploration was insisted upon. It was agreed to by the patient and Dr. Griffiths. No trouble could be found in the stomach, except that it was dilated; no trouble could be found in the gall-bladder; none in the bile ducts or in the duodenum, or any structure in the body, except the cirrhotic ovaries, which were removed. She did not vomit after the operation, having vomited constantly before. I am informed by Dr. Griffiths that she is in a perfect state of health and has gained much flesh.

There are a great many patients that I have operated on, and the results have been just as good as in this case. I have operated on women in the past and have regretted that I did so. I have failed to operate on

women and have regretted that I did not. Within fifty yards of where I now stand there lived an elegant lady, who was my patient for a number of years, who insisted upon having her ovaries removed. She asked me why I would not remove them. I replied, "Because, madam, when you ask me in two or three years to put them back I cannot do so.' Another surgeon was consulted, and the ovaries were removed. That woman's nervousness disappeared, and she is well to-day.

The question, in conclusion, is, "Shall we remove the ovaries alone, or shall we remove the uterus as well?" Now, that is a mooted question, and it frequently comes up for discussion. To-day everything must. come out; to-morrow only the uterus must come out; the uterus sometimes and then the ovaries alone. In some of my cases where the uterus was not removed and the results were bad, the uterus was finally removed and the results were good. A lady on Fourth Street had the ovaries removed by Dr. Yandell in the earliest history of his work. That woman was exceedingly neurotic, more so after the operation than before, and finally she sent for me to remove the uterus. I would not do Afterward another surgeon removed the uterus per vaginam, and she recovered.

So.

Three years ago a lady was operated on by one of our best surgeons, who took out the ovaries and tubes. She was worse after than before the operation. After two or three years she came to me, and I removed the uterus per vaginam-it was very small-and she recovered. Now, there are a number of instances of that sort that I can remember where they recovered after the removal of the uterus, but it was probably because the uterus was diseased. If the trouble is in the ovaries and the uterus is not involved, as you can tell by an examination in the abdomen, if you will remove the cirrhotic ovaries you will find that the patient will often get well. But if the uterus is diminutive in size, or is involved in the pathologic process, then the patient will not get well unless it is removed.

DR. WILLMOTH (closing: I want to thank the members of the Society for their discussion. At first to start out with I want to say something in defense of Dr. Aud who treated this case. I say that it was not his fault that he did not see this trouble. They did not stay with him but applied to others so that Dr. Aud did not have a fair chance in this case.

Regarding the diagnosis, I spent a whole week on this girl before I gave an opinion as to what the condition was. None of the doctors who had treated her had had their attention called to the tubes and ovaries. They had all treated her for stomach trouble and nothing else. She said that whenever she would eat anything her stomach would become distended with gas. They had never suspected that it was a neurotic condition and had treated her for stomach trouble. She had some symptoms of ulcer of the stomach, some of gall bladder trouble and some of movable kidney. I worked on the case one week before I made a diagnosis. I

did it by exclusion. Dr. Allen did the gastric analysis for me. I had to exclude gall bladder trouble and kidney trouble. There was but one thing left and that was a reflex condition from the tubes and uterus. There was slight tenderness over the ovaries. She was thin and it was no trouble to get the ovaries down so that they could be easily palpated. In regard to Dr. Weidner's criticism, this girl had been in this condition for five or six years. She started out with a neurotic condition' which became a chronic condition.

When this girl came from under the anesthetic she was at herself and began to improve and has continued to improve ever since. She has gained forty-five pounds since the first of January. Now as to Dr. Weidner's statement that the time has not been long enough to say whether or not she is cured, I am not worried about her drifting back into her old condition.

So far as the removal of the ovaries is concerned in a young girl, I want to say that ovaries of this kind are already removed by nature. I am satisfied, though the ovaries have not been examined by the microscope, that there is not the slightest trace of ovarian structure in either one of them. They did not look like it when removed. They were about this size. She had not menstruated for seven or eight months. As to the question of the removal of these ovaries, there is no reason why they should be left, as they contain no ovarian structure whatever. The uterus was an infantile one. It would not have been of the slightest benefit to her if she had succeeded in getting over this neurotic condition. She never could have become pregnant; that was an impossibility for her. As you all know, there is very little said about the relation of this condition of the ovaries to mental conditions. Dr. Wathen will bear me out that the majority of these cases that present this type of mental condition have cirrhotic ovaries.

So far as the removal of the uterus is concerned, I can see no reason why the uterus should be left after both tubes and ovaries have been removed. It is an entirely useless organ then. It is one of the safest operations that we do, and if left it may give trouble afterward. As Dr. Wathen has said, it may undergo changes which may necessitate a second operation.

This girl certainly has made a most remarkable recovery, and I am not worried about her lapsing back into this nervous condition. She appreciates the relief that has been afforded her, and I do not believe there is any danger of her getting back into her old condition later on.

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Editorial.

THE TREATMENT OF
BRIGHT'S DISEASE.

One of the difficult propositions of the general practitioner is the management of the diet in Bright's disease, and, in a paper lengthy and scholarly, Dr. W. H. Porter presented some remarks upon the management of the diet of patients suffering with Bright's disease, which is well worth study. In the course of his remarks upon this subject, the following is all-important, and is, in the opinion of the writer, to be borne in mind in the treatment of this most serious malady. In Bright's disease, as well as in many other affections, notably diabetes, the diet, or rather its management, is one of the potential factors for good or evil in the management of these diseases. Dr. Porter sums up the situation in the following:

"The chief and all-important treatment consists in the perfect management of the diet in accord with our advanced knowledge as to its composition and utilization by the system. Here, as in all other diseased conditions, as well as in health, the well-regulated mixed diet is the ideal one. The milk diet, which has been so long extolled in the dietetic management of all renal affections, is largely deficient in that complex substance in which the iron and phosphorus atom is combined. with a proteid known as nucleo-albumin, and out of which the hemoglobin for the blood and the lecithin for the nerve tissue is formed by oxidation reduction. Hence, milk cannot be considered an ideal diet in any class of lesions in which a progressive anemia is one of the essential features, as is the case in connection with all renal lesions.

"A well-regulated mixed diet is one that is composed of both the vegetable and animal class, but in which the latter largely predominates. When nature, unaided, cannot digest such a diet, she often can be assisted by the judicious administration of medicinal agents."

A SERUM FOR
CARCINOMA.

In the British Medical Journal for April 29th, in what might be regarded a symposium on the subject of carcinoma, and especially in a paper presented by Dr. Geo. T. Beatson, of Glasgow, on this interesting subject, he reviews the work of a number of investigators who are endeavoring to work out the cause of cancer. Among many, he especially mentions the work of Prof. Doyen, who has discovered, or rather claims as the exciting cause of cancer, the micrococcus neformans and the plasmodrophora brassica discovered by Robertson and Wade, of Edinburgh. He states that Prof. Doyen has clinically tested his theory, and claims to have found a serum which has a positive curative effect in carcinoma. If these facts can be verified, this serum will attract the attention of the profession, and should merit a careful trial.

NOTES.

DR. ROENTGEN HONORED.-At the recent convention of the Roentgen Congress at Berlin, Prof. Roentgen was honored by the erection of bronze statue upon the Potsdamer Bruke.

THE meeting of the American Medical Association, in Portland, Ore., must be numbered as one of the most successful meetings in its history, both as to the amount and character of work done and the number in attendance. Held, as it was, within the shadow of the Lewis and Clark Exposition, which is in full blast, it was a great attraction in drawing a number of visitors, and afforded them the opportunity of seeing the wonderful country of the West and its notable achievements, which have taken place in the last decade. There is no doubt that this meeting will arouse in the West a new interest in the American Medical Association.

PRESIDENCY OF THE AMERICAN MEDICAL ASSOCIATION.

IN the election of Dr. Wm. J. Mayo to the Presidency of the American Medical Association, a great compliment has been paid to the man whom the profession at large takes great pleasure in seeing his merits recognized. Dr. Mayo must be regarded as one of America's most scientific and deserving surgeons. In reaching this, the highest compliment that the profession can pay him, we are aware that it is the result of hard and assiduous labor in the field of science, and these laurels which he has attained in the fore rank of surgeons and as the director now of the greatest medical body in this country, are the result of his meritorious work.