E. Markell, Millard Hotel, Thirteenth and Douglas streets, Omaha, Neb.

UNIVERSITY OF MICHIGAN.-The Homœopathic Medical College enjoyed a year of unusual prosperity. The attendance, although small as compared with other departments, was much larger than the year previous, nearly double in fact. The year gave promise of the increasing prosperity of the present year. The department is now well under way. It has an able faculty, is free from internal discords, and with the aid of the extensive laboratories of the University and its well-equipped hospital, it certainly furnishes to its students a professional education that is not second in completeness and thoroughness to that given by any homoeopathic school in the country. The books of the superintendent show that the hospital patronage in this department last year was greater than ever before, and that the hospital came nearer paying running expenses than ever before. The new and increeased facilities given by this board in the way of a pharmacological laboratory for the proving of drugs are fully appreciated by the department, as are the additional advantages that have been provided for in pathology, clinical dermatology, and obstetrical clinics. The training school for nurses established in connection with the Homoeopathic Hospital, had a successful year and is doing good work.

AT THE OCTOBER MEETING of the Chiron Club, entertained by Dr. Russell P. Fay, at Yonkers, the death was announced of Dr. George T. Hawley, class of 1886, New York Homœopathic Medical College, practicing at Corning, N. Y. Dr. Hawley was one of the founders of the Chiron Club and was an active and zealous member until his removal from New York to Corning. The following preamble and resolutions were adopted by the club:

Whereas, The members of the Chiron Club have learned with profound sorrow of the death of Dr. George L. Hawley, of Corning, N. Y., one of the founders of the club, in the midst of a promising career of usefulness, therefore be it

Resolved, That a copy of these resolutions be spread upon the recloss of a former member and a noble and true-hearted friend and the closing of a medical career which was a credit to his profession. Resolved, That we extend our heartfelt sympathy to his bereaved wife and family.

Resolved, That a copy of these resolutions be spread upon the reords of the society, be published in the NORTH AMERICAN JOURNAL OF HOMEOPATHY, and be transmitted by the Secretary to the family of the deceased.

(Signed.) W. B. Winchell, W. T. Hudson, D. J. Roberts, Committee.

FOR SALE. Physician's and Surgeon's Library for sale, cheap. Over 200 volumes. Up-to-date works. Anatomical and Pathological plates. Send stamp for list, to P. D. Peltier, 382 Main street, Hartford, Conn.

NORTH AMERICAN

JOURNAL OF HOMOEOPATHY.

ΜΕ

Original Articles in Medicine.

THE SIGNIFICANCE OF METRORRHAGIA.*

By Theodore J. GRAMM, M.D.,

Philadelphia, Pa.

ETRORRHAGIA is the name of a symptom which unfortunately

has been frequently mistaken for the disease from which women at times suffer. This misconception has often militated against the welfare of the patient, and has consequently been attended by a certain amount of discredit for the attending physician. This misapprehension of a part for the whole, which attends all developing sciences, as medicine ever will be, has probably been fostered by the fact that until quite recently gynecological text-books have usually contained a chapter devoted at the same time to menorrhagia and to metrorrhagia. Now menorrhagia is a disturbance of the menstrual function which is exhibited in excessive quantity of the flow, and which may arise from several different pathological causes. Menorrhagia is one of the manifestations of a disturbed physiological function. In the case of metrorrhagia, however, the circumstances are quite different. It is never a variation of a normal process. When present, it is distinctly an abnormality. It is a hemorrhage from the uterus, as the etymology of the word indicates, and a hemorrhage is always caused by some serious pathological lesion. It may possibly not lead to such unfortunate error if everyone is not quite conversant with the pathological processes which induce menorrhagia; but no one is competent to measure the importance of metrorrhagia, or even to ap*Read before the Homœopathic Medical Society of Germantown, Philadelphia,

on October 18, 1897.

preciate its significance, unless he be more or less informed concerning the lesions which may induce uterine hemorrhage. In my opinion, it is essential in teaching gynecology, to keep the ideas of these two conditions very widely separated, for it is distinctly misleading for practice to say that menorrhagia consists in an abnormally profuse discharge at the time of the menses, and in the same breath to define metrorrhagia as a discharge occurring at another time than at the usual menstrual period. In thus together defining two very different conditions in the same sentence, we imply a certain relationship, while in fact there is no similarity between the external evidence of ovulation and a hemorrhage, except that both involve the discharge of a red fluid, which, however, in each case differs very materially in its physical and chemical properties, in its origin, and especially in its attendant tissue changes. If this association of widely different conditions be allowed to prevail some disastrous consequences are sure to follow. Under some circumstances this misapprehension will operate to defer quite simple surgical interference which would relieve the patient forthwith; and on the other hand, it will surely tend to postpone the only surgical treatment which promises the sole chance for preserving or prolonging life, until a time when no therapeutic measures, either surgical or medical, will avail. A matter of common experience with all who are in any way concerned with gynecological practice is that cases of metrostaxis are diagnosed with the self-sufficient term of metrorrhagia, and treatment is instituted and prolonged, which at best can only be estimated as a greater or less lack of utility. I am free to say that this subject ranks pre-eminently with those others, namely ectopic pregnancy and puerperal septic infection, to which I have recently called the attention of my colleagues, for the recent advances in medicine and surgery have greatly modified the spirit with which these subjects should be approached.

It is not my purpose at this time to describe a number of pathological conditions which are attended by metrostaxis, and from the completed pathology of the case to leave you to draw your conclusions as to what should have been the treatment, but rather I wish to briefly portray a few cases as they are apt to present themselves; and then I hope to let the clear light of pathology illuminate the correctness of my efforts to emphasize the importance of this subject.

Case I. The patient, Mrs. X., was a lady particularly well developed, but remarkably pale. The menstrual period recurred regularly and without much pain, but was prolonged beyond the usual

time, and the flow might appear during the intermenstrual period. Beyond this she was well, except that she manifested symptoms such as might be explained by the loss of blood. She had been under treatment for a long time for menorrhagia and metrorhagia. The patient then consulted a noted gynecologist, who discovered a mass in each side of the pelvis, to which the uterine hemorrhage was ascribed. Abdominal section was advised and accepted, and at the operation double hydrosalpinx was found. On the second or third day after operation she began to bleed, and her former history of metrostaxis continued with very slight modification. On examination now, the corpus uteri was found to be not much enlarged and rested in a relatively good position. When introducing the sound a peculiar roughness was felt along one cervical wall and occasionally the instrument was momentarily impeded. The cervix and vagina presented nothing abnormal, except the excessive paleness. I determined to dilate the cervix during anesthesia and examine the uterine cavity. This was done, and I found and removed a fibroid polyp, about two and a half centimeters in diameter, attached by a very short pedicle low down in the uterus, and from that day to this the patient has had no show.

Fibroid polyp, then, may cause metrorrhagia, as is well known, and it is remarkable of what small size these intra-uterine growths may be, and be capable of prolonging the mischief which their presence induces. The physician, likewise, has often received easily earned applause by relieving such serious conditions as these growths may occasion, and that by an operation which is not difficult to perform.

Case II. Many similar circumstances attended a case of large double ovarian cystomata which I operated not long ago. For the sake of brevity, and not to deviate from our objective point of showing the importance of intra-uterine polyp as a cause of metrostaxis, I shall not recite the history of the case relating to the ovarian cysts. Suffice it to say, they were large enough to make the diagnosis clear and the indications for operating certain.

The patient, Mrs. W., was certainly in a bad condition, for in addition to the symptoms induced by the cysts, such as pressure symptoms, disturbed digestion and others, she suffered from persistent metrorrhagia which had contributed to affect her health most seriously. On examination per vaginam, the examining finger was able to detect a small intra-cervical polypoid growth. At the abdominal operation, the ovarian tumors were removed with comparative

ease and thereafter the patient made a recovery which was all that could be desired, except that she still continued to bleed, and this was a source of great discouragement to her. In the third week after the section, the cervix was dilated, the cavity of the uterus thoroughly examined and the polyp removed. It was but insignificant in size, two and a half centimeters long and not quite a centimeter in diameter. A suspicion of malignancy could not be altogether disregarded, for the presumption seemed plausible that the major operation should have done much to diminish the persistent uterine hemorrhage, but which it had failed to do. The polyp after removal was carefully prepared for microscopic examination and proved to be of the glandular variety, as the accompanying photo-micrograph shows.

Case III-A foreign body or a body virtually foreign in the uterus is a cause of metrorrhagia. The two previous cases have illustrated this, and the fact will be further exemplified by the case of Mrs. O., who had miscarried in the early months of pregnancy, and had been under the care of a physician. The process of abortion was