cedure." A careful study of the course of the ball will render manipulation unnecessary of any viscera, or portions of intestine lying without the immediate netghborhood of the path of the missile.

Proposition Ninth-In cases in which the patients are too weak to endure the radical operations (laparotomy and repair of intestinal wounds), laparotomy and drainage should take their place.-Buffalo Med. Surg. Jour.

OBSTETRICS.

WHAT SHALL WE FEED WOMEN AFTER CONFINEMENT?-For-we might say centuries, the laity has insisted on giving "puerperal women” gruels, beef teas, toast water, from the first to the ninth day after confinement, and the fact is, two-thirds of the physicians have fallen into the aged groove. We think this tea, gruel, aud toast bill of fare, practically a starvation diet, irrational, impracticable, and a positive detriment to the patient. Is not the theory and practice a foolish one, when we consider for a moment that the organs connected with parturition will be more rapidly restored to the normal condition prior to conception; that the tissue changes, which we call involution, will be more quickly and perfectly accomplished, and that the new function of lactation will be more surely and plentifully established by a starvation diet. Does not common sense teach us that a diet, the opposite of a starvation one, is the proper kind to rapidly restore the uterine tissues to the normal state, and to prevent exhaustion of the patient by the unusual cell waste incident to lactation? Our plan is, to give the puerperal patient as good nutritious food as she has an appetite for, and can easily digest. The woman exhausted by labor needs rest. As soon as she awakens, give her a cup of good beef, chicken, or mutton broth; as soon as the general condition of the woman and the appetite calls for it, (a safe guide) no matter whether it is the second or ninth day, gradually give solid foods-mutton-chops, tenderloin of beef, poultry or game. I have often had patients eat a good piece of tenderloin steak the day after delivery, with a decided relish and with good results. A nutritious diet of this kind has a decided tendency to prevent puerperal women from suffering from nervous exhaustion, sleeplessness, and many annoying

and persistent nervous symptoms due to the excessive demands made on the system for the restoration of the uterus to its normal state, and for the keeping up of the function of lactation. -Med. Waif.

MENSTRUATION-CLASSIFICATION

THEORY OF OF CASES FOR BATTEY'S OPERATION.-Dr. Robert Battey, of Rome, Georgia, in his address before the South Carolina Medical Association (Transactions of 1889), stated that he had passed his sixtieth year of life. He thinks that his labors for the past twenty years have helped to unsettle certain questions which were formerly thought to be answered. During his college days, the magic eloquence of Dr. Charles D. Meigs drew beautiful pictures of the ovular theory of menstruation, and the doctrine was accepted by the medical world. But some of the details of that theory we have had to give up. The sequence of menstruation upon ovulation, for instance, Dr. Battey thinks has been conclusively disproven. Ovulation may long precede the first climacteric period, and may continue long subsequent to the second.

There is a great difference of opinion as to what is menstruation. When he asks, can a child menstruate in six months, a year, or in three years? One man answers yes, while another pooh-poohs the idea, and says no. When he asks, can a woman of seventy-five years, who has long passed the climacteric, resume her menstrual functions? One answers yes, while another says, nonsense; it is preposterous. These gentlemen simply view the shield from opposite stand-points. We must unite on a common ground before we can make progress in the physiology of menstruation.

If the term menstruation means nothing more than a periodical discharge of blood, it has little significance. As thus defined, it may exist without the ovaries and Fallopian tubes, or without the ovaries, Fallopian tubes and uterus-neither being necessary to the function. He cited a curious case in his practice. A broken down woman, addicted to morphine habit, applied to have her ovaries taken out. After cutting through an immense roll of fat, he got into the belly. Both ovaries and tubes were buried in firm adhesions. To separate them endangered hemorrhage in the pelvis. Having promised the husband that he would not greatly imperil her life, he closed up the abdomen, and left her as she was. He and her husband kept her ignorant of what had been done, but she was fully impressed that both ovaries had been completely removed. Her progress was very gratifying. Pains and nervous disturbance

ceased, and curiously she lost her menses and her monthly molimen. This improvement continued six months, when her attending physician, feeling that cure was established, informed her that her ovaries had not been removed. Immediately her menses resumed their great flow, morphine was again taken, and some six months later she returned to Dr. Battey to have the operation completed. He then extirpated the ovaries completely, when the menses again ceased, and cure was complete, and her husband having died, she plied her trade as an inmate of a bagnio with profit and pleasure.

Here we have the remarkable effect of mind upon body. This is no new thing; thus we see amenorrhea occurring upon any sudden shock.

In fifty-four of his cases, carefully traced for years, there were fifty cases in which the menopause was full and complete, but in four cases the monthly sign of the blooded flow from the uterus occurred and continued for some length of time; yet these four cases cannot be fairly used as exceptions to the law of the ovary theory of menstruation, since it is a singular fact that in the recorded autopsies of our large hospitals as high as six per cent. of supernumerary ovaries has been observed. These supernumerary ovaries are very common in the lower animals. Dr. Battey has found them in three of his cases; there was unmistakable presence of a third, and even a fourth ovary in one case.

A few years ago attention was approvingly drawn by Lawson Tait to the supposed influence of the tubes over menstruation, and it was advocated that they exercised greater influence than the ovaries. Dr. Battey has, however, often extirpated the tubes with the ovaries, but has never perceived any influence whatever upon the menstrual function that is fairly dependent upon the tubes. Even Mr. Tait has now ceased to attach importance to the tubular theory of menstruation.

Up to twenty years ago, when he began to operate, Dr. Battey accepted the ovular theory of menstruation in all its completeness. After making a number of operations—extirpating both ovaries—he was surprised to find recurrences of menstruation. Then he discovered a case of supernumerary ovary, when he thought he could understand the continuance of menstruation. But whether supernumerary ovary theory will fully and satisfactorily explain the continuance of this pseudo-menstruation remains to be proven.

English authorities especially are yet unsettled as to the justifiability of the extirpation of the ovaries solely for the purpose of effecting a change of life for the cure of diseases, Many hold that the operation is

only justifiable for the removal of positive disease, apparent in the ovaries. Mr. Tait denies that "change of life" has anything to do with the accomplishment of cure of the diseases for which we operate. But Dr. Battey still believes that change of life is the great thing we seek. The fact that he does not always get immediate results from the operation does not dismay him at all. For when he analyzes the results of Mr. Tait and others, he finds that they get no more prompt results than he does. With them one, two or three years elapse before their desired results occur-time long enough for the setting up of this cyclical process that Dr. Battey contends goes on in the female organs, and which is the essential element of cure. Hence, he holds his ground as to his theory and practice, so as to accomplish a "change of life." He believes that the modified ovular theory of menstruation is founded in truth, and will eventually be fixed amongst the principles of physiology.

Dr. Battey classifies the application of his operation into three classes of patients:

1. Cases of simple neuroses, oophoralgia and various like disturbances. He mentioned in illustration two cases sent from South Carolina. One, a young lady entering upon womanhood, had been an invalid with spinal disease, who had been for several years under many physicians in New York and elsewhere. The tatooed condition of her spinal column showed how much cupping had been done, and yet there was ample evidence of oophoritis-that it was a typical case of oophoralgia with accompanying complications. But she came to the doctor on crutches as a case of spinal disease with some ovarian troubles. He extirpated her ovaries, and in a month she returned home in health and happiness, and her cure has been complete. She is a perfect woman intellectually and socially— simply her procreative power is gone. The second case was one of oophoromania of recent date, but the case is progressing encouragingly and promises well.

2. There seems to be a wide difference in results obtained by Dr. Battey and other operators in the department of ovaro-epilepsy. His experience has been peculiarly gratifying-nine out of ten of his cases having been completely cured of their epileptic form of seizures. Probably this may be due to the great care he exercises in the selection of his cases. Epileptics frequently come to him to have their ovaries removed. But unless he can see epilepsy growing out of the perverted function of the ovaries, he will not extirpate them. One of his cases was of very long standing. The epileptic seizures had been going on so long and

frequent that he doubted the efficacy of his operation to cure. But she recovered completely after the operation. Two years later, however, the epileptic condition returned, and so violent were the seizures that she speedily died. It is a remarkable physiological and pathological fact that the epilepsy was relieved at once, and for two years after the operation.

3. Cases of oophoro-mania. At first his results were unsatisfactory and scarcely more than palliative, for the reason that alienists then turned over to him only their long-standing and incurable cases. Yet one patient who had been in an insane asylum improved sufficiently to be kept at home without restraint, and of late years her mind, though still weak, is pretty thoroughly balanced. About two years ago he operated upon a moody melancholic, which alienists regard with disfavor, and she is now well. More recently he operated upon another moody melancholic who was steadily growing worse, but who, since the removal of her ovaries, has certainly improved very much.

TREATMENT OE PERITONITIS, (J. M. Baldy, M. D., Philadelphia.) - Other than surgical means, our greatest and best channel for drainage and depletion is through the intestinal canal, by the aid of purgative medicine. Bearing in mind the principles on which this treatment rests, a purgative which produces large watery stools, is to be selected, and of these, for routine treatment, the magnesium salts are possibly the best. Again, still bearing in mind the objects of the treatment, the salts must be given in large and concentrated doses. In ordinary cases of local peritonitis it is customary to administer to the patient a teaspoonful of sulphate of magnesium or Rochelle salts, dissolved in as little water as possible, every hour, until the desired effect is produced, this effect being a large number of watery stools, even as many as fifteen or twenty if necessary; however, ordinarily, eight or ten will have accomplished the object. If we have to deal with a general peritonitis, it becomes necessary to greatly increase the dose, and I have administered an ounce of the drug at a time for three or four doses, at longer intervals, and aided the action of the medicine by repeated and large enemas, containing turpentine. There are times when the stomach will reject the salines, and then it is necessary to begin with very small doses (a quarter to half a spoonful), given at short intervals and gradually increased as it becomes possible. When the drug can not be retained at all, it is well to try some other, for instance, calomel. All of the text books object most emphatically to the use of purgatives, and as Flint says, "Clinical observation