street and Chicago avenue. Some time after the fire a relative of Dr. Winer found some boys kicking the monster about the street, took possession of it, and returned it to the owner. Dr. John K. Winer was persuaded by me to present the specimen to Rush College.

The baby has suffered from its knocks about the world, and attempts to play the phoenix, as is evidenced by the mutilated head, absence of its third leg and arm.

The monster is an example of a dicephalic, tribrachius, tripus monster. The third arm springs from the back, while the third leg is attached to the sacrum.

Dr. ALLEN B. KANAVEL read a paper (by invitation) entitled UNCOMPLICATED VARICOSE VEINS OF THE FEMALE PELVIS.* Dr. FRANKLIN H. MARTIN.-I feel my inability to discuss this paper adequately and to take the responsibility of discussing it alone. I expected to have had the assistance of Dr. Ries and Dr. Webster. Dr. Webster, in a conversation I had with him, stated that this subject was one of great importance, and one in which he was much interested. There is difficulty in discussing the subject, because of the newness of it, and the fact that very little has been written upon it. Up to this time we have been accumulating very slowly the facts, and after Palmer Dudley's paper, in 1888, and the slight ridicule it met with because of his position that the condition was analogous to varicocele in the male, it was difficult for any one who was not vitally interested to take up the subject. However, in the meantime facts have slowly accumulated, and I think we owe a great deal to the essayist for collecting those facts in the masterly manner he has, and presenting them as he has, and drawing very judicial conclusions from them. Since my attention was called to this condition by Dr. Kanavel at an operation during which he assisted me, I have seen quite a number of these cases, comparatively speaking, and I think any abdominal surgeon will, after hearing this paper, if he has not had his attention called to this condition before, immediately cast about, and in his mind's eye will recall a number of such cases, either complicating fibroids or otherwise. In a fibroid case very frequently a bunch of grape-like veins will be seen draped beneath the ovary, and at the same time large veins passing through the base of the broad ligaments. The condition will be seen frequently in cases of retroversion, in cases of prolapse, where there has been more or less mechanical interference with the return flow, and, in short, in more cases than we would believe until the matter has been looked into carefully.

I am going to report a case of considerable interest bearing on this subject, and one which illustrates, I believe, the rupture of

varicose veins.

There is one point on which I would like to speak, and that is, one of the symptoms which I believe may be characteristic of this condition is complained of by a great many women, namely, her inability to stand without pressure and pain in the pelvis. The woman will tell you that she can walk, move about, can assume any sitting position, and work, but standing is extremely painful and causes pressure in the pelvis. That may be accounted for by the distention of the veins and the fact that the pressure cannot be relieved by the movements of the muscles in the pelvis, which would tend to transmit the blood on through the enlarged veins. I have inquired into the case I am going to report presently with reference to that symptom, and it has been brought out very strongly.

*See original article, page 480.

In 1901 I operated on a young married woman who had not borne children and who had not miscarried, for symptoms caused by a well-defined tumor in her left side. A number of adhesions were found, covering a retroverted uterus, and a hematoma of the left broad ligament containing about six ounces of thick blood was evacuated, the superabundance of peritoneum incised, and ligatures placed on the uterus and pelvic side of the cavity. A cyst was excised from the right ovary, and the uterus, after freeing it, was suspended.

In 1902 the patient returned, said that she had not been well, that her menstruation had been profuse and irregular, and on examining her I found that she had a. well-defined tumor again in the left side. Her symptoms indicated ectopic pregnancy without rupture. She was sent to Dr. Byford, and he confirmed the opinion that she should be operated on, he, too, diagnosing ectopic

pregnancy.

The operation revealed another large hematoma of the left side, with no microscopical signs of pregnancy. At this time my attention had already been called to varicose veins of the broad ligament by Dr. Kanavel in one of my own cases, and I was on the lookout for such cases. This case presented well marked varicose veins on both sides of the pelvis, and the hematoma was undoubtedly due to a subperitoneal rupture of one of these veins. The hematoma was evacuated and a ligature placed at the pelvic side, over the infundibulo pelvic ligament, and another at the uterine side, and, as before, the superabundance of broad ligament cut away. Two bunches of veins presented on the right side, one beneath the ovary and tube, the other in the base of the broad ligament, extending from near the cervix to the side of the pelvis. These were each ligated at their uterine and pelvic ends, but not severed.

In October of last year, this woman, who, by the way, seems to be in perfect health following her operation, returned to me for the third time, with a well-marked tumor developed in the left. side. It was about four inches in diameter, well defined, with the semi-fluctuating feel of a recently ruptured extrauterine pregnancy. The uterus was crowded to the right side. I suspected a third hematoma, instructed the woman in regard to the difficulty, warned her to notify me on the development of hemorrhagic symptoms, put her at rest, placed elastic tampons in the vagina daily, with an abdominal bandage for counter pressure, in order to exert pressure on the tumor, gave enormous hot water douches twice a day and advised quiet. The tumor gradually but definitely disappeared, so that at the end of a month it could not be palpated. The symptoms during the time this hematoma was present were pressure, bearing down pains, and excessive and irregular menstruation. I believe that it was a third hematoma, developed from varicose veins.

I have seen several cases of varicose veins of the broad ligament complicating retroversions with adhesions, fibroids of the

uterus, and diseased appendages, but can remember but one which might be called a primary case. This one, the mother of two or three children, was brought to me for menorrhagia and indefinite pelvic pain, with a diagnosis of cystic ovaries. Upon examination under ether, an irregular, not well defined mass could be felt in both broad ligaments. The uterus was enlarged. On opening the abdomen the ovaries were practically normal, and the tubes normal, but blue and enlarged. I was at a loss to account for my findings at examination. On closer inspection, a cluster of varicose veins two and one-half inches in length and two inches broad occupied the top of the broad ligaments on each side, dropped beneath the ovary and tube, seen plainly from its posterior aspect. In the base of each broad ligament were large blue veins, not corrugated. I tied the varicose masses at the uterine and outer ends, on the upper side of the broad ligament, and the uterine end on the lower portion, but did not sever any tissue.

This illustrates a case where the varicose veins could be easily palpated, although I did not interpret aright.

In regard to this case, that woman, as a coincidence, came into my office to-day in great distress, saying that she was sure another tumor had developed, because she had the same symptom presented as in the other three cases, which was peculiar, and described by her as a sensation of deadness. She felt a numbness or coldness in the part, with the extension of pains down her limb. I examined her to-day and found that she has another hematoma, I believe, about the size of an orange, three inches in diameter, which has developed within the last three weeks. I sent her home and advised rest.

DR. ALBERT GOLDSPOHN.-It is very well and fruitful that we should take up this subject for consideration, and it has been done in a very commendable manner in the paper that has been read this evening. If I remember rightly, the statement was made that the first case was pointed out by someone in the seventies. In looking at several text-books for a few minutes this evening, I saw that Pozzi says that Richet and Berlioz, his student, two Frenchmen, describe the condition, the first one in 1854, and the second in 1858.

In regard to the anatomy the essayist spoke of, that is the cause of the more frequent occurrence of varicocele in the male and varicose veins in the broad ligament in women on the left side, I did not hear him say anything about the details of the anatomy accounting for this very well-known general fact. The best anatomy to explain the reason for this predominance of varicosity on the left side in both sexes is that the ovarian or spermatic vein empties into the renal vein at a right angle on the left side, and the blood passed around the right angle, whereas on the right side the respective vein passes almost directly in a straight line upward into the vena cava; therefore the circulation of blood from the left ovarian side is more obstructed than is that in the right vein.

Of the things I have heard mentioned, this is the most plausible one, in my opinion, to account for this phenomenon.

The whole subject of varicose veins in the pelvis of females to me has been a live one for a number of years, and I have always, no matter what operation I did upon the uterus or appendages, which was not a total hysterectomy, aimed at carrying out a technique in such a way as to destroy the veins in the broad ligament to the greatest degree. The essayist has very properly called our attention to the presence of large veins, a very general fact in cases of any pathological condition, that occurs about tumors, about sclerocystic ovaries, and even in cases of ordinary retroversions. He has intimated that a varicose condition of the veins probably causes a sclerocystic condition of the ovary. This undoubtedly is true to a certain extent, but whether the ovary and its attendant condition, irritating the organ, would be the cause of an additional afflux of blood to the parts, and the gradual development of varicose veins, is also to be considered. We know that if any member in the human body is irritated by the presence of a foreign body, as we can say such an ovary is a disturber of health, we get an enlargement of that member, which is not necessarily inflammatory, but simply vascular, and that factor may be easily accounted for in the female pelvis. The observation that the larger varices that have been discovered, diagnosticated, or suspected in patients were emptied out, and the symptoms relieved by the patients assuming the recumbent posture, is a very significant one, teaching us a lesson in regard to the treatment of pathological conditions in the female pelvis in general, namely, that the horizontal posture is our best friend for the treatment of most pelvic lesions.

Again, after surgical procedures in the pelvis, after we have removed something, have created a wound internally and inserted sutures to close it, the rational thing is for the patient to be put in the recumbent posture long enough for cicatrization to have thoroughly formed in those parts that have been operated on, and such patients should not be prodded to get up on their feet, to strut about, nor be permitted to do so too early, as such advice is wholly irrational. The rational thing in these cases is to empty out the varicose veins by the recumbent posture. As I have said, it is irrational to permit them to assume the erect posture too early.

I have treated young girls who were suffering from ovarian neuralgias, they were schoolgirls who had barely experienced the first menstruation. Their neuralgias would not stop under the best treatment of medical men, and they were in the hands of good men. I made repeated rectoabdominal examinations in those girls, and discovered large cystic ovaries. In older persons I would have been bold enough to have advised some surgical procedure; but the genital organs of these children, so to speak, are not to be tampered with by topical treatment. It would make matters worse. I have stopped their pains by putting them in the Trendelenburg position, in a hanging position in a bed, with its foot elevated, and