weeks after menstruation, which continued for one month and up to the time of menstruation. Pain is the most constant subjective symptom of this disorder, and, as a rule, it is this which. the patient first complains of, although the menstrual irregularities may precede it. One patient told of a slight pain on the affected side for some weeks before the acute attack, the others remembered only the sudden, severe, cramp-like pains in the lower part of the abdomen, which are almost pathognomonic. The pain in these cases. was probably the more characteristic because of the fact that they were all of the tubal variety. All of the patients complained of a "sick feeling" at the time of the severe pain, and one of them fell on the floor in complete syncope. Acute anaemia with slight air hunger, the result of internal bleeding, was present in three of the cases, but it could hardly be considered severe enough to seriously threaten life except in one instance, and then recovery from the operation was prompt and uneventful. All of the patients but one showed an increase in the pulse rate and a rise in temperature at the time of admission to the hospital. In one case a temperature of 104° F. and a pulse of 146 were recorded, both of which dropped to the normal twenty-four hours after the patient was put to bed. Aside from this a temperature of 102° F. and a pulse of 120 were the highest observed. Examination of these patients showed more or less marked rigidity of the abdominal muscles and tenderness on pressure, especially on the affected side. Vaginal examination invariably disclosed a tender, soft and indistinctly fluctuating mass in one fornix. In the three cases in which rupture and bleeding had occurred the mass was larger and less definite in outline, and occupied the posterior cul-de-sac. There was slight enlargement of the uterus in all of the cases but one. The passage of a membrane from the uterus, which is so commonly described in these cases, was observed in but one instance. This membrane was in the form of a complete cast of the cavity of the uterus and was expelled on the fifth day after the operation on a patient who had missed two menstrual periods. As will be seen from a review of the symptoms, diagnosis of these cases was not particularly difficult. All of the patients had one or more attacks of severe, cramp-like pains in the lower part of the abdomen; three of them showed marked evidence of internal hemorrhage; four of them complained of menstrual irregularities; five of them had a slight enlargement of the uterus; and, without exception, rigidity and tenderness of the lower part of the abdomen was elicited, and by means of vaginal examination a soft, tender tumor was found in one of the fornices. In spite of the typical symptoms in one of the unmarried cases, the family physician, unduly influenced by his knowledge of the patient's life and surroundings, disputed the diagnosis and was only convinced of the possibility of pregnancy by the extraction of a three and one-half inch fetus from the left Fallopian tube. The treatment of these six cases was practically the same in evry in evry instance, namely: median abdominal incision, sponging the peritoneal cavity free of blood and salpingooöphorectomy of the affected side. In three of the cases considerable blood was found in the pelvis, and in the others only a small quantity was found, it being probable that this small amount of blood was forced out through the fimbriated end of the distended tube without actual rupture occurring. An embryo was discovered in but one case, a thickened tube distended with blood and containing chorionic villi being the usual findings. The tube and ovary were removed in every case; the ovary, because it was always adherent to the sac and promised to form new adhesions to the intestines if left in place, and also because it was always enlarged, oedematous and softened, and therefore likely to create dysmenorrhoea and other painful symptoms if not removed. Both tubes and ovaries were excised from one patient as a means of prophylaxis, because she was halfwitted and given to roaming the streets at all times. What degree of good judgment was displayed in the treatment of this case it is left to my hearers to decide. Drainage of the peritoneal cavity through the lower end of the wound was resorted to in two of the cases because of the extent of the injury to the peritoneum at the site of the adherent sac. It is probable that both of these patients would have made good recoveries without drainage, and in the light of his more recent experience the writer would advise complete closure of the abdominal wound in similar cases. One patient suffered considerable depression at the time of operation and received an intravenous saline infusion. She developed a femoral phelbitis on each side during convalescence, but eventually made a complete recovery. None of the other patients suffered from any complications, and all were up within three weeks from the time of operation. The question of the treatment of ectopic pregnancy has aroused much discussion during the past ten years, and even now there can hardly be said to be a unanimity of opinion in the matter. Different methods must doubtless be followed in the care of early and late cases. The late cases, however, will surely become even less frequent than at present, as the symptoms and the methods of diagnosis of the condition become better known, and the arrest of the progress of the disease by operative procedure is still more widely exploited. The course of the cases here reported seems to bear out the belief of the majority of good authorities that a pregnant tube should be removed as soon as it is recognized. By no other means than this radical cure can the patient avoid the dangers that menace her health and life. Attempts have been made to classify the different conditions that may be present in ectopic gestation, and on this basis to rule out certain classes of cases from the necessity of operative cure; but the diagnosis has not, we believe, been brought to such perfection that we can thus declare a particular patient free from danger and therefore exempt from the necessity of operation. Under the proper conditions and with the necessary equipment at hand the modern surgical operation has become comparatively free of risk to life and the mortality percentage is now exceedingly small. Does any one believe that extrauterine pregnancy treated by the expectant method will ever be robbed of its terrifying dangers? The method of attack in these cases varies with different operators, the majority favoring abdominal section, while others, who have perhaps achieved unusual skill in vaginal section, prefer the latter route. The claims made for vaginal section are that the patient suffers less shock, and that a larger percentage afterward bear children than they would if subjected to laparotomy. The great objection made to the operation is that the control of hemorrhage is not certain, and for this reason laparotomy will often be necessary after vaginal section has failed. Many cases of this sort are on record, and operators have not infrequently regretted the necessity of thus exposing their patients to the added dangers of a double operation at a time when they were illy fitted to withstand the shock. While the writer greatly prefers abdominal section in most instances, he is willing to concede that vaginal section may be the better method at times, and he has recently employed it in a case with very great satisfaction. The reason for following the method in this instance was that no distinct tumor could be palpated, and, while the course of the case was very suspicious, there was considerable doubt as to the diagnosis. The exploratory incision into the posterior cul-de-sac disclosed some tarry clotted blood and a thickened but empty Fallopian tube. Drainage through the opening effected a speedy cure. Conclusions drawn from so small a number of cases may be very faulty, but the writer's reading and experience lead him to believe that extrauterine pregnancy is a surgical condition; that the utmost care should be exercised to reach a diagnosis early in the condition, before rupture if possible; that operation is the only proper treatment; and that recovery may be expected in a large percentage of these cases if they are subjected to this prompt and radical treatment. THE INFLUENCE OF WEATHER CHANGES UPON MAN AND SOME LOWER ANIMALS, WITH A RECORD OF EXPERIMENTS ON PIGEONS. E. H. BARTLEY, M.D., AND W. L. CHAPMAN, M.D. That weather changes have a distinct and noticeable effect upon many animals, including man, has been popularly known for centuries. These effects are mostly such as to produce a noticeable change in behavior some hours before the approach of a storm, and in a general way, the disturbance is in direct proportion to the severity of the atmospheric disturbance. The change in behavior of the lower animals before a storm has generally been spoken of as an instinct, without any attempt to explain it on a physical basis. That there is some physical or psychological basis of these phenomena there can be no doubt. The effect of atmospheric changes on neurotic individuals, rheumatic and gouty subjects, persons suffering with neuralgia, infectious diseases, phthisis, pneumonia, etc., can not be explained on any other supposition. Dexter, in his recent book on "Weather Influences" arrives at the conclusion that the disturbances are purely nervous or psychological. He conducted an extended study of the relation between changes in weather and the deportment of children at school and of inmates of prisons, the records of arrests for assault, cases of suicide, sickness, drunkenness, and occurrence of errors made by bank clerks. He arrives at the conclusion that there is a discernable relation between weather changes and sickness as well as deportment. He has made no inquiry into the kind of sickness produced by weather changes, nor does he give us a tangible explanation of the facts observed. From observations upon lower animals, one is forced to believe that those most affected are insects like the ant, the bee, and birds. The nervous system in the lower forms of life differs from that in man in having a much more highly developed sympathetic than a cerebro-spinal system. From this fact one might infer that whatever these influences are they must affect largely the sympathetics. In support of this idea, we have the well known influence of weather changes upon the intestinal disorders of infants, such as a prolonged hot dry spell, or a sudden change from hot to cold, damp weather, etc. This is because of the fact that the secretory and motor functions of the intestine are depressed or inhibited, and these functions are under the control of the sympathetic nerves. Similar effects are observed in some adult subjects of intestinal indigestion with autointoxication. We have under observation three cases of this condition who all affirm that they can predict a storm by the ballooning of the large intestine, and concomitant nervous disturbances, which can only be explained by an inhibition of either the secretions, the motor function of the intestine, or both of these. In three cases of habitual pretempestual disturbances an elevation of about one degree in temperature was repeatedly noted. A similar rise in temperature has been observed in rheumatic and tubercular subjects. Whether these slight disturbances, in the latter cases, are due to the nervous disturbance or some other cause connected with the malady it is impossible to say, but in the three cases of habitual disturbance, hysterical in character, the elevation in temperature was certainly from a disturbance in the nervous system, probably the sympathetic. The sole cause of the production of animal heat is chemical change or a combustion of tissues and food products. Or, to put it in another form, an increase in body temperature means an increase in tissue metabolism, which process is controlled through the trophic action of the sympathetic ganglia. The origin of the nervous impulse which starts the increased action might be in the heat centers in the corpus striatum or it may be in the solar plexus. It would be difficult to suppose that such impulses could originate from such a cause in the cerebrum of a bird or an insect. As the influence is more marked in lower animals in whom the sympathetic is most highly developed, it would seem more logical to believe that the impulses originate in the sympathetics. To place in review the symptoms noted in human subjects, viz., neuralgias, rheumatic pains, asthmatic and gouty attacks, nervous agitation, inhibition of motor and secretory functions in the intestines, with increased activity of intestinal bacteria, the increased metabolism in the tissues, irritability of temper, changed deportment, increased tendency to drunkenness, etc., one has an array of symptoms which show a marked disturbance of the nervous system and metabolic processes. Some of these sensory disturbances can not well be observed in the lower animals, but the metabolic changes ought to be studied in them with comparative ease. If we take an elevation of temperature as a measure of increased tissue change one would expect to find more disturbance of temperature in the lower animals than in man, provided that the origin of the disturbance was chiefly in the sympathetic ganglia, because of the predominance of the abdominal brain in these animals. We should expect the greatest temperature changes in those animals whose temperatures are most fluctuating and most easily disturbed. The temperature of birds is more erratic than in most other animals, and we should expect them to show such changes under weather influences more readily than most mammals. Moreover, the ability to predict storms seems to be more highly developed in birds than in most other animals. The authors are able to confirm the above conclusions by a series of experimental observations upon pigeons. These results we obtained as an accidental occurrence in the course of experiments undertaken for an entirely different purpose. In the fall of 1892, one of us in conjunction with Dr. A. C. Brush of this city, performed some experiments on the production of malaria. in pigeons, by the subcutaneous injection of water residues prepared by passing a large quantity of the water through a Chamberlain filter, collecting the residue, washing it out of the filter with sterilized distilled water, allowing the coarser particles to settle, and injecting the remainder into the breast muscle of a series of pigeons. The blood of the birds was examined for the malarial plasmodium both before and after the injections. The results were presented to the Medical Society of the County of Kings, and were published in the BROOKLYN MEDICAL JOURNAL in January, 1893, page 45. Pigeon 12 13 14 15 No. 23 A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M. 16 17 1061 106 107 107 108 107 107 107 106승 107동 1063 1063 107 108 106 107 1075 105층 1078 108 106 107 106 107 107 12 109% 107 These results showed that while the blood of the birds appeared to be normal before the injections, after the injections the blood of those that had received the water residues contained the characteristic Laveran plasmodium. The blood of the control birds did not show these organisms, and Dr. Brush, who was ignorant of which were the control pigeons, was able to differentiate them, except in one bird, in which he failed to find the plasmodium, although it had received the same amount of residue as the rest. Although the temperatures were not taken as regularly as they should have been, for lack of time, there appeared to be an elevation of temperature on the fourth day after the injections, and the birds showed that they were not well. The fifth day they seemed better, and on the sixth they appeared sick. The temperature observations made during that series of experiments were too few to be of any scientific value. After waiting some years in the hope that some one would repeat the experiments, the authors of this paper took up the repetition of the work with the intention of keeping a careful record of the temperatures of the birds, both before and after the 109 1071 107 109 108 eons. On the 9th of September, 1896, we obtained twelve healthy young pigeons. They were placed in six light, airy cages, putting a pair in each cage. Everything was done to make their surroundings hygienic and comfortable. After five days, we began on the 14th to take their morning and evening temperatures, to obtain the normal temperature of each bird. It was found that the range of temperature was considerably higher in these pigeons than in those under observation in 1892, and there was variation in the same bird. With the exception of one marked disturbance, referred to below, the greatest variation in temperature in the same bird was about one degree. From the table (see Chart I) it will be seen the average temperature for the seven days was between 106° and 107° F. except in one bird, in which it was 105 2-5° F. For the first four days the temperature was rather regular. On the fifth day a marked rise in tempera It was difficult to account for this fluctuation of temperature, as nothing had occurred during the day to excite or worry them. During the night, however, the explanation came in the form of a heavy shower attended by considerable thunder and lightning. It will be seen by the record of the temperatures that the disturbance lasted all the next day, and in birds 5 and 6 it lasted until the morning of the following day. The disturbance lasted 48 hours in some of the birds, while in others it lasted but 24. It will be observed that in some of them the temperature had fallen in the morning of that day, while in others it had begun to rise, i.e., the disturbance began to be felt 18 hours before the storm. It will be seen that the rise in temperature during that day was from 22° to 32°, while in bird No. 2 it was 42° F. Whether this rise in temperature of birds before a storm is general, we have not been able to find out. We have not been 104 и Bird 6. After inoculation.. as for example in quails, prairie chickens, turtle doves, stork, and in domestic fowls. It is suggestive of a line of inquiry in regard to the well known effect of storms upon the human subject in certain diseases. It is a well known fact that the temperature of birds is more easily disturbed than that of the human subject, and the fluctuations would be expected to be greater in them than in man. It is probably this sensitiveness to disturbances in temperature that enables birds to feel the approach of atmospheric changes sooner than mammals. For the same reason, persons who are ill, being more sensitive to changes of temperature, or with already disturbed temperature, are more easily affected by atmospheric disturbances than the healthy. It is extremely probable that the above noted disturbances due to an approaching storm are not all due to a fluctuation of temperature, but to an unexplained disturbance in the sympathetic nervous system, or, possibly, the circulation as well. In birds, however, we can easily understand that if this observation be confirmed, a rise of 3° in temperature might account for all the feelings of impending danger shown by them. After the temperatures had been watched for the week, as above mentioned, the birds were allowed to remain about two weeks longer, and then on the 11th of October they were considered ready for the experiment. Birds Nos. 1, 2, 3, 5, |