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of this kind was called for, and the child was taken home on the second day, apparently able to swallow with very little difficulty.

The accompanying figure illustrates the exact size of the object with the pin which, fortunately, had been somewhat loosened, probably before the child swallowed it; this fact having made it easier to disengage than otherwise would have been possible.

It was photographed with the painted side up in order to illustrate the exact nature of the toy which the child was allowed to put into its mouth. One entire limb and part of another have been broken off ; just when, cannot be told, but the pin was withdrawn in the exact shape illustrated here.

Fibroid Tumor Complicating Gestation-Hysterectomy

Recovery.

By F. D. THOMPSON, M. D., Fort Worth, Texas. Professor of Gynecology and Surgical Diseases of Women, Medical Department, Fort

Worth University.

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(From The Teras Medical Gazette, June, 1904.] THINK the following case is of sufficient interest to the pro

fession to justify me in reporting it:

On Thursday, April 14, 1904, Mrs. L., white, American, age 33, married twelve years, no children, no miscarriages, complexion fair and general health good, came to me from Canton, Ga., on account of an abdominal tumor which was growing rapidly. During the year 1903 her menstrual flow was increased in duration and quantity. In the early part of December, 1903, her flow ceased entirely and has not appeared since. In January, 1904, the patient observed a tumor just above the pubis and a little to the left side, and during February and March she suffered much with nausea. On examination I found a tumor extending from the cervix of the uterus to two inches above the umbilicus. The lower half of the tumor was very hard and firm; the upper half was soft as compared with the lower portion. The cervix, which was not involved, seemed to be attached to the center of the hard part of the tumor. As much of the tumor seemed to be in front of the cervix as behind it.

With this history and condition, I made the diagnosis of a fibroma occupying the lower portion of the uterus complicated with a four months' pregnancy in upper portion of the uterus. I advised an operation, consisting of the removal of the uterus and the appendages, as giving the patient the best chance for her life. This was consented to and on Saturday morning, April 16, 1904, I did an abdominal hysterectomy, removing the uterus, ovaries and tubes. The operation was performed as follows: the abdomen was opened freely, the incision extending an inch or more above the umbilicus; the uterus was lifted out of the abdomen ; the ovarian artery on the left side was ligated; the clamp forceps placed next to the uterus; the artery and broad ligament were cut between the clamp and the ligature down to the round ligament. This was ligated and a clamp placed next to the uterus; the round ligament was divided and the broad ligament cut down

[graphic]

THOMPSON: FIG. I.--Fibroid and Pregnancy. Anterior view.

to the uterine artery at the junction of the cervix with the tumor. The folds of the broad ligament were slightly separated; the uterine artery was ligated by passing a threaded aneurism needle under it; a clamp was applied next to the uterus and the uterine artery was then divided. The peritoneum from the broad ligament on the left side extending to the broad ligament on the right side and about half an inch above the bladder in front, was divided with the knife. The peritoneum and bladder were dissected down slightly below the junction of the cervix with the body of the uterus. The peritoneum was divided in the same way on the posterior surface of the uterus and tumor and pushed down to the cervix, then the cervix was separated from the uterus and tumor. When it was cut through, the tumor was lying well over to the right side, the right uterine artery could be seen and felt between the folds of the broad ligament. This was ligated, clamped, and divided. The broad ligament was then divided up to the round ligament. It was ligated, clamped, and divided. When the broad ligament was divided to the right ovarian artery, this was ligated and cut including the infundibulo-pelvic liga

[graphic]

THOMPSON : Fig. 11.–Fibroid and Pregnancy. Posterior view.

ment. This completed the separation of the uterus, ovaries, and tubes from the patient. The ovarian and uterine arteries were re-tied for safety. I then closed the stump of the cervix (which had been hollowed out during its amputation) with ten-day catgut sutures. I next began with a continuous catgut suture to unite folds of the broad ligament by starting where I put the first ligature on the left ovarian artery, continuing down to the cervix and turning in the ligated ends to the arteries. When I reached the cervix I closed the peritoneum over it, continuing in the same way until I reached the ovarian artery on the right side. When this was done the pelvis was absolutely clean showing only the continuous suture that had brought the edges of the broad ligament together. The abdomen was closed in the usual way and the patient put to bed in good condition.

I then opened the fundus of the uterus and exposed the four and a half months' fetus. The wall of the uterus when opened was not more than an eighth of an inch thick. So much of the uterus was involved in the fibroma that I believe the uterus would have ruptured long before the full term of gestation was reached.

The patient made an uninterrupted recovery, leaving the infirmary apparently well four weeks after the operation. The cuts indicate the position of the fibroid and fetus.

SOCIETY PROCEEDINGS.

Buffalo Academy of Medicine.

Section on Medicine, December 13, 1904.

REPORTED BY FRANKLIN W. BARROWS, M. D., Secretary.

At the stated meeting of the Academy, December 13, the following program was presented by the Medical Section.

Dr. D. L. EDSALL, of Philadelphia, read a paper entitled,

THE DIETETIC USE OF PREDIGESTED LEGUME FLOUR PARTICULARLY IN ATROPHIC INFANTS, WITH A STUDY OF ABSORPTION

AND METABOLISM.

(AUTHOR'S ABSTRACT.) The study was undertaken largely for the purpose of determining whether it is possible to give to infants that have difficulty in digesting a sufficient amount of milk proteid an amount of vegetatle proteid that would be of nutritive importance to the child. A series of cases of atrophic infants were given bean flour in their milk mixtures, the four having previously been predigested by means of a diastatic ferment. The clinical results, considering the class of patients, were in most instances remarkably good, the condition of the bowels usually improving and a large proportion of the babies making very rapid and good gains. The studies of absorption also show that the bean proteid in this form was quite as well absorbed as the milk proteid. A nitrogen metabolism experiment was also carried out on an adult. When bean four was substituted for about an equal food value of milk the patient gained quite as well as he had on the previous diet and also showed somewhat more nitrogen retention than he had on the previous diet. The absorption in this instance was very slightly less good, this being perhaps due to the fact that there was some digestive disturbance at first when a large amount of bean flour was suddenly added to the diet. The reason for this favorable influence of bean flour perhaps does not lie solely in its large nitrogen content. It seems wholly possible that it is due to the nature of the proteid in the bean, the relation between this and the proteid of the nuclei of animal cells being sufficiently intimate to suggest this.

DISCUSSION.

Dr. Irving M. Sxow.--The importance of the proteid content of food in its relation to metabolism, is shown by the fact that the human infant, which receives 1/2 per cent. of proteid in its food, doubles its weight in three or four months, while the dog, with 4 per cent. of proteid in its food, doubles its weight in three or four weeks. I have never seen infants gain so rapidly, under any method of feeding, as in the cases that Dr. Edsall has reported tonight. I have often thought that the principles of infant-feeding might with advantage be applied to the feeding of adults in such conditions as are often found in typhoid fever and other diseases.

Dr. Dewitt H. SHERMAN.-In beginning to feed infants with this legume flour, what is a safe percentage to use? Is this food constipating, like barley gruel; and how does it compare in strength? How much of the diastatic ferment is added to the legumes? Was beef juice used in any of the cases reported ? What are the dangers of scorbutus under this diet?

Dr. ALLEN A. Jones.-Dr. Edsall has added another most valuable research to his already excellent work in dietetics. Is the legume diet likely to cause great flatulence? Dr. Shattuck, of Boston, has, some time since, set us thinking on the importance of changing the diet from milk to some other food in cases of typhoid fever, where milk seems to disagree. In certain cases the tympanites, coated tongue and other unfavorable conditions disappear when another food is substituted for milk.

Dr. CHARLES S. Jones. It often happens in the intestinal disorders of infants that a complete change of food improves the child, regardless of the virtues of that particular food. Does this fact account, in any degree, for the success of the legume diet? I knew of a serious case of infantile scorbutus cured on plantose and orange juice. Plantose, being a vegetable albumin, appears to be more easily assimilated and to cause less uric acid than the animal albumins. Is this true also of legume?

Dr. M. HARTWIG.–Were any of Dr. Edsall's cases fed on predigested milk before his experiments with milk modified with

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