plain question? We must all commend conservatism, but we may, perhaps, differ as to what is conservatism. Conservatism means saving life and the conservation of health when used in this connection. Any operation, however radical it may be, that saves life and conserves health is a conservative procedure. A radical operation is at times a conservative one. However conservative in one sense an operation may be in preserving and attempting to preserve tissues that are a menace to life and health, it ceases to be in the proper sense a conservative procedure. I am sure Dr. Dunn's object is in the line of true conservatism. He has given us an interesting paper this morning, because it is a reflex of a school of surgery that is now very aggressive-the French school, one with which American practice, as a rule, is very much at variance, although that school has a considerable colony on this side of the ocean, especially located in New York and Chicago. It is well that this paper has been presented.

Our difference is very plain. The class of cases we are discussing upon the two sides of the question are altogether different. The so-called conservativé school of surgery operates upon a class of cases that another school of surgery does not operate on at all. When in a discussion on this subject one reports a hundred operations with altogether favorable results, and another reports an equal number of cases with quite different results, there is a misunderstanding. One man may be operating for minute lesions that are barely outside the range of physiological limits, while another is operating for serious pathological conditions. I venture to say that if we were to take forty healthy women as they walk along the street, and if it were admissible to open their abdomens, lesions of the character described could be found which have never produced symptoms of serious importance. How common it is, when operating for some other condition say an appendicitis-for the surgeon to bring the ovary into view and find little cysts hanging to it. These cysts appear on the

broad ligament, on the peritoneum, and the ovary itself. We may take five hundred cases of that kind, put them in the hands of an expert surgeon, let him operate, and he will have five hundred recoveries. They may have had nervous symptoms, errors of the digestive functions, displacements of the uterus, and a large proportion will have had dysmenorrhoea. The moral effect of any operation in such subjects is conspicuous. It is misleading

When we

to discuss inflammatory lesions of the uterine appendages from the standpoint of these operations upon the ovaries. deal with fallopian tubes long infected with gonorrhea, or following puerperal conditions or traumatism, it is futile to attempt to preserve the oviducts and restore their functions. Such pathological changes permanently destroy the function of oviducts. If the oviduct is preserved; if the lesions of the ovary are of such minor character, why should an operation be performed at all? Where we have such lesions as a cyst or hematoma of the ovary we may preserve the ovary. That is good surgery, and I think it is generally observed. In advanced inflammatory conditions it is different.

I would offer my own experience in opposition to the statements made as to the subsequent history of women who have had operations performed for the removal of the uterine appendages. This is very important on account of its influence with the laity. The changes described by Dr. Dunn as taking place in the physique of women due to the production of the artificial menopause are exceptional. I have known them to suffer with the discomforts incident to induction of the menopause, but I have seen none of the physical changes that have been described, such as change in the voice, the manner, irritability of temper, etc. When women have affections, either structural degenerations, neoplasms, or inflammatory conditions that necessitate the removal of the appendages, they are improved in every respect by the operation, so far as my observation goes.

DR. EDWIN WALKER, of Evansville, Ind.-I was very much interested in the paper of Dr. Dunn. It opens up a wide field for discussion, and it is one in which we know but little. I was in hopes that we would get more light than we did from the essayist. It has been the fashion to discuss nervous phenomena that are more or less associated with genital trouble in a very vague and general way, and I regret to say that the essayist drifted into the same channel. Dr. McMurtry has said that if we take a hundred healthy women and examine their ovaries we would find such conditions as the essayist has described, and I agree with him. I am still more certain that if we take a hundred patients that have been in the hands of various gynecologists, and espe cially if we select cases of low morale, degenerates, we should find all the nervous symptoms Dr. Dunn gives in his lot of cases,

though they retain their ovaries. He does not tell us of a single disease any of these patients had. The detailing of nervous symptoms is not a diagnosis. Unfortunately, it has been the habit of gynecologists to treat nervous diseases in a general way. What is the matter with these patients? We do not know that they have organic disease, nor do they in many cases suffer from distinct functional disease. Another important point in connection with this subject is, what class of patients were they? Were the patients the doctor referred to ordinary dispensary patients, or were they those who live lives of debauchery and intemper ance? If so, the class of nervous symptoms he portrays occur in many women whose ovaries have not been removed. There is a a great necessity for careful study of the nervous phenomena in connection with gynecological work in order to make accurate diagnosis of the nervous disease. We know it is an easy thing to get out of all this by saying that women are hysterical. I was at dinner with one of the most prominent neurologists in this country, and he said to me, “I have come to the conclusion that hysteria is cussedness." I believe that a great many of these symptoms that we portray are "cussedness." They are the result of low morale. These people have nervous conditions which are the result of all kinds of violations of the laws of health.

And when we talk of Brown

There is one other point I wish to speak of before taking my seat, and that is with reference to Brown-Séquard. We know that if we shake a red rag at a bull it infuriates him very much. We do not know why that is so. Séquard before a medical audience it has much the same effect. Brown-Séquard is responsible for more error than any other one man prominent in medicine. In 1868 he delivered a series of lectures on reflex irritation, and it has taken the profession thirty years to get rid of the theories then advanced. Following this came the work of Emmet and other, on the ovaries, which I redeeply. Brown-Séquard now comes forward with the same thing under a different guise. He says that there is fluid generated by the ovary. There may be men in the moon; it is not necessary to elaborate a theory until we find whether they are there or not. There is no evidence that we have fluid from the Ovaries which is essential to health.

gret so

In papers of this kind they are apt to cover too much ground, and are not explicit enough. There has been more error in gyne

cological literature on this subject and its relation to nervous diseases than all of the rest put together.

DR. ALBERT GOLDSPOHN, of Chicago.-I feel constrained to take a more defensive position than has been adopted by the last speaker and by most of the gentlemen who have discussed the paper of Dr. Dunn. In the first place, the paper is extremely commendable in that he advocates measures which shall save women from being no longer women in a strict scientific sense. The castration of women by gynecologists ought to be regarded in each case as a defeat. We have been conquered instead of having achieved something praiseworthy; and all efforts to save the ovaries should be looked at with much commendation, as long as it can be done without leaving too much suffering afterward. And, if that is the result, then the operator himself will be visited with the greatest retribution. He himself will have to suffer for his want of judgment, not the profession in general. Secondly, the paper is commendable, because it offers to those women who could not retain their generative organs intact an innocent and plausible means of escape from those nervous sequelae which are harassing to the patient and perplexing to the doctor.

As to the matter of conservative work on the ovaries, the essayist did not make as complete an objective presentation of his cases as I would like him to have done. But simply because he is negative in that regard, it is going too far for the opponents to say or intimate that the cases did not require operating at all or were garbled.

As to some of the more cogent reasons that the opposition presents, Dr. McMurtry this morning spoke of the ovary being the last or second organ that becomes inflamed or diseased. First, it is the uterus, then the tube, and lastly the ovary, intimating that by the process of infection the uterus is first rendered null and void, or good for nothing; then the tube, and finally the ovary; and if the latter needs to be treated, the tube is too bad anyhow; it cannot be kept, and the ovary without the tube is good for nothing and should be removed. Before pathology had given us half as much light as we have now this was a good argument, but it is not now. It is not the case that the uterus and tube that have been the theatre of infection by an army of bacilli travelling through them are always doomed. They have been the seat of war, but they are not any longer.

There are many

such uteri and tubes that are not beyond functionating, although they have transmitted pus-germs. In the generative organs pusgerms do not always linger long; their sojourn is limited. The only germs which we know to linger long in the uterus and tube are the gonococcus, above all, and the tubercle bacillus. Pus microbes and other germs die out frequently. The tube may be Somewhat injured, but oftentimes, while it is incapable of conveying an ovule, not every such tube needs to be removed, and not every ovary requires removal, even though the tube is not good. It seems to me we have a right to leave an ovary if it is not badly diseased, and may remove the uterus and tube.

Experiments were made by Emil Knauer, assistant to Professor Chrobak's gynecological clinic in Vienna, in 1895, in transplanting the ovaries in rabbits. Both ovaries were removed from four rabbits, and these immediately reimplanted. In two of the animals one ovary was placed in a fold of broad ligament and the other ovary between the layers of abdominal wall, and in the other two rabbits both ovaries were lodged in the broad ligaments near the cornua of the uterus. He proved (1) that ovaries may be thus transplanted; (2) that they will live; and (3) that they will even continue to functionate in generating new follicles. Whatever the merits of Brown-Séquard's theories and methods were in the past, I must say that the glandular theory has much to speak for it clinically, and it is a reproachable disposition on the part of gynecologists to speak slightingly of anything which may help physicians to assist their patients who are making things hot for them at home.

So far as my own experience with this treatment is concerned, it is limited to one case. I will report it, because it leads to a question I wish to ask the essayist. It was a woman on whom I vaginal hysterectomy for multiple fibroids and profuse After the operation her condition was

did a

hemorrhages a year ago.

very good.

She was perfectly healthy and took on flesh, but became fearfully afflicted soon with flushes to the head, headaches, loss of sleep, loss of memory, and mental depression. She had periods of extreme distress, of syncope, or something similar to it, and she was not relieved by any amount of bromides. It required large doses of hypnotics to induce sleep. I have seen a few such cases, and was afraid that this woman would sooner or later have to go to an asylum. However, I did not fold my arms, as