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letters to her husband and to her children, showing decided interest in her family life.
Case 2. White woman, aged 37 years; married 13 years ; mother of six children. Admitted to the asylum May 16, 1890. Insanity developed during the period of lactation. Previous to insanity she was amiable, cheerful and industrious. Her mother had been insane and her father was very intemperate. Had been insane three days when admitted. Had a previous attack ten years before, probably in connection with the birth of a former child, but no exact history. Was subject to hallucinations. Thought nearly every man she met was her brother in disguise. Imagined that she had the power of healing by laying on of her hands. Had a decided tendency to expose her person. Menstrual period irregular. Emaciated, with haggard appearance; appetite poor; slept poorly; nervous and restless during the day. Put upon a special diet of eggs, milk, beef tea, brandy, etc., but improvement was very slow. The approach of her menstrual periods could be predicted by the alteration in her behavior in the ward.
Physical examination : Bilateral laceration of the cervix; thickening of posterior lip; intrapelvic inflammatory induration of the left side, sensitive to slight pressure.
Operation November 25, 1891. Left ovary was found adherent. Breaking up of the adhesions occasioned some bleeding. Tube on the left side congested and convoluted.
After history: Recovered well from the operation. Sutures were removed on the seventh day. Note, December 17th : Patient cheerful; appetite good; sitting up in her room, sewing; conversation coherent, and has at present no hallucinations, no delusions ; simply nervous symptoms, such as are present in the majority of cases of induced menopause. At the present time is increasing in flesh and strength; complains less and less of headache and backache, and converses entirely rationally. Is much interested in the work about the place and is ready to go home at any time her husband is prepared to make the proper provision for her.
White woman, age
Married 15 years. Has had seven children, the last one born four months previous to her admission to the hospital in August, 1887. Before insanity was amiable and industrious, and neat about the household affairs. No insanity was ever in her family. Insanity came on suddenly after the birth of the last child. First symptom was that someone was after her trying to kill her. She used vulgar and obscene language. Tried to kill her mother. Her language in the hospital was of the most obscene character. She would tear her clothes, break the furniture, and tear the plastering from the walls. These attacks were intermittent. About six months ago she began to fall off, and at the time of the operation was pale and thin.
Physical examination : Deep laceration of cervix on both sides, with eversion of the lips of the cervix, and enlargement of the uterus.
Operation December 15, 1891; uterine appendages removed; small cyst in left broad ligament; one ovary was adherent; uterus somewhat enlarged.
After history : Recovery from operation very good. From being one of the worst patients in behavior, language and general character, she became one that could be kept upon the best ward of the house. She is not well, and probably never will be. She has gained in flesh ; sews, goes out on the lawn, attends the dances regularly, and behaves very well. This patient and the first one will probably never be well, as both are in a condition of somewhat advanced dementia ; but they have become better patients.
Case 4. White woman, aged 28 years. Native of North Carolina, and resident of Baltimore City. Admitted in 1891, suffering from mania. Mother of three children. Had an attack of insanity after the birth of the first child, and another after the birth of the second child. The third attack came on twelve and a half months after the birth of her third and last child. The second and third attacks considerably after the births of the respective children. The first attack was a true case of puerperal insanity, and probably determined the others. When admitted, was in a state of excitement and
indulging in obscene language. Her temperature ran up and her heart grew weak. She was put upon digitalis, eggs and milk every two hours. She gained in strength but her mental symptoms were unimproved.
Physical examination: Deeply lacerated perineum, lacerated cervix and prolapsed ovary.
Operation March 9th. Appendages removed. Great enlargement of ovaries of both sides.
In this case hereditary taint was denied. Her menstrual periods were regular. While at home, she was jealous of her husband's sisters; was fond of drink, but had not access to much of it; was indolent and careless; was fond of talking about sexual matters.
After-history: Three weeks after operation, mental condition good, language to physician chaste, appetite good. May 8th, 1892, was discharged from the hospital, recovered.
This woman, up to the time of the operation, used the most profane and obscene language Dr. Rohe had ever heard. When she recovered from the effects of the anesthetic, she burst into tears and asked the doctor's pardon for the ugly language she had used. She never afterward used any obscene or insane language to anyone connected with the hospital.
In conclusion, Dr. Rohe said: I believe that in these four cases, we have a contribution to the etiology of puerperal insanity. I believe that puerperal insanity is a phase of insanity that is due to absorption of septic matter, and when it is recurrent, that it is the result of some reflex irritation due to an inflammatory condition in the pelvis or pelvic organ. All the cases which I have examined, show some lesion of the genital canal remaining from parturition. The results of the treatment in these cases, show this: that if cases are taken before structural alterations have taken place in the brain before dementia has come on, and in the large majority of cases restitution of the mental faculties can be accomplished. There is another advantage, I believe, in this radical mode of treatment of this condition; that is, that a woman whose appendages have been removed will never have another attack of puerperal insanity at all events.
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Dr. Winslow: Are these selected cases ? Are they all the operations which Dr. Rohe has performed for insane conditions since he has been at Spring Grove?
Dr. Rohe: This is a series of cases due to one single cause. I have operated upon fifteen cases. In nearly every case there was some lesion of the pelvic organs. I expect to report all of these cases in the future. I believe that I will be able to report four or five as restored mentally. Nearly all have shown evidences of improvement. They are better patients; they are not so disposed to soil, they can be kept on better wards with quieter patients. This is a decided gain for the management of the hospital.
MEMPHIS MEDICAL SOCIETY. SEPT. 20, 1892.-Dr. H. L. Williams, Vice-President, in the chair.
The essay of the evening was read by Dr. J. F. Hill, the subject being “ Treatment of Asthma.”
Dr. Black thought the cases reported were, properly considered, that form of asthma kuown as hay fever, it being pretty generally believed that this was a reflex asthma from some irritation in the nasal passages. Sensitive spots are found there, and, these being destroyed, the fever is cured. Yet, some operations have not been so fortunate in their results, and in many cases thought to be cured, there is a return of the disease. Still, the temporary relief given makes the operation desirable. Has had a good deal of experience in the medicinal treatment of asthma, and has found morphine the most reliable remedy.
Dr. E. E. Haynes : Has had no experience in the surgical treatment of asthma, and is not satisfied with its treatment with drugs. Has found some benefit from the use of iodide of potash.
Dr. Krauss: Has had no experience with hay fever. It has been his misfortune to treat several cases of cardiac asthma or dyspnea, and in this form has found much benefit from tho grain doses of nitro-glycerin. In the intervals usually gives the iodide and bromide of ammonia.
Dr. H. Jones' experience has been so unsatisfactory he is not inclined to relate it.
In hay fever, asthma is a frequent complication. This asthma is reflex and usually follows the coryza and other symptoms. In a few cases has tried the cautery, but has been disappointed, and does not believe even thorough destruction of these tender points will give permanent relief. Nerve cutting for neuralgia is not permanent in its relief, so why should destroying the nerve ends be permanent?
The ordinary form of chronic asthma is usually due to some bronchial trouble or to heredity, and is not periodic but comes and goes at its own sweet pleasure. The only remedy for this form is morphine.
Dr. Duke: Treated an old lady, many years a sufferer, with digitalis and got decided benefit, but cumulative effect of the drug forced him to quit it. A tablespoonful of whisky would often give relief. Morphine was used till habit was acquired. Always combined atropia with morphine in treating asthma.
Dr. Jas. Williford : Has a patient, a negro woman, with asthma made worse by pressure from ascites. Salts and juniper lessened ascites and relieved asthma at one time, but, when tried again, failed.
Dr. Williams' experience has been with the irregular and not the periodic asthma, and he has not used the operative method. Iodides help asthenia by helping the bronchitis which causes the asthma. It is well to remember, however, that iodides may irritate the mucous membrane and make bronchitis and asthma worse. In the cardiac dyspnea, especially when due to aortic trouble, nitro-glycerin acts well.
Dr. Hill, in concluding, stated that Sajous, J. A. McKenzie and others had used and discussed the treatment in 1883. It was their opinion that if they could by this treatment prevent the attacks for two summers, they had little fear of return. The operative treatment, being curative and preventive, is superior to the treatment by drugs.
Attacks of asthma occur nearly always from 1 to 3 o'clock A.M. The explanation of this, suggested by Dr. Robt. Myles of New York, is that during sleep the mucous membrane capillaries become sluggish and congested, and the membrane