save, perhaps, considerable pain during the child carrying period. III. The physiology of impregnation. The theory depends on the rupture of one or more mature Graafian follicles with the escape of the ovum into the Fallopian tube. While within the tube the ovum is supposed to meet the spermatozoids, and impregnation takes place. If, after this has taken place, the ovum fails to reach the uterine cavity, a tubal pregnancy may result. The transit of the ovum from the distal end of the Fallopian tube to the uterine cavity depends, we are taught, upon the movement of the cilia of the epithelial lining of the tube. All text books lay weight upon the necessity of a normal fimbriated extremity to the Fallopian tube, for "it seems that during menstruation the fimbria are spread out and applied with their mucous side to the ovary, so as to catch the ovum when it leaves the Graafian follicle." * In the case which is here reported let me again call your attention to the fact that during the operation of April 4th, 1898, the right ovary and tube were completely removed, a number four catgut ligature was tied securely about the tube close to the uterus, and a silk suture was tied around the remaining healthy tube in order to prevent conception. This silk suture was tied using sufficient tension to obliterate the lumen of the tube, but especial care was used not to pull it tight enough to cut through the tube. Here exists the possibility of a miscalculation which might have resulted in partial closure of the lumen, or of entirely severing the tube at the point where it was tied close to the uterus. If neither of these conditions obtained, then the only other theory would be that the ovum after being discharged from the left ovary wandered free in the peritoneal cavity, and found its way into the stump of the amputated right tube. There is probably little doubt but that the ends of the amputated oviducts when secured by catgut, will reopen shortly after operation, "be "Diseases of Women." Garrigues. Page 68. cause mucous surfaces do not become adherent under the ligature, and the cases in which the ends of the oviducts remain permanently closed are ones in which plastic lymph from the muscularis and peritoneum have sealed over the ends of the closed mucous tubes." * Of these two theories this latter seems to me the most probable. Yet we are confronted by the reports of many very unaccountable cases of pregnancy following radical surgical procedures which should have certainly precluded the possibility of pregnancy, and I shall never again assure a patient that conception will not occur. Robert T Morris, M.D. "Medical Record," Jan. 19, 1901. p. 84. BIBLIOGRAPHY. Dr. J. J. Chamblis: Extirpation of Both Ovaries Followed by Pregnancy Alkaloidal Clinic, 1898, v. 684. Wetherell, J. A.: Conception After Ovariotomy. Lancet, 1888, i., 823. (Left ovary removed; could find no trace of right ovary.) Sutton, R. S.: Double Ovariotomy Followed by Pregnancy and Delivery at Term. Am. Gynecol. and Obstet. Jour., 1896, ix., 26. (Discussion.) Gordon, S. C.: Two Pregnancies Following Removal of Both Ovaries and Tubes. Jour. Med. and Science, Portland, 1895-96, ii,, 511. Am. Journal Gynec. and Obstet., 1896, ix., 28. Trans. Am. Gyn. Soc., 1896. Leonard, H. C.: A Case of Confinement Following a Supposed Double Ovariotomy, etc. Med. News, N. Y., 1900, lxxvi, 957. Robertson, J. A.: Renewal of Menstruation and Subsequent Pregnancy After Removal of Both Ovaries. Brit. Med. Jour., 1890, ii., p. 722. Ross, E. F.: Delivery at Term After Removal of Both Tubes and Ovaries, with Ventral Fixation of the Uterus. Austral. Med. Gaz., 1898, xvii., 61. MISCARRIAGE, WITH RESPIRATION IN A FIVE- BY WALTER J. GRAVES, M.D. [Read before the Boston Homeopathic Medical Society.] I find that cases of established respiration for a short time in a five-months fetus are rare, and that few have been recorded. In reporting a case of this kind I would say that my patient, Mrs. P., was thirty-five years of age; the mother of two children, the latter born eight years ago. There had been no miscarriages, and she menstruated regularly up to June 23d, 1901, after which the usual signs of pregnancy appeared in regular sequence. Quickening was noticed about two weeks prior to Nov. 5th, when, upon returning from a call in the evening, she found the front door of the house open. The lower floor being unoccupied, she (being accompanied only by her eight years old son ), became frightened by the idea that somebody was hiding in the vacant suite, who would attack her if she entered the house. When, some time later, her husband arrived, and they went into the house, she commenced to have pains, simulating labor pains, and to flow freely. In the evening of Nov. 8th, three days later, I was called. There was a profuse uterine hemorrhage; pains very irregu lar and severe; pulse and temperature practically normal. I obtained a history of a recent attack of malaria for which she had taken large doses of quinine. I ordered the usual treatment for threatened abortion, and the next morning found her condition slightly improved. Examination revealed a badly lacerated cervix, the external os being practically obliterated. The internal os was slightly dilated, very tense, and contained considerable scar tissue due to a previous instrumental deliv ery. Her condition, despite all I could do, remained about the same until the twelfth of November, when at 8 p.m. the internal os had dilated to about one inch in diameter, with labor pains every two minutes. At midnight the os was about two inches in diameter, but the fetal presentation varied continually. I got the head into position by bi-manual manipulation, and the membranes ruptured thereby secured permanent engagement of the head, which, however, could make very little progress, owing to its large size and the tenseness of the os. The pains continued severe and regular until 2 a. m., when, the patient becoming exhausted, I let her inhale a little ether, and a few minutes later the fetus was suddenly expelled with considerable force, the ether having overcome the rigidity of the os. At the moment of expulsion the patient lost consciousness, regaining it in a few minutes, to hear the fetus crying. The head was large, with a large caput succedaneum, and showed evidence of prolonged moulding, just as if it had passed through a bony ring. It was two inches long; the rest of the fetus measuring about six inches, making a total length of eight inches from vertex to heels. Mouth and anus were open, eyelids agglutinated, hair and nails visible. There was a considerable amount of lanugo on the body. Weight, one pound. It was wrapped in absorbent cotton and placed near the stove. It cried and moved its hands and feet for an hour, when respiration ceased; but by artificial means was restored, and lasted for thirty minutes longer, after which all efforts at resuscitation failed. The fetus was certainly of not over five months development. A well formed placenta was delivered about an hour after expulsion of the fetus, and the patient made an uneventful recovery. I have been unable to decide whether the miscarriage was caused by the fright, or by an excessive use of quinine, or, whether it was due to a combination of the two. The lacerated cervix may have been a factor, but two years after the laceration occurred she carried a child to term, without any symptoms of aborting. From what I have read on the subject, I conclude that the question of quinine acting as an abortifacient is still an open one; yet, as it is claimed by some authorities to have that property, I am inclined to believe that, in conjunction with the fright and the weakened cervix, it was responsible to some extent in this case. Recorded cases of established respiration in a five-months fetus are, as I have said, very rare, and I should be glad to learn of others of a like nature. EDITORIALLY SPEAKING. Contributions of original articles, correspondence, etc., should be sent to the publishers, Otis Clapp & Son, Boston, Mass. Articles accepted with the understanding that they appear only in the Gazette. They should be typewritten if possible. To obtain insertion the following month, reports of societies and personal items must be received by the roth of the month preceding. VENEREAL DISEASE AND ITS PREVENTION. Under date of Dec. 21st, 1901, the New York Medical Journal presents the "Report of the Committee of Seven of the Medical Society of the County of New York on the Prophylaxis of Venereal Disease in New York City, by Prince A. Morrow, M.D., chaitman." At the very beginning of their labors, the committee was met with the fact that there were no statistics showing the extent of venereal disease in New York, and devoted its energy, principally, to the attainment of this end. It sent out to each of the physicians in Greater New York, the following letter: NEW YORK, May 1st, 1901. "Dear Doctor: -The committee appointed by the Medical Society of the County of New York, for the study of measures for the prophylaxis of venereal diseases, deems it important to ascertain the amount of venereal morbidity in this city. As a large number of the cases of venereal disease occurring in our civil population are treated by physicians in private practice, the committee would ask the coöperation of the entire medical profession in securing statistics bearing upon this subject. As this information is sought for solely in the interest of the public health, and does not in any way violate professional secrecy, the committee trusts that you will answer promptly the appended series of questions and forward to the secretary. I. The number of cases of venereal disease occurring in your private practice during the past year. 1. Number of cases of gonorrhoea. |