recognizes a clock on the wall twelve feet distant, although she is unable to distinguish the hands or tell the time. A bunch of keys, a knife, and a silver halfdollar are named correctly at four feet. The pain is entirely gone.

December 7th.-Patient reports that she is now able to see much better, also that the pain has been absent since the last séance. She sees well at ten feet, but beyond this everything looks blurred. Séance repeated. December 9th.-Has been perfectly well: no pain. Vision entirely restored.

CASE IV. Monocular Blindness. Cure in Nine Séances.-On September 12, 1894, the patient was referred to me by Dr. Webster with the following note: "I see no sufficient ophthalmoscopic reason for the loss of all but perception of light of this young woman's left eye. If you can find no lesion of the brain to cause the blindness perhaps you can restore the sight by hypnotism as you did before."

Mary C, aged eighteen, married. The patient is an Armenian and cannot speak a word of English, but her physician is present and acting as interpreter, the following history is obtained: Has been married

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ferred to Dr. Webster, through whose kindness I saw the case on February 4, 1895. Although there does not seem to be any doubt in my mind as to the trouble being a functional one, all methods of treatment have proved ineffectual. The following is the history:

Agnes L, fourteen years of age; single. She was perfectly well up to one year and a half ago; about this time she fell on the ice, striking the back of her head. She was much frightened and jarred, but did not vomit or lose consciousness. Menses appeared for the first time shortly after this, but have never been regular, two months having now elapsed since the last period. Two months after the accident above referred to, the patient commenced to have headache, chiefly frontal, but sometimes in occiput and back of neck. On May 5, 1894, she came under the care of Dr. Boynton, at the Ophthalmic Hospital, for dimness of vision. Examination revealed almost total loss of vision in the right eye, without any change in the fundus, vessels, and disk; all being found normal. While in the hospital she had two epileptoid attacks, hysterical in character, and she also had frequent crying spells.

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five years; two children and no miscarriages; is now nursing an infant eight months old. Was fairly well up to the past month; during this time she has become depressed, emotional, and has often complained of a lump rising in the throat. A few days ago she had some headpain, and with its appearance she noticed failure of vision in the left eye, and now the patient cannot distinguish any object at any distance far or near, but she can make out the difference between light and darkness. She is poorly nourished and anæmic. Mucous membrane of lips, gums, and conjunctivæ pale. Both pupils moderately dilated, the left not reacting as actively as the right. Fundus entirely normal. Failing to find any evidence of organic trouble, the diagnosis of a functional amaurosis was made and I decided to try suggestion for its relief. The patient not being able to understand English, I was not successful in the first attempt to hypnotize her; but through the aid of Dr. Aterian I learned the proper Armenian words necessary for the purpose and was successful at the third séance in obtaining a deep hypnotic sleep. Complete recovery took place in nine séances.

CASE V. Monocular Blindness. Unimproved. This patient had been under the care of Drs. Boynton and Palmer at the Ophthalmic Hospital, and was finally re

Thorough treatment with strychnia, glonoin, iron, and the valerianates caused no improvement.

Examination.-There is a complete loss of vision in the right eye. Left eye vision is, brought up to normal with proper glass. Field much contracted in all directions. In a moderate light, both pupils dilated, the right being a little the larger. Reflex through the right retina not as good as through the left. When one illuminates the left retina, the right pupil does not remain contracted as long. With direct illumination the reaction is about the same. There is a marked loss of sensation of the cornea of the right eye, but no anæsthesia of face, body, or extremities. The patient recognizes colors readily. The knee-jerks are exaggerated but equal. The question of simulation was considered, but repeated tests by prisms and other means gave negative results. Treatment by means of drugs having failed to change the conditions present, hypnotism and metalo-therapy were tried, but both failed to influence the patient in any way.

Prognosis and Diagnosis.-From the facts brought out in the above histories, we see that an amblyopia, or amaurosis from hysteria, may be slight in form and transitory in duration, or very severe; sometimes tardy in its progress and prolonged in its existence. If the

condition should persist for any length of time and an alteration of nutrition or any morbid formative process be set up by the prolonged functional disturbance, then it is probable that finally the condition would. change into an amaurosis from inflammation and congestion. This latter condition, I now believe, is taking place in Case V., which illustrates well this type of the disease.

The diagnosis is based on two points, viz.: the absence of any demonstrable changes in the eye, and the lack of that agreement between the individual symptoms constituting the disturbance of vision which under other circumstances they would exhibit. Persons whose visual fields are unusually contracted still move with perfect security, without stumbling, in a space which is not well known to them. The only difficulty in diagnosis exists in those cases where a line must be drawn between true simulation and a hysterical blindness, that is, one having an actual existence in the imagination. It is not that they will not, but they cannot will. The retina receives the impression, but through some fault of the higher cortical centres, perhaps by inhibition, the patient remains unconscious of it.

Treatment.-Besides the measures usually recommended in the treatment of these disorders-the internal administration of strychnia, iron, etc.-I wish to urge the trial of hypnotism, and I do not do this from any optimistic point of view.

A great many of us are prone to look upon this entire subject as either belonging to the domain of quackery, or believing that it requires some special power hesitate to take advantage of this method of treatment. The time has now passed for any such argument, and any physician who would take the trouble to study the subject would obtain satisfactory results in a certain number of cases. The manner of procedure in producing hypnosis is given in detail in current literature, so that it does not seem necessary to dwell upon this part of the subject here, except to state that the fixation method is the one generally employed.

From the results obtained in the cases just submitted, the following conclusions may be drawn, viz. : 1. We possess in suggestive therapeutics an important aid in the treatment of certain morbid conditions, but just how valuable this may be, cannot be estimated until it is more generally used and the results reported. 2. The results of this method of treatment are sufficient to stimulate the profession to further use of it. 3. Instead of waiting and trying other methods first, thus allowing the disease to exist for a certain time, I would recommend the trial by hypnotism in the first place. Two of the cases already reported had been treated by other measures for some time without success. 4. The use of hypnotism by the intelligent physician, in the cure of certain morbid conditions, does not produce any bad effects, notwithstanding reports to the con

trary.

Gonorrhoea: When Cured?-A patient who has had gonorrhoea and is about to marry asks his physician whether he is completely freed from his disease and without danger of contaminating his wife. In such cases the writer instructs his patient to drink a quart and a half of beer, after which he injects into the patient's urethra a two per cent. solution of sublimate. If he is actually cured, no reaction follows; if the contrary is true, a discharge will be set up which sometimes does not appear for forty-eight hours. - DR. KRAFT, of Utrecht.

Artificial Feeding of Infants.—I do not advise using milk diluted with plain water for young babies under four months old. The simplest and most commonly used diluent is barley-water, which is almost entirely innutritious, its action being purely mechanical in breaking up the casein.-GRIFFITH.

IN 1886 I saw Austria's great surgeon, Billroth, treat the pedicle of a uterine myoma intra-peritoneally. More than once did Billroth, with his quick and graceful step, lead me around the wards of his hospital to see this and other patients. To me it was exceedingly interesting to see the kindly and almost childlike enthusiasm of his great mind, then in all its manly vigor. Operating, doing much of surgery, only makes the good man more loving, more kind, and more tender. The patient from whom he removed the uterine myoma and treated the pedicle intra-peritoneally did well.

In Berlin I saw Schroeder treat the pedicle of a uterine myoma intra-peritoneally. Again and again I stood in the operating-room of this excellent surgeon, and was always given by him the most eligible position. This great man also invited me to accompany him through the wards of his hospital. The pedicles of all cases of uterine myoma he treated intra-peritoneally. It seemed a beautiful procedure, except that I occasionally would like to see how the pedicle was doing.

In London I saw Granville Bantock remove a uterine myoma, and he treated the pedicle extraperitoneally. That first day-the first operation at which I was present-there was a crowd to see the great operator. I imagined I would scarcely be able to get a glimpse. I stood far on the outside. Bantock came in his quiet, amiable manner; he looked at his instruments, saw that all was right, then with a kindly glance of his mild, penetrating eye, and almost a suppressed smile, he, with inimitable grace, said: "The shortest to the front." This gave me a place opposite and near to the first assistant. The pedicle had attached to it a number of little fibroid tumors. It was a difficult case to manage. Bantock concluded to leave some attached. Dr. Dornan, the first assistant, subsequently gave me a picture of this mass of tumors. I was privileged to see Bantock in many operations, he always stood at a distance from the table, nowhere and at no time touching it, but with a firm position he directed the whole strength of his body to the thoughtful manipulations of his hands.

In the Woman's Hospital of New York I saw Dr. Charles C. Lee remove a large fibroid tumor, extraperitoneal treatment of the pedicle. Dr. Lee also most kindly gave me opportunities of seeing the condition of the pedicle from time to time. The patient did well. I saw Dr. Wylie remove a large fibroid tumor and treat the pedicle extra-peritoneally. The operation was beautifully performed and the patient made an excellent recovery.

On August 15, 1887, a poor colored woman came to see me at the dispensary, complaining of much pain and distress on each side of the pelvis, and in the She said she had region of the bladder and rectum.

had a constant hemorrhage, varying in quantity, since the third of the preceding May. I found the uterus enlarged to the size of the seventh month by an intermural myoma, the lower part being wedged tightly down in a small contracted pelvis. Some weeks after, this woman called again at the dispensary, she was still bleeding, sometimes profusely, and was growing weaker and weaker. We feared her life might be in danger, so we admitted her into the Woman's Hospital of Brooklyn, then located at 725 Greene Avenue. She was in an extremely feeble condition, that evening having repeated chills. After a hot bath and fresh clothing she was placed in bed, with a jug of hot water to her thin, bloodless feet. Day after day she had the most careful nursing, the best nourishment, and constant medical attendance. In some respects she seemed to improve,

notwithstanding the bleeding and other serious symptoms continued. We decided to remove the tumor, which, after the usual preparations, and with the assistance of Dr. C. N. D. Jones, I did, on November 15, 1887. The omentum was generally adherent, and especially bound firmly in the region of the uterine appendages. After liberating it, and tying the broad ligaments, with one hand under the tumor, and the other with Tait's screw, the mass was lifted from the abdominal cavity. There were especially grave difficulties in securing the uterine pedicle, it was very short; many fibroids were shelled out, finally it was transfixed with pins and placed in the lower angle of the abdominal incision. The womb was dressed two or three times each day, and the patient was apparently doing well; still for weeks this woman lay on her back, as if chained by some great weight. Day after day, as I rode around to see other patients, my thoughts continually recurred to this poor colored woman in that bed in the hospital. I knew that the continued dragging of that pedicle was to her a continued shock. I knew that that pedicle was placing her in constant danger; and of what possible utility would it be; what advantage was there in retaining that dense piece of fibrous tissue, that piece of cervix which in most instances is diseased? Why not remove it? To me the clear sunlight of heaven shone into that poor woman's abdomen. I could see that useless piece of hard cervix festering and disturbing adjoining structures, and so out of place amid the soft peritoneal tissues. Continually I could see more and more the beauties of removing it. Over and over again, I mentally went over the operation of removing the cervix, saw that it was feasible and safe, and would be so much better for the operation and for the patient! Why was it ever thought necessary to retain it?

In both methods of operation, extra-peritoneal or intra-peritoneal, it is the stump that makes the difficulty; it is the source of most of the danger, and statistical history shows that the great mortality of this operation is due almost entirely to unfavorable conditions originating in, or generated around, the stump. Emmet reports a case. "The stump was almost all cut away, leaving only enough of the cervical tissues to hold the ligatures from slipping off, and it was so covered as to be placed outside of the peritoneal cavity; yet on the fourteenth day the patient died from rupture of an abscess." This distinguished operator says further: "“I have removed the whole or portions of the uterus in five instances, and, notwithstanding the greatest care to insure a favorable result, all the patients died, sooner or later, from blood-poisoning generated about the stump." Shall we say it is a safe method when it is so frequently fatal in the hands of our best operators? It is not the operation, or the method of operation, but it is the danger which is inherent in the stump, or in this method of procedure.

On November 23, 1887, when I was privileged to present this tumor that I had removed on November 15th, before the New York Pathological Society, I stated that I believed a better and more natural procedure would have been, after opening the abdominal walls— being assured of the condition of affairs, and liberating any adhesions that might exist-then to have severed the vaginal connections, as in colpo-hysterectomy, and so remove the entire uterus. Or, if the body of the tumor or uterus were removed through abdominal incision, then to remove the uterine stump per vaginam, and, after "la toilette du péritoine," close the abdominal walls and leave the vaginal opening as the best and most natural mode of effecting drainage. I also gave the following reasons for favoring this procedure: It would shorten the operation; 2, would be less shock to the patient; 3, would lessen the dangers of the operation; 4, the patient would make a rapid recovery.

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I carried this method out February 16, 1888, for a tumor altogether weighing seventeen pounds. The pa

tient came to my office January 17, 1888. Forty years of age, twice married and no children. A uterine myoma extended from the cervix to within an inch of the ensiform cartilage, and was larger than the uterus at term. Her emaciated body seemed only a framework to support the growth; she wished to have it removed. I told her of the dangers of the operation, yet I believed it was the only way to give her any relief.

"The

At the next visit she informed me that she had seen a physician whom she had previously consulted, and he had told her that if she had the operation she would die on the table. She replied to him that she had rather die than remain as she was. I again assented to, and emphasized the dangers of the operation. She still said she wished to have the tumor removed. She was admitted into the Woman's Hospital of Brooklyn, February 5th. Operation performed February 16th. As she lay on the operating table under ether, the body seemed a mere skeleton; the monstrously large and nodulated tumor filled the whole abdominal cavity, extending up to and under the ribs. A small exploratory incision was made first midway between the umbilicus and down to the pubes. I passed my hand in and around to free adhesions, then by the help of Tait's screw, with the left hand beneath, the mass was lifted out of the abdominal cavity. The right tube was greatly enlarged, presented the greatly enlarged, presented the appearance of a coiledup and adherent mass of intestine; the left tube was also adherent, its fimbriated extremity closed, and the tube filled with pus. The tumor was removed. pedicle thus secured consisted of a mass of tumors, one of them three inches in diameter, all closely packed, reaching to the cervix. I knew that to make a pedicle of the mass would not only endanger the patient's life, but render the operation unfinished and imperfect, so I decided at once to proceed as in vaginal hysterectomy for the removal of this portion." I separated the vaginal attachments-the size of the mass rendered it necessary to remove through the abdominal incision. Drainage was secured both through the vagina and abdominal womb. By thus removing the entire uterus we not only got clear of the stump, but of the great mass of loose tissue which surrounded it and which, if it had remained, would doubtless have produced the most serious consequences; and which is probably an explanation of why the report has so frequently to be made of death on the ninth, twelfth, or fourteenth day from abscess near the stump. I do not see how in this case, with every precaution, the formation of an abscess could have been prevented in so much loose issue.

It was marvellous to see how much more rapid was the convalescence of the patient than it would have been had not the stump been removed. Keith says: "The average time of convalescence in the extra-peritoneal cases was forty-one days; of the intra-peritoneal method, three weeks." This patient was practically well on the twelfth or fourteenth day, had an excellent appetite, and had gained in flesh and strength. No such results could possibly have been secured if the stump had been left.

If the pedicle or cervix is removed, it should preferably be treated extra-peritoneally, though one of our first authorities, Dr. T. A. Emmet,' said: "If myotomy was to have a future, it would have to be done by covering the stump with the peritoneum and dropping it into the peritoneal cavity." Professor T. G. Thomas said: "He had removed the uterus from seventeen patients; nine of them had recovered and the remainder had died. A large number had been treated by the clamp, and they had done remarkably well. A smaller number had been treated by simply returning the pedicle, and they had done badly." Dirner, of BudaPesth, Hungary, says the extra-peritoneal method prevents hemorrhage and sepsis more completely than the American Journal of Obstetrics, January 5, 1885, p. 85. 2 Ibid., January, 1887.

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other method. Greig Smith says: "The dangers of the intra-peritoneal treatment are nearly twice as great as the extra-peritoneal." As I said in an article published in the New York Medical Journal, August 25, 1888: "But, even when the stump is treated extraperitoneally, there are many dangers, and may be much trouble, as of an operation performed September, 1887, by one of the most distinguished living gynecological surgeons and at a centre of gynecological science, the record is death on the seventh day from pus cavity on one side of the pedicle.' We may seek to produce the best conditions, but there are still foul septic discharges, and, if the patient recovers, it is only the question of escaping the many dangerous possibilities. At best the stump is a hard, fibrous mass, extending from the vaginal to the abdominal walls, and pulling upon both. In this case I have reported the traction upon the abdominal walls was so great that it made a considerable sink or depression in the surface, and caused such pressure from the pins that, notwithstanding every care and all possible disinfection, keeping constantly fresh gauze under the pins, yet beneath them the skin sloughed, and with all this there were the threatening dangers of sepsis, abscess, etc., from the decaying stump. Is a course of procedure the wisest that is necessarily accompanied by, or may encounter, such grave conditions? What is the good of preserving the stump intra-peritoneally or extra-peritoneally? It is only the remnant or remains of a sickly womb, and can be of no service and may do much damage-how much, who can tell ?-not only at the time of the operation, but in the subsequent history of the patient. One case is reported in which 'within a year cancer developed in the remains of the cervix and proved fatal.'"

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Dr. Joseph Price's magnificent results have done much to favor the extra-peritoneal method, still surgeons have long recognized the dangers of the stump, whether much or little is left, or whether treated intraor extra-peritoneally. Professor W. M. Polk, at the meeting of the New York Obstetrical Society, June 15, 1889, said: "Leaving a large suppurating, or rather gangrenous, stump is a surgical fault threatening the life of the patient, and improved means should be devised whereby it can be got rid of." He adds: “I should like to have the question under discussion broadened so as to take in the views of the members upon the propriety of total extirpation of the uterus, after ligation of the uterine artery. I believe it is time to look about for means of getting rid of the slowly sloughing stump, which is constantly a source of danger in addition to what pertains to ordinary laparotomies."

Dr. E. W. Cushing, of Boston, on March 28, 1895, read before the Gynecological Section of the New York Academy of Medicine a paper on Histerectomy and Total Extirpation of the Uterus by Abdominal Section." He gave the evolution of hysterectomy in this country, quoting from the New York Medical Journal of August 25, 1888, that the first case of total hysterectomy in this country for uterine myoma was performed by Dr. Mary A. Dixon Jones, February 16, 1888. Dr. Cushing referred to the various improvements in this operation, and the excellent work done by Drs. L. A. Stimson, William M. Polk, Joseph Eastman, B. F. Baer, and others. During the discussion Dr. Baldy, of Philadelphia, said he thought "it would be better to leave a small portion of the cervix." Dr. F. Krug, in a short address, favored the idea that all the cervix should be removed. Dr. Krug had on a previous occasion said that "total hysterectomy is an ideal operation." At a meeting of the New York Obstetrical Society, November 5, 1889, when Dr. Boldt presented an interstitial uterine fibroid," removed by my method of total extirpation of the uterus, Dr. Dudley inquired: "What advantage is there in removing all the cervix over that form of hysterectomy which leaves 1 Opus, second edition, 1888.

2 American Journal of Obstetrics, 1889, p. 130.

part of the cervix as a stump?" Dr. Boldt well replied, "By leaving a portion of the stump, the patient is exposed somewhat to sepsis, which can be avoided by complete hysterectomy."

As to Goffe's method, I said in a paper published in the MEDICAL RECORD, September 6, 1890: "Goffe's method, as reported by the New York Obstetrical Journal, is, as he describes it, 'taking out the whole of the uterus except a bit of the cervix, covering this over with peritoneum.' But in all his cases, as he reports them, the temperature went up the fourth or fifth day, which, says Dr. Goffe, 'means suppuration under the flap, with danger of the pus bursting into the peritoneal cavity; so in each case he dilated the cervix, drained, and irrigated. Of one he said, 'A gentle amount of pressure caused the exit of about half an ounce of pus and broken-down tissue.' The same procedures are used by Dr. A. P. Dudley. He dissects out the uterus to about three-fourths of an inch of the cervix.' The third day there is the same rise of temperature, the same process of dilating for discharge of pus. Thus, invariably, a certain amount of suppuration seems to accompany this method, so, with a bit of the cervix left,' there cannot be, as Dr. Goffe expresses it, 'all the elements of safety.'

Dr. E. W. Cushing dwelt at length upon, and especially commended, Dr. L. A. Stimson's method of first tying the uterine artery; which is indeed an excellent way of controlling hemorrhage; but Dr. Polk, at a meeting of the New York Obstetrical Society, February 18, 1890, said that "the searching for the uterine artery down by the side of the uterus, and ligating and enucleating separately, was according to the plan of Dr. Stimson, but as a matter of fact it was unnecessary, for one could ligate en masse without any difficulty." He said, further, "Ligating en masse shortens the operation." Dr. Bantock reported in the British Gynecological Journal for 1890, page 75, "the very first case in which he removed a fibroid tumor from the uterus he secured both the ovarian and uterine arteries separately, and then put a serre-noeud around the body of the uterus, and it was extraordinary how much bleeding he got."

At the same meeting Dr. Polk incidentally remarked: "The operation introduced into this country by Dr. L. A. Stimson, of removing the entire uterus including the cervix." Is not this a mistake? Dr. Stimson says his first two cases were reported to the New York Surgical Society, January 9, 1889, published in the New York Medical Journal March 9, 1889. My first case was reported to the New York Pathological Society February 22, 1888, and published in the New York Medical Journal August 25, and September 1, 1888.

Dr. Mendes De Leon, of Amsterdam, wrote me October 20, 1888: "Only yesterday I returned from a trip to Berlin. Martin told me he had performed four hysterectomies, with vaginal extirpation of the pedicle. As soon as he will reach the series of ten he intends to publish it. Is this method of tying the pedicle yours or his? I am very anxious to know more about this question. Perhaps you may find time to let me know one of these days.'

Professor A. Martin, of Berlin, was in this country only two months before I presented the subject to the Pathological Society. In several of his addresses while here he spoke of the treatment of the pedicle, strongly favoring the intra-peritoneal method; so far as I know he did not mention the vaginal extirpation of the stump, nor did anyone else previous to my publication in November, 1887.

Dr. Joseph Eastman said in the Cincinnati LancetClinic, December 8, 1894: "Dr. Mary Dixon Jones, of New York, was the first in America to take out the entire cervix. This, so far as I know, is true; at least I had never heard of its being done, nor do I consider

American Journal of Obstetrics, 1890, p. 533.