for hours after each examination. The right ovary is prolapsed, enlarged; the left can't be well defined.

Operation April 17th, 1886.-Present, Drs. T. R. Kendall, H. H. Battey, West, Huzza and Mrs. Battey. Ether, carbolic spray and solutions, carbolized silk ligatures and sutures. Abdomen opened an inch and a half; removed both ovaries and the right tube. No adhesions. The right ovary contained one large hæmatic cyst and two smaller ones. Tunic blanched, thickened and corrugated. The right tube had several cysts attached to it; was otherwise healthy. The left ovary was very much shrunken, the tunic thickened and corrugated. Put to bed in good condition. Had nausea, but no vomiting. Required no opiate. She convalesced promptly. The maximum pulse 90 and maximum temperature 101 degrees occurred on the first day. She returned home to Tennessee on the 16th of May soundly healed.

Case 70-BATTEY'S OPERATION.-Married twelve years, age 33, five children, youngest six, no abortions. Bad health since last labor. She complained of more or less constant ovarian pain, aggravated at the periods. Has been confined to her bed for a month past, and has frequently such attacks. She is a great and constant sufferer and prays for relief. She entered my infirmary April 26th, 1886, and was examined under chloroform. The ovaries are exceedingly tender to the touch despite the chloroform. The os is slightly notched at two or three points and the uterus retroflexed. The right ovary is prolapsed and enlarged, the left could not be well defined.

Operation April 30th, 1886.-Present, Drs. W. W. Fraser, of South Carolina; H. H. Battey, West, Huzza and Mrs. Battey. Ether, carbolic spray and solutions, carbolized silk ligatures and sutures. Small incision in the linea alba,

Ovaries not adherent and removed with facility, together with the right tube. The right ovary contained one hæmatic cyst, size of a wren's egg, and three or four smaller ones. The tube had several pellucid cysts along its border and two small cretaceous nodules. Its canal appeared healthy. The left ovary was shrunken and corrugated, the tunic thick and brawny like morocco leather. The left tube being healthy was not disturbed. She bore the operation well; was put to bed in good condition in thirty minutes. Pulse ran down on the third day to 56, maximum temperature 101.2 degrees occurred on the fourth day. She returned home to Alabama on the 10th of June soundly healed.

MALARIAL HEMOGLOBINURIA.

BY H. MCHATTON, M. D., MACON, GA.

My attention was first called to this disease in the summer of 1884 by having a specimen of urine referred to me for analysis. The conclusions drawn from the specimen were that the condition was that of hæmoglobinuria, and not hæmaturia, the destruction of the corpuscles taking place in the circulation at large, that quinine should be our sheetanchor in treatment, and that cathartics were contra-indicated on account of their depressing effect.

Finding that all writers (as far as I could learn by read-. ing) were of the opinion that it was a hæmaturia, and that there was great diversity in regard to treatment, I determined to study the subject to the best of my ability. To this end I published a circular letter in The Atlanta Medical and Surgical Journal, requesting the practitioners of the State to forward specimens of urine to my address, giving their opinions in regard to treatment, mortality, etc.

I received many specimens (more from Dr. Hilsman, of Albany, Georgia, than from any one else), but virtually no expression of opinion.

Living far from any medical centre, my literature has been confined to that of my own library; consequently there may be many valuable contributions to this subject that have escaped my notice.

There has been much discussion in regard to the first appearance of this disease. Feraud cites cases on the African

coast as far back as 1820, and shows that it appeared in the new French posts a year or so after their settlement. I have heard of cases in Georgia in 1825 or 1830; the probabilities are that it is as ancient as any of the malarial group.

No race can claim exemption if put under favorable conditions for its development; the supposed immunity of the negro is not real; that they suffer less is unquestionable; they are not, as a class, a migratory race, and consequently less subject to variations of climate.

I have examined a specimen of urine from a case occurring in a mulatto, besides seeing several recorded, as well as one case of a full-blooded negro.

The etiology of this condition is unquestionably malarial; it only occurs in those that have been for some time exposed to malarial atmosphere, and have given evidences of malarial toxæmia; it responds as well to quinine as the average pernicious malarial attack; it is totally different from yellow fever, the only disease with which it is often confounded.

Pathological anatomy, according to Feraud, is as follows: The skin is uniformly yellow and not in patches, as is the case in yellow fever. The earlier in the attack that the patient dies, the more intense the jaundice; ecchymoses is not as common as in yellow fever and effusions of blood in the muscles are not met with. There is no escape of blood from the muco-cutaneous openings, nothing characteristic in the cranial or thoracic cavities; the stomach is full of a greenish-colored liquid resembling spinach water. If there are inflammations of this organ, he considers that they are due to other causes, alcoholic principally.

The intestines present no peculiarity; the liver is the seat of decided changes, estimating the healthy liver at 1,796 grms. (611 oz.); the weight is usually increased from 200 grms. to

1,000 grms. (from 7 to 35 oz.), this increase being due principally to congestion. The liver feels hard to the touch, the gall-bladder is distended with very dark viscid bile, the spleen weighs from two to three times the normal, is soft early in the disease, and hard later. The kidneys are congested and their weight increased; for the lack of instruments, the minute anatomy of these as well as the other organs has not been studied.

Many spots of ecchymoses are found in them, principally in corticle substance. The veins are in a state of extreme repletion; in fact, the state of congestion is often excessive, the pancreas, superrenal, capsules, uretes and bladder present no special lesions. There has been no competent chemical and histological examination of the blood; it gives gross evidences of a large amount of bile.

The patients with this disease have always given previous evidence of malarial toxæmia, and the longer that they stay in a malarial climate, the more apt they are to contract it. One attack predisposes to another.

In the study of one hundred and eighty-five cases, Feraud found that ten occurred in the first year of exposure, fortytwo in the second, seventy-nine in the third, thirty-seven in the fourth, nine in the fifth and eight after the fifth.

The majority of patients under his care were soldiers and criminals who were sent to Africa on an average of three years' time; consequently after the third year the residents became numerically less.

Feraud divides malarial hæmoglobinuria into four types, which only differ in intensity, first mild, second severe, third grave, fourth siderant or pernicious. The mild form. is usually intermittent; still any of the four may be intermittent, remittent or continued.