Annual Address 
BY THWPRESIDENT 
FORDYCE BARKER, M.D. 
OF NEW YORK 
REPRINT FROM VOLUME II 
©fenecologtcal JEcansacttons 
1877 ANNUAL ADDRESS BY THE PRESIDENT. 
MEDICAL GYNECOLOGY. 
FORDYCE BARKER, M. D. 
New York. 
We meet at this, our second Annual Reunion, feeling 
that the experiment of our first has proved a success. A 
volume of our Transactions has been published, which is 
certainly “ fair to look upon,” as becomes a work which 
treats of woman in any of her relations. Of the value of 
its contents, we have yet to wait for the verdict of the pro- 
fession, as announced by a demand for its possession and 
the judicial sentence of keen reviewers in the medical jour- 
nals of all parts of the world. But I feel authorized to 
express, as the sentiment of the Society, as a matter of 
simple justice, a warm appreciation of the taste and judg- 
ment of the Publishing Committee and of the indefatigable 
zeal and conscientious work of our Secretary. We may 
well congratulate ourselves that such a standard of excel- 
lence, in all that pertains to the publication of the results 
of our work, has been established as a precedent. Let 
us hope that this standard may never be lowered ! Let us 
all earnestly labor to make the contents of so handsome a 
volume worthy of its “ outward adornment! ” 
One of the Founders of this Society, but one who was 
prevented by illness from attending the meeting for its 
organization and our first annual session, has ceased his 
labors as an Obstetrician and Gynecologist. Charles E. 
Buckingham, M. D., Professor of Obstetrics and Medical 2 
ANNUAL ADDRESS. 
Jurisprudence in the Medical Department of Harvard Uni- 
versity, died in Boston, February 19, 1877, at the age of 
fifty-six years. We all know something of what he had 
done in Obstetrics and Gynecology, and the position and 
rank that he had attained in the profession, and we may 
confidently anticipate that the Publishing Committee will 
secure from some one competent to do the work with taste 
and judgment, a biographical tribute to the man and the 
Professor, for our next volume of Transactions. 
At our last meeting, we had not learned that one of the 
few distinguished Gynecologists in foreign countries whom 
the Society elected as an Honorary Fellow, “ no longer 
lived in the flesh,” but “ ingenio stat sine morte decus.” 
A concise but worthy memoir of Gustav Simon therefore 
appropriately finds its place in our volume already pub- 
lished. 
It may, I suppose, be assumed that the policy of this 
Society has in most respects been settled for the future. 
Still I trust that I may not be regarded as abusing my posi- 
tion, if I venture to offer a few suggestions for your consid- 
eration. We have already a nucleus for efficient work, and 
there is no necessity of rapidly filling our list to the limits 
determined by our Constitution. Yet there is a considera- 
ble numfier of men who have done such good work in Ob- 
stetrics and Gynecology and who have won so such per- 
sonal and professiona' reputation, that they are entitled to 
original membership equally with those who have already 
been enrolled. We may confidently anticipate that those 
who, from accidental circumstances due to the hasty organ- 
ization of the Society, were not included among its foun- 
ders, will be above all petty feeling of disappointment; that 
they will recognize the fact that they were not intentionally 
left out, and demonstrate their qualifications for member- 
ship, by writing such papers as candidates, as will do honor 
to our Transactions as well as to themselves. The example 
of such will close the mouths of cavillers and will be a 
precedent for the coming men of the future. I am happy MEDICAL G YNECOLOGY. 
3 
to say that some of the most eminent of this class have 
already illustrated the worthiness of their reputation by 
taking the initiative in such a course ; these we shall be 
proud to enroll among our Fellows. 
While it is beyond a doubt that no personal jealousy or 
unworthy motive can influence a vote for or against a can- 
didate for Fellowship, and while it is necessary that the ex- 
cellence of a paper for publication in our Transactions 
should testify to the wisdom of the Society in stamping a 
reputation, already acquired, with its endorsement by an 
election to a Fellowship, yet the character of the candidate 
should be an important consideration. We are wisely lim- 
ited by our Constitution to a comparatively small number 
of Fellows ; and in order to secure for the Society the un- 
qualified respect of the profession at home and abroad, and 
to make membership an honor worth the seeking, none 
should be elected who have not won a right to the position 
by a conceded personal and professional eminence. Thus 
it may happen that papers, in every respect worthy of pub- 
lication in our Transactions, may be offered by those of 
brilliant promise as to the future, yet such men can afford 
to wait until time has demonstrated that the buds and 
blossoms of youth have developed the fruit which ripens in 
an established reputation with the profession at large. 
In the election of Foreign Flonorary Fellows, we have 
adopted the wise policy of selecting a very small number 
from those only who have done so much for the literature 
and science of our branch of the profession, as to make 
their election an expression of the highest respect which 
this Society can evince. Fionors cheapened by being made 
common are but slightly esteemed. As regards Honorary 
Fellows from among our own countrymen, I would suggest 
whether it may not be expedient in the future to confine 
our selection chiefly to such as have won the honor by good 
service in the Society, until age shall exempt them from a 
demand on our part for active work. An exception to this 
rule might be made when some one, whose professional 4 
ANNUAL ADDRESS. 
life is not devoted specially to Obstetrics or Gynecology, 
makes an important contribution to the literature or science 
of these departments, and thus becomes entitled to the 
recognition of the Society. 
In a Society of this kind, in which Fellowship is re- 
stricted to a small number, it is of vital importance that 
all should be active working members. It is to be hoped 
that no mistake has been made in the personnel of its orig- 
inal formation, and that no modification of the Constitu- 
tion may become necessary to enable the Society to “ lop 
off its dead wood.” If among its members, some were in- 
cluded because of their past promise of talent and industry, 
who neither attend its meetings nor contribute papers of 
value to its Transactions, and thus demonstrate the fact that 
they are neither useful nor ornamental as Fellows, the So- 
ciety should have some method by which it may rid itself of 
those who only “ cumber the ground.” 
I shall add only a word in regard to the financial pros- 
perity of the Society, for this is essential to its success. If 
our annual volume of Transactions be filled with good and 
interesting material, which shall adequately and faithfully 
represent our national progress in Obstetrics and Gynecol- 
ogy, and if, in addition to this, there is to be found in each 
volume a complete bibliographical index of everything that 
is published pertaining to these subjects, not only in Eng- 
lish but in foreign literature, during the current year, there 
can be no doubt that there will be such a yearly demand 
for the work by the profession, as to insure the sale of a 
large edition. Thus writers of papers are assured that the 
fruits of their labor are not buried in a volume of Transac- 
tions which no one will read, but are certain to secure a 
perusal from the largest class of the most appreciative and 
interested readers in all parts of the world ; and the finan- 
cial success of the Society will stand on a solid basis. 
Some have doubtless been disappointed by the delay in 
the publication of our first volume ; and this must have 
weakened to a certain extent the enthusiasm for Society MEDICAL GYNECOLOGY. 
5 
work in the preparation for the present meeting. I am 
assured that this delay was in no .degree due to the Com- 
mittee of Publication or to the Publishers, but that it re- 
sulted from the tardiness of writers of papers in sending 
them to the Secretary, ready for the printer, and in some 
instances from neglect to return corrected proof promptly. 
This was pardonable for this year, as our first Session so 
soon followed the organization of the Society as to give 
but scant time for the complete preparation of papers. Yet 
this excuse can never be good hereafter, and every Fellow 
should feel bound in honor to have his paper ready for 
print, when it is presented at the Annual Session. It may 
become necessary for the Society to give the Publishing 
Committee power to postpone to the following year the 
printing of papers which are so incomplete as to delay the 
publication of our annual volume. 
It is the province of this Society to take the initiative and 
give the tone and coloring to the progressive advance of 
science in Obstetrics and Gynecology in this country; to 
stamp with its approval all real merit, and to extinguish 
sham. It should make its superior influence felt in all 
work in this connection. I have no new discovery in sci- 
ence or new improvement in our art to announce, neither 
do I purpose to assume the role of a teacher ; but now, on 
this last occasion when I shall “have the floor” to speak 
officially, I design to occupy the more humble position of 
a mere suggester of the kind of work to which this Society 
may give a direction and which all must concede is much 
needed. 
The most striking progress of Gynecology during the 
last fifty years has been in the improvements in physical 
diagnosis and surgical operations. The brilliant results 
now obtained in Ovariotomy, and the surgical cure now 
rendered almost certain, of the lesions resulting from par- 
turition, which were formerly beyond the resources of our 
art, will probably make this a memorable period in the 
history of Gynecology, never to be surpassed in the future. 6 
ANNUAL ADDRESS. 
The triumphs of genius in this direction receive a speedy 
reward ; the eclat of operations brings fame and a pecuniary 
recompense out of all proportion to the returns which pa- 
tient labor, great talent, and important contributions of new 
truths in Physiology, Pathology, and Therapeutics, ever re- 
ceive. It is not, therefore, surprising that Surgical Gynecol- 
ogy, so attractive and remunerative, has chiefly engrossed 
the minds of those who have most exclusively devoted their 
time and talents to the cultivation of this branch of our 
profession ; and that Medical Gynecology has, in compar- 
ison, been left in the background and can boast of but 
little growth. I would not depreciate the importance of 
Surgical Gynecology ; for in no department of medicine 
has more been achieved or have more striking results been 
obtained in the relief of suffering and the preservation of 
life. No surgical operation has ever been devised, which 
has probably added so much to the duration of life, within 
the period of time since it has been accepted as a justifiable 
and legitimate procedure, as that of Ovariotomy. This is 
conservative surgery in its highest sense; and its beneficent 
result will be continued through all future time. So long 
as women are compelled to incur the perils of parturition 
without the aid of intelligent and skilled accoucheurs, so 
long will they be liable to lesions which make life a miser- 
able burden to the victim and a loathsome offense to others. 
In the hands of surgical experts such lesions are now al- 
most certain to be cured. But operations of this character 
must inevitably be left in the hands of the few who have 
had the opportunity for acquiring the necessary experience 
and training, and who possess the requisite aptitude and 
dexterity of manipulation. 
Brilliant surgical success is necessarily attended with 
more or less dangerous tendencies ; and it should be one of 
the missions of our Society to protect the profession and 
the public from such evils. If reckless enthusiasm for the 
tclat of operations prompt to the performance of such as 
are not absolutely necessary to preserve health or to save MEDICAL GYNECOLOGY. 
7 
life, it must be deemed criminal, and the operator be held 
as responsible for the consequences as is the master of a 
steamer who, by racing, exceeds the capacity of his engine 
and destroys the lives of the passengers by its explosion, 
or the careless switch-tender, whose mistake in the per- 
formance of duty results in the destruction of railway car- 
riages and in the terrible injuries and death of travelers. 
A Balaklava charge on the field of battle may have its 
justification or be excused by the poet’s phrase,— 
“ Some one has blundered,” 
but we have no such defense in the execution of the duties 
of our profession. The sole justification of any operation 
which involves suffering and danger to the subject, must 
be the strong probability, based on scientific knowledge, 
that compensating good will be the result. An operation 
for the removal of an intra-uterine tumor which interferes 
but slightly with the functions of the vital organs, which 
probably will cease to increase in size after the menopause 
and may possibly disappear by the conservative processes 
of nature, cannot be defended, if, on being attempted it 
should cause death ; still less, repeated fatal results from 
operations, whose sole object is the possible relief from 
symptoms which have but a slight disturbing influence on 
the general health or the problematical cure of sterility. 
It is difficult to conceive that such events can occur in the 
conscientious, intelligent performance of duty, but they be- 
fall operators who 
“ Have no spur 
To prick the sides of their intent, but only 
Vaulting ambition, which o’erleaps itself 
And falls on the other.” 
Retribution sooner or later must follow. The crushing 
force of public opinion is as terrible a punishment as the 
execution of the law. While, in my opinion, ethical dis- 
cussions should have no place in the proceedings of this 
Society, yet as individuals and as a body, we should make 
our influence felt in preserving a sound moral sense. It 8 
ANNUAL ADDRESS. 
seems hardly necessary for me to add, in order to prevent 
misapprehension, that I have no reference in my remarks to 
the surgical treatment of uterine fibroids, — first suggested 
and practiced nearly a quarter of a century ago by a Fellow 
of this Society — when they become dangerous by the 
exhausting hemorrhages which are sometimes caused by 
them or by their mechanical interference with essential 
functions ; neither do I mean to condemn incision of the 
cervix uteri, where stenosis, whether congenital or ac- 
quired, absolutely exists. 
It would not be fitting on this occasion for me to discuss 
elementary principles ; but it is certainly pertinent to ask 
what work is now most needed in Gynecology, and I may 
therefore venture to throw out a few suggestions in answer 
to this inquiry. 
Not only the specialist but every general practitioner 
desires to see settled many questions, still in dispute, as 
to the etiology, the pathology, and the appropriate treat- 
ment of the most common symptoms which cause suffering 
and prevent the healthy performance of the sexual func- 
tions, of menstruation, ovulation, conception, gestation, par- 
turition, and involution. Putting the question in this sim- 
ple way, we see that it covers a broad ground, in which 
Gynecology can as yet lay no claim to scientific precision, 
and her teachings are “ a trumpet of uncertain sound.” 
The science of the law is based on the decision of 
judges ; and what is technically termed a digest, is a prac- 
tical manual for the whole profession. But any such digest 
of Gynecological science is at present impossible, for there 
are no authoritative decisions which all are bound to accept; 
and any attempt to impose the weight of authority will be 
affected by the mental bias of theory, and will inevitably 
give undue prominence to certain doctrines, while others 
are slighted or wholly overlooked. We have yet to deter- 
mine what the truth is, in regard to many of the most im- 
portant points, on which, every day, the profession is called 
upon to decide and act. MEDICAL GYNECOLOGY. 
9 
Take the question of uterine displacements and flexions, 
which for more than twenty years has been a subject of 
active discussion and controversy. Let us first see what 
are accepted by all as facts, which have a bearing on this 
subject. The position of the uterus in the pelvic cavity, 
its relations to contiguous organs and tissues, its normal 
mobility, its change of situation with each deep inspiration, 
its displacement backward by a full bladder, its quick res- 
toration by the rapidity with which the bladder of the fe- 
male is emptied, its displacement forward by a distended 
rectum, the fact that its only unyielding or fixed attach- 
ment is that of its lower anterior portion to the bladder, 
which is continuous with a similar attachment to the upper 
part of the vagina, so that in health, the orifice of the 
cervix corresponds in direction to that of the centre of the 
distended vaginal canal, are all settled points. The propor- 
tionate influence of each adjacent tissue in keeping the 
organ in its normal relation to other organs and in restor- 
ing it to position, when physiologically or temporarily dis- 
placed, has not yet been definitely determined, and it prob- 
ably varies to a certain extent in different women. But all 
agree that the ligaments, the connective tissue, the vascular 
apparatus and the vaginal walls, each contribute to this 
end. 
That the law of gravitation will govern the displacement 
of the organ, if there be abnormal increase of its weight out 
of proportion to the normal sustaining power, is doubted 
by no one. Then, that acute displacement of the unim- 
pregnated organ causes, in some instances, severe suffer- 
ing, is a fact of common observation. There are some 
women who are liable to sudden retroversion of the organ, 
which at once causes severe pain up the whole back, violent 
headache, and a flushed face, symptoms which are imme- 
diately relieved by the restoration of the organ to its normal 
position. In one of my patients, a retroversion of four or 
five days’ duration resulted in positive insanity, which was 
cured by replacement of the organ. It is also an accepted 10 
ANNUAL ADDRESS. 
fact that the various displacements, in some instances, es- 
sentially and injuriously modify the nutritive, neurotic, and 
vascular conditions of the organ. An acute displacement 
sometimes causes such a congestion as to double the weight 
of the organ in a few days, which as rapidly decreases when 
the organ is restored to its place. On the other hand, all 
are in accord that the various pathological conditions which 
result in either increasing the weight of the organ or in 
diminishing the sustaining forces which surround it, cause 
displacements, and that the cure of the pathological cause 
is followed by restoration of the normal position of the 
organ. 
Thus we all acknowledge that uterine affections may be 
divided into two classes ; one being the displacements of 
the organ, and the other its pathological changes (functional 
derangements being common to both) ; and that when the 
one class occurs as a primary cause, the other may follow 
as a consequence. Gynecologists, however, differ greatly in 
their belief as to the comparative frequency and importance 
of these two classes. If the question could be directly put 
to all who are specially interested in the study and treat- 
ment of these diseases, and the answer be given, after due 
reflection, as to the influence which parturition, sub-invo- 
lution, disordered functions, leucorrhea, and constitutional 
causes have in producing pathological changes, I doubt not 
that the reply of a large majority would be that the path- 
ological changes much more frequently occur as a primary 
cause, and are much the more important. Yet, if one 
should seek the answer in an examination of the general 
practice of the profession and a comparson of the efforts 
made to effect cures by the selection of therapeutical re- 
sources, I am not sure that the general expression would 
not be the reverse. For example, in studying this subject, 
I find that, since 1845, one hundred and two men have 
sought immortality by devising new forms of pessaries, de- 
scriptions of which has been published. 
Is there any evidence of a corresponding activity in as- MEDICAL GYNECOLOGY. 
11 
certaining the etiology, in defining symptoms, and in dis- 
covering remedies for the various organic and functional 
diseases of the organ, as in devising means for keeping it 
in its place ? I may go farther and ask if even much of the 
knowledge of the past is not now generally overlooked or 
forgotten ? Is not the direct vascular communication be- 
tween the uterine, the ovarian, and the vaginal plexus usu- 
ally disregarded by reason of the exclusive study of the dis- 
eases of one or the other of these organs ? Is not the im- 
portant relationship which exists between hepatic disorders 
and uterine affections very generally ignored in the treat- 
ment of the diseases of both the hepatic and the uterine 
organs, from forgetfulness of the connection which exists 
between the uterine and the hemorrhoidal plexus ? Numer- 
ous illustrations must at once occur to the minds of alb 
which will justify me in the assertion that the medical has 
received much less attention than the surgical treatment of 
uterine affections. 
If in theory most of the profession would avow the belief 
that the pathological conditions of the uterus are of more 
importance than its changes of position, it would seem that 
in practice the governing principles of treatment are those 
which emanate from the school, which one of its most 
ardent enthusiasts has appropriately termed, “ the mechan- 
ical system of uterine pathology.” 
The truth of this assertion is confirmed by a reference 
to the opinions which appear to govern the practice of large 
numbers of the profession in the treatment of uterine flex- 
ions. Do we not find the feeling very common, that, when 
these flexions exist, the nervous symptoms, the pelvic pain, 
and the functional disorders are almost wholly due to what 
is supposed to be the abnormal form of the organ, and that 
the appropriate treatment must be the mechanical means 
for restoring the organ to a proper shape ? 
While I regard it as hardly excusable, in discussing gen- 
eral principles in such an address, to occupy the time of 
the Society with matters of detail, I may be pardoned for 12 
ANNUAL ADDRESS. 
relating a case which came under my observation some 
years ago, as it seems to me very suggestive in some im- 
portant points in connection with this subject. 
In April, i860, I was consulted in regard to a lady, aged 
nineteen, married three months, as to the existence of preg- 
nancy and the safety of a voyage to Europe in May. She 
had the appearance of perfect health. Menstruation was 
established at fourteen, always scanty, attended with mod- 
erate pains in the pelvis and tenderness and rather severe 
pains in the breast for the first day only, but the period 
never continued beyond the third day. Since her marriage, 
which took place two days after menstruation had ceased, 
she had not been unwell, nor had she felt any sensations 
like those usual on the first day of her period. On exami- 
nation, I found one of the most acute anteflexions that I 
ever met ; but the body of the uterus was small, while the 
vaginal portion of the cervix was rather large in proportion 
to the size of the body. I expressed the opinion that she 
was not pregnant, but I did not say that she never would 
be, although I thought so. She left for Europe the first of 
May, and the day after sailing, the menses appeared, the 
flow was more abundant than usual and continued four 
days, for the first time in her life. In June, while at Frank- 
fort-on-the-Main, exactly four weeks from the last period, 
menstruation was again free for four days. Her passage 
was taken for her return to this country in October, but 
as she had not menstruated since June, while in Paris, the 
latter part of September, her husband consulted Dr. Camp- 
bell, who pronounced her pregnant. They therefore re- 
mained in Paris for the winter, and early in March she gave 
birth to a healthy child. In May, 1861, they returned to 
New York, where I was called to see her on account of 
some supposed uterine troubles, but her symptoms proved 
to be wholly due to internal hemorrhoids. My surprise was 
great to find the uterus almost the same as at my first 
examination, extremely anteflexed, the body small for a 
woman who had been delivered but nine weeks before, the MEDICAL GYNECOLOGY. 
13 
cervix rather large. With a very flexible sound, I found 
the uterus and cervix measured two inches and seven 
eighths. In April, 1862, she gave birth to a second child, 
and in April, 1863, she had a third, having never menstru- 
ated since her first pregnancy. In the autumn of 1865, the 
family again went to Europe. They returned the following 
year, when I found her so changed, that if I had met her 
in the street I should not have recognized her. Her gen- 
eral health was completely broken down, and she was a 
wretched invalid from pelvic cellulitis and recurrent ab- 
scesses. 
The preceding December she was suffering from some 
pelvic symptoms, and, by the advice of friends, she con- 
sulted a very eminent gynecologist, who considered her 
symptoms due to anteflexion and introduced a stem pes- 
sary. Several different instruments were tried, all of which, 
as she says, caused her intolerable agony, but being a lady 
of great force of character, she was persuaded to persevere 
in wearing one of the instruments for three weeks, when she 
became severely, and I should judge from the history given, 
very dangerously ill. It was quite two years before she 
recovered her health. When she regarded herself as quite 
well, I found the uterus larger than before, but the ante- 
flexion remained the same. In June, 1869, she removed to 
Europe, where she has since remained. In December, 
1870, she gave birth to her fourth child. I have seen her 
nearly every summer, and she informs me that she has 
never had occasion to seek the advice of a physician for 
herself since the birth of her last child. Three years ago 
I begged permission to make an examination, and found 
the uterus as anteflexed as before. 
Now, while admitting that this is, in many respects, a 
very exceptional case, it was to me a very suggestive one. 
It taught me, in connection with subsequent experience in 
other cases, that the extremes of flexion of the uterus may 
exist without symptoms, and without materially interfering 
with the functions of the organ. I have found, in some 14 
cases that menstruation restores the form of the organ so 
as to permit the easy introduction of the sound, which, 
during the interval between the periods, can only be passed 
when greatly curved. 
I have utilized this observation in deciding as to the 
time when labor might be expected, in women whom I 
have known to have marked flexions of the uterus, by re- 
garding it as probable that conception took place from 
twenty-one to twenty-seven days after the last menstru- 
ation, and I have usually found that my calculation as to 
the period of utero-gestation has proved correct. 
I believe that most Gynecologists, who are not partisans 
of “ the mechanical system of uterine pathology,” will ac- 
cept the following propositions : — 
Flexions in the virgin cause no symptoms, except a 
slight dysmenorrhea, unless there be some vitiation of the 
2:eneral health, defective nutritian, neurotic disturbances, 
or pathological change of the pelvic organs other-than the 
flexion. 
In some married women, in whom flexions exist, all the 
functions of the uterus, menstruation, conception, gestation, 
and parturition, are performed without any apparent dif- 
ficulty due to change of the form of the organ. 
In the married, however, these flexions may become a 
source of irritation, and be one of the factors in producing 
functional disorders, neurotic disturbances, and pathological 
changes of structure, not only in the uterus, but in the ad- 
jacent tissues. 
Mechanical treatment, such as the use of pessaries, or 
surgical, such as the division of the posterior lip backward, 
is neither safe nor useful, until all associated pathological 
conditions, due to antecedent or coincident inflammation, 
have been overcome. 
All treatment, whether local, surgical, or mechanical, will 
fail in curing uterine disease, so long as the blood is defi- 
cient in its proper proportion of nutritive elements, and 
therefore appropriate constitutional treatment is essential 
to success. 
ANNUAL ADDRESS. MEDICAL GYNECOLOGY. 
15 
I may therefore ask whether the general neglect of these 
principles does not justify me in calling attention to the 
importance of Medical Gynecology ? 
One of our number, some years ago, made a valuable 
contribution to uterine surgery, by pointing out the im- 
portance of lacerations of the cervix uteri, as a frequent 
and unrecognized cause of disease, and by describing a suc- 
cessful mode of surgical treatment. I know the accuracy 
of his description and have seen the success of his treat- 
ment. Yet there is a medical aspect to the subject which 
should not be overlooked. This disease is always asso- 
ciated with sub-involution, which, in a majority of cases, is, 
I think, the primary cause of the failure of the lacerations 
to cicatrize and of the subsequent eversion, and I am con- 
vinced by observation that in some cases effective treat- 
ment, which secures the complete involution of the organ, 
renders the operation unnecessary. 
One of our subjects for discussion during the present 
session is, whether it be justifiable “ to remove the function- 
ally active ovaries, in the case of any grave disease, which 
is either dangerous to life or destructive of health and hap- 
piness, which is incurable by other and less radical means, 
and which we may reasonably expect to remove by the 
arrest of ovulation or change of life.” The paper on this 
subject, in our Transactions, has doubtless been carefully 
studied by all, at least those who intend to take part in the 
discussion. No one can read it without the conviction 
that this bold innovator has been governed by the most 
conscientious motives, and that his aim has been to relieve 
his patients rather than to attain surgical glory. By refer- 
ence to the paper, it is seen that he has shown the courage 
of his opinions by performing the operation on ten patients, 
only one of whom died, To quote his language in the 
“ Atlanta Medical and Surgical Journal,” he “appeals to the 
bar of the medical world, and purposes to submit to its just 
judgment.” I think, therefore, we may well believe that no 
one can be more, anxious than he to hear all the valid argu- 16 
ANNUAL ADDRESS. 
ments which may be urged against the operation. I refer 
to it now, because I think it affords another illustration of 
the importance of Medical Gynecology. 
The author distinctly asserts that, “ he does not propose 
the operation for any case which is curable by other 
means.” Here lies the whole gist of the question. 
From the description given of the symptoms in the cases 
in which the operation was performed, I should infer that 
they belong to the class described by Charcot as Ovarian 
Hyperesthesia, which Swediaur designates as Hyperkinesis, 
Schutzenberger, as Ovarialgia, and Negrier, as Ovaria. It 
is accompanied generally by the aura hysterica, the globus 
hystericus, and cerebral phenomena. Most of us, I pre- 
sume, have seen such cases, differing in degrees of intensity, 
some persisting for many years. In some cases the dis- 
ease is attended with contractures, paralysis, and hystero- 
epileptic convulsions. 
One case, which had existed for three years when I first 
saw her, was that of a young lady, twenty-one years of age, 
of delicate frame and feeble organization, in whom men- 
struation appeared at the age of seventeen, but was always 
very scanty and attended with severe suffering. For eight 
years she was under the treatment of many different phy- 
sicians, but without benefit. It is hardly possible to suggest 
a remedy which had not been thoroughly tried. Her con- 
dition was most pitiable, and during ten days, which in- 
cluded the menstrual period, she required constant watch- 
ing and attendance. Some months after the death of. her 
father, she was said to be greatly improved, and her en- 
gagement to be married was announced. I have since 
learned, that at the age of eighteen she formed an attach- 
ment, but her father, a man of very positive will, absolutely 
forbade an engagement, because, as he said, “the young 
man was good for nothing,” that is, he had esthetic tastes, 
but no business, profession, or money. The death of her 
father removed all obstacles. Since her marriage, she still 
suffers severely at her menstrual periods, but, on the whole, MEDICAL GYNECOLOGY. 
17 
enjoys a happy, and for her, a useful life, for she handsomely 
supports a luxurious husband. In this instance two nega- 
tives have not made an affirmative, for the marriage has 
not been fruitful. 
In another case, which I have no doubt has been seen 
by most of the gynecologists of New York, ovarian pains 
of agonizing severity had made life a burden for many 
years, and in this case they were attended with paralysis, 
contractures, and monthly attacks of hystero-epileptic con- 
vulsions. A year ago, while visiting the wife of a clergy- 
man, he told me of the wonderful cure of a lady, “ of pa- 
ralysisand convulsions, — for which she had been treated 
for years, by all the eminent physicians of New York,— 
by the power of prayer.” 
On inquiry, I found her to be the same lady, just referred 
to, whom I had seen several times, three or four years be- 
fore, and I therefore visited her again, to learn the facts 
from her own lips. She told me that her mother, sister, and 
brother-in-law, who constituted the family, became greatly 
interested in the meetings of Moody and Sankey. The 
house, which before was always gloomy, became cheerful 
and animated, from religious exaltation and the singing of 
hymns. Prayers were put up at the meetings for her con- 
version, and at last, to use her own words, “she experienced 
religion.” She then prayed most fervently night and day, 
either for death or for recovery, so that she might no 
longer be a trial or burden to her friends, and her prayer 
was in a great measure answered. I visited her again a 
few days since, and found that it is now fourteen months 
since she has had either convulsions, paralysis, or curva- 
tures, and that she has comfortable health, assists in house- 
hold duties, goes to church, and has a class at Sunday- 
school, except during the week of her menstruation, when 
she is compelled to stay in bed. Her suffering then she 
represents as severe, but still she gets along without any 
form of opiate, which formerly, at these periods, she was 
obliged to use in very large quantities. 18 
ANNUAL ADDRESS. 
Now, is it not well to inquire, if psychical remedies cure 
some such cases as successfully as the extirpation of the 
ovaries, whether other remedies may not be found equally 
effective in curing others. The difficulty in settling this 
question, it seems to me, lies in coming to a decision as to 
what cases are absolutely incurable by other means. 
In those rare cases of functional activity of the ovaries, 
coexistent with congenital absence of the uterus, or a mere 
rudimental development of the organ, where there results 
such constitutional disturbance and shock from the ab- 
sence of relief effected by the periodical depletion of men- 
struation, as to render life useless and intoierable, it seems 
to me that there can be no question, that the suggestion 
of Dr. Battey was a great thought, and that the operation 
which he first had the genius to devise and the boldness 
to perform, will be accepted by the profession of the future. 
But it will demand the experience and observation of years 
to determine, in how much wider range of cases the opera- 
tion is to be accepted as justifiable. 
I greatly regret that time will not permit me to discuss 
what I regard as a very general neglect of ovarian pathol- 
ogy and therapeutics, aside from what pertains to ovarian 
tumors. But I think that I have said enough to show 
clearly that Medical Gynecology should bear as important a 
part in the work of this Society, as Uterine Surgery. Uter- 
ine therapeutics have by no means kept apace with our 
progress in pathology and improved methods of diagnosis. 
It has been very much the fashion to express a skeptical 
doubt as to the value of medicinal agents, in a manner im- 
plying a latent belief that incredulity on this point is an 
evidence of a strong mind, and that a confidence in the 
efficacy of therapeutic agents is an evidence of weakness. 
In conclusion, permit me to express the hope, that you 
will elect some more worthy successor to fill the place 
which I now hold, and to thank you most warmly for the 
undeserved honor, and the kindness and patience with 
which you have listened to me to day.