^aZ^ 
,X CEDE HATOUS MYOMA-Weight, 93X?Ihs. 
REMOVED DEC. 7t^„^890, 
By Jno. H. McIntyre, A. M., M. D., St. Eouis? Mo. REPRINT FROM 
THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. 
"A Report of Ten ^elected of 
L&pa?o^om^ wii 
Read in the Section of Obstetrics and Diseases of Women, at the Forty- 
second Annual Meeting of the American Medical Associa- 
tion, held at Washington, D. C., May, 1891. 
by jno. h. McIntyre, A. m., m.d., 
OF ST. LOUIS, MO. 
The following brief report of laparotomies is made in the hope 
that its variety may not be wholly devoid of interest: 
Case 1.-Mrs. D., jet. 38, presented herself at my office in the 
early part of April of last year, suffering considerable pain and in- 
convenience from a rapidly-growing tumor in the abdomen, situated 
immediately to the right of the umbilicus. The growth was some- 
what movable, and the size of a foetal head. 
She presented an anxious expression, suffered from insomnia, 
and was rapidly losing flesh. A short time previous to this inter- 
view, a council of several gentlemen had decided that her trouble 
was floating kidney, and had advised, and she had submitted to, 
tight bandaging with compresses, to keep the supposed floating kid- 
ney in place ; this was worn for several days, until she rebelled, on 
account of the pain which it occasioned. 
As at that time there was no suspicion of anything of a malig- 
nant nature, and as I was on the eve of my departure for a month's 
absence, and she evidently needed "toning up," I left her in the 
care of my assistant, but advised removal of the growth by abdom- 
inal section, immediately upon my return home-which I may men- 
tion was hastened several days on account of news of rapidly in- 
creasing unsatisfactory condition. 
May 29 she was anjesthetized, and the abdomen opened in the 
linea alba, the incision extending from the umbilicus to near the 
symphysis pubis. Upon passing my hand within the abdomen, 2 
over and around the tumor, I found extensive attachments. The 
ventral wound was extended three inches upward, and to the left 
of the umbilicus, and the growth turned out. It was attached to 
the mesentery, the intestines and the lower lobe of the liver by an 
intricate mass of adhesions, and was carcinomatous. Of course 
there was but one thing to be done, and that was to return it to the 
abdominal cavity and close the wound. 
She rallied nicely from the operation, and much to my surprise 
the abdominal wound healed throughout nearly its whole extent by 
first intention, only a sinus remaining at the lower angle of the 
wound to give us trouble. I scarcely need say she has since died. 
Case 2.-On June 13th, just fourteen days after my very un- 
pleasant experience with the case above referred to, Mrs. A. E. A., 
set. 32, who had long been a sufferer from ovarian irritation, with 
all its attendant ills, was placed on the table, and both ovaries and 
the Fallopian tube of one side were removed through a two and 
one-quarter inch incision in the linea alba. Each ovary was not 
only inflamed and enlarged, but one furnished more than a tablespoon- 
ful of pus. The reaction was prompt, and the wound healed by first 
intention, all stitches being out by the seventh day. The cure in 
this case is complete ; the lady goes into society, does shopping, 
and now superintends her household affairs, and is again the bright 
star in the beautiful and refined home over which she presides. 
Case 3.-Mrs. R. C., set. 29, rather fleshy, though always pale, 
had been a sufferer from ovarian irritation since she was fourteen 
years of age. Her spine had been many times blistered, cupped 
and painted with iodine, croton oil, tartar emetic, etc. Her womb 
had been dilated-though for what reason Heaven only knows. 
She had been sent to Colorado, to the Hot Springs of Arkansas, 
Eureka and many others, but to no advantage. 
She was anaesthetized with bichloride of methyline, used in a 
Junker's inhaler. An incision, two and one-half inches in extent, 
was made in the linea alba, and both ovaries, and both Fallopian 
tubes were removed. She also rallied well, the ventral wound 
healing by first intention. She walked out, a block away, to the 
corner grocery, on the sixteenth day; she is now in the enjoyment 
of excellent health, and, so far, with the sexual instinct the same 
as before operation. In both these cases of Battey-Tait operation, 
there has been no return of the menstrual flow. 3 
Case Ji-.-Mrs. S. G., aet. 44; an anaemic, bed-ridden sufferer, 
with an enormous sub-peritoneal fibroma. Bowels could not be 
moved, even by powerful cathartics and rectal injections, oftener 
than once in twelve to sixteen days, when they would suddenly run 
off for two or three days. This condition was occasioned by mechan- 
ical pressure, which produced irritation and inflammation, and caused 
many adhesions. The growth was removed through an incision 
extending almost from the xyphoid cartilage to the symphysis 
pubis. While breaking up adhesions very gently with my finger, I 
had the misfortune to split the softened gut to the extent of two and 
a half inches; fecal matter poured into the abdominal cavity, which 
was quickly cleansed by sponges squeezed out of a 1:2,000 mercuric 
bichloride solution. Placing my finger in the rent, the tissues were 
so softened that the tear extended at least another inch in extent, 
making three and a half in length. It was closed up with silk, 
using the Lembert suture. 
When the operation was completed she was almost moribund. 
About a dozen and a half hypodermic syringefuls of brandy were 
thrown under the skin in the arms and legs, she was put to bed and 
her body and limbs surrounded by hot water. Reaction was ob- 
tained slowly, but perfectly, and recovery was uneventful. A 
stitch-hole sinus gave the only real trouble, and did not close for 
over four weeks. 
Case 5.-October 16, 1889, I received a letter by messenger 
from a medical gentlemen, urging me, if possible, to meet him, to- 
gether with two others, in consultation, immediately upon the arrival 
of the train. He said, "my diagnosis is uterine tumor, probably 
fibrous. She is suffering intensely from tenesmus of the bladder 
and rectum ; something must be done early, and I hope you will 
be able to come this evening." 
I found the doctor's fears to be indeed well founded. A lady 
of culture and refinement, surrounded by every evidence of luxury, 
but was in a semi-unconscious state, with a temperature of 103°, 
suffering excruciating agony, which the most heroic doses of mor- 
phia only relieved by being frequently repeated. A tumor, to all 
appearances hard and solid, protruded at the front of the abdomen, 
yet was jammed down in the pelvis, and its lower segments could 
be distinctly felt in the retro-uterine space. 4 
Matters were indeed desperate, and although abdominal section 
gave but a ray of hope, yet it was decided to give her this slender 
chance. It was done the next morning, and we found a supurating 
tumor, broken down in its entirety, which sprang from the left 
ovary, and pus, pus, pus everywhere. The operation lasted fifty 
minutes ; she rallied gradually, and with no nausea, but although 
the temperature came down almost to normal, she died of exhaus- 
tion and previous septic infection, on the fifth day after the operation. 
Case 6.-Mrs. E. D. H., set. 37. Since the birth of her only 
child, now fourteen years of age, has never been "just well." 
About four years ago began to suffer much pain, and an unusual 
loss of blood at her menstrual periods. Matters went on from bad 
to worse, during which time she had gone the "grand rounds," con- 
sulting "regulars," irregulars and defectives. At the time of my 
first interview, I found a woman nervous anaemic and pale from 
loss of blood, spending one-half of her time in bed, and losing blood 
three weeks out of four, thus having only one week in the inter- 
menstrual period in which to recuperate. Examination revealed the 
uterus enlarged to a size of that between the third and fourth month 
of pregnancy, the os quite low down, and the fundus and part of 
body easily felt through the abdominal parietes. By bimanual 
palpitation was easily made out its hard, nodular and irregular out- 
line. The removal of the ovaries to bring about the menopause 
was promptly advised, and as promptly declined, coupled, however, 
with the request that something be done other than a surgical oper- 
ation. Much against my own judgment I consented to retain the 
management of her case, and during a period of four months fol- 
lowing, subjected her to many hypodermatics of ergotine, introduced 
in the linea alba, with the advantage of producing two painful ab- 
cesses, and no control of the hemorrhage. I now informed her that 
temporizing, at least at my hands, was at an end, and that she must 
be governed wholly and absolutely by my advice, or I should retire 
from the further management of her case. A family council was 
held, which resulted in their acquiescence, and a laparotomy was 
performed the next day, bichloride of methyline in a Junker's in- 
haler being the anaesthetic used. An incision, five inches in length, 
was made in the linea alba; introducing the hand into the abdomen, 
it was easy to make out six or seven hard multiple myomatous 
tumors, varying in size from that of an almond to that of a goose 5 
egg, imbedded in and protruding from the walls of the uterus ; the 
ovaries were found and removed, without difficulty, and the ventral 
wound closed with silk-worm gut sutures. Recovery prompt and 
uneventful. Some show of blood at two or three menstrual periods 
following, but no hemorrhage; cure complete. She is not now a 
believer in hypodermic medication. 
Case 7.-Mrs. R. 0., set. 25, was first a mother at the age of 
nineteen. Had been an invalid since the birth of her youngest 
child, now four years of age. Suffered from albuminuria ; had 
"sinking spells," together with an enormous distention of the ab- 
domen, for the relief of which, she sought, not the Pool of Siloam, 
but the healing and rejuvenating waters of Lebanon, Mo., where 
she came under the professional care of my friend, Dr. J. M. Bil- 
lings, of that place, who recognizing her real condition, referred 
her to me for operation. 
The doctor arrived tne next day, but I suggested to him that 
on account of her unsatisfactory condition, it might be well to post- 
pone the operation for a few days, (her temperature being two de- 
grees above normal,) when he replied, "you may as well proceed 
with the operation, for you will never get her in better condition ; 
only a short time ago, her husband was sent for to come to Lebanon 
to see her die," Accordingly, the operation was performed the day 
after his arrival. 
Our diagnosis was unilocular cyst of the left ovary. Circum- 
ference of the abdomen, over the umbilicus, was thirty-nine inches. 
Time of operation, one hour; weight of tumor, thirty-six pounds ; 
it was multilocular, instead of unilocular, as we had supposed. 
There were extensive but not firm adhesions, which were ab- 
dominal rather than pelvic, the most troublesome being in the region 
of the liver. Pedicle was transfixed, ligated and pocketed. The 
ventral wound was closed with sixteen silk-worm gut sutures. Ex- 
ternal dressings, antiseptic gauze, compresses, and the time-honored 
flannel bandage. 
Much to my surprise, I found her at 7 p. m. on the evening 
of the day of the operation, with a temperature of 98°, and no 
vomiting. The temperature did not go above 100° until after 
the tenth day. Ten sutures were removed on the seventh day, 
and the remaining six on the eighth, the wound having healed 
throughout by first intention. 6 
On the evening of the tenth day, the temperature suddenly went 
up to 102.5°, and by the twenty-second, in spite of antipyretics, 
had reached 103°, after which it steadily and rapidly declined to 
98° within the space of five days. 
I accounted for the above condition as follows : At the time 
of the sudden rise of temperature, the skin assumed a yellow tinge, 
and within twenty-four hours had presented the dark yellow hue of 
a typical case of jaundice, continuing until the twenty-second, in 
spite of all the medication which had been used. 
I now became convinced that the trouble was occasioned by 
occlusion, more or less complete, of the ductus communis choledocus, 
on account of contraction of the raw surfaces, which had been pro- 
duced by breaking up adhesions in its vicinity, and that my patient 
would die if not relieved. So I resorted to no very gentle massage 
over this particular region, and with the most happy effect, for, 
within twenty-four hours the skin and conjunctiva had sensibly 
cleared up, and rapidly continued to do so, until they had assumed 
their natural hue. 
The temperature, within the first twenty-four hours, had fallen 
nearly 3°, and as I before stated, was normal by the end of the fifth, 
after which she went on to a rapid and satisfactory recovery. 
Case 8.-Mrs. F. C., set. 45. When in good health, a large, 
fleshy woman. Mother of several children. About four years ago, 
noticed some change in her menstruation, it being increased both in 
duration and quantity. At first she gave it little thought, as she 
supposed she was reaching the climacteric. 
Later on, she noticed a small lump in the right ovarian region, 
together with an increase in the size of her abdomen. Yet, as she 
expressed it, she thought she must be again pregnant "in spite of 
herself." The abdomen continuing to enlarge, and the period of 
pregnancy having passed, she realized the possibility of abdominal 
tumor of some kind. 
Her general health now began to fail. She lost flesh, suffered 
from indigestion, and had many profuse uterine hemorrhages, to- 
gether with a rapidly increasing abdomen, and at the time I saw 
her, the facies ovariana was well marked. 
At the preliminary examination of this case, I was at first a little 
undecided, on account of the uterine hemorrhages and the nodular 
and somewhat irregular outline of the abdomen, whether it was an 7 
enormous subperitoneal fibrona, or a multilocular cyst. I finally, 
however, decided that it was a multilocular cyst, and had the satis- 
faction of confirming my diagnosis at the operation. 
A tumor, of thirty pounds weight, was removed, which was 
partly solid, but having many compartments, the solid part furnish- 
ing a most beautiful specimen. 
The pedicle, which contained two unusually large vessels, was 
transfixed, litigated and dropped back into the abdomen. 
Wound closed by silk-worm gut sutures, and antiseptic dress- 
ings applied. Time of work, fifty minutes. Some nausea but no 
vomiting followed. Abdominal wound was inspected on the morn- 
ing of sixth day, it having healed by first intention, without a drop 
of pus or a blush of inflammation. No rise of temperature at any 
time of over 2° above normal. 
Case 9.-On December 10th, 1890, Mrs. M. B., mt 38, height 
five feet, one inch, weight, ninety pounds, was sent to me from a 
distance to have an unilateral laceration of the cervix restored. 
She first menstruated at the age of twelve. Was married at 
twenty-five. Is the mother of two children, the youngest now 
being seven years of age, from the birth of which she dates her 
ill-health. For the past five years she has been absolutely unable 
to endure marital relations. Has suffered great pain and tender- 
ness in right ovarian region, and, in a lesser degree, also in the 
left, together with weight and dragging in lower part of abdomen. 
Has suffered much from insomnia, palpitation of the heart, and is 
very melancholy. Has been often confined to her bed for weeks at 
a time, the longest being from January to June of last year, at 
■which time, as she expressed herself, she was "past pain." 
She suffered much from menstrual headaches, and was seldom 
free from the peculiar sense of heat and weight upon the vertex, so 
characteristic of uterine and ovarian irritation. At the time of 
my first interview, I found a woman j ust upon the verge of insan- 
ity. One of the first things I did was to remove a horse-shoe pes- 
sary from her vagina, which she had worn for many months. The 
little tear in the cervix amounted to next to nothing. 
Some granular erosion existed on the os, and the uterus was 
inflamed and congested. With the right index finger in the vagina, 
and the left hand upon the abdomen, I could easily make out the 
soft, baggy, and irregular rounded tumors, sausage-like, in the 8 
ovarian region, the right larger than than left, both being exqui- 
sitely tender, and although the examination was conducted with 
care and gentleness, yet she complained of nausea and faintness. 
She was therefore advised to submit to laparotomy for removal of 
both ovaries and Fallopian tubes. 
After one week of rest and preparation, the operation was 
performed on December 17th, 1890. Bichloride of methyline in a 
Junker's inhaler being the ansesthetic which I always use in my 
abdominal operations, was of course the choosen one. Through a 
two and one-half inch incision in the linca alba, the left tube and 
ovary was easily removed. Not so, however, with the right, as it 
was prolapsed deeply into Douglass cul-de-sac, and was bound down 
by many and rather strong adhesions. After being brought out 
through the ventral wound, I found not only an enlarged tube, but 
also a beautiful specimen of hsematoma of the ovary, in size about 
as large as a turkey's egg. 
The ventral wound was closed with silkworm gut sutures in- 
troduced from within outwards. The patient rallied nicely, and, as 
is usual in my experience with the anaesthetic used, with no nausea. 
Her recovery was eventful, the temperature at no time going 
above 101°. Sutures were all out by the seventh day, and she 
returned to her home in one month after the date of operation. 
A gratifying feature in this case was the prompt amelioration 
of all her unpleasant nervous symptoms-within a week after 
operation the expression of her countenance was markedly changed. 
She became bright and cheerful, and proved herself to be a woman 
of far more intelligence than I at first supposed her to be. I shall 
watch the after-results of this case with much interest. 
Case 10.-Mary A. J., single, set. 38, height 5 feet 5| inches, 
weight before operation, 199^ pounds. American, of rather mas- 
culine appearance, large bones, coarse features, having hair on the 
upper lip and chin. I found her in the poor house near Trenton, 
Grundy County, Mo., on November 26, 1890, suffering with a 
colossal growth of the abdomen, a good idea of which may be 
obtained from the photograph which I took at the time of my first 
interview. 
Measurements taken at that time were as follows: Circum- 
ference at largest part just below umbilicus, 50 inches. Circum- 
ference just below the mamma, 35 inches. From xyphoid cartilage, 9 
to symphysis pubis, 32 inches, not including the pendant appendum 
which is shown in the picture. From xyphoid cartilage to umbilicus 
13 inches; from right anterior superior spine of ilium, to umbili- 
cus, 14 inches; left anterior superior spine of ilium, 13| 
inches. Circumference of pendulous portion of growth at neck 
just below symphysis pubis, 27 inches. Circumference at its base, 
30 inches. The surface was smooth, tense and slightly clastic, 
large tortuous veins passing in various directions. 
Percussion imparted a slight wave that almost suggested fluid 
within a sac. The uterus was drawn up to the extent of twelve or 
fourteen inches. She walked with great difficulty and with a 
waddling gait, bending far backward, the better to keep " the center 
of gravity within the base," and thereby be better able to sustain 
the enormous weight of her abdomen. She was compelled to pass 
her urine while standing upon her feet. 
Attempts had been made six and two years respectively, before 
my first examination to tap her, and although a large trocar was 
thrust into the growth at several points, yet nothing came out but 
a few drops of blood. 
Diagnosis.-Either multilocular ovarian cyst or oedematous 
myoma of the uterus. 
At the beginning of her enlargement she was supposed to be 
enciente, was spurned and cast off by her family and friends, and 
after suffering many privations and hardships finally brought up 
in the poor-house, where I first saw her, at the solicitation of two 
prominent ladies from whom I had, during the past summer, re- 
moved large ovarian tumors. 
Their attention being called to this poor unfortunate, and 
being actuated by that bond of sympathy " which makes all the 
world akin," they provided the means for her care and transporta- 
tion to St. Louis, for operation, provided I thought best to do so. 
Although she was at the time failing rapidly, I saw that she had 
not the slightest ray of hope from anything but an operation, and 
believing that the justifiableness of any operative procedure con- 
sists in its necessity, I advised her to accept the only chance, 
though a slender one, for her life, which she promptly did. 
A few days later she was brought to this city by Dr. H. H. 
Wilson, of Trenton, Mo., and one of the ladies above referred to, 
and placed in the hospital. 10 
During the few days of rest and preparation before operation, 
I requested Mr. Thompson to have her weighed. The following 
was received from him : 
St. Louis, December 6th, 1890. 
Dr. McIntyre:-Your case, Miss Mary A. Johnson, in room No. 10, 
was weighed by me at 9:50 A. m., and tilts the beam at 199lbs., good 
weight. Respectfully, F. P. THOMPSON. 
On the morning of December 7th, 1890, the operation was 
performed with the assistance of Drs. Broome, Marks and Nichols 
of this city, and Dr. H. H. Wilson, of Trenton, Mo.; Drs. Gib. W. 
Carson, R. A. Quarles, P. S. O'Reilly, Moore and medical students 
Charles Lewis and F. P. Thompson of this city being present. 
Bichloride of methylene in a Junker's inhaler, was the anaes- 
thetic chosen. Anaesthesia was easily and promptly induced, and 
was maintained during the one hour and five minutes that the 
operation lasted, five and one-half drachms being used. 
An incision fourteen inches in length was first made in the 
linea alba, below the umbilicus, and afterwards extended up to 
near the xyphoid cartilage. The hemorrhage made by the incision 
in the abdomen wall was very free, and the enormously distended 
vessels required the application of a large number of pressure 
forceps. Adhesions were found almost everywhere, the most 
difficult to manage being those attached to the liver and diaphragm. 
The broad ligaments and Fallopian tubes were ligated on either 
side, the tumor turned out, the thick heavy pedicle transfixed and 
ligated, and the tumor cut away. 
It is a matter worthy of remark, that at the time of detach- 
ment of adhesions to the diaphragm the patient sank rapidly, and 
as it was thought that she might die on the table, hypodermics of 
whiskey were freely used before she rallied, and several minutes of 
time lost during the interval. 
A stream of hot water was kept playing upon the wound 
during the whole time of operation. 
The toilet of the peritoneum was necessarily hurried, and was 
greatly facilitated by pouring pitcher full after picher full of dis- 
tilled water heated to a temperature of 110°, into the abdomen. 
The ventral wound was closed with silkworm gut sutures, adhesive 
straps applied across the abdomen; compresses and the time- 
honored binder completed the dressing. 11 
As she was being carried from the operating room, through 
the hall to her bedroom, the stretcher was allowed to rest upon 
the platform scales for a few moments, and we found that we had 
106 pounds of woman left, and as her weight before operation in 
the same clothing was 199| pounds, we found that the weight of 
the tumor was 93| pounds. Placed in bed she was surrounded by 
bottles filled with hot water, and free hypodermics of whiskey 
used. Within a few hours she had rallied well and with no nausea. 
This case was manifestly one for drainage, but on account of 
the vast expanse of lax abdominal tissue, I did not believe that 
red serum would gravitate into Douglass' space sufficiently to re- 
move it through the Keith tube. I therefore remarked to the gen- 
tlemen present that if at any time the temperature went up so as 
to require it, we would cut a few ventral sutures and flush out the 
abdominal cavity. By the morning of the second day, forty-eight 
hours after the operation, the temperature in spite of antipyretics 
went up to 103.5. She was taken into the operating room and the 
abdomen flushed with hot distilled water, and many blood-clots 
and much serum removed, with the result that within six hours the 
temperature had fallen to 101°. A drainage-tube being now in- 
troduced furnished but little serum afterwards. Temperature did 
not go above 102° for the succeeding twenty-four hours. Within 
another forty-eight hours, symptoms of septicaemia became mani- 
fest, together with septicaemia vomiting, and she died at 4 A. M., 
December 12th, the fifth day after operation. 
REMARKS. 
The lesson which I learned, and the regret which I have in 
the after-management of this case, especially after witnessing the 
lowering of the temperature and the amelioration of unpleasant 
symptoms after the flushing of the abdomen with a large quantity 
of hot water, is that I did not resort to it again, or indeed as often 
as might seem necessary, for she became bright and cheerful, took 
liquid nourishment well, and flatus passed the bowels, and I began 
to have high hopes of her recovery. 
The ordinary drainage-tube did comparatively little good, as 
the enormously distended abdominal walls favored collections of 
serum in pockets, it did not gravitate into Douglass' pouch; conse- 
quently the peritoneum with its wonderful absorbing powers, which 
at once constitute its safety and its danger, took up septic material 
with fatal results. 
In looking over the literature of this subject I find no mention 
of any solid tumor of this size being removed. 
Keith, late of Edinburgh, now of London, successfully re- 
moved an oedematous myoma, together with the uterus, which was 
of 42 pounds weight, on the 18th of April, 1881. 12 
Mr. Lawson Tait, of Birmingham, England, reports in Vcl. 1, 
of his recent work, "Diseases of Women and Abdominal Surgery," 
page 187, that the largest uterine myoma which he ever removed 
in his life was of 68 pounds weight, and that it grew after the 
menopause. So, I believe that this one of my own, 93| pounds, is 
the largest yet reported. 
In all laparotomies, I carry out the strictest antiseptic precau- 
tions, although I abandoned the spray six years ago, and I now 
get better results without it than I did with it. All instruments 
are placed in a large, shallow photographer's dish, containing a one 
to forty carbolic acid solution, before and at the time of operation. 
Plenty of the finest quality of sponges, cup and flat, are kept for 
this operation alone, and are used in no other, and I give their 
cleansing and preparation my own personal attention. Bleeding 
points are ligated with fine Japanese cable silk. The pedicle is 
always ligated and pocketed. The ventral wound I always close 
with silk-worm gut, threaded upon two long veterinary needles, 
and pass the needles from within outward, always including the 
peritoneum. The idea of its use I received more than ten years 
ago, from Geo. Granville Bantock, of London. It is very strong 
and smooth, and can easily be made antiseptic; being somewhat 
stiff, it should be steeped for a few hours before being used, in a 
solution of some kind, so that there may be no difficulty in tying 
it tightly. It is the ideal suture, not only in closing the ventral 
wound in laparotomies, but also in lacerations of the cervix and 
perineum. 
For inducing anaesthesis,! use exclusively bichloride of methy- 
lene in a Junker's inhaler, and now, with an experience in its use 
in over three hundred operations of various kinds, while I have 
not infrequently seen nausea, I have only seen vomiting five or six 
times. When in doubt, I always drain, and prefer Keith's glass 
tube to all others. 
I wish here to call the attention of my professional breth- 
ren to the excellence and safety of Mr. Lawson Tait's Staffordshire 
knot in the ligation of the pedicle. 
I use little opium or morphia, for the reason, that this drug, 
by locking up the secretions, limits the power of elimination, and 
thereby favors septicaemia. For over a year past, in cases of lap- 
arotomy where pain and rise of temperature was present, I have 
used Antikamnia, in ten grain doses, with the happiest effects. 
After doing the Battey-Tait operation a large number of 
times, I wish here to add my testimony to that of others, that re- 
moval of the uterine appendages does not entail a loss of sexual 
feeling; excitability of the genital organs still remains, the voice 
is unaltered, and the womanly attributes are no less after the arti- 
ficial than after the natural menopause. 
61^ Olive Street,