REPORT OF THE 
COLUMBIA HOSPITAL FOR WOMEN, AND LYING-IN 
ASYLUM. 
P. J. Murphy, M.D., Surgeon in Charge, 
Washington, D.C. 
[Reported by W. P. Carr, M.D.] 
The object of this article is to give a brief outline of the work 
done in the hospital during the fiscal year ending June 30, 1888, 
to show the methods of treatment pursued and the results ob- 
tained ; and it is to be hoped that it may prove of interest to the 
reader, not in showing brilliant results, but as an exponent of 
what may be expected, in ordinary cases, from the more conserva- 
tive modes of treatment. For, as a rule, our methods have been 
conservative, and it is only after simple means have failed, or where 
it was evident from the first that they would be inefficient, that 
patients have been subjected to more radical and dangerous treat- 
ment. And it is in showing the large percentage of cures obtained 
in this way that I hope to atone to the reader for the infliction of 
a lengthy article. 
In spite of all that has been said and written, in late years, 
about the recuperative powers of nature and the proper way of 
assisting them, it seems to me that in the general endeavor to ob- 
tain speedy relief by operative procedures and specific drugs, we 
have given too little attention, in practice, to nature; and have 
given her too little of the real assistance of rest, hygiene and diet, 
prescribed with that minuteness of detail which is the true key to 
success. 
These points, however, have been scrupulously regarded in 
those cases operated upon, and who can say how much of the 
benefit following many operations is due to the absolute rest in 
bed, to the nutritious and easily assimilable diet, and to the moral 
effect of having undergone an operation. t 
Let us begin with 2 
Columbia Hospital for Wotnen and Lying-in Asylum. 
Diseases of the Uterus. 
There have been treated in the medical and surgical ward of 
the hospital 43 cases of inflammations of the various tissues of the 
uterus, as follows: 
Inflammation of the uterine muscular tissue, 18 case';; with 10 
complete cures and 8 cases relieved. 
Inflammation of the corporeal endometrium, 19 cases; 10 
cured, 8 relieved, and one in which the result is unknown, the pa- 
tient leaving suddenly without permission. 
Inflammation of the cervical endometrium, 7 cases; 4 cured, 
2 relieved, 1 unknown. 
Of the whole number, 24 were cured, and the remainder, with 
3 exceptions—patients leaving in a few days,—were greatly bene- 
fited. In no instance was the patient under treatment longer than 
ten or twelve weeks, and most of those marked relieved were in the 
hospital but two weeks, or less, leaving as soon as their symptoms 
were alleviated. In every case not complicated or caused by some 
incurable constitutional disease, where the patient has remained 
ten or twelve weeks under treatment, a cure has been effected. 
The following typical cases will show the treatment and results: 
case 1. 
L. H., set. 33, white, native of Maryland, admitted September 27, 
1887. Married sixteen years. Pregnant but once, thirteen years ago. 
Aborted about the third month. Menses regular, but profuse, lasting 
five days, and preceded by severe pain. During the last three years has 
suffered much from headache and pain in the back. Constipated. 
Examination.—Abdomen tympanitic and rigid; uterus enlarged, pro- 
lapsed and anteverted, cervix pointing directly backward. 
Treatment.—This patient was put to bed, but allowed to sit up a few 
hours daily, and longer, as she improved. She was given vaginal douches 
of several quarts of water, as hot as could be borne (ioo° to 120° F.), 
three times every other day, and on the alternate days a tampon of glyce- 
rite of alum applied as a temporary support. 
Her diet was nutritious and easily digestible, consisting largely of 
tender steak, mutton, beef-tea and milk. Her bowels were kept regular 
by the following mixture : 
R. Mag. sul. ...... §i. 
Ferri sul. exsice, . . . . . gr. viii. 
Potass, brom., . . . . . 3 iv. 
Acid sul. dil., . . . . . . 9 ss. 
Syr. Zingiberis, . .... iss. 
Aquae ad., 3 iv. 
Sig. Tablespoonful one hour after meals, in a wineglassful of water. Report Eor Fiscal Year ending June 30, 1888. 
When this began to act too freely the dose was diminished, as it was 
simply intended to keep the bowels regular. 
A few doses of potass, brom. were given soon after her admission to 
quiet nervousness. 
She was discharged November 15. Uterus normal in size and only 
slightly anteverted. Menses regular, and neither painful nor profuse at 
last epoch. No headache nor backache. General health good and 
bowels regular. 
In other words, she was cured, and there is every reason to 
believe that, with ordinary care, she will not have a relapse. It is 
undoubtedly true, however, that many patients discharged in as 
good condition as this one, have, by subjecting themselves to the 
same influences that produced the disease primarily, brought them- 
selves to as bad or worse condition than when first admitted to the 
hospital. And many poor women, going out cured, are brought 
by hard work, poor food, and privations, to a condition of anaemia 
and relaxation, and the slight displacements found in nearly all 
women become necessarily aggravated. 
The remedy for these evils is, of course, beyond the reach of 
hospitals, and all we can do is to deliver up the cured patient, with 
a parting word of advice, to the world in which her life is a cease- 
less struggle for bread. Our province is to remedy existing dis- 
eases, and it is gratifying to find ourselves able to do so, in a large 
percentage of cases, when we are able to watch and control the 
sufferers in all respects. 
One more case of this class will suffice : 
CASE 11. 
B. B., set. 34, white, married, native of Ireland. Admitted Septem- 
ber 15, 1887. A year ago she had a miscarriage at about the seventh 
month, and since then has had constant pain in back and left side, ex- 
tending down the thigh. Has been under treatment of Dr. Clayborne, 
of Virginia, and worn a ring pessary nearly a year. General health 
good. 
Examination. — Partially decomposed soft rubber ring removed from 
vagina. Uterus enlarged; cervix lacerated. Profuse purulent discharge 
from cervical canal. Perineum lacerated nearly to sphincter ani. 
Treatment. — Rest, douches and astringent applications, as in the 
former case. 
October 29, the patient was etherized and an operation done to re- 
store the perineum. 
November 6, sutures removed. Small fistula found through perineum 
3 4 
Columbia Hospital for Women and Lying-in Asylum. 
into vagina; touched with argenti. nit. gss. to the ounce of distilled 
water. 
November 23, uterus normal in size and position. The discharge 
has ceased. Lacerated cervix nicely healed and her pains are gone. 
Discharged. Cured. 
Lacerations of the Cervix Uteri. 
Although not less than forty patients have been treated who 
had more or less extensive lacerations of the cervix, in only five 
cases was it the principal trouble, or of such character as to call for 
treatment other than that given for inflammations of the uterus, 
and perhaps local bleeding, with Battle’s spear, which has been 
found very useful in relieving cervical enlargements. Five cases 
have been operated upon, and a cure thus effected. 
The points particularly observed in the operation are: The 
careful removal of all cicatricial tissue, the nice coaptation of the 
parts, and the insertion of a small piece of iodoform gauze into the 
cervical canal to insure its patency. Afterward, should there be 
any tendency to contraction of the canal, the passing of a flexible 
metal bougie, once a week, has been found effective in preserving 
its patency. 
The following histories are given in illustration: 
CASE i. 
C. S., aet. 27, white, married, native of Iowa. Admitted September 
27, 1887. Had a severe and prolonged labor eighteen months ago, and 
has suffered since with pain in the back and lower part of the abdomen. 
Menses regular. 
Examination.—Uterus turned to the right side; cervix lacerated later- 
ally ; some erosion and old adhesions. 
September 28, patient etherized. Eroded surfaces of cervix pared; 
one silver wire suture inserted on left side, none being needed on the 
right. Plug of iodoform gauze placed in the cervical canal. 
October 10, patient was entirely well and was discharged. 
CASE 11. 
J. R., a former patient. Had been treated for chronic metritis, with 
laceration of the cervix. 
November 19, she was etherized and trachelorrhaphy performed, five 
wire and two gut sutures being inserted. Sutures removed on the eighth 
day and on the ninth day she menstruated. The flow lasted five days 
and was normal in every respect. 
December 9, examination showed the cervix much smaller, and all of 
the congestion, formerly so marked, gone. Retroversion still existed, Report For Fiscal Year ending June 30, 1888. 
5 
though not so marked. A Hodge’s retroversion pessary was introduced 
and she was discharged. 
CASE III. 
E. F., set. 29, white, married, native of England. Admitted October 
4, 1887. Has had eight children and two miscarriages. Youngest child 
two years old. Has dyspepsia, and looseness of the bowels that is some- 
times uncontrollable. Appetite good. Menses regular, but profuse. 
Examination. — Large, strong, healthy-looking woman. Perineum 
lacerated, not involving sphincter ani. Cystocele and rectocele. Uterus 
prolapsed and enlarged; cervix bilaterally lacerated. 
Treatment.—Rest, baths, douches and astringent tampons, and a light 
but nutritious diet. 
November 23, trachelorrhaphy and perineorrhaphy performed, one 
wire and four gut sutures being placed in the cervix and six wire sutures 
in the perineum. Excellent union followed in both places, and she was 
discharged, a well woman, December 13, 1887. She has had no diar- 
rhoea for six weeks. 
Displacements of the Uterus. 
There is no class of cases, perhaps, that has been a greater 
bugbear to physicians than uterine displacements. This is shown 
by nothing so well as by the immense number and variety of pes- 
saries on the market. And as long as the displacement is regarded 
as a disease and not as a symptom, and as long as irritating 
mechanical supports are relied upon to maintain an enlarged womb 
in its proper position, so long will this bugbear continue to exist. 
Pessaries, like splints to a dislocated joint, may serve for a time to 
maintain the displaced part in proper position; but here, unless it 
be in acute dislocations of the uterus, the analogy ceases. For in 
the one case we have an acute trouble, with an intrinsic tendency 
to self-cure, and a non-irritating support; and in the other a 
chronic trouble, with no tendency to self-cure, and a support that 
tends to perpetuate the inflammation or engorgement, which is one 
of the principal factors in the causation of the disease. Undoubt- 
edly, the rational object of treatment is to restore the enlarged 
uterus to its normal size and weight, and to strengthen the natural 
hammock of ligaments in which it is swung. And this may be 
accomplished in nearly all cases not complicated, or caused, by 
some incurable constitutional disease that renders it impossible to 
bring the patient to a condition of general tonicity. 
The most common complication met with in these cases is 
“dyspepsia,” or catarrh of some part of the alimentary canal, and 6 
Columbia Hospital for Women and Lying in Asylum. 
it is useless to attempt a cure of the uterine trouble while such a 
condition exists in any marked degree. 
It is out of place to enter here upon a discussion of these 
catarrhal affections, and they are well understood at the present 
time ; but let me say that the great objects of treatment are to 
give no more food than the crippled chylopoietic system can dis- 
pose of, to let that food be of the most nourishing and easily 
digestible kind, and to save, by physical and mental rest, as much 
vital energy as possible for the building up of the tissues of the 
body. 
These conditions are best met in a hospital, where the patient 
is free from domestic worries and under complete control. And 
here, too, the local treatment can best be carried out. Hot vaginal 
douches, astringent and depleting applications on cotton tampons, 
local bleeding with Battle’s spear or leeches, carefully done, with 
attention to detail with operative measures when there are condi- 
tions requiring them, in conjunction with such general treatment 
as has been indicated above, have almost invariably restored the 
enlarged uterus to its normal size and raised it to its proper height 
in the vagina. And when this has been accomplished, the pain 
will be gone, the dragging sensation in the pelvic region, often the 
worst symptom, will be gone, and if the complicating general dis- 
ease has been successfully treated, the “dyspepsia” will be gone. 
The uterus will be more nearly normal in position, sometimes 
quite so. But even if the normal-sized uterus be not in its normal 
position, the woman is practically cured. Many women are seen 
incidentally in the hospital and dispensary with pronounced ver- 
sions or flexions of the uterus, who perform their daily avocations 
without a pain or an ache until failure of the general health causes 
relaxation of the tissues within the pelvis. The most persistent 
symptom met with is vesical tenesmus, in anteversion; but even 
this gradually disappears, in the vast majority of cases, after the 
uterus has regained its proper size. 
About eighty per cent, of all the women treated in the hospital 
have had more or less pronounced version, or flexion, of the 
womb; but in only thirteen cases was it considered the principal 
symptom. Eight of these were cured, four relieved, and one, 
under treatment but a few days, not benefitted. These cases were 
divided as follows: Anteflexion, 4 cured, 2 relieved, 1 not bene- 
fited ; retroflexion, 2 cured; retroversion, 2 relieved; anteversion, 
1 cured; procedentia* l cured. Report For Fiscal Year ending June 30, 1888. 
7 
The following cases are copied from the record: 
case 1. 
K. O., set. 30, white, married, native of Kentucky. Admitted Feb- 
ruary 24, 1888. Was delivered of her second child seven years ago. 
During that pregnancy she had a fall, that caused great pain in the right 
side, from which she still suffers. She was ninety hours in labor, and 
Dr. W. H. Bolling, of Louisville, writes: “I delivered her of a hydro- 
cephalic child by perforating the cranium.” She has been very nervous 
ever since, and her uterus has, he says, remained anteflexed. 
Examination.—Vagina large and flabby, admitting with ease four 
fingers. Uterus anteflexed, pale, and flabby. 
Treatment.—Rest, hot douches, astringent applications. Bromide of 
sodium and celerina were given for a week. 
May 7, 1888, she was discharged, relieved entirely of pain, uterus 
normal in size, and nearly normal in shape and position. 
CASE II. 
M. R., aet. 54, white, married, native of Pennsylvania. Admitted 
September 2, 1887. Is the mother of two children, the youngest an 
adult. No trouble in her labors. About seven years ago she began 
suffering from prolapse of the uterus, and it has gradually grown worse. 
Has had no treatment. General health excellent. Menopause five years 
ago. 
Examination.—Complete procedentia. Laceration and erosion of 
cervix. Perineum lacerated nearly into anus. Urethral caruncle. 
Treatment.—She was put to bed, the uterus pushed up, and kept up 
with tampons of alum glycerite. Hot vaginal douches. 
October 29, uterus in good position. Erosion healed. The urethral 
caruncle was removed and the perineum restored, four wire sutures being 
inserted. 
November 6, sutures removed. November 18, perineum in excellent 
condition, also urethra and uterus. Discharged cured. 
New Growths of the Uterus. 
Malignant tumors, 2 relieved, 4 incurable. Benign tumors, 2 
cured, 5 relieved, 2 died (one from hemorrhage from a fibro- 
myoma and one from ulcerative colitis. 
Nothing has been done for malignant growths where the whole 
of the diseased tissue could not be removed in its earlier stages of 
development, except to alleviate the symptoms with opiates, 
haemostatics, etc. Benign tumors have been removed, or treated 
by passing through them a galvanic current of fifty milliampere 
metres strength, three times a week, one pole being applied to 
the cervix uteri and the other large electrode over the tumor on 8 
Columbia Hospital for Women and Lying-in Asylum. 
the abdomen. This method of treatment has relieved the symp- 
toms, and seemed to check the growth of the tumor in about half 
the cases. But in some no beneficial effect was noted. The 
following cases are interesting: 
CASE i. 
H. T., set. 43, colored, married, native of Maryland. Admitted 
November 15, 1887. Mother of three children, youngest fifteen years 
old. Well until three years ago, when she began to have pain in the 
back and lower part of abdomen, with a feeling of “sides pulling down.” 
Dysuria, constipation, and frequent headache. Menses regular, painful, 
and profuse, lasting three days. 
Examination.—A large circumscribed growth occupies the middle ab- 
dominal cavity from the pubes to two inches above the umbilicus. 
Uterus anteverted. Sound passed five inches. 
Treatment.—She was given a laxative iron mixture, and electricity 
used—ten cells for ten minutes daily. April 22 began using a current of 
fifty milliampere metres twice a week. She was relieved of her pain soon 
after beginning the use of electricity. The tumor now extends only one 
inch above umbilicus, and the sound passes only four and one-half 
inches. But when the electricity is stopped for more than three days her 
pain returns. 
CASE 11. 
N. B., aet. 26, white, single. Admitted November n, 1887. She 
had good health until the summer of }86, when she noticed a swelling in 
the right side that troubled her very much. She was restless at night, 
had frequent smothering sensations, and severe headaches. Appetite 
and general condition good. 
Examination, November 12, revealed -a hard, pear shaped tumor, 
about five inches in diameter, extending from the brim of the pelvis 
nearly to the umbilicus, and freely moveable laterally. Diagnosis of a 
fibro-cyst of the uterus was made. She menstruated November 19th to 
28th; flow profuse. December 1st examined under ether, and the 
growth found to be freely moveable in every direction except upward, 
reaching now quite to the umbilicus. 
A consultation of the Advisory Board was held December 3, but no 
definite conclusion was reached. From December 28 to February 22 
electricity was used daily, ten cells of a McIntosh battery being all the 
patient could bear without great pain. But the tumor continued to in- 
crease rapidly, and the patient desired its removal. February 29, at a 
second consultation of the Advisory Board, it was decided to operate. A 
median incision five inches long was made, and afterward extended two 
inches upward, to permit removal of the tumor, which was found to be 
solid, and to embrace the uterus oh every side. Report For Fiscal Year ending June 30, 1888. 
9 
The ovaries, beyond some enlargement, appeared normal. The Fal- 
lopian tubes were dark, and anteriorly, near the fimbriated extremity of 
each, were three small cysts about one-half inch in diameter attached by 
short pedicles. A few ligatures were made in the broad ligaments, a 
strong cord thrown around the uterus just above the vaginal junction, 
and the right ovary and tube removed with the tumor; afterward the left 
ovary and tube. Several ligatures were required to check hemorrhage, 
and a continuous over and over suture of fine cat-gut was put in along 
the stumps of the broad ligaments, bringing the edges well together. 
Margins of stump trimmed smooth. Cavity of abdomen cleansed and 
wound closed, a small roll of iodoform gauze being placed in the lower 
part of the wound for drainage. 
During the first thirty hours the patient did well. On the second day 
she complained of pain, and the abdomen was greatly distended with 
gas. Her temperature went up to ioi°, and remained there during the 
third day, when the gauze was removed from the wound and found to be 
dry. An enema of milk of assafcetida relieved the tympanitis, but a 
diarrhoea set in, accompanied bv severe rectal tenesmus, and persisted in 
spite of treatment. 
March io, sutures removed from wound, which had healed except a 
small place in the middle. This was dressed with iodoform gauze. 
March 14, had another attack of diarrhoea, and was given hydrarg. cum. 
creta, gr. i. every hour. Diarrhoea lessened in the evening, but there 
was some tympanitis, and she was given spts. turpentine, gtt. 15 every 
three hours in emulsion. March 15, considerable distension from gas, 
relieved by enema of assarcetida. March 16, about the same. Tempera- 
ture has ranged from ioo° to 102° since 10th inst. Feels well in the 
morning but tired in the evening. 
March 17, considerable pain. Morphia given hypodermically, and, 
by the mouth, a mixture of quinine, digitalis, and tr. opii. deod. 
March 18, rapidly growing weaker, although every effort has been 
made to sustain her. Abdomen greatly distended. Rectal tube passed 
fifty centimetres into bowel and four ounces of milk of assafoetida in- 
jected. Considerable quantity of gas came away, and the bowels moved. 
Morphia and whiskey given as needed. 
March 19, seems brighter. Rested last night. In the afternoon a 
puncture was made with trochar and canula in the median hypogastric 
region, but no gas escaped. 
March 20, stopped anodynes, and gave sod. brom., 3 ss every four 
hours. Is eating well and abdominal distension going down. 
March 21, improved, appetite good. 
March 23, passed several large clots and some liquid blood from rec- 
tum, and collapsed. Stimulants were freely given, and there was some 
reaction, but she sank again and died at 3 p.m. Columbia Hospital for Women and Lying-in Asylum. 
10 
Autopsy, by Drs. Lamb and Bovee.—Incision healed, except a small 
opening extending about half-way through the abdominal wall. Adhe- 
sions firm between the line of incision and the mesentery and intestines; 
also between loops of intestines. A number of large ulcers in the caecum 
and ascending colon, but none opposite the adhesions; very large ulcers 
in the descending colon, parallel in their long diameters with the axis of 
the bowel. Large quantity of coagula and some liquid blood in the 
colon. Uterine stump looked well. No ligatures in it, but they were 
found loose in the pelvic cavity. Cause of death, hemorrhage, from 
ulcerative colitis. 
case in. 
C. C., aet. 60, white, single, native of Ireland. Admitted April 17, 
1888. Has had hemorrhage from the womb for several years, and has 
become greatly prostrated; otherwise healthy. She has consulted a num- 
ber of physicians, and been treated for *4change of life,” “dyspepsia,” 
“heart disease,” and a number of other ailments. Her position as 
housekeeper has obliged her to be on her feet most of the time, and for 
the past six months her strength has been unusually taxed. She has a 
feeling of suffocation, is very nervous, and fears, from the great quantity 
of blood she has lost, that her “time here is very short.” Appetite poor. 
Bowels constipated. Face pale and anaemic. Pulse small and thready. 
She was given an enema on the night of her admission and an examina- 
tion made the following day. 
Examination.— Vagina small, barely admitting index finger, which 
encounters a growth, hard, symmetrical, and about the size of an orange, 
attached apparently by a small pedicle to the internal os uteri. External 
os patulous. Consultation of the Advisory Board was held April 21, 
the patient etherized, and the growth above mentioned found to fill the va- 
gina, distending it abnormally. It was agreed that it should be removed. 
A vulsellum forceps passed along the left index finger, as a guide, seized 
the growth about its middle; after a few twists of the pedicle it was sep- 
arated from its attachment and removed as by ordinary forceps delivery. 
Vagina washed out with a 4 per cent, carbolic solution night and morn- 
ing, and tonics administered until patient left the hospital, June 1. She 
has been in the country since leaving the institution and has gained flesh 
and strength. 
No microscopic examination of the tumor was made, but from its ap- 
pearance on incision it was supposed to be a myo-fibroma. 
CASE IV. 
J. D., set. 40, colored, married, native of Maryland. Admitted Sep- 
tember 20, 1887. Never pregnant. Menses regular, last about a week, 
and are painful and profuse. Pain in back and pelvic region, shooting 
down the thighs. Bowels constipated. Headache. Leucorrhoea. Has 
had a lump growing in the abdomen for the last two yoars. Report For Fiscal Year ending June 30, 1888. 
11 
Examination.—Umbilical hernia about the size of a walnut. Abdo- 
men, as far up as the umbilicus, occupied by a tumor, evidently a sub- 
peritoneal fibroid of the uterus. September 27, she began menstruating 
in the afternoon; quantity of flow just as usual, and there was nothing to 
indicate danger until her nurse was aroused, about 4:45 a.m., Septem- 
ber 28, and found the patient flooding profusely. Restoratives were 
applied, but she did not rally, and died about 5 a.m. 
Other affections of the uterus treated during the year were : 
Stenosis of the cervical canal, 2 cases, cured by gradual dilatation 
tion with flexible metal sounds ; non-development of the uterus, 
three cases, in two of which some of the unpleasant symptoms 
were relieved, the other leaving in a few days. 
Diseases of the Ovaries. 
Two cases of ovaritis were treated. One of these left in a few 
days unimpaired. The other gave a history of syphilis, and was 
given specific treatment in conjunction with rest, diet and baths. 
She remained nearly three months under treatment, and was con- 
siderably improved, but not cured. 
One case of ovarian neuralgia, with the following history: 
M. W., set. 22, white, married, native of Indiana. Admitted No- 
vember 7, 1887. She suffers intensely at the menstrual periods, and 
declares that she thinks she could not live through two more attacks. 
She insists on having her ovaries removed, understanding the nature and 
danger of the operation; but would rather die than suffer as in the past. 
Husband and mother both concur, and after consultation with Drs. Mor- 
gan and Head, of the Advisory Board, it was decided to operate. 
November 9, in the presence of these gentlemen, a three-inch median 
incision was made and both ovaries and tubes removed. The latter were 
engorged and their outer ends quite friable. The thermo cautery was 
applied to the stumps, and in spite of this there was a great deal of 
oozing, requiring several extra ligatures to be placed deeply in the right 
stump. The abdominal wound was closed with three wire and six gut 
sutures, and dressed antiseptically. At 3 p. m„ a short time after the 
operation, the temperature was 97.8°, pulse 102. She did well until the 
13th, when she complained of great pain in the region of the incision. 
Some bloody discharge had begun from the uterus two days before, but 
nothing was feared from it. Her temperature gradually rose in eighteen 
hours to 104.i°. Bowels moved that day from an enema. 
November 14, the dressings were removed, and a parietal abscess 
recognized in the upper end ot the incision. The upper suture was re- 
moved, and a purulent discharge continued freely for several days. Her Columbia Hospital for Women and Lying-in Asylum. 
12 
temperature declined, soon becoming normal, and her appetite and spirits 
improved. 
November 18, remaining sutures removed. Appetite good. 
November 21, feeling splendidly. Some discharge continues from 
abscess, which is washed out daily with a 2 per cent, carbolic solution. 
November 22, sat up, feeling splendidly. 
She rapidly gained strength from this time, and was discharged De- 
cember 10, 1887. She has been under observation up to the present 
time, July 1, 1888, and has not menstruated nor suffered any pain since 
her recovery from the operation. She has never had any sexual desire, 
either before or after the operation. 
The removed tubes and ovaries were presented to Dr. W. M. Gray, 
of the Army Medical Museum, for examination, and the following is an 
extract from a letter from him : 
“These sections show thickening and seeming condensation of the 
albuginea. Also degeneration (fatty) of the large Graffian follicle. The 
first condition makes the discharge of the ovule almost impossible, which 
would, of course, give rise to the second condition. Otherwise, I think 
the ovaries are normal.” 
There can hardly be a doubt that the pain in this case was due 
to the dense capsule of connective tissue surrounding the ovary. 
The effects of pressure, or swelling, when confined by similar tough 
tissue, is well shown in true orchitis (not epididimitis) and in peri- 
ostitis, and it may be reasonably supposed that the swelling of the 
ovule within this unyielding envelope might cause extreme pain. 
It is probable that the ovula were never discharged; but, after 
reaching their maximum size, underwent fatty degeneration and 
were absorbed; or, if discharged, were not in a condition to be- 
come viable ova. The fact of her being a married woman and 
sterile, with no other apparent cause of sterility, points to the de- 
generation of the ovule as at least a possible cause of this condi- 
tion. 
In this connection I give the history of a case of nympho- 
mania, supposed to depend upon ovarian disease : 
L. J., white, single, native of Virginia. Admitted November 3, 1887. 
Began menstruating at eleven years of age. Since that time she has been 
suffering almost continually from pain in the pelvic region and back, and 
from frontal headache. Her menses are habitually profuse and very 
painful, requiring her to remain in bed two or three of the nine days that 
they usually last. Formerly the flow appeared but once in two or three 
months, but of late it recurs every five weeks. She suffers from intense 
erotic desire, and deplores the fact that any one with sufficient opportu- Report For Fiscal Year ending June 30, 1888. 
13 
nity may overcome her scruples, and her sleep is disturbed by erotic 
dreams. She has been treated by Drs. Hunter Maguire, of Richmond, 
and Wm. T. Howard, of Baltimore, the former of whom divided the 
cervix. She is constipated and nervous. 
Examination.—Uterus retroflexed, fundus bound down by adhesions, 
cervix showing cicatrix of the incision made by Dr. Maguire. An ovary 
is also prolapsed and enlarged. 
She was put upon tonics, bromide and valerian, and given a laxative 
iron mixture. Her constipation was the only symptom relieved, and she 
desired the removal of her ovaries. This was considered unjustifiable, 
and she left December 13 for Baltimore, determined to have oophorec- 
tomy performed. 
There she came under the care of Dr. Wm. P. Chunn. (See article 
by him in the Cincinnati Obstetric Gazette for January, 1888.) 
After being treated a short time, he says, she proposed the removal of 
her ovaries; but he felt uncertain of the prognosis, and considered it too 
dangerous an experiment, so she sought the care of another physician. 
May 18, 1888, she returned to Columbia Hospital, and stated that 
Dr. W. T. Howard had operated (oophorectomy) January 2d, but that 
she was no better, and had menstruated twice since the operation, the 
first flow lasting thirty days. Her sexual desire was as strong as ever, 
and there was no improvement in any of her symptoms. 
Inflammation of the Pelvic Cellular Tissue. 
Under this head twenty-six cases have been treated, ten of 
which were relieved, nine cured, and one not benefitted. Here 
again the treatment has been rest, diet, and hot vaginal douches. 
The douches are given with the patient on her back and a rubber 
cloth arranged to run the water into a slop jar. The nozzle of the 
syringe, after all the air has been driven out, is introduced into the 
vagina and several quarts of water at a temperature of no0 or 
120° F. injected. The woman remains on her back several hours, 
retaining a considerable quantity of water in the vagina, where it 
lies in the hollow of the sacrum, and like a poultice depletes and 
shrivels the tissues. Collections of pus should of course be 
evacuated. 
The percentage of cures obtained in this way has been larger 
than would appear from the figures given above, for none of the 
cases marked “relieved ” were long enough under treatment to be 
cured—the average time of treatment for these patients being three 
weeks. Every case that remained three months has been cured, 
and some in a shorter time. 14 
Columbia Hospital for Women and Lying-in Asylum. 
There were three cases in which abscesses formed and were 
evacuated. Two of these cases have been reported by Dr. J. W. 
Bovee, former Resident Assistant in the hospital. One of these, 
a very interesting case, was not given in full, and was not com- 
pleted at the time of the report. It is therefore reproduced here 
with the subsequent history. 
CASE i. 
F. B., set. 38, white, married, native of Virginia. Admitted October 
5, 1887. Mother of two children, youngest seventeen years old. Had 
an induced abortion six years ago, followed by peritonitis, and has not 
had good health since. April 1, 1887, after working hard, she had 
violent pain in the back and left hip and leg. The knee was drawn up, 
and could not be moved in any direction without causing intense pain. 
She has been treated by Drs. Reyburn and Garnett, and was seen in 
consultation by Dr. Gordon, of Maine, during the International Medical 
Congress. She has taken a great deal of medicine, but without benefit, 
suffers greatly from nausea, and her stomach will retain very little food. 
January 29, she says, an abscess broke internally, and discharged pus 
through the bowels and bladder for two weeks; and for three weeks 
longer the discharge resembled tape, and came away in great quantities. 
Her menses were regular until September, 1888, when they ceased; but 
from April to September they were scanty and unnatural in color. 
At the time of her admission she was almost in a dying condition; 
confined to bed, greatly emaciated, hysterical, and constipated. The 
left leg drawn up across the abdomen and apparently anchylosed. The 
left knee nearly touched the right breast, and could not be moved in any 
direction without causing intense pain. In the left iliac region could be 
felt a hard ridge, extending from the symphysis pubes to the spine of the 
ileum, no fluctuation could be detected. A diagnosis could not be made 
at first. Hip disease and psoas abscess were suspected. 
October 29 she was given an anaesthetic and carefully examined. The 
uterus was enlarged, hard, and pushed extremely to the right and for- 
ward by a large tumor, occupying the left iliac region and extending to a 
point above the spinous process of the ileum. This mass was very hard, 
but slight fluctuation was detected, It was evidently an abscess, situated 
deeply, with its walls immovably fixed, so that it could not be opened 
through the peritoneum anteriorly without allowing pus to escape into 
the peritoneal cavity. An incision was therefore made parallel with 
Poupart’s ligament, as in the laparo-elytrotomy operation, and the peri- 
toneum pushed up with the fingers and avoided until the place was 
reached where the peritoneum and abscess cavity were adherent. Here 
an incision was made, and over a quart of thick, greenish, extremely 
offensive pus evacuated, the finger being introduced into the sac and the Report For Fiscal Year ending June 30, 1888. 
15 
partitions, of which there were several, broken down. After this the 
uterus was found to have assumed a position nearly normal, and the en- 
largement to the left had in the main disappeared. The pus cavity was 
washed out with a hot 2 per cent, solution of carbolic acid and a glass 
drainage tube inserted. Subsequently the cavity was loosely packed 
with strips of iodoform gauze, and washed out twice daily, and at longer 
intervals as the discharge became less. 
November 1, she awoke in the night with a severe pain in the right 
side of the chest that was thought to be neuralgic. Considerable diarrhoea 
followed, lasting several days, and the pain did not disappear entirely for 
a week. Appetite poor, and heart’s action very feeble. She was given 
the following: R. Liq. potass, arsenit., 3 i.; vin. ferri amari., ad. § iv. 
M. Et. sig., 3 ii., t. i. d. 
November 16 she called attention to an ulcer in her nose, probably 
caused by absorption of septic material. It was about an eighth of an 
inch in diameter, and extended through the anterior part of the septal 
cartilage. It was painted with a solution of silver (one-eighth) and 
gradually healed. 
December 13, an ichorous discharge continues from the abscess 
cavity. She has gained flesh and strength, and is able to walk, but is 
slightly lame on left side. Uterus still fixed, and a good deal of dense 
tissue remains on the left side of it; considerable tenderness on deep 
pressure in this region. Hot vaginal douches ordered night and morn- 
ing. The sinus leading to pus sac, which now holds about two drachms, 
became very small and was dilated with laminaria tents. 
December 30, after over-exercise in walking, she was seized, while 
removing her shoes and stockings, with severe pain, shooting from left 
side of the pelvis down the thigh. She was kept in bed and given i-i6th 
grain of corrosive sublimate and five grains of iodide of potassium, t.i.d. 
She has not menstruated, but her general condition is good. After re- 
maining in bed two weeks she got up and gradually improved. 
She left the hospital June 6th, but has been under observation since, 
and at this time, July 1st, 1888, she is able to walk with ease, has gained 
her usual amount of flesh and strength, and has an excellent appetite. 
She now menstruates. A slight discharge still continues from the wound 
and there is tenderness in the region of the left Fallopian tube. The 
tube, as is usual in these cases, is probably involved, and the disease 
probably began as a pyosalpinx. 
CASE 11. 
M. L., set. 23, colored, married, native of Washington, D.C. Ad- 
mitted July 23, 1887. Mother of two children, youngest six months old, 
and since its birth she has had pain in the lower part of the abdomen, 
and a knot there. Constipated and appetite poor. Does not sleep well. 
Menses regular but painful. 16 
Columbia Hospital for Women and Lying in Asylum. 
Examination.—Uterus slightly enlarged, and pushed forward by a 
firm cellulitic deposit at its rear and sides. Small, round projection 
behind the cervix, thought to be an abscess pointing. 
Treatment.—Rest; nutritious diet—beef wine and iron; quinine and 
tr. ferri chlor. 
August 10.—Considerable yellow discharge from vagina ; patient very 
weak. 
October 8.—She has gained flesh, and is feeling perfectly well. Ap- 
petite excellent. 
October 18.—Discharged, cured. 
Affections of the Vagina. 
Vaginitis, 2 cases relieved; one not benefited. Leucorrhea, 
2 relieved (left in a few days). Vesico-vaginal fistula, 1 (operation) 
not benefited. Cyst of vulvo-vaginal gland, 1 cured (operation). 
Atresia vaginae, 1, of which the following is a history: 
C. P., set. 15, single; white; native of Maryland. Admitted July 
6, 1887. Enjoyed good health until she had a severe attack of scarlatina 
last winter. Menstruated, for the only time, last September. Has been 
under the care of Drs. Magruder and Corbett, of Maryland, and the 
latter brought her here for the treatment of atresia vaginse. 
Examination.—Anaemic; uterus retroverted ; hymen ruptured. About 
three-quarters of an inch from the vulva the vaginal walls are adherent, 
admitting only a very fine probe. These adhesions were broken up with 
the finger, in the presence of Dr. Corbett, July 10, 1887. The vagina 
was loosely packed with iodoform gauze, and this dressing changed every 
day. She was given two grain doses of potass, permang. every four 
hours, for several days; and, July 18th to 20th, she menstruated. 
Left July 22d. Vagina patulous, but not entirely healed. 
Lacerations of the Perineum. 
Only two cases are found in the record under this heading, 
although io or 12 primary and 8 secondary operations were done 
to restore the perineum, where the laceration was regarded as a 
complication of some other trouble. 
In doing this operation a horse-shoe-shaped incision is made 
along the line of junction of the skin and mucous membrane, from 
the remains of the carunculae myrtiformes on one side, around the 
bottom of the laceration, to a similar position on the opposite side ; 
and the surface included in this horse-shoe-shaped incision de- 
nuded, particular care being taken to go through the mucous 
membrane, well into the sub-mucous cellular tissue. 
When the sphincter ani is involved, the edges of the fissure Report For Fiscal Year ending June 30, 1888. 
17 
are pared deeply enough to remove all cicatricial tissue, and ex- 
pose clean, fresh edges of the muscle. 
These precautions give a much firmer union than is obtained 
by simply freshening the mucous membrane, for, as is well known, 
the vessels ramify in the sub-mucous cellular tissue, and this vas- 
cular tissue unites more quickly and firmly than surfaces of mucous 
membrane. 
In cases of laceration through the sphincter ani, it is sometimes 
found best to restore this muscle and the recto-vaginal septum first, 
and the more superficial parts at a second operation. In all cases 
great care is taken to bring the parts nicely together with deep 
sutures, four wire sutures usually sufficing. 
The parts are bathed frequently with carbolized water, and a 
cloth soaked in a hot 2-per-cent solution of carbolic acid kept over 
the vulva. The bowels are kept locked seventy-two hours, when 
the sphincter ani is involved, and then moved with Hunyadi 
water. But when the sphincter is not involved they are kept 
open from the first. 
The sutures are removed on the sixth or eighth day in slight 
lacerations; but remain in situ ten or twelve days when the 
sphincter ani is involved. The following case is copied from the 
record : 
A. M., aet. 33; white; married; native of Kentucky. Admitted 
February 24, 1888. Mother of four children, the youngest six months 
old. She states that the shoulders of this last child were very large; that 
she was torn; that her attending physician closed the rent; but the 
sutures cut out, and non-union resulted. She has no control over faeces 
or gases of bowel. General health good. Last menstruated two weeks 
ago. 
Examination.—Perineum and lower inches of recto-vaginal septum 
torn through. Uterus normal. 
February 25th, rupture closed; five wire and two gut sutures being 
inserted. 
Primary and complete union followed, and she was discharged March 
16, 1888, perfectly well, and with perfect control over sphincter muscle. 
Disturbances of the Menstrual Function. 
Dysmenorrhoea (membranous), i cured, i, unknown; suppres- 
sion of menses, 3 cured ; 1 incurable (phthisis). 
These cases were due to anaemia, and were given tonics, iron, 
and food until the anaemia was corrected, then potass, permang., 
gr. I, t. i. d., until the flow was established. This drug has been Columbia Hospital for Women and Lying-in Asylum. 
18 
found very useful, both in the Hospital proper, and in the Dis- 
pensary. In a few cases where it caused gastric pain and burning, 
this was relieved by taking large draughts of water after the dose. 
Emansio mensium, i case, incurable. This was an interesting 
case, due to congenital absence of the uterus, and was reported by 
Dr. J. W. Bovee, former Resident Assistant jn the Hospital. 
Other miscellaneous cases were treated as follows: 
Menopause, 3 relieved, 1 cured; hysteria, 3 relieved, 1 not 
benefited; threatened abortion, 1 prevented, 3 cured; varicose 
ulcer of leg, 2 cured ; hydatiform pregnancy, 1 cured. 
The following is a brief history of the latter case : 
M. H., aet. 19; colored; single; native of the District. Came to 
the Dispensary service August 9, 1887, complaining of nausea, vomiting, 
anorexia, and constipation. She was very much worried about her 
courses having been irregular and profuse during the spring, having 
appeared three times in June, and not at all in July. Her breasts were 
swollen, nipples pigmented, tubercles of Montgomery present. Uterus 
extends half way to umbilicus, and is quite soft. Pregnancy suspected. 
She did not return until October 14th, when she stated that she had been 
in bed, unwell, three weeks, and was still flowing. She was told to 
keep in bed, and was given potass, brom. grs. xx, t. i. d. She again 
presented herself November 1st, saying she had been flowing three days, 
and was in a bad way. She was admitted to the Hospital and an exam- 
ination made. A mass of hydatiform cysts was found protruding from 
the vulva and extending into the cavity of the uterus. The portion 
outside of the uterus was removed, patient put to bed and given hot 
carbolized douches. November 6th, she was etherized and examined. 
Cervix small; uterus thrown forward. Sound passed four inches. She 
was given pil. ergotin. co., one every four hours. 
November 19th, uterus normal; discharged, cured. 
July 11, 1888, there has been no return. 
In the Lying-in Department, 155 women have been delivered 
and three admitted after delivery. The presentations were : Occi- 
put, 152; chin, 1; breech, 2. 
There has been no hesitation in using forceps when needed; 
but, although 121 of these women were primiparae, there were 
only three instrumental deliveries (forceps at inferior strait). The 
explanation is, that whenever the slightest symptoms of tedious 
labor have been observed, the woman has been assisted by pres- 
sure over the fundus uteri, and sufficient pressure kept up between 
pains to prevent recession of the presenting part. Thorough lubri- 
cation of the vagina with benzoated lard, if it be at all dry, and the Report For Fiscal Year ending June 30, 1888. 
19 
use of judicious pressure in this manner is found in many cases 
quite as effectual as forceps, and is less likely, certainly in inexpe- 
rienced hands, to produce injury to the soft parts. When the 
head is fully distending the perineum, if there is danger of its rup- 
ture, the middle finger is put in the rectum and the thumb over 
the occiput of the child, and the head, which can thus be perfectly 
controlled, gently pressed out between pains. In doing this, the 
woman need not be turned on her side, as when the thumb is in- 
serted into the rectum after Fasbender’s plan. 
Four cases have occurred of posterior rotation of the occiput, 
all of which were rectified without difficulty, by introducing the 
fingers only into the vagina. Should this means fail, the method 
recommended by Ramsbotham, and later by Parry, would be 
tried, one hand being introduced into the vagina, the head raised 
so as to disengage its greatest diameter, and the occiput turned 
forward. The other hand supports the fundus of the uterus, and 
assists rotation by pressure on the body of the child. 
One woman, who had been in labor ten days when brought to 
the hospital, was found to have atresia vaginae. The septum was 
divided and the macerated fetus extracted manually. She made 
a good recovery, although greatly prostrated when she was 
admitted. 
Strict antiseptic precautions are observed in all cases. But the 
general use of corrosive sublimate about the lying-in women has 
been abandoned, as in several instances severe inflammation has 
followed its use in the vagina, even in a i to 4,000 solution ; and 
it has several times caused erythematous inflammation of the 
vulva, and even of the skin. Aside from the danger of poisoning 
by absorption, it is considered too irritating for washing out the 
uterus, or even the vagina, or for application in any manner to the 
skin of infants. The main reliance is upon strict surgical cleanli- 
ness. The house is kept scrupulously clean, slops and discharges 
removed at once, and free ventillation secured. All sponges, nap- 
kins, and other appliances used about the lying-in woman are 
boiled, and boiled water is used exclusively, with carbolic acid as 
a germicide. All needless examination and handling of the 
woman is avoided, and, when examination is necessary, the hands 
are thoroughly cleansed and disinfected. A napkin wrung out of 
a 3 per cent, solution of carbolic acid is kept over the vulva both 
during and after labor. 
Ergot is never given until the placenta has been expelled, and 20 
Columbia Hospital for Women and Lying-in Asylum. 
then only when there is uterine inertia; or, at a later period, sub- 
involution. 
There have been three deaths of mothers, two from peritonitis 
and one from oedema of the lung. (This case is given later). 
The two cases of peritonitis occurred early in the year, before 
the use of corrosive sublimate was abandoned, in a new clean 
building, and the most careful investigation has revealed no source 
of infection. Both these women were primiparae, and their death 
tends to sustain the proposition recently made by Mr. Tait, that 
peritonitis not only occurs more frequently and inexplicably among 
primiparae, but that nearly every primiparous woman so affected 
dies. He urges early laparotomy as the only hope in these cases. 
Ruptures of the perineum, unless very small, are closed by 
sutures immediately after delivery, and the woman’s knees tied. 
Tying the knees alone is sufficient for slight lacerations. 
The woman is kept in bed seven days, and then, if her condi- 
tion is fevorable, as shown by her strength and temperature chart, 
she is allowed to sit up morning and evening. Notwithstanding 
what has been said to the contrary, rest is believed to assist in in- 
volution of the uterus. 
The diet is as follows : First day, toast, liquid and farinaceous 
food; second day, lamb, or tender steak is added; third to seventh 
day, the same with potatoes, baked apples, stewed prunes; eighth 
day, house diet. 
No irrigation of the vagina is used unless the discharge be- 
comes offensive, or tenderness appears over the uterus. 
A temperature chart is kept, and if any rise occurs an examina- 
tion is made to determine the cause. 
In the after-treatment of the mother, whenever it becomes 
necessary from any cause to dry up the secretion of milk, a lini- 
ment composed of half an ounce of camphor dissolved in three 
ounces of turpentine has been found most effective. Freely used 
on the breast, it exerts a marked influence in lessening the flow of 
milk; and in mastitis it alleviates pain, softens induration, and is 
more effective in reduing inflammation than any other remedy that 
has been tried. 
With the children, Crede’s method for preventing ophthalmia 
is used—one drop of a 2 per cent, solution of nitrate of silver being 
instilled into each eye shortly after birth. No case of ophthalmia 
has occurred since this method has been adopted. 
Seven of the children were still-born : In five of these cases the Report For Fiscal Year ending June 30, 1888. 
21 
cause is unknown and the children were macerated; one was 
caused by protracted labor, and one by violent spasms of the 
uterus, the mother having chorea. Six children that were prema- 
ture lived but a short time, and four apparently healthy infants 
were, it is believed, killed carelessly or criminally by the mother. 
Other deaths were due to the following causes: Patent foramen 
ovale, two; marasmus, four; undeveloped lung, one ; uncontrolla- 
ble hemorrhage from the cord, one ; total, eighteen. 
The following are interesting cases : 
CASE i. 
J. G., set. 22, white, single, native of England. Admitted May 22, 
1888. A dwarf, with antero-posterior spinal curvature, extremely pale- 
looking, muscles flabby and small; The enormous uterus falling forward 
on her flabby abdominal walls gives her a remarkably grotesque appear- 
ance. Her pelvis, however, was roomy, and her labor, beginning at 8 
p.m., June 1, progressed favorably until after the child was delivered, 
4 p.m., June 2. The uterus then relaxed so completely that it could not 
be felt at all; but was made to contract by pressure and rubbing over the 
tundus, and the placenta was expelled entire, ballooned out by about a 
quart of blood. She was given hypodermically 30 mm. fl. ext. ergot, 
and this repeated three times within the half hour, and 3 i. of the ergot 
given by the mouth. 
But in spite of this and of constant pressure and manipulation, the 
uterus again relaxed. Ice was rubbed over the abdomen and put into 
the vagina, the abdomen flapped with towels wrung out of ice-water, and 
the vagina and uterus injected with hot vinegar and water—all without 
effect. Finally, the uterus was forced down into the pelvis, and a bowl, 
just large enough to fit closely over the fundus, forced over it and bound 
firmly in this position by putting a roll of napkins above it and applying 
the binder. No hemorrhage was possible with the uterus thus firmly com- 
pressed on all sides. The patient was given ergot for a day or two, and 
made a rapid and complete recovery. 
CASE 11. 
L. L., aet. 22, white, single, native of Maryland. Admitted January 
26, 1888. Has had one abortion, and been delivered instrumentally of 
a dead child. Pale and emaciated. Had chorea from eight years of age 
until puberty, and again throughout her first pregnancy and labor, and 
for two months after delivery. Has been very nervous for the last four 
months. She was given potass, brom. and a laxative mixture. She had 
two slight attacks of choreic spasm on the evening of her admission, and 
a severe attack on January 30, affecting every muscle of her body and 
making it necessary for her to be held during the half hour that it lasted. 
She was given potass, brom., 9 ii. every two hours; and after the 22 
Columbia Hospital for Women and Lying in Asylum. 
severe paroxysms had passed off choreic movements, confined to the left 
side, continued, although the patient was perfectly rational and tried to 
control them. 
Examination at 6 p.m. — Fetal heart distinct. Uterus contracting 
powerfully. Cervix somewhat rigid, but admits finger. She asks every 
few minutes for the bed pan, and wets the bed meantime. She also 
defaecated several times, apparently unable to control the sphincter ani. 
xo p.m., cervix in the same condition. Liquor amnii oozing from a 
small rent in the membranes, caused by the powerful contractions of the 
uterus, which have occurred almost continuously. At 11 p.m. the os be- 
gan to dilate rapidly, and at 12:5 a.m., January 31st, the child was born, 
cyanosed and pulseless. All efforts to resuscitate it were unavailing. The 
woman talked incessantly and incoherently all day, screaming frequently 
and tossing about with spasms, not confined now to one side. She was 
given the following: R. Liq. potass, arsen, g i.; vin. ferri. amari, ad. 
3 iv. M. Sig., g ii. every two hours. She was also given half a grain 
of morphia, hypodermically, at 10 p.m., and slept well all night. 
February 1st, much improved. Twitchings slight. From this time 
her recovery was rapid and steady, and she left February 15th, feeling 
perfectly well. 
CASE III. 
M. B., set. 18, colored, single, native of Maryland. Admitted July 
29, 1887, at 6:45 a.m., suffering from dyspnoea and a paroxysmal cough. 
She was frothing from the mouth, and an examination of the chest 
showed that she had oedema of the lungs. She was propped up in bed, 
stimulants given, and dry cups applied. Labor progressed rapidly, and 
she was delivered of a healthy seven-pound child at 9:10 a.m. After de- 
livery she seemed much relieved for a short time, but was seized with a 
paroxysm of coughing, became suddenly comatose, and died in a few 
minutes, all efforts to relieve her being unavailing. 
No autopsy was allowed, and urinary examination gave only negative 
results. 
Reprint from 
The Obstetric Gazette, 
August, 1888.