Annual Address 
On the 
Relation of Neurasthenia to 
Diseases of the Womb 
BY 
WILLIAM GOODELLM. A., M. D, 
. 
REPRINT FROM VOLUME III. 
eSimecoloQtcal 
1879 ANNUAL ADDRESS BY THE PRESIDENT. 
THE RELATION OF NEURASTHENIA TO DISEASES 
OF THE WOMB. 
BY WILLIAM GOODELL, A. M., M. D., 
Philadelphia. 
Gentlemen and Fellows of the American Gyneco- 
logical Society : Another year has gone by and we have 
met together for the third time. How pleasant are these 
yearly gatherings and yet how tinged with sadness ! Pleas- 
ant indeed are the warm grasp of the hands, the making 
of new friendships, the renewal of old ones, the interchange 
of thought. Pleasant is it to see new faces among us,—the 
faces of those who year by year keep up unbroken the line of 
our scientific succession. But sad, very sad are the gaps we 
see on yonder benches. Two old familiar faces, whose seams 
and furrows we knew by heart, are not there. They are not 
with us in the flesh, but they may even now be with us in 
the spirit. For what is Death but the ring of Gyges which 
makes our departed friends invisible to our mortal eye ? 
Elected by your suffrages to the highest office in the gift 
of this Society, Peaslee should stand where I now stand ; 
he should speak where I now speak. But the great general 
has fallen in the front line of life’s battle, and on his un- 
worthy lieutenant devolves the command. To the memory 
of this distinguished Fellow it would, therefore, seem be- 
coming that I should pay a large toll of tribute ; but it is 
the custom of this Society to urn its great dead in special 
niches in the volume of its Transactions. Yet I cannot re- 
frain from dropping one small pebble on his cairn. 
1 ANNUAL ADDRESS. 
2 
Edmund Randolph Peaslee was a man of high ability, 
great acquirements, and unostentatious lenrning, a man of 
inflexible honor and of rare purity of life. The double 
thread on which these golden beads were strung was ster- 
ling integrity and untiring industry. A character thus 
rounded out, an individuality so marked, made their owner 
a leader here, and a Saul among his other professional 
brothers. So identified is he with the birth and growth of 
this Society, so coupled is his name with the progress of 
Gynecology, that the memory of his example and of the 
great services he has rendered to our beloved profession will 
be handed down as a precious inheritance to those who shall 
succeed us. Enviable was the fullness of his life ; enviable 
the opportuneness of his death. Struck down at the age of 
sixty-four, while the tide of his fame was at its full, while 
his eye was not dim or his natural force abated, he died in 
the abiding faith of a Christian and in the blessed hope of a 
glorious immortality. 
The other Fellow whose death we mourn is that distin- 
guished ovariotomist, Washington L. Atlee. Against strong 
antagonisms and bitter animosities he had fought his way 
up to the very front of our profession. On September 7, 
1878, he died full of years and of honors, forgiving and for- 
given. 
Vale Peaslee ! Vale Atlee ! Valete, sed non in aeternum ! 
From this sad tribute to the memory of our dead let us 
with bowed heads pass to other matters. And first to a brief 
review of the year’s work of this Society. Of the quality of 
the essays, of the character of the debates, and of the good 
work shown in the second volume of our Transactions, we 
have no need to be ashamed. It is a far portlier volume 
than its predecessor, and contains among other valuable 
matter a complete bibliography of obstetric literature for 
the year 1877. For this precious addition to its bulk let 
me in your name return our best thanks to Surgeon J. S. 
Billings of the Army. 
For the arrangement of the material for these Transac- 
tions, and for their publication, we owe everything to our efficient and indefatigable Secretary ; but I fear that his 
forbearance was put to a severe test by the dilatoriness of 
those who kept back their papers and put off their proof- 
reading until the last moment. No branch of medicine can 
lay claim to finality ; each rests on apunctum fluens and not 
on a punctum stans. More especially so is it with Gynecol- 
ogy, whose growth is so fast that its ever-ripening fruitage 
can be gathered only by close gleaners. To-morrow makes 
the opinions of yesterday behind the times. Yet the vol- 
ume of our Transactions, which should be the channel by 
which the best and freshest thoughts and the newest dis- 
coveries should go forth to the world, is published so long 
after the annual meeting, that it is in danger of showing, 
like last year’s almanac, what was, and not what is. Such 
delay dampens the ardor of those who would like to contrib- 
ute, and especially of those who may wish to give publicity 
to original views. 
Bear with me while I make one more suggestion. In 
looking over the titles of these sterling contributions I 
could not find a single one bearing upon the diseases of 
childhood. This omission seemed so glaring that I could 
not account for it, until it occurred to me that Pediatrics 
had not been included within the province of this Society. 
I believe this to be a grave mistake, — a mistake which I 
hope will soon be rectified by an amendment to the Con- 
stitution and By-Laws. The object of this Society should 
not be limited to the diseases of women. Nor, for the mat- 
ter of that, should its mission be narrowed down to the 
education of its members alone. By educating the masses, 
by giving the best to the most, it will become a power in the 
community for good. There are social problems of the day 
which ought to be confronted, and that boldly, such as Pre- 
ventive Measures, Criminal Abortion, Sexual Excess, Dress, 
etc. The time has not yet come for us to grapple with all ; 
some indeed need delicate handling ; but one urges itself 
upon our attention : Every summer sweeps off thousands of 
our infants. This mortality is due not only to excessive 
heat, but to the needs of poverty and especially to the igno- 
A'E UR AS THE.VIA AND WOMB-DISEASE. 
3 4 
ANNUAL ADDRESS. 
ranee of mothers. They suckle their children at improper 
times, they wean them at unsuitable seasons, they supply 
them with unwholesome food. The hardships of the poor, 
their very occupations, often spoil their breast-milk. Very 
touching is the complaint of the heart-broken French rag- 
picker : “I had eleven children in all,—four of them died at 
the breast. It’s no use; one can’t have good milk when one 
works in the streets all night.” Now these mothers ought 
to be taught when, where, and how to feed their young in- 
fants ; and what better teacher, or one more authoritative, 
can there be than this Society ? I would therefore urge upon 
you the appointment of a committee to draft some simple 
rules for the guidance of mothers in these matters, and to 
bring them up for discussion at our next annual meeting. 
But the annual address of the President should not, in 
my apprehension, be limited to making suggestions or to 
taking count of stock. Under its aegis he may give expres- 
sion to some thought which he has been nursing, or to some 
hobby of which he longs to be “ delivered upon the mellow- 
ing of the occasion.” With this broad interpretation, I have 
ventured to choose for my address the subject of — 
THE RELATION OF NEURASTHENIA TO DISEASES OF THE 
WOMB. 
In the yet young and brilliant school of Gynecology there 
is, to my thinking, a tendency to make too much of the womb 
and its annexes as causes of so-called female disorders. 
Misled by traditional teaching, by such a name as woman, 
or womb-man, by such a misnomer as hysteria, or womb- 
disease, we yoke our practice to theory. Here let me say 
parenthetically, that while etymologically woman (womb- 
man) is so called because she bears a womb, physiologically 
she is a woman because she owns two ovaries,—for these 
glands are essentially the sexual organs, they, above all, giv- 
ing her sex and personality. Instead, therefore, of womb- 
man, she ought to be called ovary-man ; and I cannot but 
regret that we name her after an organ which can be seen 
and felt, and not after two organs which are not visible and, 
in ordinary conditions of health, not even tangible. Since there is in man an instinct of causality which craves 
to be satisfied, we are prone to base far-reaching conclusions 
on fragmentary evidence, or on indifferent data ; to mistake 
coincidence for causation. So, whenever we find a train of 
symptoms associated with a congested or an otherwise disor- 
dered womb in a womb-man, we jump to the conclusion that 
the congestion is not a symptom, or a sequence, or a coinci- 
dence, but the factor, and at once proceed to treat it as such. 
Then again, forgetful that the imponderables are great forces 
in nature, we disregard the tyranny of woman’s over-sensitive 
organization, and underrate the influence of nerve perturba- 
tions or of psychical disturbances. 
Now in these days of mental overstrain, nerve-tire, or 
neurasthenia as it is technically called, is so common a dis- 
order in our over-taught, over-sensitive, and over-sedentary 
women, that in its successful treatment every physician has 
an abiding interest. It manifests itself by hysteria, by spi- 
nal irritation, and by a crowd of reflex symptoms, among 
which those of a uterine complexion often overshadow and 
indeed outlast all the others. The general pathology of such 
a neurosis is not perfectly clear, but it probably consists 
essentially in mal-nutrition of nerve-centres, followed by. 
disturbances in the circulation from weakened innervation. 
These secondary disturbances consist of local anemias and 
of local hyperemias. In other words, in that equilibrium of 
the two movements of wear and repair which means health 
a disturbance occurs which means disease. There will be 
sudden ebbs and flows of impoverished blood in the various 
vital organs, — the same kind of surface-flushings and blanch- 
ings going on in the deeper structures. Thus we may see 
in the same person, and starting from one cause, alternations 
of anemia and of hyperemia of brain, of stomach, or of spine, 
with very generally stable hyperemia of the reproductive or- 
gans. The cerebral exhaustion or irritation manifests itself 
by clavus, by wakefulness, by heaviness, by asthenopia, by 
inability to read or to write or to concentrate the thoughts 
on any given subject ; the exhaustion of the stomach, by 
flatus, by nausea, by gastralgia, by capricious appetite, and 
NEURASTHENIA AND WOMB-DISEASE. 
5 6 
ANNUAL ADDRESS. 
so on; the spinal exhaustion, by tender spots, backache, and 
weariness. The anemia of the reproductive organs is exhib- 
ited by amenorrhea, or by scant menstruation, by neuralgic 
and hysterical pains ; the hyperemia by congestion, by dys- 
menorrhea, menorrhagia, and leucorrhea, by uterine flexions 
and dislocations, and by a variety of subjective and objective 
phenomena with which every phys'ician is familiar. 
During menstrual life the sexual sphere preponderates 
over the others, so the stress of the anemia or of the hyper- 
emia in these secondary circulatory disturbances very gen- 
erally falls on the reproductive apparatus. Then again mal- 
nutrition of nerve-centres produces a poverty in the quality 
of the blood, in which obtains a peculiar susceptibility to 
emotional excitement. Hysteria does not mean necessarily a 
diseased womb, nor yet is it an abstract entity, but the 
definite expression of some morbid action going on in the 
nerve-centres. But let us go a step further. Since func- 
tional relation exists between every act of thinking, feeling, 
or willing on the one side, and some molecular change in 
the body on the other, it follows that the mind-illness caused 
by the body-illness can in turn produce body-illnesses ; the 
disturber becomes the disturbed. “ Thought,” proves Tuke, 
by many apt illustrations, “ strongly directed to any part, 
tends to increase its vascularity and consequently its sen- 
sibility.” 1 Hence come those life-like mimicries of grave 
structural disease, those mad muscles and local insanities. 
“ The nerves,” says Cabanis, “ they are the man ; ” most 
emphatically they are the woman. 
Grasping this conception we can be at no loss to under- 
stand that many disorders of the reproductive apparatus do 
not constitute the essential disease, but are merely the local 
expressions of the general neurosis. These neuroses present 
in general very definite characteristics, yet such uncompro- 
mising materialists are we in medicine ; so apt are we to in- 
terpret the unknown in terms of the known; so forgetful of 
disturbed vital functions, of morbid nerve influence, and of 
that subtle interplay between mind and body ; so oblivious 
1 Itifiuence of the Mind on the Body. NEURASTHENIA AND WOMB-DISEASE. 
7 
to the fact that woman is a complex mass of action — emo- 
tional, intellectual, and physical ; so impressed by what ap- 
peals to most of the five senses, by what we can see and 
feel, that we seize upon the visible and tangible manifes- 
tations as the disease, and treat them accordingly. 
Take, for instance, this too common picture from life: A 
girl who entered puberty in blooming health, and without an 
ache, is over-tasked and over-taxed at school, and her health 
begins to fail. She loses her appetite and grows pale and 
weak. She has cold feet, blue finger-nails, and complains 
of an infra-mammary pain. Head-ache and back-ache and 
spine-ache, and an oppressive sense of exhaustion, distress 
her. Her catamenia, hitherto without suffering, now begin 
to annoy her more and more, until they become extremely 
painful. Her linen is stained by an exhausting leucorrhea, 
and bladder-troubles soon set in. She is wearied beyond 
measure by the slightest mental or physical exertion ; a 
grasshopper is a burden to her, and she finally becomes 
hysterical. Now, very unfortunately, the idea attached to 
this group of symptoms is that the reproductive organs are 
at fault, and that the unit of resistance lies in the womb. A 
moral rape is therefore committed by a digital or a specu- 
lum examination, and two lesions will be found. Firstly, as 
a matter of course, a virginal anteflexion, and secondly, an 
endometritis. These are at once seized upon as the prime 
factors, and she is accordingly subjected to a painful, un- 
nerving, and humiliating local treatment. Unimproved she 
drags herself from one consulting-room to another, until 
finally, in despair, she settles down to a sofa in a darkened 
room and lapses into hopeless invalidism. 
Now what is the interpretation of this train of symptoms ? 
What mean this head-ache, this back-ache, these uterine 
and vesical symptoms ? I cannot pretend to give the pre- 
cise pathology, but I take it to be something like this : The 
yet developing nerve-centres of this brain-crammed girl 
were unable to cope with the strain thrown on them, and 
they broke down. But jaded nerves make poor blood and 
faulty circulation. From these come cerebral and spinai 8 
ANNUAL ADDRESS. 
irritation, with head-ache and back-ache, and with general 
exhaustion. But since this girl is at an age in which the 
sexual sphere predominates, the brunt of the nervous and 
circulatory disturbances falls on the most exacting organs, 
the reproductive. There will be flashes of anemia and of 
hyperemia, the former in my observation being more con- 
stant in unmarried girls, the latter in married and in middle- 
aged single women. Active neurosis of the uterine group of 
nerves takes place with either local or reflex manifestations, 
which mimic grave structural lesions of the womb. From 
increased reflex irritability comes spasm of the circular fibres 
of the cervical canal, causing dysmenorrhea. All the sphinc- 
ter muscles are liable to such spasmodic contractions, and 
thus arise such mimicries as hysterical dyspareunia, dys- 
phagia, dysuria, dyschezia, and dyspnea Often this spasm 
continues as a vicious habit, and, in the case of the circular 
fibres of the os internum, may keep up during the intermen- 
strual period, offering such a barrier to the passage of the 
sound as to lead to the diagnosis of organic stricture, and to 
a cutting or a dilating operation. 
Other functional troubles of the reproductive apparatus 
come under this same heading of mal-nutrition, with exhaus- 
tion of nerve tissue. Thus are explainable those puzzling 
cases in which the womb is in its natural position and of its 
natural size, in which the sound readily enters, in which no 
lesion is appreciable, and yet dysmenorrhea and back-ache 
are complained of. So can we explain many cases of tur- 
gid and neuralgic ovary. In these diseases no structural 
changes can be found, and yet they are so stubborn as to 
be shunned by the gynecologist. Sometimes there will ex- 
ist a concurrence of essential and primary uterine disease, 
with secondary nervous exhaustion, the former begetting the 
latter. We see this often in women who have been hurt 
and worn-out by child-bearing, or in women exhausted by 
sexual excess. In these cases there will be an exaggeration 
of the uterine symptoms, a localized hysteria. There will 
also be very commonly an hysterical bladder, mimicking 
vesical catarrh and even stone. For hysteria is liable to NEURASTHENIA AND WOMB-DISEASE. 
billet itself upon maimed portions of the body, and especially 
on those organs — such as the womb and the bladder — 
which claim close kinship with the brain and nervous system. 
Then, again, from the hyperemia and dysmenorrhea devel- 
oped by the neurosis we get secondary structural lesions, 
such as areolar hyperplasia, endometritis, and displacements, 
which may need a special treatment, besides the general one. 
But apart from those cases which clearly start from antece- 
dent mischief to the reproductive apparatus, no good comes 
from a local treatment. Nor do they respond much better 
to ordinary therapeutic measures. They stand as a class by 
themselves, one which is in fact an opprobrium to the pro- 
fession. 
To remove this opprobrium is the chief object of my ad- 
dress to-day, for I am sure that it can be removed, and 
that by a plan of treatment first devised and first put in 
practice by my valued friend, Dr. S. Weir Mitchell, and so 
well described by him in his work entitled “ Fat and Blood, 
and How to Make Them.” He was good enough to call me 
in to some of his cases, cases which had hitherto baffled 
the best medical skill. Struck by his remarkable success I 
followed his lead in those cases of back-ache and weariness 
and wakefulness which tradition has labeled as disease of 
the womb, but which display no coarse uterine lesions,— 
cases with leucorrhea, or with amenorrhea, or with menor- 
rhagia, or with dysmenorrhea, and yet so clad with the livery 
of hysteria as to perplex alike the psychologist and the gyne- 
cologist. Then, again, I was led to combine this treatment 
with a local one in those cases of undoubted uterine disease 
in which the exacting constitutional symptoms were out of 
all proportion to the local lesions. The results of the rest, 
of the massage, of the electricity, of the seclusion, and of 
the feeding which constitute this treatment so far surpassed 
my expectations, that I can even now say with Horatio : — 
9 
“ Before my God, I might not them believe 
Without the sensible and true avouch 
Of mine own eyes.” 
Nothing is more easy than to make assertions ; nothing so 10 
ANNUAL ADDRESS. 
dreary as to narrate cases. Yet I fear that unless I prove 
the former by the latter, you will be led to say with Mr. 
Great-Heart, “ These are but generals ; come to particulars, 
man.” The particulars I shall limit to three, to but three 
out of many ; one, because local treatment was not adopted ; 
another, because it was first tried and found wanting; the 
third, because it was kept up throughout the constitutional 
treatment. 
Case I. — On March 6, of this year, a tall and large-framed 
girl of twenty was sent to me from a neighboring State. She was 
in wretched health and had been an invalid for some five years. 
Her catamenia began at the age of thirteen and were for two 
years free from pain. Then, for some unexplained cause, dys- 
menorrhea began, which had gone on increasing until it was un- 
bearable without anodynes. She suffered from aches all over her 
body, but more especially from back-ache and from constant and 
very severe pain in both ovarian regions, the left being the worse. 
She had frequent fits of unconsciousness (hystero-epilepsy), out 
of which she awakened with frightful screams. Either ardor 
urince was present, or else a very obstinate retention, for which 
the only relief lay in the catheter. To complete the category of 
ailments, she had leucorrhea, a uterine tenesmus which prevented 
her from walking, obstinate costiveness, and a loss of all appetite. 
As her mother informed me, with probably some exaggeration, 
not a week had passed by for five years without several visits 
from her physician, and many hundred miles had he driven sim- 
ply to draw off her water. About a year before I saw her she 
went to an adjacent city, and for several months was in the hands 
of a gentleman whose name is a warrant that she had the very 
best advice possible. He diagnosticated anteflexion with steno- 
sis, at least I so infer, because after a long local treatment he ad- 
vised a “ cutting operation,” and, upon her refusal to submit to 
it, introduced a tent which lighted up a very severe attack of 
peritonitis. This made her worse ; she became bed-ridden, and 
then began to suffer from wakefulness and also from severe uter- 
ine and ovarian colics, for which very large doses of chloral and 
of morphia were needed. 
On March io, after a very careful examination, I found the 
womb and ovaries very tender, the former turgid, anteflexed, and 
somewhat bound down by adhesions. The sound touched an A E LIRAS THEXIA AND WOMB-DISEASE. 
11 
exquisitely tender fundus without any difficulty whatever, and 
gave a measurement of 2.75 inches. A few drops of blood fol- 
lowed its withdrawal. Feeling satisfied both from her history and 
from this examination that the dysmenorrhea was partly conges- 
tive, and that the severity of the symptoms was out of all pro- 
portion to the local lesions, I advised Mitchell’s treatment. I 
may as well confess that I made there and then a uterine applica- 
tion,— one of iodine. It was the first and the last one, however, 
and I am now sure a wholly needless one, but the speculum was 
i?i situ, and — well, I could not resist the temptation. On the 
next day she was put to bed in a third story room and placed 
under the charge of a nurse. Her aunt, at whose house she was 
staying, and a most judicious lady, did not see her at all for the 
first week, then but once daily for a few minutes, and later in the 
treatment twice daily. Throughout the treatment my patient saw 
no one else but her nurse, the woman who rubbed her, Ur. George 
S. Gerhard, who was kind enough to apply the electricity, and 
myself. She was not allowed to read or to write, and was at once 
put on a skimmed-milk diet, although she protested that milk and 
butter were poisons to her. Two days after the beginning of this 
treatment she had a bad attack of retention of urine. I made 
the nurse pass the catheter, and sternly told my patient that this 
must never happen again. It never did. 
Apart from bromide of potassium and morphia for the first 
few days, she got no other medicines than Trommer’s extract of 
malt, dialysed iron, the valerianate of zinc, and an occasional ape- 
rient pill. By March 18 she had reached four quarts of new milk 
daily, and could sleep without narcotics. On the 19th she had her 
first breakfast, consisting of an egg and buttered toast. March 22 
her courses came on without any pain whatever; she was indeed 
unconscious of the flow until she found herself wet. On the 28th 
she drank throughout the day one pint less than five quarts of 
new milk, eat three boiled eggs with bread and butter for break- 
fast, and devoured actually one half of a broiled chicken weigh- 
ing four and a half pounds. To make a long story short, in this 
manner she went on with unmitigated appetite and uninterrupted 
improvement. Not only was her next monthly flow also without 
suffering, but by that time she was free from any pain or ache 
whatever. She now could sleep ten hours at a stretch, and nap 
it as well between her meals. On April 22 she began to sit up 
in bed, and her mother was shortly after permitted to visit her 12 
for a few days. Her astonishment at her daughter’s improvement 
was unbounded. Early in May she was walking about the house, 
and later, in the streets. On the 14th her father came and took 
her home — well. “ They left us this morning,” wrote her aunt 
to me, “ and a happier pair I have rarely seen.” 
During the forty-five days of her treatment she drank two hun- 
dred and eight quarts of milk, and averaged two and a half eggs 
a day. Her waist expanded from eighteen inches to twenty- 
seven, and she gained twenty-two pounds in weight. On the 15th 
of last August she wrote,-saying, “I have been perfectly well 
ever since my return. I have walked with father two miles every 
evening, once over three miles ; and, when I first saw you, could 
not walk across the room without screaming with the pain.” 
I have described this case somewhat at length in order 
to illustrate the mode of treatment and to show what it can 
do. But I must refer those who wish a still more detailed 
account to Ur. Mitchell’s little book. 
A NiYUA L A DDRESS. 
Case II. is the wife of a physician, who at my request 
kindly wrote out her history in the following letter: — 
July 15, 1878. 
Dear Dr. Goodell, — I take pleasure in reporting my wife’s 
case before and since she came under your observation. • 
She is now thirty-four years old, has been married eleven years, 
and has borne three children. In the first three years of married 
life there was no issue, until an operation of slitting the cervix, 
after which conception occurred. The first labors lasted from 
six to eight hours; the last only half an hour, although the child 
weighed ten pounds and a-half; none were instrumental. From 
this last accouchement resulted retroflexion, partial prolapse, hy- 
pertrophied womb measuring three and a half inches in length, 
and all the accompanying symptoms of that condition. There 
were present pelvic pains, great weariness, inability to walk even 
a block, cervical and corporeal endometritis, and great pain in 
coition. She also, from the extreme tenderness of the womb, 
could not bear the softest pessary. Finally menorrhagia set in 
so profusely that she would become unconscious during her pe- 
riods. She was under the treatment of the late Dr. Peaslee and 
of an eminent gynecologist in another city during three years and 
a half, but without lasting benefit. 
In October last, I called you in, and your diagnosis was retro- flexion of a hypertrophied womb, with eversion and hypertrophy 
of the lips from laceration of the cervix at her last confinement. 
For this you suggested an operation, which you performed No- 
vember i of last year. Although wholly successful, this opera- 
tion made no other change in her general condition than in re- 
ducing the amount of her periods and in permitting the use of a 
pessary. You now urged a system of rest, electricity, massage, 
and diet, which was begun early in December. 
Her condition at this time was inability to sleep, dreadful after- 
noon head-aches, flighty neuralgic pains of great severity, constant 
back-ache, frequent and prolonged nervous chills, distressing pal- 
pitations of the heart, obstinate constipation, and extreme emaci- 
ation. Her weight was eighty-seven pounds, although the aver- 
age weight in health had been one hundred and six. 
During the treatment she gained twenty-four pounds, — five 
pounds more than when in health. She has lost all traces of 
pelvic and neuralgic pain, sleeps from eight to ten hours undis- 
turbed by night-horrors, walks long distances without fatigue, has 
normal menstruation, is free from constipation, and has a very 
good appetite. The condition of the womb in position, size, etc., 
is normal, though she still wears the modified Hodge pessary in 
troduced by you after the operation. 
I very naturally watched this case with the greatest interest 
from its incipiency, and believe that the first permanent step 
towards a cure was your operation on the cervix ; for so long as 
there was hypertrophy, applications gave no relief ai\d pessaries 
caused excessive pain. The next successful step was the seclu- 
sion, rest, manipulation, electricity, and dietetic treatment, to- 
gether with the control you had over the psychical traits peculiar 
to hysteria. Very truly yours, X. 
This was a very stubborn case, one which needed the 
firmest moral treatment. At one time excessive vomiting 
set in, which lasted several days and came nigh ending my 
patient’s life. Nothing stopped it but a cruel scolding, which 
was hard to give, as she was a gentle, lovable creature. Dr. 
Gerhard, who administered the electricity, will bear me out 
in the statement that it was an exceedingly tough case. I 
met her last week looking perfectly well, and steadily gain- 
ing in flesh. 
NEURASTHENIA AND WOMB-DISEASE. 
13 ANNUAL ADDRESS. 
14 
Case III. — G. W., aged twenty-nine, has never been well 
since her first and only labor, eleven years ago. Eight years ago, 
after nursing a sick child, she became bedridden. She could not 
get up on her feet, because she not only suffered acute pain, but 
all her pelvic organs then “ seemed about to fall out.” Even the 
act of sitting up in bed brought on vomiting and fainting. Her 
menstruation was scant, but attended with extreme suffering; her 
micturition frequent and painful. She also had violent uterine 
colics, which lasted several weeks at a time, and for which enor- 
mous doses of opium and chloral were needed. During these 
eight years her physician, a very judicious practitioner, rarely 
missed seeing her once a day. But during these attacks he 
would often visit her three, four, five, and even seven times in 
the twenty-four hours. He early discovered a retroflexion of the 
womb, but that organ was so tender that neither he nor a distin- 
guished gynecologist, who was also consulted, could find a pes- 
sary which she could bear. For many years she used once or 
twice daily a vaginal injection of a gallon of hot water, and had 
very appropriate topical treatment. Nothing, however, did her 
so much good as eighteen applications of leeches to the cervix 
uteri, during as many successive monthly periods. Under this 
treatment her appetite and sleep improved. 
On September 25, 1877, she was placed on a litter and brought 
to me by her physician, after a long journey by rail. A more 
wretched creature I have rarely seen. She was pale, thin, and 
helpless, hysterical to the last degree, and greatly weakened by 
night-sweats. The retroflexed womb measured over three inches ; 
it was heavy and dense, enlarged in every direction by areolar 
hyperplasia, and very tender to the touch. The next day I put 
her on tonics and began a local treatment. After straightening 
the womb by rapid dilatation, I succeeded in fitting her with a 
Hodge pessary. Finding that she mended very slowly, on No- 
vember 5 I began the use of massage, without, however, discon- 
tinuing local application. A few weeks later Dr. Wharton Sink- 
ler applied the electricity. She began at once to get better, and 
that rapidly. By January n, 1878, she had increased in weight 
from eighty-three pounds to one hundred and nineteen. Eleven 
days later she walked nine of our city squares — that is to say, 
very nearly a mile — to my office, to report an additional gain ol 
four pounds, making forty in all. Shortly afterwards she weni 
home, by no means cured of her uterine troubles, but wonderfully NEURASTHENIA AND WOMB-DISEASE. 
15 
bettered in her general health. On May 27 she wrote me that 
home cares and the hardships of poverty had caused her to re- 
lapse somewhat, and that during the catamenial week she was 
obliged to keep on her back. But, she added, “ After eight suc- 
cessive years in bed, I feel it a great blessing to be able to tend 
my own wants.” 
Now, while I grant that this was not a cure, yet here was 
a woman with an incurable disease of the womb, bed-ridden 
for many years, and with so many exacting symptoms as 
to become the bete-noire of her physician, sent home quite 
able to take care of herself, and so much better as to as- 
tonish her physician and her friends. This was a success 
which under the circumstances no other treatment could 
have gained. 
While I deem the rapid increase in flesh in these cases a 
very trustworthy token of returning health, yet the success 
of the treatment does not always depend upon it. Miss K. 
R., who had excruciating suffering at her monthly periods, 
defective locomotion, and other marked uterine symptoms, 
besides great nervous exhaustion, became well although she 
gained but five pounds. Mrs. M., a sterile lady with a heavy 
and tender retroflexed womb, was entirely relieved of ova- 
ralgia, menorrhagia, and other grievous sexual symptoms 
which for years had embittered her existence ; yet her gain 
was but seven pounds. On account of the slow and in- 
appreciable increase in the weight of these patients, both 
Dr. T. V. Crandall, who gave the electricity, and I at first 
feared a failure, but they turned out to be signal cures. 
Other cases, either with or without uterine treatment, 
could be given, but these are enough to serve my purpose. 
Now, how is it that in these cases this treatment was 
followed by such success ? The symptoms were such as 
ninety-nine physicians out of a hundred would ascribe to 
uterine disease, and to uterine disease alone, and yet my 
patients got well with but little or no local treatment. 
What then is the nexus between the means used and the 
apparent uterine disorder? The explanation is, to my think- 
ing, as follows : The essence of the disease lies, not in the 16 
ANNUAL ADDRESS. 
sexual organs, but in the nerve-centres. These lack-lustre- 
eyed, thin-blooded, tender-spined, and emotional creatures 
give a history of exhaustion, of wakefulness, of great nerv- 
ousness, and of constant back-ache and ovaralgia. There 
are then four objects to be secured, — nutrition, sleep, rest 
of body and of mind, and freedom from pain. 
The question of nutrition is an important one, because 
these women are wholly without appetite and reject whole- 
some food. Repair not equaling wear, the starving nerves 
begin to clamor. By giving large doses of iron, and certain 
fixed rations of food at fixed hours, as laid down by Dr. 
Mitchell, sleep is induced and nervous pains are allayed, in 
cases which had hitherto resisted all treatment. This goes 
without saying. 
Seclusion is important, first, to free the mind from all 
care ; next, to remove the invalid from the home environ- 
ment, where her whims are pampered into an unhealthy 
importance, and her slightest caprices anticipated. Again, 
it puts the patient wholly under the control of her physi- 
cian. This is of no little importance, for there are no hard 
and fast rules of diet, massage, etc., for restoring these hys- 
terical women to health. Each case stands by itself ; each 
has an individuality to which the mental treatment must be 
adapted, and the personal magnetism of the physician can 
alone supply in each the missing nerve-link between will 
and action. Acting upon these views I have generally 
treated my patients away from their homes. Sometimes I 
have compromised the matter by putting them in a third 
story room at home, but as it were under lock and key. 
The therapeutic effects of massage and of electricity are 
very analogous, but they need a somewhat extended expla- 
nation. The four principal manipulations of massage are: — 
1. Effleurage, viz., stroking, friction, or surface rubbing. 
2. Petrissage, kneading or deep rubbing. 
3. Tapotement, tapping or percussion. 
4. Passive and active motion. 
The first two pleasantly stimulate into action the vaso- 
motor nerves and the terminal filaments of cutaneous nerves, and exercise the muscles without volition and therefore 
without any expenditure of nerve-force. Electricity does 
the same thing. Tapotement, or percussion, made by quick 
strokes with the ulnar margin of the palm, temporarily stuns 
the nerves, and these surprises effect molecular changes, 
by which relaxed fibre and tissues of loose consistency are 
strengthened. Again, both massage and electricity raise 
the body temperature, stimulate the nervous system, pro- 
mote the secretions, and increase the peristaltic action of 
the bowels. Also the new and sharp impressions of elec- 
tricity break up, as Anstie has shown, the mental attitude of 
morbid concentration on the hysterical or the pseudo-neu- 
ralgic pains. 
Thus these two agents not only act as antidotes to the 
evils which come of prolonged rest in bed, but they meet 
several important indications. Further, the assumption hav- 
ing been made that in these cases there is disturbed circu- 
lation as well as enfeebled innervation, it follows that when 
a pathological process is set up by an increased flux of blood 
to one organ, whatever tends to lessen the amount of blood 
flowing to it tends also to restore it to health. Now both 
electricity and massage increase surface circulation in the 
large vascular district of the skin. Again, by irritation of 
vaso-motor nerves they also produce reflex alteration in 
the circulation of deeper parts. But increased capacity at 
one vascular district causes lessened capacity in another. 
Hence the flux of blood is diverted from the diseased organ 
and its circulation lessened. Causing in this manner ane- 
mia of the brain, sittings of massage or of electricity are 
usually followed by sleep. 
In all of my cases the faradic current was more commonly 
used, the galvanic current being reserved for stubborn and 
deep seated pains; that is, the electricity was applied either 
by general faradization, or by central or spinal galvanization. 
In a large proportion of these cases there was more or less 
of anesthesia in one leg, — usually the left,—accompanied 
by burning and cutting pains radiating from the correspond- 
ing ovary. Faradic excitability was at first always enfeebled 
NEURASTHENIA AND WOMB-DISEASE. 
17 18 
ANNUAL ADDRESS. 
on the affected side, but after several sittings the muscles 
began to respond to the current, and motility was restored. 
In not a single instance did these nerve lesions last long. 
The ovaralgia was, however, not so readily overcome, but it 
was very interesting to watch how surely it was rubbed out 
and faradized out, — in fact, extinguished. 
This treatment I once saw act like a charm in one of those 
fat and flabby women, with feeble hearts, with menorrhagia, 
and with very exacting uterine and hysterical symptoms. 
This fat accumulates from insufficient oxidation, brought 
about either from impeded circulation or from impoverished 
blood in which those oxygen carriers, the red blood corpus- 
cles, are lessened in number. This will sometimes happen 
after a post partum flooding, or, as I have lately seen it, from 
the prolonged hemorrhage caused by a uterine polypus. The 
menorrhagia was probably the cause of it in this case. One 
finds it also in the muscles of paralyzed limbs. But to re- 
turn to my patient ; she was brought to me from a neigh- 
boring State when she had been confined to her room for 
over four years, and had not been able to move from her 
chair to her bed without the aid of crutches and that of her 
nurse. I first used the curette, then put her on a skimmed- 
milk diet as recommended by Dr. Mitchell, reducing the 
quantity daily until it seemed barely enough to keep her 
alive. Waste material was meantime eliminated by free pur- 
gation. Then by good wholesome food, by equalizing and 
stimulating the circulation through the use of massage and 
electricity, by the use of digitalis as a heart tonic, and by 
very large doses of iron — thirty-seven grains of the dried 
sulphate per diem in the form of Blaud’s pill — to increase 
the number of red blood corpuscles and thereby the com- 
bustion of the tissues, she got out of bed in eleven weeks’ 
time with a weight reduced from two hundred and twenty- 
five to one hundred and eighty-six pounds, threw away her 
crutches, walked without assistance, and has since been 
doing well. 
This treatment also answers admirably for the spurious 
womb-ills and nerve perturbations of the climacteric; NEURASTHENIA AND WOMB-DISEASE. 
19 
nothing so surely controls the heats and chills, the shiver- 
ings and sweatings, the nerve-tinglings and emotional ex- 
plosions, so common at the change of life. 
Then again there is another class of cases to which this 
treatment is peculiarly adapted. I refer to that large group 
of uterine disorders which come from sexual excess. Ex- 
cessive functional activity of the reproductive organs causes 
proportional exhaustion, and passive congestions of the 
nerve-centres. The turgidity is perhaps most marked at 
the lumbar portion of the spinal cord, whence it begets 
morbid irritability of the sexual organs. Repeated coition 
then means repeated congestions and exhaustions. And 
when one of a married couple is too weak, or one is rela- 
tively too vigorous for the other, semi-passive congestion of 
the nerve-centres obtains, and the exhaustion becomes per- 
manent. Sometimes it is the husband that suffers, and one 
would a priori suppose that, since he alone of the two parts 
with a highly vitalized fluid, this would generally be the case. 
But it is not so ; unless he happen to have the germs of 
some hereditary disease, such as phthisis, lurking in his sys- 
tem, or he be past the prime of life when he marries a young 
or a second wife. Strange as it may seem, it is the woman 
who receives, and not the man who gives, that breaks down 
in health; but fortunately the nerve-lesions, being functional 
and not structural, are curable. These cases have back-ache, 
leucorrhea, menorrhagia, loss of sexual desire, weakness of 
lower limbs almost amounting to a palsy, uterine congestion, 
and the usual local symptoms and lesions resulting there- 
from ; but they will not be benefited in the least by a top- 
ical treatment. They need to be put to bed and to be built 
up by massage, electricity, and food. They need especially 
to be separated from their husbands, and thus have both 
functional and physiological rest. In one of my cases, treated, 
unluckily, at home, a single stolen coitus undid the work, and 
put my patient back. 
Of course it would be unreasonable to suppose that the 
foregoing treatment will exclude all local treatment. Putting 
a woman to bed cannot cure a lacerated cervix, or a cervical 20 
ANNUAL ADDRESS. 
stenosis, or an acutely bent womb. But what I claim for it 
is that it has in my hands cured granular erosion, dysmen- 
orrhea, menorrhagia, inter-menstrual ovaralgia, and most of 
the diseases arising from passive congestions. I will go 
farther, and say that I believe it will often obviate the need 
of spaying a woman for pernicious menstruation. 
In conclusion, while humbly hoping that in this perhaps 
too personal a paper, the importance of the subject will 
atone for the lack of that traditional dignity and prescriptive 
phraseology which lend pomp and circumstance to a presi- 
dential address, I beg to return my thanks for the patience 
with which you have listened to one who is not your first 
choice, and who has the further disadvantage of immediately 
succeeding your very first choice. NOW READY: 
Gynecological Transactions. 
VOLUME III. 
Being the Pransactions of the American Gynecological 
" Society for the Year 1878. 
CONTENTS. 
I. Annual Address on the Relation of Neurasthenia to Diseases of the Womb. By 
the first Vice-President, Dr. William Goodell. 
II. A Case of Rupture of the Perineum without Implication of the Vulva. By Dr- 
J. C. Reeve. 
III. On the Surgical Treatment of Stenosis of the Cervix Uteri. By Dr. J. Marion 
Sims. 
IV. A Case of Extra-uterine Pregnancy, with Discharge of the Fetal Bones through 
the Bladder. By Dr. J. P. White. 
V. A Case of Foot and Head Presentation; Fracture of the Spine in Utero. By 
Dr. J. T. Johnson. 
VI. The Necessity of Early Deliverv, as demonstrated by the Analysis of One Hun- 
dred and Sixty-one Cases of Vesico-vaginal Fistula. By Dr. T. A. Emmet. 
VII. The Hand as a Curette in Post Partum Hemorrhage. By Dr. H. P. C. Wilson. 
VIII. The Treatment of Post Partum Hemorrhage. By Dr. R. A. F. Penrose. 
IX. Dermoid Tumors of the Ovary. By Dr. W. H. Byford. 
X. A Contribution to the Study of the Treatment of the Acute Parenchymatous Ne- 
phritis of Pregnancy. By Dr. W. L. Richardson. 
XI. Alternating Anterior and Posterior Version of the Uterus. By Dr. S. C. Busey. 
XII. Remarks on Gastro-elytrotomy. By Dr. H. J. Garrigues. 
XIII. The Pendulum Leverage of the Obstetric Forceps. By Dr. A. H. Smith. 
XIV. Rectal Alimentation in the Nausea and Inanition of Pregnancy; Intestinal 
Inhaustion, an Important Factor and the True Solution of its Efficiency. By Dr. H. F. 
Campbell. 
XV. Three Cases of Rupture of the Uterus. By Dr. T. Parvin. 
XVI. On the Early Delivery of the Placenta when Previa; with the Relation of 
a Case of Spontaneous Detachment of the Placenta without hemorrhage. By Dr. I. E. 
Taylor. 
XVII. Unexpected Narcotism induced suddenly on the Third Day of the Adminis- 
tration of Three-grain Suppositories of Opium. By Dr. J. P. White. 
XVIII. Treatment of Pelvic Indurations and Adhesions. By Dr. E. Van de Warker. 
XIX. On some Points in Connection with the Treatment of Sterility. By Dr. A. 
Reeves Jackson. 
XX. A Case of Extreme Anteversion and Anteflection of the Uterus at the Full 
Term of Pregnancy. By Dr. I. E. Taylor, of New York. 
XXI. Memoir of Edmund Randolph Peaslee, M. D., LL. D. By Dr. Fordyce Bar- 
ker. 
XXII. In Memoriam: Washington Lemuel Atlee. By Dr. T. M. Drysdale. 
XXIII. The Mechanism of Retroversion and Prolapsus of the Uterus considered in 
Relation to the Simple Lacerations of the Cervix Uteri and their Treatment by Bloody 
Operations. By Dr. Nathan Bozeman. 
Index of Obstetric and Gynecological Literature of all Countries for the Year 1877. 
Price of Vol. III., $5.00; Vols. I. and II., contents of which will be 
found on the following pages, will be sent to one address by mail or ex- 
press, prepaid, on receipt of $10.00 by the publishers. The three volumes 
supplied for $15 00. 
Address HOUGHTON, OSGOOD *AND COMPANY, 
WINTHROP SQUARE, BOSTON. TRANSACTIONS 
OF 
The American Gynecological Society. 
VOL. I., FOR THE YEAR 1876. 
400 pages. Many illustrations. 
The Annual Address by the President, Dr. Fordyce Barker, of New 
York, and the following papers : — 
I. Etiology of Uterine Flexures, with the proper mode of treatment indicated. By 
Thomas Addis Emmet, New York. 
II. Cicatrices of the Cervix Uteri and Vagina. By Alexander J. C. Skene, M. D., New 
York. 
III. Extirpation of the Functionally Active Ovaries for the Remedy of otherwise Incur- 
able Diseases. By Robert Battey, Rome, Ga. 
IV. On Central Rupture of the Perineum. By J. Matthews Duncan, M. D-, Edinburgh, 
Scotland. 
V. Viburnum Prunifolium (Black Haw); its Uses in the Treatment of the Diseases of 
Women. By Edward W. Jenks, M. D., Detroit, Mich. 
VI. An Illustration of Xenomenia. By Theophilus Parvin, M. D., Indianapolis, In- 
diana. 
VII. Relations of Pregnancy to General Pathology. By Robert Barnes, M. D., Lon- 
don, Eng. 
VIII. The Spontaneous and Artificial Destruction and Expulsion of Fibrous Tumors of 
the Uterus. By W. H. Byford, Chicago, 111. 
IX. Case of Abdominal Pregnancy, treated by Laparotomy. By T. Gaillard Thomas, 
M. D., New York. 
X. Pneumatic Self-Replacement in Dislocations of the Gravid and Non-gravid Uterus. 
By Henry F. Campbell, M. D., Augusta, Ga. 
XI. Hydrate of Chloral in Obstetrical Practice. By W. L. Richardson, M. D., Boston, 
Mass. 
XII. Labor Complicated with Uterine Fibroids and Placenta Previa. By James R. 
Chadwick, M. D., Boston, Mass. 
XIII. Latent Gonorrhea, with Regard to its Influence on Fertility in Women. By 
Emil Noeggerath, M. D-, New York. 
XIV. Death from Urinemia in Certain Cases of Malignant Diseases of the Uterus. By 
Alfred Wiltshire, M. D., London, England. 
XV. Clinical Memoir on some of the Genital Lesions of Childbirth. By William Good- 
ell, M. D., Philadelphia, Pa. 
XVI. Hermaphroditism. By Lawson Tait, F. R. C. S., Birmingham, England. 
XVII. Cases of Cystic Tumors of the Abdomen and Pelvis. By George H. Bixby, 
M. D., Boston, Mass. 
XVIII. Case of Solid Uterus Bipartitus; both ovaries removed for the relief of epileptic 
seizures ascribed to ovarian irritation. By E. Randolph Peaslee, M. D-, New York. 
XIX. The Origin and History of Calculi found in the Bladder after the Cure of Vesico- 
Vaginal Fistula by Operation. By Henry F. Campbell, Augusta, Ga. 
XX. Rare Forms of Umbilical Hernia in the Fetus. By James R Chadwick, M. D , 
Boston, Mass. 
XXI. In Memoriam Gustav Simon By Paul F. Mund£, M. D., New York 
Price of Volume I., $5.00. 
As contributions to advanced gynecology they exceed in value anything which we have 
ever before seen collected in any one volume. — N. V. Medical Record. 
This volume of Transactions is certainly superior to any book of the kind that has been 
issued by the American Press. — St. Louis Clinical Record. 
Now we have the first of, ife hope, a long row of volumes which will bear comparison 
with the Transactions of European Societies. Indeed, these must look to their laurels in 
this noble emulation. — Edinburg Medical Jourtial. 
This volume is one of the best collections of gynecological papers that has been published 
this year. —Annales de GyrUcologie. 650 pages, 12 chromo-lithographs and many other illustrations. 
VOLUME II., FOR 1877. 
Contains the following papers, with the discussions to which they gave 
rise : — 
I. Annual Address, on Medical Gynecology. By the President, Dr. Fordyce Barker, of 
New York. 
II. The Functions of the Anal Sphincters, so called. With two wood-cuts. By Dr 
James R. Chadwick, of Boston, Mass. 
III. Excision of the Cervix Uteri; its Indications and Methods. With one wood-cut. 
By Dr. John Byrne, of Brooklyn, N. Y. 
IV. Report on the Corpus Luteum. With twelve chromo-lithographic plates. By Dr. 
John C. Dalton, of New York. 
V. The Pathology and Treatment of Puerperal Eclampsia. By Professor Otto Spiegel- 
berg, of Breslau, Prussia. 
VI. Dilatation of the Cervix Uteri for the Arrest of Uterine Hemorrhage. By Dr. 
George H. Lyman, of Boston. 
VII. The Principles of Gynecological Surgery applied to Obstetric Operations. By 
Dr. A. J. C. Skene, of Brooklyn, N. Y. 
VIII. On the Necessity of Caution in the Employment of Chloroform during Labor. 
By Dr. William T. Lusk, of New York. 
IX. The Present Status of the Intra-Uterine Stem in the Treatment of Flexions of the 
Uterus. By Dr. Ely Van de Warker, of Syracuse, N. Y. 
X. Supplement to the report of a case of Xenomenia made at the first Annual Meeting 
in 1876. By Dr. Theophilus Parvin, Indianapolis, Ind. 
XI. A Case of Vaginal Ovariotomy. By Dr. William Goodell, of Philadelphia, Penn. 
XII. Is there a Proper Field for Battey’s Operation? By Dr. Robert Battey, of 
Rome, Ga. 
XIII. Subsulphate of Iron as an Antiseptic in the Surgery of the Pelvis. By Dr. H 
P. C. Wilson, of Baltimore, Md. 
XIV. Tetanus after Ovariotomy. By Dr. Theophilus Parvin, of Indianapolis, Ind. 
XV. Sarcoma of the Ovaries. By Dr. Washington L. Atlee, of Philadelphia, Penn. 
XVI. The Value of Electrolysis in the Treatment of Ovarian Tumors, as seen in the 
Light of Recent Experience. By Dr. Paul F. Mundd, of New York. 
XVII. Congenital Absence and Accidental Atresia of the Vagina; Mode of Operation 
to Establish the Canal, and to Evacuate retained Menstrual Blood. With three wood- 
cuts. By Dr. Thomas Addis Emmet, of New York. 
XVIII. Case of Sarcoma of the Kidney in a negro child. With Heliotype. By Dr. 
W. H. Geddings, Aiken, S. C. 
XIX. The Hvstero-Neuroses. By Dr. George J. Engelmann, of St. Louis, Mo. 
XX. Cases illustrating Important Points connected with Ovariotomy. By Dr. Gilman 
Kimball, of Lowell, Mass. 
XXI. The Radical Treatment of Dysmenorrhea and Sterility by Rapid Dilatation of the 
Canal of the Neck of the Uterus With one wood-cut. By Dr. Ellwood Wilson, of Phil- 
adelphia, Penn. 
XXII. Dr. Uvedale West’s Views of Rotation, as illustrated by the Contrast between 
the Mechanism of Simple Occipito-Posterior Positions and those of the Bregmato-Coty- 
loid Variety. By Dr. John P. Reynolds, of Boston, Mass. 
XXIII. Vascular Tumors of the Female Urethra; with the Description of an Instru- 
ment devised to Facilitate their Removal. By Dr. A. Reeves Jackson, of Chicago, 111. 
XXIV. Lying-in Hospitals; especially those in New York. By Dr Henry J. Gan- 
rigues, of Brooklyn, N. Y 
XXV. The Simpler Varieties of Perineal Laceration; their Consequences and Treat- 
ment. By Dr. Thaddeus A. Reamy, of Cincinnati, Ohio. 
XXVI. The Cyclical Theory of Menstruation By Dr. John Goodman, of Louisville, 
Ky. 
XXVII. In Memoriam Charles E. Buckingham With a Heliotype Portrait By Dr. 
George H. Lyman, of Boston, Mass. 
Index of Obstetric and Gynecological Literature of all Countries, from July 1, 1876, to 
January 1, 1877. 
The price of Volume II. is $6.50. Vols. I. and II. will be sent by mail 
or express, post-paid, for $10.00. Address, 
HOUGHTON, OSGOOD & CO., Boston. Opinions of the Press. 
As contributions to advanced gynecology they exceed in value any- 
thing which we have ever before seen collected in any one volume. With- 
out exception, every paper has an interest and value attached to it which 
is intrinsic, and which reflects the best efforts of the respective authors. 
.... The work is elegantly printed, neatly and tastefully bound. — N. Y. 
Medical Record. 
This volume of Transactions is certainly superior to any book of the 
kind that has been issued by the American press. The papers read and 
here presented are well written and well digested ; and the discussions re- 
ported have almost as much value as the papers themselves. — St. Louis 
Clinical Record. 
We think that never before was such a number of excellent monographs 
collected together in one volume of Transactions. It is a model in every 
respect. It is a volume that should be in the hands of every general prac- 
titioner as well as specialist, as in it may be found most useful suggestions 
for every day practice. We cannot commend the work too highly, and it 
is our earnest hope that future meetings of the society will give origin to 
volumes of Transactions equal to the one before us. — The Hospital Ga- 
zette. 
In conclusion, we cannot but regard this volume as a fitting monument 
of the progress of this most progressive department of medicine. The 
discussions are rich, and are full of such epitomized good sense well ex- 
pressed, as is rarely found in any volume of Transactions, while the whole 
contents exhibit the most careful supervision of the editor. — Toledo Medi- 
cal and Surgical Journal. 
Organized amid the whirl and bustle of last summer, the American 
Gynecological Society bids fair to realize the brightest hopes of its found- 
ers. Its first volume of Transactions, now before us, will bear the closest 
scrutiny, and safely challenge the severest criticisms, so superior is it in its 
breadth of thought and observation, scientific worth, and literary excel- 
lence ; the writers of the papers in these Transactions being no mere 
novices, but men skilled in the profession they represent, and experts in 
the branch of study and practice which they especially call their own. — 
Philadelphia Medical Times. 
It is not a trifling matter to be able to say of this volume that it is the 
handsomest of the kind anywhere produced But this is not only an 
elegant volume, it is a good one ; creditable to the authors, creditable to 
the great republic Now we have the first of, we hope, a long row 
of volumes which will bear comparison with the Transactions of European 
Societies. Indeed, these must look to their laurels in this noble emula- 
tion. — Editiburgh Medical Journal. 
This book of nearly 400 pages contains a series of excellent articles 
upon gynecological topics, written by the most prominent gynecologists of 
America and England. — Allg. Wiener Med. Zeitung. 
This volume is one of the best collections of gynecological papers that 
has been published this year We do not doubt that it will confer 
the greatest honor upon the medical literature of America. — Annales de 
Gynkologie. 
Few volumes that have recently come under our notice have been so ex- 
tremely interesting and instructive. The papers reach a very high order 
of excellence, and some indeed are superlatively good. — Atnerican Jour- 
nal of Obstetrics.