SYNOPSIS 
OF: 
One Hundred Ovariotomies 
BY 
Edward BorcUA/'M., M. I)„ Etc. 
ST. LOUIS, MO. 
1895. 
‘'Reprint from the Sept, number Si. Louis Medical Mirror." 
WEISS & MACCALLUMj PRINTERS, 3737 N. BROADWAY, 
ST. LOUIS, MO, SYNOPSIS 
OF: 
One Hundred Ovariotomies, 
BY 
Edward Borck, A, \E, M. D„ Etc. 
ST. LOUIS, m;o. 
1895. 
“Reprint from the Sept, number St. Louis Medical Mirror 
WEISS <fc MACCALLUM, PRINTERS, 3737 N. BROADWAY, 
ST. LOUIS, MO. PREFACE. 
The first edition were two lectures on the diagnosis and operation 
for Ovarian Tumors delivered in 1882 and 1883 at the College for Med- 
ical Practitioners, dedicated to and published by request of my class. 
This edition having been soon exhausted, but the application for 
the reprints continued to be very numerous, which proved recognition 
and in gratification thereof, I issued a second revised reprint edition 
(1000) in 1887, dedicated to the Medical Profession. (See memoran- 
dum.) 
I now submit to the Profession a preliminary report as part of my 
work done in this line in the last seventeen years, a synopsis of ICO 
cases, with remarks and personal observations and hope that my pro- 
fessional-brethren receive, “like from previous of my publications,” 
some profit thereby. 
The three cases of Hysterectomies present special points of 
interest. 
Very truly, 
THE AUTHOR. Synopsis of One Hundred cases of 
Ovariotomies. 
BY EDWARD BORCK, A. M., M. D., ST. LOUIS. 
Laparotomies for other pathological conditions, such as salpingitis, 
the removal of the vermiform process, abscesses, hernie, gun shot 
wounds, and other injuries of the abdominal viscera, are not included in 
this report. They will be published in the near future, (about 100 cases.) 
With the exception of three cases’ of hysterectomy, they were all cysts or 
cystic degeneration of the ovaries. 
On the nineteenth day of March, 1878, I performed my first ovario- 
tomy on a patient fifty-five years ol age. (See St. Louis Medical and 
Surgical Journal, April 1878 for details.) 
At that time I knew little or nothing of the operation, and had never 
seen it done. The patient recovered. This encouraged me. However, 
the next two patients I operated upon, died. (See report in the Decem- 
ber number of the Medical and Surgical Journal 1878.) These two cases 
were a great lesson and study to me. I became deeply interested and 
enthusiastic in that work and gave it henceforth my special attention, 
and was rewarded with success. In 1879 I read a paper before the Tri- 
State Medical Society at Evansville, Indiana, wherein I advocated the 
early operation for ovarian tumors; in fact,as soon as possible after the 
diagnosis has been made, as the cases are then more promising. (See 
Cincinnati Obstetrical Gazette, March, 1880.) In September, 1885, I 
reported to the Mississippi Valley Medical Society at Evansville, India- 
na, fifty cases operated upon up to May, 1885, with five deaths. (See 
New York Medical Record, September 26,1885. Volume 28, Number 13.) 
On the eighth day of July, 1895, I completed my second fifty cases, 
with seven deaths. This gives me one hundred cases with twelve deaths. The age of these patients ranged from eighteen to sixty-three years. 
Nationalities, Americans and Germans. Five were single. 
A general outline of these second fifty cases are: Forty-seven were 
single cysts, the majority on the left side. In a few cases, 1 found both 
ovaries affected, one large cyst on one and some small cystic degenera- 
tion in the other ovary. Classified as follows : Cysts of the broad liga- 
ments, 4; dermoid cysts, 2; polycysts, 8; one death : fibro-cysts, 5; one 
death; cystic carcinoma, 2; two deaths; fibroid tumors of uterus, if; 
one death. These latter three cases present marked points of interest, 
the first an American lady of Kansas, married, one chdd, about forty- 
five years of age w7hen I first saw her. Upon examination, I found a 
fibroid uterus, as she was otherwise in good condition, I advised to wait 
with the operation until after her menopause. Four years later she pre- 
sented herself again. Her menses had ceased about three years; I oper- 
ated and removed the uterus and appendages. The mass weighed twen- 
ty-two pounds. She made an uninterrupted recovery. The second ca,se 
I saw after the menstrual period had ceased already for several years. 
This lady,‘American, married, fifty-one years of age, weighed one hun- 
dred and ten pounds, has three grown up children. She states that her 
abdomen had gradually increased for the last ten years, though she did 
not gain in weight. I diagnosed a fibroid uterus, advised and performed 
operation. Mass weighed sixteen pounds and three ounces. She recov- 
ered after a good‘deal of care and attention. The third case, an Amer- 
ican lady about thirty years of age, single when I first saw her; diag- 
nosed a small fibroid uterus/ I advised no interference as long as she 
was comfortable and otherwise well. She soon after married. I kept 
her under observation from time to time for years. Eight years after 
the first; examination, she began to enlarge rapidly, suffering pain, 
oedema of legs, etc., etc. I advised then an operation and performed it, 
The mass weighed thirty-eight and a half pounds. She died on the third 
day. The first two were determined to get wTell this one apprehended 
death all the time. These cases were reported to the St. Louis Medical 
Society in detail. Published in St. Louis Medical unci Surgical Journal 
and the specimens are at the Museum of the Marion-Sims Medical Col- 
lege. The remaining forty-seven cases were all simple cysts. None be- 
yond the second or third stage. Six deaths. One of these, a youug lady 
with small ovarian cyst, first stage, no adhesions, small pedicle, very 
little hemorrhage, it was a very easy ease for operation. Death forty 
hours later. Cause anemia of heart and general debility. In four other 
deaths the tumors were in advanced stages. In the last case I operated 
upon on the eighth day of July, 1895, was a German woman fifty-five 
years of age. Apparently, this was a favorable case for operation but 
it turned out to be the worst case I ever had to deal with. The tumor 
was about of five years’ growth. She suffered wifh dreadful constipa- 
tion and pain for the last two weeks, could not sleep, had difficulty of 
respiration. She knew she could not get well without an operation be- 
4 ing performed, but was fearful of death all the time. She said she could 
not recover. Upon opening the abdomen a large cyst with strong thick 
walls presented I could not lift it out, a thick chocolate colored fluid 
was drawn off, the intestines, the mesentary, the tumor, the uterus, the 
ovaries, all 
were glutina- 
ted in a mass. 
After a faith- 
ful trial it was 
found impos- 
sible to isolate 
the tumor. 
There was con 
siderablehem- 
orrhage. I 
therefore cut 
off the cyst as 
close as possible towards the adhesions, about one-half of the cyst, 
cleaned out the consents of the cyst and united the walls of the cyst to- 
gether with a continued suture. Stopped all the hemorrhage with liga- 
tures and hot water as far as possible, closed the abdomen and aban- 
doned the oper- 
ation. She died 
thirty-five min- 
utes after she was 
removedfrom 
the table. This 
is the first case I 
have met in my 
practice where 
the removal of 
the tumor was 
impossible. 
5 
FIGURK I, ABDOMEN AFFECTED WITH ASCITIS. 
FIGURE 2, OVARIAN CYST. 
DIAGNOSIS. 
I would refer the reader to my lecture on the differential diagnosis 
with tables, and directions for a microscopical chemical examination of 
the fluid of ovarian tumors, published in Cincinnati Obstetrical Gazette, 
Sept., 1883. But as ascitis is most frequently mistaken forovarian dropsy 
(I have once done so myself) I will present here a lateral view of the two 
different contours of the abdomen observed in ascitis and ovarian cyst. 
The other symptoms can be studied in any work on that subject. 
In my very first operation, I followed Sir Spencer T. Wells, under the 
precept of I)r. Louis Bauer. I-saw at once that a more simple method 
to elevate and evacuate a cyst would be desirable. Also that some 
OPERATION. 6 
strong forceps would be useful, and plain and sufficiently strong retrac- 
tors for the abdominal walls. In my second operation, I had these in- 
struments ready March, 1878. Strong, large, sliding forceps, large 
strong wire retractor 
bent in a double L shape 
and my double needle or 
cyst elevators of differ- 
ent sizes (See figure 3. 
Half the smallest size.) 
Figure 4, shows how the needle is intro- 
duced after the abdomen is open. 
Instead of clamping the pedicle, one or 
two of these needles are thrust through it, 
transfixing the pedicle, and then a strong ligature is tied around the 
pedicle below, and separating the stump with cyst above the needle. It 
does away with theclamp. If the pedicle is to be treated extra abdominal, 
it is brought to the lower part of the incision, the needle laying cross- 
wise upon the abdomen and held there securely. To this method I have 
adhered up to this date and no change has been made by me with the 
above instruments or meth- 
od of operating. I adhere 
also to the silk ligatures. 
Otherwise I have modified 
or rather simplified rnyprev 
ious ways. (See remarks.) 
It will be interesting to read 
my lectures, 1883, upon the 
operation, re-published in 
the second revised reprint 
edition, 1887, and direc- 
tions there given for the pre- 
paration of the patient, the 
room, the atomizer, the 
solutions, etc., etc. I had 
then to stand a good deal 
of sarcasm on account of 
the course I pursued. I 
stood it all and to-day I am 
well satisfied. But one thing I would mention here which is also very in- 
teresting. My needle method has been published in almost every coun- 
try and evei’y language. Sir Spencer T. Wells presented it to the Royal 
Academy of Surgeons in 1878. When I visited Europe in 1884, 1 saw it 
employed by surgeons in England and Germany, and lam amused to 
meet young and old doctors every once in awhile who have just re- 
turned from Europe and bring the news of the great discovery they have 
made there, seeing a double needle used instead of a clamp, also using 
m 
A. 
A. THE ELEVATOR, B. PROTECTING CUP. 
FIGURE 3. 
FIGURE 4. 
D 
rC 
w 
F 
C—Right hand of assistant. 
FIG 5 EXPLAINS ITSELF. 
D—Right hand of operator. 
E—The cyst. 
F—Abdomen. 7 
the sa me to elevate the cyst, and keep the pedicle in its place extra ab- 
dominal with the same needle. I simply smile. 
Appropos 
about need- 
les, here is a 
needle I use 
tor suturing 
made out of 
asewing 
machine 
ne e d 1 e . 
See figure 
6. 
During an operation, I always keep a sufficient number of fine cam- 
bric needles ready, threaded with silk, to be used in case of any intestine 
being injured. 
FIGURE 6. 
REMARKS AND OBSERVATIONS. 
In regard to the technique of the operation, every operator has his 
own peculiar way. Experience grows with the number of cases, and we 
learn what to do and what is best not to do. For some time I have 
discarded the spray, the carbolic acid, bichloride of mercury and such 
like antiseptics. Clean hot water with a little salt or the artificial serum 
for flushing the abdominal cavity if required. Sterilized instruments 
and dressings. In one word, everything must be aseptic, that is all. 
Every case stands upon its own merits and should be treated accord- 
ingly, where there is much oozing, I use occasionally, drainage, either 
tube or gauze or both. As a rule I prefer to drop the pedicle into the ab- 
domen and close the external wound with deep and superficial sutures, 
however, of late Ido not stitch the peritoneum together nor pierce it with 
a needle. I introduce a peaslee needle, armed with ligature, through the 
skin and muscles, one half inch from the edge on one side, let the needle run 
between the muscles and peritoneum, and enter on the other side between 
the peritoneum and muscles and out through the skin, by drawing the 
deep sutures snugly together, the perit.onium will meet in close approx- 
imation and generally is united in twenty-four hours. The advantage 
is in withdrawing the sutures, the danger of any pus, should there be 
some upon the ligatures, cannot enter the abdominal cavity. Flushing 
the abdominal cavity, which I invariably practiced in my first fifty cases, 
I used but very seldom in my last fifty cases, taking care that no fluid 
from the cyst nor any other fluid will enter the abdomen, using sterilized 
aseptic gauze for sponging. I would also state that in some of my cases, 
where the pedicle was large and broad and the cyst had thick walls, I 
would cut through the cyst close to thepedicle,i’emoving the internal sec- 
reting membrane from that piece that is to remain,wait until all hemorr- 
hage, if there is any, is stopped and approximate the walls of the cyst 8 
with a continued suture. It is less liable to secondary hemorrhage than 
cutting through the pedicle. 
In conclusion, I will say, while I advocate the early operation for 
ovarian cyst, which has been proven as correct, the question as to an 
early hysterectomy of a fibroid tumor of the uterus seems to me is not 
fully settled at present There are interesting points to be considered, 
in two of the cases of fibroid uterus mentioned The advice to wait un- 
til the menopause has ceased, for the reason that there was no hemor- 
rhagia and the other conditions were good. 1 acted upon the theory 
that the uterus may atrophy or at least stop growing after the meno- 
pause. I do not regret having done so for this reason, that to my mind, 
with my little observation and experience, that nothing short off, but a 
clean hysterectomy for fibroid uterus will eradicate the disease. All 
other modes of treatment are only temporary. I admit again that I 
carefully select the patients upon whom I operate. Where the prospects 
are favorable I advise an operation but never urge or use any pursua- 
sion whatsoever. It must be a voluntary consent upon the part of the 
patient. With a few exceptions, all of the last fifty cases were operated 
upon at my late Private Surgical Home. 
4112 North Grand Avenue. ADDENDUM: 
I prefer Malliuekrodt’s. Years ago I called attention to the fact that 
chloroform kept in large bottles, opened and reopened again and again, 
will thereby lose part of its virtue, will be spoiled by absorption of 
moisture, etc. That in some cases of deaths resulting from or attrib- 
uted to chloroform, it has been found that the remaining small part of 
chloroform from a large bottle had been administered. 1 therefore 
recommend to keep chloroform in small bottles not containing more 
than two ounces, hermetically sealed, not to be opened until required, 
whatever is left maybe used in liniments. 
After some of the German medical journals gave me due credit for 
these my observations, it crossed the Atlantic again, and thus found its 
way back here. I am pleased to observe my recommendation has been 
largely adopted by physicians and druggists. 
It is also said that chloroform should be inhaled through the mouth 
exclusively, it lessens dangers and avoids vomiting. 
CHLOROFORM. 
VOMITING AFTER LAPAROTOMY. 
This is very annoying to all concerned and sometimes resists all 
treatment I will not discuss the causes nor the rem< dies, but simply 
state a successful practical experience. 
In one of my so unfortunate cases, and not knowing any more what 
to do for her, 1 introduced a rubber tube through the mouth into the 
stomach and gave some milk by that artificial channel, the patient re- 
tained it; next gave some malted milk, then beef tea, then beef tea with 
barley and a little brandy, she retained it all and did not vomit nor was 
nauseated. The next day I wanted her to swallow some food, she said 
she w’as afraid, but I induced her to try, she vomited at once; we now 
returned to the tube feeding; food wras again retained, vomiting ceased. 
I said no more of trying to eat, kept on feeding her through the tube for 
several days and waited until she asked to be allowed to discontinue 
that process. She then took her food in the natural way without 
any trouble. 
EXPLORATORY INCISIONS. 
Admitting the justifiability in certain cases, and as a rule they are 
without much danger to the patient, and a great assistance to help to 
make a correct diagnosis, still it is my opinion not to neglect the study 
of all objective and subjective symptoms, and try to make a correct 
diagnosis without au exploratory incision. At any rate, whenever I find 
it advisable or prudent to call into help an exploratory incision, to make 
of an uncertain a positive diagnosis, I do it with the previous distinct 
understanding that jf an operation is indicated and advisable, to per- 
form or complete it at once. 
E. B. MEMORANDUM OF 
Dr. Edward Borck’s 
CONTRIBUTIONS TOWARDS 
Medical and Surgical Literature. 
C$11 else Use of Bromide of Potassium in Malarial Diseases.— The Medical 
Archives. St. Louis, July, 1871. 
Subcutaneous injections of Ergotine in Affections of the Uterus.— 
The Medical Archives. St. Louis, August, 1871. 
Hypodermic Injections.— The Medical Archives. St. Louis, October, 
1871. 
1874 
Staphyloma,—Missouri Clinical Record. September, 1874. 
1875 
On SSronchocele.—67. Louis Medical and Surgical Journal. March, 
187=1. 1 Inquiry.* 
1878 
Fracture of tlie Femur,—St. Louis Medical and Surgical Journal. 
January, 1878, also Deuische Zeit'schrift fuer Chirurgie, Leipzig. 
Review on tlae Treatment of Fracture of the Femur. Three Wood- 
cuts.—St. Louis Medical and Surgical Journal. March, 1878. 
O variotomy I Reported Cases ol.—St. Louis Medical and Surgical 
Journal. April, 1878; July, 1878; and December, 187s. 
1879 
Cyst Flevator : Description of, and Method of Operating. Three Illustra- 
tions.—Cincinnati Obstetric Gazette. February, 1879, also Hlust. Vier- 
teljahrschrift de arztlichen Polytechnick. Bern u. Leipzig. 
Fracture of tlie Femur, Compound Comminuted.—Proceedings of the 
St. Louis Medical Society. May, 31, 1879. 
Compound Comminuted Fracture of the Right Fore-arm.—Pro- 
ceedings of the St. Louis Medical Society. June 28, (879. 
Reflections upon the History and Progress of the Surgical Treat) 
ment of Wounds and Inflammations. (Report on Progress of Surgery.- 
Transactions of the Medical Association of the State of Missouri. June 1879. 
Monograph on Fracture of the Femur, with fourteen handsome 
Illustrations. Second Edition. Published by Rumbold & Co., St. Louis, Mo. 
Price 50 cents. Out of Print. Nearly 2,000 copies were sold. 
1880 
Operations for Harelip.—Proceedings of the St. Louis Med. Society. 
February 21, 1880. 
Ovarian Tumors : At what Stage of the Disease is it the Proper Time to 
Operate?—Cincinnati Obstetric Gazette. March, 1880. 101 Inquiries. 
1871- 
* By the number of Inquiries is understood the letters and postals received by the author, 
from physicians in different parts of the country, asking for reprints, or inquiring 
where the said article could be found or obtained—after it had been published and 
noticed by the Medical Press 11 
Diseases of tile Maxillary Sinus.—Indiana Medical Reporter. 
Evansville, Ind., April, 1880. 3 Inquiries. 
Compound Dislocation Of tlie Wrist.—Reprint from Transac- 
tions of St. Louis Medical Society, 18S0. Four Wood-cuts. 63 Inquiries. 
1881 
Simple Methods to stop Accidental Hemorrhage. With four 
Wood-cuts.—Indiana Med. Reporter. April, 1881. Scientific American 
Supplement, No. 299. Sept. 24, 1881, page 4773. 198 Inquiries. 
1882 
Nathan R. Smith’s Anterior Splint.—Medical News. April 1st, 
1882, 'Vol. XI, No. 13, page 345. 
Surgery in Children.—St. Louis Med. and Sur. Journal. June, 1882. 
Cases from Prof. Porch’s Clinic, at College for Medical Practiton- 
ers: Amputation in Children, Webbed Fingers, Club-foot, Row-legs, Spinal 
Curvature, etc. St. Louis Medical and Surgical Journal. December, 1882. 
1883 
Clinical Lectures : Extracts from. Fracture of Femur and other 
Fractures—St. Louis Med. and Surg. Journal. February, 1883. 
Paralysis in Children, and Paralytic Contractions. Clinical Lecture 
to private class.—Philadelphia Med. and Surg. Reporter. August 25, 1883. 
209 Inquiries. 
Sponge Crafting: Observations on.—St. Louis Weekly Medical Review. 
November 3, 1883. Vol. VIII, No. 18. 96 Inquiries. 
Ovarian Tumors : (Two Lectures) Diagnosis of, and Operation. Part I. 
Cincinnati Obstetric Gazette. September, 1883. 4' 3 Inquiries. 
1884—— 
Congenital Club-foot: Clinical Lecture at College for Medical Prac- 
titioners.—Archives of Pediatrics. February number, 1884. 21 Inquiries. 
On Permanent Wound Dressing.—St. Louis Weekly Medical 
Review. March 22, 1884. Vol. IX, No. 12. 103 Inquiries. 
Foreign Letters—to Archives of Pediatrics, October, 1884; and to 
St. Louis Weekly Medical Review, July 26, August 2, 23 and 30, 1884. 
Also Report to St. Louis Medical Society, of the International Medical 
Congress at Copenhagen, September 13, 1884—same journal. 
Home Again ! A Synopsis of a Tour Abroad. The first part consists of 
the report made, as a delegate to and a member of the 8th International 
Medical Congress, Copenhagen, Denmark. August 1884. to the Medical 
Society, with such additions as may be of interest to the medical profession. 
The second part consists of general sight-seeing, and other information of the 
trip. (Through the kind notices and comments-from the Editors of almost 
every Medical Journal here, and several abroad, the applications for “Home 
Again” were over 1,300 from all parts of the U. S. A., and Canada, and 
over 100 from Europe.) 
1885 * 
Abnormal Positions of the Head.—Clinical Lecture with cases 
to Private Class of Medical Practitioners. Medical and Surgical Reporter. 
Philadelphia, Pa., January 31, 1885. Vol. LII, No. 5. 180 Inquiries. 
Little Things: 1 Wood-cut. Farewell address to Private Class of Medi- 
cal Practitioners. Nezv England Medical Monthly Journal. Oct. D85. 
Remarks on Abdominal Surgery with 50 Cases. Read 
before the Mississippi Valley Medical Society, Evansville. Ind., September, 
1881;. In full in the Medical Record, September 26, 1885. Vol. 28, No. 13. 
whole No. 777. W. Wood & Co.. Publishers, 65 & 58 Lafayette Place. 
N. Y. City. Abstract from same in Journal of the American Medical 
Association, Vol. V, No. 14, October 3, 1885. 65 Randolph St., Chicago, 
Ills. Medical and Surgical Reporter, November 28, 1885. Vol. LIII, 
No. 22, Philadelphia, Pa. 12 
-Extracts of Clinical Eectlires. Exsudative Pleuritus.—Archives 
of Pediatrics, Vol. LI, No. 9, September 15, 1885. John E. Potter & Co., 
Publishers, 617 Samson Street, Philadelphia, Pa. 
Dislocations and Fractures of the Wrist, Simple and Compound. 
With 8 handsome Illustrations.—Leonard's Illustrated Medical Journal, 
Vol. VI, No. 4, October, 1885. Detroit, Mich. 
1886 
Change of Form of the Human Thorax.—A lecture delivered 
before my private class of Medical Practitioners, with 30 illustrations taken 
from life to demonstrate the changes of form the Thorax assumes 'during the 
different stages of Phthisis Pulmonaris, Emphysema, Exsudative Pleuritis, 
Spinal Curvatures. (Pamphlet.) The drawings are now at Marion Sim’s 
Medical College. 
1887 
Ovarian Tumors. Diagnosis and Operation. Second and Revised 
Edition with Six Wood-cuts. (Pamphlet.) 
——1888 
Diseases of and Operation on the Testicles, was published 
in full in the New York Medical Record, May 19th, 1888, Vol. 33, No. 2 ■, 
Page 547; also, in the transactions of the Missouri Medical Association, 1888. 
Cause of Congenital Clllh-Foot, “Argument in favor of the 
Mechanical Theory, based upon Personal Observation” in St Louis 
Weekly Medical Review, Vol. XVIII, No. 24, Dec. 15, 1888. Discussion 
St. Louis Medical Society, January 12, 1889, same journal. 
—1889 
Short Notes on the Surgical Diseases of Children, with 
Illustrations. Presented to the Section on Diseases of Children, at the 
meeting of the American Medical Association, at Newport, R. I., June 25-28, 
1889. Archives of Pediatrics, August, 1889, page 569. Philadelphia 
Medical and Surgical Reporter, August 17th, 1889, Page 172. Journal 
of the American Medical Association, April 19, 1890. 
1890 
Treatment of Hip Diseases, “ 2nd Stage.” Presented to the 
Surgical Section, 10th International Medical Congress, Berlin, Germany. 
Medical and Surgical Reporter of August 23, 1890, Vol. LXIII, No. 8, 
whole No. 1747, page 222. Archives of Pediatrics, October, 1890, Vol. VII, 
No. 82, page 756. London Lancet, Aug. 23, 1890 page 416. 
1893 
Spina Bifida. A paper read bef re the St. Louis Medical Society. Pub- 
lished in the St Louis Rledical Lorthnightly. 
1894 
Keport of 295 Cases of Fiactures and Dislocations. Pub- 
lished in the St Louis Mexlical Mirror. With handsome illustrations. 
October number. Femur. 
November number, Patella. 
1895 
January number, Accidental Hemorrhage. 
February number, Tibia and Fibula. 
March number, Radius and Ulna. 
(Will be continued at short intervals. “No reprints—send for the Journal.”) 
Synopsis of One Hundred Ovariotomies. Medical Mirror, 
September number, with six illustrations. Dr. Edward Borck, 
SURGEON. 
OFFICE A 35T ID HeSIDENCE : 
41 12 N. Grand Ave., Near Kossuth Ave . Fair Ground.” 
ST. LOUIS, MO. 
Thursdays and Fridays from io to 12 a. m. for Ladies exclusively. 
Wednesdays and Saturdays from 1 to 3 p. m. Children’s Clinic.