more easily palpated. In both of these growths fluctuation could be demonstrated, and this condition, with their mobility and the easily elicited fluctuation through the pelvis, led to the preoperative diagnosis of ovarian cysts. Even after examination. under ether, no reasons were found for questioning the diagnosis.

Showing shaft of left humerus fractured at the surgical neck. A B C emphasizes the broken end. D F and F G emphasize the outer and inner margins of the upper fragment. The latter is tilted outward, while the shaft is tilted inward so that the angle between the two fragments is well defin d. The broken end of the shaft lies in front of the head of the bone and firm union had taken place in this position. The epiphysis is well shown, although the line of demarcation is obscured by the callus. The broken end of the shaft shows clearly, but the broken end of the upper fragment is ill-defined, nor could repeated attempts show it any clearer. The bones had become firmly united in this position and callus had filled in so completely that the apparent line of fracture of upper fragment was markedly oblique and on the outer side appeared to terminate at D and on the inner side at G. This was apparent only, due to the callus.

Upon opening the abdomen sufficiently to admit an examining finger, everything in the lower abdomen was found adherent, with the pelvis full. Above the masses of adhesion were the two before-mentioned tumor-like growths, the one on the right side being the ovary, much enlarged by a multiple cystic growth and comparatively free from the underlying adhesions which embraced the right tube. In an attempt to break up these adhesions a hematoma was opened, from which exuded a dark fluid with a quantity of shredded tissue, which was easily demonstrated as broken-down blood clots. This led to an immediate revision of diagnosis, and the operator then said the case would probably prove one of extra-uterine pregnancy. Investigation of the left side showed a very unusual and remarkable, and in some ways strikingly typical state of affairs. The superficial tumor, which had been seen and palpated through the abdominal wall, proved to be the right tube in which impregnation had occurred and which had never ruptured. The implantation of the impregnated ovary had taken place so near the free end of the tube that when the tube had become distended almost to the limit of bursting, it had relieved itself by a hemorrhage from the open end of the tube. This had occurred rapidly, but with so little

disturbance at any individual time that no crisis had been developed, yet the accumulated free blood, which had gravitated to the pelvis, had become considerable, since probably two quarts of old blood clots were removed in the course of the operation. The particularly interesting phases of this case, are, first, the mistaken diagnosis, and then the complete demonstration to the eye of a condition which is, undoubtedly, quite common, but almost never seen in the stage of development as shown in this case. There is no doubt that in the history of the case the confessed attempt at a procured abortion had been misleading.

The operation consisted in the removal of both tubes and ovaries, as well as the appendix, the latter having been drawn into the adhesions. This case made an interrupted recovery.

The second case was that of a woman, 32 years old, who had had one child 10 years before. She had a hard time of it, was badly torn and repaired at the time. One and a half years after the child was born, and one year subsequent to that, she underwent two procured abortions, and was curetted after the

Fractured arm.

Plate IV.

first one. Ever since then the left ovary has been very sensitive for five or six days following menstruation. Menses were regular, lasting five days, and usually uncomfortable only on the first day. The left side, however, has been very tender, especially soto external touch, and she was obliged to give up all active. duties. She became very low-spirited and depressed, and held herself aloof from companionship, which was very contrary to her nature. There was no leucorrhoea, except, during acute attacks, a watery discharge was noticeable on arising in the morning. Urination was very frequent and she was up at least once every night. Examination discovered a large fluctuating growth on the right side. The left side was so tender that nothing could be made out by palpation, and a diagnosis was made of cystomata ovarii, double; appendicitis, intercurrent.

At the operation, upon opening the abdomen in the midline, an ovarian cyst of the right side was easily demonstrable. This was tapped and fluid was drawn off to reduce its size so that

it could be brought through a comparatively small opening. The left side showed a very much enlarged and somewhat bound-down cystic ovary which, together with the tube, was so far damaged that it was decided to remove both tubes and ovaries on both sides, which was accordingly done.

This patient made an uninterrupted and satisfactory recovery.

The case was interesting as showing the earlier stages of what would have undoubtedly become a large ovarian cyst if left to itself, and as typical of a class of cases which cannot be adequately treated except by operation, and which, if taken at a proper time of election, prove very simple.

The third case was that of a woman, 45 years old, who had two children, then a miscarriage 13 years ago followed by another child, which was delivered very rapidly and forcibly, resulting in extensive lacerations. Five or six years ago she began to wear a support to keep up the parts beginning to protrude from the vagina, but with not much satisfaction. Up to

Shows the bone one month after operation. Although the arm and shoulder were immobilized all this time, something-perhaps the development of callus-has turned the free end of the wire downward through an arc of about 35 degrees. Functional and surgical result perfect.