menorrhoea complicated by the presence of a pedunculated fibroid simulating an ovarian tumor, and in which he removed the ovaries in an unmarried woman aged 30. The results were very satisfactory, and the case was discussed as follows: Dr. Macon did not think that the process of diagnosticating ovarian dysmenorrhoea by the exclusion of uterinė trouble should always be followed. Very little was known about dysmenorrhoea, and there were often cases in which the physical examination showed nothing.

Dr. Smyly thought that the pathological condition causing the dysmenorrhoea should always be looked for and treated, just as when treating a cough, the cause and not the symptom should be treated. Nothing was more difficult than to diagnosticate the conditions of the ovary which produce dysmen

orrhoea.

Dr. A. Smith believed that an ovary could cause dysmenorrhoea. He had shown one to the academy, which was a good example of a retention cyst. He had removed the ovary and the pain ceased.

Dr. More Madden had frequently seen great dysmenorrhoea caused by very slight abnormal conditions of the ovaries. He thought Atthill's case purely one of ovarian dysmenorrhoea.

Dr. Purefoy thought that ovarian dysmenorrhoea was difficult to treat. In his opinion the pain is not always in exact proportion to the pathological condition of the ovaries. Many have ovaries showing considerable pathological change in cases in which the patient has not complained of much pain.

Gardner22 of Baltimore examined 112 cases of dysmenorrhoea, and called attention to the great percentage of sterility among such cases. Of the 112, 44 or a little less than 40% were sterile. Of those who had been pregnant, 12 or over 10% had never had a child at full term; 15 more, or 13%, had had a miscarriage since the last full term child was born, leaving less than 37% of the total number whose last pregnancy had come to full term. Among the most prominent lesions that interfered with conception was enlarged ovaries in four cases, and prolapsed ovaries in two cases.

Parsons23 very much doubts the ovarian origin of dysmenorrhoea, to which the formation and growth of an ovarian cyst did not give rise. He states that there is no scientific proof that the ovary per se ever causes dysmenorrhoea.

Dr. Stratz of Stuttgart, in 1886, called attention to the fact that diseases of the ovaries and of the fallopian tubes might occasion dysmenorrhoea.

Reed in his text book, page 728 says dysmenorrhoea from oophoritis is wholly denied by some who say that the pain is merely referred to the ovary by the sufferer, when in fact it originates elsewhere. Nevertheless there are very competent observers who have blamed certain severe cases of dysmenorrhoea on the ovary by a process of exclusion. Dysmenorrhoea is sometimes found to be associated with large, painful, easily palpated ovaries so irritable that pressure upon them causes pain and nausea.

The study of chronic alcoholism in the female is sometimes confirmatory of the doctrine that inflammation of the ovaries may produce dysmenorrhoea, for dysmenorrhoea is often set up in heavy drinkers as a new symptom about the time the ovaries become large and tender.

The anatomy of the nerve supply of the ovaries has not received the attention it perhaps has deserved. Most textbooks pass over the subject by stating the ovarian plexus passes down with the ovarian vessels to supply the ovary, but do not state definitely how much if any more area is supplied by these fibres.*

It would be interesting to know if more than the ovaries were supplied by these nerve fibres, and if it was found to be true that they did so, the field of usefulness of the operation about to be described would be vastly widened. The operation itself consists of the usual preparations for laparotomy. The uterus is held forward, also the ovary on the side which is being operated. The peritoneum covering the ovarian vessels, viz.: the infundibulo pelvic ligament is slit parallel to the vessels and the areolar tissue

*Since writing this paper the writer has been informed that the ovarian nerve plexus supplies part of the tube, probably the outer half.

stripped from the under surface of the surface of the peritoneum, so as to include if possible any nerve fibres that may be present in this space which is situated between the two layers of the fold of the peritoneum above mentioned.

After this is done a ligature is applied at the brim of the pelvis to the ovarian vessels. It also includes the loose tissues which has been stripped from the extra peritoneal surface of the peritoneum. After ligation is completed at this point, the same process is

It was the writer's privilege to have under more or less constant observation the following case for a period of about six years, during all of which time the patient was praetically totally incapacitated for work.

Miss A., age 33. Menstruated first in the 15th year some pain with each period until she was 21, when she fell down stairs and injured the lower part of her spine, from which she still has some pain. Between the 21st and 27th year she would be incapacitated for a day or two at each menstrual

The most frequent or common type is the dorsal. The palmar dislocation is of rare occurrence. Dislocation of the index finger at the metacarpophalangeal joint, laterally has been observed. With the more frequent publication of these conditions, this dislocation is probably not so rare as formerly supposed. Anatomically, we are confronted with the nature of the ligament forming the Anterior segment of the joint Capsule. This consists of a fibrocartilaginous plate loosely attached to the proximal bone, but firmly

blended with the base of the distal one. Doubtless the purpose of this is to prevent dislocation. At the same time, however, in the event of dislocation, it interferes with its reduction. The cartilaginous plate is apt to be actually drawn over the head of the proximal bone; interposing itself between the displaced bones-the dorsal segment of the capsule offering little obstacle to displace

ment. These statistical and anatomical observations are presented as preliminary to a description of a case of dislocation of the metacarpo-phalangeal joint of the left index finger. The patient, Miss Z, aged 20, 5 feet 10 inches in height, weight 143 pounds, was employed in one of our large mercantile establishments as a clerk. While standing upon a stool four feet in length, and reaching forward to arrange some decorations, she lost her balance and fell upon an inlaid cement floor. Unable to grasp anything to prevent

*Read at 53d Annual Meeting, Chicago, May 30, 1903

her falling, she swung her left hand backwards, the fingers of which were in a state of extension, and fell, with much force. The only point of contact, from which injury resulted, was the index finger of the left hand. Seeing her shortly after the accident, there was noted a palmar dislocation, upward, inward and backwards of the head of the bone at the metacarpo-phalangeal joint. Immediate efforts at reduction, without anaesthesia, were made. These all failed, the head of the bone remaining unmovable. Profound chloroform narcosis was then produced. Active efforts at reduction were then instituted. These consisted of forcible extension, rotation and flexion with manual pressure upon the head of the bone. These all signally failed. Fearing the failure to effect the reduction might be due to a lack of skill on my part, Prof. John E. Owens, my old professor in joint surgery was summoned. After repeated and vigorous efforts by Prof. Owens, as well as myself the dislocation still remained. The patient was now allowed to come out from under the chloroform. When sufficiently conscious, she was taken to a near by "X" ray laboratory, and the hand exposed. I herewith present for your inspection the original "X" ray plate: also the finished photograph. By comparison with the uninjured metacarpo-phalangeal joint articulations, the extent of the dislocation is readily appreciated. These findings at once demonstrated the futility of further manual efforts at reduction. An operation was decided upon as the only means of securing normal approximation of the joint surfaces. The anesthetic used was chloroform, which Prof. Owens kindly administered. After the hand and forearm had been surgically prepared, an Esmarch bandage was applied at the elbow joints. I then operated in the following manner. An incision was made through the integuments and muscular fibres down to the head of the bone. The transverse anterior and lateral ligaments were exposed. Efforts at reduction were made, but accomplished nothing. A deeper dissection through. the transverse and anterior ligaments revealed the difficulty. The lateral ligament was found twisted over and around the head