Battey Blood is removed with facility by the finger, if clotted, and drainage of other fluids is adequately effected by turning the patient upon the back. In one case, where I cut through a hæmatocele to reach the ovaries, I broke up the clot with my finger, and sponged out the cavity with a soft sponge. Yandell What instruments do you employ?

Battey-My instruments are few and simple. I have none at all which are made for this operation. Those I use are, first, the old Sim's speculum before mentioned (I could not operate well with the usual form now employed in gynecology, but have operated several times with Storer's speculum by reversing the blade); second, a stout volsella; third, a pair of slender rat-tooth forceps; fourth, a pair of long scissors; fifth, a pair of old-style bullet-forceps. The operation would be facilitated by suitable instruments, which I have in mind, and hope ere long to have in hand for use.

Yandell-I observe that you use curved scissors to make the incision in the vaginal wall. Would not straight scissors be better?

Battey--I should prefer them straight in the blade, but bent at an angle upon the flat, just back of the joint.

Yandell-How many assistants are required?

Battey I have operated with three; four are better, and five shorten the time somewhat.

Yandell-How long are you generally in performing the operation?

Battey-Usually an hour. I do not hurry.

Yandell-Do you use ether or chloroform, and have you seen ill effects from either?

Battey-I use only ether, as a rule. Sometimes I employ a little chloroform at the start to overcome the smothering sensation often caused by ether. I have seen no ill effects from either. Yandell-How many times have you operated altogether, and with what results?

Battey-Ten times, with eight recoveries and two deaths. Yandell-What was the cause of death in the two fatal

cases?

Battey-In the first fatal case the patient had progressed

most favorably to the ninth day, when she was suddenly seized with agonizing abdominal pain immediately upon raising herself up in bed; the pulse ran rapidly up from ninety to one hundred and fifty, and the patient died in twenty-four hours. Autopsy showed a small pelvic abscess, which had contained an ounce of very acrid pus, which had escaped into the peritoneal cavity, where it could find no outlet, the drainage from below having been closed by adhesions. The second death occurred in Louisville, and in the last case I operated on. The patient. had for years complained of pain about the heart, and had a very irregular pulse, often running from sixty to one hundred beats in the minute. The cardiac sounds were found by myself and others to be quite normal, and the heart-troubles were believed to be merely functional and sympathetic. She bore the operation well, and it was done with greater ease and facility than in any previous case. On the second day there was a sharp attack of pelvic peritonitis, which extended somewhat to the abdominal peritoneum. On the third day the peritonitis seemed to be subsiding, and the pulse and temperature came down very much. Toward noon the heart showed evident signs of giving way; soon the pulse disappeared at the wrist, while the respiration remained good, the voice strong, and the mind cheerful. A comatose condition came on rapidly in the afternoon, and death occurred on the third day, the action of the heart being extremely feeble, while no pulsation was to be felt in the axillary and femoral arteries for four or five hours before death. Unfortunately an autopsy was peremptorily refused. Yandell If any of your other cases have had alarming symptoms, state what they were.

Battey-Of the other eight operations, my first had septicamia of a threatening character, which rapidly subsided under the peritoneal douche; the fourth had pelvic peritonitis and purulent discharges for a time; and the ninth had pelvic peritonitis and pelvic abscess, which discharged through the vaginal opening. In five there was no outward symptom; in three the pulse went at no time over one hundred, and in one it did not at any time exceed ninety.

Yandell-Have the ovaries removed been healthy or diseased?

Battey-In my first case the ovaries were supposed at the time of removal to be healthy, and I am still of this opinion; but they were not carefully examined, as one of my assistants, to whom they were entrusted, negligently allowed them to remain in a piece of cloth for two or three days of very hot August weather, when they were so very far decomposed as to render any examination very unsatisfactory. In all the other operations the ovaries removed showed unmistakable disease. In the ten operations I have removed eight cystic ovaries, the cysts varying in size from that of an orange down to that of a cherry. The ovaries removed from two cases here are being subjected to microscopic examination. The report I have not yet received.

Yandell-Is your term "normal ovariotomy normal ovariotomy" a correct one?

Battey-No; I abandoned RATme time ago, but have

as yet

Yandell-For what conditions, in general/terms, have you done these operations, and what have been the results?

Battey-I have operated in widely different circumstances. In one case the patient had amenorrhoea, convulsions, recurring hæmatocele, repeated pelvic abscesses, incipient tuberculosis from pulmonary congestions, etc. Several of the cases passed under the head of ovarian neuralgia; several had intractable dysmenorrhoea with pelvic deposits of old lymph; one had ovarian insanity, etc. All had exhausted the available resources of the art to no useful purpose. I operate on no case that any other respectable medical man proposes to cure. In most of my cases the full results of the menopause have not yet been developed. This is the work of many months, and sometimes two or three years are necessary to its full and perfect realization. In no case has the patient failed to realize such a degree of relief and benefit following the operation as to amply compensate her for all the pains and dangers incident thereto, to say nothing of the promise of full and ample recovery at the completion of the physiological "change." In two of my cases this change has seemed to occur at once in all its completeness; but it is always my expectation that it will occur gradually, and extending through two or even three years to its

final completion. In my first case (now three years ago) the restoration to health is eminently satisfactory. It is true that she is not absolutely and perfectly well, but she is fully relieved of the convulsions, the violent periodical congestions, the hæmatoceles, the pelvic abscesses, etc., for which I operated. I submit to you the question in all sincerity, if I confine myself to cases where life is endangered, or where health and happiness are destroyed-cases which are utterly hopeless of other remedy this side the grave-ought the Profession to demand at my hands the restoration of these forlorn invalids to a state of complete and absolute health in every particular? It is usual for the patients to take on fat freely in a few months after the operation. For the results and prospects of my cases in Louisville, I prefer to refer you to your own observation and the patients themselves.

Yandell-In three of the operations I saw you do, there was plainly cystic degeneration of the ovaries. Had these cysts not been removed, would they, in your opinion, have developed into ovarian tumors, and ultimately have required removal through the abdominal wall?

Battey-Yes, I think so. In two cases I have had the opportunity to watch for some months the progressive enlargement of the cysts. In one case I removed a cystic ovary, and had the opportunity of examining the other ovary, which was entirely healthy. In twelve months this also became cystic, and is now as large as a small egg, and will soon require removal.

Yandell-Do you think it good practice to subject a patient to the hazards of the operation, and remove but a single ovary, though the other may appear to be healthy?

Battey-I do not now so think. It is true that I have in three instances removed but one ovary; in two of the cases the other ovary required subsequent removal, and in the third case there is now strong reason to apprehend that a second operation may be required. The conditions for which I operate are so grave that I should not esteem the leaving of one ovary advantageous, though it appear to be quite healthy. Besides, our means of diagnosis in these cases are so imperfect, and the

maladies so intractable, that, in order as far as may be to insure the cure, I desire to avail myself of the great alterative changes which attend upon the menopause.

McClellan-What has been the effect of the operation upon the menstrual function?

Battey-I have seen nothing like proper menstruation after the operation. I do not care at present to discuss this branch of the subject, as I propose to consider it fully at a future time. McClellan-What has been the effect, if any, upon the sexual

desire?

Battey-In my married cases, without exception, it has remained wholly unimpaired. In one unmarried lady I am assured that she is "conscious of no change in her feelings in any respect" since the operation.

McClellan-Have you observed the occurrence of any symptoms indicating that any subject of this operation had been unsexed by its performance?

Battey-None whatever. In my cases thus far I am of opinion that the patients upon whom I have operated have, without exception, lost nothing whatever by the operation. The married women were all hopelessly barren; and the single were presumably barren, because married women in similar circumstances, and with similar organic and functional lesions, are incontestably barren. There is no loss whatever aside from barrenness.

McClellan-Dr. Matthews Duncan, in his address before the obstetric section of the British Medical Association, refers to this operation "as having been justified by the belief that the removal of the ovaries is the annihilation of all or some of the sexual activities," and applies to it the term "spaying." Have you published any statements that would justify such representation, or does it arise from a misconception of the objects. for which the operation is proposed?

Battey-Dr. Duncan seems to greatly misconceive both my objects and my results. This is not peculiar, however, to Dr. Duncan; for, I regret to say, I find very few medical writers or medical men who do fully and rightly apprehend me. I hope that the observation of my work and its results by others