VOLUME

C. R. AGNEW, M.D., of New York.
JOHN ASHHURST, M.D., of Philadelphia.
ROBERT H. BABCOCK, M.D., of Chicago.

P. H. BAILHACHE, M.D., U. S. Marine-Hospital
Service.

J. F. BALDWIN, M.D., of Columbus, Ohio.
ROBERTS BARTHOLOW, M.D., of Philadelphia.
JOHN H. BEMISS, M.D., of New Orleans.
HORATIO J. BIGELOW, M.D., of Washington, D. C.
JOHN S. BILLINGS, M.D., U. S. Army.

J. H. BRADSHAW, M.D., of Orange, N. J.
THOMAS BRYANT, F.R.C.S., of London, England.
W. T. BULL, M.D., of New York.
CHARLES H. BURNETT, M.D., of Philadelphia.
WM. A. BYRD, M.D., of Quincy, Ill.

W. H. CARMALT, M.D., of New Haven, Conn.
CHARLES H. Castle, M.D., of Cincinnati.
JOHN CHIENE, M.D., of Edinburgh, Scotland.
C. F. CLARK, M.D., of Columbus, Ohio.
D. C. Cocks, M.D., of New York.
J. SOLIS-COHEN, M.D., of Philadelphia.
SOLOMON SOLIS-COHEN, M.D., of Philadelphia.
T. D. CROTHERS, M.D., of Hartford, Conn.
WM. C. DABNEY, M.D., of Charlottesville, Va.
J. M. DA COSTA, M.D., of Philadelphia.
JOHN C. DALTON, M.D., of New York.
N. P. DANDRIDGE, M.D., of Cincinnati.
LOUIS A. DUHRING, M.D., of Philadelphia.
PROF. DUJARDIN-BEAUMETZ, of Paris, France.
CHARLES W. DULLES, M.D., of Philadelphia.
GEORGE J. ENGELMANN, M.D., of St. Louis.
W. L. ESTES, M.D., of South Bethlehem, Pa.
G. GRANVILLE FAUGHT, M.D., of Philadelphia.
JOHN FERGUSON, L. R. C. P. Edin., of Toronto,
Canada.

HENRY M. FISHER, M.D., of Philadelphia.
PROF. E. VON FLEISCHL, of Vienna, Austria.

AUSTIN FLINT, M.D., of New York.

W. H. FORD, M.D., of Philadelphia.

L. WEBSTER Fox, M.D, of Philadelphia.
JAMES M. FRENCH, M.D., of Cincinnati.
A. FRIEDENWALD, M.D., of Baltimore, Md.
L. L. FRIEDRICH, M.D., of Washington, D. C.
CHARLES M. GANDY, M.D., U. S. Army.
W. W. GANNETT, M.D., of Boston, Mass.
T. E. GARRETSON, M. D., of Philadelphia.
GEORGE W. GAY, M. D., of Boston, Mass.
MARIS GIBSON, M.D, of Wilkes Barre, Pa.
A. C. GIRARD, M.D., U. S. Army.
A. H. GOELET, M D., of New York.
WILLIAM GOODELL, M.D., of Philadelphia.
D. H. GOODWILLIE, M.D., of New York.
EDWARD H. GREEN, M.D., U. S. Navy.
SAMUEL W. GROSS, M. D., of Philadelphia.
ALLAN MCLANE HAMILTON, M.D., of New York.
GEORGE C. HARLAN, M.D., of Philadelphia.
HENRY HARTSHORNE, M. D., of Philadelphia.
ELWOOD B. HAWORTH, M.D., of Philadelphia.
I. MINIS HAYS, M.D., of Philadelphia.
P. L. HILSMAN, M.D., of Albany, Ga.
GEORGE S. HULL, M.D., of Chambersburg, Pa.
EZRA M. HUNT, M.D., of Trenton, N. J.
W. W. JAGGARD, M.D., of Chicago, Ill.
W. W. KEEN, M.D., of Philadelphia.
HOWARD A. KELLY, M D., of Philadelphia.
J. G. KERR, M.D., of Canton, China.
LOUIS KOLIPINSKI, M.D., of Washington, D. C.
GEORGE M. LEFFERTS, M.D., of New York.
R. J. LEVIS, M.D., of Philadelphia.
LOUIS LEWIS, M.D., of Philadelphia.
WALTER LINDLEY, M.D., of Los Angelos, Cal.
WILLIAM S. LITTLE, M.D., of Philadelphia.
J. HENDRIE LLOYD, M.D., of Philadelphia.
ALEXANDER W. MACCOY, M.D., of Philadelphia.
JOHN N. MACKENZIE, M.D., of Baltimore, Md.
THEODORE A. McGRAW, M.D., of Detroit.
RICHARD MCSHERRY, M.D., of Baltimore, Md.
ALEXANDER MARCY, M.D., of Riverton, N. J.

CLAUDIUS H. MASTIN, M.D., of Mobile, Ala.
J. EWING MEARS, M.D., of Philadelphia.
ARTHUR V. MEIGS, M.D., of Philadelphia.
WM. H. MERCUR, M.D., of Philadelphia.
J. EDWIN MICHAEL, M.D., of Baltimore, Md.
T. WESLEY MILLS, M.D., of Montreal, Canada.
ANGEL MONEY, M.D., of London, England.
RUSSELL MURDOCH, M.D., of Baltimore, Md.
T. D. MYERS, M.D., of Philadelphia.
RICHARD COLE NEWTON, M D., U. S. Army.
W. K. NEWTON, M.D., of Paterson, N. J.
CHARLES A. OLIVER, M.D., of Philadelphia.
THOMAS OPIE, M.D., of Baltimore, Md.
WILLIAM OSLER, M.D., of Philadelphia.
JOHN H. PACKARD, M.D., of Philadelphia.
ROSWELL PARK, M.D., of Buffalo, N. Y.
THEOPHILUS PARVIN, M.D., of Philadelphia.
BERNARD PERSH, M.D., U. S. Army.
WILLIAM PIERSON, M.D., of Newark, N. J.
JOSEPH G. PRICE, M.D., of Philadelphia.
S. J. RADCLIFFE, M.D., of Washington, D. C.
B. ALEXANDER RANDALL, M.D., of Philadelphia.
T. D. REED, M.D., of Montreal, Canada.
J. C. REEVE, M.D., of Dayton, Ohio.
JOSEPH G. RICHARDSON, M.D, of Philadelphia.
T. G. RICHARDSON, of New Orleans.

A. SYDNEY ROBERTS, M.D., of Philadelphia.
JOHN B. ROBERTS, M.D., of Philadelphia.
ROBERT P. ROBINS, M.D., of Philadelphia.

W. S. W. RUSCHENBERGER, M.D., U. S. N.
CHARLES E. SAJOUS, M.D., of Philadelphia.
LEWIS A. SAYRE, M.D., of New York.
EDWARD O. SHAKESPEARE, M D., of Philadelphia.
FRANCIS J. SHEPHERD, M.D., of Montreal, Canada.
HARRY M. SHERMAN, M.D., of Cold Spring on
Hudson, N. Y.

MANNING SIMONS, M.D., of Charleston, S. C.
ALEXANDER J. C. SKENE, M.D., of Brooklyn, N. Y.
J. LEWIS SMITH, M.D., of New York.
THOMAS C. STELLWAGEN, M.D., of Philadelphia.
LEWIS A. STIMSON, M.D., of New York.

I. S. STONE, M.D., of Lincoln, Va.

GEORGE M. STERNBERG, M.D., U. S. Army.

R. S. SUTTON, M.D., of Pittsburg, Pa.
LAWSON TAIT, F.R.C.S., of Birmingham, England.
RUDOLPH TAUSZKY, M.D., of New York.
T. GAILLARD THOMAS, M.D., of New York.
WILLIAM THOMSON, M.D., of Philadelphia.
L MCLANE TIFFANY, M.D., of Baltimore, Md.
JAMES TYSON, M.D., of Philadelphia.

ELY VAN DE WARKER, M D., of Syracuse, N. Y.
ARTHUR VAN HARLINGEN, M.D., of Philadelphia.
ROBERT F. WEIR, M.D., of New York.

J. T. WHITTAKER. M. D., of Cincinnati, Ohio.
CHARLES MEIGS WILSON, M.D., of Philadelphia.
JAMES C. WILSON, M.D., of Philadelphia.
RANDOLPH WINSLOW, M.D., of Baltimore.
HORATIO C. WOOD, M.D., of Philadelphia.

AMERICAN DErmatological Association.
AMERICAN GYNECOLOGICAL SOCIETY.

AMERICAN OPHTHALMOLOGICAL SOCIETY.

AMERICAN OTOLOGICAL SOCIETY.

BRITISH ASSOCIATION FOR THE ADVANCEMENT OF SCIENCE.

CANADA MEDICAL ASSOCIATION.

CHICAGO GYNECOLOGICAL SOCIETY.

CHICAGO MEDICAL SOCIETY.

CINCINNATI ACADEMY OF MEDICINE.

CINCINNATI ACADEMY OF SURGERY.
CINCINNATI HOSPITAL.

COLLEGE OF PHYSICIANS OF PHILADELPHIA.
COLORADO STATE MEDICAL SOCIETY.
INDIANA STATE MEDICAL SOCIETY.
INTERNATIONAL MEDICAL Congress.

. JEFFERSON MEDICAL COLLEGE HOSPITAL.

MEDICAL ASSOCIATION OF THE COUNTY OF NEW
YORK.

MEDICO-CHIRURGICAL COLLEGE CLINIC, PHILADA.
MEDICO CHIRURGICAL SOCIETY OF MONTREAL.

MEMORIAL HOSPITAL, ORANGE, N. J.

MICHIGAN STATE MEDICAL SOCIETY.

MINNESOTA STATE MEDICAL SOCIETY.

NATIONAL CONFERENCE OF THE STATE BOARDS OF HEALTH.

NEW HAMPSHIRE MEDICAL SOCIETY.

NEW YORK ACADEMY OF MEDICINE.

NEW YORK COUNTY MEDICAL ASSOCIATION.

NEW YORK STATE MEDICAL ASSOCIATION.
NEW YORK SURGICAL SOCIETY.

OBSTETRICAL SOCIETY OF PHILADELPHIA.
PHILADELPHIA ACADEMY OF SURGERY.
PHILADELPHIA COUNTY MEDICAL SOCIETY.

PHILADELPHIA NEUROLOGICAL SOCIETY.

PHILADELPHIA PATHOLOGICAL SOCIETY.

RHODE ISLANd Medical Society.

ROYAL LONDON OPHTHALMIC HOSPITAL.

ST. MICHAEL'S HOSPITAL, NEWARK, N. J.

TERRACE BANK HOSPITAL FOR WOMEN, PITTSBURG.

VIRGINIA STATE MEDICAL SOCIETY.

WISCONSIN STATE MEDICAL SOCIETY.

VOL. XLV.

ORIGINAL LECTURES.

FREQUENT MISCARRIAGE;

ITS PATHOLOGY AND TREATMENT.

A Clinical Lecture delivered at the Long Island College Hospital, BY A. J. C. SKENE, M.D.,

PROFESSOR OF GYNECOLOGY AND VISITING PHYSICIAN TO THE HOSPITAL.

(Reported by Edward Develin, M.D.)

GENTLEMEN: To-day I intend to call your attention to the subject of frequent miscarriage; its pathology and treatment, illustrating my remarks upon this most important branch with such cases as have presented themselves here to-day for treatment.

Case I.—The patient now before you is thirty-five years of age, and has been married nineteen years. She has had no children, but has had ten miscarriages, the last one occurring a year and a half ago. Menstruation is now irregular. Our duty is to ascertain the cause of these frequent miscarriages; and in this case I have every reason to believe that it is due to the general condition of the patient. I find nothing abnormal about the vaginal portion of the uterus or the vagina itself; neither does the body of the uterus appear to be diseased or deformed.

Whenever we see this disposition to miscarry, not due to malpractice by the patient or an abortionist, I mean when they arise from natural causes, we are always sure of one thing, and that is: that there is some disease of the uterus or some specific constitutional disease. In such cases I am always suspicious of syphilis. Frequent miscarrying points strongly to constitutional disease, and that is the reason why I have just asked the patient a few questions in order that I may ascertain if she has had any evidences of syphilis. I rather think she has; I had an opportunity of seeing her before I presented her to you, and her skin looks somewhat like that of one who might be syphilitic; at all events, it lies between this constitutional condition and disease of the uterus, and as the uterus is all right we may exclude that cause.

We read about the habit of miscarrying, and in this case we have had ten miscarriages, which suggests that it has become a habit; but I hardly believe the habit is so easily established as the literature upon this subject would lead us to believe. I think in the cases which habitually occur there is some disease of the uterus, such as laceration of the cervix, bilateral and high up. In these cases pregnancy seldom occurs, and when it does a miscarriage is the result usually.

Now from the history of this case we learn that she has no marked disease of the uterus. Having menstruated irregularly, she may have some corporeal endometritis; it cannot be marked, however, or she would not have become pregnant. I am, therefore, the more inclined to think that the difficulty is syphilitic. If this be our suspicion, and the evidence given by the pa

No. I.

tient is not sufficient for a diagnosis, our inquiries are then directed to the husband, and the chances are that you would be likely to find the cause in him.

Now these cases respond very well to the anti-syphilitic treatment, and in time a living child may be borne. It is a curious fact that this disease is self-limited to a great extent, at least, in transmission; and hence in time these miscarriages are stopped and a family is raised. In relation to this matter, one of the most important observations was made by Dr. Reade, and set forth in a paper which he read before the Kings County Medical Society. It was an elaborate paper showing that the longer the time that elapsed from the contraction of the disease until the fecundation of the ovum, the less chance was there of the transmission of this syphilitic taint. In those who have the misfortune to conceive soon after an attack of syphilis, the ovum dies in utero; at the next conception the ovum may perhaps be carried a little longer, and so on until finally a child is born showing little of the syphilitic affection. Dr. Reade also stated that the greater the lapse of time after the birth of the child, until the external manifestations of the disease, the more readily did it respond to treatment. These are important points to bear in mind.

In this case I shall take it for granted that there is some specific difficulty, and shall therefore direct her to be placed upon alterative treatment.

Now let me suppose a case: A lady has had a number of miscarriages and has been treated by her family physician, and he has failed to carry her along to the end of gestation. After a time she begins to lose faith in his treatment, and calls in some eminent physician, and he fails also; finally a third medical man is called in, and he understanding the case, as in like manner did the previous gentlemen, continues the anti-syphilitic treatment and she finally has a living child. Now this gives the last doctor a reputation at once, and yet he did not make it altogether by his skill as a physician, but simply because the transmission of the specific taint was nearing its close; and hence she was becoming more competent to carry the child the full time. Such a case came under my observation about ten years ago, and I attended the lady during her confinement, and at once placed the child upon specific treatment. I believe the child is living to this present day. The result of this was that I have since had several such cases, but sometimes I fail, just as these other gentlemen did, in recent cases. You can thus see how important it is to bear in mind these points, and by this means hold out hopes to your patient of her ultimately raising a family.

Case II.-This patient is thirty-five years of age; has been married ten years; has had three children and three miscarriages; one miscarriage occurring at three months, one at four months, and one about seven months. I supposed that these miscarriages resulted from laceration of the cervix uteri, as they are very prone to occur from that cause, but I am now informed that since her miscarriages she has borne a living child, therefore the miscarriages must be due to some other cause.