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1.1. The effect of pelvic operations on the ovaries and their function has been difficult to assess because of markedly divergent findings in a variety of experimental animals. 2.2. Six monkeys, 5 Macacus irus and one Macacus mulatta, were subjected to tubal ligation, salpingectomy, section of tube and uteroovarian ligament, subtotal hysterectomy, and total hysterectomy and were followed by laparotomies, FSH determinations, and, ultimately, autopsy. 3.3. No evidence of impairment of ovarian function was noted as evidenced by derangement of follicular or corpus luteum development, maturation, or regression, nor were there any detectable ovarian stromal changes.

The Goebell-Stoeckel fascia lata strap operation for stress incontinence of urine has been used for 30 years. This is a review of eight cases from our practice using this operation for problems of total urinary incontinence secondary to congenital defects and complications of vaginal surgery. The Goebell-Fragenheim-Stoeckel 1–3 operation was first described in 1917. In the original operation, strips of fascia lata were not used for the strap. In later modifications of the procedure, a strip of fascia lata and a small transverse suprapubic incision were employed. The basic principle of the operation is having a supporting structure beneath the urethrovesicle junction that slightly elevates the urethra in this area upon downward or caudad movement of the bladder. Such movement occurs in all Valsalva maneuvers such as coughing, sneezing, laughing, lifting heavy objects, and many body movements. During these movements, the intravesical pressure is raised. If the intraurethral pressure is lower than the intravesical pressure, at that particular moment, urine in the bladder moves to the lower pressure area in the urethra and drains to the outside. The strap procedure, by supporting the suburethral tissue and the urethral vesical angle, probably increases the intraurethral pressure to a level greater than the intravesical pressure preventing urinary incontinence associated with Valsalva maneuvers but the pressure is not elevated to such a level as to retard urinary drainage during detrusor muscle contraction for voluntary voiding. If the above physiologic explanation is true for stress incontinence, how can the Goebell-Stoeckel strap procedure be explained for total incontinence, particularly secondary to congenital defects such as total bladder exstrophy and epispadias? A physiologic explanation of the success of the strap operation in congenital defects cannot be given. This physiologic explanation remains to be answered. However, the clinical results achieved in these eight cases deserve further study. Consideration of this operation may be warranted in these severe cases of incontinence.

4 rhesus monkeys with both induced and natural endometriosis were given massive and prolonged doses of diethylstilbestrol. 2 of the monkeys died from hemorrhages deriving from hyaline necroses of the uterus in 1 and of the vaginal apex in the other. cyclic bleeding ceased and ovarian function was inhibited in all the animals. Endometrial tissue was found in the pelvic lymph nodes of all animals raising the possibility that the condition may be spread by the lymph. There was no evidence of a recession of the external endometriosis; instead in 2 animals cystic hyperplasia was found in the affected areas. It appears that stilbestrol administration exerts its beneficial effects on the control of endometriosis through inhibition of ovarian function. However no long-term therapeutic value was demonstrated and the possible risks form the associated tissue changes do not seem warranted.

During the last few years the opinion that embolism is a more important factor in the production of postoperative pulmonary complications than has heretofore been suspected has gradually been gaining ground. Since 1920, representatives of several of the largest surgical clinics in America and Europe have accepted this conclusion (Boland,1Farrar,2Cutler and Hunt3). In January, 1922, DeQuervain4of Switzerland stated that following operations upon the stomach, "three fourths of the true postoperative deaths are due to lung complications—emboli, pneumonia and lung gangrene," and that in a good share of the cases of so-called pneumonia, the processes are really embolic in nature. We5arrived at this conclusion in 1919, after having studied all the postoperative pulmonary complications and cases of femoral thrombophlebitis that had occurred in the gynecologic service of the Johns Hopkins Hospital during the preceding thirty years. At that time we expressed the

The present study is based on a series of fourteen cases of primary carcinoma of the fallopian tube. This is, we believe, the largest series that has yet been studied in any one clinic. Five of the patients were in the Johns Hopkins Hospital; the remainder were operated on in neighboring hospitals, all but two by members of our staff, and the operative specimens were brought to this hospital for study. Seven of these cases have already been reported at various times by Hurdon, 1 Vest 2 and Cullen. 3 In order to bring the series down to date and complete it, the entire group has been included and studied in this summary. It is fortunate that we have been able to obtain fairly complete clinical and pathologic data and follow-up records in every case. FREQUENCY Primary carcinoma of the fallopian tube is one of the rarest of gynecologic conditions.

The history of the treatment of pelvic abscess. Vaginal incision and drainage: a description of the operation and the immediate postoperative care. The clinical aspects of pelvic abscess. Deaths in cases of pelvic abscess following vaginal incision and age, and the pathology of the disease. General summary and conclusions. I. THE HISTORY OF THE TREATMENT OF PELVIC ABSCESS The history of the treatment of pelvic abscess carries the student back to the very beginnings of gynecology and surgery. It tells the story of painful surgical operations which were hesitatingly performed at extreme hazard, decades before Morton1introduced general anesthetics or Lister2applied the principles of Pasteur. It takes one back to an age when there were no surgical specialties. Overcoming national prejudice, it links into a common chain the names of men who, during the past century, have laid the foundations of operative

By periodic intermenstrual pain we mean the recurring discomfort which some women feel half-way between their menstrual periods. The peculiar, persisting periodicity of this pain arouses the curiosity of intelligent patients, for, as one woman told us, it is "as regular as clock-work." Many women can foretell to the day the onset of the next menses from the date of this periodic intermenstrual pain. The Germans have called this syndrome mittelschmerz. The cause of this pain has never been determined. At the present time it is variously attributed to uterine contractions, to peristalsis of the tube as it propels the ovum toward the uterus and to ovulation. We are herewith presenting a study of sixty-one cases of this syndrome. After sketching the historical background of the problem, we shall outline the main features of normal ovulation and see whether periodic intermenstrual pain is in any way associated with ovulation. The

The object of this communication is to suggest for consideration a therapeutic measure which I have found helpful in facilitating the removal of large malignant tumors of the kidney. I refer to the use of preoperative high voltage roentgen therapy for the purpose of reducing the size of these enormous neoplasms. Although I feel sure that this adjunct of therapy is being introduced in some clinics, the literature as yet contains no specific report of it. I cannot present a large series of cases, as, fortunately, a big renal tumor is not common. Also the effect that preoperative irradiation has on the chance of ultimate cure cannot be reported as this can be determined only with the passing of years. I shall, however, show the direct effect that irradiation has on the cytology and gross characteristics of these tumors and call attention to the immediate benefit of this treatment in