the prominent symptoms of the exudative dia- child with an idiosyncracy to egg, manifested thesis, namely asthma, then we may find a con- by urticaria and eczema, had a typical attack of dition closely related to the so-called thymic bronchial asthma. Attempts to immunize her asthma just brought to your attention. Second brought on oedema with the third milligram is the prominent group with eczema predominat- dose of egg albumen. Another older boy had par- ing, and third the group with asthma. It may tial relief from his asthma when beef, to which not be necessary that the connecting link be- he reacted, was withdrawn from his diet. The tween these be a demonstrable pathological lesion most striking case was a child of a year of age. of the lymphatic tissue. There may be a bio- At nine months she had had a good deal of chemical relation. Pfaundler stated several mucus in her movements so at this time she years ago that the diet had a marked effect on may have become sensitized. About every three causing these conditions, while digestive distur- weeks she would have an unaccountable attack bances are common. To quote him, "Is it not of mucous colitis and either asthmatic bronchi- possible that under certain conditions (an un- tis or asthma. It took several attacks before we favorable predisposition as to the function of realized the attacks were true asthma and not intestinal and cellular digestion) foodstuffs di- primarily recurrent infections of the bronchial gested into the gastro-intestinal tract might act mucous membranes. Attempts at regulation of. in the body like an antigen; if this should be the diet were unavailing, for apparently what the case, then it would be quite natural to as- agreed with her at one time did not at another. sume that the lymphatic diathesis represents a Finally, by testing the skin with all foods she kind of food allergia (food anaphylaxis)." was taking that contained proteid, it was found Schloss in 1912 showed that egg poisoning in that her troubles were due to beef juice. After children is a form of anaphylaxis. It is well withdrawal of this she had practically no more known that eczema is made worse by excess of asthma, although she had a few more attacks of fats and carbohydrates, but some recent work mucous colitis due to an apparent sensitiveness goes to show that protcids often are an exciting to milk proteid. But after her diet became more cause. To come directly now to the question varied she showed marked improvement in this of child asthma, it has just been shown that condition also. Here it seemed that it took the certain proteids may bring on in a child so pre- accumulation of two or three weeks of daily por- disposed typical attacks of bronchial asthma. It tions of beef juice before sufficient poison was at seems to me that this subject of proteid anaphy- hand to bring on an attack, a condition some- laxis or sensitiveness to proteids is being widely what different from the egg cases where perhaps i.pened up, and that wre are at a point of view one morsel of food containing egg may brir^ on of great importance. Whether there is any re- asthma. lation between and BIBLIOGRAPHY. lymphatism proteid anaphy- 1 Noel of laxis is a Patón: Regulators Metabolism, Edinburgh, 1912. very open question. Talbot has studied 'Klose and Vogt: Klin. u. Biol. der Thymusdrüse, Tübingen, infants in relation to to 1910. proteid anaphylaxis "Svehla: Münch. med. Woeh., 1900, quoted by Falta, Ductless asthma. The sensitization takes Glandular Diseases, N. Y., 225. apparently place ' 1915, Chap. V, p. Popper : Quoted by Falta, loo. cit. either by the unchanged proteid 8 Noel Paton: hoc. cit. passing directly « into the blood the intestinal mucous Friedleben : Physiol. (1er Thymus, Frankfort, 1858. through »Paltauf: Wien. Win. Wooh., No. 40, 1890. membrane in the earliest weeks of life, or "Hcdinger: Jahrbuch für kinderheil., 1900, 68. the •iBoneke: Berl. kl in. Woch., 1894, No. 9. through injured intestinal mucous membrane '»Jackson: Jour. A. M. A., May 25, 1907. in later some as »Rt'bni Anh. für Win. Cliir., 1900, Bd. 80. infancy during digestive upset "Crotti: Jour. A. M. A., Jan. 11 and Feb. 1013. 18 22, diarrhoea. There may be also an inherited sen- D'Oelsnittf : Quoted by Lange, a. v. sitiveness. "Holt: Diseases of Children. The infants are tested by scarifying "Sylvester: Boston Med. and Rono. Joun., April 2, 1914. the skin and in the "Andrews: Keen's Surgery, Vol. 0, p. 327. rubbing suspected proteid. "Parker: Amer. Jour. Dis. Chil., Feb., 1913. Several foods be tested at once on as 19 Veau : Quoted v. may many 10 by Lange, q. Friedlandcr: Arch. Pediatrics, July, 1907. scarifications. Egg white, various kinds of MRudberg: Arch, für Anat., 1907. meats, beef milk for -the various -1 ûinge: Amer. Jour. Tîoeiitgcnologv, Dec. 191.1. juice, casein, »Ribadeau mid Weil: Bull. Soc. Med. de Hop. do run's, 1012, grains such as barley and oat meal for the 28. 431. gluten, "Morgan and Dachtler: mid etc., are used. Within 15 minutes a small Snrg., Oyn. Obst., Dec, 1914, 781. whcal or an erythema arises where the causative proteid was innooulated. Talbot has found that various proteids arc the factors in many cases of child the commonest asthma, egs being cause. GUILLAUME 1777-1835. After the egg is found to be a cause, the asthma DUPUYTREN, ceases on the from withdrawing egg the diet. BY William Pearce Coues, M.D., Boston. This, of course, is a most inconvenient proced- ure, so he has to accustom the child attempted It has been said with truth, that if a physi- to one cfffr by starting with milligram doses of cal u in America wished to do research work on egg albumen in capsule by mouth, with increas- some subject he was especially interested in, ing amounts, and he has met with success which that he could not go far in his researches with- is, however, if not complete, encouraging. out finding that it had all been done before by My personal experience is rather limited. One a German. I would change the saying some-

The Boston Medical and Surgical Journal as published by The New England Journal of Medicine. Downloaded from nejm.org at SAN DIEGO (UCSD) on July 4, 2016. For personal use only. No other uses without permission. From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society. what as regards surgery at least, and say that tor at the École de Médecine, and in 1801 he if there was any modern surgeon especially in- was promoted to the position of "Chef de terested in certain pet theories and principles, Travaux Anatomiques." We know that about seemingly of modern times, that if he would this time he also paid great attention to the but look back he would find that much of the study of physiology and pathology, and this, as work had been done by a Frenchman nearly a will be seen later, was of lasting value to him hundred years ago, and that Frenchman was in his later work. In 1804, Dupuytren obtained Guillaume Dupuytren. one of the positions he had been striving for, In the present age of telephones, motor cars, and was appointed surgeon of the second class and dictagraphs, not to speak of the many in- at the Hotel Dieu, where almost all of his work struments of precision at the service of medical was done. men. to make their work easier and more exact, Malgaigne tells us some interesting anecdotes it is wise to look back and see what was accom- of the early days of Dupuytren in Paris, and plished by the great men of the early part of apparently it was against his parents' wish that the last century, without these aids to our he stayed there. We know that his requests for science. money to keep on with his work were not granted Among the names»of the many great French by his parents. In his early struggles, which surgeons of the last century, that of Dupuytren were almost unbelievably hard, like Velpeau's .staiuls first. In France the niutterings and and Malgaigne's, he received a call one day rumblings of the great storm that; was soon to from that great philosopher, Saint-Simon, who break in the form of the Revolution, were grow- had become interested in the boy, probably on found ing louder and more insistent at the time of account of his bent for philosophy. He the birth of in 1777. Is it a coin- Dupuytren working in bed on account of the Dupuytren could cidence that so many of the great medical men cold, and other signs of abject poverty of France, hardly any of them from the aristo- not fail to be read. After a brief visit, Saint- were born at about this time? Simon departed leaving a roll of bills amounting cracy, Malgaigne, mantel. Velpeau, Roux, Larrey, Dupuytren,—what names to two hundred francs on the barren for a nation to be of and cherish ! A Dupuytren soon saw the money, dressed quick- proud Saint-Simon study of the lives of such men as these leaves ly, and was soon at the house of man and no room for doubt as to the cause of the won- with it. He found the great at home "Here is at derful powers of France, in her hour of need said, something you forgot my in the present great European struggle. bouse." Saint-Simon could not tell the poor student so after a moment Guillaume was born at Pierre- the truth, and said, Dupuytren I them." a town of Haute-Vienne, on October "Yes, forgot Buffiere, followed were indeed hard 5, 1777. (Some authorities give October 5, The years that no day can His father was an advocate of very lim- ones, probably present physician 1778.) form any of them. Much of the ited and some accounts tell us conception means, though latter bitterness and reserve of the of medical forbears, definite is stated day great nothing on account of the in- this tells us that, as surgeon was undoubtedly concerning question. History delible of the terrible times a boy, Dupuytren was of more than ordinary at- impress through his At one tractive appearance and charm, and it is pretty which he passed in youth. time, his funds so definite that on account of this unusual personal during his early life in Paris, got on bread and cheese attraction, he was kidnapped, when of tender low that he had to subsist determination to sur- age, by a rich lady of Toulouse ; he was, however, for six weeks, but his returned to his in a short time. In mount all obstacles made him suffer all and family at officer who was stationed at endure all with lixed determination. It was 1789, a cavalry in Pierre-Bouffiere took a great fancy to the boy this time that he used the fat of the subjects which to end it did not take a great amount of urging the dissecting room to make oil, with to obtain the permission of the elder Dupuytren light his poor lamp. It might be said that fat, to allow the boy to accompany him to Paris. a substance abhorred by all dissectors, was- On arrival at Paris, he was sent to the College never used to better purpose. to the exact facts of La Marche, which was directed by Monsieur Stories conflict as regard- first at the Hotel Coësnon, a brother of the officer. It was said ing Dupuytren's appointment as to the exceed- that the young student particularly distin- Dieu, but there is no question himself in while there, but ingly bitter struggle for the place between guished philosophy Roux. is that there from the evidence at our disposal, it seems that Dupuytren and One story not in the least the type of was a concours for the place of third surgeon, he was "goody" until boy. and got into all the scrapes and troubles a position that had never been existent some that this that a normal boy should. this time, and it was supposed by At about the time that the Revolution came was created expressly for Dupuytren, whose to be to an was old enough to think great operative skill was just beginning end, Dupuytren Roux to contest the of his definite career in life, and unhesitatingly recognized. determined to be chose the of medicine. He was hard- position, and his examination proved profession of The de- ly eighteen years old when he was chosen prosee- equally good with that Dupuytren.

The Boston Medical and Surgical Journal as published by The New England Journal of Medicine. Downloaded from nejm.org at SAN DIEGO (UCSD) on July 4, 2016. For personal use only. No other uses without permission. From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society. cisión was postponed, and the candidates re- Pelletan, as chief of the service, had the right quired to go through more tests, and to deliver to assist at all operations he gave his surbord- in public a thesis, the subject of which was not inate, and he, in turn, had the right to visit all to be known until four hours before the public patients in the ward, after bis chief. Dupuy- discourse. Dupuytren was successful, and it tren would tear to shreds with merciless logic has been said that he had prior knowledge of all the fanciful diagnoses of his chief in the the subject of the discourse to Roux. Judged presence of the students. He was in his turn mer- from our study of Dupuytren's life, this does cilessly criticised, but his critics, conscious of his not seem probable ; at all events, Roux later great ability, were obliged to find other things admitted that he was too young for the position to complain of than bis operative skill. Thus at the time he tried for it. This occurrence was Percy named him the liest, of surgeons and the the starting point of a bitter feud between the last of men, and Lisfranc, the "Brigand of the two men, which was to last, for many years. Hotel Dieu." Later in life Dupuytren and Roux fell in love It so happened that Pelletan wished to have with the same young woman, and Dupuytren his nephew appointed in his place at the Hotel again carried off the prize. Dieu when the time came, instead of Dupuytren, In the year 1805, Dupuytren was attached and as Dupuytren's whole future at the Hotel to the service of Boyer at the Hotel Dieu, and Dieu was at stake, if this was done, we cannot he was claimed by the army to do his work as perhaps blame him for his attitude towards the a conscript. He was, however, so much wanted senior Pelletan if all is taken into account. How at the hospital, that the École «le Médecine* at Dupuytren became chief of the Hot id Dieu was a special session of the faculty, pleaded an ex- told to Malgaigne by Lisfranc, who was a former emption for him which was granted. In 1808, pupil, and later a rival of Dupuytren. The he was appointed adjunct at the Hotel Dieu, climax of the trouble between Pelletan and his under Pelletan, a surgeon of the old school, of .junior was reached when a Russian officer was somewhat laissez faire principles. Some of the brought into the Hotel Dieu, for a deep wound most interesting and important events in Du- of the thigh, received eight days before. Pelle- puytren's life occurred at this time, of which tan examined the case, thought there was a deep Malgaigne tells us in a most graphic way. A abscess, which had come to the surface above word concerning the Hotel Dieu, for which I'oupard's, and made a quick, deep incision.into Dupuytren did so much, will be of interest, for the mass, when a fountain of blood gushed up, here the great surgeon lived ami worked almost inundating the operator and his assistants. The constantly, for thirty years. femoral was cut across! Pelletan hesitated; Lis- The Hotel Dieu was founded by nuns in franc, who was assisting, states that Dupuytren G60 A.D., and has been in existence uninter- had told hiin how to deal with such a hemor- ruptedly ever since, 1256 years. For years it rhage, and applying his fingers with much pres- was a hospice for the poor and destitute, as well sure over the common iliac, the hemorrhage as the sick, and many of the poor of Paris found slopped. Pelletan, thinking it was the iliac it- refuge there during the long, cold winters. The self he had wounded, and not being familiar overcrowding, disease, and general misery were with the ligature of large vessels (in common too frightful to be described. In the times of with many other surgeons of his time), made epidemics the very high mortality was greatly two parallel incisions above Poupard's ligament, increased. Some things had been changed for passing a Deschampa' needle deeply between, the better before Dupuytren's time, but the then ligatmg the tissues between, encompassing mortality was still very high, and there was the abdominal wall as well as the deeper struc- great overcrowding. Dupuytren changed all tures in the ligature, which he then tied tightly. this and made order out of chaos. At this time He then asked Lisfranc to suspend the compres- there were 1000 beds, and fifteen wards, but five sion, which he reluctantly did. A frightful of these were surgical. There were 264jmrgical hemorrhage showed that the vessel had. not been 191 for men and 73 for women. Dupuy- included in the ligature ; in Pelletan beds, and desperation tren gave two of his wards to Breschet crowded charpie after charpie into the wound, on his Sansón, respectively, keeping 113 beds but all to no avail, and some hours later the un- service. Fourteen hundred ward cases (surgi- fortunate officer was no more. The occurrence 1829. In the old five cal) were treated in days naturally caused much talk, a commission of one enormous bed or or six patients lay in Russian surgeons made inquiry about the unfor- charnier. lunate ending of the case, and shortly after- Such was the Hotel Dieu, where Dupuytren's wards delivered, the wonderful Pelletan lost his position at the Hotel famous lectures were Dieu. Orales," which thrilled countless au- '"Leçons one after diences. Dupuytren, arriving morning this Dupuytren worked with all his energy while event, said to his interns with joy on his face, under Pelletan, and. studying the ward cases "Congratulate me, this place, for which I have with minuta care, soon had his lazy chief at his worked for twenty years, is mine, and it is be- and me. mercy, regarding all questions of diagnosis yond the power of any one to take it from operative procedure. Malgaigne tells us that 1 am surgeon-in-chief of the Hotel Dieu!" He

The Boston Medical and Surgical Journal as published by The New England Journal of Medicine. Downloaded from nejm.org at SAN DIEGO (UCSD) on July 4, 2016. For personal use only. No other uses without permission. From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society. was appointed to this position on September 9, Dieu, and without thinking anything about his 1814, and two years before this he had been old green coat with the holes at the elbows, appointed professor of operative medicine. walked along the pavements, munching his ' ' It is of interest to note, particularly at this meagre crust. At this time, as Gaillard quotes, time, that in connection with his work at the "Nul astre à ses cotés lève un front rival." Al- Hotel Dieu, Dupuytren established a dressing ways at about seven in the evening he would station in the centre of the French lines during make a second visit at the hospital to see the the revolution of 1830, and remained there all operated cases of the morning, and any others day under fire, with his interns, attending to demanding attention. Dupuytren's private the wounded. From 1802, the time of his first practice was slowly acquired, but at the zenith appointment at the Hotel Dieu, until 1835, he of his powers reached immense proportions. It hardly missed a day, a period of over thirty is estimated that at this time he saw ten thou- years. Lenoire says, "We have seen him sick, sand patients yearly, outside his hospital work. febrile, icteric, accomplishing the rigorous duties With ¡dl this immense amount of labor, Dupuy- which he had set himself, omitting nothing." tren did not write as much as some of the other What manner of man was this king of sur- great French surgeons of his time, but what he geons and surgeon to the King? Probably no did write was of the best. Much of this is con- great man was ever more hated and envied, and tained in the "Leçons Orales," which were gath- at the same time more looked up to for his con- ered in book form, and published by his pupils, summate skill. Gaillard tells us that he was of Pierre de Boisment and Marks. Among the commanding figure; one could easily recognize most interesting of these lectures to us today the "grand maître," a noble head and a fore- are perhaps the ones on bone cysts, abscess oí head worthy of Jupiter Olympus. His words the right iliac fossa, including appendicitis, and were usually brief; he had a tone of voice which congenital dislocation of the hip. In the essay bad a finality about it which admitted of no dis- on bone cysts we find much that sounds as if cussion and no reply. His dress was of the it were written today, so clear is the knowledge simplest, and ordinarily he was negligent in this of the condition, bone cyst occurring in regard,—an old green coat, socks over the tops of the long bones, etc. Warning is given his boots, he walked the wards of the hospital that bone cysts are liable to become malig- every inch a king, and woe be it to the person nant, and complete extirpation is advised. who thought they could presume, on account of Dupuytren made an extensive study of gunshot his eccentric dress! He did not indulge in any wounds, and also began a work on stone in the luxuries, his whole mind and body being given bladder, which was finished by Sansón and Be- to his work. It is said that he disliked compli- gin. the only work he is universally which Perhaps ments excessively, and the "flatteries remembered by to this day, is his memoir on lay unction to the sóul of the little great." contracture of the palmar fascia, and its opera- us criticised or blamed Pariset tells that he tive cure. He made a study of tuberculosis, and no as we know one, which is probably untrue, anthrax, and made an exhaustive study of his at the Hotel Dieu. from studies of early days burns, making a new classification. He was the He certainly had reason in the "penible" begin- first surgeon to the cervix of the His amputate nings to blame and criticise many. expres- uterus for cancer, and the first to devise a ra- sion was not, we are told, like the coldness of tional procedure for excision of the lower jaw. but was somewhat marble, preoccupied, giving His operation for the establishment of an arti- the idea of one in meditation. He rapt ficial anus was one of his greatest triumphs. visit the at six or thereabout would hospital His work on fractures, and especially fractures each morning, and if all the house staff were of the fibula and the lower end of the radius, is not at attention, or any were missing from their classic. there trouble. He examined proper place, was. No sketch of Dupuytren would be com- all the with care, and laid great patients great plete without a brief account of his relation to stress on a careful history, and repeated physi- cal examinations. After the visit he would sit the Court of France, and the part he played in the sad event of the assassination of the Duke down on his green sofa, which his assistants big de and students loved as part of himself, and talk Berry. over the eases. There was a special house-officer, In 1816, he was created a baron, and the whose business it was to make a careful and Order of St. Michael was conferred upon him, m i a utc record of all the unusual and interesting an«! in 1820, he was made consulting surgeon cases, the records of their operations, and to do to Louis XVIII, and on his death, in 1821, he nothing else. was appointed surgeon to Charles X. At After the operations were over, and the cases this time Dupuytren had acquired great wealth, in the wards had been visited, Dupuytren made and being cognizant of the condition of the a at of a case it rule to be present any autopsy Royal exchequer, sent the following note to the in his wards, and he was the first surgeon to follow out this rule in France. "About eleven King. he took the little roll of bread given to "Sire: Grace in part to your benefactions, A.M., I the surgeons from time immemorial at the Hotel possess three millions; I offer you one, I in-

The Boston Medical and Surgical Journal as published by The New England Journal of Medicine. Downloaded from nejm.org at SAN DIEGO (UCSD) on July 4, 2016. For personal use only. No other uses without permission. From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society. tend the second for my daughter, and the third Sainte-Beuve, Malgaigiie tells us, often spoke I reserve for my old age." with pride of the fact that he had had the honor This generous offer was not, however, accepted of being at the Hotel Dieu as one of Dupuy- by the King, perhaps on account of court eti- tren's externs. quette, or perhaps a sudden change for the bet- The following incident well illustrates the ter in the royal finances. great surgeon's insight into human character. On the 13th of February, 1820, the King's When patients came into the clinic suffering nephew, the Duke de Berry, was mortally with dislocations, it was the practice of some wounded by the hand of an assassin. The fol- surgeons to have the patient made somewhat lowing account of the tragedy is drawn from intoxicated, so that there could be more muscu- Dupuytren's own report to the Academy of lar relaxation obtained, and the dislocation re- Medicine, and Cabane 's graphic description, duced more easily, and without danger. Dupuy- which was based on this report. tren used other ways, as will be seen. A woman The Duke was on his way back to the opera, came into the clinic with a dislocation of the after conducting the Duchess, who was a few shoulder. Said Dupuytren, "Your hurt comes months pregnant at this time, to her carriage. from the fall you have had, but you didn't tell He had just turned to go back to the theatre, me .you were drunk when you fell; your son when the assassin, Louvel, plunged a poniard told me." The woman fell in a sort of swoon into his chest. The Duke cried out, "Je sail at this, and Dupuytren reduced the dislocation in an assassine, Caroline, un prêtre!" Unfortunately, instant. When the woman recovered con- the Duke pulled the poniard from his chest, and sciousness, Dupuytren said to her, "Your shoul- the wound started to bleed fast. The patient der is in place, and I know perfectly that you was carried to the ante-chamber of his opera only drink water." box, and here Dupuytren saw him. Bleeding, In 1822 Dupuytren operated on a young girl then almost universally done, had been accom- for the removal of a tumor of the neck. When tumor plished from the arm. There was a question the was nearly ready for complete remov- that the poniard was poisoned, and Dr. Bougon al from the surrounding tissues, there was sud- heroically applied-his lips to the wound; luckily denly a hissing sound and the patient suddenly for him, this proved not to be the case. After expired. Dupuytren, without moving, looked consultation, Dupuytren decided to enlarge the long and searchingly at the operation wound, wound and see if he could not stop the hemor- and then explained to the onlookers what had rhage, which was exsanguinating the Duke. happened, that entrance of air into a large cer- This exploration showed a penetrating wound of vical vein had killed the patient. This was the the chest, and all the surgeons present felt that first time this phenomenon had been demon- further intervention was not to be thought of, strated. It is said he gave on the spot, sadly and that nothing more could be done. The and gravely, as befitted the occasion, one of King, who had been anxiously awaiting the re- his most illuminating lessons. sult of the consultation, addressed Dupuytren Cruveilhier tells us that when things were thus, "Superestne spes aligna salutis?" and going wrong at operations, and in great emer- when Dupuytren replied in the negative, the gencies, where life hung in the balance, that King raised his eyes to heaven, saying, "Que la "Dupuytren was more than a man, he was the volonté de Dieu s'accomplice." The autopsy god of surgery." showed that the poniard had passed through One of Dupuytren's sayings was, "I have the right lung, the pericardium, and had entered been mistaken, but I have been mistaken less the right auricle. There were two litres of blood than other surgeons." in the right side of the chest. It is not to be wondered at that his almost the gratitude to superhuman efforts, long continued without rest, Notwithstanding King's should at last have for his services in this sad case, his their effects, and one day Dupuytren while to the Hotel Dieu treatment was severely criticised by his con- walking in November, freres, and most of them argued that non-inter- 1833, Dupuytren was seized with an attack of it was ference would have been a better policy. Noth- apoplexy; a slight attack, and he con- could, however, have the result. tinued on his way to the hospital, but the stu- ing changed dents noticed that his It is of interest that Dupuytren was made the speech was thick, and soon after in 1834, he was to take hero of one of Balzac's novels, under the name this, obliged a respite from his labors. He to of the novel was the "Messe de journeyed Italy Desplein; and his passage to that was one con- and is de- country l'Athée," Desplein (Dupuytren) tinued ovation. Before going, he said to a col- scribed thus: one of the of "Desplein, greatest league, "La repose, c'est la mort!" He was af- French surgeons, appeared like a meteor in the flicted with a pleurisy and was tapped, taking the world of science. . . . Like all geniuses, he was greatest interest in the diagnosis and treatment without an heir. . . . The glory of surgeons re- of his own ease. Almost in his dying moments sembles that of actors, which exists only in their he recognized a dislocation of the elbow, which life, and their talent is not appreciated when other good surgeons had failed to recognize. they are gone." The day of his death he had the paper read to

The Boston Medical and Surgical Journal as published by The New England Journal of Medicine. Downloaded from nejm.org at SAN DIEGO (UCSD) on July 4, 2016. For personal use only. No other uses without permission. From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society. him, wishing, as he said, "To take above the a justifiable procedure. The ovary or ovarian news of this world." He died on the 8th of tissue is buried without suture in the subperi- February, 1835, at the age of 57, aud it is said toneal fat of the abdominal wall. thai over 1000 workmen assembled at his grave, That the success of such grafting is not to pay their last respects to the Surgeon of the enough for the relief of menopausal symptoms Hotel Dieu. Two hundred thousand francs were was shown by several cases in which regular left to medicine by Dupuytren, and this sum monthly congestive periods were observed, pre- was used under 1 he direction of Orfila, for the sumably corresponding to ovulation, but with- creation of a pathologic museum, which is known out menstruation. Only when menstruation oc- as the Musée Dupuytren in Paris. curs are the menopausal symptoms relieved. It Pilastre has the following words concerniug was this observation that, led Tuffier to the con- this great man, which fittingly end an account clusion that the suppression of menstruation of his life. was the real cause of the symptoms. "Posterity has forgotten the faults and errors One of the practical problems suggested is that the contemporaries of Dupuytren rigorous- the treatment of young women from whom it is ly reproached him with, . . . and has confirmed necessary to remove both ovaries on account of the homage which science, far away from the disease which precludes réimplantai ion. Grafts passion of the times, has rendered to the greatest from other individuals have always been fail- surgeon of the nineteenth century,—a man who ures in the hands of Tuffier though he is still hail lifted himself from the most humble to the hopeful that improved technic, namely, in- highest rank, and added another name to the creased knowledge of the conditions under glories of France." which tissue grows, may ultimately give success here. The literature on transplantation of the ovary is reviewed to date by Martin2 whose conclu- sions may be quoted as follows. The surgical value of the procedure is questionable and the results are disappointing. Autotransplantation of ovarian tissue as practised at present seems PROGRESS IN GYNECOLOGY. to retard and modify the symptoms of the arti- ficial menopause in a certain number of cases. BY Stephen Rushmore, M.D., Boston. Probably the effect depends on the ability of the graft to maintain its vitality in its new en- TRANSPLANTATION OP THE OVARY. vironment. A simple technic seems to give as successful results in autotransplantation as does As a result of Tufficr's1 wide experience in a complicated technic with an attempt defi- transplanting ovaries," he has formulated "a nitely to couple up the blood vessels. The occa- new theory of menstruation." It is, briefly, sional success of homo- and hetero-transplants that each month there is produced by internal suggests that the antagonism of tissue, which is secretion in the body of the human female, a nearly constant, may be overcome, though just chemical substance of unknown origin. When how is not known, and more successful results a sufficient quantity has accumulated, it acts on be obtained. the ovary, which in turn reacts, modifying the Storer3 presents a discussion of the question secretion. It is this modified secretion which of ovarian transplantation, based chiefly on a produces menstruation and is eliminated with study of the literature, and reports a case in the menstrual discharge. If menstruation does which the operation was apparently followed by not appear, the retained substance produces a pregnancy. The patient had had the left "autointoxication," known clinically as the ovary and both tubes removed three years be- change of life. Part of this theory, namely, fore on account of gonorrheal infection. She that menstruation is a cleansing process, has a was desirous of matrimony conditioned on the familiar sound. possibility of pregnancy, and demanded opera- One fact on which this theory is based is tion though success seemed improbable. that Tufficr brought on menstruation by inject- At operation there were many dense adhe- ing blood serum from a patient who was just sions and the ovary was found to contain many about to menstruate. Furthermore, menopausal small cysts. The tubal stumps were half an symptoms disappeared following such injection. inch long. The right tubal stump was divided Tufficr holds, therefore, that menstruation downward until the uterine cavity was laid, should be preserved whenever possible in wo- open. The ovary was bisected from above men under forty. He estimates that about one- downward so that each half retained at least third of the endometrium should be left instead some of its original blood supply. The cut sur- of performing a complete hysterectomy. As face of the distal half was closed with catgut ovarian tissue also is necessary, this need may and left in 'place. The proximal segment was be supplied by autoplastic operation, successful introduced into the incision in the uterus and in a large enough percentage of cases to make it sutured so that most of the cortex projected into

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