that the breech was presenting ; attempts were made to introduce the hand to bring the feet down. The efforts being useless, the os was divided in three places in its circumference with a probe pointed bistoury, the feet were then brought down and the woman was delivered of a living female child. The placenta followed in ten minutes, no haemorrhage occurred, and the woman was cured in due time without any complications having occurred. Her husband said that the fruit of her first pregnancy was brought out piecemeal by a doctor in Jummoon, to which place these people belonged. 4. A case of placenta pnevia.?I was called to see a poor Hindu female, living in my neighbourhood, on 12th December, 1881, and on reaching there was told that the woman, who had given birth to a child before, was now in the seventh month of her pregnancy, and that profuse bleeding was going on from the womb since three days, which had almost blanched her. On examining per vaginam, it was found that the os was dilated to a diameter of about an inch and-a-half, the right half containing the membranes, while the left contained the placenta, which could be easily recognised by its feel. Palliative measures being considered useless at such an advanced stage, the membranes were at once punctured with a quill, the waters discharged, the foetus turned and brought down by the feet,?the whole taking about half an hour. The after-birth also followed easily, the uterus was compressd in the hand to insure contraction, and a few doses of ergot were administered in the following 24 hours. It must also be mentioned that on puncturing the membranes first the right hand came down, and was being followed by the head, when the hand was pushed up and the feet brought down. The woman made a good recovery in due time without any other
complication.
cyst.?Maubharu, a Hindu female child, aged brought at the Delhi Civil Hospital on the 21st October, 1882, and showed a cystic tumour of the size of an egg, with a pedunculated movable root attached to the occiput a little below the tuberosity. The skin covering the tumour was dissected, and then it was found that the cavity of the cyst communicated with the interior of the skull, the pedicle coming out of the skull through a circular opening in the occipital bone, a little below the tuberosity. A strong silk ligature was applied around the neck and the 3*.
I^
A MIRROR OF HOSPITAL PRACTICE. notes
of a few operations performed at THE DELHI CIVIL HOSPITAL.
[Reported t
by
n..
Asst.-Surgeon Ram Kisiien, l.m.s.]
r.-.T.
a
......
Horn 011 the back.?A man was admitted into the Delhi Civil Hospital with a horn on the back on the third and fourth dorsal vertebrae. It was about three inches long, about an inch and-ahalf in diameter at its base, which was movable and very vascular, and the transition from the skin to the horny substance could be distinctly made out, being gradual, the skin first being very red, then darker and darker until it assumed the color of the horn. The distal end of the horn was small, rounded off, and a little curved, just like a small cow's horn. The tumour was removed by means of an elliptical incision, and the patient made a good recovery, but there was a possibility of recurrence, as the man said that it had been removed once before by a Hospital assistant when it was of very small size. The base of the tumour was tender. The tumour was sent to the Museum of the Lahore Medical School. 2. A sebaceous cyst.?A Hindu female, aged 20 years, was admitted into the Delhi Civil Hospital on the 19th June 1881, with a sebaceous cyst on the left side of her neck in front, and covering the cervical vessels, of the size of a large orange. An incision was made in the skin, which was dissected a little, and then the whole operation done with the finger nail; the result was that no bleeding occurred and no vessel' was tied, except a very small artery at the base of the growth. 3. Rigid cervix and breech presentation.?A woman was brought to Hospital on 25th October, 1881. She was about 25 years old, was in labour since two days ; this being her second pregnancy; she looked much exhausted, and was very anxious for help. On examination it was found that the os was very rigid and thin, felt hot to the finger, and did not yield to the pressure ; was of the size of a rupee; the membranes were not protruding on account of the deficiency of the waters, which was also a cause of the os not the pains were very dilating, although 1.
strong,
The membranes
were
puncturcd when it
was
found
Arachnoid
month,
was
was found to be made of the dura mater of arachnoid membrane and filled with cerebro-spinal fluid. Sutures were applied in the wound in the skin and the ligature fixed under a piece of sticking plaster ; the whole dressed with carbolic oil, lint and carbolized gauze. The patient was a weak, badly develope I child. It was an out-door patient, and was brought by the parents two days after the operation, in a bad state, suffering from symptoms of meningitis, but was never seen again, and most probably must have died. Nothing could persuade the parents to keep the child in hospital.' Punctured wound of the'descending colon with wound of 6. the abdominal wall on the left sidi and protrusion of the wounded bowels.?Roopa, Hindu male aged 30 years, of a strong build, was admitted into the Delhi Civil Hospital on 17th August, 1882, at about 1 a. M. An hour before admission he heard a noise to the effect, that there were some thieves in the neigbhouring street, on which be left his bed, and while the thieves were running away he caught one of them in his arms, he and the thief meeting each other face to face, on which the thief stabOn admission Roopa showed a bed him on his left side. wound about an inch long, and obliquely placed below the last rib on the left side, the large intestine protruding through the of an inch long, wound, which also showed a wound about feces were issuing out of the aperture in the gut. The in the was wound sewn up with catgut, the protruding gut of the bowel was placed in the abdominal cavity, the part wound in the latter was stitched with iron wire sutures and A drachm of dressed with carbolic oil and antiseptic gauze. liquor morphire was administered at once and two grains of calomel and five of Dover's powder ordered every two hours. Only two doses of this had been given when symptoms of peritonitis were observed; the pulse was wiry, abdomen tympanitic, and respiration entirely thoracic- Poultice was then applied on the abdomen and a grain of opium ordered every 4 hours, with this half a grain of morphia was injected morning and
tumour
removed, which
.lined with
a
layer
evening. August 19thy 1882.?Morning temperature 99'4?, pulse 132, full and hard ; evening temperature 101 *3?, pulse full and hard $ respiration abdominothoracic : morphia and opium continued as yesterday#
THE INDIAN MEDICAL GAZETTE.
5?
10th.?The injection was not applied last night as he was asleep ; vomited once, but this was stopped with a little ice ; opium pills were given every 4 hours. 21st.? Had two morphia injections last night ; tympanitis apparently increasing, respiration entirely thoracic. 5 grains of calomel were given in the morning, and opium pills ordered to be repeated ; the following was also ordered to be given every two hours, and turpentine fomentations to be applied to the abdomen before applying the poultice, which was already being changed every 4 hours. R. 01. Terebinth.
Mucilaginis... Aqua? ...
...
...
???
...
...
gii gi
...
M. ft. haust not acted since the date of the injury; a piece of soap was placed in the rectum and turpentine continued and externally internally, in addition to which 46 minims of chloroform were inhaled but no opium administered. 6p. m.?Wound opened and an artificial anus made by stitching the margins of the gut to those of the abdominal wall, a small quantity of gas and a little frcces came out instantaneously. Two doses of the following were given during the
22nd.?Bowels
night:
T}t.
01. Terebinth. 01. Ricini
..
Mucilaginis Aq. Menth. pip.
...
...
...
...
...
...
...
...
U|^x
gl gii 5i
M. ft. haust.
23rd,?Two doses of the above draught were given in the day, had two motions ; the tympanitis relieved to some extent; the patient feeling better ; a grain of opium was then administered night. 24//:.?Slept fairly well last night. One grain of opium given three times in the day. 26th.?The opium was changed for nepenthe fl^x t. d29th.?Continued improving, although the temperature still ranged between ico and 102", never rose higher than 103? since
at
the commencement of the case. The bowels had not acted for the last two days, the gut protruded a little through the wound, the following was therefore ordered :? 01. Terebinth.
01. Ricini
...
Tinct.
Hyoscyam. Mucilaginis Aq. Menth. pip. ...
...
...
...
...
...
...
...
...
...
...
Tf|^x
*i
Ttjxx
gii
?i
M. ft. haust. To be given every 4 hours up to 4 doses. Had two motions in the day and therefore 20
U|^. of nepenthe were administered at bed-time. Had been taking milk for his food, now and then sago and arrowroot being given with it, and sometimes rice made into kkir. 30th.?The edges of the wound and the skin around looked sore, zinc ointment was therefore applied over it, which had up to this time been dressed with carbolic oil and lint. 31^.?Got a rigor last evening, ten grains of quinine were therefore ordered to be given in the morning and nepenthe with iodide of potassium in the day. September 1st, 1882.?Had a scanty motion last night per rectum for the first time after the injury. }^. Quin. disulph. Pot. Brom. Iod. ,, Rum mixt
...
...
...
...
...
...
...
...
...
...
gr.iii grx gr.v
t. d.
5 p. in.?Abdomen tympanitic, bowels costive. R 01. Terebinth. ...
...
-j^x.
Mucilaginis. gj_ Aq. Menth. pip. gjt M. ft. H. To be given every two hours. as on state the 2nd Sept.?In the same previous evening ; temperature ioo?. The quinine and iodide of potassium mixture, continued fomentation ; evening temthe turpentine mixture and perature 100?. still little but present, the quitympanitis improved, 3rd.?A nine mixture stopped and the turpentine mixture continued. ...
...
4th, 5th
...
...
and 6//^?Turpentine mixture continued,
[February, 1884.
7tli,?Tympanitis somewhat relieved; had two motions through the wound ; looked weak ; rum mixture ordered to be given every 4 hours. gth.?Had fever last night, for which ten grains of quinine administered in the morning. loth.?'The turpentine and rum mixtures were continued till the 14th when diarrhoea set in, on account of which the turpentine was stopped and twenty grains of compound kino powder ordered three times a day. This was continued up to the 20th, when the diarrhoea stopped. A tonic mixture containing cinchona febrifuge, nitro-muriatic acid and Inf. chiretta was then ordered; enemas of soap and water being administered occasionally. The patient began to pass the greater part of the faeces through the rectum, while only a very small quantity came out of the abnormal opening, whi~.h was covered with a soft pad, lined on the inner surface with a piece of guttapercha tissue. The patient was discharged on the 8th October, 1883. He is now in perfect health, with a very small fistulous opening on the left side communicating with the bowel, through which a small quantity of thin faeces comes out occasionally, while greater part of the evacuations, in fact whole of the faecal matter, is passed per natural opening. Remarks,?The case is a very singular one, and has therefore been sent for publication, it shows how nature pulls life through difficulties of enormous r.ature, while the symptoms are alone being treated with the aim of giving relief to the most marked. I am much indebted to Dr. Ross, the Civil Surgeon of Delhi, for his help in treating this case. Excision of the Upper Maxilla. By Surgeon-Major G. C.Ross. Milka, a Hindu male, aged thirty years, was admitted into the Delhi Civil Hospital on 6th March, 1883, with a large tumour on the right side of his face, connected with the upper maxilla, of the size of a large orange. The tumour was diagnosed to be cancerous, and contained in the interior of the antrum. The patient said that he had had it for the last four He was very weak on admission, and was therefore kept years. on tonic treatment and good food until the 16th of the month, when the operation was commenced with an incision into the skin and subcutaneous tissues down to the bone, commencing with the middle line of the upper lip, going by the side of rhe nose to the inner margin of the lower orbital plate, from which position it was carried over the zygoma. The soft parts having been dissected out, the facial artery compressed with an acupressure needle and spouting arteries tied, the zygoma and the orbital process of the malar were sawn across, the left upper incisor was drawn, the alveolar process sawn through, and the nasal process divided with bone forceps, the palate was sawn through and divided freely with bone forceps ; then the soft palate was divided and the mass removed. Actual cautery was used to stop deep haemorrhage, iron sutures were applied and strips of lint placed in the cavity, Chloroform was stopped after cutting the soft structures, as the patient was weak, but he bore the operation well. Nothing particular happened in the after-treatment, the patient made a good recovery, requiring nothing but stimulants, tonics and good food. He was discharged on the 4th of April, 1883. Dr. Ross is thankful to Dr. Kavanagh and Asst.-Surg. Gokal Chand for assisting him in the operation. Ovariotomy. By Surgeon-Major G. C. Ross. A Hindu female, aged 3 years, showed a tumour in the lower of abdomen on the left side, which she said she had the part had for the last four years. She was weak and emaciated but otherwise healthy, she had the catamenia when admitted, and was therefore detained in hospital for about ten days, during which periodshe was kept on nutritiousdiet. On the 20th of October, 1883, the patient was put under chloroform and an antiseptic spray got ready, an incision about four inches long was then made in the middle line, a little below the navel, and the principal cyst tapped with the ovariotomy trocar ; there were several smaller cysts at the top of this, which were also tapped one by one, abrown fluid measuring twenty pints was removed from the main cyst, while the fluid contained in the smaller cyst was colorless, transparent and tenacious. There were three or four slight adhesions with the intestines, which were easily torn through. One cord-like substance connected with the tumour came from the upper part of the abdomen, apparently from the liver, this was tied with a whipcord, divided and dropped unto the abdominal cavity. The pedicle, which was broad but not very thick, was then held in the clamp, tied in two parts with pieces of whipcord, looped to each other, and was then kept out of the incision in the hold of the clamp. In the operation the connection o? the pedicle with the left side of the uterus could
February, 1884.] be
THE CENSUS OF BENGAL.
distinctly
made out. The operation took about an hour and-adone entirely under spray. The woman seemed inclined to vomit, but did not do so. She was brought round with some difficulty, the pulse having once become quite imperceptible. The wound was dressed antiseptically, four silver wire sutures applied in the wound, the pedicle in the clamp having been kept in its lower end. No hsemorrhage occurred during the operation. Fifteen minims of ether were injected into the arm soon after the operation. Small quantities of ether and brandy were given every 15 minutes from 11 a.m. to 4 p.m. In the evening the temperature was 99"8? and pulse ^o. l'orty minims of laudanum were given in two doses at night. Slept Not October.? 21st pretty well; diet, milk and khir. depressed,
half,
and
was
morning temperature 98 "4?.
Two grains of quinine and one of opium were given every 4 hours and 40 minims of tincture opii at night up to the 27th, when the dressings were changed for the first time under spray and an enema applied. The temperature ranged between 100 and ioi?up to the 26th, when it fell to normal and never rose again, although for some days it was below normal on account of the weakness of the patient. The enema was repeated on the 28th ; she got a little cough on the 29th, when Dover's powder was given in three-grain doses thrice daily for two days. Citrate of iron and quinine was ordered on the 31st and continued for four days, but she then got constipated and therefore it was stopped. The patient was dressed (of course always antiseptically) on the 27th October, 1st and 4th November, the clamp was removed on the latter date, though it had not separated itself; the whipcord ligatures were then removed. It must also be added that all the silver sutures were removed on 27th October, except one close to the pedicle, which was removed on 4th November, 1883. The patient was again dressed on the 9th, when the dead portion of the pedicle was cut off as much as was possible. The temperature never rose after 26th October. The patient was discharged quite cured and in good health on
15th November, 1883.
Remarks,?Our thanks are due to Dr. Ravanagh for his assistance in the operation. The patient made such a steady progress towards recovery that no remarks seem necessary, except that the keeping of the pedicle in the clamp was much regretted afterwards, as it was only this that obliged the patient to remain in hospital for 24 days, while otherwise she woidd have, with such a favourable progress, been discharged on the 10th or 12th day, as the wound had healed up at the time, when the dressing was changed on the first occasion, except that part of the wound There was no disheld in the clamp. the
containing
charge
pedicle pedicle.
around the
St
complication.
cyst.?Maubharu, a Hindu female child, aged brought at the Delhi Civil Hospital on the 21st October, 1882, and showed a cystic tumour of the size of an egg, with a pedunculated movable root attached to the occiput a little below the tuberosity. The skin covering the tumour was dissected, and then it was found that the cavity of the cyst communicated with the interior of the skull, the pedicle coming out of the skull through a circular opening in the occipital bone, a little below the tuberosity. A strong silk ligature was applied around the neck and the 3*.
I^
A MIRROR OF HOSPITAL PRACTICE. notes
of a few operations performed at THE DELHI CIVIL HOSPITAL.
[Reported t
by
n..
Asst.-Surgeon Ram Kisiien, l.m.s.]
r.-.T.
a
......
Horn 011 the back.?A man was admitted into the Delhi Civil Hospital with a horn on the back on the third and fourth dorsal vertebrae. It was about three inches long, about an inch and-ahalf in diameter at its base, which was movable and very vascular, and the transition from the skin to the horny substance could be distinctly made out, being gradual, the skin first being very red, then darker and darker until it assumed the color of the horn. The distal end of the horn was small, rounded off, and a little curved, just like a small cow's horn. The tumour was removed by means of an elliptical incision, and the patient made a good recovery, but there was a possibility of recurrence, as the man said that it had been removed once before by a Hospital assistant when it was of very small size. The base of the tumour was tender. The tumour was sent to the Museum of the Lahore Medical School. 2. A sebaceous cyst.?A Hindu female, aged 20 years, was admitted into the Delhi Civil Hospital on the 19th June 1881, with a sebaceous cyst on the left side of her neck in front, and covering the cervical vessels, of the size of a large orange. An incision was made in the skin, which was dissected a little, and then the whole operation done with the finger nail; the result was that no bleeding occurred and no vessel' was tied, except a very small artery at the base of the growth. 3. Rigid cervix and breech presentation.?A woman was brought to Hospital on 25th October, 1881. She was about 25 years old, was in labour since two days ; this being her second pregnancy; she looked much exhausted, and was very anxious for help. On examination it was found that the os was very rigid and thin, felt hot to the finger, and did not yield to the pressure ; was of the size of a rupee; the membranes were not protruding on account of the deficiency of the waters, which was also a cause of the os not the pains were very dilating, although 1.
strong,
The membranes
were
puncturcd when it
was
found
Arachnoid
month,
was
was found to be made of the dura mater of arachnoid membrane and filled with cerebro-spinal fluid. Sutures were applied in the wound in the skin and the ligature fixed under a piece of sticking plaster ; the whole dressed with carbolic oil, lint and carbolized gauze. The patient was a weak, badly develope I child. It was an out-door patient, and was brought by the parents two days after the operation, in a bad state, suffering from symptoms of meningitis, but was never seen again, and most probably must have died. Nothing could persuade the parents to keep the child in hospital.' Punctured wound of the'descending colon with wound of 6. the abdominal wall on the left sidi and protrusion of the wounded bowels.?Roopa, Hindu male aged 30 years, of a strong build, was admitted into the Delhi Civil Hospital on 17th August, 1882, at about 1 a. M. An hour before admission he heard a noise to the effect, that there were some thieves in the neigbhouring street, on which be left his bed, and while the thieves were running away he caught one of them in his arms, he and the thief meeting each other face to face, on which the thief stabOn admission Roopa showed a bed him on his left side. wound about an inch long, and obliquely placed below the last rib on the left side, the large intestine protruding through the of an inch long, wound, which also showed a wound about feces were issuing out of the aperture in the gut. The in the was wound sewn up with catgut, the protruding gut of the bowel was placed in the abdominal cavity, the part wound in the latter was stitched with iron wire sutures and A drachm of dressed with carbolic oil and antiseptic gauze. liquor morphire was administered at once and two grains of calomel and five of Dover's powder ordered every two hours. Only two doses of this had been given when symptoms of peritonitis were observed; the pulse was wiry, abdomen tympanitic, and respiration entirely thoracic- Poultice was then applied on the abdomen and a grain of opium ordered every 4 hours, with this half a grain of morphia was injected morning and
tumour
removed, which
.lined with
a
layer
evening. August 19thy 1882.?Morning temperature 99'4?, pulse 132, full and hard ; evening temperature 101 *3?, pulse full and hard $ respiration abdominothoracic : morphia and opium continued as yesterday#
THE INDIAN MEDICAL GAZETTE.
5?
10th.?The injection was not applied last night as he was asleep ; vomited once, but this was stopped with a little ice ; opium pills were given every 4 hours. 21st.? Had two morphia injections last night ; tympanitis apparently increasing, respiration entirely thoracic. 5 grains of calomel were given in the morning, and opium pills ordered to be repeated ; the following was also ordered to be given every two hours, and turpentine fomentations to be applied to the abdomen before applying the poultice, which was already being changed every 4 hours. R. 01. Terebinth.
Mucilaginis... Aqua? ...
...
...
???
...
...
gii gi
...
M. ft. haust not acted since the date of the injury; a piece of soap was placed in the rectum and turpentine continued and externally internally, in addition to which 46 minims of chloroform were inhaled but no opium administered. 6p. m.?Wound opened and an artificial anus made by stitching the margins of the gut to those of the abdominal wall, a small quantity of gas and a little frcces came out instantaneously. Two doses of the following were given during the
22nd.?Bowels
night:
T}t.
01. Terebinth. 01. Ricini
..
Mucilaginis Aq. Menth. pip.
...
...
...
...
...
...
...
...
U|^x
gl gii 5i
M. ft. haust.
23rd,?Two doses of the above draught were given in the day, had two motions ; the tympanitis relieved to some extent; the patient feeling better ; a grain of opium was then administered night. 24//:.?Slept fairly well last night. One grain of opium given three times in the day. 26th.?The opium was changed for nepenthe fl^x t. d29th.?Continued improving, although the temperature still ranged between ico and 102", never rose higher than 103? since
at
the commencement of the case. The bowels had not acted for the last two days, the gut protruded a little through the wound, the following was therefore ordered :? 01. Terebinth.
01. Ricini
...
Tinct.
Hyoscyam. Mucilaginis Aq. Menth. pip. ...
...
...
...
...
...
...
...
...
...
...
Tf|^x
*i
Ttjxx
gii
?i
M. ft. haust. To be given every 4 hours up to 4 doses. Had two motions in the day and therefore 20
U|^. of nepenthe were administered at bed-time. Had been taking milk for his food, now and then sago and arrowroot being given with it, and sometimes rice made into kkir. 30th.?The edges of the wound and the skin around looked sore, zinc ointment was therefore applied over it, which had up to this time been dressed with carbolic oil and lint. 31^.?Got a rigor last evening, ten grains of quinine were therefore ordered to be given in the morning and nepenthe with iodide of potassium in the day. September 1st, 1882.?Had a scanty motion last night per rectum for the first time after the injury. }^. Quin. disulph. Pot. Brom. Iod. ,, Rum mixt
...
...
...
...
...
...
...
...
...
...
gr.iii grx gr.v
t. d.
5 p. in.?Abdomen tympanitic, bowels costive. R 01. Terebinth. ...
...
-j^x.
Mucilaginis. gj_ Aq. Menth. pip. gjt M. ft. H. To be given every two hours. as on state the 2nd Sept.?In the same previous evening ; temperature ioo?. The quinine and iodide of potassium mixture, continued fomentation ; evening temthe turpentine mixture and perature 100?. still little but present, the quitympanitis improved, 3rd.?A nine mixture stopped and the turpentine mixture continued. ...
...
4th, 5th
...
...
and 6//^?Turpentine mixture continued,
[February, 1884.
7tli,?Tympanitis somewhat relieved; had two motions through the wound ; looked weak ; rum mixture ordered to be given every 4 hours. gth.?Had fever last night, for which ten grains of quinine administered in the morning. loth.?'The turpentine and rum mixtures were continued till the 14th when diarrhoea set in, on account of which the turpentine was stopped and twenty grains of compound kino powder ordered three times a day. This was continued up to the 20th, when the diarrhoea stopped. A tonic mixture containing cinchona febrifuge, nitro-muriatic acid and Inf. chiretta was then ordered; enemas of soap and water being administered occasionally. The patient began to pass the greater part of the faeces through the rectum, while only a very small quantity came out of the abnormal opening, whi~.h was covered with a soft pad, lined on the inner surface with a piece of guttapercha tissue. The patient was discharged on the 8th October, 1883. He is now in perfect health, with a very small fistulous opening on the left side communicating with the bowel, through which a small quantity of thin faeces comes out occasionally, while greater part of the evacuations, in fact whole of the faecal matter, is passed per natural opening. Remarks,?The case is a very singular one, and has therefore been sent for publication, it shows how nature pulls life through difficulties of enormous r.ature, while the symptoms are alone being treated with the aim of giving relief to the most marked. I am much indebted to Dr. Ross, the Civil Surgeon of Delhi, for his help in treating this case. Excision of the Upper Maxilla. By Surgeon-Major G. C.Ross. Milka, a Hindu male, aged thirty years, was admitted into the Delhi Civil Hospital on 6th March, 1883, with a large tumour on the right side of his face, connected with the upper maxilla, of the size of a large orange. The tumour was diagnosed to be cancerous, and contained in the interior of the antrum. The patient said that he had had it for the last four He was very weak on admission, and was therefore kept years. on tonic treatment and good food until the 16th of the month, when the operation was commenced with an incision into the skin and subcutaneous tissues down to the bone, commencing with the middle line of the upper lip, going by the side of rhe nose to the inner margin of the lower orbital plate, from which position it was carried over the zygoma. The soft parts having been dissected out, the facial artery compressed with an acupressure needle and spouting arteries tied, the zygoma and the orbital process of the malar were sawn across, the left upper incisor was drawn, the alveolar process sawn through, and the nasal process divided with bone forceps, the palate was sawn through and divided freely with bone forceps ; then the soft palate was divided and the mass removed. Actual cautery was used to stop deep haemorrhage, iron sutures were applied and strips of lint placed in the cavity, Chloroform was stopped after cutting the soft structures, as the patient was weak, but he bore the operation well. Nothing particular happened in the after-treatment, the patient made a good recovery, requiring nothing but stimulants, tonics and good food. He was discharged on the 4th of April, 1883. Dr. Ross is thankful to Dr. Kavanagh and Asst.-Surg. Gokal Chand for assisting him in the operation. Ovariotomy. By Surgeon-Major G. C. Ross. A Hindu female, aged 3 years, showed a tumour in the lower of abdomen on the left side, which she said she had the part had for the last four years. She was weak and emaciated but otherwise healthy, she had the catamenia when admitted, and was therefore detained in hospital for about ten days, during which periodshe was kept on nutritiousdiet. On the 20th of October, 1883, the patient was put under chloroform and an antiseptic spray got ready, an incision about four inches long was then made in the middle line, a little below the navel, and the principal cyst tapped with the ovariotomy trocar ; there were several smaller cysts at the top of this, which were also tapped one by one, abrown fluid measuring twenty pints was removed from the main cyst, while the fluid contained in the smaller cyst was colorless, transparent and tenacious. There were three or four slight adhesions with the intestines, which were easily torn through. One cord-like substance connected with the tumour came from the upper part of the abdomen, apparently from the liver, this was tied with a whipcord, divided and dropped unto the abdominal cavity. The pedicle, which was broad but not very thick, was then held in the clamp, tied in two parts with pieces of whipcord, looped to each other, and was then kept out of the incision in the hold of the clamp. In the operation the connection o? the pedicle with the left side of the uterus could
February, 1884.] be
THE CENSUS OF BENGAL.
distinctly
made out. The operation took about an hour and-adone entirely under spray. The woman seemed inclined to vomit, but did not do so. She was brought round with some difficulty, the pulse having once become quite imperceptible. The wound was dressed antiseptically, four silver wire sutures applied in the wound, the pedicle in the clamp having been kept in its lower end. No hsemorrhage occurred during the operation. Fifteen minims of ether were injected into the arm soon after the operation. Small quantities of ether and brandy were given every 15 minutes from 11 a.m. to 4 p.m. In the evening the temperature was 99"8? and pulse ^o. l'orty minims of laudanum were given in two doses at night. Slept Not October.? 21st pretty well; diet, milk and khir. depressed,
half,
and
was
morning temperature 98 "4?.
Two grains of quinine and one of opium were given every 4 hours and 40 minims of tincture opii at night up to the 27th, when the dressings were changed for the first time under spray and an enema applied. The temperature ranged between 100 and ioi?up to the 26th, when it fell to normal and never rose again, although for some days it was below normal on account of the weakness of the patient. The enema was repeated on the 28th ; she got a little cough on the 29th, when Dover's powder was given in three-grain doses thrice daily for two days. Citrate of iron and quinine was ordered on the 31st and continued for four days, but she then got constipated and therefore it was stopped. The patient was dressed (of course always antiseptically) on the 27th October, 1st and 4th November, the clamp was removed on the latter date, though it had not separated itself; the whipcord ligatures were then removed. It must also be added that all the silver sutures were removed on 27th October, except one close to the pedicle, which was removed on 4th November, 1883. The patient was again dressed on the 9th, when the dead portion of the pedicle was cut off as much as was possible. The temperature never rose after 26th October. The patient was discharged quite cured and in good health on
15th November, 1883.
Remarks,?Our thanks are due to Dr. Ravanagh for his assistance in the operation. The patient made such a steady progress towards recovery that no remarks seem necessary, except that the keeping of the pedicle in the clamp was much regretted afterwards, as it was only this that obliged the patient to remain in hospital for 24 days, while otherwise she woidd have, with such a favourable progress, been discharged on the 10th or 12th day, as the wound had healed up at the time, when the dressing was changed on the first occasion, except that part of the wound There was no disheld in the clamp. the
containing
charge
pedicle pedicle.
around the
St
