The sound entered
point passing
for-
in consequence of the exdistension of the abdomen the uterus could
wards and to the treme
be
not
the
2y2 inches,
left, but
localized,
the
nor
cus was
36^ inches, and
rior superior iliac spine
of the sound felt
point
girth at the umbilifrom the navel to the ante-
through
the abdominal wall.
The
inches
9^
each side.
on
General health poor : no cedema of the feet. Patient was kept under observation till the 18th, during which time she had no fever, and took her food well. At
on that day chloroform was given by Mr. and the tumour was removed by ovariotomy, Drs. McLeod and Raye assisting. The incision was
2
p.
m.
Wallace,
about 4^ inches attached wall.
by
Those and
down,
and
long,
the fundus
near
was found abdominal easily broken
the tumour
adhesions to the
numerous
were
large and two small cySts were successively tapped by Sir S. Well's trochar, the united contents measuring 352 fluid ounces. It was then found one
that there
considerable mass of solid tumour by old adhesions to the abdomideep down between the layers of
was a
intimately nal
connected and dipping
wall,
the broad ligament. The adhesions were so intimate that two hours were occupied in getting it away, and the greater part of the broad ligament was removed with it, the pedicle being very broad. The solid portion was as large as a child's head, and weighed 3lbs. 120Z. In breaking down the adhesions about six square inches of the abdominal peritoneum got separated and
of the utero-vesical
SECTION.
By
\
I
A/ J
Surgeon-Major R. Harvey, m.d., Professor of Midwifery, Medical Collect, Calcutta. Case I. set.
Ovariotomy.?Puti,
26, admitted into
a
Bengali
fish woman,
College Hospital never conceived, but
the Medical
10th November 1880. Had had menstruated regularly up to a year before admission, since which she has seen nothing. First noticed a swelling in left iliac fossa three years ago, this has gradually increased in spite of much treatment, chiefly by kobirajs. Had been tapped twice. Urine is scanty and she has lost flesh, but has no
pain
or
fever.
inspection the abdomen was found uniformly enlarged by a smooth oval tumour reaching almost to On
No irreguthe umbilicus, and everywhere resilient. larities could be detected. There was complete dulness over its whole surface, with resonance in the flanks posteriorly. On vaginal examination the os uleri was reached with considerable difficulty, the anterior vaginal wall being bulged downwards by the tumour, which was here hard and somewhat nodular.
was
as
but
ligament,
adhesions that this
the
were
TEN CASES OF ABDOMINAL
removed with the tumour,
were
portion
also
was so
a
intimate
not made out at
the time ; careful examination failed to reveal any injury to the bladder. The pedicle was ligatured with
being along
the
near
catgut
the
by
ligament being cautions
playing
were
ately
then
p.m.
manner.
Full
ligament and edges of the
and the wound
antiseptic
pre-
thymol spray x ?150 kept abdomen throughout. Twenty drops
were
temp. There
full.
brought together
taken and
the
on
of laudanum At 6
of the uterus, the tube vessels were found cut
of the divided broad catgut ligatures, the cut
in the usual
closed
cornu
Several
course
secured
were
right
included in it.
a
ordered every 8 hours.
soft, and modergood deal of sick7-45 P-M- temp. 98?, pulse
97-6?, pulse had been
ness, and
112
a
vomiting. vomiting less. Temp. ioi?. 19th. 1 a.m.
101
Has
;
4 a.m.
?
8
,,
a.m.
slept fairly,
pain. 6]/2
ounces
and
99?. 98?, pulse 101. complains of only
of urine removed
quite natural and with no blood. ice freely. No vomiting. 9-30
.\.
m.?Has
120, slightly hard but
a
little
with catheter
Taking
milk and
vomited twice. Temp. 970,
compressible. Tongue
pulse
clean and
moist. tender.
Complains
1
p.
m.
2
p.
m.
of
some
Abdomen
pain.
98?. 990. 99'6?. Sleeping quietly.
slightly
Temp. ?
5 p- m. ,, No 5-30. p. m. 6 ounces of urine removed.
more
vomiting.
About
7 p.m. a sudden change took place. Temperature ioo'6? with hurried breathing?40 per minute, great restlessness and anxiety. The skin became cold and
clammy,
the extremities cold, and the pulse impercepthe wrist. No pain or vomiting. Collapse gradually deepened and death occurred at 9-30, about 30 hours after the removal of the tumour. On examination 13 hours after death. The brain, heart and lungs were found healthy; the spleen, liver and kidneys pale, and the two latter fatty. Besides the separations of peritoneum already mentioned, " the anterior surface of the uterus was found partly glued by a little recent lymph to the posterior surface of the bladder, and on separating these parts tible
a
at
found in the bladder itself through fingers could be passed easily. The margins of the rent were much thinned and lacerated." The bladder was contracted and empty, and " about two pints of sanguinolent looking fluid having a urinous odour were found in the peritoneal
large
rent
was
which three
cavity." The bladder was no doubt injured in separating the adhesions, and gave way about the time that the urgent symptoms set in some 27 hours after the operation was completed. Case //. Ovariotomy.? Kasidan,
aet.
35, Mussal-
April 1883. States that about a year ago she noticed a small swelling first above the pubes which has gradually increased. Has a child seven years old, and had a miscarriage two years ago. Men. struation regular but scanty, lasting only two or three days. Complains of pain and tenderness over the uiani,
admitted 28th
abdomen. On
inspection the abdomen was found occupied by a tumour reaching to within three inches of the umbilicus and situated rather more to the right
than
to
surface,
Universal dulness in flanks and above. The
the left side. resonance
over
its
tumour
is resilient Stretching between right throughout. anterior superior iliac spine and the navel is a On sulcus dividing the tumour as if by a band. vaginal examination the cervix found pushed forwards: uterus light on the finger. Left vaginal cul-de-sac clear, right partially occupied by the tumour, but the fingers could be made to meet in the iliac fossa entered
combined examination. The sound 2 ^ inches passing to the left, and the uterus was found freely movable, the movements not being communion
cated to the tumour.
prominent part
283
TEN CASES OF ABDOMINAL SECTION.
October, 1884.]
The
of the abdomen
girth was
round
the most
34 inches and the
distance from the navel to the right superior anterior iliac spine was 10 inches, to the left, 9 inches. The heart, lungs, liver and spleen were normal, but the patient was emaciated and exhausted, and there was a good deal of tenderness on pressure. The patient was kept under observation till the 10th May, during which time the highest temperature There were, however, almost constant pain was 99?.
sleeplessness, frequent vomiting, constipation, considerable tympanitis, rapidly increasing after the 6th, and a tendency to collapse and
tenderness,
obstinate from the
7th.
small and
was
The pulse varied from xoo to 120, and thready. Her general condition was
rapidly changing ation
for the worse, and immediate operon as giving the only chance of
resolved
was
life. It
performed at 10 a. m. on Temperature being normal when the operation was begun in was
May. 100, L)rs. On
and
Coates, Raye,
opening
McLeod,
the abdomen the
the and
iotli
pulse
presence of
and Mr. Wallace.
peritoneum
was
found
universally inflamed and glued to the anterior surface These adhesions of the tumour by recent lymph. were easily broken down and the cyst tapped, about fluid
Numerous behind and at the sides, but these also were broken down without difficulty. The pedicle was about broad, There and was secured with a strong silk ligature. was very little hemorrhage considering the number The of adhesions, and no ligatures were required. wound was then closed and dressed in the usual Full antiseptic precautions were observed way. throughout. The patient vomited twice during the operation, and was very low at the end of it, the pulse being small and thready. There was no attempt at reaction, and she died of shock in seven hours. A post-mortem examination could not be obtained. Ovariotomy.?Mrs. H., set. 29, EuroCase. III. the Eden Hospital 2nd June 1884, into admitted pean, seven
pints
adhesions
of brown
glairy
escaping.
to the omentum and bowels were found
following history:?About two years ago right iliac region about the size of a walnut. On the 21st February 1883 she came to the out-patient department, when it was found to the right lower half of abdomen, and to be as large as a man's head, freely movable and not adherent. with the
noticed
a
tumour in the
She became pregnant in May, and was confined of Since which her seventh child in February last. time the tumour has increased rapidly in size, and for the last nine or ten days has been very tender and
painful.
On examination
ated tumour
was
a
smooth, resilient, centrally situ-
found
to within three Percussion note dull above it and in the flanks,
extending
inches of the ensiform cartilage. all
over
its
change
of
surface; position
resonant
does not alter
which is very tender.
Uterus
position of tumour, freely movable, ante?
THE INDIAN MEDICAL GAZETTE.
234
flexed;
sound enters three inches, and point symphysis; and right vaginal
be fornix
can
above
felt
bulged downwards, left natural girth 34^". Right anterior superior iliac spine to navel 7 left 8". Case a as of monocyst diagnosed right ovary, with adhesions and peritonitis. Present health good; liver, spleen, and kidneys normal. io(h, 2-13 p. m.?Chloroform given by Dr. Beatson, Drs. Bird and Greenhill, and Mr. Davis assisting. An incision 2y2" long, afterwards increased to 3^," made down to the
peritoneum, which was found much 6 inches, and universally attached to the surface of the tumour by recent adhesions, easily broken down, but very vascular. A good deal of blood was lost, but no vessel required ligature. thickened?about
On pushing Wells' trocar into the cyst nothing at first flowed, but on moving it about, above 3 pints of muddy fluid mixed with frothy-like material came The cyst
away.
difficulty
was
At last
the wound.
feel
a
turing
was
Scotch it with
porridge-like
nearly emptied,
not
experienced a
mass,
Haggis, a
in
and
some
getting it up through resembling in look and
was
got up, and
on
punc-
scalpel several pounds of thick escaped. The cyst was then
matter
and
be attached by a the right ovary, and twisted 3^4 times on itself from right to left. This was untwisted, secured with a strong silk ligature Tait's Staffordshire and divided half an knot, by inch above the ligature. The stump was then seared with a Pacquelin's cautery and dropped in, the
got
out,
was
found
long pedicle springing
to
from
peritoneal cavity carefully sponged out, wound closed with six silk stitches. The peritoneum was of a deep port wine colour as The operation lasted an far as could be seen. hour and four minutes, and was well borne. Full an tiseptic precautions were used with a moderate spray
pelvis
and
and the
current.
[October, 18&4.
which has increased rapidly since. The admission was from about the size of the pregnant uterus at 7 months, situated more to right than left side, uniformly smooth, resilient, and freely Percussion gave a dull note over the movable. whole surface, and there was a corona of resonance at the margins changing its position with that of the tumour. On vaginal examination uterus was found small and light, displaced backwards and to left. Left vaginal cul dc sac clear, right occupied by a soft elastic swelling continuous with tumour. Sound entered 2^ inches, and uterus was found to be freely
right side,
tumour on
movable
independently of the tumour. The patient had lost flesh and was very nervous. She had had fever in April; temperature reaching 104? on several
occasions. The general health was, however, good, and the case considered a very favorable example of a monocystic non-adherent ovarian tumour. 8th
July, 2-15 p.m.?Patient chloroformed by
Clarke?present,
Davis and Clements. The
Dr.
Drs. Coates and O'Brien and Messrs.
Incision 3 inches
: no
adhesions.
punctured and 88 oz. of muddy fluid drawn off by Wells' trochar. Cyst was then easily extracted and found to be attached by a pedicle 1 inch broad. This was transfixed and secured by a Staffordshire knot. There was no bleeding, and the sponges passed into the pelvis came up unstained. The wound was closed with four silk sutures, and the whole operation was completed within half an hour. The tumour was unilocular with a portion of little changed ovarian tissue close to pedicle, and three or four small cysts about the size of a pea on its posterior wall. The operation was well borne; the pulse being 84 at its close. Full antiseptic precautions were taken with a moderate spray. sac was
There to 102'6?
was a on
little
pain
and
a
rise of temperature
the afternoon of the
9th,
and
again
the nth, coincident with some collection of wind in the bowel, off after and passing these with but turpentine stupes; exceptions the temperature seldom exceeded 990, and there was On the 12th the wound never any cause for anxiety. vas dressed without spray as the dressings were found stained, the discharge was purulent but sweet. Two stitches were removed on the 13th, the others on the 14th. There was free suppuration from the wound till about the 28th, and the wound did not finally close till the oth^r day, but the discharge was never foetid. on
The temperature rose to ioo? at midnight, but was above 99?, and the recovery was unin-
never after
terrupted.
The
wound
was
dressed for the first
time on the fourth day under carbolic acid spray and two stitches were removed. The others were taken out next day, when suppuration was found to have occurred in the course of five of them. The silk had been steeped in carbolic lotion before the operation. These abscesses delayed the healing of the wound, and on the 28th there were slight symptoms of cellulitis in the abdominal wall, which yieldThe wound was solidly ed at once to a small blister. healed on 1st July, and she was discharged on the 12th. The tumour was unilocular and weighed with its contents 6 y2 lbs. Case 1V.
Ovariotomy.?Mrs.
E
,
ait. 50,
Jewess,
admitted 6th July 1S84. Last January she noticed a lum^ about the size of the foetal head at term in the
???
Case V. Ovariotomy. Uncompleted operation.? Gundhri, jet. 30, Hindu, admitted on 9th February 1884 with the following history :?-Had one child eight Menstruation regular but scanty. About years ago. a year ago first noticed a tumour, as she says, in the left iliac region which has rapidly increased, causing
dyspnoea,
constant
pain
in the
abdomen, and
d ifficulty
?
point passing
for-
in consequence of the exdistension of the abdomen the uterus could
wards and to the treme
be
not
the
2y2 inches,
left, but
localized,
the
nor
cus was
36^ inches, and
rior superior iliac spine
of the sound felt
point
girth at the umbilifrom the navel to the ante-
through
the abdominal wall.
The
inches
9^
each side.
on
General health poor : no cedema of the feet. Patient was kept under observation till the 18th, during which time she had no fever, and took her food well. At
on that day chloroform was given by Mr. and the tumour was removed by ovariotomy, Drs. McLeod and Raye assisting. The incision was
2
p.
m.
Wallace,
about 4^ inches attached wall.
by
Those and
down,
and
long,
the fundus
near
was found abdominal easily broken
the tumour
adhesions to the
numerous
were
large and two small cySts were successively tapped by Sir S. Well's trochar, the united contents measuring 352 fluid ounces. It was then found one
that there
considerable mass of solid tumour by old adhesions to the abdomideep down between the layers of
was a
intimately nal
connected and dipping
wall,
the broad ligament. The adhesions were so intimate that two hours were occupied in getting it away, and the greater part of the broad ligament was removed with it, the pedicle being very broad. The solid portion was as large as a child's head, and weighed 3lbs. 120Z. In breaking down the adhesions about six square inches of the abdominal peritoneum got separated and
of the utero-vesical
SECTION.
By
\
I
A/ J
Surgeon-Major R. Harvey, m.d., Professor of Midwifery, Medical Collect, Calcutta. Case I. set.
Ovariotomy.?Puti,
26, admitted into
a
Bengali
fish woman,
College Hospital never conceived, but
the Medical
10th November 1880. Had had menstruated regularly up to a year before admission, since which she has seen nothing. First noticed a swelling in left iliac fossa three years ago, this has gradually increased in spite of much treatment, chiefly by kobirajs. Had been tapped twice. Urine is scanty and she has lost flesh, but has no
pain
or
fever.
inspection the abdomen was found uniformly enlarged by a smooth oval tumour reaching almost to On
No irreguthe umbilicus, and everywhere resilient. larities could be detected. There was complete dulness over its whole surface, with resonance in the flanks posteriorly. On vaginal examination the os uleri was reached with considerable difficulty, the anterior vaginal wall being bulged downwards by the tumour, which was here hard and somewhat nodular.
was
as
but
ligament,
adhesions that this
the
were
TEN CASES OF ABDOMINAL
removed with the tumour,
were
portion
also
was so
a
intimate
not made out at
the time ; careful examination failed to reveal any injury to the bladder. The pedicle was ligatured with
being along
the
near
catgut
the
by
ligament being cautions
playing
were
ately
then
p.m.
manner.
Full
ligament and edges of the
and the wound
antiseptic
pre-
thymol spray x ?150 kept abdomen throughout. Twenty drops
were
temp. There
full.
brought together
taken and
the
on
of laudanum At 6
of the uterus, the tube vessels were found cut
of the divided broad catgut ligatures, the cut
in the usual
closed
cornu
Several
course
secured
were
right
included in it.
a
ordered every 8 hours.
soft, and modergood deal of sick7-45 P-M- temp. 98?, pulse
97-6?, pulse had been
ness, and
112
a
vomiting. vomiting less. Temp. ioi?. 19th. 1 a.m.
101
Has
;
4 a.m.
?
8
,,
a.m.
slept fairly,
pain. 6]/2
ounces
and
99?. 98?, pulse 101. complains of only
of urine removed
quite natural and with no blood. ice freely. No vomiting. 9-30
.\.
m.?Has
120, slightly hard but
a
little
with catheter
Taking
milk and
vomited twice. Temp. 970,
compressible. Tongue
pulse
clean and
moist. tender.
Complains
1
p.
m.
2
p.
m.
of
some
Abdomen
pain.
98?. 990. 99'6?. Sleeping quietly.
slightly
Temp. ?
5 p- m. ,, No 5-30. p. m. 6 ounces of urine removed.
more
vomiting.
About
7 p.m. a sudden change took place. Temperature ioo'6? with hurried breathing?40 per minute, great restlessness and anxiety. The skin became cold and
clammy,
the extremities cold, and the pulse impercepthe wrist. No pain or vomiting. Collapse gradually deepened and death occurred at 9-30, about 30 hours after the removal of the tumour. On examination 13 hours after death. The brain, heart and lungs were found healthy; the spleen, liver and kidneys pale, and the two latter fatty. Besides the separations of peritoneum already mentioned, " the anterior surface of the uterus was found partly glued by a little recent lymph to the posterior surface of the bladder, and on separating these parts tible
a
at
found in the bladder itself through fingers could be passed easily. The margins of the rent were much thinned and lacerated." The bladder was contracted and empty, and " about two pints of sanguinolent looking fluid having a urinous odour were found in the peritoneal
large
rent
was
which three
cavity." The bladder was no doubt injured in separating the adhesions, and gave way about the time that the urgent symptoms set in some 27 hours after the operation was completed. Case //. Ovariotomy.? Kasidan,
aet.
35, Mussal-
April 1883. States that about a year ago she noticed a small swelling first above the pubes which has gradually increased. Has a child seven years old, and had a miscarriage two years ago. Men. struation regular but scanty, lasting only two or three days. Complains of pain and tenderness over the uiani,
admitted 28th
abdomen. On
inspection the abdomen was found occupied by a tumour reaching to within three inches of the umbilicus and situated rather more to the right
than
to
surface,
Universal dulness in flanks and above. The
the left side. resonance
over
its
tumour
is resilient Stretching between right throughout. anterior superior iliac spine and the navel is a On sulcus dividing the tumour as if by a band. vaginal examination the cervix found pushed forwards: uterus light on the finger. Left vaginal cul-de-sac clear, right partially occupied by the tumour, but the fingers could be made to meet in the iliac fossa entered
combined examination. The sound 2 ^ inches passing to the left, and the uterus was found freely movable, the movements not being communion
cated to the tumour.
prominent part
283
TEN CASES OF ABDOMINAL SECTION.
October, 1884.]
The
of the abdomen
girth was
round
the most
34 inches and the
distance from the navel to the right superior anterior iliac spine was 10 inches, to the left, 9 inches. The heart, lungs, liver and spleen were normal, but the patient was emaciated and exhausted, and there was a good deal of tenderness on pressure. The patient was kept under observation till the 10th May, during which time the highest temperature There were, however, almost constant pain was 99?.
sleeplessness, frequent vomiting, constipation, considerable tympanitis, rapidly increasing after the 6th, and a tendency to collapse and
tenderness,
obstinate from the
7th.
small and
was
The pulse varied from xoo to 120, and thready. Her general condition was
rapidly changing ation
for the worse, and immediate operon as giving the only chance of
resolved
was
life. It
performed at 10 a. m. on Temperature being normal when the operation was begun in was
May. 100, L)rs. On
and
Coates, Raye,
opening
McLeod,
the abdomen the
the and
iotli
pulse
presence of
and Mr. Wallace.
peritoneum
was
found
universally inflamed and glued to the anterior surface These adhesions of the tumour by recent lymph. were easily broken down and the cyst tapped, about fluid
Numerous behind and at the sides, but these also were broken down without difficulty. The pedicle was about broad, There and was secured with a strong silk ligature. was very little hemorrhage considering the number The of adhesions, and no ligatures were required. wound was then closed and dressed in the usual Full antiseptic precautions were observed way. throughout. The patient vomited twice during the operation, and was very low at the end of it, the pulse being small and thready. There was no attempt at reaction, and she died of shock in seven hours. A post-mortem examination could not be obtained. Ovariotomy.?Mrs. H., set. 29, EuroCase. III. the Eden Hospital 2nd June 1884, into admitted pean, seven
pints
adhesions
of brown
glairy
escaping.
to the omentum and bowels were found
following history:?About two years ago right iliac region about the size of a walnut. On the 21st February 1883 she came to the out-patient department, when it was found to the right lower half of abdomen, and to be as large as a man's head, freely movable and not adherent. with the
noticed
a
tumour in the
She became pregnant in May, and was confined of Since which her seventh child in February last. time the tumour has increased rapidly in size, and for the last nine or ten days has been very tender and
painful.
On examination
ated tumour
was
a
smooth, resilient, centrally situ-
found
to within three Percussion note dull above it and in the flanks,
extending
inches of the ensiform cartilage. all
over
its
change
of
surface; position
resonant
does not alter
which is very tender.
Uterus
position of tumour, freely movable, ante?
THE INDIAN MEDICAL GAZETTE.
234
flexed;
sound enters three inches, and point symphysis; and right vaginal
be fornix
can
above
felt
bulged downwards, left natural girth 34^". Right anterior superior iliac spine to navel 7 left 8". Case a as of monocyst diagnosed right ovary, with adhesions and peritonitis. Present health good; liver, spleen, and kidneys normal. io(h, 2-13 p. m.?Chloroform given by Dr. Beatson, Drs. Bird and Greenhill, and Mr. Davis assisting. An incision 2y2" long, afterwards increased to 3^," made down to the
peritoneum, which was found much 6 inches, and universally attached to the surface of the tumour by recent adhesions, easily broken down, but very vascular. A good deal of blood was lost, but no vessel required ligature. thickened?about
On pushing Wells' trocar into the cyst nothing at first flowed, but on moving it about, above 3 pints of muddy fluid mixed with frothy-like material came The cyst
away.
difficulty
was
At last
the wound.
feel
a
turing
was
Scotch it with
porridge-like
nearly emptied,
not
experienced a
mass,
Haggis, a
in
and
some
getting it up through resembling in look and
was
got up, and
on
punc-
scalpel several pounds of thick escaped. The cyst was then
matter
and
be attached by a the right ovary, and twisted 3^4 times on itself from right to left. This was untwisted, secured with a strong silk ligature Tait's Staffordshire and divided half an knot, by inch above the ligature. The stump was then seared with a Pacquelin's cautery and dropped in, the
got
out,
was
found
long pedicle springing
to
from
peritoneal cavity carefully sponged out, wound closed with six silk stitches. The peritoneum was of a deep port wine colour as The operation lasted an far as could be seen. hour and four minutes, and was well borne. Full an tiseptic precautions were used with a moderate spray
pelvis
and
and the
current.
[October, 18&4.
which has increased rapidly since. The admission was from about the size of the pregnant uterus at 7 months, situated more to right than left side, uniformly smooth, resilient, and freely Percussion gave a dull note over the movable. whole surface, and there was a corona of resonance at the margins changing its position with that of the tumour. On vaginal examination uterus was found small and light, displaced backwards and to left. Left vaginal cul dc sac clear, right occupied by a soft elastic swelling continuous with tumour. Sound entered 2^ inches, and uterus was found to be freely
right side,
tumour on
movable
independently of the tumour. The patient had lost flesh and was very nervous. She had had fever in April; temperature reaching 104? on several
occasions. The general health was, however, good, and the case considered a very favorable example of a monocystic non-adherent ovarian tumour. 8th
July, 2-15 p.m.?Patient chloroformed by
Clarke?present,
Davis and Clements. The
Dr.
Drs. Coates and O'Brien and Messrs.
Incision 3 inches
: no
adhesions.
punctured and 88 oz. of muddy fluid drawn off by Wells' trochar. Cyst was then easily extracted and found to be attached by a pedicle 1 inch broad. This was transfixed and secured by a Staffordshire knot. There was no bleeding, and the sponges passed into the pelvis came up unstained. The wound was closed with four silk sutures, and the whole operation was completed within half an hour. The tumour was unilocular with a portion of little changed ovarian tissue close to pedicle, and three or four small cysts about the size of a pea on its posterior wall. The operation was well borne; the pulse being 84 at its close. Full antiseptic precautions were taken with a moderate spray. sac was
There to 102'6?
was a on
little
pain
and
a
rise of temperature
the afternoon of the
9th,
and
again
the nth, coincident with some collection of wind in the bowel, off after and passing these with but turpentine stupes; exceptions the temperature seldom exceeded 990, and there was On the 12th the wound never any cause for anxiety. vas dressed without spray as the dressings were found stained, the discharge was purulent but sweet. Two stitches were removed on the 13th, the others on the 14th. There was free suppuration from the wound till about the 28th, and the wound did not finally close till the oth^r day, but the discharge was never foetid. on
The temperature rose to ioo? at midnight, but was above 99?, and the recovery was unin-
never after
terrupted.
The
wound
was
dressed for the first
time on the fourth day under carbolic acid spray and two stitches were removed. The others were taken out next day, when suppuration was found to have occurred in the course of five of them. The silk had been steeped in carbolic lotion before the operation. These abscesses delayed the healing of the wound, and on the 28th there were slight symptoms of cellulitis in the abdominal wall, which yieldThe wound was solidly ed at once to a small blister. healed on 1st July, and she was discharged on the 12th. The tumour was unilocular and weighed with its contents 6 y2 lbs. Case 1V.
Ovariotomy.?Mrs.
E
,
ait. 50,
Jewess,
admitted 6th July 1S84. Last January she noticed a lum^ about the size of the foetal head at term in the
???
Case V. Ovariotomy. Uncompleted operation.? Gundhri, jet. 30, Hindu, admitted on 9th February 1884 with the following history :?-Had one child eight Menstruation regular but scanty. About years ago. a year ago first noticed a tumour, as she says, in the left iliac region which has rapidly increased, causing
dyspnoea,
constant
pain
in the
abdomen, and
d ifficulty
?
