ovary can be palpated and is tender. Diagnosis of chronic ovaritis and salpingitis on right side was made. The pain was so severe that morphia had to be given hypodermically, and even when under the influence of morphia the pain was only lulled. Operation, 8th January 1897.?Chloroform, incision 3 inches. Tumor came at once into view with omentum matted over it. The omentum was separated, secured in sections and the inflamed portions subsequently cut away. The right Fallopian tube was found considerably enlarged and dilated with what appeared to be an ovarian c}7st behind it and attached to it, and another rounded and more solid body in close connection with it. The cyst was tapped with a small Fitch's trocar and some dark yellow-green fluid escaped. The tumour behind was then punctured with an exploratory trocar and the walls were found to be very thick, dark thick blood escaped and bright arterial blood came from the puncture. The tube and swelling could then be drawn forward and the uterus with left ovary and tube free and healthy were found lying behind and to left. The tumour was then recognized to be the right half of a double uterus with a dilated tube and cystic ovary, and the round ligament was traced coming on the more solid tumour at its outer angle. The right half of the uterus with tube and ovary were secured by loops of No. 4 silk passed deeply in the broad ligament, one loop passing through the wall of the left half of the uterus at about the level of the os internum, and the parts then The pelvis was sponged dry, and the cut away. abdomen closed by silk-worm gut sutures. A drain tube was placed in Douglas' pouch. Note on parts removed.?The parts removed consist of the right half of a uterus bicornis UTERUS BICORNIS WITH ATRESIA OF unicollis with a greatly dilated Fallopian tube RIGHT CERVIX HJEMATOMETRA and a diseased and cystic right ovary, also porAND HEMATOSALPINX CYSTIC tions of matted omentum, the tube ovary and uterus being also closely matted together by adheOVARY?REMOVAL OF RIGHT sion. On opening the removed portion of uterHALF OF UTERUS WITH us the walls were found to be about the normal RIGHT TUBE AND OVARY: the cavity dilated and containing thickness, RECOVERY. some thick blood, the endometrium has the The patient, a Hindu, aged 28 years, married, appearance of a thin menstrual decidua. The 4 children, no abortions, 2 years since birth df tube was also distended with blood, the uterine last child. Duration of illness 8 months. She was end patent, but the pavilion of the tube comfirst seen at the Government Maternity Hospital municating by an opening with the ovary which on the 4th January 1897, suffering from severe was generally cystic and also contained thick in the lower abdomen, shooting along the blood in a cavity about the size of a large walpain right thigh. Pain constant but becoming nut. The rest of the ovaiy showed numerous violent at times. Menstruation regular but small cysts. Progress of case.?Patient made an uninterscanty and lasting only one day, last period ceased 20 days ago. Physical signs : There is rupted recovery. Drain tube was removed about a circumscribed swelling about 5"X 3" occupy- 30 hours after operation, only pink serum having hypogastric, umbilical and right iliac ing been drawn off. Temperature never was regions. The tumour is fairly movable in the above 98'4? F. Highest pulse was 96 on the abdomen. Per vaginam: Uterus appears to first day. Slight metrostaxis occurred on the 3rd, be slightly enlarged, and there is a rounded 4th, and 5th days. Stitches were all removed on tumour to the front and right side of it. Left the 8th da}', when the wound was well healed. d

256

THE INDIAN MEDICAL GAZETTE.

20tli January.?By bi-manual examination cervix is high up, median in position, body of uterus lying to left of middle line, no pain or thickening felt anywhere in the pelvis. Patient practically well. 3rd February?By speculum examination cervix has a natural appearance. Sound passes upwards and a little to the left 2f inches. No opening found to the right. 11th February.?Patient discharged quite well.

/

[July

1898.