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A SUCCESSFUL CASE OF OVARIOTOMY.Reported by

THEODORE MORGAN, M.B.,ASSISTANT COLONIAL SURGEON IN CHARGE OF THE CIVIL HOSPITAL,

POINT DE GALLE, CEYLON.

HINGOHAMY, a spare Sinhalese woman, aged forty years’was admitted into the hospital at this station on the 25thof February, 1876, with the following history :-She is themother of three children; the last one being fourteenyears old. About ten months after the birth of this child,she perceived the first indication of a distension in the leftside of her abdomen. The tumour subsequently increasedin size, till it occupied the right side and reached two inchesabove the umbilicus. During this time the patient neversuffered from any irregularity of her menstruation.February 28th having been fixed for the operation, the

walls and ceiling of the operating and patient’s rooms weresplashed with a solution of carbolic acid, and ventilated bymeans of revolving fans, treated in the same way. Dr.Anthonisz, with the aid of Dr. Maxham, staff-surgeon,having seen that the patient was well under chloroform,exposed the tumour by an incision three inches long on thelinea alba, tapped the contents, and, as the sac was beingemptied, drew it out gradually, exposing the pedicle andinadvertently causing a knuckle of the intestine to pro-trude. Some clean lint and a towel were immediatelythrown over it, and the windows closed, to protect it fromany change in the temperature. The bowel was next care-fully replaced, and a double hemp ligature was passedthrough the pedicle, which was secured in two halves, anda second ligature put round it, and the growth was detachedfrom its pedicle and removed. It was free from adhesionsto the neighbouring structures, though, from the shortnessof the pedicle, a portion of the left Fallopian tube was un-avoidably removed. A vertical incision was next made onthe left side, half an inch long, on the margin of Poupart’sligament, through the abdominal wall. The pedicle being returned into the abdomen, one end of the ligature wasdrawn through this opening so as to make the divided sur-face of the pedicle rest on the edges of the wound, andsecured externally. The lips of the median wound werenext brought together by the aid of three long needles, andthe other end of the ligature secured outside this opening.Layers of lint soaked in a solution of carbolic acid, and abroad bandage round the abdomen, completed the dressing.The patient, still under chloroform, was removed into

another room, the door of which was provided with a curtain,which had been exposed to the action of carbolic acid. On

recovering consciousness she was desired to preserve a

semi. recumbent position and to keep quiet. Ordered two

grains of opium every three hours. She slept well, and nextmorning (February 29th) her temperature was 102° and

pulse 112. She had passed no urine, and was relieved by acatheter. The inguinal dressing was saturated with dis-charge. Opium continued every fourth hour; arrowrootand milk diet. On the 1st March the temperature anddiet were the same as on the previous day, and the dressingswere renewed. The opium was reduced to one grain. Next

day (March 2nd) the temperature was 102° and pulse 100.Urine had to be drawn off on this as well as on the precedingday. On the 4th there was no fever ; the bowels were re-lieved by enema on the 5th, and the opium was then dis-continued. On the 8th the needles were withdrawn, as thewound had healed, excepting a little spot round the liga-ture. On the 20th the end of the ligature in the medianincision came away, and was followed on the 27th by thedetachment of the other end in the groin. The case pro-gressed without an untoward symptom, and was dischargedfrom hospital on the 16th April, forty-nine days after theoperation.

In concluding the report of this interesting case, atten-tion’ may briefly be drawn-first, to the " antiseptic" pre-cautions taken during the operation and subsequent treat-ment : the object throughout was to provide and maintaina carbolised atmosphere, as far as the appliances in hospitalpermitted. Secondly, to the counter-opening above the leftgroin, which allowed of a ready escape for discharge, for itmay reasonably be supposed that but for some such pro-

vision mischief may have resulted from the retention ofseptic material. It will be observed that on the third daythe discharge had ceased, and the ligature used as drainagetube felt dry, the pulse simultaneously falling in frequency.Thirdly, to the semi-recumbent position of the patient,which tended greatly to favour that object.

It is also necessary to add that for ten days after theoperation care was taken, by means of compress and

bandage, to prevent the intestines from occupying the spaceleft vacant by the removal of the tumour.

ACUTE RHEUMATISM; PERICARDITISPNEUMONIA; HYPERPYREXIA;

DEATH.

BY STEWART LOCKIE, M.D.

J. R. M aged twenty-seven, with old acute curvatureof the spine, commenced to have pain and stiffness in theknees and ankles on March llth, 1876, but walked aboutat his occupation until the 13th, when he was obliged tostay in the house. Next morning the pains were muchworse, and compelled him to remain in bed.March 14th.-Evening: Was seen for the first time; has

pain in knees, ankles, feet, and shoulders; there is slightswelling of right knee and ankle. First cardiac sound in-distinct ; no bruit. Temperature 103 4"; pulse 136. Tohave fifteen grains of salicin every three hours.15th.-Morning: Has had scarcely any sleep daring the

night. There is slight pericardial friction at mid-sternum.Temperature 1032°; pulse 136.16th.-Morning: Had a better night, with some amount

of sleep. Pain in the knees much better. Considerablepain in right wrist and hand. Has felt ° a tightness"across the chest from an early hour this morning. Has atroublesome cough, with frothy expectoration. Pericardiacfriction sound marked, loudest over apex. Temperature101 4°; pulse 144. Urine of a dark sherry colour, turbid,acid; specific gravity 1028; clears on first application ofheat, then deposits a trace of album en.-Even ing : Coughless troublesome. Temperature 103 7°; pulse 142; respira-tion 24.

17th.-Morning : Had a comparatively easy night. Jointpains much better. Transverse cardiac dulness increased;friction inaudible at apex, but heard at centre of cardiacarea. Dulness and small crepitations over lower half ofleft lung. Temperature 1028°; pulse 144; respiration 26.Dose of salicin increased to twenty-five grains every threehours.-Evening : Has been very restless during the day,and is so still. Cough very troublesome. Temperature103.1°; pulse 150; respiration 26. To have fifteen minimsof Battley’s sedative solution d opium at once, the dose tobe repeated if restlessness continues ; to have also half anounce of whisky twice during the night.l5th.-Morning: Took both doses of opium, and had

some sleep, with intervals of deliiium. There is presentconsiderable nervous agitation, and the eyes have a wildappearance; slight lividity of countenance. There is

scarcely any pain. Cardiac dulness the same as yesterday.Temperature 1046°; pulse 156; respiration 28. Blisterover heart; whisky increased to half an ounce every twohours.-4 30 P.M.: Delirious. Temperature 105.1°; pulse14t; respiration 32. To discontinue salicin, and to havefive grains of sulphate of quinine. Anticipating a further riseof temperature, and as there was no bath in the house, aportable one was borrowed, and a porter engaged to conveyit to the house.-8.50 P.M.: Is still delirious. Temperature105.4°; pulse 144; respiration 38. Ten grains more ofquinine were administered. To have half an ounce ofwhisky every hour. He was evidently sinking fast, andthrough some mistake the bath had not been brought. At11 p.az. my assistant and I left him in order to see personallywhy the bath had not been sent. On our return the tem-perature was 107.1°; pulse very feeble. The bath had justarrived, and water was being poured into it, when the patientdied. The temperature a few minutes after death was107.1°.

I regret extremely that, through the negligence of the