honor of Ephraim McDowell, M.D., of Kentucky, the founder of ovariotomy. The appeal for aid to the project is first made to the women of the world who have been rescued by ovariotomy; next to the members of the medical profession, whose resources, have been so greatly increased; lastly to, all who appreciate this advance in surgery, and its originator as worthy of the gratitude of the human race. All contributions to the memorial fund should be sent by money order or registered letter, addressed to Dr. James M. Kellar, No. 58 Green Street, Louisville, Ky., who has been appointedsecretary and treasurer by the committee.-(Boston Med. and Surg. Journal. A DIFFICULTY IN FOETAL AUSCULTATION.-Dr. TREATMENT OF UTERINE FIBROID BY HYPODER- It is contemplated to erect a memorial statue in MIC INJECTIONS OF ERGOTINE.-Dr. Theophilus Parvin records (American Practitioner, May, 1874) three cases of uterine fibroid, in which marked benefit followed the hypodermic administration of ergot. In all the cases heretofore treated, so far as Dr. Parvin knows, the ergotine has been administered with glycerine, which Dr. J. T. Bowls, of Knightstown, Indiana, states to be a needless, and maybe injurious, addition, causing in some cases painful inflammation and threatening abscesses, which was not observed when the glycerine was omitted, and the efficiency of the injection was not found to be lessened.-Dr. A. Reeves Jackson reported to the Chicago Society of Physicians and Surgeons (Chicago Medical Fournal, June. 1874) five cases of fibrous tumor of the uterus treated by the method of Hildebrandt, and in three of them with decidedly favourable results. Dr. Jackson J. Braxton Hicks calls attention to a point with reobtained the best results from a solution prepared gard to the diagnosis of pregnacy and the life of according to the following form: "Fifty grains of the foetus, by means of the existence of the fœtal the extract (Squibb's) are dissolved in two hundred heart-sounds-which he had not unfrequently oband fifty minims of water, the solution filtered and served in the course of his practice, but which he made up to three hundred minims, by passing water does not remember to have seen in print-and through the filter to wash it and the residue summed up his observations as follows: First, It represents ergot, grain for minim, free from that the number of vibrations of the abdominal alcohol or other irritating substance." Latterly muscles in a state of half-suspension can be dishe has used this solution exclusively, and thus far tinctly counted, watch in hand; second, that has seen no irritition, pain, or inflammation result their number and sound is so like those of a very from it. He no longer selects the abdomen as the rapid foetal heart that they may be mistaken for site for injection. Although some parts of the them.-Philadelphia Medical Reporter-Medical abdominal wall-as about the umbilicus, for exExaminer. ample-may be less sensitive to puncture than others, yet all parts of it are more sensitive than the deltoid region; and, inasmuch as the latter is more convenient, and the injections placed there equally efficacious, he now habitually selects the arm in preference to any other part of the body. Another case was reported to the Society by Dr. J. H. Ethridge, three by Dr. H. P. Merriman, and one by Dr. S. Fisher, in all of which beneficial results followed the hypodermic use of ergotine.American Fournal of Medical Sciences, July, 1874. it. upon NO ANTAGONISM BETWEEN STRYCHNIA AND MORPHIA. The opinion that the life of animals poisoned by strychnia may be saved by morphia, was not supported by recent experiments made with animals. Dr. Froehlick, under the guidance of Prof. Rossbach, undertook to examine the behaviour of rabbits, placed under the influence of the alkaloids. He fixed the smallest lethal dose of strychnia and morphia, administered then first either the strychnia, and after some time the morphia, or vice versa. The animals were taken by tetanic cramps and died. When a mediate or deep morphia narcosis was obtained, the action of strychnia was more striking.-Schmidt's Fahrb., Fuly, 1874.-Detroit Med. Review. TREATMENT OF SPASMODIC ASTHMA.-Dr. Julio J. Lamadrid recommends the combination of chloral hydrate with the bromide of potassium in the treatment of spasmodic asthma. The following is the formula which he employs : B-Chloral hydrat.... aa........ Aqæ dest., aa.... .3j. zijss. .....f. zi. Sig. A teaspoonful in half a wineglass of water every two hours, until sleep is induced or dyspnoea is relieved.-Phila. Med. Times, Aug. 29, 1874. FUNCTION OF THE OPTIC THALAMI.-Professor Fothnagel, of Freyburg, gives in a reeent number of the Centralblatt the results of a series of experiments he has performed on rabbits to determine the functions of the optic thalami. They are-1. That these ganglia have nothing whatever to do with the innervation of the voluntary movements. 2. After their extirpation no indications can be obtained of any direct disturbance of the sensibility of the skin. 3. They appear to have immediate relation to the muscular sense. CROUP.-What are diseases which can simulate croup? Dr. H. Roger, of Paris, gives the following reply to this question. 1. (Edema of the larynx, but it is exceedingly rare amongst children, and by the examination of the superior part of the aryteno-epiglottic folds all doubt is removed. 2. The introduction of foreign bodies, such as a cherry-stone, a bean, &c. ; but there is no fever; besides, recollection comes in aid, as well as the other signs of which we have spoken. when fourteen years old, and have always been regular, but painful, till the appearance of the tumor, since which time they have been free from pain. During the menstrual flow cannot lie on the left side; at other times can rest equally on either side. Urinary organs in good order. The bladder is expanded upwards above the pubes, and when the urine does not flow freely it is readily expelled by pressure of the hand. Digestion and appetite good; bowels regular, but for some months has been troubled with flatulence. HISTORY. Is of healthy parentage on the side of both father and mother; all her relatives are in good health. The present ill health began in September, 1870, at which time she had an attack of what her physician called "gravel and inflammation of the 3. Retro-pharyngeal abscess, which gives rise to these symptoms-cough, fever, difficulty of respiration, suffocation; but the examination of the throat suffices to put an end to all idea of croup.-The Doctor. SOOTHING APPLICATION IN HERPES ZOSTER.- bladder." After recovery from this sickness, she R-Collodion, 3 j; Morphiæ muriat., gr. viij.-M. felt a growth in the left groin, which gradually increased in size. In 1871 the tumor grew rapidly To be painted over the vesicles without break- and extended toward the right side. During the ing them open. Read before the Medico-Chirurgical Society of Montreal. Miss Isabella Buchanan, aged 33 years, born in Brantford, Ontario, was examined by me for the first time, in October, 1873, presenting a healthy appearance, of medium height and dark complexion, but somewhat spare in flesh. On special examination, a large globular tumor occupied the abdominal cavity, the abdominal walls very thin, and the skin over the tumor marked by numerous silver lines due to extreme distention; a dark line extends down the middle, and the superficial veins dilated; areolæ of both nipples dark and well marked. The tumor is firm, appears non-adherent, as it can be freely moved in all directions. Per cussion elicits a dull note, and a small collection of fluid detected at upper part. Tenderness on pressure at the sides. Measurements are as follows:-Girth at umbilicus, 41 inches; ensiform cartilage to umbilicus, 9 inches; from latter to symphysis, 11 inches; from right ant. sup. spinous process to umbilicus, 101⁄2 inches; from left ditto to ditto, 94 inches. Vagina greatly elongated and pointing to left side. Uterus cannot be brought into view with the speculum, and also beyond reach of finger, except when standing with the left leg somewhat elevated. The uterus and right ovary can be felt on the left side of the abdomen, over the tumor, before and during menstruation; ; left ovary not felt. The menses began year had a slight leucorrhoel discharge, but, otherwise suffered no inconvenience. In February, 1872, had an attack of menorrhagia, which recurred again in May of the same year, and three or four times since; the last of which was in July 1873. She continued in good health from this time to the end of January 1874, when an offensive vaginal discharge made its appearance, which gradually increased in quantity till the last week of the following month (February), when she had what she called a congestive chill, followed by high fever and profuse perspiration. The patient's flesh and strength now rapidly failed. Night sweats set in ; the vaginal discharge has continued and is of a highly offensive odor. The menstrual flow is always preceded and accompanied by abdominal distention and intense pain. There are also continuous nausea, a fœtid exhalation from the skin, and a foetid breath. Diagnosis. That the tumor is fibro cystic, involving the body of the uterus toward the left side; that the ovaries are intact; and that a communication exists between the cavity of the uterus and a suppurating cyst of the tumor. Prognosis. From the decided failure in flesh and strength, since seen last fall, the presence of a suppurating cyst, the increasing agony and distention of the abdomen during every monthly period, the incipient urinary disorder, and the depression of spirits, I judged that the present state of things could not last more than two or three months before death would supervene. When seen during last fall, I refused to operate so long as she could enjoy life, and as she had reached the limit of that period I now, at her earnest solicitation, concluded to remove the tumor, together with the uterus and its appendages. The condition of the urine indicated the administration of carbonate of lithia, (effervescing) for some days before operating. OPERATION. On the 12th of June, 1874 assisted neighborhood of the wound were now carefully by Drs. Hingston, Kennedy, & Gardner and in the sponged, and the abdominal cavity cleared of clots presence of several other physicians-the operation of blood and other foreign matter-carbolized was commenced by making an exploratory incision sponges being constantly used. Considerable in the mesial line to the extent of about six inches- oozing, deep down in the right inguinal region, soon the upper end of the incision reaching to within became apparent. It was ascertained to be arterial, one inch of the umbilicus. The subjacent tissues and the bleeding vessel was secured and ligatedwere then carefully divided on a director. On the ends of the ligature being cut off short near the opening the abdomen it was found that the peri- knot, in this as in every other instance of ligation. toneum was extensively adherent to the whole The edges of the wound were brought together and surface of tumor. During this part of the operation closed by eight deep sutures of strong carbolized many small bleeding points appeared, but were linen, and superficially by the same number of perfectly controlled by the unsparing use of Pean's horsehair sutures. The pedicle was transfixed by forceps. The adhesions on the anterior surface two steel pins across the abdomen, the one in the being now all separated, Wells' trocar was introduc- centre and the other in the upper edge of the ed at a point where there seemed to be indistinct pedicle embracing the incision on each side; the fluctuation, but no fluid obtained. It was then écraseur was left as an additional security to prefound necessary to extend the incision 21⁄2 inches vent removal of the pedicle from between the edges above the umbilicus, and downward to within 2 of the wound. The cut surface of the pedicle was inches of the pubes, in all making an incision of then smeared over with carbolic acid and perchloabout 13 inches in length. The adhesions on its ride of iron. The wound was covered with two posterior surface were also found to be numerous. layers of carbolized lint and secured by broad straps The tumor was then firmly grasped by the operator, of adhesive plaster, passed from side to side. and elevated from below upwards and forwards- Cotton wool was placed over the abdomen and adhesions were separated, and the uterine ligaments secured by a flannel bandage about ten inches wide. divided by the actual cautery. Whenever it became The patient's pulse at this time, as well as about necessary to ligate vessels that were divided during half an hour previously, had become very weak, the operation, fine flaxen carbolized ligatures were alternately flagging and reviving. Brandy was employed, and the ends cut off near the knot. administered about every ten minutes, until the About forty such ligatures were used and left in the pulse grew stronger and fuller. She was not recavity of the abdomen. The separation of all ad- moved from the table until reaction had comhesions, among which was an attachment of the menced, when she was put to bed-the bed-linen bowels about ten inches in extent, being accomplish- having been previously well-warmed-and hot ed, the tumor was elevated, and the vessels by bricks applied to her feet. She was then warmly which it had been nourished-passing from behind covered with blankets. The temperature of the and forwards to the posterior surface of the uterus just room had been made sufficiently warm about the junction of the fundus with the cervix comfortable by a fire which was kindled for the uteri, and on the left side-were secured; and purpose of heating the cautery irons. strong carbolized linen ligatures applied and cut short, and the vessels divided. A triangular piece of peritoneum, three inches long and two broad (at the wide end) was torn from its connections-by the weight of the tumor-and removed. The tumor was then drawn upwards and backwards to bring into view the cervix uteri, which was found much elongated. The position of the ostium externum was next ascertained by external palpation. The vagina was observed to be much elongated likewise. A bougie about three-fourths of an inch in diameter was then introduced into the vagina, so as to elevate the pedicle, which was now transfixed with a long curved needle armed with a strong hempen ligature. The two halves were then securely ligated, and the wire écraseur applied about onethird of an inch above the ligatures. A few revolutions of the handle of that instrument sufficed for the constriction of the pedicle, which was then divided just above the constricted portion, and the tumor thus extirpated in two hours and fifteen minutes from first incision. The parts in the AFTER TREATMENT.-After being comfortably placed in bed, a quarter grain dose of morph. mur. was administered against my judgment, at the urgent advice of some medical friends. Slept for a few moments at a time up to 4 p.m., when vomiting supervened, for which tincture of aconite was administered every hour with good effect. At 10 p.m. drew off zij of urine, and as the skin was acting well and temperature and pulse high ; omitted aconite, and gave brandy and veratrum viride. Vomited but once since four o'clock. 13th, (2nd day,) I a.m.-Slept quietely for the last three-quarters of an hour; wind in bowels beginning to cause trouble; slight nausea and belching of wind. 4 a. m.-The medicine causes nausea and is omitted; removed 3iij healthy urine. Has slept more than half the time since I o'clock. At 5 a. m. vomited, and at 6 a. m. nausea continues; skin acting freely. 7 a. m.-Took some milk and water; removed zij urine. TI a. m.-Vomited bilious fluid with ingesta. Gave tr. capsici. 5p. m. Has slept well during the greater part of the afternoon; skin acts well; broth and a crumb of bread; skin moist; tongue clean. 6 p.m.-Cough troubles still; urine all right; takes broth freely. 17th June, (6th day), 9 a. m.—Had a good night; slept nearly all the time. All going well, except a little pain with last few drops of urine; says she "feels as though she should be out of bed." 18th June, (7th day). 8 a. m. All going on well; had a good night; pedicle troubles somewhat, and on examination find it nearly separated; there is a little pocket of pus at site of upper needle; all else looks well; urine passes freely, but of a smoky color. Ordered night and morning the effer. carb. lithia water. 19th June, (8th day). 8 a. m. Slept since ten last night splendidly, and feels all right, "sleep very refreshing," passed 3x normal urine; removed two deep sutures. 20th June, (9th day).. 11 a. m.—Passed a fair night, but cough and bad dreams troubled her a good deal; urine a little smoky-colored but quite free; had very severe perspiration between 2 and 4 a. m.; every thing on her wet by it, but skin is now normal. There is free suppuration and discharge around pedicle, which is rapidly separating from the healthy tissue below; removed écraseur and left the wire around pedicle in situ. Cough troubles. 10 p.m.-While dressing pedicle it separated, and with the two needles came away. The whole of the neck of the uterus came away and left a deep cavity, partly due to this cause and partly to elevation of abdominal walls. Wound looks well. 14th, (3rd day). From 1 to 3 had a quiet, comfortable time; skin moist and cool; drew off 3vj. of clear, normal-looking urine, with a slight ammoniacal odor. 7 a. m. Has been troubled a good deal with abdominal distension from difficulty in passing wind, which has not escaped for some hours. Is troubled with nausea, and vomited once. Gave aconite (Flemmings') 4 drop, which gave some relief, but induced great diaphoresis. At 7.30, flatus escaped easily and freely. 9 a. m. Nausea and a short spasm of pain in bowels, with a chill, and followed by emesis and perspiration. 10 a. m.—Skin cool; flatus escaped freely several times, followed by a natural stool. Dressed the wound, which is united by first intention, 11.30.Passed urine naturally, without trouble'; there is still slight nausea. Vomited again at noon, after which felt easy. Tongue a little coated. I p. m -Took beef tea with relish, for the first time; before this had taken ice and water only. At 4 o'clock and again at 7 o'clock, passed urine naturally, and slept a good part of the afternoon quiet- 22nd June, (11th day). 10 a.m.-Feels well; ly and well. At 10 p. m., her temperature was nor-tongue clean; urine abundant and normal; wound mal and pulse 100; skin cool and moist; passed discharges freely, but very deep from retraction of urine and flatus easily. From this time till 3 p. m., vagina; had purulent discharge "per vaginam.” 15th June, (4th day), she slept well the greater 10 p.m.-Heat of the day has prostrated her a part of the time, the pulse gradually going down good deal; all going on favorably. till it touched 86, and the temperature remaining normal. Changed her bed at I p. m., when she passed urine as usual. After this complained of phlegm in the throat and a tendency to cough, which greatly distresses on account of the pins passed through the pedicle hurting the abdomen. 8 p. m., skin moist but rather hot, thinks the heat of the day makes her feel so warm. Is very free from pain; takes beef tea well; flatus passes freely. 16th June, (5th day). I a. m.—Has not slept for last twelve hours, and says she is tired. 2 a. m. Can't sleep for bad dreams; skin hot and dry; pulse rather wiry; gave one drop aconite every hour. 4.30.-Pulse softer; skin cool and moist; tongue moist but furred; no pain; is tired; dreams still trouble. 8 a. m.-Cough begins to give much distress, for which gave ext. nucis vomici (fld.) in 1-20 drop doses every hour or two. 12 m.-Cough easy; slept well; skin cool and moist. 4 p.m.-well; although slept little last night; tongue Cough troubled a good deal at one o'clock, but | clean, urine normal; wound doing well and filling since then easy and well; took half a cup of chicken up rapidly; pocket of pus nearly gone. 23rd June, (12th day). Io a.m.-Gave castor oil to open bowels, as she has had no passage since evening of third day. ΙΟ a.m.-Bowels acted well, and abdomen not distended much. Removed all adhesive straps, and kept dressing in its place by a flannel roller only; removed about 3j pus, with some shreds of cellular tissue from around wound; passed a good day and feels well. 24th June, (13th day). 10 a.m.-Had a good night but bowels slightly loose; some slight pain and tenderness over bowels, also tympanites; wound looks very well and filling up fast with healthy granulations. 10 p.m.-On dressing wound and removing some shreds of cellular tissue, find a small pocket of pus to the left and above Poupart's ligament communicating with a cavity of the wound. 25th June, (14th day). Appetite good; looks a A 26th June, (15th day.) 9 a.m.-Had a good side of the centre of the body of that organ. night, slept nearly all the time; very free escape No. 10 sound can be passed through a fistulous of pus from wound; the indurated and hyperplastic opening into a cavity situated in the centre and tissue around pedicle seems to be dissolving away, upper part of the anterior aspect of the tumour, although a little still remains on the right side. which cavity will hold about 35 ozs. When removed this cavity was full of pus. The rest of the growth is of a uniform firm, fleshy character. The accompanying illustration gives a correct view of its contour and peculiarities of formation : 10 p.m. 27th June, (16th day). 10 a.m.-Passed a poor night on account of wind in bowels. Gave veratrum viride again, but it caused emesis. Tongue, skin, etc., all well; wound doing well. Gave an injection-confection of senna failing to move the bowels-which opened then twice; changed the bed linen and placed a new hair mattress under her, Gave 5 grs. calomel which moved bowels freely at 11.30, after which she felt quite easy. 29th June. 3 p.m.-Doing well. Free discharge of pus. Sat up in bed for a short time. The operation, the details of which I have the pleasure of laying before you this evening, is one that has not as yet secured for itself a place among the recognized and legitimate operations of the surgeon. That this should have been the case is not to be wondered at, when one considers its formidable character, and the grave risks to the life of the patient; but that it can continue to be thus placed 1. Uterus. 2. Ovaries. 3. Round Ligament. 4. Piece of paper which was put into the cervical canal for the purpose of indicating its position, as also the divided portion of the cervix. 2nd July-Wound discharges freely, although nearly filled up to a level with abdomen. Continied doing well up to 6th July, when I discovered a pocket of pus on right side, which, by gentle pressure, freely escaped by the wound. 9th July.-Pocket of pus in right side gone; but there is one formed on left side. 'Bowels distended with gas, which does not pass off as easily as usual. 12th July. Pocket on left side disappeared; wound doing well. Got up in an easy chair while bed was being made, and enjoyed the change. 17th July, (35th day).-Walked down town as far as Victoria Square; is perfectly well, but feels weak. Is gaining flesh rapidly; weighs 102 lbs., 32 lbs less than before the operation. From the above date, till she left for her home in Ontario, she gained half a pound per day in weight, and is quite active on foot. The tumor weighs 16 lbs, including the uterus and ovaries. It springs from the posterior and left beyond the sphere of warrantable surgery is quite impossible in the face of the wonderful success that has of late attended it in the hands of such men as Pean and Keberle. True the risk is, notwithstanding the known perfection of detail in operating, fearfully great, and we would not pen one word that would tend to remove a particle of the heavy weight of responsibility from the shoulders of him who undertakes it; but, on the other hand, it is no small gratification and pleasure to be a fellowworker with those who, in dealing with these unfavourable cases, have, by skill and daring, rescued some few of such doomed ones from an early grave. I trust that the report of this case will not long remain the only successful one on record in Canada, and that where life has become a burden and in imminent danger of an abrupt termination, others may take heart and undertake the operation with hopeful courage, trusting that their efforts may be crowned with a similar success.-Can. Med. Record. |