was attached to the transverse colon, and below and behind to the rectum, in both instances by bands of exudation tissue, and its whole peritoneal surface was covered with nodules, ranging in size from a small pea to a filbert. The vagina, except as to its extreme length and the location of the tumor upon its anterior wall, was entirely normal. The vaginal tumor was found to have been accurately described, both as to size and character, by the diagnosis made by Dr. Gregg. The bladder was exceedingly small, very thick, totally inelastic and not distensible, and the whole of its neck and a large portion of its posterior wall were infiltrated in a manner going to show that the vaginal tumor was rapidly extending itself into this viscus. The examination was not carried any further.

There are many rare, instructive and interesting features involved in the discussion of this case, but as the facts have been given somewhat at length I will not even attempt to enumerate these points.

A CASE OF OVARIOTOMY

WITH RECOVERY.

WILLIAM LOMAX, M. D., MARION, IND.

On the 30th day of September, 1877, I was called to examine Mrs. P. Y., wife of a farmer, aged forty-six, and mother of seven children, the youngest of which was six years old. She menstruated regularly, and the general health was fair, excepting a sense of weight and depression in the pelvis, accompanied by leucorrhea and frequent dysuria, with the ordinary uneasiness and inconveniences attending displacements and subinvolutions of the uterus. The uterus was found depressed in the vagina, somewhat engorged, but readily movable. Upon the left side, occupying the space between the uterus and the pelvis, a thickening of the tissues was observed, apparently loosely attached to the pelvis. Any movement of this was felt to move the uterus. But movement of the uterus did not appear to affect the tumefaction.

A prescription was made, but they never called for the medicines; and I heard nothing further of the case until the 6th of March, 1879, when I was called to see the woman on account of an abdominal tumefaction equaling that at full term of utero-gestation.

The menses were irregular, returning at intervals of three or four months, and variable in the amount of the discharge, as well as duration of the period. She informed me that something over a year ago, while reduced to a feeble and emaciated condition by a protracted bronchitis, she discovered a tumor apparently protrud

ing from beneath the right hypochondrium, and extending nearly to the umbilicus; that it was solid, painless and slightly movable, and had grown steadily and rapidly until attaining its present dimensions. I found it more or less lobulated, solid to the feel, not highly sensitive to pressure, admitting of some movement, but more firmly bound in the region of the left ovary than at any other point. There was a very distinct fissure in the right side, ranging diagonally forward and downward from the back and upper part of the tumor, apparently dividing it into superior and inferior lobes. The lower extremity of the tumor dipped down into the left side of the superior strait of the pelvis, and was felt to move in response to any movements given the body of the tumor by the hand placed upon it externally. The uterus could be readily moved upon the point of the index without communicating any perceivable movement to the tumor, showing some loose connection between the two.

My investigation brought me to the conclusion that this was an ovarian tumor, or at least a tumor having its origin in the vicinity of the left ovary, and that it would be amenable only to an operation for its extirpation. This opinion was fully communicated to the parties at the time. But they were not prepared to give their consent to such radical and formidable therapeutics on so brief opportunities for reflection and consultation. Anxious, myself, to avoid, if possible, the hazardous capital operation to which the prominent features of the case so strongly pointed, I was not very arbitrary in enforcing my views, and, yielding to the pressure of circumstances, consented to exhaust every means that could promise the least benefit, provided the diagnosis should prove erroneous. She was, therefore, put upon a treatment of strychnia and ergot internally, while the tumefaction, externally, was saturated with iodine dissolved in glycerine, and the abdomen kept enveloped in cotton batting.

This course was dilgently pursued until the following August. For a time her strength improved, and she flattered herself that the volume of the growth was diminishing; but at the end of five months it was evident that the tumor was increasing in size. In the meantime my brother, Dr. C. Lomax, of Marion, and Dr. J. L. Dicken, of Wabash, had seen and carefully examined the case, and fully concurred in opinion with me as to the character of the tumor,

and also in the propriety of its extirpation, and the woman had partially consented to submit to the operation, but, as it was now in the middle of our annual malarial visitation, it was deferred to a more salubrious atmospheric condition.

In September she was attacked with an irregular, low form of remitting fever, which, under the usual treatment, passed away in a few weeks, but left her more debilitated and uncomfortable than before.

Early in November they moved to Marion temporarily for the convenience of an operation and its after treatment. We again rerepeated our examination as thoroughly and carefully as we could, which fully assured the correctness of our previous diagnosis; and the unmistakable evidences of the progressive ravages of the disease exhibited in the increasing anemia, emaciation and debility, thinning of the neck and jaws, with a haggard, anxious expression of countenance, strongly admonished us of the imperative demand for an early operation. With this purpose she was put on a preparatory regimen best suited to sustain the vital energies and enable her to bear the shock of the proposed operation and recuperate from the severe depressing contingencies to which those energies would unavoidably be subjected Some two weeks after this she was more feeble and uncomfortable. There were large accumulations of gas in her bowels, producing painful distention, tenderness and soreness of the entire abdomen. This condition would have been very unfavorable and embarrassing to the operation, as it would have been difficult to hold the bowels in the cavity of the abdomen with its walls freely laid open, when they were so largely inflated with gas. Strychnia and quinia were continued, with essence of beef and milk porridge diet, and calcined magnesia was given as freely as could be borne without hypercatharsis. This course was pursued for some four days without in the least disposing of the gas or mitigating the suffering caused by its presence. A pretty full dose of calomel and rhubarb, with bicarbonate of soda, was now administered, which operated actively, clearing away the gas and accompanying pain and soreness of the bowels, to the great relief of our patient. The same combination was afterwards repeated every four days, with the salutary effect of maintaining a healthy condition of the bowels. The diet was continued as before, which was believed

to be as free from the production of gas as any food that could be taken. Some two days before the operation she was put upon a course of opium-four centigrams every eight hours-for the purpose of obtunding the sensibility and raising the nervous system to bear the more liberal employment of the drug when it might become an indispensable necessity.

December 11th, being the day set for the operation, our patient was fully prepared in mind for the ordeal and, physically, in as good condition as could be obtained or even desired. The steps of the operation had been pretty faithfully and carefully studied, and preparations to meet every probable demand were fully and conscientiously made. Not only had all the instruments and other appliances necessary for an ordinary case of ovariotomy been provided and arranged in place, but a full armamentarium of what might be required to meet the emergencies of almost every possible complication had been accumulated. Also, an ample force of competent professional gentlemen had been prudentially convened, in order to insure every possible aid and condition to guarantee a successful operation.

The bowels and bladder having been evacuated, the patient calmly took her position upon the operating table, when Dr. C. Lomax proceeded to administer, by inhalation, a chemically pure article of sulphuric ether, procured by Dr. Dicken specially for the occasion. When she was fully under its anesthetic influence, with the assistance and in presence of Drs. Dicken, Weddington, McKinstry, Horne, Daniells, Flynn, Meek, Dicken, Jr., O'Neal, Jr., and McClain, the operation was performed in the following manner: The principal operator stood to the right of the patient, while Dr. Dicken took a position immediately opposite, on the left, where he could more conveniently manipulate, direct and assist. That of Dr. Weddington was on his right, where he could steady and support the patient's body during the progress of the operation. Others took charge of the sponges, instruments, atomizers, etc. A disinfecting spray of dilute carbolic acid [acid 1, water 30,] was constantly maintained by playing three of the atomizers, which gave a most bountiful supply of the prophylactic mist under which the operation was being performed. An exploratory incision, some ten centimeters in length, was made through the walls of the abdomen, in