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hesions were broken up by blunt dissection, and hot packing placed against the oozing surfaces. Peritoneum divided on posterior wall of broad ligament, and cyst dissected out with the fingers, without rupturing. With a running suture the cyst cavity was obliterated and all oozing stopped. Packing was then removed from the pelvis.
The vermiform appendix which was retrocaecal and extremely adherent to the tumor and surrounding tissues, was removed by the purse
string method. The uterus was held to abdominal wall with one chromic gut suture No. 3. Abdomen closed in layers. Skin clips in skin.
At first there was no improvement in her mental condition but the wound healed by first intention and at the end of a week, all dressing was removed. From this time under ordinary tonics and good food she began to improve and by the time of her discharge from the hospital, she had entirely recovered.
The following is the report of Dr. J. R. Losee, the Pathologist of the hospital, who made the examination of the specimens.
Appendix: The specimen is made up of vermiform appendix, mesoappendix; also a cyst. The appendix was 6 cm. in length, 8 mm. in diameter at the proximal extremity, and 2 mm. at the tip. The peritoneum was smooth and regular. Section showed thickening of the wall throughout most of its extent with complete obliteration of the lumen in the distal 1.5 cms. The tissue in this area was of a white fibrous structure and there was also a small amount which had a yellow appearance. No distinct outline of a tumor was observed. Microscopic examination of the proximal portion of the appendix showed a normal glandular and lymphoid structure in the mucosa, the submucosa was thickened and presented some round celled infiltration. The muscle coats were also thickened and the serosa was quite vascular and edematous. Microscopical examination of a section of the obliterated portion, 2 mm. in thickness, showed complete absence of the structures of the mucosa and submucosa, and they had been replaced by islands of atypical epithelial cells in a fibrous tissue stroma. These cells were polyhedral in shape, occurred in different sized groups and did not show any mitosis. On examination of several sections, it was noticed that the atypical epithelial cells had not invaded the muscular coats. Sections were also made of portions of the appendix adjacent to that just described, and no epithelial proliferation was observed, but of a few wandering epithelial cells were seen in the submucosa in some of these sections. The meso-appendix was made up of a fatty areolar tissue, and there were no glands present.
Remarks: 1. The malignant process arose in the obliterated portion of the appendix and did not have a definite outline, being observed only after microscopical examination.
2. The yellow color of the tissue, which obliterated part of the lumen, was somewhat characteristic.
3. The epithelial proliferation was entirely within the muscle coats. Diagnosis: Chronic appendicitis, spheroidal celled carcinoma. Cyst: The cyst is spherical, about the size of an orange; on section it had a very thin wall and contained a thin straw colored fluid.
MEDICAL STATISTICS OF THE LYING-IN HOSPITAL
OCTOBER 1, 1913 TO SEPTEMBER 30, 1914.
ROSS MCPHERSON, M.D.,
Number of confinements.
Number of births..
In the 6,277 births it was possible to observe the presentation in 5,347 instances (85.17 per cent).
Of the above, 711 (11.33 per cent.) were brought in by the ambulance, as emergency cases.