of case has been satisfactory, and now, the thirty-third day after the operation, she is about the house, has regained some flesh, has almost no discharge, the uterus appears healthy, its depth three inches, position normal, and no hæmorrhage has occurred. The regular period for menstruation has passed several days with no indications of its appearance.

A CASE OF HYSTEROTOMY.

¡BY J. V. P. QUACKENBUSH, M.D., Albany, N. Y.

MRS. MADISON, a deformed dwarf, aged thirty years, was taken in labor with her first child, Nov. 19, 1871. Dr. Northrup of this city was called to see her, and found her in labor, with the os uteri undilated. Next day being called out of the city, he notified her he could no longer attend her, when she sent for a midwife, and remained in her charge till the evening of the 22d, when I was called in. I found her pains frequent and severe, and on examination I found the head firmly compressed and trying to enter the superior strait of a deformed pelvis. I at once saw the impossibility of a natural delivery, and, assisted by Dr. C. II. Paten, I performed craniotomy, but found that the skull, though collapsed, could not be drawn through the contracted strait. Nothing now remained for the woman save the chances which the Cæsarean operation, performed under unfavorable circumstances, might offer. As the patient was exhausted by the protracted labor and

want of rest, we thought an opiate would be desirable, and I gave her one-half grain of sulphate of morphine, which procured her a good night's rest, and she awoke refreshed on the morning of the 23d. I now performed the operation, assisted by Drs. Boulware, Hun, Paten, and Thompson; Dr. Robertson and Mr. Lyon also being present. Dr. Thompson having administered the ether, and the patient being fully anesthetized, I made the incision through the abdominal walls from a point onehalf of an inch below the umbilicus to within two

inches of the pubis. The wound being laid wide open and the intestines drawn one side, the distended uterus was brought fully into view. An incision four inches in extent was made through the walls, through which the foetus was first extracted, and then the placenta was removed through the same orifice. In making the incision through the uterine walls, an artery was severed, and considerable hæmorrhage ensued, which could only be restrained by the introduction of a silver suture, which we used, with a second one to bring the gaping edges of the wound together, as the uterus remained in a state of inertia. After we had cleansed the cavity of the abdomen, we brought the edges of the external wound together, and kept them in this position by five deep silver sutures, and four hare-lip pins twisted in figure-of-eight style, with silk thread. The surface of the abdomen was now cleansed with warm water, and adhesive straps drawn between each of the sutures, and a compress and bandage applied around the body. The patient now came from under the anaesthetic, appeared well, and only complained that

the bandage was rather tight. She remained comfortable during this day, Thursday, slept well during the night; remained in the same condition Friday and Friday night. On Saturday morning the case appeared encouraging, but in the afternoon her breathing became laborious and her pulse much accelerated. During the night she became delirious, and died of peritonitis on Sunday morning, having survived the operation seventytwo hours.

The following are the probable causes of the unfavorable result of this case:

1. The long duration of the labor, which had conti nued for ninety-six hours; for it is found that " prolonged muscular action not only reduces the strength of the patient, but favors hæmorrhage from the uterine incision and the utero-placental sinuses, by the induction of uterine muscular inertia, and consequently the failure of prompt contraction after the removal of the fœtus."

2. From the "general exhaustion, which favors the production of a fatal result from shock, peritonitis, and septicæmia."

3. My resorting to the performance of the operation of craniotomy, prior to the Cæsarean section, which caused the patient additional exhaustion; and,

4. The necessity of using sutures to draw together the wound in the uterus, caused by the want of contractility of its tissues.

With the light of experience afforded by this case, should I meet a similar one, I should operate promptly and at once; for I think these cases promise success as

much as do those where ovariotomy is performed; for in the former you find your patient in health, in the latter your patient has undergone the exhaustion consequent upon diseased action for one, two, or three years.

REPORT OF A CASE OF SOLID CANCER OF THE OVARY OF UNUSUAL SIZE.

BY JAS. L. BROWN, M.D., New York.

In the early part of November, 1871, Margaret S., æt. 39, married, the mother of four children, of whom the youngest was four and a half years old, came to the out-door department of the Woman's Hospital to seek advice on account of a large abdominal tumor. She was there seen and examined by Dr. Charles S. Ward, who had charge of the class in my absence, and who, recognizing the case to be one of peculiar interest, sent her to me. I obtained from her the following history: In December of the previous year (1870), while she was in the enjoyment of good health, her menses stopped, and she supposed herself pregnant.

After an absence of three months they reappeared, in March, April, and May, when they again ceased, and had not since returned. In June, still supposing herself to be pregnant since December, she felt what she thought were feeble movements of the foetus. In July, however, she began to notice that she was not so large as she ought to be in the seventh month of pregnancy,

and that her breasts had not increased in size. She observed, moreover, that the abdominal enlargement' was chiefly on the left side, and that she could move the tumor about quite freely.

On the 12th of July, during the riot, she accidentally received a severe blow on the right side of the abdomen, which was followed by an attack of what appears to have been peritonitis of moderate severity. She saw several physicians about this time, all of whom, she says, concurred in the opinion that she was pregnant, but that the child was probably dead. From this time the swelling began to increase rapidly, filling up the abdomen and of late expanding laterally and towards the groins. Her general health became much impaired, and she was greatly reduced in flesh and strength. She had improved somewhat during the three weeks immediately preceding her visit to me, but she was still quite weak. On examination, I found her quite emaciated, and presenting a well-marked appearance of cachexia. Pulse 115, but tolerably full. Respiration embarrassed and accelerated. No fever. There was some oedema of the legs, which, she said, had only appeared within a few days. The abdomen was greatly enlarged, giving the following measurements: Circumference above the umbilicus, 41 inches; circumference over the umbilicus, 44 inches; circumfer ence below the umbilicus, 42 inches.

The umbilicus, together with the integument immediately surrounding it, was raised above the rest of the abdomen, forming a hemispherical, bladder-like swelling about as large as an orange of medium size,