This specimen illustrates most perfectly the preserva- The subsequent treatment consisted of R. T. ferri tive efforts of nature. It is a full confirmation of the sesquichloridi gtt. xx. ter in die; also R. Sodæ bisultheories advanced in the paper above referred to. Un-phatis gr. xv. at the same intervals, allowing three doubtedly the calculus which escaped when Dr. Parker | hours to intervene between the administration of the operated, was the exciting cause of the difficulty. By different remedies. it, inflammation, first of the mucous, then of the muscular, and finally of the serous coats of the appendix, was induced. The inflammation of the two inner coats went on to ulceration and destruction of their substance, and was limited in its extent; while that of the serous coat involved a greater area, and terminated in the effusion of plastic lymph, which glued not only the appendix, but also a large portion of the cæcum to the abdominal wall.

Furthermore, this effusion of plastic material was not designed for a temporary purpose simply, but having accomplished its end in keeping the contents of the abscess out of the peritoneal cavity, it was destined to remain as a lasting wall for the breach of substance made by the ulceration and destruction of the part. 43 UNIVERSITY PLACE, Feb. 12, 1868.

A CASE OF

SUBMUCOUS FIBROUS UTERINE TUMOR.

THE EFFECT OF ERGOT IN CAUSING ITS EXPULSION.

BY THEODORE R. VARICK, M.D.,

JERSEY CITY, N. J.

MRS. McG————, a widow, æt. 40 years, the mother of one child, first noticed, in November, 1866, a swelling in the hypogastrium about the size of a small hen's egg. This continued to grow steadily until the 11th of November, 1867, the date of her application to me. At this time the fundus uteri was on a level with the umbilicus. Eight months ago she was attacked with severe hæmorrhage, which recurred at short intervals, producing extreme prostration.

On a digital examination, the os tincæ was found sufficiently open to admit the first phalanx, and I was enabled to recognize the presence of a foreign body. The sound, which I was able to pass within the uterine cavity to the depth of six and a half inches, revealed a tumor developed in the anterior wall, extending all the way from the cervix to the fundus uteri, with a smooth surface, firm feel, and projecting boldly into the cavity of the womb.

There were also used frequent vaginal injections of tepid water, followed by R. Sodæ bisulphatis ss.; Aq. rosarum Oj. M., one or two ounces of which were thrown up after each washing. Her recovery was progressive, and on the eighth day she was able to walk about her own and the adjoining room without any inconvenience.

The points of interest in this case were the absence of hæmorrhage during the operation, and more particularly the happy effect of ergot in expelling the major portion of the growth so speedily after the laceration of the capsule; thereby obviating, in a great measure, the danger of pyæmia, which has in more than one instance produced a fatal result in operations otherwise successful.

The greater safety of laceration, as compared with. incision of the capsule regarding hæmorrhage, must be apparent to any one at all conversant with the principles of surgery; while a sufficient opening having been made, the growth, with attachments scarcely if at all greater, under these circumstances occupies an analogous position to a retained placenta or a blighted ovum; it needs but strong and persistent uterine contraction to produce perfect enucleation of the mass.

REPORT OF A

CASE OF LEUKÆMIA.

OCCURRING IN CONNECTION WITH OSTEO-MYELITIS, FOL

LOWING AMPUTATION OF THE THIGH.

BY GEORGE A. MURSICK, M.D., oF New York,

LATE ASSISTANT SURGEON N. Y. VOLS.

THE following case came under my care during my service in the Stanton U. S. A. General Hospital, Washington, D. C. It presents all the characteristics of that form of disease described by Virchow as "Leukæmia," viz.: Enlargement of the spleen and lymphatic ganglia; a large excess of white corpuscles in the blood; the peculiar pale, earthy, or waxy complexion; emaciation; diarrhoea; dropsical accumulations; the hæmorrhagic diathesis;" and the gradual failure of the A process of dilatation was commenced on the 15th vital powers. It is also interesting, by reason of its of November, by means of tents of compressed sponge, association with osteo-myelitis and pyemia-of which and continued until the 15th of December, when the one of the complications of the latter disease-pneumo03 being dilated to the size of a half dollar, I admin-nia-appeared to be the immediate cause of death. istered fl. ext. ergot in drachm doses every hour, until powerful uterine contraction was produced; which had the effect to engage the lower portion of the growth in the expanded cervix. With the assistance of Dr. B. A. Watson, of this city, I operated as follows:

The patient being placed on her left side, and the uterus steadied and forced down by external pressure as far as practicable, I grasped the tumor with a pair of broad-bladed forceps, and lacerated, to as great an extent as possible, the mucous membrane covering the growth. I then removed piece by piece as much of the tumor as was within reach, leaving the balance to be thrown off by uterine contraction. This last result was effected in nine hours. The portion thrown off eime away en masse, was fibrous in character, and weighed fifteen ounces avoirdupois.

There was perfect freedom from hæmorrhage; and although no anæsthetic was used, the pain was trifling. A few days following the operation there was an offensive sanious discharge.

Case. Corporal E. Stirling, of Co. E, 143d Pa. Vols., aged 32 years, was admitted to the hospital on the 13th of May, 1864. He had suffered amputation of the left thigh in its lower third, in consequence of a gun-shot fracture received in the battles of the Wilderness, Va., May 8th. He stated that at the time he was wounded his general health was good, and that he had suffered but little from sickness during his service in the army. When admitted he appeared rather pale and anæmic, and was somewhat emaciated; the flaps of the stump were partially united, and the discharge from it was moderate in quantity, but thin and flaky. A tonic (ferri et potassæ tart,) was prescribed 'for him, together with a moderate amount of alcoholic stimulants, and a liber: diet.

May 14th. He had some diarrhoea, for which pil of opium and camphor were prescribed pro re nata. May 16th.-The diarrhoea is checked; the discharg from the stump has increased in quantity, and granulations look pale and flabby. He continu

during her recovery, except the pulse, which varied *from 130 to 160 the first five days; the sixth it fell to 110, the seventh to 105, the eighth to 92.

The eighth day the bowels were moved by injection. The bladder was relieved by the catheter three times each day, the first five days; after that twice each day, until the eighth day, when she passed water without artificial aid. The lochial discharge was normal, and on the third day the milk made its appearance. Since then she has nursed the child.

Each night of the first week she took one-fourth grain sulph. morphine at tea-time; after this it was omitted, and no drug has been since administered except an occasional dose of castor-oil.

Arrangements were made to carefully ventilate her room, and absolute quiet was insisted on. The first three weeks, no one saw her but her nurses and physicians. The first ten days, her diet consisted of beef-tea or mutton broth, with toast and tea for her breakfast, roasted oysters with toast for dinner, and milk porridge for supper.

Besides this, each day of twenty-four hours during the first fortnight, she took three ounces of whiskey and twelve ounces of milk in the form of punch. After this period she was allowed to select her own diet.

These nutriments were given with a good deal of freedom, partly because they were agreeable to her appetite, but mostly, because it was deemed best to keep her system sustained to its highest point; and concentrated articles were preferred, to avoid loading the bowels with excrementitious matter.

During the first week, two teaspoons would have contained the pus which was discharged by the incision; after this, for two weeks, the integuments suppurated rather freely.

At the end of the fourth week the wound was almost entirely healed, and the patient was allowed to get up and walk about the room if she desired. I saw her the 25th of December, 1867, when she was carrying the child in her arms, and seemed in vigorous health.

IN the MEDICAL RECORD of March 15, 1867, Dr. Parker reported several cases of abscess of the appendix vermiformis. A few of the particulars of one of these (page 26) I will briefly refer to.

On the 4th of December, 1865, Dr. Parker operated by a small incision. Some pus and a small calculus made their exit through the wound. The calculus was examined by myself, and found to consist of uric acid, biliary coloring matter, and débris of muscular food. On the 16th of the following January-the tumor in the meantime having disappeared, leaving only an indurated hardness-the patient was again attacked with violent pain, vomiting, etc., as at the first. On the 17th, some enlargement was noticed over the iliac fossa, and on the 20th (it having attained a large size, and fluctuation being discovered) I opened it, and a great quantity of pus was discharged. The patient recovered in a short time, and has never had any more trouble in that neighborhood. In the early part of Dec., 1867, he was attacked by fever of no well defined form, of which he died. On Sunday, Dec. 29th, twelve hours after death, with the assistance of Dr. Magie, I made the autopsy.

The appendix was attached by strong adhesions to the anterior abdominal wall, at about the external limit of the right inguinal region. The cæcum was also pretty firmly bound to the wall of the abdomen and iliac fossa, by adhesions. The appendix was given off from the cæcum normally, and was four inches in length. It did not lie curled upon itself, but was stretched out The wound had healed, except about a half-inch close along the cæcum, and strongly adherent to it. The to the umbilicus, where the granulations were uncov-point of attachment to the abdominal wall was an inch ered by the skin, but looked healthy. She is advised to continue wearing an abdominal bandage for some time to come, but is no longer considered a patient. An interesting point in this case is, that the girl herself did not know what operation was to be performed for her relief, and it is certain that at least two weeks had elapsed before she fully comprehended its magnitude.

(Since the above has been in type, we learn from Dr. Townsend that the wound has entirely healed, and that the patient has, contrary to the earnest advice of her medical attendants, married her paramour. There is, then, a bare chance that the operation may be repeated at no distant date.-ED.)

NEW METHOD OF CLOSING BLEEDING VESSELS.-Mr. Thomas Nunneley, Surgeon Leeds General Infirmary (British Medical Journal), has devised a peculiar, long and slender-nibbed spring forceps, for the purpose of pressing together the mouths of bleeding vessels. The jaws of the instrument are kept together by the crossing of their shanks and their expansion into an oval-shaped spring. The ends of the nibs are serrated, and the arms are made of different lengths, and the springs of different strength, to adapt themselves to deep wounds and large vessels. The forceps are brought outside of the wound, the rounded or spring extremity only being exposed. The writer claims that they are less liable to be disturbed, and to cause annoyance to the patient, than the acupressure needles.

to the right side of, and a little below the cicatrix of the former incisions. The contents of the abscess, therefore, must have worked their way for an inch or more between the abdominal muscles, before they showed any inclination to point. The parts being now removed and examined more in detail, it was found that the entire free surface (that which was attached to the abdominal wall) of the appendix was covered with a thick wall of false membrane, which was thickest at about its middle portion. At this point also, the appendix presented a tubular dilatation. Upon dissecting off this false membrane, the appendix beneath presented nothing abnormal in appearance until the point of dilatation was reached. Here there was found to be no true wall, the muscular and mucous coats being entirely absent. This dilatation extended three-fourths of an inch down the canal, and that portion of it which was without a true wall was probably one-fourth of an inch in length. Below the dilatation the appendix was normal as to its coats. On opening now the cavity of its canal, it was found to be pervious for two inches and a quarter. From this point for a quarter of an inch, it was entirely occluded, when it opened again into the dilatation spoken of above. The cavity of the dilatation was filled with a brown mucous secretion. The canal again became obliterated half an inch from the free extremity of the appendix, which from this point was converted into a solid cord.

That portion of its wall which was attached to the cæcum was normal as to its coats.

pretty much the same condition until May 27th, when secondary hæmorrhage occurred from the stump to the extent of about six ounces. The stump was laid open and a ligature applied to one of the branches of the external circumflex artery, which was bleeding; pretty free oozing of blood occurred from the surface of the flaps, which was readily controlled by the free application of the Liq. Ferri persulphas.

and supporting, with anodynes to allay pain and restlessness.

No particular symptoms marked the advent of the premia before the lung complication manifested itself, though its existence was suspected for some time before his death. The absence of the rigors, the icterode skin and conjunctiva, and the typhoid symptoms which so generally mark the course of premia, rendered the diagnosis of these frequent sequele of esteo-myelitis difficult, and had not the objective symptoms of osteomyelitis been so apparent, even the existence might have been doubted, so completely were the usual symptoms marked by the “phenomena of leukæmia." |

From this time the patient gradually became more pale and anæmic. His countenance assumed a dirty, waxy hae; his appetite failed him, and his strength grew weaker; ædema of the opposite extremity, and of the stump and face occurred, together with dropsical soramalations in the scrotum, abdomen, both pleural carines, and the pericardium. The stump became painfal and an abscess formed among the muscles of it,, SPONTANEOUS INVERSION OF THE which was incised and its contents evacuated. The fans also commenced to slough, and there was a constant thin, watery discharge from it; the end of the stamy bone became denuded of its periosteum; the modina protraded from it, and it was soft, pulpy, and RESTORATION OF THE ORGAN TO ITS NORMAL POSITION, very dark colored,

August 10th-He complains of pain in the right side. has some cough with viscid sputa; coarse mucous rales and bronchial respiration are heard in the lower lobe of the right hing poster orly; his respiration became embarrassed, his pulse more feeble, and he gradually sank and bed August 12th.

Specimens of his blood have been examined from time to time, and were found (ander the microscope) to eran an unusually laye quantity of the white, biood corpuscles. His proe was aso frequently examorà, and at no time did a contain albemen.

Awinney green bous ster death Body emachsted; skin of a pale dar coke; no rigor words; the richa Jower exien jys rematous.

UTERUS

DURING THE EXPULSION OF A FOUR MONTHS

OVUM.

BY THE UNAIDED POWERS OF THE ORGANISM.

By H. B. TRIST, M.D.,

WASHINGTON, na

Ox October 11, I was called to see Mrs. B., whom I
found miscarrying. She supposed herself to be about
the fourth month, or sit je over. On examination, a
mass was found apparently engaged in a partions os,
which naturaly enough, si first bush, was taken to be
the product of conception, and which it was confidently
expected would at once yield to samt traction with the
index. This procedure, however, filed to detach more
than some small portions of membrane and clots. The
attempt was then made with abortion freeps, but
these were soon pat aside, and recourse had to the
finger as the sser mens. The mass st... resisting any
sace degree of force, für her effort was abandoned, under
the impression that abnormal albesions must exist,
which in the course of a day or two would yield and
allow an easy expulsion of zem val. At the expiration
of this time wober XLT TADOR reresed the same
condition. By anem ve sal close exlaration, a per-
tion of the mass was foun, to give and to show itself
te de detached, so de revies of the rest. After removal,
i proved to d DAZY DE ETN payeu the smal
portion wacing baring passed probaby wià ciors at an
early period.
evident that the elastic,

pandorm, maas TÌNÌ ¤ Ihe is nsane had been
Tiker der in Oram, must be ST IV.ZIPL meros or pos-
she a parmas As R sufering consuðvesty from

to attempt any vigorous measure, further manipulation much force is lost. In fact, the patient whose case is was abandoned.