IN MEMORIAM.

The Richmond Academy of Medicine records, with profound grief, the death of their distinguished and venerable associate, Dr. Beverly R. Wellford, in the 74th year of his age. Dr. Wellford has occupied such a prominent position in the Virginia medical profession for the last half century, that it would be a work of supererrogation to recount the many important and honorable stations he has adorned.

As a practitioner of medicine and surgery, as president of the Virginia Medical Society, and the National Medical Association, and a professor in the Virginia Medical College, he has ever added lustre to the science and great practical skill to the art of medicine; while in the private circle, affable in manner, dignified in carriage, consistent in his Christian life and death, he leaves us a character worthy of all imitation. Deprived by age and increasing infirmity of participation in the active duties of practice, or the deliberations of this Academy, he yet retained to the last hour of his life a real devotion to the interests of medical science and the advancement of his profession.

Resolved, Therefore, That the Academy will attend the funeral of Dr. Wellford, in a body, and will appoint four of its members as pall-bearers.

Resolved, That the Academy will wear the usual badge of mourning for thirty days.

Resolved, That a copy of these resolutions be sent to the family of the deceased, and to the Richmond daily papers, and to the Richmond and Louisville Medical Journal, for publication.

HUNTER MCGUIRE, M. D., President.

JNO. UPSHUR, M. D., Secretary.

THE RICHMOND AND LOUISVILLE

MEDICAL JOURNAL.

VOL. XI.

FEBRUARY, 1871.

ORIGINAL COMMUNICATIONS.
"Qui docet discit,"

No. 2.

ART. I.-CASE OF INTRA-UTERINE PEDUNCULATED FIBROID TUMOR, WEIGHING TWO AND A QUARTER POUNDS, SUCCESSFULLY REMOVED. By H. P. C. WILSON, M. D., Ex-President of the Baltimore Pathological Society, and Special Surgeon in Diseases of Women to the Union Protestant Infirmary, Baltimore. Read before the Society November 18, 1870.

I would claim the attention of the Society for a little while this evening, Mr. President, in reporting a case of intra-uterine fibroid tumor. Its history, its size, the difficulties attending its successful removal, and the steps by which these difficulties were overcome, are all points of much interest, and may lend some aid to others in future operations upon similar cases.

Mrs. J. D. J., of Baltimore, (aged 43), the mother of six children, had her last child at the age of 31. Has never been pregnant since. Has never felt as well since the birth of her last child. Before, was a hearty, healthy, fine-looking woman. Has had more or less monthly irregularities since, and for the last four or five years has been subject to more or less metrorhagia all the time, and frequently to profuse hæmorrhages. At times has been subject to severe pains in the lower part of the abdomen. Her lower abdomen has been gradually increasing

in size for years; and recently she has been accused by her friends of being pregnant.

I was called to see her for the first time October 7, 1870, in consultation with Dr. McSherry. On entering the room my first impression was that the woman was in labor-pains were coming and going regularly, with the same bearing down efforts as in labor. On examining her vagina with the finger, a mass presented at the vulva in every respect resembling a child's head-having very much the same firmness to the touch-fully as large, and occupying the whole cavity of the pelvis. A little manipulation, however, together with the history of the case, satisfied me that it was an intra-uterine fibroid tumor, and I advised an operation on the following day. Dr. McSherry had made the same diagnosis before I saw her, and was most judiciously giving her ergot to assist the uterus in its efforts to expel it. While this tumor was occupying the whole of the pelvic cavity, it was found to be continuous with a tumor extending into the abdomen as high as the umbilicus; so that the abdomen looked very much like that of a woman in the eighth month of pregnancy.

We gave her anodynes that night, and agreed to meet on Saturday, October 8th, at 12 o'clock p. m., prepared for an operation. At the appointed hour, we met with Drs. William T. Howard and William B. Griffith. The difficulties of the operation were fully appreciated by us all, and there were some doubts present as to whether we would be justified in making the attempt to remove the tumor, from the apparently insurmountable difficulties in the way, and the very grave prognosis.

At 12 o'clock Dr. McSherry put her under chloroform, and when she was thoroughly relaxed, I attempted to work my fingers and hand up by the side of the tumor to see if I could determine its point of attachment and the nature of it. I did not succeed in getting my fingers higher up than the superior strait of the pelvis, and as far as I could explore with my hand and fingers (greatly numbed as they were from pressure between the tumor and bones of the pelvis), I could discover

nothing but this tumor extending far out of reach, and felt externally reaching up to the umbilicus.

I unhitched one end of the chain of my ecraseur; fastened a strong thread to it, and passed the other end of the thread through a Gooch's canula. I then attempted repeatedly to sweep this string around the tumor with the canula, and thus draw the chain around it, but in vain. Everything was so tight there was no room to work.

I then adjusted the chain to the ecraseur, encircled the presenting tumor with the chain, and handing the instrument to Dr. Griffith to hold in position, with two small pieces of sponge, in sponge-holders, I commenced working the chain up over the tumor, intending to get it as far as possible, and then cut away, thus clearing the way for me to get up further. After much patience and difficulty I worked the chain and the end of the ecraseur further than I could reach, and as far as I could manipulate the sponge-holders. I then tightened the chain, and had not given more than two or three slow turns of the wheel when the chain snapped.

I then took a smaller ecraseur which I had for the use of wire. Strong, steel, piano wire was adjusted to it, and with two fingers as a guide, the ecraseur was passed up on them, the stiff wire encircling the tumor as it ascended. The end of the ecraseur and wire were passed up entirely out of reach. The ecraseur was put to work carefully, at about half a turn in a minute, but had not worked long when the wire snapped.

A second time the wire was adjusted as above, and snapped. This time near the point of attachment to the ecraseur, so that it could be refastened without removing the wire.

A third time the instrument was put to work, and a third time the wire broke; and now, as before, near the point of attachment to the ecraseur. Fortunately there was a superfluous amount of wire at the other end of attachment, and by working up the screw we were enabled to secure the broken end again.

It was now 7 o'clock p. m. The patient had been under

chloroform from 12 o'clock (six and a half hours); though under the most judicious administration of Professor McSherry, she was not kept profoundly insensible all the time. We were all thoroughly exhausted-patient, physicians, and attendants. We had not had a mouthful of refreshment since breakfast. We had worked for six and a half hours in adjusting chain and wires, to have them every time broken, and to accomplish nothing towards the removal of the tumor. Night was upon us, and with much discouragement for my unsuccessful efforts, I tightened the wire ecraseur sufficiently to thoroughly constrict the tumor without running the risk of breaking the wire again, and left it thus for the night.

A liberal supply of nourishment was ordered, and afterward a full anodyne; and we parted to meet at 9 o'clock on the following (Sunday) morning.

October 9th. We met this morning as arranged. Patient had slept well through the night, and taken a goodly amount of nourishment. Dr. McSherry had paid her an early visit to draw off her urine; for it should have been remarked before that so completely did the tumor fill up the whole pelvis and press upon the bladder and rectum that she could neither urinate nor defecate.

I had gathered in a number of ecraseurs from my friends; but not one of them had a chain long enough to encircle the tumor. The wire stores and instrument-makers' shops were all closed, and these sources of possible supply were cut off. I went to the operation this morning with the same wire and same ecraseur as yesterday. In revolving the case over in my mind during the previous night, I had determined to attempt to remove the tumor in one of three ways:

First. With the ecraseur and wire, which was already encircling and well constricting the tumor, and which I hoped, after remaining so many hours imbedded in the tumor, and partially mummifying and softening the tissue within its grasp, would be able to cut through the mass which had so often broken it before.