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entire lower part of the abdomen and even to the corresponding thigh. I then saw the patient in consultation with Dr. Chauveau a second time, and, from the great tenderness still felt in the parts, we concluded that the treatment had not effected its object. Dr. Rockwell was accordingly requested to see the case again, which he did, November 20. He then made a fifth application of galvanism, with the same number of cells and in the same way as before described. The result so far has been entirely satisfactory.
I saw the patient with the family physician this afternoon and made an examination. She had just passed her menstrual period, menstruation having before been absent for nearly four months. It is now twenty days since the last severe paroxysm of pain, and she feels quite well, aside from weakness resulting from confinement to bed. The uterus is almost natural in size and is quite movable; but it is still retroflexed, with a welldefined enlargement above and to the left side of it. The enlargement seems to be of about the size of a Sicily orange. It is much more movable and very much less painful under conjoined manipulation than it was at my last examination. From these circumstances and conditions, therefore, I think it may be clearly inferred that the life of the foetus was destroyed at the fifth séance with the galvanic current, and that no further trouble from its growth need be apprehended.
DR. F. W. Ross, of Chemung County.-I have seen a case quite similar to the first one reported by Dr. Bozeman. In this case, rupture took place between the second and third months, when a diagnosis was made of extra-uterine pregnancy. The abdomen was opened about four months after the rupture, by Drs. Squire, Dr. Price, Drs. Wey, and myself. We found a firm, fibrinous band, or partition, across the brim of the pelvis, which
separated the pelvic from the abdominal cavity. The fœtus was evidently encysted. The abdominal wound was closed, and it united in a few days, with no bad symptoms. The patient lived a little over four months after the operation, and then died of pyæmia and exhaustion. On post-mortem examination, we discovered a condition very much the same as that described by Dr. Bozeman in his first case. We did not find the fœtus, which had evidently been disorganized. The left ovary was prolapsed and lay directly behind the uterus, and there was a dilatation of the Fallopian tube on the right side, evidently the site of the rupture. Pus had welled up through an opening in the partition between the pelvis and the abdomen, and was found in the peritoneal cavity. The uterus and all the tissues below the septum were pigmented, so as to be almost black. There was a small perforation into the vagina from Douglas's pouch. The patient died about nine months after rupture of the sac. There had been signs of pregnancy, such as cessation of menstruation, etc.
DR. ROBERT NEWMAN, of New York County.-Judging from the paper just read, we should infer that tubal pregnancy is not so rare an occurrence as might have been supposed. Dr. Bozeman's case is a remarkable one, but it is not unique. About twelve or fifteen years ago, Dr. Koehler, of this city, presented to the Pathological Society the skeleton of a fœtus at term which had a history almost precisely like that given by Dr. Bozeman. The bones were delivered through an opening in the rectum, and the woman made a complete recovery. Another similar case, the particulars of which I can not now recall, was related by one of my friends. I wish to thank Dr. Bozeman for the tribute paid to the late Dr. Rogers. It is undoubtedly true that treatment by electricity in accurately diagnosticated cases has given the greatest amount of satisfaction. The question arises in my mind as to the manner in which the fœtus disappears after it has been destroyed by electricity; whether by electrolysis or by simple absorption. It seems to me that absorption probably takes place, possibly aided somewhat by electricity.
DR. BOZEMAN.-I regard electricity as very valuable in the treatment of tubal pregnancy. With reference to its modus operandi, I think that electricity kills the fœtus, and that nature disposes of the body. I have myself, however, had very little ex
One case has come under
perience with electricity in these cases. my observation very recently which I have not had time to incorporate in my paper. The patient was a young woman who had been taken with symptoms of abortion at the third month. I saw the case in consultation with Dr. Chauveau. The day after the development of symptoms of abortion, I found the temperature 104° Fahr., and the pulse 120. Dr. Chauveau was of the opinion that the fœtus was dead, and he thought that delivery should be effected. I dilated the cervix with a laminaria tent and found the uterus empty. After further examination, the patient being under the influence of ether, I was enabled to clearly make out tubal pregnancy. There were fullness and hardness in the right iliac region, with great tenderness. Believing that rupture of the tube would soon take place, I suggested the use of electricity. This was applied by Dr. Rockwell, of New York, on Saturday last, and was repeated on the three succeeding days, the duration of each application being ten minutes. The patient is now doing remarkably well, although there is still some bloody discharge from the vagina, which, under the microscope, shows that the particles thrown off come from a fœtus, proving beyond a doubt the correctness of the diagnosis of tubal pregnancy.
In reply to a question by Dr. Moore, Dr. Bozeman said that the interrupted galvanic current from a battery of fourteen cells was employed, and that one electrode was passed up against one side of the body of the uterus, the positive pole being placed over the pubes. The current was continued for ten minutes. It was supposed, when the symptoms disappeared, that the fœtus was killed.
DR. E. D. FERGUSON inquired whether it was not supposed that the first or second application killed the foetus, the remainning applications being made in order to make sure of that result. DR. BOZEMAN replied in the affirmative.
DR. E. R. SQUIBB, of Kings County, remarked that there was a specimen in the museum of the Jefferson Medical College, consisting of a fœtus removed from the dead body of a negress, which he believed had been carried for more than twenty years. The cyst when removed was complete.
A CASE OF OVARIAN CYSTOMA, WITH OPERA-
By T. M. LLOYD, M. D., of Kings County.
CASE.-A. M., aged forty-five; domestic; single; born in Ireland; has lived in the United States thirteen years; was admitted to St. Peter's Hospital, November 9, 1883, for acne rosacea which was much benefited by treatment. Early in December, she began to complain of pain in the right iliac region and noticed that her abdomen was increasing in size. For many years her abdomen had been prominent, but her mistress, with whom she had lived eight years, had noticed it more during the past three years. She was in good flesh when admitted. Menstruation had been always attended with pain in the pelvic region, especially during the past thirteen years, but it was regular until last July, when an interval of six weeks occurred, followed by a thinner and lighter flow than usual. Since then, it has been normal in recurrence and quantity.
She came under my care, January 1, 1884. The abdomen was then quite large. Percussion-dullness over the right side extended from the base of the chest to the pelvis, and from the flank to the left side, three inches beyond the umbilicus, encroaching still farther upon the left iliac region. Changes in posture produced but little variation in the outlines of percussion-dullness. In the sitting posture, the tumor could be moved to some extent from side to side. Pulsations of the aorta were transmitted to the hand when pressed upon the abdomen. On examination per vaginam, the uterus was found to be movable and anterior to the tumor.
The patient had been in bed for some time on account of oedema of the lower extremities; urine deficient in quantity, specific gravity low, no albumen, urates in excess; radial pulse small, soft, and compressible on both sides, but much smaller on the left than on the right side; cardiac pulsations deficient in force; the first sound did not seem normal as heard over the base of the heart, but no positive murmur present; percussion evidence negative; respiratory signs normal; liver-dullness normal in extent.
January 19th.-Complains much of pain in left lower limb, markedly along the anterior crural nerve; much tenderness on pressure in the inguinal region; efforts at motion attended with pain; some oedema; kept in bed.
22d.-Daily average of urine has been less than a pint for a week past; circumference of abdomen, at level of umbilicus, fortysix inches; aspirated to-day, and fifteen pints of liquid slowly withdrawn, sp. gr., 1·018, thin, viscid, greenish, and not spontaneously coagulable (sac not emptied). To the left and below the umbilicus, a tense tumor, three or four inches in diameter, was found after aspiration, which was diagnosticated to be a part of the original tumor, but the nature of its contents was not determined. During aspiration, when the abdominal walls became relaxed, the transmitted aortic pulsation became very evident to the eye.
Patient much relieved; urine clearer and quantity increased; daily average for a week following, twenty-five ounces. The night following the aspiration, she was sensible of the tumor changing its position when she turned upon her side in bed.
The liquid did not reaccumulate rapidly.
After reaccumulation of liquid, she suffered much pain in the left limb, and it also become cedematous when she was out of bed for any length of time. This obliged her to remain in bed almost constantly.
The appetite became capricious, and the patient was much thinner. The cardiac pulsations were somewhat variable in force and frequency from time to time, but no change in physical signs was noted.
She was kept on tonic treatment, quinine and iron, and given an occasional laxative. The urine varied considerably in quantity, but averaged forty ounces per diem for two weeks preceding the operation. Sp. gr., 1.013 to 1-023; no albumen.