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as were also a few between the right abdominal wall and the cyst. It was then swept across the fundus of the cyst, and passed down between it and the omentum, so as to detach it in the few places where slight adhesions existed. Trochars were now introduced, and both cysts rapidly evacuated, the smaller one containing about four pounds of a straw-colored and less viscid fluid. Several smaller cysts, two or three times as large as the fist, were developed in the base of the tumor, rendering an enlargement of the wound, one inch at each extremity, necessary, before it could be drawn out. No other adhesions were found, except at the pedicle. The tumor, in its development, had deviated from the usual course. It had expanded the broad ligament, and encroached upon that portion of the peritoneum existing between it and the colon, so as to leave the pedicle but one inch long, four inches broad, and highly vascular, for the application of the ligature. In conversation with my brother, Dr. Washington L. Atlee, in February last, he had recommended the "écraseur" for severing the pedicle; and, as I had seen at least one fatal result from the application of the silk ligature to the pedicle too near to the colon, and as the use of the silver ligature of Dr. Sims, although less irritating than silk, would leave the proximal portion of the pedicle a sloughing, irritating mass within the abdomen, I determined to use the écraseur. The whole tumor being firmly drawn up and held steadily by my son, I surrounded the pedicle with the forefinger and thumb of the left hand, and grasped it very firmly. The chain of the instrument was now passed round it above the hand, and very close to the tumor, and moderately tightened. By maintaining this position of the left hand very firmly-the screw of the instrument being held by an assistant-I was enabled to operate upon the lever with the right, and to prevent the colon from being drawn toward the chain. The lever was turned for half a minute, then stopped for half a minute, and so alternately until the pedicle was severed, occupying six and a half minutes. (The colon had entirely escaped, with a margin of peritoneum one inch wide.) The torn surface of the pedicle was then carefully sponged and examined; the abdomen was kept closed for several minutes, and no hemorrhage, nor even oozing of blood from it, could be detected. The fluid which had escaped from the cysts was then sponged out, and the external wound closed by four silver sutures (kindly sent to me by Dr. J. Marion Sims) and adhesive strips, supported by a compress and flannel bandage. During the whole operation the patient suffered but little pain; her pulse, which was 90 at the commencement, remained so when she was put to bed; the only variation was at one period, when, for a few moments, it became sensibly weaker, and a slight paleness overspread her countenance. There was no nausea or vomiting then, nor at any subsequent period. The whole weight of the mass-solid and fluid contents-was seventeen and a half pounds. Three hours after the operation the patient complained of a screwing pain low down in the left side, and occasionally a shooting pain in the same region. Pulse 86, and slightly intermittent; nose cold; skin of arms and hands warm, and a little moist. Has taken nothing but ice and iced water; at two

o'clock she took thirty drops of the elixir of opium, having taken thirty when put to bed at half-past twelve o'clock.

5 o'clock P. M.-Patient complains of a strong inclination to pass water. Introduced catheter, and drew off sixteen ounces of straw-colored urine, with acid reaction-more, she says, than she had passed altogether during the previous week. Pulse 92, intermitting every eight or ten strokes; has less pain in left side; more in her back; slept nearly an hour; nose quite warm, as is the whole surface, with more fulness and quickness of the pulse; reaction evidently commencing.

7 o'clock P. M.-Patient now entirely free from pain; pulse 96; skin a little hotter than natural.

9 o'clock P. M.-Patient quite free from pain; skin very moist; heat natural, except of palms, which are hot; catheter removed six ounces of urine; thirst considerable; at 8 o'clock took 25 drops elix. opii.; pulse 102; sleeps at intervals. Since the operation she has been more or less troubled with flatulence without pain.

Wednesday, March 24th, 8 o'clock A. M.-The report this morning is highly favorable; the patient smiled when I entered the room, and says she feels very well; she slumbered nearly all night, waking at intervals and asking for drink; she has no pain, and the only complaint she makes is that the wind is rumbling in her bowels; pulse, 84, soft, and has lost its quickness; skin, including palms and soles, perfectly natural; perspired all night. It apppears as if the reaction, which commenced at 5 o'clock yesterday, has entirely subsided, and left her with a better pulse than I have known her to have since I commenced my attendance upon her. Removed by the catheter eight ounces of urine; mind calm, clear, and hopeful; she completed her sixty-first year on the 8th inst.

12 o'clock P. M.-Patient in all respects the same, except pulse, which is 90; to continue cold water and ice, pro re nata.

7 o'clock P. M.-Patient still lively and comfortable; pressure on the abdomen in the left iliac region gives some pain, or feeling of soreness; has passed wind from the bowels this afternoon; bladder troublesome; removed, by the catheter, ten ounces of urine, of normal color and acid reaction; pulse. 79. The intermission in the pulse, remarked yesterday, passed off during the night, and the action of the heart has been perfectly regular all day; tongue clear, skin moist, and of natural temperature; to have 25 drops elix. opii.; allowed thin arrow-root gruel during the night.

From this time until the 27th of March, fifth day, no unfavorable symptoms were manifested; the patient, on the contrary, steadily improving; examined the wound, and found it united throughout the whole extent, the lint covering it as clear as when first applied. There had been no serous discharge from the abdomen, as in all my other cases where the ligature was removed; no trace of inflammation around the silver sutures, which were removed on the seventh day; on this day she sat up for the first time out of bed.

From this time my patient sat up daily; on the ninth day the bowels were moved, for the first time, by a dose of castor oil; the discharges

consistent and natural; she had been gradually allowed a more generous diet, and was increasing in strength.

On the following Monday, the fourteenth day, she rode with me half a mile, to my office, to see the tumor, and since then she has remained perfectly well.

This case is the eighth on which I have operated for the removal of enlarged ovaria, in two of which both the ovaria were diseased and removed, one only proving fatal, the patient dying on the twelfth day. In all the previous cases I could perceive the disturbing effect of the presence of the silk ligature around the pedicle, as well as of those used to restrain hemorrhage, and until they came away they were more or less a source of anxiety both to the patients and to myself. With the écraseur to sever the pedicle, and the use of the silver suture and silver ligature, where ligatures are necessary, I am satisfied that a very large share of the dangers attending the operation will be obviated. Mrs. E. is the oldest patient upon whom, I believe, the operation has been performedDr. Clay, of Manchester, England, reports his two oldest at fifty-seven and fifty-eight. She was excessively reduced by the frequent tapping and refilling of the cyst, as well as by the previous very active medical treatment to remove the dropsy, and yet she recovered more rapidly and with much less constitutional disturbance than any other patient upon whom I have ever performed a capital operation. This I attribute very much to the use of the écraseur and the absence of any ligature involving the peritoneum.

From the American Journal of Medical Sciences.

FRACTURE OF THE PELVIS DURING PREGNANCY.

By J. WHITAKER, M. D., of Lewistown, Niagara County, N. Y.

On the 18th of December, 1856, Mrs. W., then in the seventh month of gestation, informed Dr. W. that she had fallen the day before, "slipping down a pair of steps, and striking astride the edge of an open upright barrel." She complained of excruciating pain in the left pubic region, on the least motion. He found an oblique fracture of the body of the left os pubis, with but little displacement, and no lesion of the bladder or rectum, and no positive attempt at miscarriage.

"A roller bandage was applied around the pelvis, opiates were administered, and the urine drawn off for three days by means of the catheter. No bad symptoms supervened, and in six weeks the patient was able to walk about the room. On the 6th of March, inst., she was delivered, after an easy labor, of a healthy female child, weighing ten pounds. The fracture was, of course, reopened, and I was not surprised in seeing symptoms of peritonitis present themselves; these were promptly met by blood-lettings, and the exhibition afterwards of calomel and opium. The inflammation yielded kindly, and I am happy to state that at this date the patient is doing exceedingly well, and will be up in a few days."

Bibliographical Notices and Reviews.

ELEMENTS OF INORGANIC CHEMISTRY. BY THOMAS GRAHAM, F. R. S., late Professor of Chemistry in King's College, London. Second American, from an entirely revised and greatly enlarged English edition, edited by Henry Watts, B. A., F. C. S. With numerous illustrations. Philadelphia: Blanchard & Lea.

To write a large and comprehensive work on Chemistry, thoroughly brought up to the latest stages of advancement in all the departments of that many-sided science, which shall be systematic in its arrangement, and adhere rigidly to a preconceived order in the treatment of subjects, has for the last fifty years been a moral impossibility. Such an undertaking must always be a work of protracted and intense labor; while at the same time, so rapid has been the march of discovery throughout the whole of the time specified, that in every instance the commencement of such a work has required remodelling before the termination has been arrived at.

The history of the work now before us furnishes an admirable illustration of this position. Eight years ago, the progress of the science since the appearance of the first edition in 1843, had rendered necessary the preparation of a second, of which the first part, containing less than the half of Inorganic Chemistry, made its appearance at London in 1851, and at Philadelphia in 1852. It was at that time confidently announced that the second part (to conclude the volume) would appear the following year; and as the first edition had contained organic as well as inorganic chemistry, it was probably at that time the intention of the author that his new edition should be equally comprehensive. Nevertheless, our author was not ready for the press again till quite the close of last year, and then presented us with Part II., which contains four hundred pages, very nearly, and yet only finishes the subject of inor ganic chemistry. But, upon examination, its contents still more strikingly illustrate our position, for the four hundred pages consist of two

very nearly equal parts, the first being the completion of the inorganic chemistry, and the second half a reconsideration of various subjects treated of in the part published in 1851, with enlarged information and revised opinions upon almost every topic of importance.

Now, before proceeding any farther, let us be understood as being very far from expressing disapprobation in giving this history of the book. Quite the contrary. We are glad that the author took seven years instead of one to the preparation of Part II.; glad that he occupied half of the second part in revising the first, and especially glad that he did not include organic chemistry in the work. To have acted in any other way would have been to give us an incomplete, inaccurate, and hastily executed work; whereas we have in this volume a masterly portrait of chemistry, as recent research has made it. The book is complete, precise, lucid, and comprehensive. The Supplement, comprising nearly a fourth of the whole work, must be considered as accurately presenting the whole of the immense progress made in chemistry within the last eight years. Its publication in one work must be considered as a stupendous effort; as an event constituting an epoch in the bibliography of the science, not second in importance to the publication of the Elemens de Chimie of Lavoisier. The merits of the two works, indeed, are very similar; Lavoisier himself was no discoverer, as is gracefully expressed in Brande's historical sketch: "Lavoisier, though a great architect in the science, labored little in the quarry; his materials were chiefly shaped to his hand, and his skill was displayed in their arrangement and combination." Nor is skill of this character any inferior accomplishment. It is no detraction to the beauty and grandeur of Lavoisier's theory of chemistry, that the great propositions upon which it rests were previously elaborated by Priestly and Scheele, Mayow, Hooke, and Cavendish; nor is the present compendium in any degree shorn of its merits by the consideration that it embodies the researches of Regnault, Kopp, Bunsen, Gerhardt, etc., etc. The truth is, that it is only through this faculty of some few powerful and comprehensive minds, of combining the various researches of original discoverers into harmonious systems, and showing a unity of principle in a multiplicity of observations, that the researches of the few become the knowledge of the many; without it such researches must slumber amid the transactions of societies and the obscure monographs of the original discoverers; in short, it is through the labors of literary architects, such as Graham and Lavoisier, that knowledge rises from a bare statement of facts to the rank of philosophical science.

Of course the Supplement contains the chief part of what will inter

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