PROCEEDINGS OF THE COLLEGE OF PHYSICIANS AND SURGEONS, OF LOUISVILLE.

Reported by S. M. BEMISS, M.D., Secretary.

SIXTH MEETING, October 27, 1858.

Dr. Bayless was requested to examine a tumor on the side of a lady. Found the ribs protuberant from the development of tumors in the abdominal cavity. They were first discovered twenty-four years ago. She had menstruated to within two years. Was at this time fifty-four years of age. Has had repeated uterine hemorrhages. The tumor first appearing was on the right side of the median line-other tumors afterwards made their appearance. The right side was now occupied by a very large tumor, extending from the pelvis up to the ribs. It was firm beneath the fingers, with no fluctuation. On the left side was another tumor, very hard, indeed, remarkable for its hardness, presenting, however, a point of fluctuation from a point opposite the umbilicus down. This tumor was probably half the size of the one on the right side. There were, he thought, very strong reasons for supposing them to be multilocular ovarian cysts. Upon vaginal examination, the os uteri was found very high, difficult to reach; which is supposed to be significant of this character of disease, but is also an accompanying condition to other forms of disease. In this case the os seemed spread out, and orifice apparently occluded. All these points stand opposed to the idea of multilocular disease. It was not possible to detect, through the walls of the abdomen, the form or even the body of the uterus. The abdominal region seemed altogether occupied by tumors, and he was not able to determine by palpation the position of the uterus. The os uteri being flattened and spread out, would of itself lead to the inference that the uterine walls were implicated in the diseased condition. The obscurity of the case and contradictory nature of the symptoms, show the importance of close examination before instituting surgical procedure, which might have been begun in this case under supposition that it was ovarian, and the operation carried far enough to exhibit to the surgeon his error in diagnosis.

Dr. Flint. Were these tumors observable on both sides before the cessation of menstrual discharges?

Dr. Bayless. I can not state.

Dr. Miller. The perfect regularity of the menstrual functions furnishes a strong argument in support of the opinion that the ovaria had not been implicated. In almost all cases of ovarian disease with which he had met, these functions had been disturbed.

Dr. Flint. In multilocular ovarian disease, are the tumors ordinarily multiple and distinct, or is there one large tumor, and the others dependent?

Dr. Miller. I think the latter is true. Although you may feel irregularities and protuberances, still they were attachments and irregularities of one and the same tumor. This lady had lived five years with a husband, but was sterile. Ďr. Thomson. Is there pain?

Dr. Miller. No-on the contrary, remarkable indolence. The patient bore active exercise and long walks without any complaint. In ovarian disease he had not found this ability to endure active exercise. He supposed that the most satisfactory diagnostics of ovarian disease were obtained by vaginal examinations. In all cases of ovarian cysts, the uterus is pressed down into the pelvis. In this instance had not been able to introduce the uterine sound, which he had never failed to do in ovarian disease, but frequently failed in uterine tumors. He regarded this as a case of fibrous tumors of the uterus, attached to the external or peritoneal surface. The one on the left side may have undergone calcareous degeneration, and afterwards softened in the centre, which would account for the extreme hardness of one portion of this tumor, and the fluctuation over another portion.

Dr. Thomson. Would softening occur without pain or indications of inflammation?

Dr. Miller expressed the opinion that such changes might readily occur without pain or any constitutional perturbation. Dr. Wible. Is not the attachment of fibrous tumors inferred to be to the external surface of uterus, when they are ascertained to exist, and there is found to be but little hemorrhage? Dr. Miller. I have seen cases of attachment of tumors to exterior of uterus, accompanied with very dangerous hemorrhage.

Dr. Wible. Is it not in these cases that the Vichy waters are supposed to be so efficacious?

Dr. Bemiss answered affirmatively.

Dr. Flint. Does handling these tumors produce any regurgitation or positive alteration of position of any abdominal organ.

Drs. Miller and Bayless answered negatively.

Dr. Bayless remarked, that the extensive dullness on percussion still gave the idea that there were ovarian tumors; since in these latter the tumors were superior to the intestinal tract, while in uterine tumors the bowels were frequently between them and parietes.

Dr. Miller. There is some countenance to this opinion, but the vaginal touch, the want of properly defined os uteri, and

its flattened, illy shapen outline, showed that however much the ovaries were implicated, the uterus was the principal organ affected. It had always seemed a mystery to him that Dr. Atlee had opened the abdomen by a large section for the removal of ovarian tumor, and had found the ovaries healthy and the uterus affected.

Dr. Bayless mentioned, as from Dr. Wright, a case of abdominal section, and removal of the head of the child after it had escaped through a rupture of the uterus into the abdominal cavity. It had been found impossible to bring the head again through the rent into the uterus after it had escaped into the cavity of the abdomen, and it had been amputated and left in the abdominal cavity, from which it was removed by the knife. The woman had made a good recovery.

Dr. Miller had seen a case of ruptured uterus, in which the child had escaped into the cavity of the abdomen. He had passed his hand through the rent, and obtaining the feet, had brought them down and attempted delivery. He had succeeded in bringing the body through, but found it absolutely impossible, with all the manipulation he was able to practice, to extricate the head. As a last resort, he had amputated the head, with the faint hope that its presence would be productive of less irritation than that of the whole fœtus.

Dr. Wible stated that he had been attending a case of labor which had exhibited remarkable tardiness. There was slight left and anterior obliquity. He had endeavored to obviate this by a proper regard to position. The os uteri was dilated to the size of a twenty-five cent piece-the head presenting, and the woman having quite severe pain. This condition had existed for some days.

Dr. Miller doubted whether true labor pains had occurred. Dr. Ronald had seen a case where one month before delivery the uterus was dilated to the size of half a dollar. He wished to inquire of members whether, in threatened miscarriage, we are not justified in rupturing membranes?

Dr. Miller is more guarded in injuring membranes in premature than in labor at full period. In nine-tenths of his cases at full term he ruptures membranes.

Dr. Ronald. Did you ever know, after rupturing membranes, a woman to go to full term?

Dr. Miller. No such instance has ever come under my immediate observation, but have been reported to me by females. Dr. Flint desired to say, in reference to the subject of diseussion in the earlier part of the evening, that no part of surgery presents such obscurity as abdominal tumors. He wished to present one case as illustrative of the truth of this declaration. He had found a tumor as large as an orange in the right

iliac region. It was moderately hard, without fluctuation, and with but little pain. Upon handling it one received the impression that the whole contents of the abdomen were disturbed. When, after death, the tumor was removed, it was found attached to the coecum. Its characteristics of consistency, &c., were those of a malignant tumor, and, to establish this point, a portion had been sent to Dr. Bemiss for microscopic examination.

Dr. Bemiss regretted that his engagements had pressed him so much that he had not found opportunity to examine this tumor until it had been lost.

Dr. Flint said that he had, at this time, a case of abdominal tumor under his notice, which, when handled, produced eructations. In the case to which he had referred, the whole of the cœcum was involved, and diseased action stopped precisely at the boundary of the colon, and above, the small intestine was healthy to the border of the cœcum. The cœcum was pervious the appendix was enlarged-the condition was evidently scirrhous. I propose to bring this case more fully before the College at some future period. (There was no complaint of pain, but of some soreness.)

Dr. Brandies exhibited the placenta of an Irish woman who bore a child after one pain. The child was decomposed, and had evidently been retained for some time after loss of vitality. Found the placenta detached and lying in the mouth of the uterus. Upon removal it was found flattened, thinned and carnified, its vascularity destroyed, and reduced to the condition of thick membrane solidified. Child full period.

Dr. Brandies had seen a patient in 1852, seven months advanced in pregnancy, who, at that time, suffered greatly with piles. He treated her, and she gave birth to a living child. In two years she became again pregnant, and at her period sent again for him. He found the os uteri but slightly dilated, and left, telling her he would call again. Upon again visiting her some hours after this, he found the os uteri dilated to the size of a dollar. During his examination she had a pain which ruptured the membranes. Immediately after this the anterior lip of the uterus commenced to swell, and in two or three hours it was so much swollen that it was with difficulty the finger could be passed around the tumor. He had to perforate and remove the child with very great difficulty. In four or five days, while voiding the bowels, the uterus prolapsed. It was replaced. After this the patient had menorrhagia, which was relieved by cold bathing, tonics, &c. In August, 1856, found her again threatened with a miscarriage, and found a polypoid tumor in the vagina, which was removed by ligature. In 1857 delivered her of twins. Again troubled with hemorrhage, and a growth which was destroyed with actual cautery.

Pharmaceutical Department.

CITRATE OF IRON AND STRYCHNIA.-This combination, which has lately been brought before the medical profession, and so highly lauded, is readily prepared after the following formula: R-Citrate of Iron,

Distilled Water,
Strychnia,
Citric Acid,

1984 grs.

8 ozs.

10 grs.

6 grs.

Dissolve the citric acid in oz. of the water, and add thereto the strychnia; when complete solution has taken place, add the citrate of strychnia to the citrate of iron, dissolved in the remaining 8 ounces of water by the aid of the heat. Concentrate the mixture by the aid of heat to a syrupy consistence, and pour it upon a porcelain or glass surface to dry. When perfectly dessicated, it will come off in the form of fine garnet colored scales. This preparation will then contain 1-100 of its weight of strychnia, and three grains will represent 1-33 of a grain of that medicine.-THOS. E. JENKINS, Pharmaceutist.

OXIDE OF SILVER IN COMBINATION WITH OXIDIZABLE OR COMBUSTIBLE SUBSTANCES.-When creosote is placed in contact with oxide of silver in a dry state, inflammation of the creosote follows, with development of great heat and light, and the evolution of a large amount of smoke, and the oxide is reduced to the metallic state. The same effect will take place if the oxide of silver be previously mixed with morphine or like substances.

If oxide of silver and morphine, or a like substance, be mixed together and made into pills with syrup or honey, they will in a few minutes grow hot, swell up, evolve fumes, become hard, sometimes crack open, and fall to pieces.

These strong and manifest evidences of incompatibility between highly oxidizing and easily oxidizable substances, point to the rule which should be laid down, never to associate such medicines together in the same prescription.-THOS. E. JENKINS, Pharmaceutist.