and sudden contraction of the uterus would force the fœtal head into the pelvic cavity, increase the flexion, and the power (the contracting uterus), applied in the direction of the abnormal axis-in this case backwards and rather upwards-would guide the vertex, unusually flexed, in the direction of least resistance, which would be backwards and upwards, into the abdominal cavity.

ABDOMINAL TUMORS MISTAKEN FOR OVARIAN.

BY W. L. SUTTON, M.D., GEORGETOWN, KY.

Having seen a report of some remarks in reference to tumors in the abdomen, made in the College of Physicians of Louisville, I have thought proper to transmit the following account of a case which I occasionally saw, as appears by the report, which details all of my professional connection with the case.

Before I ever saw her she had consulted the best surgeon in the West, and had been so unfavorably impressed by his diagnosis and prognosis, that she made up her mind to enjoy what little time she had to live as best she might.

This case may serve to impress upon our minds two important things

1. The great care required in forming a diagnosis as to abdominal tumors, and the uncertainty of correctness, even after great care.

2. The amount of injury which will sometimes be borne for many years.

It is probable that some confusion as to dates has occurred in the minds of her friends, from whom the earlier history of the case was obtained; or if these tumors really had any connection with her taking cold, it is difficult to conceive how they could have become distinct in the situation mentioned in the short space of time which the history seems to indicate.

The subject of the following remarks was an interesting lady of 35 years, the mother of six children, of whom the youngest is now three years old. When about thirteen or fourteen years old, she caught cold and suffered severely, and then became sensible of a tumor in each side in the vicinity of the division

between the lumbar and iliac regions. These tumors increasing in size, she, after marriage, consulted several physicians, who presumed they were of ovarian origin. They seemed, however, to offer no impediment to impregnation. Some five years ago, she had an idea that her right leg was shorter than the left, and walked lame. Upon stepping down from a slight elevation on the 25th of November, 1856, she fractured the right femur, two or three inches above the condyles. She suffered very great pain for a considerable time after this fracture; but it healed in about the usual time. Some three months after the time of this fracture, whilst still wearing crutches, she fell upon the right hip and received a severe injury. I was called to her and judged that the femur was fractured at the neck. This was on the 28th of January, 1857. Again in the usual time she was able to get about on crutches, with the limb shortened some three-fourths of an inch-but as she thought, as long as it was before the first fracture.

During all this time she was rather fleshy than otherwise, with a complexion rather pale, but not markedly so. I had attended her in three or four of her accouchments, in one of which she lost more blood than was desirable, and I deemed it proper to administer iron to invigorate her system.

During my attendance after the second fracture, I again used the iron with the same good effects as before. After this her health was tolerable until May, 1858, when she again lost her balance, and fell and hurt herself badly, and she suffered as much pain as at either fracture. From this time she suffered very much at times, and on the 1st of January, 1859, she had a slight hemorrhage from the lungs, which continued to recur occasionally until the 23d of February, when she expired.

I was requested to be present at the autopsy. She was very much emaciated; color rather sallow or waxy; some veins ramifying over the abdomen, which was rather less prominent than I had expected; the right limb some three or four inches shorter than the left; foot everted; took hold of it and found a fracture three or four inches above the condyles. Upon cutting down to the femur we found it very much cancellated. It was the opinion of the friends that the femur had given way during the dressing after death. There was also a considera

ble infiltration of the cellular substance, and just exterior to the bone an indurated membrane of considerable strength.

In the abdomen, as soon as opened, the liver enormously enlarged, extended to the pelvis. For some little distance below the edge of the cartilage it was of a proper color. The gall bladder was large and distended with healthy looking bile. But the lower portion of the liver was dark colored, thickened and having several spherical elevations of different sizes, one of which, in size of a section of one-third of an orange, was situated in the line below the right iliac region and the hypogastric, and was very evident before death. The left lobe seemed entirely healthy. On the left side nothing appeared to correspond with the prominence which had been observed during life. But upon lifting the bowels a fleshy tumor appeared of some five inches in diameter and ten long, running upwards and towards the left side. It was more or less intimately connected by adhesions to every thing with which it came in contact, the duodenum and ileum, the colon, mesentery and vena cava, these being separated in places by the knife, in places by tearing, the tumor was found to arise from, or be connected with, the left end of the pancreas. The stomach, spleen and bowels seemed healthy, save that the colon was empty and reduced in size to a mere strip, but distingushed by the longitudinal bands. The kidneys and ovaria were sound. The contents of the thorax were not examined because of want of time.

It is proper to remark that this lady had suffered for many years with severe pains which she referred to the thigh bone. And also that after her death the relative length of the lower limb was rather carelessly estimated, and being flexed, was probably longer than stated.

A CASE OF SCHIRRHUS PYLORUS.

BY W. L. SUTTON, M.D.

I can give but a very meager account of the patient from whom the stomach was taken. She was a negro woman of probably 55 years, and had been subject to frequent vomiting for many years. Sometimes she would throw up enormous quantities. Sometimes she would take moderate quantities of food for several days, and then vomit considerably. She would

go without an evacuation from the bowels an incredible period, then the discharge would be small and hard.

Autopsy. Emaciation extreme. Upon opening the abdomen nothing was to be seen but an even, uniform surface, which filled every nook of the cavity, and upon examination it was found to be the stomach enormously enlarged and moderately distended. Upon dividing the esophagus and duodenum, and lifting the stomach out, it resembled in form a pillow-case more than any thing to which I can compare it, having its form determined by the walls of the abdomen and pelvis. The pylorus was two inches in diameter, and of firm consistency, scarcely pervious.

The duodenum ran from the pylorus directly to the lower portion of the pelvis, and the intestines, small and great, were pressed together there in the smallest compass possible, being literally empy of fæces.

No note was made of any thing wrong in any other organ. When I took the stomach from a solution for preservation, I was rather surprised to see that it had lost its square form and resumed one approaching what is natural.

REPORT OF A CASE OF CROUP, SUCCESSFULLY TREATED BY TRACHEOTOMY.

BY T. W. GIBSON, ESQ.

The patient, a boy of eleven years of age, had been subject to croup for several years. The writer of this, his father, was summoned home hastily on the first of November, 1857, and on arriving there at 2 o'clock, p. m., found the patient rapidly sinking. Face and extremities livid, pulse almost imperceptible, breathing labored and short to the last degree. The three attending physicians, Drs. Coombs, Way, and Taggart, of Charlestown, Ind., concurred in the opinion that death must ensue in a few hours, and that nothing was to be hoped from medicine. It was immediately determined to resort to tracheotomy, and the operation was performed by Dr. Coombs, assisted by the other physicians named. The day light was almost gone before the operation was completed, and we were compelled to the resort of reflecting the rays of the setting sun by a mirror upon the throat of the patient. No large vessel was cut, and the hemorrhage was very trifling. Nothing pecu

liar in the method of operating occurred, except perhaps the expedient resorted to for the purpose of enlarging the opening in the trachea. With a pair of round lipped forceps a segment of the side of the opening was seized of the size designed to be removed, and while so held the segment was cut out by the bistoury, and the piece removed with the forceps. A similar operation on the other side left a symmetrical opening in the trachea, about three-eighths of an inch in length, and one-eighth of an inch in width at the center, each side being the segment of a circle. A violent fit of coughing succeeded the opening of the trachea, during which a piece of membrane three-fourths of an inch in length was presented at the opening and drawn out with the forceps, and great relief in the breathing immediately succeeded, and the urgent symptoms of asphyxia rapidly disappeared.

The patient seemed to suffer great thirst, and every attempt to drink brought on a fit of coughing, during which several other pieces of membrane were drawn out of the aperture in the trachea.

The breathing was carried on through both the mouth and the opening. Arterial action through the night very intense; pulse 140. The heart felt like some strong animal inclosed in a net and struggling for release; heat of the body very great ; skin dry.

November 2. No change in the arterial excitement; expectorates healthy pus freely through the wound. The wound itself exhibits but little sensibility, even when roughly swabbed out. At 2 o'clock, p. m., the pulse rose to 160; coma and muttering delirium supervened, accompanied by an erysipelatous blush, which, commencing at the wound, overspead the entire face in half an hour. Dr. Coombs, who came in about the time these symptoms became the most urgent, expressed the opinion that he could not live. At the suggestion of the writer the patient was enveloped in the wet sheet, wrung out of the coldest water that could be procured. The effect was prompt and decided. In half an hour the pulse had fallen to 100. The coma, and delirium, and erysipelatous blush had disappeared, and the patient slept soundly and quietly for some hours.

The leaden band had been resorted to in the first instance to keep the lips of the wound apart, but it was found to be wholly