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with profuse expectoration, which gave a great deal of trouble,- she went on well in every respect. The rapid healing ofthe abdominal wound was not for one moment interrupted-indeed, the wound healed by primary union. Her recovery,therefore, from the operation was most satisfactory, with theexception of the drawback mentioned.

DOUBLE OVARIAN TUMOURS REMOVED BY OVARIOTOMY; MOSTEXTENSIVE ADHESIONS; FATAL RESULT.

(Under the care of Dr. OLDHAM and Mr. THOS. BRYANT.)Emma C-, aged thirty-two, was admitted on the 10th of

April, 1863. She is married, and has had one child. The- abdominal tumour was observed two years ago, and was firstseen in the left side. The patient was tapped in November,1862, and twenty-three quarts of dark fluid drawn off. She,soon refilled, and when admitted measured forty-eight inchesin. circumference. Her general health is good.

April 15th.-Ovariotomy was performed in a private room.The whole tumour was firmly adherent to the peritoneum.With some difficulty this was separated. It was likewise firmlyattached to the stomach, liver, and omentum. The cyst was,at last separated, the omentum being divided and tied as theoperation proceeded, and the pedicle in the left side fastenedby three whip-cord ligatures. The right ovary was found tobe similarly affected, and the tumour situated in the pelvis be-hind the uterus. This was also removed, the pedicle beingfixed by two whip-cord ligatures.During the operation the bladder was found intimately con-

nected with the cyst -wall, and considerable care was requiredto avoid injuring it. The abdominal incision was at least eightinches long, having been enlarged to give more room. The.edges of the wound were united with silver sutures.

The patient died twenty-two hours after the operation fromperitonitis, evidences of which were seen at the autopsy. The’viscera were otherwise healthy.

OVARIAN TUMOUR OF THE RIGHT SIDE REMOVED BY

OVARIOTOMY; FATAL RESULT.

(Under the care of Dr. HICKS and Mr. COOPER FORSTER.)Nancy P-, aged thirty-eight, was admitted April 1st,

a863, with an ovarian tumour. Ovariotomy was performed onthe 22nd, in the middle of the day, by Mr. Forster. Adhesionsto the abdominal walls existed, but otherwise nothing remark-.able was noticed about the case. Symptoms of general perito-nitis ensued, and she died on the morning of the 25th. The iautopsy, twelve hours after death, showed acute general peri- Itonitis; a few flakes of lymph were discovered between the- coils of intestine, but for the most part the effusion was fluid<and sanguineous, and in amount two or three pints.

The above details we have extracted from Dr. Wilks’s post-mortem record book.

SAMARITAN HOSPITAL.

FIVE CASES OF OVARIAN DISEASE; OVARIOTOMY

SUCCESSFUL IN FOUR.

(Under the care of Mr. SPENCER WELLS. )THE following cases of ovariotomy have been treated in this

hospital since our last report (March 14th, 1863). The noteswere furnished by Mr. E. Parson, house-surgeon.CASE 1. Large semi.sol&Ugrave;l ovarian tumour; tapping ; ova-

:’I’iotomy; recovery. -M. S-, unmarried, aged thirty-six,.applied to Mr. Wells in January last with a very large multi-locular ovarian cyst. She measured forty-eight inches round’the body, at the umbilicus. Increase in size had commencedabout two years before, and during the last few weeks it hadeen very rapid. She returned to Oxford, and Mr. Wells wroteto Dr. Acland suggesting a preliminary tapping. She was

tapped on February 1st, and thirty-six pints of fluid weretaken away. Dr. Acland wrote to say, " There remains a

large partially-solid mass, not readily movable. The poorcreature’s fate is sealed without the operation." She was ac-

cordingly admitted on February 27th, and Mr. Wells performedovariotomy on March 2nd. Dr. Jottrand of Brussels, Mr. Par-tricige, and many other visitors were present. The incisionWas six inches long. The cyst was universally adherent ante-

riorly, but easily separated. On the left side considerable forcewas required to break down the adhesions. After emptyingthe large cyst, the tumour was gradually withdrawn, and along pedicle on the right side secured by a clamp. The leftovary was healthy. The wound was closed by silk sutures.The clamp was removed on the third day after the operation.She recovered well, and has been heard of since she left thehospital as in excellent health.CASE 2. Multilocular ovarian cyst; ovariotomy; recovery.&mdash;

E. C-, unmarried, aged thirty-six, admitted March 13th,1863. She had been an out-patient, under Dr. Rogers, forabout two years, the disease having commenced about fouryears ago. She became subject to severe pains in the left side,was unable to earn her living by the needle, and was admittedfor operation. The girth at the umbilicus was thirty-five inches.Mr. Wells performed ovariotomy on March 16th. Dr. Jottrand,of Brussels, Dr. Gream, &c., were present. The incision wasfive inches long. One large cyst was emptied, and then thewhole tumour passed outwards, with some assistance frompressure. A small clamp was applied on the pedicle on, theleft side. The right ovary was healthy. The wound wasclosed in the usual manner. The remains of the pedicle be-came quite dry, and adhered so firmly to the clamp that it wasnot removed till the eighth day. She left the hospital onApril 13th in excellent health.CASE 3. A scite.-; tapping; removal of small ovarian tumour;

deatlt.&mdash;A married woman, twenty-six years of age, was firstadmitted December 22nd, 1862, with considerable enlargementof the abdomen from fluid which was ascitic. Married eightyears, and had one child seven years ago. The abdomen beganto enlarge in the spring of 1862, and she suffered from dysuriafor about three months. She was tapped in the London Hos-pital in October, 1862, sixteen pints of fluid having been re-moved. Mr. Wells tapped her in December, and removedtwenty-nine pints of clear fluid. There was nothing in thenature of the fluid to decide whether it was ascitic or ovarian.The patient left the hospital on January 10th, 1863, and re-turned again in February, with the abdomen full of fluid. Itstill seemed to be free in the peritoneal cavity; but as theuterus, though movable, was rather low down, the cervix

large, and pushed to the left side, and there was marked dul-ness in the right loin, it was thought that there was disease ofthe right ovary, although nothing could be felt through theabdominal wall anteriorly, Accordingly, an exploratory inci-sion was made on February 21st, and after removing twenty-six pints of clear fluid, a growth, about the size of a smallcauliflower, was found to occupy the place of the right ovary.Nothing more was done, and the wound was closed. It healedby the first intention, and the patient recovered without a badsymptom ; but the ascitic fluid re-collected rapidly, and it be-came a question whether the tumour should be removed, ortapping repeated. It was known that the ovarian tumour wassmall, and its attachment broad ; but the prospect of repeatedtapping was so hopeless that the earnest desire of the patientto have the tumour removed was complied with, and Mr. Wellsperformed the operation on March 25th. An opening wasmade just large enough to admit the hand midway between theumbilicus and symphysis pubis, the ascitic fluid allowed to

escape, and the ovarian tumour drawn forwards, with the in-tention of placing a ligature round its base. But it brokeaway completely from its attachments, and there was freebleeding, mostly venous. There was no pedicle, the diseasedovary preserving its natural relations with the uterus, buthaving a broad base of attachment between the posterior sur-face of the uterus and the caecum, following the course of theright spermatic vessels where they cross the psoas muscle.Both artery and vein were tied with a silk ligature, the ends ofwhich were cut off short, and the knot allowed to remainwithin the abdomen. The bleeding then ceased, the abdomenwas carefully sponged, and the wound closed. The patientrallied fairly after the operation, and did not suffer pain; butvomiting became troublesome. On the second day, vomitingbecame urgent and exhausting, and she died fifty-four hoursafter the operation, apparently exhausted by the vomiting andthe rapid formation of serum in the peritoneal cavity. Onpost-mortem examination, about forty ounces of dark red serumand two ounces of blood-clot were found in the cavity. Therewas also a little recent lymph, showing slight peritonitis.CASE 4. Removal of an orariian tumour weig7ting thirty-seven.

pounds from a woman sixty one years of age ; recovery. - Amarried woman, sixty-one years of age, mother of six children,the youngest of whom is eighteen, was sent to Mr. Wells inMarch last by Dr. Giles of Oxford. A large multilocular ova-