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IN AID OF THE PRACTICE OF MEDICINE AND SURGERY.
665
infirmary on October 20th in order to have simple but ingenious construction. The opening through ovariotomy performed. She is forty-two years of age, married, which the fluid is poured has been enlarged, thereby affording and has had four children. She first noticed the disease facility for wiping out the instrument after the use of oil, eighteen months before, since which time it has steadily in- gruel, &c. creased in size, but has never caused much severe pain. The The accompanying wood engraving accurately shows the abdomen measures forty-one inches in circumference at the of the instrument, rendering but a brief descripthe construction are and umbilicus, thighs respiration slightly cedematous, somewhat laboured; the heart and lungs are healthy; catareturned to the
menia regular. The tumour is now uniform over the whole of the abdomen, with complete dulness in every part; it is evicysts, and fluctuation is in many dently composed ofSheseveral is thin and wasted from the progress of parts imperfect. the disease, but there is no sign of any other disease about the body. After a short preparatory treatment with warm baths and a little iron, the operation was performed on the 28th of October, in a room heated to about 750 F. The patient was enveloped in a tight-fitting flannel gown, and the legs were well wrapped with flannel. The woman being placed under the influence of chloroform, an incision was made nearly to the umbilicus; it was then found that the front wall of the tumour In endeawas extensively adherent to the abdominal wall. vouring to separate these adhesions with the hand the cyst wall was ruptured, but by binding the lips of the rupture round the canula Mr. Knaggs was enabled to break down the adhesions without allowing any escape of the contents of the cyst into the peritoneal cavity. There was no haemorrhage of any consequence from these torn adhesions. As the fluid was so jelly-like that it would not run through Spencer Wells’s canula, it was considered to be safer to enlarge the incision so as to admit of the removal of the large tumour in the mass, rather than, by violent breaking up of it, to run the risk of rupturing some of the cysts into the peritoneum. The incision was therefore extended to three inches above the umbilicus. The hand was then passed behind the tumour, and lifted it from its bed, and it was drawn forwards into a large vessel. The pedicle was broad and very short ; a double ligature was passed through it and tied, each portion confining one half the pedicle, and the cyst was then separated. The wound was brought together with fine thread; the pedicle was drawn out at the lowest part of the wound, and transfixed below the ligatures by a strong pin passing through the abdominal wall. A pad of cotton wool was placed over the whole, and secured by a bandage. She was removed to bed, a catheter passed every six hours, and allowed nothing but ice, brandy and Seltzer water. Oct. 29th.-Has passed a good night; 0 pulse 90. To continue the brandy. Nov. 2nd.-She was able to take a mutton-chop and six ounces of wine daily. 4th.-The bowels were moved for the first time since the operation ; the sutures were removed, and union of all the upper part of the wound was complete. 6th.-The ligatures round the pedicle, with the sloughing portion, were removed, and a charcoal poultice applied. From this time she progressed favourably, and was allowed to get up on the 24th, the wound having quite healed. She was discharged on the 4th of December. With the exception of one large and two moderate-sized cysts, the tumour was very solid, consisting of great numbers of very small cysts with strong fibrous walls ; its total weight was forty-five
pounds.
ratus.
ARMY MEDICAL DEPARTMENT.—The annual
New Inventions IN AID OF THE
PRACTICE OF MEDICINE AND SURGERY. IMPROVED PNEUMATIC ENEMA APPARATUS. Ix the number of thisjournal for
May 27th, 1865, attention was pneumatic instrument possessing among several important advantages that of requiring no effort to be made at the time of using it beyond turning a stop-cock, and also that directed
tion necessary. It consists of a cylinder divided in two chambers by a hollow piston: the lower one is filled with fluid by unscrewing the bottom cap, which is afterwards replaced ; into the upper chamber air is compressed by means of a small condensing pump connected with it. The air then pressing downwards on the piston, forces out the water or other fluid when the stop-cock is turned. To ensure that no air shall pass the piston it is made with double packings, having a space between them; this space forms a reservoir, and is filled with oil, which affords additional resistance to the passage of air, besides preserving the packings in perfect order. When the fluid has been ejected, the piston, independently of its form of construction and accurate fitting, acts also as a valve by descending on to the outlet-pipe and effectually closing it. Mr. Ashton, who is the inventor, points out, in his wellknown treatise on the Diseases of the Rectum, the benefit arising from the proper use of enemata, in many cases rendering aperient medicines unnecessary, and thereby preventing the nausea and irritation of the stomach and upper part of the alimentary canal they so often induce. Messrs. Weiss are the manufacturers of this enema appa-
to
a
general
of the Army Medical Officers’ Friendly and Benevolent Societies were held at the Ship Hotel, Charing-cross, on May 25th, 1867. On this occasion the actuary’s report of the last quinquennial examination of the Friendly Society was submitted to the meeting, and ordered to be printed and circulated among the members. It shows the financial condition of the Society to be in a highly satisfactory state, there being Mr. Brown, a considerable surplus of assets over liabilities. the actuary, calls attention in his report to the falling off of members who now join the Society, remarking, "It unmarried is much to be regretted that the number now induced to join the Society is so small, since the institution, by its successful management, holds out such large prospective benefits to them." The contributions to the Benevolent Society during the past year had been of a very liberal character, enabling the committee to recommend the sum of E540 for distribution among the various applicants for assistance.
meetings
no air is thrown into the bowel. In that instrument the fluid to be injected was contained in a cup of india-rubber, which had the defect of being acted on prejudicially if oil or medi- ; ACTI-VE cated injections were used. In the present one this disadvanwest province of tage is obviated by the substitution of a metallic piston of a cholera.
preparations Bombay
are
being
made in the north-
in order to check the
spread
of
s
infirmary on October 20th in order to have simple but ingenious construction. The opening through ovariotomy performed. She is forty-two years of age, married, which the fluid is poured has been enlarged, thereby affording and has had four children. She first noticed the disease facility for wiping out the instrument after the use of oil, eighteen months before, since which time it has steadily in- gruel, &c. creased in size, but has never caused much severe pain. The The accompanying wood engraving accurately shows the abdomen measures forty-one inches in circumference at the of the instrument, rendering but a brief descripthe construction are and umbilicus, thighs respiration slightly cedematous, somewhat laboured; the heart and lungs are healthy; catareturned to the
menia regular. The tumour is now uniform over the whole of the abdomen, with complete dulness in every part; it is evicysts, and fluctuation is in many dently composed ofSheseveral is thin and wasted from the progress of parts imperfect. the disease, but there is no sign of any other disease about the body. After a short preparatory treatment with warm baths and a little iron, the operation was performed on the 28th of October, in a room heated to about 750 F. The patient was enveloped in a tight-fitting flannel gown, and the legs were well wrapped with flannel. The woman being placed under the influence of chloroform, an incision was made nearly to the umbilicus; it was then found that the front wall of the tumour In endeawas extensively adherent to the abdominal wall. vouring to separate these adhesions with the hand the cyst wall was ruptured, but by binding the lips of the rupture round the canula Mr. Knaggs was enabled to break down the adhesions without allowing any escape of the contents of the cyst into the peritoneal cavity. There was no haemorrhage of any consequence from these torn adhesions. As the fluid was so jelly-like that it would not run through Spencer Wells’s canula, it was considered to be safer to enlarge the incision so as to admit of the removal of the large tumour in the mass, rather than, by violent breaking up of it, to run the risk of rupturing some of the cysts into the peritoneum. The incision was therefore extended to three inches above the umbilicus. The hand was then passed behind the tumour, and lifted it from its bed, and it was drawn forwards into a large vessel. The pedicle was broad and very short ; a double ligature was passed through it and tied, each portion confining one half the pedicle, and the cyst was then separated. The wound was brought together with fine thread; the pedicle was drawn out at the lowest part of the wound, and transfixed below the ligatures by a strong pin passing through the abdominal wall. A pad of cotton wool was placed over the whole, and secured by a bandage. She was removed to bed, a catheter passed every six hours, and allowed nothing but ice, brandy and Seltzer water. Oct. 29th.-Has passed a good night; 0 pulse 90. To continue the brandy. Nov. 2nd.-She was able to take a mutton-chop and six ounces of wine daily. 4th.-The bowels were moved for the first time since the operation ; the sutures were removed, and union of all the upper part of the wound was complete. 6th.-The ligatures round the pedicle, with the sloughing portion, were removed, and a charcoal poultice applied. From this time she progressed favourably, and was allowed to get up on the 24th, the wound having quite healed. She was discharged on the 4th of December. With the exception of one large and two moderate-sized cysts, the tumour was very solid, consisting of great numbers of very small cysts with strong fibrous walls ; its total weight was forty-five
pounds.
ratus.
ARMY MEDICAL DEPARTMENT.—The annual
New Inventions IN AID OF THE
PRACTICE OF MEDICINE AND SURGERY. IMPROVED PNEUMATIC ENEMA APPARATUS. Ix the number of thisjournal for
May 27th, 1865, attention was pneumatic instrument possessing among several important advantages that of requiring no effort to be made at the time of using it beyond turning a stop-cock, and also that directed
tion necessary. It consists of a cylinder divided in two chambers by a hollow piston: the lower one is filled with fluid by unscrewing the bottom cap, which is afterwards replaced ; into the upper chamber air is compressed by means of a small condensing pump connected with it. The air then pressing downwards on the piston, forces out the water or other fluid when the stop-cock is turned. To ensure that no air shall pass the piston it is made with double packings, having a space between them; this space forms a reservoir, and is filled with oil, which affords additional resistance to the passage of air, besides preserving the packings in perfect order. When the fluid has been ejected, the piston, independently of its form of construction and accurate fitting, acts also as a valve by descending on to the outlet-pipe and effectually closing it. Mr. Ashton, who is the inventor, points out, in his wellknown treatise on the Diseases of the Rectum, the benefit arising from the proper use of enemata, in many cases rendering aperient medicines unnecessary, and thereby preventing the nausea and irritation of the stomach and upper part of the alimentary canal they so often induce. Messrs. Weiss are the manufacturers of this enema appa-
to
a
general
of the Army Medical Officers’ Friendly and Benevolent Societies were held at the Ship Hotel, Charing-cross, on May 25th, 1867. On this occasion the actuary’s report of the last quinquennial examination of the Friendly Society was submitted to the meeting, and ordered to be printed and circulated among the members. It shows the financial condition of the Society to be in a highly satisfactory state, there being Mr. Brown, a considerable surplus of assets over liabilities. the actuary, calls attention in his report to the falling off of members who now join the Society, remarking, "It unmarried is much to be regretted that the number now induced to join the Society is so small, since the institution, by its successful management, holds out such large prospective benefits to them." The contributions to the Benevolent Society during the past year had been of a very liberal character, enabling the committee to recommend the sum of E540 for distribution among the various applicants for assistance.
meetings
no air is thrown into the bowel. In that instrument the fluid to be injected was contained in a cup of india-rubber, which had the defect of being acted on prejudicially if oil or medi- ; ACTI-VE cated injections were used. In the present one this disadvanwest province of tage is obviated by the substitution of a metallic piston of a cholera.
preparations Bombay
are
being
made in the north-
in order to check the
spread
of
s