16 hours Recovered. Tumor 22 lbs. Med.-Chir. Trans. vol. xxvii. p. 473. Ibid. [Philips' table. Ibid. Death. A portion of fluid removed before extraction: Ibid. Psaff's Journal. Recovered. Not removed on account of adhesion. The Not reported. American Journal of and she died from it in about 2 months. Recovered. Tapped and extracted. Lancet, April 5, 1845, p. 397. for Oct. 7, 1845. Recovered. The ligature came away in 3 weeks. Each ar- Provincial Med. & Surgical Journal 70 days 11 hours Died. Died. Tumor weighed 20 lbs.; fluid 10 lbs. Edinb. Med. & Surg. Journ. 1846. A portion of the pedicle, containing the Fall. Chemical Lecture. Lond. Med. Gaz. Unpublished, but at which I was present. Recovered. An exploratory incision was made of a few Unpublished; and the particulars The patient recovered without any untoward symptom. Recovered. The weight of the tumor, with its fluid and Unpublished; and the particulars solid portions, 50 lbs. The patient was preg- given to me by H. E. Burd, Shrewsnant of about 3 or 4 months' standing, and bury. aborted forty hours after the operation. Unpublished. Recovered. day. dominal cavity; the wound had perfectly healed, and the patient was restored to health, whilst they were still in the abdomen. After several weeks had elapsed, a small abscess appeared at the lower part of the cicatrix, an opening into which gave exit to a quantity of healthy pus and the ligatures. A free discharge was promoted by poultices for a few days, and at the end of the week the wound closed. No constitutional disturbance occurred, and there has not been the slightest interruption to the most perfect state of health since the termination of the report. The catamenia appeared with the greatest regularity, and in the same quantity as previously to the commencement of the disease. There is a tendency to corpulency, which is in a great measure checked by her active habits." Provincial Med. & Surg. Journ., Sept. 10, 1845. i All Dr. F. Bird's cases are doing well. k All Mr. Lane's patients are doing well; he gave me the account of the two unpublished cases. 7 Case 102. This case was operated upon by Mr. Morgan of Guy's Hospital, and is the same as the one reported as by Dr. Ashwell, and "Guy's Hospital," in Dr. W. L. Atlee's Table. Am. Jour. of Med. Science, vol. xxxv. 1845, p. 333. m "I may take this opportunity of mentioning, that the woman from whom I removed an ovarian tumor in August, 1844, was, when I last heard of her, some months since, in good health, and following her usual occupation, that of Jan itinerant dealer in pens and paper, in the neighborhood of Edinburgh." Mr. W. B. Page has again performed the abdominal section; the particulars of the case are given in the Lancet for Dec. 12, 1846, whence the above remarks Jare taken. n Case 115. I here beg publicly to thank T. Y. Arrowsmith, Esq., and H. E. Burd, Esq., both of Shrewsbury, for their great politeness in giving me the particulars of their cases, 115, 116. o Case 116. Mr. Burd states in a note, that "on this, the seventeenth day from the operation, the patient is doing well, and gives fair hopes of recovery." p These last four cases occurred after this work was in the press, and therefore are not included in the statistical results. LETTER XXVI. GENTLEMEN:-The Fallopian tubes, like the ovaries and other generative tissues, are liable to disease; but it unfortunately happens that the Fallopian tubes being hidden within the bony cavity of the pelvis, and not approachable either by the vaginal touch or the hypogastric palpation, may be the seats of disease, proceeding to the most inconvenient or even dangerous extent, without our being enabled to detect its existence by any process having the clearness of demonstration. I presume, indeed, that for the most part, Fallopian disorders will scarcely be clearly made out until a necrological examination may serve to reveal them. This opinion, I think, is well founded, except, perhaps, as to some samples of tubal pregnancy, of which the signs, too late discovered, are sufficiently clear to admit of our pronouncing boldly upon the case. Affections of the Fallopian tubes may serve to condemn a female to incurable barrenness. Thus, if a female, in early life or later, should experience an attack of acute peritonitis, marked with the characters of adhesive inflammation, the Fallopian tubes, one or both of them, might become attached by adhesive bands to the broad ligament, or to the bladder, so as effectually to prevent a tube ever afterwards from serving as a conductor of the ovulum to the womb. In such an instance, it would be impossible for fecundation to take place, and equally impossible to make the diagnosis of the accident during the person's lifetime. An adhesion of a Fallopian tube to the broad ligament, leaving the other one free to fulfil its office of excretory duct to the ovarium, would not, however, at all interfere with the reproductive power of the woman, since one ovary might produce germs for the fecundative conflict. Neither would such an adhesion expose her to any danger of suffering from violent traction and disruption of the adhesion in case she should become pregnant, when the womb must rise upwards to the height of the scrobiculus cordis; because, the broad ligament itself equally yields to the distending force of the growing womb, and thus carries the adherent tube upwards along with itself. No great inconvenience, therefore, is to be apprehended from an adhesion of one tube. When both are adherent, so as to prevent the fimbriæ from reaching the ovary, barrenness is inevitable. A Fallopian tube may become the seat of inflammation at its fimbria resulting in the closure of that extremity of the organ, while the uterine orifice of it also becomes closed. In this situation it sometimes is found to be filled and greatly distended with water. A beautiful drawing representing this condition of the Fallopian tube is given by Dr. Hooper, at p. 61 of his Morbid Anat. of the Uterus, &c. M. Duges supposes that pain and inflammation in the region of the Fallopian tube, unaccompanied with swelling or hardness there, may be held as signs of inflamed Fallopian tube; but I do not discern how such signs can be taken as evidence of that particular malady, since they may be as well marks of disease attacking the round or broad ligaments, and I should place very little reliance on the diagnostic skill of any one for the particular diagnosis in question. All such maladies are and must, during their course, remain obscure and unknown, except as far as they introduce constitutional disturbance. The Fallopian tube has been found full of blood, probably menstrual blood. I am not aware that any one has perished from the escape of a quantity of menstrual fluid from the uterus, in atresia of the vagina or womb; and yet it seems wonderful that where the uterus is expanded to the cubic content of twenty or thirty ounces of menstrual excretion, the uterine orifice of the tube should never suffer it to flow off into the peritoneal sac. The surprise is increased upon remembering that the tube is so expansible as we see it in some morbid specimens. hours, For example. I attended a lady in her accouchement in June, 1841. She had a favorable labor, and all the usual circumstances of a lying-in woman attended her for a period of when she complained of heavy and distressing pain in the region of the right Fallopian tube. The pain, and the complaint of it were great. Of a sudden the pain began to spread over the lower belly, and the constitution evinced its participation. The pulse became alarmingly excited and accelerated, and she was soon seen to be far gone in a puerperal peritonitis. As she had com plained of pain in the right side for some time before the accouchement, I feared that some local malady, suddenly aggravated, was at the foundation of the danger. She died; and upon inspecting the abdominal cavity, much pus and sero-pus were observed. But what most particularly struck me, was the state of the Fallopian tube, which was much larger than a stout man's thumb; and its cavity, which would freely admit of the introduction of a finger into the tube, had been filled with pus. I have little doubt, that acute inflammation of the tube, sealing the ovaric extremity of it, and afterwards filling and greatly distending its calibre with pus, discharged at length into the belly, is the true rationale of this fatal attack. As the Fallopian tube conveys the ovulum from the ovarium to the womb, it is occasionally liable to destruction from an arrest of the fecundated ovulum in some portion of the tractus. An ovulum, when fecundated, whether it be arrested in the tube or whether it be arrested in the uterus, makes its mesenteric attachment to whatever vital surface it is confined. No doubt is entertained as to tubal gestation. No doubt, therefore, can be had, that, in all such instances, the ovulum was fecundated before it had passed down the whole length of the tube. When such a tubal conception hath taken place, the woman will probably deem herself pregnant, since the rational signs of conception, such as nausea, deeper tinted aureoles, and even failure to menstruate may attend the misfortune. No suspicion of the dreadful fate that impends the victim is aroused until the tube has attained the utmost degree possible of its expansibility. That degree will rarely allow her to go beyond the third month, before the tissue gives way, and the ovum bursting, pours its contents into the peritoneum, followed by torrents of blood effused from the ruptured arterioles and venules of the tube. If the patient complains, for some days before the accident, of pain in the region of the ovary, it is probable the pain will be attributed to some other than the true cause, and the first symptom of the rupture is characterized by an instant burst of distress and a rapidly developing inflammation, attended by the evidences of a simultaneous hemorrhagic exhaustion, and the speedy evidences of approaching death, seen in mortal pallor of the face, coldness and clamminess of the limbs, shortening respiration, and a vanishing pulse, repeated with inappreciable rapidity. Suppose you should be spoken to on the subject of a pregnancy just commenced, for your counsel as to the conduct of the patient. If, after the lapse of six weeks or twelve weeks, you are hastily called to her, and find her in the condition above described, what other diagnosis have you to offer than that of a ruptured Fallopian tube? You see very clearly that such phenomena could by no means attend a sudden internal strangulation of a bowel; and the antecedent health of the woman would not allow you to attribute her symptoms to a perforation of an intestine. You have no other diagnosis to offer, and, unhappily, the only consolation for you, under such circumstances, consists in your ability clearly to point out the nature of the causes, and predict the verification of your decision after the death of the victim, which may be pronounced unavoidable. I was the distressed witness of a case of this kind, a few years since, in a fine young woman, who had been several years married without offspring, when she came at last to tell me, with unfeigned pleasure, that she was pregnant, and to take my advice as to her hygienic management. When her pregnancy had proceeded a little beyond the second month, she arose from her bed in good health and spirits. She took a broom and began to sweep some part of her apartment, when, in an instant, she felt violent pain in the region of the ovary, became suddenly of a mortal paleness and coldness, and by the time I reached her apartment, was already sinking from the peritoneal hemorrhage. Here is another case that fell under my notice. Mrs., aged thirty-two, a healthy woman, mother of four children, was in excellent health on Sunday, October 7th, 18—. At six o'clock in the morning, she was gayly singing and playing with her young children at her country seat, about two miles from town. At seven o'clock, an hour later, her husband, who was sick in his chamber, heard her slowly ascending the stairs, and groaning heavily. Upon her entering his chamber he perceived her to be alarmingly ill. Her physician, Dr. ——, was immediately sent for. He found her with a pulse at 140, and complaining of violent pains extending from the top of the thorax, on the right side, quite down to the iliac region. He attended her all day, applied a blister to the right side of the belly, and gave her a cathartic, &c. She passed a dreadful night, but was easier the next morning at 8 o'clock, when the pulse was but 120 per |