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into hydrogen gas and a residual phosphate is the quicker ac.cording to concentration and quantity." It will not now bedifficult to understand why one practitioner makes two grainshis maximum dose, another five grains, and another one drachm.I do not hesitate to affirm that one drachm of a pure hypophos-phite of potash (2 H 0, P 0 + K 0 + n A q.) or soda (2 H 0,P 0 + Na + n Aq.) taken at once will produce poisonouseffects; and if so, the hospital reports already published of ex-periments with such large doses of the hypophosphites are alto-gether valueless.

In the preparation of a hypophosphite the chief points ofattention are to keep the temperature below 2200 and equallyapplied around the vessel, and to exclude the air. A water-bath, a steam-jacket, or an oven, answers well. For the ex-clusion of air, if the vessel be of the common oil-flask form, andthe space between the fluid and the mouth be kept constantlyfilled with vapour, not only is the air excluded, but the issuingphosphuretted hydrogen does not explode within and fall backas phosphoric acid, to form an immediate phosphate. A stillbetter method is to secure a funnel with a loosely-fitting marble,or other spherical body, in it, upon the top of the vessel. Butwhen the operation is carried on a few days at the temperatureof 100° to 150°, a stratum of oil of turpentine poured gently onthe surface excludes the air, arrests the phosphuretted hydrogenwithout explosion, and forms a phosphuretted terebinthinatecamphor, which imparts a somewhat disagreeable odour to thesalt. I have not found the product less efficacious thera-peutically. By whatever mode the hypophosphite is prepared,care should be taken in the evaporation to form a dry salt thatthe temperature of 140° be not exceeded. In one of my expe-riments in the formation of the hypophosphite of soda, the saltbecame intensely dried in the oven at about 240° Fahr. On

removing it into a closely stoppered bottle, a lambent flame ofnon-explosive phosphuretted hydrogen gas played over thedried salt for several hours, proving that the constitutionalwater of composition (for it cannot exist without two atoms ofwater) was decomposed, one portion of the phosphorus takingthe oxygen to form phosphoric acid, the other taking the hydro-gen, and forming the non-explosive hydrogen gas, H3P, theexplosive kind being H10 P5; or as Levrier has it, P H.. Whenthe solution has attained the crystallizable point, a temperatureof about 7u° to 90° is best. Though there are good reasons forpreparing some of the medicinal hypophosphites by doubledecomposition, there can be none for the potash and soda hypo-phosphites. Notwithstanding what Rose says of concentratedalkaline solutions and phosphorus being converted the mostquickly into phosphates, I find the strong solutions, as 1.075 toto 1.100, best adapted for oxidizing the phosphorus quickly;but of course, if boiled in an open pan, his aphorism becomestrue. Liq. potassae or sodae, 1 .075, takes up one-fortieth partof its weight of phosphorus, a portion of which seems to passinto hypophosphorous acid from a state of vapour; but thegreater part passes through suboxidation—the yellow oxidewhich Graham calls ’’the hydrate of phosphoric oxide," andsupposes it to contain one-fifth water. On brisk ebullition this

vapour passes off, and burns non-explosively, constituting agreat source of waste in manufacturing on the large scale. Byexperiment I have proved this loss to be one-third. It is easyto distinguish the escaping phosphorus fLame by its luminosity,so different from the bright vivid explosions of phosphurettedhydrogen. Weak alkaline solutions produce much waste ofphosphorus in the form of an insoluble flocculent hydrate.

(To be continued.)

TESTIMONIAL TO DR. SPENCE, OF LETHAM, FIFE.-OnSaturday, the 9th inst., the Rev. Dr. Ceitch, Monimail, waitedon Dr. Spence, and in the name of a large number of hispatients and friends presented him with a portion of silverplate and a purse of sovereigns. In a very short time nearly.sElsO were collected for the testimonial, and the silver plateconsisted of a very handsome claret-jug and cake-basket. The

jug bore the following inscription: ’’To Wm. Spence, M.D.,Letham. Presented, along with a purse of sovereigns, by alarge circle of friends and natients. in token of their apprecia-tion of his valuable services, and their deep regret that im-paired health has rendered necessary his retirement from afield of increasing usefulness." Dr. Spence, though unable tospeak much, expressed his gratification at this token of kind-ness from his old friends now that illness had weakened hisstrength, and said that the plate would be preserved as anheirloom in his family when he was gone. Unhappily, Dr.Spence did not long survive the honour thus conferred uponhim, as will ce seen by reference to our obituary.

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

LONDON HOSPITAL.

UNILOCULAR OVARIAN TUMOUR, AT ONE TIME ASSOCIATEDWITH PREGNANCY; OVARIOTOMY; DEATH FROM

PERITONITIS ON THE THIRD DAY.

(Under the care of Dr. DAVIES and Mr. CURLING.)

Nulla est alia pro certo noscendi via, nisi quam plurimas et morborum etdissectionum historias, tam aliorum proprias, collectas habere et inter se com-parare.-MORGAGNI. De Sed. et Caus. Morb., lib. 14. Procemium.

SiNcE the last report of cases in the " Mirror" in whichovariotomy was performed (THE LANCET, vol. i. 1861, p. 34),the operation has been frequently resorted to both in publicand private practice, with results that may be consideredon the whole as fairly satisfactory, when its formidable natureand other circumstances are taken into consideration. Wenow add the particulars of thirteen cases, followed by re-covery in nine. The ages of the patients comprised amongstthe latter were respectively 22, 21, 19, 49, 23, 27, 18, 50, and38 years; all with the exception of two being favourable for theoperation. The fatal cases include four, whose respectiveages were 20, 24, 40, and 50 years. On analyzing the casesfurther, we find that adhesions, more or less extensive, werepresent in four of the successful and in all of the unsuccessfulexamples. A ligature was generally employed, excepting inthe cases under the care of Mr. Brown, a preference beinggiven by him to the clamp, consisting of an ordinary pair ofcarpenters’ callipers. In Dr. Tyler Smith’s four successfulcases, noticed in a previous number of this journal, the liga-tured pedicle was allowed to fall within the pelvis. The ad-vantage of the clamp is that in three or four days it can beremoved without inconvenience or danger, and the pedicle isgradually retracted within the abdomen. Then, again, anobjection has been raised against the clamp that it causes muchstraining in the event of vomiting or tympanitis. The tumourwas polycystic in six of the successful and in two of the un-successful cases.

Notwithstanding the liability there is in certain patients tothe occurrence of haemorrhage, peritonitis, and shock afterthe operation, statistics now show that a recovery may beanticipated in two out of every three cases, a proportion ofsnccess decidedly greater than after many of the other majoroperations of surgery.

It will be recollected that in our previous series of ovariotomycases in hospital practice all ended badly. This to some extentwas due rather to external influences than to the operationitself. Dr. Tyler Smith considers that the excessive mortalityafter the operation both in this country and on the continentmust be due to some external poison. The majority of surgeonswill agree with him that ovariotomy patients cannot safely becollected together, or mixed with patients suffering from otherdiseases; and if ovariotomy is ever to take a recognised posi-tion in our hospitals, small and separate wards must be appro-priated for the purpose, and the general hygienic conditionsrendered as favourable as possible. This applies with equal forceto any other operation in which the integrity of the peritonealcavity is invaded, as to that under consideration.

Mrs. K---, aged twenty-four, a small woman, in goodgeneral health, was admitted with ovarian dropsy, under thecare of Dr. Davies. She had the appearance of a woman at thefull term of pregnancy. Fluctuation was very distinct, and thetumour was considered undocular. Abdominal enlargement wasfirst noticed three years ago, and gradually increased in size.Eighteen months later she married, and at that time her abdo-men was so prominent that her sisters had suspicions as to hercondition. Within a month after marriage she became preg-nant ; by this time her size was that of a person nearly at herninth month. Ten months after marriage she was delivered of

520

a living child, after a very favourable labour. She nursed herbaby for some time, and now it is eight months old. A fewweeks before admission she had an attack of diarrhoea, lastingsome days. She had suffered from several attacks of acute painin the belly at different periods of the past year, followed bymuch tenderness. As no gliding of the parietes on the cystcould now be felt, adhesions were suspected as the result ofthe attacks of peritonitis. She had lost flesh lately, but atewell, and was in good spirits. Although fully aware of thedanger of the operation, she had firmly made up her mind tohave it done.The patient was transferred to Mr. Curling, and, after a con-

sultation with his colleagues, he determined to perform theoperation. This was done on the 22nd of March, 1861, in aprivate ward, with the temperature at 75°, chloroform beinggiven by Dr. Mackenzie. The integuments were divided toabout four inches at first, and subsequently the incision wasenlarged three inches upwards, to just above the umbilicus.The cyst was now exposed, and found to be loosely adherentin front, but much stronger on both sides. As the contents ofthe cyst did not readily flow through the canula, the patientwas partially turned on one side, and a free incision made intothe front of it. No fluid was allowed to come into contact withthe peritoneum. The adhesions to the omentum were very ex-tensive, but not very firm; they were, however, in the rightiliac and lumbar legions, where they were separated with somedifficulty. The tumour involved the right, and not the leftovary, as was supposed by the patient. Its pedicle was longand thin, and was secured by a single piece of whipcord, thecyst being then cut away three inches higher up. The abdo-men was now closed, and the wound united by hare-lip pins,the pedicle being brought out and secured in position at thelowest part of the wound. After removal to bed, a suppositoryof ten grains of soap-and-opium pill was introduced into therectum. For a part of the time she went on well after theoperation, especially the first twenty-four hours, being sedu-lously watched by Mr. Bush, the house-surgeon in charge.During the second night she suddenly became worse, but ralliedunder stimulants. Death, however, took place about sixtyhours after the operation.The autopsy showed extensive peritonitis of a low form. The

peritoneal surfaces were everywhere greasy with soft lymph,which showed no tendency to organize. Some ounces of thicksanious fluid, but no coagula, occupied the pelvic fossae. Thewound and the pedicle were in good condition ; the former waswell united, and the latter in process of separation. The cystproved to be, as was previously supposed, unilocular; therewere no secondary cysts whatever. Tapping had never beenperformed. Evidence was present of repeated and severe in-flammation both within and without the cyst. The obstacle tothe removal of the fluid by the trocar during the cperationconsisted of a large floating false membrane, which had en-tangled itself on the end of the canula. It was of remarkable

strength, and much resembled a piece of the omentum.

POLYCYSTIC OVARIAN TUMOUR NOTICED SIX MONTHS;OVARIOTOMY; RECOVERY.

(Under the care of Mr. MAUNDER.)M. H-, aged twenty-two, has always enjoyed good health

until within the last nine months, when she ceased to men-struate. About six months since she noticed a hard swellingon the right side of the abdomen, which has grown larger, andgradually extended towards the right side of this cavity. The

patient came under Dr. Down’s observation amongst the out-patients, when Mr. Maunder also saw her, and was of opinion,with Dr. Down, that the tumour was ovarian, and favourablefor removal. Up to the moment of admission the patient hadfollowed the occupation of a domestic servant.

Sept. 16th.-The tumour was to-day removed by Mr.Maunder, by a median incision below the umbilicus, madesufficiently large to admit the hand to sweep the surface of theswelling. From twenty-five to thirty pints of semigelatinousfluid were evacuated from three principal cysts ; after that,some slight adhesions to the anterior abdominal wall were tornthrough. The operator being ably aided by his colleagues,Mr. Hutchinson and Mr. Couper, no fluid found its way intothe abdominal cavity, and a small knuckle of intestine wasalone seen. The multilocular cyst having been withdrawn,the pedicle was tied by a double ligature, and by a second toencircle the whole, and was kept in position by a pin transfix-ing it behind the ligatures, as well as the edges of the wound.Sickness occurred during the operation, and persisted for somehours (being probably due to chloroform), and was followed by

a troublesome pyrosis, lasting some days. The patient was fedper rectum for the first week, nothing but ice being allowed topass the lips.

Oct. 29th.-To-day she leaves the hospital, with the woundhealed, except at its inferior angle, whence a little pus occa-sionally issues. Much credit was considered to be due to Mr.Woodman, the house-surgeon in charge, for the care and at-

tention bestowed by him upon the patient during the after-treatment.

GUY’S HOSPITAL.POLYCYSTIC OVARIAN TUMOUR, PREVIOUSLY TREATED BY

TAPPING AND INJECTION OF IODINE; OVARIOTOMY;DEATH IN TWENTY-SEVEN HOURS.

(Under the care of Dr. HICKS and Mr. BRYANT.)DIFFERING from the other cases in the present series, the

following had been treated by the injection of a watery solutionof iodine on the occasion of a second tapping. The compoundcharacter of the disease, however, wholly precluded the pos-sibility of any relief by this means, and ultimately the tumourwas removed in the usual way. Although the patient’s agewas most favourable, yet the disease had severely told uponher constitutional powers; the result was consequently fatal,death ensuing in twenty-seven hours, from the combined effectsof shock and peritonitis.

E. B-, aged twenty, married a year and a half. She firstnoticed the disease two months after marriage. She was ad-mitted into Mary ward, under the care of Dr. Hicks, in August,1860, and twelve quarts of fluid were evacuated by tapping.A small secondary cyst was at that time noticeable in theanterior part of the right side of the cyst-wall. In Novemberof the same year she was again admitted, tapped, and the cystinjected with a watery solution of iodine. Much irritation wascaused by the operation, but she went out in about a month.The secondary cysts were found, on this second tapping, muchincreased in size, number, and solidity. She was a third timeadmitted in May, 1861. The secondary growths had nowformed a hard mass, which had enormously increased, at theexpense of the primary, and. when tapped, only yielded a fewpints of pale, flaky fluid. The rest of the cysts were small,

; and it was found of no use to puncture them. She went outiri a fortnight; but her health beginning to fail, and the lasttapping not having afforded much relief, the only chance for-

cure which remained was by excision. On her re-admission,l this operation was proposed and accepted. She had become

tÌ",!Bic1Nlhy t,hinnar Rinr’f her first. adnnMSion

Chloroform having been administered, the operation wasperformed on July 9th. Owing to the warmth of the weather,no necessity existed for any precautions concerning tempera-ture, except to obtain fresh air. A good-sized room in thecentre of the hospital was chosen. The small incision wasmade, extending from over an inch below the umbilicus to aninch above the pubes-about four inches altogether. A re-

markably thin cyst was observed, which was tapped. Severalsecondary cysts appeared, and on attempting to withdraw themfrom the abdomen they tore easily, and discharged their con-tents into the peritoneum. They appeared to be composed of £the thinnest membrane, and broke down on the slightest touch.The greater part of the cysts were non-adherent to the parietesof the abdomen, but some were attached, and a considerablesurface of omentum was firmly adherent to them. This wascarefully separated. A very small pedicle appeared on theleft side, which was attempted to be secured by a wire suture,twisted with a pair of carpenters’ nippers. This not beingconsidered by Mr. Forster sufficiently secure, the pedicle wastied with a ligature; the contents of the cysts, with the bloodwhich had passed into the peritoneum, were then carefully re-moved ; and as considerable oozing was still taking place fromthe omentum, it was tied. The ligatures around the omentumand pedicle were returned into the abdomen, and the lips ofthe incision in the parietes were brought together by pins. Thepatient never rallied, and died in twenty-seven hours.

Pest-mOl’tern exanairaution. -Slight general peritonitis of a lowform was observed; the coils of intestine were united together,

I and the pelvis contained a pint of pink-coloured turbid fluid,but no coagulum; the ligature was round the omentum, and the

I operation appeared to have been perfect. The uterus with its- right ovary and tube were healthy and free; the ligature was, around the pedicle of the left. The anterior walls of the ab-) domen were covered in places with shreds of tissue, from ther tearing away of the cyst.