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cut up the cliild's head by making a cluiin-saw travel up from the shanks of the forceps blades. But, in extreme distortion, there was not room for the blades to pass. Dr. Barnes's operation consisted tenormin atenolol in passing a loop of strong steel wire over the head by means of Weiss's 6craseur, and then making buy tenormin sections. He showed the operation on a pelvis nearly two inches in diameter, and a seven-months fa^tus. Dr. Barnes first perforated the head, tlien introduced the croicliet to steady it ; then passed the wire-loop into the uterus, which could be done by compressing it ; and when tiie loop was sutHciently high, by removing the compression, it opened by its elasti- city, and was made to seize tlie head in its circumference at the occipital end ; then, by working the screw, the wire made a clean section of the head, taking off all the posterior part; this part was then removed by crani- otomy-forceps. The wire was then reapplied in the longitudinal direction of the head, seizing under the jaw and ear, and another section generic tenormin was made through the base of the skull. The remains of the head were then seized by Dr. Barnes's craniotomy -forceps, and easily drawn through the pelvis. He tlien perforated the chest, liooked the crotchet in the axilla of one arm to draw it down within reach of the einbryotomy-scissors; then the chest-walls were cut up by the embryotomy-scissors, and drawn through the pelvis, the other arm being tenormin 25 previously cut off or not. tenormin tablet The operation involved little or no pressure or contusion, or dragging upon the uterus, or other soft parts. The wire buried itself immediately in the head, and no bulky instruments or manoeuvres, bruising the soft parts, were necessary. — In answer to Dr. Tyler Smith, Dr. Barnes said he had not yet performed the operation on the living subject. — Dr. Cleveland thought that, in cases of high distortion, after removing the bones of the cranium, the real diffi- culty had still to be encountered ; for, in a recent case of the kind to which he alluded, he had, after long perseverance, removed every particle of the skull, as well as all the cervical vertebras, and was then foiled in the at- tempt to bring down the rest of the body within operative reach. After death, the child was found to weigh about eight pounds, without its head, and the shoulders, when compressed into as small a space as possible, were out of all proportion to the size of the pelvic inlet. — Dr. Barnes could but repeat his coviction, based upon experience, that he could bring not only tiie head, but the trunk of purchase tenormin online a mature foetus through with nearly as much facility and accuracy as the Fellows had seen done in the experiment. — Dr. Hicks considered Dr. Barnes's method a clear means of reducing the head to a minimum. — The President observed that the value of -the pro- cedure must be tested by experience ; but, for the originality of the opera- tion, Dr. Barnes deserved the greatest credit. 4. — Successful Ovariotomy in a Girl Twelve Years of Age. [Medical Press and Circular. June 23, 1869.] At a meeting of the Societe tenormin 50mg Impfiriale de Chirurgie, May 2G, M. Jouon, of Nantes, related an extraordinary tenormin iv case of ovarian tumor successfully operated on, which is reported in tiie Union Medicate. A little girl, twelve and a half years old, had suffered for tenormin online eighteen months from a very large abdominal tumor, which had become of such a size as to have reduced tlie girl to an extreme state of exhaustion. The belly presented the appearance of a twin gestation at the extreme period ; it was dense and fluctuating everywhere but at the left hypochondriac region, where the intestines were 188 REPORTS ON PROGRESS OF MEDICINE. lodged. Tlie age of tlie cliikl, tenormin 25mg the absence of all signs of puberty, and the impossibility of isolating tlie liver, made the diagnosis of ovarian tumor doubtful. I'ecamier's method of opening the cyst by caustic was adopted, and a large cheap tenormin quantity of very albuminous fluid made its escape ; a sound ■was introduced, and a multilocular sac was found, proving the existence of ovarian cysts. On the 15th of March ovariotomy was performed. There were strong adhesions to the abdominal wall where the caustic had been applied ; sev- eral punctures with a large trocar were unsuccessfully made into the sac; during the effort of extraction, two large cysts at the back of the tumor gave way; the entire mass was extracted, leaving a long pedicle from the left ligament; a clamp was applied, and the pedicle. divided. The epiploon required two ligatures; the closing suture embraced a portion of perito- neum on each side; but coaptation was difficult, owing to the thickness of the membrane. Frequent vomiting occurred during the first thirty-six hours, but complete cure was finally accomplished by second intention in forty-six days. The tumor consisted of three large cysts, and the total weight, solid and liquid, equalled twenty-six pounds, 5. — Successful Ovariotomy in the Fourth Month of Pregnan- cy^ after Rupture of the Cyst and Peritonitis. By Hex- EY Bateman, F. K. C. S. [Lancet, September 18, 1869,] Ovariotomy has now succeeded in so many instances that it lias fairly taken rank as a capital surgical operation, offer- ing fairer hopes of recovery than amputations of the limbs. Individual cases of this operation have, therefore, scarcely a claim for separate publication unless they either occur in some country where it has order tenormin online still to make its way in general estima- tion, or in which some special circumstance exists to invest it with unusual interest. Such was the case in the following in- stance : A married lady, thirty-six years of age, the mother of eight children, first consulted me on the 23d of last July. On examination, I found her to have an ovarian tumor of the right side, ascites, pregnancy of about three months' duration, and extensive recto-vaginal protrusion. When twenty years of age she had twins ; and, after the delivery of her second child, a tumor was discovered in the right iliac fossa, which at first gave purchase tenormin rise to the idea that she had a third child. The mistake was tenormin syrup soon discov- ered, and she had a good recovery. From this time swelling of the abdo- men increased very slowly during the next sixteen years, and occasioned scarcely any disturbance of the system until about a fortnight before my visit. She had then a sudden attack of abdominal pain and tenderness, with sick- ness and fever, followed by a marked and rapid increase of the abdominal swelling. The case was full of peril when I was called in, for, although the ab- dominal tenderness was subsiding, the etfu.-ion was increasing. There were considerable difficulty of breathing on lying down, and great restlessness, with scanty and deep-colored urine, abounding in lithates. Having suggested the propriety of consulting Mr. Spencer Wells, he saw the case with me, tenormin 25 mg and entirely concurred in my diagnosis as to the presence of an ovarian tumor, with free fluid surrounding it in the perito- neal buy tenormin online cavity, and depressing the recto-vaginal pouch, and in the existence of pregnancy about the commencement of the fourth month. We also 0BSTETI5ICS AND DISEASES OF WOMEN. 189 caniG to tiie oonoliision tliat the lluid in the peritoneal cavity was ovarian fluid, the jiiulden attack order tenormin of i)ain wlion I Avas tirst called in havinj^ been caused, in all ])robaliility, by the rupture of part of the wall of a niultilocu- lar cyst, and the escajie of the contents of a large cyst. Pain, tenderness, raised temperature, rajtid pulse, dry tonirue, and sickness, all pointed to difiused peritonitis, and a condition reipiiring immediate relief; and we agreed to cheapest tenormin ot^er tlie patient the choice of early taii|)ing the abdomen or re- moving the ovary, but recommended the latter, notwithstanding the spe- cial risks arising from her pregmmt condition and the peritonitis. The patient and her husband consented to the major operation, which was admirably performed by Mr. Spencer Wells, on the 14th of August, in the presence of Dr. Junker, who administered bichloride of methylene. Professor buy cheap tenormin Neugebauer (of Warsaw), Dr. Jagielski, and myself. The tumor, with its contents, and the tluid surrounding it, weighed altogether thirty- seveti i)ouuds. There was a general injection of the peritonaniin, but no recent lymph. There was some omental adhesion, and one vessel there

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