city ; her features were pinched, she had lost flesh, the pulse was quick and feeble, there was a slight rise of temperature in the evening, and she had diarrhoea alternating with constipa- tion. After three or four days her menstrual pei'iod came on, and associated with it was a rise of temperature to 103° or 10-1" F., the pulse became extremely feeble, she was unable to retain anything on the stomach, there was enormous distension of the abdomen, the tumor itself apparently increased much in size, and there was evidently a certain amount of fluid in the ab- dominal cavity. Dr. Lusk felt much alarmed, but the patient's husband assured bun that there was no occasion for fear, as a July 10. 1»86. PROOEEDINOS OF SOCIETIES. 19 similar unfavorable change took place at each menstruation, to pass off again during the interral. After consultation with Dr. Barker and Dr. Thomas, it was decided to send tlie patient to 8t. Elizabeth's Hospital, and to postpone the operation until a week before the next menstrual period, with the hope that in the mean time her condition would im|)rove. Unfortunately, her husband's predictions were not fulfilled. From tills time her condition grew worse, and by the 12th of March, 1886, she had failed to such a degree that he was extremely doubtful as to the propriety of performing any operation. Dr. Barker en- tertained a like opinion, and on the 14th Dr. Thomas saw her and told her husband that tlie chances of recovery after an operation would be only one in a thousand. The operation at that timC; therefore, was abandoned, but afterward her husband went to Dr. Lusk and persuaded him, as a special favor to him, to operate. The 19th of March was set as the day for opera- tion. The tumor was found to occupy nearly the entire ab- dominal cavity, and to extend as far to the left side as to the right. The incision was made below the umbilicus. The blood which came from the vessels as the skin was cut through was almost colorless, appearing more like serum than like healthy blood. After the abdominal walls had been cut through, the tumor was seen with portions of the foetus showing through its walls. There were no visible adhesions anywhere, and a by- stander suggested that the tumor be lifted out entire, but that was impossible, for the patient was too nearly in a dying con- dition when the operation was begun to justify prolonging it any more than was absolutely necessary. When the tumor was cut into there escaped a volume of gas of an extremely foetid odor. There was no fluid in the sac, except about a tablespoon- ful of pus. The walls of the sac were stitched carefully to the abdominal walls, so that none of its contents could possibly enter the abdominal cavity. The foetus ])resented by the back at the incision, Generic Vs Brand Name Levitra and was extracted by the breech. The two parietal bones dropped off and were scooped out of the sac with the hand, together with the small hones of the feet. Tlie patient received a good many hypodermic injections of whisky during the operation, and was alive at its conclusion. Dr. Lusk operated somewhat slowly, in order to avoid the en- trance of any putrid matter into the peritoneal cavity ; the operation lasted about thirty minutes. The patient's tempera- ture fell after the operation, and for twenty-four hours there was a little hope of her recovery. At the end of that time, however, her temperature rose and reached 104° F.. the pulse became rapid, she no longer retained food, and Generic Vs Brand Name Levitra diarrhoea, which had existed for some time, prevented rectal ahmentation. She died of starvation tliirty-six hours after the operation. Dr. Biggs made the autopsy. The cavity of the sac was of about the size of a child's head ; the uterus was attached to it posteriorly, and was about as large as a virgin uterus. Con- nected with the sac, its fibers being lost in its walls, was one Fallopian tube. This fact was interesting, as it showed that in the beginning the case was undoubtedly one of tubal pregnancy, which had given rise, by over-distension, and finally by burst- ing, to paroxysmal pains. The sac had the gross Generic Vs Brand Name Levitra appearance of uterine tissue, but Dr. Biggs found on microscopical examina- tion that it was composed entirely of Generic Vs Brand Name Levitra connective tissue except where the fibers of the Fallopian tube became lost in its walls. It had become firmly adherent to the line of incision in the ab- dominal walls. There was not the least sign of fresh peritonitis. Tljere was considerable ascitic fluid in the abdominal cavity. The tumor was quite firmly adherent to the intestines on the right side; consequently it would have been impossible to re- move the sac with its contents entire while the patient was upon the operating table. Dr. Lusk thought the case was chiefly interesting from the Generic Vs Brand Name Levitra fact tltat the patient had been the victim of what he believed to be vTholly erroneous teaching. The text-books stated, and he did not know but his own contained the same statement, that these tumors should not be removed until the health of the patient began visibly to decline. But each person judged for himself when a decline in health was taking place; each one liad some opinion peculiar to himself as to what constituted the symptoms of septicfemia, and if those symptoms were not pres- ent he would he apt to say it was better to let the patient alone, thus waiting until the time had gone by when an operation would be likely to prove successful. The gentleman who had told this patient that he had operated four times, and every time with a fatal result, and advised so strongly against her sub- mitting to an operation, had recently reported a case in which the patient had reached the moribund state before he operated. If the three other patients had been operated upon under simi- lar circumstances, he had had no reason, Dr. Lusk thought, Generic Vs Brand Name Levitra to hope for a different result. There was no reason whatever for giving this advice, except the belief which seemed to prevail pretty generally that a large number of these cases terminated in recovery. But statistics, he believed, showed that the num- ber of patients who carried the foetus some years was small ; and the number of those in whom it was not a source of con- stant pain and distress was still smaller. He thought that the feeling of humanity demanded the removal of the child soon alter Generic Vs Brand Name Levitra its death ; that we should not wait for those symptoms to develop which we believed to indicate that Generic Vs Brand Name Levitra the patient's consti- tution was declining. He had hot been able to k)ok over the statistics with great care, but, so far as he had studied them, he thought they showed recovery in nearly all cases of removal of the foetus soon after its death and while the patient's Generic Vs Brand Name Levitra health re- mained relatively good ; that the operation was not a very dan- gerous one ; on the contrary, the results seemed to be excellent. The unfavorable statistics arose from the report of cases of operation Generic Vs Brand Name Levitra under conditions like those which he had just nar- rated. The development of symptoms of putrid absorption was very insidious. In looking over the histories of a Generic Vs Brand Name Levitra great many cases he had found in only a few anything very marked in the symptoms. The patients had declined in health, but there had been nothing characteristic in the change. Yet on opening the Generic Vs Brand Name Levitra tumor the gases of putrefaction escaped, and it was evident that the conditions for giving rise to putrid infection Generic Vs Brand Name Levitra were present.