The usual trocar makes a rent; this dissects its way between the tissues, and their contractility closes the wound.

3d. The painlessness of the operation is of less importance to the surgeon than to the patient; but to the latter, to whom the preliminaries of examination are often more irksome than the grand operation itself, it is very desirable that diagnostic procedures should be painless as well as harmless.

CASE.-Mrs. O'Leary, Irish, aged 47, a widow, and the mother of seven children, the youngest of whom is 13 years old, presented herself at the Clinic for Diseases of Women at the College of Physicians and Surgeons in this city, in January, 1870. She gave the following history:

Something like three years ago she first perceived a tumor in the right iliac region, which was entirely painless, and gave no annoyance except that she was conscious of the existence of something abnormal. When first perceived it was about the size of an infant's head. This gradually increased till February, 1869, when distention was so great that she was tapped for relief, and six and a half gallons of fluid withdrawn. In July the fluid had again accumulated, and during the last week of that month she was again tapped, and two waterpails of fluid were drawn off. These operations were performed in Chicago, and thence she came to New York for advice, the abdomen being for the third time fully distended. Till October there had been no disturbance of the menstrual function; since that time the menstrual flow had not appeared.

By physical examination the abdominal enlargement presented some peculiarities, if the tumor were ovarian.

Abdomen was distended and very prominent, with slight bagging in the flanks. The sense of fluctuation was most perfect in every direction. No tumor could be outlined by palpation.

By percussion resonance was found as low as the level of the umbilicus, which was the most prominent part of the abdomen, and in the left flank; flatness in the right. There was flatness everywhere below the umbilicus. A vaginal examination gave no fluid in Douglas' cul-de-sac.

The diagnosis lay between ovarian tumor and ascites. If ovarian, resonance so low as the umbilicus, at the most prominent part of the tumor, was, to say the least, unusual; while the resonance in one flank, and the absence of a distended vaginal cul-de-sac, argued against ascites. The clinical history favored the ovarian origin.

The knowledge of the contents of the tumor could alone decide the question definitely, but there were reasons for not performing the operation of tapping until the patient should decide definitely upon the final operation. I proposed to Prof. Thomas that he should use the hypodermic syringe to solve the problem. He did so; plunging the needle in quickly and retracting the piston, it slowly filled with a pale coffee-colored fluid. The microscope showed that it contained a multitude of the ovarian corpuscles, and the application of heat solidified it. To test whether the cyst felt was single or multilocular, the needle was inserted in a different spot, but the fluid withdrawn was identical with the

former, proving it to be from the same receptacle. These punctures the patient barely felt. There followed no inconvenience of any kind.

In employing this means of diagnosis I would sug gest the use of the finest needle made, since it will be equally efficient. Those of my own case are of Tiemann & Co.'s manufacture and of wire gauge No. 21.

In the hypodermic syringe it seems to me we have another means of making conjecture knowledge, and if it does not increase the number of cases of gastrotomy, it may make results more favorable by leading surgeons to decline interference where any procedure would but hasten the fatal termination.

GASTRO-ELYTROTOMY; A SUBSTITUTE FOR THE CÆSAREAN SECTION.-A PAPER READ BEFORE THE YONKERS MEDICAL ASSOCIATION.

BY T. GAILLARD THOMAS, M.D.,
Honorary Member of the Association.

THE history of the operation of the Cæsarean section extends back into the earliest records of the obstetric art; so far, indeed, that the period of its first adoption cannot be with certainty ascertained. Like all other history which must be sought for in the earliest literature of obsolete civilizations, its infancy is enshrouded in much of that mystery with which the ancients habitually invested rites and customs. Leaving out of consideration all concerning it which is purely traditional, we may accept the facts that it was prac tised among the Jews, as conclusively shown by Dr.

Mansfield's researches in the Talmud; that it was a recognized operation during the Greek civilization; and that during the Roman it received the name under which it is now known to us. Dr. Mansfield proves by quotations from the Nidda, an appendix to the Talmud, and from the Talmud itself, that among the ancient Israelites it was performed upon the living woman. Grecian and Roman records of the operation which are preserved to us, relate only to its performance after the death of the mother and in the interest of the child alone. The first case in which it was resorted to in later times for removal of a child from the body of a living woman, which can be regarded as really authentic, dates back only to about the period of the discovery of this country, 1491.* Subsequent to this time it again became a recognized operation upon living women, and in 1581 Rousset published his celebrated essay upon it.

The ancients operated directly through the abdominal walls, choosing generally, from the location of the liver, the left side, and making straight, slightly oblique, or crescentic incisions outside of the edge of the rectus abdominis muscle. As time passed on, various modifications of these methods were practised. The primary incision was made directly over the linea alba, as is generally done at present; a transverse incision was made, extending from the rectus abdominis muscle for five inches towards the spinal column, and passing below the third false rib; an oblique incision was extended from the horizontal ramus of the pubis

* Playfair Obstet. Operations.

of one side through the median line, and terminating at the extremity of the last false rib of the opposite side; and Kilian tells us of the incision of Zang, which extended from the middle of the median line to one and a half inches from the middle of the horizontal ramus of the pubis.

Not only were various methods proposed for opening through the abdominal walls, peritonæum, and uterus; others were practised with the intention of avoiding the section of the two latter of these tissues.

In 1768, Sigault formally proposed the operation of section of the pubic symphysis, for the purpose of giv. ing increased space to the cavity of the true pelvis. At the time when this procedure was proposed Sigault was merely a student of medicine, and the Academy of Surgery to which his memoir was presented almost refused to entertain it. Some of the most eminent members of that body expressed the view that it was the undigested idea of a young and inexperienced mind. But Sigault, nothing daunted, sustained his proposition in an inaugural thesis presented at Angers in 1773, and in 1777, nine years after its conception, absolutely resorted to the operation upon a living woman. His patient recovered after having been delivered of a living child.

And now the tide of opinion turned strongly in favor of the persevering innovator. His name was lauded as that of one who had accomplished a great result for humanity, and the faculty of medicine of Paris had a medal struck off in his honor. In a short time, however, a strong opposition sprang up against