assigned for torsion are those in general which produce the normal spiral twist, increased. Schroeder van der Kolk believed that the greater force of the circulation in the umbilical arteries produced a recoil of the pelvis of the child, and this recoil turned it towards the right or left, according as the artery was found to the right or left of the child in the umbilical ring.

Simpson observes that the aorta lies upon the left side of the spinal column during the earlier part of embryo life (8-10 weeks), when the torsion generally occurs, and the right iliac artery seems to be a continuation more direct than the left; therefore the circulation in the right is stronger, and even this slight difference would be sufficient to produce versions in the floating foetus. Neugebauer, who has made these versions the subject of special study, believes also that their cause is found in the greater force of the circulation in the right umbilical artery. Spaeth reports three cases of death by torsion; in the first the mother had

*

often experienced such a sensation of weight in the abdomen as to compel her often to stand still; the cord was found twisted to the size of binder's thread for a length of 4 lines.

Rupture of the cord generally occurs in rapid deliveries with too short a cord. The seat of rupture is about 3 or 4 in. from the umbilicus, where it is always weakest by experiment. Spaeth has recorded several such cases, most of which were unattended with further injury to either mother or child. Torsion has in a few rare cases been so extreme as to induce rupture.

*Morphologie der menschlichen Nabelschnur, Breslau, 1858.

Other Anomalies.-1. The vessels of the cord may divide at some distance from the placenta. 2. Instead of two arteries and one vein, there have been found two veins and one artery, one vein and one artery, or three arteries (Churchill). 3. The cord has been seen to consist of seven divisions, of which each contained an artery and vein; one of the primitive arteries being divided into 4, the other 3 branches, while the vein separated into 7 of equal size (Wrisberg). 4. The arteries may separate from the vein within the cord and form a dependent noose; this noose may be doubled by an additional reduplication (Hüter). 5. The umbilical artery may be dilated within the body of the fœtus from the umbilical ring to the hypogastric artery (Froriep). 6. Atheromatous degeneration may affect the arterial walls to a greater or less extent (Klob). 7. Thrombosis has been observed in the placental vein (Wittich). 8. Stenosis has been observed in the arteries at their placental insertion, caused by a fibrinous deposition there (Spaeth). 9. Edema is often observed in the cords of macerated fœtuses, occasionally in those of living children (Rokitansky). 10. The myxomatous tissue of the cord has been observed to undergo hyperplasia, mole of the cord (Heyfelder). 11. Cyst formation has been described (Kölliker).

12. Finally, two cords have been attached to one placenta with a single child (Churchill). 13. In an acephalous foetus, born in the Western Lying-in Hospital, the cord was found inserted into the neck, from whence the vessels passed down behind the clavicle and sternum through the chest into the abdomen, where

they were lost (Churchill). 14. The sheath of the intestine may contain a loop of the intestine or a portion of the mesentery, hernia funiculi umbilicalis (Billroth). 15. The coats of the vessels may give way, and serious, if not fatal, hemorrhage ensue (Vel peau). 16. The vessels may continue parallel, as they are always found previous to the third month (Verrier).

Lastly, the thickness of the cord varies greatly, being determined by the amount of gelatine present. Cords have been observed almost without gelatine (lean cords); others again much thicker than the thumb (known among the older writers as fatty cords).

INJECTIONS INTO THE PERITONEAL CAVITY AFTER

OVARIOTOMY.

BY E. R. PEASLEE, M. D., LL. D.,
Professor of Diseases of Women in Dartmouth College, etc.

INTRA-PERITONEAL injections are but seldom required as a part of the treatment after ovariotomy; but cases occur in which a successful result is impossible without them. This fact has, however, not been sufficiently appreciated, I think, by some of the most experienced ovariotomists; and certainly some beginners have entirely misapprehended both their object and their value.

As I first proposed and applied injections into the peritoneal cavity, between fifteen and sixteen years

ago, I have been, perhaps, held in some degree responsible for their application, though sometimes in circumstances in which I should by no means have advised them. And to guard against misapprehension as to the circumstances requiring them, their true value, and the method of applying them, which my experience thus far indicates as the best, is the object of the following paper.*

THE OBJECT OF INTRA-PERITONEAL INJECTIONS.

The object to be secured by intra-peritoneal injections after ovariotomy is, the prevention or the removal of septicemia, by the removal of a fluid in a state of decomposition, or soon to become so, from the peritoneal cavity. More than one-sixth (three-seventeenths) of those who die after this operation die of septicamia, and it is a matter of the highest importance to reduce the number to one-sixth, or even to one-fifth of this proportion; as I feel assured the judicious use of the injections will do.

Perhaps one reason why experienced ovariotomists have so seldom resorted to these injections is the fact that they mostly use the clamp in the treatment of the pedicle of the tumor which has been removed, and that it is very awkward to make use of them while the clamp is in place, and a very harsh procedure to tear open the incision for that purpose, if they become necessary, after the clamp has been removed. This, however, I hold not to be an objection to them, since they alone can, in some conditions, save the patient's life, but rather an inducement to prefer the ligature to the clamp, as I have always done.

I have discussed this question in a Monograph on Ovariotomy, read before the New York Academy of Medicine, June 1, 1864, and published in its Transactions.

The decomposing fluid whose absorption into the blood from the peritoneal cavity may produce septicæmia, may be either of the following:

1. It may be blood oozing, after the operation is completed, from surfaces to which the ovarian tumor had been adherent, or from its pedicle.

2. Fluid from the tumor, which had been left by the operator in the peritoneal cavity.

3. Ascitic fluid thus left or secreted after the ope ration in cases of ascites complicated with ovarian

tumor.

4. Pus in the peritoneal cavity produced while some surface is healing by granulation. Septicemia

produced in this way is true pyæmia.

I shall give examples of each of these varieties from my own experience.

Some authorities assume, also, that septicemia results from the slough produced by the application of a ligature to the pedicle of the ovarian tumor (Dr. Clay's method). But I have demonstrated that no such slough is formed, unless, possibly, in very excep tional cases, as happens sometimes to the portion next the uterus when the clamp is used.

*

Since the fluid in the peritoneal cavity, from whichsoever of the preceding sources derived, does not at once become decomposed; and since, moreover, the peritoneum itself absorbs but very slowly; the symptoms of septicemia are not developed under four to seven days (and in one of my cases on the eighteenth day)

*Med. and Surg. Reporter for June 29, 1867.