Pain. The most important use of morphia in medicine is to lessen pain. Its power to do this we are naturally disposed to associate with its sleep-compelling virtucs; yet, in reality, the two powers are distinct enough, although both are possessed by this potent drug. How much apart they really are may be learned by the fact which we have discovered, namely, that while atropia destroys the narcotic effect of morphia, it leaves nearly undisturbed its power to lessen or overcome pain.

This interesting conclusion was thus reached: Several cases of intense neuralgic suffering were selected. In each of them we ascertained, by repeated trials, what dose of morphia would restore the patient to entire ease. Next the same patients were treated with full injections of sulph. atropia, i to grain, in order to see whether or not it would control the pain. How utterly wanting in this power it seemed to be, we have already stated.

The third series of observations consisted in injecting the two drugs together or in succession. Somewhat to our surprise, the morphia still appeared to possess its full and perfect power to destroy the sensation of pain.

These experiments were so varied and so numerous as to leave us no room to doubt the correctness of our final belief, that, as regards its anæsthetic property, morphia is not counteracted by atropia.

It would have been easy with larger leisure than ours to have further inquired as to the effect of the two drugs upon urine, and as to the possibility of their antagonizing one another in that direction. Enough has been done by us, we trust, to show that the question as to the physiological antagonism of atropia and morphia has not as yet been fairly answered.

If we be correct in the views expressed in the foregoing pages, certain practical lessons of some value may be learned from them.

If atropia lessens or destroys the unpleasant influence of morpia on the cerebrum, but does not alter its power to allay pain, there seems to be no reason why we should not use them together so as to obtain all that is best from the morphia with the least amount of after discomfort.

We have certainly had good results from such a use of both drugs, in the form of suppositories, in cases of disease of the bladder or generative organs.

Again, it is sometimes desirable to use either drug in very full doses. This we may do quite fearlessly when assured of our ability to restrain its action by a full exhibition of its opponent.

Tho foregoing experiments and observations authorise us, we think, to draw the following conclusions as to the use of hypodermic injections, and as to the antagonism of atropia and morphia:

1. Conia, atropia, and daturia have no power to lessen pain when used subdermally.

2. Morphia thus used is of the utmost value to relieve pain, and is most potent, in certain forms of neuralgia, the nearer it is applied to the seat of the suffering,

.3 Morphia lowers the pulse slightly or not at all, atropia usually lowers

the pulse a few beats within ten minutes, and then raises it twenty to fifty beats within an hour. The pulse finally falls about the tenth hour below the normal number, and regains its healthy rate within twentyfour hours.

4. Morphia has no power to prevent atropia from thus influencing the pulse, so that, as regards the circulation, they do not counteract one another.

5. During the change of the pulse under atropia, the number of respirations is hardly altered at all.

6. As regards the eye, the two agents in question are mutually antagonistic, but atropia continues to act for a much longer time than morphia.

7. The cerebral symptoms caused by either drug are, to a great extent, capable of being overcome by the other, but owing to the different rates at which they move to affect the system, it is not easy to obtain a perfect balance of effects, and this is made the more difficult from the fact already mentioned, that atropia has the greater duration of toxic activity.

8. The dry mouth of atropia is not made less by the coincident or precedent use of morphia. Atropia does not constipate, and may even relax the bowels; morphia has a reverse tendency.

9. The nausea of morphia is not antagonized or prevented by atropia.

10. Both agents cause dysuria in certain cases, nor is the dysuria occasioned by the one agent relieved by the other.

11. Atropia has no ability to alter or lessen the energy with which morphia acts to diminish sensibility or relieve the pain of neuralgic disease.

12. As regards toxic effects upon the cerebral organs, the two agents are mutually antidotal, but this antagonism does not preval throughout the whole range of their influence, so that, in some respects, they do not counteract one another, while as concerns one organ, the bladder, both seem to affect it in a similar way.---American Journal of the Medical Sciences, July, 1865.

Two Cases of Ovariotomy.

BY E. R. PEASE LEE, M. D.,. L L. D.,

O variotomy is no longer, by any means, an uncommon operation; and the following cases are reported mainly from their bearing upon certain questions of great practical moment respecting the manner of performing the operation itself :--

CASE 1.--Mrs. C. A., aged 42 years, married, and a mother eighteen years since, first noticed an enlargement of the right side of the abdomen in August, 1863. This gradually increased till I first saw her, in consultation with Dr. Hubbard, of this city in October, 1864. At this time her circumference was fifty inches, the lower extremities were very edematous, the pulse 115, the appetite almost gone, and the strength much prostrated. I diagnosticated a polycystic ovarian tumor, and advised tapping; both because the tumor was interfering with respiration and digestion, and because I found the patient was then too much prostrated to allow of ovariotomy.

On the third of October I tapped her, assisted by Dr. Hubbard, and removed twenty-three pounds of fluid from the principal sac. The oedema of the lower extremeties, however, did not disappear, as usual, after the tapping, though the patient's strength and appetite increased somewhat. But the sac rapidly refilled; and though the case afforded much below the average probability of success. I did not feel at liberty to oppose the patient's wish, after informing her of all the risks, that I would give her the only remaining chance of life; and I removed the tumor on the 8th of December, 1864. Present-Drs. Hubbard, J. Foster, Thomas, Conant, and Field, of this city.

I should state here that the weather was very unfavorable for some days before and a week after the operation (incessant rains and fogs); but I did not deem a delay justifiable, on account of her rapidly failing strength.

Operation. The incision extended from one inch above the symphysis pubes to four inches above the umbilicus, eleven inches in all; as it was found that a shorter incision would not admit of the removal of the tumor after all the larger sacs were evacuated. Some very firm adhesions were found to the left of the umbilicus, and others of a slight extent and firmness on its right and in the right iliac fossa. They were

all broken down by the introduction of the hand; having been previously detected by passing around the tumor, and between it and the abdominal walls, a polished steel urethral bougie, previously dipped in the artificial serum I am accustomed to use.

A double ligature (three threads of saddler's silk, waxed, but not twisted) was passed through the pedicle, each half tied around onehalf of the latter, and both cut off close to it, when the tumor was removed. The incision was then closed by seven harelip needles, one inch apart, below the umbilicus, and six silver sutures between them. Above the umbilicus there were six more silver sutures. Thus the incision was closed throughout, the stump of the pedicle remaining in situ in the peritoneal cavity. All the needles and sutures included the peritoneum as well as the rest of the abdominal parietes. A compress wet in warm water and covered with oil silk, and a flannel bandage, were applied to the abdomen, and the patient removed to her bed.

The patient died on the seventeenth day after the operation, and the following is a brief resume of her progress in the meantime :

Was restless and prostrated till one a.m., when reaction was fully established, and pulse 118. The excitability somewhat abated at midnight, when gtt. xxx. McMunn's elix. opii. were given per rectum. Slept about three hours. The enema or an opium pill per rectum was required two or three times daily during life, and thus regular sleep was usually secured each night. The catheter was used every six hours for six days, the urine being always free and normal. The compress was changed twice every twenty-four hours, and milk-porridge given as a nourishment the first five days.

First day after operation.--No pain; pulse 116 to 120; skin natural; is very comfortable, and slept well the following night.

Second day.-Pulse 116 to 120, and stronger; a little more heat and dryness of the skin; no pain.

Third day.--Pulse 112 to 120; has suffered for several hours from colic pains, and there is some tympanites. Introduced rectal tube, and removed the gas; used pill opii. per rectum, to relieve the pain, and had to repeat it twice in twenty-four hours for several days for this purpose.

Fourth day.-Pulse 112; had a slight alvine discharge; more tympanites and collection of gas, which was removed as yesterday. Gave brandy drach. j. every two hours. Not much sleep till from four to eight o'clock next morning.

Fifth day. Pulse 102 to 104; quite tympanitic, but gas passed freely through tube. Wine-whey given, since beef-tea and milk-porridge acidify. A good night ensued.

Sixth day. Pulse 102 to 110; much as yesterday; a small alvine discharge this afternoon; exhausted by the pain, and did not sleep much to-night.

Seventh day.--Pulse 100 to 112; feels exhausted. An enema of infus. menth. virdis Oij, to remove the gas, succeeded well; when patient slept well, and pulse fell to 98. Bladder more irritable yesterday and to-day, and catheter used every two or three hours. An enema of beef-tea oz. ij. and port wine oz. ss every four hours.

Eight day. Pulse 100, and quite strong; less tympanites; countenance better than hitherto. No opiate during this day.

Ninth day.-Better every way; pulse 98, and good. Repeated enema of menth. vir, with success. Two alvine discharges to-day, from a laxative given last evening; most comfortable day yet. Port wine oz. ss and beef-tea every two hours. A good night followed.

Tenth day. Less tympanites; pulse 96 and good; incision had united by first intention throughout, but it is now opened at lower part for half an inch, and oz. ss fetid pus escaped below the lower pin; it appeared to be caused by a ligature around one of the needles. Brandy substituted for the port wine, and tinct. cinchona comp. to be given (drach. j.) every three hours. Tympanites not increased; no tenderness of abdomen yet, except as due to the distension; not much sleep to-night.

Eleventh day.-Pulse 94, and strong; tympanites much reduced ; tongue better (has never been much affected), and she for the first time speaks of having some appetite, and relishes toast and tea; discharge fetid, and about drach. ij.; erysipelatous redness at lower border of the incision, Pulse 100 and weaker during the evening; more tympanitis.

Twelfth day. Pulse 94; tongue somewhat red; erysipelas extends over lower six inches of the incision. Removed all the needles in this part, and applied adhesive straps instead. Discharge fetid (drach. ij.); not much tympanites. Incision looks better this evening; erysipelas not extending; less tympanites. Has taken brandy and beef-tea every two hours.

Thirteenth day.-Pulse 96 to 104, and weaker; no appetite; feels depressed, though she slept well last night; tongue better, but still red; erysipelas disappearing, and the discharge is less, but the incision is now laid open down to the peritoneum all the way below the umbilicus. To take quiniæ sulph. gr. j. every three hours.

Fourteenth day.-Pulse 100 to 102, and soft; looks better and had a good night; tongue redder, and dry in middle; abdomen better in all respects; very little discharge from incision.

Fifteenth day.-Pulse 102, and weaker; at 1 o'clock last night vomited a green and intensely acid fluid; also twice afterwards. 14 p.m. pulse 112, and weaker; has just got over a chill which last an hour. 11 p.m., pulse 120; feels a little dizzy; discharge more fetid again, and edges of incision redder.

Sixteenth day.-Pulse 120, and weak; had but little sleep last night, and is very dizzy; a fetid pus discharges (oz. ss) from lower end of incision and behind symphysis pubis. I inject water and liq. soda chlorinat. (Oj to drach.iij.) into the cavity, and syringe it out thoroughly. 9 p.m., she is much exhausted, and I increase the amount of stimulants.

Seventeenth day.--Pulse 122, and weaker; tongue slightly dry and red; can take no food by the mouth; incision beginning to heal throughout; discharge less fetid; no dizziness. She has emaciated rapidly during the last four days, and has had slight tenderness of abdomen during the last forty-eight hours, since the chill before men