A 
SUCCESSFUL CASE 
OF 
OVARIOTOMY. 
BY 
GEORGE HOLMES BIXBY, M. D. 
JFleprinted ±roin the Journal of the Grynasoological 
Society of Boston. 
BOSTON: 
JAMES CAMPBELL. 
1 8 7 2. A SUCCESSFUL CASE OF OVARIOTOMY. 
Mrs. M., wife of a colleague, residing in New Hamp- 
shire, at the instance of Dr. Henry I. Bowditch, consult- 
ed me May 16, 1872, for an enlargement of the abdo- 
men. The patient is a slender person, of medium size, 
with sharp features, dark complexion, black eyes and 
hair, the latter slightly sprinkled with gray. She is forty- 
five years old, and is a native of Maine. Her father died 
at seventy-six, the mother is still living, having passed 
the climacteric at fifty. She is a member of a family of 
four sisters, all more or less invalids. Menstruation has 
been regular as to time, quantity, and quality, since her 
fourteenth year. She married at twenty-one, and has 
given birth three times as follows:— 
The first, in February, 1854, one year and nine months 
after marriage, the last menstruation appearing the June 
previous ; the second, in August, 1855, last menstruation 
in December previous ; the third, in January, 1857, seven- 
teen months after the second,Bast menstruation in April 
previous. The two first children were premature and 
still born, and in both, there were evidences of the 
arrest of development, at a point near the cervical vertebrae. 4 
The third child was perfectly formed and lived twenty 
hours. At thirty-four menstruation became irregular, the 
intervals being variable. Within a year the catamenia 
have become scanty, and she has suffered from habitual 
constipation. Two years ago her attention was directed 
to a small swelling in the vicinity of the right ovary, 
which has steadily increased. Corresponding with the 
growth of the tumor, there have been marked nervous 
manifestations. By inspection, the abdomen was the size 
of pregnancy at the eighth month. External genitals and 
mammae normally developed. Palpation gave evidence 
of a thin layer of adipose tissue. Upon the slightest per- 
cussion the wave of fluctuation was distinctly perceptible 
in all parts of the abdomen, save at a point immediately 
above the right ovary. A vaginal examination revealed 
the following:—Vagina normal, no pouching in Douglas’ 
fossa, cervix uteri small, the uterus ante and latero-verted, 
and movable to a limited degree., its movements being 
interfered with by a mass pressing upon it from the 
right. The uterine cavity measured two-and-a-half 
inches. Having satisfied myself as to the nature of the 
affection, I informed the husband that his wife was prob- 
ably suffering from cystic disease of the right ovary, and 
that an operation for its radical cure was certainly indi- 
cated. As to the prognosis, as far as it was possible to 
predict at all in such cases, it was my opinion that the 
operation would be*successful. In answer to his question 
as to the reasons for my predictions, I answered, first, 
I thought it to be a unilocular cyst, and very proba- 
bly free from adhesions ; second, the peculiarly nervous 
wiry temperament which his wife seemed to possess to an 
eminent degree, was a condition which I had often seen to 
operate most favorably in sustaining the vital forces, either 
against the effects of sudden shock induced by severe 
o 
operations like the one in contemplation, or by the more 5 
prolonged effect of chronic affections. Upon due con- 
sultation with his wife, my proposition was accepted, and 
I was asked to appoint the time, and select a place for the 
operation. Remembering the almost uniform ill success 
which has hitherto attended the performance of ovari- 
otomy in Boston, I informed them that the patient’s 
chances for recovery would be materially enhanced by 
having the operation performed in the country. The fol- 
lowing day the husband informed me that a place an- 
swering as he thought my requirements, had been secured 
at the house of a cousin in Winchester, on the Boston and 
Lowell R. R., eight miles from the city. The place was 
situated, he said, quite high ; and had the reputation of 
being a dry and healthy locality. Without making a per- 
sonal examination, I accepted the arrangements, and ap- 
pointed Thursday, May 23d, for the operation, that being 
ten days after the cessation of the catamenia. During 
the interval of the last visit and the day appointed for the 
operation, it occurred to me that I was constantly in at- 
tendance upon Dr. 11. R. Storer, then suffering from pro- 
fusely suppurating wounds, I therefore doubted the pro- 
priety of going every day from his bedside to that of a pa- 
tient recently operated upon for ovariotomy. Upon this 
point I sought Dr. Storer’s advice. The Doctor thought 
there was certainly some risk, and for proof referred me to 
two cases of ovariotomy recently under his care, where un- 
favorable, though not fatal symptoms, had been developed 
as lie feared by passing daily from one to the other. Upon 
hearing Dr. Storer’s opinion I abandoned the idea of an 
operation for the present at least. Two days before the 
day appointed for the operation the husband called again. 
I informed him of my determination, and stated to him 
my reasons for so doing. His disappointment was very 
great, for he assured me that in view of the operation 
since their last visit, they had travelled over two hundred 6 
miles in order to effect important domestic arrangements. 
In spite of my reasons he was unwilling, even feared to 
propose such a change to his wife, desiring rather to ac- 
cept the risk, provided all reasonable precautions were 
taken. Appreciating fully his apprehensions I determined 
to accept his proposition, and the arrangements already 
commenced, were permitted to go forward. The opera- 
tion having been decided upon, the time and place settled, 
next in order came the preparatory arrangements. For 
the benefit of my younger confreres, and at the risk of 
boring the older ones, I propose to give categorically the 
items in preparing for the operation as well as the items 
of the operation itself of ovariotomy, or rather what I 
have deemed necessary in the present case. 
I divide the preparations into two general heads. 
First, the duties of the friends at the house, or by internes 
and nurses at a hospital; second, the surgeons’ duties. 
In accordance with the first, the following directions 
were given to the husband in writing. The requisitions 
therein contained to be filled the day previous to the 
operation. 
A Crosby fracture bed if possible, if not, a single iron 
bedstead. 
A sofa for nurse. 
A rubber blanket. 
Four empty earthen ale bottles for hot water. 
Six sand bags, fi\*3 inches wide by eighteen long, for 
hot sand; a quantity of clean dry sand to be heated and in 
readiness at a moment’s warning, at least an hour before 
the operation. 
One wooden bucket for clean water, another for slops. 
A tub or large vessel for receiving the contents of the 
tumor. 
Two basins for sponges, (tin is the lightest.) 
A barrel hoop cut in two and fastened together with a 7 
strip of wood some eighteen inches apart, for protecting 
the abdomen from the pressure of the bed clothing. 
A large fan. 
A tin bucket to be filled with boiling water when re- 
quired, for warming adhesive plasters. 
An atomizer. 
A bed pan. 
Two linen handkerchiefs for the administration of 
chloroform. 
Napkins, old sheets, etc., etc., q. s. 
Two lbs. chloroform, (Squibb.) 
One pint cognac brandy. 
Aqua ammonia forte, q. s. 
Two lbs. sat. solution carbolic acid, (Nichols.) 
Six suppositories composed each of one gr. opium, and 
one-fourth gr. of ext. belladonna. 
Emplastrum adhesivi, a roll. 
Two new sponges thoroughly washed and carbolized. 
Pieces of soft flannel for controlling the intestines. 
Part second. Duty of the surgeon. Secure the ser- 
vices of a capable nurse less than fifty years old. 
The following instruments ; I mention them in the order 
they are required at the operation :— 
Two silver catheters, one for the nurse. 
Three scalpels, recently put in order. 
One tenaculum. 
Two tenaculum forceps. 
Two dissecting forceps. 
Two directors. 
One pair large straight scissors. 
One pair large angular “ 
One pair small straight “ 
Surgeon’s silk for ligature. 
Two small Brown’s skeleton wire retractors. 8 
A uterine sound for uterine exploration, another for 
exploring the abdominal cavity around the tumor for 
adhesions. 
Aspirator Dieulafoy. 
Trocar, Spencer Wells. 
“ Chassaignac long curved. 
“ “ long straight. 
“ Small “ 
Museaux forceps, long and short. 
Rachet “ 
Nou-tearing volsellum. (Storer.) 
Clamp shield. (Storer.) 
Ecraseur. 
Acupressure pins. 
“ Counter pressor. (Storer.) 
Cautery irons. 
Gas furnace. 
Silver wire. No. 
Iron “ 
W ire engager. 
“ twister. 
Hollow needles. (Simpson, modified by Storer.) 
Needles for superficial sutures. 
Galvanic battery. 
Hypodermic syringe and solution. 
Thermometer. 
Upon arriving at Winchester, on the morning of the 
23d, I found the location most admirably situated upon 
the brow of a high elevation of country, and, as I was 
informed, always with an atmosphere very dry, notwith- 
standing the fogs that prevail in the valley below at this 
season of the year. The house itself, the home of a 
sculptor, as its quaint architecture indicated, is situated in 
the midst of a beautiful garden, skirted by forest trees. 
It is built in the form of five pentagons, each pentagon 9 
containing a tier of two rooms. The apartment select- 
ed, for the operation was in* the upper story of the 
northwest pentagon, an airy, commodious room, command- 
ing from two large windows, to the north and west, a most 
delightful view of the village below and surrounding 
country for miles around. This little digression, though 
it may seem irrelevant to the subject of a scientific pa- 
per, is in our opinion by no means so when considered in 
the relation of the effects of mental impressions upon 
health and disease. The apartment was excellently well 
adapted to- the purpose. The instructions to the husband 
had been carried out to the letter. I found my patient 
assisting in the domestic affairs, in order, as she remarked, 
“ to take up her thoughts.” There had been no neces- 
sity for the cathartic ordered to be taken the night before, 
for qtiite a diarrhoea had ensued, and also a sanguineous 
discharge per vaginam. The Crosby bed was now 
dressed and placed in the centre of the room, everything 
in the way of appliances, etc., scrupulously concealed in 
closets or neighboring rooms. In the meantime, I ar- 
ranged in another room my instruments upon two waiters 
in the order mentioned in the list. Everything being in 
readiness, the nurse conducted the patient to the bed, the 
urine having been evacuated a moment before coming 
into the room False teeth having been removed, with 
no one present but the husband, nurse and myself, the 
administration of chloroform was slowly commenced. The 
anaesthesia was well taken, and in twenty minutes she 
was completely under its influence. The appliances, in- 
struments, etc., were now brought into the room and 
placed in proper positions, as follows : A table with trays 
containing surgical instruments on the right: buckets 
containing clean water, with empty one for slops, and the 
vessel for contents of the tumor, basin with sponges, 
chloroform, stimulants, disinfectants, etc., on the left. 10 
The gentlemen who kindly honored me with their 
presence were now invited to enter the room, and each 
asked to examine the case. All agreed as to the diag- 
nosis and the plan proposed and about to be executed for 
its radical cure. They now proceeded to place the 
bed in front, and about three feet from the north win- 
dow. In this procedure, at Dr. Wheeler’s wise sugges- 
tion, the operator did not assist. The patient was now 
drawn down toward the foot of the bed until the knees 
bent over, the feet resting on the seats of two wooden 
chairs. The clothing having been drawn up as 
far as possible from under the back, the patient 
was surrounded with hot sand bags and bottles, 
great care having been enjoined to have the latter well 
covered in order to prevent their burning the patient, 
while anaesthetized. The limbs were now protected by a 
sheet thrown loosely over them. 
With Dr. Winsor in charge of the anaesthetic, Dr. 
Weston supporting the limbs by the knees at the side 
and left, Dr. Wheeler on the patient’s left opposite the 
abdomen, in charge of sponges, and the nurse immediately 
at his rear, half way between Drs. Winsor and Wheeler, 
favorably situated to furnish chloroform to the former, 
and change water and carbolize for the latter, the 
operator on the right of the patient, his instruments 
within comfortable reach, the first steps in the operation 
may be said to have been taken. 
With my left hand placed with the palma surface 
upon the abdomen, making with it firm but gentle 
traction, I commenced my incision a little to the left 
of the median line, at a point four inches from the 
symphysis pubis. Cutting down first through integument, 
then fat, and cellular tissue, (great care being taken to 
keep both ends of the wound on the same level,) I soon 
came down upon the sheath of the rectus muscle. The 11 
latter was now caught up with a tenaculum, the director 
introduced, then slit up with scissors. Passing through 
the muscle, a few strokes brought me through the peri- 
toneum and in full view of a smooth bluish colored mem- 
brane, easily recognized as the cyst wall. The incision, now 
two inches in length, was enlarged with angular scissors to 
three, in the direction of the symphysis pubis. A uterine 
sound intended for the purpose, previously dipped in a solu- 
tion of carbolic acid, was now introduced through the 
wound into the abdominal cavity and swept en- 
tirely around the mass in search of adhesions; not 
having met with any resistance and little or no 
blood following this proceeding, I concluded that 
no adhesions existed; or, if any, very slight ones. 
The use of the aspirator was deemed unnecessary. With 
the aid of Dr. Wheeler, I now proceeded to evacuate the 
contents of the cyst by means of a long curved Chassaignac 
trocar, the canula emptying into the vessel held between 
the limbs at the foot of the bed. Near two quarts of a 
straw colored fluid escaped, then suddenly ceased en- 
tirely ; all attempts failed to elicit any more. A decided 
prominence still remaining in other parts of the abdo- 
men, it became evident that we had to do with other 
cysts. A careful examination with a single finger within 
the abdomen confirmed our suppositions. The opening 
made by the trocar having been secured with a racliet 
forceps, the canula was removed, and one small cyst after 
another, lying in the immediate vicinity, opened and dis- 
charged, through the first that had been previously laid 
open. Later it became necessary to substitute a ligature for 
the forceps. By steady traction upon that mass of the cyst 
wall already evacuated, it was ascertained that there 
were still other masses firmly pressed down below the brim 
of the pelvis. At this point in the operation we were ap- 
prised by Dr. Winsor of a great change in the patient’s 12 
condition. The breathing had suddenly become slow 
with long intervals, the pulse weak and almost impercep- 
tible at the wrist, with other marked symptoms of col- 
lapse. This turn of affairs, when everything had been 
proceeding so well, was anything but agreeable ; had it 
been my first experience of the kind, it might well have 
filled me with alarm. As it was, preserving as well as 
possible our equanimity, while I held on to the mass 
included in the ligature, in order to prevent the escape of 
fluid into the abdominal cavity, Dr. Weston injected 
two ounces of pure brandy into the rectum, and applied 
to the palms of the hands the poles of a galvanic battery. 
We were kept in this breathless suspense but a few 
moments ; the effect of the stimulants were soon mani- 
fest by a more normal respiration and pulse, with a cor- 
responding return of color to the face and warmth to the 
surface. In less than fifteen minutes (if my estimate of 
time on such an occasion can be trusted) all danger was 
over. The happy turn of affairs can better be imagined 
than described. After a few minutes she began to rally, 
and showed signs of nausea. Vomiting, however, did not 
occur. This unpleasant episode did not delay us more 
than a half hour. The chloroform was now resumed in 
a moderate degree, and the operation proceeded with. 
The part I had been holding on to was now carefully 
investigated with a finger within the abdominal cavity, 
and was found, as was before suspected, to consist 
of a series of semi-solid cysts, crowded down to the 
right of the uterus. By forcible traction exerted upon 
the ligated portion, cyst after cyst was brought into 
view and opened as before, through the walls of the one 
first evacuated, when the remainder emerged with a 
sally from its hiding place. In the latter no less than 
seven or eight small cysts in different stages of develop- 
ment were opened and evacuated, until finally, much to 13 
our relief, the pedicle of medium length and breadth, 
came into view. Further exploration revealed no compli- 
cation, and the other ovary perfectly healthy. The ab- 
domen was now explored with sponges attached to 
holders, having been previously saturated and wrung out 
in a carbolized solution. Not the slightest trace of blood 
or thud of any sort could be elicited. With Dr. 
Wheeler’s assistance, an external clamp was now applied 
one inch and-a-half from the cornu of the uterus, and the 
pedicle divided with stout scissors. The clamp was now 
reposed into the lower angle of the wound, and bits of linen 
cloth folded, and placed under each extremity to protect 
the parts beneath. Three wire sutures involving the 
peritoneum were sufficient to bring the wound together, 
leaving a small opening near the clamp. The latter were 
now twisted, due allowance being made for oedema. The 
soiled clothing being removed and the abdomen washed 
and thoroughly dried, I proceeded now to apply the inter- 
lacing straps of adhesive plaster, after Prof. White, of 
Buffalo, two and-a-half inches wide, not passing entirely 
around the abdomen, but commencing low down at each 
side immediately below the ribs, and ending at a point 
below the trochanters in the manner of a many-tailed 
bandage ; thus, of course, entirely covering the clamp. 
Thus protected, she was carefully drawn up to the head 
of the bed, the sand bags and bottles for the most part 
removed, the apartment cleared of all the appliances, and 
the patient left to herself and nurse. She did not rally 
immediately, but slept quietly for some hours. At 6 P. 
M. I left her in charge of her husband and nurse, with 
directions not to administer food of any description until 
after four or five hours, to draw the urine every four 
hours, oftener if necessary, and to note its quantity and 
quality. The cysts and contents weighed not far from 
thirty pounds. 14 
May 24. I saw the patient this A. M., and received 
the following report from the nurse :— 
“ Upon rallying from the anaesthesia she complained 
of pain in the small of the back. 9 P. M. She took 
small portions of milk and flour gruel well cooked, with 
one-third lime-water. Urine was drawn every four hours, 
was of normal quality and quantity ; pulse 90, tempera- 
ture 98.” No signs of nausea, the abdomen remains per- 
fectly flat. 
25th. The patient passed a fair night, has had hours 
of quiet sleep. The pain in back has entirely ceased, 
she complained of the lime water causing a burning sen- 
sation at the pit of the stomach ; the nurse assumed the 
responsibility to suspend the latter, with relief to the 
patient, no nausea, abdomen continues perfectly flat, 
pulse 17, temp. 99. 
26th. A good night, slept quietly one-half of the 
night, urine normal, nourishment continued, and was well 
borne ; abdomen flat, pulse 80, temp. 99. 
27th. There is little new to report, about such a night 
as the previous one, possibly a little more quiet, pulse 
86, temp. 98, urine free, abdomen slightly raised along 
the track of the descending colon, probably an accumula- 
tion of gas. 
28th. The patient is a little restless this A. M., owing 
to a sharp attack of colic about midnight, which yielded 
readily to a suppository composed of a grain of opium, 
and a fourth grain of the extract of belladonna, pulse 
is 92, temp. 99, urine high colored, but free. Beef tea 
added to nourishment. 
29th. A fair night, nourishment increased, urine free, 
normal color, pulse 80, temp. 98. 
30th. The patient has had a quiet night, pulse 96, 
.temp. 98. I cut out a portion of the plaster covering the 
clamp, and removed the latter, found the extremity of 15 
the pedicle dry and hard. The parts exposed were freely 
carbolized with the spray from an atomizer. Everything 
seems to be progressing well, without one unfavorable 
symptom, pulse 80, temp. 96. I removed the stitches and 
found the incision had healed by first intention, except 
at a point near the pedicle where a small pocket of pus 
had formed in the abdominal wall, owing no doubt to the 
fact of the last wire not having been sufficiently twisted. 
The cavity was evacuated, and orders left to carbolize it 
several times per day. 
June 2d. I was summoned in great haste to the bed- 
side of my patient very early this A. M. During the night 
she was taken with difficulty of breathing, severe palpi- 
tation, which continued for a time to an alarming degree ; 
but finally yielded to hot applications, stimulants, etc., 
etc. Upon my arrival she was quite comfortable again, a 
peculiar nervous condition after the attack was relieved by 
injection of the fluid extract of valerian. Shortly after the 
attack the pulse went up to 130. It continued thereabouts 
until 8 P. M., when it fell to 96. 
June 3d. Pulse is 97, temp. 95. The patient is an- 
noyed with flatulence, I therefore ordered a mild cathartic. 
Pour hours after there being no result, the dose was re- 
peated ; at 4 P. M., by the aid of an enema, a good dejec- 
tion followed. A little languor followed the effect of the 
cathartic, but she soon rallied and felt much relieved, and 
was able to be moved from the surgical bed to an ordi- 
nary one. From this time on I visited the patient for a few 
moments every morning for ten days, and every other day 
up to the fourteenth. After this I saw her occasionally up 
to the middle of June. 
The following is a report she sent me of her progress 
subsequently:— 
June 5th. I began to eat and relish solid food. 
9th. I was placed upon a lounge to have bed made. 16 
16th. I began to sit up in bed, my regular left. 
16th. 1 was placed in an easy chair, and sat up nearly 
an hour without inconvenience. 
:20th. Took a few steps without assistance. 
22d. Was carried down stairs and remained there an 
hour or two. 
25th. Walked down stairs. 
2*th. Walked down stairs and back again. 
30th. Took a few steps out of doors. 
July 15tli. Eight weeks' after operation, rode in the 
cars upward of a hundred miles, could have made the 
journey before without the least difficulty. 
Note. — I desire to express to Dr. II. 11. Storer 
my sincere thanks for the numerous opportunities of 
witnessing his abdominal sections, which invaluable ex- 
perience has been of so much benefit to me during this 
operation. As may be seen by the members of the Society 
who are familiar with his mode of operating, with a few 
exceptions I have followed it precisely. My sincere obli- 
gations are due to Drs. Winsor of Winchester, Wheeler, 
of Chelsea, and Weston, of East Cambridge, for their most 
valuable aid, and to Mr. John 13. Winslow, Superintendent 
of the Boston and Lowell 11. 11., for permitting trains to 
stop at Winchester to suit my convenience. 
Last, but not least, to Miss Thesta Huston, of Chel- 
sea, the efficient surgical nurse of my friend Dr. Wheeler, 
kindly relieved by him from an important charge for my 
especial benefit, whose fidelity, zeal, and efficiency light- 
ened my labors, lessened my anxiety, and whose efforts 
in a most unostentatious manner, greatly contributed to 
the happy result,—I would tender my sincere thanks, 
with a hearty recommendation of her invaluable services 
to any poor sufferer about to undergo the operation 
of ovariotomy. 17 
The following table, kept by the husband and nurse, 
indicates the range of the pulse and temperature, during 
twelve days and nights. Operation May 23d. 
Pulse. 
Tem. 
May 24th„ A. M.... 
90 
98 
tt 
“ M 
100 
99 
it 
“ 4 P.M... 
90 
98 
it 
“ 8 P. M... 
86 
98 
a 
25th, 4 A.M... 
77 
99 
tt 
“ 8A.M... 
77 
99 
t t 
“ M 
80 
98 
t t 
“ 4 P.M... 
80 
98 
tt 
“ 8 P.M... 
80 
98 
it 
“ Midnight. 
80 
98 
a 
26th, 4 A. M-.. 
75 
97 
«t 
“ 8A.M... 
72 
97 
a 
“ M 
80 
98 
n 
“ 1P.M... 
76 
— 
t1 
“ 4 PM... 
88 
100 
tt 
“ 8 P.M... 
76 
99 
a 
“ Midnight. 
76 
98 
i t 
27th, 4 A.M... 
86 
98 
tt 
“ 8 A.M... 
78 
100 
a 
“ M 
86 
96 
a 
“ 4P.M... 
88 
99 
tt 
“ 8 P.M... 
80 
98 
u 
“ Midnight. 
90 
99 
a 
28th, 4 A.M... 
92 
99 
tt 
“ 8 A.M... 
88 
98 
tt 
“ M 
84 
98 
11 
“ 4 P.M... 
84 
97 
a 
“ 8 P.M... 
86 
97 
tt 
“ Midnight. 
84 
98 
tt 
29th, 4 A. M... 
80 
98 
11 
“ 8A.M... 
92 
99 
a 
“ M 
96 
98 
11 
« 8PM... 
96 
97 
tt 
“ Midnight. 
96 
98 
11 
30th, 4 A.M... 
95 
98 
tt 
“ 8 A.M... 
80 
98 
tt 
“ M 
90 
98 
tt 
11 4 P. M... 
84 
96 
a 
“ 8 P.M... 
84 
100 
it 
“ Midnight. 
80 
96 
tt 
31st, 4 A. M... 
80 
96 
a 
“ 8A.M... 
84 
96 
a 
“ M 
80 
96 
11 
“ 4 P.M... 
84 
98 18 
Pulse. 
Tem. 
May 31st, 
8 P. M... 
80 
96 
a 
i i 
Midnight. 
80 
96 
June 1st, 
4 A. M... 
80 
96 
i i 
t i 
8 A. M... 
80 
96 
i i 
i t 
M 
80 
96 
it 
a 
4 P. M... 
84 
98 
Li 
t i 
8 P. M... 
80 
96 
Li 
Midnight 
85 
97 
( i 
2d, 
4 A. M... 
130 
95 
111 turn. 
i t 
Li 
8 A. M... 
130 
99 
iL 
(L 
M 
95 
96 
After valerian injection. 
L i 
4 P. M... 
100 
96 
Li 
iL 
8 P. M... 
96 
95 
• 
a 
Li 
Midnight. 
97 
95 
a 
3d, 
4 A. M... 
85 
96 
i ( 
a 
8A.M... 
85 
98 
Laxative taken. 
iL 
i i 
M 
85 
98 
a iL 
(L 
i < 
4P. M... 
96 
98 
Injection and copious dejection 
Midnight. 
90 
96 
Li 
4th, 
4 A.M... 
100 
96 
After taking brandy. 
Li 
i i 
8A.M.. 
88 
96 
L L 
Li 
M 
88 
96 
a 
L i 
4 P. M.... 
85 
. 96