A CASE OF TRANSFUSION.

By J. M. JUNKIN, M.D.,

OF EASTON.

SOME years ago, I saved the life of a patient by transfusion. No account of the case has been published; and as the simple means I used were successful, a knowledge of them might be useful to other physicians under similar circumstances. I will give a history of the case in as few words as possible.

I was called, about ten o'clock at night, to see Mrs. F. found her flooding fearfully from an abortion, at about six weeks. She was very much prostrated from loss of blood, so that the pulse could scarcely be felt at the wrist. I immediately checked the blood by a tampon of soft rags, took all pillows from under the head; still the prostration increased. I gave stimulants; she still continued to sink; I then raised the foot of the bed, so as to keep what blood she had in the brain, as much as possible. I continued increasing the elevation, until she had to be held, to keep from pressing against the head-board; still the pulse became more feeble, so that it could scarcely be felt at the carotid artery.

I said there was no chance of saving her life, except by giving her more blood from another person. The husband at once offered his arm; but how was it to be transferred?-being far in the country, and no possibility of getting any instruments, nor was there any time to spare, even if there had been any within reach to send for. I asked if there was a syringe in the house; one was brought, glass, female, with a curved neck and a bulb on the end of it; I said it would not do; but immediately thought glass would melt, so I ran to a fire, thrust the end among the coals until it was softened, drew it out into a slender tube, broke the end off to a proper size, put it in the fire to smooth the end, then back to the patient, tied up the husband's arm and drew several ounces of blood-told him to put his finger on the orifice-filled the syringe, opened a vein in the arm of the patient, and forced as much blood as possible into the vein, probably not more than two ounces passed; but I did not find

it necessary to repeat the operation; the husband's blood was of a much richer quality, so that in a few minutes the patient began to rally, the pulse gradually coming up; by daylight I was able, by lowering a little at a time, to get the bed on a level, and in the course of a few hours to place a small pillow under the head.

It is not necessary to detail anything further. The recovery was rapid and complete. A little more than a year after I delivered the lady of a large healthy child.

OVARIAN TUMOR REMOVED PER VAGINAM. RECOVERY.
BY R. DAVIS, A.B., M.D.,

OF WILKESBARRE.

On the 29th of May, 1872, I was summoned to Mrs. J. Taylor, of Wilkesbarre, aged 29 years, a multipara, of spare habit and phlegmatic temperament. She believed herself to be about seven months gone in pregnancy, but had no suspicions of any other trouble. For twenty-four hours previous to my arrival she had suffered severe pains simulating those of labor.

On making a per vaginam examination, I found the pelvic cavity well nigh filled with a firm mass or tumor, lying posteriorly to the vagina in Douglas's cul-de-sac. The os uteri occupied a position above the pubis, being pressed by the tumor firmly against the abdominal wall, where it could barely be reached by crowding the finger between the mass anteriorly and the pubis.

In the abdominal cavity were two tumors, that in the left side being a continuation of the pelvic tumor, which extended several inches above the umbilicus, and was soft and fluctuating. The tumor in the right side was firmer and more prominent, pyriform in shape and non-fluctuating, but I several times felt distinctly the motion of the child. My diagnosis, therefore, was, pregnancy complicated with an ovarian tumor, composed, probably, of a single cyst.

I gave her a quarter of a grain of morphia, to be repeated at intervals, if pains continued. They ceased, however, and she passed on to her full term without any greater inconvenience or discomfort than an occasional severe bearing-down pain, which gave her the sensation as if the head of the child was just being born.

On the 7th of August, just ten weeks thereafter, I was again summoned and found her in labor. The pelvic tumor had increased in size, making the os still more difficult to reach. I placed her in the knee-elbow position, and tried to lift the tumor out of the pelvis so as to allow the uterus to come down; but did not succeed. I now tapped the cyst through the vaginal wall with a long curved trocar and canula, and had the great satisfaction of seeing the tumor

collapse, and the uterus come down into the pelvis. The labor now terminated without unusual difficulty, the breech presenting, and the child being dead-born. The patient made a rapid and good recovery.

On the 15th of September, I was again called to see her, and found that the tumor had regained its former size, and occupied the same position in the pelvis as before. It extended upwards into the abdominal cavity several inches above the umbilicus, forming a tumor about the size of a pregnant uterus at seven months. The uterus formed a movable tumor in the median line of the abdomen, above the pubis, between the cyst and the abdominal wall; the fundus of which could be moved several inches to either side of the linea alba. The os could barely be reached by crowding the finger between the tumor and the os pubis as before.

The patient was suffering from severe paroxysms of bearing-down pains, similar again to that experienced in the last stage of labor. These were excited by walking or standing. She was anxious for an immediate operation, and in view of her great suffering, I decided to comply with her wish.

Several considerations induced me to decide upon attempting the removal of the tumor per vaginam.

1. The tumor pressed low down into the pelvis, presenting, within easy reach, a surface sufficient for making an incision four or five inches long in the posterior vaginal wall covering the cyst, without danger of wounding any other organ.

2. The cyst was unilocular, as proved by previous history.

3. The uterus was above the pubis, out of the way of the vaginal operation, but decidedly in the way of the usual operation of ovariotomy, it being directly underneath the linea alba, at the point almost universally selected for the incision through the abdominal wall. This, I feared, would seriously complicate the abdominal operation, especially if pelvic adhesions should be encountered.

4. Should I find, after making vaginal section, that the cyst could not be thus removed, I could still resort to the usual operation, and the danger to the patient would not be materially augmented by such section, if indeed it would not be diminished thereby, as vaginal drainage would thus be secured, an element in the operation of ovariotomy which is regarded by many, and I think justly so, as a very important one.

5. I thought, or at least hoped, that there were no adhesions, but in this I was doomed to disappointment.

6. The operation had been once successfully performed by Dr. T.

G. Thomas, of New York, although in his case the tumor was so small as hardly to serve me as either a precedent or guide.

Finally, I believed that the operation, if successful, would be less dangerous than ovariotomy performed in the usual way.

On September 18th, 1872, I proceeded to operate in the presence of Drs. Washburn, James, Crawford, Moore, and Murphy. The .patient, having been placed upon the table and etherized, was secured in the position for lithotomy. Two Sims's specula were now introduced into the vagina, and held by assistants; one making traction anteriorly, the other posteriorly. In this manner the posterior wall of the vagina covering the tumor was brought nicely into view. The vagina was now caught with a tenaculum, drawn well down, and incised thorough the fornix, to the extent of about four inches. After the hemorrhage, which persisted for some time, had ceased, the remaining dissection was carefully made, the peritoneum being divided upon a bent grooved director. The shining cyst wall was thus exposed.

To my dismay, pretty firm pelvic adhesions were found to exist, and I confess to having had many misgivings at this point, as to the success of my undertaking. I proceeded, however, to sever the adhesions with the finger as far as that could be done; but they extended beyond the reach of the finger.

The specula were now removed, and with the whole hand introduced into the vagina and through the wound, all the adhesions were broken up, first in the pelvis, then in the abdominal cavity between the peritoneum and the tumor anteriorly, and between the tumor and omentum; the hand being carried for that purpose to a point two inches above the umbilicus.

The specula were now reinserted; the cyst was secured by a tenaculum and tapped with a curved trocar and canula. As the fluid all escaped, I had the great satisfaction of seeing the cyst, almost without traction, come down into the vagina and into my hand.

The pedicle, which was long, was secured by a double ligature, the stump was returned into the peritoneal cavity, and one end of each ligature was left uncut and brought out at the lower portion of the incision. The cul-de-sac of Douglas was carefully sponged, and two stitches in the upper portion of the incision completed the operation; the lower portion being left open for drainage.

The patient rallied well. Indeed the patient suffered less from shock in this case than in any other case of ovariotomy I ever witnessed. At no time after the first evening did the pulse rise above a hundred. She recovered without a bad symptom, and in four weeks after the operation she called on me at my office perfectly well.