of opium directly after the operation, which were repeated at intervals all night, so that up to eight o'clock on the morning of the 7th, she had taken fourteen grains of opium and four grains of muriate of morphine, but still had only had two halfhour's sleep. Constant vomiting prevented her having any rest. Pulse from 96 to 100. To take grs. 4 of opium and a mixture of hydrocyanic acid, ammonia and soda. 11.30 P.M.: No more sickness; has had refreshing sleep twice for three-quarters of an hour.

8th. 2 A.M. Has had more sleep, and taken beef tea, lemon ice, barley water, and tea. 5 A.M. A little restless, with a slight pain from flatulence, which was relieved by passing it through the bowel; to take two grains of opium. 11 A.M.: Still very comfortable; pulse 120; to take two grains of opium. 1.30 P.M. Has had refreshing sleep; hands moist, two grains of opium. 7.30 P.M.: Very comfortable; says she feels quite well; skin moist. No swelling of abdomen; removed dressing for the second time; the pedicle begins to be offensive, to be washed with a solution of chloride of lime.

9th. Has had on the whole a comfortable day, but towards evening she was distressed with eructations of wind and feeling of sickness gave a warm rhubarb draught.

10th. 7 A.M. Has passed an uncomfortable night; been sick and restless. Bowels relieved four times and much flatus escaped per rectum after injections. A dose of creasote relieved the sickness for some hours. 10 P.M.: Has vomited a pint of dark fluid gave 20 drops of bimeconate of morphia. Sickness recurred soon after: repeated opiate in two hours, and again in four hours.

11th. From 4 A.M.: no sickness but occasional hiccup. 7.30 A.M. Is quiet and sleepy: pulse 100. 11 A.M.: Has had some very quiet and refreshing sleep, and is better. 9 P.M.: Has passed a very quiet day, sleeping, and has taken a cup of beef-tea. Barley-water and chicken broth have been given alternately every hour. Removed the two upper deep sutures: healthy pus came from the wound.

12th. 8 A.M.: Has passed an uncomfortable night, frequently

sick. Gave two grains of calomel, and in the evening the bowels were well relieved by an injection: omitted the opiate at night.

13th. 8 A.M.: Has passed a comfortable night, and is better. This evening, 7, P.M., is considerably better, and feels cheerful; removed the last suture.

14th. Has had a restless night, and is not so well this morning, but has had no return of sickness for forty-eight hours, and considerably less hiccup. Bowels have been opened three or four times. 11 P.M.: Very restless, with oppression on the chest; small quick pulse; clammy cold perspiration on the skin and hands. Gave her some hot brandy and water, and half-an-hour afterwards some port wine, with twenty drops of bimeconate of morphia, which in half-an-hour produced sleep and quieted the restlessness.

15th. 8 A.M.: Has been very sick all night after taking anything, but has less oppression, and is not so low as last night. Ordered her a drop of prussic acid every hour, and wine and nourishment to be continued. She had a relapse, rapidly got worse, and sunk at 11.30 P.M.

An autopsy was made at 4 o'clock P.M. on April 16th. An immense quantity of sanio-purulent matter was found in the pelvic cavity; the bowels had a slight blush upon them in some parts; the lower part of the omentum was very much enlarged and indurated; that which remained of what at the operation seemed to be a second covering of the cyst, was found to be very adherent to the peritoneum and nodulated in some parts, and there were evident symptoms of severe inflammation of old standing. A portion of the thickened omentum, and a piece of the layer, together with the vermiform appendix, the kidney, and the uterus, were removed for subsequent examination. In the thorax the lungs were found to be very extensively congested; the muscular coats of the heart flabby with fatty degeneration in some parts, and there was some fluid in the pericardium. The stomach was enormously distended. On examination, the uterus was enlarged, and the walls of pale aspect, but nothing abnormal could be seen; the thickened portion of omentum was of simple inflammatory origin, and contained some spots of fatty

on

degeneration; the vermiform appendix empty and natural; one side of the layer which covered the ovarian cyst was a dense layer of thickened fibrous membrane, beneath which was a quantity of less indurated areolar tissue and fat containing a good deal of black pigmentary substance. The kidney, though much enlarged, was tolerably healthy; a little interstitial fibroid formation existed among the tubes; capsules shrunk.