gain in February, 1894, and a third time in May, 1894,
but without useful results. For the previous six months she had been
almost entirely bedridden because of the great size of the tumor. There
were no symptoms referring to the bladder and rectum. At the time she
entered the hospital she was much emaciated, the eyes were sunken, and
her cheeks had a livid hue. The chest was thin and the lower ribs were
everted; dulness began at the lower border of the 3d cartilage, and the
apex-beat was best felt in the third space. Liver-dulness began at the
4th rib cartilage in the nipple line. The abdomen was enormously
distended, and covered by large veins running from below upward to the
thorax. About 3 1/2 inches above the umbilicus there was a sulcus with
its convexity downward. There was dulness over the whole abdomen,
except at the sides parallel with the lumbar spines, and a resonant
band over the stomach. The greatest girth was 54 1/2 inches. By vaginal
examination the cervix was found to be pulled up and obliterated; the
anterior vaginal wall was bulged downward by the tumor. On May 3d
abdominal section was performed. An incision eight inches long was made
in the mid-line of the abdomen. A cystic tumor, formed of small cysts
in its upper part and of somewhat larger ones in the lower part, was
revealed. It was adherent to the abdominal wall, liver, spleen, and
omentum. The adhesions were separated and the cyst tapped with a large
trocar, and then the septa between the cysts were broken down with the
fingers. The pedicle was rather small and was tied in the usual way,
and the tumor was removed. Its seat of origin was the left ovary. The
right ovary and the uterus were healthy, but poorly developed. The
tumor weighed between 80 and 90 pounds,--the patient having weighed 170
pounds on the night before the operation and 79 1/2 pounds a week after
the operation. Alarming symptoms of collapse were present during the
night after the operation, but the patient responded to stimulation by
hypodermic injections of 1/20 grain of strychnin and of brandy, and
after the first twenty-four hours the recovery was uninterrupted.
Cullingworth thinks that the most interesting points in the case are:
the age of the patient, the enormous size of the tumor, and the advice
given by the surgeon who first attended the patient (insisting that no
operation should be performed). This case shows anew the uselessness of
tapping ovarian cysts.

In the