Case of Bicephalous Monstrosity; Removal of one of the Heads by Ligature.—I was called, on the 31st of October, for the especial purpose of ". cutting off a growth from the head of an infant" born the day before. The mother, who had been confined about eighteen hours, was seated at her spinning wheel; the infant was asleep in its cradle. Examined particularly, the head was found small, the forehead flat and ape-like; the face and all other parts of the body natural.

Upon the occiput, and near the posterior fontanelle, there was a large mass, rather larger than the head of the child, appended by means of a pedicle an inch and a half in diameter. This mass exhibited the several features of the face—a cleft for the eye, but without any eye-ball; an elevation in the seat of the nose, and a fold in the place of the mouth. It had no bony cranium, but was composed of a thick scalp, covered with hair, and having a cartilaginous consistence in some places. On the posterior aspect of this cephalic mole there was a spherical mass of a bright red colour, within which distinct fluctuation was apparent. When this red mass was pressed, the infant gave no indications of suffering. When the false head was touched, it cried. When the pedicle was compressed, there were no signs of pain, but symptoms corresponding to those of apoplexia sanguinea were induced, viz. a stasis in the circulation of the part. This led me to believe that the removal of the part with a ligature might with propriety be attempted. I therefore laid open the soft fluctuating part, by an incision two and a half inches long, and gave vent to about five ounces of clear yellowish serum. On separating the edges of the incision with a couple of blunt hooks, I obtained a distinct view into the interior of the supernumerary head: there I saw two normally formed hemispheres, with sharply defined convolutions, parted by a deep sulcus, within which lay a firm falciform process.

I now passed a well-waxed ligature or band around the pedicle, and drew the knot with moderate tightness. The infant gave no indication of suffering; it remained perfectly quiet. The ligature was drawn more firmly, upon which the respiration of the child became quickened and forcible; the pulse more frequent, harder, and smaller; the pupils dilated; and the blood-vessels of the head and face injected. The external jugular vein even became apparent through the layer of fat, of considerable thickness, which covered it. I thought it prudent to take a little blood from this vessel. A third pull upon the band completed the ligature, at which moment a stream of blood burst forth from the puncture of the external jugular vein, and three ounces were allowed to flow. The infant was put to the breast, which it took greedily.

The pseudo-cephalic mass was now of a deep livid colour; and a few minutes after the operation was over, it had become quite cold. Laid open longitudinally through the thick scalp, I came upon a regular dura mater, which, besides the falciform process already mentioned, exhibited an imperfect tentorium cerebelli; beneath this a small, dark red medullary mass presented itself, which, however, had no similarity in point of structure with the cerebellum; it was without the convolutions and sulci that were apparent on the cerebral lobes; it had no hemispheres, no subdivisions, no crura, no vermiform pro

cess. There was no trace of a medulla oblongata. On raising the cerebral mass, I could, however, make out a kind of pons Varolii-a sinooth medullary mass, by which the hemispheres of the brain were connected. I perceived no other commissure. The crura cerebri, as well as all the other parts at the base of the brain, were entirely wanting. During the course of this examination the infant was never interrupted in its business of sucking. The parts were covered with a piece of linen dipped in spirits, and the child laid in its cradle. I remained an hour in the house, only quitting it at the distance of three hours after the operation, at which time the infant was tranquilly asleep, and breathing quietly: there seemed every prospect of a happy issue to the case. On my returning next day, however, to see my patient, the parents met me at the door, and informed me, with great satisfaction, that God had not persisted in punishing them with the changeling oaf, for it had just died. Death followed 36 hours after the operation.

The parts were examined anew by Dr. Kersten and M. Loesch. The conclusion was, that the case was one of true, though incomplete bicephalus. The encephalon of the normal head was perfect in all its parts. There was no cerebral connexion between it and the pseudo-cephale; but nervous cords and blood-vessels could be traced into the latter, and processes of the dura mater extended into the connecting pedicle.-Dr. Buehring, in Casper's Wochenschrift, No. 1, 1844, and Medical Gazette.

On an Epidemic Pseudo-Syphilis, by M. Aliès.—The district of of R- near Luxeuil, contains a population of 700 inhabitants. In 1840 and 1841, symptoms very like those of syphilis appeared in about 80 individuals. The principal feature of the malady consisted in an eruption of mucous tubercles in the neighbourhood of the anus and genitals. Common report attributed the origin of the disease to one of the inhabitants who was supposed to have had connexion with infected women, who on his return to the village communicated the disease to his family, whence it spread throughout the whole district. M. Aliès does not pronounce on the true nature of the disease; it is beyond doubt, he says, its appearance and situation closely resembled syphilis, and mercury rapidly cured it, whilst in those patients who would not submit to this plan of treatment the disease lasted a long time. Nevertheless, the order of appearance and succession of the symptoms, their mode of transmission and termination induced him to doubt its being of a syphilitic nature, together with the fact that a great number of his patients denied having been exposed to any source of infection, and in all there was a complete absence of secondary symptoms.-Journal de Medicine de Lyon and Gazette Medicale. [We regret very much that we have only seen a short abstract of this paper, but from what we have been enabled to lay before our readers, they will perceive that there is evidently a close resemblance between it, and the characters of " Sibbens," detailed in another part of this Number.-ED.]

THE

DUBLIN JOURNAL

OF

MEDICAL SCIENCE,

JULY 1, 1844.

PART I.

ORIGINAL COMMUNICATIONS.

ART. XIII.-Notes on Ovariotomy. By FLEETWOOD CHURCHILL, M.D. M.R.I.A.; Hon. Fellow of the Philadelphia Medical Society; Physician to the Western Lying-in Hospital and Dispensary; and Lecturer on Midwifery, &c. at the Richmond School of Medicine.

[Read before the Dublin Obstetrical Society.]

THERE are some diseases so generally fatal in their results, and so little under the control of ordinary treatment, that a practitioner may be fully justified in having recourse to extraordinary expedients, even though attended with serious risk, provided only that the risk from the operation be considerably less than the mortality from the disease under ordinary remedies.

This remark I would apply to the operation for the extirpation of diseased ovary, which has recently attracted so much attention in England; and as the subject is one of so much importance, I make no apology for laying the matter somewhat at length before this Society: for, on the one hand, we find the VOL. XXV. NO. 75.

3 с

disease almost unmanageable by the methods hitherto adopted, and ending fatally sooner or later; and on the other, an operation of the severest kind, and averaging a high rate of mortality, is proposed as a remedy. If experience shall exhibit a fair and reasonable proportion of successful cases, then, although severe, the operation will be justifiable; but if its fatality at all equal that of the disease, it will clearly be altogether objectionable.

But before we enter into the merits of the operation itself, it may not be amiss to notice one or two points in the pathology and history of the disease for which ovariotomy is proposed as a remedy.

Dropsy of the ovary, though sufficiently distinctive as a name, yet comprehends considerable differences of morbid structure; for instance:

1. The enlarged ovary may consist of a single cyst, with thin membranous parietes containing a serous fluid.

2. Instead of a single cyst there may be many, each separate from the other, or two or more communicating together. The fluid may vary in quantity, quality, and consistence in each, being in some limpid serum, in others green, yellow, or brown glutinous matter; in others, of the appearance and consistence of honey; and in others, hydatids.

3. In cases of multilocular dropsy of the ovary, we find more or less of solid matter, sometimes chiefly at the root of the tumour, in others forming a large portion of it.

4. Again, we find the ovaries enlarged considerably from fibrous tumours. Dr. Baillie remarks, that "the ovarium is much enlarged in size, and consists of a very solid substance intersected by membranes, which run in various directions. It resembles in its texture the tumours which grow from the outside of the uterus, &c."

5. Lastly, the ovaries may be the seat of malignant depositions, and though, as in the case of fibrous tumours, the enlargement is not so great as in dropsy, yet it sometimes attains a considerable size.

Although we find these diseases attain to a great development without much complaint on the part of the patient, we cannot therefore conclude that they cause no irritation in the neighbouring tissues, for we very commonly find adhesions more or less extensive between the tumour and abdominal peritoneum, or effusion into the serous cavity.

The symptoms to which these enlargements of the ovaries give rise are partly mechanical, partly sympathetic, and partly constitutional. Pressure on the neighbouring organs will be in proportion to the amount of the disease and its situation. Thus the patient may suffer from dysuria, or even retention of urine, from difficulty in evacuating the bowels, and from pain along the sciatic nerves, whilst the tumour is in the pelvis. After it rises above the brim, these symptoms are generally less marked, but certain unpleasant consequences result from pressure upon the intestines and stomach, and, when the enlargement is excessive, from the pushing upward of the diaphragm.

It is not very uncommon for some of the signs of pregnancy to be present, owing to the intimate sympathy of distant organs with the ovaries.

For a considerable time-varying in different patients-there are few constitutional symptoms, the suffering being chiefly local ; but after some time, as the disease advances, a great change takes place, in consequence of diseased action going on in the ovary. Dr. Burns observes: "In the course of the disease the patient may have attacks of pain in the belly, with fever, indicating inflammation of part of the tumour, which may terminate in suppuration, and produce hectic fever: or the attack may be more acute, causing vomiting, tenderness of the belly, and high fever, proving fatal in a short time: or there may be severe pain, lasting for a shorter period, with or without temporary exhaustion, and these paroxysms may be frequently repeated. But in many cases these acute symptoms are absent, and little distress is felt until the tumour acquires a size so great as to obstruct respiration, and cause a painful sense of distention. By this time