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has passed much gas by the rectum. Evening. — Pulse 110. January Tth. — Pulse rapidly increasing in frequency, and losing strength and force ; abdominal tympanites greatly on the increase ; frequent vomiting and delirium. From this time the patient sank rapidly, and died on the morning of the 8th, thirteen days after the operation. To those who were in at- tendance it did seem as though the result would have been more favorable had the nursing been better. The loss of twenty hours' attention on the tenth day of the treatment, with the attendant fright, was the feather which broke the Clomipramine Tablets camel's back, Eemarks. — The subsequent retraction of the vagina after tlie removal of the clamp, which left an opening in the line of incision, I consider Buy Clomipramine as only one instance of an inevitable occurrence, and one that would of a certainty occur again and again if the experiment were tried. I believe it, because in the first place there was sufficient length to the vagina to warrant any one in the first experimental trial ; and, secondly, the re- traction was too great to allow any one who witnessed it to believe in its practicability. Mrs. Foster, Buy Clomipramine Online widow, aged thirty-four years, native of Ver- mont, and resident of Virginia, consulted me on the 18th Feb- ruary, 1869, about a tumor which she had discovered in the pelvic region. She was never a strong person, yet considered herself during her girlhood as strong as most of her mates. Dates her decline from the time of an attack of enteric fever in 1863. Convalescence was very tardy, and attended for three consecutive months with metrorrhagia. She is small of stature, thin in flesh and muscle, mother of one living child, and a three-months' foetus. By abdominal palpation and vagi- nal touch, a symmetrical tumor about three inches in diameter 292 CLINICAL EECOKDS. was revealed, occupying a position beliind and above Anafranil Clomipramine the uterus. Both the tumor and womb could be moved about quite freely ; ricither was tender to the touch. Diagnosis, Ovarian Cyst. — Septemher 15, 1869. — The pa- tient passed the intervening time in Yirginia. Her suflPerings at this time were greater tlian at the time of the first examina- tion; has "bad spells, attacks of colic-pain," as she calls them, lasting from a few minutes to from one to two hours, not so severe as to call for anodynes, as, by simply resting on her couch for a brief period, they would subside. The abdomen was quite as large as it would have been at full term of preg- nancy. Yaginal touch revealed the Clomipramine For Ocd presence of the tumor much enlarged since the last examination. From that time till the 24th of November she was placed on a meat-and-milk diet, with plenty of apples. The last two weeks of the time she took daily four grs. of quinine, Clomipramine Ocd and 3 j ferri tr. murias, divided into three doses. 'At this date she was put under the influence of sulphu- ric ether, and, in the presence of Drs. Perkins, l^orthrop, Peck, and Atwood, an ovarian cyst and fluid contents, weighing twenty-seven pounds, were removed through an abdominal incision, extending from the umbilicus to the pubes. The pedicle, which was long and small (not exceeding two and a half inches in circumference), was tied with a double silken ligature, cut short and Clomipramine 50 Mg returned into the abdomen, and the wound closed by needles which were made to embrace the peritonseum. Thc'only medicine required during her recovery was morphine. The needles were removed on the sixth day. The bowels were moved on the eighth. Was not allowed to turn herself in bed till the sixteenth day, and sat up on the twenty-ninth. From this time the patient was in comfortable health till Februar}'' 1, 18Y1, when she began to fail in strength, and was troubled with Clomipramine 10 Mg occasional attacks of " colic-pains," as she expressed it, not severe, but much like the attacks of pain suffered before the removal of the ovarian cyst. I saw her about the middle of April; she had Clomipramine 20mg been confined to her bed for two days by pain and soreness in the lower part of Clomipramine Hydrochloride the ab- domen. An examination by abdominal palpation and vaginal CASES OF OVARIOTOMY. 1^93 touch discovered a tumor situated in tlie same region (beliind and above the womb) and about tlie Clomipramine Buy size of the ovarian cyst when it was first examined. Diagnosis, Ovarian Cyst. — My next visit was made about the 1st of June, when I found the cavity of the peritonaeum filled with serum, which was unmistakably external to the tumor ; pulse weak, and strength greatly reduced. It was Clomipramine Anafranil the opinion of all the physicians consulted that the ascites was in some way dependent on the pressure of the tumor ; and inasmuch as the patient was fast losing strength, and no way offering for the removal of the ascites without the re- moval of the tumor, it was Clomipramine 50mg determined upon for the earliest opportunity, which did not present, in consequence of several untoward circumstances, till the 15th of June. Sulphuric ether was again administered, and, assisted by Drs. Perkins, Peck, Mead, Korthrop, Pond, and Atwood, the old cicatrix was followed by an incision extending its entire length. A trocar was thrust into the tumor, Clomipramine Hydrochloride Tablets which proved to be solid. The walls of the incision were now drawn apart to the utmost ex- tent, the hand introduced, and innumerable slight adhesions broken up ; the pedicle reached, ligated with a double silken ligature, cut, and returned into the abdomen. The haemor- rhage, which at first was quite free, ceased after exposing Clomipramine 25mg the surface to the atmosphere for a short time. The abdomen was thoroughly sponged out, and the v/ound closed by needles, em-

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