151.-ON THE EFFICACY OF THE WATERS OF KREUZNACH ON UTERINE TUMOURS AND HYPERTROPHIES.

By DR. E. H. SIEVEKING, Assistant Physician to St. Mary's Hospital. [The water from the chief spring is described as being perfectly clear and transparent when fresh, of a temperature of 55° Fahr., and of a salt and bitterish taste. After a time it becomes dull, and brownish flocculi form and are precipitated.]

The analysis of this water by Bauer, as given in Professor Osann's great balneological work, shows sixteen ounces of the water to contain above ninety grains of mineral constituents, distributed in the following manner:

The specific gravity of the water is 1,004.

The process by which the chloride of sodium is extracted from the water necessarily alters the relation ol the constituents found in the bittern; while it removes almost all the chloride of sodium, it leaves those elements to which the peculiar effects of the Kreuznach waters are particularly ascribed in a much more concentrated form. This bittern or mother ley is the semifluid residue found in the evaporating pans; it presents a brownish yellow colour; it is translucent and clear, and has a soft soapy feel: its sp. gr. is 1,307 to 1,314. It smells like marine algæ, and has an intensely pungent and acrid taste, which is not effaced from the lips and tongue for some time after it has been applied. It is very deliquescent-a property which renders its transportation in anything but china or glass vessels impossible, as it gradually oozes and makes its way through all porous materials, and through the strongest casks and earthenware jars. It is rarely employed in the concentrated form, but merely as an adjunct in ordinary water baths, or with the water of other mineral springs. Of late, the bittern has been still further evaporated to dryness, in which state it forms an amorphous light brown mass, of which I present a specimen to the

society. Its taste and properties are the same as those of the mother ley, but it offers the advantage of being much more portable. The following is an analysis of the mother ley by Osann. He found sixteen ounces to contain 2625.72 grains, or about one-third of solid matter, distributed in the following manner :

The quantitative analysis of the mother ley varies in almost every examination that is made, owing to the accidental variations of condensation, and fortuitous changes produced by the process of extracting the common salt; but all agree in showing the presence of a large proportion of bromide of calcium. An analysis given by Dr. Prieger, in a work entitled "The Mineral Waters of Kreuznach,' published by Mr. Churchill in 1846, exhibits a considerable difference in the relation of the constituents; it is as follows:

[We need hardly say, that it is in scrofulous diseases of all kinds that these waters are more especially recommended, especially in cases of tumours or swellings where the absorbents need a stimulant; but it is in diseases which are commonly not amenable to treatment that the benefit is most remarkable, such as fibroid tumours of the uterus and ovaries, and other hypertrophic conditions of these organs.]

It appears from the cases recorded by Dr. Prieger, jun., in an interesting pamphlet recently published, that under the use of the Kreuznach waters they may be softened, reduced, and even entirely dispersed.

There is nothing in the structure of the tumours which renders such a result improbable. Until they have become very large, they are freely traversed by blood-vessels, the agents of all advancing or retrograde metamorphoses; and as long as the organic connexion between the morbid growth and its matrix is freely kept up, we may reasonably hope that our dynamical remedies may exert an eliminating effect, provided we can hit upon an agent likely to stimulate the system in a manner proportionate to the existing disease. Any one who will take the trouble to go to the museum of St. George's Hospital, and examine some injected specimens of uterine fibroid tumours, will find that they may be plentifully supplied with blood-vessels. The more extensive their growth, the more they seem to be placed beyond the pale of the organisation; and they gradually become, like foreign bodies, a source of mechanical irritation, or passive obstacles to the organic functions: they then necessarily cease altogether to react upon internal remedies. But I hold that the structure of these fibroid tumours is a further explanation of the comparative facility with which they yield to the resolvent action of the Kreuznach waters. They are, as I have attempted to show elsewhere, essentially an hypertrophic condition of the true uterine tissue, differing from it by that metabolic power which gives a morbid impulse, but identical with it in those points which the microscope and chemical reagents reveal. I the more confidently put forward this view, as I find it corroborated by a recent writer in the Reports of the Pathological Society for 1852-3. Dr. Bristowe there demonstrates in a most satisfactory manner, that the so-called fibrous tumour is absolutely identical in point of structure with the walls of the uterus, whether examined in the unimpregnated or impregnated condition.

The evidence which Dr. Prieger, jun., brings forward in proof of these tumours being amenable to treatment by the Kreuznach waters, is of a character to demand our serious attention. Those who will study his paper, will be constrained to conclude that he thoroughly understands his subject, and that he is not led away by that species of enthusiasm which frequently prompts the administrators of favourite remedies to regard them as agents of an universal efficacy. His diagnosis is cautious and well founded; and he gives us accurate statistical details of his experience.

The results of the application of the Kreuznach waters in 86 cases of hypertrophic states and fibroid tumours of the uterus and its appendages, which have been under his care, are as follows:

Thirty-one were entirely cured; of these, 2 were hypertrophy of the entire uterus; 16, partial hypertrophies of the uterus; 6, fibroid tumours of the uterus; and 7, tumours of the ovaries. In each case, no trace of the disease remained at the conclusion of the treatment.

Twenty-nine were partial recoveries; the troublesome symptoms having been removed or ameliorated, and the swelling or tumour

having been much reduced. Of these, 3 were hypertrophy of the entire uterus; 4, partial hypertrophy of that organ; 9, fibroid tumours of the uterus; 5, fibroid tumours of the ligaments; 6, ovarian tumours; and 2, ovarian tumours complicated with hypertrophy of the

uterus.

Nineteen cases were benefited so far that the continued growth of the morbid formations was arrested, without any or but a trifling reduction in size. Of these, 2 were hypertrophic states of the uterus; 8, fibroid tumours of the uterus; 4, fibroid growths of the uterus; and 5, ovarian tumours.

Seven cases presented no change whatever either in the size of the tumours, or in regard to the morbid symptoms.

The method pursued and the duration of treatment by the Kreuznach waters necessarily varies according to the duration and extent of the disease, and according to the constitution of the individual. One remarkable and well authenticated fact regarding its influence upon the organism, is the continuance of the peculiar action it has set up, long after that action has been initiated, and the remedy has been discontinued. Dr. Prieger has repeatedly observed that after the conclusion of the course in August or September, the progressive diminution of the local affection continues until the following spring. Thus in a lady who had employed the baths for eight weeks, on account of an ovarian tumour, previous to the 1st Sept. 1851, Dr. Prieger was unable to perceive a notable diminution of the tumour when she quitted Kreuznach, nor could her own medical attendant in the following January detect a marked change; still, a few months later, the tumour was found to be much reduced, and she had made use of no remedies in the interval but an occasional local application of the Kreuznach water.

We have alluded to the different modes in which the Kreuznach waters are exhibited. A few more detailed remarks on the subject may be acceptable. When administered by the mouth, the water may be taken by itself, or combined with milk, whey, or other mineral waters; and either warm or cold; the quantity varies from one to six beakers, or from a few ounces to two and more pints; it is taken in the morning at short intervals, and moderate exercise is enjoined during the potations. The baths are commonly employed tepid at a temperature of about 90° F.; at the commencement of the course the patient is ordered the use of the water only, while its power is subsequently and progressively increased by the addition of more or less of the bittern. Dr. Prieger informs us that it is usual to commence with one quart, or about 4lbs. of the latter for baths for adults, while a less quantity, proportioned to the age of the individual, is used for children. If the inspissated bittern be employed, we should use from one to two pounds for the bath of an adult. The increase in the quantity of bittern in the baths must be gradual; and in the same way, after the climax has been reached, it is progressively diminished;

"for the whole object," to use Dr. Prieger's words, "of this management would be destroyed by a too quick reduction of the effective power, and before the accustomed irritation of the skin" (a species of critical eruption) "had subsided." The bath is rarely used more than once a day, or for more than from five to twenty minutes at a time; its action is accelerated by friction of the affected parts, or of the whole body. Rest is enjoined after the use of the bath in very delicate individuals, while gentle exercise is recommended to those of a corpulent or more robust habit. The topical applications vary equally in strength and duration according to the constitution of the individual patient; and when applied as gargles, as enemata, or as vaginal injections, we must necessarily use some judgment in regulating the minutiæ of temperature, concentration, and frequency of exhibition.Association Med. Journal, Dec. 2, 1853, p. 1059.

152.-ON THE EXCISION OF OVARIAN TUMOURS. By JOHN E. ERICHSEN, Esq., Surgeon to University College Hospital. [At a meeting of the North London Medical Society, Mr. Erichsen read a paper on the excision of ovarian tumours. After some introductory remarks, he related the case of a lady, aged 65, and the methods employed to form the diagnosis, and determine the selection of the mode of operation.]

The room having been warmed to a temperature of 80°, the patient was laid on a table of convenient height, covered with doubled blankets, so that the legs hung over the end of it, chloroform administered, and the bladder emptied. (The bowels had been cleansed out with a purge on the preceding day). The operation was commenced by an incision about five inches in length, made in the linea alba from the umbilicus downwards, the tissues carefully incised, and the peritoneum opened, when the tumour presented itself. Into the part on the left side, that was soft and fluctuating, a large trocar was introduced, and about a gallon of very thick, pasty, dark-coloured fluid drawn off. The hand was now introduced into the cavity of the abdomen, and the more solid part of the tumour (which extended high up on the right side, lying against the liver) was drawn down and brought out through the wound. In doing this, a few adhesions, that passed between the anterior wall of the abdomen and the tumour, were broken through. The mass, which was of considerable magnitude, was now lifted out of the abdomen (the intestines, being protruded, were passed back with soft warm cloths), and was found to be connected by a broad attachment to the right broad ligament. This pedicle was short, wide, and composed principally of large blood-vessels, with some connecting cellular tissue; it was drawn well forwards. A nævus-needle, armed with strong whip-cord, was passed across it, care being taken to avoid any of the blood vessels. The peritoneal investment of the pedicle