Excerpt from The Southern California Practitioner, Vol. 13 In discussing the case with my fellow house surgeon, Dr. De Sausseur, of Charleston, S. C., I said I believed that had the tumor been first aspirated, and afterward the sac removed by a second operation, the patient might have lived. This was of course an after thought. Case II. (Kindness of Dr. W. E. Bullard.) Age 45, single; menstruation ceased at 39 years of age. Three years ago noticed enlargement in abdomen, which rapidly increased in size. Appetite good; heart sounds normal; respiration short of late; heart beat slightly displaced to left and upward; heart sounds normal in rhythm. Operation. Incision in median line three inches. Edema of lower abdomen; no hemorrhage. Slight adhesions, easily broken up. Cyst evacuated by large trocar and canula. Pedicle fastened to abdominal wall. Time, 75 minutes. Weight of fluid 70 1/2 pounds, of sac 7 1/2; total 78 pounds. Recovery good. Dr. Bullard writes. "I have never seen a patient take ether better than she. She is one of the few patients that I have known to leave the operating room with a better pulse than before operation. When the cystic fluid was being drawn off, the pulse improved perceptibly, and we conclude it must have been due to the relief of pericardial pressure which had embarrassed the heart's action. You will perceive, hereafter, that this record appears to be antagonistic to my argument. Let me comment upon it at once, and ask you to observe that the patient seemed to be in good condition, with a recorded normal heart beat and one evidently able to withstand a decrease in endocardial tension, especially as it was reinstated from its displaced position and, in my opinion, relieved, not depressed, by the removal of pericardial pressure. Case III. (Kindness of Dr. W. Gill Wylie). Age 43; married; 11 children; no miscarriages. Not markedly emaciated. About two years ago noticed beginning of enlargement of left abdomen. For the last six months tumor has grown rapidly; four months ago noticed hernia. Denies all pain. She now measures: Greatest girth, 56 inches; ens. cart. to pubes, 38 inches; ens. cart, to umbilicus, 17 inches; umbilicus to right crest of ilium, 13 inches; umbilicus to left crest of ilium, 15 1/4 inches. Operation. Ether; small median incision. On opening the peritoneal cavity a large quantity of ascitic fluid drained away. Large tumor in situ. Incision lengthened in both directions. Pour large vascular connections with omentum tied. Posteriorly adhesions to the intestines separated at the expense of the tumor tissue. Pedicle tied and dropped. Incision prolonged upward, and hernial sac, containing only peritoneal fluid, was dissected out. Wound closed; glass drain. Recovery good. Case IV. (Kindness of Dr. Chas. K. Briddon). Girth, 64 inches (height 5 feet 4 inches); weight before operation, 267 pounds; weight of fluid removed, 129 pounds; weight of fluid lost, 4 pounds; weight after death, 134 pounds; estimated weight of unruptured cyst and cyst walls found at autopsy, 20 pounds; probable total weight of tumor, 152 pounds. Here allow me to restate that the two main points of this paper are: First. An argument that heart failure is due, not so much to the sudden removal of pericardial pressure as to the sudden reduction in the endocardial tension. Second. A plea to remove the fluid in a primary and the sac in a secondary operation, in cases of enormous ovarian tumor. The theory that heart failure is due to sudden relief of pericardial pressure is not, I think, well founded. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com