WHITWORTH HOSPITAL, DUBLIN

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and the patient recovered without any unfavourablesymptom.

In another case since operated on by Professor Hum-phry in private, the same plan was adopted, and with thelike good result. The patient was a healthy woman, agedsixty-two, living at Brandon, under the care of Mr. Thomp-son of that place, with enormous distension of the abdomenand oedema of the lower limbs and lower part of the abdo-men. She had not been tapped. She was a person of goodspirit, who calmly determined to undergo the operation forremoval of the cyst, as the weight and distress were nolonger endurable. The sac was extensively adherent to thefront of the abdominal wall and in the pelvis, so that, as inthe preceding case, it was opened in making an incisionthrough the linea alba, and the contents of the sac at oncepoured out. The fluid was viscid, but not dark-coloured.’The adhesions were so close and tough that it was difficultto distinguish the wall of the sac from that of the abdomen,and to effect the separation. The latter was, however, atlength done with the fingers. There were no adhesions tothe omentum or to the abdominal or pelvic viscera. Thepedicle was sufficiently long to admit the easy applicationof a clamp. A few vessels were tied with catgut ligatures.Still there was some oozing into the abdominal cavity.Accordingly a drainage-tube was inserted by means of alarge trocar passed from the abdomen through the recto-uterine pouch into the vagina. One end was brought outthrough the wound, the other through the vagina, and thetwo were tied together. The wound was closed with catgutsutures, and a pad and bandage was placed on the abdo-men. Bloody fluid escaped through the tube during thefirst two or three days, and after six days the tube wasremoved. Not a single bad symptom of any kind occurred,with the exception of some pain in the body, which was atonce relieved by a small dose of nepenthe, administered byMr. Thompson, under whose care she remained. The clamp.came away, and she quickly and completely recovered.

WHITWORTH HOSPITAL, DUBLIN.CASE OF PURPURA.

(Under the care of Dr. M’DOWELL.)FOR the following notes we are indebted to Mr. Cedric

Hurford.Catherine H-, aged twenty, a milliner, of sedentary

habits, very delicate, thin, and ansemic, was admitted onthe 23rd of June, her face covered with purpuric blotches,and with a dark halo around the eyelids. On examination,she was found covered all over the body with petechiae ofvarious sizes; her face swollen and puffy; enlarged glandsunder the maxilla; tongue swollen, with a dark spongy’ elevation" on its left border; and on the inner side ofthe right cheek was another of these spongy 11 elevations,"and, corresponding to this on the outer side of the cheek,a circular eccbymosis, about an inch and a half in diameter.Both these 11 elevations" bled profusely. The gums wereextremely vascular, with a constant oozing of blood. Thepulse was weak and rapid. There was no fever, and thepatient did not complain of any pain. She stated that onthe 21st, two days previous to her admittance, she went tobed, feeling pretty well, and that on the following morningshe found herself covered with petechise.June 24th.-During the night the patient had a severe

attack of epistaxis. She is extremely weak. Ordered aneffervescing mixture of bicarbonate of potash and citricacid, with four ounces of wine, and ten drops of the oil ofturpentine every three hours.

25th. - Patient still very low. During the night had aseries of "fainting fits." Increased the stimulants, givingher four ounces of whisky. She passed a quantity of bloodin the urine, and complains of a severe pain in the back.More petechiae have made their appearance, those on thelegs being very numerous. Is to continue the mixture andturpentine, the quantity of stimulants being increased.There is a nasty fetor from the mouth. The spongy

11 ele-vations" above referred to appear sloughy. - Evening:Patient much worse; more blood passed in the urine. In-creased the stimulants, with strong beef-tea &c. -12 P.x.A slight improvement.

26th.-Still very low, but there is a slight improvement;haematuria continues; sloughs have formed on the tongueand cheek. To continue the mixture, wine, and turpentine ;the last to be taken every sixth hour. Ordered a wash (oneounce of the tincture of the perchloride of iron to eightounces of water) for the mouth, beef-tea, ice, &c.27th.-Great improvement; less blood from the mouth;

hsematuria slight; pulse stronger; patient feels better;sloughs loosening. Continue wine, mixture, and turpentine.A wash of permanganate of potash for the mouth.28th.-No blood in the urine. Oozing from the mouth

and gums stopped. Bowels have been rather confined.Ordered an enema.

July 3rd.-The patient has made wonderful progress;has continued the mixture, wine, and turpentine. Thepetechiae are gradually disappearing. Tongue and mouthare clean.10th.-Patient left the hospital to-day. She has been

taking the citrate of iron and quinine for the last few days,and is to continue it. There is an extraordinary bruit dediable over the jugular veins. A sojourn in the countryrecommended.The above case is remarkable from the suddenness of the

attack, the rapidity with which the alarming symptoms ofhaemorrhage set in, and, finally, the steady and rapid pro-gress she made towards recovery.

Medical Societies.OBSTETRICAL SOCIETY OF LONDON.

WEDNESDAY, OCT. 1ST, 1873.DR. E. J. TILT, PRESIDENT, IN THE CHAIR.

DR. JOHN GOLDSMITH, Worthing, was elected a Fellow ofthe Society.Mr. T. EYTON JoNES read a paper

’ ON A CASE OF VESICO-VAGINAL AND RECTO-VAGINAL

FISTULA.

The patient was seized with labour pains on Saturday night,and remained in labour until 5 P.M. on Tuesday afternoon,when a medical gentleman was called in, who delivered herby forceps. Ten weeks after her confinement she came underMr. Jones’s care, who discovered great swelling and red-ness of the labia. At the vaginal entrance were two aper-tures : the anterior small, barely admitting the little finger,apparently entering the bladder; the posterior covered by a,red, velvety-looking, mucous swelling, through which theforefinger entered with ease, and apparently consisting ofthe vagina and rectum dilated into one cavity, and con-taining in it the closed mouth of the uterus. She couldneither retain her fseces nor urine, and the catamenia havenever since reappeared. Two and a half years after thisdisastrous confinement she suffered excruciating pain for afortnight, at the end of which she parted with a phos-phatic calculus, one inch in circumference and two inchesin length, which had formed in the bladder or urinarypassage. Venesection had to be performed every two monthsto relieve the severe headache caused by catamenial sup-pression.

Dr. HEYWOOD SMITH thought that the paper, to be ofany use to the Society, should state accurately the exactpresent state of the parts. It did not appear from the caseas then read that it was hopeless as regards any operativeinterference, and it seemed to him that an attempt shouldbe made to remedy a state of things so deplorable.

Dr. AVELING considered that at all events some effortshould be made to restore the patency of the cervical canalof the uterus.

Dr. J. BRAXTON HICKS read a

NOTE ON THE MUSCULAR SUBSURRUS IN RELATION TOTHE FCETAL HEART-SOUNDS.

The author wished to call the attention of the Society to apoint with regard to the diagnosis of pregnancy and thelife of the foetus, by means of the existence of the foetalheart-sounds, which he had not unfrequently observed in thecourse of his practice, but which he did not remember to