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urethra. Having provided a free external opening for thedischarge of urine, Sir William said he should not furtherinterfere with the case unless the patient should show

symptoms of stricture of that portion of the urethra whichhad opposed the passage of instruments.

(By Mr. HENRY SMITH.)Perineal Section.-This patient, also, had a perineal fistula,

and showed traces of urinous infiltration about the hinderpart of the scrotum. No difficulty was met with in passinga fine grooved staff into the bladder, and, the urethrahaving been divided, a No. 9 catheter passed readily throughthe stricture, and emitted a copious stream of urine. Mr.Smith afterwards visited the patient in the ward, and,having tied the catheter in the bladder, ordered him a glassof brandy-and-water.

Operation for Obliteration of aVascular Tumour of the Fore-arm.-A vascular tumour of such size as the one in questionis of rare occurrence on the upper extremities. It was of

spongy consistence, presented no pulsation, and appearedto consist of venous sinuses. Mr. Partridge had operatedon the patient two years ago, employing hare-lip pins asfor nsevus. Seven weeks ago the patient returned with thetumour so increased as to extend from within two inches ofthe lower extremity of the ulna to two or three inches abovethe elbow; in this latter situation it expanded into a massof about the size of a man’s fist. Mr. Smith had strangu-lated the mass at the upper extremity of the tumour with asubcutaneous suture, and passed half-a-dozen pins trans-versely beneath the remainder. As the patient was a foot-man, and anxious to return to his employment, a third andsupplementary operation was performed on this occasionby the passage of another subcutaneous suture round theupper mass, which had much diminished, and of two morepins beneath what remained of the longitudinal process.Two small tumours of a similar nature, one on the ringfinger, and the other on the little finger of the correspondinghand, were also operated on by the passage of a pin aboveand below the situation of each respectively.

ST. BARTHOLOMEW’S HOSPITAL.A CASE OF STRANGULATED ENTERO-EPIPLOCELE ;

OPERATION ; RECOVERY.

(Under the care of Mr. HOLDEN.)For the notes of this case we are indebted to Mr. Hogg,

house-surgeon.Eliza B- was admitted with a strangulated femoral

hernia on the left side, of six days’ duration, with sterco-raceous vomiting, which had existed ever since the time atwhich strangulation took place. She had been rupturedeighteen years, but had never worn a truss. The hernia ap-peared to have been partially strangulated three times inthe last three years, but she had never found it necessaryto call in a doctor, as it had always got well again after afew days’ rest in bed. She had been taken with sterco-raceous vomiting and pain in the rupture six days beforeadmission, and had gone to bed, hoping to get well, as shehad done on previous occasions; but she had become gra-dually worse, the sickness and pain increasing, till, the daybefore admission, she called in a doctor, who, on the fol-lowing morning, advised her to come immediately to thehospital.

She was found to be in a -state of great collapse, andthere was considerable lividity of the skin over thetumour.The operation was performed an hour after admission.

On opening the sac, it was found to contain a large blackpiece of omentum, and behind this a knuckle of dark-coloured intestine. In consequence of the large size of thepiece of omentum, it was found necessary to make a supple-mental incision at right angles to, and to the outer side of,the ordinary one. The intestine was returned into the ab-domen, and, the piece of omentum being cut off, the stumpwas left in the wound. The patient was ordered beef-teaand milk diet, a poultice to the wound, and twenty-fivedrops of solution of opium to be taken nightly.On the day following the operation the patient vomited;

she was ordered two ounces of wine and some ice. The

vomiting continued to a small extent on the second day, and

four ounces of brandy were substituted for the wine. Onthe seventh day an injection of olive oil and barley-waterwas followed by an evacuation. On the tenth day the sick-ness returned, and brandy, ice, lime-water, and soda-waterwere ordered; also a pill containing three grains of calomeland one and a half of opium, to be taken at night. On thefollowing day the patient was well enough to be put on fishdiet. On the sixteenth day water dressings were substi-tuted for the poultice, and the nightly dose of opium wasdiscontinued. The patient recovered without any furthersymptoms, except the formation, in the line of the incisionof a small abscess, which discharged itself spontaneously.

METROPOLITAN FREE HOSPITAL.A CASE OF MALIGNANT DISEASE OF THE OVARIES;

DEATH AFTER TAPPING.

(Under the care of Dr. C. DRYSDALE and Mr. SHEFFIELD.)A WOMAN, aged forty-four, became an out-patient of the

hospital at the latter end of November last. She said thatin the month of April she had pains and soreness all overthe abdomen, but did not remark any swelling until August, Dwhen she suffered from great pain in the left groin, andnoticed a swelling in the belly at that part, about the sizeof an egg. This swelling increased rapidly until the wholeof the abdomen became enlarged as far as the chest. Themenstrual flow, which had always been quite regular exceptduring pregnancy (she had had nine children), had stoppedin March, and had not returned. She had been a delicatewoman, and fourteen years before had had rheumatic fever.Her father was alive, and her mother had died at tho ageof sixty-three. She had five brothers and three sistersalive.When examined by Dr. C. Drysdale she had a pulse of

136, and considerable dyspnœa. He found a globular dis-tension of the abdomen, extending from the ensiform car-tilage to the os pubis, and everywhere yielding the sen-sation of fluctuation, even in the loins, with dulness onpercussion throughout, except for about four inches belowthe ensiform cartilage. The dulness remained in the left andright umbilical regions, even when the patient turned onto either side. On pressure being made on the left iliacregion, a hard tumour was easily felt. The uterine soundcould not be passed, and the uterus appeared as if in a stateof complete retroflexion; it was small, and quite unconnectedwith the tumour. The urine was scanty, full of urates, andcontained no albumen. The patient was very cachectic and

’ emaciated. It was presumed that there existed an ovariantumour, complicated with ascites. When the patient wasadmitted it was decided first to tap the abdomen, and totake further steps if necessary.On December 13th Mr. Sheffield tapped the abdomen

about two inches below the umbilicus, and drew off aboutsix quarts of ascitic fluid. As the fluid escaped, the existenceof a large tumour, chiefly located in the left iliac region, be-came manifest to the eye. It extended over to the right iliacregion. The patient was in such a low state that the idea ofoperating was at once abandoned, especially as it was sug-gested that the tumour might be of a malignant nature.The patient gradually became more emaciated, and died onDecember 22nd, with symptoms of peritonitis.

After death both ovaries were found to be the seat of ascirrhous tumour ; that of the left side being of the size ofthe head of an adult, and that of the right of the size of achild’s head. Cancer cells were well seen in the juice ofthe tumours. The uterus appeared to be healthy.

THE CAUSE OF SEA-SICKNESS. - Dr. Neudörferstates, in the AUg. Mil. Zeit. No. 50, 1870, that sea-sicknessis greatly due to the reception of salt water into the lungs.The aqueous portion is excreted, but the saline particles re-main in the lungs, and hinder the interchange of gases.When the saline deposits have reached a certain amount,they act as a toxic agent, and generate sea-sickness.Hence the necessity of allowing the passage of water, butstopping the admission of saline particles. This remindsone of Professor Tyndall’s proposals of arresting dust withcotton wool, and excluding the cold air.