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the urethra are not always owing to a specific venereal cause. IConsidering the various circumstances, above indicated, underwhich simple discharges from the urethra may occur, it is ’,obvious that no one particular mode of treatment can be laiddown.The removal, rectification, or amelioration of the conditions

by which the discharge may have been excited, or on whichits continuance depends, will frequently be followed by im-provement or recovery; but it may be necessary, in addition,to make use of a weak astringent injection, on the same prin-ciple that we find it necessary to make use of an astringenteye-water in cases of puro-mucous inflammation of the conjunc-tiva, no matter by what cause, or under what circumstances,-the inflammation may have been excited.Albany Court-yard, October, 1859.

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

WESTMINSTER HOSPITAL.

POLYCYSTIC OVARIAN TUMOUR, TAPPED FOURTEEN TIMES;OVARIOTOMY; FATAL RESULT.

(Under the care of Mr. HOLT.)

Nulla est aMa pro certo noscendi via, nisi qaam plurimas et morborum et.dissectionum historias, tam aliorum pioprias, collectas habere et inter se com-- parare.—MORGAGNI. -De Sed. et Calls. Morb., lib. 14. Procemimn.

MOST physicians have observed the futility of efforts, in themajority of cases, to get rid of the dropsy arising from anenlarged ovary by the use of remedial agents. Upon this sub..ject, Dr. Watson, in his "Practice of Physic," observes :-" Theamount of my own experience tends to the persuasion thatmedicine has, in general, very small influence over the progressof this disorder. The cases that do well, do well we scarcelyknow how or why; the cases that prove fatal run their coursein spite of us."

If the tumour be allowed to go on and increase in size, it maypossibly remain thus enlarged for years without inconvenience; ior it may burst into the peritoneum, or kill by arresting thenatural functions of life. faracentesis has most certainly pro- ’,,longed life for many years, although it has had to be performed ’,an almost incredible number of times. When, however, this ’,operation has proved ineffectual at last, and the accumulationof fluid becomes so rapid that fears are entertained of imme-diate dissolution, ovariotomy is taken into serious considera-tion. It was attempted for this reason in the subjoined case. forthe notes of which we are indebted to Mr. J. E. Clarke, house-surgeon to the hospital. The woman had been tapped fourteentimes; the dropsy having increased so rapidly that the last twooperations were performed within a fortnight of each other. It

appeared to be a favourable case for the major operation, as thegeneral health was otherwise good, the tumour had grownwithin three years, and it was probable there were no adhesions.Mr. Holt performed ovariotomy on the 18th of October, andwe observed very little disturbance of any of the viscera whilethe proceeding was being effected. The pedicle was not vas-cular, and very little, if any, blood was lost. Forty hoursafterwards death ensued from the shock and the slight peri-tonitis, but from the readiness with which the tumour was gotrid of, there was at one time a reasonable prospect of a favour-able termination.Mary Ann H-, married, aged thirty-seven, for some

time past a resident in Corfu, was admitted into the above hos-pital on the 22nd of September, suifering from dropsy of theleft ovary. She stated that she was the mother of four healthychildren, the youngest aged three years, soon after the birth ofwhich she began to feel great uneasiness in the left iliac region.A fluctuating tumour soon became perceptible, which increasedin size, until about twelve months since, when she was tappedfor the first time. From that period up to the time of her

admission, she had been tapped on twelve occasions. Sinceadmission the fluid had collected twice with such rapidity thatthe intervals between the operations were obliged to be dimi-nished to ten days only, no bad symptoms following eitheroperation. About twenty-four pints of highly-albuminous fluidwere drawn off on the last occasion. She had menstruatedregularly until a fortnight before admission, but not since herresidence in the hospital. When the cyst was distended theuterus was.prolapsed. The pulse averaged 92.The operation took place on the 18th of October. The patient

was placed in a small ward, the temperature of which wascarefully regulated at an elevated degree. Chloroform wasadministered by Dr. Anstie, and when anæsthesia was com-

plete, Mr. Holt made through the abdominal walls in the me-dian line an incision about six inches in length, which wasextended to ten inches in the course of the operation. Thetumour at once presented itself to view, and was observed tobe polycystic, the walls of some of the cysts being so thin, thatone or two of the larger ones ruptured in the early part of theoperation. Mr. Holt assisted their evacuation by the trocarand canula. The entire growth was now drawn out of theabdominal cavity, and its pedicle, which was thin, not verybroad, and at the same time not very vascular, was tied bypassing a double ligature through the centre, ligatured on eitherside, and then cut through. The blood, of which there wasextremely little, and the serous fluid of the broken cysts weresponged away, and the edges of the wound were well broughttogether by deep sutures, the ligature on the pedicle of thetumour being allowed to protrude between two of the lowerstitches. In the earlier part of the operation there were foundto be some adhesions at the upper and anterior part of thegrowth, probably depending upon peritoneal inflammation afterthe different operations for tapping which the patient had un-dergone; there were none at the inferior part of the ovary, andthe tumour was removed with remarkable facility. It con-tained a number of cysts of various sizes, principally as largeas an orange, strung together, as it were, and giving the organa peculiar appearance, thus differing from the multiloculartumour, wherein a number of cysts exist within a large one.The operation from first to last occupied less than half an hour,and Mr. Holt was ably assisted by Dr. Frederic Bird and Mr.Holthouse.The patient lay remarkably quiet throughout, with her ab-

domen close to the edge of the bed, the shoulders raised, andher feet resting upon stools at the foot of it. When she becamesensible a short time afterwards, she remained calm and quiet,and was surprised to learn that the operation was over, anddeclared that she felt no inconvenience. Somewhat later shebecame very much depressed, her pulse varying from 100 to120, and very feeble, until about twelve o’clock, when sherallied a little. She passed a pretty fair night until six A.M.,when the pulse became almost imperceptible, the secretion ofurine ceased, coldness of the extremities supervened, and inspite of opium and brtndy freely administered, she graduallysank, and died at half-past four r.M.

Autopsy, twenty-two hours after death.-On opening the ab-domen, a patch of inflammation of the peritoneum coveringthe intestines was found, answering to the situation of thewound in the abdomen. Though the ligature had come awayearly, there was no blood found in the cavity of the abdomen,

but merely a little albuminous fluid similar to that of the cyst.ROYAL FREE HOSPITAL.

NECROSIS OF TUBEROSITY AND RAMUS OF ISCHIUM AND

DESCENDING RAMUS OF PUBES; REMOVAL OFTHESE PORTIONS OF BONE.

(Under the care of Mr. GANT.)

IT is quite probable that an acute ischio-rectal abscess firstformed in the following case, which, in its extensive ramifica-tions, subsequently produced necrosis of the ischium and pubis,after the lapse of some months. We watched the progress ofthe patient after each successive operation, but the cure wasnot complete until the removal of the necrosed portions of bonewas effected, when a rapid improvement took place in hisgeneral health, with convalescence.

Michael C-, aged twenty, thin and cachectic, began abouta year ago to experience a fixed, persistent pain in the situa-tion of the left tuber ischii; and simultaneously he perceived alump, of the size of a hen’s egg, at the upper and inner aspect