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the firm root of the tumour was felt, althoughthe full extent of it was not ascertained.Thirdly, the fact of the tumour remainingquite within the uterus long after the childhad been expelled. The enormous size ithad acquired, probably, we might presume,chiefly during pregnancy, would be the moreastonishing were it not for the well-knownvascularity of the uterus at the time of preg-nancy ; and, moreover, that in some in-stances tumours forming in the walls of theuterus carried a layer of the uterine muscu-lar substance with them. A case was re-corded by Bach in which the placenta ad-hered to the tumour, and thence derived theneedful supplies. An obvious peculiarityappeared to be that a tumour of this immensesize should have its roots low down, almostat the lowest part of the uterus, and itsother extremity in the fundus and body ofthe uterus, and yet be retained whollywithin the uterus, not only until the childwas born, but for many hours after. Tu-mours sometimes, however, were attached tothe surface of the uterus, over a very greatextent, by cellular substance, which attach-ments were afterwards broken away byuterine contractions, allowing the tumour todescend ; and this appearedto have been thecase in Mr. Cusp’s patient. With regard totreatment, Dr. Chowne could not have recom-mended any interference with the tumourwhile it was within the uterus in the condi-tion described, and the patient being a

woman just confined ; and when the tumourhad been detached from that situation byuterine efforts, it had been done at the ex-

pense of the patient’s vital powers, and wasfollowed by exhaustion, which proclaimedtoo plainly an inevitably fatal result.Mr. CRisp, in answer to a question, said,

that the tumour was not very vascular ; thevenous was much greater in proportion thanthe arterial circulation. He thought thetumour might have been removed by a liga-ture, but wonid not the woman have sunkrapidly had the growth been suddenly takenaway. The tumour consisted of cellular

bands, with a gelatinous kind of fluid be-tween them. Looking at its diameter, itselasticity, the readiness with which it wasmoulded to any shape, that its base was

small, its middle large, and its apex pointed,he had no doubt the tumour was a true poly-pus. When he first believed that the tumourwas a second child enclosed in its mem-

branes, and that he felt the placenta andattempted to detach it, his object was toreach the second child as quickly as possible,and bring it away.Mr. HLADLAND questioned the propriety

of the attempt to detach the placenta of thesecond child, as practised by Mr. Crisp.With respect to the tumour he thought itinvolved too much of the structure of theuterus to be a common polypus, it appearedto be more like a morbid development of

the structure of the uterus itself. Hethought a ligature could be scarcely appliedin this case, judging from the difficulty ofintroducing the catheter. Nothing wouldhave saved this woman, but the bold opera-tion of entire removal of the tumour by theknife would have been as justifiable as manyoperations which had been performed in re-ference to the uterus.Mr. DENDY agreed in the last opinion.

He did not think the tumour a true

polypus.Dr. WALLER said that the tumour was of

a more lobulated character than a polypus,and had no distinct pedicle. He mentioneda case of a somewhat similar kind, occurringin the practice of Dr. F. Ramsbotham, andin which, in consequence of haemorrhage,that practitioner detached a fibrous tumour,. having a pedicle, with the hand, and thewoman did well. In Mr. Crisp’s case hecould easily believe that any practitionermight mistake the tumour for a second pla-centa, its structure being so similar.Some little 11 skirmishing" took place

between two or three of the members re-specting the possibility of applying a liga-ture in this case, and also on the question ofremoval by the knife. The " firing" wasrather sharp, but not very elfective in produc-ing materials for a report.

WESTMINSTER MEDICAL SOCIETY.

Saturday, November 4, 1813.

Dr. REID, Presid ent.

DISEASES OF THE URETHRA AND THEIR CON-

SEQUENCES.

MR. STORKS related the following case:-J. G., aetat. 35, was under the care of Mr.

Whidborne, of Queen-square, for an attackof fever and cold, at the commencement of

August in the present year; when conva-lescent he directed the attention of Mr. W.to a small encysted tumour near the anus ; itwas regarding this that Mr. Storks’ opinionwas requested on the 14th of that month. Onexamination a small encysted tumour wasfound close to the margin of the anus, and,ftom some remarks made by the patient, Mr.S. was induced to suspect some disease ofthe urinary organs. On inquiry he elicitedthe following particulars :-Five years agothe man suffered complete retention of urine,after an attack of gonorrhoea (of which he hadhad several), on which occasion Mr. SamuelCooper passed the catheter, and subsequentlyseveral bougies, with complete relief to allhis symptoms. Since that period, however,he had neglected to pay any attention to hisurethra, with the exception of a bougie beingpassed by a chemist on two or three occa-sious some time ago. He complained ofl great irritability of the bladder, constantf gleet, and a diminution in the stream of

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urine ; several hard, knotty points could befelt through the integuments in that portionof the urethra anterior to the scrotum. Onintroducing a catheter several tight stricturesclose to the meatus were found, on passing theinstrument through which it was againarrested by a stricture in the membranous

portion of the canal. Mr. Storks desistedon that occasion from any further attemptsto pass the catheter into the bladder, anddeclined interfering with the tumour till theurethra should be in a more healthy condi-tion. On the 16th, No. 3 was readily intro-duced into the bladder. Mr. S. again visitedthe patient on the 24th, at the request of Mr.Whidborne, and found him with the pulse120 ; skin hot and dry ; tongue coated witha brown fur ; a chamber utensil contained aquart of urine which had been passed in a tole-rably sized stream since the morning. Onexamining the perineum a small undefinedtumour was found just behind the scrotum,which was much swollen and oedematous.On inquiry it appeared that some fever andgeneral indisposition had shown itself on the18th, but it was not till the 21st that anytumour was detected in the perineum, andthe scrotum remained of its natural size upto the previous day (the 23rd). Mr. Storkslooking upon the case as one of partial in-filtration of urine, with the concurrence ofMr. Partridge, of King’s College, made anincision in the mesial line of the perineum,from just behind the scrotum to the verge ofthe anus; this gave exit to a quantity ofurine mixed with some fetid pus ; and on theoperator introducing his finger into thewound he discovered a large cavity runningbackwards to the left buttock, to lay openwhich it was necessary to prolong the inci-sion to one side of the perineum, making itterminate, as in the operation of lithotomy,at a point midway between the anus and lefttuberosity of the ischiurn. The case ulti-mately did very well after the separation ofsome sloughs of cellular tissue. Mr. Storksremarked that he considered the above caseas one possessed of much interest, and de-serving the attention of the society. Infil-tratiun usually took place after complete ob-struction to the passage of the urine, when,from the long-continued pressure upon thatportion of the urethra immediately behindthe stricture, ulceration was induced, andthe contents of the bladder were effused intothe cellular membrane. The instance justreferred to, was, however, of a very differentcharacter, there being no total, and, indeed,a very partial obstruction to the passage ofthe urine. He considered it one of a classof cases well delineated by Mr. Abernethyin his" Surgical Observations" as examplesof the urethra having given way, irritationproducing ulceration. Mr. S. did not recol-lect the particulars of the four or five casesreferred to by Mr. A., but in all of them hewell remembered there was little or no ob-

struction to the passage of the urine. Inthe first case detailed by that authority thepatient had been attended by a physician fortyphoid fever ; no allusion had been made toany morbid condition in these parts, and itwas not till an attempt was made to intro-duce a clyster-pipe that any tumour was de-tected in the perineum. Mr. Abernethy hadmade some most valuable remarks to assistthe surgeon in his diagnosis as to what por-tion of the urethra had given way, as well assome general observations on abscesses ofthe perineum, well worthy of perusal.

Mr. CHANCE had met with a somewhatsimilar case to that of Mr. Storks, occurringin a gentleman who, for two years, had beensubjected to some obstruction in the urethra,but on no occasion ever amonnting to posi-tive retention. On one occasion, however,retention did occur, and then a catheter,No. 4, was passed easily into the bladderafter encountering two strictures, one anteriorand one posterior to the ligament. A tumourformed in the perineum, which the surgeonin attendance punctured, and found to con-tain urine. The tumour was subsequentlylaid open, and the patient is now doing well.The opening still exists, but it is much smallerthan it was originally.Mr. RUTHERFORD ALCOCK remarked that

cases similar to that related by Mr. Storkswere often exceedingly embarrassing to thesurgeon ; in all probability the ulceration inthis case was the result of simple irritationin the urethra. He had seen cases in whichirritation in the urethra had produced ulcera-tion, though acting in a different mannerfrom that observed in Mr. Storks’ case. An

elderly gentleman had been subject to stric-ture for a great number of years, but had de-layed resorting to instrumental treatment forits relief, in consequence of every attempt topass a catheter or bougie being immediatelyfollowed by an attack of ague. This wasdependent on the circumstance of his havingserved at Walcberen and suffered from thefever which was so prevalent among the

troops sent on that expedition. On oneoccasion, however, the retention of urinewas so nearly complete that only a few dropspassed ; there was great irritation of theneck of the bladder; the bladder itself wasdiseased, and his life was in jeopardy.Under these circumstances a small bougiewas passed into the bladder with the hope ofgradually increasing the size of the instru-ment, so that the urethra might be sufficientlydilated, but on every successive effort to doso such violent spasm ensued, followed afterthe second or third attempt by a violentattack of fever, that it was deemed advis-able to desist. A fatal result was antici-

pated. The patient was sixty years of age.Sir B. Brodie was now consulted. Thebladder-symptoms continuing, a small cathe.ter was introduced, and, to the surprise ofSir Benjamin and himself, passed into the

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bladder. It was now found, on inquiry, thaton that morning the patient had suddenlypassed a large quantity of pus. The obvious

inference, therefore, was that suppurationhad taken place in the urethra and hadcleared away the strictured part in its mem-branous portion. The -stricture, being lessorganised than the surrounding structure,more readily yielded to the suppuratingprocess. The catheter afterwards passedquite freely. It was clear, from this andother cases of a somewhat similar kind thatwhen there was considerable irritation in theurethra or about the neck of the bladdernature attempted to relieve herself, and suc-ceeded. There was, however, a point, in Jreference to this class of cases, which it wasadvisable to bear in mind, and that was thedangerous and even fatal results which mightfollow retention of urine. He recollectedthe case of a young man in the WestminsterHospilal many years since, who was admittedfor stricture of the urethra and retention ofurine for twenty-four hours. Some slightrelief had been experienced by the dribblingaway of a few drops of urine, and the blad-der did not feel to be much distended;suddenly, however, and whilst in a warm

bath, he was seized with convulsions anddied. There was no rupture of the bladder,and no appearances whatever to indicate thecause of death. He appeared to have sunkfrom irritation of the nervous system. Weshould, therefore, in persons of a sanguinenervous temperament, not delay too long theemptying the bladder by artificial means.

Dr. REID inquired what was the largestquantity of water which any member hadfound to be retained in the male bladder ?The largest quantity he had seen in femaleshad been in cases of retroversion of theuterus.Mr. CHANCE bad, in a case of gonorrhoea

in which it was necessary to use the cathe-ter, removed a pint more water than wouldfill an ordinary chamber utensil.

Dr. GRIFFITH remarked that in all casesof unrelieved retention of urine the cerebralsymptoms producing death arose from thesame causes as those of idiopathic suppres-sion of urine, viz., the presence of urea inthe blood.Mr. CHOwNE related a case of rupture of

the bladder from external violences in whichat the expiration of five or six hours, thecatheter was introduced, and a pint and ahalf of water drawn off. The next day therewas slight oozing when the catheter wasemployed. The man died, and the bladderwas found ruptured at its superior part. Itwould appear that at first there was no

escape of urine into the peritoneal cavity.The ruptured portion gaped, and no signs ofadhesion were present.

Mr. ALCOCK had seen a case of gun-shotwound in which the ball passed through theunder surface of the bladder. No urine

escaped. The man died on the third day.He could understand that in a case like thisthe swelling and tumefaction might close upthe wound and stop the egress of any fluiduntil inflammation and its consequent adhe-sion came on.

After a few words from Dr. Chowne, Mr.Chinnock, and other members, the societyadjourned.

UNIVERSITY OF LONDON.

EXAMINATIONS for the degree of Bachelorof Medicine took place on Monday, Tuesday,and Wednesday last. The second examina-tion in FORENSIC MEDICINE, Professor Daniell,Dr. Pereira, and Dr. Rigby, examiners,comprised the following questions :-What are the characters by which yon

would distinguish spots of blood upon ironfrom common rust, and what is the principalambiguity to be guarded against?-Underwhat circumstances may lead be acted uponby water, and how would you detect its pre-sence ?What are the symptoms and chemical evis

dence of poisoning by nux vomica ?-Thedeath of an infant is suspected to have beencaused by an overdose of laudanum admi-nistered medicinally. You are required tostate the smallest dose of this liquid whichin your opinion might produce death ; to de-scribe the symptoms which would arise ;and, lastly, to state how you would proceedchemically to detect opium in the untakenportion of the medicine.Three women are brought before you, in

whose cases you are required to give youropinion as to the presence or absence of preg-nancy, on the following data :-

1. A single woman denies that sexual in-tercourse has ever taken place. The last

appearance of the menses was on the 1st oflast September, and then very sparing ; theareola is dark (she is a brunette, and is sub-ject to irregular menstruation with muchpain) ; there is no perceptible abdominalenlargement ; the os uteri is easily reached ;it is round and seems closed, and its lipstumid and soft; the cervix is also soft, and ofthe full size and length.

2. The mother of three children (mar-ried). She states that her husband, a

sailor, left home on the 8th of last May ;the last appearance of the menses was

on the 22nd of May. There is a decidedenlargement of the abdomen, the tumourreaching nearly up to the umbilicus. Shedenies that she has felt any movements likethose of a child, nor have you satisfactorilydetected any with your own hand. The osuteri is high up in the hollow of the sacrum;it is soft, round, and does not admit the tipof the finger; the cervix is shortened, theuterus above it feels enlarged, and a move-able tumour within it is indistinctly felt.