Hospital Reports

ON the 24th of May, 1851, I was requested to visit Sarah G., aged 26, unmarried, servant. History.-That she was confined (being primipara) in London without assistance; the child still-born. That, after the labour, sloughing took place, and she was compelled to seek advice at one of the metropolitan hospitals, in which she remained three months, and at the expiration of that period was dismissed as incurable. Since then she has continued to suffer from the constant involuntary escape of urine and feces, which passed through the vagina, and so distressing was her state on this, my first visit, that she was unable to move beyond her bed, or bed-chair, frbm the intense paia and uneasiness produced by the irritating and offensive discharges4 On examination I found the external genitals immensely swollen, excoriated, and smelling most disgustingly. On introducing a speculum, I discovered that fistulous communications existed between the rectum and vagina, and urethra and vagina. Treatment.-I carefully cauterised the margins of the fistulous apertures with nitrate of silver, and adapted a vulcanised India-rubber apparatus to collect the urine, and prevent excoriation, and at the same time filled the vagina with lint, smeared with an ointment composed of iodide of lead, glycerine, and cod-liver oil. Pills of the iodide of iron and hyoseyamus were nightly administered. The fistulEe gradually closed, and in three or four months she returned the apparatus, as she deemed herself nearly well. After the lapse of ten months she again applied to me, having walked a distance of three miles. She complained of excessive irritability of the bladder, severe pain during micturition, agonising suffering after the discharge of urine from the bearingdown of the rectum, uterus, and bladder. Suspecting that stone in the bladder existed, I immediately examined, and found the orifice of the urethra very patulous, and the mucous membrane everted and excoriated. On sounding I discovered a large calculus. Dr. J. Bunny, at my request, then visited her, and most kindly assisted me in the further treatment of the case. Hoping that I might be enabled to remove the calculus by dilatation of the urethra, I introduced compressed sponged tents, and continued the process by Weiss's dilator. The patient complained so bitterly of the pain, and there being comparatively but little progress made, owing to the contracted state of the passages from cicatrices, and the size of the stone, determined me to have recourse at once to crushing, ana for that purpose I employed Professor Ferguson's lithotrite. By giving a smart blow on the side of the pelvis with the open hand, in the manner recommended by Sir B. Brodie and Mr. Skey, the calculus was soon seized, and broken, and on washing out the bladder a quantity of mucus and detritus escaped. The operation was repeated several times, a greater period being occupied in the treatment owing to the reappearance of the catamenia, which had been suppressed since her confinement. By the previous dilatation she was enabled to void some large pieces, one of which weighed two drachms; this was attended by a considerable amount of hemorrhage. The fragments altogether removed and collected weigh seven drachms and a half, and the fine detritus, (much of which escaped,) was unfortunately permitted to pass uncollected. The calculus was composed of the phosphate of ammonia and magnesia. The bladder, both before and after each operation, was carefully injected with warm water, and an hour after she was placed in a warm bath, and sedatives given. On the 22nd of July I last visited her. The examination then instituted convinced me that the bladder was entirely free from calculus or detritus, and the cessation of all the unfavourable symptoms confirms me in this opinion, and gives me the satisfaction of pronouncing my patient as completely freed from her distressing ailments. Since the above date I have heard that she is still going on well, that she has been at work in the harvest field, and that she retains her urine perfectly. Speenhamland, Newbury, September 10, 1852.