PRESTON AND COUNTY OF LANCASTER ROYAL INFIRMARY.

1042 delusion that she would ruin the place if detained or speak- state becoming critical, further medical advice was sought, With great difficulty a No. 8 silver catheter was introduced ing of suicide. By December 6th she was apparently so much improved and the bladder emptied, after which the haemorrhage ceased. that she was allowed to accompany a skating party According to the patient’s statement blood had been flowing to a neighbouring meadow which was flooded, when, continuously from the time of the accident to the introduction successfully evading those around, she threw herself into of the catheter. The instrument was retained in the bladder a hole in the ice, from which she was rescued with some for four days, and then withdrawn. The patient considered himself well until three months difficulty. On Jan. 12th delusions and suicidal intent meanwhile later, when retention occurred again. This was relieved, persisting, she complained of pain in the abdomen and but it was only the first of a series of attacks of a similar vomited a fluid with a red paint-like sediment, but denied nature. In October, 1879, not having passed water for having taken anything of an unusual nature. After this twenty hours, he was placed under chloroform, as it was she continued sick, vomiting green matter, and on Jan. 25th, found impossible to introduce any instrument without doing being then in considerable abdominal pain, chiefly on the so in consequence of severe rigors being instantly produced. left side, confessed that prior to the attempt to drown her- In December of the same year an attack of retention was self she had swallowed bonnet-pins and broken crochet and succeeded by a swelling in the perineum, which ultimately knitting-needles. The seat of pain was now transferred burst and allowed the bladder to empty itself through the from the left to the right side of the abdomen, and continued opening. A fistula remained. Great difficulty was soon felt until Feb. 21st, when she vomited a lady’s bonnet-pin, three in making water, as the stream became smaller and smaller, inches and a half in length, without the black head and until the patient was unable to void his urine except in drops, sharp at the point. The point of the pin stuck into the which passed both through the fistula and meatus. He ap. palate and had to be removed. Relief was immediate, but plied at the infirmary for relief, and instruments were passed the following day she again began to vomit, and a hard repeatedly until a No. 8 was got through, when the patient, spot was observed to the right of the umbilicus. A considering he was cured, absented himself until his old day later the motions were found to be tinged with blood, trouble compelled him to come again. On his subsequent and there were restlessness, passing into delirium, and admission, repeated and prolonged attempts were made tympanites. On Feb. 29th, being a little more than a under chloroform to penetrate the stricture, but without week from the appearance of the first pin, she passed success, and Dr. Marshall resolved to perform perineal another by the bowels of a similar kind, with the head section. Chloroform having been administered, and the patient intact, and a few days afterwards two portions of knittingneedles, of a larger size than the others but of the same being placed in the ordinary lithotomy p sition, with the length. pelvis well elevated, Mr. Wheelhouse’s ; taff was passed Some time elapsed during which she showed no mental down to the stricture. A careful dissection was then made improvement, and was more or less constipated and tym- in the middle line, through extremely hard, almost cartila. panitic. ginous tissue, down to the groove in the staff. A good deal On April 22nd she passed with some pain and blood of bleeding ensued during this part of the operation, and two another portion of a knitting-needle, and next day still ’, small arteries were tied. The urethra was opened and each another. This was the sixth and proved to be the last. It ’i side of it held by catch forceps. The staff was then turned was at the same time noted that tenderness had disappeared round and the urethra hooked up by the button at its and that she both ate and slept well. Her mental condition extremity. After a somewhat tedious search the minute A fine probe-pointed was most variable; at one time she talked sensibly, and orifice in the stricture was discovered. Sub- and grooved director with difficulty passed through, and the then she would laugh and express a wish to die, &c. sequently an improvement was observable, and on Sept. stricture was fairly and freely divided along its whole 23rd, 1880, being upwards of eleven months from the date of extent. No further difficulty was experienced. The gorget recommended by Mr. Wheelhouse was now brought into her admission, the patient was discharged recovered. The treatment of the local symptoms at first consisted in use, but this not proving satisfactory in its working Lund’s the administration from time to time of castor-oil, until the broad director was adopted. This being held in position, a confession of the patient established their true origin, when No. 9 silver catheter was entered at the meatus, guided special diet was ordered and an occasional enema given, the through the divided portion of the urethra, and along the tympanites, &c., being also, so far as possible, combated director fairly into the bladder. The instrument remained by the application of poultices or fomentations. Morphia in for four days, and was then withdrawn. A No. 9 gum was prescribed after admission for the mental condition, but elastic catheter was daily passed after this, and guided into the later chloral was the principal agent employed to allay rest- posterior opening in the urethra by the finger in the perineal lessness and procure sleep. wound, which was kept from healing up superficially. Remarks.-The case is of interest as showing the length October 7th : Wound in perineum healed. No. 10 passed of time that foreign bodies may be retained in the intestinal easily. The patient, who had formerly been thin and canal. The first of these made its appearance about eleven anaemic, is gaining flesh, has a good appetite, and is feeling weeks and the last nineteen or twenty from the date given much better. -21st : The patient gets out of bed daily. Can by the patient as that on which they were swallowed. And pass instrument himself. November 2nd : Left the hospital quite well with instruc bearing in mind their dangerous nature, it is still more tions to pass instrument periodically. noteworthy for the satisfactory result. Perineal section must generally be a difficult operation in cases really requiring it, but Wheelhouse’s directions seem to be a great improvement on the old way of doing it, and PRESTON AND COUNTY OF LANCASTER his operation certainly deserves to be generally known.

painful

ROYAL INFIRMARY.

TRAUMATIC STRICTURE OF THE URETHRA ; PERINEAL SECTION BY WHEELHOUSE’S PLAN ; CURE.

BELFAST ROYAL HOSPITAL.—A

proposal to

close

a

portion of this institution has recently been suggested, in consequence of the financial condition of the hospital; but before taking this decided step it has been thought advisable that the Mayor of Belfast should be requested to convene a meeting, in order that the opinion of tbe citizens might be declared as to the best means of placing its affairs on a surer basis as to annual income. It is hoped that some means may be devised which will secure a permanent income to the charity.

(Under the care of Dr. MARSHALL.) following notes we are indebted to Mr. Robert Forrester, M.B., senior house-surgeon. G. M-, painter, aged twenty, was admitted at the beginning of last October. Three years before, whilst rearing a ladder against a scaffolding, he fell a height of one foot upon his perineum against the upper part of a door, his legs being separated at the time. He felt sick, but resumed his work. MR. J. NATHANIEL BARLOW, M.R.C.S., of Writtle, About a quarter of an hour afterwards, on passing water he also voided a considerable quantity of blood. After reaching i Essex, died last week from an overdose of hydrocyanic acid, taken to alleviate intense pain arising from an internal home he had retention of urine. A medical man was called i malady. At an inquest held on the unfortunate gentleman in, but attempts to pass a catheter proved ineffectual. After the verdict returned was "Death from an overdose of prussic remaining in this condition for nearly thirty-six hours, and his acid taken inadvertently." FOR the