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SAMARITAN FREE HOSPITAL.
inferior
quill suture was then found to have given way; union appeared complete. On the 8th of February she was much STRANGULATED FEMORAL HERNIA, WITH ACUTE PHTHISIS; better, but there was still a recto-vaginal fistula that admitted the forefinger just within the opening. Purgatives were given. HERNIOTOMY; RECOVERY FROM THE OPERATION; The patient left the hospital on the 25th, expressing that she DEATH FROM PHTHISIS. felt much comfort; but the fistula, although smaller, persisted. Readmitted April 30th. On consultation, it was deemed (Under the care of Mr. COULSON.) advisable to perform the same operation again. This was THE influence of tubercular disease of the lung over the proaccordingly done on May 3rd, the bowels having been first well gress of coincident traumatic affections has been much discussed. opened. The new perineum was slit open by a bistoury; but It is undoubtedly unfavourable. In the case we here briefly the internal sphincter was not cut, owing to the presence of a This time there was no sickness, and union was record, however, the patient, the subject of advanced phthisis, large artery. on the third day, when the sutures were removed. complete became suddenly affected with strangulated femoral hernia; The case progressed satisfactorily. On the 9th of May, howand, herniotomy being practised, her recovery from the effects ever, there was a passage of blood per vaginam, and a large of the operation advanced by equal steps with her rapid decay clot. This the patient believed to be catamenial, but it did from phthisis, and the complete curefrom hernia was apparently not recur thenext day. On examination, a large mass of fa;cal matter was found impacted in the rectum. An injection, with only prevented by her death from the lung disease. Jane B-, aged fifty-four, was admitted into the operation a long tube, Was given, and subsequently a large dose of castor ward of St. Mary’s Hospital, June 23rd, 1858, having been oil. The mass had, however, to be broken by a spoon before transferred from the care of Dr. Chambers, who was treating it came away ; when it did so, a small portion came out per her for phthisis. She was the subject of strangulated femoral vaginam, with some hæmorrhage. On the 13th, an examinathat a fistula had again formed, such as would tion hernia ; and there was constant sickness. Herniotomy was per- admitproved the little finger. Iaa sitac it appeared transverse, the formed bv Mr. Coulson in the usual manner. The fasciæ were mucous membrane so loose, however, about it, that, with one to be adherent to the and the intestine found was sac, firmly of a livid colour. The stricture was divided, and the bowel re- finger in the vagina and the other in the rectum, the opening turned. The wound healed favourably after the operation. could be readily closed by gentle traction from behindforwards. The phthisical The patient was put on tonics; and, the bowels having been well She was troubled with persistent sickness. it was decided to endeavour to unite the fistula by a symptoms became rapidly more serious ; there was profuse ex- opened, Third Operation, on May 24th. An ana,l speculum being was well with and much She sweating. supported pectoration a of vaginal mucous membrane tonics, and the bowels were opened under the influence of in- passed per rectum, it. quantity This was cut, and the speculum rethrough protruded and of She jections, subsequently gentle purgative. grew moved. A silk ligature was then passed through the vaginogradually weaker, and died suddenly on the 19th July. At rectal septum, and this was pulled down and the edges pared. the post-mortem examination the right lung was fOllnd to be riddled with abscesses, of which one of the largest burrowed The upper border and internal surface of the artificial anus was into the liver. The wound following the operation had com- in like manner pared. Three buck-shot were now attached each to a silver wire, which were passed through, first, the pletelv healed internally; superficially union was not yet fully recto-vaginal septum, and, secondly, through the upper portion established. of the artificial anus, and there secured by a clamp and six ST. MARY’S HOSPITAL.
,
SAMARITAN FREE HOSPITAL. PROLAPSUS OF
UTERUS;
RUPTURE INTO THE
RECTUM, WITH
DESTRUCTION OF THE EXTERNAL SPHINCTER.
(Under the
care
of Dr.
ROUTH.)
other shot. On the 29th, union was complete. Two of the shot had made their way outwards; the last was still firm, and this was removed. The patient gradually improved in health, and left the hospital on June 5th, cured. As far as the finger enabled one to judge, there was no opening, and water injected per vaginam did not pass into the rectum, and vice veaeic.
following instance was an example of severe rectovaginal fistula, associated with prolapsus uteri, which was submitted to three different operations before a cure of this inconvenient and painful deformity could be accomplished. This was, however, attained, and the patient left the hospital much improved in general health and strength. S. F-, aged thirty-six; married nine years, and had had The Ophthalmoscope. By JABEZ HOGG, Assistant-Surgeon to the Royal Westminster Ophthalmic Hospital. London: -three children, the last three years ago. She was then in i Churchill. labour forty hours; instruments were used, and the child was born alive. She kept her bed only seven or eight days. A THE substance of this brochure has already appeared in our month after, when lifting a heavy weight, she felt something pages, and in a more condensed form had previously been give way, and the womb came down. She lost some blood, brought before the Medical Society of London. The author’s but reduced it herself. It comes down now after much walkapology for a reprint ’4 is, shortly, that he believes the instruing. Examination.---Womb completely prolapsed with vagina; ment destined to open out a new era in ophthalmic medicine; and by the publication of this pamphlet he hopes to assist in os large, congested, and ulcerated. When the parts are reduced, the rectum and posterior part of vagina are found to commu- diffusing amongst the profession a knowledge of its practinicate by a large, triangular-shaped opening, about an inch and usefulness in the diagnosis and treatment of some and a quarter in length by as much in breadth at the inferior cability obscure forms of eye-disease.’’ part. The external sphincter was completely cut across; the A short account of the appearances presented by the healthy at the several so as to admit in was intact internal, fibres, apex, of her retaining her motions. Ordered to be well purged, prior eye, when viewed by the aid of the ophthalmoscope, precedes to the that of the morbid alterations which this instrument is capable First Operation.-The vaginal mucous membrane was deof detecting in the organ. Such introductory notice is of value; nuded on each side, together with about a quarter of an inch and it may be remembered that the plan is carried out in of external skin, extending upwards to about half an inch from in Mr. Dixon’s work ’’ On the Eye;" so true is it of a extenso of the within its and the upper portion vagina, posteriorly cavity to about one inch above the apex of the fistula. The part as of the whole-" Pour savoir l’homme malade il faut wound was brought together by two deep quill sutures, and savoir l’homme sain." Mr. Hogg observes: several small superficial interrupted sutures, excepting quite " The optic nerve is seen faintly tinged with pink, and from inferiorly opposite the anal commissure, this opening being left to form an artificial anus. A good deal of blood was lost. its centre-the papilla optica-emerge the artery and vein of She was then put to bed, and kept under theinfluence of the retina; the arrangement generally being, an artery and vein passing upwards, and a similar pair downwards; both opium. The patient was very sick for the two following days, and, vessels then divideinto many branches, and run on towards the spite of the remedies employed, this did not yield till the third periphery of the retina." This concise and accurate account presents a strong contrast day. On Feb. 1st the sutures were removed; the third or THE
Reviews and Notices of Books.
202
quill suture was then found to have given way; union appeared complete. On the 8th of February she was much STRANGULATED FEMORAL HERNIA, WITH ACUTE PHTHISIS; better, but there was still a recto-vaginal fistula that admitted the forefinger just within the opening. Purgatives were given. HERNIOTOMY; RECOVERY FROM THE OPERATION; The patient left the hospital on the 25th, expressing that she DEATH FROM PHTHISIS. felt much comfort; but the fistula, although smaller, persisted. Readmitted April 30th. On consultation, it was deemed (Under the care of Mr. COULSON.) advisable to perform the same operation again. This was THE influence of tubercular disease of the lung over the proaccordingly done on May 3rd, the bowels having been first well gress of coincident traumatic affections has been much discussed. opened. The new perineum was slit open by a bistoury; but It is undoubtedly unfavourable. In the case we here briefly the internal sphincter was not cut, owing to the presence of a This time there was no sickness, and union was record, however, the patient, the subject of advanced phthisis, large artery. on the third day, when the sutures were removed. complete became suddenly affected with strangulated femoral hernia; The case progressed satisfactorily. On the 9th of May, howand, herniotomy being practised, her recovery from the effects ever, there was a passage of blood per vaginam, and a large of the operation advanced by equal steps with her rapid decay clot. This the patient believed to be catamenial, but it did from phthisis, and the complete curefrom hernia was apparently not recur thenext day. On examination, a large mass of fa;cal matter was found impacted in the rectum. An injection, with only prevented by her death from the lung disease. Jane B-, aged fifty-four, was admitted into the operation a long tube, Was given, and subsequently a large dose of castor ward of St. Mary’s Hospital, June 23rd, 1858, having been oil. The mass had, however, to be broken by a spoon before transferred from the care of Dr. Chambers, who was treating it came away ; when it did so, a small portion came out per her for phthisis. She was the subject of strangulated femoral vaginam, with some hæmorrhage. On the 13th, an examinathat a fistula had again formed, such as would tion hernia ; and there was constant sickness. Herniotomy was per- admitproved the little finger. Iaa sitac it appeared transverse, the formed bv Mr. Coulson in the usual manner. The fasciæ were mucous membrane so loose, however, about it, that, with one to be adherent to the and the intestine found was sac, firmly of a livid colour. The stricture was divided, and the bowel re- finger in the vagina and the other in the rectum, the opening turned. The wound healed favourably after the operation. could be readily closed by gentle traction from behindforwards. The phthisical The patient was put on tonics; and, the bowels having been well She was troubled with persistent sickness. it was decided to endeavour to unite the fistula by a symptoms became rapidly more serious ; there was profuse ex- opened, Third Operation, on May 24th. An ana,l speculum being was well with and much She sweating. supported pectoration a of vaginal mucous membrane tonics, and the bowels were opened under the influence of in- passed per rectum, it. quantity This was cut, and the speculum rethrough protruded and of She jections, subsequently gentle purgative. grew moved. A silk ligature was then passed through the vaginogradually weaker, and died suddenly on the 19th July. At rectal septum, and this was pulled down and the edges pared. the post-mortem examination the right lung was fOllnd to be riddled with abscesses, of which one of the largest burrowed The upper border and internal surface of the artificial anus was into the liver. The wound following the operation had com- in like manner pared. Three buck-shot were now attached each to a silver wire, which were passed through, first, the pletelv healed internally; superficially union was not yet fully recto-vaginal septum, and, secondly, through the upper portion established. of the artificial anus, and there secured by a clamp and six ST. MARY’S HOSPITAL.
,
SAMARITAN FREE HOSPITAL. PROLAPSUS OF
UTERUS;
RUPTURE INTO THE
RECTUM, WITH
DESTRUCTION OF THE EXTERNAL SPHINCTER.
(Under the
care
of Dr.
ROUTH.)
other shot. On the 29th, union was complete. Two of the shot had made their way outwards; the last was still firm, and this was removed. The patient gradually improved in health, and left the hospital on June 5th, cured. As far as the finger enabled one to judge, there was no opening, and water injected per vaginam did not pass into the rectum, and vice veaeic.
following instance was an example of severe rectovaginal fistula, associated with prolapsus uteri, which was submitted to three different operations before a cure of this inconvenient and painful deformity could be accomplished. This was, however, attained, and the patient left the hospital much improved in general health and strength. S. F-, aged thirty-six; married nine years, and had had The Ophthalmoscope. By JABEZ HOGG, Assistant-Surgeon to the Royal Westminster Ophthalmic Hospital. London: -three children, the last three years ago. She was then in i Churchill. labour forty hours; instruments were used, and the child was born alive. She kept her bed only seven or eight days. A THE substance of this brochure has already appeared in our month after, when lifting a heavy weight, she felt something pages, and in a more condensed form had previously been give way, and the womb came down. She lost some blood, brought before the Medical Society of London. The author’s but reduced it herself. It comes down now after much walkapology for a reprint ’4 is, shortly, that he believes the instruing. Examination.---Womb completely prolapsed with vagina; ment destined to open out a new era in ophthalmic medicine; and by the publication of this pamphlet he hopes to assist in os large, congested, and ulcerated. When the parts are reduced, the rectum and posterior part of vagina are found to commu- diffusing amongst the profession a knowledge of its practinicate by a large, triangular-shaped opening, about an inch and usefulness in the diagnosis and treatment of some and a quarter in length by as much in breadth at the inferior cability obscure forms of eye-disease.’’ part. The external sphincter was completely cut across; the A short account of the appearances presented by the healthy at the several so as to admit in was intact internal, fibres, apex, of her retaining her motions. Ordered to be well purged, prior eye, when viewed by the aid of the ophthalmoscope, precedes to the that of the morbid alterations which this instrument is capable First Operation.-The vaginal mucous membrane was deof detecting in the organ. Such introductory notice is of value; nuded on each side, together with about a quarter of an inch and it may be remembered that the plan is carried out in of external skin, extending upwards to about half an inch from in Mr. Dixon’s work ’’ On the Eye;" so true is it of a extenso of the within its and the upper portion vagina, posteriorly cavity to about one inch above the apex of the fistula. The part as of the whole-" Pour savoir l’homme malade il faut wound was brought together by two deep quill sutures, and savoir l’homme sain." Mr. Hogg observes: several small superficial interrupted sutures, excepting quite " The optic nerve is seen faintly tinged with pink, and from inferiorly opposite the anal commissure, this opening being left to form an artificial anus. A good deal of blood was lost. its centre-the papilla optica-emerge the artery and vein of She was then put to bed, and kept under theinfluence of the retina; the arrangement generally being, an artery and vein passing upwards, and a similar pair downwards; both opium. The patient was very sick for the two following days, and, vessels then divideinto many branches, and run on towards the spite of the remedies employed, this did not yield till the third periphery of the retina." This concise and accurate account presents a strong contrast day. On Feb. 1st the sutures were removed; the third or THE
Reviews and Notices of Books.
202