The operation gave entire relief at once; he ate and slept well, and indeed suffered no farther inconvenience, except a slight discharge from the ear. The wound healed kindly by granulation, and he left the hospital July 20th. The prompt relief afforded in this case was owing no doubt to the removal of the tension caused by the swelling of the membrane which lines the unyielding bony walls of the tympanum and mastoid cells. Epithelial Cancer of the Glans Penis. DR. HUTCHISON also presented a specimen of Epithelial Cancer of the Glans Penis with the following history: Charles Dozle, Ireland, age 60, presented himself for treatment in October, 1864, complaining of pain about the glans penis, scrotum and perineum. He had congenital phymosis, but an enlargment could be felt through the foreskin on the under part of the glans penis which was sensitive to the touch. His general health had suffered somewhat on account of the pain which was so severe at night as to prevent sleep. I advised slitting up the prepuce for the purpose of examining the tumor more satisfactorily. He would not consent to the operation and subsequently consulted DR. MOTT and one or two other eminent surgeons without being benefitted. He applied to me again early in March and consented to have any treatment adopted that I deemed proper. I exposed the glans by dividing the prepuce and found an elevated graunlar surface on the left side of the glans, which presented the appearance of epithelial cancer, bleeding readily when touched. I advised removal of the organ, which was done with a scalpel, a short distance behind the glans. Four arteries were tied and the mucus membrane of the urethra was divided by the knife into four equal parts which were tacked to the edges of the cutaneous portion of the wound. The object of this procedure was to prevent contraction of the orifice of the canal which is so liable to follow the ordinary operation.. On the following day he said that he had slept better the previous night than for a number of months. With the exception of retention of urine after the third day, which necessitated the introduction of a catheter into the bladder several times, no untoward symptom followed the operation, and he now feels quite well. The diseased portion has lost its color and is also diminished in size by the alcohol in which it has been preserved. The specimen was examined under the microscope by DR. SPIER, and was found to be epithelioma. REGULAR MEETING, MAY, 1865. Report of a Case of Hydrophobia. BY R. C. STILES, M. D. John McE., aged 23, a native of Baltimore, a currier by trade, well built, and of temperate habits, was brought to the hospital about noon on Friday, May 5th. From his own statement and that of his friends, the following history was obtained :— He had been bitten by a dog on the Monday morning previous. The dog was morose, disposed to be let alone and snapped at those who disturbed him, but was not supposed to be mad. He was killed four days afterwards. The patient was bitten on the back of the hand; the wound was very slight. On Monday night he felt slight pain in the hand but slept well. The following morning the pain had extended to his arm and shoulder and he could not drink his tea-attempted to take it through a tobacco pipe, but could not swallow it. He ate however a crust of bread; but neither ate nor drank again till he entered the hospital. On Wednesday night he had pain in his chest with difficulty of breathing, was raving and furious so that it took several persons to keep him in bed. He was seen by a physician on Wednesday evening who pronounced the case one of hydrophobia. A physician from New York saw him on Thursday afternoon, and pronounced the case one of hydrophobia; ordered an injection. Symptoms while in the hospital.-The pulse on admission was 160 per minute, became more frequent and after four hours was imperceptible.. The blood examined under the microscope presented an increased proportion of white corpuscles, about one of the white to twenty of the red. The lungs on auscultation were found sound, but almost every inspiration was interrupted by a spasmodic closure of the glottis producing a sobbing respiration which continued till death. The skin was covered with a cold sweat. The temperature in the axilla an hour after admission was 92 Fahr. The heat of the body rose with the application of warmth to the lower extremities, which were quite cold at first. The tongue was furred; he was constantly spitting a clear liquid; on taking some toast soaked in wine and sugar he vomited and continued to vomit whatever he took till an hour before death. He used a gutta percha tube to draw some tea into his throat to quench his thirst, but he vomited it continually. He stated that he had passed his urine and fœces involuntarily since Tuesday. There was a slight involuntary discharge of urine while he was in the hospital. The most interesting phenomena, however, were those presented by the nervous system. Sensation was affected in the right arm, (the one bitten,) which felt numb, and did not recognize painful impressions as readily as the other. There was no tenderness on percussion or pressure over the spine; no tenderness over the abdomen except in the loins, which I attributed to the soreness from previous convulsions. The spinal senses were very acute long after the pulse ceased to be felt. The eyes were red and protruding. He said he felt them protrude. The sound of running water distressed him, and caused a shiver to pass through his frame. Draughts of air or the lighting of flies on the face produced a similar effect, but he complained that he could not breathe under a musquetoe-het. There were constant twitchings of the muscles of the face, these moving the alo nasi, and the lips in particular. His right hand was paralyzed; when he moved in bed he moved the right arm by the aid of the left. All his movements were sudden, even turning in bed. His intellect was clear, and he answered questions with remarkable precision till ten minutes before his death. He raved, however, for about an hour before death. He had the fearfulness of delirium tremens. When water was mentioned he repelled it with an intense expression of terror. He dreaded the approach of night for he said he then saw ugly sights. Long after the pulse had entirely failed he leaped from the bed and fell on the floor, excited by a light having been brought near him. Death at 11 P. M., in an attack of vomiting--Post-mortem 11 hours after death. Rigor mortis extreme, particularly of the bitten arm. External appearance.-Diffused purple discoloration of posterior surface of trunk and limbs; eyes staring; scar of bite almost imperceptible. Brain normal. Spinal cord and its meninges deeply congested-possibly from subsidence of the blood. Heart unusually rigid. Lungs-Liver and spleen normal. Kidneys somewhat congested. Bladder empty. Intestines deeply congested. Pharynx and upper portion of esophagus slightly congested. Stomach con tracted. Blood, fluid. This case was a type case of hydrophobia not to be confounded with delirium tremens, tetanus, or other nervous disorder; commencing within twenty-four hours after the bite of a rabid dog. Death occurred through failure of the heart's activity, and the symptoms pointed to the upper portion of the spinal cord as the seat of lesion of the central nervous system. No treatment whatever was employed except the applications of heat to the lower extremities. ART. II.-Two Cases of Vesico- Vaginal Fistula. BY S. BARRETT, Her history of Mrs. H. came under my care in February, 1864. her case was as follows: In November preceding her admission into my Infirmary she was confined of prima-para; it was a pelvic presentation: the labor was protracted and tedious. After the body of the child was expelled, the head was retained for eight or nine hours before her attending physician succeeded in delivering her. She made a tolerably good recovery. About two weeks after her confinement while sitting at the dinner table she felt a sudden gush of urine, and was unable to retain it after that. She was treated for paralysis of the bladder more or less of the time until she came under my care. On examination I found a fistulous opening about 2 inches from the orifice of the urethra of sufficient size to admit the end of the fore-finger. Regarding this operation as every other in surgery, the best, when the least complicated means are used, I proceeded to close the fistula after making effort to denude the edges of all hardened tissue, with five silver sutures, and twisted the ends over the wound, with the precise degree of tension to the sutures, subsequent experience has taught me, is the great desideratum to success in these cases. A siphon catheter was introduced in this case, which I now regard as unnecessary, except in cases where the natural caliber of the urethra has been lessened or closed. Two of the sutures ulcerated out in about six days, leaving a fistula about one-fourth as large as at first. A second operation was performed in April following. One suture cut its way out in about the same time, leaving a small pin-hole through which the urine dribbled. The third operation I performed last March, closing it entirely. After the two last operations no catheter was introduced at all, and the patient was allowed to move about without restraint. Mrs. V. N., aged 44, of Dutchess county, came under my care the first of September last. She had been three times pregnant; the last time fourteen years since. At her last confinement craniotomy was performed; after which she was unable to retain her urine. Having been reduced so low at the time her case was regarded and treated as one of paralysis of the bladder up to the time of her admission here. An examination revealed a fistula commencing three inches posterior to the orifice of the urethra, and extending back to within one inch of the os-uteri, sufficient to admit the finger freely into the bladder. The surrounding tissues were very much thickened and hardened. The urethra was closed by the thickened tissues about one inch from its orifice, and would not admit a small sized probe. After considerable careful manipulation I succeeded in passing a small sized dilator, using a larger size daily; in about, a week it was sufficiently enlarged to admit a common sized catheter. I then proceeded to close the fistula as in the other case.. The sutures were inserted a half inch at least from the edge of the cut surface and down to the muscular fibres of the bladder. A catheter was introduced and retained four days, after which the urethra remained sufficiently pervious for the urine to pass, it was removed, and the woman allowed to sit up. The sutures were retained three weeks, during which time I applied daily a solut. of nit. argent gr. xx, aqua 3i to the sur |