As soon as the operation was completed, the patient was put to bed and slept soundly twelve or fourteen hours, passing from her agony into an elysium of rest, and from this moment her improvement continued without interruption.

On the 15th of June, about five months after the bladder was first opened, the general health was so far restored, that after a careful examination of the urethra and bladder, I determined to effect the closure by my button suture. Now the hypertrophied condition of the urethra had subsided, and the sound revealed no abnormal sensitiveness of the vesical cavity. The vesico-vaginal septum had diminished in thickness, from three-quarters of an inch to one-quarter, and was no longer either hard or sensitive. The uterus was less anteverted. The operation was finished in a few minutes, and a catheter introduced into the bladder as usual. Everything progressed very well until the fourth day, excepting that there was a little more mucus in the urine than usual; but at this stage, she complained of an uneasy feeling in the urethra, which was soon followed by vesical tenesmus and straining, forcing out the catheter. Morphine was then given, but still the exacerbation continued, and on the 7th day, when I removed my suture apparatus, the edges of the opening which had not united at all, looked unhealthy.

Now, as soon as the aperture was thus re-established, the symptoms all abated, and after a few days the patient was as well as ever.

She was discharged July 19, with instructions to return home and remain there in the country until her general health was fully restored. This was done,

and on February 22d, 1862, she returned for further treatment, with a happy face and looking quite robust. She declared she had not suffered the least pain or inconvenience from her bladder since she had left the infirmary seven months before. Examination now showed the most satisfactory condition of the urethra and bladder. A few days after admission, I proceeded to close the remaining fistule in presence of my friend, Prof. Samuel Choppin, of New Orleans, and several other medical gentlemen. Now, as far as I could determine by a look into the bladder, the mucous membrane was restored and of healthy appearance, nothing unusual in the thickness of the septum. Five interrupted sutures, secured by my button, sufficed to close the opening. Not an untoward symptom followed, and the patient left her bed the week after, with perfect control over her urine. She was discharged April 24th, cured.

Nearly nine years after this, I addressed, last December, a letter of enquiry to Dr. M. G. Davis, formerly of Gerrenton, and now of Greenwood, Miss., who had previously charge of the case, and received, Jan. 18th, this reply:

"The woman, Eliza, I have had no interview with for several months, but previous to my leaving Gerrenton, I saw her frequently, and talked with her regarding her disease and the operation you performed. She is entirely cured, and can do as heavy a day's work of washing, ironing, or cooking as any woman. She has perfectly recovered the voluntary power over her bladder, and a full collection of urine can take place before there is any urgent call to discharge it." With regard to the reparation of the mucous mem

brane, it must suffice here to declare that it is reproduced endowed with all its original functions, and having endured for nine years, as in this case, it is hardly doubtful that it will continue on to the natural end of life.

REMARKS.

Unusual interest attaches to the above case because of the clear diagnostic and complete cure of a disease, ulceration of the bladder, which pathologists have regarded as very rare occurrence in either sex.

Louis found it but once in five hundred autopsies. Prof. Gross has met with it a few times, but of limited extent in the male bladder. In one case referred to as illustrative, the ulceration was "an inch in length by half an inch in width."

Dr. Budd, of London, and Mr. Coulson, as Dr. Gross states, have met with extensive ulcerations, such as I have described, in the female. In one case, "fifty-seven years of age," cited by the former, "the bladder was entirely denuded of mucous membrane, except a spot as large as a shilling on the posterior surface of the viscus, just behind the urethra, and at another, immediately round the orifice of the right ureter." There "the disease proved fatal at the end of the ninth month from the first appearance of vesical symptoms." Mr. Coulson's first case was "a French woman, who immediately after her delivery was at tacked with all the symptoms of ulceration of this organ, and died within a week after." Here "the whole of the inner membrane of the bladder was found completely destroyed." In a second case observed by him, the disease commenced "a month after

marriage," and "terminated a month after delivery," though the extent of the ulceration is not stated. It was remarked that "during the latter half of her pregnancy, her symptoms were much milder than before, but soon after the child was born, they returned with their accustomed severity and destroyed the person."

The history of Dr. Budd's case and mine appear to coincide, but both Mr. Coulson's cases, as I infer from the details of their termination, were instances of gangrene of the mucous coat, resulting from mechanical violence and paralysis. With regard to the mode of diagnosis, and the relief procured by it, my case stands alone. I am not aware at least that surgery records another instance of an ulcerated bladder being opened, illuminated, and inspected before death, and it is probable therefore that no such lesion of equal extent has been cured before or since. To Prof. Willard Parker is due the suggestion of opening the male bladder for relief of catarrh, and this encouraged me to extend the prac tice to the female bladder, as I have described. Dr. Emmet and other American surgeons have since adopted the practice in cases of vesical catarrh in the female, and I doubt not with equal success. Prof. Eve of Nashville, Tenn., reported to Dr. Parker in January, 1866,† the result of the operation in a young man aged 24, laboring under all the symptoms of stone, though none was found. The history of this case does not prove that catarrh of the bladder existed at the time of the operation, but the operation was urgently necessitated, and produced an excellent re

*

* Vesico-Vagina Fistula, 1868.

Trans, N. Y. State Med, So., 1867.

sult, which serves to illustrate the value of the surgi cal resource in question, and its further application in practice.

Delay in the report of my case of ulceration was due to the suspension of all the medical journals in the South during the war, and now this report ac quires a greater interest by my ability to state the actual condition of the patient, after a lapse of nine years since her cure by operation.

CASES OF TRIPLETS.

BY J. M. TONER, M. D., Washington, D. C.

IN the Washington Evening Star of January 23d, 1870, I read the following notice:

TRIPLETS.-Mrs. Felix Malone, residing on Eighth Street East, near East Capitol Street, yesterday gave birth to triplets, one boy and two girls; and Mrs. Gray, the nurse, when asked, "Do you think they'll live?" replied, "Yes, indeed! why not? they're bouncers.'

The morning of January 25th, being in the vicinity of the residence of the person here alluded to, I called to make some enquiries relative to the facts in the case. I saw Mrs. M., who is a native of Ireland, thirtyfive years of age, nine years married, has had two miscarriages, and three full term pregnancies, the last two triplets. She has always been attended by midwife, with whom I conversed. The triplets were