A CASE of this kinid, presenting some peculiar features, recently occurred in ily practice. On Auigust 4th, I was requested to see Mrs. F., in conjunction with her me(lical adviser, Air. Foster. I found her extremely weak and emaciated; pulse 140. fler lips were much excoriated; urine was dribbling awvay, mixed with foetid pus. On introducing my finger intio the vagina, it came into contact with its posterior wall, in the shape of a firm globular body resting against the neck of the bladder. The os uteri was high above the symphysis pubis. Examination by rectum showed that a large fluctuating tumour occupied the pelvic cavity, completely blocking up the anus. The nature of the case was thus confirmed beyond the possibility of doubt. From her medical adviser I learned that he had been summoned on May 3rd, and found her suffering from severe abdominal pain and difficulty of passing urine. At that time, she had been pregnant abotit seven weeks. He was again summoned on June 3rd, and found her completely prostrate and in great agony. He drew from the meatus urinarius a large quantity of soft membranous substance, which was followed by a loud splash of foul ammoniacal urine. August 5th. The patient was put under chloroform and the bladder emptied. I could pass my two hands deep into the pelvis, and could compress the abdominal aorta at its bifurcation. A firm tumour could be felt low in the right inguinal region, over which a loud brwit could be heard, caused, no doubt, by the pressure of the tumour on the iliac artery. The patient being in the obstetric position, the anus was found dilated to an inich and a quarter in diameter by the fundus and its contents, and the posterior wall of the vagina protruded externally. My right hand, warmed and oiled, was introduced into the vagina, and two fingers of the left into the rectum. A careful and determined attempt was made to replace the uterus, but failed. An anxious question now presented itself as to the course to be pursued. Having carefully weighed the whole bearings of the case-(a) the probability of adhesions from the repeated attacks of peritoneal inflammation ; (b) the ulcerated state of the bladder, the patient passing foul ammoniacal urine containing large quantities of pus and sometimes blood ; (c) the inflamed state of the vaginal parts; and considering, above all, the exhausted condition of the patient-I decided to draw off the liquor amnii through the rectum by the aspirator. The parts were well sponged, and a fine needle (never before usedl) wvas thrust home to the fluid, nearly two pints being quickly drawn off. The head of the fcetus could now be felt through the rectum. An opiate was administered at bed-time. August 6th, II A.Al. Pulse, II2 ; temperature, 99. There was no abdominal pain, tenderness, or sickness. The opiate was repeated. At 9 P. M., uterine action set in. The pains steadily increased until 8 A.MI., wlhen she was delivered (feet-presentation). August 7th, II A. M. IPulse, 140; temperature, Ioo. There was no pain or abdominal tend(lerniess. The opiate was repeated. August 8th. Pulse, I 20; temperature, 98. The opiate was repeated. August gth. PIulse, I i6; temperature, 96. She had a good night, an(i expressed herself as feelinig much stronger. August 12th. Pulse, 120; temperature, I00. The urine was highly alkaline, containing a large qtuantity of foetid pus. I ordered mineral aci(ls. August i8th.-Her meidical attendant reporte(d that she steadily improved. Pulse, Joo. For a fortnight, she wvas kept entirely on slop(liet, consisting of strong beef-tea, milk, and fariniaceotis food. Auugust 29th. The patienit was now able to go about in lher usual way, and proposed to go into the country. It will be seen from the above statemeint that not one unfavourable symptom follow,ved the operation, the state of the pulse and temperature being such as might be expected from the exhausted condition of the patient and the diseased state of the bladder. As I believe this to be the first case that has been treated in a similar manner by means of the aspirator, and as the result of the operatioin has proved to be so safe and successful, I have been induced to state it fully anid accurately, in the hope that the merits of this mode of treatment might be compared witlh the recognised treatment in similar cases. Dr. Philipson, of the Newvcastle-upon-Tyne Infirmary, to whom I submittedI the fcetus, was kinid enough to examine it, an(I reported to me that, from its characteristics, it seemed to be of the age of about five months of uttero-gestation ; that the forehead, instead of being arched, was flattened, anid the whole craniuLm antero-posteriorly compressed. The body and limbs also, especially the upper extremities, were very much distorte(l. CLINICAL MEMORANDA.
British Medical Journal