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hospital on October 21, 1887, having a tumor in the abdomen which she noticed about three months ago. Its size was equal to about three or four pints of fluid, and was not, on examination, found to be adherent. The patient was in excellent condition; menstruated regularly, until the last three times, when the menstrual flow was attended by considerable pain. She claims not to have been sick at any time, except during childbirth. She is the mother of three children, aged respectively seven, six and five; the six-year-old child dead. An examination as to the cause of the dysmenorrhoea was the accidental means of discovering the existence of a tumor.

October 31, at 10:30 A. M. operation was performed, Dr. Wyllys Andrews assisting. The patient, room, assistants, all having been prepared for a strictly antiseptic operation, an anaesthetic was administered and the abdomen opened by an incision one and a half inches in length, opening down upon a small adherent cyst (thin-walled). The cyst was carefully tapped, and about two quarts of thin, yellowish fluid removed, and the collapsed cyst drawn out through the incision, exposing a small compact pedicle, which led to the right side of the uterus; the fimbriated extremity of the right tube was adherent to the cyst wall. The pedicle was tied with heavy silk, cut short, carefully examined for bleeding points, and dropped. The left ovary and uterus were examined by fingers and found to be all right. The cul-de-sac of Douglas was carefully sponged out, but no blood or serum was present. The "toilet of the peritoneum" having been thoroughly made, the abdominal wound was closed with silk sutures as in the preceding case, great care being taken to include the peritoneum in each ligature, owing to persistent retraction. The external wound was dressed antiseptically and patient put to bed in a seemingly excellent condition.

The after-treatment in this, as in the preceding case, was about the same; both patients recovered and have left the hospital.

VARICOCELE.

This patient, aged twenty-two, male, entered the hospital August 17, 1887, for operation. The scrotum was amputated at 3:30 P. M. of same date. After putting the patient under the influence of an anaesthetic, it was decided to apply a clamp and amputate; the hæmorrhage was then controlled, and the wound

closed and antiseptically dressed. Patient was then put to bed, but required three or four men to control him while coming out from the anaesthetic. He broke down one bed in his struggles. 9 P. M., hæmorrhage and swelling having occurred, it was found necessary to open a few stitches and secure the bleeding vessels.

On the 18th the patient did not sleep; bleeding still slightly continues; scrotum swollen. 3 P. M., gave ether and opened scrotum, ligated the vessels and put in a few deep sutures before again closing the wound.

August 19: No further hæmorrhage.

August 22: Scrotum and penis smarted so that patient could not sleep; gave hypodermic injection of morphia.

August 25: Wound has suppurated, but is granulating nicely. August 28: Rapid improvement in patient's condition; he walked out doors an hour or so to-day.

August 31: Owing to business matters patient was compelled to leave the hospital, and left on his own responsibility..

COMPOUND COMMINUTED FRACTURE OF LEFT FOREARM AND LACERATED WOUND OF LEFT THIGH.

Mr. S. C., aged twenty-six, was brought into the hospital August 10, 1887. The patient was caught in a cable and sustained a compound comminuted fracture of the left forearm, and laceration of all the muscles of the thigh just below Poupart's ligament. Left scrotum lacerated and testicle forced up into groin above. Bones of forearm wired. At 8 P. M. the patient was etherized, testicle seized and brought down into scrotum, forearm cleaned, hæmorrhage checked, and two pieces of ulna and radius, each about one and a half inches long, were removed. The muscles of the thigh were all mashed into pulp; thigh treated in the same way; bone, arteries, nerves and entire muscles brought together as well as possible with silk sutures, the whole cleaned and dressed. Catheter passed and urethra found intact. Both limbs were put up in metal splints and dressed daily.

August 13: Pulse, 126; temperature, 101.4°.
August 14: Pulse, 112; temperature, 101°.

August 16: No hæmorrhage; swelling subsiding; little fever; fair appetite.

August 19: Arm suppurates and discharges quite freely; temperature about normal; leg discharged freely; no hæmorrhage.

August 25: Arm begins to granulate and show signs of healing.

August 29: Discharges from arm and leg are much less, and not so offensive.

September 4: Wound in the thigh is now much contracted; all the wounds are full of healthy granulations, and patient doing well.

September 14: Patient was etherized and bones of forearm were brought into position, properly sawed and adjusted, drilled and wired together. There will, in all probability, be a shortening of at least two inches, and possibly some diminution of motion, especially of prehension and rotation.

September 20: Arm is getting much stronger; passive motion is directed to be kept up in fingers.

September 27: Leg is healing nicely and rapidly; very little discharge.

October 7: Patient doing well; sat up once to-day in chair. October 15: Steadily improving.

October 24: Was up to-day moving about in rolling chair. October 30: He walks across the ward with a little support. November 10: Gaining strength rapidly. Arm now put up in wood splint.

November 20: Leg entirely healed up; arm improving, and no discharge.

December 10: Doing well, passive motion helping to remove stiffness.

FISTULE IN URETHRA, ONE IN ANO, WITH STRICTURE.

C. W., aged forty-two, male; stricture dilated; external urethrotomy. August 6, patient entered the hospital for operation on three fistula in perineum. Patient in excellent condition physically, and dates his trouble back to 1865, when he had a gonorrhoea which ran into gleet and resulted in a stricture, and this finally into three urethral fistulæ.

August 7: The patient was etherized and several attempts made to dilate his stricture, which seemed to be an inch or more long, but without success.

August 10: Gradual dilatation was practiced daily, with intention to operate as soon as stricture was cured.

August 21: It having been found impossible to perforate the stricture, the operation of external urethrotomy was resorted to. 4 P. M., the patient was etherized and placed in lithotomy posi

tion; staff introduced to stricture, and then cut down upon from without. Stricture was one-half inch long, was carefully cut through, and sound passed; hæmorrhage stopped and wound partly dressed.

August 22: Doing well; passed urine during the night; no chill; no fever.

August 30: All sutures removed but two; wound much contracted; patient urinates now two or three times a day, and in fair quantity, instead of a little every half hour, as before.

September 5: Number 12 sound passed without difficulty. September 14: Patient has been intoxicated for the past three days, but is now all right again; wound still contracting. September 20: An attempt to pass a sound caused a severe urethral chill and fever. A hypodermic injection of one-third grain of morphia was given, together with seven and one-half grains of antifebrin, chill subsiding in about two hours after. September 22: Sound passed all right, and no fever. September 25: Passed number 12 sound.

September 27: Patient left the hospital enabled to pass his water freely, with good stream. External incision was almost closed.

SYNOVITIS OF LEFT HIP-JOINT.

Patient, aged twenty, female; entered hospital September 3, 1887. Ten weeks ago patient tripped and fell on left hip, which caused only a slight bruising, and was unnoticed at the time. Two weeks later she became quite lame, and at present can only get about with crutches. Movement and pressure in the joint are attended with considerable pain.

September 4: Patient put to bed, and a weight (two bricks) and pulley adjusted, which gave immediate relief to the hip. September 10: Joint is much less painful, even upon friction. September 18: Patient improving rapidly.

October 1: Very little soreness felt on rotation.

October 7: Weight removed. Friction now causes some pain at hip.

October 9: Owing to pain felt at hip, the weights were reapplied.

October 15: Improving-no pain on motion, but a little by friction.

October 22: Left for home, where the weights will be reapplied if necessary.

B

CORRESPONDENCE.

LETTER FROM BERLIN.

Dr. George A. Hendricks, Editor of THE PHYSICIAN AND SURGEON, Ann Arbor, Michigan:

MY DEAR DOCTOR: It may, perhaps, be of some interest to you to hear the news and gossip in this part of the medical world, and as an old alumni, it will give me great pleasure to write occasionally and tell you how things go here.

College work begins rather slowly, and the various courses are not fully begun until the first of November. The attendance this year is good, and among the two thousand medical students here are a goodly number of Americans, besides representatives of almost every country on the globe. Berlin claims the honor of being the medical center of the world, and its claim is perhaps well taken; for many of the most brilliant medical discoveries and advances were made here, and among its faculty are such men as Virchow, Waldeyer, Koch, von Bergmann, Helmholtz, Du Bois-Raymond, Leyden, Levator, Hirschberg, and others, all in active service, and, were I to name those who are "retired" or deceased within a few years, the number of familiar names would be largely increased.

The hospitals are very extensive, and in a city of a million and a half, the supply of clinical material is unlimited. The buildings are mostly old, however, and the lecture-rooms are most wretched apologies for such-small, illy-ventilated, and dark. The newer buildings, especially the various surgical clinics, are of a more modern style, but still there is room for much improvement. Prof. Leyden's lecture-room for internal medicine will seat comfortably perhaps one hundred students; the ceiling is low, and it has windows on one side only, while Professor Gerhardt's, on the same branch, makes up for lack of length and breadth, by being very high and containing two circular galleries, from which the poor myope look down on the patient with a pair of opera-glasses. Every case is recorded with the greatest minuteness, and the records carefully preserved. If the patient die and is not claimed within twentyfour hours, he is taken to Virchow's Pathological Institute and a careful post-mortem made, and the record of it also carefully filled to furnish data for scientific work.

Virchow, whose name we meet so frequently in our textbooks, lectures and demonstrates every day on the various

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