Cystitis, subacute, following parturition, 113, 311. Cysts, treatment of, 422. Davis, William B. Revaccination during the present Deafness, total, of one side, diagnosis of, 572. Dermatology, recent progress in, 627, 661. Galloupe, I. F., and Graves, T. T. Case of sloughing Gay, George W. A case of encephaloid cancer of the Gestation, a case of, extending three hundred and six Diagnosis of enlarged bronchial glands in children, 152. Glaucoma, trephining the sclerotic in, 539. Diphtheritic inflammation, 450. Diphtheria successfully treated, 657. Diseases of the throat, recent progress in the treat- Dislocation of the tendon of the peroneus longus Displacement of the heart to the right side, 72. Dropsical fluids, fat in, 447. Drunkenness as a form of anæsthesia, 640. Goodell, J. H. A case of large amount of liquor Graham, Douglass. Massage in amenorrhoea and dys- Graves, Thomas Thatcher. A case of gestation ex- Dupuy, Eugene. The localization of functions in the Gunshot wound of the left kidney, recovery from, 681. Dura mater, ossified hæmatoma of the, 477. Dwight, Thomas, Jr. Recent progress in anatomy, Dyer, J. F. Senile gangrene of the foot; recovery Eczema, chronic, treatment of, by glycerole of sub- Edes, R. T. Clinical lecture on a case of facial paraly- Elbow-joint, excision of, 715. Gynecological notes, 270. Gynecology, recent progress in, 213. Election of officers of the Obstetrical Society of Bos- Heart, rupture of the, 486. Electricity in intestinal obstruction, 338. Hernia, diaphragmatic, 458. Hernia, umbilical, with cyst of broad ligament, 624. Electrodes, new, and battery for electrolysis of uter- Hodgkins, D. W. Salicylic acid in acute rheumatism, Electrolysis again, 287." Elephantiasis arabum, 631. Ellis, Calvin. General softening of the brain seldom Embolism, changes in the intestines from, 480. Embolism of the pulmonary arteries, 743. Embolism, pulmonary, results of, 479. Encephaloid cancer of the lungs, a case of, 6. Enlargement of the bursa mucosa over the ligamentum Enuresis, 154. Eosin, 242. Epididymitis, cases of mumps complicated with, 384. Epithelioma and lupus, 662. Epilepsy, causes and treatment of, 396. Erectile tumors, new method in the treatment of, 1. Excision of knee-joint by a new method, 362. Eye, enucleation of the, 580. Eye, foreign body in the, 546. Fæcal residue of milk-digestion, 156. Fats, digestion of, 489. Fibroid tumor of the uterus complicated with perito- Fisher, T. W. Recent progress in the study of men- Fissure of the neck of the bladder, 218. 595. Homœopathic swindle, a, 677. Homœopathy in the University of Michigan, 223, 607. Huse, Ralph C. Salicylic acid in acute rheumatism, Quantity and tension galvanic Hydrate of chloral in obstetric practice, 184. Hydrophobia, histological changes in, 478. Hypodermic injection of carbolic acid for polyarthritic Hypodermic injection of hot water for the relief of pain, Keratitis, neuro-paralytic, 535. Kidney, recovery from gunshot wound of the left, 681. Knight, F. I. Recent progress in the treatment of Fitz, R. H. Recent progress in pathology and path- Labor, difficult, 277. ological anatomy, 446, 477. Forceps delivery, the mechanism of, 368. Gall stones discharged through the side, rare case of, Lachrymal canaliculi, anatomy of the, 511. Larynx, artificial, in case of stricture, 419. Leprosy in Trinidad, 664. Liquor amnii, a case of large amount of, 510. Lupus erythematodes, the anatomy of, 661. Macula lutea, color of the, 537. Maine General Hospital, medical clinicl, 82. inic Measles, German, 16. Medical chemistry, recent progress in, 11, 37. Medical education in Germany, 131. Medical education, the present aspect of, 490. Medical journals, American, 281. Medical jurisprudence, the teaching of, 18. Medical library, the national, 674. Medical text-books, 520. Membrana tympani, treatment of perforation of the, Placenta, partial s paration of the, 426. Menorrhagia, 216. Menstruation as a pathological phenomenon, 312. Mieturition, painful, cured after a successful opera- Milk diet in the albuminuria of pregnant women, 186. Miscarriage in a subject of syphilis, 309. Miscellany, 28, 56, 112, 142, 258, 318, 378, 408, 438, Molluscum contagiosum, 628. Monstrosity, rare form of. Case of acephalus, 439. Morrill, F. Gordon. A case of double pleurisy, 442. Mumps, cases of, complicated with epididymitis, 384. Myers, Robert P. Pachydermatocele of left labium, 852. Myopia in Swiss teachers, 516. Nævus, the treatment of, 661. Nasal douche, the injurious effects of the, 649. New methods in the treatment of exstrophy of the New York, letter from, 109, 497. Nichols, Arthur H. School children and dangerous Nitric acid as a caustic, 217. Placenta prævia, 16. Pleurisy, double, a case of, 442. Poisoning by the Indian marking-nut, 628. Poisoning from strong tincture of aconite root, 547. Pregnancy, a case of extra-uterine, 561. Pruritus, the treatment of by the smoke of juniper Psoriasis, internal use of tar in, 630. Puerperal eclampsia, temperature in, 186. Puerperal inflammation of the ileo-sacral articula- Puerperal patient, an instance of unusually high Puerperal state, two cases of peculiar mental trouble Putnam, Charles P. Salicylic acid in acute rheum- Putnam, James J. A recent theory of phosphorus Norfolk District Medical Society, proceedings of, 15, Rapid dilatation of the female urethra, 90. 455. Recent progress in anatomy, 241, 272; in dermatology, Renal vein, results of ligature of the, 481. Revaccination during the present epidemic of small- Rheumatism, acute, a rapid cure of, with salicylic acid, Rhode Island Medical Society, annual meeting of, Richardson, W. L. A case of uterus subseptus, 349; Roxbury Medical Society, recent proceedings of the, 424. Ringworm, boracic acid in the treatment of, 665. Salicylic acid, 151, 333. uterus successfully treated by persistent mechanical Tennessee, letter from, 167. Therapeutic properties of zinc phosphide, 277. Throat, diseases of, recent progress in the treatment Thrombosis and phlebitis of the brain sinuses, diag- Thrombosis, death by, 396. Tinker, Martin A. A case of extra-uterine pregnancy, Tonsillotomy, 422. Torrey, Samuel W. An instance of unusually high Transfusion and auto-transfusion, 741. Traumatic separation of the symphysis pubis, with Triplets, with triplex placenta, 73. Tuck, Henry, and J. B. S. Jackson. Rare form of Salicylic acid in acute rheumatism, 164, 212, 381,511, Tumor, ovarian, a case of, 484. Sanitary supervision of schools, 343. Sarcoma of the iris, 536. Twins, cases of, 98. Tyndall and Bastian on the germ theory of disease, Sarcoma of the skin, multiple and idiopathic, medul- Typhoid fever and polluted milk, 367. Sarcoma of the uterus, a specimen of, 158. Scarlet fever, acute rheumatism, peri and endo cardi- Scarlet fever, permanent change in the color of the School children and dangerous communicable diseases, School children and infection, 456. Schools, sanitary supervision of, 343. Scrotum, case of sloughing of, recovery without cas- Secondary arches of the foot, 243. Sesamoid bones of the hand, 242. Sewerage of Boston, the, 79, 429. Typhoid fever, efficacy of cold-water treatment in, 244. Ulcerations of the os uteri, on so-called, 289. Uterus, a case of chronic inversion of the, successfully Varicella, inoculation of, 628. Version of the child, on, 203. Shaw, Henry L. The injurious effects of the nasal Vertebræ, true anchylosis of, 489. Skin, idiopathic atrophy of the, 632. Skin diseases, an analysis of five thousand cases of, Skin diseases, rubber cloth in, 665. Skulls, broken, 485. Skull, fracture of the, a case of, 424. Smith, I. W. Case of acute rheumatism treated with Spasm, rotary, of the head and neck, 701. Spine, fracture and dislocation of the, with chronic Splint, new india-rubber, 249. Staining, double, with hæmatoxyline and aniline, 241. State Board of Health, 605. Strabismus, influence of corneal opacities on the pro- Stricture of the vagina, 271. Vertigo, 488. Vienna, letter from, 345. Vital statistics of Providence, the, 282. Vivisection bill, the English, 724. Wadsworth, O. F. Recent progress in ophthalmology, Salicylic acid in acute rheumatism, Wainwright, Henry, the trial of, 103. Wells, Frank. Rupture of the rectum caused by a Wescott, William H. Removal of a great number of Suffolk District Medical Society, proceedings of, 158, White, J. C. An analysis of five thousand cases of Surgery, recent progress in, 683, 710. Surgical cases, 231. Suture, union of tendons by, 713. Symblepharon, new operation for, 514. the, with fracture of the femur, 415. skin disease, with remarks upon some of the prin- Symphysis pubis, a case of traumatic separation of Whooping-cough, blindness from, 515. Syphilis, retarded union of fracture due to, 424. Syphilis, the discussion in London on, 491. Tactile corpuscles, 273. Tampon-canula, Trendelenberg's, 419. Wing, Clifton E. On so-called ulcerations of the os Wood, Edward S. Recent progress in medical chem- Worcester City Hospital, medical clinic, 525. Tarbell, George G. A case of chronic inversion of the Zinc phosphide, therapeutic properties of, 277. THE BOSTON MEDICAL AND SURGICAL JOURNAL. VOL. XCIV. THURSDAY, JANUARY 6, 1876. NO. I. NEW METHODS IN THE TREATMENT OF EXSTROPHY OF THE BLADDER AND OF ERECTILE TUMORS. BY HENRY J. BIGELOW, M. D., Professor of Surgery in Harvard University. I. EXSTROPHY OF THE BLADDER; OPERATION. THIS operation consists in removing the exposed mucous membrane of the bladder, so that flaps drawn from the adjacent skin may adhere directly to its raw surface. In the case detailed below, the mucous membrane was removed down to the ureters. Flaps drawn from the sides were then united on the median line. Union was solid in about ten weeks. The usual surgical resource for this sad malformation has been an attempt only to cover the mucous membrane. But it would seem better to obliterate it, by the same operation, than to form a cavity which is worse than useless because it collects the salts of the urine. The usual operation, of which a case is given below, also needs a more extended dissection. It requires that a first flap be turned down upon the bladder from above, the object of which is to secure a lining of skin for the new cavity. This flap is covered with two others drawn from the sides and united upon the median line. The denuded surface from which the first flap was taken is then similarly closed by further incisions. By the operation now proposed, both the first flap and the dissection for covering the surface which supplies it are unnecessary. In both operations flaps are best cut where the skin is most relaxed. Hence it is better to include in the incisions the loose integuments of the groin and even of the scrotum. The edges can then be brought together in any direction in which the flaps yield most readily. In a third case cited below, where the bladder (open over the pubes) still presented a cavity, I was able to close this, so that by wearing a truss-pad the patient could retain urine for two hours. This case, however, was not one of complete exstrophy, like the others. I am indebted to Dr. H. H. A. Beach for the following abstract from the hospital records. CASE I. Complete Exstrophy; New Operation. — E. C. A., six years old, presented a complete exstrophy of the bladder, which was wholly exposed over a surface of two and a half inches; the skin was tense and the abdominal wall thin. The testicles were still in the inguinal canal. December 13, 1874. Operation, under ether. The mucous surface of the exposed bladder was carefully dissected off, and the lateral flaps, including both inguinal regions, were united upon the median line and transversely above it. Sixteen silver sutures were introduced, and a piece of adhesive plaster was placed over the whole, to keep the parts immovable. December 14th and 15th. Patient doing well, with little pain. December 16th. A good deal of swelling about the wound, with a small slough near its upper extremity, where urine oozes. December 18th. Pulse 140. Temperature, A. M., 101°; P. M., 103°. December 21st. Twelve sutures removed. December 22d. Remaining sutures removed. December 25th. Patient doing well. The wound is healed, except at its upper extremity, where there is a little discharge. January 22, 1875. A small abscess is forming under the flap. Patient has had a slight convulsion. January 25th. Abscess discharged through one of the needle-holes. January 26th. Edges separated a little by ulceration at the upper extremity. March 1st. Patient is running about. March 12th. Photograph was taken. April 10th. Union solid and no tenderness remaining. May 7th. Discharged, well. CASE II. Complete Exstrophy; Old Operation. — C. P., aged seventeen, entered the hospital with complete exstrophy. Above the symphysis was a pulpy, vascular, and florid swelling, two and a half inches in diameter, formed by the protruded mucous surface of the posterior wall of the bladder. The umbilicus was wanting; no hernia existed, and the testicles had descended. The surface was very sensitive and tender, the penis rudimentary, with a complete epispadias. The urine, distilled from the ureters, fell upon the urethra, which served imperfectly as a spout. The patient was anxious and suffering. A plate covering the part caused excoriation. June 2, 1868. Operation, under ether. A transverse incision midway between the bladder and the sternum, with vertical incisions at its extremities, surrounded three sides of a flap, of which the hinge was next the bladder. The flap was turned down over the bladder as far as the penis. Additional transverse incisions were now made, and four side flaps were dissected up, two of them abreast of the bladder, and two on a |