SURGICAL COMPLICATIONS AND SEQUELS OP FEVERS. 43 



contraction of the v+ilva.^ In another, reported by Gueneau de 

 Mussy, there was complete occlusion of the vagina and men- 

 strual retention, necessitating puncture, with a fatal result. 

 The ulcers are generally on the posterior wall of the vagina, 

 and in three cases recto-vaginal fistula? have resulted. One is 

 reported by Lebert, in which, when convalescent in the seventh 

 week, chill, fever, and diarrhoea set in, and four weeks later 

 the fistula was discovered by injection. It was situated in 

 front of the h^nnen, and was as large as a 5-centime piece. 

 A month later she died of pelvic peritonitis. A second is 

 reported by Liebermeister.^ It was caused by the sloughing 

 of a large piece of the recto-vaginal septum, in mass. The 

 large fistula thus produced healed without operation. The 

 third case has been under my own observation, in St. Mary's 

 Hospital, for three years past, and is the only case I have 

 found of both recto-vaginal and vesico- vaginal fistulas. Up to 

 March, 1872, she was perfectly healthy, when, at the age of 

 thirty-four, she had a severe attack of t^q^hoid, for four months, 

 following exhaustive nursing during her husband's fatal 

 illness. About the fourth week the labia sloughed away 

 to a large extent, and both water and feces passed b}^ the 

 vagina. In October 1812, she was admitted to the hospital, 

 under the care of my colleague. Dr. Grove, having two large 

 vesical openings (separated by a slight bridge of tissue), 

 which destroyed the posterior part of the urethra and all the 

 floor of the bladder up to the uterus ; and one rectal opening 

 an inch in diameter, one and a half inches above the anus. 

 Dr. Grove operated on her three times unsuccessfully ; once on 

 the rectal opening bj^ the rectum, when he divided the sphincter, 

 and twice by the vagina. From Dec. 1873 to Dec. 1875, I 

 have done nine operations. Thrice unsuccessfully I attacked 

 the fistulae proper, when, becoming convinced that the attempt 



* Russell, Glasgow Med. Journ., 1864-5, xii. 165. 



* Ziemssen's Cyc, Amer. ed., vol. i. p. 184. 



