has been performed four times in all, with gum-elastic catheter having been introduced, success. Fistula in Ano.-The case reported under treatment last month still remains so. Puncture of the Bladder.-Once after extravasation of urine. The patient died on the ninth day, with extensive disease of both kidneys, probably tubercular. The case reported last month remains under care. the edges of the aperture were pared and then dissected up from the sides of the penis to a sufficient extent to allow of the under surfaces (not the edges) of the flaps, being made to meet over the catheter, the raw surfaces thus placed in apposition having a breadth of about a third of an inch. To retain them there, an ingenious plan, which we have not before seen tried, was Operation for Cure of Ununited Frac-resorted to. Sutures of ordinary stout silk ture. The reported case remains under treatment. No others have occurred. Plastic Operations. Harelip.-The case reported last month, and three others ope rated on during the month, have all recovered. were introduced through both flaps at short distances from each other, each of them having fixed at one end a moderate-sized shot corn; another shot, with a hole through its middle, was then threaded on to the opposite end of each suture, and passed down low enough to hold the parts tightly retained, and on the third day the flaps appeared to be uniting favourably. In the night of the fourth, however, the catheter having been accidentally stopped, the man made some paroxysmal efforts to pass his Vesico- Vaginal Fistula.-The cases re ported last month, are progressing favour-together, and then immovably fixed by being ably, but still under treatment. Mr. Erich-compressed with forceps. After the operasen's operation of transplanting skin for the tion everything looked promising; the parts closure of an opening into one nostril has were in most accurate apposition, without succeeded, and the patient has been dis there being exerted any undue tension or charged. When the parts are quite con-pressure. The gum catheter was of course solidated, and the œdema subsided, it is hoped the deformity which remains will not be great. Two cases of operation for the relief of contracted cicatrices of burns, reported last month, still remain under treat ment in their respective hospitals. Trans-water, in one of which the urine was forced planting operations, for the relief of severe ectropium, have been performed with suc cess in three cases-one under the care of Mr. Partridge, in King's College Hospital, another under that of Mr. Paget, in St Bartholomew's, and a third, under that of Mr. Haynes Walton, in the Central London Ophthalmic. To another important plastic operation, by Mr. Paget, we must devote a few lines. The patient, a man, in rather delicate health, aged thirty-four, had had, in consequence of sloughing from urinary infiltration, the floor of the penile portion of his urethra completely destroyed to the ex-use the aperture is much diminished. In tent of about an inch and a half. The catheter, when introduced, was visible from the anterior verge of the scrotum to within a short distance of the commencement of the glans. Many months having elapsed since the occurrence of the first disease, and the parts having got into a perfectly quiet and stationary condition, Mr. Paget deter-main under care. mined to attempt an operation for the clo- Operations for Cataract.-Extraction, sure of this opening. This was done nearly two cases successful, one a failure. The in the manner adopted by Mr. Le Gros successful cases were both under the care Clarke, in a successful case published in of Mr. Haynes Walton, in the Central Lonthe Medico-Chirurgical Transactions. Adon Ophthalmic Hospital. Depression one, by the side of the instrument, and broke open the line of union in many parts. None of the sutures had previously been removed, but after this untoward accident the parts became swollen and unhealthy, the sutures were of necessity taken out, the whole ultimately gave way, and the condition of the parts is now much what it was before the operation. Employment of Cautery, &c.-In a case of perineal fistula, in University College Hospital, Mr. Statham has resorted to the actual cautery, a heated iron, and under its St. George's, Mr. Pollock has in two cases made use of the galvanic cautery; in one, a case of vesico-vaginal fistula, with much benefit, in the other, for the destruction of a vascular growth within the meatus of the female urethra; in the latter it has not been completely successful. All the patients re successful. Absorption two, both progress. nature of the disease, and its entire want ing favourably. Operations for Artificial Pupil.-Mr. C. G. Guthrie's case, recorded last week, has recovered, with much improved vision. Two others have been successfully operated on by Mr. Walton.-Med. Times and Gaz. Oct. 22, 1853. History of the Recent Epidemic of Infantile Leucorrhœa. With an Account of Five Cases of Alleged Felonious Assaults recently tried in Dublin. By WILLIAM R. WILDE, F. R. C. S., Surgeon to St. Mark's Hospital. (Concluded from page 180.) of resemblance to syphilis, dismissed the One of the latest authorities upon this subject is Mr. Kesteven, of London, who, In the Medico-Chirurgical Transactions, Mr. Kinder Wood has described the dis-in the Medical Gazette for February 28, ease in its most acute and dangerous form, 1851, has recorded a case of this very naas ten out of twelve cases proved fatal. In ture, and attached thereto some practical bis Surgical Lectures, Mr. Lawrence de and useful observations, from which the scribes the disease under the head of a following is an extract. With reference to "Peculiar Affection of the Genitals in Fethe physical indications of chastity, the male Children'-see Medical Gazette for medical opinion upon which, he says, may August 21, 1830, vol. vi. p. 828)-and be divided into two classes, the public and mentions a case in which he was concern private, the former, or the most frequent, ed, and which was tried at the Old Bailey," are those in which vaginal discharges in in which it was supposed, "in consequence young children are mistaken by the parents of previous professional opinions, that it or friends for the evidences of sexual interwas the venereal disease; the child was course by elder male persons having gonorquestioned and interrogated, until, I believerhoea or syphilis. Such cases have frefrom fear and apprehension, she gave in to quently occurred to myself, as they have to the idea that had been suggested and strong- others; and, although now better underly entertained by the parents, and said that stood by the profession than formerly, yet a certain youth had done something or other so strong is often the notion entertained by to her." As the learned author did not the public with regard to these cases, that it mention, in the work referred to, what the is not unfrequently extremely difficult to result of the trial was, I lately wrote to persuade parents that we have merely to deal him, and received the following answer: with the results of ordinary disease, and "I can, however, inform you, that the ac- not with those of violence. This notion, in cused person, who was of respectable fami- several cases that have come under my ly and character, was acquitted. I do not notice, has unfortunately been confirmed know that there is any legal report of the by hasty and erroneous opinions, given by case. The child was not seen by me until surgeons on the mere representation of the the ulcerations, which had been extensive friends, without a proper examination havand deep, were cicatrized. The affection ing been made. It is scarcely possible to had been pronounced to be venereal by a speak too severely of such culpable and wilgeneral practitioner, who was first called ful ignorance. Within the last few weeks, in; and this opinion was corroborated by a a child of nine years of age was brought to surgeon of some eminence, although not me, upon whom it was suspected that vioconnected with a hospital. The matter lence had been inflicted. A careful exami was first brought before the police-office in nation afforded evidence that the case was Bow Street, where the magistrate-the late simply one of vaginitis. There was comSir Richard Birnie-having inquired very plete absence of any indication of violence, carefully into all the circumstances, and for although it can scarcely be believed to heard my decided opinion respecting the be possible that sexual entrance into the vagina of an infant could, under any cirrhoea in children under ten years of age, I cumstances, be perpetrated; yet in the attempt, much contusion of the young and delicate soft parts must have ensued, had it been made. The parents were satisfied, and an individual unjustly suspected was forthwith released from so odious an imputation." cannot say whether the inflammatory symp. toms are equal in appearance to those now described. The disease is, I believe, usually painless in the first instance; and it is only when excoriation has taken place from the irritation of the discharge, and that the urine passing over the abraded surface prohadduces some degree of soreness, that any complaint is made. After some time, the period varying according to the virulence of the disease, and the state of cleanliness or the contrary in which the child is kept, the What might have been the result Cosgrave's case gone to the jury, or what would have been the charge of the lord chief justice, it is difficult to say; but it was quite manifest that the court held the medical opinions for the defence at a dis-discharge excoriates the labia both on their count. Conversing with some of the most intelligent of the jury, they informed me that, independently of the alibi, they were strongly inclined to an acquittal on account of the contradiction of the crown witnesses; and that, being conversant with such cases, they made it a rule to acquit where the man was not diseased. With respect to the alibi, which, like all similar evidence, must be a matter of the merest chance-but was here the means of saving the prisoner where medical evidence was not receivable-it was so far useful in assisting the public to come to a proper conclusion as to the veracity of the witnesses produced by the crown. external and internal surfaces, the fourchette, perineum, the margin of the anus, and all that portion of the integument of the thighs washed by the discharge, or which come in contact when moved one upon another. In fat children, the amount and extent of excoriation, which presents much the character of an eczematous eruption, is always greater than in those who are thin, or have been in any way wasted by previous ill health. The extent of this eruption is generally very well marked by a defined eczematous margin, extending from the pudendum, in a crescentic form, over the thighs, and sometimes into, the cleft of the nates. The character of this eruption, its defined margin and extent, may possi bly, to a practised and unprejudiced eye, results either of violence or the mechanical irritation produced by the "friction of the penis" between the thighs and external labia, as was endeavoured to be proved by the crown in the late trials in Green Street. Several questions of grave importance are suggested by the foregoing details; and first, with regard to the original propa-serve to distinguish this disease from the gation of such cases in a pathological as well as an ethical point of view. The disease, although denominated by Churchill and other modern writers upon the diseases of children, leucorrhœa infantilis, is better designated by the term vaginitis, for it is of a much more inflammatory character than either leucorrhoea or gonorrhoea, at least, as these two diseases present in the adult female; and the discharge is much more profuse in the former, and much more purulent in the latter. This discharge proceeds principally from the vagina, although the external parts are generally bathed with it when we come to examine them, in the same way as the surface of the glands and the inside of the prepuce are usually covered with discharge, in persons labouring under gonorrhoea, particularly where the foreskin{tion bestowed by mothers on their children. is abundant. The redness and swelling of the labia, clitoris, and orifice of the vagina, are generally very great, and the hue of the former is somewhat purplish. Not being acquainted with the appearance of gonor With respect to the discharge, it is gene. rally of a very acrid nature, and is the cause of the excoriation and eruption upon the true skin; and, unless the disease has been discovered by accident in an earlier stage (such as by observation of the child's linen, or by the chance of some second party seeing the child), the two circumstances which first attract attention are, the difficulty of walking, or the pain in making water; but the date of the discovery varies from a few days to several weeks, according to the violence of the affection, or the care and atten For the same reasons, the duration of the disease will vary from a fortnight to six weeks or two months. The age at which this vaginitis is most frequent is from four to ten, but it may appear earlier, of which an example is given in the Associa- the man's passions need in nowise be af tion Medical Journal for the present week, fected; he may, as I endeavoured to exAugust 27, extracted from the Deutsche plain to the court at the late trials (because Klinik, in which this disease appeared in a I have known such to occur), simply apply child five months old, and produced inflam- the penis to the genitals of the child, as (in mation of the lymphatics and violent con- his opinion) a sanitary measure; and thus stitutional symptoms. The causes of the a rape would, in the eye of the law, be condisease have been already explained in the sumated, and the disease be communicated; foregoing portion of this communication.whereas, in the latter, with aroused pasThe little patient is generally pale, and sions, a certain amount of violence (even looks out of health; the tongue is almost without penetration, which is scarcely posinvariably white; and there is some loss of sible) must be inflicted upon the labia and appetite. The treatment consists in ex- external parts, and evidences of which treme cleanliness, the use of mild astringent would be unmistakable. washes, attention to the state of the digestive organs, the administration of bark and other tonics, and the removal to a more I healthy atmosphere. Where the disease has been of long standing, as in the case of the child Cosgrave, and the excoriation and superficial ulceration has proceeded to anyquences thereof be a profuse vaginal disdepth, the parts bleed freely, even with charge, such as that seen in the cases which handling; and, therefore, if such friction as recently formed the subject of investigation the medical witness swore might have taken here? Or, again, if the discharge proceeds place, and, as the crown wished to prove, only from the external parts and the true had really occurred while the child was la- skin, must not such discharge be the result bouring under the disease, very great pain of suppuration consequent upon extreme must have been experienced, and consi-violence, laceration, and contusion, such as derable hemorrhage ensued. would attract the attention of the mothers Suppose, however, that a violater was careful enough (as in the five cases tried at Dublin) to avoid rupturing the hymen, but simply to have recourse to the friction" with the penis, sworn to by the medical officer of the crown, would the conse Is the disease communicable by infec- and friends, long before such discharge was tion? Professors Cusack and Geoghegan established, no matter how willing children think it is; and their evidence, when pub-might be to conceal the act? Would not lished, will prove this. If it be, and that some hemorrhage, or other marks of viothe accused man has no disease, it ought, lence be apparent on the dress? Could chilin the minds of dispassionate persons, to go dren so treated have pursued their ordinary far in exculpating him. Suppose, how play without complaint, or walked, as one ever, that the unfortunate man accused of of these did, a couple of miles immediately the crime happens to have gonorrhoea, after the committal of the crime? Would what will be his defence? This is a very it not be, to say the least of it, a very reserious question, which I submit to the in-markable coincidence-taking up the opingenuity of medical jurists, and to practi-ion of the crown-that each of the five tioners acquainted with the appearances children said to be violated should happen of gonorrhoea, and also of vaginitis, in young children. to be at the moment labouring under this well-known affection called "vaginitis," or "leucorrhoea infantilis ?" These are medical questions worthy the consideration of the practitioner and the medico-legal jurist, although they may not be appreciated or Under two circumstances only is the violation of a child of tender years likely to be attempted; to get rid of disease by instantaneous transmission upon the application of the male to the female genital or-understood by lawyers; but there are others gans, under the ignorant delusion to which I have already referred; or for the gratification of sensual lust In the former case, In the instructions which I gave the lawyers for the defence in Kane's case. I pressed them to ask this question; but they said they were afraid of it. As lawyers, they had nothing to do with the medical question, or the elucidation of truth; they had only to "get off the prisoner." which intimately concern the police, the crown lawyers, and the country at large, a few of which I will here briefly stare. Have any cases, in which the crime of violation upon a child of tender years has been fully and satisfactorily proved, resembled those which formed the subject of this communication; where, in each instance, belief of the occurrence, but also tutor it into details such as few prostitutes would be willing to recite. (Such really occurred in the case of Walsh v. Barber.) These infatuated mothers are much to be pitied, more particularly when the police, the the state of the child was accidentally discovered many days after the date assigned to the commission of the crime? and are any of the signs of rape laid down by medical jurists, either in the infant or adult, similar to those which presented in the five Dublin cases? With respect to "corrobo- medical examiner (who should, in such rative evidence," such, I believe, can al-cases, be the guardian of their honour), and ways be procured, because, in most in stances, the threatened or tortured child simply acknowledges to the fact of sitting upon the accused's lap, being in his company, or having received some trivial act of kindness from him, at the time and place when the crime is alleged to have occurred; and plenty of witnesses can always be pro-ing them in public courts, and attaching to cured to corroborate these facts. 66 the law-officers of the crown, back them in their mistaken idea. They should be shown the moral injury they are inflicting on their children-forcing them, under the threat of torture, to lie; demoralizing their young minds, by tutoring them into descriptions of scenes of immorality; expos them in after life the stigma-one which How does it happen that, in no instance, will not be forgotten among their friends does the child ever tell what has occurred and neighbours-that they were violated until interrogated or threatened by the mo- and diseased. Lawyers must be shown, ther? She has neither love nor lust to in-that all these cases are got up by a sysfluence her. She has no feeling of shame tematic procedure on the part of the moto cause her to withhold the desired infor- {thers, and that, in nine cases out of ten, mation; and yet it is supposed that, for a that procedure is but a paraphrase of the "bit of sugar," or a penny worth of straw- scene so graphically described by Sir Astberries," she (who may have been hereto ley Cooper. So long, however, as such fore truthful, affectionate, and obedient) cases are entertained by the police, supwill withhold from her friends the name of ported by medical testimony, and brought her ravisher for days together, or until forward by the crown prosecutor, so long compelled to give it up by threats or pun-will they continue to disgrace science, moishment; or that she only remembers the rality, and justice. But then, it must be name when mentioned to her? With re-remembered that, with the exception of the gard to the veracity of children, much might presiding magistrate, each person concernbe written, did space permit; but all who ed in the trial has a pecuniary interest are acquainted with human nature know therein. Having once taken up the case, with what pertinacity they will adhere to the police, no doubt with the best intena lie equally with the truth; and, as a cer- tion, endeavour to show that crime has tain amount of latitude is given by the court been committed. The medical officer of and the jury to children, lawyers say they the police is not only paid for the examina. are dangerous witnesses" to cross-ex- tion, and the subsequent examination at amine. Those who practise medicine court, but, being himself a policeman, looks much among the lower orders can bear with a jaundiced eye upon all accused pertestimony to the difficulty of eliciting the sons. The crown solicitor receives his ruth about the most ordinary accident or salary, and all his clerks and officers are disease among young children. paid for their briefs, and what is called "the getting up of the case." The attorney. general is paid his fee, and all the crown lawyers are paid their fees-the county pays for all. Where does the fault lie? I believe in the police-office. If the cases were properly investigated there, all this unnecessary expense, all this disgrace toward the accusers, and unjust accusation of the accused, might be avoided. The system of medical police in this country is lamentably defective, and of this we have had examples in this and in other trials of 44 Generally speaking, the mothers are themselves fully convinced of the commission of the crime, and are, therefore, not only most justly indignant, but are anxious, by every possible means, to have the accused party punished. One can, therefore, understand how persons in their rank of life will, by constantly going over the case with a child, prompting it when it forgets, and suggesting to it when it comes to the recital of the commission of the act, not only persuade the child into the positive |