692 MORBID ANATOMY.
June the opening in the bladder was touched with the ni- trate of silver ; and from that time the urine and faeces passed by the natural outlets. On the 21st she walked and rode out without inconvenience ; and Dr. M. discontinued his attendance. About the 14th of July diarrhrea came on, followed b} r vomiting, and she died on the 23d.
On dissection, the laceration of the perineum and the cicatrix near the umbilicus were found, externally. In the upper and anterior part of the vagina was a direct and perfectly cicatrized opening into the bladder, which, when forcibly dilated, was not more than 2 lines in diameter (No. 2482). Upon the vaginal surface it appeared as a marked indentation ; but, upon the vesical, it might readily have been overlooked. The bladder contained a calculus (No. 2689), that seemed to have formed about one of the sloughs from the wounded parts ; also a puriform secre- tion, but no urine nor faeces. The organ was thick and muscular, and upon its inner surface of a dull red color. At the fundus it adhered to the ileum about 3 ft. from the caecum ; and between the two was an opening about 2 lines in diameter. Beneath the cicatrix in the skin a portion of omentum was found (No. 2344), about in. in diameter, and closely adherent to the rectus muscle, through which it had passed, and to the integument. There were no peri- toneal adhesions, except immediately about the wounded parts, and no acute inflammation ; though there were traces of a carbonaceous discoloration of the membrane, that were probably the result of former inflammation, and a trace of pus in the cellular tissue of the pelvis.
In connection with the above case, Dr. M. referred to the collection of " hay-hook cases," published by Dr. Z. Howe in the Med. Jour., March, 1840 ; to the very remark- able case published by Dr. Sargent, of Worcester, in which a rake-handle passed through the body from the perineum to the clavicle (Amer. Jour, of Med. Sc., Oct., 1853) ; and to the cases of impalement by various means, that Dr. Coale collected from the journals, etc., and published in the Med. Jour. (Vol. LV. p. 387.) 1857.
Dr. Jeremy Stimson, of Dedham. These cases of impalement from the sliding down from a
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