cation; I shall therefore follow this paper with another, which will probably be published in the June No. of New York Med. Journal.

CASE OF INTUSSUSCEPTION IN AN INFANT TREATED BY MECHANICAL MEANS.

BY A. WOHLFARTH, M.D., N. Y.

WILLIAM R

a well-developed boy, 19 months old, the offspring of healthy parents, was suffering from whooping-cough for several weeks; when, on January 22d, 1870, at 10 P.M., he was suddenly taken seriously ill. Though the symptoms became gradually more aggravated, the parents of the child did not send for medical aid until 5 A.M. the following day, when I was called in. From the mother I then learned the history of the case: The week previous the boy had slight diarrhoea, and, as above stated, whooping-cough, which was more severe at night. The night previous to my visit he was very restless, and awaking from a short nap, said he could have a passage from his bowels; his mother took him from his cradle, and flexing his thighs upon his abdomen, held him over the vessel. While in this position a severe paroxysm of cough occurred, and almost simultaneously a loud gurgling noise, accompanied by a cry of agony, was heard by those present in the room. After forcible straining, instead of the expected defecation, a small quantity of mucus deeply stained with blood was passed, and a pro

lapse of about two and a half inches of the rectum occurred. After the coughing had ceased, an old lady in the family succeeded in replacing the prolapsed bowel. As usual, the paroxysms of cough returned at intervals during the night, but those attacks were now accompanied with a prolapse of the rectum and a discharge of some bloody mucus. After midnight vomiting followed drinking, and the child also began to show symp. toms of pain in the abdomen. The parents had applied mustard to the chest and feet, and had also given him a spoonful of castor-oil, but without the least beneficial effect. The last natural passage was noticed about thirty hours previous to this night.

On examining the patient I found the head cold and covered with a clammy sweat, pulse almost regular, tongue cold but moist, respiration normal, abdomen somewhat distended, not painful on palpation, discharge of urine normal in quality and quantity, and the expression of the face languid and denoting distress. All these symptoms, especially the vomiting in the intermissions of the paroxysins of cough and the discharge of bloody mucus, led me to conclude that there was intussusception of the intestines. To confirm the diag nosis, with the greatest caution I examined the abdomen, which revealed a diffused hardness in the left umbilical region, but too indistinct to be taken for a tumor. I prescribed opium and bismuth internally and applied opium externally.

The prognosis of the case being in my opinion very grave, I immediately informed the parents of the infant's slight chance of recovery. This statement in

duced them to call Dr. Burke in consultation, who On came the following day, January 23d, at 9 P.M. examining the patient, Dr. Burke's opinion was that we had to deal merely with a colitis, and suggested the administration of calomel in repeated doses. As he was formerly the family physician, and as I had not of intussusception in children, I seen many cases yielded to the proposition, as an experiment either to discard or verify my diagnosis.

The calomel was given for twelve successive hours, without in the least alleviating the symptoms. When meeting the Doctor again the next morning, I had cleared up all doubt about the nature of the disease by examthe ining with the finger per rectum. A fleshy mass, size of a hen's-egg, could be distinctly felt about 3 or 4 inches from the sphincter ani. It was immovable, ring-shaped, and corresponded to the hardness felt on palpation of the abdomen. Satisfying the Doctor of the error in diagnosis, we concluded to try copious and forcible injections of water by means of a rectal tube and syringe. Two attempts to accomplish the object failed. Under the difficulty of the case I felt it my duty to call in the aid of some one who had a large experience in the practice of children's diseases. Dr. A. Jacobi was consequently called in consultation. The Doctor came the same evening, January 25th, and corroborating the diagnosis, suggested the placing of the child in a position similar to that resorted to for the purpose of examining women with Sims' speculum. The attempt to do so in the cradle having failed, I succeeded by placing the child in the nurse's lap, who

held it in this position for twelve consecutive hours. While the child was in this posture a long rectal catheter was introduced, for the purpose of filling the rectum with water by pressure of a certain height. During this time prolapse of the rectum did not recur with the paroxysms of cough, the vomiting also dimin ished, and would only occur when more than a teaspoonful of water or milk was given. The temperature in the rectum was 100° and the pulse 120. There was slight tympanitis and great restlessness all night.

January 26th, at 11 o'clock A.M., Dr. Jacobi and my. self found the child in the condition above described, and an examination per rectum revealed no improve ment in the invaginated portion of the colon. Both of us presuming that the intestine was firmly fixed by swelling of its tissue, we resorted to a new plan for reduction. A flexible stem, with a soft sponge attached to one end, was used for the purpose of trying to push up the invaginated portion. Although I used, after injecting a quantity of sweet oil, as much force as I deemed prudent, I again failed. From the first day the child was constantly kept under the influence of opium; and I may safely assert that inflammation had not as yet set in. At last I resorted to a method previously used by Dr. Schnetter, of this city, namely, inflation of the intestines with carbonic acid gas. I procured from Messrs. Schultz & Warker, manufacturers of mineral waters, an apparatus peculiarly well adapted for this purpose, a drawing of which is given on the next page.

I introduced into the rectum a thick rectal catheter, and connected it by an india-rubber tube to the appa

ratus. The apparatus was then charged with a proportionate quantity of bicarbonate of soda, tartaric acid, and water. The faucet on the side of the appa

ratus to regulate the escape of gas was then opened, and thus the rectum was gradually filled with gas. As the catheter quite filled the rectum, I suppose