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bings of the carotids. The feet commenced to swell profession to require cases being given in illustration. But about the ankles early in the summer, ædema extending I will quote one having a different result, from the New now to nearly the knee in both limbs; the chest swells, York Medical Record," January 9th, 1875, page 21, wrists and hands are slightly cedematous, face a yellow- entitled; A case of metastasis of parotitis to the brain ish pale, waxy; all appearance of the dropsy invading by William M. Kemp, M.D. New York. the chest and abdomen. On auscultation over the heart, there is a loud, rough, double murmur heard nearly all over the chest. This murmur is loudest on the right edge of the sternum at the first, second and third intercostal spaces; there is dullness, also, here, extending below. The murmur extends into the carotids, the heart beats over å large space, the apex beat is below and outside the nipple. One rough murmur heard only here. The murmurs are so loud as to. obscure other sounds, and heard also on the back of the chest. Upper left chest, both sounds of the heart can be distinguished -breathing, right chest, nearly normal; some râles at the depending part; left chest, patches of dullness and want of breathing, numerous râles; kidneys normal; urine not albuminous.

"After this, during the next eight weeks, she had two attacks of raising sputa streaked with blood, cough, etc., which subsided in a few days; also, attacks of great anguish, threatening dissolution; dropsy increased. March 10th.-Dropsy has greatly increased; effusion into all the cavities; mind begins to wander; is more or less delirious. March 15th.-Paralysis of the whole left side and throat, unable to speak. Death ensued March 16, 11 P. M.; Age, 62."

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Then follows numerous cardiac, carotid, and radial, or pulse, tracings, by the sphygmograph; the revelations by a post-mortem, of an enormously enlarged heart," with many of its usual accompaniments; also, a photo graphic illustration of the frightfully diseased condition of the valves of the heart; all of which show what a terrible three years of suffering that must have been; and all commencing immediately after the suppression of the sciatica; for it is positively stated that," when this left, pain commenced in the chest about the heart; had about this time a fit, falling insensible," and pain, for which Morphia was used, and "continued ever" after, while she lived; and, of course, to relieve more or less constant and severe suffering, or it would not have been given.

Mary B.- -aged two and one half years, who never had any previous sickness, was seen by me at the Children's Class Northern Dispensary, suffering from parotitis. The disease had been of four days duration. Lin. campora was prescribed with warm bath at night, as the child was feverish. Examination of throat and lungs revealed nothing. After using the liniment for twelve hours the swelling of the gland markedly diminished, but the child became more and more feverish, restless, tossing about in bed, screaming and rolling its head from side to side; it vomited several times and on the sixth day of the disease was seized with a convulsion in which it died. No post mortem examination was permitted. There was evidently a translation of the disease to the brain, probably in the form of meningitis. Dr. S. J. Radcliff, of Washington, D. C., in a recent communication to the Philadelphia Medical Times goes over the lit erature of the subject, but fails to find cases of fatal metastasis to the brain, save in the experience of Dr. Dickson, of Charlestown, who is said to have seen this fatal complication. We are unable to find a recorded case of parotitis, with death resulting from metastasis to the brain. Authors speak of its possible occurrence but none quote from actual experience,"

That child was killed outright, and the responsibility for its untimely death rests solely upon the Allopathic branch of the medical profession; the imitator of its terrible errors, namely, the man who did the work, simply carrying into practice its uniform teachings of many centuries upon such subjects. The child "never had any previous sickness," consequently must have been healthy and vigorous; but twelve hours of the local application of camphor liniment was all the time required (though death was delayed a little longer), to send it to its grave, and throw an unsuspecting and confiding household into mourning, for years no doubt, over the sad result.

"

The apparent deviation from the strict demands of the law, in this case, may be easily explained upon What a record! And all this suffering, and premature either of two hypotheses, viz: that the disease settled death, together with millions of other cases equally bad, upon some of the small glands of the brain and thereby solely due to the utter ignorance in the Allopathic school caused the fatal result; or, and what is much more of the certain and frightful results that must and do fol- probable, the morbid blood congested in the parotid low the suppression of all forms of disease. And think gland, was rapidly absorbed, or forced on out of the of it, all you who pattern after such ignorance; bring it vessels there, and to the brain to produce congestion home to yourselves and your own families, for it will be thereof, the convulsion and death, without giving time brought there, when you least expect it in terrible scenes for it to first develop its specific results upon other of suffering and premature death, just so sure as you perpe- glands. This view of the case is sustained by the fact, trate such outrages upon yourselves or those most dear to you. that the "swelling of the gland markedly diminished The only possible exceptions will be where you can cure in the twelve hours use of the liniment; but much more the disease homoeopathically, and throw it back into so, in that the entire literature upon the subject ap former conditions; as you always must the suppressed pears not to furnish another parallel case of translation eruption of small pox, scarlet fever, etc., if you would of this disease to the brain, unless this may have been save the life of your patient. But how infinitely better the fact in the experience of barely one other physician. to escape all risk, and all the additional suffering as well Please score another death, also against the Alloas an enfeebled constitution, by applying your truly cur-pathic ignorance, of this whole subject of metastasis; ative measures, before any of the vital organs have been as shown in the following from the New York Medical assailed, and the general vitality of the whole system has Record, of Dec. 14th, 1878, just at hand, this morning, been so exhausted as to make it a most serious question, Dec. 16th: whether you can save life, even for a comparatively short time. I have not, as yet, I believe, even alluded to one of the most marked of all the facts to be found in nature, to prove that a law must underlie and govern the metastasis of disease, with unerring certainty. I refer now to the mumps, and to the well-known fact in connection therewith, that when, from any cause, this disease is suppressed from its natural seat, the parotid glands, the law compels it to confine its specific, or direct, action, to the glandular system, and also compels it, in case of the difference in sex, to seek the gland, or glands, for its future operations, in different parts of the human organism. Such instances are too well-known to the entire

"Tetanus from a Hypodermic Injection of Quinine.Dr. A. Ady, of West Liberty, Iowa, writes: On the 19th of this month I injected fifteen grains of bromide of quinia, dissolved in thirty minims of dilute alcohol, into the cellular tissue above the crest of the left ilium of a man aged sixty-two years, for an intractabie periodic neuralgia in that position. The neuralgia was relieved, but there was more than ordinary inflammation at the site of injection, followed by a forming slough. It gave him considerable pain on the 21st and 22d, when Morphia was ordered sufficient to relieve him. During the 23d and 24th he was reasonably comfortable, and sat up most of the afternoon, Sunday, entertaining com

pany. Upon retiring, at 10 P. M., he was seized with tetanus, and died in twenty-three hours. I had been intimate with him for twenty-six years, and, with the exception of occasional attacks of this neuralgia, he enjoyed uninterrupted health."

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Thus, it took only five days, for stupidity to finish a man who had "enjoyed uninterrupted health," with the exception of occasional attacks of neuralgia," for twenty-six years! How far removed was this from manslaughter? Indeed, death came within the time, allotted by law, to constitute it murder, excepting in intent. But he was killed just the same as though it had been done by intent, and simply by driving the disease from his hip, or ilium, to the spinal cord, or base of the brain, by the local treatment used.

Are there any intelligent men left in our ranks who desire to longer pattern after such ignorance?

OUR POSITION.

BY EDWARD P. FOWLER, M.D., NEW YORK. Not one of us doubts that in the department of Therapeutics medicine has received no other such tributary as the great principle of Homœopathy.

Also, that without mutilation no special principle can be separated from the unit principle, and that no special principle can be accepted as a reliable guide unless it be carefully compared with its congeners and correctly explained by that greatest of teachers-experience. Therefore we adhere to the stand we have always maintained, that it is our duty to investigate everything, and to openly employ whatever may promise benefit, and also to endeavor to weigh all testimony connected with our profession with such impartiality as is vouchsafed to human judgment, and to accept the consequences, whatever they may be-a stand which we regard as being indispensable, no less to the honest practitioner than to the professed scientist.

In the face of these facts we decline to be assigned to an exclusive or intolerant attitude, as it is contrary to all our instincts, our education, and to all the traditions of pure medical science.

Clinique.

It is the only coherent and non-contradictory system A CASE OF FISTULA IN ANO, WITH A FEW which has ever been propounded for the application of remedies to disease.

Its positive benefits are beyond the powers of human computation, and it is more than possible that its negative benefits have been of equal magnitude.

Through the whole world of Therapeutics it has exercised a power as subtle and as insensible as the power of gravitation, but the results have been as tangible as the piling up of the mysterious tides of the ocean. It has made obsolete the old-fashioned murderous deluge of drugs.

It has dried up the rivers of blood by which the medical profession so short a time since robbed the people of

health and life.

PRACTICAL REMARKS REGARDING THE SURGICAL OPERATIONS FOR ITS RELIEF ; AS ALSO THE ACTION OF SPHINCTER TERTIUS DESCRIBED BY HYRTL. By T. G. COMSTOCK, M.D., ST. LOUIS, MO. Cases of fistula in ano, or more correctly fistula in recto, occur so frequently in surgical practice, that I shall take occasion to call the attention of the profession to a few particulars regarding the surgical anatomy of sphincter muscles.

Vienna, while attending the lectures of Prof. Hyrtl, I Some years ago, when a pupil of the University of It has so modified the medical body entire as to have first learned the existence of a Sphincter tertius. It is refuted or removed the old charge that the medical proremarkable that this sphincter is not mentioned by Gray fession as a whole are more destructive to life than sav-action is really that of a sphincter) does exist, is to me a or other English anatomists. That such a muscle (whose ing of it.

Let the old school of to-day study a mirrored likeness of itself, and place beside it a faithful portrait of its late father, taken not longer than twenty years ago I remember him well-and it is not unlikely that diligent search would be made for "the connecting link."

The truth is, the old school has unwittingly absorbed much of the usage of Homoeopathy, and is now, to a greater or less extent, accepting its principle; and so certainly as the principle is true, the day is at hand when the entire medical profession will recognize its full value and will employ it so far as it proves useful. This hour is near, and before it comes it is well that we should clearly define and put on record the position which we hold, and always have held, in the history of medicine. We distinctly state that we have never resigned any department, or any portion of a department, in the science of medicine. We claim to be the legitimate representative of all past medicine, differing from no other regularly educated medical scholars, except in that we have added to the body of medicine the vast resources of Homœopathy.

-Ali the truths, all the uses, and all the glories of medicine, from its pre-historic birth down to the present moment, belong to us by inheritance, and we have never forfeited or signed away our rights; and we proclaim by word that which our acts proclaim, that there is nothing of use in any department of the whole domain of medicine which we are not willing to adopt, and that openly; nay, more, we consider such to be our solemn duty, in the violation of which we would betray the most sacred keeping ever entrusted to man.

We hold it to be a self-evident proposition that no one part of the unit Nature, or its laws, can be set forth as perfect except as it assists to compose the unit.

matter of no doubt; and if such were not the case, the ters), would be followed by very unpleasant consequences radical operation for fistula (dividing the lower sphincfæcal evacuations. That such an untoward result for-in other words we should have as a result, involuntary tunately does not often occur, every experienced surgeon knows, but the reason for this we shall give by quoting the following, which we have translated from Hyrtl's Anatomy.*

vided the sphincter muscles in operations for fistulæ, "The older surgeons were astonished after having dithat no involuntary discharges of fæces followed. Faget found after removing the lower end of the rectum from a patient, that he could retain his fæces and flatus, and he explained this upon the hypothesis that a new sphincter must have subsequently formed. Houston was not diswhere a fold occurs as it passes through the pelvic inclined to believe that the lower portion of the rectum, fascia, was surrounded with a development of circular fibres. Lisfranc, who many times extirpated the terminal portion of the rectum, noticed that such patients stools, and declared it as his opinion, that as a positive were not deprived of the power of holding back their necessity a superior sphincter must exist. Likewise every unprejudiced observer must allow of the exist ence of such a muscle, for the reason that in prolapsus ani, where both the external and internal sphincters are paralyzed, no involuntary stools occur.”

of the rectum into the vagina (cloaca) the same thing "In rupture of the perineum and congenital opening happens. Ricord cites the case of a woman, æt. 22, where the rectum opened into the vagina, yet the bow

*Handbuch der topographischen Anatomie, Von Josef Hyrtl, Zweiter Band, p. 141, 5te Aufage, Wien, 1865.

els acted regularly, and what is more remarkable, the husband, after having been married three years, had no conception of this abnormal condition of his wife."

essay, but the facts adduced by Hyrtl are undoubtedly true. I was called in consultation in May last to see a gentleman, who, to avoid a collision, jumped from a When the index finger is introduced into the rec- railroad train going at the rate of forty-five miles an tum of a patient who has had no action from the bow- hour; he struck with great violence upon the end of a els for a few days, as a rule, just above the anus, no railroad iron, which seemed to have raised up, and fæces will be found, and yet the column of fæces would which penetrated him in the region of the perineum. naturally sink down to this point, if not held back by The injury was so great that it seemed almost as if he an opposing circular muscle. Kohlrausch opposed this was cleft in twain; suffice it to say, the lower end of the view, which presupposes the existence of a third sphinc- rectum was so contused and injured that it sloughed ter, because he found upon dead subjects, as well as in away. Fortunately the patient had, a short time prepatients, hard scybala in the lower portion of the rec- vious to the accident, passed a large stool, and notwithtum; but I take occasion to mention that the existence standing the severity of the shock and loss of blood, of fæces in the rectum upon subjects, simply proves with the subsequent surgical fever, he had no operation that the sphincter tertius no longer acts, and the same from his bowels for some seven days. This gentleman thing in the living (in patients) may be the result of dis- has recovered, but the lower portion of the rectum is eased conditions, and which affords an example of an quite gone, and yet he can control his stool. Is not this exception to the rule. Enemata which are not intro-an instance of the existence of Hyrtl's sphincter? When duced high enough into the rectum, are liable to come we have a fistula of the rectum, why is it necessary to away immediately; on the contrary, if the canule [ex- divide the sphincter in order to enable the parts to heal? tremity] of the syringe is pushed up sufficiently high 1st. Because all efforts at healing, as a general rule, the injection will be retained a longer time. Dr. O'Beirn fail, unless we can expose the pyogenic membrane called attention to the fact that an elastic tube can be which often lines the fistulous tract. 2d. The healing introduced quite a distance into the rectum, before any process is prevented by the constant motions of the flatus is given off, and then the discharge comes sud-sphincter and levator ani muscles; because with every denly. All these observations make it probable, à priori, act of respiration they contract, and thus prevent healthat at a certain distance above the internal sphincter ing; and to do away with this effectually we must make ani, a third sphincter must exist. Nelaton and Velpeau a section of the sphincter. Occasionally cases are rehave demonstrated the existence of it as a thickened ported where a cure results without dividing the sphincband of muscular fibres, four inches above the anus. This muscular development is not always easy to find. To find it upon the cadaver, care should be taken that the rectum is not forcibly distended with air."

ter.

Sir Astley Cooper mentions two cases; Ashton* mentions several in his large experience; Dr. Ordway, of Boston, reports that he has cured many cases by injec "In order to demonstrate it well, the rectum should tion with sesqui carbonate of potash (vegetable caustic); be cut upwards longitudinally and stretched upon a however, such cures are, in the experience of the profesboard, and the several layers carefully dissected off, sion, exceedingly exceptional. In my own experience until the muscular layer is reached, when the sphincter I know of only one case thus cured: It was a clergytertius, if present, will be seen as a broad bundle of man, who refused to be "cut," and after one year rethickly conglomerated muscular fibres. Not unfre- ported to me that he was cured by injections and pressquently this investigation will be fruitless as a result, ure combined; the pressure was by means of a combut the physiological fact that there are developed mus- pressed sponge introduced from time to time within the cular fibres encircling the rectum at this point is not to anus. Patients fear the knife, and willingly resort to be doubted. In one instance I have publicly demon-salves for relief, and in this respect history repeats itself strated the existence of the fibres of the sphincter ter- for the past two hundred years. Louis XIV., King of tius taking their origin from the sacrum. France, was so unfortunate as to be afflicted with a "This third sphincter does not permit the excrements fistula. His medical attendant seems to have been a (fæces), which are in the sigmoid flexure, and are press- real practical surgeon, versed well in surgical pathology, ing down, to reach the lower rectum. Only when the as well as therapeutics. He diagnosticated the ailment desire for an evacuation exists does it relax and allow of the King, and informed His Royal Highness that the the fæcal column to come down on to the lower sphinc- cure could be accomplished only through a surgical opters. These latter can voluntarily keep back the stools eration. The King was very shy of being cut, and as for a long time, and are assisted in their efforts by the various methods of treatment had been proposed for levator ani muscle, as likewise by the buttocks (nates), | him, "without any resort to the knife," he was shrewd firmly pressed together, so that when one is unfortu- enough to object to have them tried upon his own Royal nately in such a critical situation, (for obvious reasons), person, until he should have seen their good effects upon he takes care not to take long steps, or to run. At last others; and he accordingly ordered a number of his subthese muscles, from having such an unusual strain upon jects suffering from fistula to be treated in accordance them, become paralyzed, and then follows what, under with the different plans which had been suggested. such circumstan ces, is, of course, unavoidable. When Among other cures, the mineral springs of Barége, as the lower end of the rectum is removed, or the sphincters also the waters of Bourbon, were proposed, and to these are divided, as in the operation of rectal fistula,' then springs he sent the patients accompanied by a physician, the patient will not be afflicted with the most hopeless whose province it was to observe the results of the and disgusting of all ailments, viz., involuntary stools; drinking of, and the bathing in the waters, as well for when the slightest desire for a stool is experienced, as the injecting of the same waters into the fistulæ. Afand the upper sphincter is relaxed, the evacuation below ter some months, these invalids were all brought back is being accomplished, because simultaneously the two to Paris, and the fistula were nearly as bad as when they lower sphincters will involuntarily be relaxed." went thither. Next, chambers or wards were fitted up at royal expense, and the patients with fistula were there carefully treated in accordance with the various methods of cure of pretenders, who recommended ointments, salves and solutions for injecting, as likewise internal medication. A whole year was spent in this way in experimenting, but not one of the patients was cured by any of these means. At last the king gave in to his sur* Fistula in Ano, and Hemorrhoidal Affections, London, 1873. + Boston Medical and Surgical Journal, vol. 99, p. 657.

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I should perhaps mention that Dr. James R. Chadwick, of Boston, in a very elaborate article,* regards the sphincter tertius as a collection of constricting bands, and a part of the general circular layer of muscles, whose function is to dilate before and contract behind the scybala, thereby propelling them on their way, and not retarding them." He proposes to call this sphincter a Detrusor facium." I did not intend to discuss Dr. Chadwick's Transactions of the American Gynecological Society, Vol. 2, p. 43. Boston, 1878.

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Fistula of the rectum may occur in the young or old, and may accidently happen to those leading a pure and regular life; but high livers and those who are intemperate are especially liable to them.

The following case came accidentally under the attention of the writer: In August last, while on a visit at Le Roy, N. Y., I was consulted by Miss a young lady æt. 26.

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good-sized silver probe; then the probe, armed with the ligature, is introduced into the fistula and pushed into the opening in the rectum, and brought out through the anus; then the two ends are passed through a little leaden ring (not unlike to a good-sized buckshot with a hole through it), and stretched to its maximum tension, then the ring is crushed or clamped with strong forceps or pincers in such a wise that the fistula is included or strangulated within an elastic noose, and this tension steadily maintained until the ligature in time performs the part of a knife by cutting through the sphincter, when it is discharged. This new method by the elastic ligature has not only the sanction of Dittel the inventor, but of Allingham and Sir Henry Thompson.*

I returned to Le Roy with the patient, and, assisted by Dr. R. Williams, proceeded to make the operation, September 26th, 1878. The bowels were evacuated early She informed me that some eighteen months previous in the day with an enema, and Dr. Williams adminis ly, from the effects of a fall, she had suffered from an tered to her, by inhalation, a mixture of three parts of abscess in the ischio-rectal region, which had finally ether to one of chloroform: she soon came under its interminated in a double fistula. For this affection she fluence, when I introduced an elastic ligature into each had been to a "Cure" for five months, and was there sinus, and passed them through the common opening treated by the lady physician in charge, who had im- into the gut; the ends of each were then brought through proved her general health very much, and had endeav- the ring of lead and each one separately clamped, as I ored to heal the fistula by various injections, and other have above described. The patient, although delicate applications, but without effect. Upon examining the and nervous, had no untoward symptoms after the opecase, I found two fistulous openings upon each side of ration, with the exception of a diarrhoea on the fourth the posterior commissure of the vagina, extending into day, which soon subsided. One ligature cut through on the rectum. I introduced a probe into one opening, and the eighth day, and the other ligature on the tenth day. found a fistulous tract terminating in the rectum, at a The patient was quite comfortable through the whole distance of over two and one-haif inches above the anus. time of treatment, excepting the slight looseness of the I then introduced a second probe into the opposite open- bowels above mentioned, and made a rapid recovery. A ing, and succeeded in passing it through the tract of little fiap or cleft made by the division of the sphincter the same opening also into the rectum; with one index did not entirely heal for some weeks, bnt she always had finger in the rectum, I made the end of each probe imperfect control of her bowels, and at this time, three pinge upon it. Here, then, was a double fistula with months after the operation, she is quite well.

After the

one common opening in the rectum. After this diag-operation, I was obliged to return to St. Louis, bnt left nosis, I announced to the young lady's mother that her the patient in charge of Dr. R. Williams, a resident pracdaughter's ailment could be easily relieved by a sur-titioner in Le Roy for twenty-five years past, and to whose careful attention the favorable issue of the case is gical operation, the nature of which I explained to her. Several objections were made to the operation, and I not a little due. was solicited to try and cure it by other means. The first objection was that such an operation was not approved of by her last medical adviser, who proposed to cure the fistula by placing the patient under the influence of ether, and then forcibly distending the sphincter to paralyze the same. and afterwards to treat the fistulous tracts by injections, and thereby hoped ultimately to affect a cure.

I am quite certain that experienced surgeons will not give up the knife for the elastic ligature, and the writer of this does not wish to be considered as recommending it above the knife; but it certainly has its advantages, and these I shall take the liberty to enumerate. SUMMARY OF THE ADVANTAGES OF THE ELASTIC LIGA

TURE.

2d. Her last medical adviser regarded the patient as 1. Applicable as a substitute for the knife when pa"a bad subject for the healing process, should any sur-tients are delicate, timid, possibly phthisical, and posigical cutting be done." tively decline "to be cut."

3d. The patient herself objected to the knife. As I had firmly stated that no cure could follow any procedure whatever short of a radical operation, and as the patient was a near relative of mine, and therefore feelings of delicacy were involved in the matter, I proposed that the young lady and her mother should accompany me to Bufialo, to consult Dr. J. F. Miner.

They accordingly did this, and Dr. Miner was consulted Sept. 23d, and he quite agreed with me in the diagnosis, and approved of the treatment as above proposed-in other words, Prof. M. said "it was a case to be treated in accordance with the principles and prac tices of surgery," that the pyogenic surface of the fistulous tracts should be freely and completely exposed, and incised into the common opening in the rectum, and the sphincter divided. As the patient had at all hazards objected to the knife, as a substitute, I suggested to Dr. Miner the feasibility of operating by ligature, to which he assented. The principle of this operation by ligature is as old as Hippocrates, who used the seton in fistula. For improvements in the use of the ligature, we are indebted to Dr. Dittel, of Vienna, who first proposed the elastic ligature, which is made of india-rubber, the size of a small whip-cord. The end of the ligature is split with a pair of scissors; then it is threaded in the eye with a

2. Appropriate when the opening in the gut is situated unusually high up.

3. Operation followed by no hemorrhage.

4. Patients not necessarily confined to bed after the operation, but may go in the air, and in some instances, even pursue their ordinary avocations.⚫

5. Little suppuration after the operation.
6. Recovery usually rapid.

7. Operation in many cases may be performed at the surgeon's office, and patient get up from the operating chair and go home without discomfort.

Lastly, Dr. Wm. Allingham says: "I do not consider that the elastic ligature can ever supplant the knife in the treatment of fistulous sinuses. In complicated cases the knife must be depended upon mainly, but I am of opinion that the india rubber ligature is valuable in many cases as a substitute, and in others as an auxiliary, to the usually employed method of excision."

*See Braithwaite's Retrospect, Part 69, 1875, pages 108 and 179; also Part 78, page 268; also Elastic Ligature in anal fistula. Directions for its Use, by Allingham.--Phila. Med. and Surg. Reporter, vol. 33, pp. 153 and 110.

Having given my reasons for using this ligature, sup ported by surgical authorities, I accordingly made trial of it in this case,

ACUTE PERITONITIS AS A RESULT OF TRAU-
MATIC INJURY.

BY GERTRUDE A. GOEWEY, M. D., OF ALBANY, N. Y.
January 31st, was sent for in great haste to see Mrs. S.
age 28, mother of two children, who was evidently suf-

fering from acute peritonitis, the result of a fall two

weeks previous.

Upon seeing the patient, I obtained the following his tory. Patient fell upon the sidewalk, which was covered with ice, striking upon the left side of abdomen; was picked up unconscious and carried into the nearest house. Physician sent for; became conscious after two hours of rubbing and bathing, with applications, of the usual restoratives, and then taken to her home.

Two allopathic physicians had prescribed for the patient. The last one called had ordered the day before, a hot-bath.

The patient was put in a tub of hot-water, and she said she thought she would expire in the bath. The following night was taken with a severe chill, nausea and vomiting, followed by sweat, and fever; colic pains, which were persistent and continued up to the time of my visit. I found her moaning from the severity of the pain, lying with her shoulders raised, thighs flexed upon the abdomen, limbs drawn up.

Countenance exhibited the greatest anxiety; large drops of sweat upon the forehead. Pulse, 180, heart, rapid, thready. Respiration thoracic, and forty to the minutes. Temperature 105°; skin hot and biting to the touch.

street cars,

Upon examination, I found the whole pelvic region BO sensitive, that she was not able to bear the least pressure of my hand, the most sensitive spot being on the left side, just above the symphysis pubis. Tympanites slight. Could not bear the weight of the bed-clothes, the least jar of the bed, or, walking across the room; even the noise of the and carriages annoyed her. I attempted to make vaginal examination, but had to desist; the least disturbance of the pelvic organs elicited pain. I was, however, satisfied that the uterus was prolapsed and lying upon the floor of the pelvis. Patient said that ever since the fall, she had felt as if everything was protruding from the vulva, or as if the parts were all open, and the pain had been similar to labor-pains.

She had had hemorrhage from the time of the accident until, after the hot bath, the flow was checked.

For ten days had a thin, watery diarrhoea. Had not urinated for twenty-four hours; passed the catheter, and drew about two gills of dark colored urine. Patient had slept very little for a week, and taken very Little food since Sunday, and this was Friday. I applied hot | fomentations to the abdomen of cotton batting, covered with oil silk, to retain the heat longer, and ordered them to be renewed frequently. Gave Bell, and Aconite.

At four o'clock, P. M., was sent for again. Patient being in great agony on account of the severity of the pain. Pain had not ceased for an instant during the day, consequently she was much exhausted, with great

mental excitement.

Feb. 1st. Patient had slept some through the night tympanites increasing; nausea and vomiting, with frequent desire for stool, the passages being serous, affording temporary relief of the colic. Urine passed involuntarily during the night. Continued the applications to the bowels. Temperature, 104°; pulse, 120. patient so weak that I feared she would expire before morning. Ordered beef tea.

Called again at 9 p. m.; temperature, 1044°; pulse, 130;

Feb. 2d. Found my patient so weak as not to be able to raise a hand. Could only speak in a whisper, and complained of pain in left arm; ro feeling in it; seems as if paralyzed. Had fainted during the night, and again this morning. The soreness was a little less, and could bear the pressure of my hand without causing intense pain.

Tympanites still increasing; the bowels presented a puffy appearance, with great tenesmus and desire for stool, evacuations muco-serous. Temperature, 1034°. I insisted upon her taking all the beef tea she could, which fortunately she retained; milk disagreed. In the evening found my patient a little stronger; had slept two hours, and seemed brighter. Temperature the same as this morning.

Feb. 3d. Patient had passed a very restless night in now complained of pain in her head for the first time. consequence of one of her children being sick. She Tongue coated dark brown, with great distress in the bowels and rectum, evidently from the accumulation of

gas

in the intestines.

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This no doubt was the cause of the great distress she complained of. I introduced the nozzle of Davidson's syringe into the rectum, which gave relief. This was frequently resorted to in order to relieve the patient of the accumulation of gas.

There was constant thirst, and fever higher than yesterday. Urine passed involuntarily. Patient began to be alarmed. I still insisted upon her taking beef tea, and in the evening, to my great delight, found her better. Temperature had decreased; pulse stronger.

Feb. 4th. She had slept several hours during the night, and now, for the first time, could extend her limbs, although she felt more comfortable in having them flexed. Soreness was much less except at the one spot before mentioned; used the catheter; urine not so high-colored. Tympanites decreasing. The colic pains had somewhat subsided.

The temperature was 102°, and I felt encouraged. She had taken a cracker with her beef tea. I now ordered eggs and soup. In the evening found her about the same; had slept two hours, and to all appearances was improving.

Prescribed Opium every fifteen minutes until relieved. and applied flax seed poultices mixed with a little lard to keep moist longer, but so great was the heat of the abdomen, that notwithstanding the paste being medium thick, it was dried to a crisp, in less than twenty minutes. And as before I had them renewed frequently. She did not feel the moisture of the paste, but simply the press-midnight and prevented sleep.

ure.

I remained with her two hours, until she was somewhat easier and promised to call in the evening.

Visited her again at 9 P. M. Had slept fifteen or twenty minutes at a time was a little more comfortable, as far as the pain was concerned, but the least effort of talking would bring it on again.

Gave one power of morphine, and continued the Aconite and Bell.

Feb. 5th. Early in the morning was sent for; the pain in the bowels had returned, and my patient was very much exhausted. Her countenance was pale and pinched; large circles under the eyes. Had refused the beef tea on account of nausea. The pain had returned soon after

Upon questioning her she said her husband had given her a small piece of toast, to which I attributed all this trouble. I attempted to give her an enema of sweet oil with a few drops of opium, but found she could not retain any of it. I then applied hot cloths to the small of the back, as the greatest distress was in the rectum, and soon found that the applications relieved her. She fell asleep during my visit. When I called in the evening I was told she had slept two hours or more without

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