the eternal truth of nature, bringing them at the same time into still higher experiences of sympathy and charity toward all mankind. Now, a faithful discharge of these high trusts will alike entitle you to the approving smiles of heaven and the lasting gratitude of your fellow-man.

STRICTURE OF THE RECTUM-A CASE - OPERATION. Read before the Tri-State Medical Association, Nov. 10, 1886,

BY B. G. HENNING, M.D.,

Professor Materia Medica, Therapeutics, and Clinical Professor of Diseases of the Rectum, Memphis Hospital Medical College.

MR. PRESIDENT AND GENTLEMEN-Permit me to occupy a brief portion of your time with the report of a case of stricture of the rectum which recently came under my observation :

Mrs., aged thirty, the mother of two children, one born 1877 and the other in 1878. Her health had been good until 1876, at which time she contracted syphilis, and had the various manifestations of its constitutional effects, but under judicious treatment regained her usual good health, and gave birth to the above mentioned children, both of whom died in early infancy. Just preceding the birth of her last child, she was attacked with a troublesome cough and diarrhoea, for the relief of which she applied to a physician, who informed her that she had consumption. After her confinement the cough disappeared, and the diarrhoea was superseded by a nocturnal dysentery, attended with a deep distressing pain in the rectum, commencing in the evening and abating only with the approach of day. That distressing condition lasted about a year, when she began to improve in every respect, and had fair health until 1882. At that time the dysentery and nocturnal pain in the rectum returned with even more violence than ever before. She then noticed that the fecal matter discharged was shaped (to use her language) like a tapeworm, flat, ribbon-like. In 1884 she applied to Dr. W. B. Rogers for treatment, who, after an examination, for the first time informed her of the presence of a stricture of the rectum. He insisted upon the importance of an operation, but she refused to be operated upon, and returned home

determined to live out a brief but miserable existence, and so remained, becoming day after day more emaciated, unable to eat and digest barely a sufficiency of food to sustain life.

In March last she again sent for Dr. Rogers, who found her reduced to almost a living skeleton, unable to have an action from the bowels except with the greatest difficulty after large and repeated enematas. A rectal examination revealed a stricture about two inches up the bowels, which would not admit the point of the index finger. In connection with the stricture there were three fistulas, one opening in the floor of the vagina and the others on the nates two or more inches from the anus. Internal proctotomy was performed by Dr. Rogers, in which the entire stricture tissue was divided posteriorly by a deep incision, not severing the sphincter, and iodide of potassium and bichlo. of mercury in combination prescribed. After this operation she improved rapidly, regaining her uniform good health, and having daily healthy, easy actions from the bowels; and had it not been for the remaining fistula, would have considered herself again a sound woman. No dilatation was kept up after the operation.

In May last, about two months after the division of the stricture, I was called to treat her. I found that the stricture had contracted again so as not to admit the end of the index finger, and was as hard as a piece of cartilage. She was again annoyed by obstinate constipation, and alternate attacks of diarrhoea and tenesmus, and géneral gastro-intestinal disturbance, pain and emaciation. I performed external proctotomy, in which not only all the stricture tissue was divided, but the sphincter and integument, from the anus to the tip of the coccyx, were cut through in the median line, forming a triangle with the base downward and the apex above the stricture in the rectum. After the operation, the touch of the finger introduced, revealed a large pouch above the stricture, with thickened walls from which the fistula emanated. Only a moderate amount of hemorrhage followed the operation, which was easily controlled by tighly packing the rectum with cotton. No attention was given to the fistula.

On the day after the operation a part of the packing was expelled in the act of defecation, the remainder removed and the rectum washed with a syringe. No further attention was given to the incision, but a rectal bougie was introduced every alternate day. The patient still uses the bougie as ordered, which is a wax candle properly shaped. An examination was made on Tuesday last, and the stricture still admits the passage of the candle, the dilated pouch is contracted to its normal size and the fistulas are all healed. The patient claims to be in perfect health in and about the rectum.

There are a few features of this case of especial interest: One is, that the pains in the rectum were not only characteristic of syphilis, i. e., nocturnal, but that the dysentery manifested itself only at night; and another is, that the fistulas all healed without any surgical interference immediately after the operation or division of the stricture and sphincter, which can be accounted for only, by the contents of the rectum, in the absence of a contracting sphincter, having a free and unobstructed outlet. If that be so, why may not many of the complete simple fistulas in ano, in which there is so much tissue between the anus and its external opening, to be divided in the usual operation, be cured by simply dividing the sphincter in the median line posteriorly, and giving free vent to all fecal matter? I wish also to call your attention to the improvised bougie used in the case, viz.: a wax candle, which I assure you is a most excellent instrument, hard, round, smooth and easily cleaned with warm water; can be shaped with a knife to suit the case. Lastly, why was external proctotomy performed in preference to internal? The answer is that it provides for free drainage and discharge, and therefore is less dangerous than the apparently simple division of the stricture; it also does away with the contractions of the sphincter muscle, which plays so important a part in the suffering in severe cases of ulceration and stricture of the rectum. The operation of nicking and dilating so hard and cartilaginous a stricture would have been impossible.

Now is the time to renew your subscription to the MISSISSIPPI VALLEY MEDICAL MONTHLY; Vol. VI closes with this issue.

HYDROPHOBIA..

Read before the Tri-State Medical Association, Nov. 10, 1886.

BY W. A. HARRIS, M.D., SOMERVILLE, TENN.

Ben. Franklin, an intelligent and well-grown boy, nine and a half years of age, son of Dr. Franklin of LaGrange, Tenn., was bitten July 7, 1884, by a dog supposed to be mad. The dog was a common cur; was not known to have been bitten, and soon after biting the boy was killed.

The boy was bitten on right cheek under the eye, and on the right hand in three different places, and on the fourth and middle finger of the same hand. The wounds on hand and fingers were severe and bled freely, the bleeding being promoted by sucking and free applications of warm water. No caustic applications were used. The wounds healed readily, and no further inconvenience resulted until Tuesday, the 9th of September, about two months after the injuries had been received, when, in assisting to freeze some ice cream, he complained of pain in the right hand and arm, which soon extended to his shoulder and neck. He was not, however, disposed to attribute the pain to the exercise, saying he had felt it occasionally for a day or two in his arm and wrist. Still this was not sufficient to detain him from school or his accustomed play. At this stage it was observed that he was nervous and restless at night, and complained of being disturbed by bad dreams, and suffered some annoyance from itching in the cicatrices. On the following Thursday night he had fever, and later in the night he experienced difficulty in swallowing water. On Friday evening his temperature was 100, and pulse 112; tongue slightly coated. He was disposed to converse freely, answering all questions with readiness. Said, after an injection of morphia, that he felt all right, and but for the choking feeling when attempting to swallow water that he would be well. September 13, his temperature and pulse were about the same as on the preceding day, pupils slightly dilated, with an anxious, uneasy expression of countenance when not engaged in conversation; right eyelid slightly drooping; no headache; skin moist; respiration somewhat hurried, about 25 to 35; more nervous and restless; the

least noise alarmed him; still complained of itching pain in the cicatrix, and a swollen feeling in the back of his neck and throat; his right hand partially paralyzed; no difference in sensation of right and left side. He showed no fear of water when placed before him, but when requested, sat up in bed, took the cup in his hand and attempted to drink, but the effort invariably provoked the characteristic spasm of the pharynx and esophagus, causing more or less strangulation and exhaus tion. He was able to take occasionally a small quantity of water through a straw, but these attempts occasioned such frightful convulsions that they were finally, at his own urgent request, abandoned, and to allay his thirst, small pieces of ice were substituted. As the day advanced the paroxysms became more frequent and more distressing, the slightest noise, a draught of air, or touch, provoked them. In the evening, temperature 101, pulse 120; skin dry and hot, with frequent desire to urinate; urine scant and voided with difficulty; abdomen flat and hard. During ensuing night he took short naps, the paroxysms occurring occasionally during sleep, accompanied by a short, croup-like noise which awakened him.

Sunday morning, September 14. All symptoms very much aggravated; right arm and hand entirely paralyzed. When assisted across the room dragged the right foot, which, he said, felt two inches short; tongue and mouth covered with a viscid, tenacious mucus, which he constantly attempted to spit out or wipe off; complained of oppression in the upper part of his chest; spasms returned without any apparent exciting cause, and extended to the diaphragm ; sat up in bed and ate with some effort part of a chicken gizzard and piece of biscuit softened with gravy. The mind, which up to this time had been remarkably clear, now became subject to slight or passing hallucinations. Toward evening the countenance assumed a dusky hue and more anxious expression, and he kept in constant motion; talked incessantly, begged to be moved from room to room and from one bed to another; pulse 144 and becoming weaker; temperature 104; skin cool; frothy saliva poured from his mouth constantly. The saliva, mingled with quantities of bloody mucus, so accumulated, that it was