shallow and movements from the rectum were sufficiently frequent, though there was also leakage through the small abdominal opening.

February 15 the weather became very damp and the patient took a severe cold which greatly prostrated her, obliging her again to take her bed. She became nervous and hysterical, even delirious and unable to sleep night or day; laryngitis with aphonia and bronchitis followed, the function of her kidneys became impaired, nausea and vomiting became uncontrollable, then came uræmia with suppression of urine and she died exhausted just ten weeks from the day of the first operation. Her friends positively forbade an autopsy and the clinical history alone can be available as to the lesions of her kidneys and lungs.

Many interesting reflections are suggested by this case, the tolerance for the foreign body during so many years while disintegration and absorption were constantly going on, the shelter or nest which the intestinal walls furnished with the thinnest possible layer of new tissue intervening, the immediate occurrence of sepsis when this protecting wall was broken and immediate communication with the intestine was opened, the comparative facility with which such bodies may be removed when the preliminary difficulties of approaching them have been overcome, etc. The condition which is illustrated by this case is by no means new to medical science. As early as 1679 a small book was published in Paris giving an account by De Bligny of a case of extra-uterine fœtation continuing 25 years.

In 1767 a quarto was published at Heidelberg by Nebel, giving an account of foetal bones which had been retained in a woman's abdomen 50 years. Other cases have been reported in which the fœtus was retained even longer than 50 years, the condition having been suspected and, in the lapse of years forgotten, the health of the patient not being affected. It is not of infrequent occurrence that normal pregnancy should take place, once or oftener, from beginning to end, while the extra-uterine foetus was also present, demonstrating the accommodative adaptation of nature to unusual conditions.

Not a few cases have been reported in which after a period of more or fewer years the disintegrated portions of the fœtus were expelled through a fistula in the rectum, the perineum, the bladder or the vagina. An interesting case of that character was re

ported in 1846 by Yardley* in which Drs. Hodge and Horner of Philadelphia were the consultants, the foetal elements being removed piece by piece as they presented themselves at the rectum and perineum, during a period of several months, until all had been discharged. The patient subsequently made a good re

covery.

A case is reported by Mounaly (Philosophical Transactions, London, 1743-50, XI., 1012) in which it is said a cure resulted after the removal from the Fallopian tube of a fœtus which had been retained 13 years. Unfortunately the original report was not accessible so that it is impossible to determine the method of removal or any other details. Küster reports a case (Gazette Obstétricale, Paris, 1876, V., p. 86) in which the clinical history was somewhat similar to the one which is reported in this paper, but in which there was an intercurrent attack of pyæmia. After the fœtus had been retained 27 years fragments of bone began to come away through a fistula in the rectum. Küster then enlarged the fistulous opening and removed the remaining portion of the foetal skeleton through this opening, the patient recovering.

The only reported case which I have been able to find which resembles mine in the removal of a long retained foetus by abdominal incision is reported by A. Martin, in which he removed by abdominal incision a fœtus which had been retained 12 years, the woman recovering. The other details of this case I have not

been able to obtain.

New York City.

PERITONEAL IRRIGATION AND DRAINAGE.

A. H. CORDIER, M.D.

Professor of Abdominal Surgery, Kansas City Medical College.
Concluded from last issue.

Some operators have endeavored to inaugurate an ultra-refinement in the indications for the use of drainage, and have advised the surgeon to have constantly present at his sections an experienced bacteriologist who, with sterilized platinum wires, glass cov ers and an oil emersion lense will quickly mount, stain and ex

* American Journal of Medical Science, 1846, Vol. XI.,

p. 348.

amine any suspected fluid or tissue for pathogenic micro-organisms. The operator, if his work is finished before the germs are discovered, or the number of neighborhoods estimated, will wait with fear and trembling for the verdict as to whether he is to introduce the drainage tube or close up, and let nature battle with a few staphylococcus or streptococcus settlements, and if the patient dies he will console himself and the friends of the departed with the assurance that it was a dispensation of the good and allwise Providence. I would advise, when in doubt as to whether to drain or not to drain, in a given case, to introduce the tube. Bacteria may not be discovered in a fluid taken from one part of the pelvis, yet in another location, within an inch of that one, myriads of pyogenic germs may exist.

Much better a drainage tube in the hands of a well trained operator than a microscope in the hands of a bacteriologist.

If 20 per cent of the cases of diseased uterine appendages, and a large percentage of cases of peritonitis be due (as is claimed by some who oppose the use of drainage) to tuberculosis, I cannot understand why drainage should not be used in every case where such a diagnosis is probable, especially in the modern recognition (1862 to 1898) of the curative effects of drainage in tubercular peritonitis.

Aseptic fluids do no harm if absorbed, but it must be remembered that a peritoneum from which a large growth has been removed, or one that has sustained much traumatism, will not absorb rapidly, but will be disposed to give out much fluid, which, if left in the vicinity of the intestines to become stagnant, will, in all probability, become septic by bacterial invasion from this canal. If any pus-forming agents are introduced during the operation, or even if some are already present in limited numbers, the presence of much blood in the peritoneal cavity prevents to some extent the absorption of these pathogenic bacteria and their destruction by the phagocytes, and thus being allowed to remain they rapidly multiply in this fertilized hot-bed, paralyzing this function of the white cells by overwhelming numbers, attacking the peritoneum, producing a rapidly fatal peritonitis in the majority of instances. If this truth is accepted no surgeon should fail to irrigate and drain after an operation for the removal of pus tubes, dermoids, etc., or where there was much diffused blood during or following an intra-peritoneal operation. A peritoneum cannot