LONDON: S. C. NALEY, MANAGER, 139-143 OXFORD STREET, W. No. I. but so soon as I place my fingers there I find a doughy sensation; that is, a feeling as if I were pressing on a lump of dough, very different from the peculiar rolling sensation experienced on pressing upon the abdomen in its natural condition. There was pain there on Saturday when I placed my fingers with only slight pressure there, but now there is almost no pain on pressure. On Saturday, after he was shown to you, he began to get better, and on Sunday he got suddenly better. In this case we never had total obstruction of the bowels; the man was always able to pass wind, and an injection was always followed by a good passage. In bad cases of typhlitis, where the obstruction is complete, you may give injections, and after getting away what is in the lower part of the bowels you get nothing further away. In cases of this kind, if the patient continues to pass wind, I think I should never summon the surgeon to help me in the case, but where there is complete obstruction, you should always see what can be done by a surgical operation to help the patient. The usual effect in intussusception is a complete obstruction of the bowel, and the usual place for intussusception to occur is at the ileo-cæcal valve. To recapitulate: the man is an Italian thirtyseven years old; he had been working in Washington, where he was attacked with diarrhoea ten days before admission, and four days before admission he had severe pain in the hypogastrium or right iliac fossa. He had no cough, expectoration, or hemorrhage. His heart was normal, and the lungs gave no abnormal sign on physical examination. We gave him a pill composed of extract of belladonna one-eighth grain, and opium one-half grain every three hours. He had little or no fever prior to coming here, and has had little or no fever since his admission to the hospital. When he first came in his temperature was 101° Fahr., Intussusception you know is a sliding of one but for the last two days it has been below portion of the intestinal canal within another normal. I showed you, I think, on Saturday portion, an invagination, and in some cases the last, that there was quite a good deal of swell-tumor formed by the invaginated portion of ining in the right iliac fossa; also, I showed you that the abdomen was filled with wind, unmistakably tympanitic. This morning there is, of course, some tympanitic resonance in the abdomen, but no more than natural. There is still dullness in the iliac region, and in every region except there the abdomen feels natural, testine has even presented at the anus, so great has been the amount of invagination. The usual symptoms of intussusception are that you have a tumor at the point of invagination, pain in the abdomen, and complete obstruction of the bowels followed by fecal vomiting. In these cases surgery, owing to the very |