entered the aorta, and was probably deflected by the semilunar valves. When this occurred, syncope, which was all but fatal, ensued. This complication had not occurred in the few cases previously recorded.

The supposition that hemorrhage might ensue upon the prolonged retention of a canula in the sac wall is unfounded; such a result has not occurred in any of the reported cases. Embolism did not occur, although a loop of wire projected into the aorta.

With regard to the prospects of a radical cure offered by the operation, the physical signs did not indicate the existence of organizable coagula before surgical interference was undertaken. After the operation, the physical signs indicated the beginning of an attempt at radical cure. As to the material used, the author thinks, after reviewing those employed in the past, that faith should be pinned to horse hair, rendered aseptic, as it is easily passed through a canula, and in large quantities it coils readily and is easily compressed.

The first case of the introdution of a forforeign body into an aneurism, was reported by Mr. Moore, of the Middlesex Hospital, in 1864. Twenty-six yards of fine iron wire were introduced into a thoracic aneurism. The patient died on the 5th day. The operation was repeated in March, 1871, by Dr. Doinville, and by Mr. Murray, of New Castle, in May, 1872. The case of the latter lived for three weeks, with twentyfour feet of iron wire introduced into an aortic aneurism.

The case of Loreta, of Bologna, in 1885, gave the greatest promise of success. He resorted to laparotomy in a case of aneurism of the abdominal aorta, intending, if possible, to separate the sac from its connection and to close its opening out of the artery by suture or ligation. If this was found impracticable, to stuff the cavity with wire. Adhesions to surrounding viscera prevented his finding the origin of the aneurism, and a little more than two yards of silvered copper wire were introduced, and the point of puncture touched with carbolic acid. There

was no bleeding. The abdominal wound healed by first intention. The tumor, by the seventieth day, was reduced from the size of a child's head to that of a walnut. The patient died on the ninety-second day, from rupture of the aorta below the sac. Loreta attributed the rupture to an ischemia of the aortic tunics due to compression and to changes going on in the aortic sac.

In four, out of thirteen cases, death has ensued on or before the fifth day, In these cases death should be attributed to the operation itself. The author considers the operation worthy of further trial. Practiced as a last resort, it has undoubtedly lengthened life, and it is far from improbable that, if, often adopted, a permanent recovery will occasionally be obtained in cases that are hopeless without it.

Mr. Richard Barwell, in a lecture on the subject of the introduction of foreign bodies into aneurismal sacs, expresses the opinion that the clot formed around such bodies is unstable and soft, and draws attention to the danger of shreds of it being carried away as emboli. In ordinary electro puncture, while the clots formed around the needles are firm, the difficulty is the small effect that three or four small solid clots can have on the contents of a sac containing twenty, thirty or more ounces of blood. Such considerations led him to think that increasing the stability of the cluts and the area of galvanic action at the same time, might furnish the secret of success in dealing with these large aneurisms. Accordingly, in the case reported in the Lancet for June 5th, he passed an electric current through a coil of about ten feet of fine steel wire, introduced into the sac of a thoracic aneurism through a tube of ivory sharpened as a hypodermic needle.

A second sac formed, and on the seventh day the case ended fatally, by the rupture of the sac.

The post-mortem examination showed that the existence of the second sac, which could not have been reached by the wire, made a fatal termination inevitable, but it also showed that the coils of steel were surrounded

BY J. FLETCHER INGALLS, M. D., CHICAGO.

Dr. Ingalls, in the current number of the Jour. Am. Med. Ass'n, adds five to the published cases of intubation of the larynx, with two recoveries.

All of his cases were for diphtheritic croup. A close observation of them leads him to the belief that success must largely depend on skilful after-treatment. As a large per-cent age of the mortality in this operation is due to pneumonia supervening, which, doubtless, was caused by the entrance of foreign substances into the lungs in many cases, too much care cannot be exercised in the administration of food and medicine.

He found that half teaspoonful doses of liquid food or medicine could be slowly swallowed as the child lay on its side, without causing a paroxysm of coughing.

In both his successful cases the tube was displaced by the patient, in one on the fourth day, by a voluntary effort on the part of the child, without cough. She triumphantly displayed the tube, and said, "she knew she could get it out."

One of the cases was complicated with a severe diphtheritic bronchitis. The tube was coughed out on the second day, and difficulty being found in returning it, the next size smaller was used; on the fourth day this was again coughed up, and,the breathing remaining good, was not replaced. The child talked ni a whisper, less distinctly after the tube was removed than before. On the eighteenth day the voice was still weak, and bronchial rales had not entirely disappeared, but otherwise the child remained perfectly well.

More attention is now being given to dietetics than at any former period in the history of medicine.

This is essentially the day when preventive medicine and attention to nutrition are to the

front in the work of progressive physicians; the advances in our knowledge of sanitation and the physiology of digestion have largely aided in the securement of this result.

We may be in doubt regarding the selec tion of the special drug with which to combat the specific germ which attacks our patient, but we are always safe in supporting him with food that is easily assimilated and directs itself to the repairment of the ravages made by disease. The most desirable way in which to administer food, of course, is the natural one, where it comes in contact with the digestive secretions in proper manner and

order.

There are many cases, however, in which which it may be the means of prolonging or artificial feeding is beneficial, and some in saving life.

Numerous diseases which interfere with deglutition, such as diphtheria, cut throat, inflammation of throat from the swallowing of caustic poisons, severe stomatitis, tetanus, postpharyngeal abscess, etc., etc., and gastric and abdominal affections, such as cancer, ulcer or catarrh of stomach as well as many acute diseases and continued fevers present necessities for artificial feeding and medication.

If, then, a condition presents itself where it is deemed best to avail ourselves of artificial feeding or medication, the questions which What are the best present themselves are: modes of introducing the materials into the materials to employ, and what are the best system?

As to the question of the best form of nutriment for use, the older way and the one still somewhat in vogue, is to use fluid foods taken by the mouth. Beef tea, milk and brandy, and stimulants, in the same form as they are arrow-root and other gruels have all been

of the operator will almost invariably meet with success. In this matter, as in many others, we should trust very little to the nurse, until we have demonstrated to them fully the preparation of the peptone and its proper introduction into the bowel.

Dr. Duncan J. Mackenzie (British Med. Jour., June 19, '86), in an article entitled "Continuous Rectal Alimentation; an Artiticial Stomach," suggests a very ingenious plan, by which a tin vessel filled with fluid in process of digestion, and kept at moderate degree of heat, is gradually allowed to empty itself into the bowel through rubber tubing, connected with celluloid catheter, the latter introduced into the bowel about two inches. At no time is the bowel overloaded. The principal advantage of his suggestion, I think, consists in the convenience and the time saved by transmitting the peptone into the bowel directly from the vessel in which it is prepared. Tin vessels, with stop cocks and rubber tubing attachments, such as are sold in the shops for douche purposes, would answer nicely. Previous to the introduction of the catheter into the rectum, Dr. Mackenzie passes the catheter through the centre of a square piece of soft rubber, perforated so as to grasp it firmly, and large enough to fit snugly over the anus. At each corner tapes are attached through small openings, and two are tied behind and two in front to a band around the loins. The rubber is pressed closely up to the anus and the tapes are tied as tightly as convenient.

Great advantage frequently lies in administering food and medicaments through the rectum, though many times we must desist temporarily or entirely, on account of already existing rectal irritation, or that which results from our efforts at feeding in spite of all precautions. Under such circumstances, if the conditions will permit, I would suggest a plan which I have found of value and the results very satisfactory in a number of cases. I have not seen the subject referred to, and so far as I am aware, the plan is original with me. It is that of

VAGINAL ALIMENTATION.

Where the conditions will allow, the necessity of properly nourishing our patient being urgent, we may use the vaginal cavity alone as a means of introducing peptones and medicines into the circulation, or in conjunction with other channels. The canal varies in capacity and distensibility, and, of course, the extent of absorbing surface is not as great as in the bowel, but there can be no question that it is sufficient to aid nutrition, and we can absolutely depend upon it for the

In administering food, the liquid peptones should be given carefully as by the rectum, in a smaller quantity, but oftener. Semisolid masses, such as thoroughly minced and mac erated raw beef with minced sweet-breads, I have found can be given very conveniently by using Anderson's vaginal capsules in sizes to suit the case.

After the introduction of the food or medicament, I have usually placed over the vaginal opening a small mass of absorbent cotton covered with oil silk and held in position by a T bandage.

The apparatus for rectal feeding suggested by Duncan Mackenzie, referred to above might well be applied in a similar way to vaginal feeding.

In January, 1884, Mrs. M., aged about 70, came under my care suffering with typhomalarial fever and gastro-intestinal catarrh of such a severe type as absolutely to preclude all nourishment or medication by either the stomach or bowels, except at rare intervals. The case urgently demanded free quantities of quinine; the stomach being resentful of all intrusion, the rectum was brought into requisition, but the effort was a failure, great irritation resulting which could not be controlled even though the enema included laudanum in free amount. It suddenly suggested itself to me that I might utilize the vagina for the reception of my remedy, and I at once acted upon the idea with a very satisfactory result, being enabled to saturate my patient with quinine (thorough cinchonization secured at pleasure) and such other remedies as the conditions required. I at once realized that here was a channel by which I could also nourish my patient. For a period of six weeks Mrs. M. was almost entirely medicated, stimulated and nourished through the vagina, the surface of the skin being utilized to some degree. At proper intervals the cavity was cleansed with borated solutions, but at no time were the absorbents of the lining membrane idle, and at no time did the vagina resent or resist the intrusion.

The patient did not recover, but I am sure her life was prolonged and her comfort subserved by the means I have related. Had she been younger, the result might have been different. I have used this means of nourishing

and medicating my patients in probably a dozen instances since my first experience, and I feel safe in arriving at the following conclusions regarding vaginal alimentation and medication, viz:

1. In cases which demand artificial alimentation where the conditions will permit, the vagina may be utilized to supplement feeding by the rectum.

2. In some instances disease of the alimentary canal in its entirety precludes feeding by either the stomach or the rectum. In such cases the vagina may be utilized to practical advantage.

3. That whether the vagina or rectum be used for purposes of feeding, the materials should be as thoroughly digested previous to using as is possible; the milk, albumen or beef fibre completely peptomized and the starchy matters changed into dextrose or glucose.

4. In many instances the vagina may be utilized for purposes of general medication and stimulation, and the stomach saved for the important one of feeding.

5. In many cases vaginal feeding stimulalation and medication is beneficial; in many others it is a potent means for saving and prolonging life.

6. In both rectal and vaginal feeding the same gentle care is necessary, and one advantage possessed by the latter over the former is that the vagina is much the more tolerant of intrusion, and can be utilized for an almost unlimited time without revolting.

A CASE OF PUERPERAL FEVER.

BY J. S. HALLAM, M. D., OF CENTRALIA.

Read before the Southern Illinois Medical Association, June 17, 1886.

On the fifth day of February last, I was called to attend a woman in her third confinement. The messenger reported that she had one very severe convulsion, and when he left the house she was totally unconscious.

Accompanied by Dr. McFarland, who had been requested to attend her in her confinement, I hastened to her home, some six miles distant.

We found the woman still totally unconscious, breathing heavily, pupils dilated, and insensible to light. Edema was well marked in the face, the extremities were apparently distended to their utmost capacity. While preparing to make a vaginal examination, she attacked with one of the most violent convulsions I ever witnessed. Chloro

was

form was immediately and freely administered, and, as soon as practicable an examination per vaginam was made. The os was found sufficiently dilated to admit the forceps, which were applied with some difficulty, owing to the head being high up in the superior strait.

By careful manipulation, but with considerable force, the head was delivered, and was followed in a few minutes by the body. In about twenty minutes the placenta was delivered after Credé's method. (I do not know why this should be called Crede's method, for I had practiced this method of removing the secundines twenty years before I heard or read of Credé). The delivery of the secundines was followed by rather free hemorrhage. We waited patiently, hopefully, one, two, three, four hours, anxiously looking for results. Although we were perfectly satisfied that the influence of the anesthetic had passed off, yet consciousness did not return, nor did the convulsions, while we remained.

It was reported by the husband, that in about half an hour after we left she was at

tacked by another convulsion. I returned, and learned that she had had two or three during my absence. She was put upon the usual remedies, chloroform, chloral, bromides and morphine. When one failed to control the convulsions, another was tried, but all failed. The convulsions continued to occur at varying intervals until the evening of the third day, when Dr. McFarland bled her from the arm to the amount of two pints, so he informed me.

In about half an hour she became fully conscious, and had no return of the convulsions. Her recovery after the bleeding, though somewhat protracted, was uninterrupted.

This is one of a series of cases, six or eight of which have come under my personal observation, or have been reported to me, when the same physician bled freely under the same conditions, and all made a satisfactory recovery.

Now, gentlemen, can we draw a practical lesson from these cases? I am aware that, theoretically, the use of the lancet is condemned in puerperal eclampsia, not only by our highest authorities, but by the majority of obstetricians through the country, and that bleeding is fast becoming one of the lost arts in the practice of our profession. Nor do I claim that a few cases establish a correct principle in practice. But I do claim that a series of six or eight cases submitted to the same treatment, and all having made a satisfactory recovery, is strong presumptive evidence that the treatment was rational.

The physician to whom I have referred