Fluoric Acid.- Urethritis, chronic, gleet from stricture of the urethra.

Thuja. Urethritis, discharge thin and greenish, a scalding pain while urinating followed by a sensation as if a drop of urine remained behind.

Mezereum -Urethritis, discharge watery; swelling and titillation along the urethra, with itching of the prepuce; perineum sore and tender with heat.

Alumina.-Urethritis, chronic, drawing and tearing pains in

the morning.

Agnus Castus.-Urethritis, posterior, with loss of sexual power and coldness of the parts.

Nux Vomica.-Urethritis, posterior, chronic; when the discharge has ceased there is complaint of irritation far back in the urethra referred to the neck of the bladder, with urging to urinate and stool.

Kali Bich.-Urethritis, ropy, stringy discharge from the urethra in old cases of gleet.

Thuja. Urethritis, recurrent gonorrhoea.

Ichthyol.- Urethritis has frequently been cured with this

remedy.

Sandal-wood.-Urethritis, sub-acute, receding stage, thick, muco-purulent discharge, with stinging and smarting pains on passing the urine.

Millefolium.-Urethritis, slimy, watery discharge with swelling of the penis and testicle.

Kreosotum.-Urethritis, with corrosive acrid discharge and itching of the urethra.

Petroselinum.-Urethritis, with sudden irresistible urging to urinate with strangury.

Kreosotum.-Urethritis, with corrosive, acrid discharge and itching in the urethra.

GONORRHOEA IN THE FEMALE.

Word-picture from Carleton's Genito-Urinary and Venereal Dis

eases.

Aconite.-Heat, swelling and redness of external genital organs with frequent desire to urinate.

Alumina.-Itching in pudendum. Burning in genitals, which are inflamed and corroded; patient is unable to walk. Amelioration from washing in cold water. Discharge profuse, resembling the

washings of meat.

were prolapsed.

Lassitude and feeling as though the organs

Argentum Nitricum.-Profuse, purulent and bloody discharge. Great soreness of the parts which may ulcerate and bleed. ritus vulvæ.

Pru

Aurum.-Profuse, light-yellow discharge from the genitals. Burning and intolerable itching of the pudenda. Acrid leucorrhoea which excoriates the genitals. Induration of the inguinal glands.

Belladonna.-Vagina dry and hot. Congestion and inflammation of the labiæ. Discharge of white mucus from the vagina, with violent stitches in the pubic region and inner parts; great pressure, as if the pelvic viscera would protrude through the vulva.

Calcarea Carb.-Lymphatic temperament. Milky discharge from the genitals with burning, biting and voluptuous itching of the parts, attended with pressure in vagina, which may be swollen, red and inflamed.

Cannabis Sativa.-Cutting pain in the labiæ during urination. Urethra plugged with pus. Swelling of the vagina, with itching, burning and a thick white discharge.

Chamomilla.-Yellow, acrid, watery discharge, which smarts, burns and excoriates the parts.

Copaiva.-Itching of the vulva. Red spots on the vulva, with burning, milky leucorrhoea.

Kreosotum.-Gonorrhoea.

Has been used in the male, but is most frequently indicated in the female. Great urging to urinate. Discharge bloody and very offensive, sanious, yellow, yellowish-white, foul, acrid, excoriating the labiæ, with itching. and smarting. Corrosive itching within the vulva and on the labiæ. Burning, itching and swelling of the labiæ.

Mercurius.- Inflammation of the vulva, which is swollen, red, and hot. Pressing down pain. Discharge of mucus tinged with blood. Copious discharge of watery mucus. Yellow leucorrhoea, with offensive odor.

Pulsatilla.- Discharge of thick, milky mucus. Burning, stinging, and swelling of the labiæ.

Sepia.- Redness and itching of the labia and vagina, with discharge of yellow, greenish watery pus or foul smelling fluid.

Sulphur.- Itching of the clitoris, and burning of external parts, attended with a thin, burning discharge, especially in the morning.

ORIGINAL ARTICLES IN SURGERY.

CONDUCTED BY

WILLIAM TOD HELMUTH, M.D., LL.D.

GEORGE W. ROBERTS, Ph.B. M.D.

SIDNEY F. WILCOX, M.D.

C

A CASE OR TWO OF APPENDICITIS.*

BY JOHN KENT SANDERS, M.D.

Cleveland, Ohio.

ASE 1.- Mr. B., aged twenty-one, had a history till within two months very good. He then had an attack of bowel

trouble, so-called. This kept him in bed two weeks. Then had an interval of feeling fairly well for three weeks, when he had another attack. He had more acute pain and a good deal of localized soreness in the right iliac region. The acute pain was relieved sooner than the first attack, but did not recover his full strength when the third attack came on, ten days previous to his entering the clinic.

His temperature ranged from 100 in the morning to 101 8-10 in the evening. Considerable tympanitis, diarrhoea, constant pain in the right inguinal region, which was considerably swollen. He was unable to carry his right leg into full extension. Tongue heavily coated with yellow paste and bright red tip and edges.

A diagnosis had been given of typhoid fever and he was placed in the hospital with that idea. After being there two days, I was asked to examine him, and found what I diagnosed as appendicitis. I operated Jan. 9, 1895. The abdominal walls were excessively thick, with unusually large amount of adipose tissue.

The ordinary oblique incision was necessarily increased by another incision at right angles. There was a large mass of adhesion of the omentum and several coils of the small intestine around the cæcum and appendix. The adhesions were broken up and the appendix amputated. When all oozing was apparently stopped, we started to sew up the wound, when the patient showed symptoms of collapse. Artificial respiration was, with difficulty, kept up for some time, the patient being so large and excessively fleshy. Not responding to restoratives, the peritoneal cavity was flooded with three quarts of normal saline solution at blood heat. The patient finally rallied and the incision was closed with the mattress suture. Drainage of gauze was left in and a large thick dressing placed. *Written especially for the NORTH AMERICAN,

The dressings became saturated in an hour and had to be changed. There was considerable blood mixed with the salt solution which came away, and as the patient showed symptoms of hemorrhage the sutures were loosened and two or three bleeding points on the omentum were caught by hæmostatic forceps. This was done without anæsthesia, and without any pain to the patient, which showed that the shock was very profound. The sutures were again tied and drainage left in. The dressings were not moist until the end of twenty-four hours, when they were changed and the drainage left out.

The patient did well from that time and was discharged from the hospital at the end of three weeks.

Case 2.- Miss B., a clinic at the Cleveland University of Medicine and Surgery, Sept. 25, 1895.

History till within a year previous was good. No trouble with menstruation until eight months previous. At that time was attacked with severe pain in the right iliac region and a great deal of pain in the uterus and right ovary during the entire flow, which was unduly prolonged. She was troubled at that time more or less with constipation. This attack kept her in bed for some ten days. At her next monthly she had the same trouble to a much less degree, but in two months she had so severe an attack that she was taken to a hospital, where a diagnosis was made of endometritis and incipient inflammation of the tubes. As soon as she was over the menstruation she was curreted with dilatation and the uterus packed with iodoform gauze.

In due course of time she left the hospital, but in spite of the operation, at each menstruation she had about the same history, except that the pain was more confined to the right iliac region and the period of constipation more prolonged each time. When she entered the clinic she was nearing her monthly; tympanitic; very much distended, severe colicy pain in the right inguinal region. An ill-defined tumor presented itself in this locality, constipation for two days previous, temperature ranging from 100 in the morning to 103 in the evening. Under chloroform examination per vaginam and rectum disclosed an ovoidal shaped tumor, dipping down into the right iliac region, involving the right ovary and apparently attached to the right broad ligament. A diagnosis was made of a chronic recurrent appendicitis. Her friends and she demanded an operation at whatever risk, in view of her suffering. The following day an oblique incision was made an inch to the right of McBurney's point. On cutting into the peritoneum extensive adhesions of the

omentum and bowels were found. The omentum was attached to the right and back portion of the cæcum, and the appendix vermiformis was imbedded in folds of the omentum and bound down by adhesion to the right ovary and adhered for some little distance along the right broad ligament. In breaking up the adhesions a small sac of pus was broken into and with considerable difficulty the appendix was removed. The right ovary was so irritated by the inflammation surrounding it that it was deemed advisable to remove it. Fortunately the pus from the sac did not contaminate very much of the peritoneum as the field of the adhesions was carefully separated from the general peritoneum by packing of iodoform gauze. The oozing, which was general at first, was stopped by the pressure of the gauze, and the abdominal opening was closed without drainage.

The incision was necessarily very long, and as there was considerable adipose tissue, the mattress stitch, which I first saw described by Marcy, was used, the suture material being kangaroo tendon.

The patient made an uninterrupted recovery, menstruation was not established until one week after the operation and came on without any discomfort. The patient was discharged from the hospital in the fourth week, and since that time has had no return of dysmenorrhoea. Case 3.

Miss K., aged 19. A clinic at the Cleveland University

of Medicine and Surgery.

A good history until within a year. At that time became pregnant. In the latter months of gestation was accused of being pregnant, but denied the possibility even after labor, which came on while she was doing heavy washing. She left the wash-tub, went to her room, was delivered of an eight pound male child, left him and the after-birth in the vessel, and then within a few minutes returned to her work. Even after the crying infant was discovered in her room she denied that she had anything to do with it. She did not go to bed at all and kept at her work. For two or three months she had no particular trouble with the exception of a broken breast, until within a few days of her coming to the clinic. At that time she had a temperature of 104, excessive tympanitis, great soreness and tenderness all over the bowels and persistent diarrhoea. A diagnosis was made of threatening peritonitis. The next day her temperature was no lower, pulse 100. She then gave the history of a fall on her back some three days previous, at which time she felt something giving way as she expressed it. The greatest point of tenderness was in the right inguinal region, there was also a de