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point, it was my pleasure to read quite a lengthy dis itonitis has not had time to shut off the disturbing cussion upon the matter. It was pointed out by an element and encapsulate it in an abscess. anatomist that the base of the appendix rotates upon I will make a suggestion in these cases. It is not two or three planes and never upon one point. Al the element of time that makes the difference, but the though I believe it does nothing more, McBurney's nature of the material that excites the peritonitis. point will serve a purpose in attracting attention perforation may be made and no streptococci or to the region more than has been done heretofore. I other virulent germs may have entered. In this case it think the teaching of older medical men had a good is a nonseptic peritonitis, therefore a local peritonitis; deal to do with the mortality in these cases, for the for the same reason that, in cases of gonorrhæal salvery reason that they were thoroughly imbued with pingitis, attacks of local peritonitis are common. The the idea that when you have disease of the intestine gonococcus may enter the peritoneal cavity, and it you are to place the intestine in a splint with opium, has been pretty well established that when it does and while the patient is relieved from pain the mis enter that cavity it is not an extremely dangerous chief is going on there in spite of the opium. While visitor. It sets up a localized peritonitis, and these laxatives may be abused, I think that very frequently, are the attacks of localized peritonitis that prostitutes especially by the use of calomel, good could be done have. Entirely different is the course of the peritowith them at the outset, and very many cases are nitis which arises from the bursting of an abscess, the cured with the use of purgatives and hot applications result of infection at the time of confinement. Here and rest in bed, while if the opium treatment is con the most virulent germs enter the cavity and give tinued to any excess, just what you want to avoid, rise to a general peritonitis which may result fatally that is the accumulation of fecal matter in and around in a few days, possibly in a few hours. As I said bethe parts, will result disastrously.

fore, the different course of the peritonitis in the Dr. Buchanan: One or two points I think might second and third classes of cases of appendicitis, may be dwelt on a little more at length than has been done not be due to the element of time but it may be in the this evening. I suppose it would be right to confine nature of the exciting cause of the peritonitis. the discussion to the matter which has been presented Now the subject of inflammation of the Fallopian by the gentleman who opened the discusssion--the tubes which frequently gives rise to what is comsubject of appendicitis and pelvic peritonitis. These monly recognized as pelvic peritonitis, is a subject two subjects illustrate the advances which the gynæ which I believe in this part of the country has not recologist has made in medicine. On the subject of ceived sufficient attention. I have seen within the appendicitis all medical men are pretty well versed ; last couple of years a good many cases where abscesses they do not require the services of a specialist to give of the ovaries and tubes could be demonstrated easily, them any information; whereas, when they come to and where the operation has not been recommended examine the ovaries and tubes, many otherwise well to the patient by the attending physician, even though informed practitioners are all at sea ; it is because attention was strongly called to it. I recall one case they are not accustomed to the bimanual method of where a patient with an ovarian abscess was treated examination; they are not in the habit of taking these for malaria by a gentleman who is considered in the parts between their fingers and finding out what they front rank of the profession in this city, until the abhold. In most cases of pericæcal abscess operation scess broke through the vagina. Now that could is readily acceded to, while in many ovarian and tubal only have come through lack of examination. abscesses they frequently object to the opening of the other case was one of gonorrhæal salpingitis, followed abdomen for the removal of these abscesses, because by very severe local peritonitis, in which a mass they have no familiarity with the examinations neces could be distinguished very easily after the peritosary to demonstrate the condition.

nitis had subsided. This patient is now under electric In inflammation of the appendix I believe that treatment. Her doctor comes every day, or second wherever there is a tumor to be demonstrated, there day, and applies the battery. This woman has been is always localized peritonitis and the cases can be about one and one-half years undergoing this and grouped into three classes:

similar treatment and has not had a well day. AnFirst, those in which the inflammatory collection is other case was treated by a most excellent physician such as to give rise to a tumor which can be felt, and in this city, one who stands very, high, which I never which goes on to resolution. These are the great ma saw but once and then at his request. This patient jority of cases, and for that reason alone I think it

had probably an abscess, certainly as large as my fist. would be unwise to treat all cases by abdominal sec This woman had been carrying this abscess, accordtion. Statistics given are to the effect that a very ing to accounts, for about three years. She was an large percentage of cases get well with merely pallia- invalid as most of these cases are. It was pitiable to tive treatment.

see her turn in bed. This gentleman had not advised The second class of cases includes those in which or apparently thought of an operation. He was much the peritonitis goes on to the formation of a localized pleased at her being a little better than she was a abscess. This abscess sometimes opens spontane month before. ously, occasionally through the bowels; when an in Another case I saw about a year ago in a neighborcision is required, it is often merely the opening ing town. She had an abscess that could be distinctly of an abscess, the peritoneal cavity not being in felt by any person who put his hand on the abdomen. vaded.

this patient had been constantly in bed for two years, The third class of cases comprises those where no and in that time had not touched her feet on the floor. local abscess is formed, but where the first peritonitis She has since died. I mention these cases because I is a general peritonitis, and these are the unfortunate believe that many others of similar character now exor fatal cases that Dr. Werder has spoken of, and he ist in this and neighboring communities, and that this gives a reason for the difference: for one being local matter is not sufficiently talked of by the profession ized and the other generalized peritonitis. The per- here.

DR. LANGE: The subject of peritonitis has been tient with an extremely bad case.of cholera morbus. limited to pelvic peritonitis and appendicitis. I am I gave him morphine, remained with him about half at work at the present time upon a paper reporting a an hour, and when he was better, the wife of the messeries of twelve cases of typhlitis, part of the number senger came to me and said: “Doctor, my husband that I have treated during my professional life and of has the same thing.” I went into the adjoining house which I have accurate and full notes. I will publish and found this patient with apparently a very severe these cases as I complete them. I must state I have attack of cholera morbus; but it was septic general never lost a case of typhlitis I stand with the Ger peritonitis, and killed him in forty-eight hours. Here mans in this respect, if as the reader of this paper were two cases occurring at the same time and side stated, the mortality in Germany is very much lighter by side, and though I may lack special acuteness, I than in America. Of these twelve cases of which I could see no difference between them. It was imposhave notes, one only received surgical treatment, and sible for me to say that one had a certainly fatal afthat was a simple incision through the belly wall for fection and the other a temporary slight illness withthe evacuation of pus. Dr. Werder seems to support out any mortality. This was true until the effects of the statement that after a duration of three days, the the morphine decided one to be cholera morbus. inflammation-typhlitis--not showing any apparent Both were chilled, both were shocked, both were very improvement, a section would be indicated. It strikes tender and tympanitic, both drew up their legs, both me that this is entirely too energetic, that it is to say were cold and blue and almost pulseless, and both the least unwarranted. This is all right when pus had death in their faces. Both also vomited and has been demonstrated. Otherwise it is not war purged, and both were evidently in unutterable anranted, because we still sometimes have septic peri- guish. I could appreciate no difference between tonitis after abdominal section with the most careful them. From this and like evidence, I believe a diagprecaution by the most careful operator. In other nosis of general septic peritonitis is not always corwords, antisepsis is not yet thoroughly understood nor rect; and further, that when such a patient has remastered. As long as this is true, it is unwarranted covered under the magnesium treatment no general to advocate incision in typhlitis because it does not peritonitis existed. I am told by a laparotomist of improve after an existence of three days. The reason large experience, that most of his women on the third is not sufficient. It must still be the demonstration or fourth day have such an attack; that he gives them of pus. It is justifiable, however to dilate the sphinc- magnesium and they get well. But this is certainly ters, enter the hand into the rectum and search for not general septic peritonitis. I believe it is a colic pus, because it forms frequently behind the cæcum, with meteorism from handling or exposing the bowels; and when so, cannot be found by examination through a condition analogous to that frequently seen after the belly-wall.

hard protracted labor, and in such cases the magneAmong the twelve cases I shall report, is one in sium treatment is excellent. But in my opinion a which the tumor was as large as a melon, whereupon patient with septic peritonitis dies. There are two careful and repeated examinations, no pus could ever ways, generally, by which septic inflammatory agents be found. A deformity lasting almost two months reach the peritoneum: by ulceration through the after recovery existed by reason of extreme flexion of stomach or intestinal tract, and in women from the the thigh upon the abdomen during the inflammation, genitalia The messenger for the cholera morbus and the whole limb was infiltrated and ædematous man probably had some ulcer of the bowels, perhaps from vein pressure, and before the leg could be painless, with a perforation which happened through brought down and the tumor disappeared, had a his violent run to my office that night. No post-morduration of between three and four months. The re tem was had. covery is perfect. I think I have a right to assume One thing that appears from Dr. Werder's paper that no pus existed in that case, and I would, with all and the discussion, is that no one mentioned idiodue regard for the opinion of the authority quoted by pathic peritonitis. I believe there is no such peritoDr. Werder and of Dr. Werder himself, insist that nitis. The messenger of whom I spoke was seen by this rule is unjustifiable. The criterion, I think must other physicians, and the conclusion was that he died be the demonstration of the existence of pus.

of idiopathic peritonitis. But this was many years The treatment of general peritonitis has undergone ago, and barring puerperal and traumatic inflammasome change. The change advocated in the last few tions of the peritoneum, all others were idiopathic. We years is the administration of purgatives, particularly know better now. As to the treatment of this septic the sulphate of magnesium instead of opium. I be inflammation of the peritoneum, if there be a chance lieve that general septic peritonitis is always fatal, to benefit patients, I believe it to be by opium, and and I believe we often speak of general septic peri- very slight. Dr. Andrew Clark, as all the world tonitis where it does not exist, as for instance: I was knows, was a very eminent physician, and he reported recently concerned in a case where an abdominal sec a number of cases of acute general peritonitis cured tion was done, and on the third day it was concluded by the opium treatment. I do not know whether that that the patient had general septic peritonitis. She is correct. It possibly is, but from what I have seen, was given at my earnest solicitation morphine. The I must doubt it. As to what I have seen of magnesulphate of magnesium treatment was ruled out by sium treatment in cases where the diagnosis was cermy insistence, and she recovered. I was doubtful of tain, I must condemn it. Can you do anything else it at the time, and now I do not believe she had sep when you think of typhoid or duodinal or gastric ultic peritonitis. One case of septic peritonitis I re cer perforation? I believe the prognosis to be always member very distinctly, occurred five or six years extremely bad, and the only forlorn hope to be openago. A patient came to my office in the middle of ing the belly and washing it out. the night out of breath, said his neighbor was very Dr. Macfarlane also objects to the opium treatment; sick, and took me to his bedside. I went with this to "putting the bowels in splints" in perityphlitis. I man for a distance of three blocks and found the pa have here twelve cases of such peritoneal inflamma

same manner.

If I had sep

tion, all of which recovered and all of which were so Dr. BUCHANAN: I would like to express myself treated. I have had additional cases of which I have against making a fixed time for operation. I think no record, which were treated and which ended in the with Dr. Lange that to fix absolutely on the third day

Therefore I shall continue so to treat as the time to operate if the patient is not improving, them. But I do not use morphine alone; I do not is rather arbitrary. I could submit a number of cases trust to niorphine alone. I use also calomel, we were that got well without an operation. I have seen many wont to say for its alterative effects, now we give it cases that did badly for three days and eventually refor its antiseptic and antiplastic effects.

covered without early interference. I think Dr. Lange Dr. Kænig: It seems to me Dr. Lange must have has been wonderfully fortunate in the class of cases misunderstood Dr. Werder in regard to at least one he has had, if he has had twelve consecutive recoverassertion. He said Dr. Werder had not mentioned ies. One of his cases would have been much better idiopathic peritonitis. If I am not mistaken, Dr. with an operation. I think very few of us would be Werder declared that peritonitis might be produced as willing to let such a mass go on, even to the size of a a result of “catching cold” at the time of the cata- small melon, without opening it up and endeavoring menial period. If that means anything else than idio- to do away with the origin of this immense inflammapathic peritonitis, I fail to understand it. The term, tory exudate. I think there was pus in this case. Ac“catching cold,'' to my mind, is simply an admission cording to the history given, this patient did not make of ignorance. I wish also to add the weight of my a very pleasing recovery. I think Dr. Grube has very testimony in favor of the opium treatment. We want well stated the two classes of cases that should be to relieve the nervous system of the irritation that the submitted to operation, those in which pus can be disease produces, and we can do it better by opium demonstrated and those in which the perforation is than by any other remedy.

through the appendix, and is setting up general periThe late Prof. Austin Flint was sometimes jesting- tonitis. If you can catch such cases in time, it is ly accused of having reduced his medication to the proper to remove the appendix and wash out the cavuse of two drugs, whisky and opium, and I well re- ity. Usually they die. member his remarks regarding opium. In serious dis- Now in regard to septic peritonitis. As I undereases, he admitted, it was not curative under the ordi- stand Dr. Lange, he makes the test of septic peritonary acceptation of that term, but he declared that it nitis the death of the patient. If he dies it was septic was curative nevertheless, for the reason that it estab- peritonitis, and if he recovers it was not septic perilished a tolerance of the disease for the time being, al- tonitis. I do not think this a fair way to test the lowing nature to repair the trouble under the reduced method of treatment for that disease. sensibility of the nervous system.

tic peritonitis, I would like to have some very vigorDr. Grube: I can recall two cases which I think ous treatment with epsom salts at first, and if that illustrate the fact that no one line of treatment can be did not succeed very soon, I would be willing to take laid down, Each case must be treated on its own very large doses of opium. merits. One case was of peritonitis which went along The case which has been cited, in which marked for some two weeks or more, until I was satisfied there improvement took place, which was supposed at first was pus present. I demonstrated the presence of pus to be septic peritonitis and recovery occurred in three by the hypodermic needle and then I operated. It days, it seems to me from the description of the was a very simple operation. I merely cut down symptoms, was one of beginning septic peritonitis. through the muscles of the abdominal wall and met I think very likely if the operations of this gentleman the abscess cavity, and instead of cutting into it, I took were all followed on the third or fourth day by the the forceps and stretched it and the pus came out, symptoms described by Dr. Lange, it was the result and that was the extent of the operation. Any phy- of septic conditions. It has been remarked that Dr. sician can do that.

Sands always advocated the removal of the appendix. The next case was very much like it, and I thought This is certainly proper in case you can find it, but I would have another opportunity for operation, for you cannot always get it. It is a nice thing to reI had some of the surgical enthusiasm. I watched move and a safe thing to remove; at the same the case, and in about a week the whole thing disap- time I do not think it is a very good thing to peared without any pus at all. My idea of the treat- hunt for it. There is a great deal of change taking ment of all these cases is as Dr. Lange said. The place in the surrounding parts which render it time for operation is when you can demonstrate the difficult to find. The rule that operations should presence of pus, and not until such time, with the ex- be made parallel with and a short distance above ception of the cases where you have collapse, and if Poupart's ligament is a very good rule, except in they are not operated on quickly, you have no those cases where the abscess does not approach the chance of saving your patient. My own experi- ligament. There is a class of cases where the localence has been that each case has to be watched ized peritonitis occurs opposite the umbilicus or a carefully. What is necessary in the case is simply little lower. opening the abscess, or else we will kill our patients Dr. LANGE: I do not set myself up as a judge very quickly.

concerning the case Dr. Buchanan has reference to, Dr. McKibbon: The gentleman on my left has but merely submit my opinion. I think the doctor stated the history of two cases that he had. Dr. Senn, will agree with me, that if my associate in the case of Milwaukee, has given the history of the cases he was correct when he said that nearly all his patients treated. He claims the operation done in this con- had such symptoms on the third or fourth day, dition is practically of very slight importance, and on that it was not septic peritonitis, because if all his the other hand that by waiting for these cases to be patients had septic peritonitis and all got well, come bad, is the worse treatment that can be pursued. that gives a grand and new aspect to the whole He says the operation is not of sufficient magnitude matter. I did not believe at the time that it was to wait until there is something turning up.

septic peritonitis ; recovery confirms that belief. I

Western Medical Reporter.


Entered at Chicago post office as second-class matter. THE EDITOR would be glad to receive any Items of general interest in regard to local events, or matters that it is desirable to call to the attention of the profession. Letters written for publication or containing items of information should be accompanied by the full name and address of the writer, although not necessarily to be

am entirely willing to put myself on record that when this inflammation does not kill, it is not septic and not general ; in other words, that septic

A Monthly Epitome of Medical Progress. general peritonitis is fatal despite opium, calomel,

JOHN E. HARPER, A. M., M. D., Editor. magnesium, or any drug that may be given ; that

G. FRANK LYDSTON, M. D., when such a case ends in recovery it involves an

ASSOCIATE EDITORS. error of diagnosis. Another point, the operation of

HUGH BLAKE WILLIAMS, M. D., opening an abscess, which I did in one of my

Subscription, $1.00 a year; to Europe, $1.25. twelve cases, is quite a different thing from opening the cavity on the third day of perityphiltis. There may be no pus sac, no pus cavity ; if not you will get

published. All communications should be addressed to into the general peritoneal cavity, easy enough in any

WESTERN MEDICAL REPORTER, 163 State Street, Chicago. event; if you do not, if you content yourself with cutting down to the tumor adherent all around and do not free it, and palpate and

examine it, you

An Army Medical Board will meet in this city durhave accomplished nothing. Doing this thor

ing February to examine candidates for appointment oughly all the chances are you will get in;

to the Medical Corps of the U. S. Army. The Surand if you do not and there is no pus what have you

geon-General's notice will be found in another col

umn. accomplished ? Nothing. The criterion still must

Candidates must be between the ages of 21 and be, pus or no pus.

28 years, graduates of regular medical schools, and of DR. GREEN : I want to say one word in regard to

good moral character. The examination will be trying to make the distinction between septic and

physical as well as mental. The latter will cover subnonseptic peritonitis. It seems to me in nearly all jects of preliminary education, general literature and cases it can be detected by the general symptoms of

general science and medicines. The examination the patient. I think the best guide is the condition

will be oral, written and practical. There are twelve of the patient. That is the general condition, and

vacancies in the staff to be filled by the successful

candidates. As the pay of an assistant surgeon is the general aspect of the patient. If the disease is of a bad nature, the patient will readily succumb.

$1,600 a year and his rank is first lieutenant, the posi

tion is a most desirable one. These are the symptoms I have allowed to guide me in all such cases, and I think no physician ought to find any trouble in distinguishing after twenty-four

Interleaved Advertisements. hours what kind of a case of peritonitis he is dealing with. I think twenty-four hours will determine the

Doctors are proverbially good natured and long case, thirty-six hours at the utmost.

suffering and bear with equanimity impositions that DR. WERDER: I am thankful for your kind con would move any other class of men to rebellion. This sideration of my paper and also for the discussion is exemplified in the fact that they continue to subof the subject. I have very few remarks to make,

scribe for and read medical journals which insult because the matter has been discussed so thorough

them with interleaved advertisements. Publishers ly that there is not much to be said. Only a few find interleaving profitable and will continue the points I would mention. The first is in regard to

habit till the subscribers to their publications express McBurney's point. I have very little experience their disapprobation in no uncertain manner. with it. Of course the appendix is a very movable

Cannot the reform idea be extended so as to include organ, but Dr. Macfarlane claims that if you put the

this improvement in journals ? Readers want the adend of your finger at the point he claims as diag vertisements and the best men read them carefully nostic, that that point touches the base of the ver

and find in them many and valuable hints as to new miform appendix, and the base of it is always located medicaments and instruments, but no man, when in the same place unless the cæcum is displaced. reading of an interesting obstetrical operation, wants It may be so, but if so the displacement is very com

to be interrupted by a flame-colored leaf telling him mon. I know Dr. Clark claimed great results for

of the advantage to be derived from a kidney cure or the opium treatment. He gave opium simply accord

rheumatic specific. The publishers must live or jouring to effect only. If I am not mistaken he gave

nals will not exist. It is desirable that they should what are usually considered enormous doses, redu live and make money, but they can attain both ends cing the respirations in some cases to ten or twelve without marring the beauty of their productions by per minute. Of course these are enormous doses. the interleaved advertisement. I think no one to-day gives those enormous doses, and I know our results are no worse than Dr. Clark's were.

Keeley and the Washingtonian Home. I prefer the calomel treatment.

If I had peritonitis I would not want to suffer very much pain, The Washingtonian Home, at Madison Street and I would want a dose of morphine, but as a routine Ogden Avenue, is the city inebriate asylum. While treatment I think I would prefer the purgative treat not under city control it receives a bonus of $25,000.00 ment. When opium is given the bowels confine the a year from the municipal government in considerafecal matter which contains septic germs, and some tion of which it furnishes free treatment to all ineof these cannot help getting into the general ab briates consigned to it by the police magistrates. It dominal cavity. Septic peritonitis has often been is one of the best known institutions of Chicago. produced by an accumulation of fecal matter which Dr. Leslie E. Keeley, of Dwight fame, has offered could not be passed. Often cases of peritonitis are to take charge of the institution, conduct it on the due to germs getting into the abdominal cavity terms upon which it is now managed and in addition through the bowels. Now purgation will carry that use his secret methods of treatment on the patients. off.

In this proposition Dr. Keeley's friends see magna

nimity and a yearning to make all men, who drink, before the woman recovered sufficiently to scream. sharers in the benefits of his discovery and laud him The husband swears he will never call another doctor freely for his goodness.

till after he has examined his diploma. Now is it not The Washingtonian Home loses no money by its desirable that doctors should be marked. contract with the city and its income from private patients is not inconsiderable. These facts Dr.

Notice. Keeley knows and his proposition is a thinly veiled scheme to secure the official endorsement by the city An Army Medical Board will be in session in Chiof Chicago of his method of treating inebriety. He

cago, Illinois, during February, 1892, for the examiwill not be satisfied with the endorsement but wants

nation of candidates for appointment in the Medical as a bonus the privilege of treating city patients at a Corps of the United States Army, to fill existing vaprofit and a free hospital for his private patients, all cancies. of which he will get if his proposition is accepted. Persons desiring to present themselves for examiThe endorsement by this city of him and his reme nation by the Board will make application to the Secdies would be worth many times $25,000.00, for it

retary of War, before January 15, 1892, for the neceswould be used as an advertisement to attract patients sary invitation, stating the date and place of birth, all over the world. Dr. Keeley could take the Wash

the place and State of permanent residence, the fact of ingtonian Home, conduct it as a private charity of his

American citizenship, the name of the medical college own with no remuneration save the endorsement of

from whence they were graduated, and a record of the city and from the private patients attracted by service in hospital, if any, from the authorities therethat endorsement, derive a princely income.

of. The application should be accompanied by cirThis city will not accept the proposition. It is not tificates based on personal knowledge, from at least ready to yield the control of its public institutions to

two physicians of repute, as to professional standing, men who deal in secret remedies even though it is

character, and moral habits. The candidates must claimed those remedies are the result of revelations.

be between 21 and 28 years of age, and a graduate

from a Regular Medical College, as evidence of which, Label the Doctors.

his Diploma must be submitted to the Board.

Further information regarding the examinations Since the imperial government has given physi

may be obtained by addressing the Surgeon General cians' carriages the right of way in Berlin the drivers

U. S. Army, Washington, D. C. of these vehicles are required to wear a regulation

C. SUTHERLAND, hat that they may be recognized at once. A number

Surgeon General U. S. Army. of physicians in this country have been impressed by this and have advocated the adoption by all doctors, when not incog, of a distinguishing badge or mark. No concerted action has been taken as every man had his own ideas as to what the badge should be and how it should be worn. Many and valid reasons were

Surgery. given for having medical men marked “doctor" in

DRAINAGE AFTER LAPAROTOMY.—Dr. Rufus B. Hall, delibly and it is to be regretted that the plan resulted in nothing tangible.

Med. Record, Dec. 12, 1891, advocates drainage after If any one doubts the desira

all cases of abdominal section. He believes drainage bility of having physicians labelled, let him read the following: On the West Side there lives a young

as now used is a comparatively harmless procedure.

He uses only the small perforated tube suggested by couple who have recently come to the city. They

Dr. Price and has never seen harm result from it. have few acquaintainces and know no physician.

The two cases in which hernia resulted in the line of The wife developed a furuncle of large size on the

the cicatrix, it was at some distance from the point buttock near the genital fissures. Domestic remedies

of drainage. had no effect and after a sleepless night during which she suffered greatly, her husband suggested that a ACTINOMYCOsis Hominis.-- John B. Murphy, M. D. doctor be called in. She agreed but asked if he -- The North American Practitioner. A young woman knew a doctor. He did, he did not know his name twenty-eight years of age, had a severe toothache in but every morning as he went to work he met, near the left side of the lower jaw, and shortly afterward a the house, a man whom he knew to be a doctor be swelling appeared in the throat. It was impossible cause he had a full beard, wore a silk hat and carried to open the mouth, and great pain was felt when an instrument bag. He would send him over that swallowing. The face was poulticed for several days morning. On his way down town he met the sup and the symptoms disappeared. Some days after posed doctor, but being in a hurry he asked no ques this, she was again attacked with severe pain in the tions but told him to go to No.

street as tooth, ringing in the ears, and a swelling appeared in his wife wanted to see him.

the mouth and on the outside of the jaw, the pain inWhen the "doctor" arrived at the house the lady creasing and the swelling enlarging. led him into the parlor and began moving the things At the time of examination, about one week after, off the center table, remarking as she did so that she there was found a swelling behind the angle of the had been suffering for several days with a boil which left jaw, and the mouth could not be opened more prevented her setting down. Leaning over the table than three-quarters of an inch. The left tonsil was she raised her skirts till the troublesome member was much enlarged, filling most of the pharynx. A lancet visible and requested that it be examined. The man was introduced into a spot on the skin, which indiwas in a cold sweat, but he succeeded in saying that cated an abscess was about to break, and a considerhe was a piano tuner and the instrument exposed was able amount of pus evacuated. This gave relief and not the kind he played upon. He made his escape the patient made a rapid recovery, but failed to re



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