instances the A. androsemifolium has been used instead of A. cannabinum. I am sure druggists sometimes substitute one for the other. This may sometimes account for failing to obtain expected results, for their pathogeneses are quite unlike.

The peculiar powerless feeling in the sphincters, the anus actually remaining open, in acute cases, is a strong indication for its use in rectal troubles, especially if other general symptoms correspond with those of the drug.

ARSENICUM.

OBJECTIVE.

Excoriation around the anus, very painful at stool.
Pruritus.

Mucus membrane of rectum red in patches, especially near the sphincters.

Inflammation of entire rectal mucus membrane, with spots of ulceration.

Ulcers around anus, with intolerable burning.

SUBJECTIVE.

Rectum and anus:

Prickling, stinging, itching in the rectum.

Burning in the anus and tenesmus with no stool.

Griping and burning in anus.

Tearing, smarting in anus on passing faeces.

Burning in the anus after a loose stool, dark colored.

Feeling as though the anus was contracted.

In anus continual itching, soreness.

Continual aching in the anus, with seeming inability to keep it closed.

Gnawing pain in the rectum, as of worms.

Burning in rectum.

Tenesmus reaching as high as the sigmoid.

Feeling as though internal organs would escape with stool.
Abdomen:

Pain in the bowels, relieved by an evacuation or discharge of flatus-
Distension of lower abdomen.

Weight in stomach.

Sharp colic, with diarrhea.

Rumbling in bowels.

Epigastrium tender to the touch, or pressure.

Pricking in bowels; soreness.

Eating causes pain in the stomach.

Qualmishness alternating with pain.

Shooting pain in the left hypochondrium.

Fullness in stomach and bowels after moderate eating.
Abdomen hard and distended with gas.

Increased peristalsis.

Back:

Pain or feeling of weakness in the sacrum.

Dull lumbar pain.

Dull pain across the sacrum extending down to the thighs.
Burning in lumbar region.

Pain and tenderness down the spine.

Whitish balls becoming reddish after exposure to the air.
Involuntary.

Much flatulence.

Diarrhea with vomiting.

Call to stool, without relief.

Alternate looseness and constipation.

Rice water like.

Fatty appearance, owing to presence of pus.

Blood-discs and pus-corpuscles found in the stools.

Dysenteric, bloody mucus.

Drug Characteristics:

Thirst.

Copious urine, with excess of phosphates.

Abdominal pains relieved by stool or discharge of flatus, by

warmth.

Diminished appetite.

Intermittence of symptoms.

Surface of the body cold, or sensitive to cold.

Neuralgic pains.

Heaviness, lack of power in legs.

Therapeutic Indications:

The pathogenesis of arsenicum shows that it is applicable to ulcers within the rectum, fissures and pruritus. For these conditions it is one of our most valuable remedies. Beyond these it is of little or no value in diseases of the rectum, and here the general condition of the patient should indicate arsenicum.

MEDICAL, SURGICAL, AND OBSTETRICAL REPORT OF THE EMERSON HOSPITAL FOR THE YEAR 1906.

This report embodies the work done in the Hospital from January 1st, 1906, to January 1st, 1907.

It is a pleasure to record that no work of this character could be done under pleasanter conditions than attended the accomplishment of what follows. With the exception of a few probationers and nurses who were unfit and who were dismissed, everybody has been interested, not only in the successful outcome of each case, but in all of the detail which goes to make up a successful case.

APPENDICITIS.

A more satisfactory report of a limited number of cases of appendicitis I have never put forth, in that it shows a more general appreciation of all the conditions surrounding appendicitis than any single report I have ever seen. There were 71 cases operated on solely because of the condition of the appendix. Of these 43 were acute cases; that is, the stage of inflammation affecting the appendix was an acute one. In other words, they were in the midst of an acute attack of appendicitis; notwithstanding this fact, in 14 of these cases occasion was taken to rectify other faulty intra-abdominal conditions. Of the remainder 7 were acute suppurative cases, 3 of which were drained, 2 of the latter proving fatal. Four of the seven suppurative cases were not drained, this in itself marking a decided advance in the after-treatment of suppurative cases. A short time ago no one would have deemed it safe to close a case of suppurating appendicitis without drainage, yet a large proportion of these cases can now be closed with reasonable assurance that union by first intention will take place, and that whatever septic material may be left within the peritoneum will be taken care of by the latter. Fourteen of the cases of this group were intercurrent cases, and all were successful except the two cases as noted above. Both of these cases should have lived. They were extreme, so far as the condition of the appendix was concerned, but no more so than many others with which I have had experience, and which have lived.

One of them was a lad of sixteen years, whose general physical condition was very bad, with a heart, the action of which was considerably affected by the excessive use of cigarettes. After the operation we were unable to get any gas through, and at the most critical stage (at what should have been the beginning of the convalescence) the action of the heart became very uncertain and erratic. When the character of the heart's action changed, he perceptibly failed, and the, end was fatal.

The second case of death was in a young woman who was in

a bad condition when brought to the Hospital. She made no effort to help herself, was frightened, and after the operation could not be quieted. The impossibility to reasonably control her contributed, I have no doubt, to the fatal result in her case.

Among the noteworthy successful cases was that of Mrs. A. L. W., age 35. This case was an especially interesting one of acute appendicitis. She has had six children; youngest twins, eight months old. Oldest child 14. While carrying her third child (now ten years old), she had a great deal of discomfort through the abdomen, and after it was born had an attack of severe pain in the right side. Two years later she had another attack of severe pain in right side, and at the time of menstruation she always felt discomfort in the right half of the abdomen. During her last pregnancy she claims that she flowed at regular periods, and that the labor was normal. When the babies were two months old she had a very unusually severe attack of pain in the right side, lasting all night, and leaving her very sore; and has had three attacks since, each one worse than the preceding one, until the soreness through the right side of the abdomen has become constant. In August she flowed quite profusely, in September not so freely, and has had none since. There has been no nausea, no morning sickness, and none of the usual signs of pregnancy except enlargement.

nant.

She entered the Hospital November 1st, and was unmistakably pregnant, and so far as one could judge on such insufficient data as was obtainable, must have been about eight months pregThis would seem incredible from her history, but her condition could not be read otherwise. She was exquisitely tender through the right side of the abdomen and pelvis, and after having her under observation for forty-eight hours, I determined to operate and remove the appendix, feeling sure this was the offender. Accordingly this was done, and a badly diseased appendix (ready at any moment to break down) was taken away. When she entered the Hospital her temperature was 98, pulse 70; but when we found the temperature next evening had gone to 102 and the pulse to 112, it was felt operation was less dangerous than the taking of any chances in her delicate condition. After operation her subsequent course was absolutely without incident; she had no further pain, the soreness disappeared, and there were no signs of uterine disturbance at any time. At the proper time an uncomplicated delivery followed.

The following case, while not classified under appendicitis (because the appendix had been previously removed), should be included in the record at this point.

Mrs. M. A. P. Age 21.

On February 1, 1905, I first saw this case in the country. Thirteen weeks previous to that she had been operated on for appendicitis, an interval operation. This wound did not heal by

first intention for reasons which I do not know, and a fecal fistula resulted. At the time I saw her there was a large, ragged, indurated opening in the right side of the abdomen in the course of an incision about two and one-half inches long, and a cup-shaped cavity was full of a very foul smelling pus which came from the sinus reaching into the pelvis. I operated at her house. The wound did not heal as a result of this operation, and five weeks later she came to the Hospital and was admitted with a normal temperature and pulse, but with a sinus in the right side. Under quiet and rest and treatment this all healed, and she was discharged from the Hospital one month later with the wound healed. and her general condition very much improved. This improvement continued for several months, and at first she was entirely relieved, but after a time the left side began to give her considerable trouble. She complained of an ache in the left side, especially after stools. Menstruation was very scanty, but was regular and without pain. Her health improved so much that she married, and I heard nothing more of her until August 14, 1906, seventeen months after leaving the Hospital. She then complained of much soreness across the abdomen and through the pelvis, and one could determine that everything was bound down by adhesions. Stools were accomplished with increasing difficulty, and she was sent back to me by her physician to see if something more could not be done; and after carefully considering the whole situation, I determined to operate again, which I did on August 16th, 1906.

A median incision was made and it was found that the contents of the lower abdomen and pelvis were indescribably adherent, and at first one could not make out one part from another. There was a cyst of the left ovary reaching almost to the umbilicus. The right ovary was a pus sac buried in the pelvis, and it was only by the most persistent effort that it could be enucleated. Two loops of the small intestines were bound down into the mass in the pelvis, and they were flexed so sharply upon themselves that obstruction of the bowel was inevitable in the near future if they had been left to themselves. After they were relieved from their adhesions, one of the sections showed plainly a double kink, there being a decided contraction at this point. At the time I was not concerned about this at all, because I had succeeded in freeing them without opening the bowel; but forcible manipulation was necessary, and I now think that this latter in connection with the constricted bowel caused a paralysis of the bowel, from which she died.

She came from the operating room in good condition, pulse being about 100, but at no time were there any gas pains, nor could we get any movement of gas, and the vomiting was persistent and finally well-nigh continuous.

This is the fatal case included in the summary under the