and rainy weather, with poor tents, pitched in the mud.

But the incidents of camp life, which are yet so fresh in memory,

and associated with our sojourn at Savannah before and after the battle of Shiloh, will afford material for another article in this series.

G

ENTLEMEN: On the 9th of April, Mrs. gave birth to what was, apparently, a perfectly formed and healthy female child. The infant's bowels not having moved, a dose of castor oil was administered a day or so after its birth; catharsis, however, did not follow its administration, but the medicine was after a time ejected from the stomach. An enema was now thrown into the rectum, but was not retained. On the afternoon of the 11th my attention was called to the patient, and on examination I found the rectum to terminate in a cul-de-sac. This kind

of malformation is very rare, and in them one of two conditions exists: 1st, The walls of the rectum may be perfectly formed, the cul-de-sac being formed by a constriction of the walls, or, more frequently, by a septum thrown across, bearing the same relation to the rectum as the imperforated hymen does to the vagina. 2d, The rectum may terminate in a pouch before it reaches the anus, being, as it were, too short. In such cases we find a cul-de-sac more or less deep, terminating in the anus; the bottom of the cul-de-sac being separated from the rectum above by perhaps cellular tissue. In the first

case, operations have frequently been successful; in the second case, the prognosis is more grave; yet an operation is the last and only hope of saving the life of the child.

This infant, although it has nursed some, is quite emaciated, and has been vomiting biliary matter in considerable quantity; hence little hope can be entertained of its recovery. After each of the students had examined the infant, Prof. Roler wrapped a narrow bandage around a bistoury, with the exception of its sharp point, and then introducing his little finger into the cul-de-sac, as a guide to the instrument, he carefully introduced it, and upon withdrawing the instrument, gases, and a quantity of meconium, escaped.

The infant died, however, during the night of the 14th; and at the autopsy, held on the 15th by D. T. Nelson, M.D., the pathological condition of the rectum was found to correspond with that of the second case enumerated above. The bistoury had pierced the cul-de-sac, and penetrated the bottom of the pouch above. In the ilium was found a small perforation, diagnosed as rupture from over distension of the intestine. The small intestines, with the exception of

the duodenum, and a small portion of the jejunum, were highly inflamed and distended. The ascending, and a small portion of the transverse, colon, presented a high state of inflammation; the hepatic flexure having nearly a gangrenous appearance, and in a few days, at the most, would have ruptured. The portion of the liver in contact with the inflamed bowels,

was of a deep brown color, almost black; and the gall-bladder was distended with bile. No other pathological lesions or malformations were discovered. Death was undoubtedly caused by the inflammation of the bowels, as a probe could be very easily introduced, at death, into the rectum, through the opening made by the bistoury.

L

OUIS XIV., at forty-seven years

of age, had attained the apogee of his glory. He had built Versailles, Trianon and Marly; had enlarged greatly the palaces of Fontainebleau, Saint Germain, Saint Cloud and Chambord; had received from the authorities of Paris the title of "The Great;" his life had become much more regular, and he had abandoned the last of his mistresses, Mlle. de Fontanges. Maria Theresa died in 1683, and he subsequently contracted a secret marriage with the widow of Scarron, Mme. de Maintenon.

January 15th, 1686, the king complained of a small tumor in the perineum, on one side of the raphe, two fingers'-breadths from the anus, barely sensitive to the touch, and destitute of pain, redness and pulsation. It did not interfere with defecation, nor

exercise on horseback, but subsequently increased somewhat in size, and became so indurated, that on the 31st of January, it was determined to attempt its resolution.

On the 5th of February, Daquin, the king's chief physician, prescribed a poultice, composed of beans, broomrape, barley, rye and flaxseed soaked in wine and vinegar, which was to be renewed every five or six hours. During the next few days, in which the king was confined to his bed, a plaster of white lead (prepared by boiling) and hemlock, was also applied. pain of the swelling increased to such an extent, that by February 16th the patient was obliged to retain the recumbent position. The skin meantime had become somewhat reddened in the vicinity of the little tumor, which had not, however, increased in

The

size. It was thought that suppuration had occurred, and, therefore, at the point where ulceration seemed imminent, an ointment of colophony, yellow wax, resin and olive oil was applied, and the whole covered with a plaster containing yellow wax, turpentine, Burgundy pitch, and the acetate of copper. The desired effect was produced. Fluctuation became evident on the 18th, and the pain increased, as in ordinary suppuration.

The courtiers, as usual, interested themselves greatly in the malady of the monarch, and were loud in praise of a certain sparadrap, with which the inventress, Mme. de La Daubiere, had accomplished marvellous results. The physicians consented to its use, on condition that its composition should be made known to them, and that it should be prepared by the royal apothecaries. The formula was as follows:

Gum elemi and turpentine,
boiled in plantain water, S

Yellow wax, 3 viij.

Balsam of Peru, 3 iss.

lb. ss.

No results were obtained by the use of this compound, so the former treatment was renewed; and on the evening of February 19th the abscess burst, and discharged during the ensuing night. A slightly indurated projection was still evident after this

occurrence.

On the 20th of February caustic was added to the ointment of colophony, which had the effect of enlarging the wound. It then gave issue to a thicker and more sanguinolent pus, which escaped incessantly, but brought about a notable diminution in the size of the tumor.

On the 21st of February the king suffered from an attack of gout in the

right foot, and on the following day from lassitude and cephalalgia; but there was no fever. The orifice of the sinus slightly contracted; there was a reddish, sero-sanguinolent discharge; no insomnia. On the 23rd of February it was determined to open the abscess from below. Two cauteries were applied, an eschar made, and the opening effected with a lancet. Pus escaped, and the early dressings were renewed. There was some gouty pain during the night. On the 24th the abscess became indurated, and resolution was attempted by introducing into the wound a tent, smeared with a balsam composed of the oils of flaxseed, juniper, olives, cloves, laurel, and turpentine, with aloes, sulphate of zinc and acetate of copper. There was some sleep at night, and less gouty pain. On the 27th of February the pus became more thick, and fomentations were applied, consisting of the decoction of absinthe, roses, pomegranate rind, and leaves of myrrh in red wine. February 28th, the balsam was discontinued, and the abscess injected with a lotion for wounds.

March 2nd: There was no resolution of the tumor. It was dressed with red precipitate, one drachm, and the colophony ointment, one-half pound. The sleep of the patient was disturbed, and the gout increased in severity, yielding, however, to treatment by the 8th of March.

The disease went on, alternately progressing and retrograding, until the middle of May. The king had had hitherto an external blind fistula; but, May 17th, when injecting the cavity, it was noticed that the injected fluid did not completely return, which led to the suspicion that the intestine

had been injured, and the fistula had become complete the ulcer sometimes appearing cured and sometimes re-opening. To remove all doubt on this point, an exceedingly red decoction of hypericum perforatum (St. John's Wort) was injected, which did not return by the wound; and the king, placing himself upon a chamber, passed the entire decoction from the bowel. Afterward, to make sure of the locality of the intestinal lesion, a probe was introduced through the fistula, and the index finger, when passed into the rectum, encountered the extremity of the probe, at a distance of about two or three fingers'breadths above the anus. A small quantity of pus and blood followed its withdrawal.

On the 27th of May the king mounted his horse. In August he had a quartan fever, and was bled and purged. Cinchona was subsequently administered in the following manner: One ounce of cinchona in powder was infused in a pint of good Burgundy wine. During the first twenty-four hours the mixture was agitated several times, and finally left to stand. Of this, four to five ounces were administered every four hours, night and day. In a few days the patient was relieved.

But the fistula remained unchanged. It was evident that there was but one means whereby to cure it; and that was an operation. But, at the court of Louis XIV. it was not easy to induce submission to such procedures. All sorts of people still announced infallible cures; and a trial of these must of course be made. After the plasters and ointments, the waters of Bareges were vaunted. The rumor spread that the king was about to

make trial of these waters; but it was considered desirable that they should be first tried on some of his subjects. Four persons affected with anal fistula were first sent to Bareges, under the direction of Louvois, surgeon-inordinary to the king. Lotions and injections of these waters were used ineffectually. Finally, a woman appeared who declared that she had been cured of a fistula by the waters of Bourbon-l'Archambault. Four additional patients were at once despatched to Bourbon, with a royal surgeon, and returned in the same condition. Lastly, beds were established under the superintendence of Louvois, and filled with patients affected with fistulæ. They were treated under the surveillance of the surgeonin-chief, Felix, by those who pretended they could cure them. All failed.

The surgeon Bessieres, who had free license to speak at the court, declared to the king that all remedies were, and would be, valueless; and that no cure was possible, except by an operation. For a long time the surgeon-in-chief, Felix, had proposed this; but had expected that the royal patient would consent only after he had become thoroughly disgusted with all the measures proposed by the empirics.

Louis XIV. had left Fontainebleau and returned to Versailles, thoroughly resolved to undergo an operation at the hands of Felix, to whom he had given permission to choose his assistants. The king decided that the affair was to be kept secret.

On the 18th of November, 1686, about eight o'clock in the morning, Felix, having Bessieres for an assistant, proceeded to operate, in the

presence of the physician-in-chief, Daquin; the physician - in - ordinary, Fagon; and Louvois. Taking in his left hand a bistoury, made expressly for the purpose, and having a probe attached to its extremity, he passed the latter into the rectum by the fistula. The finger of the right hand, pressed into the intestine, encountered the flexible probe, and withdrew it from the anus; thus allowing the bistoury to cut with great promptness and facility the tissues between the fistula and the gut. He finally introduced scissors into the fundus of the wound, and divided the intestine somewhat above the opening, as well as all bridles of tissues which he encountered. One hour after the operation the patient was bled from the arm, and placed upon a severe regimen-abstinence from all solid alimentation; a weak broth being only permitted morning and night.

If the chronicles of that period can be trusted, Felix, despite his skill, hesitated so long before making the first incision, that his royal patient found it necessary to re-assure him; and the result of this to the surgeon was that he retained, during the remainder of his life, the trembling which he then first experienced.

The bistoury employed upon this occasion is preserved in the Museum, by the Faculty of Medicine of Paris. Its form is exceedingly primitive. It consists of a blade somewhat more than one-third of an inch broad, and eight or ten times as long, slightly curved upon itself, and terminating in a flexible stylet.

Although the operation had been done with all the requisite skill, there remained in the site of the fistula, callosities which interfered with cica

trization. trization. In order to their removal, the "suppurative" and resolvent ointments, as well as mercury, were tried to no purpose. Twenty-two days after the operation, Felix extirpated these growths with the knife.

December 27th, the wound was almost closed, and the dressing consisted only of charpie and the lotion for wounds. But there remained an indurated nodule in the neighborhood of the anus, interfering with cicatrization. On the 1st of January, 1687, Felix scarified this callosity deeply, and then applied to it red precipitate in powder, which produced a deep eschar. On the 7th of January there was a new and final scarification with lancet and scissors, the fifth since the beginning. An escharotic, compounded of equal parts of alum and red precipitate, was applied, and succeeded by excessive pain. Dysuria and a sanguinolent discharge occurred. The wound was bathed with barley-water; but the patient passed an uncomfortable night. From this date improvement was dedecided; the eschars separated, and cicatrization was complete by the 14th of January. February 18th the patient had another gouty attack; but on the 18th of March the king again mounted his horse.

It is curious to note the opinion of the physician-in-chief, Daquin, on the nature of this fistula. This is what he says:

"This tumour hath never been painfull, and hath displayed neither redness nor inflammation from its beginnynge throughout its progress. It was made to suppurate only with difficulty, and resolution could in no wise be obtayned. The greater parte thereof soon became indurated and