distressing symptoms have always ceased when I have followed the following rules: Place the patient's head and shoulders low, and if a large quantity has been withdrawn allow the pressure to be renewed by rolling the patient on the well side, so that the organs can be again partially compressed and the heart and lung returned to where they were before the withdrawal of the fluid, give cardiac stimulants, apply friction to the extremities, and enjoin rest for a few minutes-until the circulation and respiration are harmoniously restored. Can thoracentesis be performed during pregnancy? has been answered in the affirmative. In a paper read before the Société de Chirurgie, Paris, an account is given of an operation on a woman in the seventh month of pregnancy, without disturbing. gestation; a healthy child being born at full term.1 The siphon method with the mercury manometer offers a means by which a slow, gradual, and steady flow can be accomplished, and at the same time the inter-thoracic pressure can be definitely watched. Dr. Ellis recently removed by this method from one patient one hundred and thirteen ounces in sixty-five minutes, the patient not expressing pain or discomfort, the flow being so gradual and uniform; and Dr. Garland, by opening the valve of the manometer, was able to read the amount of hydrostatic pressure in the chest. The anhydrous method, of not even permitting water to come into contact with the external wound, has in a number of instances inclined me to conclude that empyemata do better when this method is followed; providing that no perforation of the lung has occurred, producing a pneumo-pyo-thorax; we thereby do not add another factor towards producing that molecular change in the remaining entombed pus globules which so soon occurs on the addition of water, whereby their cells are ruptured and their contents placed in a more favorable condition to undergo that septic change and decomposition unfavorable to recovery. Conclusions.-Thoracentesis, or removing from the lungs the diseased parts, or the accumulated results of disease from within the thoracic cavity, are operations I have successfully performed without a fatal result twenty-one times during the past fifteen years. Any physician with an accurate anatomical knowledge 1 N. Y. Med. Journal, Sept. 1876, p. 307. 2 Boston Medical and Surgical Journal, April 15, 1880. can perform thoracentesis, when necessary, in any remote rural district without an assistant, with any small instrument having a cutting edge, and, if drainage be desirable, a piece of any hollow plant or the large quill of a feather with openings made along its side, introducing the hard end into the opening made between the ribs (if more complicated instruments cannot be had); and may thus be the means of saving a valuable life. Thoracentesis ranks among the first operations in surgery in saving life. Thoracentesis is justifiable to prevent pain and prolong life where an ultimate recovery of the lungs cannot be expected. Thoracentesis has been followed by a complete restoration to health. Complete absorption has followed when air, pus, or serum has been left in the chest after thoracentesis. The costal and pulmonary pleural membrane may be restored to its former healthy condition under favorable circumstances after thoracentesis for the removal of either pus or serum. General or local anesthesia may be resorted to, to prevent pain or shock of the operation. Hectic fever, the result of unhealthful decomposition, ought to be relieved by a free incision, to promote thorough removal of the effete matter, and disinfecting cleansings of the entire lining membrane of thorax, thereby removing, as quickly as possible, all material favoring septic disintegration of the pus and blood globules prior to absorption into the general circulation. By my recorded illustrations I have shown that thoracentesis can be successful on the nursing infant as well as on the adult; can be resorted to when both lungs are diseased, and even in far advanced pulmonary consumption, where the lungs are compressed by surrounding matter; and that relief from distressing suffocation can be obtained, life prolonged, and painful death averted. LAPAROTOMY AND COLOTOMY, WITH FORMATION OF ARTIFICIAL ANUS FOR OBSTRUCTION OF INTESTINES. BY WILLIAM A. BYRD, M.D., ILLINOIS. MR. CHAIRMAN AND GENTLEMEN: It is because I believe it to be an act of professional duty peremptorily required by the unsettled position of this operation in the minds of the most eminent surgeons, that induces me to report the following case for your consideration and criticism: January 14, 1880, I was called by Dr. Joel G. Williams, of Fowler, Illinois, to see Mr. John B. Gilmer, of Coatsburg, Illinois. The patient was a farmer, aged 43, who had been suffering with enteritis for some three months, but for some three weeks before I saw him he had ceased to have any discharges from his bowels, except blood and mucus. He had been seen by several physicians, all of whom pronounced his case hopeless, except Dr. Williams, who, thinking laparotomy offered some hope, telegraphed for me. I found the patient emaciated, and worn out with pain and the want of sleep. There had at times been vomiting, but it was not a constant symptom, and at no time was it stercoraceous. The abdomen was tympanitic and so greatly distended as to almost prevent breathing and greatly crippling the action of the heart. Having four or five years ago successfully relieved a patient, who had typhoid fever, of excessive tympanites, for Dr. Francis Drude, with the aspirator, I decided to try the same treatment in this case. The needle was passed into the abdomen at its most prominent and resonant part, about two inches above the umbilicus, and a large quantity of gas withdrawn, causing great relief. I now decided that the obstruction was in the left iliac region, and that lapar otomy offered about the only chance for his life. The obstruction had before been supposed to be situated at the ileo-cæcal valve. Injections had been resorted to, and a soft rubber tube passed up the rectum, which folding or rolling up on itself left the impression that the obstruction was higher. I was so deceived myself. The patient was so much relieved that he wanted any farther interference deferred. 16th. Was sent for again, and found the tympanites nearly as great as before, and the patient anxious for an immediate laparotomy. It being late in the afternoon, and wishing to operate antiseptically, I aspirated again, and ordered a drachm of fluid extract of opium per rectum, and promised to return early the next morning. I requested Drs. J. A. Wagner and E. B. Montgomery to accompany me, but Dr. Montgomery was prevented by an obstetrical case. 17th. At 9 A. M. we commenced the operation, first washing the patient's abdomen with carbolized water, one to forty, and shaving the abdomen. The assistant's hands were carefully washed in carbolized water, then oiled with carbolized olive oil. Drs. Joel G. Williams, J. A. Wagner, H. C. Skirvin, and Messrs. Chas. M. Gilmer and Richard Powell acted as assistants. Putting the patient under the influence of ether, the abdomen was opened for eight inches in the median line when the distended bowels poured out. The distension of the bowels was so great that before a proper search could be made for the ob struction the gas had to be removed with the aspirator, which was done by inserting the needle of the aspirator into different points of the intestines until they collapsed. Two knuckles of ileum and the sigmoid flexure of the colon were now found bound down in the pelvis and occluded by a band passing from one knuckle of the ileum over and including three-fourths of the diameter of the other knuckle, then splitting like a Y and inclosing the colon. The band was very vascular and about the size of my little finger, and round at its commencement, flattening and spreading out fan-shaped before it became attached to the peritoneum over the left ileum and sacrum. Where it passed over and was attached to the second knuckle of ileum it was about an inch and a half wide. I ligated the round part of the band with carbolized silk, divided it between the ligature and second portion of ileum, then cut off the ends of the ligature near the knot and dropped the pedicle. The second knuckle I enuclea |