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year there appeared a small opening in the lower end through which was discharged pus and fecal matter. This persisted for several months, with no tendency to close under the usual methods of treatment. In the latter part of 1904, I was called to see patient in consultation. At this time she was bed-ridden, emaciated, anemic and required rather large doses of morphin to relieve what seemed to be severe pain. A fistulous tract led from the lowest part of the abdominal incision backward, downwarddoi:10.1001/jama.1906.25210020032003c fatcat:baz6vqxadzfmldp5nb6vsuimdm