flatus catheter, and give hyoscyamus and belladonna, all the patient will bear. Vaginal examination discovers nothing bearing upon the case. The mustard-water injections come away, bringing nothing with them. August 1st. Condition unchanged, except that the patient has had some stercoraceous vomiting this morning, and some delirium from the belladonna. There being but little constitutional disturbance, I advised desisting from any active treatment for the present; give nourishing food, and that

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... which will leave the least residue. Continue quinine, and give enemata three times a day, with turpetitiue stupes to the abdomen to relieve tympanites. August 6th. Condition much the same. Now commenced applying electricity, one pole externally, following the course of the large intestine, upon the abdomen, the other inserted into the rectum. A current so powerful as to be unbearable upon the abdomen is scarcely felt in the rectum. Continued electricity for a week, together with injections of milk, and once or twice injections of glycerine. From this time to the 22d the treatment was expectant, with the exception of aspirating the bowels for the relief of the tympanites on the 14th and 18th, which afforded but slight relief. On the 22d the hand was introduced into the rectum after Simon's method, but the obstruction could not be removed with the use of a reasonable amount of force. The tympanites was now extreme, and, the patient beginning to show unmistakable signs of failing, the operation of colotomy was advised as a dernier ressort. In consultation with Dr. Newton, on the 24th, the conclusion was reached that unless relief from the obstruction were obtained the patient must die, and that soon. The consent of the friends was obtained, and the following morning appointed for the operation. August 25th. The patient passed a night of discomfort from the distention of the abdomen and embarrassment of respiration. The temperature at ten a. m. is 101°F., pulse 120, the patient courageous aud confident. The operation was performed by the writer, assisted by his brother, Dr. H. A. Smith, and Dr. Clark. The patient was etherized, and placed upon a table on her right side, with a pillow beneath her loin. The anterior and posterior superior spinous processes of the ilium were made out, the distance between them measured, and a transverse incision five inches in length was made, the centre of which was exactly half an inch behind the mid-point between the anterior and posterior iliac spinous processes. Immediately beneath the skin was found a layer of adipose tissue two inches in thickness, which necessitated making the incision in the skin an inch longer. The muscular layers were very thin ; the layers of areolar adipose tissue lying immediately upon the intestine were overloaded with fat. Care was taken to make the incision in the deep structures of the same length as the primary one. The gut was easily found ; two long silk sutures, armed with a needle at either end, were passed through it, parallel to the sides of the wound, the four needles passed through the skin above and below. The gut was then opened, the loop of the sutures drawn out and divided, and the four points made secure, except that one of the sutures tore out through the gut, as it did on two further attempts to secure it, so that a clamp was at last applied to retain it. Brownish-colored, semi-solid fascal matter poured forth from the opening the instant it was made, and continued until an ordinary chamber vessel was nearly filled. The edges of the skiu were then approximated, and the wound covered wiliialight dressing. The patient rallied well from the operation. At nine in the evening her pulse was 120, temperature 103.5°F. August 26th. Slept well ; the abdomen now perfectly flaccid ; general condition good ; the faecal fistula is still discharging the contents of the bowels. The case went on uninterruptedly, rectal injections being used frequently, to the 6th of October, when she bad a profuse discharge of faeces by the rectum, the first natural movement of the bowels for nearly three months. From that date to the present (February 1st) she has continued to improve, the wound now being scarcely half an inch in extent, faeeal mutter passing both by rectum and artificial opening. It is hoped that the opening will close spontaneously, otherwise a plastic operation will be performed for its accomplishment. It is hardly necessary to add that the patient has long been up and about her ordinary household duties, taking the entire care of the wound herself. The cause of the obstruction is still in doubt ; if stricture of the intestine, why should it ever have relaxed ? There is no cancerous caehexia whatever present.