and eruptions on the skin; which effects, if continued or occurring in sanguine or irritable subjects, required a suspension of the bath for two or three days, or, if need be, a temporary recourse to tepid bathing. Precisely similar effects are occasionally observed at all thermal bathing places, and the condition is designated in Germany the " Bad-sturm or Spa Fever," and elsewhere termed the "Reaction Fever." According to Dr. Heim, of Wildbad, as quoted by Dr. Johnson in his "Pilgrimages to the Spas," this reaction is precisely that which ought to inspire the greatest hopes in the patient, as it announces a change in his constitution, and a victory over his malady. The disagreeable sensations, however, which he feels, often put him out of humor with the baths, especially if old pains and discomforts that had ceased now reappear, which they often do. He becomes impotent and morose when he is re-visited by rheumatic pains, neuralgia, gout, hæmorrhoids, etc., which he had thought to be extinct. Such reaction, however, is indispensable towards the victory of nature and the baths over the disease, for which they were employed.

Dr. Bell states that analogous effects are familiar to the gouty subjects who visit Bath, in England, and bathe in and drink the water, and on whom, in consequence, a fit of acute gout supervenes. The nearer the warm approaches to the hot bath, the more likely is the fever of reaction to occur.

It is proper to add, that aside from these changes of temporary duration which, as it appears, are to be regarded in the light of critical phenomena, more serious effects are sometimes observed, and that these constitute grounds of positive contra-indication of the continued use of the hot bath. Dr. Bell cites the following instances: "Fourcroy relates the case of an individual, who, being immersed in a bath of the immoderate heat of 180° Fahr., fell down apoplectic an hour afterwards. Buchan narrates the history of a patient who was seized with paralysis from having used used a bath "excessively hot." Venel saw a sick person sink into a state of fatal debility by remaining too long in a hot bath, and the same author tells

of a Spaniard who died of hæmorrhage from the same cause. Rostan (Dictionnaire de Medicine, Paris, 1833, Art. Bains.) relates a most extraordinary case of a young woman who, suffering from severe pains in her limbs, was advised by a quack to remain for twelve hours in a bath, of which the temperature should be progressively raised to a degree approximating the boiling point. After six hours she lost consciousness. An hour later she was found with her head resting on a plank, which stretched across the bathing-tub, entirely insensible. She was taken out of the water-her face was black and enormously swollen-the surface of the body of a deep red, very hot and congested, the pulse hard, frequent, and irregular, the respiration labored and burning, and there were convulsive movements of the limbs which were excited by the slightest touch. Venæsection to the extent of withdrawing twenty-eight ounces of very red blood arrested the convulsions and restored consciousness and the power of speech. After diverse accidents, especially a very severe epigastric pain, which was treated by leeching and emollient applications, this woman recovered. Six weeks afterwards the entire cutaneous epidermis was detached. The pains in the limbs had not recurred eleven months after this severe treatment.

These are, however, instances of an insane abuse of an agent which, as we have seen, may be made the means of relieving or curing many distressing maladies. But it would be well to prohibit its employment in the case of persons liable to either cerebral or pulmonary congestions, or afflicted with cardiac trouble, and in any case to recommend it to be used with great precautions under the supervision of a medical adviser.

ART. II.-LACERATION OF THE RECTUM. Reported by M. T. TAYLOR, M. D., Fishersville, Jefferson, Ky.

On Thursday, at 3 o'clock P. M., September 2, 1869, J. C., in attempting to descend from a stack of grain, which was being

threshed at the time, slipped down upon the large or blunt end of a pitch-fork, it entering the body about one-half an inch behind the anus, and passing upward to perhaps an inch from the point of entrance, where it struck the posterior portion of the rectum, lacerating the bowel up to a point near the sigmoid flexure.

The depth to which the fork penetrated, as evidenced by the blood and shreds of areolar tissue on the handle, measured nearly eight inches. The implement was a common steel fork, used by farmers, the prongs resting on the ground, and the handle leaning against the stack in nearly a perpendicular position. The end of the handle, which entered the body, was round, and measured one and one-half inches in diameter at the largest part. The man weighed 160 pounds, and the momentum gained by such a weight in slipping nearly perpendicularly from a height of, perhaps, 20 or 25 feet, was sufficient to drive the steel prongs into the ground to their full extent, where the fork remained fastened, throwing the body forward to a considerable distance, the elastic steel causing the fork to spring back when the weight was thrown off.

The man was placed on a sled and carried to his home (a distance of three-quarters of a mile) immediately. I saw him one hour after the accident, when I found him pale, but not greatly prostrated, and somewhat cold. He did not complain of much pain, except when moved. There had been no rigors; the pulse 95, rather soft and intermitting. There had been much hæmorrhage, which still continued, though in lessening quantity.

The fork had entered the body, as already stated, a little behind and to the right of the anus, the sphincter ani just escaping. On removing a few shreds of areolar tissue, which were hanging from the wound, I introduced a silver probe into it, and passing my finger into the rectum, found that it came in contact with the probe about one and one-half inches from the anus. I explored the wound, following the general course that the implement would naturally make, pressing the probe to the posterior surface of the wound, so as to prevent its passing up the

rectum. It passed readily to the depth of nearly eight inches, corresponding to the mark on the handle of the fork. The rectum, from the point where the implement came in contact with it, was lacerated as far as I could explore it with the finger, as I found by introducing the index finger of each hand, the one into the wound and the other into the rectum as far as it was possible to do so; I concluded, therefore, that the bowel was ruptured to a point near the sigmoid flexure, or as far as the course of the gut corresponded to the general direction of the wound.

There was no loss of sensation in the lower extremities; passive motion gave considerable pain, but there was but a little while the patient was perfectly at rest.

Whiskey and water were administered in small quantities till the pulse became stronger. At 7 o'clock it was 100 and less intermittent, the hæmorrhage very slight, and the temperature natural. The wound was cleansed by introducing a flexible tube into the rectum and injecting tepid water with some little force, which had the effect of washing out portions of clothing, hair, and coagulated blood. Water-dressing was applied to the external wound, with directions to keep it constantly saturated with cold water, and a full dose of morph. sulph. administered, to be repeated every two hours until sleep or rest was procured. Acidulated drinks; beef-tea for nutriment.

Second day-September 3-8 o'clock A. M.-Pulse 110, rather soft; no excess of heat; but little thirst; hæmorrhage almost entirely ceased; slept two or three hours during the night; countenance somewhat pinched, but seems perfectly self-possessed; complains of deep-seated pain in the posterior pelvic region; expresses himself as being very sore, as if he "had been beaten all over with a stick." Prescribed epsom salts to empty the bowels; continue whiskey and cold water applications to external wound.

Same day 2 o'clock P. M.-Arrive just as the salts are acting. The attendants had gotten him out of bed, and he was resting on his hands and feet, he being unable to get in any posi

tion except on "all-fours." At every peristaltic movement of the bowels the fluid fecal matter would pass mostly through the wound; "squirting it," as the attendant expressed it, “in all directions." Complains of great soreness in the pelvic region; pulse considerably accelerated; hot, dry skin; much thirst, and general febrile symptoms. Wound cleansed with tepid water. Use, by means of flexible tube and syringe a tepid solution (3i. to Oij) of chloride of soda. Prescribed laudanum and carb. ammonia, to be repeated every two or three hours until pain is lessened or sleep procured. Sponge the body with acidulated water; continue beef-tea and whiskey.

Third day-September 4-8 o'clock A. M.-Find patient in much better condition; slept pretty well; pulse 110, softer; skin not so hot; thirst much less; took as much beef-tea as he ought, and relished it; found slight discharge from wound, but could tell but little about it from the fæcal matter that was mixed with it; several small actions through the night, he having no power to control the discharges, the fæcal accumulations passing through the wound. The septum between the external wound and anus presents the appearance of sloughing. Repeat the chloride of soda injection after thoroughly cleansing the wound. Also, apply a solution of carbolic acid to external wound. Substitute morph. sulph. for the laudanum, and continue ammo. carb.

Fourth day-September 5th.-Patient in much the same condition as yesterday. Discharge from wound increased; not so much fæcal matter, but still enough to shroud the character of the pus. Continue treatment.

Fifth day-September 6-8 o'clock A. M.-Found patient much improved every way. Had slept well; pulse 90, soft and full; skin moist; no thirst; appetite good. On examining the wound found the septum sloughed through, thus making the wound and the anus one and the same opening. A considerable slough had been thrown off, making the external wound assume a triangular appearance. No fecal matter, and the dis