raped by a tramp. The legal phase of the case terminated the next day when the perpetrator of the outrage was buried at the county's expense. As soon as possible the child was taken to a surgeon, some hundred or more miles distant, and her injuries attended to. As to the exact condition immediately after the outrage I am unable to state, but whatever operation was made at the time to overcome the effects of her injuries was not wholly successful, as at the time of her coming under my care the case presented the following, as shown in the illustration:

There was a complete rupture of the perineum. through the external and internal sphincters, and a laceration of the recto-vaginal septum up to within half an inch of the at

tachment of the cervix uteri, as shown in the accompanying sketch. The right labia minora was also torn in halves transversely. There was a prolapsus of the rectum, filling the entire vulvar orifice with folds of mucous membrane, and the movement of the fæces were only controlled to an extent sufficient to lead one to believe in the existence of a possible third sphincter of the lower bowel as mentioned by some anatomists. It was necessary to keep the child in diapers, for when the desire for stool came, it was impossible to retain the fæces long enough to reach a water closet unless one happened to be close at hand. The existence of this condition for two years had induced quite an extensive chronic congestion of the tissues about the orifices and some eczema of the skin of the inner aspect of the thighs. Preparatory to the operation the child was fed on nourishing food, and the day prior thereto was given two enemas and at night one grain of merc. dulc. lx; the morning of the operation another enema was given and the lower bowel was thoroughly cleansed. May 15th at 11 a. m. the child was operated upon under chloroform. The rectum was torn along the right side for over an inch and then the tear turned to the left and extended transversely across the bowel to the opposite side. By drawing down upon the nates, the child being in the dorsal position, the parts concerned were fully exposed to view, small sutures being used to keep the labia and the bulging mucus membrane out of the way. The cicatrized edges of the torn bowel were denuded and united by six silkworm gut sutures, no effort being made at this time to secure a union of the sphincters. Aristol dressings were applied and the child's limbs bandaged together at the ankles and knees. On putting her to bed fifteen drops of paregoric (tr. opii camph.) were given to check peristalsis, and a purely liquid diet was ordered. In the afternoon a frequent desire to micturate developed and before nine o'clock the next morning she had urinated twelve times, necessitating constant changing of the dressings. In order to prevent any fever and

to control the bladder symptoms, aconite and cantharis were given in alternation every half hour for several hours, until the latter trouble passed away. Some nausea and vomiting called for an occasional dose of ipecac. On the seventh day under an anæsthetic, the stitches were removed and it was found that the upper half of the wound had united.

May 26th a second operation was performed to cover the failure of the first and including the sphincter muscles. When the sutures were removed one week later, it was found that there had resulted a perfect union of the rectovaginal septum, but that the stitches holding the sphincters in apposition had pulled out at some time owing to the restlessness of the child. Further effort to repair the ruptured sphincters has been postponed until the child is old enough to understand the necessity of keeping absolutely quiet. At the present time she has control of the bowels, there is no prolapsus and with the exception of the unrepaired sphincter her condition is satisfactory to all parties concerned.

REPORT OF A CASE OF TETANUS.

R. K. PAINE, M. D.,
MANITOWOC, WIS.

July 21st, 1897, a young Polish man was shot in the palm of the left hand by the accidental discharge of a pistol containing a blank 22 cartridge. The tissues were considerably lacerated, and contained powder and the fragments of the shell. The wound was made as clean as possible by my assistant, Dr. Patchen, but a little suppuration followed and there was some pain and swelling in the hand. In about twelve days the wound had healed, but at this time he began to notice a little stiffness of the back, legs and jaws,

with some aching pains; very soon he could not open his jaws more than one-fourth of an inch, and he had difficulty in swallowing. The muscles of the face, and back of neck became somewhat rigid, giving the characteristic facial look of tetanus. He complained of headache, loss of appetite and weakness. His bowels moved easily. Gelsemium verat. viride, nux vom. and strychnia high were given him without checking the onward march of the trouble to any appreciable extent. It was then, after three or four days of this kind of treatment, that I decided to try tetanus anti-toxine, and accordingly it was injected into the abdominal tissues on the morning of Aug. 9. The evening following a profuse papular eruption appeared on the abdomen. This eruption was accompanied by intense itching, and it gradually spread all over the body. Four injections were made from eighteen to thirty-six hours apart, improvement being manifest in twenty-four hours after the first injection, and on the 18th of August he was discharged, cured of his tetanus.

The eruption continued from the first injection and until after he was all over the tetanus, in spite of all I could do, until I thought of trying a high dilution of the poison that caused it. Following up the thought I ran up the eighteenth dilution, or potency, of the drop or two remaining in the bottle of anti-toxine and gave it to him on No. 8 pellets. From the first dose he began to improve, and was soon rid of a very troublesome affliction.

The tetanus appearing so late might have been overcome without the attempted aid, as it has sometimes been done, and even in spite of bad treatment, and that may have been the case here; but be that as it may, I got a pretty good "proving" of tetanus anti-toxine, and by the aid of it have cured a number of very obstinate cases of skin disease, for which I got a fee. But it cost me about six dollars a dose to prove it, beside my professional services, as the patient was a Polak who promised big, and begged pitifully; but true to his race characteristics he went back on his word, his debt, and his only benefactor.

THE RELATION OF HOMEOPATHY TO POTENTIZED DRUGS.

MAYBELLE M. PARK, M. D., H. M.

WAUKESHA, WIS.

I hesitate, from my few years of practice, to speak to you on a subject of such weight and fundamental importance, but I voice not only my own thoughts but the words of Hahnemann, the master of homoeopathics, who gave us the Organon, the Bible of medical literature, the Materia Medica Pura, the masterpiece of materia medica, and the Chronic Diseases, the crown of therapeutics. Just as we go to the Bible for moral and spiritual guidance, so we should go to the Organon for definite and specific directions in any difficulty in our medical practice; it contains the alpha and omega of the laws governing the conscientious homœopathic physician. Says Dr. Kent, "Very few are able to read the Organon at first and see anything in it but words, and yet the oldest practitioner of pure homoeopathy finds nothing in it to change and the older he grows and becomes more active in work, the more he depends upon it and the more consistent it becomes."

We are all apparently unanimous on the one law, "similia similibus curantur" but we are not united on the method of applying, or gaining, the result to be reached by the similimum. We jeer at the allopathic shot gun prescriptions but I wonder how many before me have examined their own ammunition lately. In the Organon we find what Hahnemann says in regard to the single remedy. Sec. 169: "On account of the limited number of thoroughly known remedies, cases may occur where the first examination of the disease, and the first selection of a remedy prove that the totality of symptoms of the disease is not sufficiently covered by the morbific elements (symptoms) of a single remedy; and where we are obliged to choose be