TREATMENT OF DISEASES- 343 



How far it is safe to allow a patient to pass a bougie for himself or herself, 

 is another question. I am disposed to think it is an unwise act to allow when 

 the bougie is solid, for I am sure I have seen great irritation and harm follow 

 upon the practice, and in several cases deep seated suppuration. Curling has 

 given a case where the patient caused his own death by perforating the bowel, 

 half an inch in extent, above the stricture. I have, consequently, been in the 

 habit of instructing my patients to use candles as bougies, and have been well 

 pleased with the practice. 



There comes a time, however, when this treatment by dilatation ceases to 

 be beneficial; when the stricture has so closed as to render it useless; or ulcer- 

 ated so as to render it unwise to adopt the practice; or associated with so much 

 distress as to forbid its use; and under these circumstances the practice of 

 oolotomy is of great value; it gives comfort to a degree that sometimes aston- 

 ishes, and always gratifies. On convalescence or recovery, it is not found to 

 be practically associated with such inconveniences as surgeons of old have 

 practically surrounded it. It prolongs life and adds materially to its comfort, 

 and little more than this can be said of most operations. But it must not be 

 postponed till the powers of life have become so exhausted as to render the 

 chances of recovery from the operation poor; or till the large intestine has 

 become so distended as to have become damaged or inflamed. It should be 

 undertaken as soon as it is clear that the local disease has passed beyond the 

 power of local treatment with any prospect of good, and the general powers 

 of the patient are beginning to fail; as soon as the local distress finds no relief 

 from palliative measures, and a downward course, with unmixed anguish, is evi- 

 dently approaching. The difficulties of colotomy are not great, nor are its dangers 

 numerous. When unsuccessful, it is usually made so from the delay in its 

 performance; from want of power in the patient; or death has resulted from 

 the secondary effects of the disease on the abdominal viscera. 



When most successful, it gives immediate relief to most of the symptoms, 

 and makes life worth living. When least so, by lessening pain, it renders 

 what remains of life endurable. The operation is now regarded as established, 

 and creditable to surgical art, and according to Curling; but, in the general 

 way, it has been postponed until too late a period to demonstrate its value. 



HYDROPHOBIA. — Treatment. — Cut off the bitten part, or apply 

 dry cupping, or suction, at once. Also the caustic potash. The internal 

 remedies heretofore employed have had little success. Perhaps nothing now 

 known promises more than to keep the patient, for a long time, under the 

 inuuence of chloroform or ether. The tincture of scullcap, in 2 or 3 dram 

 doses, will allay the nervous agitation, and is always worth using. It has been 

 proposed to clear the throat of the tough mucus by cauterizing it with a strong 

 solution of nitrate of silver applied with a shower syringe. The remedy is 

 worthy of a trial. 



Some of the Western physicians declare the red chickweed, or scarlet 

 pimpernell, to be an absolute remedy for this disease, and cite some quite 

 remarkable cases of its success. Four ozs. of this plant, in the dried state, are 

 directed to be boiled in 2 qts. of strong beer or ale, until the liquid is reduced 



