trouble for which the operation was demanded. I have made twenty-two abdominal sections of all kinds. The first was a case of perityphlitic abscess that I was called to treat in February, 1869. When I first saw the case I mistook it for one of hip-joint disease, but the abscess afterwards developed over the cæcum, and I cut down and evacuated the pus and a grape-seed. The case is reported in the May, 1869, number of the St. Louis Medical and Surgical Reporter. Since then I have read a very able article in the American Journal of the Medical Sciences, by Dr. V. P. Gibney, calling attention to the liability of perityphlitic abscess being mistaken for hip disease.

The next case was that of John Lyons, that was reported in the Philadelphia Reporter for October 25, 1879. I was called to him October 9, 1878, and found a strangulated hernia of five days' duration with eight inches of intestine and a large piece of omentum gangrenous. The gangrenous bowel had separated, permitting a large amount of fecal matter to become extravasated into the abdominal cavity. The gangrenous mass was cut off, and the abdominal cavity washed out well, and the ends of the divided bowel stitched into the external opening in such a manner as to allow of the abdomen being occasionally washed out with a weak solution of carbolic acid and common salt. As hopeless as the case appeared the man made a good recovery, and has attended two crops of corn since the operation.

The next case I reported to this Section in New York last year.

Now I must think, until I am convinced otherwise, that washing out of the peritoneal cavity had a good deal to do with the recovery of these cases; thereby the products of inflammation. that sometimes become so poisonous are gotten rid of. This doctrine is not new, neither is it original, Dr. Peasely having taught it several years ago, and it was still more eloquently and forcibly reiterated by Dr. Marion Sims in the New York Medical Journal a few years ago, and also by Dr. Wm. T. Briggs in the Nashville Medical Journal. There are cases such as must occur in the practice of almost every physician, and a careful consideration of the condition necessitating an operation will lead to the preservation of many precious lives that are now lost. Had Vallet been seen earlier, by a competent physician, he might have been saved. What I want to insist on is that in these cases of obstruction, abdominal section should be resorted to before

peritonitis sets in if possible. Many cases of obstruction in the cæcal region are caused by seeds or enteroliths becoming entangled in the appendix, causing ulceration, and, in the majority of cases, perforation and death. In other cases of perforation there are adhesions formed, permitting the pus to ultimately work its way externally. But the source of danger resulting from these adhesions must not be overlooked. Another thing that I wish to call your attention particularly to is the benefits derived from having an artificial anus formed. This is not a fictitious advantage, as it allows the gases that form in the bowels to escape without distending them and perhaps causing small cracks in the peritoneal coat inducing peritonitis or paralysis from over distension. The artificial anus may be readily and easily closed by the method I describe in my report of the John Lyons case in the Philadelphia Reporter. If the reporting of these cases causes any ignorant or rash man to undertake the operation, then, to some extent, am I sorry that I have reported them. But it was not for such persons that they have been reported, but rather that they may to some degree throw light upon paths that others will have to travel, that were once so dark to me, and that are yet by no means perfectly clear.

ARTHRITIS OF THE TEMPORO-MAXILLARY

ARTICULATION.

By D. H. GOODWILLIE, M.D., D.D.S.,

NEW YORK.

ARTHRITIC inflammation may be of a local or constitutional character. The former may be excited by dislocations, blows, luxations, or any lesion in neighboring parts. In the latter by some blood-poison, viz., syphilis, rheumatism, gout, scrofula, etc., and as such must have disease medicines that are antidotes or specifics to the particular blood-poison.

It is my desire in the following cases to call attention to my method of producing extension in acute inflammation of this joint from either of the above causes.

CASE I. Gouty Arthritis of the Temporo-maxillary Articulations.— A. P. B., of Hanover, N. H., sixty years of age, was brought to me by the late Prof. A. B. Crosby, M.D. He had been a man of very robust constitution; but for the past two or three years had suffered with attacks of gout, and was now certainly an object of pity to look upon.

The gout from which he had suffered came with terrific violence into both temporo-maxillary articulations, and when he came into my office his teeth were chattering like one in a malarial chill from excessive irritation and spasm of the muscles of the jaw. This caused great pressure on the inflamed articular surface, and gave him excruciating pain, so that he got no relief except from the effects of morphine hypodermically administered. The arthritis was preceded by neuralgia of the inferior maxillary nerve.

On examination of the mouth I found that his teeth had no decay in them, but some were very much worn by mastication upon the crowns, and some pulps (nerves) were exposed, and in

consequence he had pulpitis, causing neuralgia that was followed by acute arthritis.

In the treatment nothing could be done with him, except under the effects of morphine and an anaesthetic. This relieved him from pain while consciousness to some extent remained. The pulpitis, the exciting cause of the facial neuralgia, was removed by protecting the exposed dental pulps (nerves) from the air and attrition by means of gutta-percha and an interdental splint.

The principle of the treatment of arthritis in these joints is the same as in others, differing only in the method of application. I do not know that any extension appliance has ever been used for the relief of arthritis of this joint.

The method that I employ is as follows: In this case the patient was under the anesthetic effect of morphine and nitrous oxide. If there is any rigidity of the muscles, cautiously force open the mouth and take an impression of either the upper or lower teeth, and a rubber splint is made from the cast to cover

over all the teeth in one jaw. Upon the posterior part of this splint is made a prominence or fulcrum (D), so that when the mouth is closed the most posterior teeth close upon it, while all the anterior teeth are left free. The next step is to take a plaster-of-Paris impression of the chin, and from this make a splint