[The cut gives a view of the oreration complete. Copied from Thomas].

In half an hour after the operation, forty drops of laudanum were given; in ten hours thirty, and in ten hours twenty; then ten drops three times a day. The diet was concentrated, little and often. In eight days the cold water dressing was discontinued, and a thinly sliced piece of old fat bacon applied over the wound. This was renewed once a day by allowing it to remain for a short time in hot water.

In ten days the ligatures of the vagina and rectum were removed by anal and vaginal speculums, having a convenient opening in either instrument, by which to clip and extract the ligatures. At the expiration of fifteen days the external ligatures were removed, one of them having shown some evidence of irritation and swelling. After the removal of the external ligatures, by Dr. Holiday and myself, to our great satisfaction, and that of the patient, we found the parts firmly united. The bowels remained undisturbed for three weeks, without any fullness, flatus or irritation.

An injection of castile soap suds, with a tablespoonful of honey, was then given. In a short time considerable focal matter was passed, considerable griping and pain ensued. The injection was repeated-more focal matter passed, and with some relief. The pain in the bowels continued, at intervals, for several hours, when a dose of castor oil with twenty-five drops of laudannm was given. This acted promptly, and while a large amount of focal matter was being passed, pressure to the perineum was carefully kept up. This gave complete relief, and all passed off by the anus without the slightest rupture of any part. The patient remained here ten days longer, passing the contents of the bowels in a healthy, and to her happy way.

I am naturally inquisitive, when I find a difficult operation has succeeded, to get at the "great guide marks," (as Sidney Smith expresses it), to find what is the grand ensignia of success. instinctively look to some one or few remedies, by which it is attained. In most things, however, a second sober thought teaches us, as did it King Lear, when he asked the "good apothecary to give him an ounce of civet to sweeten his imagination," that mostly, success is made up of atoms, the "littles are to be heaped up to make the bigs." It is the grains of sand, or the diversified particles, that make up the mountain. It is the drops of water, taken collectively, that make up the cataract, and give music to its volume; and the individual links in the chain which measures correctly the area of land, directed by the compass of a competent engineer. Often then, if a link is omitted,

"Whether tenth or ten thousandth,
It breaks the chain alike."

My reading and observation has taught me that the operation for Complete Rupture of the Perineum, has failed as often, or oftener, than most capital operations, and those who lay too much stress on the "liberating or oblique lateral incisions of Diffenbach, the metalic or lead suture of Mattauer, the silver wire of Sims, the division of the sphincter at two points by Baker-Brown, or the quilled suture, as practiced by Roux, of Paris, important as they severally are, will often fail unless we care for the littles."

"When thou wast little in thy own sight, wast thou not made the head of the tribes?" When I practiced medicine, (and that for thirty years), I solved the important problem, as I thought, of

first restoring the disordered secretions, and equalizing the broken balance of the circulation, and that, if possible, without an exhaustive method. In surgery, too, if we attain much in operations of this magnitude, we must look, unmistakably, to the condition of the general system prior to and after the operaticn. Take the present operation as an example. The complete preparation of the system is one of the littles of which authors say but little, and without which, you cannot keep the bowels quiescent long enough to insure complete reunion.

The same rule is equally important in ovariotomy. Show me a surgeon, in either operation, who has a summary way of dispatching his cases, and I will show you one who is not generally sucessful, no matter what time he makes, or how adroitly he handles the knife. Recto-vaginal openings are generally the result of flatus, and this induced oftener than otherwise, by unhealthy secretions or improper diet. Prof. Simpson advises the introduction of a tube into the rectum, by which the flatus may pass off, but this, in a given time, will become obstructed, and invite action of the bowels. The sphincter ani, was divided but at one point in the present case, and if the muscular fibres are completely divided, I cannot conceive of the necessity, (as) Baker-Brown advises), of dividing the muscle at two points. I am strongly in favor, however, notwithstanding the quasi authority on this point, of dividing the sphincter, and doubt if a case like the present can do so well without it.

The use of the metalic suture originated in the United States. Mattauer, of Virginia, treated these cases with lead used as interrupted suture; Sims, the apostle of other days, improved on this John the Baptist, and has given us the best of all sutures, silver wire, which is destined to be the rule and not the exception.

When I commenced the operation I intended to use the oblique lateral incision of Diffenbach, because of the case having been operated on before. After dividing the sphincter, however, I was satisfied to avoid that complication, of the many essentials, not so much written about, as the warmly contested modes of operating, is the position on the side implicitly enforced, with the broad bandages securely pinned from the hip bones down to the lower third of the thigh. There are other littles, if less essential, worthy of sound memory:

The bowels to be left quiet for twenty days.

The external ligatures not to be removed under fifteen days. Diet concentrated, little and often.

Cold water dressing suspended from eight to ten days.
Laudanum to keep the bowels quiet.

In the practice of medicine, as of surgery, the gratitude of our patients is a jewel not always worn, and when we find it "it is like the murmuring of a rivulet in a parched and sandy desert."

This poor woman, a miserable sufferer for ten years, when she found the parts had healed, and she was no longer an object of loathing to herself, and those around her, there was no measure to her joy and her gratitude.

I can not say of how much interest this case may be to the profession, I have tried to help myself to a better understanding of the operation, and if I have not aided others, I have the opprobrium of being selfish for having helped myself.

Translations.

Bouchardat on Coffee.

Translated from the Annuaire de Therapeutique, by GEO. E. WALTON, M. D. Cincinnati,

In every part of the habitable globe, we find articles employed that act specifically on the nervous system-articles which stimulate, and sometimes derange our intellectual faculties. Among these stimulants of the nervous system, some, such as alcohol and tobacco, have grave inconveniences that more than counterbalance the good, while others, such as tea and coffee, have almost always only happy results when wisely employed.

I will premise what I shall say concerning coffee, by informing you that we, in France, are large consumers of this article. While in London each inhabitant consumes only two and a half pounds annually, we in Paris need eight pounds each, for our yearly supply.

Definition. Coffee is the seed of the coffea Arabica, a small evergreen growing to the height of ten or twenty feet, belonging to the order Rubiaceæ. It seems that the origin of the word coffee is involved in doubt. Perhaps the best explanation is that which traces it to the Arabic word Cahveh, which is derived from Cahouah, a verb, signifying to become satiated. This word was employed as a noun, somewhat as our word drink. Thus, they have the cahveh or coffee of wine; the cahveh or coffee of the hull of the coffee

seed, and the cavoeh of the coffee seed; the infusion which we call coffee, and which they call Buun.

History.-The coffee tree was known to the Hebrews and Arabs. According to Abdelcader, coffee has been used as a drink in Ethiopia (to which country it is indigenous) from time immemorial. It is thought it may also be a native of the soil of Abysinia, and Arabia. The origin of the use of coffee is shrouded in doubt. Naironi tells a story which attributes the discovery to a goatherd and a superior of a monastery. The goat-herd told the monks that the goats were wakeful and frisky all night long, contrary to their usual custom. The superior watched them one night while they were grazing, and observed that they ate of the fruit of certain small trees. He then procured some of the frui boiled it in water, and on drinking it, found that wakefulnes ensued. Having made this discovery he utilized it, by causing the monks to drink of the infusion to prevent them sleeping during the night watches. Although this tradition is so improbable, yet it is received with the utmost confidence in the Orient. By varied paths the use of coffee traveled westward, first making its appearance in Eastern Europe in 1583, at which time. it is mentioned by Leonard Rauwolf, a German physician. Coffee was first used in France in 1644, under Louis XIV. The first cafe was established in Paris in 1672, by an Armenian named Pascal at the fair St. Germain. Cates did not, however, become a permanent institution of the capital, until a year or so later, when a Sicilian named Procope opened a cafe at a fair, and when the fair closed, removed it to the Rue des Fosses, St. Germaine, opposite the Theatre of Comedie, Francaise. Here it became the daily resort of the most celebrated men in letters, medicine and science, and the names that echoed through the saloons were those of Voltaire, Boileau, La Fontaine, Piron and Fontenelle. It still exists under the old name of Cafe Procope, and still the savans of the Latin quarter gather within its walls.

In 1714 the first coffee tree in France was presented to Louis XIV, and placed in the royal garden, where it flourished under the care of the botanist, Jussieu. From this tree three plants were taken in 1720, and confided to Capt. Duclieux for transportation to Martinique. During the voyage, which was long and perilous, two perished, and the third would have also died, had not the captain bestowed on it the most assiduous attention, and