can do where there is an absence of hem orrhage is to carefully examine the viscera which from the nature of the producing force are most liable to injury.

If the hemorrhage is great, the visceral injury should be sought first in the solid viscera or abdominal vessels. Wounds of the solid viscera, except the spleen, should be sutured if they are small, tamponed if they are large. In all wounds of the spleen no matter how slight, splenectomy is the indication. Nephrectomy is indicated if the renal vesels or ureter are torn, or the kidney is displaced.

If an injury of the anterior wall of the stomach is found it should be enlarged sufficiently for an inspection of the posterior wall and the posterior wound if found should be closed through the enlarged anterior opening (Senn).

Injuries of the stomach and intestines should be closed by Lembert or Matress sutures. If a gunshot wound the tissues around the penetration should be cut away. If the wound of the intestine is a longitudinal rent or tear it should be closed transversely and vice versa, to avoid stricture. In explosion wounds of the intestines resection and anastamosis may be necessary.

The

Injuries of the bladder should be sutured with Lembert or Matress silk sutures passing only through the muscular coat. bladder should be tested for a leak in the suturing, before closing the abdominal wound. Gauze drainage should be left in the suprapubic wound for several days if the rupture is extra-peritoneal and the bladder should be drained for twenty-four hours by intermittent syphonage.

Whenever there has been an intra-peritoneal injury to the viscera the abdominal cavity should be filled with salt solution before closing the abdominal wound.

In conclusion I wish to report the following cases which illustrate in part the above principles of treatment :

Case 1. Incised wound of the chest wall. Puncture of the lung, diaphragm, and stomach. Operation, 12 hours after injury. Recovery.

A. R., aet. 36 years. At 7 p. m., while

The

deeply intoxicated, was stabbed with a stilletto, the instrument passing through the clothing, including an overcoat. point of entrance was in the left mammillary line at the seventh interspace. The patient was examined by the house surgeon on entrance to the hospital and it was decided that the wound had not penetrated the chest wall. There was little shock and the patient rested well through the night. At 8 a. m. he vomited the stomach contents which consisted of the evening meal mixed with a large amount of blood. Diagnosis of stomach penetration was then made and gastrotomy was advised. Incision was made in the median line and the stomach brought outside of the abdominal cavity. Two wounds in the greater curvature of the stomach were found which were closed with Matress sutures. The abdominal cavity was flushed with salt solution and closed without drainage. The wound in the chest wall was enlarged and the rent in the diaphragm was examined. No hernial protrusion existed and no repair was made. The wound in the chest wall was packed for several days and then allowed to close. Recovery was complete with no complications.

F. C., aet. 34 years. At the time of the accident, 10 a. m., the bladder was distended with urine. The patient was pinned to the ground under a heavy box, weighing several hundred pounds. On admission to the hospital, he complained of intense pain throughout the pelvic region but particularly in the perineum and back of left hip. There was no fracture of the pelvis. Catheterization showed hematuria. Diagnosis of rupture of the bladder was made and immediate operation advised. On opening the suprapubic space, extravasated urine poured out of the tissues. The wound in the bladder was found in the lower anterior quadrant and was 11⁄2 inches in length. It was closed with Matress silk sutures and the abdom

inal wound closed with gauze drainage. The bladder was syphoned intermittently for 24 hours and thereafter the urine was drawn every four hours for four days, after which natural urination was allowed. Recovery was complete, the patient leaving the hospital in sixteen days.

Case 3. Gunshot wound. Exploratory laparotomy. No visceral injury found. Recovery.

C. R., aet. 40 years. Was shot about 8 p. m. with a number 32 calibre revolver at close range. The point of entrance was just above Poupart's ligament and just inside the external iliac vein. From the direction taken by the probe and the symptoms of shock, it seemed probable that the bullet had entered the abdominal cavity. The abdominal cavity was opened in the median line below the umbilicus but no injury was found. There was no hematuria and no trace of blood in the bowel. The bullet was not located. The abdominal wound was closed and the patient made a good recovery.

Exploratory

Case 4. Stab wound. laparotomy. No visceral injury found. Recovery.

J. D., aet. 35 years. Patient was stabbed about 8 p. m. with a knife, the character of which was unknown. The point of entrance was on a level with and one inch to the right of the umbilicus, the direction being toward the median line. There was very little shock although the external hemorrhage was quite profuse. The pain was severe and localized over the central portion of the abdomen. Exploratory laparotomy was made and the intestines carefully examined for injury but none was found. There was a considerable amount of blood in the abdominal cavity which came from the wound in the parieties. The abdominal cavity was flushed with salt solution and closed. The penetrating wound was enlarged and followed down to the peritoneum which was closed with catgut and the wound of the soft parts packed for several days, after which it was closed. Recovery was complete.

I do not doubt but that some might say

that the last two cases should not have been submitted to the dangers of abdominal section as there were no symptoms of visceral injury except the location and direction of the external wound, and no injury to viscera was found. I believe, however, that the treatment was warranted and in accord with the best authorities. If no exploration had been made and there had been an injury to the viscera, an expectant plan of treatment would have been condemned and justly.

SCILLA.

By J. C. Fahnestock, M. D., Piqua, Ohio.

It is generally called squills--; or another common name for this bulb is Sea Onion. This perennial plant is found in those countries which border on the Mediterranean Sea. This sea onion is a pearshaped bulb about the size of your fist. This bulb sends forth long, lanceleolate, deep green leaves, and in the center of these arises a scape from one to three feet high, smooth and round, and at the top is a spike of white flowers, each flower on a purple pedicle.

There are two varieties of this sea onion; one having colorless bulb scales, the other having scales of a reddish or roseate color. The latter is the one used in our homeopathic preparations.

Squills is a very old remedy, being used by the Egyptians thousands of years ago. Hahremann made the first proving of squills.

Every remedy has a sphere of action, and each a nature of its own wherein it differs from all others; thus it naturally follows that it agrees with and is suitable to complaints of a certain kind, and is not at all applicable to those of other kinds. It is like people, who differ from each other, and like the nature of the different diseases which differ in character from each other.

When we come to the study of the sea onion, we find that it is not a quick acting remedy, nor do its symptoms come on so suddenly and stormy as those of the Aconite patient, nor is it slow like Gel. or Bry. By close study it is observed to con

form to troubles such as measles, whooping cough, bronchitis, etc., taking it several days to reach the height of its action.

There is a weary, languid feeling of the entire body. Constant, dull, rheumatic pains in the whole body, which abate dur. ing rest and increase during motion. Small red spots are noticed on hands, feet, and chest, and may cover the entire body, with boring and itching. Stretching of the arms, with yawning, but without drowsiness. The sleep is restless, full of dreams. After rising in the morning there seems to be quite a debility, especially in the hips. Chilliness, which is generally followed by heat. The squills patient is easily angered, and is ill-disposed; does not and will not perform mental or physical

labor.

If it be in children they have a whining mood. In cases of measles where we have the itching eruption, child sneezing, with acrid coryza causing the nose and upper lip to become sore, eyes illed with water, and the little patient will bore his fists into his eyes, due to the biting, acrid water, whines and cannot sleep, here squills will be the remedy.

Now with this trouble there may be a diarrhoea which is very offensive; stools brown, or real dark, slimy, fluid, with frothy bubbles. The stools are involuntary, passing when sneezing, coughing, or passing urine. I have never used squills for diarrhoea only on the above conditions.

Again, in whooping-cough we find very similar symptoms; violent, acrid coryza, eyes full of water, child bores his fists into eyes, rattling of mucus in chest, sneezing, and paroxysms of coughing with involuntary urination. Very often when the child begins to cough it must sneeze. When he attempts to take a drink of cold water he begins to cough. One swallow of water and then must stop, cough and sneeze, which makes the child cross and irritable.

I just recently had two cases of whooping cough with the above named symptoms, which were rapidly cured with squills.

To remind you again of a condition found under squills, the child is very thirsty,

but it produces such a dyspnoea that but a sip of water can be taken at a time. The child will draw in its breath just as you do when going in bathing in cold water. In the bather's words, "It takes your breath." Again, as the remedy goes deeper, we notice the accumulation of mucus in the chest, and the symptoms read, "A cough in the mornings, with profuse mucus expectoration." This loose, morning cough is not so fatiguing as the dry, evening cough. A feature is noticed that every time the child coughs there is a spurting of urine. With the wheezing, rattling cough there may be pleurisy which compels the patient to sit up to get relief. Squills often follows Bry. in cases of pleurisy.

One more condition to which I wish to call attention in this brief outline, is that in reference to the action of the remedy upon the urinary organs and the circulation.

Hahnemann tells us that "dropsical swellings can only be cured by scilla when the symptoms of the urinary organs correspond to those of scilla. Such swellings are very rare. Scilla will, on the contrary, be found a specific remedy in cases of diabetes." He also tells us that most of those patients who were treated with scilla for dropsical swellings, were hurried into premature graves.

I will relate a case of a lady past eighty years old, who was for a number of years, troubled with irregular action of the heart, intermitting every third or fifth beat. Took cold easily and was troubled with a "filling up of the lungs" as she expressed it, and a severe cough. With this cough she would often spit blood with the mucus. Felt very much exhausted every time she contracted a cold.

June 1, 1901, I was called to see this lady. Found her sitting in a chair unable to lie down. hands and feet badly swollen, ascites. Short, labored breathing, cough with much expectoration of mucus streaked with blood. Was very thirsty, but could not drink owing to shortness of breath. Pulse very irregular. Mouth felt dry, with pricking sensation of tongue. A constant desire to urinate. and only a

small quantity voided each time. Urine generally clear. Often a desire to have the bowels move when urinating. Examination of urine did not show any albumen much to my surprise.

I gave her squiils 3x for two days, and the only change noticed was for the worse. I then gave it in the 30 with no better result. Then the 200 was tried, but the patient only grew worse. It looked as if the old lady could only last a short time, and I informed her relatives to that effect. I then concluded to try squills in another form. I procured one ounce of squilla chips and put them into a pint of Port wine. This she took a tablespoonful every three hours until she began to have nausea, then only a teaspoonful every three or four hours. To the delight of every one, the heart became more regular. cough lessened. and urine increased.

Within one week she could lie down, cough nearly gone, appetite began to return as well as strength, and in two months she was quite well and has remained so ever since.

I have seen several cases of dropsy due to a leaky heart improve greatly from the use of squills in Port Wine. In all other troubles I use the 3x, 6x, 30x and 200 with good results, symptoms agreeing.

Reader, these are a few outlines of the action of squilla. To refresh your memory please turn to your materia medica and read again its symptomatology, and I shall be repaid for this short article.

OBSTRUCTIVE LARYNGITIS AND

INTUBATION.

By W. H. Phillips, M. D., Lecturer on Rhinology and Laryngology, Cleveland Homeopathic Medical College; Clinical Assistant, Department of Ear, Nose and Throat, Good Samaritan Dispensary.

This paper is not intended to be a learned dissertation upon either intubation or the disease for which it is done, obstructive laryngitis; but simply a report of and some conclusions drawn from the cases which have fallen to my lot within the past year. The term obstructive laryngitis is used because although the vast majority of these cases are undoubtedly diphtheritic, yet

there occurs one now and then where the diagnosis is, to say the least, doubtful.

I have seen and intubated so far this year sixteen cases, ranging in age from four months to ten years. Of these ten presented up to the time of intubation no pharyngeal membrane at all. Of the remaining six only two had extensive pharyngeal involvement the balance only slight tonsillar deposits, which made their appearance subsequent to the obstruction.

The stenosis appeared anywhere from a few hours to a week after the onset of the disease as evidenced by the rise in temperature and general appearance of illness, and when once present, progressed rapidly.

In only four of the cases had antitoxin been given prior to the intubation, and in three of these it had been given in the morning of the same day on which intubation was performed. The disease had either appeared so mild or the diagnosis was so much in doubt till the obstruction appeared, that it had not been considered necessary. In several of the cases marked cyanosis was present at the time of intubation and, in one, a septic case, on raising the child to insert the tube, respiration ceased, the pulse became thready and the child livid. The tube was quickly introduced, artificial respiration performed and hypodermics of brandy and atropine given.

The child revived and did nicely for two weeks, then died from a post diphtheritic paralysis. The tube was retained in the majority of the cases either three or four days, and only once was it necessary to reinsert it after removal. Three of the sixteen died, one, the case above referred to, ten days after the tube was removed, from paralysis; the second thirty-six hours after intubation from extension of the membrane downward; the other on the fifth day after intubation from a complicating pneumonia.

While the number of cases here reported is not large, they are fairly representative of the disease in question. They demonstrate the type of diphtheria in which intubation now seems to be most often necessary. They show its fatal complica