nipple. The orifice of entrance was in the 5th intercostal space, and the ball ranging downwards fractured the 6th rib, and entered the abdomen between the 6th and 7th ribs. Much bleeding and marked shock followed, pain in situ and pain in the right shoulder. There was no escape of bile from the wound. The patient vomited the contents of the stomach, but no blood. A wound of the liver was diagnosticated. The hemorrhage gradually ceased, but the patient died in the evening of the same day never having rallied from the profound shock.

Autopsy. The bullet was found to have passed entirely through the upper surface of the liver, and to be embedded in the substance of the diaphragm. Peritonitis was beginning. Whilst an exploratory incision might have satisfred our curiosity perhaps, in regard to the nature of the injury, it could not in any way have improved the chances of the patient for recovery.

CASE 5.-Pistol wound of back, perforation of small intestine. Death in 29 hours from peritonitis.-W. G., colored, aged 34, was shot by a policeman, whilst attemping to escape. The man was running, and was about 15 feet distant from the officer. The weapon used was a large sized Smith and Wesson pistol. The ball entered one inch to the left of the second lumbar vertebra, and a probe could not be made to follow its track. Seven hours after injury the pulse was 82, respiration 32, temperature 983, and there was no shock. Soon pain about the umbilicus set in, and rigidity of the abdominal muscles; vomiting occurred, and also an alvine evacuation of blood; urine was passed voluntarily; there was numbness of the left thigh, in the parts supplied by the anterior crural nerve. The temperature began to rise and in 12 hours reached Icot, pulse 90, respiration 48, and thoracic, the abdominal tenderness remaining. Fifteen hours after the shooting, consultation was held with an eminent ex-military surgeon, who entertained the opinion, that as we did not know where the bullet had passed or what was injured, and the case was a legal one, it would not be best to try any experiments with him in the way of abdominal section. Whilst rather desirous of giving the poor fellow the slight chance for life that laparotomy offered, I recognized the wisdom of the advice and refrained from operation. The peritonitis became more marked and he died therefrom in 29 hours from the time of injury.

Autopsy-The ball entered the back, opposite the 2nd lumbar vertebra, grazed the 3rd lumbar vertebra and then passed into the

abdominal cavity, pierced the small intestine by two openings and finally dropped into the pelvis. Feces had escaped, and an intense general peritonitis was set up, with the deposition of lymph upon the neighboring coils of intentines.

In the light of the post mortem examination, I regret not having performed laparotomy upon this patient, though I regard the probability of success as having been exceeding remote. There were, however, only 2 holes in the intestines and they could have been easily sutured. It must always be a delicate matter to decide in favor of laparotomy when the ball enters from behind.

CASE 6-Pistol wound of back; empyema and recovery.-A. B., admitted August 21, 1884, shot with a No. 32 calibre pistol, the bullet entering 6 inches to the left of the spine, and 3 inches below angle of scapula. When shot the woman was in the act of crawling under a bed, and had her left side exposed to her assailant who was standing up and but 6 feet distant. When admitted she had but little pain, but was tender in epigastrium and over abdomen generally; had no paralysis; could urinate; had vomited, but without hematemesis; bowels had been opened; no shock; no tympanites; bullet wound nearly over spleen. Respiration somewhat painful ; next morning temperature 993, pulse 104, respiration 28, a slight rise of temperature in the evening and on the next day to 100°, but she feels comfortable; abdomen not tender, no pain, tongue furred; 24th, temperature, 983, pulse, 84, respiration 24 and feels well. The case progressed favorably with slight fever for a week when sharp pain in the side and increased temperature announced the advent of traumatic pleurisy. At this time my term of service ceased, and she fell into the hands of Prof. Tiffany. Her case now developed into empyema, and under the skillful treatment of Prof. Tiffany was conducted to a successsful termination by thoroughly draining the pleural cavity after resecting a portion of a rib.

Since writing the foregoing remarks, the remarkable cases of Dr. Andrews of Chicago have come to my notice, in one of which a bullet entered the linea alba, one inch above the navel, and was subsequently passed per anum; the other entered the right side near the eleventh rib and emerged between ensiform cartilage and navel, and probably penetrated the stomach. Both recovered without trouble. under opium and restriction of food. Both patients were youths and the pistols were of small calibre.

As the result of personal experience and of studying the reports of recorded cases, I am lead to the following conclusions:

Ist. The simple fact that a penetrating gun-shot wound of the abdomen has been received, does not justify laparotomy, unless other unequivocal symptoms of intestinal perforation or hemorrhage are present.

2d. Small pistol wounds do not demand laparotomy.

3d. Wounds of the back or side are not to be treated by abdominal section, until it is positively certain that perforation has occurred, as it is impossible in many cases to tell what abdominal viscera have been injured, and it would be useless to open the belly for wounds of the liver or other large solid organs, to say nothing of the probability of finding the injury confined to the soft parts, spinal column, etc.

4th. All penetrating wounds from fire-arms of large size, inflicted upon the front of the abdomen, in which it is highly probable that the small intestines have been lacerated, demand exploratory incision, suturing of holes, and ligature of bleeding vessels.

5. Cases in which the nature of injury is doubtful, are best treated by large doses of opium, and rigid abstinence from food for several days.

DISCUSSION ON DR. WINSLOW'S PAPER, ON PENETRATING GUN SHOT WOUNDS OF ABDOMEN.

DR. HARRIS said that he fully approved of the conclusions in this paper, and he reported a case in point where the conservative line of treatment was carried out.

DR. J. E. MICHAEL spoke on two of the cases mentioned by Dr. Winslow and still further elucidated them, and reported the case of a man who, in anger, struck the stock of his gun against the ground. It went off and the shot penetrated his abdomen. Peritonitis occurred but he recovered under the conservative treatment. He spoke also of a colored man who was stabbed with a carving knife in the left side over the spleen. The symptoms showed that internal hemorrhage was going on. The patient died and the autopsy showed that the spleen had been cut, and that the bleeding had come from its vessels. In the light of the autopsy, it seems that he might have made an exploratory incision. He would have had to ligate the vessels and

extirpate the spleen. The strong probabilities were that the patient would have died, and the law would have been unable to ascertain who had killed him.

DR. BRANHAM said there was another side to the question; and reported a case that died from a gun-shot wound. The autopsy revealed that the colon only had been perforated, the shot having gone through to the skin at the back. In this case had laparotomy been done the patient might have been saved.

DR. MICHAEL. That was a diagnosis from the autopsy. Such precision is impossible during life. The operation in question is a very serious one, especially in a hospital, and should not be undertaken unless there is very clear evidence that it is required.

DR. BRANHAM said the position of the wound in the case he referred to, and the concomitant symptoms were such as to point to the true state of the case before death.

OBSERVATIONS ON THE ORIGIN AND CURE OF THE DISEASE CALLED “HAY ASTHMA" (CORYZA VASOMOTORIA PERIODICA ).

BY JOHN N. MACKENZIE, M.D., of Baltimore, Md.
Surgeon to the Baltimore Eye, Ear and Throat Charity Hospital.

The therapeutic history of the disease commonly known as "hay fever" furnishes a striking illustration of the way in which errors in medicine are perpetuated through lazy subscription to prevailing ideas and blind acceptance of the dicta of "authority."

Ignorance of intra nasal pathology on the part of those investigating the complaint, false theories founded on the examination of solitary cases, and especially the so-called pollen theory have, by drawing attention to less essential conditions, not only been insuperable barriers to therapeutic progress in the disease, but have also by the measures based upon them, in no small measure contributed to the sufferings of the unfortunate victims of this complaint.

The orthodox treatment of the advocates of the pollen theory is to keep the patient indoors, and, if possible, confined to his room during the hay fever season. He must wear spectacle frames fitted to the orbits and fill his nostrils with cotton. When out of the range of pollen he must remove the tampons from his nasal passages and add a fresh source of distress by the inhalation of irritating powders or snuffs.

Apart from innumerable other inconveniences attendant upon such a line of treatment, imagine the tortures of confinement to a closed chamber through the intense heat of our summer months; picture to yourselves the spectacle which the sufferer presents with his eye balls covered with an unsightly apparatus, and his nasal passages stuffed with cotton, uncomfortable and unavailing, as those who have tried it will tell you.

The use of snuffs in the nasal passages is a questionable practice under any circumstances, and the general practitioner had better