hand to the 200th centesimal potency. Dr. Gorton afterwards potentized the 200th up to the C. M. potency. The key note of this remedy is "sleepy indigestion or somnolent dyspepsia, a state of overwhelming drowsiness." Dr. Yingling has given the name Succus Fruti to the remedy, and claims that the results obtained for its use have been very gratifying.

Some Headaches.

Belladonna-Headache better from hair hanging down; worse if put up.

Neu

Ephiphegus-For sick headache brought on by exertion, shopping or any flurrying event in the lives of women. ralgia, nervous headache, 3x.

Lachesis-Headaches from suppressed or delayed discharges, as also from ovarian and uterine diseases, (Gardiner.)

Naja Menstrual sick headache; pain in left orbital region extending back to occiput, preceded and followed by nausea and vomiting. Intermittent.

Onosmodium-Ivens cured a patient of headache of ten years' standing. Dull headache in left eye and in the left temple. At times so sharp as to be almost unendurable. Worse on lying down, and in the dark. Glasses relieve, but onosmodium cured.

Consult Malcolm and Moss' Regional and Comparative Materia Medica for fifty different remedies conveniently arranged.

PHOSPHORUS

CAPILLARY BRONCHITIS.-Dr. Laird, N, A. Journ. Hom.: Phosphorus is almost specific for the hoarse, barking, croupy cough that sometimes remains after the acute symptoms have subsided. In puny, debilitated infants atelectasis does not always disappear with the cure of the original disease. In this condition there is no better remedy than sulphur.

Conducted by J. Wylie Anderson, M. D.

Indications for Operations Upon the Liver and Biliary Passages.

Pantaloni's recently issued work upon this subject (Chirurgie du foie, etc., Paris) gives, among mnch other categorical information, the indications for very many procedures of surgical intervention, which indicate the rapid growth of our knowledge upon these subjects.

Puncture of the liver may be either exploratory or therapeutic, the latter being largely restricted to hydatids. Aseptic exploratory puncture is used as a routine diagnostic procedure, being contraindicated only in suspected malignant diseases, in which exploratory laparotomy is to be preferred.

Intrahepatic injection is indicated in the treatment of hepatic abscess and hydatids.

Laparotomy, classified according to locality into parahepatic transpleural and lumbar, is done both for exploratory and therapeutic purposes. The former is practiced in trauma of all kinds, whether recent or old. The latter has been employed with success in a few cases of cirrhosis, tuberculosis and syphilis, and malignant disease has even been improved by this intervention. Advanced cancer however, is usually made worse by laparotomy.

Thermocautery of the liver, however performed, has been employed only to check hemorrhage, in connection with other operations.

The parahepatic tamponade is often employed in connection with laparotomy, as a mode of drainage, whenever the latter is indicated.

Intrahepatic curettage is indicated in abscesses, hydatids and syphiloma, in connection with laparatomy, hepatectomy, etc. Suture of the liver is practiced in trauma, either accidental or operatory, also in hepatopexy, resection, hepatostomy, etc.

Hepatotomy is done sometimes for exploratory purposes alone, with the object of locating deep hydatids, syhilomata, etc. For curative purposes (aside from resection) this operation has been practiced to divide double monstrosities (xiphopagi), and in connection with liberating hydatids.

Hepatostomy is an operation practiced in connection with the treatment of abscesses and cysts of the liver, in order to secure drainage and permit of treatment of the interior wall of the cavity; also to anticipate the extension and internal rupture of the accumulations of fluid.

Partial hepatectomy is done in connection with the treatment of wounds, hernia of the liver, numerous infectious granulomata (syphilis, tubercle, tumors of all kinds.

Hepatopexy is practiced for floating liver.

Hepatic phlebotomy has been done in various congestive and inflammatory affections of the liver and biliary passages. Radiography of the liver is practiced for suspected gall

stones.

Parabiliary laparotomy is indicated as a step in the numerous operations practiced upon the biliary passages and gallbladder.

Catheterism of the biliary passages is either exploratory or therapeutic in aim, and is of general applicability.

Injection of the biliary canals is done for the purpose of asepsis in connection with other operative procedures. Under this head the insufflation of air may be mentioned.

Drainage of the biliary passages is done in connection with other procedures, and has for its aim the lowering of the tension of the bile, prevention of infection, and is, in fact, a step of wide applicability.

Cholelithotripsy has been done a few times as a step in the removal of gall-stones.

Simple incision of the gall-bladder, cystic duct and common duct is a step which must be taken in most operations for gall-stones. Lithectomy is a term which denotes the actual ablation of the stone after incision.

Extraperitoneal cholecystostomy is an operative procedure of wide applicability in affections of the biliary passages.

Puncture of the gall-bladder is resorted to only in cases of necessity for exploratory purposes. This manoeuvre has not much of a field in therapeutics. Cholecystotomy, on the other hand, is an operation which must be performed in every case of biliary infection, in calculus of the gall-bladder or cystic duct, and in dropsy of the gall-bladder.

Cholecystostomy is one of the best known of all operative precedures about the biliary passages. The leading indication is in biliary infection, with or without the presence of lithiasis, including hypertrophic biliary cirrhosis, angiocholitis and cholecystitis.

Cholecystectomy, or ablation of the gall-bladder, has been done for tumors, including incipient carcinomata, and for persistent biliary fistulæ (in connection with enteroanastomosis), certain traumatisms, inveterate biliary lithiasis, certain advanced forms of cholecystitis, etc.

Cholecystenterostomy (anastomosis of gall-bladder and intestine) is an extensive resource in certain cases of obstruction of the common duct from tumors, calculi and stricture, and in fistula of the gall-bladder.

Dilatation of the biliary passages and plastic operations (cholesyringectomy) are employed in connection with the treatment of fistlæ.

Numerous operations are performed upon the cystic duct in connection with the removal of gall-stones (cysticolithotripsy, lithectomy, cysticotomy).

Cysticectomy, or resection of the cystic duct, has been done in connection with an operation for calculus.

Cysticoenterostomy has recently been performed for obstruction of the common duct.

Many operations upon the common duct have been performed, most of them within comparatively recent years. Explorative duodenotomy for examination of the common duct, choledocholithotripsy, choledocholithectomy and choledochotmy have all been employed for calculi within the common duct.

Choledochectomy and choledochoenterostomy have also been performed the first unsuccessfully, while the latter, in which anastomosis buttons are used, is pronounced to be one of the most delicate and brilliant of all intraabdominal operations.

Operations entirely similar to those performed upon the common and cystic ducts have also been carried out in connection with the hepatic duct (hepaticotomy, hepaticolithectomy, etc.), and upon the dilated biliary radicles (cholangiostomy, etc.); the indications were naturally connected with the presence of calculi, infection, etc.

Fistula in Ano.

By Dr. Crooks. (Medical Monograph.)

1. A careful physical examinatiun of the lungs as well as of the entire rectum is to be made in every case.

2. Pulmonary tuberculosis is not necessarily a contradiction. 3. Do not stop until every sinus has been divided.

4. Remove all diseased tissue; large wounds are not to be feared.

5. Divide the spinchter but once and then at a right angle. 6. Special attention is to be given to the mucous opening. 7. Invasion of the perineum is to be avoided, especially in females.

8. Systematic antisepsis is necessary.

9. Care and patience are required in the after-treatment. 10. In the after treatment two warnings are to be heeded: Complaints of unusual pain and increase in the discharge. Either of these may mean the formation of another abscess.

II. Hemorrhage and incontinencs are the chief dangers. Both are amenable to treatment and should not deter from operation.