should overlap the permanent dressing well on all sides. (Prof. Lister, p. 142.)

Carbolic acid can be mixed with shell-lac in any amount by the aid of heat, and the result when cooled varies according to the quantity of the acid, from brittleness to fluidity, the intermediate proportion giving a firm but flexible solid, with considerable elasticity. The lac thus associated with carbolic acid retains it with great tenacity, so that a thin layer spread on calico forms an application which retains its virtues for days, at the temperature of the body, and at the same time does not irritate the skin. This substance forms an admirable substitute for the lint recommended for the formation of a scab in the treatment of compound fracture. The adhesiveness to the skin, which is its virtue in this case, is in other cases undesirable; this may be obviated by brushing it over lightly on the under surface with a weak solution of gutta percha in bisulphide of carbon. (Prof. Lister, p. 143.) FRACTURE OF THE LEG.-The back-splint should be very slightly curved for the calf of the leg, 3 inches wide at the widest part, and two and a half at the ankle. There ought to be a hole for the heel, that sloughing of that part may not be caused by pressure. One of the worst results from fracture of the leg is inversion or eversion of the foot, so that the patient walks on the side of the foot instead of on the flat of it. Another unfortunate result is rotation of the foot outwards, so that the patient afterwards walks with the toes rotated outwards instead of forwards. These accidents are easily avoidable by having a foot-piece, nearly at right angles with the back-piece. To this the foot must be firmly bandaged, taking care that the three balls of the sole of the foot are all equally pressed against it. The back-piece is to be made of iron, and must have two short transverse bars projecting from its sides, and looped, to receive the slings. A cradle, two flat wooden side-splints, and pads stuffed with tow, complete the apparatus required. There should be no bandages surrounding the limb, so as to obscure our view of it, and moreover they are liable to cause oedema. (Prof. Paget, p. 188.) LIGATURE OF ARTERIES ON THE ANTISEPTIC SYSTEM.-When catgut is kept steeped in a mixture of oil and carbolic acid, holding in solution a small quantity of water such as the acid enables the oil to dissolve, it becomes completely antiseptic, and when employed as a ligature to an artery may be safely left in the wound, the ends being cut off close. A simple solution of carbolic acid in oil will not do, for the gut remains quite rigid, the oil not entering at all into its substance, nor will a solution of acid in water answer the purpose, for the gut

Bnt

swells too much and becomes weakened. A vessel tied by this antiseptic ligature becomes permanently occluded by the internal and middle coats becoming blended together. a most wonderful thing happens to the bit of ligature-it becomes an organised and living structure, continuous with the external coat of the artery. (Prof. Lister, p. 131.) PARTIAL ANCHYLOSIS -If it cannot be determined that complete anchylosis has taken place, or whether the adhesions are fibrous, and if fibrous, whether they will yield to gradual extension or not, give chloroform, and these points can at once be satisfactorily determined. In cases of partial or fibrous anchylosis it is better to commence the treatment by dividing the tendons of rigid muscles, and by dividing subcutaneously cicatrices. Partial displacement of the articular surfaces is easily produced by continued extension without tenotomy. The tendons having been divided, if any displacement of the surfaces exist it must be remedied, and then gradual extension made by a properly fitting instrument. Numberless cases, however, exist in which the adhesions are so firm that they do not yield to gradual extension; in these chloroform must be given and the adhesions ruptured. The force applied for the purpose of rupturing adhesions must be applied in the direction of flexion, and the adhesions must be ruptured instantaneously. (Mr. B. E. Brodhurst, p. 172.)

REDUCTION OF OLD DISLOCATIONS.-Provided manipulations are employed in cases of old standing dislocations instead of the pulleys and physical force, reduction may be successfully accomplished at almost indefinite periods from the accident. If there is no attempt at repair of the injury in the new situation, and the limb is useless and painful, we are bound to attempt reduction. Chloroform is to be fully given, and then the head of the bone loosened from its attachments by moving and rotating it. Before this is done, in some cases it is well to divide any tendons which may be in the way of reduction. This is to be done subcutaneously and the punctures allowed to heal before the reduction is attempted. (Mr. B. E. Brodhurst, p. 178.)

REPRODUCTION OF BONE FROM PERIOSTEUM IN RESECTION OF JOINTS.-Experiments made by M. Ollier, of Lyons, conclusively establish the power of periosteum to reproduce bone. These experiments are of great importance as bearing on resection of joints. (p. 180.),

When the elbow-joint is excised, the bones only being removed, and the periosteum left entire, it is a most singular and startling fact that reproduction of the bone takes place,

the form of the original bone being preserved. A case is related in which both the condyles of the humerus and the olecranon process were reproduced. There was a regular joint, surrounded by a capsule and containing hyaline cartilage. The details of the operation are described. (Mr. T. Holmes, p. 175.) SPRAINS.-Compression.-Plunge the injured joint, say the ankle, into water as hot as can be borne, and keep it there for at least two hours, maintaining the temperature of the water by fresh quantities of the hot. Then having dried the part strap it carefully with adhesive plaster from the toes to the middle of the calf, as tightly and equally as possible, using long strips an inch wide. Next day the plasters will be found quite loose from the shrinking of the limb, which is now generally almost free from pain. The plasters must be removed and fresh ones applied, and this must be repeated on the next day, and again after an interval of two days. It is seldom necessary to apply them more than this, as the patient is able to use his limb, and is free from pain. (Dr. C. H. Higgins, p. 164.)

VARUS. The treatment of varus should not be delayed beyond one or two months from birth, as lapse of time only increases the difficulty of cure. As the distortion is a compound one, so its removal must be effected by various stages. It is better in every case to divide the three contracted tendons, viz., those of the tibialis anticus and tibialis posticus, and the tendo-Achillis. The tendons of the tibial muscles should be divided first, and the inversion of the foot overcome, before the tendo-Achillis is divided. (Mr. B. E. Brodhurst, p. 195.)

AFFECTIONS OF THE SKIN, ETC.

It

ARSENIC IN SKIN DISEASES.-Arsenic is adapted to the treatment of all chronic diseases of the skin which are neither contagious nor specific, neither strumous nor cancerous. is therefore necessary in six out of every seven cases of chronic skin disease which we are asked to relieve, and moreover these cases are curable by arsenic, and are absolutely incurable without it. If Fowler's solution is used, five minims should be given three times a day, after meals. It must be clearly understood by the patient that no results are to be expected for some time. If there is no improvement in a month, the dose must be slightly increased, and a slight increase may be made in the dose every three or four weeks, if necessary. If conjunctival inflammation of both eyes occurs, the dose may be reduced to four minims, but the

medicine must not be abandoned in a panic. It must be distinctly understood by the patient that the medicine acts slowly, and it may require combination with other treatment, such as aperients, or iron. (Mr. T. Hunt, p. 354.)

DERMALGIA.-There are two forms of dermalgia, the hysteric and the rheumatic. By dermalgia is meant an increased sensibility to touch confined to a limited portion of skin. Often the pain is independent of contact with any sensible object. Blisters, the linimentum belladonnæ, and the valerianate of zinc or bromide of ammonium internally, are the most likely means of affording relief. Subcutaneous injection of morphia is sometimes called for. (Dr. H. S. Purdon, p. 63.) CARBUNCLE." On a very strong impression, I say that carbuncles will spread after cutting in as large a proportion of cases as they will spread in without cutting." If they can be divided in the first three or four days whilst still hard and brawny, it may relieve some measure of the suffering; at a later period the incisions have no influence at all. Although abandoning the plan of crucial incisions of carbuncle, incisions are called for, if a portion of integument holds in and retains a slough or a quantity of matter, just the same as in an ordinary abscess. There is no good to be obtained by large feeding or abundant stimulants in ordinary cases of carbuncle; let the patient continue his ordinary mode of living. The importance of cleanliness is very great. Patients with carbuncle must not be shut up in their rooms, they should have plenty of free air. (Mr. J. Paget, p. 264.)

CONVERSION OF UPPER LAYER OF CUTICLE INTO LEATHER.— The application of a solution of tannin, of the strength of 600 grains to an ounce of water, to the skin, converts the upper layer of the cuticle into leather. It may be applied, according to circumstances, by a layer of lint saturated with the solution, or by means of a brush. The tannin combines chemically with the gelatine of the skin, forming a contracted impermeable layer of tannate of gelatine; it, in short, tans, or converts into leather the superficial layer of the cuticle. This may be made of use in many cases, as in the treatment of skin affections which depend on a local cause. It may also be found useful in checking and preventing unhealthy local sweatings, and in various other affections in which gentle and uniform pressure is required. (Mr. J. Martin, p. 329.) ERYSIPELATOUS INFLAMMATION.-To apply Nitrate of Silver.Unless nitrate of silver is properly applied it is liable to be unsuccessful. The parts should be carefully washed with soap and water, and afterwards with water alone, and then wiped

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dry with a soft towel. A concentrated solution of four scruples of the nitrate to four drachms of distilled water is then to be applied two or three times on the inflamed surface and beyond it, on the healthy skin, to the extent of two or three inches. Care must be taken that no part is left untouched. In twelve hours, if any inflamed part be unaffected, the solution must be immediately reapplied. (Mr. J. Higginbottom, p. 258.)

HERPES ZOSTER.-Mr. Jonathan Hutchinson gives some interesting cases showing that herpes zoster is liable to occur, as a result of the therapeutical administration of arsenic. (p. 262.) ITCH.-Except sulphur is used properly in itch it is productive rather of harm than good. In recent cases we should apply the sulphur freely to the interdigits and wrists only, and apply soothing remedies to the general surface, because the eruption on the general surface is sympathetic, the acari existing only about the hands and wrists. The sulphur is generally used a great deal too strong, one part to sixteen is quite strong enough. It is very commonly the case that the scabies is cured by the use of sulphur, but the secondary eruption is intensified. In such cases it is necessary to abandon all sulphur treatment, to give a bran-bath, and use freely some soothing lotion, and the patient soon gets well. (Dr. T. Fox, p. 259.)

LIPOMA NASI.-In cases of large, overgrown, knobby, purple noses, shave the overgrowth down with the knife until the fibro-cartilages are seen. There is usually very free hemorrhage, which is easily checked by pressure and ice. The wound should be dressed with cerate. A smooth even scar will result, much more sightly than the previous diseased state. (Mr. J. Hulke, p. 352.)

VENEREAL AFFECTIONS.

CHRONIC GONORRHOEA.-Glycerine of Tannin.-The following injection is of great service in cases of gleet and chronic gonorrhoea :-Glycerine of tannin, three ounces; olive oil and mucilage, of each one ounce. If used in the acute stage of the disease it should be diluted with equal parts of mucilage. (Mr. J. D. Hill, p. 271.)

HERPES ZOSTER, (sometimes Syphilitic.) In syphilitic herpes zoster the patches are located exactly as are those of common herpes zoster, and are as clearly under the influence of nerve distribution. But these cases differ from the common herpes zoster in that the eruption is usually on both sides of the