temperature, and the exclusion of light. It must be secured in situ, with gentle pressure, by thin strips of soap plaster, spread on unglazed calico (which adheres without warming). I find this by far the best dressing. Pressure can be accurately applied by strips fixed to the forehead and cheek, and if necessary, by an additional broad strap passed from temple to temple. Any kind of compress bandage inay also, if required, be readily applied over the pads and plaster. Inflammatory or other complications coming on after the operation must be treated on general principles, such, however, very seldom occur; rest on the couch for 48 hours in a partially darkened room, and confinement for a week, being as a rule, all the after-treatment required.Ophthalmic Hospital Reports, April, 1869, p. 197.

76.-TREATMENT OF CATARACT BY PHOSPHORUS.

M. TAVIGNOT, a well-known and much esteemed Parisian oculist, has lately published in the France Médicale, a series of cases which would go far to prove that frictions on the forehead with phosphorated oil, and instillations of the same into the eye, may contribute to the melting away of the hardened lens or capsule, and the restoration of sight, without the usual operation. These cases are worthy of attention, and should be read by all those who take an interest in ophthalmology.-Lancet, Jan. 23, 1869, p. 126.

77.-TWO CASES OF ORBITAL TUMOUR, TREATED BY FIRST EXTIRPATING THE DISEASE, AND THEN APPLYING THE CHLORIDE-OF-ZINC PASTE.

Under the care of GEORGE LAWSON, Esq., at the Middlesex Hospital.

The results of operations for the removal of orbital tumours, and especially of those which are of the malignant class, are generally so unfavourable, that it is pleasing to be able to record instances in which the disease has been eradicated, and the patient has continued for a long time free from any recurrence. In a visit to this hospital a few days since, we had the opportunity of seeing two patients who had been operated on by Mr. Lawson for orbital tumours, both of which were apparently of a cancerous nature. The first patient was a female in the cancer wards, who was admitted into the hospital as far back as January 30th, 1866. She was then suffering from a scirrhous tumour of the left orbit, and from a small growth of a similar nature on the cheek of the same side of the face. From both localities the disease was excised, and, all hemorrhage having been arrested by the application of the actual cautery, the chloride-of-zinc paste, spread on small pieces of lint, was laid evenly over the whole of both surfaces. In due time the sloughs separated, and the wound on the cheek soon cicatrised; but in the orbit the whole of the bony walls perished from the action of the caustics, and were detached in one piece. The skin now contracted closely round the gap, and the patient soon became convalescent. As it was impossible to say that the disease would not recur, the woman was allowed to remain in the hospital, where she has continued up to the present time, and without any recurrence of the tumours. As it is now nearly three years since the operation, the committee have rightly considered that the patient is no longer a fit subject for the cancer charity, and she has therefore received orders to leave the hospital in a short time.

The second patient was only admitted into the hospital on December 1st. The account which he gave of himself was that the right eye was removed last June, on account of an intraocular growth, but that very shortly afterwards a tumour began to grow from within the orbit. On his admission, the lids were tightly stretched over a firm, nodulated tumour, which occupied the orbit, and bulged considerably beyond it. Mr. Lawson treated this case in a

manner similar to the last one. The pain following the operation was very severe; but it was relieved, and sleep obtained, by subcutaneous injections of one-third of a grain of morphia, repeated as often as his sufferings rendered it necessary.

On the fourteenth day after the operation, we saw the sloughs produced by the chloride of zinc lifted away with a pair of forceps from the orbit. As they were removed, they left the bones which they had covered perfectly bare and blanched. No doubt in this as in the first case there will be considerable exfoliation of bone. If any suspicious-looking granulations should spring up, they will be touched freely with the solid chloride of zinc, or with potassa cum calce.-Lancet, Jan. 2, 1869, p. 10.

78.-IMPROVED OPHTHALMOSCOPE.

By HENRY GREENWAY, Esq., Plymouth.

This instrument (manufactured by Weiss) is designed to furnish the practitioner with means whereby the eye can be examined with nearly the same steadiness and precision as with the large and expensive apparatus of Liewith nearly the same amount of freedom as attends the use of the

breich, and

The remainder of this self-winding tape is contained in a box at the lower end of the mirror handle.
and lens are represented nearer together than they should be, in order to economise space in the sketch.
Engraving, showing ophthalmoscope complete. Only a small portion of the tape can bo seen, as the mirror

ordinary hand-mirror and lens. It is simple in construction, and consists of two parts-a double convex lens, mounted on a stem, which slides on a graduated brass bar, five inches long, at one end of which is a knob which rests against the patient's face, the other end terminating in a hook; the second portion comprises a perforated mirror, supported on a handle, from the centre of which runs a spring measuring-tape. These two parts are united by connecting the end of the tape with the hook before mentioned.

To use the instrument for indirect examination of the eye, place the thumb of one hand in a ring, fixed underneath the hook at the near extremity of the graduated bar, and the middle finger in a ring attached to the under surface of the slide, and the forefinger on its upper surface; then lay hold of the mirror-handle with the other hand, in such a manner that the tape may pass between the fore and middle fingers in front, the thumb being placed behind; the patient being seated, in the usual manner, by the side of a lamp, the knob at the extreme end of the brass bar should now be placed against his face, and in such a position that the mounted lens shall be in a line between the spectator's eye and that about to be examined. By withdrawing the mirror-hand from the other, the tape can be drawn out to the required extent (about 18 inches) and be fixed by merely pressing the forefinger on it. The lens focus (from one to three inches) will be obtained by moving the slide to and fro on the graduated bar. By gently pressing the bar towards the patient's face with the thumb of the lens-hand, and by keeping the tape slightly on the stretch with the mirror-hand, the whole instrument will have the steadiness of a solid construction. As a further aid, the surgeon may sit the reverse way on a chair, and make its back serve as a rest for his elbow. Should the back be too high, a thick book or other substance should first be placed on the seat of the chair.

For the direct method of examining the eye, the presence of the tape will not prevent the mirror being used in the ordinary manner.

A small black card-board screen, to be hung at the side of the patient's head, is supplied with the instrument. This will sometimes be found useful in private practice, where a screened lamp is not at hand.-British Medical Journal, Nov. 28, 1868, p. 573.

79.-AN IMPROVEMENT UPON POLITZER'S METHOD OF INJECTING AIR INTO THE EUSTACHIAN TUBES IN CERTAIN CASES OF DEAFNESS.

By Dr. JOHN BRUNTON, A. M.

Politzer's method of injecting air into the Eustachian tubes is based upon the fact, that when the circumflexus or tensor palati muscle is put upon the stretch in the act of swallowing, the mouth of the Eustachian tube is opened, and air is allowed to enter the tube.

Politzer directs the patient to take a mouthful of water; the operator then inserts a canula into the right or left nostril, as the case may be; attached to this canula is an India-rubber bag filled with air; on the patient making a sign that he is about to swallow, the operator, closing the nostrils of the patient upon the canula with one hand, so as to prevent all egress of air, as the patient swallows, squeezes the bag, thereby injecting a strong current of air, which immediately rushes up the mouth of the Eustachian tube, which has been opened by the action of the circumflexus or tensor palati muscle in the act of swallowing.

This method is very useful in many cases, especially those of a catarrhal nature, often restoring the loss of hearing in a manner that seems marvellous to the patient. Nevertheless, advantageous as the operation may be, it has often unpleasant disadvantages. Sometimes, as has occurred to myself, the movement of the patient (the act of swallowing) and the movement of the operator (the act of pressing the bag) are not exactly in unison; and the consequence is, that unpleasant fits of coughing follow by too early pres

sure of the air, or no injection of air takes place by a too late pressure, necessitating a repetition of the process, which may or may not be very acceptable to the patient.

On account of this, the improvement which is described below suggested itself to me, in consistence with those movements of harmony which abound in the human system. My improvement, as shown by the accompanying woodcut, consists in allowing the patient to be himself both the subject and the operator.

Το

The apparatus consists of an India-rubber bag (10 oz), to which is attached a sufficiently long flexible tube, so that the bag may rest on the floor. the other end is fixed a gum elastic canula, which the patient passes into his nostril. He then takes a mouthful of water, and as he swallows, holding his nostrils tight with the fingers, presses the bag with his foot, and thereby injects the requisite air.

I have used this apparatus a good many times, have found it invariably satisfactory, and free from the unpleasant results above-mentioned. The movements are in unison.

The accompanying woodcut represents the patient in the act of applying the instrument. Any instrument maker can supply the apparatus, the cost of which is trifling.

It has been stated that a late distinguished aural surgeon sacrificed his much-valued life, while investigating the means to allay ringing noises in the ears, by the injection of medicated vapours, such as the vapour of chloroform, ether, hydrocyanic acid, and the like. If he had used such an apparatus as this, perhaps he might have been still spared to us. I have on several occasions injected the vapour of sulphuric ether and chloroform with ease and without discomfort, to the advantage of the patient. It is only necessary to separate the bag from the tube and pour a few drops of the ether into the bag; the ether immediately becomes volatilized; adjust the tube, and then proceed as with common air.-Glasgow Med. Journal, Nov. 1868,

p. 38

DISEASES OF THE SKIN.

80.-HOW TO USE THE NITRATE OF SILVER IN ERYSIPELATOUS INFLAMMATION.

By JOHN HIGGINBOTTOM, Esq., F. R. S., Hon. Fellow of the Royal College of Surgeons of England. [Mr. Higginbottom complains that his mode of using nitrate of silver has been carelessly and incorrectly reported in all the medical and surgical works which have professedly copied the plan from his published work.] The method of applying the nitrate of silver is as follows:

The affected part should be well washed with scap and water, then with water alone, to remove every particle of soap, as the soap would decompose the nitrate of silver; then to be wiped dry with a soft towel. The concentrated

solution of four scruples of the nitrate of silver 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. The solution may be applied with a small piece of clean linen, attached to the end of a short stick the linen to be renewed at every subsequent application. As the solution of nitrate of silver is colourless, it is necessary to pass a little linen, just moistened, over every part where it has been used, in order to be equally diffused, so that no part be left untouched.

In about twelve hours it will be seen whether the solution has been well applied. If any inflamed parts be unaffected the solution must be immediately reapplied. Sometimes, even after the most decided application of the nitrate of silver, the inflammation may spread; but is then generally much less severe, and is eventually checked by repeated application. It is desirable to visit the patient every twelve hours, until the inflammation is subdued.

By these means we have complete control over the disease.

For the successful application of the nitrate of silver the ordinary brittle stick, either solid or in solution must be used. Not the " lunar caustic points perfectly tough," nor the crystals and cake used for photographic purposes.-Practitioner, Jan. 1869, p. 34.

81. ON THE USE OF SULPHUR IN ITCH.

By Dr. TILBURY Fox, Physician to the Skin Department, Charing-Cross Hospital. [The writer says that not a week passes but he sees cases in which sulphur has been much misused, producing evil instead of good.]

Sulphur is a remedy which can do a great deal of good and a great deal of harm. That I may prevent some of the latter, I again call attention to one or two therapeutical points of practical importance touching the cure of itch, which by reason of its very commonness is apt to have a stereotyped treatment. Now scabies is usually treated as though all the eruptive phenomena seen in the body of a scabius subject were really "scabies;" that is, as though there were some parasite to destroy wherever a rash exists, and acari were present in or immediately about the papules and vesicles of which the eruption in different parts of the body is composed. The fact is, that in the early stage of itch the acari are almost entirely confined, if not absolutely, to the hands in adults, and to the region of the buttocks and feet in children. In chronic scabies, or in disease derived from contact with a person affected with chronic scabies, acari are no doubt present elsewhere, and in parts other than the hands. But in the general run of cases the essential seat of scabies is the interdigits and the wrist. The mass of the eruption about the arms and the body is secondary to the irritation induced by the acari about the hands, and if the acari there be destroyed, the "sympathetic" eruption. if not artificially aggravated, vanishes. Sulphur is the best remedy for the de