ing the step, forces the flexor muscles of this toe into action. But when the lateral expansion of the soft parts is denied, it finds room in the direction of the least resistance, which is at the front of the nail. The nail groove is converted finally into a pocket or pouch, into which the outer angle of the nail is pressed.

One predisposed to this disease, suffers first by a simple itching or tingling, not unlike that of a corn; occasionally severe twinges of pain are felt. Swelling and heat are then discovered, any slight injury causes an ulcer, and intense pain

ensues.

In the first stage of this trouble, cut the nail short, trim both corners well back, keep the front rasped thin, and avoid exciting causes. If ulceration has taken place, relieve the bottom of the groove and the toe-nail pocket from pressure.

Two plans of treatment are proposed; the one temporizing, the other radical; for the former, remove the toe-nail, which gives relief, till a new one develops; or trim the free border of the nail back to the base, relieving the pressure, but take care to leave no spicula or sharp edges. This operation Dr. A. prefers to the former method, but it must be repeated every few months.

Three methods for radical cure deserve mention.

1. Removal of entire nail and matrix. The objection to this is that it leaves the top of the toe unprotected.

2. Removal of merely the margin of the nail with its matrix. The nail will remain narrower, and the recurring margin never be renewed.

3. Removal of soft parts along the border of the toe, taking away the groove and obstructing the growth of the angle of nail. This least objectionable method is as effectual a cure as removing the nail, but care should be taken to effectually ablate the nail growth and remove the upthrust of indurated tissue anterior to the outer angle. When the deformed matrix sends forward a malformed margin, remove both margin and matrix. In rare cases it may be proper to combine two operations in removal of margin of nail and side toe.

General anesthesia is unnecessary; local application of

snow, ice, or freezing mixture, is sufficient. When engorgement of tissue is extreme, the hemorrhage may be great, but no harm can follow.

Dr. A. dresses the wound with salicylic acid in substance, using the dry powders; and orders the dressings to be kept wet for a few hours with cold water. Profuse granulations should be repressed, but they do not come up under the use of salicylic acid.

M. E. K.

INSTRUMENTAL DILATATION OF THE RECTUM FOR OPERATIVE PURPOSES. W. Hack. Archiv. fur Klin. Chirurgie. 1877. Bd. XXI. Hft. 2.-The operation is performed, after the rectum is carefully cleansed, in profound chloroform narcosis. The patients are placed upon the table on their backs, with pelvis elevated, the thighs strongly flexed upon the abdomen. With the well-oiled speculum (Simon used them from 5 to 5 ctm. in diameter, and from 15 to 17 ctm. in circumference), the rear wall of the rectum is pushed aside; the side walls are held back by a vaginal tenaculum, and the projecting skin of the anus by double hooks, or by a flat speculum. If necessary the sphincter is ent backwards in the raphé, as such incision into the lower end of the rectum facilitates the access to the cavity of the os sacrum. In cases of recto-vaginal fistula, the edges of the fistula are now pared off, if possible transversely; the sutures are partially put in by the means of Simon's needle-holder, and fine Chinese silk; or with Langenbeck's needles, used for staphylorrhaphy.

In the after treatment a strong cathartic was administered by Simon, at least every second day, the method of constipation having proved dangerous. The removal of the sutures is effected through the vagina; the slight formation of pus around the threads had always enlarged the canals of the stitches sufficiently to admit of the passage of the knots. The cases operated upon by Simon present the best proof of the practicability of his method; we can here only speak of them in a few words. The first case was a person with two small vesico-vaginal fistulæ, and a large recto-vaginal fistula. The fistula was unsuccessfully operated upon through the

vagina, whereas the cure was effected by two operations from the rectum; the vesico-vaginal fistula were also cured.

second case, a woman 45 years of age, was cured of a rectovaginal fistula, which was immovable, and situated 1 ctm. from the orifice of the uterus.

The third case occurred in a woman, 32 years old, who had contracted a recto-vaginal fistula during an attack of typhus, the tube of the injection syringe having perforated an ulcerated place of the rectum. The fistula was cured after an operation through the rectum, only leaving small places of the size of a pin's head, which afterwards healed up under cauterization.

The fourth case is that of a soldier, who had contracted two fistulæ by a gun-shot wound through the bladder and rectum. The fifth case gives the best proof of the practicability of this method. The patient, 22 years old, suffered from a vesicovaginal fistula, besides there existed a communication between the bladder and the rectum, and an occlusion of the vagina.

FAT-EMBOLISM RESULTING FROM RUPTURE OF A FATTY LIVER. -Hamilton. (British Med. Journal, Oct. 6, 1877.) Fatembolism is a pathological lesion which has been described within the past few years more especially by Zenker, Wagner and Busch. It generally happens that the subject of it has sustained a fracture of bone, or some operation has been performed necessitating the opening of the medullary cavity of a bone. The oil which so escapes into the surrounding parts becomes absorbed by the neighboring blood-vessels and is carried to the right side of the heart, and subsequently to the lungs. Here it gives rise to the most complete capillary embolism, entirely precluding the passage of the blood through the organ, the patient accordingly dying from gradual carbonic acid poisoning. These cases of death in a few hours after a simple fracture of bone, or operation on bone, were, up to the time that this important discovery was made, totally unaccounted for; the patient was generally said to have died from "shock." In the case here reported the oil, which acted as embolon, was derived from an unusual source. The patient

was a lad about fourteen years old, and a sailor. While aloft he slipped and fell a considerable distance onto the ship's deck, alighting on his right side. Although stunned, he soon recovered sufficiently to walk about the deck. In an hour or two afterwards, however, he became very much distressed; his breathing became embarassed, coma ensued, and he died a few hours after the injury. At the post-mortem examination, the liver was found to have sustained a few small ruptures, from which a little blood had flowed, but only a comparatively small quantity. The liver itself, however, was peculiarly fatty, and, for a lad of his age, unusually so; whereas the other organs seemed perfectly normal, so that the lungs and kidneys were retained as specimens of healthy organs, and were hardened in chromic acid for microscopic examination.

In due time, sections were made of the lung and kidney, and in order to bring out their outlines more prominently, a half per cent. solution of perosmic acid was employed as a staining re-agent. The most extraordinary appearance was revealed by this means in the lung. The whole of the middle and smallest sized arteries were found to be plugged with oil, which now had a black color, owing to the action of the perosmic acid. Even the minutest capillaries were completely choked up with oil. The oil was generally in one large elongated mass, occupying the lumen of the vessel for a considerable distance, or it was in drops of various sizes closely aggregated together. Similar embolisms were detected in the kidneys, but only in small number.

II. THERAPEUTICS.

EFFECTS OF SULPHATE OF ATROPIA ON THE NERVOUS SYSTEM.— Sidney Ringer. (Journal of Anatomy and Physiology, from Edinburgh Medical Journal, July, 1877.) From his experiments, Ringer concludes that the late occurrence of tetanus in atropia poisoning, is not due to paralysis of the motor nerves, but that it is owing to the cord being slowly affected. It appears that whilst the poison very quickly paralyzes, it takes many

hours, or even days, before it tetanizes. He also concludes that atropia paralyzes much more through its depressing action on the spinal cord than on the motor nerves, and that it has a direct paralyzing action on the cord, and does not affect it through its depressing action on the circulation. In atropia we have a drug which quickly paralyzes the reflex functions of the cord, but requires a much longer time to diminish the resistive power of the cord; hence, paralysis precedes, and may even disappear, some hours before the onset of tetanus.

BROMIDE OF ARSENIC IN THE TREATMENT OF NERVOUS DISEASES.-Clemens. (Allg. Med. Central-Zeitung.) Cl. states that he has obtained astonishing results with bromide of arsenic in the treatment of diseases of the nervous system, and especially epilepsy. The following is the formula which he thinks should replace Fowler's solution: Pulv. arsenic alb., potass. carb., aa 3j.; coque cum aq. dest., b. ss. ad solut. perfect.; aq. evaporat. adde aq. dest., 3xij.; brom. pur. 3ij. refrigerat. S. arsenic bromatum. Of this he gives one or two drops in a glass of water once or twice daily. This dosage may be continued for months, or even years, without producing any unpleasant effects. In only two cases of epilepsy did he effect a complete cure, but in all the cases, marked relief was ob tained. In connection with the bromide of arsenic an almost exclusively meat diet is advised. The patients should be as much as possible in the open air. Unlike the bromide of potassium, the arsenical salt does not require to be given in increasing doses, and, instead of interfering with digestion, improves the nutrition and strength.

ACTION OF THE SALTS OF SILVER ON THE MUSCULAR AND NervOUS SYSTEMS.-Curci. (Giornal. Veneto di Scienze, from Edin. burgh Med. Journal, July, 1877.)

In a series of experiments on the action of silver on the mus cular and nervous systems, Curci used one part of chloride of silver, three parts of hypophosphite of soda, and thirty of distilled water. Administered thus, silver does not irritate the skin or mucous membrane. Injected subcutaneously, it pro