mummification was complete by the first process. I continued tc walk without the least thought of my ongle encarné, and about three weeks after was able, by means of a foot-bath, to remove the hardened layer of skin, under which I found a tissue of new formation, which erfectly resisted the pressure of the edge of the nail. Shortly after he whole had returned to its normal condition, and more than two years have since passed without a return of the disorder."

The modes of removing the nail proposed by surgeons are too barbarous to be mentioned.

Ulcer caused by In-growing Toe-nails.-This is generally caused by cutting the nails close at the sides and round the corners, which starts that part of the nail to growing faster, and in a short time the corner begins again to project into the flesh. The nail should be cut frequently, but not at the corners. Bathe the feet often, and wear a shoe sufficiently wide at the toe.

3. ONYCHIA.

This disease of the nails of the fingers and toes consists essentially of inflammation of the matrix of the nail. It may not extend beyond the matrix, or it may, and usually does, extend so as to involve the adjacent soft parts.

It may be caused by an external injury, as a bruise by a pressure upon the end of the nail from a shoe or boot, by a foreign body passed under the nail, as a splinter, or by some constitutional derange ment, as syphilis, scrofula, or eczema. It may be confined to one toe, or, if the cause be constitutional, several toes may be affected at the same time. The amount of inflammation may be slight, or so extensive as to produce suppuration, ulcerations, funguous granulations, with ichorous, sanious, or foetid discharges, with loss of part or the whole of the nail, or even of death after loss of one or more bones of the toe. This disease is always troublesome, painful, and difficult to

cure.

TREATMENT.—When caused by external injury, the treatment must be conducted with reference to the degree and nature of the injury. If pus forms beneath the nail, it can be let out by carefully making an opening through the nail. A foreign body beneath the nail must be removed. If caused by pressure of a hard boot or shoe, the pressure must be removed, and the patient kept quiet in the horizontal position, and treated as for in-growing nail.

When onychia depends on general eczema, the treatment proper for that disease must be followed in connection with proper local

treatment.

When the constitution is scrofulous, the onychia usually begins at the nail. This form is more commonly seen on the fingers.

Syphilitic onychia is also most common on the fingers, and is accompanied with syphilitic eruptions on other parts of the body. The matrix of the nail frequently turns red, swells, suppurates, and ulcerates. The skin around the nail becomes puffed and swollen, and the entire extremity of the toe becomes enlarged, while the suppuration, ulceration, and fungous growths at the edge of the nail increase so as to partly overlap the nail, and give the toe an appearance as of the ordinary nail. The nail may at the same time become discolored, brittle, altered in thickness, rough, and even fall off.

As the general disease is cured, the local affection disappears, or becomes easily manageable.

When onychia appears in the malignant form, there is very great pain from the first, and destruction of the periosteum, with disease, and perhaps death of the bone, without any apparent cause, either local or constitutional. When onychia is the result of in-growing of the nail, that condition must be cured.

Local applications may be useful to correct foetid discharges; those already mentioned for other diseases of the feet may be used. Muriated Tincture of Iron will often be beneficial.

In all psoric and dyscrasic constitutions the specific remedies for such specific diseases will be necessarily employed. In eczematous onychia the Benzoated Oxide of Zinc-oinment is recommended by Wilson and others. Scrofulous and syphilitic cases require the specific treatment proper for those diseases. In extreme cases the amputation of the toe has been recommended.

4. BUNIONS.

The word bunion should be restricted to an enlargement over the first joint of the great or little toe, produced by pressure or by some other cause effecting a change in the position of the joint.

The common cause is the wearing of shoes too short and with a narrow sole; this gives too much pressure to the toes, and throws too much of the body's weight upon the articulation of the bones of the feet, impeding the action of the muscles, causing pain and inflammation, malposition of the great toe, and the ultimate formation of a bunion. It often occurs in persons of constitutional derangement, with feeble. joints, and subject to pain in the joints of the foot after walking; gouty, rheumatic, and scrofulous constitutions show this form most frequently. In such persons the synovial tissues, the tendons, &c., are liable to this disease. The great toe becomes distorted in position, pointing obliquely across the other toes, leaving the shoe to press upon the joint. In persons advanced in life, the synovial membranes of the

joints become worn and secrete less fluid than is needed in a healthy joint; they become stiff, painful on motion; partially anchylosed.

A bunion consists in an enlargement or thickening of the integuments over the first joint of the great toe, generally only of one foot. The pain is generally trifling at first, but it becomes more painful as inflammation involves the joint; the skin thickens in layers or scales over the surface, and is studded with clusters of small superficial corns; if the iritation of a tight shoe be continued, the bursa between the skin and the bone will become enlarged, the fluid effused causes swelling over the joint; the pain increases and extends to surrounding parts; suppuration may take place within the bursa, which progresses slowly and with pain; the ichorous fluid may extend into the cellular tissue before it bursts externally. It may even cause caries of the bones or exfoliation of the joint.

TREATMENT.-Sensitive and delicate persons may suffer from pain in the joints of the feet when there is little enlargement or evident inflammation. The skin is tender, soft, moist, clammy. In this stage the disease may be easily relieved by a lotion slightly stimulating or an anoydne in which the foot may be bound up by a roller of two or more thicknesses. Tincture of Arnica or Belladonna will answer. Another slight affection is a small tumor on the instep, caused by a boot too tight; it is under the skin hard and immovable. In some cases it may progress to the extent of forming a small but sensitive corn.

The treatment of these distortions of the joints, whether confined to the great toe or to the small one opposite, is often confined to placing between the toes flexible sheets of lead, not too thin, so as to keep the toes nearly in their natural position.

Tumors about the toe-joint have been produced by gout or rheumatism. These are cured by wearing loose shoes of buckskin or flannel; and then the common treatment for the general disease.

A true bunion in its first stage appears inflamed, but is not attended with much swelling; the pain in the joint is mostly felt when the shoe >is worn; in a few days it subsides, but is liable to reappear when the short, small, or badly made shoe is worn. Removing the shoe is usually relieved by changing it for a large soft one, and bathing with an alcoholic lotion.

If the irritation is continued the pain and tenderness will gradually increase in proportion as the foot is used, and is felt more in the joint under the ball and along the toe, over the instep; the skin becomes thickened, forms in scales or layers, and one or more small corns form on the surface.

This case is best treated by rest and cooling, soothing lotions; after carefully extracting the corns, a plaster of Soap-cerate and adhesive plaster may be applied over the joint. If the great toe is unduly in

clined inwards towards the others, apply a piece of sponge or pledget of linen between it and the next toe will carry the toe outward and remove pressure from the joint.

A bunion on the outer side of the foot begins with itching, heat and pain increased by pressure of the boot. For this, the pressure must be removed, a loose cloth wet with an anodyne lotion; and, for a final cure, a soap-plaster, worn for some days.

In many cases there are constitutional derangement, influenced by changes of weather, which may cause the whole disease without irritation. In some of these cases the attack is sudden, resembling an attack of gout. In all of these cases constitutional treatment must be the chief reliance for cure.

When the bursa under the bunion is inflamed, confine the patient to a couch, and subdue the inflammation; and if an abscess forms, cause it to be opened; after which heal it by soothing dressings. If the inner surface of the bursa does not granulate, apply a minute quantity of strong Nitric-acid on the point of the probe. This will start a new action and the bursa will heal.

Ganglions, are usually the result of inflammations of a bursa mucosa. They may appear on the surface of the foot or instep, and may cause contraction of the extensor tendons of the toes, great inconvenience and lameness in walking.

When the ganglion is inflamed and filled with fluid effused, this should be let out by puncture, and the foot kept at rest. If the fluid hardens and will not flow, the orifice must be enlarged and the impli cated tendon may be divided. In all operations on ganglions and bursæ it is only necessary to make a small opening and then rely on local measures of a soothing character, with general homoeopathic treatment.

5 NÆVUS MATERNI.

PATHOLOGY.-These tumors or "marks" are formed in the erectile tissue, and are divided into:

1. Nævus in which there is a predominance of veins.

2. Nævus in which there is a predominance of arteries. 3. Mole.

TREATMENT.-John Bell advises to cut the tumor out. He says, "you must cut them out,—not cut into them." Sir Astley Cooper cut into one as large as a hickory nut on the back of a child's neck; the child bled to death in four hours.

Dr. Mott objected to cutting out; and also said the use of the Kalipurum was unsafe.

VOL. IL-57.

2. The next mode to cutting out was by using red-hot needles. This caused little pain.

3. The next method is to transfix the tumor with needles, at right angles, and strangulate them with twisted suture.

4. Collodion.-Cover the nævus with a solution of gun-cotton in ether. We prefer this to any of the above. (Amer. Jour., Oct. 1849, p. 555.)

5. Tartar-emetic.-It is proposed to rub the nævus with a solution of Tartar-emetic in Olive oil. It soon becomes covered with pustules which become confluent, and are removed by poultices. If the granulations look favorably inclined, they are touched with Nitrate of Silver. Third species of Nævus.-Mole.-On one occasion, Dr. Mott, in a lecture on this subject, said he knew no cure for a mole. A note was sent to him recommending Labarraque's, Sol.-chlorur-sodium. Mott accepted the suggestion, and said he was not too old to learn.

Dr.

Acetic-acid.-Apply strong Acetic-acid to the small flat nævus, following this by compresses soaked in vinegar. This coagulates the blood in its vessels, the nævus becomes hard and yellow, and is thrown off from the parchment-like layer by a process of exfoliation. (Wilson. p. 336.)

Alum. Apply a wet compress kept moist for a considerable time. The nævus becomes white and flat.

GENUS V.-TRICHOSIS.-MORBID HAIR.

The hairs, like the cuticle, are beautifully organized, and maintain a vital, though not a vascular connection with the body. Some evidence of their retaining a degree of vitality is found in the fact, first pointed out by Mandl, and verified by Todd and Bowman, that hairs have a tendency to become pointed after having been cut short off. The process is very slow, and seems to consist in a further condensation and elongation of the elementary cells at the new extremity.

1. TRICHOSIS POLLICIS.-GRAY HAIR.

Well-authenticated instances have occurred in which the hair has grown white in a single night, from the sudden influence of grief, or of some other depressing passion; it is thence supposed that fluids circulate through them. It is rather probable that this phenomenon results from the secretion at the bulb of some fluid,-supposed by Vauquelin to be an acid,-which may percolate the tissue of the hair, and chemically destroy the coloring matter. The ordinary gray hairs of aged persons resemble other hairs in every respect but color; and the process of changing from dark to gray seems to take place rapidly in each individual hair.