hand; nothing can be more unscientific and unskilful. If the tendon be not already destroyed, you may put it in a way never

to recover.

Instead of this, take a towel in the left hand, and then with this seize gently, but firmly, the affected finger; tell the patient that the operation is necessarily painful, and that you will be obliged to hurt him; therefore you do not deceive him; select a point upon the lateral surface about midway betwixt the tendon and the artery; put the point of the scalpel on this point; now cut down-without haste-to the bone in a line parallel with the tendon, making the incision about two-thirds the length of the phalanx implicated by the disease. Try to spare both the artery and tendon; if you must sacrifice one of them, by all means sacrifice the artery-the tendon, never. The hæmorrhage can be controlled; the symmetry and utility of the finger are not impaired by the loss of an artery; but destroy the tendon, and they are gone for ever. Use the knife, therefore; use it early, use it properly, and you will have the satisfaction of benefiting your patient.

To stop here is to leave one's work half done. And we have abundant experience to prove that a paronychia, after having been opened, has not continued to improve, until the remedies we shall presently describe have followed the employment of the scalpel. Over and over again have we seen this happen.

In the second place, after opening a paronychia, apply a warm. flaxseed poultice for a few hours-not exceeding twenty-four. If the poultice be too long applied it will do harm. Sometimes it may not even be necessary to use a poultice. The more recent the attack, the more beneficial will be the poultice. a poultice without the scalpel is of but little use.

But

In the third place, on leaving off the poultice, apply a wash: R. Zinci Sulphatis gr. iv.-xvi.; Sp. Lavandula Comp. 3 i-iv.; Aquæ pur. vel. Aquæ Rosæ 3 viii. M. S. Red wash.

Saturate a piece of old muslin or linen with this wash, and keep it constantly applied to the diseased part. Continue the use of this remedy till recovery is complete.

In the fourth place, give the patient from ten to thirty minims of muriated tincture of iron three times a day in a little sweetened water. This remedy should be taken just before meals and the mouth always washed with cold water immediately after taking it, to prevent the action of the iron on the teeth. Begin to give this preparation of iron as soon as possible after seeing the patient, and continue it till recovery takes place. In addition to this, it may be necessary in some cases to give the sulphate of quinia.

Commentary.The knife evacuates the pus; depletes locality; relieves tension; and abolishes pain. The poultice promotes molecular change, and soothes the inflamed tissues. The zinc acts as disinfectant, as local astringent and nerve tonic; iron improves the appetite, invigorates the blood, and seems to prevent the extension of diffuse inflammation."

PRACTICAL MEDICINE.

CASE OF EXALTED REFLEX IRRITABILITY OF THE SPINAL NERVES OF THE LEFT SIDE OF THE BODY.-The very curious case which is here described, is one of several broadly allied apparently in their pathology which we have lately seen in the hospitals of London. Our readers will remember that we referred several months since to one in St. Bartholomew's Hospital, under Mr. Holden's care: a boy in whom, by touching the upper part of the spine, or a small tumor on the side of his neck, unconsciousness, with muscular ragidity and other anomalous symptoms, were produced. The case is graphically described by Mr. Holden in the volume of St. Bartholomew's Hospital Reports for 1867.

Another case was not long since under Dr. Barclay's care, to which reference is made further on.

There is just now in the Middlesex Hospital, under Doctor Greenhow's care, a man fifty years of age, affected with motor ataxy, in whom reflex spinal excitability is remarkably exalted. An unexpected touch produces violent spasmodic contractions of the legs, accompanied by a painful appearance of alarm and distress. This has been produced frequently by the accidental dropping of a diet card upon his bed, or the chance touch of a student's coat against the bedclothes. An interesting feature is that if the man is prepared for the touch, no effect is produced. The following is an account of Dr. Salter's case:

Frederic D, aged fifty, by occupation a clerk, married, and of regular habits, was admitted into the hospital on the 12th of March. He was quite well until eighteen months ago, when he experienced a sudden fright and shock, from finding a man in the night apparently dead at the bottom of a staircase. The man died the next morning. It so overcame him that he has been in a nervous and agitated state ever since; the slightest thing producing palpitation of the heart and a sense of alarm. He sleeps in a house alone at night, and if the slightest sound occurs, such as a door creaking, or a blind shaking in the

window, or a window rattling from the wind, it startles him so that it completely takes away his breath, and sets his heart palpitating to such a degree that he is obliged to press both his hands upon it, as it were to quiet it. From the time of the occurrence he has felt restless, unsettled, and unwilling to be alone; disliking the dark, and burning a candle "for company;" very low in his spirits and given to sighing. Even any unusual exertion will, since that time, produce breathlessness and palpitation, which was never the case before. But a most curious circumstance is, that from the time he has felt an aching tenderness in the whole of the left side of the body, including the left arm and leg, the feeling being the same as if he had been overusing the muscles. There is no surface tenderness, no cutaneous hyperæsthesia, but a tenderness of the muscles on pressing or squeezing them, and a constant wearying aching in them. At the same time this symptom appeared, there was also observed a tendency of the left arm and leg to start involuntarily, accompanied with a feeling like cramp coming on in the leg, especially on walking, or still more if he attempted to run. The movement would jerk his leg to such a degree that it would jump off the ground, so that it suddenly obliged him to stop and hold his leg with his hands. In a moment it would go off again, and he would be able to resume his walk. The right side of the body was perfectly free both from the tenderness and jerkings. But a still more curious phenomenon, that was recognized soon after his admission into the hospital, but which had existed from the first, is that if his left arm or leg is squeezed or grasped, it suddenly becomes tetanic-starts up, or flies out, without the will or control of the patient, and becomes momentarily stiff and rigid, reminding one of a galvanized or strychnized frog. As long as the limbs are not touched they remain perfectly quiet and motionless; nor will merely touching them move them; it must be done by a firm squeeze; but the moment they are grasped, up they fly in the convulsed description described. The same squeezing applied to the muscles of the right limbs. produces no result whatever.

Dr. Salter observed that this case was remarkable in three particulars. In the first place, it was remarkable from the nature of the phenomena themselves; in the second place, from their unilaterial distribution; and in the third place, from their darting from an emotional cause. About this last cause there could be no doubt; the man's morale ever since the fright, and the fact that he never had the symptoms before, and has had them ever since, leave no doubt that they are to be attributed to the mental shock he sustained. If such symptoms were

observed in a woman, they would be classed among the extravigant manifestations of hysteria. Perhaps the absolute pathology of the case, bearing in mind its emotional cause, and that it consists in a perturbation of the function of voluntary movement affecting one side, comes nearer to that of chorea than any thing else. But if it were sought to define the actual condition apart from its essential pathology, it would appear to consist in an exaltation of reflex irritability in the left half of the spinal chord and its nerves. Whether the chord itself was at all concerned, or whether disproportionate development of reflex results depended merely on a morbid irritability of the afferent nerves, might be doubtful. Dr. Slater was inclined to believe that this last was the true view, and that the nerves effected with this hypersensitiveness were soley the nerves of "muscular sense." There was no cutaneous hyperæsthesia-the hyperæsthesia was strictly confined to the muscles; and the violence of the reflex results was in proportion to the strength with which the muscles were squeezed.

Since these notes were taken, we find that the man, having steadily and rapidly improved, left the hospital perfectly well, after having been in it three weeks, although he had suffered from the symptoms for eighteen months. The treatment adopted was at first tonic and sedative, afterwards simply tonic. Dr. Salter attributes the patient's speedy recovery as much to the moral effect of the assurance that he had nothing serious the matter with him as to any special influence of the treatment.— London Lancet.

ATROPINE AS AN ANTIDOTE TO OPIUM POISONING.-The following is the history of a case occurring in my practice, which shows the value of belladonna in cases of poisoning by opium:

Mrs. W., aged thirty-eight, has been troubled with retroversion, perimetritis, and severe endometritis, and has had several severe attacks of pericarditis, which have left extensive adhesions. Had several neuralgic pains all along the left side, for which I had been in the habit of giving her subcutaneous injections of gr. ss. morphiæ sulphatis.

On January 20th last, I gave her one of these hypodermic injections, which gave but slight relief; the next morning I repeated it, injecting exactly m. xv. Magendie's solution (equal to gr. ss. morphiæ), and remained in the room fifteen or twenty minutes, when she seemed a little easier, and I retired to my

office down stairs; but was very soon summoned by the nurse, who stated that Mrs. W. was dying.

I found her lips purple, the respiration seven per minute, no pulse at the wrist and but one sound at the heart; pupils contracted to a fine point, frothing at the mouth, and the extremities cold.

I commenced artificial respiration (for while I was cogitating on my handiwork, she entirely stopped breathing), which by myself and assistants was kept up for about half an hour, when I attempted to give her some strong coffee, but she could not be made to swallow. I had sent for several neighboring physicians, who were all out; but just at this moment my friend, Prof. Chas. A. Budd providentially called on me, and was immediately shown to the room. He declared that she was dead, and "laughed in his sleeve" at the idea of keeping up artificial respiration.

By this time I began to think of sending for an undertaker (for she had come to me from a neighboring city for treatment) but as a 66 drowning man clings to a straw," so I was eager to give her every possible chance, and asked Dr. Budd to suggest something, at the same time mentioning belladonna, when he said that atropine might be given hypodermically, if I wanted to do something, but as she was dead it would not bring her around. We resolved, however, to try it. By this time artificial respiration had been kept up for an hour and a half. Onesixtieth of a grain of the sulphate of atropia was injected, and in fifteen minutes she showed signs of life, the pupils began very slightly to dilate, and in ten minutes more she began to breathe; respiration rose to twelve per minute; in half an hour we repeated the dose, making in all one-thirtieth of a grain of atropine; and in about fifty minutes from the time of giving her the first injection, she returned to consciousness, and is living now, with a blank in her life of two and a half hours.

To Prof. Budd is due the credit of suggesting the remedy.— [M. S. Buttles in the Medical Record.

TREATMENT OF PSORIASIS.-This article is addressed to Prof. Hebra, requesting him to make a further trial of the means which the author has found so efficacious.

The doctor is particularly interested in the malady, as he himself was a victim to its ravages. The remedy he proposes is simply an animal diet. He relates his case very minutely,