small, round marble (also the suggestion of my father), directly upon the orifice and applied the adhesive strips. The result has not transpired, as the case is still under treatment, but thus far the plan has given greater relief than several trusses worn at different times. The truss usually employed is badly constructed, as there is a large projection in the centre of a broad concave pad, which presses the margins of the hernial ring apart, increasing the size of the orifice, and only giving support to the abdomen.

In many cases the single strip across the abdomen is insufficient, two additional strips placed diagonally across the abdomen, and crossing each other at the umbilicus, is required.

FISSURES OF THE ANUS

Are frequently present without being recognized by practitioners; they are the source of great general suffering, and of still greater local distress, affecting the various pelvic organs, particularly the rectum, occasionally the uterus in the female, more rarely the bladder and the prostrate gland in the male.

Three years since I was consulted by a patient who had suffered for a long time with distress in the rectum and region of the prostrate gland, seriously affecting micturition. He had been treated by a surgeon for stricture of the urethra by the introduction of bougies for many months, but without relief. After investigation I discovered fissure of the anus. Relief of all the symptoms followed the treatment of the fissure.

Another case, about the same date, of inflammation of prostrate and neck of bladder had been treated variously: one "variation" was with the drainage tube of M. Chassaignac in the perineum, two fissures of the anus were discovered and treated accordingly.

I have treated a large number of these fissures since 1853, at first following the plan of stretching the spinchter ani with a finger of each hand till the rupture was effected, as I was instructed to do by Mr. Axenfield, Interine of Eourcine Hospital, in Paris, in the year 1852. This procedure I found to answer in many cases of anemic females with lax muscular fiber, but in

vigorous subjects the "stretching" would only occasionally produce complete rupture. I substituted the plan of cutting the muscle at the seat of the fissure, but this plan was followed by a long process of healing. I now prefer the subcutaneous division of the spinchter ani at a distance from the fissure, as the cicatrization is more rapid, and it is attended with less local irritation.

THE TREATMENT OF FRACTURES

Has been greatly simplified in these latter days; the cumbersome boxes, close confinement, violent extension, and galling counter-extension have been superseded by light splints (where any are required), starched cloth, gutta-percha, plaster of Paris and sole-leather appliances, with agreeable extension with weight and pulley, and early locomotion upon crutches. While results prove that in the majority of instances the shortening of limbs rarely takes place, where the surgeon is faithful in his attentions, and frequently readjusts the appliances in the early stage of

treatment.

FRACTURE OF THE PATELLA.

The "ring treatment" of this fracture is claimed as a new idea, and was recently announced as "another benefaction given to humanity by the profession," but it is an old plan revived, unquestionably without any knowledge of its previous application. In 1853, I was called to treat a case of comminuted fracture of the patella after an accident of many days' standing. There were six fragments scattered in all directions practicable. I placed a splint on the posterior aspect of the limb, and attempted to gather up the fragments by means of adhesive strips frequently renewed, succeeding in measurably approximating the fragments. In order to confine them I moulded a piece of gutta-percha over the knee-joint, cutting a fenestrum large enough to admit the fragments, and extending the margins above, below and laterally for four inches; this was retained in place with a roller.

Another case was presented in 1855, after a long treatment,

with a fissure between the fragments of three-quarters of an inch, I applied Malgaigne's clamp and reduced the fissure onehalf, then moulded gutta-percha, as before described, to retain the fragments in the new position.

The patient sued the original attendant for malpractice, but failed to obtain a verdict in his favor, on the defendant testifying "that he declined the case at first, as he was no surgeon, and urged the patient to go at once to a surgeon; but the patient wished him to do the best he could:"

Another case, taken after first treatment, with excessive inflammation and tumefaction of the joint, requiring leeching, and the treatment for two weeks before application of apparatus was made, resulted in the approximation of the fragments to within one-sixth of an inch, and was maintained in position so that the patient now uses the limb without any splints.

Another case was treated from the first day of the accident, by the same method, and the fragments secured in perfect apposition. After a time the gutta-percha itself was fractured, and sole-leather was moulded upon the joint as a substitute. There is a perfect cure, with no trace of a fracture.

You will perceive that I used a posterior splint, admitting of slight flexion of the joint, which is the natural position, supporting the equilibrium of the muscles, as all straight splints and forced extension is unnatural, and consequently painful to the patient.

Sole-leather is better than gutta-percha, as it is more serviceable and less liable to break.

Adhesive plaster retains the splint in place till the roller is applied.

Should the "ring" cause too much tumefaction of the integuments over the patella, a piece of linnen or cotton cloth can be

placed over it, and the pressure will sufficiently support the

IN FRACTURES OF THE LOWER JAW-BONE,

Where a piece has been broken out, I have drilled through the alveolus sufficiently to admit of fine silver wire, and secured the apposition of the fragments without any other appliances; this has proved, in my hands, far preferable to affixing wires to the teeth, or the use of the ordinary external splints and bandages.

The treatment of compound fractures with carbolic acid applications, has, in my hands, resulted in the saving of very badly

mashed limbs, which, under ordinary circumstances, must have been sacrificed by the knife.

THE TREATMENT OF MORBUS COXARIUS,

In these latter days, has been completely revolutionized, and the United States of North America can claim, for its surgeons, the priority in the methods of treatment now admitted to be the most successful.

Professor Alden March, of Albany, suggested the necessity of removing the pressure from the head of the famur from the acetabulum.

Dr. H. G. Davis, of New York, first gave effect to the principle, in the application of his splint, secured by adhesive plaster applied the entire length of the limb longitudinally and diagonally, so as to draw over the bellies of the muscles, diffusing the traction equally upon all parts of the limb, securing "elastic extension" by this means in connection with an elastic perineal strap as counter-extension.

The principle established and elaborated to effective demonstration by Dr. Davis was appropriated and employed by others, with modified appliances, to such an extent that new names are applied to this method of treatment, to the manifest injustice of Dr. Davis; give him the honor due to the pioneer. Let Dr. Sayer be accredited with all that he may have added to the "original" as follower, and award to Dr. Fayette Taylor his meed of praise for improved apparatus, which seems to me to fulfill all the indications of treatment more complete than any I have seen.

ORTHOPEDIC SURGERY,

In all its branches, has progressed as remarkably as any of the foregoing topics, but I refer you, for the special record to the elaborate discussion by H. G. Davis, M. D., etc., New York, in "Conservative Surgery," etc., published by Appleton & Co., 1867, to the monographs of Dr. Fayette Taylor, New York, and Dr. Prince, of Illinois, and "Orthopaedic Surgery," of Louis Bauer, M. D., of Brooklyn, and the Transactions of the American Medical Association.