from two to six hours. I have not yet treated a case that was not very greatly benefitted by this mixture.

The effect on the case above cited, was to greatly reduce the high temperature and quick pulse, and decrease all the most aggravating symptoms inside of eight hours. Although the child. had glandular enlargements on both sides of the neck, and had ear complications, and was so ill that the family physician feared that he might not recover, yet in four days he was sitting up in a chair.

I have had two cases in whom the nasal passages were nearly occluded, and the throat was so seriously affected that they could not speak aloud, nor swallow a liquid without a part of.it passing up through the nostrils, that were at once relieved of all of these symptoms by the application, by the spray producers, of the vaseline comp. already given.

Vaseline is the very best remedy that can be applied to the throat in these complaints. It relieves the sensation of rawness and dryness, and prevents the secretions from adhering to the mucous membrane. I have frequently prescribed it in the cold state, to be given from a teaspoon as frequently as the patient complained of dryness in the fauces. I always direct that vaseline be applied to the neck, breast, nose, and around the ears of every patient, and upon the whole body in case the patient has scarlet fever or measles. It has a cooling effect, and lessens the liability to take cold.

Carbolic acid stands next in efficacy, but if it is not used in a very dilute form, it will do much harm through its anæsthetic property.

Before closing this subject I wish to enter my protest againstthe employment of the chloral of potassa. I have not the least hesitancey in saying there are a great many cases of sore thrort that would have run a mild course, had it not been for a gargle of chlorate of postash. I never knew of a mild case that was relieved by it, or of a severe case that was not made far worse from its effects. Common table salt is but of little use in these cases, but it is very much better than chlorate of potassa in any case. Habit has had much to do with the prescription of this remedy by the profession. I am very certain that no physician who has had an ulcerated or diphtheritic throat will use it on himself the second time. The pain it occasions is always great and its effects are equally injurious. I am sure that this much vaunted remedy must soon be used in the chemical laboratory only.

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FINGER STUMPS. By H. C. Fairbrother, M. D., of East St. Louis.

There are some features about finger stumps which do not belong to the general subject of stumps. Surgical amputation of the finger is a comparatively rare operation. Amputation here is generally performed by machinery, railroad cars and such like, and all that remains for the surgeon to do is to finish up the job by a little nipping and trimming. Hence flaps are rarely obtained, and as a consequence, more cicatricial tissue is met with in proportion to the size of the stump than elswhere.

Great importance always being attached to the length of these stumps, the bone is often so, sparingly removed that it can never be covered, but thinly, by soft parts, with the inevitable result of permanent tenderness. The finger bone is usually cut off with plyers, and sometimes very poor ones, by which it is more or less split and crushed. This is necessarily followed by suppurations and the discharge of spiculæ for many weeks or months after the operation. The finger stump is more exposed to vicissitudes of weather, more exposed to view and to contact with external objects than any other stump, and it is therefore more important here than elswhere to avoid every morbid condition to which stumps are liable. These are some of the features which place finger stumps, to a certain extent, in a special group.

Now take a finger, that, by coupling cars or other work dangerous to the hand, has been crushed off, or so nearly so as to require amputation. When the extremity has been clipped away, the stump will probably present a jagged and split end of bone projecting to a greater or less extent beyond the soft parts, and the skin, it may be, stripped off still further back. In such a case, what is the proper course to pursue? Some there are, who assert that it makes little difference what is done, something or nothing; that it gets along about as well in the one case as in the other. To be convinced of the fallacy of this opinion one has only to pass under review some of the numerous stumps to be met with in such profuse variety in any of our larger railroad yards. There he may observe good stumps and bad stumps, the latter very much in the majority; tapering stumps and clubended stumps; the pale, bluish stump and the stump so unnatur

ally red and shining that the owner prefers to keep it hidden from view; the sensitive stump and the stump with but little feeling; the cold stump and the stump that is rarely free from a burning sensation; the neuralgic stump, and the stump that is subject to periodical abscess. And for all these varieties the surgeon is held accountable. This accountability may not be always just but it is sufficientiy so to justify an interest in the study of the subject. Now, taking the case of a finger injured as referred to above, there are three courses of treatment pursued by different surgeons. Those who follow the teachings of extreme conservative surgery, rendered popular by such men as Bryant, place entire reliance upon the healing powers of nature, and so large is the number of reported cases illustrating the value of this treatment that their reliance would seem not to be misplaced. Who is it, indeed, that cannot bear testimony, to this wonderful healing power? This physico-vital phenomenon by which useless material is cleared away and every tissue-bone, muscle, nerve, skin -falls into line and does duty in the work of repair, at the drum beat of what we are pleased to term nature.

In the case of the fingers torn or cut off by accident it is held that the process of granulation alone may be relied upon to cover the stump, though the bone be somewhat projecting. If these granulations fail to encase the entire extent of exposed bone, the remaining portion will be soon chiseled away by necrosis, and in a much better style than if done by the plyers. I have often had occasion to observe this beautiful process of granulation, creeping out upon, and finally enveloping denuded portions of bene.

A few years ago a man came to me on the street with a finger crushed so nearly off, about the middle of the second phalanx, as to be easily snipped away with scissors. The bone extended perceptibly above the soft parts. He was directed to come to my office in the evening for its removal. He failed to come, however, until after three or four days, when he merely wanted the finger dressed, being stoutly opposed to any kind of a "surgical operation." He continued, from time to time, to return for dressing. Granulations gradually enveloped the bone, and, after a period of three months, a very fair stump was turned out.

As a rule, however, the stump which results from this extremely conservative mode of treatment, has some undesirable

features. It is apt to be slender and pointed, with a large area of cicatricial tissue, and this tissue being drawn tightly over the bone is easily abraded, and when abraded, slow to heal and painful to endure. One of the most desirable attainments in every kind of surgical operation, is to obtain in the result the least possible amount of cicatricial tissue. This tissue is the poorest of nature's patchwork, and a bad substitute for true skin, yet the surgeon must accept it for what it is worth; for when a portion, however small, of true skin is destroyed, there is no power in the universe to replace it. The adjacent skin may sometimes be drawn upon sufficiently to close up the breech, but no new texture is ever manufactured. The hand that guides an infinite system of planets and paints the petals of the primrose, is still when the delicate texture of true skin is to be repaired. Cicatricial tissue is either as good as an omnipotent Providence saw fit to make, or as good as a Providence not quite omnipotent, could make.

Another course of procedure without regard to the finger in question, is to remove the bone down upon a level, or a little below a level with the soft parts, without attempting, however, to obtain flaps. This is the course pursued by the majority of surgeons. It is an easy method of operating, spares the length of the finger and generally results in a passable stump, and sometimes a first-class stump. The third form of treatment is to operate with sole reference to flaps. It is to consider a perfect stump of greater value than the length of the part sacrificed in order to obtain it. It aims to avoid even the slightest amount of cicatricial tissue.

In other cases where the finger is fractured, but not torn off,. and especially where the fracture is compound or comminuted,. or both of these, the stump which may be obtained by a good amputation, is generally better than the finger which remains after the fracture has been healed. The finger bones are so short that the joints next the sight of fracture are almost necessarily involved, even though the fracture be neither compound nor comminuted, which is a very rare occurrence in the finger. If the joint escape dislocation and rupture of its synovial membrane, it will surely be involved in the inflammation which accompanies the union of the fractured bone.

The effect of this inflammatory process is often so grave as to entirely destroy the motion of the joint; and even more, it glues

the tendons to their sheaths, and binds the sheaths together in a bundle, thus doubly insuring the stiffness of the finger; and a finger that is stiff, even though it be at but one joint, is often of less value and more annoyance than a good stump.

During the last six years twenty-one cases have come under my care, of injury to the fingers resulting in amputation. Eighteen of these were treated by cutting away the bone with plyers down into the soft parts and leaving the stump to heal by granulation. In one the projecting bone was allowed to remain, as related above.

In two cases the bone and soft parts were cut away to such an extent as to give perfect fitting flaps.

Nearly all these cases are in men who work about the railroad yards and rolling-mills in East St. Louis, and are still under my observation; and the only two stumps that I am truly proud of are the two where the flaps were obtained. These are covered with healthy skins, for which cicatricial tissue is but a mere apology. They look better; they are less sensitive to cold, or to contact with external objects; they are free from neuralgia and every morbid condition.

Whatever method, however, of operative procedure is selected, there is another element which exerts more or less influence upon the final condition of the stump, viz.: the after treatment. "Now what is the best thing to put on this?" is the question that will be asked, if an application has not already been ordered; and this question has been asked the medical profession ever since there was such a profession, and the answers to it have possessed that beautiful lack of agreement characteristic of the profession. This question is asked to-day with as much force and, it may be, as little answer, as it has been through all the centuries, and this very question I would like to ask this society this afternoon: In case of an open wound, what is best to put on it? It might reasonably be supposed that the germ theory, as developed and confirmed during the few years past, would have much to do with the answer to this question; but does it? The germ theory, viz.: that putrefaction takes place only in the presence of living organisms, has been accepted by the majority of the best surgeons of the world, and out of that theory has been born the antiseptic treatment; and by anti-septic I mean anti-germ. This may, indeed, have put a more rational phase on external applications. They are called antiseptics, and