as erysipelas is of the aplastic state. Erysipelas and rheumatism, therefore, stand opposed to each other, and cannot exist simultaneously in the same patient. The only apparent exceptions. which I know of to this rule are those where a patient with one of these diseases is subjected to influences calculated rapidly to reverse his diathesis. In such circumstances rheumatism may follow erysipelas before the effects of the latter have had time to subside, and erysipelas may follow rheumatism in the same way. These sequences are rare, and are not true complications of the two diseases together.

The causes of the hyperplastic diathesis are identical with those of the rheumatic cachexy. They probably all act by producing or retaining an excess of acids in the system, which is shown by the excessively acid secretions of the skin, stomach, and kidneys, and' by the extreme difficulty of producing any of the alkaline inflammatory effusions. Whatever checks the excretion of acids, as, for instance, cold to the surface, or inaction of the kidneys, tends to excite rheumatism. As able discussions are already before the profession upon this topic, it is not necessary that I dwell upon it.

The hyperplastic diathesis is to be diagnosed by considering the following questions: Has the patient now or habitually any symp toms of undoubted rheumatic character? Is the stomach habitually acid? Do slight injuries or abrasions of the skin dry up with an unusual promptness, and with unusual freedom from suppuration? Do eruptions on the skin seem unable to mature pustules? Do such eruptions tend to the squamous form? etc. etc.

The surgical relations of the hyperplastic diathesis are these: All cutting operations may be undertaken in such patients with excellent success. Incisions easily unite by first intention, and ulcers cicatrize rapidly. Operations upon the veins may be undertaken without fear of pyæmia, and, in general, unless bad ventilation or other mismanagement change the diathesis before recovery, there will be perfect safety from all aplastic complications. Periostitis and arthritis in this diathesis scarcely ever produce necrosis or caries, however severe the inflammation may be. On the other hand, sprains and dislocations produce very unfavorable results. The inflammation set up by the accident partakes of the rheumatic type, and has a true rheumatic persistence and obstinacy. The ligaments are thickened by plastic effusion, and fibrous anchylosis may occur from a similar deposit within the joint, and many months often elapse before recovery takes place from slight sprains.

The treatment of the hyperplastic diathesis is substantially the same as for rheumatism. Meat and spices should be rigidly excluded from the diet, and alcoholic stimuli be entirely avoided. Baths of warm soap and water may be taken, the dress should be thoroughly warm and dry, and the muscular exercise be moderate. Medication should be varied to suit the case, but, in principle, it should be the same as for rheumatism.

The limits of this paper do not permit of a discussion of all known diatheses, such as the strumous, the scorbutic, the cancerous, the syphilitic, etc. It is, however, around the aplastic and the hyperplastic states that the chief interest centres. The surgeon who cannot diagnose and control these two conditions is ignorant of a most important part of our resources. He stumbles like a blind man among the avenues of life and death, not recognizing the direction in which his patient drifts, nor the means of safely guiding his course. On the contrary, he that clearly comprehends the subject is, in many circumstances, complete "master of the situation." He makes his calculations with entire confidence that phlebitis and pyæmia will not step in to ruin his most careful plans, and, in many cases, he can snatch from death victims who would assuredly be lost under less intelligent management.

Respectfully submitted,

E. ANDREWS.

VOL. XIV.-10

THE

AMERICAN METHOD OF TREATING JOINT DISEASES

AND DEFORMITIES.

BY

HENRY G. DAVIS, M. D.,

NEW YORK.

This then is the mode of cure, and it neither requires cutting, burning, or any other complex means.-HIPPOCRATES, Sydenham Society's Translation, vol. i. p. 632.