I would not be understood as advocating the universal rejection of the knife and the adoption of caustics for such purposes. But I think that in caustic pastes we have a therapeutic, or rather surgical, remedy that we could employ frequently with as good or better results than are obtained from the knife. Over three years ago, while acting as Adjunct Surgeon to the Long Island College Hospital, I was consulted by a patient with cancer of the left mamma. Its removal was

advised. The diagnosis and the remedy proposed was indorsed by other surgeons whom she consulted. She went to a cancer doctor," who removed it with paste. I have since regularly visited the patient to observe the result. A better result, more through removal and more symmetrical scar I have never seen. About a year ago, I was consulted by an elderly gentleman who had what was diagnosed by himself as commencing epithelioma on the right cheek over the zygomatic arch. The diagnosis was confirmed by the highest surgical authority of this city and of New York, and its immediate removal advised. Having in mind the above-mentioned case, and also having recently had my attention called to the sulphate of zinc paste (zinci. sulph., ac. sulphric. qs. ut fiat magna), I determined to use it in this case, though the surgeon of New York, who was consulted, flatly denounced such a method. My patient was willing to submit to the treatment proposed. The face was shaved, and the surrounding surface protected by ointment. The paste was then applied, the cuticle having been destroyed by carbolic acid. It occasioned scarcely any pain at all. After three days the scar began to separate, and entirely fell off in seven, leaving a healthy-looking, granulating surface, which healed in a surprisingly short time. The patient has since had no further trouble.

The late Prof. Simpson was an enthusiastic advocate of the sulphate of zinc as an escharotic. His statement in regard to its action are summarized by Dr. Stephen Smith, of New York, in an admirable lecture upon the subject, published in the New York Medical Record, February 14, 1880. It is as follows: "He states that the part to which it is applied is rapidly destroyed to a depth corresponding to the thickness of

the superimposed layer; the slough is of a white color, and separates usually on the fifth or sixth day, leaving behind it, when the morbid tissue is removed, a red, granulating, healthy and rapidly cicatrizing wound. This slough shows no tendency to chemical or putrefactive decomposition, but is firm in texture and free from taint or odor; the local inflammatory reaction around a sulphate of zinc eschar is generally light and transient; there is no marked effusion or swelling in the surrounding parts, except where the caustic was used in the neighborhood of loose cellular tissue; the general system is not affected by its absorption, nor are there any constitutional symptoms, however freely or lavishly it is used."

Dr. Smith continues: "We have in the sulphate of zinc a caustic which, in its various forms, is adapted to a great variety of conditions. Prof. Simpson sums up its advantages, as compared with other caustics, as follows: 1. Its powerful escharotic action. 2. The rapidity of its action. 3. Its great simplicity and manageableness. 4. Its facility of application. 5. Its non-tendency to deliquesce or spread. 6. Its perfect safety. 7. Its efficacy. He speaks hesitatingly as to the seventh statement, but adds that he has seen not only the surface of cancroid and cancerous ulcers speedily and perfectly excavated by its application, but the surrounding characteristic induration became at the same time rapidly absorbed, and the remaining wound speedily cicatrices. He has also found epithelial or cancroid ulcer of the cervix uteri, under the local application of the powdered sulphate of zinc, exfoliate its ulcerated surface, have its sanguineous and seropurulent discharges arrested, the parts temporarily, if not permanently, healed, and the patient's health and strength and spirits restored; though, on first using the caustic, he believed the disease to be altogether beyond the reach of any remedial measure. 'My experience in the use of the sulphate of zinc as a caustic has been considerable, and fully coincides with that given above."

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NEW TREATMENT OF ABSCESSES.

In the wards of Dr. Steven Smith, a new treatment of abscesses has been very successful. (Chicago Medical Review.) When

the abscess points, it is opened and the contents evacuated. The cavity is then injected with carbolized water, and over-distended for two or three minutes. The water is then pressed out, and over the whole area undermined by the cavity, small, dry, compressed sponges are laid and bound down with a bandage. Carbolized water is then applied to the bandage and injected between its layers until the sponges are thoroughly wet, after which a dry bandage is applied over all. The sponges by their expansion make firm and even compression upon the walls of the abscess, and hold them in perfect apposition, thus favoring a union. The dressing is left on for five or six days, unless there is a constitutional disturbance or pain in the seat of the former abscess. It is found, in most cases, when the bandage is removed, that the abscess has completely closed by an approximation of its walls, and the external wound heals readily under a simple dressing of carbolized oil. A case was recently seen where this admirable result was secured in a child, although the abscess was a large one, originating in caries of the head of the femur and opening on the outside of the thigh. No constitutional disturbance, no discharge, no reaccumulation, and no pain followed its use. Mammary and sub-mammary abscesses have been treated by this method with excellent results.

TREATMENT OF WOUNDS BY IMMERSION.

(C. B. Hutchins in Western Lancet.) A car caught the arm of a laborer between its wheel and the track, causing a double compound fracture of both bones of the left forearm. At both ends of the fracture the bones were uncovered. It was two or three days after before dressings were applied. A tin receptacle was made which would allow the forearm to lie on the bottom, and the arm was covered with a solution of boracic acid. The arm had become enormously swollen, and the temperature of the fluid was so much increased that it was necessary to keep ice in the fluid for some days. This was the whole treatment. There was not a tablespoonful of pus escaped from the wounds. The arm whilst being a little deformed, was as useful as before the injury. The solution was renewed about every three days at first, and then at longer intervals.

PARAFFINE SPLINTS.

It is desirable to get a substance (Braithwaite's Retrospect) which can be readily adapted to the limb. The material which answers this purpose best is cotton wool. Any kind of cotton wool may do; but the unbleached, unrefined cotton, made up in pound parcels, is much better than the white refined material. When about to make a splint, this unbleached cotton wool is taken and the single sheet unfolded. The thickness of the sheet is generally sufficient for most splints of the leg and the arm; if the surgeon, however, desires to have it thicker, he can double the layer. A portion of this sheet, of sufficient size to envelop the limb, is cut with scissors-not torn. It is not necessary to be careful about forming the cotton wool into any particular shape, provided it is sufficient to cover the limb and slightly overlap. The adaptability of the cotton is such that it fits the various curves of the limb. The portion so cut is rolled up into a form which will enable it to be placed into the vessel containing the liquid paraffine. It is then submerged in the paraffine for a couple of minutes. As demonstrating the amount of paraffine the cotton wool will take up and the rare, faction of the cotton wool itself, it may be said that the vessel -containing the liquid paraffine may be almost full, and yet a large roll of cotton may be passed into this dish without causing the paraffine to overflow. After it is thoroughly saturatedthe cotton is turned out of the vessel on a portion of "mackintosh," which has had its surface previously oiled, in order to prevent the paraffine adhering. On this surface the sheet of cotton is unrolled. In lieu of the oiled mackintosh a piece of paper, a tray, or the polished surface of a table, provided these are well oiled, may be used. After the paraffine has cooled to such an extent as to enable the surgeon to place the back of his hand on it without inconvenience, it is ready for application to the limb. This cooling process will occupy about three or four minutes, according to the thickness of the layer. During this time the surgeon may occupy himself in preparing the limb of the patient. This may be done by applying either a gauze or other roller bandage, so as to prevent the paraffine coming into direct contact with the limb; or by placing

or two strips of tin next to the limb as a guide for the cutting off of the splint. When the splint is not to be removed from the limb till the end of the treatment of the case, such as in a simple fracture, the former method may be adopted; but when the splint has been cut off immediately after its application, such as one would prefer in a compound fracture, the latter method is the preferable. This sheet of cotton wool, saturated in the paraffine, is then applied to the limb, the surgeon seeing that the cotton overlaps; he then applies a bandage, preferably of gauze, pressing the cotton firmly. This pressure causes a greater cohesion in the splint, and also squeezes out any superabundant paraffine. The limb is then plunged into cold water, or cold water is applied externally, when the splint will become solid in a few minutes. If, however, the splint is to removed, instead of placing it in the cold water, it is cut up the side opposite the tin strip previously introduced. This may be done by first marking a line with a sharp knife, and subsequently cutting it up with dressing scissors. As soon as both sides of the splint are cut, before removal from the limb, it may be then plunged into the cold water; and after it has acquired a sufficient consistency to prevent alteration of shape, it may be removed from the limb and plunged into cold water to complete the consolidation. If it should be very inconvenient to cut the splint on both sides of the limb, the splint may be cut on one side only, and then separated so far as to enable the limb to be withdrawn, the surgeon seeing that the shape of the splint is retained, and after removal from the limb, the opposite side can be cut if desired. Windows can be made in the paraffine at any part wanted. The time occupied in applying such a splint, cutting it off, and consolidating it, would probably be about ten minutes. If the surgeon, instead of wishing to consolidate the paraffine, would like for any reason to retard the cooling, he, in that case, does not apply the cold water; the paraffine then remaining from about twenty minutes to half an hour in a plastic condition.