some instances, however, it is necessary to re- | years old, has been married two and a half years,

verse the polarity, using the negative pole for a few minutes in order to loosen and detach the electrode. You see the surface of the metal has been acted upon, and it is covered with an apple-green salt, which is readily wiped off. The electrode, after being thoroughly washed, must be rubbed with emery-cloth, so that it will present a bright, clean surface for the next application.

Into the vagina is now inserted a loose wad of iodoform gauze, to which a string has been attached. This is removed by the patient in twenty-four hours. She is ordered to report in three days, but the application is repeated only at the end of a week. Some cases are completely cured by two or three of such applications, but some require more. When the condition shows improvement the strength of the current is reduced, and it is continued for only five minutes.

Case II.-The next patient I show you, Mrs. M., is 26 years old. She has been married eight years; has had one child and three miscarriages, the last one seven months ago.

She complained of backache, severe pelvic pain, especially on the left side, radiating down the thigh, and a profuse leucorrhoea which is sometimes streaked with blood. Her menstruation is profuse, lasting for ten and twelve days at a time, and the interval is only two weeks. She says she was curetted after each miscarriage, but has not been well since the last. She presented herself on the last clinic day, and was so extremely sensitive to digital examination that it was with difficulty that an accurate diagnosis of the condition of the appendages could be made. Bipolar faradization was administered, and she experienced complete relief from her pain for the remainder of the day, and, as you have heard her say, though the pain has returned, it is nothing compared with that she experienced before the application was made. This patient has a fungous endometritis, and in this case, when the local condition is somewhat better, that is, when her pain has been entirely relieved, I shall dilate under an anesthetic and curette the uterine cavity. We will then have an opportunity of verifying the diagnosis, and ascertain positively if there is any disease of the appendages.

and has never been pregnant. She has suf. fered from dysmenorrhoea since puberty, and since her marriage she complains of pelvic pain. At first it was confined to the left side, but now it extends over the whole pelvis. She complains also of backache and leucorrhoa. You will observe, on examination, that she has an anteflexion which is somewhat unusual, the flexion being confined to the body of the uterus, and the cervix is elongated.

The most satisfactory treatment of these conditions is dilation under an anesthetic and the introduction of a straight stem or hard-rubber drainage-tube, which is kept in place for a week, while the patient is confined to bed. Subsequent treatment might also be necessary. This is not, however, always a convenient plan of treatment for this class of patients, and for this reason we will adopt another method which will accomplish the same result, though it is slower, viz., dilation with the negative pole of the galvanic current. I will make this application with the patient in the lateral position because you can better observe the technique. The dorsal position is usually preferred because it saves time, but in every instance when this method is adopted the vagina should be irrigated with an antiseptic solution, because, the electrode being introduced along the finger as a guide, without such precaution septic material might be introduced into the cavity of the uterus. When the lateral position is employed a speculum is introduced, and the cervix and os cleansed by means of a pledget of absorbent cotton saturated in the antiseptic solution held in the grasp of the dressingforceps.

You will observe that quite a considerable resistance is offered to the entrance of the electrode at the point of flexion, but by depressing the handle of the instrument toward the perineum while the current is turned on, it passes the constriction after a very few moments. It is not advisable in these cases to use more than 10 or 15 milliampères for four or five minutes, because cauterization is undesirable. The applications are repeated usually twice a week. In this case we will employ vaginal bipolar faradization afterward to relieve the pelvic pain of which she complains, though it is not always used in these cases unless the

Case III. The patient, Mrs. Z., is 23 application to the canal is followed by pain.

Onychia Maligna. This affection is generally, if not always, a local manifestation of tuberculosis. As in other lesions produced by the latter malady, its exciting cause may be a traumatism. The patients are most frequently cachectic children. This being the case, constitutional remedies appropriate to the underlying condition are demanded. Codliver-oil, the compound syrup of the hypophosphites, syrup of the lacto-phosphate of lime, syrup of the iodide of iron, etc., creasote, and other constitutional tonic remedies, are indicated. In order to carry out the local treatment it will, as a rule, be necessary to remove the nail, as the ulcer extends backward beneath the nail, and the latter is so damaged in structure and nutrition that it will at length loosen and spontaneously come away, either en masse or piecemeal.

Hypertrophy of the Nail.-The proper treatment of this affection depends, to a cer

In addition to

is to dust the parts with iodoform, boracic acid, nitrate of lead, aristol, or europhen. Instead of a powder, lotions containing antiseptic sub-tain extent, upon its cause. As a rule, its stances may be brought into requisition. A origin is in local conditions which cause press20-per-cent. solution of nitrate of silver makes ure, but it may occur in association with certain a good dressing, and can be applied to the local and general maladies. The nail may open surface upon pieces of absorbent cotton or hypertrophy in eczema, psoriasis, ichthyosis, patent lint. Strong solutions of caustic potassa lichen ruber, syphilis, rheumatism, tuberculoare also advised. sis, and diabetes mellitus. Sometimes the malformation develops during the course of a specific fever, as small-pox or typhoid fever. We may, therefore, be obliged to combine constitutional with local treatment. sulphur, of which I have already spoken, arsenic and iron are also of value in debilitated subjects. They improve the nutrition of the nails and assist the action of the local measures. When the nail is simply thickened or lengthened, the redundant portion can be removed by means of the knife, scissors, cutting-pliers, or saw. If the hypertrophy is but moderate in degree, pareing the free end of the nail and pushing back the free margin of skin at the sides and base of the nail will often arrest the faulty growth. It is advantageous, also, in such cases, to use the ointment of lead or tin oleate upon the base and sides of the nail. If the free edge be brittle, it can be protected by means of wax or gum. An ointment of salicylic acid also does good in such cases. If the soft tissue at the side of the nail is swollen, painful, and fungous, constituting the affection generally known as ingrown nail, the soft parts may be depleted by means of the knife or leeches, or may be removed in toto by excision. After this has been done, a sedative lotion or ointment can be applied.

Quite a number of authorities advise simply slicing off the nail-groove and scraping the matrix. After the ulcer has been thoroughly exposed a stimulant antiseptic should be applied to the surface. Iodoform constitutes an excellent dressing. The only objection to it is its odor. Probably aristol or europhen will be found equally effective here, as they have in many other conditions. Boric acid has also been used, but appears to be inferior to iodoform.

A favorite application with some of the best authorities is the powdered nitrate of lead. Another plan is to cauterize the surface with the solid stick of nitrate of silver. Powdered bromide of potassium has also been employed successfully, and was thought to exert a local analgesic effect. A solution of the acetate of lead is useful where there is a high degree of inflammation present. Chlorinated soda, creasote, yellow wash, and nitric acid are other remedies which have been employed in solution with success. According to Prof. S. D. Gross, an ointment containing 2 grains of arsenious acid to the ounce of spermaceti ointment occasionally acts almost as a specific.

It is often, however, desirable to avoid anything like operative interference. Early in the case a cure can generally be effected by carefully inserting a small piece of absorbent cotton between the nail and the adjacent fold of skin. In this manner the horny plate is gradually raised, when the soft parts can be readily removed without producing much pain. If need be, cocaine may be applied before abscission. If the soft parts are much inflamed and very painful, it is a good practice, as advocated by Mr. Dornville, of Exeter, England, to bathe the surface with a solution of hydrochlorate of cocaine of the strength of 10 grains to the ounce. By the aid of this procedure cotton can be interposed between the

nail and adjacent tissue without causing any suffering. After the application of the solution has been made every second day for a period of two or three weeks, the surface is hardened and insensitive. Another device for the gradual and painless elevation of an ingrown nail is painting the interstice between it and the granulations with a solution of 10 parts of gutta-percha in 80 parts of chloroform. The nail should be first thoroughly cleansed, and the application is repeated several times upon the first day. Subsequently the intervals are lengthened. Dr. Patin has reported a number of cases in which the foregoing method proved very effective. When the nail has at length been raised from its bed, it can be easily removed or retrenched with the scissors. Dr. Hoffmann, of Erlangen, disinfects the toe with a solution of corrosive sublimate, then slightly raises the edge of the nail and deposits a few drops of the solution of the chloride of iron. The operation is repeated upon the second or third day. If suppuration occur, the scab is removed by means of forceps and the solution re-applied. In three or four days the crust is again picked off, and after a few such applications the nail is found to be so soft and brittle that it can readily be excised or trimmed off with the scissors. Dr. Pürckhauer, of Bamberg, describes a method which he has found productive of good results. That part of the nail which is imbedded in the flesh is painted with a 40-per-cent. solution of caustic potash. The upper surface of the nail is so rapidly softened that at the end of a few seconds it can be readily scraped off with a sharp-edged piece of glass. By repeating the procedure the nail can be shaved down to the thinness of a sheet of paper. The scale is then grasped by the forceps and removed by means of a pair of scissors. If pain recur with the reproduction of a new nail, the corresponding part of the nail can be softened by a repetition of the same method. If, as generally happens, the case is not seen until the granulations are profuse, the whole toe swollen and excessively painful, I find that decided relief is accomplished by cauterizing the affected part with the solid stick of nitrate of silver, or with pure carbolic acid. After this has been done, a shred of cotton can be inserted beneath the nail in the manner already described.

amelioration are that they are attended by but little pain and that they allow, in most cases, the patient to continue his usual avocations. If, however, they prove unsuccessful, or the patient wearies of a tardy method, more radical measures can be practiced.

Atrophy. The treatment of atrophy of the nails depends upon its cause. As the affection occurs in connection with many constitutional diseases, constitutional treatment is requisite in most cases. If atrophy of the nails take place in syphilis, antisyphilitic remedies should be given according to the stage of the disease and the condition of the patient, not forgetting that iron is often needed in syphilis in order to combat the specific anæmia. If the atrophy develop consecutive to an attack of fever, reconstituent remedies are demanded, and as the general health improves the nutrition of the nail is favorably influenced. The preparations of iron, bitter tonics, mineral acids, strychnine, hoang-nan, phosphorus, kola-nut, etc., promote the growth of a healthier nail. If the atrophy has been caused by tuberculosis, we must employ those remedies which may modify the progress of the general malady. Change of climate, out-door life and exercise, hygienic regulations, cod liver oil, creasote, guaiacol, hypophosphites, etc., are the means upon which we place the most reliance. If, fortunately, our efforts to arrest the progress of the constitutional malady be crowned with success, the nails may eventually assume a normal appearance. When we are able to trace a connection between the malnutrition of the nails and a serious disease of the nervous system, such as ataxia, we must make use of such means and remedies as are most likely to favorably modify the course of the general malady,-electricity, systematized athletic exercises, the practice of massage, the administration of nitrate or oxide of silver, the iodide of potassium or strontium, phosphorus, chloride of barium, etc. If the nails atrophy in consequence of cerebral paralysis, the methods which we adopt for moderating the intracranial circulation, for promoting absorption of the clot and restoration of nervous influence, may be followed by improved nutrition of the nail.

The local applications which we may employ in case of ungual atrophy consist principally of oils or fats and protectives. The The advantages of these plans for gradual office of the latter is, of course, to guard a