to be accounted for by some natural cause. The time has not yet come for legislators and county-rulers to pay due regard to the claims of the medical profession; at present, the rule is to save money, wherever possible, and the fees for post-mortem examinations form an item not much in favor with the judges who have to allow them. For this reason alone, the more minute examination must be dispensed with in many instances, and the interest of science sacrificed on the altar of misplaced economy.

ART. II.-Case of Senile Gangrene following Pneumonia. Reported to the Alliance Medical and Surgical Society. By JOSEPH PRICE, M.D., Randolph, O.

On April 11th, 1859, I was called upon to see Horace White, aged sixty-one years, of nervous temperament, with light blue eyes and white hair, and having the appearance of a man of more than his years. By occupation a farmer.

The history obtained of himself respecting his previous condition was, briefly, that he had been out of health more than a year, suffering with coldness of the extremities during the greater part of that time. Appetite poor; inability to labor, a great part of the time; had suffered with pain in his right side, and at times with slight headache; in short, was very much debilitated. Two days previous to my visit, was taken with a chill, followed by fever, headache, pain in the right side, on inspiration, with cough, and expectorating a mucus more or less streaked or mixed with blood: the rusty sputa.

On examination, I found him laboring under pneumonia of the right lung. Hurried respiration; pulse 90, and rather soft; urine high colored and scanty; bowels constipated; skin hot and dry; tongue coated of a yellow color, and not very dry; complaining of thirst, with dryness about the pharynx.

Put him under treatment practiced in cases of asthenic inflammation, as in all cases coming under my care at the time there was a tendency to low form of epidemic disease, and more particularly in this case, as there had been a general prostration of vital powers previous to the acute disease. Omitting venesection and antimony, I gave him a cathartic containing mercury, to arouse

the secretions, following it with alterative doses of calomel combined with opium and ipecac, alternated with comp. syrup of. squills and veratrum viride, continuing it until the pulse came to near the healthy condition; this, with counter-irritation to the side, and mucilaginous drinks, was the treatment adopted, with slight variation, for ten days, when the inflammatory symptoms subsided, and the case, to all appearance, was convalescing, as the tongue had thrown off its coat, leaving it moist and natural in color; fever subsided; pulse from 60 to 66; all the secretions normal; respiration near eighteen per minute, and without pain. Ordered an infusion of serpentaria and wine whey, to be taken alternately, during the day; and at night Dover's powders, to procure rest. Dismissed the case about the 23d of April, and heard nothing further from the case until the first of May. Was again summoned to see him. Found a train of symptoms which appeared unfavorable to a healthy termination. Pulse was now 45, and fluctuating; but little force to the heart's action; countenance pale and sunken, with a sallow appearance of the skin generally; some cough, and expectorating a dark, greenish matter, which, with the breath, were intolerably fetid; tongue deep. red color, smooth and moist; cold perspiration, with great general prostration. Intellect good; said he at times felt very much like smothering; had no pain in respiration, and but little more frequent than normal.

He manifested an anxiety disproportioned to the extent of disease, which led me to conclude that the lung, or a portion of it, was gangrenous, as there were present all the symptoms described by authors in circumscribed gangrene of that organ. Taking this view of the case, I deemed the prognosis rather unfavorable. Prescribed tonics and stimulants freely. Quinia sulph., grs. ij., every two hours, alternating with a wineglassful of wine whey, with as much nitrogenized food in the shape of eggs, beef tea, etc., as could be tolerated by the stomach. Opium at night, to secure rest; and, when deemed necessary, procured alvine evacuations by administration of castor oil and spts. turpentine. Under this continued treatment, with slight alteration, for more than three weeks, the system rallied; the pulse gradually coming up to 60 per minute; discharge from the lungs diminished in quantity, and became mucous instead of pur

ulent, and lost its offensive smell, accompanied by a general improvement in strength and appearance.

Supposing the case once in three or four

46

again convalescing, I did not visit him but days. On my return to see him, about the 20th of May, he complained of a pain in the small toe of the left foot; said he had not slept any the night previous, with it." Described the pain as "stinging and darting," from the end of the toe upwards to near the outer maleolus, without any cessation, and was nervous from pain and loss of sleep. Upon examination of the toe, could discover none of the symptoms of inflammation, except the pain; no redness, heat or swelling. Pulse and tongue natural; appetite good; skin moist, and of normal temperature.

Being satisfied that there had been gangrene of a portion of the lung, and knowing that he had lost his father with senile gangrene of the lower extremities, about fifteen years since, set up similar to this, led the family and myself to believe the discase in the toe was of that character. The pain continued in the part, being aggravated at night, for about two weeks, before there was any change discernible in the foot or toe, when a small black spot appeared on the extremity; and at the same time swelling commenced in the toe, with a red border around the black spot.

His general health improved all the time, and continued, except an irritable condition of the nervous system; appetite good; could take animal food enough, with ale or porter, to sustain strength opium, conium, or hyoscyamus being used to control the nervous irritability. Local applications at this stage did not appear to be of any benefit, except keeping it moist by mucilaginous poultices.

At about the end of the fourth week from the commencement of the pain in the toe, the disease had extended upwards as far as the matrix of the nail, when it made a terminating pause, and the dead part become detached by ulceration, and stripped off like a closed-ended thimble, leaving the parts beneath of a dark reddish color, and slightly sensitive. Commencing again, it extended upwards, and soon involved the whole toe, making another pause for near two weeks, and nature made an effort at amputation, which I assisted, removing as much as was entirely sphacelated of bone and soft parts.

I saw him again in three days; found him laboring under cholera morbus, which produced some prostration. Gangrene again commenced, and made slow progress for ten days, when it involved all the phalangeal bones of the small toe, and near one-third of the metatarsal, and also extending under the two adjoining toes, through the soft parts, affecting the osseous structures but little, but taking the soft parts down to the bones, about one and a half inches in width at the base, terminating in an apex under the third toe. Here it stopped again, and nature commenced her plan of amputation, which I again assisted, removing all that was dead as fast as loosened, and taking off the metatarsal bone about one inch above the articulation of the fifth

toe.

Treated him with tonics and stimulants, with local applications of carb. zinc and chlor. mercury, dusting it on all the diseased surfaces, each alternate day keeping the parts, in the interval, covered with basilicon ointment. This appearing to operate well, I continued it for near weeks, at which time the parts had become cicatrized to an extent that I conceived the case out of danger of further progress of the kind, and dismissed him.

Six months have elapsed since the above was written, and the subject of this report has been gradually increasing in strength, and is without symptoms of an outbreak of a similar character.

ART. III.-Incarnatio Unguis - Inverted Toe-Nail. By Dr. B. WEBER, Cincinnati, Ohio.

Since the time of Paul of Egina (A. D. 668), a number of methods have been proposed for the healing of this extremely painful, and at the same time disabling affliction. All of them, though, up to this day, have proved either insufficient, or their application is too painful and disheartening. We will enumerate them in their succession. Paul of Ægina recommended the removal, by the knife, of the soft parts which cover the nail, to where it had grown in, and then cauterization of the wound. Abul Kasem (1106), Ambrose Paré (1509), and our cotemporaries Brachet and Amupet, followed the same practice.

Fabricius Ab Aqua Pendente (1619) tried to obviate the irrita

tion of the nail upon the flesh by lint pledgets dipped in warm water; Depault by a small piece of tin, and Richerand by small plates of lead. Ozanan and Cheliny did the same, or used spunk instead of lint. Pittschaft recommended to scrape the nail thin, then to place a thin layer of wax over it, and moisten the part of the nail grown in every night and morning with tincture of opium. Plaquier scraped the sick side of the nail thin, then cut away that whole side, and applied emollient poultices. Astley Cooper pursued pretty much the same method. Lafay scrapes the nail thin, then cuts out of the middle of it a V-shaped piece, the point being towards the root of the nail; then he inserts into the anterior ends of the cut a lead wire, and brings them gradually together by twisting together the wire. Guillemot cuts away the part of the nail which is not grown in, by which operation, he says, the part grown in must come out of the flesh of its own accord. Sanson and Begia consider this mode of operating suitable only for very light cases. Lis Franc inserts the bistoury under the nail, and cuts that entirely away with the soft parts adhering to it. The process most advocated in later times is that of Dupuytren. He inserts the blade of a pair of straight, sharp scissors under the middle of the nail, and splits it into two halves. Getting hold of the diseased portion with a princette, he beads it over, and, tearing it loose from its connection, extracts it. The excrescences he cauterizes with the red hot iron. Rust follows Dupuytren's method, but uses, instead of the "actual cautery,' the red precipitate. Vanderbach applied the kali causticum under the perforated adhesive plaster (emplastrum penetratum), to remove the nail; and Kremer, from his own experience, highly approves of this method.

In the last May number of the Cleveland Medical Gazette we find mentioned the modes of proceeding of Drs. Gillman and Alcantara, to which I here subjoin my own method, which in numberless instances made all others superfluous. To attain my object, I made use of the following composition:

R Cortic. querci, 3 ss.

Gallarum turcicarum, 3j.

Conscisse coque in aq. commun., 3 x., ad remanentiam, 3 vj. Colatura addatur

Argen'i nitrici fusi, ♬ j.-3 j.

Acet. saturn, 3 ij. M.

D. S. Embrocatio.