is that if used for any length of time, when removed, it leaves a tubular passage of considerable calibre lined with granulations. This passage if long, as in large wounds, is often apt to close at two or more points in its course, thus penning up the slight discharge and producing retention and suppuration. The disadvantage of the capillary drainage is that it is not fitted to give exit to large amounts of fluid. Its advantage is that it leaves no such tubular passage, but that while giving us the means of introducing tubing for freer drainage, if at any time it is needed, it allows nearly complete healing, even while a few of its strands are still in situ. Especially is this of value in larger wounds with long drainage paths.

The method referred to is as follows: When the wound is ready to be closed, a fenestrated rubber drainage-tube and a bundle of horsehair of fifteen to thirty or more strands are both placed side by side in the wound. At the end of twenty-four or forty-eight hours the abundant oozing of bloody serum usually necessitates a redressing, but by this time the first abundant discharge has ceased. Accordingly at the first dressing after the operation I remove the rubber tube, leaving the horsehair in place. If the oozing will probably be small, I often even remove a large part of the horsehair. At the second dressing, say in three to six days, I remove all the horsehair or all but two or three strands. In doing so I always remove the hairs one or two at a time, as the nice adjustment of the surfaces is thus scarcely at all disturbed. At the third dressing, if all has gone well, the last horsehairs are removed and the capillary passage heals within twenty-four hours.

For joints or in other wounds where possible longer slight discharge may take place, the horsehair may be left for longer periods as judgment dictates.

I have used this method in amputation of the breast, often bringing tubing and horsehair out through a button-hole counter-opening in the axilla and treating it as described above. I have used it in a large number of amputations of the upper and lower extremities and in the removal of tumors of the neck and other parts of the body and find it to work admirably.

The same result may be attained by first using the tubing alone, and replacing it at the first redressing by the horsehair, but the pain and the mechanical disturbance of the wound are so much greater than the method above described that I have never found it to answer as well. Of course for small wounds, only the horsehair is required.

J

While speaking especially of rubber tubing and horsehair, this method of combined drainage will answer equally well with any of the other materials mentioned, and it is to the method that I particularly design to call attention rather than to the material used.—Dr. W. W. Keen, in Medical News.

SOME MOOT POINTS IN THE NATURAL HISTORY OF SYPHILIS.-The Edinburgh Medical Journal gives the following summary of this question, as set forth by Mr. Jonathan Hutchinson in the Lettsomian Lectures for 1886:

The

Mutual Relations of the different Forms of Primary Veneral Sores. No one thinks that there are two forms of syphilis, and no one doubts that there are two kinds of sores. Are they related or independent? That is all we dispute about. fact that favors the creed of those who think that they are independent is, that the secretion of the chancroid is very contagious, and always produces a sore like itself. This was proved by Bassereau by confrontation. Since then syphilization has abundantly proved his point. It must be remembered, however, that it was done almost exclusively on those who had had syphilis. Here was a fallacy, for the patient might, in consequence of his prior syphilis, be insusceptible of fresh contagion. But the practice was tried by Danielsen on a number of lepers who had never had syphilis, with similar results. It might seem that the proof of specific distinctness was here given. It is necessary, however, at this stage to insist that there is an important difference between a specific contagion and a specialized contagion. All inflammatory products are probably, under favorable conditions, contagious, as gonorrhea, erysipelas, and diphtheria, and so on. It is possible, then, that the poison which produces the chancroid is after all only a specialized product of inflammation, and not a specific virus. Many facts seem to support the conclusion just hinted at, and to imply that soft sores are after all an appanage of syphilis. In practice we encounter a great variety of conditions and great differences in course in the "soft" group of venereal sores, and are obliged to conclude that they agree in one feature only—the absence of hardness. The rounded form, punched out and ragged edges, and gray base, are conditions not present in Mr. Hutchinson's experience in one of five of the venereal sores which do not harden. This want of uniformity in conditions is a strong argument against specificity. Another equally strong argument is that the true chancroid on the genitals is seldom

seen, excepting in those who have had syphilis already. In using this argument he by no means wishes to deny that the typical chancroid is sometimes seen in those who have never had syphilis. Mr. Hutchinson thinks all a priori probability favors the suggestion that non-indurated sores are produced by the secretion of true chancres, which have been changed in character either by the inflammatory process or by the nonsusceptibility of the tissues of the recipient.

Phagedena. All will admit that syphilitic inflammations have a remarkable tendency to become phagedenic. This may occur in all stages of syphilis, and to all kinds of sores.

Hospital Phagedena. Epidemics of this form he believes to originate from cases of syphilitic phagedena. A knowledge of the fact that phagedena usually goes with true syphilis is of much importance for purposes of retrospective diagnosis. While some have assumed that scars on the penis, or its extensive malformation by bygone phagedena, imply the probability of syphilis, others have asserted that they rather favor the belief that the disease was not true syphilis. His vote would go with those who regard them as important, though not conclusive, evidence of constitutional disease, He also regards scars in the groin as presumptive evidence of syphilis.

Second Attacks. In 1839 Ricord said that a person who had once had syphilis was not liable to it again. Up to 1858 he had met with no exceptions that satisfied his mind. In the following year occurred the first case in which he himself witnessed and treated two attacks of undoubted constitutional syphilis in the same patient. It is, Mr. Hutchinson thinks, generally accepted, that second attacks after considerable intervals are not very uncommon; but, at the same time, that Ricord's law holds good in reference to a very large majority.

Incubation Periods. Opinions vary greatly on this point. If by incubation periods we mean, as he contends we ought to do, the interval between contagion and the production of an induration which can be diagnosed, then Mr. Hutchinson believes we shall seldom find it less than five weeks, and more often six. If we date to the first appearance of a sore, then it will be a week or ten days shorter, for the development of hardness takes that time. In the case of a medical man who vaccinated himself in the forearm from a syphilitic infant, the punctures, which had quite healed, became irritable on the twenty-first day, and were well characterized chancres on the forty-first. In another series of vaccination-syphilis, eleven patients received the virus on the same day.

In all the punctures, or vaccine-vesicles, healed; and in all they became irritable at the end of the fifth week, and were well indurated at the end of the eighth.

They occur to those who

They develop in the retrowholly without ulceration.

In

Recurrent Chancres of False Indurations. have had syphilis, and usually on the site of former chancres. They occur usually within five years after syphilis. coronal fold of the prepuce, and are often They do not resemble tertiary gummata. They are rarely attended by an enlargement of glands, and never followed by constitutional disease. On Indurations as a Symptom, and on Syphilis without Chancre. many cases it lasts only a very short time, and is only very doubtfully marked; in others it may, in size and duration, simulate a new growth. In woman it is often very ill marked, and its characters vary much in relation to the special tissue affected. In some cases no initial lesion can be discovered. These cases divide themselves into two groups— those in which an attack of gonorrhea preceded the constitutional symptoms of syphilis, and those in which no local disease of any kind was observed. Respecting the last it is undoubtedly possible-indeed, in most instances, probably true—that a chancre had been present and had escaped recognition.

Gonorrhea-Syphilis. The frequent occurrence of cases in which syphilis follows what was considered to be only gonorrhea suggests the suitability of recognizing what we might call gonorrhea-syphilis. Mr. Hutchinson quotes cases from several authorities in confirmation of this.

Syphilis conveyed in Vaccination with clear Lymph. A gentleman in our profession vaccinated his own arm repeatedly, and in many places, from syphilitic infants, being very careful on every occasion to use only clear lymph. On the first two occasions he failed, but on the third he succeeded, and three indurated chancres were the result, followed in due course by constitutional symptoms. Had that repetition not taken place, and had a report of results been given to the world after the first two trials, how strong would have been the conviction of all in the truth of the creed, that pure lymph, even from infected vaccinifers, is safe! The interest of this demonstration does not end with its relation to the practice of vaccination. It proves that the virus of syphilis may exist in a perfectly clear fluid, and in company with that of another specific fever. We know from experiments that if the purulent secretion of soft sores be filtered so as to get rid of pus-cells, it is no longer inoculable. The converse is probably true of the virus of syphilis. The contagion

of the one is pus, that of the other the particulate micro-parasites of a specific fever.-American Prac. and News.

LUXATION OF THE ULNA IN COLLES'S FRACTURE.—It is now about fifteen years since Moore, of Rochester, called attention to the occurence of dislocation of the ulna and its separation from the triangular cartilage in Colles's fracture of the radius. He first observed these complications in the case of a woman, who, in a fit of mania, leaped from a third-story window, and broke her spinal column and both wrists. Four additional cases have been studied by him and have confirmed his convictions that, even when these fractures are the result of ordinary violence, they present the same features of a separation of the triangular ligament from the ulna, rupture of the lateral ligament, and tearing off of a portion of the styloid process of the ulna.

Moore's assertions have not so far secured the consideration they seem to deserve. Indeed, the credit of the discovery of the important relation of the dislocation of the ulna and fracture of the styloid process to Colles's fracture has lately been assigned to another investigator, Mr. Clement Lucas, whose observations were published in Guy's Hospital Reports for 1883 and 1884. These observations support the views so long ago expressed by Moore, although they differ from his in certain particulars.

There can be no doubt of the correctness of the statements of both Moore and Lucas. It is, moreover, certain that there is more or less displacement of the ulna from its connections at the wrist, with fracture. of the styloid process, in many fractures at the lower end of the radius, in which these lesions are not discovered or even suspected. Moore estimates the frequency of these complications as about fifty per cent., and Lucas found them present in fifteen out of twenty-eight specimens in Queen's College Museum, which he subjected to a careful and critical examination.Phil. Med. News.

INGROWING TOE NAIL.-For ingrowing toe nail M. Lucas-Championniere recommends washing the toe with a five per cent solution of carbolic acid. Local anesthesia is produced and the nail is removed by avulsion and the rim of the bed of the nail is excised. Carbolic acid is again used, and a salicylic cotton wool dressing impregnated with vaseline, containing a fifth of boric acid, is applied; it is then powdered over with iodoform and enveloped in salicylic cotton wool, which is again enveloped in ordinary cotton wool, and finally bandaged. After an interval of three weeks there is cicatrization and the dressing is removed. -Med. and Surg. Reporter.