of the soft tissues over the margin of the nail. The condition is treated by splitting the nail, removing the piece of nail, the soft tissue, and the adjacent matrix, and dressing antiseptically. XXXI. DISEASES AND INJURIES OF THE LYMPHATICS. Lymphangitis is inflammation of lymphatic vessels. Reticular lymphangitis, which is inflammation of lymphatic radicals, is seen in some circumscribed inflammations of the skin. It is apt to attack the hands, causing redness and swelling, fading at the point of initial trouble while it spreads at the periphery; it is caused by micro-organisms derived from decomposing animal matter (Rosenbach). Erysipelas also causes it (see Erysipelas). Tubular lymphangitis, which is due to the entry into the lymphatic ducts of virulent microorganisms or their products, is seen in dissection-wounds, septic wounds, snake-bites, etc. It is announced by oedema. and by minute hard red streaks running from the wound up the extremity. Suppuration may occur. Lymphadenitis, or inflammation of the glands, may follow lymphangitis or may be due to the deposition of infective material, the lymph-vessels not being inflamed. In septic lymphadenitis there are pain, tenderness, and swelling. In severe cases there are chill and septic fever. Suppuration may arise. The treatment is to drain and asepticize the wound, to apply over the glands and vessels iodine and blue ointment or ichthyol, and to employ rest and compression. Internally, milk punch, quinine, and nourishing diet are required. If suppuration occurs, incise and drain. Acute lymphadenitis, or acute inflammation of lymphatic glands, may follow lymphangitis or may be due to tubercle, syphilis, glanders, cold, or traumatism. Suppuration may or may not occur. In inflammatory lymphadenitis there are pain, heat, and nodular swelling. In severe cases there is fever. The treatment is to asepticize any area of infection, place the glands at rest, apply cold and lead-water and laudanum, or inject into the gland every day 5 m. of a 3 per cent. solution of carbolic acid to prevent suppuration. If pus forms, evacuate, drain, and asepticize. Chronic adenitis is almost invariably syphilitic or tubercular. It requires constitutional treatment and the local use of ichthyol, iodine, or blue ointment. Lymphangiectasis (varicose lymphatics), or dilatation of the lymphatic vessels, is due to obstruction. It results, as a rule, from chronic lymphangitis or the pressure of a tumor, and is most usually situated in the pubic, the inguinal, or the scrotal regions or on the inner side of the thigh. There are two forms: the varicose, in which the vessels have a tortuous outline, like varicose veins, but are covered only by surface epithelium; and lymphatic warts (lymphangioma circumscriptum), in which wart-like masses spring up, these masses being covered with epithelium and filled with lymph. In most cases of lymphangiectasis there is considerable hard oedema. Rupture of the dilated vessel causes a flow of lymph (lymphorrhea). Lymphangioma is an advanced stage of lymphangiectasis (p. 209). The treatment in mild cases is to pierce each vesicle with the minus pole of a galvanic battery and pass a current. In severe cases destroy the mass with the Pacquelin cautery or excise it with a knife or with scissors. Elephantiasis.-True elephantiasis (elephantiasis Arabum) is chronic hypertrophy of the skin and subcutaneous tissues following upon a lymphangiectasis produced by a nematode worm (the filaria sanguinis hominis). Spurious elephantiasis is hypertrophy of the skin and subcutaneous tissue due to chronic inflammation (in a leg which possesses an ancient ulcer, or in the scrotum of a man with urinary fistula). The treatment is massage and bandaging, sometimes ligation of the artery of supply, extirpation, or amputation. Malignant Lymphoma, or Hodgkin's Disease.-(Sce p. 203). XXXII. BANDAGES. A bandage is a fibrous material which is rolled up and is then employed to retain dressings, applications, or appliances to a part, to make pressure, or to correct deformity. It may be made of plain gauze, of gauze infiltrated with plaster of Paris or soaked in silicate of sodium, of gauze wet with corrosive-sublimate solution, of flannel, of calico, or of unbleached muslin. Unbleached muslin, which is the best material for general use, is washed to remove the sizing, is torn into strips, and the edges are stripped of selvage. One end is folded to the extent of six inches, this is folded upon itself again and again until a firm centre is formed, and over this centre the bandage is rolled. In a well-rolled bandage the centre cannot be pushed out of the roll. A cylindrical part of the body may be covered by a circular bandage, each turn exactly covering the previous turns. A conical part may be covered by a spiral bandage, each turn ascending a little higher than the previous turn. As each turn of a spiral bandage is tight at its upper and loose at its lower edge, the reverse was devised to correct this inequality; hence a conical part should be covered by a spiral reversed bandage. To make a reverse hold the roller in the right hand. (do not have more than six inches of slack), place the thumb across the fresh turn, fold the bandage down without traction, and do not make traction until the turn has been carried well around the limb. A projecting point is covered with figure-of-8 turns. The groin, shoulder, breast, or axilla can be covered by figure-of-8 turns, each succeeding turn ascend ing and covering two-thirds of the previous turn and forming a figure like "the leaves on an ear of corn." Such a figure is called a "spica." spica." In bandaging an extremity the peripheral turns should be tighter than the turns nearer the body. Never apply a tight bandage to the leg or the arm without including the foot or the hand. In firm dressings leave the fingers exposed, and use them as an index of the condition of the circulation in the part. Spiral Reversed Bandage of the Upper Extremity.-In making this form of bandage, use a roller two and a half inches wide and eight yards long. Take a circular turn about the wrist, and a second turn to hold the first; pass obliquely across the back of the hand to the extremities of the fingers; ascend the hand to the root of the thumb by several spiral turns; cover the wrist by a figure-of-8; ascend the forearm by spiral reversed turns; cover the elbow by a figure-of-8, and the arm by spiral reversed turns; end the bandage by two circular turns, and pin them (Pl. 11, Fig. 4). Spiral Bandage of All the Fingers (Gauntlet).-The gauntlet bandage requires a roller one inch wide and one. and a half yards long. Take two circular turns around the wrist, pass obliquely across the wrist to the root of the thumb, and descend to its tip by spiral turns; cover in the thumb by spiral reverses, and return to the wrist. Cover in each successive finger in the same manner, and terminate by two circular turns around the wrist (Pl. 11, Fig. 2). Spiral Bandage of the Palm or Dorsum of the Hand (Demi-gauntlet).-The demi-gauntlet requires a roller one inch wide and four yards long. This bandage has only a limited value; it must not be applied tightly, as it makes much pressure at the finger-roots, but leaves the fingers free. If it is desired to cover the palm, supinate the hand; if to cover the dorsum, pronate the hand. Take two circular turns around the wrist, sweep around the root of the thumb, and |