the knife divided first the skin, and then the palmar fascia. The ring-finger was now reduced nearly to its natural position. Being desirous of sparing the pain of a second incision, Dupuytren endeavored to prolong the incision of the palmar fascia, towards the ulnar edge of the hand, but could not succeed; he was, therefore, compelled to make a transverse incision opposite the articulation between the first and second phalanx of the little finger, and thus separated its point from the palm, but the remainder of the finger was still immovable. A third incision divided the skin and fascia, opposite the metacarpo-phalangeal joint of the little finger; the benefit was very slight, and he was forced to make an incision opposite the middle of the last phalanx, when the finger at once became straight. Is it not clear, from this case, that other parts besides the palmar fascia were engaged in the disease? Do not we all know that the prolongations of this fascia are attached to the sides and not to the middle of the first phalanx? From the facts which have just been mentioned, M. Goyraud concludes that permanent contraction of the fingers never depends on the palmar fascia; that we should avoid dividing this latter in any operation for the relief of the disease, and that Dupuytren, probably, divided the subcutaneous bands developed in the cellular tissue, and not prolongations from the palmar aponeurosis.

This opinion seems to me to be too exclusive, and I agree with M. Sanson in thinking that permanent contraction of the fingers may depend on the palmar fascia, on the skin, or more frequently on transformation of the cellular tissue into fibrous bands.

The treatment of this affection is exclusively surgical; we can expect no benefit from any other means than division of the fibrous bands by which the finger is retained in the flexed position. Dupuytren made an assistant extend the finger as far as possible, and then divided the most tense part of the band; if the finger could now be straightened completely, the operation was finished; if not, he made one or more incisions above or below the first one. When the fingers became free, he maintained them in the extended position by means of bandages and splints, for a month or six weeks; but as soon as the state of the wound permitted, he commenced movements of flexion and extension.

M. Goyraud operates in a different way: he makes his incision along the side of the band, and in the same direction with it, and then divides the band in various places, or excises a portion of it. This method has many advantages over that

of Dupuytren; the patient runs less risk of inflammation extending along the sheaths of the tendons, or palm of the hand; it allows us to commence moving the fingers at an earlier period, and leaves a much smaller cicatrix. When we have restored the finger to its natural position by means of operation, we are not to think that the patient is free from the danger of relapse. Considerable care must be bestowed on the aftertreatment; the joints must be frequently moved; discutient lotions, &c., applied, and the patients must be particularly cautioned against using any hard bodies, or employing himself in any occupation by which the palm of the hand may be irritated.-Prov. Med. and Surg. Journ., Oct. 1841.

New Theory of Tinea; its supposed Vegetable Origin:--A few years ago a young Hungarian physician, M. Gruby, announced, as the result of an extensive series of microscopical observations, that the cutaneous disease, known by the name of tinea or favus, is owing to the development and growth in the skin of cryptogamous plants of the genus fungus, which he has called micoderme. He tells us that they exhibit the aspect and form of such vegetable productions from their earliest appearance to their complete maturity, at which stage, if examined with a magnifying glass of two or three hundred powers, he has distinctly recognised the fruits or sporules in the interior of their cavities, as we observe to be the case in other fungi. He is of opinion that the disease is propagated by these seeds. This novel idea of the etiology of the disease has excited much attention among the French dermatologists; and it is but just to M. Gruby to acknowledge that the researches which have hitherto been made on the subject at the St. Louis Hospital in Paris, have tended to confirm the accuracy of his statements.

The treatment, naturally suggested by this theory of the disease, is that of applying caustics or whatever is calculated to destroy the vegetable substance.

M. Devergie has, during the last year, been giving an extensive trial to a solution of the acid nitrate of mercury (of the French codex): the spots become at first of a reddish yellow color, and subsequently black after the application.

M. Emery, of the same hospital, is in the habit of employing a strong solution of iodine for the same purpose, and it has appeared to answer extremely well.

In another article in the same journal, Dr. Petel recom

mends an epilatory ointment; as, in his own opinion, the only prospect of effecting a rapid cure depends upon extracting the hairs from the diseased spots. This gentleman's experience, however, cannot well be trusted to; as he tells us that tinea is never present where the hairs have fallen out, and that the method which nature follows is always by the removal of the hair. He tells us, too, that all internal and external remedies are of little or no use until the hairs are extracted, or fall out spontaneously. It would seem, from what he says, that the empirics, MM. Mahon, have more success in the cure of the disease than any of the regular practitioners in Paris: their plan consists in applying, first, a strong lixivial soap to the head, and then an epilatory plaster, which, when removed, draws the hairs off with it.

Dr. Pelet recommends the following formula for an epilatory ointment and powder:

After cutting the hair very short, the crusts are to be detached by applying linseed poultices to the scalp, and washing it repeatedly with soap and water. After several days' use of these means, all the affected parts are then to be rubbed with the ointment: this is to be repeated daily. The swelling and redness of the scalp gradually subside, but without ever ceasing entirely. The pustules, the successive reproduction of which keeps up the disease, become more rare and appear only at long intervals. To effect this change, from two to three or four months are often required. When this is the case, a pinch of the powder is to be sprinkled among the hair every second day or so. The hair becomes gradually loosened, so that it can be easily detached with a fingers or with a forceps, without causing pain. When the affected parts are rendered quite bald, the treatment is nearly at an end; all that is necessary is to anoint the head with a small portion of the ointment every two or three days, and to keep it exceedingly clean.-N. Y. Lancet, from Bulletin de Therapeutique.

Case of Gun shot Wound of the Face, with loss of a greater proportion of the Tongue, and extensive lesion of the bony structure, successfully treated; together with an account of interesting nervous Phenomena, resulting from the injury. By J. F. PEEBLES, M. D.-In the month of August, 1840, Washington Perkins, a middle aged man of robust constitution, but intemperate in his habits, induced by a fit of jealousy to attempt self-destruction, placed the muzzle of a fowling-piece, charged with duck-shot, immediately below and in front of the angle of his right jaw, and discharged the gun with his foot.

I saw him a few minutes after the accident; the hemorrhage was frightful, though he was composed and sitting up in bed. Upon examination I found an entire breach in the inferior maxillary bone at the point where the shot had been received of more than inch in length, involving the loss of the two lower molar teeth. Passing obliquely upwards through the mouth, the tongue was torn across in the line of the shot, all the free portion of it with the attaching frænum, completely severed and thrown forward between the front teeth. The charge passed out through the antrum about three quarters of an inch below the eye, carrying with it also the two cuspidati and their alveolar processes.

In addition to the injury of the inferior maxillary bone already named, there was a transverse fracture at the symphysis. Owing to the nature and peculiar situation of the injury, the means for arresting the profuse hemorrhage were confined principally to rest in the recumbent posture and cold applica tions to the head, face and neck. But the quantity of blood which had found its way into the stomach, and still continued to trickle down the throat, despite our efforts to prevent it, very much embarrassed and impeded their effects by the frequent retchings it induced. As soon as fainting came on, however, firm coagula formed in the cavity of the mouth and the orifices of the wounds, and the hemorrhage entirely ceased. In this state he was left for the night with directions for the diligent continuance of rest and the cold applications to the head and face.

During the night, from the frequent gratification of his intense thirst, the coagula were removed, and the bleeding par tially returned, but a bit of ice in the mouth controlled it until the following morning, when all oozing was promptly sup pressed by pledgets of lint soaked in a solution of kreosote applied on the bleeding surface.

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drawn to the left side; he complained of feeling a notch in the glass from which he drank, owing to loss of sensation in the right portion of his lower lip, phenomena which indicated lesion in the motor and sensitive nerves which supply the lower portion of the face. Over the inferior maxillary bone where the charge had entered there was a circular but jagged wound of over an inch in circumference, either way, extending up on the neck. On introducing the finger the fractured ends of the inferior maxillary bone were found to present a remarkable peculiarity. Instead of being shattered, and split or splintered as might have been expected from the violence of the accident and the nature of their structure, the ends of the bone were found presenting regular and transverse surfaces, as if only that plug of bone had been clearly removed which had received the violent charge, without material injury to the adjoining portion. The osseous system of this man had always exhibited evidence of remarkable fragility. He had suffered fracture of the thighs five different times, and as it is usual in individuals suffering from fragilitas ossium, the bones had in each instance united, with but little inconvenience, and with remarkable facility. Was not the regularity and favorable nature of the fracture to be attributed to this condition of the osseous system, which, doubtless, was general?

The end of the tongue was retracted and swollen, so as considerably to impede deglutition. The left antrum was exposed, while the external wound above presented the form of a triangular incision, with a flap perfectly preserved and thrown back. This was now brought down, the parts adjusting themselves perfectly together, and confined with adhesive plaster. The portion of inferior maxillary bone between the symphysis and the breach at the angle had fallen inwards, protruding the teeth longitudinally into the mouth, and was so loose and detached as to occasion some thoughts of the propriety of its immediate removal. It was however erected into its proper position and confined as securely as the circumstances would permit, and for the few succeeding days the patient remained tolerably comfortable. After this time for the succeeding ten days alarming hemorrhage from time to time continued to recur, but by the diligent continuance of cold applications to the head and face, together with the topical application of kreosote to the bleeding surface of the tongue and cheeks, it was checked; when he ceased to suffer further annoyance or danger from this score. At the end of the second week the external wound over the antrum had healed by the first intention, and although the antrum still remained ex