1893, since which time periods of rest, more or less prolonged, have been advised and secured. Disease of the os calcis, periostitis, and hip disease have all been suspected in turn by different observers who have examined her. After careful consideration of the case I made a probable diagnosis of Achillo-dvnia. May, 1895. In addition to symptoms before named there is now found a tilting of the pelvis and consequent lateral curvature of the spine, resulting from the more marked disability of the left foot. The left calf and foot show slight atrophy as compared with the right. Expressed the opinion that this is a case of "non-deforming club-foot" (according to Schaffer). Feb., 1896. Atrophy of left leg is now more marked. It is half-inch shorter and calf is three-fourths inch smaller. The left foot is noticeably more arched than the right and measures two sizes shorter. April, 1897. Treatment recommended has not been followed. Dr. Caldwell informs me that deformity increased to such an extent that he performed an operation for its relief. CASE II.-April, 1896. Rev. L. D. W., 46 years, (Fig. 3) walks with a gait entirely wanting in elasticity and grace. Never was laid aside by any sickness. When a boy at school could run as fast as his fellows, and was in every way as active as they. As he grew toward manhood, working on a farm, he remembers that there crept on gradually some trouble in the feet and legs manifested by increasing liability to fall, and in lessened activity. These symptoms have been slowly progressive till the present. A very interesting feature in this case is that this is distinctively a family affection. An older brother had some disability of the feet and limbs, similar in kind, which finally induced him to quit farming. Also a sister has some similar affliction the exact nature of which he does not know. A daughter twelve years old presents similar deformity and symptoms. One child, four years old, manifests some similar symptoms. Other children in the family of six are free from disability. In the majority of cases seen by the writers, the history of the deformity is that of an insidious beginning and steady increase, while in a small minority of cases the condition evidently followed an attack of anterior poliomyelitis. The conditions found present, however, in these latter cases would seem to indicate a lesion other than that which is the anatomical basis of an infantile spinal palsy. In an article by Herbert Allingham, in the Br. Med. Journ., Oct. 2, 1897, is shown a cut of a typical case of contracted foot, and concerning the pathology of which he says it is probably due to an affection of the crossed pyramidal tract. The cut of foot shown in Dr. Allingham's article is from a case of Friedreich's ataxia. If this surmise be correct, may it not be that this part of the cord is similarly affected is some cases of varied diseases, thus giving the affection a definite pathology, though associated with different forms of spinal cord affections nosologically considered? Treatment resorted to early is productive of much benefit. A simple night appliance strapping the arch down and keeping the foot at an acute angle with the leg, together with good boots worn in the day-time, have given much satisfaction. Frequently it is necessary at the commencement of treatment, however, to perform fasciotomy and tenotomy, to place the foot in an improved position. These feet are found frequently to be very rigid and unyielding. More than six hundred pounds force we have sometimes employed without satisfactorily replacing the foot. The most successful results follow an early diagnosis, and an intelligent and persistent use of mechanical means. 12 East Bloor Street, Toronto. NITRO GLYCERINE FOR SCIATICA.-Troussevitch has cured several obstinate cases of sciatica by giving the following drops: R Solution of nitro-glycerine (1 per cent.).. Tincture of capsicum. Peppermint aq.. 3 ss. 3 iss. 3 iij. M. Sig. Five drops thrice daily in a tablespoonful of water for the first three days, then ten drops thrice daily on the subsequent days.Practitioner. REFERENCES.-N. Y. Med. Rec., May 23, 1885, p. 561; Bradford and Lovett, Orth. Surg., 746: Young, Orth. Surg., p. 353; Tubby, Deformities and Orth. Surg., p. 352; Lovett in Parks Surg., vol ii., p. 665. Editor "CANADA LANCET." SIR,-When at the Ontario Medical Association meeting in June the subject of the "Victorian Order" for providing District Nursing was discussed, I was in full sympathy with the resolution passed by the Association in respect to that subject. Why? Because the object of the nursing project from having been misunderstood, and perhaps in a measure unwittingly misrepresented, I was under a false impression in respect to it. Since Dr. Worcester, of Waltham, Mass., who has made a special study of the subject both in Europe and America and has had much practical experience in district nursing amongst the poorer classes in Massachusetts, has been in Ottawa and explained the working of such a system and its most excellent results my views have changed; as also, I particularly desire to state, have the views of a number of the medical practitioners of this city with whom I have had converse on the subject. To be brief, three special advantages may be named as almost certain to result from the proposed nursing scheme, if carried out, as follows: FIRST. It would be a decided advantage (rather than a disadvantage) to our already somewhat considerable army of regular nurses, by increasing, probably in a little time quadrupling, the demand for these "ministering angels." The new Order of nurses would go forth amongst the sick and distressed of the poorer classes, visit them, only, say for an hour or so (never remaining, as for a day or a week), for a small sum paid to the Home, not to the nurse. One of them would be sent out, say to a woman at the commencement of labor, by the physician engaged, she would take the place at the bedside and in the room of the very incompetent neighbor or friend, or even mother, of the patient, now commonly in attendance. With a knowledge of the requirements of the case, with kindly sympathy, tender and clean hands, she would arrange everything for the comfort of the patient, the prospective baby, and also for the coming physicain, and in the best possible manner, very different from that in which they are now commonly arranged; sometimes providing, from the Nurses' Home, certain necessaries not obtainable in the patient's house. If properly chosen or selected, as naturally adapted to this sort of semi-mission work, the district nurse would bring such a stream of sunshine (really and figuratively, with fresh air), such confidence, cheerfulness, hope and comfort, as would not only produce a favorable individual effect on the patient, but cause her family and neighbors to make great efforts on other occasions of the kind to employ a regular outside nurse for some days or a week or two, in order to have the benefit of a nurse's constant attendance instead of only visits. So in a case of pneumonia, of enteric fever, of acute rheumatism, pulmonary tuberculosis, or any other disease. The very natural result of this sort of nursing would be, and as appears to have been Dr. Worcester's experience in Waltham, to greatly increase the demand for the regular nurse, as now provided. SECOND. The District Nurse is to be sent only under a physician, it appears, in all cases, and she cannot fail to prove a very great time and labor saver to the physician in all cases in practice which she attends, especially in midwifery practice. This, Dr. Worcester states, is his experience. She will let the attending doctor know just when he is needed at the bedside, saving him hours of patient, or impatient, waiting; or "watching" calls or visits; she will enable him to leave the case sooner, and to know when other after calls would be most needed by her morning visit to the patient and reporting the conditions. THIRD-The District or Visiting Nurse would by her sympathetic presence and other personal characteristics, and her knowledge and acts, bring into the often unventilated, unclean, perhaps darkened, noisy, illmanaged, unhappy house of the sick, pure air and light, cleanliness, quiet, comfort, etc., and so assist immensely to promote recovery and health— abbreviating the period of illness, preventing suffering, despair, death— in a word, to lessen the mortality by modifying and removing the cause of it, wherever she might be sent. Trusting the above may enable the readers of the LANCET to a better understanding and appreciation of the proposed "Victorian Order," OTTAWA, November 25th, '97. I am, etc., EDWARD PLAYTER. TO CURE ITCH IN TWO HOURS.-Employ fresh sulphuret of calcium made as follows: B Sulphur (flour), 3 ounces. Quicklime, 6 ounces. Water, two pints. Boil together till combined, then allow to cool and settle. Decant and preserve in hermetically sealed bottles. Application-Rub patient all over with soft soap for half an hour, then place in a tepid water bath for another half hour. Next rub over with the solution and allow it to dry on the skin for a quarter of an hour. Complete by washing in the bath.-VLEMINKX (Belgium). THE BRANDT METHOD.-This consists essentially in friction baths at a temperature of 65° F. every three hours, when the temperature is 102.5 or higher. It is the safest, most grateful and most successful single means of combating typhoid fever. DROPS FOR ATONIC DYSPEPSIA. Ꭱ Tincture of nux vomica, 2 drachms; Mix and take five to ten drops three times a day. -Therapeutic Gazette. SURGERY. IN CHARGE OF GEO. A. BINGHAM, M. B., Associate Prof. Clinical Surgery, Trinity Med. Coll.; Surgeon Out-door Department FRED. Le M. GRASETT, M.B., C.M., Edin. Univ.; F.R.C.S.E.; M.R.C.S., Eng. ; Surgery, Trinity Medical College. 208 Simcoe Street. T SOME REFLECTIONS ON APPENDICITIS. On the ground of an extensive experience in appendicitis, Dr Le Dentu, in an instructive paper read before the Paris Academy of Medicine, concludes as follows: 1. While it is true that a large number of appendicitis cases should be treated by surgical means, there are some in which a definite or temporary cure can be secured by internal medication. These comprise cases in which, at no time in their evolution, are complicated by threatening peritonitis or peritoneal septicemia. 2. There are soine appendicitis cases which go on regularly to the formation of an abscess. Sometimes these are characterized by a frank inflammatory reaction; sometimes the phlegmasia is well localized to the cæcal region; sometimes the malady runs a natural course without signs of impending danger, and here it may be of advantage to allow the abscess to accumulate and become circumscribed before resorting to interference. The formation of the pus collection is revealed by local signs (localized pain, a tumor of the form of a breast-plate or globular, fluctuation), and general signs-increase of fever, more or less restlessness, followed quite often by a remission coincident with the arrest of pus formation. În these patients early intervention is not, in my opinion, without risk. It can result in a dispersion of the agents of infection confined to a limited area, and this result is to be more feared than the appearance of pus in the first few hours. 3. Surgical intervention becomes opportune and necessary when it is believed, from the signs given above, that a focus has formed. The operation varies in technique according to the situation of this focus. If situated directly beneath the abdominal wall, a simple incision of all the layers is sufficient. It is necessary to guard against the rupture of adhesions (except cases where one has reason to suspect the existence of multiple foci) and against trying to enucleate the appendix. It should be left in place if it is not floating or easily detached, and one should confine himself to suturing any perforation that may be discovered. Tamponnade of the abscess cavity and partial suture of the abdominal wall complete the operation. If at a later period an eventration should re |