straps, splints, &c., each description being illustrated by a good, though rather coarse wood-cut. There are a series of these illustrations, which exhibit the use of the handkerchief in various diseases of the head, body, and extremities, in a variety of ingenious ways, many of which were not known to us before, and their adoption we think will be likely to be found useful.

"The handkerchief, or square linen, may," he says, "replace all the bandages that we have before treated of, and in its dimensions, as well as in the tissue composing it, must be regulated by the size of the part to which it is to be applied, or the circumstances of the moment. It is, therefore, a matter of indifference whether it be of silk, cotton, or linen; and if too short to go round a part at the time of its application, may be easily lengthened by attaching to its extremities two pieces of tape or ribbon. From this original piece we may form various other shapes suited to circumstances, viz., the triangle, the long square, the cravat, and the cord, made by twisting the cravat on itself.

The following is his account of Baynton's plan, and will convey a specimen of the style of the work:

"As the treatment of ulcers by the use of adhesive strips is of considerable importance, a detailed account of Baynton's plan is here given.

"Several strips of adhesive plaster, the manner of preparing which has been already described, of about two inches in breadth, and sufficiently long to pass round the limb and leave an end of about four or five inches; several longitudinal compresses made of soft calico, and a calico roller about three inches in breadth, and varying from four to six yards in length, according to the size of the limb, are first prepared. Then one of these strips is to be applied to the sound side of the limb, opposite the inferior part of the ulcer, so that the lower edge may be placed about an inch below the lower edge of the sore, and the ends drawn over the lower part of the ulcer, with as much gradual extension as the patient can conveniently bear; the other strips are then applied in the same manner, each above and in contact with the other, until the whole surface of the sore and of the limb is covered from one inch below to two or three inches above the affected part.

"The whole of the leg, if it is the part affected, should then be covered equally with the longitudinal compresses, and the roller applied round the limb, from the toes to the knee, with as much firmness as the patient can support without complaint. One or two spiral turns of the roller should be first passed round the ankle-joint, then as many round the foot as will cover and support every part of it, except the toes, and the same continued up the limb as far as the knee; the roller should be carried from the ankle upwards in reverses, as many of them being made as the parts require, in order that each turn may

lie flatly on the limb. Should the parts be much inflamed, or the suppuration be very abundant, the applications are to be wetted frequently with cold spring water. The patient may take exercise if he pleases, as this will be found to alleviate the pain and tend to accelerate the cure. The bandage ought to be daily applied soon after rising in the morning, when the parts are most free from tumefaction; and the force with which the ends of the plasters are drawn over the limb gradually increased as the parts return to their natural state of ease and sensibility. When the cure is thus far accomplished, the roller should be applied with as much tightness as the patient will bear, more particularly if the limb be in that enlarged or compressible state denominated scorbutic, or if the edges of the wound be thickened.

"We may remark, that this bandage is liable to produce excoriations of the limb, but these are never serious except when they occur over the tendo-Achillis. To prevent them or accelerate their disappearance, Mr. Baynton recommends the application of a small shred of soft leather under the adhesive plaster: or a bit of sheet lead may be used in place of the shred of leather, as it answers better.

"During the years 1830 and 1831, several of the most eminent surgeons of Paris submitted Baynton's method of compression to a series of experiments, which, as the result will show, were highly favourable to it. Velpeau found the average time of cure ten, fifteen, or twenty days, for ulcers of three, four, or five inches in circumference. Ph. Boyer, who perhaps pushed the experiments further than any one else, found the average period of treatment calculated upon a large number of cases, to be twenty-six days; and this result is so much the more striking, as Duchâtelet was noticing at the same period the average length of time required by the older methods, which he found in six hundred and ninety cases to be fifty-two days and a half, giving a difference of more than half in favour of Baynton's plan. In the course of these experiments some modifications were introduced; as, for instance, that by Velpeau and Ph. Boyer, of the substitution of good diachylon plaster for the mixture of Baynton. So, with respect to the breadth of the plasters, the above surgeons found them more advantageous when only an inch or an inch and quarter broad. In the course of the experiments, Roux and Ph. Boyer found that the inflammatory state of the ulcer did not counterindicate the employment of compression, which often arrested even its secondary effects. Marjolin, however, recommended the reducing of the inflammation before proceeding to compression. Velpeau and Roux extended the compressive treatment to contused wounds with disorganization of the skin, which were getting into an atonic state, andalso, to every species of wounds with or without loss of substance, when the cicatrization was slow, or otherwise checked by a general vice of the constitution, attending, however, in the latter case to internal remedial agents calculated to benefit the system. Ph. Boyer endeavoured to cure syphilitic and scorbutic ulcers by compressive strips alone, but without success; while, by exerting this species of

compression, and employing, at the same time, the ordinary internal remedies, the cure was remarkably hastened.

"Ph. Boyer's observations all tend to support the opinion of Baynton himself, that, when the leg is properly bandaged, walking, at least moderately, tends to facilitate the cure, and renders it more complete. With regard to the periods of renewing the bandage, Velpeau found it quite sufficient to change it every three, four, or five days, according to the degree of irritation. Boyer never dressed them oftener than once in forty-eight hours. Valbrune considered it necessary to renew the bandage oftener, if the cessation of swelling caused it to become relaxed, but agrees with Velpeau and Boyer in thinking that the less often the bandage is disturbed the better."

SCIENTIFIC INTELLIGENCE.

Case of extensive cancerous Ulceration of the Leg, in which the Limb was removed after the Glands in the Groin had become enlarged, without a Return of the Disease.-Secondary Hemorrhage on the tenth Day after Operation, by John Stuart Vesey, M. D., Surgeon to the Magherafelt Poor-House, &c. &c.

[For the Dublin Journal of Medical Science.]

William Ray, aged 64, a large and powerfully built man, consulted me on the 21st of August, 1842, labouring under the following symptoms: the front and sides of the right leg were covered by an ulceration, with a border of dark purple and immoveable skin which reached, above, to within a hand's breadth of the tuberosity of the tibia, and, below, covers the anterior part of the ankle joint. The ulcer itself presented the following characters: it was nearly four inches long, and two and a-half broad; its edges were very hard and elevated; inverted at some parts, everted at others: the surface presented alternate elevations and depressions, with here and there isolated formations of large unhealthy granulations, from each of which a dot of thick white matter could be pressed. The discharge from the diseased surface was thin and brown, profuse in quantity and possessed of the peculiar odour that characterizes cancerous ulceration. He had had from the commencement of his ailment, a burning and stinging pain in the sore, extending to the foot; but within the last three weeks this symptom had increased to such a degree as to render him miserable, and deprive him totally of sleep. The disease was of four years' duration, and during that time he had consulted many practitioners, and tried numerous applications, without any success. Several surgeons, one of them of high eminence, had told him the disease was cancer. On the thigh of the same side, within two inches of Poupart's ligament, its long diameter parallel to the course of the vessels, there was a swelling larger than a hen egg, which a minute examination proved to be formed by the junction of three irregular glandular tumours. Its base could be grasped by the hand, but it admited of slight motion in all directions. It was firm to the feel, but this firmness was by no means deserving of the name of " stony hardness." It gave him no pain, and the skin over it was not discoloured. It was of twelve months' standing, and began, he says, as a small, moveable, painless kernel. In the left breast (close to the nipple) there was a firm tumour as large as a marble, and, like that in the groin, unattended by pain or cutaneous discoloration. It made its first appearance three months before.

On the back of the metacarpal bone of the right thumb, there was

an unhealthy sore, about an inch in length, with elevated edges and a border of dark-coloured skin. It was of five weeks' duration; attended with a scanty discharge, and a constant burning pain, worse at night; but never increased by the sharp and sudden stings that characterize the ulcer on the leg. He had no cough, nor any irregularity of respiration; no tumour or uneasiness in the abdomen. Pulse natural.

The man himself was desirous to have the limb taken off, but there was some hesitation on my part before I decided on this step. I was so situated that I could not have the advantage of a surgical consultation; but on examining, again and again, the enlarged glands in the upper third of the thigh, I came to the conclusion, from their mobility and freedom from pain, that they had become enlarged from mere irritation, and had not yet assumed the cancerous action. I saw nothing to forbid an operation on the tumour in the breast, although the ulceration on the thumb was unhealthy, yet it had less the appearance of well marked cancer than of a common sore in a worn down habit. In fine, I thought all his symptoms would be apt to yield to treatment if once the constitution could be, as it were, removed from under the influence of an irritating and extensive disease. Accordingly, on the 2d of September, 1842, I removed the limb below the tuberosity of the tibia and head of the fibula. The superficial vessels bled considerably; the tourniquet could not be effectually applied, owing to the extent of enlarged glands in the upper third of the thigh, and my assistant failed in making adequate pressure on the artery between Poupart's ligament and the glandular mass. I experienced the usual difficulty and delay in securing the tibial vessels, owing to their great retraction; and, from this cause, as well as the others adverted to already, the arterial hemorrhage was unusually great. An alarming syncope was the consequence, to rouse him from which a liberal supply of wine internally, and cold water dashed forcibly in his face, were necessary. When placed in bed he acted like a madman, shouting loudly, and tossing about, with every other evidences of strong nervous excitement. A draught, containing tincture of opium was administered. In half an hour no further bleeding having occurred, the stump was dressed with adhesive plaister and a bandage.

Ordered wine and chicken broth.

On the third day the angles of the wound for about an inch in extent, had united, the centre was open. Up to this, and for the two following days, he laboured under high nervous excitement, with great pallor of the face, weak and rapid pulse, oppressed and hurried respiration, though nothing abnormal could be detected by the stethoscope.

From 6th to 12th September, the stump had made no progress in healing; on the contrary the centre of it looked very unfavourable, and was covered by an ash coloured coating: its starting causes him much annoyance. Continue wine and soup, and let him have pills of camphor and hyosciamus,

VOL. XXV. No. 74.

2 Y