the line of demarcation formed, the gangrenous slough commenced to clear off, and granulation began to fill in the open part. The patient's strength was fair, and the same applications were carried out for five weeks and three days. Thus, on the 25th of April all but two inches of bone was covered by granulation. Everything seemed progressing but the one essential point. There had been no attempt at union of the bones; on the contrary, out of each broken end of the tibia, which overlapped, had grown granulated excrescences. Under the circumstances, I determined to try what a little mechanical operating might do. So, under an anaesthetic, a good half-inch of bone was sawn off each exposed end, holes drilled front to back and side to side, two pieces of steel wire passed through the separate holes and twisted, and, in order to make it still stronger, the drill was passed between the wires diagonally from the upper segment into the lower, and left there. The side-splints, heavily padded at either end, were applied. This left the centre of the leg with a space between the splints, so that the granulated surfaces could be readily dressed. The whole put up in the box-splint. On the 6th of May, eleven days after the suturing, the bone was covered and the drill removed. On the 17th the wires had become so loose that, through an incision of the newly-made tissue, they were drawn out, bringing with them a piece of bone one and a half inches long by one inch wide. From this time there was little trouble. The surface went on filling in, skin formed over the denuded part, and on July 7th, or one day short of sixteen weeks, it had all covered. There was a fistulous opening at inner seat of bony union, which discharged slightly. The entire limb was now encased in a plaster-splint, and the patient allowed to go about on crutches. A trap was cut at point of fistula and dressed with dry lint. After some weeks the discharge ceased. In four months the plaster was removed, and he was allowed to use the leg. At present writing, thirteen months after the injury, he can walk five miles at a stretch, without the aid even of a stick. The boot of the injured side has been raised only a quarter of an inch to make it equal with the other.

Query. Extension was never applied - Where does the extra length come from? He suffers no pain now, except in cold, wet weather, and but for his limp no one could tell that he had been injured. Notwithstanding his prolonged vacation he declares he would not exchange his leg for any number of wooden ones. It is some years now since I have used extension in fracture of the leg, and yet, of numerous cases treated, good, bad, and indifferent, in no single instance has there been shortening, except in the case just reported. If splints are not to hand, any piece of board will answer, cut in length from knee to heel,

and three to four inches wide, with a right-angle extension reaching to the height of great toe; one applied to each side of leg. Care must be used in padding not to allow the splint to press on the bone at the knee or ankle, and to have the great toe on a line with the inner margin of patella.

While writing the above another case has come to mind, peculiar in the fact that, happening in the unsettled back country, or "bush," and no doctors to hand, it was expected to get well without treatment; but after three weeks, as it got worse, the man was brought to Melbourne, and, falling into my hands, I found fracture of both bones. No attempt at union, but sidesplints applied, like an ordinary case, and, though rather protracted, it did not hesitate to do itself credit.

A JEWISH CIRCUMCISION.

BY J. HOLBROOK SHAW.

I recently attended a Jewish circumcision, and as the details of the ceremony may be interesting to the readers of the GAZETTE, I will give them. The armamentarim consisted of: First, a glass of water, containing two pieces of cloth; second, a glass of vinegar and water, containing a sponge; third, a wine-glass of carbolic acid (five per cent.); fourth, a bottle of tincture of arnica; fifth, two strips of bandage of cotton flannel, one inch wide and eight or ten inches long; sixth, a knife, resembling a table knife in shape, with ivory or bone handle, very bright, twoedged, and apparently very sharp; seventh, a silver instrument for holding the prepuce perfectly flat.

The ceremony was supposed to take place at 9 A. M. The Rabbi arrived at 9:30, and at 10 an oldish man, whom they called the principal, and a younger man (his son, I thought) came. A huge pillow was placed on the bureau, and the young man, who was rather corpulent, sat down on it, much to my astonishment, as I had supposed that the baby went on that.

I was thus far sitting without my hat on, but was now requested to put it on, which I did, the more willingly as the room was rather cold.

The baby was brought in on a pillow and placed in the arms of the fat young man, head towards him, feet away, thighs flexed, one in each of his hands. Just before this arrangement was completed the Rabbi engaged in a lengthy and quite unintelligible chant, and the oldish man took a position on the infant's right, armed with a cup of sugar and water and a sugar-teat, which teat he applied at the critical moment with an assiduity which did him credit, and contributed much toward making the operation a success.

The Rabbi now wiped the infant's genitals and neighboring parts with a napkin, and the penis itself with the carbolic solution, using considerable care in getting it clean.

The prepuce was pulled well down over the glans, and the instrument for the purpose of holding it placed in position. One quick cut of the sharp knife did the work, and the shortened prepuce was pushed well back upon the penis, the sponge of vinegar and water being at once applied over the whole with the right hand, while the left grasped the penis firmly at the frænum. Application of the tincture of arnica was next made, and the bandages slowly and carefully applied in a circular manner, the glans being left uncovered.

The bandaging being satisfactorily done, the child was placed upon a napkin, folded in a triangle and applied in the usual way. Another napkin was bound around over the first to keep the whole in place. The cloths from the glass of water were then placed over the penis, and the operation itself was over.

There was a gold-embroidered scarf which various ones wore during the ceremony; but up to this time at least they seemed to feel free to converse on any subject, as the youth who held the baby gave his opinion of certain plays which he had

attended.

Another man now put on the scarf and held the baby while a glass of beer was given to the Rabbi, who held it in one hand and a book in the other; and standing before the child he chanted away at a break-neck speed, with more or less assistance from the others, though their efforts were dwarfed by his, decidedly. At length the Rabbi, who had at the beginning of this part of the ceremony wet his right forefinger in his mouth (whether to turn the leaves of his book, or for some occult purpose, I do not know), dipped this finger in the beer and placed it in the child's mouth, after which the man with the sugar-teat did his duty. Amidst the chanting of the assembly the child was conveyed by the principal to the arms of a woman, who retired with it, and the ceremony was over. The principal, the fat youth, and the Rabbi retired, while the rest of the company sat down to a table spread with cake and liquors. Of these good things I was cordially invited to partake; but I satisfied myself with a small piece of cake, and, on the plea that professional business demanded my attention, I begged to be allowed to withdraw. They very kindly excused me from further attendance, though. evidently much distressed on account of the pleasures which I was obliged to forego.

I was much pleased to have had the opportunity to witness so ancient a ceremony, and to observe that it had not escaped the antiseptic tendencies of the age.

STENOSIS OF THE NOSE.

BY D. G. WOODVINE, M.D., BOSTON, MASS.

[Read before the Massachusetts Homœopathic Medical Society.]

Stenosis of the nose we understand to be a narrowing of the nasal passage below the normal size, even to occlusion.

There are a variety of causes which may bring about a narrowing of the post-nasal passages, while another train of causes may produce an occlusion without a narrowing of the passages. One cause of narrowing of the post-nasal passages may be said to be the too early removal of the primary incisor teeth of the upper jaw. This may be done accidentally, or through ignorance. It is true that a child may accidentally fall and knock out two, three, or even four of the upper primary teeth, and, as a consequence, we may have a contraction of the jaw, and on the appearance of the secondary teeth they will overlap each other, or else they will come in sidewise. Again, it may be induced by the too early removal of the teeth, when they decay early, and parents think that they are unhealthy if allowed to remain, and consequently insist on having them removed, frequently in spite of the advice of the dentist to the contrary. When the teeth loosen early, ignorant and meddlesome persons sometimes take upon themselves the important duty of removing them. These unfortunate circumstances are all likely to occur to children during the period of primary dentition. Similar accidents may also occur occasionally during the early period of second dentition, for even in the latter case the patient has not arrived at maturity, and there is likely to be a contraction of the upper jaw and a narrowing of the roof of the mouth, making a deep groove in place of what would otherwise be a broad and flatter surface. It is patent what would be the effect upon the nasal passages where such an accident occurred. The perpendicular capacity of the nares would be reduced as well as the lateral diameters, which would materially interfere with the breathing capacity of the nose.

Direct blows upon the nose may result in deviation of the septum to a variety of extent. The most common form of deviation of the septum is the S-shaped, or bulging out of the septum to one side or the other, closing, practically, the nostril in which the bulging occurs. This is practically a temporary occlusion, which may be temporarily removed by forcing the end of the nose around in the direction of the bulge, when the air will readily pass through the nostril, as long as the end of the nose is held in this position.

Temporary tumors of the septum may occur, so says Choin, On Diseases of the Throat, as a result of blows upon the nose. These

are of an ecchymotic character, which, if properly and early treated, are not likely to last long. The colloid tumor of the septum is of a jelly-like character; but, like other tumors, obstructs the nasal cavity, and thus narrows the breathing capacity of the nose. Cartilaginous tumors, or hypertrophy of the septum, may occur as a result of injury to the nasal septum. Obstructions to the nasal cavity, called foreign bodies, are sometimes of a very serious character. These may be divided into two classes; one consisting of bodies introduced from without, and the other consisting of calcareous concretions in the nasal fossæ.

Edema of the septum, as described by Choin, may become a means of decided narrowing of the nasal passage.

Tumors of the nasal passages, such as polypi, single or multiple, may so obstruct the nasal passage as to greatly interfere with nasal respiration; not by narrowing the passage, but by either partially filling up the passage, or by packing the passage so that it is completely occluded. The polypi, which are found in the nasal cavity, are of the mucous or gelatinous, fibrous or granular character. Another variety are the malignant tumors, which are not as common.

Occlusion of the posterior nares may be congenital, as reported by Choin and Dr. Carl Emmert, who had each a case in his practice. We have seen one case of occlusion of the posterior nares resulting, according to the statement of the patient, from a very severe attack of acute pharyngitis, in which the veil of the palate and the soft palate became adhered to the posterior wall of the pharynx. In this case there was not a particle of air that passed through the nose into the pharynx. In another case there was a very small, opening, the veil of the palate being adhered. A third case was evidently the result of secondary syphilis. In this case there was destruction of the tonsils and the pillars of the fauces, and mostly all the soft tissues of the pharynx. Where the soft palate should have been there was an aperture about the size of a buck-shot, and this was closed up by a false palate, which some ingenious dentist had devised to aid the young man in talking. This last case was one of the most remarkable that we ever witnessed. In all these three cases it was distressing to see them attempt to remove any secretion from the nostrils, especially in the case of complete occlusion of the nares.

Adenoid growths in the posterior nares, or on the posterior wall of the pharynx, may greatly interfere with nasal breathing; also very much hypertrophied tonsils. In these cases there is great distress in breathing at night, when the patient is asleep. The patient lies with the mouth wide open, because he cannot