32 



SURGERY. 



tion, and diminish the spasm. The wound is to be cleansed from all 

 foreign bodies, pus to be discharged by a free incision, if necessary, 

 and warm anodyne poultices and fomentations are to be applied. 

 Excision of the wound, or division of the nerve leading to it, has 

 been practised with great benefit. Bleeding should be employed 

 with great care, and purgatives combined with mercury are always 

 of advantage. Opium is almost indispensable, and may be used 

 externally and internally. Camphor, musk, assafoetida, and tobacco 

 are also of use as antispasmodics. 



Chronic tetanus is seldom fatal, and frequently idiopathic ; it lasts 

 several weeks, and should be treated by the shower-bath, tonics, and 

 electricity. 



DISEASES OF BONES. 

 CARIES. 



Caries is an unhealthy inflammation of the bone, attended with 

 softening, and leading to suppuration and ulceration. The bone has 

 its cells filled with serous, and often with scrofulous fluids, and 

 when dried has a spongy and worm-eaten appearance, and resembles 

 a lump of sugar after being dipped in hot water. The disease most 

 frequently attacks the thick bones, and the extremities of long bones ; 

 and it may result from local injury, or simply from constitutional 

 causes, such as scrofula, or effects of mercury. It is attended with 

 pain and swelling, and after ulceration there is a foetid discharge 

 containing portions of bone. 



Treatment. — The constitutional treatment consists of fresh air, 

 tonics, and alteratives ; and the local treatment in removing those 

 portions incapable of repair, and endeavouring to establish healthy 

 granulations. Sometimes it may be necessary to remove loose por- 

 tions of bone which are disintegrated, and to apply escharotics to 

 the surface. 



CARIES OF THE SPINE. 



This occurs most frequently in children, and in persons of a 

 scrofulous temperament. At first there is a sensation of numbness 

 in the lower extremities, languor, and a stumbling gait. The patient 

 usually sits with his legs drawn up under the chair, has a constric- 

 tion of the chest, and derangement of the digestive organs ; in a 

 short time paralysis ensues, and there may be a pointing of matter 

 at some portion of the spinal column, most frequently about the 

 dorsal vertebrce. The bodies of the vertebrce are softened and com- 

 pressed, and thus a curvature takes place, most generally in a pos- 

 terior direction. Many die from fever and irritation, and recovery 

 is usually attended with deformity. 



Treatment, — Absolute rest upon a mattrass, attention to the 



