coming on behind it. The usual time for the growth of a new nail is from four to six months, according to the condition of general health.

In cases of accidents from violent collision of the toe against a stone or other hard substance, extravasation will immediately follow the blow, and be attended with great pain; if the injury is very severe the nail becomes loosened and falls off, and a new and perfect nail will be produced. If the whole nail has not been detached, the loosened part is sometimes cut away, and this may be followed by a deformed growth. It is better, if possible, to avoid cutting the nails in any other direction than that in which they are ordinarily cut when too long. Cutting off at the edges is often followed by abnormal growths, which tend to grow into the side of the toe.

The injury caused by the falling of a heavy weight, or the stepping of a horse on the toes, is one of the most painful to which they are exposed. The soft part of the bruised extravasation extends to the secreting vessels at the root of the nails, inflammation involves the different layers of which the nail is composed; they lose their adhesion to the root, and cease to furnish support to its further growth. The injury when very severe is followed, when the inflammation subsides, by early falling off of the nail; the parts beneath are exquisitely tender till the damaged secreting glands at the root of the nail have time to supply a new nail, which is likely to be a very ill-formed and imperfect one.

In-growing Toe-nails.-This most painful of the diseases of the nails is most common in the great-toe. It is caused by the improper manner of cutting the nails, or by the flap of flesh being forced up against the edge of the nail, from wearing shoes too narrow or badly made, or from the edge of the nail becoming curved, or beginning to grow in a wrong direction after being trimmed on the side.

When pain begins to be felt at the side of the toe, it is commonly thought to result from the nail having grown too long and too wide at the corner. Trimming gives temporary relief; but the pressure of the shoe continues to press the side of the toe against the corner of the nail, the edge of which is rougher than before, the pain and uneasiness is increased, but lower down and nearer the root. The flap thickens, is pushed upward still farther, and partially covers the nail, which, as the pain continues, is again and again cut, until the scissors can no longer reach the part that is supposed to cause the suffering. The consequence is, that a point is left which penetrates the flesh, keeps up and increases the previously existing irritation, produces severe pain and ulceration, and, if neglected, fungus sprouts forth from the parts most affected.

In other cases, the nail forms such a decided curve under the flap that its edge along the whole length of the toe is imbedded in the soft parts, which become so inflamed and so much swollen, that not above one

half of the nail can be seen. Walking will increase the inflammation, and ulceration will take place in the whole length of the furrow. Under improper treatment or neglect this will continue with many persons for months, until the whole is covered with fungus, or what is denominated proud flesh. The pain will then be so severe that the weight of the body cannot be sustained upon the toe, and the patient is compelled to rest the limb.

The treatment generally relied upon in these cases has not been quite satisfactory. We omit all notice of the various mechanical means that have been resorted to, as they have failed to cure permanently, even when they palliated for the time. Nitrate of Silver, rubbed freely and repeatedly between the nail and flap, with the intention of destroying both, has sometimes succeeded when the disease did not arise from a point or sharp edge of the nail protruding into and irritating the flesh, and when the ulceration is not very extensive. This experiment has, however, been carried too far: a piece of caustic has been laid in between the nail and the flap of skin where it excited violent irritation and constitutional derangement without any benefit.

When the nail has penetrated into the flesh and ulceration has commenced, these measures are of little benefit; and the only question generally considered is the best mode of excision of a part of the nail. We have still some promising resources to be tried before we resort to a painful surgical operation.

M. Wahn, principal physician of the Military Hospital of Nice, suffered for a long time from this affection, and was disabled from walking; after trying many remedial measures, he says: "I examined again, for the twentieth time, the seat of the disease, and was struck with the idea that if I could dry up, or even tan the diseased surface so that the ulcer might be converted into a firm surface, capable of resisting the cutting action of the edge of the nail, I might obtain complete cicatrization, and consequently a cure. Running over in my mind the most energetic tanning substances, I decided on employing the Perchlorure de Fer, (Perchloride of Iron). I obtained some in a powdered form, and insinuated it as deeply as possible between the free edge of the nail and the ulcer. I felt almost immediately a moderate sensation of pain, accompanied by a feeling of constriction and a strong burning sensation. After a quarter of an hour I attempted to walk, and to my great satisfaction, I found that I could bear my weight on my foot throughout its entire length, without the least pain a thing I had not done before for many months. The following day I carefully examined the diseased parts, and found them. mummified, and as hard as wood. I applied a fresh quantity of Perchlorure de Fer, which I allowed to remain for a quarter of an hour, but I have reason to believe that this application was useless, as the

mummification was complete by the first process. I continued x walk without the least thought of my ongle encarné, and about three weeks after was able, by means of a foot-bath, to remove the hardened layer of skin, under which I found a tissue of new formation, which erfectly resisted the pressure of the edge of the nail. Shortly after he whole had returned to its normal condition, and more than twe years have since passed without a return of the disorder."

The modes of removing the nail proposed by surgeons are too barbarous to be mentioned.

Ulcer caused by In-growing Toe-nails.-This is generally cause-i by cutting the nails close at the sides and round the corners, which starts that part of the nail to growing faster, and in a short time the corner begins again to project into the flesh. The nail should be cut frequently, but not at the corners. Bathe the feet often, and wear a shoe sufficiently wide at the toe.

3. ONYCHIA.

This disease of the nails of the fingers and toes consists essentially of inflammation of the matrix of the nail. It may not extend beyond the matrix, or it may, and usually does, extend so as to involve the adjacent soft parts.

It may be caused by an external injury, as a bruise by a pressure upon the end of the nail from a shoe or boot, by a foreign body passed under the nail, as a splinter, or by some constitutional derange ment, as syphilis, scrofula, or eczema. It may be confined to one tee, or, if the cause be constitutional, several toes may be affected at the same time. The amount of inflammation may be slight, or so extensive as to produce suppuration, ulcerations, funguous granulations, with ichorous, sanious, or foetid discharges, with loss of part or the whole of the nail, or even of death after loss of one or more bones of the toe. This disease is always troublesome, painful, and difficult to

cure.

TREATMENT.—When caused by external injury, the treatment must be conducted with reference to the degree and nature of the injury. If pus forms beneath the nail, it can be let out by carefully making an opening through the nail. A foreign body beneath the nail must be removed. If caused by pressure of a hard boot or shoe, the pressure must be removed, and the patient kept quiet in the horizontal position, and treated as for in-growing nail.

When onychia depends on general eczema, the treatment proper for that disease must be followed in connection with proper local

treatment.

When the constitution is scrofulous, the onychia usually begins at the nail. This form is more commonly seen on the fingers.

Syphilitic onychia is also most common on the fingers, and is accompanied with syphilitic eruptions on other parts of the body. The matrix of the nail frequently turns red, swells, suppurates, and ulcerates. The skin around the nail becomes puffed and swollen, and the entire extremity of the toe becomes enlarged, while the suppuration, ulceration, and fungous growths at the edge of the nail increase so as to partly overlap the nail, and give the toe an appearance as of the ordinary nail. The nail may at the same time become discolored, brittle, altered in thickness, rough, and even fall off.

As the general disease is cured, the local affection disappears, or becomes easily manageable.

When onychia appears in the malignant form, there is very great pain from the first, and destruction of the periosteum, with disease, and perhaps death of the bone, without any apparent cause, either local or constitutional. When onychia is the result of in-growing of the nail, that condition must be cured.

Local applications may be useful to correct foetid discharges; those already mentioned for other diseases of the feet may be used. Muriated Tincture of Iron will often be beneficial.

In all psoric and dyscrasic constitutions the specific remedies for such specific diseases will be necessarily employed. In eczematous onychia the Benzoated Oxide of Zinc-oinment is recommended by Wilson and others. Scrofulous and syphilitic cases require the specific treatment proper for those diseases. In extreme cases the amputation of the toe has been recommended.

4. BUNIONS.

The word bunion should be restricted to an enlargement over the first joint of the great or little toe, produced by pressure or by some other cause effecting a change in the position of the joint.

The common cause is the wearing of shoes too short and with a narrow sole; this gives too much pressure to the toes, and throws too much of the body's weight upon the articulation of the bones of the feet, impeding the action of the muscles, causing pain and inflammation, malposition of the great toe, and the ultimate formation of a bunion. It often occurs in persons of constitutional derangement, with feeble joints, and subject to pain in the joints of the foot after walking; gouty, rheumatic, and scrofulous constitutions show this form most frequently. In such persons the synovial tissues, the tendons, &c., are liable to this disease. The great toe becomes distorted in position, pointing obliquely across the other toes, leaving the shoe to press upon the joint. In persons advanced in life, the synovial membranes of the

joints become worn and secrete less fluid than is needed in a healthy joint; they become stiff, painful on motion; partially anchylosed.

A bunion consists in an enlargement or thickening of the integuments over the first joint of the great toe, generally only of one foot. The pain is generally trifling at first, but it becomes more painful as inflammation involves the joint; the skin thickens in layers or scales over the surface, and is studded with clusters of small superficial corus; if the iritation of a tight shoe be continued, the bursa between the skin and the bone will become enlarged, the fluid effused causes swelling over the joint; the pain increases and extends to surrounding parts; suppuration may take place within the bursa, which progresses slowly and with pain; the ichorous fluid may extend into the cellular tissue before it bursts externally. It may even cause caries of the bones or exfoliation of the joint.

TREATMENT.-Sensitive and delicate persons may suffer from pail in the joints of the feet when there is little enlargement or evident inflammation. The skin is tender, soft, moist, clammy. In this stage the disease may be easily relieved by a lotion slightly stimulating or an anoydne in which the foot may be bound up by a roller of two or more thicknesses. Tincture of Arnica or Belladonna will answer. Another slight affection is a small tumor on the instep, caused by a boot too tight; it is under the skin hard and immovable. In some cases it may progress to the extent of forming a small but sensitive corn.

The treatment of these distortions of the joints, whether confined to the great toe or to the small one opposite, is often confined to placing between the toes flexible sheets of lead, not too thin, so as to keep the toes nearly in their natural position.

Tumors about the toe-joint have been produced by gout or rheuma tism. These are cured by wearing loose shoes of buckskin or flannel; and then the common treatment for the general disease.

A true bunion in its first stage appears inflamed, but is not attended with much swelling; the pain in the joint is mostly felt when the shoe is worn; in a few days it subsides, but is liable to reappear when the short, small, or badly made shoe is worn. Removing the shoe is usually relieved by changing it for a large soft one, and bathing with an alcoholic lotion.

If the irritation is continued the pain and tenderness will gradually increase in proportion as the foot is used, and is felt more in the joint under the ball and along the toe, over the instep; the skin becomes thickened, forms in scales or layers, and one or more small corns form on the surface.

This case is best treated by rest and cooling, soothing lotions; after carefully extracting the corns, a plaster of Soap-cerate and adhesive plaster may be applied over the joint. If the great toe is unduly in