504

development of this condition, being of long-standing, ofrachitic origin, and with a tendency to the formation of bonyoutgrowth, as shown by the exostotic masses existing onthe shafts of the tibite. Another point to be observedis the excellent power of locomotion possessed by the

subject, who merely applied for relief from an unsightlydeformity, and not for the restoration of power to uselesslimbs. The method of treatment pursued has been

briefly given in the above notes ; it was conducted on the

principles almost universally employed at the hospital formany years, for a more detailed description of which I mayrefer to a paper on the Treatment of Genu Vaiguiii writtenby myself and published in THE LANCET of Jan. 20th, 1877.Speaking generally on the nature and treatment of this

deformity, I may remark that in my experience abnormaldevelopment of the internal condyle rarely exists, and thatosteotomy is therefore seldom required for the relief ofknock-knee. Of the value of manipulative exercises I havethe highest opinion ; these constitute the active part of thetreatment which I advocate, the splint being only used tomaintain the improved condition obtained by the exercises ;they are so simple that auy person of ordinary intelligencecan be readily taught how to practise them, the services of askilled attendant of the "professional rubber" type beingwholly unnecessary to the patient.

KASHMIR HOSPITAL.PENETRATING WOUND OF ABDOMEN, WITH PROTRUSION

OF INTESTINES AND OMENTUM.

(Under the care of Mr. DOWNES.)A YOUNG Brahmin girl was admitted in July, 1878, with

a penetrating wound of the abdomen. She reached the

hospital at about 10 A.III., the accident having happenedearly in the morning of the same day in a village about fivemiles distant.The girl was about eight years old ; she was carried on a

charpoy (a light bed used all over India). Her father statedthat she had fallen out of a window, probably about twelvefeet from the ground, and in falling a sharp piece of wood,part of a railing, had pierced the belly. On uncovering thewound it was found to be an inch or an inch and a half long,with torn, jagged, irregular margins situated between theumbilical and left lumbar regions ; out of this protruded alarge piece of bowel and omentum. About one-half of thetransverse and descending colon bad protruded. The bowelhad been wrapped up in a black very dirty piece of cottonoloth. As the girl could not bear to have the bowel handledshe was placed at once under chloroform, and the wound andprotruding bowel were washed well with tepid water con-taining one per cent. of carbolic acid. A triangular flap ofskin and fascia bad been torn upwards and inwards fromthe wound to a distance of two or three inches, where itretained a broad attachment. The bowel having been pro-truded in nearly an empty state had become distended withfluid, and was in a state of strangulation; it was not otherwiseinjured, An attempt was made to return it, but without suc-cess. The wound was therefore enlarged by half an inch with ablunt-pointed bistoury, the finger being ued as a director.The bowel and omentum were then easily restored. The guthaving been reduced, two or three silk sutures were putthrough the wound in the peritoneum, and the muscles andthe edges were brought together. No attempt was made tobring the skin together with sutures, because the edges wereso far retracted that they could not be brought into exactposition without considerable tension. The skin was, how-ever, kept in fairly good position with strips of plaster. A

piece of lint, covered with carbolic oil, was placed over thewound, and over all a laver of cotton-wool, two or threeinches deep, was fixed with a broad bandage.The patient was immediately put to bed, and small doses

of opium were given three times a day, and nothing butmilk was allowed for her diet; the relations were enjoinedto be very careful that she was kept lying on her back andperfectly quiet. Next morning she was rather feverish,and complained of a little pain ; but on the day followingshe had no fever, no pain, and only complained that thediet was not enough to satisfy her appetite. On the fourthday she was allowed a little rice with the milk. On thefifth day the dressings nnd the sutures were removed ; thedeep wound had healed by first intention without a drop of

pus. The two edges of the skin gaped about a couple ofinches ; but, in course of time, this healed by granulation.On about the sixth day a dose of castor oil was given, asthe bowels had been unmoved since the accident; the oilacted freely, and the opium was discontinued. A day ortwo afterwards the oil was repeated, and the patient couldnot be kept in bed any longer-in fact, she was quite cured.After having been in hospital about ten days she returnedhome with the external wound nearly healed.

Cotton-wool has been used as a kind of antiseptic dressing,and this case may be recorded as an illustration of the successof this mode of dressing. Its simplicity gives it an advantageover the more complicated antiseptic dressings, the difficultyand expense of which are a drawback.

Reviews and Notices of Books.Wood’s Hozcselzolcl Practice of Medicine, Hygiene, and

Surgery. A Practical Treatise for the Use of Families,Travellers, Seamen, Miners, and others. Edited byFREDERICK A. CASTLE, M.D. In 2 vob. Illustratedby over 700 Wood Engravings. London : Sampson Low,Marston, Searle, and Rivington. 1881.

THIS work represents a great undertaking. There are

many systems of domestic medicine, but we have seen noneso pretentious and so complete as this. The work consistsof two large volumes, each having eight or nine hundredpages, the type and paper being excellent. We shall best

give our readers an idea of the scale and character of thebook by enumerating the titles of the chapters and the namesof the authors respectively. It will be seen that the listincludes some of the most respected names in Americanmedical literature.The contents of Volume 1. are as follows :-Anatomy and

Physiology, by Leroy Milton Yale, A.M., M.D.; Hygiene-Food and Air, by E. H. James, M.D.; Drainage, Sewerage,and Water-supply, by J. W. Pinkham, M.D.; Clothing, byJ. V. Shoemaker, A.M., M.D.; Climate, by Arthur Nichols,M.D.; Exercise, by Dr. Shoemaker; House-building, byCarl Pfeifl’er, Architect; -Disease, its Nature, Causes, andManifestation,-, by Henry Hartshorne, M.D.; Therapeutics,or the Modes of Employing Remedies, by Richard

Dunglison, A.M., M.D.; Mineral Springs, by George E.Walton, A.M., M.D.; Obstetrics, or the Art of Midwifery,by Theophilus Parvin, M.D., LL.D.; the Care of Infantsin Health, by Beverly Robinson, A.M., M.D.; Diseasesof the Digestive Organs in Infancy, by J. Lewis Smith,M.D. ; the Nervous System of Infancy and Childhood, byMark Putnam Jacobi, Ph.G., M.D. ; Accidents and

Emergencies, by Alpheus B. Crosbie, M D., Albert H.

Crosby, M.D., and John T. Hodgkin, M.D.; Poisons, theirEffects and Antidote", by Albert F. Prescott, M.D.The contents of Volume II. are :-Acute Infectious Dis-

eases, by James Whittaker, M. D , and three other physicians;Vaccination, by Frank P. Foster, M.D. ; Chancroid and

Syphilis, by Henry Piffard, A.M., M.D.; the Skin andHair, by James C. White, M.D. ; the Hands alid Feet, byLeroy Milton Yale, M.D. ; the Eye and its Diseases, byD. B. St. John Roosa, M.D., and Edward T. Ely, M.D.;the Ear and its Diseases, by Albert H. Buck, M.D.; Deaf-Mutism, by J. W. Chickering, Jun., A.M. ; the Nose andits Diseases, by Frank H. Bisworth, A.M., M.D.; theThroat and its Diseases, by J. Solis Cohen, M,D, ; Diseasesof the Respiratory Organs, by Alfred L. Loomis, M.D.; theKidneys in Health and Disease, by A. Braxton Hill, M.D. ;the Male Genito-Urinary Organs, by Edward L. Keyes,A.M., M.D. ; Diseases Peculiar to Women, by A. ReevesJackson, A.M., M.D. ; Idiocy, &c., by Allan McLane

Hamilton, M.D. ; Insanity, by Judson B. Andrews, A.M.,M.D.; the Mouth and Teeth, by Frank Abbott, M.D.;Diseases of the Digestive Organs, by Fredk. A. Castle, M.D,;