internally, and freely applied externally to the wound. Silicia, one dose, was given at night, and continued during the entire healing of the part.

May 7th.-Continued treatment as before.

May 8th. The wound was entirely healed, appetite good; the patient was able to swallow solid nourishment, and all evidences of trouble had passed away.

The patient continued to improve, the dressings having been freshly applied every day until the 16th of May, when my services in this case were no longer required. About the first of June, the patient left the hospital, perfectly cured.

Figure 2 represents the appearance of the patient after leaving the hospital.

She is now able to take any kind of nourishment, and a few weeks since went to her home perfectly well, with only a slight deformity of the chin, which is shown in figure 2.

This case is particularly interesting, not only as showing the complete success of this operation, but the quickness of the cure by the remedies employed.

An exceedingly interesting case of osteo-sareoma, involving the lower jaw, has been operated upon quite recently by Mr. Heath, in the University College Hospital, London, very similar to the one in point, but, with a fatal termination.*

The success of this operation, I believe to be largely due to the after treatment, and in this connection I cannot but testify my approbation of the brilliant success following the use of staphysagria and calendula lotions, and the internal use of arnica, to overcome the shock attending operations of this magnitude, as well as to facilitate reaction.

• Vide London Lancet, April, 1868, page 242.

ARTICLE X.

Hypertrophy of the Tarso-Phalangeal portion of the Foot. Operation for its Removal. By E. C. FRANKLIN, M. D., of St. Louis. Professor of Surgery in the Homœopathic Medical College of Missouri.

The term hypertrophy is employed to designate the increased size and weight which an organ acquires through an augmented nutrition, without any accompanying alteration in its organization or structure. Among earlier writers the expression was used to designate those preternatural enlargements so frequently found in the thyroid gland and heart; but subsequently was employed to characterize any unusual development in either organ or tissue of the body. It has been divided into two varieties, true and false. True hypertrophy consists of an increase of mass and volume, independent of the accession of any element foreign to the organ involved. False hypertrophy, is considered rather as a heterologous product, depending upon a deposit of plastic organizable matter into its' interstices in the form of infiltration.

Hypertrophy may be general or local; it may occupy an entire organ, or only a portion of its structure. It may exist independent of other lesions, or so blended with them as to involve the whole organ in an interminable mass of disease. The muscles, areolar and adipose tissues, generally partake of the true variety; while the so-called parenchymatous organs, by infiltration of their structure, manifest the false variety.

No organ or structure is probably entirely exempt from it; but among those most frequently affected, are the mammæ, thyroid gland, tonsils, heart, liver, prostate gland, lymphatic ganglions, bones, skin and adipose tissue.

The best example of hypertrophy as affecting the cutaneous structure is elephantiasis, which the increase of size and weight is oftentimes enormous.

Causes of Hypertrophy.-The most marked instance of hypertrophy occur from perverted nutrition, which often assumes a low or inflammatory type. This is exemplified in the indolent enlarg ment of glands; the thickening and induration of areolar tissue; the enlargement of bones under chronic processes of disease. Hypertrophy also occurs from exalted functional activity, as is seen in the large and strong muscles of the blacksmith's arm from

constant use, or in one kidney when the functions of the other have been lost by structural change.

In every part of the body, the muscles are proportionate, in size and structure, to the efforts required of them; and it is a law of nature, that whenever called upon to undergo excess of action or labor, their fibres augment commensurate with the action they are called upon to sustain. Thus, the legs of a danseuse, from the exertion they undergo, are comparatively larger than their upper extremities, that are not so much called into exercise.

The same condition pertains to other organs of the body, especially the lungs, liver, testicle, etc. When either of these organs become affected, by disease, to an extent that impairs its structure, the remaining one is certain to become preternaturally expanded, as a compensation for the loss of its fellow.

Pathology.*-Hypertrophy essentially consists therefore, in an augmentation of the nutritive functions of an organ. When in a state of unusual activity, the quantity of blood which an organ receives is considerably increased, in consequence of which it assumes a deeper color than one which is less exercised, at the same time that it augments, somewhat, in density; its elementary products are increased in number, or, such as already exist are augmented in size.

This is the manner in which alteration in structure is brought about.

In the false variety, or that kind which is the result of chronic irritation, there seems to be superadded to the alteration that occurs in the true variety, a deposit of new substance in the interstices of the connecting cellular tissue, producing a real change of structure.

In the case before us, the hypertrophy seemed to depend upon an infiltration of plastic, organizable matter into the interstices of structure, producing an enlargement of the same.

This was observed after the birth of the child, and increased gradually up to the time the writer was called upon to perform the operation of excision. At the time of operating, the patient, a girl, was thirteen years of age, and was employed as a domestic in the family of one of the homeopathic physicians of this city.

The hypertrophy attained the size observed, with exceeding slowness of development, and was unattended with pain. The

Franklin's Science of Surgery, page 336.