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Syme's rules be adhered to, it ensures a stump to which an artificial foot can be affixed at no great expense, and with the safest prospect of easy progression, without suffering and without perceptible lameness. Mr. Teale's method has chiefly become famous for the rectangular shape of the flaps; but I am disposed to look upon the principle of measurement as the feature which is most decidedly an advance on other plans. A loig flap, a perfect square, each side of which is equal to half the circumference of the limb; and a short flap, equal in length to one-fourtlh of the other, is a concise and intelligible rule, on the basis of wlhiclh a cons1iderable section of operative surgery admits of execution with niearly mathematical precision. As a general propositioin, all sur-geons admit that the modern practice of excisioni averts many amputationis; and of excision of the elbow, in particular-, scarcely any onie spealks in other terms than of great praise. But a casc ex.hibite(d at this meetinig illustrates our want of more precise iniformationi on the matter. The specimen shown was onie in which ani arim had been amputated to relieve the patient of an useless limb, mouths after the elbow-joint had been excised; no union, but, on the conitrary, discasecl action, haviing been set up between the ends of the bone. 'Ihe operator was so able a surgeon, that it is quite probable the restult was inevitable. He certainly followed a method which very maniy excellenit surgeons would approve, but with two exceptions; that the joinlt hlad been excised througlh one longitudinal incision, made posteriorly; anid that the hcad of the radius had not been removed, because healtlhy. Excisioni of the elbow is certainly practicable through a single incisioni; but the first element to rapid healing is the performance of a clean ol)eration wvith the least possible laceration and bruising; and, with this view, I thilk the 1 incision decidedly preferable. Tlhe H incision affordls still greater facility for the resection, but ilnvolves unnecessary xpostre of surface, length of cicatrix, and risk of insufficient subseqtilci-t solidity. The retaininig one of the articular surfaces in such an exbcsioni, because apparently healthy, is in theory a conservative procee(liiv'r; in practice, the reverse. As regards the clhoice between partial and(1 comiiplete excision, the latter unquestionably deserves the preferenice; butt, oni this point, more precise information is wanted. As applied to the kncej]oin1t, excision has been for many years, and is still, a subject of animnated controversy, carried on, for the most part, without regard to the coistitutional cause of the local affection, and w%ith insufficient respect for, and adlherence to, the fundamental principles of clinical observationi anid logical reasoning. If surgeons will keep more steadily in view the great aphorism expressed in the title to Abernethy's work on the Conslit:uti'Onl of Local Diseases; if they will be as dliligenit in the tr-eatmiienit of the earlier stages of joint-diseases as they are in the managem-ien-t of wvounds after excision and amputation; if poor young people be not asked to go backwards and forwards to out-patient rooms for tlheir big, tender joints, in the early stages of joint-disease, to be looked at by the surgeon, and paintecd by an assistant; if proper medical treatmiienit be followed, anid nourishmenit provided; above all, if the articulationi be set at perfect rest, by embracing the joint above and below the seat of pain, and if the sufferer be placed in condition to breathe abundaince of pture air, and have a clean and healthy skin-we shall hear v-ery little miiorc of either amputation or excision for diseased knee-joints. Long before Sir Benjamin Brodie insisted on the necessity of embracinig the hil) if you wish to fix and rest the knee, Percival Pott had tauvght that sp'linits are a mischievous absurdity in the endeavour to maintaini rest, uinless they fix the joint above the part to be kept quiet; biit, in tlis imiiportant point of practice, as in that section of his writings whliereini, forestalling Paget, he proves that callus is not essential to the uinioni of a fiacture, Percival Pott wrote in vain, so far as the majority of surgeons are concer-ned. The more faulty part of his tlheory and practice is rememlbered; his philosophical precepts are unheeded. In the preceding remiarks, I have especially had in view those articular affections associatedl with, if not directly dependent upon, the scrofulous or tubercular diatlhesis. No less important class of cases are those in which the constitutional predisposition is gouty or rheumatic. For the diagnosis aind successful treatment of these cases, close inquiry is necessary inlto the constitutional history, and into the functions of digestion and secretioii. The liver and kidney are often at fault; and local treatment stainds little chance, if the poison be not eliminated and the assimilation improved. Chemical depuration, local douching at alternately high and low tcmperatures, friction, and electricity, are an assemblage of resources to which the surgeon must have recourse, if he wish to do justice to his patient, to himself. and to his profession. The necessity of constitutional treatment, and of a thorough knowledge of therapeutics, is illustrated by no subject better than by syphilis. A great deal has beeni said about the doctrine of duality, which certainly possesses scientific and practical interest; but, for precise evidence on the action of mercury and iodide of potassium, we arc nearly as much in need as we were twenty years ago. Iodide of potassium, as commonly given in five-grain doses, is powerless in many cases of tertiary syphilis, which yield to it as to a charm if given in scruple doses three or four times daily. The combination wvith the salts of iron, the alternation with a course of the bichloride and bark, the exhibitioni of the iodides of potassium and iron with cod-liver oil, are resources of the rr ost potent efficacy; but they will only be productive of the good wAhich may be anticipated from them when a number of accurate clinical observations shall have been conducted, after collectioln of the large body of information already on record in the surgical annals of various coulntries. The subject of hernia was one of the earliest to which surgeons devoted themselves. MIany excellent memoirs and treatises have been written upon it; and, since the days of Richter, the question of intraand extra-peritoneal herniotomy has been a favourite theme. It is nowv denied by few that it is an advantage, if practicable, to avoid opening the sac; but the comparatively little danger of extraperitoneal herniotomy has been productive of mischief, by diverting attention from the means to be adopted to reduce a strangulated hernia without recourse to the knife at all. If proper and early attention be given to the means of reduction, interference with the knife will he required onily in cases of great rarity. Above all, attention must be paid to the position of the body, whiclh requires most perfect rest, with the shoulders much below the level of the hips; and the taxis must be scientifically applied, nlot for a few minutes with a movement of the fingers like a cook's in making a pie-crust; but the pressure on the tumour witlh one hanid must be gentle, uniform, and long continued, while the fingers of the other hand are delicately engaged in manipulating and influencing thae direction of the neck. Chloroform anid enemata are, of course, important adjuvants; and I do not doubt that, if people who have a herniia be told the symptoms of strangulation, so. that they may guard against them, if once these appear, and immediately apply for professional aid; and if physicians and surgeons will closely adhere to tlhe rule of practice of physically examining the abdomen, as every other part, wlhen symptoms point to its functional derangemelnt, we shall lhear little of operations for hernia, which will theni cease to be necessary, very rare cases excepted. (To be cozttiienzil.)

Vomiting of Pregnancy Treated by Hypodermic Injection of Morphia