TWO MIDWIFERY CASES
519 to be any abnormal laxity of the joints generally. The limb was kept on a splint and evaporating lotions applied, and in a fortnight's time he was able to do light work, the wrist being still somewhat weak. Remarks.-The mechanism of dislocation seems to have been as follows :-When the boy stumbled, his grasp of the moving cask tightened, and in endeavouring to recover himself the whole weight of his body was exerted on his right arm, so putting the ligaments of the wrist joint on the
... joint on the stretch. Almost immediately the movement of the arm backwards was arrested by the elbow sharply striking the other cask behind. The hand being fixed and bent backwards, the radius and ulna were thus easily jerked out of place. It was remarkable how easily the different bony parts involved could be recognised almost as if one were examining the bare skeleton. Moreover, the dislocation was quite uncomplicated, for the wrist was frequently and carefully examined by myself and others, but no thickening of bone or other sign of fracture in any part could at any time bd detected. The peculiar and unusual deformity, the straightness of the hand, the relative position of the styloid processes, which were entire, the arch of the carpal bones, the absence of crepitus, and the ability to supinate fully after complete pronation, were sufficient aids to diagnosis from other injuries at the wrist joint. Leytonstone. THE value of cocaine as a local ansesthetic is now well established, and few who have carefully tested its use, either by the simple application of a solution to the skin or mucous membrane or by hypodermic injection, will be sceptical as to its efficacy. During the past two years I have used it pretty largely in general practice, and the interest attaching to the extent and variety of its applicability, both in medicine and surgery, induces me to add this note. Externally I have found cocaine useful in neuralgia!l, two obstinate cases of sciatica yielding under its application ; in operating on cysts and small tumours, such as ordinary sebaceous and Meibomian cysts; a fibro-cellular tumour, about two inches in diameter, was removed from the gluteal region of an old lady without the slightest pain ; in pruritus ani; in stitching two cases of ruptured perineum, where the laceration was considerable; in opening abscesses in various parts; in coccydynia; in two cases of chronic articular rheumatism, where the excessive nocturnal pain resisted ordinary treatment. As an ointment I am finding its application of great assistance in the treatment of an obstinate case of vaginismus.