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the finger with baths and fomentations, and in im- proving the patient's health by food and wine, and tonics by day, and narcotics at night ; and then, the sooner the finger is off the better. I think it is best, in such cases, not to remove the head of the metacarpal bone, and not to expect primary union ; but to put in a few points of suture, and to leave the rest of the healing to be done by granulation tissue. "In other cases, these fingers come to amputation later ; that is to say, by free incision and careful and tedious dressing and splinting, the finger is 'saved,' and the surgeon rightly congratulates him- self on his skill ; but, a few weeks or months later, the patient comes back with the finger more or less flexed, stiff, wasted, cold, and painful ; it is always in the way, it catches in everything, and is a con- stant worry to him. In almost all cases of this kind it is best to remove the finger, and have done with it. Of course, cost accutane 2011 no two cases are alike ; it may be right, in this or in that case, to try to make the finger straight and flexible and useful again by open division or splitting of webs and bands, and by skin-grafting. This was done with success in one case, a few weeks ago, by Air. Pollock, my house surgeon at that time ; but this operation is not alwavs practicable. As for the forcible movement of these withered fingers under an anaesthetic, I be- lieve that it is practically no good at all ; and total cost accutane treatment in nine cases out of ten, the patient and the surgeon will agree that the finger is better off than on. But, of course, the head of the metacarpal bone should be left. Indeed, I cannot see what right we ever have to remove this useful and innocent bit of bone ; the loss of it does not really improve the look of the hand, or conceal the absence of the finger, but it does impair the grip and the dexterity of the much does accutane cost no insurance other fingers. "There is another point to be considered : whether the cut ends of the flexor tendons ought to be stitched in the wound or allowed to slip back into the palm of the hand. It is said that if they slip back thev mav carrv infection with them. I do not 1090 MISCELLANY. [N. Y. Med/ Jour., think there is much meaning in this phrase ; if the cut tendon is so unhealthy as that, it will not be dis- infected by any amount of stitching. Practically, I have never seen any harm come of leaving the cut tendons to look after themselves ; and, if they do much does accutane cost aetna insurance retire up into the palm, they leave online buy accutane florida the more room for the natural drainage of the tendon sheath." The Clinical Study of Idiocy.— Professor G. B. Pellizzi, director of the psychiatric clinic at the Royal University, Sassari, Italy (Journal of Men- tal' buy accutane online canada pharmacy Pathology, vol. iii, Nos. 4 and 5) as a result of studies on the relation of clinical facts to anatomo- pathogenic findings, arrives at the following conclu- sions : ( I ) Given a case of congenital idiocy which becomes apparent during accutane purchase canada early infancy and which does not present any acute manifestations, it is im- possible to make a positive diagnosis regarding the true origin of the' affection on the basis of clinical facts. (2) The idea, introduced by Koenig and Freud, calling for the restriction, on clinical prin- ciples, of the limits of the so-called common idiocy (degenerative, genetic, evolutive, biopathic) is erroneous. (3) Neuropsychopathic heredity is gen- erally found in cases how much accutane cost without insurance of cerebroplegias. (4) The duration depends on the nature and the gravity of the lesions. The educability of these subjects also stands in relation to these conditions. (5) The cjual forms of the idiocies as considered above must be taken broadly : It may be that developmental de- fects have their primary origin in pathological pro- cesses of the various cerebral zones ; best price for generic accutane besides, the former may manifest themselves in a manner quite similar to that characteristic of pathological idiocies, as has been demonstrated in this paper. Martial on Alcohol and Eye Disease. — Dr. Deneffe, in Janus for December, buy generic accutane no prescription calls attention to the retrobulbar cost accutane insurance neuritis often caused by the abuse of alcohol, and points out that even in Martial's time (A. D., 54 to 98) the dangerous effects of alcohol on the eyesight were known. In support of this as- sertion he refers to Martial's Epigrams, vi, 78. As Martial is not quite so generally accessible as generic accutane no prescription some accutane prescription expiration of the other classics, we quote the epigram generic accutane cost without insurance : Pater nobilis, Aule, lumine uno Luscus average cost accutane insurance Phry.x erat, alteroque lippus : Huic Heros medicus : bibas caveto; Vinum si biberis, nihil videbis. Ridens Phry.x, oculo, valebis inquit. Misceri sibi protinus deunces, Sed crebros jubet: exitum requiris? Vinum Phryx, oculos bibit venenum. which may be somewhat freely rendered as follows : Phryx, good friend Aldus, of one eye had lost The use, and in the other was dim-sighted. To him his accutane cost with blue cross insurance doctor said, "Count accutane acne treatment cost well the cost Of drinking; if you drink, your vision's blighted." Phryx, smiling, bade his eye a mock price accutane prescription farewell, .'Knd ordered flagons deep, as quick as how much does accutane cost with blue cross blue shield insurance winking. One after one. Shall I the sequel tell? While Phryx the wine, the wine his sight, was drinking. K. IV. M. The Fissure of Sylvius. — It is common to sup-

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