done or she must soon die from exhaustion. By this time she had become so emaciated that she only weighed 128 lbs., her ordinary weight before the growth of the tumor being 135 lbs. About this date she again consulted with my partner in business, Dr. Stanley, and myself, when we again gave her the choice of the operations, and told her candidly of the probable result. This time she chose ovariotomy, and we decided on the 1st of October as the day for the operation.

The proposition originated with Dr. Battey, September she concluded something must again be some six years ago, and as Dr. Goodall observes, somewhat startled the medical profession. The object aimed at is that of lessening or stopping the periodic congestion of the womb, in fact establishing an artificial menopause, thus by cutting off the supply to, and causing decrease or dispersion of the fibroid growth. The doctor puts forth a plausible theory, but more time and experience will be required to test his method in practice. Some supporters of the doctor's views seem to think that it may be considered by many as an objectionable mutilation, causing barrenness, and unsexing the woman, yet they consider it quite justifiable in consequence of its being far more successful and less dangerous than enucleation, or even attempted enucleation, and not so great or so dangerous a mutilation as extirpation of the fibroid uterus. If this operation is ever regarded with favor by the profession, its early performance should be done in suitable cases, before the patient is worn out by exhausting hemorrhages and long suffering.

CASE OF OVARIOTOMY-RECOVERY.

BY L. HARVEY, M.D., WATFORD, ONT. Mrs. G., aged 34, applied to me in the latter part of 1877, concerning an enlargement of the abdomen, which she had noticed since the birth of her last child, then two years old, and which she said had been gradually and steadily increasing.

Having selected as assistants, besides Dr. Stanley my partner, Drs. Harvey and Newell, of Wyoming, all three of whom were formerly my students, knowing their reputation and ability as practical surgeons, which, by the way should always be taken into consideration by the surgeon, before commencing any major operation, as a great deal depends on the efficiency of the assistants at such times, we commenced the operation, using pure chloroform as the anesthetic, Dr. Newell attending to it very carefully. As soon as she was profoundly under its influence I made an incision through the integument, extending it from the umbilicus to within inches of the pubes. I then carefully cut down to the peritoneum, made a small opening in that membrane and after introducing the groved director extended the opening to the same extent as the external cut. The tumor being thus exposed, we tapped it with a large trocar and canula, and after drawing off about 12 quarts of fluid, we tied a cord tightly around a section of the sac just below the trocar, the assistants having kept the sac well drawn up into the wound. This cord not only prevented any of the fluid escaping when the ca

After a careful examination I pronounced her trouble to be an enlarged ovary, and explained to her the probable result. I told her that after a time she could have the palliative operation (tap-nula was withdrawn, but also gave us something by ping), or the curative and more formidable operation of removing the sac. She declared she would die before she would consent to the latter. I saw her occasionally until September 1878, when, owing to the burden of the tumor she willingly consented to be tapped, but persistently refused the major operation. We tapped her with a large sized trocar, and removed 34 lbs. of a dark colored grumous fluid, after which she gained flesh rapidly for a time, but before three months she noticed that she was again increasing in size, and after this increased very fast. As soon as warm weather set in last spring, she found herself considerably burdened and lost flesh rapidly, so that by the middle of

which the tumor could be conveniently raised as might be required. I then proceeded to break up the adhesions which I found to be very extensive all over the right hypochondriac region, and also some firm bands at the upper and on the left side. This having been accomplished we raised the tumor pretty well out of the abdomen and emptied the sac of the remaining portion of the fluid, then after carefully examining the pedicle as to length, size, &c., we concluded to treat it by ligature, and accordingly transfixed it with a needle armed with a double thread of carbolized whip cord; we then tied it on either side and cut off the pedicle, bringing out the long ends of the ligatures near the

weight of body; and in the hope too that our fellow practitioners may not despair in putting forth an effort to save life even under the most unfavorable circumstances.

These phenomena soon became more accentuated; his walking became more distressing, his calves, thighs and limbs were traversed by true fulgurating pains. His gait became more and more difficult during the winter of 1877; his strength diminished sensibly, but the patient had not yet perceived the sensation of "down" under the soles of his feet in walking. Constricting (TRANSLATED FROM THE Gazette des Hopitaux.) pains around the chest, in the region of the ster

LOCOMOTOR ATAXIA.*

BY G. T. MCKEOUGH, M.B., M. R.C.S., ENG., ETC.,
CHATHAM, ONT.

I have had this patient brought into the amphitheatre, in order that we may study together the principal phenomena which he presents; explained in this manner, they will be more deeply impressed on your minds. But I ought first to relate to you the history of the case.

num, appeared now, the helplessness of his limbs Then a remarkable phenomenon manifested itself; augmented, standing upright became difficult. the man was in company with some friends, when they remarked to him that his left eyelid had fallen, covering the eye more than on his right side; some days after he noticed besides, that his left eye squinted, and that he saw double. These phenomena were but transitory, and after a few months, scarcely a trace of them remained.

But while the symptoms affecting the eyes disappeared, those affecting the limbs were accelerated, and especially the lower extremities, where the helplessness, and the incoordination in walking became so pronounced, that the diagnosis of locomotor ataxia was no longer doubtful.

Some special phenomena appear yet to complete the clinical picture of this affection; troubles of micturition, difficulty in urinating, paralysis of the bladder, necessitating the use of the catheter. Sharp pains in the stomach declare themselves, and persist a long time.

He is a man thirty-eight years old, a sculptor, formerly a soldier, and while serving as such, he underwent successive fatigues during the seige of Paris. In 1871 he contracted syphilis, which affection produced its ordinary evolution, viz., after the chancre the secondary eruption, etc. His health afterwards was very satisfactory until the year 1876. At this period, without any known cause, appeared some peculiar phenomena relative to his sight; the man could not see well; he could distinguish the top of objects, but could not see parts situated towards the base; he could not see the earth. At the same time he thought he saw objects dancing about, as if he was drunk. These troubles of vision lasted a fortnight After having given the pathological history of and then disappeared. Some months later, in this man, let us now examine his present state. I November 1876, the patient was seized with per-will interrogate him before you, and you will see sistent pains in the calves of his legs, but these his manner of keeping himself upon his feet; he pains were not "shooting" in character; they says that he staggers, that he feels "as if he was were more the sensation of a violent burning, "as on springs, on something that was pushing him if he had had thrust a red hot fire brand into the upwards." Standing in the erect posture is calves of his legs." These symptoms lasted only difficult. In order to progress forward, you see he a few days, then, once again, all abnormalities is obliged to support himself, that he projects his disappeared. Nothing abnormal with respect to legs to the right and to the left, and that he "heels it," as they say. When he walks, it appears to him that he is walking on thick carpet. Some patients believe even that they walk on sponges. If we make him close his eyes, he can no longer stand upright; he falls immediately he is deprived of the aid of sight. Sensibility is, however, not abolished, but he has himself remarked to us that there is a retardation in his tactile sensibilities, and that when he knocks his foot, it is some time

his head or stomach.

It was in the month of January, 1877, that the patient first perceived that he staggered, and had difficulty in walking straight. His muscular force was not diminished, but, when taking long walks he felt that he was less master of the movements of co-ordination of his legs.

*Under the care of M. Hardy, M.D., Physician to the Hopital de la Charité.

There is, however, no marked disturbance of sensibility; it must not be believed that all ataxics present anæsthesia, and it is wrong to attribute the incoordination of the movements in walking to disturbance of sensibility.

before he perceives it. You can also ascertain, heel, retardation in the perception of sensations. that notwithstanding the apparent feebleness of his muscles, it is absolutely impossible either to flex or extend his leg. He supports likewise, a heavy burden; the weight of a man mounted on his shoulders does not make him flinch. His weakness is then only apparent, there is something The visceral phenomena have been very marked which hinders him from making use of the muscu-in our patient; the stomach, the bladder (cystitis lar force still intact. As to his upper extremities, of the neck and muscular paralysis) have presented there are no marked disorders; he perceives, how special characters, in accord with the fulgurating ever, that he does not draw well, and that his pains in the limbs. But it is the muscular atrophy writing is a little shaky; there exists a slight trem- of the left upper extremity which is the most rebling of the hands. markable feature in this case. It is not true proBut there is another phenomenon rather singular, gressive muscular atrophy; that which we observe which ought for a moment to arrest our attention, is confined to a group of muscles, especially to the that is, a considerable diminution in the size of his ball of the thumb-muscles of the thenar eminence, left forearm, the circumference being about a it does not spread; it is confined simply to a centimetre (about one-third of an inch), less than small sclerosed centre of the posterior cells of the the right forearm. You observe also that the left cord, towards some of the motor cells of the antehand is thinner than the right, that the thumb aprior cornu; although this phenomenon is rare, it is proaches nearer the index finger, and that he can not unknown in locomotor ataxia. not extend it beyond a very feeble acute angle, whilst that of the right hand can make, with the index finger, a right angle. This is owing to the disappearance of the muscles of the ball of the thumb ("thenar" eminence). There is muscular atrophy on that side; it is that which hinders the movements of the thumb, diminishing its amplitude, and interfering with its movements in opposition to the other fingers (monkey's hand). Notice, ing, writing, etc. however, the exaggerated contraction of the pupils is long, and its progress slow. and the remains of divergent strabismus.

Sensibility is preserved in his limbs, and in his hands. The state of his general health is very good; as regards his genital functions, "he believes he could still perform them."

What shall I say of the prognosis? It is sad to admit, but it is very grave, the disease always proIf some of the collagresses from bad to worse. teral phenomena at the beginning have been transitory, see how progressive are the constituent features of the disease. The gait becomes more and more difficult, next the impossibility of draw

But the duration of the disease You have seen in our service an ataxic man, lying in No. 12 bed, St. Charles Ward, during the past eighteen months, who is absolutely unable to move any more, who has become completely powerless, speaking with difficulty, reduced, in a word, to the state of a piece of furniture, inert and blind, although his intelligence is relatively preserved,

and he has still some memory.

All these facts being disclosed, it remains for us to give a name to this collection of divers phenomena. A diagnosis is here required: it is progressive locomotor ataxia, characterized, as you As regards therapeutics, alas! we have no means know, by sclerosis of the posterior columns of the whatever of curing or arresting this affection. We spinal cord. We have all the precursory details, can only alleviate the symptoms. The external and all the most characteristic symptoms. Remark remedies, which are the most efficacious, are the how insidious is the onset, and how it deviates at cutaneous revulsives along the tract of the vertefirst from the signs of an affection of the cord. bral column, such as dry cupping, blistering, the The primitive symptoms, disturbance of vision, of actual cautery, and sulphur baths every other day. hearing, etc., are only transitory, but they barely Internally, benefit is obtained from the use of disappear, when there appear more evident signs, iodide of potassium, which acts by absorbing the defects of the equilibrium, transitory fulgurating connective tissues in a state of proliferation. It is pains, the peculiar projection of the feet, of the the best remedial agent we have; it does not cure

but it relieves, and retards the progress of the dis- has ever put them under the harrows on that acease. Nitrate of silver in doses of 1-5th of a grain, count. per day, has an action somewhat similar to that of You take care to tell us that you are "much iodide of potassium. It is best to employ them alter- pleased with the decision, and you congratulate Dr. nately, each for a fortnight or three weeks. We Mallory." Of course it is good to rejoice with those owe to them a sort of half success. The painful who rejoice, but on the other hand, even in the midst symptoms occupy a large place in the treatment of of our satisfaction at a victory, is it not right to re this affection. We relieve them by hypodermic in-flect upon the galling inequality which may result jections, by chloral and applications of chloroform. from the triumph which we celebrate? We should endeavour, finally, to combat, as much as possible the long and cruel sleeplessness which affects patients suffering from this disease so much, and who as I have told you, having preserved their intelligence, are all the more impressed by their sad situation.

Correspondence.

To the Editor of the CANADA LANCET.

It is difficult to see the justice of forcing Ontario graduates to undergo a painful ordeal, resulting in grief to very many, while men who come, or go, across the sea are enabled to avoid it, and it seems unwise in this way to procure the existence amongst us of two classes of physicians, the one consisting of natives of the country, who are visited with prosecutions and fines if they pursue their profession without having passed the examinations of the College of Physicians and Surgeons, and paid its fees, the other of a preferred class from Great SIR,-On reading, in your last issue, your no- Britain, who have an Imperial immunity from protices of the matter of "Mallory against the Medi-secutions, fines, examinations, and fees, who too cal Council of Ontario," and of the "Trinity Med-have obtained the immunity simply at the cost of ical School annual dinner," I observed that the graduation, or it may be, of that of a very indifferopportunities seemed to be thought favourable for ent diploma. It is likely that now Ontario men writing some hard things about the Council. may come to see that there is really "discrimination," and certainly not in their favour; also that the contrast between the positions of the two classes of medical men will be productive of mutual repulsion, and among the native physicians, of no small lack of contentment with the conditions which allow so great unfairness.

I may say first that I quite agree with you, that any thing bordering on trades-unionism is not to be tolerated in our profession, yet it occurred to me, that our college was receiving more than its fair share of buffets for its supposed leaning towards trades-unionism, both from the bench and Fress; both Judge Hagerty and the Lancet seeming to speak of the institution with undue severity.

In your report of the "important decision," we are told that the learned judge was severe on the medical Council for the extortion of a large fee from British graduates who desire to practice in Ontario, "and warned that body not to attempt it." And yet it might be known that "the body" is not alone in the attempt, but that something of the same nature with the course condemned by his lordship is done at Osgoode Hall, in the instances of lawyers from Great Britain seeking admission into the ranks of their brethren in Ontario; and so far as has been heard, no judge, however learned, has ever reflected upon the authorities of Osgoode Hall, because of their regulations, or has warned them of the impropriety or extortion of their proceedings"; nor do we know that the Law Journal

You seem to lay all the blame of the absence of reciprocity with Great Britain, on the Ontario Medical Council. In this, I am persuaded, you do the Council injustice. There has always been on its part a desire to obtain agreement with that of Great Britain, but there has always been the endeavour to obtain it on equal terms, and surely that cannot be found fault with. The medical profession in Great Britain has never been willing to grant equal terms, partly because there is a disposition to underrate every thing Colonial, especially if it is Canadian, and partly because of the composite nature of our Council. It is, without doubt, to be desired, that we could come to terms with the brethren across the Atlantic; but I cannot agree with Mr. Justice Cameron's recommendation, that we should concede to them whatever they require of us. We should not thus present ourselves, to