ished. Sensibility to touch, pain, temperature, we may, therefore, say is present, but is impaired.

This examination changes to some extent my opinion of the locality of the lesion in the spinal cord. I was disposed at first to locate the disease in the antero-lateral region, but as the disorder is mainly that of co-ordination the lesion must be located farther back, and mainly in the posterior columns.

His difficulty in walking is not so much due to the want of sensibility in the plantar surface, which at first suggested itself as the explanation, as to the marked want of co-ordination in the muscles concerned.

The electrical examination is necessary to complete our study of the case. You see the muscles respond perfectly to the faradic current, and contract energetically to a moderate current.

constant current daily, in conjunction with the internal administration of phosphorus dissolved in cod-liver oil, of which he should take a teaspoonful, containing one hundredth of a grain of phosphorus, three times daily, after meals.-Clinic by Prof. Bartholow. Cin. Med. News:

THE THERAPEUTICS OF ACUTE RHEU

MATISM.

1. In the feeble, anæmic, nervous subject, he gives tinct. ferri chlor. M. xxx., every four hours; orders the joints to be kept at rest, wrapped in cotton if the patients desire it; and if they are very painful, small blisters (the size of a silver dollar) to be applied around them. An occasional laxative of Rochelle salt is added. The iron cuts short the In the early stage of posterior spinal sclerosis, disease, lessens the danger of cardiac complication, you remember that the disorder, as a rule, mani- and also has the power, as Anstie pointed out, of fests itself first in the lower extremities, and after-preventing impending attacks. The blisters relieve wards extends to the arms in the second stage, or, in the opinion of some writers, in the third stage. Our patient has no trouble in his upper extremities; he can use his knife or fork in eating, and button his own clothes without difficulty. We infer that the disease is in its first stage, and has not involved the upper part of the spinal cord. What confirms our opinion as to the diagnosis and the localization of the affection in the lower part of the cord is the fact that the sexual functions are recently impaired ; he has not had an erection for some time, and lately has had some nocturnal seminal losses. This sexual impairment generally belongs to the early symptoms, and usually precedes, rather than follows, disturbances of motility.

The disease is therefore still limited to the lower part of the spinal cord, and as the power of coordination resides in the posterior part of the structure we conclude that it involves mainly the posterior columns, making it a case of posterior spinal sclerosis, which now explains fully the attacks of fulminant pains that have so long annoyed him.

pain, and bring about a more alkaline condition of the blood and urine. Thus treated, cases of this type rarely last more than two weeks, heart complication is infrequent, convalescence is rapid and relapses uncommon.

2. Fat and flabby subjects require the alkaline plan:-Two drachms of potassium carbonate, 2 drachm of citric acid and four ounces of water every four hours, until the urine ceases to be acid, when the amount is to be reduced one half, the reduction being then continued daily until the fourth or fifth day, when, if the urine continue alkaline, quinia (six grs. every four hours), or preferably tinct. ferri should be added. If the attack is severe, blisters are applicable. With this treatment, this class get well within two weeks.

3. Vigorous subjects, often with hereditary tendency. These cases are often promptly relieved by salicylic acid, in scruple doses. Not less than 3ij. should be administered in twenty-four hours, and considerably more may be required. It is more effective given in solution with an excess of alkali. In considering the question of treatment, we find A cure is thus not infrequently effected in three or a general agreement of opinion among authorities four days, but some stomachs can not bear it, and that, as regards therapeutics, the condition is if it depress the heart it must be stopped. If after not encouraging. No one will dispute this who three or four days it produce no improvement, it has had anything to do with the disease. The best is useless to persist in it. In all forms the diet results obtainable-palliation of symptoms and the should be liquid. Opium is objectionable by arrest of the disease--are perhaps secured more checking elimination; atropia promotes eliminasatisfactorily with phosphorus than anything else. tion, and is therefore preferred as an anodyne, It should be given for a long time and in small being given hypodermically in the neighborhood doses (about one hundredth of a grain), for which of the affected joints, and it is rarely to exceed gr. cod liver oil is a good vehicle. Some curative re-a-day.

sults have been obtained by this treatment. In Should cardiac complication arise, the carbonate order to maintain the nutrition of the parts affected, of ammonia (g. v. doses frequently), and infusion a weak continued current should be applied from of digitalis, with hypodermic injection of morphia, the spine to the lower extremities; although this should be given at once, to dissolve fibrin, check will have no effect upon the diseare, it will materi-inflammation and lessen the work of the heart. ally relieve the pain. He shall therefore have the When the acute symptoms have subsided, substi

tute iron and quinine for the ammonia and morphia. Experience also shows a blister on or near the præcordia to be useful.

In the sudden hyperpyrexia (fortunately very rare), where the temperature leaps without cause to 106-109 F., the cold bath is necessary to ward off certain death-Prof. Bartholow in Med. News and Abstract.

TREATMENT OF HÆMORRHAGE.

Dr. A. L. Ranney, in the New York Medical Record, gives the following concise rules for meeting all possible indications in the treatment of hæmorrhage :

other serious injuries to the child. He gave records showing for version a saving of 31 living infants out of 43, and all the mothers; for forceps, high operation, head above brim, 40 per cent. of children and 60 per cent. of mothers; for expec

THE FORCEPS, VERSION, AND THE EXPECTANT PLAN IN CONTRACTED PELVIS.-Dr. Wm. T. Lusk read a paper on the above subject before the New York Academy of Medicine, Dec. 18, in which he considered the management of labor in three varieties of contracted pelvis: 1. The flattened, nonrachitic pelvis; 3. The pelvis equally contracted in its principal diameters. The intent of operative interference was to save the child's life; in dead children, craniotomy held equal advantage. No case was known of a living child being delivered at full term where the conjugate diameter was less than 234 inches. If this diameter was 31⁄2 inches or more, no interference was demanded. Discussion should be limited to pelvis between these diameters. With such a pelvis, a cervix fully dilated, a favorable presentation and no complica (.) Always ligate the bleeding vessel in moder- tions, the expectant plan was the best. Version ate hæmorrhage when convenient to do so. (2.) was indicated only when the child was nearly in Use compression over the wound on the main the normal condition, the contraction limited to trunk in moderate hæmorrhage when ligature of the brim and sufficient space in the transverse diathe wounded artery is inconvenient. (3.) In vio-meter. Extreme traction force in version might lent hæmorrhage enlarge the wound and tie the fracture the clavicle, humerus or skull, and produce artery. (4.) As a rule never attempt ligation except when bleeding actually exists. The exceptions to this rule are, (a) in exposed vessels of large calibre demanding ligature as a safety measure; (b) in delirium tremens following an injury; (c) when necessity for transportation exists. (5) tant plan 354 out of 407 children and all the mothHe described the Tarnier forceps, Ligation should, as a rule, be applied at the bleed-ers but 12. ing point, and not remote from it. (6.) Use the which he had modified somewhat, and claimed external wound as a guide to your incision to reach with them to be able to bring the head of the child the vessel, except when the wound exists on the from the brim to the floor of the pelvis in much side opposite to the vessel injured, when a probe less time and with less force than by any other may be cut down upon. (7.) Always use the greatest precaution to avoid needless loss of blood in reaching the vessel until the fingers can compress it. (8.) The artery when found should be tied above and below the wounded portion, and at a bifurcation three ligatures shou'd be used. In case the lower end cannot be discovered, use compression in the wound as a substitute for ligature. (9.) A ligature should not be placed close below a large branch. (10.) In recurring hæmorrhages the treatment should depend on the color of the blood and on the severity of hæmorrhages. If the hæmorrhage springs from the proximal end of the artery, (a) tie if possible; (b) amputate if necessary; (c) use styptics and compression if both are impossible. (11.) Amputation is preferable to ligature, (a) when great swelling of the limb renders ligation difficult; (b) when exhaustion of the patient forbids further search for the vessel; (c) when competent assist ance is needed and not attainable. (12.) In case a large vessel is injured without actual hæmorrhage, hot flannels to the limb are indicated as a preventive measure. (13.) In case an aneurism is the seat of the hæmorrhage, provided the aneurism is traumatic in its origin,-it should be treated on the same principles as if it were a wounded

artery.

method.

[The Tarnier forceps have extra traction handles. curved posteriorly in order to admit of traction more in the axis of the superior strait.-ED. L.]

Dr. Isaac L. Taylor believed that, in the superior strait, the Tarnier forceps were not so good as the straight forceps. Within the limits mentioned by Dr. Lusk-234 to 31⁄2 in. conjugate diameter— there was a vast difference of opinion among prominent obstetricians as to the best method of procedure in such cases. Dr. Lusk, in his demonstration, has applied the forceps over the occiput and face of the child. There was a difference of opinion also as to whether the application of the forceps in this manner was the best, some favoring it, and others, as Hodge, Wilson and others, applying the blades directly to the sides of the head. Dr. Goodell recommended to apply the instrument with one blade against the pubis and the other against the sacrum, but Dr. T. did not believe this had ever been done. Dr. Taylor rejected in toto the application of the forceps over the occiput and face and there was no advantage in doing so in a simple flat pelvis. More space could be obtained by bringing the coronal suture in contact with the promontory of the sacrum and applying the forceps

He thought that Tarnier's forceps was a great improvement on older instruments, but did not believe they would come into general use.

Dr. Fordyce Barker considered the vital condition of the woman as an element to assist in deciding between forceps and version; version producing more shock. There were certain rules relating to these cases which he regarded as estab

in the oblique diameter of the pelvis. The head could be fixed in that position by the straight forceps. Moderate compression was made, it was true, but it was not made antero-posteriorly-to which he was opposed in all cases-but upon the parieto-frontal portion. The important point was to know how to handle the base of the skull. If this came in contact with the sacrum and the straight forceps were applied, the operator being|lished. on the floor making traction, the instrument acted 1. In that form of contraction of the superior in the same manner as the Tarnier, downwards and strait called the oblique oval of Naegele's the forbackwards, and with to-and-fro movement at the ceps should not be used, but always version. will of the operator. If the head did not yield, version could be employed, to be decided on by the size of the child, of the fontanelles, etc. The chief point, as he regarded it, was simply whether with a head presentation and dilated os in a contracted pelvis, it was proper to attempt to deliver | examination. with forceps. He did not object to the attempt, but after making two or three reasonable efforts, and failing, version should be resorted to, aided by external pressure, which was here of the greatest importance.

2. In that class of cases in which the contraction is at the inferior strait, with a straight sacrum, narrowness of the sub-pubic arch, etc., we should never resort to forceps, but always select version, if we can make the election by a sufficiently early

3. In face presentations we should never use forceps when the head is above the superior strait and not engaged.

He would not say that the forceps should never be applied when the head was not engaged at the superior strait, for he had safely delivered several women, where it was necessary to save the mother's life, when the head was lying loose, not engaged at all. But if the face presented, he would not use forceps. He had, in three cases when the face had become engaged in the strait, delivered by the forceps by first flexing the head and converting it into a vertex presentation and partially rotating it; then taking off the blades, he had reapplied them as if it was a vertex.-New York Med. Record.

Dr. T. Gaillard Thomas felt compelled to say that statistics had but little weight with him. He often thought of Sydney Smith's remark, "That there is only one thing more unreliable than figures, and that is, facts." In a case of labor in contracted pelvis, not below 234 inches antero-posteriorly, expectancy, at the beginning should invariably be practiced; even though convinced that the forceps must end it. The forces of nature should be allowed to mould the head and change its shape, and then the case might be terminated favorably; NERVE-STRETCHING OF THE SUPRA-ORBITAL IN whereas, too early use of forceps might produce terrible results. So long as the foetal heart beat NEURALGIA.-Dr. Masing relates (Petersb. Med. regularly, the maternal soft parts were cool and Woch., December 20) the case of a woman, sixty moist and the pulse between pains not accelerated, years of age, who suffered for some years from we could safely trust to expectancy. When the fearful facial neuralgia, almost every branch of pulse became rapid, the temperature increased and the fifth pair being unplicated. No remedy had the dangers of continuous pressure imminent, exafforded other than temporary alleviation, and when pectancy became a crime. In a case in good conshe came under the reporter's care he determined dition the question arose, "Shall the woman be to try the effect of stretching the supra-orbital nerve delivered by the forceps or by version ?" There as being the only one of those implicated that was was no other operation at our disposal. His con-accessible. This was done January 30, 1879, the victions were: If the uterus did not clasp the child's body so firmly as to render turning exceed ingly difficult, or the waters had not been so long evacuated that the result of turning would probably be dangerous from forcing the hand up to the fundus, with the head above the superior strait or entered into it to some degree, version, as a rule, admitting of exceptions, was the suitable operation.

nerve hanging in a loop outside the orbit, and from that time all the most terrible symptoms ceased, and the patient progressively improved, so that by October 6 she was pronounced completely well, having undergone a relapse, brought on by cold, in April, which a few eight-grain doses of quinine

mastered.

Dr. Goodell thinks laceration of the cervix uteri If the child had fairly entered the cavity of the is frequently caused by premature rupture of the pelvis so as to be fixed-rendering version unusu- bag of waters. It is likewise produced by the forally difficult-then the forceps should be selected. ceps and, again, by attempts to push the upper lip But having elected either operation, the choice was of the os over the child's head. One-sixth of not final. Having failed with the forceps after Goodell's women patients have laceration of the using a justifiable degree of force, version might cervix. He thinks this is due to too much interstill be employed; or, version failing, the forceps ference. might be used.

LITHOLAPAXY.

Litholapaxy is the name of a new operation for the crushing and removing of stone from the bladder at one sitting, an operation perfected by Dr. Henry J. Bigelow, and described with cuts, in the Boston Medical and Surgical Journal, January 8, 1880. The following is an abstract of Dr. Bigelow's paper, copied from the Chicago Medical Ga

is drawn and replaced by water from the bulb. The lithotrite is then introduced and the stone crushed. A large catheter is now passed into the bladder to evacuate the fragments, which fall at once to the bottom of the bulb, and remain there undisturbed by the current of air. If the side of the bladder, hanging loose, clogs the catheter, the bladder should be distended by the injection of a little water from the bulb, which will be retained in the bladder by closing the cock of the catheter. This operation is safer than the old one of sev- In pumping, a couple of ounces of water are genteral short sittings, although it requires greater skill, ly moved backward and forward between the bladand should be attempted only by experienced litho-der and the bulb, once in a second or two. The tritists. The experience of Dr. Bigelow demon- short elastic tube between the bulb and the cathestrates that the bladder will tolerate long opera-ter prevents the jar of pumping from reaching the tions, provided that the fragments, which are the bladder. The tube should be held just off the real cause of subsequent inflammation, be removed. | floor of the bladder to avoid being clogged by the

zette.

FIG. 1.-A, glass trap to receive the fragments forming, with the screw-catch B, which supports it on the stand, a ball-and-socket joint. C, Elastic bulb or bottle for pumping fluid in and out of the bladder.

D, Elastic tube, five inches long. One end is attached to E, the evacuating catheter, and the other is continued into the bulb to form a chamber above its orifice for isolation of air.

F, Coupling between the cocks of the evacuating catheter and the elastic tube.

G, H, Small hose for expulsion of air and introduction and expulsion of water to and from the bulb, with a movable attachment at G. FIG. 2.-Diagram of a bulb used for experiment.