dividual muscular fibres, more especially in the legs. These symptoms, with the frequent sharp neuralgic pains in the dorsal part of the spine, and sometimes in the legs and feet, were sufficient to cause a great amount of discomfort and loss of sleep, but were not accompanied by any general derangement of digestion, nutrition, and secretion, until within a few weeks before his death. But the steadiness and co-ordination of muscular action in the lower extremities began to fail visibly in the early part of the present year; and such failure steadily increased until, six months since, his gait became so unsteady that it greatly limited his attention to business. The sharp, twinging pains through the back, shoulders, and region of the pectoral muscles, also increased much in frequency and severity.

During the slow progress of his suffering, he received, from time to time, the counsel and advice of several of his medical friends, and submitted to a variety of treatment. He used early and efficient counter-irritation over the affected portion of the spine, and, subsequently, anodyne plasters and liniments. He used, internally, both iodine and mercurial alteratives, the bromides, chloral, ergot, and various tonics, but with very little apparent control over the progress of the disease. About four or five weeks before the fatal result he rather suddenly lost all power of motion in his lower extremities, and, at the same time, suffered a great increase in the pains and muscular twitchings between the scapular and around the chest. To relieve the intensity of his suffering, he called for, and received, from one of his medical

friends, daily, a subcutaneous injection of morphia, which afforded much temporary relief. But the paralysis rapidly extended upward until it included the rectum, bladder, and whole lower half of the body. His appetite and digestion failed; hiccough became troublesome; the extremities cool; the pulse feeble; the mucous membrane of the mouth and fauces tender; the mind incoherent; and at last he sank into a pulseless and lethargic condition, which ended in death on the morning of the third day.

Although no post-mortem examination was made, there can be no reasonable doubt but that his disease was a slow organic or structural change in the upper half of the dorsal portion of the spinal cord.

Concerning the exact nature of the morbid change in the cord, all might not agree. It differed from cases of ordinary spinal atrophy or progressive locomotor ataxy in these particulars: The pains and local tenderness were both much more severe and persistent; the impairment of muscular motion and co-ordination did not become manifest until a much later period in the progress of the disease than usual; and, in the end, paraplegia came on much more sudden and complete.

My professional familiarity with the case was limited to the last six months of the patient's life, and I regarded it as one of true sclerosis; in other words, an inflammatory thickening or hypertrophy of the connective tissue, so interfering with the sensibility and nutrition of the true nerve-matter as to cause both irritation and atrophy, thus accounting for both the unusual. pains and progressive failure of sensibility and motion.

F., 4 powders. Sig., one every three hours, followed with castor oil on taking the last.

April 6th, 10 A. M. Was called, and learned that nine large round worms had been voided since Thursday. Found the child much depressed; pulse soft, feeble, and about 120; face purplish; and inclined to sleep. Was told that her mother had, during the morning, given her a dessert spoonful of "vermifuge," which I found to be composed, principally, of wormseed oil. Has voided one worm since daylight. Gave milk - punch, and half grain doses of quinia every hour. 12 M. - Has aroused so as to talk; countenance now natural; tongue clearing off; occasional reddish spots upon the face; no cough; and has no pain.

April 7th, 9 A. M.-Eruption of measles upon the face and forehead, but slight upon the body. Bowels moved twice during the night; one worm voided. Is wakeful; slept but little during the past night. To have warm drinks and to be kept from a current of air.

April 11th.-Has been free from fever since last report; some cough, which was allayed by taking a simple expectorant of syr. ipecac and sang. canadensis. Bowels open.

April 12th-Discharged.

In this case the measles were very light; and were she not affected at the same time with worms, no disturbance would have resulted. As it was, the child nearly succumbed to the reflex condition induced by their pres

ence.

CASE II.-W., aged fifteen; pure African; came to my office, and showed a large swelling in the left groin. There is a warty excrescence upon the penis, posteriorly, and near the frænum, which is reddened and appears inflamed. No other lesion of structure. Touched the wart with strong solution of carbolic acid, and directed him to return.

April 7th.-A small, soft chancrous abrasion upon the glans can be seen. This I touched with carbolic acid, and I prescribed tinct. iodine to be applied to the inguinal swelling.

April 26th.-This boy called in occasionally for a few days, and the

sore upon the glans healed readily. The inguinal swelling subsided slowly, without opening.

Of the specific character of the affection above described, I am not

sure.

The boy admitted having connection with a girl, as likewise did two or three others, who had simple gonorrhoea, at the same time. It is not at all uncommon to meet with negro boys, of a more tender age than this fellow, laboring under syphilis and gonorrhoea.

In ante bellum days, we read of a social status among the slaves which shocked our sensibilities. If such a condition obtained then, which was worse than what we know to be true now, if the admission of patients is relied on, the slave condition was truly deplorable. Emancipation certainly has not proved a reformation.

I would not tempt incredulity on the part of the readers of THE EXAMINER in the relation of what is well known to be true; and the same is true, also, of a certain class of whites in our midst.

In illustration of the latter remark, I will relate the following case:

In March, 1871, a woman brought to me her little boy, three years old, who, as she said, another doctor had told her had "a bad disorder." I found phymois, and upon the left side of the glans, bulging out through the preputianal integuments, a hard swelling. This had been touched with some kind of caustic by my predecessor in the case, which caused inflammation, and the phymotic condition as above stated.

I merely advised some soothing application for the present, and soon lost sight of the case. I learned subsequently that some one had him in charge who treated the affection as syphilis. A glance at the social surroundings of the family would suffice to render a diagnosis certain.

I once met with the case of a white girl, not over nine years old, who had to exhibit as profuse a crop of condylomata upon the genitals, and extending well over the whole perinial region, as was ever seen in one of riper years. There appeared to be both gonorrhoea and syphilis in this case. Her mother was a white woman, but cohabiting with a coal-black

negro.

G

ENTLEMEN: This patient, J. R, aged thirty-two, native of Ireland, came into the hospital Dec. 3d; states that two days previous to his admission he was pitched out of a saloon, striking on his hands and right shoul

der; has had some pain in the hand and arm since; says fingers feel numb; cannot move the injured arm freely. Now let us proceed to examine him, and see if our diagnosis corresponds with that on the House-Sur

sion, as used by Nathan R. Smith.

At this point the patient was etherized, and Professor Powell effected the reduction by means of extension and pressure in the axilla, the head of the humerus being wedged below the acromial end of the clavicle. The arm was then dressed in a sling, and

ally.

During the remainder of the clinic hour, the attention of the class was directed to a case of concussion of the brain, from a fall; a case of surgical shock; and an amputation of the thigh, lower third, for a compound dislocation of the knee and ankle.

of acquired syphilis (La France Medicale, Nov. 5, 1873): 1. Period of primary accident, or syphilitic chancre: No mercury should be employed; the regime should be slightly tonic, ferruginous, and hydrotherapeutic. Mercury is to be exhibited only in order to procure resolution of indurations which are indolent in disappearing, and is the more useful and necessary as the ganglionic system is more profoundly affected. In all other, cases observe scrupulous cleanliness, and employ lotions of aromatic wine, or alcohol mixed, with a variable quantity of water; and dress simply with calomel ointment, or dry lint. Cauterization is useless, if not dan

gerous.

2. Period of secondary accidents: When local manifestations, though imminent, are not yet declared, and the patient is in a prodromic stage, we find intense cephalalgia, general lassitude, wandering pains, and moral

depression. These point to a speedy explosion of the disease. Mercury is not yet indicated, but laxatives, if the secretions are disturbed; iron, if there be chloro-anæmia; and, as a rule, rest, by the aid of opium and baths. Mercury is to be exhibited when exanthemata occur, even if these be of the roseolous and papular varieties, for which M. Diday considers such a medication valueless. Discontinue the mineral on subsidence of the eruption, lest anæmia or obesity (sic.) be induced. The author does not recommend the administration of mercury by inunction, or subcutaneous injection, but prefers the use of the bichloride or protochloride internally, especially the former, and discontinues the remedy on the disappearance of all syphilitic manifestations. The intercurrent indications are to be met. Baths, and the iodide of potassium, are useful in case of syphilitic fever, and at the outset of secondary manifestations.