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quency, though he had a feeling of stricture about the chest, especially on the right side, and he had an occasional hacking cough, raising from time to time a little thin mucus. On inquiry we found his appetite was good, his food not distressing him, but his bowels costive, requiring cathartics to cause a movement. His urine he now passes frequently; it is often offensive in odor and loaded with mucus. We also found that his tactile sensibility was not entirely natural, it was quite acutehyperesthetic-the slightest touch was perceptible and often painful or tingling. The temperature of the paralyzed parts was not far from normal, and the thermometer under the tongue stood at 99.5 deg. These were the leading conditions as we observed them on our first examination, December 18, 1875. On the 19th I examined his lungs by percussion and auscultationfound slight dullness on the posterior part, a little more of the right than the left lung, and at the point of most dullness their was feebleness and some rudeness of the respiratory murmur. These signs afforded evidence of some congestion, probably hypostatic, from lying so constantly upon the back.

I now ask your attention to the history of this case, and to an explanation of the phenomena observed.

On the 10th of July last, five months and eight days before our examination, Mr. C. fell backward by the turning of a stick of timber on which he was standing, seven or eight feet above the ground, and struck upon a comparatively smooth but hard surface, the part first coming in contact with the ground being the lower part of the neck or upper part of the shoulders. He remembers distinctly when he was falling, showing that the fall was from the rolling of the timber and not from any stroke or seizure; and doubtless he instinctively bent his head forward to save it from injury, the blow being received on the back of the neck and shoulders. After the fall he remained unconscious for four weeks, when his mind gradually cleared up, his condi tion not materially changing since that time. While unconscious his urine was drawn off with a catheter, and for some time after that it dribbled away constantly, but for the last few weeks it has passed frequently but is controlled. He has but little pain in

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any part, but the right shoulder is sensitive and sometimes moderately painful. When the chills occur they are accompanied with sensations of numbness in different parts of the body. These are the principal phenomena attending this interesting case, and we have brought them out so fully because they all aid in coming to conclusions respecting the pathological conditions present, and may afford indications for treatment. course there can be no doubt but that the injury inflicted by the fall is the cause of the paralysis. What was the seat and nature of that injury? There is no evidence of fracture or displacement of the vertebræ and pressure upon the cord by the bones. The first effect produced was probably severe concussion not only of the cord but of the brain as well. The immediate unconsciousness would indicate that. But whatever injury to the brain was produced has been repaired-at least for the most part, as no brain symptoms are now present. But more serious injury was done to the spinal cord at the point where the blow was inflicted. Whatever it was, it affected the motor more than the sensitive tract, and the right side somewhat more than the left. Whether there was any actual solution of continuity of the matter of the cord, it may be difficult to say; or whether there was any rupture of vessels and hemorrhage causing pressure. But whatever the first lesion, inflammation undoubtedly followed, and that inflammation has not entirely disappeared, and its results, I fear, will not be readily overcome. There may be inflammatory softening, there may be plastic exudates and hardening, there may be effusions, or thickening of the meninges and pressure upon the cord in its narrow canal, or there may be proliferation of connective tissue at the expense of the cells and conducting fibres of the cord, thus interfering with their functions. There is irritation at the point designated—in that part of the cord giving origin to the nerves of the upper extremities, causing the rigidity of the muscles, and there is interruption of the conducting power of that part of the cord causing the functional loss in the muscles below.

With this view of the subject the leading present indication is to overcome the inflammation still going on and remove its ef

fects. The stimulus of electricity applied to the part would, I think, be more likely to increase than diminish the inflammatory process, and it would be of little use as applied to the nerves and muscles in the more remote parts,—would at present, I fear, be worse than useless. The time may come when this agent in this case may be of great service, but I choose to dispense with it at present.

I have advised the following treatment;

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I have directed that he lie upon his side as much as possible, or sit up as he may be able; that his bowels be kept soluble by a laxative pill, and that ice bags be applied to the spine in the region of the injury, kept on two hours at a time at first, and we shall judge of the propriety and time of their repetition and continuance by the effects produced. We shall give attention to the condition of the bladder, washing it out as may be necessary, as you have seen me do to-day. Shall take care that bed sores do not occur, and watch carefully all the conditions, being governed in the future by the indications presented.

These cases thus reviewed, and especially this last one, you can but see have much practical interest; and I propose to make them the starting point of a future lecture, or of lectures upon the pathology, diagnosis and treatment of paralysis. A few cases thoroughly studied, considered in all their bearings and relations, will be more valuable to you, than many cases superficially discussed, and I intend to make the last case particularly, the subject of future remarks.

“BAVARIAN SPLINT," MODIFIED. By R. J. PEARE, M. D., House Surgeon, Michigan University Hospital.

It must be the experience of surgeons who have been in the habit of using the splint known by the above name, that it is very difficult to make properly, owing to the fact that the flowing

plaster gravitates to the most dependent part of the layers of cotton which surround the limb, and between which the plaster is poured. Thus the plaster is not under the control of the surgeon and cannot be manipulated as desired by him. Again, it is heavier than need be and burdensome to the wearer, and lastly, it is not durable. These objections I have sought to obviate by making the splint as follows: First, cut a piece of strong factory cotton long enough to envelop the portion of the limb to be supported, and have three inches to spare; also allow for a margin of one and a half inches, at what will be the upper and lower edge of the splint. Next, cut strips of the same material two inches wide and of such length as to fit between margins mentioned. Now pin on smoothly and tightly the first piece of cotton spoken of, dividing the surplus three inches equally between the two sides. The plaster is now mixed and when in proper condition to set, saturate with it separately and quickly each of the strips that have been cut and (carrying with them all the plaster that will adhere) apply them lengthwise between the top and bottom margins before described, till the desired thickness has been attained. Four layers of this kind will be found strong enough for any ordinary purpose. Opposite to the line of pinning should be left a space of cotton free from these layers, to act as joint to the splint, or better, to cut down through the middle and paste over its adjacent edges. All that now remains to be done is to turn over the margins at top and bottom of splint, and the surplus one-and-half inch left free along the line of pinning upon the plaster, before it dries, for the purpose of protecting and strengthening the edges. The splint must harden and be removed before remaining margin can be covered.

It may be seen from these details that the splint may be in creased in thickness at whatever point strength is most required; that the gravitation of the plaster is wholly overcome by the inlaid strips; that its strength and durability are thereby also increased, while its bulk is diminished; that its edges are protected from crumbling by the overturned margins, and that, when skilfully made, it is compact in form and sightly in appearance.

Such a splint will last many weeks, while but a short time is sufficient to wear one out when made in the usual way.

ANKLE-JOINT-RECOVERY.

A CASE OF "SYME'S OPERATION" FOR DISEASE OF THE Reported to the Washtenaw County Medical Society. By DONALD MACLEAN, M. D., Prof. of Surgery, University of Michigan.

On the 20th Nov. last I was consulted by Mrs. S J. H. (from Sibley, Osceola Co., Iowa), in reference to disease of her right heel and ankle joint, of which she gave the following history:

Patient is 28 years of age, married, had always enjoyed good health until the spring of 1869, at which time she sprained her right foot slightly in the act of kicking. After this trivial accident a slight pain continued in the neighborhood of the heel, but for two months was regarded with indifference. It then became more serious and patient described it as a dull and heavy pain, aggravated at night to such an extent as to prevent sleep. Hot applications were resorted to and afforded some relief.

No external manifestations of disease were detected until two months later, when a swelling began to appear on the outer side of the heel. This swelling gradually increased and the skin became discolored over it. An incision was made into this swelling, and some blood escaped, and after a time, pus.

In August, 1869, patient consulted Dr. Henley, of Tabor, Iowa, who made a free incision down to the os calcis, which she says he found roughened and presenting two depressions, the result of ulceration. The doctor endeavored to afford relief by removing with a gouge, all the diseased portion of the bone.

From this treatment no permanent benefit resulted, so that in a short time, patient says she was in a worse state than she was before.

From this time until December, 1871, the disease made steady progress in spite of the repeated efforts of a variety of "Specific Doctors," "Cancer," "Herb," "Botanic," "Homœopathic," etc., etc. At the date just referred to she applied to Dr. Gott, of Virogna, Wis., and he at once advised amputation of the foot, but at the patient's urgent entreaty, he made an effort to avoid this extreme measure, and removed only the carious portion of bone by the chisel and gouge.

From this operation patient says she derived some temporary

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