knees bent up, but legs not crossed; his hands open, wrists extended, in fact, as perfectly natural as any child, and which the mother states is the first time this has ever occurred in his life. April the 9th, 1874, I received a letter of the warmest thanks and congratulations, and among other things containing "To you the great satisfaction of relieving the poor little fellow of excruciating pain almost every hour of his life. fast, and, strange to say, the little parts seem to have grown. It would do your very heart good to hear his roar of laughter as he sits frolicking in his father's arms.

His wound is healing

"Most gratefully,

MRS. W. B. E."

This child was directed to have a mechanical support to its head and trunk, and limbs to be kept in a proper position, and to be put upon a more nourishing diet.

A few days afterwards I received the following letter:

"IIis body has assumed natural, flexible positions; his little hands, which have always been tightly clenched, are open and natural; he looks more and more natural every hour; his bowels act naturally, not having to resort once to his daily remedy-the enema-since your operation upon him. It is just one week since the operation. The little fellow does not wake until between six and seven in the morning, ate a whole spring-chicken of respectable size for his dinner yesterday and two snipe and a slice of buttered toast and a whiskey toddy for his dinner to-day. He holds a chicken bone in his hand now, and when it is guided to his mouth he bites it in an ecstasy of delight. His little parts seem to have grown considerably, notwithstanding the soreness of the wound."

I saw this child again on January 7, 1875, and found it immensely improved, although the treatment had not been efficiently carried out, no support having been given to the head. It could not hold its head up with the strength of the normal child, although it could sit down and get up and stand balancing itself without assistance; could speak several words and had acquired the power of eating-could chew its meat without difficulty.

Of course, this case requires long-continued careful treatment by manipulation, friction, and such constitutional remedies as are indicated to restore nervous vitality. In a letter from the mother dated Washington, March 20th, 1875, she says, "Baby begins to

talk, understands accurately, and is growing fat-eats half a pound of mutton at a meal, provided it is Southdown."

CASE II.-F. A. A., sent to me for treatment by Dr. Paul F. Eve, of Nashville, æt. 2 years, came to my office May 15, 1874. He was a well-developed child and quite intelligent. Father died of heart disease; mother in fair health. This is the third child; two children were lost in infancy. Has been reared by the bottle, all meats strictly forbidden to be used; child quite eager for meat, but is not allowed to have it. Said by some to have scrofula. Child walked well until last September, when he had slight fever for a few days resulting in a loss of power in the lower extremities, being more marked in the left leg.

Present condition. He has very little control of the left lower extremity, which can be drawn out about an inch longer than the right, due to the relaxed condition of all the muscles of the thigh and leg.

The right limb is very weak, but the muscles seem more firm, and have more power than the other.

Measurement shows half an inch atrophy of left leg.

Mother notices that the boy is very fretful, restless at night, peevish in the day, and that his penis is often excited. Muscles respond to electricity.

Diagnosis. Congenital phimosis exists, and is, probably, the cause of the partial paralysis now existing in the lower extremities from reflex irritation.

May 16, 1874. I operated upon this case, assisted by Prof. W. II. Pancoast, of Philadelphia. Prepuce clipped off, mucous membrane torn off to the corona, dressed back with oiled rag.

23d. The child throws his left leg about readily and is daily gaining power in the entire extremity. Used electricity. 27th. Boy walks several steps alone. Electricity daily. 30th. Almost perfect control of left lower limb, only too much bending of the knee backwards. Muscles regaining power rapidly. Boy always on the go.

June 4. Brace to support the knee has been used several days. Boy uses both limbs readily. The penis is uncovered (with ease) daily. He returns home to-day. Walks anywhere about the house with perfect use of limbs. Was directed to use electricity for some time.

CASE III.-L. H. W. (female) æt. 3 years and 9 months; was delivered by forceps, first child. Mother's age, 36. Child was resuscitated after two minutes. The mother during pregnancy suf fered from muscular rheumatism. Child's health has never been perfect since birth, has always suffered from the present trouble. When the child began to crawl she would lie on the floor, but unable to roll over. Then, when the age came for the child to sit up, she was unable to keep the body upright. She had power over all the joints (and they could all be placed in normal positions), excepting that there was want of power of keeping the trunk erect. Some kind of infantile paralysis was suspected, but not clearly made out. Treatment has been iron, tonics, phosphoelectricity applied to spine morning and evening, without any apparent improvement except what might fairly be attributed to time. The condition has been from the start what it is now. Lives on milk diet, meat, etc. Present condition (as seen in Fig. 1).

rus, cod-liver oil, and

When she is held up, as it is impossible for her to stand, adduction of both limbs, crossing similar to those of Mary B. (to be

hereafter described). The adductors are tense and the tendones Achillis also, although no spasm is excited by pressure, and the tension may be voluntary.

The clitoris is red, and when it is touched there is excited a spasm of the thighs. Child never sat alone or made any efforts to stand erect. Suggested to watch the child in order to ascertain if the trouble is dependent upon genital irritation, and decided, if this seems to be the probable cause, to relieve it by an operation. 28th. Child chloroformed by Dr. Yale, after which I made pressure on the clitoris, and a marked spasm of the entire body was produced as from the shock of a galvanic battery, although the child was perfectly anesthetized at the time. Removed the clitoris; some bleeding vessels were cauterized with nitrate of silver; wire breeches used to confine the limbs, and ice bags applied to the wounded parts.

30th. The child sat alone to-day for a minute, the first time her mother ever saw her even attempt to sit erect.

31st. Divided the tendones Achillis and replaced the child in the wire cuirass.

June 20. Divided the adductors on either side near the symphysis pubis, and kept the legs abducted by applying two iron rods twelve and fourteen inches in length to the heels and soles of her shoes.

July 4. Girl moves her limbs readily and has more power over her body. Contraction at the knee daily lessening. Electricity to the spine has been employed the past two days.

10th. Wheel-crutch is used with good effect in exercising her limbs; when she left for her home.

CASE IV. August 4, 1874, I was called in haste to the St. Nicholas Hotel to see a case of retention of urine, and found Mr. A., æt. 52; a strong man; never had his glans penis uncovered; prepuce redundant; frænum very much contracted, causing the urethra to be patulous and irritated. Lately has been suffering from paralysis of the bladder. Had not passed urine for fortyeight hours.

I drew off his urine, and the following day again passed the catheter; slit up the prepuce, which I found almost cartilaginous, and which did not bleed until half an inch had been divided; nicked and tore back the frænum and freely exposed the glans. No adhesions around the glans; slight bleeding, arrested by styptic

cotton.

Reflex irritation from the end of the penis had caused spasm of the neck of the bladder, which was the original cause of the retention or loss of power in the bladder to force water.

6th. Passed his water voluntarily, and has continued to do so ever since.

CASE V. Charles E., æt. 3; was sent to me by Dr. Douglass, of Roundout, October 12, 1874, for some lameness of his right leg, "but for which it was impossible to discover any cause." He was well developed, but rather pale. The father states: "He is always very active but very clumsy, constantly tripping and tumbling down. I have noticed particularly," he says, "his tripping in going up the steps in the back yard, and once he fell, cutting his forehead, on which now there is quite a scar."

On stripping him, I could find the slightest difference in the nates, the right being a very little smaller than the left, but the ileo-femoral crease was the same as upon the opposite side.

When I laid him upon his back, the first thing that attracted. my attention was his penis, which was rather large and in a state. of extreme erection. The orifice of the urethra was very large, wide open, and exceedingly red. The prepuce was firmly adherent to the glans all around the orifice of the urethra, thus drawing it open when the organ was erected. The father states that his wife had often spoken to him about the "extraordinary size of the organ and its frequent stiffness." He is very restless in his sleep, constantly shifting and talking.

Very slight pain on complete abduction and eversion of the right thigh. Extension, adduction, and flexion perfect. No pain on concussion, and, consequently, there could be no disease of the hipjoint.

Diagnosis. Partial paralysis from congenital phimosis, and the soreness of which he complains being due to the bruises from frequent falls. Recommended circumcision.

December 10, 1874.-I received a letter from his physician, Dr. Douglass, stating that he had circumcised the boy, assisted by Dr. George C. Smith, October 15, 1874, and that the child was now perfectly well.

CASE VI.-In December, 1873, I received a letter from Dr. Brigham, of California, asking my advice in regard to a case of acquired paralytic club-foot. From the description of the case given me in his letter I was led to suspect irritation of the nervous