therapeutically; and I am sorry to say, not unfrequently with little discrimination-without proper scientific knowledge of its effects and the diseased conditions to which it is applicable-and as it is a powerful agent, when indiscriminately used, is as likely to do harm as good. Its use as a means of diagnosis requires knowledge of pathological facts, and if these I have mentioned be borne in mind, you will be aided in distinguishing between central and peripheral palsy.

We have peripheral paralysis with its degenerative changes in cases of paraplegia, where there are destructive changes in considerable portions of the cord-those nerves terminating in the effete portion of the cord undergoing the fatty degeneration spoken of but paralysis of the parts supplied with nerves coming from the portion of the cord below the diseased part would be central, and such degenerative changes in the nerves would not be likely to occur.

In some forms of infantile paralysis, the nerves concerned terminate in a diseased cord, and hence they are peripheral; but in others a limited portion of the cord only is diseased, interrupting, however, more or less completely, communication from the brain to all parts below the lesion; but most of the nerves terminating in the part of the cord not diseased in itself, the paralysis would be central, and this degeneration of such nerves would not take place.

Traumatic injury of nerve trunks causing paralysis is always peripheral; so is paralysis from what is called "rheumatic thickening" of the neurilemma, or from any disease or pressure in the course of a nerve trunk. Lead paralysis is usually peripheral, and any peripheral paralysis when complete is followed by the degenerative changes in the nerves which have been. described, and by failure to respond to electricity.

Allow me to refer again in the light of these facts to the case of Mr. C., whom you saw here so seriously affected. You will remember that all the parts supplied with nerves directly from the brain and the upper portion of the cord for a very short distance down, were in a state of integrity, the injury causing

the loss of power being below, in the lower part of the cervical and upper part of the dorsal region.

For some distance at this point the cord was in a morbid state, and the nerves belonging to the upper extremities terminated in this diseased portion of the cord. The part of the cord below this injured and diseased portion, we have reason to suppose was not of itself diseased; the paralysis of the lower extremities being produced by the obstruction of communication between them and the volitional portion of the brain, that obstruction being at the injured and diseased portion of the cord.

The

We had then in this case specimens of the two forms of paralysis-peripheral and central—the paralysis of the upper extremities being peripheral, and that of the lower, central. nerves of the upper extremity terminating in a diseased part, those of the lower in a healthy part of the cord. But in neither the upper or lower extremities was the paralysis complete; the cord at no point was entirely effete, and destitute of all activity, but its function was greatly perverted and impaired. The impairment was chiefly to the motor tract, as the sensibility was much less affected, but even the motor function was not absolutely abolished, as there was some slight power of motion when you saw the patient, though it was so slight as to be of no practical use.

I called your attention to the rigidity of the muscles of the upper extremity, and to the absence of rigidity of those of the lower.

In this we have illustrated another pathological fact of great importance, and which I have not before alluded to in this lecture, viz: that nerves belonging to a paralyzed part, terminating in a portion of the spinal cord, or the brain undergoing active disease—where there is hyperæmia or inflammation, and where the part is not absolutely effete and destitute of active processes, are in a state of irritation; and although the muscles which they supply are not under the control of the will, they are excited and irritated by these irritated nerves, and are likely to be thrown into a condition of spasmodic contraction or

rigidity, such as you saw in the upper extremities of Mr. C. The nerves belonging to the lower extremities terminated in the lower part of the cord which was not in an active state of disease, and the muscles of these parts were not thus rigidly contracted.

Now if the conducting function of the diseased part of the cord can be restored, the nerves and muscles of the lower extremities would readily resume their activity, unless too much enfeebled by long disuse; but this weakness arising from desuetude could be overcome by friction, by electricity, by strychnine, and by exercise-passive at first, and active as soon as any voluntary power at all should be present.

At another lecture I intend to call your attention to the therapeutical principles which these pathological facts suggest, and particularly to the general rules which should govern in the use and avoidance of electricity and galvanism in the different forms of paralysis which you will encounter.

NOTES OF CASES OCCURRING AT THE SURGICAL CLINIQUE OF THE UNIVERSITY OF MICHIGAN, under the care of DONALD MACLEAN, M.D., Prof. of Surgery. From the Graduation Thesis of WILL. J. HERDMAN, M.D., now Demonstrator of Anatomy, Michigan University.

STRICTURE OF THE URETHRA OPERATION RECOVERY.J. M., Hillsdale, Mich., aged 38, unmarried; presented himself at the clinique December 15, 1874, and gave the following history:

On the 9th of July, while driving a team attached to a wagon laden with a large log, the wheels of the wagon struck against the roots of a tree, rolling the log off the wagon in such a way as to wedge the patient between the tree and the log, causing fracture of the bones of the pelvis, also of the right femur at the upper third, and rupture of the urethra. Extravasation of urine took place into the tissues of the perinæum and scrotum, abscesses soon formed and were opened by his medical attendant and with the pus, urine escaped, and has continued to do so up

to the time of admission to hospital. The urine was also infiltrated into the tissues of the fractured thigh, in consequence of which there was non-union of the fracture and gangrene of the soft parts, so that amputation became necessary and was performed by Dr. A. F. Whelan, of Hillsdale, in May, 1874.

On examination, the following state of matters was found: The patient's vital powers seemed nearly exhausted, he was much emaciated, and complained of great weakness, hectic fever, night sweats, loss of appetite and depression of spirits. The urine, mixed with pus and blood, dribbled away persistently from three fistulous openings, one in perineo, one at the side of the scrotum, and one just below Poupart's ligament, on the amputated thigh.

Exploration of the urethra revealed a tight, unyielding stricture in the deep portion of the urethra.

The professor observed that in all probability the present deplorable condition of the patient is maintained by two causes, vis : : 1st, stricture of the urethra, and 2d, exfoliation from the bones of the pelvis. Careful exploration with the probe failed to demonstrate the presence of dead bone, and a somewhat prolonged effort to introduce an instrument into the bladder through the strictured urethra was unsuccessful.

The direction of the urethra was found much changed by the deformity of the pubic arch, the results of the fracture, as well as by the long dense stricture.

The professor pointed out the necessity of overcoming the stricture as expeditiously as possible, with the hope that the urinary fistula would heal without further treatment, and if dead bone could be discovered its removal should also be effected if possible. The patient was ordered good, nourishing diet, combined with tonics and stimulants.

Violent irritative fever set in within twenty-four hours of the examination at the clinique, and for two weeks exhaustion from septicæmia seemed imminent. During this time local treatment was confined to simple attention to cleanliness. The constitutional treatment consisted in nourishing essences and the following prescriptions:

Zi

Sig. One tablespoonful every fourth hour.

R Spts. frumenti....

Sig. to be repeated three times a day.

On the 7th January, 1875 the patient's constitutional condition was much improved, and the professor, desirous of avoiding a recurrence of the bad consequences which had followed his former attempts to pass instruments, determined to perform a radical operation without further delay.

The patient having been placed upon a table and chloroform administered, a grooved staff was introduced into the urethra and carried down to the commencement of the stricture, but could not be made to penetrate it. Prof. Maclean now made a free incision down to the staff, laying open the urethra. Attempts were then made to carry the staff, catheters, filiform bougies, &c., through the narrow, tortuous canal which led through the strictured portion, but without success. A grooved director of very small size, and pliable, was then resorted to, and this, by careful and patient manipulation, was at last carried into the bladder, a fact which was demonstrated by the flow of urine along the groove; by carefully following the director inward with the knife the stricture was soon completely divided, and a full sized instrument was at once passed into the bladder. operation consumed about thirty minutes.

The

The wound

Everything went on well after the operation. gradually healed, the old fistulæ closed up, the patient recovered the full control of the function of micturition, and his general health improved with striking rapidity. Full sized instruments were introduced from time to time to prevent undue narrowing of the urethra as healing took place. On Feb. 13th he appeared at the clinique, and with the utmost facility introduced for himself a No. 12 metallic bougie, and as his general health seemed