changeable form, the compressible, flexuous body, encased within, is incessantly varying its position and shape. "Lateral curvature of the spine in a young girl, however slight, ought always to be regarded as requiring immediate care; the patient ought not to be left to the chance of her growing out of it."" Syme is also opposed to orthopedic spinal supports. SYME'S PRINCIPLES OF SURGERY, PAGE 230. "Should the patient unfortunately, during the process, fall into the hands of a machine-maker, who attempts to prop up the weak and twisted spine by means of iron frameworks, the morbid alterations which have been described will be accelerated; for all such contrivances must prove either insupportable to the patient, or inefficient in straightening the spine; and granting even that they could accomplish this, they would still labour under the great objection of confining the movements of the trunk, and preventing the muscles from obtaining that exercise which is essential to the recovery of their strength. The result would be not more satisfactory if the practitioner were to go to the opposite extreme, and, regarding the muscles as the sole seat of disease, attempt to strengthen them by enjoining exercise in the erect posture, or, still worse, recommending a weight to be carried on the head, in order to render their actions in balancing it more energetic than usual. Such means, however useful in preventing curvature, must manifestly tend to increase it when once commenced. In the management of persons pre-disposed by their age, sex, temperament, or constitutional make, to this disease, every means ought to be used for strengthening the system in general, and the trunk in particular. All longcontinued and constrained positions must be interdicted— frequent exercise of such kind as calls into action the muscles of the trunk, should be enjoined. The use of stays, corsets, and every rigid article of dress, however designated, must be strictly prohibited.” THE LYING-DOWN SYSTEM. The lying-down system, and the mechanical horizontal extension of the spine have been for some time in fashion, seemed to do some good, and are still advocated by some practitioners; but the improvement was only apparent, not lasting. The horizontal position (protracted sometimes even for years), had a very bad influence on the general health of the young patients,-in fact it is not sufficient to diminish the curve, and to straighten the spine, but it is absolutely necessary to invigorate the organs which will maintain the straightened spine in its good position, therefore the weak atrophied or paralysed muscles must be strengthened. This can neither be done by mechanical support nor mechanical extension, nor by a horizontal position, although this last, when used in combination with other rational means, is of the greatest value. Syme advocates the lying-down. If curvature has already taken place, it is evident that the first step towards reparation must be relieving the weak and bent spine from pressure. The only mode of effectually accomplishing this is to make the patient assume the horizontal posture, which can be done without any great hardship, if a smooth, well-stuffed sofa is provided, instead of the floor, or a board, which is sometimes used for the purpose. When the curvature begins to diminish, the patient may rise occasionally for a few minutes, and exercise the muscles by some suitable employment, which ought never to be continued after the slightest feeling of fatigue is experienced. By persisting in this system, the disease will certainly be arrested in its course; the distortion if not very great, will be removed; and the worst cases will be considerably improved. During a short time, it appeared that Paré's iron corsets would give way to the tenotomy of the spinal muscles, advocated and performed by Guerin; but owing to Malgaigne's severe critical examinations of the results of the section of the tendons of the retracted and contracted muscles of the trunk und spine, these operations had soon to be given up. GYMNASTIC TREATMENT. Professor Delpech, of Montpelier, was the first to try the scientific application of common gymnastics in the treatment of curvatures; he invented many apparatus on which special movements had to be done, and as he used special exercises in special cases he had many good results. But the inexperience and ignorance of the usual gymnasts of the nature and development, as well as of the treatment of deformities are the causes why the usual gymnastics have done more harm than good. "There is no more difficult physiological problem than to determine exactly which positions and movements are the most suitable for the purpose of acting on a certain region of the body. Gymnastics, therefore, can be only of value when directed by a medical man acquainted with the study of muscular physiology, a study which is so complex that we frequently see parents justly alarmed because after having consulted two medical men about their scoliotic children, the one recommends the right-arm to be specially exercised, while the other especially recommends the movement of the left arm, although in the majority of similar cases, there is no rational indication for the special exercise of either arms. There is no doubt but that the common gymnastics, recommended by medical men, is sure to aggravate the scoliotic curvature, while the free exercises will only increase the strength of the parts which are well-developed, and which the patient uses naturally in preference to the weak ones." -(Dally). Electricity has also been used but merely empirically, just the same as vapour baths, fumigations, and other useful things. Unhappily, many of these means have been applied irrationally, and the consequences are that the public, followed by the profession, again take refuge in mechanical supports. "I may now be justly asked what I suggest for all that which I have criticised. My answer is this "We do not find so much fault with the means applied, as with the unscientific mode of application, although we maintain that the so-called orthopedic corsets aggravate the complaints which they pretend to cure, and that there would be less hump-backed people if the iron corsets, cuirasses, metallic plates and levers, iron girdles, &c., were never invented; mechanical assistance may be used in cases where cervical extension is required, nor do I undervalue the help of apparatus when a part is to be fixed in a certain position-I have made use of all the means I have named. "The treatment I am advocating is not a system based on the effect of a special agent, but on the combination of all those organo-plastic means, the good effects of which have been proved by experience, viz: suitable regime, fresh air, localised exercises and localised electricity, various hydro therapeutic applications, spontaneous or forced positions, and finally manipulation and passive movements."-(Dally). My own experience confirms that of Drs. Eulenburg and Dally. I wish only to add that besides all the means named by Dally, I make use also of Ling's movements, with resistance, and the so-called self-straightening method; for which purpose the patient must be taught, first, to see when he is in a good or bad position; secondly, to try to retain it before the looking glass; thirdly, to be aware of the difference of mental impressions produced by the normal and abnormal position, and finally to change, by often repeated practice, the intentional good position (that is, the position which he obtains by the effort of his will for a short time) into a habitual one when the repeated efforts of the will are wanted no more. I lay special stress on the importance of directing the influence of the patient's mind to the effort of maintaining a good position, because no real cure of a lateral curvature can take place so long as the patient is unable to remain in the normal position without constantly thinking of this position. DIET IN SICKNESS. II. BY JOHN H. CLARKE, M.D., Ipswich. Rheumatic Fever presents a contrast in many ways to the exanthemata, and requires an exceptional diet. We know that patients suffering from this disease have an abnormal amount of lactic acid in their systems, and many think that the presence of this acid constitutes the essence of the disease. "If meat in any form, solid or liquid, be eaten, it seems to turn into lactic acid, which many think is already in excess in the rheumatic blood-at all events, it adds to the quantity of organic acids in the body. The power of fully converting it into living flesh is wanting, and until this power is regained a semi-conversion into the substance named takes place. The smell of sour milk in the skin of rheumatic fever patients is well known, and seems to support the theory alluded to. Meat augments it, and adds to the acidity of the urine. The redder and more muscular the meat is the more it disagrees."* *Chambers' Manual of Diet, p. 269. Acting on the above hints I have lately restricted the diet of two patients suffering from rheumatic fever to a farinaceous diet, consisting chiefly of oatmeal gruel made with water. In one-a mild case-the perspirations were very slight and had very little odour, and in the other an excessive acid-smelling perspiration followed a good draught of milk taken just before going to bed. This was during convalescence when all feverish symptoms had subsided. In New Zealand acute rheumatism is one of the commonest diseases from which the colonists suffer, and the great cheapness of meat is offered as an explanation, certainly they take a much larger proportion of animal food than we do in this country. The dietary of patients suffering from inflammation of any part or organ of the body does not differ essentially from fever diet. Inflammations however have this advantage, that the stomach is not so severely affected as in general fevers from blood-poisoning, the fever in the former case being only symptomatic. From this it follows that the diet need not be so strict, and should the tongue be clean and the appetite good, there is no reason why the lighter kinds of solid food such as soles, lightly boiled eggs, and light milk puddings should not be allowed. It is necessary to keep the quality of the blood up to the healthy standard if possible, as the healthier it is, the less fibrin it contains, and the more easily it circulates through the congested vessels. I shall conclude my remarks on acute diseases with a few words on acute dyspepsia. The common form of this malady, which is accompanied by fever, and is termed by some "gastric fever," or "bilious fever," requires very little consideration in the matter of diet. The usual history is some error or excess, and if the patient can only be persuaded to lie quiet and fast, the offending matters of undigested and fermenting food will find their way into the intestines, which, irritated by their presence, will hurry them along and expel them with one or more loose stools and there the disease will end. The patient after a night's rest will rise with his usual appetite for food. There is another kind of acute dyspepsia which is or is not accompanied by fever. There is the history of a chill followed by pains at the stomach of a neuralgic character, flying all over the chest and giving the patients alarm as to |