the patient fell down From the beginning of the pains, sensation in the feet was gradually lost. For one year the patient has not felt the ground under herself at all; the legs appear to her as though made of wood. The sensibility of the upper extremities was also impaired, with loss of the sense of touch, for the last year. The body, also, feels as though made of wood. The bowels were sluggish, often many days passing without a movement. Micturition infrequent, though the bladder was often found to contain much urine. The urine is never passed in bed involuntarily.

Hereditary circumstances: The father of patient died in the fortieth year of his life with tuberculosis. Of ten brothers and sisters, seven are said to have died from lung troubles.

The patient menstruated for the first time in her seventeenth year, and since then regularly every three weeks, until May of this year. During menstruation the pains increased.

Present state, taken on the 14th and 15th of November: The patient is of large size, with a weak osseous system, poorly developed muscles, rather tender and somewhat dry skin; hair somewhat gray, and the fat of the cellular tissue under the skin deficient. The patient complains of violent cutting pains originating in the hip joint and extending to the soles of the feet; also of a steady burning at times in the region of the scapulæ ; but of pain in the spine there are no complaints. She complains of difficulty in micturition and defecation. The skull is small, round, and symmetrical; in the face no anomalies to be noticed. The eyes are placed symmetric illy, and move symmetrically in all directions. The sight in left eye impaired ever since the disease of the cornea, which caused the corneal opacity. At first, also, the right eyesight was impaired, but within one year has become far-sighted. There is no restriction of the field of vision. to be detected. The tongue can be stretched out straight, and there is no disturbance in swallowing or speaking. The supraclavicular cavities equal; thorax long, broad, flat; the right infraclavicular space deeper than the left.

The palpitation of the heart is not to be felt. Auscultation shows, on the left side vesicular breathing; on the right side below the clavicle, uncertain inspiration and bronchial rales. No anomalies about the heart, except a blowing sound, which will have to be pronounced anæmic with the existing anæmia. The patient sits up. Now, we see the muscles of upper extremities are weakly developed ; the power of muscles deficient, and movements take place slowly. In approaching the tips of the fingers, a slight wavering of the extremeties is noticeable, and the longer the finger tips are kept approaching, the more the wavering of the extremities increases. With closed eyes, the finger tips missed the

prescribed point, and trembling is very distinct. The pricking of a needle, as far as the upper third of the upper arm, is felt but little. On both shoulders and on the neck the feeling of pain is normal. On the trunk, the feeling of pain on the right side, beginning from the third rib, and on the left from the fourth rib, is decidedly weakened. The patient does not react at all in these parts, while the reaction is very marked at the upper part of the chest and the neck. The finger sensation of touch on both sides of the trunk in front is wanting, beginning with the fifth rib; coarse touching, however, is plainly felt and localized. Above the mentioned regions, the feeling of touch is a normal one. On the posterior portion of thorax, the weakening of the sensation of touch is perceptible, beginning at the height of the fourth vertebra. A disturbance of temperature, either here or anteriorly, is not to be felt. From the fifth vertebra downwards a very strong pressure must be made in order to be felt. This is especially so in the gluteal region.

Lower Extremities. Stretched out straight, we observe no abnormal position of the feet. The muscles everywhere are limp. Both extremities can be lifted from the couch, but with difficulty, and with much trembling. The bending of the feet, the bending and stretching of the knee-joints, take place slowly and hesitatingly, with perceptible trembling. The patient has no consciousness whatever of the situation or relation of her extremities, and is perfectly anæsthetized in the parts, except that percussion of the tibia is said to be felt. This absolute anesthesia reaches behind as far as sacrum, and in front to the umbilical region. No reflex action, in fact, is to be noticed anteriorly below the abdomen. In the abdomen, however, reflex action can be produced, especially in the left side. The patient is able to stand up only

when completely supported.

Operation, Nov. 7. Anæsthetic, chloroform. Patient vomited twice during operation. Operation with the patient in abdominal position, with raised pelvis. An incision was made about twelve centimetres long in the middle of a line, beginning between tuber ischii and trochanter major. After severing the skin and cellular tissue down to the fascia lata, the lower edge of the gluteous maximus was raised and the fascia slit, and the ischiatic nerve reached between the biceps femoris on one side, and the semimembranosus on the other. After severing the nerve sheath with anatomical pincers, and laying it bare towards the upper portion, three tractions were made on the raised nerve, at first toward the centre, then toward the periphery.

After thorough cleansing of the field of operation with five per cent carbolic solution, a short drainage tube was inserted in the lower portion of the wound, and the wound sewed up.

The wound was dressed after Lister's method. This operation was repeated on the other limb. (After the tractions, the ischiatic nerve appears considerably lengthened; it can easily be lifted up from the wound, and remains lying loosely on the bottom.) The pulse, which had ninety to ninety-six vigorous beats at the begining of the operation, did not change its frequency during the tractions; but directly afterward an increase of the beats to one hundred and sixteen to one hundred and twenty was noticed. In the breathing no alteration was perceivable. Duration of the operation was one hour, including application of bandages.

CONDITION OF PATIENT ONE HOUR AND A HALF AFTER THE OPERATION.

Woke up completely free from pain in every part of the body, and the sensibility of the lower extremities had returned. She feels plainly somewhat forcible touching of the soles of the feet; feels a fine touch of the lower part of thigh and foot, and localizes it accurately. Prickings with a needle are felt somewhat like burning or simple touching, and localized accurately. The dull

ing of the sense of pain in the trunk appear, however, unchanged.

At 6 P. M., the patient so far has had no return of the pains, states of her own accord that she has lost the wooden feeling in her legs, and there exists a feeling like the running of ants on the soles of her feet. Movements of the foot and toe joints are completely free, and are made vigorously on both sides. A delicate sense of touch exists now in both extremities. Sense of temperature: cold and slightly warm objects are accurately distinguished; also, in the soles of the feet the power of distinguishing is found. Now, in the trunk, the sensibility has completely returned. In the gluteal region, of course, no examination can yet be made.

Nov. 8. Sensibility everywhere completely returned; no trace of lancinating pains. Movements of the lower extremities are now quite vigorous; the legs can be kept raised a long time without trembling.

Nov. 9, A. M. Up to date, no trace of pains. The patient praises, especially, the feeling of freedom and movability in the back; no pain in back; repeated examinations of sensibility show a complete restoration of the same; fine sense of touch in soles of feet; perfectly normal movements of the toe joints. The two feet can be raised on high, and kept elevated for some time without any trembling. Movements of the upper extremities decidedly more sure. The wavering on approaching the tips of the fingers only slightly to be noticed. With closed eyes the patient

misses the finger tips, but less pronouncedly than before the operation. Subjective state of health and appetite excellent.

Nov. 10

The patient has of her own accord made an attempt to stand, and can do so with but slight support.

Nov. II. Quite free of pain; stool and urine normal. The patient is able to remain standing, with the feet not far apart, for a long time without assistance; shows with it, however, a slight wavering which, with closed eyes, would cause her to fall. She can walk well with assistance, stumping with the heels; hyperflexion in knee joint; raises the toes; the feeling of having the floor under her is perfectly normal.

Nov. 13. The patient is able to go a few steps without any assistance at all. With closed eyes, a wavering is still present when

patient is standing.

Dec. 7. Patient seems quite well. All the functions are normal; appetite good. The patient can walk some distance without much fatigue; no pain.

Dec. 12. Patient walks daily for from half to three quarters of an hour, and is but slightly fatigued; appetite good; functions normal, etc.

TUBERCULOSIS CONFINED TO ABDOMINAL ORGANS.

BY CHARLES A. BARNARD, M. D., OF CENTERDALE.

[Read before the Rhode Island Homeophatic Society.]

YOUR attention is directed to this obscure pathological condition, not with the expectancy of adding light, but rather of diffusing that already possessed by 'the profession. Dr. Geo. D. Wilcox has granted me material aid by loaning reports of cases from the Berlin and Vienna hospitals, and also extracts from his German works. Passing, without reference, those vexed questions, ætiology and pathology, I shall confine myself to the more practical matters of symptomatology and diagnosis.

From careful and extended research I deduce the proposition that cases in which tubercules occur only in the abdomen are very rare, and that as the number of organs which are affected lessens, so does the number of cases.

When the peritonæum alone is affected the course is very similar to that of chronic peritonitis from other causes.

Prof. Romberg, of Berlin, says the essential symptoms consist in painfulness of the abdomen, dulness of sound on percussion, and not unfrequently effusion in the abdomen; and it is worthy of notice that the children have pain in evacuating the bowels when the stools are hard, as constipation is usually present. In

fact chronic peritonitis of children is mostly of a tuberculous

nature.

To this opinion the following case from the Medical Clinic in Berlin seems apropos. June 22, '47, a girl five years of age was brought to the Clinic. The abdomen was large, and below the naval the percussion sound was flat and did not change by change of position. No fluctuation could be detected. The distention of the abdomen had existed four years. A year before the child suffered from measles, since which time the distention had visibly increased, but without any marked emaciation. The child passed daily from one and a half to two quarts of urine, very pale, becoming rapidly ammoniacal, of a specific gravity of 1005, and not containing any abnormal constitutents. The normal solid constituents were diminished, and the case must therefore be regarded as one of diabetes insipidus. This increase in the quantity of urine was the more remarkable as there was no thirst.

The exhibition of iron and baths was followed towards the beginning of winter by decided improvement. The urine became normal in quantity, and the child well nourished and of robust appearance, but the distention of the abdomen remained unchanged.

Jan. 27, 1848, the child came again to the Clinic, presenting a marked change for the worse. There was extreme emaciation, and increased distention of the abdomen, which was now sensitive throughout, shrunken skin and hectic fever, which soon terminated fatally. The autopsy revealed old and new adhesions, studded with tubercules and gluing the intestines together, with here and there interspaces filled with serous or purulent fluid. In front of the vertebral column was a mass of mesenteric glands united by tubercular deposit to the size of a child's head. The intestines were healthy. The lungs, bronchial glands, and spleen were tubercular.

Dr. Hennoch, in his treatise on the "Diseases of Abdominal Organs," says that chronic peritonitis is a disease of far more frequency than is usually supposed.

It is found in its most decided form in children from four to ten years of age. of age. The commencement is often so obscure as to be entirely overlooked. Frequently recurring colicky pains, irregularity of the bowels, constipation alternating with diarrhoea, diminished appetite, sickly countenance, and gradual emaciation. are symptoms which may be supposed to be caused by the presence of worms. After a few months, beside increasing emaciation, there is afternoon fever, thirst, and accelerated pulse. If the disease is suspected, early careful examination of the abdomen will reveal tenderness; and usually the sensitiveness will be in