It is strongly urged that fibroids should be removed while they are small and as early in their history as possible, before the woman's health is run down by haemorrhages, before troublesome adhesions are formed, and before the kidneys become diseased through pressure. If this course were adopted the mortality would be very low, the writer having had only one death in forty operations.

In the case, the subject of these remarks, the operation took half an hour and the patient made a good recovery.

The Montreal Medical Journal, April, 1905.

REGENERATION OF THE AXONES OF SPINAL

NEURONES IN MAN.

His paper

is

He remarks that the

Such is the title of the paper by Dr. D. A. Shirres. based to a great extent upon personal observation. opinion is pretty generally held that the axones do not regenerate, and that experiments on monkeys, dogs, etc., have failed to show that regeneration takes place. Quite recently Dr. James Collier in Brain states that immediate suture of the spinal cord proves that regeneration is possible. Sir William Gowers is referred to as also mentioning a case where there was complete motor paraplegia, and that after a time there was considerable restoration of function. When the patient died some years afterwards, sections of the cord went to show that some regeneration of the axones had taken place. The reason is advanced that regeneration in the spinal neurones is prevented because they have no neurolemma sheath. Further, as these cases of transverse myelitis, or crush injuries to the cord have been regarded as very serious, but little has been for them surgically. The pressure may be removed, but if the cord is found tɔ have been divided no attempt has been made to restore its continuity. In many cases operation has been deferred too long.

In some cases the pressure upon the cord may have been of only momentary duration, and no coarse changes are visible, but there must be some marked changes as there is paralysis. In other cases the pressure may have lasted a week or more. In the majority of cases of frac ture dislocation and pressure in the cord, there is motor and sensory paralysis with increased reflexes. Dr. Shirres thinks that in these cases there is not transverse division of the cord, and that when such is the case there

is flaccid paralysis with loss of the reflexes, motion and sensation. In some instances of injury to the cord the reflexes may be at first retained, but later on lost owing to the extension of blood clot or such like to the lumbar enlargement and thus involve the lower neurones. In this way

a paraplegia which at first retained the deep reflexes may become flaccid, with loss of the reflexes and atrophy of the muscles. The cell bodies of the neurones must receive nourishment and stimulation or they will un dergo degeneration. Electricity is a valuable means of supplying the requisite stimulation by the employment of needle-electrodes placed in the muscles or nerves.

"The order of appearance of the motor and sensory paralysis in progressive lesions is practically constant in the large majority of cases. They are motor paresis and spasticity, increase of the reflexes, anaesthesia below with local hyperaesthesia, sphincter paralysis, thermo-anaesthesia, followed by flaccidity with loss of the deep reflexes, progressive lowering of the faradic excitability, muscular wasting and loss on the sphincter tone. Pain and temperature are always earlier affected, and to a greater extent than sensibility to touch."

A very interesting case is reported. The patient was 48 years of age, and was brought into the Montreal General Hospital in the spring of 1902 suffering from a fracture dislocation of the 9th and 10th dorsal vertebrae. He was put under the care of Dr. G. E. Armstrong. The writer saw the case with him. There were found complete loss of motion and sensation, flaccid paralysis, loss of superficial and deep reflexes, and bladder and rectal retention. Twenty-four hours after the injury, Dr. Armstrong cut down upon the cord and found that it was completely severed and the portions separated by at least half an inch. The case was regarded as hopeless. The lower portion of the cord and the motor roots from it were tested, and found to respond well to the electric current. This proved the lumbar enlargement was not injured. At the end of six months there was no return of the reflexes nor any sign of spasticity. This very clearly proved the view held by Bastian and some others that total transverse lesion destroyed the reflexes, and caused flaccid paralysis, and that the loss of the knee jerk and the flaccid state is due to removal of the higher centres and not to any concomitant injury of the lumbar enlargement.

At the end of eleven months, the cord was cut down upon again, when it was found that its two portions were separated by one and a half inches. The dura mater was opened and three inches of the spinal cord of a dog inserted. A few fine stitches united the pia-arachnoid of the one to the other. The dura mater was then closed, the patient making a good recovery from the operation. The fifth week after the operation the patient could recognize flatus in the lower portion of the abdomen.

Six days later he could feel the passage of a catheter, and ten days later could inform the orderly that the bowels were going to move. About the same time he began to feel the sensation of pins and needles in his feet, and in two months from the operation he could describe sensations up to the knees. There was slight reaction restored in the muscles to percussion. An abscess formed in the right kidney causing the death of the patient.

A very careful study was made of the cord. There was the typical ascending degeneration in the upper portion of the cord in the columns of Goll and Burdach and in the direct cerebullar tracts and in Gower's tract. In the substance lying between the portions of the cord there were fibres found and uniting with the cord above and below. There were clear indications of regeneration. He does not assert that the dog's cord caused the improvement, but the nerve fibres were present uniting the two segments of the cord. A number of pathologists who saw the specimens were of the opinion that regeneration was taking place. This paper is one of very great interest and marks a stage in the onward progress of neurology, as it goes a long way towards establishing two important facts. That complete destruction of the cord causes loss of the reflexes and a flaccid condition of the muscles, without their being a coincident injury to the lumbar enlargement; and that regeneration of spinal axones

can occur.

CAESAREAN SECTION.

The

Dr. H. L. Reddy has a paper based on six cases of Caesarean section. The usual preparatory treatment for a laparotomy was adopted, and the anaesthetic used in all cases was alcohol, chloroform and ether. The incision was made in the middle line, from two and a half inches above to three and a half inches below the umbilicus. A 10 per cent. solution of gelatine stopped all bleeding. The left flank was well depressed and pressure over the right side of the fundus aided by one hand over the fundus uteri, brought the uterus outside the abdominal cavity. bowels were kept back by means of hot towels, and the uterus was covered by the same. The uterus was then opened from the level of the Fallopian tubes down to the contractile ring, or an incision of six inches. The wall of the uterus was cut through rapidly, and in five cases also the placenta. The bleeding was not severe in any case. The presenting part of the child was seized and it was delivered, the cord being clamped and Aseptic ergot was injected subcutaneously into the nuttock and the Esmarch bandage relaxed. The uterus at once contracted and there was no difficulty in removing the placenta and, membranes, except in one case.

The os was ascertained to be patent for drainage, and the opening in the uterus was closed by interrupted sutures one-quarter inch apart of No. 4 braided silk. Lambert sutures were used to bring the peritoneum together. The peritoneal cavity was dried out and filled with saline solution. The abdominal wound was closed by three layers of sutures, a continuous cat-gut for the peritoneum, interrupted silk for the musculoaponeurotic tissues, and interrupted silkworm or horse hair for the skin.

In any case where it was thought necessary to render the patient sterile the Fallopian tubes were tied in two places and cut between.

In the first case both mother and child were saved and did well. In the second case the child did well, but the mother, who was very delicate, died of heart failure on the third day. In the third case, the mother made an excellent recovery, but the child died on the twenty-third day. The fourth case did well. the mother being able to nurse her child, when both left the hospital. The fifth case was also satisfactory to mother and child, both doing well. Case six was favorable to both mother and child. Only one case was not rendered sterile by trying the Fallopian tubes. case the membranes were very adherent and difficult of rmoval.

In one

Under absolute causes, the writer mentions tumors that obstruct the descent of the child, and contracted pelvis, varying from three to three and a half inches. Relative causes for section may be found in very protracted labor. As the death rate should be nil to both mother and child, Caesarean section should not be left as the dernier ressort that is too often the case.

EMPYEMA OF THE FRONTAL AND ETHMOIDAL CAVITIES.

Dr. Robert H. Craig reports a case of empyema in these cavities. He removed the anterior half of the middle turbinal and freely opened the ethmoidal bulla and anterior group of cells. The cavity was curetted and flushed with an antiseptic solution. A few days later the frontal sinus was opened. An incision was made in the interfrontal furrow, and a small button of bone removed, midway between the supra-orbital notch and the midline. The cavity was found to contain granulation tissue. It was curetted and flushed with 1 in 5,000 bi-chloride solution, and then swabbed with bi-chloride of zinc, 40 grains to the ounce. The nasofrontal duct was enlarged and curetted and a gauze drainage inserted. At the end of two weeks the naso-frontal duct was enlarged to secure very free drainage as the progress of the case was not satisfactory under antiseptic solutions daily. The case recovered in one month. The writer recommends that in empyema of the frontal sinus free drainage be es

tablished between the nasal and frontal cavities, before the external route be resorted to. All growths in the way should be removed, and the excision of the anterior half of the middle turbinal will facilitate the treatmen of the naso-frontal duct.

ΠΟΙ

INJURIES TO THE HEAD AND FACE FROM FORCEPS.

Dr. Ridley Mackenzie describes three cases of children, in whom injuries had occurred from the use of forceps during labor. These children died in the hospital and, therefore, autopsies were possible. In the first case there was a large purplish swelling, not tense pulsating, over the parietal region. There was fracture of the skull, but no injury to the brain. The tumor was due to haematoma of the pericranium. The second case presented two tumors over each parietal eminence. The autopsy showed that these were haematomata of the pericranium, but there were no fractures nor injuries to the brain. The third case presented a large swelling over the right side of the head. There were paralysis and wasting of the muscles of the right side, and conjunctivitis and keratitis. The autopsy revealed a pericranial haematoma and an underlapping of the right parietal bone. The facial nerve was flattened, no injury of the brain was noticed.

The injuries usually met with after the forceps are "intracranial effusions of blood, paralysis of the facial nerve, depression and fissure of the skull, pericranial haematoma, laceration of the scalp, injuries to the eyes, ears, nose and mouth."

To favor the absorption of haematomata cold and pressure should be employed. If the blood has not absorbed by ten days, the tumor should be opened and drained. Fractures are left alone, and injury to the facial nerve treated by time, electricity and protection of the eye.

HYDROSALPINX, A CASE REPORT

Dr. F. A. L. Lockhart reports this case from the Montreal General Hospital. The patient was 22 years of age. She came into the hospital complaining of weakness, vomiting after eating, and of being sore all over her stomach. Four years ago some abdominal operation performed for pelvic trouble, but the exact nature of this could not be ascertained. The tube was reached through an abdominal opening. On removal its wall