sensitive, but the scrotum, penis, and sacrum were anesthetic, that the sensory paralysis disappeared first, that there had been considerable atrophy of the muscles of the thigh and calf, probably from disuse, that the patient had felt nothing give way as he was immediately unconscious, and that he began to use his legs in about four months, and could walk at the end of seven months. The anesthesia of the scrotum and penis had led to the opinion that the injury was at the twelfth dorsal vertebra and first lumbar.

Dr. Elliott thought that the lesion had not been above the first lumbar. Above that point, which was the end of the cord, there would probably have been destruction of the anterior horn cells with ankle clonus and great localized atrophy. He could hardly conceive of any thing less than this happening at a higher level after an injury attended with so much paralysis.

Dr. Shaffer had seen several such cases. The lower the point of injury, the better would be the prognosis. The result had certainly been very good in this case, where there must have been a partial dislocation or fracture. He recalled the case of a man who was thrown from a vehicle and struck the ground in a sitting position. Rigidity of the spine had developed, but recovery had followed with perfect motion of the spine. A certain amount of compression of the anterior column could occur without serious results. If the posterior columns were injured, we would get symptoms such as had been present in the patient exhibited.

Dr. Sayre had seen a case similar to the one under consideration. In a railroad accident in which an express car had rolled down a bank, a man had been struck violently by the safe. He was paralyzed from the waist down, with no control of the rectum or bladder. This condition lasted some three years. He gradually improved under treatment similar to that described, and had been restored to perfect health.

Fracture of the Spine. Dr. Whitman presented a patient with a rather different history. He was a young man, twenty-two years of age, who had fallen twenty-five feet from a cliff. He could walk with assistance, and, although he had pain, stiffness, and weakness in the back, numbness and weakness in the legs, and pain in the lower part of the abdomen and the anterior surface of the thighs, he resumed work, as a clerk, at the end of a week. Dr. Whitman had examined him on August 8th, about two weeks after the accident, on account of

a "lump" composed of the projecting spines of the second, third, and fourth lumbar vertebræ. There was some pain on extensive motion of the back and moderate rigidity at the seat of the fracture. A brace relieved the symptoms in a great degree, and at the end of a month he considered himself well, although he was still wearing the brace. It was seen that the normal lumbar lordosis had been replaced by a projection. Motion was practically normal. There had been fracture and compression of the vertebral bodies, and yet the symptoms had been insignificant.

Dr. Myers recalled the case of a man who had fractured his spine in a fall of twenty-five feet in a doubled forward position. Pain was not severe, but weakness in the lumbar region, the seat of the fracture, prevented sitting up or standing. He was in bed for three weeks, and then walked with a cane. A kyphos was found, and a spinal brace relieved his symptoms very quickly. He was well in six months. Fractures of the vertebræ often gave symptoms but poorly marked when compared with fractures in other locations. The most common symptom was weakness. Crepitus and false points of motion were not usually detected. Pain was moderate, and deformity was frequently absent until after the patient had assumed the erect position for several days.

Unusual Fractures of the Neck of the Femur. Dr. Taylor presented a boy fifteen years of age, who, in October, 1896, felt sudden severe pain in the right leg, followed by lameness for two weeks. No shortening was noticed. After that he had lameness and disability with but little pain, till January 3, 1897, when he slipped and fell on the floor with the knee bent under him. He was unable to rise or walk, and the neck of the right femur was found to be broken. He was treated by a plaster of Paris application, and in July, 1897, when first seen by Dr. Taylor, he was limping badly, the trochanter was one inch above the line, there was extreme eversion and very limited motion. Crutches were advised. In December, 1897, the patient had been free from pain for many months and there was increased motion. In April, 1898, under an anesthetic, more mobility and lessened eversion were gained by manipulation, which was repeated in September, 1898, with further improvement.

Status Præsens: Thirty degrees of free lateral motion, considerable free rotation, and thirty degrees of flexion. Trochanter a full inch

above the line. Walking was very free, but with a slight limp. An apparatus, soon to be laid aside, was worn to prevent outward rotation.

Dr. Taylor also presented a boy of eighteen years who, in December, 1897, fell on his left knee. There was immediate stinging pain in the left hip, but he could walk with some assistance. He soon walked with a cane, and three weeks after the fall there was a marked limp with very little motion in the hip. The limb was one inch short and rotated outward. The trochanter was one inch above the line, and there were tenderness, induration, and muscular spasm about the hip. Treatment was by traction splint, long crutches, and a high sole on the foot of the well side. In May, 1898, the patient had been free from pain for two or three months, and there was more motion. The splint was removed. In September a cane was substituted for the crutches.

Status Præsens: Walking with a considerable limp. No pain. Can raise the leg while lying. Shortening of one and one half inch. Limited motion at the hip and adduction. These cases were of especial interest on account of the youth of the patients and the slight violence of the accidents.

Dr. Whitman said that the first patient doubtless had coxa vara, which weakened the neck of the femur, causing it to break under a moderate degree of violence. In three cases of coxa vara in young subjects he had operated by removing a wedge from the base of the trochanter in order to restore the neck to its normal position and strength. The second patient also probably belonged to the same class. He recalled the case of a young colored girl who, after a period of slight limping and outward rotation with slight stiffness of the hip and pain in the thigh, suffered a fall on her way to school. She was carried home with typical fracture of the neck of the femur. by the use of a traction splint with a favorable result.

She was treated

Dr. Taylor said that he was confirmed in his opinion that bending of the neck of the femur had preceded the accident and had made easy the fracture of the bone in the case of the first patient presented. In the second case, however, there had been no previous signs or symptoms of deformity of the femoral neck, and such a condition must be considered hypothetical.

Congenital Dislocation of the Hip. Dr. Elliott exhibited a further dissection of the specimen shown at the last meeting of the Section. [See The American Practitioner and News, October 15, 1898, pp. 263,

264.-EDITOR.] The patient had been a girl seven years of age. The dislocation of the right hip had been upward and forward. The neck had been found to be short, and the muscles shortened and somewhat atrophied. During life there had been more than one inch of shortening, and the child had walked with difficulty like one with weak muscles. The head had made a deep and extremely well-defined acetabulum, lined with cartilage, below and near the anterior superior iliac spine. The original acetabulum was almost equally well defined, measuring one and one eighth inches in its vertical and one inch in its transverse diameter, with a depth of one fourth inch. So well defined a first acetabulum at this age was rare. Lorenz cited one at the age of eighteen years, and the older anatomists found them at very late periods of life. As a rule, however, the acetabulum not in use failed to keep pace with the development of the other parts, and at an age much younger than that of the specimen it was usual to find it rudimentary and frequently presenting a convex contour. The old acetabulum was found to contain some fat, but was chiefly occupied by an exceptionally large ligamentum teres, measuring one and one half inches in length, three-fourths inch in width, and three-sixteenths inch in thickness, running from a well-defined cotyloid notch through the vertical diameter of the acetabulum to an insertion in the femoral head. As a rule the ligamentum teres had been found at the age of three or four years to be a mere ribbon or to have disappeared. In the usual dislocation on the dorsum ilii, the disappearance of the ligament might be explained by the facts that it had no function and was compressed closely between the margin of the acetabulum and the femur. In the specimen, however, the displacement had been directly upward, and the tremendous size of the ligament was apparently the result of its being called on to sustain the weight of the trunk at every step in walking. Its great size, then, was physiological rather than pathological.

Dr. Witman said that the old acetabulum appeared to be of fair size, and that, as the tissues were doubtless far more yielding in life than in the preserved specimen, an operation by the open method, in which the hypertrophied ligament would have been removed, might have been successful.

Dr. Sayre said that, as the head was as broad as, if not broader than, the place where the acetabulum should be, it was doubtful whether chiselling away a part of the head would not have been required before reduction.

Tabetic Talipes Valgus. Dr. Judson presented a photograph of talipes valgus of the left food in a man about thirty-five years of age affected with locomotor ataxia of several years', duration. It was an instance of Charcot's joint affecting the tarsus. The patient's right knee-joint had been exsected for this condition, but stability had not been restored to the knee by the operation. Pathologically there were pulpy and fluid degeneration of the bony and other tissues, and disintegration of the structures of the joints. Equino-varus also occurred

in locomotor ataxia and in Friedreich's disease, but was the result not of bony changes but of abnormal muscular action. The primary disease was so serious and disabling that the question of treating these secondary affections was not often a practical one. Mechanical treatment might, however, be considered with three objects in view: (1) To give firmness to the foot and ankle, and direct the sole to the ground; (2) to give lateral support to a Charcot's knee, and (3) to stiffen the knees by the use of automatic joints in order to prolong the period when locomotion is possible with the aid of crutches.