being situated anterior to the center of gravity of the diseased spine.

In addition, if one examines a normal spine in regard to its physiological curves it will be apparent that the center of gravity of the vertebral column passes anterior to the dorsal region, owing to the normal kyphosis there, which in disease renders this region the most difficult to treat deformity in and unfortunately is the commonest seat of the tubercular focus. In the cervical and lumbar regions there is a normal lordosis and the center of gravity of the spine passes through them.

A plaster jacket to accomplish the purpose for which it is intended must fit snugly against the sternum, otherwise

FIGURE 4.

Upper dorsal disease treated with the Taylor Back Brace and Head Support (only half of the head ring showing.)

Furthermore, when the jacket is not on, those having the care of the child will, in handling it, flex the spine by holding the patient in their arms in the usual manner, thus increasing the damage done by disease by crowding the healthy vertebral bodies against the diseased, softened one.

Above the ninth dorsal vertebra the plaster jacket is valueless unless it is used in conjunction with the Sayre "jurymast" or some form of "head support" which will lessen the superincumbent weight on the softened vertebral body and prevent the dragging down of the upper part of the spine, which is the tendency, owing to the upper extremities. and thorax, with its contained viscera,

FIGURE 5.

Bent Wire Head Support for Cervical Potts' Disease.

FIGURE 6.

Case showing how the Plaster Jacket alone will not prevent deformity in upper Dorsal Pott's Disease.

more or less flexion of the spine will be possible, increasing thereby the damage to the diseased focus. The Taylor steel back-brace, which splints the lower vertebrae to the pelvis and acts as a lever, putting the upper vertebrae backward, should similarly be supplemented by a head support and means of preventing the shoulders from sagging forward when the disease is above the ninth dorsal vertebra (Fig. 1).

To illustrate the case in question diagrammatically, we may use a notched piece of wood in the shape of the letter "L" inverted, as shown in Fig. 1-A, with a weight, "W," attached to the projecting limb corresponding to the weight of the

head, thorax and upper extremities acting on a diseased vertebral body, which is represented by the notch. If the action of the weight is not antagonized the notched piece of wood must assume the shape indicated in Fig. 1--B. Further, if another piece of wood be brought into use and spliced to the notched piece of wood as a support, and only reach to the notch or just beyond it, we would not feel at all confident that more or less falling forward would not occur, as is seen in Fig. 1-C, D. On the other hand, as we see in Fig. 1-E, F, if the support extend well beyond either side of the weak point we may be sure the effect of gravity on the mechanism is antagonized and falling forward cannot occur.

My preference lies in lower dorsal and lumbar disease in the plaster of Paris. jacket, except in hot weather and for cases with intelligent parents (Figs. 2 and 3); in upper and mid-dorsal I use the steel back brace in some of its forms, depending on the case, with the head support (Figs. 4 and 5). In cervical Pott's disease no back brace may be necessary, and any collar that will immobilize the head and transfer its weight from the neck to the thorax will effect a cure. The after-treatment for Calot's operation calls for practically the same mechanical methods and braces used in cases not requiring this operation.

I wish to put myself on record as opposing that form of steel back brace for lower dorsal and lumbar Pott's disease in which a simple waistband is used and not the "U" piece of the Taylor brace for a similar mechanical reason that the plaster jacket is insufficient in upper dorsal disease.

It is very evident, or should be so, that any so-called spinal support that depends for its efficiency on axillary crutches attached to a waistband is absurd, as the shoulder girdle is freely movable. To be efficient the steel uprights must be in as close contact as possible with the discased vertebral segments. Too much padding to the uprights is bad as getting hard and matted from perspiration. The smooth leather covering without padding, if the brace is properly fitted, has in the long run been found the best.

I have here also a case which was recently sent to me with a history of having worn a plaster jacket from the beginning of the disease and no other form of support, which treatment you can see was useless in preventing deformity. (Fig. 6; compare Fig. 1-C.)

It goes without saying, in conclusion, that the earlier diagnosis is made and efficient treatment is instituted the more satisfactory are the results obtained.

BIBLIOGRAPHY.

Sayre, L. A. Orthopedic Surgery. D. Appleton & Co. New York, 1892. P. 469.

(2) Taylor, R. T. Johns Hopkins Hospital Bulletin No. 47, February, 1895. Medical News, March 13, 1895.

(3)Sayre, L. A. (v. s.), p. 469. (Brackett, E. G. Medical and Surgical Report of the Children's Hospital, Boston, 1869-1894. (5)Taylor, C. F. Transactions of the New York State Medical Society, 1863. ()Taylor, H. L. Canada Medical Record, November, 1893.

DISCUSSION.

Dr. L. Gibbons Smart: Are the head supports worn during recumbency, and do not the braces chafe?

Dr. R. T. Taylor: During recumbency, as the superincumbent weight is removed, the head supports are taken off. If a proper brace is prescribed, applied and fitted by the attending surgeon (and not by instrument-makers, who invariably and naturally are ignorant of the anatomy, pathological processes and mechanical principles involved) there is no trouble from chafing, provided the patients keep the straps well buckled, so that the brace cannot slip up and down and rub the spine, which should be bathed twice daily with alcocol. Sending a case to an instrument-maker for treatment is as bad as telling a patient he needs medicine, he better go to an apothecary and get him to prescribe, or referring an eye case to an optician.

MORNING EXERCISE.-Early morning exercise is denounced by hygienic teachers. At that time vitality is at its lowest ebb and needs the stimulation of food.

UTERINE HEMORRHAGE.

By B. Bernard Browne, M.D.,

Professor of Gynecology, Woman's Medical College of Baltimore.

SECRETARY'S REPORT OF REMARKS MADE BEFORE THE MEDICAL SOCIETY OF THE WOMAN'S MEDICAL COLLEGE, MARCH 22, 1898.

THE subject of uterine hemorrhage has engrossed the attention of medical writers from the very earliest period. Hippocrates, in his second book (Пepi yvvaiKELv) on "Diseases of Women," gives a full description of fluor rubra or uterine hemorrhage, and the treatment which is recommended by him is followed to some extent at present, even after the lapse of 2000 years: a sponge is to be wetted and applied to the pudenda, soft garments are to be moistened with cold water and

laid on the belly, and the foot of the bed

is to be raised.

Celsus also mentions the frequency of uterine hemorrhage occurring after miscarriages, and states that "when putridity of the discharge occurs many women thus perish; indeed, few recover." Soranus of Ephesus (A. D. 98-125), in his celebrated work, "De Utero et Pudendo Muliebri," advises that in cases of uterine hemorrhage the woman be put in the knee-chest position and tampons, saturated with a decoction of galls, be inserted into the vagina.

In the Bible, also, we find many allusions to uterine hemorrhage, as in Leviticus 15: 25, in referring to "the woman having an issue of blood many days out of her ordinary time or that ceaseth not to flow after the monthly courses," etc. And in Luke 8: 43, “And a woman having an issue of blood twelve years, which had bestowed all her living upon physicians, neither could be healed by any."

Uterine hemorrhage may occur in the unimpregnated uterus, during pregnancy or after delivery or abortion. The two latter forms depend generally on special causes, which have to be studied in connection with pregnancy and delivery. The scope of my remarks will, therefore, be confined to the first class. Menorrhagia or metrorrhagia may assume various forms, both in regard to the amount of blood discharged and to the period of

their persistence. The most frequent causes are some disease of the uterus, such as endometritis, especially of a gonorrheal origin, chronic metritis, subinvolution, lacerated cervix, a granular condition of the os, a fibroid tumor, a polypus or cancer. Displacements of the uterus and ovarian diseases may also be

causes.

Certain acute infectious diseases are apt to cause profuse menstruation, especially smallpox, scarlet fever, typhoid fever and inflammatory rheumatism. Diseases of the heart, liver and kidneys are also frequent causes.

Uterine hemorrhage may also be considered under the following classes:

1. From birth up to the period of puberty.

2. From puberty to the menopause. 3. After the menopause.

Many of the cases of supposed hemorrhage of the uterus and premature menstruation in infants and children are doubtless caused by slight lacerations and lesions at the vulva or in the vagina.

A short extract from the histories of the following sixteen cases taken from the records of my service in the Hospital of the Good Samaritan during the past sixteen years (out of a large series of such cases) will serve the purpose of bringing before you the great variety of conditions. under which uterine hemorrhage may occur and also remind you of the great progress that has been made in the treatment of this condition.

Case 1-March 26, 1883.-Elizabeth G., colored, married, aged forty. Metrorrhagia since December 10, 1882. No pain. Dilated cervix with tupelo and sponge tents, and March 30 removed a fibroid tumor from the uterine cavity. April 30 cured.

Case 2-April 24, 1883.-Frances G., colored, single, aged thirty-eight. Menorrhagia for the past twelve years. Diagnosis, intrauterine fibroid. Tumor removed April 26; discharged cured May 8, 1883.

Case 3-November 14, 1883.-Rachel T., colored. Uterine hemorrhage. Uterus enlarged. Dilated cervix and removed fibroid tumor from the fundus. Discharged cured December 5, 1883.

Case 4-May 20, 1884.-Susan M., colored, single, aged twenty-four. Metrorrhagia for two years; very profuse. Diagnosis, fibroid uterus. Laparotomy. Tubes and ovaries removed. Hemorrhage ceased. Discharged cured. Examined two years afterward; no return of hemorrhage; uterus much smaller.

Case 5-October 30, 1883.-Mrs. I., aged twenty-eight, white, married ten years, two children; youngest six years old. Three months after confinement had a severe hemorrhage from the vagina, which continued for nine weeks; has had profuse hemorrhages every two or three weeks since that time. Diagnosis of chronic inversion of uterus was made. Operation November 2, 1883. Discharged cured November 14, 1883. (A new operation for chronic inversion of the uterus.-New York Medical Journal, November 24, 1883.)

Case 6 November 21, 1887.-Mrs. Minnie H., white, married, aged thirtyrive. Has had hemorrhages at repeated intervals during the past year. Diagnosis, cancer of the cervix and anterior vaginal wall. Curettage and applied tampon of a saturated solution of chloride of zinc. Entire uterus sloughed out. Hemorrhage cured. Discharged December 20, 1887.

Case 7-June 19, 1888.-Mrs. C. W., white, married, aged thirty-nine; seven children. Been sick one year; bleeding at times since the birth of the last child, two years ago. Diagnosis, polypus on uterine wall. June 21 operated. Discharged well July 24, 1888.

Case 8-October 15, 1889.-Mattie D., mulatto, widow, aged thirty-one. Uterine hemorrhage for the past two years. Diagnosis, fibroid tumor of the uterus. Operated October 16; removed tumor size of a small fetal head. Discharged cured October 29, 1889.

Case 9-June 30, 1890.-Mrs. Lena B., white, widow, aged forty-seven. Has had menorrhagia and metrorrhagia for the past two years. Cystocele and rectocele, bilateral laceration of the cervix, perineum ruptured down to the sphincter. On July 3 curetted and operated for all the other conditions. Discharged well July 19.

Case 10-March 19, 1891.-Miss Mar

garet C., white, single, aged forty. Has had uterine hemorrhage for the past year. Uterus enlarged. Dilated the cervix and removed a mass of soft growths from the cavity. May 4 discharged well. June 25 she returned to the hospital complaining of return of hemorrhage. June 26 uterus thoroughly curetted; large carcinomatous-looking growths were removed which, upon examination, proved to be malignant. July 13 vaginal hysterectomy was done. She did well until the third day, when the nurse injected the vagina with a bichloride solution by mistake. She died the following day.

Case 11-July 20, 1891.-Mrs. Anna* C., white, aged thirty-five. Has had several children. Uterine hemorrhage for past year. Diagnosis, epithelioma of the cervix. July 21 vaginal hysterectomy. Discharged August 29 well.

Case 12-September 29, 1891.-Mrs. Virginia P., white, married, aged fortyfive. Uterine hemorrhage for the past year. Diagnosis, ovary prolapsed, lacerated cervix and endometritis. Cervix re

paired, uterus curetted. Left the hospital well October 15.

Case 13-January 29, 1896.-Annie P., colored, single, aged forty-six. Was under Dr. Smith's care for cardiac hypertrophy; had also profuse uterine hemorrhages from a fibroid uterus. Curetted under chloroform April 27; hemorrhage ceased.

Case 14-September 28, 1896.-Julia S., single, colored, aged forty-six. Úterine hemorrhages for one year; uterus in a state of fibroid degeneration. Hysterectomy by combined method. Discharged cured November 14, 1896.

Case 15-April 24, 1897.-Emily W., colored, married. Menorrhagia for past year. Diagnosis, endometritis and lacerated perine. Operated May 1; discharged cured May 26.

Case 16-May 3, 1897.-Maggie S., colored, married, cook, aged thirty. Uterine hemorrhage. Diagnosis, subperitoneal fibroid. Laparotomy June 23. Myomectomy; removed two tumors the size of a goose egg and sixteen smaller ones. Discharged June 23 cured.

*This patient has been seen by me in the last few weeks. She has been in excellent health since the operation.

Society Reports.

SECTION ON OPHTHALMOLOGY -COLLEGE OF PHYSICIANS

OF PHILADELPHIA.

MEETING HELD MARCH 15, 1898. MEETING March 15, 1898, George C. Harlan, chairman, in the chair.

Dr. G. C. Harlan's second case of Kerato-globus, a sister of the case shown at the February meeting, presented many features similar to it-globular distention and perfect transparency of both corneas; deep anterior chambers; oscillating irides; lenses present; hyperopia of 5 D. and no cupping of disks. The horizontal diameter of each cornea is 14 mm. and of each ball at the equator 24 mm.; the pupils are only 1 mm. and under atropine 2 mm. During the past two months the vision has been failing and the fields are decidedly limited. The optic disks examined with difficulty on account of the small pupils, appear dull and gray and the retinal veins engorged. The lowered vision is accounted for by

the condition of the nerves and is inde

pendent of the kerato-globus. The pahave no unusual ocular condition. The rents and three children of the patient occurrence of this anomaly in two members of a family confirms the view of its congenital origin.

Dr. Edward Jackson found the curvature of the corneas to be uniform almost to the scleral junction, and that the lenses were present but displaced slightly downward.

Dr. W. F. Norris believed the R. lens was present, but in the left eye its presence was doubtful. The patient was probably suffering from progressive optic

neuritis.

Dr. Edward Jackson showed a case of "Anomaly of the Iris." The man, aged sixty-nine, had good sight until nine years before, when he had severe pain in the right eye and the whole right side of the head. This eye now presents high irregular astigmatism and a pale optic disk; Vn. 2-40. The left eye had continued good until four years ago, when vision became impaired without pain or inflammation. There was a macula of the