ninth dorsal vertebrae. A jacket had been worn for four years. The operation seemed very cruel and had been undertaken with fear and trembling, only partially dissipated by the favorable reports. of French operators. The kyphos had been nearly all reduced after so much snapping and cracking that it was thought the child's back was broken. There was no reaction, and the patient was up and about in less than four days. The procedure was applicable to the early stages of the disease. In the presence of a large kyphos or anchylosis or abscess it was a dangerous method.

Dr. W. R. Townsend related a case in which an inconsiderate resort to this operation would have been disastrous. A girl three and one-half years of age was under treatment upon an open frame for disease in the upper dorsal region. There was a cough and impeded respiration and other symptoms of bronchitis, followed rather suddenly by asphyxia and death. Autopsy showed a retro-pharyngeal abscess in the median line directly over the vertebral column and extending to the right. There was no pressure on the trachea, which was normal in size and not flattened. Numerous enlarged glands had pressed on the recurrent laryngeal nerve and caused paralysis of the vocal cords. The second dorsal vertebra was so much diseased that the finger was pushed right through to the spinous process. Forcible reduction would have ruptured the abscess or done some damage to the bone. The dangers of the operation were readily realized. The procedure might give good results in suitable cases, but it should be well tried before being widely recommended.

Dr. Myers had not as yet heard of any cure as the result of this procedure. The cases should be very carefully selected and care taken to ascertain that no abscess was present. The operation was dangerous, and results should be waited for before the method should be commended at all. The protection given to the spine after the operation should be most perfect.

Dr. H. L. Taylor could not think well of this method without the light of further experience. The tendency had been

to make the procedure much less radical than it had been at first when reduction of the deformity sometimes called into action all the strength of the operator, with perhaps resection of the projecting spinous processes and in suitable cases excision of wedges of bone. In some instances the spinous processes were wired together after reduction, and it was considered important to incase the head and the pelvis in the plaster of Paris jacket. With the obvious tendency towards simplification of the treatment, it remained to be seen how much of the original operation would remain after the method had been well tried. It was safe, thus far, in the hands of experts, but it would be dangerous to encourage the general practice of the method.

Dr. R. H. Sayre said that if the diagnosis were made before the kyphos appeared there would be no necessity for this operation. He thought that if it could be determined in advance which cases could be straightened without damage this operation could be readily accepted. In some cases there were no vertebral bodies left and the column was held together by the spinous and transverse processes. In other cases the bone was so diseased that forcibly straightening the spine would produce gaps between the vertebrae, leading to the production of abscesses. It was extremely doubtful whether this method should be employed. In any event the cases should be most carefully selected, and there should be no elevation of temperature and no morbid action present.

Dr. Manley thought that the forcible correction of this deformity in appropriate cases was justifiable, to be followed by some form of thoracic support after correction.

Dr. Elliott said that two cases of forcible correction, followed by death, had been recently reported in the British Medical Journal.

Dr. A. B. Judson had seen no reason for not being satisfied with treatment by the use of the steel brace. Patients with Pott's disease suffered so much inevitable daily traumatism in standing and walking that the injury accompany ing the method under discussion would not

seem to be necessarily fatal or even dangerous.

The question was whether it was wise to add to the unavoidable and habitual traumatism. If we could restore the curves and strength and mobility of the spine almost any treatment would be accepted. But it could not be hoped to carry recovery to that desirable point. Moreover, it was very doubtful whether consolidation would come to our aid at the opportune moment to secure the improvement in shape made by the forcible reduction.

Dr. Phelps had looked up the literature. of the subject. On the one hand it had been stated and demonstrated by radiographs that bone had been reproduced in cases in which there was wide separation after reduction, and one operator had reported 204 cases, with no deaths and no accidents. On the other hand, other operators had reported many relapses, sometimes with paralysis, a number of deaths had been reported, the kyphos had been reduced in a cadaver, with rupture of an abscess, and in another subject with fracture of a vertebra. Some investigators are enthusiastic in favor and others condemn in round terms. Although there was probably a field for operation, it was necessary to proceed slowly.

Dr. Gibney said Dr. Townsend's patient was an exceptional one. Most patients seen offer no contraindication to the operation. He had not found that patients with a deformity of the spine were cheerful at the prospect of going through life with it. They were morose and felt that Nature had treated them harshly, and it was necessary to do something for them. If he had a child with such a deformity he would welcome almost anything which promised relief. He understood the dangers of the operation and was opposed to its wholesale performance. While fully appreciating the importance of what had been said, he thought that clinical facts were also entitled to weight. He believed that deformities could be materially reduced by the method, but that it should be done gradually at several sittings rather than all at once.

Dr. Gibney also presented a patient with "Lateral Curvature Treated by Forcible Reduction;" a girl fourteen years of

age affected with lateral curvature of the spine, whose parents had urged that something be done to correct the deformity, being willing even to have a section done. Under an anesthetic a twisting motion was employed for some five or ten minutes, and the patient was then put into plaster of Paris. She was treated three times. There had been no reaction. She had gained one and three-fourths inches in height and the back was in a much better position than it had been before.

Dr. Townsend presented a patient with. "An Unusual Case of Pott's Disease" in whom the deformity had not been attended by symptoms. The patient was a girl eleven years of age. Two weeks ago the mother, when giving the child a bath. had for the first time noticed a projection, which, on examination, was found to be at the tenth and eleventh dorsal vertebrae and so sharp that the case did not seem to be a favorable one for forcible reduction. The child was in good health and had had no pain or any other symptom and no history of illness. She was extremely active and could stand any amount of jarring. Excepting near the kyphos the spine was very flexible. There was also at the site of the projection a slight deviation to the right, but no sign of rotation.

Dr. Gibney recalled the case of a patient who, without pain and with no history of symptoms, presented a similar deformity of apparently rachitic origin. He had intended to annly forcible reduction.

Dr. Myers presented a bov seven years of age with Pott's disease of the third and fourth dorsal vertebrae, complicated with an abscess discharging in the neck be

the right sterno-cleido-mastoid muscle. The treatment had illustrated the effect of the supine position in securing good drainage. The spine had been protected by a brace, but the discharge was profuse and the temperature varied between 100 and 103°. When he was placed supine in bed, without a pillow, in two weeks the temperature dropped 2°. He was then allowed to leave his bed and the temperature soon rose to the former level. He was then returned to bed and

the temperature subsided as before. The discharge gradually decreased, and when it had nearly ceased he was allowed to be up. His general health was entirely restored and there had been no discharge for several months.

Dr. Townsend presented a girl three years of age with Pott's disease of the upper cervical vertebrae. There was an abscess the size of a hen's egg extending around the outer side of the sterno-cleido-mastoid, about half being deep-seated, the remainder superficial. Two-thirds of the abscess was posterior to the muscle, and over the swelling were a number of enlarged veins. The patient had been put on a frame, and the abscess would be opened without undue delay by an incision back of the muscle.

Dr. Phelps urged the importance in similar cases of early operation to prevent rupture into the pharynx and the occurrence of tuberculosis from the flowing of the infective material into the larynx during sleep.

Dr. Taylor presented a man, fortyseven years of age, with "Malignant Disease of the Spine," in poor general condition and giving a history of very severe pain in the lower part of the back for eight months. In that time he had lost much flesh and had been disabled by limitation of motion in the lumbar region of the spine and difficulty in locomotion and other movements of the body. The upper part of the back was rounded and the spine of the first lumbar vertebra was prominent and deviated to the left. There was a well-defined area of sweating in the right loin, probably from invasion of a sympathetic ganglion and vaso-motor paresis. This symptom was not present in tubercular disease of the spine, but he had observed it before in cases of malignant spinal disease. Partial relief would probably follow the application of a jacket, and morphine would be given to control the pain.

Dr. Sayre suggested the use of the actual cautery to temporarily relieve the pain.

Dr. Elliott exhibited an “Apparatus for Forcible Extension." It was an instrument which he had devised for forcible extension, especially for the reduction of

the congenitally dislocated hip. It was light and inexpensive, and consisted of a small rectangular frame about six inches wide and fifteen inches long. In the center of the long axis was an extension screw. To a cross-bar on this extension screw was attached preferably the ends of a skein of yarn which had previously been adjusted to the ankle of the patient. The frame could be affixed to any table or bed, and the force employed, the patient being firmly held by an assistant, could be regulated at will and, if desired, measured in pounds. The instrument, besides being used for reduction of dislocation of the hip as described, could also be conveniently used in the forcible. reduction of the spinal column in cases of angular curvature, the proper adjustments being easily made.

Medical Progress.

THE CYSTOSCOPE.-The cystoscope is a very useful instrument in the right hands, but it takes constant practice and experience to draw intelligent deductions from its use. Dr. B. D. Coates, in the Cleveland Journal of Medicine, writes that we may learn from its use:

"1. The condition of the vesical mucous membrane; the source and frequently the cause of hematuria.

"2. The condition of the ureteral lips, and whether urine is being conveyed from both kidneys to the bladder or not. If not, we may learn which of the two is the secreting kidney and observe the character of the jets of urine propelled from the ureteral cones, whether it be clear, murky or bloody.

"3. To collect the urine from each kidney separately for further examination.

4. To satisfy ourselves as to an existing constriction or obstruction of the ureter which would aid in guiding us as to what course we should pursue.

"To decide whether one or both kidneys be affected and to what extent each may be involved is a question that always confronts the surgeon who contemplates operative measures. Providing no obstruction of the ureter exist whereby the catheter cannot be made to pass beyond. I know of no greater aid to, nor better

method of determining the character of the excretion, nor for estimating the quality and quantity of the excreting tissue that each individual living kidney possesses, than by using the modern cystoscope, with the ureteral catheter adjustment. It would seem that cystoscopy of today is no longer an experiment. The surgeon who contemplates operative measures in any doubtful case of vesical or nephritic origin, before deciding what course he should pursue would do well to exhaust the light that the modern cystoscope may throw upon the apparently dark field, often of obscurity, uncertainty and anxiety."

HOW TO PRESCRIBE.-According to the North American Practitioner medicines that should not be prescribed in powders can be classified into (1) those that absorb moisture readily from the air; (2) those which form a fluid in combination with other substances, and (3) those that are decomposed by the oxygen of the air and change color. In the first class belong the acid phosphates and their derivatives, the phosphoglycerates. These salts put up in powders liquefy in twentyfour hours; also sodium bromide, which is extremely deliquescent; crystalized cal-cium chloride; strontium chloride; ammoniac citrate of iron and ferricopotassic tartrate; piperazin and lysidin; chloral, dry vegetable extracts, and, in general, all products prepared by evaporation in a vacuum, especially desiccated peptones and extracts of animal organs. The second group includes the substances that alone are not affected by the air, but, combined, absorb moisture rapidly; such as antipyrine and sodium salicylate. The third group comprises the alkaline and ferroalkaline iodines and the aristols. A little trick that sometimes prevents trouble is to add a certain amount of liquorice powder or cinchona; also to keep the powders in an air-tight glass jar.

measles. In both a maniacal delirium was the most marked symptom. This condition appeared in one case as a sequel on the twenty-first day of illness, and was ushered in by mental depression and attended by hallucinations. This patient gradually recovered. In the other mental troubles appeared with the invasion of measles and were of similar character to those of the former case. With the appearance of rash, which was delayed till the ninth day, the nervous symptoms began to abate, but pneumonia supervened and proved fatal. The ages were thirteen and fourteen years respectively. If these data are worth anything-and they are supported by the experience of other observers they teach the importance of the nervous element as a factor in the pathology and treatment of children's fevers. This is probably of more consequence at or about the period of puberty, though it can at no age be overlooked. It is likewise the more to be considered in connection with cases of delayed or "suppressed" eruption. In its therapeutic aspect it must necessarily remind us of the paramount value of measures to hasten the appearance of the rash and frequently also of a judiciously sedative treatment.

THE REMOVAL OF WAX FROM THE EAR.-According to the New York Medical Journal Alberto Ricci of Turin. has ascertained that the solution of hydrogen dioxide possesses the peculiar quality of rapidly disintegrating the obstructive masses of cerumen in the ear. It suffices to pour into the meatus auditorius externus a small quantity of the solution and leave it for a few minutes in contact with the ceruminous plug. The latter is then most easily and safely removed by syringing with water, even though it were a hard concretion.

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stored away for future use.

This seems a little amusing when it is known that long before bacteriology had become a full-fledged department of medicine, and before Koch ever dreamed of establishing a new school of this science, women all the world over used bacteriological methods in the kitchen and preserving-house, and put into practice a method which has only in recent years been thoroughly explained.

The thrifty and observing housewife too often noticed the mould on the tops of her jelly jars, imperfectly sealed, and soon knew enough to associate this foreign covering with the fact that the top of her jars were not tightly covered. The methods followed for many years has been to thoroughly clean the jar by heat and then to pour the preserved substances, while steaming, into the hot jars and then apply the covers, thus carrying on the process of ster

ilization as thoroughly as the modern bacteriologist would do.

While it is very praiseworthy for the intelligent woman to wish to know why she does certain things, and why a broken link in the chain of preserving results in spoiled matter, the so-called weaker sex has long ago drawn inferences to convince itself that some objects, wherever they came from, tainted the fruits put up, and carefully sealing prevented any harmful change.

It is a little like the cart before the horse when the modern bacteriologist sets out to teach woman what she knew long before modern bacteriology was brought to such perfection.

PHYSICIANS, as a rule, have. after several years of practice, a fair experience in prescription-writing, but unPrescription-Writing. less they have had some instruction in compatibilities and combinations they too often make grievous errors, which their friends the pharmacists correct. The knowledge of the solubility of many of the most important drugs is, to say the least, very meager on the part of many a man experienced in the therapeutical power of those drugs.

In this issue Mr. Henry P. Hynson gives a hint on the solubility of a very familiar drug, the iodide of potassium. It is, as everyone knows, one of the most soluble chemical compounds in the pharmacopeia, and yet few have known that what is called a saturated solution is not easy to prepare, and when an ounce of the salt and an ounce of water is prescribed more than a one-ounce solution results. Even when hot water is used the salt goes into solution easily, but the result is not what is intended by the prescriber.

This shows that a course of practical pharmacy is needed in medical schools to give the physician some idea of the appearance of the various substances so commonly used and the changes that take place in them by combination with other drugs. The use of tablets and pills already combined by the manufacturer has simplified prescribing and robbed the physician of many a patient, but some prescriptions must always be made up fresh, and it is here that some knowledge of pharmacy on the part of the physician is essential.