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perextension, thus giving absolute rest to the paralyzed muscles. Fractures at the elbow and wrist were not uncommonly fol- lowed by neuritis and consequent deformities in the hand and fingers. Time largely must here be relied on for cure. The hot douche, active motion, and massage were the best agents we had to aid in recovery. The suture of nerves divided at the wribt gave brilliant re- sults when skillfully done. The questions as to the nervous origin of rotary lateral curvature of the spine he would not speak on decisively before so many neurologists, but would pass on to the deformities of the lower extremities, many of which that were known as distinctly neurotic were treated by ortho- paedic surgeons. Many reflex paralyses and contractures producing deformi- ties and disability in these parts could be cured by blistering the spine ; many others could be traced to irritation in distant parts. An excellent illustration of troubles that were due to irritation at a remote point had been sent him by a surgeon in Belfast, Ireland. A little girl of ten years had had a persistent cough, so that spurious pertussis had been diagnosticated. There had been no elevation of temperature. The cough had continued for two weeks, when a fire had broken out in her bedroom, frightening her badly and causing the cough to dis- appear. Its place had been taken within a few hours by pain in her right hip joint, shooting pains throughout the distribution of the anterior crural nerve, and painful reflex spasm when ad- duction and abduction were attempted. The pain bad increased for four or five days, when the temperature had risen to 102° F. ; an abundant herpetic eruption on the thigh, knee, and leg had broken out, and much tenderness had appeared over the fourth lumbar vertebra. The eruption had continued for fourteen days, and with the temperature had as suddenly disappeared, leaving, however, the thigh wasted, pain on extreme exteasion, and pain over the trochanter and the crest of the ilium. This had appeared to some to indicate a neurosis of the hip, and to others an osteitis of the hip. However, the limping in the walk I April 27, 1889. PROCEEDINGS OF SOCIETIES. 469 had nearly disappeared in six months, though weakness had persisted in the joint for nearly a year. Finally, the mystery had been solved by the discovery of a i)iece of needle in the right foot, and complete relief had followed its extraction. Keflex disturbances were especially to be looked for from affections of the ear, nose, eye, and genitals; also from those of the intestinal tract. The numerous contributions to literature by men working in these special fields had simplified therapeu- tics and increased the accuracy of diagnosis in these disorders of reflex origin. It was now difficult to deal charitably with a surgeon who put a splint on a muscular deformity depending on a neurosis. The management of such deformities must largely consist in the management of the neuritis. Taking up muscular deformities depending on central le- sions, the speaker remarked that they were generally amenable to simple methods of treatment, but that this did not restore the function of the limb. The question of cutting or stretching tendons was an open and disputed one. From his own obser- vation, he saw no reason to condemn the practice of cutting; correction of the deformity was certainly obtained. Among meta-hemiplegic disturbances he would mention drop-wrist and di"op-foot. In the case of the first the only means of relief he knew of was the mechanical support of the hand, since its weight alone was enough to cause the paralyzed muscles to let the wrist fall into its characteristic deformity. Buy Sildalis For spastic contraction of the lower extremities he relied on subcutaneous division of the adductors of the thigh, the flexors of the leg, and the extensors of the foot, with confine- ment of the limb in an overcorrected position for many weeks, and instructions for associated movements at home. The aeti- ology of the affection was to be studied, of course, so that any discoverable factors in the causation of the spasm could be eliminated. The results from this method of treatment had, on the whole, been satisfactory to the parents of the children in whose cases it had been employed. He made no effort to secure the management of such cases. The muscular deformities most diflScult to treat arose from diseases in the spinal cord. He treated the deformities arising from compression myelitis consecutive to Pott's disease by fixa- tion, prolonged rest, prolonged administration of iodide of po- tassium in large doses, and, in the older patients, by the use of the Paquelin cautery lightly applied along the spine. He used no electrical treatment whatever. Dr. Weir Mitchell had lately revived an old method used by his father, which consisted of daily suspension, lasting from a few minutes to several hours. In England the plan of cutting down on the cord at the point of compression and removing the thickening of tiie mem- branes which caused it was being tried. So far as his observa- tion went, tension obtained by pulleys was as etficient as that

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