8th-Pa skin is uninvolved. There is no pain nor ten- | Femur, with Effusion into the Knee-joint.derness, no fluctuation nor pulsation, nor is Elizabeth B, æt. 15, was admitted on October there any impulse on coughing. There is no 4th. Ten days ago the patient, who lives with dimpling nor retraction of the nipple. The her aunt, was stooping to pick up something glands in the axilla are not affected. Two from beneath the bed, when she suddenly felt days after admission (January 11th) the patient a sharp pain in the knee. She is stated never was under the influence of ether, and Mr. to have been ill before. Her temperature, on Bloxam made an oblique incision, under anti- admission, was 102.2 Fahr., and the kneeseptic precautions, about three inches long, joint was hot and a trifle swollen. Ice-bags along the axillary border of the left mammary were applied. 5th-Morning temperature 103° gland. From this wound a mass of tissue was Fahr., evening temperature 101° Fahr. Paremoved, about the size of a pigeon's egg. tient passed a bad night, and has no appetite. On section, this was found to consist of dense Tongue furred, and bowels confined. She was fibrous tissue scattered about, in which were a ordered to take infus. sennæ comp. 3iss. 7thnumber of cysts, containing a dark-brown The knee is about the same. Her temperature viscid fluid, which was not at all offensive. The in the afternoon was 103.2° Fahr. wound was then closed by means of horse hair tient passed a restless night, temperature 103.3° sutures, and a drainage-tube inserted. Tem- Fahr. The joint is more swollen and someperature some hours after the operation 99.2° what easier. 11th-Patient passed a better Fahr., pulse 78.. The wound was dressed on night, temperature 101.2° Fahr. She comthe 14th, when it looked healthy, with very plains of pain in the right groin. The tongue little discharge. Temperature 101° Fahr. is cleaner. The swelling seems somewhat less. Patient feels comfortable, and there is no pain. 17th--Patient's condition remains about the 23d-Sutures were removed to day; everything same. She has required sleeping draughts on is proceeding satisfactorily. Patient left cured two or three occasions. The swelling of the on the 25th. knee is less, but the lower part of the thigh is very tender to the touch. The temperature has returned to normal. 25th-There is a good deal of thickening around the lower part of the thigh, but not much pain. The synovitis of knee has practically disappeared. Poultices and fomentations were constantly applied. No fluctuation could be detected. No further elevation of temperature took place, and the thickening gradually diminished. Patient was discharged, as an in-patient, on November 14th. Inflamed Inguinal Glands, consequent on Irritation from External Hemorrhoids.— Ellen N-, cook, was admitted on December 11th, complaining of swelling and pain in right inguinal region. She says she has been suffering from piles for two years, and has now some inflamed, external piles. Three or four days ago she had to lift a heavy pan off the fire and the glands began to swell two or three hours later. The next day the enlarged glands became painful and hot, and continued to increase in size, until her admission to the hospital. She had an ulcerated throat three months ago, and this has recurred since. Patient is anæmic looking, but says her general health is good, and menstruation is regular. She was kept in bed, and her bowels opened by means of laxatives. The swelling at once began to decrease, and the pain disappeared. Her temperature was never above normal. She left cured on the 19th. The case is peculiar, because the patient notices that when the piles become inflamed she has lumps in her groin, generally on the right side near the body of the pubes, but they had never been as large nor as painful as on the present occasion. Case of Acute Periostitis of Lower End of | Case of Paraplegia of doubtful Origin.Alice D—, æt. 20, domestic, was admitted on October 9th. She is suffering from loss of power in both legs, below the knee; she can both flex and extend the knee, but is unable to walk. Patient complains of pain over the internal malleoli of both legs, also just above the patella-this is worse in damp weather, and is increased by pressure. The right leg is slightly flexed on the thigh. She says she has pain occasionally of a shooting character in the epigastric region, usually in the morning after taking food. Patient is very stout, and this seems more marked about the legs. Both hands are weak and tremulous, the left being the worse. The catamenia is regular, and there is nothing abnormal in the heart or lungs. Patient says she enjoyed the best of health until she was sixteen years of age, when she | Elizabeth H—, æt. 25, married, was admitted gradually began to feel weak, and apt to fall April 19th. Patient has one child, three years down, and she had to give up her situation in old, and three weeks ago she was prematurely consequence. The following week she had confined of another at seven months. Patient some sort of fit, on recovering from which she is a pale, cachectic-looking woman. At the found herself unable to use either leg, from the edges, and under surface of the tongue she has hip downwards. Both arms, as high as the several shallow, sloughy-looking ulcers. The shoulders, were likewise affected, the muscles tongue itself is enlarged, red, and the epithewere relaxed, with the exception of the flexors lium is absent in patches. The right side of of the left forearm, so that the fingers of the the tongue, towards the centre, is elevated and left arm were pressing into the palm. She was indurated. Several glands in the neck, and then an in-patient at the Lambeth Infirmary, groin, and around the elbows are enlarged. and the battery was used at intervals. For- Patient says the ulceration commenced some merly she had the same pain about the six months ago as a round nodule, situshoulders, elbows, and wrists as she now has inated on the tip of the tongue, after a time this opened in the centre and then spread. No active treatment was adopted at this time on account of her being pregnant. A lotion of seven grains of bi-cyanide of mercury to half an ounce of water was ordered to be applied to the ulcerated surface every morning. Patient complains that this gives her great pain, so it was ordered to be used every other morning, and she was put on a mixture containing 15-grain doses of iodide of potassium with 3iij of tincture of bark, to be taken three times a day, together with 5 grains of quinine, in a powder, to be taken every day at noon. May 8th-The patient has decided signs of phthisis, and the conclusion was arrived at that the ulceration was tubercular. The above treatment was, therefore, abandoned. Temperature last night 102.6° Fahr., this morning 99° Fahr. The glands of the neck are smaller and the tongue is less swollen. Glycerine of borax was substi the legs. For some time after the "fit" she was unable to retain her urine, which dribbled away, and this continued for some months, but she gradually improved, and in six months she had recovered the power. There was also general anesthesia of both the arms and legs when first affected, but under the use of the battery the sensation first returned, followed later on by the power of movement in the arms and in the legs as far as the knees. Eighteen months after her first attack she was able to sit up and use her arms a little. Strength gradually became restored to the arms, but even now they are far from the normal standard. Her father died of heart disease, and her mother of dropsy and bronchitis. Brothers and sisters are healthy, with the exception of one brother who is consumptive. Patient was ordered to walk a little,' with assistance, every day. She complains of great fatigue after walking a few steps. Galvanism was prescribed, one pole being ap-tuted for the bi-cyanide of mercury, as an applied to the lumbar region. 20th-Patient is now able to walk across the ward, leaning on one person's arm only. November 1oth-Patient can now stand up and do a step or two quite alone. 27th-Yesterday patient fell while taking a little promenade, and afterwards complained of great pain in the left leg, which gave way and caused the accident. She seems to have lost all power in the legs once more, and can neither stand nor walk. The same treatment was continued. December 7th -Patient has begun to pick up again and can now walk a little. 20th-The improvement has continued and she can walk a little with the help of a nurse. Patient was discharged, on January 4th, very much improved in health, and able to walk with the help of sticks. Case of Tubercular Ulceration of Tongue. plication for the tongue. 23d-The condition Patient was GASTRALGIA. WINTER PRURITUS. B. Tinct. stramonii Tinct. hydrastis Aqua lauro-cerasi 3ss. Ziiss. Dr. W. F. Corlett (Cleveland Medical Gazette) says, as this annoying affection is merely a local neurosis, internal medication M. Sig.—One teaspoonful in water every four avails but little except in severe cases where hours. the paroxysms of itching occur several times during the day, when hydrobromic acid may be used with marked benefit. It is by local measures, however, that we are effectually able to control it. At the outset of a paroxysm apply caustic potash in strength varying from x to xxx grains to the ounce of water, to which a drachm of glycerine may be added, after which the following ointment should be employed:- Dr. J. A. Batte (Mississippi Valley Medical Monthly) has obtained excellent results from- B. Creasoti Ol. terebinthinæ Resorcin Gum arabic Aqua. In mild cases, by omitting the caustic potash, the following lotion will be sufficient: B. Menthol Acidi carbolici M. Sig. One teaspoonful every four hours. PEDICULOSIS. INTERTRIGO. B. Pulv. camphoræ . Bismuth subnit. Plumbi carb. Ung. zinci oxidi benz.. gr. xx. 3j. CYSTITIS. Sig. Rub well into the affected surface. GASTRIC CATARRH. Professor Da Costa often orders B. Argenti nitratis Ext. hyoscyami M. Ft. pilula No. xii. gr. ij. three hours. Sig. One pill three times a day. SUBACUTE RHEUMATISM. Dr. A. J. Conger (New England Medical Monthly) recommends B. Potassii iodidi Vini colchici seminis Ext. hyoscyami 3iiss. 3j. f3iv. 3ss. 3j. 3v. M. Sig. One teaspoonful, well diluted, every four hours. M. Sig. One teaspoonful in water every four hours. |