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it is impossible for patients to come for skilled mas- sage and electrotherapeutics, daily treatments of a certain kind can be instituted by simple instruction to the parents regarding .giving massage and elec- tricity, and a brace may also be fitted. Where spe- cialists are to be employed it is now generally con- ceded by all that these patients do better with the orthop.iedic surgeon than with the neurologist. Just a few words about the operative treatment and then I am through. No case should be con- sidered as a surgical proposition until at least eight- een months have elapsed, and better yet is it to wait two years. No case should have any surgical inter- ference no matter how long after the original at- tack while any spontaneous megatouch funky monkey game online recovery is .going on. The surgical procedures are three, namely, tendon I'OI'E: SYPHILIS. transplantation and fixation, arthrodesis, and nerve grafting. The last named is the least desirable, as so far the results obtained in most cases leave much to be desired. However, it is worthy of trial if everything else has failed, or if the other two sur- gical procedures are found impracticable. Arthrod- esis is preferred by many as better even than megatouch funky monkey online ten- don manipulation. This view I do not share, preferring the latter download games online ru funky monkey slots where there is a chance of suc- cess. The operation of arthrodesis consists simply of removing the cartilaginous surfaces of articulat- ing bones and holding them in the position desired by plaster of Paris bandages until firm ankylosis i> secured. This operation, like any other surgical procedure, must be done under the strictest aseptic precautions. Arthrodesis is sometimes combined with tendon transplantation. The technique of ten- don transplantation is too involved to go into a gen- eral paper as this is. A few pointers however about this procedure are these : It should be done under an Esmarch bandage when possible. It should only be done after all deformities and contractures have been corrected. Too much should not be attempted at once. .Small normal muscles should not be ex- pected to take up the work of larger paralyzed ones besides their own. .\fter the operation, when the plaster of Paris bandage has been removed from the limb which, following the play funky monkey barrel game online free operation had been put up in an overcorrected position, a light brace should be worn for a while and massage and elec- tricity continued for a variable while. Muscle edu- cation must also be commenced again. i6o West Oxf. Hcxdred .vnd Sixth Street. AX INSTRUCTIVE C.\SE OF SYPHILIS. FOL- LOWED BY P.^RESIS. By Curr.^x Pope, M. D., Louisvilh, Ky., Former Professor of Nervous and Mental Diseases, Louisville Medi- cal (^ollc^c: funky monkey game online barrels .Medical Supcrinlcnuem. The Pope Sanntoriuni. In the long retrospect of the practice of two dec- ades, when one looks backward through the vista of experiences, certain cases are apt to stand out with startling clearness, to be impressed upon the memory indelibly. Doubtless every physician has to suffer, to suffer intensely for those real errors. for the sad mistakes he makes, to wish profoundly that things might have been otherwise, that his view might have been clearer, and his prophecy more prophetic. These mistakes are indeed the ■"slings and arrows of outrageous fortune" that gall and irritate, that serve to teach yet greater care, nvire thought fulness, and deeper study, but to suffer for what we reasonably know to 1)C the truth, to know that we are maligned for our truthfulness, cursed for our knowledge, makes us realize of what strength must have been the cour- age, moral anrj physical, that uplifted the martyrs during the hours of their trial play funky monkey online free and tribulation. One would indeed lie untruthful were he not to confess "to a feeling of pride, a pleasant glow of satisfaction upon finding that he is correct after the lapse of many years, to see the fulfillment of his diagnosis, to kfww that he was correct. This would play funky monkey barrel game online indeed transcend the justified feelings of professional satis- faction were it not for the sad terminations that marked the outcome of the diagnosis, to funky monkey slots free feel that after all a human being suft'ers, when things might ( ?) have been so different. One's recollection of his own indignation and what he underwent, tem- pers his feelings to the "shorn lamb's." But let us put aside our retrospective musings and come to the more interesting details of the case in hand. .\bout a decade ago, I was asked to see a case by a brother practitioner. It was, alas, one of those instances where the family forced the consultation and selected the consultant ; so much the worse for me. Totally unaware of the hidden and smoldering fires beneath the volcanic crust upon which I so cheerfully walked, I promptly complied. I was not enlightened by the medical advisor or family, with which explanation I record the case. The anamne- sis ran as follows : ' Case. A man of business, aged fifty-two years, had been complaining for a number of months of anomalous symptoms largely pointing toward the nervous system, es- pecially the brain. He was married, his wife was living, and of the union five children had been born, one prema- turely ; one lived a few weeks, and the other three aged respectively eighteen, sixteen, and eleven years were living. The oldest, a girl, was nervous and had had "minor" hys- terical attacks ; the boy, aged si.xteen, was strong, well i)uilt, intelligent, and healthy : funky monkey slot the boy, aged eleven years had had acute articular rheumalism and an attack of chorea from both of which he had seemingly recovered, although his growth was hardly up to my idea of a boy of that age. The patient was about five feet, eight inches in height, weighed usually 150 pounds, but at present weighed 14S pounds, gross (unstripped). He was dark skinned, mark- edly so of face, the skin play funky monkey online being rather dry and leathery looking. He had badly shaped ears, irregular eycbrou.s. widely set eyes, and a more active innervation of one side of his face, that gave him a peculiar expression A\hcn his face became mobile. He was able to give a very clear ac- count of his life. He came of funky monkey slot game fairly gRod stock, though two maternal aunts had had tuberculosis. The pulmonary form was fatal to one, but the other made .i complete re- covery from the bone tuberculosis, which attacked the tibia ; funky monkey game free online curetment and subsequent treatment proving efficient. On the paternal side one individual had died insane but he could not give details as the relative Ii\ ed in funky monkey game play online a distant State. His father and motlicr had liecn both healthy ; the mother having free online funky monkey barrel game died of pneumonia, the father beiiig yet alive, active, and in possession of all his faculties at the age of seventy-nine years. The patient himself was healthy as an infant, was funky monkey online game breast fed and grew rapidly. He lived on the farm until his twelfth year when his parents re- moved to the city, where he had resided ever since. He had had little education : country school and a few years in the primary branches of the city school svstem. Had been ambitious and read a great deal so as to "educate him- self, taking especial pride in "keeping up with events." He had been rarely sick, measles, mumps, and cliickenpox. he remembered. He started as a clerk when about sixteen or seventeen years funky monkey online free games of age. Was always industrious and sober, in fact drank practically nothing until ten or twelve years ago, when fortune smiled on him. He then began to .seek more "relaxation," which included free indulgence at table, and gradually increasing consumption of alcohol in all its forms. Had always used tobacco excessively, both chewing and smoking Denied any genitourinary infections, any specific disease or any opportunity for the contraction of same, claiming he came to the marital bed in a state ot virginity, and had never lapsed subsequently. Had al- ways gotten along well in his family. During his early married life there were no children, assigning "financial reasons" as the cause, although both he and his Wife really wanted children "to bless the union." He had always been of a rather quiet religious type and fairly regular church attendant. About two years ago he began to lose his health, funky monkey slots review first noticing some "indigestion" with an accom- panying insomnia, the "result of the stomach trouble."

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