The strength of all movements of both limbs was decidedly poor in comparison to the bulk of the muscles. When she was examined (towards evening) extension of the left hand being especially so. When at all tired she has considerable difficulty, or may be unable, to fully extend the left forefinger. When the limbs are extended horizontally in front of her, the left finger begins to flex after about fifteen seconds; later the left elbow to flex.

Then both limbs begin to slowly drop and finally fall to the bed, after about thirty seconds, as she then says that she becomes so tired that she can not hold them up any longer. Each movement becomes very weak, and finally impossible to exhaustion of the muscles after it has been repeated in rapid succession for a considerable time. This full flexion and extension of the left fingers become slow and laborious after about twenty-five movements, or about twenty seconds, and full extension no longer possible after fifty-three, or about forty seconds. First, the movement becomes slow and weak, and only possible with effort, and this increases until the movement is finally lost. Flexion of the left arm against gravity is greatly exhausted after about forty attempts. The so temporarily paralyzed muscles recover quickly. When at all tired she finds it very difficult to continue any action beyond a certain time. All movements are much stronger and less easily exhausted in the day than towards evening.

There is no tremor in the horizontally extended arms; of all movements excellent.

Trunk: No definite weakness of the abdominal or spinal muscles; respiration is almost entirely thoracic, regular and fairly deep. She does not complain of getting out of breath too easily. Cough very feeble and becomes exhausted after four or six attempts.

Lower extremity: All movements of the limbs are fairly strong when first tested, but tire easily, but not so easily exhausted as those of the upper extremity. Raising the left limbs stiffly from the bed gets tired after twenty-five times, but not exhausted till about sixty attempts.

No tremor or involuntary movements in these limbs, and co-ordination is natural.

Gait: Quite natural, and does not seem to tire easily. Subjective: No numbness or tingling; complains towards evening of a general tired feeling.

Objective: No change of any form of sensation.

Reflexes Biceps 20, not easily exhausted by repeated taps; triceps, 20; K. S., brisk, reduced after 70 taps rapidly repeated, but lost after 150 in patellar tendon; A. J., no clonus; epigastric, normal; abdominal, normal; plantar, flexor.

Sphincters: No affection.

Treatment: Seemed to avail little. I gave 1-30 gr. strychnine, massage, and the interrupted current of galvanism.

A REPORT OF SOME CASES FROM THE SURGICAL CLINIC OF THE ATLANTA COLLEGE OF PHYSICIANS AND SURGEONS.

By J. L. CAMPBELL, M.D., ATLANTA,

In reporting these cases it is not my intention to give anything new or rare, or to report any work out of the usual line, but to give you an idea of the work done at the college clinics. The results obtained are uniformly good, as far as can be expected with the class of cases we have. The wounds heal as readily as in the modern sanatoriums and hospitals, and pus in a clean case is almost unknown.

Of course, I do not mean to say that the same class of cases can be operated on at a college and done as successfully as at a well-equipped hospital, although appendicitis, abdominal tumors, and, in fact, almost any operation that can be performed anywhere has been done successfully at the college; the more perfect the surroundings, however, the better the chance of recovery becomes.

The nursing in the clinic cases is generally done by a relative or friend of the patient, and is of the most rudimentary kind.

The dressings are prepared by the students who may have been in the dissecting-room less than an hour before. The pledgets of cotton used for sponges are prepared and sterilized the day before using. The vessels and pans are also sterilized by steam. We are careful to cleanse our hands thoroughly, and to see that the students assisting

in the operation do the same. No attempt is made to do aseptic work, but bichloride of mercury, sol. 1-2000, is used freely for sponge and to irrigate the wounds except, of course, where it might be absorbed and cause poisoning.

A solution of cyanide of mercury 1-2000 is used for the hands during the operation, as it is an excellent solution to remove blood.

The patient seldom gets any preliminary treatment or preparation before the day of operation, but great care is taken to prepare the field of operation just before beginning.

It would be impossible in the limited time I have here to give anything like a detailed report of the work done at the surgical clinic, so only a few cases will be reported, those selected being from the Saturday clinic, and all except one operated on during the session just closed.

Case No. 1-Traumatic Empyema.—Mr. I. J. C., aged thirty-five, white, Henry county. In March, 1904, was knocked down and stepped on by a mule. The seventh rib in the anterior axillary line, left side, was broken. He suffered a great deal from pain and nervousness, running a temperature of about 1021⁄2 for two months from the time of the accident. He then noticed a bulging of the left side. His physician aspirated three times in the next month and got about three pints of pus altogether. In June Dr. Smith, of McDonough, sent him to me. I saw him at the college, where he had been carried from the train. He was emaciated, weak and livid. He was given a hypodermic of morphine and strychnine. A hypodermic needle was introduced into the chest at the seventh intercostal space and a milky-looking pus was removed. Then with a 2 per cent. solution of cocaine I made a free incision at the scar made by the previous

aspirations, and removed nearly a gallon of pus. A large drainage tube was inserted and the cavity irrigated daily for about a month. He was able to be up in a week or ten days after the operation and came to the college to be dressed from that time until he went home, where some of the relatives attempted to irrigate and dress him. They failed, however, and he came back in August in almost as bad condition as at first. I then resected three ribs, intending to resect six, but he took the ether badly and had great shock, so it had to be given up. The cavity was packed with about two yards of iodoform gauze. He reacted well, and four days later was given a little ether and the whole pleural cavity mopped with pure carbolic acid, followed immediately by alcohol, then wiped out with moist gauze, packed lightly and dressed as usual in such cases. From this time the cavity was irrigated and dressed as often as needed. He made a complete and uninterrupted recovery and was perfectly well by November 1, 1904, nine months from the time of the accident.

Case No. 2.-Tubercular Elbow Joint.-A young man from Florida, a student here in the Southern Shorthand and Business University, came in complaining of pain and swelling in the left elbow, and could not get the arm straighter than about 145 degrees. On examination the arm was found thickened around the joint and a small mass above the olecranon fossa. Dr. F. W. McRae operated on him and found the bone beneath the mass and in the olecranon fossa bare but not necrosed. It was cleansed out and packed with gauze and the arm put in plaster of paris. The wound was well in two weeks. The arm was then put in a plaster of paris cast, cut so that it could be removed and the arm given passive motion. When I heard from him last he was greatly improved.