the muscular fibre had degenerated as shown in ac companying diagram. Advanced stage of fatty degeneration of muscle. Transverse striæ have disappeared. Oil granules and globules. any, with but very This patient is still under observation and treatment without any improvement, and, if slight loss of power and weight. The characteristic phenomena presented by the case, are: 1st. The progressive muscular atrophy, probably supervening upon an attack of diarrhoea during the second summer. 2d. The very gradual loss of power, first exhibited positively, in the tendency to fall forwards when walking. 3d. The regular development, in form, of the osseous system, and of the intellectual faculties. 4th. The total absence of electro-sensibility, except in a few muscles, and the retention of motility. The marasmus essential of some French authors is precluded, as well by the absence of electro-sensibility as by the microscopic appearances-this disease being characterized by simple atrophy of the muscular tissue, without metamporhosis. Infantile or atrophic paralysis is also precluded by the absence of electro-sensibility, retention of voluntary powers, the universality of the atrophy, and persistence in the gradual process of the disease, continuing through such a long period without unfavorable result. Though the picture of progressive muscular atrophy seems sufficiently distinct and definite, yet the case presents several novel and interesting features. Diminution of muscular power is well marked throughout the entire system of voluntary muscles, excepting those of mastication and deglutition, yet this power does not seem to be appreciably affected by either cold or moderate exercise, and the sense of cold, which Duchenne says is a real diminution of temperature, is absent. The variation in the temperature of different localities is sufficiently marked to attract attention. The fibrillary contractions, which Meryon never saw, which were absent in one-fifth of Duchenne's cases, and present in all but two of Bazire's fifteen cases, and which, according, to Trousseau, are "often present," are wanting. Trousseau's editor suggests that this symptom is absent in all cases where the anterior roots of the spinal nerves are unaffected, which, if true, would lead to the conclusion that this case had not yet advanced to that extent, and would seem also to indicate that the muscles were the primary seat of the disease. From the imperfect history of the case it is impossible to determine in what member, or in what anatomical subdivision of the body the disease first made its appearance, yet it seems to have demonstrated itself first in the muscles of the trunk, contrary to the experience of most observers. When it does first attack the trunk, the course of the disease is, according to Duchenne, as follows: Trapezii first, and in succession the Pectorales, Latissimi dorsi, Rhomboidei, Levator anguli scapulæ, extensors and flexors of the head, sacro-lumbales, and abdominal muscles, yet, in this case, the Trapezii, Latissimi dorsi, and levator anguli scapulæ only respond to electrical excitation. The atrophy or wasting is uniform, at least in all the superficial muscles-thus preserving the symmetry of the figure, and seems to have attacked the muscles affected simultaneously, and progressed pari passu in all, on both sides and in upper and lower extremities, for there is no deformity, no irregularity of osseous development, no departure from the usual form, excepting the anterior spinal curvature, consequently the modifications of the shape and the changes in the attitude of parts, so characteristic of the disease, are absent. Trousseau (p. 300, vol i. Clinical Medicine) asserts that the disease rarely attacks females, and that there is no case on record in which it has become general in a female, but his editor, in a foot note, briefly refers to a case of a woman then under treatment, in whom the atrophy had "so far advanced that there is wast ing of the intercostal muscles and complete atrophy of the tongue, with difficulty of deglutition and respir ation." The case under consideration is certainly another exception to the rule, as laid down by Trousseau. Not only is it rare in females, but also in children. Meryon reports eight cases, four being brothers in the same family, and the other four belonging to only two families, Adams one, and Hillier three, two being females, one being three and a half years old. But the most interesting and novel feature of the present case is the existence of advanced degeneration, the total absence of electro-muscular contractility, and the retention of voluntary power. It is perfectly clear that an advanced stage of degeneration, even fatty metamorphosis, may co-exist with voluntary power in the same muscle, for there may be healthy and fatty fasciculi in the same muscle, but it is not clear that voluntary power can be retained in a muscle which has advanced so far in the process of degeneration that no response can be elicited to a battery. Duchenne says (Trousseau's clinic, p. 281,) that "voluntary muscular contractility remains normal unto the end, even in the most advanced stage of the disease, in those fasciculi which have not undergone a morbid change," from which view Trousseau dissents, believ ing that a muscle may lose "its contractile property in consequence of certain modifications of structure antecedent to fatty metamorphosis, and refers to the report of a microscopic examination (p. 277) by M. Robin, who never met with the "maximum stage of fatty matamorphosis." This question could be, perhaps, explained by the extraction of a fibre from one of the muscles retaining electro-muscular contractility, but the friends of the patient decline any further investigation. ON THE INTRODUCTION OF SUTURES INTO THE BY CHARLES F. RODENSTEIN, M. D., Westchester, N. Y. On the first of January of the present year, I was called upon to assist in the performance of a Cæsarian Section. After the extraction of the child by the operator, I was requested to close the wound. Profuse hemorrhage followed both the abdominal and uterine incisions After the womb was emptied of its contents it did not contract. The lips of the wound stood wide open, and blood continued to flow from the uterine vessels. I carried silk sutures through the whole thickness of the uterine wall, and by closing the wound firmly stopped the hemorrhage. After removing the blood which had escaped into the abdominal cavity, I closed the abdominal wound in a similar manner. When the operator returned to the bedside of the patient he disapproved of the introduction of sutures into the uterus; and to remedy the apprehended evils of this procedure he opened the abdominal wound on the third day, and removed the sutures from the womb. Such are the circumstances which suggested the subject for this paper. When I closed the uterine wound with silk sutures I acted on the spur of the moment. The womb lay before me with its gaping wound, and the blood |