The Taylor splint is usually considered the best. The patient is measured and the brace fitted by the doctor himself. Some advertisers offer to relieve the doctor of this duty or to give him full instructions. A druggist might just as well advertise full instructions to the doctor how to write his prescription, and a doctor, after making the diagnosis, might just as properly send a patient to the druggist for treatment as an orthopedic case to the instrument maker. Neither druggist nor instrument maker knows anything of disease. These measurements usually suffice:-Take a point A. directly over the trochanter on the sick side, on a level with the anterior superior spines. Then take, 1. Circumference of the pelvis at A. 2. From A. to the opposite A. S. S.-anterior arm. 3. From A. to the mid point between the A. S. S. and the posterior superior spine of the opposite side-posterior arm. 4. From A. to 211⁄2 inches below sole of foot. 5. Circumference of thigh at middle. 6. Circumference of calf at middle. The lower part of the upright is made in two pieces so that the length is adjustable. The buckles for the perineal straps are placed: well out, so when the adhesive straps are tightened at the bottom it will not slip up and force the patient to walk on his foot. When possible, it is better to fit the brace to the patient while it is still in the rough. The sole of the shoe of the well foot is raised 2 1-2 inches. If the legs are of unequal apparent length the upright of the brace is adjusted so that when the patient is dressed the distance from iliac crests to bottom of brace and high sole are the same. The family and patient usually need constant reminder that the leg should be continuously on a stretch and that the foot should never touch the brace or the ground. The joint between the upright and pelvic band wears loose quickly and needs renewal; in general the brace needs watching for repairs. As a rule it is better for the patient to discard the brace at night, and by buckling the plasters to the spreader straps sleep in his old extension. The advantage of the splint is that it permits an out-of-door life, and this is emphasized to the family. If pain or spasm reappear or deformity increase, the child will have to go to bed again. If, however, he improve, the splint is worn until all muscle spasm has been absent for at least six months. Then he goes about on crutches with the high shoe on the well foot and the sick leg swinging, for a few more months, being given massage and passive motion and allowed a little active motion. If the motion gradually increase, and no pain or spasm appear-good-a long and hard battle has been won. THE CAUSES AND TREATMENT OF STUTTERING. BY DR. C. R. GROSSER, WILKES-BARRE, PA. Not having a very interesting case to report, I thought I would take up the subject of stuttering; causes and treatment as recommended by Drs. Gutzman, Kussmaul and other specialists in disturbances of speech. I have used these methods in four cases ranging from seven to thirteen years with excellent results. Often the distinction is not made between stuttering and stammering. According to Kussmaul, individual sounds are difficult for the stammerer, but not for the stutterer-with the latter the syllabic combinations offering the greatest obstacies. In stuttering a spasm accompanies the impeded utterance, but not so in stammering; and the greater nervous embarrassments underlie stuttering. Other differences are given by Kussmaul, but the one which is perhaps of most practical importance in making a differential diagnosis, is that stammering is very often accompanied by anomalies of the tongue, lips and articulating organs in general; while malformations, defects, paralysis, etc., are rarely observed in connection with stuttering, except that you not rarely find adenoid growths in the pharynx. This, whilst not directly the cause of the defective speech, it seems to be the point which reflexly heightens the excitability of the nerves which lead to the spasmodic condition of which stuttering has its origin. Normally, we talk during expiration. A stutterer begins at the end of inspiration just before expiration is about to begin, and in that case the diaphragm instead of going up for expiration, sinks lower and lower in a forced inspiration; the stutterer then draws a hasty breath to begin to talk once more, when normally expiration should occur, but does not. mechanism of the descent of the diaphragm, instead of its ascent, while many stutterers talk, has been demonstrated in X-Ray photography and may be plainly observed with the fluoroscope. This In advanced cases of stuttering, especially in young adults, they are usually dumb in the presence of strangers or under influence of the slightest excitement. They sweat and flush easily, showing an irritative condition of the sympathetic nervous system. When they project their tongues, a general tremor of the organ and a Fibriller tremor of the separate muscles of it may be observed. Knee jerks are lively and cutaneous reflexes are very active. There exists a general heightened irritative condition of the nervous system, having its highest expression in the spasmodic incoordination that occurs when they attempt to perform the rather complicated series of acts required for speech. In such cases, the prognosis as to a lasting cure is none too good, but can be distinctly improved by teaching them how to breathe properly. Many of the older writers claimed that stutterers are usually of a mental calibre lower than normal. This theory has since been discarded. The characteristic speech of the mentally deficient is a drawl, not a stutter. TREATMENT:-Speaking requires a form of breathing different from what we ordinarily employ. It requires especially a lengthening of the expiration. Normally, expiration and in spiration, as we hear it in the sound sleeper, are about equal. For speaking, inspiration must be short and quick, and expiration prolonged. This quick inspiration cannot be accomplished through the nose. In speaking, we breathe in and out through the mouth so that the first thing is to have our patients open their mouths and keep them open during the breathing exercises. Some stutterers' expirations are not longer than three seconds. In order to do anything with them, they must be taught to expire slowly, and it is not a difficult task. There are certain delicate people of highly organized nervous systems, who become faint and giddy. In such cases the breathing exercises must be taken up gradually. If we wish to effectually and easily teach the process of breathing, it must be carried out under consciousness; for this costal breathing is necessary so that the patients may feel the rise and fall of the thorax walls. Patient's attention must be directed to the rise and fall of the ribs, and especially taught to control the fall of the ribs, so as to have a constant supply of air at command. Younger children can be taught costal breathing by having them put their hands on your chest; note the rise and fall and ask them to imitate it. Costal breathing may be exaggerated and more air for expiration secured by certain movements of the arms, viz:lifting the hands out straight from the body; palms down and continue the upwards movement until the backs of the hands touch above the head, for if only the palms are brought together above the head, then there will be no enlargement of the thorax, as there is a compensating muscular mechanism that acts on the scapula. These simple exercises for breathing, taking care that the epiration is prolonged, need only take a few minutes each day in the beginning and gradually prolonged; they must be under control of the doctor, parents or friends, as well as themselves. Next, have the patient break inspiration up into several divisions, breathing in successive whiffs, to exercise the respiratory muscles in stopping and starting; then we have them expire in the same way, in a number of puffs, being careful that the breath is not held by the closure of the glottis but must be retained by the equilibrium of pressure between internal and external air Now comes the teaching of coordination in the use of the muscles necessary for vocalization. After the patient can prolong expiration, etc., he should breathe, first, audible, then whispering and finally vocalization or "talk out loud" always with simple sounds and always during expiration. SYMPOSIUM ON PULMONARY TUBERCULOSIS. BY DR. JOHN E. SCHEIFLY, EDWARDSVILLE, PA. Pulmonary Tuberculosis is universally the most dreaded of all insidious diseases, and in fatality is so destructive among the human race as to rob millions each year, not only of their lives, but causes unknown suffering in many homes. It is the most prevalent disease of modern times, and common as it is, we have accomplished little in proportion to its virulency, until recently by our new method of treatment. Modern science has fully demonstrated its curability, the possibility of its prevention and entire eradication. It is not merciful in immunity, as no race is exempt. The Indian who lived in the most favorable climate, and who for years was thought to be immune, is even found among its ravages. By Koch's demonstration and discovery of the tubercle bacillus in 1882, he revolutionized the former accepted views of its etiology. It is now conceded by all as the direct cause of Phthisis, but all medical men will not agree as to its mode of entrance and transmission into the body. This direct etiological factor of tuberculosis, the bacillus of Koch, needs no description, as the frequency of finding it makes it easily recognizable by all. Its channel of entrance into the body at the present time. is receiving considerable attention and study by some of the |