and then again when it occurred in females with any uterine disease, the pain was most severe in the top of the head.

There were pains also of a rheumatic character, a marked nervous depression, loss of appetite--in fact the nervous symptoms were ordinarily out of all proportion to the other symptoms. After a period of time varying from a few hours to ten or twelve days the fever subsided and was sometimes followed by free perspiration or copious discharges from the bowels. In my own work, I met with many cases of dysentery. The catarrhal symptoms do not all subside with defervescence, but may and generally do outlast it for some time. In many cases the cough has lasted for months, and to the writer the development of a few cases of phthisis appeared to be directly traceable to an attack of la grippe. The vitality was lowered in many subjects to such a degree as to produce a condition favorable to the development and growth of the bacillus tuberculosis.

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The complications and sequelæ of la grippe were in many cases of more importance than the disease itself, and the most important and most common of these are the inflammatory diseases of the lungs and bronchi. In cases of already existing pneumonitis or bronchitis should la grippe attack the patients, these diseases rapidly assume an asthenic type, the vitality being quickly lowered, and the death rate more than doubled.

Where pneumonitis or bronchitis develops in patients suffering from la grippe, these diseases ordinarily assume the catarrhal type, with a very grave prognosis.

The pulmonary complications cannot be diagnosed very early, owing to the masking of the physical signs.

I have seen cases of la grippe progressing with the ordinary physical signs of a common coryza, when gradually the pain in the lung would become localized, the rales more distinct, and perhaps on the next examination a small portion of the lung tissue collapsed and inflamed.

Some authorities, among them Dr. Graves, hold that a kind of paralysis of the lungs takes place, and attribute it to an affection of the vagus, contending that the virus producing the disease acts upon the nervous system in general and upon

the pulmonary nerves in particular. Be this as it may, we do find the disease frequently complicated by affections of the lungs and respiratory apparatus in general.

Cases of Bright's disease are apt to rapidly prove fatal when attacked by la grippe; so also cases of tuberculosis, and pregnant women are apt to abort.

Diagnosis. This can usually easily be made, owing to its epidemic prevalence. The first cases might easily be mistaken for non-specific catarrhal diseases, but these lack the characteristic depression, neuralgic and rheumatic symptoms.

In none of the catarrhal diseases are those symptoms so marked as in la grippe. The depression and asthenic condition which appears early in la grippe are either absent entirely, or begin much later in the progress of those diseases.

Prognosis. In uncomplicated cases of la grippe, the prognosis is good; but some epidemics have shown the opposite of this rule. Where la grippe develops in cases of other diseases, especially any of the pulmonary affections, the prognosis becomes much more grave.

In all epidemics the death rate in the thickly crowded cities has been fearfully increased, in many instances being doubled.

Where tuberculosis already exists, the disease runs its course much more rapidly than it had done previous to the onset of la grippe. In persons predisposed by heredity to tuberculosis, the disease has developed promptly after an attack of la grippe. Thus in both instances confirming the position taken by Dr. Graves already referred to, that the disease seemed to have an affinity for the pulmonary nerves in particular, interfering much with the nerve supply and of course with the blood supply of the lungs, thus preparing fully a "soil" for the development of the bacillus tuberculosis.

I have seen many cases confirmatory of the position taken, and the mortality statistics of the large cities will show that the number of deaths from lung troubles of various kinds, and especially from tuberculosis has been doubled in the last two years (1889 and 1890) during the winters of which la grippe has prevailed. Although in uncomplicated cases of la grippe the prognosis is good, yet no time can be fixed as a date within which recovery will take place. Every case is a rule to itself.

Relapses are common. One attack, instead of securing immunity against another, appears to predispose to another. The system appears to be put in a condition favorable to the development and growth of the virus.

Treatment. To sum up in a few words, the treatment from the beginning must be supportive. Anything looking to depletion must be avoided. The nearest approach to anything of that kind must be a free mercurial purge in the beginning of the attack. At the time a case of la grippe is usually seen it is necessary to administer in addition to a purgative, antifebrin or phenacetin for the purpose of reducing the temperature and relieving the muscular pains that are such prominent symptoms in the disease. These remedies are doubly beneficial by also producing free diaphoresis, and thus relieving the other excretory organs. Antifebrin may be repeated as needed during the progress of the disease, in doses of from 5 to 8 grains for adults, and proportionately reduced for children. Quinine is also demanded in moderate doses. A favorite combination in my hands and one that appeared to me to act finely in most cases was the following: R Cocaine, pulv. camph., aa. gr. iv; antifebrin, 3j ; quiniæ sul., caps. no. XX. S.-One every two hours till the relieved; then from four to six hours as demanded. In those cases where the rheumatic element was well marked I found salicylate of quinine of much benefit. Hot drinks were found useful, so also whisky in the form of toddy, milk punch, or eggnog.

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The complications, or disease upon which la grippe was engrafted, were treated of themselves, but always keeping in mind the known tendency of the disease no matter what its name, when existing with la grippe, toward an asthenic condition.

I might go more deeply into details as to the cough and special neuralgic symptoms, but in view of what has been already stated I deem it unnecessary. Opiates, as a rule, are not needed, antifebrin or some of the coal tar derivatives usually sufficing for the relief of pain.

After the first mercurial purge, the bowels should be kept open by any mild purgative.

Tr. aconite, macrotis, belladonna and other remedies have been recommended as specifics, but trial has demonstrated their want of efficacy. It is important to keep severe cases of the disease in a warm, well-ventilated chamber, out of drafts of air.

During convalescence tonics, especially those directed to the nervous system, will be in demand.

Quinine, iron, arsenic, nux vomica, and phosphorus, make eligible preparations in their various combinations, and should be used as the special indications of each case demand.

In cases complicating or complicated by bronchitis or pneumonitis, counter-irritants will be demanded as well as the usual remedies adapted to those diseases. Cod-liver oil I have found of more utility than anything else where the cough was disposed to be troublesome or become chronic.

THE WOOD CORSET;

With Improvements for the Treatment of Lateral Curvature and Pott's Disease of the Spine.

A. M. PHELPS, M.D., NEW YORK.

The question of a suitable spinal support in lateral curvature of the spine and convalescent cases of Pott's disease, has been before the profession from the earliest time, and not until Dr. Sayre devised the plaster-of-Paris corset did we have a brace that accomplished nearly all that is desired in a support.

The plaster-of-Paris corset I believe to be one of the most efficient of supports. It certainly has the advantage of cheapness, and it is well adapted for use in clinics and dispensary practice. It has, however, the disadvantage of weight. Steel braces have been made. Many of them, when suitably applied, furnish very good results. Dr. Vance constructed, to take the place of the plaster-of-Paris corset, a paper corset.

If the profession could have at their disposal a corset which combines strength, durability, porosity, and lightness, it would meet a long-felt want. I had heard something of the wood corset, but knew nothing of its construction. Therefore, three years ago I visited Europe for the express purpose of learning the details of its construction. On my return, I presented the

corset at the New York Academy of Medicine,Surgical Section. I visited Dr. Valtuck, of Odessa, Russia, and from him personally I learned the details, after several days of hard work. I found that Professor Lorenze, of Vienna, had been using the corset for some time, and was much pleased with it. At that time, however, many of the corsets proved to be inefficient on account of errors in their construction. We have used the corset constantly since that time, and with the modifications which we have made, it is the most efficient, comfortable, and suitable spinal brace that I know of.

It has been with the greatest difficulty that we have succeeded in getting the proper materials for constructing the corset, and even now it is cheaper and better to import the wood from Vienna. The spruce timber which grows there makes a better shaving than any timber that we have attempted to use which grows in America. It is tougher, and works better with the glue.

The materials necessary for making the wood corset are: One dozen plaster-of-Paris bandages; one tight-fitting shirt, fifty pounds plaster-of-Paris, two pounds oakum, two yards of raw unbleached linen, a blue pencil, one pound of cologne glue, a little glycerine, a knife for splitting wood, a glue-pot, a hammer, a large clothes brush, some towels, two sandbags, a quantity of wood shavings, some shellac, an eyelet punch, a number of eyelets, and hook lacings, and two yards of knit shirting.

All of these articles are kept in stock by Messrs. John Reynders & Co., 303 Fourth avenue, New York, who have kindly imported for me such materials as could not be procured in New York.

THE DETAILS OF THE WORK.

Suspend the patient after the tight-fitting shirt has been applied. Indicate with the blue pencil mark around the body on the shirt, the length of the corset desired. Apply the plaster-of-Paris bandages as in making an ordinary plaster-ofParis corset. When the plaster is set, remove it from the body by cutting it down in front. Strip out the shirt from the corset, when the blue pencil marks will be seen on the inside of the plaster corset. A few turns of the plaster band