(A). On each end of the splint is made a place for fastening electric straps (B), that pass upon each side of the head to a close-fitting skullcap (C). (Fig. 1.)

When the apparatus is in place, and the elastic straps tightened so as to lift the chiu, then pressure is brought to bear on the fulcrum at the posterior molar tooth, and so by this means extension is made at the joints, and the inflamed surfaces within the joints are relieved from pressure; then immediate relief is experienced.

As soon as this apparatus was put on this patient his pain stopped instantly, and he took no more morphia. He continued for a time his anti-gout remedies, and after some manipulations of the lame muscles of the jaws under electricity perfect motion. was restored.

CASE II. Arthritis from Septic Poison.—Miss Clara B., of Iowa, twenty-one years old, was sent to me by Dr. J. C. Hutchison, of Brooklyn. Her history, in a few words, was as follows: Six years before had exposed dental pulps (nerves) of the inferior molars of both sides. A liberal supply of arsenic was used to devitalize the nerve, and this was left in many days. Soon after the teeth became very painful, the jaw swelled, extending also to the submaxillary gland and tonsil of left side. Necrosis of cellular portion of the jaw containing the teeth followed, and they were all removed with the necrosed bone. The submaxillary and tonsillar glands suppurated, and opened externally with a great discharge of pus. With this great amount of swelling in jaws and glands, she suffered much from dyspnoea. Her vital powers became very much exhausted from want of food and septic poison.

When she came under my care in June, 1879, she was quite anæmic and very despondent, troubled with insomnia, loss of appetite, and vomiting. No menstruation for the past eighteen months; complained of great pain on left side of the head at the temporo-maxillary articulation, partial ankylosis. At times there was a discharge from the ear, and also into the naso-pharyngeal cavity, where she had quite an abscess. No teeth in the lower jaw, while the upper set was quite perfect. Two large scars as the result of the suppurating submaxillary and tonsillar glands, one about an inch and a half anterior to the ramus, and the other made by the suppurating tonsil on the anterior border of VOL. XXXII.-29

the sternocleido-mastoid muscle one and a half inch long by onehalf inch broad.

Treatment consisted in applying an extension apparatus in the same manner as in the first case. Her alimentation con sisted in a teacupful of warm milk, to which was added one teaspoonful of maltine, pepsine, and pancreatine every three hours. Vomiting stopped, and digestion immediately improved, and then tonics were added. Warm sponge baths of salt water and bay rum every night and morning, and a mild current of electricity.

She continued to improve, and in February, 1880, menstruation returned. In March the apparatus was given up, and a lower artificial denture inserted, and now her mastication was restored. In June, 1880, one year after treatment was begun, she had gained twenty-four pounds in weight, and has been perfectly well up to the present time.

CASE III. Arthritis from Impacted Wisdom Tooth.-D. L., aged eighteen years, had an impacted right inferior wisdom tooth that produced extensive swelling with partial ankylosis; great pain in the joint. Administered an anæsthetic, forced open the mouth, and removed the impacted tooth lying in the ramus. Extension apparatus applied; muscles were manipulated under electricity every day, and at the end of two months' treatment he was well.

CASE IV. Arthritis from Tonsillitis.-Miss Mary H. had a severe attack of tonsillitis, which extended into left temporo-maxillary articulation. Had been suffering some time before I saw her. Unable now to open her mouth. Contracture muscles very stiff from misuse. An apparatus was worn, and every day the mouth was cautiously opened, so as not to stir up any new inflammatory process in the joint. She made a good recovery.

In all arthritis the muscles suffer more or less according to the extent of the inflammatory process. Contracture muscles get stiff from the products of inflammation, while in the depressor muscles may be expected some degenerative changes from want of exercise.

I will not further trespass on your time, but only say that from experience it will be found: 1. That arthritis of this joint, like

all other joints, the result of local or constitutional causes, requires proper and prompt treatment, as it may pass in a very short time from its most incipient stage to one of suppuration and destruction. 2. That arthritis without proper treatment more often results in fibrous ankylosis, and that bony ankylosis is the exception. 3. That the highly developed muscles of the jaw from pathological changes, the result of inflammation or even from misuse, have always more or less impaired motion, and in some cases require more treatment than the joint trouble. 4. Cases do sometimes occur in which the poisonous effects of overdoses of mercury have had a disastrous result.

NEW SURGICAL INSTRUMENTS.

BY JOS. H. WARREN, M.D.,

MASSACHUSETTS.

MR. CHAIRMAN AND FELLOWS:

I wish to show you a few instruments that I have devised, and first will show a few vermicular-pointed catheters in three sizes. (Fig. 1.) The point to them is about one and threetenths centimetres long, and in shape is a combination of the screw and wedge. By its peculiar spiral motion it avoids, to a very great extent, the friction in the urethral canal, and dilates the urethra with far less difficulty and much less pain than the usual catheter. It should, however, be understood that these catheters are designed for use not so much in normal urethras, as in those that are constricted by strictures or enlarged prostates. In a healthy and normal urethra the ordinary soft rubber or metallic catheter will generally answer better.

The

I next show you Sir Henry Thompson's tube as I have improved it. (Fig. 2.) My idea has been to have a tip, one-half of which is thrown back by a spring after it has entered the bladder so as to allow the debris of the crushed stone to enter the tube freely. The other half, being unjointed, acts as a scoop to take up any remaining particles in the bladder. The point or tip may be made to revolve or may be stationary. same arrangement may be applied to the straight tube of Bigelow, which does not have the curve of Sir Henry Thompson's. The tip can be perforated by a few holes to prevent closure by the suction of the aspirator. A thin rein of steel can be attached to the movable portion of this tip and worked at its lower end by a thumb-screw. In this shape it can be used for removing small particles from the bladder, shot and balls from deep gunshot wounds, or foreign substances from the throat, nose, and ear. Internal medication to the uterus, throat, and