spinous processes all of the weight that may not be taken by the brace, and to protect the diseased bodies of the vertebræ from jar and concussion.

The brace is made by supporting a large pad, shaped into an

FIG. 1.

Brace for cervical spondylitis partially applied, with the chin nearly touching the chest; which is the typical position in advanced cervical spondylitis. occipital socket in which the head when held by a strap passing around over the forehead will rest immovably. This occipital pad rests on an arch formed by the joining of two steel straps passed down over the posterior face of a leather shell-back brace, and these are there secured in such a manner as to be raised or lowered to any desired position and there held by set screws.

The accuracy with which the leather shell-back brace fits every outline of the body, makes it a nearly immovable foundation.

In applying the brace the leather shell-back should be securely laced and strapped to the body, and the occipital pad should then be in a position so far posterior to and above a level with the occiput, that considerable force shall be required in lifting and carrying backward the head so as to place the occiput on the pad, and with the

FIG. 2. Brace for cervical spondylitis applied.

chin somewhat elevated; then buckle the strap over the forehead and the head will be securely held in place. Fig. 1 shows the brace partially applied with the head forward and chin nearly touching the chest which is the typical position in advanced cervical spondylitis, while Fig. 2 shows the head in the corrected position as held when the brace has been securely applied, with the occipital pad serving as a fulcrum on which to lift the head.

With the several chin-supporting braces in use the head is

thrown backward and upward every time the patient opens his mouth in the acts of speaking and mastication, while few of these forms of apparatus impede in any manner whatever lateral rotation. The Sayre Jury-mast has no retarding effect whatever on rotation, neither does it make any attempt to carry the head backward so as to transfer a portion of the weight to the transverse processes. The wearing of each of these forms of apparatus that depend on chin straps or chin pads are frequently seen to result in flattened jaws, giving a fish mouth appearance to the patient's face and even more frequently they are seen to interfere with dentition.

The brace which I am offering for your kind consideration not only obviates these distressing disadvantages, but the patient may also be able with cap and coat to walk the streets without attracting attention to the fact that he is wearing any sort of mechanical appliance.

In all the cases in my charge wearing this brace it is never removed night or day except for bathing and change of underwear.

I have used this brace for quite a number of years with what I believe to be very marked success, and the cases, though my records are not complete, are upwards of a hundred, besides quite a number of surgeons in the Northwest have followed my lead for a number of years in the same plan of treatment.

My first paper on this method of treating cervical spondylitis was published in the April, 1878, number of the Chicago Medical Journal and Examiner.

34 EAST MONROE STREET.

CASES OF GENITOURINARY SURGERY.

BY DR. F. KREISSL, CHICAGO.

CYSTOTOMY FOR STONE.

This phosphatic concrement was removed by cystotomy from the bladder of a patient about 64 years old who was referred to me by Dr. Wm. Cuthbertson, who at present, in the capacity of majorsurgeon, is somewhere near Cuba. The case has some interesting features. Some six months ago he presented the symptoms of senile enlargement of the prostatic gland and those of a foreign body in the bladder. The urine was of alkaline reaction and contained much blood, pus and casts. Cystoscopic inspection of the bladder was impossible on account of the enlargement of the gland, especially of the right lobe which protruded so much into the upper end of the urethra that it was impossible to pass the cystoscope or a solid silver catheter to probe for the stone which I suspected to be present. I advised rest in bed, flushing of the bladder with salicylic acid followed by lactate of silver. The patient improved but slightly for a while, when suddenly purulent, right-sided orchitis set in. When making an incision, the entire tubular tissue was found substituted by pus.

After three weeks the wound had healed. An examination by rectum two weeks later brought out the fact that the big nodule of the right lobe had disappeared and this induced me to try once inore to introduce a sound, which this time could be done without any difficulty, revealing the presence of this stone. The disappearance of the enlarged lobe will easily find its explanation in the suppurating orchitis, another proof, if such be necessary, of the efficiency of castration in senile enlargement of the prostate gland. Four weeks ago I proceeded to the removal of the concrement; litotrity was out of place on account of the stone not being free in the viscus and I therefore preferred suprapubic cystotomy. It was a dangerous task, the patient having suffered two apoplectic strokes within the last four years, his heart and pulse indicating far advanced myocarditis and his kidneys being badly deranged. His weight was 235 pounds at the time of the operation, and the urine showing ammoniacal decomposition; naturally the incision in the bladder was long, but I succeeded in removing the sacculated concrement without injuring the peritoneum. Catgut suture and drainage of the bladder from the urethra and abdominal wound finished the operation. NotChicago Medical Society, June, 1898.

withstanding a uremic attack, a week after the operation everything. went along satisfactorily. The urine became acid and clear; drains were removed ten days after operation and the wound commenced to close. On the sixteenth day after the operation the urine was passed voluntarily up to the amount of six ounces at a time. Two days afterward the temperature, which had remained. normal, went up to 102 degrees and the symptoms of pneumonia, in all probability hypostatic, set in to which the patient succumbed two days ago. The concrement weighs about 575 grains. It is nearly one of the largest stones removed from the bladder without injuring the peritoneum.

PAPILLOMA OF THE BLADDER.

The second specimen, a papilloma, was removed by suprapubic cystotomy from the bladder of a gentleman 69 years old. The tumor is somewhat interesting, as after opening the bladder I felt two thin pedicles, each about one-half inch in length, one inserted behind the right prostatic lobe and the other near the mouth of the right ureter forming an arch in reaching the body of the growth. After removing the tumor, no terminal line could be found, although there is no doubt that originally there were two papillomata which had grown into each other. The first week after the operation was uneventful. On the 9th day, the up to that time healthy and granulating wound became ugly looking, the patient got restless, later on delirious and died in coma on the fifteenth day. It was known to me before the operation that he was suffering from diabetes for several years and I therefore waited for nearly two months before getting at the operation, although no sugar was found during that period in spite of frequent test meals. Even five days after the operation, the urine was free from it, while another examination made on the ninth day gave 8 per cent grape sugar. Dr. Bellfield who saw the case previously advised, with good reason, strongly against an operation unless indicated by the extremest necessity. This was the case when I operated. The patient had for weeks, many profuse, almost uncontrollable hemorrhages and constant tenesmus and this condition demanded surgical interference which would have been justified. even if sugar had been present in the urine at the time. patient also strongly urged an operation.

BOTTINI'S OPERATION.

The

The patient, 56 years old, whom I wish to show you now was operated for senile enlargement of the prostate gland six weeks ago. Besides his prostatic ailment he had a stricture of the membranous urethra of the size 16 of the French scale. He presented all the symp