Congenital Word-Blindness

injected twice a week; -no trouble has been experienced in the introduction of the apparently large, amount of fluid, and even the miiost debilitated patients, miiale or female, have shown no ill effects. An ordinary two-way aspiration syringe of 100 c.cm. capacity is used, with a nieedle of suitable bore. If the bore is large thelre is considerable leakage froni the site of the puncture, anid if it is too small the back pressure oni the syringe makes tlh6 giving of the injection a tedious process both for the patienit and the giver. The syringe and needle are sterilized by boiling; where an antiseptic lotion has been used for this purlpose one has found difficulty in removingall trace of the antiseptic, and a slight loc4l reaction has occurred. The flank or the back is the most suitable place, and each side is used alternately; the near area of the sciatic nerve should be avoided, and if the temiporary swelling is at the level of the iliac spine a little more discomfort is causedl to the patient. The skin of the selected site is well washed with ethei' soap and then treated with iodine before being frozen with an ethyl chloride spray. It is imipossible to give a general statenment as to how deep tlle needle should go. In some cases the needle is passe-d definitely to the subcutaneous tissues; in others there is less discomfort if the injections are made into the superficial museles. As a rule the treatment causes transienlt discomiifort anid nothinig more. The fluid has been injected at varying temperatures, but C01e has found that about 1050 F. is very suitable, and tends to cause less of a r'igOr thani a temperature lower than that of the body. The fluid should be inijected slowly, otherwise the tissues have insufficient time to avail themselves of their natural eldsti(ity, and the patient becomes very restless and coml)lains of a " drawing " p)ain. When the desired amounit has been given the needle should be slowly withdrawn, anld the site of the punctime massaged with iodine before being sealed with flexible c'ollodioni and covered with a swab. Slight oozing nearly always occurs if the injection has beeni actuxally subcutaneous, but this readily stops without interference. If the injection is made into the superficial layers of miuscle there is, as a rule, no leakage. T're patien-t should be cal e-fullv propped up in bed by pillows so that tlie disteideod area does not take any pressure. Absorptioin is verv r'apid, and there is sekldoml any trace of the fluid after two hours. We have had nonie of the reported soddenness of the skin even after fifteen or twenty injectionis hiave been given. If it is desirable to give intramuscular medication to the patient this cani readily be combined with the RingerLocke injection inlto the suiperficial muscles. The absorption of, sav, karsulphan has, it is thought, been mulch mzore rap)id, and no after-effect has been observed. About two to six lhous after the injection most patients have some rise in temperature, attended in the majority of instances by a mild rigor. Morowoka states that genieral paralytics seldom have a r'igor, but this has not been borne out here. Practically every patient of this type lhas a definite elevation of temperature after one or more of the injections; in onepatient the temperaturerose to above 1020 F. twice in the first tw-elve injections; in another 101.60 F. was the highlest figuire recorded; uhilst a third lhad a temperature of 1030 F. after the second and fourth injections, and no rise above 100) F. subsequently. The senile type of case, as a rule, shows little reaction of teimpelrature, bult in the toxic case there is a definite tendency to rigor. Onle such patienit had a teimperature of 1030 F. four timlies in the first fifteen injectioins; in aniotlher the temperature. rose to 1020 F. after each treatment; whilst a third rose to 1040 F. after the first tlhree injections anid theni settled down to ani almost regular normlal figure. Usually tlhe temperature subsides withini twelve hours and is unacz.,ompanied by an-y distur-bance of the pulse or respiration rate. Sleep is usually much mlore tranquil, and the patiejit feels decidedly better. There seelim to be no contraindications. In only one case has the treatment by Ringer-Locke solution been abandoned, and thenl because a coexistent and spreading attack of herpes made it a matter of difficulty to find a suitable site. Trpic sores in the genleral paralytic are by nlo meanls a conltraindicationl; indeed, we have found that inl the very rare cases where such existed they tended to heal more quickly when ordinary treatment was oambined with the inijection of Ringer-Locke solution. Certainly, the tendency to secondary septic infection is much lessened. Except for rise of temperature no complications have been observed. Morowoka states that in dementia praecox a rash is sometimes seen; this has not been the experience here with other classes of cases; only once has a slight rash been observed, and that in a patient of plethoric mien.