on the abdominal viscera in the false pelvis, and behind on the posterior supra'iliac spine. Now, in the place of making-extension upon both legs which is here advocated, the point of counter-extension is placed in the centre of gravity, of the trunk opposite the extremity of the ensiform cartilage, and this inertia or weight of the trunk is brought to bear by raising the bed-foot upon blocks of wood or bricks. These I have frequently supplemented by shoulder-straps, with axillary pads fixed to

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... the rail at the head of the bed, with the addition sometimes of a chin-strap having the same attachment. These I have used, however, more frequently in cases of spinal disease or injury higher up in the trunk, thereby shifting upwards the point of counter-extension. In cases of disease of the upper lumbar or lower dorsal vertebra, or their joints, I believe that I have secured considerable benefit to the patient .by the adoption of double extension, combined with aspiration of the abscesses which form, frequently leaving persistent sinuses, which usually go on from bad to worse, and too often cause despair to the surgeon, and inevitable death to the patient. In such cases, persistent extension in the recumbent posture has, as far as I know, not been hitherto tried by the surgeon. Of course, this method, in order to produce any good whatever, and in fact not to produce harm, must be applied equally to both legs. The system introduced by Profegsor Sayre attempts to effect a certain amount of extension as a continuation of the effects of suspension by the head and shoulders; but my experience of this method (undoubtedly the best hitherto adopted in supporting the trunk by lateral pressure, and modifying, if not altogether preventing, horizontal and lateral motion) does not lead me to think that any appreciable amount of longitudinal extension is kept up. It certainly does not answer well in those severe cases in which the recumbent posture is absolutely necessary in the treatment. The amount of the weight applied to the legs in the cases I have treated has not been great, sufficient only to give relief, and not to cause discomfort to the patient. Relief it certainly does give in the great majority of cases; and it does so, I believe, by protecting the diseased surfaces from the pressure produced by the contraction (spasmodic or otherwise) of the powerful spinal muscles, which are affected just as the muscles are which act upon the joints of the extremities, and produce the startings of the limb with which surgeons are familiar. We thus insure as great an amount of physiological rest to the diseased spinal structures as the problem before us will permit. Lastly, the brief limits of my design permit me to mention only another class of cases, to which I have applied, I believe, for the first time, double extension to the legs. In a case of fracture of the lower lumbar vertebrae, produced by a fall from a great height, and attended by complete paraplegia, I placed the patient on a water-bed, raised the foot of the bedstead on two blocks of wood eight inches deep, and applied gradually as much weight to the legs, by two of Buck's stirrups, as the patient could bear comfortably. The idea was, as in the cases of diseased spine, to take off from the fractured surfaces, by continued persistent and gentle extension, the pressure of the powerful longitudinal muscles of the spine, and to ensure as far as possible the apposition and rectilinear direction of the fragments of the broken spine itself. If we consider the effect of the simplest movements of the head and arms upon the spinal structures, and not less the effect of the movement of the ribs in coughing, sneezing, and even in ordinary respiration when the trunk is in the recumbent posture, or when we are floating in water, it will not be difficult to understand how this gentle and persistent extension acts on these structures when injured. The use of a water-bed does not prevent it; nay, in spite of its advantages in other respects, such as the prevention of bed-sores, and in the use of the bed-pan, the movement of the fractured surfaces upon each other is necessarily increased by the rolling and billowy motion of the water consequent upon the least effort of the patient, and produced even by the mere effort of respiration. Now, combined with the water-bed (so necessary in the treatment of these cases), we can very easily employ the system of double extension which I have advocated, and thus counteract to the utmost possible extent the injurious movement that I have mentioned. Again, in these cases there is always a tendency for the pelvis and buttocks to sink into the water-support, and thus to give a bend or curve to the trunk at the point of fracture. This is in a great measure counteracted by the extension, in the vertical direction of the body, by the action of the weights and pulleys. Double extension in such circumstances produces much the same effect as horizontal traction upon the body of the swimmer who is being taught to float by his instructors, by traction upon his head and legs. I have found that patients express themselves as comfortable under its action, and I feel sure that, when properly and judiciously applied, double extension mitigates suffering and places the patient, as far as mechanical measures can, in a position most favourable for recovery.