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the new bone thrown out from the periosteum felt hard andfirm, and had the same shape as the normal tibia. Thewound had by that time cicatrised over in the centre.Patient was ordered ivory-dust in form of jelly. The upperand lower parts of the wound healed slowly, and smallspicules of bone were occasionally removed from the epi-physes.The patient was discharged on August 8th. The bone

was then very strong, and the tibial ridge only deficient atthe upper part, where the periosteum had ulcerated previousto admission. A posterior splint of poroplastic felt wasdirected to be worn for some months, so as to obviate anyrisk of the new bone yielding under the weight of the body.

ACUTE NECROSIS OF TIBIA ; RESECTION AND REMOVAL

OF DISEASED SHAFT AND MOST OF THE FIBULA,LEAVING THE PERIOSTEUM; CURE.

(Under the care of Professor SPENCE)The following notes were taken by Mr. Dunlop, clinical

clerk :-Annie H-, aged eleven years, was admitted to Ward 15

(surgical), Ang. 7th, 1875, sufft’ring from necrosis of righttibia. Six weeks before admission the patient felt pain inthe right foot, which prevented her from wearing her boot.Considerable swelling having taken place, she applied atthe hospital, and was admitted to the medical house, wherewarm water was applied. The swelling diminished, but asinus formed at the upper part of the tibia. She went home,where she remained for a week, and then applied to Prof.Spence, who admitted her to Ward 15.On examination the sinus at upper part of tibia was found

enlarged by ulceration, and a large, firm piece of bare deadbone was seen. Another sinus had also formed about twoinches above the internal malleolus, and dead bone was alsofelt there. Lint, dipped in carbolic lotion, was applied. Pulse102 ; temperature 100 4° F.August 11th.—Esmarch’s apparatus having been applied,

Professor Spence removed the whole length of shaft of tibiaby separating the periosteum and resecting the tibia im-mediately below its tubercle at the upper part, and at itslower end about an inch above the internal malleolus, bymeans of the chain saw, leaving only the thickened peri-osteum. Before the compressor was taken off, the cavityleft after removal of the bone was stuffed with oiled lint,and thus the operation was rendered perfectly bloodless.The limb was then laid on a wire splint, and slung.

12th.—Pulse 120; temperature 100°. Charcoal lint ap-plied as dressing, oiled lint taken out, and many-tailedbandage applied to give support.

16th.—An infusion of eucalyptus globulus used as dress-ing.

Patient continued doing well until the 31st, when she ap-peared flushed, and complained of sore-throat. Pulse 130;temperature 100°. Chlorate of potash was ordered as agargle, and also given internally. She soon recovered fromthis, and the general health improved until Sept. 12th, whena large abscess which had formed over the head of fibulawas freely opened, and a large quantity of pus escaped. Aconsiderable sequestrnm of the fibula, nearly its upper third,and its head with articular surface complete, was removed.She was ordered one grain of sulphate of quinine and fivedrops of dilute sulphuric acid thrice daily. Improvementwas now marked, and a large mass of new bone was thrownout, taking the place formerly occupied by the tibia.

Sept. 13 h -Several small abscesses which had from timeto time formed over the fibula have been opened, and to-day one was opened which had formed in popliteal space.Considerable pieces of dead bone have also been removed ordischarged from lower part of fibula.27tb.-A lateral splint applied to outside of limb to give

support, and pad behind to prevent bending. The cavitycontinues fiiling up with new bone. No more pieces of deadbone discharged.

Oct. 20th.—The parts are rapidly becoming consolidated.Nov. 1st.—Much in same condition.Feb. 4th, 1876.-Prof. Spence divided the tendo Achillis,

which had been contracted before her admission to thehospital.

22nd.—To-day Prof. Spence enlarged an opening abovethe outer mall(-olus, and removed a large sequestrum of thefibula. He at the same time divided the distal part of the

long flexor of the great-toe, which had become contractedand had displaced the distal phalanx.25th.-The case may now be considered cured, as the

shaft of the tibia has been reproduced and feels solid,although it is not considered advisable to remove the splintor permit her to rest on the limb, as the fibula has beennearly removed throughout its entire length in portions atdifferent times during the progress of the case.In this case the reproduced bone is not so shapely as in

that of R. H-. It is more flattened, and, owing to theloss of skin and periosteum in front previous to the opera-tion, the cicatrix is broad; but the leg is strong from thedeposit of new bone.

Note by Professor SPENCE. - The cases just narratedare, I think, specially instructive, as showing the advan-tages of resection in certain cases of acute necrosis. I findthis method sometimes spoken of as if shortening theperiod of treatment were its object. It could scarcely beadvocated on that ground. Its real advantages are—(1st)The early removal of a diseased texture which is injuriouslyaffecting the health and keeping up irrigative fever. (2nd)By removal of the diseased shaft to diminish the risk ofneighbouring joints becoming affected, thus necessitatingamputation under most unfavourable conditions. (3rd) Ob-viating the risk of repeated haemorrhages from ulcerationof enlarged periosteal vessels. Whilst the result of theseand other similar cases shows that the removal of thediseased bone is speedily followed by relief of the consti-tutional disturbance, and that we can trust to reproductionof bone from the periosteum left.The two cases were testing cases for the operation, as

both patients were extremely debilitated ; and in the caseof the girl, the sloughing of the integument and periosteumover the front of the tibia, and the subsequent necrosis ofthe fibula, made me very doubtful what might be the result.

Medical Societies.ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

THE annual general meeting of this Society was held onWednesday, the 1st inst., the President, Sir James Paget,in the chair. There was a large attendance of Fellows, andthe feature of the evening was the eloquent and dis-

criminating address delivered by the President, which con-sisted of obituary notices of deceased Fellows. The chairwas taken at 8 P.M., when the ballot for the election ofofficers and council for 1876-77 was opened.The abstract of the income and expenditure of the Society

for the year 1875, having been previously distributed amongthe Fellows, was taken as read, and the hon. secretary, Dr.Job n Harley, proceeded to read the report of the President andCouncil, which contained little more than the usual financialand statistical details as to the numbers and position of theSociety. The total number of Fellows is 650 ; 20 new

Fellows had been elected during 1875, of whom 3 were hono-rary, 14 resident, and 3 non-resident. Twenty-one had beenremoved by death, including two of the hon. fellows-viz.,Dr. G. Andral, of Paris, and Prof. Luigi Porta, of Pavia,-the latter of whom had only last year been elected to theSociety. The report referred to the system of payment ofcomposition for subscriptions, adopted by the Society,which appeared now to be telling somewhat to the dis-advantage of the income of the Society, and recommendedthat in future fifty copies of communications to the Transac-tions should be given to their authors instead of twenty-five(which alteration in the bye-laws was adopted at a laterstage of the proceedings). It also mentioned that a com-mittee had been appointed to examine into the relations ofmembranous croup and diphtheria, consisting of Drs. CharlesWest, Dickinson, Semple, Gee, Hilton Fagge, Payne, JohnHarley, and Mr. Howse. Lastly, it was stated that a new

catalogue of the library and subject-index were in courseof preparation, and would appear simultaneouslv.The adoption of the Report was moved by Dr. Semple,