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abdomen, now protrudes half an inch from the wound.Temperature normal; pulse 78.25th.-The temperature went up to 100° last night, but is

normal this morning; pulse 82. The tube in the cavity isnow about an inch and a half long. Discharge much less.General health much improved. Diet increased. No pain.27th.-Large drainage-tube came out in the night, and so

this morning a smaller one was substituted. Very littlepus washed out. Temperature 97’; pulse 80.

Dec. 4th.-There has been no pus washed out for two orthree days, and so syringing is discontinued. A very smallpiece of drainage-tube is now left in the cavity. The open-ing of the cavity is too small to admit even the tip of thelittle finger, but the probe goes in about an inch and aquarter. Wound dressed as usual. Temperature 97.5°;pulse 80. Patient gets up.7th.-Tube removed entirely; no discharge. Probe goes

in about an inch. No pain, only a tickling, itching sensa-tion round lips of wound.13th.-Wound dressed with small piece of padding and

iodoform; is healing rapidly. Patient eats well and is upall day. Has no pain whatever.

17th.-Patient discharged. Wound quite healed up. Hewas looking much better than when he came in, and hadgained several pounds in weight.The only drug treatment the patient had was a quinine

mixture until the operation and slight laxatives regularlyafterwards.

Remarks.—The clinical interest in this case was the painlesscharacter of the swelling, and the very slight degree ofpyrexia attending this large and rapidly formed collection ofpus. The patient declared that he had never experienced arigor and did not sweat, and it was not till his admission to thehospital that a slight rise of temperature at night was noticed.This, taken with the history of the patient having eaten forsome time raw meat, led to a suspicion that the swellingmight prove to be a hydatid cyst undergoing suppuration,but the peculiar doughy infiltration of the integuments overthe tumour was considered decisive of the abscess beinghepatic. The case also illustrates the advantage of a largeopening and drainage-tube, the patient being dischargedcured within a month of the operation. In a previous case,where the incision was made between the eighth and ninthribs, owing to narrowness of the intercostal space only asmall drainage-tube could be introduced. Considerable dif-ficulty was experienced in keeping the tube free, and puswas constantly re-collecting in the abscess, so that thepatient was in the hospital some months before the abscessclosed up. As regards the comparative results obtained byaspiration and free drainage respectively, Dr. Ralfe has hadseven cases of hepatic abscess under observation. In thefirst three aspiration was relied on, and of these all havedied. Of four cases treated by incision and drainage threehave made a complete recovery ; the fourth case recoveredfrom the operation, but as soon as the abscess closed tuber-cular phthisis developed, which rapidly proved fatal.

NORTH-EASTERN HOSPITAL FOR CHILDREN.TWO CASES ILLUSTRATING THE TREATMENT OF THE

DEFORMITY FOLLOWING TUBERCULAR DISEASEOF THE KNEE-JOINT.

(Under the care of Mr. BILTON POLLARD.)

For the notes of the following cases we are indebted toMr. H. Downes, house-surgeon.CASE 1. Tibia flexed and displaced backwards; joint

opened by division of the patella; anterior crucial ligamentdivided and limb straightened; joint healed under one

dressing.—Eliza P--, aged seven years, was admitted onSept. 27th, 1886. Her father and two of her brothers haddied from consumption. The disease of her knee beganwhen she was two years of age. Plaster-of-Paris bandageswere applied for a few months, and then for a period ofeighteen months nothing more was done. The leg becamedrawn up and shortened. Two years ago an operation wasperformed on the knee, and the child returned home withdischarging sinuses. For the last seven months the kneehad been quite sound, but the deformity had been steadilyincreasing. On admission the child was well nourished, andpresented no signs of disease. There were scars of oldsinuses on the front and inner side of the right knee. Thejoint was flexed almost to a right angle, and so firmly fixedthat no extension or flexion movements could be made.

The tibia was displaced backwards considerably, and the legwas much wasted.On Oct. 8th an incision was made across the front of the

knee, and the joint opened by sawing across the patella. Itwas found impossible to straighten the limb owing to thetibia being held backwards by means of a mass of fibrousbands taking the direction of the anterior crucial ligaments,These bands were divided, and then it was possible to bringthe tibia forwards; but the limb could not be quitestraightened owing to the interval between the condylesbeing so filled up as to prevent the somewhat enlargertspine of the tibia riding forwards into it. This interval wasdeepened sufficiently to accommodate the spine, and then theleg was brought forwards into a line with the femur.There were no visible signs of recent disease in the joint.A few vascular points were seen and ligatured, but thetourniquet was not removed until the dressing had beenapplied. The two halves of the patella were united by asilver wire suture. The middle portion of the skin woundwas sutured, but both ends of the wound were left open fordrainage. No tube was employed. The wound was dustedwith iodoform, and a dressing of salicylic wool was appliedand firmly bandaged on. A piece of galvanised iron wasplaced behind the knee in the middle of the wool as

a support to the joint. The limb was raised to a

right angle with the body for a few hours. The spraywas used during the operation, and the strictest atten-tion was paid to antiseptic details. The temperaturereached 1006° F. on the second day after the operation; itthen fell to the normal and remained so. No blood or dis-charge showed through the dressing, and there was no needto change it, but on the twenty-second day after the opera-tion this was done to remove the stitches. The wound washealed except at a small spot opposite the wire in thepatella. Three weeks later the wire was removed from thepatella, and a week after that the limb was put up in plaster-of-Paris and the patient was discharged. She was seen sixweeks later. The limb was straight and slight movementat the knee was possible. The patella was soundly unitedand freely movable at the condyles of the femur.CASE 2. Left leg flexed and abducted at the knee and

anlkylosed; joint excised and bones wired; joint healedunder one dressing.-Annie P --, aged eight years, wasadmitted on Aug. 31st, 1886. Her father and grandfatherdied of consumption. The disease of the knee commencedafter a fall when the patient was fifteen months old. Theknee had never suppurated, but it got much deformed andalmost prevented the patient from walking. The child hadbeen twice in the hospital during the year. Weight exten-sion and forcible movement under chloroform failed ?reduce the deformity.On admission, the patient could only hobble about a

little; the knee was flexed to an angle of 45° from theextended position; the leg was abducted and rotatedoutwards at the knee ; the joint was firmly ankylosed, andthe patella was fixed to the external condyle.On Oct. 2nd the joint was opened by a transverse cut

across the patella; the patella was firmly ankylosed to theexternal condyle, ’from which it was freed by a verticalsaw-cut. The greater part of the external condyle had beendestroyed, and as it was found impossible after the divisionof fibrous bands to bring the leg straight, a slice of bonewas removed from the lower end of the femur, and a verythin layer was removed from the tibia; a few vascularpoints were tied. The limb was put straight, and the

patella was united by a wire to the front of the femur, the: femur and tibia being united by a second wire. The rest of: the treatment was identical with that described in the first! case. The temperature remained normal throughout. On. the second day after the operation a spot of blood appeared. through the wool, so a layer of the latter was removed and. a fresh layer applied, but the wound was not exposed.I Four weeks after the operation the dressing was removed

and the wound was found healed in its entire length. Thedressing was stained with blood only, and was perfectydry. Three weeks later the limb was put up in plaster-of-

. Paris and the patient was discharged. The patient W8iseen a month later; the limb was soundly healed, but there

, was a small sore opposite the wire suture which united theL tibia to the femur. This was removed, and after a week thel wound was healed.

Remarks by Mr. POLLARD.-The first case appears to mel of much interest and importance. It is well known that. after strumous disease of the knee, when the tibia is dis-

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placed backwards, it is useless to attempt to straighten thejoint until the tibia has been carried forwards, for unlessthis precartion be taken, either the backward displacementwill be increased or the tibia will give way at the upper- epiphyaial line. To Mr. Beck’s teaching at University Col-.iege 1 owe che knowledge that the cause of the difficulty instraightening the limb in such cases is the shortened anterior.crucial ligament combined with other adventitious bands,and in this case I was able to demonstrate the correctnessof that teaching, and to show that the deformty mightbe remedied after dividing these bands without removing.any bone, and subsequently without impairing the growthof the limb. In the second case the external condyle of thefemur was so destroyed that it was impossible to straightenthe limb without performing an excision. This 1 regretgreatly, and I would not have done it if any other meanswould have succeeded, for the growth of the bone will beimpaired thereby. The cases are good examples of whatcan be achieved by aseptic surgery—primary union-under a single dressing without tubes. I do not know thatthe complete method of dressing detailed in the first casehas as yet been published, but 1 claim no credit for it; I.owe it likewise to Mr. Beck, and my cases are only instances- of the success which has attended it equally in his hands as,well as those of other surgeons. For such operations asose described I prefer Volkmann’s method of dividing the(patella, for I should anticipate firmer union of a wiredpatella than of a sutured ligament.

ST. VINCENT’S HOSPITAL, DUBLIN.TWO CASES OF ABSCESS EVACUATED WITHOUT ANY

RESULTING DISFIGUREMENT; REMARKS.

(Under the care of Dr. QUINLAN).FoR the report of these cases we are indebted to Mr. Al. C.

O’Gorman, resident pupil.CASE 1.—C. B--, aged seventeen, a messenger, was ad-

mitted on Oct. 12th, suffering from a large swelling occupying’the whole right submaxillary space, and in which deep-seatedfluctuation could oe detected. On the 15th, the purulentmatter being apparently half an inch from the surface, asilver wire was introduced in a horizontal direction, be-ginning in the healthy tissue to the right of the abscess,passing through it, and coming out about half an inch onthe inner side of it. Lint wetted in spirit lotion was appliedto the external surface. On the next day purulent matterwas coming out at both openings; but after a few days itwas evident that the lower part of the abscess was workingtowards the surface. This arose from the circumstance thatthe lower part of the abscess extended down the neck muchfurther than was at first supposed, and in consequence a"pocket" of purulent matter pressed upon the tissues and,produ ed absorption of them. As the skin was actuallybeginning to thin, another wire was on the 20th intro-,duced through the external opening of the original wire,passed through the pocket" above described, and

’brought out well below it. In a few hours the pus’began to discharge through the lower opening, and thetendency to point" at once ceased. The discharge became,gradually thinner, the abscess being carefully evacuatedby pressure with a tampon of soft cloth in the morning,mid-day, and evening. On the 25th the discharge from theopenings of the original wire having entirely ceased, it wasremoved, and the evacuation process through the secondarywire carefully continued. On Nov. 22nd all dischargeceased, the swelling was much reduced, and the redness ofthe skin greatly lessened. On Nov. 7th the secondary wirewas removed, and on the 10th the openings had healed up.On Nov. 16th the patient was discharged. There was slightswelling and induration on the site of the abscess, and verylittte redness of the skin on the spot where it had threatenedto point. Three red points showed the sites of the entranceand exit of the wires. On Nov. 22nd the boy was seen, and,all traces of the abscess were rapidly disappearing, therebeing no disfigurement whatever.CASE 2,—M. H-, aged thirty-nine, a healthy, well-

nourished woman, the mother of eight children, had beenconfined of her last child, a girl, on June 2nd. A monthafter, a swelling appeared in the left iliac fossa over Poupart’siigament, accompanied with great pain, gathering up of theleft thigh, and stooping of the body. She became graduallyenable to make the slightest exertion, and was at last obliged‘o take to her bed. She was admitted on Aug. 19th. She was

treated with hot poppy fomentations and linseed poultices,together with hypodermic inj ections of morphie, to keep downthe pain, which was extreme; quinine and nourishing dietwere given to support her strength, which was very muchreduced. Suppuration took place, so that on Aug. 25th thepurulent matter was within half an inch of the surface.Two silver wires were introduced through the abscess-onein a direction parallel to Poupart’s ligament, and the otherat right angles thereto. The matter gradually dischargeditself along these wire setons, a dressing of calico steepedin spirit lotion being kept continuously applied. The painand swelling steadily subsided, and the discharge, which wasprofuse, became less of a purulent and more of a saniouscharacter. On Sept. 10th it had ceased for some days, andone of the wires was withdrawn. After an interval of threedays the second wire was withdrawn, and the openingsclosed. On the 20th she was able to walk without stooping,contraction of the leg, or pain; and on the 28th she wasdischarged, cured, and without any mark over the site ofthe abscess, except four red pinhole openings correspondingto the entries and exits of the wires.Remarks by Dr. QUINLAN.-In both these cases large

abscesses were evacuated without the production of anyexternal mark or disfigurement. In the second case thesituation of the abscess in the groin rendered this a pointof little consequence, although this case clearly shows howdisfigurement can be avoided in abscesses of the neck andface, where the avoidance of marking or deformity is mostdesirable, especially in the case of females. The treatment is

dependent upon the early introduction of the wire, uponthe avoidance of poultices (which tend to relax the capil-laries of the skin) during the wire process, and upon theapplication of spirit lotion, which cools the surface, keepsdown inflammation, and hardens the skin. This method issuperior to aspiration, which causes too many punctures,and has not the same power of keeping the sac of theabscess empty by the drainage of the matter, whetherpurulent or saniou?, as fast as it is secreted. This constant

drainage, which is greatly aided by the use of the flattampon of old soft calico, causes the sac of the abscess tocollapse, and removes all pressure and consequent chance ofabsorption from the skin. The red wire openings left afterthe operation are small cicatrices, not larger than the headof a full-sized pin. These undergo cicatricial contractionand disappear. In the case of Miss 0. D-, recorded inTHE LANCET some years ago, they cannot now be detected,even by the aid of a lens.

Medical Societies.ROYAL MEDICAL & CHIRURGICAL SOCIETY.

Surgical Treatment of Hydatids of the Liver.AN ordinary meeting of this Society was held on Tuesday

last, Mr. G. D. Pollock, F.R.C.S., President, in the chair. Thewhole of the evening was occupied by the discussion ofMr. Barwell’s paper.Mr. RICHARD BARWELL read a paper on widely incising,

by a two-stage method, Hydatids of the Liver. Hydatids ofthe liver may be treated surgically by (1) puncture with asmall trocar, (2) evacuation with a large persistent opening,and (3) electrolysis. This last has not commended itself to thejudgment of the profession. The author recommends thatthe first method should always be primarily resorted to,chiefly because it sometimes is curative-viz., in cases ofsingle barren cyst; but in a large proportion of cases there arenumerous daughter or secondary cysts, and then the tumoursfrequently recur. Under such circumstances the mostefficacious treatment is by keeping a large opening patent

’

for some time. The object of the paper was to point out thesafest way of making such an opening. After discussingcertain other methods, it was shown that incising the abdo-minal parietes first, then stitching to them the cyst or itssurroundings, and finally cutting into the tumour after a fewdays, was regarded as a very safe and efficacious procedure.The author recommended certain precautions to be takenwhen the cyst wall appeared so thin that a needle puncturemight cause effusion of hydatid fluid into the peritoneum.Some modifications introduced with a view to meet specialcircumstances were discussed. The case of a young