382

the insertion of the ligamentum patellas. Dr. Fox wasaverse to treating most cases of sprain by rest, especiallyafter middle life.-Dr. ETTLES alluded to the use of opiumliniment, and doubted if any absorption of opium could takeplace.-The PRESIDENT alluded to cases of chronic weaknessof the muscles around a joint-e.g., atonic flat-foot, somecases of scoliosis, knock-knee, &c. He asked as to the effectof rest in producing atrophy of muscles.-Dr. J. F. WOODSobserved that he had in many cases removed the pain aftersprains by " suggestion " and manipulation.Mr. T. H. OPENSHAW read a paper on Pelvic Cellulitis.

He quoted a case in which an abscess had been opened justinternally to the anterior superior spine of the ilium and the cavity was found to extend to the pubes and down into thethigh. After four months the patient was discharged with asinus. Mr. Openshaw also spoke of a second case in whichthe patient was discharged with a sinus, and of a third casewhich had healed after some months. He deprecated earlysurgical interference unless it were absolutely necessary, thepoints of urgency being implication of the skin and suddenlywide tracking of pus. Further, some cases got well spon-taneously and others burst by themselves. He quoted fivecases in support of his contention.-The PRESIDENT was dis-posed to leave matters much to nature. About half the cases

suppurated, and nine-tenths of these opened just above, andto the outer side of, Poupart’s ligament.

NORTH LONDON MEDICAL AND CHIRUR-GICAL SOCIETY.

Exhibition of Cases and Specimens.-Recurrent Appendicitis.A MEETING of this society was held on Jan. 21st, the

President, Mr. J. MACREADY, being in the chair.Mr. W. R. H. STEWART showed a case of a man,

aged twenty-three years, upon whom he had recentlyperformed a plastic operation for a Deformity of the Nose.A cast showing the condition before operation was alsoexhibited. This showed a broad and deep groove in themiddle line running from the lower end of the nasal bonesdownwards between the lateral nasal cartilages. The nosethus presented two well-marked tips. Along the floor ofthe groove there was a scar, and from this situation a

tumour (a dermoid, it was thought) had been removed

during infancy. At the operation it was found thatthe anterior margin of the septal cartilage was muchbroader than natural, and much of it, as well as of thelateral cartilages, had to be pared away before the sides ofthe cleft could be brought together so as to make the tip ofthe nose a single one. The result of the operation, six daysafter its performance, was very satisfactory and the patient’sappearance was greatly improved.

Dr. ARTHUR WiLSON read the notes of a case ofRecurrent Appendicitis in a little girl aged five and a

half years. There had been four attacks, two of themvery severe, within five months, and about three weeksafter the last subsidence of the inflammatory swellingthe appendix had been removed by Mr. Mower White.The subsequent course of the case had been in every waysatisfactory. The appendix showed considerable inflamma-tory thickening of its coats and three-eighths of an

inch from the tip of it there was a marked constrictionof its lumen. Distal to this the lumen was dilated into asmall spherical cavity containing thick, purulent materialand a semi-solid body, probably fæcal in nature. Themucous lining of the tube was nowhere ulcerated.-ThePRESIDENT, Dr. STILES, Dr. GLOVER, Dr. TAIT, Dr. BAILEY,Dr. WATSON, and Mr. MOWER WHITE took part in the dis-cussion which followed and Dr. WILSOX replied.

Mr. PEYTON BEALE showed a male patient, aged twentyyears, suffering from a Large Soft Swelling below the Calfof the Left Leg. The patient was the subject of congenitalsyphilis and had also a congenital malformation of the lefttarsus and metatarsus. There was marked hypertrophy ofthe bones of the leg, the left leg being three inches longerthan the right. The swelling was thought to be caused bylymphangiectasis, probably due to syphilitic fibrosis of thelymphatic vessels above. There was also considerablevaricosity of the superficial veins of the leg and foot, nodoubt due to partial blocking of some of the deep veins ofthe leg, also the result of syphilitic fibrosis.

Mr. BEALE also showed a man, aged forty-seven years,in whom he had excised the left elbow for tuberculous

disease. 1 The point of interest in the case was the fact thatexcision of the same elbow had been performed thirty-sixyears ago at Bath so successfully that the patient had earnedhis living by hard manual work.

Mr. ALLAN HAIR, for Mr. TRAER HARRIS, exhibited apatient who, as the result of a blow, had sustained adouble fracture of the body of the lower jaw. Onefracture was just in front of the ramus of the jaw on theleft side, and the other was between the two bicuspid teethon the right. The fragments had been fixed by means of aKingsley’s splint, which the patient was still wearing eightweeks after the accident. There had been sequestra thrownoff at the seat of both fractures and the septic condition ofthe mouth at the time of the accident had no doubt, in spiteof the free use of 1 in 60 carbolic lotion since, tended todelay the union of the fragments.

ÆSCULAPIAN SOCIETY OF LONDON.

Rodent Ulcer.-Perforating Gastric Ulcer, Laparotomy,Recovery.- Gastric Ulcer with Probable Ad7tesions.-8eniteEndometritis.

A MEETING of this society was held on Jan. 22nd, Mr.STEPHEN PAGET, President, being in the chair.

Mr. G. DENTON showed a patient, a woman aged fiftyyears, suffering from Rodent Ulcer of the Cheek. The sore,which was of three years’ duration, was of the size of a florinand had penetrated nearly to the mucous membrane. Nooperation was allowed.

Mr. A. Q. SILCOCK read notes of a case of PerforatingGastric Ulcer in which Laparotomy had been per-formed with a successful result. A young unmarried womanwas suddenly seized with symptoms suggesting gastric per-foration. After twenty-four hours she was taken to St.Mary’s Hospital. Mr. Silcock opened the abdomen in theleft epigastric region and found on the anterior wall of thestomach towards the cardiac end a perforation from whichthe contents of the organ had escaped freely, setting upperitonitis. Stitches inserted would not hold, but tore theirway through the dense tissue surrounding the opening. Aconsiderable fold of the stomach wall on either side was

therefore taken up and the reef or tuck thus made secured bystitches (a method also practised by Mr. William H. Bennett inthe treatment of dilated stomach). The peritoneal toilet wasperformed of necessity somewhat hastily and imperfectly, agauze tampon was inserted, and the abdominal wound closedexcept at the point of its egress. The patient recoveredwithout a bad symptom. (A fuller account of this interestingcase will shortly be published in our columns.)

Dr. B. G. MORISON read notes of a case of Hæmatemesisoccurring in a subject of chronic dyspepsia and attributedto gastric ulcer. The concurrence and continuance of fever

(temperature 101° F. falling to 99.8°), previously absent andunexplained by any other defined cause, suggested theformation of local adhesions.

Dr. L. DuRNO read notes of two cases of Senile or Post-climacteric Endometritis. The patients, aged respectivelysixty-four and sixty-five years, had ceased to menstruate fromtwelve to fifteen years previously. In both cases slowlyprogressive emaciation was associated with a more or lessthick and offensive discharge, a tender vagina ulcerated hereand there, and enlarged uterus with smooth interior. Rest,tonics, and swabbing the endometrium, in one case withnitric acid and in the other with iodised phenol, followed byvaginal douches, effected a cure in from two to three months.Dr. Durno discussed at length the difEerential diagnosisbetween this class of cases and malignant disease of theuterus.

LIVERPOOL MEDICAL INSTITUTION.

Abdominal Hysterectomy.- G’astration for Enlarged Prog-i tate.-°,Saddle Nose" remedied by Celluloid Bri4e

Permanently Buried.-Thoracic Aneurysm.-Suppurationi

in the Small Omental Sac.-Unsuccessful Attempt to

Ligature the Left Subclavian Artery.A MEETING of this society was held on Jan. 28th,

Dr. RICHARD CATON, President, being in the chair.Dr. BRIGGS exhibited specimens from four cases of

1 This case was reported fully in THE LANCET of Jan. 30th, page 310.