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and a free exit is provided for any secretion which may findits way into the wound, such symptoms will in all probabilitybut seldom arise.

It is now well known that thyroid extract has a bad effecton patients with exophthalmic goitre. Under its influencethe pulse becomes more frequent and the other symptomsare increased. In some instances where other treatmenthad been followed by marked improvement the adminis-tration of thyroid extract has been followed by a

relapse into the former condition. In my opinion itshould never be given in exophthalmic goitre as it is

only adding fuel to the fire. The results of surgicaltreatment of exophthalmic goitre undertaken with the

object of reducing the amount of secreting tissue by removalof one lobe, or of inducing atrophy by ligature of some ofthe arteries which supply the gland, are of great interest.Unfortunately, the operation itself though sound in principleis at present by no means free from risk. The steadyimprovement, however, which has resulted in many cases inwhich it has been successfully performed affords still furtherevidence that the symptoms of exophthalmic goitre are dueto the over-activity of the thyroid gland.

It is a fact of considerable interest that along with theenlargement of the thyroid gland in exophthalmic goitreother ductless glands may be increased in size. The thymusgland is very often enlarged ; in all the cases recentlyexamined at St. Thomas’s Hospital Dr. H. Mackenzie]8 hasfound the thymus persistent and enlarged, the microscopicalstructure being normal. Exophthalmic goitre and acromegalyare sometimes found to occur together. I have recorded twoexamples of this and collected records of three others.]9 In

acromegaly the pituitary gland is enlarged and the enlarge-ment seems to be analogous to that of the thyroid inexophthalmic goitre, so that we have the remarkable factthat all these three ductless glands may be simultaneouslyenlarged. We know no explanation of this but it suggeststhat possibly some common factor may be the cause of theenlargement. That some association exists between thethyroid and pituitary glands is further shown by the

enlargement which takes place in the latter when the formeris removed or disabled by disease.These facts all indicate that in the treatment of exophthal-

mic goitre attention should be directed to the thyroidgland. Time will not permit me to discuss the question ofoperative treatment, but there can be little doubt thatremoval of part of the enlarged gland is a rational method oftreatment and when the risks of the operation are diminishedit should be more frequently employed in severe cases inwhich medical treatment has failed to do good. Of medicaltreatment much has been written. In my own cases inunc-tion of red iodide of mercury ointment over the goitre andbelladonna given in large doses internally so as to check thehypersecretion of the gland have been of most service.If the palpitation is excessive convallaria has proved moreuseful than any other member of the same group of drugs.Where there has been great nervousness the bromides havedone good. In only one case have I seen decidedly goodeffects from taking thymus. In this case three tablets ofdried thymus were taken each day for nine months, for thelast six and a half of which the red iodide of mercury wasused as well. As a result of this treatment the pulse-rate,which varied from 132 to 143, fell to 84 ; the thyroid gland,which had been considerably enlarged, returned to itsnormal size ; the tremor became much less ; and the exoph-thalmos was diminished.

In conclusion, Mr. President and gentlemen, allow me tothank you for the kind help which you have given me by yourattention in my endeavour to place before you some of thefacts which help to explain the function of the thyroidgland and the practical uses to which such knowledge canbe put in the treatment of disease, and I trust that thewishes of the founder of this lectureship have thus beencarried out in the spirit, if not in the actual letter of hisbequest.

______

18 Allbutt’s System of Medicine, vol. iv., p. 503.19 Edinburgh Medical Journal, 1897, p. 170.

THE BRISTOL MEDICAL MISSION.-The annualmeeting of the Bristol Medical Missionary Society was heldon March 9th under the presidency of the High Sheriff(Mr. C. Wills). The honorary secretary reported that during1898 7536 out-patients had been treated and 1880 patientshad been visited at their homes. The total income for theyear was E732 and the expenditure amounted to C695.

ABSTRACTS OF

Three LecturesON

THE JOINTS OF MAMMALS CONTRASTEDWITH THOSE OF MAN.1

Delivered before the Royal College of Surgeons of England onMarch 6th, 8th, and 10th, 1899,

BY F. G. PARSONS, F.R.C.S. ENG.,HUNTERIAN PROFESSOR.

LECTURE I.

Del’ivered on Ma1’ch 6th, S99.

IN this lecture the temporo-maxillary and shoulder-jointsas well as the articulations in connexion with the claviclewere treated. In the temporo-maxillary joint special stress.was laid on the fact that in man the external lateral

ligament of the jaw ran downward and backward and,was attached below to the posterior part of the outer-

side of the neck of the condyle. The occasional

appearance of a post-glenoid process in man’s skull was

pointed out as well as the fact that the long axes of thecondyles ran backward and inward. In the lower Primatesit was shown that the glenoid cavity became more and more.flattened by the non-appearance of the eminentia articularisor pre-glenoid process, while the post-glenoid process wasconstantly present and was situated only at the outer part ofthe back of the cavity in the catarrhine monkeys. In the-lemurs, on the other band, it was directly behind the centreof the condyle and in these animals the long axis of thecondyle was quite transverse.The suggestion was made that the obliquity of the trans-

verse axis of the condyle in man was due to the fact that inthe higher Primates the post-glenoid process checked thebackward movement of only the outer part of the condyle.The backward direction of the external lateral ligament wasfound to be present in monkeys as in man, and it was shownthat when the mouth was opened this ligament becametense and checked the backward movement of theneck of the condyle ; the jaw was then convertedfrom a hinge into a lever of the first class and the-

condyle moved forward on to the eminentia articulariswithout the necessity for any action of the externalpterygoid muscle. The various mechanisms of the jaw inthe different orders of the Mammalia were then dealt with indetail, and among other things it was shown that the inter-articular meniscus was present in all mammals until theEdentata were reached in descending the scale. In thisorder the structure was shown to be absent in the armadilloas it was also in the Tasmanian devil (Dasyurus) among theMarsupialia. In the Monotremata it was also wanting.This absence of the meniscus among lower mammals thelecturer regarded as telling against the likelihood of its

representing the quadrato-jugal bone of lower vertebrates.and he inclined to the belief that it was simply, apad adapting the joint to various different kinds ofmovement. In reviewing the clavicular articulations it was’pointed out that when a clavicle was present it was.

connected with the dorsal side of the presternum and that.in a generalised mammal there was usually a rod of cartilage:which connected the two bones. In this rod an ossifiednodule was frequently found and this the lecturer regardedas the homologue of the sternal epiphysis of the clavicle ofthe Primates. Synovial joints might be developed betweenthe cartilaginous rod and the sternum and in some

instances between it and the bony clavicle. Theinter-articular fibro-cartilage of man was shown tc-be a constant structure in the Primates and the possibilityof this being a mere fibrous ingrowth from surroundingtissues to adapt the joint to various kinds of movement was.discussed. The coraco-clavicular ligament, it was stated"was single below the higher Primates and in some animals--e.g., Dasypus and Bradypus-was very long. The acromio--clavicular joint existed only when the clavicle was fullyossified, otherwise the bony ends were connected by nbrous-

1 These lectures will be published in full in the Journal of Anatomy

753

tissue which in the case of the three-toed sloth (Bradypus)bad entirely disappeared.

In the shoulder the coraco-humeral ligament was describedas being peculiar to the Primates and the lecturer’s experi-ence made him think that it had little or no morphologicalconnexion with the distal end of the pectoralis minor. Thethree gleno-humeral ligaments of man were called attentionto and it was stated that the inferior one was unsatisfactoryand difficult to recognise. The tendon of the biceps in manwas free in the joint cavity, but in every other mammal inwhich it was intracapsular a reflection of synovial membranepassed from its ventral border to the ventral partof the capsule. The lecturer stated his opinion thatthe upper of the three gleno-humeral ligaments inman, lying as it did anterior (ventral) to the tendonof the biceps, was the remains of the reflection whichin other mammals connected the biceps with the

- capsule. The middle gleno-humeral ligament of man was’,shown to be more or less persistent all through the mam-.malian class, sometimes, as in Rodentia, being very prominent.and sometimes indistinguishable, but always when present- running from the attachment of the biceps tendon to thelower part of the lesser tuberosity of the humerus. A

ligament corresponding to it in position was shown in theshoulder-joint of the Monotremata and it was pointed outthat this ligament was of great functional importance in themechanism of the joint of those animals.

LECTURE II.

Delivered om Dlarc7a 8th, 1899.

Ix this lecture the elbow, wrist, and hip joints were dealtwith. In the elbow the presence of an oblique ligamentpassing from the internal condyle to the radius just behindthe tubercle was noticed and the name of oblique radio-.Itumeral ligament" was suggested for it. It lay superficial to.the capsule and checked pronation. It was frequently foundamong the Primates, Carnivora, and Rodentia. A distinctionwas drawn between the elbow used only for supportand that used for prehension. The ungulate elbow wastaken as a type of the former and it was noticedthat the radius lay entirely in front of the ulna,that its head was transversely elongated, that therewas no orbicular ligament, and that the lateral ligamentswere both attached to the radius. The human elbowwas taken as a type of the form adapted to prehension and.in reviewing the various orders of mammals it was noticedhow sometimes one and sometimes the other of these two

primary forms of the joint were approached. An orbicularligament was always found when pronation to the extent of-a quarter of a circle was present ; it seemed to be a condensa-tion of the connective tissue surrounding the head of the_radius. In the wrist-joint the extreme diminution of the lower- end of the ulna into the human styloid process was noticedand it was pointed out that in a generalised mammalian wrist.such as was found in most of the lower Primates, the Insecti-vora, Carnivora, and Rodentia, the lower end of the ulna wasreceived into a cup-shaped cavity formed by the cuneiform.and pisiform bones, and that the joint cavity between thesetwo bones communicated with that of the wrist. The Igeneralised mammalian arrangement of ligaments was anX on the palmar side and an oblique plane on the dorsal.The palmar "X" was formed by decussating radio- and ulno-carpal ligaments ; the latter was always the more superficial- and passed from the ulna to the scaphoid ; the former ranfrom the radius to the semilunar and cuneiform. In man the

,ulno-carpal ligament was suppressed. The dorsal ligamentin most mammals had the same oblique fibres from the.radius to the cuneiform bone which were found in man. Inthe lower Primates it was noticed that the joint becamedivided into two lateral portions by an antero-posteriorpartition which grew from the palmar part of the- capsule ; this was also seen in other mammals. Thetriangular fibro-cartilage of man was found continuouswith the inter-osseous membrane in the hedgehog andthe possibility of this meniscus being the thickenedlower end of the membrane was discussed. The wrists ofthe Cheiroptera, Ungulata, and Monotremata were specialised,the effect in each case being a firm hinge-joint, though this- 8ffect was gained by different means in the three orders.In the hip-joint the three special thickenings of the capsule,tl-e iKt)-, ischio-, and pubo-femoral ligaments of man, were

drawn attention to, and it was shown that in the lowerPrimates these were less well seen and that in othermammals they were not present at all. The lecturer hadbeen unable to find any evidence supporting the theorythat the ilio-femoral ligament represented a degeneratedscansorius or gluteus quartus muscle ; he regarded theligament in question as a thickening of the capsule due tothe gradual assumption of the erect posture. The presenceof the ligamentum teres was next drawn attention to and itwas shown to be absent in the orang, many Insectivora, thePinnipede Carnivora, a few of the Ungulata, some of theEdentata, and both examples of the Monotremata. Thelecturer expressed his ignorance of the factors whichdetermine the presence or absence of this structure,but stated that it did not necessarily vary withthe presence or absence of the gleno-humeral ligamentof the shoulder. In the Cape hyrax and the armadillothe ligament was shown to be continuous with the pubicportion of the capsule instead of being free in the

joint, while in some animals, such as the horse, goat,hyrax, and Cape jumping hare, it was continuous throughthe cotyloid notch with extra-capsular structures-a facttending to confirm Sutton’s view that the ligamentum tereswas the remnant of an extra-capsular muscle.

LECTURE III.

Delivered on March 10th, 189D.

IN this lecture the knee- and ankle-joints were described.In dealing with the lateral ligaments of the knee it

was shown that in almost all mammals the fibres of

the external lateral ligament showed a twisting in such

a way that those attached posteriorly to the femur becamesuperficial as they descended and finally were the mostanterior at their attachment to the fibula. In some animalsa twist in the opposite direction was evident in the internallateral ligament. The low attachment of the internal lateral

ligament was shown to favour rotation and in the bat’s knee,which was a perfect hinge, it was pointed out that the lateralligaments were attached just below the joint cavity. Inthe armadillo, which had very free rotation of the knee,the internal lateral ligament was attached to the middleof the shaft of the tibia. The oblique ligament ofWinslow was stated to be practically a human charac-teristic. Five varieties of the ligamentum mucosum

were demonstrated: (1) in which it was quite unconnectedwith the femur, as in the lemur ; (2) in which it was feeblyconnected with the femur, as in man ; (3) in which it formedan antero-posterior partition between the two condylo-tibialarticulations, as in many monkeys and the otter; (4) inwhich it completely subdivided the knee into three joints,two condylo-tibial and a trochleo-patellar, as in the three-toea sloth (Bradypus) and the Ornithoryhnchus ; and (5) inwhich it subdivided the knee into two unequal joints, thecondylo-tibial of one side being shut off from the rest as inthe brocket deer (Cariacus).The most primitive arrangement of the semilunar car-

tilages seemed to be that of the Monotremata in whichboth were attached to the tibia anteriorly and to the femurposteriorly. In the generalised mammalian knee the ex-

ternal cartilage was attached to the internal condyle bya perfectly separate ligament. In the lower Primates this

cartilage formed a perfect ring, while in man the originalattachment to the femur persisted as an oblique band behind,and merged with, the posterior crucial ligament. In thefruit bat, in which the knee was a perfect hinge, it was

pointed out that the semilunar cartilages were absent,’while in the insectivorous bat (Plecotus), which had slightrotation of the knee, they were very feebly developed.It was further shown that the bat’s knee bent forward owingto a complete twisting round of the hip. A curious mecha-nism of the knee in many of the Marsupialia was demon-strated, enabling these mammals to extend their knees by anapproximation of the fibula to the tibia, compensating themfor the absence of a bony patella. In the ankle the presenceof the anterior fasciculus of the external lateral ligament wasshown only to occur in the higher Primates and the serialhomology of the middle fasciculus with the dorsal ligamentof the wrist was seen by tracing it down through the mam-malian series. In the Marsupialia a semilunar fibro-cartilagewas present between the external malleolus and the astra-galus and evidence showing that this was derived from theexternal lateral ligament was given.