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little works would be combined in one or two volumes for eachof the three kingdoms, purchasable at a remunerative price.It is probable that nearly the whole of the needful statistical,meteorological, and geological data stands ready for collation.It was suggested by Dr. Chevers that a director for eachkingdom, posted at London, Edinburgh, and Dublin,efficiently supported by officers of health, and aided bya staff of about four highly qualified assistants, couldprepare and publish the first edition of these works withintwelve months of starting. The cost of printing the localhistories is doubtful, but the average expense ought not toexceed f20. The cost of the annual supplementary reportswould be small, and two officers at headquarters could editthem. Consequently, there would be no heavy expenditureafter the first eighteen months. The President concludedby saying that, in the cause of suffering humanity, he wouldbe glad to see this plan carried into effect not only in theUnited Kingdom, in India, and in the colonies, but also inAmerica and in every country throughout the civilisedworld.-In the discussion which followed, Sir JosephFayrer, SirWiDiam Smart, Surgeons-General Gordon andManifold, Drs. Don, Dickson, Thorne, and Cock, and theRev. J. Long took part.

ACADEMY OF MEDICINE IN IRELAND.

Inaugural A clcl2,ess.-Frctctu?,ed Patella.THE opening meeting of the Surgical Section was held on

Nov. 9th, when the PRESIDENT delivered an inaugural ad-dress on the Progress of Surgical Science.Mr. COPPINGER exhibited a specimen of Osseous Union

in a Patella removed from a woman aged sixty-three, whodied three months after the injury from heart disease. Heread a paper on the subject, showing that there was adistinct history of fracture from muscular violence, and therewas at first considerable effusion into the knee-joint, withseparation of the fragments. The close union of the fracturewas attributed to an attack of inflammation of the parts inthe neighbourhood of the patella, leading to an increase in thesupply of blood to the seat of the fracture and to early andcomplete absorption of the liquid effused into the joint.The specimen showed a simple transverse fracture unitedby bone, but the fragments were joined at an angle, provingthat the fractured surfaces of the bone had been displacedto some extent forwards. The author recommended that thetreatment for ordinary transverse fractures of the patellawith separation should include careful attention to position,the early removal of effused fluid and blood from the joint byaspiration if necessary, and the subsequent application of aplaster-of-Paris case to prevent flexion of the limb. Mr.Lister’s method of freely opening the joint and suturing thepatella was advocated for cases of ununited fracture or liga-mentous union, but objected to as a routine treatment forordinary cases son the following grounds :-The opera-tion is hazardous, has not received a sufficient trial, andeven in careful hands may be complicated by the accidentalentrance of septic matter into the joint.-Mr. THOMSONcongratulated Mr. Coppinger upon having confined himselfto two or three questions for consideration in the discussionof a subject about which so many varieties of opinionexisted. He had had himself in hospital a man with two frac-tured patellas, who fell from a fort wall in India duringthe Mutiny, breaking both patellae. The fragments wereunited at a distance of some inches by fibrous band, and hewas still able to go about, comparatively with great comfort.In going up- and down-stairs, however, he had to becautious; but on the level ground he got on prettymuch as anybody else did. Concerning the important questionof opening the knee-joint, he entirely concurred with Mr. Cop-pinger in saying that upon no ground, except where the patientwould have an absolutely useless limb, was it justifiable. Cer.tainly it was not in a case of recent fracture of the patella.At the same time, while dissenting from the view Lister hadtaught in the address lately given to the Medical Society, inno sense did he abate one jot of his belief in the applicabilityand thorough truth of the Listerian method. The Listerianniethod was not dead in Dublin, and it was not dead, hewas glad to say, in the surgical world.-Dr. MAPOTHER didnot think he received from the reading of any communica-tion a greater shock than that he had experienced onreading the address of Professor Lister on fracture of the

patella. For astounding audacity, it exceeded anything hehad ever conceived. In a simple transverse fracture of thepatella, an incision was to be made two inches long in frontof the bone, an opening made, and the cavity of the synovialmembrane washed out in order to produce bony union.That such a statement should be put forward in these daysalmost exceeded credibility. In the case of a transversefracture of the patella, there was scarcely a doubt that byposition and by apposition of strong adhesive rubber-piasterabove and below, the fragments could be kept very closelytogether, and he believed that ligamentous union was veryoften better than bony union, even if they could get bonyunion, which he believed they could not. On readiogProfessor Lister’s paper it occurred to him that ill manyforms of fracture of the clavicle, the two fragments could bekept together by suturing ; but in fracture of the patella,the shocking practice he advocated as to the great synovialcavity seemed to be attended with extraordinarydanger.-Mr.BARTON took it as proved by the complicated apparatus inuse for many years and the theories put forward that surgeonswere not satisfied with the result of ligamentous union.Whatever exception might be taken 8S to the advisabilityof drilling the fragments, as Prof. Lister had pointed out, stiilthat had been done with perfect safety ; the joint of thepatella had been drilled and sutured with perfect immunityfrom inflammation and absolute security from the dangersthat would accrue without antiseptic measures. He did notadvocate the general adoption of the procedure in all recentfractures ; for he had attempted the operation of suturing theolecranon process, and he knew the difficulties that attendedit, combining the possibilities of success and the dangers offailure.—Mr. CORLEY said one point had been demonstratel-namely, that surgical history repeated itself. At a formerdiscussion on the subject, the President (Mr. Wheeler) wasthe exhibitor of an apparatus for producing bony union; andsometimes afterwards Mr, Wheeler showed a patella whichexhibited bony union, the inference being that it hadresulted from the application of the apparatus. But to-nightthey had a patella in which bony union was obtained withoutany apparatus at all, because Mr. Coppinger’s apparatuscould scarcely be said to have any effect in producing bonyunion. Thus they had the two extremes-an elaborateapparatus shown as producing bony union, and another iawhich it had been produced practically without any appa-ratus ; while there were surgeons who denied that bonyunion could occur.—Dr. McARDLE observed that the case heexhibited was one treated by rubber plaster-a piece abovethe patella and one below it, drawing the parts together.The leg could be flexed now as well as those the patella ofwhich was not broken; and therefore if such a result couldbe had by simply strapping, an elaborate apparatus was notrequired. He did not believe it was necessary to cut intothe knee-joint to procure bony union. The second case hehad exhibited was one of detachment of the quadricepsextensor cruris from the patella, and in that, though tnemuscle was extended up to the middle of the thigh, with therubber plaster he had beenabletobringit down. InMr.Barton’8remarks about the lengthening of the constricture he did notagree.-Dr. BALL called attention to the fact that one surfaceof the patella was either bounded by cartilage or synovialmembrane and the other was subcutaneous, and the forma-tion of the bone around the fracture only occurred wherethere was a large amount of areolar tissue or lean mus-cular tissue. In fracture of the tibia there was scarcelyany adventitious formation of bone. Unless the fragmentsof the patella were in absolute apposition the union by bonewas almost impossible. Union of bone in fracture of thepatella was not so great a desideratum. He had himselfa case in Sir Patrick Dun’s Hospital, in which the frag-ments were considerably separated and there was effusioninto the knee-joint, so that it was impossible by anymechanical means to bring the fragments into apposition,and he adopted Mr. Hutchinson’s plan of aspirating theknee-joint after removing the fluid. The fragments werebrought together and the man left the hospital with thefragments in as close apposition as could be wished.-Mr. STOKES, adverting J.o Dr. Mapother’s statement thatafter reading Professor Lister’s address he experienced oneof the greatest shocks he ever had in his life, said thatafter reading the same address himself he had not for manyyears past experienced a keener sense of pleasure, for itrecorded seven surgical results, which could only becharacterised as brilliant, results which had hardly everbeen equalled and never surpassed. Although he did not

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concur with Mr. Thomson in thinking they should not hopefor our ciite for osseous uniun in these fractures, yet the surgeonwho operated undertook, as Lister himself had said, a tre-mendous responsibility. Occasional failure, however, in spiteof the most careful antiseptic Listerian precautions, shouldrnske them very slow in recommending or performing theoperation until some other method of carrying out antisepticpractice than that now used and advocated by Lister wasdiscovered ; and that that method would be discovered hehad no doubt whatever.-Dr, K. M’DONNELL said the onlyimportant question for the surgeon always to consider in amatter of the kind was, would he conscientiously andhonestly, being in the position of the patient, submit to theoperation himself. It was very difficult to do that, but stillthey could make some attempt at it. In considering thebtilliant cases mentioned by Lister, which were a very im.portant addition to surgery, and having regard to Listerismand its results, was there a single surgeon present who, if hefractured his patella, would submit to have his knee-jointopened, the fragments stitched together, and a drainage-tube put through the joint ? That was the way conscientiousmen would look at the matter.-Dr. LENTAIGNE said he hadsuch confidence in the Listerian method, though it was saidto be dead, that if he fractured his patella, and his limb wascrippled so that he could not use it, he would without hesi-tation submit to the operation at Mr. Lister’s hands.-ThePRESIDENT said that in the case which he exhibited ofbony union resulting from the use of his own splint, theseparation was about two inches and a half. That casewas seen by Mr. Colles, Mr. Butcher, and Mr. Tuf.nell, and ultimately the use of perfect motion of the ijoint was recovered. About two years afterwards the Iman died of phthisis in the Richmond Hospital. Throughthe courtesy of Dr. Gordon, he obtained the patella,in which was found complete bony union. The patella wasexamined by Prof. Macalister, and seen by Mr. Hamiltonand others. He was confident the result was attributable tothe u-e of his spliut, with which he had since producedsimilar successes, although happily there were not in thesecaes the same means of veritication. In his opinion thebest attainable result was bony union, which he held to befully authenticated by the statement in Prof. Haughton’sAnimal Mechanics " that every portion of the humanstructure was organised with the object of rendering thegreatest possible amount of work. As to Mr. Lister’s treat-ment of fracture of the patella, opening the parts andsuturing the fragments together, he would make no com-ment beyond remarking that in his recent publication Mr.Liafer made drainage and cleanliness the prominent essen-tial factors.-Mr. COPPINGER said that as regards bonyunion, it was obvious the patella would not be where it wasif a bone was not the proper structure. But what he hadmsgested was that inefficient bony union was much moredangerous than fibrous union, and much more liableto lead to dangerous injury, such as a compound fractureinto the the knee-joint, an injury which would not occurif the union was of fibrous tissue.

Reviews and Notices of Books.A 1lTccaual of Pcat7aolog. By JosErn COATS, M.D., Patho-

logist to the Western Infirmary and the Sick Children’sHospital, Glasgow, Lecturer on Pathology at the WesternInfirmary, &c. London: Longmans, Green, and Co. 1883.

THE importance of the study of pathology as the basis ofscientific medicine needs no advocacy. The correct inter-

pretation of morbid lesions and their mode of productionmust underlie all our efforts in the discrimination of diseases,and point the way to a rational system of therapeutics, sothat in the present day no one can contend that the laboursof the pathologist are without definite practical bearing.Ths London Pathological Society has been of the greatestservice in this respect, for, although its sphere has been inthe main restricted to morbid anatomy, it has been themeans of stimulating and furthering research to a degreehardly to be conceived by its founders. A review of the

progte"s of pathological science as exemplified in theTransactions d Lliat Society alone would be instructive.Yet, as comp(.d with the extent to which the subject has

! been pursued on the Continent, the contributions of thel I’athological Society are insignificant. Commensurate with’

this activity in pathological research has been the growth of’

its literature, so that it becomes increasingly difficult to, keep pace with the advancing doctrines put forward on all: sides. When, then, we find so accomplished a student andI zealous a worker as Dr. Coats undertaking the preparation

of a manual which shall be abreast of the time, we have nohesitation in according him, on behalf of all student?, manygrateful thanks. The labour involved in the preparation ofsuch a manual as the present can be known only to theinitiated; and, having perused the volume, we consider thatthe author has succeeded in his difficult task, and has herepresented the most comprehensive and exact work on thesubject, fully up to date, that has yet been issued in thiscountry. This is high praise, but no impartial reader canavoid awarding it. It is no detraction from the merit of thework that in arrangement and method it follows the modelof some of the German text-books, for it is difficult to seehow otherwise the subject could be presented; and themain fault, if it be one, is that it aims at being so compre-hensive.The work opens with affections of the circulation and

of the blood—hyperaemia, anaemia, thrombosis, embolism,dropsy, and inflammation being dealt with, besides sectionsupon such morbid states as diabetes, leukhsemia, and uraemia.In the description of the circulatory disorders the teachings ofCohnheim and his pupils are largely laid under contribu-tion ; and, indeed, it is difficult to estimate the value of theresearches, which, more than any other, embrace the studyof pathology from its physiological side. In spite of thespeculative tendency of Cohnheim’s mind when dealing withpathological problems, as in his " Vorlesungen," no one candeny the importance of his discoveries and their bearing onpathological processes. Cohnheim’s work stands alone, andif it be transcendental, it yet affords food for thought, andsupplements rather than replaces the more solid anatomicallabours of Virchow. It is not altogether satisfactory thatwe have no English version either of the master’s lectureson Tumours or of the pupil’s on General Pathology, for eachis in its department the highest literary production ofmodern pathological science. Passing over the chapters onthe degenerations and on hypertrophy, in each of which theEnglish reader will find evidence of the greatest exactitudeand minuteness of knowledge in these matters of generalpathology, we find that Dr. Coats deals in the next placewith the infectious tumours or granulation-tissue tumours,those formations which are the outcome of the presence of a

specific poison in the blood, as tubercle, syphilis, leprosy,glanders, &c. Here, in connexion with tubercle, we have adescription of Koch’s bacillus, the discovery of which has,in our opinion, affected but little the notion of the in-fectiveness of tuberculosis as exemplified in its mani-

festations, although etiologically it may be of much im-

portance. Dr. Coats, we may add, inclines to the viewthat scrofula is a tubercular manifestation, and his specu-lations upon the source of the tubercular virus are clearlystated. Appended to this is a section dealing with bovinetuberculosis, and another on lupus, which modern inquirywould ally intimately with tubercle. The section on tumoursis accurate, and the discussion of their etiology interesting;but we must venture to protest against his classification,which is hardly in accordance with histogenetic facts. Thus,under the head Connective Tissue Tumours we find angionnand adenoma grouped with lipoma and fibroma; under

Compound Tissue Tumours, cystoma (a division for whichVirchow is responsible, but which to our thinking forms soheterogeneous a group as not to be considered strictly as"tumours"), papilloma, and teratoma; and, lastly, underCellular Tumours we have classed the sarcomas, carcinomas,and lymphoma! Perhaps in a future edition Dr. Coats