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30th.-Opisthotonos no longer produced, but choreic Isymptoms very bad. Sleep had been rather disturbed. ITemperature 98-6°; pulse 104.

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31st.-Choreic symptoms very bad. Sleep much disturbed.Circulation beginning to fail. To continue the sulphate ofzinc, ten grains four times a day, and the chloral and bromidedraugbt. Temperature normal; pulse 96.August 1st.-Rather better; slept well last night, and

was quite quiet during sleep.2nd.-Rather quieter; a good night ; taking milk freely.

The vibration of the muscles of the forearm, which had

previously rendered it very difficult to count the pulse,is much reduced. To continue the treatment.

4th.—Quieter; muscular spasms less; slept well last

night. The sulphate of zinc increased to eighteen grainsfour times a day.

6th.-Considerable epistaxis at 1 A.M.; rather quieter.Sulphate of zinc increased to twenty-four grains four timesa day. The sphincters of the bladder and of anus are beyondcontrol, and the evacaations are passed unconsciously.

.

7th.—First sound of the heart very weak; pulse dicrotic ;considerable effusion in the bronchial tubes ; chorea lessviolent. Ordered twenty-six grains of sulphate of zincwith five minims of digitalis four times a day. An ounceand a half of brandy to be given in small quantities duringthe twenty-four hours, mixed with milk.8th.-Quiet night; pulse stronger; lungs clearer, but

some crying. Ordered thirty grains of sulphate of zinc withten minims of tincture of digitalis four times a day.9th.-Fair night; pulse steadier, 108; crying a little.

Continue treatment.10th.--A fair night; face pale; point of nose and extremi-

ties cold; not much movement, but great crying; pulse 140and very dicrotic ; first sound of the heart almost inaudible.Continue the sulphate of zinc with ten minims of tinctureof digitalis four times a day; omit the chloral draught.llth.-Had a fair night; chorea has ceased; heart’s action

very weak ; pulse very dicrotic ; evidently sinking. Diedat 7 P.M. of weakness. A post-mortem examination was notpermitted.

Medical Societies.ACADEMY OF MEDICINE IN IRELAND.

Ununited Fracture of the Humerus, and a ,3method ojTreatment thereof by ]I;[etal S’creu-Taps.-’lectrolysisfur the Treatment of Urethral Stricture.A MEETING of the Surgical Section was held on May 21st.Mr. HENRY FITZGIBBON exhibited a brace fitted with

drill and screw-taps for the fixation of resected bones,and reported a case of Ununited Fracture of the Humeruswhich he had successfully operated upon by this method.Mrs. T--, admitted into the City of Dublin Hospital onMarch 13th, 1885, with comminuted fracture of humeruswhich refused union, was sent to the seaside untilNov. 14th, when she was readmitted with permanent non-union. The patient was operated on successfully on

Nov. 26th by means of screw-taps and wire sutures, whichwere removed on the twenty-first day after the operation.The patient was exhibited to the Academy, with firm unionand a useful arm, on April 16th. Mr. Fitzgibbon attributedthe non-union to the pressure of the comminuted fragmentbeing displaced inwards so as to cause pressure upon thebrachial vessels, depriving the lower fragment of sufficientblood-supply.—Mr. BENNETT corroborated Mr. Fitzgibbon’sdescription of the operation, which, he said, was performedupon a woman who wa an unfavourable subject for it bothas regards age and nutrition, presenting, as she did, extremeflabbiness of muscle. The union was perfect not only asregarded junction of the bones, but also in their appositionand the line of direction of the humerus, so that there waslittle or no deformity. In mechanical detail Mr. Fitzgibbon’smethod offered some advantages; but iron pegs were pre-ferable to silver, as being rigid and efficient, whilethe silver were flexible.—Mr. WHEELER, having seen

the patient before, during, and since the operation,mentioned the result of his observation. The patienthaving a fracture of the humerus as described, the

house-surgeon put np the arm in the usual method withtwo splints, which were well adapted, and it rested upon apillow. Xext morning the bones, being displaced, were

readjusted. The cause of non-union was her indocility andrestlessness, wishing to have the splints opened, and not, as,Mr. Fitzgibbon had suggested, the want of blood-supply.At the same time, everything except electricity was used,to excite inflammation and produce union, so as to avoidoperative interference. The operation selected by Mr. Fitz-gibbon was that most suitable, and as the result The patientrecovered, with every motion perfect except the upwardswhich’was not so perfect as it was before the accident. Inhis own practice he observed a noteworthy point whichhe had not seen recorded in the books-namely, that infracture of the humerus, where there was much immo-bility, if the bone united, an immensity of callus wasthrown out, and that was always on the inner side.-Mr. O’GRADY having operated in half a dozen cases ofununited fracture, said they varied so much in their con-ditions that no line of treatment in common could be laiddown; for instance, the treatment of a transverse fractureof ’the humerus was different from that of an obliquefracture of the thigh. He had used ivory pegs till it wassuggested that the pigs from which the material was ob-tained might have had tuberculosis, and thenceforwardedhe used the plain iron pegs, which were driven by meansof the common Archimedean drill with an up-and-downmovement. His drill was the one the late Mr. Huttonhad. In the after-treatment he adopted the strictest;antiseptic procedure-namely, cleanliness and rest, butwithout the newly-developed paraphernalia.-Mr. CORLEYsaid there were already nineteen different methods for thetreatment of ununited fracture, the large number suggest-ing that none of them could he regarded as perfect. Mr.Fitzgibbon’s formed the twentieth, which he hoped wouldbe perfect. The accident in question-i.e., the non-unionof fracture of the shafts of long bones-was of rare occur-rence, only one case having come under his observationduring twenty years’ experience as a hospital surgeon.No doubt, cases arose through the irritability or restlessnesaof the patient, or want of care on the part of the surgicalattendant, pointing to the old adage that" prevention is bette?than cure." He approved of the ordinary Archimedean drill.-Mr. M’ARDLE mentioned the advantage of using a steeigimlet., with a thread the size of the screw, as giving a hold,.and obviating the detritus which Mr. Fitzgibbon’s instru-ment produced. He had used ivory screws, which becameloosened sufficiently to draw out.—Mr. TOBIN considered if;was an interesting question to determine how long wouldthe screw bite in the bone, seeing that it ultimately loosened.- Mr. FRANKS thought that the method, while ingenious,was rather complicated, and that the’surgeon should not beconfined altogether to the use of screws. About a year anda half ago he had himself treated a case of ununited fracture-of the humerus, the fracture passing through the neck ofthe bone below the attachment of the capsular ligament.In the first instance, the case had been wrongly diagnosedas a dislocation and put into splints. At the end of sixweeks it was sent up from the country to him. He foundthe lower fragment projecting underneath the skin, whichwas so extremely thin he feared the slightest movementwould send the bone through it. Having decided to removepart of the bone, he exposed it by an incision from theshoulder, and he then removed about two inches of thelower fragment. From the upper one he could takenothing, because it was bound by the capsular liga-ment. He scraped the bone to revivify it ; then, withan ordinary bradawl, he drilled two holes through thahead of the bone, passing through the capsular ligament,and two the other way through the lower fragment, andinserted two tolerably thick silver wires, joining and twist-ing them. Six months afterwards he removed the wires,which, but for the irritation they caused, he would have letremain. Following the operation, he used further antisepticprecautions, with cleanliness and rest. He preferred passingthe wires through and thus joining the ununited bones, a&

being a simpler method than using screws. The less thesurgeon trusted to complicated methods and the more he usedhis fingers the better.-Mr. FITZGIBBON replied. The argu-ment of Mr. Bennett had convinced him of the advantage ofsteel screw-taps over silver. The grip of the screw was beyondquestion; for when he thought he had it sufficiently outto remove it with his fingers he had to readjust the braceto extract the last eighth of an inch of it. In the casesalluded to it might have been that the ivory screws beingtaken from measly pigs produced an amount of irrita-tion and suppuration that would account for the loosening.So far from the brace being a complicated instrument, it

447

was an ordinary carpenter’s tool. To make the hole with abradawl was objectionable, because of the continuouswabbling backwards and forwards, instead of in the samedirection, like the brace. Having seen Hutton and Hamiltonoperate in ununited fracture, he noticed a great deal of diffi-eulty in getting the wire through the hole in one fragmentand then through the hole in the other. But there was no

difficulty in introducing or removing the screw-taps.Mr. P. J. HAYES read a paper on the Treatment of Urethral

Stricture by Electrolysis, the comparatively novel methodpractised by Drs. Robert Newman’of New York and S. T.Anderson of Bloomington. He gave the details of three.cases in which he had himself adopted the method with en-couraging results. Therefore, he strongly advocated the- trial of electrolysis not alone in simple cases, but even forthe most complicated forms of stricture as calculated to-effect unhoped-for benefit, and as not at all interfering withthe subsequent employment of other measures, minor orserious. The outcome of the experience of Dr. Anderson,with whom he had had the advantage of direct communica-tion on the subject, combined with his owr, indicated that,electrolysis was best adapted for the treatment of annularstrictures rather limited in length. Having ascertained thesituation of the stricture, the tip or exposed metal bulb ofan electrode ought if possible to be lodged within it, or, ifthis was impracticable, the tip must be in close contactwith the anterior face of the stricture. Then a small galvanicbattery was connected by its negative pole with the urethralelectrode, whilst the positive might be attached either to amoist sponge electrode, or, better still, to a thin metal platecovered with moistened chamois leather. The positiveelectrode would be advantageously applied either to thepatient’s perineum. or against the inner side of one thigh.As to the strength of the current to be employed thepatient’s own sensations would prove the best guide. Thecurrent should be perceived, but it ought not to be pushedto cause pain, nor should the surgeon attempt more than itwas needful to effect at each 8éance, using only mild currents,and manipulating the electrode with gentleness, and never,pushing it through the stricture, as it accomplished moreby being allowed to remain in the stricture than by beingcaused to quickly traverse it. The stance might be repeatedwery ten days if desired. Cauterising would be producedwhen strong currents were employed, but with mild,currents the gradual breaking up of fibroid tissue waseffected by a combination of chemical decomposition and- vital absorption until but a thin lamella of cicatricial’issue remained to mark the seat of the stricture.-The PRESIDENT: Do you think there is actual chemical’decomposition as the effect of the electrode which appears toliquefy the nitrogenous matter-in other words, that theeffect is more chemical than physical?-Mr. HAYBS: Certainlymore chemical than physical. There is probably acombina-tion of both.-Mr. FITZGIBBON said it would be a step in’advance if electrolysis proved a permanent cure for resilient,stricture.-Mr. TOBIN observed that there was a difficultyof a twofold character which the surgeon encountered-first, to know with certainty whether he was pressing on’the stricture, and, secondly, whether it was permeable.-Mr.BEVVETT suggested the desirability of taking precautions indirecting the action of the current.-Mr. CoRLBYindicated thenumber of false passages in the immediate neighbourhood ofthe urethra, not one of which could be distinguished from it,and asked would the point of the instrument have the sameeffect if it went into one of those false passages.-Mr.WHBELBB. assumed that Mr. Ilayes did not propose thatelectrolysis was suitable for every case of stricture, the pro- Icedure being in some to dilate and in others to cut.—Mr.HATES replied. Encouraged by his own success, he wishedto induce others to try electrolysis. In one of his casesthere should have been a cutting operation had he not em-ployed electrolysis, which could be done in the majority ofcases, and, if ineffective, any other method, major or minor,’could be afterwards adopted.

The Section then adjourned until November.

CAMBRIDGE MEDICAL SOCIETY.

AT a meeting held on Friday, July 2nd, Dr. J. B. Brad-’bury, President, in the chair, the following communicationswere made:-Abdominal Titmozt2- of Unusually Lange Size. - The

PRESIDENT brought forward this case. James B -, aged

sixty-two, a labourer, was admitted into Addenbrooke’sHospital on Dec. 16tb, 1885, and died on Feb. 20th, 1886.One sister died from cancer of the breast. His presentillness began two years ago, with loss of strength, andvomiting, and a swelling appeared just below the xiphoidcartilage. The patient was much emaciated, and complainedof distension of the abdomen, but not much pain. Therewas some cedema of both legs. The abdomen was greatlydistended and the veins prominent. The swelling was mostprominent above the umbilicus, and there was much bulgingin the flanks. A large, painless, uneven tumour could befelt extending from below the ribs to one finger’s breadthbelow the umbilicus in the middle line. The left flank wasresonant, the right was dull. There was evidence of fluidin the peritoneal cavity. The upper limit of hepatic dulnesswas in a line with the nipples. Urine 1027, acid, no albumen;urea 2 per cent. A few enlarged inguinal glands on theleft side. On Dec. 19th the aspirator needle was introduced infour places over the most prominent parts of the tumour, butonly a drop of blood was obtained. The swelling continuedto increase in size and the patient gradually became weaker,until towards the end constant vomiting set in and he diedon Feb. 19th.-Mr. GRIFFITH gave the following account ofthe post-mortem examination, which had been made by him.The abdominal cavity was greatly distended with a largetumour, which was so large as to obscure all the viscerafrom the front, except in the left inguinal region, wherecoils of the small intestine appeared. This mass was appa-rently divisible into an upper and left half and a lowerand right half by an oblique line running from above down-wards and to the left; the former presented a coarselylobulated, jelly-like mass passing upwards into the lefthypochondrium, where it had become slightly adherent tothe abdominal wall; the latter was enclosed in a firm, strong,fibrous capsule and closely adherent to the abdominal wallall over the right side. After removal of the mass, thenormal relations of the intestine had not been much dis-turbed. The ascending colon passed upwards behind themass, being only partially involved in it at the lower part,the small intestine was quite free, so that the tumour hadgrown in front of the ascending colon and pushed the smallintestine to the only free part of the abdominal cavity-viz., the left inguinal region. The stomach, liver, andspleen had all been pressed upwards, carrying the dia-phragm before them, and diminishing to a considerableextent the vertical diameter of the thoracic cavities.The mass itself weighed 33 lb., and was soft and jelly-like inconsistency. On section it presented the same characters,and in addition large areas of softening and haemorrhages.Microscopically, the parts near to the seat of haemorrhagesconsisted of a very large number of delicate, thin-walledbloodvessels, with small haemorrhages here and there alongtheir course ; between them connective tissue cells, irregularin size, shape and outline, with usually a single nucleus,embedded in a fine reticulum of fibres, besides a few largecells becoming transformed into fat cells. Other partssimply consisted of bands of connective tissue with largemasses of fat cells between. All the organs were normaland healthy except the stomach (which was peculiar inbeing very small and contracted, forming nearly a straighttube stretching across the vertebral column) ; and the rightkidney, which could not be found after the removal of themass, nor could any trace of it be detected on very carefulnaked-eye examination. Unfortunately, the right ureterwas not looked for and traced upwards to ascertain its pre-sence or absence.-Dr. BRADBURY thought that the. tumourwas probably a sarcoma of the right kidney, judging fromthe post-mortem evidence, although there were no sym-ptoms during life, except a small quantity of urine, to pointto this conclusion. He found that hsematura was absent inabout half the cases of cancer of the kidney.Recovery after Fractured Spine.-Mr. WHERRY related acase of recovery from Fracture of the Lumbar Vertebræ,with Paralysis of Legs; and one of recovery after Fractureof the Cervical Vertebrae, with Paralysis of Arms; deathoccurring twelve years after. Case 1: Charles C-, agedsixty, on Oct. 29th, 1873, fell 57 ft. from a scaffold, and at28ft. a plank checked his fall, and lower down he alightedon an office ridge roof. He was nineteen weeks in Adden-brooke’s Hospital. A catheter was used for two years; herecovered power in his bladder by degrees, and from hisinvalid chair began to walk with crutches, and could go ahundred yards pretty well. He had enjoyed fair healthduring the past thirteen years ; now his legs are swollen