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that the knee-joint was as accessible to surgery as any partof the body and he thought that the change of opinionwhich had occurred with regard to this point was largelydue to the fact that drainage was not now much employed.The opening of the knee-joint in order to wire a fracturedpatella gave rise to no anxiety and yet neither irriga-tion nor drainage was employed. Mr. Barker thoughtthat passive movements should be commenced at once

and active movements as soon as the wound was

healed.-Mr. WATSON CHEYNE agreed that the plan of

washing out the cavity with an antiseptic solution wasundesirable, but he did not go as far as Mr. Barker withregard to drainage. Where the opening was an incisionmade by the surgeon drainage was undesirable, but if thewound was made by a foreign body a drain should bearranged for twenty-four or forty-eight hours and then ’’,removed if there was no sepsis.-Mr. WALLIS, in reply, said ’i,that in some cases he thought that the use of a strong anti- septic was unavoidable. He mentioned a case in which therewas septic inflammation of the knee-joint which continued inspite of treatment for some months until he applied purecarbolic acid to the joint surface. The joint healed and theman was able to resume work, although there was not muchmovement in the joint.

Dr. G. A. SUTHERLAND and Mr. WATSON CHEYNE con-tributed a paper on a Case of Chronic Hydrocephalus treatedby Intracranial Drainage. The patient was an infant, agedsix months, who was suffering from congenital hydrocephalusand hereditary syphilis. No improvement had followed afterthree months of medical treatment and the head wassteadily increasing in size. The condition at the time of theoperation was one of very marked hydrocephalus, the bonesof the skull being soft and widely separated and the vertexoccupied by a large membranous space measuring nine inchesin its widest diameters. The operation consisted in makinga small opening in the dura mater opposite the left lowerangle of the anterior fontanelle and introducing a catgutdrain, one extremity of which was passed between the brainand the dura mater for a distance of one inch and the otherpushed through the substance of the brain into the expandedlateral ventricle. A very small quantity of ventricular fluidescaped, the opening in the dura mater was completelyclosed with catgut sutures, and the scalp wound sewn upand dressed in the ordinary way. On the fifth day after theoperation, when the dressings were removed for the firsttime, the wound was entirely healed. From the date ofthe operation there was a steady and uniform diminu-tion in the size of the head without the occurrence of anybad symptoms, and within a few weeks the spacesbetween the cranial bones were entirely obliterated andthe anterior fontanelle was much smaller, depressed, andpulsating. Later symptoms of basal meningitis developed andthe infant died from that affection three months after the

operation. At the necropsy the membranes at the base of thebrain were found to be thickened and adherent and a con-siderable quantity of fluid was present in the subdural space.The brain was small and cystic in parts but there was nodistension of the ventricles. Reference was made to thework of Dr. Leonard Hill, whose experiments on the

absorption of fluids from the subdural and subarachnoidspace suggested the line of treatment which had beenadopted. By establishing a permanent communicationbetween the ventricles and the subarachnoid space it washoped that however much fluid was secreted in the ventriclesit would be carried off at once by the veins, and in theabsence of injurious pressure the brain would be left free todevelop if it could. The result of the operation had shownthat in hydrocephalus the excess of ventricular fluid could beremoved by this method of intracranial or subdural drainage.They had brought a similar case for inspection which hadbeen operated upon three weeks ago, and members could seefor themselves what an extraordinary diminution had takenplace in the size of the skull. They did not supposethat in this case acy useful result would accrue as regardsmental development, but the operation, at any rate, gavethe child a chance. It proved, moreover, that if theycould get these cases earlier, before the brain had beeninjured by pressure, there was a reasonable chance ofpermitting the development of the brain to proceed.-Mr. STANLEY BOYD said that the post-mortem appearancesin the first case threw a doubt on any probability that theresults of the operation would be permanent. It seemedthat the hole through which the drain of catgut camebecame adherent to the dura mater and the object of the

operation was frustrated. Even in the living patient whowas shown it was likely that when catgut had becomeentirely absorbed the brain would be likely to becomeadherent to the dura mater, obliterating the communication.

WEST LONDON MEDICO-CHIRURGICALSOCIETY.

Exhibition of Cases.A CLINICAL meeting of this society was held on March 4th,

Dr. H. P. POTTER, President, being in the chair.The PRESIDENT showed a case of a Button-hook removed

by Gastrotomv from a woman together with a Skiagramtaken by Dr. F. H. Low showing the hook in the stomachbefore removal. (For a fall report of this case and a repro-duction of the skiagram see p. 786.)-Mr. KEETLEY alludedto a case of a woman who had swallowed a plate of falseteeth which had become impacted in the oesophagus andhad led to a fatal result. He congratulated Dr. Potter onthe success of his case.Mr. KEETLEY showed a case of a man who had been

mauled by a Leopard, who after the injury had a very hightemperature and had been treated by anti-streptococcicserum.-Mr. McADAM EccLES mentioned a case of a manwho had been severely wounded by a lion in the thigh andwho had died from septicæmia.—The PRESIDENT remarkedthat he thought that it was not unlikely that tetanus mightresult from such wounds.-Mr. TwYNAM related three casesof Shark-bite in boys in which there had not been any un-toward result.Mr. KEETLEY also showed the case of a boy on whom he

had performed Erasion of the Knee-joint for early Tuber-culous Arthritis. The result was all that could be desired.-The PRESIDENT alluded to a case of a woman on whom hehad performed arthrectomy on both knee-joints with verygratifying results.

Dr. SEYMOUR TAYLOR exhibited a case of LocomotorAtaxia in a man.-Dr. WHITFIELD remarked that in somesuch cases there was delayed sensation and not trueanæsthesia.Mr. McADAM EccLES showed a case of a girl, aged three

years, with Wandering Rash on the Tongue. He alsobrought forward a case of an Injury to the Lower End ofthe Left Radius in a boy, aged fourteen years, and with it askiagram taken by Dr. Low, which well demonstrated theinjury.-Dr. ABRAHAM showed a case of Acute Psoriasis ina boy.

Mr. McADAM EccLES (for Mr. BIDWELL) showed a manwho Fractured his Right Patella some years ago and morerecently his Left. This Mr. Bidwell had wired, but thesame patella was refractured a few months later, the wirebreaking as well. It had been wired again. Mr. McAdamEccles remarked that he believed that possibly bony union ofthe patella was not always so much to be desired as wascommonly thought.

Dr. WHITFIELD showed a case of Spasmus Nutans in aninfant.-Mr. McADAM EccLES alluded to a similar case.

BRITISH ORTHOPÆDIC SOCIETY.

Acquired Flat Foot.A MEETING of this society was held at the Royal

Orthopædic Hospital, London, on Feb. 25th, Mr. H. A.REEVES presiding.Mr. A. H. TUBBY, Mr. LUKE FREER, Mr. E. MUIRHEAD

LITTLE, and Mr. THOMAS showed cases.Mr. MUIRHEAD LITTLE opened a discussion on some

points of interest in Acquired Flat Foot. The arch of thefoot was no arch in an architectural sense. Its functionswere those of a spring buffer and a lever. Golbiewski,Meyer, and Dane had shown that under the weight ofthe body the base of the fifth metatarsal bone descendedmore than did the scaphoid. In the over-pronatedfoot, on the other hand, the inner arch descended morewhile the fifth metatarsal ascended under weight. Accord-ing to their over-pronation was the initial change inflat foot, yet this condition was found accompanyingtoo high an arch. Inefficiency of the long muscles on

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the inner side of the ankle was an important factorin causation. The subastragaloid joint was of great impor-tance in this connexion. Rigidity was of considerablemoment as affecting treatment. In bad cases there weresigns of ill-nutrition of the limb and the foot was oftenclammy and bathed in sweat. Theoretically flat foot shouldnot accompany genu valgum but it was often present. Ithad no special connexion with scoliosis. Bone deformitieswere secondary. Diagnosis was easy, but cases of I I in-ankle" with high arch were sometimes taken for flat foot.

Footprints were often used as a means of diagnosis andrecord but were not always trustworthy. He had studied thefootprints of fifty recruits passed as fit for the army anddescribed a simple method of measuring such prints and ofnumerical comparison. The treatment was palliative or

curative. He had never trusted to gymnastic exercises aloneand could not say to what extent patients benefited by them.Mr. Jackson Clarke had stated at a former meeting that hehad known the sound foot to break down under the exercises.Reduction must always be first effected by rest in adductedpositions, manipulation under an anæsthetic, or if neededtenotomy of peronei and extensors. Wedge-soles were mostuseful. They corrected over-pronation. Whitman’s brace-a metal support-fitted to the arch of the corrected foot wasoften of service. In other cases a concealed spring convexoutwards on the outer side of the foot or the familiar out-side upright pad and T-strap were necessary.

Mr. JACKSON CLARKE said that the importance ofexercises was perhaps exaggerated. He treated his caseswith an iron and T-strap.Mr. OPENSHAW pointed out that it was a mistake to

suppose that the inferior calcaneo-scaphoid ligament wasstretched and thinned. It was the internal ligament thatwas so affected. He thought the arch itself was not diseaseduntil the astragalus almost touched the ground. He thoughtno operation equalled Ogston’s for severe cases.

Mr. LUKE FREER concurred with Mr. Jackson Clarke’sviews as to exercises. He preferred a raised sole with steelspring arch inside the boot.

Mr. TUBBY referred to Mr. Golding-Bird’s method ofestimating flat-foot. He thought the peroneus longus caused"in-ankle." In certain cases excision of half an inch of thetendon effected a cure.

Mr. LITTLE, in reply, agreed with Mr. Openshaw as tothe projection and sinking of the astragalus. Mr. Golding-Bird’s method was entirely inapplicable to footprints. Hehad not seen any signs of over-action of the peroneus in his"in-ankle cases. He could not understand how removinga portion of tendon cured spasm unless non-union was

aimed at.A vote of thanks to the Chairman and to the hospital

authorities closed the proceedings.

ÆSCULAPIAN SOCIETY OF LONDON.

Exhibition of Specimen. - Suppurative Mastitis with AcuteHepatitis and Acute Nephritis.-Leg and Cord Presen-tation.A MEETING ot this society was held on March llth,

Dr. B. G. MORISON, President, being in the chair.Mr. BREMRIDGE showed a woman, aged forty-five years,

the subject of Lupus Erythematosus, which began threeyears ago at the nasal root, spreading thence to the fore-head and cheeks, not involving the eyelids. Close below themastoids were symmetrical, thick, red patches 3’75 em. indiameter.Mr. W. CAMPBELL M’DoNNELL read notes of a woman,

aged thirty-five years, seen one month after the delivery ofher fourth child with Rigors. Her temperature was 102.4°F.,her pulse was 120, and her respiration was 36 per minute at1.15 P.M. The liver was felt 7’5 cm. below the rib, wasvery sensitive to gentle pressure and ached constantly.There was a deep abscess of the left breast, incision ofwhich was refused, and there was acute nephritis (albuminequalled one-third). On the fifth day permission to openthe abscess was given. Under chloroform one pint of puswas evacuated. Profuse recurrent hsemoirhage followed,but was controlled by replugging and redressing the wound.The patient passed a good night. On the seventh day theskin, fat, and gland were sloughing; the temperature was104.6°. Under chloroform about two-thirds of total mammaryskin, fat, and gland, now sloughed, were dissected away.On the following day healthy granulations were seen. On

the tenth day the liver could not be felt; albumin equalledone-tenth in the urine. On the twenty-fourth day therewas no albuminuria. In six weeks the breast wound hadhealed over and the patient was well though weak.

Dr. J. W. HUNT related a case of a Leg and Cord Pre-sentation of a ten weeks’ Living Foetus. On making quitemoderate traction on the leg the body came away leavingthe head in utero. Ergot was given and in about threehours the head was found in the bed.

WEST KENT MEDICO-CHIRURGICALSOCIETY.

Exhibition of Cases and Specimens.A CLINICAL meeting of this society was held at the Royal

Kent Dispensary, Greenwich-road, S.E., on March 4th, thePresident, Mr. P. W. ARBUTHNOT LANE, being in the chair.

Dr. F. S. TooGOOD showed the following cases :-1. Caseof Suprapubic Cystotomy in a boy, aged four years, forstone. There was persistence of the sinus for four monthsand ultimate closure by buried sutures around the sinus.2. Case of Fractured Patella. Perfect union and completemobility of the joint was secured by Barker’s method ofsuture. 3. Hæmophilic Elbow-joint. 4. Case of a woman,aged twenty-three years, in whom Lateral Curvature of theSpine and Paresis of the Legs and Left Arm dated from anattack of myelitis caused by a fall down-stairs occurringfive years ago.

Dr. R. E. SCHOLEFIELD read notes of a case of a man,aged sixty-five years, who showed no symptoms of typhoidfever during life, but in whom numerous Typhoid Ulcerswere found post mortem. Dr. Scholefield then showed theperimetric charts of a case of Symmetrical Scotoma withRemi-achromatopsia in a patient aged fifty years.

Dr. F. T. TAYLOR showed a specimen of Aneurysm of theHeart and Ruptured Auricle from a man who was found deadin a water-closet.

Dr. MORGAN DOCKRELL showed-(1) a case of Bazln’sDisease; and (2) a case of Tuberculosis of the Lips.

Mr. ERNEST CLARKE exhibited a series of beautifulmounted specimen of eyes illustrating the disastrous effectsof Irido-cyclitis in producing (1) detachment of the retina;(2) glaucoma; (3) anterior synechiæ (complete) withexclusion and occlusion of the pupil; and (4) anteriorstaphyloma.

LIVERPOOL MEDICAL INSTITUTION.

Exhibition ot Cases.A MEETING of this society was held on March 3rd,

Dr. MACFIE CAMPBELL, President, being in the chair.Dr. RAWDON related two cases of Inguinal Hernia in

which the strangulated bowel was excised and end-to-endunion by Murphy’s button successfully resorted to. In thefirst case the coats of the gut had become so injured by thestrangulation as to cause it to rupture during a carefulattempt to return it. The patient made a good recovery.The button" " may have passed but it had not been seen.In the second case the bowel was on the verge of gangrene.The "button" was passed on the twenty-first day. Anexcellent radiogram was exhibited, taken by Dr. Hollandfour days before, which showed the shadow of the button.-Mr. BANKS, Dr. ALEXANDER, Mr. PUZEY, and the PRESI-DENT made remarks upon the subject of intestinal anasto-mosis.

Dr. T. R. GLYNN showed a patient suffering fromFriedreich’s Disease in whom apparently it was not heredi-tary.-Dr. BRADSHAW and Dr. A. DAVIDSON spoke.Mr. BANKS showed a Hydatid Cyst containing daughter

cysts removed from the adductor muscles of the thigh of aboy, aged twelve years who came from Rhyl. It had beenpresent for seven years, recently rapidly increasing in size.From the history and symptoms a diagnosis was made ofinflamed hydatid cyst, corroborated by an exploratorypuncture. Mr. Banks from his own experience had noticedthat a considerable number of cases of hydatid disease camefrom North Wales.

Mr. RICHARD WILLIAMS showed a case of Tuberculosis ofthe Iris in both Eyes in a girl, aged thirteen years, who hada very tuberculous history.

Mr. R. W. MURRAY made some remarks on the Treatment