709

tinuous with the membrane covering the torameu ovate ; itwas also attached to the inner wall of the auricle by somethin bands and fine filaments. With the heart in position,the edges of the membrane were nearly vertical. In crossingto the outer wall of the auricle it was twisted, and was fixedclose to the opening of auricular appendix. There was asmall patent foramen ovale. Dr. Fowler considered it wascaused by an overgrowth of the valve of the foramen ovale,which had been pushed over to the opposite wall by theblood, and then became adherent. It had not interfered withthe action of the heart. He had not been able to find anysimilar case recorded.Mr. BRYANT showed a Cyst containing Oil removed from

the Parotid Region. A girt aged nineteen had had a verysmall growth at birth, which increased to the size of a flatwalnut; it warrant-lucent. During removal the sac ruptured,and discharged half an ounce of clear oil. The cyst was thinand smooth on the inner side. He found no record of suchacasein the Society’s Transactions. M Guerin had lately describeda case of congenital oily cyst near the ear in a woman agedthirty. Dr. Wilks had also recorded a case of fatty cyst ofthe pelvis. These growths, he thought, must be regarded asdermoid in origin, and he mentioned that his patient,although well in every other respect, had never menstruated,as if possibly there might be some " dermoid

" condtton ofthe ovaries.-Mr. DORAN asked if the enrlothelillm of thesac was squamous or columnar ?--Mr. BRYANT stated thatthe microscopic examination of the sac had not yet beenmade.-The PRESIDENT referred tothe case mentioned by Mr.Bryant, which occurred in a man who was tapped, and a largequantity of oily fluid was withdrawn from the pelvis. Someyears later he came under Mr. Curling’s care, when a stonewas removed from the bladder which had for its nucleus asmall ball of hair, strongly suggestive of the dermoid natureof the original disease.—Dr. COUPLAND suggested that suchcysts as that shown by Mr. Bryant were connected in someway with imperfect closure of the outer extremity of one ofthe branchial clefts.-Mr. DAVIES-COLLEY once had underhis care a woman aged twenty-six, who had a small cystjust above the right zygoma. On opening it about half a.drachm of olive-oil-like fluid was collected, which in a fewminutes coagulated into a firm yellow fat.

Dr. CARRINGTON showed a card specimen of Fracture ofCervical Spine, with wound of cesophagus.Mr. J. HuTCHlNSO showed a living example of a

rare form of skin disease, named by him Lupus Lym-phafcus.The Society then adjourned.

CLINICAL SOCIETY OF LONDON.

YraumaticRupt,u2-c of an Ovarian Cyst.-Large Odontomeremoved from the Lower Jaw.-Charcot’s Joint Disease.THE first meeting of this Society after the vacation took

place on the 14th inst., J. Lister, Esq., President, in the- chair. In taking the chair he announced the decision of theCouncil to nominate the following distinguished men ashonorary members, in commemoration of the InternationalMedical Congress of 1881 : - Sir James Paget, secondPresident of the Society and President of the Congress ;Dr. H. J. Bigelow of Boston ; Dr. Billings of Washington ;Professor Esmarch of Kiel ; Professor Volkmann of Halle ; zProfessor Verneuil of Paris ; M. Ollier of Lyons ; M. Pasteurof Paris; Drs. Pantaleoni and Mazzoni of Rome.

Dr. WILTSHIRE read notes of a case of Traumatic Rupture,of an Ovarian Cyst. A lady aged twenty-eight, just con-valescent from typhoid fever, fell while in a hansom cab,struck her abdomen, and burst an ovarian cyst which shehad had about three years. Severe shock and collapseensued, but under opium and restoratives she slowly re-covered, and two years after the accident remained quitewell and free of her tumour, wilh the exception of a smallmass supposed to be the remains of the collapsed cyst andpedicle. Though an expectant plan of treatment was elected,in the belief that no haemorrhage was going on, yet the pro-priety of immediate operative interference was discussed,chiefly in relation to the question of rapid death from internalhaemorrhage, and its arrestment by means of abdominalsection, accompanied, of course, by removal of the ovary.Operation in connexion with ruptured dermoid, purulent

infective, or strangulated (twisted) cysts, and peritonitis wasalso referred to ; and allusion was made to the treatmentof dangerous intra-peritoneal haemorrhage from rupturedectopic gestations, varices of the bruad ligament, ruptureduterus, &c. The prognosis in rupture of infective ovariangrowths was adverted to, and the views of pathologists andsurgeons thereon respectfully sought.-The PRESIDENT re-marked that such a case must be one of g’eat anxiety,requiring prompt decision in dealing with it. One importantpoint would be whether the cyst were unilocular or multi-locular ; if the latter, theoretically the better treatmentshould be to rid the patient of the fluid and diseased growth ;if a single cyst, the fluid might be allowed to become ab-sorbed. Still it was a matter only to be decided by experi-ence. The dwindling of the solid mass in this case wassingular.—Dr. WILTSHIRE, in reply, said that Dr. Oldham,who saw the case on the day of the accident, thought it wasa multocular cyst, together with some solid material. Drs.Kidd and Swan of Dublin were of the same opinion. Themain question in such cases is as to the probable prognosis,iuview of recull’ence from peritoneal infection, as m twocases recorded by Dr. Bright in his essay on AbdominalTumours. The surgical aspect of such cases is also of greatimportance.

Mr. CHRISTOPHER HEATH read notes of a case of LargeOdontome removed from the Lower Jaw. This was one ofthe rare tumours described by Broca as "odontomes odonto-plastiques," and consisted of a mass of dentine studded withnoriules of enamel. The mass weighed 315 grs., and measured1; in. by l4in. The patient was a young lady of eighteen,who had never been able to close the teeth properly, butotherwise was supposed to have gone through the first andsecond dentitions naturally. Last Christmas she had somepain and uneasiness about the right angle of the lower jaw;and in April her father, a dental surgeon, extracted thesecond bicuspid tooth, there being no molars then present.A dentist who was frequently consulted thought he detectedan encysted tooth, and tried to extract it with the elevator.The result was an acute attack of periostitis. Profuse sup-puration ensued, and on firm pressure near the angle puscould be forced up from the interior of the bone. Undertreatment the inflammation subsided, and the patient wentto the seaside, and on her return there was apparently someexposed bone, with greatly hypertrophied mucous membraneon each side. A month later, after imprudent bathing,sudden increase of pain and swelling took place, and sheconsulted Mr. Heath, who found great enlargement of thebone, with a fungus-like growth in the mouth, and appa-rently bare bone, the appearances closely resembling thoseordinarily found in a case of sarcoma of the jaw. Anoperation involving removal of a pOltion of the jaw wasdeclined, and the swelling slowly diminished again. In

, September Mr. Heath undertook an operation for removal,

of the supposed sequestrum of bone, and after considerabletrouble succeeded in elevating the mass described from itsbed, since which the jaw has slowly contracted to its proper

! stage.-In reply to a member, Mr. HEATH said that he wasi not aware of any history of a direct injury at an early age.-, The PRESIDENT said the case was one of great interest,

practically in the fact of its close resemblance to a tumour’ of the lower jaw, and its removal by mere extraction; andl pathologically in its structure-compo-ed as it was of; dental tissues. Such cases are rare, and it was important,. as Mr. Heath had said, to be on one’s guard against remov-: ing a portion of the jaw by mistake.

n

’ Mr. KEETLEY showed a patient suffering from Charcot’s.

Joint Disease. The case was that of a shopkeeper, Mr. J.P-, aged thirty-four, married ten years, having threehealthy children. Up to October, 1880, no other symptoms

- than the following had been noticed :-(1) Slight 11 weak-, ness in the legs," of twelve years’ duration, and attributed

by the patient to the lameness oc-asionally produced by a} " corn" beneath the right great toe ; (2) pains in the muscles,- described as "rheumatic" ; (3) attacks of diarrhoea, occurring

fortnightly for long periods at a time. But in October,1 1880, the "corn"utcerated, and the corresponding great toe1 became greatly swollen. About a week afterwards the hip,, groin, and thigh of the same side (the right) swelled enor-- mously, but the surface was pale and comparatively free from, pain-i.e., such pain as did exist was not synchronous with1 the occurrence of the enormous swelling. A deep fluctuating1 point being opened towards the lower part of the front. of the thigh, several ounces of synovia or synovial-liket fluid escaped. In two months the patient was able

710to stand again and move the joint freely, but therewas left one inch and a half shortening, a tendency toeversion, and a peculiar "crunching" or crepitus onmanipulating the hip in a certain manner. The joint wasalso somewhat loose. Apparently the head of the femur haddisappeared. From this time for nine months the limbsteadily increased in uaefulness, the powers of spontaneouslyrotating it both inwards and outwards seemed to also return.Then the left hip was attacked exactly like the right,but not so acutely. This attack came on whilst the patientwas being severely purged by two pills and two blackdraughts prescribed by a chemist on the theory that thepatient looked "bilious." While the swelling of the lefthip was subsiding after the manner of that on the right sidea year before, severe pains attacked the front and inner sideof the left thigh and the left knee also, but passed awayafter some hours. At present the patient has only occa-sionally slight pains in the left thigh, but great numbness onthe front aspect about the knee. He can already get aboutagain on crutches, and even stand without them. There isnow evidence of the left hip having undergone anatomicalchanges like those of the right. The right great toe jointsare alsodeformed since theswellingthereoftwelvemonthsago.The "corn" is now represented by a thin red scab. There arevarious symptoms of tbes dorsalis besides those above-mentioned. There are loss of patellar tendon-reflex, of iris-reflex, of the power of standing with the heels together andthe eyes shut, partial loss of sensation in the outer sides ofboth teet, perverted sensation in the right foot, slight deaf-ness of the left ear, and (?) an ataxic gait disguised by thejoint affections. And, though there are no gastric crises,there are what might be termed "intestinal crises "-viz.,the above-mentioned periodical attacks of diarrhoea. Inthe case of each hip, the subsidence of the general swellingleft a marked enlargement of the inguinal glands, which per-sisted some time. The internal treatment has been iodideof potassium with salicylate of soda, five grains each threetimes a day. Is it justifiable to try nerve-stretching in thiscase ? There are the following grounds for entertainingsuch an idea. In most of the cases, now not few in number,in which nerve-stretching has been done for the lightningpains, general as well as local benefit has accrued not onlyby way of lessening the pain, but also of diminishing oreven removing the mcoordination. And the same generalimprovement as regards the whole neurosis has beenobserved in leprosy, when the pains of that diseasehave been treated by nerve-stretching. Done antiRepti-cally it is by no means a very serious proceeding. More-over, to do nothing in such a case as this does notsecure for the patient a good prognosis. If the speaker hadany evidence to show that nerve-stretching had checked thevisible changes in the skin in leprosy he would be still moreinclined to try it. Could any of his hearers speak to thatpoint ?-Dr. DUCKWORTH said these cases seem to be morecommon in France ; so rare were they in this country thatat the time of the meeting of the Congress Sir James Pagetwrote to Professor Charcot about this affection, having beenunable to come across any specimens of it in the chiefLondon mnseums. The ulceration on the foot resembledthat described by Professor Ball of Paris at the Congress.Professor Ball related fifteen cases, which were regarded byhim as neuro-trophic. The question of nerve-stretching wasdiscussed at the Congress, some advocating it, others, as

Professor Erb of Leipsic, being opposed to it; at any rate,the majority of speakers were in favour of nerve-stretchingwhere there was much pain.-Dr. BUZZARD said that thecondition of a suppurating corn occurred in a case broughtbefore the Society ten years ago by Dr. Greenhow, and he(Dr. Buzzard) had seen it since in several cases. It was, nodoubt, a trophic change. The present patient has suffered fromparoxysmal attacks of diarrhoea every fortnight for the past tenyears, and from heartburn, but not from gastric crises. Hehad related a similar case at the Pathological Society, andhad found in nine cases of tabetic arthropathy six with"crises glistriques," and one with paroxysmal diarrhoea. Itwould be interesting to know whether this intestinal affec-tion were a primary affection of the intestinal canal or weresecondary to gastfic disorder from implication of the vagus-nucleus in the sclerosis. He had suggested such an expla-nation to account for the gastric crises, and their frequentassociation with articular changes might be due to thatnucleus being in close proximity to the nucleus governingthe nutrition of joints-a hypothesis which would also ex-plain the conjunction of articular and cardiac affection in

rheumatism. Atrophy of the cells in the anterior grey cornuai in tabetic arthropatby had not been borne out by post-mortemL examinations ; nor did the electro-muscular reactions coin-I cide with the view of the implication of those cells. IndeedL he had seen a case where there was great muscular develop-I ment about a shoulder-joint affected with tabetic arthropathy.. -Dr. ALTHAUS said that the cedema observed in Mr.

Keetley’s case was rare, the swelling as a rule being firmand hard, not pitting on pressure. The hypothesis, then,

; of connexion between the gastric crises and joint affectionwas insufficient, gastric crises being far more common thanthe arthropathy, which is excessively rare. The medullary

, centre assumed to exist by Dr. Buzzard was an ingenioushypothesis, but one incapable of proof. Charcot’s viewas to the involvement of the anterior cornual cellshad not been verified. Professor Volkmann of Hallestarted the view that these affections were really dueto injury from the jerking and spasmodic (involuntary) move.ments ; but Dr. Althaus did not think this could be enter-tained, for, in some cases, the joint affection is an early andnot a late symptom. Nerve-stretching, at present, shouldbe limited to cases where there was nerve pain; it doessometimes no harm.-Mr. PAGE said there had been severalcases in England since M. Charcot and Dr. Buzzard had drawnattention to the arthropathy, and Mr. Macnamara showedtwo casps at the Congress. A similar case was lately seenat St. Mary’s Hospital; the patient suddenly, while walking,found one limb shorter than the other without having anypain. Mr. Page also had recently seen a case in private.He showed at the Congress a patient in whom the smalljoints of the foot were affected, the tarsal joints enlarged,and bones freelv movable on one another without pain.There was a doubtful history of syphilis, and iodide of potas.sium was given. The patient also had suppurating corns,which were not painful. It was then found he had all therecognised symptoms of tabes. After a time the swelling ofthe foot subsided and the bones became anchylosed; andwhilst under observation the other foot became affected.The foot was greatly swollen on admission, the swellinghaving occurred suddenly and painlessly. In course of timethe swelling subsided. The painlessness was remarkable.He had been subject to gastric crises, and lately intestinalcrises and profuse hoematuria.-The PRESIDENT observedthat the affection was obscure, but thought it remarkablethat no specimen could be found in the College of SurgeonsMuseum, for it was not so extremely rare in this country.There was lately in King’s College Hospital, underone of his colleagues, a case where the knee-joint wasaffected.-Mr. KEETLEY, in reply, thought Dr. Buzzard’stheory a reasonable one, but if true, it was remarkable thatthe gastric crises should have lasted so long. Still this wasparalleled by the very early occurrence of ocular symptomsin some cases. It does not appear that any particular jointsare affected. He had found only one case where both hip-jointswere affected out of twenty-three, yet symmetry in the dis-tribution of the joint disease is not unusual. The markedcharacteristics of the disease were very striking, and hebelieved Charcot right in saying that the disease is tolerablycommon. The great and rapid swelling without pain,followed in two months by shortening, eversion, and restora-tion of power, was quite singular. He thought the apparentrarity due to the fact that such cases came chiefly under thenotice of physicians and not surgeons.The Society then adjourned.

OPHTHALMOLOGICAL SOCIETY OF THEUNITED KINGDOM.

President’s Address.-Relation between Apparent Movementsof Objects and Rotation of the Eyes.-Tlniocular Dip-lopia. - Suppurating Ophthalmitis from .embolism. -T11berculosis of Iris.-Perineuritis Optica.-Double OpticNeuritis with Cerebellar Tubercle.

AT the opening meeting for the session of this Society, onthe 13th inst., the President, Mr. BOWMAN, F.R.S., made afew remarks. He alluded especially to the assembly of theInternational Medical Congress in London, " when morethan 3000 medical men met, from almost every part of thecivilised world, to communicate and to receive knowledge,discuss questions most nearly interesting them, and to be.come personally known to each other." It had proved emi-