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thought that the suggestion of Mr. Jackson Clarke that nebone might be thrown out from the anterior common lig!ment and help to fill the cavity was a very likely one. Bshowed an elderly woman suffering from caries in whom thdeformity was practically reduced by wearing a suitablapparatus which had enabled her to resume her occupation.Mr. JACKSON said that of the two factors, th

disease and the deformity, the former was of primary importance. The deformity tended to increase after the disease wachecked owing to the adaptive growth of the healthy portionof the spine, which were "kinked down" at the disease(

For some time past he had used Chance’s splint aJan efficient means of arresting the disease. He had tried thimethod of immediate reduction in the case of a girl with : sharp angular curvature which had only existed for tw(months. The deformity was reduced without much force beingused, a distinct crack of the bone being heard. A plastetcuirass strengthened by metal strips was then applied whilethe manual extension was kept up. The plaster jacket had tcbe removed after a few weeks and the curvature was found tohave returned. Reduction by forcible extension was againperformed and this time the spine was put up in an over-extended position. Five weeks later there was considerablediminution of the curvature and on extending the spinethere was some slight cracking bat no further yielding. Thechild was now going to have a Chance’s splint with anoccipital band to control the movements of the head. He

thought that the splint shown by Mr. Jones confined thewhole body too absolutely. He recalled one case in whichthere had been absolute fixation in such a splint for fouryears, but this did not prevent the formation of a boss, and thechild’s general health suffered. He thought that two years’fixation in such a splint would be a very serious thing forthe child especially if any bronchitis occurred. He thoughtthat the best plan was to employ fixation for three monthsand then apply a Chance’s splint.

Mr. W. G. said that the operation would allowthe subsequent treatment to be commenced with the spinestraight. It did not appear to offer any danger to life, andthere was no evidence that any of the cases had been madeworse. He thought that ossification would go on as wellafter this operation as before. Bone would probably bethrown out by the anterior common ligament. He did notthink that the post-mortem specimen shown by Mr. Murraytaught much. The gap which was shown might have beenformed post mortem as it was empty, not even containingblood as would have been the case if it had been formedduring life. He believed that these cases would be foundto have ankylosed as firmly as cases treated by other Imethods.msMioas.

Mr. COTTERELL said that he had operated on two cases.The first was that of a child who had been treated for dorsalcaries and paraplegia for five months by rest without

improvement. The curvature was relieved by forced exten-sion in October and the paraplegia was rapidly passing off.In the second case an angular curvature was easily reduced,but while putting the jacket on the child stopped breathingand artificial respiration had to be resorted to. Undoubtedlythe position required for the extension made things verydifficult for the anaesthetist.Mr. THELWALL THOMAS (Liverpool) considered the objec-

tions to forcible straightening of the spinal column tobe based on a wrong reading of museum specimens, whosevery existence depended-too often, alas !-upon inefficienttreatment. The ordinary treatment of spinal caries neverreally prevented undue pressure of the softened bodies oneach other, and it was easy to account for the large mortalitywhich they all knew exiated from abscesses and dissemina-tion of tubercle, brought about by this constant grindingpressure. The theoretical objections that were raised to thenew treatment-namely, (1) that paraplegia would result,(2) that abscesses would occur, and (3) that disseminationof tubercle would be brought about-had all been disprovedso far and the only pathological item which remained nowto be settled in the minds of some was what filled the "gap"assumed to be always produced by forcible straightening.The practice of surgery consisted almost entirely of making"gaps which nature obligingly filled up (even after suchproceedings as scraping tuberculous bone) and certainly theyought not to worry about that.Mr. A. E. BARKER endorsed all that Mr. Watson Cheyne

had said and agreed that it would be well to wait to see

the result in the cases already operated on. He mentioneda case in which a fatal acute pleurisy followed the rupture ofa spinal abscess when a patient was suspended in a tripod

3W for the application of a plaster jacket and he thought that a;a- similar accident must be expected in a certain proportion of

the cases. He thought that the evidence was quite againsthe the possibility of the new formation of bone in sufficient

quantity to fill up the gap. M. Calot stood by the analogybetween the ankylosed spine and an ankylosed knee and

ie agreed that what would be bad for one would be bad for the’t- other. Mr. Barker would anticipate extension of the disease

if he attempted forcibly to extend a tuberculous knee, and he1S thought that that was the general experience of surgeons.id Mr. ROBERT expressed his satisfaction that theis subject had been so well discussed, even though some

speakers had been pessimistic. He reminded the society thata the object of the paper was to lay certain clinical facts beforeo them in relation to the immediate straightening of spinesg which were at complete variance with traditional and present,r belief. In no case had abscess, dissemination of tubercle,e or paraplegia followed reduction. Instead of producingoparaplegia it had in several instances by relieving pressure0 on the cord cured it. Mr. Watson Cheyne had urged thatn when the backs were straightened they were not cured. The- same argument might be applied to neglected deformitiese following tubercle in joints. Mr. Watson Cheyne andeMr. Barker deprecated the immediate reduction of tuberculous

and knees. Mr. Jones constantly practised such rednc-i tions without any of the evils referred to following. The fatal3 character of Pott’s disease was admitted and the difficulties3 of governing the deformity by mechanical means were iwell known that some radical effort should be made to bringr about a better state of things. When he first practised this; method with a full sense of the responsibilities friends’ warned him of paraplegia, abscess, and dissemination. Now. these dangers had proved groundless they were told to; beware of the gap." Had he feared the separation of

bodies he had no right to operate upon a single case, speakers who advocated the removal of intra-articular

.

pressure in joints deprecated it in the spine which exhibited: the strongest tendency to bony exudation. Fixation could

be more efficiently applied to a straight than to a crooked-spine, and prevention of the crunching of vertebrae fromsuperincumbent weight should tend to firm and rapid union.He had just received a communication from M. Calot statingthat he had patients walking without supports after thepractice of immediate reductions, and in no instancedid the spine " wobble." Such a fact should altogetherdissipate the pathological fear. Mr. Tubby and he verycordially accepted the suggestion of the President to’show cases when sufficient time had elapsed.Mr. TUBBY said with reference to Mr. Murray’s communica--

tinn 0ll tion that gentleman had granted all the points of theirargument but had then branched off into speculations

tl had spoken of the possibility of a " wobbly hump " resulting,as if such an event were likely, in the spine. He thanked Mr.Watson Cheyne for his criticism but wished to join issue with

F. him on this point-viz., that the cure of the deformity and oft, the disease were entirely different. In dealing with tuber-g culous joints such as the hip and knee one object in treat-y ment was to separate the parts and give them rest,.y and this was precisely what was done in the spine when

it was straightened. Mr. Tubby added that he:. thought the reason why a diseased spine took so’

o long in healing was on account of the want of completee rest. As to the disputed question of ossification takingt place in the gap formed by reduction, certain specimens,r notably one in the St. Thomas’s Hospital museum andi another bearing on the question in the Hunterian Museumr were alluded to. In the first- named specimen ossification in,. and filling up of, the gap had evidently occurred during ordinary course of the disease the back having been kept, straight. As to the plea uttered by Mr. Watson Cheyne and, Mr. Barker that Mr. Jones and he would now withhold their

hands, there was no reason for doing so. Abroad this treat.l ment was still being extensively tried, 600 cases, according to

M. Calot, having been operated upon in France and so long,

as no danger or undue risk was incurred he failed to see thenecessity for reaping experience at second-hand.

HARVEIAN SOCIETY OF LONDON.

Hernia of the Abdominal and Operations for itsof the of

A MEETING of this society was held on Nov. 18th, Dr.MILSON, the President, being in the chair.Mr. ALBAN DORAN read a paper entitled Hernia

1457

of the Abdominal Cicatrix and Operations for its CureThis paper was given at length in THE LANCET 0

Nov. 27th. -— Mr. BUTLER - SMYTHE congratulated hi.colleague on the success attending his efforts to relievethose women°suffering from ventral hernia. Mr. Doran ha(his sympathy in that one instance where the hernia ha(returned after operation, but perhaps it might be some consolation to him to know that there was no surgeon living owhom it could be said that he had not had many cases following his operations. He (Mr. Butler-Smythe:

the idea of operators stating that they could noitrace a single case of ventral hernia in their owr

practice." The fact was that when an operation forthe removal of an abdominal tumour was unfortunatelyfollowed by a hernial protrusion, varying from the sizeof a walnut to that of a pouch reaching from the

cartilage to the pubes and containing thegreater portion of the abdominal contents, it was, to say theleast, improbable that those patients would return to the

original operator but rather would seek fresh advice. Ventralhernia would now and again occur no matter bow carefulthe surgeon might be in the matter of closing the abdominalwound. In most of the cases read that evening it seemedthat the hernia had occurred at either end of the abdominalscar, and this looked as if the closing of the upper and

angles of the wound bad been imperfectly In,his opinion the chief point in sewing up the wound was to,approximate the sheaths of the recti muscles as accuratelyas possible. Union of fibrous tissue was stronger and morepermanent than that of muscle or skin. He was convincedthat if attention were directed to the accurate suturing ofthe aponearosis the chances of hernia would be greatlydiminished.-In reply to Mr. Butler-Smythe Mr. remarked that the edge of the rectus muscle as wtll as itssheath should always be included in the suture whether the;aponeurotic layer were united separately and continuouslyor simply closed by deep interrupted sutures passed throughall the layers of the parietes.Mr. E. W. read a paper on Empyema of the

Antrum of Highmore. He limited his remarks to those casesin which the ostium maxillare was patent and the symptomcomplained of was a discharge from the nose. The dis-

was usually purulent, unilateral, intermittent, and affected by posture. An examination of the nose by specu-ium and light revealed pus in the middle meatus ; after

cleansing the nose pus reappeared when the head was hungdown and towards the unaffected side. As aids to diagnosisbe mentioned transillumination of the antrum, catheterisa-tion through the ostium maxillare, percussion of the teeth,and exploratory puncture through the nose, alveolus, orcanine fossa. He also insisted upon a careful examina-tion of the teeth in the upper jaw. A carious first or

second molar was a very common cause of empyema,but any tooth in the upper jaw might involve theantrum; it was also important to bear in mind thata tooth which was quite free from caries and to the ordinaryobserver apparently healthy might have an alveolar abscessat its root. The indications for treatment removalof the cause by dealing with dental or nasal disease ; (b)evacuation and drainage of pus ; (c) antiseptic irrigation ; and(d) removal of morbid tissue (when present) from theantrum. He advocated that an alveolar tube should be

in every case. In acute or subacute cases a cure wouldoften be effected provided that the tube was of large calibre(at least an eighth of an inch) and that its upper extremitywas on a level with the floor of the antrum. The length ofthe canal from the gum to the floor of the antrum could be

’ best determined by means of a small boule used inthe same way that it is used to measure the position andlength of a stricture of the urethra. In chronic casesor those that resisted treatment by the alveolar tube forsix months it was necessary to open the antrum throughthe canine fossa and thoroughly remove all morbid tissuefound therein. The canine fossa operation should always be

by an alveolar tube to facilitate drainage in the after treatment. He had had no experience of opening the 1antrum through the inferior meatus of the nose as he con- sidered that there was no case which could not be effectually 1treated by the alveolar tube with or without the canine fossa 1operation. In some cases the nasal discharge continued after draining the antrum ; attention should then be directed to ‘the frontal sinus or fronto-ethmoidal cells.-Mr. LENNOX

, remarked on the great improvement observed in the cgeneral health of patients who had been efficiently treated r

. for empyema of the antrum.-Dr. SPICER had yet to, see a complete cure of a case of chronic antral empyema byithe ordinary irrigation tubes inserted through the alveolus.,By that he permanent cessation of pus flow, bad

in the nose, and pain ; and (2) permanent removalL of tube, no irrigation worries, and healing of fistula in a. case of antral empyema of several months’ or years’ standingand in which the antrum was not merely a receptacle of

fronto-ethmoidal pus. Anything short of this he could onlyregard as a very equivocal palliation, for, indeed, in manycases the irrigation apparatus aggravated discomfort bycausing recurring acute sinusitis with pain and, further,the taste of pus was always in the mouth. He had knownmany cases that had endured this for years. After givingthe alveolar tube methods a trial for years with the cooperationof the most skilful dentists he had been compelled to dropthese methods as never successful in chronic cases such aschiefly came under his notice. At one time he had a largeaccumulation of these failures, many of which he subse-quently submitted to the radical operation, and if the antralempyema were uncomplicated these had been completely cured.usually in a very few weeks. During the last eight years hehad operated radically on well over thirty cases. The pointshe regarded as essential for the success of the radical opera-tion were (1) a large opening through the canine fossa;(2) thorough curettement of diseased antral mucosa; (3) veryfree counter opening from the nose into the antrum; and(4) no drainage apparatus (the air blast suffices to clear theantrum of pus umil the mucosa is healtby). No bad results,certainly no disfigurement or sinking of the cheek, hadoccurred in any of his cases.-Dr. WILLIAM HILL had expeIi-ence of cases in which an alveolus had been drilled and a tubeinserted without marked relief, so that it was necessary tomake an opening in the canine fossa and scrape out theantrum.-Mr. SEWILL said that the operation ofpuncturing through the alveolus was a simple one andone which in conjunction with a permanent drainageapparatus was considered tfficient treatment by distinguishedsurgeons.-Dr. DUNDAS GRANT spoke of the frequency withwhich the uncinate process of the ethmoid became diseasedand led to accumulation of pus in the antrum. Such caseswere purely nasal and demanded nasal treatment.

LIVERPOOL MEDICAL INSTITUTION.

Removal of from the Larynx by Thyrotomy.-An Account of Operations the Liver. - Ice-cream as a Vehicle of Infection in I’ever.-Details of the Clamp and Cautery Operation for rhoids.

A MEETING of this society was held on Nov. 18bb,Dr. RICHARD CATON, President, being in the chair.Mr. BARK showed a case of Removal of Epithelioma from

the Larynx by Thyrotomy. The patient was a man, aged forty-one years, from whom he had removed the right vocal cord,ventricular band, and arytenoid cartilage for epithelioma by

Hahn’s tube was used for seven days. Thepatient made an uneventful recovery. The man had sufferedfrom hoarseness for two years previously to the operation.There was now, eight months after the operation, no sign ofrecurrence. He had a strong though hoarse voice.-Dr. HuNdrew attention to the duration of the disease and said that itwas not unusual for a malignant papilloma to remain quiescentfor some years causing no symptoms except hoarseness. He

preferred to remove Hahn’s cannula immediately after theoperation on account of the risk of septic pneumonia.-Mr. RUSHTON mentioned a case of thyrotomy wherehe had removed Hahn’s tube immediately but had beenobliged to re-introduce it later.Mr. RUSHTON read notes of Nine Operations on

the Liver. Three were for abscesses, four for hydatids andtwo were cases of gall-stones impacted in the ducts. Allwere successful. In one case of hydatid, punctured less thantwenty-four hours before extraction of the cyst, universalperitonitis had resulted. There were vascular injection of theperitoneum and purulent effusion with large non-adherentflakes in the pelvis. This was treated by copious washingand by pelvic drainage through an additional suprapubic

1 See Proceedings of the Laryngological Society of London, Pro-ceedings of the West London Medico-Chirurgical Society, and Brit.Med. Jour.