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LIVERPOOL MEDICAL INSTITUTION.

Tagliocotian Skin-.qrafting of the Arm.-Ununited Fractures1’reated by Bone-grafting.-Tabetic or Trophic .Foot.-Physique and Health in the Liverpoul Schools.A MEETING of this society was held on Dec. 19th, 1907,

Mr: FRANK T. PAUL, the President,- being in the chair.Mr. G. P. NEWBOLT showed lantern slides of a case

operated upon by the Tagliocotian Method. - The patient’sforearm had been severely injured in a railway accident, bothbones being broken, the skin much lacerated, and the musclesand tendons partially torn away. A long flap of skin wasraised from the abdomen below the left breast and the armwas passed under it so that it lay as if in a sling. As a resultof this operation, which was completed in two further stages,the arm had been saved; sensation was good and there wassome movement in the fingers. The patient is still undertreatment. ’

Mr. RUSHTON PARKER related two cases of UnunitedFracture treated by clearing out unossified tissue from betweenthe fragments and planting in the interval small pieces ofbone clipped from the seat of fracture. One case was thatof a man, aged 35 years, whose left humerus had beenbroken six months previously and imperfectly united byincomplete callus, permitting movement and unfitting thelimb for use. Union resulted in six weeks. The other casewas that of a woman, aged 48 years, with total non-union ofthe left ulna of eight months’ standing. There was pain aswell as weakness and flexibility at the seat of fracture.Union was still absent in six weeks but after hammeringthe seat’ of fracture it resulted firmly a week later.The practice was based upon the principle laid down

by Sir W. Macewen in his celebrated case.’-The PRESI-DENT said that he quite accepted the truth of Sir W.Macewen’s observations on which Mr. Parker had based histreatment of these interesting cases, but he did not considerthat these observations contained the whole truth in refer-ence to the development of bone. If so, how were they toexplain the formation of bone in various tissues, such as

arteries, where no bone cells had ever existed ? The constantprecursor in such cases was a calcareous degeneration. Ifthis excited any inflammatory change the young connectivetissue formed bone. Calcified arteries, cysts, tumours, &c.,in this way frequently originated bone in the neighbourhoodof the calcareous deposit, and he would suggest that Mr.Parker should try the effect of the presence of phosphate oflime alone, as this could be introduced without a regularoperation.

Mr. T. C. LiTLER JONES showed a patient both of whosefeet he had amputated on account of the condition knownas Tabetic or Trophic Foot. Lantern slides were shown ofx ray photographs of the feet at various stages of the disease,exhibiting very clearly the progressive melting away of thephalanges without primary inflammatory changes. Thepatient had none of the ordinary symptoms of tabes dorsalis,appeared to be in excellent health, and could walk remark-ably well on his artificial feet.

Mr. A. S. ARKLE read a paper on Physique and Health inthe Liverpool Schools based on his examination of childrenfrom schools of three classes under the control of thecounty borough education committee and the boys of a

public school. The statistics showed clearly that there was aclose relation between status in life and feeding and the growthand development of the children. The influence of feed-ing was shown by comparing the children of industrial schoolswith those of the lower class of council schools. In regard tohealth, attention was drawn particularly to heart lesions andabnormality of the eye, ear, nose, throat, and teeth.-ProfessorT. R. GLYNN said that some of the facts demonstrated byMr. Arkle’s figures might have been anticipated, but others,as the small number of congenitally syphilitic children, werecontrary to what might have been looked for ; the explanationwas in some degree the early death of the infected children.He hoped that Mr. Arkle would have an opportunity of extend-ing his observations in other directions, such as the relativeprevalence of hereditary degeneration.-Dr. E. W. HOPEmentioned that the excellent work which had been done byMr. Arkle during the last few years gave some indication of

1 Reported to the Royal Society in 1881, repeated and amplified inhis lecture at the University of Liverpool in December, 1906, againrelated to the Royal Society in January, 1907, and published in theProceedings of June and in the British Medical Journal of June 22nd,1907.

the magnitude of the task of the medical inspection of schoolchildren. It was absolutely necessary, as the excellentMemorandum of the Board of Education pointed out, to followup the examination by an extension of the amelioration ofthe sanitary condition which had already proved so powerfula factor in improving the health of children. The methodsof carrying out the Act had not been decided upon and Dr.Hope expressed the belief that the views of the medical pro-fession, if focussed and brought to the notice of the educationauthority, would receive every consideration at the hands ofthat body. He regarded the medical inspection of schoolchildren as an extremely important accessory in publichealth administration.-Mr. J. BARK agreed with Dr. Hopethat the object of the Education Department was to preventthe occurrence in children of certain diseases which weredetrimental to their physical and intellectual future. In thecase of adenoids the earlier the removal was undertaken thebetter. The best results were obtained in children operatedon between the ages of two and seven years. 90 per cent.of young children with enlarged faucial tonsils had adenoids.If the new Act was carried out efficiently the future genera-tions would be freer from deafness and chest troubles thanthe present. Dental examination and treatment were mostimportant; oral sepsis was responsible for much of thephysical deterioration of the race.-Dr. A. C. WILSON,medical officer to the truant schools at Hightown, said thathe agreed with Mr. Arkle that under-feeding was the greatcause of bad physique in the poorer classes of children. He

rarely met with congenital syphilis, and this he attributedto the infected children dying out or getting into specialinstitutions for the deaf and dumb, blind, or imbecile, &.c.

The most pressing reform needed was the better care of theteeth. He was glad to say that the Liverpool educationcommittee had recently appointed a dentist for all Liverpoolschools. He believed that defective vision in children wasto some extent due to the eye not being trained to distances.- Several other members having spoken, Professor GLYNN

proposed, and Dr. G. G. STOPFORD TAYLOR seconded, theappointment of a subcommittee of the institution to considerand report on the Memorandum of the Board of Education.This proposal was adopted and a subcommittee was elected.

LEEDS AND WEST RIDING MEDICO-CHIRURGICAL SOCIETY.

Exhibition of Cases.A MEETING of this society was held on Dec. 20th, 1907,

Dr. J. ALLAN being in the chair.Mr. B. G. A. MOYNIHAN showed a case of Complete

Gastrectomy. The patient was a man, aged 43 years, with atwo and a half years’ history. At the operation, on May 31st,1907, a condition of "leather-bottle" stomach was disclosed.The whole stomach was removed, the jejunum being joinedto the cesophagus. The patient now ate well, worked asbefore, and had gained 3 stones in weight.lMr. MOYNIHAN, with Dr. T. WARDROP GRIFFITH, exhibited

a case of Gastro-enterostomy for Pyloric Stenosis followingcorrosive poisoning. The patient swallowed half a pint of11 sprits of salts." At the operation the pyloric antrum wasfound to be almost solid. Gastro-enterostomy combined withjejunostomy was performed.

Dr. A. G. BARRS, with Mr. J. F. DoBSON, showed a case ofSub-diaphragmatic Abscess and Empyema rupturing throughthe Lung, apparently following a duodenal perforated ulcer.Drainage of the abscess and empyema by separate operationswas followed by recovery.

Dr. T. CHURTON showed: 1. A case of Acute SpinalMyelitis in a boy, aged nine years. There were absoluteparalysis and anxsthesia of the legs and incoordination ofthe detrusor and sphincter muscles in micturition. OnJuly 13th he fell en his back ; in August the first symptomwas difficulty in micturition. On the 17th signs of totaltransverse myelitis showed themselves. 2. A man, aged 57years, with Heart Disease and Anuria. Theocine sodiumacetate, one grain every six hours, with strophanthin, 1/200th ofa grain, had caused a great increase in the quantity of urine.In two former cases five-grain doses had been used ; the

patients both got worse. 3. A girl, aged seven years, withPartial Anuria and old Mitral Disease. Half a grain of

1 See THE LANCET, Dec. 21st, 1907, p. 1748.

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theocine every eight hours with digitalis were administeredand the urine became doubled in quantity.; Mr. LAWFORD KNAGGS showed: 1. A case of Actino-mycosis of the Jaw after two scraping operations. The

patient had been accustomed to drive a cart laden withgrain and whilst doing so to chew some of the grain. AtChristmas he pulled out one of his teeth and afterwardsgrains would lodge in the wound and the latter did not heal.Soon after the disease made its appearance. 2. A case ofStone in the Left Ureter of 11 years’ history, with removal.A median laparotomy was performed in October, 1907. Theureter was dilated and the kidney was hydronephrotic. Thestone was pushed up from the pelvis to the loin. The ureterwas then exposed through an incision in the posteriorperitoneum and the stone was steadied by two strips of gauzeslung round the ureter above and below it. In this way theureter was temporarily occluded above and below and when thestone was expressed through a longitudinal incision no urineescaped. The wound in the ureter was closed with fine silksutures à la Lembert and a drainage tube was passed throughthe left loin. The peritoneum was then closed over theureter and the abdominal incision was sutured in the ordinaryway. Recovery was without incident. 3. A case of Extro-version of the Bladder; Hysterectomy ; Peter’s Operation.The patient was a woman, aged 31 years. At four years of ageshe had had Wood’s (?) operation performed by Mr. W. H. H.Jessop. The result had been satisfactory, the bladder wallbeing covered over. Her condition, however, as she grew upbecame one of great misery, the vulva being kept in a

constant state of irritation and inflammation as a result ofthe dribbling of urine and the deposit of phosphates on-thehair and within the cul-de-sac which had been formed byoperation. Her sufferings were aggravated at the periodsand on inspection the condition of the parts was very foul.On June 26th, 1907, an operation was proceeded withand six weeks later a second one was performed. The partswere now clean, there was no offensive odour, and the urinewas retained for four, and sometimes for five, hours. Therewas a small leak from a deep pocket in the original woundarea, but she kept herself quite comfortable by a small padwhich she changed two or three times a day.

Dr. J. GORDON SHARP exhibited a case of Vaso-motorNeurosis with Dermographism in an undersized boy, 14years of age. The patient had always a diffused blush overhis face, which became accentuated by excitement and bystimulation of the skin. When any part of the skin of thebody was written upon by a blunt instrument there followedin a few seconds a deep blush, and in a few seconds laterthe writing appeared as a white wheal, and remainedfor some time. The pulse-rate was now about 100. Athrill was felt in the mitral area, and in the same regionpresystolic and systolic murmurs were heard but conductedto other areas.

Dr. BARRS and Mr. H. LITTLEWOOD showed a case ofParaplegia with Sarcoma of the Spinal Meninges, in whichlaminectomy and removal of the growth were performed,recovery ensuing. The patient had for six months sufferedfrom pain in the back at the level of the tenth dorsal spine,with stiffness and numbness of the right leg. There hadbeen a rapid increase of symptoms. On admission to hos-

pital there were found to be complete paraplegia withanæsthesia up to two inches above the umbilicus and anarrow zone of hyperaesthesia above this. Laminectomywas carried out and the tumour was removed. The patienthad been shown to the society before but at that time hecould only move his legs, whereas now he could walk.

Mr. LITTLEWOOD showed : 1. A case of Carcinoma of theRectum and Splenic Flexure in a patient, aged 52 years.Colotomy was performed on Nov. 8th, 1906, but with norelief. On Nov. 14th the abdomen was opened in the middleline and a mass was found in the splenic flexure. A Paul’stube was put into the cæcum. On Dec. 6th an enterectomywas carried out and on Jan. 10th, 1907, proctectomy was per-formed. 2. A case of Carcinoma of the Rectum and Ascend-ing Colon in a patient, aged 69 years, in which a polypoidmalignant mass was found. On August 22nd, 1907, proct-ectomy was performed. The patient had symptoms ofobstruction three months later and a mass was found in theascending colon with nodules in the liver. On Nov. 14th alateral anastomosis of the small intestine with the transversecolon was carried out and great relief followed. 3. A caseof Pigmented Lymphangioma of the Foot in a patient aged14 years.

Mr. W. THOMPSON showed a case of Actinomvcosis of

the Cheek and the Glands of the Neck. 18 weeks previouslya swelling had appeared in the mouth which bad burstexternally. The patient bad been in the habit of eating alittle corn when feeding his pigeons.

Dr. A. WEAR showed: 1. Erythema Induratum Scrofulo-sorum in a patient, aged 36 years. The first appearance ofthe disease had occurred ten years previously, both legsbeing affected simultaneously, and repeated attacks had sincebeen experienced. 2. Adenoma Sebaceum. The tumourswere situated on either side of the nose.

Mr. L. A. RowDEN and Dr. W. H. MAXWELL TELLINGexhibited a case of Chronic Favus of Six Years’ Duration ina Child Treated by X Rays. Only a single exposure was givenon each affected area.

Dr. TELLING showed : 1. A case of Congenital Hypotonia(or amyoplasia) in an infant, aged one year and nine months.Since birth the hands and feet had been noticed to be very

, soft ; these especially, and the limbs and skeletal musclesgenerally, were markedly flaccid and toneless, allowingconsiderable bending at the joints. The patient had beenunder continuous observation for 15 months with no notablechange in the muscular condition. 2. Subacute Tylosis of

. the Nail-matrix. The condition had commenced about threeand a half months previously in one finger and rapidlyspread to all the other fingers. There was a dry warty over-

, growth at the distal margin of the nail-bed which waslifting up the nail and spreading to the root in a V-shaped

. manner.

L Dr. E. F. TREVELYAN showed : 1. Five cases of PeripheralBirth-palsv, illustrating lesions of the brachial plexus.2. Brown-Sequard Paralysis in a woman, aged 47 years, whohad been stabbed in the back in August, 1907. On Oct. 4th

s a scar was seen in the neck to the right of the third cervical, spine. There were motor paresis of the right arm and

paralysis of the right leg and a considerable sensory loss on! the left side. The patient was improving.

Dr. ALEXANDER SHARP showed a case of Fibroma of thei Larynx.L Mr. A. L. WHITEHEAD exhibited a case of CongenitalL Left-sided Ptosis treated by Plastic Operation.

Mr. MICHAEL A. TEALE showed : 1. A case of Staining ofr the Cornea of the Right Eye following an extensive hæmor-i rhage into the anterior chamber. 2. A boy showing a Con-r genital Coloboma of the Right Iris directed upwards andr inwards.; Cases were also shown by Dr. A. BRONNER, Mr. H. SECKERL WALKER, and Mr. ALEXANDER SMITH.

EDINBURGH MEDICO-CHIRURGICALSOCIETY.

Exhibition of Cases.A MEETING of this society was held on Dec. 18th, 1907,

Dr. JAMES RITCHIE, the President, being in the chair.Dr. ALEXANDER BRUCE showed the following patients.

1. A woman suffering from Myasthenia Gravis. She becamefatigued on the slightest exertion and after climbing a stairshe was completely collapsed. No muscular atrophy waspresent and there was no reaction of degeneration in themuscles, but the myasthenic reaction to electricity waspresent—i.e., the muscle soon ceased to respond to elec-trical stimulation. 2. A woman suffering from Amyo-trophic Lateral Sclerosis. This was essentially progres-sive muscular atrophy along with lateral sclerosis. The

patient also showed bulbar phenomena. The conditionhad lasted barely two years. Atrophy of the left handand arm was marked, the right extremity not being soadvanced. The facies was peculiar, the lips were tightlycompressed, and there was difficulty in protruding the tongue.3. A woman exhibiting Neuritis of the Left Median Nerve.She had pricked her hand with a needle last July andsubsequently a diffuse cellulitis of the front and back of thehand developed with pain along the course of the mediannerve which was followed by desquamation of the skin inthis area. At present there was tenderness over the wholeof the left arm with tactile anesthesia over the wholearea of distribution of the nerve, while marked hyper-algesia was present over this area. There was involve-ment of the roots of nerves of the cervical plexusand this extended as far down as the fourth dorsalnerve. The muscles of the left shoulder were atrophied.