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the Left Ankle, arising from traumatism, but with no painor other sign except the thickening of the tibia and fibulaat the joint.

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NORTH LONDON MEDICAL ANDCHIRURGICAL SOCIETY.

Exhibition of Cases and Specimens.A MEETING of this society was held in the Great Northern

Central Hospital on Nov. l4th, Mr. CHARLES KING being inthe chair.Mr. G. MOWER WHITE showed three cases of Fracture of

Bones having points of interest. The first was an ununitedfracture of the humerus occurring in a woman forty-sevenyears of age, in whose history no evidence of syphilis wasascertained. On account of failure to obtain union in thefirst instance, the ends of the bone were fastened together bymeans of ivory pegs. After a considerable period of im-mobilisation union had not resulted, and the portions ofivory in the tissues had become absorbed. The next methodof treatment adopted was securing the ends of the bone

by short rods of nickel. As bony union still failed to occur,the ends of the fragments were exposed and portions of freshrabbit’s bone were placed within the periosteum. Union stillfailed to be brought about, and the speaker said that heseemed to have arrived at the end of the justifiable methodsof treatment.-Mr. C. KING, Mr. CRESSWELL, and Dr.GALLOWAY discussed the case, and all concurred in the

opinion that syphilis might possibly have something to dowith this remarkable failure of union.

Mr. WHITE then showed two cases of Fractured Patella,the one treated by means of a back splint and approximation ,of the fragments by kneecaps and bandaging. and the othertreated by means of wiring the fragments. The superiorityof the latter method was readily appreciated, both in thecharacter of the result obtained and in the great shorteningof the period of convalescence.

Dr. E. C. BEALE brought forward the case of a young girlabout twelve years of age who had suffered from repeatedattacks of Gastro-enteritis. The stools showed numerousflecks of hæmorrhage, and at the same time the child hadsuffered from attacks of purpura. At present she was in aperiod of quiescence, so far as the gastro-enteritis was con-cerned, but the purpura was still to some extent visible ; theskin showed numerous papules on the sites of the originalpurpuric spots. Dr. Beale felt inclined to ascribe all these

symptoms to poisoning by faulty ingesta, and that theenteritis was in this case an inflammation of the mucousfollicles, as evidenced by the numerous minute haemorrhagespresent throughout the stools.

Dr. JAMES GALLOWAY showed a patient suffering fromChronic Phthisis who had for five years been the subject of acurious variety of Lichen Planus. The eruption, mainly onthe extremities, was of the circinate variety, and in manyrespects resembled some of the later superficial syphilides.This patient had been treated for nearly ten months with’guaiacol in the form of the carbonate and also as a solutionof the pure product. The tuberculosis had passed into aquiescent condition, and the skin eruption was better than ithad been during the last five years.

Cases of Embolism of the Arteria Centralis Retinæ asso-ciated with Albuminuric Retinitis, and a case of almost

complete Optic Atrophy following a blow on the headwere also demonstrated.

WEST LONDON MEDICO-CHIRURGICALSOCIETY.

Adjourned Discussion on Gastric Ulcer.A MEETING of this society was held on Nov. 15th,

Dr. A. SYMONS ECCLES, President, being in the chair.Mr. KEETLEY said that in cases of perforation not

diagnosed early enough it was clear that confusion withcolic or "stomach-ache" seldom arose, and that, thoughperitonitis was recognised, the mistake was made of not atonce determining the cause and dealing with it.

Mr. McADAM ECCLES laid stress on the value of drainagein cases of escape of the gastric contents, and for this

purpose he makes a second opening lower down, which hekeeps open for twenty-four to thirty-six hours.

Dr. CLIPPINDALE discussed the etiology of gastric ulcerand assigned a leading place to local constriction in womenby corsets and in men by belts.

Mr. SWINFORD EDWARDS raised the question of the valueof gastric endoscopy for diagnosis previously to perforation,and narrated a case of a middle-aged man who had a copiou,discharge of bright-red blood from the rectum. No gastricsymptom was present, but at the necropsy perforation of theright gastro-epiploic artery was the only lesion found.

Mr. R. W. LLOYD discussed the dietetic and medicinaltreatment, and called attention to the varied localisation ofpain in the cases where perforation afterwards occurred.

Dr. ALDERSON thought that local counter-irritation was avaluable adjunct to treatment.

Mr. BIDWELL referred to the operative treatment in non-perforating cases. He mentioned a case where operation hallbeen performed for persistent symptoms, and others wherethe symptoms were due to adhesions either within or withoutthe stomach in consequence of the cicatrisation of an ulcer.Considering the uncertainty of the diagnosis of perforation,he held that an operation ought to be performed unless thephysician can assure himself that the case is not one of gastriculcer.

Mr. SNAPE asked the opinion of surgeons present as to theadvisability of operating in severe cases before perforation.

Mr. BRUCE CLARKE in reply, said that in cases of hxmor-rhage threatening the life of the patient he would follow theordinary surgical indication and cut down on the bleedingpoints.

Dr. ABRAHAM called attention to a singular appearance inDr. Alderson’s case-i.e., that the stomach walls appearedmicroscopically to be infiltrated with cells somewhat

resembling those of a pigmented sarcoma.Dr. LAWRENCE urged the value of albuminate of iron.Dr. PEARSON thought that some cases of gastric h2emor-

rhage in girls might be assigned to vicarious menstruation.The PRESIDENT summed up briefly, and regretted that no

speaker had been able to distinctly define the various indica-tions for operation.

LIVERPOOL MEDICAL INSTITUTION.

Is Cancer Curable by Surgical Operation ?-Successful case ofCholecystotomy.

Ax ordinary meeting of this society was held on Nov. 14th,the President, Mr. CHAUNCY PU7.EY, being in the chair.

Dr. DAVIES-in opening the discussion on Is Cancer curableby Surgical Operation ?-said that evidence goes to prove thatcancer is something far other than a mere local disease. In

fifty-three cases of uterine cancer submitted to the operationof complete hysterectomy there was early recurrence inalmost every instance. Numberless authorities advocate anddescribe partial or complete hysterectomy, but their writingsdo not contain the facts as to the actual benefit derived fromthe operation. In his opinion patients with recurrence of thedisease suffer more acutely than those in whom it hasnever been touched. He thought that cancer was mostprobably a micro-parasitic disease in the blood. In his

opinion alimentary cancer was as unsatisfactory as theuterine form, and more reliable details of results were

much needed. He also thought that the subsequent andremote results of operation on breast cancer were very bad,notwithstanding that the operation was becoming more andmore severe, with clean sweeping of the axilla and evenremoval of the arm. Statistics, immediate and remote,would be a great help. There was no evidence that casesof non-recurrence were also examples of early operation.Patients ordinarily live for two or three years whethertreated by surgery or left alone. When cases live for ten ortwenty years after operation the question to determine waswhether the case was ever one of cancer at all. Dr. Davies,in concluding, advocated the serial and methodic investiga-tion of a large number of cases, extending over many years,such investigation to be duly audited by a competent com-mittee.

Mr. PAUL said that he had no intention of advocatingeither side of the debate, but hoped to state his views

impartially. He thought there was no such diversity in

practice, as had been suggested by Dr. Davies, amongst theleaders in surgery. Having given the facts upon which hisviews were based, he expressed the opinion that cancer waslocal in origin, but could only occur in tissues favourably

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predisposed to its growth, and that it could be cured in thesame sense that a tuberculous joint could be cured by excision.He then proceeded to give the results of surgical treatmentin cancer of the alimentary tract. The best successes quotedwere in cancer of the lip, gums, cheek, rectum, and anus, buthe believed the colon and pylorus would yield equally goodresults in time. Finally, he considered that surgical successdepended upon-(1) early recognition, (2) thorough extirpa-tion, (3) inherent favourable tendencies in the tumour, and(4) judicious constitutional after-treatment.Mr. BANKS dwelt more particularly on cancer of the breast.

He said that he could well remember the time when cancerwas held to be an absolutely constitutional disease, but.later many veered round to the opposite opinion and

alleged that it was purely a local malady. He believed in acancerous diathesis, but thought that some local irritation wasnecessary to start the disease ; if, however, the portion of theeconomy so affected could be clean scooped out, ’’ like thebad bit out of an apple," there was no absolute reason whythe disease should not be eradicated. If once it is admittedthat cancer is a purely diathetical disease, the surgeonmay give up all attempts at its removal, for, whateveris done, it will return locally or at a distance ; on theother hand, if he believes too implicitly in a mere localfocus which spreads and affects the system, he will oftenbe led away into rash and futile operations which cannever, in the nature of things, succeed and which doserious harm by prejudicing certain operations in theminds of the public, both medical and lay. Mr. Banks con-fessed that the only remedy at present, if one was employedat all, was the knife, and that admittedly a very poorone. When a student he was taught that if there was

secondary infiltration of the glands this was a bar toall operative procedure, but about eighteen years ago he hadbegun to practise a much more free local removal of thebreast, accompanied by a clearing out of the axilla. Hebelieved that if this could be thoroughly done it was a per-fectly justifiable operation. He thought that if they couldonly get people to come early enough with their breasttumours and have them removed they might save one out offour from further invasion. While, therefore, he deprecatedreckless and useless operation, he would regard anyone whoshould refuse absolutely to remove breast cancers on anyconsideration as a person perfectly devoid of reason andcommon sense.

Mr. W. S. CRAWFORD advocated the treatment of certaincases of mammary cancer by surgical means. He gaveparticulars of four cases, microscopical sections of whichhad been shown. In one the patient died five years after heoperated and without any return of the cancer ; the secondcase was now living, three and a half years after operation,with no apparent return ; the third case died three and ahalf years after operation from other causes ; and in thefourth a different form of cancer attacked the second breastthree years after the first one was removed.

Dr. IMLACH said that, according to some modern"localists," out of 500 operations for cancer 100 remained.free from recurrence, while, according to Sir James Paget,perhaps only one individual would remain free. He was

surprised at the meagre information which was supplied bythe supporters of hysterectomy for cancer. Surgeonsgenerally complained that patients with cancer are not sentto them sufficiently early, but he believed, with Dr. Davies,that cases of non-recurrence were very seldom examples ofearly operation. If any hospital committee, disappointedwith the results of cancer surgery, desired an inquiry intoresults they should carry it out for themselves, with the aidof medical assessors.

Dr. ALEXANDER admitted that the results of operation forcancer were not satisfactory, but there could be no doubtthat surgery was sometimes a I I cure " for the disease, and he,cited some cases from his practice to prove this point. Apartfrom " cures," surgery gave distinct relief, especially in- cancer of the tongue and rectum, where recurrences tookplace outside the alimentary tract and killed the patient byexhaustion without the terrible agonies experienced by thosewho died unrelieved by operation.Mr. BRIGGS, Mr. J. D. CRAWFORD, Mr. ROBERT JONES,

Dr. WALLACE, Dr. CARTER, Dr. RAWDON, and Mr. RUSHTONPARKER also took part in the debate.Mr. CLEGG showed a female patient aged twenty-six years

from whom he had successfully removed several Stones fromthe Gall-bladder.-Dr. RAWDON and Dr. O’HAGAN maderemarks on this case.

MANCHESTER MEDICAL SOCIETY.

Cervioal Pachymeningitis.-Pulsating Orbital Swelling.-Abscess of Spleen.-Ipecacuaha Alkaloids.

A MEETING of this society was held on Nov. 6th, thePresident, Mr. F. A. Sou2fiAM, being in the chair.

Dr. LEECH showed a case of Cervical Pachymeningitis.The patient came under his care nineteen years ago, beingthen fifteen. He was suffering from loss of power overboth arms and the left leg. Prior to the paralysis he hadsuffered from an abscess at the back of the neck, andfrom a sinus it left a piece of bone of consider-able size had been discharged. Soon after admission intothe Infirmary power was entirely lost in the arms andlegs, the muscles were rigid, the deep reflexes muchexaggerated, and tremors were easily produced. Themuscles of the upper extremity were wasted, and therewas characteristic deformity of the hands. He had incon-tinence of urine, and some anaesthesia. The boy remainedcompletely paralysed for many months, yet he eventuallyrecovered. He could not stand for two years, and threeyears elapsed before he could walk. For sixteen years hehas remained well and able to work. The right hand is alittle deformed, and the reflexes are unduly marked-other-wise he is in good health.Mr. JONES showed a case in which both Common

Carotid Arteries had been tied for a Pulsating Swellingin the Right Orbit. The patient, a woman aged twenty-four, was confined in January, 1891, after a tediouslabour of thirty-six hours. Immediately after the birthof the child the patient noticed a peculiar noise in thehead, which she compared to a loud knock at the door.This sensation was most noticeable on the right side of thehead, and it was not attended with any pain. Fourteendays later both eyes became swollen, but the condition didnot persist in the left eye. A little later the right eye beganto protrude, and after two months the protrusion was mostnoticeable. She was under treatment for a few weeks,which consisted of rest in bed and intermittent pressureon the right carotid artery, no benefit being derived.She was admitted into the infirmary in December,1891. The symptoms usually associated with orbitalaneurysm were present in a more or less marked degree.Ligature of the right common carotid artery was practisedin August, 1892, after a further trial of digital compressionof the artery had been resorted to. The patient made a goodrecovery, and there was a marked improvement in her con-dition for a time until a violent attack of coughing, whichwas attended with much straining. Pulsation and the othersymptoms returned in the orbital swelling. Her conditionremained stationary for many months, when she received anaccidental blow from a child’s elbow, and an aggravation ofthe symptoms followed. She was readmitted last January,and as it was found that the pulsation in the swelling couldbe controlled by pressure on the left common carotid arterythis vessel was secured. The benefit accruing from thisoperation was of a very temporary character. Her conditionnow is very much what it was when she first came underobservation, and the question was discussed whether injec-tion of coagulants into the dilated pulsating veins wouldnot be a justifiable proceeding. If the patient gives herconsent she will be again admitted for further treatment.Mr. JOSEPH COLLIER mentioned a case of Abscess of the

Spleen in a woman aged forty-five years, married, with nohistory of injury, who had never lived abroad, and who wasadmitted into Crumpsall Hospital with signs of left pleurisy.Later there existed a high temperature, much pain in theleft side, and afterwards bulging in the left hypochondrium,which increased, was fluctuant, and slightly pulsating.Abscess of spleen was diagnosed, with haemorrhage from thesplenic substance into its cavity. The patient was in a verylow condition ; the abscess was opened, and over a pint ofblood-stained pus, blood-clot, and broken-down spleensubstance was removed ; the haemorrhage from the remainingportion of the spleen was easily controlled by pressure with asponge towards the hilum ; the remainder of the spleen wasscraped out with a lithotomy scoop. The cavitv was packedwith iodoform gauze. There was no further bleeding, but thepatient died from collapse in twenty-five hours. At the

necropsy no peritonitis was found, but the peritoneum waspushed down by the abscess ; there had been no haemorrhageinto the large abscess cavity. Left basal pleurisy was