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. 3. A blow over the stomach, ending in abscess, whichopened both externally and into the stomach:one case.

4. Ulceration from without, caused by pressure: onecase.

II. Disease: eighteen cases.1. Cancer of the stomach : six cases.2. Simple perforating ulcer of the stomach: probably

twelve cases.3. An abscess originating external to the stomach, and

opening both into this organ and externally, mayhave been the cause in one or two cases.

B. The situation, size, and other clearacters of the externalopening.-In none of the cases hitherto recorded did the open-ing at all equal in size that which exists in Catherine R .

C. Escape of food swallowed by the abnormal opening.-Thiswas observed in all the cases; but in six, fluids only are notedas having escaped. In the case of St. Martin, the necessityfor an artificial plug became, after a year or to, superseded bythe formation of a natural one, from a fold of the mucous mem-brane of the stomach. The author pointed out that the escapeof food, recently swallowed, from a fistulous opening in theabdomen, did not necessarily indicate a direct communicationwith the stomach.D. Duration of the fistula, and possibility of cure.-In cases

resulting from cancer of the stomach, death, as might be ex-pected, speedily ensues; three months being the longest periodthat a patient has survived the fistula. On the other hand,where wound or simple ulcer of the stomach has been the cause,

the patients have generally lived many years, apparently inthe enjoyment of good health. One case is on record of awoman who lived twenty-seven years with a fistula into thestomach ; and the opening into St. Martin’s stomach has ex-isted for thirty-five years, he being still alive and in goodhealth. As to the question of cure, the author stated that infour of the cases the fistula appears to have closed sponta-neously, but in two of them it reopened. In two other casesthe obliteration of the fistula was the result of treatment; butin none of the cases was any cutting operation resorted to.E. General health of persons affected with gastro-cutaneous

,98tula. -In permanent fistulæ, the general health has in mostcases been wonderfully good. The chief abnormal symptomshave been great thirst, increased appetite, obstinate constipa-tion, deficient secretion of urine, and, in women, amenoirhcea.

F. The physiological observations which have been made incases of gastro-cutaneous fistula.-In six of the cases observa-tions had been made as to the appearance of the gastric mucousmembrane, and the movements of the stomach, &c. Out offour cases in which the colour of the mucous membrane has beennoted, it has been a bright vermillion red in three; but in thecase of St. Martin it was a "pale pink," varying in tint withthe full or empty state of the organ. ’ Movements of the sto-mach, for the most part of an undulatory nature, have beenobserved in five of the cases. In three cases, irritation of themucous membrane has been observed to give rise to nausea andfaintness, but not to cause any pain.The author went on to notice the various theories which

have been entertained as to the mechanism of the act of vomit-ing ; and stated that, from all the observations that had beenmade, including that upon Catherine R—, the following con-clusions might be arrived at :-

1. That the act of vomiting is produced by the contractionof both the stomach and the abdominal muscles.

2. That the contraction of the stomach is limited to thepyloric extremity, and has for its main object the closure ofthe pylorus.

3. That the chief part of the act is effected by the contrac-tion of the diaphragm, as well as of the recti and obliquemuscles. ’

In three of the cases observations had been made on thechemical and physical characters of the gastric juice, and onits digestive powers over different articles of diet,-viz.: onMagdelaine Gore, in Paris, at the commencement of the pre-sent century, by M. Clarieu; on Alexis St. Martin, by Drs.Beaumont, Dunglison, and Smith; and on a female at Dorpat,in 1853, by Messrs. Otto Von Gninewaldt and Ernst vonSchreeder. The nature of the results arrived at, in each ofthese cases, was briefly alluded to, and they were stated to beof a somewhat conflicting character.No experiments as regards the gastric juice have as yet been

undertaken in the case of Catherine R-. Although thefistula, in her case, affords unparalleled opportunities for

making such experiments, the author doubted if the resultsobtained would be of much value in her present debilitated

state of health. He observed, however, that for some monthsshe had been improving in strength; and expressed a hopethat she might yet become a fit subject for experiment.The paper was illustrated by numerous photographs of

Catherine R-, and by drawings of several of the other re-corded cases of gastro-cutaneous nstulse.

MEDICAL SOCIETY OF LONDON.

SATURDAY, Nov. 28TH, 1857.MR. HIRD, PRESIDENT, IN THE CHAIR.

INJECTIONS OF IODINE IN OVARIAN DROPSY.

MR. BAKER BROWN related the case of a young lady, twenty-six years of age, who had suffered from ovarian dropsy, whichhad developed itself with great rapidity. She had been tappedtwice when she came under his care, and though very muchdebilitated, it was determined, with the patient’s wish, as theonly means that could be resorted to, and as the only chanceof saving her life, to inject the cyst with iodine, the chances ofthe success or non-success of the proceeding having been com-municated to the patient. Five ounces of the tincture ofiodine of the Edinburgh Pharmacopoeia were injected, and thepatient made a good recovery. Mr. Brown related the case toshow the efficiency of the remedy even in an advanced stage ofthe disease, but more especially with the view of reprehendingthe system of denouncing remedies because they were new. Apractitioner who had seen this patient in the early stage of thedisease, and when well fitted for the iodine, had denounced theemployment of that remedy, declaring that all who used it haddied! In well-selected cases, however, the remedy was a,valuable one, and its use had been attended with great success.Mr. HARVEY had seen iodine injections used with much

benefit in Paris, in cases of ovarian dropsy, hydrocele, enlargedbursa, &c.

Dr. WINN briefly described a case of .

POISONING BY SULPHURIC ACID.

The patient was a child four years of age, and had swal-lowed a quantity of sulphuric acid by accident. Difficulty, ofbreathing and pain, followed by cough, dark tongue, fever,and glossitis, supervened. A grain of calomel was given everyhour, and a blister applied. The next day the calomel wasomitted, and the blister dressed with mercurial ointment.The child recovered.

Mr. PRICE read a paperON SOME FEATURES OF PRACTICAL INTEREST IN CONNEXION WITH

THE OPERATION OF RESECTION OF THE KNEE-JOINT FOR ARTI-CULAR DISEASE. ,

The author divided his subject into four heads : First, by dis-cussing the various ages at which the operation might be per-formed, and with success. Secondly; the state of the patient’shealth at the time of operating, as influencing the immediateor future result. Thirdly, the nature and extent of the disease.Fourthly, the value and absolute importance of correct after-treatment. With regard to the first division of the subject,the author thought that experience justified him in statingthat success had proved that the operation could be performedat any early age, from three or four years, or even younger’ifnecessary, and that, with a very fair hope of a beneficial result,the proceeding might be adopted in oases in which it wasthought, by reason of advanced years, to be inadmissible. Theauthor insisted that as long as the operation was negatived byopinions derived from theory, and not from practice, consider-able opposition would remain regarding this point. The im-mediate and future results from the operation when resorted to inpatients distressed and worn down by the long existence ofpain and consequent general disturbance were entered into atsome length. It was contended that the shock produced by theoperation, supposed to be of a violent character, was, in reality,of a trivial nature, provided the various steps, as laid down bythe author, were duly followed, both as regards the operationand the subsequent treatment, and that the relief from painand distress was frequently so marked that little doubt couldexist as to the conclusion to be drawn-viz., that the operation,with very great propriety, ought to be adopted even when thepatient’s health is shattered by the existence of the localdisturbance. Some water-eoloured drawings exhibited thevarious forms of joint disease for which resection had beenadopted, and illustrated the author’s opinion, that there is no

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disease, not including malignant affections, involving the knee-joint, when confined to the articulation, and the parts imme-diately concerned therein, which cannot be treated efficaciouslyby the local removal of the mischief. To this general rule,however, the author was inclined to make one exception-viz., diffuse strumous infiltration of the heads of the two longbones, tibia and femur. The great importance of correct after-treatment was insisted upon as highly conducive to the successof the operation; and the various practical features were illus-trated by a model of the apparatus now usually and almostuniversally adopted for the management of the limb.The above is a very concise summary of Mr. Price’/!! paper,

which practically showed that within a short time generalassent must be given to the operation, and that those surgeonswho still continue to resort to amputation through the thighfor articular disease deserve an amount of censure proportionateto the damage and injustice done towards their patients in de-priving them of what might have been made highly usefullimbs. The above remarks had resulted from a considerableattention paid to the various features of the operation, and, aspractical deductions, the author trusted they would be re-

ceived. ’

Mr. HaRD said that it was desirable to ascertain whether thilimb in young subjects-before puberty-grew after resectioiof the knee-joint.Mr. WEEDEN COOKE spoke generally in favour of the opera

tion, but said that in many cases of diseased knee-joints thEdisease could be treated successfully by rest, and on Scott’lplan. Resection was not applicable to joints in a state of inflammation, but in cases of disorganized joint.A FELLOW inquired to what extent the shaft of a bone, whet

implicated in the disease, could be removed by the operationand whether resection was admissible in cases of compoundfracture of the knee-joint when amputation was inevitable.Mr. BAKER BROWN considered the success in these cases de.

pended on the after-treatment, the administration of opium,perfect rest, and full support, with plenty of wine.

Dr. STOCKER said, in these cases, after the operation, therewas no pain. With respect to the administration of largequantities of wine, he thought we were apt even in fever tocarry this plan of treatment too far. Milk diet, with bark,was often better than wine.Mr. HENRY SMITH agreed in the main with the paper. The

question as to whether the limb grew after resection of theknee-joint in early life must be answered in the affirmative.Several years since, Mr. Jones had operated on a boy belowfifteen years of age. This boy’s limb had grown since equallywith the other, and he did not even require a high-heeled boot.He (Mr. Smith) should not like to perform the operation on achild below four years of age. The limb in such a case wouldnot be so useful as though the patient were an adult. Mr.Syme had rejected the operation in early life because, in his case,the limb did not grow after the resection. There was, however,a greater shock from the operation in an adult than a child, buteven in an adult the shock was less than that from amputation.Mr. Jones, of Jersey, was in the habit of administering largequantities of wine to his patients.

Mr. HIRD remarked, that it would appear that in the periodfrom four to puberty the operation was less advisable than afterthat period.

In reply, Mr. PRICE said he felt pleased that to themajority of his observations the various speakers had expressedassent. The subject was one of extreme interest, and he hoped,on a future occasion, to be able to bring fresh facts before theSociety.

____

At a meeting of the Society on the 21st ult., Dr. HARE reada paper on

THE DIAGNOSIS OF TUMOURS AND ENLARGEMENTS OF THE

KIDNEYS.

The author, after stating that under favourable circumstances(in a thin person, with the abdomen flaccid, &c.,) the lowerend of the kidneys, even in a healthy condition, may occasion-ally be detected, next described some of the malformations andmalpositions to which these organs are liable. He then referredto a certain mobility sometimes presented by the kidneys, evenwhen otherwise in a normal state. Such kidneys may occa-sionally be moved as much as four or five inches. A knowledgeof this condition is important, as healthy kidneys presentingthis peculiarity have been mistaken for abdominal tumours ofdifferent kinds. The great size which renal tumours mayattain was mentioned: a cancerous kidney in a boy aged onlyeight years weighed 31 Ibs. The general characteristics of

tumours of the kidney were then adverted to-those revealedby inspection, palpation, percussion, auscultation, &c. Thecharacters of the upper part of a tumour of this kind are rarelyto be made out, owing to its anatomical position; but the form,condition of surface, &c., of the rest of the tumour may oftenbe readily determined. These vary much, according to thenature of the disease affecting the organ, as does also the amountof resistance to pressure. The whole may be solid or elastic,or may even present fluctuation. When one part of a renaltumour is solid and the other elastic, &c., (containing fluid,)the latter is, in by far the majority of cases, situated nearer themedian line than is the solid portion. The value of the usual

position of the colon in front of renal enlargements was especiallyenforced. Dr. Hare 4iad only once met with a murmur pro-duced in a renal tumour; he believed such murmurs to bevery rare. The characters of the pain, secondary and localeffects, general symptoms, and conditions of the urine, occurringin different kinds of these affections were described, and theauthor then passed in review the diseased conditions of otherorgans, which might be, and often have been, mistaken forkidney tumours; and particularly dwelt upon the difficultiesof diagnosing certain malignant growths from the tumoursunder consideration. With regard to the spleen, he took theopportunity of mentioning, what he did not remember havingseen named elsewhere, that he had frequently noticed an ex-cessive quantity of lithic acid in the urine in cases of enlarge-ment of that organ, (" Transactions of the Pathological Societyof London," 1851-52,) and in connexion with that point re-ferred to some experiments lately published by Dr. Ranke.The different kinds of renal disease capable of giving rise toenlargement of the viscus were passed in review, and the de-structive physical characters and characteristic symptoms ofeach were enumerated, so as to aid in the differential diagnosisof tumours of the kidneys.The paper was illustrated by some recent specimens, and by

numerous drawings, some of which represented the form andappearance of the abdomen in patients suffering from theseaffections, while others showed the appearance of the tumoursin sitit, or when removed from the body.A discussion ensued, in which several members took part.

PATHOLOGICAL SOCIETY OF LONDON.DR. QUAIN IN THE CHAIR.

Dr. WILKS exhibited three specimens ofFIBROUS TUMOUR OF THE OVARY.

He brought them forward in consequence of there being muchdifference of opinion expressed during the last session as to therarity of this form of disease. The first specimen was a verylarge and dense fibrous tumour of the ovary, weighing betweentwo and three pounds. Its section displayed the curving andconcentric fibres as are seen in the hard tumour of the uterus.The second was an ovarian tumour, weighing three pounds,lately sent to Guy’s Museum by Mr. Burgess, of Glastonbury ;it was of ten years’ growth, and was of a uniform fibrous struc-ture throughout. The third specimen came from a woman wholately died in Guy’s Hospital, and in whom there was found atumour of both ovaries, each the size of an ostrich’s egg; theycontained a few cysts, but the bulk of their structure consistedof a uniform fibrous tissue. The specimens, Dr. Wilks stated,showed the various grades of disease between a solid fibroustumour and the multilocular cysts. The latter may exist in itssimplicity, or, as commonly happens, with some amount ofsolid growth amongst it. Again, this may occur, but with thesolid predominating, as in the third specimen exhibited, or withthe tumour entirely solid until it reaches the dense structure ofthe fibrous tumour of the uterus.Mr. PRICE exhibited a specimen of

ULCERATED PATELLA, REMOVED THIRTEEN MONTHS AFTER SUC-CESSFUL EXCISION OF THE KNEE-JOINT,

which he had lately taken from one of his cases. The patient,a woman, had made an excellent recovery from the operation,but, subsequently, .the patella became involved on its undersurface in disease-ulceration. This being fully established, itwas deemed prudent to remove the bone, which was done byenlarging the channels of one or two abscesses, and, by meansof a probe-pointed bistoury, dividing its attachments subcu-taneously. The case formed a precedent for the advantage tobe gained by taking away the bone in the operation of excision.even when known to be healthy, while its absence does not iany way interfere with the subsequent advantages sought fo7