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commonly thought, especially by the older writers. i ne

statements made by various writersin text-bookson medicinewere quoted, and statistics given of thirty- five cases occurringin the Middlesex Hospital, of which nineteen were dischargedas recovered or relieved. Reference was also made to a paper’by Dr. Osler of Johns Hopkins University, in which a similar’l’iewwas taken to that put forward in connexion with the pre-sent case as regards the prognosis in tubercular peritonitis.-Dr. CHARLTON BASTIAN referred at some length to thestrange anomalies of distribution of tubercle through thebody, and these were all the more difficult to understandwhen it was remembered that some very competent autho-rities believed that the disease was solely acquired by con-tagion. In some cases in which intra-abdominal tuberclewas abundant and of long standing it was wonderful that itremained localised, and did not disseminate.-Dr. BURNEYYEO, in support of Dr. Finlay’s proposition that this lesionwas curable, referred to the case of a boy, aged eleven, whowas introduced to his ward at King’s College Hospital withascites. The diagnosis of tubercular peritonitis was sup-ported by the facts that one of the surgeons had recentlyTemoved a tuberculous deposit from his cheek, and that histemperature was characteristic of the malady. He con-ceived that the treatment which was adopted had some-thing to do with the favourable result which followed. Thelad was given iodoform with cod-liver oil internally, andiodine was rubbed in locally. Tubercle of the peritoneumran a different course and had a different history fromtubercle elsewhere-for example, in the lung,-and thismight perhaps be due to the fact that air was excluded.Even if we came into possession of an absolute cure fortuberculosis, still many cases of pulmonary phthisis wouldTemain unbenefited, for the morbid lesions which took placein the lung in connexion with tuberculosis were for themost part irremediable.-Mr. WILLIAMS was convinced thatthe prognosis of pulmonary tubercle was often given too’1lllfavourably, and he had arrived at this conclusion frompost-mortem experience. Obsolescent tubercular lesions werevery frequent, and this fact had been recognised by the olderwriters.-Dr. HADDEN said that in children tubercular peri-tonitis often got well, but recovery was rare if the pleurfcwere involved. He inquired as to the evidence of thepresent case being of tubercular nature; certainly therewere instances of effusions into multiple serous cavitieswhich were not of this character. - Mr. R. W. PARKEE.asked how many cases of tubercular peritonitis were asso-’ciabed with effusion of fluid; he thought that as a rulethey were dry. He wondered if an abdomen full of pus- could dry up.-Dr. BARLOW had seen Dr. Finlay’s case,and thought the view taken was that which presentedfewest difficulties; he felt masses in the abdomen whbbwere suggestive of tubercle. Cases of multiple effusion oinon-tubercular nature were more often of pyaemic character,and the prognosis in them was worse. We were familialwith cases of serous effusion into the pleura which recoverecwithout aspiration, and then two years later a fatal tubertulosis developed. The general idea was that the originapleurisy in these cases was tuberculous, but he did noi

think that it was proved; it was more reasonable to believlthat a person with a tendency to tuberculosis was als(liable to serous effusions. The majority of cases o

tubercular peritonitis were dry, though they might pas!through periods of effusion of benign character, whiclwould absorb without counter-irritation. The presenciof pus in these cases he regarded rather as an epiphe,nomenon; some ulceration, perhaps of Peyer’s patchesmight yield and set up a localised purulent inflammation.—Dr. F. TAYLOR said that in the majority o

- cases tubercular peritonitis was dry ; but in some instancerecently published, in which operative measures had bee]adopted, the fluid was serous. He referred to the case of iwoman who was admitted into Guy’s Hospital under hi<are with a distended abdomen of two months’ durationpain, and high temperature. By paracentesis clear serun’was drawn off, but the patient got weaker and died. Posmortem irregular masses of tubercle were found. Hthought that the recent surgical successes in dealing wit:tubercular joints had an important bearing on th’question of the curability of tubercle in general, buhe admitted that, for instance, in the lung tuberclaet up other morbid processes not so amenable ttreatment.-Dr. EWART thought much of the diicrepancy of opinion arose from the fact that there wei,two forms of tubercular peritonitis-one much more fatf

than the other. These graver cases found in the post.mortem room were of the dry variety, with abundantcaseation, and were usually part of a general tuberculosis.Other cases were localised, and were more analogous tolocal disease of lung, pleura, or joint. Clinically, he hadseen recovery from both the wet and dry forms.-Dr.FINLAY, in reply, recapitulated the grounds which led himto the diagnosis of tubercle-the course of the complaint,the involvement of the pleurae, and the feeling of masses inthe abdomen. He agreed that peritoneal tuberculosis waEgenerally dry, though fluid was sometimes effused. ThElatter form was more favourable. He believed that recovery was even more common than with pulmonarytubercle, perhaps because the abdominal walls were mOrEyielding.

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MEDICAL SOCIETY OF LONDON.

Excision of Gasserian Ganglion.-Tlze Abuse of Drainage.AN ordinary meeting of this Society was held on

Oct. 27th, the President, Mr. Knowsley Thornton, being inthe chair.

Professor WILLIAM RosE read a paper on a case in whichthe Gasserian Ganglion had been removed for persistentneuralgia with a successful result. The paper, which ispublished in full in another column, was illustrated bydiagrams. The patient was shown, as well as micro-scopical sections of the ganglion, which exhibited a re-dundancy of fibrous tissue, indicating a chronic inflam-matory condition of the nerve.-Mr. THORNTON askedwhether, seeing the diseased condition of the second divi-sion of the fifth, cure might not have been brought aboutif the operation had stopped short with the removal of thesuperior maxilla.-Dr. FERRIER had seen a case in whichthis proceeding had been attempted, but had to be givenup. It was a question if the patients would consent toundergo the deformity which must necessarily result, butperhaps it was a question which had better be left to them.The loss of the eye he regarded as an unfortunate accident;he did not believe that it perished from loss of trophic influ-ence, but that it was due to irritation. He thoughtremoval of the ganglion was justifiable if after resection ofa portion of a trunk of a nerve the neuralgia recurred,though it should be remembered that in some cases resectionof the nerve gave permanent relief. The pathology ofneuralgia was obscure, and in many cases it might be ofcentral origin. Section of the nerve above the ganglionmight cause an ascending degeneration, and thus leadto relief by producing atrophy of the centre. It was

probably still a little too early to say if the cure inthe present instance would be permanent.-Dr. ALTHAUSasked if the entire ganglion were removed or only a portion.Some years ago he brought before the Medico-ChirurgicalSociety a case of bilateral neuritis of the fifth nerve;keratitis and iritis supervened, but no panophthalmitisdeveloped. There was excessive pliotophobia in the eyewhich had the better vision; there was also extreme hyper-secretion from the eyes, nose, and mouth; the tongue, beinganaesthetic, was much lacerated by the teeth, and therewas a painful amount of tinnitus aurium present. In thecase shown the ansestbesia seemed to be more circumscribed,and hence he thought some of the ganglion might be left.He believed that irritants entering the eye probably causedthe trouble there.-Mr. DAVY regarded the operation as byno means free from danger, and thought it would behazardous in less competent hands. If the first division ofthe fifth presided over the nutrition of the eye, it would beimpossible to excise the ganglion without injury to thatorgan ; he himself could not regard the slight irritationswhich had been quoted as sufficient to cause the loss of theeye. He surmised that as good a result would have beenobtained if the superior maxilla alone had been removed.From what he had heard, he would not be inclined torepeat the operation on a living subject. Operations evenon main trunks of nerves were often followed by returnof symptoms.-Mr. BALLANCE agreed with the suggestionthat the Gasserian ganglion could be removed without abla-tion of the upper jaw. He was glad to hear that the loss ofthe eye was considered to be an accident, and also thatsection of the nerve above the ganglion would probablycause atrophy of the centre and thus abolish the pain. Thesections exhibited certainly showed increase of fibroustissue. Mr. Clutton some time’ ago removed two Meckel’s

926

ganglions according to Chavasse’s method, and the infra-orbital nerves in each showed separation of the nerve

bundles by a large quantity of fibrous tissue.-Mr. HOSE, inreply, said that had it not been for his want of success inprevious partial removals of the fifth he would not havegone on after removing the jaw. He would make knownthe further history of the case in twelve months’ time. Hisimpression was that he had removed the entire ganglion.The circumscribed area of anaesthesia was diminishing,owing t3 ingrowth from neighbouring anastomoses. The

patient had much secretion from the mouth and the eyeboth before and after the operation. At first the skin pre-sented a very glazed appearance, due to trophic disturbance.Mr. LOCKWOOD read a paper on the Abuse of Drainage

of Wounds. He began by remarking on the greatbenefits which had accrued from the systematic drainageof wounds, and proceeded to argue that this had ledto considerable abuse of the process. Although of latethere had been some reaction, he thought it not im-

proper that the subject should be discussed. The necessityof drainage in the case of wounds made by the surgeon inhealthy tissues was first discussed. An ideally successfulwound was defined as being one which healed without con-stitutional disturbance and under a single dressing. Obvi-ously the insertion of a drainage-tube rendered this con-summation impossible, as the dressing had to be changedfor its removal. Next the inefficacy of drainage-tubes wasmentioned, and cases given to show how frequently, whenthe wound was aseptic, they were found blocked withblood-clot, the dressings being practically unstained. Theasepticity of some of the cases had been properly ascer-tained by the inoculation of cultures. A similar objectionwas taken to soluble drainage-tubes-namely, that theywere just as liable to become occluded. It was quiteunnecessary to drain with the view of giving exit to blood,as by proper precautions none need be effused. Further,should any collect, it did no harm so long as the wound wasaseptic. The occurrence of serous inflammatory effusionwas next discussed, and first wounds were described whichhad been treated without drainage, and in which none hadbeen seen. These wounds included amputation of limbs,extensive amputations of the breast, and operations forhernia and for the removal of tumours. Some of these hadbeen tested and found aseptic. Next similar wounds werereferred to in which some effusion had occurred, but inwhich it had been harmless. Wounds in which there wasmuch effusion had been tested, and always found to beseptic. The latter condition was thought more potent thanchemicals, foreign bodies, or want of pressure in causingeffusion and subsequent suppuration. The importance ofthe systematic testing of wounds was referred to. Manyso-called aseptic wounds were in reality septic. Wheneverit had been necessary to dress a wound to remove buttonsutures or drainage- tubes, and the wound had been provedaseptic, the greatest confidence was felt in the ultimateresult, and the first dressing was always the last. Any-thing short of asepticism was unsafe, especially if

drainage was omitted and the wound put up to healunder a single dressing. There was no methodwhich allowed harmless contaminations to enter but ex-cluded the harmful. Cases were quoted of severe woundstreated without drainage, and which healed beneath a

single dressing. They easily carried off the palm for

rapidity of healing, painlessness, and economy. The use ofdrainage in abdominal wounds was mentioned. In suchcases drainage was the exception and not the rule, and thesame ought to apply to other operations. There were someregions in which the omission of drainage seemed hazardous,particularly in those which involved the scrotum, thetriangles of the neck, and perhaps the loose tissues withinthe abdomen. Wounds in tissues in which septic processeswere established needed drainage, although cases were men-tioned which seemed to show that a distinction ought tobe made between those which were chronic and thoe whichwere acute. The relation of the constitutional state of thepatient to drainage was next mentioned, and the questionof auto-infection of wounds mentioned, and a supposed in-stance given. Last, the precautions which had beenadopted were described. Stress was laid upon the prepara-tion of silk (which was alone used for sutures andligatures), sponges, and instruments, the latter byboiling in soda and water. The 5 per cent. carbolic gauzeand alembroth wool seemed to make the best dressing, thewhole being adjusted with Martin’s rubber bandages.-

Mr. REGINALD HARRISON, though admitting the usefulnessof the drainage-tube, could not regard it as an unmixedblessing. There were certainly many conditions underwhich it could be entirely dispensed with.-Mr. ALBANDORAN said that no appliance introduced within the lasttwenty years had done more good in abdominal surgerythan the drainage-tube if properly used. It was a con-trivance intended for permitting the pumping out of fluidfrom the abdominal cavity, and was one of the greatestsafeguards after adhesions had been broken down. It hadbeen abused, because it had been used where not wanted,.and when employed it had often not been used properly.-Mr. ROSE believed that a drainage-tube during the firsttwenty-four hours was useful to take away excess of blood.When the tube was blocked with blood, it had alreadydoneitswork. &mdash;Mr. H. ALLINGHAM thought the use of a drainage.tube was often better than employing the amount of pressurenecessary to keep the wound in accurate apposition.-Mr.LOCKWOOD, in reply, thought that a drainage-tube put inand taken out again within twenty-four hours simply toremove blood that should have been stanched at the timeof operation was a confession that the highest ideal insurgery was not being aimed at. He was not now using somuch pressure as he did at first. He regarded the method headvocated as economical both as regarded time and expense.

CLINICAL SOCIETY OF MANCHESTER.

AT the meeting on Oct. 21st (Dr. Simpson, President, inthe chair), Dr. MILLIGAN showed some cases of Ear Disease;Dr. BUCKLEY an Ovarian Tumour; and Mr. HERBERTLUND brought forward a patient upon whom he hadoperated for Myeloid Sarcoma of the Lower Jaw.

Dr. HILL GRIFFITH showed a girl, S. M-, aged twenty.eight, who had Serous Iritis of the Left Eye for five months’with three yellowish nodules at the ciliary border of the.iris, some clots on Descemet’s membrane, and numerousposterior synechiae, but very little clouding of the iris;.vision was 16 Jager. There was phthisis on the mother’sside, and the patient had fine crepitations at the apices.There was no history of syphilis, and no benefit resultedfrom one month’s treatment by mercurial inunction. Enu-cleation should only be done if the disease had alreadydestroyed the eye, or if from its extreme rapidity this was,likely to take place; few, if any, were primary.

GLASGOW OBSTETRICAL AND GYN&AElig;CO-LOGICAL SOCIETY.

THE first meeting of the session was held in the FacultyHall, 242, St. Vincent-street, on Wednesday evening,Oct. 22nd, Dr. M. Cameron, President, in the chair. Afterthe treasurer’s and secretary’s report the president gave hisretiring address, and the following office-bearers wereelected :-Hon. President: Lawson Tait, F.R C.S. Pre-sident : Robt. Park, M.D. Vice-presidents : G. Halket,M.D., and D. Tindal, M.D. Treasurer: Robt. Pollok,M. B. Secretary: G. A. Turner, M.D. Reporting Secre-tary : Robt. Jardine, M.D. Pathologist: T. NigelStark, M.B. Members of Council: A. Scott, M.B.: T. F.Gilmour, L.RC.P.E.; Thos. Richmond. L.R C.P.E.; A.Miller, L.R.C.P.E,; R. Kirk, M.D.; H. St. Clair Gray,M.D. Dr. Stuart Nairne showed a cancerous uterus whichhe had removed by abdominal section ten days before inthe Samaritan Hospital. The patient was reported to bedoing well. Dr. Robt. Jardine’s paper on PuerperalEclampsia was held over until the next meeting of theSociety.

FOOTBALL CASUALTIES.-Four serious accidentsoccurred to players in football matches on Saturday atSheffield. Two sustained fractured legs, one had his collar-bone broken, and the other his arm fractured. A youthwhilst playing football at Mansfield on the same day hadhis right arm badly fractured.-Mr. W. B. Thomas, Christ,Church, the President of the Oxford University Athletic Club,whilst playing football against Lincoln College on Tuesdaybroke his collar-bone.