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in tabes dorsalis.-Dr. HADDEN said that he thought theconnexion was one that had received very general assent oflate.-Dr. A. MONEY remarked that several papers had

appeared in the Lyon uledical by M. Teissier and otherspointing out the frequent association of cardiopathy andarterial disease with tabes dorsalis.-Dr. LONGHUITST, inreply to Mr. Smith, said the patient had no morphia.Mr. MEREDITH read notes of a successful case of Lapa-

rotomy for the relief of Acute Intestinal Obstruction fol-lowing upon Ovariotomy. The patient, a feeble old woman,aged iifty-eight, was operated on at the Samaritan FreeHospital in April, 1885, for double ovarian cystoma, com-plicated by very extensive adhesions (parietal, pelvic,omental, and intestinal). The subsequent progress of thecase was in all ways satisfactory during the first week, atthe end of which time all sutures were removed after thebowels had acted, the abdominal incision being found wellunited, and the pulse being recorded as normal. On theevening of the same day the patient suddenly com-plained of nausea, and soon after vomited a quantity ofdark-green fluid. On examination, the abdomen was foundfree from distension and universally resonant on per-cussion, excepting immediately over the region of theceecum, where some dulness was detected. The conditionwas diagnosed as commencing intestinal obstruction, pro-bably caused by an adhesion band. All nourishment by themouth was at once stopped, and replaced by nutrientenemata of beef-tea, containing occasional doses of tincture ofopium. By the following morning there had been no returnof the sickness, but the patient looked worse, the abdo-men was somewhat fuller, and the urine passed during thenight was for the first time found laden with albumen. Im-mediate operation was decided upon as likely to afford thepatient the only chance of recovery under the conditionsbelieved to exist. On opening the abdomen the peritoneumwas found intensely red and congested, evidently in anearly stage of acute inflammation. Attention was attractedto a coil of greatly distended small intestine, which wasbadly kinked and obstructed in consequence of the tractionexerted upon it by a portion of the ligated omentum whichwas closely adherent to its surface. This having been re-leased with some difficulty, owing to the inflamed andsoftened state of the bowel, another distended coil similarlyobstructed by a separate omental band was also set free.No further obstruction being discoverable, the abdomen wasthen closed. The acute symptoms were at once relieved by theoperation, and the temperature fell to normal again on thethird day, but convalescence was tedious. No evacuation ofthe bowels took place until the twenty-third day, whenfaecal matter was for the first time detected in the rectum,and relief followed upon the use of an enema. Thenceforththe bowels acted daily, and the patient left the hospital onMay 16th, exactly six weeks from the date of her first opera-tion. When last heard of at the end of October, shestated that she had quite recovered her health and wasabout to resume domestic service. In commenting on thecase, Mr. Meredith urged the advisability of early resort tooperation under similar circumstances, quoting an instancein his own practice where the patient’s life might readilyhave been saved by such means.-Mr. T. SMITH askedwhether the albumen in the urine was associated with theemployment of the carbolic spray.-Mr. MEREDITH repliedin the negative. °

The following living specimens were exhibited :-Dr.Radcliffe Crocker : Arsenical Pigmentation in a case ofChorea. Mr. Malcolm Morris and Dr. F. Semon : Lupus ofFace and Larynx. Mr. Clutton : Tubercular Ulceration ofPalate. Dr. S. Mackenzie for Dr. Handford (Nottingham) :A case of Xeroderma (? Myxoedema).

MEDICAL SOCIETY OF LONDON.

.Jrritable,Ilmin and Congestion of the Brain in C1Lildl’cn.-Simple Pneumothora.r, with rapid recovery.

Ay ordinary meeting of this Society took place on Mondaylast, Mr. Brudenell Carter, F.R.C.S.. President, in the chair.

Dr. DAY read a paper on Irritable Brain and Congestionof the Brain in Children. He considered that the essentialproximate cause of cerebral irritability was ansemia. Manyindividuals about to suffer from nervous headaches expe-rienced curious sensations of restlessness and depression,probably due to cerebral anaemia. The causes of cerebral

irritation were very numerous; sometimes it followedaccidents either to the head or some other part of the body;it supervened at other times on chronic illness or acute dis-ease. It was as much a primary disease in some cases asirritability of the larynx or bladder. Sometimes theirritability led to congestion, and this to meningitis. Irri-tability was, again, a symptom of actual disease of themeninges or brain. Many cases were read illustratingDr. Day’s remarks. He believed that in many cases coldsponging was the best method of reducing the febriletemperature. Cerebral irritation is frequently accom-

panied by fever and often followed by frontal headache.Excessive heat or profound cold may set up congestion of thebrain. Delay in the treatment of such cases may allow ofthe development of coma, which leads to death. Thedistribution of the blood may be unequal in different partsof the brain, some being congested, others anaemic. Congestion of the brain very early succeeds irritation; if, indeed,it do not sometimes accompany irritation. A want ofbalance in the venous and arterial circulation of the brainmay disturb its functions. In some cases there are negativesymptoms-lassitude, change of manner, without fever,vomiting, or constipation. After lasting for some time, thisstage may be succeeded by one in which positive signs andfever develop. In diagnosis the temperature is of butlittle value unless taken in connexion with other signs.The temperature of the body is very mobile in some nervouschildren. It is difficult, if not impossible, to draw theline between active congestion and inflammation.-Mr. R. B.CARTER considered that hospitals for sick children affordeda fine field for ophthalmoscopic observation in cases ofcerebral disease. He remembered that M. Bouchut haddrawn a distinction between neuritis and perineuritis; forthe optic nerve received its blood-supply from the anteriorcerebral, whilst the coverings of the nerve were suppliedfrom the pia mater. In a case of coma after convulsions hehad noticed the same colour as the surrounding fundus inthe optic disc. In an undoubted case of meningitis he hadseen there was the perineuritis that M. Bouchut haddescribed.- Dr. CHARLES WEST doubted whether the observa-tions of Bouchut were of much scientific value. The oph-thalmoscope might corroborate a diagnosis, but it seldominitiated one. Most of the cases that Dr. Day had broughtforward were probably examples of congestion rather thanmere irritability. Pure and simple meningitis in the childwas of very rare occurrence. Tubercular deposit,s mightgive rise to various symptoms, and when inflammationsupervened the clinical source suddenly altered its character,vomiting being a notable symptom.-Dr. SANSOM spokechiefly of the peripheral causes of cerebral irritation. Inhis experience, hypermetropia, and myopia more rarely, wereoften a cause of cerebral symptoms, simulating irritation. Ina case which was first looked on as dyspepsia Dr. Sansomdiscovered optic neuritis, and gave a grave prognosis.Vomiting supervened later on, and opisthotonos developed.A sarcoma of the cerebellum was discovered. Althoughneuritis existed, there was sometimes no defect of vision.

Dr. WHIPHAM read notes of a case of Sudden Pneumo-thorax. The patient was a man aged twenty-one, whocaught a severe cold. He was admitted into hospital onDec. 10th, 1885. The condition began on Dec. 4th with aviolent pain at the lower part of the right side. There wereamphoric sounds over the right side; the vocal fremituswas fairly distinct, although most of the other signs ofpneumothorax were present. On Dec. 14th the patient wasso well that he was put on ordinary diet. On Dec. 23rd theair had become so far absorbed that the liver was at itsnormal level. In the middle of January the man was dis-charged well. A few other cases had been recorded, alto-gether eight in number. Five occurred in individualsunder the age of thirty- seven. Dr. Thorburn’s and Dr. GeorgeJohnson’s cases occurred in lungs in which there was noobvious previons disease, and it was suggested that adhesionsof the pleura had undergone alterations allowing of rupture.In Dr. S. Mackenzie’s patient, aged fifty-seven, there wasemphysema. Vogel believed that latent tubercular. cavitiesmight be the cause of sudden pneumothorax. In cases ofthe kind under consideration absolute rest seemed to be allthat was necessary for perfect recovery. Active interferencewould be but seldom necessary, only when dyspnoea or

cardiac distress seemed to call for it.-Dr. S. WEST hadrecorded a somewhat similar case in the Clinical Transa-tions, and had collected twenty-four such cases. The

comparative absence of symptoms in Dr. Whipham’s case

642

was remarkable, for in healthy individuals the symptomsat the onset were very severe. Most of the patients wereunder the age of thirty. He thought it was very doubtfulwhether in the majority of cases there was not a gross lesion.In experimental pneumothorax of animals it was difficult tomaintain the affection, as the air was rapidly absorbed.

HARVEIAN SOCIETY.

Compound Fracture of the Patella.-Sprained Joints.A MEETING of this Society was held on Thursday,

March 18th, J. Hughlings Jackson, M.D., F.R.S., President,in the chair.Mr. G. R. TURNER read a paper on Compound Fracture of

the Patella. The patient, a fireman, aged thirty-two, wasadmitted into the Seamen’s Hospital on June 1st, 1885, witha compound transverse fracture of the patella. The cavityof the joint was open through a contused wound, two inchesand a half in width, from which blood was exuding, thepatellar fragments being separated by about half an inch toan inch. Thorough cleansing under antiseptic precautions,the limb being fixed on a straight posterior splint, with thewound left open, constituted the first treatment. A blood-clot subsequently was found to be projecting between thefragments, but it was not disturbed. At the end of thesixth week a small sequestrum came away from the lowerfragment. The man made an excellent recovery, and was dis-charged in October with power to flex the knee nearly to aright angle, the fragments being then separated by aboutone inch and a quarter, and by three quarters of an inchwhen the limb was extended. In his comments upon thecase, the author referred to the slight separation of thefragments in cases of compound fracture, possibly dueto the escape of fluid from the joint; to the asepticcourse of the case, notwithstanding partial necrosis; andto the question of treatment, in which he gave the pre-ference to the expectant plan as opposed to wiring.The paper was concluded by a detailed summary ofnineteen cases of this injury at present on record.-Dr. WALFORD described a case of compound fracture of thepatella, in which, with partial antiseptic treatment, recoveryhad taken place in four months.-Mr. Picic commented onthe influence of antiseptic treatment in lessening the gravityof the injury, and related the details of a remarkable caseunder his own care, ending in synostosis of the joint. Hebelieved in very thorough cleansing of the wound, theedges being left open to admit of any putrescible matterbeing kept antiseptic. The separation of the fragmentsdepended upon the amount of fluid effusion, but it wasmuch more marked in cases where the capsule was torn.-Mr. GANT pointed out that in one case complete success hadbeen obtained without antiseptics, although he had nodoubt as to their value. He should never employ wiring incases of simple fracture, the less severe treatment beingquite as successful in its ultimate results, but he woulduse it in every case of compound fracture where the jointwas once opened. Any great effusion, either of serum orblood, should be drawn off. In ordinary fractures he hadused gutta-percha pads, drawn together by Malgaigne’shooks, with success. Where all the bones were injured byany form of destruction or partial anchylosis, he shouldprefer excision of the joint.-Mr. J. H. MORGAN referred toMr. Pick’s case, and observed that in the presence of much ieffusion union was assisted by the removal of the fluid. Insuch a case he should prefer to suture the fragments.-Mr.FiTZROY BENHAM suggested that the limb should be keptflexed at an angle of 10°, believing that no action of thequadriceps extensor was liable to take place in that posi-tion.-Mr. TURNER, in reply, commented on the extremerarity of compound fracture of the patella. He had foundone case of suppuration in simple fracture.Mr. EDMUND OwErr read a paper on Sprained Joints, in

which he urged that a sprained joint should be dealt withon the same principles as those which guide the surgeon inhis dealings with a fracture at or near the articulation. Headvocated rest and compressicn for the joint, and main-tained that if only the parts be at once enclosed within aplaster-of-Paris casing, with even compression, effusion willbe prevented and pain allaypd. He employed Croft’s methodof applying the gypsum splints, and urged its adoption inpreference to lotions, ice-bags, simple bandaging, and

strapping. He instanced various illustrative cases.-Mr.

GANT would recognise two classes of sprains: those inwhich the tendons were affected, and those in which theligaments only were injured. He related a case in whichthe extensor tendons had been torn by the foot beingdoubled under the leg. Passive movement should beemployed early, even though pain was caused thereby.-Mr.ElALLMARK advocated the use of American plaster appliedat once, instead of evaporating lotions. He would allowpassive movement as soon as it was possible without causingpain.-Mr. Picx thought it difficult to decide when to beginpassive motion, but he should generally begin early andpersevere, using evaporating lotions at first. He referred tothe use of very hot water in recent sprains on the stage.- -Mr. VASEY mentioned the successful use of clay mouldapplied at once round a sprained joint.-Mr. OWEN, in reply,observed that he would be guided by the heat or coldnessof the joint, and not by pain, in deciding when to com-mence passive motion.

EPIDEMIOLOGICAL SOCIETY.

Cholera in Fleets and Ships.AT the meeting of this Society held on Wednesday,

March 10th, Dr. Dickson, President, in the chair, a paper wasread by Sir WILLIAM SMART on Cholera in Fleets and Ships.The author pointed out that one of the earliest Englishobservers of cholera was Mr. Curtis, of H.M.S. Seakorse, andof the Naval Hospital at Madras, in 1782, who called thedisease the "cramps," and the same name was used by Mr.Girdlestone, surgeon of the 101st Regiment, which regimentlanded at Madras that year, and was at once attacked bycholera of the most intense type, the cramps being the mostprominent symptom. At that time Dr. Paisley, the headof the E.I.C. Medical Staff at Madras, considered the diseaseto be the same as that which prevailed epidemicallyin Londonin 1669-70, which bore the name of " cholera morbus," appliedto it by Dr. Sydenham at the time; of which, in contrastingit with ordinary summer cholera, he states: " It differs fromthat as far as the poles are asunder." To Dr. Paisley theapplication of the name to the Asiatic disease appears tohave been due. After Curtis, who published in 1807, wehave no naval authority on cholera, although it must havebeen seen by surgeons of ships in the East Indies. In 1833it was among our ships at Lisbon, when the Spaniardsdenied its presence in Spain ; it also was seen in the WestIndies. In 1837, when epidemic at Malta, some ships wereinfected. In 1850 the squadron at Malta was severelyattacked throughout the summer, and three times it ap-peared from infection received in the harbour, but fromall the ships the disease disappeared when they were takento sea. In 1854 it broke out in the fleets in the Black Seaand the Baltic. In the former the infection was broughtfrom France, and it ravaged five ships, especially theBritannia, of which Sir William Smart gave the history indetail. He mentioned the length of exposure in some ships,twenty having cholera from the third to the seventeenth dayafter entering the infected port. The fleet went to sea,and in three of the line-of-battle ships there were violentoutbursts at sea. That in the Britannia was the worst, and shereturned to port on the fifth day, having lost 50 men in thefirst twenty-four hours of the outburst, and 93 out of 201attacked in five days. She was cleared out and smoked, afterwhich the disease ceased in her. Eighty-five men were trans-ferred to the Apollo, of whom 26 died. The nurses sent withthe sick were attacked, and some died, but the crew of thefrigate were not at all infected by their visitors being elevendays on board. The Baltic fleet was infected with variolaon leaving England, and that was followed by fever; butthree months had elapsed when cholera appeared in theGulf of Finland. With cholera on board, the combined fleet,English and French, went up the Gulf to Cronstadt, where theinfection became worse; then it went to the mouth of the Gulf,and it had nearly disappeared when the French army arrivedfrom Brest, bringing among the troops fresh infection toattack the sailors and marines who had landed to besiegeBomarsund, and thence took it to their ships. The Frenchtroops and ships suffered much more than the English. OnSept. 17th the French ships left for home, taking theirtroops, but the English did not leave the Baltic till Dec. 7th.In that fleet there were no severe outbreaks as in theBlack Sea fleet. and the disease was more of the diarrhoealtype. In the Black Sea there were 655 attacks of cholera