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case of old-standing inflammatory disease of the knee-joint, ofa more severe character, and to which he did not consider thesame treatment applicable. In this instance he has employedthe actual cautery in the vicinity of the joint. The first appli-cation was of decided benefit, and was followed by considerablealleviation of pain; the second, however, has been less success-ful. The case is still under treatment.

There is a little girl at the present time in the hospital witha penetrating wound of the right knee-joint, which has healedup, inflammation being subdued by constant irrigation, bymeans of cold water dripping from a wet rag over the joint.

NEURALGIA AND OTHER DISEASES OF BONE.

ON the llth December, three cases of diseases of the boneswere submitted to operative relief at St. Bartholomew’s Hos-pital by VTr. Stanley. The first was an instance of severeneuralgia of the internal cuneiform bone of the left foot of ayoung man, which had resisted all treatment for twenty-twomonths. There was no external indication of actual disease ;but Mr. Stanley cut down upon the bone, and with a verysmall trephine came upon its interior, which contained a dropor two of pus, that had become pent up, and had softened the.osseous structure around. If all circumstances prove favour-able, a cure is now anticipated.A boy was then given chloroform, who had been an inmate of

the hospital since September of last year, being admitted atthat period with a compound fracture of the right femur, anda general bruising of the whole of the left leg and thigh, theresult of being caught between the spokes of a wheel. The leftknee-joint inflamed, suppurated, and was opened to give exitto several ounces of pus. All traces of disease have subsided,but the joint remains stiff. There was a piece of loose bone-at the seat of fracture in the right thigh, which had beenbroken in two places. This kept up constant irritation, withpurulent secretion and the formation of fistulous openings. Anincision was made with some precaution, as the femoral artery;i’an across the seat of fracture, and a somewhat oval exfoliationwas removed from the end of one of the pieces of broken bone.Another portion was felt to be loose, but its detachment wasleft for another opportunity.The third case was one of extensive swelling of the foot and

ankle of a child, the result of disease of the astragalus ; and- when the parts were laid open, ulceration of the calcaneo- ’,

.astragaloid articulation was discovered, but more particularlyimplicating the astragalus itself, as Mr. Stanley had antici-,pated. The affected portions were gouged away, and the woundfilled with lint.We are happy to state that Mr. Skey’s patient, whose foot

.an effort was made to preserve, (see "Records" of Dec. 4th), isgoing on well.

RECTANGULAR FLAPS.

THE stump, resulting from the rectangular form of ampu-tation recently resorted to at St. George’s Hospital, and whichwe noticed in our " Clinical Records" of the 4th inst., hasturned out as well as was expected. The patient, however,--had a slight attack of pyaemia, from which he has recovered.The same kind of flap operation of Mr. Teale, of Leeds, wasperformed by Mr. Holthouse, at the Westminster Hospital, onthe 30th of November, upon a girl of eighteen years of age.The right thigh was amputated at its lower third, for old--standing and extensive disease of the knee-joint, implicatingthe soft structures, especially above the articulation, and runningup the back of the thigh. The skin all around was red, withsinuses above, at the side, and below the joint, presenting aworm-eaten appearance. The cartilages, moreover, were de-stroyed, and the bones diseased. Silver sutures were used,and the stump has already healed, with a little suppurationaround the ligatures only on the arterial vessels, although buta week has elapsed since the operation was performed. Thispatient is doing very well, and will probably make a good re-covery, notwithstanding there is a strong phthisical tendency.

There is much to be said in favour of Mr. Teale’s mode ofamputating limbs, and we have no doubt it will receive a fairtrial at the hands of our hospital surgeons. The last operationperformed in this manner which we had the opportunity ofwitnessing was at St. Bartholomew’s Hospital, on the Ilthinst., when Mr. Lawrence amputated the thigh of a man fordisease of the knee-joint. The flaps were not brought intoapposition until after the patient was removed to his ward.

TREATMENT OF ERYSIPELAS OF THE LIMBSBY ELEVATION.

WE have noticed a very useful plan of treatment for erysi-pelas of the extremities adopted by Mr. Mitchell Henry atthe Middlesex Hospital, which is worthy of a fair trial else-where. It consists in elevating the affected leg or arm in avertical direction, above the horizontal plane of the body. Thiscauses a subsidence of the swelling associated with the disease,and completely removes the pain; the circulation in the veinsis accelerated towards the heart, and the hitherto inflamed andred skin assumes a pallid aspect. All these good results wewitnessed, on the 3rd of December, in a very severe case oferysipelas attacking the left leg of an elderly man, who suf-fered most severely from acute pain consequent on the swellingof the limb from the inflammation. In twelve hours both thepain and the swelling had entirely disappeared under this verysimple mode of treatment. The same good effects had also ensuedin a case of erysipelas of the elbow in a boy who was pointedout to us. The limbs, especially the inferior, may be supportedon pillows, but it is more suitable to elevate them by the handor the foot by means of a cord attached to the framework ofthe patient’s bed.

Medical Societies.MEDICAL SOCIETY OF LONDON.

MONDAY, DEC. 6TH, 1858.DR. WILLSHIRE, PRESIDENT, IN THE CHAIR.

DR. MURPHY brought before the Society a remarkable case ofMollities Ossium, in which it was necessary to perform the

C2ESARIAN SECTION.

The following are the particulars :-Mrs. N-, aged thirty,had been married about sixteen years, and had given birthto seven children, all born at the full time, without anydifficulty in the labour. Three or four months previous tothe birth of her last child (May 29th, 1856,) she complainedof constant weariness and dull aching pain in the lower partof the back and down the thighs, slightly increased on walk-ing. She continued to go about, however, up to within atthour or two of that confinement. Dr. Frazer, of Torrington-square, her medical attendant, had not seen her for severaldays before, but, calling in accidentally, found her inlabour, and just about to send for him. The labour was quitenatural, and terminated in less than two hours. Her subse-quent recovery was slow, but at the end of three weeks Dr.Frazer ceased to attend her. She was then able to go about,

but complained of weakness and slight pain, or rather uneasi-ness, in the loins and thighs. Dr. Frazer did not see her

again professionally until July, 1858, two months previous toher last confinement. She had never lost the sense of weari-ness in the loins and thighs since the birth of her last child,but in October, 1857, when she again became pregnant, thepain and difficulty in walking gradually increased. She wasable to go to chapel Jan. lst, 1858, but afterwards was unableto leave the house. Dr. Frazer was engaged to attend her inApril of the present year, and found her sitting at her work-table in the parlour. She had then only complained of sick-ness of the stomach, which was relieved by appropriate re-medies. Each time Dr. Frazer saw her, she was dressed andsitting in her chair, and after his fourth visit he ceased to attendher until sent for on July 10th, when the pains of labour, whichbegan on the 8th, assumed a decided character. Being engagedat the time, his partner, Dr. Andrews, saw her, who, on makingan examination, was surprised at the extreme narrowness ofthe outlet of the pelvis. Dr. Frazer saw her in the afternoon,and observed the same peculiarity. The pains were feeble, andthe patient somewhat exhausted. An anodyne was ordered,in the hope that, if sleep were procured, more vigorous painswould advance the presentation. On July llth, Dr. Frazer,finding no alteration, requested the assistance of Dr. Murphy,who saw the patient about two P.M., and, having made an ex-amination, found it impossible to introduce two fingers betweenthe pubic rami; by pressing back, however, against the coccyx,and using the left hand, he was able to get two fingers withinthe brim of the pelvis, bending them upwards and forwards, toavoid the strongly-projecting promontory of the sacrum. Thepubic bones were doubled back so much that the space in the

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brim seemed hardly two inches in the antero-posterior measure- Iment. On the left side it was diminished to half an inch, onthe right it was open to about two inches and a half. Passingthe finger round the brim, the space seemed to be hardly largerthan a florin, through which protruded the os uteri and mem-branes : the head could just be touched. The nature of thedifficulty being thus revealed, Dr. Murphy felt satisfied that itwas totally impossible to attempt perforation; in fact, no in-strument could be used for that purpose. The patient, how-ever, had no pains for some hours previously, and he wasanxious to ascertain what the uterus might do if it were pos-sible to get the head within reach of instruments. It was

agreed, therefore, to see her at five P.M. There was no changein the action of the uterus.-Nine P.M.: The pains had re-turned for a short time, but made no difference in the position.An anodyne was ordered, and she was left in the charge of Dr.Andrews for the night.

July 12th.-She slept a good deal during the night; thepains returned in the morning, and continued stronger thanbefore. Dr. Murphy saw her at twelve o’clock. The mem-branes were ruptured, the funis had descended and ceased topulsate; there was no alteration in the pelvis. The necessityfor the Caesarian section was decided. Dr. Murphy wished tohave Dr. West’s opinion, who made a most careful examination,and arrived at the same conclusion. She was at once takeninto University College Hospital, and placed in a ward pre-pared for the purpose. Being placed under the influence ofchloroform, Mr. Quain, who kindly rendered his assistance,performed the operation. An incision was made in the line ofthe linea alba, the uterus exposed, and its parietes divided.The placenta protruded, was immediately extracted, and thechild removed. The haemorrhage, which was considerable, wascontrolled by the contraction of the uterus. The intestines,which had slightly protruded, were replaced, the edges of thewound united by the hare-lip suture, and a space left belowfor the escape of the discharges. She was bandaged, placed inbed, and twenty-five minims of Battley’s sedative given inbeef-tea.

July 13th.-The patient slept at intervals during the night;pulse 120; tongue dry; skin hot, but moist. Towards eveningshe complained of sickness and pain in her bowels, and sufferedgreat thirst; she had taken five minims of black drops everysecond hour during the day. At night the pain and sicknesswere relieved, but symptoms of exhaustion were setting in;pulse 160, rapid and feeble; is restless, and not inclined to sleep;this increased during the night so as to amount to jactitation,with hiccup and blowing respiration.

14th. -Exhaustion extreme; pulse scarcely felt. She diedat twelve o’clock.

15th.-Twenty-four hours after death the post-mortem exa-mination was made. The abdomen was much distended andresonant; no attempt at union in the line of the incision. On

opening the abdomen a quantity of bloody serum escaped; theintestines were distended with flatus, especially the stomach,which occupied the whole upper part of the abdomen; somelymph was found on the peritoneum. The uterus presented adark-red surface, its divided edges being widely separated.When the stomach was laid open, and the flatus escaped, someundigested currants and a small quantity of feculent matterwere found in it. The head and lungs were healthy. Thepelvis was found to be brittle throughout; all the articulationsloose, and even the pubic and ischiatic portions of the coxalbones moved on each other, much more, however, on the leftthan the right side; both iliac bones were much distorted andvery carious, being perforated in several places, and as thin astissue paper. The horizontal rami of the pubis were parallel,the pectineal eminence on the left almost touching the promon-tory of the sacrum; the space, by measurement, was half aninch, but the bones were very easily pressed together; the de-scending rami were also closed in, the left being carious andeaten through at the pubic and ischiatic junction; the aceta-.bula were also eaten through, and the head of the femur wasin a similar condition. The brittleness of the bones was suchthat a plaster-of-Paris cast could not be made of it. There wasno observable difference in the stature of the patient. Thechild’s head was well ossified.

Dr. Murphy regretted the delay in the performance of thisoperation, and quoted from Mauriceau, Hamilton, Hull, andothers, several cases to prove the evil consequences of delayand hesitation in such instances; in some, the patients died un-delivered ; in others, the operation failed because performed toolate. In mollities ossium he was aware that the chances were

greatly against the patient’s recovery, not only because of thedifficulty of reunion in the uterine wound-because of the pro-

cess of disintegration in its tissues then going forwards, as Dr.West has well pointed out; but also because the existing dis-ease is one of disintegration. Nevertheless, he argued that thesafety of the patient is not more secured by any other opera-tion ; that in some cases, as the present one, craniotomy is im-possible; in others, when performed, death has been the result.As an illustration of his argument, he quoted from Dr. R. Lee’s"Clinical Midwifery" the only case of mollities ossium thatcame under Dr. Lee’s notice, in which craniotomy was withgreat difficulty performed, and the uterus was ruptured. Insuch cases, therefore, where the risk to the mother is equallygreat whatever operation be performed, Dr. Murphy laid itdown as a principle, that no practitioner is justified in takingaway human life, even from an unborn child, unless he is nearlycertain that it will be the means of saving the parent, and incases where the mortality from craniotomy is as great as fromthe Caesarian section, he is bound to adopt the operation thatmay save the child.A discussion ensued, in which several gentlemen took part.

PATHOLOGICAL SOCIETY OF LONDON.DR. WATSON, PRESIDENT.

DR. WILKs exhibited a specimen ofCONGENITAL DISEASE OF THE HEART.

It came from a girl, eighteen years of age, who died of phthisis,under Dr. Wilks’s care, in Guy’s Hospital. She was said t@have been in good health until a few weeks before admission,when the pulmonary symptoms commenced, and she had beenable to follow her occupation as a domestic servant. She was,however, of small stature, and her skin was livid, but this wasattributed to the extensive disease in the lungs. Her pul-monary disease was of the most acute kind, and attended byhigh febrile symptoms. The most interesting feature in thecase was the existence of a systolic bruit heard over the valves,and which, from its character and position, was believed to besituated in the pulmonary artery. It was thought, however,that as phthisis co-existed, the murmur might have arisen fromobstruction in the pulmonary branches, contracted by tuber-cular disease. After death the cause was found to exist at themouth of the pulmonary artery, the valves being replaced by,or rather having united into, a funnel-shaped membrane, butin which traces of the union of the valves could still be seen.The aortic valves were only two in number, and at the bottomof one of them a slight partition could be perceived. The fora-men ovale was widely open; the right ventricle was thicker thanthe left, and the organ bore a strong resemblance to a foetalheart. The point of interest in the case was in its affording astriking example of a foetal disease having been the prime causeof the alteration of the valves, it being clear that the normalvalves had existed up to a certain period.

Dr. WILKS also related a case of

CONGENITAL CONTRACTION OF THE AORTA.

This occurred in the same place as in other recorded case, im-mediately below the left subclavian artery, and close to the-ductus arteriosus, and the circulation to the lower parts hadbeen carried on mainly by the mammary and epigastric arteries.The main interest in the case was the fact that other abnormalconditions existed, as only two aortic valves, with a pouch inthe weak spot of the heart, and the mitral valve was almostdeficient in its muscular columns, the tendinous cords beingattached all around the auriculo-ventricular opening. Thespecimen came from a well-developed young man, twenty-twoyears of age, who died, under the care of Dr. Rees, in Guy’sHospital. having been ill with cardiac symptoms only a fewweeks before his death, having previously enjoyed good health,and been able to serve in the militia.

Mr. SYDNEY JONES presentedA SPECIMEN OF COMMUNICATION BETWEEN THE SIGMOID

FLEXURE AND BLADDER, THE RESULT OF ULCERATIONOF A FALSE DIVERTICULUM.

It was taken from a gentleman, aged sixty-four. About thecommencement of last January, the patient first began to passfaeces in the urine ; notice being directed to it by the passagethrough the urethra of straw-like bodies. These were ex-amined microscopically. and a diagnosis was come to that there

was a communication between the bowel and bladder. Thepatient continued to pass faeces in his urine till his death, which