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tubercle of the tibia. The patella and semilunar cartilageswere left in situ. The wound was well washed with solutionof the perchloride of mercury and the stump dressed withiodoform and wood wool. Drainage was provided. Thechief events after operation were the formation of an abscessin front of the femur under the quadriceps tendon, necessi-tating incision and drainage on Jan. 26th, and of one or twosmaller abscesses higher in the thigh in February. ByMarch 15th nearly all the openings had healed, and a notableimprovement had taken place in the patient’s general con-dition on April 8th ; the stump was healed, ’with the excep-tion of one sinus at the back ; the semilunar cartilageswere drawn to the back of the condyles, and the cicatrix laybetween them. The patient was exhibited to show thenature of the stump left after amputation through the knee-joint by the method adopted.Mr. BIDWELL showed (for the President) a case of Injury

to the Lower End of the Humerus. A boy aged five, underthe care of the President at the Evelina Hospital, thirteenweeks ago had a fall on his hand, and is said to have dis-located his elbow. Splints were applied for a few days only,and after they were taken off the bad position returned.There was considerable deformity of the elbow, which wasonly slightly movable; extension not permitted; arm wastedand circumference of elbow increased by three-eighths of aninch. The distance between the condyles of the humeruswas increased by three-quarters of an inch. The outerhalf of the articular surface of the humerus was displacedsomewhat forwards and outwards. The union was complete.The ulna was in normal relation to the humerus. Theprobable injury consisted in a fall upon the radial side ofthe hand, pushing up the radius against the radial headof the humerus, and causing a fracture running from justabove the external condyle to the middle of the articularsurface. The treatment recommended was excision.Mr. BIDWELL also showed (for the President) a very typical

case of Rickets in a boy aged three years and a half, underthe care of the President. The head was much enlarged,with depression over its fontanelles, which never closed; theprominence of the occipital region, the stumpy appearance,the contracted chest, with well-marked beaded ribs; theelevation of the sternum, the prominence of the abdomen,with enlargement of both liver and spleen, the bowingforwards and outwards of the femora and tibise, withmarked lordosis, and genu varum, were all very charac-teristic. The enlargement of the wrists was also marked.The child had never walked. It had been improperly fed,but no family history of rickets or of syphilis was obtainable.Mr. CORNER introduced a series of cases illustrative of the

Antiseptic Power of Salol (salicylate of phenol) as a dressingfor wounds, after the part had been rendered aseptic by a1 in 20 solution of carbolic acid. He did not claim for itgreater power than iodoform, and probably other antiseptics,but it had advantage over some. It possesses a pleasantaromatic odour, can be used freely without fear of irritationor poisoning, is absorbent of moisture, which drying formsa hard but friable covering. It will prevent putrefaction; itwill not destroy it when once established. It has been usedin increasing frequency for several years at the PoplarHospital, and with excellent results, in compound fracturesand dislocations, also as a dressing in amputations, minorand major, and in compound comminuted and depressedfractures of the skull. The first case shown was a com-pound comminuted depressed fracture of the frontal bone,in which the bone was elevated and some spicules re-

moved. Afterwards the wound was washed with a solutionof carbolic acid (1 in 20), the opening filled with salol,and a drainage-tube inserted. The dressing was undis-turbed for fourteen days, remained sweet, and healed onthe twenty-sixth day. His temperature remained from thefirst under 100°. A second case treated in January, 1889,was a compound fracture of the olecranon, head of radius,aùd humerus, opening the elbow-joint, with considerabledamage to soft parts, the elbow having been crushed bythe passage of a railway engine over it. The olecranon wassplintered and drawn up, causing serious tension of skinand necessitating removal of both portions. The antiseptictreatment and dressing were the same as in the previous case,but required changing after four hours and again next day,in consequence of oozing through. The parts were thenleft untouched for thirty days. The temperature went upthe day after the injury, and remained about 101° for threedays, 100’ for two days, and then fell to normal. Two othercases were shown: one a crushed compound fractured

finger, dressed twenty-one days before, and not exposedsince, there having been neither pain nor elevation of tem-perature ; the other was a compound fracture of first phalanxof finger, only dressed at the time of the accident, and leftundisturbed for a month, when it was found perfectly healed.It was pointed out that this was the common experience insuch cases, and that even if gangrene followed the partsremained sweet.

Dr. G. A. CARPENTER showed: (1) Case of Retinitis Pig-mentosa ; (2) Drawing of Tubercle of Choroid, from a caseof general tuberculosis.

Dr. F. J. SMITH showed: (1) A case which had beendiagnosed by Dr. Hughlings Jackson as "Glioma of thePons"; (2) Case of Disseminated Sclerosis, to which wassuperadded some specific lesion of the cerebrum.

MIDLAND MEDICAL SOCIETY.

AT a meeting held on March 6th (Mr. Hugh Ker,F.R.C.S. Edin., President, in the chair) the following living.specimens were exhibited :—

Congenital Absence of FibuLæ.-Mr. WILLIAM THOMAS.exhibited a child aged four, in whom there was congenitalabsence of both fibula; and corresponding parts of feet--viz., the outer two metatarsal bones and phalanges. Thefeet were in a condition of rigid talipes valgus. He in-tended to divide the tendo Achillis, and by a speciallyconstructed apparatus to supply the function of the absentfibula.

Resection of portion of Tars2cs.-Mr. THOMAS also showeda boy on whom he had performed the operation of tar-

sectomy. The limb was put up at the time of the operation,and the dressings removed for the first time on March 4th,when it was found soundly healed.Hydrocephalus.-Dr. WELCH introduced three cases of

bydrocephalus, occurrirg in the same family.Haemophilia.-Mr. BARLING showed a patient, a male

aged thirty, the subject of hemophilia and haemarthrosis.About fifteen years ago the patient first suffered fromsudden swellings of his knee-joints, the swellings arisingwithout cause and recurring at intervals. The elbow-jointsand the right ankle also suffered in the same way, theeffusion being at times followed by blood-staining of thesuperficial tissues. Several times severe and dangeroushaemorrhage had followed from small wounds, and therehad also been hæmaturia, hoematen-iesis, and epistaxis.The patient’s father is alive, but his mother died ofphthisis ; one brother died, aged ten, from haemorrhage;a maternal uncle is also a "bleeder," and has suddenswellings of his joints ; a sister’s child bruises very easily.Ten years ago the patient had rheumatic fever, with endo-carditis, which produced an aortic murmur. The softtissues over both knees are thickened, especially on theleft side, and flexion in each is limited in each to an angleof about 35°. Both elbows are limited in their extension,but the right ankle moves freely. Dr. Wickham Leggehad described several joints deranged by haemorrhage inhaemophilia, in which thickenings and adhesions of the

synovial membranes and erosions of the cartilages werefound. In one of his cases there was also endocarditis, andit seemed probable that in these patients the marked jointchanges were produced by hæmorrhage in tissues whichwere very liable to react to slight irritation ; this was.

especially so in view of the fact that the microscopicchanges found were similar to those of chronic rheumaticarthritis.-Mr. HALL EDWARDS showed a boy who was thesubject of haemophilia.

Dr. SUCKLING read a paper on Syphilis of the NervousSystem.

-

The following are notes of the proceedings at the meetingon March 20th.

Sporadic Cretinism.-Dr. SUCKLÍNG showed a girl agedfour years suffering from sporadic cretinism. The childwas born in Birmingham, and had been well cared for, butthe mother had noticed that it was not right from birth, thevoice being very peculiar and the tongue protruding. Themother had a second child, which was all right, but it died.from convulsions following whooping-cough. The father ofthe child was said to have been a steady man, and to havedied from inflammation of the lungs. A half-brother of his.had an idiot child. The child’s paternal aunt was a con-firmed inebriate, and was under treatment for alcoholic

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paralysis. The child had exactly the appearance of myx-tedema, the skin of the face being pale and translucent,with oedema of the upper and lower eyelids, not pitting onpressure. The nose was broad and flattened; the lower liplarge, slightly cyanosed, and drooping. The tongue usuallyprojected from the mouth, being very large, with hyper-trophied papillae. The skin generally was very rough,especially that of the hands and feet, which were swollen,cold, and cyanosed. The child was stunted, measuringonly 26 in. in height (the proper height being about36 in.), and weighing 24 lb. The circumference of thehead was 1821 in. The forehead did not recede verymuch, and the occiput projected well, the vertex beingflattened. The teeth were all decayed, and the hair wascoarse and scanty. The fontanelles were closed. Thearms and legs were short, the body long, but the abdomenwas not much swollen. The child was of a very placid andtranquil disposition ; it could only utter a few words, andwas quite unable to stand. No trace of the thyroid glandcould be felt. The neck was short and thick, and therewere no fatty tumours in the posterior triangles. Thetemperature was subnormal. The urine could not becollected, but it was free from albumen. The child’s con-dition had not followed on any infantile disease, but hadbeen present from birth.Bemiplegia from Inherited Syphilis.-Dr. SUCKLING also

introduced a boy aged three, who had been under his carewhen three months old, suffering from snuflles and mucoustubercles around the anus and mouth. When two years of

age choroiditis disseminata and nystagmus were discovered.The child did well on iodide of potassium and hydrarg. c.creta. A few weeks ago the child complained of headache,and shortly afterwards became hemiplegic. The movementson the paralysed side were weak and tremulous. Thechoroiditis was still present to the same extent as whenfirst discovered.Eruption due to Brass-grinding.-Dr. CARTER showed a

boy suffering from a papular eruption. A large number ofthe workmen in the same foundry were affected in a similarway, and Dr. Carter, after a careful investigation, hadeome to the conclusion that it was due to the use of oil inthe process of brass-grinding.

Dr. PuRSLOow exhibited a man who was suffering fromSyphilis in an unusually severe form.Dr. MALINS showed a Dermoid Tumour of the Ovary

that he had recently successfully removed.Mr. JORDAN LLOYD exhibited a specimen of Enchondroma

of the Submaxillary Gland ; the bones from a case ofExcision of the Knee in which union had been perfect;Fibrous Bodies removed from the Prostate by the Supra-pubic Incision ; and a specimen of Subluxation of theAstragalus, for which he had recently performed amputation(this accident occurred twenty-six years ago, and the con-dition had not been recognised at the time).Mr. HUGH KER read notes on a case of Removal of the

Ovaries for Epilepsy, in which great benefit had followedthe operation.Dr. SIMON read a paper on the Treatment of Sciatica.

IPSWICH CLINICAL SOCIETY.

THE first meeting of this Society was held in the Board-:room of the East Suffolk Hospital, Ipswich, on Wednesday,April 10th. An inaugural address was given by the President, after which the following cases illustrative of Spinal Disease were read-viz., a case of Spinal Myelitisfollowing Pott’s Disease, by Dr. Casley; a case of SpinalMeningitis, by Mr. Hetherington ; and a case of SyphiliticSclerosis of the Spinal Cord, by Dr. Hollis. Dr. Goodhartthen read an interesting paper on the Use of Ice in theTreatment of Pneumonia, illustrated by numerous tempe-rature charts. The paper was much appreciated and wasfollowed by a good discussion.

HOUSING OF THE POOR.-In connexion with theExhibition an International Congress on the Housing ofthe Poor will be held at Paris on June 26th, 27th, and 28thnext. An influential committee of patronage is now beingformed. A fee of twenty francs entitles to membership,and members will be privileged to take part in themeetings and to receive copies of all publications issued bythe Congress.

Reviews and Notices of Books.Onderzock naar den aard en de oorzaak der Beri-beri, en de

Middelen om die Ziek;te te Bestrijden. (An Investiga-tion into the Nature and Origin of Beri-beri, and themeans,to be adoptedfor Counteracting the Disease.) By Drs. C. A.PEKELHARING and WINKLER. Utrecht: Kemink & Son.1888. Pp. 128 ; with 8 Plates (Dr. C. L. VAN DER BURG).

[FIRST NOTICE.]THIS work--the result of the investigations in the East

Indies of Professor Pekelharing and Dr. Winkler, of the

University of Utrecht-embraces all that is known at thepresent moment of this endemic affection. The intro-duction gives a short account of their residence in the

colony, and their method and means of working, while itpays a tribute of gratitude to the medical profession locatedthere for the valuable aid rendered them in many ways.After a short disputation as to the meaning and derivationoftheword"beri-beri" (Malay, "biribi" =abrupt and trippinggait; Hindustani, "bharbari"=swelling; and the Japanese"kakke," from the Chinese "kiaku-ki" =disease of the

legs), and a short historical sketch of the discovery andappreciation of its symptoms from the earliest times, theyproceed to deal with the clinical observations in extenso.First, then, comes the important statement, that "beri-berihas no dependence on anaemia for its symptoms." Since 1882,when Scheube1 published his investigations, the majority ofmedical men resident in Japan, China, Lower India, theMalayan Archipelago, Borneo, Java, Mauritius, &c., havecome to regard beri-beri as the result rather of a multipleneuritis than of a spanæmic or anaemic state. On page 86it is stated that " almost universally also has this affectionbeen regarded among medical residents as a disorder ofinfectious origin." While on page 12 we find that Scheubeand Baelz,2 among others, gave it as their opinion, "withoutexamining the blood microscopically," but purely fromclinical data, that anaemia was neither a constant noran important factor. The chemical investigations of

Schneider,s moreover, have shown that the number of

blood-corpuscles may be increased as well diminished in thisaffection. Scheube also denies that any weight can beattached to the formation of crenate corpuscles, and thediminished tendency to the formation of rouleaux. Hence itis that we find in the various descriptions of the

malady the contradictory statements as to the presence andinfluence of anaemia : some writers averring that a healthyappearance, with an occasional and slight tendencyto anaemia, marks the disease ; while others regard an acuteanaemia as one of the most constant symptoms. The con-siderations as to the initial stage of beri-beri (pp. 13-19) areof great importance. Drs. Pekelharing and Winkler are thefirst who make any mention thereof, who give a detailedaccount of its symptoms, and who furnish the reason whythis has been overlooked by previous observers. This initial

period is characterised " by a quantitative alteration, evi-denced by a diminution in the susceptibility to the electricinfluence, usually for both species of current; frequently, too,by a qualitative change in the electrical reaction of thosemuscles which determine the flexion of the foot...... in addi-tion there is an increase in the diameter of the circumferen-tial measurement of the calf of the leg." This increase isillustrated by a series of sketches. It is difficult to estimatethe utility of this discovery too highly, from a scientificstandpoint, since by it many obscure symptoms of this affec-tion can now be explained, as well as from a practical one,since the symptoms of this period can neither be feigned norconcealed. There will therefore no longer be any fear of

1 Beitr. zur Geschichte der Kak-ke, 1881 ; and Die Japanische Kak-ke,1882. 2 Infectionskrankheiten in Japan, 1882.

3 Prager Vierteljahrschr. für Pract. Heilkunde.