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which they presented. They were all accompanied by feverand rigors. The disease might be called " herpes im-petiginiformis" from the appearance of the crusts. Therewas no restriction to the course of certain nerves as in an

ordinary zoster. Finally, it was a most dangerous disease.

Medical Societies.ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

TUESDAY, MARCH 12TH, 1872.T. B. CURLING, F.R.S., PRESIDENT, IN THE CHAIR.

ACCOUNT OF A CASE OF RESECTION OF THE SHOULDER ANDELBOW JOINTS IN THE SAME ARM, FOR GUNSHOT INJURIES.

BY WM. MAC CORMAC, F.R.C.S.,ASSISTANT-SURGEON TO ST. THOMAS’S HOSPITAL.

THIS paper detailed the history of a French soldier whohad been wounded at the battle of Sedan. The right arm,in the region of the shoulder and elbow joints, was exten-sively injured, the soft parts being much lacerated and thebones extensively comminuted by a shell explosion. Thequestion arose whether it was at all possible to save thelimb. Rather, however, than perform disarticulation at theshoulder-joint, Mr. Mac Cormac determined to excise boththe shoulder and elbow joints-an operation hitherto, hebelieved, unique. The patient narrowly escaped death frompyaemia, but he afterwards made a satisfactory recovery; iand the interest of the case centres in the amount of useful-

I

ness subsequently enjoyed by the limb. Some portions ofnecrosed humerus have yet to come away, and in the deltoidregion a sinus still remains. The elbow is soundly healed,and regeneration of the excised bones has taken place. Theoperation was performed subperiosteally; and in the after-treatment the limb was supported on carefully adjustedcushions-a method Mr. Mac Cormac prefers in most casesto the employment of splints. The shoulder can now, afteran interval of eighteen months, be moved freely backwardsand forwards, but not raised from the side, the deltoidmuscle having been almost completely destroyed by theoriginal injury. Flexion, extension, and rotation are veryperfect in the elbow, and the usefulness of the hand isnearly as good as before. Four inches of the upper end ofthe humerus, very greatly comminuted, were removed; anda long piece of ulna, in addition to the head of the radiusand the articulating condyloid surface of the humerus,was taken away. Mr. Mac Cormac considers that he mayfairly classify this case as one of successful double resectionof the two principal joints in the same upper extremity.The PRESIDENT remarked that the case was probably

unique, and as such very interesting.Mr. CROFT thought that splints were worse than useless

in cases of resection in the upper extremity; had alwaysused sand-bags with very good effect; and asked the authorwhat special means were adopted to keep the limb quiet.Mr. TIMOTHY HoLnzES thought that all excisions might

be treated without splints; but he preferred in elbow casesto use a very light splint, which really did no harm, andwas specially adapted for children. He quoted a case inwhich no splints were used, a result being that the ends ofthe bone eventually projected from the wound. He askedfor Mr. Mac Cormac’s experiences as to subperiosteal ope-rations ; believed that the amount of bone saved was oftenhurtful rather than beneficial; instanced a case in point;and remarked that in successful excisions of the head of thehumerus the arm can always be moved some way from thetrunk, though the want of power in this case may havebeen caused by the great amount of injury done to the del-toid muscle.Mr. JOHN WOOD had discarded splints for some time;

and, ten days after the operation, commenced and con-tinued to alter the position of the limb once every twenty-four hours, believing that with careful and frequent mani-pulation a very fair olecranon may be produced. He pre-sumed that the question of splints or no splints entirelydepended upon whether a movable or an anchylosed jointwas required.Mr. SPENCER WELLS quoted a case that had occurred to

a continental surgeon at Metz, in which a subperiosteal

section of the entire humerus was successfully made. Hebelieved that in active service splints were necessary, andthat plaster-of-Paris bandages answered exceedingly well.Mr. TnOMAS SMITH failed to comprehend how splints could

be safely or properly dispensed with, and averred that withchildren they were absolutely necessary.Mr. MAUNDER thought that the question of splints wholly

depended upon the sort of joint desired. He rarely usedsplints at all for the elbow, except in cases of children, andthen only during the first week, but always applied themin knee cases, though he considered it an open question inexcisions of the hip.Mr. CALLENDER was surprised that no reference had been

made to the very capital anterior splint used in America,and asked Mr. MacCormac why no effort was made to savethe limb in its entirety.

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A VisiTOR (an American surgeon) said that the bent wiresplint was much used in the United States, and believedthat, in subperiosteal operations, mischief was sometimescaused by the subsequent growth of awkward spiculee,which might, and indeed sometimes did, endanger arteries.Mr. SAVORY commented sarcastically on the varied ex-

periences and the various facts that had been enunci-ated in the course of the discussion. Believing it to bean axiom in surgery that repose was necessary to repair, hewas surprised to hear surgeons advocating a "perpetualmotion" style of practice with reference to excised joints.He also took exception to the title of the paper, inasmuchas about four inches of the humerus and a large mass ofthe ulna were removed by the operation.Mr. MAC CORMAC, in replying, answered this last objection

by remarking that the fragments alluded to were detached,lying in the wound bathed in pus; so that there was nooption as to their removal. And with respect to an observa-tion by Mr. Callender, Mr. Mac Cormac pointed out thatexcision of the joint was the recognised method of treat-ment for gunshot injuries of the shoulder, and that it wasattended by a far smaller proportionate rate of mortalitythan was conservative treatment-thirty-five per cent., ascompared with fifty-two per cent. according to Billroth’stables.

ON THE SURGICAL TREATMENT OF SUPPURATING OVARIAN

CYSTS, AND ON PELVIC ADHESIONS IN OVARIOTOMY.BY T. HOLMES, F.R.C.S.,

SURGEON TO ST. GEORGE’S HOSPITAL.

A case was related in which chronic suppuration occurredin an ovarian tumour, after paracentesis had been performedfor the first time. Ovariotomy was postponed for somemonths on account of the patient’s condition. When it wasperformed the cyst was found extensively adherent in otherdirections, and so tightly wedged into the pelvis that it wasimpossible to reach its pedicle. It contained about a gallonand a half of fluid, of which about half was pure pus. Theremains of the emptied cyst were dragged out of the abdo-men, a clamp was applied to its neck (at a distance abovethe pedicle which could not be accurately ascertained), andthe wound was closed. The patient recovered, and after herrecovery no sinus was left, nor was any tumour to be felt.The symptoms of acute and chronic suppuration in ovariancysts were discussed, and it was attempted to be shown thatif the general condition admits of it the suspicion of suppu-ration is a reason for performing the operation instead ofdelaying it. The case was also used to show that, in someinstances, the results of ovariotomy may be perfectlyfavourable, though pelvic adhesions have prevented thecomplete delivery of the tumour. If the neck of the cystadmits of being embraced in a clamp, the lower portion ofit may be obliterated during the healing of the wound.The superiority of this method, when feasible, to the othercourses which may be pursued in dealing with pelvic ad-hesions, was shown.Mr. BRYANT remarked that the accurate diagnosis of a

suppurating ovarian cyst was most important; that wasting,a hot skin, a permanently high temperature, bad appetite,local pain and tenderness on pressure, all indicated sup-puration. If any doubt as to the diagnosis exists, he wouldbe still more induced to interfere quickly, to remove thecyst if possible, or to take away as much as could be re-moved. He quoted a case to show the desirability of not

leaving ligatures, and one also that showed the useful pecu-liarities of catgut.

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Mr. SPENCER WELLS thought that with care the diagnosisbetween a suppurating cyst and peritonitis could be ascer-tained without great difficulty. An elevated temperaturenight and morning, with or without increase of pain on pres-sure, were two positive signs of the presence of a suppurat-ing cyst. And if peritonitis exist operative procedure is stillmore decisively indicated. A very serious case under hiscare, in conjunction with Drs. Farre and Watson, in whichperitonitis occurred from the bursting of the cyst into theabdominal cavity, ultimately did well. He considered itundesirable to separate adhesions before tapping the cyst,that as much should be removed as possible, and that itwas a good plan to leave a drainage-tube in the wound afterthe operation, to give free exit to the suppurative dis-charges.Mr. HoLES, in replying, doubted if the diagnostic signs

spoken of by Mr. Wells were positive as well as negative,because in some cases high temperature exists without sup-puration, and in some cases of peritonitis the temperaturehas been persistently high.

PATHOLOGICAL SOCIETY OF LONDON.TUESDAY, MARCH 5TH, 1872.

MR. JOHN HILTON, F.R.S., PRESIDENT, IN THE CHAIR.

MR. MCCARTHY exhibited two interesting cases. Thefirst was a child with Congenital Hypertrophy of the Skincorresponding to branches of the sacral plexus : it was firstnoticed when the child was three weeks old, and is gettinglarger. The President said it had much the appearance ofichthyosis. The second case was a child about six yearsold with patches of Discoloured Skin on the legs and dorsumof the feet. Along the spine of the scapuloo were a numberof small nodulated growths, such as Dr. Addison spoke ofin bronzing of skin.A report from the Morbid Growths Committee on Dr.

Gowers’ case of enlarged liver, &c., was read by Dr. Church.The growths in the liver and in the mammary and otherglands were of a like character, and described as medullarysarcoma. The disease commenced in the lumbar glands.Mr. CARR JACKSON showed a patient whose thigh he had

amputated at the hip-joint, after excision of the head of thefemur had failed. The patient, aged twenty, had been suf-fering from hip-joint disease for about five years. Twoyears ago the head of the femur was excised. He did wellfor a time, and could get about on crutches; then sinusesopened again, and it was thought better to amputate at thehip: this was done about two months ago. - Mr. Jacksonthen showed a child whose astragalus he had removed forcaries. Also an astragalus, removed by Mr. Shillitoe ofHitchin, from a bricklayer who had dislocated it in a fall.In reply to the President as to the condition of the ace-

tabulum in the first case, Mr. Jackson said he thought thedisease began in the ligamentum teres, and that the ace-tabulum was healthy. J

Dr. GREEN HOW exhibited a specimen of Softening of theLeft Anterior Cerebral Lobe, with plugging of the left an-terior cerebral artery and right middle cerebral artery; andread an interesting account of the case. The patient, awoman aged twenty-seven, had a succession of fits at thetime of her delivery, and was found to have right hemi-plegia ; the muscles of the face and tongue were involved;she was also aphasic. About two months afterwardsshe had another fit, and then she was found paralysed onthe left side. She died a few days after. In addition tothe lesions above-mentioned, the heart was much diseased,the aortic valves covered with vegetations, and the mitralorifice narrowed so as to admit only one finger.Mr. GAY showed the parts removed in three cases of

Excision of the Head of the Femur. Two were from boysabout six years old; one presented in a marked degree allthe recognised symptoms of hip-joint disease, the painespecially being severe; the other had so few symptomsthat for a time the character of the disease was doubted-pain was quite absent in whatever way the limb was moved.In the first case it was seen that the head of the bone washollowed out, and a sequestrum was lying in the cavity ;he thought the intense pain here was caused by the tension.The third case was that of a man aged thirty-two, from

3 whom part of the shaft as well as the head of the- bone was removed. Referring to Mr. Jackson’s case, he

said he had no objection to remove the head of the bone- when the acetabulum was diseased, as it was generally- secondarily affected.l Mr. T. SMITH thought acetabular disease was very;serious; and asked if Mr. Gay would remove the cariousbone or leave it., Mr. GAY said that the disease generally began in the; thigh-bone, and the other parts of the joint were diseased

secondarily ; when the primary cause of disease was re-; moved they would get well ; he would, however, scoopaway or remove dead bone, but not the parts only denudedof cartilage; all the cases he had so treated had done well.

Dr. PYE-SMITH exhibited a Malformed Hea,rt from a childfourteen weeks old. It had been cyanotic during life, but nomurmur could be heard over the heart. The great vesselswere transposed, the aorta arising from the right ventricle,the pulmonary artery from the left; the right ventricle wasdilated and much hypertrophied; the vense cavse andtricuspid valve were normal; the foramen ovale open, cribri-form ; the left side of the heart thin, and more like a normal

right side; the ductus arteriosus patent; the septum ven-triculorum complete. The coronary arteries arose from theaorta.

Dr. C. T. WILLIAMS showed a specimen of Ulceration ofthe Vermiform Appendix, causing local peritonitis.Mr. WAREN TAY showed a Tumour removed from the

inner side of the right arm of a child aged nine months.The growth appeared at the fourth month; it was soft,semi-fluctuating, and the skin not freely movable over it.Microscopically, it consisted of fibroid tissue, enclosing aquantity of fat-what Mr. Holmes describes as the con-genital innocent tumour of children.Mr. HAWARD showed a Fibroid Tumour of Testicle from

a patient aged eighty-one. The right testicle had graduallyenlarged; there was no pain, and it only gave inconvenienceby its weight and dragging on the cord; it was nodular,hard and elastic; cord not affected. No glands of the groinwere enlarged. The man died from sloughing of the scrotum.This was a very rare specimen. It arose from the tunicaalbuginea, and the secreting tissue was not affected. Micro-scopically, it was made up of fibroid tissue.Mr. HULKE asked if sections had been taken from several

parts of the tumour, and if any cartilage cells had beenfound.Mr. HAWARD said none could be found.Mr. ANDREW GLARK showed a number of organs-heart,

kidneys, a rib, &c.-affected with melanotic disease, se-condary to melanosis of the eye.Mr. T. SMITH showed a fine specimen of an Aneurism of

the Right Axillary Artery, for which the subclavian wasligatured. The patient, aged thirty-two, had noticed theswelling for about nine months. When seen it was the sizeof a lemon, freely expanding, and pulsating. The radialpulse was not affected. The back of the hand was aedema-tous, and the fingers were clubbed. The patient died ofpyasmia. Pressure had been attempted, but was obliged tobe given up; for though it controlled the supply of blood tothe tumour, yet the pain it gave could not be endured formore than a few seconds.

CLINICAL SOCIETY OF LONDON.

FRIDAY, MARCH 8TH, 1872.MR. COOPER FORSTER, VICE-PRESIDENT, IN THE CHAIR.

Dr. BUZZARD showed a case of Unilateral Face-Atrophy,dating from an attack of chorea. A female, aged twenty-five, applied to him at the National Hospital for Paralysison account of fits, epileptic in character, which had troubledher for eleven years. She had been attacked with choreawhen six years old, and again at thirteen; and, after thissecond attack, the right side of her face was observed togrow thin. The atrophy involved chiefly the frontal, malar,and inferior maxillary bones, together with the alar carti-lage, the buccinator, masseter, and, in a less degree, thetemporal muscles. The tongue was greatly wasted on thesame side, and the palate was also involved. Cutaneoussensibility was unaffected. She was liable to attacks of