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pressed bone found at its bottom ; there were no symptomsof compression. (2) A second wound, as before described,above the zygoma ; probing revealed dead bone at a depthof two inches from the surface. (3) Exophthalmos of lefteye and loss of vision in it, with redness of the conj unctiva ;the mental functions were heavy, owing to the constant i

headache on the injured side.On June 30th the temporal wound was enlarged, and a

piece of the greater wing of the sphenoid was removed witha sequestrum forceps. The piece was as large as a half-sovereign. The two wounds were then dressed with carbolicsolution (one in thirty).July 14th : After the removal of the dead bone the tume-

faction in the temporal region gladually subsided, theexophthalmos little by little diminished, and the parietalwound healed without exfoliation. At this date he had asudden attack of violent pain in the occipital region, andvomited freely and often. The pain and vomiting werechecked by the hypodermic use of morphia, and did not return.

Sept. llth: The temporal wound was now healed, andthe exophthalmos was much reduced. His general con-

dition was much improved, and he was discharged.Jan. 12th : He returned to get a medical certificate of the

case. The exophthalmos had quite disappeared, but theleft eye was turned towards the outer canthus. He still com-plained of slight headache, but his general health was good.

jgmfo’.—The interest of the case is the probable occur-Tence of limited fracture of the greater wing of the sphenoidfrom contrecoup. The patient was positive as to not havingreceived a blow on the temple, and it is difficult to see howit could have reached so deep-seated a bone without notice-able injuries of the external parts.CASE 2. Compound Fracture of the Lower Extremity of the

- SMmgrMs.—A child, aged nine years, fell from, a mule, andhurt his arm. He afterwards rode six hours without anydressing to the wound or splint for the fracture. There wasa wound above the internal condyle as large as a sixpence,from which protruded a sharp point of bone connected withthe cylinder of the humerus. The forearm was everted bythe action of the extensors and supinators. The internalcondyle was not broken, and the movements of the jointwere normal. A careful examination showed that the lineof fracture extended obliquely downward and outward froma point two-thirds of an inch above the inner condyle to themiddle of the external condyle. It will be remembered thatthe origin of the pronator radii teres and of the flexors is fromthe inner aspect of the lower fragment, while that of the two o supinators and the extensors is from the upper, and that the z,result must be supination with abduction. In a case ofsimple fracture of this kind, the treatment is easy, the limbbeing extended, and a padded splint placed along its inneraspect from the axilla to the wrist, and secured by a roller, or bystrips of adhesive plaster. The existence of the wound abovethe inner condyle made this mode of treatment more difficult.The following was the mode of adjustment resorted to. Apad was fitted to the exterior aspect of the arm (with theforearm bent at a right angle) extending from the middle ofthe deltoid muscle to the olecranon. A grooved splint wasplaced over the pad. A pad was now placed on the inneraspect of the arm from a point on a level with the upper endof the outer pad to a point half an inch above the wound.The arm was then bandaged to the splint with an ordinaryroller, and after the forearm had been encased in blanket,it was bandaged from the wrist up with a plaster- of-Parisbandage, which was likewise passed over the pad and splinton the arm ; and the forearm was suported in a sling. Theresult of this method of dressing was to draw the shaft of thehumerus towards the splint, while the lower part of thesplint pressed the external condyle inwards. There wasmoderate fever for a fortnight after the accident, and slightdischarge from the wound. After a month the splint wasremoved, and the bone found united. The movements ofthe elbow were fair. A week later there suddenly occurredconsiderable swelling about the joint, and high fever. Thejoint was poulticed, and after a fortnight a fluctuating swell-ing was observed over the external condyle. This was iincised, and about two ounces of laudable pus evacuated.No bone came out of this opening, which soon healed, leavingthe joint in good condition.At the date of this report, a year and a half from the time

of the accident, the motions of the joint are almost perfect;a slight impairment of flexion being caused by the callusalong the line of union. There seems to be a probability thateven this slight impediment will disappear in course of time. I

Medical Societies.PATHOLOGICAL SOCIETY OF LONDON.

Cecneer of Sigmoid ’Lexac°e. - Addisoa’s Disease.-Pul-’In,onary Embolism.-Rupture of Œsophagus.

THE ordinary meeting of this Society was held on Tuesdaylast, Dr. Wilks, President, in the chair. Several very in-

teresting specimens were shown, especially a dissection ofthe solar plexus in a case of Addison’s disease ; and a dis-cussion occurred as to whether sporadic cases of epidemiccerebro-spinal meningitis are met with in London practice.Mr. Hutchinson showed a remarkable case of bronchocelewhich had become ossified and then necrosed.

Dr. DiCKlNSON showed a specimen of Cancer of SigmoidFlexure. The patient, a woman, aged forty-nine, was broughtinto St. George’s Hospital with a large abdominal tumour onthe left side projecting 2!J- inches from the surface, reachingfrom the ribs to pelvis, and from the middle line to the loin ;it was tympanitic on percussion. The tumour was sharplyoutlined. It appeared to be a collection of gas outside theperitoneum. There was no history of bowel obstruction orulceration ; faeces liquid and fairly abundant. Shortly after-wards the tumour became red like a "pointing" abscess. Mr.Pick punctured it; fetid gas, and then a little faeces escaped.For some time a purulent and feculent discharge continued,then it got less, and the woman died. At the autopsy acavity was found in the cellular tissue outside the peritoneumleading to a cancerous stricture of the sigmoid flexure whichwas very narrow indeed. Such a complication of strictureof the intestine Dr. Dickinson thought to be very uncom-mon.-Mr. HARRISON CRIPPS asked if the other abdominalorgans had been examined, and if secondary growth had beenfound. The tumour looked like a simple adenoid growth, nottechnically a cancer; if so it was of the kind that might beremovable by the surgeon.-Dr. DiCKlNSON said that thetumour had not yet been examined microscopically. Hebelieved the other internal organs were free from secondarygrowths. To the naked eye the tumour when fresh waslike soft encephaloid.

Dr. DOUGLAS POWELL and Mr. SUTTON showed a Dis-section of the Nerves in a case of Addison’s Disease. Theman, aged twenty-two, had well-marked symptoms ofAddison’s disease. Six months before admission he had afebrile attack, with flying pains about the body. He wasconfined to the house for six weeks, and became veryemaciated. He was a laborious out-door porter. On ad-mission the look of the man was that of an emaciated manwith great prostration, answering questions slowly. Therewere several deerly pigmented moles on the neck. Thenipples were dark, and there were splashes of pigment overthe belly, and some of the spines of vertebra;. The handswere of a dead-white colour, and the ends of the fingers werelike those of a dead man. The pulse was very feeble, andat times almost disappeared altogether, and if he rose inbed he had attacks of syncope. He suffered much fromvomiting. Temperature low. Urine, sp. gr. 1030, acid.Mucous membranes not discoloured. Blistering fluid was

applied below one clavicle, and as soon as the blister healedthe characteristic pigmentation appeared very markedly.He gradually and steadily got worse. On March 7th thetemperature rose, and on March 11 the he died, with a drytongue and all the signs of exhaustion. For a day or twobefore death the odour of the body was cadaveric. At theautopsy the left lung showed consolidation, undergoingsoftening at the apex, and a smaller spot of tubercle at theright apex. Kidneys, liver, and spleen normal. Heart fiveounces and a half ; very small; friable. Aorta unusuallysmall. Supra-renal capsules were much enlarged, rough, andnodulated ; on section the cortex and medulla were indis-tinguishable, both infiltrated with a fibroid matter containingfatty and calcareous nodules. Some of the lymphatic glandsnear the capsule were enlarged. — Mr. SuTTON made acareful dissection of the nerves, and for comparison thoseof another healthy subject; those of the morbid specimenwere enlarged ; the nerves did not come out clearly; theirsheaths were thickened; the ganglia were enlarged andindurated. The dissection also showed two branches of Theleft vagus passing to the semilunar ganglion, as had beendescribed by Dr. Coupland and Dr. Habershun. This case

736

was one that agreed with many others which showed thatthe destruction of the capsules had little or nothing to dowith the symptoms of Addison’s disease. The changesfound in the capsules could hardly have been producedin eight months. The symptoms were caused by theextension of the disease to the neighbouring nerves.

The supra-renal capsules were proportionately very large inthe foetus, as was shown by another dissection of Mr.Sutton’s. Microscopical examination did not show any markedchange in the ganglia.-Dr. WILKS said the nerves did notseem to be implicated in mass, but the diseased processtravelled back along the fine branches. It was a case towardsthe solution of a vexed question. At the last discussion thegeneral opinion seemed to be opposed to the view that thesymptoms were due to the nerves being involved.Mr. STANLEY BOYD showed a specimen of Embolism of

Pulmonary Artery. The patient was a woman who hadsustained fracture of the metatarsal bones of the right footand severe bruising of the right leg and thigh. Thrombosisof the femoral vein ensued, and a little later .she somewhatsuddenly became cyanosed, and her breathing became ex-ceedingly rapid, though not difficult. There was no pulseat the wrist; she died in ten minutes. At the post-mortemthe right pleura contained two ounces of bloody fluid, butthe lungs were normal; in the right side of the heart was analmost completely decolorised clot, which extended to thebifurcation of the pulmonary artery. Beyond this a firm clot,having no connexion with the walls, was found; the left pul-monary artery was plugged as far as its second bifurcation.The clots in the various branches all ended abruptly. Therewas an appearance of an embolus in the clot in the left artery;on section of this supposed embolus, it was found to befirm, verydark in the centre, with a pale, faintly laminated periphery,Mr. STANLEY BOYD also showed two specimens of Itap-

ture of the (Esophagus. The first patient, a young womanaged eighteen, was admitted into University College Hospitalunder Mr. Heath, in a moribund condition ; the most markedsymptom was vomiting of the most severe kind ; there wasno dyspnoea, and no subcutaneous emphysema. At thepost-mortem about two ounces of bloody fluid, free from anytrace of food, was found in the left pleura ; this had appar-ently been extravasated through a rent in the left side of theoesophagus and its investing pleura. This rent was 5 centi-metres long ; its edges were well defined and not ragged ;themucous membrane had been destroyed for a short distancei.i parts, and the pleura over this part of the oesophagus hadquite disappeared, but was still smooth and glistening in theimmediate neighbourhood. The gastric mucous membraneshowed the recognised signs of self-digestion. The supra-renal bodies were much enlarged, and on section werefirm and of a yellow colour. Microscopic examinationshowed a dense, very small round-celled growth, containingmany granular protoplasmic masses with marginal nuclei.Dr. Sidney Coupland, who had seen the specimens, agreedwith Mr. Boyd in considering the change to be tubercular.Inquiries that Mr. Boyd had made proved pretty con-

clusively that the girl had been suffering from Addison’sdisease for about seven months at least before her death.Mr. Bond believed that the rupture of the oesophagus hadoccurred during life, founding this opinion on the form ofthe rupture-a long tear, not a circular or irregular aperture-on the character of the fluid found in the pleura, and on theabsence of much evidence of post-mortem digestion.Zenken and Ziemssen had described sudden pain, cessationof vomiting, emphysema, collapse, and suppression ofurine as the symptoms of rupture of the oesophagus,and as the-e were not present he concluded thatthe rupture must have occurred shortly before death.-Mr. STANLEY BOYD then related a case of Rupture of the(Esophagus, in which the oesophagus had ruptured into theright pleura, and exhibited the specimen. The patient wasau infant, aged four months, who had been exceedingly illfor some weeks before death, owing to an attack of erysipelassucceeded by peritonitis, which had followed an operationfor strangulated undescended testicle. About two hoursbefore death, dyspnceasliddeiily set in and lasted for an hour.After the d spnoea passed off the child was able to take foodin small quantities ; but while the dyspricea lasted the childchoked when given brandy and milk. At the post-mortemabout one ouuce of clear, deeply blood-stained fluid, freefrom lymph, or any trace of milk, was found in the rightpleura; both lungs were partially collapsed, the lower andmiddle lobes on the right side were very red, and were studdedwith petechie, and at the root there was a considerable

subpleural haemorrhage ; the pleura was absent from the ceso-phagus over the whole of its right side, below the root of thelung, and its torn edge could be easily seen near the dia-phragm. Pressure on the oesophagus caused a bubble of air toescape through a small opening in its wall; on the inneraspect of the gullet several small blood-clots were found nearthe hole referred to; this measured abouttwomillimetres, andfor a short distance above and below it the circular muscularfibres were exposed. Mr. Boyd considered that the clots in thegullet, the bloody fluid in the pleura, the marked redness andnumerous petecbiae on the surface of the lung proved that theperforation took place during life, and that possibly it had beenthe cause of the dyspncea which set in a few hours before death.- Mr. BuTLIN could scarcely think that the first case was anante-mortem rupture of the oesophagus, and he suggestedthat it should be examined by the Morbid Growths’ Com-mittee. He asked if any blood was found in the pleura orstomach, or had been vomited.-Mr. BOYD said that fromtwo to three ounces of blood unmixed with food was foundin the left pleura. In answer to the President, he said thatmost of Ziemssen’s cases of spontaneous rupture of the ceso-phagus were taken from English literature; one was re-

corded in the Pathological Society’s Transactions. - Mr.MORRIS asked if any of the cases had any symptoms of dis-turbance of the vagus nerves.-Mr. BoyD said there was in-tense collapse in most cases ; one case lived eight days.-Dr. DOUGLAS PowELL said the first case was one of Addi-son’s disease, and it was a moot point whether the involv-ment of the branch of the vagus to the semilunar gangliondid not account for the vomiting. He thought it diflicultfor an oesophagus to rupture unless the nutrition of its coatswas previously interfered with.-Mr. WALSHAM mentionedthat there was a specimen of a rupture of the oesophagus in St.Bartholomew’s Hospital which was said to be spontaneous.

(To be concluded.)

CLINICAL SOCIETY OF LONDON.

Antiseptic Ligatqtres. -Spina Bifida.-Congenital IntestinalObstrzcction.-Primary Perichondritis of Larynx.

THE ordinary meeting of the Clinical Society was held onFriday, April 28th, Professor Lister, F.R.S., in the chair.Two living specimens were exhibited in the ante-room-oneof acne varioliformis by Dr. Stowers; the other a child withabsence of the right external auditorymeatusanda superfluousrudimentary auricle on the left side, by Mr. Morgan.

Dr. HECTOR C. CAMERON (Glasgow) read a paper onCases of Antiseptic Ligature of Arterial Trunks in their Con-tinuity, which included all in which he had performed suchan operation. The material used was antiseptic catgut (pre-pared by one or other of the methods suggested by Mr.Lister) of medium size, and tied in a reef knot with sufficient

tightness to ensure division of the internal and middle coatsof the vessel. Very accurate coaptation of the cutaneousmargins of the wounds was practised by stitches of carbolisedsilk and silkworm gut, with an occasional stitch of thicksilver wire for purposes of relaxation, where that seemed de-sirable. Free drainage was effected by means of india-rubberdrainage-tubes in all the cases except one, in which a num-ber of strands of carbolised catgut were employed. Theoperations, as well as the subsequent dressings, were con’ducted with rigid antiseptic precautions. Case 1: A labourer,aged thirty-eight, in good general health, was admittedinto the Royal Infirmary on July 17th, 1876, with a traumaticaneurism of the lower and inner part of the left arm of sixmonths’ duration. The brachial artery was tied in thefirst part of its course with carbolised catgut on July 20th.On July 30th the wound was healed, having furnishedthroughout only a slight sero-sanguineous discharge, andhaving been free from any pain or swelling. The patientwas readmitted to the wards the following winteron account of limited gangrene of one or two toes, fromwhich he also made a good recovery. His arm, he said,was as strong as ever. -Case 2 : An old soldier, aged forty-four, was admitted on July 14th, 1880, with a large poplitealaneurism, extending as high as the junction of the lowerwith the middle third of the thigh on its inner side. Amonth before he noticed a small pulsating tumour at theback of the knee, which he felt suddenly give way on July 8diwhile he was at work. The swelling at once greatly in-

I creased, while the pain became so severe as to make him