WEST LONDON MEDICO-CHIRURGICAL SOCIETY

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WEST LONDON MEDICO-CHIRURGICALSOCIETY.

Exhibition of Cases.A CLINICAL MEETING of this society was held on June 4th,

Mr. W. BRUCE CLARKE, President, being in the chair.Dr. HENRY SUTHERLAND showed (1) a case of Epilepsy,

the disease having commenced after a miscarriage at thefifth month ; and (2) a girl, aged nine years, with con-

genital absence of the iris.Mr. McADAM ECCLES showed (1) a woman, aged forty-

eight years, with Symmetrical Nodules of a Fibrous Natureon the posterior aspects of both ulnae ; she was affected withchronic rheumatoid arthritis ; and (2) a man, aged seventy-five years, with a Rodent UlcEr of the Left Axilla. Therewas extensive superficial ulceration, with rolled edges, sero-sanious discharge, and slight induration. A microscopicsection of the ulcer showed the usual appearance of rodentulcer.

Dr. H. P. POTTER showed a man, aged fifty-nine years,with Scurvy due to privation. He had extravasations on thedorsum of each foot, in the calf of one leg, ecchymosisand purpura of the legs and arms, spongy and bleedinggums, with marked fcetor of the breath. Under a liberaldiet, including potatoes, he was recovering.

Mr. L. A. BIDWELL showed (1) a woman, aged fifty-oneyears, with a Swelling connected with the Left Wrist andanother on the outer side of the Right Elbow ; they wereprobably of a tuberculous nature ; ( 2) a man, aged thirty-four years, with a Primary Sore affecting the Right Cheek ;and (3) a girl, aged seventeen years, who had had a Swellingjust above the Hyoid Bone for ten months. This swellinghad gradually increased to the size of a hazel nut.

Dr. BURRELL showed two cases of Mucoderma.Dr. SEYMOUR TAYLOR showed a man, aged fifty years,

who had had an Injury to his Head twelve weeks ago, whenhe was admitted to hospital in a comatose condition,with hsemonhage from the right ear. He now has facialpalsy, loss of taste in the right side of the tongue, and paresisof the right side of the soft palate ; there was no deafness.The diagnosis was fracture of the petrous bone or haemorrhageinto the aqueduct of Fallopius.

EDINBURGH MEDICO-CHIRURGICALSOCIETY.

Exhibition of Cases and Specimens.A MEETING of this society was held on June 2nd, the

President, Dr. ARGYLL ROBERTSON, being in the chair.Mr. CATHCART showed a woman on whom he had success-

fully operated for Perforation of a Gastric Ulcer. He hadseen the case seven hours after the onset of the symptomsand agreed with the patient’s medical attendant that theywere due to the condition indicated. At the operation itwas found that the peritoneum generally was not affected.The perforation was found on the posterior wall near thelesser curvature. It was closed by folding in the edges andstitching the opposed surfaces together. He washed out thelesser peritoneal sac. The patient made an excellentrecovery and was in better health than she had experiencedfor years.Dr. STEWART STIRLING showed a child with Psoriasis in

whom the distribution was unusual.Dr. NORMAN WALKER showed a girl with Scleroderma of

the Upper Arm, which had improved under the internaladministration of thyroid extract combined with baths andmassage.Mr. MILES showed a specimen of Hydrocele of the Cord

obtained as the testicle had to be removed for strumousdisease. He also showed the bones from a case of Middle-ear Disease in which death was due to septic meningitis,notwithstanding free opening and other measures. The caseclinically presented several of the characters of cerebralabscess.

Dr. ALEXANDER BRUCE made a communication on theEndogenous Fibres of the Lumbo-sacral Region of the Cord.These fibres occupy a small area on the posterior aspect ofthe cord at the side of the posterior fissure, and anotherarea anterior to the postero-median column. These twoareas were unaffected in locomotor ataxy, but were de-generated below the seat of lesion when the cord was

destroyed transversely. He believed that the fibres in thesetracts contained fibres derived from the posterior horns andunited different levels of the cord. He held that the fibreshad a downward course in the cord. The communicationwas illustrated by an admirable lantern demonstration andby sections shown under microscopes.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF SURGERY.

Distension of the Bladder with Air in Supra-pubic Cystotomy.—Pyloroplasty.—Fracture of the Metacarpal Bone of theThumb.A MEETING of this section was held on May 14th, Mr.

WiLLiAM THOMSON, President, being in the chair.Mr. JOHN LENTAIGNE exhibited an apparatus for distending

the bladder with air in the operation of supra-pubiccystotomy. It consisted of an indiarubber air-pump withreservoir of the same material, similar to that used withthe ordinary hand spray. This was attached by meansof a rubber tube to a silver catheter, which was introducedinto the bladder. In using the apparatus the reservoir wasfirst distended with air, which was then allowed to graduallydistend the bladder, and the operation was then performed.If it became necessary to force the bladder forward in thewound pressure was made on the reservoir outside. Mr.Lentaigne had used this apparatus in a recent case, inwhich he had closed the bladder wound with catgut sutures,and the entire wound had healed by first intention.

Mr. LENTAIGNE also exhibited a patient on whom hehad performed the operation of Pyloroplasty on Feb. 26th lastfor fibrous stricture of the pylorus with great dilatation of thestomach. The healing of the wound had been uneventful,and the patient, who was now apparently in perfect health,had gained over 2st. in weight.-Mr. MYLES said that if theoperation of pyloroplasty took two hours in the hands of askilful operator it compared very unfavourably with the

operation of gastro-duodenostomy, which could be done inabout twenty-five minutes. The results of the latter operation were also very favourable.

Professor E. H. BENNETT gave some further particulars inrelation to the Fracture of the Base of the Metacarpal Boneof the Thumb in addition to those which he published in1881 and in 1886. Continued observation has fully establishedthis injury as the commonest metacarpal fracture. Photo-

graphs taken with the x rays confirm the view he hadpublished as to the path of the fracture passingobliquely through the base without implication of thedorsal surface of the bone,-Mr. SWAN said thatmany surgeons had considered the injury to be a dislocation;it was not until he read Professor Bennett’s communicationin the Dublin Quarterly Journal of 1881 that he understoodthe nature of the injury.-Sir WILLIAM STOKES said thatthey owed the description of the injury to Professor Bennett,who had received very full recognition by eminent writers,not only at home, but in France and Germany, for havinggiven the best description of the injury.

Reviews and Notices of Books.A Short Practice of Midwifery, embodying the Treatment

adopted in the Rotunda Hospital, Dublin. By HENRYJELLETT, B.A., M.D., B.Ch., B.A.O. Dublin University,L,R.C.P. Irel., L.M., Assistant Master, Rotunda Hospital.With a Preface by W. J. SMYLY, M.D., F.R.C,P.Irel., lateMaster of the Rotunda Hospital. With 45 Illustrationsand an Appendix containing the Statistics of the Hospitalfor the last Seven Years. London: J. & A. Churchill.1897. Price 6s.

DR. JELLETT has written this little book partly at therequest of several of his pupils, and partly as an expositionof the principles that govern the practice at the RotundaHospital. There is an interesting introductory preface byDr. Smyly, who indicates some of the main points in whichthat practice differs from what is generally taught else-

where, and he expresses his responsibility for them.