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ureters were dilated, and the kidney was destroyed. If bydilatation of the urethra the growth could be detected andremoved before it became multiple, it would be great gain;for in their earlier stages these growths are often single.-Mr. HILL, in reply, thought it would be interesting to learnthe sequel of Dr. Carter’s case. Mr. Cripps’ statement wasnot in accordance with other observers, who believe vessel-formation to be the first stage. All are not vascular, how-ever, very few vessels occurring in the present case. Reply-ing to Mr. Morris, he pointed out that the symptoms ofvesical irritation do not always precede the development ofhydronephrosis; for in a case under his care last summer,where a villous growth had led to dilatation of the ureterand disorganisation of the kidney, bladder symptoms onlyappeared a few days before death.The Snnietv then a.dionr)ied.

CLINICAL SOCIETY OF LONDON.

Talipes Euiao-varus.-Myxcedema.THE ordinary meeting of the Clinical Society of London

was held on Friday, December 9th, Professor Lister, F.R.S.,in the chair. The question of the cases of talipes suitable forexcision of the tarsal arch was raised by Mr. Bennett. Adiscussion on Myxoedema was adjourned to the next meet-ing. The President nominated Mr. Pearce Gould and Mr.Walsham as auditors of the Society’s accounts.Mr. W. H. BENNETT exhibited a man, aged forty-seven, who

had been the subject of severe Talipes Equino-varus, and onwhom he had performed excision of the tarsal arch. He hadpreviously been treated by tenotomy, but with only temporarysuccess. There was wasting and shortening of the left limb,the heel was much raised and the sole twisted directly in-wards ; the man hore his whole weight on the outer borderof the foot. No alteration in the shape of the foot could bemade by any force applied. On June, 30th, 1881, a flapwas raised from the dorsum of the foot, and the bonechiselled away in fragments until the anterior part of thesole could be placed in a perfectly flat position ; the tendoAchillis was divided, the wound united, a drainage-tubeinserted, an antiseptic dressing applied, and the limbplaced on a splint with a foot piece. By July 8th the wholewound had healed except a small sinus. The antisepticdressing was now discontinued on account of severe carbolicirritation of the skin, and a few days later erysipelasattacked the wound, which had to be opened up. Theunion of the bones all broke down. By September 8th thewound was again healed. November 3rd he was allowed towalk with a boot and iron supports. The foot is now alittle shortened, the sole nearly flat, the heel a trifle in-verted ; the union of the bones is firm but not bony ; thegait is better than before the operation, and is improving.Mr. Bennett thought the case successful, and that it demon-strated the value of the operation in cettain cases where thedeformity from long duration could not be remedied byother measures. The operation is a serious one, and

ought not to be performed unless absolutely necessary.Perhaps fibrous union at the usual seat of a joint waspreferable to bony union of the divided bones. -Mr.DAVY was glad to see that opinion was coming roundas to the value of this operation. He had operated onseventeen feet in fourteen patients. The more he fol.lowed it out the more successful he had been. He thoughtit was to be reckoned as a resection of a joint rather than ofthe tarsal arch. The more he confined his attention to thetransverse tarsal joint the better his results. He showedtwo casts of a case of extreme talipes equinus, before andafter operation, in which he removed a part of the os calcis,astragalus, cuboid, and scaphoid. After recovery the boywas a perfect plantigrade, with a freely movable ankle-joint.In opening the tarsal joint a square piece of skin correspond-ing to the base of the wedge should be removed, then a

counter-opening made on the inner side, and a wide triangu.lar director passed across from the outer side to raise up theskin and tendons ; with a fine saw an accurate wedge oibone should then be removed. He had treated all his caseswithout antiseptics and without any dressing of any kindwhatever. Of the seventeen cases he had lost one. Mr.Bennett’s case is the oldest on record. All the childreroperated on had been previously treated by surgeons foimany years. Many of his cases had at once been able tcearn their living; the majority had recovered with bon3

union, but firm fibrous union would answer well. He hadnot had any case of relapse. - Mr. MARSH asked ifMr. Davy could show some of his cases. He thoughtthe cases ought to be examined some time after treatment.Mr. Bennett’s case was not unattended with danger, and behad seen one case where life was seriously imperilled. Hethought the foot must be stiff or " wooden" after this operation. and he considered that the cases should be carefullyexamined. He suggested that a sub-committee should beappointed for this purpose.-Mr. HAWARD said the imme-diate result of Mr. Bennett’s case was admirable. But thisoperation ought to be one of extremely limited use; tobe practised only in incurable and extreme cases. Hewas surprised to hear how many children Mr. Davy hadoperated on. He had seen very few children in whom thesimpler treatment failed. Many cases of relapse after

tenotomy are due to neglect of the latter half ofthe proper treatment. The tendons are divided, thefoot replaced in position, and then the treatmentends ; but if the manipulative treatment is carried outthere are very few cases needing this operation. The fewcases of adults with talipes are suitable for it, but he shouldbe sorry to see it done in children.-Mr. LISTER thoughtMr. Bennett’s case was a good one for the operation, andsuccessful, but the operation, he thought, was not called for inchildren. If Mr. Davy adopted antiseptic measures hisresults would not be thought remarkable, but quite ordinary.When the carbolic acid caused irritation in Mr. Bennett’scase he should have substituted eucalyptus gauze or iodo-form dressing for the carbolic gauze, as they are both of themthoroughly trustworthy antiseptics. Occasionally, but veryrarely, erysipelas occurs under strict antiseptic dressing;in King’s College Hospital he had seen one case only.But he had had four cases where there was a septic con.dition, which could not be corrected, and one of them died.Using antiseptic means he should undertake this operationwith perfect confidence, but should regard it as an unneces.sary mutilation in a child.-Mr. BENNETT had never seenany case but the one he presented in which he should con-sider this operation justifiable. When the carbolic irritationoccurred all antiseptic dressing was discontinued for somehours, but afterwards he used carbolic injections and gauze;to this relaxation he attributed the attack of erysipelas. Hethought it was doubtful if Mr. Davy would have lost hispatient from septicsemia if he had used antiseptics.Mr. J. R. LUNN read an account of the two cases of

Myxoedema he had shown at the previous meeting.-Casel.A man aged forty-seven, with a good family history. Move-ments of locomotion slow ; skin dry, harsh, and translucent,does not perspire, does not pit on pressure ; face puffy, noseflattened, lips thickened ; teeth fairly good, breath offensive;speaks slowly, with a nasal intonation. Hair on head andpubes thin, none in axillae. No changes seen in fundus ofeye. Pulse 80, small and weak; respiration 18. Noalteration in sensation, taste good. Urine sp. gr. 1015,34 to 38 oz. per day, contains a trace of albumen occa-

sionally, passes about 194 grs. of urea in twenty-fourhours. Is drowsy, and has had delusions lately.-Case 2. A woman aged forty-five, mother of eight children,has had five miscarriages. No history of gout, syphilis, in-temperance, or fright; looks like a cretin, is very drowsy,often has horrid dreams, but is free from delusions. Move.ments are slow; hands are puffy, harsh, and dry; she neverperspires ; alae nasi thickened ; she always feels cold.Temperature 950 to 97 ’4°; pulse 76; respiration 18. Hair thin;taste normal; hearing not good ; slight hyperesthesia ofskin generally to a prick of pin. Catamenia ceased in 1880;no disease of uterus. Urine sp. gr. 1020, distinct trace ofalbumen at times, 6 ’78 grs. of urea to the ounce.

Dr. CAVAFY showed and read notes of two cases ofMyxcedema. Case 1 was a woman, aged fifty-nine, married,who had had six healthy children and four miscarriages;catamenia ceased at forty-five. She had good health tilleight years ago, when she suffered from dyspepsia, which hascome on at intervals since. Five years ago she had a severemental shock, after which she gradually became very weak’ and low-spirited, walking with difficulty, and the charac-

teristic swelling of the disease slowly supervened, but wasnot sufficiently marked to attract attention until two yearsago. On admission to hospital there was moderate tense

swelling of the cheeks, nose, and lips, with a bright patch of, dilated capillaries on the cheeks, the skin of the face being

waxy. The hair was scanty, eyebrows raised, scanty, andeyelashes largely wanting; hands broadly swollen, covered

1045

with dull-red, dry and rough skin ; the rest of the skin wasdry and harsh. Her expression was dull nnd listless, andspeech slow and nasal; the gait slow and awkward; commonsensation blunted, special sensation unaffected, intelligencegood. Urine free from albumen, and scanty ; no visceraldisease. Temperature always subnormal, averaging 96’5°; 1pulse about 48. While in hospital she had had two attacksof dyspepsia and diarrhoea lasting a week and three days re-spectively, and was discharged feeling rather stronger, butwith no appreciable change in her condition. Case 2 was amarried woman, aged thirty-three, who had had five childrenin eleven years, three having died in infancy. Five yearsago, after the birth of one of her children, she began to feelvery weak and her eyelids swelled. In a year the swellingbecame general, her speech slow, and all her movementsvery awkward, so that she sometimes fell. On admissionthe face was much swollen, upper eyelids especially pearlyand semi-transparent, nose very broad, and the lips muchthickened; the hands were large, clumsy, red and rough, feetand ankles swollen, and the whole skin dry and rough. The

expression was placid, speech slow, but the intelligence andspecial senses were unaffected. Her movements were slowand awkward, common sensation rather dull, and she feltconstantly chilly. Urine free from albumen, viscera healt.hy;pulse varied from 45 to 65, temperature averaged 97 6°. Sheremained a month in the hospital without change, but hassince become worse owing to grief at the loss of a child. Itseems probable that the oedema and nervous symptoms areboth due to a common cause in the central nervous system,as the former predominated in the second case and the latterin the first case. This view is supported by the slow pulseand subnormal temperature, which was greatest in the secondcase, in which there was most cedema. The acute dyspepticattacks in Case 1 somewhat resembled the gastric crises inlocomotor ataxia.

Dr. W. M. ORD showed a man with Myxcedema, a

London railway clerk, aged forty-two. Nearly three yearsago he had a convulsive fit; since then he had been quitechanged in character. His face swelled, his speech wasaffected, progression became slow, and he now shows all thesigns of myxoedema. His skin is swollen, nose broad, lipsthickened, brightlimitedflushoJlt the cheeks; the hands and feetare not swollen, and he uses his hands very well in writing ;his speech is more slovenly than usual in these cases.

Generally these patients complete what they want to do orsay, but this man does not complete his words. There isalso some loss of power in the right side of the mouth;many teeth are lost, especially on the left side; therehas been a great falling off of hair, and what remainsis dry, scanty, and dull. There is a distinct loss of powerin the lower limbs. The temperature, even in the mouth, islow-95-go to 974°. Urine is of low specific gravity-1008 ;no albumen or sugar ; it gives a very red colour with nitricacid. There is distinct accentuation of second sound at thebase of the heart. The arteries are very hard and resis-tant. He is very lethargic, irritable, and suspicious. Thesuperficial and deep reflexes are quite unaltered. SinceJuly he has become thinner. He is peculiar in failingto show deformity of hand and foot, and he showssome little tendency to bulbar paralysis. Dr. Ord badseen one case of myxoedema, with marked signs of bulbarparalysis; this patient ultimately died of asphyxia.—Dr.MAHOMED read a communication, in which he suggestedthat this disease was an unusual manifestation of chronicBright’s disease. His paper will appear in THE LANCET olnext week.As the hour for closing had arrived, the discussion was

then adjourned till the next meeting.

OPHTHALMOLOGICAL SOCIETY OF THEUNITED KINGDOM.

Retinal Periarteritis. - Tumou.r of Laerytnal Glançl.-Cystic 1’,ttmoui- of Eyelid. - Retinitis Pzg7rzentosa.-Titiiiott2, at Sclero’co2-)zeal Junction.-Gla’llcoma.-OpticNeuritis in Chorea. - sequel to a Case of CerebralZ’2crrco2c°.-AxiaL llreurztis Ù Sp1:nal Disease.-UnilateralHemiopia -in Spinal Atrop7aJ.-PcolIctlaalmie Goitre.The ordinary meeting of this Society was held on Thursday,

Dec. 8th, W. Bowman, F.R.S., President, in the chair. Therewas a large attendance of members, and several interestingpapers were read and living specimens shown.

Dr. MULES of Manchester showed a case of GeneralRetinal PeriaTteritis in one Eye. The patient was a man,aged fifty-nine, suffering from chronic albuminuria andvalvular disease of the heart. The arteries of the retinawere all transformed into snow-white cylinders, capable ofbeing traced to their third divisions. The exudation so nearlyobliterated the red colour of the vessel that only the mostminute inspection enabled one to determine the existence of ablood current here and there in the form of fine red dots. Ex-tensive haemorrhages wera present in the retina. Visionwas reduced to perception of light in the affected eye. Thesight of the other eye was reduced.-Dr. BRAILEY consideredit a case of renal disease with thickening of the arteries,which he had shown always occurred in the common whitepatches.-Dr. GOWERS, on the other hand, contended that,closely as the two states might correspond mircroscopically,yet, as their ophthalmoscopic appearances were so different,they could not be the same. He had figured a conditionclosely like that described by Dr. Mules in his "MedicalOphthalmoscopy," but the change did not extend so far

along the vessels, nor so uniformly.Mr. MASON (Bath) showed a woman, aged thirty, who two

years and a half ago noticed a white speck near the innercanthus of the right eye. In March, 1881, the growth wasthe size of a split pea, implicating equally the cornea andconjunctiva, slightly elevated, smooth, of apale cream colour,and very slightly vascular. It is steadily increasing in size,and is becoming more vascular. Vision is normal; the otherstructures of the eye are healthy.-Mr. BOWMAN thoughtit a very remarkable case, something like the more commoncongenital tumours. It appeared to be under the conjunc-tiva. He should advise that the growth be shaved off. Heonce treated a closely similar tumour, in which, after otherfutile attempts to stop its growth, he succeeded by incisingto a slight extent the cornea immediately in advance ofthe edge of the tumour.Mr. R. J. PYE-SMITII (Sheffield) sent notes of a case of

Acute Glaucoma followino, Concussion, cured by Eserine.On the fifth day after a fall downstairs, the left eyeof a lady, aged seventy, became acutely glaucomatous :(+ T. 2), vision reduced to counting fingers, cornea

steamy, pupil dilated, coloured rings observed round a

candle. The use of eserine discs entirely relieved all thesymptoms within twelve hours. Very slight and transientrelapses occurred for a year at intervals of not more than amonth. They were always dispelled by the use of an eserinedisc, and latterly became less and less frequent till theyseem to have finally ceased three months ago. The eye isnow normal, and can read "brilliant" type (Jaeger I) withthe reading-glasses that have been used for several years.-Dr. BUZZARD related the facts of a case seen by him withMr. Goulden. A lady aged sixty-four had suffered for eightweeks from severe frontal neuralgic pain in both eyes,especially the left. He found great increase of tension inthe globes, intense photophobia, pupils moderately dilatedand immovable to light. A leech was applied to eachtemple in both eyes, and by Mr. Lawson’s advice eserinediscs were used two or three times a day. She rapidly re-covered, and has had no relapse during twelve months.-Mr. BOWMAN thought this evidence of the value of eserinein some cases of glaucoma very important, as it seemed toindicate that it might be used in place of an operation. InMr. Pye-Smith’s case, which was probably traumatic inorigin, as the eserine subdued the primary attack, it waseasy to understand its producing a permanent cure. In theother case, however, this was not so easy to understand.-Dr. C. E. FITZGERALD mentioned a case of acute glaucoma ina woman who, when first seen, could only count fingers, whowas treated by eserine, and the vision was rapidly restored.The treatment was equally successful in subsequent re-

lapses.-Dr. BRAILEY thought these cases supported theview that glaucoma is hypersecretive; but in chronic glau-coma there is also diminished outflow of fluid. He suggestedthat eserine acted advantageously by causing powerful con-tractionof the ciliary body, and especiallyof thecircular fibres,which pulled upon and so opened out the ligamentum pectina-tum.-Mr. A. CRITCHETT had recently had under his care aman with chronic glaucoma who was treated persistently witheserine and his vision steadily got worse.-Dr. ANDREW(Shrewsbury) had seen great good from the use of eserinein eyes showing early signs of sympathetic irritation; insuch cases at the same time as he excised the bad eye, orwhen this operation was delayed, he used eserine to the"sound eye." Where the iris was at all hazy he recom-