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tenotome the cyst was cautiously exposed, and pushed for-ward into the wound. The dissection was continued withthe narrow knife and the handle of the tenotome, eachbloodvessel being ligatured as it came into view, and a fewsmall ones were twisted. When all the vessels were tied,the cyst was finally enucleated, and when the bleeding wascompletely stopped, the wound was brought together withsome wire sutures, and dressed with salicylic dressings,which were continued until the wound healed. The patientwas dismissed on August 14th.

EXCISION OF NECK OF FEMUR.

There is at present in the hospital a case of excision ofthe neck of the femur in a child for old-standing necrosisassociated with abscess over the trochanter, which had beenrepeatedly aspirated. The child is up to the present doingwell. The operation was done according to Lister’s anti-septic method.

Medical Societies.ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

THE ordinary meeting of this Society was held on the13th inst., Dr. Charles West, President, in the chair. An ela-borate paper by Dr. Gowers and Mr. Sankey was read, dealingwith the pathological anatomy of "Canine Chorea;" thepaper was illustrated by a series of microscopical prepara-tions. A brief note by Mr. Wilkes, of Salisbury, on an unsualcase of stone in the bladder, and a paper by Mr. Barwellupon congenital dislocations of the knee, were also read.

Dr. WEST, on taking the chair as President for the firsttime, acknowledged with hearty thanks his sense of thehonour done him by the Society. To be chosen Presidentof that Society was, he considered, the highest honour towhich any member of the profession could aspire. Althoughhe felt some misgivings in having to follow so closely uponhis eminent predecessor, he would have the advantage ofthe Society’s seventy years of tradition to guide him inmaintaining its honour and dignity.A paperwas read on "The PathologicalAnatomy of Canine

Chorea," by Dr. W. R. GOWERS and Mr. H. R. O. SANKEY.The paper contains an account of the changes found in thenerve-centres in two cases of the disease of the dog whichhas been termed chorm, although it bears but little resem-blance to the chorea of man. It consists of quick muscularcontractions, separated by an interval, and without inco-ordination, or fidgety movement. In the two cases the movements were similar. In one they were confined to one fore-leg, and the changes found in the nerve-centres were slight,the medulla oblongata presenting nothing abnormal. In thespinal cord the large nerve-cells of the cervical region werevery granular and appeared swollen, the body of the cellbeing in some instances apparently distended with granulesso that it had an almost globular form. This change wasmore marked on the right side than on the left. In theupper part of the cervical region there was a slight increasein the minute nuclei of the anterior column on the rightside. In the upper lumbar region the nerve-cells of theright posterior vesicular column were much more granularthan those of the left. In the other case, a young retriever,the twitchings were general and had commenced (in oneforeleg) after distemper, two months before death. Theywere more marked when the animal was at rest, and wereaccompanied with considerable weakness; in the limbs, espe-cially the bind limbs, sensation was considerably dimin-ished, the posterior half of the trunk and bind limb beingquite insensitive. The muscles of the neck and those of thelarynx, tongue, and jaw were involved in the twitching.After death the heart, the muscles, and the cerebral hemi-spheres with the central ganglia were healthy. Micro-scopic examination showed extensive disease in the spinalcord, medulla oblongata, and cerebellum. The most con-

spicuous change was an infiltration of small round lymphoidcells, precisely resembling white blood-corpuscles. Areas

so infiltrated were found abundantly in both white and greysubstance in all parts of the cord, the distribution varyingmuch : in some parts in the lateral, in others in the anterior ’,in others in the posterior columns. In places theanterior, in others the posterior grey cornua were

infiltrated. In some places the nerve-tissue appeareddisintegrated and destroyed, but there the infiltra-tion was slighter; it was in the form of ramifyingtracts, always corresponding to the course of vessels.From this the authors are inclined to regard it as

a leucocytal infiltration. The nerve-cells in many parts ap.peared hpalthy, but in others were very granular, and insome parts were surrounded by the lymphoid cells. Somenerve-cPlls had a granular centre and an ill-defined boun.dary. The protoplasm of many was encroached on byvacuoles, partly outside the cells. These had in placesalmost destroyed the cells. They appeared formed duringthe process of hardening, but the authors suggest that theyare of pathological significance, since they were absent inanother cord similarly prepared. In the medulla oblongatathe changes were similar but slighter, and confined toscattered areas of cellular infiltration. A similar infiltrationexisted extensively in the medulla of the cerebellum, andwas in some places very dense. The cortex of the cerebellum,however, was healthy. In each dog the effect of sectionof the cord was observed. In the slighter case Dr. Hugh-lings Jackson had noted that the movements continued fora few moments after pithing. In the other, in which thechanges in the cord were extensive, artificial respiration waskept up after division of the cord, and no movementsoccurred in the parts below the section, although they con-tinued in the muscles of the head and jaw. In otherrecorded cases, however, similar movements have been ob.served to persist after the section of the cord. It isremarkable, therefore, that in this case, in which the cordwas so diseased, the movements should have beenarrested. It is possible that in some cases the move-ments may be encephalic (perhaps cerebellar), in othersof spinal origin; but another explanation of the cessa-tion of the movements may be that the section of thecord temporarily inhibited by shock the action of theweakened nerve-cells of the cord. The cellular infiltrationappears from its course to have been the result of vasculardisturbance, but whether primary or the result of functionalover-action of the nprve-elements, it is difficult to say. Itsrandom position indicates an independent progress, andaccounts for the motor and sensory paralysis, but its limita-tion to the cord, medulla, and cerebellum suggests a primarydependence on functional disturbance of the nerve elements.The only morbid appearance common to the two cases was achange in the nerve-cells of the cord, and this may be re-garded as the primary morbid change, the indication oftheir over-action, to which the vascular change and cellularinfiltration are secondary in origin. To decide these andother points, however, further observations are necessary.—The PRESIDENT, in according to the authors a vote ofthanks, said that good honest work like this was never lost,serving as materials from which hereafter some real and im-portant conclusions may be deduced.-Dr. CADDY madeseme remarks tending to show the dependence of differencesin muscular power among animals upon the development ofthe sninal cord.-Dr. JOHN HARLEY said that probablywhat had been found in the case of the dog would be equallyapplicable to man ; and he agreed in the suggestion thrown

; ont by the authors of the paper, that the movements ofchorea are probably due to the intrinsic action of the nerve-

.

cells, to which the vascular changes are secondary. He, had himself been enabled to produce chorea artificially inB the dog by the administration of the alkaloid cryptopia,

The movements came on about half an hour after the ab-sorption of the drug, and lasted until it was eliminated.

’ This could only be by its direct action on the nerve-cells,- especially as examination of the spinal cords of animals so treated did not reveal any evidence of intense vascular

congestion or stasis.. A paper was then read on a °Case of Vesical Calculusj- the nucleus of which was a piece of necrosed bone; removed- by Lithotomy," by Mr. W. D. WILKES, Surgeon to the Salis-1 bury Infirmary. The patient, M. P-, ngedfifty, an agri-- cultural labourer, a tall, thin man, was admitted into theI Salisbury Infirmary in Oct., 1876, for stone in the bladder.s A small orifice to urethra and sensitive passages indicated

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lithotomy rather than lithotrity, and the former operation(lateral) was performed on Oct. 30th. After several unsuccessful attempts, the stone was grasped by a large forceps,and became crushed in them, whilst holding it firmly forextraction. After extracting the large fragments, a largepiece was found on a kind of shelf on the upper and backpart of the bladder, of which a piece of necrosed bone wasthe nucleus. There was no vessel to tie, no tube was in-serted, and the patient was in a very fair state. After the

operation it was learnt that thirteen years ago the patientfell from a tree some eighteen or twenty feet upon his righthip; an abscess formed, and two or three pieces of deadbone came away from tbeinsideof the right thigh, just belowthe adductor longus. He had no trouble till March, 1876,when bladder symptoms began. The nucleus of necrosedbone weighs 8 grains, the crushed fusible calculus (dry)weighs 430 grains. The patient is now all but well. Thecase is another illustration of an unusual cause of calculusin the bladder, from necrosed bone detached from a neigh-bouring portion of the skeleton, the first case having beenreported to the S ociety by Sir Henry Thompson in 1866,who also had a similar case at University College Hos-pital in a lad of fifteen years of age, in 1872, who made a.good recovery.

This was followed by a paper on " Congenital Dislocationof the Knee, Tibia forwards," by Mr. RICHARD BARWELL,of which the following is an abstract. Harry B-, agedsix weeks, was brought to Charing-cross Hospital to seeDr. Barlow on account of an eruption about the thighs, onOctober 24th, 1876. This was quite unimportant, but Dr.Barlow detectei an abnormal condition about the lowerlimbs, and asked Mr. Barwell to see the child. The positionof the thighs and legs was unusual, the former being kept- extended on the body, the latter hyperextended at the knee.Across the front of the joint was a deep tegumentary fold,above which the parts, more especially in the middle lineof the limb, were soft, sinking deeply, and below which thetuberosities of the tibia could be felt unduly prominent.The popliteal depression was replaced by a protuberance,which could be felt as double, and was easily recognised asthe condyles of the femur ; below this the no-mal hardnessover the back of the tibia was lost. Mr. Barwell diagnosedcongenital dislocation (almost complete) of the tibia for-ward. On the left side, the patella, though small, wasevident; on the right, he could, with the most careful ex-amination, find no patella. Besides this condition of theknees, the following peculiarities existed. The thighs couldnot be straightened on the pelvis ; this was compensated byremarkable flexibility of the loins, the position simulatingthough not due to hip dislocation ; there was equino-varus ofthe right foot, and slight double internal strabismus. Thisis the fourth child of healthy parents; there is no deformityin any branch of the family ; the birth waR normal, head-presentation without instruments. During the third monthof gestation the mother had a fall down stairs; during thesixth a severe fright. She had a very uncomfortable preg-nancy, not being able to get about, for it was very lowdown. Partly on account of the skin eruption, partly onaccount of his being "a very wet baby" Mr. Barwellthought it better to postpone active treatment, but saw thechild from time to time. Although a simple attempt toflex the limb entirely failed, yet he found that by placingthe thumbs on the tuberosity of the tibia in front, and thefingers on the femoral condyles behind, he could partiallyreduce the dislocation, and then bend the limb somewhat;therefore when other circumstances suited he had the childadmitted into hospital, and on the 9th of January, chloro-form being administered, he pressed the joint as far as pos-aible into positicn and flexed the limbs in much as could beeffected without using too much force, then placed them inplaster of Fd.ris. The left could be more perfectly bentthan the right. In a fortnight this was repeated, and bothlimbs could now be well bent, and the tibia lay in goodposition ; the left patella had increased in size, the right one,could be felt, but was small. On Feb. 10th the plaster was re-moved : knee in good position; movement good; no dressingapplied, but free passive motion in the direction of flexion en-joined. At this date the knees were normal, and couldboth be bent till the heel was close to the buttock;the patellæ on both sides nearly or quite normal; the foldof skin across the front of the joint had disappeared. Thisdeformity is so rare that there are not half a dozen cases on

record. One is given by von Ammon ; two specimens, pro-bably still.born children, shown by Guérin, one case seen

3, by Hilton, one mentioned by him as having been seen by Sir,r Astley Cooper; and one case, recently reported at the Clinicale Society, by Mr. Godlee. Some of these cases are described

as congenital absence of the patella, others (Guerin ands Godlee) as dislocation forward of the tibia at the knee.- The author submits that since dislocation is not always

present when the patella is absent, and the patella is presentwhen dislocations occur, this absence or presence is an un-essential feature in the case, and ought not to give the

i name to this condition. The only wr ters who speak of anyv treatment are Hilton and G,dlee. The former surgeon’s!, can hardly be called treatment, as the patient only learnedI to walk fairly well in about twenty-four years. Mr.) Godlee treated his case by instruments ; the childa crept about tolerably well, but did not use the legs nicely at the fifteenth month. Mr. Barwell’s case was. cured in about six weeks of treatment, and he thinks

the mode of treating the dislocation the correct one.-Mr. ADAMS questioned whether enough importance had beenattached to the general condition of the limbs; he under-stood that both hips and feet were deformed, and consideredit in that case resembling those instances of muscular de-formity which are mostly found in the subjects of breech-

, presentation. In such cases the condyles of the femurt could be felt in the popliteal space, but the luxation was> very slight. Slow forcible flexion of the legs mostly cured

these cases.-Mr. HULKE pointed out that in the cases

. referred to by Mr. Adams the knee-joint is fixed ; in Mr.Barwell’s and like cases the joint is very loose and mobile.- Mr. JOHN VPooD remarked that the treatment in Mr.Barweli’s case was pursued for a very short time with great

, result. He supposed the dislocation was a partial one,. connected with laxity of the ligaments of the knee-joint. - Mr. HULKE referred to a specimen shown by, Mr. Adams at another Society some years ago, which

illustrated the fact that in older subjects a displace-ment of the lower epiphysis of the femur may simulateso-called anterior dislocation of the knee. The case wasthat of a lad about twelve or thirteen years of age, inwhom the epiphysis had been displaced by injury.-Mr.BARWELL, in reply, said that his patient was not an

example of breech presentation. Tne mother stated thelabour to have been quite natural. Only one foot-viz., theleft-presented an equino-varus. The difference betweenMr. Adams’s cases and his own was that in the former thelimbs were small and ill-nourished, but in the latter it wasquite the reverse. The forward displacement of the tibiawas very well marked, the dislocation being nearly entire.He attributed the condition rather to shortness of muscle,especially the rectus, than to anything else. In Mr.Godlee’s and Mr. Hilton’s cases the joint was very lax, andcould be moved in every direction except that of flexion,but in his own case no lateral movement could be obtained.He was equally surprised with Mr. Wood that the childrecovered so rapidly-viz., after wearing a plaster-of-Parissplint for two periods of two and three weeks respectively.The Society then adjourned.

CLINICAL SOCIETY OF LONDON.

THE ordinary meeting of this Society was held on Friday,March 9th, Geo. Callender, Esq., F.R.C.S., the President,in the chair. Some interesting cases of exophthalmicgoitre with unusual symptoms were shown by Dr. BurneyYeo, and other papers of interest were read by Mr. Godlee,Dr. Theodore Williams, and Mr. Lowne. Mr. Godlee inhis note on gas in the peritoneal cavity, called attention toan hitherto unobserved fact likely to be of practical valueto surgeons. The President requested that members whodesired to read papers should send them in not later than aweek before the meeting at which they were to be read.

Dr. BURNEY YEO brought forward two cases of Exoph-thalmic Goitre, one of which presented some phenomenawhich be believed to be new. The patient, a marriedwoman thiity-five years cf age, came under observation inMay, 1876, having suffered from palpitation for about three