805

pressure over the right kidney always caused pain, moremarked on the anterior than on the posterior surface. No

pain could be elicited by manipulation of the left side.There was no clear history of renal colic. Right lumbarnfphro-lithotomy was performed on Feb. 11th, 1892. Onecalculus was felt embedded in the kidney tissue on theanterior surface and removed by an incision directly overit. Jb was about the size and shape of a small marblecovered with little spikes, and was probably the cause ofmuch of the pain. The second (the largest) and the third(the smallest) were removed respectively from a calyx andthe pelvis by a fresh incision through the kidney substance.The first stone was composed almost entirely of oxalate oflime, and the two others chiefly of urates, the third onehaving a striking resemblance to the smaller one found inthe bladder. The different layers of muscles were carefullyapproximated by buried sutures of silk worm gut. Adrainage tube was inserted down to the kidney for forty-eight hours. The wound healed by first intention, no urinecoming through it. For a week a fair amount of blood waspassed with the urine; it then became clear, and theaverage daily amount since passed has been approximatelyforty ounces.Mr. EALES showed a man aged twenty-four years who

had a Sinus opening through the Upper Lid close to thenose and reaching in a direction almost directly backwardsfor about two inches. Fluid injected into the sinus camedown into the nose. Mr. Eales stated that this man firstcame under his notice on Feb. 17th complaining that in abrawl on Dec. 8th he had been struck by another man whohad his pipe in his hand when he struck at him, and thatever since the sinus had existed and would not heal. Hewas at once put under chloroform, the opening of the sinusenlarged and examined, when a bard substance was foundand extracted by forceps, which on examination proved tobe the vulcanite mouthpiece of a tobacco-pipe, broken offand measuring exactly two inches in length. Mr. Ealeslikewise showed a lad aged thirteen who was suffering froma Ruptured Globe. The lens was displaced into the vitreous.The retina was detached (T = - 2) and the sclerotic wasruptured below for a considerable extent about the equator,the anterior parts of the eye being unruptured.

SHEFFIELD MEDICO-CHIRURGICAL SOCIETY.

THURSDAY, MARCH 24TH.Mr. W. F. FAVELL, M.R.C.S., President, in the chair.

DR. CLEAVER showed a specimen of Arrested Develop-ment of the (Esophagus from an otherwise healthy maleinfant, born at full term. As the child was unable to swallow,an unsuccessful attempt was made to pass a catheter downthe oesophagus, and thus inject the milk. The child lived i

for six days and a half. On post-mortem examination, theccsophagus was found to end in a cul-de’sao at the level ofthe bifurcation of the trachea, from which point it wascontinued to the stomach as a mere membranous structure.Mr. T. ROBINSON showed a female patient with "Argyria."

Nitrate of silver had been prescribed six years before forsickness connected with uterine disease. She had taken itat first for about twelve months, and four years later sheagain took it for three months, of her own accord, for similarsymptoms. Altogether she took about 340 grains ofnitrate of silver. The discolouration, which only becamemarked after the second administration, was confinedto the face almost entirely, the exposed part of the con-junctiva being slightly tinged. There was no blue line onthe gums.Dr. HUGH RHODES showed for Mr. A. JACKSON a case

of Charcot’s Disease of the shoulder and knee in a managed sixty-two. There was a history of syphilis at seven-teen years of age. The illness began seven years beforewith lightning pains, gastric crises, and increasing ataxia,which spread from the legs to the arms. The shoulderbecame diseased six years before, and the knee four yearslater. Both joints were very typical examples of Charcot’sdisease, the mobility, especially in the shoulder, beingincreased, and the onset of the affection nearly painless.Much of the shaft of the humerus was worn away, and thehead cf the bone could be put into the position of nearlyall the dislocations. The circumference of the knee was

four inches greater than that of the opposite joint. Therewas effusion into both joints, and the articular surfaceswere eroded and grating.Mr. C. ATKIN also showed a man with old-standing

Charcot’s Disease of the knee, who had been shown to theSociety some years before.

Dr. BURGESS showed two cases of Friedreich’s Disease.One a girl aged twelve, with marked tabeto. cerebellar gait,swaying of the trunk, and slow nodding of the head.Superficial reflexes present; knee jerks absent. No ataxiaof the arms; speech unaffected. The difficulty in walkingwas first noticed four years before, after an attack of scarletfever. The patient was the eldest of the family living, andnone of her brothers and sisters were similarly aftected.The other patient was a man aged twenty-six, with ataxicgait, nodding of the head, twitching of the mouth, anddistinct affection of the speech. A sister was said to besimilarly affected. Superficial a,nd deep reflexes were

exaggerated. Both feet were high-arched, with claw-likecondition of the toes and prominent extensor tendons.There was no pain or any sensory disorder ; no evidence ofsyphilis. He first noticed that he staggered in tle dark fouryears before, and had gradually become more and more un-steady. For the last three years he had found it an effort totalk. A shoemaker by trade, he had found difficulty inaiming with his hammer for the past two years.Mr. R. J. PYE.SMITH read a paper on the Disposal of the

Dead. He contended that the altered conditions of moderntown life, as well as the dangers of our present system ofburial, required a reconsideration of this question. Theencasing of the body in a wooden coffin and burying it deepin the earth or in a vault he characterised as the wors1lpossible compromise betwten the antagonistic aims ofpreserving a body as long as possible and of hasten-ing its disintegration. He maintained that the sub-stitution of a perishable coffin of papier mÛché, or of papercovering a light iron tray and frame, would prevent thepollution of air and water; and that burial at a depth ofnine feet in cases of infectious disease would be an effec-tive check to their danger. On this point he referred to theobservations of Darwin and Pasteur, showing that earth-worms, by the medium of which such diseases might betransmitted, never burrowed deeper than eight feet fromthe surface ; also quoting Fitigge to prove that few patho-genic bacteria could grow in the cold earth, and that bothsoil and air had a direct influence in preventing the forma-tion of ptomaines. He further referred to Dr. Poore’sexperiments on the filtration of urine as indicating the smallrisk to the watercourses from earth-tc-earth burial. Mr.Pye-Smith advocated shallow graves, the systematic plant-ing of trees, shrubs, and flowers, and no reinterment in thesame spot within at least twenty-five years. Finally, as asargument in favour of rational interment rather thancremation, he urged that nature needed the products ofanimal decay for the growth of the vegetable kmgdom, onwhich we in turn depended for our sustenance and wealth.

NOTTINGHAM MEDICO-CHIRURGICALSOCIETY.

WEDNESDAY, MARCH 16TH.Mr. ANDERSON, F.R.C.S., President, in the chair.

Operation in Chronic Intestinal ObstrucUon.-Mr. GRAVread a paper on this subject. He related four cases, in thefirst of which the gympcoms were acute; but, as the resultshowed, there was no real obstruction. In the other threecases there was an acute attack following symptoms point-ing to obstruction, varying from six months to ten years induration. In two cases a band was found post mortem,under which a large quantity of 4ma:1 intestine was pf:l:rtia]Jystrangulated ; in one case the band was peritoneal, and izthe other formed by adherent small intestine. The fourcases were contrasted to show the difficulty of decidingwhen to give up ordinary measures and when to advbeoperation in the face of apparent improvement. Stresswas laid on the inadvisabiJity of giving opium until thediagnosis was made, in consequence of its tendency to mab:symptoms. The operation of laparotomy was described, andthe recommendation given to commence the search for theobstructed portion by following the course of the emptycoils of intestine lying in the pelvis. The causes of the