- Email: [email protected]
GENERAL HOSPITAL, BIRMINGHAM.
HOSPITAL MEDICINE AND SURGERY.
161
and not to pericardial distension. This impaired cleared up. The patient was weak for some time, his pulse continuing to be rapid, and his temperature showing some irregularity on his first getting up. Nothing further happened except a trivial attack of urticaria caused by the antitoxin. The patient left the hospital The pulse on Dec. 14th to go to the convalescent home. and temperature were then normal and the wound in the neck had healed. Remark by Mr. SPENCER.-The above case is important as an instance of septic pharyngitis which would without doubt have ended fatally if the antitoxin corresponding to the organism causing the disease had not been administered. It would be useless, indeed harmful, to inject streptococcal antitoxin haphazard in any acute affection of the throat. To such treatment the identification of streptococci as the cause of the disease is an essential preliminary. In the present case beyond the organisms found there was nothing very marked in the pharynx. In other cases an acute œdematous inflammation attacks the glottis as well as the tongue and Even if tracheotomy is causes rapidly-increasing dyspnoea. performed death may occur from failure of the heart.
thickening resonance
OF
HOSPITAL
PRACTICE,
BRITISH AND FOREIGN. Nulla autem est alia pro certo noscendi via, nisi quamplurlmas et morborum et dissectionum historias, tum aliorum tum proprias cellectas habere, et inter se comparare.-MORGAGNI De Sed. et Gaur.
Morb., lib. iv. Prooemium.
-
WESTMINSTER HOSPITAL.
(Under
the
care
of Mr. W. G.
SPENCER.)
A CASE OF ACUTE PHARYNGITIS DUE TO STREPTOCOCCUS PYOGENES FOLLOWED BY SEPTICÆMIA, DEEP GLANDULAR INFLAMMATION, AND PERICARDITIS, AND RELIEVED BY THE ADMINISTRATION OF STREPTOCOCCAL ANTITOXIN.
THE value of the anti-streptococcic serum has in few cases been more strikingly shown than in that recorded below. Only discredit can result from the employment of this very powerful remedy indiscriminately in all septic cases, for it .appears to be perfectly inert against other varieties of microorganisms. We have published recently several cases in which this serum proved to be of service and others also in which but little benefit resulted. We need to be better acquainted with the capabilities and the limitations of the power of the anti-streptococcic serum and this is only possible by the publication of cases, such as the following, in which the treatment has been employed scientifically. A man, aged twenty-one years, was first taken ill on Oct. 16th, 1898, with a sore throat which was followed by swelling in the neck. The symptoms increased in severity and he was admitted to the Westminster Hospital where he was first seen by Mr. Spencer on Oct. 24th. The patient was partly onconscious, had great difficulty and pain in swallowing, and kept placing his hand over his heart where he felt pain. ’The face was very pale. The temperature was 101.4° F., having been 1030 during the night; the pulse was 120, small .and of low tension ; and the respirations were 30 and quiet. The mouth could only be partly opened; the tongue was ’somewhat swollen and covered with a dry brown fur. The tonsils were not enlarged ; the back wall of the pharynx was -covered with brown sticky mucus, but there was no sign of any membrane. The left side of the neck was much swollen, red, brawny, and cedematous. An incision had been made at the posterior border of the sterno-mastoid by Mr. Silas, the house surgeon, immediately after the patient’s admission ; swollen glands were reached from which a sanious fluid escaped, but no thick pus. On auscultation a loud pericardial friction rub
gradually
GENERAL A CASE
HOSPITAL, BIRMINGHAM.
ILLUSTRATING A METHOD OF TREATING EXTROVERSION OF THE BLADDER IN THE FEMALE.
(Under
the
care
of Mr.
CHAVASSE.)
EXTROVERSION of the bladder has received an amount of quite out of proportion to the frequency of the occurrence of this deformity and this is undoubtedly to be attributed to the difficulties which are experienced in its treatment. Very many procedures have been devised to remedy this malformation and probably the most elaborate that described by Mr. Reginald Harrison at a was meeting of the Medical Society of London in 1897.1 The method described by Mr. Chavasse is obviously only applicable to the rare cases in which the patient is a female child but it has given in this case at least good results. Tredelenburg’s method, which was at first employed, is very ingenious, as are all the inventions of that eminent surgeon, but it is not always equally applicable ; it is probable that it would have proved of more value in this case if the treatment had not been interrupted. A girl, aged four years, was admitted into the General Hospital, Birmingham, in June, 1897, on account of extroversion of the bladder. The child had previously been the inmate of another hospital and from the cicatrises seen upon the abdominal wall it was evident that a plastic operation to remedy the defect had been unsuccessfully performed. The usual appearances associated with this congenital defect presented themselves. It was resolved to attempt to remedy the condition by separating the sacro-iliac symphyses as advocated by Trendelenburg. On June llth both sacro-iliac synchondroses were separated and the innominate bones were pushed forward ; iodoform gauze was used to fill in the gaps left between the bones. To mainnotice
tain and to increase the
approximation of the hip bones a weight-and-pulley apparatus acting crossways was applied to each buttock by means of strapping and fixed to the sides of the cot. The exposed portion of the bladder wall slipped back into the pelvis on the fifth day after the operation and at the end of a fortnight the deficiency in the abdominal wall was reduced to a slit-like aperture. The operation, however, seemed to cause a good deal of shock to the child who did not thrive well, took food badly, and developed bronchitis. The wounds consequently granulated slowly and healing was not complete till seven weeks after the operation. It was not then considered advisable to attempt any plastic operation and the child was sent to the Jaffray Suburban Hospital. Here it was deemed best by those in charge to leave off the weights and the pulleys attached to the buttocks so as to
enable the child to reap the benefit of fresh air. As a result the defect in the abdominal wall speedily became more apparent and the bladder again protruded. The child’s health having much improved at the beginning of Decoibsr
1
THE LANCET, April 17th, 1897,
p. 1091.
162
PATHOLOGICAL SOCIETY OF LONDON.
she was sent back to the General Hospital and on the 6th of that month the following operation was performed. Both ureters were catheterised and dissected clear of the mucous membrane of the bladder. Two small oblique openings were then made in the upper part of the anterior walls of the vagina into which the ends of the ureters were PATHOLOGICAL SOCIETY OF LONDON. passed, each on its own side, and stitched to the edges of the incisions by horsehair sutures. The catheters were left in the ureters and projected beyond the labia so as to carry the Cystic Accessory Thyroid Body.-Molluseum Fibrosum assourine clear of the patient. All the exposed portion of the ciated ?vith Neuroma.-Fracture cf the Cervical Spine. posterior wall of the bladder was then cut away and the Cysts of the Suprarenal Body.-Tuberculous Cliolangitis. M2cltiloceclar Cyst in the Hernial Sac. resulting cavity was packed with iodoform gauze. This proved successful; the right ureteral catheter came out spontaneA MEETING of this was held on Jan. 17th, the ously on the third day after the operation, the left being President, Dr. PAYNE, society in being the chair. withdrawn on the fourth day. All the urine from this time Mr. A. E. BARKER was voided per vaginam. Jan. On presented specimens from a case of 24th, 1898, Thiersch’s tinfoil to the cleft was close Cystic Accessory Thyroid Body, already reported in 1896 ta plastic operation performed, being employed for insertion under the bridge of skin dis- the society, and which had since terminated in d2ath. They sected up on the right side. Three weeks later as the fiap were removed at various times after 1896 as recurrences of was granulating healthily it was divided at its upper part very slow development and of a very low order of malignancy and swung round and found to cover in the whole of the in every other respect. The patient, a man apparently defect except a small portion at the left lower angle. otherwise in the best of health, was operated on by Mr The flap subsequently contracted somewhat, leaving an Barker for the first time in October, 1889, when he was fifty of age. The tumour was then enormous and had begun exposed portion at this angle about as large as a shilling, years but as it caused no inconvenience an ordinary indiarubber nine years before (1880) in a small nodule just above the female urinal was applied and the child was sent home early inner end of the left clavicle. The operation and the clinical in April. To close in what remained of the cleft she was details of the growth together with the microscopical strucreadmitted into the hospital on July llth and a small flap ture of the mass removed were reported in the British Medical Journal of June 21st, 1898. Although the patient was made on Thiersch’s plan on the left side, tinfoil being remained in excellent health several recurrences took place At the end of inner of used. fourteen the again days edges both flaps were freshened and united. On Sept. 19th the and were removed between 1889 and 1896 when the operator sequel to the society. Since then several other patient was examined under chloroform; firm union was reported thehave taken place slowly and have been removed. recurrences found to exist between the flaps, the urine dribbled away in from 1898, a large swelling, apparently an the of but orifice the there was no Finally, August, constantly vagina, excoriation of the skin round the genital organs over the effusion of blood, appeared at the root of the neck pressing buttocks or the thighs. No enlargement of either kidney upon the larynx and causing fatal dyspnoea. This effusion. could be detected on palpation. The mother stated that the was probably due to rupture of some of the delicate vessels. child was readily kept dry by means of the urinal during the in the intracystic papillary growths already described. The day and at night by the use of absorbent wool the wetting pathological interest of the case lies in the fact of the slow of the bed was prevented. The child’s health and general development of the tumour in the first instance lasting overcondition had manifestly improved, she took her food well nine years and its recurrence in the glands of the neck and ran about most of the day as she liked. during the following nine years ; finally, in its destroyRemarks by Mr. CHnvACSE.-The patient was exhibited at ing life not by generalisation or cachexia but by an accidental hæmorrhage pressing upon the air passages.-a meeting of the Midland Medical Society on Nov. 2nd, 1898. I then quoted some statistics of the late Mr. John Wood1 Mr. BERRY said that he thought the case was unique in its. showing that cases of ectopion vesicas in the female were as long duration-eighteen years. Clinically these malignant 1 to 10 in the male and stated that this was the first time I adenomata might be -regarded as semi-malignant. They had met with the condition in a female subject. Mr. Lawson were entirely different from ordinary’sarcoma and carcinoma Tait in some remarks which he made on the case said that of the thyroid, cases of which usually ran their course within with all his experience of women’s diseases he had never a year, and in one case which he had seen in three months. before seen this malformation in a female. On referring to the Such cases rarely came under the notice of the surgeon at experiences of others I find that the late Mr. Earle in a clinical an operable period. If the larynx, trachea, or pharynx were lecture on the subjectsaid : ’’ This is the only instance I involved he thought the formidable operations sometimes have witnessed in a female, although I have seen several undertaken were hardly justifiable. The question of whether males. In looking for authorities on the subject I find only a thyroid tumour was adherent to the pharynx was often. 8 recorded instances of similar malformation in females, very difficult to determine until the tumour was exposed whilst no less than 60 cases of males are related by different during the operation. He asked what was the relation of authorities." St. Hilaire3 calculates that one quarter of the the sterno - mastoid and of the carotid vessels to cases thus affected are females. Martin and Taylor4 state the tumour and whether there had been any implication of observed in the male, very rarely the recurrent laryngeal nerves,-Mr. SHATTOCK said that is that "exstrophy usually in the female," No figures are, however, given. Wood’s there were exceptions to the , rule that tumours of high; statistics may therefore be accepted as approximately correct differentiation were of low malignancy and also to the rule of and the malformation be regarded as comparatively rare in the duration of carcinomata stated by Mr. Berry. He the female. In the present instance for more than a year mentioned a case which was operated on by Mr. Bryant. A the urine has been voided per vaginam apparently without tumour was removed, probably from an accessory thyroid, discomfort to the patient, but whether as she approaches which proved to be a carcinoma of extremely simple in the neck had been removed since on puberty the same immunity will continue remains to be seen. structure. Glands It is within the range of possibility that as time goes on the two occasions but although three years had passed there had the openings of one or both ureters into the vagina may become be: no recurrence.-Mr. BARKER, in reply, said that stenosed and that hydronephrosis or ascending pyelitis may sterno-mastoid was adherent to the front and side of theresult, but at present there is no evidence of any such com- growth. The vessels were directly under the tumour. The plication. If one may be allowed to draw any inference patient was hoarseon.so that the recurrent laryngeal nerve was from a single case my experience leads me to advocate the probably pressed Mr. T. CARWARDINE (Clifton) showed ’Lantern Slides and transplantation of the ureters into the vagina as a method of treatment to be considered in ectopion vesicæ occurring in Sections from a case of Molluscum Fibrosum associated with female subjects, as the operations are readily performed and a large Neuroma of the Outer Cord of the Brachial Plexus. the results are so far satisfactory that they add materially to and gland-like tumours, probably neuromata, in the axillæ, the comfort of the patient and to those who have the charge groins, and elsewhere. In addition to numerous molluscous. nodules there were many pigmented patches in various parts of her. of the body. There was a large tumour in the posterior 1 Heath’s of Practical Surgery, vol. i. Dictionary triangle of the neck which inconvenienced the patient by 2 London Medical and Surgical Journal, vol. i., 1828. severe pains referred to the arm. The tumour was 3 Histoire Générale et Particulière des Anomalies de l’Organisation excisedshooting and proved to be a soft fibroma growing from the chez l’Homme et les Animaux, Paris. 4 American Text-book of sheath of the outer cord of the brachial plexus. The Genito-Urinary Diseases, 1898.
Medical Societies.
-
161
and not to pericardial distension. This impaired cleared up. The patient was weak for some time, his pulse continuing to be rapid, and his temperature showing some irregularity on his first getting up. Nothing further happened except a trivial attack of urticaria caused by the antitoxin. The patient left the hospital The pulse on Dec. 14th to go to the convalescent home. and temperature were then normal and the wound in the neck had healed. Remark by Mr. SPENCER.-The above case is important as an instance of septic pharyngitis which would without doubt have ended fatally if the antitoxin corresponding to the organism causing the disease had not been administered. It would be useless, indeed harmful, to inject streptococcal antitoxin haphazard in any acute affection of the throat. To such treatment the identification of streptococci as the cause of the disease is an essential preliminary. In the present case beyond the organisms found there was nothing very marked in the pharynx. In other cases an acute œdematous inflammation attacks the glottis as well as the tongue and Even if tracheotomy is causes rapidly-increasing dyspnoea. performed death may occur from failure of the heart.
thickening resonance
OF
HOSPITAL
PRACTICE,
BRITISH AND FOREIGN. Nulla autem est alia pro certo noscendi via, nisi quamplurlmas et morborum et dissectionum historias, tum aliorum tum proprias cellectas habere, et inter se comparare.-MORGAGNI De Sed. et Gaur.
Morb., lib. iv. Prooemium.
-
WESTMINSTER HOSPITAL.
(Under
the
care
of Mr. W. G.
SPENCER.)
A CASE OF ACUTE PHARYNGITIS DUE TO STREPTOCOCCUS PYOGENES FOLLOWED BY SEPTICÆMIA, DEEP GLANDULAR INFLAMMATION, AND PERICARDITIS, AND RELIEVED BY THE ADMINISTRATION OF STREPTOCOCCAL ANTITOXIN.
THE value of the anti-streptococcic serum has in few cases been more strikingly shown than in that recorded below. Only discredit can result from the employment of this very powerful remedy indiscriminately in all septic cases, for it .appears to be perfectly inert against other varieties of microorganisms. We have published recently several cases in which this serum proved to be of service and others also in which but little benefit resulted. We need to be better acquainted with the capabilities and the limitations of the power of the anti-streptococcic serum and this is only possible by the publication of cases, such as the following, in which the treatment has been employed scientifically. A man, aged twenty-one years, was first taken ill on Oct. 16th, 1898, with a sore throat which was followed by swelling in the neck. The symptoms increased in severity and he was admitted to the Westminster Hospital where he was first seen by Mr. Spencer on Oct. 24th. The patient was partly onconscious, had great difficulty and pain in swallowing, and kept placing his hand over his heart where he felt pain. ’The face was very pale. The temperature was 101.4° F., having been 1030 during the night; the pulse was 120, small .and of low tension ; and the respirations were 30 and quiet. The mouth could only be partly opened; the tongue was ’somewhat swollen and covered with a dry brown fur. The tonsils were not enlarged ; the back wall of the pharynx was -covered with brown sticky mucus, but there was no sign of any membrane. The left side of the neck was much swollen, red, brawny, and cedematous. An incision had been made at the posterior border of the sterno-mastoid by Mr. Silas, the house surgeon, immediately after the patient’s admission ; swollen glands were reached from which a sanious fluid escaped, but no thick pus. On auscultation a loud pericardial friction rub
gradually
GENERAL A CASE
HOSPITAL, BIRMINGHAM.
ILLUSTRATING A METHOD OF TREATING EXTROVERSION OF THE BLADDER IN THE FEMALE.
(Under
the
care
of Mr.
CHAVASSE.)
EXTROVERSION of the bladder has received an amount of quite out of proportion to the frequency of the occurrence of this deformity and this is undoubtedly to be attributed to the difficulties which are experienced in its treatment. Very many procedures have been devised to remedy this malformation and probably the most elaborate that described by Mr. Reginald Harrison at a was meeting of the Medical Society of London in 1897.1 The method described by Mr. Chavasse is obviously only applicable to the rare cases in which the patient is a female child but it has given in this case at least good results. Tredelenburg’s method, which was at first employed, is very ingenious, as are all the inventions of that eminent surgeon, but it is not always equally applicable ; it is probable that it would have proved of more value in this case if the treatment had not been interrupted. A girl, aged four years, was admitted into the General Hospital, Birmingham, in June, 1897, on account of extroversion of the bladder. The child had previously been the inmate of another hospital and from the cicatrises seen upon the abdominal wall it was evident that a plastic operation to remedy the defect had been unsuccessfully performed. The usual appearances associated with this congenital defect presented themselves. It was resolved to attempt to remedy the condition by separating the sacro-iliac symphyses as advocated by Trendelenburg. On June llth both sacro-iliac synchondroses were separated and the innominate bones were pushed forward ; iodoform gauze was used to fill in the gaps left between the bones. To mainnotice
tain and to increase the
approximation of the hip bones a weight-and-pulley apparatus acting crossways was applied to each buttock by means of strapping and fixed to the sides of the cot. The exposed portion of the bladder wall slipped back into the pelvis on the fifth day after the operation and at the end of a fortnight the deficiency in the abdominal wall was reduced to a slit-like aperture. The operation, however, seemed to cause a good deal of shock to the child who did not thrive well, took food badly, and developed bronchitis. The wounds consequently granulated slowly and healing was not complete till seven weeks after the operation. It was not then considered advisable to attempt any plastic operation and the child was sent to the Jaffray Suburban Hospital. Here it was deemed best by those in charge to leave off the weights and the pulleys attached to the buttocks so as to
enable the child to reap the benefit of fresh air. As a result the defect in the abdominal wall speedily became more apparent and the bladder again protruded. The child’s health having much improved at the beginning of Decoibsr
1
THE LANCET, April 17th, 1897,
p. 1091.
162
PATHOLOGICAL SOCIETY OF LONDON.
she was sent back to the General Hospital and on the 6th of that month the following operation was performed. Both ureters were catheterised and dissected clear of the mucous membrane of the bladder. Two small oblique openings were then made in the upper part of the anterior walls of the vagina into which the ends of the ureters were PATHOLOGICAL SOCIETY OF LONDON. passed, each on its own side, and stitched to the edges of the incisions by horsehair sutures. The catheters were left in the ureters and projected beyond the labia so as to carry the Cystic Accessory Thyroid Body.-Molluseum Fibrosum assourine clear of the patient. All the exposed portion of the ciated ?vith Neuroma.-Fracture cf the Cervical Spine. posterior wall of the bladder was then cut away and the Cysts of the Suprarenal Body.-Tuberculous Cliolangitis. M2cltiloceclar Cyst in the Hernial Sac. resulting cavity was packed with iodoform gauze. This proved successful; the right ureteral catheter came out spontaneA MEETING of this was held on Jan. 17th, the ously on the third day after the operation, the left being President, Dr. PAYNE, society in being the chair. withdrawn on the fourth day. All the urine from this time Mr. A. E. BARKER was voided per vaginam. Jan. On presented specimens from a case of 24th, 1898, Thiersch’s tinfoil to the cleft was close Cystic Accessory Thyroid Body, already reported in 1896 ta plastic operation performed, being employed for insertion under the bridge of skin dis- the society, and which had since terminated in d2ath. They sected up on the right side. Three weeks later as the fiap were removed at various times after 1896 as recurrences of was granulating healthily it was divided at its upper part very slow development and of a very low order of malignancy and swung round and found to cover in the whole of the in every other respect. The patient, a man apparently defect except a small portion at the left lower angle. otherwise in the best of health, was operated on by Mr The flap subsequently contracted somewhat, leaving an Barker for the first time in October, 1889, when he was fifty of age. The tumour was then enormous and had begun exposed portion at this angle about as large as a shilling, years but as it caused no inconvenience an ordinary indiarubber nine years before (1880) in a small nodule just above the female urinal was applied and the child was sent home early inner end of the left clavicle. The operation and the clinical in April. To close in what remained of the cleft she was details of the growth together with the microscopical strucreadmitted into the hospital on July llth and a small flap ture of the mass removed were reported in the British Medical Journal of June 21st, 1898. Although the patient was made on Thiersch’s plan on the left side, tinfoil being remained in excellent health several recurrences took place At the end of inner of used. fourteen the again days edges both flaps were freshened and united. On Sept. 19th the and were removed between 1889 and 1896 when the operator sequel to the society. Since then several other patient was examined under chloroform; firm union was reported thehave taken place slowly and have been removed. recurrences found to exist between the flaps, the urine dribbled away in from 1898, a large swelling, apparently an the of but orifice the there was no Finally, August, constantly vagina, excoriation of the skin round the genital organs over the effusion of blood, appeared at the root of the neck pressing buttocks or the thighs. No enlargement of either kidney upon the larynx and causing fatal dyspnoea. This effusion. could be detected on palpation. The mother stated that the was probably due to rupture of some of the delicate vessels. child was readily kept dry by means of the urinal during the in the intracystic papillary growths already described. The day and at night by the use of absorbent wool the wetting pathological interest of the case lies in the fact of the slow of the bed was prevented. The child’s health and general development of the tumour in the first instance lasting overcondition had manifestly improved, she took her food well nine years and its recurrence in the glands of the neck and ran about most of the day as she liked. during the following nine years ; finally, in its destroyRemarks by Mr. CHnvACSE.-The patient was exhibited at ing life not by generalisation or cachexia but by an accidental hæmorrhage pressing upon the air passages.-a meeting of the Midland Medical Society on Nov. 2nd, 1898. I then quoted some statistics of the late Mr. John Wood1 Mr. BERRY said that he thought the case was unique in its. showing that cases of ectopion vesicas in the female were as long duration-eighteen years. Clinically these malignant 1 to 10 in the male and stated that this was the first time I adenomata might be -regarded as semi-malignant. They had met with the condition in a female subject. Mr. Lawson were entirely different from ordinary’sarcoma and carcinoma Tait in some remarks which he made on the case said that of the thyroid, cases of which usually ran their course within with all his experience of women’s diseases he had never a year, and in one case which he had seen in three months. before seen this malformation in a female. On referring to the Such cases rarely came under the notice of the surgeon at experiences of others I find that the late Mr. Earle in a clinical an operable period. If the larynx, trachea, or pharynx were lecture on the subjectsaid : ’’ This is the only instance I involved he thought the formidable operations sometimes have witnessed in a female, although I have seen several undertaken were hardly justifiable. The question of whether males. In looking for authorities on the subject I find only a thyroid tumour was adherent to the pharynx was often. 8 recorded instances of similar malformation in females, very difficult to determine until the tumour was exposed whilst no less than 60 cases of males are related by different during the operation. He asked what was the relation of authorities." St. Hilaire3 calculates that one quarter of the the sterno - mastoid and of the carotid vessels to cases thus affected are females. Martin and Taylor4 state the tumour and whether there had been any implication of observed in the male, very rarely the recurrent laryngeal nerves,-Mr. SHATTOCK said that is that "exstrophy usually in the female," No figures are, however, given. Wood’s there were exceptions to the , rule that tumours of high; statistics may therefore be accepted as approximately correct differentiation were of low malignancy and also to the rule of and the malformation be regarded as comparatively rare in the duration of carcinomata stated by Mr. Berry. He the female. In the present instance for more than a year mentioned a case which was operated on by Mr. Bryant. A the urine has been voided per vaginam apparently without tumour was removed, probably from an accessory thyroid, discomfort to the patient, but whether as she approaches which proved to be a carcinoma of extremely simple in the neck had been removed since on puberty the same immunity will continue remains to be seen. structure. Glands It is within the range of possibility that as time goes on the two occasions but although three years had passed there had the openings of one or both ureters into the vagina may become be: no recurrence.-Mr. BARKER, in reply, said that stenosed and that hydronephrosis or ascending pyelitis may sterno-mastoid was adherent to the front and side of theresult, but at present there is no evidence of any such com- growth. The vessels were directly under the tumour. The plication. If one may be allowed to draw any inference patient was hoarseon.so that the recurrent laryngeal nerve was from a single case my experience leads me to advocate the probably pressed Mr. T. CARWARDINE (Clifton) showed ’Lantern Slides and transplantation of the ureters into the vagina as a method of treatment to be considered in ectopion vesicæ occurring in Sections from a case of Molluscum Fibrosum associated with female subjects, as the operations are readily performed and a large Neuroma of the Outer Cord of the Brachial Plexus. the results are so far satisfactory that they add materially to and gland-like tumours, probably neuromata, in the axillæ, the comfort of the patient and to those who have the charge groins, and elsewhere. In addition to numerous molluscous. nodules there were many pigmented patches in various parts of her. of the body. There was a large tumour in the posterior 1 Heath’s of Practical Surgery, vol. i. Dictionary triangle of the neck which inconvenienced the patient by 2 London Medical and Surgical Journal, vol. i., 1828. severe pains referred to the arm. The tumour was 3 Histoire Générale et Particulière des Anomalies de l’Organisation excisedshooting and proved to be a soft fibroma growing from the chez l’Homme et les Animaux, Paris. 4 American Text-book of sheath of the outer cord of the brachial plexus. The Genito-Urinary Diseases, 1898.
Medical Societies.
-