LIVERPOOL ROYAL INFIRMARY.

645 CASE 4.—Samuel C-, aged twenty, applied on Feb. 1st, 1S7S. Had worked ten years in the Annesley pits. Horizontal oscillations 50 in the minute ; had been suffering six months; had not to look upwards when at work ; was much worse when stooping, and attributed the disease to Clennie’s lamp ; is temperate, and no great smoker. CASE 5.-Frederick E-,aged fifty, residing at North infirmary in November, 1877. His Wingfield, applied at the eyes were quiet when he was in repose, but if he became excited they would begin to oscillate horizontally as much The disease was aggravated by as 90 times in a minute. stooping or looking upwards, which he said sets them "a-gate." Had been bad seven months, and the eyes had got worse even while resting. Is temperate, but a great smoker. Ordered to leave off smoking and working underground, and to take phosphide of zinc, with steel and nux vomica. Remarks by Dr. BELL TAYLOR.—This curious affection, which has only attracted notice of late years, is evidently more common than most writers on the subject suppose. The five preceding cases have come under my notice within as many months, and there are always one or two cases under treatment in the out-patient department of our hospital. The disease is clearly the result of strain, and appears to be analogous to writers’ cramp, pianists’ and telegraphists’ cramp, or the similar affection of the gastrocnemii occasionally observed in ballet-dancers ; and may be developed in any or all of the muscles supplied by the third nerve, and is clearly caused by the overtaxing of these organs. The patientmakes a great and sustained effort to see in a dim the muscles engaged in the accommodative strain are overburdened, in course of time give way, and at last, whenever called upon, just as in the analogous cases cited above, become, as it were, agitated, fluttered, escape from the control of the will and perform irregular motions. If the internal recti are most affected, horizontal oscillations occur; if the superior rectus and inferior oblique have been overtaxed, owing to the patient having been compelled to raise the eyes above the horizontal plane, the oscillations are either vertical or rotatory-in either case they usually vary from 60 to 120 in the minute. If one eye turns inwards during the oscillatory motion more than the other, the effect of a squint is induced, and the patient sees double. The remark of one of the patients as to a drop of drink enabling him to master the disease is significant evidence as to the influence the advent of this affection. of a want of tone in In all the above cases the sight was good when the eyes were at rest. The fundus was healthy, and there was no ametropia. The disease may last from a few months to a few years, but, as a rule, the patients get well if they leave off working in the pit, abandon bad habits, and attend to the general health.

light;

favouring

patient improved. The disease was, however, evidently very extensive, and death took place from exhaustion. seven weeks after the operation. At the post-mortem examination the posterior wall of the bladder was found completely involved in a scirrhous mass undergoing ulceration. The communication between the rectum and bladder would admit the passage of two fingers. No other cancerous deposits were discovered. The operation quite fulfilled all that was expected of itthat is to say, it was the means of prolonging life and mitipain. The chief distress of the patient on his adgating mission was referable to the distension of the bladder withflatus and feculent matter. Mr. Harrison remarked that, as all means of relieving this by medicine had proved ineffectual, there were only two courses open-viz., either to paralyse the sphincter ani by such an incision as would be followed by incontinence of faeces and flatus, or by opening

time the

the colon to divert the faeces from the fistulous comnnmication. The latter course was decided upon as affording the best means for giving relief. Mr. Harrison’s previous. experience of the operation was very favourable to it, and he had no hesitation in recommending it in cases such as

these.

QUEEN’S HOSPITAL, BIRMINGHAM. EXTREME GENU VALGUM IN BOTH LOWER LIMBS; SUECUTANEOUS DIVISION OF THE INTERNAL CONDYLE OF BOTH FEMORA; COMPLETE REMOVAL OF THE DEFORMITY.

THE

(Under the care of Mr. FURNEAUX JORDAN.) efficacy and apparent safety of this operation, together

with the ease with which it may be performed, promise t give it permanent value. Thomas D-, aged twenty, was admitted with severe double in-knee. He could walk with crutches only, and then not without pain. The deformity was increasing, and gave him a dwarf-like appearance ; one knee overlapped the other when his feet were put to the ground. Mr. Jordan performed (March 31st, 1877) the operation devised by Dr. Ogston, of Aberdeen, with the instruments used by Mr. Adams in section of the neck of the femur. A tenotome wasintroduced about three inches above the centre of the internal condyle of the left femur, and carried into and through the joint to the front of the notch between the condyles; Adams’s. saw was passed along the incision, and, the teeth being;.

LIVERPOOL ROYAL INFIRMARY. MALIGNANT DISEASE

(Under the care

OF BLADDER COLOTOMY.

of Mr. REGINALD

AND

RECTUM;

HARRISON.)

IN the following case colotomy was performed, with considerable temporary success, for the relief of recto-vesical fistula. James R-, aged fifty-three, was admitted on October

9th, 1877, suffering from

a

recto-vesical fistula of

a

malig-

nant nature. The disease appeared to have commenced in the rectum ten months previously. On admission the patient

’,

was in a very miserable and reduced condition. Within the rectum was a scirrhous ulceration, which communicated with the bladder by means of an opening, through which a largesized bougie could be passed. On introducing a catheter into the bladder there was first an escape of most fetid flatus, followed by urine containing fæces in considerable The patient was very severe pain, much of which was due to the suffering collection of flatus within the ladder. washing out of the bladder and rectum, in additionFrequent to various applications, failed to give permanent relief. After a consultation with his colleagues, Mr. Harrison opened the left colon, and made an artificial anus. The operation was effected without any

quantity.

any

anodyne

the gut being readily found. difficulty, The relief that followed most marked, all the more was

distressing symptoms

at

once

disappearing,

and for

some

directed backward, the internal condyle was sawn through. The tibia was then with moderate force readily put into a proper position, driving upwards the detached condyle, ready for union in its new position. All antiseptic precautions. The limb was kept in position by a long splint. were taken. No shock, or bleeding into the joint, or synovial effusion,or fever followed. Six weeks later the right knee was operated on in a similar way. The limbs retained an excellent position, and after a few weeks passive movements were made, the first time under chloroform. The man soon walked with. straight limbs and knee action, but it was found that some talipes equinus retarded easy progress. It was proposed to