MEDICAL SUPERINTENDENTS' SOCIETY.

792 pressure on the ureters for the last hours of life. The blood extended into the submucous tissue of the bladder, it also spread through the inguinal canal up on to the abdomen, chiefly on the left side as far as the ribs and nipple, forming a layer one inch thick and three inches wide. The liver was a typical hobnail cirrhosis. The kidneys were healthy, except for some The specimen was taken from a woman aged seaming. thirty-eight, admitted with oedema, pyrexia, and cough, who increasingly drowsy and died.

urine, probably from

twenty-four

became

MEDICAL SUPERINTENDENTS’ SOCIETY. AN interesting meeting of this Society Paddington Infirmary on April 13th.

In the wards the of Neurotic Caries; two cases of cases

following

Symptoms Chronic

cases were

was

held at the

discussed: Two

closely simulating Spinal

Cardiac Disease attended with Nocturnal Delirium; Pyo-salpinx removed by Abdominal Section; two cases of Myxcedema in the male; a case of Choroiditis Disseminata, which had undergone marked improvement under prolonged treatment by mercury, with remarks by Mr. J. B. Lawford; cases of Facial Paralvsis, Arthritic Amyotrophy, and Blenorrhagic Arthritis, and the resulting deformities ; and two cases of Hysteria in the male. Afterwards Mr. VICTOR HORSLEY made some remarks on the operation in cases of Traumatic Hemi-epilepsy, the advisability of liberally removing all cicatricial matter in such cases, and the most favourable position for trephining. Dr. T. E. HILLIER read a paper on five cases of Chronic Cardiac Disease attended with Delirium. Finally, Dr. SAVILL read a paper on two cases of Hysterical Spinal Disease, which illustrated how closely neurotic symptoms will sometimes resemble organic disease of the vertebral column, and the great difficulty and importance of making a correct diagnosis, seeing that the lines of treatment for the two diseases are so essentially diverse. The meeting was well attended by members and their friends, who took much interest in the proceedings.

ROYAL ACADEMY OF MEDICINE IN IRELAND. The Treatment of Tubercular Peritonitis by Abdominal Section and Flushing out, Without Drainage.—Suture of Patella. AT a meeting of the Surgical Section held on Friday,

Feb. 22nd,

Mr. O’CALLAGHAN gave three cases in his practice, and the statistics of this treatment up to the present. The case in which he previously recognised the disease was that of a boy, aged fifteen, presenting the following appearance: general emaciation; pale face; bright malar flush; hurried respiration; large distended abdomen, tumid yet symmetrical. He complained of dull colicky pain, never severe, but continuing day and night. Appetite gone; what little fluid he could take frequently vomited. Temperature 100°; pulse 98, and thready. On opening the abdomen, which was full of a sero-purulent milky fluid, the peritoneum and intestines were found to be covered with little nodules like millet seeds, and the mesentery was like the I I roe" of a fish. The abdominal cavity was flushed out with bloodwarm water from the tap, " meanwhile massaging the abdomen " until the water flowed out quite clear. The boy made a perfect recovery, and is now, ten months after operation, free from disease and doing his daily work. As to the pathology of the disease we are more or less ignorant. Mr. O’Callaghan looks upon it as a distinctly local form of degeneration as met with in joints and other serous cavities, and, if dealt with early in this manner, will be perfectly cured. As to the physiology of this method of cure we are entirely in the dark, and can only accept it as a fact. Diagnosis is not always easy, but we should, when meeting with a doubtful case, without hesitation make an exploratory incision, as even in simple ascites or malignant disease the result is often marvellous, and the operation, with ordinary precaution, has little, if any, risk. These are the first cases reported in Ireland, and may be the means of stimulating the profession here to give up the expectant and practically impotent medicinal treatment, and to recognise that those hitherto hopeless cases, if recognised early, are now curable by abdominal section, neglect of which must be looked upon in the future as a surgical

crime.--Mr. THOMSON congratulated Mr. O’Callaghan not only upon the result of his cases, but upon his courage in carrying out the operation in rather an isolated position. The difficulty which suggested itself, looking at the satisfactory results following incision of the abdomen and the washing out of the peritoneal cavity, was that similar

results did not follow the like process in respect of other Mr. KENDAL FRANKS said the subject of cavities. tubercular peritonitis and its treatment presented great difficulty. In his view, on seeing the tubercles on the peritoneal aspect so like the ordinary miliary tubercles, the disease was tuberculous, and microscopical examination had established that they contained the bacilli of tuberculosis. He regarded opening the abdominal cavity as a comparatively harmless operation.-Mr. W. THORNLEY STOKER, while advocating as strongly as anyone that the operation of opening the peritoneum for exploratory and therapeutic purposes should be undertaken more frequently than at present, objected to applying the term "tubercular" to disease of the peritoneum, unless authenticated by the discovery of the bacillus.-Dr. FRAZER observed that even the discovery of a bacillus under the microscope was not conclusive, as not being satisfactory evidence that it was a tubercular bacillus; for instance, there was a bacillus connected with leprosy, and there might be many other forms of that strange organism.-Dr. FITZGIBBON (the President) thought the arrest of the disease was due to the removal of the ascitic fluid, as being not only one of the products of tuberculai peritonitis, but as favouring the development of the disease. Even in cases of undoubted tuberculosis, the practice adopted by Mr. O’Callaghan was sound. As to the identification of the organism, in bis experience, where competent microscopists identified tuberculous bacillus the ultimate result had proved that they were right.--Mr. O’CALLAGHAN replied, mentioning two instances of the bacillus tuberculosis being found in the peritoneum. Mr. MYLES described a new method which he had devised, of extra-articular suture of the patella, to bring about bony union in transversefractures. The method consisted in passing a strong pin transversely through each fragment of the patella and then bringing these together by a figure-of-8 suture.Mr. MELDON, having seen Mr. Myles’ device tried, said the treatment afforded a fair prospect of bony union in the cases for which it was designed, a remarkable feature which struck him being the small force required to bring the parts together.-Mr. ORMSBY said he had taken such a fancy to Mr. Myles’ device that he would adopt it in his next suitable case of fracture of the patella. The treatment had one great advantage-t hat the pins did not pass into the joint. It seemed as if the skin was likely to be frayed by the figure-of-8 suture.-Mr. W. THORNLEY STOKER lid not agree in some of Mr. Myles’ propositions; for xample, that fracture of the patella meant generally )ermanent disablement. The result of the treatment by posture and coaptation produced by sticking plaster, adopted isually by himself and his colleagues in the Richmond Hospital, was generally the production of a perfectly useful limb. Vlr. Myles’ plan seemed a good one, and he would be inlined to adopt it as having certain advantages over Malgaigne’s, particularly as the purchase applied to the wo fragments was close to the seat of fracture. The real uestion was as to the method to be adopted in dealing Iriiiiarily with fracture of the patella, and that question ould only be answered when Mr. Myles’ plan received a rial; from the mechanical advantages it seemed to possess, e was himself disposed to tryit.-Dr. BALL concurred with ir. Stoker as to the proportion of cases of fracture of the atella, in which a fairly good result ensued from the treatment. An important factor as regards bony union was the natomical position of the patella. Callus, which united vactured bones, did not sprout out from pericsteum or bone iusele at all, but from connective tissue in muscle of the immediate neighbourhood of fracture. There was a very large amount of callus surrounding the bones on the aspects )vered by muscle, and very little of that was subeuA synovial cavity of a joint limited the formaneous. on of callus much more sharply, as in the neck of No bone was formed which could sprout into e femur. e joint; so that the only way in which union by bone ’ fractured patella could be got was by approximation the surfaces in the way Mr. Myles had pointed out.r. CORLEY did not think there was any great difference tween Mr. Myles’ plan and Malgaigne’s hooks.-Mr. HOMSON pointed to the illustrative case of fracture given -