156 NORTH-WEST LONDON CLINICAL SOCIETY.

case. The patient was ultimately discharged as cured, andthere was no trace of disease anywhere. With regard to thesecond case, he thought it was very difficult to account forthe rotation. If in his third case he had tried to find thesource of the bleeding he felt sure he would have lost hispatient ; even flushing the abdomen was sometimes followedby shock.

Mr. FREDERICK EVE described a case of Acute IntestinalObstruction from Gall-stone, with Laparotomy, Removal ofStone, and Recovery. A man forty-two years of age wasadmitted to the London Hospital on March 19th, 1894.Four days previously he had been attacked with pain in theabdomen, vomiting, and absolute constipation. The vomit-ing was continuous. Nothing was ascertained by palpation.He denied having had previous abdominal trouble. Bella-donna was prescribed and a large enema given, after whichhe passed a small fluid motion and felt easier. The nextmorning he was worse and the abdomen more distended.On March 20th laparotomy was performed. When theabdominal muscles were relaxed under ether a hard bodyfeeling like a rifle bullet could be felt in the right iliac fossa ;this was evidently an impacted gall-stone. It was exposedand was found to occupy the ileum two or three inchesfrom the ileo-cascal valve. The small intestine abovethe obstruction was considerably distended. The largeintestine was completely empty. The ileo-cascal orificewas brought into view and an attempt made to

push the calculus through it, but unsuccessfully. Thecalculus was then worked up the ileum into a free

loop which could readily be brought outside theabdomen, and after applying elastic ligatures above andbelow it was extracted through a longitudinal incision. Thiswas closed with Lembert sutures of fine silk, a graft ofomentum was attached, and the intestine replaced in theabdomen. Rectal alimentation was maintained for four days.The further progress of the case was uneventful, and thepatient left the hospital after being in it about four weeks.After the operation it was elicited that eighteen yearspreviously the patient had been subject to severe attacks ofpain in the epigastrium, sometimes accompanied withvomiting. For seven or eight years he was never entirelyfree from pain, but about once a week had a severe attack.Ultimately the pain and attacks of vomiting ceased quitesuddenly. He had never passed a gall-stone. This troublemight be referred to the presence of a biliary calculus in thegall-bladder aid the sudden cessation to its passage into theduodenum; so that it might be inferred that the calculus hadoccupied the intestine for some ten years-a circumstancenot without precedent. The calculus was cylindrical inshape and its circumference was three inches and a

quarter. Mr. Eve remarked that at first the result oflaparotomy for this apparently simple form of obstructionwas by no means encouraging. Writing in 1889, Dufourtcollected nine cases, all of which proved fatal except one inwhich the stone was slipped into the large intestine. Mr.Eve had collected eighteen cases occurring subsequently tothis period, of which (after incision and suture of the

intestine) nine recovered. This advance might be attributedto improved surgical technique, for operative interferencewas not longer delayed in the earlier than the later groupof cases. In conclusion, the following suggestions weremade with regard to treatment :-1. When a diagnosiswas possible expectant treatment should be tried, as one-third of the cases of marked obstruction from gall-stonerecovered without operation. 2. But operative interferenceshould not be long delayed, as the patients were nearly allaged, the mean age being sixty-four years. 3. After openingthe abdomen the calculus should, if possible, be forcedthrough the ileo-cascal valve. 4. If the calculus be immovableor at a distance from the valve, and the intestine healthy,the stone should be excised. 5. When the intestine wa!inflamed, and the stone immovable and adherent to it.an attempt might be made to break the calculus up witineedles. This failing, it should be extracted, the intestinofixed to the abdominal wall near the wound, and surrounde(with iodoform gauze. 6. In only one case out of twentyseven was it found necessary to resect the intestine of

account of ulceration.-The PRESIDENT observed that alwould probably agree with the conclusions formulated b;Mr. Eve.-Mr. MAYO ROBSON fully concurred in the utteimpossibility of making any diagnosis in cases of obstructionby gall-stone.-Mr. EvE replied.

Mr. J. W. BROWNE recounted a case of Empyema associateswith Hydatids of the Liver.

NORTH-WEST LONDON CLINICAL SOCIETY.

EErythematous Ulceration of the Extremities. - HereditaryCongenital Spastic Paralysis.-Nævi cicred spontaneouslyand by Electrolysis.-Malformation of Chest.-MultipleOsteotomy for -Deformity. - Exophthalmos. - Myelitis.-Hæmatoma of the Pinna.-Hallux Rigidus.-Polypus of,the Frontal Sinus.

A MEETING of this society was held on Jan. 9th, Mr. F.DURHAM being in the chair.

Mr. JACKSON CLARKE exhibited a boy suffering from.Ulcers on the Hands and Legs, pain in the knee, and cold-ness of the extremities. Bazin’s and Raynaud’s diseaseswere discussed, and Mr. Clarke distinguished the present asan unusual form of erythema iris.

Dr. GUTHRIE showed two of three children in a familyaffected with Hereditary Congenital Spastic Paralysis. Healscshowed the father, who had exaggerated knee-jerks, ankle-clonus, and a spastic gait. Tne mother and two otherchildren were healthy. This disease in early infancy wasthought to be rare.-Dr. CAGNEY believed the disease to bemore common in very young children than was supposed.-Dr. GILL spoke of similar cases under his care.

Mr. NATHAN showed the remains of a Congenital Nasvusof the Scalp. There was left a patch of atrophic skin nearlybald. The case had been mistaken for ringworm. He alsoshowed a Nsevus of the Pinna which had been electrolysed.-Mr. CLARKE thought that the first case was unique and ofexceptional interest.-The CHAIRMAN discussed the treat-ment of nævi.

Dr. HARRY CAMPBELL showed an extreme instance ofBarrel Chest in a man with Emphysema, and pointed out themanner in which this deformity affected the circulation.

Mr. JACKSON CLARKE exhibited a girl in whom both theFemur and the Tibia had been submitted to Maoewen’sOsteotomy Process. The result was good, and as the musclesdeveloped there would be a satisfactory cure.-Mr. BRODIE,commented on the case.

Mr. GORDON BRODIE showed a boy with Exophthalmos.The cranial bones were enlarged and the chest misshapen.The upper part of the sternum projected backwards and pressedon the trachea. The child had adenoids.-Dr. CAMPBELLindicated the high palate and the facial expression, whichclearly indicated nasal obstruction. He had no doubt thelatter had influenced the development of the entire cranium.-Mr. JACKSON CLARKE believed that the shape of the headwas due to mechanical causes in utero.-Mr. CoALL thoughtthat the efficacy of nasal obstruction in causing remote

changes was overrated.-Dr. CAGNEY regarded the deformityboth of the head and of the chest as typical of rickets, and’he referred to the constant association of adenoids with thatdisease.

Dr. HARRY CAMPBELL showed a case of recovery fromMyelitis, and he advocated the use of blisters in this andother acute spinal diseases.-Mr. CoALL spoke also of the

efficiency of blisters combined with ergot in acute spinaldiseases.

Mr. JACKSON CLARKE showed a case of Hæmatoma of thePinna. There was no associated psychosis. The tumourgrew and pain increased. He, therefore, proposed to

operate.-Mr. BRODIE and Mr. RiDLEY commented on

the case.Dr. ATKINSON (for Mr. MAYO COLLIER) showed a case of

Hallux Rigidus and also one of Polypus of the Frontal Sinus.

CAMBRIDGE MEDICAL SOCIETY.

Fibroid Ticmour of the Vterus removed per Vaginam.-Guns7tot Wound.-Salicylates in Acute Rheumatism.

A MEETING of this society was held on Dec. 7th, 1894,Mr. HYDE HILLS, President, being in the chair.The PRESIDENT exhibited a specimen of a portion of a

Large Fibroid Tumour which he had removed per vaginamwith the écraseur. The notes of this case he had broughtbefore the society on a previous occasion.

Mr. WHERRY showed a young man who shot himself acci.dentally seven weeks previously. Holding a gun by the muzzlein the right hand, a charge of small shot entered the arm atthe level of the axillary fold and shattered the humerus intomany fragments, not injuring the artery or trunk nerves..