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statistics of such cases, for the following reasons:-1st, the Ipatient is a woman of middle age only; 2nd, her health is verygood; 3rd, there is no hereditary taint in the family; 4th, theprogress of the growth has been very rapid; 5th, none of theaxillary glands are enlarged.

Medical Societies.

ROYAL MEDICAL AND CHIRURGICAL SOCIETY.TUESDAY, NOVEMBER 27, 1849.—DR. ADDISON, PRESIDENT.

THREE fellows were elected, and one proposed.ON THE SECTION OF THE TENDO-ACHILLIS IN SOME CASES OF

FRACTURE OF THE BONES OF THE LEG. By CAMPBELL D.EMORGAN, Surgeon to the Middlesex Hospital.

After referring to the operation of tenotomy, as practised notunfrequently on the continent in cases of fracture, whereunusual difficulty is experienced in reducing and keepingquiescent the fractured ends of a bone, the author relatedthe following cases illustrative of this practice, where thetibia and fibula were the seat of injury,and the tendo-Achillisthat of the operation. He believes they are the only in-stances thus treated in this country. The first case is fur-nished by Mr. Shaw, in whose practice it occurred:Ň’W. S-,aged forty, was admitted into the Middlesex Hospital onFeb. 12, 1847, having fallen down stairs in a state of intoxica-tion. Both bones of the leg were broken, and the fracture ofthe tibia extended through both malleoli, the foot beingtwisted outwards. Violent spasms of the muscles frustratedall attempts to keep the fractured extremities of the bones inapposition; the slightest movement brought on this spasmodiccontraction, which extended to all the muscles of the limb, soas to cause great distortion of the foot, and render the skinover the base of the tibia extremely tense. All the symp-toms continuing unabated on the following day, and the suf-fering of the patient being considerable, Mr. Shaw deter-mined on dividing. in the usual way, the tendo-Achillis, whichwas very tense. After this, all the difficulties entirely ceased,and no further trouble was experienced in the treatment of I.the case. The second case occurred in the author’s own prac-tice. The patient was a female, aged sixty-six, of drunkenhabits, and was admitted into the Middlesex Hospital inMarch, 1849. She had been knocked down by a cab, andboth bones of one leg were fractured a little above the ancle.The symptoms and condition of this patient were very similarto those of the last, and every mechanical and therapeuticmeasure which could be suggested to relieve the spasms weretried in vain. The author divided the tendo-Achillis on theninth day, with instant relief to the suffering of the patient,and immediate removal of all untoward symptoms. In lessthan a month, the chasm left after division of the tendon,which was not very great, had disappeared; and, a fortnightsubsequently, she was able to walk on crutches, and the footwas free from deformity. After some general remarks on thevalue of the operation in the foregoing cases in relieving suf-fering and spasm, the author proceeded to remark that hethought so simple and harmless a proceeding as dividing thetendo-Achillis might be adopted with advantage in othercases of more frequent occurrence, especially as the curewould not thereby be retarded. He concluded with noticinga remark of M. Bonnet’s, that he has frequently divided thetendo-Achillis in cases of diseased ankle-joint, where rest wasimperative, and the heel was drawn up by the muscles in-serted into it.Mr. B. PHILLIPS said, that the paper was one of much in-

terest, as it referred to the treatment of fractures and injuriesof joints. The plan mentioned in the paper had been adoptedin Germany and France to some extent; he trusted, however,that it would never meet with the same reception fromBritish surgeons. Cases might occur in which the division ofthe rectus in fracture of the patella, or of the triceps for frac-ture of the olecranon, might be resorted to harmlessly, orusefully employed, where difficulties presented themselves intreatment, but, on the contrary, these operations might beresorted to where no necessity for the proceeding might exist.The propriety of the operation, however, under any circum-stances, might be questioned. Let us look at the effect ofthe division of a tendon when of the proper length, as it wouldbe in the cases in which it was proposed to divide it. Im-mediately, on section, the cut ends of the tendon separatedto the extent of half an inch or more; this was usually thecase, and in the instances recorded in the paper would appearto have occurred; a large space would thus have to be filled

up by the deposit of new matter, and the tendon would beelongated. This occurred in cases where the tendo-Achilliswas divided for retraction of the heel. "Vhen the tendon,before operation, was of the normal length, he feared the sameresult would follow as occasionally took place when the tendo-Achillis was ruptured by accident; the tendon would be solong that the heel could never be lifted from the ground.The late Justice Taunton ruptured the tendo-Achillis whendancing, and was lame ever afterwards; he could not raise hisleft heel. He feared this kind of result would render theoperation at best but doubtful, though this elongation did nottake place in the cases under discussion.Mr. LONSDALE had had some experience in the division of

tendons for the cure of deformities, and he had no such fearas that expressed by Mr. Phillips, that the tendon wouldbecome elongated on incision after division; on the contrary,his fear was, that it would be too short, and that union wouldbe too rapid if proper extension were not kept up. In caseswhere the muscles were paralyzed and weak, the tendonafter division might certainly become elongated, but not sowhen the limb was healthy. If the parts were kept properlytogether, no unnatural elongation would occur.Mr. AVERY had seen many preparations, in which tendons

had beerr divided, and the union was so close that it wasdifficult to determine where the section had been made.Mr. DE MORGAN observed, that in the cases related, the

chasm between the divided portions at first did not exceed aquarter of an inch, that being sufficient to get the bone intoposition, and in a short time after there was no appreciablespace at all. From what he had seen of -the division oftendons when divided subcutaneously, he had no fear of theirbecoming lengthened. The cases in which tendons werelengthened from rupture by accident bore no analogy what-ever to the cases lie had related. He should not hesitate,after what he had observed, to perform the operation in casesof less severity than those detailed-even, indeed, to save twoor three nights of pain or uneasiness to the patient. Heshould not hesitate to divide the tendo-Achillis in cases offracture of the lower ends of the tibia and fibula, where therewas much spasm, even though that spasm might be relievedby splints or other apparatus.Mr. CHARLES HAWKINS considered that the operation under

discussion might be usefully employed in some cases ofinjury, in which neither fracture nor dislocation was present,as well as to relieve some of the urgent symptoms which occa-sionally presented themselves during the first few days incases of fracture and dislocation. He had no fear that thetendon would become elongated. The plan, he thought, mightbe advisable in certain cases of fracture of the patella, whichwas an accident, as a general rule, reflecting less credit on thesurgeon than almost any other. The limb was scarcely ever auseful one after that accident. This arose, no doubt, from thedifficulty of keeping the ends of the divided bone in apposition.He had seen but one casein which bony union had followedfrac-ture of the patella, but in this case the other patella hadbeen afterwards broken, and lameness was the result. A casehad presented itself to him the other day, in which it appearedto him that division of the tendo-Achillis might have been ofadvantage. A lady, about eighteen months ago, becamealarmed whilst driving along a country road, and jumped outof the carriage. She walked a considerable distance after-wards, but on reaching home complained of severe pain in theankle-joint, to which several applications were made, withoutaffording her any relief. It remained stiff, painful, and’use-less, and the advice of the late Mr. Key was sought. Amongstother applications, caustic around the ankle was ordered, thecauterized surface to be kept open. He (Mr. Hawkins) sawthis patient about a month ago. The ankle-joint was unin-jured, but the tendo-Achillis was so contracted that she couldnot put her heel to the ground, and was obliged to walk on hertoes. There was great pain, which was relieved on the footbeing straightened. No kind of apparatus had been of ser-vice. Might not division of the tendo-Achillis in this caserelieve the spasm ? He thought, at all events, the trial shouldbe made.Mr. LE GROS CLARKE did not think that the profession gene-

rally would agree in the remark of Mr. Hawkins respectingthe lameness said to follow fracture of the patella. He didnot regard the division of the ligamentum patella as so un-important as some seemed to think it, recollecting its conti-guity to the knee-joint; and he questioned even its utility; forsupposing that it did assist us in keepingt he divided portionsof bone together, the tendon would elongate in proportion, sothat what we got in one direction we lost in another.

Mr.LLOYDD, with respect to the question as to whether union

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was close after division of tendons or not, would answer, thatin general the union was close. At first some space wouldexist, but it gradually got less until it would be almost inap-preciable. He could understand, that in some cases of frac-ture division of tendons would be serviceable, when, from thepowerful action of the muscles, the ends of the divided bonecould not be brought and kept together. He had neverdivided the tendo-Achillis for this purpose, but he had sug-gested it. He was somewhat astonished at the remark ofMr. Hawkins respecting the results of fracture of the patella.The accident was a very common one; so far as he knew, allthe patients he had seen recovered with good limbs, and could,after a time, walk well. He recollected the case of an oldgentleman who fractured both patellas: he was confined to oneposition for some time, but he eventually recovered andwalked well. Younger persons usually walk as well after asbefore the accident. A gentleman, a good shot, and a greatwalker, fractured his patella from a fall; the accident was notdiscovered for some time, as his leg was broken by the sameaccident. When the fracture of the leg had united, thedivided portions of the patellae were found three inches apart.Contrary to expectation, at the end of a few months he walkedas well as ever. When he (Mr. Lloyd) was first a student,the divided portions of patella were attempted to be broughttogether by force; the result was, inflammation of the tissuesof the joint, and occasionally lameness; but now such untowardresults were not to be looked for. He had seen bony union ofthe patella in only one case, though he had seen the boneunited after being broken into several pieces.Mr. CHARLES HAWKIINS, in his observations, had referred to

cases of fractured patella after they had left the hospital.When they left the care of the surgeon, they seemed well;but when the muscles were used and acted on the bone, thespace between the divided bone became elongated, and thelimb was used with difficulty. He mentioned the case of acountry gentleman in whom this had occurred, no apparatus,except a very cumbrous one, being of service. He had seena case of bony union of fracture of the patella consequent

upon a blow from a wheel. Inflammation of the joint fol-lowed ; no apparatus was applied; the leg was kept in theform of the letter V.; and recovery, with bony union, tookplace. The other patella was subsequently fractured: bonyunion did not occur, elongation took place, and the motions ofthe limb were interfered with.Mr. BAINBRIDGE (Tooting) had some years since seen an in.

strument, which was invented by the late Mr. Earle, fortreating fractures of the patella. He now used this instru-ment in cases of this accident: the patient walks about withit, after a few days, and never suffers from injury to themotion of the leg. Such injury, he believed, arose from bind-ing the limb too tightly. He had seen cases in which thelimb was bandaged from the toe to the hip. He related acase, in which the ends of the divided bone were three inchesapart, and yet the patient, a heavy man, walked well andfreely. He related another case, in which the knee-cap wasin the middle of the thigh, and the man walked about well.He had used Earle’s apparatus.Mr. HODGSON said, that generally, after tendons had been

divided, they were shortened. He might mention, that insome cases in which the tendo-Achillis had been divided fordeformity, he had found the use of complicated apparatus toretard the cure, by producing sores and other inconveniences.In cases where section of this tendon had been resorted to, hethought it better to employ passive exercise of the parts; andwhen able to bear it, to stand on the leg, and swing itbackwards and forwards. In all cases of fracture of the

patella which he had had an opportunity of examining afterdeath, the union had been by cartilage or ligament. He hadnot seen a single instance where the fracture was longitudinal,of bony union. The ligamentous union was, he thought, toserve a good purpose; for were the union osseous, exudationsfrom the bone might interfere with the motions of the limb.He had seen two or three cases, in which the tendon above ’,the patella had been ruptured, and a chasm was left after- ’’,wards, into which three fingers might be placed. This re- ’,mained for life, to the great inconvenience of the patient. IMr. LONSDALE considered that.the shorter the ligamentous

union between the divided portions of the fractured patella, Ithe better it was for the patient; for the longer it was, the Imore difficulty he would have in walking. So long as the Iupper portion of the patella lay within the trochlea of thefemur, the limb would be tolerably useful; but when above it,not so.Mr. LLOYDD said, that in cases of fractured patella, he was

in the habit of placing a splint at the back of the leg during

the progress of cure and some time afterwards; this he regardedas beneficial in keeping the divided portions of bone to-

gether.Mr. ERICIISEN thought the Society greatly indebted to Mr.

De Morgan for having pointed out so simple a means to enablethe surgeon to obtain proper command over the foot in casesof fracture of the leg. Every surgeon must have experiencedgreat difficulty in the treatment of oblique fractures of thetibula and fibula low down, from the inability to keep the footin position, in consequence of spasm of the muscles of the calf,and if section of the tendo-Achillis removed this, it was cer-tainly a justifiable procedure. There was one class of injuriesthat had not been adverted to this evening, in which sectionof the tendo-Achillis had been advantageously resorted to-hemeant disfocations of the astragalus forwards; and its employ-ment in these cases was one of the many improvements insurgical practice for which we were indebted to the modernschool of Dublin surgeons. In the cases he alluded to, reduc-tion was prevented in consequence of the impossibility of dis-entangling the upper surface of the calcareum from the arti-culating surface of the tibia against which it was jammed by thespasm of the strong muscles of the calf. Now in these cases thetendo-Achillis had been divided with the view of removing thisspasm, so enabling the surgeon to obtain command over thefoot and to reduce the astragalus. It had been done success-fully in Dublin, but he was not aware that the operation hadbeen practised in this country, except in one case in the pro-vinces, that had been mentioned to him by his friend Mr.Cadge.Mr. SHAw recollected a case, under Mr. Arnott, of simple

dislocation of the astragalus. The tendo-Achilliis was divided,and chloroform administered, but reduction could not beeffected, and it was found necessary to excise the bone.CASE OF MONSTROSITY. By JAMES BOWER HARRISON,M.R.C.S.E.,

formerly Surgeon to the Ardwick and Ancoats Dispensary,Manchester.

(Communicated by DR. W. VtiSALIUS PETTIGREW.)The author was called, on the 10th of January, 1849, aboutseven o’clock in the evening, to attend a poor woman who was,in labour. On making a vaginal examination, he found themembranes protruded in a pyriform tumour, but could notdetect through them any part of the child. After the mem-branes had burst, he made a further examination, and felt asoft tumour presenting, which resembled the bag of mem-branes before it had ruptured. Passing his hand around thetumour, he at length discovered a hard substance partiallyconcealed between the tumour and the parietes of the uterus.This hard body was a distorted leg and foot. A ligature waspassed round the foot; ergot of rye was given; the pains, be-fore feeble, became stronger; and, with the aid of slight trac-tion, the foot was now brought down, when a finger passed upto the top of the thigh felt a substance which resembled thebody of a child having only one leg and no organs of genera-tion ; the soft mass being still felt. After some time, thewhole mass, with the distorted body of the child, descendedand came through the os externum. The foetus was a mon-strous growth. The soft mass was found by a hernial pro-trusion of the abdominal viscera, owing to deficiency of theabdominal parietes below the umbilicus. The navel stringhad become detached. The right leg was directed trans-versely, and the foot curved inwards. The left leg was pushedupwards, out of its proper position, by a second tumour, thesac of a spina bifida, the left foot being curved like the other,The ossa pubis were deficient, as well as the spinous andtransverse processes of the lower vertebrse, and the posteriorwalls of the sacrum. The genital organs were imperfect; thehead, shoulders, arms, and chest, were all natural. Somelittle time having elapsed, the placenta was removed withthe hand; the whole being accomplished by about ten or half-past ten o’clock: the mother did well. The author regardsthis case as having considerable interest in an obstetricalpoint of view; particularly as regards the presentation of asoft tumour in the manner described. (A good drawing byMr. Stephenson, was exhibited, which showed the distortedform of the foetus.)

MEDICAL SOCIETY OF LONDON.

MONDAY, DEC. 3.THE Society was engaged, this evening, in discussing some

points regarding its internal management. The questions ofremoval, the annual election of a new president and other im-portant matters, were discussed.