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four, in the summer of 1889, gave his knee a wrench, andafter this he became liable to sudden attacks of pain, eitherwhen going down stairs or making other movements ofextension. The subjective sensation was described as beingas if something slipped out, and firmly grasping the kneegenerally put matters right enough to enable him to walk.The accident was getting very frequent, sometimes three orfour times a day, and his knee was never free from somepain. It was, however, never very acute. The patientwaswatched to see if there was any change in the appearance ofthe knee when he thought the cartilage was out, butnothing very definite was to be made out, this beingpartly due to his habit of instinctively pressing the kneeand making the movements which, by experience, hehad found were efficient to restore the joint to its ordinarycondition. A vertical incision, an inch and a half long, three-quarters of an inch away from the inner border of thepatella, and with its centre corresponding to the tibio-femoralline, was made down to the joint. The internal cartilagewas found separated at its anterior attachment and alongthe margin, being displaced into the centre of the joint. Itwas irregular, thickened, and crumpled. It could withdifficulty be brought up with the forceps to anything likeits proper position, and it did not seem feasible to obliterateits tolds or get it fastened in its place. Almost the wholeof the cartilage was then removed from the posterior attach-ment by the scalpel, there was very little trouble on takingit away and almost no bleeding. The joint, which hadonly one little blood-clot in its cavity, was syringed outwith 2 per cent. perchloride of mercury solution. A smalldrainage-tube was inserted within the lips of the incisedsynovial sac, which were not stitched together. The lipsof the wound were closed by fine sutures, and the wholepart was dressed in an aseptic manner. The after-historywas that the patient suffered hardly any inconvenienc fromthe operation; the wound was not dressed for a for taight,and when looked at was soundly healed (the drainage-tube Ihad worked out). He had now perfectly free movement,and but rarely any tenderness in the scar. His former sym-ptoms had disappeared.-Mr. HERBERT ALLINGHAM hadfound twenty-three of these cases on record. Eleven of thesehad parts of cartilage removed, while in the remainder itwas sutured to the head of the tibia. He advocated thisprocedure as preferable to wearing a knee truss, which wascumbersome and.uncertain in its action. He thought thesynovial membrane should in all cases be carefully suturedafter the operation.
Dr. ANGEL MONEY exhibited a child twenty-one monthsold with an Instrumental Indentation of the Left FrontalBone. The indented area was saucer-like, and measuredone inch and a half by one inch and a half. There were nointellectual, emotional, motor, sensory, or trophic sym-ptoms to be ascribed to the lesion, which the mother feltcertain was done at birth by means of instruments. Thechild was rather above the average intelligence for thistime of life.
Dr. ANGEL MONEY also showed a man, aged fifty, withthe following conglomeration of signs and symptoms:Double aortic disease, fibroid tortuous arteries, excessivelyhigh arterial tension, staggering gait, amblyopia, incipientoptic nerve atrophy, increased knee-jerks, right ankle-clonus. The exhibitor opined that the nervous leRionsmight be secondary to the arterial disease. The man hadworked for many years in lead, and there was a lead lineon the gums. Syphilis, lead, alcohol, and gout were
spoilers of arteries, and caused sclerosis of these structuresand of the nervous tissues. Dr. Money believed that thedoctrine of collocation of function and structure shouldreceive wider application; probably tracts of similarfunction suffered frequently together from the same sets ofcauses. The bloodvessels probably frequently led the wayto nervous diseases. The aortic disease might be due toperforating ulcers of the aortic valves-a favourite termwith some French authors.-The PRESIDENT had seen
several cases with this curious state of arteries. In oneinstance, which proved fatal from apoplexy, the lesion wasregarded as a paralysis of the vaso-motor nervous system.
WEST LONDON MEDICO-CHIRURGICALSOCIETY.
Treatment of Strumous Glands.AN ordinary meeting of this Society was held on Jan. 3rd,
the President, H. Campbell Pope, M.D., in the chair.
Mr. BERTRAM THORNTON (Margate) read a paper onOperative versus Therapeutic Treatment of StrumousGlands. He alluded to the records of the last fifty yearsat the Royal Sea-bathing Infirmary, Margate, which testifiedto the unsatisfactory and tedious methods of treatmentprevailing up to within the last few years. Havingreviewed the various modes of treating enlarged glands intheir different stages, such as erosion, by poultice, iodinepaints, mercurial ointments, calcium sulphide, &c., injec-tions of various drugs, and applications of strong caustics,he pointed out that whatever action these methods had inthe diseased glands, the process was very tedious and un-certain, and the resulting scars most unsightly. Anoperative experience of about a hundred cases of variousdegrees of magnitude led him to urge the excision ofevery enlarged gland or part of a gland after a reason-able period (say, six or eight months) of constitu-tional treatment and change of air to the seaside.Modified operations, such as scooping, aspiration, small
punctures with drainage, were nearly always unsatisfactory,as diseased gland tissue was left behind. Hitherto he had,fortunately, had no death or serious complication to record,and the vast majority of ca<-es had healed rapidly. Heclaimed for the method of excision that many months oftedious treatment were saved, the resulting scars were lessunsightly, and that the operation, if performed with skill andcare and in good hygienic surroundings, was usually satis-factory.-The PRESIDENT asked if tuberculosis had not beenfound to follow operations for the removal of glands, andwhether there was not danger of the disease spreading in otherorgans.-Mr. EDWARDS agreed about the importance ofdrainage, and thought that this should be done not only byhorse-hair and catgut, but by drainage-tubes.-Dr. ALDER-SON said he would sometimes use hot fomentations withpoppy water if there was no doubt that an abscess in agland would have to be opened.—Mr. KEETLEY thought
: that when a chronic enlargement of a gland, not syphiliticpersisted in spite of sea air &c., the sooner it was excisedthe better, and that the dangerous and difficult cases werethose in which the radical treatment had been procrasti-
: nated.—Mr. LLOYD thought it remarkable that the casesj mentioned should have healed so rapidly, considering what! their constitutional disease was.-Dr. ECCLES pointed out
the influence the air of Margate must have had on theB course of the cases.—Mr. THORNTON made some remarksl in reply.
Mr. KEETLEY described, with diagrams, a mode of, amputating at the ankle-joint for intractable circular ulcer
of the leg, in which the skin and deeper soft tissues of theL dorsum of the foot were transferred to the back of the leg,) as well as the sole of the foot to the shin (as in the case- published by him in November, 1885).b Mr. PERCY DUNN showed a pathological specimen of
a Perforating Wound of the Heart caused by a FracturedRib ; also an Enlarged Lateral Lobe of the Prostate withUlceration.
i Dr. CLEMOW showed the Meninges of a Brain with: Intermeningeal Haemorrhage.
MEDICAL OFFICERS OF SCHOOLS’ASSOCIATION.
A GENERAL MEETING of this Association was held at therooms of the Medical Societyin Chandos-street, on Jan. 15th,the President, Sir William Savory, Bart., in the chair. Theproceedings commenced with a discussion of the questionas to the advisability of the return of boys to the publicschools at the usual time, in view of the still prevailingepidemic. It was generally admitted that schools situatein London, and perhaps in some other large centres ofpopulation, occupied a somewhat exceptional position in thisrespect at the present time ; and, indeed, it was understoodthat some such establishments were practically unable tomeet the requirements of ordinary school life, owing to theprostration of a large proportion of the staff of servants&c. by influenza. On the other hand, it was felt that theextension of the holidays by a week or so only could, inthe case of schools situated in country districts, not beexpected to have much effect in the way of preventing theintroduction of the malady, or even its development intoepidemic proportions; and it was stated that this was thedecision which the authorities of the great majority ofpublic schools had already adopted. The following resolution