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the wound ; fluid had accumulated in the joint, and had tobe let out, but the leaving a tube in for twenty-four hourshad obviated this.The PRESIDENT was exceedingly struck with the results

of these cases, though he admitted that they still left openthe great question whether the operation was necessary.He himself had never seen a case of cure after excision haveso good a result as one after natural cure. In the latterthe limb appeared to be firmer, stronger, and formed amore useful organ of progression. He admitted, however,that there was a greater promptitude of cure after opera.tion. He confessed that he still looked upon the bacillarytheory with scepticism.Mr. BARKER, in reply, said he was prepared to main-

tain everything he had stated in his lectures, but hewished them to be taken in their entirety. In startingthis new procedure lie deferred to those who were his

seniors, and he had therefore left these cases for a longertime. He waited, in fact, to give them a chance to resolveor to become so ameliorated that the operation might bepostponed. What the functions of the limbs would ulti-mately be must be left till later, and he thought it pre-judging the cases to analyse them too carefully in thatrespect at present. His method he had published indetail, and he regarded the action of the water as purelymechanical. He considered that the presence of abscesswas a strong presumption that the bone was extensivelydiseased, and the acetabulum could not be fully dealt withwithout removing the head. Practically he had found thehead, in many of the cases, gone, or all but gone. By"excision" he meant a very modified procedure, simplycleaning from the surface of the bone that which had beenmuch diseased or almost destroyed.

CLINICAL SOCIETY OF LONDON.

Defective Development of Tlaoracic and Abdominal Walls.-Functional Paraplegia.-A " Woodlouse-shaped Child.- -Congenital Deformity of Knee -Hereditary MultipleExostoses.-Old Dislocation of both Radii.-Mixcd Sub-maxillary Enchondi-oma.-litbercular Peritonitis andDouble Pleurisy.A "CLINICAL" meeting of this Society was held on

Oct. 24th, Dr. CHARLTON BASTIAN, Vice-President, beingin the chair.

Dr. SIDNEY PHILLIPS exhibited an infant aged five weekswith a protrusion of the intestine, absence of xiphoid car-tilage, and partial protrusion of the heart with each systole.

Dr. ELWIN HARRIS showed a case of Functional Para-plegia of ten years’ duration in a man aged seventy, whichgot quite well under treatment. It was associated withanaesthesia, and followed exposure to cold.Dr. BARLOW showed a little " Woodlouse-shaped " Child,

aged two years and three-quarters. It presented a mostremarkable kyphosis, and there was considerable mobilityin the lumbar region, It walked on its elbows and knees,and its mode of progression was not unlike that of a wood-louse. There had been fibrous ankylosis of the knee-joints,but these had been reduced under chloroform. The patho-logy of the condition seemed to be extremely obscure, butthere might have been malposition in utero. Dr. Wilson ofLeytonstone showed a similar case two years ago.Mr. WATSOX CHEYNE showed a case of Congenital

Deformity of the Knees. The patient was a girl agedthree years, and presented dislocation of both tibiae forwardsupon the femora. In her mode of progression she somewhatresembled a seal.

Mr. C. COTES showed a case of Hereditary MultipleExostoses. The father had had bony growths as long as hecould remember, but they had given him no inconveniencetill five years ago, when he began to suffer from sciatica,and he found that a lump at the upper and back part of theright femur was increasing in size. On examination it wasfound that he had exostoses at the extremities of his longbones, and on his ribs and scapulae. He had three daughtersand two sons. All except the younger son showed nothingunusual. The latter had exostoses on his long bones andon both his scapulae. His mother stated that one of thelumps on his left scapula was rapidly increasing in size.Mr. W. G. SPENCER exhibited a girl aged thirteen with

old Dislocation of both her Radii. The head of the leftradius was obviously dislocated backwards, while the posi-

tion of the head of the right was more doubtful, but hethought it was displaced slightly forwards. There was nc<

evidence as to whether it was congenital, or had beenacquired early in life. Her mother said that the conditionhad certainly existed before the child was six years old, andshe never to her knowledge had met with an accident.Mr. LANE read a paper on a case of mixed Enchondroma

of the Submaxillary Gland which had been recently underhis care. It occurred in a man aged thirty-six, and it hadbeen noticed for four years. It was intimately connectedwith the submaxillary gland, which had to be dissectedfrom its surface. His object in bringing the case beforethe Society was to obtain the experience of others as to itssupposed rarity.&mdash;Mr. PARKIN had been over the records ofGuy’s Hospital for the last ten years, and had discoveredfour cases of submaxillary chondroma, including that nowrecorded. During the same time nineteen cases of parotidchondroma were met with. There were also two cases oftrue sarcoma of the submaxillary gland. An investigationof their sex and age did not throw much light on the pre-disposing causation, for two were males, aged thirty-six andtwenty, and two were females, aged fifty-two and twenty.In one of the cases the growth had been noticed for sevenyears, in two for ten years, and in one for four years. Hehad examined two of the cases microscopically, and theywere precisely like the mixed parotid chondromata.-Mr.ROGER WILLIAMS said that relatively to parotid tumours.these growths were rare. They were often found, not inthe gland, but in its vicinity.--Mr. PEARCE GOULD hadremoved a slowly growing tumour from the submaxillaryregion of a woman in the Middlesex Hospital at the earlypart of this year. It presented a precisely similar structureto the one now recorded.Dr. FINLAY gave the clinical history of a case of Tuber.

cular Peritonitis and Double Pleurisy, resulting in recovery.The patient, a youth of seventeen, by occupation a barman,came under his care in Middlesex Hospital on Oct. 26th,1888. There was an indefinite history of consumption insome relatives on the mother’s side and of a slight attackof ascites with whooping-cough in his own case whenonly three years of age, otherwise he had always enjoyedgood health and been sober. Nine days before admissionhe began to suffer from some abdominal pain and swelling.The latter condition gradually became more marked, andon admission he was found to have a considerable amount,of ascites, the abdomen measuring 34 in. in girth at the levelof the umbilicus. His temperature was 100&deg;, pulse 120,and respiration 24; tongue rather dry and coated. In thechest at both posterior bases there was impaired resonancewith diminished vocal fremitus and scarcely audible breath,sounds. At the line of commencing dulness on the leftside faint friction sounds were present. The area of dul-ness, especially on the left side, gradually increased forabout a fortnight, the friction sound became more marked,he lost weight and sweated at night. For a few days atfirst the ascites also increased, the girth of the abdomenmeasuring 38 in. on Nov. 2nd, but it soon began to

diminish, and by Nov. 13th the girth amounted only to321 in. The temperature also at this time was noted tohave been normal or subnormal, with only one exception,for several days, having previously ranged between 992&deg;and 1032&deg;. On Nov. 30th the ascites had disappearedaltogether, and the pleural effusion was rapidly declining.Coarse friction sounds were heard over the lower half of theleft chest, but these soon cleared up, and he continued tomake steady progress in convalescence. On Jan. 30th, 1889,lie was sent to a seaside convalescent home. The abdomenpresented a dilfused sense of resistance on palpation over itslower half, suggesting matting together of portions of thein-tegtines; while in addition masses of more definite characterwere felt in the left upper umbilical and iliac regions andin the right lower umbilical region. After three weeks’residence at the seaside he returned to his work, and pre.sented himself for examination at the hospital on March 13th,when it was found that the masses near the umbilicus wereless plainly felt than formerly, and that one in the left iliacfossa had disappeared. He had gained lOlb. in weight, andthe condition of his chest was quite satisfactory, presentingnothing abnormal except slight impairment of resonanceand weak breathing for a couple of inches at the posteriorbases. The case was brought forward not because therewas anything unusual in recovery from tubercular peri-tonitis, but to accentuate the fact that the reverse was thecase, recovery being much more frequent than had been,

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commonly thought, especially by the older writers. i ne

statements made by various writersin text-bookson medicinewere quoted, and statistics given of thirty- five cases occurringin the Middlesex Hospital, of which nineteen were dischargedas recovered or relieved. Reference was also made to a paper’by Dr. Osler of Johns Hopkins University, in which a similar’l’iewwas taken to that put forward in connexion with the pre-sent case as regards the prognosis in tubercular peritonitis.-Dr. CHARLTON BASTIAN referred at some length to thestrange anomalies of distribution of tubercle through thebody, and these were all the more difficult to understandwhen it was remembered that some very competent autho-rities believed that the disease was solely acquired by con-tagion. In some cases in which intra-abdominal tuberclewas abundant and of long standing it was wonderful that itremained localised, and did not disseminate.-Dr. BURNEYYEO, in support of Dr. Finlay’s proposition that this lesionwas curable, referred to the case of a boy, aged eleven, whowas introduced to his ward at King’s College Hospital withascites. The diagnosis of tubercular peritonitis was sup-ported by the facts that one of the surgeons had recentlyTemoved a tuberculous deposit from his cheek, and that histemperature was characteristic of the malady. He con-ceived that the treatment which was adopted had some-thing to do with the favourable result which followed. Thelad was given iodoform with cod-liver oil internally, andiodine was rubbed in locally. Tubercle of the peritoneumran a different course and had a different history fromtubercle elsewhere-for example, in the lung,-and thismight perhaps be due to the fact that air was excluded.Even if we came into possession of an absolute cure fortuberculosis, still many cases of pulmonary phthisis wouldTemain unbenefited, for the morbid lesions which took placein the lung in connexion with tuberculosis were for themost part irremediable.-Mr. WILLIAMS was convinced thatthe prognosis of pulmonary tubercle was often given too’1lllfavourably, and he had arrived at this conclusion frompost-mortem experience. Obsolescent tubercular lesions werevery frequent, and this fact had been recognised by the olderwriters.-Dr. HADDEN said that in children tubercular peri-tonitis often got well, but recovery was rare if the pleurfcwere involved. He inquired as to the evidence of thepresent case being of tubercular nature; certainly therewere instances of effusions into multiple serous cavitieswhich were not of this character. - Mr. R. W. PARKEE.asked how many cases of tubercular peritonitis were asso-’ciabed with effusion of fluid; he thought that as a rulethey were dry. He wondered if an abdomen full of pus- could dry up.-Dr. BARLOW had seen Dr. Finlay’s case,and thought the view taken was that which presentedfewest difficulties; he felt masses in the abdomen whbbwere suggestive of tubercle. Cases of multiple effusion oinon-tubercular nature were more often of pyaemic character,and the prognosis in them was worse. We were familialwith cases of serous effusion into the pleura which recoverecwithout aspiration, and then two years later a fatal tubertulosis developed. The general idea was that the originapleurisy in these cases was tuberculous, but he did noi

think that it was proved; it was more reasonable to believlthat a person with a tendency to tuberculosis was als(liable to serous effusions. The majority of cases o

tubercular peritonitis were dry, though they might pas!through periods of effusion of benign character, whiclwould absorb without counter-irritation. The presenciof pus in these cases he regarded rather as an epiphe,nomenon; some ulceration, perhaps of Peyer’s patchesmight yield and set up a localised purulent inflammation.&mdash;Dr. F. TAYLOR said that in the majority o

- cases tubercular peritonitis was dry ; but in some instancerecently published, in which operative measures had bee]adopted, the fluid was serous. He referred to the case of iwoman who was admitted into Guy’s Hospital under hi<are with a distended abdomen of two months’ durationpain, and high temperature. By paracentesis clear serun’was drawn off, but the patient got weaker and died. Posmortem irregular masses of tubercle were found. Hthought that the recent surgical successes in dealing wit:tubercular joints had an important bearing on th’question of the curability of tubercle in general, buhe admitted that, for instance, in the lung tuberclaet up other morbid processes not so amenable ttreatment.-Dr. EWART thought much of the diicrepancy of opinion arose from the fact that there wei,two forms of tubercular peritonitis-one much more fatf

than the other. These graver cases found in the post.mortem room were of the dry variety, with abundantcaseation, and were usually part of a general tuberculosis.Other cases were localised, and were more analogous tolocal disease of lung, pleura, or joint. Clinically, he hadseen recovery from both the wet and dry forms.-Dr.FINLAY, in reply, recapitulated the grounds which led himto the diagnosis of tubercle-the course of the complaint,the involvement of the pleurae, and the feeling of masses inthe abdomen. He agreed that peritoneal tuberculosis waEgenerally dry, though fluid was sometimes effused. ThElatter form was more favourable. He believed that recovery was even more common than with pulmonarytubercle, perhaps because the abdominal walls were mOrEyielding.

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MEDICAL SOCIETY OF LONDON.

Excision of Gasserian Ganglion.-Tlze Abuse of Drainage.AN ordinary meeting of this Society was held on

Oct. 27th, the President, Mr. Knowsley Thornton, being inthe chair.

Professor WILLIAM RosE read a paper on a case in whichthe Gasserian Ganglion had been removed for persistentneuralgia with a successful result. The paper, which ispublished in full in another column, was illustrated bydiagrams. The patient was shown, as well as micro-scopical sections of the ganglion, which exhibited a re-dundancy of fibrous tissue, indicating a chronic inflam-matory condition of the nerve.-Mr. THORNTON askedwhether, seeing the diseased condition of the second divi-sion of the fifth, cure might not have been brought aboutif the operation had stopped short with the removal of thesuperior maxilla.-Dr. FERRIER had seen a case in whichthis proceeding had been attempted, but had to be givenup. It was a question if the patients would consent toundergo the deformity which must necessarily result, butperhaps it was a question which had better be left to them.The loss of the eye he regarded as an unfortunate accident;he did not believe that it perished from loss of trophic influ-ence, but that it was due to irritation. He thoughtremoval of the ganglion was justifiable if after resection ofa portion of a trunk of a nerve the neuralgia recurred,though it should be remembered that in some cases resectionof the nerve gave permanent relief. The pathology ofneuralgia was obscure, and in many cases it might be ofcentral origin. Section of the nerve above the ganglionmight cause an ascending degeneration, and thus leadto relief by producing atrophy of the centre. It was

probably still a little too early to say if the cure inthe present instance would be permanent.-Dr. ALTHAUSasked if the entire ganglion were removed or only a portion.Some years ago he brought before the Medico-ChirurgicalSociety a case of bilateral neuritis of the fifth nerve;keratitis and iritis supervened, but no panophthalmitisdeveloped. There was excessive pliotophobia in the eyewhich had the better vision; there was also extreme hyper-secretion from the eyes, nose, and mouth; the tongue, beinganaesthetic, was much lacerated by the teeth, and therewas a painful amount of tinnitus aurium present. In thecase shown the ansestbesia seemed to be more circumscribed,and hence he thought some of the ganglion might be left.He believed that irritants entering the eye probably causedthe trouble there.-Mr. DAVY regarded the operation as byno means free from danger, and thought it would behazardous in less competent hands. If the first division ofthe fifth presided over the nutrition of the eye, it would beimpossible to excise the ganglion without injury to thatorgan ; he himself could not regard the slight irritationswhich had been quoted as sufficient to cause the loss of theeye. He surmised that as good a result would have beenobtained if the superior maxilla alone had been removed.From what he had heard, he would not be inclined torepeat the operation on a living subject. Operations evenon main trunks of nerves were often followed by returnof symptoms.-Mr. BALLANCE agreed with the suggestionthat the Gasserian ganglion could be removed without abla-tion of the upper jaw. He was glad to hear that the loss ofthe eye was considered to be an accident, and also thatsection of the nerve above the ganglion would probablycause atrophy of the centre and thus abolish the pain. Thesections exhibited certainly showed increase of fibroustissue. Mr. Clutton some time’ ago removed two Meckel’s