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CASE 2. (From notes taken by Mr. Wilson.) Acute Ne-crosis of Upper Eml of Tibia; Suppurating Knee-joint;Sequestrotomy ;Incision of Joint; Healiizg. -Fredk. W-, ,

aged eighteen years, a carman, was admitted on Feb. 27th,1881. About three weeks before admission he .knocked his left leg against a cart-wheel. iOn admission there was an abscess over the inner tubero-

sity of the tibia and above the tubercle. There was someiulness of the capsule of the joint, and the lower third ofthe femur felt larger than on the other side, but there was notenderness.On February 24th the abscess was opened and a large quan-

tity of pus mixed with blood exuded, and next day a backsplint was put on.On March 9th an incision was made on the inner side of

the joint, and a week later, under an ansesthetic, and afteran Esmarch’s bandage had been applied, an incision wasmade and several pieces of necrosed bone were removed.There was acute suppuration of the head of the tibia andan abscess cavity in the head of the bone. Free incisionswere made to ensure free drainage, and the leg put upon aback splint. The patient passed a good night after the opera-tion, and the wounds began to heal at once.On April 9th an incision was made just below the inner

tuberosity of the tibia, and a large quantity of offensive puslet out.The wounds have progressed favourably towards healing.

The wound was probed, and a small fragment of necrosedbone was detected on July 27th.On August 5th a Thomas’s splint was applied.Two small splinters of bone were removed on August 9th,

.and by November 16th several small pieces of bone hadcome away. Two sinuses remained unhealed. The patientleft, and was to report himself in about a month’s time.

NEWCASTLE-ON-TYNE INFIRMARY.

LOCOMOTOR ATAXIA; SEVERE LIGHTNING PAINS ; LEFT

SCIATIC STRETCHED ; MARKED RELIEF.

(Under the care of Dr. DRUMMOND and Mr. PAGE.)FOR the following notes we are indebted to Mr, James

Limont, senior house-surgeon.R. R-, aged twenty-three, a fisherman, was admitted

for shooting pains in the legs and staggering gait. The

patient stated that he had been greatly exposed to cold andwet during the past eleven years, and that he had frequentlyslept in trousers saturated with salt water. His habits hadbeen very intemperate, and he had suffered from syphilis.In the summer of 1881, seven months before admission, hebegan to complain of pains in both legs, especially the left ;subsequently he lost power in the lower extremities, andfailed to control their movements properly.As regards his family history, it may be stated his

mother died twelve years ago of a tumour in the brain;one sister died of consumption. The father is still livingand healthy.On admission the man exhibited the typical features of

locomotor ataxia. The ataxic gait was most characteristic;he staggered and fell whenever he attempted to walk withclosed eyes, and was quite unable to stand when the eyeswere shut, even though the feet were widely separated. Hecomplained bitterly of the lightning pains, and had thegirdle sensation well-marked. Analgesia was present inpatches, and retarded sensibility was very marked in thelegs (occasionally twenty-three seconds elapsed before aprick of a pin was discovered). The superficial skin reflexesand the knee-jerk were entirely absent. His sight wasdim, the ophthalmoscope revealing pronounced syphiliticchoroiditis.On March 7th, about five weeks after admission, as the

pains still continued very severe, Mr. Page cut down uponand stretched the left sciatic nerve. The operation wasdone antisepticalty.-On the 15th the wound was entirelyhealed, and the patient expressed himself as greatly relievedof the pains in the left leg.-On the 30th he left the hospitalquite relieved of the pains in both legs, but in no other waychanged.

THE Essex and Chelmsford Infirmary has received£100, as a donat on from Mr. Arthur Pryor, through theChristmas offertory at Widford.

Medical Societies.PATHOLOGICAL SOCIETY OF LONDON.

Cirrhosis of ,Liver. - Cancer of Œsophagus. - Lympho-Sarcoma.—Larynx from a case of Tubercle. - UlcerativeEndocarditis.—Heart Diseccse.-Fibrirzous Concretion o2z.

Pleura.—Lardaceous Disease of Liver.—Vesical Polypus.-Rickets in a Baboon.

THE annual meeting of the above Society was held onTuesday last, January 2nd, Dr. S. Wilks, President,in the chair. For the first hour the ordinary, businessof the Society was transacted, and during this time theballot box was open and in the charge of Dr. Edmunds andMr. Eve, scrutineers. - The last half hour was devoted to thespecial business of the annual meeting, which is reportedelsewhere.

Dr. ANGEL MONEY showed a specimen of Cirrhosis ofLiver from a child, aged eight, who suffered from ascites forten days before death. She had stayed at a beer-shop fortwo months when three years old, and on her return homeit was found that she had acquired a taste for alcohol.There was no history of syphilis. The liver weighed 19 oz.The amount of fibrous overgrowth was very excessive.There was no fibroid overgrowth elsewhere. The historyjustified the belief that the cause of the disease was alcohol.- Dr. S. WILKS said there had been two or three similar

specimens shown recently from quite young children in whomthere was a history of drink, although in many others therewas no such history.

Dr. NORMAN MOORE exhibited four specimens :-I.Carcinoma of (Esophagus, a carcinoma affecting the wholemiddle part of the (Esophagus. The new growth infiltratedthe whole wall, and had caused a stricture just admitting alarge probe. The oesophagus was adherent to the lung, andat the adhesion its wall was perforated, so that any foodwhich passed the stricture might enter the lung. The lungat this point was not gangrenous, but was simply pneumonic.The distribution of the secondary masses of new.growth wasinteresting. The stomach was not affected, but the smallintestine had several firm, whitish constricting masses, ofprecisely the same relations to the tube as that in the oesopha-gug. There were numerous secondary growths in both lungs,and one in the outer wall of the left ventricle. The liver,spleen, mesenteric glands, and both kidneys containednumerous masses of the same. The growth was a scirrhouscarcinoma, and the secondary masses were all cf firm texture.The patient was a man aged fifty-six. He ha’1 symptoms ofdysphagia in May, and died in Decemher. Out of twelvecases of carcinoma of the oesophagus examined at St. Bar-tholomew’s since 1867 all were males. In six the lower endwas the seat of the growth, and in five the middle of theoesophagus. In four cases secondary growths were found inthe lungs. Exhaustion was the commonest cause of death.Uleeration’into a vessel occurred in two case?, gangrene ofthe lung in one, and fatal pleurisy in three. The agesof the patients were from thirty-six to fifty-eight.—2. Lympho-sarcoma invading the Duodenum. The growthoriginating in the lumbar glands had penetrated the duodenalwall and produced at one place narrowing and elsewhere dila-tation of the duodenum. The specimen was from a woman,aged forty-one who died in St. Bartholomew’s Hospital,under the care of Dr. Gee. During life an irregular ovoidtumour was felt in the epigastric region. The greater part ofthe tumour was dull on percussion. A lesser region wasresonant. The dull part proved to be where there was thegreatest infiltration with narrowing of the intestine; theresonance was not due to intestine in front of the tumour, butto the dilated duodenum. The patient’s illness was of abouteight months’ duration. The first sypmptom she noticedwas a pulsation in the abdomen. Af er a time attacksof vomiting came on, which usually began a quarter ofan hour after taking food. The lumbar and inesenterileglands and the duodenum were the only parts infiltrated.-3. Endocarditis with Miliary Ab,-ct- sses of the Heart in a caseof Hip-joint Disease. The hip-joint showed denudation ofthe cartilage on the acetabulum and head of the femur, andwas full of pus when opened, as was also the right sterno-clavicular joint. The heart showed growths on and destructionof the aortic valves, and an ulcer on the upper part of the ven-