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by several surgeons as a new growth in the subcutaneoustissue, but on operation it turned out to be a chronic abscessin a very unusual position. The third case was that of awoman with a swelling of the joint, clearly an effusioninto the joint, with raised temperature and of severalmonths’ duration. It was supposed to be tuberculousdisease of the synovial membrane, but no improvementtook place after several weeks’ treatment by counter-irritation, rest, &0. Suddenly it was noticed that spon-taneous fracture had occurred above the condyle, andthen it became clear that the case was one of endosealsarcoma, though no expansion of bone or other signs of thatdisease were present. Amputation was then performed, andthe case did well. Mr. Marsh said there were a few of thecases in which an accurate diagnosis was impossible, as onedisease might exactly simulate another, and often typicalsymptoms were absent. He said that diagnosis had often tobe modified, and deprecated the system of holding to anoriginal diagnosis blindly. Careful observation should

always s be made as the case proceeded, and the surgeon shouldnot in any way be biased by his original expressed opinion.He then said that he had lately been treating enlarged burgsebeneath the semi-membranosus by excision with ligatureof the neck of the sac, and showed the advantages of thisprocedure over the old method of injecting irritants,aspirating, &c.-Mr. PEARCE GOULD said that he quiteconcurred in this new method, and had used it frequently.

alr. PEARCE GOULD then read a paper upon Suture of theUrethra after Rupture and External Urethrotomy. Herelated several cases in which, after rupture had occurredthrough accident, he had cut down upon the urethra andsutured the torn ends with the finest silk, over a largecatheter, and then sutured the various layers, compressorurethræ, fasciaa, and skin also. The catheter was kept inonly three or four days, and the cases did wonderfullywell, no trace of a stricture resulting. He divided cases of ’,stricture which were impassable into (1) those without and(2) those with fistulæ. These he treated by dividing thestricture by Wheelhouse’s method, introducing a catheterand suturing layer by layer in the same way as before. Hethen discussed the relative advantages of external andinternal urethrotomy, and showed that, although brilliantsuccesses were recorded after the latter, the former withsuture, layer by layer, was the safer, in that the surgeon sawand knew exactly what he was doing.-Mr. HOWARD MARSHrelated a case of Suture of the Urethra in which the opeia-tion was performed by Mr. Bowlby.-Mr. GORDON BRODIEand Mr. PEYTON BEALE made some remaiks, in which theyfully agreed as to the danger, in many cases, of internal

urethrotomy.

MIDLAND MEDICAL SOCIETY.

Exhibitioin of Cases and Specimens.-Axial Rotation ofOvarian Cysts, causing Twisting of the Pedicle.

THE second ordinary meeting of this society was held onWednesday, Nov. 21st, Mr. T. F. CHAVASSE, President,being in the chair.

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Fingers, with Anesthesia, after a Fracture of the Bones ofthe Forearm. Mr. Freer had divided the tendons of thepalmaris longus, flexor carpi radially flexor sublimis, andflexor profundus digitorum with good result?. The pointsof interest in the case were the cause of the anæs-

thesia, the condition of the nerve trunks, and the

prognosis of any attempt at neiva suture.-Dr. SHORTshowed a case of Large Gouty Concretions in thehands of a woman fifty years of age. The swel’ing of thefirst metacarpo-phalangeal joint measured 6½ in. in circum-ference. The first attack of gout had occurred eight yearsbefore, at the end of twelve months’ privation.--Dr. SHORTalso showed a case of Pneumothorax in the left side of a man’forty-nine years of age, occurring suddenly during the firstweek of October of this year. In this case the diaphragmhad never been much depressed, and the spleen could not befelt below the margin of the ribs. The patient said that foreleven years he was short of breath on exertion and had hada cough, so that it seemed probable the left lung might havebeen pattially disabled and the diaphragm fixed by adhesions.A cystometric tracing showed that the affected side was ratherless than the sound side. All the other signs of pneumothoraxwere very well marked. The rght lung showed no signs oftuberculous deposit, and in spite of the complete absence of

vesicular breath sounds over the left side the patient could walkabout fairly well, and only experienced dyspnoea on exertion.-Mr. CHAVASSE showed a Left Kidney removed by Laparo-tomy from a boy aged seven years. The patient on variousoccasions had had seven calculi removed from his bladder bymedian, lateral, and supra-pubic lithotomy. In August last hewas admitted to hospital suffering from pain in the left side.Aspiration yielding pus, an incision was made in the ninthintercostal space and a drainage-tube inserted. In a fewdays the discharge from the wound was shown to be urine.The fistula showing no signs of closing, nephrectomy wasperformed successfully on Nov. 9th. The organ was dilated,cystic, and showed numerous small interstitial abscesses in theexisting cortical substance. It contained no calculus.—Mr.GEORGE HEATON exhibited the Intestines, Umbilicus, andBladder of an infant with a congenital fæcal fistula. Fasceawere first discharged from the umbilicus two days after birth,and from that time till the patient’s death when threeweeks old all the motions were passed through the abnormalaperture. The specimen showed an opening at the umbilicus,lined by mucous membrane, and leading by a short widecanal into the small intestine some six or eight inches fromthe ileo-csecal valve. The small intestine above the aperturewas much dilated. The large intestine was very muchcontracted. The cseoum and vermiform appendix laydeeply in the true pelvis, attached to the sacrum bya long meso-ceecum, and the ascending colon passedupwards to the left side of the spinal column. Mr.HEATON regarded it as a patent Meckel’s diverticulumwhich had probably passed through the umbilicus into adilated umbilical cord and been ligatured inadvertently bythe midwife in attendance.-Dr. THOMAS WILSON showedan Ovarian Cyst in which axial rotation had given rise totwisting of the pedicle and haemorrhage into the walls andloculi of the cyst. The walls in the lower part near thepedicle were from one to one and a half inches in thickness elsewhere a line of heamorrhage was seen inside the fibrouscapsule of the cyst.

Dr. THOMAS WILSON read a paper on Axial Rotation ofOvarian Cysts, causing twisting of the pedicle. These caseswere divided into three groups : the first comprisedcases in which no serious pathological or clinical con-

sequences ensued ; the second included cases of acute

strangulation of cysts due to twisting of their pedicles ;and the third those of chronic strangulation and itsresults. The symptoms, signs, diagnosis, treatment, andpathology of esch group were described. The causaticnwas then discussed and referred to purely mechanical factors,the chief being-(1) the specific gravity of the tumour, (2) theposition of attachment of the pedicle at or near the lowestpart of the tumour; and (3) the varying position and condi-tions of the lowest part of the containing cavity, especiallydepending on posture, and on variations in the hollow viscera,which have a more or less fixed base to act from-viz., thebladder, uterus, cæcum, sigmoid flexure, and rectum. Thesmall intestine transmits abdominal pressure to the surfaceof the tumour, and helps indirectly to fix it in the lowest

part of the cavity available at any moment ; but movementsof this viscns do not appear to be likely to have any directinfluence in producing axial rotation.

PATHOLOGICAL SOCIETY OF MANCHESTER.

Exhibition of Specimens.A MEETING of this society was held on Nov. 14th, Prc-

fessor SHERIDAN DELÉPINE, President, being in the chair.Dr. WILLIAMSON showed Sections of a Spinal Cord, in

which there was a small syphilitic gumma in the region ofthe left lateral pyramidal tract, about the mid-dorsal region ;it also involved the outer part of the intermediate g eymatter and neck of the posterior horn. Around the gummawas a zone of myelitis, and slight changes extended to theopposite side of the cord. The symptoms commenced withsevere pain about the mid-dorsal region of the spine. Thiscontinued for nine weeks ; then both legs became numb ; a,

week later paresis was noticed, which developed into com-plete paralysis. There was marked anaesthesia, on the lowerhalf of the abdomen and on the right leg, but on the leftleg-i.e., on the same side as the tumour growth—sensation was only slightly impaired. (During life the case was underthe care of Dr. Steell.)

Dr. THOMAS HARRIS showed preparations from severalY 3