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stitutional disturbance. The hand was greatly inflamed, andthere were red lines extending along the inside of the limb tothe axilla, where a mass of enlarged glands could be felt, andany pressure on them caused him much pain. He was at onceadmitted into the hospital. A poultice was then applied to the ’,finger, and the entire limb wrapped in hot fomentations. He Iwas ordered a mild purge, and to be well supported with beef-tea and stimulants.Aug. 5th.-The limb had yesterday become so brawny that i

the house-surgeon made several incisions into i, so that to-daythe redness and tenderness are much lessened.9th.-The size of the arm is much diminished, but the skin

looks of a dead leaden colour, and it is evidently extensivelyundermined. The axillary glands are suppurating. The manhas lost flesh, and looks anxious.16th.-The skin over the dorsum of the hand and all along

the outer side of the limb has sloughed away, so that theextensor tendons are exposed almost as clearly as if they hadbeen dissected out. The man’s pulse is weak, and he ema-ciates from day to day.

19th.-The muscles along the inside of the arm are nearlyall exposed, the skin hanging in tatters at places. As the manwas now in a very precarious condition, Mr. Teevan deter-mined, after consultation with his colleagues, to remove thelimb, as the only chance of saving life. Accordingly, the

patient was put under the influence of chloroform, and thearm was amputated just below the shoulder-joint, by a longinternal flap and a short external one, as the sloughing hadextended so much higher on the dorsum of the limb thanalong the inside. A few hours after the operation the mansmiled, and said he was very comfortable and quite free frompain.20th.-Slept very well last night; tongue clean; appetite

good.From this date he made a most rapid recovery, the wound

was healed in three weeks, and he left the hospital at the endof the following month, looking strong and well.

CHARING-CROSS HOSPITAL.

STRUMOUS DISEASE OF THE SHOULDER-JOINT;RESECTION; GOOD RECOVERY.

(Under the care of Mr. CANTON.)RESECTION of the shoulder-joint is a comparatively rare

operation, although we have placed several cases on record

where it has been performed in adults with a very fair share ofsuccess ; indeed more so than occurs with respect to almost anyother articulation. In the child it is still more uncommon, but

through the kindness of Mr. W. Travers, the resident medicalofficer, we are enabled to publish the following successful ex-ample in a little girl, aged four years :-

C. R-, aged four years, of the dark strumous type, wasadmitted into the children’s ward on Oct. 10th, 1864, withstrumous disease of the right shoulder-joint. The motherstated that about two years since the child had been ill withmeasles, from which she apparently perfectly recovered. Sometwo months after the attack had subsided it was noticed thatshe cried if the arm was roughly handled, and at length couldnot bear the joint to be moved at all. She also moaned a

great deal during her sleep. At this time the shoulder did notappear in any way swollen or inflamed. These symptoms con-tinued for twelve months, the pain evidently becoming gradu-ally worse. The child now, too, became pale, thin, and capri-cious. At the end of the twelvemonth the joint was noticedto be swollen, but not red ; the swelling slowly, yet certainly,increased ; the pain was more constant. At the expiration offour months from this time, an abscess formed in the axilla,burst, and discharged freely. The child was placed undermedical treatment, but without benefit, and, after remainingeight months longer, gaining no relief, she was brought to thehospital by her mother, and admitted as above.On admission, the shoulder was found swollen, and the

structures apparently thickened ; movement much impeded, andcausing great pain. A sinus still remained in the axilla, fromwhich exuded a thin sanious pus. The child looked wan andill; her countenance spoke of constant pain and anxiety. Thelimb was confined, and kept at perfect rest; and tonics, withgood nourishing diet, ordered to be given. Opiates, as far aspracticable in so young a subject, were given at night; yether nights were broken and fitful. This treatment was

pursued for upwards of a month ; and although the child’s

general health was very much improved, the disease seemedin no degree stayed, but rather increased. A probe passedalong the course of the sinus proved the head of the humerusto be extensively diseased. On Nov. 19th Mr. Canton re-moved the upper part of the bone, to the extent of about aninch and a half, together with a portion of the glenoid cavity,which was also found to be affected. The horseshoe-shapedflap was employed. The structures around the joint were foundthickened, and apparently in a state of strumous degeneration-But little blood was lost during the operation, and no vesselneeded a ligature. The edges of the wound were adjusted,and kept in position by the aid of sutures. A pad was placedin the axilla, and the arm gently, yet firmly, bandaged to thebody. No bad symptom followed the operation, and the childslept sounder the first night after than she had done for a verylong time. In the course of a few days her appetite improved,and the countenance lost its former constant look of pain. Ateach daily dressing the wound discharged a small quantity ofhealthy pus, which gradually became less, and has now en-tirely subsided. At this date (three months after the opera-tion) the wound has quite healed, and a fair amount of motionis obtainable. The child complains of no pain, and her health,is greatly improved.

Medical Societies.ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

TUESDAY, FEB. 28, 1865.MR. PARTRIDGE, F. R. S., PRESIDENT.

CASE OF ICHTHYOSIS OF THE TONGUE.

BY J. W. HULKE, F.R.C.S.,ASSISTANT-SURGEON TO THE MIDDLESEX AND ROYAL LONDON OPHTHALMIC

HOSPITALS.

I ICHTHYOSIS is a term provisionally applied by the author to<an affection of the mucous membrane of the tongue, whichconsists in hypertrophy of its epithelial and papillary tissues.It is characterized by yellowish-white, raised, tough, leatherypatches, which are clinically distinguished from syphiliticnodes, condylomata, and cancer. Mr. Hulke had seen butone case, which he relates.

i Mr. BiREETT, in 1853, saw a patient, an old sailor, who hada similar affection to that described by Mr. Hulke. It hadexisted many years, and was merely an annoyance.

Mr. HOLMES CooTE remarked that he had published a,

similar case in Holmes’s " System of Surgery," but had notgiven a name to the affection. It occurred in an old woman.There was no evidence of syphilis ; it was not cancerous, but

merely a thickening of the epidermis.Dr. STEWART said that the year before last a gentleman

from India came to ask him if an affection of his tongue wassyphilitic or not. After due inquiries, there was no groundfor the slightest suspicion of that as a cause. He had hadsyphilis four years ago, but had got well of it, and then mar-ried. Mr. Henry Lee saw him, and thought he was free fromsyphilis. All sorts of detergents were applied, and the solu-tion of the chloride of zinc had no effect. Dr. Neligan haddescribed a similar condition of the tongue in a case which, afterslight irritation, ended in cancer. His (Dr. Stewart’s) patientwas still in good general health.Mr. PAGET said the affection described by the author was

sufficiently rare to warrant each member giving his individualexperience. He referred to a specimen in the museum of St.Bartholomew’s Hospital taken from a patient who died ofcancer of the tongue, with disease of the lymphatic glands.Although ultimately the disease was cancerous, it had for tenyears resembled the condition described by the author of thepaper. This patient also used to pare down the growth as ifit were a corn. He (Mr. Paget) did not wish to imply that theform of disease was more likely to end in cancer when thispatient became old than many other diseases of the tonguewhich were accompanied by irritation. Mr. Hulke’s case wasthe first of the kind placed on record, and was interesting assuggesting that diseases of the tongue should be studied inconnexion with those of the skin. Mr. Paget then related acase which was, he believed, an instance of ringworm on thetongue.Mr. C. H. MOORE alluded to a case in which it was difficult

to distinguish cancer of the tongue from other affections ofthat organ. He referred to a case then under his care in Mid-

259

dlesex Hospital, in which there was an ulcer of the tongue, andopposite the growth was a patch of disease like that describedby the author. There was also a similar patch on the cheek.Although it was clear that Mr. Hulke’s case was not yet oneof cancer, yet it would be a bold thing to assert that cancerwould never occur in the part diseased. Although at presentonly an hypertrophy, it might afterwards become cancerous.Mr. HuLKE then briefly replied. He had no doubt, he said,

that the patches Mr. Moore spoke of in his patient’s case re-sembled the masses on the tongue of his (llr. Hulke’s) patient;yet the clinical history of the two cases was very different.

REMARKS UPON OSTEO MYELITIS CONSEQUENT ON GUNSHOTWOUNDS OF THE UPPER AND LOWER EXTREMITIES, ANDESPECIALLY UPON THE TREATMENT OF STUMPS AFFECTEDWITH OSTEO-’NIYELITIS AFTER AMPUTATION NECESSITATEDBY SUCH INJURIES.

BY THOMAS LONGMORE,:IIEPUTY INSPECTOR-GENERAL; PROFESSOR OF MILITARY SURGERY,

ARMY MEDICAL SCHOOL.

THE author commenced his communication by noticing theparticular interest which had been excited amongst militarysurgeons, especially French surgeons, during the last fewyears in the subject of osteo-myelitis, or endosteitis, as it iscalled by some writers, after gunshot wounds of the extre-mities, and of its proper treatment. The interest arose, notfrom any belief that a difference existed between the nature ofthe inflammation of the medullary tissue when developed aftergunshot injuries and the corresponding inflammation occasion-ally seen after the ordinary injuries and amputations of civillife; but from the comparative frequency of its occurrence aftergunshot injuries, and after amputations consequent upon them,together with its severe and obstinate character, often in menof previously sound constitutions, in military practice, con-trasted with the comparative rarity of its occurrence in soundconstitutions in civil practice. After the Crimean campaign,Dr. Valette, a French military surgeon, who had had one ofthe large hospitals at Constantinople under his charge duringthe period of the war, and again, since the Italian campaign of1859, M. Jules Roux, the principal surgeon at the large marinehospital of St. Maudrier at Toulon, had both written at con-siderable length on the subject. Dr. Valette’s observationswere chiefly directed to this inflammation in its earlier andmore acute stages, as witnessed amongst the wounded sentdirectly after the battles of Alma and Inkerman, amongstwhom it had produced the most fatal consequences. Theauthor remarked that in perusing Dr. Valette’s reports theconclusion could scarcely be avoided, that the so-called osteo-myelitis in a large number of the instances referred to musthave been truly cases of pyaemic poisoning, and that in all, thesymptoms of the osteo-myelitis must have been greatly aggra-vated by circumstances tending to the development of pyaemia.Dr. Valette found all attempts to check the disease ineffectual,and came to the conclusion that all resections and amputationsfor the effects of this inflammation after gunshot fractures ’,should be abandoned, and exarticulations substituted, thewounded being scattered at the same time in tents as widelyas possible.M. Jules Roux’s observations were made on the disease in iits more chronic condition, and he was led to advocate the i

same views with regard to the necessity for exarticulation as Ihad been advocated by Dr. Valette. M. Roux had under hiscare about 2000 soldiers who had been wounded in the Italiancampaign, a considerable number of whom presented diseasedconditions demanding consecutive amputation or other surgical (interference. At first M. Roux practised amputation, but withsuch unfavourable results that he was induced to try exarticu-lation in similar cases instead. This operation proved re- imarkably successful. There was no death out of twenty-two isuccessive cases, among which were four cases of exarticulation Iat the hip-joint. In a memoir on the subject which was read Ibefore the Imperial Academy of Medicine at Paris in 1860,M. Roux argued that when osteo-myelitis after gunshot 1wounds assumes a chronic form, amputation generally only ,takes away a portion of the inflamed bone, and in consequence iof this incompleteness in the operation the disease is aggra- ivated in the remainder. Hence, he asserted, the failures of Isecondary amputations for gunshot wounds of bones ; and Jhence also, in his opinion, the preference which ought to be Ifgiven to exarticulation, or removal of the whole of the dis-eased bone, when a surgical operation becomes indispensable.The views of treatment propounded by M. Roux had led to 1

several protracted discussions at the Academy of Medicine atParis. They were particularly analyzed in an elaborate dis-

I course by Baron Larrey, which he afterwards published. Ini this discourse Baron Larrey arrived at certain conclusions, six’ in number, with the general terms of which the author said hebelieved most English army surgeons would agree. The fol-

’ lowing are the conclusions referred to :-! lst. Osteo-myelitis after gunshot wounds is more frequentthan has been hitherto supposed; but is not inevitable, and inmost instances is a means of cure.

2nd. It may either be limited to a given point of the bone,extend itself partially, or im-ade the whole of the bone more orless quickly.

3rd. Every rational mode of treatment must be adopted inthe first instance. We are encouraged to do so because weknow osteo-myelitis is susceptible of spontaneous cure.

4th. Sometimes it necessitates resection, and sometimes con-secutive amputation, and sometimes, in certain cases, exarticu-lation is preferable.

5th. The existence of osteo-myelitis is sufficient to explainthe want of success which occasionally follows partial opera-tions in bones affected with this inflammation. But,

6th. It does not justify the too exclusive proposition in sur-gery, that resection of joints and amputations in the shafts ofbones are to be abandoned for exarticulation in all such cases.The author of the present paper thought, however, that the

settlement of the question of the proper treatment of chronicosteo-myelitis might be carried a step further in precision,especially in cases where want of success had seemingly fol-lowed partial operations on account of its presence. Manycases, lie stated, came before military surgeons, in which,after amputation had been performed in continuity for gunshotinjuries, or for the effects of osteo-myelitis consequent uponthem, the portions of the limbs left afterwards presented suchdiseased conditions as to necessitate further surgical inter-ference in order to avert fatal consequences from the patients.In these cases, where the morbid state of all the tissues is

manifestly due to the continued osteo-myelitic action subse-quent to the amputation, what is the course to be pursued ?The arguments of M. Jules Roux would urge most forcibly inthese cases, that exarticulation is the only treatment that canscientifically be adopted; and even according to the conclu-sions of Baron Larrey, these would appear to be the "certaincases" to which he refers in his 4th conclusion, where curativetreatment in the first place and consecutive amputation in thenext place having failed, disarticulation would be the pre-ferable course to follow. The author had been led to adopt adifferent conclusion ; and, in order to show to the Society thegrounds on which his conclusions had been based, he called

attention, firstly, to certain preparations belonging to themuseum of the Army Medical Department from cases in whichexarticulation had been performed or death had occurred onaccount of osteo-myelitis ; and secondly, to the histories ofsome similar cases in which a cure had been effected without

exarticulation being resorted to.The first three preparations exhibited consisted of the upperportions of three humeri. In each of these the history was-amputation at the middle of the upper arm for a gunshotwound, and exarticulation at the shoulder within a year after-wards for osteo-myelitis. The fourth preparation was one ofthe upper part of the femur which had been removed from thepatient after death. Amputation had been performed in themiddle of the thigh for a gunshot wound in India, and thepatient died about a year afterwards from the effects of osteo-myelitis in the stump. There was every reason to believe that

in all these cases the osteo-myelitis was due to the shock ofthe original gunshot injury, and not to any peculiarities in theamputations or other causes. To show that the simple shockof a gunshot wound is capable of giving rise to general endos- teitis in a bone, another preparation was exhibited in whichthe entire shaft of the femur had been subjected to the actionof this inflammation. In this case a musket-ball had only pene-trated the soft tissues, and struck the bone, without producing’ complete or even a partial fracture of its substance.! Another preparation of the upper half of a humerus wasexhibited from a case in which the author had performed ex-articulation for osteo-mvelitis four years ago, before his atten-tion had been turned to other modes of treatment. In thiscase the previous amputation had been performed for theeffects of a kick from a horse, and the preparation was exhi-bited to show that the consequences of the osteo-myelitis wereexactly similar to those which had occurred after the gunsl:otInjuries.

’ All the preparations above named showed that in each caseextensive necrosis of the shaft had resulted from the endos-

teitis with which it had been affected; that the necrosed por-K 2

260

tions were well defined within fixed limits; that in no instancewas the necrosis continued to apophysis, although in all thecases the apophyses were more or less in the condition knownby the term "osteo-porosis;" and that the sequestrated por-tions of the shafts were surrounded by copious shells of newbone, as in cases of ordinary necrosis.

Three cases were then related, in which amputation at themiddle of the thigh had been followed by osteo-myelitis in thestump, but in which cures had been obtained without ex-articulation. The amputation had been performed in two ofthese cases for gunshot wounds, in the third for the conse-quences of a compound fracture from a fall. In each of tiiesecases the removal of the sequestra left by the osteo-myeliticaction was effected by surgical interference, and a sound andhealthy condition of the stump resulted. In the case first de- scribed, the patient at the time of his admission into hospitalat Fort Pitt, from India, had suffered so severely from theeffects of the prolonged irritation to which he had been sub-jected, and the thigh-stump was so extensively diseasedthroughout, that at a consultation of the staff of the hospitalthe removal of the stump at the hip-joint was determined tobe the only course which held out a fair hope for the patient’srecovery. Fortunately, before this serious operation was un-dertaken, a study of the preparations laid before the Society,and some others of a similar kind, led the author of the paperto determine, as a preliminary measure, to open freely thecicatrix of the amputation-wound, and to take steps for re-moving all pieces of necrosed bone that might be found withinthe remaining portion of the shaft. The operation was so con-ducted that, if necessary, it could have been converted at thetime into amputation at the hip-joint, or this formidable opera-tion be reserved for a subsequent resource, if the removal ofthe necrosed bone did not lead to cure. Complete success,however, attended the first effort: the dead portion of theshaft, which reached up to the trochanters, was extracted,together with some smaller detached fragments. The patientrapidly improved in all respects afterwards, and eventuallywalked from the hospital with an artificial limb applied to thestump, which had become perfectly sound.The second and third cases mentioned were those of soldiers

who had suffered amputation of the thigh for gunshot wounds,and from subsequent endostitic necrosis in the stump. Inboth cases the necrosed portions of the shaft were removed bygradual traction through openings in the line of cicatrix of theamputation-wound. In one of these instances, in which theman’s limb had been smashed by a round shot just above theknee, at Lucknow, in 1857, an opportunity was afforded ofexamining the state of the stump five years after the date ofthe amputation. The stump was then thoroughly sound, andthe man able to perform hard work and long journeys bywearing an artificial limb upon it. The motions of the hip-joint were perfect.The author of the paper stated his present conviction to be

that if similar steps had been adopted, and the necrosed se-questra removed, in the instances brought before the Societyin which exarticulation at the shoulder had been performedby himself and others, the stumps might have been similarlypreserved ; and that in the instances of the femoral stump,and the femur affected with endostitic necrosis, the lives ofthe patients might probably have been saved by such a pro-ceeding. In cases where amputation had been previously per- ’,formed, the amputation cicatrix.should be opened for the re-moval of sequestra, or, if more convenient, the stump couldbe opened from other directions; where no previous amputationhad been done, the sequestra should be extricated as in ordinarycases of necrosis.

Though not a matter of such importance to avoid exarticu-lation of a humeral stump as it is of a femoral stump, owing tothe danger to life in the latter operation, and the importantuse of a thigh-stump for the adaptation of mechanical con-trivances for assisting in supporting the weight of the body,yet the author maintained the preservation of a humeral stumpto be of great value to the possessor, especially when the powerof compressing it to the side is retained.An osteo-porotic condition of the articulating heads of the

bones, corresponding with the condition shown in the prepara-tions, will not interfere -with a successful result if the necrosedsequestra be completely removed. The author alluded to acase in which he had removed a foot at the ankle-joint, inwhich, on saiving off the two malleoli, the extremities of boththe tibia and fibula were seen to be extensively affected withfatty osteo-porosis ; yet the ends of these bones became firmand solidified under an improved condition of general health,the removal of the source of irritation which had previously

existed in their immediate neighbourhood, and the stimulus ofuse. There could be no doubt that the head and neck of thefemur in the case of the thigh-stump which had been preservedby the removal of the sequestra, the largest of which was ex-hibited to the Society, was in a state of osteo-porosis at thetime these sequestra were extracted. The amount of irritationto which the bone had been subjected, the length of time thathad elapsed, together with the conditions observed in analogouscases where the opportunity of examining the conditions ha.dbeen afforded, sufficiently established the fact.The author concluded by observing, that while adopting

generally the views of Baron Larrey, before quoted, in refer-ence to the nature, progress, and treatment of ostco-myelitisafter gunshot injuries, the following appeared to be fair deduc.tions from the facts and observations he had brought to thenotice of the Society :-

lst. In gunshot injuries of bone, it will be found for themost part-what might be anticipated from the intimate con-nexion which exists between the periosteal and endosteal in-vestments of the bony tissues, and from the violent generalmischief effected by the stroke or passage through them of aprojectile-that all the structures participate not only in theimmediate local destruction, but also in the extended inflam-mation which follows, whether the inflammation after a timesubsides and terminates in repair, or whether it continues in achronic form.

2nd. There exists this difference between the inflammationof the endosteum and that of the periosteum : that of theendosteum has a special tendency after gunshot injuries to

degenerate into a chronic condition analogous to that of sup-puration in other tissues, to extend itself along the cancellatedstructure, and thus to produce disintegration and death of thebony substance; that of the periosteum, at the same time,will exist only to such a degree as to cause it to exert a pro-tective influence by the formation of new bone around thediseased tissues, just as in ordinary cases of necrosis fromother causes.

3rd. If amputation in continuity be performed while theendosteum is suffering from the inflammatory irritation excitedby the violent injury to which the whole bone has been sub-jected, especially when this has assumed a chronic form, theendostitis will most probably still pursue its course, even

though the divided soft parts may at first become healed,slowly inducing death, more or less extensive, of bony tissue,and in time the usual consequences of such a condition through-out the whole stump.

4th. The morbid condition of the endosteum does not usuallyextend from the shafts of bones into their apophyses.

5th. When amputation has been followed by these conse-quences, exarticulation should not in any case be resorted tofor the removal of the diseased stump, until the effect of com-plete extraction of the dead bone by proper surgical inter-ference has been ascertained.

6th. Experience shows that, even although a patient’s con-stitution may be greatly impaired by the prolonged local dis-eased action to which it has been subjected, and though theremay be every reason to conclude that the articular extremityof a bone is in the condition understood by the term " osteo-porosis," yet the complete removal of the endostitic sequestra,may speedily be followed by restoration of the general health,and by a condition of the stump so sound and firm that it may

ibe applied to any purpose of utility for which, according to itslength and position, it may be competent.

Mr. FERGUSSON said the Society was under special obliga-tions to the author for his able and interesting paper. The

principles he had laid down applied to civil as well as to mih-tary practice, and he regretted that examples from the field of

I civil surgery had not been brought forward. It had fallen tohis (Mr. Fergusson’s) lot to see a number of instances likethose described-viz., of gunshot wounds&mdash;and also of cases soexactly similar in results, though from other causes, that thetwo classes could scarcely be dissevered. The author hadtravelled over an interesting field, and it was scarcely possibleto do more than make a few brief remarks on some of thepoints in the paper. The subject of inflammation of bonewasone of great interest, and he fancied that even the most prac-tised surgeons could never tell to what extent inflammation, would occur after an injury. There was a great similarity ingunshot wounds and in compound fractures. The matter! formed after gunshot wounds produced compression, and thisexcited inflammation of the periosteum, or of the internal liningmembrane, which he considered to be analogous to the perios-teum. He considered the author’s views were, whether

applied to military or civil practice, correct&mdash;viz., the extrac-

261

tion of dead bone rather than amputation. He spoke for thegood of surgery when he stated his decided conviction thatmany cases of amputation for diseased bone were not required,the extraction of the necrosed part only being sufficient. He

cordially agreed with the author that we should do all in our

power to remove the sequestra.Mr. HOLMES COOTE had listened with the greatest interest

to the author’s paper. It occurred to him that cases of thedisease described admitted of being classified under two heads.He related two cases in point which had occurred in civil 1

practice. Mr. Lawrence removed a leg for disturbance in thecirculation of the limb. The stump did not close. He ampu-tated again, and afterwards for a third time. The man left thehospital, but was still not well, and at another hospital a fourthoperation was performed. The bone in this case presented pre-cisely the appearance described by the author. In another casea young man had his knee crushed ; amputation was performed,and he got quite well. Afterwards swelling of the stumpoccurred ; it inflamed, and necrosis ensued. A piece of deadbone was removed, and recovery followed. In some cases, he

thought the disturbance was due to the shock of the accident,and in others to disease creeping up the bone.Mr. BARWELL said the patient whose case Mr. Coote had

related first in his remarks came to the Charing-cross Hospital,where the bone was disarticulated. He (Mr. Barwell) broughtthe specimen to the Pathological Society. The bone wassoftened, and also inflamed and thickened. He asked theauthor if he believed osteo-myelitis always ended in necrosis.He had seen cases in civil practice in which inflammation ofthe bone had not been followed by necrosis. In reference tothe extension of disease after injury, he said that after excisionof the knee disease sometimes travels up, but never down.With regard to the practice of the author, he had no doubt asto its superiority over that of M. Roux.Mr. BIPKETT showed a drawing of a thigh-stump from which

necrosed bone had projected several inches. It had been pulledat, and had gradually protruded. On admission at Guy’s alittle more force was used, the bone was pulled out, and theboy got well. In reference to the paper, Mr. Birkett said thatthe author, having been much abroad, was perhaps not awarethat the practice he recommended was generally carried out incivil practice in England.Mr. LONGMORE, in reply to Mr. Barwell, said that in all the

cases to which he had referred necrosis followed. He did not

bring forward the views contained in his paper in order tocontrast military with civil practice, but because M. Roux’sviews had attained immense influence. He had been led todoubt M. Roux’s views by*observilig specimens in the museums,and then came to the conclusion that in cases in which thebones had been disarticulated, not only the limb, but life,might have been saved if the simple operation of removing thesequestra had been practised. Since he had forwarded hispaper to the secretary he had received from Dr. Fayrer, ofCalcutta, a surgeon of great experience in military surgery,a pamphlet strongly recommending M. Roux’s practice. Hementioned this to show the great influence M. Roux’sopinions had had.

ANNUAL GENERAL MEETING. G.

WEDNESDAY, MARCH 1ST.MR. PARTRIDGE, F.R.S., PRESIDENT.

After the reading of the Auditors’ Report, its adoption was ’ moved by Dr. GREENHOW, and seconded by Mr. CHARLES .!HAWKINS. IA rider was proposed by Mr. C. HAWKINS, and seconded by

Dr. WYNN WILLIAMS,&mdash;"That the attention of the Councilbe drawn to the necessity of the immediate investment of allcomposition fees.’’

It appeared from observations made by Mr. Hawkins that acomposition fee which he had paid had not been invested according to the law of the Society. It appeared there hadbeen some little irregularity in regard to these fees in former years, which, however, was explained by the treasurer. !

Second rider moved by Mr. SPENCER WELLS, and seconded iby Dr. C. J. B. WILLIAMS,&mdash;’’ That the attention of the Council ibe called to the large annual contributions paid by the Patho- ilogical and Obstetrical Societies.’’

This proposal gave rise to a very long discussion, and in some respects of a personal character. The speakers in sup-port of the rider were Mr. Spencer Wells, Dr. C. J. B. Williams,Dr. Quain ; and in opposition to it, Dr. Webster, Mr. CharlesHawkins, Mr. Quain. and Dr. Markham.

Notwithstanding the length to which the debate extended,the question may be very briery summed up. It was con-tended by the one party that the sum of sixty guineas paidannually by the Pathological Society for fifteen meetings, andforty guineas by the Obstetrical Society for ten meetings, was

excessive, and should be diminished. It was argued that theSociety should not make a profit from permitting Societies

having a kindred object to meet in its rooms, especially as itwas established for the promotion of medical science.

’ The speakers on the other side contended that both thePathological and Obstetrical Societies were now in a mostflourishing condition, and that they were at liberty when theypleased to cease their tenancy. It was further complainedthat the subject had been mooted frequently, giving rise touseless discussion and to an irregular mode of proceeding. Theproper course for the complaining Societies to pursue would befor them to make formal application through their respectiveCouncils to the Council of that Society.

The rider was eventually negatived by a very large majority.The Report of the President and Council was then read,

from which it appeared that the Society continued in a pros-perous condition. An apparent decrease in the total numberof fellows from 634 to 627 was not real, the names of severalforeign and non-resident fellows having been included in pre-vious statements who had been dead for some years, but whosedecease had not been made known to the Society. There wasreally an increase, the number 627 being opposed to 622, thecorrected number for the corresponding period last year.Twenty new fellows had been elected during the year; ofwhom twelve were resident, seven non-resident, and one aforeign home fellow. Four resident and seven non-residentfellows had died during the same period. The total ordinaryincome for the year had been :C1384; the total expenditure,ordinary and extraordinary, had been :iE1287 5s. 3d., whichwas above :E250 in excess of that of 1863, the difference beingpartially occasioned by an expenditure of above &pound;100 more onthe " 1’ransactions" than on the previous volume, by an in-crease in the expenditure on the library and in salaries, andby an extraordinary expenditure of &pound;70 on a collection ofmedical portraits, &c. A balance of &pound;345 17s. 2d. remained

in the hands of the Society’s bankers ; and the amount ofstock held by the trustees of the Society was &pound;4244 6s. 6d.It was stated in the report that during the year 348 works hadbeen added to the library, exclusive of periodical publications;and that the Society’s valuable collection of medical portraitshad been increased by two considerable collections, presentedby Mr. T. B. Curling and Mr. Charles Hawkins ; a likenessof Dr. Jenner, modeled in wax, had been presented by Dr. B.Babington ; and some bronze medals of the late Sir B. Brodie,Prof. Tiedemann, &c., by Mr. Charles Hawkins. The tri-ennial inspection of the library, in accordance with the bye-laws, had been made by the Library Committee, and thelibrary found to be in most satisfactory condition and in per-fect order. The report received from the committee on theEffects and Uses of Chloroform had been published in thelast volume of the "Transactions;" and the Council, in ex-pressing their thanks to those gentlemen who so kindly under-took and carried out the investigation, congratulated the

Society on the success which had attended the appointment ofscientific committees.

The PRESIDENT then read a resolution, which he stated theCouncil had requested him to bring before the meeting inorder that the opinion of the Society might be taken on thesubject. The resolution was to the following effect :-" Thatthe publication of the Proceedings’ in their present form bediscontinued, and that for the future they be published as anappendix to the annual volume of ‘ Transactions,’ omitting theabstracts of those papers which are published ill extenso in the‘ Transactions.’ "

After a discussion, in which Dr. Fuller, Mr. Chas. Hawkins,Mr. Moore, Dr. Balfour, Mr. Curling, and Dr. Webster tookpart, it was moved by Mr. CHAS. HAWKINS, seconded by Mr.MooRE, and carried,-" That the Society is of opinion that thepublication of the Proceedings’ should be continued in itspresent form, and, if possible, appearing more frequently."

ANNUAL ADDRESS.

The PRESIDENT then delivered the annual address. Afteralluding to the continued prosperity of the Society, both as toits scientific labours and the matter of its finances, he pro-ceeded to give obituary notices of the fellows who had beenlost to the Society by death since the last annual meeting.Some of these had been contributors to the Transactions," and had otherwise adorned their profession by their eminent