The suturing of the wound is the next step. This is done by the application, in the first instance, of a sufficient number of mattress sutures of fine catgut. As a rule, a round (intestinal) needle will do this work, and it has the advantage of not causing bleeding, and of rendering the sutures less liable to cut through the mucosa. By means of these stitches, any tendency to inversion of the edges is completely overcome; and a number of interrupted sutures of fine catgut will then secure absolutely accurate apposition of the edges. In many cases through infiltration of either the skin or the mucosa it is very difficult, if not impossible, to attain accurate apposition of the cut surfaces except by this method of suturing.

In cases where there are sores on the glans, or on parts of the mucosa which cannot be removed, the wound and the sores are dusted with iodoform, and dressed with strips of iodoform gauze ; the penis is kept in the elevated position by means of a T bandage. If there is no sore left, and if the swelling is not great, the wound is dusted with iodoform, and a cap of cotton wool is applied over the penis, leaving the meatus free; the wool is kept in position by means of collodion. This dressing rarely requires removal; it remains in position for two or three weeks, and then drops off, leaving the wound firmly united. Where sores are left on the mucous surface, the dressings may require to be changed two or three times a week, though this is rarely the case. Partial failure of union is most likely to occur near the frænum, and is almost invariably due to infection from a soft sore in its neighbourhood. The last patient upon whom I operated for this condition had a number of soft sores on the glans, and also on the mucous surface of the prepuce. He did not re-appear at the hospital until a fortnight after the operation, and then he said that he had been away in the country looking for work, and that he had been struck on the penis by a cricket ball, and yet the wound was perfectly healed. These cases are all treated as out-patients.

The advantages of this operation are-(1) that you see where you are cutting, and so run no risk of removing either too much or too little tissue; (2) by the use of the knife clean cut edges are obtained, and so immediate union is very likely to be secured; (3) the method of suturing makes it possible to obtain absolutely. accurate apposition of the cut edges; (4) the use of catgut sutures renders their removal unnecessary.

Medical Society of Victoria.

ORDINARY MONTHLY MEETING.

WEDNESDAY, APRIL 3, 1895.

(Hall of the Society, 8 p.m.)

The President, Dr. ROTHWELL ADAM, occupied the chair, and twenty members were present.

The following gentleman was elected a member of the Society: Alexander Corry, M.D., M.A.O., Royal University, Ireland, residing at Mount Egerton, proposed by Dr. S. Zichy Woinarski, seconded by Professor Allen.

DONATION FROM MRS. AUBREY Bowen.

A letter was received from Mrs. Bowen stating that she had forwarded a cheque for £213 to the Treasurer of the Medical Society of Victoria to redeem all outstanding debentures, and so free the Society's Hail from debt. Mrs. Bowen also wrote to say that a bust of the late Dr. Aubrey Bowen had arrived in Melbourne from London, and would be placed in the Hall on the completion of the pedestal.

The President (Dr. R. ADAM) said that members would agree with him that Mrs. Bowen was certainly continuing the good work commenced by the late Dr. Bowen. The site on which the Medical Society Hall now stands was obtained from the Government chiefly through Dr. Bowen's personal exertion. The idea of raising money by means of interest-bearing debentures was also Dr. Bowen's, and now by means of Mrs. Bowen's handsome gift to the Society, the Hall was clear from debt. It gave him very great pleasure to move a hearty vote of thanks to Mrs. Bowen for her generous gift.

Dr. JAMIESON had much pleasure in seconding the motion. The late Dr. Bowen had always taken a deep interest in the affairs of the Society, having occupied every possible honorary office, as well as being one of the trustees named in the Crown grant. It was the duty of the Society to record a very hearty vote of thanks to Mrs. Bowen for her gift.

The motion was carried with acclamation.

REPORT.

Mr. SYME presented, for Dr. A. L. Kenny, a report on the condition of the eyes of the patient from whom a cerebral tumour

=

had been removed, shown at the February meeting, and exhibited charts of the visual fields. Right eye, Vision 86 L., g 7 L. J. 1 at 30 c.m. Hm. 0.25 D. The fields showed very slight contraction, and with the ophthalmoscope some slight enlargement of the retinal vessels, and slight choroidal disturbance at the outer side of the optic disc was noticed. Left eye, Vision & 6 L., § 8 L. J. 1 at 32 c.m. Hm. 0.25 D. Fields and discs much as in right. Mr. SYME stated that the patient had resumed duty as a constable.

EXHIBIT.

Mr. G. A. SYME showed a patient upon whom a Bond's modified (Russell's) operation had been performed. The cyst was a large one presenting in the left lobe of the liver, and contained an immense number of daughter cysts. The mother cyst was removed, the cavity well irrigated and then wiped dry and clean with gauze, and the abdominal incision closed. The operation was performed on the 18th January, 1895. On the fourth day the temperature rose to 101° F., and he had some discomfort in the right hypochondrium. Again on the twelfth and thirteenth days after operation the same occurred, but on all occasions he was relieved by free purgation. The wound healed by first intention, and he was discharged apparently well on February 11, the twenty-second day after operation. He was re-admitted on March 7th, with a temperature of 102°, with great pain in the left hypochondrium, and looking very ill and thin. He also had some vomiting. The scar of the incision was bulging and very tender, with an area of dulness round it. He stated that off and on since his discharge he had felt pain, and that two days before, he had some shivering. Three days after admission, he became jaundiced. On the ninth day after re-admission, the scar gave way, and a quantity of bile and pus was discharged. Pus continued to escape for four days, and on two occasions there was an appreciable quantity of bile on the dressings. The jaundice disappeared, the wound closed, and he recovered perfectly, with a firm scar.

Mr. SYME considered this a very good test case for the operation. It showed that while bile might escape, it could make its way to the surface without doing serious harm, and the patient was now in a much better condition than if Lindemann's operation had been performed.

Mr. F. D. BIRD said that he was much interested in the case, having performed a similar operation in some recent cases of hydatid disease. His experience was that the case progressed well for a week or ten days, when the adventitial sac often filled up with fluid. This fluid, if simple serum, will become re-absorbed, and the swelling will disappear. In a recent case, where the cyst was a very large one, the swelling re-appeared at the end of a week, and the tumour became as large as it was before operation. Mr. FitzGerald's suggestion, that another cyst had burst into the adventitial sac, seemed a reasonable one. The fact that this does occur is not against Bond's operation, for even where an opening has to be made a second time, the resulting scar is in every way superior to that left after a Lindemann's operation.

Dr. ROTHWELL ADAM said that the adoption of Bond's operation in cases of abdominal hydatids was a great advance in treatment. About six months ago, he operated on a hydatid of the pelvis. He tried to stitch the adventitial sac to the abdominal wall, but failed. At Mr. Syme's suggestion, he thoroughly cleaned the cavity, and dropped back the adventitia without stitching. A rise of temperature occurred six days later, and a re-accumulation of fluid was discovered at the site of the former hydatid. An exploring needle was passed into the swelling, and half an ounce of clear serum was obtained. He agreed that Mr. Russell's suggestion, not to stitch the adventitial sac before returning it to the abdominal cavity, a good one, but did not think that this method would answer so well in cases of hydatid cysts of the liver.

The following paper was then read :—

NOTES ON THE DIPHTHERIA BACILLUS, WITH DEMONSTRATION OF METHODS FOR ITS DE

TECTION.

By THOMAS CHERRY, M.D., M.S. Melb.

Demonstrator and Assistant Lecturer in Pathology, University of Melbourne.

Any doubts which existed as to the part played by the KlebsLoeffler bacillus in the causation of diphtheria have been virtually settled during the last two or three years. The discovery that poisonous substances may be extracted from the spleen and other organs of persons dead of diphtheria, identical in physiological action with those produced by the bacillus when grown in peptone broth, seems to prove conclusively, if further proof were wanted,

Recent investiga

that this bacillus is the cause of the disease. tions have all tended at once to widen and to simplify our conceptions of the phenomena of diphtheria, and a full study of the bacillus has brought to light many facts which have unexpectedly cleared up anomalous points in its etiology. Many cases which are clinically simple sore throats, will in future be recognised as diphtheria on the strength of the bacteriological diagnosis, and we can thus understand how a series of isolated cases keeps the virus alive and active from one epidemic to the next. The site and the extent of the affection of the mucous membranes, and the character of the exudations are matters of secondary importance. The recognition of the presence of the bacillus as the test of the disease is attended by no greater difficulties than is the recognition of the tubercle bacillus as the one cause of all forms of tuberculosis. The fact that the one may grow for long periods in the throat without causing serious inconvenience, and yet set up a severe form of the disease on transmission to another throat, is paralleled by the fact that tubercle bacilli may remain long inert in a lymphatic gland, and then suddenly set up acute general tuberculosis.

Summarising the results of the latest investigations, I may remind you that the diphtheria bacilli are found most abundantly in the superficial layers of the exudation, and not, as was formerly taught, in the deeper tissues. They are separated from the epithelium of the mucous membrane by a layer of fibrin and small round cells, and in malignant cases they may form almost a pure culture in this situation. Considering the varieties of organisms present in the mouth in all circumstances we are prepared to find other bacilli and micrococci as almost constant companions of the diphtheria organisms. The streptococcus pyogenes has frequently been isolated from diphtheritic membranes. The pseudo bacillus is probably an attenuated form which may persist for many weeks after an attack of the disease, or which may be found in throats apparently healthy, or in simple inflammation of the tonsils and fauces. All the evidence shows that the bacillus of diphtheria may vary much in virulence, and it is found that age of an artificial culture is an index to its degree of attenuation. Thus, a growth in agar, which has been standing say for three years, may be partially revived by rapid transmission through three or four successive broth cultures, but a dose of c.c. will now cause only a small local swelling in a guinea-pig instead

the