Syme's and not with Bassini's in regard to the greater difficulty in separating the cord from the sac in cases of congenital hernia; but he did not think that this was an argument in favour of any other operation as against Bassini's, because in the latter the separation was commenced near the internal ring, where it was more easily effected. Now, in regard to the question of the permanency of the cure in these cases, he supported his position both on theoretical grounds and on the results of experience. Theoretically, these were quite different from the old operations to which Mr. Syme had referred. In the latter the inguinal canal was never exposed, and no proper suturing of the internal ring and the canal was attempted; neither was the sac, as a rule, completely removed from the canal; nor in any of them was the cord transplanted. Macewen made the first advance in emptying the canal of the sac, and also in suturing the conjoined tendon to Poupart's ligament. His results showed one failure out of ninety-eight cases, some of which had been under observation for ten years. Post-mortem evidence, as furnished by Macewen and Lauenstein, showed the parts perfectly closed, with the sac lying over the internal ring. Of Bassini's cases, a hundred and eight had remained well from one to four and a half years. Some of them were soldiers, and accounts from the army surgeons showed them to be perfectly well. He, therefore, thought that there was already strong practical evidence as to the efficiency of these newer operations, which were founded on sounder surgical principles than the older methods. In no case where he had done Bassini's operation had there been any suppuration. He had with other operations seen first some escape of serous fluid, which was followed later by pus. In Bassini's operation, as a rule, there was not much tension, as the threefold layer is freed until it comes easily across to Poupart's ligament.

PATHOLOGICAL EXHIBITS.

Dr. MOLLISON showed the following specimens :

For Mr. C. S. Ryan.

An Alveolar Sarcoma of the Kidney.-This was an extensive tumour of the left kidney, varying considerably in its appearance; in parts it showed large masses of caseation, at others it was dotted with hæmorrhagic extravasations, while one extremity of the growth was almost cartilaginous in consistence. Sections taken from the soft greyish growing edge of the tumour showed

that it was composed of large epithelioid cells enclosed in an alveolar network of fibrous tissue. Some of the alveoli would contain only one cell, while in others the cells were evidently closely connected with the fibrous framework of the tumour. The kidney weighed 1 lb. 91⁄2 ozs., and measured 6 inches by 4 inches in length and breadth respectively. The pelvis and ureter were completely blocked with new growth. The patient, a man of 62, had only noticed the swelling about six weeks. He had noticed blood in the urine and had lost weight. He had no pain except

on coughing. His recovery was uninterrupted.

For Dr. Moore.

(a) An Alveolar Myxo-Sarcoma of the Ovary.—This specimen, which was removed at an autopsy, was a very large fleshy tumour of the left ovary, measuring 8 inches by 4 inches. The new growth had also infiltrated the broad ligament and encircled the rectum firmly, causing almost complete obstruction, so that the large intestine became enormously distended with semi-fluid fæces, and the cæcum gave way, forming a fæcal fistula through an incision which had been made for exploratory purposes. The other ovary was also affected by the growth, and the peritoneum was dotted with patches of it. The uterus and ovaries when removed weighed 51 lbs.

(b) Carcinoma of the Rectum.-This was a very firm ulcerating growth, involving about three inches of the rectum and completely encircling it. Microscopically, it presented all the characteristics of carcinoma, without any colloid change.

(c) Tubercular Epididymitis.—This specimen was removed from a young man who some two years previously had had his other testicle removed in a country hospital for what was said to be sarcoma. His urine deposited pus, in which tubercle bacilli could be demonstrated. The epididymis was considerably swollen and dotted with cheesy patches, at the lower end it was softening down and suppurating. The body of the testicle was unaffected.

A Rupture of the Aorta.-This specimen was removed from a woman who fell dead while working a mangle. The pericardial cavity was full of blood, and there was a tear in the aorta, about half an inch long, a little way above the aortic valves. The wall of the aorta was thin, and the lumen enlarged at the site of the rupture. The aortic valves were thickened and bound together.

Gummata of the Liver.-There were about half a dozen yellowish firm cheesy nodules scattered through the liver, the largest as big

as a walnut. Death had been caused by a meningeal hæmorrhage, probably owing to the rupture of a small aneurism of one of the meningeal vessels.

For Dr. Felix Meyer.

A Sub-mucous Fibroid of the Uterus.-The tumour, which was larger than the foetal head, bulged into the cavity of the uterus, and presented at the os, which was thinned and dilated, simulating the early stage of labour. The uterine cavity was enlarged, and stretched upwards in front of the tumour. The patient had suffered from severe hæmorrhages for eight or nine months, and had wasted considerably. She thought she was pregnant. Krug's operation was performed, the whole uterus with the tumour being removed through an abdominal incision, and the peritoneum sutured, thus shutting off the vagina from the peritoneal cavity. The patient recovered completely.

British Medical Association.

VICTORIAN

BRANCH.

The usual monthly meeting was held on May 29. The President, Dr. SNOWBALL, occupying the chair.

Dr. McADAM showed a very interesting case of what he called 'Epidermis Hypertrophica." Over the thenar and hypo-thenar eminences of both hands, and the soles of the feet, the skin was thickened and rough; the fingers were also contracted; the hair in the frontal portion of the scalp was short. stubbly, and thin. The patient was a woman, aged 42, and the affection had come on gradually. When a child, she had taken arsenic for some time.

Dr. DYRING showed a case of Localised Edema of the Abdominal Wall, in a well developed man of 43. He had a similar condition five years previously, after an injury, which gradually disappeared. The present condition had existed for seven weeks, and had followed an attack of influenza. He had also what appeared to be a lipoma of the abdominal wall.

Dr. FELIX MEYER then read "Notes on Six Recent Cases of Abdominal Section." The first was for fibro-myoma of the uterus, concerning the diagnosis of which some difference of opinion existed, and which illustrated Lawson Tait's dictum, that you can never be certain as to what is in the abdomen until it is

opened. The case in question had been variously regarded as a tense ovarian cyst, and as a fibroma of the ovary, as well as a uterine fibro-myoma. In another case an exploratory laparotomy was performed, and the condition found to be a pregnant uterus, with a fibro-myoma. The patient suffered intense pain, which was relieved by the operation, though nothing further was done. In a third case of uterine fibro-myoma, the tumour was sub-mucous, and presented at the os uteri like a fœtal head. Complete extirpation of the uterus was performed. Two laparotomies were for ovarian cyst-one a simple case; in the other the cyst was so adherent, that it was thought wiser not to attempt its complete removal, so it was divided with scissors, and a pedicle formed and brought out of the wound, which was closed above it, and a glass drainage-tube inserted. The pedicle separated in fourteen days, and the patient recovered perfectly. In the other ovariotomy, in tapping the cyst some fluid escaped into the abdomen, and was simply wiped out, and no lavage or drainage employed. The remaining laparotomy was for pelvic peritonitis with severe symptoms, but no pus was found; the uterus and appendages were matted together with adhesions, which were separated, and drainage employed. All six cases recovered.

A discussion followed on the question of the curative value of operations per se, and the relative merits of lavage and merely wiping out the peritoneal cavity. Tait's dictum was also criticised, and with regard to the treatment of pregnancy, associated with uterine fibro-myoma, it was shown that no authoritative opinion existed.

Hospital Reports.

MELBOURNE HOSPITAL.

Case of Dislocation of the Tibia backwards, and Rupture of Popliteal Artery and Veins.

Under the care of Mr. C. S. RYAN.

Reported by T. E. GREEN, M.B., B.S. Melb., Resident Surgeon.

E. R., admitted April 7, 1895. Patient was sliding on an American slide, and was either pushed by some men, or struck his foot against the fence at the end of the slide. Great swelling immediately ensued up and down the limb, which became very tense and painful.

U

On admission, the foot and leg were quite blue and cold, and devoid of sensation. The pulsation of the tibial arteries could not be felt. There was great bruising and subcutaneous effusion of blood round the knee-joint, and a fractured femur was suspected, with the end of the lower fragment pressing back on the vessels.

Under chloroform, Mr. Ryan made an incision into the popliteal space, which he found filled with blood-clot. Having evacuated this, it was discovered that there was a dislocation of the tibia backwards, and the posterior, lateral, and crucial ligaments were completely torn away from the femur. The periosteum was also stripped up for some distance from its posterior and outer aspect, and the popliteal artery and vein were torn through. It was decided to amputate, and the operation was performed in the middle third of the thigh by means of long anterior and short posterior flaps, which were united by means of deep silver and superficial horse-hair sutures. Dry dressing (iodoform powder and gauze) was then applied, and a bandage, which was also carried round the waist to support the stump.

The wound healed with some sloughing of a portion of one flap, and the patient was discharged on April 27, 1895.

Bullet Wound of Femoral Artery.

Under the care of Mr. C. S. RYAN.

Reported by T. E. GREEN, M.B., B.S. Melb., Resident Surgeon.

R. H., admitted May 2, 1895. Patient accidentally shot himself in the leg and in the mouth with a revolver. In the latter instance no serious injury had been sustained, and the bullet was removed from behind the pinna, the ball having entered in the angle between the jaws on the left side, tearing the soft palate and grazing the tongue. The other bullet passed through the left thigh, just below the apex of Scarpa's triangle, and the track pointed directly backwards. No pulsation could be felt in the dorsalis pedis, or in the posterior tibial artery, and the left foot and leg were somewhat colder than the right, and also felt numbed. Patient had lost a good deal of blood, and was pale. Bleeding had ceased at site of injury.

Under chloroform, Mr. Ryan cut down and found that the bullet had passed right through the femoral artery, without injuring the vein. The aperture in the vessel was plugged with a small clot, and when this was disturbed, bleeding came on fairly