PROCEEDINGS OF THE ROYAL MEDICAL AND CHIRURGICAL SOCIETY OF LONDON. March 10th, 1868. SAMUEL SOLLY, F.R.S., President, in the chair. Present-53 Fellows and 3 visitors. Books were presented from Dr. Alderson, Dr. Anstie, Dr. C. T. Williams, and Baron Hippolyte Larrey; from the Royal Society, the Linnean Society, the University of London, and the Academy of Sciences of Munich. Dr. Thomas Buzzard and Dr. Walter Butler Cheadle were admitted Fellows of the Society. The following gentlemen were proposed for election as Fellows of the Society: Thomas Crawford, M.D. VOL. VI.NO. II. William Rhys Williams, M.D. 5 The following communications were read: I. A Case of Excision of the Wrist by Lister's Method. By J. W. HULKE, F.R.C.S., F.R.S. (Received Dec. 28th, 1867.) (Abstract.) The author briefly points out the differences of Lister's method. of excising the wrist from the common methods by lateral incision or by a single cut across the back of the joint, and then narrates a case where he successfully employed it. The patient, a groom, had disease of the left wrist, of several months' duration. After other plans of treatment had failed, the author removed all the carpal bones, and the ends of the radius and ulna, as also those of the metacarpal bones, by Lister's method, and the patient recovered such a useful hand that he became coachman to a nobleman, and drove a brougham in town. II. On Excision of the Wrist-Joint. By JAMES F. WEST, F.R.C.S. (Exam.), Surgeon to the Queen's Hospital, and Professor of Clinical Surgery in Queen's College, Birmingham. Communicated by the President, SAMUEL SOLLY, F.R.S. (Received Dec. 31st, 1867.) (Abstract.) This paper, on excision of the wrist-joint, gives an account of three cases in which that operation has been performed at the Queen's Hospital, Birmingham, with marked success, and is accompanied by photographs showing the state of the parts some months after the operation. The history of the operation was briefly recited, particular attention being called to Professor Lister's memoir on the subject, by which the cases suitable for operation are more clearly defined, and many minute yet im portant points in the treatment of the cases subsequent to the operation are made out. Mr. West insisted on the importance of early removal of all the carious portions of bone, but the retention of those parts, either of the radius and ulna or of the carpal bones, which appeared free from disease; he also advocated free separation of the thumb from the rest of the hand during the treatment of the case, so as to counteract the tendency to inversion of the thumb, which always follows excision of the wrist; and further, the early use of passive motion of the fingers, with a view to prevent their becoming stiff and useless. In the first and third cases the whole of the bones entering into the formation of the wrist-joint were removed: in the second, a carious fragment of radius, extending for about an inch above the joint, was alone removed. The patient recovered in each case with a hand having considerable strength and mobility, after a variable period of time extending from three months to two years. At the conclusion of the meeting, Mr. John D. Hill exhibited a patient on whom excision of the elbow-joint had been successfully performed in a case of compound fracture of the right olecranon, with transverse fracture of the patella, and in which inflammation and disorganization of the elbowjoint had ensued. March 24th, 1868. HENRY LEE, F.R.C.S., Vice-President, in the Chair. Present-53 Fellows and 4 visitors. Books were presented by the Rev. O. P. Vincent and by the Managers of the Royal Institution. Dr. William Johnston and Mr. George Eastes were admitted Fellows of the Society. The following communications were read: I. A Case in which the Corpus Callosum was absent. By THOMAS B. CHRISTIE, M.D., Superintendent of the North Riding Asylum, Clifton, York. Communicated by J. L. H. Down, M.D. (Received Dec. 10th, 1867.) (Abstract.) A patient, æt. 20, died; and it was found at the autopsy that the corpus callosum was wanting. He had been idiotic and without the power of speech from birth. The calvaria was small, dense, and shelving off considerably in the anterior portion. The encephalon was very small, and weighed only 28 oz. The specific gravity of the grey matter was 1040, and of the white 1045. II. Notes respecting Non-Uniting Fractures. By GEORGE W. CALLENDER, F.R.C.S., Assistant-Surgeon to, and Lecturer on Anatomy at, St. Bartholomew's Hospital. (Received Dec. 31st, 1867.) (Abstract.) After referring to the statements made by Amesbury and Hamilton respecting non-uniting fractures, the author relates a series of cases to show that the union of a broken bone is never prevented although it may be delayed, by constitutional causes. Instances are given of the repair of fractures in cases of recent and long-standing paralysis, and cases of non-union occurring during childhood are incidentally referred to. The results of the treatment of fractures at St. Bartholomew's Hospital during the past seven years are mentioned; also the history of a case of nonuniting fracture of the thigh, and cases of non-union from special local causes. It is concluded that three well-defined varieties must be enumerated of fractures which fail to unite : 1. Fractures, not inaptly termed spontaneous, which ensue from diseases of bone; in which it is evident that no union is likely to take place. 2. Fractures (a) with separation of the bone and periosteum to such an extent that there cannot be thrown out bone-material enough to fill up the gap between the fragments; (b) occurring through bones not provided with periosteum, when it is difficult to keep the broken ends together. 3. All fractures other than the preceding; and in these cases, although union may be delayed, it rarely fails, except as the result of bad management of the injury. Several cases are narrated to show the effect of non-uniting fracture upon joint movements, and the treatment of those injuries where the thigh is the bone involved is briefly referred to. Cases are cited in illustration of the great length of time after the lapse of which a fracture, if properly treated, may be repaired, and the occasional good results from mere fibrous union are illustrated by pathological observations. The question of joint-stiffness after fractures is considered, and the importance of not interfering with such stiffness until the fracture is firmly united is insisted upon, and reasons are given for the presumption that such premature interference by the use of passive movements is a frequent cause of non-union. The following are the conclusions arrived at: Non-union of an ordinary fracture should never occur. Under careful treatment bones will unite two years or longer after the occurrence of the fracture. It is reasonable to suppose that such fractures would have united at an earlier period, if properly treated. Treatment of delayed union should consist 1st. In the improvement of the health, and in the avoidance of local obstructions to the circulation. 2nd. In placing the broken bone in the best position attainable. 3rd. In leaving it at rest until it unites, its doing so being simply a question of time. 4th. In avoiding all attempts to overcome the stiffness of joints adjacent to, but not involved in a fracture, until the bone is |