intestines were then examined and no other wound being found, the cavity was thoroughly cleansed with hot water, and the superficial structures closed with silk sutures. No nourishment of any kind was given for 48 hours, and then nutrient enemata only; on the 10th day liquid, and on the 20th solid foods were given by the stomach. The man was up on the 20th day, and fifth week. The paper is sup left the hospital cured in the plemented by a table containing notes of all published cases of laparatomy for gunshot wound of abdomen up to date. These are 69 in number, with 27 recoveries and 41 deaths; under the old "do-nothing" system of treatment, less than 8 per cent. recovered. Cerebral and Spinal Surgery.-This retrospect would be incomplete without a reference to the able paper read by Dr. W. Macewen at the Glasgow Meeting of the Association. The paper having appeared at length in the columns of the B. M. J., there is no need to enter into its details here. We were present at the meeting and were more than impressed by the display of brilliant cases which Dr. Macewen presented to his audience at the conclusion of his address. Dr. Macewen's paper will become historical. We venture to think that cerebral surgery at the present time owes its greatest debt to the skill, intelligence, and care of our Glasgow contemporary. Real advance and advantage must follow the publication of so masterly a contribution to professional literature. Local News. MR. JORDAN LLOYD, F.R.C.S., has been recently appointed Assessor in Anatomy at the 1st M.B. Examinations of the University of Durham. NEW INVENTIONS, DRUGS, ETC. TOILET LANOLINE.-We have pleasure in calling attention to Burroughs, Wellcome & Co.'s toilet lanoline. It is prepared by rubbing together lanoline and purified petroleum jelly, perfuming the combination slightly with otto of rose. Toilet lanoline has proved an admirable antiseptic application to the skin in cases of sunburn, chapping, wrinkling and minor blemishes of the skin. It possesses soothing and healing properties, and is an elegant preparation. MESSRS. BURRoughs, WellCOME & Co. have received the "Grand Diploma of Honour" for their preparations shown at the Sanitary Exhibition now being held in Ostend. : New Books, etc., Received. Therapeutics its Principles and Practice. By H. C. WOOD, M.D., LL.D., Professor of Materia Medica and Therapeutics, and Clinical Professor of Diseases of the Nervous System in the University of Philadelphia. Seventh edition. London: Smith, Elder & Co. 1888. A Text Book of Physiology. By M. FOSTER, M.D., LL.D., F.R.S., Professor of Physiology in the University of Cambridge. Fifth edition. London: MacMillan, and Co. 1888. British Pharmaceutical Conference. J. and A. Churchill. 1888. Unofficial Formulary, 1888. London : The Mineral Waters and Baths of Ashby-de-la-Zouch. By CHARLES A Directory for the Dissection of the Human Body. By JOHN CLELAND. M.D., LL.D., F.R.S., Professor of Anatomy in the University of Glasgow. London: Smith, Elder, and Co. 1888. THE BIRMINGHAM MEDICAL REVIEW, NOVEMBER, 1888. ORIGINAL COMMUNICATIONS. ON INFLAMMATORY DISEASE IN THE NEIGHBOURHOOD OF BUT UNCONNECTED WITH JOINTS.* BY T. H. BARTLEET, M.B., F.R.C.S., SURGEON TO THE GENERAL HOSPITAL, BIRMINGHAM. I HESITATE in bringing before you, at the first meeting of the Session, a surgical paper which records no great surgical triumph. It may perhaps afford food for thought, and provide subject for discussion, and it is so far original that I have failed to find references to the subject in question in any surgical records. Indeed among many other reasons for bringing before you to-day the paper I have the honour of presenting, a chief reason is the desire of eliciting the opinions of my surgical colleagues, as to the diagnosis and treatment of what I consider to be an important, and at the same time a somewhat neglected class of surgical cases. Far be it from me to imply that the individual cases receive insufficient attention, what I do mean is that they are omitted, as far as I know, in surgical class books, and indeed have no place in surgical literature generally. In my reference to disease around, or external to joints, I only include inflammatory disease, that is I do not include malignant disease or exostosis or bursa or any other of the many surgical conditions that may exist * Read at a Meeting of the Birmingham and Midland Counties Branch of the British Medical Association Oct. 11th, 1888. N in the neighbourhood of joints, what I do refer to is inflammatory disease around, or near to joints, but not affecting the interior of the joint, the synovial cavity or the cartilage, not in fine, what one calls arthritis. However one might technically define a joint, surgically a joint consists of bones encrusted with cartilage, lined by synovial membrane, which contains a fluid, the bones held together by ligaments, surrounded usually by tendinous expansions of muscles, and covered by the usual cutaneous envelopments. In all these different structures we find results of disease in cases of destructive arthritis, changes well known to every surgeon. The deeper joints present at all events this difference, that they are often surrounded by muscles instead of by tendons. I must ask you to bear in mind this anatomical difference between superficial joints such as the ancle, elbow and knee, and the deeper joints such as the hip and shoulder. The symptoms of acute arthritis as occurring in, for example, the knee are too well known and need not be detailed; the cases are often of such gravity, and so frequently lead to operation, that they have received attention at the hands of most surgeons, special attention at the hands of very many. Disease outside the capsule of the joint has received little or no attention, though often deserving a great deal, since I think I shall show you by the relation of some cases that the diagnosis and treatment are alike important and difficult. I must ask your forbearance if I do not make myself very intelligible; my classifications are new, and it is quite possible that better ones can be formulated. As I said before, we all recognise a typical case of arthritis of the knee, and I think we should all equally readily recognise a marked case of extraarticular inflammation, I remember two cases which occurred at the General Hospital while I was a student; a young girl was admitted for some trifling ailment, the house surgeon removed a small sebaceous tumour from over the patella; this slight operation was followed by suppuration all round the knee joint, which was accompanied by constitutional symptoms so severe as to imperil the life of the patient. The oedema and redness of the skin, the swelling, not limited by the superficial area of the synovial sac, the fluctuation over the patella, led us to form the no doubt accurate opinion that the affection was extraarticular. A case which followed a like course, and which was due to a needle breaking in the patella, I need not relate in · detail. Cases of suppuration, following teno-synovitis in front and behind the wrist, but affecting neither the wrist nor carpal joints are very common in hospital, and not uncommon in private practice. There are, however, cases much more obscure than any of these, not very frequent perhaps, but when occurring of the greatest importance alike to the patient whose limb may be sacrificed to an erroneous judgment, and to the surgeon whose reputation might be wrecked by a failure to discriminate. a rare and obscure condition. A few years ago I was summoned to Torquay to see the son of a gentleman with a view to amputating a foot at the ancle joint. I will briefly narrate the case. A young man, about 17 years of age, of delicate appearance, had some months before concussed his foot by jumping off a door-step; the injury was not sufficiently severe to induce great care, and in consequence synovitis of the ancle was set up, the foot became hot, swollen, and intensely painful, and at the same time great constitutional irritation was developed. High temperature at night, sweats and sleeplessness unless under the influence of morphia. He had been subjected to the ordinary treatment, local and general, the former including immobilization and the employment of a swing; ultimately the question of amputation was referred to me. On examining the youth's ancle I found swelling all round, that is over the front of the joint, on each side of the tendo Achillis, and under each malleolus. There was no swelling or fluctuation between the malleolus and the skin; the swelling around the ancle was semi-fluctuating, there was greatly increased heat of the ancle, which was most acutely sensitive to the slightest movement; the patient also complained of starting pains, there were no sinuses and there was no pointing of matter; there |