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E-Empyema, Treatment of by Val-

vular Canula

178

Endocarditis

46

Epilepsy, Masked Case of

82

Erythrasine

85

Ergot, Influence of on Involution 88

Eye, Injury of from Lightning Stroke 223

Erythema

280

Eczema

280

Erysipelas

281

F-Foxwell, Arthur 13, 90, 178, 227

Fætal positions, frequency and causes of 88

Femoral Hernia, Gangrenous, case of 158

G-General Paralysis in Females 174

Gritti's Amputation through thigh 183

H-Hogben, Edgar, B.A., M.D., 44,

65, 155, 270-Hill, A. Bostock, M.D.,

139--Harvey, A., M.B., 87

Hæmoglobinuria in acute rheumatism 128
Paroxysmal

132
Hypodermic injection, Tetanus after 81
Hyperidrosis

83, 280

Hydrops Intermittens Articulorum 182

Hæmorrhoids, Whitehead's operation

for

188

Human Heart, Vessels of the Valves of 270

I-Internal Recti Muscles, insufficiency

225

Infantile Palsy, epidemic of

80

Infammatory disease round joints,

cases of

195

Intestine, gangrenous, treatment of

... tgo

Kreuznach Mother-Liquor and Calcium

Chloride in the Treatment of Skin

Diseases ...

279

L--Lloyd, Jordan, 1, 143, 158, 182, 192

Lactic Acid in Urine

128

Liver, Amyloid disease of, an infiltra-

tion or not

Leucocythæmia, Arsenic in

227

Liver, enlargement of, in Rickets 65

Lithotomy, Petersen's operation for

Suprapubic

9

cases of

Larynx, Intubation of

42
Leukæmia in Pregnancy
Lipomatosis Neurotica

176
Laryngitis, Rheumatic

181

M---Moore, Surgeon-General Sir

William, 143—Morrison, J. T. J.,

239 —

MacCormac, Sir William,

M.A., F.R.C.S., 241.

Mycosis, Axillaris

86
Maloja Kursaal, the

14, 19
Masturbation, appliance for

189

Myoma, bleeding, treated by Galvan-

ism, case of

233

D--Bartleet, T. H., M.B., 193-

Barling, Gilbert, 168
Birmingham, Vital Statistics

139
Birmingham Pan System

143
Birmingham Polluted Wells, closure of 143
Bright's Disease, Retinal changes in... 224

Mental affections in 81
Bulbar Paralysis, apoplectiform

82
Bladder, Sarcoma of

186

C-Carter, Alfred H., M.D., p. 145,

205-Crooke, G. F., M.D., 134-

Clark, Annie E., M.D., 41, 275:

Chronic Bright's Disease, Mental

Affections in

129

Cerebral Arteries, Syphilitic Aneurism

of

135

Cats, Diphtheria Spread by

141
Ciliary Muscles, "Unilateral Tonic
Spasm of

226
Craniotomy and its Alternatives

89
Cerebral Tumour, Case of

155
Calculus, Renal, Exploration of Kid-
ney

168
Chorea of Habit
Carbuncles, Erasion of ..

188
Cancrum Oris after Typhoid

233
Cardio-vascular Nutrition

272
Cardiac Dyspnea

274

Congenital Hernia, Treatment of 276

Constipation in Infants, Treatment of 277

Callosities, Corns and Warts, Treat-

ment of

... 279

D-Diabetes in an Infant

130
Pathology of

131
Syzygium Jambolana in 132

Davos Þörfli

15

Platz

16

Frauenkirch

16

Hotels at

17

and Engadine, Map of

16
Dyspepsia and the green Diarrhea of
Infants

41
Dilatatio Uteri, Prof. Vulliett's method

266

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Mitral Obstruction and Regurgitation 273

Myocardite Infectieuse diphtherique... 273

Milk and Foods for Infants, Steriliza-

tion of

277

Massage, Swedish

267

N-Nephritis, a case of, lasting twenty

years

137

0-ORIGINAL COMMUNICATIONS,

On Suprapubic Lithotomy. By

Jordan Lloyd, M.B., F.R.C.S.

The Davos and Engadine Valleys.

By Arthur Foxwell, B.A., M.B.... 13

Presidential Address. - Birmingham

and Midland Counties Branch of

the British Medical Association.

By Thos. W. Thursfield, M.D.,

M.R.C.P.

49

The Enlargement of the Liver in

Rickets. By Edgar Hogben, B.A.,

M.D. ...

Introductory Lecture on Gynæcology
at Queen's College. By Professor
Lawson Tait, F.R.CS, LL.D.

97
On the Methods of Diluting the

Blood and their Clinical Applica-
tion. By T. Stacey Wilson, M.B.,

C.M.
Practical Observations on Chronic

Heart Disease. By Alfred H.
Carter. M.D....

145, 205
Case of General Tuberculosis and

Tubercular Tumour in the left Lobe
of the Cerebellum. By R. M
Simon, M.D....

150
Notes of a Case of Cerebral Tumour.
By Edgar Hogben, B.A., M.D.

155

A Case of Gangrenous Femoral

Hernia. By Jordan Lloyd, M.B.,

F.R.C.S.

158

Surgical Cases. Under the care of

Gilbert Barling, F.R.C.S....

168

Inflammatory Disease in the Neigh

bourhood of but Unconnected with

Joints. By T. H. Bartleet, M.B.,

F.R.C.S.

... 193

Value of Plastic Methods, and their

place in Surgery. By Sir William
MacCormac, M.A., F.R.C.S. 241

Personal experience of Hay-Fever.

By Bertram C. A. Windle, M.A.,

M.D.

259

Oil of Turpentine, Physiological

action of

94

P-Pathology Prize, at General

Hospital, The

144

Phenacetin

229

Profession, low estimation of, reasons

for...

51

Psoriasis, treatment of, by Iodide of
Potassium

84
Pemphigus, Congenital Traumatic
Puerperal Temperature...

87
Phthisis, treatment of, by Oxygen and
Ozonized Oxygen

90
Pleurisy, treatment of Acute, by Milk
Diet

92
Pontresina

14
Promontogno

31

Presystolic Murmur, the

44

in Aortic Regurgi-

tation without mitral lesion 45

Pregnancy and Heart Disease...

47

107

...

38

...

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78

...

Bennett on Diseases of the Bible

... 123
Roose on Nerve Prostration

126

Morrison on Ventilation and Drain-

age

Beli's Notes on Surgery for Nurses 127
REPORTS OF SOCIETIES
B. M. A., Birmingham and Midland

Branch

Midland Medical

236, 285

Russell Prize, The

144
Ribs, Resection of, in Empyema 184

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233, 282

...

Skin, alterations of, at the time of
Puberty and Menopause

279
T-Tait, Prof. Lawson, LL.D., 97

-Thursfield, T.W., M.D.,M.R.C.P.,
49—Taylor, John W., 266.

Tarasp Schuls

31

Thusis

31

Tornadoes, Prize Studies of

47

Tubercular Tumour in Left Lobe of

Cerebellum, Case of

150

Thyroid in Epilepsy, Galvanisation of 176
Tuberculisation of Natives by Strangers 179
Typhlitis and Perforation; Lapar-
otomy ; Recovery

187
U-Urine, Secretion of, Influence of
Vagus on

129

Urine, Micro-Organisms in :

Urticaria, Pathogeny of...

86

Ununited Tibia

171

Urethral Stricture, Electrolysis of 184

Urinary Bladder, Rupture of

185

Urticaria

281

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BY JORDAN LLOYD, M.S., F.R.C.S. (ENG),
SURGEON TO QUEEN'S HOSPITAL, BIRMINGHAM.

DR. Bigelow has taught the profession that litholopaxy is the procedure for the removal of stones from the bladder, and that none other should be thought of in any case until the surgeon is confronted by some contra-indicating circumstance. Unfortunately the obstacles to litholopaxy are many; a large number of vesical calculi therefore will still have to be dealt with by other means. My remarks will be confined to stone as it occurs in the male, and it will be well at the outset to enumerate the circumstances under which Bigelow's operation is inapplicable. Firstly, those negativing conditions of the stone itself, as large size, excessive hardness, multiple number (when they amount in the aggregate to a considerable mass), and, lastly, encysted stones. Secondly, anatomical conditions, such as stricture and enlarged prostate. Thirdly, advanced kidney disease, where the prolonged administration of ether is likely to be dangerous; and, lastly--the largest class of all ---calculi in boys. With regard to the latter, the recently published results of the work of Surgeon-Majors Keegan and Fryer in India, make

* Paper read before the Midland Medical Society, Feb. 29. 1888.

А

it probable that many stones in boys will, in the future, have to be dealt with by litholopaxy; setting aside these, however, there still remain a large number for the cure of which the profession is not yet unanimous in its opinion as to the best procedure. There are three claimants in the field at least : lateral, median, and suprapubic lithotomy. My own experience suggests that to each might legitimately be allotted a share of the residuum. To the lateral operation I would assign stones of moderate size, which are very hard or multiple ; and those cases complicated by advanced kidney disorder, or by stricture. To median lithotomy, small stones in small children only, and the remainder, large stones, encysted stones, and stones associated with enlarged prostates to suprapubic lithotomy.

The six cases detailed at the end of this paper have occurred during the past 18 months : they do not include all my lithotomies for this period, and although I might not now elect to deal with the whole of them by the suprapubic incision, there were circumstances in each, at the time of operation, which led me to adopt it in preference to perineal lithotomy.

Suprapubic lithotomy was probably the first operation practised for the removal of a stone from the bladder. It has been revived, and has fallen into disuse again and again, and not until quite recent times has it ever taken a tight hold of the operating surgeon's fancy; probably because its frequentlyoccurring wound of the peritoneum and injury to the pelvic connective tissue gave the operation a higher death-rate than attended incisions through the perineum. It was not until Peterssen, of Kiel, systematised a plan by which danger could be reduced to a minimum, if not altogether avoided, that the operaion came seriously into competition with Cheselden's laterallithotomy. Our countryman, Garson, demonstrated by experiment, several years ago, how the peritoneal reflection was lifted up from the pubes during combined rectal and vesical distension; but no particular notice seems to have been taken of his observations. Whether Peterssen worked out the matter for himself or took advantage of Garson's publications there is no need to discuss,

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