thread moderately thick, like a cord, tied in knots at short distances, is fully described by him. He also speaks of cauterizing the part from which the tumor was removed. Epulis, a soft, fleshy excrescence which forms upon the gums, was treated by Albucasis by excision with forceps and scalpel, after which styptics are to be applied to the part, and if the tumor should grow again, the actual cautery, knob-shaped, must be resorted to. (Chirurg. i, 22, and ii, 28.) The same treatment is advised by modern surgeons.

Of all the ancient surgical writers Albucasis has treated the subject of operations upon the teeth with the greatest fullness and care. He directs that free scarification of the gums be made before performing extraction, and then pulling the tooth direct with forceps, the patient's head being meantime held between the knees of the operator. (The writer of this sketch has vivid and painful recollections of submitting to this mode of vice-like retention of the head, while a rural Arab-of-a-doctor wrenched a molar from his inferior maxillary with a cant-hook, known to many still living, as a turn-key. This heroic method is not yet entirely obsolete.) Albucasis directs that hollow teeth be stuffed with a tent of cloth before applying the forceps. If a piece of the alveolar process be broken, he advises its removal. He also gives directions for filing projecting points or diseased portions of teeth. When teeth have been loosened by accident, he directs that they shall be secured by threads or wires of gold. In his second book, thirtieth chapter, he gives drawings of instruments for the extraction of roots of teeth.

[To be Continued.]

NEW YORK SURGICAL SOCIETY.

TH

CASES OF EXCISION OF THE KNEE-JOINT.1

HREE patients upon whom he had performed excision of the knee-joint were presented by Dr. C. T. Poore. All the operations were performed with the circular incision. The antiseptic spray was not used. The wounds were thoroughly washed out with a solution of carbolic acid, one to forty. The bones were sutured together with wire sutures, and drainage tubes passed through the anterior flap around the joint and out through the popliteal space. secure immobility the limb was placed upon a posterior splint, and plaster of Paris bandages applied from toes to groin, an interval being left at point of operation.

The first patient was a boy 16 years of age, with a rather poor family history. He had pulpy disease of both knee joints; in the right the tibia was dislocated backwards and flexed at a right angle with the femur. The right knee joint was excised in 1879, and the result was firm union of the tibia and femur with two inches shortening. At the time of dismissal from the hospital he had quite good flexion of the left knee, and was able to act as an assistant to a surveyor, which compelled him to do considerable walking. Last summer he fell and injured the left knee; this was followed by swelling and pains, and it has left that joint stiff in a straight position. Notwithstanding this he is able to get about very well.

The second patient was a girl 13 years of age, who fell and injured the left knee joint six years ago. The injury was followed immediately by swelling and pain, and six weeks subsequently an abscess formed, which was opened in Bellevue Hospital. She was subsequently a patient at Roosevelt Hospital, where several large abscesses formed about the joint and the lower portion of the thigh, and were opened. She left there considerably improved, but with the limb flexed at nearly a right angle. She subsequently was admitted to St. Mary's Hospital, where Dr. Poore operated upon her in

1 Stated meeting, January 9, 1883.

May, 1882, by removing a V shaped portion of the lower extremity of the femur. There was considerable shortening. after the operation, and there still remained a small external ulceration, but no exposed bone.

The third patient was a boy who had suffered from Pott's disease, and also had osteitis of the head of the tibia with abscess, which opened into the joint. Excision was performed in the usual way, and there was nothing peculiar concerning the subsequent progress of the case except that on the following day the temperature arose to 105.5° F., but fell to the normal within a few hours, and afterwards there were no unfavorable symptoms except the occurrence of a small slough upon one side of the joint, for which Dr. Poore was unable to account. In this case there still remained a small sinus into which a probe could be introduced, but he was unable to detect any rough bone. In all the cases the wounds healed promptly, and all the patients were up on the fortieth day.

FRACTURE OF THE CALCANEUM.

A specimen was presented by Dr. Stimson, which illustrated fracture of the posterior portion of the head of the calcaneum. He believed it to be probably the result of muscular action. The patient was a man fifty-three years of age, who was admitted to Bellevue Hospital in November last, for a disease of the tibia which required amputation. Eight years ago, while crossing the street, he was knocked down by a wagon and received the injury which the specimen illustrated. At the time the injury was received, the patient said that the skin was not bruised. The fragment was the portion to which the tendo-Achillis was attached, at least partially. It was more than an inch in length, and about three-fourths of an inch in breadth. On its outer side the periosteum was complete; on the inner side there was a growth of bone which presented the appearance of having been the result of reparative process. The fragment had united with the bone at its upper border, but was about half an inch anterior to its original position.

In reply to a remark of Dr. Bull, that he thought that pure muscular action could not produce this fracture; that it was the result of direct violence, Dr. Stimson remarked that there were several cases upon record, in which the fracture occurred as a result of muscular action. Dr. Peters

also referred to a case in which fracture occurred as a result of muscular action.

MELANOTIC SARCOMA.

Dr. Gerster presented a specimen of melanotic lymphosarcoma which he removed from the neck of a man on the fourth of the present month. Three months ago the patient got heated from running about, and then sat down in front of an open window and was chilled. This was the only fact which he had been able to ascertain, concerning the cause of the growth, although he did not attribute much importance to it as an ætiological factor. Immediately after this occurred, the man noticed a slight swelling at the corresponding angle of the jaw, which gradually increased in size. There was no sore throat following the chilling nor nasal catarrh. The tumor continued to grow, and he consulted a physican who proposed to inject into it tincture of iodine. At that time it was about the size of an Italian chestnut. Considerable re-action followed the injection, the tumor did not resume its former size and shape, but continued to grow rapidly, and after three months it attained the size of a small orange. It was situated in the upper cervical triangle below the angle of the jaw. Laterally it was quite freely movable, not so vertically; and the skin over it was attached to the tumor. Dr. Gerster diagnosed lympho-sarcoma of rapid growth, and gave a grave prognosis. Removal was advised, the exsection was not difficult. Immediately after cutting through the skin, it was noticed that the mass had a peculiar dark color. On account of its appearance, and from the fact that through a slight puncture made by a hook introduced into its capsule for the purpose of lifting. the tumor up, a black material exuded, he did not attempt to remove the tumor from the capsule, but dissected out the capsule and all, keeping well to the outside of the growth. At the lower and inner part of the tumor, where it approached the superior thyroid artery, there was a dense mass of connective tissue of recent inflammatory origin, which had attached the capsule to the blood-vessel, and also enclosed a small bundle of lymphatic vessels. Immediately upon the oozing of the black material, which presented the appearance of graphite mud, through the opening made by the hook, he removed the instrument and applied a ligature round

the point, carefully cleansed the part, and then proceeded to the dissection without further assistance of this kind. At the upper and outer angle of the jaw, a large number of lymphatic glands were found, which had exactly the characteristics of the tumor itself. They looked like a chain of small blue grapes, and burst as soon as touched. They were dissected away, together with some connective tissue by which they were surrounded. When the tumor was cut open it was found to contain a cavity in which there moved freely a black body that was surrounded by the dark fluid material already mentioned. Microscopical examination revealed that the growth consisted almost entirely of round celled pigmented elements with a very sparse stroma. The mass which was free in the center was doubtless the original swelling or lymphatic gland noticed first by the patient in the neck, it contained glandular tissue. The thick melanotic envelope enclosing this glandular body apparently represented the degenerated glandular capsule. The wound was closed by a few silver wire sutures and healed by first intention. Early recurrence of the disease is to be expected.

FIBRO-MYOMA OF THE SCROTUM.

Dr. W. T. Bull presented a specimen accompanied by the following history H. C. F., forty-eight years of age and married, entered the hospital October 16, 1882. He gave no specific history; there was no history of cancer in the family; there was no history of traumatism. About twenty years ago the patient first noticed a small, hard lump, about the size of a marble, in the lower part of the right side of the scrotum. There was neither pain nor tenderness on pressure, nor disfort of any kind. This mass gradually increased in size until two or three years ago, since which time it had grown much more rapidly. On admission he complained only of the weight and inconvenience. The scrotum formed a tumor as large as a child's head, the enlargement being on the right side. The skin was normal with large veins, the tumor was ovoid in shape, and reached upwards as far as the external abdominal ring, which was dilated and filled up, when standing, by a hernial protrusion as large as a goose egg, which could be easily returned. The surface of the tumor was smooth but uneven, and marked by several rounded projec