were lenticular spots on the abdomen. In three cases there was no diarrhoea to speak of. The patient from whom the specimens had been obtained died on the twelfth day. The spleen was of normal size, but the other typhoid lesions were characteristic. The solitary follicles were particularly affected.

Stated Meeting, December 12, 1877.

Dr. E. G. JANEWAY, President.

Congenital Deformity. - Dr. PUTNAM JACOBI presented to the Society a child aged five months which showed several interesting deformities. There was anchylosis of both elbows, partial on one side, and nearly complete on the other, with paralysis of the extensor muscles of the forearm. The flexors were also paralyzed, but in a less degree. The feet were in a condition of talipes equinus. The legs could not be completely extended. Dr. Putnam Jacobi said an interesting feature of the case was its etiology, which would seem to be due to some centric lesion. The infant did not seem to be idiotic.

Visceral Sarcoma.-Dr. BRIDDON presented, several specimens of cystic sarcoma removed from a woman aged twentyfour. The patient entered the Presbyterian Hospital, June 2, 1877, suffering from a movable tumor the size of a cocoanut, situated in the gluteal region. It was removed June 7th, but returned June 20th, in the track of the drainage-tube. A close examination of the wound showed the manner of growth. This was exemplified by the granulations, which increased in size, then became cedematous, until the ordinary character of the cystic sarcoma became manifest. After the return of the neoplasm in the course of the drainage-tube, it was scooped out, but reappeared after ten days, when it was again removed in a similar manner, and a solution of chloride of zinc applied. The wound had completely cicatrized by August 15th, at which time she left the hospital. There was, however, in the cicatrix, a tumor the size of a nut. The patient returned to the hospital October 13th. It was then found that two tumors

existed in the right gluteal region. They were removed by an incision which was ten inches in length, and extended from the floating ribs to the trochanter major. The patient did not do well after the operation. There developed symptoms of pneumonia, and, on examining the chest, signs of consolidation were discovered at the base of the right lung. Death took place by exhaustion.

Autopsy. The heart was dislocated to the left. The right lung was adherent, and filled the cavity of the right chest. It weighed 46 oz. The upper lobes were normal. The lower lobe presented the appearance of a pulpy mass. This was due to the presence of a sarcomatous tumor, which did not involve the pleura. The left lung was slightly diminished in size from compression of the right. The liver was the seat of sarcomatous growth, and weighed 6 lbs. 12 oz. The spleen weighed 25 oz. The upper part was normal, but the lower portion contained a sarcomatous tumor.

Dr. Briddon said it was of interest to note the tendency of the tumor to reproduce itself in the track of the drainage-tube and sutures.

Sarcoma of Humerus.-Dr. C. M. ALLIN presented a portion of different viscera which he had taken from a patient suffering from sarcoma. The patient was a young man, and was admitted to hospital April 3, 1877. His family history was good. The first sign of disease noted was the occurrence of pain between the elbow and shoulder, and during December, 1876. The shoulder was found to be swollen. The swelling extended, and in three months involved the forearm and hand. On admission, a tumor was noticed two inches below the head of the humerus. This steadily increased, and was accompanied by a feeling of numbness over the surface of the growth. The right arm below the axilla measured seventeen inches, the left twelve inches. Subsequently, the affected arm measured eighteen inches, the left twelve inches. It was decided to amputate at the shoulder-joint. On examining the humerus after the operation, it was found to be surrounded with a sarcomatous mass extending down to the lower fourth. This mass was found to be both external and internal to the periosteum. For two weeks the patient did

well, but on April 30th pain was complained of in the wound, which continued for a month.

May 30th.-Pain was felt in the chest, but no sign of thoracic disease could be made out.

June 5th.-An abscess which had formed discharged. It was found also that a painless tumor had returned in the cicatrix.

July 5th.-Another swelling appeared.

July 25th.—The tumor reached above the scapula. Pain was complained of in the left thigh.

October 1st.-A large mass of the tumor sloughed out. Patient much weaker. Died from exhaustion.

October 20th. Autopsy.-The whole of the scapula was found to be involved, with the exception of a narrow margin on the posterior border. The clavicle and acromion process were not involved. The scapular muscles were displaced by the growth. Pleuritic adhesions were found, but no fluid. There was a hard deposit in the right lung. The mesenteric glands were enlarged, and white. A small tumor was found contiguous to the vena cava, and in it was found a thrombus. A tumor was found in the hollow of the sacrum, which put the lumbar plexus on the stretch. In the iliac vein were found fibrine and some of the sarcomatous growth. There was oedema of the lower extremities, but no ascites.

Dr. Allin also presented some drawings, showing the microscopical character of the growth, and the appearance of the sarcoma in the vein.

Dr. JANEWAY was of the opinion that the sarcomatous matter found in the vein was the result of contiguity of tissue.

Dr. SELL recited the subsequent history of a patient from whom a sarcomatous mamma had been removed, and presented to the Society. After the operation the wound healed up, but after six weeks a tumor appeared in the cicatrix. After this had reached the size of the first, the patient passed under the care of a cancer-doctor. He applied a paste, and eventually sloughed it out, leaving a large granulating surface, which did not heal. The tumor reappeared in the sore.

Dr. Sell understood that during the treatment the patient died suddenly, but no post mortem was obtained.

The specimen which was presented to the Society proved to be alveolar cancer.

Epithelioma of the Upper Lip, involving the Ala Nasi.—Dr. Post presented an epithelioma of the upper lip which he had removed from a man forty-five years of age. The disease made its appearance when he was twenty-three years old, and in the eighteen years of its course involved the right side of the upper lip and part of the ala nasi. After the removal of the epithelioma, a plastic operation was required to bring the flaps together. Dr. Post said it was rare to find epithelial cancer commencing in so young a patient. Dr. Briddon had removed an epithelioma from the same region a few months ago. A plastic operation was required to adjust the flaps.

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Compound Fracture of Humerus.. - Dr. ERSKINE MASON presented a man to the Society who had received a compound fracture of the condyles of the humerus. He was forty-five years old and a car-driver by occupation. The injury was received by being dragged over the dashboard of the car. was admitted to Bellevue Hospital March, 1877, and on examination there was found only a slight external wound. It was proposed at first to seal up the opening, in preference to performing resection of the elbow.

March 27th.-Phlegmonous erysipelas developed, and extended to the arm and shoulder. The suppuration was extensive, and for two weeks the temperature ranged between 104 and 106.

April 20th.-The external condyle came away, and one week later the internal condyle was taken out. Subsequently a portion of the head of the radius was also discharged.

May 16th. The patient sat up for the first time. After the wounds healed, the elbow, wrist, and phalangeal joints. were firmly anchylosed, but by persistent passive motion the patient had excellent use of his elbow as well as of the other joints. Passive motion was commenced. Dr. Mason said the case might in one sense be considered as one of spontaneous resection. Ins ealing up the wound when the patient was first seen, the intention was to perform resection later if it was found to be indicated.

NEW YORK ACADEMY OF MEDICINE.

Stated Meeting, December 6, 1877.

Dr. S. S. PURPLE, President.

Alimentation in Surgical Accidents and Diseases.-Dr. FRANK H. HAMILTON read a paper on the above subject, in which he urged that alimentation should be more studied in the treatment of surgical cases than it was. He said that in hospitals there was a tendency to cut off extra diet, though liquors and medicines were given freely. He suggested also that it would be a wise plan to attach a diet-kitchen to dispensaries.

Dr. POST said that in some periods of a disease, as in the hot stage of intermittents, alimentation was scarcely possible, even were it indicated; and he thought in many cases that it would be well to allow the stomach rest for a few hours or a few days, if found necessary. There could be little doubt, however, as to the general indication of alimentation in all diseases.

Dr. ANDREW H. SMITH said it should be borne in mind that the introduction of alimentary matters into the stomach did not always mean alimentation. It was known that the blood would take up only a certain amount of oxygen, and he was of the opinion that it was much the same in regard to articles of nutrition. If more were absorbed than could be assimilated, they would be thrown off.

Bibliographical and Literary Notes.

ART. I.-Lectures on Practical Surgery. By H. H. TOLAND, M.D., Professor of the Principles and Practice of Surgery, and Clinical Surgery, in the Medical Department of the University of California. Philadelphia: Lindsay & Blakiston, 1877.

Ar the request of the students of the University of California, the author, whose "engagements are so numerous" that he "could not find time to write a book with the scientific