and where the pressure was greatest a small area of gut appeared of doubtful vitality, so that care was taken to leave this part just under the wound. Six inches of the diverticulum were resected, the proximal inch being utilised as a nipple, through which a glass tube tapped the distended gut, and a pint or two of foul contents was evacuated; the cut end of this piece was then inverted and sutured; whilst the cut end of the distal inch was sutured in the upper angle of the wound. On November 12th focal discharge appeared and continued to escape from the upper part of wound until November 17th; this was probably due to yielding of the bowel wall at the site mentioned above. The patient got up on November 28th, and the wound was healed by December 6th.

Strangulated Inguinal Hernia: Rupture of Bowel.—Mr. Morrison showed a specimen from the body of a man, aged 58, whom he saw for the first time on December 5th, and upon whom he operated forthwith, only to find that the distended gut had burst. According to the history there had been complete obstruction for twenty days, but unfortunately an obscure swelling in the left inguinal region due to a small knuckle of herniated, and ultimately, gangrenous gut had not been appreciated until too late. Stress was laid on the importance of investigating the accessible hernial regions in every case of intestinal obstruction. In this instance, the whole lumen of the small bowel was involved in a small sac just beyond the internal ring.

Mr. Leedham-Green showed a young woman with a patch of Actinomycosis in the cheek which had gradually softened, and was evidently waning under treatment with iodide of potassium, gr. x., three times daily.

Gangrene due to Embolism.-Mr. George Heaton showed the blood vessels of a lower limb removed for embolic gangrene. The patient was a lady, aged 63. She had old standing cardiac mischief. Some months previously she had an embolus lodge in the posterior tibial artery, and gangrene threatened for a time. The second embolism took place suddenly some eight ys previously and was followed by typical dry gangrene.

The specimen showed an old embolism of the posterior tibial artery at the point of origin of the peroneal artery. Below this part the artery was converted into a fibrous cord, the recent embolus could be seen lodged in the mouth of the anterior tibial artery and completely blocking it. The popliteal and femoral arteries above were full of recent thrombus.

Dr. Rickards read a paper entitled "Notes, with Comments, of two cases of Actinomycosis," under the following headings:Actinomycosis, a comparatively rare disease, probably not so rare as the number of cases recorded would indicate. Notes of two cases, thoracic and abdominal; the elements in diagnosis: the portal of infection: treatment with special reference to the exhibition of iodide of potassium.

Professor Leith showed some interesting slides under the microscope prepared from Dr. Rickards's cases, and also specimens of streptothrix akin to the micro-organisms seen in cases in actinomycosis, and gave an account of the microscopical appearances of these organisms. In the discussion that followed, Messrs. Lucas and Leedham-Green, Dr. Ratcliffe, and the President took part, and Dr. Rickards then replied

Mr. Gamgee read a paper entitled "Some Remarks on the Surgical Treatment of Intestinal Obstruction," of which the following is an abstract:-The variation in symptoms of intestinal obstruction: methods of diagnosis, in which special stress was laid on visible peristaltic action of the bowels: difficulties attending the diagnosis of such cases, especially with regard to the presence of peritonitis: general principles of surgical treatment and operative details. In the discussion that followed, Messrs Morrison, Heaton, and Milward, Drs. Short and Sydenham, and the President took part. Mr. Gamgee then replied.

BIRMINGHAM AND MIDLAND COUNTIES BRANCH. PATHOLOGICAL AND CLINICAL SECTION.

A MEETING of the Section was held on Friday, October 28, 1904, Dr. MALINS in the chair.

Specimens.-Dr. Thomas Wilson showed: (1) An adenomyomatous uterus removed, together with a small sarcoma of the right ovary, from a multipara aged fifty-seven years. The menopause occurred at the age of fifty-three, and one year and a half later discharge, bleeding, and pain began and continued. (2) A cervical fibroid, weighing 9ålbs., removed under local anesthesia from a 9-para, aged thirtyeight. The patient was suffering from polyuria, myocardial degeneration, and chronic alcoholism, and the tumour had been growing for about two and a half years.

Sarcoma of Kidney.-Dr. Walter Jordan showed a sarcoma of the right kidney removed post mortem from an infant aged four months. When admitted into the Children's Hospital, the child was found to have a tumour causing great enlargement of the abdomen, the right half of which it entirely occupied, while an indistinct rounded edge was felt to the left of the median line. The child had vomited daily since birth, and the bowels had been moved six to nine times a day, but it was well nourished, and seemed strikingly comfortable and happy in view of the abdominal condition. The day after admission the temperature ran up to 104°, and the child died twenty-four hours later. No history of pain or of hæmaturia could be obtained. The growth was very large, and weighed 2lb. 10oz. (the child, with the tumour together, weighing only 11lb. 6oz.). The ureter and the renal vessels were healthy. The greater part of the abdomen was occupied by the growth, the intestines being crushed into a small space occupying the left flank. When the tumour was cut into, it was found to be occupied partly by a number of large ragged cysts, containing a brownish fluid, and partly by large white nodules of new growth, and other nodules into which hæmorrhage had taken place. Only a very small portion of normal kidney tissue was found,

at the lower end of the growth. The supra-renal capsule was stretched over the upper end of the tumour, but not involved in it. Dr. Emanuel, who had prepared sections, reported that microscopically the growth was composed of tubular acini, lined by a single lay of cubical cells, with solid cylinders of similar cells separating the tubules, and running in between the acini and the cylinders' delicate strands of fine fibrous tissue. The tubules, or acini, were of new formation, and were not merely normal urinary tubules entangled in a new growth. Dr. Emanuel was of opinion. that the growth could not be classed among the sarcomata, but was of the nature of a carcinoma arising in embryonic renal tubules (the metanephros).

Ulcerative Colitis.-Dr. Douglas Stanley showed the large intestine from a female patient, aged twenty-six, admitted under his care for ulcerative colitis. The patient had suffered from colitis a year previously, but recovered. When admitted the second time, there were abdominal tenderness, contraction of the colon, frequent offensive motions containing blood and yellow-stained mucus. There was difficulty in retaining food of any description. The patient died with symptoms of perforating peritonitis. The colon showed diffuse ulceration, with necrosis of all the coats in many places. There were ulcers in the lower nine inches of the ileum.

BIRMINGHAM BRANCH.

PATHOLOGICAL AND CLINICAL SECTION.

A MEETING of the Section was held on November 25, 1904, Mr. L. P. GAMGEE, F.R.C.S., in the chair.

Congenital Elevation of Scapula.- Mr. Milward showed a girl, aged fourteen and a half years, with congenital elevation of the scapula. The deformity had been noticed as long as the mother could remember. The right shoulder was some two inches higher than the left, and the scapula was rotated some forty-five degrees, bringing the upper angle prominently up under the trapezius, and causing pain there.

Abduction of the arm from the side was limited. Infantile paralysis, scoliosis, and mal-development of the scapula were absent. The X-rays showed that there was a marked deformity of the first five ribs on the right side. They were variously contorted, and the fourth and fifth apparently projected backwards, pushing the lower end of the scapula upwards and inwards. Mr. Milward considered this the primary deformation, and that shortening of the muscles was secondary. Mr. Charles R. Keyser, in a paper recently read before the Clinical Society of London, had stated that cases of congenital elevation of the scapula might be classified into four groups (1) Where there was a bridge of bone between scapula and spine; (2) where certain muscles were absent; (3) where there was a long and everted supra-spinous portion of the scapula; (4) where the scapula was normal or small and the muscles defective. The present case did not seem to fall exactly into any of these groups, unless into the last, with the important addition of costal deformity. If treatment were called for, it was proposed to remove the projecting supra-spinous portion. At present such a measure seemed hardly justified, as the symptoms were but slight.

Excision of Both Lachrymal Sacs.-Dr. Jameson Evans showed a girl, aged nine, in whom both lachrymal sacs had been removed. She came under his care in August, 1904, when she was suffering from double interstitial keratitis and muco-purulent dacryocystitis, associated with disease of the bony lachrymal canals. The dacryocystitis and lachrymal strictures were treated for over a year by probing and injections of protargol without much improvement. Owing to the distress caused by the probing, the ineffectiveness and tediousness of conservative measures, and the inconvenience and expense of coming a long distance for treatment, excision of the lachrymal sacs was decided on. This was done by a slightly curved incision extending downwards and somewhat outwards from the lower border of the internal palpebral ligaments. The sacs were separated from their attachments and removed without opening their cavities. The wounds healed by first intention, and the scars were barely percep