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MEDICO-CHIRURGICAL TRANSACTIONS.

PUBLISHED BY

V J

THE ROYAL MEDICAL AND CHIRURGICAL SOCIETY

LONDON.

VOLUME THE SIXTIETH.

LONDON : LONGMANS, GREEN, READER, AND DYER,

PATERNOSTER ROW.

1877.

3S

*. CO

MEDICO-CHIRURGICAL TRANSACTIONS.

PUBLISHED UY

THE KOYAL

MEDICAL AND CHIRURGICAL SOCIETY

OF

LONDON.

SECOND SERIES. VOLUME THE FORTY-SECOND.

LONDON : LONGMANS, GREEN, READER, AND DYER,

PATERNOSTER ROW. 1877.

If

PKJKTED BT J. E. ADLABD, BARTHOLOMEW CLOSE.

ROYAL MEDICAL AND CHIBUBGICAL SOCIETY

OF LONDON.

PATRON.

THE QUEEN.

OFFICERS AND COUNCIL,

ELECTED MARCH 1, 1877.

CHARLES WEST, M.D

VICE-PRESIDENTS

TREASURERS.

SECRETARIES.

LIBRARIANS.

f RICHARD PAINE COTTON, M.D. J WILLIAM WOOD, M.D.

1

{

JOHN COOPER FORSTER.

JOHN WOOD, F.R.S.

WILLIAM WEGG, M.D.

JOHN BIRKETT.

JOHN HARLEY, M.D., F.L.S.

JOHN WHITAKER HULKE, F.R.S.

OTHER MEMBERS OF COUNCIL.

r CHARLES MURCHISON, M.D., LL.D. Ed., J F.R.S.

1 TIMOTHY HOLMES.

ROBERT BARNES, M.D.

LIONEL SMITH BEALE, M.B., F.R.S.

WILLIAM CHAPMAN BEGLEY, M.D.

EDWARD HEADLAM GREENHOW, M.D., F.R.S.

WILLIAM OGLE, M.D.

RICHARD BARWELL.

ARTHUR EDWARD DURHAM.

RICHARD PHILLIPS.

JOHN SOELBERG WELLS.

ERASMUS WILSON, F.R.S.

ABOVE FORM THE COUNCIL.

RESIDENT ASSISTANT-LIBRARIAN.

BENJAMIN ROBERT WHEATLEY.

A LIST OF THE PRESIDENTS OF THE SOCIETY FROM ITS FORMATION.

ELECTED

1805. WILLIAM SAUNDERS, M.D.

1808. MATTHEW BAILLIE, M.D.

1810. SIR HEXRY HALFORD, Bart., M.D., G.C.H.

1813. SIR GILBERT BLANE, Bakt., M.D.

1815. HEXRY CLIXE.

1817. WILLIAM BABIXGTOX, M.D.

1819. SIR ASTLEY PASTON COOPER, Bart., K.C.H., D.C.I*

1821. JOIIX COOKE, M.D.

1823. JOIIX ABERXETHY.

1825. GEORGE BIRKBECK, M.D.

1827. BEXJAMIX TRAYERS.

1829. PETER MARK ROGET, M.D.

1831. SIR WILLIAM LAWREXCE, Bart.

1833. JOIIX ELLIOTSOX, M.D.

1835. HEXRY EARLE.

1837. RICHARD BRIGHT, M.D., D.C.L.

1839. SIR BEXJAMIX COLLIXS BRODIE, Bart., D.C.L.

1841. ROBERT WILLIAMS, M.D.

1843. EDWARD STAXLEY.

1845. WILLIAM FREDERICK CHAMBERS, M.D., K.C.H.

1847. JAMES MOXCRIEFF ARXOTT.

1849. THOMAS ADDISOX, M.D.

1851. JOSEPH HODGSOX.

1853. JAMES COPLAXD, M.D.

1855. CAESAR HEXRY HAWKIXS.

1857. SIR CHARLES LOCOCK, Bart., M.D.

1859. FREDERIC CARPEXTER SKEY.

1861. BEXJAMIX GUY BABIXGTOX, M.D.

1863. RICHARD PARTRIDGE.

1865. SIR JAMES ALDERSOX, M.D., D.C.L;

1867. SAMUEL SOLLY.

1869. SIR GEORGE BURROWS, Bart., M.D., D.C.L.

1871. THOMAS BLIZARD CURLIXG.

1873. CHARLES JAMES BLASIUS WILLIAMS, M.D.

1875. SIR JAMES PAGET, Bart., D.C.L., LL.D.

1877. CHARLES WEST, M.D.

FELLOWS OF THE SOCIETY APPOINTED BY THE COUNCIL AS REFEREES OF PAPERS,

FOR THE SESSION OF 1877-78.

BARCLAY, ANDREW WHYTE, M.D.

BURROWS, SIR GEORGE, Bart., M.D., D.C.L., F.R.S.

CALLENDER GEORGE WILLIAM, F.R.S.

CHOLMELEY, WILLIAM, M.D.

CHURCH, WILLIAM SELBY, M.D.

CLARK, FREDERICK LE GROS, F.R.S.

CURLING, THOMAS BLIZARD, F.R.S.

DAVIS, JOHN HALL, M.D.

FAGGE, CHARLES HILTON, M.D.

GREENHALGH, ROBERT, M.D.

HABERSHON, SAMUEL OSBORNE, M.D.

HAWKINS, C^SAR HENRY, F.R.S.

HEWETT, PRESCOTT GARDNER, F.R.S.

HEWITT, GRAILY, M.D.

HILTON, JOHN, F.R.S.

HUTCHINSON, JONATHAN.

LANE, JAMES ROBERT.

MARSHALL, JOHN, F.R.S.

PAVY, FREDERICK WILLIAM, M.D., F.R.S

POLLOCK, GEORGE DAVID.

POLLOCK, JAMES E., M.D.

POWER, HENRY.

PRIESTLEY, WILLIAM OVEREND, M.D.

RADCLIFFE, CHARLES BLAND, M.D.

REES, GEORGE OWEN, M.D., F.R.S.

RINGER, SYDNEY, M.D.

SANDERSON, J. BURDON, M.D., F.R.S.

SAVORY, WILLIAM SCOVELL, F.R.S.

SIEVEKING, EDWARD HENRY, M.D.

SIMON, JOHN, D.C.L., F.R.S.

SMITH, SPENCER.

SOUTHEY, REGINALD, M.D.

THOMPSON, REGINALD, M.D.

THOMPSON, E. SYMES, M.D.

TILT, EDWARD JOHN, M.D.

WILKS, SAMUEL, M.D., F.R.S.

TRUSTEES OF THE SOCIETY.

SIR GEOEGE BUEEOWS, Bart., M.D., D.C.L., F.E.S. (LESAE HENEY H AW KINS, E.E.S. THOMAS BLIZABD CUELLXG, F.E.S.

TRUSTEES OF THE MARSHALL HALL MEMORIAL FUND.

WALTEE BUTLEE CHEADLE, M.D. WILLIAM OGLE, M.D. THOMAS SMITH.

LIBRARY COMMITTEE FOR THE SESSION OF 1877-78.

CHAELES HILTOX FAGGE, M.D.

ALFEED MEADOWS, M.D.

JOSEFH FEANK PAYNE, M.B.

J. BUEDOX SAXDEESON, M.D., F.E.S.

JOHN WILLIAMS, M.D.

WILLIAM MOEEAXT BAKER.

JOHN CEOFT.

EOBEET FAR QUH ARSON, M.D.

ARTHUR B. E, MTEES.

HEXEY POWEE. fJOHN HAELEY, M.D. LJOHX WH1TAKEE HULKE, F.E.S. r CHAELES MUECHISON, M.D., LL.D. Ed. Hon. Libs.) F.E.S.

\ TIMOTHY HOLMES.

FELLOWS

OP THB

ROYAL MEDICAL AND CHIRURGICAL SOCIETY OF LONDON.

EXPLANATION OF THE ABBREVIATIONS.

P. — President. V.P. — Vice-President.

T. — Treasurer. S. — Secretary.

L. — Librarian. C. — Member of Council.

The figures succeeding the words Trans, and Pro. show the number of Papers which have been contributed to the Transactions or Proceedings by the Fellow to whose name they are annexed. Sci. Com. is attached to the names of those who have served on the Scientific Committees of the Society.

OCTOBER, 1877.

Those marked thus (f) have paid the Composition Fee in lieu of further annual subscriptions.

Amongst the non-residents those marked thus (*) are entitled by composition to receive the Transactions.

Elected

1846 *Abercbo31BIE, John, M.D., Physician to the Cheltenham

General Hospital ; 13, Suffolk square, Cheltenham.

1851 *Acland, Henry Wentworth, M.D., F.R.S., Honorary- Physician to H.R.H. the Prince of Wales ; Physician to the Radcliffe Infirmary ; Regius Professor of Medicine, and Clinical Professor in the University of Oxford.

1847 Acosta, Elisha, M.D., 24, Rue de Luxembourg, St.

Honore, Paris.

X FELLOWS OF THE SOCIETY.

Elected

1852 Adams, William, Surgeon to the Great Northern Hospital, and to the National Hospital for Paralysed and Epi- leptic ; Consulting Surgeon to the National Orthopaedic Hospital, Great Portland street ; 5, Henrietta street, Cavendish square. C. 1873-4. Trans. 3.

1867 Aikin, Charles Arthur, 7, Clifton place, Hyde park.

1837 *Ainsworth, Ralph Fawsett, M.D., Consulting Physician to the Manchester Royal Infirmary; Cliff Point, Lower Broughton, Manchester.

1S39 Alcock, Sir Rutherford, K.C.B., K.C.T., K.T.S., D.C.L., late H.M.'s Envoy Extraordinary at the Court of Pekin. Trans. 1.

18G6 Allbutt, Thomas Clifford, M.A. and M.D., F.L.S., Lecturer on the Practice of Physic at the Leeds School of Medicine, and Physician to the Leeds General Infir- mary ; 35, Park square, Leeds. Trans. 3.

1863 Althaus, Julius, M.D., Physician to the Infirmary for Epilepsy and Paralysis; 18, Bryanston street, Portman square. Trans. 2.

1862 Andrew, Edwyn, M.D., Hardwick House, St. John's Hill, Shrewsbury.

1862 Andrew, James, M.D., Physician to, and Lecturer on Medicine at, St. Bartholomew's Hospital ; 22, Harley street, Cavendish square. Trans. 1.

1820 Andrews, Thomas, M.D., Norfolk, Virginia.

1870 Arnott, Henry, Chichester.

1819 fARNOTT, James Moncrieff, F.R.S., Chapel House, Lady Bank, Fifeshire, and 36, Sussex gardens, Hyde park. L. 1826-8. V.P. 1832-3. T. 1835-40. C. 184*6, 1855-6. P. 1847-8. Trans. 8.

1817 fAsHBURNER, John, M.D., F.L.S., 161a, Piccadilly. C. 1821, 1830-31.

1874 Aveling, James H., M.D., Physician to the Chelsea Hos- pital for Women ; 1, Upper Wimpole street, Cavendish square.

FELLOWS OF THE SOCIETY. XI

Elected

1836 Baird, Andrew Wood, M.D., Physician to the Dover Hospital ; 7, Camden crescent, Dover, Kent.

1851 *Baker, Alfred, Surgeon to the Birmingham General Hospital ; 20a, Temple row, Birmingham.

1873 *Baker, J. Wright, Senior Surgeon to the Derbyshire General Infirmary; 102, Friargate, Derby.

1865 Baker, William Morrant, Assistant Surgeon to, and

Lecturer on Physiology at, St. Bartholomew's Hospital ; Surgeon to the Evelina Hospital for Sick Children ; 26, Wimpole street, Cavendish square. Trans. 4.

1869 Bakewell, Robert Hall, M.D., Dunedin, New Zealand.

1839 fBALroUR> Thomas Graham, M.D., F.R.S., Surgeon General; Coombe Lodge, Wimbledon Park. C. 1852-3. V.P. 1860-1. T. 1872. Trans. 2.

1848 Ballard, Edward, M.D., Inspector, Medical Department, Local Government Board ; 12, Highbury terrace, Islington. C. 1872. V.P. 1875-6. Trans. 5.

1866 *Banks, John Thomas, M.D., Physician to Richmond,

Whitworth, and Hardwicke Hospitals ; Consulting Physician to the Coombe Hospital ; 10, Merrion square east, Dublin.

1847 Barclay, Andrew Whyte, M.D., Physician to, and Lecturer on Medicine at, St. George's Hospital ; Medical Officer of Health for Chelsea ; 23a, Bruton street, Berkeley square. S. 1857-60. L. 1861-2. C. 1865-6. V.P. 1872-3. Trans. 2.

1862 Barker, Edgar, 21, Hyde park street.

1833 fBARKER, Thomas Alfred, M.D., Consulting Physician to St. Thomas's Hospital ; 27, Wimpole street. C. 1844-5. V.P. 1853-4. T. 1860-2. Trans. 6.

1876 Barlow, Thomas, M.D. and B.S. Lond., Assistant Physi- cian to Charing Cross Hospital, and to the Hospital for Sick Children ; 10, Montague street, Russell square.

xu

FELLOWS OF THE SOCIETY.

Elected

1861 Barnes, Robert, M.D., Obstetric Physician to, and Lec- turer on Midwifery at, St. George's Hospital; 31, Grosvenor street. C. 1877. Trans. 4.

1864

1840

1859

1868

1874

1875

1862

1860

1856

1871

1858

1819

Barratt, Joseph Gillman, M.D., 8, Cleveland gardens,

Bayswater. Barrow, Benjamin, Surgeon to the Royal Isle of Wight

Infirmary ; Southlands, Ryde, Isle of Wight.

Barwell, Richard, Surgeon to the Charing Cross Hospital ; 32, George street, Hanover square. C. 1876-77. Tra?is. 3.

Bastian, Henry Charlton, M.A., M.D., F.R.S., Professor of Pathological Anatomy in University College, London, and Physician to University College Hospital ; 20, Queen Anne street, Cavendish square. Trans. 1.

Baxter, Evan Buchanan, M.D., Assistant Physician to King's College Hospital ; Professor of Materia Medica at King's College ; 28, Weymouth street, Portland place.

Beach, Fletcher, M.B., Medical Superintendent, Clapton

Idiot Asylum, Lower Clapton. Beale, Lionel Smith, M.B., F.R.S., Professor of the

Principles and Practice of Medicine in King's College,

London, and Physician to King's College Hospital ;

61, Grosvenor street. C. 18/6-77. Trans. 1.

*Bealey, gate.

Adam, M.D., M.A. Camb., Oak Lea, Harro-

Beardsley, Amos, F.L.S., Bay villa, Grange-over-Sands, Lancashire.

Beck, Marcus, M.S., Assistant Surgeon to University College Hospital ; 30, Wimpole street, Cavendish square.

Begley, William Chapman, A.M., M.D., late of the Middle- sex County Lunatic Asylum, Hanwell ; 26, Saint Peter's square, Hammersmith. C. 1877.

fBELL, Thomas, F.R.S., F.L.S., The Wakes, Selborne, Hants. C. 1832-3. V.P. 1854. Trans. 1.

FELLOWS OF THE SOCIETY.

• ■ :■.

• : -■■

Elected

1871 Bellamy, Edward, Senior Assistant-Surgeon to, and Lec-

turer on Anatomy at, Charing Cross Hospital ; Professor of Anatomy in the Science and Art Department, South Kensington ; 59, Margaret street, Cavendish square.

1847 Bennet, James Henry, M.D., The Ferns, Weybridge, and Mentone.

1845 fBERRY, Edward Unavin, 76, Gower street, Bedford square.

1820 Bertin, Stephen, Paris.

1872 Beverley, Michael, M.D., Assistant Surgeon to the Nor-

folk and Norwich Hospital ; 63, St. Giles's street, Nor- wich.

1865 #Btckersteth, Edward Robert, Surgeon to the Liverpool

Royal Infirmary, and Lecturer on Clinical .Surgery in

the Liverpool Royal Infirmary School of Medicine; 2,

Rodney street, Liverpool. Trans. 1. 1815 ^Billing, Archibald, M.D., F.R.S., Member of the Senate

of the University of London ; 34, Park lane. C. 1825.

V.P. 1828-9. 1854 Bird, Peter Hinckes, F.L.S., Medical Officer of Health for

the Fylde Union, West Lancashire ; 4, Clifton terrace,

Lytham, Lancashire, and 1, Norfolk square, Sussex

gardens, Hyde park. 1856 Bird, William, Consulting Surgeon to the West London

Hospital ; Bute House, Hammersmith. 1849 Birkett, Edmund Lloyd, M.D., Consulting Physician to

the City of London Hospital for Diseases of the Chest ;

48, Russell square. C. 1865-6. 1851 f Birkett, John, F.L.S., Treasure?-, Consulting Surgeon to

Guy's Hospital ; Corresponding Member of the " Societe

de Chirurgie " of Paris ; Inspector of Anatomy for

the Provinces in England and Wales ; 59, Green street,

Grosvenor square. L. 1856-7. S. 1863-5. C. 1867-8.

T. 1870-76. Trans. 8. Set. Com.

1866 Bishop, Edward, M.D., Cintra park, Upper Norwood. 1843 fBLACK, Patrick, M.D., Physician to, and Lecturer on

Medicine at, St. Bartholomew's Hospital; 11, Queen Anne street, Cavendish square, C. 1856. V.P. 1866. T. 1869-70.

XU FELLOWS OF THE SOCIETY.

Elected

1861 Barnes, Robert, M.D., Obstetric Physician to, and Lec-

turer on Midwifery at, St. George's Hospital; 31, Grosvenor street. C. 18/7. Trans. 4.

18G4 Barratt, Joseph Gillman, M.D., 8, Cleveland gardens,

Bayswater. 1840 Barrow, Benjamin', Surgeon to the Royal Isle of Wight

Infirmary ; Southlands, Ryde, Isle of Wight.

1859 Barwell, Richard, Surgeon to the Charing Cross Hospital ;

32, George street, Hanover square. C. 1876-77. Trans. 3.

1S68 Bastian, Henry Charlton, M.A., M.D., F.R.S., Professor of Pathological Anatomy in University College, London, and Physician to University College Hospital; 20, Queen Anne street, Cavendish square. Trans. 1.

1874 Baxter, Evan Buchanan, M.D., Assistant Physician to

King's College Hospital ; Professor of Materia Medica at King's College ; 28, Weymouth street, Portland place.

1875 Beach, Fletcher, M.B., Medical Superintendent, Clapton

Idiot Asylum, Lower Clapton.

1862 Beale, Lionel Smith, M.B., F.R.S., Professor of the

Principles and Practice of Medicine in King's College, London, and Physician to King's College Hospital ; 61, Grosvenor street. C. 1876-77. Trans. 1.

1860 *Bealey, Adam, M.D., M.A. Camb., Oak Lea, Harro-

gate.

1856 Beardsley, Amos, F.L.S., Bay villa, Grange-over-Sands, Lancashire.

1871 Beck, Marcus, M.S., Assistant Surgeon to University College Hospital ; 30, Wimpole street, Cavendish square.

1858 Begley, William Chapman, A.M., M.D., late of the Middle- sex County Lunatic Asylum, Hanwell ; 26, Saint Peter's square, Hammersmith. C. 1877.

1819 IBell, Thomas, F.R.S., F.L.S., The Wakes, Selborne, Hants. C. 1832-3. V.P. 1854. Trans. 1.

FELLOWS OF THE SOCIETY. Xlll

Elected

1871 Bellamy, Edward, Senior Assistant-Surgeon to, and Lec-

turer on Anatomy at, Charing Cross Hospital ; Profeseor of Anatomy in the Science and Art Department, South Kensington; 59, Margaret street, Cavendish square.

1S47 Bennet, James Henry, M.D., The Ferns, Weybridge, and Men tone.

1845 fBERRY, Edward Unwin, 76, Gower street, Bedford square.

1820 Bertin, Stephen, Paris.

1872 Beverley, Michael, M.D., Assistant Surgeon to the Nor-

folk and Norwich Hospital ; 63, St. Giles's street, Nor- wich.

1865 #Bickersteth, Edward Robert, Surgeon to the Liverpool

Royal Infirmary, and Lecturer on Clinical .Surgery in

the Liverpool Royal Infirmary School of Medicine; 2,

Rodney street, Liverpool. Trans. 1. IS 15 -(-Billing, Archibald, M.D., F.R.S., Member of the Senate

of the University of London ; 34, Park lane. C. 1825.

V.P. 1828-9. 1854 Bird, Peter Hinckes, F.L.S., Medical Officer of Health for

the Fylde Union, West Lancashire ; 4, Clifton terrace,

Lytham, Lancashire, and 1, Norfolk square, Sussex

gardens, Hyde park. 1856 Bird, William, Consulting Surgeon to the West London

Hospital ; Bute House, Hammersmith. 1849 Birkett, Edmund Lloyd, M.D., Consulting Physician to

the City of London Hospital for Diseases of the Chest ;

48, Russell square. C. 1865-6. 1851 f Birkett, John, F.L.S., Treasure?-, Consulting Surgeon to

Guy's Hospital ; Corresponding Member of the " Society

de Chirurgie " of Paris ; Inspector of Anatomy for

the Provinces in England and Wales ; 59, Green street,

Grosvenor square. L. 1856-7. S. 1863-5. C. 1867-8.

T. 1870-76. Trans. 8. Sci. Com.

1866 Bishop, Edward, M.D., Cintra park, Upper Norwood. 1843 fBLACK, Patrick, M.D., Physician to, and Lecturer on

Medicine at, St. Bartholomew's Hospital; 11, Queen Anne street, Cavendish square, C. 1856. V.P. 1S66. T. 1869-70.

Xiv FELLOWS OF THE SOCIETY.

Elected

1840 Blakiston, Peyton, M.D., F.R.S.

1865 Blanchet, Hilarion, Examiaer to the College of Physicians and Surgeons, Lower Canada ; 6, Palace street, Quebec, Canada east.

1865 Blandford, George Fielding, M.D., Lecturer on Psycho- logical Medicine at St. George's Hospital; 71, Gros- venor street.

1867 Bloxam, John Astley, Assistant-Surgeon to Charing Cross Hospital ; Surgeon for Out-Patients to the Lock Hos- pital ; Junior Surgeon to the West London Hospital ; 8, George street, Hanover square.

1823 Bojanus, Louis Henry, M.D., Wilua.

1846 fBosTocK, John Ashton, C.B., Hon. Surgeon to H.M. the Queen; Surgeon-Major, Scots Fusilier Guards; 73> Onslow gardens, Brompton. C.1861-2. V. P. 1870-71. Sci. Com.

1869 Bourne, Walteb, M.D. [care of the National Bank of India,

80, King William street, City.]

1870 *Bowles, Robert Leamon, M.D., 8, West terrace, Folke-

stone.

1841 fBowMAN, William, F.R.S. , F.L.S., Surgeon to the Royal

London Ophthalmic Hospital, Moorfields ; 5, Clifford street, Bond street. C. 1852-3. V.P. 1862. Trans. 3.

1862 Brace, William Henry, M.D., 7, Queen's Gate terrace, Kensington.

1874 Bradshaw, A. F., Surgeon-Major ; Surgeon to the Rt. Hon. the Commander in Chief in India ; Army Head Quar- ters, Bengal Presidency. [Agent: Vesey W. Holt, 17, Whitehall place.]

1867 *Brett, Alfred T., M.D., Watford, Herts. 1876 Bridges, Robert, M.B., Consulting Physician to St. Bar- tholomew's Hospital ; 52, Bedford square.

1867 Bridgewater, Thomas, M.B. Lond., Harrow-on-the-Hill, Middlesex.

FELLOWS OF THE SOCIETY. XV

Elected

1868 Broadbent, William Henry, M.D., Physician to, and

Joint Lecturer on Medicine at, St. Mary's Hospital ;

Physician to the London Fever Hospital ; 34, Seymour

street, Portman square. Trans. 2.

1851 j-Brodhurst, Bernard Edward, F.L.S., Surgeon to the Royal Orthopaedic Hospital ; 20, Grosvenor street. C. 1868-9. Trans. 2. Pro. 1.

18/2 Brodie, George Bernard, M.D., Consulting Physician- Accoucheur to Queen Charlotte's Hospital; 56, Curzon street, Mayfair. Trans. 1.

1844 fBROoKE, Charles, M.A., F.R.S., Consulting Surgeon to the Westminster Hospital ; 16, Fitzroy square. C. 1855. L. 1866-72. V.P. 1875-76.

1860 Brown-S£quard, Charles Edouard, M.D., F.R.S., Lau- reate of the Academy of Sciences of Paris ; New York, United States. Sci. Com.

1874 Bruce, John Mitchell, M.D., Assistant Physician to, and Lecturer on Materia Medica at, the Charing Cross Hospital ; Assistant Physician to the Hospital for Consumption, Brompton ; 60, Queen Anne street.

1867 Brunjes, Martin, 27, Edgware road.

1871 Brunton, Thomas Lauder,M.D.,F.R.S., Assistant Physician to, and Lecturer on Materia Medica at, St. Bartholomew's Hospital ; Examiner in Materia Medica at the Univer- sity of London ; 50, Welbeck street, Cavendish square.

1860 Bryant, Thomas, Surgeon to, and Lecturer on Surgery at, Guy's Hospital ; 23, Upper Brook street, Grosvenor square. C. 1873-4. Trans. 8 ; Pro. 1. Sci. Com.

1855 Bryant, Walter John, M.R.C.P. Edinb. ; Physician to the Home for Incurable Children, Maida vale ; 23a, Sussex square, Hyde park gardens.

1823 Buchanan, B. Bartlet, M.D.

1864 Buchanan, George, M.D., Inspector, Medical Department,

Local Government Board ; 24, Nottingham place,

Marylebone road.

XVI FELLOWS OF THE SOCIETY.

Elected

1864 Buckle, Fleetwood, M.D.

1876 Bucknill, John' Charles, M.D. ; 39, Wimpole street.

1839 Bodd, George, M.D., F.R.S., Consulting Physician to the Seamen's Hospital, Greenwich ; Ashleigh, Barnstaple. C. 1S46-7. V.P. 1857. Trans. 5.

1833 fBuRuows, Sir George, Bart., M.D., D.C.L., F.R.S., Physi- cian in Ordinary to H.M. the Queen; Consulting Physician to St. Bartholomew's Hospital; Member of the Senate of the University of London ; 18, Cavendish square. C. 1839-40, 1858-9. T. 1845-7. V. P. 1849-50. P. 1869-70. Trans. 2.

1837 fBusK, George, F.R.S., F.L.S., Consulting Surgeon to the Seamen's Hospital, Greenwich ; Member of the Senate of the University of London ; 32, Harley street, Caven- dish square. C. 1847-8. V.P. 1855. T. 1866. Trans. A.

1873 Butlix, Henry Trextham, Surgical Registrar to St. Bartholomew's Hospital ; Assistant Surgeon to the West London Hospital ; 47, Queen Anne street, Caven- dish square. Trans. 2.

1871 Butt, William F., 25, Park street, Park lane.

1868 Buzzard, Thomas, M.D., Physician to the National Hos- pital for the Paralysed and Epileptic ; 56, Grosvenor

street, Grosvenor square.

1851 *Cadge, William, Surgeon to the Norfolk and Norwich Hospital; 24, St. Giles's street, Norwich. Trans. 1.

1861 Callender, George William, F.R.S., Surgeon to, and Lecturer on Surgery at, St. Bartholomew's Hospital ; Surgeon to the Charter House ; Examiner in Anatomy at the University of London ; 7, Queen Anne street, Cavendish square. C. 1874. Trans. 4. Sci. Com.

1875 Carter, Charles Hexry, M.D., Physician to the Hospital for Women, Soho square ; 45, Great Cumberland place.

FELLOWS OF THE SOCIETY. XV11

Elected

1853 Carter, Robert Brudenell, Ophthalmic Surgeon to, and

Lecturer on Ophthalmic Surgery at, St. George's

Hospital ; 69, Wimpole street, Cavendish square, W.

Trans. 1. 1845 fCARTWWGiiT, Samuel, late Professor of Dental Surgery at

King's College, London, and Surgeon-Dentist to King's

College Hospital ; Consulting Surgeon to the Dental

Hospital; 32, Old Burlington street. C. 1860-1.

Sci. Com. 1 868 Cavafy, John, M.D., Assistant-Physician to, and Lecturer on

the Principles and Practice of Medicine at, St. George's

Hospital ; Physician to the Victoria Hospital for

Children ; 2, Upper Berkeley street, Portman square. 1871 Cayley, William, M.D., Physician to, and Lecturer on

Pathological Anatomy at, the Middlesex Hospital ;

Physician to the London Fever Hospital and to the

North-Eastern Hospital for Children ; 58, Welbeck

street, Cavendish square. 1845 fCHALK, William Oliver, 3, Nottingham terrace, York

gate, Regent's park. C. 1872-3. 1844 -{-Chambers, Thomas King, M.D., Hon. Physician to

H.R.H. the Prince of Wales ; Consulting Physician

to, and Lecturer on Medicine at, St. Mary's Hospital ;

Consulting Physician to the Lock Hospital ; 24, Mount

street, Grosvenor square. C. 1861. V.P. 1867. . L.

1869-72. Trans. 1. 1859 Chance, Frank, M.D., Burleigh House, Sydenham Hill. 1849 Chapman, Frederick, Old Friars, Richmond Green,

Surrey. 1877 Charles, T. Cranstoun, M.D., Lecturer on Practical

Physiology at St. Thomas's Hospital; 10, Mitre court

Chambers, Temple. 1868 Cheadle, Walter Butler, M.D., Assistant-Physician to,

and Lecturer on Pathology at, St. Mary's Hospital ;

Assistant-Physician to the Hospital for Sick Children ;

2, Hyde park place, Cumberland gate. 1873 *Chisholm, Edwin, M.D., Camden, near Sydney, New

South Wales.

VOL. LX. b

XV111 FELLOWS OF THE SOCIETY.

Elected

1865 Cholmeley, William, M.D., Physician to the Great

Northern Hospital, and to the Margaret Street Infir- mary for Consumption ; 63, Grosvenor street, Grosvenor square. 1872 Christie, Thomas Beith, M.D., Medical Superintendent, Royal India Asylum, Ealing.

1866 Church, William Selby, M.D., Physician to, and Lecturer

on Clinical Medicine at, St. Bartholomew's Hospital ; 130, Harley street, Cavendish square. 1860 Clark, Andrew, M.D., Physician to, and Lecturer on Medicine at, the London Hospital; 16, Cavendish square. C. 1875.

1839 fCLARK, Frederick Le Gros, F.R.S., Consulting Surgeon to St. Thomas's Hospital ; 63, Warrior square, St. Leonards-on-Sea. S. 1847-9. V.P. 1855-6. Trans. 5.

1848 Clarke, John, M.D., 42, Hertford street, May Fair. C. 1866.

1866 Clarke, William Fairlie, M.D., M.A. Oxon., South- borough, Tunbridge Wells. Trans. 2.

1850 Clarkson, Josiah, New Hall street, Birmingham. T)-ans. 1.

1842 -j-Clayton, Oscar Moore Passey, Extra Surgeon-in-Ordi- nary to H.R.H. the Prince of Wales, and Surgeon-in- Ordinary to H.R.H. the Duke of Edinburgh ; 5, Harley street, Cavendish square. C 1865.

1853 Clover, Joseph Thomas, 3, Cavendish place, Cavendish

square. C. 1873.

1857 Coates, Charles, M.D., Physician to the Bath General and Royal United Hospitals; 10, Circus, Bath.

1868 Cockle, John, M.D., F.L.S., Physician to the Royal Free Hospital ; 7, Suffolk place, Pall mall. Trans. 2.

1850 Cohen, Daniel Whitaker, M.D., South Bank, North Down lane, Bideford, Devon.

Colely, Davies, see Bavies-Colley.

1854 Collins, Frederick, M.D., Wanstead Lodge, Essex.

FELLOWS OF THE SOCIETY, XIX

Elected

1865 Cooper, Alfred, Surgeon to the Lock Hospital ; Assistant Surgeon to St. Mark's Hospital ; Surgeon to the West London Hospital ; 9, Henrietta street, Cavendish square.

1843 fCooPER, "William White, Surgeon-Oculist in Ordinary to H.M. the Queen ; Consulting Ophthalmic Sur- geon to St. Mary's Hospital; 19, Berkeley square. C. 1858-9. V.-P. 1873-4.

1868 Cornish, William Robert, Surgeon-Major, Madras Army ; Sanitary Commissioner for Madras ; Secretary to the Inspector-General, Indian Medical Department.

1860 #Corry, Thomas Charles Steuart, M.D., Surgeon to the Belfast General Dispensary ; 146, Donegall Pass, Belfast.

1853 Cory, William Gillett, M.D., Hengistbury House, Christ- church, Hampshire.

1847 fCoTTON, Richard Payne, M.D., Vice-President, Con- sulting Physician to the Hospital for Consumption, Brompton ; 33, Cavendish square. C. 1863. V.P. 1876-7.

1864 Coulson, Walter John, Surgeon to the Lock Hospital, 17, Harley street, Cavendish square.

1860 fCouPER, John, Surgeon to, and Lecturer on Surgery

at, the London Hospital ; Assistant-Surgeon to the

Royal London Ophthalmic Hospital ; 80, Grosvenor street. C. 1876.

1877 Coupland, Sidney, M.D., Assistant Physician to, and Lecturer on Pathological Anatomy at, the Middlesex Hospital ; 7, Nottingham place.

1862 Cowell, George, Surgeon to, and Lecturer on Surgery at, the Westminster Hospital ; Surgeon to the Royal Westminster Ophthalmic Hospital; Surgeon to the Victoria Hospital for Children ; 19, George street, Hanover square.

1841 Crawford, Mervyn Archdall Nott, M.D. C. 1853-4.

XX FELLOWS OF THE SOCIETY.

Elected

1868 Crawford, Thomas, M.D., Deputy Inspector-General of

Hospitals (India) ; Umbalah, Punjaub.

18/3 Creighton, Charles, M.B., Anatomical Museum, Cam- bridge.

1869 *Cresswell, Pearson R., Dowlais, Merthyr Tydvil.

18/4 Cripps, William Harrison, Surgeon to the Great Northern Hospital ; Assistant Surgeon to the Royal Free Hos- pital ; Assistant Demonstrator of Anatomy, Sr. Bartho- lomew's Hospital ; 61, Pall Mall.

1847 Critchett, George, Surgeon to the Royal London Oph- thalmic Hospital, Moorfields ; Ophthalmic Surgeon to the Middlesex Hospital; 21, Harley street, Cavendish square. C. 1865. V.P. 1872. Trans. 1.

1868 Croft, John, Surgeon to, and Lecturer on Operative Surgery at, St. Thomas's Hospital ; 61, Brook street, Grosvenor square.

1862 Crompton, Samuel, M.D., Physician to the Salford Royal Hospital and Dispensary ; 24, St. Ann's square, Man- chester.

1837 Crookes, John Farrar, 5, Waterloo crescent, Dover.

1860 Cross, Richard, M.D., Carlton House, Belmont road, Scar- borough.

1872 Crosse, Thomas William, Surgeon to the Norfolk and

Norwich Hospital ; 22, St. Giles's street, Norwich.

1849 *Crowfoot, William Edward, Beccles, Suffolk.

1846 Curling, Henry, Surgeon to the Margate Royal Sea- Bathing Infirmary, and the Ramsgate Seamen's Infir- mary ; Ramsgate, Kent.

1837 fCuRLiNG, Thomas Blizard, F.R.S., Consulting-Sur- geon to the London Hospital ; 39, Grosvenor street. S. 1845-6. C. 1850. T. 1854-7. V.P. 1859. P. 1871-2. Trans. 13. Pro. 1. Sci. Com.

1873 Curnow, John, M.D., Professor of Anatomy at King's

College, London, and Assistant Physician to King's College Hospital; Examiner in Anatomy at the Univer- sity of London ; 3, Warwick street, Cockspur street.

FELLOWS OF THE SOCIETY. XXI

Elected

1847 Cuerey, John Edmund, M.D., Lismore, County Waterford.

1822 Cusack, Christopher John, Chateau d'Eu, France.

1852 Cutler, Thomas, M.D., Spa, Belgium.

1872 Dalby, William Bartlett, M.B., Lecturer on Aural Surgery at St. George's Hospital ; 18, Savile row. Trans. I.

1836 *Daniel, James Stock, Ramsgate, Kent.

1848 Daukeny, Henry, M.D., San Rerno, Italy.

1874 Davidson, Alexander, M.D., Physician to the Liverpool Northern Hospital; 49, Rodney street, Liverpool.

1853 Davies, Robert Coker Nash, Rye, Sussex.

1852 Davies, William, M.D., 18, Gay street, Bath.

1876 Davies-Colley, John Neville C, M.C., Assistant-Sur- geon to, and Lecturer on Anatomy at, Guy's Hospital ; 36, Harley street, Cavendish square. Trans. 1.

1852 Davis, John Hall, M.D., Physician Accoucheur to, and Lecturer on Midwifery at, the Middlesex Hospital ; Physician to the Royal Maternity Charity, and Consulting Physician-Accoucheur to the St. Pancras Infirmary ; Examiner in Obstetric Medicine at the Uni- versity of London ; 24, Harley street, Cavendish square. C. 1869-70.

1867 Day, William Henry, M.D., Physician to the Samaritan Free Hospital for Women and Children ; 10, Manchester square.

1846 *Denton, Samuel Best, M.D., Ivy Lodge, Hornsea, Hull.

1859 fDicKiNSON, William Howship, M.D., Physician to, and Lecturer on Pathology at St. George's Hospital, and Senior Physician to the Hospital for Sick Children ; 9, Chesterfield street, Mayfair. C. 1874-5. Trans. 13. Sci. Com.

XX11 FELLOWS OF THE SOCIETY.

Elected

1839 fDixoN, James, Consulting Surgeon to the Royal London Ophthalmic Hospital, Moorlields ; Consulting Ophthal- mic Surgeon to the Asylum for Idiots ; Harrow Lands, Dorking. L. 1849-55. V.P. 1857-8. T. 1863-4. C. 18G6-7. Trans. 4.

1862 Dobell, Horace B., M.D., Consulting Physician to the

Royal Hospital for Diseases of the Chest, City road ; 84, Harley street. Trans. 2.

1845 Dodd, John.

1877 Doran, Alb an Henry Griffiths, Surgeon to Out-Patients, Samaritan Hospital ; Pathological Assistant to the Museum of the Royal College of Surgeons of England ; 20, Lower Seymour street, Portman square.

1863 Down, John Langdon Haydon, M.D., Physician to the

London Hospital ; 39, Welbeck street, Cavendish square. Trans. 2.

1867 Drage, Charles, M.D., Hatfield, Herts.

1853 Druitt, Robert, F.R.C.P. [8, Strathmore gardens, Ken- sington Mall.] Trans. 2.

1865 Drtsdale, Charles Robert, M.D., Physician to the Far- ringdon Dispensary ; Assistant-Physician to the Metro- politan Free Hospital ; 1 7,Woburn place, Russell square.

1865 Duckworth, Dyce, M.D., Assistant-Physician to, and Lecturer on Skin Diseases at, St. Bartholomew's Hospital; 11, Grafton street, Bond street. Trans. 1.

1876 Dudley, William Lewis, M.D., 117, Cromwell road, South

Kensington. 1845 Duff, George, M.D., High street, Elgin.

1874 Duffin, Alfred Baynard, M.D., Professor of Pathological Anatomy in King's College, London, and Physician to King's College Hospital; 18, Devonshire street, Port- land place.

1874 Duka, Theodore, M.D., Surgeon-Major, H.M.'s Bengal Army ; 38, Montagu square.

1871 Doke, Benjamin, 1, Cavendish terrace, Clapham Common.

FELLOWS OF THE SOCIETY. XXU1

Elected

1871 *Dukes, Clement, M.D. and B.S., Horton crescent, Rugby,

Warwickshire.

1867 Dukes, M. Charles, M.D., Wellesley Villa, Wellesley

road, Croydon.

1833 fDuNN, Robert, 31, Norfolk street, Strand. C. 1845-6. Trans. 2.

1861 Du Pasquier, Claudius Francis, Surgeon-Apothecary to H.M. the Queen, and to the Household of H.R.H. the Prince of Wales ; 62, Pall Mall.

1863 Durham, Arthur Edward, F.L.S., Surgeon to, and Lecturer on Surgery at, Guy's Hospital ; 82, Brook street, Grosvenor square. C. 1876-7. Trans. 5. Sci. Com.

1874 Durham, Frederic, M.B., Surgical Registrar to Guy's Hospital ; 38, Brook street, Grosvenor square.

1843 Dukrant, Christopher Mercer, M.D., Physician to the East Suffolk and Ipswich Hospital; Ipswich, Suffolk.

1872 Eager, Reginald, M.D., Northwoods, near Bristol. 1836 Earle, James William, late of Norwich.

1868 Eastes, George, M.B., Lond. Surgeon-Accoucheur to the

Western General Dispensary ; 69, Connaught street,

Hyde park square. 1824 Edwards, George. 1823 Egerton, Charles Chandler, Kendall Lodge, Epping.

1869 Elam, Charles, M.D., Assistant-Physician to the National

Hospital for the Paralysed and Epileptic ; 75, Harley street, Cavendish square.

1861 *Elliot, Robert, M.D., Physician to the Fever Hospital and to the Dispensary, Carlisle ; Coroner for Carlisle ; 35, Lowther street, Carlisle.

1848 Ellis, George Viner, late Professor of Anatomy in Uni- versity Collegs, London. C. 1863-4. Trans. 2.

1868 Ellis, James, M.D. , the Sanatorium, Anaheim, Los Angelet County, California.

XXIV FELLOWS OF THE SOCIETY.

Elected

1854 *Ellison, James, M.D., Surgeon-in-Ordinary to the Royal Household, Windsor ; 14, High street, Windsor.

1842 fERicHSEX, John Eric, F.R.S., Surgeon Extraordinary to H.M. the Queen ; late Professor of Cliuical Surgery in University College, London, and Surgeon to University College Hospital ; 6, Cavendish place, Cavendish square. C. 1855-6. V.P. 1868. Trans. 2.

1874 Evans, George Hexry, M.D., Assistant-Physician to the

Middlesex Hospital ; Assistant-Physician to the City of London Hospital for Diseases of the Chest, Victoria park ; 29, Devonshire street, Portland place.

1845 Evans, William Julian, M.D.

1877 Ewart, William, M.B., 33, Somerset street, Portman square.

1875 *Fagan, John, Surgeon to the Belfast Hospital for Sick

Children; 11, College square north, Belfast.

1864 Fagge, Charles Hilton, M.D., Assistant-Physician to, and Lecturer on Pathology at, Guy's Hospital ; 1 1, St. Thomas's street, Southwark. Trans. 6.

1869 Fairbank, Frederick Royston, M.D., 46, Hallgate, Don- caster.

1858 Falconer, Randle Wilbraham, M.D., Physician to the Bath United Hospital ; 22, Bennett street, Bath.

1862 Far qtjh arson, Robert, M.D., Physician in charge of the Skin Department, and Lecturer on Materia Medica at St. Mary's Hospital ; Physician to the Belgrave Hospital for Children ; 23, Brook street, Grosvenor square.

1844 fFARRE, Arthur, M.D., F.R.S., Physician Extraordinary to H.M. the Queen ; Physician-Accoucheur to H.R.H. the Princess of Wales ; 18, Albert Mansions, Victoria street, Westminster. C. 1857. V.P. 1864. Sci. Com.

FELLOWS OF THE SOCIETY. XXV

Elected

1872 Fayrer,Sir Joseph, K.S.I., M.D., F.R.S. Edin., Honorary- Physician to H.M. the Queen, and Physician to H.R.H. the Duke of Edinburgh ; Surgeon-Major, Bengal Army ; Examining Medical Officer to the Secretary of State for India in Council ; President of the Indian Medical Board; 16, Granville place, Portman square.

1872 *Fenwick, John C. J., M.D., Physician to the Durham County Hospital; Chilton Hall, Ferry hill, and 16, Old Elvet, Durham.

1863 Fenwick, Samuel, M.D., Physician, with charge of Out-

patients, to, and Lecturer on Medicine at, the London Hospital ; 29, Harley street, Cavendish square. Trans. 3.

1852 *Field, Alfred George.

1849 Fincham, George Tupman, M.D., Physician to, and Joint Lecturer on Medicine at, the Westminster Hospital ; 13, Belgrave road, Pimlico. C. 1871.

1866 Fish, John Crockett, B.A., M.B. Camb., Junior Physician to the West London Hospital ; 92, Wimpole street, Cavendish square.

1860 Fitzgerald, Thomas George, Surgeon-Major. [6, White- hall yard.]

1866 Fitzpatrick, Thomas, M.D., M. A., Dublin ; Physician to the Western General Dispensary; 30, Sussex gardens, Hyde park.

1842 Fletcher, Thomas Bell Elcock, M.D., Consulting Physi- cian to the Birmingham General Hospital ; 7, Waterloo street, Birmingham. Trans. 1.

1864 *Folker, William Henry, Surgeon to the North Stafford-

shire Infirmary ; Bedford House, Hanley, Staffordshire. 1848 f Forbes, John Gregory, 82, Oxford terrace, Hyde park.

C. 1868-9. Trans. 3. 1852 fFoRSTER, John Cooper, Vice-President, Surgeon to Guy's

Hospital ; Examiner in Surgery at the University of

London ; 29, Upper Grosvenor street. C. 1868-9.

S. 1873-5. V.P. 1877. Pro. 1. 1877 *Fortescue, George, M.B., late Surgeon to the Sydney

Infirmary ; Sydney, New South Wales.

XXVI FELLOWS OF THE SOCIETY.

Elected

1865 Foster, Balthazar Walter, M.D., Professor of Medicine at the Queen's College, Birmingham, and Physician to the Birmingham General Hospital; 16, Temple row, Birmingham.

1859 Fox, Edward Long, M.D., Consulting Physician to the Bristol Royal Infirmary, and Lecturer on Medicine at the Bristol School of Medicine ; Church House, Clifton, Gloucestershire.

1877 Fox, Tilbury, M.D., Physician to the Skin Department of University College Hospital; 14, Harley street.

1S58 Fox, Wilson, M.D., F.R.S., Physician-Extraordinary to H.M. the Queen ; Physician in Ordinary to H.R.H. the Duke of Edinburgh ; Holme Professor of Clinical Medi- cine in University College, London, and Physician to University College Hospital ; Examiner in Medicine at the University of London ; 67, Grosvenor street. C. 1875-6. Trans. 3.

1871 Frank, Philip, M.D., Cannes, France.

1843 Fraser, Patrick, M.D. C. 1866.

1868 Freeman, William Henry, 21, St. George's square, South Belgravia.

1836 fFREXCH, John George, 10, Cunningham place, Maida hill. C. 1852-3.

1876 Furner, Willoughby, 111, King's road, Brighton.

1864 *Gairdner, William Texxant, M.D., Physician in Ordi-

nary to H.M. the Queen in Scotland ; Professor of the Practice of Medicine in the University of Glasgow; Physician to the Glasgow Royal Infirmary ; 225, St. Vincent street, Glasgow.

1874 Galabin, Alfred Lewis, M.A., M.D., Assistant Obstetric Physician to, and Lecturer on Midwifery and the Diseases of Women at, Guy's Hospital ; Assistant- Physician to the Hospital for Sick Children ; 14, St. Thomas's street, Southwark. Trans. 2.

1865 Gant, Frederick James, Surgeon to the Royal Free

Hospital, 1 6, Conuaught square, Hyde park. Trans. 2.

FELLOWS OF THE SOCIETY. XXV11

Elected

1867 Garland, Edward Charles, L.R.C.P. Edin., Yeovil, Somerset.

1867 Garlike, Thomas W., Highfield, 126, Tulse hill, Brixton.

1854 Garrod, Alfred Baring, M.D., F.R.S., Consulting Physi- cian to King's College Hospital ; 10, Harley street, Cavendish square. C. 1867. Trans. 8.

1851 fGASKOiN, George, Surgeon to the British Hospital for Diseases of the Skin ; 7, Westbourne park. C. 1875-6. Trans. 1 .

1819 Gaulter, Henry.

1848 Gay, John, Senior Surgeon to the Great Northern Hospital, and Consulting Surgeon to the Asylum for Idiots ; 10, Finsbury place south. C. 1874-5.

1866 Gee, Samuel Jones, M.D., Assistant-Physician to St. Bar-

tholomew's Hospital ; Physician to the Hospital for Sick Children; 54, Harley street, Cavendish square. Trans. 1.

1821 *George, Richard Francis, 1, South Parade, Weston- super-Mare.

1877 Godlee, Rickman John, Assistant-Surgeon to Charing- Cross Hospital ; Assistant-Surgeon to University College Hospital ; and Demonstrator of Anatomy at University College ; 22, Henrietta street, Cavendish square.

1870 Godson, Clement, M.D., Assistant-Physician-Accoucheur to St. Bartholomew's Hospital ; Physician to the Samaritan Free Hospital ; 8, Upper Brook street, Grosvenor square.

1867 Goodeve, Edward, M.B., Hon. Physician to H.M. the

Queen ; late Surgeon-Major, H.M.'s Bengal Army ; Drimagh, Stoke Bishop, near Bristol.

1851 Goodfellow, Stephen Jennings, M.D., Consulting Phy- sician to the Middlesex Hospital ; Swinnerton Lodge, near Dartmouth, Devon. C. 1864-5. Trans. 2.

1877 Gould, Alfred Pearce, M.S., Lecturer on Anatomy at the Westminster Hospital; 93, Gower street, Bedford square.

1873 Gowers, William Richard, M.D., Assistant Professor of Clinical Medicine at University College, and Assistant- Physician to University College Hospital ; 50, Queen Aune street. Trans. 4.

XXV111 FELLOWS OF THE SOCIETY.

Elected

1851 Gowlland, Peter Yeames, Surgeon to St. Mark's Hos-

pital ; Surgeon-Major Hon. Artillery Company; 34, Finsbury Square.

1846 Gream, -George Thompson, M.D., Physician-Accoucheur to H.R.H. the Princess of Wales; Heathfield, Ringwood, Hants. C. 1863.

1868 Green, T. Henry, M.D., Physician to, and Lecturer on Pathology at, Charing Cross Hospital; Assistant- Phy- sician to the Hospital for Consumption, Brompton ; 74, Wimpole street, Cavendish square.

1875 Greene, William T., M.A., M.D., 218, Old Kent road.

1875 Greenfield, W. S., M.D., Assistant-Physician to, and Lec- turer on Morbid Anatomy at, St. Thomas's Hoapital ; 93, Wimpole street, Cavendish square.

1843 fGREENHALGH, Robert, M.D., Consulting Physician to the Samaritan Free Hospital for Women and Children, and to the City of London Lying-in Hospital ; 72, Grosvenor street. C. 1871-2. Trans. 1.

1860 Greenhow, Edward Headlam, M.D., F.R.S., Physician to the Middlesex Hospital ; and Consulting Physician to the Western General Dispensary ; 14a, Manchester square. C. 1876-7. Trans. 3.

1868 Grigg, William Chapman, M.D., Assistant Obstetric Phy- sician to the Westminster Hospital ; Physician to the In-Patients, Queen Charlotte's Lying-in-Hospital ; As- sistant-Physician to the Victoria Hospital for Children ; 6, Curzon street, Mayfair.

1852 Grove, John, Spring Grove, Hampton, Middlesex.

1860 Gueneau de Mussy, Henri, M.D. ; 15, Rue du Cirque, Paris.

1849 Gull, Sir William Withey, Bart., M.D., D.C.L., F.R.S., Physician-Extraordinary to the Queen ; Member of the Senate of the University of London ; Consulting Physi- cian to Guy's Hospital ; 74, Brook street, Grosvenor square. C. 1864. V.P. 1874. Trans. A.

FELLOWS OF THE SOCIETY. XXIX

Elected

1837 Gully, James Manby, M.D.

1854 Habershon, Samuel Osborne, M.D., Physician to Guy's Hospital ; 70, Brook street, Grosvenor square. S. 1867. C. 1869-70. Trans. 3.

1849 Hailey, Hammett, F.L.S.,Tickford Lodge, Newport Pagnell, Bucks.

1870 Hamilton, Robert, Surgeon to the South Hospital, Liver- pool; 1 Prince's road, Liverpool.

1838 fHANcocK, Henry, Consulting Surgeon to the Charing

Cross Hospital, and to the Royal Westminster Ophthal- mic Hospital; Standen House, Chute, Wilts. C. 1851. V.P. 1869.

1874 Hardie, Gordon Kenmure, M.D., Deputy Inspector General of Hospitals ; 13, Sussex place, Onslow gardens, and Duff House, Banff, N.B.

1836 Harding, John Fosse, Ulverstone House, Uckfield, Sussex. C. 1858-9.

1856 Hare, Charles John, M.D., late Professor of Clinical

Medicine in University College, London, and Physician to University College Hospital; b7, Brook street, Gros- venor square. C. 1873-4.

1857 Harley, George, M.D., F.R.S. [25, Harley street, Caven-

dish square]. C. 1871-2. Trans. 1. Sci. Com. 2.

1864 Harley, John, M.D., F.L.S., Secretary, Assistant-Physician to, and Lecturer on Physiology at, St. Thomas's Hospital ; 39, Brook street, Grosvenor square. S. 1875-7. Trans. 7.

1866 Harper, Philip H., 30, Cambridge street, Hyde park.

1859 Harris, Francis, M.D., F.L.S., 24, Cavendish square.

1872 Harris, William H., M.D., Professor of Midwifery and Diseases of Women and Children, Madras Medical College, Madras.

1870 Harrison, Reginald, Surgeon to the Liverpool Royal Infirmary, and Lecturer on Surgery at the School of Medicine ; 38, Rodney street, Liverpool.

XXX FELLOWS OF THE SOCIETY.

Elected

1854 Haviland, Alfred, Medical Officer of Health for the com- bined Districts of Northamptonshire ; Northampton.

18/0 Haward, J. Warrington, Assistant-Surgeon to St. George's Hospital ; Surgeon to the Hospital for Sick Children ; 5, Montagu street, Portman square. Trans. 1.

1828 -j-Hawkins, Cesar Henry, F.R.S., Sergeant-Surgeon to H.M. the Queen, and Consulting Surgeon to St. George's Hospital; 26, Grosvenor street. C. 1830-1, 1860. V.P. 1838-9. T. 1841-4. P. 1855-6. Trans. 12.

1838 -{-Hawkins, Charles, Inspector of Anatomical Schools in London ; 27, Savile row, Burlington gardens. C. 1846-7. S. 1850. V.P. 1858. T. 1861-2. Trans. 2.

1848 Hawesley, Thomas, M.D., Consulting Physician to the Margaret street Dispensary for Consumption and Diseases of the Chest; 17, Cheyne walk, Chelsea.

1875 Hayes, Thomas Crawford, M.D., Assistant-Physician- Accoucheur and Assistant-Physician for Diseases of Women and Children to King's College Hospital; 17, Clarges street, Piccadilly.

1860 Hayward, Henrt Howard, Surgeon Dentist to, and

Lecturer on Dental Surgery at, St. Mary's Hospital ; 38, Harley street, Cavendish square.

1861 Hayward, "William Henry, Church House, Oldbury, Wor-

cestershire. 1848 *Heale, James Neayton, M.D., Medecroft, Winchester, Hants.

1865 Heath, Christopher, Holme Professor of Clinical Surgery in University College, London ; and Surgeon to Uni- versity College Hospital; 36, Cavendish square.

1850 Heaton, George, M.D., Boston, U.S.

1874 *Heaton, John Deakin, M.D., Senior Physician to the Leeds General Infirmary, and Lecturer on Medicine at the Leeds School of Medicine ; Claremont, Leeds.

1821 Herberski, Vincent, M.D., Professor of Medicine in the University of Wilna.

FELLOWS OF THE SOCIETY. XXXI

Elected

1843 Hewett, Prescott Gardner, F.R.S., Serjeant-Surgeon- Extraordinary to H.M. the Queen ; Surgeon in Ordinary to H.B.H. the Prince of Wales; Consulting Surgeon to St. George's Hospital ; Corresponding Member of the Academy of Medicine, and of the " Societe de Chi- rurgie," Paris; 1, Chesterfield street, Mayfair. C. 1859. V.P. 1866-7. Trans. 7. Set. Com.

1855 Hewitt, Grailt, M.D., Professor of Midwifery in Univer- sity College, London, and Obstetric Physician to Uni- versity College Hospital ; 36, Berkeley square. C. 1876.

1872 Heyn, Julius Charles William, M.D., 42, Westbourne terrace, Hyde park.

18/3 Higgens, Charles, Assistant Ophthalmic Surgeon to Guy's Hospital ; 38, Brook street, Grosvenor square.

1862 Hill, M. Berkeley, M.B. Lond., Professor of Clinical Surgery in University College, London, and Surgeon to University College Hospital ; Surgeon to the Lock Hospital ; 55, Wimpole street, Cavendish square.

1867 Hill, Samuel, M.D., 22, Mecklenburgh square.

1841 fHiLTON, John, F.R.S., Surgeon-Extraordinary to H.M. the Queen ; Consulting Surgeon to Guy's Hospital ; Consulting Surgeon to the Royal General Dispensary, St. Pancras ; 10, New Broad street, City. C. 1851. V.P. 1863-4. Trans. 4.

1859 Hird, Francis, Surgeon to the Charing Cross Hospital; 13, Old Burlington street.

1861 *Hoffmeister, William Carter, M.D., Surgeon to H.M. the Queen in the Isle of Wight ; Clifton House, Cowes, Isle of Wight.

18"2 Hogg, Francis Roberts, M.D., India.

1843 fHoLDEN, Luther, Surgeon tc St. Bartholomew's Hospital; Consulting Surgeon to the Metropolitan Dispensary ; Surgeon to the Foundling Hospital ; 65, Gower street, Bedford square. C. 1859. L. 1865. V.P. 1874.

XXX11 FELLOWS OF THE SOCIETY.

Elected

1868 Hollis, William Ainslie, M.A., M.B., Camb., Assistant- Physician to the Sussex County Hospital; 10, Old Steyne, Brighton.

18b'l Holman, "William Henry, M.B. Lond., 68, Adelaide road, South Hampstead.

1856 Holmes, Timothy, M.A. Camb., Librarian, Surgeon to, and

Lecturer on Surgery at, St. George's Hospital ; Surgeon in Chief to the Metropolitan Police Force ; 18, Great Cumberland place, Hyde park. C. 1869-70. L. 1873-7. Trans. 6. Sci. Com.

1846 fHoLT, Barnard Wight, Consulting Surgeon to, and Lec- turer on Clinical Surgery at, the Westminster Hospital ; Medical Officer of Health for Westminster; 14, Savile row, Burlington gardens. C. 1862-3.

1846 Holthouse, Carsten, 15, George street, Hanover square, and Balham hill house. C. 1863.

1865 Howard, Benjamin, M.D., late Lecturer on Operative Sur- gery, and Surgeon to the Long Island College Hospital, New York.

1865 Howard, Edward, M.D.

1874 Howse, Henry Greenway, M.S. Lond., Surgeon to, and Lecturer on Anatomy at, Guy's Hospital ; Surgeon to the Evelina Hospital for Sick Children ; 10, St. Thomas's street, Southwark. Trans. 2.

1877 *Hudson, Robert Samuel, M.D., 58, West-end, Redruth, Cornwall.

1857 Hulke, John Whitaker, F.R.S., Secretary, Surgeon to,

and Lecturer on Surgery at, the Middlesex Hospital ;

Surgeon to the Royal London Ophthalmic Hospital,

Moorfields; 10, Old Burlington street. C. 1871-2.

S. 1876-7. Trans. 7. Sci. Com. 1857 Hulme, Edward Charles, Woodbridge road, Guildford.

Trans. 1. 1844 fHuMBY, Edwin, M.D., 83, Hamilton terrace, St. John's

wood. C. 1866-7. 1855 Humphry, George Murray, M.D., F.R.S., Surgeon to

Addenbrooke's Hospital ; Professor of Human Anatomy

and Physiology in the Cambridge University Medical

School ; Cambridge. Trans. 5.

FELLOWS OF THE SOCIETY. XXXU1

Elected

1866 Hunter, Charles, Ben Ehydding, by Leeds.

1873 Hunter, William Guyer, M.D., Principal of, and Professor of Medicine in, Grant Medical College, Bombay ; Surgeon-Major, Bombay Army, Bombay.

1849 Hussey, Edward Law, Senior Surgeon to the Radcliffe Infirmary, and Consulting Surgeon to the County Lunatic Asylum and the Warneford Asylum ; 8, St. Aldate's, Oxford. Trans. 1.

1856 Hutchinson, Jonathan, Surgeon to the London Hospital ; Surgeon to the Royal London Ophthalmic Hospital, Moorfields, and to the Hospital for Diseases of the Skin ; 15, Cavendish square. C. 18/0. Trans. 6. Pro. 2.

1820 Hutchinson, William, M.D.

1840 fHuTTON, Charles, M.D., Consulting Physician to the

General Lying-in Hospital ; 26, Lowndes street, Belgrave square. C. 1858-9.

1866 Iles, Francis Henry Wilson, M.D., Watford, Herts.

1847 Image, William Edmund, Consulting Surgeon to the Suf- folk General Hospital ; Bury St. Edmund's, Suffolk. Trans. 1.

1856 Inglis, Cornelius, M.D., Athenaeum Club, Pall Mall,

1876 Irvine, James Pearson, M.D., Assistant'Physician to, and Lecturer on Forensic Medicine at, the Charing Cross Hospital ; 3, Mansfield street, Cavendish square.

1871 Jackson, J. Hughlings, M.D., Physician to the London Hospital ; Physician to the National Hospital for the Paralysed and Epileptic ; 3, Manchester square.

1841 f Jackson, Paul, 24, Wimpole street, Cavendish square.

C. 1862.

1868 Jackson, Thomas Carr, Surgeon to the Great Northern Hospital, and Surgeon to the National Orthopaedic Hospital ; 91, Harley street, Cavendish square.

1863 Jackson, Thomas Vincent, Surgeon to the South Stafford- shire General Hospital; Darlington St., Wolverhampton.

VOL. XL. C

XXXIV FELLOWS OF THE SOCIETY.

Elected

1841 Jacobovics, Maximilian Moritz, M.D., Vienna.

1825 James, John B., M.D.

1840 *Jenks, George Samuel, M.D., 18, Circus, Bath.

1851 Jennee, Sir William, Bart, M.D., K.C.B., D.C.L., F.R.S., Physician in Ordinary to H.M. the Queen, and to H.R.H. the Prince of Wales; Professor of Clinical Medicine in University College, London, and Physician to University College Hospital ; Member of the Senate of the University of London ; 63, Brook street, Grosve- nor square. C. 1864. V.P. 1875. Trans. 'i.

1851 Johnson, Edmund Charles, Corresponding Member of the Medical and Philosophical Society of Florence, and of "l'Institut Genevois."

1847 Johnson, George, M.D., F.R.S., Physician to King's College

Hospital ; Member of the Senate of the University of London; 11, Savile row, Burlington gardens. C. 1862-3. V.P. 1870. Trans. 10.

1868 Johnston, William, M.D., 44, Princes square, Hyde park.

1848 Johnstone, Athol Archibald Wood, Consulting Surgeon

to the Brighton Hospital for Sick Children, St. Moritz House, 61, Dyke road, Brighton. Trans. 1.

1862 Jones, Charles Handfield, M.B., F.R.S., Physician to, and Lecturer on Clinical Medicine at, St. Mary's Hospital; 49, Green street, Grosvenor square.

1876 Jones, Leslie, M.D., 3, Brighton Parade, Blackpool, Lancashire.

1875 * Jones, Philip Sydney, M.D., Consulting Surgeon to the Sydney Infirmary ; Examiner in Medicine, Sydney University. [Agents: Messrs. D. Jones & Co., 1, Gresham buildings, Basinghall street.]

1837 fJoNES, Thomas William, M.D., Bylocks, Enfield High- way. C. 1858.

1859 Jones, William Price, M.D., Claremont road, Surbiton, Kingston.

FELLOWS OF THE SOCIETY. XXXV

Elected

1865 Jordan, Fueneaux, Surgeon to the Queen's Hospital, and Professor of Surgery at the Queen's College, Birming- ham ; 22, Colmore row, Birmingham.

1816 *Katjffmann, George Hermann, M.D., Hanover.

1872 Kelly, Charles, M.D., Medical Officer of Health for the

West Sussex Combined Sanitary District, Worthing, Sussex. 1848 *Kendell, Daniel Burton, M.D., Heath House, Wakefield, Yorkshire.

1847 Keyser, Alfbed, King's Hill, Berkhampstead.

1857 Kiallmark, Henry Walter, 66, Princes square, Bays- water.

185 1 Kingdon, John Abernethy, Surgeon to the City of London Truss Society, and to the City Dispensary ; 2, New Bank buildings, Lothbury. C. 1866-7. V.P. 1872-3. Trans. 1. Sci. Com.

1876 *Koch, Edwin Lawson, M.D., Principal, Medical School of Ceylon; Colombo, Ceylon. [Agents: Messrs. Henry S. King & Co., 65, Cornhill.]

1 855 Lane, James Robebt, Surgeon to, and Lecturer on Surgery at, St. Mary's Hospital ; Surgeon to the Lock Hospital; 49, Norfolk square, Hyde park. C. 1870. Trans. 1 .

1840 -|Lane, Samuel Armstrong, Consulting Surgeon to St.

Mary's Hospital and to the Lock Hospital ; 49, Norfolk square, Hyde park. C. 1849-50. V.P. 1865.

1865 Langton, John, Assistant-Surgeon to, and Lecturer on Anatomy at, St. Bartholomew's Hospital ; Surgeon to the City of London Truss Society ; 2, Harley street, Cavendish square.

1873 *Larcher, 0., M.D., Laureate of the Institute of France,

of the Medical Faculty, and Academy of Paris, &c. ; 97, Rue de Passy, Passy, Paris.

1841 *Lashmar, Charles, M.D., 83, North End, Croydon,

Surrey.

XXXVI FELLOWS OF THE SOCIETY.

Elected

1862 Latham, Peter Wallwork, M.A., M.D., Downing Pro- fessor of Medicine, Cambridge University ; Physician to Addenbrooke's Hospital, Cambridge; 17, Trumping- ton street, Cambridge.

1816 Lawrence, G. E.

1843 #Leach, Jesse, Moss Hall, Heywood, Lancashire.

1868 Leared, Arthur, M.D., Senior Physician to the Great

Northern Hospital; 12, Old Burlington street.

1843 fLEE, Henry, Surgeon to, and Lecturer on Clinical Surgery at, St. George's Hospital ; 9, Savile row, Burlington gardens. C. 1856-7. L. 1863-4. V. P. 1868-9. Trans. 13. Pro. 2. Set. Com.

1869 Legg, John Wickham, M.D., Physician to Casualty Depart-

ment and Demonstrator of Morbid Anatomy, St. Bar- tholomew's Hospital; 47, Green street, Park lane. Trans. 2. 1836 Leighton, Frederick, M.D.

1872 Liebreich, Richard, Ophthalmic Surgeon and Lecturer on Ophthalmic Surgery at St. Thomas's Hospital; 16, Albemarle street, Piccadilly.

1806 Lind, John, M.D.

1872 *Little, David, M.D., Surgeon to the Royal Eye Hospital, Manchester; 21, St. John's street, Manchester.

1871 Little, Louis Stromeyer, Shanghai, China.

1870 Livingston, John, M.D., New Barnet, Hertfordshire.

1819 Lloyd, Robert, M.D.

1820 Locher, J. G., M.C.D., Town Physician of Zurich.

Trans. 2.

1860 Longmore, Thomas, C.B., Hon. Surgeon to H.M. the Queen ; Surgeon-General, Army Medical Staff, and Professor of Military Surgery, Army Medical School, Netley, Southampton ; Woolston Lawn, Woolston, Hants. Trans. 2.

FELLOWS OF THE SOCIETY. XXXV11

Elected

1836 Lowenfeld, Joseph S., M.D., Berbice.

1871 Lownds, Thomas Mackford, M.D., late Professor of Anatomy and Physiology at Grant Medical College, Bombay ; Egbam Hill, Surrey.

1852 Luke, James, F.R.S., Consulting Surgeon to the London Hospital ; Woolley Lodge, Maidenhead Thicket, Berks. C. 1858. Trans. 4.

1857 Lyon, Felix William, M.D., 4, Graham street, Edinburgh.

1867 Maberly, George Frederick, Leamington, Warwick- shire.

1873 MacCarthy, Jeremiah, M.A., Surgeon to, and Lecturer on Physiology at, the London Hospital ; 26, Finsbury square.

1867 Mac Cormac, William, M.A., Surgeon to, and Lecturer on Surgery at, St. Thomas's Hospital ; 13, Harley street. Trans. 1.

1862 *M'Donnell, Robert, M.D., F.R.S., Surgeon to Steevens' Hospital ; 14, Lower Pembroke street, Dublin. Trans. 2.

1846 M'Ewen, William, M.D., Surgeon to Chester Castle ; 27, Nicholas street, Chester.

1866 Macgowan, Alexander Thorburn, Kingswood park, near

Bristol. 1823 fMACiLWAiN, George, Consulting Surgeon to the Finsbury Dispensary, Matching, Harlow, Essex. C. 1829-30.

V.P. 1848. Trans. 1. 1822 Macintosh, Richard, M.D. 1859 *M'Intyre, John, M.D., Odiham, Hants.

1873 MacKellar, Alexander Oberlin, M.S. I., Assistant Surgeon, St. Thomas's Hospital ; Albert Embankment, Westminster Bridge.

18/6 Mackey, Edward, M.D., 54, Inverness terrace, Bayswater.

1854 *Mackinder, Draper, M.D., Consulting Surgeon to the Dispensary, Gainsborough, Lincolnshire.

XXXV111 FELLOWS OF THE SOCIETY.

Elected

1860 Maclean, Johx, M.D., 24, Portman street, Portman square.

1849 Maclure, Duncan Maclachlax, M.B., Lecturer on Phy- siology at the Westminster Hospital ; Assistant-Phy- sician to the National Hospital for the Paralysed and Epileptic ; 34, Harley Street, Cavendish square.

1876 Macxamara, Charles, Surgeon to the Westminster Hos- pital ; Surgeon Major Bengal Medical Service ; late Examiner in Surgery at the Calcutta University; 13, Grosvenor street.

1842 Macx aught, Johx, M.D., 74, Huskisson street, Liverpool.

1876 Mallam, Bexjamix, Percy Villa, 316, Camden road.

1855 Marcet, William, M.D., F.R.S. ; Villa Bianca, Cannes. C. 1871. Trans. 3. Sci. Com.

1867 Marsh, F. Howard, Assistant-Surgeon to St. Bartholomew's Hospital ; 36, Bruton street, Berkeley square. Trans. 2.

1838 Marsh, Thomas Parr, M.D.

1851 Marshall, Johx, F.R.S., Professor of Anatomy to the Royal Academy of Arts ; Professor of Surgery in Uni- versity College, London, and Surgeon to University College Hospital ; 10, Savile row, Burlington gardens. C. 1866. V.P. 1875-76. Trans. 2.

1864 Masox, Fraxcis, Surgeon to, and Lecturer on Anatomy

at, St. Thomas's Hospital ; 5, Brook street, Grosvenor square. Trans. 1.

1839 Meade, Richard Hexry, Consulting Surgeon to the Brad-

ford Infirmary ; Bradford, Yorkshire. Trans. 1 .

1870 Meadows, Alfred, M.D., Physician-Accoucheur to, and Lecturer on Midwifery at, St. Mary's Hospital ; 27, George street, Hanover square.

1865 Medwix, Aaron George, M.D., Dental Surgeon to the

Royal Kent Dispensary, 1 1, Montpellier row, Black- heath, Kent. 1867 Meredyth, Colomiati, M.D., 10, George street, Hanover square.

FELLOWS OF THE SOCIETY. XXXIX

Elected

1874 Meeriman, John J., 45, Kensington square.

1852 Merryweather, James, Consulting Surgeon to the National Dental Hospital ; 25, Brook street, Gros- venor square.

1847 Meryon, Edward, M.D., F.G.S., 14, Clarges street, Piccadilly. L. 1859-60. C. 1864-5. V.P. 1868-9. Trans. 2.

1815 Meyer, Augustus, M.D., St. Petersburg.

1840 Middlemore, Richard, Consulting Surgeon to the Bir- mingham Eye Hospital; 19, Temple row, Birmingham.

1854 Middleship, Edward Archibald.

1873 Milner, Edward, Surgeon to the Lock Hospital; 32, New

Cavendish street, Portland place. 1863 Monro, Henry, M.D., Physician to St. Luke's Hospital;

13, Cavendish square. C. 1868. 1844 fMoNTEFiORE, Nathaniel, 36, Hyde park gardens. 1836 Moore, George, M.D., Hastings.

1873 Moore, Norman, M.D., Warden of the College and Lecturer

on Comparative Anatomy, St. Bartholomew's Hospital ; the College, St. Bartholomew's Hospital.

1861 Morehead, Charles, M.D., Hon. Surgeon to H.M. the Queen; Deputy-Inspector General of Hospitals; 11, North manor place, Edinburgh.

1857 Morgan, John, 3, Sussex place, Hyde park gardens.

Trans. 1. 1861 Morgan, John Edward, M.D., Physician to the Manchester

Royal Infirmary, and Professor of Medicine in the

Owens College, Manchester; 1, St. Peter's square,

Manchester.

1874 Morris, Henry, M.A. Lond., Senior Assistant-Surgeon to,

and Lecturer on Anatomy at, the Middlesex Hospital ; 2, Mansfield street, Portland place. Trans. 2.

1851 Mouat, Frederic John, M.D., Deputy Inspector-General of Hospitals ; Medical Inspector to the Local Govern- ment Board ; and Member of the Senate of the University of Calcutta; 12, Durham villas, Kensington.

xl FELL0TYS OF THE SOCIETY.

Elected

1868 Moxon, "Walter, M.D., F.L.S., Physician to, and Lecturer

on Clinical Medicine at, Guy's Hospital ; 6, Finsbury

Circus. Trans. 1.

1856 Murchison, Chakles, M.D., LL.D. Edinb., F.R.S., Librarian, Physician to, and Lecturer on Clinical Medicine at, St. Thomas's Hospital, Consulting Physician to the London Fever Hospital ; Examiner in Medicine at the University of London ; 79, Winipole street, Cavendish square. C. 1870-71. L. 1877. Trans. 3.

1875 Murphy, William Kirkpatrick, M.A., M.D., 29, Queen

Anne street, Cavendish square.

1873 Murray, Ivor, M.D., F.R.S. Ed., 8, Huntress Row, Scar- borough.

1863 Myers, Arthur B. R., Surgeon to the 1st Battalion Cold-

stream Guards ; Hospital, Vincent square, Westminster.

1876 Napier, William Donald, 22, George street, Hanover

square, W. 1870 Neild, James Edward, M.D., Lecturer on Forensic Medi- cine in the University of Melbourne; 166, Collins street east, Melbourne, Victoria.

1835 tNELsoN, Thomas Andrew, M.D., 10, Nottingham terrace, York gate, Regent's park.

1843 INewton, Edward [4, Upper Wimpole street]. C. 1863-4. 1868 Nicholls, James, M.D., Duke street, Chelmsford, Essex.

1849 Norman, Henry Burford, Portland Lodge, Southsea, Hants.

1847 *Nourse, William Edward Charles, late Surgeon to the Brighton Children's Hospital; 11, Marlborough place, Brighton.

1849 Noverre, Arthur, 16, Park street, Grosvenor square. C. 1870-71.

1864 Nunn, Thomas William, Surgeon to the Middlesex Hos-

pital ; 8, Stratford place, Oxford street.

1870 Nunnelei, Frederick Barham, M.D. Tram. 2.

FELLOWS OF THE SOCIETY. xli

Elected

1S47 O'Connor, Thomas, March, Cambridgeshire.

1843 fO'CoNXOR, William, M.D., Senior Physician to the Royal

Free Hospital ; 30, Upper Montagu street, Montagu

square. 1858 Ogle, John "William, M.D., Consulting-Physician to St.

George's Hospital ; 30, Cavendish square. C. 18/3.

Trans. 4.

1855 *Ogle, William, MA., M.D., Physician to the Derby In- firmary ; 98, Friar Gate, and The Elms, Derby.

1860 Ogle, William, M.D., Medical Officer of Health for East Hertfordshire; 10, Gordon street, Gordon square. S. 1868-70. C. 1876-7. Trans. 4.

18/0 Oldham, Charles Frederic, India [Agents : Messrs. Grindlay and Co., 55, Parliament Street].

1871 *0'Nelll, William, M.D., Physician to the Lincoln Lunatic Hospital, Lincoln.

1873 Ord, William Miller, M.B., Physician to, and Lecturer on Medicine at, St. Thomas's Hospital ; 7, Brook street, Hanover square. Trans. 3.

1875 Osborn, Samuel, ; 17, Gresham park, Brixton.

1^74 Page, Herbert William, M.B., M.C., Assistant Surgeon and Lecturer on the Practice of Surgery at St. Mary's Hospital ; 28, New Cavendish street.

1847 *Page, William Bousfield, Surgeon to the Cumberland Infirmary, Carlisle. Trans. 2.

1840 tPAGET> SlR James, Bart., D.C.L., LL.D., F.R.S., Sergeant- Surgeon to H.M. the Queen ; Surgeon-in-Ordinary to H.R.H. the Prince of Wales ; Consulting Surgeon to St. Bartholomew's Hospital ; Member of the Senate of the University of London ; 1, Harewood place, Hanover square. C. 1848-49. V.P. 1861. T. 1867. P. 1875-76. Trans. 10. Sci. Com.

1858 *Paley, William, M.D., Physician to the Ripon Dispen- sary ; Ripon, Yorkshire. 1847 Parker, Nicholas, M.D., Paris.

m IT-

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• • • I •! t d

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Queen

i

*». Htatrm Row

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BtOthNL

r -;^h jilice.

■ 1
	'
	and 1
	B.B H
	square
1858	*Paley. ^ eary ; Kn^J
	Parkik, -\J^

I

;

rgeon Si Mary*!

imbcrland

-eant-

-in-Ordinarv to

' ^urgeou to

Member of the Senate of

. Harewood place, Hanover

P. 1861. T. 1867. P.

Psician to the Ripon Dispen.

Xlii FELLOWS OF THE SOCIETY.

Elected

18/3 Parker, Robert William, Assistant-Surgeon East London

Children's Hospital ; 8, Old Cavendish-street. Trans. 1. 1841 Parkin, John, M.D. Rome ; 10, Margaret street, Cavendish

square. 1865 Pavy, Frederick William, M.D., F.R.S., Physician to,

and Lecturer on Medicine at, Guy's Hospital ; 35,

Grosvenor street.

1869 Payne, Joseph Frank, M.B., Assistant-Physician to, and

Lecturer on Forensic Medicine at, St. Thomas's Hos- pital ; 78, "Wimpole street.

1845 -(-Peacock, Thomas Bevill, M.D., Consulting Physician to

St. Thomas's Hospital ; Consulting Physician to the City of London Hospital for Diseases of the Chest, Victoria Park ; 20, Finsbury circus. S. 1855-6. V.P. 1867. C. 1869. Trans. 2.

1856 Peirce, Richard King, 94, Addison road, Kensington.

1830 Pelechin, Charles P., M.D., St. Petersburg.

1855 *Pemberton, Oliver, Surgeon to the Birmingham General Hospital, and Professor of Surgery at the Queen's College, Birmingham; 18, Temple row, Birmingham. Trans. 1.

1874 Penhall, John Thomas, 5, Eversfield place, St. Leonard's, Sussex.

1870 Perrin, John Beswick, Medical Tutor and Demonstrator

of Practical and Surgical Anatomy, Owen's College ; 51, Nelson street, Manchester. 1852 Phillips, Richard, 27, Leinster square, Bayswater. C. 1877.

1846 Philp, Francis Richard, M.D. [Colby House, Ken-

sington.]

1867 Pick, Thomas Pickering, Assistant-Surgeon to, and Lecturer on Anatomy at, St. George's Hospital; 13, South Eaton place, Eaton square. Set. Com.

1841 fI>I™AIf> Henry Alfred, M.D., Consulting Physician to St. George's Hospital, and to the Royal General Dis- pensary, St. Pancras ; 28, Gordon square. L. 1851-3. C. 1861-2. T. 1863-8. V.P. 1870-1.

FELLOWS OF THE SOCIETY. xliii

Elected

1871 Pollock, Arthur Julius, M.D., Physician to, and Lecturer on the Principles and Practice of Medicine at, Charing Cross Hospital ; Physician to the Foundling Hospital ; 85, Harley street, Cavendish square.

1845 fPoLLOCK, George David, Surgeon -in-Ordinary to H.R.H.

the Prince of Wales ; Surgeon to St. George's Hospital ; 36, Grosvenor street. C. 1856-7. L. 1859-62. V.P. 1870-1. Trans. 4.

1865 Pollock, James Edward, M.D., Physician to the Hospital for Consumption, Brompton ; 52, Upper Brook street, Grosvenor square.

1871 Poore, George Vivian, M.D., Assistant-Physician to Uni- versity College Hospital ; Physician to the Royal In- firmary for Children and Women, Waterloo road ; 30, Wimpole street.

1843 Pope, Charles, M.D., The Rectory, East Harptree, Bristol.

1846 Potter, Jephson, M.D., F.L.S. 1842 Powell, James, M.D.

1867 Powell, Richard Douglas, M.D., Physician to the Hospital for Consumption and Diseases of the Chest, Brompton ; 15, Henrietta street, Cavendish square. Trans. 1.

1867 Power, Henry, Ophthalmic Surgeon to, and Lecturer on Ophthalmic Surgery at, St. Bartholomew's Hospital ; 37a, Gt. Cumberland place, Hyde park. Sci. Com.

1857 Priestley, William Overend, M.D., Physician-Accoucheur to H.R.H. the Princess Louis of Hesse ; Consulting Physician-Accoucheur to King's College Hospital, and to the St. Marylebone Infirmary; 17, Hertford street, Mayfair. C. 1874-5. Sci. Com.

1869 Pullar, Alfred, M.D., Surgeon to the Kensington Dis- pensary; 1, Pembridge place, Bayswater.

1874 Purves, William Laidlaw, M.D., Aural Surgeon to Guy's Hospital ; 9, Upper Wimpole street, Cavendish square. Trans. 1.

1850 Quain, Richard, M.D., F.R.S., Consulting Physician to the Hospital for Consumption, Brompton ; Member of the Senate of the University of London ; 67, Harley street, Cavendish square. C. 1866-7. Trans. 1. Sci. Com.

xllV FELLOWS OF THE SOCIETY.

Elected

1835 fQuAiN, Richard, F. R.S.j Surgeon-Extraordinary to H.M. the Queen ; Emeritus Professor of Clinical Surgery, University College, London, and Consulting Surgeon to the Eye Infirmary attached to the Hospital ; 32, Caven- dish square. C. 1838-9. L. 1846-8. T. 1851-3. \\P. 1856-7. Trans. 1. Pro. 2.

1852 Radcliffe, Charles Bland, M.D., Consulting Physician to the Westminster Hospital ; Physician to the National Hospital for the Paralysed and Epileptic ; 25, Caven- dish square. C. 1867-8.

1871 Ralfe, Charles Henry, M.D., M.A., Physician to the Seamen's Hospital, Greenwich ; 26, Queen Anne street, Cavendish square.

1857 Ranke, Henry, M.D., 3, Sophienstrasse, Munich.

1854 Ransom, William Henry, M.D., F.E.S., Physician to the

Nottingham General Hospital ; the Pavement, Notting- ham.

1869 Read, Thomas Laurence, 57, Gloucester road [11, Peter- sham terrace], Queen's gate, South Kensington.

1858 Reed, Frederick Geokge,M.D., 46, Hertford street, May-

fair. Trans. 1.

1821 Reeder, Henry, M.D., Yarick, Seneca County, New York, United States.

185" Rees, George Owen, M.D., F.E.S., Consulting Physician to Guy's Hospital ; 26, Albemarle street, Piccadilly. C. 1873. Trans. 1.

1869 Reeves, Y\tilliam, 5, the Crescent, Carlisle.

1855 Reynolds, John Russell, M.D., F.R.S., Professor of the

Principles and Practice of Medicine in University Col- lege, London, and Physician to University College Hospital; 38, Grosvenor street. C. 1870.

1865 Rhodes, George Winter, Surgeon to the Huddersfield Infirmary ; Queen street south, Huddersfield.

1847 Richards, Samuel, M.D., 36, Bedford square.

FELLOWS OF THE SOCIETY. xlv

Elected

1852 Richardson, Christopher Thomas, M.B. 1869 Rickards, Walter, M.D., Physician to the Royal Free Hospital ; 8, Cavendish place, Cavendish square.

1845 t^IDGEJ Benjamin, M.D., 8, Mount street, Grosvenor square.

1863 Ringer, Sydney, M.D., Professor of [Materia Medica in University College, London, and Physician to Univer- sity College Hospital ; Examiner in Materia Medica in the University of London ; 15, Cavendish place, Caven- dish square. Trans. 4.

1871 Rivington, Walter, M.S., Surgeon to, and Lecturer on Anatomy at, the London Hospital ; 22, Finsbury square. Trans. 2.

18/1 *Roberts, David Lloyd, M.D., Physician to St. Mary's Hospital, Manchester ; 23, St. John's street, Deansgate, Manchester.

1852 Roberts, John, M.R.C.P., the Park, Westow hill, Upper Norwood.

1857 Robertson, John Charles George, Medical Superinten- dent of the Cavan District Lunatic Asylum ; Monaghan, Ireland.

1873 Robertson, William H., M.D., Consulting Physician to the Devonshire Hospital and Buxton Bath Charity j Buxton, Derbyshire.

1843 Roden, William M.D., Morningside, Kidderminster, Wor- cestershire.

1850 Roper, George, M.D., Physician to the Royal Maternity Charity ; 6, "West street, Finsbury circus.

1857 Rose, Henry Cooper, M.D., F.L.S., Surgeon to the Hampstead Dispensary ; Penrose House, Hampstead. Trans. 1.

1849 Routh, Charles Henry Felix, M.D., Physician to the Samaritan Free Hospital for Women and Children ; 52, Montagu square. Trans. 1 .

1863 Rowe, Thomas Smith, M.D., Surgeon to the Royal Sea- Bathing Infirmary ; Cecil street, Margate, Kent.

xlvi FELLOWS OF THE SOCIETY.

Elected

1845 Russell, James, M.D., Physician to the Birmingham General Hospital; 91, New Hall street, Birmingham.

1871 Rutherford, William, M.D., F.R.S., Professor of Phy- siology in the University of Edinburgh.

1856 Salter, S. James A., F.R.S., F.L.S., Dental Surgeon to, and Lecturer on Dental Surgery at, Guy's Hospital ; 17, New Broad street, City. C. 1871. Trans. 2.

1849 fSAXDERsox, Hugh James, M.D., 26, Upper Berkeley street, Portman square. C. 1872-3.

1855 Sanderson, JohnBurdon, M.D.,LL.D.,F.R.S.,Jodrell Pro- fessor of Human Physiology and Histology at University College, London ; 49, Queen Anne street, Cavendish square. C. 1869-70. Trans. 2. Sci. Com. 2.

1867 Sandford, Folliott James, M.D., Market Drayton, Shropshire.

1847 San key, "William Henry Octavius, M.D., Lecturer on Mental Diseases at University College, London ; Sandy- well park, Cheltenham.

1869 Sansom, Arthur Ernest, M.D., Assistant-Physician to the Loudon Hospital ; 30, Devonshire street, Portland place. Trans. 1.

1845 fSAUNDERs, Edwin, Surgeon-Dentist to H.M. the Queen, and to H.R.H. the Prince of Wales ; 13a, George street, Hanover square. C. 1872-3.

1834 Sauvan, Ludwig V., M.D., Warsaw.

1859 Savory, William Scovell, F.R.S., Surgeon to, and Lecturer on Surgery at, St. Bartholomew's Hospital ; Surgeon to Christ's Hospital ; Examiner in Surgery at the University of London ; 66, Brook street, Grosvenor square. C. 1871-2. Trans. 4. Sci. Corn. 3.

1873 Scott, J. M. Johnston, M.D., 14, College square, east, Belfast.

1861 *Scott, William, M.D., Physician to the Huddersfield In- firmary ; Waverley House, Huddersfield.

FELLOWS OF THE SOCIETY. xlvii

Elected

1863 Sedgwick, "William, 12, Park place, Upper Baker street. Trans. 2.

1877 Semon, Felix, M.D., 6, Ckandos street, Cavendisk square.

1875 Semple, Robert Hunter, M.D., Physician to the Blooms- bury Dispensary; 8, Torrington square.

1873 *Shapter, Lewis, B.A., M.B., Physician to the Devon and Exeter Hospital ; the Barnfield, Exeter.

1840 Sharp, William, M.D., F.R.S., Horton House, Rugby. Trans. 1.

1837 fSHARPEY, "William, M.D., F.R.S., LL.D., Member of the Senate of the University of London ; 50, Torrington square. C. 1848-9. V.P. 1862.

1836 +Shaw, Alexander, Consulting Surgeon to the Middlesex Hospital; 136, Abbey road, Kilburn. C. 1842. S. 1843-4. V.P. 1851-2. T. 1858-60. Trans. 4.

1848 *Shearman, Edward James, M.D., F.R.S. Edin., F.L.S., Consulting Physician to the Rotherham Hospital ; Moorgate, Rotherham, Yorkshire.

1859 Sibley, Septimus William, 4, Savile row. Trans. 4. Sci. Com.

1848 Sieveking, Edward Henry, M.D., Physician-Extraordinary to H.M. the Queen; Physician-in-Ordinary to H.R.H. the Prince of Wales ; Physician to St. Mary's Hospital ; 17, Manchester square. C. 1859-60. S. 1861-3. V.P. 1873-4. Trans. 2. Set. Com.

1871 Silver, Alexander, M.D., Physician to, and Lecturer on Clinical Medicine at, Charing Cross Hospital ; 2, Stafford street, Bond street.

1842 fSiMON, John, C.B., D.C.L., F.E.S., Consulting Surgeon to St. Thomas's Hospital ; 40, Kensington square. C. 1854-5. V.P. 1865. Trans. \.

1865 Sims, J. Marion, M.D., Surgeon to the New York State Women's Hospital ; 267, Madison Avenue, New York.

xlviii FELLOWS OF THE SOCIETY.

Elected

1857 Siordet, James Lewis, M.B., Villa Preti, Mentone, Nice.

1872 Smith, Gilbart, M.A., M.B., Physician to the Royal Hos-

pital for Diseases of the Chest, City road ; Visiting Physician to the Margaret Street Infirmary for Con- sumption ; 6S, Harley street, Cavendish square.

1866 Smith, Heywood, M.A. M.D. Oxon., Physician to the Hos- pital for Women ; Physician to the British Lying-in Hospital ; 2, Portugal street, Grosvenor square.

1835 Smith, John Gregory, 23, Gloucester place, Greenwich.

183S fSMiTH, Spencer, Surgeon to, and Lecturer on Clinical Surgery at, St. Mary's Hospital; 43, Oxford terrace, C. 1854. S. 1855-8. V.P. 1859-60. T. 1865.

1863 Smith, Thomas, Surgeon to, and Lecturer on Clinical

Surgery at, St. Bartholomew's Hospital ; Surgeon to the Hospital for Sick Children ; 5, Stratford place, Oxford street. S. 1870-2. C. 1875-76. Trans. 3. Sci. Com.

1864 *Smith, Thomas Heckstall, Rowlands, St. Mary Cray,

Kent.

1847 Smith, William J., M.D., Consulting Physician to the Weymouth Infirmary ; Greenhill, Weymouth, Dorset- shire.

1873 Smith, W. Johnson, Surgeon to the Seamen's Hospital,

Greenwich .

1874 *Smith, William Robert, M.B., [Royal County Hospital,

Winchester], 13, Crescent road, Plumstead, Kent.

1868 Solly, Samuel Edwin, Colorado Springs, Colorado, U.S.

1865 Southey, Reginald, M.D., Physician to, and Lecturer on

Forensic Medicine at, St. Bartholomew's Hospital; 6, Harley street, Cavendish square.

1844 Spackman, Frederick R., M.D., Harpenden, St. Alban's.

1874 Sparks, Edward Isaac, M.B. [Abroad.] Trans. 1.

FELLOWS OF THE SOCIETY. xlix

Elected

1851 Spitta, Robert John, M.D. Lond., Clapham Common, Surrey. Trans. 1.

1S75 Spitta, Edmund J., late Demonstrator of Anatomy at St. George's Hospital ; Ivy House, Clapham Common, Surrey.

1843 *Spranger, Stephen, Cape Town, South Africa.

1854 Stevens, Henry, M.D., Inspector, Medical Department, Local Government Board ; Greenford House, Sutton, Surrey.

1842 fSTEWART, Alexander Patrick, M.D., Consulting Phy-

sician to the Middlesex Hospital ; 75, Grosvenor street. C. 1856-7. L. 1863-8. V.P. 1871-2.

1859 Stewart, William Edward, 16, Harley street, Cavendish square.

1856 Stocker, Alonzo Henry, M.D., Peckham House, Peck- ham.

1865 Stokes, William, Jun., M.D., Professor of Surgery, Royal College of Surgeons, Ireland, and Surgeon to the Richmond Surgical Hospital ; 3, Clare street, Merrion square, Dublin, Trans. 1.

1843 Storks, Robert Reeve, Paris.

1858 fSTREATFEiLD, John Fremlyn, Surgeon to the Royal London Ophthalmic Hospital, Moorfields ; Ophthalmic Surgeon to University College Hospital; 15, Upper Brook street, Grosvenor square. C. 1874-5.

1876 Stretton, William Harris, M.D., Physician to the Farringdon Dispensary ; 8, Suffolk place, Pall Mall East.

1871 Strong, Henry John, M.D., 64, North End, Croydon.

1863 Sturges, Octavius, M.D., Assistant-Physician to, and Joint Lecturer on Medicine at, the Westminster Hospital ; Assistant-Physician to the Hospital for Sick Children ; 85, Wimpole street, Cavendish square.

1871 Sutherland, Henry, M.D., Lecturer on Insanity at the Westminster Hospital ; 6, Richmond terrace, Whitehall. vol. lv. d

1 FELLOWS OF THE SOCIETY.

Elected

1869 Suteo, Sigismund, M.D., Seirior Physician to the German Hospital ; 37a, Finsbury square.

18/1 Sutton, Henry Gawen, M.B., Physician to, and Lecturer on Medicine at, the London Hospital, and Physician to the City of London Hospital for Diseases of the Chest ; 9, Finsbury square. Trans. 1 .

1855 Sutton, John Maule, M.D., Medical Officer of Health; Town Hall, Oldham.

1861 *Sweeting, Geoege Bacon, King's Lynn, Norfolk.

1854 *Symonds, Frederick, Surgeon to the RadclifFe Infirmary, and Consulting Surgeon to the Oxford Dispensary ; 35, Beaumont street, Oxford.

1S70 Tait, Lawson, Surgeon to the Birmingham and Midland Hospital for Women ; 7, Great Charles street, Bir- mingham. Trans. 1.

1864 Taussig, Gabriel, M.D., 70, Piazza Barberini, Rome.

1875 Tay, Waren, Surgeon to the London Hospital and Surgeon to the North Eastern Hospital for Children and the Hospital for Skin Diseases, Blackfriars ; 4, Finsbury square.

1873 Taylor, Frederick, M.D., Assistant-Physician to Guy's Hospital ; 15, St. Thomas's street, Southwark.

1852 Taylor, Robert, 7, Lower Seymour street, Portman square.

1845 fTAYLOR, Thomas, Warwick House, 1, Warwick place, Grove End road, St. John's wood.

1859 Tegart, Edward, 49, Jermyn street, St. James's.

18/4 Thin, George, M.D., 22, Queen Anne street, Cavendish square. Trans. 2.

1862 Thompson, Edmund Symes, M.D., Physician to the Hos-

pital for Consumption, Brompton ; Gresham Professor of Medicine ; 3, Upper George street, Bryanston square. S. 1871-4. Trans. 1. Set. Com.

1S57 Thompson, Henry, M.D., Physician to the Middlesex Hos- pital ; 53, Queen Anne street, Cavendish square.

FELLOWS OF THE SOCIETY. li

Elected

1852 Thompson, Sir Henry, Surgeon-Extraordinary to H.M. the King of the Belgians ; Emeritus Professor of Clinical Surgery in University College, London ; 35, Wimpole street, Cavendish square. C. 1869. Trans. 4.

1862 Thompson, Reginald Edward, M.D., Assistant-Physician to the Hospital for Consumption, Brompton ; 9, Cranley place, South Kensington. Trans. 1. Sci. Com.

1876 Thornton, John Knowsley, M.B., CM., Surgeon to the Samaritan Free Hospital for Women and Children ; 83, Park street, Grosvenor square. Trans. 1 .

1875 Tibbits, Herbert, F.R.C.P. Ed., Medical Superintendent of the National Hospital for the Paralysed and Epi- leptic ; 30, New Cavendish street.

1848 Tilt, Edward John, M.D., Consulting Physician to the Farringdon General Dispensary and Lying-in Charity ; 27, Seymour street, Portman square.

1872 Tomes, Charles S., B.A., Lecturer on Anatomy and Physio-

logy at the Dental Hospital ; 37, Cavendish square. 1867 Tonge, Morris, M.D., Harrow-on-the-Hill, Middlesex. 1871 *Trend, Theophilus W., M.R.C.P. Edinb., Raeberry Lodge,

Southampton. 1867 Trotter, John William, Surgeon-Major, Coldstream

Guards ; Bossall Vicarage, York. 1859 Truman, Edwin Thomas, Surgeon-Dentist in Ordinary to

Her Majesty's Household ; 23, Old Burlington street. 1864 Tufnell, Thomas Jolliffe, Consulting Surgeon to the

City of Dublin Hospital ; 58, Lower Mount street,

Merrion square, Dublin. Trans. 1. 1862 Tuke, Thomas Harrington, M.D., Manor House, Chis-

wick, and 37, Albemarle street, Piccadilly.

1875 Turner, Francis Charlewood, M.A., M.D., Assistant-

Physician to the London Hospital ; 15, Finsbury square.

1873 Turner, George Brown, M.D., 3, Warrior square, St.

Leonard's-on-Sea.

1876 Venn, Albert J., M.D., CM., Obstetric Physician to the

Metropolitan Free Hospital ; Assistant Physician to the Victoria Hospital for Children ; 40, Brook street, Gros- venor square.

Hi FELLOWS OF THE SOCIETY.

Elected

1870 Venning, Edgcombe, Surgeon, 1st Life Guards; Knights- bridge Barracks, and 87, Sloane street.

1865 Vernon, Bowater John, Ophthalmic Surgeon to St. Bar- tholomew's Hospital and to the AVest London Hospital ; 43, Weymouth street, Portland place.

1867 Vintras, Achille, M.D., Physician to the French Embassy

and to the French Hospital, Lisle street, Leicester

square ; 141, Regent street. 1828 Vulpes, Benedetto, M.D., Physician to the Hospital of

Aversa, and the Hospital of Incurables, Naples. 1854 Waddington, Edward, Auckland, New Zealand. 1870 Wadham, William, M.D., Physician to, and Lecturer on

Medical Jurisprudence at, St. George's Hospital ; 14,

Park lane. 1864 Waite, Charles Derby, M.B., Senior Physician to the

Westminster General Dispensary ; 3, Old Burlington

street.

1868 *Walker, Robert, L.R.C.P. Edinb., Surgeon to the Carlisle

Dispensary; 25, Lowther street, Carlisle.

1867 *Wallis, George, Corpus Buildings, Cambridge.

1873 Walsham, William Johnson, CM., Demonstrator of Anatomy and Operative Surgery at St. Bartholomew's Hospital ; Surgeon to the Metropolitan Free Hospital and to the Royal Hospital for Diseases of the Chest, City Road; 27, Weymouth street, Portland place.

1852 Walshe, Walter Hayle, M.D., Emeritus Professor of the Principles and Practice of Medicine, University College, London ; Consulting Physician to the Hospital for Consumption ; 37, Queen Anne street, Cavendish square. C. 1S72. Trans. 1.

1851 Walton, Haynes, Surgeon to St. Mary's Hospital, and to

the Ophthalmic Department; 1, Brook street, Gros- venor square. Trans. 1. Pro. 1.

1852 Wane, Daniel, M.D., 20, Grafton street, Berkeley square. 1821 Ward, William Tilleard, Tilloards, Stanhope, Canada. 1858 Wardell, John Richard, M.D., Calverley park, Tunbridge

Wells.

FELLOWS OF THE SOCIETY. liii

Elected

1846 Ware, James Thomas, Tilford House, near Faruham, Surrey.

1818 Ware, John. Clifton Down, near Bristol.

1866 Waring, Edward JoHxV, M.D., 49, Clifton gardens, Maida vale.

1877 Warner, Francis, M.D., 15, Finsbury square.

1861 Waters, A. T. Houghton, M.D., Physician to the Royal Infirmary, and Lecturer on the Principles and Practice of Medicine, in the Liverpool Royal Infirmary School of Medicine ; 69, Bedford street, Liverpool. Trans. 3.

1837 IWatson, Sir Thomas, Bart, M.D., D.C.L., F.R.S., Physician-in-Ordinary to H.M. the Queen ; Consulting Physician to King's College Hospital; 16, Henrietta street, Cavendish square. C. 1840-1, 1852. V.P. 1845-6.

1861 fWATsoN, William Spencer, M.B., Surgeon to the Great Northern Hospital ; Surgeon to the Royal South London Ophthalmic and to the Central London Ophthalmic Hospitals ; 7, Henrietta street, Cavendish square. Trans. 1.

1854 Webb, William, M.D., Gilkin View House, Wirksworth,

Derbyshire. 1840 Webb, William Woodham, M.D. 1842 fWEBER, Frederic, M.D., 44, Green street, Park lane.

C. 1857. V.P. 1865.

1857 Weber, Hermann, M.D., Physician to the German Hospital; 10, Grosvenor street, Grosvenor square. C. 1874-5. Trans. 6.

1844 fWEGG, William, M.D., Treasurer, 15, Hertford street, Mayfair. L. 1854-8. C. 1861-2. T. 1873-7.

1874 Wells, Harry, M.D., British Vice-Consulate, Gualeguay- chu, Entre Rios, Argentine Confederation.

1861 Wells, John Soelberg, Professor of Ophthalmology in King's College, London, and Ophthalmic Surgeon to King's College Hospital ; Surgeon to the Royal London Ophthalmic Hospital ; 16, Savile row. C. 1877.

llV FELLOWS OF THE SOCIETY

Elected

1854 Wells, Thomas Spencer, Surgeon-in-Ordinary to H.M.'s Household ; Surgeon to the Samaritan Free Hospital for Women and Children ; Professor of Surgery and Pathology at the Royal College of Surgeons ; 3, Upper Grosvenor street. C. 18/0. Trans. 10. Pro. 1.

1842 fWEST, Charles, M.D., President, Corresponding Member of the Academy of Medicine of Paris; 61, Wimpole street, Cavendish square. C. 1855-6. V.P. 1863. P. 1877. Trans. 2. Sci. Com.

1828 Whatley, John, M.D.

1875 Whipham, Thomas Tillyer, M.B., Physician to, and Lec- turer on Botany at, St. George's Hospital ; 37, Green street, Grosvenor square.

1849 White, John.

1852 Wiblin, John, M.D., Medical Inspector of Emigrants and Recruits; Southampton. Trans. 1.

1844 fWiLDBORE, Frederic, 245, Hackney road.

1870 * Wilkin, John F., M.D. and M.C., New Beckenham, Kent.

1837 Wilks, George Augustus Frederick, M.D., Stanbury, Torquay.

1863 Wilks, Samuel, M.D., F.R.S., Physician to, and Lecturer on Medicine at, Guy's Hospital ; 77, Grosvenor street, Grosvenor square.

1863 Wtllett, Alfred, Assistant-Surgeon to, and Demonstrator of Practical Surgery at, St. Bartholomew's Hospital ; Surgeon to St. Luke's Hospital ; 36, Wimpole street, Cavendish square.

1S64 Willett, Edmund Sparshall, M.D., Resident Physician, Wyke House, Isleworth, Middlesex.

1840 fWiLLiAMS, Charles James Blasius, M.D., F.R.S., Physician-Extraordinary to H.M. the Queen; Consulting Physician to the Hospital for Consumption, Brompton [47, Upper Brook street, Grosvenor square]. C. 1849-50. V.P. 1860-1. P. 1873-4. Trans. 1. Sci. Com.

1S59 *Williams, Charles, Assistant-Surgeon to the Norfolk and Norwich Hospital ; 9, Prince of Wales road, Norwich.

1866 Williams, Charles Theodore, M.D,, Physician to the Hospital for Consumption, Brompton ; 47, Upper Brook street, Grosvenor square. Trans. 3.

FELLOWS OF THE SOCIETY. lv

Elected

1872 Williams, John, M.D., Assistant Obstetric Physician to University College Hospital ; 28, Harley street, Caven- dish square.

1859 Williams, Joseph, M.D. Holmhurst, Cambridge park, Twickenham.

1868 Williams, William Rhys, M.D., Lecturer on Mental Diseases at St. Thomas's Hospital ; Bethlehem Royal Hospital, Lambeth road.

1829 Willis, Robeet, M.D., Barnes, Surrey. L. 1838-41.

1839 fWiLSON, Erasmus, F.R.S., Professor of Dermatology, Royal College of Surgeons of England; 17, Henrietta street, Cavendish square. C. 1877. Trans. 2.

1863 Wilson, Robeet James, F.R.C.P. Edin., 7, Warrior square, St. Leonard's-on-Sea, Sussex.

1850 *Wise, Robert Stanton, M.D., Consulting Physician to

the Southam Eye and Ear Infirmary ; Banbury, Oxford- shire. 1825 Wise, Thomas Alexander, M.D., Thornton, Beulah hill, Upper Norwood, Surrey.

1841 Wood, George Leighton, 28, Green park, Bath.

1851 Wood, John, F.R.S., Vice-President, Senior Surgeon to

King's College Hospital, and Professor of Clinical Sur- gery in King's College, London ; 68, Wimpole street. C. 1867-8. V.P. 1877. Trans. 3.

1872 Wood, Samuel, St. Mary's Court, Shrewsbury.

1848 Wood, William, M.D., Vice-President, Physician to St. Luke's Hospital for Lunatics ; 99, Harley street, Caven- dish square. C. 1867-8. V.P. 1877.

1842 Worthington, William Collins, London road, Lowestoft,

Suffolk. Trans. 3. 1865 Wotton, Henry, 62, Bedford gardens, Kensington.

[It is particularly requested that any change of Title, Appointment, or Residence, may be communicated to the Secretaries before the 1st of October in each year, in order that the List may be made as correct as possible.]

lvi FELLOWS OF THE SOCIETY.

HONORARY FELLOWS.

(Limited to Twelve.)

Elected

1853 Beodie, Sir Benjamin Collins, Bart., M.A., D.C.L., F.R.S., Brockham Warren, Reigate.

1847 Chadwiok, Edwin, C.B., Corresponding Member of the Academy of Moral and Political Sciences of the Insti- tute of France ; Park Cottage, East Sheen.

1873 Christison, Sir Robert, Bart, M.D., D.C.L., LL.D., Physician-in-Ordinary to H M. the Queen in Scotland ; 40, Moray place, Edinburgh.

1868 Darwin, Charles, M.A., F.R.S., Corresponding Member of the Academies of Sciences of Berlin, Stockholm, Dresden, &c. ; Down, Bromley, Kent.

1857 Farr, William, M.D., D.C.L., F.R.S., General Register Office, Somerset House, and Southlands, Bickley, Kent.

1868 Hooker, Sir Joseph Dalton, M.D., C.B., K.C.S.I., D.C.L., LL.D., F.R.S., Member of the Senate of the University of London, Director of the Royal Botanic Gardens, Kew ; President of the Royal Society; Corre- sponding Member of the Academy of Sciences of the Institute of France ; Royal Gardens, Kew.

1868 Huxley, Thomas Henry, LL.D., F.R.S., Professor of Natural History in the Royal School of Mines ; Secretary to the Royal Society ; Corresponding Member of the Academies of Sciences of St. Petersburg, Berlin, Dresden, &c. ; 4, Marlborough place, St. John's wood.

FELLOWS OF THE SOCIETY. Mi

Elected

1847 Owen, Richard, C.B., D.C.L., LL.D., F.R.S., Superinten- dent of the Natural History Departments in the British Museum ; Foreign Associate of the Academy of Sciences of the Institute of France ; Sheen Lodge, Mortlake.

18/3 Stokes, George Gabriel, M.A., D.C.L., LL.D., Lucasian Professor of Mathematics in the University of Cam- bridge ; Secretary to the Royal Society, &c. ; Lensfield Cottage, Cambridge.

1875 Stokes, William, M.D., D.C.L., LL.D., F.R.S., Regius Professor of Physic at Dublin University ; 5, Merrion square north, Dublin.

1868 Ttndall, John, LL.D., F.R.S., Professor of Natural Philosophy in the Royal Institution ; Corresponding Member of the Academies and Societies of Sciences of Gottingen, Haarlem, Geneva, &c. ; Royal Institution, Albemarle street, Piccadilly.

VOL. LX.

lviii

FELLOWS OF THE SOCIETY.

FOREIGN HONORARY FELLOWS.

(Limited to Twenty.)

Elected

1872 Bernard, Claude, Member of the Institute of France, and

of the Academy of Medicine ; Professor of Medicine at the College of France ; Professor of General Physiology at the Museum of Natural History ; Rue de Luxem- bourg, 24, Paris.

1876 Billroth, Theodor, M.D., Professor of Surgery in the University of Vienna ; Vienna.

1864 Donders, Franz Cornelius, M.D., Professor of Physiology and Ophthalmology at the University of Utrecht.

1875 Draper, John William, M.A., LL.D., Emeritus Professor

of Chemistry and Physiology in the University of New York; 13, University Buildings, Washington square, New York.

1876 Edwards, H. Milne, M.D., Member of the Institute of

France, and of the Academy of Medicine ; Dean of the Faculty of Sciences and Professor at the Museum of Natural History of Paris ; 57, Hue Cuvier, Paris.

1835 Ekstromer, Carl Johan, M.D., CM., K.P.S., and W., Physician to the King of Sweden ; President of the College of Health, and Director-General of Hospitals; Stockholm.

1868 Gross, Samuel D., M.D., F.C.P. Philad., D.C.L. Oxon., LL.D., Professor of Surgery in the Jefferson Medical College of Philadelphia.

1S6G Hannover, Adolph, M.D., Professor at Copenhagen.

1873 Helmholtz, Hermann Ludwig Ferdinand, Professor of

Physics and Physiological Optics ; Berlin. 1859 Henle, J., M.D., Professor of Anatomy at Gottingen.

FELLOWS OF THE SOCIETY. lix

Elected

18/3 Hofmann, A. W., LL.D., Ph.D., Professor of Chemistry,

Berlin. 1868 Kolliker, Albert, Professor of Anatomy at WUrzburg.

1856 Langexbeck, Bernhard, M.D., Professor of Surgery in the University of Berlin.

1868 Larrey, Hippolyte Baron, Member of the Institute; Inspector of the " Service de Sante Militaire," and Member of the " Conseil de Sante des Armees ;" Com- mander of the Legion of Honour, &c. ; Rue de Lille, 91, Paris.

1862 Pirogoff, Nikolaus, M.D., Professor of Surgery to the Medico-Chirurgical Academy in St. Petersburg, and Director of the Anatomical Institute ; Consulting Phy- sician to the Hospitals Obuchow, Peter-Paul, and Maria Magdalena ; St. Petersburg.

1850 PiOKitansky, Carl Freiherr vox, M.D., Curator of the Imperial Pathological Museum, and Professor of Patho- logical Anatomy at the University of Vienna. Referee for Medical and University Education to the Austrian Ministry; Vienna.

1856 Virchoav, Rudolph, M.D., Professor of Pathological Ana- tomy in the University of Berlin ; Corresponding Mem- ber of the Academy of Sciences of the Institute of France ; Berlin.

CONTENTS.

			PAGE
List of Officers and Council . . v
Presidents of the Society		vi
Referees of Papers			vii
Trustees of the Society .			viii
Library Committee			viii
List of Fellows			ix
List of Honorary Fellows			lvi
List of Plates .			lxv
Woodcuts			lxvi
Advertisement .			lxvii
Regulations relative to Proceedings			lxviii

I. Subcutaneous Division of the Neck of the Femur for Anchylosis of the Hip-joint, with a table of twenty- two cases which have been operated upon up to the present time. By William Adams, F.R.C.S., Sur- geon to the Great Northern Hospital; Consulting Surgeon to the National Orthopaedic Hospital

II. Case of Resection of the Tarsal Bones for Double Con- genital Talipes Equino-varus. By J. N. C. Davies- Colley, F.R.C.S., Assistant Surgeon to, and Lec- turer on Anatomy at, Guy's Hospital

III. Notes of a Case of Pseudo-hypertrophic Paralysis, with a few observations on surface thermometry. By William M. Okd, M.B.Lond., F.R.C.P., Physician to, and Lecturer on Medicine at, St. Thomas's Hos- pital .....

11

19

lxii CONTENTS.

PAGE IV. On a Form of Chronic Inflammation of Bones (Osteitis Deformans). By Sir James Paget, Bart., D.C.L., LL.D., F.R.S., Consulting Surgeon to St. Bartholo- mew's Hospital, &c . . . .37

Y. A Case of Complete Absence of both the Upper Limbs, and of Faulty Development of the Right Lower Limb. By John Whitaker Hulke, F.R.S., Sur- geon to the Middlesex Hospital, and to the Royal London Ophthalmic Hospital, Moorfields . . 65

VI. On the Use of Flexible Tracheotomy Tubes. By W. Morrant Baker, F.R.C.S., Lecturer on Physiology and Assistant Surgeon to St. Bartholomew's Hos- pital, and Senior Surgeon to the Evelina Hospital for Sick Children . . . .71

VII. A Case of Lodgment of a Tracheotomy Tube in the Right Bronchus, and its Extraction. By John "Whitaker Hulke, F.R.S., Surgeon to the Middle- sex Hospital, and to the Royal London Ophthalmic Hospital, Moorfields . . . .85

VIII. On a Case in which a Flexible India-rubber Trache- otomy Tube was removed from the Right Bronchus. By Henry G. Howse, M.S., F.R.C.S., Surgeon to Guy's Hospital, and to the Evelina Hospital for Sick Children . . . . .93

IX. A Case in which a Silver Tracheotomy Tube was re- moved from the Left Bronchus, where it had been lodged seven weeks. By R. Clement Lucas, B.S., F.R.C.S., Assistant Surgeon to Guy's Hospital (communicated by J. W. Hulke, F.R.S., Hon. Sec.) 99

X. A Case of General Teleangiectasis most developed in the left half of the body, associated with abnormali- ties of the large blood-vessels of the left lower limb and in the neck. By John "Whitaker Hulke, F.R.S., Surgeon to the Middlesex Hospital, and to the Royal London Ophthalmic Hospital, Moorfields 105

XL A Case of Sclerema Adultorum. By George Gas- koin, M.R.C.S., Surgeon to the British Hospital for Diseases of the Skin .... 113

CONTENTS. lxiii

PAGE

XII. A Case of Simple Atrophic Sclerema, associated with Disorder of the Circulatory and Alimentary Func- tions. By John Harley, M.D. Lond., Senior Assistant Physician to, and Lecturer on General Anatomy and Physiology at, St. Thomas's Hospital 131

XIII. On the Minute Anatomy of Two Cases of Carcinoma

of the Breast preceded by Eczema of the Nipple and Ai-eola. By Henry Trentham Butlin, F.R.C.S., Surgical Registrar to St. Bartholomew's Hospital . 153

XIV. Dislocations of the Thigh : their mode of occurrence as

indicated by experiments, and the Anatomy of the Hip-joint. By Henry Morris, M.A.,M.B.,F.R.C.S., Assistant Surgeon to, and Lecturer on Anatomy at, the Middlesex Hospital . . . 161

XY. On Necrosis without Suppuration, with a Case of Intra- osseous Necrosis of the Femur without Suppuration, for which Amputation at the Hip-joint was per- formed. By W. Morrant Baker, F.R.C.S., Lec- turer on Physiology and Assistant Surgeon to St. Bartholomew's Hospital, and Senior Surgeon to the Evelina Hospital for Sick Children . . 187

XVI. Three Hundred additional Cases of Ovariotomy, with Remai-ks on Drainage of the Peritoneal Cavity. By T. Spencer Wells, F.R.C.S., Surgeon to the Queen's Household and to the Samaritan Hospital for Women . . . . .209

XVII. The Pathological Anatomy of Canine " Chorea." By William R. Gowers, M.D., Assistant Professor of Clinical Medicine in University College, and H. R. O. Sankey, M.R.C.S., Resident Medical Officer to the National Hospital for the Paralysed and Epi- leptic . . . . .229

XVIII. On Direct Wounds of the Ureter. By Timothy

Holmes, F.R.C.S., Surgeon to St. George's Hospital 249

XIX. Note on the Delhi Boil (Furunculus Delhinus). By H. Vandyke Carter, M.D., Surgeon-Major H.I.M Indian Army ..... 265

\

lxiv CONTENTS.

PAGE XX. A Case of all but Universal Paralysis in a Child, following exposure to heat ; with complete recoveiy. By James Andrew, M.D., F.R.C.P., Physician to, and Joint Lecturer on Medicine at, St. Bartholo- mew's Hospital, and Dyce Duckworth, M.D., F.R.C.P., Assistant Physician to St. Bartholomew's Hospital ; Examiner in Practice of Physic in the University of Edinburgh . . . 273

XXI. On an International Calculating Scale for Ophthalmo- logical Purposes. By W. Laidlaw Purves, M.D., Aural Surgeon to Guy's Hospital . . 291

XXII. Twenty-five Cases of Ovariotomy; with some Remarks on the Causes and Treatment of the Fever so fre- quently following the Operation. By J. Knowseey Thornton, M.B., CM., Surgeon to the Samaritan Free Hospital for Women and Children . . 297

XXIII. A Case of Primary Cylindrical Epithelioma of the Lung, with Secondary Deposits in the Pleura, Bron- chial Glands, and Liver. By David W. Finlat, B.A., M.D., Physician to the Royal Hospital for Diseases of the Chest, and Medical Registrar to the Middlesex Hospital, and Robert W. Parker, M.R.C.S., Assistant Surgeon to the East London Hospital for Children, and Surgical Registrar to the London Hospital .... 313

Index ...... 327

LIST OF PLATES.

PAGE

I. Chronic Inflammation of Bores (Osteitis Deformans).

Figs. 1 — 4 from photographs. (Sir James Paget) . 64

II. Ditto.

Figs. 1 — 8. Microscopic sections from tumours of

forearm and pleura, tibia, &c. (Ditto) . 64

III. Ditto.

Figs. 9 — 13. Microscopic sections of skull and tibia.

(Ditto) . . . . .64

IY. Ditto, Upper and Lower End of Femur, § diameter, and

Curve of the Femur. (Ditto) . . .64

V. Ditto, Cranium, real size. (Ditto) . . .64

YI. Case of Complete Absence of both the Upper Limbs,

&c. (J. W. Hplke) . . . .70

YII. Eczema and Carcinoma of the Breast.

Figs. 1 — 9. Microscopic sections. (H. T. Butlin) . 160

YIII. Dislocations of the Thigh.

Figs. 1, 2. The capsule ruptui-ed, front and back view.

Fig. 3. Front of capsule, showing the ilio-femoral and the pectineo-femoral ligaments. (Henry Morris) . . . . .186

IX. Ditto.

Fig. 1. Recent case of dorsal dislocation of the head of the femur.

Fig. 2. Rupture of capsule in the case of dorsal dis- location. (Ditto) . . . .186

X. Necrosis without Suppuration.

Figs. 1, 2. Sections of femurs removed by amputa- tion at the hip-joint, of which nearly the whole shaft had perished. (W. Morrant Baker) . 208 XI. Ditto.

Figs. 1, 2. Sections of femur and tibia, of which a

large portion of the shaft has perished. Figs. 3, 4. Sections of femur and tibia affected by chronic inflammatory hypertrophy and sclerosis. (Ditto) . . . . .208

VOL. LX. f

lxvi LIST OF PLATES, ETC.

PAGE

XII. Pathological Anatomy of Canine Chorea.

Figs. 1 — 7. Microscopical appearances. Spinal cord, enlargement, infiltration into lateral and pos- terior columns, &c. (W. R. Gowers, M.D., and H. R. O. Sankey) . . .248

XIII. Ditto, ditto.

Figs. 8 — 14. Ditto. Morbid appearances of nerve cells of anterior cornu of spinal cord and of cerebellum. (Ditto, ditto) . . .248

XIV. Delhi Boil, Microscopic appearances. (H. Y. Carter,

M.D.) . . . . .272

XV. Primary Cylindrical Epithelioma of the Lung.

Figs. 1 — 4. Microscopic appearances. (D.W. Finlay,

M.D., and R. W. Parker) . . .326

XVI. Ditto, ditto.

Fig. 5 — 7. Microscopical appearances. (Ditto) . 326

Woodcuts.

page Resection of the Tarsal Bones for Double Congenital Talipes Equino-varus. Fig. 1. Before operation. Fig. 2. After opera tion. (J. N. C. Davies-Colley) .

International Calculating Scale for Ophthalmological Pur poses. (W. Laidlaw Purves) .

Ice-water Cap of coiled India-rubber Tubing, with Ice Pail as used after Ovariotomy. (J. Knowsley Thornton)

15

293

302

ADVERTISEMENT.

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The Abstracts of the papers read will be furnished to the Journals as heretofore.

SUBCUTANEOUS DIVISION OF THE NECK OE THE FEMUR

FOE \

ANCHYLOSIS OE THE HIP-JOINT.

WITH A TABLE OF TWENTY-TWO CASES WHICH HAVE BEEN OPERATED UPON UP TO THE PRESENT TIME.

BY

WILLIAM ADAMS, F.E.C.S.,

SUEGEON TO THE GBEAT NOETHEEN HOSPITAL; CONSULTING SUEGEON TO THE NATIONAL OETHOP.EDIC HOSPITAL.

Received May 9th— Read October lOtli, 1876.

The object of the present paper is to bring before this Society the results, as far as I have been enabled to obtain them, of the cases of anchylosis of the hip-joint, which have been operated upon by the subcutaneous division of the neck of the thigh bone, an operation which was first performed by myself at the Great Northern Hospital on 1st December, 1869.

During the six and a half years which have now elapsed the operation has been successfully performed in so many cases by the leading provincial and metropolitan surgeons in England, and also by Dr. Sands, of New York, and the unfavorable cases have been so few, that the subcutaneous section of the neck of the femur may

vol. lx. 1

2 SUBCUTANEOUS DIVISION OF THE NECK OF THE FEMUR

now be considered to be an established operation in surgery.

When the subcutaneous method is applied in the per- formance of operations of unusual magnitude, such as division of the neck of the thigh-bone, division of the shaft of the femur or humerus, it would be unreasonable to expect the uniformly favorable results which follow the subcutaneous division of tendons, because the condi- tion upon which the safety of the subcutaneous method depends cannot all with certainty be fulfilled. In these large operations the air may be effectually excluded, but the injury to the deeply seated structures may be exces- sive, either from cutting or laceration by the saw. Hence the absolute immunity from inflammation or suppuration claimed for the subcutaneous method is not maintained, and deep-seated suppuration will occasionally follow such operations, although the rarity of such a result has aston- ished every surgeon who has practised them.

In a very large proportion of the cases operated upon, subcutaneous division of the neck of the thigh-bone has proved to be as harmless an operation and as free from all risks as subcutaneous tenotomy; and there can be no doubt that such success largely depends upon the atten- tion paid to the following points — first, the selection of appropriate cases ; and, secondly, the care taken by the operator in performing the operation strictly in accordance with the laws of subcutaneous surgery as to the exclusion of air, and the smallest possible disturbance or laceration by the saw of the tissues surrounding the bone.

Nevertheless, as the cases operated upon have multiplied in number, there has been a certain proportion of bad results, such as local suppuration, with its more serious complication, pyeernia, leading to the death of the patient. I am not aware, however, that this result has followed in more than one case out of the total number of twenty-two operated upon up to the present time. This occurred in a boy, aged eight years, who had fibrous anchylosis of the left hip, with the limb in a deformed position, and was

FOE ANCHYLOSIS OP THE HIP-JOINT. 6

operated upon by Mr. Croft at St. Thomas' Hospital March 4th, 1871. There had been abscesses in the neigh- bourhood of the joint some years previously. Attempts at forcible extension had been employed a week before the operation, when the contracted muscles were also divided, so that perhaps the articulation was not in a sufficiently quiescent state at the time of the operation. Suppuration followed, and the child died of pyasniia on March 30th, 1871.*

A second death, however, in a girl, aged eighteen, not quickly following the operation, from pyaemia, but occurring eight months afterwards, in consequence of prolonged suppuration, followed by symptoms of kidney disease, with albuminuria, and also tubercular deposit in the lungs, may be added to the list, making a total of two deaths.

This case, like Mr. Croft's, belonged to the most un- favorable class, viz. advanced strumous disease with abscess, the fistulous openings from which were indicated by two depressed cicatrices. It belonged to the class which I had decided to reject, but it presented some favorable points, and, emboldened by previous success, I departed from my own law, and have reason to regret so doing.

This was the last of the five cases in which I have performed the operation. All the others terminated favorably, although in one a deep abscess formed six weeks after the operation, the wound of which had healed soundly without suppuration. In the other three cases no suppuration whatever occurred, and they proceeded with as little local disturbance as in ordinary cases of teno- tomy.

Such a result bears good testimony to the general safety of the operation, and although the dangers of all operations must increase with their magnitude, these may be kept within the narrowest possible limits by the

* This case is described in a pamphlet * A New Operation for Bony Anchy- losis of the Hip-joint with Malposition of the Limb by Subcutaneous Division of the Neck of the Thigh-bone,' by Win. Adams, 1871, p. 19. London : J. and A. Churchill.

4 SUBCUTANEOUS DIVISION OF THE NECK OF THE FEMUPv

judgment of the surgeon in selecting his cases, and the skill shown in the performance of the operation.

Amongst recent surgical writers, Mr. Holmes is the only one who speaks of the operation with distrust, and refers to the difficulty of performing it in a truly sub- cutaneous manner. Mr. Holmes observes,* " But in cases which really require any such operation, i. e. where the changes in the relative position of the bones is consider- able, there is often a very large deposit of bone around the joint, and the shape and size of the anchylosed arti- cular ends has been much altered. It may, therefore, be impossible in such cases to execute any section really deserving of the title subcutaneous, and the operation approaches in gravity and in extent to that of excision, and is liable, like excision, to be followed by renewed disease in the divided surfaces by exhausting suppura- tion, or by pyaamia."

To this I would reply that in any particular case of bony anchylosis of the hip-joint, when there is a doubt as to the possibility of the neck of the femur being divided subcutaneously, in consequence of alterations which may have taken place at the articulation, such as described by Mr. Holmes, it should not be attempted ; but some other operation below the joint, such as that first proposed and successfully performed by Mr. Grant, should be adopted.

Mr. Gant has, in two cases of anchylosis of the hip- joint with malposition of the limb, successfully divided the shaft of the femur subcutaneously, just below the small trochanter, using instruments similar to those employed by myself ; but the saw had a longer cutting edge, and a thinner blade — the width the same.

The following account of Mr. Gant's first operation is taken from the ' Lancet ' December 21st, 1872. " Anchy- losis of the hip-joint, with extreme malposition of the limb upwards and inwards ; subcutaneous section of the femur below both trochanters.

* ' Treatise on Surgery, its Principles and Practice,' by T. Holmes, M.A. C.mtub. Smith, Elder, and Co., 1S75.

FOR ANCHYLOSIS OF THE HIP-JOINT. O

u On December 10th Mr. Gant performed the above operation at the Royal Free Hospital on a boy, aged six years, remarking that it differed both from Mr. Adams' subcutaneous section through the neck of the femur, and from the American operations of section and incision between the trochanters, by Barton and Sayre.

" The reasons which induced Mr. Gant to perform this new operation had a double foundation. First, on the pathological ground that the section is not made in a diseased portion of the femur, but in sound bone. Second, the anatomical reason that, the section being made below the small trochanter, the resisting psoas and iliacus muscles are set free. Further, that there is no risk of atrophy or necrosis of the head of the bone from cutting off its vascular supply.

" Mr. Gant thinks that this operation will be applicable, instead of excision, to a class of hip-joint cases where the disease is quiescent, but the limb useless, the state being simply that of anchylosis with malposition, and especially appropriate in young subjects where removal of the epiphysial head of the femur might be followed by further shortening of the limb.

" After section the limb was at once freely movable, and being brought down into a straight position it was fixed by means of sand bags ; extension was maintained by a weight from the foot, and counter extension by a perineal band.

" Result. — Primary union of the wound ; osseous union of the femur; an angle can be felt at the junction of the section ends of the bone, but this slight deformity is not visible externally ; the limb is perfectly straight, and the boy can stand and waik without any inconvenience or limp."

Mr. Gant has since performed this operation in another case, a boy Eet. 14. Firm union took place, but the per- manent result in regard to the use of the limb is, he in- forms me, unknown to him. In Mr. Gant's operation the true subcutaneous character is preserved, together with

6 SUBCUTANEOUS DIVISION OP THE NECK OP THE FEMUR

its immunity from inflammation and suppuration, hence its success.

I cannot agree with Mr. Grant in the reasons he has assigned for preferring this operation to my own, or even as to the class of cases to which he considers it applicable, but I regard it as admirably adapted to the class of cases indicated by Mr. Holmes, viz. those at- tended with considerable alterations in the joint, and often with new bone thrown out in its neighbourhood, in which my operation would be liable to fail, or be followed by deep suppuration.

Mr. Gant's operation has also the merit of being much easier of performance, as the bone is reached immediately under the skin ; and if the point of the saw be kept very close to the bone, there need be very little disturbance of the surrounding tissues, or risk of haemorrhage.

I have twice divided, with the subcutaneous saw, the shaft of the femur for great deformity resulting from badly-united fractures, and once the shaft of the humerus for straight anchylosis. No suppuration whatever oc- curred in these cases, and the operations were performed without difficulty.

Mr. Maunder divided the neck of the femur subcuta- neously, in the manner I have recommended, in a case of fibrous anchylosis in a child eight years of age on 1st July, 1874. See ' Lancet/ July 11th, 1874. The child was the subject of dislocation of the left femur on the dorsum ilii, consequent upon hip-joint disease. No suppuration oc- curred.

Mr. Maunder has also performed operations on the shaft of the femur in a subcutaneous manner in cases of deformity. In a recent number of the ' Lancet/ March 25th, 1876, it is stated, " Lately, at the London Hospital, Mr. Maunder has practised section of bone with chisel and mallet in three instances. In each case the femur was the bone divided. In one case (that of an adult) slight suppuration occurred, while in two (a child and an adult) primary union took place. The shaft of the bone was

FOR ANCHYLOSIS OF THE HIP-JOINT. 7

divided to remedy distressing deformity, and the patients are now in a position to to become useful members of, rather than remain burdens on, society."

Imperfectly subcutaneous operations, such as those here referred to, are applicable only to certain cases, and are essentially the same as those performed by Langen- beck, Meyer, Pancoast of Philadelphia, Brainard, L. S. Little, and others. Such operations, although successful in many instances, must be attended with a much larger percentage of unfavorable results than the true subcuta- neous operations, and are not applicable to the hip-joint from the dangers of deep suppuration which must attend such a procedure.

Mr. Bryant, in the second edition of his ' Practice of Surgery/ just published, speaks very favorably of the operation proposed by myself, and in dividing the neck of the bone subcutaneously, adopted precisely the method I have recommended.

Mr. Bryant observes, " I have performed the operation with marked success in three cases. ... In each of my own cases the neck of the thigh-bone was readily divided in less than five minutes, and the wound above the trochanter healed in a few days ; the boys, aged eight, fifteen, and sixteen respectively, walked in eight weeks. I did not attempt to obtain movement in any of these cases, being well satisfied with the result secured/''

With regard to obtaining useful motion and a false joint as the result of the operation, I may state that I have never succeeded in so doing. I did not attempt it in my first case, but after the success obtained by Mr. Jessop, of Leeds, in which he obtained useful motion in two cases, I tried it in two cases with some success for a short time. Although I could obtain some motion under chloroform, it was quickly lost, partly from the inclination to stiffen, as well as the unwillingness of the patients to submit to chloroform, and subsequent pain in the attempts to preserve motion by the passive movements adopted. I

8 SUBCUTANEOUS DIVISION OF THE NECK OP THE FEMUR

therefore abandoned the attempt, and was satisfied in obtaining anchylosis in the straight position.

A most remarkable and successful case, however, in which useful motion has been obtained in both hip -joints, after subcutaneous division of the neck of the femur for anchylosis, with both legs in a straight line with the body, has been published by Mr. Lund, of Manchester.*

In the case operated upon by Dr. Sands, of New York, useful motion was obtained, and existed eight months after the operation, when the patient was exhibited to the New York County Medical Society, October 27th, 1872. In this case Dr. Sands observes, "After the operation the patient was confined to bed for six weeks, in the hope of obtaining bony anchylosis in the straight positions ; but as it was found at the end of that time that the parts remained freely moveable he was permitted to get up and to move about the ward on crutches. f

In Mr. Sydney Jones' remarkable case of bony anchy- losis of both hip-joints, with the thighs in an extremely abducted position, the operation was successfully per- formed on both hips, and no suppuration occurred. In this case tolerably free motion was kept up for some time, and under chloroform the motion was very free, but some inclination to stiffen was apparent when I last saw it.

Before concluding this paper I would mention, as a remarkable circumstance, that Mr., afterwards Sir C. Bell, proposed the operation of dividing the neck of the thigh- bone in a manner approaching to the true subcutaneous method, not for bony anchylosis of the joint with deformity, for which my operation was designed, but he proposed that it should be performed during the progress of the disease for the purpose of allowing the head of the bone to remain at rest in the acetabulum — in fact, merely to

* 'Brit. Med. Journ.,' May 29th, 1876.

t " A Case of Bony Anchylosis of Hip-joint successfully treated by Subcu- taneous Division of the Neck of the Femur," by H. B. Sands, M.D., Surgeon to the Bellevue and Rosevelt Hospitals (reprinted from the 'New York Med. Jouru.,' December, 1873), New York. Appleton and Co., 1873.

FOR ANCHYLOSIS OF THE HIP-JOINT. V

secure immobility — believing that this would contribute in a great degree to the production of bony anchylosis, and that a freely movable joint would remain at the seat of operation, so that the effects of anchylosis, as to the loss of motion and the production of deformity, would be prevented.

In reference to the operation Sir C. Bell observes, " Such a cut as would permit the use of a small saw to divide the neck of the bone would not be a formidable operation."*

Had this operation, however, been performed during the progress of the disease, I believe its author would have been disappointed, at least in the majority of cases, as to the production of false joint, as the patients could not have borne the rough manipulation by the frequent repetition of flexion, extension, and rotation necessary to maintain free motion. Still, the operation proposed by Sir Charles Bell is of such a remarkable character, and of so much interest in connection with that proposed by myself, which, to a certain extent, it foreshadowed, that I thought it due to this illustrious surgeon that it should be noticed in the present paper. It is the more remark- able as having been published in the year 1828, three years before Stromeyer's operation of subcutaneous teno- tomy, from which the introduction of subcutaneous surgery may be dated.

This proposed operation of Sir C. Bell was first brought under my notice by my colleague, Mr. Carr Jackson, long after the publication of my paper.

* The ' London Medical Gazette,' January 12th, 1828, p. 139.

Note to last case in Table on p. 10 : — Mr. Willett has since communicated, with reference to this case, that deep suppuration, followed by necrosis, ensued. Exarticulation at the hip was performed on February 26th, 1877, and the patient died the same day.

10 SUBCUTANEOQ3 DIVISION OF THE NECK OF THE FEMUR.

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A CASE

OF

RESECTION OF THE TARSAL BONES

FOE

DOUBLE CONGENITAL TALIPES EQUINO-YARUS.

J. N. C. DAVIES-COLLEY, F.K.C.S.,

ASSISTANT-SURGEON TO, AND LECTURES ON ANATOMY AT, GUY'S HOSPITAL.

Received October 6th— Read October 10th, 1876.

Although great progress Las been made of late years in the cure of talipes by the introduction of subcutaneous tenotomy, and the improvement of mechanical appliances, there will always remain a number of cases, which, from the age to which they have attained, the rigidity of the tissues, and the altered shape of the bones, present in- surmountable obstacles to treatment by the ordinary methods. It is not improbable that many of these cases might be successfully treated in the way which was adopted in the following instance :

Edwin H — , set. 12, was admitted into Guy's Hospital on May 8th, 1875, under the care of Mr. Cooper Forster. From birth he had suffered from deformity of both feet. When he was four years old he was taken to Gloucester Infirmary, where some tendons were divided, but without

12 RESECTION OF THE TARSAL BONES FOR

any beneficial result. Since then he has not been under any treatment whatever.

On admission the anterior part of each foot is turned inwards at a right angle to the rest of the foot, and is twisted in such a way that the patient walks on the outer edge of the dorsum, while the sole looks backwards. The heels are raised, especially that of the left foot. On the dorsal aspect of the external cuneiform and cuboid bones bursae have formed, and that upon the right side is sup- purating. He stands with his legs about a foot and a half apart, and he can only walk, or rather waddle, with great pain and difficulty.

He was kept in bed, and the bursal inflammation soon subsided. Splints were applied to the outer side of the legs, and an attempt was made to improve the position of the feet by elastic bands.

During Mr. Cooper Forster's absence in September, the boy came under my care. He was then in much the same condition as when he came in, except that the sup- puration of the bursa on the dorsum had disappeared. I found that the feet were quite rigid, and that hardly any improvement could be produced in them by the applica- tion of force. I first divided subcutaneously the tendo Achillis, the tibialis posticus tendon, and the plantar fascia of the left, which was the more deformed foot. As very little was gained by this operation and the subse- quent treatment, I resolved to adopt severer measures. It was at first my intention to remove the cuboid bone. Mr. Howse, however, suggested to me that it would be far better to cut out a wedge-shaped piece of the tarsus without paying any regard to its articulations.

Acting upon this advice of my colleague, I decided to expose the bones of the instep, and then to saw it through in two places in such a way that the two sections shoufd meet at the inner border and diverge towards the outer border of the foot. I thought, also, that it would be easy to arrange that the upper surface of the segment removed should be somewhat more extensive than the lower, and

DOUBLE CONGENITAL TALIPES EQUINO- VARUS. 13

that in this way the peculiar twist of the foot, which con- tracted at the same time the sole and its inner border, might be remedied.

On October 12th chloroform was administered, and after an Esrnarch/s bandage had been applied, I made an incision three inches in length along the outer border of the left foot, from the middle of the os calcis to the middle of the fifth metatarsal bone. From the centre of this incision I carried another two inches long transversely across part of the dorsum, dividing the tendons of the peroneus longus, the peroneus brevis, and the extensor brevis digitorum. When I had carefully reflected the soft parts, I found that I had to modify my plans. I could not expose the whole of the triangular surface, which I had intended to saw out, without dividing the extensor tendons, or making an incision upon the inner side of the foot. I therefore decided to remove first the cuboid. This was readily done by means of the scalpel and elevator, and the bone was found to be of normal size and shape. Then I sawed off the great process of the os calcis in a plane looking forwards, outwards, and upwards. Next, by means of an elevator, bone-forceps, and dressing- forceps, I took away piecemeal portions of the three cuneiform bones, for the deformity could not be reduced until I had excavated as far as the inner border of the foot. I then pared off some more of the os calcis with a strong knife, and continuing the plane of section inwards I cut away nearly all the scaphoid and a part of the head of the astragalus.

Finally, I removed the articular cartilage from the base of the two outer metatarsal bones. The foot could now be easily placed in the normal position, and the osseous surfaces fitted each other with a fair degree of accuracy. The soft parts of the sole had not been touched.

On relaxing the elastic tourniquet, a brisk haamorrhage ensued. The wound was dressed with carbolic gauze. The antiseptic spray was used during the operation and at each dressing.

14 RESECTION OP THE TARSAL BONES FOR

It was found necessary, on account of the continuous oozing of blood from the bones, to put in a sponge soaked in carbolic lotion, and to keep it there until a week after. Very little systemic disturbance followed the operation. His temperature only once reached 101°. I at first had some difficulty in keeping the foot in good position, but at the beginning of November I adopted a plan which enabled us to adjust the surfaces and to dress the wound very easily. It consisted of a back- splint extending from the middle of the thigh to within four inches of the heel. To the distal end of this was fastened a transverse bar of wood, terminating on either side in short upright bars, to which I attached the fore part of the foot by means of strapping.

By November 23rd the left foot was nearly healed, so I decided to operate upon the right. I at once proceeded to resect the tarsus, without any previous division of the tendons. The bones were so soft that I was able to pare them away without using the saw. In every other respect the operation was the same as that performed upon the other foot.

Again there was a troublesome oozing of blood, which could only be restrained by the retention of a sponge between the cut surfaces. He made a rapid recovery. His temperature only once rose to 102°, and was usually below 100°. There was but little discharge, and no burrowing of pus. The same apparatus was used to draw the front part of the foot into position.

By the 1st of January he was able to get about in a wheel-chair.

On February 3rd, less than ten weeks from the second operation, the wounds were quite healed, and he left off the dressings and splints. A few days before he had begun to walk with assistance. He could now walk by himself, and no apparatus was used from that time.

In March he went to the Bognor Convalescent Esta- blishment.

DOUBLE CONGENITAL TALIPES EQTJINO-VARUS.

15

Upon his return in April I examined him carefully. The feet were quite free from any tenderness. They were rather short for a boy of his age, and the heels projected somewhat backwards. I was surprised to find that the arch of each instep was as good as in a well-formed foot. The movement of the ankles was considerably improved, though not as free as it should be. He could walk well,

Fig. l.

Fig. 2.

Before operation.

After operation.

treading upon the whole of the sole. The strength of the feet was also shown by the fact that he could jump and hop. The movement of the toes was perfect, and the peronei had acquired some firm attachment to the outer side of the foot. I could not, however, satisfy myself that the peroneus longus had any influence upon its inner border. The cicatrices of the incisions had contracted so

16 RESECTION OF THE TARSAL BONES FOR

much that their original direction could no longer be recognised. No depression remained to show where the tarsal bones had been removed, and I doubt very much whether any one who examined the feet would have sus- pected that so much had been taken away. The woodcut (Fig. 2) shows the condition of the feet at this time, and as I brought him here on the 25th of last April some of the Fellows were then able to test by actual inspection the completeness of his recovery.

In September his father wrote to say that he was quite well and able to work, and that he had lately walked six miles with but little fatigue.

Remarks. — Since I operated upon this patient, I have learned from Mr. Adams' interesting work on club-foot that Dr. Little formerly suggested that " in inveterate varus, the treatment might well be commenced in robust subjects by ablation of the os cuboides." In the Society's ' Transactions ' of 1857 there is an account by the late Mr. Solly of a case in which he removed all the cuboid, except the posterior articular surface, in both feet of a young gentleman, aged 23. Mechanical treatment was then used and the patient made a fair recovery. Mr. Solly considered that the operation materially expedited his cure.

Mr. Davy has recently published a series of cases in which removal of the cuboid bone had been followed by good results. I have not heard of any other instances in which this treatment has been adopted.

The chief points in the operation which Mr. Howse suggested and I performed upon this patient appears to me preferable to that just mentioned, are the following :

1. After resection the foot can be placed at once, if desired, in its proper position. Certainly in my own case the removal of the cuboid alone would not have allowed of this.

2. There is no large cavity left which has to be filled up with reparative material. Moreover, as the bony sur- faces are exposed, and the articular cartilages taken away,

DOUBLE CONGENITAL TALIPES EQUINO-VABUS. 17

I consider that fibrous, and possibly bony, union is likely to be established with greater rapidity.

3. The patient will probably be able to discard the use of apparatus much sooner, for little, if any, traction has to be-used in order to restore the proper shape of the foot. In the case I have related the patient began to walk with- out any apparatus in ten weeks after the second resection, and he has never had to wear any since, whereas the patients of Mr. Solly and Mr. Davy appear to have re- quired to use mechanical appliances for a long time after- wards.

With respect to the operation itself and the subsequent treatment, the following points may be deduced from the single successful case which I have brought before you.

1. It is not necessary to divide the tendo Achillis before the resection. If the elevation of the heel be not great it may not be requsite to perform tenotomy at all.

2. Esmarch's bandage is of great use, as in the blood- less state of the tissues it is easy to remove such portions of bones as will leave two plane surfaces suited for exact coaptation.

3. It is better to begin by removing the cuboid, and then to cut or saw off such portions of the adjacent bones as must be taken away, in order that the foot may be placed in a good position without the employment of much force.

4. As so many synovial cavities and sheaths of tendons have to be opened, the dangers of the operation are much diminished by the careful use of antiseptic precautions.

5. The subsequent employment of such a splint as that which was used in this case facilitates very much the maintenance of the foot in good position, and renders the change of dressing a simple and almost painless proceeding. I may add that I have since used splints made upon this principle for the treatment of ordinary cases of talipes, and have found them very efficient in everting and abducting the front part of the foot.

In conclusion, I would submit that this operation may VOL. lx. 2

18 RESECTION OP THE TARSAL BONES, ETC.

be adopted with advantage in many cases where ordinary methods have been employed without success, or where the parts are so deformed and rigid that ordinary methods are likely to fail.

I should also recommend it in cases where it is desir- able for the patient to avoid the long and painful treat- ment and the expensive apparatus which are required for the cure of the severer examples of this deformity by ordinary methods.

NOTES OF A CASE

PSEUDO-HYPERTROPHIC PARALYSIS,

WITH A FEW OBSERVATIONS ON SURFACE THERMOMETRY.

BY

WILLIAM M. ORD, M.B.Lond., F.R.C.P.,

PHYSICIAN TO, AND LECTUBEB ON MEDICINE AT, ST. THOMAS'S HOSPITAL.

Received October 10th— Read October 24th, 1876.

In a case of the above-mentioned disease, which I had the honour of reporting to this Society three years ago, the overgrown calves appeared to be constantly warmer than the thighs. I take now the opportunity of recording a case in which the thighs were found to be warmer than the calves, and, in connection with the discrepancy, of making some remarks on methods and conditions of the taking of the temperature of the surface of the body, par- ticularly with reference to simultaneous variations of the tymperature in different parts.

William M — , a boy of 7 years, was admitted into St. Thomas's Hospital on the 30th June, 1876, under the care of Dr. Bristowe, to whose kindness I owe the advantage of being able to investigate the case.

The boy's mother stated that he had been weakly from

20 PSEUDOHYPERTROPHIC PARALYSIS.

birth, and that for at least four years he had been getting weaker on his legs. Of late he had been in the habit of falling about, his falls being chiefly on his face. He had not been known to lose consciousness on any occa- sion, nor to be at any time convulsed. His father was stated to be consumptive. His mother had had chorea before marriage, and described herself as being still excessively nervous. Of four other children, all younger than the subject of the present history, one, a boy of six, was beginning to be affected with pseudo- hypertrophic paralysis ; a second, a girl, died in convul- sions during teething ; a third, aged two years and a half, was said to be healthy ; and the last, an infant, was alleged to be very weakly. There was, as far as could be ascertained, no history of syphilis in the parents, but as the father did not appear for examination, the point was not fully decided.

William M — , whose photograph is placed before the Society, is a fair-haired, somewhat ruddy child, three feet five inches in height, and in weight two stone seven pounds and a half. His expression is not exactly vacant, nor indeed dull, but a sort of apish look is produced by a habit which he has of raising the eyebrows and wrinkling the forehead. His intellectual power appears to be by no means defective. He has been to school, has learned to read, and, considering that his schooling has been much broken by his illness, he shows certainly an average capacity of acquiring knowledge. In manner he is lively and cheerful, with a disposition to impish mischief and tricks.

When stripped and examined in the erect posture he is found to stand with the feet planted about six inches apart, with the buttocks thrown back, the back bent deeply forwards, and the shoulders again thrown back beyond the line of the buttocks. He has difficulty in remaining perfectly still, tending obviously to fall for- wards. The heels are raised from the ground, and the body balanced for a few seconds on the balls of the great

PSEUDO-HYPERTROPHIC PARALYSIS.

21

toes. A strong backward movement of the shoulders is necessary to reinstate him on the soles of his feet. As long as he continues to stand this backward-and-forward swaying movement goes on. He not seldom loses equili- brium, and either falls or shows a tendency to a fall, only averted by the assistance of some fixed object to which he clings. While he stands the muscles of the upper limbs twitch constantly, and he often seems to try to grasp the floor for support by strongly flexing his toes.

The muscles of the calf are enlarged distinctly out of proportion with the other muscles of the body. They are abnormally firm when at rest, and during contraction they become as hard and knotted as the biceps of a blacksmith. The right shoulder droops, and the right deltoid is en- larged and hardened, while the other muscles of the shoulder are perhaps a little wasted. The left deltoid is also larger than proportion would demand. The remark- able forward curvature of the back is due to weakness of the muscles ; the vertebrse are not diseased and are free ; the sacro-lumbar muscles appear to be increased in bulk. The feet are not large and the insteps are high. The following measurements of various parts of the body have been taken :

Circumference of head from occipital protuberance

round frontal protuberance . . .19 inches.

Circumference of chest at nipples . . . 22 „

Arm round deltoid . . . 6f „

Arm below insertion of pectoralis major . . 6 „

Forearm, broadest part . . . 6i „

Wrist . . . . . 4£ „

Thigh . . . . . 11* »

Calf. . . . . . 9£ „

Ankle . . . . . 6 „

The limbs of the two sides agreed in their measurements.

Movements. — In walking he moves cringingly, like a bather going over a shingly beach, holding the shoulders in the air and putting his feet down in a hesitating way. As the bather tries to make the pressure of his feet on the

22 ^SEUDO-HYPERTROPHIC PARALYSIS.

ground as light as possible, the patient evidently tries to help and sustain the weak lower limbs by the exertion of the upper. In advancing, he raises the upper arm to a horizontal position and keeps the two arms in line with each other and the shoulder, making, as Dr. Twining, House Physician at the time, suggested, a use of the arms comparable to the use of a balancing-pole. At each forward step one shoulder is thrust forward, and on this, as a pivot, the other is then swung in turn forward, dragging the pelvis after it, and so pulling the foot along the floor. These are movements made when he is naked. With boots or shoes on his feet he makes a more rapid shuffling movement, being able to slide his feet along the floor. He can make an attempt at a run,' but it is only a quicker shufflle. In walking more than in standing he is apt to fall. His fall is a collapse, like that of a dead body from which a support hitherto keeping it in an erect position has been suddenly removed. It seems as though, for an instant, the nervous control of the muscles were suspended, letting the body come crashing in a heap to the ground with the face downward. His face, chest, and arms present many bruises received in these falls.

In rising from the ground he begins by raising one knee to the kneeling position with the foot well planted, and then, placing his hand on the knee, raises his body by the shoulders very painfully, swaying in an uncertain and wavering fashion which has been compared by my clinical clerk, Mr. Gulliver, to the movements of an acrobat perched upon a rope, who is exchanging under the pres- sure of weight the stooping for the erect position. Mr. Gulliver also observed him ascending stairs and noticed that, at each step, the body was raised by the agency of the hand placed upon the knee. The extensors of the foot must be weak, inasmuch as when he hangs a foot out of bed he cannot bring it to an acute angle, indeed, scarcely to a right angle with the leg. In the same position he cannot raise his knee towards his body unless with the aid of his hands.

PSEUDO-HYPERTROPHIC PARALYSIS. 23

The general weakness of the back and lower limbs is again shown by his movements in bed. These start from the shoulders. If he wish to turn from side to side he twists the shoulders round and drags the body after. Not always however, for unless his purchase is good the body remains helpless, and, without external aid, the change of position is not effected. In all these various directions of combined movement, no such assistance is given by the great extensors of the foot, as might have been expected if their strength had been proportioned to their bulk and hardness.

As a general result of all observations it may be deci- dedly concluded that there is a general failure of muscular power, and that this failure is most conspicuous in the back and legs.

Sensation. — The skin presents no unusual appearance and no variations of vascularity, except that the exposed parts are more ruddy.

The sensibility of the skin is good. In the calves the limit of confusion, when callipers are applied, is fifteen sixteenths of an inch. In the forearm it is about the same. Generally speaking discriminative sensation is a little more acute on the right side of the body than on the left.

Electrical sensibility. — The muscles of the body gene- rally, and of the calves in particular, were less than naturally sensitive to faradic electricity. The unruliness of the patient under this kind of observation interfered, however, with the attainment of accurate results.

The constant current being used it was found that the calves did not contract at the closure and opening of the circuit with less than thirty-six cells of a Stohrer's battery, the thighs with less than thirty, and the sacro-lumbar muscles with less than twenty to twenty-four.

Microscopic examination of the muscles of the calves. — Portions of the muscles of both calves were removed for examination by means of the emporte-piece, made for me by Mr. Hawksley, and described in my former paper. I

24 PSEUDOHYPERTROPHIC PARALYSIS.

exhibit it now). On the first occasion the instrument brought away from both legs a very large proportion of adipose tissue mixed with a small quantity of muscle. Supposing that the interval between two muscles had been reached I renewed the experiment, and, though satisfied that I explored the middle of the gastrocnemius, I still brought away on two occasions a preponderance of adipose tissue.

Dr. Charles, Demonstrator of Physiology, has been good enough to make examination of the muscles removed on the various occasions, and I submit his report, which describes muscular structure of a far from natural cha- racter.

" The three pieces of muscle were prepared as follows :

" First piece was examined in glycerine after having remained several days in monochromate of ammonia 2 per cent. sol.

" Second piece was stained with hsematoxylin sol. and examined in Dammar varnish, after having remained four days in chromic acid | per cent.

" Third piece was teased and stained with hgemat. sol. almost immediately after its removal from the limb ; it was mounted in Canada balsam in the usual way.

11 The following points were noticed :

" (a) That many of the fibres were very small, and that they all presented very close transverse striation.

" (j3) That in some of them the striation was obscure or very badly marked, here and there often being replaced by a cloudy or finely granular appearance.

" (y) That between many of the fibres was a coarsely granular material abundantly provided with nuclei.

" (8) That many of the fibres appeared quite healthy, and that well-marked fatty degeneration could nowhere be detected."

Before making any statements regarding the tempera- ture of the limbs, I will state that the viscera of the chest and abdomen appeared to be quite healthy ; and as the question of temperature will occupy the rest of the

PSEUDO-HYPERTROPHIC PARALYSIS. 25

paper, it will be convenient to introduce here a few notes regarding the younger brother of the patient.

Henry M — , aet. 6, the next brother of the patient, was brought to me once or twice for inspection. He exhibited generally the symptoms of his brother, but in a lower degree. He could walk and run with only a little difficulty, and could stoop and raise himself without assistance. There was evident enlargement of the calves, and his gait and attitudes were a delicate caricature of his brother's.

The information to be got by testing him was limited, the child being of defective intellect.

The following measurements were taken :

Circumference of head .... 19^ inches.

Circumference of chest .... 19£ „

Eight calf . . . . . 7| „

Left calf . . . . . 8| „ Right thigh not measured, being distorted by tumours.

Left thigh . . . . . 11

Arm, middle . . . . . 6 „

Forearm, middle . . . . 6 ,,

Temperature. — Many observations of the temperature of the calves and thighs were made, and circumstances occurring in the process of observation directed my atten- tion to several points connected with the estimation of the temperature of the surface of the body.

It is, in the first place, obvious that too very distinct lines of observation are open — first, of absolute temperature in one part, or many; second, of relative temperature of different parts. The object which I originally had before me was to arrive at a knowledge of the relative temperature of the muscles of the overgrown calves and of the less developed thighs. It was not in my power to insert any thermometrical apparatus into the muscles, as had been done by Becquerel and Breschet in the case of a few young men, and by many observers in animals ; and for the object in view it was necessary to get more than the temperature of the surface, for there was, in my mind, an idea of

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26 PSEUDOHYPERTROPHIC PARALYSIS.

the possibility of a rise of temperature in the muscles independently of the skin ; and from many observations it appears pretty certain that the temperature of the skin when exposed to the air does not at all correspond with the temperature of subjacent parts. In relation to this I would refer especially to Mr. A. H. Garrod's paper on some of the minor fluctuations in the tempera- ture of the human body, published in the ' Proceedings of the Royal Society ' for 1869. Mr. Garrod here, among other interesting statements, gives a series of tables showing that on stripping the warm body of clothing in a cold air the temperature under the tongue rose at the same time that the surface became colder, and shows reason for explaining the change by local alterations of arterial tension. Again, the very careful electro-thermical observations of Becquerel and Breschet give ground for believing that the muscles are decidedly warmer than the connective tissues around them.

In comparing, therefore, the calf with the thigh I endeavoured in the first place to place them under exactly similar conditions of rest, exposure, and pressure. That is to say, the patient was placed flat on his back, not turned to either side, his legs were kept straigktly extended, and he was covered with a light blanket. For reasons which I will afterwards more fully explain, I did not use thermo-electrical apparatus, but a pair of very accurate and very accurately corresponding mercurial thermometers made for me by Mr. Hawksley. They were made after the plan of some which I had seen used by our lamented friend, Dr. Sibson, in observations on the temperature of the face in thoracic aneurism. I now exhibit a pair of these which, in practice, were either supported by a boxwood backing, or were strapped on to the skin and covered with cotton wool. I exhibit also a beautiful and very perfect arrangement devised by Dr. Dupre. For my purpose Mr. Hawksley has devised and made two thermometers, having like these the bulb drawn out into a flat spiral, so as to expose a large surface on

PSEUDOHYPERTROPHIC PARALYSIS. 27

each side, but having added to them pads and means of fixation, which make them more available for my purpose. Mr. Garrod relates that he used a flat spiral thermometer for ascertaining the temperature of the pectoral region, but does not mention that it was covered in any way on the free surface when the opposite surface was applied to the skin. Mr. Hawskley has made me a circular pad or cushion of glove-kid stuffed with cotton wool. The pad is two inches in diameter, is five eighths of an inch thick in its centre, and thins very gradually to the margins, where it is supported by a rim of wire, and has a socket to be attached to the stem of the thermometer. The stem being thrust through the socket the bulb lies flat against one side of the cushion. To the other side is sewn an elastic band with tapes attached. By this arrangement the bulb is readily bound against any surface, and when properly fixed is inclosed in a chamber with non-con- ducting walls, so that loss of heat from its free surface and from the free surface of the adjoining skin is pre- vented, and the temperature of the parts beneath the skin is allowed to influence the thermometer, if exposure be maintained for a sufficiently long period. The thermo- meters are non-registering and have to be read in situ. Within the last few weeks I have learnt from one of Dr. John Davy's earlier papers that he made use of an instru- ment constructed upon similar principles for the same purpose. In 1839 he wrote as follows : — " That the thermometer might be applied equally to all parts of the surface ; its bulb, in form uearly cylindrical, was fixed to a small piece of cork hollowed and lined with fine wool, and thus half its supei'ficies was applied in each instance."

With the above-described instruments, and with the observance of the conditions above laid down, eleven com- parative observations were made on William Marshall :

28 PSEUDO-HYPERTROPHIC PARALYSIS.

Aug. 9th.-Right thigh 95-6 1 Th. h 0.8o warmer Left calf 94*8 J °

Left thigh 96-2 \ -,. . , „ „

Right calf 93-5 } Thigh 2-7 warmer.

„ 10th.— Right thigh 936 "1 n . „ _ .

Left calf 93-7 } Calf 01 warmer.

„ 15th.— Right thigh 95-5 \ E j

Left calf 95-5 J * „ 18th.— Right thigh 96.2 1 Th. , 0.7 warmer.

Left can 9o'5 J „ 22nd.-Right thigh 93-5 1 Th- . M warmer.

Left calf 91-4 J s Ward 65-0. „ 25th.-Ri.ght thigh 94-5 1 ^ warmer<

Left calf 92'8 J °

•• " " "^IjtKMS }«*«—*

„ 610. Oct. 12th.— Left thigh 933 "I „ ,

Right calf 93-3 / EquaL

Small ward 70-0. Oct. 9th.— Left thigh 93'4 1T „ „

Right lei 95-6 jLeg2'2warmer-

The first six observations were made in warm weather, the windows of the ward were open, and the average tem- perature was about 70° Fahr. The observations were made in the morning between 8 and 10, excepting the last three, which were made in the afternoon. In the first ten observations the thermometers were placed in the same positions on thigh and calf. On thigh over the inner portion of the great extensor in its middle length ; on calf over the inner portion of the gastrocnemius in its middle length. The thigh and calf of opposite sides were compared, lest the ligature over the thigh, though of slight tension, might affect the blood current to or from the leg. In the last observation the positions were changed respectively to the middle of the front of the thigh and to the middle of the front of the leg between the tibia and fibula. This observation was made in relation to statements of Dr. John Davy, and is excluded from the ten used for the establishment of an average.

It will be observed that in one instance the calf was warmer than the thigh to the extent of one tenth of a degree, that in two cases the temperature of the parts

PSEUDO-HYPERTROPHIC PARALYSIS. 29

compared were equal, and that in the remaining seven the thigh was from 07° to 2 '7° Fahr. warmer than the calf. The average of the whole ten cases gave l,07°in favour of the thigh, the average of numbers being 94,64° for the thigh, and 93'57° for the calf.

In a similar case, reported by me to the Society three years ago, the results were the reverse of what I have stated here, the calf being found in nine observations to be from 1*8° to 3*9° Fahr. warmer than the thigh.

The discrepancy of the two sets of observations has led me to take some care in exploring the conditions of surface thermometry, with the view of eliminating error and of satisfying myself as to the probable value of the tables in my first case.

I must admit in the first place that the first series of temperatures were not taken under a knowledge of many conditions which I have since found to be important, and that having been made sometimes on the exposed, some- times on the partly covered, sometimes on the completely covered body, with only one instrument, and that a recording instrument, with an exposure of much less duration, they have much less of the claim of precision. But it must be remembered that under all these differences of method the results were actually more unvarying than under the uniform management of the second series.

It does not appear to me, indeed, that their value is lost if, after remembering their consensus, we recognise some important differences in the cases associated with the two series. The differences are :

1st. That while in the second case the duration of the disease appeared to have been twice as long as in the first the muscles had not grown to nearly an equal bulk.

2nd. That other muscles than those of the calf were affected with the hypertrophy in the second case and not in the first, indicating the presence of a much later stage of the disease.

3rd. That the information given by the microscope leads again to the inference that the muscles in the second

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28

PSEUDO-IIYPEl.

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30 PSEUDOHYPERTROPHIC PARALYSIS.

case have advanced considerably in a progress of degenera- tion which was not at all detected in the first.

The smaller bulk would probably indicate a less intensity or comprehension of the local mischief, and the degenera- tion would indicate that even if active hypereemia had constituted an important element in the early stage the balance of nutrition had, later on, been reversed. It would follow that a smaller increase of temperature might in the beginning be looked for, and that in the later period now under observation a diminution proportionate to the amount of the degeneration might not improbably have occurred. In a word, the second series, though reversing the first, do not necessarily contradict them.

In this light it has seemed to me desirable to endeavour to learn what is the natural ratio of temperature between the calf as a mass and the thigh as a mass. The examina- tion of this question shows many difficulties to exist. As an illustration of the difficulties I subjoin Dr. John Davy's table of temperatures obtained with the instrument already noted.* The observations were made on the naked body at 7 a.m., immediately on quitting bed. The temperature of the air of the room was 70°.

At the central part of the sole of the foot . . . 90°

Between the malleolus iuternus and the insertion of the tendo

Achillis, where the artery is felt . . .93

Over the middle of the tibia .... 91*5 Over the middle of the calf . . . .93

Over the popliteal artery at the bend of the knee . . 95

Over the femoral artery in the middle of the thigh . . 94

Over the middle of the rectus muscle . . .91

Over the great vessels in the groin . . . 96-5

Under the axilla, the whole surface of the bulb being exposed 98

This, with some other determinations, occupied an hour, at the end of which time the sole of the foot gave no more than 85°, five degress less than at first.

In these observations the middle of the calf gave a higher temperature than the middle of the rectus muscle, * ' Account of Experiments on Animal Heat : Researches, Physiological and Anatomical,' 1839, p. 150.

PSEUDO-HYPERTROPHIC PARALYSIS. 31

and approached within one degree of the temperature of the skin over the femoral artery in the middle of the thigh. But if the observations were made in the order in which they are recorded it is clear that the conditions would not have been the same at or towards the end as at the beginning, since it is shown that the sole of the foot cooled no less than five degrees in the period of examina- tion ; and it cannot be assumed that the parts cooled altogether in the same ratio, it being quite possible that while the feet were cooler the thighs might have become warmer. For Mr. Garrod has given reason for stating it to be a rule that the application of warmth to the feet produces a lowering of temperature elsewhere ; and I have myself made observations which confirm this and carry it further. I will quote one of these :

A well-nourished boy, of 16, having bared his legs, was covered with a blanket and a light shawl, and allowed to recline in a large easy chair for five minutes, the temperature of the room being 64*2°. He felt now com- fortably warm. The thermometers applied for twenty-five minutes gave —

For the right calf .... 93-5° „ left „ . . . 917°

although no difference of conditions, internal or external, was known to exist.

A hot-water bottle was then placed against the side of the left thigh, and while the thermometers were applied reversed to the calves, two others were placed over the inner part of the rectus in each thigh at the junction of the middle and lower thirds, the thermometer on the left thigh being thickly covered with cotton wool as well as being three and a half inches distant from the bottle. The fellow instrument was similarly covered. The readings at the end of thirty minutes were —

Right thigh ..... 95-1°

Loft thigh ..... 95-8

Right calf ..... 94-7

Left calf ..... 91-3

32 PSEUDOHYPERTROPHIC PARALYSIS.

A sensation of warmth was experienced in the thighs, of cold in the calves, which also felt cool to the applied hand.

The application of warmth to the thigh was, therefore, followed by a fall of 0*4° in the calf of the same side, and a rise of 1"2° in the calf of the opposite side.

On the other hand, it is clear that no considerations of this kind will explain the difference in the temperature of the skin over the middle of the calf, 93'0°, as compared with the temperature of the skin over the tibia, 91 "5 . The texture of the epidermis, thickness of subjacent fat, and nearness to large vessels will be among the circum- stances thus causing such differences. These influences have been balanced by selecting for comparison in different limb-shafts parts agreeing as much as possible in these points ; and when healthy people have been examined an average of 1'5° excess has been observed in the thigh as compared with the calf. The average of seven carefully selected cases among healthy people gave 93*87° for the thigh-muscles, and 92*30° for the calf-muscles. But it will be necessary to make many more comparative observa- tions before their average can be regarded as correct, the variations being considerable, though with only one excep- tion the excess was always on the one side. It will be seen that the average temperature differences in the case of W. Marshall were 1*07° or less than the difference in healthy persons.

Used with the precautions mentioned the thermometers I have described answer, I fully believe, the purpose in view, namely, the determination of the heat of the mass of flesh beneath the surface over which the pad is placed. But there are other cases in which the temperature of the surface is alone sought, or sought in comparison with the temperature of the depths. For such kind of investigation the use of some kind of thermopile and galvanometer would seem suitable ; and, indeed, for very delicate observations of a comparative nature thermo-electrical apparatus suggests itself as most appropriate.

PSEUDO-HYPERTROPHIC PARALYSIS. 33

Thermo-electricity has, in fact, been already so applied, by Becquerel and Breschet, Helniholtz, Lombard, Gavarret, Montgomery, and others.

The original apparatus of Becquerel was a needle of copper soldered end to end with a needle of steel, so that their axes were continuous. This was either applied to a surface or thrust beneath, so that in either case the junction of the two metals was placed at the point to be examined as to its temperature. The free ends of the needles were connected with the poles of a very delicate galvanometer, the needle of which was left not quite perfectly astatic, and the actual temperature was estimated by comparing the deflection in each experiment with the deflection produced by immersion of a similar coupling in water of known temperature. The results were very interesting, but cannot be accepted as thoroughly accurate.

In using this kind of apparatus the experimenter is on the horns of a dilemma. He may use either a very simple thermopile of one pair of elements, and as a necessary associate a galvanometer of great delicacy, or he may use a thermopile of greater complexity and sensitive- ness, in association with a less sensitive multiplier.

Error has to be guarded against in these appliances, both from the side of the pile and from the side of the galvanometer. In proportion as the galvanometer is made more sensitive it will tend to be affected by the currents produced by weak chemical actions, and by the currents existing in animal bodies. On the other hand, it is neces- sary to protect the thermopile from unequal heating, and, where comparative observations are made, to ensure perfect calibration of the two instruments, to maintain equal pressure, and ensure perfect equality of application.

I will take Dr. Montgomery's experiments recorded in p. 1 7 et seq. of the first volume of Holmes' ' System of Surgery.' They were comparative observations made with the view of determining whether heat were generated in inflamed parts. Small dart-like thermopiles, like those which I now exhibit, were used in conjunction with a vol. lx. 3

34 PSEUDOHYPERTROPHIC PARALYSIS.

sensitive galvanometer. The darts were made of small bars of platinum and steel joined at an acute angle, and brought to a point at their junction. They were connected with each other, and then included in the galvanometric circuit. Being applied to the surface at different spots, or thrust, one into a vein, the other into an artery, they caused deflec- tion of the galvanometer in one direction or another accord- ing as one was made warmer than the other.

Now, in thrusting a needle into the skin friction is involved, and if the skin at two points be of unequal toughness, if one needle be a little blunter or less polished, an element of disorder is introduced. Becquerel and Breschet take note of this as well as the next difficulty, that of currents being possibly produced by electrolytic action, a danger which is likely to be greater when bloods of different composition are investigated with the aid of very sensitive galvanometers. They suggest, accord- ingly, the varnishing of the needles (a precaution, indeed, which Dutrochet afterwards systematically used), but recognise the frictional error that may thus be introduced. Again, when a needle is introduced into the body it is apt by mechanical irritation, and, when composed of two metals, by galvanic stimulation, to cause contractions of muscles and currents in nerves. In preparing frogs for electrical investigation it will always be noticed that if a silver probe and the end of a pair of steel forceps come together under the lumbar nerves a sharp contraction of the limbs accompanies each contact.

I cite these points as illustrative of the difficulties which occur to me as having to be met in such investiga- tions, and as grounds for my hesitation in makiitg use of the same kind of apparatus for my own purpose.

If the surface alone is to be examined the proper com- pensation of the thermopiles is necessary, and is a matter involving great care and special arrangements. For it is unnecessary to remind the Society that in applying warmth to a thermopile, directly the rise of temperature travels beyond the midpoint between the poles reverse currents

PSEUDOHYPERTROPHIC PARALYSIS. OO

are set up. It was probably to avoid this that Dr. Mont- gomery had the two piles which I now exhibit made so long ; and it must be observed that this would prevent much error in short observations, but would not supersede the necessity of proper compensation.

My friend Dr. Kilner informs me that he has very nearly completed an electrical arrangement which will be available for clinical purposes. In this the distal end of the thermopile is immersed in a chamber containing water of known temperature, and in the same chamber is inserted at only a short distance the end of another pile, which is introduced into the circuit. As one pile becomes warm it raises the temperature of the water, and this in turn warms the second pile. The two currents then neutralise each other, and, as Dr. Kilner hopes to show, eliminate error. In such an instrument, combined with a suitable galvanometer, the indications of the needle can be measured and translated readily into the language of ordinary ther- mometry.

Supposing that such an instrument prove successful, and that the registration of surface temperatures becomes possible, and that observations may be made readily in clinical work, the difficulties on the physiological side will have to be borne in mind. The signs given by this or any other instrument must be subjected to criticism by the light of our knowledge of the influences effective in modifying local and comparative temperature in the body.

In conclusion, I have to acknowledge my great obligations to Dr. Charles, Dr. Twining, Mr. Nicholson, and Mr. Gulliver, who have assisted me in many ways, in relation to this case and the observations of temperatures generally.

ON A FORM

OF

CHKONIC INFLAMMATION OF BONES

(OSTEITIS DEFORMANS).

BY

Sib JAMES PAGET, Bart., D.C.L., LL.D., F.B.S.,

CONSULTING SURGEON TO ST. BARTHOLOMEW'S HOSPITAL, ETC.

Received November 1st — Read November 14th, 1876.

I hope it will be agreeable to the Society if I make known some of the results of a study of a rare disease of bones.

The patient on whom I was able to study it was a gentleman of good family, whose parents and grand- parents lived to old age with apparently sound health, and among whose relatives no disease was known to have prevailed. Especially, gout and rheumatism, I was told, were not known among them ; but one of his sisters died with chronic cancer of the breast.

Till 1854, when he was forty-six years old, the patient had no sign of disease, either general or local. He was a tall, thin, well-formed man, father of healthy children, very active in both mind and body. He lived very temperately, could digest, as he said, anything, and slept always soundly.

At forty- six, from no assigned cause, unless it were that he lived in a rather cold and damp place in the North of England, he began to be subject to aching pains

dO CHRONIC INFLAMMATION OF BONES.

in his thighs and legs. They were felt chiefly after active exercise, but were never severe ; yet the limbs became less agile or, as he called them, "less serviceable/' and after nbout a year he noticed that his left shin was misshapen. His general health was, however, quite unaffected.

I first saw this gentleman in 1856, when these things had been observed for about two years. Except that he was very grey and looked rather old for his age, he might have been considered as in perfect health. He walked with full strength and power, but somewhat stiffly. His left tibia, especially in its lower half, was broad, and felt nodular and uneven, as if not only itself but its periosteum and the integuments over it were thickened. In a much less degree similar changes could be felt in the lower half of the left femur. This limb was occasionally but never severely painful, and there was no tenderness on pressure. Every function appeared well discharged, except that the urine showed rather frequent deposits of lithates. Regarding the case as one of chronic periostitis, I advised iodide of potassium and Liquor Potassa? ; but they did no good.

Three years later I saw the patient with Mr. Stanley. He was in the same good general health, but the left tibia had become larger, and had a well-marked anterior curve, as if lengthened while its ends were held in place by their attachments to the unchanged fibula. The left femur also was now distinctly enlarged, and felt tuberous at the junction of its upper and middle thirds, and was arched forwards and outwards, so that he could not bring the left knee into contact with the right. There was also some appeai-ance of widening of the left side of the pelvis, the nates on this side being flattened and lowered, and the great trochanter projecting nearly half an inch further from the middle line. The left limb was about a quarter of an inch shorter than the right. The patient believed that the right side of his skull was enlarged, for his hats had become too tight ; but the change was not clearly visible.

Notwithstanding these progressive changes, the patient

CHRONIC INFLAMMATION OP BONES. 39

suffered very little ; he had lived actively, walking, riding, and engaging in all the usual pursuits of a country gentle- man, and, except that his limb was clumsy, he might have been indifferent to it. He had taken various medicines, but none had done any good, and iodine, in whatever form, had always done harm.

In the next seventeen years of his life I rarely saw him, but the story of his disease, of which I often heard, may be briefly told and with few dates, for its progress was nearly uniform and very slow. The left femur and tibia became larger, heavier, and somewhat more curved. Very slowly those of the right limb followed the same course, till they gained very nearly the same size and shape. The limbs thus became nearly symmetrical in their deformity, the curving of the left being only a little more outward than that of the right. At the same time, or later, the knees became gradually bent, and, as if by rigidity of their fibrous tissues, lost much of their natural range and movement.

The skull became gradually larger, so that nearly every year, for many years, his hat, and the helmet that he wore as a member of a Yeomanry Corps needed to be enlarged. In 1844 he wore a shako measuring twenty- two and a half inches inside; in 1876 his hat measured twenty-seven and a quarter inches inside (PI. I, fig 4). In its enlargement, however, the head retained its natural shape and, to the last, looked intellectual, though with some exaggeration.

The changes of shape and size in both the limbs and the head were arrested, or increased only imperceptibly, in the last three or four years of life.

The spine very slowly became curved and almost rigid. The whole of the cervical vertebrae and the upper dorsal formed a strong posterior, not angular, curve ; and an anterior curve, of similar shape, was formed by the lower dorsal and lumbar vertebras. The length of the spine thus seemed lessened, and from a height of six feet one inch he sank to about five feet nine inches. At the same

40 CHRONIC INFLAMMATION OF BONES.

time the chest became contracted, narrow, flattened laterally, deep from before backwards, and the movements of the ribs and of the spine were lessened. There was no complete rigidity, as if by union of bones, but all the movements were very restrained, as if by shortening and rigidity of the fibrous connections of the vertebra? and ribs.

The shape and habitual posture of the patient were thus made strange and peculiar. His head was advanced and lowered, so that the neck was very short, and the chin, when he held his head at ease, was more than an inch lower than the top of the sternum.

The short narrow chest suddenly widened into a much shorter and broad abdomen, and the pelvis was wide and low. The arms appeared unnaturally long, and, though the shoulders were very high, the hands hung low down by the thighs and in front of them. Altogether, the attitude in standing looked simian, strangely in contrast with the large head and handsome features.*

All the changes of shape and attitude are well shown in sketches from photographs taken six months before death (see PI. I, figs. 1 to 3). Only the lowering of the necks of the femora is not shown. In measurement after death the axes of the shaft and neck of the right femur formed an angle of only 100° instead of 120° or 125°, and this change of shape added to the appearance of increased width of the pelvis.

But with all these changes in shape and mobility of the head, spine, and lower limbs, the upper limbs remained perfect, and there was no disturbance of the general health.

In 1870, when the disease had existed sixteen years, the left knee-joint was, for a time, actively inflamed and

* An attitude somewhat similar is given by a rare form of what I suppose to be general chronic rheumatic arthritis of the spine involving its articula- tions with the ribs. The spine droops and is stiff, the chest is narrow, the ribs scarcely move, the abdomen is low and broad, but there is no deformity of head or limbs.

CHRONIC INFLAMMATION OF BONES. 41

its cavity was distended with fluid. But the inflamma- tion soon subsided, only leaving the joint stiff er and more bent.

About this time some signs of insufficiency of the mitral valve were observed, but the patient now lived so quietly, and moved with so little speed, that this defect gave him no considerable distress.

In December, 1872, sight was partially destroyed by retinal hasrnorrhage, first in one eye, then in the other,* and at nearly the same time he began to be somewhat deaf. In the summer of 1874 he had frequent cramps in the legs, and neuralgic pains, which were described as " jumping over all the upper part of the body except the head," but change of air seemed to cure them.

In January, 1876, he began to complain of pain in his left forearm and elbow which, at first, was thought to be neuralgic. But it grew worse, and swelling appeared about the upper third of the radius and increased rapidly, so that, when I saw him in the middle of February, it seemed certain that a firm medullary or osteoid cancerous growth was forming round the radius.

Still the general health was good. Auscultation could detect mitral disease, but the appetite and digestion were unimpaired, the urine was healthy, the mind as clear, patient, and calm as ever. As letters about him at this time said (C his general health has been excellent -" " he is free from pain except in the left arm ; he sleeps well, enjoys himself, and does not know what a headache is."

After this time, however, together with rapid increase of the growth upon the radius, there were gradual failure of strength and emaciation, and on the 24th of March, after two days of distress with pleural effusion on the right side, he died.

* Mr. Brudenell Carter saw him in January, 1873, and observed " the right retina sprinkled with small dots of arterial haemorrhage, chiefly in parts remote from the centre j" and "there was no other change." The left retina was at this time healthy, hut in February Dr. Clifford Allbutt found " several little plugs " in its vessels.

42 CHRONIC INFLAMMATION OP BONES.

The body was examined five days after death, and showed no marked signs of decomposition. As it lay on a flat board its posture was remarkable, for the head was upraised to the level of the sternum, being supported by the rigid and arched spine, and the lower limbs, with the knees bent and stiff, rested on the heels and nates.

The pericranium, dura mater and all the substance of the brain appeared healthy.

The right pleural cavity contained at least a pint of pale serous fluid, with flakes and strings of inflammatory exuda- tion. The lung was compressed, and in its pleural cover- ing were numerous small nodular masses of pale cancerous substance. The proper pulmonary structure appeared healthy, and so did the left lung and its pleura, except that in the pleura and anterior mediastinum there were many small masses of cancer.

The heart was enlarged but thin-walled. The tricuspid and pulmonary valves and artery were healthy ; the mitral valve was opaque, contracted, stiffened with athero- matous and calcareous deposits.

The aortic valves were slightly opaque but pliant, and both in them and in the first part of the aorta were numerous small patches of atheroma.

The liver and digestive canal and kidneys, examined externally, appeared healthy.

The right femur, the left tibia, the patellee, and the upper part of the skull, were taken for separate examina- tion, and will be separately described.

In the other bones of the skeleton, except the left radius, no signs of disease appeared externally, but I regret that they were not all more carefully examined, for I think that, at least in the clavicles and pelvis, some changes like those in the long bones of the lower limbs would have been found.

The upper third of the left radius was involved in a large ovoid mass of pale grey and white soft cancerous substance, similar to that of the nodules in the pleuras and mediastinum, but with growths of bone extending

CHRONIC INFLAMMATION OP BONES. 43

into it. The rest of the radius and the ulna appeared quite healthy.

Some nodules of similar cancerous substance were imbedded in the bones of the vault of the skull.

Microscopic sketches of these structures by Mr. Butlin are appended (Plate II, figs. 1—3).

The curvatures of the spine and its rigidity appeared due to shortening and hardening of its fibrous structures. The vertebras appeared healthy ; there was no appearance of overgrowth or anchylosis among them.

In no part, whether near or far from the diseased bones, was there an indication of any change of structure in skin, muscle, tendon, or fascia ; but in the right hip- joint and in the left knee-joint there was some thinning and wasting of articular cartilage, such as one sees in chronic rheumatic arthritis. The other hip- and knee- joints and both ankle-joints were healthy.

In the arteries of the lower limbs there was extensive atheromatous and calcareous degeneration.

The enlargement of the skull may be estimated by comparison of the following measurements :

Diseased skull. Average skull. Circumference at the level of the middle of the tem- poral fossa ..... 2Gi in. 21 in. From occipital spine to base of nasal bones . . 15 in. 13j in. From mastoid to mastoid process . . . 18| in. 15} in.

All the sutures, at least all those of the vertex, were obliterated. The outer surface of the upper part of the skull was lowly bossed by the predominant thickening of the hinder part of the parietal bones. The thickness was in every part increased to the extent shown in these fol- lowing measurements.

In a median vertical section the thickness of the frontal bone was 11 — 13 lines.

„ „ parietal . 14 — 16 „

„ ,, occipital . 8 — 12 „

In a horizontal section, through the middle of the temporal

fossa, the thickness of the frontal bone was . . 8 — 9 „

„ temporal „ . . 6 — 9 „

„ at their junction . . . 2 „

„ of the occipital bone was . . 10 — 12 „

44 CHRONIC INFLAMMATION OF BONES.

Comparing these measurements with those of average healthy skulls, it may be said that the bones of the vault of this skull were in every part increased to about four times the normal thickness.

The whole outer surface of the skull-cap was finely porous ; in the least changed parts, such as the squamous bone, perforated with innumerable apertures for blood- vessels ; in the most changed, finely reticulate, as with delicate cancellous and medullary texture.

The inner surface was comparatively smooth and appeared little changed, except by the enlargement of all channels and apertures for blood-vessels, and especially by the deepening of all the grooves for the middle menin- geal artery and its branches.

On the cut surface, in the median vertical section, that which might be regarded as the altered internal table of the skull was a layer, having a very unequal thickness varying from two to six lines, consisting of hard white bone, close-textured, in some parts porous or finely reti- culate, in more looking compact and dense like limestone or white brick (PI. V).

The rest of the thickness of this part of the skull, representing probably the altered diploe and outer table, was made up of bone in various degrees porous, cancellous, or cavernous, with spaces filled with soft reddish substance, a kind of medulla. Its surface was covered with a very thin layer, a mere coating of more finely porous bone.

In the horizontal section, at the level of the upper part of the squamous bone, the same altered characters were observable, but a larger proportion of the substance of the skull was finely porous or reticulate.

By the cavities in the skull-cap in which cancerous growths were lodged the structure of the bone was neither more nor less altered than in other parts.

A portion of sphenoid bone showed changes of structure very similar to those already described, but with a much more uniform and regular finely porous condition.

The bones of the face were not uncovered, but they

CHRONIC INFLAMMATION OF BONES. 45

showed, neither to sight nor touch, any appearance of disease ; not a feature was unnatural.

The conditions of all the long bones were so similar that one description may serve for the altered structure of both femora and tibia?.*

The periosteum was not visibly changed, not thicker or more than usually adherent.

The outer surface of the walls of the bones was irre- gularly and finely nodular, as with external deposits or outgrowths of bone, deeply grooved with channels for the larger periosteal blood-vessels, finely but visibly perforated in every part for transmission of the enlarged small vessels. Everything seemed to indicate a greatly in- creased quantity of blood in the vessels of the bone.f

The medullary structures appeared to the naked eye as little changed as the periosteum. The medullary spaces were filled with soft, yellow, ruddy, and bright crimson medulla, of apparently healthy consistence. The medullary laminas and cancelli had a normal aspect and arrange- ment, and in the shafts of the long bones the medullary spaces were not encroached upon.

The compact substance of the bones was, in every part, increased in thickness. Taking, for example, the femur, the thicknesses of its walls and those of a healthy femur of about the same length and age are compared in the following tables.

Thickest parts of the wall . Articular covering of head, about Wall of neck, about Wall of the trochanter major, about Articular covering of the condyles, about Lateral walls of the condyles

Changes in similar proportions were found in the walls

* Their changes are shown in PI. IV. The specimens are in the Museums of the Royal College of Surgeons and of St. Bartholomew's Hospital, f But see p. 47 in the account of the microscopic examination.

Healthy	Diseased.
Lines.	Lines.
. 3-6	6—10
i 4	3—10
. i— 3	4—6
i i 4 2	3—5
i. J, 4 3	3—5
1 i • Tf 4	2 and more

46 CHRONIC INFLAMMATION OF BONES.

of the tibia. In the patellae the walls were from three to five lines thick.

The thickening of the walls of the shafts of the bones appeared due chiefly to outward expansion and some superficial outgrowth. In some places there were faint appeai'ances of separation of parts of the outer layers of the walls, and of these becoming thick and porous, while the corresponding parts of the inner layers were less changed ; but in the greater part of the walls the whole construction of the bone was altered into a hard, porous or finely reticulate substance, like very fine coral. In some places, especially in the walls of the femur, there were small, ill-defined patches of pale, dense, and hard bone looking as solid as brick.

In the compact covering of the articular ends of the long bones, and in those of the neck and great trochanter of the femur, and in the patellee the increase of thickness was due to encroachment on the cancellous texture, as if by filling of its spaces with compact porous, new-formed bone.

Mr. Butlin was so good as to make careful microscopic examination of the diseased bones, and to give me the following report on them, together with the annexed drawings of their minute structure.

" Microscopical examination was made of sections cut from the skull and from the tibia, some of them froin the recent bones, but the majority of them from portions of bone deprived of earthy salts and rendered sufficiently soft to be cut with a razor. The appearances observed were essentially the same in both bones, but most of the drawings and description were taken from the tibia, the sections of which were much clearer than those of the skull.

" The examination was conducted from a twofold point of view : first, to discover the changes which the bone had undergone ; second, to discover, if possible, the nature of the process which had led to such changes.

" With a low power the number of Haversian systems

CHRONIC INFLAMMATION OP BONES. 47

and canals in any given section was seen to be much diminished (Plate II, fig. 8; Plate III, fig. 9). The space between the Haversian canals was occupied by ordinary bone-substance, containing numerous lacunas and canaliculi. The Haversian canals were enormously widened, many of them were confluent, and thus the appearance of a num- ber of communicating medullary spaces was obtained, an appearance which was rendered still more striking by the presence in the canals of a large quantity of ill-developed tissue in addition to the blood-vessels (Plate II, figs. 4 — 6). With a high power the contents of the Haversian canals were seen to consist generally of a homogeneous or granular basis, containing cells of round or oval form about the size and having much the appearance of leucocytes. Larger nucleated cells were also present, and fibres or fibro-cells, sometimes in considerable quan- tity. Myeloid cells were occasionally observed, but they were not plentiful ; fat also existed in many of the larger spaces, especially in the skull. The vessels were usually small compared with the channels in which they ran ; indeed, they did not seem to be much larger than those of normal bone (Plate II, fig. 6). The walls of some of the canals were lined by a single layer of osteoblasts, a condition precisely similar to that observed in the normal ossification of bone in membrane. The presence of new bone was most evident in the perios- teum of the tibia, external to the ordinary compact layer of the shaft (Plate II, fig. 7). This external layer was, of course, but thin, and was much softer and less deve- loped than the cortex of the bone from which it sprung ; it evidently was not nearly sufficient to account for the great increase in the diameter of the tibia. From the diminution in size of the medullary canal it was thought that a similar recent formation of bone would be found on its outskirts, but this expectation was not justi- fied by observation.

" With a medium power the number of (Plate III, fig. 12) lainellce surrounding the Haversian canals was

48

CHRONIC INFLAMMATION OP BONES.

easily seen to be not larger than in normal bone, whilst the arrangement of the intervening space was most complex and totally different from that of healthy bone. The lacunas and canaliculi throughout the sections did not strikingly differ from those of ordinary bone."

I am indebted to Dr. Russell for the following chemical analysis of portions of the diseased skull and tibia, and of a healthy tibia in comparison with them.

	SkuU.	Tibia.	Normal tibia.
Inorganic constituents (Ash)	6059	61-22	6362
Organic „	3941	38-78	3638
Phosphoric acid (Po05) .	22-76	2545	25-50
Carbonic „ (CO*) .	3-59	395	359
Fat . .	683	3-45	—
Moisture in the sample (dried at 115° C.)	15-49	11-83	973
The C02 calculated as calcium carbonate
(CaC03) ....	8.17	899	8-16
The P.X)5 calculated as calcium phosphate
(ca;2Po4)	49-70	55-56	55-66
Specific gravity	1-895	1-889	1.886*

Cases of the disease which I have described are so rare that I believe no one has seen a sufficient number of them to enable him to distinguish this disease, either clinically or anatomically, from some which seem like it. Speci- mens illustrating it are commonly included under a general name of hyperostosis, osteoporosis, senile rachitis, or the like. But I hope that, if I add to the description I have just given some notes of similar cases which I have seen or found on record, the disease may be so distinguished as to deserve in pathology a separate place and name.

Case 2. — Some ten years ago I saw a gentleman, between

fifty and sixty, very active, tall, thin, and muscular, a

master of hounds. For many years before his death he

had curvature of the thighs and legs, exactly like that

* Specific gravity of normal skull 1-990.

CHRONIC INFLAMMATION OF BONES. 49

already described, and stooping of the spine. The changes of the limbs were attended with severe pains, which he used to relieve with hard rubbing, but the general health was unimpaired. In the last years of his life the upper part of his right humerus became very large, and as he was riding and suddenly raised his arm the bone broke near the shoulder. The evidence of large tumour now became clear, and I amputated the arm at the shoulder- joint. The tumour was well marked and very vascular medullary cancer investing and infiltrating the upper part of the humerus. The rest of the humerus was healthy, and the fracture, which was just below its neck, was evidently due to muscular force acting on its struc- tures spoiled by the cancerous growth. He died a few days after the operation, but was not examined after death. The similarity of his case with that which I have described is, I think, certain.

Case 3. — I saw, with the late Dr. Brinton, a gentleman between forty and fifty who may be still living. He was a sturdy and quite healthy man; his tibiae were curved and enlarged exactly like those in the first case and he had similar pains, but there was more thickening of peri- osteum and an appearance of more external formation of bone. He was treated with iodide of potassium and many other things as for periostitis, but without avail.

Case 4. — A case is recorded by Dr. Wilks in the ' Transactions ' of the Pathological Society,* and through the kindness of Sir William Gull, whom the patient occa- sionally consulted, I am enabled to add some facts to those in Dr. Wilks's report, and to show photographic portraits.

A summary of Dr. Wilks's report is that the patient was sixty when he died. Signs of the disease, beginning with pains like those of rheumatism in the legs, were first observed fourteen years before his death. It was soon found that the tibiae were enlarged, and in subsequent

* Vol. xx, p. 273, 1869. VOL. LX. 4

50 CHRONIC INFLAMMATION OP BONES.

years the cranium and nearly all the bones of the skeleton underwent similar changes. About a year before death the general health began to suffer from the thorax having become implicated in the disease. Gradually the chest became more contracted and at last quite fixed; the breathing became more difficult until at last the respira- tory apparatus altogether stopped.

Sir William Gull's notes tell that the patient consulted him when fifty-six years old, and said that he first noticed enlargement in the left tibia when he was forty-five years old ; that he had seven brothers well and strong, and was eldest in the family. He complained chiefly of weakness, inability to make exertion, feeling of nervousness with occasional vertigo, shortness of breath, stiffness in neck, hoarseness and feebleness of voice. His general health was good ; he was not much troubled with pain anywhere ; but had occasional strange sensations about the head, and much cough. His height, when a young man, was five feet three and a half inches, now four feet eleven and a half inches. The urine was normal and of normal colour. The cranium was enlarged and thickened ; the clavicles much thickened, as also the long bones ; the phalanges and facial bones and perhaps the lower jaw were not altered. The ribs were thick and immovable, as was also the sternum. There was general dulness over the chest on percussion. The respiration was chiefly diaphragmatic.

Less than a year before the patient's death Sir William Gull recorded that he was breathless, and had occasional attacks of mental confusion in which he remarked that he could not understand the sense of words. His voice was hoarse and feeble, and the hyoid bone seemed thickened. The head had continued to enlarge, and he maintained that he was still losing in height. The neck was fixed, and somewhat forward. All the viscera appeared normal. The urine, repeatedly examined, was always found normal, and of normal colour.

The record of the post-mortem examination by Dr. Goodhart leaves no doubt that the disease in this case

CHRONIC INFLAMMATION OF BONES. 51

was tlie same as that which I have described, and it may- be important that this patient also had cancerous disease. " A growth .... corresponding to the growth described as epithelioma of the arachnoid surface of dura mater/' grew from the inner surface of the dura mater, was as large as a chestnut and made a pit in the brain near the left Sylvian fissure.

The description of the changed structure of the bones, for which I may refer to the ' Pathological Transactions,' seems to me to indicate that the disease was more advanced in the direction of degeneracy than that which I have described, or that it had not been in any degree repaired.

Case 5. — I owe to Mr. Bryant the opportunity of seeing a similar case which was under his care in Guy's Hospital, and of which Mr. Viney was so good as to give me notes.

The patient was a carpenter, sixty years old, a hard- working married man, and had seven children. When about sixteen years old he had a slight attack of gonor- rhoea, but without sores, and no history of syphilis could be learned. When thirty-five years old he received an injury to his pelvis. Shortly after this he had trouble with his bladder, which became much distended \ a large quantity of clotted blood was washed out. He lay in bed for this six weeks, and at the end of three months was able to go to work again.

For the last five years he had been troubled with gout in his left great toe. His father suffered from this. The attacks had been short; a few days' rest always sufficed for recovery.

About three years before admission he first felt pains of a shooting description about the tendons of the popli- teal space, whenever he straightened his legs. At this time also he first noticed a swelling of the legs, which began at the ankles. These symptoms, without his taking any special notice of them, continued for about a year.

In the last year and a half the tibias had become much swollen and curved forwards, and on account of the pain

52 CHRONIC INFLAMMATION OF BONES.

he had in them from standing he had been obliged to give up his regular work. Until admission he did not notice anything wrong with his other bones, but he had lost about half an inch in height.

The tibiae presented a marked curve forwards. The anterior border of each was rounded to a very marked degree, so that it could not be felt at all distinctly. The right tibia was slightly larger than the left. The inner sur- face of each measured about four inches at its widest part. The veius above the ankle were in a varicose condition.

The fibulae were very much enlarged ; the femora enlarged in their shafts and bowed outwards. The great trochanter was drawn up to the level of a vertical line drawn from the anterior superior spinous process of the ilium to the horizontal line of the body, instead of being about two and a half inches below this line. The patellae were little larger than natural.

The bones of the upper extremity were enlarged, but not to so marked a degree as those of the lower. The enlargement was most marked in the humeri and the left was thicker than the right. He could not straighten his arms, probably owing to the enlargement of the olecranon. In the clavicles the natural curves were very much increased and the bones thickened, the left more so than the right. In the scapulas the spines and acromion processes were very much enlarged.

The chest was slightly flattened from side to side, but moved fairly whilst breathing. The ribs on the right side were slightly larger than those on the left.

There was a general curve backwards from the cervical to the dorsal vertebrae, so that the patient's usual position in bed was with his head bent forwards, and his legs in a semi-extended position.

The bones of the hands and feet did not seem to have shared in the general thickening.

There seemed to be a slight thickening about the external protuberance of the occipital bone, but there was no other evidence of the cranial bones being involved.

CHRONIC INFLAMMATION OP BONES. 53

The patient had cold perspirations over his legs in the evening. His urine had a specific gravity of 1014, was strongly acid, contained a little albumen but no excess of phosphates.

[Six months later Mr. Bryant told me that this patient's bones were still enlarging, and that there were evidences of enlargement of the skull.]

I have looked for records of cases similar to these in nearly every work that seemed likely to contain them, but in vain. I have found only three cases, and the first two of these are doubtful.

Saucerotte* relates the case of a ma# who died at forty and in whom all the bones, those of the head, face, orbits, ribs, vertebras and limbs had begun to enlarge about seven years before death. He increased in weight from 119 livres to 168, wholly from increase of bones; he had rheumatic pains ; for a time sleepiness, oppression at the chest, and very small pulse ; but these passed-by and he died with some acute illness. No examination was made.

Rullierf tells of a man, aged seventy-eight, who died in the Hotel Dieu of empyema. He had previously been in good health, and nothing had indicated any derange- ment of cerebral function. The skull was very large, osteoporotic, and heavy, and, except the lower jaw, all the bones of the face were healthy. The ribs were thicker and larger than usual ; the sternum narrow and very thick ; the pelvic bones changed like those of the skull. The clavicles were thick, curved, and solid. The other bones were healthy.

WranyJ has fully described the condition of the bones in a case of spongy hyperostosis of the skull, pelvis, and left femur, taken from a woman fifty years old, of whom, however, nothing is told but that she died of pyasmia, and

* ' Melanges de Chirurgie,' Paris, 1801.

t ' Bulletin de l'Eeole de Medecine de Paris,' t. ii, p. 94, 1812.

% ' Prager Vierteljahrschrift,' 1867, B. i, p. 79.

54 CHRONIC INFLAMMATION OF BONES.

that she had " spongy hyperostosis of the skull with atrophy of the facial skeleton, spongy hyperostosis of the vertebral column, pelvis, and left femur, with elongation of the latter bone ; kyphoscoliosis of the upper dorsal part of the spine ; pelvic abscess ; emphysema and oedema of both lungs, abscess of the left ; marasmus."

I cannot doubt that this disease was the same as I have here described, and the paper is valuable, both for the many signs indicated in it that the bones softened and yielded to pressure in the early part of the disease, and for the careful comparison of the distortion of the pelvis with the dissimilar distortions in rickets and mollities ossium. The spine was very curved ; the chest small and too arched ; the whole trunk very short.

From these cases which, though few, are well marked and in some chief points uniform, as well as from a recol- lection of two more of which I have no notes, I think we may believe that we have to do with a disease of bones of which the following are the most frequent characters : — It begins in middle age or later, is very slow in pro- gress, may continue for many years without influence on the general health, and may give no other trouble than those which are due to the changes of shape, size, and direction of the diseased bones. Even when the skull is hugely thickened, and all its bones exceedingly altered in struc- ture, the mind remains unaffected.

The disease affects most frequently the long bones of the lower extremities and the skull, and is usually symme- trical. The bones enlarge and soften, and those bearing- weight yield and become unnaturally curved and misshapen. The spine, whether by yielding to the weight of the over- grown skull, or by change in its own structures, may sink and seem to shorten with greatly increased dorsal and lum- bar curves ; the pelvis may become wide ; the necks of the femora may become nearly horizontal, but the limbs, how- ever misshapen, remain strong and fit to support the trunk.

In its earlier periods, and sometimes through all its

CHRONIC INFLAMMATION OF BONES. 00

course, the disease is attended with pains in the affected bones, pains widely various in severity and variously described as rheumatic, gouty, or neuralgic, not especially nocturnal or periodical. It is not attended with fever. No characteristic conditions of urine or faeces have been found in it. It is not associated with syphilis* or any other known constitutional disease, unless it be cancer.

In three out of the five well-marked cases that I have seen or read-of cancer appeared late in life ; a remarkable proportion, possibly not more than might have occurred in accidental coincidences, yet suggesting careful inquiry. f

The bones examined after death show the consequences of an inflammation affecting, in the skull the whole thick- ness, in the long bones chiefly the compact structure, of their walls, and not only the walls of their shafts but, in a very characteristic manner, those of their articular surfaces.

The changes of structure produced in the earliest periods of the disease have not yet been observed, but it may certainly be believed that they are inflammatory, for the softening is associated with enlargement and with excessive production of imperfectly developed structures, and with increased blood-supply. Whether inflamma- tion in any degree continues to the last, or whether, after many years of progress, any reparative changes ensue, after the manner of a so-called consecutive hard- ening, is uncertain.

The inflammatory nature of the disease is evident also in the changes of minute structure in the affected bones. J

* There has not only been no history of syphilis in any of the cases, but no known syphilitic changes have been observed in any patient.

t See, also, Sandifort, quoted at p. 61 j Museum of St. Bartholomew's, ser. i, 111 and 112, sections of a femur, large, curved, porous, with a tumour growing around its shaft ; and 49, a hyperostotic skull from a man who died with cancerous disease of the eyeball, heart, and other organs; and Museum of Guy's Hospital, specimens of symmetrical osteoid cancer of the ilia, with cancer of the spine and cranium, associated with hypertrophy of the cranium. Dr. Goodhart was so good as to give me a report of this case.

J And this is also the opinion of Wrany, 1. c.

56 CHRONIC INFLAMMATION OF BONES.

On these Mr. Butlin writes, " With regard to the nature of the process by which these changes were accomplished, there are probably only three things which could produce so great an increase in the size of a bone, namely, new growth (tumour), hypertrophy, and chronic inflammation.

" The first of these may be at once set aside as out of the question.

" Nor is the second much more probable than the first, for the process is evidently no mere hypertrophy. The whole microscopical architecture of the bone has been altered j the structure appears to have been almost entirely removed and laid down afresh on a different plan and in a larger mould.

" Of the three causes chronic inflammation alone remains, and upon examination one or two facts will be found to bear strongly upon the theory of this being essentially an inflammatory disease. Not only the absorption of the old structure which has taken place, but also the manner of this absorption, point to its inflammatory nature. Traces of this are not, of course, always discernible, as the process is almost everywhere far advanced. But still careful observation not uncommonly discovers that the sides of the widened canals, instead of being smooth and even (Plate III, fig. 10), are eaten out in a series of curves or concavities with the production of what are called Howship's lacuna?, so characteristic of inflammation. The tissue contained in the canals, too, almost precisely resembles the tissue found in the spaces of inflamed bones, only differing from it in being generally more fibi'illar and less rich in cells, a fact easily to be accounted for by the very long duration of the disease and the general tendency towards organisation which was displayed throughout. The apparent cessation of the process of absorption and the gradual process of repair may be regarded as still further leading towards the same con- clusion.

" Further than this the microscopical observations do not extend."

CHRONIC INFLAMMATION OP BONES. 57

The chemical analysis by Dr. Russell may be regarded as confirming this conclusion. It shows, at least, that there is no such change of composition in the bone as would be expected in any merely degenerative softening.

Holding, then, the disease to be an inflammation of bones, I would suggest that, for brief reference, and for the present, it may be called, after its most striking character, Osteitis deformans. A better name may be given when more is known of it.

It remains that I should point out the distinctions between this disease and the several forms of hyperostosis, osteoporosis, and other diseases among which it has been confused.*

1. Among ca