525 Mr. HULKE had employed Mr. Holt's plan in thirty cases, many of which were out-patients at the hospital. He had never seen any untoward result, though the patients went about as usual. He did not regard it as a serious operation. The PRESIDENT had in many cases followed Mr. Holt's plan of proceeding. He had never seen any but good results from it. Mr. THOMPSON replied seriatim to objections raised by Mr. Holt. First, that there was no difficulty in measuring the distance at which a

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... was situated from the meatus in order to adjust his instrument, and that no man who found that a difficulty was competent to use an instrument in the urethra atall. It was, indeed, an ill compliment to surgeons to imagine want of ability to accomplish so easy a matter. Secondly, that it was not often necessary to apply the instrument for two strictures in the same urethra, but if there were two, no difficulty in applying it twice existed. Thirdly, that although it had been his practice to tie in a gum catheter twenty four hours afterwards, he did not regard it as necessary; he had done so as a precaution, and if any objection to this existed, it would be as safe to dispense with it here as after Mr. Holt's operation. From the remark, that there was no advantage in distending to No. 16, if the bougies subsequently passed could not exceed No. 12, he differed very widely. It had long been admitted to be a desideratum to find some means of dilating the stricture to the size of the canal where it is situated, and it is notorious that the bulbous portion, where stricture most commonly exists, is little more than half dilated by a bougie which fills the external meatus. The subsequent dilatation by such a bougie sufficed, but if thought necessary it might be maintained by the distending instrument itself, which formed an excellent dilator. He had a patient at this moment who preferred it to a bougie for ordinary use. Again, it had been assumed on theoretical grounds that its power was deficient. He could only say that in practice the instrument had resisted very severe tests, and was amply strong enough for its purpose; but he would say again, as he had said in the paper, that where the induration surrounding the urethra was very considerable, involving, possibly, the substance of the corpus spongiosum throughout, especially when anterior to the scrotum, incision was more likely to be permanent in its effects than either his own or Mr. Holt's method. He agreed with Mr. Acton that this was highly useful in some cases. An important distinction existed between forcible catheterism and distension, which had been well drawn by Mr. Fergusson : the dangers of that now happily exploded method resulted from tearing away the stricture from its connexions, and driving it down the urethra. Simple expansion from within outwards, provided it was thoroughly efficient, had now been proved to be unattended with danger. Finally, it was most satisfactory to him to hear from Mr. Holt and others the success which had attended his operation, because in some particulars it was closely allied to his own proceeding: thus, he contended that Mr. Holt's operation might be perfectly performed with his (Mr. Thompson's) instrument, but that the latter possessed in addition these two advantages-first, power to carry the distension to a much higher point; and, secondly, that it could be done gradually and slowly, so as to over-distend the tissues as much, and rupture them as little, as possible. It was on these two grounds of difference that he claimed for this proceeding an examination and a trial, since he conceived them to constitute an improvement of no mean value. PATHOLOGICAL SOCIETY OF LONDON. APRIL 21ST, 1863. MR. PRESCOTT D. HEWETT, PRESIDENT. THE minutes of the last meeting were read and confirmed, and new members were proposed. part in the discussion on this case. According to the invitation previously announced, severa cases of operation about the ankle-joint in the living subjec (altogether seven in number) were presented by various mem hers of the Society. EXCISION OF THE ANXLE-JOIKT. Mr. CANTON presented a young man from whom Mr. Hancoel had removed in 1857, for caries, portions of the astragalus and inferior surfaces of the tibia and fibula, including the malleoli. The result was very satisfactory: he can walk well with an apparatus applied to the limb. He was eight months in the hospital, five of which were spent in bed. Another case of the same kind, also under Mr. Hancock's care, was mentioned, but the patient failed to appear. CASES OF M. PIROGOFF'S AMPUTATION. Mr. BRYANT showed the first case, which was that of a man on whom he performed this operation in 1860. He left the hospital in ten weeks with the bones united, but some sinuses were present. He went into the country, and did not walk till some months after. He has a good movable stump, on which he can bear his whole weight and lead an active life. Mr. LITTLE presented a man on whom Mr. Maunder performed this operation about two years ago. He was fourteen weeks in the hospital, and final healing took place in six months. It was a good firm stump, enabling the owner to bear his weight on it and walk with facility. SYME'S AMPUTATION OF THE ANKLE-JOINT. Mr. HOLMES presented a man on whom he performed this operation about twelve months ago for caries of the tarsus and metatarsus. He was in the hospital five weeks, and the stump healed kindly, becoming very firm, and bearing the weight perfectly. Mr. HENRY THOMPSON presented a young woman, aged twenty six, on whom he had done this operation in 1857. She was in hospital about four or five months, and then went to Margate, where she did not improve; but soon after her return the stump was sound. She could then bear her weight upon it, and had an artificial foot made by Weiss, which she has worn ever since. She has an excellent stump, and performs her duties as teacher in an infant school. The second case exhibited by Mr. Thompson was that of a young woman aged eighteen, whose foot he removed in July, 1855. She made a good and quick recovery, wears a common circular boot, and walks three miles daily to her avocations in a laundry. A third case shown was that of a boy, upon whom Mr. Thompson performed the operation in December, 1861. He was discharged from the hospital in two months, cured; has worn a circular boot since, and has an excellent stump. Mr. Thompson remarked that these were three out of six cases in which he had performed this operation, and were all he could produce at the meeting. He should not now enter upon the various points of comparison between Syme's operation and that modification of it in which a portion of the os calcis was left in the flap, but only refer to the different results which remained after the two operations as regards the kind of artificial limb which was applicable afterwards. He thought it was very important for the surgeon and the mechanician to act in concert in most amputations of the lower extremity; and he therefore showed also two artificial limbs to illustrate the advantage in relation to this matter which the proceeding of Syme offered over that of Pirogoff. In the former, the patient enjoyed the advantage of complete ankle-joint movement in the limb; while in the other, the stump being so close to the ground, there was no room for it, and the best substitute that could be applied was that afforded by iron hinges outside the limb. One of the artificial limbs exhibited belonged to a gentleman, for whom it was made by Mr. Masters, of the Old Kent-road. The patient weighed eighteen stone, and had been operated upon by Mr. Syme; the stump was excellent, and he could take active exercise with the limb shown, which suited him admirably. He (Mr. Thompson) wished to point out the necessity for taking off a sufficient slice of bone, including the two malleoli, instead of merely removing the lower portion of the latter, so as to avoid extreme width and a bulbous stump, which was more difficult to fit with a well-made artificial limb than a stump which tapered gradually from the calf downwards. In reply to a question from Mr. Thomas Smith, Mr. Thompson said he believed the objection to the bulbous form of stump did not materially apply if the common circular shoe, which laced round the lower part of the leg, was worn; but it did to the artificial leg. Mr. HoLasES thought that one recommendation of Syme's operation was that no apparatus was required, and that a circular shoe was sufficient. He doubted the value of an artificial . limb with the ankle joint movement. Mr. HOLMFS showed a cast of a foot in which Fracture and Dislocation of the Astragalus had taken place, and that bone had been removed.