It certainly could not have been treated according to the most careful aseptic methods, and yet the result is free motion at the ankle-joint and about, that looks almost entirely natural. It is evident that a good result may be had from either method.

Dr. FOWLER.-I intended to ask Dr. Wight if it was not his opinion that the pressure upon the overlying structures had led to gradual sloughing, and whether this was not a case which in the beginning would have been a proper one to cut down upon and remove the fragment?

Dr. WIGHT.—I suppose you are right; the main part of the astragalus had been cut off from the blood-supply, and had perished and worked its way out. In such a case incision would be proper. Dr. PILCHER.-The two cases are quite dissimilar; the character of the dislocation was entirely different. In one case the great mass of the astragalus was thrown downward and backward, in the other a portion of the astragalus has been thrown upward and forward. one simply a fracture of the astragalus, in the other case a fracture of the adjacent bones as well, so that the cases are hardly comparable.

I remember a similar case of compound fracture involving the ankle-joint, which was occasioned by the individual being thrown from his carriage on the hard asphalt pavement on Bedford Avenue in a runaway accident, and my recollection now is that there was a loss of a portion of the astragalus, in which, notwithstanding the very careful treatment in accordance with the best light surgeons had at that time, the result was a prolonged illness, extensive suppuration and very nearly a loss of his life, which finally was saved by amputation, a result which I think was not infrequent in such cases in former years of compound dislocation of the ankle-joint. In the case now presented by Prof. Wight there must have been exceptional conditions to have enabled this man to have escaped septic infection with its attendant evils.

Dr. FOWLER.-As I understand, in this case there was no breach of integument in the beginning; my idea was that the superadjacent structures this blackened portion-looks as if it had been exposed to the air for quite a long time, as if it had been partially extruded and there remained. If you place that fragment in its former position, you will see that it is the part which would naturally have projected from the surface before the final removal of the entire fragment. In that case probably the inflammatory conditions of the surrounding structures had in great measure subsided, and in that way this case is hardly comparable with the operation for removal in the early stages, when they are in a condition when infection could most readily occur.

Dr. WIGHT.-Another point in favor of that view would be the fact

that that was removed on the 5th of February, and on the 25th it was pretty much all healed up, in the condition it is now. The original injury was the 1st of December.

Dr. BOGART presented a case of "Compound, Comminuted, Depressed Fracture of the Skull, with Considerable Loss of Cerebral Tissue. Recovery."

J. S., aged seventeen, the patient whom I present, was brought to the M. E. Hospital by our ambulance, on the evening of January 13th, with a history of having been struck by a hammer in the left posterior frontal region. The ambulance surgeon, who saw him about fifteen minutes after the accident, found him suffering from a compound, comminuted, depressed fracture of the skull. He was in a condition of mental stupor, answering some questions, correctly, in monosyllables; others, incoherently. His pupils responded slowly to light. He uttered no complaint of pain, and his pulse and respiration were normal. The wound was protected by an aseptic compress, and the patient immediately transferred to the hospital. On his arrival there, I was promptly notified, and directed that his head should be shaved and disinfected, and other preparations made for doing whatever might seem indicated for his relief.

When I reached him, about an hour after the accident, his general condition remained unchanged. Examination disclosed a semicircular wound of the scalp extending forward, from a point in the vicinity of the intersection of the left temporal ridge and the coronal suture, about one and one-half inches. Immediately beneath this wound the skull was fractured and unequally depressed over an area about one and one-half by three-fourths inches; that part lying nearest the vertex and immediately beneath the scalp-wound being most depressed, about three-eighths of an inch, as though the opposing surfaces of the face of the hammer and the skull had not been brought into contact in parallel planes. Blood and brain matter oozed from the wound.

Under ether anæsthesia, I enlarged the scalp-wound and removed the depressed bone, which was much comminuted, revealing an extensive wound of the dura and brain, which had been penetrated and from which there was free hæmorrhage, as well as a considerable loss of cerebral tissue.

Hæmostasis having been effected by the application of a number of catgut ligatures to cerebral as well as meningeal vessels, the wound was then thoroughly irrigated with the pure salicylic solution and the scalp-wound, except that immediately overlying the cranial deficiency, closed with sutures. The remaining portion was loosely packed with iodoform gauze and an aseptic dressing applied.

January 14th, 8 A. M.-T. 99.6°; P. 62; R. 18. Patient's general condition improved. Complains of no discomfort. Mind is not clear. Sleeps most of the time. 4 P. M., T. 101°; P. 80; R. 25. January 15th, 8 A. M.-T. 103. 2°; P. 88; R. 25. 12 M., T. 104°; P. 100; R. 25. Wound dressed. Packing removed and drainagetube inserted. Wound aseptic.

From this date patient's temperature gradually declined, the somnolency diminished and his mental condition improved, until the 22d, when his temperature became normal and his mental condition sound.

February 1st, he was permitted to be up, and on February 13th, one month after admission, he was discharged with only a slight granulating surface at the site of the unsutured portion of his wound, which was completely healed a few days later.

The wound pursued an absolutely aseptic course, and recovery was rapid and uninterrupted save for the transient rise in temperature, which was probably due to the iodoform used in the primary dressing.

On inspection, the scalp is seen to be depressed over the seat of injury and the pulsation of the cerebral vessels is well marked. Palpation readily detects the cranial deficiency without giving rise to pain. Upon inquiry, I have learned that his friends have observed no change in his mental condition.

My object in presenting the history of this case is to call attention to the almost entire absence of cerebral symptoms, together with the prompt healing of a wound involving a considerable loss of brain. This result is undoubtedly due to the fact that the seat of the brain injury was anterior to the motor area.

matter.

Dr. WIGHT.-I was just reviewing some impressions I have had with reference to fractures of the skull, and the impression I have is that injuries at the anterior portion of the head are less fatal and less troublesome to treat than those in the middle regions, or posterior. That is no new observation, but I would like to call attention to that point. I think Dr. Fowler and myself had a running commentary on that subject last year or the year before, until the President was obliged to stop us, we taking up so much time.

Dr. WIGHT presented the following case: A man, between thirtyfive and forty years of age, fell into the hold of a vessel and received fatal injuries to the head, and also a compound dislocation of the right semi-lunar bone, which was still attached by the anterior ligament. There was a hole in the wound into which I could put my finger, and I found this bone projecting up, and I presume that that bone made this wound. It turned right over upon itself, still holding on, as you see, by the anterior ligament-that is, the attachment to the radius. There was apparently no other injury but that. My impression is that

it must have been caused by a fall upon the hand. I believe there are one or two cases on record somewhat similar, but I cannot now point out where they are to be found.

MEDICAL SOCIETY OF THE COUNTY OF KINGS.

A regular monthly meeting of the Medical Society of the County of Kings was held at the Society rooms, 356 Bridge Street, Tuesday evening, April 15, 1890, at 8 o'clock. Dr. Chase in the chair.

There were about 75 members present.

The minutes of the previous meeting were read and approved. The Council reported favorably upon the following applicants, and recommended that they be elected to membership:

Drs. Wm. Moser, Florence A. Bellknap, Peter Scott, Jas. M. Sayles, Chas. J. Peterman, Geo. D. Barney, Wm. F. Dudley, Chas. H. Jones, Thos. U. Joyce, R. P. Thompson, Thos. Dixon, and John Von Glahn.

The Council also reported that the matter of the legality of admitting graduates of irregular schools to membership in the Society, which was referred back to them at the last meeting of the Society, was still under advisement, and that final report would be made at the next meeting..

The above report of Council was received and approved.

The following applications for membership were announced: Henry Wallace, 183 Congress Street, L. I. C. H., 1890; proposed by Dr. Wm. Wallace; Dr. J. M. Van Cott, Jr.

C. F. Kuhn, 168 Jay Street, L. I. C. H., 1883; proposed by Dr. D. G. Bodkin; Dr. W. B. Chase,

Edward J. Mealia, 233 Van Buren Street, of Col. Physicians and Surgeons, N. Y., 1883; proposed by Dr. W. B. Chase; Dr. D. G. Bodkin.

H. A. Alderton, 381 Franklin Avenue, Univ. City of N. Y., 1885; proposed by Dr. J. E. Sheppard; Dr. J. M. Van Cott, Jr.

Franklin Pierce Miller, 282 Stuyvesant Avenue, Med. Dept., N. Y. Univ., 1876; proposed by Dr. Belcher Hyde,; Dr. J. M. Peacock. The chair appointed the following standing committees:

General Medicine-Glentworth R. Butler, Wm. H. B. Pratt, Wm. Browning, C. E. Emery.

Surgery H. W. Rand, P. L. Schenck, Alex. J. C. Skene, Wm. H.

Bates.

Obstetrics-A. Ross Matheson, J. C. MacEvitt, Lucy M. Hal!. The scientific business of the evening was opened with a paper by Dr. Jas. L. Kortright, entitled "Accidental Hæmorrhage."

The second paper of the evening, on the "Treatment of Dysentery," was read by Dr. H. A. Fairbairn, and discussed by Drs. McCorkle, Wallace, Grover, Hutchinson, Briggs, Evans and Owen.

The chair stated that Dr. Jas. J. Keyes had been added to the Registration Committee, and requested all members to report to this committee the names and addresses of any new comers in their respective vicinities.

There being no further business, on motion, adjourned.

W. M. HUTCHINSON,

Secretary.

PROGRESS IN MEDICINE.

SURGERY.

BY GEORGE R. FOWLER, M. D.,

Surgeon to St. Mary's Hospital, and to the Methodist Episcopal Hospital, Brooklyn.

IS ARTHRECTOMY OR RESECTION TO BE PREFERRED IN TUBERCULAR

GONITIS?

Plum (Hospitals Tidende, 1889, 3 Räkke, Bd. VII., No. 2. Centralblatt f. Chirurgie, 1890, No. 8, p. 145). P. declares that resection. is the operation to be preferred. Arthrectomy furnished in his experience but unsatisfactory functional results. The object of the operation, namely, the removal of all of the diseased portion of the joint surfaces cannot be carried out without dividing the lateral ligaments of the knee-joint in order to reach the posterior wall of the joint capsule. Following these steps of the operation, the most desirable result, namely, a solid anchylosis in good position, is rarely obtained. P. has fre quently observed that, even after several years following the operation, complete bony anchylosis had not occurred; on the contrary, flexion with valgus position of the knee developed, which persistently recurred in spite of frequent forcible straightening of the limb. Besides which

P. has seen a not inconsiderable comparative lengthening of the diseased extremity following arthrectomy. The functional disability, in his experience, has been very decided, and has led him to entirely abandon this operation in favor of resection, believing that the unfavorable functional results, reported as occurring as sequelæ to the latter operation, to be very much exaggerated.

(In all probability it will be ultimately found that both arthrectomy and resection will ultimately find a place among the resources of the surgeon in dealing with tuberculosis, the choice of the operative pro