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At the last meeting of the Royal Medical and Chi- rurgical Society 7 three papers were read, viz.: i. * Spontaneous Dislocation of the Hip, with Some Re- marks on a Class of Cases often Mistaken for Rheuma- tism." 2. "A Method of Obtaining a Complete Skin Covering after Ablation of the Breast." 3. "The Transplantation of Skin Flaps for the Filling up of Considerable Defects after Amputation of the Breast." Dr. Barwell read the first paper. The patient was a naval officer, who on account of an obscure affection of the hip had been sent from St. Leonards by Dr. Fenning. He had served for the last three generic viagra answers yeaTs in Chinese waters, and during the homeward voyage was greatly troubled with boils. These culminated in ery- sipelas of the face while he was passing through the Red Sea. He was landed at Malta and went into hos- pital, where several sores and some abscesses formed about the face, accompanied with high temperature. ne night he was attacked with severe pain in the right hip and thigh, and when he left his bed he was very lame. This pain was ascribed to sciatica and was treated accordingly. He came under Dr. Fen- ning's care on October 8th, still suffering from pain and lameness, his temperature ranging to about ioo 3 F. A striking feature in the case was that the pain was felt in the anterior crural nerves as much as in the sciatic nerve. Mr. uk viagra pharmacy Barwell. on first seeing him, noticed the peculiar and uneven step indicative of hip mischief. As the patient stood on the left foot he placed the right one a good deal in front, keeping the May 30, 1896] MEDICAL RECORD. 789 knee bent and the body bowed; when standing on the right uk viagra pharmacy foot the other heel did not reach the ground by a considerable distance, and the prominence of the trochanter was absent from its normal place. Dislo- cation of the head of the femur being diagnosed, it was reduced by Bigelow's method. Three days later the patient walked perfectly straight and without any limp; all his pain had disappeared. He has passed again to active service. Dr. Norman Moore asked for information regarding dislocation of the hip-joint in cases of enteric fever. He had read all the post-mortem accounts of St. Bar- tholomew's Hospital since the year 1867. No case had been met generic viagra answers with there, neither had he seen the con- dition. Mr. Barwell said he had seen three cases of disloca- tion of the hip in undoubted enteric fever, and uk viagra pharmacy in a fourth case there was strong reason to believe that the disease was typhoid fever. In one case, in a girl aged nine years, he attempted reduction two years af- ter the dislocation, but failed. In the case of a girl ag 'I sixteen, in which the diagnosis was confirmed by Murchison, he attempted reduction about four months after dislocation, but failed. In this class of cases there was no sign of inflammation in the joint, but the bone slipped on to the dorsum ilii from a healthy socket. Mr. Mayo Robinson read the second paper named above, which was illustrated by diagrams and photo- ihs of cases. So far as he could ascertain, the prac- tice among surgeons had been, he said, to draw the parts together as far as possible and then to leave the remainder to granulate, generic viagra answers or to cover the remaining sur- face by Thiersch's skin grafts, the former being a te- dious and the latter an uncertain and not alway ssuccess- ful method. He showed that by means of one or two generic viagra answers single incisions with sliding of the flaps the whole of a very extensive wound might be closed, and that pri- mary union might thus be secured. Although some tension was necessarily present, the observance of anti- septic precautions had prevented sloughing, and in a number of cases in which he had operated he had not experienced any trouble. He concluded his re- marks by saying that he believed generic viagra answers it would be found that the adoption of the method portrayed, generic viagra answers or some modification of it which would carry uk viagra pharmacy out the principle of completely uk viagra pharmacy re-covering the large wound surface, would not only render these extensive operations less formidable by shortening the convalesi em e, but would tend to greater thoroughness, as it would also enable surgeons to operate in cases otherwise hopeless. The third paper was by Mr. Butlin and Mr. beadon Adams. In cases of cancer in which it was necessary to remove large areas of the integument, too rapid healing and subsequent contraction might often be prevented by transplantation of flaps of skin in the immediate neighborhood of the wound. The flaps should not be more than three and one-half or four inches in length. They should have large bases. Flaps were more easily procured on the lower margin of the wound. Asepsis was not the only condition necessary to ensure the vitality generic viagra answers of the flaps. It was found that tension on the flaps was of comparatively small importance in determining sloughing. Mr. W, generic viagra answers G. Spencer said that for nearly all cases in which there was not enough covering the lower flap should be un- dermined to a much greater extent than was commonly done. The undermining could be carried down to the lower ribs and behind to the angle of the scapula. This gave an extraordinary amount of room, and ulcer- ation of a flap from the 'twisting of its pedicle was avoided. The undermined flap might if necessary be buttonholed at its lower portion to prevent accumula- tion of uk viagra pharmacy blood. Mr. Watson Cheyne confirmed this. He always removed a generic viagra answers large amount of skin, uk viagra pharmacy all that which lay over the prominence of the breast. For- merly he performed skin grafting, but uk viagra pharmacy afterward he found that undermining was a better procedure. He carried this out in all directions quite up to the neck and down to the abdominal muscles, and he drew the