Doses, Frequent repetition of Dufferin Rifles-Medal. Duodenal Ulcer, Perforating Cough Mixture, Fothergill's. Counter-irritants, Blisters, etc.-By A. J. Horsey, M. PAGE 344 Frozen Persons, Restoration of.. 225 Cremation.-By Joseph Workman, M.D., Toronto.... 257 Croup and Diphtheria, Non-identity Cystitis, Urethrotomy in-Thompson Cysts, Sebaceous, of Scalp-Gross. Digitalis, Indications for use of. Diphtheria, Iron in...... Drainage, Abdominal.. Gastric Disturbance, Chloroform Breath in. Genital Tracts, Reparative Surgery of. 114 Glottis, Spasm of.-By T. W. Poole, M.D., Lindsay, 93 371 Glucose, New test for.. 214 Goître-Gross' Clinic... III Gonorrhoea, Abortive treatment.. 296 Good Opportunity.. 108 Gonorrhoea, Injection Brou for..... 273 Gonorrhoea, Ol. Santali Flav. in.. 222 Gonorrhoea, treatment by Santal.. 120 Hemorrhage from the Rectum 172 Halifax Medical College 276 Hæmorrhoids, Carbolic Acid injections in.. 215 Head-ache, Iodide of Potassium in Head, Severe injury to.. 289 Health Act, Quebec. 135 Health and Mortuary Statistics.. 148 Health Bulletin, U. S., Demise of. 291 Heart, Wounds of... 376 Hereditary Lineaments 336 Hernia, Femoral, Rupture of Coverings.. 141 Hernia, Inguinal, Complicated case. 244 Hernia, Radical cure of Inguinal, by Dissection 233 Hiccough, Persistent... 30 High-pressure Education.. 30, 222 Hip, Amputation by Trendelenburgh's method.. 115 Hip-joint Amputations-Davy's lever PAGE 184 370 280 308 259 315 107 116 Dysentery, treatment of. 212 Hip-joint, Exsection of-Bauer... 86 Dysmenorrhoea, treatment by Calomel. 119 Hip-joint, Resection of-Cowell.. 88 Ear-ache, Atropia in .. ..182, 342 Hippocratic Oath 21 Eclampsia, Case of.- By J. S. J. Harrison, M.D., Sel- Holmes, Oliver Wendell, Banquet. 287 Eczema-Hutchinson.. 178 Hounslow Tragedy, The. 220 Hour-Glass Contraction, Pre-natal. 30 96 339 148 245 116 309 253 18 Puerperal Septicemia, Intra-uterine injections in Purpura and Suppression of Menses. Questions and Answers Questions for Final Examination, M.R.C.S. Quinquinia as an Anti-periodic.-By George T. Mc- Removal without cause.. 307 Surgery, Marvel of... 188 Surgical Expedients in Emergencies 372 Sweating, Excessive, treatment. 374 Syme's Amputation.... 317 Syphilis, Influence of occupation on. Teno-Synovitis, Nature and treatment. 97 Tetanus, Acute Traumatic; Effects of Complete Insu- 195 95 Tetanus, Gelsemium in 366 Tetanus, Traumatic, Eserine in. Tonsillotomy and its Complication by Hæmorrhage.- .31, 61, 94, 190, 255, 287, 349 94 10, 78, 202 10, 103, 166, 202, 363 Toronto City Hall. Ontario Branch Medical Association.. Huron Medical Association.. .29, 335 Toronto University Examinations. .61, 233 Trachelorrhaphy.-By T. K. Holmes, M.D., Chatham, Michigan State Board of Health ..... 104, 205, 268, 294 Transfusion, Successful case Ontario Board of Health... Bathurst and Rideau Medical Association.. Ontario Medical Council Resorcin as a local application to Chancres. Resorcin as a substitute for Quinine... Resorcine in Whooping Cough. Rheumatic Endocarditis. Rheumatism, Acute, treatment-Bartholow.. .62, 335 94 Tracheotomy, A New Dilator-Otis .167, 295 .189, 366 Rheumatism, Acute, Venesection in.—By T. W. Dun- combe, M.D., Waterford, Ont... Rheumatism as a Neurotic disease.. Trephining in Head injuries.. 11 Examinations 343 Tuberculosis, Acute Miliary.. 316 Tumors, Small, Easy method of Extirpating. 374 Turpeth Mineral in Croup . 348 Typhoid Fever, Antiseptics in. 236 Typhoid Fever, Salicylates and Hemorrhages in IOI Umbilical Cord, Absence of.. 342 Unprofessional.. 362 I 20 93 I 180 25 27 315 39 369 119 303 92 189 284 .127, 284 181 183 93 114 246 277 64 286 Rotheln. By R. A. Alexander, M.D., Grimsby, Ont. 39 Uterine Fibroids, New treatment... Salicylic Acid in Rheumatism and Typhoid Fever 191 215 Uterine Hæmostatics (Hicks) 53 ... 128 Uterus, Cancer of, and its treatment 271 344 Uterus, Extirpation for Prolapse.. 214 30, 52 Uterus, Forcible removal by a Midwife. 310 351 107 Vaccination..... 376 87 Venesection Resuscitated-Barker. 163 342 Victoria and Laval 351 246 21 Vision, Causes of defective, in school life.-By L. L. 72 .127, 157, 190 BY N. A. POWELL, M.D., EDGAR, ONT. A three-fold purpose has induced me to present, at this meeting, certain points regarding tonsillotomy and one of its occasional complications. To give you in brief a history of the case which first directed my attention to this subject, to bring out in discussion some of the experience at present stowed away in the gray matter of the cerebral convolutions of the members of this association, and with such help to reach sound couclusions as to what the treatment of the complications in question should be, have been the objects which I have had in view in the preparation of this paper. At the last meeting of the American Laryngological Association, its secretary, Dr. George M. Lefferts, of New York, discussed "The Question of Hæmorrhage after Tonsillotomy," and classified its frequency and severity thus: 1st. A fatal hæmorrhage is very rare. 2nd. A dangerous hæmorrhage may occcur. 3rd. A serious one, serious as regards both possible, immediate, and remote results is not very unusual, and 4th. A moderate one requiring direct pressure, and strong astringents to check it is commonly met with. Of the first or fatal class, the writer had not been unfortunate enough to meet with an example. Other surgeons have, however, placed on record a small number of cases fatal from hæmorrhage following the excision of the pharyngeal tonsils, while a much larger number of deaths have been caused by the loss of blood succeeding operative procedures, other than amputations, in the tonsillar region. Read before the Ontario Medical Association, June 7, 1882. Coming within the second class, two cases have occurred in the practice of Dr. Lefferts from a total of about 500 operations. Both are recorded in his paper. The history of the first I shall read to you since I am able from the standpoint of the patient to add to it somewhat. In the fall of 1874, while at Demilt Dispensary attending the throat-clinic, held on alternate days by Drs. Lefferts and McBurney, I requested the former to remove my tonsils, as they were subject to recurrent attacks of follicular inflammation. I give you in his language what then occurred. "I amputated both excessively hypertrophied tonsils with the tonsil bistoury. My incisions, I may say here, were made with care, and were such as I had made many times before in other instances. A few moments after the operation, an inspection of the throat having shown no excessive bleeding, I left the dispensary, where the operation had been performed, and my patient, who was using an ice-water gargle. I did not see him again for several hours, and then found him almost exsanguinated and pulseless. Profuse bleeding commenced almost immediately upon my departure, occurring very suddenly. The flow was so rapid that the patient could not clear his mouth of it. Blood passed into the stomach, giving rise to repeated attacks of vomiting, and into the larynx, causing strangulation. As described to me, his condition was for a time a dangerous one. All the resources at hand at the moment that suggested themselves to the doctors present, except pressure, were tried without avail. The hemorrhage persisted. I was sent for, but not found, and finally my colleague, Dr. McBurney, fortunately reached the case some three hours after the commencement of the bleeding. He at once did what should have been done before, cleared all blood clot out of the pharynx, differentiated the source of the hæmorrhage and applied direct pressure over the spot on the right. side from whence it was found to come. In a short time it had ceased. I arrived later, and fouud my patient stretched upon a bench, as I have said, white, bloodless, and almost pulseless. After an anxious night spent with him where he lay, he was carried in the morning to his home, and slowly convalesced during the following month. There was at no time a recurrence of the bleeding." In the removal of the right tonsil, the one that gave rise to the trouble afterwards, Dr. Lefferts was assisted by a surgeon who happened to be present. This latter gentleman held the vulsellum forceps in order to free Dr. L.'s right hand for the use of the bistoury. I noticed that as the section was made strong traction was also made upon the tonsil, and this must have placed on the stretch the tissue last divided, which was the lower part of the gland. In this part lay the artery-probably the tonsillar branch of the ascending pharyngeal-from which the subsequent bleeding occurred. Its mouth opened deep in the sulcus, between the tongue and the stump of the tonsil, and it was so obliquely divided that the contraction and retraction by which natural hæmostasis is effected could not take place. Possibly this vessel was enlarged at the expense of the others supplying the gland; possibly also the indurated tissue through which it ran prevented its closure. About half-an-hour after Dr. Leffert's hurried departure to fill his next engagement, the bleeding became very free. I then asked some of the physicians from other departments of the dispensary to look at the wound. They did so and one prepared for me a tannic acid gargle as advised by Mackenzie, while another immediately after its use applied to the part a solution of the persulphate of iron with a brush. Between them they filled the fauces and pharynx with ink manufactured on the spot; a third gentleman then began giving me ten grain doses of quinine, while another spoke rather indefinitely of the hypodermic use of ergotine or the ligation of the carotid. The fifth could only offer his regrets that he had to leave at once, as he "wanted to wait and see Lefferts stop this." These gentlemen were all educated and skilled physicians in their own specialties, and all but the last seemed anxious to be of service, but none of them remembered the simple surgical fact that direct pressure on the mouth of any bleeding vessel will control the loss till other and more permanent means of checking it may be adopted. The flow being rapid I became faint and exsanguinated in a short time, and in the opinion of those better able than myself just then to form a correct opinion, I could not have survived another hour without the help which Dr. McBurney afforded. It was estimated by several gentlemen present that the loss of blood amounted to between six and seven pints. If either my friends, the throat specialists, or a good practical surgeon had been present when it began, it would not probably have reached as many From the statistics which I have at hand, based With the con He should use the tonsillotome preferably for children, and especially if ether be not given. If |