of the attack, and just previous to the expulsion of the lungs to atelectasis may occur, shows that in one of the casts.

some of them there had been no true respiration, but merely a sonorous vibration of air in the fauces, and in others, that the test had not been executed with all the necessary precautions.

4. The confusion which has arisen between the idea of atelectasis in the medico-forensic sense and the clinical, (the former beiug that of utter absence of air), has had no small part in giving support to the theory of Schröder, i. e., spontaneous return to atelectasis.

5. In all the cases adduced by Schröder and others, the subjects were either infants immature or very feeble, which had perished by slow death quite different from that of infanticide.

In August, 1876, the patient suddenly, without any premonitory symptoms except a slight sense of suffocation, coughed up a whitish mass slightly tinged with blood. When placed in water it assumed the present shape. Little disturbance followed the expulsion, the child going about as usual. At irregular intervals varying from once a day, to once in five days and two weeks, she coughed up these casts with slight effort and no pain. There was no intervening cough; the exudation was thrown off usually in the early morning, sometimes at night, seldom in the daytime. This continued for nearly three years. The treatment was mainly expectant. Her general condition re- 6. Direct experiment on the lungs of rabbits, mained good otherwise, and now for several years dogs, etc., which had just begun to breathe, showshe has been free from cough. Physical examina- ed that in no case, when the lungs were left to tion of the chest : Inspection-normal. Percus- themselves, did they spontaneously lose so much sion-no abnormal dulness. Auscultation-res-air as to sink to the bottom when immersed in piratory murmur of somewhat diminished inten- water. sity at the upper part of the left lung, with what I should describe as a rustling or indistinct sonorous breathing over the left bronchus behind. No abnormal respiration elsewhere.

ON THE POSSIBILITY OF THE LUNGS
RETURNING TO THE STATE OF ATE-

LECTASIS.

BY JOSEPH WORKMAN, M.D., TORONTO.

(Translated from Rivista Sperimentale).

Tamassia, on this subject, having related his own experiments, sums up his views in the following

conclusions:

1. The doctrine of English Jurisprudence, which recognizes no necessary relation between life and respiration, proves nothing either for, or against, the hypothesis that the lungs when once distended by respiration, may spontaneousty return to the

atelectic state.

2. The cases cited by English writers against the diagnostic value of the pulmonic hydrostatic test, relate, in the majority, not to the phenomena of true respiration, but to organic reaction of the tissues.

3. Minute examination of the cases given by Thomas, Lieman, Schröder, Hecker and Herman, in which it might seem that spontaneous return of

7. Direct experiment on the lungs of rabbits, dogs or men, who had breathed for some minutes, hours, or years, and had been suffocated, showed that in order to deprive the lungs of floating capacity, an enormous pressure is needed.

8. Lungs but a little distended by respiration or congested, or insufflated, require less pressure to deprive them of floating power than normal lungs

do.

9. Decrepid age being excluded, it may be held. that the more advanced is the age of the individual, the stronger will be the resistance of the lungs against sinking under pressure, and losing the air contained in them.

10. Slowness in dying lessens the resisting power of the lungs.

II. This resistance is notably diminished by the inception of putrefaction.

12. The theory of Schrôder has therefore no positive basis, and whenever the hydrostatic test and the other examinations completing it, show that there has been no air at all in the lungs, we may, with perfect security, infer that the infant had never breathed.

VENESECTION RESUSCITATED. Dr. Fordyce Barker says he is gradually getting to bleed more glected in practice, and would now adopt it in frequently. He thinks it has been too much nesome cases of abortion, and puerperal convulsions, renal congestions, with coma, convulsions, etc.

removed at a sitting, with very little loss of blood, and moreover, the view is not obscured by blood and clots. It is not always an easy matter to slip the noose over the growths, and valuable assistance may be had from the two little instruments I show-the first, which is simply a director with a bifurcating point, will be found of assistance in passing the wire around large growths. The little hook, the shaft of which is bent at nearly a rightangle, is useful in pulling them through the loops when it is placed in position over the tumor. Nasal polypi are exceedingly liable to recur. This recurrence I believe to be best combatted by touch

MR. PRESIDENT AND GENTLEMEN,-I do not propose to occupy your valuable time with a long dissertation on the pathology and clinical history of nasal polypi, but would wish to draw your at tention to one or two points in the diagnosis and treatment of these growths which are of considera-ing the stumps with glacial aceitic acid on a cotton ble practical interest. holder-the pain it causes can be instantly stopped by spraying with this solution :—

........

..zii.

First-As to diagnosis-the disease with which polypus is most frequently confounded is hyper- R Acid Carbolici gr. i., sod. bibor. sod. bicarb, trophy of the mucous membrane over the turbinat-aa. grs. ii., glycerine zi., aq 3j. Patients also exed bones and septum. It can be easily differen-perience much benefit from the use for some time tiated from this by examining the nose carefully after of this powder :with a probe, laryngoscope, and nasal speculum. I may remark here that the practitioner should be provided with two kinds of nasal speculi; Bosworth's, for noses which are more or less retroussé answers admirably, but will be found of little use in long or overhanging noses; for such, a simple hard rubber conical speculum is best suited.

When the nasal cavity has been well illuminated you will notice in hypertrophy of the mucous membrane that the color is whiter, that there is no translucency, and that there are no folds and depressions as in the case of polypi. There is frequently also thickening of the septum, on one or both sides, a condition, but rarely associated with

...grs. xx. 3ii.-M

R Pulv. potas. chlor.. Pulv. zinci sulph............................ Pulv. acid boracis...... Sig. Put a teaspoonful in a teacupful of water, and either draw in through the nose every morning, or use with the syringe or post-nasal douche.

Correspondence.

SEMPER PARATUS.

To the Editor of the CANADA Lancet.

SIR, I am thoroughly convinced that the majority of country physicians will agree with me, polypus. It is also very unusual to find a polypus when I affirm that in many instances we have not springing from the septum. The subjective senat our command, in emergencies, medicines and sations are not very reliable for diagnostic pur- appliances upon which we can place reliance poses, as in both cases they are those of obstruc- for the amelioration of the condition of our patients. tion to nasal breathing. With the probe, in the In some cases the friends are compelled to travel case of polypus, one can lift them and determine many miles to get an instrument or medicine, where their points of attachment. One should never at- if a little forethought were exercised, not only this tempt to remove these growths without carefully unnecessary travel could be obviated, but the sufdetermining this point, and without thorough illu-fering of the patient lessened—a great consideramination, otherwise it is a mere groping in the tion. Not long since I was called to an arm and dark, unsatisfactory alike to physician and patient. With regard to treatment, I look upon removal with the snare as the only satisfactory mode of dealing with polypus. It is comparatively painless and almost bloodless. Several polypi can be *Read before the Canada Medical Association, Sept., 1882.

shoulder presentation, and finding it impossible to turn, I decided to use the blunt hook; but such I had not with me, consequently had to despatch a messenger to a medical friend, to come and bring his instruments. He came-minus the hook, so sent again; the hook came and the woman was

sufferer-had to send only two miles for the long ones; and for the third time, consecutively, another lacerated perineum. The question arises, on whom, when, and where, is the next stitching to be done? I hope, quoth the raven, nevermore !

I am now thoroughly equipped with a fine set of obstetrical instruments, purchased from a Toronto firm, Stevens & Son, and in addition I carry a syringe, lancet, chloroform, ergot, liq. ferri perchlor., the alum egg, etc., in this obstetrical bag, so that they may not be used in other cases than those for which they are intended and save trouble in collecting them together when hurried. To make a resumé of my observations, I will divide them under the following headings:

Ist. Do not trust your abilities without the aid of every medicine, appliance and instrument, when called to a case of labor.

2nd. When thus equipped, your anxiety is relieved to a great extent, and your reputation not liable to be endangered.

3rd. Of still greater consideration, is the timely alleviation of the sufferings of one who has placed the most trying agony of her life in your hands. To you, alone, her every thought is directed; so, be ever prepared for an emergency.

soon delivered. The child was fortunately dead; it had spina bifida, club feet and a monstrous head Four hours of pain and mental anguish might have been spared the woman and I and the attendants relieved from anxiety-all the result of not having with me an instrument that would not cost over $2. This was my first experience with the hook, although in practice nearly fifteen years. For nearly ten years I carried with me the instrument; but never having a case in which to use it, it was placed aside and lost, and of late years I never thought of its necessity. I had seen its use and was delighted with it, and within two hours after my arrival home I had one made by a blacksmith in the village. I mention this fact to show the high opinion I had formed of the utility of the instrument and to state that any intelligent blacksmith can make one. Do not be startled at my revelations when I tell you that, two days afterwards, I received a telegram from a person living sixteen miles north of this place, but did not go until messengers came for me. It was also a shoulder presentation. The attending physician was exhausted with his task and the woman could not have survived long. The doctor's message was, "For God's sake, come. I went cheerfully, thank heaven, although I have, so to speak, been spat in the face for many years through man's ingratitude. I am "always ready" to assist a woman in her misery; however poor she is, the greater claim has she on my services. I did not regret my going; in Ontario, there are many who might profit by the trembling grasp of the attendant's hand repaid the above experience. "It is human to err," is me at my approach to the miserable cabin. Before admitted, but to knowingly walk in the ditch the I had warmed myself, I handed the doctor the second time is inexcusable; so this article is inhook, and luckily for the woman, she was delivered tended to thwart the first unlucky step you may in a few minutes afterwards. In this case, as make. in the former, the perineum was lacerated to the sphincter ani, and was attended to at once. In the former, the accident was not noticed at the time. Considering the number of years I have been in practice and having a first-class midwifery business, wherein I have often flattered myself at my success, I must confess that my eyes were opened to the SIR, I notice in your last issue of the LANCET necessity of being-to use the language of my text the communication of Mr. J. L. Mills, of Brantford, -semper paratus, when two such cases had broken in defence of the high price of the above little inso suddenly on me. Now for my third case, which strument. He says I probably forget that he has I attended a few days after the last mentioned. It to pay 25% upon goods of this description coming is useless to enter into the ordinary particulars; from Great Britain. I do not forget this fact, but suffice it to say, that I found the short forceps im remember in connection with it, that we have other possible to adjust, and as a result-luckily for the articles from the same place, far more difficult to

This article was written, not because of any cacoethes scribendi the writer has, but for the good of the fraternity at large; for it cannot be denied that, among the 1700 doctors of medicine

Jan. 11th, 1883.

SYNTAX.

NASO ORAL RESPIRATORS.

To the Editor of the CANADA LANCET.

No pain or hydrorrhoea. He removed as much as possible from the growths, to mitigate symptoms and prolong life.

Dr. Nevitt said he had a sim lar case at present under his care. He was applying the fuming nitric a id, much to the relief of the patient. Both pain and hydrorrhoea were marked.

October 19th, 1882.

The President, Dr. George Wright in the chair. Dr. Holmes was elected a member of the Society.

The President, Dr. George Wright, in the chair. Dr. Spencer showed a woman with an eruption, probably syphilitic, chiefly on the face, neck, and forearms. Treatment had not been followed by much benefit. Dr. Cameron advised giving iodide of potassium in much larger doses than had been given. Dr. A. H. Wright showed fractured os innomined three weeks ago, atum and spine.

The specimens were from a young girl, who had fallen from a window to the ground a distance of 15 feet. She probably fell on her feet and then backwards to the ground. On admission to the General Hospital shortly after the accident, she was paralyzed in the lower extremities and movement caused great pain. Examination discovered fracture of the ramus of the pubes, and it was thought of the crest of the ilium. There was a sanious discharge from the vagina; later it became purulent and offensive. Her bowels were not moved during 16 days subsequent to admission, though purgatives were fully given, but when once their action was re-established the evacuations became very frequent. She died 28 days after admission. A post mortem examination was made a few hours after death. The left os innominatum was broken into seven pieces, a small piece was broken out of the bottom of the cotyloid cavity and fractures extended from that cavity across the iliac and ischiatic portions of the bone. The arches of the eleventh and twelfth dorsal vertebræ were broken off from the bodies. The spinal cord was much disintegrated.

Dr. Nevitt showed an exostosis removed from the ungual phalanx of the great toe of a young girl.

Dr. Macdonald reported a case of epithelioma of the uterus and vagina in a woman, a farmer's wife, aged 60. Symptoms first showed themselves last April in a bloody vaginal discharge, lasting for a day or two, and recurring from time to time.

Dr. Reeve exhibited a patient illustrating the the treatment of Ectropion by transplantation of flap without pedicle, and gave an elaborate description of the various steps of the operation. The case was a marked example of cicatricial keloid resulting from a burn. The upper lid had been treated by transplantation two years ago with a satisfactory result. The operation on the present occasion was for the restoration of the lower lid. The extent of raw surface made was 25 x 15 mm., and flap 65 x 40 mm. was transplanted from the inner side of the arm. The operation was performand the flap had united perfectly. This was the fifth case operated on by Dr. Reeve, of which four were completely successful. In answer to Dr. Cameron, Dr. Reeve, said he had not tried treatment of keloid by friction with sand; that the mode of operating by transplantation without pedicle was that developed by Wolfe, of Glasgow; and that no keloid had formed on the arm as a result of the removal of the flap.

Dr. Zimmerman reported a case of malignant disease in a compositor. He had had pain, nausea, and vomiting, for the last six years; the pain was located chiefly in the umbilical region. He had contracted the opium habit from taking medicine freely for the pain and required very large quantities to give him relief. In April last he had symptoms of lead colic. In August he had intestinal hemorrhage which recurred on several occasions subsequently. There was the cachectic appearance but no bronzing of the skin. The stools gave no indication of stricture.

On post mortem examination a cancerous mass was found occupying the hollow of the sacrum involving the rectum and sigmoid flexure but not lessening their calibre to any considerable degree. The left supra-renal capsule was wholly involved in scirrhous growth; the right one was healthy.

Dr. Zimmerman said the disease was rare in the supra-renal capsules, especially in one alone, and it would be interesting to know if the capsule had been primarily diseased in this case. In reply to Dr. Cameron, he said the frequency of malignant disease of the pelvic tissues in young people might be due to great activity of the sympathetic.

Dr. Graham reported a case of a child, aged three Board of Health was held during the early part of years, with symptoms resembling those of leucocy- | December. Present:-Dr. Oldright (in the chair), themia. Splenic dulness was increased; the red Covernton, Cassidy, Rae, Yeomans, Bryce, (Secrecorpuscles about normal number; and white cor-tary) Prof. Galbraith. puscles in proportion of 1 to 20 red ones. history of ague. The case might be anæmia, with splenic and glandular enlargements. Dr. Cameron said he saw one exactly similar two months ago.