was slight. The jaw was drilled and wired, and the cheek and jaw soon united, but there was undoubted evidence that the tumor was beginning to grow from its deeper parts. Naked-eye inspection and the microscope showed it to be

sarcomatous.

Mr. Paul referred to six cases of edematous tumor which he had met with in the palate and fauces, three ulcerating and three encapsuled. The latter were perfectly innocent, but the former class sometimes showed a malignant tendency.

Forced Examination of the Larynx in Children.

It is sometimes extremely desirable to have a chance to make a detailed laryngoscopic examination of young children. One is apt to hesitate, however, to employ general anesthesia, and parents will object to anesthetics unless some operative procedure is intended at the same time. Besides, laryngoscopic examination under an anesthetic is usually unsatisfactory. For a physician who does special work on the throat, some method of accomplishing this purpose of satis factory laryngoscopic examination of children is absolutely necessary.

In " Progressive Medicine," the new quarterly review of current medical progress, Dr. A. D. Blackader, of Montreal, describes two novel methods. The first is Escat's suggestion, and is instrumental. He has devised a peculiar form of tongue depressor, as shown by the accompanying figure. As may be seen in

the illustration, the instrument is curved so as to adapt itself exactly to the base of the tongue. On the distal extremity a blunt fork is fixed, of which the two branches descend, one on either side of the epiglottis, ending in two rounded points, which, when the instrument is used, are supposed to lodge in the pyri form sinuses on each side of the laryngeal orifice. The instrument serves, therefore, not only to control the tongue, but to pull forward the rima glottidis from the posterior wall of the pharynx, and so to provide good conditions for the

employment of the laryngoscopic mirror. It is probable that on the principles used by Kirstein, in what he calls autoscopy, i. e., laryngeal examination without a mirror, the examiner will be enabled with a little practice to see a good deal of the larynx (especially its posterior part, which is the more important one), by direct vision, and without the use of the mirror. The method of the manipulations with the new instrument is well illustrated in a diagram presented. In

Diagram showing position of laryngoscopic tongue depressor during
forcible examination of larynx in children.

the second diagram the position of the instrument in the throat is well shown. It will as a rule be necessary, even with the instrument, to have the movements of the child restrained by a sheet rolled around its arms and legs in the usual way, and to have it carefully held on the knees of an assistant, but with this the examination of the larynx can be made much more satisfactorily than with the ordinary tongue depressor.

A simple method for the examination of young children is also given in the same number of "Progressive Medicine," which seems extremely practical and well worth noting. It was demonstrated by Lack at a meeting of the Laryngological Society of London about a year ago. The advantage of this second method is that no special instruments are required and no force is employed. It is described by Dr. Blackader as follows: "The infant is placed in the usual position for laryngoscopy, the index finger of the left hand is passed well into the mouth, and the terminal phalanx hooked around the hyoid bone, which is pulled forward. The rest of the finger acts as a tongue depressor, the knuckle as a gag, while the left thumb under the chin serves to steady the head. With the use of a small mirror the larynx can now easily be seen. The method causes VOL. XIX-12

no pain, and requires no anesthetic, while the younger the infant the less is the resistance and the easier the examination." These manipulations certainly commend themselves by their ease and simplicity, and it would seem that the method deserves thorough trial that its merits may be tested in practical use.

Papilloma of the Nasal Cavity.

Richmond McKinney, of Memphis (N. Y. Med. Jour., March 4, 1899), reports a case of papilloma of the nasal septum. The extreme rarity of this growth is made apparent by the fact that such an astute observer as Bosworth, in over 200 cases of benign tumors of the nose, has seen but one case of papilloma, and an eminent English observer, Watson Williams, of Bristol, reports having seen but two cases of nasal papilloma in his entire experience. While Hopmann has reported a larger percentage, having found, in a total of 430 cases of benign nasal tumors, 78 of papilloma, Jonathan Wright, of Brooklyn, in more recent investigations, repudiated Hopman's results by clearly showing that this observer had described the ordinary polyp formation which had, from pressure, taken on a false papillomatous appearance. We are, therefore, unable to say how many cases of true nasal popillomata have been observed. The inference is, however, that a large percentage of the cases reported by Hopmann and others were not instances of true papilloma.

McKinney's case occurred in a medical student of 24 years of age, who sought relief from nasal stenosis occasioned by the growth. This latter was about the size of a coffee bean, attached to the upper and anterior portion of the cartilaginous septum, behind the tubercle. Removal was effected with the cold snare and the base cauterized with the electro-cautery. Six months later the growth had not recurred. Excellent photomicrographs of a section of the papilloma illustrate this article.

[NOTE. In an article on nasal papilloma, appearing in “ An American Textbook of Diseases of the Eye, Ear, Nose and Throat," just published, Dr. Jonathan Wright states that ten or a dozen undoubted cases of papillary fibroma or papilloma had at that writing (August, 1896) been reported. Assuming that there were twelve authentic cases on record at the time of Dr. Wright's report, another has since been reported by Beaman Douglass; mine, therefore, makes the fourteenth authentic case.-R. M.]

Thrombus in Transverse Sinus.

At the Gesellschaft der Aertze (Berlin Cor. Med. Press & Cir., vol. 67, no. 3116) Biel showed a man whom he had operated on for "thrombophlebitis sinus transversi ex otitide." The sinus was reached by an opening made through the mastoid portion of the temporal bone, and in order to enlarge the opening the jugular vein was ligatured. The wound healed and recovery followed. The first surgeon who performed this operation was Zaufal, who met with considerable success.

GYNECOLOGY.

UNDER CHARGE OF T. J. CROFFORD, M.D.

Consulting Gynecologist to St. Joseph's Hospital, Memphis, Tenn.

Notes on Abdominal Section.

Before the Clinical Society of London, at a recent meeting (British Med. Jour., no. 1988), Mr. J. Hutchinson, Jr., read notes of three cases in which he performed abdominal section. In none of them was there any external wound.

CASE I. A man, aged 32, was run over, and subsequently became collapsed. He had slight abdominal distension and much tenderness, with dullness beyond the left linea semilunaris, which shifted on change of position. On the following day the temperature had risen to 102°, and the abdominal distension had increased. On opening the abdomen it was full of blood, but in spite of careful search Mr. Hutchinson could find no vessel requiring ligature. Great relief followed the removal of the blood, but some oozing occurred subsequently, as evidenced by dullness in the flanks and the escape of blood into the dressings. The patient left the hospital a month later. The author raised the question whether the presence of effused blood within the peritoneal cavity was likely to prove injurious, and he thought it was.

CASE II. A single woman was brought to the hospital, with symptoms pointing to intestinal obstruction. On opening the abdomen over two pints of clear, pale yellow, odorless fluid escaped. The intestines were slightly congested, the stomach dilated, and the uterus enlarged as at the third month of pregnancy. He was at a loss to discover the nature of the fluid, and closed the wound. In spite of a passing improvement the patient aborted on the following day, and died soon after. Post mortem. The abdomen again contained a large quantity of the same serous fluid, and the intestines showed signs of commencing peritonitis. Exactly in the middle of the posterior surface of the bladder, one inch above the peritoneal reflexion, and therefore hidden from view, was a small, round perforation, one-seventh of an inch in diameter, through which urine could readily be expressed. The bladder and urethra were otherwise normal. If the nature of the fluid had even been suspected, he thought it might have been possible to discover and repair the perforation. He surmised, under the circumstances, that the wound was caused by an unskillful attempt to procure abortion. From the history, it seemed likely that the urine had been leaking into the peritoneum for at least four days. He discussed the effects of effused urine in the peritoneal cavity, and recalled that experiments on animals had shown that healthy urine might be injected into the abdomen without giving rise to much local reaction; that in moderate quantities it might be absorbed and the animal recover.

CASE III. A woman, aged 47, was admitted with the history that, previously in perfect health, while lifting a basket on the preceding day she had been seized with pain in the left side of the abdomen, followed by vomiting and some collapse. A smooth, movable tumor could be made out to the left of the middle line, about the size of a fetal head. This was dull on percussion, but there was no dullness in the flanks. Nothing of interest was made out by vaginal examination. He diagnosed ovarian cyst, the seat of a twist or rupture. On opening the abdomen a quantity of characteristic, glairy fluid escaped, and it was seen

that the largest cyst of a multilocular ovarian tumor had ruptured. The fluid was sponged away, but the cavity was not irrigated. Recovery followed. Admitting that the thin, serous fluid of an ordinary ovarian cyst might, if effused in the peritoneal cavity, undergo absorption without giving rise to much trouble, he asked whether this thick, glairy fluid would prove equally innocuous.

Cancer of the Uterus.

Every practitioner knows that nothing is more discouraging than the palliative treatment of epithelioma of the uterus. Hundreds of remedies have been tried with but little satisfaction. However, two methods of comparatively recent application deserve attention for the good results obtained, not only in attenuating the disagreeable and dangerous symptoms observed (hemorrhage, fetid leucorrhea, pain), but also in a certain prolongation of life of the patient.

They are injections of arsenious acid and applications of carburet of calcium. M. Hue of Rouen, who was the first in France to employ arsenic in this affection, injects a Pravaz syringe of the following solution, twice or three times a week, in the neoplasm: Arsenious acid, iv grs.; cocain, xx grs. ; water, Ziiiss.

M. Boisseau prefers the following formula: Orthoform, xx grs.; arsenious acid, ii grs.; alcohol, water, aa zij.

After having removed by antiseptic solutions all the secretions of the neoplasm, he paints the surface with the arsenical solution, which, thanks to the presence of orthoform, causes but little inconvenience. The following day it is reduced, and becomes detached after several days, when the application is renewed. Finally, when the slough becomes very thin and yellow in appearance and easily detached, it is certain that there is no more carcinomatous tissue. This method requires several months for the treatment of extensive cancer, and a daily application of the arsenic.

M. Aimé Grinsard strongly recommends the employment of carburet of calcium, which, in contact with water, is transformed into oxide of calcium and acetylene, for inoperable cancer of the uterus, and his modus operandi is as follows:

The speculum is introduced, and the vagina washed out and dried by plugs of cotton. A small piece of carburet of calcium (a small nut) is pushed down the speculum and placed in direct contact with the malignant granulations. Immediately a bubbling noise is heard, due to the discharge of acetylene gas. The vagina is plugged with iodoform gauze, and the operation is terminated. At the end of three or four days the gauze is removed and the vagina washed out with a sublimate solution of one in a thousand in order to remove the grit of the stone from the infractuosities of the cancer, after which a new piece of calcium is introduced, and so on every third or fourth day for a month, and finally the operation is only needed once a month.

By this treatment the gravest hemorrhage is arrested, while the fetid leucorrhea ceases immediately in two-thirds of the cases.

The only precautions to be taken when operating is to well dry the vagina and to efficiently plug after the insertion of the carburet of calcium.-Paris Cor. Med. Press & Cir., vol. 66, no. 3101.