Rheumatic Laryngitis.—“This is a painful affection of the vocal organ, attended by more or less hoarseness and fatigue of the parts after talking, and sometimes by grave or even fatal obstruction of the glottis. The affection may be either acute or chronic. The acute disease, from having been associated with articular rheumatism, has been recognised for several years, but it has been but little studied, and the literature of the subject is meagre. Of the chronic form, to which I would now draw attention, I can find no mention in medical literature." This chronic form occurs in a person of rheumatic diathesis, but often the larynx or the tissues about the hyoid bone present the only evidence of the constitutional affection. The pain is not constant, but may frequently disappear for a few days, especially during fine weather, to return again on slight exposure, or with changes in the temperature. Its course is erratic, but nearly always obstinate. Rheumatic pains about the body are not infrequent, and often there is an inherited or acquired predisposition to rheumatism. In no case have I found the pain very severe. Sometimes it is most noticeable on using the voice, but is usually more troublesome when swallowing. It is usually referred to one side of the larynx, sometimes also to the trachea, the greater corner of the hyoid, base of the tongue, and lower part of the corresponding tonsil. Sometimes these latter situations seem painful while larynx escapes, but even then there is usually fatigue after talking. Hoarseness and aphonia are also frequent symptoms. One or both arytenoids may seem slightly congested, or the redness may be confined to one side of the fauces or to the pharynx. The cords remain clear, and the inflammatory symptoms seem altogether inadequate to account for the discomfort. In some cases the parts involved seem slightly swollen, but in others no change of form is noticeable. It is this slight redness and swelling which enables one to diagnose it from neuralgia, and the result of treatment will bring confirmation. Its duration varies from two months to one or more years. Treatment: Locally stimulant and astringent sprays, or pigments, and in some cases galvano-cauterisation of the congested surface seems to have aided much in recovery. Constitutional treatment is mainly to be relied on: Iodide of potassium, salicylate of soda, guaiac, colchicum, and cimicifuga, have all been tried with more or less success. Extract of phytolacca has been given with apparent benefit, and oil of gaultheria, in doses of fifteen mimims, three times a day, has at times given satisfaction. E. Fletcher Ingalls, B.M., M.D., in American Journal of the Medical Sciences. January, 1888. SURGERY. BY JORDAN LLOYD, F.R.C.S., Hydrops Intermittens Articulorum.—A valuable paper on the above rare and but little known disease by A. H. Fridenberg, M.D., of New York, appears in the N. Y. Med. Rec., June, 1888. He claims that the two cases herein published are the first which have been recorded in America, and he supplements these by notes of twenty-four others, being all he can find recorded after a most exhausting search of medical literature. The main characteristics of the disease may be briefly summed up as consisting in serous exudation into one or more joints, arising without appreciable cause and recurring and subsiding spontaneously at certain definite periods. The leading features of the malady are mainly suggestive of involvement of the vaso-motor system. Palpitation, attacks of syncope, exophthalmos, rigors and transpiration find mention in five cases. The symptoms of Basedow's disease are fully developed in two cases. Various emotional disturbances, depending perhaps on the marked anæmia, are emphasised in others. The remarkable influences exerted upon the course of the disease by the intervening pregnancies must not be overlooked, although a satisfactory explanation is impossible. In eight out of nine recorded, pregnancies occurring in the course of the disease, a complete cessation of the attacks, from the conception for an average period of six weeks, is noted. There does not appear to be any causal or periodic relation between the occurrence of the attacks and the menstrual function. We need not hesitate to look upon the disease as a neurosis of vaso motor origin and of a noninflammatory type. The most interesting feature, apart from the mystery of its pathological significance, is its periodicity, which Dr. Fridenberg does not regard as in any way "malarial." He obtained most benefit in his cases from electricity applied in the form of the galvanic current to the medulla, daily at first, less frequently later, the electrodes being placed upon the mastoid processes, and the strength of the current being cautiously regulated according to the patient's sensations, avoiding dizziness and flashes of light. Gritti's amputation through the thigh.-Dr. E. Ried, of Munich, describes (Annals of Surgery) a modification of the above operation as follows:-The extremity is held in the extended position. The anterior flap is formed by an incision passing from the middle of the external condyle of the femur (on the right side), or the internal condyle (on the left) to within two or three fingers' breadths below the border of the patella; the incision is carried from the other condyle downward and forward, meeting the first at the tuberosity of the tibia. The skin is retracted and the ligaments divided. The crucial ligaments are left intact. The femur is divided at the upper limit of the patella. The posterior flap is now formed of skin and connective tissue; the rest of the structure being divided as high as the point of division of the femur. The arteries are tied. The patella is freed from fat and connective tissue, and the articular surface of the bone sawn off. The two flaps are apposed by means of one deep silver-wire suture, and several superficial catgut and silk sutures; closing with drainage, antiseptic dressing, and higher position of stump. The apposition of sawn surface of patella of femur is a loose one. Ried's mortality is thirty per cent. in ten cases; ages of patients varied between nineteen and sixty. are Operative treatment of paralytic joints.-Zinsmeister (Deutsche Zeitsche fur Chirurg., Bd. xxvi., p. 498) writes of the procedure of making an artificial anchylosis in joints which useless from paralysis. Albert has recently operated on 10 patients; 14 operations: 5 at the knee, and 9 at the foot. The results were satisfactory in all. Six weeks after the operation, as a rule, the patients were able to go about. The operation is especially indicated for the poor who are unable to procure appliances for locomotion. Albert does not advise a typical resection, but a simpler procedure; namely, the removal of the cartilaginous surface of the joint. This is sufficient for anchylosis, and wiring of the bones is not necessary. It is not necessary to remove the synovial membrane. A typical aseptic first intention does not give as firm an anchylosis as if there is some slight suppuration, and he advises keeping a small layer of iodoform gauze on the wound until slight suppuration takes place. In paralytic club foot it is better to remove the astragalus. Resection of Ribs in Empyema.-At a recent discussion in the French Congress of Surgeons, Bouilly divided into five classes the cases in which the above operations are to be considered :— 1st. Large cavities in which the lung, fastened to the vertebral column by thick false membrane, is entirely and permanently collapsed. In these cases the operation is useless and dangerous. 2nd. Large cavities in which the lung though condensed still preserves a slight vesicular murmur; intervention is then sometimes useful, particularly in young patients, and when the cavity does not extend beyond the third rib. 3rd. Cavities from eight to twelve centimetres in diameter; these are those which present the most favourable conditions for cure. 4th. Simply fistulous tracts of greater or less length; if they are short and straight the results will probably be good; the prognosis becomes less favourable when the fistulæ are long and tortuous. 5th. Cases in which there are moderate-sized cavities with fistulous tracts communicating with them; in these the prognosis is favourable. The Treatment of Stricture of the Urethra by Electrolysis.Dr. Burchard (N. Y. Med. Record, June 16) writes favourably of the above. He details several cases at length and thus concludes:-Firstly. Many cases of stricture of the urethra, especially those of a fibrous nature, can be more effectively relieved by the action of the galvanic current applied locally than by either gradual dilatation, divulsion, or internal urethrotomy. Secondly. The operation, while radical and effective, is conservative and physiological. And Thirdly. The operation is painless and bloodless. Successful Operation for Ruptured Urinary Bladder.-Dr. H. H. Grant reported the case (American Practitioner, June 9) to the Louisville Surgical Society. The patient had been run over by a light cart, and suffered intense pain. Some ten or fifteen minutes after the accident he endeavoured to urinate, but could pass a few drops only. When first seen, the bladder had not been emptied for six hours. The catheter was introduced, and only two or three ounces drawn. External examination showed only a little bruise. The catheter was again introduced and allowed to remain for ten or fifteen minutes, but no water came at all, and there was no fluctuation over the abdomen. The perineum was aspirated but no urine found. A sound was introduced into the urethra and met with obstruction, which was thought to be due to rupture of the urethra. An incision (after using all antiseptic precautions) was made from the pubes to the umbilicus. The peritoneum was infiltrated, and some bloodclots were found loose in the abdominal cavity. There was also some oozing through two little openings in the peritoneum. When the peritoneum was opened a large amount of fluid, probably as much as a half gallon of blood and water, rushed out. A finger found, crushed off from the pubes, a piece of bone, evidently loose, though not entirely free. This was not disturbed. A sound was passed into the bladder and protruded through a rent into the peritoneal cavity. This rent was easily reached by passing a strong ligature through the posterior portion of the bladder and drawing it out. The bladder was closed with Lembert sutures of silk one-fourth of an inch apart; eleven being used. The abdomen was closed with due antiseptic pre |