water which is to be used in the syringing process. affection. We often find two points of pain and swellNo towels or napkins are needed about the neck, to ing in the same ear, and they are very apt to occur prevent spilling the water; no assistant beside the in succession, so that we are by no means sure of bepatient, if he be an adult, and if the procedure be car- ing done with a case because one furuncle is cured. ried out as I will describe. The patient being seated, The swellings that occur in the lower portion of the holds the bowl well under the auricle, in the hollow canal, the bony portion, which is two-thirds of the just under the tip of the auricle, keeping the head per- whole length, are not usually circumscribed, but diffuse, fectly straight, and using both hands to steady the and are therefore to be classified under that head. vessel. The surgeon should thoroughly straighten the They are more painful than furuncles, from the fact auditory canal with the left hand, and with the right, that the integument is thinner and closely adherent to placing the nozzle of the syringe well into the meatus, the periosteum, so that such an inflammation is analogous direct the stream down to the membrana tympani. It in the fearful pain which it occasions to a paronychia, is well to prepare the patient for the shock of the water and requires the same treatment, that is, a free inciby allowing a part of the first syringeful to pass into sion through the tense and swelled structure down to the concha, and not into the canal. the bone. I should also say that the pain experienced in swallowing, chewing, and the like motions, from the pressure of the upper jaw, through the glenoid fossa, upon the swelled auditory canal, is one of the symptoms of which patients with either the diffuse or circumscribed forms of external otitis complain very much. The causes of furuncular inflammation of the outer ear are not very plain. Like furuncles in the other parts of the body, they are often an evidence of a deteriorated condition of the general system; but again they occur where the subjects are in good general health. In such cases some local irritation by mechanical or chemical means, such as have been mentioned in the discussion of diffuse inflammation, is probably the cause. It will be seen that no patient is capable of thoroughly syringing his own ear, and that no person who has not been taught the simple process will be able to accomplish the object for which syringing is undertaken, that is, the cleansing of the auditory canal and the outer surface of the membrana tympani. Notwithstanding these facts, patients suffering from an ulcerative process in the ear, and who require the daily removal of the pus as an essential to recovery, are often sent away without other instruction than the advice to syringe the ear. It is almost as difficult for a person to properly syringe his own ear, as to cauterize his own palpebral conjunctiva. We certainly would never think of leaving the latter manipulation to any but a person who had been taught to manage it properly. The ear affected with chronic external otitis should be cleansed from one to three times daily, while the secretion is at its height. The parts should be then dried by means of cotton twisted about a thin bit of wood, or a steel cotton-holder. The agents which may be used in checking ulceration are numerous. I prefer solutions of nitrate of silver, of alum, and of the sulphates of zinc and copper, to the others. The nitrate of silver I use in strong solutions, from 20 to 40 grains to the ounce, pencilled over the parts; the sulphates and the alum in solutions of from 1 to 4 grains to the ounce, instilled into the ear. The choice of the astringent is, however, much less important than the thorough removal of the pus, which should be done at least three times a week, and, if possible, daily, by the physician himself. It is sometimes almost marvellous what may be done for a neglected suppuration of the auditory canal, however many alteratives and other constitutional remedies the patient may have taken in vain, by the mere daily removal of the pus and the application of a caustic or astringent. 2. Circumscribed or furuncular inflammation of the external auditory canal is quite a common affection, and I imagine there are many more cases of this affection than is shown by the statistics of the writers on otology, inasmuch as it is not a serious affection in its consequences, and very often gets very little treatment. The subjective symptoms of a furuncular inflammation of the external auditory canal, are pain and a sense of fulness in the ear. There is scarcely ever any tinnitus aurium, for the reason that the circumscribed swelling makes no pressure upon the membrana tympani and ossicula auditus, which pressure is usually the cause of the sounds in the ear described under the term of tinnitus aurium. On examination we find roundish isolated swellings, that are very tender and sensitive to any contact. Even the touch of a delicate probe will sometimes cause patients to make an exclamation of pain. These swellings are not usually very red; for the integument is quite thick in the outer portions of the canal, and this is the usual site of the The general treatment will be determined by the condition of the patient. The local is simple; a deep incision should be made into the swelling, if any one very tender point can be found. It is a matter of indifference as to whether suppuration has or has not occurred in deciding as to the expediency of an incision. It should be made as soon as the case is made out. Leeches do very little good in furuncular inflammation. After the incision the ear should be douched every fifteen minutes or half an hour, by means of Clarke's eardouche, until the pain is relieved, when it may be used at intervals. The ear should also be cleansed by means of a syringe and the cotton-holder of which we make so much use in aural therapeutics. The thorough cleansing will usually relieve the impairment of hearing caused by the swelling and closure of the canal, while the incision and douche will cut short the pain. Each new furuncle is of course to be healed in the same way. 3. Vegetable fungous growths. It was only a few years ago that a discovery was made as to the appearance of a vegetable fungus or mould in the ear. This discovery, which was made by Schwartze, of Halle, in 1867, has cleared up a great many obstinate cases which were once supposed to be due to impaction of the wax, or chronic inflammation. In 1844 a case was reported, but it failed to attract attention until Schwartze published his case and referred to Mayer's. The fungus known as the aspergillus, and which may be found on mouldy bread and on the walls of damp rooms, is that which invades the ear. The pencillium also forms in the auditory canal. The microscope is required to determine positively that the growth is the aspergillus or pencillium; but having once seen a case, you will nearly always be able to know without such an examination with what you are dealing. Dr. Wreden, of St. Petersburg, Orne Green, of Boston, Knapp and myself, of New York, have published cases of the formation of aspergillus in the ear. It is now very well known, as well as its fellow fungus the pencillium, as the cause of an obstinate external otitis, the pencillium having been made to grow with the asper gillus by Blake, of Boston. Subjectively, the symptoms of aspergillus are pain, | thigh, where it simulated eczema, as it does in the ear tinnitus aurium, vertigo, and impairment of hearing. at times. The objective appearances consist in the close adherence of lardaceous, yellowish white flakes or scales, which are easily mistaken for epidermis, to the walls of the canal and on the outer surface of the membrana tympani. These flakes are of a whitish color, and very adherent. They cannot be thoroughly removed by the syringe, but the angular forceps is required. This removal should be only undertaken when the canal is illuminated by means of the mirror which is attached to the forehead by a band encircling the head. These parasitic flakes form very rapidly, so that when you have on one day thoroughly removed them, on the next you will often find them fully formed; and again you may remove a cast of the walls of the canal and of the drum membrane. The integument beneath the mould is found reddened and sensitive. Particles of dirt are very often mingled with the epidermis and fibres making up the flakes, scales, or casts that are removed, and in one of the varieties of the aspergillus, the nigricans, black points are found, which sometimes cause the mass blocking up the ear to be mistaken for impacted wax. But if you have once seen and examined the two products, you will hardly make this mistake. If you do, the reappearance of the fungus in a few hours will correct the error. As I have said, there is apt to be pain and tinnitus connected with the presence of the parasite. The pain is dependent upon the inflammation of the canal, which has denuded it of its epidermis, and given opportunity for the appearance of the mould. The tinnitus is dependent upon the pressure made upon the membrana tympani by the formation. There is often vertigo in addition to the tinnitus, depending upon the same cause. * I need not give the microscopic appearances in any detail. Quoting from my friend, Dr. William B. Lewis, I remark that there are three essential parts: 1. The mycelium, a dense network of false membrane, delicate fibres which form the basis of the structure. 2. The fructifying portion arising from this. 3. The free spores which lie upon and in the mycelium. The causes of the affection are not quite clear. But I think we may assume that the fungus never invades a healthy ear. We cannot, therefore, promise a patient who comes to us with this affection that he will be well when the aspergillus ceases to grow. He may have suffered from chronic catarrh of the middle ear previously to the attack of the parasite. In the majority of the cases the inflammation that has preceded the aspergillus formation is an otitis externa, which is tractable. I am aware of the view that the fungus causes the inflammation, but my experience has taught me that the growth of the aspergillus merely aggravates a previously existing affection of the canal and membrana tympani. The treatment is very simple, and consists essentially in the removal of the fungus as fast as it forms, by means of the forceps and the syringe. Warm water should be freely used after the growth is removed. Then the denuded surface may be brushed over with a strong solution of nitrate of silver, or a weak one of sulphate of zinc may be in tilled. The use of the socalled parasiticides is unnecessary. Other parts of the integument are liable to the growth of the aspergillus fungus. Professor William H. Draper, of this city, saw it on the inner side of the * American Journal of the Medical Sciences, vol. lix., p. 110. I have said sufficiently in regard to polypi from external otitis to show you that they arise from improper or neglected treatment. The discussion of their nature and the means for their removal I will leave until we come to the subject of suppuration in the middle ear, as I may also that of exostosis and hyperostosis in the canal. Eczema of the passage requires no further mention than that made in my lecture on the diseases of the auricle.* Condylomata arising from syphilitic poison sometimes occur in the auditory canal. Stöhrt of Würzburg has reported fourteen cases, occurring chiefly among women, and one with two exceptions in connection with condylomatous formations on the genitals, in the axillæ, under the breasts, and between the toes. The consequences of these formations may be chronic suppuration and narrowing, perhaps hyperostosis of the bony canal. The local treatment consists essentially in carefully cleansing the ear, as often as may be necessary, while anti-syphilitic remedies are employed. Original Communications. TREATMENT OF DISEASES OF THE AIRPASSAGES BY THE MEDICATED SPRAY. Whooping Cough, Ulcer of the Trachea from Mechanical Obstruction. Acute Catarrh of the Smaller Bronchi. Syphilitic Condylomata of the Larynx Resulting in Ulceration. Chronic Phthisis, Large Excavation of the Right Lung. Chronic Catarrh of the Fauces and Nasal Cavities. The Administration of Chloroform per Spray. BY JOHN J. CALDWELL, M.D., BROOKLYN, N. Y. My treatment of whooping-cough may or may not be entirely new to the profession, viz., local medication by the Spray Atomizer, such as is made and sold by Messrs. Codman & Shurtleff, and others-my favorite medicinal agents being bromide of ammonium and potassium, together with liquid preparations of belladonna. Believing in Niemeyer's views of the pathology of this disease, "that whooping-cough is a catarrh of tense hyperesthesia of the air-passages," I made my the respiratory mucous membrane, combined with inhave been so satisfactory and rapid that I ventured to medication directly to the parts affected, and the results submit the following cases for the RECORD. CASES 1 and 2 were my little daughters, aged respectively two and four years. They contracted the disease in July, 1869, it being at that time prevalent in our city, and in their cases the malady was decided and little or no relief, I resorted to the above treatment as distressing. After exhibiting the usual remedies with little ones severally upon my knee in such a position an experiment. Getting up steam, and placing my that the spray should play right into the face, as a natural consequence they began crying, and that was just what I expected and most desired, for the deep inspirations would carry the bromides and belladonna home to the local trouble. My formula is as follows:-BF. Ext. belladonna, gttæ. Ammon, bromidi. Pot. bromidi.... Aqua dest.... * Medical Record, vol. vi. ... V.-X. i.-iì. 3 i.-iv. 3 ii. + Archiv für Ohrenheilkunde, Bd. iv., s. 255. Of this we use a tablespoonful at each application. July 11th, children much better; the intermissions of greater space. Made another application July 14th; attack very mild; scarcely any whoop. Continued treatment July 16th; whoop and spasmodic action gone, with a slight cough which passed away in a few days. CASE 3.-August 24th, was called across the street to see my neighbor's children, three in number; found them suffering from same affection. The father informed me that the distress was so great and constant that the children could not rest, and were becoming very weak and emaciated; that their physician did not relieve them, and that as the weather was so oppressive he felt fearful for their lives. I administered the spray treatment to them in turn while they were sitting upon their father's knee. They called on the following succeeding days, viz., 26th, 27th, and 28th, and on the 1st of September I discharged them cured. CASE 4.-September 9th, Mrs. McG. called at the office with her little son, aged two years, afflicted in the same manner. After three or four applications we had similar happy results. Here we may say, that when the nights are passed with much disturbance from spasmodic coughing, it is our habit to administer the same solution by the stomach, in doses suitable for the occasion. CASE 5.-In October, 1870, I was called to the family of Mr. S., of Sackett street, where I found his five children suffering severely with whooping-cough. I left the Atomizer at the house, with a sufficient quantity of the mixture, at the same time instructing the mother (who was a competent, intelligent person) how to administer it. I now and then called to watch progress, and at the expiration of two weeks was pleased to find that the patients, like the others under my care, had speedily and entirely recovered. ULCER OF THE TRACHEA, the smaller bronchi; at the apex of both lungs discovered impeded and lengthened expiration, a condition which is very clearly described by Professor Armour, of our city, as a loss of tonicity and contractility of the air-cells and smaller bronchial tubes of this portion of the lung. September 6th, administered spray-atomizer fluids, containing carbolic acid, tincture of arnica, and glycerine; also, as a counter-irritant, a pitch-plaster sprinkled with tart. antimony; ordered as a constitutional treatment, Wyeth's preparation of iron, bark, and strychnia, with a generous diet and a favorable atmosphere. September 7th, 8th, and 9th, continued this treatment, and September 11th ordered the plaster removed, and the eruption cleansed and dressed with olive oil. September 13th, 14th, and 20th, continued the spray and other treatment. September 27th, discharged cured. The above is typical of many cases treated by this means with like results. SYPHILITIC TUBERCLE; OR, CONDYLOMATA OF THE LARYNX, RESULTING IN EXTENSIVE ULCERATION OF THE SAME. J. McL., aged 50, of robust and athletic habit. He informed me as to his history, some twenty years since being led into the wilds of California, where he acted the part of a vigilance committee officer, and that there he had contracted syphilis, which was rudely and imperfectly treated. June 5, 1871, he came to my office complaining, without any apparent or assignable exciting cause, of a feeling of tickling in the throat, his voice deep and hoarse, with a harsh barking cough. These symptoms of his history led me to believe his trouble to be syphilitic catarrh, with condylomata of the larynx, involving the vocal cords. Consequently I placed him on the Ricord mixture, and ordered him sprays containing tr. of iodine and glycerine; this treatment was continued for the space of several months, seeing him at short intervals up to September 30th, with little or no beneficial results; every variety of specific treatment would from mechanical obstruction, complicated with inflam-seem of no avail in his case. The thickened membrane, mation of the bronchial mucous membrane, treated by the Spray Atomizer. My medication was in this instance composed of a solution of carbolic acid, tr. of iodine, and glycerine, and as a counter-irritant I used pitch-plasters sprinkled with tart. antimony. CASE 6.-November 18, 1869, Mr C. called at the office, complaining of a severe, short, sharp cough. He informed me that his occupation was that of a stone-cutter, and that it was very dusty work, and he, like the other men of his trade, was continually inhaling this foreign matter, and consequently this cough was very prevalent among his trade. With himself the disease had been of so long standing that he feared consumption. Ordered him a spray of the above-named ingredients, and suspended him from his vocation during treatment. November 20th, 24th, and 27th, continued treatment. Ordered the plasters to be removed, the eruptions cleansed and dressed with belladonna plasters; continued this treatment till December 15th, when he was discharged free from all trouble of the air-passages. Among the other causes of mechanical bronchitis are, for example, the grinders' rot, or knife-grinders' disease, and carbonaceous dust, occurring with miners, inhalation of lamp-smoke and carbonic acid formed in pits and wells, and cotton particles, and dust met with among operatives in cotton-mills, needle and glass-grinders, and glass-blowers. ACUTE CATARRH OF THE SMALLER BRONCHI, Mr. F. S. G. lately returned from Europe suffering from the above-named trouble. On examining his chest I found impeded respiration, with mucous râle in the partially occluded respiration, became so alarming that we called in consultation Drs. Beard, Rockwell, and other medical gentlemen, at which time he was examined by the laryngoscope, which revealed the above-mentioned condition of his throat. Here it was agreed that a spray containing a solution of nitrate of silver of 40 grains to the ounce should be used, together with the use of the constant current of eight or ten cells (Stöhrer's battery). October 1.-This treatment was continued until about the 20th of the month, with very little improvement. November 2.-Throat trouble still more alarming; another examination by the laryngoscope: thickening and ulceration clearly defined; present at the examination, Drs. Beard and De Bow. November 3, 6 A.M-Called in haste; Mr. McL. reported dying from suffocation. Accompanied by Dr. Vickers, we proceeded at once to his house, when we found marked and laborious long-drawn breathing so characteristic of stricture of the larynx, with stridor audible at quite a distance, with symptoms of carbonic poisoning. After placing his feet in hot mustard water and administering a zinc emetic, we exhibited a mixture of ether and chloroform, with only temporary relief, after several hours' trial of various anti-spasmodic remedies. By the happy suggestion of Dr. Vickers we gave him a hypodermic injection of a solution of atropia, amounting to about one-sixtieth of a grain. This was followed by a dilatation of the pupils, as well as a relier from his spasmodic stricture; half an hour subsequent, repeated the hypodermic injection of one-sixtieth of a grain, which produced a quiet sleep. We also (by the advice of Dr. Vickers) continued this treatment for several days, together with the administration of iodoform, with pyrophosphate of iron, of two grains each, morning and evening, with very happy results, all the alarming symptoms having subsided. He still keeps his room, with the endeavor to establish a dry and equitable temperature. Thus, together with a generous diet and a continuation of the iodoform, we may entertain great hopes of ameliorating his trouble. The above is a case wherein the usual and well-known remedies, the spray and electricity, seemed utterly to fail of any good results. lung by ulceration from phthisis, which resulted in a cicatrix and restoration to health-a condition of things so vividly described by John Hughes Bennett in his able clinical lectures. In the treatment of hemorrhage of the air-passages, I found the spray styptics (especially when moderated with glycerine) to be a most reliable, rapid, and satisfactory remedy, and mention the above simply as a typical case. CHRONIC CATARRH OF THE FAUCES AND NASAL CAVITIES. On the 13th of May, 1869, Mr. E. called at the office, and complained of pain and difficulty of swallowing, and occasionally became worse; had also, on examining his throat, discovered small phlyctenula or encysted tubercle coming on the soft palate, which, on account of their color and disagreeable odor when squeezed, he ex-believed to be tubercles, and from this he feared he had consumption. He also complained of an irritating, disagreeable sensation of prickling, of dryness in the throat, which made him unwilling to swallow, but frequently made him hawk and hack for a long time; this hacking increased to a troublesome spasmodic cough, and his voice became husky, and finally hoarse; at night his nose became stopped and he was compelled to sleep with his mouth open, and in the morning his tongue was very dry, followed by slight hemorrhage, and the effect was most depressing. The treatment of the diseases of the cavity of the nose is attendant with more or less difficulties, owing to the fact that the cavity is large and complicated by many sinuosities, interrupted by many thin bony and membranous proHeat-jections, and therefore little accessible, and for the most part not accessible at all to instruments by which growths might be removed, or topical remedies applied. CHRONIC PHTHISIS, LARGE EXCAVATION OF THE RIGHT LUNG. Tongue slightly furred; no diarrhoea at present, but says he is very subject to attacks of it; body greatly emaciated, and copious sweating at night. Other functions normal. Milk mixed with an equal part of lime-water, and strong beef-tea with toast, to be taken frequently in small quantities. June 1.-Ordered him cod-liver oil and iron tonics; also directed him to spend the warm season in the country. September 1.-Returned very much improved. September 28.-Was called at his house, and found him suffering from HEMOPTYSIS. May 13, 1869, we commenced the treatment in Mr. E.'s case: A nasal douche, containing glycerine, iodine, and carbolic acid in solution of one or two quarts of warm water, temperature of over 100° F., for the reason that warm glycerine solutions are more efficacions and agreeable to the inflamed and irritated membrane. After this exhibition we directed the spray fluid, containing the same ingredients, directed to the diseased portion of the fauces and vocal chords. This treatment was continued in this case for a few weeks with entire success. Since the above I have treated cases, quite a number of them, with like results. Still, I would not have it understood that all cases of chronic catarrh treated in this way result so favorably; on the contrary, many of them, especially those with a specific taint, partially or wholly resist all sorts of treatment. We now have under this treatment a young lady in whom we can trace no taint whatever. Still, she has been under our care for over one year-with marked benefit, yet not entirely cured, though she cannot leave off the treatment, because her trouble becomes aggravated both as to her suffering and to the foul odor of her disease. Within the past two years I have also found the gentle constant current useful in these cases; often, when all other remedies fail, this will effect a cure. Blood coughed up in mouthfuls of a frothy and florid color, mingled with sputa; amount of hemorrhage was quite alarming. Ordered him a spray solution of glycerine and liquid sulphate of iron of equal parts, of a few minutes' duration, to be repeated every two or three hours. This acted very kindly as a hæmostatic; also administered a solution of bromide of sodium and tr. of verat. to control the excited heart's action; this reduced the number of his pulse from 110 to 75 or 80, having the effect of making it normal, soft, and regular. Endeavored to establish strict mental and bodily repose, rest in bed, head and shoulders elevated, unstimulating diet. ice-cold drinks, counter-irritant to the chest, and fluidicating the cavity, I em loy in all applications a solution extract of ergot, drachm doses, every three or four hours. Under this treatment in a few days the bleeding ceased. Soon after he expectorated the coagulum of the bronchi in small portions. After, which, under generous diet, with inunction of cod-liver oil from head to foot and cod-liver oil injection per rectum, he made steady and rapid progress. Here I may state that my attention was called to his sister (a married lady, 20 years his senior), who had undergone the same ordeal when about his age; she also had lost the apex of the right Of the fluids to be employed for deodorizing and med of glycerine, which seems to hold the agents more steadfast, and to mollify them; as caustics: nit. silver, carbolic acid, persulph. iron, and other strong solutions; milder caustics: sulph. zine, sulph. copper, subacetate of lead, bichloride of mercury; sedative solutions: Prussic acid, tr. of opium. These drugs may be added to some of the above solutions of metallic salts. But if this be desired, it is better to substitute a solution of morphia for tr. of opium. The Prussic acid is incompatible with the copper, silver, and precipitated mercury solutions; it goes conveniently with the alum and common solutions. Styptic or hæmostatic solutions: ice-cold salt water containing an ounce of salt to a pint of ice-water, which takes the first place. If this is insufficient to stop hæmorrhage, a fluid ounce of the tr. sesquichloride of iron may be added to each pint of ice-cold salt water. Stimulating solutions: one ounce of eau de Cologne upon ten ounces of salt water is a useful stimulant; strong spirit of wine may be taken in place of the eau de Cologne. Mode of applying these fluids to the nose by means of the douche and spray apparatus is as follows:-The fluid of the proper composition and temperature is filled into the glass vessel; all air in the india-rubber tube is now replaced by fluid, the escape of the air upwards being facilitated by gentle manipulation. The glass vessel is raised and fixed in the position which will give the desired pressure. THE STEAM ATOMIZER consists of the sphere-shaped brass boiler steam outlet tube, with packing-box formed to receive rubber packing, through which the atomizing tube passes steamtight, and by means of which tubes of various sizes may be tightly held against any force of steam by screwing down its cover while the packing is warm. There is a safety-valve of graduation for high or low pressure by the spring and screw in its top, the non-conducting handle by which the boiler may be lifted while hot, the medicament cup and cup-holder, the support, the base, the glass face-shield with oval mouth-piece connected by the elastic band with the cradle, whose slotted staff passes into a slot in the shield-stand, where it may be fixed at any height or angle required by the the milled screw. The upright arm of the Bergsson atomizing tube, is formed in part by a rubber tube which dips into the medicament placed in the bottom of the jar. In this instrument the receptacle for the medicament, and the shield for the protection of the face are united in one piece, while the spray is rendered exceedingly fine by being thrown forcibly against the sides of the jar. Then there is the elastic bulb which, with its valves, serves to force air into the elastic chamber, which, alternately expanding and contracting, supplies a steady stream of air to the atomizing tubes, one branch of which dips into the vial containing the medicament. The stopper is made of elastic rubber, and fits perfectly the atomizing tubes and vial. In addition to its other uses, this instrument constitutes a perfect douche for bathing and making medicinal applications to burns, sensitive eyes, inflamed surfaces, painful sores, and for perfuming or disinfecting the sick-room. The freezing apparatus for producing local anesthesia is similar to the above, with exception of atomizing tubes (which are of metal), and is all that is required for producing local anæsthesia by freezing with ether or with rhigolene., The metallic tubes which accompany this apparatus are equally efficient for inhaling purposes, except for liquids liable to be vitiated by contact with metal, for which glass, silver, or platinum tubes should be used. Again, there are glass tubes for throwing spray downwards into the larynx, or, when inverted upward, into the posterior nares; glass tubes for throwing spray upwards into the posterior nares; dental tubes, the bifurcated portion of the tubes designed to deliver spray on both sides of the gum at the same moment, and a conical end of air-tube, over which the rubber tube of the bulbs is passed when used, and regulator tocontrol amount of liquid. These tubes are for teeth extraction, painless removal of dental pulp and other opera tions in dental surgery. With the bulbs they form the most desirable apparatus yet devised for these uses. CHLOROFORM ADMINISTERED BY SPRAY. I have found this agent far more safe when administered by the spray atomizer, as per experiments upon myself, patients, and the lower animals; the same may be said of ether and alcohol, both rapidly and softly producing anesthesia; the theory being that the extra amount of oxygen and attenuation producing this effect more gradually, thus the nerve, arteries, and peripherals saved much time, as well as chloroform and ether. This are not so suddenly paralyzed; aside from this we have method will be found useful in stricture of the trachea and oesophagus, asthmatic and other spasmodic troubles. I was quite astonished to find alcohol, when administered in this way, so rapidly produce uncon sciousness. ON THE USE OF DR. SQUIRE'S CATHETER IN PROSTATIC ENLARGEMENT, AND ITS MODIFICATION. BY S. CARO, M.D. NEW YORK. W. P. F., Esq., aged 81, average weight 250, habits temperate, and is in every respect healthy. In the month of May, 1870, he complained of difficulty in micturition. My advice was to have the urinary canal examined, in order to ascertain the cause of the trouble, as I considered it due to the enlargement of the prostate. To this he opposed, and nothing was done. On the 12th of September last, whilst at dinner, he was suddenly seized with strangury, and was compelled to leave the table, but before reaching the door he discharged his urine involuntarily, but with much pain. I was immediately summoned, and upon arriving at his residence examined the urinary canal with a No. 8 elastic bougie, and found an enormous enlargement of the middle lobe of the prostate. The bougie was passed with great difficulty, and left in situ for the night. In the morning it was withdrawn, and urine was voided quite freely. The evening of the 13th I used a No. 10, with a little more ease. Until the 27th, this bougie was introduced morning and evening, leaving it in the canal several hours at a time. In the mean time the compound tincture of iodine was applied in the perineal region. On the 28th a No. 12 bougie was readily passed, and left in situ for two hours. A professional gentleman, relative of the family, on a visit, was intrusted to introduce it at night, leaving it in urethra for two or three hours. Unfortunately, and contrary to instructions, this gentleman went to an evening party, left the bougie within reach of my patient, who, being desirous to retire, introduced it himself, forced the instrument the wrong way, lacerating a fold of the urethra and prostatic gland, causing some hemorrhage, great inflammation of the adjacent parts, producing cysto-peritonitis, with great difficulty of micturition. From the 28th of September until the 1st of October the water dribbled and only by drops; there was no possibility of introducing a catheter of any size. Applying to Mr. Philip Schmidt (Stohlmann, Pfarre & Co.) of 107 East 28th street for one of Dr. Squire's vertebrated catheters, he kindly furnished me with a No. 8. Oct. 2d, 2 a.m., whilst the patient was suffering fearfully from uræmic convulsion, the passage of |