ment by the patient in cases of otorrhoea. The most the patient should be directed to do is to dry his ear according to its need, by running into the canal and down to the fundus a twisted pencil of absorbent cotton. The surgeon is to use the syringe only when it is absolutely necessary to remove by it the matter from the ear, and thus prepare the organ for the application of medication by his hand. This latter part of the treatment should consist in the blowing of powders into the ear. Of these, Dr. Burnett recommends one prepared by triturating equal parts of tincture of Calendula officinalis with boracic acid (gr. to minim), allowing evaporation, then rubbing one part of the thus calendulated boracic acid with one or two parts of pure boracic acid. Alum should not be used, on account of its tendency to produce furuncles. Comparative tables are given, which show that by the dry method of treatment the average duration of treatment may be shortened from 212 days under the old plan, to 34 days by the dry method.

Treatment of Nausea and Vomiting in Uterine Affections.-Dr. Chéron recommends the following:

A teaspoonful of number 1 to be mixed with a tablespoonful of number 2, and the mixture to be taken during effervescence; the dose to be repeated every hour or half hour. The above represents the maximum quantity to be taken in a day. (Revue des Maladies des Femmes). La France Médicale. 18th October, 1881.-G.S.M.

The

Resection of the Sternum. This operation was performed by König (Göttingen) upon a woman, aged 36 years, suffering from a tumour (osteoid chondroma) of the sternum of 2 years' growth, but otherwise in good health. tumour was oval in shape, situated in the body of the sternum, and extended from the level of the second costal cartilage above, to near the xyphoid process below, but did

not reach much beyond the normal limits of the bone on either side. The soft parts were reflected by a crucial incision so as to expose the tumour, the manubrium, xyphoid cartilage, and inner portions of the costal cartilages. Then, by means of an elevator, the ribs were separated from the underlying soft parts about an inch and a quarter from their insertion, to allow of the introduction of a broad flat hook, against which the ribs were divided with a knife. The sternum was divided in a similar manner, at the level of the first intercostal space. Sharp hooks were then used to raise the right side of the sternum and portions of ribs still attached to it, and the bone and tumour, which projected considerably into the mediastinum, were separated from the soft parts with the finger. The same thing having been done on the left side, the upper part of the sternum was drawn forward, and the separation with the finger proceeded with from above downwards. Both mammary arteries being exposed were ligatured and divided. In spite of all care taken, the right pleura was torn at the level of the fourth rib, the air entering with a "lapping" noise, but a compress of gauze was immediately applied over the rent and held firmly there. It was then found that there was a firm adhesion between the tumour and the pericardium, necessitating the division of the sac with scissors, so that the surface of the heart was exposed. During the further separation of the tumour, the left pleura was also torn. As the operation proceeded, several assistants, following the operator's hands, promptly covered the exposed tissues with gauze compresses, which they held firmly applied on all

sides.

The wound was closed with sutures, two drainage tubes inserted, and a very large antiseptic dressing applied. The patient lost a considerable quantity of blood during the long operation two and a half hours-but made a good recovery. For the first day respiration was very rapid, and on the fourth, the pulse rate increased considerably, but the former symptoms passed off, the latter was removed by a few doses of digitalis, and no other threatening symptoms arose. The wound healed rapidly and well. The operation was performed upon 17th July last.-Centrabl. f. Chir., 1882, No. 42.—D. M‘P.

New Operation for the Cure of Uterine Displacements.-The following notes from a paper in the Liverpool Medico-Chirurgical Journal may prove interesting as demonstrating the efficacy of the operation for prolapsus and retroflexio uteri, which was simultaneously brought before the

medical profession by Dr. Alexander of Liverpool and Dr. James A. Adams of this city.

The operation consists in cutting down upon the external inguinal rings where the round ligaments may be grasped, and gently drawing out these ligaments, so remedying any prolapsed or retroflexed condition the womb may be found in.

Dr. Alexander has now operated in ten cases of displacements of the womb, and he gives the results in the January number of the above mentioned Journal.

With one exception the cases all did remarkably well, and the women were relieved from the painful symptoms which their disease had given rise to. In one case the patient suffered from distinct retroversion of the uterus, and was also addicted to epileptic fits of a severe character. A month after the operation she left the hospital cured, not only of her uterine affection, but also of her epileptic fits. She was subject, previous to the operation, to as many as five fits in a day. Since the womb has been replaced in its normal position she has become pregnant, and the future course of this case will demonstrate the influence that shortening of the round ligaments will have on pregnancy. She has now reached the fifth month.

Dr. Alexander's paper is full of practical and useful hints as to the best mode of retaining the ligaments after they have been pulled out, and also as to details of subsequent treatment. In concluding, he says, "It is a certainty that up to June last I never heard that any surgeon had proposed to utilise the round ligaments in the correction of uterine displacements. From a paper in the Glasgow Medical Journal of that date, by Dr. Jas. A. Adams, Demonstrator of Anatomy in the Glasgow University, I find that he has been working at the same subject, and that he had attempted to perform the operation on the living subject between two and three months after the date of my first operation, but failed, owing to adhesions. . . The matter is not one of any importance, but I freely admit Dr. Adams' claim to originality to be as great as my own, and hail with pleasure his powerful support to what I have no doubt will come to be a useful operation."

Bromide of Ethyl during Labour.-M. Lebert, who has been employing bromide of ethyl largely in midwifery cases, accords it great value in simple confinements. It diminishes and finally suppresses the pain, without having any hurtful effect upon the mother or upon the child. He states also that under its influence labour is more rapid and surgical interfer

ence rendered less necessary. The subsequent recovery he believes to be speedier, and the tendency to flooding much less than when the drug is dispensed with.-Lyon Médical. 1883. —J. A. A.

Laparo-Colotomy for Removal of a Foreign Body.At the German Surgical Congress, held in June last, Uhde (of Braunschweig) showed a wooden tool he had removed from the left colon of a man, aged 25, by laparo-colotomy. The tool was one used for sewing sacks, and measured 94 in. in length, with a circumference at its thicker end of 3 inches. The patient, an inmate of a house of correction, had pushed this into his rectum on the 1st June, 1882, and left it there. On the 25th June a sudden movement of the body was followed by abdominal pain, and he found that the tool after that was not so easily felt from the outside of the abdomen as it had previously been. In July he suffered from feverishness, diarrhoea with bloody evacuations, tenesmus, and difficulty of micturition. In October there were rigors, with severe pain in the left hip and thigh. The pain increased so much that on 6th April, 1882, he came to the hospital at Braunschweig for relief. At that time the foreign body could be felt through the abdominal parietes to the inner side of the left antr. supr. spine of the ilium. On the next day an unsuccessful attempt was made to reach it by introducing the hand and part of the forearm into the rectum. On the 13th April an incision was made in the left lima semilunaris, through which the foreign body was felt within the descending colon, jammed between the last rib and the sacrum so firmly that the colon was only brought to the wound by considerable traction. The piece of wood was removed through an incision in the gut nearly 11⁄2 in. in length, and this incision was closed with silk sutures. The operation was performed antiseptically, and, in spite of considerable vomiting and hiccough during and after the operation, the patient made a good recovery.

Similar operations, both successful, were performed by Reali in 1848, and by Studsgaard in 1878. In the former case the foreign body had been in the bowel for nine days, in the latter for twenty-four hours. In the present case it had been there for 317 days.-Beilage Z. Cbl. f. Chir. 1882. No. 29.

D. M'P.

THE

GLASGOW MEDICAL

No. IV. APRIL, 1883.

JOURNAL.

ORIGINAL ARTICLES.

NOTES OF TWO CASES OF TUMOUR OF THE LARYNX, IN ONE OF WHICH THE TUMOUR WAS SUCCESSFULLY REMOVED BY THYROTOMY.

BY D. N. KNOX, M.A., M.B.,

Lecturer on Surgery, Western Medical School, Glasgow.

(Read before the Southern Medical Society, 11th January, 1883.)

TUMOURS of the larynx are not so common but that notes of the two following cases may be of interest to the members of this Society. Previous to the discovery of the laryngoscope in 1857, the number of cases reported in medical literature was considerably less than 100, but since that date several hundreds have been recorded as occurring in the practice of a single surgeon. The tumours chiefly found are papilloma and fibroma among the benign, and epithelioma, encephaloid cancers, and spindle-celled sarcoma among the malignant. Of the former class, papilloma is by far the most frequent. Morell Mackenzie states that out of 100 tabulated cases of benign tumour, 67 were judged to be of this character. In appearance, these tumours are generally pink or white; they are usually sessile, and often multiple. Their most common size is that of a large split pea. Their favourite seat is the vocal cords. From this being their position, they are easily seen by the laryngoscope, and their nature easily made out.

As regards symptoms, the presence of a tumour is usually indicated by some alteration of the voice, such as hoarseness or aphonia, paroxysms of dyspnoea, and croupy cough. There may also be other symptoms, such as dysphagia, and the feeling

No. 4.

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Vol. XIX.