M.D., of Philadelphia; Remarks on Vomiting, Physiological and Clinical, by J. H. Musser, M.D., of Philadelphia.

In the business meeting the Society voted an appropriation of one thousand dollars to the Entertainment Committee of the Ninth International Congress, and three hundred dollars (one hundred annually for three years) to the Rush Monument Fund.

The following officers were elected for the next meeting:

President.-R. J. Levis, M.D., Philadelphia. Vice-Presidents.-J. T. Ullom, M.D., Greene County; J. L. Seybert, M.D., Centre County ; W. F. Hughes, M.D., Bedford County; A. M. Cooper, M.D., Bucks County.

Permanent Secretary.-William B. Atkinson, M.D., Philadelphia.

Recording Secretary.-Charles W. Dulles, M.D., Philadelphia.

Corresponding Secretary.-J. H. Musser, M.D., Philadelphia.

Treasurer.-O. H. Allis, M.D., Philadel

phia.

Chairman of Committee on Publication. W. H. Parish, M.D., Philadelphia.

The next meeting will be held in Philadelphia on the first Tuesday in June, 1888. Dr. John H. Packard is Chairman of the Committee on Arrangements.

THE AMERICAN LARYNGOLOGICAL AS

SOCIATION.

MEETING OF MAY 26, 27, and 28, 1887. (Continued from page 682.)

Third Day, Morning Session.

CONSTITUTIONAL CAUSES OF THROAT-AFFECTIONS. BY S. W. LANGMAID, M.D., of BOSTON.

THE HE writer suggested that the most interesting lesson to be drawn from the observation of the lesions in throat-trouble is that there is some underlying cause, which may be external or intrinsic. Our attention has been directed too much to the local condition and to atmospheric influences. Why atmospheric conditions are active at one time and not at another is a matter worthy of consideration. One of the most intractable diseases which we have to treat is chronic recurring coryza. Sometimes destruction of the mucous membrane of the nose is sufficient; but, as a rule, the treatment must take in all the circumstances of the life of the sufferer. A sense of a lump in the throat, so often complained of, is often an indication of an overloaded colon, and more good is done by a dose of castor oil than by local treatment. The so-called clergyman's sore throat, or follicular laryngitis, has its origin not in the necessary use of the throat, but the seden

tary life, with errors in diet and other conditions, plays an important part. Throat-trouble is sometimes a rheumatic or gouty manifestation, and treatment has to be directed to this condition. Local treatment in many throat-troubles is of the nature of repair; constitutional and hygienic treatment must be in the direction of a renewal of the normal processes. Swelling and congestion of the mucous membrane, hypertrophy of the tonsil, elongation of the uvula, etc., must be regarded as symptoms, and the symptoms will not be banished unless the underlying constitutional abnormality be removed.

In the discussion, Drs. Glasgow and Cohen agreed with the reader of the paper.

Dr. Delavan said that in this country we pay too little attention to the hygienic surroundings which are employed at the various spas abroad. This method of treatment is very beneficial in cases of interference with the portal circulation and in gouty diathesis. He had found the salicylates of great service in some of these .cases of throat-trouble. Habitual constipation usually accompanies chronic disease of the pharynx. I have used in these cases the officinal pill of iron and aloes, directing that one be taken at night.

The following papers were read by title: "Affections of the Crico-Arytenoid Articulation," by George W. Major, M.D., of Montreal.

"Cancer of the Larynx," by Hosmer A. Johnson, M.D., of Chicago.

"A Case of Recurring Laryngitis Hemorrhagica," by C. E. Bean, M.D., of St. Paul. The report of

A CASE OF STENOSIS OF THE LARYNX TREATED BY DIVULSION AND SYSTEMATIC DILATATION

was contributed by Morris J. Asch, M.D., of New York.

Miss K. enjoyed good health up to about the age of 27. She then had some pulmonary disorder the exact nature of which could not be ascertained. In 1884 she had some wheez ing in breathing, with slight cough. These symptoms increased in intensity gradually, and in May, 1885, the patient came under the observation of the author. There was at this time great dyspnoea, which was increased by lying down. Examination of the throat showed no abnormality in the larynx or above the cords. Below the cords there were two white swellings united by a membrane posteriorly. The opening of the larynx was diminished to one-third of the normal size. The membrane was cut and divulsion performed. This caused great improvement. Later metallic sounds were used daily, and the forceps once a week. She grew much better, and ceased attending. In September she again returned, with the difficulty of breathing as great as before. This was the result of acute inflammation of the larynx. Under

the use of steam and cold compresses the swelling subsided. O'Dwyer's tubes were tried, but they at once produced spasm and were coughed out. Schroeder's hard-rubber tubes were then used, and within three months the cure was perfect. All the symptoms have now disappeared. There was no history of syphilis and no history of previous inflammation. The affection was evidently the result of subcordal hypertrophic laryngitis.

Dr. J. Solis Cohen said that his experience in stenosis of the larynx had been limited. In one case, reported twenty years ago, he had removed a morbid growth by thyrotomy after it had been destroyed by the internal use of the galvano-cautery, which was probably the first use of the galvano-cautery for this purpose in the United States. The growth had been examined by several microscopists, .who pronounced it epithelioma; but this was evidently an error, as the patient still lives. On this supposition I separated the thyroid cartilage and removed the tumor with one vocal cord. Preliminary tracheotomy had been performed ten days previously. The operation was followed by adhesion of the vocal cord to the tissues of the opposite side. He then had devised an instrument to cut this adhesion. He never had had the courage to attempt dilatation of the larynx without previous tracheotomy. It is better to perform tracheotomy so as to have nothing to interfere with the breathing, and then pursue the most active measures for the relief of the stenosis. When the operation is performed with antiseptic precautions the tracheotomy-wound heals up in a very short time. He had seen it close within four or five days of the operation. The danger from the operation is less than the risk of injury from the other methods of treatment.

Dr. E. C. Morgan recently had had under treatment a case of laryngeal stenosis. During a period of eight or ten months he was enabled to control this by the administration of iodide of potassium and by local applications of iodo-glycerin to the larynx. Finally, the disease advanced so far that on several occasions he advised tracheotomy, to be followed by dilatation. The patient postponed the operation, although warned of his danger. He had at times suffocative spells at night, and finally succumbed in one of these spasmodic attacks. If tracheotomy had been allowed and dilatation performed, that man would probably have been alive to-day.

Dr. Delavan: The various forms of dilators used in these cases are likely to be replaced by O'Dwyer's tubes. This method has a most promising future before it. The tube can be left in for a length of time and respiration go on uninterruptedly.

A paper was presented by D. Bryson Delavan on The Etiology of Deflections of the Nasal Septum."

Dr. S. W. Langmaid read the next paper, on

FOREIGN BODY IN THE LARYNX.

months after swallowing a pin about two The patient came under observation three inches in length, which had lodged in the throat. Immediately after the accident an unsuccessful effort had been made to remove it with the bristle-probang. At the time that were ulcerations of the larynx, which were relieved by treatment. Two years later the patient again presented herself, when an examination showed the pin, which had emerged It was with some difficulty removed.

she came under the speaker's notice there

from the ventricular band with the head down.

A PECULIAR APPEARANCE IN THE PHARYNX.

instances he had seen, on examining the Dr. J. Solis Cohen stated that in several pharynx, what appeared to be the belly of a muscle above the Eustachian tube, and that from this there extended to the fornix of the pharynx what looked like a tendon. This he had seen on both sides. He asked whether or not any of the other members had observed the same appearance. The report of a case of

RECURRENT NASO-PHARYNGEAL TUMOR; CURE BY ELECTROLYSIS,

was read by Dr. Rufus P. Lincoln, of New York.

The patient presented himself in April, 1886. A growth had been removed from the posterior nares by another physician one year previously. It returned, and the operation was repeated six months later. When the patient came under observation he was unable to breathe through the left nostril. On examination, a large growth was found occupying the left half of the posterior nares, and it was decided to treat this by electrolysis. On June 3, two needles connected with the negative pole of the battery were introduced through the anterior nares into the growth, while the positive pole terminated in two large sponge-electrodes which were applied to the front and back of the chest. In all sixteen applications were made, at intervals of three or four days. This caused an entire disappearance of the growth. The immediate effect of the electrolysis was to cause distention and a change in the color of the growth, but these passed off in the course of twenty-four hours. There is up to the present time no evidence of return of the growth.

DISCUSSION.

Dr. F. H. Hooper: In October, 1881, a youth presented himself with a tumor extending from the tip of the right nostril into the naso-pharyngeal cavity. There had been a great deal of hemorrhage, and the patient was in a bad condition. He was sent into the hospital and operated on by Dr. J. C. Warren with the galvano-cautery snare, and the whole

mass removed in one piece. From that time to this the patient has been constantly under treatment. The tumor has been growing, and from time to time has been snared off. The tumor has been pronounced to be a most malignant form of myxosarcoma, but the general health is excellent. He proposes to try the effect of electrolysis upon the growth.

Dr. D. Bryson Delavan said that during the past fifteen years he had seen a number of these patients operated upon, and recalled many cases in which the result was disastrous. Although there have been successful cases, none had come under his observation. The great point is in the early diagnosis. If taken in time, even if it cannot be cured, it can be kept in check as a rule. After the age of twenty-five years it has been stated that these tumors have a tendency to stop growing, so that if kept in check until this age they may entirely disappear. It seems to him that the galvano-cautery exercises a modifying influence on the tissues which remain which cannot be caused by the knife.

TWO UNIQUE CASES OF CONGENITAL OCCLUSION OF THE ANTERIOR NARES. BY W. C. JARVIS, M.D., OF NEW YORK.

Complete congenital occlusion of the an terior nares is rare, and the author has been unable to discover any cases in searching the literature of the subject. The first case was a young man 18 years of age, with complete closure of both nostrils. Inspection showed on each side within the anterior nares a cupshaped depression of white, glistening membrane. On the left side a small hole was discovered. The operation was performed in April, 1886. The burrs devised by the speaker, connected with an engine, were used to cut through the cartilaginous occlusion. This was accomplished in a few minutes, and the air passed freely through the nostril. At a subsequent operation the right nostril was opened. In April, 1887, the opening in the right nostril had become contracted, and had to be reopened. In a second case, in which the anterior nostrils were occluded by an osseous growth, the operation was performed in the same manner as in the previous case, with success.

A COMPARATIVE STUDY OF SOME OF THE METHODS OF TREATMENT BEST ADAPTED TO THE RELIEF OF OCCLUSION OF THE POSTERIOR NARES. BY DR. ALEXANDER W. MACCOY, OF PHILADELPHIA.

The paper was restricted to the consideration of occlusion due to enlargement of the soft parts. He had never seen occlusion of the posterior nares due to osseous growth. He referred to the methods used in the treatment of occlusion of the posterior nares, and highly recommended the use of chromic acid fused on the end of a probe, the end of which is covered with a tube, which is withdrawn

when the probe has reached the desired position. This is followed by the use of an antagonistic solution. He had found this better than the use of the galvano-cautery. After using cocaine he had not been able to use the cold-wire snare in these cases, on account of the contraction caused by the drug. He had also found difficulty in using the needles recommended by Dr. Jarvis. The chief object of the paper was to call attention to the superiority of chromic acid used in this way over the other methods of treatment which had been recommended. He did not recommend the use of the acid either in crystal or in solution, for then it was not easy to limit the application to the desired point.

DISCUSSION.

Dr. W. C. Jarvis never uses cocaine as a preliminary measure when he intends to remove posterior hypertrophies. He first includes the hypertrophies in the loop and tightens the wire before applying the cocaine spray. The tissue included in the loop cannot be affected by the contraction produced by the drug. We thus have the advantages of the anaesthetic without its disadvantages. It has been pretty generally recognized that chromic acid has many disadvantages. It may produce serious symptoms. The snare will accomplish in a few minutes what chromic acid requires considerable time to do.

Dr. C. C. Rice agreed in the main with the author of the paper. The turbinate bodies are difficult to penetrate with the needles, and there are many cases in which it is difficult to apply the loop posteriorly. He had not found any special disadvantages in the use of chromic acid.

Dr. D. Bryson Delavan formerly used chromic acid, but then gave it up. Lately he had again tested it, selecting for this purpose five patients, three of whom were physicians. He added enough water to the crystals to make them deliquesce, and then applied it with a cotton-wrapped probe, the excess of acid having been removed. He had also used it by fusing it on a probe. In all these cases there was more reaction than follows the use of the cautery or the snare, and all the patients preferred the cautery to the chronic acid.

A paper on "Plaster-of-Paris Dressing for Fracture of the Nose," by J. W. Robertson, M.D., of Detroit, was read by title.

Dr. De Blois, of Boston, exhibited a plaster splint which he had employed with advantage in a case of fracture of the nose. The splint consisted simply of a plaster cast into which a piece of roller bandage had been incorporated. This was applied over the nose and held in position by the strips of bandage. Dr. J. O. Roe, of Rochester, exhibited a saw run by an electric motor.

The Association held an executive session,