polypi, and advised their removal. At various times polypi had been removed from the nostril, but without affording much relief. For the past three years he had had constant colds in the head: nasal obstruction, especially in the left nostril: and severe headaches. There had been no epistaxis. With regard to his personal history, he had always been a steady fellow, a teetotaller, and claimed to be a strong man. He had never lost a day's work through illness till the present time.

I saw him for the first time in February of this year. He had a cachectic appearance, and, what was noticeable, a slow deliberate way of answering questions. On examining the nose, there was found a large tumour, of a pale waxy appearance, entirely plugging up the left nostril. The tumour extended from the anterior naris back to the posterior choana. It was adherent by a broad attachment to the nasal septum, and spread in all directions-forwards, upwards, outwards, and backwards-having numerous bands of attachment to the floor of the nose. It was impossible to pass a probe between the tumour and the turbinal wall, or between the tumour and the floor of the nose, and this could be done only partially between the tumour and the nasal septum. It was fairly vascular, bleeding after being touched with the probe.

As its appearance made me suspicious regarding its nature, I removed a portion of the growth, and sent it to Dr. Leslie Buchanan, of the West of Scotland Clinical Research Laboratory, for microscopical examination. Dr. Buchanan reported that he found it to be a spindle-celled sarcoma, with an admixture of round cells.

Treatment.-A 10 per cent solution of cocaine was applied to render the parts non-sensitive, and adrenalin was used to control hæmorrhage. The septal attachment was cut through with the electro-cautery, and, thereafter, the mass was removed with the scissors and the cold snare at three or four sittings. After removal, the parts were thoroughly cauterised with the electro-cautery.

I think the growth probably originated at the posterior extremity of the turbinal, and spread forwards in the line of least resistance, becoming adherent to the nasal septum and floor of the nose.

By transillumination an attempt was made to find out if the maxillary antrum was involved. Unfortunately, it was one of the cases where transillumination of the antral cavity gives no positive help. As the result of the illumination, there was a slight dark shadow on both sides, not on one side more than the other.

Postscript. The patient was shown at a meeting of the Medico-Chirurgical Society on 1st May. I saw him again in September. He reported himself as feeling very well. Nasal respiration was quite established, and there was no evidence of any recurrence.

In connection with this case, it is interesting to note that in the August number of the Journal of Laryngology Dr. Price-Brown, of Toronto, reported three cases of sarcoma of the nose removed by the electro-cautery. The patients were well, and there had been no recurrence of the growth after intervals of, in one case, eight and a half years, in another of nine months, while the third was a recent case.

Dr. Price-Brown pleads for the intranasal operation with the use of the electro-cautery.

HAMMER-FINGER, WITH NOTES OF SEVEN CASES OCCURRING IN ONE FAMILY.1

BY JAMES SCOTT, M. A., M.B.

HAMMER-FINGER is a deformity which has hitherto attracted very little attention. It is seldom mentioned in surgical textbooks, even in connection with the analogous condition of hammer-toe. Probably this is because the average case causes little trouble or inconvenience. Where, however, more than one joint or more than one finger is affected, or even in an ordinary case where the diminished span of the hand interferes with the patient's occupation, the deformity causes considerable inconvenience, and calls for active treatment. Unfortunately, in such cases the deformity is generally well developed before treatment is thought of; whereas, if the condition had been recognised at an early stage, there would have been much more chance of curing the deformity without surgical interference, which is difficult and complicated for so trifling an

affection.

The following seven cases occur in members of one family. In the tree showing the relationship of the cases to one another sex is indicated by the letter "M" or " F," and those members

1 Read at a meeting of the Glasgow Medico-Chirurgical Society held on 16th October, 1903.

affected with hammer-finger are indicated by a numeral to distinguish them in the report of their cases.

F1, æt. 15, is the youngest daughter of the family in the fourth generation. All four fingers of the right hand present a distinct contraction at the first interphalangeal joint (Fig. 1).

We may define the angle made by the second phalanx, when

extended to its utmost, with the prolonged axis of the, first phalanx as the angle of contraction.

In the fifth digit the angle measures 45°; in the fourth, 30°; in the third, 25°; and in the second, 20°.

The range of movement at this point is thus curtailed in proportion to the degree of the incompleteness of extension, the angle of the extreme flexion being practically constant (about 60°). Movements, however, though thus restricted in amplitude, are quite free, and there is no indication of any inflammatory condition of the joint structures.

At the metacarpo-phalangeal joints the range of movement is greater than usual, especially in the fifth digit, where the first phalanx can be hyperextended till it makes an angle of about 130° with the metacarpal bone. By this means the

extremities of the digit are brought into line with the other fingers, and the first interphalangeal joint projects backwards, instead of the terminal phalanges forwards.

There is also an increased range at the terminal joint, but here hyperextension is only passive-taking place when the hand rests on a flat surface, and bringing the distal phalanx into line with the other fingers.

Lateral deviation of the terminal phalanges of the fifth

(a) CASE F1-Left fifth digit, showing rotation forwards and slightly outwards of head of first phalanx.

(b) Normal fifth digit.

CASE M3.-Right fifth digit fully extended, showing rotation forwards and slightly outwards of head of first phalanx.

digit, and of the fourth to a less degree, is considerable in this case, and increases with flexion of the terminal phalanges. This, together with the flexion of the digit, curtails the span of the hand by more than an inch.

Proportionately to the contraction of the digit, and so greatest in the fifth digit, the flexor tendon can be shown to have contracted (or, rather, not to have fully developed) by grasping the wrist when the finger is being forced backwards, the tendon is then at once made taut; but as flexion of the

No. 5.

Y

Vol. LX.

wrist does not increase the power of extending the finger, this contraction of the tendon is clearly not the sole lesion.

Forcible extension also puts the skin on the stretch, and brings it farther away from the bone than usual, with so firm an edge as to suggest that the flexor tendon had stretched the vaginal ligaments and lay immediately beneath this sharp anterior edge of skin.

The skin is, however, quite smooth, and presents no puckerings or ridges.

The head of the first phalanx (Fig. 2 (a), p. 337) is rotated forwards and slightly outwards.

The contractions of the fingers in this case have developed

slowly and painlessly. For the fifth digit no date can be given, nor can the patient say that she was ever free from the deformity; but in the fourth the contraction was first noticed about five years ago; in the third, about one year ago; and in the second, quite recently.

It must be borne in mind, however, with regard to those dates, that the contractions might have arisen a much longer time ago and not attracted any attention.

In the left hand all the joints have a perfectly normal range of movement.

F2, æt. 24, is the oldest daughter of the same family as F1.