7. Mich'l O'Rorque 2 years, Chicago.. Dr. E. W. Lee. Nov. 23, 1877. 2 mos. croup. croup. Membranous Recovered. 94 Brown St., Dr. E. W. Lee. Oct. 12, 1878. croup, no membrane visible. Chicago. 9. Albert Caproni.. 4 years. Diphtheria. Died. 254 S. Halsted Dr. E. W. Lee. St., Chicago. Dec. 9, 1878. REMARKS. Sick three days. Used chloroform. Sick two days. Asphyxia immi- Sick thirty-six hours. Lived two Sick five days. Chloroform. Lived Three days sick. Tube worn nine 12. Aaron West.. 5 years. Diphtheria. Recovered. S. Dearborn Dr. E. W. Lee. Aug. 17, 1879. husky voice; dilated nostrils; epi- Lived sixty hours after operation. Duration of previous illness, five Duration of previous illness, one death, exhaustion. Anesthetic, Previous illness, eight days. Lived respiration, 48; temperature, 103° F. Low operation. REMARKS. Previous illness, seven days. Tube Previously ill, ten days. Tube worn Previous illness, eight days. Lived tensive diphtheric exudation. Marked symptoms of blood-poisoning. Anesthetic, chloroform. tions prominently two varieties of tracheal constriction. The first variety, although rare, has, however, been demonstrated in a certain number of cases. It arises through the presence of fleshy growths springing from the wound, especially through those deeply seated upon the borders of the tracheal incision, and which grow in the midst of a cicatricial tissue projecting into the air-passages after the closure of the cutaneous wound. The second variety, up to the present time, has not been described at all. A tracheotomized child was seized with a fit of suffocation just as the physician was attempting to effect a permanent removal of the cannula. Examining the depths of the tracheal wound, he perceived a reddish prominence in the interior of the trachea, which was taken for fleshy vegetation of the posterior wall. The child died in a fit of suffocation. Professor Guyon recognized, upon the postmortem specimen sent him, that the projection regarded during life as vegetation was formed by the posterior wall of the trachea itself, which was folded longitudinally in its entire thickness. This folding was itself due to the approximation of the posterior extremities of the tracheal rings, separated anteriorly for the introduction of the cannula. M. Currie, experimenting with the view of discovering the conditions of the production of this protrusion, concluded that this particular variety of constriction, which hitherto had not been pointed out, ought to be, nevertheless, rather frequent among children. It occurs after the introduction of the cannula, and the more readily according as the membranous span which lies between the posterior extremities of the rings is large. It affects chiefly first the three rings of the trachea. The projection which results produces a tracheal constriction that may persist and prove a permanent obstacle to the removal of the cannula. THE ENDOSCOPE IN THE LOCAL TREATMENT OF CHRONIC GONORRHEA OR GLEET AND GONORRHEAL RHEUMATISM* WITH A. HINDE I. THE ENDOSCOPE It was in the first quarter of the present century that the experiment was first made to render visible the urethral canal from its meatus to the bladder by Barini, in Frankfort, in 1806; Fisher, in Boston, in 1824; Segalas, in Paris, in 1826; and Hacken, in Riga. These experimenters failed to attract professional attention. To Desormeaux, after years of arduous toil in this field of investigation, we owe the credit of successful accomplishment. In 1852 he exhibited his endoscope in the French Academy. In 1865 he published his valuable monograph† on this subject, in which he advanced a series of facts and original observations which have opened up a new path in the diagnosis and treatment of urethral diseases. Desormeaux's instrument is too well known to need description here, therefore we shall mention only a few details, showing some defects in his original instrument. Desormeaux's lamp gave insufficient light, and on this account Bruns used the calcium light, and Dr. Andrews, of Chicago, the magnesium light. These modifications were too complicated and hence were not generally used. At the present time kerosene or kerosene and camphor forms the burning material for the lamp. Desormeaux's lamp is connected with a tube containing a reflector and telescope; to the end of the latter are connected the urethral tubes. Desormeaux's instrument is too costly-one hundred and fifty francs (twentyfive to thirty dollars) and also too complicated for general use, and consequently simplified instruments have been invented by Warwick‡ and Wales, but their instruments have not come into general use, and Fürstenheim pronounces them inefficient. After several years of experimentation with a view of simplifying the endoscope I decided upon the use of the following instrument: 1. For the lamp, a circular wick; ordinary kerosene is all sufficient. 2. A common laryngoscopic reflector is also needed, but if sunlight can be obtained, a plain reflector will best answer our purpose. † De l'endoscope et de ses applications au diagnostic et au traitement des affections de l'urethre et de la vessie, Paris, 1865. Brit. Med. Jour., 1867, vol. ii, p. 124. § Virchow's Jahresbericht, 1868, vol. ii, p. 180. |