FOREIGN CORRESPONDENCE.

LONDON LETTERS.

LONDON, September 11, 1886. DEAR DOCTOR.-Your kind suggestion to me, before I left St. Louis, to write anything of interest to you, occurred to me the other day while I was present at an operation. The operation was so interesting in itself and so well performed by the operator, Mr. Charles Stonham, F. R. C. S., that I was induced to make note of it. I hereby send you a report of it, which, if you deem sufficiently interesting, you may use for publication.

HISTORY.-Patient, a lad of 15 years. The exact date of beginning of present trouble is not definitely known. His family history is good. At present there is great difficulty in breathing; very loud snoring at night, and a very troublesome epistaxis, occurring about three or four times a week. Both nostrils are completely blocked, breathing being possible through the mouth only. The general health otherwise is good.

PRESENT APPEARANCE.-By probing through the anterior nares one could feel on each side a mass filling up the posterior nares. By examination with speculum and probing, one could easily see and feel, that the growth was not attached to either side of the nasal passages. By having the patient open his mouth and say "ah," the lower border of the growth was readily seen. By introducing the finger back of the palate, the mass was felt attached to the anterior surface of the nasal vertebræ. Touching the growth caused it to bleed.

OPERATION.-As a preliminary step, the operator performed laryngo-tracheotomy, introducing a tracheotomy tube. Thereupon he stuffed a sponge into the pharynx, which prevented blood from running down the larynx. This having been done, Lawrence's operation was begun. An incision was made commencing on a level with, 'and a little to the inside of the lower margin of the right orbit. It was carried down the side of the nose, around the nose and up the other side to a corresponding point. The

operation next divided the cartilaginous septum, with bone forceps, cutting obliquely upwards and backwards. The nasal bones were now separated from the nasal process of the superior maxillary bones and then forcibly bent upwards, thereby fracturing or rather disarticulating them from the frontal bone. The entire vomer was divided and removed by means of sequestrum forceps. The turbinated bones were pressed against the walls of the nasal fossæ so as to make as much room as possible. The growth was now perfectly visible. The anterior part, i. e., the part attached to the basilar process of the occipital bone, was readily removed with Paquelin's cautery. The posterior part, i. e., the part attached to the anterior surface of the vertebræ could not be so readily removed. Some of it was removed with the sharp spoon, but the greater part being very tough and so firmly attached resisted this maneuvre. The surgeon grasped it with a forceps, applying them as near the base as possible; guiding the cautery by means of the forceps, he succeeded in removing the growth. The nose was now replaced and the wound sewed up with silver wire. The apposition of the parts was perfect. The tracheotomy tube was removed and the wound. sewed up. About thirty minutes after the operation hemorrhage occurred, lasting about an hour, leaving the patient in a condition of syncope. The temperature, in the succeeding days, rose as high as 101° F. This was owing to a basilar meningitis. It however yielded to bromide and iodide of potassium. To-day, the fourteenth day after the operation, I saw the lad. The success was perfect, not the slightest disfigurement, and nasal breathing perfect. Respectfully, AL. J. KANNE.

For the opportunity of publishing the following letter from Dr. Geo. E. Ranney, we are indebted to Dr. J. E. Post, of Lansing, Mich. [ED. COURIER.

LONDON, ENGLAND, 449 STRAND, SEPT., 9, 1886.

DEAR DOCTOR:-I have been spending my time in London visiting the different hospitals and have a programme by which I can find something of interest to occupy me about all the week. Wednesday I was present at one ovariotomy at the woman's hospital; and in the afternoon of same day, I witnessed six operations, one for the removal of half of the upper maxillary, two explora

tions of surgical kidneys, and emptying abscesses of pus, an operation for the radical cure of hernia, etc.

Yesterday I visited the surgical wards at the university in the forenoon, and in the afternoon was present at the same place to witness two excisions of knee-joint, the cleaning out of an old sinus in abdomen of a patient on whom one year ago the surgeon operated and removed a hydatid cyst from liver and the wound never fairly healed. He enlarged the opening and scraped out a quantity of calcareous material. He also removed a fatty tumor from the leg and a lupus from face, involving both cheeks and nose. I mention this to show you just an average run of surgical practice here. From two to four nights in a week we visit either a skin clinic or the hospital for throat and ear troubles, where at either place we see a hundred patients at each visit with privilege of examining any we chose to do. We occasionally visit the cancer hospital and witness the work there and the operations. One hospital for the treatment of syphilis in men and and another in women, afford us ample opportunity for observation in that line. Another for piles and fistula and one for the treatment of children, present large clinics and are good in their way. In a few minutes I have an engagement to go to Guy's Hospital to witness operations. They always have something good there. They remove kidneys with impunity and with one hand tied behind them. I have seen six or seven explorations of the kidney since I have been in London. I have seen a great deal of vast importance. I do not pretend to take any special courses here, but will go to Germany, probably the latter part of the month, where I expect to take some special courses. I saw Tait at Brighton, would have gone to Birmingham to see him operate, but it was his vacation time and his hospital was undergoing repairs. I expect to go down there before I return. My paper was well received at Brighton; I was elected a member of the B. M. Association. Was nicely entertained by the leading men in obstetrical section. Yours truly,

G. E. RANNY.

MISSIONARY NURSE.-Miss Annie Ellers has gone as a missionary to Korea and has been well received there. Her superior train ing as a nurse, it is believed, will render her services invaluable to the physicians. She has gone to Seoul where cholera is prevailing

now.

the several city wards. The shaded part indicates the part of the The accompanying map shows the distribution of diphtheria in

city which is supplied with

W=wells.

sewers, C=cases, D-deaths,

DIPHTHERIA IN ST. LOUIS JUNE-OCTOBER, 1886.

In a lecture before the Massachusetts Teacher's Association, Dec. 1884, Dr. Frank Wells makes allusion to a matter which may well be considered at this point, viz., the danger which may arise from the wells of the country school-houses in remote country districts, which are used only in school terms. During the vacations no water is taken from them, and hence it becomes stagnant. Not infrequently the well is partially filled with rotten wood, fallen leaves or even dead animals. In the autumn this water is drunk by the pupils and either alone or in conjunction with other unsanitary influences causes disease. It would be better to have no well at all than to have one in which the water is impure.

The dangers which arise from the drinking of impure water are such that it is of the highest importance to be able to determine the presence of decomposable organic matter or sewage in water for drinking purposes. The following test of Heisch's is reliable and simple: "Fill a clean pint bottle three-fourths full