LARYNGOLOGY AND RHINOLOGY.

IN CHARGE OF

PRICE-BROWN, M.D.,

Laryngologist to Western Hospital; Laryngologist to Protestant Orphans' Home.

REMOVAL OF FOREIGN BODY FROM THE NOSE AFTER TWENTYTHREE YEARS.

S. W. Carruthers (Brit. Med. Jour., Feb. 12, 1898) gives the history of a peculiar case. A little girl, seven years old, was pushed down, and got something in one side of her nose, which twentythree years afterwards proved to be a stone. It always produced more or less irritation, and at the ages of eleven, thirteen, and twenty-seven she had polypi removed by different surgeons from the same nasal fossa, who, however, did not appear to have discovered the stone. When the woman was thirty Carruthers was consulted. He found a hard foreign body, lodged about an inch from the nares, above the inferior turbinated. He extracted it with forceps. He accounted for the comparative freedom of breathing through the affected nostril which the patient had always enjoyed to the position of the stone. The dimensions of the stone are not given, but it was large and nodular, and free from the calcareous deposits of which rhinoliths are composed.

RESECTION OF FACIAL AND NASAL WALLS OF THE ANTRUM WITH INVAGINATION OF NASAL MUCOUS MEMBRANE INTO THE CAVITY FOR THE CURE OF OBSTINATE CRUPYNEA.

Bonnereghaus (Archiv. fur Laryng. und Rhinol. Band VI., Heft 2.) A large number of patients suffering from antral disease remain uncured for years, in spite of treatment. For this condition the author describes a method of surgical treatment which he has used successfully in a number of cases.

First, any carious teeth of the superior maxillary on that side are removed and their alveoli scraped. An incision is then made down to the bone from opposite the second incision to the wisdom

tooth. The tissues are next dissected upwards to near the infraorbital foramen. Then sufficient of the anterior wall is removed to allow of a thorough examination of the antrum. The necrosed bone on the nasal side is carefully dissected out, taking care to keep the nasal mucous membrane without perforation. Within the antrum itself the diseased mucous membrane is scraped from the underlying bone. Care is taken not to interfere with the bony walls of the lachrymal canal. The separated nasal mucous membrane which now forms the sole partition between the nose and antrum is pushed from the nose into the cavity and kept in position by strips of iodoform gauze. The mouth wound is packed also with iodoform gauze. In a few days the nasal mucous membrane will have adhered to the walls of the antrum. After-treatment consists in cleansing by blowing and washing out night and morning; the oval aperture remaining open for inspection and cleansing.

(Query: Would not the enlarged nasal cavity have a tendency to produce atrophitic rhinitis ?)

SUPRA-TONSILLAR FOSSA AND ITS AFFECTIONS.

Donald R. Paterson (Jour. Laryng. etc., April, 1898), in a long article, draws attention to the existence at the upper and anterior side of the faucial tonsil of a fossa, hitherto looked upon as a mere tonsillar crypt, but in reality not in any sense of that nature. Having arrived at this conclusion from personal observation, he examined extensively into throat literature, but could get no light upon the subject, except that he found that His, in the year 1885, described the cavity as an anatomical space." Later on, after more extensive investigation, His gave it the further title of "supratonsillar fossa."

A web of membrane, particularly in young subjects, is frequently found to be attached to the free border of the anterior pillar, extending downwards and backwards over the tonsil, called the plica triangularis, and it is between this plica and the upper portion of the tonsil that the supra-tonsillar fossa is found.

One of the chief features of the fossa is the tendency to the accumulations of tonsillar secretions within the cavity, induced by the presence of the plica, a kind of pouch having been formed. The object of treatment is free drainage, either by punching out the upper portion of the tonsil, or removal of a portion of the plica. Papilloma may form upon the plica; malignant disease has also been known to commence in the fossa, while foreign bodies have in a few instances been found lodged within it.

PAPILLOMA OF THE TONSIL.

In the February number of the Journal of Laryngology a number of cases of papilloma of the tonsil were reported by different members of the London Laryngological Society. Although these neoplasms are common on the palate and pillars, records of their occurrence upon the tonsils have been exceedingly rare. At this meeting Hill, Wingrave, Wagelt, Butlin, Horne and Yearsley all reported cases. In all of them the attachment was pedunculated, and limited to a particular spot upon one tonsil. After removal no case of return has been reported.

Mention might be made here of a case reported by T. H. Machell, of Toronto, to the Toronto Medical Society several years ago, and published in the New York Medical Journal, Jan., 1895. In this case what were supposed to be papilloma studded the tonsils completely. They were all pedunculated, each growth having a distinct pedicle. The patient died of scarlet fever. This appears to be the only case on record of such widespread and diffuse papillomatous growths of the tonsil.

TWO CASES OF LARYNGEAL SPASM FATAL, IN THE FIRST ATTACK, OCCURRING IN THE SAME FAMILY.

C. H. Hunter (Brit. Med. Jour., April 2, 1898) gives a brief outline of these remarkable cases, both being perfectly well up to a few minutes before death, and occurring within two days of each other. The first was a boy nineteen months old, one of twins, the other having died a month after its birth. Just before his death his mother took him up to wash him. In a fit of passion he threw his head back and became livid and rigid. He was at once put in a hot bath; but this was of no avail. He died without uttering a sound, and before the doctor arrived. Two days later he was hastily summoned to the boy's sister, aged seven months. The doctor arrived within two or three minutes but found the baby dead. The mother said in this case that the child was lying perfectly well and quiet in her arms. Suddenly without any screaming, the baby became rigid and blue in the face, and died without uttering a sound, just as her brother did.

In both cases there were well marked carpo-pedal contractions, but no general convulsions. In neither case had there been crowing respiration. In the post-mortem examinations all the organs were found healthy. There were no laryngeal obstructions, but there were some indications of rickets. Frederick Taylor says that

rickets is found in seventy-five per cent. of the cases of laryngismus stridulus. This might be the predisposing cause in these cases.

RECURRENT MEMBRANOUS PHARYNGITIS.

Middlemas Hunt (Tour. Laryng., Feb., 1898) reports a case of this disease in a middle-aged lady which had lasted for 19 years. The attack would begin with acute sore throat, followed by formation of membrane over the left tonsil and wall of the pharynx, and also on the left side of posterior surface of epiglottis. This would last for a week or two and then gradually disappear. After a similar interval it would be repeated. This went on year after year for the whole of that time, with the exception of a period of four months, when she was confined to bed from injury to the foot. The membrane on the epiglottis was not continuous with that of the pharynx.

Microscopical examination proved the absence of Klebs-Loeffler bacillus, but the presence of streptococci and staphylococci. Middlemas Hunt was of the opinion that the disease had each time been artificially produced. He ascertained that the patient had a prescription for Liquor Epispasticus repeated at long intervals. He had given this to her some months before the trouble originally began.

In reference to this matter, French soldiers have been known to escape duty by producing artificial membranous sore throats, resembling diphtheria, by rubbing in powdered cantharides with the finger.

MULTIPLE PAPILLOMATA OF THE LARYNX IN YOUNG CHILDREN TREATED BY TRACHEOTOMY ONLY.

T. C. Railton (Brit. Med. Jour., Feb., 1898) gives the history of two little girls, aged respectively three and four years; both had multiple laryngeal papillomata: tracheotomy in each case gave immediate relief to respiration. One required to wear the tube for forty-five months before the growths were all absorbed; the other for twenty-five months. In each case the child made a good recovery eventually without any return of the papilloma. At first silver tubes were worn, then soft rubber ones. The latter were renewed three times a week. In his remarks, the writer attributes the spontaneous atrophy of the growths to the removal of the irritation of respiration and coughing.

IMPACTION OF COIN IN ESOPHAGUS: ULCERATION INTO

AORTA: DEATH.

T. H. Hawley (Brit. Med. Jour., March, 1898) was summoned to attend a boy aged four years seven months, suffering from collapse, after vomiting a pint of blood. His condition varied for ten hours; then another violent attack of hæmatemesis was followed by immediate death.

The history showed that six months previously the boy had swallowed a halfpenny. From this time forward he complained of pain on the right side of the throat after swallowing food, which had always to be of a semi-fluid nature. There had been no loss of flesh, no bleeding, no vomiting, no regurgitation.

On post-mortem examination the halfpenny was found impacted in oesophagus about an inch below the level of the aortic arch. The edges in contact with the oesophagus had formed two deep ulcers. The one on left had eaten into the descending aorta, making an opening large enough to admit of a quill.

ESOPHAGOTOMY AND REMOVAL OF DENTAL PLATE WITH UPPER CENTRAL INCISOR TEETH.

A. A. Snyder (New York Med. Jour., Sept. 1897) gives the history of the case. A woman, aged 22 years, had swallowed a broken dental plate. It lodged in the oesophagus. The voice became af fected, and she complained of pain on the left side of the sternoclavicular joint. Owing to irritability of the parts, even under cocaine, removal by the natural passage was impossible. On the third day, having localized the foreign body, a two-inch incision was made along inner edge of sterno-mastoid muscle. The jugular vein and common carotid were exposed, and the oesophagus being entered through the wound, the plate was extracted. The size was one and a half inches by one and a quarter. excellent recovery. In this case the X failed to locate the foreign body.

The patient made an

rays were tried but