their original nature), it would seem that those adenoid tumors which at first seemed innocent, were, in reality, malignant at the beginning, and, hence, if by operating in the early stage we prevent a formation of malignant growth, why not take the risk and not even wait for a chance of development? I leave this question as I find it. When we can determine exactly the true character of the future growth of a tumor, then we will be more certain in our treatment, whether it be surgical or medical.

Medical Treatment.-I know of no better medication for these tumors than the proper homœopathic remedy, so long as there is a constitutional defect to cure; and what remedy seems to be more strongly indicated than Mercurius iodatus? In all glandular diseases it is used, in the swollen and indurated tonsils, in the swollen glands of Peyer. In all diseases where gland structure becomes involved, this or other preparations of Mercury, and sometimes Iodine, are exceedingly useful; not to be given indiscriminately, but after a careful and painstaking investigation of the symptoms.

Conium Maculatum.-The pathogenesis of this drug also shows a marked leaning toward gland structures. According to Noack and Trinks, the chief tendency of Conium is to liquefy and fluidify animal matter both normal and abnormal; "old contusions in which glands are indurated and increased." These are some of the general symptoms. A most careful investigation is necessary before this is given, and then in doses, first high, 30th, and if improvement is manifested, descending in the scale, and with the lower attenuations make also an application on the outside with the tincture. Persistency, I think, is necessary, if we want to do the best medicinally with tumors. Hence, when satisfied one remedy possesses the true similimum we should persevere. Other remedies are, Calc. carb., Hepar s., Arsen., Lyc., Puls., Ignatia, etc.

Surgical Treatment.-In pure adenoma the tumor may be removed by the knife, but should any sign of degeneracy of the tumor itself or its base or its capsule be discovered, the actual cautery or galvano-cautery should be used to finish the operation. The wound should be closed by dry sutures, which are easily prepared, and firm adaptation of the edges of the wound

can be made in a manner preferable to that by interrupted sutures, which produce more or less irritation. The dressings most recommended are Staphisagria, Calendula, Carbolic acid water. If the wound, however, is a clean cut, a simple dressing of water is all-sufficient. My practice is to approximate the edges of the wound by means of the dry suture spoken of, covering with a piece of lint, and placing over that a strip of oiled silk, unless there is signs of more than the usual amount of inflammation, when I make use of either of the articles enumerated and afterward place the patient under treatment with the best selected remedy which may suit the glandular growth and the patient's constitution.

ΜΥΧΟΜΑΤΑ.

From Myxa, mucous, and Oma, a morbid condition.

The myxomata are tumors consisting of mucous tissue, which is a succulent connective tissue, the intercellular substance of which yields mucin.

The physiological prototype is found in two situations, in the vitreous humor of the eye and in the umbilical cord. In both the intercellular substance is homogeneous and yields mucin. The microscope shows their cells to be angular and stellate, with long anastomosing tuberculæ ; others are isolated and fusiform, oval or round in shape, possessing usually one, in some cases two distinct nuclei. Their contour is indistinct, owing to the refractory nature of the intercellular substance, which is amorphous, slightly granulated, jelly-like, and yields mucin. The blood vessels, which are not numerous, are readily visible and easily isolated. The development of the myxoma is from one of the connective tissues, adipose being their favorite seat. They may be found in subcutaneous, submucous, intercellular, muscular and connective tissue of the brain, spinal cord, and sheaths of nerves. Their growth is slow, but they sometimes attain an enormous size. The changes which may take place in these growths are, the formation of sanguine cysts by rupture of the capillaries, or the cells may undergo fatty degeneration and thus be destroyed, with liquefaction of the intercellular substance. In character they are soft, often fluctuating, a translucent mass,

poor in blood, and from which a pink or colorless jelly flows on pressure, in which may be seen the elements of their growth. Growing from the sheaths of nerves they constitute one form of neuroma; growing from the placenta they constitute the uterine hydatids; in the nose one kind of nasal polypi. They are generally of benign growth, so that when once removed they rarely return. In the old classification they are called mucous polypi, vesicular moles, gelatinous tumors, etc.

Clinical Diagnosis.-By their soft, jelly-like consistence, having few blood vessels, and their rapid growth, without pain, unless from pressure.

Treatment. We advise, in prescribing for these tumors, that the same care be exercised as already spoken of; and hence the remedies should be selected from that class which seems to affect the constitution, not by a destruction of the mucous tissue but by an excessive production of the same. I think it possible that the true remedy may be found for the cure of these myxomatous tumors among that class which show a disposition to produce excessive mucous tissue. Bearing this in mind we remember that Calcarea carb. stands out prominently as one of that class; and what remedy is so often prescribed for the soft polypi?

Teucrium, Dulcamara, Lycopodium, Sambucus, Silicea, Graphites, and many others may be mentioned.

In regard to the medical treatment of polypi, either of the papillomata, adenomata, or myxomata (for we have all these and more varieties forming polypi which are found in the nostrils), the most important procedure is first to be certain that we have a polypus to treat. This can be easily ascertained by the different sized specula, and oftentimes the finger will tell, by touch, the variety. Having satisfied ourselves of the variety and position the remedies should first be tried.

While prescribing remedies I propose that the patient be placed under a different regimen from that they have been accustomed to; if living on meats, etc., I would change to less nutritious diet, substituting milk and cream; if spare, thin diet and using vegetables, give a more nourishing one of meats; changing in this manner the order of their living, but under

no conditions making the change unless the system is well nourished by the food prescribed. An impoverished state of the blood is to be avoided.

If the medical treatment does not succeed, then a resort to surgical means is justifiable. In the soft myxomatous variety, astringents, caustic, tearing them away with the forceps, are the usual means.

Dr. J. E. James makes record of a case supposed to be of the myxomatous variety, cured by blowing powdered Sanguinaria canadensis root upon it. For the other varieties the ligature, or what is better, the écraseur, and the forceps to twist these growths off, are the best means.

Should much hæmorrhage occur, the persulphate of iron will answer a good purpose to arrest it, with glycerine to promote the healing process afterward.

XXVII.

NEUROMATA.

BY M. O. TERRY, M.D., UTICA, N. Y.

NEUROMA are neoplastic formations which may be divided into two general classes, the true and false neuroma. (Neuroma verum and spurium.)

True neuroma consist chiefly of nerve-fibres intermingled more or less with connective tissue, which is sometimes soft, sometimes tough, sometimes rich and at other times poor in vessels. From these differences various forms of neuroma result, such as fibro-neuroma, glio-neuroma, myxo-neuroma, etc. It has not been certainly ascertained whether ganglion-cells occur in these neuromata. The origin of the newly-formed nerve-fibres is partly referable to granulation-tissue, and partly to the increase and division of the already existing nerve-fibres. (Heller.) Wagner says that neuromata consist of vascular connective tissue in for the most part preponderating quantity, and of nervefibres; the latter are rarely parallel, for the most part branched and closely interwoven, broad or small, mostly medullated, rarely without medulla, and usually without connection with the fibres of the affected nerve. Many neuromata contain almost only gray non-medullated nerve-tissue, nerve-fibres recognizable with difficulty in their bed of connective tissue, neuroma amyelimcum in opposition to neuroma myelimcum.

Virchow distinguishes the pure neuromata in which the nervous elements preponderate, the telangiectactic neuromata, and according to the kind of interstitial tissue, the fibrous, glious, and mucous neuromata.