chest symptoms developed. He would not resort to the preliminary tracheotomy unless the subsequent operation was evidently to be an excessively bloody one, and the risks not to be avoided by position, slight anesthesia, etc.

Dr. Sands could recall only a single case in which he had used Trendelenburg's tube, and in that instance it worked very well. Pains were taken to prevent the expansion of the rubber bag over the lower orifice of the cannula, and the only inconvenience observed was the occurrence of coughing, as already mentioned by Dr. Peters. He thought that if the instrument could be used with success so far as to completely occlude the trachea, it would form a very valuable invention. He had noticed, however, that it frequently failed to accomp ish the purpose for which it was designed, as it allowed blood to pass down into the trachea. He had many times excised tumors of the pharynx and tonsils, or had removed the upper jaw without encountering the least danger from the entrance of blood into the air passages. He thought that if three points received due attention during such operation, little or no danger need arise from this cause. In the first place, the patient should be placed in a chair with his head inclined slightly forward; in the second place, profound anesthesia should be avoided, as the blood would enter the larynx only when it was rendered quite insensible, as was the case with deep narcosis; in the third place, he thought it was desirable to operate quickly. In two cases of naso-pharyngeal polypus which he had removed some years ago, no blood entered the trachea so far as he could discover, and the patients made a good recovery. The principle of tamponing the trachea was important, however, and he would be glad to see it realized in practice. His own experience had not led him to regard tracheotomy as an operation likely to cause pneumonia, yet he was not prepared to deny that such might sometimes be the case.

Dr. Gerster said that the weight of Dr. Sands's remark was largely in the proposition which he made not to carry the anesthetic too far. He had had occasion to perform several operations upon the upper jaw, and had always been careful not to place the patient too profoundly under the influence of the anesthetic; only just sufficiently so that he would not resist violently enough to prevent finishing the operation. In all these cases he had not seen any difficulty whatever, because when any blood entered the trachea the sensitiveness of that tube induced reflex movements which caused an immediate rejection of the blood.

Dr. Stimson doubted whether the patient could always be depended upon to give evidence of the presence of blood in the trachea by cough. He had one patient whom he had anesthetized six times for the removal

of a constantly recurring growth in the upper maxilla. The woman took ether badly, and complete anæsthesia was never obtained for more than one or two minutes at a time. In that case he had seen the pharynx so full of blood that air bubbled up through it, and yet the patient never coughed. He was not positive that blood made its entrance into the trachea, but it was in the pharynx in large quantities, and air bubbled up through it. No bad consequences followed.

The President remarked that during the last fifteen or twenty years he had performed quite a large number of these operations, and he believed that by simply bearing in mind the suggestion made by Dr. Sands no difficulty need be experienced with reference to a serious quantity of blood getting into the trachea. He believed that in a large proportion of cases the most bloody operations could be performed with safety without preliminary tracheotomy.

Fracture of the Calcaneum.-Dr. L. A. Stimson presented a specimen which illustrated fracture of the posterior portion of the head of the calcaneum. He believed it to be probably the result of muscular action. The patient was a man, fifty-three years of age, who was admitted to Bellevue Hospital in November last for a disease of the tibia which required amputation. Eight years ago, while crossing the street, he was knocked down by a wagon, and received the injury which the specimen illustrated. At the time the injury was received the patient said that the skin was not bruised. The fragment was the portion to which the tendoAchillis was attached, at least partially. It was more than an inch in length, and about three-fourths of an inch in breadth. On its outer side the periosteum was complete; on the inner side there was a growth of bone which presented the appearance of having been the result of reparatory action. The fragment had united with the bone at its upper bor der, but was about half an inch anterior to its original position. The specimen was accompanied by photographs and a plaster cast which illustrated the deformity.

Dr. Bull thought that pure muscular action could not produce this fracture; that it was the result of direct violence,

Dr. Stimson remarked that there were several cases upon record in which the fracture occurred as a result of muscular action.

Dr. Peters referred to a case in which fracture occurred as a result of muscular action.

Melanotic Sarcoma.-Dr. A. G. Gerster presented a specimen of melanotic lympho-sarcoma, which he removed from the neck of a man on the fourth of the present month. Three months ago the patient got heated from running about, and then sat down in front of an open win

The exsec

dow and was chilled. This was the only fact which he had been able to ascertain concerning the cause of the growth, although he did not attribute much importance to it as an etiological factor. Immediately after this occurred the man noticed a slight swelling at the corresponding angle of the jaw, which gradually increased in size. There was no sore throat following the chilling, nor nasal catarrh. The tumor continued to grow, and he consulted a physician, who proposed to inject tincture of iodine into it. At that time it was about the size of an Italian chestnut. Considerable reaction followed the injection. The tumor did not resume its former size and shape, but continued to grow rapidly, and, after three months, it attained the size of a small orange. It was situated in the upper cervical triangle, below the angle of the jaw. Laterally it was quite freely movable—not so vertically-and the skin over it was attached to the tumor. Dr. Gerster diagnosed lympho-sarcoma of rapid growth, and gave a grave prognosis. Removal was advised. tion was not difficult. Immediately after cutting through the skin it was noticed that the mass had a peculiar dark color. On account of its appearance, and from the fact that through a slight puncture made by a hook, introduced into its capsule for the purpose of lifting the tumor up, a black material exuded, he did not attempt to remove the tumor from the capsule, but dissected out the capsule and all, keeping well to the outside of the growth. At the lower and inner part of the tumor, where it approached the superior thyroid artery, there was a dense mass of connective tissue of recent inflammatory origin, which had attached the capsule to the blood-vessel, and also inclosed a small bundle of lymphatic vessels. Immediately upon the oozing of the black, muddy material, which presented the appearance of graphite, through the opening made by the hook, he removed the instrument and applied a ligature round the point, carefully cleansed the part, and then proceeded to the dissection, without further assistance of this kind. At the upper and outer angle of jaw a large number of lymphatic glands were found, which had exactly the characteristics of the tumor itself. They looked like a chain of small blue grapes, and burst as soon as touched. They were dissected away also with some connective tissue by which they were surrounded. When the tumor was cut open it was found to contain a cavity, in which there moved freely a black body that was surrounded by the dark fluid material already mentioned. Microscopical examination revealed that the growth consisted almost entirely of round-celled pigmented elements, with a very sparse stroma. The mass, which was free in the center, was doubtless the original swelling or lymphatic gland noticed first by the patient in the neck. The thick melanotic envelope inclosing this glandular

body apparently represented the degenerated glandular capsule. The wound was closed by a few silver-wire sutures, and healed by first intention. Early recurrence of the disease was to be expected.

Fibro-Myoma of the Scrotum.-Dr. W. T. Bull presented a specimen accompanied by the following history: H. C. F., forty-eight years of age, and married, entered St. Luke's Hospital, October 16, 1882. He gave no specific history; there was no history of cancer in the family; there was no history of traumatism. About twenty years ago the patient first noticed a small, hard lump, about the size of a marble, in the lower part of the right side of the scrotum. There was neither pain nor tenderness on pressure, nor discomfort of any kind. This mass gradually increased in size until two or three years ago, since which time it has grown much more rapidly. On admission, he complained only of the weight and inconvenience. The scrotum formed a tumor as large as a child's head, the enlargement being on the right side. The skin was normal, with large veins, the tumor was ovoid in shape, and reached upward as far as the external abdominal ring, which was dilated and filled up when standing by a hernial protrusion as large as a goose-egg, which could be easily returned. The surface of the tumor was smooth, but uneven, and marked by several rounded projections which were semi-fluctuating. The right testicle was, on its lower end, softer than the left, and apparently somewhat flattened, but movable in the tunica vaginalis. The circumference of the tumor at its upper limit was fifteen inches, at its lower part eighteen inches and was of firm, elastic consistence, and not at all tender. There was no pain, either from it or the hernia. The patient had worn no support. There were no enlarged glands. Removal was advised. The parts were washed with a solution of carbolic acid (1-40), after which ether was administered. Dr. Bull was assisted at the operation by Dr. George A. Peters and Dr. R. F. Weir. The hernial protrusion was put back and held, the tunics covering the tumor were dissected down to the capsule, and the cord exposed. A strong ligature was placed round the cord two inches from the tumor, and held by the forceps; the cord was then cut across about one inch from the tumor, and it appeared normal, but it was evident at once that the lower end of the hernial sac, which was adherent to the surface of the tumor over a space as large as half a dollar, had been cut across with it. The blood vessels were ligated with catgut, the wound in the peritoneum was united by continuous catgut suture, the irregular portion of redundant scrotum was cut off with the scissors, a drainage tube was introduced, and the wound was closed with sutures of carbolized silk. peat bags, and absorbent cotton were used in the dressing. was discharged from the hospital, cured, November 13th.

Iodoform, The patient The hernial

protrusion was diminished in size, and was retained by a truss. The tumor weighed three pounds and a half. It had been examined by Dr. Satterthwaite, who reported that it was a composite growth, consisting chiefly of ordinary fibrous tissue, to a less extent of fatty tissue, and to a still less degree of non-striated muscular tissue. It was situated behind the cord, which was lengthened, but otherwise unaffected, and above the right testicle, which was normal, as was also its tunica vaginalis. The origin of the growth was apparently from subcutaneous connective tissue, its outer layers forming a sac that was infiltrated with lime salts over most of the surface, while, where depositions were absent, there were small hernial protrusions of tumor substance.-New York Medical Journal.

NEWS MISCELLANY.

Small pox is very prevalent in Leadville and Pueblo.

A baby show, on the American plan, will be shortly held in Hamburg.

The Tiempo, of Valencia, notes the birth of an infant with a beard and a full set of teeth.

During the past year there were 300 persons killed and 1,000 injured in the anthracite coal mines.

The system of sewerage in operation at present in Denver, is perhaps the best in the United States.

At Vienna and St. Petersburg, Physicians' Mutual Aid Societies have at length been organized.

The newspapers say that Montreal exports to the United States about 150 subjects for dissection every winter.

All will be pained to learn of the death of Prof. Wm. H. Van Buren, which occurred March 25th, at the age of 65.

A Kentucky mule deliberately put its head through a crack in a post and rail fence, and stayed there until it choked itself to death.

The authorities at Berlin are discussing the propriety of prohibiting the importation of American pork, which is said to be largely infected with trichinæ.

New York has just made the discovery that Central Park, from a carelessness about drainage, is a source of malaria and ill health to the houses round about.

Women have distinguished themselves once more in the London University class-lists. The scholarship and gold medal for obstetrics are taken