metastatic panophthalmitis, which is often double and presents a different clinical picture, but is associated with different bodily conditions. In none of the cases examined could Wagenmann discover any relation of the cocci to the blood-vessels, nor were cocci found in the vessels themselves. 3d. The inflammation is due to a fresh infection from the cicatrix. This view, original with Leber, is maintained by the author, who in all cases found more or less marked evidences of suppuration in the cicatrix, and in the majority cocci. The clinical picture of the cases not microscopically examined also suggested the cicatrix as the point of origin of the fresh inflammation. REMOVAL OF INTRA-OCULAR MELANO-SARCOMA, WITH PRESERVATION OF VISION. Rolland (Recueil d'Ophthal., January, 1890) reports a case of intra and extra-ocular sarcoma, in which the tumor was successfully removed and vision maintained. As the case is certainly unusual, it is here given at some length. The patient, a man of thirty-two, in robust health, only complained of the annoyance caused by a growth upon the upper and inner aspect of the sclera, six millimetres from the sclero-corneal junction. This growth was uneven and rough, brownish-black in color, and about the size of a bean. It had taken about ten years to reach its present size, and the patient attributed its origin to a blow on the eye from a twig, received while on an excursion. It was firmly attached to the sclera from which it emerged, and while covering the cornea in consequence of its weight and the action of the upper lid, was not adherent to it. The visual acuity was normal and the ocular movements limited toward the nasal side. Only with the pupil dilated ad maximum could anything wrong be detected with the ophthalmoscope. There could then be seen in the fundus a reddish growth, of the size of a "very large fly's head," corresponding in position to the external portion of the tumor. Microscopical examination showed the tumor to be a melanosarcoma. Appreciating the natural objections of the patient to the removal of an eye with perfect vision, Rolland proposed the extirpation of the tumor, which was accordingly done under strict antiseptic precautions as follows: The growth being fixed by a silver wire passed through its neck, a button-hole was made in the sclera about four millimetres long enclosing the base of the tumor, which was then loosened in its attachments. Then by steady traction combined with lateral and twisting movements, the entire tumor was removed, the extra and intra-ocular portions proving continuous. There was a loss of about one-third of the For vitreous. The scleral wound was closed by a single catgut suture, and the conjunctiva brought together over it with fine silk sutures. five days the eye was bathed every half hour day and night with iced boric solution, and on the sixth day there was no reaction, the cornea and media being clear and the vision perfect. The stitches were allowed to fall out of themselves. Seven months later the patient was enjoying perfect vision and health. From this case Rolland concludes that an eye affected with melanosarcoma in which the vision is normal should not necessarily be removed in toto, enucleation being reserved for such as are disorganized by the neop asm. When vision is intact one should attempt the removal of the growth by a long incision into the eye, such an operation having no danger to life if done with strict antiseptic precautions. INTRA-OCULAR INJECTION OF IODINE IN RETINAL SEPARATION. This method of treatment proposed by Schoeler has been considered by Dubarry in his inaugural thesis (Contribution à l'étude du traitement du décollement de la rétine par les injections intraoculaires de teinture d'iode, Paris, 1889). Experiments on animals showed that the quantity of liquid injected should be small and away from the crystalline lens. In man the injection of the tincture of iodine should be made slowly and without force, and at the part of the separation most removed from the posterior pole of the eye. The immediate symptoms were: Intra-ocular and peri-orbital pain of several hours' duration. The sensation of a black or red ball apparently placed before the operated eye. Ophthalmoscopic examination shows the presence of fluid in the vitreous in the form of a more or less rounded brownish mass. On the following day mydriasis and conjunctival hyperæmia. The results observed by him in six cases at the clinic of M. Abadie and reported in full detail were: The treatment was purely surgical. The chief disadvantages of intra-ocular injections were a subsequent retinal torpor or the frequent development of capsular cataract. This latter seemed sometimes to diminish after a time but did not disappear, and was sometimes followed by an irido-choroiditis with threatened phthisis bulbi. These complications seem due to excessive quantity of the fluid injected or to its too irritant quality. Dubarry concludes by advising continued. attempts with other or perhaps modified solutions of the iodine tincture. OUABAINE AND STROPHANTHINE AS ANESTHETICS. The search for new local anesthetics continues. Panas (Union Médicale, 1890, p. 272) has studied the local action of strophanthine and ouabaine upon the conjunctiva, and finds that: Ouabaine, while producing anesthesia in the rabbit, has no effect on the human eye. Strophanthine, although superior in its action to ouabaine, has irritant properties which render it less serviceable than cocaine. DISEASES OF THROAT AND NOSE. BY WM. F. DUDLEY, M. D. Attending Physician, Department Throat and Nose, Dispensary of L. I. C. Hospital; Assistant THE OBSTRUCTIVE FORM OF LARYNGEAL TUBERCULOSIS WHICH SIMULATES BILATERAL ABDUCTOR PARALYSIS. Percy Kidd (Brit. Med. Jour., March 29, 1890) reports six cases of stenosis occurring primarily at the rima glottidis, and depending not on the amount of swelling, but on the mechanical fixation of the vocal cords in the position of phonation. In these cases the laryngeal examination showed the vocal cords separated about one-eighth of an inch, congested and showing no movement with inspiration On phonation closure of the glottis ensues. Epiglottis and ary-epiglottic folds swollen and infiltrated. In three of the patients ulceration existed to a considerable degree. In one case upon which an autopsy was performed the following conditions were found in addition to the above: The mucous membrane of larynx infiltrated and irregularly but superficially ulcerated, the left ventricular band being especially swollen. The apex of left arytenoid cartilage was exposed by the ulceration. A small red sessile tumor, containing giant cells and tubercle bacilli, projected from the internal aspect of right arytenoid cartilage. The vocal cords were almost in contact. Both arytenoid cartilages were fixed. The crico-arytenoidei postici muscles thin and pale and interspersed with yellow lines. On microscopic examination the fibres of these muscles proved to be almost devoid of striation and contained oil globules and coarse granules. Both arytenoids were firmly fixed by a tubercular growth that extended down to the perichondrium. This explains the immobility of the vocal cords. This fact is also important, that the posterior crico-arytenoid muscles showed more marked degeneration than the lateral crico-arytenoid muscles. It is probable that the effects of the peri-arytenoid inflammation was first felt by the abductors, resulting in impairment of their function. This condition, aided by contraction of their antagonists the adductors, led to approximation of the cords, which became permanently fixed in their new position by the increasing infiltration. Horsley and Semm have demonstrated that the crico-arytenoid post. muscles lose their direct electrical excitability before the laterals, and the former may be considered, therefore, the more vulnerable muscles. In all the cases reported there can be little doubt that the want of mobility of the vocal cords was due to interference with the cricoarytenoid articulations. The severe and abiding nature of the obstruction clearly points to some operative means for relief. Tracheotomy was performed in five of the cases, but the results were not satisfactory, although the lives of the patients were prolonged. Where stenosis of the larynx is caused mainly or entirely by fixation of the vocal bands near the median line, thyrotomy and excision of parts of the rigid cords would be justifiable if we can satisfy ourselves of the absence of disease in the lungs. The danger of necrosis of cartilages is no doubt very great in tuberculous patients, but this complication. is less likely to be produced by simple splitting the thyroid cartilage than by persistent irritation of the tracheal tube. Fixation of the vocal bands in the median position, simulating bilateral abductor paralysis, may occur in tubercular disease of the larynx as the result of three different causes: 1. Plastic infiltration around the arytenoid cartilages leading to adhesive perichondritis and spurious ankylosis. 2. Ulceration, followed by morbid adhesion of the altered vocal cords. 3. Suppurative crico-arytenoid arthritis. A possible fourth is the existence of non-suppurative adhesive arthritis. In all cases of this description some surgical measure is indispensable, consequently an early recognition of this condition is clinically important. A METHOD OF CORRECTING ADHESIONS BETWEEN THE SOFT PALATE AND PHARYNGEAL WALL. C. E. Nichols (Jour. Resp. Organs, Feb., 1890). All previous methods heretofore advised have had one fatal defect, namely, they do not prevent reproduction of the adhesions. The line of adhesion generally occurs in the situation of the faucial pillars below the palatal level. This method obviates the possibility of reformation of adhesions by the establishment of a firm cicatrix at the base of the proposed incision by means of a seton left in situ until a cicatricial eyelet is made at the outer angle and the tissues are in condition for operation. An incision is made in the median line, cutting down upon the end of a curved steel bougie passed into the naso-pharynx as a guide. A staphylorrhaphy needle, armed with four to eight strands of coarse silk suture, is passed through the median incision into the nasopharynx back of the adhesion and out through the adhesion into the oro-pharynx, just at the lateral wall of the pharynx. The suture is then tied and the knot slipped around into the naso-pharynx. The suture is moved slightly each day and in two weeks a canal is formed of cicatricial tissue of larger diameter than the bundle of threads and perfectly healed. The tissue between the two openings is then cut and the parts kept dilated until healed. No abrasion must be made in the line of the canal or the operation will be nullified. Pain of the procedure is slight and the hæmorrhage is easily controlled. Some nausea and gagging are at first produced by the presence of the loop, but the pharynx soon becomes tolerant of the foreign body and deglutition is but little interfered with. ACUTE HÆMORRHAGIC GLOSSITIS. Holger Mygind reports a case of this nature as the first on record. The initial symptoms were loss of appetite, rigor and fever, followed by bleeding from nostrils. Within an hour the patient felt pains in his tongue, which became black and swollen until articulation was extremely difficult. He vomitted considerable blood at short intervals and was troubled by abundant secretion of viscid saliva and mucus. On the third day the tongue presented the following appearance. The tumefaction marked, especially on right side, the two sides being separated by a deep gutter-like depression. The color of the upper surface of the tongue was a dark blue, except a narrow strip on margin, which was normal in appearance. The mucous membrane of the floor of the mouth (sulcus alveolo-lingvalis) was much swollen from effusion of blood, the papillæ being especially prominent, looking like two dark-blue shining grape-like bodies, situated on either side of the frænum lingvae. The palate, arches, the glosso-epiglottic ligaments were not involved. No swelling of the glands. The glossitis continued unchanged for four days and then subsided, and on seventeen days from commencement of attack the tongue and floor of mouth presented a normal appearance. That this was not a case of simple hæmorrhage is proved: 1. Because the lesion had an inflammatory |