Acute synovitis of the ankle of a boy.

CLINICAL

RECORDS.

POLYPUS OF THE EAR.

THE auditory canal, like other

passages in the

body,

is

occa-

to the presence of polypi; in fact, it would seem to be a character peculiar to narrow channels lined by A polypus mucous membrane to give origin to these tumours. of the ear is looked upon as of more importance than might at first sight be imagined, and is liable to give rise to much mischief. Mr. Harvey describes those of the meatus as of two kinds-the true and the false. The true polypus grows from a peduncular attachment, and is a fibro-plastic or ciliated epithe-

sionally subject

in the usual manner under the veins, and complete obliteration has ensued, with a cure of both ulcers. A second case of varicose veins and ulcers of both legs was submitted to the same treatment in a man whose constitution was broken down; two pins below each knee, and one above the left knee, were introduced. It is important to observe that this patient had been similarly operated upon three years ago, on his left leg, with a cure of the varix at that time ; but the present knot of enlarged veins was an entirely fresh batch. There can be no doubt that in the majority of cases the veins operated upon are completely obliterated; but we believe, with Dr. Pirrie of Aberdeen, that a permanent cure of the tendency to varix is not accomplished, and that in many cases, sooner or later, the varix returns in

some other veins. the false polypus, on the other hand, is a fungoid The obliteration of varicose veins we saw also attempted at has no distinct stalk or neck, but rather a thick King’s College Hospital on the 22nd October, by Mr. Fergusson, base, and arises from any part of the meatus or membrane of the subject being a young woman, a housemaid, who was much the tympanum. We mention these characteristics because it upon her feet, and the veins of whose left leg were enlarged is most important to distinguish between the two kinds, one of and tortuous. A pin was passed underneath a large vessel at which is illustrated by a case under Mr. Bowman’s care, at right angles to its trunk, and another was introduced through King’s College Hospital, in the person of a woman thirty years the vein itself in the direction of its length, so that some of age, subject to a growth in her ear for six years. It had amount of inflammation might be induced; a twisted thread been partly removed on a previous occasion; its growth, how- was now passed round the pins, with the effect of producing ever, proceeded until it protruded from the meatus, and formed obliteration by the compression thus established. a tolerably large and firm tumour. Some fluid of a serous character was evacuated by puncture, and although this diminished CURE OF VESICO-VAGINAL FISTULA BY its bulk at the time, it soon became as large as ever. The diagnosis of the seat of origin was here a matter of diffiLIQUOR AMMONIÆ. culty, for the external appearance of the growth was that of WE are anxious to record an instance of the cure of vesicomucous membrane; and, as Mr. Bowman remarked, fistula, by the application, direct to its edges, of the it was almost impossible to state with certainty what was its vaginalof ammonia. The case occurred in St. Bartholomew’s liquor point of attachment, but he was disposed to believe it might Hospital, in June last, under Mr. Lloyd’s care. The patient, be the membrana tympani. This only invested the case with who was twenty-six years of age, had been the subject of a the greater interest, for in the treatment this important mem- fistula of the kind mentioned since her confinement in August brane would become destroyed, unless great precautions were of last year, and was, as is usual, much troubled and inconused in the extraction of the polypus ; and the mischief might venienced by the continual dribbling of her urine. A catheter even extend so far as to destroy the ossicles of the ear, and was kept constantly in the bladder to relieve this condition, perhaps cause death by the extension of the disease to the brain and the caustic ammonia was applied to the edges of the fistula, itself through the temporal bone. situated rather high up the vagina; and this was repeated a Mr. Bowman, therefore, made up his mind to treat the case few times, with the effect of causing perfect closure, so that she by slow torsion, which was commenced on November 30th, was enabled to get up and walk about the ward without the by passing a needle through the protruding mass, and then escape of any urine into the vagina. On passing the finger into applying a twist. This was repeated on the 3rd of December, this passage, a deep indentation could be felt in the situation which at once showed the influence it bore upon the circulation, through which the urine had so long passed. She left the by causing a dark livid appearance. This process was to be hospital, apparently cured, many weeks back. There can be continued, with the hopethat ulceration of the neck of the no doubt, as we heard Mr. Lloyd remark recently, that the tumour would occur, and by this means its safe removal be parts have been well tested by this time, and that the cure is accomplished, without any ulterior mischief. On the 14th of December, Mr. Walters, the dresser of the complete. case, informed us that, after the second twist given to the ACUTE SYNOVITIS OF THE ANKLE OF A BOY, needle, the polypus collapsed, and turned black. On the fourth day, the polypus dropped out, looking like a piece of rag. A WE would draw attention to a case of synovitis of the ankle.. few days afterwards, a slight discharge which had existed of an acute character in a little boy six years of age, now joint since the introduction of the needle ceased, and the patient a in the Charing cross Hospital, under Mr. Barwell’s patient was discharged, her hearing having been improved by the recare. Inflammation of the synovial membrane of this joint moval of the growth, which must therefore have left the tym. cannot be said to be common as compared with other articulapanum intact. tions, and more especially in the young. The present example, therefore, is one of interest. It was caused by an injury, and THE CURE OF VARICOSE VEINS. when admitted on the 7th of November leeches were applied with advantage, and subsequently blisters, conjoined with rest A MAN aged about thirty-five years was recently admitted and quiet in bed. More recently bandaging has been adopted into University College Hospital with a varicose condition of with the good result of removing the swelling; at the same the veins of his left leg and thigh, associated with a varicose time he is taking fifteen minims of the liquor of the bichloride the ulcer. From latter a good deal of blood had been lost of with tincture of cinchona, and when we last saw lately, and much inconvenience was felt from the presence of himmercury he was going on as well as could be desired. knots and clusters of the tortuous veins extending up several Most surgical writers of authority, in describing synovitis inner side of the thigh. The dilated vessels running up the leg and its various causes, make the observation that it very selto the middle of the thigh were of considerable size. Two pins dom attacks young children, and in them it requires sometimes were placed beneath the veins above and three below the knee, rather a severe injury to a joint to give rise to inflammation of .and the usual sutures applied over a small piece of bougie, on the synovial membrane. the 19th October; this was done without chloroform being given. The varicosed knots were reserved till a future occasion for injection with the solution of the perchloride of iron. A HERPES CIRCINATUS ON THE HAND, AND LICHEN week later the veins were found to be obliterated, and the SIMPLEX ON BOTH ARMS. - effect of this was to diminish the venous knots already referred to. The ulcer had completely healed. Finally, some of the RINGWORM is the mildest of all the varieties of herpes, and dilated veins were injected with the solution, but not the is accompanied with but little inflammation; the vesicles also others, as coagulation had taken place within them. This was are known to be of the smallest. We, were recently shown an infollowed by some inflammation and an abscess, with a little stance of this affection in a married woman, thirty-four years of age, at the Charing-cross Hospital, under Dr. Willshire’s constitutional disturbance, but the man has gone on well. We saw some remarkably large varices at the above hospital care, with a large patch of the disease on the back of her right on the 16th ultimo, situated at the inner side of the left thigh hand-in fact, one of the largest we have seen, for it is three of a man of sixty, who had a varicose ulcer of both in diameter. She has, besides, an eruption of lichen inches in which the veins were in a varicosed condition. Three somewhat abundant, on each arm. She has been five weeks and a half under treatment, the eruption, however. pins above and three below the knee of each legwere

lial

growth; growth, and

dried-up

__

legs, simplex, placed

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