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NOTE ON AN INTERESTING CASE OF MELANOTIC SARCOMA.
1433
precedent to his trial, he should such prisoner is insane, it shall be lawful for one of His an inquiry as to his fitness to Majesty’s Principal Secretaries of State, upon receipt of such plead, or, having been allowed to plead, that the jury ought certificate, to direct by warrant under his hand that such This procedure does not seem to have been called upon to say whether or not from the person shall be removed," &c. to have been followed in the present case. because the conevidence he committed the act charged against him. The fourth case which we have cited is exactly similar to demned man was not respited during His Majesty’s pleasure, the case just discussed up to and including the point of pro- but respited to penal servitude for life ; for if a certificate of cedure where the accused is allowed to plead. It differs, insanity after inquiry had been sent to the Secretary for however, from it in the following particulars-(l) there was Scotland, the condemned man would have been removed from no doubt that the accused committed the act charged ; prison to an asylum, and would not be condemned to penal (2) that accused had already been incarcerated in an asylum servitude for life. It has been suggested in some quarters that this points to for a few months some time previously, but had been discharged therefrom on an action of liberation ; (3) evidence a movement toward the abolition of capital punishment. It is only human that juries should shrink from returning was adduced at the trial on behalf of accused by medical witnesses and others to rebut the testimony of the Crown verdicts which involve the lives of prisoners, and, perhaps, doctors as to his insanity; and (4) accused himself gave the histories of several recent cases show a trend of opinion evidence on his own behalf, thereby affording an oppor- in this direction. I offer no opinion on the question of the tunity to the jury to form an opinion for themselves on the propriety or otherwise of such abolition, but so long as question of his sanity or insanity from his behaviour,i capital punishment finds a place on the statute-book the same demeanour, and mode of witness-giving. In the previous should be awarded where the law demands it until it be case the accused was incarcerated in an asylum on account repealed. of an alleged crime which was not proved against him; in Glasgow. this case no attempt was made by the accused to deny the crime charged against him, but he declared himself to be aame and that he would rather suffer ten years in prison than suffer incarceration in an asylum. Both cases are alike in that the whole case -alleged insanity and alleged crime-was MEDICAL, SURGICAL, OBSTETRICAL, AND placed before a jury, but while in the previous case present THERAPEUTICAL. insanity was proved the alleged crime was not proved; in this case the alleged crime was proved and the alleged insanity was not proved. NOTE ON AN INTERESTING CASE OF MELANOTIC The fifth case, which may be called the Wigtownshire case, SARCOMA. contains also certain points of interest respecting lunacy pro-
questioned in the
same
either have been
subjected
way
to
Clinical Notes:
oedure associated with crime. The accused, soon after the commission of the act of shooting and killing his aunt, was -sent to an asylum-Perth Lunacy Prison-by the authorities tinder the terms of the Act of 1857, Section 89, or of the Act of 1862, Section 15. After a residence of eight years in that place he recovered his sanity, was liberated, but was at once arrested on the charge of murder. At his trial the fact that he was found to be insane at the time of committing the act and was placed under care in Perth Lunacy Prison was sufficient evidence of non-liability for the consequences of his act, and the evidence of the medical witnesses satisfied the court that he had now recovered his sanity. But although he was acquitted by the jury on the ground of his insanity at the time, he could not be there and then liberated by the court, but could only be freed after petition and by order of a .Secretary of State. The last case cited (Case 6) is in some respects the most txtraordinary case of the series. Here was a man who brutally murdered his wife, who was duly tried and duly defended, whose mental condition had been examined by medical persons who could not, however, declare him to be of unsound mind, who is found guilty and is sentenced to death, on whose behalf there was no recommendation to mercy by the jury nor petition for reprieve by the public, ’but whose execution does not take place owing to what seems a very unusual intervention of the Secretary for .Scotland. It is not publicly known at whose instance the attention of the Secretary for Scotland- was called to the ,case, but the fact remains that by his instructions a commission of lunacy experts was sent 15 days after the trial and six days before the date of execution to the prison in which ,the condemned man was confined for the purpose of examining him. These experts are presumed to have - reported to the Secretary for Scotland, but what was contained in their report is not publicly known. It was publicly announced, however, several hours before the time ;appointed for the execution to take place that he was reprieved and his sentence respited to penal servitude for life. This procedure gave rise to considerable discussion at the time, and one of the questions then canvassed was the legal position of the Secretary for Scotland,in so acting. I have not been able to discover by what powers under the Scottish Lunacy Acts the Secretary for Scotland acted. There is a form of procedure in Section 89 of the Act of 1857 which provides that "in the case of a prisoner who exhibits insanity when in confinement as a prisoner under any sentence or under any charge of any crime or offence or under any civil process, the sheriff shall inquire, with the aid of two medical persons, as to the insanity of such prisoner, and if it shall be certified by such sheriff and such medical persons that, . 1__________
___
--
__
----
____
__
____
-"
BY HENRY
BURNS, M.B., CH.B. EDIN.,
SURGEON, ROYAL NAVY; HOUSE SURGEON
TO THE DUMFRIES AND
GALLOWAY ROYAL INFIRMARY.
THE patient, a man 25 years of age, was admitted to the Dumfries and Galloway Royal Infirmary on July 13th, 1909. His family history was good and free from any story of malignant disease. The personal history showed that about eight months before admission, while at work as a mason, a large stone fell on his left inguinal region. He quite recovered from this accident in a few days and resumed work. Three weeks before admission he noticed a swelling in his left inguinal region and another on the back of his left heel, but he could not state which appeared first. The swellings were neither painful nor tender. That in the groin, at first quite small, gradually grew larger and "black spots " appeared in the skin over and around it; that on the heel, he said, consisted of a hard mass, painful only when his boot pressed upon it, and about the size of a halfpenny. About ten days before admission he observed small black swellings on other parts of his body, chiefly on his chest. He stated that he had been losing weight and strength for some time. On examination numerous swellings could be seen and felt in the upper part of Scarpa’s triangle and in the inguinal region of the left side. They varied in size from that of a pea to that of a walnut; they were hard and neither painful nor tender. The skin over them and for a considerable distance around was studded with small black spots, the On the back whole having a very mottled appearance. of the left heel a swelling, with a circumference equal to that of. a four-shilling piece and projecting about a quarter of an inch beyond the skin surface, could be seen. It was coal-black and densely hard, and neither painful nor tender. On other parts of the body-the chest, abdomen, axillas, and limbs-small lumps could be seen and felt scattered about in the subcutaneous tissue, the ones nearer the surface being black. These were fairly hard The left lower limb was and neither painful nor tender. greatly swollen and oedematous. The patient was quite cheery about himself and his condition. The breath-sounds The ’liver was not enlarged, and were harsh in character. the urine contained melanin. A small lump was excised from the left forearm and examined. It showed the structure of a melanotic sarcoma. The course of the disease was as follows. The cedema of the leg diminished greatly by rest in bed. On August 4th the scrotum and penis became swollen and oedematous, while the swellingss on the heel and in the groin had increased in size and new swellings had appeared on various parts of the
.
1434 The breathing was now somewhat laboured and the The left leg breath sounds were harsher in character. became more cedematous and ascites developed. By the 20th the mass on the left heel had broken down and so also had a swelling in the right gluteal region. The black nodules had greatly increased in number all over the body and one had appeared on the forehead. The breathing was more laboured and cough had started. The patient was now very depressed and could not sleep except under the influence of morphine. There was dulness over both bases of the lungs and the anterior edge of the spleen could be palpated. On the 26th the abdomen was extremely ascitic and was ounces of yellowish fluid being drained off. A tapped, 200 f,,v", inserted For the three days Southey s tube was iiiserueu. For Lue next three aays the amount of fluid drained off was 50, 62, and 25 ounces respectively. Breathing became very difficult and cough very troublesome. The patient became very restless. On the evening of August 30th he became very cyanosed and died in a few minutes. Throughout the whole course of his illness he never once complained of pain. Post-mortem examination.-The abdomen and pleural sacs were full of fluid. The omentum was densely infiltrated with the growth and was absolutely black all over. The stomach was affected, as were also the small intestine, large intestine, and rectum. In the liver were several small scattered black nodules; it was slightly increased in size. The spleen was enlarged and had numerous small nodules in it. On cutting it a growth of about the size of a Tangerine orange was discovered and was easily shelled The bladder had out. The kidneys were not affected. The peritoneum was numerous nodules in its walls. Both lungs were infiltrated with studded with nodules. the growth and nodules were found in the pleura and pericardium. The mediastinal tissue was also infiltrated. The sternum itself was black with the growth and could be broken fairly easily. Neither testicle was affected, but the scrotal tissues were greatly indurated. The swellings in the left inguinal region and on the left heel were black all through.
body.
Medical Societies. ROYAL SOCIETY OF MEDICINE. LARYNGOLOGICAL SECTION. Exhibition of Cases and S’pecimens. A MEETING of this section was held on Nov. 5th, Dr. J. DUNDAS GRANT, the President, being in the The following cases and specimens were shown :— Mr. G. SECCOMBE HETT : Post-mortem specimens from a The case of Chronic Glanders in a man aged 24 years. principal visible lesions during life had been ulcerations within the mouth, nose, and pharynx. In the lungs and liver the strong resemblance to tertiary syphilitic lesions was noted. Dr. DAN McKENZIE: Perforation of the Nasal Septum from Salt Dust in a woman employed in a salt factory. Three other females, out of a total of eight employees, were affected to a less extent. Microscopical sections from the marginal tissues showed typical giant cell systems. Dr. STCLAIR THOMSON: 1. A woman, aged 46 years, affected with Tuberculosis of the whole of the Left Vocal Cord and the Interarytenoid Space, in whom consolidation of the right The lesions were completely apex had been diagnosed. healed by two months’ silence and sanatorium treatment. 2.
chair.
was
Two
Dumfries.
A NOTE ON THE REMOVAL OF FOREIGN BODIES FROM THE STOMACH. BY BILTON
POLLARD, F.R.C.S. ENG.,
SURGEON TO UNIVERSITY COLLEGE
I HAVE
recently
extracted
a
two
HOSPITAL,
LONDON.
shilling-piece
from the
stomach, of a girl, aged 15 years, without cutting into the stomach, in a way which I have not hitherto seen mentioned, and a short note on the method adopted may perhaps be of interest. The method was as follows. The operator opened the abdomen by a longitudinal incision through the upper part of the left rectus muscle and seized the coin through the wall of the stomach with his finger and thumb ; an assistant passed a flexible forceps, described below, by the mouth into the stomach. The coin was adjusted in the grip of the forceps and care was taken to avoid inclusion of mucous membrane ; the assistant then withdrew the forceps and with it the coin. The method of extraction outlined above was devised by me several years ago in order to remove a halfpenny from a little child’s stomach, but it was not then put into practice as the coin was eventually passed per vias naturales. For that case I had had a long flexible forceps made after the pattern of Durham’s tracheal forceps. The principle of the forceps is the same as that of Toynbee’s well-known forceps for the ear. The blades of the instrument, which when uncontrolled spring apart, are fixed to a piece of copper wire, around which a tube composed of spirally coiled wire is placed. The instrument is operated by the handles in such a way that the wire tube slides over the blades of the forceps and brings them firmly together. For the extraction of the two-shilling piece this instrument was passed with the blades closed. The coin was removed No at the first attempt in the way already described. resistance was felt when the coin passed through the cardiac orifice, nor indeed at any part of its transit through the oesophagus. The abdominal incision was sutured in layers and the patient made a normal recovery.
Harley-street, W.
.
in whom Tuberculosis of the Epiglottis, Cords, and Folds of the Larynx respectively had been Interspaces, arrested by galvano-cautery and sanatorium treatment. It was pointed out that tuberculosis developing in the larynx after the process had been arrested in the lungs did not generally assume an acute form, but was apt to become extremely tedious ; also that, in spite of a fair amount of active mischief in the chest, the temperature began to improve with the improvement in the larynx. 3. Papilloma of the Larynx in a boy, aged 62 years, of four years’ duration, cured by tracheotomy and repeated operations with direct laryngoscopy. This case showed the persistent recurrence of papillomata in spite of frequent and complete removal and the natural tendency of the disease to disappear about the age of 6 years. It also emphasised the advantage and harmlessness of wearing a tracheotomy tube, and occasion was taken to decry the useless and crippling employment of laryngo-tracheotomy, as recently proposed, in these cases. 4. A woman, aged 56 years, after LaryngoAfter having been fissure for Subglottic Enchondroma. previously shown before the section in 1908 by Dr. A. Stanley Green and Dr. H. Lambert Lack, the enchondroma had been finally removed by laryngo-fissure by Sir W. Watson Cheyne. Dr. W. JoBSON HORNE: A case of Laryngeal Neoplasm presenting Unusual Features in a woman, aged 65 years. The growth occupied the posterior half of the right side of the larynx and appeared to spring from the ventricle or ventricular band. Pieces had been removed at intervals for microscopical examination, and these sections were referred to the morbid growths committee for report. Mr. W. STUART-Low: Three cases of Inoperable Carcinoma, extra-laryngeal, pharyngeal, and lingual respectively, in whom ligation of the thyroid vessels for partial ablation of the enlarged thyroid gland had been performed with great benefit. The PRESIDENT : 1. Infiltration of the Left Ventricular Band. The patient was a woman, aged 62 years. The infiltrated band bulged so as to cover the whole of the left cord and the anterior part of the right one, occasionally dipping between the cords and preventing approximation. Microscopical examination revealed only inflammatory hyperplasia, and the diagnosis lay between neoplasm and tuberculosis. 2. Epithelioma of the Right Vocal Cord in a man, aged 60 years ; removal by thyrotomy. Microscopical examination of the conical outgrowth below the right cord showed early epithelioma. At the operation the right vocal cord with portion of the right arytenoid cartilage were removed and the underlying cartilage was freely scraped. The patient returned home nine days after the operation greatly benefited. The PRESIDENT and Dr. McKENZIE showed a case of Epithelioma of the Left Vocal Cord Removed by Thyrotomy. Mr. H. CLAYTON Fox : Paralysis of the Right Vocal Cord
patients,
precedent to his trial, he should such prisoner is insane, it shall be lawful for one of His an inquiry as to his fitness to Majesty’s Principal Secretaries of State, upon receipt of such plead, or, having been allowed to plead, that the jury ought certificate, to direct by warrant under his hand that such This procedure does not seem to have been called upon to say whether or not from the person shall be removed," &c. to have been followed in the present case. because the conevidence he committed the act charged against him. The fourth case which we have cited is exactly similar to demned man was not respited during His Majesty’s pleasure, the case just discussed up to and including the point of pro- but respited to penal servitude for life ; for if a certificate of cedure where the accused is allowed to plead. It differs, insanity after inquiry had been sent to the Secretary for however, from it in the following particulars-(l) there was Scotland, the condemned man would have been removed from no doubt that the accused committed the act charged ; prison to an asylum, and would not be condemned to penal (2) that accused had already been incarcerated in an asylum servitude for life. It has been suggested in some quarters that this points to for a few months some time previously, but had been discharged therefrom on an action of liberation ; (3) evidence a movement toward the abolition of capital punishment. It is only human that juries should shrink from returning was adduced at the trial on behalf of accused by medical witnesses and others to rebut the testimony of the Crown verdicts which involve the lives of prisoners, and, perhaps, doctors as to his insanity; and (4) accused himself gave the histories of several recent cases show a trend of opinion evidence on his own behalf, thereby affording an oppor- in this direction. I offer no opinion on the question of the tunity to the jury to form an opinion for themselves on the propriety or otherwise of such abolition, but so long as question of his sanity or insanity from his behaviour,i capital punishment finds a place on the statute-book the same demeanour, and mode of witness-giving. In the previous should be awarded where the law demands it until it be case the accused was incarcerated in an asylum on account repealed. of an alleged crime which was not proved against him; in Glasgow. this case no attempt was made by the accused to deny the crime charged against him, but he declared himself to be aame and that he would rather suffer ten years in prison than suffer incarceration in an asylum. Both cases are alike in that the whole case -alleged insanity and alleged crime-was MEDICAL, SURGICAL, OBSTETRICAL, AND placed before a jury, but while in the previous case present THERAPEUTICAL. insanity was proved the alleged crime was not proved; in this case the alleged crime was proved and the alleged insanity was not proved. NOTE ON AN INTERESTING CASE OF MELANOTIC The fifth case, which may be called the Wigtownshire case, SARCOMA. contains also certain points of interest respecting lunacy pro-
questioned in the
same
either have been
subjected
way
to
Clinical Notes:
oedure associated with crime. The accused, soon after the commission of the act of shooting and killing his aunt, was -sent to an asylum-Perth Lunacy Prison-by the authorities tinder the terms of the Act of 1857, Section 89, or of the Act of 1862, Section 15. After a residence of eight years in that place he recovered his sanity, was liberated, but was at once arrested on the charge of murder. At his trial the fact that he was found to be insane at the time of committing the act and was placed under care in Perth Lunacy Prison was sufficient evidence of non-liability for the consequences of his act, and the evidence of the medical witnesses satisfied the court that he had now recovered his sanity. But although he was acquitted by the jury on the ground of his insanity at the time, he could not be there and then liberated by the court, but could only be freed after petition and by order of a .Secretary of State. The last case cited (Case 6) is in some respects the most txtraordinary case of the series. Here was a man who brutally murdered his wife, who was duly tried and duly defended, whose mental condition had been examined by medical persons who could not, however, declare him to be of unsound mind, who is found guilty and is sentenced to death, on whose behalf there was no recommendation to mercy by the jury nor petition for reprieve by the public, ’but whose execution does not take place owing to what seems a very unusual intervention of the Secretary for .Scotland. It is not publicly known at whose instance the attention of the Secretary for Scotland- was called to the ,case, but the fact remains that by his instructions a commission of lunacy experts was sent 15 days after the trial and six days before the date of execution to the prison in which ,the condemned man was confined for the purpose of examining him. These experts are presumed to have - reported to the Secretary for Scotland, but what was contained in their report is not publicly known. It was publicly announced, however, several hours before the time ;appointed for the execution to take place that he was reprieved and his sentence respited to penal servitude for life. This procedure gave rise to considerable discussion at the time, and one of the questions then canvassed was the legal position of the Secretary for Scotland,in so acting. I have not been able to discover by what powers under the Scottish Lunacy Acts the Secretary for Scotland acted. There is a form of procedure in Section 89 of the Act of 1857 which provides that "in the case of a prisoner who exhibits insanity when in confinement as a prisoner under any sentence or under any charge of any crime or offence or under any civil process, the sheriff shall inquire, with the aid of two medical persons, as to the insanity of such prisoner, and if it shall be certified by such sheriff and such medical persons that, . 1__________
___
--
__
----
____
__
____
-"
BY HENRY
BURNS, M.B., CH.B. EDIN.,
SURGEON, ROYAL NAVY; HOUSE SURGEON
TO THE DUMFRIES AND
GALLOWAY ROYAL INFIRMARY.
THE patient, a man 25 years of age, was admitted to the Dumfries and Galloway Royal Infirmary on July 13th, 1909. His family history was good and free from any story of malignant disease. The personal history showed that about eight months before admission, while at work as a mason, a large stone fell on his left inguinal region. He quite recovered from this accident in a few days and resumed work. Three weeks before admission he noticed a swelling in his left inguinal region and another on the back of his left heel, but he could not state which appeared first. The swellings were neither painful nor tender. That in the groin, at first quite small, gradually grew larger and "black spots " appeared in the skin over and around it; that on the heel, he said, consisted of a hard mass, painful only when his boot pressed upon it, and about the size of a halfpenny. About ten days before admission he observed small black swellings on other parts of his body, chiefly on his chest. He stated that he had been losing weight and strength for some time. On examination numerous swellings could be seen and felt in the upper part of Scarpa’s triangle and in the inguinal region of the left side. They varied in size from that of a pea to that of a walnut; they were hard and neither painful nor tender. The skin over them and for a considerable distance around was studded with small black spots, the On the back whole having a very mottled appearance. of the left heel a swelling, with a circumference equal to that of. a four-shilling piece and projecting about a quarter of an inch beyond the skin surface, could be seen. It was coal-black and densely hard, and neither painful nor tender. On other parts of the body-the chest, abdomen, axillas, and limbs-small lumps could be seen and felt scattered about in the subcutaneous tissue, the ones nearer the surface being black. These were fairly hard The left lower limb was and neither painful nor tender. greatly swollen and oedematous. The patient was quite cheery about himself and his condition. The breath-sounds The ’liver was not enlarged, and were harsh in character. the urine contained melanin. A small lump was excised from the left forearm and examined. It showed the structure of a melanotic sarcoma. The course of the disease was as follows. The cedema of the leg diminished greatly by rest in bed. On August 4th the scrotum and penis became swollen and oedematous, while the swellingss on the heel and in the groin had increased in size and new swellings had appeared on various parts of the
.
1434 The breathing was now somewhat laboured and the The left leg breath sounds were harsher in character. became more cedematous and ascites developed. By the 20th the mass on the left heel had broken down and so also had a swelling in the right gluteal region. The black nodules had greatly increased in number all over the body and one had appeared on the forehead. The breathing was more laboured and cough had started. The patient was now very depressed and could not sleep except under the influence of morphine. There was dulness over both bases of the lungs and the anterior edge of the spleen could be palpated. On the 26th the abdomen was extremely ascitic and was ounces of yellowish fluid being drained off. A tapped, 200 f,,v", inserted For the three days Southey s tube was iiiserueu. For Lue next three aays the amount of fluid drained off was 50, 62, and 25 ounces respectively. Breathing became very difficult and cough very troublesome. The patient became very restless. On the evening of August 30th he became very cyanosed and died in a few minutes. Throughout the whole course of his illness he never once complained of pain. Post-mortem examination.-The abdomen and pleural sacs were full of fluid. The omentum was densely infiltrated with the growth and was absolutely black all over. The stomach was affected, as were also the small intestine, large intestine, and rectum. In the liver were several small scattered black nodules; it was slightly increased in size. The spleen was enlarged and had numerous small nodules in it. On cutting it a growth of about the size of a Tangerine orange was discovered and was easily shelled The bladder had out. The kidneys were not affected. The peritoneum was numerous nodules in its walls. Both lungs were infiltrated with studded with nodules. the growth and nodules were found in the pleura and pericardium. The mediastinal tissue was also infiltrated. The sternum itself was black with the growth and could be broken fairly easily. Neither testicle was affected, but the scrotal tissues were greatly indurated. The swellings in the left inguinal region and on the left heel were black all through.
body.
Medical Societies. ROYAL SOCIETY OF MEDICINE. LARYNGOLOGICAL SECTION. Exhibition of Cases and S’pecimens. A MEETING of this section was held on Nov. 5th, Dr. J. DUNDAS GRANT, the President, being in the The following cases and specimens were shown :— Mr. G. SECCOMBE HETT : Post-mortem specimens from a The case of Chronic Glanders in a man aged 24 years. principal visible lesions during life had been ulcerations within the mouth, nose, and pharynx. In the lungs and liver the strong resemblance to tertiary syphilitic lesions was noted. Dr. DAN McKENZIE: Perforation of the Nasal Septum from Salt Dust in a woman employed in a salt factory. Three other females, out of a total of eight employees, were affected to a less extent. Microscopical sections from the marginal tissues showed typical giant cell systems. Dr. STCLAIR THOMSON: 1. A woman, aged 46 years, affected with Tuberculosis of the whole of the Left Vocal Cord and the Interarytenoid Space, in whom consolidation of the right The lesions were completely apex had been diagnosed. healed by two months’ silence and sanatorium treatment. 2.
chair.
was
Two
Dumfries.
A NOTE ON THE REMOVAL OF FOREIGN BODIES FROM THE STOMACH. BY BILTON
POLLARD, F.R.C.S. ENG.,
SURGEON TO UNIVERSITY COLLEGE
I HAVE
recently
extracted
a
two
HOSPITAL,
LONDON.
shilling-piece
from the
stomach, of a girl, aged 15 years, without cutting into the stomach, in a way which I have not hitherto seen mentioned, and a short note on the method adopted may perhaps be of interest. The method was as follows. The operator opened the abdomen by a longitudinal incision through the upper part of the left rectus muscle and seized the coin through the wall of the stomach with his finger and thumb ; an assistant passed a flexible forceps, described below, by the mouth into the stomach. The coin was adjusted in the grip of the forceps and care was taken to avoid inclusion of mucous membrane ; the assistant then withdrew the forceps and with it the coin. The method of extraction outlined above was devised by me several years ago in order to remove a halfpenny from a little child’s stomach, but it was not then put into practice as the coin was eventually passed per vias naturales. For that case I had had a long flexible forceps made after the pattern of Durham’s tracheal forceps. The principle of the forceps is the same as that of Toynbee’s well-known forceps for the ear. The blades of the instrument, which when uncontrolled spring apart, are fixed to a piece of copper wire, around which a tube composed of spirally coiled wire is placed. The instrument is operated by the handles in such a way that the wire tube slides over the blades of the forceps and brings them firmly together. For the extraction of the two-shilling piece this instrument was passed with the blades closed. The coin was removed No at the first attempt in the way already described. resistance was felt when the coin passed through the cardiac orifice, nor indeed at any part of its transit through the oesophagus. The abdominal incision was sutured in layers and the patient made a normal recovery.
Harley-street, W.
.
in whom Tuberculosis of the Epiglottis, Cords, and Folds of the Larynx respectively had been Interspaces, arrested by galvano-cautery and sanatorium treatment. It was pointed out that tuberculosis developing in the larynx after the process had been arrested in the lungs did not generally assume an acute form, but was apt to become extremely tedious ; also that, in spite of a fair amount of active mischief in the chest, the temperature began to improve with the improvement in the larynx. 3. Papilloma of the Larynx in a boy, aged 62 years, of four years’ duration, cured by tracheotomy and repeated operations with direct laryngoscopy. This case showed the persistent recurrence of papillomata in spite of frequent and complete removal and the natural tendency of the disease to disappear about the age of 6 years. It also emphasised the advantage and harmlessness of wearing a tracheotomy tube, and occasion was taken to decry the useless and crippling employment of laryngo-tracheotomy, as recently proposed, in these cases. 4. A woman, aged 56 years, after LaryngoAfter having been fissure for Subglottic Enchondroma. previously shown before the section in 1908 by Dr. A. Stanley Green and Dr. H. Lambert Lack, the enchondroma had been finally removed by laryngo-fissure by Sir W. Watson Cheyne. Dr. W. JoBSON HORNE: A case of Laryngeal Neoplasm presenting Unusual Features in a woman, aged 65 years. The growth occupied the posterior half of the right side of the larynx and appeared to spring from the ventricle or ventricular band. Pieces had been removed at intervals for microscopical examination, and these sections were referred to the morbid growths committee for report. Mr. W. STUART-Low: Three cases of Inoperable Carcinoma, extra-laryngeal, pharyngeal, and lingual respectively, in whom ligation of the thyroid vessels for partial ablation of the enlarged thyroid gland had been performed with great benefit. The PRESIDENT : 1. Infiltration of the Left Ventricular Band. The patient was a woman, aged 62 years. The infiltrated band bulged so as to cover the whole of the left cord and the anterior part of the right one, occasionally dipping between the cords and preventing approximation. Microscopical examination revealed only inflammatory hyperplasia, and the diagnosis lay between neoplasm and tuberculosis. 2. Epithelioma of the Right Vocal Cord in a man, aged 60 years ; removal by thyrotomy. Microscopical examination of the conical outgrowth below the right cord showed early epithelioma. At the operation the right vocal cord with portion of the right arytenoid cartilage were removed and the underlying cartilage was freely scraped. The patient returned home nine days after the operation greatly benefited. The PRESIDENT and Dr. McKENZIE showed a case of Epithelioma of the Left Vocal Cord Removed by Thyrotomy. Mr. H. CLAYTON Fox : Paralysis of the Right Vocal Cord
patients,