James Pleasant Parker.

Annals of ophthalmology and otology online

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Annals of Ophth. and Otol., Ill, 212; pilocarpin.

4. Metcalfe — Rev. de Laryng., No. 2; pilocarpin.

5. Plicque — Ann. des mal. de Toreille, September; electricity

in otology.

XVIII — Instruments.

1. Alderton — Rev. de Laryng., No. 9; irrigation tube.

2. Delstanche — Rev. de Laryng., No.; incus extractor.

3. Dench — improved Galton whistle.

4. Eschbaum — Monats. f. Aerzte Polik., No. i ; new dilators.

5. Dundas Grant — ^Jour. of Laryng. ; magnifying ear speculum ;

furuncle knife.

6. Lautenbach — Med. News, January 27; double-headed ear

screw for foreign bodies.

7. Lewy — Internat. Cong. Rome, Jour, of Laryng. ; new acou^

meter.

8. Lucae — Berl. klin. Wochenschr., April 16.

9. Todd — N. Y. Med. Jour., May 5 ; middle ear syringe^



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THYROTOMY FOR REMOVAL OF MULTIPLE PAPILLOMA. 87



THYROTOMY FOR REMOVAL OF MULTIPLE PAPIL-
LOMA OF THE LARYNX,

By Wendell C. Phillips, M. D.,
of new york.

assistant surgeon to the manhattan eye and ear hospital throat

department; instructor in diseases of the nose and

throat in new york post-graduate medical

college and hospital.

VN., colored, ii years of age, came to the throat department
• of the Manhattan Eye and Ear Hospital June 30, 1893, and
gave the following history :

Born in Tennessee ; father dead, cause of death unknown : child
was in good health until 3 years of age, when mother left her in
the South and did not see her for seven years, November, 1892,
when she learned that the child had lost her voice ; child says voice
had been lost for several years. The child had been neglected,
had lived a wild out-of-door life, with scarcely any clothing and
no shoes and stockings, constantly exposed to the elements.

Diagnosis, Papillomatous growths were found occupying the
region of right false cord, extending around to and partly covering
left cord. Temp. 100', pulse 86, but patient is strong and vigorous.

She was admitted to the hospital and given potassium iodid 10
grs. three times a day and local applications. This treatment was
continued for three weeks with no improvement. July 29, I
removed two or three small pieces with Schrotter's tube forceps
and the pathologist's report confirmed the diagnosis.

August 2. Removed two small sections.

November 22. During this interval several pieces were curetted
out, with some relief, It was noted that after forceps were intro-
duced she had for several minutes great difficulty of respiration.
On two occasions I feared tracheotomy might be necessarv. Her
tonsils were hypertrophied and were removed to give more room
for examination. This plan of treatment was followed, occasion-
ally removing portions until March, and with no permanent
improvement. Respiration was comparatively easy except when
running or climbing stairs. At this time her condition began to
be more serious, and an operation — thyrotomy — was advised and



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88 THVUOTOMV FOR REMOVAL OF MITLTIPLE PAPILLOMA.

consented to. Accordingly, on March 30, 1894, she was admitted
to the Manhattan Eye and Ear Hospital, and on May 4 a prelim-
inary low tracheotomy was performed under an anesthetic. Alcohol
and chloroform being used before ether to prevent struggling and
possible asphyxia. She was placed in a room the temperature of
which was kept at 75''. There was but little reaction and she
slept well all night. Her temperature for. the first week did not
reach 100^. She was kept on special diet — milk, soups, etc. — and
she did not cough except when tube was cleansed. As is usual,^
the g^'owths reduced considerably in size as a result of the
tracheotomy. On April 20, sixteen days after the tracheotomy, I
performed the operation of thyrotomy, ether being administered
through a rubber funnel" attached to a long piece of tubing which
was inserted into the tracheotomy canula. The shoulders were
elevated, leaving the head hanging well down. A long iitcision
was made down to and exposing the entire thyroid cartilage,
crico-thyroid membrane and the cricoid cartilage. With a probe-
pointed curved scissors the probe blade was plunged through
the crico-thyroid membrane and the entire body of the thyroid
cartilage divided through to the notch. The hemorrhage was
considerable for a moment, but entirely subsided. Small French
sponges were passed downwards into the trachea and no trouble
was experienced from blood passing downwards.

When the segments of the thyroid were held apart by retractors,
the masses of papillomatie protruded from the wound. They were
very numerous and were found to be attached not only to the vocal
cords, but to the entire subglottic region, and also to the ventricles.

The gi'owths were removed mostly with a curette, a few being
removed by the cutting forceps and scissors.

The whole surface was thoroughly curetted and thoroughly
cauterized with the galvano-cautery. After hemorrhage had been
controlled the cartilage was closed by four stitches of the largest
catgut, and the external wound entirely closed with silk.

It is scarcely necessary to say that the operation was performed
under strict antiseptic precautions.

She was again placed in a room with constant temperature at
75' . Diet special, milk and bran water. She was very restless
all night and slept but little ; no pain.

At 9 p. m. the temperature began to rise and by 3 o* clock a. m.
of the 2 1 St it had reached 10^^ /V and pulse 136, resp. 32.
Phenacetin and cafferin were given and by 6 a. m. temperature
was 103'. (Accompanying charts give temperature range).



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THYROTOMY FOR REMOVAL OF MULTIPLE PAPILLOMA. 89

For the next four days temperature ranged from 104^/2° gradu-
ally down to normal. Pulse was exceedingly weak and irregular,
and j^ff grs. strych. was administered hypodermatically every
three hours. On the 2 2d she complained for the only time during
the treatment of slight pain in the throat. On this day the pulse
reached 140°. The inner tube was cleansed when necessary. The
discharge through the tracheotomy tube increased for a few days
after operation, but at no time has she had any symptoms of any
extension to the bronchial tubes or lungs ; she took nourishment
well and could breathe freely by mouth even when tube was closed.

On the 24th the dressing was changed and found to be healed in
the upper part, but two or three of the lower stitches were
separated ; cleansed and packed with iodoform gauze.

The lower part of the wound has gradually healed by granula-
tions, and but a small sinus now remains.

Her voice, entirely lost before operation, has improved slightly.
No hope of return of phonation was given previous to operation,
and the vocal cords were found to be badly damaged by the long
continued pressure of the papillomata.

Examination with mirror May 21st, one month after operation:
Entire larynx is still somewhat congested but appears to be clear,
and no sign of recurrence or of stenosis from adhesions.

It is interesting to note that previous to operation the case was
diagnosed as multiple papilloma of the vocal cords while the
operation proved it to cover so large a surface, and that no endo-
larjngeal procedure would have been successful in her case.

July 15th. Examination to-day reveals no recurrence. Phona-
tion is much improved, but no natural tone can be produced, it
being forced and hoarse.



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9() THYROTOMV FOU RKMOVAI. OF MUI/ril»I.K I»Al»lI.I.OMA.



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THE NASAL TREPHINE. 91f



THE NASAL TREPHINE IN HYPERTROPHY OF
THE INFERIOR TURBINATED BODY.

By G. Melvh-le Black, M. D.,
of denver, colo.

PROFESSOR OF RHINOLOGY AND LARYNGOLOGY IN THE COLORADO SCHOOL

OF medicine; ex-house surgeon MANHATTAN EYE

AND BAR HOSPITAL, NEW YORK.

IN advocating this method of treatment, it is not my intention to
condemn other well known and well tried procedures, such
as the galvano-cautery, the snare, and chemical caustics. Each
have their places in the treatment of hypertrophic rhinitis. In
any surgical procedure in the nose the object in view should be
to remedy the defect with as little damage to the part as possible,
whereby its function may be preserved. It is my desire to brings
to your attention in the use of the Nasal Trephine an instrument
which, in skillful hands, brings about more reduction in the size
of the turbinated body, with less damage to the part, than any
other operation I know of.

The Nasal Trephine as sold by most instrument makers is.
from */4 to 1^4 inches in length, is attached to a steel stem which
fits into a dental hand-piece and is run by a dental engine
or an electro-motor. If the turbinated body is universally
hypertrophied, the trephine is placed against the anterior
and inferior portion of it, as indicated by the dotted lines
in the drawing, and a semicircular or circular piece of
tissue removed from the entire length of the body. If
the hypertrophy is confined to a portion of the turbinated
body only, the trephining is limited to that portion.
I have found that the trephines spoken of above were so short,
that before one-half of the hypertrophied surface was trephined'
through, the trephine would be plugged full of hypertrophied
tissue, necessitating the withdrawal of the instrument and removal
of the tissue therein. This was found to be very inconvenient,
inasmuch as the hemorrhage, which followed the withdrawal of
the instrument, so disguised the part as to render it difficult to
reintroduce the trephine in the same place. I therefore had Mr.




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^2



THE NASAL TREPHINE.



E. B. Meyrowitz, of New York, make for me a set of trephines
2*/2 inches long. This drawing shows the largest instrument in its
actual size :

The three rings in accompanying drawing indicate the size of
their calibers. With this instrument the objection which I found
to the usual trephines in use is overcome," it being suffi- /^
cicntly long to trephine from one end of the turbinated
body to the other without its becoming plugged with \J
tissue. The advantages of the operation over the cautery q
and acids are:

I . The clean Cut surfaces of the semicircular opening •



I



made at the inferior portion of the turbinated body, fall
together and heal by first intention, thereby at once re-
storing free nasal respiration.

2. There is no secretion to speak of after the first
twenty-four hours.

3. There is no perceptible cicatrix. The surface of the
turbinated body is of normal shape.

4. It is extremely rare that more than one operation is
required.

5. There is no danger of adhesion of the turbinated
body to the septum.

The only objection that I can see to this operation is
that hemorrhage is quite free for a few moments, and that
some oozing continues for several hours ; however, I hare
never found the hemorrhage alarming or even annoying.

I have used the trephine in hypertrophy of the inferior
turbinated body for the past three years with universal
success. I began its use in cases of true hypertrophy only
where it was especially indicated, but of late have been
gratified to find that it has proved of great value in cases
of engorgement which were not benefited by the usual
cleansing and astringent applications. Some of these
cases of engorgement are very hard to manage. Even the
galvano-cautery fails to produce anything more than tran-
sient benefit. It is disagreeable to find it necessary to
cauterize every few months, as eventually we have almost
a functionless turbinated body from such extensive destruc-
tion of tissue. With the smallest size trephine, the
turbinated body is penetrated from end to end just beneath
the mucous membrane, thereby a portion of the vascular plexus is
<lestroyed. The immediate result being more or less swelling of



II



V



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THE NASAL TREPHINE.



9a



the turbinated body from extravasation of blood, which lasts
about four or five days when the body begins rapidly to reduce in
size, until at the end of two weeks from the time of the operation
it is of normal size and appearance. In a few instances it has.
been necessary to repeat the procedure, but as a nde one opera-
tion is sufficient. In these cases of engorgement it is well to
operate upon one side at a time, not proceeding with the other
until the swelling has subsided.

I cannot recommend the operation for hypertropiiy of the
middle turbinated body, inasmuch as, owing to the position of
this body, it is next to impossible, in the majority of instances, to
do anything more than trephine directly into the body from below,
upwards. The snare and cautery are much more efficacious in
this region.



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*94 PROFESSIONAL NEWS.



PROFESSIONAL NEWS.

Dr. Henry A. Alderton, of Brooklyn, N. Y., whose ability is
•excelled only by his energy, and will to work, has consented to
assist in gleaning from the current otological literature of the
world all that is practical and useful for the readers of the

AXNALS.



Dr. G. W. Grove, formerly assistant surgeon in the Eye Depart-
ment of the New York Nose and Throat Hospital, and the O. D.
P. Bellevue Medical College Hospital, has removed from New
York to Kansas City, Mo.

Dr. W. H. Wakefield has removed from Winston, N. C, to
Charlotte, N. C.



The Kansas City, (Mo.) Academy of Medicine spread its Fifth
Annual Banquet at the Midland Hotel on Tuesday evening,
January 8th. The Academy is doing the best work of any society
west of Philadelphia, and has in its library the largest collection
of recent *'up to-date'* medical books west of New York.



Dr. T. Melville Hardie, of our editorial staff, was quietly
married on the evening of December 17th, to the only daughter of
Judge Gwynn Garnett, of Chicago. After their wedding tour Dr.
and Mrs. Hardie will reside at 3604 Grand Boulevard. The
Annals wishes them all happiness in the coming years.



FOR SALE.

The Practice of an Oculist and Aurist.

This practice has been in existence eleven years, and produces

about $14,000 in cash. Splendid central location, fine offices,

long lease, name and address of patients for eleven years to whom

notices may be sent; will thoroughly introduce purchaser; college,

hospital and railroad appointments a possibility to the right man ;

best reasons for selling; beautiful city of 200,000 inhabitants.

This is one of the rarest opportunities and will be sold for $7,000

^ash. Do not apply unless you mean business. Address B, care

Dr. Jas. P. Parker, Union Trust Building, 701 Olive Street,

^aint Louis, Mo.



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BOOK NOTICES. 95



BOOK NOTICES.

A Phactical System of Self-Instruction in the German
Language for Physicians and Medical Students. By
Albert Pick, M. D. Published and for sale by Edward S.
Tanner, Newtonville, Mass., in twelve parts at fifty
cents per part or six dollars for the complete work.

As the title of this work implies it is intended for self-instruction
and will enable physicians to learn to read German medical litera-
ture and converse with German patients in their tono^ue. The
instruction is imparted by means of a series of short essays on
medical subjects in German with interlinear translation and pro-
nunciation. Each lesson is supplemented by a number of element-
ary phrases used in conversation, and by some brief but sufficient
remarks on grammar. It is well adapted for the purpose of
imparting a knowledge of medical German and will surely '*fill a
long felt want" if the hungry doctor, for medical science, will
study it carefully and learn to curry favor with wealthy German
patients.



A Book for Trial-Lenses. Of all the books that I have been
called upon to review this is the most original. When closed it
has the appearance of a substantially bound volume about the size
of Gould's excellent New Illustrated Dictionary of Medicine. It
opens at the middle and presents to view, in racks, a complete set
of Nachet's trial-lenses, trial-frames, etc.

The only two leaves in the book are of heavy board and are
intended to hold the lenses in place while it is closed, and these
leaves have Snellen's test-letters on them and can be removed
from the book and hung on the wall, or elsewhere, and used for
testing patient's vision. The book (case for trial-lenses) fits a
*' dictionary holder" which allows it to be raised or lowered to
any height and ••fixed" on an incline of any desired angle.

The portability and convenience of this simple ingenious case
and holder for test-lenses commends it to those who work at
refraction four to six hours each day, as it holds the lenses so near
and convenient that stooping and fatigue are avoided. The author
(inventor) of the book has no ''copyright" and he desires no
advertising as he is a busy blank-book manufacturer who has all



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96 BOOK NOTICES.

the business he wants. The idea came to him while watching me
test his little daughter's eyes, and he had the book (case) made
and presented it to me. Any ophthalmologist can have a good
book-binder dissect an old worn-out Nachet case and get the
leather strips bearing the numbers of the lenses and the racks, and
have the book made, at small expense, and the *' dictionary holder"
can be obtained at any stationery store. J. P. P.



One Hundred Years of Business Life. By Messrs. W.

H. SCHIEFFELIN & Co., OF NeW YoRK CiTV. A GREETING TO
THEIR FRIENDS, IN THE FORM OF A PAMPHLET SETTING FORTH
THE HISTORICAL AS WELL AS COMMERCIAL SIGNIFICANCE OF THE
COMPLETION OF A CENTURY OF EXISTANCE OF THE HOUSE OF W.
H. SCHIEFFELIN & Co.

The fine ** hand-made" Holland paper, handsome engravings,
and elegant printing of this beautiful pamphlet cannot fail to
excite admiration. It is absolutely the most beautiful pamphlet
ever produced in America, or any other country.

It is in keeping with the high grade of drugs and pharmaceutical
preparations that are supplied by W. H. Schieffelin & Co., who
do all they undertake well. The writer was brought up by one of
the most thorough, careful, and conscientious pharmacists w^ho
ever conducted a pharmacy, and every pound of opium and
cinchona bark that entered the establishment had to be assayed
before it was placed **in stock," and it was the writer's business ,^
for seventeen years, to make the assays and estimate the value of
the drugs, and during all of those years no error was detected
in the assay of a package, bearing the assay on the label, of
Schieffelin & Co., though it would have been a great pleasure
to have detected an error, as there was a standing prize for the
detection of an error in an assay of their laboratory.

[As one who was brought up under the old regime, I cannot
refrain from saying in this connection that the modern craze of
physicians to be their own pharmacists and dispense tablets and
preparations that they are unable to determine the contents of, will
do scientific therapeutics more harm than homeopathy. It appears
that physicians who feel *' called" to fight scientific pharmacy do
not see that the more intelligent and best trained pharmacists will
soon be compelled to qualify as physicians, because a pharmacist
cannot live without the support of physicians, and no well trained
pharmacist will submit to being placed on a level with a common
merchant. Pharmacists make the best physicians and surgeons, and



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BOOK NOTICES. 97

it requires but little effort for a well trained pharmacist to make a
doctor, and he will enter the medical college with a full knowledge
of materia medica, therapeutics, chemistry and pharmacology, so
that ''medicine** will come easy to him. His hands have been
trained to handle small packages, small weights and very small
amounts of money, which develops good use of his hands and
enables him to excel other men in operative surgery.]

To return to the pamphlet of W. H. Schieffelin & Co., we find
it divided into six chapters, giving six changes in the composition
and name of the firm and periods of development of American
commerce. The story is well presented and is very interesting.
The pamphlet contains fifty-six pages, with an appendix, giving a
complete history of "One Hundred Years of Chemistry and
Pharmacy,'* all of which must be read to be appreciated.

J. P. P.



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98 MISCELLANEOUS.



MISCELLANEOUS.

ALVARENGA PRIZE OF THE COLLEGE OF PHYSICIANS OF
PHILADELPHIA.

The College of Physicians of Philadelphia announces that the
next award of the Alverenga Prize, being the income for one year
of the bequest of the late Sefior Alvarenga, and amounting to
about $i8o. will be made on July 14, 1895, provided that an essay
deemed by the Committee of Award to be worthy of the prize
shall have been offered.

Essays intended for competition may be upon any subject in
medicine, but cannot have been published, and must be received
by the secretary of the college on or before May i, 1895.

Each essay must be sent without signature, but must be plainly
marked with a motto and be accompanied by a sealed envelope
having on its outside the motto of the paper and within it the
name and address of the author.

It is a condition of competition that the successful essay or a
copy of it shall remain in possession of the college ; other essays
will be returned upon appplication within three months after the
award.

The Alvarenga prize for 1894 was awarded to Dr. G. E. de
Schweinitz, of Philadelphia, for his essay on Toxic Amblyopias.

Essays, in competition for the next award, should be sent to the
secretary of the college. Dr. C. W. Dulles.



HYDROGEN DIOXIDE. Hj O2.

By Dr. L. D. Kastenbine, A. M., M. D., Professor of Chem-
istry, Urinology, and Medical Jurisprudence, Louisville Medical
College, Professor of Chemistry Louisville College of Pharmacy.
This remarkable liquid which contains the greatest percentage of
oxygen of any compound known, was for sometime considered as
a mere solution of oxygen in water, and consequently was called
oxygenated water. It was afterward obtained free from water
and found to be a definate chemical compound of hydrogen and
oxygen, and differing from water in containing twice as much
oxygen. It has a somewhat bitter, astringent taste, and is color-



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MISCELLANEOUS. W

less, transparent and without odor. It contains 94 per cent of
oxygen gas by weight, and will yield 475 times its volume of
that gas.

A fifteen volume solution is one that will give off fifteen
volumes of gas from one volume of the solution A ten volume
solution will yeld ten pints of oxygen gas from one pint of the
solution, and so on.

These solutions, although more stable than mere concentrated
preparations, nevertheless decompose and lose their nascent
oxygen on which its powerful antiseptic powers depend, and con-
sequently we find the commercial brands varying considerably
from their reputed strengths. Of the various brands of commer-
cial dioxides I have examined, I find Marchand's to be the one
which yields the largest amount of available oxygen under all
conditions of exposure, and the one which contains the minimum
percentage of free acid. All the marketable articles I have seen
are free from barium compounds, but the majority do not come
up to the 15 volume standard, but are 6, 8, 10 and 12 volume
solutions.



NOTICE.

A Calendar for 1895 upon receipt of request. P. Blakiston,
Son & Co., Medical Booksellers, 1012 Walnut street, Phila-
delphia, will send free by mail, postage prepaid, a neat desk
calendar for 1895.



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100 COLLABORATORS.



V<,LUME IV. JANUARY, 1805. No. U

ANNALS OF OPHTHALMOLOGY AND OTOLOGY

PUBLISHED QUARTERLY

By Jas. p. PARKER, M, D.

701 Olive Street, SAINT LOUIS, MO.

Subscription Price, per annum, $6.00; Single copies, $l.50.



EDITORIAL COLLABORATORS.

Alderton, Henry A Brooklyn •

Ayres, S. C ~ Cincinnati

Barkan, Adolf San Francisco

Bettman, Boerne Chicago

Burnett, Charles H PMladelphia

Burnett, Swan M Washington, D. C.

Chisolm, Julian J Baltimore

Claiborne, Jno. Herbert New York. City

Coleman, W. F Chicago

Dessar, Leonard A ^ New York City

FoucHER, A. A Montreal

Fryer, B. E ~ Kansas City

Gould, George M Philadelphia

Gradle, Henry Chicago

Hardie, T. Melville Chicago

HoTZ, F. C Chicago

Jackson, Edward Philadelphia

KoLLOcK, Charles W Charleston, S. C.

Lederman, M. D New York City

May, Charles H New York City

NoRRis, William F Philadelphia

Oliver, Charles A ~ Philadelphia



Online LibraryJames Pleasant ParkerAnnals of ophthalmology and otology → online text (page 9 of 56)