an operation was performed to close the fistula by suturing, but was ineffectual.

He then came to New York and was subjected to five more attempts at closure by his physician at home. The methods varied: Sometimes silver wire sutures were used, after paring the edges; sometimes, silk. Twice were the hairlip pins and figure-of-eight suture used. But after each operation mucus and discharges burst the wound open and left him more desperate than before. The successive parings of skin and cartilages had resulted, with what ulceration occurred between times, in the sacrifice of a considerable portion of the left lateral half of the thyroid cartilage, the entire gap being nearly three-quarters of an inch, though the opening in the cartilage proper was five eighths of an inch in diameter. The edges of the fistula were cicatrized, and induration ex

FIG. 1.

tended half an inch from the opening. Through this great gap one could get a most extraordinary view of the vocal chords in action. The anterior ends were attached just within the lower edge of the fistula on the median side, and when at rest the cords fell flat on either side and were lost in the mucous membrane. On attempted phonation they sprung into view and vibrated at an angle of thirty degrees with the horizonafterward falling

EXTERNAL APPEARANCE OF LARYNGEAL back to nearly the

FISTULA.

horizontal position.. The movement

of the cords to assume this angle with the horizon when the patient is erect I do not find noticed in such authors as I have consulted.

Attempts to speak or make audible voice when the fistula was uncovered were futile. The voice being produced in the mouth and pharynx by the utilizing of sound of vibrating cords, it was vain for him to try to phonate when all the sound escaped from the side of the larynx. All he could do was to produce a fizzing or buzzing note like the sound one might make by blowing through a single reed of an organ. When, however, a flat pad covered the fistula, he could phonate perfectly, though with a slightly husky tone.

I decided that by the following not very complicated plastic opera

tion I could close the fistula, if I did preliminary tracheotomy to prevent expulsive efforts at coughing from forcing mucus and air through the sutures.

November 13, 1885, assisted by Dr. Bangs, the patient was etherized

and thracheotomy done at the two upper rings. When the patient breathed well through the tube the glottis was stopped. through the fistula with a sponge attached to a string drawn out through the mouth. The edges of the fistula were thoroughly pared. A broad elliptical space was then included between two incisions, a, b, being somewhat wider than the fistula and extending obliquely downward on the patient's neck. A part of the included skin below the fistula was dissected up so us to make a flap on its upper edge, which, when turned over, more than covered the hole. The cuticle was then denuded from the part of this surface not wanted to cover the whole, and the rest of the elliptical space made raw for the reception. of the overturned flap. The latter was then stitched over the fistula by two rows of fine continuous catgut; one row on the edge of the orifice tacking the surface of the flap at the circle of denudation, and the second on the outer edge of the flap fastening it to the

SUTURING.

The skin on either side of the neck was then undermined and slid over the flap mentioned, so as to meet directly over its centre. A lateral slash, 134 inches away, was necessary to relieve tension, and served to admit a drainage tube.

Antiseptic compresses were applied and the sponge removed from the larynx by the mouth. The patient made a very comfortable recovery with primary reunion throughout. The tracheal tube was removed on the fifth day, and he was allowed to talk at the end of a week. He left the hospital with a perfectly solid larynx-and excellent phonation, which has been maintained.

EARLY Diagnosis of Vertebrae Caries.-Inquire concerning tubercular inheritance, convalescence from infantile diseases, or spinal injury; as these enter into the question of causation. Next ask if the patient be troubled with restless nights, moaning, disturbed sleep, indisposition to play, desire for support, or epigastric pain. If it falls, it is apt to scream with pain, generally epigastric. The child walks carefully, or if very young it does not walk at all.

The back is held rigidly, the shoulders thrown back, or one higher than the other. The child does not stoop, or if it does, great care is taken. Sometimes only a pain in the back is felt, especially when a jar is sustained.

The gait is almost pathognomonic. The carefulness, and rigid carriage are never found except in disease of or about the spine. The expression is often pinched and anxious. In stooping to pick up any thing, it lowers the body with the spine held rigidly; or, the pain coming on, the attempt is given up.

Pressure to develop spinal tenderness is valueless.

The examination as to mobility may be made by having the child lie on its face, and grasping the heels, slowly extending the limbs with the opposite hand to the diseased side. This will show if the spinal column is rigid or not. Spinal rigidity makes the diagnosis certain.

In the cervical region, the symptoms are, torticollis, occipital neuralgia, or hyperæsthesia. Brushing the hair causes pain; motion is interfered with, but the deformity is slight.

A thorough physical examination should be made, the child being entirely naked.-Amer. Pract. and News.

CHOLERA among Children.-At a recent meeting of the Vienna College of Physicians, Eisenschitz gave the following observations upon Asiatic cholera among children (Weiner Medizinische Presse):

He agrees with the opinion of Goldbaum that cholera is a vaso-motor paralysis caused by the specific poison. Except in the case of nursing children, he does not believe that children have a less resistance than adults to infection.

The question of fœtal infection from cholera the observer could not answer; his only post-mortem examination in such cases was negative. Monti believes that a nursing child may become infected through mother's milk; it is more probable that both mother and child are directly infected from the same source.

Artificially nourished children are much more exposed to infection than those who nurse. This is undoubtedly dependent upon the con

tamination of the foods taken.

The mortality was fifty-five per cent. which is not greater than among adults; of seven nursing children all died.

Although prophylactic means were insufficient, no physician or nurse became ill.

Structional changes observed were essentially the same as in adults. The swelling of the solitary glands and of Peyer's patches was more widely extended than with adults. In the typhoid stage of cholera infarcts frequently occurred in the lungs. The grandular alterations. were especially pronounced in fulminant cases.

Regarding the prognosis, cases which manifested the usual prodromal symptoms, resulted more favorably than those whose advent was sudden. The predominance of vomiting over diarrhoea was considered a favorable symptom. Temporary improvement the observer did not consider a ground for encouragement, as asphyxia and collapse frequently recurred.

In general it can be said that the chances for the individual are in proportion to the average rate of mortality.

The duration of the illness was essentially the same with children as with adults.

The algid stage endured in favorable cases from six to thirty-six hours; in fatal cases from nine to fifteen hours.

In cases which recovered the typhoid stage endured six to ten days; with those who died, from five to fifteen days. With children less than four years old the algid stage did not exceed twenty-four hours.

The condition known as typhoid fever was characterized by the usual symptoms of typhoid fever, with the addition of persistent vomiting, with dilatation of the stomach, and without singultus; the matter vomited was often acid.

Eisenschitz treated cholera sicca twice. In these cases the stools are often greenish-yellow, instead of rice-water, in appearance; white flecks appear with the stools, and in the intestines abundant rice-water matter is found. Dejections occur during the algid stage without straining; tenesmus is often present during the typhoid stage. Convulsions the observer considered caused by a condition of hydrocephalus, and not peculiar to cholera.

Post-mortem rise of temperature was often seen.--Med. News.

ITEMS.

-The next meeting of the Medical Editors' Association will be held at Saratoga during the meeting of the Homeopathic Medical Society. The President, Dr. Bushrod W. James, will deliver an address. It is desirable that all medical editors who can, shall attend, as the organization is a permanent one. Mr. A. L. Chatterton, 78 Maiden Lane, New York, is the secretary,

-An article on Guatemala, by W. T. Bringham, which will appear in the June num. ber of Scribner's Magazine, will contain a number of illustrations made from photographs taken by the author in his long journeys in that country, which he calls An Uncommercial Republic."

-The Twenty-third Annual Session of the Homoeopathic Medical Society of the State of Wisconsin will be held in Waukesha, June 23 and 24, the officers are: Pres. O. W. Carlson, M. D., Milwaukee; Vice President, R. K. Paine, M. D., Manitowoc ; Sec. Joseph Lewis, Jr., M. D., Milwaukee; Treasurer, Helen M. Bingham M. D., Censors, Joseph Lewis, Jr., M. D., Q. O. Sutherland, M. D., Lewis Sherman, M. D. -Judge C. Fuller, of Michigan, decided, when a physician refuses to testify on the the ground that the evidence would be expert testimony, · After many years' study and observation, I decide that a physician's knowledge is his stock in trade, his capital, and we have no more right to take it without extra compensation than we have to take provisions from a grocery, without pay, to feed the jury. The court rules that the witness is not compelled to testify."

-DANGEROUS LEMONADE.-A style of lemon-squeezer has been sold quite extensively which is made of galvanized iron, or iron covered with a coating of zinc. A word of caution should be given against their use, as the citric acid of the lemon will readily dissolve the zinc, forming unwholesome and poisonous salts. Lemon-squeezers should be made either of plain iron or wood, or, where the surfaces brought into contact with the fruit are of glass or porcelain. Zinc is a metal which is readily attacked by the weakest acids, and no article of food or drink should ever be allowed to come in contact with it.

-In the treatment of many diseases there arrives a time when measures outside of the regular remedies may be resorted to. This time is when the successfully used remedies has conquered the disease, but during its efforts to secure the victory the patient has used up nearly all his vital power, and then to return to health and vigor, tonic preparations take their place. Stiger's Phosphated Coca Malta Tonic, it is found gives better satisfaction as a general tonic than any other preparation. The combination of malt with Erythroxylon Coca is in itself most excellent-the still further additions of Hypophosphites of Lime and Soda make this tonic unrivalled in the various nervous and mental diseases in which we so often need preparations of this kind. More complete particulars may be found on page eleven.

THE

AMERICAN HOMEOPATHIST.

VOL. XIII.

NEW YORK, JULY 1, 1887.

No. 7.

The report comes to us from Berlin that a physician of that city has discovered a new disease. This is certainly a case of misdirected energy and entirely wrong, and for one we desire to enter our protest. We have already more diseases than we know what to do with. What we really need is a new remedy for some of the old diseases. A new cure for phthisis or something of that kind.

* *

The poet's dictum concerning the dangerous tendencies of a little learning is emphatically true so far as it applies to a little learning in the science of medicine. There is also an apposite adage that suggests itself in this connection. "That fools rush in where angels fear to tread." Give a man or woman a smattering of medical knowledge and they are ready not only to prescribe on any and all occasions but above all to criticise and condemn those whose knowledge is as far behind their comprehension as the sunlight is beyond the glimmer of a rush light. We have been particularly impressed with this fact in connection with the subject of nurses. The attempt to train nurses to a proper understanding and performance of their work was a laudable. endeavor to reform a very apparent evil. But the trained nurses of today in many cases have been taught too much or too little. They know too much, or think they do, for the position they occupy. the nurse who is trained to do her work carefully and conscientiously, who can promptly and skillfully carry out the physician's instructions, and carefully watch and intelligently report the progress of a case of disease we have only unqualified praise; but the nurse who thinks she can instruct the physician as to his duties is a nuisance that needs to be suppressed. With a little experience with a nurse of this kind the physician soon becomes disgusted with trained nurses and it is not surprising that a reaction is setting in against the highly lauded trained

nurse.

**

In a recent issue of the Chicago Health Journal we find the following comparison between Homœopathy and Allopathy which intentionally,