Tracheo-Laryngotomy for Ext'n of Watermelon Seed-J. G. O'Brien, Dublin.

size prevented its introduction. I took the curved end of a No. 8 silver male catheter, split and bent the sides of one end, so as to avoid any danger of its slipping beyond my reach, filed the edges of the other end perfectly smooth, and attempted its introduction; but with. out success. I introduced a quill; but, from its small size and position in the tube, it would soon become obstructed, and have to be withdrawn. The only means at my command, whereby I could keep the opening sufficiently patent to admit an amount of air sufficient to support life, was to sit, and, with a small pair of needle, artery and dressing forceps combined, hold the parts separated and the trachea open. This was an exceedingly tedious procedure, and a treatment to which I could not hope to resort a great while; but, hoping that the swelling, or cause that was preventing the entrance of air through its natural channel, would soon subside, I persevered; and, for three days and nights, with the exception of a very little while, at intervals, I was with the patient. It was truly trying to my powers of endurance; but, when I could observe a small amount of air entering naturally, and the quantity gradually increasing, until to retain an artificial opening was no longer necessary to the preservation of the patient's life, the satisfaction of promised success was a sufficient reward to compensate for the trials of the ordeal through which I had passed.

It was now six days since the first operation. The temperature, which, at one time, had reached 1054 in

APPENDIX-Section on Surgery and Anatomy.

the axilla, had declined to 102; the respirations, which had ranged as high as 75 per minute, had declined to 50; and nourishment, which had been given principally per anum, was now taken, not only per orum, but with relish. A small quantity of sweet milk and beef tea had been given, at intervals, from the first. The temperature of the room had been kept steadily from 80 to 85 degrees, by the use of a kerosene stove and fireplace, and the atmosphere filled with moisture, by keeping up evaporation from a kettle of boiling water on the stove. In addition to the treatment directed to the bronchial trouble, which I deem unnecessary to detail here, I made a trial of fluid extract of quebarcho as a respiratory stimulant, and its effects, in this particular case, were well marked.

From this time-the sixth day-improvement was steady and continued. The wound, though patent, was not used, either for the entrance or exit of air, except during coughing, and the swelling subsided very rapidly, until, on the eleventh day, the patient was discharged as convalescent, both temperature and respiration normal, and only a slight degree of bronchial trouble, as evidenced by auscultation and the continuance of some cough. Granulations were rapidly thrown out, and, by about the fifteenth day, the wound was entirely closed to the admission of air. Considerable caution was used for several days, and the change from the close, warm and moist room to an open, dry atmosphere was gradual, for fear of exciting a relapse of the bronchial

Tracheo-Laryngotomy for Ext'n of Watermelon Seed—J. G. O'Brien, Dublin.

trouble. With the exception of the scar which marks the seat of operations, the patient is, to-day, in as perfect health as before she passed through the trying ordeal from which she so narrowly escaped with her life..

I report this case, not because it is a new or uncommon one, but deeming it of interest from the extremeyouth of the patient, and its successful result under so unfavorable circumstances. Then, too, I have known several instances of death occurring, in young children, from foreign bodies in the air passages, because of the reluctance of physicians to resort to an operation for their removal; when, if performed, their lives might havebeen saved. And, while, in comparison with operating on children three years and older, experience leads me to regard it as a difficult and dangerous operation, I feel fully justified in saying that it would be inexcusable to allow any case, no matter how young, to die without the benefit of the chances afforded by an operation; at least, as a dernier resort.

APPENDIX-Section on Surgery and Anatomy.

COMPLETE NECROSIS OF THE LOWER JAW BONE,

From the Second Bicuspid Tooth Backward, Including the Condyle and a Plate of Bone Extending Forward Beyond the Symphysis.

By B. F. BRITTAIN, M. D., JACKSONVILLE, Texas.

I herewith submit a report of a case of necrosis of the lower jaw bone, which occurred in Sidney, Cherokee County, Texas.

A robust young man took the toothache in one of the lower molars, and, while it was very sore and tender, he exposed himself one night by sleeping out on the bank of the river, which aggravated the symptoms. The side of his face became enormously swollen, and his sufferings were intense.

In this condition, I visited him. Finding the tooth quite loose, I lifted it out with a pair of forceps. The other two molars dropped out while the patient was asleep, two or three days afterwards. The swelling and inflammation continued a number of days. I gave opiates to relieve the suffering, and applied hot fomentations to reduce the inflammation of the jaw. In a few days, the accute inflammation subsided, but the face

Complete Necrosis of Lower Jaw Bone-B. F. Brittain, M. D., Jacksonville, Tex.

I

continued swollen and tender. After a month or six weeks, pieces of the alveola process began to come away. On examining carefully, I found a considerable portion of the jaw bone stripped of its periosteum, but which appeared too fixed to admit of removal. waited a reasonable time for the dead bone to separate. I could not satisfy myself of the extent of the necrosis, on account of the inability of the patient to open his mouth more than enough to admit the finger between the front teeth. There was profuse discharge of pus from the mouth, and through some fistulous openings external to the jaw.

This was the condition of matters when I determined to operate. I was assisted by my brother, Dr. J. M. Brittain, and Drs. J. B. and F. A. Fuller, H. V. Collins and Floyd. On November 30, 1885, the patient was chloroformed, and I proceeded to operate through the mouth. The plate of necrosed bone extended from the second bicuspid forward, beyond the symphysis. I cut down to the dead bone at this point and siezed it with forceps, to elevate it, but it broke off. I made a number of efforts to raise the bone, but it continued to break off till I reached the ramus, when I succeeded in bringing the whole forward and out of the mouth. I found, somewhat to my surprise, the condyle and coronoid process came with the ramus-all necrosed, with not a particle of periosteum remaining.

I saw the young man the fifteenth of April. He is now well.