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examined by Dr. Harris; the breathing was found equal onboth sides, but not much air entered the lungs. After ashort consultation, Mr. Holden, believing the piece of woodto be either in the larynx or a little below it, determined tohave the child placed under chloroform, and to performtracheotomy, if the foreign body could not be reached bythe finger or the forceps. As nothing could be felt with thefinger, tracheotomy was performed above the isthmus of thethyroid gland. The operation was very troublesome onaccount of the number and distension of the veins cutthrough at every step. These bleeding vessels were liga-tured one by one. The trachea was abnormally small, andeven when the opening was made there was great difficultyin introducing the tube. Partly from the above cause, andpartly from the blood which obstructed the view, for aminute or two the child’s life was in danger. After theintroduction of the tube the breathing was much relieved,and all dyspncea passed off at once, showing that the ob-struction was above the opening in the trachea. Mr. Holden,however, did not make any exploratory attempts to find thepiece of wood, but hoped that, as the irritability of theglottis subsided, the foreign body would be coughed upthrough it. The child was placed in a tent cot near thefire, and kept at a temperature between 60° and 70° F.Steam was introduced under the tent by india-rubbertubing, so that the patient was kept in a warm, moist atmo- Isphere. The dressers and some of the other students tookturns (of two hours each) in sitting up with and watchingthe patient, lest the tube should become clogged withmucus, or some other accident occur.5th.-The patient breathes easily and looks well. Foreign

body not yet discovered.6th.-This morning, about 9 A.M., whilst coughing she

said that she felt the piece of wood come up into her mouth,and thought she would have brought it up completely, butinstead of that she swallowed it. The tube became severaltimes blocked up with mucus, and was moved, cleansed,and replaced by the dresser on duty.7th.-About 1 r.M. to-day had a motion ; this was searched

and the piece of wood found; it had taken twenty-eighthours to perform its journey through the alimentary canal.It measured three-eighths of an inch by one-eighth. Thetube was then removed from the trachea, and the wounddressed with oiled lint.9th.-Granulations thrown out from the cut edges of the

trachea. Voice nearly the same as previous to the opera-tion. No pain.12th.-Wound healing fast. Voice completely restored.

Breathes noiselessly.19th.-Up and about the ward; only slight superficial

wound remaining.January lst, 1874.-A small abscess formed yesterday on

the left side of the wound, which was opened this morning,and about a teaspoonful of pus let out.25th.-Discharged from the hospital, both wounds com-

pletely healed.

NOTTINGHAM GENERAL HOSPITAL.A SUCCESSION OF EPILEPTIC CONVULSIONS CUT SHORT

BY LARGE DOSES OF BROMIDE OF POTASSIUM.

(Under the care of Dr. RANSOM.)THE following case, for the notes of which we are in-

debted to Dr. Ottley, is interesting in several particulars.Firstly, as regards the severity and frequency of the fits;secondly, as regards the enormous doses of bromide of

potassium that were given and tolerated; and, thirdly, therapid and marked benefit that followed this treatment. Themental condition after the fits, and the temporary paralysisof the most affected muscles, are also matters worthy ofnotice.Wm. L-, a turner, aged twenty-one, was admitted into

the hospital on Nov. 29th, suffering from a succession ofconvulsive attacks, which had begun on the afternoon ofthe 28th. He was for the most part quite unconscious, andthe following history was not obtained until his recovery.About four years ago he began to suffer from epilepsy. Thefits were almost always nocturnal, and the only evidence hehad of them, apart from what his mother told him, was afeeling of great lassitude on the following morning. They,

were never frequent, and he believes that he has been freefrom them for twelve months before the present attack.On Nov. 28th, whilst at work, he fell down in a fit. This

was followed by a second before he had fully recovered,and until Nov. 30th the paroxysms increased in frequency.Between these dates he had not, it is believed, been threehours without convulsion, and in the intervals had neverbeen thoroughly conscious, though able to say a few wordsand to give indications of pain.

On Nov. 30th the convulsions were very frequent. He hadfive in twenty-five minutes, and they had the followingcharacter. The face was first drawn to the left side, andthe eyeballs rolled in the same direction ; the left hand wasclenched, the thumb being placed between index and middlefingers, and the respiration was arrested; the clonic stagesoon followed, in which the movements were much moremarked on the left side ; the face became dusky, and theveins of the neck much distended. The tongue was notbitten. As the convulsion ceased the eyeballs and face wereslowly turned to the right side. Respiration was acce-lerated, 50 or 60 per minute, and the patient passed into a,torpid, almost comatose state, in which he could swallowand could move his right arm and leg, though not those onthe left side. Immediately before the attack the pupils weresmall, during it they increased greatly, and in the thirdstage returned to their normal size. At noon he begantaking twenty grains of bromide of potassium everyhour. At 12.30 the fits were less frequent. From 1.30 till5.40 there was no convulsion, and at 9 P.M. the last fitoccurred.On the following day, Dec. lst, he slept much, and com-

plained occasionally of some abdominal pains.Dec. 2nd.-Last night he had little sleep, was delirious,

and shouted constantly. This morning the movements onthe left side are weak and imperfect, but this weakness doesnot amount to hemiplegia.14th.-He continues to improve. There is now no im-

pairment of motion or sensation on either side. He hasoccasional occipital headache, but this has been absent forthe last two days, and he considers himself in his usualhealth.The following is a summary of the treatment :-On Dec. 1

the bromide was decreased to twenty grains every fourhours, on the 5th twenty grains three times a day, on the8th ten grains three times a day. On the 14th he wasordered, afresh, twenty grains three times a day, which willbe continued for twelve months.

Jan. 26th.-Has continued to take the bromide, and sofar has had no return of the convulsion. He now attendsas an out-patient.

HÔPITAL ST. LOUIS, PARIS. TWO CASES OF PENETRATING WOUND OF THE ABDOMEN,WITH ISSUE OF THE EPIPLOON, ENDING IN RECOVERY.

(Under the care of Dr. PÉAN.)WE are indebted to Mr. Urdy, house-surgeon to the

hospital, for the notes of the following cases. _

CASE 1.-The wound was seated in the left hypochondrium,and was caused by a gouge. Haemorrhage occurred, andthe epiploon came through. When admitted into thehos-pital, the epiploon formed a tumour of the size of a nut; itwas strangulated by the lips of the wound, but was not verypainful. Ice was ordered to be constantly applied to theabdomen, so as to ward off consecutive inflammation, andocclusion was effected by means of gold beaters’ -skin andcollodion. After three days the use of ice was discontinued.No reaction occurred; obstinate constipation was observed.Three successive doses of saline purgatives were requiredto bring on a débâcle, or breaking up of fsecal matter. Eightdays after, the goldbeaters’-skin was removed, and lint wassimply applied. The tumour had diminished, and was pain-less ; it was very vascular, and fleshy granulations of anexcellent character were noticed on the epiploon. On the29th October (fourteen days after admission) the patientleft the wards. There existed a tumour of the size of asmall cherry; the surrounding part of the pedicle washardened, and a kind of puffiness extending into the abdomenwas to be noticed.CASE 2.-The above case may be compared with another

one admitted some time previously into the wards. The

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patient had received a cut with a knife slightly below theepigastrium on the mesial line. The protruded epiploonformed a tumour of the size of the fist. The surgical treat-ment was the same. Healing was left to nature, and allwent on safely and nicely. At the end of two months thetumour bad diminished to the size of a nut, and offered thesame characters as the one above described. The processof disappearance of the tumour is effected by means of sup-puration and of decreasing size; it returns gradually into theabdomen.

Medical Societies.ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

TUESDAY, FEB. 24TH, 1874.DR. C. J. B. WILLIAMS, F.R.S., PRESIDENT, IN THE CHAIR.

CASES OF (SO-CALLED) ICHTHYOSIS LINGUIE.BY W. FAIRLIE CLARKE, M.A. (OXON.), F.R.C.S.,

ASSISTANT-SURGEON TO CHARING-CROSS HOSPITAL.

THE term 11 ichthyosis" was first applied to a morbid condi-tion of the tongue by Mr. Hulke in 1864. In its earlier stagesthe disease has something in common with warts and corns,and with "papillary tumours of the gum." But it is dis-tinguished both pathologically and clinically from theseaffections in two ways. (1) It attacks only the tongue andthe inside of the mouth; no other mucous membrane issubject to such an affection. (2) It slowly spreads, butgives only slight inconvenience and no pain. In this stateit may remain many years, but sooner or later it assumesthe characters of epithelial cancer.

Ichthyosis linguae manifests itself in an overgrowth of thepapillary and epithelial elements of the mucous membrane,and it is the dorsum of the tongue which is affected in themajority of instances. In some cases the enlarged papillaemay be seen sprouting up in small groups, in others thewhole of the affected surface is smooth, hard, and almostcartilaginous. It presents either a silvery or a snow-whiteappearance, quite different from any fur which ordinarilycovers the tongue. When the disease has once manifesteditself, it is very persistent. Though it sometimes respondsa little to treatment, and though it varies slightly, it neverwholly leaves a spot which it has once attacked.The essential nature of the disease appears to be that of

a chronic inflammation, accompanied by an overgrowth ofthe papillae and a loss of power to throw off the effete

epithelium. The irritation which gives rise to this inflam-mation sometimes acts on the periphery of the nerves, andsometimes it is situated between the periphery and thecentre. It would appear that any persistent or oft-repeatedirritation of the lingual branches of the fifth pair is capableof causing the disease in persons who have a strong inborntendency to the development of warty growths under slightcauses.

If a portion of the ichthyotic coating be examined underthe microscope, some increase in the thickness of the epi-thelial layer is seen, some enlargement also of the papillae,and a great development of the rete mucosum. Around thebases of the papillse, and in the submucous and musculartissues, there is a very abundant nuclear cell-growth. Thereis also a notable increase in the number and size of thebloodvessels in all parts. When the disease reaches thestage of epithelial cancer, the most striking feature is thedevelopment of the rete. It increases enormously at theexpense of the papillae, reducing them in many places tomere threads, and dipping down between them in the formof large club-shaped processes. Towards the terminationof some of these processes the cells may be seen to haveassumed a circular arrangement, forming the laminatedcapsules, or nests of cells, that are so characteristic of epi-thelioma. These points are illustrated by microscopicalsections and drawings.Nine cases of ichthyosis linguae are related at length,

some of which were under the author’s own care, whileothers have been communicated by friends or gleaned frompublications. In an appendix eight more cases are brieflynoticed. Several of the cases are illustrated by drawings.The paper concludes with some general remarks upon the

disease and its treatment. 1. It is much more common in

men than in women. Out of sixteen cases (one being setaside for special reasons) only one was a female. 2. Itnever occurs before puberty. It is an affection of earlymanhood and of middle age. 3. Though a venereal ulcera-tion may occasionally be its starting-point, there is noreason to think that it is always associated with syphilis.On the contrary, it is clearly distinguished from the mani-festations of that disease. 4. With regard to treatment:- If the disease presents itself in a very early stage, itshould be promptly and thoroughly excised. On the otherhand, when it has become epitheliomatous, no time shouldbe lost in performing an operation. But during the wholemiddle period the best thing that can be done for thepatient is to study his general health. If any local measuresare used they should be of an unirritating kind. If anyjagged teeth are present they should be removed. At thesame time the patient should be advised to guard histongue against all sources of irritation, and to pay parti-cular attention to his digestion. ’Under this treatment theichthyotic coating often alters for the better, though it isnever altogether removed.Mr. ACTON said he had seen many affections of the tongue,

especially from syphilis. He was not aware of the diseasecalled " ichthyosis." He had examined the tongue of thepatient exhibited, but would call it .. psoriasis," an affectionwhich is a common attendant upon syphilis. He had seenichtbyosis of the body, and it differed from this on thetongue. One of the most frequent causes, but not the onlyone, was syphilis ; then the irritation from broken teeth,tobacco-pipes, &c. The affection had been noticed in India,and he had seen many Indians who suffered from it. It wasnot difficult to diagnose before ulceration ; but if there wasulceration, it was difficult to say whether it was a gumma-tous tumour or an epithelial cancer till the microscope wasused. He would like to hear how the author of the paperdistinguished them. He thought, if psoriasis of the tonguewas seen early, local treatment did good ; if there wasulceration, large doses of iodide and bromide of potassiumwere useful. The author’s remarks on the general treat-ment were very good. He was sorry to hear that the authorconsidered the disease so fatal.Mr. HULKE thought the profession was indebted to Mr.

Clarke and Mr. Morris for bringing so many cases forward.Ten years ago he brought the first case before the Society.It was not published in the Transactions; and this he theless regretted, as it gave him the opportunity, six yearslater, of bringing the case, with fuller details, and whenepithelioma had supervened, before the Clinical Society.The patient was a strong, healthy man. There was no evi-dence of syphilis in him or any of his family. He (Mr.Hulke) had seen some half-dozen other cases, and in most ofthem no evidence of syphilis. His strong impression wasthat, in the majority of cases, syphilis had nothing what-ever to do with it. Sir J. Paget had remarked upon theclose parallelism between ichthyosis of the skin and theaffection of the tongue; and approved of the name ichthy-osis. Mr. Clarke had pushed the anatomy farther than hehad been able to do, as he (Mr. Hulke) had examined sec-tions six years before epithelioma supervened, and thechange was then exclusively confined to the epithelial andthe immediately subjacent tissue. He did not quite followMr. Clarke when he said the epithelioma was derived out ofthe ichthyosis. He (Mr. Hulke) had not ascertained it inhis own case; for, after trying local treatment, he had cutout the patches, and he then lost sight of his patient, andon his return, after six years, the epithelioma had appearedin the centre of the tongue, near the tip, and he thoughtnot in one of the cicatrices. In no subsequent case couldhe assure himself of the transition of the one into theother. He joined issue with Mr. Clarke as to the inflam-matory nature of the affection. It lasted twenty years ormore, and was restricted to the corium and subjacent tissue;it was quite soft and pliant, and there was no cedema orthickening, as in subacute inflammation, as in chroniceczema, &c. As far as his observations went, treatmentwas of absolutely no use. Mr. Clarke’s observations andhis own agreed as to the supervention of epithelioma. Inevery case he had watched, epithelioma had followed. SirJ. Paget said the same ten years ago when his case wasdiscussed.

Dr. FAYRER said that cases like those described were oftenmet with in India, more among natives than Europeans.