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CLINICAL RECORDS.

POLYPUS OF THE EAR.

THE auditory canal, like other passages in the body, is occa-sionally subject to the presence of polypi; in fact, it wouldseem to be a character peculiar to narrow channels lined bymucous membrane to give origin to these tumours. A polypusof the ear is looked upon as of more importance than might atfirst sight be imagined, and is liable to give rise to much mis-chief. Mr. Harvey describes those of the meatus as of twokinds-the true and the false. The true polypus grows from apeduncular attachment, and is a fibro-plastic or ciliated epithe-lial growth; the false polypus, on the other hand, is a fungoidgrowth, and has no distinct stalk or neck, but rather a thickbase, and arises from any part of the meatus or membrane ofthe tympanum. We mention these characteristics because itis most important to distinguish between the two kinds, one ofwhich is illustrated by a case under Mr. Bowman’s care, atKing’s College Hospital, in the person of a woman thirty yearsof age, subject to a growth in her ear for six years. It hadbeen partly removed on a previous occasion; its growth, how-ever, proceeded until it protruded from the meatus, and formeda tolerably large and firm tumour. Some fluid of a serous cha-racter was evacuated by puncture, and although this diminishedits bulk at the time, it soon became as large as ever.The diagnosis of the seat of origin was here a matter of diffi-

culty, for the external appearance of the growth was that ofdried-up mucous membrane; and, as Mr. Bowman remarked,it was almost impossible to state with certainty what was itspoint of attachment, but he was disposed to believe it mightbe the membrana tympani. This only invested the case withthe greater interest, for in the treatment this important mem-brane would become destroyed, unless great precautions wereused in the extraction of the polypus ; and the mischief mighteven extend so far as to destroy the ossicles of the ear, andperhaps cause death by the extension of the disease to the brainitself through the temporal bone.Mr. Bowman, therefore, made up his mind to treat the case

by slow torsion, which was commenced on November 30th,by passing a needle through the protruding mass, and thenapplying a twist. This was repeated on the 3rd of December,which at once showed the influence it bore upon the circulation,by causing a dark livid appearance. This process was to becontinued, with the hope that ulceration of the neck of thetumour would occur, and by this means its safe removal beaccomplished, without any ulterior mischief.On the 14th of December, Mr. Walters, the dresser of the

case, informed us that, after the second twist given to theneedle, the polypus collapsed, and turned black. On the fourthday, the polypus dropped out, looking like a piece of rag. Afew days afterwards, a slight discharge which had existedsince the introduction of the needle ceased, and the patientwas discharged, her hearing having been improved by the re-moval of the growth, which must therefore have left the tym.panum intact.

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THE CURE OF VARICOSE VEINS.

A MAN aged about thirty-five years was recently admittedinto University College Hospital with a varicose condition ofthe veins of his left leg and thigh, associated with a varicoseulcer. From the latter a good deal of blood had been lostlately, and much inconvenience was felt from the presence ofseveral knots and clusters of tortuous veins extending up theinner side of the thigh. The dilated vessels running up the legto the middle of the thigh were of considerable size. Two pinswere placed beneath the veins above and three below the knee,.and the usual sutures applied over a small piece of bougie, onthe 19th October; this was done without chloroform beinggiven. The varicosed knots were reserved till a future occasionfor injection with the solution of the perchloride of iron. Aweek later the veins were found to be obliterated, and the- effect of this was to diminish the venous knots already referredto. The ulcer had completely healed. Finally, some of thedilated veins were injected with the solution, but not theothers, as coagulation had taken place within them. This wasfollowed by some inflammation and an abscess, with a littleconstitutional disturbance, but the man has gone on well.We saw some remarkably large varices at the above hospital

on the 16th ultimo, situated at the inner side of the left thighof a man of sixty, who had a varicose ulcer of both legs, in which the veins were in a varicosed condition. Threepins above and three below the knee of each leg were placed

in the usual manner under the veins, and complete obliterationhas ensued, with a cure of both ulcers. A second case of vari-cose veins and ulcers of both legs was submitted to the sametreatment in a man whose constitution was broken down; twopins below each knee, and one above the left knee, were intro-duced. It is important to observe that this patient had beensimilarly operated upon three years ago, on his left leg, with acure of the varix at that time ; but the present knot of enlargedveins was an entirely fresh batch. There can be no doubt thatin the majority of cases the veins operated upon are completelyobliterated; but we believe, with Dr. Pirrie of Aberdeen, thata permanent cure of the tendency to varix is not accomplished,and that in many cases, sooner or later, the varix returns insome other veins.The obliteration of varicose veins we saw also attempted at

King’s College Hospital on the 22nd October, by Mr. Fergusson,the subject being a young woman, a housemaid, who was muchupon her feet, and the veins of whose left leg were enlargedand tortuous. A pin was passed underneath a large vessel atright angles to its trunk, and another was introduced throughthe vein itself in the direction of its length, so that someamount of inflammation might be induced; a twisted threadwas now passed round the pins, with the effect of producingobliteration by the compression thus established.

CURE OF VESICO-VAGINAL FISTULA BY

LIQUOR AMMONIÆ.WE are anxious to record an instance of the cure of vesico-

vaginal fistula, by the application, direct to its edges, of theliquor of ammonia. The case occurred in St. Bartholomew’sHospital, in June last, under Mr. Lloyd’s care. The patient,who was twenty-six years of age, had been the subject of afistula of the kind mentioned since her confinement in Augustof last year, and was, as is usual, much troubled and incon-venienced by the continual dribbling of her urine. A catheterwas kept constantly in the bladder to relieve this condition,and the caustic ammonia was applied to the edges of the fistula,situated rather high up the vagina; and this was repeated afew times, with the effect of causing perfect closure, so that shewas enabled to get up and walk about the ward without theescape of any urine into the vagina. On passing the finger intothis passage, a deep indentation could be felt in the situationthrough which the urine had so long passed. She left thehospital, apparently cured, many weeks back. There can beno doubt, as we heard Mr. Lloyd remark recently, that theparts have been well tested by this time, and that the cure iscomplete.

ACUTE SYNOVITIS OF THE ANKLE OF A BOY,

WE would draw attention to a case of synovitis of the ankle..joint of an acute character in a little boy six years of age, nowa patient in the Charing cross Hospital, under Mr. Barwell’scare. Inflammation of the synovial membrane of this jointcannot be said to be common as compared with other articula-tions, and more especially in the young. The present example,therefore, is one of interest. It was caused by an injury, andwhen admitted on the 7th of November leeches were appliedwith advantage, and subsequently blisters, conjoined with restand quiet in bed. More recently bandaging has been adoptedwith the good result of removing the swelling; at the sametime he is taking fifteen minims of the liquor of the bichlorideof mercury with tincture of cinchona, and when we last sawhim he was going on as well as could be desired.Most surgical writers of authority, in describing synovitis

and its various causes, make the observation that it very sel-dom attacks young children, and in them it requires sometimesrather a severe injury to a joint to give rise to inflammation ofthe synovial membrane.

HERPES CIRCINATUS ON THE HAND, AND LICHENSIMPLEX ON BOTH ARMS.

RINGWORM is the mildest of all the varieties of herpes, andis accompanied with but little inflammation; the vesicles alsoare known to be of the smallest. We, were recently shown an in-stance of this affection in a married woman, thirty-four yearsof age, at the Charing-cross Hospital, under Dr. Willshire’scare, with a large patch of the disease on the back of her righthand-in fact, one of the largest we have seen, for it is three

inches in diameter. She has, besides, an eruption of lichensimplex, somewhat abundant, on each arm. She has been fiveweeks and a half under treatment, the eruption, however.