Examination revealed a pinkish-gray tumor involving the anterior five-sixths of the left vocal cord, filling the ventricular opening and obstructing the glottis. The growth had the appearance of malignancy. The greater part was removed at the first sitting. Three days later more fragments were removed. Microscopical examination was made with the report that the neoplasm was a slowly-growing carcinoma, with keratohyaline transformation of the epithelial cells. Several other growths were removed in a similar manner from the region of the left cord, at varying intervals. Subsequently, sedative measures were carried out for several months, with gradual improvement of the patient's condition. Finally, after a year's interval, the voice was found to be normal and the larynx well. The conclusion is drawn that in certain cases of carcinoma of the larynx, it is better to try endo-laryngeal methods, before resorting to the more formidable operation of laryngectomy.

OPHTHALMOLOGY AND OTOLOGY.

IN CHARGE OF J. T. DUNCAN.

In the Therapeutic Gazette is an excellent symposium on Iritis. The first article is by Burton Chance, on "Iritis in General Disease."

As might be expected, those diseases dependent upon the evolution of micro-organisms within the body are likely to produce disorders in such highly vascular structures as the iris and ciliary body; consequently we may assume that all cases of iritis and iridocyclitis, not dependent upon traumatisms, have as their causative basis a general toxemia.

1st. Syphilis.-Iritis is seen both in hereditary and acquired syphilis.

(a) Hereditary. In this it is seen during the first two years of life, at about six years of age, and occasionally it manifests itself for the first time in late adolescence. In these later groups it may occur alone or along with interstitial keratitis. One or both eyes may be attacked. Attacks of iritis in infants and children if not traumatic are almost invariably due to inherited syphilis.

(b) Acquired Syphilis. In acquired syphilis, iritis, or iridocyclitis, may be met with at two periods, either within a year after the infection, or at a much later time. It generally de

velops as a plastic inflammation, or as one which is accompanied by the formation of gummata. Usually it occurs at the time of definite general manifestations, and until these signs accompany it, it is difficult to decide upon a correct diagnosis as to the causation. At the outset the inflammation is limited to one eye. At times one meets with iritis in the tertiary stage of syphilis ten or fifteen years after the original infection.

Rheumatism.-Iritis may develop in the rheumatic; nevertheless it is rare in rheumatism.

Gonorrhoea. Frequently, when iritis attacks young men who have had gonorrhoea, with indeterminate rheumatic symptoms, the arthritis is an infectious process capable of permeating the system; and the cause of the iritis is believed to be the gonococcic material. We find in some cases a distinct connection between the general disease and the iritis.

Gout. It is doubtful whether iritis develops in true gout. He hesitates to classify as gout those irregular cases of so-called uric acid diatheses. Nevertheless, competent observers have declared that iritis does occur in gout; but before accepting this dictum as final we must exclude rheumatism, gonorrhoea and syphilis as other probable causes.

Tuberculosis.-Iritis in tuberculosis is less rare than it was once thought to be. It is found in scrofulous children and in adolescents with enlarged lymph glands, who may or may not have demonstrable tuberculous deposits in their lungs.

Acute Infectious Diseases.-Iritis may occur in the course of the acute infectious and exanthematous diseases. It has been seen in typhoid fever. I noted it in a goodly number of smallpox patients, and also in others suffering from epidemic cerebrospinal meningitis.

Malaria.-I have known sailors who have had malaria while in the East, and others who resided years ago in the malarious districts of this country, to have iritis, which has recurred and recurred until after a prolonged antimalarious course had been followed out.

He also holds that in meningitis, pyæmia and diabetes iritis is seen.

After an article on the Symptomatology, by Risley, the treatment is spoken of by Ziegler, under the headings:-1, Local; 2, Systemic, and 3, Surgical.

I. Local Measures.-The local treatment of plastic iritis (rheumatic, spongy, and syphilitic) has for its keystone the prompt and effective use of a mydriatic. Atropine sulphate gr. iv to f3jshould be instilled until the pupil dilates widely. If

synechiæ have already formed they will probably break loose. Some patients have an idiosyncracy against atropine, and in these cases hyoscyamine sulphate may be used.

The supra-orbital neuralgia is usually nocturnal in its manifestation, and may often be relieved by belladonna spread over the eyebrow and covered by dry heat. A more modern analgesic, however, is found in hyoscine hydrobromate, which I have often used with almost magical effect, when instilled in the strength of gr. 1-4 to f3j.

In addition to the mydriatic, hot stupes are most valuable to relieve the pain, congestion and sluggish circulation. A towel should be wrung out in hot water (kept hot) and held to the eye from ten to thirty minutes three times a day. This application encourages rapid absorption and increases the action of the mydriatic.

Leeching is absolutely necessary, in many cases, to relieve the overloaded blood-vessels and lymphatics, especially where the congestion creates a muddy-colored iris. As soon as this depleting effect manifests itself the action of the mydriatic is greatly enhanced, and the "brow-pain" and weight in the eye begin to disappear.

While we no longer confine these patients in a darkened room, it is well to have them wear an eye-shade, or "London smoke" glasses, as the admission of too much light is both dazzling and painful to the afflicted eye.

II. Systemic Treatment.-Internally, calomel is our sheetanchor, particularly in the early stages. I usually order gr. 1-4 four times a day for five days, and if the symptoms are still marked, repeat the dose for a second period of five days.

Later, if antisyphilitic treatment is indicated, daily inunctions of unguentum hydrarg. 3j are ordered, and ascending doses of potassium iodide, ranging from gr. v to gr. e (well diluted) t. i. d., are given for a considerable period of time (six months to two years).

If the rheumatic tendency is more pronounced, sodium salicylate, aspirin, or salacetin may be administered liberally.

Serious iritis or iridocyclitis runs a more chronic course, and does not yield to treatment so readily. Atropine must be used with great caution, as glaucomatous symptoms may develop at any moment, when eserine would be indicated. Calomel, salicylate of soda, and turpentine may be used singly, seriatim, or conjointly.

In traumatic iritis heat is contraindicated, and cold compresses constantly applied (day and night) are most efficient. Calome!

gr. 1/10 every hour or two hours is valuable. Atropine is generally indicated.

III. Surgical Procedures.-In chronic iritis, or in the recurrent form, if marked posterior synechiæ or pupilary exclusion are present, iridectomy is often indicated.

In conclusion I may repeat: iritis occurs in such protean forms, and is so manifestly hybrid in its types, that the treatment must be based upon the essential elements in the symptom-complex exhibited in each individual case. The prognosis is generally

good.

Prevention of Deafness.

By far the greater number of diseases which affect hearing owe their origin to a pathological condition in the nose or throat, the point of entry being the eustachian tube. A comparatively small number arise externally from the auricular canal, such as impactions of wax, eczema and furunculosis of the canal, foreign bodies, traumatism, etc., but the majority of these do not offer serious menace to the organ of hearing. Even in these cases, however, care should be exercised. Rupture of the drum from excessive force in syringing for cerumen or from inexperienced efforts to remove a foreign body may be responsible for subsequent deafness.

The toothpick nor the hairpin should ever be employed to relieve an itching ear, as injury is frequently thus done. Suppurative inflammation of the ear should be promptly relieved by incision, thereby preventing many cases of deafness. Nasopharyngeal catarrh, being an important factor in the development of ear disease and consequent impairment of hearing, is the more important factor on account of its frequency, and should, therefore, be treated with the care and perseverance that its importance demands.

Subjective noises in the ear is another late symptom which first attracts the attention of the patient. Many of such patients consult the aurist only after the disease has made such headway that cure is out of the question, whereas in the early stage it could have been arrested and much benefit attained.

RE-ORGANIZATION OF THE TORONTO GENERAL HOSPITAL.

We publish in this issue the interim report on the re-organization prepared by a committee appointed by the Board, Nov. 7th, 1906.

It has been finally decided that for the present there shall be three co-ordinate sections in Medicine; three in Surgery; one in Obstetrics; one in Gynæcology; one in Ophthalmology; and one in Rhinology, Otology and Laryngology. In making the division as to the "Eye and Ear" Department, the most modern custom has been adopted, that is, there is a separate service for the eye and another for the nose, throat and ear.

The Board, however, reserves the right to change this system if it be deemed advisable at any future time. The age limit will be 55 for heads in Surgery, Obstetrics, and Gynecology, Otology and Ophthalmology, and 60 for heads in Medicine. The term limits for heads will be 10 years, which may in individual cases be extended to 15 years for special reasons. These term limits will apply only from dates of appointments under the present regulations. The heads of all services may be specialists in their departments as a rule, but specialists may combine eye and ear treatment, and gynecologists may do general surgery in their work outside the Hospital.

The Hospital and the University authorities have reached a very important position from a scientific standpoint.

There will in the near future be established in the Hospital two new departments, one of Pathology and Bacteriology, and another of Pathological Chemistry, each in charge of a professor appointed and paid by the University.

We also publish an important letter from one who has given much attention to the subject of hospital management for many years. We believe, too, that he voices the opinions of the majority of physicians of Toronto outside the University Staff. Without attempting to discuss in detail "General Practition