special skill-the first doctor who sees the patient need not hesitate to do it; and if he sees him a short time after strangulation has occurred, he can do it in presence of conditions most favorable to success.

NOTE. On making more extensive researches in the literature bearing on this subject, I have found that the "evacuation method" has been frequently and satisfactorily employed in the treatment of pneumatosis. I have learned also that lately it has sometimes been used in hernia, but as yet have seen no recorded case.

It is to be regretted, I think, by the Profession at large that so good an idea has been so little known; and I feel that this fact fully justifies me in presenting the above views.

ORIGINAL CORRESPONDENCE.

"Sit mihi Fas scribere audita."

DIVISION OF LARYNX AND ESOPHAGUS WITHOUT WOUNDING THE JUGULARS OR CAROTIDS.

WARRENTON, N. C., 1871.

I send you the following interesting case: On the morning of the 17th of June, 1869, I was halted in the road by a young girl, who seemed terribly agitated, running to and fro and pulling her hair, as I rode up to her. She screamed out that her father had cut his throat, and please go in and do something for him. I immediately went to the house, a little way off, and found an old man lying upon a bed, weltering in his own blood, which seemed to have flowed pretty freely. Ghastly and cadaverous, his countenance presented strong marks of guilt, and added to this sad spectacle was a deep chasm, with jagged edges, caused by several ineffectual attempts at suicide. For nine years this old man had been a paralytic, and depended entirely for support upon the efforts of his wife and daughter. Previous to the time of the attack of paralysis he had been very useful to his family, and had quite a neighborhood reputation as school-master and surveyor. He was an Irishman by

birth, and naturally of quick and excitable temper. Thus prostrated by disease so long, and becoming more useless every day to his family, he at last reached that state of mind in which rashness knew no bounds, and, to put an end to his miserable existence, he made ten attempts with a razor to sever his larynx. The incision when I first saw it (ten minutes after it occurred) extended from the inner border of both sterno-cleido mastoid muscles, dividing the larynx above the thyroid cartilage, passing between that and the hyoid bone, severing it entirely through, and completely separating the hyoid bone from its attachments to the thyroid cartilage, the edge of the razor passing on, cutting the posterior wall of larynx, and dividing anterior wall of esophagus without wounding or injuring in any way carotids or jugulars.

After the larynx had become so extensively wounded, nothing but a low mumbling took the place of imperfect articulation, already present from partial paralysis of vocal cords; it was with extreme difficulty that bystanders could make out what he wished to express. He was unable to swallow anything unless in the recumbent posture (assuming the dorsal decubitus) without the food or drink passing through externally, finding its exit at the wounded æsophagus and larynx. I placed the hyoid bone and thyroid cartilage as near in apposition as possible, moving the head about until I thought the "dislocation reduced." I then sutured the external wound throughout its entirety, and to a casual observer very little deformity or inconvenience could be discovered, except at times, when he would, with difficulty, attempt to speak, the air would gush out between the sutures. I then put on one of Gibson's bandages for fracture of the lower jaw, extending the roll to the chest, to be fastened to another bandage around the chest, instead of passing it under the chin, as is done in Gibson's operation for fracture. I then gave him an opiate, and left him.

The next morning, 8th of June, I visited him, and found him very comfortable, although in the night he had pulled the bandage forcibly from his head. I ordered his wife to replace it, and

to give him another opiate that night. From the considerable loss of blood, and being already in a state of malnutrition, I ordered tincture ferri. chlor. xv. gtts. three times a day in a little water, in order to make for him as much blood as I could, and give him all the chances for recovery. For five succeeding days he seemed to be doing well, when, on the morning of the sixth, I found that a good many of the sutures had been torn loose, as if by violence, and upon inquiry was informed that he had made another attempt at destroying himself, but was prevented from doing further damage by his wife. The wound had begun to heal very nicely, when this attempt was made to drag it apart, but the epiglottis had begun to swell, and it was with some difficulty that he could breathe or swallow. I cut apart the sutures, and removed them from each side, making an aperture in the half-closed wound to the extent of about two inches directly over the pomum adami. I fed him altogether on fluids, as he was unable to swallow solid food without a great deal of pain. He, at this juncture, expressed a wish to get well, and made no further attempt at violence upon himself.

On the 15th June I visited him, and found marked symptoms of inflammation, with considerable dyspnoea, and the wound healing very sluggishly, the attempt at union by first intention being defeated. I knew that the only mode left was to coax it to granulate from the extremities toward the centre, and to promote this, I ordered a wash of pb. acetatis grs. iv. to 3., and cloth constantly wrung out of cold water to be applied to the parts; I employed no sutures in the membranous or cartilaginous portions of the larynx, and had removed all that had been applied externally with the exception of four or five, which drew together a space of about three inches. On my next visit I found him considerably improved, yet there was some difficulty in removing mucus from trachea and larynx; he continued to improve for three weeks, at the end of which time I considered him nearly well. The central opening had now nearly closed, the upper portion being somewhat contracted and falling within the inner margin of the lower flap, which was

considerably stretched, and projected on account of the weight of the trachea and the sharp point of the pomum. I made an incision in the tract of the old wound about two inches in length, pulled the upper flap as near as I could in apposition with the lower, and used a compress and bandage with gentle traction over trachea and around the neck, in order to relieve the tension resulting from a falling forward of the trachea, thus dragging the edges apart and opening the wound. Subsidence of the epiglottean inflammation soon took place, dyspnoea became less conspicuous, the newly severed part began to heal nicely in a few days, and in a better position, and at the expiration of four weeks the wound had completely closed. He could now talk to his friends with comparative ease, and all who knew him said that he spoke plainer than before the injury. Indeed, the old man looked better than I had ever seen him, and had gained considerably in flesh. He remarked to me that he thought the loss of blood had benefited his paralysis, and that he had more sensibility in the paralysed part than he had for years. He might have felt better soon after the accident from general relaxation due to loss of blood affecting the lysed parts equally with the rest.

para

The case is remarkable on account of so extensive a wound of larynx and æsophagus occurring without injuring any important veins or arteries.

Persons who attempt destruction of their lives by laryngotomy lose sight of the fact that when they throw their heads back, as they all do, the vessels most important to their lives in this crisis, hide themselves behind the sterno-cleido-mastoid muscles, and in the attempt to wound them, they only strike muscle, and if they go further, larynx, trachea and æsophagus, as in this case.

I was led to report this case in support of one reported by Dr. I. R. Godwin, of Fincastle, Va., and to add another to Dr. Gross's list. WILLIS ALSTON, M. D.

Dr. E. S. Gaillard, Louisville, Ky.:

BALTIMORE, MD., 1871.

Dear Sir, I purchased at a book sale the following numbers of your Journal. Please let me know what they are worth to you, or any one else wishing to possess them. For 1866 I have the January, November, September, June, December, July, and August numbers. Those of 1867 complete except January; those of 1868 complete; for 1869, January, February, March, April, May, and June numbers; for 1870, December, March, April, May, and June numbers.

In some of the numbers I see where offers are made for back numbers.

Wishing to hear from you, I am yours respectfully,

A. T. GOLDSBORO, 105 West Lombard street.

NOTE.-Subscribers whose files are injured or lost can obtain from the writer of this letter any of the Journals specified. It is a rare opportunity; for the editions of the Journal are, almost all of them, exhausted.-ED.

REVIEWS AND BIBLIOGRAPHICAL NOTICES.
"Judex damnatur cum nocens absolvitur."

STROUD'S PHYSICAL CAUSE OF THE DEATH OF CHRIST. D. Appleton & Co.: New York. 1871.

This old, yet remarkable and interesting volume is well worthy of the careful examination of every physician. The physical and physiological questions discussed, and the pathological as well as psychological problems elucidated, are of extreme interest and importance. Those whose interest in medicine is not confined to recipes connected with the pestle and mortar, or limited to the practical considerations of the ledger and cash-book, will find this volume of Stroud unusually attractive. The mere tradesman in medicine cannot be advised to purchase it. The following letter, addressed by James Begbie, M. D., F. R. S. E., Physician to the Queen, etc., to Dr. Hanna, author of another life of Christ, will be found interesting: