Vol. IV.

No. 1.

GENTLEMEN :-The case to which I will first call your attention is one whose treatment involves the use of some apparatus, the construction of which will be explained to you in your course on electricity. I, therefore, will now merely call your attention to this galvanic accumulator, and will show you the manner of employing it. In cases where the actual cautery is required, the use of the galvanocautery with Trouve's accumulator, as it is called, affords the most convenient method of obtaining the desired result; it is portable, neat, and always ready for service, requiring very little care in its management.

Now,

The case before you is that of a young man suffering with chronic pharyngitis, of the form known as follicular pharyngitis, or clergyman's sore throat; a frequent form of disease. when these follicles are enlarged for any length of time, medicines have no effect whatever, astringents have no effect; the only means for their relief is their destruction, either by caustics, such as nitric acid, or the actual cautery. We can also use what causes much less pain than the preceding, the galvano-cautery. These follicles, which are prominent and readily recognized, cause irritation and keep. up the cough; but in addition, we often find accompanying this another affection, which also tends to cause difficulty in breathing; it is enlargement of the mucous membrane over the inferior turbinated bone. The exuberant tissue overlying this bone is often mistaken for polypus. It is difficult to get rid of it by any other means than by actual removal with the galvanic loop, wire-snare, or the cautery. Some of the different forms of instruments devised for attacking this tissue are here upon the table; here is the ingenious instrument for applying the galvano-cautery, the knife, the loop, etc., and here is the wire-snare introduced by Dr. Jarvis, of New York.

The use of this accumulator enables us to regulate with much nicety the amount of electricity, and consequently the degree of heat, so that the instrument can be used at a white heat or only a red heat, as desired. The great advantage of the galvano-cautery is that the

instrument can be placed in the pharynx, larynx, or nostril, before it is heated, the application can be made at once on completing the circuit, and immediately checked, or continued as long as may be necessary. In order to apply this to the nares we make use of an ingenious device for avoiding accidentally cauterizing the septum or adjacent structures. It has a small disc exposed at the side, by which the application is made, all other parts being protected. I came upon this in Paris last year, and I have found that it answers the purpose very well. The electrode is insulated entirely, except at the side where the little disc shows. You may also use plates of ivory to protect the septum, but they are less convenient.

Let me show you the best way of examining the throat. The ordinary method is to stand in front of your patient and depress the tongue and lower jaw, until you can see the pharynx; but I prefer to stand at the side of the patient, who throws his head backward, then, depressing the tongue, I get a very good view, from the side, of the back of the throat; it exposes a much greater part of the pharynx. As the patient opens his mouth I can see the enlarged follicles distinctly. I will now take the pointed. electrode and cauterize several of these. I will demonstrate to you the fact that this method is painless, or, at most, gives rise only to a pricking sensation. This is easily done, and the patient says he felt no severe pain. The inflammation set up by this application will produce a cicatrix and a contraction of the follicle. The operation will have to be repeated upon the remaining follicles before he will be cured. There is no nasal obstruction in this case, but the application of the same method to treating such an affection as I have referred to I shall now show you.

HYPERTROPHY OF MIDDLE TURBINATED BONE TREATED BY GALVANO-CAUTERY.

The second case has an enlargement over the middle turbinated bone, which interferes with respiration and keeps up constant catarrh. The electrode at a red heat will accomplish more good in a few minutes than could be obtained by nitrate of silver in three or four weeks. Being careful to avoid the septum, I have made this application as in the preceding case; here you observe, however, that there is some bleeding, contrary to the usual statement in the books. The instrument should be withdrawn while at a red heat, for if allowed to cool, it may adhere to some of the tissue, and tear it, so as to produce hemorrhage.

TROUVÉ'S POLYSCOPE FOR LARYNGOSCOPY. While this patient is going out I will show