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body. The breathing was now somewhat laboured and thebreath sounds were harsher in character. The left legbecame more cedematous and ascites developed. Bythe 20th the mass on the left heel had broken down andso also had a swelling in the right gluteal region. The blacknodules had greatly increased in number all over the bodyand one had appeared on the forehead. The breathing wasmore laboured and cough had started. The patient was nowvery depressed and could not sleep except under the influ-ence of morphine. There was dulness over both bases of thelungs and the anterior edge of the spleen could be palpated.On the 26th the abdomen was extremely ascitic and wastapped, 200 ounces of yellowish fluid being drained off. A

f,,v", was inserted For the three days Southey s tube was iiiserueu. For Lue next three aays theamount of fluid drained off was 50, 62, and 25 ouncesrespectively. Breathing became very difficult and coughvery troublesome. The patient became very restless. Onthe evening of August 30th he became very cyanosed anddied in a few minutes. Throughout the whole course of hisillness he never once complained of pain.

Post-mortem examination.-The abdomen and pleural sacswere full of fluid. The omentum was densely infiltratedwith the growth and was absolutely black all over. Thestomach was affected, as were also the small intestine, largeintestine, and rectum. In the liver were several smallscattered black nodules; it was slightly increased in size.The spleen was enlarged and had numerous small nodulesin it. On cutting it a growth of about the size of a

Tangerine orange was discovered and was easily shelledout. The kidneys were not affected. The bladder hadnumerous nodules in its walls. The peritoneum was

studded with nodules. Both lungs were infiltrated withthe growth and nodules were found in the pleura andpericardium. The mediastinal tissue was also infiltrated.The sternum itself was black with the growth and couldbe broken fairly easily. Neither testicle was affected,but the scrotal tissues were greatly indurated. The swell-

ings in the left inguinal region and on the left heel wereblack all through.Dumfries.

A NOTE ON THE REMOVAL OF FOREIGN BODIESFROM THE STOMACH.

BY BILTON POLLARD, F.R.C.S. ENG.,SURGEON TO UNIVERSITY COLLEGE HOSPITAL, LONDON.

I HAVE recently extracted a two shilling-piece from thestomach, of a girl, aged 15 years, without cutting into thestomach, in a way which I have not hitherto seen mentioned,and a short note on the method adopted may perhaps be ofinterest.The method was as follows. The operator opened the

abdomen by a longitudinal incision through the upper partof the left rectus muscle and seized the coin through thewall of the stomach with his finger and thumb ; an assistantpassed a flexible forceps, described below, by the mouthinto the stomach. The coin was adjusted in the grip of theforceps and care was taken to avoid inclusion of mucousmembrane ; the assistant then withdrew the forceps andwith it the coin.The method of extraction outlined above was devised by

me several years ago in order to remove a halfpenny froma little child’s stomach, but it was not then put into prac-tice as the coin was eventually passed per vias naturales.For that case I had had a long flexible forceps made afterthe pattern of Durham’s tracheal forceps. The principle ofthe forceps is the same as that of Toynbee’s well-knownforceps for the ear. The blades of the instrument, whichwhen uncontrolled spring apart, are fixed to a piece of

copper wire, around which a tube composed of spirallycoiled wire is placed. The instrument is operated by thehandles in such a way that the wire tube slides over theblades of the forceps and brings them firmly together.

For the extraction of the two-shilling piece this instrumentwas passed with the blades closed. The coin was removedat the first attempt in the way already described. Noresistance was felt when the coin passed through the cardiacorifice, nor indeed at any part of its transit through the

oesophagus. The abdominal incision was sutured in layersand the patient made a normal recovery.Harley-street, W.

Medical Societies.ROYAL SOCIETY OF MEDICINE.

LARYNGOLOGICAL SECTION.

Exhibition of Cases and S’pecimens.A MEETING of this section was held on Nov. 5th, Dr. J.

DUNDAS GRANT, the President, being in the chair.The following cases and specimens were shown :—

Mr. G. SECCOMBE HETT : Post-mortem specimens from acase of Chronic Glanders in a man aged 24 years. Theprincipal visible lesions during life had been ulcerationswithin the mouth, nose, and pharynx. In the lungs andliver the strong resemblance to tertiary syphilitic lesions wasnoted.

Dr. DAN McKENZIE: Perforation of the Nasal Septumfrom Salt Dust in a woman employed in a salt factory.Three other females, out of a total of eight employees, wereaffected to a less extent. Microscopical sections from themarginal tissues showed typical giant cell systems.Dr. STCLAIR THOMSON: 1. A woman, aged 46 years, affected

with Tuberculosis of the whole of the Left Vocal Cord and the

Interarytenoid Space, in whom consolidation of the rightapex had been diagnosed. The lesions were completelyhealed by two months’ silence and sanatorium treatment. 2.Two patients, in whom Tuberculosis of the Epiglottis, Cords,Interspaces, and Folds of the Larynx respectively had beenarrested by galvano-cautery and sanatorium treatment. Itwas pointed out that tuberculosis developing in the larynxafter the process had been arrested in the lungs did notgenerally assume an acute form, but was apt to becomeextremely tedious ; also that, in spite of a fair amountof active mischief in the chest, the temperature beganto improve with the improvement in the larynx. 3.Papilloma of the Larynx in a boy, aged 62 years,of four years’ duration, cured by tracheotomy and repeatedoperations with direct laryngoscopy. This case showed the

persistent recurrence of papillomata in spite of frequent andcomplete removal and the natural tendency of the disease todisappear about the age of 6 years. It also emphasised theadvantage and harmlessness of wearing a tracheotomy tube,and occasion was taken to decry the useless and cripplingemployment of laryngo-tracheotomy, as recently proposed, inthese cases. 4. A woman, aged 56 years, after Laryngo-fissure for Subglottic Enchondroma. After having been

previously shown before the section in 1908 by Dr. A. StanleyGreen and Dr. H. Lambert Lack, the enchondroma had beenfinally removed by laryngo-fissure by Sir W. Watson Cheyne.

Dr. W. JoBSON HORNE: A case of Laryngeal Neoplasmpresenting Unusual Features in a woman, aged 65 years.The growth occupied the posterior half of the right side ofthe larynx and appeared to spring from the ventricle orventricular band. Pieces had been removed at intervals for

microscopical examination, and these sections were referredto the morbid growths committee for report.

Mr. W. STUART-Low: Three cases of Inoperable Carci-noma, extra-laryngeal, pharyngeal, and lingual respectively,in whom ligation of the thyroid vessels for partial ablationof the enlarged thyroid gland had been performed with greatbenefit.The PRESIDENT : 1. Infiltration of the Left Ventricular

Band. The patient was a woman, aged 62 years. Theinfiltrated band bulged so as to cover the whole of the leftcord and the anterior part of the right one, occasionallydipping between the cords and preventing approximation.Microscopical examination revealed only inflammatory hyper-plasia, and the diagnosis lay between neoplasm and tuber-culosis. 2. Epithelioma of the Right Vocal Cord in a man,aged 60 years ; removal by thyrotomy. Microscopicalexamination of the conical outgrowth below the right cordshowed early epithelioma. At the operation the right vocalcord with portion of the right arytenoid cartilage were

removed and the underlying cartilage was freely scraped.The patient returned home nine days after the operationgreatly benefited.The PRESIDENT and Dr. McKENZIE showed a case of

Epithelioma of the Left Vocal Cord Removed by Thyrotomy.. Mr. H. CLAYTON Fox : Paralysis of the Right Vocal Cord