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as typhoid, tuberculosis, or syphilis. Various dermatoses might occur, such as erythema nodosum, herpes, impetigo herpetiformis, erythema nuiltifornie, lichen ruber, and an- gioneurotic edema. Acute catarrh was generally associated with that of the laryn.x and bronchi. Dysphagia had been by some authors regarded as a symptom of tracheal in- flammation. New methods of tracheal injection were touched on, such as that of Marangos, who injects through the n»se, and Mendel, who projects Toprol Xl 100 Mg the fluid against the side of the pharyn.\, whence it runs down into the trachea. Ozena might occur primarily in the tube, and several in- stances of severe stenosis were on record from crust accu- mulation. Nothing new had been advanced as to the eti- ology of this affection. Tracheal hemorrhage had been reported by numerous writers, and generally as Metoprolol Vs Toprol Xl a sequel of influenza. It was necessary to follow up such cases, as they might eventually become tuberculous. But there were cases in which the blood could Toprol Xl Generic Name be seen to ooze from varicose vessels just below the glottis, while the rest of the tracheal walls were perfectly clear. Tuberculosis was gen- erally a feeble episode only, in the laryngeal and pulmonary disease it accompanied. Primary tuberculosis of the tra- chea, however, had been observed. True tuberculoma of the trachea had been described twenty-five years ago by J. N. Mackenzie, but few authoritative cases were on record. Syphilitic lesions found in the trachea comprised catarrh, erythema, condyloma, ulcers, perichondritis, cicatrices, and gumma. Infiltration in this region might be delayed for years. The use of the bronchoscope as recently developed offered the possibility of a greater definiteness of localiza- tion of lesion. Each case called for treatment constitu- tionally and mechanically, according to its special require- ments. It was difficult in clinical practice to separate syphilis of the trachea from that of the bronchi. Tracheal Tumors. — Dr Clement F. Theisen of Al- bany, N. v.. presented a Is Toprol A Beta Blocker paper based on a study of most of the authentic cases of primary tracheal tumors on record. 135 cases being considered. Of these 89 were benign and 46 malignant. Of the former, the varieties found comprised fibroma (polyps), lipoma, papilloma, ecchondroma and chondroosteoma, adenoma, intratracheal struma, and lymphoma ; of the latter, carcinoma and sarcoma. Particu- lar attention was given by the author to intratracheal stru- ma, ten cases of which were now on record. The majority of papillomata occurred in children and were undoubtedly congenital. Only one genuine case of lipoma is recorded. Two cases of lymphoma and seven of adenoma were con- sidered. Twenty-four cases of fibroma were found, fifteen of which were pedunculated. In the majority of cases they Generic For Toprol Xl occurred during middle life. Very little was known as to the genesis of ecchondromata and chondroostcomata. Of the malignant growths, primary carcinoma occurred most frequently in the medullary form, but occasionally as a cylindroma. In a number of instances the growth orig- inated in the tracheal mucous glands. One case seemed Generic Name For Toprol Xl to be Toprol Xl Vs Metoprolol Tartrate a malignant degeneration of an original strumor, and in this case an extensive resection of the trachea was per- formed. Cancer favors the male sex. Of sarcoma, the author had been able to find records of eighteen cases. While endotracheal operations have been performed sev- eral times, they offer little chance of permanent success. The sexes suffer alike in this form of malignancy, young people rather than old. The author then discussed the eti- ology, symptomatolog>-. diagnosis, and treatment of tracheal tumors in general. .\n extensive bibliography was ap- pended. Tracheal Stenoses. — Dr. Willi.\m K. Simpson- of New York City enumerated as the extrinsic causes of stenosis, struma, pressure by tumors, glandular h>-pertrophies, em- physema pressure, aneurysms, phlegmonous inflammations of cellular tissue, extension of bone disease, trauma ; in- trinsic causes were classified as cicatrices and adhesions, morbid growths and foreign Metoprolol Tartrate Vs Toprol Xl bodies, inhalation of irritants and ingestion of corrosive chemicals, and inflammations leading to thickening of the tracheal walls. The author then discussed the mode of action of these various causes in detail, and enumerated the symptoms caused thereby. The especial symptom was the stridulous breathing. Tra- cheal dyspnea had some characteristics peculiar to itself. It was inspiratory in character, the inspiration being longer than expiration ; might be labored, noisy, or wheezing, was at times audible for a considerable distance, but had not the peculiar brassy, croupy, stridulous sound of laryngeal dyspnea. Diagnosis could be made by the laryngeal mirror, aided in obscure cases by the .i-ray. Operation revealed a greater extent of stenosis than would be indicated by the mirror image. Treatment depended on the recognition of the cause. Outside of specific cases it was entirely surgical. Toprol Xl Beta Blocker We had at our command tracheotomy, tracheal fissure, with exsection of the stricture tissue, resection of the portion of the trachea involved, and finally the various forms of dila- tation. Dr. Simpson showed various models of cannula employed for the last-named purpose. Foreign Bodies and Tracheoscopy. — Dr. A. Coolidce, Jr., of Boston spoke of the behavior of foreign bodies drawn into the upper air passages, and said that the im- portant question, after considering the nature of the body, its probable position, and the patient's general condition, was, what is the danger of leaving it alone ; ne.xt, if an attempt at removal was made, was the patient's chance improved or not ; and, finally, what operation should be done? Various statistics were quoted, but the proper methods of treatment adopted during recent years rendered an entirely new consideration of all the foregoing points necessary. The author briefly traced the history of tra- cheoscopy and bronchoscopy, and discussed the physical principles involved. In the older methods the surgeons worked in the dark ; with modern instruments, he could see just what he was doing, and inspection of the trachea and bronchi became just as definite a procedure as inspec- tion of other bodily areas requiring special instruments. Modem essentials were a proper tube, a good illumination, and an instrument for extraction of the foreign body which could be easily and safely used through the tube. The author submitted various instruments, and spoke of certain modifications in their employment which had proven of service to him. In closing, he reported three cases, in ad- dition to the five previously reported to the Association. The foreign bodies were respectively a prune stone, shingle nail, and hook. All were successfully removed. Dr. Emil Mayer Toprol Xl Generic Recall had had five personal cases of bron- choscopy, and expected to publish shortly a record of his experience. In one of these cases a melon seed had been removed from a child of ten months. .\s far as he knew this was the youngest case on record. The introduction of the tube was sometimes very difficult. Dr. E, Fletcher Ing.\ls had found some of the instru- ments on the market clutusy. if not even dangerous. He had done the upper operation some twelve or fourteen times and Toprol Xl Vs Generic the lower once. He was in doubt as to the ad- visability of Toprol Xl Vs Metoprolol using cocaine or atropine in these cases. There had been some unaccountable cases of death follow- Tng a successful operation. Dr. J. SoLis-CoHEN thought that stenoses following tra- cheotomy often arose Toprol Xl 50 Mg Recall from the fact that the operation was done too high up. He had adopted the practice of using two tubes, one long and the other short. These were changed frequently, so that the irritation from pressure did not constantly bear on the same spot. Tubes flattened lat- erally were preferable to round tubes. Dr. D. Brvson Delav.\n believed that damage was some- times done to the vagus through too much manipulation of 55-2 MEDICAL RECORD. [Oct. 6, 1906 these regions. Such damage might explain some of the mysterious fatal cases. Dr. Thomas Hubbard had found that rings of cicatricial tissue sometimes formed after operation, causing dyspnea. Dr. Thomas J. Harris said that dyspnea was sometimes hard to account for, as no stenotic ring could be found to explain it. Dr. John O. Roe called attention to the fact that hi his experience those who had had a tracheotomy done in their childhood rarely reached an advanced age. Dr. J. W. Gleitsmann said that the tubes in halves which Dr. Coolidge had shown had been known to turn over each other, thus rendering the manipulation of the bronchoscopy tubes very difficult. Dr. W. K. Simpson said that small bodies were often expelled through the short O'Dwyer tubes by the act of coughing. Dr. C. F. Theisen referred to a recent publication by Schroetter, describing a bronchoscope devised after a ne\< principle. It had been described in a recent issue of the Wiener medisinische IVoclicnschrift. Fibroma of the Larynx in a Child of Five Years; Apparent Cure; Recurrence as a Papilloma; Laryn- gofissure; Cure. — Dr. Thomas J. Harris of New York gave the later history of a case which was origmally re- ported to the Association one year ago. The sequence of later events is indicated in the title. The stenosis returned in about six months after she had seemed cured, and ap- peared to be granulomatous in nature, but the microscope showed it to be papillomatous. A tube was then worn for about six months longer, since which time the larynx had been free. The voice, however, was gone. A fair view of the larynx could now be obtained with the short Killian tube, Generic Name For Toprol and while there was no evidence of any neoplasm, there was very little cord remaining. Hysterical Mutism. — Dr. G. Hudson Makuen of Phil- adelphia gave a general description of this condition. He also reported the case of a young man of twenty-two year.*; who was struck across the bridge of the nose and right orbit by a live trolley wire. He was dazed for a few hours, but apparently not severely injured. The power of speech, however, was in complete abeyance. When coming under the author's observation some time later, several Toprol Generic Equivalent minor faults of the upper air passages were removed, without any eflfect on the loss Toprol Xl Generic Equivalent of speech. There was marked anesthesia in the larynx. The patient could not hold the vocal cords ui approximation sufficiently to make them vibrate and produce sound; he could not produce either resonant or whispered sounds, and did not seem to know how to begin to try, lacking the mental conception of articulative move- ments as well as that of movements for vocalization. In- struction was carried on for some weeks, with the result of the acquirement of a few short, partly-whispered words, but the patient soon forgot what he had apparently ac- quired. There was a "psychological lesion" in the center for motor speech. All sorts of laryngeal stimulation were tried for some time. During the fourth month of his illness he had two typical hysterical seizures, and during the second one, which was very severe and happened at night, his silence of fifteen months was broken, though his first words were uttered in a state of unconsciousness. He was gradually awakened and talked constantly. From that time on progress was satisfactory, though for a con- siderable period he was troubled with various nervous symptoms. Papilloma of the Larynx From Inhaling Flames. — Dr. A. B, Thrasher of Cincinnati presented the history of this case. His patient, a man, had been injured two month; before coming under observation by an explosion of gas in the cellar of a drug store. He had had a severe inflam- mation of the upper air tract, from which he had made a slow recovery and had gradually become aphonic. Exam- ination revealed in addition to a general redness Is Toprol Xl A Beta Blocker of the parts several granulomatous-looking masses springing from the ventricles and almost obstructing the entire cords. Other similar bodies Cost Of Toprol Xl were seen below the cords during forced inspiration. Examination of a fragment removed revealed Toprol Xl Coupon a papillomatous neoplasm, with some admixture of granu- lation tissue. The masses were removed a few at a time, bleeding following each seance being rather profuse. Sil- ver nitrate, 10 per cent., was applied to the base of each nodule. A few months later the larynx was sufiiciently cleared to allow of a view of both cords, and his voice be- came considerably stronger. Still later the voice became normal, though no later view of the region was had. The author noted that so far as this one case went, it lent favor to the theory of the inflammatory origin of laryngeal papil- lomata.

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