may become necessary to relieve the extreme tension and pain incident thereto. When the symptoms begin to subside aggressive measures should be instituted to hasten absorption of the inflammatory products to enhance the promise or restoration of function to the organ. Jaborandi, by some used in the acute stage, would now prove highly use-ful. Iod. pot. in comp. tr. gentian as tonic is indicated. When patient is permitted to be up, a well-fitted suspensory should be worn.

DISCUSSION ON DR. A. A. DAVIDSON'S PAPER.

Dr. D. D. Quillian, of Athens: I have listened with interest to the paper just read, and I rise mainly to report a very peculiar case that I had in my practice about a year ago. I was called to attend a lady in confinement, and about two weeks before the expected confinement her child. contracted mumps, and when labor came on she had pre-viously contracted the disease. The parotid glands on both. sides were involved at the same time, both glands very much swollen and very tender. Labor came on at the heighth of the inflammation of the parotid gland. The pain during the second stage of labor was extreme. The expulsive pains and the increased pressure of the blood ves-sels caused such suffering that I found it necessary to resort to instrumental delivery. I administered chloroform, applied the forceps and delivered. The second day following confinement, without my knowledge or consent, the patient drank a glass of ice water, and in a few minutes she was seized with intense pain in the left ovarian region. This pain was so intense that she developed symptoms of shock, cold extremities, and clammy perspiration. I was hastily summoned; I applied a hot water bottle, and in the course of half an hour or three-quarters succeeded in relieving the pain for the time being, but it occurred at in

tervals for two days. After this pain had occurred in the left ovarian region, there was an eruption which appeared, extended entirely over the left ovarian region down the left limb to about the middle third of the thigh, which continued for several days. It resembled an acute eczematous eruption, and subsided after the use of mild ointments. While this pain continued in the left side, the swelling in the left parotid gland had materially lessened. At the end of two days I succeeded in relieving the pain in the left side, after which the swelling returned in the left parotid gland. After this the disease pursued the usual course, with gradual subsidence of the swelling, and recovery.

The peculiarly interesting feature in this case to me is that she had parotiditis during pregnancy, just prior to her confinement. The authorities I have consulted on this subject say that women in that condition are usually exempt from such contagious diseases. Another interesting feature was the eruption which appeared in the ovarian region, extending down the limb. This eruption might have been produced by the hot water bottle that was applied, but I hardly think so. But, as I have previously remarked, the eruption subsided under mild astringent oint

ments.

If this case is oi sufficient interest to the members to enable them not to be surprised if they should meet with similar cases in practice and be able to afford them prompt relief, I shall feel repaid for giving the history of it.

REPORT OF CASES IN EYE, NOSE AND THROAT PRACTICE, WITH REMARKS ON INTUBATION.

BY ROSS P. COX, M.D., ROME, GA.

I wish to report very briefly, first, an unusual case of laryngeal intubation. This was a case of repeated and prolonged intubation, done on a boy baby, aged about fifteen months.

Last Christmas eve night I was called by a colleague who had treated the case for three or four days. Antitoxin and other approved remedies against diphtheritic croup had failed.

There were present the usual signs and symptoms of croup, well advanced to the danger line. There had been little fever and no serious symptoms, except those due to asphyxia.

I introduced the second sized O'Dwyer tube, giving instant relief. This tube was coughed out of the larynx several times during the first few days, due, I think, undoubtedly to the low position of the head during paroxysms of cough. Reintubation was necessary within two or three hours after expulsion. Finally, I replaced the second size with the smallest tube and directed the attendant to slightly raise the head while the cough lasted. After four days I withdrew the tube, but after twelve hours was compelled to reintroduce it. It then remained in place for four days; but some fourteen hours after withdrawal it had to be reintroduced.

As he continued to take nourishment well, I allowed the tube to remain in the larynx for six days. This was the fifteenth day of the intubation. Two hours after the tubewas removed I was compelled to reintubate for rapidly increasing asphyxia. This was a bit discouraging, but four days later, on the nineteenth day of the intubation, I had the satisfaction of permanently withdrawing the tube and witnessing the prompt and complete recovery of the patient.

The special features of this case are the youthfulness of the patient, aged very little over one year, the necessity of intubating for the fourth time, and the retention of the tube for about eighteen days. It took nourishment well, with neck placed horizontally or slightly abroach.

About two years ago I made my first effort at intubation in private practice. This was also my first and last failure. There were several fair excuses for this, but this case was an acute failure. I believed at the time, and still believe, that the tube was properly placed in the larynx, but, as it seemed to hinder rather than help the breathing, I quickly drew it out and proceeded to tracheotomy on a practically dead child. The parents delayed their consent until the child was moribund.

Of recent cases of severe croup, I have had six. Three of these were treated with intubation after antitoxin had failed; two were treated with antitoxin, without intubation, and one was managed without either antitoxin or intubation. All of these recovered except one. This one was also a perfect success so far as the larynx and intubation were concerned, but died subsequently of pneumonia.

I have raised the subject of intubation because I wish in this connection to bring an earnest message and a plea tomy professional brethren who are remote from the special

ist and must depend upon their own resources in dealing with membranous croup and laryngeal diphtheria.

If some enterprising doctor in these communities will expend $20 for an intubation set, and will take a short course of study and practice, preferably, but not necessarily, at the nearest teaching center, there are few things, I believe, more certain than that he will not very infre quently save human life under circumstances so positive and appealing, that he will from this simple operation receive and give more substantial benefit and happiness than from any other known to his art. The operation of intubation is too simple and its results too vitally important for specialists to arrogate to themselves its benefits and uses. I am acquainted with no procedure in the entire field of medicine and surgery whose results are so immediately and eminently satisfactory to all concerned as intubation in proper cases.

I speak what I know when I say that a fairly apt man, without any training other than he can give himself at home, can master this operation and do it with the utmost confidence and success.

case,

Since which was first my also my first and only failure to give relief, counting those instances where the tube was coughed up and where, after removal by myself, it had to be reinserted, I have fourteen times been called upon to intubate the larynx, usually late at night, with bad light and the crudest kind of assistance, and have found no real difficulty in its accomplishment.

The relief afforded on these occasions forms some of my pleasantest bits of professional experience.

When there is time to wait, as a rule antitoxin should first be tried. Where we cannot wait, it should be used in addition to the operation, for it is usually impossible to say that diphtheria is not present.