/Ji-e w/d. ON THE RESULTS OF THE TREATMENT OF NASO-PHARYNGEAL FIBROMATA, WITH DEM- ONSTRATION OF SUCCESSFUL CASES, TO- GETHER WITH A TABLE OF SEVENTY-FOUR OPERATIONS BY DIFFERENT SURGEONS. [Read before the American Laryngological Association, June, 1883.] BY RUFUS P. LINCOLN, M.D., NEW YORK. Reprinted from the Archives of Laryngology, Vol. iv, No. 4, Oct., 1883.] ON THE RESULTS OF THE TREATMENT OF NASO- PHARYNGEAL FIBROMATA, WITH DEMONSTRA- TION OF SUCCESSFUL CASES, TOGETHER WITH A TABLE OF SEVENTY-FOUR OPERATIONS BY DIFFERENT SURGEONS. By RUFUS P. LINCOLN, M.D., NEW YORK. IT is my desire to call attention to the treatment of a class of cases which, I believe, has never received the consideration which it deserves, but upon which I desire to elicit discussion. I refer to those growths usually called naso-pharyngeal polypi, especially those of a fibroid charac- ter, and which I prefer to designate by the term “ naso- pharyngeal fibroma.” The myxoma is excluded as being beyond the province of this paper, as well as those growths having their origin exclusively in the anterior nasal passages. These tumors, if not interfered with, inevitably cause great suffering, deformity, and ultimately destroy the life of the patient. The object of treatment is, therefore, first, their thorough removal, with the destruction of all diseased tissue at the place of origin ; second, avoidance, so far as possible, of ac- cidents incident to operations of the naso-pharyngeal region ; and third, to secure the result with the least external dis- figurement. To illustrate my subject, I have limited my researches to the records of cases published since 1867. The selection of this date is purely arbitrary, but it furnishes a period suffi- ciently long to embrace within it cases illustrating every Reprinted from the Archives of Laryngology, Vol. iv, No. 4, Oct., 1883. 2 Naso-Pharyngeal Fibromata. variety of treatment, and the fertility of the surgeon’s re- sources in his efforts to accomplish a cure. Some cases may have been overlooked, but none intentionally omitted. A great variety of methods of treatment have been advo- cated and practised, as will be seen by referring to the table of operations herein presented. In advance, I wish to dis- claim the purpose of advocating any one method as appli- cable to every phase of the disease that presents itself; at the same time, I believe you will conclude with me that there are many cases which may be successfully treated by a method simpler and safer than that usually employed by many of our distinguished surgeons. An eminent operator, in advocating the removal of these growths through a partial excision of the upper jaw, re- marks : “ The operations for the removal of the naso- pharyngeal polypi, although formidable in character, are re- markably successful in their results.” 1 If we refer to the table of cases which forms a part of this paper, we find, that of twenty-eight patients treated by a section of the bones of the face, in several instances the growths returned, necessitating a repetition of the opera- tion or the substitution of some other; and also that in eight cases, more than 28 per cent., death followed imme- diately or in a few days—a result suggesting a doubt as to the propriety of the above-quoted conclusion, and justify- ing a careful consideration of other methods which have been employed. I have succeeded in compiling the history of fifty-eight patients, including three of my own, one of which is given to you to-day for the first time. These cases fairly repre- sent seventy-four operations, which I have tabulated as follows : 1 H. B. Sands, M.D., Brown-Sequard’s Arch, of Scientific and Prac. Med., June, 1873, p. 517. Rufus P. Lincoln. 3 No. of Operations | Number and Sex of Patients. Age of Patients. Operations Involving Section of Facial Bones or the Laying Open of Cicatrices Resulting from Previous Operations of this Character. Removal by Knife, Scissors, Avulsion with For- ceps, etc. Removal by Ecraseur or Ligature. Removal by Injection or Cauterization with Chloride of Zinc. Removal by Electrolysis. Removal by Galvano-Cautery Ecraseur. * 74 58 8 years 2 No. operations, 39. No. operations, 7. No. operations, 12. No. cases treated, 2. No. cases treated, 3. No. operations, xx. Males . . 48 IS it 6 No. patients, 28. No. patients, 7. No. patients, n. No. cases in which No. cases report- No. patients, 10. Females . 8 r6 3 — — — recurrence is re- ed under observa- — Not stated 2 17 kk 5 No. cases in which re- No. cases in which No. cases in which ported to have tion for a year or No. cases in which 18 3 currence is reported to recurrence is re- recurrence is re- taken place within more without re- recurrence is re- 19 kk 2 31 have taken place within ported to have ported to have a year, i. currence, i. ported to have 20 1 a year, 14. taken place within taken place within — — taken place within 21 2 a year, o. a year, 6. No. cases in which N 0. cases in which a year, 3. 22 1 — — — there is no record there is no record 23 Ik 2 No. cases reported No. cases report- No. cases report- after the discon- after the discon- No. cases report- under observation for a ed under observa- ed under observa- tinuance of treat- tinuance of treat- ed under observa- 2S year or more without tion for a year or tion for a year or ment, 1. ment, 2. tion for a year or 26 1 recurrence, 4. more without re- more without re- — — more without re- 3° kk 1 4 currence, i. currence, 4. No. fatal cases, 0. No. fatal cases, 0. currence, 6. 33 1 No. cases in which No. cases in which No. cases in which No. cases in which 35 kk *' there is no record sub- there is no record there is no record there is no record 39 kk 1 sequent to the opera- subsequent to op- subsequent to op- subsequent to op- 40 2 ■ 6 tion, or a few months eration, or a few eration, or a few eration, or a few ♦ 1 U ; after, 13. months after, 5. months after, 2. months after, 2. 42 No. deaths during or No. fatal cases, 1 No. fatal cases, 0. No. fatal cases, 0. 45 kk *' attributable to the oper- (No. 21). 47 1 5 ation, 8. 48 52 kk aj In three other cases 54 I operation nearly proved 55 I fatal (Nos. 20, 23, and Not stated, 8 46). * In this class is included one case treated by means of the actual cautery (No. 70). SYNOPSIS OF TABLE OF CASES (pp. 264-281.) 4 Naso-Pharyngeal Fibromata. I will conclude with a report of a case I treated last January by means of the galvano-cautery dcraseur, with subsequent destruction of the stump with the galvano- cautery. After which you will have an opportunity to examine this patient, together with others operated upon by me some years ago by the same method. A. H. G., (No. 74 in table,) a student, aged seventeen years, applied to me Dec. 30, 1882, for examination. He complained of inability to breathe through his nose, and stated that nine months before he had undergone an operation, while under the effects of ether, for the removal of a “polypus,” having at that time the same symptoms as now. I subsequently learned from the youth’s parents that the operation was suspended because of the loss of blood and the prostration of the patient, a portion only of the “ polypus ” having been removed, and that polypus-forceps and scissors were the instruments used. Several weeks elapsed before he recovered his strength sufficiently to resume his studies. The patient was of healthy American parentage, but had him- self been of a delicate nervous constitution, and was subject to frequent “colds.” He was of studious habits, and for the pre- vious two years had been at a boarding-school, but had often been obliged to suspend his studies on account of headaches, which had become more and more constant until the question of aban- doning school had been seriously considered. Nasal respiration was partially restored by this first operation, but gradually became more difficult, until at the end of three months it was as bad as ever; the consequent evils were again, therefore, added to his nervousness and diffidence, until his life had become a burden to himself and a source of constant anxiety to his family. Examination: On inspecting the nostrils anteriorly I found the septum deviated to the left, and at a point about two inches from the margin of the right an obstructing mass, occupying the whole space, of a light pink color, smooth and elastic to the pressure of a probe. On attempting post-nasal rhinoscopy the post-nasal cavity was found occupied and completely filled, so as to press slightly on the soft palate, by a tumor of the same appearance as that discovered anteriorly. By manipulation they were found to be connnected and one and the same, and evidently fibrous in character. The whole mass was covered with mucous membrane, Rufus P. Lincoln. 5 but its inferior surface was rough and ulcerated. By means of a finger introduced through the mouth the tumor was followed to its attachment to the vault of the pharynx, mainly on the right side, by a rather large pedicle. There was no external deformity of the nose or face. I advised the removal of the tumor by means of the galvano- cautery ecraseur, and a subsequent treatment of the stump by the galvano-cautery. After some deliberation this method was con- sented to. On Jan. 8th the operation was performed after the manner deT scribed by me to this Society four years ago.1 A looped platinum wire was passed through the right nostril into the throat and carried up behind the tumor to its attachment by means of a finger introduced through the mouth. The two free ends of the wire were then each passed through the two arms of an electrode, which was run as far as possible toward the base of the growth, thus encircling the pedicle close to its starting- point. The patient was then etherized, and the electrode being con- nected with the battery, the pedicle was divided in two or three minutes without difficulty and with the loss of but a few drops of blood. The tumor was then withdrawn through the mouth. The excised surface of the tumor was about three-fourths of an inch by one inch, being oval in shape ; the mass was irregularly pear-shaped, as large as a seckel pear, and lobed where it extended into the right nostril. Nasal respiration was at once perfectly established, and the patient quickly rallied from the effects of the ether. It seemed necessary to make but five applications of the gal- vano-cautery to the stump, which were done at intervals of a week. An examination of the tumor showed it to be a fibroma. Near- ly four months have now passed since the last operation, and there are no indications of a recurrence of the tumor, as you will be able to satisfy yourselves on inspection. I am happy to be able to present to you, for a second examination, the two patients you saw at the meeting of this Association in 1879, at which time a detailed report of their cases and operations was made by me. 1 Trans. American Laryngological Association, 1879, pp. 247-255. 6 Naso-Pharyngeal Fibromata. You will remember the first case—J. B. J. (No. 33 in table,)—had been operated upon by me in April, 1875, eight years ago, for a large recurrent “ naso-pharyngeal polypus,” a fibroma. The operation was the same as that used in the case just given to you. There has been no return of the trouble. There is an interesting feature in this case, of great prac- tical value, to which I beg to call your attention. There was in this gentleman’s right cheek, at the time I operated upon him, a tumor, which reached nearly an inch below the zygomatic arch, which continued behind it, and was evi- dently related to the main tumor. It has completely disap- peared, and has never received any direct treatment. It would seem that the nutrient supply to this pro- longation had been cut off by the destruction of the main growth, and that in consequence this had atrophied. The other patient, Mr. M. B., (No. 39 in table,) who was also treated by the same method in Jan., 1876, seven years ago, is even more remarkable in his history, because of his feeble condition when I took him in hand, and because of the enormous tumor that was literally splitting open his head. The growth had been twice before removed by emi- nent surgeons. Here is a model in wax made by my friend Dr. Good- willie, from a cast taken at the time of the operation, but after the bulk of the tumor had been much shrunken by electrolysis. This tumor was also a fibroma, and there has been no recurrence. Rufus P. Lincoln. 7 Date. Operator. Reference. Sex. Age. Previous Dura- tion of Symp- toms. Situation and Extent. Pathological Nature. Treatment. Result and Subsequent History. Remarks. ,UX‘9' (■) Thomas Bryant. Trans. Path. So- ciety, of London, vol. xviii, p. 107. Male. 15 i year. Solid growth, three and a half by two inches, attached to base of skull, and completely filling upper part of pharynx. Fibrous. £craseur, with whip- cord loop, tightened daily. Tumor came away on sixth day. No sign of disease after operation. No subsequent history reported. Fourteen months before Mr. Bryant had attempted to remove a similar poly- pus, of two years’ growth, with the wire Scraseur. In five days wire came away without tumor, which became shrivelled for a time, but subse- quently began to grow again. July 23, 1867. (a) D. W. Cheever. Boston Med. and Surgical Journal, March 11,1869. Male. >9 13 months. Firm, lobulated tu- mor filling upper and back part of pharynx, and attached to body of sphenoid bone. Not stated. Resection of superior maxilla by Langen- beck’s operation. At- tachments divided with scissors, and point of section cauterized with strong nitric acid. Symptoms cf recur- rence noticed after eleven months. Thirteen months previ- ously an operation was performed for the relief of disease, of which this was the recurrence, and the origin of the growth dated two and a half years before that time. 1 In attempting to make a collection of the fibromata of the naso-pharyngeal region, it has been found impracticable to include only those of purely fibroid character. This is due partly to a partake of a mixed character. want of uniformity in the use of pathological terms by different writers ; also to the fact that many of the tumors Were, however, the few questionable cases that appear in this table eliminated, the sum of the evidence would remain unaltered. TABLE OF SEVENTY-FOUR OPERATIONS ON NASO-PHARYNGEAL FIBROMATA BY DIFFERENT OPERATORS FROM 1867 TO 1883.1 8 Naso-Pharyngeal Fibromata. Date. Operator. Reference. Sex. Age. Previous Dura- tion of Symp- toms. Situation and Extent. Pathological Nature. Treatment. Result and Subsequent History. Remarks. 1868. (3) D. W. Cheever. Ibid. Male. (Same pa- tient as above.) 2D 11 months. Tumor in same situa- tion as above, of size of English walnut. Not stated. Langenbeck’s opera- tion repeated, and a small portion of inner angle, just below or- bital process, removed on account of thicken- ing. After section of pedicle, the bone thor- In a recent note to the writer, Dr. Cheever states that there has been no recurrence since this operation. 1868. (4) D. W. Cheever. Ibid. Male. 41 13 months. Both nostrils and the pharynx above the soft palate completely filled with a tumor of the size of a pullet’s egg, whose anterior edge extended to within one half inch of alveolar border, and which was attached to the ethmoid and body of the sphenoid. In size and shape like a large lemon. Fibrous. oughly scraped. Temporary displace- ment of both superior maxillae. Attachments severed as near the bones as possible, and the remaining portion scraped away. Operation followed by shock, and patient died from exhaustion 120 hours after operation. 1868. (s) M. L. Thomas. Lancet, May 1, 1869. Male. 18 18 months. Tumor implanted in basilar process, stretch- ing down to left cheek, and invading the maxil- lary sinus. Tumor of pharynx, extending through right nostril nearly to outlet, and attached to basilar surface. Fibroma. Excision of the supe- rior maxilla, and re- moval of the polypus. No recurrence after several months. Aug. 6, 1868. (6) Mr. Rouse. Lancet, Feb. 27, 1869. Not stated. 14 Several months. Fibrous, and fibro-cellular. Langenbeck’s opera- tion. Tumor seized and extracted with polypus forceps. No record after thir- teenth day after opera- tion. Sept. 14, 1868. (7) Thos. Waterman. Boston Med. and Surgical Journal, April 8, 1869. Male. 39 4 years. Firm, lobulated growth, situated be- hind soft palate, ex- tending into left nasal fossa, and attached to sphenoid. Not stated. Langenbeck’s opera- tion. The tumor cut and torn away, and the points of attachment swathed with Squibb’s liq. ferri subsulpnat. Subsequent history not given. Rufus P. Lincoln. 9 Date. Operator. Reference. Sex. Age. Previous Dura- tion of Symp- toms. Situation and Extent. Pathological Nature. Treatment. Result and Subsequent History. Remarks. Oct. 12, 1868. (8) Thos. Waterman. Ibid. Male. 33 2 or 3 months. Growth filling left half of space between base of skull and pos- terior nares, and hav- ing a broad surface of origin from basilar pro- cess of spheno-occipital bone. Glandular, and partially fibrous. Excision of left supe- rior maxilla by Vel- peau's operation. Tu- mor removed with scissors, and the bone from which it grew cut away. Squibb’s liq. ferri subsulphat. ap- plied to points of at- tachment. No recurrence at the end of four months after operation. Mar. 11 1869. (9) A. Bonnes. Bulletin Gen. de Therapy Oct. 30, 1869. Female. as Several years. A polypus of four branches, weighing eighteen grammes, which filled upper part of pharynx and both nostrils (the right more completely than the left), and originated from base of skull. Fibrous. Ablation by means of a metallic nail attached to a thimble. No recurrence at the end of four months after operation. Apr. 13, 1869. (10) H. G. Clark. Boston Med. and Surgical Journal, Oct. 19, 1871. Male. 26 Not stated. Soft tumor, of size of pigeon’s egg, filling both nasal cavities and upper part of pharynx. Fibro-cellular. Incision, on left side of nose, through middle of lip. Tumor scraped out with finger. The bone, which was a little rough, was chiselled. Tumor began to return two months after opera- tion. Four years before this operation a small soft tumor had been removed with the knife. Time of recurrence not given. March, 1871. (») H. G. Clark. Ibid. Male. (Same pa- tient as above.) 28 21 months. Tumor filling whole naso-pharyngeal cav- ity, and pressing soft palate downward. Ibid. Incision made in old cicatrix, and the growth cleaned out as thor- oughly as possible. Tumors removed bv tube Scraseur through the nose. No record after one month subsequent to op- eration. Nov.11, 1869. (12) Ephraim Cutter. Boston Med. and Surgical Journal Nov. 22,1870. Female. 15 Not stated. Two pedunculated polypi hanging down Behind the sou palate from the post-pharyn- geal wall, one of which was of cylindrical shape, and extended two thirds the length of the tongue. In a commu- nication to the writer, Dr. Cut- ter states that he regards the growth as re- current fibroid, and that its ori- gin was at the basilar process of occipital bone, more to the left side thap the right. Larger growth after- ward returned. (Time of recurrence not given.) IO Naso-Pharyngeal Fibromata. Date. Operator. Reference. Sex. Age. Previous Dura- tion of Symp- toms. Situation and Extent. Pathological Nature. Treatment. Result and Subsequent History. Remarks. July *4* Ephraim Cutter. Female. 15 Not stated. Tumor occupying Recurrent Fi- Tumor removed by In a recent note to the 1870. Ibid. (Same pa same position as the brous. tube 6craseur through writer, Dr. Cutter states tie n t as larger of the above. the mouth. Seat of that both growths subse- above.) pedicle touched with quently recurred, and (13) nitrate of silver. were removed in the same way at least four times. He has not seen the case for three years, when he last operated, and cannot say whether there has been recurrence since then or not. i860 Prof. Von Bruns. Male. 23 2 or 3 years. Large tumor filling Fibrous. Electrolysis. From Only a hard knot, of ana Berliner klin. entire pharynx, sending May, 1869, to March, size of pea, remained in 1870. IVochensch.y July i, prolongation through left nostril to its an- 1870, 130 applications. posterior edge of vomer. No recurrence at the end Boston Med. ana terior orifice, and push- ing left eyeball out- of two years after cessa- Surgical Journal, tion of treatment. Nov. 28, 1872. ward, downward, and The patient had been (m) forward. operated on, three years before the treatment by electrolysis was com- menced, with Maison- neure's ficraseur, but the growth returned. Prof. Oiniselli. Not stated. Not Not stated. Tumor occupying Not stated. Electrolysis. Appli- At the end of the 1871. stated. whole wall of pharynx. cations made every course of treatment tu- Surg. Journal, Nov. stopping left nostril twenty days, from Nov. mor so reduced in size (15) 20, 1873. completely and right 20, 1869, to Oct., 1871. that only an insignificant nostril partially, and prominence was to be pushing epiglottis seen on posterior inferior against base of tongue. wall of pharynx. No subsequent history. May 10, H. O. Hitchcock. Male. Not 2 or 3 years. Tumor weighing three Fibrous. Langenbeck’s opera- Previous efforts to re- 1870. Trans. Michigan stated. ounces firmly attached tion. Tumor removed move polypus by avul- sion and afterward by the State Med. Society, to outer wall of right piecemeal. 1870, p. 94. nostril, and along upper . M. Verneuil. Male. l6 8 months. Large polypus at- Not stated. Resection of superior Considerable hemor- 1880. Gaz.des hopit.y Aug. tached at left of base of maxilla, and one lobe of rhage ; syncope ; intro- 9, 1870. skull, filling pharynx tumor after another re- duction of blood into air- and sending prolonga- moved. passages ; death during (17) tions into nasal fossa, maxillary sinus, orbit, pterygo-maxillary fis- sura, and, possibly, the operation. temporal fossa. 1870. Mr. Holmes. Male. 35 4 years (?). Tumor of pharynx Fibrous, with The whole of supe- Recovery from opera- Lancet, Jan. 16, hanging down behind a few spindle- rior maxilla, with ex- tion rapid ; but the 1875. soft palate, projecting cells. ception of orbital plate, growth recurred. (Time (18) into left nostril, and at- removed, and the tu- not stated.) tached to body of sphe- mor cleared away as noid or basilar process of occipital bone. far as possible. Dec. 3, Mr. Holmes. Male. 38 (?) 3 years (?). Large mass project- Fibrous, and Cicatrix of former No history subsequent 1873. Ibid. (Same pa- ing into nose and ad- containing operation opened up to recovery from opera- t i e n t as herent to base of skull. more round- and tumor taken away tion. above.) cells than spin- almost entirely. The (19) dle-cells. whole of the soft tissues then gouged away from base of skull where the tumor was adherent. Nov.26, Dr. Cabot. Male. 4° 18 months. Polvnus occupying Glandular Nasal bones sawn in Patient almost col- 1873. Boston Med. and pharynx and permeat- polypus. (Fi- Dro-cellular.) line of lateral nasal su- lapsed after operation. Surg. Journal, Feb. ing every available part tures, and the nose but rallied and made a 9, 1871. of nose. Appeared in turned downward over good recovery No sub- both anterior nasal ori- the mouth. Tumor re- sequent history. (ao) fices and also at upper moved with scissors and inward part of right and forceps. Trache- orbit; its entrance into otomy performed dur- orbit being from the ing operation on ac- sphenoid bone. count of difficulty of respiration. 12 Naso-Pharyngeal Fibromata. Date. Operator. Reference. Sex. Age. Previous Dura- tion of Symp- toms. Situation and Extent. Pathological Nature. Treatment. Result and Subsequent History. Remarks. 1871. (21) Cooper Foster. Lancet, May 20, 1871. Med. Times and Gazette, May 27, 1871. Male. »9 Not stated. A tumor of enormous s:ze, the nasal portion of which was princi- pally confined to left side. Attached to left side of external base of skull, it filled the base between greater and lesser wings of sphe- noid, the orbital plate of the frontal, and crib- riform plate of ethmoid, and extended from right nasal fossa, by way of sphenoid fissure, into the back of the orbit. Made up of small fusiform cells and stel- late connective tissue. Tumor could not be circumscribed and large portions were torn away with forceps. Much of it left in situ. Patient died twelve days subsequent to oper- ation after convulsions and coma. The autopsy showed general arachni- tis and circumscribed sloughing of brain. The cribriform plate of eth- moid was broken, and at the back part there was a small opening and a fracture extending for- ward from it. 1871. (22) • W. R. Whitehead. N. Y. Med. Rec- ord, Jan. 2, 1872. Female. Not stated. Not stated. A tumor of two ounces weight com- pletely filling the pos- terior nares, projecting from pharynx into mouth, and attached from basilar process of occipital bone to a point as far down as the third cervical vertebra. Muco-fibrous. Removed by avulsion by means of the fingers. No history after opera- tion. Some time previously the patient had had a small polypus torn away with forceps through the right nostril. Oct. 20, 1871. (23) H. B. Sands. B n-Siquard's Arch. 0/ Scient. and Practical Medicine, June, 1873. Male. 20 i year. Firm, elastic tumor occupying pharynx and nasal cavities (tne right more completely than the left), and having a pedicle with broad at- tachment to base of skull. Oval in shape and measuring 2j inches in length, 2$ in breadth, and ij in thickness. Diameter of pedicle ij inches. Fibrous. Flap in soft palate, including horizontal plate of palate bone, re- flected downward. The hard palate found in part absorbed from pressure of tumor. The 6craseur at first used, but the chain breaking, the pedicle was divided with scis- sors as close to bone as possible. Impossible to satisfac- torily detach pedicle at time of operation, and the wound in palate left open. There was pro- found exhaustion from hemorrhage, and the pa- tient recovered without any bad symptoms. The tumor almost immediately began to grow again. Rufus P. Lincoln. 13 Date. Operator. Reference. Sex. Age. Previous Dura- tion of Symp- toms. Situation and Extent. Pathological Nature. Treatment. Result and Subsequent History. Remarks. May io, 1872. (24) H. B. Sands. Ibid. N. Y. Med. Record, Feb. 2, 1878. Male. (Same pa- t i e n t as above.) 20 6 months. Large fungous-look- ing mass completely obstructing right nasal cavity and attached to basilar process of oc- cipital, body of sphe- noid, right pterygoid process, hard palate, and septum nasi. Fibrous. Partial excision of the jaw ; connections of tumor divided; large part of septum and nearly all the remains of hard palate removed with forceps; the pedi- cle severed with gal- vano-cautery f'craseur, and galvano-cautery applied to stump. A small prolongation of the polypus into the sphenoidal cells was al- lowed to remain. Pa- tient recovered rapidly after operation, but the tumor subsequently re- curred. (Time not stated.) In Jan., 1877, removed a third time, and in March recurred again. From May to Aug., 1877, treated by electrolysis. The stump then touched with Paquelin’s cautery and the patient discharged. No subsequent record. 1872. (25) Leon Labb6. Lancet, Oct. 19, 1872. Aug. 2,1873. Female. Not stated. Not stated. Naso-pharyngeal tu- mor, of size of small hen’s egg. Not stated. Soft palate slit with galvano-cautery knife, and tumor removed with galvano-cautery 6craseur. Cauterizations on root of polypus with galvanic button for some time after operation. No recurrence at the end of nearly a year. Mar. 12, 1873, to April 7, 1873- (26) Paul Bruns. Berlin, klin. Wo- chensch., 1873, No. 82. N. Y. Med. Record, May 15,1874. Male. 3° 8 years. Large tumor resting on arch of post pharyn- geal wall, right side, and filling almost the entire fauces. Fibrous. Electrolysis. Four weeks after last application no trace of tumor remained. No sub- sequent history. June iS, 1873. (*7) Spencer Watson. “ Diseases of the No**,” p. 439. Male. 55 7 years. Left nostril occupied by a firm growth, at- tached by broad base to anterior and upper part of outer walls, and to small portion of cribri- form plate of ethmoid. Fibrous. Bone divided about junction of nasal pro- cess of superior maxilla and nasal bone, and root of polypus torn away with finger. The bones at upper part of cavity scraped, and strong perchloride of iron applied to surface of attachment. Recurrence noticed in seven months. 14 Naso-Pharyngeal Fibromata. Date. Operator. Reference. Sex. Age. Previous Dura- tion of Symp- toms. Situation and Extent. Pathological Nature. Treatment. Result and Subsequent History. Remarks. Apr. 29, 1874. (*8) Spencer Watson. Ibid., p. 441. Male. (Same pa- tient as above.) 56 3 months. Soft polypus, large as hen’s egg, occupying whole nasal cavity as far back as the sphe- noidal cells (from which the deeper portion originated), and ptery- goid processes. Naso-pharyngeal tu- mor implanted on basi- lar process. Fibrous. Nasal bones split up and portion of nasal process of superior maxilla cut away. Tu- mor removed piece- meal. In two months patient died from intracranial disease; the nostrils in meanwhile having again become completely ob- structed. 1873- (29) Leon Labb6. Lancet, Aug. 2, 1873. Male. as Not stated. Fibrous. Soft palate slit with galvanic knife, and greater portion of tu- mor removed with gal- vano-cautery 6craseur. Remaining part with scissors, and the seat of attachment cauter- ized with heated iron. No subsequent history. 1874. (30) Mr. Callender. Lancet, Jan. 16, 1875- Female. Not stated. 2 years (?). Growth situated un- der orbital plate and ex- tending along base of skull as far as vertebral column. Fibrous (?). Cicatrix of a former operation opened up, and the mass removed as far back as possible. Case afterward lurned out to be'malignan' and patient died two years after operation. Seven years before, su- perior maxilla resected, and a similar tumor, in- vading the antrum, re- moved. Recurrence at end of five years. June, 1874. (31) Berkeley Hill. Lancet, June 20, 1874. Male. l6 Not stated. Large naso-pharyn- geal tumor extending outward through the pterygo-maxillary fis- sure and passing for- ward under the cneek. Not stated. Growth removed by temporary displace- ment of upper jaw. Operation completed satisfactorily, but at its conclusion patient died on table, either from shock, loss of blood, or chloroform. Dec. 18, 1874. (3a) James L. Little. Archives of Clini- cal Surgery, J uly, 1876. Male. 4° 2 years. Tumor weighing two ounces completely fill- ing posterior nares, pro- jecting from pharynx into mouth, and attach- ed from basilar process of occipital bone to a point as far down as third cervical vertebra. Fibrou*. Preliminary trache- otomy and excision of greater part of anterior maxilla by Fergusson’s operation. Tumor re- moved by galvano- cautery and scissors, and hemorrhage con- trolled by galvano-cau- tery. Patient much prostrated, and early on following morning sank suddenly and died. Rufus P. Lincoln IS Date. Operator. Reference. Sex. Age. Previous Dura- tion of Symp- toms. Situation and Extent. Pathological Nature. Treatment. Result and Subsequent History. Remarks. Apr. 26, R. P. Lincoln. Male. *5 3* years. - Elastic tumor weigh- Fibrous. Galvano-cautery 6c- Subsequent to the oper- 1875- Trans. American ing one and three- raseur, looped platinum ation, twelve applications Laryngolog. Ass’n, fourth ounces, inserted in vault of pharynx, wire being carried of the galvano-cautery, r879. through right nostril. (a platinum disk being occupying to a great encircling the tumor at used,) at intervals from extent the right nostril. its base. four to seven days. No (33) occluding the left pos- recurrence up to the pres- terior nasal region, and ent time. sending a prolongation Avulsion with forceps - into right zygomatic had been previously at- fossa. tempted in this case, but Aug. 5, H. Gulcke. Male. IS Not stated. Two tumors : one a Not stated. With the galvano- unsuccessfully. Subsequently several 187s. N. Y. Med. Record, large flat body, above cautery the attempts were made to June 25, 1881. lower edge of velum, on whole of the lower remove the base of upper posterior wall of phar- tumor, and the greater tumor with the galvano- ynx ; and the other, part of the upper, were cautery; but it was found softer and more conical. removed. impossible to keep the (34) closing entrance to left loop in position. The nostril. mass then began to grow again, and it was finally entirely scraped away with a sharp spoon. No recurrence up to last re- port; March, 1881. Dec. R. C. Brandeis. Female. 22 Several years- Pear-shaped tumor Fibro-sarco- Removed with wire Growth soon returned. 1875. A trier. Practitioner, one inch in length and ma. of fine Scraseur passed (Time not stated.) April, 1877. three and three-fourth inches in greatest cir- through right nostril. (35) cumference, occluding both nostrils, filling up- per part of pharynx and attached to basilar pro- July, R. C. Brandeis. Female. cess of occipital bone. 22 Not stated. Two tumors in same Fibro-sarco- An attempt to oper- Several applications of 1876. Ibid. (Same pa- situation as above, ma. ate with 6craseur hav- chromic acid were made (36) t i e n t as though somewhat less ing failed, the tumors to the remaining stumps, and there was no sign of above.) in size. were removed with double-curved scissors. recurrence nine months after operation. 16 Naso-Pharyngeal Fibromata. Date. Operator. Reference. Sex. Age. Previous Dura- tion of Symp- toms. Situation and Extent. Pathological Nature. Treatment. Result and Subsequent History. Remarks. Dec., H. B. Sands. Male. iS 2 years. Tumor of size of Not stated. Exsection of superior Growth soon returned. 1875. A rchtves of Clint- hickory-nut, attached maxilla and removal (Time not stated.) (37) cal Surgery, Aug., to basilar process of oc- with galvano-cautery. May 17, 1876. cipital bone. H. B. Sands. Male. 15 Not stated. Tumor two inches in Not stated. Lateral attachments Recovery complete. No 1876. Ibid. (Same pa- length, attached as divided with galvano- recurrence. t i e n t as above, and extending cautery knife, pedicle (Communicated to au- above.) forward to great wing divided with bistoury, thor by Dr. Sands.) (38) of sphenoid and down- and the remaining part ward to level of hard removed with forceps palate. and scissors. Jan. 15, R. P. Lincoln. Male. 21 57 years. Large tumor attached Cavernous fi- Removal with gal- Seven thorough cauteri- 1876. Trans. American by a pedicle three and broma. vano-cautery 6craseur; zations of the stump with Laryngolog. Ass’n, a half inches in circum- a looped platinum wire the galvano-cautery were 1879. ferenceto vault of phar- ynx, completely filling being passed through made during the next four left nostril into the months, and there has upper part of mouth, mouth, and carried up been no recurrence of the occupying wfiole of left behind the tumor. growth up to the present nostril, and pressing time. septum to the right to In this case a “ naso- such an extent as to en- pharyngeal polypus ” tirely occlude the right first appeared in 1869, and (39) nostril. in that and the following year it was twice removed by excision, after division of the soft palate. On account of the extreme debility of the patient electrolysis was employed for a year, (twenty-two applications in all,) as a preliminary to the radical Feb. R. C. Brandeis and Female. Not operations by the gal- vano-cautery ficraseur. Not stated. Hard mass, of size of Fibro - cellu- Removal by 6craseur No recurrence seven 1876. D. W. Yandell. stated. pigeon’s egg, and lar. introduced through years after operation. Amer. Practition- weighing 140 grains, oc- nostril. (Communicated to author (40) er, April, 1877. cupying whole post- by Dr. Brandeis.) nasal cavity and attach- ed to pterygoid plate of sphenoid. Rufus P. Lincoln. l7 Date. Operator. Reference. Sex. Age. Previous Dura- tion of Symp- toms. Situation and Extent. Pathological Nature. Treatment. Result and Subsequent History. Remarks. 1876. <40 R. C. Rrandeis. Ibid. Female. Not stated. Not stated. Two tumors of post- nasal cavity, each about s:ze of hazel-nut and both attached to ptery- goid process of sphe- noid bone. Fibrous. Removal by wire 6craseur. Patient subsequently treated for chronic nasal catarrh, and up to last re- port (time since operation not stated), no recur- rence of tumor. 1876. (42) Dr. Mason, of Prov- idence. Boston Med. and Surgical Journal, May n, 1878. Male. 14 Not stated. Pear-shaped polvpus of pharynx and right nostril. Fibroid. Removal by looped ligature passed through the nose. Tumor soon reappear- ed. (Time not given.) Nov. 2, 1877. (43) D. W. Cheever. Ibid. Boston City Hos- pital Reports, 1882. Male. (Same pa- t i e n t as above.) «S Over a year. Oval tumor, large as pullet's egg, nearly fill- ing pharynx, obstruct- ing right nostril, and at- tached to bodies ol sphenoid and right pal- ate bones. Fibroid. Nose sawn down and depressed (Ollier’s operation). Tumor re- moved. attachments scraped off the bones, and surface touched with nitric acid. In a recent note to the writer. Dr. Cheever states that there was slight re- currence in this case, and that the patient has been lost sight of. Sept. 2, 1876. <44) H. Guleke. N. Y. Med. Record. June 25, 1881. Male. 8 Not stated. Tumor pressing down the soft palate and at- tached to posterior wall Not stated. Complete removal with galvauo - cautery 6craseur. No recurrence up to last record, March 8,1881. (Four and a half years April, 1877. (45) J. J. Chisolm. Trans. Med. and Chir. Faculty of State of Maryland. 1878. p. 180. Male. 47 5 years. of pharynx. Tumor growing from base of skull and ob- structing right nostril. Not stated. Removal by wire loop passed around base ol growth and tightened daily. Tumor came away in three days. after operation.) Tumor recurred with- in four months. Feb. 25, 1878. <46) L. Me Lane Tiffany Trans. Med. and Chir. Faculty of Maryland, p. 180. Male. (Same pa- t i e n t as above.) 48 6 months. Firm, pear-shaped tumor, six inches in cir- cumference at largest part, and over three inches in length, filling greater part 0! posterior nares and pharynx, pressing on soft palate, resting against bodies of cervical vertebrae, and attached bv pedicle to light ptervgoid pro- cess and basilar process of sphenoid. Fibro-sarco- ma. Preliminary trache- otomy. Nose separ- ated from upper jaws and turned up over forehead, and both up- per jaws temporarily depressed. Pedicle di- vided with Paquelin’s cautery, and tumor ex- tracted with lithotomy forceps. Chloride of zinc, in crystals, ap- plied to the bones at seat of attachment. The shock great, and electricity resorted to to stimulate respiration. Pa- tient rallied slowly, but made a good recovery. In a recent note to the writer, Dr. Chisolm states that the patient died six months after this second operation from some acute chest trouble. 18 Naso-Pliaryngeal Fibromata. Date. Operator. References. Sex. Age. Previous Dura- tion of Symp- toms. Situation and Extent. Pathological Nature. Treatment. Result and Subsequent History. Remarks. May 28, 1887. <47) J. L. Ratton. Lancet, Nov. 3, 1878. Male. 18 1 year. Large growth, with base at least two inches in diameter, springing from body, pterygoid processes of sphenoid bone, back of pharynx, and margin of foramen magnum, filling left nostril, and protruding between alveolar pro- cess of upper jaw and the upper lip. A sepa- rate process attached to edges of spheno-maxil- lary fissure and passing into spheno - maxillary fossa. The hard palate had been completely absorbed by pressure of tumor. Fibrous. Preliminary laryn- gotomy. Skin flaps of Kergusson’s operation. Nasal process of supe- rior maxilla divided and anterior wall of antrum removed. Rase of tu- mor cut off with whip- cord ligature. Patient only partially rallied after operation, and died the same even- ing from exhaustion. Aug., 1877. <48) W. Roth. Wiener med. Wo- chen., July 24, 1880. Male. 43 Not stated. Tumor larger than a pigeon's egg occupying upper part of pharynx, extending into both nasal fossae (the left more occluded than the right), and attached by pedicle to base of skull. Fibrous. Removal with galva- no-cautery through the nose, after fixation of the tumor. No recurrence up to two and a half years after operation. Aug.31, 1877. (49) Nov. 7, D. W. Cheever. Hoston City Hos- pital Reports, 3d Series, 1882. Male. 21 3 years. Hard, firm tumor in upper part of pharynx, secluding both nostrils and attached to basilar process of occipito- sphenoid bone. Not stated. Fergusson’s incision on left side of face. Superior maxillary bone sawn across be- low molar bone and depressed. Tumor de- tached with scissors, and base cauterized with nitric acid. Four years afterward patient remained free from trouble. In a re- cent note to the writer, Dr. Cheever states that there has been no recur- rence up to the present time. 1877. (So) Henry Morris. Med. Times and Gaz., May 28, 1881. Female. l6 Several years. Tumor of large size, irregular shape, and broad base, occupying greater part of pharynx above soft palate, and blocking posterior nares. Fibro-cellular. Removal with 6cra- seur. No sign of recurrence up to last report, three and a half years after operation. Rufus P. Lincoln. *9 Date. Operator. Reference. Sex. Age. Previous Dura- tion of Symp- toms. Situation and Extent. Pathological Nature. Treatment. Result and Subsequent History. Remarks. May 7, 1873. <50 J. C. Ogilvie Will. Lancet, December 6, 1879. Male. »7 2 years. Naso- pharyngeal growth of size ot small tomato, arising from base of skull; also a second tumor, of size of walnut, attached to floor of nasal fossa. Fibrous. Smaller tumor re- moved with 6craseur. For removal of larger, Langenbeck’s opera- tion. Growth extir- pated by avulsion and use of scissors. No recurrence at date of last record, six months after operation. Oct. 17, 1878. (SO Macfie Campbell. British Med. Jour- Feb. 28, 1880. Male. 54 3 years. Naso-pharyngeal tu- mor extending in the mouth to the soft pa- late, completely block- ing right nostril, and pushing septum toward left. Large growth in pharynx depressing ve- ium and obstructing the nasal fossae. Glandular carcinoma of Billroth. Fergusson’s incision. Superior maxillary bone, with orbital plate, the palate bone, and part of malar bone re- moved. A small sinus under the orbit remained and had to be freely incised. Six months after operation no appearance of recur- rence. Oct., 1878 to March, 1879. (53) M. Barthelmy. Le progr 'es mid.. No. 49, 1879. Bui. et Mem. Soc. de Chir. de Paris, N. S., vol. v, p. 903. Not stated. 14 Indefinite. Not stated. Two unsuccessful at- tempts to remove tu- mor by avulsion. The velum was then divi- ded, and nine times in the course of two months injections of five drops of chloride of zinc (sat. solution?) were made. Growth became entire- ly destroyed, but at the end of six months there were signs of recurrence. No subsequent history given. 1878. (54) D. W. Cheever. Boston City Hos- pital Reports, 3d Series, 1882. Male. 15 (?) 3 years. Naso- pharyngeal growth of size of Eng- lish walnut. Not stated. Removal by galvano- cautery. Recurrence soon no- ticed. 1879 (?). (55) D. W. Cheever. Ibid. Male. (Same pa- t i e n t as above.) x6 Not stated. Tumor of size of hen’s egg. with broad attachment to posterior wall of pharynx, par- tially occluding both posterior nares, hanging well down in thorax, and arising from basilar process of occipito- sphenoid bone. Fibrous. Depression of supe- rior maxilla. Attach- ments of tumor to bone scraped off. In a recent note to the writer, Dr. Cheever states that there has since been no recurrence. 20 Naso-Pharyngeal Fibromata. Date. Operator. Reference. Sex. Age. Previous Dura- tion of Symp- toms. Situation and Extent. Pathological 1 Nature. ! Treatment. Result and Subsequent History. Remarks. Feb. 6, 1879. W) M. Cruveillier. Bui. et mem. soc. chir. de Paris, April 5, 1880. Male. 17 Over 2 years. Large and resisting bi- lobular tumor occlud- ing right nostril, fill- ing posterior part of nasal fossa, and attach- ed, one lobe to ptery- goid plate of sphenoid, and the other to basi- lar process of occipital bone. Not stated. Palate divided in me- dian line, and polypus extracted with forceps. Gap in palate closed a year afterward ; up to which time there was ap- parently no recurrence. June 20, 1879. (57) M. Duplay. A rchiv. gin. de wed., 1880, vol. i, p. 353- Male. 14 3 years. Hard, elastic tumor of size of chestnut (French) filling naso- pharyngeal space, and apparently implanted on basilar process by a large base. Fibrous. Incision through soft palate, and prolonged two centimetres in front upon vault of palate. Tumor removed with dcraseur, and stump destroyed as far as possible with thermo- cautery. Within three months manifest tendency to re- production, and Septem- ber 26th an injection ol ten drops chloride of zinc (sat. solution ?) was made. Repeated twelve times, and last injection fifteen days before date of report, after an in- terval of four months; during which there did not seem to be any sign of recurrence. Oct. 2, 1879. <58) Prof. Aschenoven. A rchiv. fur klin. Chir., 1880, xxv, p. 150- Male. S3 Not stated. Tumor of naso-pha- ryngeal space, large as hen's egg, attached by pedicle with broad base to base of skull. Sarcoma. Preliminary trache- otomy. Temporary dis- placement of both up- per jaws. Tumor re- moved with forceps and sharp spoon. Eight days after opera- tion erysipelas set in, but patient made a good re- covery. No subsequent history given. 1879. (59) M. Verneuil. Bui. et mem. soc chir. de Paris, N. S., vol. V, p. 836. Male. Not stated. Not stated. Naso-pharyngeal tu- mor of enormous size. Not stated. Solt palate divided and considerable por- tion of growth removed with 6craseur. Appli- cations of chromic acid to pedicle then made every two or three days. Remaining part of tu- mor gradually underwent softening and atrophy. Subsequent history not given. Rufus P. Lincoln. 21 Date. Operator. Reference. Sex. Age. Previous Dura- tion of Symp- toms. Situation and Extent. Pathological Nature. Treatment. Result and Subsequent History. Remarks. Jan. 17. H. Guleke. Male. 17 Nearly 1 year. Tumor of size ot Fibroma. Removal with the In a recent note to the 1 £80. N. Y. Med. Record, small hen's egg spring- galvano-cautery writer. Dr. Gulshe states June 25, 1881. ing from upper wall ot seur. that there has been no pharynx and occluding posterior part of right recurrence up to the present time. (60) nostril. In addition, a number of small, soft bodies in pharynx, es- pecially on right side. ftlch.io, Henry Morris. Male. 14 2 years. Tumor of pharynx Fibrous. The facial and pala- The patient, who was 1880. Med. Times and descending behind soft tal parts of superior at the time in verv bad Gazette, June 4,18S1. palate and plugging maxilla removed, and a condition, died before posterior nares. Pro- large mass of very hard completion of operation. cess of the growth ex- growth dissected and tended into spheno- wrenched away, to- maxillary fossa through gether with part of sep- naso-palatine foramen turn nasi, to which it (61) and through sphenoidal was firmly adherent fissure into cavernous A considerable portion sinus. Then upon side of tumor left in situ. of body ol sphenoid bone it reached to the sella Turcica ; thus extending within the skull. June 1, Henry Morris. Male. 45 4 years. Elastic tumor, chiefly Glandular Osseous aperture Growth recurred in five 1880. Ibid. attached to ethmoid, fill- carcinoma of made in a previous or six months. ing up whole left nostril, Billroth. operation (not by him- and extending also into self) enlarged by snip- right nasal cavity and ping away parts of na- (62) extending into pharynx. sal bone and nasal process of superior maxilla, and tumor re- moved. 22 Naso-Pharyngeal Fibromata. Date. Operator. Reference. Sex. Age. Previous Dura- tion of Symp- toms. Situation and Extent. Pathological Nature. Treatment. Result and Subsequent History. Remarks. Jan. ii, 1881. (63) Henry Morris. Ibid. Male. (Same pa- tie n t as above.) 45 1 or 2 months. The same as above. Ibid. Previous opening into nose enlarged by chip- ping away anterior border of superior max- illa, and growth scraped away as thoroughly as possible. Subsequent history not given. Sept. 1, 1880. (64) C. B. Nancrede. Phil. Med. Times, Dec. 18, 1880. Male. 52 2 months. Large, irregular, and lobulated growth com- pletely tilling pharynx and left nostril, attached to base of skull; involv- ing internal angular process of frontal bone, nasal process, and or- bital plate of superior maxilla, and displacing the eye outward and upward. Tubular epi- thelioma. Kergusson’s incision and removal of left su- perior maxilla, left malar, nasal,lateral mass of ethmoid, and ptery- goid processes of sphe- noid bone. Portions of tumor re- moved with lingers, for- ceps, and scissors. The case did well, with the exception of slough- ing of the cornea, two weeks after operation, from secondary implica- tion of the nerve. Subsequent history not given. Oct. 26, 1880. (63) Henry Morris. Med. Times and Gazette, June 11, 1881. Male. 14 2 years. Tumor of pharynx large as small pear, with somewhat narrow pedicle, and a long, ir- regular branch, which probably projected into one nostril at posterior nares. Fibrous, and fibro-cellular. After two unsuccess- ful attempts to remove with Gcraseur, tumor extracted by avulsion, with forceps, through the mouth. No recurrence up to eight months after opera- tion. Nov.17, 1880. (66) M. Desprfis. Bui. et mem. soc. chir. de Paris. May 5, 1882. Male. 18 2 years. Large naso-pharyn- geal tumor implanted on a large surface at base of skull, with one prolongation into right orbit, and a second, large as an apple, into zygomatic fossa. Not stated. Removal of superior maxilla by NSlaton's operation. Tumor ex- tracted, and the bone at seat of attachment scraped. Orbital pro- longation not entirely removed. Growth began to recur within a month. A year previous to op- eration the soft palate had been divided, and in- terstitial injections of chloride of zinc made, but in spite of this the tumor had continued to increase in size. Dec., 1880, to Jan., 1882. (67) M. Desprfes. Ibid. Male. (Same pa- tien t as above.) 18 1 month. Tumor growing from pedicle of above. Not stated. For fourteen months growth cauterized at in- tervals with a saturated solution of chloride of zinc. In two months tumor ceased to grow, but the applications had been kept up for a year longer, and it was proposed to continue them for several months still. Rufus P. Lincoln. 23 Date. Operator. Reference. Sex. Age. Previous Dura- tion of Symp- toms. Situation and Extent. Pathological Nature. Treatment. Result and Subsequent History. Remarks. 1881. - (68) George A. Peters. N. y. Me,/. Record, July 23, 1881. Male. 17 18 months. Elastic tumor, exten- sively attached to basi- lar process of occipital bone, occupying poste- rior nares, projecting forward into both nos- trils, pushing uvula for- ward and downward, and encroaching some- what upon throat. Fibroma. Maisoneure’s opera- tion for removal of up- per jaw, and extraction of tumor. Growth recurred within very few months. July, 1881. (69) Charles McBurney. N. Y. Med., Record y March 4, 1882. Male. (Same pa- tient as above.) x7 Not stated. Growth in same situa- tion as above, but rather larger. Fibroma. Same operation as by Dr. Peters, with excep- tion of removing the portion of bone. Tumor recurred very quickly. Au’mn of 1881. (7°) George A. Peters. Ibid. Male. (Same pa- tie n t as above.) >7 Not stated. Tumor much the same as above. Fibroma. Destruction of growth by burning down with actual cautery, which was applied seven or eight times, at intervals of two or three weeks. Each time after the cauterization the growth seemed to recur from less space. In a recent note to the writer. Dr. Peters states that the polypus is now growing slowly, and that it hasinvolved parts which make further operation impracticable. In a recent note to the writer. Dr. Hooper states that he has seen the pa- tient within six months, and that there has been no recurrence. In 1877 he was treated for post- nasal tumor by Dr. K. I. Knight with the galvano- cautery by puncturing. After a few sittings, growth diminished in size, but subsequently re- curred, and in 1879 a con- siderable portion of tumor was removed by Dr. Gar- land, through anterior nares, with forceps. Dec., 1881. (71) F. H. Hooper. Boston Med. and Surgical Journal, Aug. 24, 1882. Male. *3 i year. Large, smooth tumor, completely filling pos- terior nares, and oc- cluding right nostril. Fibrous. Complete removal with Jarvis’ snare. 24 Naso-Pharyngeal Fibromata. Date. Operator. Reference. Sex. Age. Previous Dura- tion of Symp- toms. Situation and Extent. Pathological Nature. Treatment. Result and Subsequent History. Remarks. 188a. <7a) R. F. Weir. N. Y. Med. Record, June 3, 1882. Male. 8 i year. Tumor ij x if x inches, weighing over half an ounce, attached to basilar proce»s of oc- cipital bone, partially occluding the nostrils, and hanging down nearly to base of tongue. Fibro- sarcoma. N6laton’s operation. Soft palate divided, and a large part of hard palate, together with vomer, removed. Dur- ing operation, trache- otomy performed, on account of sudden as- phyxiation. Attach- ments jf, tumor cauter- ized. The child rallied at first, but then suddenly sank, and died within an hour after operation. May 27, 1882. (73) George F. Shrady. N. V. Med. Record. Sept. 16,1882. Male. 14 4 years. Tumor filling superior vaults of nose and pharynx, entirely oc- cluding left posterior naris, extending across septum into right pos- terior naris, and attach- ed to basilar process oi occipital, to the sphe- noid, and to the adja- cent temporal bone. To the left it spread to a slight extent into ptery- goid fossa, and was continuous with a tu- mor in the cheek bv a prolongation into left spheno-maxillary fossa. A lobe of tumor also extended into cavity of antrum, through an opening made in poste- rior surface, by absorp- tion. Fibro- sarcoma. Preliminary laryn- gotomy. Fergusson’s incision, and lower half of left upper jaw re- moved. Soft palate di- vided, and tumor re- moved by cutting at- tachments with curved scissors. Patient died within an hour after operation. At the autopsy a tumor, of size of horse-chestnut, evidently continuous with naso-pharyngeal growth, found attached, by in- flammatory adhesions, to under surface of left mid- dle lobe of cerebellum. Jan. 8, 1883. (74) R. P. Lincoln. Male. 17 2 years. Elastic tumor of size of seckel pear, occlud- ing both nostrils poste- riorly, extending into right to \\ ithin two inches of anterior ori- fice. and attached to basilar process of oc- cipital bone, and to sphenoid, principally on right side. Fibroma. Galvan o-c autery Scraseur, passed through right nostril, as in cases N os. 33 and 39. Five applications of galvano-cautery to stump at intervals of one week. No recurrence up to pres- ent time. g. p. putnam’s sons, printers NEW YORK