tients, died within the first eight weeks from shock, hemorrhage,
pneumonia, septic infection, or exhaustion. The cases collected by
these authors show a decrease in the death ratio in the total
excision,--29 per cent as against 36 per cent in the Kraus tables. The
mortality in the partial operation is increased, being 38 per cent as
opposed to 25 per cent. Cases reported as free from the disease before
the lapse of three years are of little value, except in that they
diminish, by so much, the operative death-rate. Of 180 laryngectomies
for carcinoma prior to January 1, 1892, 72, or 40 per cent, died as a
result of the operation; 51 of the remaining 108 had recurrence during
the first year, and 11, or ten per cent of the survivors, were free
from relapse three or more years after operation. In 77 cases of
partial laryngectomy for cancer, 26, or 33 per cent, died during the
first two months; of the remaining 51, seven cases, or 13 per cent, are
reported as free from the disease three or more years after the
operation.

Injuries destroying great portions of the face or jaw, but not causing
death, are seldom seen, except on the battle-field, and it is to
military surgery that we must look for the most striking instances of
this kind. Ribes mentions a man of thirty-three who, in the Spanish
campaign in 1811, received an injury which carried away the entire body
of the lower jaw, half of each ramus, and also mangled in a great
degree the neighboring soft parts. He was transported from the field of
battle, and, despite enormous hemorrhage and suppuration, in two months
recovered. At the time of report the wounded man presented no trace of
the inferior maxillary bone, but by carrying the finger along the side
of the pharynx in the direction of the superior dental arch the
coronoid apophyses could be recognized, and about six lines nearer the
temporal extremity the ramus could be discovered. The tongue was
missing for about one-third its length, and was thicker than natural
and retracted on the hyoid bone. The sublingual glands were adherent to
the under part of the tongue and were red and over-developed. The
inferior parts of the cheeks were cicatrized with the lateral and
superior regions of the neck, and with the base of the tongue and the
hyoid bone. The tongue was free under and in front of the larynx. The
patient used a gilded silver plate to fix the tongue so that
deglutition could be carried on. He was not able to arti