In some cases he had seen the polyp was so difficult to get at or was situated so far back in the nose that it could not be reached by means of a tenaculum or scissors, or even the special knife devised for that purpose. For these patients Arculanus describes an operation that is to be found in the older writers on surgery, Paul of AEgina (AEginetus), Avicenna, and some of the other Arabian surgeons. For this three horse-tail hairs are twisted together and knotted in three or four places, and one end is passed through the nostrils and out through the mouth. The ends of this are then pulled on backward and forward after the fashion of a saw. Arculanus remarks evidently with the air of a man who has tried it and not been satisfied that this operation is quite uncertain, and seems to depend a great deal on chance, and much reliance must not be placed on it. Arculanus suggests a substitute method by which latent polyps or occult polyps as he calls them may be removed. There is scarcely an important disease for which Arculanus has not some interesting suggestions, and the more one reads of him the more is one surprised to find how many things that we might think of as coming into the purview of medicine long after his time or at least as having been neglected from the time of the Greeks almost down to our own time are here treated explicitly, definitely, and with excellent practical suggestions. He has a good deal to say with regard to the treatment of angina, which he calls synanche, or synanchia, or cynanche, or angina. Parasynanche is a synonymous term, but refers to a milder synanche. He distinguished four forms of it. In one called canine angina, because the patient's tongue hangs out of his mouth, somewhat the same as from an overheated dog in the summer time, while at the same time the mouth is held open and he draws his breath pantingly, Arculanus suggests an unfavorable prognosis, and would seem to refer to those cases of Ludwig's angina in which there is involvement of the tongue and in which our prognosis continues to be of the very worst even to our own day. At times the angina causes such swelling in the throat that the breathing is interfered with completely. For this Arculanus' master, Rhazes, advised tracheotomy. Arculanus himself, however, apparently hesitated about that.