outer border of the pinna is the helix. This begins in the crus (stock, leg) of the helix, just above the meatus, or canal leading into the eardrum, and ends in the lobule. Between the helix and the cupshaped depression, the concha, at the bottom of which is the meatus, there is a ridge, bifurcated above, called the antihelix. That bifurcation is named the crura of the antihelix; and the slight depression between these crura is the triangular fossa. The groove between the helix and the antihelix is the scapha (boat, boat-shaped). The prominence at the inner edge of the concha is the tragus (tragus, a goat-because of the hair which grows upon that part of the ear in middle life); opposite and below the tragus is a prominence, the antitragus, and between these points is the intertragic notch. Other depressions and prominences have special names, but these are unimportant here. The shape of the concha (a shell) is the special phenomenon observable in musicians' ears. In these persons the concha is (1) large; (2) deep; (3) rectangular. The lowest border is horizontal, and at right angles with the helix, which makes the outer border of the concha. The photograph herewith of the Apollo in the Louvre shows such a concha. In singers, even the noted artists, the lowest border of the concha is not seldom out of the horizontal line as this border goes back from the intertragic notch; thus forming a slightly obtuse angle with the antitragus (the ear of Mme. Emma Eames is an example), but this obtuse angle is not found in the instrumentalists. In some singers (Cavalieri, Schumann-Heink, for example) the lowest border is horizontal, but the antihelix slopes backward slightly. Richard Wagner had a typical external ear of the musical form. In his case the lowest border of the concha made a sharp right angle with the antihelix. WassilySafonoff, the Russian composer, Rachmaninoff, Marie Mattfeld, and Cleofanti Campanini, who led the Metropolitan orchestra in New York, have this sharp angle like Wagner. Ordinarily in musicians the lowest border of the concha is rounded slightly as it joins the antihelix. This is seen in the ears of Paderewski, Verdi, Ysaye, von Bülow, Balfe, Wilhelmj, Perosi, Tschaikowski, Parry, Massenet, Maud Powell, Elgar, Litolff, and innumerable others. It is noteworthy also that the lowest border of the lobule in musicians is commonly almost parallel to the lowest border of the concha, but this formation is not invariable. The only marked exception to this shape of the lobule the writer could find is in Joachim's ear. The form of the concha described here is found in the David of Michelangelo, and it was evidently known to the ancient Greek sculptors; in some of their statues the helix and lobe form an exaggerated rectangular letter C. In profile portraits of musicians made by painters, Mozart's, for example, this form of the ear may be lacking, because the painter does not always copy the unimportant ear as literally as the camera does. Photographs, however, are sometimes deceptive, as an inclination of the head apparently changes the real angles of the concha. The accompanying illustrations are examples of the musical external ear. Liszt, Grieg, d'Albert, Leoncavallo, McDowell, de Beriot, Rosenthal, Lhevinne, Hubermann, Bauer, Mahler, the two Damrosches, are other examples. It is a curious coincidence also that musicians almost without exception have large noses. When, on the contrary, the ear-lines are vertical, and the concha is narrow, with little or no lower border, and the lobule is large and pendant, the person, no matter how intelligent he may be, lacks the musical sense, is tone-deaf. It is said the General Ulysses S. Grant was not interested in music, and he could not recognize old popular tunes. His ear-lines vertical. were If a child has vertical ear-lines, it is useless to attempt to teach him music. One might as well try to make a pianist of a boy that has short, stubby fingers. Again, when a person with vertical ear-lines asks a musician to play an instrument the request is merely an act of patient courtesy, and the final applause is wilful mendacity or a sign of relief. A CONTRIBUTION TO THE TREATMENT OF HAY FEVER. BY GEORGE A. LEITNER, M. D., Surgeon, Nyack Hospital; Attending Paysician, Although much has been written on the subject of hay fever and numerous methods have been suggested for its treatment, none of these can be regarded in the light. of specifics. This is not at all surprising when it is considered that in hay fever we are not dealing with a distinct pathological entity, but rather with a complex of symptoms having many sources of origin. , 1910 , Vol. V. Much more is known concerning the exciting than the predisposing causes, the former comprising chiefly the pollen of various plants-in this country; particularly ragweed and golden rod-as well as dust and animal emanations. As regards the predisposing factors these are to be sought first in pathological conditions in the nasal cavities, such as the presence of spurs and deflections of the septum, hypertrophied turbinates, inflammation of the antrum, and also in a neurotic disposition. In view of the diversity of factors concerned in the etiology of hay fever it is apparent that each case is a law unto itself and must be treated individually, ascertaining if possible the underlying cause. In a general way the cases may be grouped into those in which distinct pathological changes are found in the nose and those in which the hyperesthetic condition of the nasal mucous membrane is but a part of a general neurosis. In both of these classes of cases the results of treatment, short of a change of climate, still continue far from satisfactory. When, therefore, my attention was called to the possible value of a special culture of the bacillus of Massol in this condition, through an article by Dr. H. Holbrook Curtis (Merck's Archives, January, 1909) I decided to give it a trial. Dr. Curtis in this article stated that the active solution of this culture had a pronounced effect upon the vaso-motor system of the nose, so that turgescent hypertrophies seemed to disappear and edematous conditions resulting from hay fever subsided. It may be mentioned here that the preparation of lactic acid bacilli employed in Dr. Curtis' experiments has since been introduced under the name of Massolin. , 1910 , Vol. V. The results so far obtained by us have been most interesting and encouraging. We found that in those cases in which there were distinct pathological conditions in the nasal cavities, such as hypertrophic rhinitis, nasal spurs, polyps and sinus troubles, the use of this culture proved it to be almost a specific. Some of the cases were relieved immediately and others were greatly benefited. In those cases where the underlying cause was undoubtedly a neurosis there was not the slightest evidence of any benefit. Although the removal of pathological changes in the nose when present in cases of hay fever is usually considered an essential feature of treatment, it has been found that in not a few cases the disorder nevertheless persists, thus showing that these lesions are to be considered only as contributory causes. It seems probable that in such cases the Massol bacilli either directly antagonizes the toxic element in pollen or so modifies existing pathological conditions as to increase the resistance power of the mucous membrane towards the morbific agent. However, this is only a theory which is presented here for what it is worth. The series of cases under consideration were all chronic, dating back in the most recent case eight years. All had been subjected to various operations or the usual treatment with adrenalins, oils, cocaine, etc., without relief. In most of the cases, treatment with the solution of Massol bacilli was not required beyond several days and a most interesting fact was that the majority remained immune to the exciting cause without further attention. The following series of cases are illustrative: CASE I. Mr. M., an unusually well developed and robust athlete, suffered for nine years with prostrating attacks of hay fever, the irritant in his case unquestionably being the pollen of golden rod. He had chronic nasal trouble, including nasal spurs, hypertrophied turbinates and a peculiarly sensitive mucosa. He had been under treatment for several weeks with various sprays and douches and had submitted to operative treatment during previous years. At the time the Massolin treatment was begun he was absolutely incapacitated and unable to undertake any physical exertion. Spraying with Massolin was commenced in the afternoon, three applications being made before bedtime. This resulted in the first night's good sleep since the commencement of the attack. He felt so well the next morning that he returned to business and continued treatment in a crude manner by means of a cotton swab. At the end of forty-eight hours all symptoms had subsided. He discontinued treatment and remained free for the remainder of the season. In this case the immunity was very surprising, as he is an ardent golfer and spent every spare moment upon the links which were lined with golden rod in full bloom. CASE 2. Sister D. had been a victim for over eight years of most pronounced hay fever symptoms in which the irritant was undoubtedly the blossom of hay. Her history for some eight years back had been one of most pronounced incapacitating attacks during the blossoming of hay. She had been confined to her room for some days when treatment with Massolin was established, beginning on a Saturday afternoon. When visited on Sunday morning the change in the facial expression especially in connection with the eye disturbance, was most marked and by Monday she was entirely free from all symptoms. In this case the patient deliberately exposed herself during the harvesting of the hay without any relighting up of the usual train of symptoms. CASE 3. Mrs. W. presented the usual train of symptoms, the exciting cause being undetermined. She had suffered for years and had submitted to various opera |