140 and respirations were 30. Pressure was reduced to 4 pounds at 8.10 p. m., and at 8.20 p. m. to 2 pounds. He complained of diminished vision. By 8.45 p. m. all excess pressure had been removed. The patient apparently was in fair condition, but at 9.15 p. m. he had a severe convulsion and became unconscious and cyanotic. He was placed once more in the pressure chamber and the pressure gradually increased to 16 pounds, all the pressure available. At 10.15 p. m. he had a second convulsion, pulse became too rapid to count, respiration was over 50, but the cyanosis had disappeared. At midnight the patient was still unconscious, respiration 56, again cyanotic, and pulse too fast to count. At 1 a. m. Cheyne-Stokes breathing occurred; shortly after this the patient died.

FOREIGN BODY IN THE NARES.

By C. B. CAMERER, Lieutenant Commander, Medical Corps, United States Navy.

During the routine physical examination of a seaman, age 22, who had been admitted to the medical service of the hospital ship Mercy, it was noted that he had difficulty in breathing through the right nostril. When he was referred to the nos and throat service for examination, what appeared to be a thick mass of mucus was observed well back on the floor of the right nostril and apparently adherent to the right septal wall. However, following routine cleansing procedures, the mass was still present, and upon further examination was found to be hard, rough, and firmly attached, which fact led to the supposition that it might be an aberrant tooth or possibly a neoplasm or foreign body, and an X-ray examination was ordered.

A foreign body of some sort, circular in outline, about 12 millimeters in diameter when viewed laterally, and uniformly of about 6 millimeters in thickness when viewed antero-posteriorly could be plainly discerned in the X-ray plates.

Under local anesthesia removal was accomplished with considerable difficulty, the mass being firmly attached to the base of the septal wall. It was found to be a piece of cork, thickly calcified, which had eroded through the nasal mucosa and became firmly adherent to the deeper structures.

Following removal and routine local treatment at site of attachment, recovery was uneventful.

Several days subsequent to the removal of the foreign body the patient stated to the writer that he recalled very dimly having been attended by a physician at the age of 5 years for some kind of nasal trouble, and as he recollected, there was some question of a foreign body having been introduced either by a playmate or himself.

This case is considered to be of interest in view of the long period of time this foreign body had been in the nostril (about 17 years)

and the lack of symptoms (or their disregard) by the patient prior to admission, also for the dense calcareous deposits which had thoroughly permeated the cork, and further, for the attachment to the deeper structures, requiring the employment of considerable force to facilitate removal.

AN UNUSUAL NASAL POLYP.

By P. M. ALBRIGHT, Lieutenant, Medical Corps, United States Navy.

W. J. D., Veterans' Bureau case, age 32, white, was admitted to United States naval hospital, League Island, Philadelphia, Pa., on January 2, 1923, with the diagnosis of "large nasal polyp."

The patient gave the following history: For the past four years has had headaches (frontal), which were worse in the morning upon arising and gradually cleared during the day. States that he has had discharge from both nostrils and has had difficulty in breathing through left nostril. At times he could feel an obstruction in his left nares which he would attempt to pull from nose and which family physician also attempted to remove but unsuccessfully. Says that obstruction was relieved at times by posture, and that he always had a foul odor to his breath and a foul taste in his mouth.

Examination showed a large nasal polyp, which filled the entire left anterior meatus and which upon postnasal examination was found to hang into the epipharynx. Upon shrinking it was found that the polyp was suspended by a long pedicle which had its origin in the left antrum; the pedicle coming from the sinus, passing under the left middle turbinate and extending over the inferior turbinate. Examination of the nasal accessory sinuses was clinically negative. Transillumination showed a clouding of the left antrum, which was confirmed by X ray. Needle puncture of left antrum and irrigation with normal saline showed washings clear.

As the sinus was clinically negative and there was no evidence of pus in the washings nor evidence of an ostitis by X ray, it was thought that the clouding was most likely due to the thickened membrane of an old chronic maxillary sinusitis from which the polyp had its origin.

The polyp, with pedicle, was removed under local anaesthesia. The posterior portion of the polyp which hung into the pharynx showed degeneration and had a very foul odor.

The accompanying illustration shows the size of the polyp and pedicle, which has shrunken considerably due to the action of the cocaine before removal and action of the preserving fluid.

This case has the following points of interest: Long duration, size of polyp, its origin, and length of pedicle.

REPORTS.

A REPORT ON THE SANITARY CONDITIONS OF THE SECOND BRIGADE, UNITED STATES MARINES, SANTO DOMINGO, FOR THE YEAR OF 1922.

By J. J. SNYDER, Commander, Medical Corps, United States Navy.

History and description.—I am prefacing my annual report with a description of the country occupied by the Second Marine Brigade so as to make it clearer and to show the kind of duty the troops were called upon to perform. The island of Haiti or Santo Domingo lies between 68° 20′ and 74° 30′ west longitude, and 17° 36′ 40" and 19° 58′ 20′′ north latitude and contains 28,987 square miles. It is divided into the two countries of Haiti and the Dominican Republic, and it is only with the latter that we have to deal. The Dominican Republic, or Santo Domingo as it is usually called, occupies the eastern two-thirds of the island, and contains 19,325 square miles. The entire island is mountainous, the ranges having an casterly and westerly trend, with fertile valleys in between. When a British King asked an admiral fresh from the Spanish possessions to describe this island, he took a sheet of paper in his hand, crumpled it, then threw it on the table, exclaiming: "There it is, Your Majesty!" The description still holds. With a mountain peak towering to a height of over 12,000 feet, and many others of lesser height, and caressed by the unceasing trade, many varieties of climate may be found, and most of them salubrious and inviting. The character of soil and the vegetation vary between the wonderful Vega Real of the north and the desert regions around Lake Enriquillo in the southwest. The rainy season is expressed by the character of its flora, so we have forests and jungle or cactus. Irrigate the desert, as at Barahona, and it responds abundantly. The native fauna are negligible. A ratlike animal and birds of the same varieties as are in the United States are found. There are a few snakes, and alligators are found in Lake Enriquillo.

Population. This is of mixed races. The Spanish, French, Negro, and Indian races predominate, while there is a sprinkling of other races. As the first-settled country of the New World, it attracted the hardy conquistadores of Spain who quickly overran it and convinced its original Indian proprietors by means of the sword