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the best. It is then poured into the frontal sinus with the specimen held on its side. The sphenoidal and ethmoidal sinuses are then filled. The maxillary antrum is filled from an opening in the canine fossa. The amount of fluid necessary to fill the cavity enables us to determine its cubical contents. In order to improve these specimens for demonstrating purposes, after the metal has become hard, windows may be cut into the walls of the accessory cavities. Enlarged blood-vessels appear through the bone. The furrows in the bone for the vessels may be outlined with water color. All the individual features of these cavities are thus capable of being demonstrated. Their position to the cranial cavity, to the mouth, to the nasal cavities, and their relation to one another, are exactly given. They should serve as a valuable addition to the corrosion anatomy of the nose.

THE CONTAGIOUSNESS OF ACUTE OTITIS

MEDIA.

BY DR. L. WOLFF, FRANKFURT-AM-MAIN, GERMANY.

AT

T the second meeting of the German Otological Society in 1893, I reported on the simultaneous appearance of severe middle-ear disease in three brothers and sisters, and concluded as follows: "The most interesting point in this communication is the question of the etiology. It is very striking, that of four sisters and brothers who were all taken sick with catarrhal symptoms, three should suffer from simultaneously appearing purulent middle-ear disease and two of these were ill for some weeks with very severe aural symptoms. Everybody is surely of the opinion that there was a common infectious agent."

Not only the onset, but the course of the disease and also the variety of the middle-ear infection, presupposed influenza, though the pathological bacillus was not determined. Since the observation of these cases I have had numerous opportunities to observe the simultaneous appearance of acute middle-ear disease in members of the same family. The last observation was that of three boys. The oldest of these, following a severe cold (influenza?), suffered from a double otitis with high fever. One week later another brother began to suffer from a double otitis with severe symptoms, and on the next day, the youngest brother was taken ill with the same affection. After paracentesis, all three children recovered completely in the course of a number of weeks.

Our well-known colleague, Marcel Lermoyez, has been very much struck by this grouping of acute middle-ear

disease in members of a family who live together. Though we regard this peculiar onset as the result of common infection, Lermoyez, in a paper entitled "La contagion des otites moyennes aigues," cites seven cases and concludes that acute otitis media is contagious, and demands that the patients be isolated.

If we examine the cases which he gives each case corresponds to two case histories; one, of the one first affected, and the other, of the one secondarily infected we find that Lermoyez mentions as the etiology of the middle-ear inflammation in two cases, influenza; in one, angina; and in one, measles. In three cases, the acute otitis media developed without a preceding illness. It will be noted that in four of the cases described, the disease was typically infectious. If we acknowledge a similar infection for both patients, the complication with otitis is then readily explained — especially if we remember how very frequently · the ear is attacked in all infectious diseases. Why should we, therefore, and what right have we to say that an ear disease is transmitted from one patient to another?

Lermoyez then cites three further cases where the ear disease of the secondarily affected person was preceded by no other illness, and he thinks that the otitis was transmitted as such disregarding the fact that in one of the cases the patients were children suffering with catarrhal nasal troubles, and that thereby a suitable condition for a middle-ear affection was present. In the other three cases, the variety of the middle-ear disease is one which we usually consider as characteristic for influenza. Thus, in Case 5 Lermoyez speaks of an hemorrhagic myringitis and in the corresponding case of an enormous bloody bulla. The same existed in Case 7, and in the corresponding case the otitis was a typical hemorrhagic one. Does it not seem most likely that the secondarily affected patient also suffered from infection. with influenza? Influenza, unquestionably, can be transmitted, and the contagiousness of the affection is probably doubted by few at the present day. Finally, in regard to the first case, of the woman whose husband had an otitis following influenza, and she was subsequently taken

ill with otitis, it is most likely that her otitis was the result of an influenza infection. But in this case, and in the two previously mentioned, no symptoms of an affection preceding the otitis, not even of infection, are said to have been present. Nevertheless, assumption that the otitis was transmitted as such does not seem warranted. In times of epidemics, cases of typical infection are not uncommon where the otitis begins without any other symptom of an infectious attack, although it is probably nothing more than a secondary infection.

Lermoyez regards the similarity of the form of middle-ear disease in the various double cases as a proof of their contagiousness. Finally, this author sees a support for his view in the fact that the occurrence of secondary otitides, in the hospital is much more frequent than in private practice. He thinks this is due to the close contact and surroundings of hospital patients. But, surely, is it not more likely that it is because hospital patients are of an entirely different class of the population, and is not this class of the population the most liable to affections of the naso-pharynx and the ears?

In conclusion, it seems to me that in the above cases the aural inflammations were the result of infectious diseases, and that they are secondary in nature and originate from a common primary cause. The latter, of course, like every infectious disease, can be transmitted from one individual to another. But that acute otitis is in itself contagious, and necessitates the isolation of patients, does not seem to me to have been proven.

THE OCCURRENCE OF RHODAN IN THE NASAL SECRETION, AND ITS ABSENCE IN OZENA.

I

BY DR. MUCK, ROSTOCK, GERMANY.

HAVE recently demonstrated that rhodan (potassium or sodium) forms a normal constituent of the nasal secretion, and that it is derived principally from the serous glands. Moreover, the catarrhal thin fluid secretion is as rich in rhodan as the sero-purulent.

One sometimes is able to obtain a very distinct ferric chloride and iodine acid-reaction, if we touch the pockets of the nose with our reagent paper. The accumulation of salt at this location and at the introitus in general is because the nasal secretion in passing dries up in this region; and in drying, the salts are here precipitated.

If, in the presence of chronic catarrhal inflammations of the nasal mucosa the serous exudate becomes greater than the mucous, then the rhodan test is unusually striking. Hoppe-Seyler found that the quantity of anorganic salts in a state of serous exudation increased from 1 to 1%.

The continuous discharge of a large amount of thin, fluid, nasal secretion is a symptom of nasal hydrorrhea. This fluid can be nasal or cerebro-spinal in origin. It has been demonstrated that the fluid in nasal hydrorrhea in general corresponds to the composition of the cerebro-spinalfluid, and this has frequently given rise to the idea that this hydrorrhea is a flowing off of the brain water, through the nose. Cases of this kind are known. Cerebro-spinal fluid does not contain rhodan; consequently, in doubtful cases the origin of fluid dropping from the nose may be determined by the rhodan reaction.

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