The amount of rhodan contained in nasal secretion is individually different, just as the amount of rhodan in the saliva varies. In general, whenever the saliva is unusually rich in rhodan a very distinct rhodan reaction appears in the nasal secretion. The opposite holds true in the absence of rhodan in saliva.

I examined twenty cases of genuine ozena, for the presence of rhodan. I regard under the picture of genuine ozena, cases of chronic rhinitis with atrophic processes, especially of the lower turbinal and with the formation of crusts and fœtid pus which does not appear to come from any of the accessory cavities. The result of the examination was, that in the secretion of ozena-patients no rhodan was present. In one case, a very weak reaction was found. The fluid contained in Gottstein's packing gave no reaction. These results correspond to the histological condition of the atrophic nasal mucosa in which the glandular cells have atrophied. Fatty degeneration of all glandular epithelium is the most constant condition present in ozena; consequently, the serous secretion is diminished in quantity and its constituent parts must decrease. I cannot say whether the fetor in ozena can be traced at all to the absence of rhodan.

ENTOTIC MURMUR DUE TO ANEURYSM OF

THE OCCIPITAL ARTERY.

BY DR. MUCK, Rostock, GERMANY.

The patient, C. W., 68 years old, fell eight years ago from a ladder, striking the back of her head. She became unconscious and vomited. No results followed this injury until the middle of this year when she became conscious of a continuous pulsatile beating in her ear, which later became so intense as to disturb her sleep and interfere with her general health. On the 23d of September she visited the clinic for relief.

On admission a healthy woman presented a lobular, pulsating tumor, situated under the skin, beginning at the posterior margin of the mastoid process and extending backward to within 2 or 3 cm of the occipital protuberance. The vertical diameter of the tumor was the same as the one just mentioned. The pulsation was uniform, most marked at the anterior lower corner, corresponding to the place where the occipital artery becomes superficial. Pressure exerted at this point prevents pulsation in the entire tumor. At the posterior margin of the tumor, there is a linear cicatrix about 2 cm long. Mt and hearing normal on both sides.

It was decided to operate, to relieve the patient of this very unpleasant murmur. The dissection of the aneurysmal sac was somewhat difficult, as it was found to communicate with a number of small arteries. The healing of the wound, retarded somewhat by an attack of erysipelas, was complete in the middle of October.

The effect of the operation was not brilliant, inasmuch as the pulsation could still be felt in an area of 2 cm in diameter. The subjective aural symptoms had, however, completely disappeared.

Disturbing entotic murmurs produced by pathological dilatation of the blood-vessels about the ear have been frequently described. We have, however, not been able to find a case where these auditory sensations were the result of aneurysm of the occipital artery.

ner.

THE MASTO-SQUAMOSAL SUTURE.

BY DR. ADERMAN, OREBRO, Sweden.

HE frequency of a masto-squamosal suture has been previously investigated by Kieselbach and by KirchThese two authors, however, did not arrive at the same conclusions, and so I have thought it worth while to study the relations on a larger number of skulls, especially as I had the opportunity of examining the large collection in the Natural History Museum of Vienna.

Kieselbach found, in an examination of 300 skulls, a complete suture on both sides in 15; complete on the left side with a trace on the right, in 8; left complete, right without trace, 5; right complete, left trace, in 4; bilateral trace of the suture, in 20; left trace, right no suture, in 12; right trace, left no suture, in 6; and finally, in 76.9% of these 300 skulls, neither a suture nor a trace was present on either side.

Kirchner, in his 174 skulls, found 6 which presented a complete suture, and of these, 5 were the skulls of children under ten years of age.

My investigations have shown that the presence of this suture is distinctly more frequent. I regard a distinct masto-squamosal suture as present, when it appears like an ordinary suture of the cranial bones, though it may have disappeared at a number of points, as is usually the case at the apex of the mastoid process. If the two bony surfaces were completely divided by a long suture, I have designated this suture as an unusually well developed one. A trace of the suture is one which is represented by small apertures, usually in the middle of the mastoid process, and there are

furrows in the bony surface. The collection of skulls contained skulls of known and skulls of unknown age. I have examined 2554 skulls. Of these 1413 were of unknown age; originating in Austro-Hungary, 724; 241 were brought from the neighboring countries, Italy and Greece; 448 were of various other races; Hindoos, Javanese, Malays, etc. These three groups presented practically no difference. Of the 1413, 219 presented distinct sutures on both sides; in 54 the suture was distinct on one side and on the other, a trace; in 7, a distinct suture on one, while on the other there was no trace. Of the skulls with distinct sutures, 9 were children's skulls and 3 were those of old people; 19 had very well developed sutures on both sides; 180 had traces of sutures on both sides, and 79 only on one; 874 were completely without sutures; of these, 14 were skulls of children. The skulls of determined age were 1141. Of these, 142 had distinct sutures on both sides; 57 were distinct on one side, a trace on the other; 5 distinct on one side, with no trace on the other; very well developed sutures were found present on both sides in 13; 164 had trace on both sides; 73 a trace on only one side; 700 were without trace on either side. Of the skulls with distinct sutures on one or both sides, there were none belonging to children, 5 were those of old people. Among the skulls without sutures there was one child's skull and those of 24 belonged to old people. Of middle age, those without sutures were 33; with distinct sutures, 28. I have examined the skulls of all these various races, and have not been able to find any particular difference as to the frequency of the suture, with the exception of the negro. I have examined 79 negro skulls, and of these there was only one with a bilateral distinct suture. One had a bilateral and one a unilateral trace of suture, and 76 were completely without sutures. There were no children's, or skulls of very old people, in this group; 49 were of definite age; the middle age was 27; the age of the one with the distinct suture was 30.

Finally, of 5138 mastoid processes, 1806 had sutures. Of these, 64 were well-developed, 845 were easily recognizable, and 951 presented traces.

ACUTE MASTOIDITIS COMPLICATED BY

SCLERODERMA.

BY DR. M. KAMM, BRESLAU, GERMANY.

M. S., seventeen years old, was taken ill in the beginning of October, 1899, with pain in the left ear. Otorrhoea one week later, which soon became less, but pain set in behind the left ear. On October 26th there was a small perforation of the Mt in the upper anterior quadrant, through which yellowish pus appeared in moderate quantity. The drum was otherwise reddened, thickened, and bulging. H. Weber to the left; Rinne, left negative.

The patient complained of severe pain in the left mastoid process, and when the head was rotated in the opposite direction. The skin below the mastoid process, down to the clavicle, is thickened and hard. A Bezold mastoiditis was immediately suspected, though this diagnosis was given up after we had examined the other side, where, in the absence of any otitis, the skin of the neck was in the same condition. On further examination, we found that the skin all over the body had this same board-like consistence, except the abdomen, the buttocks, and the lower extremities. The consistency of the abnormal skin was something like that in the frozen cadaver, which cannot be indented with the finger nor be raised in a fold.

There was no question but that we had to deal with a case of diffuse scleroderma, an affection which is rather rare, and of which there are not more than one hundred cases recorded in literature. The patient had no idea of the abnormal condition of her skin, nor did she know anything about the origin.

To explain the pain in the mastoid region, we had to decide between an empyema or a carious process in the bone. As the symptoms of otitis were not severe, we first enlarged the perfora