REPORT OF THE TRANSACTIONS OF THE OTOLOGI- MEETING OF MARCH 12, 1903. THE PRESIDENT, EDWARD B. DENCH, M.D., IN THE CHAIR. Presentation of Cases. Dr. TOEPLITZ presented a case of perichondritis. The illness began six weeks ago with pain in the ear. A diagnosis of subacute otitis was made and paracentesis was performed. Pain shortly after developed at the anterior meatal wall. Later, the whole tragus became swollen, and it was again incised. Notwithstanding, the swelling and infiltration proceeded backward and below, occupying the lower part of the concha. Incision was made through the cartilage extending below the auricle and a compressive bandage applied. Subperichondrial abscess cured without deformity. Dr. H. KNAPP presented a girl of five years, having been under his care for the above affection. When first seen, January 22, 1903, the cartilaginous walls of the concha, including the crus and spine of the helix, were swollen and bluish, under the spine fluctuating. The calibre of the ear canal was narrowed, containing thin pus. The child had suffered from otorrhoea for a month; the palatal and pharyngeal tonsils were swollen. Dr. Knapp, making the diagnosis of a perichondritis consequent to the acute purulent otitis media, incised the posterior wall of the cavum conchæ and the lower wall of the spine of the helix. Thick pus escaped, not the thin, flocculent liquid seen in chronic perichondritis. Probing discovered an extensive abscess cavity, whose cartilaginous wall was smooth and firm, extending to the osseous portion of the ear canal. Using the probe as a director, he split the postero-inferior meatal wall in its whole length, and scraped the cartilaginous wall with a small sharp spoon, in order to leave no degenerated parts in the wound. The cavity was carefully wiped, and then packed with sterilized gauze. The ear canal and tympanic cavity were thoroughly wiped with absorbent cotton, the ear bandaged, and the patient kept in the hospital until the next afternoon. There being neither pain nor discharge and the tampon being dry, the patient was sent home without changing the dressing. Four days later she came again: no pain, no discharge, the tampon, though soaked with dried secretion, perfectly inodorous, and the ear free from secretion and pain; the dressing was left in place, and the patient sent home again. In a week she returned, and as all signs of inflammation had disappeared the tampon was removed; this was done without pain or blood, the wound being dry, as if it had been exposed to the air for a week. Two weeks ago, that is, about six weeks after the operation, I examined her again. The auricle was healthy and in good shape. The ear canal was normal, the membrana tympani entire, somewhat dull, the hearing good. Dr. Knapp said that this case had given him great satisfaction. He has considered the affection one of perichondritic abscess induced, as in most cases, by purulent otitis media and furuncles. The bluish, lustrous swelling was the same as in the degenerative perichondritis, which runs such a protracted course and leaves so hideous a deformity. He is inclined to believe that this calamity was spared his little patient by the early exposure, cleansing, and sterilizing the whole diseased area. Discussion.-Dr. LEDERMAN spoke of a case of perichondritis coming on after frost-bite. Considerable of the cartilage was found diseased. Incision was made on both sides and a strip of iodoform gauze was passed through the auricle. The case healed completely, without deformity. Dr. W. H. HASKIN presented a case in which iodoform poisoning had complicated the healing of a mastoid wound. The patient, a child of four, had had two simple mastoid operations performed. During the after-treatment of the second one, meningeal symptoms were very well marked. The child recovered and later suffered from a reinfection of the mastoid, necessitating another operation. The mastoid process was curetted and granulations were removed from the middle ear. The subsequent course was unusual, inasmuch as fever arose two weeks after the operation and persisted for a number of days without anything to account for it in the wound. The doctor was about to operate again, when, instead of iodoform gauze being used in the dressing, plain gauze was applied-with the result that on the following day temperature had fallen to normal. Dr. LEDERMAN inquired whether the urine had been examined for iodine. Answer, "No." Dr. HASKIN said that he had endeavored to ascertain whether the meningeal symptoms after the second operation could possibly have been explained by the susceptibility of the child to iodoform. Dr. HARMON BROWN replied that he had had the child in charge and that plain gauze had been used. The next case presented was a natural exenteration of the middle-ear cavities. Dr. DUEL presented this patient for Dr. BERENS: A young woman who had suffered for ten years from otorrhoea. She had visited the Manhattan Hospital on account of the loss of hearing. On examination, a defect was found in the posterior bony wall, and the middle ear, attic, and antrum were perfectly exposed without any ossicles, just as if a perfect radical operation had been performed. Discussion.-Dr. HASKIN had recently removed some granulations in a suppurating ear and had then found the outer wall of the attic defective, exposing the ossicles in position. Dr. DENCH recollected two cases where nature had exposed the bodies of the ossicles and where the articulations were distinctly visible. Dr. JOHN GUTMAN presented a patient who had been operated on for a large epidural abscess after acute otitis media. At the beginning paracentesis did not relieve the symptoms. The headache, rigidity of head, and tenderness along the posterior mastoid margin, with a temperature of 103°, persisted. Operation was urged but refused by the relatives until the condition of the patient had become very much worse. At operation, the entire mastoid process was found disintegrated. A fistula led back to a large epidural collection, exposing the dura of the cerebellar fossa. This dura was covered with granulations, which were removed. The sinus could not be recognized, and it is supposed that it became obliterated by the purulent process. The girl made an uninterrupted recovery. Dr. LEDERMAN presented a case of microtia. A child two and one half years old, microcephalic and deformed head. Both auricles are rudimentary; there are no auditory canals. The child apparently hears. Dr. Lederman asked the opinion of the Section as to whether anything should be done for cosmetic purposes, and at what time, as in these patients the canal is usually absent and the middle ear is defective in its anatomical construction though the labyrith may be intact. A brief consideration of the prognosis in chronic suppurative otitis, based on the results of a year's treatment in such cases. By THOMAS J. HARRIS, M.D. Dr. HARRIS placed the following questions: 1. What is the future as regards the cure of the patient suffering from chronic discharge of the ear? 2. What chances has he for the relief of his symptoms along conservative lines of treatment, and what risk is he running of sooner or later suffering from fatal complications? Dr. Harris has examined the suppurative cases for a period of eighteen months, in the service of Dr. Phillips at the Manhattan Eye and Ear Hospital. These cases have all been recently re-examined. Of over 100 cases observed, 50 attended regularly. All minor operations, principally for adenoids, extraction of polypi, and granulation tissue were first performed. Then medicinal treatment was begun. The total number of cases treated was 66. Forty of these were discharged cured at the end of from one to six months, 15 greatly improved, 11 not improved. Of the 40 cases reported cured, 5 were cases of acute exacerbation and are not included. Of the 35, subsequent examination at the end of the year was made in 20, of which there were 2 cases of relapse. Of the 11 cases not improved, the radical operation had been advised and refused in 4. In 88% improvement or a cure was secured. The cured and improved cases were treated by various medicines, including hydrogen dioxide, formalin, boric acid with alcohol. A weak formalin solution, ten to twenty drops to a quart of hot water, has served well in the irrigating of the ears. The syringing was followed by instillation of hydrogen dioxide in full strength. The danger in the use of the latter remedy is not recognized by the writer. The treatment was concluded by thorough dry cleansing, which was repeated two or three times a day. In cases of slight secretion, the dry treatment was employed and the instillation of the boric acid in alcohol drops. In the presence of a greater amount of granulation tissue, in addition to curetting, chromic acid and nitrate of silver were employed. The nose and throat were treated, and in children the general health was improved by tonics. The writer believes that this form of treatment should be persisted in for weeks or months, and that the usual time of two to three weeks is altogether too short. The average time of treatment for the cases which he reported was from two to three months. If after this time the discharge is not controlled the question of operation comes up. The writer thinks that a conservative note should be struck in the present era of aural surgery, and that the protecting wall of nature is amply sufficient. He does not think that a slight otorrhoea without other symptoms is sufficient to demand it. The writer draws attention to the comparatively large percentage of patients whose hearing is impaired after the radical operation. He also cites two fatal cases occurring in the practice of aural surgeons during the past year. The complete cessation of the discharge is not always assured. Facial paralysis is becoming alarmingly frequent; though it generally clears up, it is nevertheless very disagreeable and may occasionally be permanent. A lasting cure is not always obtained; a healed cavity may subsequently become reinfected. The importance of operation in presence of intracranial complications, of course, is not to be doubted by any one; at the same time, that chronic otorrhoea per se without other symptoms is an indication for a radical operation is open to question, and to regard every case of suppuration as "a slumbering volcano or a charge of dynamite," is extreme. The exceedingly small proportion of autopsies where death has been due to an intracranial otitic lesion makes this point clear. Again, it must not be forgotten that loss of hearing does not infrequently follow operation, as recent statistics have shown. Comparing the relative proportions of cures from ossiculectomy to those obtained by radical operation, the results of the two methods seem to be about the same, while the interference with hearing has been very much less in the former than in the latter procedure. Conclusions.-1. Chronic otorrhoea in a large percentage of cases is amenable to suitable medicinal treatment. 2. In addition to proper attention to disease of a general character and to the naso-pharynx, peroxide of hydrogen, with or |