for four or five weeks without any other marked symptom, and at operation he was surprised at the unusual amount of caries encountered.

Dr. CLEMENS inquired whether in Dr. Friedenberg's case the mastoid pain had previously existed." It had existed in the beginning, but not at the present time." He thought that the pain in the mastoid process originated whenever the process extended to the periosteum or the meninges. Hence he thought that in a case of central disease the otorrhoea could persist without any pain in the mastoid process. He reported that the first case of this character which he had seen was very similar to the condition described by Dr. Sheppard. The outer layer of the mastoid was thin but healthy, while the entire interior was disorganized.

Dr. CLEMENS reported a case of double mastoiditis, where there were some mastoid tenderness and bulging drums, with profuse otorrhoea. After three weeks both mastoid processes were operated upon and were found completely destroyed.

Dr. SHEPPARD had observed a case of mastoiditis in a patient whom he had first treated for eczema of the canal.

Dr. FRIEDENBERG said that he had operated upon a patient according to the radical method for chronic otorrhoea two weeks ago. The facial spur showed no tendency to granulate. He desired the opinion of the Society as to the advisability of skin grafting.

Dr. DENCH said that he had been practising skin grafting frequently of late, and had been very well satisfied with his success after primary grafts. He said that Mr. Ballance was now also practising primary skin grafting, and that he made it a practice to remove his gauze packing on the third or fourth day, so as to remove the superficial layer of the graft. He thought that he thereby obtained healing more promptly. Dr. Dench seemed to think that the graft when applied directly to the bone took in most cases. As a dressing, he now employed pledgets of cotton, which were removed in eight days.

Dr. LEWIS said that he also had been practising skin grafting of late, and had at first been very much disappointed in the apparent sloughing of the skin graft, but found that it was only the superficial surface which sloughed, and that the process of healing was uninterrupted and the duration was very much shortened.

Dr. Lewis spoke of the propriety of removing adenoids during acute otitis, and reported the case of a child between two and three years of age who had suffered from otitis for five weeks.

There was a profuse discharge due to streptococcus and pneumococcus infection. The membrana tympani was bulging, notwithstanding that paracentesis had been made three times. The supero-posterior canal wall was bulging. There was no mastoid tenderness. Temperature was 100.4°. He wished to know the opinion of the Society as to whether, under these conditions, it would be proper to remove the adenoids now or wait, or whether it would not be better to open the mastoid cells.

Discussion. Dr. QUINLAN said that the same question had been brought up some years ago at an otological meeting, and he thought it was a very important one. He remembered having seen three cases where the ear condition had been made worse by the removal of the adenoids, and the mastoiditis seemed to have been augmented. He thought it wiser to wait until the acute symptoms had subsided.

Dr. DUEL said that in his experience the early removal of adenoids had given him only good results, and that he was in the habit of removing the tonsils and adenoids when doing the paracentesis.

Dr. FRIEDENBERG reported a case of otitis of four weeks' standing with muco-purulent discharge. This would cease, and at the end of five or six days there would be a fresh onset. He purposed removing the adenoids and performing a large section of the drum membrane.

Dr. DUEL stated further, that in mastoiditis it was his practice to remove the adenoids and tonsils at the same time with the mastoid operation. He had seen only good results come of this practice.

Dr. GRUENING had recently seen a small boy with a temperature of 103°. The mastoid was involved and adenoids were present. He thought that ordinarily the adenoids could be removed at a later time, and not in the presence of fever or any threatening complication.

Dr. DENCH would not operate for the removal of adenoids while fever lasted.

Dr. TOEPLITZ had seen a child of three years with otorrhoea where the adenoids had been removed. Temperature rose to 103° and remained high for four days. It then came down and the otorrhoea ceased.

Dr. GRUENING did not think that the adenoids had anything to do with the mastoiditis.

Dr. QUINLAN thought that as the adenoids were known to be a source of many of the ear infections, it would be better to remove them in a large percentage of cases.

Dr. SHEPPARD removed the adenoids in a patient while there was an epidemic of grippe in the house. The patient contracted pneumonia and died. The operation had been held responsible for the fatal result, and he was against operating during complications.

Dr. FRIEDENBERG thought that a feature not to be forgotten was, that as loss of blood is badly borne by children, the adenoid operation should not be performed if the mastoid operation has been severe.

Dr. DENCH reported a case of catalepsy occurring in otitic meningitis. Two weeks ago he operated at the Infirmary for acute otitis with mastoid involvement. Paracentesis was performed; temperature relieved. Later the mastoid tip became. very tender. At operation the antrum was found normal, the tip involved. A perforation was present inwards toward the digastric fossa and posteriorly into the cerebellar fossa, producing an epidural abscess. The sinus was exposed, found thrombosed; the internal jugular was resected. For six days the patient did well, then he became apathetic, with slow pulse, double optic neuritis, and catalepsy.

Dr. DENCH thought that he had to deal either with a cerebellar abscess or with meningitis. The cerebellum was exposed and the fourth ventricle was accidentally tapped. The patient before the last operation developed a very marked form of catalepsy. This was less marked after the intracranial pressure was relieved.

Dr. McKERNON spoke of a woman of forty-one upon whom he had operated for chronic otorrhoea by the Stacke method. She did perfectly well for six days, and then suddenly developed a double facial paralysis and had difficulty in swallowing. The reaction with the electric battery was normal, and the Doctor thought the condition due to hysteria and gave a good prognosis. Paralysis on the right side cleared up after thirty-six hours, and on the left side after seventy hours.

REPORT ON THE PROGRESS OF OTOLOGY FOR THE THIRD AND FOURTH QUARTERS OF THE YEAR 1902.

BY DR. A. HARTMANN, BERLIN.

Translated by Dr. ARNOLD KNAPP.

ANATOMY OF THE EAR.

152. Alexander, C. On the pathologic histology of the aural labyrinth, with special regard to the organ of Corti. A. f. O., vol. lvi., p. 1.

152. The patient was a laborer, sixty-six years old. He died from carcinoma of the tongue. During the last two years he had become progressively deaf. The day before his death his hearing was found to be and. Microscopic examination revealed a normal external and middle ear and marked atrophy of the organ of Corti, mucoid degeneration of the spiral ligament, and atrophy of the spiral ganglion of the cochlear nerve-in short, an affection of the membranous cochlea and of the cochlear nerve, without involvement of the rest of the labyrinth, and with intact labyrinthine windows. Three stages of atrophy were determined in the organ of Corti: first, circumscribed disappearance of the sensory epithelium in normal surroundings; second, defect of the sensory epithelium, with associated increase of the supporting cells; third, complete atrophy of the bacillary papilla. In place of the atrophied sensory and supporting cells, there was squamous epithelium.

The etiology was supposed to be marked arterio-sclerosis and, possibly, a cancerous cachexia.

HAENEL.

PHYSIOLOGY OF THE EAR.

153. Frey, H. Experimental study on the transmission of sound in the skull. Zeitschr. f. Psych, u. Phys. der Sinnesorgane, vol. xxviii,, p. 9.

154. Meyers, C.

On the pitch of Galton whistles.

vol. xxviii., p. 417.

Journ. of Phys.,

155. Hammerschlag, V. The location of the reflex centre for the tensor tympani muscle. A. f. O., vol. lvi., p. 157.

156. Zimmermann, G. On the mechanism of hearing. Münch. med. Wochenschr., 1902, No. 50.

153. The question as to the way by which the sound waves reach the labyrinth is still quite unsettled; we know very little regarding the transmission of sound waves in bone. The author has endeavored to study this subject, and especially to investigate the sound conduction in bone. He puts the following questions: (1) In what way is the sound transmitted in human bone, and what influence has the structure of the bony tissue on this process? (2) How does the macerated bone compare with the flesh in this particular?

(3) How are the sound waves transmitted in the cranial bones? To what extent does this occur, and in what way?

(4) What differences are there in these phenomena in the macerated and in the fresh specimens?

The important part of the apparatus is the microphone. By the aid of this, in a series of investigations the kind of transmission was studied on a macerated and then on a fresh thigh bone. It was shown that the important factor for the transmitting ability in a bone depended upon its density and in the relative position of its bony parts. The compact bone, as a rule, transmits better than the spongy, with the exception of those bones where the spongiosa is of a firm density and where the compact portion has a very small diameter. This condition holds equally for the dry,

macerated as for the fresh, moist bone.

The author then studied the transmission of sound in the head by means of a macerated skull and a fresh skull containing brain and all the soft parts. A tuning-fork was introduced in the auditory canal and adjusted to the promontory. The following results were obtained:

First. The direction which sound waves take upon reaching the head depends principally upon the distribution of the bony substances, in regard to its density.

Second-The sound waves emanating from the auditory canal of one side spread over the whole skull, especially to the symmetrical points of the other cranial half-in other words, to the opposite pyramid.