carefully removed. Healing and complete cicatrization followed in about five weeks. About the end of a year there was a recurrence of the disease, which was promptly removed as before. Symptoms of erysipelas developed the following day which in no way interfered with the favorable granulating process of the wound. The case was discharged one week after the operation. CLEMENS. 187. Examination with the continuous-tone scale gave, in the first case, complete deafness on the deformed ear. In the second case, the organ-tones from a2-f5 are distinctly heard; the tones h-a very indistinct; speech is heard by the right ear, after carefully closing the left (with a moistened finger), somewhat imperfectly and only with a very loud voice. In the third case, a child of three months, the hearing appears to be present. BRÜHL. 188. The author defends the treatment of furuncles of the external auditory canal with the pressure packing which he described in Monats. f. Ohrenheilk., 1899, No. 2, against the unfavorable criticism of Grosskopf in his monograph "Inflammations of the External Auditory Canal" (Haug's klin. Vorträge, vol. iv., No. 6). PIFFL. 189. The best results, according to the author, are furnished by instillations of 95 per cent. alcohol with 4 per cent. boric acid and 2 per cent. cocaine in the presence of very severe pain. After the instillation the ear is occluded with cotton; the pain rapidly diminishes. SACHER. 190. A croupous otitis. Dressing was stained light blue. Bacteriological examination: bacillus pyocyaneus was cultivated in pure culture. BRÜHL. 191. A patient, twenty-seven years old, with hereditary tuberculosis. A polyp was removed from the outer canal and a round ulceration was found at the posterior and superior bony canal wall. It healed, and shortly after another ulcer formed in the cartilaginous canal. The pus contained tubercle bacilli, RIMINI. 192. Of 3332 patients there were 72 cases of foreign bodies, of which 52 occurred in the ear, 11 in the nose, 6 in the mouth, I in the pharynx, and 2 in the larynx. A case of a fly in the vallecula and a case of complete aphonia produced by inspissated cerumen are interesting. After removing the cerumen the aphonia disappeared. SACHER. 193. A little girl, two and a half years old, was taken ill with a double-sided epidemic parotitis, with the development of an abscess which perforated into the external canal. After an extensive incision and removal of the necrotic glandular tissue, fever and pain disappeared. Four days later temperature rose suddenly and death ensued from meningitis. According to the author, this case is remarkable, in addition to the rare termination of epidemic parotitis in the formation of an abscess, in involvement of the meninges, which must have resulted metastatically, as the middle ear and labyrinth were intact. RIMINI. 194. The author cites the cases of Bezold, Mariani, and Schäfer, and reports on two personal observations of destruction of the drum-in one case from steam, the other by fluid iron. In the latter case, the drum was not directly injured by the melted metal, as no iron was found in the canal, but through the production of steam. The characteristic condition is the unusually decided loss of hearing at the beginning. In most cases a whisper can only be heard near the ear. The simultaneous affection of the labyrinth is probably produced by hyperæmia following the great heat, and thus the permanent damage to the hearing followed hemorrhages which had taken place in the labyrinth. NOLTENIUS. MIDDLE EAR. a.-ACUTE OTITIS MEDIA. 195. Schilling, R. On the presence of the pseudodiphtheria bacillus in acute otitis media. Monatsbl. f. Ohrenheilk., 1902, No. 10. 196. Ferreri, Gherardo. On purulent otitis media in ozæna. Archivio ital. di otol., vol. xiii., No. 3. 197. Schröder, W. Two cases of severe acute otitis media after taking snuff. Münch. med. Wochenschr., 1902, No. 47. 198. Kühnlein, J. On the etiology of acute otitis media. Monatsbl. f. Ohrenheilk., 1902, No. 11. 199. Sendziak, S. On the favorable action of erysipelas upon the course of severe, acute purulent otitis. Monatsbl, f. Ohrenheilk., 1901, No. 12. 200. Halsted, T. H. The early diagnosis and treatment of acute mastoid inflammation. Philadelphia Medical Journal, Aug. 2, 1902. 201. Cheval, V. A case of Bezold's mastoiditis. logique Belge, 1902, No. 10. La presse otolaryngo 202. Moure. Treatment of acute purulent otitis. Ann. des mal, de l'or., du lar., etc., 1902, No. 7. 203. Mahu. Combined prolapse of the sinus and of the dura mater, making a mastoid trephining impossible. Ann. des mal. de l'or., du lar., etc., 1902, 10. 195. The bacteriological examination of fibrinous membranes which were cast off and freshly formed during the acute otitis media, showed the presence of pseudodiphtheria bacillus, which can produce diphtheritic membranes as well as the true diphtheria bacillus. BRÜHL. 196. The author attempts to show that a particular form of purulent otitis media can be produced by ozæna, characterized by an obstinate course and uncontrolled by treatment. In seven of these cases the bacillus mucosus ozænæ was found present. RIMINI. 197. The middle-ear disease followed the taking of snuff in four and in three weeks, respectively. In the second case, both ears were diseased, though perforation took place only in one. SCHEIBE. 198. In support of his view that bathing is of little influence in producing acute otitis, the author has examined the histories of the patients in Gerber's Dispensary, and has come to the wellknown conclusion that this disease occurs most frequently in winter and in spring and most rarely in the summer. PIFFL. 199. The author reports a case of acute otitis in a man fifty years old, with tenderness of the mastoid process, which, after existing for five weeks, healed during the course of facial erysipelas. PIFFL. 200. HALSTED believes that in every case of suppuration of the middle ear the mastoid is involved. Thirty children, dying from various complications of measles, were autopsied with special reference to their ears, and every single case showed pus in the mastoid, while during life in the majority of the cases the ears were not thought to be involved and many were not even examined. CLEMENS. 201. A case of this character is described, which recovered after three operations. The author is inclined to operate early, to prevent cerebral complications and to preserve a better function of the ear. BRANDT. 202. The author agrees with Zaufal that, even in the presence of suppuration in the tympanum, a paracentesis is not absolutely indicated; the naso-pharynx should be carefully treated, carbolic-acid glycerine instilled, and revulsive measures should be adopted. If the fever and pain persist, paracentesis should be done in the anterior and lower quadrant. After operation, irrigation with hot boric-acid solution should be repeated several times each day, and the ear should be bandaged. Ear inflation and irrigation from the tube are contra-indicated. ZIMMERMANN. 203. In operating upon a mastoiditis after acute otitis and beginning at the typical location underneath the linea temporalis, cm behind the meatus, the sinus and dura were exposed within cm. Eighty-six temporal bones were examined and one analogous case found. ZIMMERMANN. b. CHRONIC PURULENT OTITIS. 204. Geronzi. Formalin in the treatment of chronic otorrhoea. Archivio ital. di otol., vol. xiv., No. I. 205. Ehrenfried. A particular method of treating chronic otorrhoea, with a list of the medical agents employed. Deutsche med. Wochenschr., No. 52, 1902. 206. Dench, E. B. Various operative procedures for the relief of chronic suppurative otitis media, and their comparative value. American Journal of Medical Sciences, Nov., 1902. 207. Jaumenne. The radical cure of otorrhoea in Jansen's clinic in Berlin. La presse otolaryngologique Belge, 1902, No. 10. 208. Frey, Hugo. The closure of the retro-auricular opening by subcutaneous injection of paraffin. Arch. f. Ohrenheilk., vol. lvi., p. 289. 209. Buhe, E. The influence of the radical operation on the hearing. Arch. f. Ohrenheilk., vol. lvi., p. 223. 210. Citelli, S. Stapedectomy in a patient suffering from chronic purulent otitis. Archivio ital. di otol., vol. xiv., No. 1. 211. Resser, M. Obosrenje, 1902, No. 8. 212. Reinhard, P. the base of the skull. On cholesteatoma of the middle ear. Medicinskoje A case of chronic otorrhoea complicated by fracture of Monatsbl. f. Ohrenheilk., 1901, No. 9. 204. The action of formalin in 55 cases of chronic otorrhoea is described. To relieve its irritating action, a solution in glycerine was used-2 %, 5 %, up to 10 %. In a very short time after its use the fetor disappeared, and the granulations in the middle ear seemed to be very favorably acted upon. In the author's experience a 5% solution of formalin in glycerine, with the addition of a 5% solution of sodium carbonate, is best borne by the patient. RIMINI. 205. This method consists of instilling dissolving fluids in the ear and through the perforated drum into the middle ear and accessory cavities. Then, with a pipet inserted air-tight in the canal, aspirating and pressure movements are performed to facilitate the removal of the dissolved masses of pus. The treatment is more efficacious if the pipet is connected with a small pump, or with the water pipes so that a continuous suction is obtained. NOLTENIUS 206. This paper deals with those cases in which the suppuration is of long standing and has not yielded to the ordinary measures usually employed for its relief. DENCH believes that no matter how virulent the primary affection is, if the case is seen early in the acute stage serious intratympanic caries can be prevented; the only exception he makes to this general rule being early involvement of the mastoid cells, following acute inflammation within the ear and tubercular infection of the intratympanic structures. The various operative methods employed for the cure of chronic suppuration are presented in detail; the writer's experience and that of others for these operations being reviewed thoroughly. A choice of any particular method must depend upon the extent to which the bony structures are involved. While in former years the writer depended upon simple operative measures, later experience has led him to believe that conservative surgery in this region is a mistake. Accepting that the simple operation of ossiculectomy is indicated in a certain proportion of cases, it will become more and more restricted as the experience of the surgeon becomes wider. In speaking of accidents during the course of a radical operation, wounding the facial nerve can always be avoided if the rule of removal of the posterior wall of the canal until the horizontal semicircular canal is seen, be uniformly followed. As to the results of the radical operation on the function of audition, Dench says: "The surgeon is not warranted in promising the patient that the hearing will be as good after the operation as it was before, unless at the time of the operation the power of audition is greatly diminished in the affected ear." However, the question is not so much the preservation or improvement of audition as the removal of a serious menace to life. CLEMENS. 207. The indications for the radical operation, and the method of operating, as practised at Jansen's clinic, are described. BRANDT. 208. The author recommends subcutaneous injection of paraffin to close the retro-auricular openings in those cases where the |