regions supervened. During the year infiltration of the tissues of the face on the left side appeared. M. TOEPLITZ.

SOFT PALATE AND PHARYNX.

315. Hubbard, Thomas. Scarlatinous perforations of the pillars of the fauces. The Laryngoscope, Oct., 1902.

316. Broeckaert, J. New contributions to the study of acquired and congenital perforations of the palatal vault. La presse oto-laryngologique Belge, 1902, No. 9.

317. Macaud. A case of paralysis of the soft palate. Ann. des mal, de l'or., du lar., etc., 1902, No. 10.

318. Voisin. Partial paralysis of the soft palate, of traumatic origin. Ann, des mal. de l'or., du lar., etc., 1902, No. 8.

319. Ritter, S. A contribution to the pathological anatomy of the faucial tonsils. Arch. f. Laryng., vol. xiii.

320.

Poliewktow, A. On the treatment of scarlatinous angina with injections of carbolic acid. Medicinskoje Obosvenje, 1902, No. 10.

321. Richardson, C. W. Keratosis of the pharynx. Am. Jour. Med. Science, Oct., 1902.

322. Galler, P. Pharyngeal ulcers due to malaria. Russkÿ Wratsch, 1902, No. 41.

323. Tschlenow, M. On lichen planus of the mucous membrane. Medicinskoje Obosvenje, 1902, No. 15.

324. Hanssel, F. Congenital pharyngeal polyp. Wiener klin. Wochenschr., 1902, No. 50.

325. Zwillinger, H. A clinical and histological study of the diagnosis of certain forms of epipharyngeal sarcomas. Wiener med. Wochenschr., 1902,

Nos. 42, 43.

326. Winslow, R. Accessory thyroid tumor of the base of the tongue. Amer. Medicine, Dec. 12, 1902.

327. Ferran and Rosenthal.

Contributions to the study of hypertrophy of the lingual tonsil. Lyon médical, 1902, No. 34.

328. McCaw, J. F. Primary epithelioma of the uvula and soft palate, and treatment with Roentgen rays. N. Y. Med. Jour., Aug. 9, 1902.

329. Shurly, E. L. Tumor of the pharynx; an accessory thyroid gland, Removal followed by myxedema. Phila. Med. Jour., Sept., 1902.

330. Seligmann, C. G. Endotheliomata of the soft palate. Brit. Med. Four., May 3, 1902.

331. Root, Arthur G. A case of sarcoma of the tonsil. N. Y. Med. Jour., April 12, 1902.

332. Thorne, J. M. Notching the soft palate for cure of postnasal obstruction in adults. Brit. Med. Jour., April 19, 1902.

315. In cases of scarlatinous, streptococcal angina with deepseated peritonsillar abscess, perforation of the faucial pillars occurs, which may become permanent, leaving a blind pouch. These lesions, formerly considered as of congenital origin, are,

according to HUBBARD, the result of an abscess or necrosis, unless positively disproven. The importance of scar tissue is overestimated. Two cases, observed in children of four and two years of age respectively, are cited in full. The scarlatinous ulceration is usually bilateral. M. TOEPLITZ.

316. A young lady presented an oval perforation in the left anterior pillar of the soft palate, the result of a severe attack of scarlet fever with necrosing angina in her seventh year. Congenital defects occurring in the soft palate are, according to the author, an aplasia. BRANDT.

317. It is not quite certain whether this case is one of genuine paralysis after an attack of diphtheria six weeks preceding, or the mechanical immobilization by an inflamed and enlarged pharyngeal tonsil. The latter opinion seemed to be the correct one, as the soft palate returned to its normal condition after the removal of the pharyngeal tonsil. ZIMMERMANN.

318. In this patient a typical paralysis of the soft palate had existed for a month after an onset with pain in the neck and chills. The author is inclined to regard this not as the result of diphtheritic infection, but thinks the paralysis is due to the resection of the lingual branch of the facial during the incision practised by the physician. ZIMMERMANN.

319. Two photographic illustrations of faucial tonsils in which retention cysts (abscesses) are visible. ZARNIKO.

320. (1) Injections with carbolic acid should be undertaken as soon as the character of the infection is diagnosticated; in other words, usually on the second day of the disease. (2) In the moderate cases, the injections should be repeated every day for four or five days until the temperature drops. (3) In severe cases of scarlatinous diphtheria and swelling of the lymph glands, the injections should be practised for seven or eight days,-fourteen to sixteen injections,-during which time the urine should be carefully examined. (4) The dose for small children is 0.015 pure carbolic acid up to 0.03 per day; grown children (six to eight years) twice as much. SACHER.

321. The histological changes in the epithelial structures prove a keratosis of the faucial and pharyngeal mucous membrane in the condition commonly known as pharyngomycosis. The changes begin in the subepithelial structures, and are identical in the naso-pharynx, pharynx, or fauces. Leptothrix is not a

constant factor, most frequently found on tufts in the fauces, more rarely in the pharynx, never in the naso-pharynx. It is an accidental deposit and has no causative relation to structural changes. There is a condition in the pharynx, occurring in the very young and the aged,—a true mycosis; true keratosis occurs in middle life. M. TOEPLITZ.

322. A patient, forty-five years of age, suffered since 1898 with malaria. In May, 1901, five small erosions were noticed on the posterior and lateral pharyngeal wall, which greatly enlarged and formed an ulcer 3cm by 14cm. The ulcer was quite deep; the margins were thickened; it was partly situated in the posterior and partly in the right lateral wall of the pharynx. The disturbance in swallowing was so great that even fluid could not be taken without great discomfort; there was marked anæmia; there were no signs of syphilis or tuberculosis; specific and local treatment was resorted to. Microscopic examination did not disclose any signs of cancer. Quinine and arsenic were given internally. Quinine subcutaneously by enemas and stomach-tube saved the patient's life. The ulcer healed in a short time.

SACHER.

323. Lichen planus occurs most frequently in the buccal mucous membrane. It usually begins just as the disease of the external skin, though sometimes precedes the latter and may be isolated. It usually develops after the appearance of a disease of the skin. The clinical picture is so characteristic, that its diagnosis does not present difficulty. The pathological anatomy of the disease has not been determined; its etiology and pathogeny are not clear. Prognosis in general is favorable. Its treatment consists in the proper and energetic use of arsenic.

SACHER.

324. On examining the pharynx on the left side, a tumor as large as the small finger was noticed. In addition to that, the left posterior palatal arch was missing. The tumor is shiny and of deep red color; at one point, bluish red; it is hard to the touch. The attachment is lateral, directly underneath the orifice of the Eustachian tube. Histologically, the typical structure of a dermoid tumor was shown. WANNER.

325. In order to clarify the difficulties connected with the differential diagnosis between certain forms of sarcoma of the epipharynx and preceding hyperplastic pharyngeal tonsils, the author has collected a number of cases out of the literature with the

histological picture of adenoid vegetation developed into lympho-sarcomas, and cites a case which originally presented an enormous hyperplasia of the lymph tissue of the naso-pharynx and rapidly recurred after removal. Death followed after a number of months.

Even histological examination of the tumor masses may be uncertain, unless it is possible to remove a part of the tissue from the limiting area.

Important from a differential diagnostic standpoint, the malignant tumors are characterized by a rapidity of growth, restriction of growth to one-half the naso-pharynx, development of the hard glandular swelling, tendency to hemorrhage, suppuration of the soft palate from the posterior pharyngeal wall, the hanging down of the tumor on one side, and especially the spontaneous breaking off of certain fragments. WANNER.

326. A girl, aged seventeen, had a growth in front of the epiglottis, which made the voice muffled and produced difficulty in swallowing. It was about half the size of a hen's egg and was enucleated from without through an incision made in the median line from the chin.

327. A short, explicit article on the etiology, symptoms, diagnosis, and treatment of hypertrophy of the lingual tonsil. The most important symptoms are the sensations of a foreign body, the tendency to swallow and clear the throat, dry attacks of coughing similar to hysterics, occasionally pain localized in the region of the lingual bone. If the symptoms are pronounced, radical treatment is indicated. The destruction of the tonsil with the galvano-cautery in a number of sittings at weekly intervals is recommended. RAU.

328. A woman, aged thirty-seven, had three small ulcers on the soft palate, which, after 6 months, enlarged and filled the throat with a hard mass involving the uvula, velum palati, each posterior faucial pillar, the right lateral and a portion of the posterior wall of the pharynx on the right side; it had an irregular, nodulated outline and an ulcerated and necrotic surface, and proved microscopically to be an epithelioma. The growth was removed as freely as possible with curette and electro-cautery knife. After two weeks the wound, when beginning to cicatrize, was subjected to the application of the Roentgen rays, protecting the mouth, tongue, lower part of face and neck by sheets of block tin, and the upper part of the face by heavy tinfoil. The

exposures were made three times a week for seven weeks, when only one small area as large as a split pea remained unhealed. After an interruption of this treatment for three weeks, marked increase in the area of ulceration and infiltration of the velum and right lateral and posterior pharyngeal walls took place, which necessitated another removal of the growth with curette and cautery. Microscopically there was now found, in addition, a very rapid colloid degeneration of the epithelial cells replacing the protoplasma.

M. TOEPLITZ.

329. In a girl, æt. sixteen, the laryngoscope revealed a darkred, globular, smooth, broadly pedunculated tumor, about the size of a small hen's egg, attached well down at the very base of the tongue, a little to the right of the median line, and in juxtaposition to the epiglottis, but not infringing much upon it. It was diagnosed as adenoma, owing to the history of progressive increase of subjective symptoms, such as a desire to swallow, difficulty of deglutition, extra secretion of mucus, and frequent expectoration, with apparently good general condition. The removal of the growth with the snare was followed by considerable bleeding, and marked signs of myxedema developed later, which were eliminated by thyroid extract. A full survey of the literature on the subject is given.

M. TOEPLITZ.

330. SELIGMANN, at a meeting of the Pathological Society of London, held on April 29, 1902, drew attention to two tumors of the soft palate, which he regarded as endotheliomata. They occurred in patients, aged fifty-six and forty-three years respectively. In neither of them were there any enlarged glands or other signs of metastasis. ARTHUR CHEATLE.

331. ROOT's patient, a man, aged twenty-three, began his illness with an ordinary cold and a persistent cough, painful deglutition, swelling of the left tonsil, with abscess formation and hemorrhage from it. The swelling pressed the anterior pillar forward and upward, extending downward below. The margin of the epiglottis was hard, of irregular surface, injected without ulceration, with large firmly attached base and of boggy consistence. The left cervical glands were involved. It was operated from without with ligation of the common carotid twice within six days. Relapse took place after five months, and death three weeks later. The tumor was a short spindle-celled sarcoma. M. TOEPLITZ.