As to instrumentation, he did not believe that any operation without an anesthetic could always be done thoroughly, no matter what instrument should be used. He had seen Dr. Gradle's instrument some years ago in Chicago. It seemed to present some strong points. The Brandegee forceps, however, had proved so successful in his hands, together with the Gottstein curette, that he should be loath to use any other. With these instruments a complete operation could be accomplished (under an anæsthetic) in a few seconds. The temperature, of course, should be taken before the operation. Dr. C. E. MUNGER had used Dr. Gradle's instruments for the past two years, and had operated with them one hundred and eighty-five times on adults and small children. He thought they brought out adenoids in their entirety as did no other instrument. The instrument, as made at present, broke easily when sterilized under steam, and should be made stronger. It was used more easily on adults, who co-operated with the operator. Dr. D. J. McDONALD said that for five years he had given bromid of ethyl as an anesthetic in adenoid operations over seven hundred times without a death. It was not necessary to have an expert anæsthetizer. An operation could be done in forty seconds under bromid of ethyl. Dr. BRANDEGEE asked Dr. Gradle whether it was his rule to rely solely upon the instrument shown, without Gottstein's curette, or other instrument. Dr. GRADLE, in closing the discussion of his paper, said, in response to Dr. Brandegee's question as to the use of Gottstein's curette, that he had practically ceased using it since he relied upon the instrument shown. He had formerly used it, but as by the use of his instrument adenoids could be removed in their entirety he did not consider further procedure necessary. As to congenital condition, he had not seen it except in very young babies. He had watched the mode of production, and found it to be, distinctly, a form of inflammatory hypertrophy. This had led him to infer that it could not have been congenital or it would have had a different etiology, as a coryza could not occur before birth, but could within the first few weeks of life. In babies under eight months old, he used a small Hartmann curette for diagnostic purposes, doing what was necessary at the same time. In children one or two years old, he used his own smallest pattern. He considered removal by forceps a cruel operation. Older children had told him that his operation gave them very little pain when cocain had been used freely. He knew of no reliable statistics as to ethyl or bromid of ethyl. Hinkle found eighteen deaths in American and English literature, 1892-1898, a proportion appallingly large. As to hemorrhage, he had discovered that it came from tags. By the use of his instrument, no tags were left, consequently no hemorrhages occurred. He thought the use of the thermometer wise, but operated under disturbance of temperature rather than defer operation until it became still higher. REPORT ON THE PROGRESS OF OTOLOGY DUR- BY DR. ARTHUR HARTMANN. Translated by Dr. ARNOLD KNAPP. (Continued from page 411.) GENERAL. a.-REPORTS AND GENERAL COMMUNICATIONS. 17. Schmiegelow. Reports from the oto-laryngological department of the St. Joseph's Hospital, 1902, Copenhagen. 18. Pick. Clinical contributions to otology. Wien, klin. Rundschau, 1902, No. 32. 19. New York Eye and Ear Infirmary. Eighty-second annual report for the year ending Sept. 30, 1902. Aural surgeons: Bacon, Dench, Adams, Whiting, McKernon, and Lewis, Jr. 20. Manhattan Eye and Ear Hospital. Thirty-third annual report for the year ending Sept. 30, 1902. Aural surgeons: Webster, Emerson, Lewis, Hepburn, Clemens, Phillips, Berens, Duel. 21. New York Ophthalmic and Aural Institute. Thirty-third annual report for the year ending Sept. 30, 1902. Aural surgeons: H. Knapp, A. Knapp, R. Jordan, J. A. Jackson, C. Mund, J. Wolff. 17. 163 patients were treated during the year. Of these, 7 died; 156 operations were performed, of which 20 were simple mastoid operations and 35 radical operations. A review of the treatment in middle-ear suppuration is added. In acute purulent otitis the patients are advised to stay in bed. Of the unusual cases, one is mentioned where the simple operation on the mastoid process revealed a large epidural abscess which had given no symptoms. Another case is described where a carious process in the mastoid continued, though the otitis media was cured. In chronic suppuration the simple operation was performed 12 times. In the other operations the radical operation was done. In 63% of the cases of the radical operation, complete healing took place. As regards the healing both before and after the radical operation, 17 cases are quoted, of which in 10 the hearing was improved after the operation, in 3 it was unchanged, and in 4 it was diminished. MÖLLER. 18. (1) A case of objective perceptible tinnitus due to chorea pharyngis. A noise was perceived with aid of the auscultation tube at irregular intervals up to 100 times a minute. The cause was chorea-like clonic contractions of the pharyngeal muscles, espeially of the soft palate and the Eustachian tubes. The disease is supposed to be the result of extensive changes in the nose and the naso-pharynx. (2) Spontaneous cure of a chronic purulent otitis media, as after the radical operation. Removal of a sequestrum with the forceps, representing almost the entire posterior bony auditory wall. (3) A cyst within the tympanum. A bluish-red soft tumor as large as a bean, in the tympanum. Puncture revealed a small quantity of slightly clouded, yellowish-brown, serous fluid, which contained cholestearin crystals, red blood corpuscles, and cells filled with fat granules. WANNER. 19. Number of ear patients, 10,235; throat patients, 9607; ear operations, 1674; paracentesis of membrana tympani, 490; ossiculectomy, 34; mastoidectomy, 219; Schwartze-Stacke, 37; cerebral abscess, 4; epidural abscess, 36; sigmoid sinus thrombosis, 6; thrombosis of internal jugular, 6; removal of granulations and polypi, 62. CLEMENS. 20. Number of ear patients, 4044; throat patients, 3460; ear operations, 1379; paracentesis of membrana tympani, 35; ossiculectomy, 6; mastoidectomy, 111; cerebral abscess, 2; thrombosis of lateral sinus, 2; thrombosis of internal jugular, 2; radical operation, 9; removal of granulations and polypi, 36. 21. CLEMENS. Number of ear patients, 3638; mastoidectomy, 33; radical operation, 23; ossiculectomy, 10; paracentesis, 149; aural polypi, 18; nasal polypi, 56; removal of adenoids, 710; ligation of internal jugular, 1. CLEMENS. 22. b. GENERAL PATHOLOGY AND SYMPTOMATOLOGY. Buhe. Two unusual anatomical conditions in the temporal bone : 1. after facial paralysis of thirty-five years' standing; 2. defect of the bulb of the jugular vein and of the sigmoid sinus. A. f. O., vol. lvii., p. 101. 23. Sugar. On otitis after measles, and its prophylactic treatment. Klinisch-therapeutische Wochenschrift, 1903, No. 1. 24. Stenger. On the value of otitic symptoms for the diagnosis of head injuries. Berl, klin. Wochenschr., 1903, No. 5. 25. Alexander and Reko. The province of the rhodan reaction of the saliva in ear diseases. Wiener Klin. Wochenschr., 1902, No. 42. 26. Alt. Disturbances of musical hearing. 1902, No. 30 and No. 31. Wiener klin. Wochenschrift, 27. Randall. Some notes on aural vertigo. Journal American Medical Association, February 28, 1903. 28. Amberg. A case of diplacusis monauralis. Journal American Medical Association, January 24, 1903. 22. (1) The specimen was that of a person thirty-five years of age who had suffered from a complete facial paralysis following a middle-ear suppuration when six months old. It is stated that during the suppuration small pieces of bone were frequently discharged from the ear. The main trunk of the facial nerve does not pass from the geniculate ganglion in its usual path peripherically, but passes directly through the tympanum filled in with porous bone, terminating in the external tympanic wall above and in front of the drum. A thin nerve passes on in the facial canal and joins below the second knee the peripheric main part of the nerve, which also terminates blindly in the bone a little above the junction. The bone fragments which were cast off had evidently produced a complete rupture of the facial nerve. (2) The sigmoid sinus as well as the sigmoid sulcus are absent from the very well developed mastoid emissary downwards, and including the bulb of the jugular vein. In place of the sinus, the dura mater is slightly thickened. The internal jugular vein, which is only one-quarter as broad as normal, can be followed to the apex of the petrous pyramid. The middle ear is intact. As there are no signs of any middle-ear suppuration, especially no scar formation in the region of the jugular vein, this case cannot be considered as the result of an old sinus thrombosis, but is principally a congenital deformity. HAENEL. 23. This is a compilation of what is known in literature on the otitis of measles. The author recommends as a prophylactic |