73. Cheatle. Report on the examination of one thousand school children between three and sixteen years of age, in the Hanwell District School, including the Ophthalmic School.

74. McMillan. Examination of hearing in the school children in Chicago. Medicine, Detroit, April, 1902.

75. Gutzmann. On the speech of the deaf. Deutsche med. Wochenschr., No. 18, 1902.

72. The female sex is more predisposed to catarrhal deafness than the male. In one-sided affections the right ear is affected earlier and more severely than the left in the female, while in the male it is the opposite. Paracentesis was performed about one hundred times in acute cases. If the Eustachian tube was open, operation was deferred till the pain became excessive and could not be relieved. Douches of very hot water acted favorably. In more than one hundred cases of mastoid inflammation the pain, redness, and swelling were relieved by this procedure.

CLEMENS.

73. The first school contains children from the poorest parts of London, the Ophthalmic School receives children with eye disease from all parts of London. Examination of hearing was made with the whispered voice at a distance of eighteen feet. The hearing power was more or less defective in 520 cases. In 432 children the ears were found normal. The external ear was found diseased in 49, the middle ear in 518, and the internal ear in one child. The various pathological processes were tabulated and discussed. Adenoids were present in 434 cases. In 174 cases they were associated with enlargement of one or both tonsils. In 394 of the cases of adenoids the ears were also affected; in 40 the ears were normal. HARTMANN.

74. Of 6729 children between the ages of six and eighteen years, 1080 (16%) were deaf in one or both ears. The examination was made by means of the audiometer, the construction of which is described. CLEMENS.

75. In this paper the author shows that the normal perception of speech takes place through three senses: the hearing, sight, and touch. If the hearing is partly or completely destroyed the other two senses step in and in a proportionate degree to the amount of deafness. Hence it becomes apparent that the totally deaf will learn lip reading much more rapidly and better than one who is only pronouncedly deaf. To show that these three senses are more or less associated the author cites the observation of

Goldammer, that children who have been born blind under the same circumstances generally learn to speak later than those who can see. While we employ the hearing and sight in an entirely conscious manner for the perception of speech, the condition of the sense organ is entirely different. GUTZMANN relates that most normally speaking persons are very little instructed as regards the movements of the tongue in speaking, and are not usually able on command to move the mouth and tongue up or down, to the right or left. As the power to bring the tongue into a definite voluntary position plays an important role for the deaf, when they learn to speak, it would seem that for these patients it would be a great advantage if they were taught from their youth to pay more attention to the sense of touch. It is, moreover, very important for the deaf to obtain comprehension for pitch and intensity of tone by the aid of touch, because in this way only can the disturbing monotony of the speech of the deaf be overcome. Naturally the hearing remnants must be employed to improve the speech. For this purpose the author uses a hearing tube which enables the deaf one through a lateral branch of the tube to compare the speech of the physician with his own, and thereby to imitate as nearly as possible in pitch and intensity the words spoken by the physician. The sight is of aid to the deaf, because with the aid of a mirror the movements of the tongue and lips can be followed. The sense of touch can be employed by the patient holding with one hand the larynx of the physician and with the other his own larynx in the region of the thyroid incisure. After considerable practice and perseverance the deaf can distinguish distinctly differences in the pitch and intensity of enunciated vowels and the monotony of their speech is thereby diminished.

76.

NOLTENIUS.

b.-GENERAL PATHOLOGY AND SYMPTOMATOLOGY.
Schumacher.

No. 19, 1902.

Ear disease in abdominal typhoid.

Wratsch. Gaseta,

77. Frost. A case of primary erysipelas of the throat migrating to face via left Eustachian tube and auditory canal. Am. Medicine., Apr. 26,

1902.

78. Manasse. Two cases of isolated rheumatic disease of the maxillary bones. Münch. medic. Wochenschr., No. 20, 1902.

79. Harland. Somnolence in ear disease. Phila. Med. Journal, 29, 1902.

March,

76.

The author examined the ears of 100 children suffering

I.

from abdominal typhoid. He comes to the following conclusions: Pathological changes in the ear occur in abdominal typhoid in children in 47% of the cases and if the cases with injection of the mucous membrane of the tympanum are to be considered the number rises to 78%—that is, ten times more frequent than in adults. 2. The number and intensity of the ear diseases in children are in direct relation to the severity of the typhoid. 3. The infection reaches the middle ear from the naso-pharynx and through the blood. 4. Irrigation of the naso-pharynx with the syringe must be avoided as this may further the passage of the secretion into the Eustachian tubes. 5. The ears of patients suffering from typhoid must be constantly looked after; neglect of this may lead to dangerous results. SACHER.

77. A woman, æt. fifty-three, was seized with pain throughout the body, redness and swelling of pillars, pharynx, and tonsils, œdema of uvula. On the 2d day swelling of the right, on the 4th day of the left submaxillary glands, two days later the glands between the angle of jaw and the left ear became involved; on the fifth day dysphagia and albuminuria, on the 9th purulent otitis, followed by cutaneous erysipelas over the ear, cheek, and forehead, anterior portion of scalp and whole face including the chin, and the neck. The right middle ear also became involved, but subsequent to involvement of face. All symptoms subsided on the 16th day.

Recovery.

TOEPLITZ.

78. In both cases the pain was referred to the ear.

SCHEIBE.

79. The patient, eighteen years of age, complained of a tendency to sleep as soon as the attention was not actively engaged. Occasional discharge from the left ear since childhood. The attack of somnolence had previously occurred during a period of suppuration from the ear. After removing the discharge the somnolence disappeared, which it did also on its next recurrence. CLEMENS.

C. METHODS OF EXAMINATION AND TREATMENT.

80. Leiser. Air- and bone-conduction. Arch. f. Ohrenheilk., vol. lv., P. 147.

81. Melzi. On the use of the hard-rubber bougie in chronic affections of the Eustachian tube and the middle ear. Arch. internat. de laryngol., d'otol. et de rhinol., vol. xv., No. 2.

82. Alt. Subcutaneous paraffin injections. Monat. f. Ohrenheilk., 1901, No. 9.

83. Pynchon. Pneumatic massage. Laryngoskope, May, 1902.

84. Hopkins. On the use of compressed air in chronic otitis media. Annals of Otol., Feb., 1902.

85. Lichtwitz. On the treatment of lupus in the ear and nose with hot air. Arch. internat, de laryng., d'otol. et de rhinol., vol. xv., No. I.

80. Leiser claims that we should only compare air- and boneconduction under exactly the same conditions, and that the sources of sound and the vibrating tuning-forks should be held equally distant from the bone in testing the bone-conduction as they are from the ear in testing the air-conduction. In this respect, in practising Rinne's experiment a mistake is often made. In his examinations he has always found the bone-conduction to be much greater than the air-conduction. Weber's experiment depends not upon the restricted discharge of the waves, but on the increased sensibility (affection of Corti's organ in middle-ear disease) and on the increased resonance (obstructed cerumen). The increased bone-conduction in Rinne's experiment can be explained in the same way. According to the author both experiments have a diagnostic value. HAENEL.

81. The author has been able to cure three cases of middleear catarrh by slow dilatation of the Eustachian tube with hardrubber bougies. SCHWENDT.

82. With the aid of injections of white vaseline, according to Gersuni, a defect in the mastoid process as large as a bean resulting after an operation for cholesteatoma was brought to close. In the same patient a contraction deformity of the auricle resulting from perichondritis was also completely corrected by injections of paraffin. The reaction after the injections was slight. PIFFL.

83. In middle-ear disease the slow vibrations, 30 to 90, give the best results. In labyrinth affections the more rapid, 300 and over, to the minute, are preferable. CLEMENS.

84. The hot air must be introduced into the external ear, leaving a space for the returning air. Rise of temperature results from increasing the pressure. Before application a double layer of gauze is introduced into the canal. The hot air is used in conjunction with other treatment. CLEMENS.

85. The radical removal of lupus, with the subsequent transplantation of skin, is not available in the nose and ear on account

of deformity. After describing the various methods, including that of Finsen, the author recommends the treatment with hot dry air, as demonstrated by Hollander in Moscow. This apparatus is modified so that the tubes through which the hot air leaves the apparatus can be approached as near as possible to the diseased part. It is not necessary to go beyond 120-130° in order to induce destruction of the lesion. The procedure is not especially painful, and healing is rapid without deformity.

d.-DEAFMUTISM.

SCHWENDT.

86. Schubert. Examination of the deaf-mutes in the institutes of Nürnberg, Zell, and Altdorf. Sonderabdruck aus der Festschr. zur Feier des 50 jährigen Bestehens des arztlichen Vereins Nürnberg, 1902.

86. Seventy-two inmates were examined and the results were somewhat different from those usually obtained. Absolute deafness in both ears was found in 12 children; slight hearing remnants in 27; 33 were found capable of receiving instruction by hearing. The usually favorable number of the last class is explained from the fact that under the children examined three were not really deaf-mutes. One child was able to understand conversational voice at 8 m, two could hear whispered voice at 8 m. The children were examined with Bezold's continuous-tone series, and the etiological factors were determined. The author regrets that the period of vibrations is not determined in the case of Bezold's tuning-forks, as some of the forks from the Münich Institute showed great differences. This different intensity became especially apparent in the transition from the tuning-forks to the pipes. The source of error is that to determine the hearing duration tuning-forks rich in overtones are employed. According to Schubert, the vowel u is quite correctly enunciated by many completely deaf. This is explained because each sharply phonated u is associated with a slight blowing which can be felt if we pronounce the five vowels in a loud tone against the back of the hand. The vowel u has, therefore, to be placed with the explosive consonants.

The practical result of this examination is the establishment of hearing classes in these various institutions. HARTMANN.

EXTERNAL EAR.

87. Eitelberg. A case of neuralgia of the auricle. No. 26, 1902.

Wiener med. Presse,