cerebellum. The pulse continued to beat for two hours and thirty-five minutes after natural breathing had ceased. Artificial respiration was kept up for two hours. CHEATLE.

98. A boy nine years of age with right-sided cholesteatoma was taken ill with pyæmic symptoms. Swelling over the mastoid process. A thick strand could be felt in the neck to within 2 cm of the clavicle. Gerhardt's symptom present. The radical operaation was performed; the jugular vein was ligated 1 cm above the clavicle. The vein and the sigmoid sinus were evacuated. There was dulness on the right side low down in the lung. Four days after operation there was cough, fœtid expectoration, and continuous temperature of about 38.5° C. Two weeks after the first operation a rib was resected and an abscess of the lung evacuated with the Paquelin cautery. Streptococci were found. Normal The wound in the neck was healed

temperature two days later. after three weeks, the wound in the lung after four and a half weeks.

99.

BRUEHL.

DENCH reports on 22 operated cases, of which 2 were fatal, one of septic pneumonia, and the other of acute nephritis, perhaps caused by the anææsthetic. In 4 cases the internal jugular had to be ligated; in all healing took place. In all doubtful cases it is best to remove the vein to exclude danger of general infection, although this is not necessary in every case of sinus thrombosis. If the patient has remained under observation for several days without rise of temperature and without symptoms of general infection, the evacuation and removal of the thrombus are sufficient, if such is present. In those cases where during operation it becomes apparent that thorough removal cannot be undertaken and infectious material is likely to remain in the vein, immediate excision is necessary. If after a simple operation with resection of the sinus symptoms of general infection remain for two or three days, the vein also should be excised. CLEMENS.

100. At the first operation the sinus was found broken down and was tamponed. Fever and chills began to appear. The jugular vein was ligated four days later. The symptoms persisted. Iodine was found in the urine and iodoform intoxication was suspected. After replacing the iodoform gauze with sterile gauze rapid improvement took place and persisted.

ZIMMERMANN.

101. This case is instructive from a number of points. First of all, we should not wait for chills to make a diagnosis of sinus disease. Slight, regular fever, continuous headache, vomiting, and depression are suspicious. Second, if pus is found about a sinus this sinus must be punctured as an apparently normal exterior may hide a purulent thrombus. ZIMMERMANN.

I02. A woman twenty-four years of age, was affected with severe meningeal symptoms. She had suffered for years with recurrent otorrhoea. At operation a purulent focus was found in the attic which had destroyed the tegmen, and the prominent dura was covered with granulations. Eight days later the symptoms were completely relieved. LAURENS agrees with Broca that in this case the meningeal irritation symptoms resulted from the inflammatory cedema in the neighborhood of the purulent focus and that the oedema disappeared on relieving the purulent focus, just as in a case of ordinary abscess.

ZIMMERMANN.

103. A very interesting discussion on otitic meningitis. A single case is reported showing the successful operative treatment of purulent otitic meningitis where the diagnosis had been confirmed before operation by lumbar puncture. A man, eighteen years of age, with chronic suppuration, became suddenly ill with distinct meningeal symptoms. Lumbar puncture revealed a cloudy fluid rich in leucocytes. The radical operation was performed with exposure of the dura in the middle and posterior cranial fossæ. The dura was normal. After operation apparent health. One month later meningeal symptoms again set in. Lumbar puncture again drew off fluid with increased quantity of leucocytes. The cyanosis and irregular respiration were suggestive of cerebellar abscess which was found and evacuated. At the same time the radical operation was done on the other ear, which also suffered from chronic suppuration. Recovery took place.

In this case we have a meningitis healed twice with caries of the roof of the tegmen tympani after removal of the main focus. BRUEHL.

104. Notwithstanding radical evacuation of a cholesteatoma, symptoms appeared suggestive of temporal lobe abscess-namely, progressive left-sided paresis of the extremities, rather uniform rise of temperature, obstinate headache, and marked weakness. Aphasia was wanting. At the operation BROCA-notwithstanding

puncturing through the tegmen tympani in various directionsdid not find a drop of pus. As the canula was forced in the direction of the posterior cornu a large quantity of cerebro-spinal fluid was evacuated. After operation the patient made a rapid recovery.

This case is regarded as serous meningitis which must always be suspected when the supposed abscess is not found. The direct puncture of the lateral ventricle has better chances for cure than the lumbar puncture, as the foramen of Monro may be occluded. ZIMMERMANN.

105.

The author discusses the symptoms, gross and pathological anatomy, prognosis and treatment of hernia resulting from opening the dura and especially those which set in after an interval of a few days. They can usually be avoided by careful packing, in cases where it is possible, by suturing the dura, and above all by a sufficient evacuation of the abscess so that subsequent increased pressure does not occur. If the hernia has occurred it is usually best to pursue the expectant plan together with asepsis and moderately compressing bandages. ZIMMERMANN.

106. A patient was presented where the sinus, jugular bulb and vein had been exposed to a marked extent. Though the vein was thrombosed down to the clavicle and was ligated directly over the sternum, recovery took place. BRUEHL.

107. The unusual feature of this case is that fourteen days after an operation where sinus thrombus had been evacuated on the diseased side, symptoms of thrombosis on the other side set in. Rest in bed and antiphlogistic measures relieved the condition rapidly. MOELLER.

d.-OTHER MIDDLE-EAR DISEASES.

108. Reik. Catarrhal, non-purulent otitis, a factor in the etiology of facial paralysis. Johns Hopkins Hospital Bull., April, 1902.

109. Gellé. A case of hysterical mastoid pain. Arch. internat. de laryng., d' otol., et de rhinol., vol. xv., No. I.

108. If facial paralysis appears during a cold it is probably produced by otitis media with extension of the inflammation to the nerve or pressure from exudate. The best method of treat-" ment is paracentesis. In cases of facial paralysis aural examination should never be neglected. CLEMENS.

109. In a young girl of eighteen, after severe mental shock,

marked pain was felt in the mastoid associated with other hysterical symptoms. The mastoid was opened by another physician, without result. As a differential diagnostic point, the pain in this case was superficial and appeared to have its location in the skin. The author thinks that operation in these cases is of no value and recommends psycho-therapy in addition to suggestion; antiseptic and calmative ear baths may be employed. SCHWENDT.

NOSE.

a.-GENERAL PATHOLOGY AND SYMPTOMATOLOGY.

110. Abignon. The role of the nasal fosse in the prophylaxis and treatment of pulmonary and laryngeal tuberculosis. Arch, internat, de laryng.. d'otol., et de rhinol., vol. xv., No. 2, March-April, 1902.

III.

Schoenemann. Changes in the vessels contained in the nasal mucous membrane in nephritis. Arch. f. Laryng., xii., 3.

I12. Thost. On hay-fever. Münch, med. Wochenschr., 1892, Nos. 17, 18. 113. Linder. On nasal dysmenorrhoea. Münch, med. Wochenschr., 1902, No. 22.

114. Collet. Vertigo of nasal origin. Ann, des mal. de l'or., du lar., 162, 1902.

115. Holländer. On the mechanical disposition to tuberculosis, especially in regard to plastic operations on the nose for lupus. Berl, klin. Wochenschr. 1902, No. 14.

IIO.

Tuberculous infection usually occurs from the air. The nasal cavities serve to filter the air. Tubercle bacilli and diphtheria bacilli are frequently found in the nasal secretion of the vestibule in healthy subjects. In the deeper parts these bacilli become more scarce. This is probably because the nasal mucosa has a definite antiseptic action associated with a phagocytic activity of the leucocytes. Every retronasal catarrh is dangerous from the possibility of tubercular infection, as it is probable that it is the beginning of this infection. The regulating of temperature and humidity of the inspired air by the nasal cavities is not to be undervalued. It has been shown that the amount of hæmoglobin in the blood is reduced where nasal respiration is interfered with and is increased in free respiration. Hence thorough and free respiration should always be aimed at. Swellings of the turbinals, spurs and deflections should be removed. The treatment of the nose, in short, forms a part of the prophylaxis against tuberculous

infection.

SCHWENDT.

III. The author has examined the nasal mucosa in eight different forms of nephritis and has found that the number of capillaries in the epithelium is increased, that they break through the basal mucous membrane, and that the capillary loops push themselves through the basement cells. The capillary wall and epithelial coverings burst and the blood is let out. These changes are characteristic of nephritis as they were absent in 75 other cases. Clinically, in the presence of severe hemorrhage in nephritic patients one should not waste time in looking for distinct bleeding points but should tampon at once. ZARNIKO.

112. This is the result of the examination of 400 patients. The very many interesting facts must be read in the original. It is interesting to see that in a comparatively large number of persons operations on the nose have been followed with favorable therapeutic results. SCHEIBE.

113. In about 30 cases dysmenorrhoea was influenced by cocainizing the lower turbinals and the tuberculum septi. In 16 of these cases the same effect was also obtained by suggestion. In several cases during laparotomies where the internal genitals. were exposed, the corresponding parts of the nose were cocainized and repeated transient hyperæmias of the uterus were observed. The author recommends the nasal treatment of dysmenorrhoea. According to the experience of the reviewer, two patients upon whom he was induced to try the nasal treatment both with cocaine and galvano-cautery for dysmenorrhoea did not get relief.

SCHEIBE.

114. A man of thirty-three years had experienced three times in the course of a month pain in the neck with simultaneous vertigo, after a feeling of irritation in the nose and sneezing. The author regards this as a form of nasal vertigo which passed along the second branch of the trigeminus to certain bulbar centres causing secondary cerebral anæmia. ZIMMERMANN.

115. In lupus of the nose the mechanical closure of nasal respiration is followed by a descending form of tuberculosis of the upper respiratory tracts and, on the other hand, the lupus process in the upper respiratory tracts will get well if the primary nasal lupus is healed or the stenosis of the nasal openings removed. In performing a rhinoplasty it is more important to provide a free nasal opening rather than form a new septum.

MUELLER.