b. METHODS OF EXAMINATION AND TREATMENT.

116. Courtade. A graphic measure of the impermeability of the nasal fossæ. Arch. internat. de laryng., etc., vol. xv., No. 1.

117. Jürgens. The diagnostic importance of the rhodan reaction on the saliva in ear disease. Monatsbl. f. Ohrenheilk., 1901, No. 8.

118. Downie. On the subcutaneous injection of paraffin for the removal of deformities of the nose. Brit. Med. Journ., May 3, 1902.

119. Wroblewski. On resection of the lower turbinal. Arch. f. Laryng., xii., 3.

116. This instrument serves to measure the extent of nasal respiration and consists of three glass plates of which two are held to the outer nasal openings and the third in front of the mouth. The patient is asked to breathe naturally. The extent of the breathing is shown by the size of the precipitate which the moist expired air forms on the glass plates. In order to fix this precipitate the mirrors are covered with a substance which takes on an intense stain when moist. SCHWENDT.

117. The author has continued the experiments of Koerner and Muck on the rhodan reaction of the saliva in middle-ear disease, and has found that this reaction is usually absent in chronic and acute purulent processes, while it is present in catarrhal otitis, in sequelæ of purulent otitis, and in ear diseases where the middle ear is not affected. The reaction, however, was frequently slightly positive in the presence of purulent otitis as well as in purulent acute and subacute middle-ear diseases, and in certain cases of severe disease of the middle ear and mastoid process requiring operation. The latter results are explained, that in these cases the disease was probably in the mastoid process and that the tympanum was later involved so that Jacobson's nerve was spared.

In six cases the author was enabled by this reaction to make a diagnosis of middle-ear disease which is not possible in any other The reaction also gives a clue as to the course of the disease process.

way.

PIFFL.

118. DOWNIE relates two cases, with photographs, in which the deformity due to falling in of the bridge of the nose had been much improved by injecting paraffin subcutaneously. Care was taken to prevent the paraffin from infiltrating the eyelids.

119.

ARTHUR CHEATLE.

The author objects to removing the turbinals with scis

sors. He prefers to cut them partly through and then apply the cold or hot snare. Packing is usually not necessary.

ZARNIKO.

C. OZENA.

I20. Minder. Report of fifty autopsies on the nose and accessory cavities with regard to the measurements of the facial skeleton. Archiv f. Laryng., xii., 3.

120. ance.

This paper has been written under Siebenmann's guidIt must be remembered that Siebenmann identifies ozæna with the microscopical picture of epithelium metaplasia. If this condition is present, he speaks of ozana which may be present with the formation of crusts and fœtor, and an associated atrophy of the nasal chambers may or may not be present. Fifty heads were examined according to the Starke method, and parts of the lower and middle turbinals were used for microscopical examination.

The cranio-metric index of the upper face was determined and the following conclusions were reached:

1. Leptorrhinia is usually associated with leptoprosopia; platyrrhinia is associated with chamæprosopia.

Metaplasia of the turbinal mucous membrane is as frequent in lepto- as in chamæprosopia.

3. Atrophy of the turbinals in metaplasia of the mucous membrane is not necessarily associated with an unusually dilated condition of the nasal cavities.

4. In about one-half of the cases ozæna was associated with disease of the accessory sinuses.

5. There is no etiological connection between ozæna and empyema.

6. A preponderance of sphenoidal or ethmoidal disease in combination with ozæna with empyema was not found.

7. Empyema of the accessory sinuses is most frequent in the acute infectious diseases, in tuberculosis, and very rarely in other diseases.

8. In combined empyemata the maxillary antrum and frontal sinus are most frequently involved.

9. In two autopsies the author found vomited matter in the nose, in the maxillary cavities, and in the ethmoid cells.

10. Very rarely it is not possible to push in the middle meatus with the finger in the opening of the maxillary antrum.

d. ACCESSORY SINUSES.

ZARNIKO.

121. Reitter. Empyema of Highmore's antrum and acute peritonitis. Monatsbl. f. Ohrenheilk., 1901, No. 8.

122. Wright. A case of isolated, unilateral, latent empyema of the sphenoidal sinus with delirium and mental symptoms. Operation. Recovery. Ann. of Otol., Feb., 1902.

123. Raoult. The choice of operations in paradental cysts of the superior maxilla. Ann. des mal. de l'or., du lar., 1902, 1.

121.

The author describes a case of apparently idiopathic septic peritonitis where at autopsy an empyema was found in the left antrum of Highmore, and believes it possible that the peritoneal cavity was infected by swallowed pus from the empyema.

122.

PIFFL.

WRIGHT'S patient, a physician, æt. fifty-seven years, presented himself with low speech, dazed manner, and in a desperate condition, owing to unendurable pain, described by raising the left hand to the vertex toward the occiput and bringing it down to his left eye and below. He had an attack of the grippe ten months before, with some coryza and pain, which subsided for five months. During a second attack of pain, which lasted some weeks, he was forgetful, irritable, and emotional, and two months later the pain gradually became atrocious, of a boring character with hyperæsthesia of the scalp, sneezing, without nasal discharge, but with a foul smell, in his breath, noticeable by others, of retained decomposing secretions, not of dead bone or ozæna. Temperature was subnormal, pulse slow. The patient's mind soon became wandering in occasional slight delirium. A foul-smelling cheesy mass had been spat up from his naso-pharynx. There was proptosis of the left eye. While pulling the soft palate forward by a tape and placing the finger of an assistant as high up as the tip end of the middle turbinal, the gouge end of an ethmoidal curette was introduced through the left nostril, until it rested upon the finger and infringed upon a solid wall, and was then raised a little above the finger. With a boring motion soft bone was perforated and pus was then seen far back in the anterior nares. The withdrawn instrument contained in the groove of the gouge cheesy, dark, foul-smelling secretion. The distance from the ala nasi to the firm posterior wall of the sinus was 3 inches. The right

sinus did not contain any pus. The middle turbinates were removed. After the operation a chill ensued, with a temperature of 104.5° F., but which fell on the next day to 100° F. The proptosis disappeared, as well as the pain and odor. The mental condition improved, but the delirium remained for ten days. A second operation from without, through the anterior and posterior ethmoidal cells into the sphenoidal sinus, did not reveal any pus or dead bone. The patient made good recovery.

M. TOEPLITZ.

123. Three cases are reported. The author recommends in non-infected dental cysts which project into the nose or into the superior maxilla, that the cysts be curetted through the alveolus and a counter opening be made. If the cyst is infected without involving the sinus, it should first be carefully evacuated and cleansed, so that by making a counter opening the sinus is not involved. This is, of course, not necessary if the sinus is already infected. ZIMMERMANN.

e. OTHER DISEASES.

124. Bruck. The treatment of fugacious erythema of the nose. Allg. med. Centralztg., 1902, 53.

Ann. of

125. Rose. Rhinophyma. Ljtopiss russkoj chirurgii. Bd. vi., Heft 6. 126. Pierce. A case of congenital fistula of the external nose. Otology, etc., May, 1902.

127.

Marie and Guillain. Three cases of ulceration of the nose, coinci

dent with lesion of the posterior columns of the cord.

du lar., 1902, 5.

Ann, des, mal, de l'or.,

128. Lauffs. Gonorrhoeal rhinitis in the adult. Bresgen's Sammlung zwangloser Abhandlungen, v., 11.

129. Pegler, Hemington. Specimen of cystic growth of the septum with microscopic section. Laryng. Soc. of London, April 11, 1902.

130. d'Astros. Nose-bleed in the newly born. Arch. de méd. des infantes, vol. v., No. 4.

131. Henrici. Cases of foreign bodies. Arch. f. Laryng., xii., 3. 132. Cheatle. Specimen of rhinolith. Laryng. Soc. of London, April 11, 1902.

133. Roulay. Clinical study of the congenital occlusion of the posterior choanæ. Arch. de méd. des infants, vol. v., No. 3.

134. Kamm. A case of closure of the posterior nasal opening. Allg. med. Centrlztg., No. 55, 1900.

135. Brochowski. On the occurrence of scleroma in Eastern Prussia, with a description of two new cases. Inaug. Diss., Konigsberg, 1902.

124. The application of gauze with benzine to the skin for a few seconds will relieve sudden erythema immediately.

BRUEHL.

125. Two typical cases are reported which have been healed by operation. Microscopically rhinophyma belongs in the class of granulation tumors because the process seems to be practically a very large production of granulation tissue, while the associated changes in the glandular elements of the skin are purely secondary. SACHER.

126. A woman, aged twenty-four, had a swelling on the nasal dorsum, which gradually developed until after three months it was of the size of a pea. Edema of the forehead and eyelids set in. The skin over the swelling was reddened. A supposed abscess was opened and the oedema and discharge disappeared. A fistulous passage remained subject to inflammation, with one opening over the lower third of the nasal bones and the other one above the cartilaginous portion of the tip, both communicating and discharging sebaceous material and pus; from the upper end a few hairs were protruding. The fistula was lined with mucous membrane. The upper end branched off and ended blindly beneath the left nasal bone. The fistula resulted from a congenital dermoid cyst. M. TOEPLITZ.

In

127. In three cases, of which two are surely and one probably dependent upon syphilis, the nasal openings had been destroyed by ulcerations and drawn together by the scar. In one case, in addition to the scar there is a rodent ulcer which the author regards as an example of the well-known carcinoma originating in scar tissue. In all cases the knee phenomenon was absent. one case the pupillary reflexes and cremasteric reflex were absent. Atactic disturbances were not present. In two cases at autopsy Burdach's columns were found slightly sclerosed. The connection, according to the author, is that the old syphilis at one time produced an ulcerative process and had at another the changes in the posterior columns. ZIMMERMANN.

128. A report of two cases of gonorrhoeal rhinitis coincident with urethral gonorrhoea. Gonococci were present in the nasal pus. Recovery after insertion of tampons with 1 per cent, argonin solution. BRUEHL.

129. A man, aged thirty years, complained of obstruction of the left side of the nose. On examination, a bluish-gray body, resembling a polypus, was seen occupying the middle meatus. A distinct attachment seemed to be present in the septum at about the region of the tubercle or a little higher. It was removed with a