snare under antiseptic precautions. On removal it proved to be a cyst with a short hollow pedicle. No bleeding or running of fluid followed removal. A week later the patient suffered from shiverings, pain in the limbs, and headache, with a temperature of 100°.

As influenza was present in the house, the same diagnosis was made. Nine days after removal symptoms of meningitis set in, and death occurred six days later.

There seemed reason to suspect that the case was one of meningocele. The section showed two distinct zones of tissue: an outer consisting of nasal mucous membrane, and an inner made up of connective tissue containing many elastic fibres, but without a definite squamous epithelial lining. ARTHUR CHEATLE. 130. Ten cases are reported, of which eight are syphilitic. Three varieties of epistaxis in sucklings in the first six months are described. (1) Resulting from local lesion in coryza, especially syphilitic coryza; (2) epistaxis in severe septic disease; (3) primary idiopathic bleeding.

HARTMANN.

131. (1) Stone in the right tonsil which had formed around a wheat grain; (2) sleeve button in the larynx; (3) a rod, 6.5 cm long and thick as the little finger, was shot from a gun and penetrated the right cheek, passing through the antrum into the nose, perforating the middle turbinal and impinging on the septum. There was discharge of pus from the nose, fistula of the cheek, and anchylosis of the jaw. Extraction through the nose.

ZARNIKO.

132. The rhinolith weighing 140 grains was removed from the right side of the nose. The patient was a woman fifty years old, and trouble had been present for twenty. The nucleus consisted of a portion of necrosed inferior turbinate bone. There was a history of syphilis. ARTHUR CHEATLE.

133. Two cases are reported. The closure in 80 per cent. of the cases is bony; in 10 per cent. partly, and in 10 per cent. entirely membranous. Incomplete closure is very rare.

HARTMANN.

134. A patient thirty years old, presented complete closure of the right choana. The left was closed with the exception of a small opening the size of a bean. The closure was maintained by a fibrous wall which appeared to be resisting to examination with the probe. The mucous membrane moved on both sides during

phonation and swallowing. According to the author, this was a case of abnormal muscle fibres originating from palatal muscles. HARTMANN.

135. To the five cases of scleroma reported in 1900, the author adds two more and speaks of the symptoms and differential diagnosis based upon these seven cases. The difficulty of diagnosis. is shown by the fact that the ministerial investigation on the occurrence of scleroma in East Prussia met with negative results. The author states that in East Prussia, near the border line, there is an endogenous area of scleroma from which, in time, additional cases will probably come to treatment.

HARTMANN.

NASO-PHARYNX.

136. Regnier. Nervous troubles in relation to the presence of adenoid vegetations in the naso-pharynx in children. Ann, des mal, de l'or., du lar., 1902, 2.

137. Iljisch. The removal of adenoid vegetations in narcosis. Gaseta, 1902, No. 15.

Wratsch.

138. Lartigau and Nicoll. A study of hyperplasia of the pharyngeal lymphoid tissue, with special reference to primary tuberculosis of the pharyngeal tonsil. Am. Journ. of Med. Sciences, June, 1902.

139. Boulai. Naso-pharyngeal polyps cured by galvano-caustic punctures. Arch, internat, de laryng., etc., vol. xv., No. 2, March-April, 1902.

140. Munger, Carl E. Report on an unusual case of adenoids. Annals of Otol., March, 1902.

141. Montenyott. Complications after adenoid operations. Pedriatics, May, 1902.

142. Holmes. Enormous naso-pharyngeal soft fibroma. Ann. of Otol.. May, 1902.

136. In a boy of eleven years choreic movements and relapsing facial eczema were cured by the removal of adenoids. In another case after similar operation, movements of the diaphragm, which were first very slight, later became pronounced.

ZIMMERMANN.

137. The author strongly recommends bromethyl.

SACHER.

138. LARTIGAU and NICOLL arrive at the following conclusions: "1. Adenoids consist essentially of hyperplastic pharyngeal lymphoid tissue. The epithelium and fibrous-tissue changes are inconstant and variable, and independent of the age of the patient. The new-formed fibrous tissue is largely perivascular in distribution. It may occasionally be one of the factors in the

process of disappearance of the adenoid. 2. The hyperplastic pharyngeal tonsil often contains micro-organisms, and these are mainly pyococcal forms. The bacteria for the most part lie near the surface, and the infection usually occurs from the surface, with or without demonstrable lesion of the epithelium. 3. Primary tuberculosis of adenoids is probably more common than most previous studies show. Sixteen per cent. contained tubercle bacilli, ten per cent. with characteristic lesions of tuberculosis. The tubercle bacilli were present in small numbers. 4. The lesions in primary tuberculosis of the adenoid are generally close to the epithelial surface and focal in character. Occasionally they may be found in the deeper parts of the pharyngeal lymphoid tissue. 5. The pharyngeal tonsil may be a portal of entry for the tubercle bacillus and other micro-organisms in localized or general infections." M. TOEPLITZ.

139. Retronasal polyp was cured with galvano-caustic ignipunctures. The author recommends this procedure; although it takes a long time it appears perfectly safe.

140.

SCHWENDT.

In the removal of adenoids in a boy of thirteen, a tumor was removed consisting of cartilage. The author assumes that this originated from an intervertebral disc.

HARD.

141. On the third day after operation for the removal of adenoids, chorea of the face and extremities set in followed by severe endocarditis with a temperature of 105° F. Recovery after two months. HARD.

142. A woman, æt. nineteen, had suffered from otorrhoea until her sixteenth year, from difficulty of breathing since her third year, with embarrassed respiration, frequent cough, and, lately, difficult deglutition and return of food through the nose, which symptoms were aggravated by a severe attack of the grippe. The entire pharyngeal space was filled by a tumor hanging from the right side of the vault, of soft consistency, smooth surface, and of pale grayish color, extending from pillar to pillar, below to the base of the tongue. It was in contact with the epiglottis, adherent to the base of the tongue and posterior wall of the pharynx. The adhesions were separated by a blunt hook and the finger; the growth was lifted out of the lower pharynx. When the wire loop failed to extract it, it was twisted upon its long axis, until it gave

way at its point of attachment above and anterior to the mouth of the Eustachian tube. The microscopic examination revealed a soft fibroma arising from the submucous connective tissue. The description of the case is followed by a full study of the literature of the subject, and illustrated by photographs of the tumor, microscopic sections, and by the picture of another patient with a "frog face" who had died from chloroform after the operation on the tumor. A bibliography containing 298 titles is appended. M. TOEPLITZ.

SOFT PALATE AND PHARYNX.

143. Clauda. A case of perforating tuberculous ulceration of the palatal vault. Arch, internat, de laryng., etc., vol. xv., I, January and February, 1902.

144. Bissell. The bacterial pathology, symptomatology, treatment, and quarantine of tonsillar inflammations. Med. News, May 31, 1902.

145. Siredey. On the use of the methylene blue in the treatment of angina due to fusiform bacilli and the spirilli of Vincent. Ann, des mal, de l'or., du lar., 1902, 3.

146. Lermoyez and Gassne. Acute gout of the pharynx. Ann, des mal. de l'or., du lar., 1902, 5.

147. Weber.

Secondary hemorrhage on the fifth day after tonsillotomy. Laryngoscope, April, 1902.

148. Roy. Two unusual cases of hemorrhage following adenotomy and tonsillotomy. Laryngoscope, Feb., 1902.

149. Hartz. Tonsillar and peritonsillar suppuration. Am. Med., April

19, 1902.

150. Brown. A fatal case of primary acute infectious pharyngitis with extreme leukopenia. Am. Med., April 19, 1902.

151. Hoedlmoser. On fulminating phlegmon of the pharynx and larynx. Mon. f. Ohrenheilk., 1901, No. 7.

143. In this case the dysphagia was very pronounced. The diagnostic symptoms are described which serve mainly to differentiate this rare condition from syphilitic perforations. Cauterization with lactic acid was recommended.

SCHWENDT.

144. BISSELL distinguishes: first, follicular tonsillitis simplex without known micro-organismal origin; secondly, tonsillitis showing the presence of the Klebs-Loeffler bacillus, necessitating the use of anti-toxine; thirdly, tonsillitis revealing the streptococcus pyogenes to the exclusion of other organisms of which several fatal cases are fully given; fourthly, tonsillitis produced by the micrococcus of sputum septicemia. Tonsillar infection due to

oidium albicans is also considered. In rheumatic anginas, fiftytwo cases of suppurative tonsillitis contained as predominating organisms the staphylococcus pyogenes aureus, being the cause of the pus production. In three instances, an organism corresponding to the colon bacillus was found in the abscess contents. disinfection of rooms a candle consisting of paraformaldehyde is used and supplemented by formaline and carbolic acid (5%), for substances needing their solvent and penetrating powers.

For

M. TOEPLITZ.

145. As the fusiform bacillus and spirillum are easily stained with methylene blue, the author was induced to use this remedy in the treatment of the disease The remedy is directly applied in the powdered form to the ulcers and deposits. After three days decided improvement took place, which was complete within a week. ZIMMERMANN.

146. The authors report this case fully, aware of the scepticism with which such disease of the pharynx is frequently treated. The case was that of an old gentleman who in the middle of the night was suddenly taken with severe pain in the neck, fever and general prostration. The pain continued for eight days, during which time only liquid food could be taken and in drops. Local symptoms beyond an unusual redness of the left side of the pharynx were not present. The authors suspected a peritonsillar abscess. Suddenly on the ninth day the symptoms disappeared without any evacuation of blood or pus. On the following night typical gouty swelling appeared in the great toe, from which it seemed proper to assume that the preceding pharyngeal inflammation was of a gouty nature. A number of similar observations are added. ZIMMERMANN.

tome.

147. A pale and anæmic girl, æt. five, was operated on for very hard and tough tonsils, without an anesthetic, with the tonsilloThe hemorrhage ceased fifteen minutes after the operation. On the fifth day an oozing hemorrhage from the left tonsil, which had offered more resistance to the cutting blade than the right, was checked by a gargle of diluted Monsel's solution. The hemorrhage returned, the child became unconscious, and the hemorrhage ceased for two hours. Large quantities of clotted blood were vomited. The hemorrhage returned, but was permanently stopped with Monsel's solution. M. TOEPLITZ.

148. In Case 1, a young lady had, after the use of cocaine and