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general medicine as are in relation to the healthy and diseased auditory organ. These abstracts, which shall follow the original publications as early as feasible, will, from time to time, be supplemented by comprehensive reviews on the present status of special subjects, important questions, and definite fields of research and practice. This program is decidedly excellent and the names of the editors and colaborers warrant the success of the enterprise. As to the expediency of a new journal in otology, there being a good many in existence, all of them having a reviewing department of the world's otological work, we need. only remind our readers of the fact that the literature on any field has a tendency to follow, in quality and quantity, the labor bestowed on the cultivation of that field. The success of new enterprises is governed by the law of the survival of the fittest.

Four numbers of the Review (Oct., Nov., Dec., 1902, Jan., 1903) have appeared. They are printed on fairly good paper, 48 octavo-pages each number. The arrangement of the subjectmatter is as follows: I. Collective review on a special subject, of 4-10 pages. II. Abstracts: (1) Anatomy, Embryology; (2) Physiology; (3) Pathologic Anatomy; (4) Pathology and Diagnosis; (5) Therapeutics and Technique. III. Reports of Societies. IV. Nose and Pharynx. V. Professional News.

The quality of the abstracts is in line with those to be found in the better class of otological periodicals. If provided with a good index, at the end of the year it will be a permanent valuable addition to the library of any aurist.

H. KNAPP

ARCHIVES OF OTOLOGY.

A BRIEF REPORT OF FORTY RADICAL OPERATIONS FOR CHRONIC PURULENT OTITIS AND COMPLICATIONS, WITH REMARKS.'

BY DR. ARNOLD KNAPP AND DR. C. H. R. JORDAN.

F

ROM October 1, 1900, to October 1, 1902, 45 radical operations were performed in the ear department of the New York Ophthalmic and Aural Institute; of these 40 were performed by Dr. Jordan and myself. They represent the subject of these remarks and include all of the operations of this kind performed by either of us during this period of two years; they are consequently not selected

cases.

These 40 cases of chronic otorrhoea may be classified according to the symptoms and pathological findings at operation as follows:

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This classification is necessarily more or less arbitrary; the symptoms of the various groups frequently differ only in degree, yet they are serviceable for purposes of description.

I Read at meeting of the Otological Section, New York Academy of Medicine, February 16, 1903.

The following are the noteworthy features in these cases. (The case histories will be published at the end of the paper.) In the first group, cases of simple caries, the operation was performed in two (4, 9) on account of an almost complete stenosis of canal. An imperfect operation had been done elsewhere without a plastic, the disease remained and the canal was stenosed. In one of these (9) a small exostosis was found on the external semicircular canal, the patient had been totally deaf for a number of years, and the medial tympanic wall was absolutely smooth and bony without any details, the window-niches being obliterated. In the third (6) the patient suffered from caries in the posterior segment of the tympanum and antrum associated with profuse and obstinate granulations which resisted repeated minor operations. At the radical operation after the antrum and attic had been cleaned out, every attempt to curette the posterior tympanic wall was followed by a facial convulsion so that this area remained untreated. The case healed promptly except for this area, which to-day after 14 months though very much contracted in size is still unhealed. In the fourth case (27) after long conservative treatment the Stacke operation was performed, when at ossiculectomy the ossicles were found normal and the antrum full of granulations. The radical operation was done in one case of caries to improve the hearing at the earnest solicitation of the patient. Bone conduction was reduced. No stapes was found. Skin grafts were inserted and the wound healed rapidly but the hearing was not improved.

In the second group, caries with severe symptoms consisting in headache and nausea, there were five cases with defect in the tegmen antri. In one case (10) the stapes was accidentally removed during the operation; this was followed by no ill-effect except that the hearing, which previously had been good, was very much reduced. One (8) was characterized by unusually slow epidermization; healing took place after eight months though now occasionally there is slight moisture at the round window. The following cases in this group are not entirely healed though free from symptoms, Case 1 is still under treatment for suppuration coming from

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the tympanic floor, where there is quite a recess. outer wall of the hypotympanic recess had not been trimmed down at the first operation. In another (5) a fistula remains in the posterior tympanic wall just back of the oval window. At operation an unusually deep recess was found under the aqueductus Fallopii. A scab forms, covering a small drop of fetid pus. The third (23) has an apparent involvement of the labyrinth; the stapes is in position and intact but a copious thin discharge is flowing from the niche of the round window. There are no other labyrinth symptoms.

In the third group are included those cases where an acute reinfection of the antrum has taken place giving mastoid symptoms, and cases where thin fluid pus is found retained in the antrum and aditus by granulations, a stenosed canal, or cholesteatoma, causing marked symptoms. One case (2) presented a subperiosteal abscess, a perforation through the mastoid cortex, a large epidural abscess, and cholesteatoma. The retro-auricular wound was left open and subsequently closed at a second operation. In another case (3) there was so much destruction in the mastoid that the wound was kept open, for purposes of proper dressing. The healing was very slow owing to remaining necrosis. Grafts were inserted. A secondary operation to close the posterior wound was kept in view but the patient ceased attendance. In one case (24) the cholesteatoma filled the whole mastoid process and had perforated the cortex and the sigmoid sulcus. In Case 29 the destruction from cholesteatoma was so extensive that not only the sinus and dura were exposed but also the jugular bulb and the maxilla joint by erosion of the floor of the tympanum and anterior meatal wall. In this case the patient had had no discharge from her ear for the last ten years and the canal was tightly packed with an epidermis plug.

In the group of cases with labyrinth fistula there was a case (14) of a man with a history of long standing otorrhoea, who suddenly became very ill and suffered from such intense vertigo that the head could not be lifted from the pillow. The antrum contained pus, granulations, and cholesteatomatous masses and there was a large defect in the anterior half

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