Original Communication.

COMPLEMENTARY MENSTRUATION
FROM THE EAR.1

BY DR. CARLES,

GRENOBLE, FRANCE.

and washing are repeated, and thus the whole under-surface of the eyelid is denuded. This method is applied to the lower lid at the same time. Very little reaction follows this apparently harsh treatment and very little pain; it is more like a soreness and stiffness of the lids, as the patients express it. At the end of twenty-four hours the eyelids are separated ON the 4th of June last I was asked by and washed with our ordinary L. S. solu- some friends to give my attention to their tion. This irrigation treatment may be housekeeper, Mrs. X., 58 years of age. She continued for a week, or until desquama- complained of incessant and horribly paintion of the granulations cease. If after ful itching of the left auditory canal. Exthree weeks a few irregular granulations amination by speculum revealed no lesion remain, they may be cut off with scissors capable of explaining such itching. There and the spots touched with a solid stick was no excoriation or eczema, the passage of nitrate of silver. The success of this was smooth and of normal aspect, the operation depends upon its thoroughness. membranum tympani was of a dull-white If any true trachoma remain behind, they color and in good position; there was a will again spread over the remaining small perforation at its postero-inferior healthy conjunctiva, as no granulations part. There was no indication of otorcan grow on the cicatricial tissue which rhoa. Interrogated upon this point, the forms. Burow's operation is also per- patient related the following interesting formed to protect the contraction of the history:cartilages of the eyelids, which nearly always follows a prolonged attack of granular lids.

After-treatment. We again adopt the following line of treatment: Saturate the cotton pads with the lotion as prescribed, keeping the eyelids moist day and night, and not allowing any pressure on the pads, simply holding them in place with the adhesive strips. The patient will be kept in bed for two or three days, at the end of which time he will be able to open both eyelids without pain and in a week or ten days leave the hospital cured.

(To be continued.)

Seven years previously Mrs. X, who, prior to that time had been in good health and regular as regards menstruation, “saw blood," as she expressed it, much more abundantly and, above all, more irregularly than had been her wont: that is, twice in a month. She was at the time in La Pitié under the care of Professor Berger, who diagnosticated a uterine fibroma without indications for operation, as she was nearing the menopause. What is of interest to specialists, however, is that every time when her menses returned the patient experienced the following symptoms: Heaviness and congestion of the head, localizing itself finally in the left ear, with a very distressing sensation of full

Professor G. D. Liveing. His portrait was recently presented to Professor Live-ness in that organ, accompanied by intoling, of Cambridge University. A bronze bust is to be placed in Cambridge Chemical Laboratory.

erable buzzing, lasting an hour or two, then ceasing suddenly with the advent of the menses and a discharge from the left nos

'Travail communiqué à la Société Francaise de Laryngologie, Mai, 1901. Translated for THE MED

ICAL BULLETIN from Revue Hebdomadaire de Laryngologie, d'Otologie, et de Rhinologie, 14 Septembre,

1901.

tril. This flow was, according to the patient, of peculiar character, of an orangered color, with streaks of blood. It was of an extremely fœtid odor, which was perceptible to the patient herself, whom it sadly distressed. It was likewise very abundant. At length the rhinorrhoea and catamenia simultaneously disappeared.

I requested the patient to return to me. during a catamenial epoch. She was unable to do this on account of her occupation, but she brought me some cloths stained, according to her declaration, by the discharge from the ear. There were large spots, some dark yellow and greenish, streaked in some places with blood, others of brick-red, uncoagulated blood, surrounded by a white zone, which could be nothing but menstrual blood. The ear was in the same condition as when first exam

dry.

Three years ago the discharge, which previously had issued from the nose only, returned, and came both from the nose and left ear, with the same characteristics of color, severity, odor, and absolute cor-ined, and the perforation was absolutely respondence to the menstrual epoch, and with the addition of incessant itching of the auditory canal. She states that she was not at the time afflicted with cold in the head, coryza, or any other affection which might account for a purulent otitis. During the last three years the flow from the nose and ear has never ceased to appear and disappear with the menses.

When examined, as has been said, the canal and the membranum tympani were normal except for a small perforation in the postero-inferior quadrant. There was almost complete insensibility of the conduit and the drum-head, to such a degree that I could touch with a stylet every part of the wall of the canal and penetrate the middle ear through the perforation without the patient's manifesting any sign of perception. Astonished by the absence of the defensive reflex produced by the extremely painful sensation which occurs when the middle ear is touched, I inquired of the patient, who replied that, far from being painful, the sensation was agreeable to her, in that it caused a momentary relief of the itching.

The sensibility of the pavilion was normal. The auditive acuity was diminished. The low voice could be distinguished at a ́meter (a little more than a yard) by the right ear, at only half that distance by the left ear. An air-douche drove no fluid through the perforation. There was no abnormality of the nose and pharynx.

Here, unfortunately, my investigations ended, for the patient did not return. I have since learned that, pleased with the interest which I manifested in her case (I had spoken in her presence of its rarity), she had been persuaded by those around her to exhibit herself in the hospitals, where she would not only be treated gratuitously, but might even get pay for allowing herself to be examined.

However incomplete, the case is certainly very interesting, and involves consideration of three important questions: Was the flow from the ear complementary to that from the genitalia or was it independent? What was its seat? What was its cause?

It is impossible to reply to the first question absolutely and categorically, although everything points to an affirmative answer. In the first place, the blood-stains had. every appearance of menstrual blood: its color, lack of coagulation, and a serous areola. Furthermore, the appearance, disappearance, and cessation of the bloodflow from the ear with the advent and cessation of the menses was significant. Finally, both flows were entirely regular.

The flow, without doubt, was derived from the middle ear. For some time it escaped through the Eustachian tube and the nose. During the last three years the discharge occurred both through the nose and the ear after perforation of the mem

branum tympani. As regards the causes which lead to vicarious menstruation by the ear, they generally depend, as is known, upon some local or general pathological condition.

with glossitis for three years, beginning simultaneously with a very severe congestive and febrile affection of the lungs. At the date of the meeting the eruption principally displayed itself in the form of whitish festoons. Especially predominant in front of the circumvallate papillæ, it spared the lower surface of the tongue entirely and also its posterior extremity.

In this particular case both of the customary causes were present. A chronic otitis media acted as the local cause, while hysteria was a constitutional factor. The otitis exhibited an unusual evolution, but, much to my regret, I was unable to follow its course. The intermittence of the flow of pus, its appearance only at the men-glossitis was proportionately aggravated. strual period, and total disappearance in the intervals are decidedly curious. The diminution of hearing, like the diminution, not to say abolition, of the sensibility of the auditory canal and membranum tympani, is a constant and absolute sign of hysterical ear.

With each new tuberculous attack and even with every indisposition, febrile or not, which the patient experienced, the

Abstracts.

Elephantiasic Edema of the Lips.

The organ might be compared to the saburral tongue, with the difference that it desquamates instead of being covered with saburral matter at each general or local ailment, tuberculous attack, or dental abscess.-Revue Hebdomadaire de Laryngologie, etc.

Pseudomyxomatous Peritonitis.

The above is a very rare affection and still more rarely diagnosticated during life. Weber has observed three cases from which he constructs a clinical picture of the disease. The first case was that of a woman, had been made of cirrhosis with ascites, 46 years of age, in whom at first a diagnosis but subsequently of ovarian cyst. Operation showed that the peritoneum was filled adherent to the serous membrane. The with a colloid mass which, in places, was uterus and its adnexa could not be exam

Dr. Henri Malherbe describes the case of a man, 35 years of age, who was the victim of an enormous hypertrophy of the lips, which were tripled in volume. This labial œdema seemed to have occurred without assignable cause. The patient was of undoubted lymphatic constitution. Codliver-oil was given internally, and every evening energetic compression was ined and it was necessary to close the abmade upon the lips by caoutchouc bands domen before the operation was finished. kept in place all night. Every eight days More than ten liters (17 1/2 pints) of colsuperficial linear scarifications were made. loid fluid were, however, withdrawn. The At the end of eight months of this treat-patient succumbed eight days after the ment, followed regularly, both lips had resumed the normal size.-Revue Hebdoma- operation. There was no autopsy. daire de Laryngologie, etc.

Exfoliative Glossitis.

At a meeting of the Society of Medical Sciences of Lyons M. Bouveyron reported the case of a man who had been afflicted

The second case concerned a woman, 76 years of age, in whom likewise ascites had been diagnosticated. Aspiration having given exit to colloid fluid, laparotomy was performed. The peritoneal cavity was full. of free colloid masses and thin-walled cysts as well as with colloid fluid. These cysts were present almost everywhere; the

ovaries were also transformed into colloid, but fixed at its posterior part. The cirmaterial. The case was believed to be one cumference of the mass was bathed in a of colloid cancer of the ovaries with mul- foetid fluid. On the next day this mass tiple metastases, and, radical intervention was, without the least hæmorrhage, rebeing deemed impossible, the wound was moved by vaginal injection. It formed a closed after the peritoneal cavity had been complete tube, upon the internal surface emptied of the free colloid masses which it of which the rugæ of the vagina could be had contained. The woman revived and did very plainly discerned. The microscope not die until two months later, of exhaus- also proved that the entire mucous memtion. At the autopsy it was found that brane had been expelled. It showed, in adwhat had been taken for a colloid cancer dition, numerous streptococci in the morwas, in reality, but a colloid cystoma. The tified tissue. The removal of this large free colloid masses of the peritoneum were eschar led to the formation of three fistulæ, derived from rupture of the cysts whose which communicated, respectively, with walls were exceedingly delicate. the urethra, bladder, and rectum.

In the third case operation showed the beginning of the process under the form of a multilocular colloid tumor of the ovary. The tumor was ruptured in spots; the col- | loid fluid was freely discharged into the peritoneal cavity and in places was adherent to the serous membrane. The patient was completely cured.-La Tribune Médicale.

Phlegmonous Perivaginitis.

Under this title Bazocchi and Zaccaria describe the case of a woman of 23 years, admitted to the hospital on account of a serious typhoid condition which had existed for about two weeks and was characterized by somnolence, headache, abdominal pain, and weakening of the heart's sounds. The pulse was frequent and the spleen hypertrophied. In the succeeding days the situation was aggravated. Chills and tremors became worse, and the skin was of a subicterode hue. The pulse was 120, the temperature oscillated between 38° and 39° C. (100.4° and 102.2° F.), with a slight evening rise. Nothing was learned from the serum-reaction.

Under these circumstances there was perceived for the first time, five days after entrance, the presence of some vaginal ulcers. Twelve days later another vaginal examination disclosed a mass of blackish tissue in the vagina, free at the periphery,

The general condition remained grave. At the end of five days peritoneal manifestations appeared. There was meteorism, with extreme sensibility of the abdomen to touch, vomiting, and delirium. At this time an exploratory puncture of the spleen revealed the presence in that organ of Eberth's bacillus, which rendered the diagnosis positive. The peritoneal symptoms gradually subsided, defervescence began two weeks later, and from that period the convalescence was uninterrupted.

When she left the hospital the woman preserved as evidence of the violent inflammation a cicatricial contraction of the lower part of the vagina scarcely admitting the passage of a finger. The fistulæ exhibited a tendency to spontaneous cure; without being entirely obliterated, they only occasionally permitted the escape of urine or fæces.-La Tribune Médicale.

Suture of the Heart, with Recovery. Dr. Watten has recently reported the case of a man, 23 years of age, who, during a scuffle, received a stab in the right side. of the chest. He was taken to the hospital three hours after the occurrence. The wound was about 4 centimeters (about 1 1/2 inches) in length, was situated in the fourth intercostal space of the right side, 2 centimeters (3/4 inch) from the border of

the sternum. Digital examination of the | time the patient, notwithstanding various wound, from which the blood issued in manifestations, such as cardiac weakness abundance, showed that the internal mammary artery was intact and that the diaphragm was not perforated. On the contrary, when directed upward and inward, the finger, after entering the pericardium, clearly detected a wound of the heart.