treatment, by the use of caustics and the pharyngeal douche, has succeeded in removing all traces of the vegetations. In such cases the best method probably would be the employment of the galvano cautery as used by Voltolini, but I myself have never employed it.

The good effects of the operation generally appear quickly. As soon as the posterior nares are cleared the voice becomes more sonorous, the pronunciation clearer, and, as the respiration now occurs through the natural channels, the expression of the face is at once changed in a surprising manner. If any organic alterations in the tympanic cavity have already taken place, owing to the catarrh extending so far, the effect of the operation on this part may be trifling. But if such changes have not taken place, the hearing will be considerably improved, although the disease has continued for a long period, and I have even observed defects of the membrana tympani to be repaired after the operation. The anomalous signs above mentioned as occurring during the inflation of the Eustachian tube and tympanum by the air-catheter invariably disappear. In recent cases the hearing can be perfectly restored to its normal state, even without the employment of Eustachian catheterism. As a matter of course, the surrounding mucous membranes, which generally suffer at the same time, must have their proper share of therapeutical attention.

If the vegetations are completely removed by operation, I have reason to believe that the cure will be radical. At least I have never observed a recurrence of the complaint during the year and a half which have elapsed since I performed the first operation. It is true that I have paid especial attention to the after treatment, and continued it for a long time, and this plan I most urgently recommend to those of my confrères who may have an opportunity of removing the local disease by the above-described little operation.

It would be easy to illustrate the preceding descriptions by reports of cases from my journal, some occurring with and others without an accompanying defect of hearing. I trust, however, that I have said enough to induce others to apply

themselves practically to a complaint which, although not dangerous, is still very troublesome and important in its consequences.

DESCRIPTION OF PLATE V.

Adenoid Vegetations in the Naso-Pharyngeal Cavity.

Fig. 1. Cylindrical vegetations on right lateral wall of the nasopharyngeal cavity, covering the opening of the Eustachian tube: remains of vegetations after operation in fornix and left lateral wall (rhinoscopical view).

Fig. 2. Microscopical view of a section of the adenoid vegetation from the fornix,

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