NOSE, THROAT AND EAR.

UNDER CHARGE OF RICHMOND MCKINNEY, M.D., MEMPHIS. Laryngologist to East End Dispensary; Laryngologist to Presbyterian Hospital. Case of Recovery After Abscess in the Left Frontal Lobe.

At the Berlin Medical Society, Herzfeld (Med. Press & Cir., vol. 72, no. 3245) showed a young man aged 20. The patient came to the Klinik on May 15; he had nasal catarrh first on the right and then for three weeks on the left side, then he had severe left frontal headache of a malarial type. Examination showed swelling of the mucous covering of the turbinated bones, copious purulent discharge, high temperature (40° C.), and slow pulse, 86 at first, later 50. The speaker, from the character of the pulse, concluded that intracranial disease was present. On May 22d he trepanned the left frontal sinus; this contained much pus and granulations. The posterior wall of the sinus was carious, and could be penetrated with a probe. This was removed when the dura mater projected. No pus appeared at first. Then a piece of frontal bone was opened, the dura mater split, when a large quantity of pus escaped from the subdural space. A small fistula led into the abscess cavity proper. This was enlarged until the finger could be passed in. The result was favorable. The rather large intradural and intracerebral abscess had caused absolutely no other symptoms than those named. The intelligence had in no way suffered except for slight weakness of thought.

A Mucous Polyp, Springing from the Right Eustachian Tube Eminence.

A. Jurasz (Monat. fuer Ohrenheilkunde, vol. 35, no. 6) reports a rare and interesting case of mucous polyp, growing from the eustachian eminence of the right ear. Indeed the occurrence of a true mucous polyp in the nasopharynx is of such rarity that the author has nowhere in the literature seen a similar case reported.

The patient was a woman, 26 years of age, who consulted Jurasz on account of a simultaneously developing stoppage of the right naris, and a persistent dryness of the throat, which had presented themselves every morning for a year.

Further symptoms there were none, particularly no disturbance of hearing. The rhinoscope showed anteriorly no abnormality. On the contrary, posterior rhinoscopy revealed in the nasopharynx a gray, semi-transparent, ball-like tumor about the size of a walnut, which lay on the right side, and covered the lower portion of the right choana. Otherwise there was neither in the throat nor in the trachea any change whatever apparent.

Failing to remove the tumor with a snare through the nose, it was caught through the mouth in a fenestrated forceps and thus removed. Examination with the mirror revealed a dropof blood coming from the superior border of the right tubal eminence, which was concluded to have been the seat of the tumor's attachment. The choana of this side appeared perfectly normal. No further mucous polyp could be found in this region or in the nose, so it was apparent that this was an isolated tumor, without any relation whatever to the nasal choanæ. Microscopic examination of the tumor showed it to be a soft fibroma.

A Contribution to the Study of Lupus of the Larynx.

Durano, in his Paris thesis (Rev. Heb. de Laryng. d'Otol. et de Rhinol., vol. 22, no. 28) devotes several pages to a succinct consideration of the general characteristics of lupus vulgaris,. of which lupus of the larynx is a manifestation.

According to the published statistics, laryngeal lupus is observed in a proportion of 9 per cent. It is more frequent in adults. It is encountered especially in females. Lupus generally is insidious in its onset, frequently being unperceived, since it. provokes no pain, and, in most cases, no vocal trouble. In the majority of cases it remains confined to the region above the glottis, leaving intact the vocal cords. Nevertheless the patient may present himself with hoarseness, and complete aphonia, when the cords are invaded and ulcerated.

Laryngoscopic examination reveals a pale general color of the organ, which contrasts with secondary lupus, where the coloration is much deeper in the neighboring portions. Upon the thickened and infiltrated mucous membrane we encounter at times superficial erosion, at times ulcerations with a grayish and pimpled base, and edges thickened and bare.

The epiglottis is frequently attacked with laryngeal lupus; it presents at times a vast loss of substance, and its edges are cut out. The vocal cords may be rough, tumefied, and present pimples and ulcerations; they may be attacked with paresis and even paralysis.

Primary lupus of the larynx is very rare; the symptoms are the same as those of secondary lupus.

As in all tubercular troubles, the prognosis of lupus of the larynx is serious. The functions of the vocal cords may be compromised in a definitive manner; further, a laryngeal stenosis with all its consequences may be produced. Generally this affection is slowly evolved, and its duration may be very lengthy.

It is of utility to examine all of the mucous membrane of patients suffering from lupus. This may be of value in differentiating this affection from other laryngopathies that are likely to be confused with lupus.

Tuberculosis of the larynx invades especially the arytenoid region, the ventricular glands and vocal cords; the voice is more alterated than in lupus. There frequently exists dysphagia, and the general state of the patient is very much compromised.

The differential diagnosis of laryngeal lupus from tertiary lues is more difficult, because these two affections have much the same situation, the same tendency to slow evolution and insidious destruction of the tissues. In the doubtful cases specific treatment decides the question.

It is necessary to bear in mind the fact that hybrid conditions or tuberculosis are not rarely encountered in association in practice.

It is much easier to differentiate laryngeal lupus from cancer of the same region. Laryngoscopic examination reveals variable lesions, according to whether there exists an encephaloid or epitheliomatous form of cancer. Further, the fetid breath, glandular enlargement, the age of the patient and the cachexia permit an avoidance of error.

The treatment of laryngeal lupus is general and local. The first should be nothing other than that of treatment of pulmonary tuberculosis; the local treatment of topical medication. such as is commonly applied in tubercular laryngitis.

GYNECOLOGY AND OBSTETRICS.

UNDER CHARGE OF T. J. CROFFORD, M.D.

Professor of Gynecology, Memphis Hospital Medical College,

AND

W. D. HAGGARD, M.D.

NASHVILLE, TENN.

Professor of Gynecology and Abdominal Surgery in University of the South (Sewanee); Gynecologist to the Nashville City Hospital; Professor of Gynecology,

University of Tennessee.

Injuries of the Head in the New-Born.

A. F. Currier (Med. News, vol. 79, no. 5) has made a study of more than 60 cases in which the skull was injured in process of birth, from which he draws these conclusions:

Indentations and depressions of bone showed 2 of the right frontal, 16 of the left; 5 of the right parietal, 9 of the left; 1 of the right temporal; 1 of the occipital and left parietal. The depressions varied from inch to 2 inches long, inch to 1 inches deep, and inch to 1 wide. The marks and depressions disappeared in most cases in a few weeks or months, but in some cases they remained visible for years.

In 17 cases there were fractures of one or more bones. In 1 case there were extensive dislocations of cranial and facial bones. In 5 cases the bones were fissured. In 5 cases the scalp was more or less extensively lacerated. In 5 cases the brain was injured. In 4 cases there were injuries during fetal life.

There were 21 forceps deliveries, 3 high forceps, and 3 versions. There were 12 normal deliveries, and 7 labors were prolonged, the period varying between fifteen hours and six days. There were 3 precipitate labors. There were 6 cases in which there was tumor of the scalp. In 23 cases there was hemorrhage of one variety or another.

Of the abnormal presentations 2 were breech, 1 face, 1 face, arms and cord, 2 occiput posterior. There were 5 cases in which there was coma and 6 of convulsions, 4 of paralysis, 1 of idiocy. In 24 cases there was deformity of the pelvis of one kind or another.

Death occurred in 26 cases from various causes.

In 3 cases

the scalp was incised and the bone elevated, and in 1 there was trephining and elevation.

VOL. XXI-36

Ovarian Symptoms and Their Value as Evidence of Ovarian Pathologic Conditions.

L. W. Atlee (Amer. Jour. Obs., etc., vol. 44, no. 284) in an exhaustive paper endeavors to demonstrate the ease with which symptoms arising from conditions other than diseased ovaries may be confounded with the symptoms supposed to be given rise to by them. He claims:

That certain uterine pathologic conditions may cause symp toms which are most marked by pain referred to the regions we have been taught (erroneously, perhaps) appertain especially to the demonstrations of ovarian disease.

That in certain women, when the general health has deteriorated, though showing no pathologic condition beyond anemia of a mild grade, symptoms referable to the ovary are not infrequent.

That in a woman with a neuralgic dyscrasia, should the neuralgia develop in the lumbo-abdominal distribution, very confusing symptoms may arise.

In the peculiar condition sometimes seen in women passing large quantities of oxalate of lime crystals in their urine, the symptoms referable to renal, ureteral and vesical irritation may simulate or lead to a diagnosis of ovarian disease.

In the two great neuroses, neurasthenia and hysteria, we frequently have symptoms simulating those given rise to by true pathologic conditions.

The treatment indicated for reflex ovarian symptoms is the correction of the morbid conditions giving rise to them; and in the searching light of modern scientific medicine, with its numerous aids to a correct diagnosis, a better understanding of cause and effect in these cases, and hence a clearer and truer deduction from premises, we will find the indications for spaying narrowing themselves down to a quota that will make a very small figure when compared to those of a decade ago. The number of women who are now walking demonstrations of the futility of this measure are a lesson from which much may be learned, and they can cry out against such treatment in the words of Talleyrand, "worse than a crime, it was a blunder."