reaction of the blood was negative. Biopsy of a specimen from the base of the tongue showed carcinoma solidum. Roentgen treatment was recommended, and between April 30 and May 8 11,100 roentgen units were distributed over the right and the left anterior and posterior portions of the neck and over the intraoral regions. On September 9 the patient was readmitted, with a recurrence of his tumor at the original site. The lymph glands on both sides of the neck were palpable. On September 10 ten radon seeds were inserted into this mass, and the patient was discharged on September 14. During this admission a hard mass, measuring about 1 inch (2.5 cm.) in diameter, was noted in the midline in the floor of the mouth, directly behind the symphysis of the mandible. Roentgeno¬ grams showed erosion and destruction of the symphysis mentis. The patient was discharged from the hospital on September 14 and one week later returned for a further course of roentgen treatment to the floor of the mouth. Hospital of Philadelphia, in 1939, 320 (13 per cent) had otitis media. Of this group 126 had acute purulent otitis media. The cases of these patients were selected for review. Cases of patients with contagious diseases were not included in the group.The highest incidence of acute infection of the middle ear occurred from January to May, during which period 85 of the group were admitted. The majority (110 patients) were under 5 years of age, and 49 were under 2 years of age. The group included 77 boys and 49 girls, of whom 96 were white children and 30 were Negroes. Cultures of purulent discharge taken from the external auditory canal with a sterile swab showed mixed organisms, with Streptococcus haemolyticus, Pneumococcus and Staphylococcus aureus predominating. Acute purulent otitis media was associated with the following conditions : acute nasopharyngitis (febrile convulsions) in 37 patients, lobar pneumonia in 33, bronchopneumonia in 15, acute bronchitis in 8, diarrhea in 4, acute tonsillitis in 4, conditions following tonsillectomy and adenoidectomy in 2 and miscellaneous maladies in 11. In regard to 12 patients with acute purulent otitis media, no history of any accompanying or preceding illness could be obtained.Four deaths occurred in the group. Three patients were seriously ill on admission and died in less than twenty-four hours. In this group one had strepto¬ coccic meningitis with bilateral mastoiditis, another had Pneumococcus type V meningitis with bilateral mastoiditis and the third had Pneumococcus type XVIII meningitis. One patient with bronchopneumonia and mastoiditis died some days after admission.All the patients were divided into two main groups : those in whom spon¬ taneous drainage occurred and those who had myringotomy. Each of the groups was subdivided into patients receiving chemotherapy and those not receiving chemotherapy.
mediastinotomy is indicated in cases of mediastinitis and extending periesophageal suppuration. Dr. Arbuckle demonstrated that beautifully in the cases he pre¬ sented. My mention of conservatism pertained to patients in whose cases the diagnosis of esophageal perforation was still somewhat in doubt despite a slight elevation of temperature or even, occasionally, cervical emphysema. This type of case is variously described in the literature, and most authors have indicated that the patient recovers in a few days without surgical intervention. Head, Myerson, Van Eichen, Clerf and others have stressed the conservative management of this group of patients.Careful watchful waiting means, of course, frequent temperature readings as well as repeated white blood cell counts. I thoroughly agree that any increase in findings indicates immediate operation. Dr. Pearlman mentioned laceration of the esophagus as opposed to perforation, and this difficult differential diagnosis is all important. Routine mediastinotomies in questionable cases would appear to be unnecessary, and I cannot agree wth Dr. Galloway that such an operation is simple and without danger. This brings back the question of the term "prophylactic mediastinotomy." This term originally denoted drainage of the mediastinum through the neck in cases of external trauma of the esophagus, such as that from stabbing or a gunshot wound. At the present time the term is frequently used loosely to designate the opening of the retropharyngeal space and the placement of a gauze pack in the inferior part of the wound in an attempt to keep the infection from traveling into the mediastinum. Dr. Lederer and Dr. Fishman suggested clarification of this term in an article written in 1934 and gave reasons for and against the operation. Certainly the term should not be used when a simple mediastinotomy is done to drain an advancing mediastinal infection due to an esophageal perforation.A brief review is presented of the more important hematologic disorders affecting the nose, oropharynx, larynx and auditory apparatus. Lingual mucosal strophulous glossitis and dysphagia in connection with anemia respond favorably to treatment directed toward the special type of anemia and the underlying cause.In the Plummer-Vinson syndrome curious veils of mucous membrane partly obstruct the lower part of the pharynx. Here, too, treatment directed to the disease is more effective than esophageal instrumentation. Aplastic anemia is frequently associated with oropharyngeal ulceration, necrosis and bleeding, and any severe anemia may produce vertigo, tinnitus and even deafness.
In April 1941 the patient was seen in the neuromedicai service. The impression at this time was that there was a disturbance of function in the pons and the cerebellum. However, roentgenograms of the skull failed to show evidence of tumor. On May 12, 1941 the patient still had dizziness and headache, although of less severity.
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