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A 5-year-old boy presented with an infected left-sided branchial fistula. Despite antibiotic treatment and repeated excision of the fistula, purulent discharge from the wound persisted. Three-dimensional computed tomography (3D CT) reconstruction greatly facilitated the diagnosis and management of this case by showing the course of the fistulous tract. The complexity of the tract suggests that this represents a variant arch anomaly because it contains features of first, second, third, and fourth arch remnants.

A case of tuberculous osteomyelitis of the mandible in a 76-year-old woman is reported. The patient sought treatment for a periostitis of the left side of the mandible. A purulent discharge was evident. Roentgenographic examination of the mandible revealed bone destruction from the midmandible to the ramus on the left side. The diagnosis was made by microscopic examination of the specimen from the involved bone. This case proved to be primary tuberculous osteomyelitis caused by the absence of the primary focus.

Endometritis is a localized inflammation and/or infection of the uterus, characterized by subinvolution, and associated with chronic bacterial uterine infection and purulent discharge. Diagnosis and treatment of endometritis is a source of controversy among practitioners fueled by lack of large-scale clinical trials with objective case definitions and economically meaningful outcomes. Objectives of this study were to assess diagnostic criteria for endometritis and quantify its impact on reproductive performance., American Association of Bovine Practitioners Proceedings of the Annual Conference, 2000

Background Antimicrobial resistance (AMR) in Neisseria gonorrhoeae (Ng) is a major public health problem worldwide. Nucleic acid amplification tests (NAATs) have rapidly replaced cultivation for detection of Ng. We have evaluated the ESwab system for NAAT diagnostics combined with delayed Ng cultivation of NAAT positive samples for gonococcal AMR surveillance. Methods Based on clinical indications, a urethral, cervical or anal swab was collected from patients with purulent discharge. Gold standard for diagnosis was the APTIMA Combo 2 assay (Gen-Probe). In another study, swabs from urine (UR) and urine sediment (US) were collected if Gram-negative diplococci were observed in direct smears. Flocked swabs were stored in ESwab Liquid Amies (Copan) at room temperature (RT) and 4°C and cultured after 1, 24 and 48 hours. Results From 35 patients with Ng positive NAAT, we obtained 34 (97%) Ng cultures from ESwab samples stored for 1 hour at RT. Storage for 24 hours at 4°C and RT resulted in 32 (91%) cultures. Storage for 48 hours at 4°C yielded 25 (71%), and at RT only 13 (37%, p = 0.007) cultures. Fourteen urine samples resulted in 13 (UR) respectively 14 (US) cultures after storage for 1 hour at RT. Storage for 24 hours at 4°C and RT resulted in 11 and 7 (UR), respectively 12 and 10 (US) cultures. Storage for 48 hours at 4°C and RT gave 3 and 1 (UR), respectively 5 and 2 (US) cultures. Conclusion Delayed Ng cultivation from the ESwab system was successful after storage at 4°C for 24 hours in 91% and for 48 hours in 71% of cases. The ESwab system for NAAT diagnostics combined with delayed Ng cultivation of positive NAAT samples appears highly effective for future sustainable and essential gonococcal AMR surveillance. This approach is now being validated in routine practise.

In daily thoracic surgical practice characterized by “oncogenic addiction,” the extent and importance of infections of surgical interest are underestimated. However, vast geographic areas of our planet are still plagued by thoracic infections. In the Western world, reduced exposure to pleuropulmonary infections has rendered surgical training somewhat incomplete. In our current state of knowledge, surgery for infectious disease is misinterpreted as the surgical management of infectious complications. In contrast, the history of thoracic surgery has been marked by surgeons contributing with their skills to the anatomic and biological eradication of pleuropulmonary infections. Experienced surgeons will likely agree that surgery for thoracic infections is the mother of all surgeries, decisively contributing to the birth of modern cardiothoracic surgery. A number of images remain carved in stone in the memories of trainees and thoracic surgeons: severely depleted and emaciated patients, dissection of complex mycetomas growing into the apex, the threat of postoperative bleeding despite extremely cautious hemostasis, and the unrelenting purulent discharge from a Petzer drain of

Background: The aim of the present study was to assess the incidence of wound sepsis following closure of ileostomies and colostomies in our institution. Methods: Circumferential subcuticular wound approximation was used in 51 patients in our institution. Evidence of wound sepsis (assessed by the presence of cellulitis, induration and or purulent discharge) was documented both in the postoperative period and in outpatient follow-up. Results: A wound infection rate of 0% was achieved, both in the immediate postoperative period and upon 6-week follow-up. Conclusions: Circumferential subcuticular wound approximation is, therefore, a safe and efficacious technique for dealing with the skin woundafter stomal closure, virtually abolishing wound sepsis.

Purpose: The modified Hanley technique, which is used for treatment of a deep horseshoe fistula, has reduced damage to the external anal sphincter compared to the classic Hanley technique, but its shortcoming is that it causes inconvenience to the patient due to the fact that a drainage tube must be left in place for a long time. To solve this problem, the authors devised a self-pulsed washable seton and then compared the results of its use to determine its clinical usefulness. Methods: The subjects of this study were 34 patients who were diagnosed with a deep posterior complex anal fistula and who were operated on by using the modified Hanley technique between January 1999 and December 2004. Twelve patients who were treated with the self-pulsed washable seton were classified as Group A, and 12 patients who were treated by using a conventional loose seton were placed in Group B. These two groups were compared for period of purulent discharge, period of leaving the seton alone, and recurrence rate. Results: The period of purulent discharge was 18.75 days (15∼24) for group Aand 29.75 days (24∼37) for group B. The period of leaving the seton was 21.58 days (18∼29) for group A and 32.58 days (28∼39) for group B. The recurrence rate after surgery was 8.3% in group A and 16.7% in group B. Conclusions: The self-pulsed washable seton devised by the authors shortened the treatment period through more effective wound management, so we propose using it as a new method for treating a deep posterior horseshoe fistula.

An 11 week old baby boy had an infected hemangioma of the right fifth finger. Necrosis and a purulent discharge that cultured staphylococcus aureus developed distally. All treatments were performed with the SPTL 1 flash-lamp pumped dye laser

We describe a case of a high-pressure polyurethane injection injury to the hand, and discuss how its management differs from other injection injuries. A male patient was transferred to our hospital due to persistent purulent discharge from the 2nd finger, which began 15 days after the injury. The injected foreign body, polyurethane, could not be recognized by the patient and was not indicated radiographically. During surgery, the polyurethane foam was removed. The patient had no functional impairment 24 months after surgery.

A 73-year-old man who had undergone a right pneumonectomy and open window thoracostomy due to tuberculous empyema, presented with purulent discharge from the previous operation site. The computed tomography of the chest showed diffuse pleural thickening and a low attenuated lesion, with air bubbles in a dependent portion of the right hemithorax. These air bubbles were revealed to be due to 7 pieces of retained surgical gauze by flexible bronchoscopy. The patient showed marked clinical improvement with diminished purulent discharge after removal of the foreign bodies. (Tuberc Respir Dis 2004; 57:78-81)

A 14-month-old girl had purulent discharge from a sinus over the subpubic region for 2 weeks. Radiography and voiding cystourethrography revealed a 4.5 cm. long fistula extending to the retropubic region without any connection to the lower urinary tract. The fistula was excised. Histological findings revealed that the fistula had 3 different types of epithelium: stratified squamous, transitional and columnar. Clinical and pathological findings indicated that the sinus was most likely a remnant of the cloaca.

A 14-year-old Quarter Horse was presented for evaluation of a chronic, intermittent purulent discharge from the left nostril. A radioopaque mass and multiple, air-fluid interfaces in the paranasal sinuses were identified on survey radiographs. The mass was removed and identified as a dentigerous cyst. Substantiated reports of dentigerous cysts in the paranasal sinuses are rare.

The use of "crack" cocaine is now reaching epidemic proportions, and with it a myriad of previously unrecognized medical complications have arisen. 1 An ophthalmologic condition called "crack eye" has recently been described. 2 Patients with crack eye have exhibited pain, photophobia, lacrimation, chemosis, and hyperemia in association with corneal epithelial defects. We have seen a patient who presented with bilateral infectious corneal ulcers. Her presenting complaints included a relatively painless decrease in visual acuity, redness, and persistent purulent discharge. Report of a Case. —A 27-year old Hispanic woman presented to the ophthalmology clinic at Jacobi Hospital, Bronx, NY, with decreasing visual acuity of 3 weeks' duration in both eyes. She first started smoking crack approximately 4 months prior to being seen. At that time she noticed redness, burning, and itching. These symptoms initially caused her to rub her eyes frequently, but during the next 2 months, in spite of

A case of a 12 years old school girl is described. She presented nine days after the onset of acute periumbilical abdominal pain which was later accompanied three days prior to admission by purulent discharge from the umbilicus. Radiological investigation revealed a pelvic collection of pus with retroperitoneal extensions. Late presentation made the attempt to save the patient unsuccessful. A review of the literature reveals that extensive intraperitoneal and retroperitoneal extension of abscess resulting from anomaly of the urachus is extremely rare.

It has been shown that persistent penile irritation and purulent discharge from around the urethral meatus may rarely be caused by inflammation of tiny tubular structures previously known as paraurethral ducts. They appear to be rare embryologic remnants which can be involved in the venereal disease complex. Local excision is the appropriate treatment if symptoms are not responsive to antibiotic therapy.

Eleven patients with olfactory disturbances caused by inflammation of the ethmoid sinuses are reviewed, and the functional results of endonasal surgery are evaluated.Rhinoscopic examination showed the presence of a purulent discharge and mucosal thickening of the superior meatus.Radiographic examination showed opacity in the ethmoid sinus and the olfactory region.A standard olfactory acuity test, each side separately in 9 patients and both sides together in 2 patients (20 tests in 11 patients), and an intravenous olfaction test with alinamine were performed before and after surgery.The standard olfactory acuity test showed that 16 out of 20 (80%) recovered more than 1 grade in the detection threshold, and 15 out of 20 (75%) recovered more than 1 grade in the recognition threshold after endonasal ethmoidectomy.We conclude that patients with olfactory disturbance caused by ethmoid sinusitis can expect good results of surgical treatment.

A case of hemangioendothelioma in the mastoid bone and ear is presented. This tumor is very rare in the skull and has never been reported in the ear. The presenting symptoms were purulent discharge and loss of hearing in the involved ear. Excision of the tumor was followed by irradiation, and the patient is well and free from disease three years postoperatively.

DACRYOCYSTORHINOSTOMY in adults has become the procedure of choice for the cure of chronic dacryocystitis, mucocele, and epiphora. The marked trend from dacryocystectomy to dacryocystorhinostomy is due to the high percentage of successes of the latter in relieving the purulent discharge and tearing. There is apparently no reason for any other procedure being performed for these conditions so long as at least one canaliculus is patent. Age is not a contraindication. Rychener1has employed this operation on patients from the age of 18 months to 72 years. I have performed the operation for the relief of recurrent acute dacryocystitis in a patient 80 years of age. The need for dacryocystorhinostomy in young children has been mentioned only in the recent literature. Redmond2reported its use bilaterally in a 3-year-old child, with success, and Aalde,3in a 3-month-old boy. Simpson4successfully performed dacryocystorhinostomy on a 7-year-old boy

THE mouth contains a variety of anaerobic and micro-aerophilic organisms which under normal conditions are harmless saprophytes. However, when oral tissues become devitalized or diseased these same bacteria may cause an infection which is painful, debilitating, and resistant to treatment. The condition is characterized by a fetid odor and necrosis of tissue to form thick adherent slough, without a great deal of purulent discharge, unless there is secondary deep abscess formation. This type of infection so frequently accompanies tumors of the oral, nasal, and paranasal cavities that it has become one of the major problems in their management. The complication may occur in the primary tumor, in a post-operative cavity or surgical defect, or in an area of necrosis resulting from roentgen or radium therapy. Once the process has gained a firm foothold, it is difficult to overcome by ordinary measures. Instrumental removal of slough is inadequate. The usual oxygenic agents such as sodium perborate, potassium chlo...

THE TERM "sinusitis" has a definite meaning. There is a tendency, however, to use it as a "grab bag," into which all problems referable to the nose are thrown. It is just as dangerous to put the word into the vocabulary of the enlisted man as is the term psychoneurosis. Preferably, it should be used with care and only after definite evaluation. Persistent purulent discharge from the upper part of the nose following the usual period of a "cold in the head" is the deciding point, a condition which occurs in only a relatively small percentage of personnel at the Orlando Army Air Base. The symptom complex of headache, nasal obstruction and anterior or posterior discharge of nasal mucus is usually indicative of acute catarrhal rhinitis and not of sinusitis. Cultures of discharges of nasal mucus from normal-appearing nasal passages were taken at the Orlando Army Air Base during a

Metastatic hypernephroma of the accessory nasal sinuses is, judged by the literature, of infrequent occurrence; this case is reported in the hope that it may, therefore, be of some interest. REPORT OF A CASE The patient, a white woman aged 52, first seen on Jan. 25, 1934, complained of a swelling above the right eye and a bloody purulent discharge from the right nostril. The family and the personal history were completely irrelevant. The patient had had an infection of the head in November 1933, with profuse bloody purulent discharge, especially from the right nostril. The infection apparently subsided, but a month later a slowly increasing swelling appeared above the right eye; the nasal discharge, both anterior and posterior, persisted, but there was no pain or headache. The patient thought the vision of the right eye was slightly impaired. Except for occasional discomfort in the left upper quadrant of the

Tuberculosis of the middle ear and mastoid is more frequent in adults than is generally recognized on account of the difficulty of finding tubercle bacilli in the purulent discharge. In infants and young children the disease extends to nearly all parts of the temporal bone and, because of this, is more serious than in adults. For those who practice in the West, the disease assumes relatively even more importance, because of the number of tuberculous patients who annually come West in search of health. Judging from a study of the literature, tuberculosis of the middle ear rarely receives the serious consideration that such an important disease deserves. The milder types are easily overlooked, unless the etiology of all cases of suppurative otitis media can be thoroughly studied by a competent bacteriologist. The absence of pain often results in a late examination by an otologist, because patients do not seek

Summary A survey of the flora of the vagina of 100 apparently normal dairy cows is reported. C. renale is a frequent and possibly normal inhabitant of the posterior urinary tract of dairy cows. Its significance is discussed. C. pyogenes is associated with an endometritis in cows characterised by copious purulent discharge. Apart from C. pyogenes there is no evidence of other organisms being associated with sterility in cows.

Summary A study was made comparing the effects of artificial insemination techniques on maintenance of pregnancy in cows (64th to 152nd day of pregnancy). Using semen diluted with sodium citrate-sulfanilamide-yolk, seven cows were inseminated by the rectovaginal technique with mid-cervical deposition of semen and eight cows with intrauterine semen deposition. All cows that received mid-cervical semen depositions continued normal pregnancies and had normal intact fetuses and fetal membranes when slaughtered 18 to 44 days later. Of eight cows inseminated just into the uterus, one aborted 9 days after the insemination. The remaining, cows of this group had fetal resorptions, as manifested by a purulent discharge prior to slaughter and the presence of disintegrated fetuses and fetal bones upon slaughter 18 to 77 days following the insemination. In four of six cows that were inseminated into the uterus with diluted semen containing added penicillin and streptomycin, normal pregnancies continued, while pregnancy was interrupted in the other two. Therefore, mid-cervical deposition of the semen by the rectovaginal technique is recommended in the artificial insemination of cows.

In view of the striking results reported to have followed the injection in persons suffering from various infections, of bacteria killed by heat according to the method advocated by Wright, it was thought desirable to test this method of treatment in patients with streptococcus complications in contagious diseases, especially in scarlatina. We have seven such cases to report. The bacteria injected were grown upon serum agar slants for 24 hours at 350 C. They were then suspended in 0.85 per cent sodium chloride solution and killed by heating to 600 for 30 to 45 minutes. In each instance cultures from the suspension after heating showed it to be sterile. The number of bacteria in the suspension was determined by Wright's method. The culture was always obtained from patient to be treated, from the purulent discharge from the abscess, the ear, or nose, or from the surface of the tonsil. Determinations of the opsonic index were made by Wright's method, the cultures from the individual being usually employed, although the indices closely corresponded, whatever streptococcus was used. The index was usually estimated daily and served as a guide to the injections. A pronounced fall in the index following the injection was rarely observed, but more or less rise was found after each injection except one. Slight local tenderness usually was found present at the place of injection for a day or two, and occasionally the local reaction was quite pronounced. Some idea of the character of the cases and their course can be

Of all the infectious agents that afflict the eyes of the newborn infant the most serious and historically the commonest is Neisseria gonorrhoeae. Numerous other infectious agents such as Staphy-lococcus aureus, Diplococcus pneumoniae, Streptococcus viridans or hemolyticus, Haemophilus influenzae and, rarely, a number of other bacteria may be the cause of conjunctivitis. However, most of these appear later than the fifth day of life, and frank purulent discharge is rarely seen.1 The adoption of legislation in most parts of the world has brought about a great advance in the prevention of gonorrheal conjunctivitis. In the United States 49 of . . .

Congenital prepubic sinus (CPS) is an extremely rare anomaly, which is often associated with purulent discharge from a midline opening overlying the pubis. CPS was first described by Campbell et al. in 1987 and they suggested that it might represent a variation in normal embryological development. Several theories have been proposed regarding the pathogenesis of CPS. However, the etiology of CPS is still unclear because the anatomical and pathological features of CPS often differ from each other. We report a case of CPS and review the literature to improve the global understanding of CPS.

Tympanostomy tube treatment was used in 181 patients on 323 ears and a followup study was made as an average three years and two months later. Sixty-five percent of the ears had healed completely and in these the average tube treatment time had been 11.3 months. In 22% the tubes were still in position, the average time for treatment being 24.2 months. Five percent showed purulent discharge and recurrence of the glue ear was noted in 3%. A dry perforation developed in five patients. Cholesteatoma was seen in four ears but in only one of these it may have been related to the location of the tube at the posterior drum margin.

Inflammation of periorbital tissues is common in pediatric patients, but little information regarding guidelines for treatment is available. The patient with periorbital cellulitis has erythema and swelling of the soft tissues of the eye. The condition is distinguished from more severe orbital involvement by the absence of ophthalmoplegia, proptosis, or impaired vision (Table I).1 This review was initiated to develop bacteriologic data for the treatment of periorbital cellulitis. PATIENT POPULATION Patients hospitalized at the Children's Hospital of Denver between December 1972 and June 1976 with the diagnosis of orbital or periorbital cellulitis were reviewed. Patients with periorbital cellulitis (lid swelling and erythema without ophthalmoplegia, proptosis, or impaired vision) were analyzed; clinical, bacteriologic, and roentgenographic data were obtained. A positive blood or cellulitis aspirate culture was required to prove a bacteriologic cause. Roentgenograms were interpreted by two pediatric radiologists. FINDINGS Seventy-one cases of periorbital cellulitis without orbital involvement were identified during the study period. Children ranged in age from 10 days to 18 years; 41 (58%) were 4 years of age or younger. The right periorbital tissues were involved in 39 patients (55%) and the left in 28 (39%); bilateral involvement was noted in four. A temperature greater than 37.8 C (100 F) was documented on the day of admission in 52 (73%) children; 34 (48%) had temperatures greater than 38.3 C (101 F). Although not a presenting complaint, 19 (27%) exhibited mild conjunctival hyperemia without purulent discharge. Clinical sinusitis manifested by a history of drainage, pain, or local tenderness was noted in ten (14%) patients.

Infections of the Middle Ear as Related to Other Respiratory Infections.Dr. George S. Frauenberger. (The presentations were from the Central Institute and the National Forum for Deafness.) Of the 2,529 patients admitted to the Inpatient Department of the Children's 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

Penicillin has undoubtedly been used locally in sinusitis by many physicians. However, since a patient treated by us evidenced such remarkable improvement, it is felt that a report of the case and the method may be of interest. REPORT OF A CASE The patient was treated on foreign duty in an Army station hospital where reference to any great amount of literature is impossible. The use of penicillin was based on the excellent and comprehensive information found in the War Department Technical Bulletin no. 9, issued Feb. 12, 1944, which is prepared by the Surgeon General and distributed to all medical officers of the Army. The patient was first seen at an outpost, complaining that he had been troubled with nasal obstruction and copious purulent discharge for the past seven or eight years and that the condition had become worse in the past four months. "Examination of his nose revealed

An epidemic of very large proportions has occurred on a number of fox ranches in Minnesota. The specific disease under consideration had been diagnosed as “fox distemper” because of its similarity, from the clinical aspect, to the disease in dogs which is known as “canine distemper.” The varied features of canine distemper, which is described as appearing in several forms—the upper respiratory, the central nervous system, and the intestinal types—were all present in the foxes afflicted with this disease on each individual ranch. Most foxes exhibited a very marked infection of the conjunctiva and nasal cavity, from which issued a purulent discharge. A large number of foxes exhibited nervous symptoms before death, ranging from muscular twitching to violent convulsions. A diarrhea appeared to be always present.Many foxes were not recognized as being sick but were found dead in their pens, although visited daily. Autopsies on a hundred foxes showed a great preponderance of pneumonia, usually extensive. The li...

A 12-year-old-male child, presenting with bilateral proptosis and with features of chloroma, later developing a picture of full-fledged acute myeloid leukaemia, is presented. The literature is briefly reviewed.

Myringitis granulosa is not a rare pathologic condition of the tympanic membrane. However, the condition can be misdiagnosed as chronic suppurative otitis media, since intermittent purulent discharge is the commonest symptom in both disorders. Although the clinical features of myringitis granulosa have been well described by several authors, its pathogenesis is still obscure. In this study, 40 cases of myringitis granulosa were examined in detail to clarify the clinical features and the pathogenesis present. No drum perforations, no hearing impairments and normal X-ray findings indicated that myringitis granulosa had no relation to chronic suppurative otitis media. The other areas of the affected tympanic membrane, except for the site of granulation, showed such pathologic conditions as atrophy, clouding and calcifications. In these pathologic tympanic membranes, epithelial migration was disturbed to a high degree. We suggest that the granulation process on the tympanic membrane should be divided into two stages: (1) injury reaching the lamina propria of the tympanic membrane; and (2) disturbed epithelization of the tympanic membrane. The disturbance of epithelial migration of the tympanic membrane occurs with both stages.

The occurrence of purpura as a complication of gonorrhŒal rheumatism has been noted so seldom that I report the following case: March 2. Mr. B., aet. 19, milkman, with a previous history of chronic gonorrhŒa, has had an acute exacerbation since February 8; also an efflorescence on lower extremities since February 26; also pain and swelling of several joints, March 2. On examination: penis Œdematous; purulent discharge from urethra, containing gonococci; inguinal lymph glands swollen spindle-shaped. A symmetrically distributed efflorescence of anterior and inner aspect of leg, and inner aspect of thighs extending into gluteal regions; over left ankle, the most troublesome joint, skin thickly covered; also upper extremities present a limited number about the wrists; rest of body free. The great majority of the lesions macular, some slightly elevated, of definite, irregularly circular outlines; sizes varying from pinhead to one-cent piece in area; in color a deep bluish-red, not

On May 22, 1899, Dr. Fuller, of Bath, sent me an infant suffering from ophthalmia neonatorum. Dr. Fuller had been called in consultation to see the baby in Richmond and found it in such a critical condition that he advised having it taken to me at once. The baby was between two and three weeks old, and the disease had developed into a critical condition. There was a profuse purulent discharge issuing from both eyes, and so much chemosis and swelling of the lids that it was difficult to make a satisfactory inspection of the cornea of either eye; it was finally determined that the cornea was involved and about to break down in each eye. The mother was making a supreme effort to save the sight of the child, having recently left her bed to make the journey to Portland. She was delicate, exceedingly nervous, but intelligent and anxious

One hundred and fifty cases of congenital dacryocystitis are analysed. Epiphora alone should be treated conservatively with local massage and antibiotics. Syringing and probing should be done in all cases of purulent discharge. The best results are obtained when it is done in the first year of life, and where the duration of discharge is less than 2 weeks.

Otitis Externa Granulosa is not a very uncommon condition seen in our country. The condition is associated with accumulation of wax prior to the infection of the lining of the external auditory meatus. The foul smell is due mainly to the wax forming a solution in the purulent discharge. It is recommended that the granulations be removed by a careful curettage and the ear cleaned by dry mopping on a single attempt with patient under general anaesthesia.

REPORT OF A CASE. Patient. An army officer, 50 years old, unmarried, was under my care during the last two weeks of his life. For much of the previous history I am indebted to Dr. A. Howard Smith, of Marietta, Ohio. History. Both parents died of heart disease. The patient had spent most of his life at army posts in the west. He is said to have been a neat, sober, quiet, well-balanced man. There is a probable history of syphilitic infection twentyfive years ago. About ten years ago he was operated on for fistula in ano. He had considerable purulent discharge from the ears and had a mastoid operation many years ago. Ten years ago he was retired from active service. During the last two and a half years he served as a recruiting officer. Inquiry at the Adjutant General's office in Washington brought the following list of ailments for which

At many medical meetings physicians have listened to a discussion of this subject from various standpoints, radical and conservative, without coming to a definite conclusion, and I do not suppose that any better results will be attained at this particular meeting. In fact, as one reviews his own impression of the subject, he is at first radical and then again conservative according to his experience in cases from year to year. I suppose my own standpoint may be regarded as a conservative one, and yet there are certain cases in which I believe operation to be imperative; in some of the cases in which I claim a contraindication exists it may be impossible to lay down a definite rule. In cases of chronic middle-ear suppuration with large perforations and a very slight amount of purulent discharge, which, however, will not cease after long-continued treatment and

The interesting and uncommon features present in this case I believe warrant its recital. Patient. —Mrs. S., 65 years of age; a widow; domestic by occupation; was admitted to the hospital Nov. 30, 1907. History. —Patient's family history is negative. Three years ago she suffered from an attack of pneumonia, followed by an acute purulent otitis media in the right ear, from which she eventually completely recovered. Nov. 3. 1907, she was confined to bed with an attack of influenza, and almost immediately an acute otitis media made itself apparent in the left ear. The tympanic membrane ruptured of its own accord, and soon a purulent discharge was noticed. At first there was little pain, but gradually the pain became more severe in character and extended over the region of the mastoid process. This condition was allowed to go on for two weeks, when the pain, temperature and deafness made

The increasing use of iodin suggested to me its application to the freshly severed umbilical cord. The tincture, as is well known, tends to form a dry iodin-impregnated scale or scab over any moist surface not giving off a purulent discharge, such as a clean varicose ulcer or a freshly sutured wound. The treatment to be described was tried on several infants with satisfactory results. In one case the cord was found mummified and separated on the fourth day, the granulated surface healed to a small dry scab within the same week. Others averaged ten days to two weeks for the entire process Iodism was not observed. The technic used is as follows: As soon as the cord is cut and tied, blood and vernix caseosa are wiped off with a sterile pledget. The stump is then painted with the official tincture until deeply stained; especially the cut end, the ligature

In a 2-day-old baby with symptoms of respiratory distress a right-sided pleural empyema caused by haemolytic streptococci was found. Possible sources of infection are discussed. The mother had purulent discharge from a tooth a few weeks before delivery, and this may have been the focus. The baby was treated with pleural drainage and ampicillin with good result.