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A stick accidentally pierced the cheek through the open mouth. Pieces of the stick broke off and remained in the cheek and later presented in the External Ear canal with granulations and purulent discharge. The case created interesting problems in diagnosis and management.

The study of Gradenigo's syndrome presented by W. H. Sears, of Huntingdon, Pa., to the American Laryngological, Rhinological and Otological Society in 1925, as a candidate's thesis, has aroused new interest in the reporting of such cases. I have recently had a case in which this syndrome was present that was of more than passing interest to me. History .—On Dec. 14, 1926, Edwin B., white, aged 7, was brought into the clinic with a purulent discharge from the ear, of more than one month's duration. The child appeared fairly well developed and well nourished, and had been up and about since the otitis began. The ear was cleansed with solution of silver nitrate. The faucial tonsils were unusually large, and it was learned that the patient had had previous attacks of tonsillitis. The child had marked left convergent strabismus. His mother was told to bring him back the

All children who suffer from ophthalmia neonatorum in the County of London are admitted to the hospital of the London County Council, of which Professor Sorsby is the ophthalmic surgeon. His experience is therefore unique, and a monograph on this subject from his pen is, of course, completely authoritative. Since 1914 notification of a purulent discharge from the eyes of a newborn infant has been compulsory in England and Wales. This booklet is a study of the problem of ophthalmia neonatorum. It is composed largely of tables, charts and graphs, and is therefore difficult to review and well nigh impossible to abstract. Nevertheless, many of the conclusions reached by the author are worth recording here. His approach is sound. He admits that the rates recorded by the Registrar General, consistent though they be, are not an unquestionable indication of the incidence of ophthalmia neonatorum ; and he remarks that notification is

During the summer of 1930 twelve reports from rabbitries in the regions of Santa Barbara, Ventura, and San Diego were made of a disease presenting the following symptoms. The rabbits were acutely ill and exhibited, as a rule, an oedematous condition in the regions of the nose and lips, the external genitalia and a conjunctivitis. A purulent discharge occurred from the eyes and nose. The ears also became greatly thickened and drooped as a rule. Animals that lived longer than a week or 10 days after the appearance of symptoms often developed nodules around the nose, eyes, or on the ears. Upon autopsy, the lymph nodes and spleen were found usually to be enlarged. The nodules and oedematous areas were found to contain a gelatinous material.The disease was transmitted with facility by rubbing the discharge from the eyes and nose, or the extract from tissues, into the skin, or by injecting the same. Comparison of the above findings with reports of Hobbs,1 Rivers2 and others who have studied infectious myxomatos...

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Report of Case A 31-year-old brewery platform worker was first seen in the eye clinic * at the Wills Eye Hospital on Feb. 19, 1962. The chief complaints at that time were that the lids of the right eye had been "sticking together," especially in the mornings, and that a purulent discharge had been noted from the right eye for the previous 10 months. The right eye had been red and tender intermittently in the same period of time. The vision had always been normal O.D., except for the times when a mucopurulent material was present. On April 20, 1961, ten months prior to the clinic visit, the patient was fitted for contact lenses by a Philadelphia optometrist. The patient was instructed in the "one-finger control" method of removing contact lenses. About one week later the patient lost the contact lens for the right eye. It was after losing the lens

A nontreponemal spirochete was isolated from the rectum of a homosexual man with a chronic purulent discharge. Known infectious causes of the disease were excluded. Although the pathogenicity of the organism was not proved, the patient's symptoms rapidly resolved following penicillin G benzathine therapy. When culture of a nonhemorrhagic, purulent rectal discharge fails to verifyNeisseria gonorrhoeae, health care personnel are encouraged to carefully examine a Gram's-stained smear of the discharge for spiral-shaped organisms. (JAMA241:52-53, 1979)

A dentigerous cyst of an extra-ordinarily large size, simulating malignancy of the maxillary antrum, is rare.

Patient. —Bertha K., aged 9, admitted to the Children's Memorial Hospital, May 31, 1911. Previous history unimportant; fell down stairs in the spring (1910) while on rollerskates. Two days later the mother discovered that there had been bleeding from about the vulva and, on examination, found a mass about the size of the end of her thumb protruding from the labia in the region of urethra. When the patient was admitted to the hospital the size of the growth had not been reduced, although it had been treated by a number of physicians. No operative treatment had thus far been undertaken. A purulent discharge was always present. There was no itching and no discomfort on urination. Local Examination. —A tumor was seen at the external meatus, extending about a quarter of an inch upward into the urethra. Its base was spread over almost the entire circumference of the urethral canal

For the first time in Brazil Sporothricosis is described in dogs. In the two cases studied the disease was characterized by the appearance of cutaneous nodes of different consistences and sometimes ulcerous, covered with dark scabs. Fistulous openings complete the lesion and purulent discharge could be observed as well as involvement of the drainage limph nodes. In the contents of the nodes, in the purulent exudates of the fistulae and the scrapings of the ulcers, there were many parasites, in characteristics "cigar shape". Cultures were obtained easily at room temperature and at 37 °C. The disease followed a chronic course and no marked constitucional symptoms were noted. In one of the cases the treatment with Griseofulvina was not successfull but the ministration of potassium iodine resulted in a quick but false recovery, because after some months there was a recrudescency.

On 13 patients, 22 ischemic skin ulcers which had resisted a variety of therapeutic agents were treated with ordinary gold leaf. Three coexisting lesions served as controls. After initial cleansing and debridement, the ulcers were wetted with 95% alcohol, covered with four to eight layers of gold leaf, and protective dressings were applied; this procedure was repeated every 48 hours. A venous-stasis lesion decreased in size 86% in one month, and a diabetic ulcer showed 44% improvement in 11 days. Twenty decubitus ulcers decreased an average of 62%, and three coexisting control ulcers increased in size an average of 96%. Deterrents to successful treatment include a hemoglobin value below 12 gm/100 cc, excessive friction, undermining of ulcer edges, ringing of the lesion with scar tissue, and copious purulent discharge. No adverse reactions to gold leaf were observed.

SINCE 1817, when James Parkinson 1 recognized the entity of paralysis agitans among the heterogeneous collection of tremors and paralyses, the most persistent attempts have been made to treat this disease. It is instructive to review some of the methods used and the claims that have been made for them. Parkinson himself suggested that blood be taken from the upper part of the neck, that vesications be applied to the same part and a purulent discharge obtained by use of the Sabine liniment. If that should fail, an issue should be made, and kept open, beside the vertebral column. He reasoned, on ingenious theoretical grounds, that improvement should result. Before very long this method had fallen into disrepute, and we read of Elliston 2 giving carbonate of iron and of Brown-Sequard 2 giving barium chloride. Both reported cures, as well as some remissions and some failures. Then Trousseau 2 reported

The usual understanding or definition of typhoid carrier is a person who, though apparently well, has the bacilli of typhoid a fever in the stools or urine. There have not been many reports of cases in which the typhoid organism has been cultured a from other discharges in persons otherwise apparently well. Therefore I believe it worth while to report the following cases: Case 1. —B. S. N., man, white, aged 34, with negative family history, in 1898, while serving in the U. S. Volunteers in Porto Rico, suffered a severe attack of typhoid fever. Ever since then there has been a chronic purulent discharge from the left ear with an occasional acutre exacerbation. When I saw him, the temperature was 100, the mastoid was tender,there was a free flow of creamy pus from the left external meatus, the inferior posterior half of the left membrana tympani was destroyed, and

So-called idiopathic lipemia is extremely rare. The clinical histories of but 5 patients have been reported in the literature. The present case is the sixth to be recorded and, as far as can be determined, is the first to include the results of a postmortem examination. A clinical report of this case has been published by Goodman, Shuman and Goodman.1 REPORT OF A CASE History.—W. R., a Gentile male infant, was first seen at the age of 1 year in the pediatric service of the Boston City Hospital, on April 10, 1939. He was brought to the hospital because of a purulent discharge from the left ear, of one month's duration, and failure to gain weight. The family history was not remarkable. The father, mother, 3 sisters and 1 brother were living and in good health. There was a history of 1 stillbirth, and 1 sibling, aged 3

The previously reported successful therapy of keratosis blennorrhagica by one of us (E. E.1) has prompted this further study of the effect of artificial hyperpyrexia in the treatment of this disease. The technic was fully described in the previous communication and need not be reviewed. It suffices to state that it is a minor variation of the blanket method employed by Norman Epstein and Maurice Cohen2in the treatment of syphilis. The rarity of gonorrheal keratoses renders the presentation of small series of value in the establishment of this therapeutic agent. The cases reported are also noteworthy because of the association of corneal lesions with the keratosis. REPORT OF CASES Case 1.— G. F. M., a man aged 22, in 1929 had polyarthritis which followed a purulent discharge from the left ear. Although there was no history of syphilitic lesions, a diagnosis of syphilis was made. Treatment consisted

Since 1888, when Parinaud first described this form of conjunctivitis, very few instances have been reported. It was my good fortune to study such a case. REPORT OF CASE An American school girl, aged 13 years, came to the office, Nov. 22, 1923, with a swelling of the left upper eyelid and the left side of the face which had been present for the past three weeks. The condition started about four weeks previously as a "cold in the left eye," characterized by redness of the conjunctiva, tearing, and the adhesion of the lids by a purulent discharge in the morning. In a few days, this acute inflammatory condition of the left eye subsided, but the upper lid began to swell, and continued to do so until the ptosis interfered with vision. One week after the swelling in the lid began, a swelling started in the left preauricular region, which

The work of recent experimenters, notably Dandy and Weed, has greatly increased our knowledge of fluid circulation within the cranial cavity, providing exact means for the study of cases of hydrocephalus. Application of these methods to each individual problem will frequently point the way to successful therapeutic attack. The case to be presented here was at first indistinguishable from that of a simple obstructive internal hydrocephalus. During the months that it was necessary to keep the patient in the Presbyterian Hospital, I was much indebted to Dr. Howard Mason for help and counsel. REPORT OF CASE History. —J. P., an Italian boy, was born of healthy parents at full term, after an easy labor. There were no tuberculous contacts. At 7 months, he began to creep. About this time, there appeared a purulent discharge from the left ear. At 9 months, the first tooth appeared, and the infant was trying

In this paper I wish to consider briefly, nasal catarrh as met with in children, and characterized by an inflammation and purulent discharge from the nasal and naso-pharyngeal mucous membrane. The word catarrh in the sense that it is ordinarily used, is a kind of cloak to cover up our lack of knowledge of the true inwardness of these cases. The literature on this subject is rather confusing and unsatisfactory. MacKenzie recognizes two forms,acute and chronic; under the acute form, he classes the gonorrhœal and leucorrhœal infection that may occur in the new born. Frankle describes but one form, the acute. Cohen is inclined to attribute all cases of purulent discharge to remote specific infection. Lennox Browne, Sajous, Seiler, and Robinson, make no special mention of purulent discharge in children, but class it along with other cases and hypertrophied glandular structures. Bosworth in his recent work, devotes a small chapter

An extensive literature has grown up around the subject of osteomyelitis of the maxilla in nurslings and infants. The clinical picture has been described under a varied terminology, and many factors have been ascribed to its causation. The onset of the disease has varied from the first week to the ninth month of the infant's life, but the greatest number of cases on record have occurred within the first few weeks of the neonatal period. The basic clinical picture has been strikingly uniform, with redness, swelling, purulent discharge, necrosis and sequestration of the maxilla on one or all of its surfaces (nasal, orbital, facial and palatal). The points of entry, the method of spread of the invading organism and the clinical course have varied greatly, however. The subject has been extensively reviewed and summarized in the American literature twice within recent years in articles by Bass1and Wilensky.2

Lowry and Franks's recent report 1 of primary gonorrheal cutaneous infection caused me to recall an unusual case of gonorrhea of the umbilicus which I observed a few years ago. The patient, a young Greek, had acute urethritis. In excreted pus gonococci were demonstrated in great numbers. Shortly after the onset of the urethritis, his umbilicus became inflamed, and a thick, creamy, purulent discharge developed. Numerous typical gramnegative intracellular diplococci were found in the pus. Long-continued treatment with mild protein silver cured the umbilical infection. 3115 Webster Street.

In the course of a critical study, of wound infections conducted in this laboratory during the past two years, theBacillus pyocyaneoushas often been found a troublesome cause of delay in the repair of wounds. While this organism has never been the source of acute danger to the patient, its presence has seemed to retard the production of healthy granulations and impede the growth of new epithelium. It has been an organism difficult to eradicate by the use of most antiseptics. It was rarely an inhabitant of fresh wounds, but its incidence has increased after the first week following injury, and it has often remained the predominating infection. Examination of the discharges of a large-number of wounds has shown that when the reaction of the purulent discharge was strongly acid, theB. pyocyaneuswas rarely present. It was much more common in wounds showing secretions of low acidity, and

The following cases represent some of the various forms of mastoiditis resulting from epidemic influenza, and are instructive as they do not all present the uniform indications for operation. Case 1. —I saw this patient, a boy 6 years of age, May 1, 1897, in consultation with his family physician, Dr. G. L. Magruder, who gave me the history of a case of suppurating otitis media in both ears, resulting from epidemic influenza. The little patient was extremely emaciated, with a small and feeble pulse; there was a profuse purulent discharge from both external auditory canals, and over the right mastoid region, extending back toward the occiput and downward into the neck for several inches, there was a large boggy swelling, very sensitive to pressure; the right auricle was also very prominent. There were no brain symptoms, as far as could be ascertained. An operation having been decided on, the

Since the publication of the work of Bass and Johns on pyorrhea, there has seemed to be a tendency among dentists and many medical men to administer emetin in all cases of dental infections without establishing the presence of the endameba. That the endameba is not the cause of all cases diagnosed as pyorrhea by competent dentists is shown by the history of such cases as that outlined below. Its publication at this time seems, therefore, justified. History. —A. L., man, aged 18, high school student, first seen Aug. 2, 1912, complained of attacks of sore mouth complicated by fever, earache and knee pains. The family history was negative except for tuberculosis in the second generation on the mother's side (no contact). The patient had been a healthy infant until 3 months of age, when he had otitis with a purulent discharge. The sore mouth began at the age of

Numerous cases of gonorrheal septicemia have been reported in adults following genital infections with the gonococcus. In children such cases occur but are very unusual, being extremely rare in infants. Sepsis occurring as a result of gonorrheal ophthalmia is practically an unheard of condition. The case here reported is of interest because of the unusual pathogenesis and the age of the patient. REPORT OF CASE A. M., aged 4 days, was admitted to Cook County Hospital Feb. 24, 1937, from an outlying hospital. The birth was a precipitous one, the child being premature and weighing 5 pounds (2,268 Gm.). The eyes of the baby had been treated by the Crede method one hour after birth. Vaginal and cervical smears taken from the mother were negative for gonococci. On examination there was noted a thick, yellow, purulent discharge from both eyes. The conjunctivae were swollen and reddened, and smears

C. D. R., male, aged 33. First seen Nov. 25, 1896. Two weeks before, right eye became sore, for which he was treated by his family physician. It was extremely painful until two days before, when something seemed to give way and water gushed from between the lids, after which it became easier. There was an abundant purulent discharge. The cornea was not clear at any point but had a fleshy appearance and bulged from the general curvature of the eyeball (total staphyloma). The man lived at some distance in the country and failed to attend regularly, coming only once or twice a week. For two weeks he was treated in the usual way with boracic acid, bichlorid and nitrate of silver with very little effect on the discharge, which was abundant from the time first seen. A microscopic examination by Dr. E. C. Anderson, chief of the Microscopic Laboratory

NUMEROUS organisms and infectious agents have been implicated in keratoconjunctivitis. The following case illustrates a severe type of infection produced by an organism of the diphtheroid group. REPORT OF CASE History. —M. A. V., a 26 year old unmarried white woman, was first seen at the Institute of Ophthalmology on March 21, 1944, with the following history. At the age of 7 she had an attack of scarlet fever, which left her eyes sensitive to light for about one year. There was, however, no other ocular complaint until six years prior to the first examination, when, rather suddenly, severe blepharoconjunctivitis developed in both eyes. This condition was treated with drops by several doctors, and there were numerous exacerbations and remissions. There was considerable purulent discharge, and the patient stated that the margins of the lids remained red and irritated. In 1940 she noted a decrease in visual acuity, especially in

Some time ago, it occurred to one of us (I. F.) that the purulent discharge from suppurative otitis media and mastoiditis might contain the products of bone disintegration and thus give evidence of a destructive process in the bone. As we were unaware of such work having been done with this point in view, we recently commenced making chemical analyses of pus from various sources, and also of pus from discharging ears. The first problem that we set ourselves was to determine the calcium content of pus from ears with frank bone necrosis, and compare it with the calcium content of pus from ears without demonstrable bone necrosis and from abscesses elsewhere in the body. Although our material is entirely too meager to warrant any definite conclusions, our results have been so strongly suggestive that we believe it advisable to make this preliminary report in the hope of stimulating further

July 23, 1916, I was called in consultation by Dr. Chett McDonald to see a man, aged 23, who complained of very frequent and painful urination, with much tenesmus. He gave a history of venereal sore, diagnosed chancroid, two years before, and gonorrheal infection of the urethra beginning a year later and persisting to the date of consultation. He had been in the Navy and had been sent to the hospital at Great Lakes. He stated that he had had two negative Wassermann tests and had been under treatment while there, and later at Bremerton, Wash., with sounds, irrigations of permanganate, and instillations of silver nitrate. He had obtained his discharge from the Navy, and was at the home of his parents. There was a scar of the glans where the chancroid had been. There was a slight purulent discharge from the urethra, and urination was followed by a mucous

Chancroid, or ulcus molle, is an acute, inflammatory, destructive ulcer characterized by very slight induration and moderate pain on palpation. It is caused by venereal inoculation with Hemophilus ducreyi and occurs usually on the genitals or the surrounding skin. Other areas may also be involved, usually as a result of autoinoculation. The causative agent was first described by Augusto Ducrey in 1889 and is found in the purulent discharge from the surface of the lesions. It is a small nonmotile, non-spore bearing, non-acid fast, gram negative bacillus measuring from 1 to 2 microns in length and about 0.5 micron in thickness. It appears as a short rod and may be arranged in pairs, groups or chains lying parallel to one another. Several other forms may be assumed including a parallel "school of fish" arrangement. It may be intracellular or extracellular in position. Variations in staining characteristics have been described by

The case herein reported is one of probable diphtheritic eczema of the skin of the auricle and external auditory canal. Bart1over one hundred years ago called attention to this infection. In 1922 Biberstein2made a classification of the disease and gave therapeutic suggestions. REPORT OF CASE The patient, a white woman aged 32, was first examined on Feb. 15, 1939, at which time she presented an erythematous vesicular and exudative dermatitis involving the right auditory canal, the entire right auricle and a large area of skin on the right side of the face and neck. There was a purulent discharge from the middle ear. She gave a history of infection of the middle ear which began four months previously. During the past month the middle ear was treated by an otologist. About this time the right auricle became reddened and edematous (fig. 1). Shortly afterward vesicles appeared

In 1889, Parinaud 1 described a rare form of conjunctivitis characterized by the formation of small vegetations in the conjunctiva and enlargement of the preauricular glands. According to Parinaud, the vegetations are red or grayish yellow, at first semitransparent, later opaque, and may attain the size of the head of a large pin. Between the large vegetations are small yellow granules not dissimilar to those of tuberculosis of the conjunctiva. The growths are usually situated in the fornices, but may also be found on the tarsus or the bulbar conjunctiva. There is a mucofibrinous secretion but no purulent discharge. The eyelids are puffy, and present irregular hard nodules to the examining finger. Soon the preauricular glands become enlarged. The glands in the anterior triangle of the neck or even the supraclavicular glands may also become enlarged. These glands may suppurate. The process may last up to six months. Occasionally the