Notes on Books
BMJ (Clinical Research Edition)
THF, reputation attained by Professor BEZor.D is sufficient to cause great value to be attached to any expression of opinliOn emanating from him. The present work is not merely made up of statements of his views, but of a mass of statistical information of the greatest interest and importance, founded on 4,876 cases of ear disease occurring in 4,341 patients, and -dating from 1872. An interesting comparison is drawn between the relative frequency of the different forms of ear dis--ease as shown
... dis--ease as shown in recent and early statistics respectively, the difference being due to the improvements in the metlhods of' -testing the lhearing power, the diminished importanee attaehed to alterations in the appearanee of the membranie, the *recognition of disease in Shrapnell's membrane and the tym--panic " attic," of cholesteatoma, etc. The uniformity in the percentage of cases referable to outer, middle, and inner ear i-n the two last trienniia, as comparable with the variations in tfhe earlier ones, shows the increase in the certainty of dia-*gnosis. As three epoehal points in the later development of otology he marks Schwartze's artificial openiing of the mastoid, the Lantiseptic metlhod of treatmelnt, and Riniie's tulning-fork test. Among other remarkable points is the singular frequency -of otomycosis, amounting to 0.7 per cent. of all cases, confirmed in every instance by microscopical examination. The -operative removal of exostoses of the meatus is strenuously opposed on the strength of an experience of 116 eases. The -outward growtlh of the lhorny layer of the skin of the meatus is described in connection witlh the formation of long epi--dermic ribbons in that passage. Chlronie nion-suppurative catarrlis of tlhe middle ear are sub--divided inlto those with indrawn membrane, those witliout indrawn membrane, and tllose in whiclh the subjective tests give uncertain results, while at tlle same time there is no distinct evidenice of the disease beinig situated in the internal ear. To this last class he gives the name of " dysakousis," and to it belong 4.2 per cent. of all cases of ear disease, whereas the second group-the seleroses-eonstitute 7 per cent. Professor Bezold holds that no hard and fast line can be drawn between simple and purulent otitis, except the arbitrary onie of the presenee or absence of perforation. He describes the distinctions between phtllisieal or marasmic perforationi anid perforation in otherwise healthy subjects. He insists that the commoni opinion that perforations usually occur in the anterior half of the membranie is erroneous ; that, although the extension of acute suppuration to the mastoid cells is " the chief if not the only " cause of the prolonged persistence of acute purulent median otitis, suppuration may persist in the mastoid, altlhough the tympanlic perforationl has closed. The well-known " Bezold's perforation " of the " lower" surface of the mastoid (eonfining the term " inner" to the sigmoid groove) occurred in 30.5 per cent. of acute empyemata of the mastoid, chronic suppuration with growths or perforatlons situated in Shrapniell's membrane in 1.2 per eent., eholesteatoma in 1 per cent. (in the years 1890-1892, 2.1 per cent.), tuberculous suppurative inflammation of the middle ear (exhaustively discussed) in 0.7 per cent. of all cases, and 4.4 per aent. of cases of chronic suppurative otitis. The writer's advocacy of the boric acid treatment is, of course, vigorously maintained, .-and he insists thati"the danger attributed to iiisufflation of powderedboric acid in small or unfavourably Situated perforations of the membrane is founded on the tlieoretitEl views expressed by a number of otologists, and observation specially directed to this point for years has revealed nothing to confirm it." The diagnosis of diseases of the internal ear is cautiously described, Jacobson's immoderate scepticism being trenchantly attacked. The value of the tests by means of the " continuous tone range " is dwelt on and illustrated by the results in some cases of necrosis of the labyri-nth. The whole work is full of individuAlity, a point in whichl it is widely different from the numerous current treatises on otology, and its study will be found an instructive and refreshling change from the perusal of these -works. NOTES ON BOOKS. Kelly 's London Medical Directory, 1896. (London: Kelly and Co. 1896. Cr. 8vo, pp. 544. 6s. 6d.)-The eighth annual issue of this Directory has appeared. It shows some increase in bulk, due in part to the increase in the number of members of the medical profession, in part, we are told, to the greater fulness with which the contribution of individual members to medical literature are recorded, and in part to the addition of new societies, publications, and institutions, and the amplification of the details ,given of many of those noticed in previous editions. The volume is one which has been proved to be of great value to residents in London. Co. I896. (Small 8vo, pp. 478. 6s. 6d.) -We need do little more than mention the appearance of the half-yearly volume (July-December, I895) of this well-known serial. It has now been established for over half a century, and its many excellencies are well known. It is announced that with the next volume, to appear in July, will be issued a general index for the past three years. Herbert Fry's iloval Guide to the London Chlarities. Edited by JOHN LANE. (London: Chlatto and Windus. I896. Small 8vo, PP. 340. is. 6d.)-This is the thirty-second annual edition of this well-known handbook. It contains an immense amount of information about charities of all kinds in London, well tabulated and drawn from official sources. It will be found a most useful work of referenlce, and will often save much time which would otherwise be spent in inquiry.