In 1902 Seitz of Constanz endeavoured, with the material then available, to establish the relative mortality under ethyl chloride, and investigated something like 16 000 cases, chiefly on the continent, and he found that up to that time only one fatality had been recorded (that of Ltheissen) and he accordingly fixed the death rate at 1 in 16,000. I may endeavour at the present time to make a rough estimate of the mortality as follows. There are some 35,000 medical and dental practitioners in

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... United Kingdom at the present moment. One may safely assume that during the past three years at least one-seventh, or 5000, of these have been using ethyl chloride pretty constantly, probably not less often than once in every ten working days-that is to say, that each of them has given ethyl chloride about 30 times per annum on the average, which will amount to 150,000 administrations per annum for the whole profession, or 450,000 for the three years. I find that out of the above list of fatalities 17 occurred in the United Kingdom, so that with these data the mortality works out at 1 in 36,000 approximately, upon which basis ethyl chloride compares very favourably with ether and chloroform. It is almost certain, however, that there have been considerably more than these 22 deaths which have come to light, but even if I were to find on continued inquiry that there were as many as three times the number (and this is rather unlikely) I should still only have a death-rate of 1 in 8000, and the fact remains that ethyl chloride is a comparatively safe anoesthetic agent, certainly much safer than chloroform for short operations. If we except the extraction of teeth, there is probably no operation for which ethyl chloride has been more frequently employed than that for the removal of adenoid growths of the naso-pharynx. In the throat department of the Royal Infirmary, Edinburgh, alone it has been administered on upwards of 1500 occasions without a mishap. And out of the fatal cases above recorded we have only one occurring when the anaesthetic was given for this particular operation. In this case the administrator was a student who had practically no experience of anesthetics and the operator was a house surgeon who had performed this operation only on half a dozen previous occasions. On examimation of chloroform statistics we find that the number of fatalities which have occurred under this drug when used for adenoid operations is very great, and during the decade 1890-1900 no less than 100 such deaths occurred (Chaldecott). This is surely a strong argument for the employment of ethyl chloride and the avoidance of chloroform in operations for the removal of adenoids and tonsils. As regards personal experience I have now administered ethyl chloride to all classes of patients on considerably over 2000 occasions and have been happy in not seeing a single fatality, and indeed nothing worse than two cases of temporary respiratory arrest with considerable cyanosis and very widely dilated pupils. One of these cases was sufficiently alarming and demanded immediate and careful treatment, and such cases, quite apart from actual deaths, make it quite plain that no one should undertake the administration of ethyl chloride at any time unless he is prepared and quite qualified to deal with an anaesthetic emergency. The dangerous symptoms come on with a rapidity not exceeded by the onset of troubles in chloroform anaesthesia. Ethyl chloride is most essentially not an anaesthetic to be administered, as it has been in the past, haphazard, according to the " instructions for use" provided with a new inhaler by the enterprising instrument maker or druggist. In dental work it is best not to give ethyl chloride alone but either to give it in mixture with nitrous oxide for short cases, in small doses of from two and a half to four cubic centimetres, or in sequence with ether for the longer cases. In my opinion the "boom" in ethyl chloride is well-nigh at an end, but while the publication of such a list of deaths as is recorded above may well discourage the promiscuous and irresponsible use of a highly toxic and very rapidly acting ansetbetic, yet one would hope that ethyl chloride will not be unduly discredited or sink into comparative desuetude; it should rather take its proper place as a valuable addition to the anaesthetist's armamentarium for properly selected and suitable cases. The fact, however, that any unregistered dentist, any L.D.S. diplomate, can administer such a drug without let or hindrance under the impression that it is a sort of "glorified nitrous oxide to any or all of his confiding patients constitutes a public danger whin cannot be ignored. -B;'M/o;7)'ap/t/.—1. Munohener Meòicinische Wochenschrift. SURGEON TO THE CHILDREN'S HOSPITAL, BIRMINGHAM. IN young children a form of mastoid abscess not uncommonly occurs without the pre-existence of any discharge from the external auditory meatus and without the presence of any perforation of, or scar on, the membrana tympani. Such was the character of the abscess in ten out of 61 cases of mastoid abscess in children under 15 years of age operated upon by me. These ten cases had the following characteristics in common :-1. In each case the patient was an infant or quite a young child, the youngest being six months old and the eldest seven years. 2. There was no history of otorrhoea, nor did any discharge from the auditory meatus appear during the course of the case. 3. There was no perforation of the membrana tympani visible. 4. The abscess formed slowly, in some cases a month elapsing between the first appearance of the swelling and the first attendance of the patient at hospital. 5 There was a marked absence of pdn. 6. The auricle was not displaced downwards and outwards as in the ordinary form of mastoid abscess resulting from suppurative otitis media. 7. There was no elevation of temperature. 8. There was very extensive destruction of bone ; but, in spite of this, there were no symptoms of intracranial complications. As an example the following case may be quoted. CASE 1 -The patient, a boy, aged one year and nine months, was first seen on Dec. 16th, 1898. There was present over the right mastoid process a fluctuating swelling, which had been gradually forming for three weeks. The mother stated that the child had apparently not been in pain and that there had never at any time of his life been any discharge from the external auditory meatus. When admitted into hospital the patient had a normal temperature, the ear was not displaced, and there was no bulging or perforation of the membrana tympani. The child looked in good health and there were no symptoms of any intracranial complications. The abscess was opened and a patch of carious bone was seen on the mastoid process, its exact situation being a point just behind the supra-meatal triangle, in other words, about the centre of the line of the masto-squamosal suture. The carious bone was scraped away and the sinus so formed was found to lead into the interior of the mastoid. It was found that the outer shell only of the mastoid was intact, the rest of the process being carious and in its centre was a sequestrum half an inch square, evidently the result of caries necrotica. The outer shell of the mastoid was cut away and the carious bone in its interior was scraped away, the resulting cavity being three-quarters of an inch deep. the caries having extended into the petrous bone. The wound healed soundly. The patient was last seen 11 months after the operation. The membrana tympani was then unperforated and there had been no otorrhoea,. This was the only case among the ten in which there was an actual sequestrum, but in all the amount of boi2edestruetion was great, in several the sinus groove being opened and the dura mater over the upper surface of the petrous bone exposed. The explanation usually given of the occurrence of this kind of mastoid abscess is that there has been, in the first instance, tuberculous disease of the middle ear and that the disease has spread to the antrum, so causing the mastoid abscess, the membrana tympani remaining intact all the time. But, bearing in mind the mode of ossification of the temporal bone and studying the details of the two cases given below, it becomes manifest that the variety of mastoid abscess under discussion may be due to primary caries of