Jniy,i9i7.] Rhinology, and Otology. 229 THE AMERICAN LARYNGOLOGICAL, RHINO-LOGICAL, AND OTOLOGICAL SOCIETY. Meeting at Chicago, June 15 and 16, 1915. ( Continued from p. 170.) Vertigo of Labyrinthine Origin following a Chronic Suppnrative Otitis Media with Cholesteatoma; 1st: Simple Mastoid with Curettage of the Middle Ear and Eustachian Tube ; 2nd: Radical Labyrinth Exenteration.-Francis P. Emerson.-The otologist is particularly interested in those labyrinth cases which, in their final

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... confirmed by operation, may be readily labelled pathologically, and yet in their clinical manifestations may have presented a reasonable doubt as to the surgeon's attitude in regard to immediate operative interference. The relation of the vestibular apparatus to the brain demands exact diagnosis, and immediate surgical intervention in all pyogenic invasions of the labyrinth if life is to be saved. The case outlined is offered as one with delayed symptoms, and one which was perhaps less clear clinically than many. The .patient, male, aged sixty-two, was admitted to the Massachusetts Charitable Eye and Ear Infirmary, August 11, 1913, with a diagnosis of otitis media suppurativa chronica of the right ear. The case is summarised as follows : The patient is a man prematurely old. There is a perforation of the septum. His wife has had two miscarriages. The hearing test for his good ear, that is, the left, the writer has found to be strongly suggestive in other cases of lues, i. e., a low note, but little, if any, raised, a positive Einne with marked lowering of bone conduction, and the whispered voice reduced to ^ or ,V In this case there was a negative Wassermann, but no examination was made of the cerebro-spinal fluid. His eyes and a physical examination did not give evidence of specific disease. Could lues then be eliminated as a direct or contributory factor in this patient's symptoms ? The right ear gave a history of discharge for thirty years, and in addition there was a cholesteatoma, which, as is well known, is apt to invade the labyrinth. There were granulations in the posterior quadrant. The rotation test done several times always showed vestibular irritatio when the vertical canals were in the plane of rotation. Unfortunately the difference in the after nystagmus between the turning to the right or to the left was not recorded. The fistula and caloric test were negative and there was no spontaneous nystagmus. The hearing test, done by two different observers, showed total deafness for the right ear, except a bone conduction of three inches. Can we say that this then was a ease of diffuse purulent latent labyrinthitis, and that the apparent vestibular reaction was compensatory ? According to Euttin this does not occur unless a latent purulent labyrinthitis has existed for a long time and has been followed by a complete' ossification of the labyrinth or sequestration. In this case there was no clinical history of vertigo until five weeks before admission, and our operative findings showed the horizontal canal free, while the superior and posterior contained a greyish-rod granular, nonadherent detritis. There was no organised tissue or evidence of ossifica-. tion present. The second day after operation we had a clear, serous