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tures and the necessity for their proper disinfection are overlooked by the busy practitioner, and in a num- ber of cases which had come under his notice he had found that there had been absolutely no attempt at dis- infection of the nasal passages or of the external audi- tory meatus, although all the symptoms pointed to a fracture involving the base. The speaker's custom is to douche or spray thoroughly the nasal cavities, and when necessary to plug wholesale viagra cheap them anteriorly and pos- teriorly with some disinfectant gauze, after which he usually plugs the external auditory canal. With re- gard to the drainage of these conditions he said that it is often a very serious matter, although, if the dis- ease involves only the area posterior to the auditory canal, it may not be so difficult. The securing of proper drainage when the area anterior to this canal is involved is the most difficult matter, but this should not be neglected. Hemorrhage is another dangerous factor, ami it should receive prompt attention. The meningeal vessels are those especially likely to be involved, while the sinuses need not necessarily wholesale viagra cheap be injured. Brain Surgery Dr. J. C. Oliver, of Cincinnati, presented a report of four cases representing injuries and operations upon the brain. Casi 1. was that of a man, aged fifty-nine, who fell through a dust chute, striking upon his head. He presented ptosis on the left side, hemorrhage from the left nostril, and motor aphasia; the pupils were mid- way between contraction and dilatation and did not react to light. There was no paralysis wholesale viagra cheap of the limbs nor of the lace. The autopsy viagra type best showed that the symp- toms were each dependent upon separate lesions. There was wholesale viagra cheap found rupture of the middle meningeal arterv on the left side, a fracture of the left orbital plate, and also a distinct, separate fracture of the crib- riform plate on the left side. Case II. The patient presented Jacksonian epi- lepsy, the wholesale viagra cheap convulsion always beginning in the left leg, then involving the left arm and the left side of the face, and then becoming general. viagra type best Following the convulsion the patient would have left-sided paresis, which would remain for only a few hours. After the attack he would become maniacal, in which condition he was dangerous to those about him. The con- vulsions occurred in groups, so that he would have ten or fifteen in a day. Because of the symptoms, trephining was done over the leg centre on the right side of the brain. A varicose vein in the diploe was found to have ulcerated through the internal and ex- ternal plates of the skull, and had also caused absorp- tion of the dura mater at one point. At this viagra type best point there was a small hernia or protrusion of the pia and brain. No other lesion was discovered. The course of the vein was bitten out with rongeur forceps and the channel in the diploe plugged with a sterilized match. Following the operation the patient was free from epilepsy for six months. After this he began to experience pain in his left leg, and there was a grad- ual return of the convulsions. As it was believed that the return of the convulsions was dependent upon the adhesions which had formed, the patient was again operated upon, nine months after the first operation, and a plate of viagra type best gold foil inserted in the viagra type best deficiency in the skull. A few months subsequently the patient died suddenly in the night from causes unknown. Subsequent to the operation he experienced no convul- sions. An examination of the head after death showed no gross lesion of the brain. The gold plate had very effectually accomplished the purpose for which it was inserted. Case III. The patient in this case had an inflam- matory condition in the left upper eyelid which went on to suppuration. This was opened and the patient returned to his occupation, that of a machinist. After being at viagra type best work for about three weeks he began suffer- viagra type best ing with pain in the head, which was most marked over the left frontal region. He became stupid. On testing the vision it was found to be if in each eye. A choked disc was present in the left fundus. A par- esis involving the right side was found to exist. The deep reflexes were normal. Temperature was slightly subnormal, the pulse was irregular and hard. The diagnosis of cerebral abscess of the left frontal lobe was made, and a trephining over this area and explo- ration of the brain in this region led viagra type best to the evacuation of an abscess containing three ounces of pus. The patient recovered and is now in his usual condition of mind and body. Case IV. In viagra type best July, viagra type best 1895, the patient was treated for an acute otitis media. This condition persisted in spite of treatment. On the 13th of October the patient was found comatose, with pulse of about wholesale viagra cheap go. The pupils contracted, slightly reacting to light, and the Cheyne-Strokes respiration was apparent. This condition continued until the following morning, when he was removed to the Cincinnati Hospital. That evening his temperature was 103 F. ; he was deliri- ous and the pulse was rapid; he had divergent strabis- mus, and there was no evident facial paralysis: pulse, 132; respiration, 26. He became very restless and had to be restrained. The reflexes were present and active; slight trismus was noticed. In view of the fact that these symptoms followed the ear trouble and also in view of the very evident meningitis, it was deemed advisable to trephine over the temporo-sphe- noidal lobe for possible abscess. This was done with a negative result. The left lobe of the cerebellum was then opened with likewise a negative result. The pa- tient died within an hour after the operation. Post- May 23, 1896] MEDICAL RECORD. 739