600

attributed the improvement mainly to stimulationof the organ of Corti and of the cortical auditorycentres, in addition to a certain amount of local vaso-dilatation.

Sir James Dundas-Grant was convinced that manycases escaped benefit through the imperfect intro-duction of the Eustachian catheter. In the intervalsof catheterisation the patient could keep up thetreatment for himself by the use of a self-inflatorcontaining a few drops of diluted chloroform. Opera-tive treatment was seldom of any value.

Mr. Herbert Tilley said that the early stages ofchronic adhesive otitis were frequently overlooked,even by otologists. In the ordinary type of serousexudation into the tympanum, it was his practice toinject through the Eustachian catheter a few drops of10 percent, argyrol after having removed the catarrhalfluid by inflation and aspiration with a Siegle’sspeculum. A few cases improved with endocrinetherapy.

Dr. W. S. Syme emphasised the importance ofsepsis in the nose and throat; nasal accessory sinusdisease was more common than was usually supposed.

Mr. Sydney Scott laid stress on Mr. MacLay’ssuggestion of employing the speaking-tube in the

re-education of the hearing. Dental sepsis had animportant relation to deafness, and an X ray examina-tion of the teeth could not be dispensed with.

In the afternoon Mr. Norman Barnett demon-strated at the Bath Ear, Nose, and Throat Hospitala large number of cases of chronic middle-ear suppura-tion treated by conservative operation, and of chronicnon-suppurative e middle-ear deafness treated byvaporisation and ionisation.

FRIDAY, JULY 24TH.Occupational Diseases of the Ear, Nose, and Throat.A discussion on this subject was opened by Mr.

F. H. Westmacott. He said that the subject mightmost conveniently be discussed under two headings:(1) Industrial diseases which were included inSchedule 3 of the Workmen’s Compensation Act of1906, extended by various orders, and included inthe Act of 1923 ; (2) industrial diseases which were metwith in workers but which were not so included andmight or might not cause incapacity of employment.In the first category the list of diseases affecting theear, nose, and throat included anthrax, lead, mercury,phosphorus and arsenic poisoning or their sequelae,poisoning by nitrous fumes, ulceration of the mucousmembrane of the nose or mouth produced by dust,chromic ulceration, compressed-air illness, glanders.Among the second group were inflammation of theauricle followed by slough and necrosis, as occurredin cold-storage workers ; rupture of the tympanicmembrane due to explosions in mining, blasting,tunnelling, or gun-firing tests ; acute or cedematouslaryngitis might be directly caused by inhalation ofirritant fumes of chlorine, bromine, iodine, ammonia,or sulphuric acid ; membranous laryngitis, non-

diphtheritic, occurred in workers in steam and irritat-ing vapour, such as in stokers and cooks ; chroniclaryngitis was found among professional voice users,from misuse or faulty voice production; hypertrophiclaryngitis was frequent in street hawkers, salesmen,or those exposed to dusty occupations. In continuousnoises, such as riveting in boiler-making or loudmachinery, which gave rise to continuous nerve

strain, deafness was due not so much to damage tothe sound-conducting mechanism as to destructionof the sensitive nerve-endings which constituted thesound-perceiving apparatus. More severe deafnesswas produced by intense sounds made up largely ofovertones of high pitch than by noises of lower pitchsuch as were heard, e.g., in cotton mills. Tinnituswas invariable, but vertigo was only present in directproportion to the loss of perception of the uppertone limit.Surgeon-Commander S. W. Grimwade, R.N., said

that with the exception of diseases of the ear, occupa-tional diseases of the ear, nose, and throat were notat all common in the Royal Navy. During nearly

two years’ service at the R.N. Hospital, Plymouth,he had seen only four cases of labyrinth concussionfrom gunnery practices ; all of these showed a verymarked degree of deafness, which, however, wastemporary, and they soon returned to normal.99 per cent. of all cases of deafness in the navy weredue to suppuration of the middle ear, and therewas no question that more careful examination ofrecruits would eliminate a large number of these cases.Wing-Commander D. Ranken, R.A.F.M.S., said

that they found in the Royal Air Force that the effectsof nasal obstruction, though disagreeable enough onthe ground, were intensified in the air; the engorgednasal mucous membrane associated with high altitudefrequently gave rise to insufficient ventilation anddrainage of the frontal sinuses, and pilots often com-plained of headaches of varying duration during orimmediately after descent. More important still wasthe presence or absence of Eustachian obstruction, forif equalisation of the pressures on either side of theear drums by means of swallowing or auto-inflationcould not be made during a rapid descent, pain anddeafness together might occur, with such effects oflabyrinthine disturbance as vertigo, nausea, or evenfainting. There were two methods of preventingaeroplane deafness : harmful sound waves were cutoff at their source by fitting silencers to the engines,and the persons exposed to noise were protected byear protectors on -the principle of a " baffle " system.Major T. Jefferson Faulder, R.A.M.C., T.F., said

that, showing the magnitude of the problem, thetotal number of first awards of war pensions forvarious aural disabilities had been 31,750 ; inDecember, 1924, this had diminished to 18,500, andapproximately one-half of this total was assessed at20 per cent. or less disablement. During the waradmissions to hospital on account of ear conditionsamounted to a total of 182,440, diseases of the nose.37,520, diseases of the respiratory organs otherthan tuberculosis 801,840, tonsillitis and sore-throat441,040. As regards the question of ruptured drum-head, various opinions had been given, usually, inhis own opinion, in the direction of over-estimation.

Mr. E. B. Waggett considered that the statistics ofthe recent war gave a wholly misleading impression,and he believed that the very heavy figures con-

cerning hospital entries of chronic otorrhoea, aural,nasal, and throat operations, were to be explained onpsychological rather than surgical grounds-chronicotorrhoea formed a convenient excuse for the soldierdesiring a holiday at the base.

Dr. T. Ritchie Rodger (Hull) said that the soundsprevailing in boiler-making works were comparativelylow in the scale, ranging round about 400 and 500double vibrations per second. In regard to the occu-pational deafness of boiler-makers the mass of evidencewas that the injury to the cochlea was conveyed byair-conduction, not by bone-conduction ; middle-eardefects had no part in the causation. Meatal plugsof wax or vaselined wool were the only aids to pre-vention of the disability.

Mr. T. B. Jobson (Guildford) said that in 1915 hehad had the opportunity of examining 50 Germansoldiers shortly after their exposure to prolongedgunfire, and about 80 per cent. of them showeddiminution of acuity of hearing both for air- and bone-conduction. In from three to six months almost allof the cases had returned to normal.

In the afternoon Dr. P. Watson-Williams gavea demonstration of his method of making a completeinvestigation of the nasal accessory sinuses.

SECTION OF THERAPEUTICS.WEDNESDAY, JULY 22ND.

Treatment of Asthma.This Section met on three days, under the presidency

of Prof. R. B. Wild.Dr. W. Langdon Brown (London), in opening a

discussion on this subject, said that the treatment ofasthma summarised in itself, as it were, the chieftrends of modern therapy : Psychotherapy, sensitive-