Dorothy Wolff

LXXIII The Human Ossicular Ligaments

Controversy has arisen from time to time as to whether or not the human ossicles possess true joints and ligaments comparable with those of other bones of the body. Anatomically, a joint is defined as the articulation of two or more bones, the opposed ends of which are covered with hyalin, cartilage; are bound together, and are enclosed by a joint capsule consisting of ligamentous f~bers arising from the periosteum of the opposing bones. The capsule is lined with an endothelial membrane, the synovial membrane, which secretes the fluid that keeps the joint surfaces moist. An interarticular cartilage is frequently present.

LVII. Pathology and Routes of Infection in Labyrinthitis Secondary to Middle Ear Otitis

The material presented in this paper is compiled from two fields of study. The microscopic observations were made by one of us, D. Wolff. The clinical observations were made by the other, L. W. Dean. The microscopic investigations are based upon forty-six cases of otitis media and an examination of serial sections from sixty-eight ears. Both ears in each of the forty -six cases could not be examined. Bilateral observations were made in twenty-one cases. In the bilateral group studied evidence of otitis existed in each ear, although frequently one side was more fulminating than the other. Suppurative labyrinthitis was observed in fourteen ears (eleven cases). The sections show that infection may pass from the middle ear to the labyrinth by direct extension and by indirect extension. The routes of direct extension are: 1. Fistula through the round window. 2. Fistula through the oval window. 3. Fistual through the bony capsule as a result of (a) Necrosis of bone or (b) Mechanical trauma. Indirect extension is by the blood vascular route and lymph vascular route. It is, of course, quite impossible to classify definitely the processes of nature. We must, therefore, recognize that no one route excludes another and the infection may be a combination of the direct and indirect extension.

LXXXIII. Microscopic Observations of the Eustachian Tube

Autopsy No. 3920. The case is that of a hydrocephalic fivemonths-old white female child of a mother aged 18 and a father aged 24 years. This was the only child and the only pregnancy. The child entered the hospital with a history of crossed eyes and vomiting, the onset of the trouble having been three weeks previous to the admission date. The vomiting occurred five or ten minutes after feeding and was of projectile character. The child cried continuously. No previous illness had occurred and no history of trauma could be elicited. No drowsiness had been noted by the mother. The family physician had said the difficulty was in the feeding, but no improvement followed the medicine administered by him. The child was treated by a chiropractor with no improvement; Physical examination revealed a hydrocephalic infant, fat but slightly flabby, whose head fell forward. The circumference of the head was 50 ems. The fontanelle was wide, tense and bulging. Scalp vessels were moderately dilated. A soft purpuric mass was on the right frontal region. The ears were negative. (The patient was not seen by the Otology Service.) Pharynx and nose were negative. The neck showed enlarged cervical glands. There was no evidence of deformity or paralysis. All reflexes were exaggerated.

XXXVII Microscopic Observations of the Developing Petrous Apex

The gross devilopment of the petrous apex was described last year by Profant!’ (May, 1936). In 1933 Glick? presented microscopic studies of the apex of the growing child and adult. The anatomy, pathology and clinical importance of this region have been discussed by Eagleton,‘ Kopetzky and Almour‘, Vail,“ Wilson,” Friesner, Druss et al.,’ Guild‘’ and Jones.‘ It is the purpose of this communication to present clearly the microscopic anatomy of the developing apical region as it appears in various stages from the ten weeks fetus to the seven-year-old child. A table of measurements indicating the rate of growth from infant to adult is also included. According to Profant, “there is never a true petrous apex because the region is shaped like that of a truncated pyramid.” “Petrous tip” is the term preferred by Profant. The petrous apex or tip, as presented in this paper, may be defined as that portion of the temporal bone anteromedial to the cochlea.

II. Discussion from the Point of View of Studies on Human Temporal Bones. LXXIV

An awakened interest in the problems of hearing and deafness is evidenced by the number of experimental reports which have recently appeared. Many of these studies have attempted to throw some light on the relationship between the function of hearing and the anatomic structure of the ear. The Wever-Bray technic has opened an avenue of approach to the study of the acoustic nerve and its end organ. Since the proper conditions have not appeared, however, this method has not been used to study the human ear. Histologic studies have been made in certain cases with attempts to apply the results of animal experimentation to human hearing, but it has not been possible to make these experiments clinically practicable. This does not in any way detract from the scientific value of these studies. Other experimenters are following the older method, that of testing the hearing of patients before death and attempting to correlate the histologic observations with the results of the hearing tests. There is no quarrel between those working in these different fields. If the facts of the hearing process are determined, the investigations from all angles of approach must eventually be in agreement.