Ira Frank

VII Carcinosarcoma of the Larynx

Since the time of Virchow various tumors have been described as carcinosarcoma, or malignant tumors of dual origin. Recently, Saphir and Vass, l and Saphir~ have reviewed the literature of these tumors. From this study, and from the study of a series of their own cases, they have shed grave doubt as to the existence of such tumors. Rather, they strongly suggested that in most cases of diagnosed carcinosarcoma, the tumors were actually carcinomas which had undergone morphological variations and which at times resembled sarcomas.

LIV Papilloma of the Tonsil—With Report of Three Cases

True tumors of the tonsils, whether benign or malignant, are rare lesions, those of benign type being much less frequently observed than the malignant. Liveriero, in 1933, made a thorough study of the world literature (1827-1932) and found reports of only 150 cases of benign tumor of the tonsils. According to Vidau, the first case of benign tumor of the tonsil was reported by Robert in 1827; the first complete monograph on the subject was published by Ardenne in 1897.

XXVII Transitional Cell Carcinoma of the Upper Respiratory Tract

There is considerable confusion in the literature as to the nomenclature and biologic nature of malignant tumors of the upper respiratory tract. In general it has been recognized that there are at least two types of such tumors. These two types differ only in whether or not the cells have a tendency to mimic the normal metamorphosis of cell types in stratified squamous epithelium. Those tumors whose cells have this tendency have been variously called: squamous cell carcinoma, spinous cell carcinoma, epidermoid carcinoma of the skin or mucous membrane type, and various other names. The other group includes anepidermoid carcinoma, transitional cell carcinoma, anaplastic carcinoma, carcinoma solidum simplex, basal cell carcinoma, lymphoepithelioma, etc.

LXXVI. Sheath of the Internal Carotid Artery: A Route for Infections from Primary Lesions

The purpose of this investigation was to trace the route of intracranial complications originating from pharyngeal infections. Though such a complication is not very common, we had the opportunity to study two relevant instances where an acute meningitis followed a severe tonsillar infection. A neck dissection in these two instances revealed that the inflammation apparently had spread into the meninges by way of the sheaths of the internal carotid arteries.

XXXIII. The Deafness of Beethoven

The deafness of Beethoven should be of great interest to all lovers of fine music, to those interested in biographic literature and certainly to all otologists. No apology therefore is necessary; indeed, it seems appropriate to consider this subject with a group of otolaryngologists. Although there is a fair amount of literature dealing with the life and work of Beethoven, it deals mostly with a critical analysis of his musical creations and an appraisal of his influence on the world of music. The books and articles which discuss his deafness are not numerous and are written mostly in the German, French and Italian languages; there is little available literature in English about his deafness. The principal sources to which I am indebted for such information as is given here are mentioned in the appended bibliography.

LIII. Recent Nasal Fractures

I t is to be regretted that current literature so rarely brings to the mind of the student and general practitioner the pressingneed of proper care and attention to fractures ot the nose. It is the universal opinion of those experienced in this work that there are few cases of fractures in any location on the skeleton that require more constant care and vigilance than fractures of the ossa nasi; and it may be added that there is· no facial organ more sensitive to deformity in its relation to disfigurement of the face.

XXX. Gasparo Tagliacozzi and His Contribution to Rhinoplasty

The early part of the sixteenth century must always rank among the most remarkable periods in the history of civilization. The invention of printing had made literature the property of many to whom it had hitherto been inaccessible. The downfall of the Byzantine Empire scattered over Europe numbers of fugitive Greeks, who carried with them to the Western world many treasures of classical literature. Raphael, Michelangelo and others revived the glory of the ancients in the realm of art. The narrow limits of the old world had vanished, and the Spanish and Portuguese navigators opened up the way to vast new domains, while the Reformation revolutionized the spirit of mankind and put an end to the age of ignorance and superstition. During this active period the greatest discoveries in the study of anatomy took place. Every part of the human frame was carefuIIy studied and important discoveries made. Andreas Vesalius, the reformer of anatomy, who had the courage to set aside the teachings of Galen and undertake a new arrangement for anatomic instruction; Eustachi, his contemporary, for his observations of the internal ear and the tube which bears his name; Falloppio, who rectified the knowledge then possessed of the anatomy of the ear; and William Fabry of Hilden, a pupil of Falloppio, who merits distinction for his efforts in the comparative anatomy of the ear and larynx and for the employment of the tube in tracheotomy. It was in this century that Gasparo Tagliacozzi (Tagliacotius, Taliacotius*), professor of anatomy and surgery in the

XXXV. A Report of Two Severe Cases of Ulceromembranous Angina

There occurred recently in my service two unusual and severe cases of ulceromembranous angina, which were of interest not only because of their severity, but also because of the widely differing clinical forms which they assumed. The contrast of these two cases, which I was fortunate to be able to study simultaneously, was so marked--considering that they both represented the same disease, with presumilbly identical etiologic factors-that I feel that a brief report may be of interest to you. Moreover, a rather diligent search through the literature has shown a marked dearth in the number of serious and fatal cases reported, and has further revealed the existence of debatable points in etiology and treatment. It is, therefore, that I present these two cases in the hope of provoking a general discussion and a recital of personal experiences. Case l.-L. S., male, aged forty-eight years, a peddler, was admitted to my service on June 4th. He gave a meager history, which indicated that five weeks previously he had suffered with a peritonsillar abscess which when opened had discharged a large quantity of pus. Some time after admission he was able to tell us that following this evacuation the symptoms continued without remission, though there was no further formation of pus, and his condition grew more serious day by day. He presented himself at the hospital in a pitiful condition, unable. to swallow or to open his mouth beyond a one-half inch separation of the incisors. He was weak and emaciated, having lost approximately twenty-five pounds since the onset of his illness. General physical examination negative. Examination of the

LV. Nondiabetic Acidosis—With Special Reference to Postoperative Acidosis in Children

It is my purpose in the following paper to bring under one head and in concrete form a review of the literature, clinical and experimental, which is fast tending to outline distinctly the hazy concept we now call acidosis. I shall add thereto certain personal observations and attempt to produce from the whole a practical clinical entity, with definite etiology, definite diagnostic points, specific treatment, and direct and simple prophylaxis. The subject should be of serious interest to those whose work is related to childhood, and especially to those of us who must frequently anesthetize children-for it is in the young that nonsymptom producing acetone is frequently found -it is in the young that the metabolic balance is most easily disturbed-and it is in the young that we tamper with several of the important etiologic factors of symptom producing acetonemia when we remove tonsils and adenoids under general anesthesia. The literature on the subject is well nigh boundless, for a study of it leads to many branches and subbranches .. each of which terminates in a maze of more or less conflicting theories supported by laboratory and clinical evidence. I consider, therefore, that a brief review of this literature, amalgamating the important points which have been brought out in the course of the last decade or so, and which will assist