Ralph A. Fenton

LXXXIV. Otolaryngologic Aspects of Commercial Aviation

While the visual function is of paramount importance to the aviator, he must also possess good breathing space, good hearing and, an excellent sense of balance. A full supply of air is necessary to the flyer, and in the thinned air of high altitudes his oxygenation is impaired, with danger to the accuracy of his responses in control of his ship. It is true that at such heights there is a long distance in which control of the plane may be recovered; but even a temporary loss of control may lead to fatal difficulties. This is especially true in flying high over the transcontinental routes across the Rocky Mountains and the Andes. Also, distinct effort is needed in expiration during flight, because of the high air pressure flowing past the plane at good speeds, due to the slip stream thrown back by the propeller as well as to the rapid movement of the plane. These matters are, of course, covered fully in the general medical examination, in the tests of breathing capacity. For these reasons the otolaryngologic examiner is required to look very carefully into the matter of mechanical obstructions to free breathing. Septal deviations or thickenings; turbinal hypertrophies; nasal polyps and the underlying accessory sinus involvement; nasopharyngeal fibromata; adenoids; hypertrophied tonsils where there is a history of repeated severe attacks of inflammation; paralysis or stenosis of the larynx; nasal, pharyngeal or tracheal ozena with obstructive crust formation-all these conditions, if not easily remediable, require attention from the student flyer and must be done away with before he can be passed

LXXV. Radical Treatment of the Ethmoid: INTRANASAL

Approach through the narrow threshold of the nostril should impose a certain caution upon the operator, and his indication for operation should be an ethmoiditis limited to accessible intranasal cells. Contraindications of a general nature include disease which may be implanted in or become localized in the operative field, such as tuberculosis and syphilis; disease affecting metabolism, such as diabetes or chronic nephritis, especially when associated with hypertension; severe anemia, especially with relative lymphocytosis; hemophilia, or any prolongation of bleeding or clotting time from nonhereditary causes, may all forbid or at least delay resort to radical intrasanal surgery. Local contraindications include narrowed passageways, whether the small nostril of childhood, or the acquired atresia of healed septal abscess or other severe loss of substance in the vestibule and upper septum. Orbital or intracranial complications of ethmoid suppuration forbid intranasal work, except as a step in adequate external operations. If a coexistent suppurative process in the homolateral frontal or maxillary requires radical external operation, naturally the ethmoid may best be reached at the same time externally.

XXXI Otology and Aviation

The medical research board established by the army through Colonels Lyster and Eugene Lewis early in 1917, for investigation of all physical and mental factors pertaining to military aviation, was headed by Prof. Yandell Henderson, with the active collaboration of the late John B. Rae. They established the medical research laboratory at Mineola, which continued until 1920, when a school for flight surgeons was created at Mitchell Field. In 1926 this institution, known since 1922 as the School of Aviation Medicine, was moved to Brooks Field and in 1931 to Randolph Field, Texas. The first commandant of the air medical school, Col. Louis H. Bauer, served from 1919 to 192 5. A research laboratory was established in 1933 at Wright Field, Ohio, for intensive study of the effects of flight on the human organism.

XXXIV Some Observations on Nasal Neurology

Diagnosis and therapy in the nose and accessory sinuses have run the gamut from empiricism to surgical radicalism, and now back again to the intricacies of biochemistry and cellular physiology. One of the most confusing divisions of nasal anatomy has resisted accurate exploration for a long time, and only recently some of its mysteries have been cleared up. Nevertheless, the innervation of the nose remains one of the most important factors in any study of this region. This importance is ordinarily brought to our attention because of the production and transmission of pain-discomfort, sensitiveness-as an evidence of disturbed or interrupted function.

III. Some Annoyances in the Management of Malignancies of the Accessory Sinuses

The average practitioner in our specialty is fortunate if he does not see very many cases of malignancy of the sinuses; the diagnosis, course and treatment of such processes have been detailed for us from the vast and carefully studied material of such clinics as those of Hajek, Hirsch, Dan Mackenzie, Holmgren, Beck and New. Nevertheless, one who sees relatively few of these frightful lesions often feels the need of counsel; and it is in such a spirit that these fragmentary observations are presented for your advice and comment. I cannot too highly praise the wisdom and kindliness with which Dr. Otis B. Wight has guided our use of radium in all of this work.

II Sulfanilamide in Otolaryngology: Some Personal Experiences

Hundreds of papers respecting sulfanilamide and its therapy have appeared in the past year, and in our field important recent contributions have been made by McMahon,! Kopetzky,2 Houser and others. The chemical and pharmacologic facts regarding this drug have been published in detail; one feels, therefore, that a brief record of personal experiences might be more valuable than a review of the voluminous literature, which has been very thoroughly covered recently by Schenck.

LXXXIV. Vaccines from Hemolytic Cocci in Sphenoethmoidal Disease

Following the false dawn of vaccine therapy in 1895 and the temporary and unauthorized excitement over Mannoreks work with the streptococcus, a veritable sunburst of enthusiasm for vaccines again occurred about twenty years ago. Hasty proponents of the new serologic vocabulary were busy with papers and case reports; and the pharmaceutical houses, with biologic departments and detail salesmen, gave practical emphasis to Shakespeares

IV Current Evaluation of Nasopharyngeal Defense Mechanisms

While Harris Peyton Mosher was at first intrigued by the anatomy of the ethmoidal labyrinth and the other accessory sinuses, he began the study of regeneration of antral epithelium and (using vital stains) of excised tissue, as long ago as 1931. Proetz and Hilding were already at work on ciliated epithelium; and Larsell and I since 192 8 had begun our work on mucosal protection. We made, thereafter, a thorough study of various factors, tending to the belief that the main element in mucosal defense consists in the carpet of mucosal cells lining the nose, nasal cavities, nasopharynx and upper respiratory tract. Herewith, somewhat dogmatically stated, are our conclusions down to the present: .

LXXII. Dyestuff Antiseptics in Rhinology

Numerous attempts have been made to utilize the penetrating power of organic dyestuffs for enhancing the action of antiseptics. It is, of course, probable that such penetration is rarely deeper in vivo than the second or third intercellular spaces from the epithelial surface. Two distinct ways of using the complex coal tar derivatives have grown up. One type possesses intrinsic antiseptic powers, and this includes most of the true dyestuffs: the other includes dyestuffs or combinations or their substances of origin, to which accepted antiseptics have been added and integrated. Mercury and the phenol derivatives are the common additions to this second class. The conclusions reached in this study are clinical and are based upon published bacteriologic studies already of record. Aqueous solutions have been used in the nose, which have limited the concentrations employed to 1 :100 up to 1 :10,000. In otology, of course, as in limited nasal ulcerations, very strong solutions are possible by the aid of 50 per cent alcohol, with or without glycerin. True dyestuffs include the rosanilin group (triphenylmethane) , which forms various colors with addition or subtraction of certain radicles, or owing to mixture of two or more substances. Their action is not caustic, but is undoubtedly due to the phenyl radicles. Crystal violet is the purest, then gentian violet (pyoktanin), methyl violet, and fuchsin. Other dyes occasionally employed, from neighboring chemical groups, are malachite green and methylene blue.