The larynx of old persons has frequently been examined. However, a perusal of the literature reveals that no two physicians agree in their findings as far as the muscles of this organ are concerned. Kofler 1 mentioned slight atrophy of the muscles, without giving further details, and Imhofer 2 found that the lipoid pigment usually situated around the nuclei of the sarcolemma increased in amount in old persons. Segre 3 found simple atrophy of the adductor and the abductor muscles, characterized by an increase of the nuclei of the sarcolemma and an increase in both the collagenous and the elastic fibers. This atrophy was least marked in the interarytenoid and the vocal muscles. In contrast, Imhofer 4 did not observe an increase in elastic fibers. The cricothyroid muscles showed hypertrophy in the cases of Segre,3 which was considered compensatory, because of the atrophy of the adductor muscles. Carnevale Ricci5 described essentially the same conditions as Segre3 except for the lack of compensatory hypertrophy of the cricothyroid muscles and, in addition, observed fatty degeneration of the laryngeal muscles.Because the changes found in the laryngeal muscles are not sufficient to explain the gross changes of the senile larynx and the characteristic

No abstract

This is not a book for any postgraduate who is still working for any higher examination. It contains statements which will surely cause his downfall, and much that will confuse him. It is not even intended that undergraduates should see it at all. The professional prostatectomist, however, is certain to enjoy either his violent opposition to, or alternately, his complete agreement with a surgeon who is much, and equally, respected by both sides, and who has put into this book a lot more wisdom than the present criticisms may suggest.

No abstract

The histologic examination of tumor-like formations in the external auditory canal, frequently observed in association with chronic suppurative otitis media, may yield information of diagnostic, prognostic and corroborative clinical importance. It is well recognized that neoplastic formations such as carcinoma, specific granulomas associated with tuberculosis and syphilis, and manifestations of metabolic disorders may be combined with chronic suppuration of the middle ear. These groups will be discussed briefly with emphasis on certain points of clinicopathologic interest. The main purpose of this communication is to encourage a renewal of interest in the benign neoplastic formations and perhaps a new interpretation of their clinical significance. CARCINOMA Malignant neoplasms affecting the middle ear are relatively frequent. The literature shows a paucity of material on the subject, and even any reference there to "primary" carcinoma of the middle ear requires explanation. Proof of the occurrence of such a neoplasm is most difficult. Notably do these neoplastic responses occur in the presence of a marginal perforation of the tympanic membrane in cases of chronic suppurative otitis media, often associated with cholesteatoma. Some authors 1 have commented on this type of suppurative process as having but a casual relationship, but it is of the greatest importance because of the possible invasion of the middle ear by epidermis from the canal and the tympanic membrane. It would be most hazardous to venture a diagnosis in a case of this kind, especially after the tumor has invaded the mastoid or the internal ear and even extensively involved the external ear. It must also be borne in mind that such neoplasms as invade the middle ear and its surroundings may have their origin from the eustachian tube and the pharynx (usually adenocarcinoma) or from the neck, to say nothing of the rarer instances of metastatic origin.Any neoplastic formation in the canal or the middle ear, whether it evidences a tendency to bleed or not, should be subjected to routine From the