Penicillin in infections involving the central nervous system and skull.

The author examined personally 169 cases of otitic facial palsy which were treated without surgery of the Fallopian canal. This extensive follow-up showed that no case got complete recovery unless recovery had commenced within two months of the onset of the palsy. Many began recovery later and recovery was considerable, but it was never complete. He therefore concludes that if complete recovery is important to the patient the nerve should be decompressed two months from the onset of the palsy unless recovery has already begun. He found that the faradic response was not a reliable guide in distinguishing between anatomical and physiological damage to the nerve. He lays down general rules for guidance : Pre-operative palsy in acute otitis media requires simple mastoidectomy. Pre-operative palsy in chronic otitis media requires radical mastoidectomy, and only if a fistula is discovered is a decompression performed. Post-operative palsy noticed directly after operation indicates immediate decompression and, if required, repair of the nerve. Post-operative palsy after a free interval should be treated conservatively. In all cases where immediate operation is not indicated the nerve should be decompressed and examined if there is no recovery after two months. The etiology of Bell's palsy is discussed and an exceptionally interesting case is described. This patient had suffered from a Bell's palsy for fifteen years and after this time a partial paralysis became complete. After no improvement with a few months' treatment, decompression of the nerve was performed. A narrowing of the bony facial canal was found extending from just outside the geniculate ganglion to just below the horizontal canal. The canal was widely opened and the nerve sheaf split. Complete recovery of the facial movement was observed seven months after operation. It is thought that this is an unusual case of Bell's palsy but it provides an additional reason for surgical treatment of Bell's palsy which fails to recover spontaneously. The author describes a case of apicitis suppurativa treated surgically by what he calls a modified Streit's operation. This consists of removing the bone at the root of the zygoma and exposing the dura for a width of about 2f cm. at the superior aspect of the petrous pyramid. The dura is carefully elevated until the apex of the petrous pyramid is reached. An abscess here can now be opened with a slightly curved chisel and punch forceps. In his case a drain was left in …