ANATOMICAL AND CLINICAL CONTRIBUTIONS 
TO THE KNOWLEDGE'OF THE DISEASES 
OF THE NASO-PHARYNGEAL REGION AND 
THE EAR IN CONSUMPTION 
Dr. EUGENE FRANKEL 
HAMBURG 
[Reprinted from the Archives of Otology, Vol. x, No. 2, June, 1881] ANATOMICAL AND CLINICAL CONTRIBUTIONS TO 
THE KNOWLEDGE OF THE DISEASES OF THE 
NASO-PHARYNGEAL REGION AND THE 
EAR IN CONSUMPTION. 
Dr. EUGENE FRANKEL, of Hamburg. 
Translated by Dr. F. E. D' Oench, of St. Louis, Mo. 
ALTHOUGH our knowledge of the pulmonary diseases 
leading to consumption, and of the organs generally 
affected by them, may now be conside-red almost complete, 
it is still defective in regard to some organs, and parts of the 
body. This may be accounted for partly by the difficulty 
attending the examination of these organs, partly by the 
lack of attention bestowed upon them, though Wendt (y. 
Ziemssens Handbuch der Krankheiten des chylopoetischen 
Apparatus, Bd. i, I, 2te aufl., 1878, p. 246) and, later, 
Schalle {Virchow s Ar chiv, vol. Ixxii, 2) described a method 
of greatly reducing these difficulties; nevertheless, this 
method was not taken advantage of, and to cast some addi- 
tional light on the diseases of this region is, therefore, the 
object of this paper. The title I have chosen may need 
some explanation. In studying the morbid changes in this 
locality, I confined myself to consumptives, noting every 
morbid change, even those which undoubtedly cannot be 
ascribed to phthisis ; the title chosen may, therefore, not 
seem entirely justifiable, but it is my belief that at least 
one-half of the morbid changes to be described are due to 
phthisis. 
The results described are based upon the post-mortem ex- 
Reprinted from the Archives of Otology, Vol. x, No. 2, June, 1881. Diseases of the Naso-Pharyngeal Region in Consiimption. 
101 
aminations of 50 consumptives, selected without regard to 
age, sex, or duration of the disease, from the whole number 
of those who had died of phthisis within a period of about 
four months. 
The anatomical changes in the lungs were due, in by far 
the greatest number of cases, to disseminated, fibrous, or 
caseous peribronchitis ; in a few instances to tuberculous 
peribronchitis, caseous broncho-pneumonia, or desquamative 
pneumonia; sometimes to cirrhosis, or caverns of varying 
size and age (combinations of these different forms were, of 
course, not infrequent); obliterations of the pleura, some- 
times partial, sometimes total, on one or both sides, often 
gave rise to complications. Most cases had taken a chronic 
course ; there were only a few of acute disseminated peri- 
bronchitis, and none of acute miliary tuberculosis. Death 
had been caused in some instances by recent pleuritis, pneu- 
mothorax or perforating peritonitis, due to tuberculous 
ulcers of the intestines; every body was highly emaciated. 
In 8 cases the larynx was affected, in 21 the intestines, in 
14 both larynx and intestines, in 7 the destructive processes 
were confined entirely to the lungs. 
Of the whole number of cases 36 were men, 14 women ; 
there were none under 10, 2 between 10 and 20, 14 between 
20 and 30, 17 between 30 and 40. 15 between 40 and 50, 1 
between 50 and 60, and 1 between 60 and 70. 
The method of examination was as follows: After remov- 
ing the parts of the base of the skull in question, according 
to Schalle's method, they were sawed through in a sagittal 
direction on both sides of the septum narium, then the 
cavity of the tympanum was opened, the semicircular canals 
were examined, and, finally, the cochlea and vestibule were 
exposed. In this manner all the parts in question can be 
carefully examined, and, owing to the small number of sec- 
tions, can easily be reunited and used for demonstrations; 
sometimes it is advisable to remove the floor of the nasal 
cavity by a horizontal section, leaving only a narrow bridge 
to connect it with the neighboring parts. 
Of the specimens obtained in this way, morbid changes 
were found in 29 of them in the naso-pharyngeal region or 102 
Eugene Frankel. 
the auditory organs ; the nasal cavity and inner ear, how- 
ever, did not share in them. Tuberculous affections of the 
nasal cavity, as is well known, are rare, only a few cases hav- 
ing been described so far, by B. Frankel {y. Ziemssen s Hand- 
buch, i, p. 137), who published the case observed by Willigk, 
by Laveran {Union MM., 1877, No. 35), by Riedel {Deutsche 
Zeitschrift fur Chirurgie'), and by Tornwald {Deutsches 
Archiv f. Klin. Medicin, Bd. xxvii, H. 5 and 6, p. 588). In 
none of my 50 cases did I find any tuberculous affections, 
and, therefore, in opposition to Tornwald, believe that they 
are very rare in the nasal cavity. On some other occasion, 
however, I shall describe the case of a boy, five years old, 
who had died of tuberculous pleuritis and amyloid degen- 
eration, following resection of the head of the right femur, 
where I found miliary tubercles on the mucous membrane 
of the septum narium ; caseous ostitis, accompanied by the 
formation of several sequestra, had set in, and a number of 
tubercles had formed on the mucous membrane of the sep- 
tum, on a line with the left middle meatus, every one of 
which was surrounded by a delicate wreath of blood-vessels; 
there was a strong fetid odor. 
Of these 29 cases 10 were confined to the naso-pharyngeal 
region exclusively, all of them being ulcers, frequently in- 
volving the pharyngeal ostium of the Eustachian tube, and 
sometimes penetrating to the rough surface of the basilar 
process of the occipital bone. Men and women were equally 
often affected; 6 were between 20 and 30, 1 between 30 
and 40, 2 between 40 and 50, and 1 between 50 and 60; only 
once neither the larynx nor the intestines were affected; in 
5 cases there were ulcers in both, in 4 in the intestines, 
and in 1 in the larynx alone. This confirms the observation 
of Wendt and Wagner {I. c., p. 302), who frequently found 
ulcerations in the naso-pharyngeal region, associated with 
ulcers in the intestines. 
As regards the location of the ulcerations, it is notable 
that in eight of the ten cases the tonsil was affected ; in 
the other two they were confined to the region of the orifice 
of the Eustachian tube; in four cases the mucous membrane 
of the latter region, on both sides, as well as of the tonsil, Diseases of the Naso-Pharyngeal Region in Consumption. 
103 
had ulcerated, once only on the left side ; in three of these 
eight cases, the orifice of the Eustachian tube was not 
affected. The auditory organs remained intact in every 
case, even when ulcerations had formed at the entrance to 
the Eustachian tube; this is the more remarkable, because 
in other diseases of the naso-pharyngeal region secondary 
changes in the auditory organs are not rare, for instance 
when otitis media has resulted from adenoid growths in the 
pharynx. 
These observations agree with those of the investigators 
mentioned above, Wagner and Wendt, who found that in sev- 
eral cases of large ulcers of the tonsil the middle ear re- 
mained either entirely intact or was affected only on one 
side. 
The form of the ulcers varied ; in general those extending 
to the Eustachian tubes or the posterior wall of the pharynx 
were confined to the upper strata of the mucous membrane, 
while the more circumscript ulcers near the tonsils presented 
a crater-like appearance, and in two cases had laid bare the 
bone. Tuberculous eruptions, either with or without exu- 
dation, were entirely wanting. Nevertheless, I would invite 
clinicists and anatomists to search for ulcerations in the 
roof of the pharynx in those cases of phthisis in the course 
of which symptoms of tuberculous meningitis have devel- 
oped, in order to determine whether or not any connection 
can be established between them. 
In the great majority of cases the ulcers appeared more 
or less unclean, uneven, partly covered with disintegrating 
growths resembling granulations, partly with yellowish- 
brown nodules of the size of a pin-head, here and there also 
with punctiform ecchymoses, while a dirty, puriform, green- 
ish-yellow viscous secretion overspread their surface ; the 
edges of the ulcers frequently presented a ragged appear- 
ance ; in some cases they were lined with the grayish-yellow 
nodules just mentioned, which sometimes, when the ulcers 
themselves were free from them, appeared in the surround- 
ing tissue ; frequently the ulcers were undermined to a con- 
siderable extent. 
Besides the ulcers just described lesions of the mucous 104 
Eugene Frankel. 
membrane at or near the mouth of the Eustachian tube 
were sometimes found, which, on account of their shallow, 
circular shape and sharp edges, very much resembled the 
laryngeal ulcers of consumptives. 
Besides the nodules mentioned above, hemorrhages were 
observed in the neighborhood of the ulcers, and also, though 
very seldom, cicatricial cords, presenting a very curious ap- 
pearance, due to the net-like manner in which they inter- 
laced. In two cases, the mucous membrane looked as 
though it were worm-eaten, an appearance due to the pores 
of the distended ducts of the numerous racemose glands. 
Here and there a few small cysts were noticed. 
In order to gain an insight into the development of these 
ulcerations, I examined a few where tubercles could be sus- 
pected, with the microscope, without, however, being able 
to find any, though Wendt saw them in two cases on the 
border and in the neighborhood of the ulcers. Though the 
formation of ulcers from the disintegration of tubercles 
must therefore be granted in a few cases, it is certainly a 
very rare occurrence, and so I would give for many of them 
the following explanation: 
The changes found consisted in a very dense infiltration 
of cells and nuclei, sometimes diffuse, sometimes more cir- 
cumscribed, and of about the size of two or three glandular 
acini ; sometimes it was confined to the layers nearest the 
epithelium, sometimes it extended in between the glands, 
surrounding the numerous small blood-vessels of the sub- 
epithelial layer and the distended ducts of the glands. 
In some places the epithelium of the ducts still remains, in 
others it is missing, while dense masses of cells and nuclei 
fill the duct ; the glands themselves appear intact, only 
here and there an interlobular infiltration is visible. The 
calibre of the blood-vessels within this zone is partly very 
much reduced, partly obliterated by compression. Beyond 
the layer of the glands there is no sign of this infiltration. 
Judging from this condition it, therefore, seems probable to 
me that in consequence of the compression of the blood- 
vessels necrobiotic processes are brought about, the emi- 
grated blood-corpuscles disintegrate, the epithelium is de- Diseases of the Naso-Pharyngeal Region in Consumption. 
105 
stroyed, and finally ulcers are formed, the depth of which 
depends upon the extent and character of the infiltration. 
As regards the development of these shallow lesions which 
sometimes occur on the mucous membrane of the orifice 
of the Eustachian tube, I have not arrived at any definite 
explanation. It is not quite clear what Wendt and Wag- 
ner (Z. c., p. 303) mean by the follicular origin of some of the 
ulcers examined by them, whether they are due to the cas- 
eous degeneration of the numerous lymph-follicles of the 
mucous membrane, or whether they have an origin similar 
to that of the follicular ulcers developing in the larynx and 
trachea of consumptives out of the ducts of the mucous 
glands of these organs. 
That these ulcerations can heal has already been stated 
by Wendt and Wagner and is proved by the cicatricial tis- 
sue in their neighborhood, a fact which cannot seem strange 
when we take into consideration that we find cicatrices as- 
sociated with fresh ulcers in organs which, like the larynx 
and intestines, are the favorite seat of tuberculous affections. 
I cannot, therefore, agree with Michel (" Die Krankheiten der 
Nasenhhole und des Nasenrachenraumes," Berlin, 1876), 
who attributes all more extensive ulcerations of the naso- 
pharyngeal region to syphilis. 
Before entering on the discussion of my clinical obser- 
vations, I wish to refer briefly to the origin of the small 
cysts mentioned above, which I found not only in the naso- 
pharyngeal region, but also in the antrum of Highmore, of 
varying size and number, and frequently unattended by any 
ulcerations; while I agree with the explanation given by 
Wendt and Wagner (Z. r., p. 268 ff.) of their development, 
I will only add that in the cases which I examined they 
were retention-cysts, due to compression of the ducts of the 
racemose glands by the cellular infiltration of the subepithe- 
lial layer, thus preventing the discharge of their secretion ; 
in a few cases the contents had suppurated and the mem- 
brane had become so thin that even a slight pressure was 
sufficient to burst the cyst. Of course, the same result 
might take place spontaneously, for instance, from very 
rapid growth, thus giving rise to a lesion which, in turn, 
might develop into an ulcer. 106 
Eugene Frankel. 
In regard to the time of appearance and subsequent 
course of these ulcerations, I can say the following: i. 
They are sometimes found when only slight changes can be 
detected in the lungs, although they generally accompany 
the later stages of phthisis ; or 2, they may remain latent 
and are only discovered by the post-mortem examination, 
though sometimes the painful sensations caused by their 
presence constitute the chief grounds for complaint. I re- 
member, for instance, the case of a young book-keeper, 24 
years old, where, in addition to tuberculous ulcerations of 
the epiglottis, there was a deep, crater-like ulcer near the 
tonsil, which was the cause of constant complaint. He con- 
tinually had the sensation of mucus adhering to this spot, 
causing him to hawk violently ; a crust formed at night, 
which could only be removed with great difficulty. Months 
later caseous degeneration and ulceration of the solitary 
follicles of the posterior wall of the pharynx set in, consid- 
erably intensifying the sufferings of the patient, and ren- 
dering the last months of his existence particularly painful. 
He frequently complained of a pricking pain in both ears, 
a symptom which I consider to be due, in many cases, to 
ulcerations in the naso-pharyngeal region, and not, as is gen- 
erally assumed, to tuberculous ulcers of the pharynx, or 
lesions of the larynx, especially the posterior wall; in this 
I agree with Traube, who, in his " symptoms of the diseases 
of the respiratory organs," ascribes the pain often felt in the 
ear by consumptives, to ulcerations in the neighborhood of 
the orifice of the Eustachian tube. This is proved by those 
cases in which, although no ulcerations can be found in the 
larynx or pharynx, the patients complain of pain in the 
ears, and an examination with the rhinoscope reveals ulcers 
in the naso-pharyngeal region, especially at the ostium 
tubes ; yet I will not deny that cases occur, in which just 
the reverse of the morbid changes mentioned exists, to 
which the explanation of Frankel, given in his paper " on 
tuberculosis of the pharynx " must be applied {Berl. Klin. 
Wochenschr., Nos. 46 and 47, 1876). He ascribes the pain to 
perverse sensations conducted through Jacobson's and the 
glosso-pharyngeal nerve. In a third series of cases the ex- Diseases of the Naso-Pharyngeal Region in Consumption. 
107 
amination of the auditory organs themselves gives a suffi- 
cient explanation, (to which I shall recur later,) at the same 
time it indicates the treatment to be resorted to. 
In regard to the differential diagnosis of these ulcers I 
agree with Frankel, " that the appearance of the ulcers is 
sufficiently characteristic to make a diagnosis," he states 
this to be true of the ulcers found in the pharynx of tuber, 
culous persons, while I claim that it is also true of those 
of the naso-pharyngeal region, not only in the living, but 
also in the dead subject. 
In treating these ulcers I would recommend a i-per-cent. 
solution of creosote dissolved in equal parts of alcohol and 
glycerine. It is a preparation frequently used in Dr. Bulau's 
wards in cases of painful tuberculous ulcers of the larynx 
and pharynx, which often afforded at least temporary re- 
relief; I sometimes also applied absolute alcohol, or made 
use of hypodermic injections of a 2|-per-cent. solution of 
carbolic acid, which, applied at the angle of the jaw, caused 
the pain to disappear rapidly. 
I shall now proceed to describe those changes which had 
taken place in the auditory organs. They were found dis- 
eased in 16 cases: 8 of which were complicated with affec- 
tions of the naso-pharyngeal region. The other eight were 
confined to the auditory organs alone. Beginning with the 
latter, it is a curious fact that all were men, the youngest 
being 26, the oldest 68 years old ; while three were between 
40 and 50, one a little over 30, and two almost 30. In the 
great majority of cases, a direct connection can hardly be 
found between these morbid changes and the phthisis itself; 
in only two cases I consider it possible to speak of such a 
connection, though even for them I would not make 
any positive statements, because it remained uncertain 
whether phthisis had developed sooner than the morbid 
processes in the ear, or vice versa. In both cases extensive 
changes in the mucous membrane of the cavity of the tym- 
panum, combined with caries of the walls, had taken place, 
especially in the case of a young man of 26. The drum- 
head of the right ear, which was the one affected, was en- 
tirely destroyed, while beyond it a bowl-shaped cavity ex- 108 
Eugene Frankel. 
tended, reaching from the mastoid cells to the orifice of the 
Eustachian tube ; the ossicles were gone. A narrow strip 
of mucous membrane still existed on the floor of this cav- 
ity ; in the remainder of it the roughened bone lay exposed ; 
near the orifice of the Eustachian tube a sequestrum pro- 
jected, still firmly attached. The whole vestibule was de- 
stroyed, the bone converted into a sandy mass, the facial 
nerve gone from its first inflection to its point of emer- 
gence at the stylo-mastoid foramen, and the cochlea was ex- 
posed with all its turns. The case of phthisis had been a very 
severe one, the pulmonary tissue had been destroyed to a 
great extent, cavities had formed, and there were ulcerations 
in the larynx and intestines. 
Such extensive morbid changes in otherwise healthy per- 
sons being but very rarely caused by a purulent otitis me- 
dia not dependent upon a dycrasia, it seems very probable 
to me, that, as this was not a primary tuberculous ostitis of 
the petrous portion of the temporal bone, although the exist- 
ence of such an affection was put beyond doubt by Zaufal 
and others, it was a caseous inflammation of the mucous 
membrane of the tympanic cavity, " speedily followed by 
ulceration and degeneration of the mucous membrane. . . 
and sometimes by caries of the bone " (Schwartze, Pathol. 
Anatomie des Ohres, 1878, p. 80). In the second case also, 
that of a young man of 24, the right ear was the one 
affected ; the drumhead, with the exception of a narrow 
crescent on the roof of the auditory canal, had been de- 
stroyed, caries of the wall of the labyrinth below and be- 
hind the promontory had begun to the extent of a pin's 
head, and all the ossicles were gone, while the vestibule and 
cochlea had remained intact. The destructive process in 
the lungs was mainly confined to the right side; the larynx 
and intestines were normal. 
Such extensive destructive changes as in the first case 
just described, could only be wrought in the course of 
months, so that both the ear and lungs may have become 
affected at the same time, or the former may even have been 
the starting-point for the phthisis which afterward developed 
in the lungs. See also v. Troltsch (3d ed., 1867, p. 337, note), Diseases of the Naso-Pharyngeal Region in Consumption. 
109 
and Urbantschitsch {Lehrbuch der Ohrenheilkunde, 1880, p. 
370), who discuss the possibility of tuberculosis developing 
in connection with chronic purulent otitis media. I also 
observed a case of this kind about three years ago. 
The case was one of a young merchant without any hereditary 
taint, who, in the fall of 1877, became affected with purulent oti- 
tis media, which would yield to no treatment, and greatly reduced 
the patient, especially through the great pain which he suffered at 
night. Nothing abnormal could be detected at the time in any 
other organ, especially the lungs; the otorrhcea was more or 
less profuse, and never ceased entirely ; in the spring of 1878, a 
periproctal abscess formed, after the incision of which an incom- 
pleteexternal fistula of the rectum remained, which, however, after 
being operated, healed, though very slowly ; in the meantime a 
cough began to trouble him, morbid changes in the apex of the lungs 
were discovered, tuberculosis of the intestines and ulcers of the 
larynx followed, and in the spring of 1879 the patient died. 
Undoubtedly the phthisis of this case, was in direct con- 
nection with the purulent otitis media, and it would be of 
interest to know how frequent such an occurrence may be. 
Of course this would involve the examination of the audi- 
tory organs of every consumptive, and, when a purulent 
otitis media exists or has existed, the determination of its 
duration and its connection with the general disease. 
Of the remaining six cases, four were due to a mucous 
(left-side) and (once) a muco-purulent (right-side) catarrh of 
the middle ear; twice sclerosis had begun in the tympanic 
cavity, which had given rise to the formation of thread- 
like pseudo-ligaments, partly between the ossicles them- 
selves, partly between them and the wall of the labyrinth ; 
the drumhead had remained uninjured, but appeared some- 
what opaque ; whether or not the hearing was impaired I 
do not know, as no tests were made, which, besides, would 
have no bearing on this question. 
I have already stated that I do not think that any direct 
connection exists between these local affections and the 
primary disease, still, I wish to define my position more ac- 
curately, in so far as I am in complete accord with v. 110 
Eugene Frankel. 
Troltsch (Z. r., p. 242) in thinking that phthisis predisposes to 
the development both of an otitis media sicca and mucipara. In 
proof of this I can cite the results of my examination 
of the auditory organs of non-consumptive persons, where 
sclerosis of the middle ear was rarely found. 
It now but remains to consider the last category of cases, 
in which both the naso-pharyngeal region and the auditory 
organs were affected. Here, also, most of the cases were 
those of men, only one of the whole number (eight) be- 
ing a woman. One was between 10 and 20, two between 
20 and 30, one between 30 and 40, and four between 40 
and 50 (a woman among the last). Three were cases of 
otitis media with sclerosis, four of catarrh, and only one of 
purulent otitis media. 
The last-mentioned case was one of a man 42 years old, 
who had died of caseous peribronchitis of both lungs, com- 
bined with cavities in the right upper lobe and tuberculous 
ulcers of the intestines, and who, during life, had complained 
of pain in the right ear when swallowing. Larynx and 
pharynx were found normal ; there were no ulcerations in 
the naso-pharyngeal region, the mucous membrane of which 
was of a scarlet-red and infiltrated with numerous ecchy- 
momata. The drumhead in the right ear was entirely 
destroyed, the floor and inner wall of the tympanic cavity 
covered with creamy pus, below which lay the rough bone 
of the wall of the labyrinth ; the circulation between the 
hammer and anvil was imbedded in a jelly-like, viscous exu- 
dation ; of the malleus there remained only the head and 
short process, and a piece of the handle about 1-2 mm. 
long; of the incus, the body and a piece of the short pro- 
cess ; while the stapes was gone entirely. 
In regard to the connection in this case between these 
morbid changes in the ear and the general disease, I hold 
the same opinion as in the case of purulent otitis media, 
complicated with caries of the wall of the labyrinth, which 
I described above, although in the absence of a history 
I have no sufficient proofs for this. 
In the three cases of dry otitis media combined with the 
formation of numerous synechiae (twice in the left ear, once Diseases of the Naso-Pharyngeal Region in Consumption. 
111 
in both), the changes in the naso-pharyngeal region con- 
sisted twice in the presence of cysts in Rosenmuller's fossa 
or the tonsil respectively, and once in spotted extravasations 
of the roof of the pharynx ; in the first two cases the gen- 
eral disease was confined to the lungs, in the last the larynx 
and intestines were also affected. 
The remaining four cases were catarrhs of the middle 
ear; twice affecting both ears, and once the right, and 
once the left alone ; in only one case (where both ears 
were involved) the drumhead had been destroyed. The 
morbid changes in the naso-pharyngeal region consisted in 
two cases in cicatricial bands: once in Rosenmuller's fossa, 
and once at the roof of the pharynx, between which the 
mucous membrane had sunken in ; while in the two other 
cases ulcers had formed, one of which, of crater-like shape 
and situated near the tonsil, had penetrated to the bone, 
while the other extended as far as the orifice of the Eus- 
tachian tube on both sides. It is not improbable, therefore, 
that, judging from these conditions, these processes are 
directly connected with the coexistent changes in the audi- 
tory organ^. 
Aside from the functional changes, which very probably 
existed in everyone of the 16 cases, subjective symptoms in 
form of pain were manifested in only one case, so that there 
were no indications for treatment of the aural affection ; the 
nature of the treatment would be regulated by general prin- 
ciples, and need not be enlarged upon. 
In conclusion, three cases remain to be reported, which 
were confined to the naso-pharyngeal region ; retention- 
cysts of about the size of a bean had formed, twice in the 
neighborhood of the tonsil, and once near Rosenmuller's 
fossa, and although I do not think that any connection ex- 
isted between them and the primary disease, still they may 
be of importance in deciding the question in regard to the 
frequency and nature of the idiopathic as well as secondary 
morbid changes of the naso-pharyngeal region, which some- 
times are associated with certain general diseases. In two 
of these cases (men of 23 and 31) ulcerations of the larynx 
and intestines had formed in addition to the destructive 112 
Eugene Frankel. 
processes in the lungs; in the third (a woman of 43) there 
were also ulcers of the intestines. 
The total number of specimens examined was 50, of these 
36 were from men ; of these there were diseased 22 
14 " women ; " " " 7 
Total, . . 29 
The morbid changes affect 
the naso-pharyngeal region alone, . 13 times. 
the auditory organs alone, . . 8 " 
" " " and naso-pharyngeal region, 8 " 
Total, . . 29 
The respective ages were 
between 10 and 20, .... 1 
" 20 " 30, . . . .10 
" 30 " 40, . . . .5 
" 40 "50, . . . . 12 
50 " 60, . . . . o 
" 60 " 70, . . . .1 
Total, . . 29 Diseases of the Naso-Pharyngeal Region in Consumption. 
113 
Sex. 
Age 
KIND OF AFFECTION. 
KIND OF PHTHISIS. 
Complications 
in the 
Male 
Female 
Larynx 
Intes- 
tines 
A ffections of the naso-pharyngeal region alone. 
T 
Ulceration of the tonsilla pharyngele. 
Ulcerations of the roof of the pharynx extending to the orifice of the 
Peribronchit. dissem., vomicae lob. super, destr. 
I 
I 
5° 
Peribronchit. dissem., vomicae inveterat. lob. super. 
I 
Eustachian tubes ; erosions on the mucous membrane of the orifice. 
utr. 
I 
32 
Bowl-shaped ulcer'of the roof of the pharynx extending over the 
Peribronchit. et bronchopneum. dissem. caseos. ; 
I 
mucous membrane of the posterior wall of the pharynx. 
vomicae lob. super, d.; pleurit. adhaes. dextr. 
Pneum. desquam., vom. lob. sup. utr. 
I 
3° 
Ulceration of the orifice of the left Eustachian tube, covered with 
I 
nodules. 
Peribronchit. dissem. caseos. bilat. 
I 
26 
Ulceration of the mouths of the tubes; the mucous membrane of 
I 
the roof of the pharynx appears honey-combed. 
Peribronchit. dissem., caverns especially in the left 
I 
26 
Ulcer of the pharyngeal tonsil. 
I 
I 
upper lobe. 
X 
25 
Ulcerations of the naso-pharyngeal region, including the posterior 
wall of the pharynx and the mouths of the tubes. 
Crater-shaped ulcer of the pharynx lined with nodules. 
Peribronchit. dissem. 
I 
I 
25 
Peribronchit. tuberc., pleuroobliterat. and caverns r. 
46 
Two deep, bowl-shaped ulcers of the roof of the pharynx. 
Two ulcerations of tne roof of the pharynx, one of which, situated 
Empyema sin.; peribronchit. caseos. bilateral. 
I 
I 
27 
Peribronchit. dissem., vomicae lob. super, utr. 
I 
I 
near the tonsil, exposes the bone. 
I 
31 
Colloid cyst in Rosenmuller's fossa (right). 
Peribronchit.; cavities. 
X 
23 
Cyst, of the size of a bean, at the roof of the pharynx. 
Peribronchit.; cavities, especially in r. upper lobe. 
I 
I 
I 
43 
Retention-cyst, near the tonsil, about half the size of a cherry-stone. 
Peribronchit. dissem. caseos.; caverns in r. upper lobe. 
I 
A ffections of the auditory organs alone. 
I 
33 
Otitis media sicca bilateral. 
Bronchopneum. caseos. bilat.; caverns in r. upper lobe 
X 
49 
Otitis media sicca bilateral. 
Peribronchit. dissem. acut. 
intact 
I 
X 
29 
Otitis med. suppur. dextr. car. creser. pariet. labyrinth (cyst in 
Bronchopneum. caseos. d.; peribronchit. apic. sin.; 
intact 
antrum of Highmore of r. side). 
bronchiectasiae. 
intact 
intact 
68 
Otitis med. exsudat. mucosa sin. sine perfor. mbr. tymp. 
Peribronchit. dissem. tuberc. ex epididymit. caseos. 
I 
28 
Otitis med. exsudat. mucosa sin. sine perfor. mbr. tymp. 
Cirrhos. et peribronchit. bilateral. 
I 
26 
Otitis med. suppur. dextr., defect, mbr. tymp.; caries pariet. tympan. 
Caveitis on both sides. 
X 
47 
Otitis med. dextr. suppurat. sine perforat. mbr. tymp. 
Empyema sin., peribronchit. caseos. ; caverns. 
intact 
intact 
I 
47 
Otitis med. mucosa sin. sine perforat. mbr. tymp. 
Peribronchit. et bronchopneumon. caseosa ; caverns on 
left side. 114 
Eugene Frankel. 
Sex 
Age 
KIND OF AFFECTION. 
KIND OF PHTHISIS. 
Complications 
in the 
Male 
Female 
Larynx 
Intes- 
tines 
A ffections of the naso-pharyngeal region and auditory organs. 
I 
I 
I 
44 
4o 
4a 
Otitis med. sicca sin., suppurated cyst near the tonsilla phar. 
Otitis med. mucosa bilateral sine perforat. ,mbr. tymp. cicatricial 
cords in the roof of the pharynx. 
Otitis med. suppur. dextr. c. perfor. mbr. tymp. et caries pariet. 
labyrinth ; hemorrhages in the mucous membrane of the roof of 
the pharynx. 
Cirrhos. et peribron. dissem., pleurit. adhaesiva fibrosa. 
Pneumothor. dextr., bronchopneumon. caseos. et 
vomicae pulm. dextr. 
Cirrhos. lob. super, utr.; caverns in r. upper lobe,peri- 
bronchit. dissem. caseos. 
intact 
intact 
1 
1 
I 
J9 
Otitis med. mucosa sin. sine perfor. mbr. tymp.; cicatricial cords in 
the mucous membrane of tile roof of the pharynx. 
Cavities in the apices of both lungs; peribronchit. 
dissem. 
I 
1 
I 
I 
I 
25 
41 
28 
Otitis med. sicca bilateral sine perfor. mbr. tymp. ; small cyst, the 
size of a hempseed, in the mucous membrane of both of Rosen- 
muller's fossae. 
Otitis med. mucosa bilateral, c. perfor. mbr. tymp. dextr. sine 
perfor. sin.; large ulcer of the roof of the pharynx, extending on 
both sides as far as the mouth of the tube. 
Otitis med. mucosa dextr. sine perfor. mbr. tymp.; crater-shaped 
ulcer near the pharyngeal tonsil, surrounded by cicatricial bands 
and small cysts. 
Slaty induration and peribronchit. dissem. and bron- 
chopneumon. caseosa in both lungs. 
Tuberculos. pleurae ; cavities in both lungs. 
Cirrhos. et bronchopneumon. caseos. sin.; peribronchit. 
et tuberculos. pulm. dextr. 
intact 
1 
intact 
1 
X 
33 
Otitis med. sicca sin., membr. tymp. non perfor.; ecchymos. multi- 
plic. mucosae tegminis pharyngis. 
Pleurit. tuberculos. bilateral., peribronchit. dissem. 
1 
X g. p. putnam's sons, printers 
NEW YORK