tendon. By means of this guide suture the exten- sor proprius hallucis tendon, which was rapidly freed, was drav/n downward through the sheath of the tibialis anticus and anchored firmly in the bed already prepared for it. In fastening it, the foot was held in the position of calcaneovarus, and the tendon was pulled upon with just enough force to render its course a straight one. Immobiliza- tion should not be continued more than three weeks, because by that time firm union had occurred. The patient was then allowed to walk with the trans- planted tendon protected from undue tension by an appropriate splint. The therapeutic results achieved by this method, in the 250 cases operated in the last three and a half years, had been unusu- ally gratifying. SECTION IN LARYNGOLOGY, OTOLOGY, AND RHINOLOGY. Results of High Explosives on the Ear. — Dr. J. iioKDON Wilson, of Chicago, said that the otolog- ical cases resulting from the bursting of a shell divide themselves into two groups: i. Those Buy Levitra Professional Online in which a piece Buy Levitra Professional Online of the shell has struck the ear ; 2. those in which the damage has come from the ex- plosion without any fragment of the shell striking the ear or its immediate neighborhood. It is with this second division that this paper is concerned. It includes a large number of cases in which the diagnosis is frequently very difficult and the treat- ment as yet unsettled and obscure. In previous wars serious damage to hearing from concussion was extremely rare. In the present con- flict, which is preeminently a war of trenches and high Buy Levitra Professional Online explosives, cases of concussion deafness are numbered by the thousands. The concussion efir'ects on the ear are no longer confined to the artillerj' men who fire the big guns ; far more numerous are the disastrous results produced by bursting shells on all classes of combatants. There are no figures available which can help us to form even an ap- proximate estimate of the numbers injured in hear- ing either temporarily or permanently by shell ex- plosions. In the early days of the war the large number of cases of deafness after shell explosions, the intensity of Buy Levitra Professional Online deafness, and sometimes the long persistence of this symptom, gave serious ground for fearing a serious lesion comparable to that of labyrinthine hemorrhage. This is disproved by the subsequent history of cases and by the available postmortem examinations. There have been pub- lished alarming percentages on the subject based on conclusions from an insufficient number of cases. A large proportion of the men suffering from shell concussion deafness get better very rapidly, in one ear usually more rapidly than the other. Those with simple rupture of the tympanum without sup- jiuration are the first to recover ; it is estimated that about fifty per cent, of these have serviceable hear- ing with a month. Buy Levitra Professional Online Cases of concussion deafness without perforation are more obstinate ; of these Juno Buy Levitra Professional Online 29, 1918.] LETTERS TO THE EDITORS. 1243 only twenty- four per cent have serviceable hearing within a month : total and seemingly incurable curable deafness is rare yet a very considerable number of those who have been exposed to a hoavy Buy Levitra Professional Online bombardment which caused severe or complef; deafness for one or Buy Levitra Professional Online more days will be found on ex- amination to have diminution of hearing. Shell shock deafness means that the patient has been made deaf by the concussion of the shell, associated it may be by little obvious injuries due to its burst- ing. It must be noted that though not observable to the casual observer a trauma to the ear is fre- quently present and observable to the otologist. In many the probaljility of internal injury to the ner- vous system must be considered. The jjathology of nerve fleafness from high exjjlosives is still little known. Complete jjathological examination have ijccn few. The postmortem examinations of petrous temporal bones obtained in I'Vance by Doctor Wil- son, showed severe damage to the organ of hearing in the internal ear, very little damage to the equilib- rium mechanism in the ear, and injury to the nerves of the ear. The examination substantiates' the hy- jjotlicsis that deafness from the effects of higli cx- [ilosives may result in distinct damage to the periph- eral organ of hearing with little damage to the middle ear or the drum Buy Levitra Professional Online membrane. The cases seen in a base hosjMtal some time after injury can be divided into three grou])? : i. Those with nerve deafness; 2, those who have had nerve deafness of Buy Levitra Professional Online a varying degree, and who with a vary- ing amount of indefinite nerve symptoms have still the fixed idea Buy Levitra Professional Online that they cannot hear; 3, malinger- ers. Tlie majority in this group undoubtedly have had shell concussion wliich aiTected liie hearing and at the time of examination many still showed traces of traumatic neurosis. But the defective hearing lias now been recovered from partially or entirely and Buy Levitra Professional Online they are now consciously exaggerating the de- fect still remaining or consciously claiming its |ier- sistence. The cases now to be considered belong to group one. All have been exposed to and had their hear- ing damaged by the shell explosion. It was noted that here we have a tyjie of deafness which is not usually noted in civil practice. The jirogress of these cases especially within the first few ilays is lo%vard recovery. At the end of two or Buy Levitra Professional Online three months, although the number of the totally deaf is I datively not great, yet there are a very consider- able number of men with marked impairment of iicaring and wlio show no tendency to improvement. 1 f now left alone they arc not likely to improve. I lie future for these men is not satisfactory; they are deprived in no small measure of the pleasures of social life and ham]HTed in their industrial out- look. The (|ue,Uion then arises can anything be done for them to improve the remnant of hearing still present or must we fall back on such advan- tages as lip reading oflers?