pedic surgery. This series were all males. The grandfather had large masses in the upper end of the tibia. The father had his principally in the lower end of the tibia. All these articles are beautifully illustrated by ordinary photographs of the patients, and by dissected specimens―none with X-ray pictures.

The conclusion arrived at by the study of these German articles, is that multiple hereditary osteomata are caused by some disturbance of the cell-growth at the epiphyseal union of long bones; that rachitis plays no part in their causation, nor does hereditary syphilis; that the growths are, first, chondroma, and later take on bone formation. That the disturbance of the shaft of long bones is due to trophic disturbances of the blood and nerve supply to the bone. That the growths end at puberty when the epiphyseal joint ceases to exist.

We will have to differ from these deductions in certain respects. All growths show one of three characters: either, first, they are a reversal to an embryonic state; second, a retrograde change to a lower type or a type in a lower animal; or, third, they are adventitious growths. A study of our pictures will show you that there are all three of these classes illustrated; but that most of the growths are pure osteomata growing by cell-prolification from the cancellous tissue of long bones, and not the epiphyses. The question of heredity and parental influence is also illustrated beautifully, the cases all with one exception being in female line of descent; the mental and physical characteristics being embodied also in the descent of the species.

BIBLIOGRAPHY.

Glasgow Med. Jour., 1889, xxxi, 134.

Internat. Med. Jour., Phila., 1894-5, iii, 1-5.

Lancet, Lond., 1897, i, 954.

Boston Med, and Surg. Jour., 1903, cxlviii, 1-6.

J. Bland Sutton. Tumors.

Cullen. Johns Hopkins Bulletin, Balt., 1907, xviii, 101.

Sternberg. Acromegaly.

DeSouza. Leite. A Thesis on Acromegaly.

Bessel-Hagen. Unterknocken und Archiv fur Klin-Chirurgie Bd. xlv, Berlin, 1891.

Fr. Rubinstein.

Ein Fall vom Multiplen Exostosen mit Wachstein-storemgen der Knochen. Berlin-Klincl. wach. 18, s, 794. Hartmann. Ein Seltiner ausgang Multiplier Cartilaginar Exos

tosen.

Arch. F. Klin. Chirurgie Bl. xlv, s, 572.

Aus der Orthopediah Chururgischen anstalt des Privat-docenten Dr. Joachimstall.

Ueber Multiple Hereditare Exostosen von Dr. Jungmann.

Ein Beitrag zur Lehre ueber die Multiple Exostosen von Dr. W. Reich..

Duetsche Zeitschrift fur Chururgie 43, 1894, iii, 128.

Hugo Stark. Ein Fall Vom Multiple Familiena Exostose mit Demonstration.

Muenchener Med. Wachenschrift.

Edward H. Ochsner. Annals of Surgery, Vol. xlvi, p. 608.

Multiple Exostoses, Including an Exostoses within the Spinal Canal.

HEADACHES AND NEURALGIAS, DUE TO DIS

EASES OF THE NOSE AND ACCES

SORY SINUSES.

DR. HUGH M. LOKEY, M.D., ATLANTA.

The subject of my paper is not a new one-in fact, it has been so frequently written upon, that if I were addressing a body of rhinologists it would be a stale subject to them. But there is so little written in the text-books on this, most of the literature on the subject being in nose and throat journals, and in reprints, which seldom reach the man in general practice, and as I consider this a very important subject for the consideration of all branches of the profession-headaches being a trouble we all have to treat-I hope to be able to interest you in this paper.

First, let us take up the anatomy of the nose and accessory sinuses, briefly considering the large area of mucous membrane involved, and the blood and nerve supply, it will then be easier to understand how reflex irritation. and pain, distant from the area of inflammation, can be produced.

The nasal cavities are divided by the nasal septum, which forms a perpendicular inner wall to each. The outer borders are formed by the lateral nasal walls, from which project the turbinate bodies dividing the meati.

The sinuses we will here consider are, the maxillary, or antra of Highmore, situated one in the body of each superior maxillary bone, lying to the outer side of the nasal cavity, and beneath the orbital cavities. The frontal si

nuses situated in the frontal bone, above the nasal cavity and the orbital cavities. The ethmoidal sinuses, or cells, in the ethmoid bone lying between the nasal cavity and the orbital cavities, and the sphenoidal cells in the body of the sphenoid bone, at the upper and posterior part of the nasal cavity.

The mucous membrane lining the nasal cavity and all the sinuses is continuous, that over the turbinate bodies having a thick underlying submucous membrane in which there is a large number of veins. The blood supply of the nasal fossa is from the sphenopalatine artery, a branch of the internal maxillary. Two branches are given off from the sphenopalatine, the internal going to the septum and the external to the lateral walls, ethmoid cells, frontal sinus and antrum of Highmore. The anterior and posterior ethmoid arteries supply short branches to the attic, ethmoid cells and frontal sinuses. The veins empty into the pharyngeal plexus, ophthalmic vein, facial vein, superior longitudinal sinus, and the intra-cranial vein. The nerve supply to the septum, the nasal walls, turbinates and accessory sinuses is chiefly from sensory branches of the fifth nerve, which anastomose with branches from the sympathetic. It is to the extensive distribution of the fifth nerve that the varied forms of headaches, neuralgias, migraines tic-douloureux, etc., are due.

This nerve distributes sensory fibers to dura and pia mater, orbit, eyelids, nose, gums, teeth, tonsils, palate, sphenoid and ethmoid cells, frontal and maxillary sinuses, nasal fossa, pharynx, articulation lower jaw, ear, parotid gland, scalp, forehead and face.

Pressure upon filaments of one branch, may be referred back through gasserian ganglion, and out to the extremities of another branch. It has been a common practice for the physician to prescribe anodynes and opiates for facial neuralgias, and for the dentists to extract teeth that