DISCUSSION ON VERTIGO.

Symptoms revealing a state of consciousness, attributable to incoördination of afferent impulses connected with the vestibular system-disturbances of muscle-sense-vestibular ocular tracks-vestibular-spinal tracks. DIFFERENT VERTIGO-COMPLEXES.: Destructive lesions of labyrinth, or of vestibular tracks, partial or complete.-Heterogeneous stimulations of the paired intact vestibular-end organs.-The hypersensitive labyrinth.-Clinical manifestations of vertigo, associated with nausea, headache, visual disturbances, nystagmus, diplopia, staggering gait, vasomotor and cardio-vascular symptoms, pallor, flushing, sweating, dyspnoea, fainting, vomiting and diarrhoea. OBJECTIVE EXAMINATION.: The tympanic membrane.-Middle-ear track.-Upper air passages.-Hearing tests.-Oculomotor tests.-Labyrinthine reactions.-Postural, caloric, galvanic tests.-Differentiation between destructive and non-destructive disturbances of labyrinth.-Discrimination between peripheral and central lesions.-Vertigo associated with acute, non-perforative otitis media, with chronic otitis media, with labyrinthine fistula, with otosclerosis, post-suppurative adhesions; with peripheral nerve deafness, gun deafness; with rhinitis, ethmoiditis, sinusitis, nasal polypi, postnasal catarrh and dental infections.-Influence of general health on recurrent vertigo and vice versa.-Other factors. Syphilis, malaria, etc. PRINCIPLES OF TREATMENT.: Seek the cause, which, if peripheral, may be removed by operations on the ear, nose, throat, or even by extraction of dead teeth.-If central, by intracranial surgery, decompression, or by neuropathic medical treatment. CONTROVERSIAL PROBLEMS.: (1) Medicinal treatment: Iodide, bromides, atropine, quinine. (2) Attention to upper air-passages. (3) Fenestration of tympanic membrane. (4) Possible value of Küster's operation in certain cases. (5) Exploration of the saccus-endolymphaticus. (6) Fenestration of the external semicircular canal. (7) Indications for destroying the labyrinth.