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In November 1943, one of Barbara Hepworth's daughters (Sarah, one of triplets) developed osteomyelitis of the thigh. This necessitated operation and subsequent treatment at the Princess Elizabeth Orthopaedic Centre in Exeter by Mr. Norman Capener. Artist and surgeon subsequently became friends and she encouraged his activities as a 'weekend sculptor'. At his invitation she came to the hospital in November 1947 watching him in out-patients but more particularly in the operating theatre; other visits to London and Exeter followed. These studies of orthopaedic procedures form the great majority of Hepworth's sixty-plus hospital drawings/paintings but there is also a small group of six paintings involving an operation on the ear made in April and May 1948. The link between these two and the introduction to the ear surgeon, Mr Garnett Passe, is unclear. Five of the paintings of the ear operation are still in circulation but there is also a sketchbook containing no fewer than 28 drawings. A selection of the sketches together with the fenestration series of paintings will be discussed and also the relationship with the surgeon, Mr Garnett Passe.

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Alfred Gardiner Brown was the first designated Aural Surgeon to be appointed to the consultant staff of The London Hospital, at the age of 38. In July 1880 he published the paper showing his adaptation of the way in which the tuning fork was applied to the head and its use in measuring hearing power by comparing it with the sense of touch. Had he been blessed with a longer life it is highly probable that he would have made a significant contribution as he was of an innovative and inventive mind. He died at the age of 44.

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We report a case of bilateral sensorineural hearing loss of two years duration which appears to have been due to late Borrelia burgdorferi infection. The 39-year-old woman presented with bilateral deafness and multiple other neurological complaints some six months after developing a 'target' lesion on the lower leg after walking in the New Forest. 'Serology' for Borrelia burgdorferi became positive and the patient made a complete recovery from both her deafness and her other neurological problems after a five-week course of oral antibiotic therapy.

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This chapter presents (1) a review of several studies on the relationship between violent/aggressive behavior and the use of cocaine and/or the use of alcohol; and (2) findings from our study of cocaine-dependent men, illustrating deviant and violent behavior before and during cocaine addiction careers. As had been found in previous research, use of alcohol and cocaine seemed to increase the likelihood of the cocaine users in our sample engaging in deviant or violent behaviors. The extent of deviant or violent behavior, in our sample, during periods of cocaine use, periods of cocaine-alcohol use, periods of alcohol use only, and periods of abstinence for both alcohol and cocaine are discussed. Changes in the nature of the deviant or violent behaviors prior to and after the onset of cocaine addiction are also described.

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A retrospective study comparing adverse events using bismuth iodoform paraffin paste (BIPP) and Xeroform as dressings for newly fashioned mastoid cavities after mastoidectomy was undertaken. There were 20 patients in each group. Adverse events were defined as offensive packs, mastoid cavity infections and systemic signs of infection. There were no adverse events using BIPP packs whether or not prophylactic antibiotics were used. Xeroform packs were associated with a significantly higher incidence of adverse events compared to BIPP when using no antibiotic prophylaxis (P less than 0.005) or amoxycillin (P less than 0.005). Adverse events with Xeroform packs were abolished using ciprofloxacin and metronidazole prophylaxis. We conclude that BIPP is the mastoid dressing of choice.

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The neuro-otological findings are described in 3 unrelated patients who had xeroderma pigmentosum. All had impaired hearing. Routine audiometric assessment suggested that the hearing loss was of cochlear origin; brainstem evoked potentials in 2 patients and electrocochleography in 1 support this conclusion. Two adult patients had a supranuclear ophthalmoplegia. Vestibular function was mildly deranged and visual suppression of the vestibulo-ocular reflex impaired.

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The therapeutic efficacy of oral acetazolamide has been evaluated in a small pilot study of 14 patients with Menière's disease (23 hydropic ears). Symptomatic improvement was found in 4 cases. In 2 of these patients the improvement was not sustained, whilst another had to stop the drug due to the development of bilateral renal calculi. A deterioration in symptoms was seen in 3 cases. Significant adverse side-effects were encountered in 6 of the 13 patients (46.2 per cent) who complied with drug dosage instructions. It is suggested that this high incidence of side-effects may be consistent with a general metabolic difference between Menière's patients and normal subjects. We conclude that oral acetazolamide has no place in the medical treatment of Menière's disease.

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This paper presents the results of various metabolic investigations in patients with Menière's disease. It is a follow-up article on the preliminary findings of the study which was published in this Journal recently (Moffat et al., 1979). Fifty patients (29 male, and 21 female) with Menière's disease conforming to the criteria set out by the Committee of Hearing and Equilibration of the American Academy of Ophthalmology and Otolaryngology (1972) were involved. The incidence of abnormal metabolic states was no higher than that of a comparable group in the general population. One of the patients had a diabetic glucose tolerance test curve, four had lag curves. One patient had a high TSH level and was clinically myxoedematous. Three patients (two male, and one female) had primary hyperlipidaemia and one female patient had hyperlipidaemia secondary to myxoedema. There was no significant difference in response to intradermal pin prick skin tests compared with a controlled group.

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We describe two infants with respiratory difficulty. The respiratory difficulty in one infant was secondary to a lateral saccular cyst, and the other infant had a laryngocele. Surgical treatment was marsupialization of the lesion. Postoperatively, a polyethylene endotracheal tube was left in place for three days to serve as a postoperative airway and also as a stent. With this procedure, we were able to avoid tracheostomy and recurrence of disease.

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Patients with cholesterol granuloma of the middle ear cleft will usually present with a secretory otitis media, and exhibit evidence of diffuse disease within the mastoid upon roentgenographic evaluation. The following patient with an isolated middle ear cholesterol granuloma presented with signs and symptoms more closely resembling a glomus tumor.

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