24 SMITHSONIAN MISCELLANEOUS COLLECTIONS VOL. 93 



aurists for car troubles in 9.939 school children failed to show even 

 a single case of the tumors. The detailed data were : 



Reichard, Riga 1,055 children, no ear exostoses 



Weil, Stuttgart 5,905 children, no ear exostoses 



Bezold, Munich 1,918 children, no ear exostoses 



Sexton, U. S. A 570 children, no ear exostoses 



Norrell, U. S. A 491 children, no ear exostoses 



Kessel (1889) believed that the growths appeared between the ages 

 of 10 and 13, or later — most frequently about the age of puberty. 

 Erhardt thought they originated during the period of the ossification 

 of the canal ; and Edward, of Berlin, thought similarly that these 

 exostoses could originate only in the skeletal parts still in the process 

 of formation — opinions opposed by De Rossi, Ferreri, and others. 



Braunberger (1896) stated they developed both before and after 

 the ossification period of the external meatus, though they are more 

 common in advancing age. Lake (1898) thought the "hyperostoses 

 often appeared latish in life." 



According to Bezold and Siebenmann (1908, p. 102) " they develop 

 nearly always after puberty." To which Bezold adds, " In 170 cases 

 which I observed up to 1896 there was none below 15 years. Neither 

 did I find a single case in public schools or deaf-mute institutions." 

 In another place, however, as noted above, he mentioned a case in a 

 boy of 14. 



Gray (1910) states that the bony growths in the ears are " seldom 

 found in children." Alexander (1930) failed to find these growths 

 in children, even in those whose parents were badly affected by ear 

 exostoses. 



In contrast to this Marx (1926), who conceives a substantial dis- 

 tinction between hyperostoses and exostoses, regards as an essential 

 mark of hyperostoses that they occur in early childhood, whereas the 

 exostoses develop in the adult. Von Troeltsch's (1873) cases " were 

 predominantly in the middle-aged"; and Whitney (1886), in his 

 Indian series, found them " as a rule in men past middle life." 



A most helpful record in this connection is that of Korner (1904, 

 p. 105), who, although going into no details, gives a list by ages " of 

 the hyperostosis and exostosis cases " observed by him in his private 

 practice, " in 1,000 consecutive patients with ear diseases." The data 

 follow: 



