Among the non-infectious group is found a heterogeneous collection: 2 of congenital heart disease, I of extensive burns, and 3 of non-infectious dermatitis. Of these only I was found free of otitis. This was a VA-month-old infant with a congeni tal heart disease. Although this would appear to have the least possible connec tion with otitis, yet the only other case of congenital heart disease in this group was a 1-year-old child showing otitis media in both ears and both drums filled with pus.
In the face of these facts it seems one cannot conscientiously attend any grave disease in children without the most careful examination as to the condition of the ear. It is as much a duty to ex amine the drum-membrane as it is a duty to examine a rash upon the skin. E. II. Pomeroy (Boston Med. and Surg. Jour., Jan. IS, 1900).
Treatment. — All forms of inflation and aspiration of the middle ear, as also syringing and douching the nares and naso-pbarynx, must be most carefully avoided, since all of these manceuvres tend to force pathogenic germs from the naso-pharynx into the middle ear. If the nares and naso-pharynx are full of tenacious secretions that the patient can not gently blow frorn the nose, a moder ate use of a spray of Dobell's solution, or simple fluid petrolatum, once or twice daily will soften these secretions and favor their outflow. But no inflations or aspirations of the naso-pharynx should be employed by which to open the middle ears. Both doctor and patient should be taught that the stopped condition of the ear or ears is a preventive of worse condi tions in the ear, and must be cheerfully endured for a few days. Watery sprays must be avoided, as a rule, as they tend to "waterlog" the tissues and increase the swelling and discomfort in the nose.
The acute catarrhal otitis media of tlic exanthemata, of typhoid fever, or grippe originates also by infection from the naso-pharynx, but, owing to the more weakened condition of the patient in these maladies than in simple coryza, it tends to a more virulent course from the outset. Nevertheless, the simpler the local treatment of the naso-pharvnx and ear in such cases, the less likelihood there will be of secondary infection, and the more favorable will be tbe course of the aural disease in the end. A mild, anti
septic nasal spray to cleanse the pharynx in such cases will be sufficient.
Nasal or pharyngeal catarrh, whether idiopathic or symptomatic of measles or scarlet fever, is frequently complicated by acute middle-ear affections. The dis ease brings with it the necessity of free ing the nasal cavity at frequent inter vals; and the simple blowing of the nose, if violently or carelessly done, as is usu ally the ease, may be a source of danger. It should be done as seldom as possible, as violent blowing only adds to the exist ing irritation and congestion. If this is not sufficient, the mucus must be made less consistent and removed by an alka line douche. Fridenberg (Med. News, Aug. S, '96).
At the very outset of an attack of any one of the exanthemata, the nose and naso-pharynx should be frequently and thoroughly cleansed. A spray with warm antiseptic saline solutions, alternating with a free use of medicated oily sprays containing, if necessary, suitable germi cides, will usually be sullicient. IV. C. Phillips (Archives of Otol., Apr., '97).
If there is pain in the ear, it can be allayed best with dry heat applied by means of the hot-water bag, hot-water bottle, or hot stone wrapped in flannel. The endeavor to open the stopped ear and to relieve slight ear-pains by infla tions, aspirations, and syringings has often converted simple catarrhal otitis media into the painful and serious acute purulent otitis media.
Simple catarrhal otitis media, even when painful, can be allayed by the simple application of dry beat about the tar:z. it, in thost. in:At-Ince: de Icanding it, with an antifebrile treatment of the gt nem] system. if this plan is pur t.uttl from the outset of the inilamma ti,n. There will be no harm in instilling, into the ear. if it pains. 10 drops, warmed, of a s.)lution of carbolic acid (1 to 40), or cm of formalin (1 to :000), if these can bt borne.
vnselin, pure or mixed with itdoform. has given great relief to pain, in acute middle-ear inflammation, while it seemed to overcome any tendency to sup' uration. Iodoformized vaselin was of especial service in cases complicating influenza. Delstanehe (Jour. de Med., etc.. June IS, '92).