One hundred eases of acute otitis media treated by instillation= of cocaine, 5-per cent. solutions. Ninety-five per cent. of all the cases escaped suppurative inflam mation. Five or 6 drops of the cocaine solution should be instilled as often as rain returns. A single medication, the meatus being closed afterward with cot ton, will cause pain to cease within ten or fifteen minutes. Ordinary cases of acute otitis media will subside under two or three days of treatment, the drops be ing instilled about four or five times daily. Inflammation in the naso-pharynx must be treated also. Wolfenstein (N. Y. Med. Jour., Nov. 5, '92).
For an acute attack of otitis media the indications are to relieve the pain and subdue inflammation. Both of these are best met by filling the canal with water, as hot as it can be borne, immediately applying a compress wrung out of hot water to the ear and side of head; or by the local use of extract of opium or solution of morphine or cocaine. These failing, opiates internally, combined often with salicylate of soda, or the coal-tar runedies may be used. If pain Stiii C011 tinues and the membrane is found bulg ing from retained secretions in the rniddle ear, an incision should be made in the membrane. J. C. Workman (Columbus Med. Jour., Feb. IS, '96).
In many eases of acute inflammation of the membrane, the use of leeches and hot fomentations will cut short inflam /nation of the tympanic cavity. Where they a vertical incision should be made in the posterior segment of the membrane. Even if no pus be present the incision will do no barn). W. Dalby (Brit. Med. Jour., July 24, '97).
Applieations of dry heat to the ear hy means of salt-bags, bran-bags, etc., while valuable, lose much of their efficiency because the heat is applied too far away irom the seat of disease. A dental in strument personally modified so that dry heat may be applied directly to the tym panic membrane. In otalgia of all kinds it is of great value in promptly relieving the pain. In the dry treatment of otor rhcea it is also of value, the ear being first thoroughly cleansed and the surface then dried with the instrument. Van sant (Jour. Amer. Med. Assoc., Oct. 2, '97).
The advantage of instilling an anti septic into the inflamed ear, in the early stages before perforation of the drum membrane occurs, is that the auditory canal is thus rendered, to a great degree, aseptic. IIence it is a safer place for the
membrana to rupture into, since, when the membrana ruptures and the germs causing the acute inflammation are poured into the outer ear freed from staphylococci by antiseptic instillations, there is then less danger of the entrance of the last-named germs, the promoters of chronic purulency, into the drum cavity, and secondary infection is less likely to occur.
Irrigation of the external auditory meatus recommended in all cases of scar let fever or measles, with a solution of I in 1000 aqueous solution of corrosive sublimate, with 10 per cent. of added glycerin. R. H. Woods (Jour. of Laryn., etc., Jan., '98).
Acute Purulent Otitis Media.—Acute catarrhal otitis media, instead of under going resolution, may pass into acute purulent otitis media, induced by the passage of pathogenic germs from the naso-pharynx into the middle ear.
The organism most potent in tbe eti ology of the otitis media of scarlatina is the streptocoecus pyogencs. The less chance there is of contamination from the outer air through the external ear, the more the pyogenie cocci predominate over the rod forms; but. prior to perforation of the membrana tympani, the occurrence of such organisms is not precluded, since they may ascend from the mouth and air passages. Next to the .streptoeoccus, the most important organisms are the staphy lococci albus and aureus. Apparently the diplocoecus pneumonia, of Frankel or the bacillus pneumonix of Friedlander does not play such an important part in the otitis media of scarlet fever as in that due to other causes. Braxall (Amer Jour. Med. Sci., Sept. '95).
Case of acute otitis complicated with mastoiditis following the surgical re moval of adenoids from the naso-pharynx. This untoward result was largely due to the irrigation of the naso-pharynx carried out before and after the opera tion. Barr (internat. Otol. Cong.; Attn. des Mal. de FOr., etc., Jan. '96).
Fatal case of acute general infection with Friedlander's bacillus in a ease of otitis media and empyema of the mastoid. Examination of the pus removed at the operation fIS well as that obtained at the autopsy, blood from various organs, and urine showed a pure eulture of Fried lander's bacillus. Among pymmias due to Friedlander's bacillus the meningeal form occupies an important place. Brun ner (Miinch. med. Woch., Nos. 13, 14, '96).