Spirit. Vini Rectif. 5vj.
Apo Destillatte ad Fiat solidi°. Signa.—" To be applied to the inside of the ear on cotton-wool." Vaccine treatment is of great value in rebellious cases; the organisms may be cultivated after isolation from the discharge, and a subcutaneous dose of poo to 500 million of the killed staphylococci should be injected. Rarely, however, will vaccines be needed if the above solution be con scientiously employed. Furunculosis of the meatus has become more common since the introduction of the telephone, and the use of the anti septic lotion may be employed as a preventive.
Inflammation of the meatus caused by otorrhccal discharges, and not depending upon furuncles, may be speedily relieved by leeches, fomen tations, and weak astringent injections, followed by dry Boracic Acid insufflations.
Fu-ngi—Aspergillus funzigatus—are sometimes found infesting the meatus. They may be easily destroyed by the above liquid instilled into the meatus so as to fill the canal for some minutes, after which a plug of cotton-wool moistened by the solution may be inserted. Each alternate day dry Boric Acid may be insuillated.
Cerumen, Epithelial debris and Foreign bodies in the meatus are best removed by syringing with warm water. A new or sterilised India-rubber enema apparatus answers very well, and it is hardly necessary to say that the nozzle should not be introduced within the meatus, but should be held within a few lines of its orifice. The auricle when pulled upwards and
backwards permits the free flow of water in and out of the meatus, and by persevering for some time the stream, getting behind the cerumen or foreign body, forces it out. If this fails, variously shaped instruments devised for the purpose may be used; about the best is a loop of wire gently coaxed past the obstruction and drawn forwards. Sometimes when the plug has been rotated or tilted forward its edge may be grasped by a fine forceps and the mass delivered, but much harm may be done to the canal or tympanum by unskilful poking, and the novice should content himself with syringing alone.
When there is much difficulty in removing the wax, it will be well to adjourn operation for a time, as prolonged syringing sometimes causes faintness, tinnitus, and deafness owing to congestion or extravasation in the labyrinth. The introduction of a little solution of Bicarbonate of Soda (r!, grs. to each drachm) for a few days greatly assists in the removal of the wax. Papain, Glycerin and Peroxide of Hydrogen also assist the disintegration of wax and other concretions.