used will pass through a perforated membrana tympani into middle ear. The best astringent solution is Sulphate of Zinc, grs. I.-III., to water 1 ounce. Nitrate of Silver is very objectionable, causing often paralysis of all muscles supplied by portio dura. (A. O., 1876, p. 146.)

Otitis Media. From using the nasal douche. (N. U. B., C. M. A., p. 291.) Suppurativa.

A clinical lecture. (W. A. Phillips, O. M. & S. R., 1876, p. 155.)

Ear, Middle. Suppurative Inflammation of the. Two clinical cases in which trepanning of the mastoid was performed, in one of which recovery took place, and in the other death. (W. H. Woodyatt, O. M. and S. R., 1876, p. 347.)

SUPPURATION of, in relation to life insurance. (L. Thomas, H. W., vol. XI., p. 311.)

THERAPEUTICS OF.-Aconite Of value at the beginning of the acute form or less frequently in those acute attacks complicating the chronic form, when cold or mal-treatment has suppressed the flow of pus. The pain is tearing, stitching, increasing steadily in force, causing cries of anguish, intolerance of noise; the face flushed and hot. Patient restless and thirsty; burning heat, with chills running up the body. In the acute form, the meatus externus is red-sometimes thickened and dry; the membrana tympani also dry and red, almost coppercolored; the minute vessels engorged and throbbing. Aconite acts with magic promptness here, often in one half-hour giving entire relief, but requires other remedies to guard against remote results.

Arnica. Of first importance in cases of traumatic origin, blows, explosions, unequal pressure of the air, etc., when the traumatic lesion threatens a severe suppuration. The pain is tearing, pressing, deep, with internal heat extending to the mastoid region; with the pain, impatience and sensitiveness to noise; the meatus externus normal; the membrana tympani reddened, but by large vessels rather than capillary. In traumatic cases the congestion and ecchymoses are usually more marked at the upper half of the membrane.

Aurum.-Caries of mastoid process. The subjective symptoms, so far as the ear is concerned, are decidedly negative, but the general ones make the choice between this remedy and Fluoric acid, Nit. acid and Silicea, easy. Pain like a bruise, or as if pulled, worse at night, by uncovering and at rest; better by motion, by waking, and, while sensitive to cold, yet is relieved by

going into the open air, even in bad weather. The tissues of the meatus externus are bathed by a fetid pus, the odor being characteristic of necrosed bone. The membrana tympani is usually perforated; the ossicula more or less disintegrated and thrown off. Often the osseous middle ear is denuded, sinuses connecting the canal with the fistulous opening upon the external surface of the mastoid process.

Baryta.--Although this remedy is mentioned under the term otorrhea, my conviction is that it is homeopathic to lesions external to the membrana tympani, and especially to the structures of the pharynx, thus involving the Eustachian tube.

Belladonna.-Indicated in acute suppur ative form, with sticking in and behind the ear; the pains are described as digging, boring and tearing, often coming and going suddenly. They extend to the throat accompanied by ringing, buzzing aud roaring. The patient is sensitive to light and noise; the face is red; the whole head hot and pulsating. The membrana tympani is not changed in position, but congested, the vessels covering the entire surface n papillary lines, reminding one of pannus.

Borax.-Diseases of mucous membrane, stiches in the ear which discharges, causing involuntary starting; lancinating headache; tickling sensations in the ear; itching and soreness. Children fret and cry and are easily frightened. (Bell mentions fear of downward notion or rocking in children as characteristic. I am inclined to believe it true in acute suppurative inflammation of the middle ear.) Ear hot; meatus externus swollen; discharges more mucus than pus.

Calcarea. In chronic rather than acute form. Scrofulous subjects, fat, rapidly grow ing, large-headed, soft - boned children. Adults, who in youth were vigorous, but now fail, with low power of assimilation. Great weakness, dejection, sensitiveness to cold, damp air. The pains about the head are pressing or pulsating, often semi-lateral; coldness of the head; sweat on the head evenings. The pain in the ear is also beating, with knocking, buzzing and roaring. Detonations in ears; meatus externus filled with whitish, pappy, fetid pus or viscid discharge. Membrana tympani perforated, and often the edges covered with granulations, which extend to the walls of the meatus externus; occasionally these enlarge to form polypi, usually of the mucus (raspberry) variety. I have found these exuberant granulations to yield more promptly to the Calc. jod. than the Calc. carb. I the growth is large, mechanical

removal will relieve symptoms caused by pressure, but it does not prevent the rapid renewal. Silicea should follow the Culcarea after the ulceration assumes an indolent type.

Capsicum.-In chronic suppuration, in adults especially. The pains in and about the ear are acute, shooting, pressing, with bursting headache, great thirst, with chilliness and shiverings.

In April, 1873, I published in the "Ophthalmic Hospital Report" for the New York Journal of Homœopathy, cases showing its value. Two years have added many cases to our list of cures. The typical are those in which acute symptoms occur in chronic cases; the mastoid cells become involved, and their dense structure yields slowly, hence the danger of cerebral trou ble, as the diploe of the temporal bone above threatens to give way before the petrous portion below and behind. In

children the mastoid cells break down with comparative ease, and Hepar hastens the relief when the case has advanced, far before Capsicum is used. In some cases the swelling behind the ear has been very great; the auricle turned almost to a right angle with the side of the head; the meatus externus closed almost entirely; the pus yellow, flowing quite freely, and not specially offensive. În every case the membrana tympani was perforated.

Carbo animalis and Carbo veg. are found in our repertories as remedies for otorrhoea, and one writer says suppurative inflammation of the middle ear. Thus far all the cured cases seen at the clinic and in my private practice were those where the lesion was external to the membrana tympani. In looking for cured cases reported in the journals and year-books, I have not found a case which leads me to expect the action on the middle ear.

Causticum.-The most brilliant cures from this remedy have been in non-suppurative disease of the middle ear (proliferous), yet it is indicated in suppurative cases, especially in those in which the facial branch of the seventh pair of cranial nerves is involved. It has never been my good fortune to see suppuration cease under its use, although the complicating facial paralysis was relieved. The indications are to be sought in the symptoms of the head and face.

Chamomilla.-The same is true of this remedy as the foregoing one. Its triumphs are with non-suppurative cases, otalgia and catarrhal inflammation, yet the debatable ground where catarrh ends, and suppuration begins is one where dividing lines are

drawn with difficulty. In acute inflammation, when patients are excessively pros trated by shooting, drawing pains, of which they become perfectly intolerant, Cham. is the remedy par excellence. The forehead is hot but moist, the cheeks red and burning, or alternately one cheek hot, the other cold and pale; the same local alternation of heat and cold is often noticed in other parts of the body, with shuddering. The auricle is usually hot and red, the meatus red but not swollen; membrani tympani less congested than one would expect when the severity of the pain is considered. Under Chamomilla the relief is often as sudden as the suffering has been intense, but I have noticed that the congestion of the membrana tympani remains longer than when Bell., Gels., or Hepar was indicated.

Cicuta. In hæmorrhage occurring where the tissues of the tympanum have suffered from prolonged suppuration China has been the only remedy which has afforded me any satisfaction. Cicuta is mentioned in all our repertories, but in only one instance was it effective, and then only temporarily.

Elaps.--Chronic suppuration, complicated with chronic naso-pharyngeal catarrh; of fensive discharge from the nose; the pos terior wall of the pharynx dry, mucous membrane fissured or covered with crusts, which leave a raw surface when removed; nasal passages filled with similar crusts, causing "snuffles," pain from root of nose to forehead, dull pain from nares to ears; when swallowing pain goes to ears; deafness, offensive discharge from ear, yellowish-green, which stains linen green, with buzzing; skin dry and hot; frontal and occipital headache, described as congestive and lancinating, worse by motion and stoopping. Of great value for nasal catarrh in children; they are compelled to sleep with the mouth open on account of nasal obstructions-"snuffles," mothers term the

condition.

Gelsemium.-At the beginning of acute form; associated in the mind with Acon., Bell. and Cham. In catarrhal subjects after cold in the head, closure of the Eustachian tube; tense, dull, bound, giddy sensation in the head, with chilliness; thirst not excessive, as in Acon. and Bell.; pulse rather slow; stupor and drowsiness rather than restlessness. Gelsemium is especially applicable to catarrhal inflammation, but the same may be said for it as regards prophylaxis as has been said concerning Cham. Graphites.-- Deafness; excoriation behind the cars; meatus externus dry, scabs, or oozing of water and pus, or blood; sen

sation as of a valve opening and closing in the ear; roaring and detonation; cracking in ear when swallowing. The above are the leading symptoms of this remedy. They are suggestive of lesions of the Eustachian tube, of the external meatus and auricles. In every case in which discharge existed, cured under my observation, the membrana tympani was intact; and the same is true of cases reported by Ruckert and others in the year-books.

Hepar.-In acute as well as chronic form; drawing, tearing, stitching pains, worse at night and in cold air; soreness of surface in spots, very sensative to touch; skin ulcerates from slight injury; itching in the ears: scabs behind the ears; discharge not specially fetid; walls of meatus externus and membrana tympani very sensitive to touch; the ulcerated surface often covered with white shreds, which are removed with difficulty.

Kali-bichrom-In chronic suppuration The pains are pricking, sticking, lancinating in character; come and go quickly and change location suddenly; the ulceration in the car (membrani tympani and inner portion of the middle ear) causes an itchingburning, with stitches up into the head and down into the neck. The discharge is yellow, rather thick in consistency, often mixed with tenacious stringy mucus, which can be drawn through the perforations in the membrana tympani. The pains are mitigated by heat, but the authorities state that general conditions are worse in sum

mer.

Kali-carb.-Local conditions somewhat the same, except the discharge, which is thin. The selection must be based on the general symptoms of the patient.

Lycopodium.-For scrofulous subjects, those who suffer from eruptions, from abdominal troubles, and sequelae of scarlet fever. Hence, used in chronic suppuration. The subjective symptoms are meagre. The meatus externus is excoriated by an offensive discharge, which is not uniform in consistency. The tissues of the membrana tympani are largely destroyed. Of great value as an intercurrent remedy.

Mercurius. In acute as well as chronic suppuration, the metal or the soluble preparation is more frequently indicated than any other remedy. In the acute form the pains are deep-seated, tearing, or shooting, extending to the malar, or the inferior maxillary bone; sometimes they are spasmodic, causing sudden movements of the patient; they are aggravated evenings till midnight, by warmth, particularly in bed; the pain abates toward morning, and frequently en

tirely ceases till toward the next evening; the thirst is less during the severe pain than when it abates; the perspiration is profuse, without relief of the suffering. In chronic form, Merc. is frequently indicated by enlarged and sensitive cervical glands, results of sudden cold; also by occasional tearing pain during the continuous flow of pus; the pus is fetid, whitish or tinged with blood. The membrana tympani is broken down to a very great degree, and often repairs very promptly even in cases where the perforation has existed for months. Mere, dulcis has special action on the Eustachian tube and mucous membrane of the pharynx.

Nitric Acid.-In ulceration or caries of the ossicula or mastoid process, the remote results of syphilis or abuse of mercury. Shooting pains; sensitiveness of the bones, aggravated by every change of temperature, at night, on washing, on rising from a seat, and by touch. (See Aurum.) Better while riding in a carriage. Fluoric acid has inclination to uncover and to wash with cold water. (See Silicea.) The discharge is thin and fetid, as in all cases of caries.

Pulsatilla-More frequently indicated in acute suppuration than any other remedy. In chronic trouble the results have not met my early anticipations. The local pains are from within outward, sharp, shooting, or tingling, from a moderate degree, increasing gradually to intense, ending suddenly, only to increase steadily after a brief time. The general condition of the patient is of marked character; suffering from shifting pains, which pass suddenly from one part to another; aggravated at evening, by heat or close room, when seated, or on rising if one has been long seated; also by repose if lying on the side, yet ameliorated by either motion or rest, so that a change of position is the result. Movement, walking, warmth, and open air relieve some symptoms, but aggravate others. Contradiction in many senses is symptomatic of these patients relieved by Puls. Fever without thirst is characteristic.

The external ear is sensitive; meatus externus red and swollen; profuse discharge of thin pus, or pus and mucus; this removed, shows in recent cases phlyctenular inflammation, or later thickening and separaration of derma, or still later, ulceration and perforation. These conditions are found more usually in children, and correspond to phlyctenular conjunctivitis.

Psorinum.-A remedy closely allied to Sulphur. Bell says: "Whether derived from purest gold or purest filth, our gratitude for its excellent services forbids us Jo