or benzionol with camphor menthol used warm with an oil atomizer several times a day. Any watery solutions as a spray or douche in the nose is contra-indicated in acute catarrhal diseases, and does positive harm. In the acute contagious diseases the nose and throat should have very careful attention, using a warm oil solution frequently. The after effects on the ears is often the most serious results of these diseases, this brings us to earache. Why is it always to be considered a serious trouble, demanding prompt and energetic treatment? Because it is an inflammation of an important organ of special sense, involving delicate structures and important nerves and vessels, and in close proximity to the brain, unless speedily checked ending in suppuration. It should have the same consideration you would give to a threatened inflammation and suppuration of the lungs, liver or other important organs.

Treatment.-Confine the patient to a warm room of equal temperature. If an adult warn them of the serious nature of the trouble, and insist on them remaining in bed. Dry heat: Of first importance as a local application, hot salt bags, hot water, rubber bag, etc., constantly applied over the ear as hot as can be borne; give your remedies every quarter to half-hour. Acon., bell., ferrum. phos., puls., are oftenest indicated. If no improvement in an hour or two, or if getting worse, hot water is the next thing to employ, as a douche warm as can be borne, used with a mild current fountain syringe, or dropped in the canal from a sponge, drop by drop. As soon as relief is obtained, dry canal gently with absorbent cotton, and re-apply your dry heat, don't stop remedies or heat too soon. It is best not to use oils in the ear, as hot water is safer and generally better. The only oil solution that I can recommend is plantago oil; I have prescribed this with a four-per-cent. solution of cocaine in oil one-half and one-half, a few drops used warm in the ear. Poultices, the heart of an onion, laudanum and sweet oil, or glycerine, are mentioned only to be condemned, they leave a sediment in the canal, and encourage fungus growth, while poultices produce just what we are trying to avoid, viz., suppuration. After trying these measures faithfully for a few hours, if no relief is obtained, then our case is getting desperate as suppuration comes on very rapidly in these cases. There is one other measure that may seem unorthodox to you, but its value is thoroughly established in this condition, and I do not hesitate to recommend and use it, particularly in an adult, where the preceding methods have failed to give relief; this consists in local blood-letting by applying one or two big hungry leeches to the front of the tragus

only, first stopping the canal with cotton. The results are usually little short of marvelous. A patient that has been suffering hours of agonizing pain, will often go to sleep by the time the leech. has filled itself. These measures energetically carried out, will save a very large per cent. of cases from suppuration with its consequent complications and dangers. If suppuration ensues, and nature is tardy in affording an exit to the pus, the swollen and bulging drum. membrane should be punctured. After cleansing the canal with an antiseptic solution, this can be done safely under a good light with a sharp pointed bistoury, wrapping the blade with thread within a short distance of the point to avoid wounding the canal. The puncture should be at the most prominent point of bulging, and carried down toward floor of canal, to favor free drainage; even puncturing with a long needle will afford great relief, gentle syringing with a warm antiseptic solution afterwards is agreeable; usually cessation of pain is immediate and permanent after liberation of the pus, but should pain continue for any length of time after the discharge is established, look out for complications, probably mastoid inflammation. Acute suppuration of the middle ear will be cured promptly in most every case if treated from the beginning in a proper manner. Here is where the careless, dilly-dallying doctor gets in his worst work. It is nothing short of criminal at this stage of medical progress to tell parents that their children will outgrow their running ears, or to prescribe a syringe, and tell them to wash it out with carbolized water, and it will soon stop. All the experience of the past ages is against such advice-might as well say a child will outgrow oph.-neon. For results of such advice, consult the statistics of deaf and dumb, and blind asylums. Two extremes are to be condemned in this connection: one is too much washing or syringing the ears; the other is packing the canal full of powder, and damming up the discharge. Cleanliness is important, the ear should be wiped out frequently and gently with soft tufts of absorbent cotton, afterwards dropping in the ear, once or twice daily, about ten drops of warm. saturated solution of boracic acid; if there is no diminution of the discharge in a few days, his solution may be changed with advantage to sulphate of zine, two to four grains to an ounce of water. After a week or so if discharge continues, a little boracic acid powder may be blown in the ear once or twice a day; keep pledget of cotton frequently changed in canal; as soon as ear is dry, stop all local treatment. It is needless to add that internal medicine is a great help in all cases, and gives us a superior advantage over our old school competitors. Sulphur, silecia, mercury, hepar, calc.,

etc., according to indications. Some of these cases are obstinate, especially the ones following scarlet fever and measles, local treatment should be used in conjunction with the internal remedies; always remember that early and energetic treatment is of the greatest importance, the longer the condition runs the harder to cure. Many chronic cases are practically incurable. If mastoid trouble develops, indicated by pain, redness and swelling back of ear, some authorities advise cold application, but I am partial to heat from the beginning, hot flax-seed poultices, applied day and night back of the ear until better, followed by dry heat. Internally, ferrum phosphate, hepar sulphur, and capsicum, are generally indicated. Unless relief is obtained soon, an operation will be necessary.

There is a form of sub-acute hypertrophic, catarrhal inflammation of the middle ear, prevalent among children and young adults, where you can do the patient a great deal of good, and make a reputation for yourself. This trouble comes on from catarrh of the nose and throat, extending into the Eustachian tubes and ears. It is not accompanied with pain, the only symptom being the catarrh and hardness of hearing. Treat the catarrh with oil spray, gargles of glycerite of tannin or alum, give kali-mur., puls., merc., hepar, or kali. bich. About twice or three times a week, use the politzer air bag, test their hearing before and after treatment by having them shut their eyes and hold your watch away about four feet, bring it up until it is heard, measuring the distance with a tape line on each side, the improvement from first treatment often seems like magic. Where the inflation with the air bag makes an improvement in the hearing, it is always indicated, but where no improvement or a diminished hearing distance follows, it is contraindicated, and will do harm, for in these cases, the loss of hearing is due to disease of the auditory nerve or some of its branches, the ouly treatment is general, such as nerve tonics like kali. phos., strych. phos., ferrum phos., or pic., etc. Many of these cases are caused from la grippe. To treat successfully even the simplest ailments of the ear, requires a few special instruments, a four-inch concave mirror and head band, set of aural speculæ, small cotton carriers, forceps, ear syringe, nasal speculum, ,and tongue depresser, a gas lamp or student's lamp, then by practicing examinations on healthy ears, one soon acquires the necessary dexterity, and becomes familiar with the different appearances of the drum membrane and canal in health, as well as in disease. There are two conditions or symptoms that I will call your attention to, briefly on account of their importance, as they nearly always shortly precede

a loss of hearing and a chronic disease of the ear, if these are not already present. First is tinnitus or noises in the ear, this is always a dangerous signal, and does not occur in healthy ears, but it is one of the most distressing symptoms of progressive deafness. Second is inspissated cerumen or hardening of the ear wax; it will most always recur after removal, and the hearing is either. defective or will soon become so. Hardness of Hearing, Deafness! what terror these words bring to the heart of one that fully understands their significance. Deafness, it steals on one insidiously, like a thief in the night, and robs him of that which can ne'er be regained, and leaves him poor indeed. Deafness, it stifles talent, ere talent can rise. It blasts genius, ere genius can be heard. It sows hot hate by a cold hearth, and turns the germs of good into the giant of evil, and truly we can say, "Hell hath no fury," like a buzzing ear! You may think that I exaggerate, but let me implore you for humanity's sake, to examine into the history of these cases and note the mental and moral effect of deafness. You will find eccentricity, crankiness, moroseness, melancholy, insanity, suicide or the asylum are not infrequent results. I quote from a letter recently received from a very intelligent woman in a neighboring city. "If it were not for my child I could wish that I were dead. One of my earliest friends suicided at St. Clairsville this week, which puts me in the notion." I could name men in this city, high in the business world, known to most of you, at least by reputation, who have bowed their heads, and wept like children in my office, while reciting to me their mental suffering, the result of defective hearing. In the face of such evidence, together with the deaths that are all too frequent from inflammation and abscess of the brain, sinus, thrombosis, pyemia and septicemia, the results of suppuration of the ears. Can the medical profession much longer ignore the importance of this subject or the necessity of prevention and intelligent treatment of these cases in the early stages, while they are yet curable? I think that the time has arrived in this era of advanced medical knowledge, to cease classifying these cases along with hysteria, hypochondria, toothache, and infantile colic.

I

TYPHOID FEVER.*

By E. A. SIMONDS, M.D.,

Carthage, N. Y.

HAVE named this paper "Typhoid Fever," as I have found it, and hope to be pardoned if occasionally found outside the beaten path of recognized authority, following ways that if not new or original, are not at least thoroughfares, but ways that have led across lots to success in many a hard fought battle.

I began treating typhoid fever fourteen years ago, and I can safely say that every case, while it lasted, proved to be a veritable Banquo's ghost. The intense fever, the delirium, the anxiety of the friends haunted me continually. Every hurried step heard at night, was thought to be a messenger from the sufferer, and I lived in a continual atmosphere of calamitous expectancy.

Then came antipyrin and its congeners. It certainly did reduce fever and prevent delirium. With what gratitude and thanksgiving it was received! The ulltima thule was reached. But I very soon found that the patients treated with antipyrin almost never got well. Instead of getting me out of trouble, it increased the difficulties, leaving the patients with weak hearts and a deathlike pallor, and weakness that some have never recovered from. I saw that I had to decide between pyrexia and prostration, between delirium, defective oxygenation and death, between the "devil and the deep sea," the lady or the tiger. Which?

About this time, the German bacteriologists discovered that the introvenous injections of pathogenic germs did not produce reaction, but that their ptomaines produced fever immediately. A woman died with typhoid, living on the banks of a brook of spring formation. It being a dry season, many people living in the vicinity of the creek were obliged to go to the creek for water; result between forty and fifty cases of typhoid. Some families had as many as seven cases! All of which except the initial case fell to the care of the writer. At this time I began to ask myself such questions as these: If a patient gets a foreign body in the larynx or trachea, he immediately coughs and ejects it. Why? If an offender in the bowels or stomach, he proceeds to turn the rascal

* Read before the Medico-Chirurgical Society of Central New York, Syracuse, 1898.