Whether the remedy here recommended will stand the test, is a question for the future, and I can only hope that the members of this society will take sufficient interest to give it a trial when an opportunity affords itself.

At this juncture it might be of some interest to the members of the society, to examine the much-talked-of intubation set originally devised by Dr. O'Dwyer, of New York.

Dr. D. Brown has given a statistical table of 2,368 cases, by 166 operators; of this number of intubations, 647, or 27.6 per cent., recovered.

CHRONIC OTITIS MEDIA, NON-SUPPURATIVE.

BY ELLA B. RUTLEDGE, M. D., COLUMBUS, OHIO.

Read before the Central Ohio Medical Society.

As the subject I have chosen to bring before you, is one of the most difficult in aural surgery, inasmuch as there are three hundred cases out of one thousand, incurable, I trust you will pardon me if I am unable to lay any claim to the Divine gift of healing the incurable three hundred.

As far as my observation has extended, I have found it to be a complication of diseases of the nasopharynx, and rarely, if ever, an independent disease.

As the normal hearing is greatly in excess of actual need, much may be lost before observed by the patient, and the ear may be damaged beyond repair before treatment is commenced, and for this very reason this disease is extremely dangerous to the hearing.

Labyrinthine complications frequently occur in very chronic

cases.

Diseases of the nasopharynx are often due to disturbances of the vaso-motor nervous system. The shock to the vaso-motor system, caused by cold or exposure, causes the arterioles to become distended, and the mucous membrane hyperemic. Repeated shocks cause this disturbance to become permanent, and the mucous membrane hypertropied.

The turbinated mucous membranes receive their nerve supply from branches from Meckel's ganglion, which is connected with the carotid plexus through the Vidian and petrosal, which in turn are connected with the tympanic branch of the glosso-pharyngeal or Jacobson's nerve. Therefore, vaso-motor disturbance is alone sufficient to account for aural complications.

Constitutional syphilis, acquired or hereditary, predisposes to otitis media. Rheumatism is frequently a cause, the rheumatic inflammation attacking the mucoperiosteal lining of the drum. Strumous and tuberculous subjects are usually affected with aural complications, the cheesy deposits in the tympanum exciting inflammatory trouble. Acute attacks of otitis media, if neglected, have a tendency to become chronic. The throat affections attending the exanthemata, frequently extend to the middle ear. Gestation is sometimes a cause of otitis media. Draughts of air and concussions from loud noises, may be the causes of this disease.

Deafness and tinnitus aurium are the most important symptoms, the tinnitus being due to the congestion of the lining of the eustachian tubes and tympana. This condition is usually increased by lying down, as the supine position tends to increase the hyperemia. Pain is not usually present, but when the eustachian tube is closed, and there is pressure on the fluid of the labyrinth, pain and vertigo are prominent symptoms.

The pathological changes are so varied that we can only mention a few of the most prominent. The changes in the mucous membrane are the same as the changes produced by inflammation of mucous membranes elsewhere; enlargement of follicles, increased secretion caused by overstimulation, thickening of the submucosa by cell proliferation, hypertrophy of the mucous membrane, and later atrophy of the parts, and destruction of the mucous glands.

The eustachian tube is frequently blocked up with masses of mucus. The pharyngeal tonsils sometimes become enlarged and compress the mouth of the tube.

The first case that I wish to report is that of a broken down minister, aged forty-five. Visited my office October 13th 1889. He was suffering from tinnitus aurium, which had been troubling him for several months; so severely at times, that he could not distinguish the sounds of his own voice. He also complained of vertigo. He was subject to frequent attacks of neuralgia of the ophthalmic

especially of the supra orbital branch of the frontal. He had been suffering for ten days with severe neuralgia of tympanic nerves. He also complained of bearing-down pains in the inguinal region, when subjected to any mental strain. It was impossible to breathe with the mouth closed when lying down, if tired, or after any mental effort. Hearing distance by watch, three inches, right; four inches, left. Bone conduction, sixteen-sixteenths; tuning fork, eight-thirtyseconds, right-ten-thirty-seconds, left. On examining the anterior nares, found the inferior and middle turbinateds very much hypertrophied, the middle turbinateds pressing against the septum, so that at only one point was it possible to pass a small probe. On examining the nasopharynx, found the mouths of the eustachian tubes exuding a stringy mucus; they were also very much congested. There was a follicular pharyngitis, and the pillars of the fauces were much thickened, but the tonsils were in a fair condition. The exter-nal auditory canal was devoid of cerumen. The inflammation of the tympanum had produced an itching sensation, and the patient, to relieve this, was in the habit of introducing sticks and pins, and had caused a diffuse inflammation of the canal. The membrana tym-pani as darker than normal, and bulging, due doubtless to fluid in the tympanic cavity. There was a feeling of fullness in the frontal sinus, and a dull aching in the center of the forehead, due probably to a congestion of the mucous lining of the sinus and closure of the infundibulum, preventing the escape of the secretions.

Applied a four per cent. solution of cocaine to the nares, which reduced the swelling very slightly. Cleansed the parts thoroughly with an alkaline solution, and sprayed the eustachian tubes with a solution of argentum nitrate, thirty grains to the ounce, and also prescribed the following:

M. Sig. Spray three times per day, after cleansing with the following:

Also prescribed Fellows' Syrup of Hypophosphites Comp., one teaspoonful after meals.

Patient returned October 15th.

Hearing distance, six inches, right; eight inches, left. Inflated by Politzer's method, and hearing arose three inches more on each side. Began the reduction of the turbinated mucous membranes, with pure chromic acid, liquified by the atmosphere, after which gave the following:

October 19th. Hearing distances twelve inches, right; fourteen inches, left. Inflated by Politzer's method, having patient lean the head to the opposite side. Sprayed the tubes with pure tincture of iodine; also painted same lightly on the membranes.

October 23d. Inferior turbinateds reduced to normal. Hearing distance, by watch, twenty-four inches, right; thirty inches, left. Continued above treatment until November 23d. Hearing distance, by watch, thirteen feet. Nares in good condition, passages free; throat also in good condition, and the general health very much improved.

Returned December 23d. Hearing distance still thirteen feet. Patient had had an attack of la grippe, but made a good recovery. February 20th. Condition same as before.

I would have performed paracentesis in the above case, but patient objected.

Case 11.-Lady, aged twenty-nine. First came under my care November 28th, 1889. She was in very delicate health; had been a cripple since her thirteenth year, from caries of the vertebræ. She also had a running sore in the roof of the mouth, just back of the incisor teeth, which had troubled her for several years. She was suffering from atrophic rhinitis, and there was an ulcer on the posterior wall of the pharynx, behind the uvula. Tonsils were almost destroyed, but filled with cheesy deposits. There was also an ulcer on the left tonsil, about two lines in diameter. Tinnitus aurium had been present for five years. Hearing distance, twenty-four inches, right; contact, left. Bone conduction, sixteen-sixteenths, right;

twenty-sixteenths, left. Membrane retracted, and the light-reflex broken up, and short process of the malleus protruding. There were crackling sounds in the tympanum, due to the interchanging of air between the throat and tympanum, owing to the imperfect permeability of the tube. There was a feeling of fullness, due to the collapsed membrane; and pain in the left ear, caused probably by pressure of the base of the stapes on the fenestra ovalis.

Case positively incurable, but might be relieved. Prescribed a saturated solution of iodide of potassium, fifteen drops three times a day, to be increased one drop each day. Cleansed the nares with an alkaline solution; and applied to the nares with cotton on a probe, the following:

Inflated the tubes and sprayed with a solution of argentum nitrate, thirty grains to the ounce, and increased to sixty grains. Hearing distance arose in right ear to nine feet, in left to thirty inches. The increase in left ear was only temporary, the tube collapsing soon after inflation. Catheterized the tubes and sprayed with tinct. camphoræ and tinct. iodi, equal parts. Tinnitus still present, but much modified and at times altogether absent. Performed paracentesis on left membrane in the posterior superior quadrant, about two drops of blood escaping. The hearing was improved somewhat by the operation. I also painted the tonsils with the iodine and camphor mixture.

January 28th. The nose and throat were in a good condition, the secretions from the nose normal, and the cheesy deposits and ulcers had disappeared. When the iodide of potassium had reached ninety drops ter die, decreased one drop each day. General health much improved.

March 28th. Hearing distance, w., nine feet, right; w., three inches, left. Tinnitus still present. The disease is only arrested temporarily, and, in time, there will probably be total loss of hearing.