I believe this method of brushing the lids with a strong solution of bichloride is destined to supersede most of the older procedures.

The

Operation. The patient is anesthetized, and the face and eyes thoroughly scrubbed with soap and water; the granulated lids are brushed vigorously with the tooth-brush, which is repeatedly dipped in the bichloride solution; there is free bleeding, which is washed off with a bichloride douche by an attendant; the lids are dusted with acid and covered with gauze, cotton, and a roller-bandage. patient was ordered to bed, and an ice-bag applied to control pain. From what I have said before you will readily conceive that I believe blennorrhoeal ophthalmia and granulated lids to be identical,one an acute and the other a chronic form of the same disease. We might compare the acute blennorrhoeal disease to an acute gonorrhoea, and granulated lids to a gleet. Further, I believe that the primary origin of the disease is probably referable to the secretion of genitals affected with gonorrhoea, and that this secretion produces in the human conjunctiva acute blennorrhoea, which may become chronic, and then we call it granulated lids, or trachoma. The disease is most frequently communicated from one eye to another, probably by means of towels, handkerchiefs, fingers, etc., but it is not infrequently contracted more directly from its first source, as in the case of the child whom I first presented to you to-day.

Laryngology and Rhinology.

CHRONIC NON-SUPPURATIVE INFLAMMATION OF THE MIDDLE EAR.

CLINICAL LECTURE DELIVERED AT ST. LUKE'S HOSPITAL, CHICAGO.

BY S. J. JONES, M.D., LL.D.,

Professor of Ophthalmology and Otology in Northwestern University Medical School (Chicago Medical College), Chicago.

GENTLEMEN,-I have arranged to present to you to-day a number of cases of chronic non-suppurative inflammation of the middle ear, grouped together to illustrate an affection that has been regarded as among the opprobria of otology,-that large class furnishing the most frequent cause of progressive impairment of hearing. In addition to

Vertical section, showing external, middle, and internal ear and Eustachian tube.

the cases in the hospital I have requested some of my private patients to present themselves, that you may have an opportunity of witnessing the fact that no age and no climate seems to exempt people from this

affection. The cases that will be presented to you manifest several

allied conditions producing the same result, impairment of hearing, not total deafness. They vary from youth to old age.

The first is A. B., sixteen years of age, who is, as you see, in appar

ently vigorous health, of good constitution, and the son of healthy parents. Although a native of an Eastern State, most of his life has been spent at his present residence, San José, California. His case is one of hypertrophy of the tissues of the middle ear. Inspection of

the external meatus shows normal shape, but absence of the normal secretion of cerumen. The drumheads are unnaturally concave externally. Instead of presenting the normal pearly-gray appearance, the membranes are less translucent than normal. They look more like parchment or ground glass. The change in the shape of the drumhead has diminished the size and modified the appearance of the re

flection of the light thrown upon it, which should appear as a sharply-defined triangle, the apex of the triangle being at the central part of the membrana tympani, and its base in the anterior and inferior quadrant. The nostrils are nearly normal in shape and condition. Inspection of the pharynx shows follicular enlargement and altered mucous secretion. In testing hearing with a watch as a convenient, though inaccurate, test of the hearing-power, it will be perceived that he does not hear it tick when as remote from his left ear as from his right, the hearing-distance being five inches with the left ear and eight with the right. This corresponds with the usual result in examination of ears, in which it is generally found that the left ear is more frequently affected and more changed than the right one. On testing with a vibrating tuning-fork it will be noticed that he hears the fork more readily also with his right ear through the ordinary conducting apparatus, but when that vibrating fork is brought in contact with the teeth the sound, through bone-conduction, is heard more loudly in the left ear than in the right, which is frequently a cause of great surprise to patients. Because they hear the ticking of a watch at a greater distance with the better ear, they are apt to answer, when asked with which ear they hear the vibrating

tuning-fork better when placed against the teeth, that they hear it louder in the ear with which they have heard the tick of a watch

Türck's tongue-depressor.

better; but upon fixing their attention closely upon the matter when requested, to their astonishment they find that it is heard louder and quicker

SHEPARD & DUDLEY

Tuning-fork.

in the more affected ear.

This patient is not an exception to that rule. He is more fortunate than many in not being troubled with tinnitus 'aurium, which patients frequently say is much more annoying to them than their impairment of hearing. It is more apt to occur in patients more advanced in life, as is also aural vertigo. These patients manifest a susceptibility to atmospheric and telluric influences as marked as in rheumatic patients. This one is not an exception in that respect, either. Great and sudden changes of temperature quickly modify the hearing-power. Even though a change in the weather be from bad to more favorable states, if that change be great, hearing is apt to be worse for a few days, until the system shall have adapted itself to the altered atmospheric conditions.

Nest of ear-specula.

The next patient is a young man, C. D., twenty-three years of age, a resident of Walla Walla, Washington. His vocation is that of a