them are satisfied by prescribing a gargle. The parts reached by this means does about as much to relieve the urgent symptoms occasioned by the inflammation, as the washing of otorrhoeal secretions away from the external ear does to the inflammation of the tympanic cavity. Many will think that in this I am exaggerating the importance of the treatment of the pharyngo-nasal and nasal cavities in the acute affection, but I am very certain that I am not doing so. The patient, if not under four years of age, should be directed how to use the tongue depressor on himself. This instrument is required for both examination and treatment, as it provides a free access of light and prevents interruption by the tongue during the use of the reflector and the spray producers. Even a slight pressure on the tongue, if made by the physician, will produce a reaching, a contraction of the fauces, and an eləvation of the soft palate, which will render the examination and the application of the spray impracticable, but if the patient has the instrument entirely under his own control, the dread of being choked will be avoided. The mind being at rest and all apprehension of any disagreeable sensation produced by the tongue depressor being removed, the muscles of the fauces and velum will remain quiet and passive. This is just the condition that the patient's mind must be placed in, if a successful application is to be made. The patient is directed to place the depressor well on the tongue-but not as far back as to cause a gapping sensation,-to open the mouth as widely as possible, and to breathe freely and naturally. This manner of using the depressor is not only more convenient for the physician, but more pleasant for the patient. Fig. 3.-Long-handled tongue depressor. For many years I have used a tongue depressor (Fig. 3) whose handle and shaft is about twelve inches long. This length of shaft allows the patient's hand to be placed so far down his breast that it will not be in the way of the operator. Into the head of the shaft is fastened either a long or short tongue-piece, i. e., one that is adapted to the length of the patient's jaw. With this instrument the soft palate, the uvula, the tonsils, the lateral and posterior walls of the pharynx may be exposed to view. I have been particular in describing this simple instrument and the method of using it, because in my judgment, a successful treatment cannot be made if the patient does not in this way and to this extent hold his own tongue down. The next question is, how can we induce even a six or seven year old child to allow the application of the spray. This is of course left to the tact of the physician. Every child and even every adult is afraid of instruments; but far worse than this, children have had their confidence so frequently abused, and have so frequently been deceived-in plain language, been lied to so often-that they will not believe one word said to them concerning the effect of either the spray producers or of the remedies to be applied. My experience has led me to believe that every child is a close and accurate observer of the words and actions of a physician. I always take advantage of this, and make it my means to successfully overcome the fears of the little patient. As a general thing my patients have been in the hands of a physician who has made just that kind of attempts at treatment of the throat that has greatly frightened the child. I will relate the worst case of this kind that I ever met; it occurred some years ago. I am pleased to say that such cases are not of of frequent occurrence. The boy, æt. 6 years, had two times been wrapped so tightly in a sheet that he could not kick or fight with his hands; he was then placed on a nurse's knees, the father held the feet, the mother held his mouth open with a spoon handle, while the physician manipulated the graceful swab (made of stiff pine wood and a few wraps of domestic), repeatedly assuring the struggling child that he would not hurt him, etc. On entering the bed-room I found the patient, who was suf fering from scarlet fever, sleeping with his mouth open and breathing with some difficulty. The conversation with his mother concerning his case awoke him. Just as soon as he saw me he turned over, crawled on his hands and knees to the other side of the wide bed, at the the same time crying and saying "No I won't, I won't." His mother and aunt both commenced to assure him that I would not hurt him in the least, etc. I at once desired them to discontinue their efforts to induce him to submit to the application of the spray, but at the same time commenced to lay the instruments out on a small table at the bedside. While I was telling the mother that I was sure that he had been deceived by others, yet he would believe me when I told him that I would not hurt him in the least, or give him any disagreeable medicine, he loudly contradicted me and said that I never should do anything for him. I did not heed him in the least, but addressed the mother, informing her how I wished her to use the spray producer while I was absent. She remarked that she feared that she could not persuade to him submit to their application. I insisted that he would not only submit; but would ask for it, as every one of my patients liked it. By this time I had placed a small quantity of vaseline comp. in the cup of a spray producer that throws a horizontal stream (No. 1, Fig. 3), and after it was warmed over a gaslight I sprayed a few whiffs into my own mouth, stating that the reason why children liked it was because it was sweet. I then addressed the child and told him that I did not mean to hurt him in the least, and if I did so he could take his head away at once, as no one should hold him, and I would not make another application. His mother then wished to hold his head, but I insisted that no one should go near him. This had a quieting effect on him; I gave him the tongue depressor, but he at first threw it down and reminded me of my promise not to hurt him. I assured him that I would not hurt him, and as he had the instrument in his own hands I was. sure that he would not hurt himself. He then placed the tonguepiece on the tip of the tongue, and just as soon as I pointed the spray instrument towards his face he threw down the depressor and said that I was going to hurt him. I then in a kindly way assured him that he knew that I had not done anything to him; therefore he ought not to cry out in that way, after he had promised that he would not do so. After a little firm but kind persuasion-his father and mother all this time looking on, but taking no part-he again placed the depressor on his tongue, and instantly I had the spray sent into his mouth. This of course only touched his tongue and soft palate, which, as far as the local application was concerned, did not do the least good, but so far as the boy's fears were concerned, gave him substantial proof, in spite of his preconceived dread, that he was not going to be hurt. The instant that the spray touched him, it brought about another episode, during which he again accused me of hurting him, after I had promised that I would not do so. I firmly yet kindly denied causing him the least pain, and stated that he knew that I had not done so, therefore his complaint was a mistake, and was made against his promise, which was, that he might jerk his head away if I should cause him the least pain. On requesting him to place the depressor on his tongue again, he desired to know the number of applications to be made; on being told that I desired to throw the spray three times more into his throat, he complied. The instant that the depressor was on his tongue, I had the spray (which had been kept warm and ready for him,) in his mouth. This time the stream struck fairly into the fauces, and caused him to gag. To this he complained, and wanted to go to his mother, but I made it my business to control the mother as well as the child. On a little more persuasion I made two more applications, the last one was sent up behind the soft palate, but without the instrument touching it. At my next visit, made six hours afterward, I had but little trouble. I occupied about seven minutes in making five applications, three of which were good ones, sent up behind the soft palate, and two failures. I was careful always after this not to cause him to retch. The time occupied at the first visit was fully 45 minutes. At the third visit I had no trouble in making the applications. He called to his mother, while she was engaged in detailing to me his symptoms during my absence, and desired her to get the instruments from off the mantle, in order that I might make the applications. At this, and each succeeding visit, I used the spray producers (indicated in Figs. 2 and 4, Nos. 1, 4) and 2, using each in the relation named, and applied about a-half a dram of the mixture, always made warm, by each instrument. The mixture used is made as follows: This preparation is not unpleasant to the taste, and has a very soothing and agreeable effect. It should be applied once in |