MEDICATED ICE IN SCARLATINA.

In a short communication to the Lancet (Jan. 8, 1876), Mr. Edward Martin says: "Every practitioner has at times to face the difficulties of the scarlatinal throat in young children. It may sadly want topical medication; but how is he to apply it? Young children cannot gargle, and to attempt the brush or the spray often fills them with terror. In many cases neither sternness nor coaxing avails. If the doctor thinks it his duty at all hazards not to leave the throat untouched, the child is subjected to a struggle and a fright which probably render the proceeding more productive of harm than good. If, on the other and more wiser side, he, when persuasion fails, goes no further, he is haunted by the feeling of not having done all that might have been done for the case. Most of us at times have been impaled on the horns of this dilemma. Yet these little ones in almost every case will greedily suck bits of ice, as I doubt not most of your readers can testify. This has long been my chief resource where I could not persuade the child to submit to the sulphurous acid spray. Lately I have been trying an ice formed of a frozen. solution of the acid (or some other antiseptic), and I think my professional brethren will find it a valuable addition to their means. Though, of course not so tasteless as pure ice, the flavor is so much lessened by the low temperature, and probably also through the parched tongue very little appreciating any flavor whatever, that I find scarcely any complaint on that score from the little sufferers; they generally take to it very readily. The process of making it is so simple that a few directions to any intelligent nurse will quite suffice; or in urban practice the chemist who dispenses the other prescriptions will undertake this one also. A large test-tube immersed in a mixture of pounded ice and salt is the only apparatus required, and in this the solution is easily frozen. When quite solid, a momentary dip of the tube in hot water enables one to turn out the cylinder of ice as the cook turns out her mould of jelly. I have tried the three following formule, all of which answer, though I think I prefer the first:

1. Sulphurous acid, half a drachm; water, seven drachms and a half: mix and freeze.

"2. Chlorate of potass, one scruple; water, one ounce : dissolve and freeze.

"3. Solution of chlorinated soda, half a drachm; water one ounce; mix and freeze.

"However, the form is of secondary importance, and each practitioner can construct his own. Boracic acid, salicylic acidor any other harmless antiseptic with not too much taste, would, doubtless, be as useful as those I have indicated. It is the idea of applying them in the shape of medicated ice' that I recommend to the profession, with the belief that it is of practical value."-Monthly Abstract Med. Science.

Ophthalmology and Ýtoloxy.

MYRINGITIS.-A Clinical Lecture by Prof. Joseph Gruber, of the Imperial University, Vienna. (Allg. Wien. Med. Ztg.) Translated from the German by A. G. Sinclair, M. D., Ophthalmic and Aural Surgeon to Harper Hospital, Detroit.

Among the cases which I have exhibited to you in this clinic you have rarely seen a normal membrana tympani. In nearly all, and as you are aware our clinical material is very great, the drum membrane was found to have undergone changes attributable either to an antecedent or still progressive attack of inflammation. We are, therefore, justified in classing inflammation of this membrane with the most common forms of aural disease. If, however, we limit the term to those cases in which the inflammation is confined to the drum membrane, we must admit that as a primary, idiopathic disease,myringitis is of very rare occurrence, so rare, indeed, that many of the older aurists denied its existence. If one read carefully the writings of those who entertained the opposite opinion, he will readily perceive that these authors classed other and very different forms of disease under this head.

The first aurist who diagnosticated and in a measure correctly described this disease, was Kramer of Berlin. The picture which he presented cannot, however, be accepted as true in the light which more recent investigations have thrown upon the nature of this disease. Indeed he is placed in a peculiar light as an observer when we find in his clinical reports the statement that a few days are sufficient for the healing of a perforation the size of a pea "in the antero-inferior segment," resulting from such inflammation. When we know how slowly such extensive perforations heal, usually requiring months for complete recovery, we must, however unwillingly, believe that many cases

which Kramer classed as myringitis would have been placed in a different category by more thorough investigation.

Myringitis occurs in connection with otitis externa, especially that form of it which, after v. Troeltsch, I have described to you as otitis externa diffusa. Here the drum membrane is involved from the very beginning of the disease. It also arises in the various forms of inflammation of the lining membrane of the tympanic cavity, especially in connection with otitis media suppurativa. As a sequel it frequently follows otitis external circumscripta, and inflammatory action in various other portions of the ear.

The subjective symptoms are the same in the primary and consecutive forms of the disease. With regard to the objective symptoms, however, this is not the case, and with the methods of investigation at our command at the present day, we are enabled to diagnosticate primary myringitis with perfect certainty and to define its course.

Among the causes of inflammation of the drum membrane are the following: Wounds, irritation from any cause, and cold. Wounds of the memb. tymp. often heal by first intention, giving rise to no inflammatory action worthy of note. Frequently, however, they result in inflammation which may either be cir. cumscribed, or involve the entire membrane.

Such lesions may be very various in their nature: excoriations, penetrating, and incised, wounds with various complications, and according to the nature of which will be the severity of the resulting inflammatory reaction. In many cases even the most trifling injury, as for example, a slight abrasion caused by the introduction of a hair pin, or tooth pick into the external auditory canal, gives rise to inflammation in its most violent form. It has also been observed that perfectly normal drum membranes are much more likely to be attacked by inflammation after injuries than such as are opaque, cicatricial, or otherwise degenerated. The number of cases of myringitis arising from exposure to cold is much greater than those of traumatic ori

gin. The introduction of cold substances into the ear is a common cause; plunging beneath the surface in the cold bath, also the cold water of the douche finding its way into the ear after the use of the steam bath. It is also likely to follow the removal of masses of cerumen which have long excluded the drum membrane from contact with the air. In cases also in which the drum membrane has become hyperaemic through obstructed circulation arising from the plugging of the ears with cotton or charpie inflammation is very readily excited.

Exposure to currents of air is also a very frequent cause. The introduction of foreign substances into the ear, either accidentally or by design, many give rise to myringitis. In this country for example, the people resort to the placing of such remedies as camphor, French brandy, chloroform, ether, garlic, portions of onion, etc., in the external auditory canal for the relief of toothache,and either by the irritation which they produce, or through the unskillful efforts made to remove them, inflammatory action is excited, which is very prone to attack the drum me'nbrane. I have also repeatedly met with it as the result of the use of various proprietary remedies for earache, especially one advertised by a local apothecary under the high-sounding name of "Acousticon." By means of the microscope it has been found that fungous growths of various forms give rise to myringitis. Wreden of St. Petersburg has rendered invaluable services to science by his investigations and discoveries in this direction. The older surgeons, particularly Saissy, believed that irritation in the vicinity of the ear, from the use of blisters, irritating salves, etc., would produce the disease. I cannot, from my own experience, confirm this opinion. Yet I have frequently observed artificial eczema not only upon the auricle, but also in the external auditory canal, as the result of the use of remedies of this class in cases in which the skin is very sensitive.

Among the subjective symptoms of primary acute myringitis pain is the most prominent. In some instances, however, this is only present early in the course of the disease. The pain is

drawing, tearing, or lancinating in character, and is usually marked by a degree of severity, which on account of the small size of the membrane can only be explained by the richness of its nerve supply.

Great febrile disturbance frequently follows the attack and may even occur with the onset of the disease. In plethoric individuals, delirium may occur, and children are frequently seized with attacks of vomiting, and convulsions. In short, during an attack of primary inflammation of the drum membrane symptoms may occur of so serious a character as to lead to the belief that grave cerebral complications are present.

If we compare these symptoms with those which manifest themselves during the earlier stages of meningitis we must admit that myringitis may readily be confounded with meningitis, especially in the case of children; and it will also become ap parent why the older aurists so generally believed aural dis charges to be connected with cerebral affections, an error which would have been avoided had they possessed the means of investigation at our disposal to-day.

In affections of the auditory nerve symptoms present which are identical with some of those attending otitis externa: dimin ished hearing, and noises variable in kind and duration. These are to be explained similarly with those occurring in otitis, and are due to a hyperæmic condition of the membrana tympani, which is followed by exudation and various other changes which diminish the conducting power of the drum-membrane. When fever occurs the sensibility of the auditory nerve is lessened and thus the difficulty in hearing still further increased.

(To be Continued.)

INTERNATIONAL CONGRESS OF OPHTHALMOLOGY.-This congress will be formally opened on Tuesday September 12, 1876, at Chickering Hall, Fifth avenue, New York. Drs. C. R. Agnew, Henry D. Noyes, and D. B. St. John Roosa, of New York, constitute the preliminary committee of arrangements. Inasmuch as a large proportion of the scientific work will