membrana tympani, Allen, also of London, forced a stream of tepid water through an Eustachian catheter into the middle ear, and allowed them to dissolve, and thus gradually to escape into the pharynx.

After seeing the tolerance shown by the mucous membrane of the middle ear, when suppuration has caused spontaneous perforation of the drum-head, and having witnessed, in the hands of Hinton and Allen, the procedures followed by them without any unfavorable results, I adopted their plans, electing one or the other as might seem the more desirable in each case. After having pursued this plan for more than nine years, without having had occasion to regret it as far as I am aware, I am convinced of the advantages of introducing liquids into the middle ear in certain pathological conditions, more especially in those cases of chronic non-suppurative inflammation of that cavity attended with dryness.

In addition to the benefit that the liquid is to the middle ear, and its effects on the contents of that cavity, it aids in opening the Eustachian tube, and after its use, even in very small quantity, it will be found that air can be forced through the Eustachian tube into the middle ear in larger volume than before such moistening. Moreover, I am accustomed to use a stream of liquid with a syringe and Eustachian catheter as a very useful mechanical means of dilating the Eustachian tube in great diminution of its calibre, instead of using Eustachian bougies. Considerable pressure may thus be made without giving pain, and without danger of laceration of the mucous membrane, or of the danger of breaking of bougies. The operation is simple; it is easily done, and is efficacious. It is the reverse of the method practised by Horner, when he distended the Eustachian tube by liquid forced through the external meatus and middle ear into the Eustachian tube.

It is claimed that as the middle ear, in its normal condition, contains only air and mucus secreted in sufficient amount to keep it moist, the introduction of any liquid into it is unnatural and must do violence.

If such be the case in its normal state, it does not follow that the same must be true in a pathological condition.

The same conditions pertain to the naso-pharynx, yet I am not aware that it is claimed that, because this space, in its normal condition, is a cavity for air, and has a mucous lining, it

would be unwise to introduce any liquid into it in chronic catarrhal inflammation of its lining, with accompanying thickening and altered secretions. On the contrary, removal of such secretions and lubrication of the surface not only give comfort to the patient, but greatly aid respiration. If such treatment benefits this portion of the mucous lining of this cavity, why should not the same good results follow a continuation of the treatment to the other parts of the same membrane that extend through the Eustachian tube, and form the lining of the middle ear and mastoid cells? It may be answered that, in consequence of the conformation of the naso-pharynx, any liquid introduced into it will readily escape, either forwards or backwards, and will not remain long in contact with the parts, whilst liquids will be longer retained in the middle ear.

This difference can be compensated for by adapting the liquid used to the difference in the conditions, which requires that they should be less irritating in character.

It is an established fact that acute inflammation of the middle ear has repeatedly followed the use of the usual douche for affections of the naso-pharynx.

If it be assumed that such use of the douche caused the inflammation of the tympanum, it gives rise to the inquiry whether it should not rather be called abuse than use of the douche that is responsible for that result. There are certain precautions in the use of that douche that cannot, with safety, be disregarded. The evil results that have followed its use may have been owing to too low a temperature of the liquid used ; or the liquid may have been of too irritating a character to be long retained in so sensitive a cavity, whilst it could with safety be used in the naso-pharynx, because of its ready escape therefrom, or the column of liquid may have been of such elevation as to do mechanical violence by its pressure. The inflammation may have resulted from one or more of these causes.

Another argument that has been urged against the entrance of liquids into this cavity is that, in sea-bathing, if salt-water enters it, acute inflammation follows. This may or may not be so. It seems not unlikely that, in many cases, important factors are overlooked in estimating probable causes of a recognized consequence. During an experience of two years, extending over a distance from the coast of Maine to the coast of Georgia, as a surgeon in the navy of the United States, during the block

ade in the late civil war, I had frequent occasions to observe the results of exposure of men on the vessels of the blockade, and in going from a northern port and in returning to it, in producing inflammation of the middle ear. At a later date, I had a similar opportunity of making such observations on the New England coast, during one summer that I was surgeon of a prac tice ship for naval apprentices.

During the period of the blockade, the ship's crew suffered considerably, at times, from acute inflammation of the middle ear, but it was usually when the vessel was very wet from storms, or when her decks were damp from washing them. At the season when the crew bathed most in the sea, there were comparatively few cases of such inflammation, notwithstanding the fact that the men would dive a great deal, and would frequently leap from some part of the ship into the sea, with consequent concussion and exposure as great as the effect of breakers in sea-bathing.

The same was true in regard to the bathing of naval apprentices, with this difference in the result, that a case of acute inflammation of the middle ear was a rare occurrence during the whole summer cruise, although the boys and young men bathed in the sea almost daily when in port. This exemption was probably due in part to the fact that the decks of that ship were not kept damp by unnecessarily frequent washing of them, and there was less exposure to storms than on the blockade; but we were in a more northern latitude.

These facts seem important as throwing some light on the subject of causation of a disease which is generally supposed to be a direct result, either of admission of liquids into the external or middle ear or both, or else of the mechanical violence of waves impinging on the ear. Little heed seems to be taken of the disturbance of the general circulation, which causes such local congestions and inflammation, either from rapid change of temperature of the body from sudden or too long-continued immersion of it in water of much lower temperature, or from the wearing of clothing made damp by the atmosphere of evenings at the sea-side, especially by persons who are accustomed to the drier atmosphere of an inland residence.

So much has been said concerning the effects of sea-bathing on the production of ear disease, that we may with advantage

review the general impression of the danger from accidental admission of sea-water to the ears.

So, also, in regard to the effect of liquids designedly introduced in pathological conditions.

The object of this paper is to ask a more careful revision of accepted views on this point, and the more general adoption of a procedure that has been shown to be not only free from danger when judiciously practised, but to be highly beneficial in cer

tain conditions.

Since water made slightly saline is better tolerated by the mucous membrane than when pure, the addition of borax, or chlorate of potassa, or some kindred substance to it is desirable.

The amount of liquid to be introduced should be governed by the object to be accomplished. The temperature of it should be the same as that of the blood, and it should not be forced into the tympanum with violence. Then pain scarcely ever results; and the patient usually finds that after a few hours have elapsed a more comfortable feeling in his ears is experienced-more open, as it is often expressed-than had been experienced for a long time before.

It is conceded that the impressions of patients often aid in guiding our treatment; and I have so often been assured by those whom I have treated in this way of the comfort (with improvement in hearing) that has followed it, that I can confidently advise its more general adoption.