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Just How to Manage Otorrhea.-(By F. E. Burgevin, M. D., of Spiro, I.T.)Otorrhea, from the purulent middle-ear catarrh, the “running ears" of the laity, was at first my bete noire. I used the classic treatment of Pomeroy and others-syringing, insufflations of powdered boric acid, etc., sometimes with benefit, sometimes the reverse, but never by any chance curing any of them, until I dreaded to see a patient with cotton in his ears come into the office. Now I cure them in a few days or weeks without difficulty, and really prefer this class of cases to any other. When I was at the Manhattan Eye and Ear Hospital in 1890, Dr. Pomeroy said that one case had been under treatment nearly ten months and was slightly improved. He said that it required one or two years to cure this disease, and then it generally returned. My method of treatment is as simple as it is effectual, and any doctor after reading my description attentively can use it as well as I can and cure every case. Once daily I fill the ear with a warm solution of some good peroxide of hydrogen, beginning with a 35 per cent solution, and increasing the strength every day until the pure drug is used. Hydrozone is the same, only twice as strong, and I use it when I can get it simply from motives of economy. After cleansing the ear thoroughly, which at first may require twenty minutes to two hours, according to the foulness of the auditory canal, I then instill a few drops of glycozone (warmed) and close the canal securely with a bit of absorbent cotton. This is allowed to remain in situ until next treatment. The first cleansing should be very thorough, the perox. ide being repeatedly instilled until all foaming ceases. In some cases it may require two, three or more treatments to cleanse the ear properly, especially if the lumen be occluded by a furuncle, or by swelling, or inspissated discharge. Do not be discouraged by any little difficulty like this, keep right on and you will finally succeed in getting the ear clean. After that it is plain sailing. Thenceforth the daily treatment need not consume more than ten to twenty minutes. It is better to treat the case every day, but I have had good success with patients who could not come oftener than once a week. Do not give the patient medicine to use at home and expect to cure him; and never tell him what you are using. In children who dread the procedure, I do not attempt much the first time or two, but strive to win their confidence, which is not ordinarily difficult, as the treatment is not at all painful and is always followed by a certain sense of relief, so that children who were in mortal terror of me at first will, after a few treatments, come to me of their own accord. Even babies of one or two years who would not suffer me to touch them at first, after experiencing the grateful relief afforded, will place the head on the chair in the proper position and gladly submit to the treatment.

When the diseased ear has once been thoroughly cleansed I consider my work as lialf done. Thenceforth improvement is usually very rapid, even old inveterate cases yielding in few weeks. Relapses occur, but are easily man ed, and I have seldom had a second relapse. Of course, mastoid disease, necrosis, polyps, etc., must receive appropriate treatment; but I have no hesitation in saying that all sim. ple, uncomplicated cases (which include the vast majority of all cases under one year's duration) may be cured by this treatment if it is properly and thoroughly carried out. Care must be taken to have the medicaments warm and not too hot100 F. is about right-and to always stop up the ear with a bit of aseptic cotton be. fore permitting the patient to leave the office. Be careful to use a piece of cotton of just the right size to securely close up, the meatus; if too large it will work out, allowing the solution to escape and leaving the ear unprotected; if too small it will slip back into the canal and so fail of its effect. Neyer syringe the ears in otorrhea; it is risky and useless. usually drop a little warm solution of sodium borate-5 per cent-in the ear to prevent a slight stinging which sometimes ensues when active steps are taken I also dry out the canal with cotton on an applicator, but this should be carefully done with speculum, and the canal well lighted. These points are non-essentials, merely refinements which render the treatment a trifle more pleasant, perhaps, that is about all. The general health will probably require overhaul. ing, indications being met as they arise. It is a good idea to regulate and antisepticise the bowels as a routine measure, using salines and intestinal antiseptics-e. g., the sulphocarbolates are needed. In the South especially, malarial and other miasmatic affections will often need looking after; also any other existing disease may require attention, but it is presumed that the practician will know how to handle these. We all ought to try to help each other; not one of us has much to learn; and in these brief talks it is my principal aim to set an example for the rest, hoping my little crumbs may some day come back to me in the shape of seasonable aid from some brother who has a few pointers himself and, like me, is willing) to "whack up."-Kansas City Med. Record.

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LeRoy Crummer, Omaha, Neb., “ The Use of

John Prentiss Lord, Omaha, Neb., "A New

Retention Suture in Operation for Cleft

William F. Waugh, Chicago, " Corn Nuclein."
L. L. Uhls, Osawatomie, Kas., The Rela-

tion of the State to the Insane."
A Mary Strong, Omaha, Neb., Heart Disease

in Obstetric Cases.

W. T. Marrs, Peoria Heights, Ill., Therapeu-

tic Notes.
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J. M. Bell, St. Joseph, Mo., “Gastric Ulcer.''
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C. O. Thien haus, Milwaukee, Wis., “Diagnosis
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and Treatment of the Sigmoid Flexure,

with Report of a Case.”
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Uterine Pregnancy."

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C. B. Hardin, M. D., Kansas City, Mo.

Professor of Hygiene and State Medicine, Kansas University, NSPECTION, palpation, percussion, auscultation, mensuration, aus.

cultatory and palpatory percussion, etc., are methods used in determining the nature and extent of diseased processes. They are all im.

portant, though not equally so, to the modern man of medicine. I deem it useless to give a history of these important methods (so well is it known), and shall strive only to point out to you a few of the more important, and may I say much reglected values, which to the close observer they reveal. In a broad or generic sense, their application embraces the entire human body, therefore physical diagnosis strictly embraces the subject as a whole, instead of the thoracio and abdominal cavities and their contained viscera as most generally construed. Physical diagnosis correctly interpreted means medical diagnosis (so far as territory embraced is concerned) and could be used except for custom as an interobangeable term in this regard. For purposes, however, of curtailment of time and conformity to usage, we shall in our discussion largely, if not wbolly restriot the application we shall nake of these methods to the territory embraced by the thoracio, abdominal, and perhaps pelvio regions.

I think one of the most important elements in the use of physical signs is their application to the normal individual, forming as it does the stepping stone, to a knowledge of abnormal states. Knowing their revealments in the physiological man is an absolute prerequisite to what they would teach in any departure therefrom.

The first lesson to learn therefore is the one scarcely ever learned; viz., what do these various methods interpret-in the man not diseased? If

you don't know when you are in the presence of a normal individual or organ, how can you possibly know by any method or system a departure into the realm of disease.

In the application of these methods, they can only be valuable to him who by their use can determine a normal from an abnormal structure; normal from an abnormal individual. It is quite as important and much more gratifying to the subject to pronounce a man normal and his organs, than to detect disease by the application of physical methods. This capacity to detect disease, and know health and to be able to arrive at these conclusions by comparison, presupposes some musical aptitude upon the part of the examiner in the application of physical methods. Indeed if you are not in this sense musical, capable of differentiating sounds, tones, vibrations, etc., which touch the band and ear, you can scarcely hope to get any considerable value out of this form of physical exploration; or at least lose a large share, which would be yours by its possession.

A tone coming to the ear, a vibration to the band, an impulse seen with the eye, all have a real interpretation, a meaning, which, if perceived reveals the condition of the structures which produce them. One does not get into the heart and possibilities of physical exploration who is blind to this fact. In your diagnosis you will be in error to the extent you fail to properly appreciate sound, sight, touch, etc., where these aids become essential. You readily see that this misinterpretation can proceed from two sources as regards the examiner; an incompetency to apply physical methods, or neglect to do so, or even partly from both. The mere act of placing your ear to the chest simply to catch a jumble cf car. diac and respiratory sounds without a sharp sense and appreciation of differentiation is of no real practical value. You may make a valuable psychical impression on the patient and his friends, but you advance neither science nor art in so doing.

A very large part of physical examinations are conducted along such lines of mere presumptiveness and assumptiveness. In so doing, one violates the interests of every one concerned and causes an enduring reflection upon the most valuable means that we have in the precincts of diagnosis. Reference has been made to the naturally musical ear and the incomparable advantages it offers in the detection of disease, early in its course in the application of physical methods. This remark is made in view of appreciating the presence of morbific changes by the possession of this and other qualifications, very soon after they have begun, so as to afford us

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