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14
"The above table is similar to that which has been published annually
for several years past. In the first column an analysis of the conditions
present is shown, while in the second column the number of cases under
each of these conditions appears. The two largest groups are the acute
and the chronic suppurations. The word 'chronic' in this connection
needs elaboration. Formerly, the term 'Chronic Suppuration' was
applied to cases in which the suppuration has lasted a long time, e.g.,
3 months. Duration was the criterion, but that has never been the
criterion used in these reports. It is an arbitrary one and it is much
more illuminating to take as a criterion the bacteriological field. In the
acute condition it is presumed that micro-organisms (usually one variety
only) have invaded the tissues. Gradually the tissue cells and the body
fluids gain the upper hand and the micro-organisms are banished to the
discharge which also diminishes. So long as one variety of microorganism
is present in this, the body can deal with it and it quickly
becomes scanty. But if it does not entirely cease, owing to its small
amount it lies in the ear and is liable to become a culture medium for
additional micro-organisms derived from the skin, or introduced from
outside. If this happens the fluid becomes irritating to the tissues, and
they continue to suppurate. Chronicity begins, and it is plain that this
begins early.
"Treatment is brought into line with the changing conditions.
During the acute stage instillations of glycerine and carbolic acid 1 per
cent. are used. When the discharge becomes scanty these are left off and
boracic powder is blown into the ear. This is the normal ending. Sometimes
the patient does not attend the Clinic till it may be assumed that
the chronic stage has begun. If this is only recent, careful cleansing and
boracic powder are usually sufficient to cause the discharge to cease, but
if the trouble has lasted a long time, and there is much swelling and
congestion of the tissues, a careful examination must be made as to
whether the septic area is accessible in its whole extent, or as to whether
the mastoid is the main source of purulent discharge. If the latter is the
case, an operation in Hospital is necessary. If, on the other hand, the
septic area is accessible, and there are no granulations, or polypi, etc.,
active antiseptic treatment is given. This consists in zinc ionisation.
This method has the unique advantage of being efficiently antiseptic and
non-irritating to the tissues.
"As acute inflammation in the middle ear so often follows inflammation
in the nose, it is necessary to deal with this at the same time.