View report page

138
intractable complaint, and that there are no satisfactory arrangements
for its treatment at present when it afflicts the infants of the poorest class.
The following is a fairly typical history. A child aged three years
and two months is brought to the centre with the complaint that he is
"not getting on." He has been liable to feverish catarrhal infections
since about nine months of age. When fifteen months old, double otitis
media occurred in one such attack. One ear healed in a few days, the
other continued to discharge. He attended the out-patient department
of a general hospital for two or three months, but without relief. The
mother then ceased to take him, and some six months from the start of
the illness the ear became dry (July). At the age of two (October) he
contracted whooping cough, and a month later otorrhoea reappeared.
He received treatment from the doctor who attended him at his home,
and later reattended the hospital. After six weeks' treatment without
benefit, he was taken to a children's hospital instead, and attended for
three months. The ears were sometimes dry for a few days, but always
relapsed. Attendance, therefore, ceased, and for the past nine months
the discharge has been practically continuous. He is five pounds underweight
for his age. He is said to have no appetite, and is in poor
condition. The chest is malformed, he breathes stertorously through
the mouth, and is said to snore in sleep. There is a chronic mucopurulent
nasal discharge with soreness of the nostrils. Both ears are
discharging copiously. With slight difference in detail, this history
will cover a large number of the chronic cases seen at the infant clinics.
There is also a fair degree of uniformity in the treatment prescribed.
The usual instruction is to dry the discharge, clean the ear with wool,
and then insert drops. These mostly contain hydrogen peroxide or
spirit. The parent is directed to carry out the treatment two or three
times daily. One has only to watch the mother attempt this singlehanded
with a struggling baby to realise that it can seldom contribute
anything to the healing of the disease. One suspects that the "three
times a day" becomes once daily, or even less.
We have made the experiment of having a number of these cases
brought to the clinic every morning and left with us until the evening.
A thorough toilet of the auditory meatus is undertaken three times in
the day with strict cleanliness, and the ear is kept covered in the intervals
with a pad and bandage to prevent the child's fingers being thrust into
it. A 10 per cent, solution of Argyrol is dropped into the nose at each
dressing. The day is spent out of doors in a cot. Unless the discharge