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An extended trial has been given to the iodine (0.75%) and
boric powder. Unlike ionisation, there are practically no contraindications,
it is quickly applied, and, at the least, it effects a big
improvement in those complicated cases unsuitable for ionisation.
Foul-smelling discharges, granulations, long-standing mastoid
cases, etc., improve remarkably, so that, with few exceptions, the
practice has been, after careful cleansing and investigation, to
start treatment with the powder. The following figures indicate
what is happening. There were 39 active cases examined, of
which 9, almost inactive, received no special treatment, 5 drying
up and 4 remaining under observation at the end of the year.
Four cases were ionised, 2 with immediate success and 2 requiring
a continuation of the treatment beyond the end of the year.
Twenty-six received the iodine and boric treatment, of which
20 were discharged dry, 1 defaulted, and 5 were still under treatment.
Those requiring accessory or operative treatment are
referred accordingly, but the iodine and boric powder effects a
great improvement in most cases, pending further action, and
parents are always grateful for the amelioration, if only on
account of the smell.
This method is receiving favourable notice generally.
Ionisation also continues to impress. But there are those who
doubt the efficacy of all local applications and attribute improvement
or "cure" to careful cleansing. In a disease so- apt to clear
up, at least temporarily, without any special treatment, it is
difficult to prove that any special method is successful. Anyone
using either of these two methods, however, must have been
impressed with the results, and, in the case of the powder, the
astringent and antiseptic effect is easily appreciated in complicated
cases. Strict preliminary cleansing is essential to success,
certainly, but experience with plain boric powder has shown both
ionisation and the iodine powder to have definite advantages. At
present, therefore, the routine adopted at the Clinic is: thorough
cleansing and investigation, classification, reference, if necessary,
for treatment of accompanying defects, ionisation in cases of
simple tympanic sepsis, and the use of iodine and boric powder
in the more complicated cases, with further consideration later in
those which do not completely clear up. Cases of undoubted attic
or mastoid disease are, of course, referred to Hospital.