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23
Dr. Friel has furnished the following report upon the Ionisation
Clinic:—
The Otorrhœa Clinic was started two years ago and is run on
similar lines to the clinics of the London County Council for the treatment
of discharging ears by zinc ionisation. It should first be stated
that the work is carried out in co-operation with the Minor Ailments
Treatment Centres, and there has been complete agreement and harmony
between the two. This is essential for the success of the clinic. One
session a week is held, on Friday mornings during term. Every child
found by the school doctors, nurses or teachers, to have ear discharge
has his, or her, name placed on a list which is kept in the office at Bruce
Castle. The children are then called up to the clinic in rotation.
During the first year it took considerable effort to work through the list;
now we have to deal only with fresh cases as they arise, or are discovered
among children entering schools.
As this is the first detailed report of the work of this clinic it may
be permitted to state the principles on which the work is carried on. As
by far the greater number of cases seen are of chronic otorrhcea, this
condition is dealt with more fully. The treatment of acute otitis media
with discharge already present, consists in trying to prevent the development
of the chronic condition by adopting some means to prevent the
discharge from becoming a breeding ground for additional varieties of
micro-organisms derived from the skin, air, handkerchiefs, etc. The
insufflation of boracic acid powder has generally proved satisfactory.
The case is otherwise in chronic otorrhcea. If the discharge is either
(a) slight in amount; (b) does not come from some inaccessible part of
the ear; or (c) is distinctly mucoid in character, the insufflation of
boracic acid usually suffices. But in other cases we need treatment more
vigorously antiseptic, such as zinc ionisation.
Each case is examined with a view to determining what is keeping
up the discharge. Sepsis is the basic factor, but frequently one or more
additional factors are present either in the ear, nose, throat, or mouth.
If a polypus is present in the ear, this is first removed. If there is
rhinitis or inflamed tonsils, these require treatment as well as the ear
itself. Every effort is made to remove additional factors when present
and so to convert cases which, when first seen were unsuitable, into ones
suitable for treatment by zinc ionisation. The cases suitable for zinc