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15
I am indebted to Dr. Friel for the following statement : —
" The Table printed above classifies the conditions found in the
discharging ears in 1935 and summarises the results of treatment. In
the chronic cases the basic factor keeping up the suppuration is the
infected discharge stagnating in the ear and irritating the tissue with
which it is in contact. The septic fluid may be in a space accessible
in its whole extent or it may extend into an area totally inaccessible,
such as the mastoid. Moreover, in some oases there may be additional
factors—a polypus or granulations—present. Usually, these latter are
in an accessible position and can be dealt with. If they (the sepsis or
the granulations) are in a place difficult of access, such as the attic,
recovery is delayed. Sepsis alone in an accessible position is responsible
for the largest single class of cases of chronic suppuration. The inflammation
shows degrees of severity. When the chronio condition has
recently set in it is mild, and easy to treat successfully. Cleansing and
insufflation of boracic powder a few times is sufficient. But when it
is considerable and of long duration with much discharge there is only
one method of treatment known to the writer which acts quickly and
decisively—zinc ionisation. On the establishment of an ear clinic a
considerable accumulation of such cases is found. Each ear must be
examined to find out what is keeping up the discharge and whether the
area involved is accessible or not. If it is inaccessible, operation in
hospital to gain access to the area holds out the only prospect of cure.
" The field of zinc, ionisation is in the treatment of those cases where
the sepsis is in an accessible position. Usually, one treatment causes
complete or almost complete cessation of suppuration. Its economic
importance is in the rapidity with which it clears up these cases.
" The arrears of chronic cases having been disposed of there is then
time available to treat cases of ACUTE otitis media, whether suppurative
or catarrhal, of nasal catarrh, and of obstruction of the Eustachian
tube, etc.
"As has been said, operation holds out the only prospect of a cure
for a mastoid case. No hesitation is felt in sending a child to hospital
when the inflammation is ACUTE. This is so for two reasons; first,
the urgency to avoid extension to the interior of the skull or to the large
blood vessels, and second, because good results are the rule. These
two facts do not apply to the chronic oases of mastoid disease. Frequently
the condition has existed for months or years, the results