and this being equally useless, excision was proposed, and Dr. Jenner consulted, who said she was dying, that medicine could do no good, while an operation did offer the "shadow of a chance" of success. Upon this, the patient and her husband desired that the trial should be made. Mr. Wells found the operation quite easy. An incision, seven inches long, was carried along the outer border of the left rectus abdominis, and the spleen was turned out very easily. The vessels were secured by silk ligatures, which were cut off short and returned. There was very little bleeding. The patient had recovered from the shock, there were as yet no signs of peritonitis; and, if she should recover from the operation, all that we know of removal of the healthy spleen in dogs, and in man accidentally by wounds, led to the hope that the absence of the spleen might be tolerated and a good state of health regained.

Dr. Crisp said the case was a very interesting one, but he did not think it was parallel with cases of removal of spleen from dogs. He had, he said, never seen a healthy liver with such a spleen. He thought the liver had more to do with blood formation than the spleen had.-Medical Times and Gazette, Dec. 2, 1865.

Midwifery and Diseases of Women and Children.

THE OTORRHEA OF CHILDREN.

Clinical Lecture by PROF HI. RODGER, at the Hospital for Sick Children in Paris.

"I have presented to you, gentlemen, five little patients suffering from otorrhoea, and I take this opportunity to give you my views of this disease. The discharge from the ear is only a symptom, just as the discharge from the urethra, the mucous sputum from the air passages, etc.; its causes are very various; it may be owing to a simple irritation or inflammation, but it may also be based upon a very serious organic lesion in the interior of the ear and its nearest vicinity, and then, of course, lead to a very different prognosis and treatment."

(After recaptitulating the details of these cases, Professor Roger continues :)

"These five cases present, as I have already indicated, all the different species of otorrhoea occurring in children, namely: 1. Acute Otitis; 2. Chronic Otitis; 3. Otorrhoea, or simple or ulcerative inflammation of the mucous membrane of the meatus auditorius, consequent upon some disease of adjoining parts or the tissues surrounding the meatus. These

different species we will now consider more closely according to their causes, symptoms, prognosis and treatment.

"1. Acute Otitis.-If a child runs out of doors during a cold wind, or happens, while somewhat heated, into a cold draught, it acquiressometimes a severe cold with headache, sometimes a catarrhal angina with cough, or else a like inflammation of the meatus auditorius, etc. Sometimes, even, the child takes all these together, or in succession : coryza, angina, otitis. When the lattter sets in, the child awakes soon after falling asleep, or in the middle of the night, with pretty lively fever and complains, if it is able, of pain in the region of the ear. Generally, such pain is acute and sometimes very violent. The child cannot sleep, cries, and if it is not yet sufficiently intelligent, nothing will pacify it, and all our endeavours to find the cause are fruitless. If the pain in the ear is not so severe as to make the child put its hand to it, we have not a single sign from which to surmise the seat of the trouble. The pain will then be sought for in the abdomen, and colic be thought of since neither cough nor dyspnoea is found, and the expression of the face as well as the undisturbed intellect will not allow us to think of a cerebral affection. If we happen to examine the child's ear, we discover perhaps a little redness and swelling in the external meatus, so that it seems narrower, as it were. At the same time the inner membrane of the meatus is dry and extremely sensitive to the touch. Deglutition is painful, and if angina be present, this pain is still greater. The pulse is pretty active, the skin hot, with thirst and loss of appetite. "These symptoms continue for about two or three days; the pain gradually becomes less continual, appears in paroxysms, and radiates to the other ear, especially when an angina is combined with it. Sometimes this simple otitis really affects both ears, but this is rare. At all events, the severe pain is accustomed to abate in a few days spontaneously, the child becomes calmer, and we then discover upon the pillow on which its head rested, or in the nightcap, a greenish spot caused by a discharge from the ear; this discharge consists at first of but a few drops of purulent matter, but it is accompanied by difficult hearing or deafness—a fact which is more easily discovered in older children than in those quite young. In many cases, however, the pain remains very acute and lasts longer than the period mentioned. The discharge which sets in does not diminish the pain, and is sometimes more, sometimes less profuse. We may, in such a case, be tolerably certain that the inflammation has progressed to internal parts of the ear, and need not be surprised if under these circumstances congestion supervenes.

"When a discharge from the ear has once shown itself, the diagnosis

is manifest; but before this sign appears, it remains in doubt, especially when the attention of the physician has not been called to it by some circumstance. It is impossible to know whether the cutting of teeth, especially of molars, is not the cause of the pain, or if the angina, if such coexists, which may have affected the Eustachian tube, be not to blame i in any case, a close examination of the mouth and throat will give the clue.

which

"However that be, the disease can terminate-1, in recovery, takes place after 2-4 weeks, the discharge becoming gradually milder and less copious; or 2, by passing into a chronic state, which engenders an otorrhoea of long duration, and not unfrequently a consecutive alteration of the membrana tympani also.

"The treatment is rather simple. In the acute period local remedies are applicable, especially emollient cataplasms, or the introduction of a few drops of oil of almonds into the meatus, or even of a drop of laudanum. When the intense pain has subsided, two or three injections daily of a tepid infusion of elder in milk, Decoct. Papaveris, Decoct. Althoa, etc. But if the pain continues very severe, and if there is reason to suppose that the middle and internal ear participate in the inflammation, two or three leeches may be applied to the mastoid process and the bleeding from the bites continued for some time. A little later, when purulent discharge from the car has begun, recourse may be had, according to circumstance, to aromatic or to astringent injections decoctions of cinchona, of folia juglandis, of rhatany with milk and limewater, etc). The injections must be made freely to cleanse the meatus continually, so that the secreted matter may not, by remaining too long, increase and keep up the irritation. The cure is assisted by the use of derivatives, especially irritating foot-baths, simple sinapisms to the calves of the legs, etc.

"2. In Chronic Otitis, repeated injections of water merely are made to free the meatus thoroughly from all pathological secretions. The diseased membrane is then treated, by smaller injections, with astringent or even caustic fluids (acetate of lead, sulphate of zinc or copper,) which are allowed to remain in the ear by closing its external orifice with a little cotton. If there is reason to believe that the membrana tympani is perforated, it is well to be cautious in the use of these injections.

"3. Secondary, or consecutive, Otitis is that which follows upon other diseases, or is developed in their course. Sometimes it originates during a simple catarrhal inflammation of the throat by continuation through the Eustachian tube into the middle ear. But it occurs especially in the course of eruptive fevers, so in small-pox by the development of

pustules in the meatus, in measles, scarlet fever and typhus. In these cases the otitis begins during the height of the disease, and in the course of measles more rapidly than in the others. In scarlet fever it is produced by inflammation in the vicinity, and scarlatina is next succeeded in point of frequency of the occurrence of otitis by typhus. In the latter it is chiefly congestion by which deafness is suddenly produced, and it is well known with what rapidity difficulty of hearing or deafness supervene in severe cases of typhus; it is the same congestion which in this disease produces splenization and hepatization of the lung.

"The symptoms of secondary otitis are not very conspicuous, however characteristically the symptoms of the main disease may show themselves. The ear-ache is usually not severe and does not engage the attention of the physician; perhaps he recognizes the otitis by accident, perhaps only when discharge from the ear is present. As slow and indeed insiduous as the approach of this inflammation, is also its course and duration-all consecutive inflammations, especially of mucous membrane, taking generally a chronic course. The discharge from the ear becomes permanent, is usually profuse, at times less so; the secretion collects in the meatus or tympanum, and is very fetid and irritating; the membrane, which lines the meatus and the exterior of the membrana tympani, gradually undergoes an alteration by the chronic inflammation, the continual moisture and the irritation. It is softened, swelled and becomes the seat of fungous proliferations or ulcerations. The inflammation may continue upon the periosteum, and even to the bone, and lead to caries, perforation of the membrana tympani, destruction of the ossicula auditus and thus cause irremediable deafness. It may be asserted that the majority of cases of real deafness have their origin in secondary otitis; and variola, measles and scarlatina chiefly are to blame in this respect.

"The treatment of secondary otitis does not differ much from that of the primary; but specific local remedies, such as astringent and caustic injections, must be employed sooner and more energetically, together with the internal use of tonic and antiseptic remedies.

"Properly, a fourth form of otorrhæa ought to be mentioned here, which occurs frequently in children and may be regarded as specific. In children, suffering from eczematous or impetiginous eruptions, e. g. crusta lactea, a purulent and very fetid discharge from the ear is produced, either immediately or after the eruption has been transferred to the mucous membrane of the meatus. The consequences in such a case can be very serious, and we must combat them energetically. The treatment consists in fomentations and injections, at first of mild and depurating, afterwards of astringent or even caustic lotions. At the same

time internally those remedies, which are commonly employed against chronic eczema and impetigo in children.

"To this class, also, belongs scrofulous or tuberculous otitis. It is chronic from its beginning, but instead of progressing from without inwardly, the inflammation takes the reverse course. Usually it is the consequence of caries or necrosis of the mastoid process or the petrous bone. It then forms an abscess, which empties outwardly by perforating the membrana tympani, and a continual discharge of an offensive pus mixed with detritus of bone results, which in the course of time brings the mucous membrane of the meatus to a state of ulceration.

"In caries of the petrous bone, symptoms also appear which show an affection of the neighbouring parts of the brain, more especially of the facial nerve. In the latter case we observe, at the same time with the offensive otorrhoea, a paralysis of the face. A little girl, which we have in the Hospital at present, had measles six months ago, and an otorrhoea remained, which was not cured. Gradually the little one lost her appetite, became emaciated, had alternately diarrhea and constipation, and finally swelling of the cervical glands. Lately, only, the mother discovered a kind of distortion of the face of her daughter and brought her to us. She looks very pale now, is poor and feeble, and has very conspicuous glandular tumors on the neck under the lower jaw, and at the same time the right half of the face is immovable, without expression, and the paralysis distinctly observable on the lids of the right eye and the depressed angle of the mouth. What is the cause of this condition? The supposition of caries of the temporal bone near the middle or internal ear explains all these symptoms; it explains also the paralysis of one side of the face by the alteration the facial nerve has probably suffered in its passage through the said bone. The swelling of glands, and the exploration of the chest (by which a blowing respiration is detected, with dull sound in the apex of the right lung,) point decidedly to a tuberculous diathesis and leave hardly a doubt but that the suspected osseous lesion, whereupon the otorrhoea and paralysis are based, is of scrofulous origin.

"What prognosis have we in such cases? Without doubt a sad one; for the local disease, as well as the general diathesis and especially the tuberculosis of the lungs, lead us to expect nothing favourable. The strength of the patient will sink more and more, the local lesion will gradually affect the brain and cause a fatal meningitis. (The child really died soon after.) What is possible to be done is simply to cleanse the meatus continually, and this must be done very cautiously. The internal treatment is directed against the tuberculous diathesis."-Translated for the St. Louis Medical and Surgical Journal.