rown far backward, for the fluid
then escapes into the antrum, or when the chin is resting upon the chest.

Another symptom that is peculiar is a feeling of something moving in the
ear. This is only felt when the head is moved suddenly. Sometimes the
patient says: "I went in bathing and got some water into my ear, and I am
unable to get it out." He thinks the water went into the ear by the way of
the external ear canal. It was due to the chilling of the surface of the
body, or the water accidentally entered into the ear through the mouth, or
nose, throat, and eustachian tube, and this caused an exudation of fluid
to take place in the middle ear. Hearing gurgling sounds in the ear during
coughing, sneezing and swallowing is an important symptom. The drum on
being examined varies greatly. The simplest case is seen when fluid
contained in the cavity is small in quantity and consists of a thin serum.
The upper level of this fluid can then be seen like a hair crossing the
drum in a more or less horizontal direction. It retains its horizontal
position when the patient moves his head backward and forward.

Treatment.--The fluid can be evacuated by an opening made into the drum,
but it usually accumulates again. The proper treatment is to treat the
diseased condition of the nose and throat, as described in other parts of
this book.

CHRONIC CATARRHAL INFLAMMATION OF THE MIDDLE EAR.--The expression, acute
inflammation of the middle ear, is rightly employed when it is applied to
a case in which the underlying cause is of a temporary nature, as for
example, a cold in the head, and mild attack of influenza, perhaps also in
an attack of hay fever. But when the causes are of a more permanent
character and the middle ear continues for an indefinite period to be the
seat of all sorts of disturbances the combination of these different
diseased phenomena receives the name of chronic catarrhal inflammation of
the middle ear.

Causes.--Troubles (lesions) located in the upper pharynx, the
naso-pharyngeal (nose-pharynx) vault and the nasal passages. Adenoids may
cause it.

The course of this disease has of recent years been growing more
favorable, because the causes are being removed more and more.

Symptoms.--Symptoms of the acute inflammation would be present, and
impairment of hearing which sometimes comes so gradually as not to be
noticed by the patient. It will be better and then worse. A harassing,
hissing, blowing, ringing,