usually accompanies it. Pains soon or later add
to the discomfort. One side is usually affected first.

[EYE AND EAR 363]

Treatment.--It must be devoted to removing the causes just mentioned.
Restore the general health. Abstain from alcohol, tobacco and excess of
all kinds. Active outdoor exercise, horseback riding, mountain climbing,
rowing, walking, etc., are great health producers.

ACUTE SUPPURATIVE INFLAMMATION OF THE MIDDLE EAR.--This inflammation of
the middle ear is one in which, at an early stage of the disease, the free
liquid poured out assumes a pus-like character. At the onset the mucous
membrane of the eustachian tube and middle ear becomes first congested and
afterward oedematous (watery swelling). Then a serous or a bloody-serous
fluid is poured out into the middle ear; and finally this assumes all the
outward characteristics of pus. In a few exceptional cases this pus fluid
will find a sufficient passage through the eustachian tube; but in the
great majority of cases this passageway becomes closed almost at the very
beginning of the attack, and then the free exudation; under an ever
increasing pressure and on account of the softening and breaking down of
the tissues of the drum forces an opening for itself directly through the
drum membrane.

Causes.--The same causes that produce the acute variety will produce this
variety of the disease. It occurs more frequently during the spring and
fall months as the result of changes in the climate. Acute and chronic
catarrh of the nose and pharynx are causes. It frequently occurs in
connection with scarlet fever and measles. It complicates nose and
pharyngeal diphtheria.

Symptoms.--Pain in the ear is the most striking symptom noticed by the
patient. In infants and young children of two or three years of age it may
appear and not be recognized until a slight discharge appears at the
opening of the external ear. The child is feverish, fretful and peevish,
seemingly suffering great pain, and the parents think it is, not very sick
or has only an earache. Sometimes physicians fail to recognize the trouble
until the discharge appears in the external ear. The symptoms are more
severe at night. Any physical or mental exertion increases the plain. The
pain is sometimes very severe, and a spontaneous or artificial rupture of
the drum eases the suffering very quickly in some cases, and a bloody,
serous, pus-like discharge escapes into the external ear canal. Often