terial filling the passage. And in any event, if the wax cannot be
seen, one is justified in treating the case as if it were present, if
sudden deafness has occurred and competent medical aid is
unobtainable, since no harm will be done if wax is absent, and, if it
is present, the escape of wax will usually give immediate relief from
the deafness and other symptoms.

=Treatment.=--The wax is to be removed with a syringe and water as hot
as can be comfortably borne. A hard-rubber syringe having a piston,
and holding from two teaspoonfuls to two tablespoonfuls, is to be
employed--the larger ones are better. The clothing should be protected
from water by towels placed over the shoulder, and a basin is held
under the ear to catch the water flowing out of the canal. The tip of
the syringe is introduced just within the entrance of the ear, which
is to be pulled backward and upward, and the stream of water directed
with some force against the upper and back wall of the passage rather
than directly down upon the wax. The water which is first returned is
discolored, and then, on repeated syringing, little flakes of dry
skin, with perhaps some wax adhering, may be seen floating on the top
of the water which flows from the ear, and finally, after a longer or
shorter period, a plug of wax becomes dislodged, and the whole trouble
is over.

This is the rule, but sometimes the process is very long and tedious,
only a little coming away at a time, and, rarely, dizziness and
faintness will require the patient to lie down for a while. The water
should always be removed from the ear after syringing by twisting a
small wisp of absorbent cotton about the end of a small stick, as a
toothpick, which has been dipped into water to make the cotton adhere.
The tip of the toothpick, thus being thoroughly protected by dry
cotton applied so tightly that there is no danger of it slipping off,
while the ear is pulled backward and upward to straighten the canal,
is gently pushed into the bottom of the canal and removed, and the
process repeated with fresh cotton until it no longer returns moist.
Finally a pledget of dry cotton should be loosely packed into the ear
passage, and worn by the patient for twelve or twenty-four hours.

=PERSISTENT AND CHRONIC DEAFNESS.=--A consideration of deafness
requires some understanding of the structure and relations of the ear
with other parts of the body, notably the throat. It has been pointed
out that the exter