in withdrawing the
effused blood by means of a hollow needle. In the event of suppuration
supervening, incision and drainage must be carried out.

#Epithelioma# may attack the auricle and extend along the external
auditory meatus. It begins as a small abrasion which refuses to heal,
and is attended with a constant foetid discharge and intense pain. The
disease may spread to the middle ear and invade the temporal bone, and
facial paralysis then ensues. The adjacent lymph glands are early
infected. The treatment consists in removing the growth freely, and
excising the associated lymph glands at an early stage of the disease.
In inoperable cases radium or the X-rays may be employed.

#Rodent cancer# also may attack the outer ear.

#Impaction of Wax or Cerumen.#--Hyper-secretion may result from
unknown causes, or it may accompany or be induced by the discharge
from a chronic middle-ear suppuration. The association of these two
conditions should be borne in mind. An accumulation of wax may be
caused by the too zealous attempts of the patient to keep the ear
clean, the wax being forced into the narrow deeper part of the meatus.

The chief _symptom_ of impacted wax is deafness, which is often of
sudden onset. Impaction of wax causes deafness only when the lumen of
the auditory canal becomes completely occluded by the plug. Tinnitus
aurium and vertigo are sometimes present, and may be troublesome if
the wax rests upon the tympanic membrane. Pain is occasionally
complained of, and is usually due to the pressure of the plug upon an
inflamed area of skin. Certain reflex symptoms, such as coughing and
sneezing, have been met with.

It is only by an objective examination of the ear that the diagnosis
can be made. The plug varies in colour and consistence, and may be
yellow, brown, or black in appearance. Sometimes from the admixture of
a quantity of epithelium it is almost white in colour.

_Treatment._--The ear should be syringed with a warm antiseptic or
sterilised solution. The lotion is at a suitable temperature if the
finger can be comfortably held in it. The ear should be turned to the
light, a towel placed over the patient's dress, and a kidney basin
held under the auricle and close to the cheek. A syringe provided with
metal rings for the fingers and armed with a fine ear nozzle should be
held with the point inserted just within the aperture of the external
meatus and in contact with the roof of the canal. Care must be