e borne in mind that the skin may
present a normal appearance even when suppuration has occurred.
Palpation of the affected area with the probe causes intense pain.
Sometimes oedema over the mastoid with displacement forwards of the
pinna supervenes, and simulates acute inflammation of the mastoid.

_Treatment._--If seen in the earliest stages, an attempt may be made
to relieve the pain by the application of a 20 per cent. menthol and
parolein solution, or by the use of carbolic acid and cocain, 5 grains
of each to a dram of glycerine. When suppuration has occurred, the
best treatment is by early incision, transfixing the base of the
swelling with a narrow knife and cutting into the meatus. If the
tendency to boils persists, a staphylococcal vaccine will be found of
value.

#Foreign Bodies.#--It is unnecessary to enumerate all the varieties of
foreign bodies that may be met with in the ear. They may be
conveniently classified into the animate--for example maggots, larvae,
and insects; and the inanimate--for example beads, buttons, and peas.
Pain, deafness, tinnitus, and giddiness may be produced, and such
reflex symptoms as coughing and vomiting have resulted.

The main practical point consists in identifying the body by
inspection. The mere history of its introduction should not be taken
as proof of its presence. In children it is advisable to give a
general anaesthetic so that a thorough examination may be made with the
aid of good illumination. If previous attempts to remove the body have
caused oedema of the meatal walls, and if the symptoms are not urgent,
no further attempt should be made until the swelling has been allayed
by syringing with warm boracic lotion, and by applying one or more
leeches to the tragus. An attempt should always be made in the first
instance to remove the body by syringing. It is rare to find this
method fail. Should it do so, a small hook should be used, sharp or
blunt according to the consistence of the body. Maggots, larvae, and
insects should first be killed by instillations of alcohol and then
syringed out.

AFFECTIONS OF THE TYMPANIC MEMBRANE AND MIDDLE EAR

#Traumatic Rupture of the Tympanic Membrane.#--Perforating wounds may
result from direct violence caused by the patient--for example, in
attempts to remove wax or foreign bodies, or by clumsiness on the part
of the surgeon. It is also a comparatively common complication of
fracture of the middle fossa of the base of the s