the fenestra ovalis is exposed to the contact of atmospheric air. The apparatus so important to good audition-viz., the membrana tympani and bones of the ear-being lost, the function must necessarily be very much impaired; in some cases the Eustachian tubes close, and in this way the external and middle ears are entirely impaired.

Fifthly. The possible, nay probable, occurrence of a transfer of the inflammatory action to the brain or its membranes, by metastasis or continuous inflammation, is an argument of the highest importance in this discussion.

Sixthly. The partial or complete loss of the function invariably accompanying the disease, should be inducement enough for us to investigate the propriety of allowing these discharges to continue, without medical interference.

The arguments in favour of non-interference may be summed up in a few words:

First. It is a diverticulum of nature which it is dangerous to interfere with.

Secondly. It very frequently (the object of nature being obtained) heals up itself, leaving no great derangement of the organ.

In reference to the first, we would remark that although a diverticulum, (or source of counter-irritation,) and in some cases protecting important organs, yet the seat of the discharge is itself an important organ, and no man would select that as the place to establish counter-irritation in the case of disease in any other organ, especially as it is well known that a purulent discharge from behind the ear, the back of the neck, or the arm, would be productive of all the good effects claimed for a discharge from this locality.

We might with the same propriety establish inflammation in the eye for the relief of cerebral, dental, or aural diseases, and in this way impair or destroy the function of that organ, whose structure is so delicate, and yet no more delicate than that of the

ear.

But, say the advocates of the do-nothing-practice, what are you to do? "Suppression of discharges from the ears induces diseases of the brain," and daily experience shows this to be a fact. Granted. Cannot the disease be transferred from the organ of hearing to some other less important part, and there maintained to an indefinite period without the danger of producing any evil consequences? Certainly it can; and if not cured in the sense meant by the above aphorism, yet its seat of action may be changed, and ultimately, by judicious attention to the case, allowed to heal up entirely, as is the practice in almost any other instance, where for a time an issue or purulent discharge is desirable. There is nothing peculiar in the structure of the ear, that

gives it any superiority as a seat of inflammatory action, to relieve other parts in a diseased or tending to a diseased condition. So far from this being the case, we are of the opinion that the skilful physician is not justified in allowing this discharge to continue a single day in any case, where he, by slight irritation behind the ear, or the back of the neck, or other parts, is enabled to arrest it, but on the contrary he should be as anxious to stop it as he is to arrest a purulent ophthalmia or other inflammatory affection of the eyes.

We cannot agree with Dr. Bonnafont, as quoted in No. 5, of Ranking's Abstract," that "chronic mucous discharges from the ear are always owing to ulceration of the parietes of the external auditory canal, or of the membrane of the tympanum." For it is well known that polypous and other growths produce the same discharges, and great care should be taken in the examination of the auditory canal, with the speculum in a sun light, lest these productions escape our notice. They should, in fact, be always suspected to exist in cases of chronic otorrhea. That "these discharges, generally very easily treated in their acute stage, frequently become very obstinate, and terminate in disorders which almost always involve a more or less serious degree of deafness, and sometimes the death of the individual," are facts which should influence the profession, we are fully convinced.

We have found, in reference to the treatment, that in the early stages, in uncomplicated cases, the production of moderate irritation behind the ear-with careful syringing, first with tepid water, to wash out the secretions, followed by a solution of the plumb. acetat. in the proportion of from two to six grains to the ounce of distilled water-all that was necessary. A small half-moon blister, or a drop or two of croton oil, or the latter used in the form of unguent, are means usually resorted to, to establish this irritation. When complicated, however, with general or local disease, acting as concomitant, and sometimes, as the cause of the otorrhea, the treatment must necessarily be varied to suit the case. Scrofula, particularly in children, is a very common condition connected with the disease, and requires the usual constitutional treatment, in addition to the local applications. General debility, gastric irritation, papular eruptions, spreading erysipelatous and other cutaneous diseases, induce otorrhoeas, and should be treated accordingly. Cases of simple acute otorrhoea, induced by cold or any of the common causes, are treated so successfully by the above, or similar means, that the publication of cases would scarcely be deemed advisable. Of the chronic forms, however, which are considered more difficult to cure, and many of which are absolutely incurable, the following cases may be found instructive.

Miss B., aged fourteen years, light complexion, rather full habit, has had a discharge from both ears for about a year; hearing distance with a watch in left ear, one foot; in the right the watch could be heard indistinctly when placed in contact with the ear. The treatment consisted in washing out the canal well, with tepid water, and then throwing in the aqueous solution of the acetate of lead; four grains to the ounce; and the application of blisters behind the ears. The hearing began to improve immediately, so that at the end of a week the discharge from the left ear had ceased, and the hearing distance increased to six feet. The hearing distance in the right ear was restored to four inches, the discharge continuing. At the end of four weeks the improvement in the right ear became stationary, at ten inches hearing distance; the discharges though small, remained.

On close inspection it was found that a moderate sized polypous growth had been overlooked, on account of the tumefaction in the first examination, in the lower part of the middle third of the auditory passage. This was carefully excised, and the blistersurface restored behind the ear, with the use of the aqua plumbi. In four days the discharge had nearly ceased; the hearing distance advanced to two feet; and in ten days the dis charge of both ears no longer existed; the hearing distance was respectively six and ten feet.

Second case, August 1846.-Mr. B., an artist, dark complexion, aged thirty-four years, has had a discharge from both ears ever since he was two years old. The hearing distance, as indicated by my watch was, in the left ear two inches, in the right ear four inches.

On examination with the speculum, the membrane of the tympanum of the left ear was entirely destroyed, together with. the bones of the middle ear. When air was driven by the patient through the Eustachian tube, the fluids were seen to bubble and heard to rattle in the ear.

The discharge from this ear was not great, and chiefly of a thin watery character.

The membrane of the tympanum of the right ear was destroyed to about two-thirds of its extent, and the bones of the ear were exposed; the handle of the malleus projected into the portion of the membrane which remained, which was also thickened and ulcerated, discharging with the surrounding surface a large quantity of fœtid purulent fluid. The Eustachian tube was here also pervious, as shown by the air press and catheter, and by voluntary sufflation.

Half moon blisters were applied behind the ears, and an ear lotion of four grains of the acetate of lead, to an ounce of water

was directed, to be applied after carefully syringing the ears out with clean tepid water three times a day.

This treatment was continued with the use of a mild astringent gargle, (the throat being slightly inflamed) for three days, when my patient left the city for his residence, some eighty miles distant, in New Jersey, to return at the end of a week or ten days.

On the 31st of August he again called upon me, and I found the blistered surface healed. The discharge from the left ear had ceased, and the internal surface was dry and shining. The hearing distance had increased to four inches.

The discharge from the right ear had diminished, but the process of destruction was evidently still going on. The hearing distance had however improved to about five inches. The blisters were re-applied with directions to add a small quantity of the ceratum cantharidum to the ordinary dressings, in order to keep up the irritation and discharge. The strength of the lotion was increased to six grains of the acetate of lead to the ounce, and the fluid extract of sarsaparilla, as prepared by Maris & Co., of this city, was directed to be taken in teaspoonful doses twice a day. The gargle to be continued-exercise in moderation to be taken, and to avoid coffee, and most of the unnecessary stimulants. On the 2d of September he left for his home, the hearing distance having increased to six inches in the left, and seven inches in the right ear. The discharge from the right ear almost nothing.

Sept. 17th. The hearing continues in the improved condition; the discharge from right ear still to a small extent. The sulphate of copper in solution was directed as a lotion. The etherial vapour was introduced a few times through the Eustachian tubes, with some small improvement in the sensibility of the nerves of audition. The ears were directed to be kept warm, and protected from dust and changes of temperature, by the use of wool in the auditory canal.

On the 19th patient left the city for his home, with the hearing improved in the right ear to ten inches, the discharge having entirely ceased; and in his left, to something more. One year nearly has passed away and the improvement continues.

Other cases might be taken from our case-book, but we did not design to make a long article; "sapienti verbum sat."

Practical Observations on Ship Fever as it prevailed in Philadelphia and its environs, in the months of June, July, and August, 1847. By LAURENCE TURNBULL, M. D.

This disease prevails at the present time to some extent as an epidemic in our city and suburbs. During the last three months, there have been over three hundred cases admitted into the

almshouse, and a corresponding number under the care of physicians resident in the city. Having had a number of cases in charge, I have taken this method of making known my views of its nature and treatment, hoping my endeavors may add some thing to the general stock of knowledge concerning it.

The first great cause of this fever may be traced to the starving state of the population of Ireland; with the subsequent crowded condition of our immigrant ships, without a proper attention to cleanliness and ventilation on the part of their commanders; thus causing the generation of an animal effluvium, which, contaminating the surrounding atmosphere, is received into the lungs, thence proceeding into the circulation. The extreme series of organic capillaries being thus irritated, occasions a subversion of the existing mode of action, through which the different secretions and functions are diminished, increased, or modified.

This disease attacks all ages, from the infant to the old man, and not the poor immigrant ouly, but the residents of our city, passing by means of this contagious effluvium into the lungs of all constantly exposed to its baneful influence. There cannot be a doubt concerning its contagious nature, as nine of the most severe cases out of twenty-one, in my own practice, were those residing in the same houses with the sick, noue of them having been on board ship, but citizens for some time.

The period which elapses before the disease shows itself averages from one to two weeks, but in most cases it makes its appearance in a few days after leaving the vessel.

Nearly every ship which enters our port brings a greater or less number of invalids, some having suffered for twenty-six and twentyeight days, without proper nourishment or medical attendance. In many instances, the number of passengers in the Liverpool packets to New York, has exceeded five hundred, and the regulations of those ships obliged them to leave their berths between the hours. of three and four, A. M., for the purpose of cleansing them, so much water being used in this process as to leave them in a damp and unhealthy condition for many hours. The water for culinary purposes was not distributed until nine, so that the strong and active alone procured a meal before twelve or one, P. M. To insure personal cleanliness for those who were not so disposed, a barrel of water was provided and a portion of it poured over the poor creatures, who were not even fortified by proper food. It cannot therefore be a matter of astonishment that a number should be sick on the voyage, and a still larger number fit only for the hospital on their arrival, having had within the vessel all the elements to generate typhus fever. First, their crowded condition; secondly, their want of proper rest; thirdly, the want of proper nourishment; and