hen clean, dry absorbent cotton is applied, and
pressure made on the wounds if bleeding does not soon stop or is
excessive.

The after treatment of the bites consists in cleanliness and the use
of vaseline. The patient must stay in bed, and the hot-water bag be
constantly kept on the ear till all pain ceases. If the drum
perforates, a discharge will usually appear from the external ear.
Then the canal must be cleansed, once or more daily, by injecting very
gently into the ear a solution of boric acid (as much of boric acid
as the water will dissolve), following this by wiping the water out of
the canal with sterilized cotton, as directed for the treatment of wax
in the ear (p. 35).

The syringing is permissible only once daily, unless the discharge is
copious, but the canal may be wiped out in this manner several times a
day with dry cotton. It is well to keep the opening into the ear
greased with vaseline, and a plug of clean absorbent cotton loosely
packed into the canal to keep out the cold. Excessive or too forcible
syringing may bring about that complication most to be feared,
although it may appear through no fault in care, i. e., an implication
of the cavity in the bone back of the ear (mastoid disease). Germs
find their way through the connecting passage by which this cavity is
in touch with the middle ear, or may be forced in by violent
syringing. When this happens, earache, or pain just back of the ear,
commonly returns during the first or second week after the first
attack, and tenderness may be observed on pressing on the bone just
back of the ear close to the canal. Fever, and local redness and
swelling of the parts over the bone in this region may also occur.
Confinement to bed, and constant application of a rubber bag
containing cracked ice, to the painful parts must be enforced. If the
tenderness on pressure over the bone and pain do not subside within
twenty-four to forty-eight hours, surgical assistance must be obtained
at any cost, or a fatal result may ensue. The opening in the drum
membrane, caused by escape of discharge in the course of middle-ear
inflammation, usually closes, but even if it does not deafness is not
a necessary sequence.

The eardrum is not absolutely essential to hearing, but it is of great
importance to exclude sources of irritation, dust, water, and germs
which are likely to set up middle-ear trouble. More ordinary
after-effects are chronic discharge from the ear following a