cute
inflammation and perforation of the eardrum, which may mean at any
time a sudden return of pain with the occurrence of the more dangerous
conditions just recited, together with deafness. Bearing all this in
mind it is advisable never to neglect a severe or persistent earache,
but to call in expert attention. When this is not obtainable the
treatment outlined below should be carefully followed.

=Symptoms.=--Pain is severe and often excruciating in adults. It may
be felt over the temple, side and back of the head and neck, and even
in the lower teeth, as well as in the ear itself. The pain is
increased by blowing the nose, sneezing, coughing, and stooping. There
is considerable tenderness usually on pressing on the skin in front of
the ear passage. In infants there may be little evidence of pain in
the ear. They are apt to be very fretful, refuse food, cry out in
sleep, often lie with the affected ear resting on the hand, and show
tenderness on pressure immediately in front or behind the ear
passage.

Dullness, fever, chills, and convulsions are not uncommon in children,
but, on the other hand, after some slight illness it is not infrequent
for discharge from the ear to be the first sign which calls the
attention of parent or medical attendant to the source of the trouble.
For this reason the careful physician always examines the ear in
doubtful cases of children's diseases. Unless the inflammation
subsides with treatment, either a thin, watery fluid (serum) is formed
in the middle ear, or pus, when we have an "abscess of the ear." The
drum if left to itself breaks down in three to five days, or much
sooner in children who possess a thinner membrane. A discharge then
appears in the canal of the external ear, and the pain is relieved. It
may occasionally happen that the Eustachian tube drains away the
discharge, or that the discharge from the drum is so slight that it is
not perceived, and recovery ensues. Discharge from the ear continues
for a few weeks, and then the hole in the drum closes and the trouble
ceases. This is the history in favorable cases, but unfortunately, as
we have indicated, the opposite state of affairs results not
infrequently, especially in neglected patients.

=Treatment.=--The patient with severe earache should go to bed and
take a cathartic to move the bowels. He should lie all the time with
the painful ear on a rubber bag containing water as hot as can be
comfortably borne. Every two ho