of the drum eases the suffering very quickly in some cases, and a bloody, serous, pus-like discharge escapes into the external ear canal.  Often a patient will say:  “I felt something give away in the ear, a watery discharge appeared, and the pain soon subsided.”  In many cases the rupture of the drum gives little or no relief from suffering.  This is due in some cases to the small and insufficient size of the opening in the drum.  If the pain persists, after a free opening has been made, it may indicate that pressure exists in some cavity or cavities other than the middle ear proper.  A sensation of fullness and sometimes of throbbing or pulsation in the affected ear; roaring, singing, whistling, etc.; impairment of hearing; increased pain, when the jaws are opened and shut, are symptoms of minor importance.  If there are no complications after free discharge sets in the pain disappears, the fever gradually returns to the normal point, and the patient drops to sleep.  In the course of a week or two the discharge subsides and if the rupture is not too extensive the wound will close and the patient will soon be well.  Frequently, however, on account of disease of one or more of the bony parts, the wall of the middle ear or the mastoid cells, the discharge continues for weeks and may become chronic in its character.

[364 Mothers’ remedies ]

Treatment.—­Apply heat or cold first.  Open the bowels.

How to apply heat.—­With the patient lying on his side with the affected ear turned upward, fill the external ear canal with hot water (about 105 degrees F.), then place immediately over the affected ear a hot flaxseed meal poultice, five or six inches square and one-half inch thick, and spread a folded blanket or shawl over the whole to keep it warm as long as possible.  Bread and milk with catnip, or onions will do if flaxseed is not at hand.  The flaxseed holds the heat longer.  Water is a good conductor of heat, and that which fills the external auditory (ear) canal may rightly be considered as an arm of the poultice which extends down to the drum itself.

Leeches also can be applied in front and below the tragus (front of the opening).  If the symptoms do not improve under this treatment and especially if the drum is bulging, an opening should be made at the bulging point of the drum.  The canal is now syringed with a warm antiseptic solution—­like one part listerine, etc., to twenty parts of warm boiled water, with a clean syringe, or warm boiled water can be used alone.  If there is any odor carbolic acid one part, to fifty or sixty of water can be used.  A strip of sterile gauze is put into the canal for drainage and protection.  This syringing can be done from two to four to five times a day, and gradually decrease the number of times as the discharge lessens.  It must be syringed and dressed often enough to allow a free discharge and produce cleanliness.