A practical treatise on the diseases of the ear including the anatomy of the organ . uldbe applied, as Wilde long ago pointed out, not on the mastoidprocess but on the tragus, for the reason which Von Troltschgives, that in this place the vessels which supply the canaland outer layer of mernbrana tympani are most convenientlyand surely reached. Leeches in this form of disease are not 124: AURAL DOUCHE. as certain in their effects, however, as when used for an inflam-mation of the middle ear ; when, as we shall see, they exert analmost magical influence, so rapid is their effect. In the earlyst
A practical treatise on the diseases of the ear including the anatomy of the organ . uldbe applied, as Wilde long ago pointed out, not on the mastoidprocess but on the tragus, for the reason which Von Troltschgives, that in this place the vessels which supply the canaland outer layer of mernbrana tympani are most convenientlyand surely reached. Leeches in this form of disease are not 124: AURAL DOUCHE. as certain in their effects, however, as when used for an inflam-mation of the middle ear ; when, as we shall see, they exert analmost magical influence, so rapid is their effect. In the earlystages of the disease, when the pain is severe, and suppura-tion has not yet occurred, but the canal is red, swelled, andsensitive, great benefit will be produced by scarifications of thecartilaginous wall. This scarification is made with a tenotomyknife. The incisions should be from three-fourths to an inchlong on the walls of the canal, as recommended by Gruber, ofVienna. Warm water should also be allowed to run into theear, by means of Clarkes aural douche, or any similar E. H. Claries Aural Douche. When patients are told to apply warm water to the ear, unlessthey are particularly instructed, they will almost invariablyuse the syringe, thinking that is the way in which the water isto be applied ; but what is required is the steady flow of warmwater upon the part, and this is best attained by means of thedouche. Patients should be instructed in its use, and espe-cially should they be told that, unless the auricle is kept onthe stretch, so that the walls of the canal are apart, the waterwill not enter the ear. The douche is the same as the so-called nasal douche of Weber, and is very valuable in casesof aural inflammation. As has been seen in the first chap-ter, Hippocrates advised the use of warm water to the ear for DIFFUSE INFLAMMATION—TREATMENT. 125 the relief of pain, but it fell into undeserved disuse until thevalue of its application was reinforced upon the mind
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