KALI PHOSPHORICA IN SUPPURATIVE OTITIS.

BY HENRY C. HOUGHTON, M.D.

This remedy has proved of great value in my hands in suppurative inflammation of the ear when marked by special objective symptoms; in fact we have no subjective ones to guide us, as there is no pathogenesis of the salts. I was led to its use by the study of Dr. Walker's translation of "Dr.. Schussler's Therapeutics." He states its indication under Section C. "In the muscle cells fatty metamorphosis. In the muscular juice, or myosin, putrid decomposition." Under Section A, "In the blood corpuscles, to rapid decomposition," and claims that it cures septic conditions, scorbutic bleedings, mortification, putrid-smelling diarrhoea, a dynamic typhoid condition. In the "Therapeutical Index," arranged by Dr. Walker, are found the following symptoms: "Breath offensive, fetid, tongue coated like brownish liquid mustard. Diarrhoea foul; also, if accompanying any other disease, with putrid evacuations. Dysentery with putrid, very offensive stools. Evacuations, putrid, very offensive smell. Intermittent fever, profuse, fetid perspiration, debilitating mastitis, if the pus is brownish, dirty looking, with heavy odor. Suppurations dirty, foul matter, with offensive odor. Toothache with easily bleeding gums."

It will be seen from the above that the dark color and offensive smell of the discharge are the characteristic features. I have used Potash in many cases having the above indications, and am gratified at the results obtained. In otitis external the epidermis is moist, crusts form and scale off leaving the canal red and shining, but a few days suffice to form similar crusts; the inner third of the canal and membrane is either filled or the walls abundantly covered with thick, dark colored pus, fetid and sometimes grumous or granulous; the tissues when cleaned are rough, easily bleeding or covered with small granulations. In otitis media the membrane

of the tympanic cavity takes on the same type and gives a purulent product free from mucus, the blood vessels rupture easily and slight oozing of blood will often follow the most careful cleansing with absorbent cotton, but if the ear is kept dry by daily use of the cotton, and the remedy given two or three times daily, a change for the better is soon observed.

A few cases are given as illustrative of its value:

A. H. B., September, 1880. A miss of thirteen years; has suffered for a number of years from suppurative otitis. Her father being a physician has given the matter his care, with relief of the symptoms, but lately the disease is making marked progress. Present condition: Right auricle normal, outer third of canal in fair condition, inner extremity covered with dark fetid pus, which flows from upper wall. M. T. intact but retracted and cicatrized, the upper edge of the M. T. and the upper wall of the canal near the membrane ulcerated and covered with fine granulations. Under Kali phos. three grains night and morning, the secretions of pus became laudable and bad odor disappeared; when such results are reached I give Silicia, three grains night and morning, and expect cicatrization.

Miss G. V.; age 9; October 13, 1880. Seven years ago had scarlet fever, and later measles; both ears suppurated and hearing failed; there has been more or less discharge ever since. Present state auricle normal: outer third of canal filled by crusts of damp epidermis, cerumen and pus, easily removed and very fetid. It was impossible to define the relations of the membrana tympani or inner third of the auditory canal. Hears test watch both ears. Eustachian tube closed. Tonsils large and irregular; Calcarea phos.

October 20th. Slight improvement; continue Calcarea phos.* November 13th. Not as well, more pus and odor increased, the orifice of auditory canal crusted and moist, Kali p.

December 1. Much improved; less accumulation in canal, dry crusts removed easily; the outlines of M. T. defined; perforation right and left anterior inferior quadrant.

The remedy was given till December 29th, when sickness kept me from business, and the patient was not seen till March 5, 1881;

there had been some degree of relapse, but on resuming the Potash improvement was evident, and the case gives every indication of a happy result.

Mr. J. R. A.; age 52. Had scarlet fever at seven or eight years of age, suppuration in both ears ever since. May 4, 1880, both canals in about the same condition; crusted at the outer extremity and covered with dark, offensive pus and granular, cheezy masses internally and upon the remains of the membrane. Until August 1, 1880, the patient received Mercurius vivus, and occasionally doses of Psorinum for relief of itching in the channels. Then Calcarea phosphorica or Sulphate till December 1, with occasional doses of Coffea for nervous symptoms. From December 1, 1880, to present date the Potash has been used with marked results; there is now very little discharge from either ear, the odor is seldom noticed by others, the tissues present a more healthy appearance, and the general health of the patient is better than for months.

Master A. A. S.; age 13. Had earache as a child; last attack nine months ago; two weeks ago his mother noticed a bad smell from the ear. May 7, 1881, present condition, R. M. E. closed by an accumulation of dark, offensive material, purulent and granular; removal of a portion exposed a cellular polypus which nearly filled the canal. An attempt at removal caused so much distress that the mother was given Alcohol to instill in the ear morning and night, and Kali phos. three grains night and morning was given for one week.

May 14. Much improved. Odor not noticeable. Removed the shriveled fungus and continued Kali po.

May 21. Tissues dry. M. T. irregular, scarred, the results of early suppuration undoubtedly; Concentrated petroleum instilled. No medicines given.

May 28. All right. As the hearing of the other was normal, or nearly so, the parents would not undertake treatment directed to the improvement of the power of the right ear.

In this case it may be suggested that the Alcohol played the more important part as a factor in the case, but it may be said that this would be an exceptional instance, for we know that the local effects of Alcohol, as shown by our German colleagues, is not

so rapid in its results, unaided by internal medication. The other cases cited show the effect of the salt in long continued suppuration, which I judge to be that of removing morbid conditions of the minute blood vessels, thus preparing the way for such a remedy as Silicea or Calcarea, which act upon bone, periosteum ⚫ or other fibrous tissue; whatever hypothesis we may adopt we shall be glad of any remedy which helps to a cure.

RELAXATION OF THE MEMBRANA
TYMPANI.

BY J. H. BUFFUM, M.D.

The importance of proper tension of the tympanic membrane will at once be conceded by all who have given the matter attention. If there is not sufficient tension of the drumhead in whole or in part, we lose at once clearness of sound perception from the confusion of the vibrations, inasmuch as we must have different portions of the membrane responding differently to the same sounds, according to the variation in the tension. Where there is a relaxation of the whole drumhead, we may have entire loss of receptive power for sound vibrations, and consequently loss of hearing power from disturbances in its chain of conduction.

Change in position of drumhead as a result of its relaxed condition may, and frequently does, result in adhesions of the membrane to different parts of the walls of the tympanic cavity. These adhesions, with resulting change in the position of the manubrium mallei and consequent disturbance of its tension existing in the chain of bone conductors, must occasion impaired hearing, as the force of the vibrations are deviated from their natural channel. Again, the change in the position of the handle of the malleus, either from want of support or retraction, we have resulting with the imperfect conduction, unequal pressure upon the stapes and tinnitus.

While this condition has been recognized by aurists, little attention has been given to it or its treatment. I believe, however, the affection should be more definitely defined, and should not include cases of retracted membrane, although possibly arising from the same causes as those of relaxed membrane. Again, I believe that many of these cases are confounded with those cases of loss of hearing arising from tubal paralysis; that it is a condition which accompanies the latter affection, I am willing to admit.