canal. I have seen many cases of abscess and the most severe inflammation due to endeavors to clean the ear with the omnipresent hairpin and other objects used for this purpose. The use of cotton in the ear in general is to be condemned. It produces an artificial condition in the outer canal of the ear which reduces its physical resistance and makes it more liable to injury from exposure. The ear is sometimes injured by the entrance of cold water. This happens occasionally during ordinary bathing, but more frequently in outdoor bathing and in swimming. In surf bathing, where the water is thrown up with considerable force, it is much more liable to enter the external orifice of the ear, and severe inflammation may originate from this cause.
Salt water has been claimed to be more injurious than fresh, but my personal experience leads me to believe that it is more a question of temperature than of the quality of the water. Some years ago a large reservoir was built by an educational institute near this city, the water, which was quite cold even in summer, being supplied by an artesian well. The tank was used for bathing purposes, but earache soon became so frequent among the boys that the use of the reservoir for this purpose had to be entirely abandoned. In ordinary bathing, the entrance of water into the ear can easily be avoided. In swimming or surf bathing it is advisable to use a pledget of lamb's wool to close the opening of the ears. Ordinary cotton soon becomes saturated and is of no use in this connection, but the wool, which is slightly oily, forms an excellent protection in these cases.
The "running ear" is a diseased condition which should not be tampered with by the inexperienced, but which should not be neglected. The old idea that the child will outgrow it, or that it is a secretion of the head which if interfered with would prove dangerous, has been fruitful of many cases of deafness and even more serious complications.
Another condition to which I would call your attention is the incipient development of deafness in children. Where the capacity of hearing is quickly lowered from the normal to fifty per cent, it is so striking that the patient is much distressed and even confused. But when this change takes place insidiously from day to day, it is frequently not observed by either the patient or those around him until it has greatly advanced. Children thus affected hear only with difficulty and by straining certain small muscles of the ear, which soon become fatigued, and the child becomes listless and inattentive. I have seen numerous cases in which children have been severely punished for inattention, when this was due to defective hearing. Watchfulness and early attention in these cases will frequently prevent the more serious forms of deafness.