508 PEDIATRICS 



and know very much less if a large majority of the cases were not 

 intrusted to them by the pediatrist, who recognizes the principle 

 that those who are best fitted to perform it should be trusted with 

 important medical work. So well is the seriousness and difficulty 

 of operative procedures, as connected with diseases of children, 

 recognized by experts, that 1500 pages of Gerhardt's handbook 

 are dedicated to external pathology and operations, and that spe- 

 cial works, besides many monographs by hundreds of authors, 

 have been written by such masters as Guersant, Forster, Bryant, 

 Giraldes, Holmes, St. Germain, Karewski, Lannelongue, Kirmis- 

 son, and Broca. 



Ear specialists recognize the fact that otology is mostly a specialty 

 of the young. The newly-born exhibit changes in the middle ear 

 which are variously attributed to the presence of epithelial detritus, 

 to the aspiration of foreign material, or to an edema ex vacua occa- 

 sioned by the separation of formerly adjacent mucous surfaces. Pus 

 is found in the middle ear of 75 % of the still-born or of dead nurs- 

 lings. It contains meconium, lanugo, and vernix. Aschoff * exam- 

 ined 50 still-born, or such as had lived less than two hours; 28 of 

 them had pus in the middle ears (55 %). He also examined 35 

 infants that had lived longer than two hours; 24 had pus (70 %). 

 Evidently the latter class had been exposed to a microbic invasion. 

 The diagnosis in the living infant is very difficult, mostly impossible, 

 on account of the large size of the Eustachian tube, which after 

 having admitted the infection, allows the pus to escape into the 

 pharynx and the rest of the alimentary canal. Many of the newly- 

 born that die with unexplained fevers perish from the septic material, 

 or its toxins, absorbed in the middle ear or the intestines. Nor are 

 older children exempt. Geppert (Jahrb. f. Kind., XLV, 1897) found 

 a latent otitis media in 75 % of all the inmates of the children's 

 hospitals. Both latent and known otitis is often connected with 

 pneumonia, or with pneumonia and enteritis. In individual cases it 

 may be difficult to decide which of the two or three is the primary, 

 which the secondary affection. 



The great vascularity of the middle ear, but still more the access- 

 ibility of the funnel-like Eustachian tube in the infant, renders 

 otitis media very frequent. Schwartze's assertion that otitis media 

 furnishes 22 % of all ear cases in general or special practice is surely 

 correct. Besides, difficult hearing is very frequent in the young, a 

 fact of the greatest import to pedagogy. As early as 1886 Bezold 

 found that of 1900 school-children 25 % had only one third, and 11 % 

 of the others only one fifth of normal hearing. The frequent affec- 

 tions of the nose and pharynx in the young explain these facts and 

 exhibit the possibilities of prevention. Finally, the immature con- 

 1 Aschoff, z. f. Ohrenh. vol. xxxi. 



