OTITIS INTERNA. 201 
This solution, after being slightly warmed, should be poured into the ear 
every five hours. The passage should then be filled with iodoform gauze, first cut 
in very narrow strips. 
As long as there is a notable gain it should be persisted in, but if improve- 
ment is not plain, a solution of double the strength should be tried. That is, 
instead of one ounce there should be added two ounces of the hydrogen perox- 
ide to a cupful of water. 
Some writers have recommended the introduction of iodoform powder or 
iodol in this class of cases. They would doubtless act fairly well if properly ap- 
plied, but when simply dropped into the passage, as many would use them, the 
effect would scarcely be more than to convert one bad odor into another equally, 
if not more offensive. Again, if the passage is much swollen and there is con- 
siderable discharge, the use of powders is not advisable, for they coat the sides 
of the canal and choke it up. However, if a solution of the peroxide of hydro- 
gen does not effect a cure, boracic acid powder may be tried as follows: 
Obtain an ordinary small blower such as is commonly used with insect 
powder. Draw over the tin tube two or three inches of the smallest soft rubber 
tubing that can be obtained. Introduce two or three teaspoonfuls of the powder 
into the blower, gently insert the end of the rubber tubing into the passage as 
far as possible, and then start the blower. By this means the powder will be 
forced to the parts most affected, and which it could not reach were it merely 
dropped in. 
Another very simple method of introducing the boracic acid is by means of a 
piece of small rubber tubing, about one foot in length, in one end of which has 
been inserted, for a short distance, a goose quill. The powder is taken up in 
the quill, which is then carefully carried into the ear passage as far as possible ; 
and when in place, the operator gives a short, quick blow through the tube, to 
free the powder from the quill. Then he blows steadily for a fraction of a 
minute, for the purpose of forcing the powder as far as possible into the ear 
passage. 
This method is Sewell’s, and he repeats the operation from three to six times 
at one sitting, as it is necessary to nearly fill the ear passage, taking up evi- 
dently only a comparatively small quantity of the powder at each dip of the 
quill. 
He has very great confidence in boracic acid in cases in which the discharge 
is copious, offensive, and purulent; applies it morning and night for a week, or 
until the discharge has materially lessened, and thereafter once daily until a cure 
has been effected ; and urges that by this treatment he has permanently cured 
cases of the very worst form that have existed for years. Time, patience, and 
care, however, are required, and in many cases the treatment must be persisted 
in for several weeks. Every day also before applying it the ear must be cleaned 
by syringing, and methylated spirit used in the operation, in the proportion of 
