OTITIS INTERNA. 203 
dening, causes the poor victim to shake his head violently, rub his ear on the 
ground, utter sharp, shrill cries, and often run about and otherwise act as 
though delirious. When the affected ear is examined he shrinks under the 
touch, and likely endeavors to break away, so great is the tenderness. 
The passage to the ear may not at first seem affected, but generally it soon 
becomes more or less reddened, quite swollen, and hot and dry to the hand. 
There are also signs of disturbance of the general system, as a hot nose, 
fever, rapid pulse, thirst, and entire loss of appetite. 
The painful symptoms usually persist four or five days, although in occa- 
sional cases death soon occurs from meningitis, caused by extension of the 
inflammation in the ear to the brain. Sometimes the victim dies during an 
attack of convulsions. 
If the sufferer lives, fluid exudes within the middle ear, and in the course of 
four or five days bursts through the drum membrane, and makes its way out 
through the external ear passage. 
This discharge, yellowish and streaked with blood, becomes purulent; and 
although odorless at first, in three or four days it is highly offensive. 
After an opening has been made in the drum membrane and a discharge 
occurred, the pain speedily subsides, together with the signs of general disturb- 
ance. In most cases that discharge keeps up for two or three weeks and then 
disappears, and the opening in the drum membrane closes and heals; but this 
happy result is rare indeed. Asa rule the injury is permanent, the hole in the 
membrane remains, the small bones of the ear are attacked and destroyed, and 
other delicate structures become diseased beyond repair; and, although the 
victim may live for years and keep in apparently good condition, very generally 
the habit of shaking his head continues to his death; there also persists a highly 
offensive odor about the ear, notwithstanding there may be little or no external 
discharge. 
Much less often the disease of the structures of the internal ear gives rise to 
an abscess at the back of the ear. In these cases the usual signs of an abscess 
appear upon the surface, as swelling, tenderness and fluctuation on pressure. 
During an attack of otitis interna, in consequence of the severity of the 
symptoms, the general system suffers severely, the victim is soon weakened, and 
there is notable loss in weight or decided emaciation. 
The results of internal treatment are never highly satisfactory in this disease, 
because relief of the pain is the first requirement, and that is difficult, owing to 
the peculiar resistance of dogs to the action of opiates. 
Cocaine in a five per cent solution should be tried, ten drops being dropped 
into the affected ear, and the head held firmly for a few minutes, to prevent it 
being thrown out, or the finger used to plug the ear. Or, better still, by means 
of a glass dropper, which can be obtained from any druggist, take up about one- 
fourth of a teaspoonful of the cocaine solution, gently enter the tip of the 
