ear, it is rarely so severe as to give much annoyance, and little is thought of it by even the patient, until the hearing is impaired, or he is tortured with tinnitus. He will usually quiet any fears he may have before this time, by the thought that he has "catarrh," for which he believes there is no relief. Actual inspection will generally show an altered appearance of the membrana tympani, pointing directly to the affection of the

ear.

If the inflammation be subacute the membrana tympani will be congested, a leash of large vessels may extend along the handle of the malleus, quite to the centre of the membrane, while smaller vessels may reach toward the centre of the membrana tympani from all parts of its circumference. If several attacks have occurred, the membrane of the drum may appear of a uniformly dull red color, without distinct vessels.

In the chronic form of inflammation the membrane of the drum will have lost its lustre, and will be less translucent. Especially is this the case with children, in whom the disease has not progressed so far as to cause impairment of hearing, but who have had occasional earache."

Later when the chronic inflammation has lasted for several years, the hearing power will have become gradually less, and the patient will have to be very attentive to hear what may be said to him; if a child, it will become inattentive, apparently. The membrane of the drum now, may appear milk-blue in color, or white, thickened, and opaque, with its external concavity increased so much that the membrane seems almost to be wrapped about the ossicles of the middle ear, as the wind wraps the sails about the masts of a vessel. The cone of light, because of the variation in the shape and texture of the membrana tympani, may have disappeared either partially or entirely, or may be changed only in position on account of the change in its external concavity. On the appearance of the membrana tympani we thus have an index of what may be taking place within the middle ear.

Chronic catarrhal inflammation, which is most likely to follow the same affection of the nasal passages and pharynx, is

very insidious, and much to be dreaded, for though it may proceed slowly, yet, sooner or later, it will commonly be the result of the diseases of the nares and pharynx, and then unless properly treated, in time, will end in progressive impairment of the hearing.

What may be done to prevent these ill results?

Protect the nasal mucous membrane, that the air breathed may pass through its natural channels to the lungs.

If the mode of living could be changed in such a way as to modify the variation of temperature to which we are continually exposed, one cause would be removed, and the trouble in a great measure prevented. I know of no means by which this is possible, and as the acting cause cannot be removed, we must guard against its consequences, or, when the affection already exists, do what we can to relieve it. In view of this, it will be necessary to avoid as far as possible any exposure which may cause a determination of blood to this locality, by sufficient clothing, especially to the feet, keeping them dry and warm. We may then attend to the topical application, which may be soothing or stimulating, as the stage of the case requires.

In the early stages we should treat the local congestion by the usual means, unstimulating astringents and general derivatives. Astringents, even, are not always necessary for the same result may be obtained simply by affording protection to the mucous membrane against the stimulating action of the air, by a substitute for its natural secretion, and thus permitting the parts to resume their healthy condition. The turgescence of the vessels will diminish, the parts will become less sensative, a normal secretion will take place, the "stuffy feeling" will pass off, and the patient will breathe through his nostrils and keep his lips closed.

I have seen a number of cases, chiefly females, in whom. epistaxis had been an almost daily occurrence for years, relieved of their annoyance in this way. In these instances the bleeding could not be attributed to vicarious menstruation.

Among them was a woman, aged about 25 years, who came

to the Illinois Charitable Eye and Ear Infirmary, in this city, with catarrhal inflammation of the middle ears, which slightly impaired her power of hearing. The nasal mucous membrane was thickened, dry, and unusually red. She was anemic, and had a very delicate skin. Hemorrhage followed the use of the eustachian catheter, an unusual thing except in these cases, and those in which ulceration is present. She stated that she had been annoyed with nasal hemorrhage nearly every day for three years, that her nose felt sore all the time, and, to use her own language, "If this could be cured, I would be more than half well."

Discontinuing the use of the eustachian catheter, vasoline was prescribed to be applied upon the nasal mucous membrane, twice a day. As a result the nose is no longer sore, and the catheter is used every day without hemorrhage at

tending it.

The membrane has diminished in thickness, and the nasal passages are larger in consequence. A month has elapsed between the attacks of bleeding, and even when they occur, the amount of blood lost is small. Her general health has improved under tonics.

In conjunction with the treatment already indicated, inhalations of chlorate of potash and glycerine may be given with decided advantage, as the vapor exercises a soothing influence upon the whole membrane of the air passages. The heat and moisture of the inhalations clear off the secretions, while the chlorate of potash affects the mucous membrane here as elsewhere.

In cases where the irritability takes the form of itching, the scales of epidermis collect, and the lining membrane is dry, a combination of the subnitrate of bismuth, with vasoline (31 to 3i) forms an ointment, which acts better than vasoline alone in relieving the pruritus, and in removing the products of the desquamation.

In those cases in which the mucous membrane has become almost fibrous in its nature, very little vascularity remains, and to restore it the parts must be subjected to moderate and

repeated stimulation, just as in any other chronic inflammation. A very good method of stimulation is by means of air impressed with iodine, as thus the medication reaches all of that irregular surface, and does not, as would be the case with liquids, settle in the depressions, and unduly stimulate them while other parts would escape entirely.

When the circulation has been restored and repair begins, it is well to substitute, as before, something for the mucus which is yet lacking.

On motion, the paper was accepted and referred to the Publication Committee.

Dr. N. S. Davis.-Dr. Jones has two or three short papers. There is not time to hear them now. I move that they be heard to-morrow at half past ten o'clock, following Dr. Jewell's paper.

The motion prevailed, and the Society adjourned until 9 o'clock Thursday morning.

THURSDAY MORNING.

The Association was called to order by the President at 9 o'clock, and the Assistant Secretary, Dr. Earle, submitted the names of Dr. Herrotin, of Chicago, and Dr. J. T. Everett, of Sterling, Lee County, as proposed members. Referred to the Board of Censors.

Prof. J. Adams Allen submitted, on behalf of the Committee on Necrology, the following report in regard to the late Dr. J. W. Freer.

OBITUARY.

JOSEPH WARREN FREER, M. D., President and Professor of Physiology and Microscopic Anatomy, in Rush Medical College, died, at his residence in Chicago, April 12th, 1877.

He was born at Fort Ann, Washington Co., N. Y., on the 10th of July, 1816.

His father, Elias Freer, was of Hollandish descent, the ancestry being among the early Dutch settlers on the Hudson. His mother was of the Paine family-early settlers of New England. Both families have numerous representatives in the West, including many well-known and estimable citizens. His educational advantages were those of the common school,

until fifteen years of age, after which he attended for two years what was then termed a High School. At eighteen he entered the office of Dr. Lemuel C. Paine, then of Clyde, N. Y., as a pupil of medicine, and, in order to pay his way, attended the doctor's small drug store. During this period, he took a course of three months instructions in the French language, but the teaching being furnished by a New England lady, he afterwards found that he had scarcely become au fait in pronunciation.

In his nineteenth year, June 14th, 1836, he came to Chicago, where for a few weeks he was employed as a clerk in a dry goods store; then being seized with the prevailing anxiety to acquire land, he invested in a "mud claim" on Calumet river, about four miles from any neighbors, except Pottawatomie Indians. He remained there about two months, and, in the meantime, nearly died of filth, bad food, and ultimate sickness. During the latter he became unconscious, and in this condition he was carried back to Chicago, and received into the residence of Mr. John Dye, then standing on the corner of State and Clark streets. In the fall of the same year, his parents having immigrated West, he concluded to follow their fortunes. They settled on "claim land," at a place called Forked Creek, near Wilmington, Ill. There he remained until July 4th, 1846. During this time he formed several valuable acquaintances, particularly Hon. Richard L. Wilson, formerly editor of the Chicago Evening Journal, and Dr. Hiram Todd, to the latter of whom he was ever grateful for valuable advice, and the use of his excellent literary and scientific library. In later years he often spoke of Dr. Todd in affectionate terms, characterizing him as "a gentleman of the old school, of liberal education and culture."

Aside from incidental advantages of this sort, he had little opportunity to educate himself, for with the earlier settlers the material man demanded more than the moral or mental. Nevertheless, he did burn some midnight oil over a little Dublin Dissector, an ancient work on chemistry and sundry literary works, borrowed from his cherished friend, Dr. Todd.