due to gonorrhea, and one-tenth to the carelessness of the doctor or midwife when the child is born. Other causes of blindness are trachoma, syphilis, the poisonous effects of wood alcohol, tobacco, and lead, uncorrected errors of refraction, injuries, and inflammation due to pus organisms. The blindness of the new born is due to infection received from the birth canal of the mother, and for this reason a few drops of a 1 per cent solution of nitrate of silver (4 grains of nitrate of silver to 1 ounce of water) or a 10 per cent solution of argyrol (see p. 87) should be dropped in every baby's eyes as soon as it is born, except in cases where it is positively known that no infection of the birth canal of the mother is present. The eyes should first be cleaned with a solution of boric acid, a separate piece of absorbent cotton being used for each eye; the lids then carefully separated and one or two drops of the silver nitrate or argyrol solution placed in each eye between the outer ends of the lids, which should be separated so that the solution may enter the space between the eyelid and the eyeball. Care must be taken not to touch the delicate membrane of the eye with the eye dropper. Only one application of the solution is necessary.

Trachoma.-Trachoma is a chronic infectious disease of the lining membrane of the eyelids, communicable to others by means of towels, handkerchiefs, fingers, or other articles which transfer the infected discharges from the eyes of those suffering with the disease. It may begin as an acute inflammation, but more often its onset is insidious, and the patient may not be aware of its presence for some time. The lining membrane of the eyelids become thickened, the eyelid is heavy, and drops over the eyeball. In severe cases the patient shuns the light on account of the pain it causes. If the lids are everted, a number of small granular bodies, resembling sago grains, will be noticed. There is also a mucopurulent discharge present, more abundant in some cases than in others. The disease produces a roughened condition of the inside of the lid which irritates the front of the eyeball, causing an inflammation of that structure which often leads to blindness.

Prevention.-The disease occurs among Indians and persons who live in the mountains of Connecticut, Tennessee, and Virginia, or who dwell in the thickly populated portions of large cities; in fact, it is prevalent among those persons who have not the conveniences to live properly. To prevent its spread, each member of the family should have his own towel, handkerchief, and wash rag. The wash basin should be scalded, if used by more than one individual, after each washing. No person should sleep with another who has trachoma, or on a bed that has been slept in by such a person. Children with trachoma should not be allowed to go to school until cured. The patient should place himself under the care of a physician and strictly follow his directions

EARACHE.

The ear consists of three portions—the external, middle, and internal ear. The middle ear is a little cavity which communicates with the nose by a small tube. It is situated at the bottom of the ear canal from which it is separated by the eardrum. Pain in the ear is usually caused by inflammation of the lining membrane of the middle ear. This becomes swollen and the tube leading to the nose is blocked up, which results in an accumulation of fluid in the middle ear cavity. The pressure of this fluid causes pain, which is not relieved until the tube becomes open or the eardrum ruptures, allowing the fluid to escape through the ear canal. This inflammation often follows cold in the head and it is much more likely to occur if there are adenoids, large tonsils, or other obstruction of the nose which renders the free passage of air difficult. Acute catarrh of the ear also frequently accompanies scarlet fever, measles, pneumonia, smallpox, typhoid fever, and tuberculosis.

Symptoms.—Pain may be entirely absent in catarrh of the middle ear, but it is usually very severe. The patient also complains of fullness in the ears, dizziness, and deafness. A baby or child will often pull at its ear as if it felt some obstruction in the ear canal. Whenever a baby appears sick and the cause has not been ascertained it is well to think of earache. Touching or gently pulling on the ear makes baby cry out with pain. On account of the warmth it usually prefers to lie with the affected ear against the pillow. There is generally a rise of temperature, but this is not always the case. The pain is relieved when the eardrum ruptures and there is a discharge of serum and pus from the ear canal.

Prevention.-Adenoids and large tonsils should be taken out. The inflammation of the lining membrane of the nose should be treated and bony processes or other obstructions in the nose removed. Children should sleep with the windows open at night, and if they are strong and robust cold tub baths should be given in the morning upon arising. A child should not be permitted to play with children suffering from colds and in the wintertime should be kept out of street cars and other crowded places where the danger of infection is greater.

Treatment.-Heat should be applied to the ear, either by means of a hot-water bottle or by hot cloths. The applications should be continued for half an hour and should be renewed every two hours. During the intervals between the application of heat the ear should be kept warm. A warm solution of carbolic acid and glycerin should be instilled in the ear-a few drops every two hours. Care should be taken to see that the drops run into the ear canal and are not merely deposited on the outside of the ear. The carbolic acid and

glycerin mixture is made by thoroughly mixing 1 dram of carbolic acid with 7 drams of glycerin. Half a grain of Dover's powders or four drops of paregoric may be given to a child 1 year old, and proportionate doses for children of other ages. The opiate should not be renewed unless the pain is severe. The child's bowels should be kept open by giving it a small dose of salts or castor oil.

Accumulation of wax in ears.—Wax is secreted by numerous small glands in the auditory canal. In health it disappears by evaporation or is forced out by the movement of the jaws. In adults, and less often in children, the wax accumulates in the ear and forms a hard plug. This is most likely to happen after water or soap has entered the ear or in persons engaged in greasy and dusty occupations. Picking the ears with pins sometimes causes slight inflammation of the skin with exfoliation of epithelium, which, mixing with the wax, forms a plug. The impacted wax causes deafness, but no other symptoms unless it presses against the eardrum, when it may produce pain, vertigo, vomiting, and general nervousness and irritability.

Treatment. The wax may be softened by dropping into the ear a few drops of a solution of glycerin and water, half an ounce of each, to which 20 grains of bicarbonate of soda have been added. After this has been used a day or two several drops of peroxide of hydrogen may be placed in the ear and the ear then washed out with -warm water containing a teaspoonful of bicarbonate of soda to the pint. The stream should be thrown well into the opening of the canal, but without much force, as otherwise fainting may be produced or the eardrum injured. The washing out the ear canal is sometimes effective without the preliminary use of the ear drops.