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PROCEEDINGS OI SOCIETIES. [N. Y. Med. Jode.' irritating healing powder be applied in a finely divided state so as to lie upon the surface in a thin film. If there were poljpi, they should be removed with the sharp curette, and granula- tions should be treated with astringents. Buy Levitra With Dapoxetine The author also re- lated some cases of catarrh of the middle ear, which he spoke of as being either acute, subacute, or clironic. Dr. 1). B. St. John Roosa opened the discussion with an earnest appeal for the more general recognition of ear diseases in children in the early stage. Treatment by such simple meth- ods as had been employed by the author of the paper would tend greatly to diminish the statistics of deaf-mutism, of bad hearing, and of facial paralysis which sometimes re.sulted in neglected cases. It was true that a large percentage of cases of disease of the ear in childhood ended in recovery in spite of the fact that tliey either got no treatment at all or only that which was unintelligently employed. But there was a featfnl con- tingent wliich did Buy Levitra With Dapoxetine badly. There could be no difference of opin- ion as to the general principle of treatment by olsanliness and astringents, with attention to the naso-pharynx. There was no organ in the body more susceptible of immediate relief in the majority of instances than the ear. The treatment in the Buy Levitra With Dapoxetine main was local. Although every practitioner would have occasional- ly to regulate the skin, the bowels, the diet, etc.. Dr. Roosa did not believe that any " constitutional " treatment was of much value in these acute aural cases in children. Dr. Oken D. Pomekoy spoke a word in behalf of ihe general practitioner, who had been blamed for not early recognizing and properly treating cases of acute disease of the ear in children. The ravages resulting from otitis in childhood were not always susceptible of being arrested. In scai-let fever they often went on to the destruction of the hearing apparatus in a very short time. It was very difficult to see the drumhead in a child, es- pecially when the ear was in a state of acute inflammation. Lit- tle children were not capable of making their sufferings clearly known, and the physician might easily overlook the symptoms in the ear, as he had done even in his own family, until a dis- charge took place which could leave no doubt as to the cause of the pain. If it became necessary to open the mastoid it could be done in children without the drill ; a .sharp knife was the only instrument required. There might be a considerable se- questrum of bone in disease of the ear in children without de- struction of life. He had recently had a case in which the larger part of the temporal bone sloughed off and the meninges were left bare, yet the patient recovered. Of course there was facial paralysis. In proportion to the severity of the disease, tlie dan- ger to life was much less in children than in adults. It was a good Buy Levitra With Dapoxetine rule, when a child was suflering without any apparent cause, to examine the ear. Dr. Simon Bauuoh thought the arraignment of the general practitioner was deserved, judging from the small attendance at the meeting. If such a subject as disease of the api)endages of the womb had been announced, it would no doubt have been difter- ent. He thought one reason why cases of disease of the ear in childhood were not recognized by Buy Levitra With Dapoxetine the general practitioner at an early date was the fact that a common cause was scarlet fever, but the aural trouble did not become manifest usually until the period of desquamation, when the physician had relaxed his efforts or had ceased his visits altogether. Dr. Baruch now made it a custom to gently pull the ears, and by other means try to detect any symptoms of disease during the course of scarlet fever before perforation of the drumhead had taken place. Dr. Joseph A. Andkews thouglit that Dr. Buy Levitra With Dapoxetine Roosa's remarks did not apply alone to America, but to the whole world. This was evident from the remarks of those able to judge abroad. Dr. Andrews called attention to the fact that Buy Levitra With Dapoxetine the suture between the petrous and squamous portions of the temporal bone closed later than that between the mastoid and squamous portions, and might be one of the dangers to the young patient from spread of disease from the tympanic cavity to the meninges and brain. Only the day before, a physician had asked him to Buy Levitra With Dapoxetine see a patient in consultation to whom the parents had called him only a little while before. A few hours later the patient was dead. This was only one of those cases in which the physician was called too late to be of any assistance. So many children died of meningeal disease without ever having had their ears examined that it was impossible to say how often middle-ear disease .spread to the meninges. As to trephining the mastoid in these little patients, there was no evidence of mastoid cells until the end of the first Buy Levitra With Dapoxetine year after birth. The mode and propriety of operating were matters of dispute, and he would not now dis- cuss them. He regarded iodoform as injurious in acute inflam- mation of the middle ear, for it was not dissolved, and was very irritating. Boric acid was capable of accomplishing more good than any other medicinal application, both in acute and in chronic inflammation of the middle ear. Tannic acid was ob- jectionable also. Dr. Garrisu said many patients with chronic suppurative otitis were scrofulous, and required constitutional treatment. He also applied leeches and hot poultices, employed the douche, and further allayed ])ain by tincture of opium and almond- or sweet- oil. Dr. Laurence Johnson was convinced that such lessons as had been Buy Levitra With Dapoxetine inculcated in the paper would prove of benefit to the general practitioner, and, if obeyed, would diminish the number of cases of ear disease followed by deaf-mutism .and other evil consequences. In an institution in which there were only sub- acute or chronic cases of suppurative ear disease, he had in- structed the nurses to Buy Levitra With Dapoxetine donche the ears of the children. The nurses who had charge of the girls had carried out his instruc- tions, while who had charge of the boys had failed to do s'). At the end of some days tdl the girls manifested improve- ment, while no change had taken place in the condition of the boys. The douche was capable of doing harm if used too fre- quently ; he would not repeat it until after the boric acid em- ployed had become wet with the discharge. In acute cases he further controlled pain by the use of Buy Levitra With Dapoxetine morphine and glycerin, two or three drops of Buy Levitra With Dapoxetine solution of morphine to a drachm of gly- cerin. Dr. Leszynsky spoke of a case in which there were symp- toms of meningitis and no evidence of disease of the ear until after a discharge took place, when the other symptoms ceased- The child was old enough to Buy Levitra With Dapoxetine describe her sufferings intelligent- ly. In another case local treatment was of no benefit until after constitutional treatment had been adopted. Buy Levitra With Dapoxetine The subject was further discussed by several speakers. NEW YORK SURGICAL SOCIETY.