THE TRANSMISSION OF DISEASE BY THE MOSQUITO
Journal of the American Medical Association (JAMA)
chief to the structures of the middle or internal ear, or that the pain and discomfort incident to this process would offset the anesthetic qualities obtained, but practical experience has proven these fears unfounded. My first experiment with this method was done on a patient suffering from a left facial paralysis of seven months' standing; the left ear was filled with exúdate and almost deaf. The case is more fully reported by my friend, Dr. H. 0. Beik,1 who suggested a paracentesis of the
... acentesis of the drum membrane on the affected side for the relief of the paralysis. A jet of ethyl chlorid was allowed to play into the canal for some seconds and the incision was then made. With the exception of a slight burning sensation due to the ethyl chlorid nothing was felt by the patient, who was a very nervous woman. She almost completely recovered from her facial paralysis and her hearing returned to normal. Encouraged by this success, which demonstrated the harmlessness of the procedure, I have since used this freezing method on every available case that presented itself during my service at the above mentioned clinics and also in my private practice. In no instance was the subsequent course of the case any different from what might have been expected, had ethyl chlorid not been used. In my earlier cases, I used an ordinary ethyl chlorid tube held twelve to fifteen inches from the ear and allowed a jet of the liquid to play into the auditory canal through the previously inserted speculum. This had some disadvantages. One had no assurance that the drug actually reached the desired spot and hence anesthesia was sometimes imperfect; much liquid was wasted and more than necessary was injected, producing more or less pain and discomfort to the patient, and it was almost impossible to avoid getting some of the liquid on the face or even into the eye of the patient, unless previously protected by a towel. These disadvantages have been completely eliminated by a new nozzle especially designed for the purpose and made for me by the Gebauer Chemical Co. of Cleveland, Ohio. This nozzle is about two inches long, very slender and is attached to the metal container at such an angle as to permit a good view of the parts beyond when partly introduced into the speculum. The apparatus is held in the same manner as any ear instrument, the body of the container forming the handle and a very fine spray, not a jet, is easily directed to the desired spot ( Figs. 1 and 2) . In practice, I begin with an almost imperceptible spray, which I allow to play on the part, until the patient feels a certain degree of coolness within the ear, then very gradually increase the volume of the spray by slowly opening the valve, at the same time facilitating its rapid evaporation by means of a jet of air blown into the canal from a Politzer bag. With a little practice one soon learns to know how far it is necessary to carry the procedure in order to obtain a sufficient degree of anesthesia. For my part, I usually shut off the spray when the patient begins to complain of an aching sensation, "then blow in a little more air and operate; the whole procedure taking but a few minutes. A minimum amount of ethyl chlorid is used and none wasted, an item of some importance when dealing with such an expensive drug. In searching the literature on the subject I find 1. Reik: "The Relationship Between Otitis Media (non-suppuration) and Facial Paralysis of the Refrigeratory Types. Trans. Am. Otological Soc., July, 1904, p. 376. that Brieger2 mentions the use of ethyl chlorid for similar purposes, but up to the present time have not been able to get access to his paper and am not familiar with his method of application. In addition to the usual minor operations about the ear canal, such as paracentesis, incising furuncles, extracting polypi, etc., I have recently began to use ethyl chlorid in the manner above described as a preliminary to the application of Lucas's sound in the treatment of chronic otitis media and find it an ideal way to avoid pain, the one objectionable feature of that form of treatment. The results thus far seem to indicate a far greater percentage of markedly improved cases than I was able to obtain before introducing the preliminary freezing; however, further experience is necessary to more fully confirm this statement, and I shall take pleasure to report on the same at a future date. 449 East Twenty-second Street.