I am not unmindful of the diversity of opinion among otologists as to the essentials of treatment of an acute inflammation of the middle ear; and in giving my personal opinions, based on considerable observation and experience, it is possible that I shall advocate some measures which may seem somewhat radical and not thoroughly approved by some of you. It is gratifying to know, however, that the trend of medical teaching to-day is in favor of more radicalism in the treatment of acute middle-ear inflammations and that the so-called conservative treatment, in the management of these cases, is considered by most progressive otologists as carrying with it a decided element of danger.
Most authors divide acute inflammation of the middle ear into two forms, the catarrhal and the purulent. Clinically, the two forms should be considered as different stages of the same disease, the difference in the character of the