To remove impacted wax, the same baking soda (bicarbonate of soda) is the best preparation to use. A teaspoonful of the soda should be mixed with just enough warm water to dissolve it; this should then be dropped into the ear until it is filled, and allowed to remain in contact with the wax for five or ten minutes. It is to be repeated three times during the day; and then the ear should be thoroughly syringed with a quart of hot water. No other syringe than the fountain douche should be used.
For ordinary purposes a good douche can be extemporized from an old quart bottle by attaching a convenient length of rubber tubing to its mouth, and, filling the bottle full of the hot water, invert it and allow the water to flow through the tubing into the ear.
Other forms of deafness are too deeply seated to be dealt with by any one but a specialist.
The earliest symptom of beginning deafness in many cases is a ringing sound in the ears. Many patients describe it as a noise all through the head rather than in the ear itself. It is at first intermittent and occasional. The ringing may be present for some time, scarcely perceptible, when suddenly the sound will change, becoming much louder, and the note jumping high up in the scale, where it will continue to ring quite loudly for some minutes, and gradually die away, to appear again some time afterward. It may reappear in a few hours, as the trouble with the ears progresses. Ringing in the ears may also be the prelude to an acute attack of earache; but it is here followed very soon by pain, which so predominates over the ringing that it is no longer heard.
If the hearing is properly tested just as soon as the ringing in the ears has become more or less constant, some degree of deafness will be detected. As the case progresses, even before all the so-called superfluous hearing has been destroyed, the patient will realize that he is becoming deaf. For this condition there is nothing to be done by the patient himself. Advice from a physician should be obtained just as soon as diminution of hearing is suspected.
Much can be accomplished, however, by the patient toward preventing the deafness becoming worse. Careful attention should be devoted to the general health, to keep the nose and throat in as healthy condition as possible—to prevent "taking cold," especially colds in the head. Exposure to changes of weather should be avoided; the feet never being allowed to become wet, or, if they do become wet, the shoes and stockings should be changed for dry ones as soon as possible. Turkish baths and plenty of outdoor exercise are strongly to be recom-
