Poisoning due to mobilization of lead from the skeleton by leukaemic hyperplasia of bone marrow.

infection from entering from the meatus, are of paramount importance, and call for the use of a unique antiseptic. The incision in the tympanic membrane is done under a general anaesthetic and with good illumination of the drumhead. It is made from below upwards in the most bulging portion of the posterior half of the drum, and may extend beyond the pars tensa of the drum into Shrapnell's membrane. A wick of sterile gauze, which is kept moist with the antiseptic of choice, is placed in contact with the incision in the drum to serve as a drain. Chronic Suppuirative Otitis Media.-No consideration of ear disease in children would be complete without reference to this condition, which is still too frequent among our school-children. Not uncommonly it is already of some years' standing when the child arrives at the age for attending school. The parents may not have sought advice for what in their opinion was a trifling complaint, and as a result of repeated infection from the external auditory meatus the disease, even at this early age, may be deep-seated and associated with osteitis in the " honeycomb " of the mastoid air cells. It is worthy of repetition that, in these untreated cases, if it were not for the secondary infection from the outer ear, middle-ear inflammation would lose half its significance. In the course of numerous operations done for chronic suppuration in children it has been my experience that the destruction of the bone of the mastoid and the delicate middle-ear structures is usually greater at operation than had appeared to be likely. It is frequently our custom to persist for years in various kinds of conservative treatment, in the hope that these, added to increased general resistance to disease acquired with the years, may tip the balance in favour of resolution of the chronic inflammation. I am of the opinion that no benefit to the patient's hearing is likely to follow from delaying operation after five years of conservative treatment has been tried without cessation of the discharges. Healing may occur after some further years of treatment, it is true, but these years of ulceration in the middle ear and mastoid cells will have taken their toll of the delicate hearing mechanism. With the healing an increased amount of scar tissue is laid down; fixation of parts which should move is more prominent, and increased deafness is the result. Prolonged toxaemia from the chronically inflamed bone may have permanently affected the sensitive end-organ in the labyrinth, ard may have laid the foundation for an even more resistant deafness. An operation performed on those patients before leaving school would save much time spent -in dispensaries in later years; and, what is more important, would reduce considerably the incidence of deafness among our adult population. If a modified radical mastoid operation (modified to preserve the middle-ear structures and the hearing) is followed by the same careful conservative treatment which these children get before operation, a better-hearing ear is usually the result in a few weeks. Improvement in hearing must not be sacrificed for early cessation of discharge. The latter takes place usually within a matter of months. The mental brightening and physical benefits in school-children which so often follow a modified radical mastoid operation for chronic suppurative otitis media make the operation one of the most satisfactory to both patient and surgeon.