THE VALUE OF COUNTER-IRRITATION IN THE 
TREATMENT OF CERTAIN AFFECTIONS 
OF THE MIDDLE EAR. 
By ALBERT H. BUCK, M. D., 
New York'^TtyT""* 
A sense of confidence that a certain drug or remedial procedure 
will produce a given effect, affords the practicing physician the ut- 
most satisfaction. In the comparatively short list of aural remedies 
and remedial procedures there are very few in which this degree of 
trust may confidently be reposed, and, among these few, counter- 
irritation does not at the present time hold a very high rank. It is 
true that the older authorities—for example, Wilde and Toynbee — 
advocated the employment of counter-irritation in the treatment of 
various aural diseases, and from their day to the present time it has 
been the almost universal custom to apply blisters behind the ear for 
all sorts of aural affections. In fact, there are not a few general 
practitioners who make a regular practice, in all cases in which their 
advice is sought for the relief of deafness, tinnitus, or any other aural 
symptom, of first syringing the external auditory canal, and then, if 
that fails, of blistering the skin throughout an extensive area around 
the ear. They make no serious effort to ascertain the real nature of 
the disease, and employ these two procedures in a perfectly haphazard 
manner. I am disposed to believe that the frequent observation of 
the barren results following this practice of indiscriminate blistering, 
influenced many of my fellow specialists, as it did me at one time, to 
consider this uncomfortable therapeutic procedure as well-nigh impo- 
tent to relieve a single one of the aural affections for which it is so 
often used. It is also probably for the same reason that so little is 
said about the use of counter-irritation in almost all of the treatises 
on otology which have been published since the time of Toynbee and 
Wilde. My own experience during recent years leads me to place 2 
a higher value upon counter-irritation than I was at one time willing 
to concede to it; and, from conversations which I have held with 
some of my colleagues, I think I am justified in saying that this 
opinion of the value of counter-irritation in certain forms of disease 
of the ear, is that held by not a few of the aural specialists of this 
country. 
The class of cases in which I find counter-irritation particularly 
useful comprises all those in which the vessels of the middle ear and 
immediate neighborhood remain more or less gorged with blood long 
after the disappearance of pain in the affected region. This passive 
congestion of the middle ear is observed in its simplest and most 
easily controlled form in the later stages of an acute catarrhal inflam- 
mation of the middle ear, and is then often associated with a free 
exudation of serum or mucus in the tympanic cavity. It is observed 
in a more obstinate form in a few cases of chronic catarrhal inflam- 
mation of the middle ear, associated with, and apparently dependent 
upon, a high degree of congestion of the naso-pharyngeal mucous 
membrane. In the treatment of cases like these counter-irritation 
often proves of decided value. I would not go so far as to say that 
we can depend upon its curative efficacy alone, but would simply 
claim for it the power to materially enhance the good effects of the 
naso-pharyngeal treatment. In some cases even I have noted the 
fact that, despite a prolonged course of naso-pharyngeal treatment, 
and a systematic employment of Politzer’s method of inflating the 
middle ears, no demonstrable diminution in the quantity of the exu- 
dation in the tympanic cavity, or in the degree of congestion of the 
manubrial and peripheral blood-vessels of the drum membrane, took 
place until after counter-irritation in the mastoid region had been 
practiced systematically for a longer or shorter period of time. 
In infants and young children sufficient counter-irritation may 
usually be obtained by painting the skin over the mastoid process 
once or twice daily with two or three coats of the tincture of iodine. 
As soon as decided soreness is produced, the skin should be allowed 
to remain quiet for three or four days before the applications are 
resumed. From the progress of the case it will be an easy matter to 
decide how long this mode of counter-irritation should be kept up. 3 
In adults it is also sometimes possible to produce a sufficient degree 
of irritation of the mastoid integuments by means of the tincture of 
iodine, but as a rule it is better to resort at once to the application 
of the ordinary Spanish fly blistering plaster or of Squibb’s canthari- 
dal collodion. I prefer the latter, and usually apply at least three or 
four coats to the skin behind the ear, taking the precaution — and 
this is an important part of the procedure — to cover well the freshly 
painted skin with a piece of rubber plaster. If Husband’s plaster or 
ordinary court plaster be used instead, care must be taken to keep up 
slight pressure over the part for a few hours, or we may fail in our 
efforts to produce an actual blister. It is not necessary to apply a 
blister larger than one and one half inches by five eighths of an inch. 
It is also advisable not to apply the blistering material later than two 
or three o’clock in the afternoon, as from five to seven or eight hours 
are usually required for the formation of a well-marked collection of 
serum. When such a sac has formed, its contents should be evacu- 
ated, as much of the dead cuticle should be removed as may be pos- 
sible, and the raw surface should be dressed with vaseline or with 
simple cerate. For so long a period as may be found necessary, a 
fresh blister should be applied on every fifth or sixth day, according 
to the condition of the skin behind the ear. So far as I can remem- 
ber, I have never applied to one and the same mastoid region a 
series of more than six or seven blisters. By that time either I have 
found that the evidences of congestion of the middle ear had dis- 
appeared, or I have lost faith in the efficacy of the procedure to pro- 
duce the desired effect.