Otitis media and mastoiditis occurring in infancy have long been recognized as most troublesome disorders and, of recent years, would appear to be receiving the attention they merit. The frequency of otitis media or otitis media and mastoiditis found both in the infants' wards and in the autopsy room of the Alder Hey Children's Hospital has led to this statistical and clinical enquiry into this common and frequently lethal occurrence.Of the 1,324 infants under one year admitted to this hospital during the year 1936, 195 (14 per cent.) suffered at one time or another from otitis media or otitis media and mastoiditis. In a certain proportion the ear infection was undoubtedly secondary to some other pathological process. The remainder were cases in which the ear infection appeared to be responsible for the child's illness and in which, in the majority, suitable treatment of the ear resulted in improvement. This latter and more interesting group is here called 'primary.' The difficulties of making such a classification will at once be apparent, and any case which seemed in any way doubtful has been included in the secondary group. The greatest difficulty was encountered in those associated with nutritional defect. A recent otitis occurring in an infant who had been under observation for some time for hypothrepsia or athrepsia was considered as secondary. A comparatively long history of otorrhoea or otitis and more recent failure to gain in weight was regarded as probably 'primary otitis.' Doubtful cases were placed in the group of secondary otitis. Some of these were perplexing.For example, a hypothreptic child was admitted with a history of insufficient feeding for the past five weeks. At first the tympanic membranes showed lack of lustre and nothing else. After two weeks, during which the infant was ill, fretful, pyrexial and vomiting, the tympanic membranes showed more definite OBSERVATIONS ON SECONDARY GROUP.-In the group associated with respiratory infections the greatest number of cases and the highest death rate (31 per cent.) occurs in the age group 3-9 months, while in the group associated with nutritional disturbance the greatest number occurs in the age group 0-6 months, i.e. the earlier months of life, with a death rate in this group of 45 per cent. In the group associated with nasopharyngitis, the greatest number is in the age group 0-6 months. The previous feeding of these children does not appear to influence the results noticeably. II. Primary otitis media and mastoiditisThe 'primary' group has been sub-divided as follows: (A) CLASSICAL MASTOIDmS.-This sub-group includes those instances in which the child was admitted with mild constitutional disturbance, a history of otorrhoea, evidence of pain in the ear shown by restlessness and rolling of head, with redness, swelling and oedema over the mastoid process, i.e. signs of exteriorization. There were seven such patients, among whom the other ear was involved in four.Treatment was by operation.(B) oTITs MEDIA AND LATENT MASTOIDITIS.-Here are included ...

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The high incidence of parenteral infection in infancy, however its r6le in the production of morbidity and mortality rates is interpreted, cannot be doubted. Many statistics are available in the literature. One of the latest surveys, for example, is that by Alexander and Eiser (1944) who found evidence of parenteral infection in 88-6 per cent. of their cases, the bulk of this infection taking the form of upper respiratory infection and otitis media. The common organisms were haemolytic streptococci, pneumococci and staphylococcus aureus. Parenteral infection is even more deadly in the premature infant whose powers of resistance are feeble. Inl Walton Hospital, Liverpool, evidence of parenteral infection has been found in one-third of premature infants coming to post-mortem examination. When penicillin became avilable for civilian use it was thought that parenteral infection in infancy might be a good field for its use and immediate steps were taken to test this possibility. A gift of a small quantity of penicillin was obtained and seven cases were treated. These are included in the series about to be described (group, A, no.

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In 1938 a survey of the incidence of otitis media and mastoiditis in infancy was published from Alder Hey Children's Hospital (McConkey and Couper, 1938). A clinical classification of such cases was suggested and conclusions were drawn regarding the relative merits of conservative and operative treatment. Simultaneously a second and more detailed investigation was in progress, with certain aspects of which this present communication is concerned.This second series consists of fifty infants under the age of one year, suffering with an illness characterized by otitis media (sometimes with mastoiditis), and varying degrees of diarrhoea and vomiting. More than half of these children were judged to be suffering from the so-called latent mastoiditis, i.e. they all suffered from otitis media but there were no external signs of involvement of the mastoid process. Four cases, presenting the classical clinical picture of mastoiditis, were also included. The question of diagnosis and treatment is one of great difficulty and importance and briefly resolves itself into two major problems (a) to decide if infection has spread to the mastoid process, and (b) to decide if operation is advisable, and if so, the best time for this treatment.In an endeavour to find some reliable indication of prognosis, of whether the mastoid antrum was involved or not, and of the optimum time for operation, a series of Schilling counts was performed on each case. There is a great mass of literature on the subject of these counts and their application to all sorts of conditions. For the present purpose it is sufficient to state that the Schilling count is a modification of Arneth's