The author advises a complete amputation of such underdeveloped ears, since a better and firmer seat of attachment is offered thereby to the prothesis to be worn over it, at the same time giving the artificial organ a better position in reference to its normal relation to the face. An irregular stump makes this more or less difficult, as in the case just referred to, but even these patients are loath to part with an irregular ugly mass of tissue they consider themselves thankful to be born with. The auricular prothesis used in this case is shown in Fig. 125, and its position and appearance when placed on the stump is shown in Fig. 126. Another, showing both anterior and posterior surfaces, is given in Figs. 127 and 128. The fistular conditions mentioned should be thoroughly dissected out and healed from the bottom when practical by antiseptic gauze packing. Those involving the middle ear require special treatment that cannot be included under plastic procedure. MACROTIA Abnormal enlargement of the ear is often found in the idiot, but is commonly seen as a hereditary defect in many without having the least relation to the mental development of the person. These conditions occur more frequently in men than in women. Enlargement always depends upon overdevelopment of the cartilaginous structure of the auricle, and may also be the result of direct violence, the result of blows upon the organ, as in prize fighters, football players, and other athletes. Following violence the auricle undergoes either an acute or chronic hypertrophy of the chondrium, resulting in the condition known as the “cauliflower ear.” Again, there may be hematoma occasioned by direct violence, termed othematoma traumaticum, or a spontaneous development of such hematoma without any appreciable injury, as found in the insane. In the latter form the disease appears suddenly without warning or inflammatory manifestations, the hematoma reaching its full size in three or four days, after which a passive resolution in the form of absorption of the tumor takes place associated more or less with an organization of the blood mass, and leaving the auricular appendage unduly enlarged, distorted, and thickened, with here and there islands of seemingly detached or displaced cartilage firmly adherent to the overlying skin. Early in these cases much can be done by the application of external medication, depletion, and pressure bandage, and the removal of the effusion producing the swelling and lying between the perichondrium and the cartilage, by the introduction of a trocar cannula or by incision, as may be required. The union between cartilage and perichondrium is always slow, requiring about three weeks in the traumatic variety and often months in the noninflammatory form. Be the enlargement due to whatever cause, the patient not infrequently presents himself for a correction of the deformity.