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will probably seldom arise. ' * A few words will convey what is meant by the proper and improper treatment of acute inflammation of the middle robaxin generic ear. In the majority of cases, ordinary antiphlogistic measures, as applied to any acute inflammation else- where in the body, will ameliorate the disease, but * robaxin 750 mg Read at a meeting of the Society for Medical Progress of New York, February 9, 1898. we frequently find that septic fluids have robaxin 500mg tablets been in- jected into the acutely inflamed ear, or generic robaxin oils instilled which, as soon as perforation of the drum mem- brane occurs, give rise to secondary infection and mastoid involvement. When pus has formed in the tympanic cavity and Nature is not prompt in evacu- ating it, paracentesis should be performed without further delay. This operation should be done under strict antiseptic precautions. A safe rule to follow, in robaxin 500 the treatment of acute non -perforative suppurative otitis media, is to regard robaxin canada the condition as we would an acute abscess elsewhere in the body and treat it in the same way, i.e., by early evacuation and drain- age. Possibly, during the past few years, otology has been placed more upon a scientific basis by the increased recognition of this cardinal principle than by any other method of treatment. Without exhaustively entering into all the details of mastoid disease, it is the object of this paper to outline, in a general way, some of the points neces- sary to a proper appreciation of mastoiditis and its successful treatment. It is practically impossible to determine the percentage of frequency of involve- ment of the mastoid in relation to the number of cases of both acute and chronic suppurative otitis media. Since the severe epidemic of influenza sev- eral years ago there has been a large increase in the number of cases. From the topography of the tem- robaxin mg poral bone in children, with its numerous sutures and fissures, we find mastoid involvement to be much more frequent in young people than in adults. This is due not only to the anatomic peculiarity of the parts but also to the fact that frequently there exists in children a purulent discharge from the ear, which is not recognized until, from auto-infection robaxin brand name and ex- tension of the morbid process, severe symptoms, such as meningitis or sinus thrombosis, are manifested. purchase robaxin Mastoid disease may be divided into two classes, robaxin 1000 mg primary and secondary. True primary mastoiditis is rare, generally being due to traumatism of the robaxin 500 mg parts. Beginning as a periostitis with damage to the overlying soft tissues, we later find the disease extending inward, osteitis and necrosis of the body of the bone resulting. This form may also be due to exposure, tuberculosis, or specific disease, in the last instance following the development of gummata. Recently a number of observers have studied this acute form and have elucidated many new and valu- able points. Sheppard, in robaxin 750 a very robaxin high extensive review, Digitized by Google 578 CONSIDERATION OF MASTOID DISEASE. [Medical News collected 114 cases, giving the history as generic for robaxin far as as- certainable in each, and thus throwing much light upon the subject. The common habit of indiscriminately blowing a so called antiseptic powder into the auditory canal or middle ear is productive of much harm, the pow- der becoming impacted and preventing the discharge of robaxin euphoria the purulent material so that retention of pus with all its disastrous consequences results. Syringing the diseased ear, unless performed with much care and always under proper illumination, is to be con- demned. It is a good rule, and one which should always be observed, that no instrument or solution should be applied to the tympanic cavity unless the parts are under the direct control of the eye. Galette, in a recent article, conclusively shows that mastoiditis following acute tympanic suppura- tion is always due to secondary infection; therefore, it will be seen that the study of the etiology and prophylaxis of mastoid disease is in reality a study of middle-ear suppuration, and from the hygienic point of view the proper aseptic treatment of the latter affection alone will prevent the occurrence of a great number of mastoid cases. Gelle and Luc, from robaxin generic name an exhaustive study of a large number of mas- robaxin 75 mg toid cases, arrived at the conclusion that direct in- fection may occur without middle-ear involvement. Bearing in mind the sequence of events conse- quent to osteitis elsewhere in the body, we find that inflammation of the mastoid presents nothing un- usual. At first there is an increased vascularity of the soft tissues lining the pneumatic cells, the lining membrane becomes thickened, and the bone shows inflammatory robaxin 500 mg muscle relaxer invasion. This process may cease, robaxin 550 mg res- olution taking place, or, if it continues, new osse- ous tissue is produced, causing the cells to become reduced in size with obliteration of the diploic spaces. Finally, a complete obliteration of the pneu- matic spaces occurs, the bone becomes sclerosed and ivory- like in consistency. In other cases, from the extension of pathogenic organisms from the mid-

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