in. The hearing
may be slightly or seriously impaired. Such patients are not accepted by
life insurance companies.

Treatment.--Cleanliness of the parts and perfect drainage must be secured.
Syringing with one to fifty carbolic acid solution (acid one part, warm
water fifty parts) is good treatment. The opening in the drum should be
made large enough to give free discharge to the pus in the middle ear.

The patient's strength must be built up if necessary.

INFLAMMATION OF THE MASTOID' CELLS. (Acute or Chronic Mastoiditis).--This
disease represents one of the most serious terminations of an acute or a
chronic suppurative inflammation of the middle ear. This is fortunately a
comparatively rare event. There are, however, quite a good many cases of
this terrible disease.

Causes.--It occurs as a primary or secondary disease. The first condition
is rare and the result from injury, exposure to cold and dampness, or from
syphilis or tuberculosis. Secondary disease is catarrhal or pus-like in
form. This results from an extension of middle ear disease through the
antrum, as a rule. The disease may develop at any time and endanger the
life of the sufferer.

Symptoms.--Dull constant pain behind the ear and tenderness on pressure,
more severe at night, the tenderness is very apt to be followed in a short
time by redness and swelling of the skin in the same region. The pus may
drain from the mastoid into the middle ear cavity. If this does not happen
it may swell behind the ear and break through some other place. It may
involve the structures within the brain. If meningitis develops, the
patient has headache and later it becomes very severe. Lights hurts the
eyes, The patient is restless, sleepless, may have nausea and vomiting and
a constant high temperature. The neck is stiff and rigid. If there is more
brain involvement (phlebitis) there will be sudden rise of temperature,
followed by a rapid fall of temperature and attended by profuse sweating
and chills,--a dangerous condition. There can be abscess of the brain
also. In abscess of the brain symptoms are less severe and localized; the
rigid neck and fear of light and vomiting are absent.

[366 MOTHERS' REMEDIES ]

Treatment.--If seen early it may be aborted. If an examination of the drum
shows bulging, an incision of the drum head should be made. If an opening
is there it should be enlarged, if necessary. Cold applications are
valuable and should be applied directly