Diagnosis and treatment of ear diseases . n. Death oc-curred from exhaustion. DISEASES OF THE EAR. 361 pus has already formed in them. If the tenderness, redness, and swellingare very marked, we may lean toward the belief that pus has alreadyformed, rather than toward that which implies a simple congestion. Tenderness on pressure and swelling in other parts of the head.—I haveobserved this symptom several times. In one case, for instance, the patientcalled my attention to a spot of marked tenderness on the very top of thehead. In the course of a few days a circumscribed swelling appeared atthi
Diagnosis and treatment of ear diseases . n. Death oc-curred from exhaustion. DISEASES OF THE EAR. 361 pus has already formed in them. If the tenderness, redness, and swellingare very marked, we may lean toward the belief that pus has alreadyformed, rather than toward that which implies a simple congestion. Tenderness on pressure and swelling in other parts of the head.—I haveobserved this symptom several times. In one case, for instance, the patientcalled my attention to a spot of marked tenderness on the very top of thehead. In the course of a few days a circumscribed swelling appeared atthis spot, and then very slowly the swelling and tenderness both disap-peared, though not until after the mastoid affection proper had almost gotwell. In several cases I have observed phenomena of the same nature mid-way between the occipital protuberance and the mastoid process. In twoof my cases this metastatic inflammation went beyond the stage of tender-ness and infiltration of the tissues, and terminated in the formation of an ^ St. m . f Fig. 25.—Section of the temporal bone showing the relations of the antrum to the facial canal. A =?antrum ; = pneumatic cells: St. m. f = stylo-mastoid foramen, or orifice of facial canal. abscess on the side of the head, at some distance from the area of mastoidinflammation. In two of Dr. Simrocks cases of mastoid disease, which Ihad the privilege of examining, such a metastatic abscess had developed inthe temporal region. In all cases of this nature, we must assume that someirritating products of the mastoid inflammation are carried either along thevenous or along the lymphatic network of vessels, to some remote spot onthe head, where they soon give rise to an acute inflammation which may attimes eventuate in the formation of an abscess. Facial paresis or paralysis.—When we consider how near the antrum isto the canal containing the facial nerve (see Fig. 25), we can no longerwonder that it should often become affected in
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