. A Reference handbook of the medical sciences embracing the entire range of scientific and practical medicine and allied science . p-pears tn be involved. Pain irhicli is locatedin the mastoid process or its ncinity,and irliich persists despite free drainage, is another diagnos-tic symptom of mastoiditis. Still anotlier is to be foundin hypermniia and adema of the s/cin covering the mastoidprocess. When this is found in a case in which furuncularinflammation of the external auditory canal is not present,it is time, in the vast majoiity of instances, to only exception is in those c
. A Reference handbook of the medical sciences embracing the entire range of scientific and practical medicine and allied science . p-pears tn be involved. Pain irhicli is locatedin the mastoid process or its ncinity,and irliich persists despite free drainage, is another diagnos-tic symptom of mastoiditis. Still anotlier is to be foundin hypermniia and adema of the s/cin covering the mastoidprocess. When this is found in a case in which furuncularinflammation of the external auditory canal is not present,it is time, in the vast majoiity of instances, to only exception is in those cases in which this symp-tom manifests itself very early in the disease (the secondor the third day). As a rule, liowever, hyperemia andcedema develop at a relatively late stage of the disease,and when they are present the signification generally isthat the case has progressed very rapidly, or that themastoid is quite thin, or tliat the operation hasbeen delayed beyond the period of safety. Extension ofthe inflammation into the soft parts of the neck generallymeans that a perforation throiigli the inner table has taken. place. It may also signify a similar perforation throughan luiusuallv thin bony wall of one of the large cells atthe tip of the mastoid process. If the terapjeratnre remains high or is of a septic type,the operation ought not to be delayed. , it must be remembered that there are cases ofwell-marked mastoiditis in which all of the symptomsmentioned above may be alisent. A good rule to follow, in all cases of mastoiditis, is— when in doubt operate : never wait for redness andswelling over the mastoid. While the operation is one 702 that requires skill and is not to be lightly undertaken,yet it is also one that if properly performed is practicallydevoid of danger. On tiie other band, the disease itselfis characterized by a decided tendency to spread beyondthe limits t)f the mastoid jnocess. It may force its waythrough the inner table of the skull,
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