. Surgery, its principles and practice . remembered, inexamining children with thespeculum, that the drummembrane occupies appar-ently a more horizontal po-sition in infancy than inadult life, and that it isnecessary to draw the auricle downward, backward, and outward, inorder to separate the lower wall of the meatus from the upper wall, sothat a clear and distinct view of the membrana tympani may be —In every case of an acute inflammation of the middle eara free incision should be made through the drum membrane. Previousto the operation the parts should be thoroughly steril
. Surgery, its principles and practice . remembered, inexamining children with thespeculum, that the drummembrane occupies appar-ently a more horizontal po-sition in infancy than inadult life, and that it isnecessary to draw the auricle downward, backward, and outward, inorder to separate the lower wall of the meatus from the upper wall, sothat a clear and distinct view of the membrana tympani may be —In every case of an acute inflammation of the middle eara free incision should be made through the drum membrane. Previousto the operation the parts should be thoroughly sterilized by moppingout the canal with an alcoholic solution of bichlorid of mercury of astrength of 1: 3000. All instruments used should be sterihzed by hands of the operator should also be sterilized, as for any of the drum membrane is an exceedingly painful operation, andshould always be performed under general anesthesia, except possiblyin the case of very young infants. In adults nitrous oxid is the best. Fig. 442.—Incision of Membrana Tympani in AcuteOtitis Media, Involving Lower Portion of Tympanic Cavity. DISEASES OF THE MIDDLE EAR. 817 anesthetic, while in young cliildren chloroform is preferable. Particularattention is called to the term incision of the drum membrane. Form-erly paracentesis of the membrana tympani was advised. Paracentesisis an operation devoid of value, and in every case where it is necessaryto open the tympanic cavity artificially, a free incision should be madethrough the membrana tympani. This incision should be made in theposterior segment of the membrane, and should extend from the inferiorpole, upward along the posterior periphery of the membrane as far as thetympanic vault. (See Fig. 442.) If the upper portion of the middle ear alone is involved, that is, if theinflammation involves the tympanic vault alone, the knife should firstbe thrust through the most prominent portion of the tumefaction, and theincision shoul
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