398 
G. ARCHIE STOCK WELL. 
the ear of one of his patients, and that embraced the whole internal 
ear, vestibule , cochlia and semicircular canals. 3. In the teg men 
or roof of the tympanum, and also in the antrum, provoking 
meningeal inflammation, or, perhaps, abscess of the middle lobe of 
the brain lying above; in the inner plate of the mastoid, also 
resulting in meningitis, cerebral abscess, thrombus of the lateral 
sinus, and resultant pyaemia: or a phlebitis may extend from 
the mastoid cell along the mastoid emissary vein, involving the 
lateral sinus, thereby securing thrombus, and ultimate fatality. 
Some of the more rare occurrences of mastoid disease, or freaks, 
perhaps, would be a better term, are: Inflammation of and conges¬ 
tion of the eye and orbit of the affected side with, perhaps, pro¬ 
trusion of the globe. Cerebral abscess of the middle lobe occur¬ 
ring on the opposite side of the head arising from reflex and sym- ! 
pathetic causes, and periosteal abscess midway between the mas¬ 
toid process and occipital protuberance. 
In asthenic subjects, whether the condition is one of long 
standing or a sequel merely to the disease itself, inflammation is 
equally prone to advance to caries and necrosis with little or no 
manifestations of acute suffering or pain ; consequently the specu¬ 
lum and mirror must be relied upon largely for diagnosis. At 
intervals too, during the progress of the disease, pain if present 
will altogether subside or disappear, and such subsidence is the 
more unfortunate in that it inculcates a prognosis that is sure to 
be a cause of regret later on ; especially is this so if there is 
coincident disappearance of tumefaction and swelling. 
As before suggested, febrile conditions may be altogether 
wanting; especially is this the case after the inflammation has 
passed from the acute to the chronic stage. More is to be de¬ 
pended upon a dry parchment skin, dry staring coat, dry glassy 
eye and a hot ear; the nose is hot, yet may be either dry or 
moistened, according as inflammatory products do or do not 
find their way through the eustachian tube and posterior nares. 
While you may find a natural and safe outlet by process of 
time and disintegration and with mucli less serious attendant re¬ 
sults than might reasonably be expected, a vast amount of 
unnecessary suffering is included along with “ wear and tear ” 
