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Operation was recommended and performed July nth. at which the tegmen antri was found necrosed away and a small ragged perforation existed in the dura just over the tegmen from which pus was oozing. No chiesteatoma appeared in the brain abscess, mastoid antrum, or car. .\ large bone cell at the tip of the mastoid was filled with pus. its inner wall necrotic and broken through into the digastric fossa — Bezold's type of mastoiditis. The tip of the mastoid was removed and a separation of the tissues was made from this dee|) abscess through the side of the neck and skin and a rubber tube inserted. The brain abscess cavity was held open with a gauze cigarette drain with a large (piantity of fluffy gauze laid over this. The patient did well for a time and during her stay in the hospital progressed apparently favorably, hut several weeks later the house surgeon who had been dressing the case was sununoned to the patient's house to Buy Cialis Tablets Australia see her. She was then presenting symptoms of retained secretion and was extremely weak, partly delirious, pulse slow and weak. The house surgeon got her into the hospital where we again evacuated pus in greater quantity than before apparently March 9. 1918.] GRAHAM: TWO STAGE PROSTATECTOMY. 447 both Buy Cialis Tablets Australia troiu ihc original abscess and certainly from an- other more deeply situated than the first. She again rallied and the next day appeared bright and cheerful. The im- provement, however, lasted only a few days ; she continued to grow weaker and her death occurred a few hours after a sudden collapse, with accession of temperature, restless- ness, delirium, and coma on September isth. A peculiarity about this case was the resemblance to true aphasia exiiibited by the patient, which as the abscess was on the left side we were at first in- clined to consider it. It was merely Buy Cialis Tablets Australia that the patient was slow in cerebral processes and unless she was sufficiently roused she would not make sufficient effort to answer intelligently. This was made clear in that, very late in her illness, at sharp urgent ques- tioning, she could name familiar objects. Case III. — Brain abscess villi labyrinthine irritaiiou following chronic middle car suppuration; operation; recov- ery. Tony M., twenty-seven years of age, well nourished and muscular, came to the clinic Buy Cialis Tablets Australia of the Brooklyn Eye and Ear Hospital, December 26, 1916. The purulent discharge from the right ear had existed since childhood. He now com- plained of having had pain in the affected ear for two weeks. It appears from questioning him, however, that for several years he has suffered from earache every winter. Last winter he gave up an outdoor job for one in a factory thinking this less exposing, and believed he had less pain last winter as a consequence. This winter he has had more or less pain constantly since the middle of November. He had never had pains so severe as during this last attack. The pain Buy Cialis Tablets Australia was his only complaint, but it was observed that his gait was slightly staggering and when questioned he said he had dizziness at times. The mas- toid was but slightly, if at all, tender. The hearing in the affected ear was poor but he was able to understand conversation when standing close at hand,i with the Barany noise apparatus at the unaffected ear. He could touch the end of his nose with the forefinger of either hand promptly and accurately. On January 2, 1917, he Buy Cialis Tablets Australia exhibited a spontaneous nystagmus. This was not regu- larly directed but was continuous during the clinical examination ; his stagger was also noticeable. There was no spontaneous pastpointing. The pain was better and he declined operation at this time. His blood count showed normal, viz., white blood cells, 7,100; polynuclears, sixty- nine per cent. : lymphocytes, twenty-seven; mononuclears, two; eosinopliiles, Buy Cialis Tablets Australia one; transitional, one. The pulse was slow and full but not significantly so. Wassi'rmann reac- tion was negative. Severe pain returned and he willingly went to a bed in the hospital, January 8, 1917. Pulse, 60. Operation, Jan- uary Buy Cialis Tablets Australia gth. The pus in the antrum, when opened, escaped as from Buy Cialis Tablets Australia under much pressure and in large quantity. The cavity of the mastoid antrum was found to be a part of the brain abscess, the cavity extending throu.gh the bony roof and upward and backward into the brain substance about an inch beyond the level of the antral roof. The brain abscess cavity seemed to be firmly walled off from the surrounding brain substance by previous hyperplastic inflammation. The malleus, much necrosed, was found in the middle ear cavity sourrounded by a dense mass of granulation tissue. It was believed to have been exerting pressure on the Buy Cialis Tablets Australia foot plate and to have been the Buy Cialis Tablets Australia cause of the nystagmus. The cartilaginous canal was incised along its length and the mastoid wound and external meatus were left open so as to give the freest access to the abscess cavity for further dressings or possible subsequent opera- tion. On the third day after operation the temperature rose to 102.4° F. His first dressing wfas now renewed with a warm wet bichloride dressing and the temperature subsided Subsequently to operation the pulse was not lower than 72, and Buy Cialis Tablets Australia neither nystagmus nor vertigo at any time subsequent to operation, hut there was occasional complaint of headache in the right temporal region for six weeks after operation. The man wa;^ kept in bed in the hospital for seven weeks ; ear was then dry. His wound was entirely healed in eight weeks. The ear was healed, having previously con- stantly discharged from early childhood up to seven weeks after operation. 425 Clinton ,\vf.nue, Brooklyn. TWO STAGE Buy Cialis Tablets Australia PROSTATECTOMY. T^cciity Consecutive Cases Without a Fatality. By Evauts a. Graham, M. D., Chicago, Instructor in Surgery, Rush Medical College. There has been perhaps no more encouraging de- velopment of surgery in recent years than the re- markable lowering of the mortality of operations for the removal of the prostate. Instead of its former reputation of being one of the most serious and dangerous operations, prostatectomy is now a com- paratively safe procedure when performed with due precautions. The early, high mortality has been re- duced to a point where at the present time, when