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Related post: 512 SOUTHERN MEDICAL JOURNAL June 1917 cranial complication develop after a rad- ical mastoid operation has been performed. My observation agrees with those of S. Macuen Smith — "almost without excep- tion these patients improve in general health, it being not uncommon, in cases where the chronic otorrhea was of a num- ber of years' duration, for the patients to state that they had never before realized what robust health really was." The rad- ical mastoid operation should be regarded as a major procedure, especially when we consider the opportunities for causing irreparable injury. This operation is not only safe in the hands of competent op- erators, but is usually productive of a maximum amount of good. It is frequently the first step for relief of an intracranial lesion, and if a chronic otorrhea has its origin in the mastoid antrum or lower cells, it can only be relieved, as a rule, by a radical mastoid operation. DISCUSSION Dr. Tl". Likely Simpson, Memphis, Tenn. — It seems to me in listening to this paper that it is rather remarkable the results that Dr. Stucky has had. For instance, he is certain no compli- cations have arisen from the operation for chronic mastoiditis. I believe his paper stated the operations were done over a period of a good many years, and it seems to me that necessarily some of those operations must have been done on cases where there was a labyrinthian suppu- ration, probably not only chronic, but acute. And knowing this, it is very remarkable he did not get cerebellar abscesses Buy Grifulvin V and meningitis in some of his cases. Another point I would like to speak of is the hearing results. I believe that the results would probably have been better if the radical opera- tion had not been done, but, instead, the Heath operation had been performed in these cases of chronic suppuration in the middle ear, where there was a small opening in the drum. I do not believe that one is justified in doing a radical mastoid for a chronic suppuration in the middle ear, even though it has extended over a long pe- riod of time with only a small perforation in the drum, if the hearing is quite good, no cholesta- toma, etc., present. I believe instead of a radical operation the Heath operation is indicated. Dr. Stucky (closing). — The doctor asked about the labyrinthian involvement. Remember, I tried to emphasize in my paper that this is a report of cases operated upon five years and more ago. I have had several cases of labyrinthian disturbance, markedly so. There were several cases of facial paralysis, but they got well, and at the end of five years they had none or very little labyrinthian disturbance, and they had no facial paralysis. I have had cerebellar abscesses and absces.ses of the frontal lobe, and sinus thrombosis. They died. All of my patients do not get well, so I could not report the end re- sults. The Secretary asked a auestion about facial paralysis. I have had, I tnink, 19 cases that were brought in that had facial paralysis of varying degree before the operation, but they finally cleared up Buy Grifulvin very nicely. I have never had a Grifulvin V Micr case of permanent facial paralysis. THE TECHNIQUE OF TONSIL EX- CISION WITH EXHIBITION OF INSTRUMENTS* By M. M. Cullom, A.B., M.D., F.A.C.S., Eye, Ear, Nose and Throat Surgeon, City Hospital ; Surgeon to St. Thomas Hospital, Nashville, Tenn. The flood of literature relating to the tonsil which has submerged the conscien- tious medical worker for the past six years is a matter of wonder to many. To my mind it is only a tribute to the impor- tance of the subject. An intimate knowl- edge of no organ in the body has been followed by Buy Grifulvin Online a greater revolution in medi- cal thought and practice. Great as has been the addition to our knowledge, and as numerous as have been the problems solved, I think we have only scratched the surface in our studies of the question Grifulvin V of focal infection. To my mind, focal infection is destined to ex- plain many conditions which are now ob- scure, and hold out the promise of hope to those who have lived in despair. There- fore, no apologj' can be considered neces- sary for the discussion of an organ which plays such a sinister part in the drama of human suffering, and whose surgical treatment is fraught with such moment- ous results. Let us revert a moment to the days when the tonsillotome reigned, and indi- cations were fulfilled by removing a por- tion of Grifulvin V 500 the gland and leaving the rest "to atrophy." The methods of removal and the means for controlling hemorrhage were both crude. That accidents were not more fre- quent was no doubt due to the fact that most patients operated on were children. 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