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Ward, and Dr. J. Ilasbrouck, Dr. Roberts having the con- trol of his own instrument, with which his daily practice had made him familiar, the patient being placed in a suitable light upon a high table under ether. The operation was at first conducted by direct light, but later, as the daylight waned, the meatus was illuminated by mirror on the forehead of the operator and artificial light employed. The first step was to remove as far as possible the integument covering the growth, that it might not retard the action of the trephine. This was done by means of a small periosteal knife, the skin being cir- cumscribed and scraped off". The bony growths, first the larger one, were attacked with the small trephines already described. The cutting edge of the trephine was set in a plane correspond- ing with the projecting growth. The trephine was replaced Purchase Atrovent by a small-sized burr, and with this the cut surface representing the place of the attachment of the growth was smoothed down so that it was not quite flush with tiie surface of the external auditory canal. In a similar way the smaller growth was also removed. There was so much haemorrhage that it was neces- sary to stop frequently to swab out the canal and to cleanse the meatus by syringing, so as to remove the blood and debris of soft and bony tissue. The operation, which lasted nearly two hours, was thus rendered very lengthy and tedious. A probe could now be carried the whole length of the auditory canal, which was about of its normal width. There was so much oozing of blood that it was difficult to determine whether any damage to the membrana tympani had Order Atrovent Online been done, but, so far as could be ascertained, it was uninjured. Antiseptic precautions were observed so far as possible. The canal was plugged with antiseptic bydronaphthol gauze and a bandage applied to keep it in place. Upon recovering from the influence of ether, the patient complained of no pain, and slept well the first night after the operation. The dressing was Generic Atrovent allowed to remain for four days, and was then removed. During all this time he complained but little of pain, and slept well every night. When the dressing was removed, however, there was considerable purulent discharge, so that it was thought best to leave the canal free for the purpose of cleansing. The walls of the canal were so swollen, especially in its posterior part, that the condition of the membrana tympani could not be made out. Up to this lime he had suffered little or no Buy Atrovent pain. But on the evening of the sixth day after the operation he sent for me on account of very severe pain, and had all the symptoms of acute inflammation of the middle ear. The pain, which was relieved by the application of leeches and instillations of hot water, was soon followed by a profuse purulent discharge, and by carefully cleansing the canal I was able to detect a small perforation of the membrana tympani in its anterior lower quadrant. The ear was carefully cleansed by syringing with hot water several times a day, hot water frequently instilled, and instillations of Magendie's solution of morphine also used to allay the pain, which soon became much less. Coincident with this attack of pain the hearing, which had been quite good, became very much impaired. The meatus and auditory canal were swollen, but not so much so that I could not watch the progress of the disease of the middle ear. The wound in the membrana tym- pani closed in about three weeks, and hearing again improved, so that the voice could be heard from twenty to thirty feet. 270 rOOLEY: nYPEROSTOSRS OF THE EXTERNAL AUDITORY OANAL. [N. Y. Mbd. Jooh., Tho Mwollinff of tho jitjditory canal now, howuvor, Ix'famc very nuicli tnoro pronoiinccHl, (•aii''inf,' vory nmcli ooiiiraolioii, ewpo- Buy Atrovent Online rially in its i>()Htori»)r portion m-nr tho intMiihrarin tympani, so that not ovon tho sinallost Cheap Atrovent Hi)ooiiInni ooiild lio introihicod for tho purpose of oxntnination. ThtM-o was no lonpor any i»urnlont dischargo. This swelling of tho walls of tho canal (thorc wore no Kmniilatlons) thruatonod to entirely cIobc the canal, ospociftlly in its posterior part, and was acooin|)aniod hy a i^ood deal of pain, hnt ipiito dilVoront in character from tliat of tlie acute in- tlaniniation of tho middle onr. A variety of rnoasuros wore re- sorted to to prevent closure of tho canal, at first by dilatation with sponjre tents, which did hut littlo in tho way of wi(Ionin)i: it, hut liiey caused no littlo inconvonionco and pain. I thoti Purchase Atrovent Online tried tho uao of elastic rubber tubing, using for tho purpose pieces of flexible soft catheter recommended by Dr. Emerson, but those wore still more i)ainful tiian the tents, and had to bo discon- tinued. Occasional a])|)licati()ns of nitrate of silver were also made, but all of these i)lans seemed only to agfjjravate tho swelling and to increase the difticulty. They were therefore nil abandoned, and the case treated as one of acute inflammation by the freiiuont instillations of hot water only. Improvement now at once took place, as shown by the subsidence of the swelling and widening of the canal, and the meatus has now reached its normal size. There is still a considerable degree of contraction of the posterior Order Atrovent part of the canal, but a glimpse of the membrana tympani can be had. All syinptoms of pain and irritation have subsided, and the hearing is nearly normal for the voice. A watch, however, is only heard op contact. This was the condition of the patient when last seen, about three weeks jigo. Careful examination Buy Aerovent does not reveal any remnants of the exostoses. If we compare the results obtained in this case and that reported by Matthewsoii with those published cases operated on by other methods, it must be acknowleds^ed that they g^ive very much Buy Cheap Atrovent better results and are far less tedious and dan- gerous and more effective than any methods hitherto em- ployed. Dr. Matthewson in his paper gives a brief resume of the history of the cases which had been operated upon up to that time. We may best sum up the advantages of such instruments in Matthewson's conclusions, "that it is less tedious, A few tests of this and any Atrovent Online hand drills in perfo- rating dense bone will demonstrate that it is less dangerous,

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