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the radial and circular layers. The mucous membrane of the tympanic membrane showed in all the cases great fullness of the vessels and many extravasations of blood ; furthermore, in- May 10, 1884.] REPORTS ON THE PROGRESS OF MEDICINE. 539 filtration of small cells in some of the cases and of pus-cells in most of them. The tympanic cavity contained either mucus and pus, or tenacious mucus alone, or mucus, pus, and blood, or granular cells, or small fibrous masses. In all the cases the lining membrane of the promontory was increased in thickness, the blood-vessels were enormously full, and paxil price without insurance the extravasations of paxil 25 mg blood were here recognizable by the naked eye. In one half the cases there was simple infiltration of the mucous membrane, with round cells, in the other half round cells and pus-cells were purchase paxil found together. The mucous membrane lining the an- trum was changed in the same manner. generic paxil paxil price The labyrinth was found to be normal in every respect, the only change being a coagulation of paxil cr the cheap order paxil lymph. paxil 10 mg The reporters paxil price india were not able to de- cide whether the changes in the middle ear occurred simultane- ously with and independently of the diphtheritic affection of the naso-pharyngeal cavity, or whether the disease extended by continuity through the Eustachian tubes to the ear. They think, however, that the disease of tlie middle ear either fol- lowed one of the milder forms of diphtheria or corresponded to the initial stage of this disease, since the membranous deposits could be readily removed, were easily brokeu up, and did not present the appearance of true diphtheritic membranes. They call special attention to the absence of micro-organisms in all the diseased parts. The Hyphomyoetes (Aspergillus Flatus, Niger and Fumi- GATDS, AND EuROTIUM RePEXS), AND THEIR RELATIONS TO OTO- MYCOSIS AspERGiLLiNA.— Siebenmann (Ibid.) has a long and in- teresting paper on the aspergiUus fungus in the ear, based mainly upon his own observations. He agrees with AVreden in regarding these aspergilli as genuine parasites that penetrate the skin. He thinks that there are four tilings necessary for the origin and growth of the various forms of aspergillus vege- tation: 1. Conidia or spores; 2. A peculiar condition of the terrain ; 3. A temperature purchase cheap paxil from 20° to 40° C. (68° to 104° F.) ; 4. A moderately abundant supply of air. In rx paxil every normal ear there is a temperature of 20° to 40° 0., paxil prescription with free access o( air, but such an ear is unfavorable as a nidus for fungi, in so far as pure unaltered epidermis is a poor soil for aspergillus ; while only when moist, and even then but scantily, does it afi'ord nourishment for the growth of the fumigatus variety alone. It can, therefore, be affirmed with certainty that the latter variety of aspergillus alone can flourish paxil buy in a normal auditory meatus, and even this only under the rare and abnormal paxil price in pakistan circumstances that the entire district continues moist day after day. It may be said that, almost without an exception, a free layer of serum affords the aspergillus the original, the most favorable, and paxil 12.5 mg per- haps, after all, the only possible soil upon which it can flourish. The primary cause is an inflammation of the skin or middle coat, but it must cheap purchase online paxil not be one which secretes a serum capable of under- going rapid decomposition. Everything that has a tendency to transform a suppurative into a serous otorrhoea, or to diminish the amount of the secretion, or to prevent decomposition, favors the growth of fungus. The favorite situation of the fungus pellicle is the tympanic membrane and the inner third of the meatus; more rarely the tympanum, and still more rarely the outer two thirds of the meatus. Aspergillus in the ear rarely clings as a membrane to the epidermis paxil 30 mg ; usually it rests upon the .surface of the exposed rete or corium, without penetrating the latter. On the contrary, mycelium of the deeper layers of the thallus may become surrounded by the cells of the rete Mal- pighii. Subjective symptoms are occasionally absent ; generally there are deafness, tinnitus, pain, itching, and a discharge. Deafness and tinnitus are particularly well marked when the fungus grows upon the soil which has been furnished by the secretion from a myringitis. Itching is very rarely absent. The affection is accompanied by a slight aqueous, serous discharge. Otomycosis has no specially characteristic subjective symptoms. The one significant symptom in a large number of cases is the occasional removal, by scratching, of a fungus membrane from the ear. Among the objective symptoms are a shght redilening of the locality which the fungus is about paxil discount to attack, injection of the vessels of the manubrium, with absence of tlie paxil mg light spot, and a serous secretion generally within twenty-four hours. The scattered, darker, punctiform spots which are usually observed upon the lower side of the membrane are tbe remnants of old, cast-otf membranes. These fungi rarely possess any odor, though occasionally they smell like mold. Eurotium repena gives rise to no subjective symptoms. Objectively, it appears as an envelope or covering to ceruminous plugs, either as a fine wooly or green- ish deposit, or as a fine sulphur-yellow layer, in which it is min- gled with broken-down, discolored, gray or brown conidiophores. AspergiUus Jiaous and niger can generally be recognized by the naked eye, while the examination oi Aspergillus fumigatm and Eurotium repens needs the assistance of a microscope. Fresh cerumen is hostile to the growth of aspergillus. Syringing with lukewarm water has frequently cured eases, but alkalies have rarely proved of any use. The sulphates, silver nitrate, strong solutions of carbolic acid, and instillations of oil are con- traindicated, because they may excite an eczema. Glycerin and

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