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duce the size of these tubes, both as to their diame- ter and their length. This obviously means chang- ing the large tube for a smaller one. Tube pressure must ever be moderate. Too much pressure causes pain ; it may likewise cause sepsis, yet if the tube be too small it allows too rapid contraction of the meatus and loss of view. If after an operation there is pain or fever, it is practically always due to some defect in the drainage of the soft parts. It is well, however, to look after the tube. Some patients tolerate greater pressure than others. A large variety of tubes from which to select must be on hand. To get the tube just the right length will not be found difficult, for if Zetia Coupon it presses too hard behind the tragus, it can easily be shortened at its outer end. Occasionally patients do not tolerate the tube, either on account of pain or sepsis, and a good Price Of Zetia sub- stitute for it can be provided by firmly rolling some Zetia Prices seven eighths inch ribbon gauze upon a Zetia Coupons Heath's wool holder till it is Zetia Hair Loss of the proper size, and looks like a tiny bandage on the end of the instrument. This, while on the wool holder, is introduced in- stead of the tube. Drainage is then carried on by percolation through the gauze, and by regulating the size of the roll, the pressure may be suitably modified. This gauze roll is changed daily and re- turn made to the tube Zetia Discount Card as soon as appears possible. Another procedure he adopts is to wrap a layer or two of gauze around a small tube in such a way that it will intervene between the rubber and the tis- sues. This prevents septic absorption. In a very septic case, especially where a large amount of the mastoid process has required re- moval, Heath inserts a small strip of gauze or gutta percha tissue in the lower angle of the wound be- hind the ear to act as an extra drain for two or three days. In septic cases hot fomentations are used instead of the ordinary wet dressing until the wound has become more healthy. Heath tells his patients to try and blow through their ears occasionally after the operation, to see if Nature has removed the anterior tympanic dam above referred to. They can usually do this Zetia Price in four or five days, showing that the dam has been re- moved. In these daily after treatments two main objects are constantly in view, and unless Buy Zetia Online these objects are kept in view at every Buy Zetia dressing, the operation may not prove a success ; first, to stimulate granulations in the parts desirable to fill up and close ; and, sec- ond, which is the more important, to retard granu- lations in What Is Zetia the parts desirable to keep open. In other words, keep the Discount Zetia meatus large and open to the drumhead, and close the antrum. Three stock solutions are always on hand to ac- complish these purposes. 1. Cheap Zetia Alcohol for cleansing, and to retard granula- tions. 2. A Zetia 10 Mg ten grain to the ounce solution of zinc sul- phate, to retard granulations. 3. Iodoform in glycerin to stimulate granulations. Two cotton wool plugs are always used, and changed daily ; one for the antrum, and one for the meatus. The antral plug is always Zetia Cost saturated with the iodoform mixture, and is barely large enough to fill the cavity. The meatal plug is sometimes sat- urated with the zinc solution, sometimes with alco- hol, and sometimes with the iodoform. All depends on whether it is desirable to stimulate granulations in the meatus or to retard them, always remembrr- ing the necessity of keeping the meatus Cost Of Zetia open ad the drum in full view. Iodoform emulsion is used to moisten the meatal plug until it is seen that the bridge of bone is covered with granulations; after that, it will be found best, as a rule, to use a solu- tion of zinc sulphate or alcohol for this plug. Zetia Discount For exhuberant granulations in any part of the cavity a fifty per cent, solution of silver nitrate is applied by means of a tiny hard cotton mop on an applicator. Before applying this, all excess of the solution in the Zetia Online mop must be wiped off. Naturally, this strong solution of silver nitrate is to be used only when it is desirable completely to destroy some granulations. In this way the cases are treated daily, for the wound being septic, daily cleansing is essential. No one should attempt the Heath conservative mastoid operation unless he is prepared to give the time, care, and attention necessary for the proper con- duct of the case. By Heath's after treatment the surgeon is enabled to mould the cavity to Zetia Cheap the shape and size which he desires that it shall permanently retain. The advantages of using the instruments he has designed for the various stages of this treat- ment must be seen to be fully appreciated. Every- thing is organized and ready; and the painlessness of his method of dressing an ear is remarkable. Heath says to his pupils : "Be sure to assume the mastery of the disease at the operation, and stick to it." The foregoing article was written after I had as- sisted _ Mr. Heath in twenty operations upon the mastoid. The operations were all done exactly as described. The material for the pathological de- scription was obtained from personal instruction bv Cholesterol Zetia him, and from a lecture given by him at the Lon- don Polyclinic. I observed Mr. Heath do the after treatments in a large number of patients, and the remarks on this subject are based on these observations. Since returning to my practice, I have done a few operations, and followed out the after treat- ments according to the Heath method, and the re- sults have been entirely satisfactory.

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