A case of masked acute otitis media, going on to masked mastoiditis while under sulphatherapy is descriptionbed. Pain and tenderness were relieved, but returned on the withdrawal of the drug on three occasions, while the tympanic membrane remained intact. In this way three doctors who saw the case were foiled. Operation revealed extensive mastoid pathology with a perisinus abscess. A cortical mastoidectomy was done. Recovery was complete with return to normal hearing in one month.
Open' endotracheal anaesthesia without expiratory valve or re-breathing bag is descriptionbed and recommended as a routine procedure for the removal of tonsils and adenoids in young children. The use of adequate premedication with nembutal is discussed. The importance of high dosage is emphasized.
Mesantoin is a useful anti-convulsant drug. Cases of grand mal epilepsy which do not improve on any of the recognized drugs have done well on mesantoin. Careful control of the blood picture must be maintained. We suggest fortnightly full and differential blood counts. The proportion of cases which go wrong may be very small but that does not preclude the utmost care being taken.
At this critical stage in man's social evolution, from primitive independent tribes to a closely integrated, highly evolved, world-wide society, various dangers threaten. Sudden physical changes in feeding habits, and in the pattern of posture and of neuro-muscular activity may be acting adversely upon man's physiology and psychology. Economic and political organization is net keeping pace with the greater and closer integration of the communities of men, and this sociological immaturity leaves the whole community of civilized man in danger of extinction by war. The pattern of behaviour of the individual has been destroyed by a growth of scepticism and a decay of the authority of conventions. This has led to bewilderment and neurosis. It is the duty of the medical profession to preserve and extend the life, health and happiness of humankind. It should therefore take a wider view of its mandate and study mans's adaptation to his changing environment, i.e. human ecology, and apply both to man and to his environment whatever regulation may be necessary to ensure that the adaptation shall be as harmonious as possible.