For a number of years I held to the impression that the type of infection in acute mastoiditis had very little to do with the clinical symptoms, and that no matter what organism predominated, the course of the condition was not materially altered by the character of the infection. Latterly, I have become convinced that the predominating type of infection does play a very important rôle, and that, furthermore, epidemic types of infection causing mastoiditis are the most virulent in their activity. And yet, on the other hand, in the majority of the cases in which I have found the most extensive mastoid necrosis, there has been a mixed infection, with the so-called less harmful bacteria predominating. This doubtless is due to the fact that, in a given series of cases, as, for instance, two years ago, when during the winter months I operated on more than sixty patients
MCKINNEY R. SOME PHASES OF STREPTOCOCCIC INFECTION IN ACUTE MASTOIDITIS. Arch Otolaryngol. 1926;3(6):514–520. doi:10.1001/archotol.1926.00580010548002
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