(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

Full text of "The human ear and its diseases; a practical treatise upon the examination, recognition, and treatment of affections of the ear and associate parts"

Google 



This is a digital copy of a book tha^ was preserved for generations on library shelves before it was carefully scanned by Google as part of a project 
to make the world^s books discoverable online. 

It has survived long enough for Ihe copyright to expire and the book to enter the public domain, A public domain book is one that was never subject 
to copyright or whose legal copyright term has expired. Whether a book is in Ihe public domain may vary country to country. Public domain books 
are our gateways to Ihe past, representing a wealth of history, culture and knowledge that's often difficult to discover 

Marks, notations and other marginalia present in the original volume will appear in this file - a reminder of this book's long journey from the 
publisher to a library and finally to you. 

Usskge guidelines 

Google is proud to partner with libraries to digitize public domain materials and make them widely accessible. Public doruain books belong to the 
public and we are merely their custodians. Nevertheless, this work is expensive, so in order to keep providing this resource, we have taken steps to 
preveni abuse by commercial parlies, including placing technical restrictions on automated querying. 

We also ask that you: 

+ Mcikt^ nofi-comwcrcial itsip of the- files We designed Google Book Search for use by individuals, and we request that you use these files for 
personal, non-com mere ial purposes. 

+ Refntin from tjitlomtiieii querying Do not send automated queries of any sort to Google's system: If you are conducting research on machine 
translation, optical character recognition or other areas where access to a (aige amount of text is helpful, please contact us. We encourage the 
use of public domain materials for these purposes and may be able to help, 

+ Maintain attribution The Google ''watermark" you see on each file is essential for informing people about this project and helping them find 
additional materials through Google Book Search. Please do not remove it. 

+ Keep ii legaf Whatever your use, remember that you are responsible for ensuring that what you are doing is legal. Do not assume that just 
because we believe a book is in the public domain for users in the United States, that the work is also in the public domain for users in other 
countries. Whether a book is still in copyright varies from country to country, and we can't offer guidance on whether any specific use of 
any specific book is allowed. Please do not assume that a book's appearance in Google Book Search means it can be used in any manner 
anywhere in the world. Copyright infringement liability can be quite severe. 

About Google Book Search 

Google's mission is to organize the world's information and to make it universally accessible and useful. Google Book Search helps readers 
discover the world's books while helping authors and publishers reach new audiences. You can search through the full text of this book on the web 



at http: //books, google , com/ 



V *- ^. 






THE 

HUMAN EAR 



AND 



ITS DISEASES; 



A PRAC'JICAL TREATISE 



UPON THE 



BXAHmA TION. RECOGNmON. AND TREA IMENT OF AFFECJmS 

OF THE EAR AND ASSOCIATE PARTS: PREPARED FO? 

THE INSTRUCTION OF STUDENTS AND THE 

GUIDANCE OF PHYSICIANS. 



J uv 

W. M. yflNSLOW, M.D„ Ph.D., 

OCULHT AMD AUfllST TO THH PinSHJUGH HI>M(Bi.prATM rC I10^1»ITAL -. PORHEIILV CLINICAL A&SIST- 

ATfT TO WILLS' OPllThALMJC HnaPlfAL : ASSI!«TANT SirHEiFON TD THH KVB AND BAH 

UEfT. OP IHR CKlLDHKn's IID^FJTAL ; DCl'LIST TO THE CIIELDRHK'!! HOX- 

<]I»PATKIC HOrilTtALH AND SUHI.BDH TO BEDmHD AT, J10S- 

riTAL, ttt mii-K.--, MRflHBR OF TJIR HftHVl- 

VATHIC nrHTHALHfiUH.IlAl. AMl> 

i/nnXXilCAl- MH-IBIVr 



0N£ HUNDRED AND THIRTY-ElfiHT ILLUSTRATIONS. 



BOERICKE & TAFEL: 

NEW YORK: PHILADELPHIA: 

145 CIrandSt. ioii Arch St. 

1^8 2. 



EDtend aecording (o Act of Cangnifts. in the yenr ii»2, 

By W. H. WINSLOWf 

In tha Offlca of Lbe LLbriiiaD of CoDgroa tt WuhingtOD, D. C. 

AIL rlfhU revorred. 



"1% 



PRIiFACE. 



** Jam me vobis, judiccs, ijidicabo, 
d de meo quodam amore ghruE, 
nimis acH fortasse, verum tamen 
honfsto, vobis confihbor" — CiCBBO, 



P1TT8BUBGH, Pa-, 

Januarf, IWl. 



GGoro 



CONTENTS. 



CHAPTER I.. 

AtvA'TOiit op the Ear 9 

Comparative andtomiT' The buxuan ear. Tbe auricle. The eitCfnal au- 
d[toi-y meatus. ThetjoipiLnuni, The (ympanit^ membrtLDC. The maAtoid 
procCEB. The osaicles of tlie car. The EuHlaohian tube. The interiial 
e«p. The vestibule. The Bemicircular canala. The otolitha. The cocli- 
lea. The organ of Corti. Tbe internal auditory meatus. The infuit'a 
«ar. 

CHAPTER II. 

Phybiology of the Ear, 66 

The external ear. The trmpanio membrane. The ossiolet^ The mastoid 
cells- The EuHlachian Lube. Tbe mueous membraue. The tjmpanlc end 
tubnl muscl»i' The oval and round windows. The internal ear. The 
auditorv nerve. DelinitLon of bound. Analogy of tbe eve and ear in 
structure and fuDctLuns. 

CHAPTER III. 

EXAHIlfATION OF THE EaR, ETC,. 78 

Method of recording aca^e. Otoscopes. EarBpeoiila. Testing the hear- 
ing. Cleansing the ear. Synnges. Syringing. Inflation and aoBcuIta- 
tion. Examination of the throat. Examination of the naao-pharynx. 
EjEamination of the noHe. Examination with the Eiiatachian catheter. 
Boogies. Entotic teat of hearing. Symp(om»i. Causes. Diagnosia. 
Treatment. 

CHAPTER IV. 

DlSEASEa OF THE ExTERI4AL EaR 123 

Malformations. Ilypertrophy. Erythema. Eryaipelao. Froatbitten 
anricles. Eczema. Skin diseases. Furuncles. Anthrax. Abscess. Vaa- 
cular tumors. Simple angtomata. Cavernous angjomata. Othtematomala. 
Other turaors- Comedones. Sebaceous cysts, Knchondromata. Kibro- 
mata. Sarcocnala- Epitheliomata. Injuries. Practnre of the auditory 
procew. Foreign bodies. Ceniminosia. Acute dermatitis of the exterrul 
canal. Chronic dermAtitia. Chronic adetioid dermatitis. PhlegmoDoos 
iDflammatioQ of the canal. Oataoperiostilia and ezostoslB. 



vui coNTBiria. 

CHAPTER V. 

IifjuRiES AND Diseases of the Me^bra^a Tvmpai^!, . , 18S 

The membrana tyrupani. Injnriea of tlie membrane, Hypersmin, Hj^- 
ringitis. Atrophj. Hypertrophy, Projeotiund. HemorrbBgeH. Epithe- 
lioma, etc. 

CHAPTER VI. 

DiBBABES 0¥ THE MlDDLB RAH 207 

Otalgia. Tianitus. Acute inflammation. Chronic purulent inflammation. 
Artificial membrana tjnipani. 

CHAPTER VII. 

CokpucAtiofs of Chronic Pdbui-ent Inflamication of the Tym- 
panum, 280 

Polypi- Other (nmore. Exostoses. ParaJjBia of the facial nerve. Mas- 
toid disease- FhlehiiiH. Pyaemia. Meningitis. Cerebral abecera. Carice 
of the temporal bone. 

CHAPTER VIII. 

Diseases of the Middle Eak and A^ociate Parts* . 316 

Catarrhal inflammaiion. Coryza. Acute pharyngitis. Chronic nasal 
catarrh. Nasal polypus. Adenoid tumors, Enlarjfed tonaiU. Chronic 
pharyngjtla, Pmi- pharyngeal nbflcess. Chronic inQammationof the Eus- 
tachian tube. Chronic inflammolion of the tyrapnonm- General treat- 
ment of chronic inflammation of the tube and tympanum. Treatment of 
coryza. Treatment of acute piinrynKitiS' Treatment of chronic naaat ca- 
tarrh. Treatment of naAul polypue. Treatment of adenoid tumors. Treat- 
ment of enlarged tonsils. Trdiment of chronic pharyngitis. Treatment 
of chronic inflammation of the Eiietachian tube. Treatment of chronic 
inflammatioD of the tympanum. Operations upon the membrana tympaoi, 

CHAPTER IX. 
EiiEcnticiTY IN Aural Disease 45B 

Dynnroic electricity. A constant battery. An inconBtant battery. A 
Galvano-Fandic apparatus. Eleclroites- Qualities of the currents. 
Methodof application. Symptoms of aural electriEation. Brenner's for- 
mula. Electricity in disease. 

CHAPTER X. 

The Internal Ear, 473 

AnEcmia. TreaimenlofanDprnia. Hypenemia. Treatment of hyperemia. 
Inflammation of the labyrinth. Af^nigre's disease. Treatment of inflam- 
mation of the labyrinth. Deaf-mutism. Treatment of deaf-matiam. Id- 
Btrnments to aasiiit the bearing. 



THE 

HUMAN EAR AND ITS DISEASES. 



CHAPTER L 

ANATOMY OF THE EAR. 

It is a fundamental Jaw io Zoology, that the greater the division 
of ftiDctiooal Jabor, the higher is the degree of development, and 
the position of the individual in the animal kingdom. 

In the Protozoa, there \a little or no division of labor. The 
amceba lives, moves, and has its being, in fact, performs all the 
functional actions of life, with it^ jellylike, sarcode body. This 
undergoes temporary mutation for specialized work, fashions a 
mouth or an anus, a stomach or a limb, as circumstances require^ 
and then changes again to a state of dignified inertia. 

The essential vital processes go on as harmoniously and per- 
fectly, iu these microscopic mucous masses, as they do in man, 
with all his glorious eDdowment of elaborate and specializeil 
parts. The keenest examination of these animalcule fails to 
reveal the presence of any nervous structure. There is sensation 
and motion, without sensory or motor nerves and ganglia ; and 
one family of the amceba possesses the remarkable power of select- 
ing, from the particles of different stones over which it moves, 
only those of a special kind of flint, of which each individual 
bailda himself a house or shell. Can it be that^ in these minute, 
unorganized wonders, a nervous fluid pervades the tissues, and 
performs the duties of nerves and ganglia? That taste, smell. 
Bight, and hearing are decentralizetl, and their pleasures pass 
from cell to cell as a breeze rnove^, carrying exquisite delight to 
the innermost recesses of being? 

It is probable from reoeot researches, that repeated discbai^es 

2 



10 TBS HVHAH lAft A5D ITS DISKA8B3. 

of oenral omreotSr in cerlaio dircvtioos tbroi^b coDDCCtive tid- 
soe5, may modiry the Dotritioo c^ tracts so niacti, as to produce 
altimatelj- a,Derve 6bre along tbe course of least reaistaiice. 

The cctocarp of some mediisie cnotaiits maltUndcs of short did- 
conoected iwrve fibres, yet oervoos corrents jorop frnm one to 
aootbefp aod paes all around the fringe of cilia. 

There are so many mysteries of the nen'<«is system, and our 
knowle^e of nerve temjioations is so defective, that we should 
not be dogmatic. There seems to be a correlation between spe- 
cialized sense organs io the higher animals, so that when one of 
them is dtstroyed, some or all the others become more acute, and 
{Ht>ne to take on in some measure the functions of the lost one. 

This IS readily conceived, when we retiectj that the:^ special 
sense organs are united in the lower furms of animals ; that in 
them nerve terminations, little or not at all specialized, and, per- 
haps, ner\'oas fluids alone convey to the corporeal structure the 
various vibrations, which we denominate sensations. 

The senses of sight and hearing, so highly specialized and so 
diBsimibr in the nobler animals, show this correlation as we de- 
scend the animal scale, until, in the lowest forms, they become 
united and simplified to such a degree that it b ditticolt to say 
whether we have an eve or an ear under observation^ and natu- 
ralists escape from a dilemma by the happy expedient c^ calling 
it a sense capsule. 

Tbe first appearance of any special sense organs is io the Pro- 
tO£oa, but in the ccelenteraFe Radiale^i thev are mor« numerous 
and characteristic. The tentacle of the»e animals have nncner- 
OQS s^cs apon the surface, each of which contains a cmled thread. 
When touched, tbe sacs rupture and the threads dart out in a 
straight line, causing a pricking sensation in the human skin 
where they come in contact with it. They are thought by natu- 
ralists to be allied to tactile corpuscles. They are present in less 
numbers io Articiilata and Mollusca. Their analogy to the i»gan 
of the common stinging nettle is interesting. 

The echinoderm Radiates are the first animals which poffless a 
true nervous system of ganglia and fibrs. Some of the latt» 
terminate in pigmented capsules, contain ii^ carbonate of lime 
crystals, situated at tbe dtstal extremity of certain tratacke, and 



ANATOMY OF THB BAR. 11 

surrouDiled by movable spines called ejelida. There is no posi- 
tive evidence of the function of these curious structures, though 
naturalists are iDcliued to consider them eyes, as they call them 
ocelli. The crystals are freely movable in the sacs, and the cap- 
sules are thus humologous with the internal ear of higher animals. 
The presence of pigment might be considered an ocular analogue. 
They are probably foreshado wings of the eye, because imperfect 
seeing would be much more useful to the weak organisms, wan- 
dering along the surface, or crawling in the depths over the 
myriad skeletons of their ancestors, than imperfect hearing, 
which at the best in such rudimentary organs would be of very 
little use. 

The lower forms of Motlusca and Artlculata have similar pig- 
■roented sacs, containing colored carbonate of lime lapelli, of in- 
determinate or combined auditory and ocular functions; but the 
higher forms have the organs so specialized as not to leave any 
doubt of their analc^ie^. 

An organ of hearing consists essentially of an auditory cap- 
sule, or labyrinth, which receives sonorous vibrations upon its 
surface, that pass by means of its fluid contentj^ across it and 
impress the terminal filaments of the auditory nerve. The vibra- 
tions are intensified by the presence of one or more freely movable, 
sclerous particles almost always pre^nt, called otoliths, otoconites, 
lapelli, ear-stones, ear-sand, etc. This general definition of an 
ear covers the representatives of the organ in all the Invcrtebrata, 
though various slight modifications obtain, in anatomical struc- 
ture and bodily position in the different orders. For instance, 
the ear-stones are of various shapes and colors, and there may be 
one or many in a capsule. The otic capsule may be smooth 
within, or lined by delicate cilia, upon which the lapelli vibrate; 
it may have an opening outwards (ITomarus and Patisjno7i), or be 
a clcAed sac; it may be exposed upon the surface of the body 
{Crustacea and Insecta), inclosed within the cephalic cartilage 
{Cephalopoda), or within the calcareous skeleton {Lucifer), 

The organ of hearing of Vertebrata consists of an otic cap- 
sule and auditory nerve, corresponding to the invertebrate ear, 
and of certain append^es, which increase ita complexity and 
functional power. Fishes have the capsule, with one, two or 



12 TBE HUHAN KAR AND TTB DiSffASBS. 

ihrte semicircular canala^ the whole inclosed in bony walls, atid 
having generally bo communication with tbe pharynx^ or with 
^e exterior surface of the body. In amphioxus^ the otoliths 
are absent^ in oeaeoua fishes, a single large one nearly fills the 
vestibule. In some fishes, the vestibule of one side unites with 
itfl fellow, and commumcatea with tbe swim bladder by a chain 
of bones; or the swim bladder is prolonged into the cranium, 
and connects with the auditory capsule, which arrangement 
greatly intensifies the sound* 

Some BatmchiaDS have a simple otic capsule, partially or en- 
tirely inclosed ; others have a middle ear added to this, with a 
tympanic membrane upon the side of the head, a single bone 
[oolumndfa) extending from it to the membrane of the single 
vestibular opening, and Eustachian tubes, sometimes united in the 
middle line, communicating with the pharynx. 

Reptiles have the internal ear inclosed in bone ; a rudimentary 
cochlea ^ a middle ear with columnella (stupes) from the vestibule 
to the tympanic membrane upon the surface of the head, and 
well-developed Eustachian tubes. 

Birds have the otic capsule inclosed in bone; a spiral cochlea; 
a columnella; a tympanic membrane on the side of the head, 
shielded by a fold of skin, and Eustachian tubes, which unite 
before reaching the pharynx. Large foramina extend from the 
middle ear to spaces between the tables of the skull. 

Mammalia have the internal ear inclosed in osseous tissue ; the 
vestibule is proportionately small ; the cochlea ifl much increased 
in size and complexity, and has part of the auditory nerve dis- 
tributed to it. Instead of a single bone, a chain of ossicles, con- 
nected with muscles, extends across the middle ear from the 
foramen ovale to the tympanic membrane. This membrane 
forms the bottom of a canal that opens upon the surface of the 
head and is generally surrounded by an auricle. The auricle 
and canal constitute the external ear. Separate Eustachian tubes 
communicate with the pharynx, and there are foramina from the 
middle ear to the mastoid cells. There are a few modifications 
of this arrangement in the lower animals of the class. 

After this abridged sketch of the dawn and development of 
the organs of hearing in the animal kingdom, one may the better 



ftpprrcUte the ilelknl^ anatomy and e^cquj^ite fimotionB af UiQ 

ThB Human Ear k dtviclM for conv^iknoe of siudy inlci the 
«riti.-mul car, tile tnidJIe ear, nnd the iiitLTnal inir. Tbi^ drA 
viitapTif^'H tlie niirich* imd rxti-nml midttory ftinal: the M>ix>Dd, 
the trmpAnum vriih two divcriiculn, the inasloid o!ll» mid pro- 
<iew lM-liiD<l, Liml the KiHlnHmn lulie in front; the Lliird, the 
vtfltiUtk', HTDiiciKutar canaJ:^ aod cuc^hlca. 




liiiii(vihr ftHA: S. coacJii; 4, trntfuii; 7, «n(]tmKn«; B, «TlenuJ aivJJtoify 
mntw; B, Ubob. Th« doti in the dcprmidoit reproaool tvboccouj gkutlM. 

The Auricle, or pious, b compoevtl of retictdar mrtitage, 
iQUM'li^, »m) ^kln, 14'ttli vt^^t-'U^ nt:!r%'t?i, ttoil |cUn<lo. It VJirtva tu 
(bnii> ««>, color, and aa^h of Httaclnm-nt^ awl jdn? thit v-xtcnul 
muJitorr <nniil l)i*C^'(;en lh«^ lulkulaLioii uf the lower jaw and tlie 
cmMoM prot^csH, It rt^eaibloi u idicll, with ridgv^, d?j>n>«lon«, 
MjroDitr (Old promomoiy. 

Tin.' Iragus ia a curbed promlntmv of cartilj^w, with it* ivo* 
cavity Inu^kwiinLi^ t^ilonti-d in fnml ivf the t-Aieru.nl lamiUH, which 



• An E|«i*GnUr> Trrvt^vc oii tlmnnu AiiiioiiiT. Hj Profovor JnHrpb 
l^ifflt. rolvwubj <f PMtBs^Uiuiiii, J. H- rii^plnrutl Jk Co, PhilodcIphU. 



14 TBB HUUAH EAR AKD ITS DtStABES. 

opens inwards from the bottom of a deep depression called the 
concha. 

The concha is the largest and deepest depression in the auncle ; 
it has a semi-spiral course towards the meatus. It is divided by 
a ridge of cartil^e, which starts from its posterior border, curves 
forward, upward, backward, and downward, to end in a point 
above the lobule. This forms the outer rim of the upper half of 
the auricle, and is called the helix. Upon its anterior border is a 
little eraipcnce called rhe process of the helix. There is another 
ridge inside the helix, which curves downward parallel with itj 
and becomes elevated into a nodule opposite the tragus, called the 
autitragus. The ndge is called the antihclix. It turns forward, 
divides into two limbs, and includes the triangular fo^sa, or fossa 
of the antihelix. The depression between the two helices is 
called the fossa of the helix, or scaphoid fossa. 

The curved outlet of the concha below the meatus, between the 
tragus and antitragus, is called the notch. 

The fibro-cartilage of the ear has several fissures, is covered by 
tough perichondrium and ligamentous bands which strengthen it, 
and has appended to it below, a mass of connective tissue and fat, 
covered by the skin, called the lobule. 

The seven intrinsic muscles of the ear are attached to different 
processes of the cartilage^ and all but one run towards the audi- 
tory canal. They lie close upon the cartilage ; are striate^], thin, 
pale, and difficult to dissect. They are of little or no use in man, 
and have been denomiuated ventigia^ vestiges of muscles, which 
in some mammals are well developed, and perform important 
offices in shaping the auricle in audition. 

The auricular cartilage is firmly attached to the skull by three 
ligaments. The anterior ligament extends from the process of 
the helix to the root of the zygomatic process. The posterior 
ligament attaches the convexity of the concha to the mastoid pro- 
cess. The annular ligament connects the cartilage with the 
osseous portion of the auditory canal. 

There are three extrinsic muscles of the auricle: the attollens 
aurem, or superior levator; the attrahcns aurcm, or anterior 
auricular; and the retrahens aurem, or post auricular muscle. 

The attollens is large and fan-shaped. It arises from the border 



TAB SXTKfiSAL AtTDtTORT MBATU8. 



15 



of tli<* oceipito-fronlul apon<iiro6i»^ iuhI is HiBerio) into iht oani- 
la^ 911 the ]Hi»u?nor surfftiv^ tlie fom <»f the aniitielix. li 
«lmmi tin' auricle apwanl. 

The at1mli<iH hi a thin l>un<l of mii«ciitikr 1fl>res, wTiich ftrij«<« 
fn^m (lie (eioponU fajcm, and tfi inHcrted into ibe tclix unit 

Till* Mrnlietif^ aiwe from the maBtnid [m>ceF^ and is in&art«d 
iota Iho buck of tlio ooni^hn, 

Tlw auricle H covered W t^kin, whidi 14 pciy ttitn and adherer 
clfM^dv in ihc de|in*?tiioitH, btil is thioWr, and ^jmrnied from the 
cnrtilftire in other part^ hj ounneotive Xi^ne coiitaininK conaidc'ru* 
ble fat. Ttte ."^kiii forms a .^ort '>f [tiwoh for the iohalf^ which 
mndv h&« aht <«r(ilAt(v' t'xK'iidiri;^ intu it. Thv: »kii; cxtond^into 
the audjtt^' facial like the lAngef of a gl<>ve, and coverti with a 
(Mii-nlo l.ivtr ihr i^uu-v stirfnii' <>f tin* tym|cuiif- tm-mbnin*'. 

Tlifl Extenml Auditory Meatus, or auini, ^^tends from the 
faottpni iff the <^tUThA to the obliqi^ly plai?i»] tym]iiinH; rnvn^^ 
bnue, awl is dividnt into two [torliouH, the external fibro-cartt' 
tagioouf, aUiiit 10 mm., and t)i« inkTVMil osw'f>ii!S Al^ut 20 mm. 
in length, ihtft makin;* (Ik* whi.)Ie ninal in t^4; udolt alvuit ^(\ 
ami. {l{ iadiea) lon^. hs nv&tkg^ diameter is G mm. ; it is imr- 
rowcftl in (hi* middle of tJi«T t«<kiiy poHioii, nrnl i-xiiantled iit both 
«i>dH; IF oval from above dovnn'uni, and niiisin a einuoita crMirse 
^oniHhing hke the letter S, twir>ted a littlt^ in a spimL It <*ftn be 
Dttrly p>1mi^bt<*tK'4l by dntwrni: the-hiirick- iipwnrd and a little 
"backward. It ih oi'uw M^niigbler, especially in negroe?t, u-iiidi 
may amottot for tb<ir nm^^ietl talent. 

The HbrfMarlibkgiixMi^ {>arlion htm n fow fi^^ire^ fAM m-ith 
elastic liBfiUC. It is joined lo the osteons eanal by tie annular 
li^nK-nt, » a>vered by |ierirbundriuni, and h iminedJatc-ly hmfw 
rounded by fnt and connective! ti^uo. The bony portion comifitfi 
i.t{ lliiii platefi which have become joinel together, oa tJm' have 
devdopbd ontwimld and likt<.rally from iho tyinjiKnie rin^. The 
aupefior wall of tbeouial te vurnioonted bycetls^ which commu- 
vSe^ vrith the i.vlU of liir ma>4toid proiv^, and it M'jiarntcft the 
canal fn>fn the midUle oerebral f*)isfa. Th<T po^icrlor wall is thick 
and honcyctnidk'd with \:vt^r t-ennlar gpaoos, aome of whidi o{>en 
into the middle oar. It separates the caaal frum tbo sigmoid 



16 THB B01fA!f BA& AND ITS DISBABBS. 

fossa of the transverse sinus. The anterior superior wall forms 
the roof of the teraporo-maxillary articulation; the bone is here 
frequently very thin, and is separated from the condyle of the 
jaw by a thin interarticular cartilage. 

The bouy canal is covered with periosteum, to which the thin 
skinissotightlyadhereutthatit looks pinkish like a mucous mem- 
brane. This is quite sensitive, becomes very thin af the deepest 
part, and passes as a delicate epitlieUal layer over the tympanic 
membrane, where there are no glands or hairs. The skin of the 
auricle and cartilaginous portion of the canal is separated from 
the cartilage by more or less connective tiesue and fat, has hair 
follicles and hairs, sudoriferous and sebaeeous glands. The latter 
are lai^ aud numerous in the concha, and the sudoriferous glands 
are very numerous upon the posterior surface of the auricle. The 
tragus is sometimes ornamented by a tuft of hair. The hair fol- 
licles and hairs, and the glands are tike those of the skin of other 
parts, except that some of the sudoriferous glands within the 
canal, mostly limited to the cartilaginous portion, become altered 
in character, and take the name of ceruminous glands. The 
coiled tube of a ceruminous gland is thick, and the excretory 
ducta are shorter than in its allied sweat gland. There are from 
one to two thousand ceruminous glands. They are most numer- 
ous at the junction of the cartilaginous and bony canal, and se^ 
Crete a light, reddish -ye How, bitter, sticky wax, or cerumen, which 
exudes like plum sap on the bark, and forms a covering for the 
surface of the cartilagiuous portion of the canal. It is a kind of 
bog for venturesome insects, and an omnium gaihem/m for dust 
and dirt. 

Vess^. — In the connective tissue, beneath the skin covering 
the cartilage, and within the skin and peri<^teum of the osseous 
canal, run the lymphatics, bloodvessels, and nerves. 

The arteries and veins of the external auditory canal b^in at 
the umbo, or about the centre of the tympanic membrane, and 
form a capillary network, which passes to the periphery and forme , 
a ring. This network communicates with another in the middle 
ear, through the periphery of the membrane, around the malleus 
handle, and through Shrapnell's membrane. From the rii^ upon 
the outer surface vessels go along the auditory canal to the m^frtiM, 



THB EXTERNAL AODITOBT HEATUS. 17 

where they receive branchee from the anterior surface of the 
auricle; some of these then joiD the temporal vessels separately; 
others unite into a single trunk and pass to it under the name o^ 
the anterior auricular artery or vein, A few branches pass through 
fissures in the auricular cartilage; others curve around its edge 
and join the posterior auricular. 

The arteries and veins of the posterior surface of the auricle, 
though a few above anastomose with the terminal capillaries of 
the occipital and posterior temporal, for the most part, unite to 
form larger vessels, which run towards the mastoid and join the 
posterior auricular. This is a branch of the external carotid in 
one case, and of the temporo-maxillarv vein in the other. The 
artery lies in the sulcus, between the auricle and the mastoid, and 
the vein a little farther posterior. The posterior auricular re- 
ceives below the stylo-inastoid vessels, which come from the in- 
ternal and middle ear and the mastoid cells. The occipital vein 
receives the mastoid vein through the mastoid from its cells and 
the lateral sinus of the brain. 

Delicate lymphatics arise upon the surface of the tympanic 
membrade, pass out of the external canal, form trunks, unite 
with those from the anterior surface of the auricle, which are 
very numerous, go forward and downward, and debouch into 
three or four parotid lymphatic glands on and beneath the paro- 
tid gland. Other lymphatics, from the posterior surface of the 
auricle aud the region of the mastoid process, empty into three to 
five posterior auricular lymphatic glands upon the mastoid and 
upper end of the stemo-^leido-mastoid muscle. From these 
glands, lymphatics communicate below with the superficial cervi- 
cal glands in the posterior triangle of the neck, and, what is more 
important, with the chain of submaxillary lymphatic glands be- 
neath the angle of the jaw. These communicate with the deep 
oervical lymphatic glands; and, finally, the united currents pass 
by fewer and larger ducts into the right lymphatic duct, which 
empties into the subclavian vein. Thus an interrupted com- 
municatiou exists, like a canal with locks, from the external audi- 
tory canal to the venooa system, which has a decided significance 
for the cliniciau. 

. Anaatomoaes are frequent between the braochea of the superfi- 
cul veaaela aod tlune Ijing deapcr* 



18 



TIIA BUHAN EKK AND IT0 PlflBAflKA. 



The n/7Tvw of (he ftnmlr ntii^l cxtcmnl fonnl nrf dcrivrd prin- 
dpally frorn t!ie (mriculO'U*iii|ii>ml, n brandi of tlio inlVrior iiiax- 
illniy: Ih* poHtmor aum-ulnr, n l>mnrh of the fuciul, ami the 
atiriculnri.- inugnutL TJw oiirioulo't(;mfK>ral tiorvo ariMs by two 
rwio* fp>m ihrr mfcrior maxillary n<Tvc, lirnralb lh»* hjL<c of tbc 
skull, iiiptitk- '>f jtml interior lo iIk' &rticu]ali4)ti of ilitr lovrer jaw- 
It givr^ off imm«dint<-ly a bmncb lo the otic ^n^linn ; punn 
bciMslb tif* liitfTiial |)<cr\'x^>iil muflcio, bookwartl and ontwnrd 
nro^inil the neck gf ihc jawWiii', where il gjvo* n Wnti^t |o tbc 
fibcitti; UD lurmor atirictilur braiH^li, dbdribiXcd to ibe auricle 
liclow (ho mcniijff; a few filnmrntA to tho -ynipfitlwrir pkxn* cai 
tlK? internal inHxilliirv arivry, and a btipi?:ior auriculnr bruiH-b, 
^liirh M)p[iUf» the fikin of the lia^UA and conti^oo^ fotrlv of tbc 
psnna. 

Tbo jnnin [>ortion of tlie D4^r^x% with tliQ trnifwral arlcry, gxvwrv 
iijiwiinl lhn>ifgh Uil- parulut ^Inml^ j^i\hw n f*;w li1iiim*ulM lo it and 
ihc artk-ulalicH) of i}ic}aW| llwn |Ki»f« in frorl of iIk- irapir* and 
iliviik-s inf" two bninelnw; iIh- nnh-ruir ti-in|M»r:il, wblrb lakes 
tbe general ciiirse of ibe leraporal anerv, and etimimiMirji;f> with 
the laicial ; and the po^crior tL'nifM>ml, wlik*b 6upplio> Ihc ttUf^ 
hens aurem muselG, and ibeekin of ihe upper anienor ^urfaeo of 
tlii> anrkU^ timl cifntigtioiiTi [xtrto atioviv Filiun<-ntj4 fruni Ul^ 
Buperior auri«ilar, inferior aunc^tilar^ and pneieriop temporal, are 
di^trlbnioil ro the ntidrtory aanal and Tympnuic meinbnne, where 
Uw AlampntB terminate in fcrka) proct^i^Ms, and make tbo Mirfacv 
esEqtiiAiiely K^riHitivtr, T\w. pifttierior division of the inferior 
maxilbirVf lh« aurirulo-tcmponih i« most r-iklMv'o; ard iC is 
tlimiigli l!ie uervett, traocil criil, that mo^t of th<^ j^in h Ml fhim 
opcnitii>ii« on tbc front of the aunVh aiKl in ihc external auditory 
canal, Tlie auricles of moles are fiownsitive lliai they «Trca« 
tactile orgMw, 

The [KKterioT auricular nerve comes off from Iho facial ju«t 
after it inuke$ ItA exit at the MtylcKomsroid fomnwn. ft recdves 
immediately a branch niade by a itnion of one Alamont fmm the 
piieiiRkogit^ric% on*: fn^m the ^l4:^«i>-|ibftryiiges], and one from the 
aiiricaUris ma^tius, and then pasfies up between the ma£4oid pro- 
cewaud tlio unriele, and cfivid(» inti) two bninrbc^: an cH^Hpilal, 
which goes to the ba<?k of llie head, and an auricular, whicJi sup- 



TBB TTHPAVUH. 19 

plies the retrahens aurem and the Bkin over the mastoid, and 
upon the jxwterior surface of the auricle. 

The auncularis inagniis arises from the eecond and third cer* 
vical nervea, winds upwards around the posterior border of the 
stem o-cleido- mastoid muscle, parses into the parotid gland, sends 
filaments to the posterior auricular and pnetimognstric, and di- 
vides into several branches. The auricular passes under the 
auricle, runs upward and backward, and supplies tlie integument 
of the mastoid process and the bach of the auricle. 

The occipitalis minor arises from the second cervical, ascends 
along the posterior border of the sterno-cle id o- mastoid muscle to 
the back and aide of the head. It gives off an auricular branchy 
which passes upward and baj^kward, and supplier the skin of the 
upper part of the auricle ; Chat behind this part and above it goes 
to the attollens aurem muscle* 

Sympathetic nerves, not only, communicate with the other 
nerves that supply the auricle and external auditory canal, but, 
also, accompany the vessels to those parts. Galvanization of the 
superior sympathetic ganglion causes a marked hyperemia of the 
auricle. 

Tho Tympanum, or middle ear, is situated in the ba^^ of the 
temporal bone, and its cavity is very irregular in 6ha|)e. The 
walls are covered by periosteum and mucous membrane, Ita 
length is about 10 mm,, the vertical depth 6 to 8 mm,, and width 
2 to 6 mm., and it contains the ossicles, or ear-bones. It may be 
described as having six walls. 

The superior waM is a thin plate of compact bone, forming 
the roof, and it separates the cavity from the middle cerebral 
foesa. It has many cells and vessels in that part which joins the 
squamous portion of the temporal bone, and these are more 
abundant in infants than in adults. It is sometimes fissured, 
when the mucous membrane of the tympanum and the dura 
mater alone separate the cavity from the brain. 

The inferior wall, or floor, is generally thick enough, consid- 
erably inclined forward and inwani, and its surface is a mere 
groove, lying below the openings of the Eustachian tube and 
mastoid antrum, and the tower border of the drum-head. It 
separates the tympanum from the internal jugular vein, which 



20 THE H0HAK BAR AND 1X3 DI3EA8B3. 

enters the skull beneath. In the floor close to the inner wall is 
a foramen for the entrance of Jacobson's nerve, the tympanic 
branch of the glosso-pharyngeaK 

Hie external wail comprises the annulue and frame of bone, 
which holds the tympanic membrane, and closes the inner end of 
the external canaL The membrane is attached firmly to the 
groove, which in the infant is situated iu the inner surface of the 
processus auditorius. This Is a ring of bone, deficient above, 
which closes and grows outward aa development progresses, and 
forms the bony part of the external auditory canal. 

The portion of the external wall behind the membrane curves 
towards the posterior wall, and forms part of the boundary of 
the foramen of the chorda tympani nerve, or the iUr chorda 
poderixis. In the portion of lx>ne in front of the membrane, is 
the anterior foramen, the iter cJiordw anieriuA, This is high up, 
and is the beginning of the canal of Hnguier, which runs for- 
ward and downward through the bone, comes out inside the 
articulation of the jaw, and transmits the chorda tympani nerve. 
Parallel to it and juat below is the Glaserian fissure, a mere slit, 
which goes from the tympanum through the bone and opens in- 
side the articulation of the jaw. It transmits some tympanic 
vessels and nerves, and the laxator tympani muscle. The long 
process of the malleus lies in its tymjmnie sulcus. 

The Tjnnpanlc Membrane, membra natym}>ani^ or drum-head, 
is inclined somewhat forward, downward and inward, in adults; 
it is more slanted in early life, and so oblique in infants as to be 
seen with difficulty. It is oval in shape, its vertical diameter is 
about 10 mm., and its transverse 9 mm, ; it is depressed inward 
like a funnel, and its external surface presents the concavity of a 
very short hollow cone, at the apex of which is seen the yellow 
clubbed end of the handle of the malleus. 

It is composed of an external dermic layer, without glands or 
hairs, an inner mucous, and a middle fibrous layer ; the latter 
forms the skeleton of the membrane. It has an outer set of 
radial fibres next the skin, inserted into the handle of the malleus 
and the tendinous ring around the periphery of tlie membrane, 
in the annulus, and continuous with the cellular tissue of the 
auditory canal; and an inner set of circular fibres next the 



THE TYUPANIC UBUBRANB. 21 

mucous membratie, firmly united to the others, much thicker 
around the periphery, and few and thin near the centre of the 
drum-head. A few of these circular fibres are attached to the 
malleusj a few othen go from the neck of the malleus to the 
posterior border of the merabrane^ within the fold of mucous 
membrane that is reflected over the chorda tympani nerve; and 
a perpendicular set runs along the handle of the malleus. Be- 
tween the two fibrous layers, in a sort of socket of fibro'Cartilage, 
the long process, maDubrium, or handle of the malleus, and the 

Fio. 2. 




Ottep Surface of the Rkjht Tympanic Memrrane (Bameli).*— A, 
Manubrium of maileim ; B, end of mnnubriuiD ; C. Hhort prot'er^a ; D, poaterior 
fold. The triangk of ligbt 1^ seen belov, 

short process, are held in a position, running from above anterior, 
downward and backward. It is movable in the groove or eocket 
like an enarthrodial joint. 

These fibrous layers make the membrane firm and resistant, so 
as not to rupture from ordiuary shocks. When rupture does 
occur it is near the end of the malleus handle^ generally anterior, 
or posterior, or around its central boss, leaving a mai^in around 
the periphery. The membrane is elastic, so that adhesions often 
take place with the inner wall of the middle ear without any 
rupture. In the upper segment, the fibrous layers are so thin that 
the skin and mucous membrane come together. 

The mucous membrane of the middle ear forma the inner 
layer of the tympanic membrane. It is thin and closely adhe- 
rent to the fibrous layer in the centre, and looser at the periphery, 
where it is reflected upon the bone, 

• The Ear; ite Anatomy^ Ph.Teiotc^y, and DiseaacH. By C H. Burnett, 
A.M^ M.D., PtuladetphitL. Heory C. Lea's Sona & Co., FliiludelphLa, Po,, 
1877. 



22 THE HUMAN SAB AND IT3 DISKASES. 

The chorda tympaai nerve passes horiEontallj from behind 
forwards !□ the middle ear, n«*ar and inside the h^indle of the 
malleus, and the mucous membrane leaves the tympanic mem- 
braoe, goes over the nerve, and returns again to it; this makes a 
sort of mucous shelf, divideil into two pouches, where mucus 
and pus are likely to lodge. The posterior large pouch is be- 
tween the malleus and the border of the tympanic membrane, 
contains a few fibres of the middle layer of the latter, and is 
shaped like a tent with the point downwards. This may be seen 
with good Illumination. The anterior smaller pouch is in front 
of the malleus and has no fibrous tissue^ it is lower down than 
the other, and contains within the fold all the parts which enter 




Iki^ek Suhface of the Right Tympanic Mehdkane (Burnett). — A^ 
Manubrium; B^ t?nd of mHnubniini - C, head uf mallGUB ; D, hody <jf inciw; 
E, abort procei^ of incus ; F^ tenticular process of incus ; Q H, chorda tjm)iatii 
nerre ; I^ point of insertion of the tenaor tj^mpani muacle. 

the middle ear through the Gla'^rian fissure. There is another 
very small pouch above the short process of the malleus, with an 
opening posterior, and above the posterior pouch, 

ShrapnelFs membrane, or the flaccid membrane, is the part of 
the drum-head above the mucous shelf forming the first two 
pouehe-s. It is freely movable, contains little fibrous tissue, and 
the mucous and dermic layers are loose and come near tc^ether. 
It was once thought to contain an opening, the foramen of Bi- 
vinus, but this is not now believed. 

Estemally the handle of the malleus forms a slight ridge ruD- 
ning from its depressed cartilaginous end, or umbo, to the yellow, 
button-like projecting short process above, and divides the mem- 
brane into two portions, an anterior, and a larger, posterior se^ 



TKB TTUPANIC URUBKASTR. 



2;i 



atmL TliCfllioit pDCCis of the ihaIIcu:^ rurriu* n T^ll^^lit nJiU-ro* 
|H»^itnor nilg<^, whkb t iJie lower lx>umlar_v ol" Slirj|rn^Ii*a tUuv-UI 
mcfitiirEtiio U-t'irc riKfitiuiici). On tliv uukT Mtrfun*, n irbii^lir, ur 
iXHie i>r ligbt, M well with iiii a^x ai the ew) of ihe oiattubrium, 
Knd iu IttKL*, ;) mm. wi(k\ vn ihv iJvHphory of i)h- nii-mhrtiiio in 
(be anlerior Enfemr quatlrenL It shinee like a meiaIHe mirror^ 
iind is cauwd by ihu ftiQiid ?)iii|v of tlra mvinbronc ainl ibu r»* 
Aei'iiiig t]ii»Hiieft c-f die dermiL- layer. Ic la (liellrec tiling lo ulter 
in a|i[K.'unin(^^' vrhcu Uivrt- ir^ diM?iiJ4>^ in the niiiKncvur. 

T)>e tucmbmie may be for pratrtical p«rp<»Gfi iUvi<)ed inu» 
Ihrc^ portiniiA : an upper H^mi^aC ulmvc lh« short |>ct>ns^ of the 
molli'^LH anil Uje traanvenw fokU before mentioned^ cnlkil ^ini|>- 
ocli'^ inL-mbrane ; an antt^or lower M'^mi'iit in frctnt of the lual- 
kiiA kindle ami the cone «)f light ; and a posterior longer ^egiueikt 
l)cliind i\v* hiiiwlk- aiw! tht- coiiu ; tU^^m^ l:t*t two ufxr boiin<liHl 
almvr- by Hie iniicifn^ Mds within^ hikI by the E^iort {mK-tr« of thi- 
niallcitt^. 

The color of a norninl iyni|)ciiL)c tucinbrane i^ from a. bluish to 
A Tt'llowivh-gTuy, (lidenng nt dillurciil agi^ And by iiniuoinicwl 
varintiom in amJ an«und il It ia l^^hter m inlaiklR, be^ufw tlie 
ilertuk' layn* h^ tlikkcr, and gciionitly nbiided wilh jnnk. It has 
an arober-gray, tfiinglwenl appeirance near tbe centre, in front, 
and Miind tliir mnllcus. 

Thi w»t<b of the dtrniic? »nrfkee, the anterior and piwterior 
aurimbir, pu^ into the miditory onml ntid fonn ci ring Around 
the periphery of the membrane j this ^nds brancbefi lo a ^milar 
ring in the mticon» Inyor \;-ithin, and nmtiy UrunclK'Tt lowarde the 
centrt of the aiemi>nuke in tlie derma, which anite freely into 
oupilbry ni4»hc». 

The stylo-mahtoid artery, a branch of the po'^terior auricular, 
pl»M (liron;:li thi-^Atylo-ma^toid foRimen and (be pu»tvrior wall 
iiitB> tlie middle ear; the tympanic, a Lraiieh of ttie niaiilltiry 
iwrtiutj of (lie internal maxilfar}', poises up behind thi^ urtii^ula- 
Uon of the javr tltrougli the GlaheHan It^ure into the tymfannm, 
supplyintr tho Inxator tyicpcint inuR-k in it» eour>c; the Vidian, 
a branch of tlie Aphefiu^maxiilary {H>rtioii of the intitnul nuLiil- 
LiiT, gitn alonj( tfa« Vidian canal with the tkcr%'0, and scnd^ a 
anmll branch into tlie tympanum. A. Wanch of the Mylo-iuo^toid 



24 THS HUMAN- BAR AKD ITS PISEABBS. 

arteiy and the tympanic branch of the internal maxillary unite 
to form a ring around thf jieriphery, in the mucous membrane 
covering the tympanic membrane. This ring communicates with 
the external ring described above, and it forms a set of capillaries 
which ramify ovt^r the internal surface of the membrane. One 
vessel, quite large, called the tympanic trunk, rung downwards 
from the riug, along the anterior border of the manubrium^ turns 
around its lower end, and communicatea freely with the general 
capillary network of the mucous layer. The veina are fewer, 
but take the same general course. 

There la a capillary net of lymphatics in the mucous layer of 
the membrane, communicating with that found upon the other 
walls. 

Nerves. — There are no nerves to the fibrous layer of the drum- 
head ; the mitcous layer is supplied by a few filaments from the 
common tympanic plexus. 

The posterior waU of the tympanum is wider above than be- 
low, and the floor of the tympanum rises towards and lessens its 
height. In the npper part, there is a large irregular opening 
called the mastoid antrum, which may be r^anled aa a vestibule 
leading from the middle ear to a suite of rooms, the mastoid cells, 
which lie al)ove, behind, and below the antrum in the shell of 
compact bone that forms the mastoid process. The wall has a 
few smaller openings into the mastoid cellSj a foramen for a 
branch of the facial nerve to the tympanic mu^les, and just in 
the angle, low down, between the posterior wall and the rim of 
the outer wall arouud the membrane, are the foramina for the 
atylo-mastoid vessels and the chorda tympani nerve. 

The facial nerve, in its aqueduotus FallopiJ, passes downward 
Dear the angle of the posterior and the inner walls, gives off the 
chorda tympani nerve below the level of the middle ear, and the 
filament above for the stapedius and laxator muscles. 

The Uafltoid ProceBS is like a crashed honeycomb; the cells 
are quite lai^e and irregular in shape, and they lie very near the 
lateral sinus and the external surface. The external part of the 
mastoid process is behind the auricle, it extends below the level 
of the external meatus and the ear proper, and the auricle has 
firm attachment to its anterior surface. Behind and a little 



TBE IIAST01T> PR00IBB» 



25 



vbow tlie mraftpv, nt thi* npficr bunlcr of (In* initntolt!, tin* tc-m- 
|>orxl hone rti quhe tliin, und an o|Mriiifi^ tlin.>ii^h wxitilcl enter 
t\w tip[)fT iinn of till' iilgnioul finrliini uf iliv Intt-ral r<iMU7i. 

A vein from the external wirfiice eotere (lie mastoid fi>rafne« 
And cca[>lir?« into tlio hl«*ml HinuH ir lljit« |inrt of itn rHMir^-, thuii 
inaklDg a free connection between the ina^rokl Htirfaee and rhe 
v«nou» ciirRoit, im|K>rtfuit to conttidor wich fMvtt-ttnrk'uleir aTwtn^ 

Tw 4. 




Majtoih SrAcm akd Tvm-AicrM il-«™ljr).—1. Promontory; 2,pjnBinid( 
3i rilgci/ Fall'>|mn i^nriAl; i, round fmilow; 6,Qr>l viuio*: 4, KuiUehiMi 
Irtbe; 7, aDtfiur ^r Kuntochiui airiilo^: 3, t<AQAl of Lriinor ttmpflni muKlct 
9, f^llopiua Oiftal vi|>oM!<l; Ui> oanM for gmt iictmvuil ikerTr; 11, ntwl^ 
celld I 13, niArtoIil aiUruiu i 13. fonUDva Cur Ut* Ijrmpun^ Itnoeli vf Ui« Imu&I 

The nia^oid celU are lined with a delicnte, quite viuv^itlnr mu- 
eow m^mlmiio, iTAittitinon^ with ihnt of the middlf cur, and ite 
reaaek coiumnnicotc treelv with the diploio vcsapIs of iht minial 
wnll. 

The iiu<'ti>id proce« does not moeh the ahrj\'<yd*«Til)ed <kvcU 
f>pmefit until tlie n^of (Miberty. In thechiMjt idathindouUe 
ibdlof boae, oMitaining vcfysmall cells. It develo|» OQlwaitk 

8 



20 



TUt liUAlAlf UAn ANU lT£f DlSKASfB. 



with tho tyiD|>ai)ic nof*, w])i<*h forrn? tke 4*xt«rnfll awlitory catul. 
A knowledge? cil' th\K Ji(TL«rvu<w in of vu:<t mijvtrluncc in tlio traU- 
meiit vf <^hiJ()rti] aftlk-tul wilh cur diHCWtu^, bcaiuHc- all iho wtilU 
about til? ear nro of itbout tho <x>n«iiatcncy of |>A«t<rbnaHy fiiid tbcj 
mav bo cxtsily |>crrontUxl b^ cari'loa^ or rougii luaDiirulttti&D ami 
muw fiitiil injury. 

7%f onUnor wait of tho tynipanum \s wider obovo ihan bcIoW| 
m smaDor thim ibe |MbkTior wall, unJ oondinUt of a ibiii plate of 
bono, SGpnraiinf; ih^ tympn^iim from llic oarolid canul, irhioh M 
juM iiimJc- of it- It hae%a Uyr^mcn for lh<! posvVLgt: of lymphatic*^ 
nod a i<iiiill arlory from tiie carotii), Ai ibc up[>*.-r \mn uf tb<t 
w«1I, titcrc b an o|^nJng snirroiimlcd by q conicjil rim Qf boac, 
whicb piojvctfl a little W-kward into tho lympaouiu, and baft 
\Kxiti cttlltfl tbi; ouii-rW pynuni<r Tlw furafi»ei) bad^ to n canal 
in the temporal bone, which cilvadd forwards invrard, Ami a little 
dovrnwani to tW 1)W«c of tbc temporal honi^, «nd ojtcn» in tlic? J119- 
»urc between it and tli« {^reat wiug of the sphenoid, trtin^ a little 
furthvf pmlongat by cartihigc. It (Hjntuinv tlic luni^i^r ryinpaid 
niuwltj wbiib «riM» from lli^ aii)cntur prw.'c*© cf lli« jjiint uiiig 
of ibe splictioid ju«L U'hitid thv foranicti uvalt% fmia th^* mrtilugs 
of tht- <»iml utid uf till- Kunta<-fiian Itibt- btJttvr, and tbe upper 
K^all of the caiial, and paMH« alon^ ihLs to tliu foraiiKD, vbere ito 
t<*tidoit untL-m thu tur. Tbi» tuniti at right auglei to ItH tubular 
OHirsf, oiJtAi-urd» from the antL^nor pyramid, uml in iu'M.-rtcd into 
tbc nnk'nor Hirfacv of ihu innct nl^o of tJji: rTiauiibriuiu nuir ibt 
root. Jti«it below the anicrior pyniniid, but considerably above 
ibe floor of the tyni|uiiiuii)» m a lar^^r ojH'iiing for the Euftibchiaa 
tubc- 

77i< haicr imfi of the tynipiiniiiu ia verti^^ib itnd k inwq 
tlirviigh the cxtiTnal c«na1, wbei) tbc dmni<>b(!a<l w tleetroyed. 
The fln^t d]iug to aliniiTt atlt'niioii is a pale^ pjoklnh proiubiciKv, 
i^-cn nlHni[ tlio tjiiddle of the Iuuku, whidi is an ekvatiou <3il[ed 
the piKriuoDtory, eauaed by iIk- lower coil of tbc oiohleiL Tbia 
la nrnrvr tbc tympanic membntre, in tbc normal (itr, than aay 
other piirt of the wall, and atn oflen })e^eeu ttircugb ii anu (lale* 
yellovr «\)oU In tlie wuH jmt anterior to this iftu pitehfork- 
abapod ^i^oxcf with fines downward, in which run braaelicB of 
like tymjianir plexui» of i)crve«. 




T08 l^fHIR TTVPAKIO WAii. 



27 



Oq b I^vgI vritli tli« lower bonkT of the ])ix>muntoryr nnd be- 
hhu\ it, iH a mundei tjpeuiiip into ilii^ t.iA^lileu, 2 mtti. in diiirm'ii'r, 

a [ueioUraiie, Boiutitimw calM ilie meiubraiL» oecuucWio, cNjm" 
jMM^ nf Uirrv l»yvn»: an otilf-T mtuim^ ii miO(11i< fiiinju--*, iu»t £n 
iatemal Beroiu layer. Tt»e latter b batbed bjr the ilutd thai fHla 
Uie ljri»|)«nic M^la ofth^^ cocthlcii. 

On a line wuh Ihe pmmoutorv, aWve and a little behind ii, 
«» tlut u Vi<rt(<uil line nlojt^ tXn |Hx«k'rior border wouli) libocl il, 
die foiumcD ovale, or oval vriiidow, is found. In ^tiaj^e is nearer 
Tvnironn chau oval, rik) tlie Imig cliamcler b uilvro-pwtmcu-, 




BmiTT tlofKit TvHr.inic Wall rBumctl]. — Xnlv th« orifice for the t«Ddoi> 
oT tfc« ubaot ijmipuii mnfclif, Ulii £#r th(> fiDpohuv* mid lli««hiifdiv ^fnn|Bni 

MTTCv 



iitcliDcd a little dovrn^fard and liackwartL It it 3 niio. lon^ and 
1,7 mmp wide. A [uTiMiidimlar Mm* dro]>|>ed fnim lb juinlerii^r 
cud would make a ehoni of an anterior arc, repnsentiri^ iRnrly 
one-tlitnl of tJie round wi]idr>w. Tlie foranieu <nraleo|)en3 into 
the v^tiWIc and iV elwxl by mctnbnuic; tli^ vti^tibular i^tnTaco 
of this membrane is ^rmt-'i, ils middle layer is Kbroui^, and \U 
tytn|niiic MirTact; u cox'cr^d by tbe bony foot-plate of tiftV !^tap«8. 
It is opjxHtte tke tympHttio mcmbniQe, and connected witli it by 
the chain of OMicled. SometimeB puts of the anvil an<l »tape9 



28 THB HUUAN EAR AKD tTB DIBBABBS. 

or tbe oval window can be seen through a perforated dnim- 
bead. The pyramic}, or eminentia stapedii, lies behind the round 
window, and is curved so that Its summit nearly reaches the oval 
window. A canal extends from its apex to its base and opens 
into the aqueduct of Fallopius. It contains the stapedius muscle^ 
the tendon of which escapes at the a]>ex and passes to the stapes. 
The base of the pyramid ia partly in the posterior wall, and bor- 
dera the foramen for the chorda tympani nerve* Behind the 
pyramid, there is an elevation of the posterior wall into a ridge, 
that curves upWard and forward along the inner wall, and forms 
its posterior an(1 upper boundary. This is tbe bone covering the 
aqueduct of Fallopius containing the facial nerve. Sometimes tbe 
bone here is deficient, and the facial is exposed to tbe middle ear. 
The inner wall is covered by mucous membrane, continuous with 
that upon the other walls, and reflected over the muscles, ten- 
donSj and ossicles. 

The Ossicles of the Ear. — The middle ear contains three 
small bones, united by ligaments into a series, or chain, and moved 

Fig. 6. 

* 9 



,. p 



The OaslcLEM (Leid^).— 1. Inner surrace of malleos : a, head ; h, articulu- 
facet; c, manabrium ; d, slender procesa. 2. Outer Hurfnce of maJleus; iettera 
as above, but e^ nhnrt process. 3- Poaierior surface of malleuH: a, head and 
lace( ; ft, ahorl procena ; c, aleoder process^ 4. Toner aurfoce of mcoe ; a, body ; 
b, articular facet; c, short procew; d, long process; e, lenticular proce?B, 5, 
Outer Rurface of locus ; tetters aa above- 6- Lenticular procefta broken off. 7. 
9t«pes: a, bead; b, c, crura; d, base. 8. Bane of stapes^ 9. StApes cut to 
■how obturator groove, a, a, 

by muscles. They extend from the tympanic membrane to the 
membrane of the foramen ovale, and are called the malleus^ 
incus, and stapes. The orbicular, or lenticular bone, once de- 
scribed as a sesamoid bone in the articulation of the incus ami 
stapes, does not exist 



TBB 08SICLI3 OP TBV RAR. 



The moifriMp or UamrDcr, rons&U of ■ bu&d, iwek^ two pro* 
CttPOJ , aiid manubrium, or handle. It is 9 mm. lon^, nnd the 
DOdc diviiUn i1 into twu ouirty i^iim) piiriA, TIte head i.-^ dub- 
ahaped and nmnded ; It is 2J mm. thick, uD'l iu h^n;; diiimtit«T 
is ncArly \-ortJc«] in jiwitkw. It^ poeteriorp itilenml s^urTaee has 
a vatieaJ, oval depressions or lac«t, for articulation M'illi the 
iDCns. The nook 'u h cx>nstrictii>ti U-lovrihe haul. The head and 
Dwk piujcct into the middle ear, are free from the tympnnb mvm- 
iN-atief And ejclr^ml n little ulxive iIm nppax margin. Juat below 
tlie ueek there i« uvnmll proltil)enirK.v, rtillei] U^e ^hort prnc^G, 
which projecte otitward agaiosc themembranatymjimiifUnd looha 
like a minute yellow pcarJ. 

The slender process, or pnwemui gracilis, is loti^ and »lini, 
like the blade of a Cntlln knife; it prvgcdiii forward from the 
inner earface belovr the iieek into tlw Olas^ian fiwiin?, wlKft? ii 
ia ooDoeetixl with the U>no below W li^unents, vtlxnAi permit 
alight movement. Below lh»e two proccasea the manuUriuiu 
extejkl^ downward and backward; it is Ehick and r>undet] &t 
llr^, (lien bayonet^iaiked, with one c^lge nntwanlj and gr^ually 
dimink^MS to terminate in a slightly clubbed cxtmmity. The 
wliole len^h of Uivt proc^ew I'usa l>etw«en the two Bbivufl layen 
uf tl^e tympantc membrane, 33 before deeeribed, and abowi^ clearly 
ikroii^K it. 

The malleos is held in poeition by ligaments* The interior 
UgiBkcot extoiidi^ fr«>in tl3<- ncrk i>r die loutlea'^ ar^l root of llio 
processus gradlis, tlirou^^h the GloseriaD fawrer to the ^pine of 
the Aphencid, nod U al:?4i attai'iied to the frame of tho tympanio 
membrane and the walls of the fisfiorep The fibre* ninning to 
tJio eplicn-ii^l an^ uurnlioned in »>nie anntoiniiml workr* a^ the 
kxaior tympani muscle, but later researches have pfoved cbem to 
be a Ui^amcnt 

The 0ii|M'nor ligament jaavum from the roof of the tympanum 
4c»wnward and ontwanl to the head of tho mullcurt. The external 
ligament estend« from tlie lHa|>oral bone, aljove and ineide tlie 
aegmenl of Kivioiu, where the anniiUi^ is deficiL-iit. t4) the frunt 
of the neck of (he malleus. The pjicilenor ligament 19 iUv |M>i- 
terior Gbr^ of tke external ; the two really constitute a laiMhaped 



30 




THIt R0»A5 VAlt JI!>D ITff Dtl 



ligimmt> cxd'tKling from the (tmlfgutMif It^oe lo the maUetiSj and 
9onKttfiieH called the axial ligamotil. 

Xh<* m^ok or tl)t< mulltnis iiu>v<-3 but little, Iht owide feecntog 
10 rock ujHin this {lart as a lever ii|>an a fulcrunt 

7)^^ mc7M, or anvil, is ro named on aicoount <if itii ropcmblaiK^ 
tofla anvil, il )i.ij< a body aiuI a fthorc and long^prctceAs; Ui« 
proccfisffl arc ncnrlir at right angle?; to eadi oflier. TliP kQgtb 




Pio. 7.— Two int^\m dirkled 
Into How !"')• 




I If*. 8,— FiT«triuifno1cn<linikd 
iMi> miUioMtcn <tNii.). 



oj' the Hliort prot'effl and \yx\y !>* a1>ou1 5 mm,, iliiii of thr long 
|iriKy?«« aiul bwWf 7 nioi,; ihc l>ody is 2J ram. in diameter at ilfi 
thickesl part 

Tln^ l"in<? look* more like a hiciispid tooth ihsn an anvil; the 
bodv has opitot^lie ilio pnxHw«u< a» oval fiwx't, which look* for- 
vranl an<l onhvard, and k arlicuUted hy a capr^ular ligament with 
the head *jf the mallru^. Th^thick, j>oiulc«l, i^hort, or horizontal 
(irocvas extenrl^ backward aiHl downward; thia proetva and the 
txKlv of the tmiie are very n<iir tlie roof of th«* tympumim. 

The loDff proott*, or de«cvnding ramui, curves a little ontn-ard 
and downiianl, lK<H>i]if^ uleiidcr, Uicn ium.< almiptly iniranl, 
forms a biitiort-like, or le&cieiilar extremity, whicli an» ulatw with 
lite haul of the ^\a\vi*ti byanupubr lifpim^^nt. A fcv^im^d bone 
is round rarely in the joint, wLu-li h^ l)e«n de^^ntted aa the 
lenticular bone, or m orliculanr- AnntomiHt^ now deny the 
cxif^lence of th^ formation, luid ranBidtT it when found the len- 
lionlar prorerH tJiat lias boen bntkc-n ofl' during di#«ect>on. This 
procei;^ b said to exist as a separate l>one in the f<etuA. 

The JUi'nii \* held in [KtinitLon by it» tym[nnic' and articular 
ligameata The superior ligaoieitt i^a^es from the roof of the 



Tut O801OLKS Cr tUK RAa. 



31 



tjmpnmim to 1h^ toiHclle of the filiorl |»roc«»a ; tiie fiMtBrior liga- 
mcnl foi^tca^ iho {mint of the short process to n ^li^bt ginimttuMicc 
uiMin llir {Kc^terior imM uf tlj«> mr jiitft abnvc tlic Inr^t opcniug, 
the antnins, into the mastoid celtd. 

Tbc prir»r(|K»| piirL of tJw inrij* h mar tlio niof of the tjrm- 
ptDUD), ami hfifl'^ abnve Uie inner end of th« external canal, t f., 
uIkivt llio iippiT u«)go of Uie lymjntiic; mcmbmiie, utoiig M'itli the 
bad of the malleus 

7^ riaptft, or fftirru|) brniv, » the ^jhaIIi^ bono in tli<^ iitiman 
skel«4oD. It cousin of a heArl^ iierrlc^ two armti, and a Iuim, It 
iA4 mm, lonf^ Jrum ib« bcn<l to tbt inner ^iirfiui^ of the base. 
The bftfe U 2Ma 3 mm, lont:> 1 mm. uMe, and about i mm. 
tfciok. It iF^ t<hu]>i*(l much Hk- lh<> old-fEi£hi<>iiv<) in>[i ntirrnp, 
ajtfl «xlci>dfl horiz^itally froni the lenticular procee&of the in<*iu 
to llw" iwal window. Tht* bend ii^ n short horijtonrul (ryliiider; 
its outer eurfacie has a cup-sbaped depraeion, into which proji-ct* 
Llie ieulifular pmo«« f>f ihi- iuni*- A i.^|«i]bir ligament am- 
necta the two bon^and fq^m^ a ball-and-socket joint. The jaiic- 
tionof ihe h«did with lli« araw m oallwl \\iv iiwrk, tlioiigh node- 
preecjon exists. 

Tlie crtint, bmndu'^, or arms, spring from the ncok, oiif^ from 
tlte anterior and on* fn>ni the posiprior [Hirttfin, ciirM^ away ffoni 
cacfa otlKT in a bori/ontal pliinr, iinJ finally join opposite t.mU of 
the oval plate, which formfllI»el«L'*o. The ^intiTior arm i& shorter 
ud Icwi etirvi^l than tlie posterior They diminish in thloktifM 
as they approach the ba.4e, aad are nli^lrtly furroweil upon their 
inncf fturfiiic<es for insertion of the r>l>tnmtor ligiament. 

TW has*-, or font-pIaUr, of the t^ta;>i?a is a thin laminn of Inme, 
ducnb-bell or kidney sliaped in a per|>ei]d!cular plane, and like a 
COnaTO-oonvex leiw in a hori/onfal one. ll pnij^cth al e(U*h wid 
a tittle beyond the Junction of the crura. lis convex surface ia 
lowanlft the vestibule. Th« plate is smaller tbAU the foramen 
ovale, into wbieli it ts held by an annular lit.'anieni from Ibe liony 
margin, and by a 61>roui« eonnectian with the membrane, wliieh 
|>erniir<« a Mti^lit in-hiul-oiit movernHif. 

The obturator liniment, or figame/ttatn ottfiiraforlum stapfffi^, 
is a thia plane of ligamenloas li^HiiOi tliat extendi lyefM^'OMi the 
crura and the buL«c of the stains and elates the opejiinjc. 



32 TBI HUMAS lim AEp ITB D1BBA5IS. 

The oeeicles of the eu- are covered by periofiteum, and delicate 
cflnitage k pn^est apmi the articular sarfaices. Tbe heavy beaida 
of the malteus and ioctia are above the axial Jioe of mobooj and 
thk (freaiJy facilitates moremefit. 

Jtutda. — Tbe laxatt^ stapedis is meDtiooed by some irritefB as a 
£nt»de, by others as a ligatDent. If it does not posese musctilar 
fibree, it may act by elastic tenEioD. Described as a nmscle, it arises 




Ki'^HT ABT[crL4TF:D OffiTCL^ (X 4 diam.) iBanietl)- — i, Incus; a, body; 
if short proc«H4 ; c. long proems ; e, leniicaUr proccn : d, heul of fttspes, mod 
Dialleo-<up«dal u-liculaLioa ; I, cmn;/ Dunubrium of mslleiifi; ff, alender 
prttcem; A, Deck; i, head; j^ maUeo-incudAl articolation. 

from the spine of the apbenoid and cartilage of the Eustachian 
tube, pasM» through the Glasenao fissure, and is iuserted into the 
TOt}t of the procensDs gracilis and neck of the malleus. It is 
said to be supplied by the tympanic braoch of the fadat nerve. 

The tensor tvmpani muscle arises from the temporal and 
BpbcDoid bones at the end of the Eustachian tube, from the carti- 
lage of the tube, and from the walls of a bony canal above the 
Eustachian tube, passes along this to tbe ear, and terminates in a 
tendon, which turns outwards at a right angle over tbe processus 
cochleariformis, and is inserted into tbe anterior inner edge of the 
handle of the malleus, a little below the processus gracilis. It 
is supplied by a nerve filament from the otic gangljon. 

The stapedius muscle arises from a canal in the pyramid upon 
the inner tympanic wall behind and a little below theoval window; 



TBI VK&SVLB or TIIS TtUPAlTUlf. 

tu lendoD lGav«s Uie dtimmtt iinc] riiti.s upwiinl 11114) fi^rwiinl, and 
b iii«C7rU^I into Oii.^ pwkrior vdjse Qi' the arii<-ular suri'w^ of the 
bead or the riCd{K:i. Tlie uitijttli* tiemU at in obULM uiij^Il- lUlvr 
tt Itvvw tli« pyramid, and is stpplied by a Ghuoeat from the 
faHaJ nerve and ouh Imui the otic gjiQfzlioti. 

Tbc liixau>r ba«u« f^ULfwilts mti;<cle arum from the iDn€r wall, 

one niilliraeter abore tJje piritenor-cidpcrior liordcror the oval 

wtudow, ami 18 iiij^^^^rted into the jiiiicition of ihe |K»UTior limli 

and toot-plute of the stajkc^ It reoeiveB a tifttmc^nt from the 

' iacud ucrvLV 



Tlw middle ear id liai.<i) bv jK^rio^knim and mucou)^ mf^mbnine; 
Um laU«r 10 redeKScd over the surJaoe^ uf tiie ii^at^iilA, mu^ci^ 



Pio^lOi 




RKHn'TySPAitUW vtIcWed »'ftOM AfioW 'X Sdinm,) (BurnoU^ — a, Anl«- 
rior ]ii:iiB>«»t uf ihi* nult^^tii ; b, chr>nU lyni|aai (i«rt«: r, hrodof irmllciir: d. 
IKvCfnor ti|Etiiie«t of imwi; <; 'l^vi proucM orbKiui;/,tenBOJ-|,vni|]ttiii mutdft 

dea, w»d til*? HionU lympaiii nerve, forming; fohK pmj^'tioii^ 

abelves, ainl poi'keu, tta before d«t^<ribal. Il h thiu, delicnte^ 

and };lMtuiN% and upon the va\\U of the cavity 114 intimately 

poocuiecl>:d with tlte iM-nosteunir so timt it has morv the appeurauoe 

lof aseruUd tikau a n3titM>us memhrane. It <v)ijtaiiu no glamla, 

[tacofrpt nuir tJj(T euirancc of tlie Ku^titofmti uibo^ wb«r« raoamose 

bave been d««cnUM). It u well supplied vritfa veetteU and 

^MTVta, luid hnincW uf both tr>v«r^ itM buMrnieut mfrmbruiH- ind 

into itfi depre^ioiu aad fold^ to supply the ^tru^tin^ of ilie 

lympanum. 

Vmelt <ff the Tympanuit^ — ^These are tJie styto-masloid, a 



tm UUHAJt BAR AUD its D1IBA8B9, 



bmnch of the posterior auricular, which enten thft tympntiiiiii 
frottj liM* jw«i<*nor wall ; ihr- vxtcrim] tvmpamc, » 'irvinch of the 
internal majilUrj-f which enters from the anterior v/M-, the 
(iiHjer) tympanic, a bniU'h fn^m lh<T Vidian, vfhkit mitm (Vom 
Die inner wnll ; the iDfirrior tympcinir, a branch of the inti?rna) 
cunrlid, which uili-n* fmai thr uiiffTiur mill ; ami Ihc liibil iym- 
pnnio, a branch of the aiw^n<lir>g pharyngcalp whit-h entCTs from 
tin* afikTJor ;vall, haviiij* i&ji|f|i]it*tl tlK* Kii^lnrliiaa tiilxr nii'V tt'nsor 
tym|Mini a>n«-lf. Tin's*!: vc?tHi-lM aujif^tnmtvc fiwlv, form a rich 
<<a|>illnry net, supply the hone^, [jerioslenm, ligaments, oiuwlMt 
atui mueuutf inctnbmne of the tympaitiuni and ntuj^toHl ms\h^ imd 
anmnnnicatc throngh the tympanic Qkenibnme with the Vttwla of 
the (*xt»mnl Cftnaf , a« wirll, a# with iIkh^l- of the ^'troiM bone and 
contigvooa slructorefl- 

Th*? wins of the tympamini conimntM<:atc fn'cly with itie tnas- 
toitl veAAola, th<! ve^seU of Ihe siin-mimliiij; Wno, anil ihtiH^ vf lb^ 
€3ct4!rniil cnnnl ; but tW most im|)or1ant onert )>e»ctratc the ioner 
and npper walh of the tyiiip«Diiin and join tJ>e iniilcllo iu<*n!n* 
geal; ollw-nstlR' Vulinr], petmifiol, sind muscular bi-anrho;, join 
the pharyngiiil ploxii^; thv fi>ni>er trnpty into tlii> tnliTiul max- 
illary^ ami finally into the tein|>ora], and the latter iato tl>e id* 
t<trmil jn^nltir vx'iti. 

The lymphatics of tliomitlJJe car paw through the pet muii bone 
tlong tin* KtiHtaic'tiian ami tm^^r rynk|iaoi ainal» to join ihe pha- 
rynifeal plexus, ai^ before ilcflcrit>e(L 

.V**nr*'. — Tht otic- ganglion, having rcocivcd its wrn^itivc fibiw 
frofii the inferior maxillary, it£ aymp^ithetic flbroi fnini the grcAt 
m<-iiinp.^i] pbrxtm, and motor fibnH from tlit iiilvmal pturvfroiil and 
from the facial throngh Ihe small |>etro^l, wnciA a brancti along 
the cnnal of tli4^ tcn.^^or tyni|GLni ma^^v^U' hiiiI s^iipjilit.?^ it with motor 
influence. 

The lynipaitic branch fff the glo.*HO-pharynK«il f Jnoolirwii')^ 
n(^^^'r'), the moHl imjiortaDt nerve nf the tymjxinum, enter* it by a 
foramen between the jugnlnr fowui und tbi.' carotid C!ina1 in the 
6<>or rH^ttr th<- ioner waW^ and rocfiivo^ filaments which havo pasMd 
through Ihe Roor from th^ (ftrt>rid pli-xim of thv Htymjiftlb^tio 
I'ytitcni. Il iictf in j^roov'tK upon the inner tyminnic wall, breaks 
up into numerous hranolu*i«, with whioh a kr^ uamber of ganglia 



I 



VBRVBS OP T88 TTMf%!tnM. 



86 



ivlbi an^ Riinjrl^i ^ that the m««h hm \xtn jtwlly ilcnomiiiaUid 
the Irmpanir plexus. In ih^di^tribiitior of lilam^rnr^, one ¥np- 
ph'ft* tJw int]c>iii>i nicmlintiii^of (111* Kitntochian liiU% on*? gow 
npvanbi to the small petrosail and one to the large p^troMl 
nerval, ooft to tin* nvjil wimloWj one to the round wiiitlow, lutil 
many olhci^ iinitiag with otJ»er iwrres supply (h« mucous inai>- 
bmneof the lym]Ktniim nml mjii^toid rcllx. T)i« oonti«Tii4>n r>f 
the nerve by tilameDifi to tlw petrosals, with ibv otk* and spheiio- 




Nititwi IK nii^ ArttAi. Rir.mx f Ihimi>llV— 1, Fifth ntrv^ nnil CSftwmin 
^niflim: 2, iFTihir IvrapiJii ttkUH4«; 3. motor fimmh of flflli ; 4. ninllMis; 5, 
ttDftll prtittMl ; ^ inciin ; 7^ otic giutf liob ; 8^ Tocid Uk^rvc m rnoHi : V, diordA 
^■ipnoj iHrVGi 10, ipumlrmim ivnipam ; 11, (gnaar (dldli niuM^le^ t-, iiiidillc 
finnnjntp*al urtt^rr; 13i» liu^inl nt^vf; 14,3iiiririiTiMrTiipr»r*l ni-Mv ; |*i. Iofi>rJAr 
L^vvirsl neni?: lO^extrnttl i:it4rrtKOif1 idiip4c1« ; 17, iiiicmxl (ilirrTsi^irl mmcl^; 



pnktine ^n^lia, make^a clom ^yiapathftic Mmnoction Utwten 
th« ear, Uiroat, iii^e, ti<cth, ami ifyv*^ uimI explninA muny ^tirionK 
Avrnptonks. 

Amoof; the nerves of tlio mMcDi.- wir licforc ei^iiniomlwi ifl a 
hnnch ofihe fuoUl, wliich |w»ffi tlimogli a fonmen in ih^ inner 
ivall of the t5mpanuiT), Hcod« om* lilamunt to the Inxalor tym- 
paii, one to the Htapediua, and one to tlie fixator bafia stapi^dia 
mcwelce* 

The chonia lyropani wrve enters the lymiiannm at th« lower, 
p, post^Tior con»or, eurvw* up fl!on^ the bnrder of the tym- 



36 



TBS HUHAV EAR AVD ITS DTSBASFtt. 



pttiiui luijcnljntue, yaiwm fvnmnljt nbovt thu tviidiiii of the Uitufor 
tyiit|>jLtii tiiUM:lc and bduw tliv J^bvrl proc^M vi' clit? iu£a1I«iit4, id 

«i»i] K*^^ ^'^^ ^ iJi^' tyLDpunum tlin>u^h tbe causA of ltii|^wr. 
It ]iEi9 no |>1i\.-<iiiliii;i(':i] officv ill n>Dii4Hliiin Willi thtf t»r. 

Tbe Eualacliiau Tube, fmai its loramm in tbe middle of the 
mitenor wall gf llit- t)^iup»iuni» ruun bvm'nlli t)ie mnal of tb^ 
iciiM>r t^'iupaiiii muM:1c, downward, forwanl, und iDwanI fron tbe 
middle ^r U> tlic^ pbaryiix, iind tha"^ |K'rmiui ii tVvM^ |im»nge of tb« 
tur riviru tht? rbroiu to tlic air Ic pasN<4 from th^r tympcinum st 
an angle of I3i^^ wiih the extt^rnid ntidibiry ^mial, btit ftova the 
vxu-mul HH^tliiv thmu^h the far to the pbaryngt'Al end of tb« 
tube the dii^eoiloQ ofleD aj)[in>iimat(ti u> u ourve, lu aii tDfant^ 
Um- direction fmm the ^torDal meatus to tjic iimer end of the 
mbe ifi nearly tmnsverw. 

The Ku'^tiii^huui tnbt- ii« )<<^>anUcc] froii Xhv tciHwr ^mpani 
miLside \>y a thin scale of bone odeti iiK^oniplefe^ buc n'itb lis de- 
rK-H-nritifi (illbd vt'itli nirtlln<^ »il<) librotitt ti^ue; tlim U mlltxl the 
pr'H'o^utt coi.'bWrifomii>i. 

The bony |K>rtion oF iheEiti^tadiiAn ttibc U^ibmil \2 mm. long, 
and \l6 inner apcrinre is id the li^uiv between the great vrlng of 
d)<: *<[ihenoid and the lempoml bone. This end ia rough; the 
cartilaginouii gwrtion is joined U> it mul proloiipf it nlxMil 24 mtn.^ 
makinj* the whole length of ih(> tiilie about 36 mm, \\^ tnchcH). 
A triangular ptat^^ of eiirlilnge l.'^ rtirled u[>oq ibielf lo form the 
i^mila^inoi)^ |>ortt«>n, but its ciiger*, which ure below, dn tu>i meet, 
and the spocx^ U lilletl tiy fibrous and musiculnr tiasoe. 'I'he ttibe 
]» liiK^ With miKHKi-T; nKTuhr.ine i^ntinnotir^ with thiil of the mid- 
dle e«T £iihI Ibe pharynx. Itiieanal U »hii|M?<l like two tmneated 
ecMu^s 1»U^i<^ A little laterally iind Joined by the ttmnll cuds; 
one |>art is in the oeectfus, and the other in tlie hliro-cartilag^noua 
porliou. 

I'be uajTowot port of tbe tube ie at tJie junction of the concs^ 
aiul h ealled iJie bttlimUH^ whi^- tlie vertimi diameter » 2 mm. 
ind the honxottal ift I mm. Tbe aur&l end has a diameter of 4 
to-t.5mra, ;thepliaryngea)^4.dto t)mm. in be^it, &nd4 to^tnm, 
in vridlJi;lhcex|]andod )iluiryn|^<al end, oroeLium, is dtoG.Sraai* 
dee^ Tbe cartilaginous |rortIoD b heUI in position by fibrous 



Tnt ftJSTACDCAS TUBV. 



37 



tiicue mwi the nitiaoW Franmunditig it, ntid it8 inn«r end is eome- 
trlmt fmtvnliti^ Thi- plmrvngi^l v%\*] h:n< n ilif^iliillv <'1(^vji1(mI 
IrihW, ei^|iecidllv pwtcrior, aim) is expnrxW lik*? rhe niomli vf a 
trum)M-t, with iti* KkiAv^ ]m?<j««il h little tr^:HlH*r, )«f Uint tl»^ fi|>e»- 
inp B^sui irregular, per|>fncllcvlar oval It varks wmsi'lrrnMT 
in tin' tfliA]ic vf its lumrn In <)iflun-iit iiiflivhliiuls, »m) n|H)n the 
two 6id«s ID the aiioe peiwn, aiMl corre6|nn<lA m aw irlUi tlM 
ext^rrail ni<.<iiiii«; u larf^- ipi.'mii» acvnm[Riinof u hir^monihH 
tube, 'i'hp month is Biiualccl a very tittle Mow the angle fornwd 
by ihe pojiierior Qt\^ cif ihi^ (-xWrroal wall of iho n«*ul frw^a and 
tha ifirerior turMn^ted fnne, and a little ahove ihe floor of th« 
nooe, ami exii^mal to it^ ^^ukT wall. 

Tlir two tliiy>a( o;)^'nin^ ar<* al>^ut 2& U> 30 mm. apart. If a 
ktfnofn Hlraiv Ite pUctd wru^^i with an etid In c»oh Kii$£ftr>hlan 
tulxr, itn middle will nearly toiif'h tlio plrarynx, 

Some pcrwMJft witii vvn- larj^v thm«u, othtti* with jiroal I'I^mIiIi 
of (he lB?^^of Uie bJiuII, require Eufitaohiao Gallielers with roiwtd* 
enble curve. I mttin-d iliiit the* <«chi>terH uwnI by (Vifi^^is 
Miot and iJcHir^nce, ac thfir rlinic& in Parts, were mtic-h lc» 
cnrv^ than th<we tw^ by l'ri>iL^5«ir Urubcr, At Vienna, and 
t^fDHBor LQt/e, at Jierlin. The KrHtdi ^knlK Hke ibwke of tJie 
Ijitin races geiicriLily, hu^v narrower bttses than tl»e Au<.lriun and 
German. 

In ver>' iurmwt<ktil^ «>tiH'tim«« a ncfiHy «traif;lit fltthelw 
will ^ Ihron^h the nasal foaaa directly into ilie tribe, t^kcawon* 
ally, the inferior inrbiiint^'d lioiie of one f^de h -to low down, of 
Ibe Tunwr la ao bent laterally, timt one onoot introdtice a outhe* 
l9, whvn retort mL)?<l Ij^ had to a flpeerul oni\ npitH^Hl throo^h 
Iho oilier na«il foana, or through tJie nH>uth> it is vot)* fr^tienlly 
the case thai tlie di^e^b^ ear m the one correttponding u> (lie ^ide 
of iJwr iMffir deform«i — too frequent to lie accidental. 

When aeatholer in tn pmllion, thi^ inofilh of ibt^ Kufltaeliiftii 
tube tan be cnovnl nearly 6 mm. The point of a catheter in posi- 
tion may be luruHl iipwan) aiul <,^i1u'anl, exib^ly hnnzonlal artd 
vomMitnee even downward and outward. This depend? no tlte 
piNntion of the palatr^boue, the width of (lie tfkulL^ and Ihe aIi4i[}« 
of tite temporal bone. 

The Eu«ta«^htaji tube la 1jne<] in il« hony portion by ppri«<tiiiiD, 



dd 



TBB QVUA5 BAA Atflr ITS DlaBABBJ. 



It) iu rurtiluginixiH |H>rliuii t>y |H:nf?li(milnDmf butJi bemg covered 
by piuooug mcDtbTaue. TL4.' baiMMof tb« pliniyikx aro covered 
Uy |icrtitf4<:um, comicctiv^; tiMUc, und hxwcly up|>l>ud inucouo 
iiioiubraue. Tbc macout^ menbmito oJ' tixe tul>o an<L pharymt^ 
Dff low 110 tbc poLiU^i in fumtnhcil with citintcd t.-fHlhtOiutD, tlw 
ta]ift of wbi<Ji act from tbc tyi»|:iunLim dovruwunlA ^ ciUotrd g[>i- 
thcliuin ttliM> covcnt lb« naiia>un ncmbranc of ibu rvnpirutory 
poi'lioii of llic noi^o. Bi'Iov tli<r fioliitoljoiic the pbnrytix »0«ii|>^ 
pUitJ witb 3^iUkiikiHi9 cpiibrlUiiii. Th<t niuct>ik?i tueiubniiir af tJ>c 
KuMachmo uibc, exempt ito up|hrr wall, U tKhly tilled wilb iMi^ 
Qvtio mid fulliculur glund», nbidi fiiMilly du9ap|M*r low&rUd (lie 
tyjiipauic cavltj. 

JftuWrA — Tbc EtiMnchuin tuW !.*« stirrouiKlM) hj rtlruclurco 
wlik-l) itiflucnoe iU atiimi deiriOt^ly* IkiKAlli ibc nuicotia mem' 
hmiw of 1I11; |i)iur)'ii\, und iijnui niid vriiliin ihv (^ruiiLt;(!vo tmu* 
beiirttlti, llH^rt; are iiuuivroun fiiutcIw, wbHi cuutmct wtlh rvvry 
act of bwallomQg, and ibu^ idTv^'t ibr ixioitivrj uf tht; Ewtcii.<)ibQ 
orili4.-e and ilH pntuleucy. 

Tbr U'liwir (vdnii oiuwlu m l)ir mimt importnnt onv in nunnvo- 
tioii witb ibe KuHlmTliiuii iuImv ll oris^?* by a broad, thin, fan- 
Tihapcd luyiT of iibrcA frotu the- «cTi|ibi»id Iikvb »ixl T![iiim of ttiv 
b|>beijmd butie, auil fn>iu die milerit^r li|i »r thv KuaUidimu (%r- 
tlbge, wmcliiDis uniting with the UniM.»r tynifHiDi, iiml Ik-chiuo* 
narrower as ii paHses dowiiwurd imo its tendon. This passes 
nn»uud lijt^ liiuiiubir priK-vw (buuk) of tbc irUTnid plm-gvid 
pluie, f;x[iands a^in into & ribbon of ilbn-B, and is iiifrened Into 
ibc poaK^rior 4*(lge of tlu* Korisojiinl ptmion uf iIk^ pii1uUT-b<j|»e ite 
far as the middk Um. Here ii mUigl^ its ^hren witb iih fellow 
of ihi< op{i4je}Uev^ide-» ariii with thi' luyj^m nvular mu>rltt% wbii^ 
extend from the nanii 6j>iDe sad aponeiiroeU down in th« middle 
liiK' and rirrm tlie bulk of rb<^ iivnin. 

Tbc leViUor palati iuuscIl> aripws from the under surface of the 
apex of the iietroux jiortion of the tein|M>ail botie^ and frtmi tlic 
adjoining ^artila^inoiK portion of the KustacUian iub*;j it passes 
over ibit upper coiK^av^ edj^ of the t^ii)ii;rior ix>]i&Inctar of tlie 
pharynx, {^(M» downward ;imi ini\'urd„epn4id^ out tt» librct! in 
lU*.-. pc4teriof pan of tbe »qJ1 palate with thv libres of tlie tensor 



Title fANATQ'l-UAirMiKAL HU5CLBB. 



39 



nlnti, aod cxtcitdd to tlic ruiddiv line, miiigUti^ wilh Umoc of itd 
fellovr, and i>f thi^ iix-tiln. 

from Ui«Atvluiil procc9>| pa^MM down Wwccn (he mipcriur aikI 
lie cont^riccor muscJtv, ittiJ, ti|irvaijii]^ imjI Uriitutli tliu uiu^xitia 
nbrni»c of ihc pJmryiix, i?« inMrrKi) into the (ntddk- vxHWttnUor 
nivaclc uit) Ui« uppei- [mrt uf iIk^ ihvrvid iTtirlilugc. 

TIh" p*l,iiO'pliftrvoj;«iA <iji»clc fcrrni* dii- |>o*Lerior pillur uf ihe 
ffluvce; it iiiuun iVoiu tbc Auc^il uud la uiiiigW with Uk; itiiivctc^, 



b'lo. 12 




UoacLta or Pj^litb ahu KACObiiLeidf),— l, LvvmorpikUtiiuiiw'meft 
it Kamvfvl ; S. i^npor \a\ati iduboIct ! 3, njLygv* uviilu jniuid«« ; 4, l^UHiMoht»n 
if 4, ori};m uf |Hlni4i'[j^]inntiH and tMi)ritu>f>hdfvij|pi!UH iNivwIn; 0, pnn v€ 

whtcli form half of the soft |>a1ate and uvula ; w |)crfcntcd by 
th*: k-Vii(Lir [iQilEiti, ]ww^ontwui\l mid dowu^vard lM?hind the ton- 
ail, and ^prcnditig out i« iti^ertvd into th? pckstonor bonli^r of the 
thyri»M mriihij^* and the khU of ihi^ pharynx, amtHigsl the &lam 
of the middle constrit-tor mu^lo. 

The ftU|>erior oouatrittor niQM^Ie t)f the pharynx, aUo, hus rela- 
tion with the Kititacrhiaii tulw. It h a thin, jm^ qiiucIrilatiTftl 
JiimWf which arises from the lowpr half *>f the internal plate 
the pteryj^>id prooe^i and the hoi»t< of the sphenoid hutlt^r mid 
tli^ pteryRo-maxillary ligameut, atid curves badcward and 
~D|i«rarvl to Join xIa feltuvr in tl»e median Jiii« arkd be iii>aeiliHi into 



40 



THg BOUAV CAX AND ITS DIBKASVB. 



•ike phnr^ngffll nplncon the IvviiUr proonvi of llie vicriptlnl txnie. 
Tli« iipa<x- ubovQf bctue^vi t( H»d ihc le\'ator jutjitt and Ku^Uichu n 
tube, 13 destitute at' m\v<'[v^ ui>il fiM(?d wiUi l^1irnuF< li^ue. 

Tbt intcrual pt«Tv;c^i<i '\i Mitl Lo tttkt lis origin hv fiomc iibrai 
fmni lltr nmU'r iHirdon itf ihc GQriiltigv of thr Kii--<l»'--liiiiii Itibe, 
ai>iJ till? MreniA pixtUilile fr\*tn eenAatioufl pn^loo-d iu lli« lygioii 
by contmHmg ?trtnig)y tlir muw:Uv of nia<4ticutK>D. 

Tbc roof of the pharynx hAs nicli n number of lar^ f(il1!cu1«r 
ditd rw^emo^u glanda, surrotittiled Ivy npoii^ Ibwuc so miu^i lik« 
that of tbo tnikeilj that ii htw bct^D called the pbnryng^il lomil, or 
too^illu pbaryngea. 

The muoflim mcmbm&c of the phaiynx below the Ivvcl of the 
pdlati^booe cojihuos a grvut many f<>IIi<7ii1ar and mcemotfr |j;Und?, 
«fhid» arc v^ry frt^netitJj- bypcrtrojibiwl ami in a condition of 
mflamaiali<M> ; aud tlte whol«f rc^km of the thronl abovo ihe 
lavTtix i» ridily iqipplie<t witli gUtuir<, in a thick nml <|iiite vas- 
cular uiticou9 meoibraner loonelv ultochcd to the cellular tifftic 
ujKJn the umw:W9 luid iHin^Tt. 

Th*t ttjitetita proper, snugly etifertxa-eil Wtvreen the pillaiB of the 
fnucv^, arc compoond folltciilar gUixU. Tlicj vjirb Imvo iw^'lvc (o 
Gncvtt lur^ follk-nlur u|M?niii^ U|»<mi tbe surfai-Y, vrliirh IniJ into 
pouoba» baviug Hinnller fotliolcfi o|x3nng htU) ihem. They move 
wllli l\w ?<ij|K'nor cojiM rit-Hor awl thti j>alat4>-pharv»geite muff<?fc*, 
and wiicu hjr|M:Tlro]di]»] L-xen-iHea pvniH'ioUA inGiKiicv u|ion tl» 
pharynx and Uit- onfict? oC xIk KiiHw^bbin litlie. 

TAf VrMtl/t uf the Ku«tiK-liian tidw, up|H;r pliarrtti »n<1 a)»c»' 
dale miiit'iiA iiieiithnLii&, miuului and )^Laih)t< an; nuait*rvitt axid 
jmjiortuiit, 

Tlie vx tenia] curotid artery t^ipplic^ th« eotire rfgioci by iistia- 
ni4'roti» bnirehii<, whkh aro here enumerntcd. Tlio liiignnl giv«i 
bruiu'lii^ lo rhi? 94}t\ jialaEi: nnd luiiiiiL Tlie asc^mlin)^ pbaryngtal 
8UpplJ€8 the conatrictor, teKsor, and levator mufck-s ; thr nin<vHi> 
inrjiihraiie i>r Ihf ^ft pmtaie, phnrvnx, Ku.Macldan lubp, and lym- 
pa&um ; tbc tonsil and {losterior pillar of Uie Imii^v, Tb«; farial, 
by it»a^<<Wing palatiuc ImDch.Mipplie^tbeauperiorconaUkror, 
tenjrnr palati. levator palati, and iutcmal ptcr^'gind nnirH^lm; tlic 
mucijuH membrariG <if the 8«>nL judato, plLuriiix and Kustachian 
tube ; tbe tonsil and deep cervical lymphatic glands. 



SUB VB$Kl£t». 



41 



TUo ifitcmal ntazilUry )d;ivc& a Lrnivcli to tbe (rnipftniim 
ihrotigh (he CtljLteruin liivurt', a Vidiihn Iminch lo thi; KtinitK-liiftii 
luW atni (vni|j(kiium, and \tciro»si\ bmnohffl ofclic luifMk ruonin^ 
gcnl to ih« tytu|>n»iitn. It dupplic» tltc convtfieli»r, Icvuhir 
pftlaE), tcnaucpalallf ami |tleryg<>i<l mttwlea; Uie itiuotuh muii)E>i^ii<> 
of Uw: luMil fomi, wfi anil imnl pal0lC| pharynx, luuj KutU^Jiian 
liibr^ All ll>0Mr arteries Ana^fonioe^ freely wlUi each other. 

Tho tivtenial cur<>ti<l gtviv ofT, m \\:^ cun^l In ^h1^ tiMiipom) 
bou«r fl ftiQAtl brauchp wliicli ^o€» ilm^u^li Um autei'lur waM ijiIu 
ibe l^)U|niiuai.i I^wcrdoivn it Wvit in iJiuii^urvuii jvixutmiU^-f U^- 
nouh An4 out^dc of th<^ lonjtil, 

Tli€ vi-int^of llie tvtri|iiimiin, a§ ibcv pa«fi out tlirough tht? Iid- 
Mim ami fimimiiiu oik) aJong (h^ Kn^tnvhinn t<il^,takclhe Aaroe 
names ob llic eoL'i^e]>f>o[KlMi^ arceriert, Soojc unUc wtth ilit midille 
meiiiiigiiil iif tJ»- iiikTiial iimxiUjirv, which rv(:i(-ivLi« llii- plrry^nklt 
lubtiiMT, atnJ othoi^ am] |xl»&k« ht-liiiiO the iieek of iIju Jawhuiie 
to unite vrith llic tcin|>i)ri) vein. Th« S^idiaii, |icLniNil, aii<i imu- 
eiiUr hniiii-li*% juia the j»hurviig<^1 ]iIc3lII4 behiiul llie |>h?)iyni, 
iihioh rt'ei:tvt?» hruijcliun ftimi iIk* {iharytix, Mill |)ulale ami IoiimI, 
«P(I UDitw wjtli theiitlcrnal jugular. The Jiugual nxvi voi hraDdie^ 
(ntm till* M»n |olut'-, piUjiixtfriun'e^ iiikI Uiii«ii, iind j^m^ ^» jolu 
die iiitt-iLml jugalar, Tlv lacial nK*ivts ilie iullritir brauti* iitiai 
tlio plirJiUK an>iiml il»e Uku^\ mnl Aoft [abtv. All ttiv veiiiH aiiito- 
toniose freely with esuli other and have no V£lv4«. 

TIjc lyin|iliulia4 funn » 4^]>il1uty ri<-twurk in the i^ir mid 
Kii9lacliian tube, escape from lib anierior orifiee, and unite \rith 
II vmat »ys£L*iii of vowi'ls from Ihc najvil and (ihary^i^ul mui-oiiM 
membraiitB and the uiieriar of the cranium, TlK-se emjity into 
tbr iltvp (vrviml ^IhikIm, whkh rwviv*? diictji fruin tht^ !<u|HTii>r 
cervical glauiJs, and eKteLid as a clmin allhig the carotid arteiy 
and iiiti.Tiitil jupibr vi^in, lo Linu]]yd('lK>iu^h itiii> ihv rif^lit lyui- 
pliaiiu duet, Uhi8 toriuiLg a liircet con mu nictation bettt^ecn the 
middk' i-sir and the bUmd-curreui of the right Hubvlnviati vein. 
(|iUEe aclust'^r of glaiHlff \6 ^Ttimtcd juj<r Ixni-nlh Hk angb of the 
jaw, whidi nxviv^s^ d«<:L-> from the irupeificial aud deep glHiid«> 
These arc especially prone to <uigorgein^iit from L-xtvriuil dts^iiw 
of lJi<; auricle, aud from pliaryageal and ton&iUir diAeofi?. 



TBB HtlUATI tAR iVD ITS DISBASB9. 



Tftf JVrrcrx in nnd about the lymfraotim iirc numfrmiK The 
fncifll ticrx'o, id Ihi^ internal auditory meatus, ^nif H^veraT 61a- 
ni^iitFi to tli« atidilon' nerve. In the miiicihict of Kallnpiufl it 
g\\vt^ olf the i^rcttl |totrci«a1 branch, vihwh Join« witli »orav srin* 
p:LihHi4' tihimei)ts from the niroliil plfsu^^ and a litaniHil fmni 
the tympana* branch of the gto««H)*phiiryn^'nl^ takt-^ i\w numc of 
(he A'idinn nerve, goes through the canal in the temporal bone, 
thmn^li the for-amen facerum antaim nnd ncitv^ tht ("p of th^ 
phnrvns In the spheiio-palatine ganglion. This m* locnted tie&r 
th« KfilK'no-ifiibtinc foruuM-n, iti fhi? i^pbeiio-nnuilbr}' f(wv«. The 
•u|>erior inAxlH^iry nerve, after iu eiit frDm tlie fordnien rotun- 
dum, M^nds two Knmll IrnTiclio* to tht>: pmiflion^ and it thttH n>* 
oeivr?4 motor, sympathetic, boiI n»*niT'>ry fibres The ganglt^vn 
sends branch^ to thv levui4.>r pulnti, Hi^yf^m iivulir* pulafo-fslo^us 
ttni plato-pharj'ngeUR niu«^lefi; to the mucons membrane of the 
naml ftK^jBf soA pulnte, hani fKxIftto, iLtid giirti?^ ; to tlic latcnl and 
posterior pharynx, the orifi<^*e and canal of the KiistJichran tulie, 
and thi* toni^il. 

The fadnl, in (he a^iueJuot, itenJii a fibre, tlie Aniall pctncjQil 
nervot angniented bv a 6lain€nt fmra the aympathetie branch of 
the glosHo-pharyo^l, through a superficial canal in the temporal 
l>onr, and down throngh & torn men in ihvt Kpineof ihesphencnd. 
to join the otic ganglion^ which is eiiunted inside the inferior<| 
miucillars' nerve, jtutr below tho fomm^n ovale. 

The ganglion rcocivestwo or three sensitive RlaoientA from tlie 
beginning of the aurii:ulo-tem]>om], motor f laments from the in- 
t€rnu] pterygoid of th« tnteroul maxillary, and sym)iatbetio fibi-J 
men 1A from the t-ympathoTir pkxiH upon the middle meninf^I 
artery. It trends one branch to the teifsor palati, anil cne to the 
tentior lympnni mu^le. 

The fneial^ in its aqueduct near the pyramid, pvos oF a branch 
that penetrates the inner walE of th<- tirtn|mauiD und «U])plje« the 
mu[H'le« therein. 

The internal maxillary gives off the infernal plerygowl nerve, 
which snp|ifi<?( the inlemul ptnygoid musL-le, and some think, 
abo, the tensor palati. 

Tbc pneumogaatric nerve in the jntnilar foaaa gives off an 




TVt irVTRRttilL BAR. 



49 



anrii'liTar limncb (Arnold's), which r«eiwfl a filament from tho 
ff;la«v(0*f>>inrynir4^l, fnitiT% the tcm|kiru! htmtr nwr the tfyVwl 
l^rore^, aixl jflirm iIht facial in the a<]!i«diioL Jnst bel<*w the 
jtijrnUr fii«w, thi' phnnngLiil hrandi Imvriw the fnrial. It rcoriv(» 
a flianipnt frora the spinal aoreiiif>py, anri, at tJic Iwnler of the 
mittdk- coni'trictttr mii7H:lc, )inih?ff with the gloiwopharyng^l, 
CTiperior laiyDgeail, mnd sriii|>Arhetic to form the ph&ryup^l 
pl<^ii!^. Tliw plt:tit» wnijfi bmnchfTt tn Ihf Im-nfor {mlnli, palahi- 
pharn)goii4,aDcl<x>DMru'tornii)>4rfefi,nnd to ttiomnanift membran* 
of the ptiarj-iit. By oth<.r portions of Ih** pmHimripijttric, iy.»rn- 
tnanirrntfoii i^ marie with |Ik> ir.^i>pluij;ii^ laryDV, ^I<^ 

Th*' t''^>^^*>-p'>^''y^^'^l nerv4? from ft» pctroup tni)}?'ton flenda a 
TK-rve filament to tii*^ trunk of the pniTiraogaMrlc ; it gireft off 
tlw* aaripiilsr, to unite wilh a fibre frcmi the pnenmoj^artnc", mid 
this joinfl the i»o?ieti(>r anrioolarof tho farial lM>fore inenlioned. 
A tin*.- bnuiiOi anaetuinose^ with the superior cervical ^nglion of 
the fnrnipathetifl. 

Anf>theT hniiK-h (Jac^obon's) traverses a caiiai in the temporal 
bone Iketvrt^n t)i« mroiif] cfkiiiil jiikI thejngLiUr fiwsa, <?nlfrn tlie 
tympanum by a Inramen in the floor near the inner wallj and 
dividm intv wveral branehci^ whtoh supply the tymiKintim and 
<!onti)iumi4 parte, 

Ttii^ pharyngeal hranehefi of the glosfo-pliarynfreal leave tli« 
trank low«r dowa. They are throe or four filainentA, that join 
I with brritwhc* of the pneHmoj^tric and riyaipathetic to form the 
pharyngeal plexus Thi^ ia itHirihuteci to (he mu'^ii'i memhiane 
of the pliJirynx u&il larynx^ and to the 5tyhKpharyn;^i»<, salpin^o- 
i plmrynpHL* and coosifit'fur mn.^t*!*'*. Other filam«iitii are dij*- 
triUifiil ta rhi- 1nti«flr fju<^ frod palate, and 1nngni\ 

Tbe Int«rDal Bar, th^ mofi irn|KirlBiit portion of the auditory 

isppcimii£<, inehid'^ the labyrinth, the internal auditory nenv, and 

the internal atwhtcHy meatiM. It is situated deep within tt»e 

tcfti[M>ra[ bone, and extcmlH a liltk farther hat'k than the t^m- 

r panic cavity. The bony labyriatli is aeparute and merely fHir* 

Iroiindeil by the temporal bone in the infant^ but it bec<>me6 

nnited soUiJIy wiih it in Inter ymrs, 

Thi^re are two dit^tinct fuirts; one composed of bone, called tlie 



44 TBB HUHAH BAR AND ITS DI8BA8KB. 

bony labyrinth ; and the other of membrane, called the mem- 
branous labyrinthp 

The bony labyrinth has three divteiona: the vestibule, the 
aemidrcular canaU^ and the oochtea. 

The name labyrinth is frequently imed by authors to signify 
only the vestibule and semicircular canals. 

The Vestibule is situated between the tympanum and internal 
auditory meatus; its bony wall is thiDj and it lies imbedded iu 
the petrous bone- 

The semicircular ranals are situated posterior and eztemal, and 
thecoohlea anterior and internal to it. Itisoval in perpeudicular 
section ; pear^i^haped with small end forward in horizontal sec- 
tion. It is about h mm. long and deep, and 3 to 4 mm. wide. 
Its outer wall is the inner wall of the tympanum, and contains, 
as l)efore mentioned, the oval window, or Jejtettra ovatig, closed 
by the membrane and base of the stapes. 

Ju^t behind this is the ampullar opening of the horiaoutal 
semicircular canal. Above it is the termination of a ridge of 
bone from the inner wall and roof, called the pyramis veetibuli 
of the crista vestibuli. There are several minute openings in 
this for the passage of nerves, and these constitute the superior 
macula cribrosa. 

The tliKir of the cavity is a mere groove with a few smalt 
fonmina for vessels. 

The anterior wall has little sudace and shows the oval opening 
of the soala vestibuli, or canal of the cochlea. 

The posterior wall has considerable surface and several open- 
ings. In the centre is the unexpanded opening of the horizcmtat 
somicircular canal. At the junction of the superior, posterior, 
and iuoer walls is the straight opening common to the superior 
and posterior ^micircular canals. The ampullar end of the 
pc*?t€rior semicircular canal is at the junction of the inferior, 
pwterior, and inner \^'alls. The ampullar end of the superior 
semicircular canal opens in the roof just behind the crista ves- 
tibuli. 

The crista vestibuli is a slight ridge of bone, which bc^ns on 
the outer wall above the o\'al window, goes across the roof and 
down the inner wult, and separates into two limtis oear the flocv 



of the restibuK one currinff forirafvls and one backwards. The 
inner mill ie dividfil \ty the crisUt v«*tjl>«li inlo nn anterior po^ 
tlnn ^lijhtly w«>cafi% caltcvJ rlio reciesfiii* sphoriciw, nrid a ])os1erior 
uj>|RT [Mirriiih, aU» MMitt^whiU il<Tj»r&wH|, <m\hx\ llie rw**«iLs ellip- 
tiovuL, hnuDfled below br u eiri-ht (groove, tbi* tiiniis Miiloirormtt. 
Just tWow and tft'liinil tlii?- lnU<'r in n foramen, the aqfia»fluctiifi 
viTtlibult, thr)Uj:h whtcrh the- vi^T^tibular vi*in ^^t^ backward mid 
inward til mtitrh the b^iie, alon^ vtth the funnd frcHU thedum 
tiijitrr, wlii'"h coritii?iitttrri.4iro-»'pirinl tliiid. 

The space beiwecu the linib§ of the cmla is oalle'l the fe^essus 
GOChlcirM. In ihh, ncdr thi' upper part, are ^vmil foramiiu, 
called the macula iribixx^a (inferinr). 

In lite anlerinr infi-rior part of tW roiMTn&ti^ f;pheri4rii4 ir^ tW 
tuaeiila mbrfea media, Alwive and Iiebind the re<.i(*«n.4 ellipHeus, 
rifur lh(^ umimlUr fiilnin'.t!r »f the po«tcrinr wmteirtuUr raiial, i» 
another (tmup of forainhia, tho laae^ifacribnxa [K«tenor, The 
miK-iila <Ti1irci^ HUjUTJor \ft at itie K-rmmution uf the crir^tJi (ijk4I 
tJie «xterntl wall, 

Th««e foramina nil communicate with the internal anditorj 
menluff, and rwxivc filami'iite from th^ internal aiiditiii^" nonxv 

TIm* walla of the vestilmlc are m rtiJIed for i-onveaience. It ifl 
no»t romxi to nprfllc of the difTcTVin »iilk of a cavitv mode by 
ftplimml siirfarts, 

Tlur rid^, dt^^rilwd aa pixijeotiitK fmm twn anrl part of th^ 
Ihird vall, c^ti^rrH^ the cavity iirtmnd Uie mwldiA like a Mi 
around th» waUr, and thiiii makcA a K(^iniriph«^rif>nl f^[iar^ antmor, 
and a f«mi-elliptii^l ^paf^e p<Mterior. The ant^rinr oontaiii<i the 
Aacnaltt* ri>tiin<1i]!t, am) lh<* pi"Ht*'rior the iitnriila*, 

The S«imcarcnlar Ctinala arp l^ony, ovsl tnltcH of aiminal 
J*ujrh, im-gularly nirvrti more ihan a half <jin?le, !*o ihjit ihwr 
o^^ninga oniric ni^rly tngi*fl)i»r, Tliey arv« namfl AfvH>rdmglo(heJr 
jHwitKtn, the >'ti|it>rior« fhe |>o^lerior, mu\ llw iiiri>ri<tr. or honiunital. 
Titer ai« icittjalnl above, thi* innrr Im'^k purl nf thi^ tym|niiiniii, 
iH'hifld and a little oiicaido of the veettfhale, with whtrh th<*y c^om* 
mnnteate by five onfio**;. Two of tb<*e t-^rminate in §trai^ht tabe», 
and tbrvc have* ninpullardilatAlionu. Thv latter have t>Fea oalled 
ampullar fiv>m tlietr fancied reftemblaiioe to m wide-i»otith<>d ju^. 

Tbi> poft^rrior ai>a)ii^in<ular ciiial ht 22 mm., th« mi|N!rior 20 



i6 



TDI DDMAN KAK A5D ITS DISKASfg. 



mm., UI11I tlieliorijMi»tsl I5iikri>. in loiii^li. Tlieir^^JK^nthluiakclAn 
I'ary from 1 U> L7iutn., but tlieain|mll» have a diameter of about 
2.5 mia. 

The oaDftle are oi' thin bone, streu^liencd by fibrou« Hasue, and 
mut'h i^citorted. If a cube l« plun-d jur^t b<.*biiul ibe vcsitbuVo, 
approximately^ llip bonxoutal semicircular canal would tie flat 
bcot-utb the lovvcFj the »i)K'rior upoti iUv innerpOiKl tiie {M^chor 
U|>oii thep<tfJefiorMirra«««of ii respeclively. 

Tbe Miperior Gttoal ia vertical in ponitioii, lit ri|^bt angloi to Oie 
otbiT i.Miuil>ir niid nrubet a niHinded [>roQHuence on Uie antefwr 
lurfuce of the petrous bone, It« umpullu oiwn» iu Uw> roof, 



Fio. IX 



ru. u. 




Fii». 13.— Tfl« LAuyiuHTii Exr)hit> tl-ddrj'^-lt Vt^iiLulur bnuK^i of 
■liiliUfrv iivrvc; 3. l>nm )i Ui ilic Mcniltu ; 3, limich <o lliv mrk-ulufi; 4, tinuich 
10 the >niinilUorihc|uUnorcuijU ; 6»brmacli to tfa« iiuputU orthvtMmnAtMJ 
auhfl ; 4, bnuHli lo llic nmputU of iliv aiifcvlor ouiol ^ T, cvcIiIa' llvrrc ; ^ 
cochlea «lu>«ang wlr. modloliiB. air. 

Kao. 14.— TiiK XiuiVMor TiixVKmirLX aisp AMmi.JC f X 3 dtiun-); 
(|j^7).-«l, Bmntli V> tt*l\\aiU: 2,bmncti toiacciiliM; S^brukdi Uf iilKculiu; 
4^bnipcb lotbe pivti-rior unpnlU; \ brnncli t) horixonu! •mpuDa; 6,btvicb 
M Mpenot mmpnWa : 7, htmacU m the uochlcti, 

atid iH other end, alW uniting widi ll»c omlilaE«ti emJ of the |k»- 
terior ranal, opcut bjr a straight tube 3 mm. long, into the ina«r 
|MiAlerk>r |i«rr of (he vt^stibule. 

Tbe poeicrior semicircular canal, the lon^:«fit cd" th« ibrt*, ta 
alAo placerl verticallyp tnd extendi lo the IhutIc |nri i>f iho tem- 
jwvinl Uiae. Its Bttsight end opeits in ihi^ iniipr jxwterior part of 
ilievcHtibuK u) union with Iho HU|M>ri(U- cflnnl, u.<< nlrradyil^v 
4(rnb«l. and its ampulla opens at the lower iuner part of the 
pOAteHur walk 



Tnt IRTBHMAL BAI. 



\ 



The hori^umtal caoal, the j'borC'?^! of the three, t^xtewis I^ack- 
vhtkU lit ri^bt nn^livto thv othi;r<«nul& lt» iimvYpihliil limtt 
opeas into Uic veBiibule in the mi^Idle of the poslorior w-M, and 
ite umptillsi III tlio upper [Rirt «>!' the 4^xt<>nia1 ami putsUTJiir wiilJs, 

Tbiu the three fiemioirc-utar canals have five o|»enin;js, two 
Atmight unoxpim(J«tl tutNM, aurl three cvpuncLxl int^ the pectiUnr 
|iear-shap«l anipull^e. 

Tfa« vcMibiilt and MMtiicircular mnaU an; lined throa«;h«'ii>( by 
ft fibn>«erou>i membrane; the fibrous fK>rtio[], like a peritwleiim, 
•dbcrw ekt^Jy to i\u- iiUK»r nurfncu; ir, wnd?* u tubular pr<Kit*t 
alonjjt the aqasdiictus vcetibuli to the dur» mater ; it ext«iH]« into 
end lim^ tin? acala^ of tJte avlibtn, and M^utU a talmlnr prolonga* 
tioD along the sqttflHlnctUfl coohle* la cliedum mater. 

The seroui «iirliu?e conjiiHtJ^of a ha^niftnt m^Miibrane oovurwl 
by toawllmted epithelium, Thcfibro-Fferoiit? mr^mbmne pa<«4a4ov%r 
the membranes of the round iknd oval ^«indou% ft nvcn-itM a 
bland^ wnlery (Iiiid, mlMI llio pcritympli (sc|ua labyrintlii^ or 
lk|iiorC\itiinniitt because itAiirroiimU (he membranous Inbyrinth. 
It t* fmi\ to be rtHvH'L-d in Moinv measure from the HtilmriKbuuid 
8{Hicc ihmngh the foramen aeiiAtica, anil to <$(!31|k< when in ex* 
<es« thruuffh the aqutuluctur^ cochlew. The perilymph is a weak 
alkaline fluid, coniAimng a little aUninmi. This (liiiil rttirronnils 
llie Diembraaotts wmidronlar mraile and the ^ocidt*^, an*l m coo- 
tlniioti^ tlimiigli the oval openinj^ hi the anterior wall of tiie ve»* 
tibide with that which filla the vecitibular and t)'mpaD[c scaliB of 
ih«- cochlea. 

The bony tabyrioth incloses the membranoos labyrinth, which 
eoa^i^^i of a mo con.<4tricleiil in ihi: mi(lill<^ into two potiohej^^ and 
of three canaltt communicating ivith it These are oamiter|>arlB 
in «hape of the Inmy labyrinth, hnt are a little i^maller Thry 
do not Host freely in the perilymph, bc-cau^a^ cumerotu ve?«?lt^ 
octYCfl, lymphtitint and ftbrouA UiinU hold th'Tu ratht^r near to 
Uie oeeeous hibTrinth. The fibrous band» have been called li^- 
menta tab>'nntliieuniilieLilonim. The vestibular portion w (closer 
lo tfie inrier wail of the <svit>% and is removed a little dihlanee 
from tJieoiiter wall, w> that it doe< not intiTfi-re with the oval 
vriiMlow. The membranouFi ampulla lie olote to the bony wall, 
but othpr |>art» of the labyrinth are luorc removed. 



48 TBB HUMAIV BAR AKD ITS DiaBASBS. 

The portion of the membranous labyrinth contained in the 
vestibule fe constricted in the middle. The anterior lower por- 
tioti IS of globular form, is exiled the saerulug rotundup, and orcu- 
pies the recessus sphtencua (fovea hemispherica). The posterior 
and upper portion is elliptical in shape, is called the utrictilue, 
and occupies the recessus elbptious (fovea semielliptira). This 
shows the five openings of the tubes and amputlse of the mem- 
branous semiciroular canals, which occupy the bony semicircular 
canals, being held in position by ligaments at their convex por- 
tions. 

The membranous labyrinth is composed of several layers. The 
fibrous layer is a dense membrane showing connective tissue ceils 
and nuclei. It ia the thickest and most' important layer, fur- 
nishing a firm support for the delicate structures within, for the 
attachment of external ligaments, and the jwissage of nerves and 
vessels. Next to this layer uix>n its inner surface there is a net- 
work that is supposed to consist of nerves and ganglia. The 
hyaloid layer, or tunica propria, covers this, and is closely united 
with the fibrous layer. It resembles the hyaloid membrane of 
the eye, but upon close examination ehows longitudinal fibrilla- 
tion and elongated nuclei. 

Upon the inner surface of the hyaloid layer of the semicircular 
canals are found various si?^ papillary prominences, or minute 
elevations, which are most numerous nt^r the middle portion of 
each arc, and do not extend into the utricuhis. Over these and 
upon the whole internal surface of the canals, there is a layer of 
thick, nucleated pavement epithelium, which terminates at the 
ampnllse, where ciliated epithelium is found. 

The vestibule, or saccules, and the ampullse are covered by a 
thin, yellowish ciliated epithelium. The hyaloid layer is thick- 
ened where it extends into the ampullte, and the short ciliated 
ridge is called the crista aeustica. There is a similar projection 
of ciliated cells in the saccules, called the macula aeitstioa. At 
the end of each crista acuatiea an elevation of ciliated epithelium, 
called theplanum semUunare, extends along each ampulla. 

Filaments of the auditory nerve from the network mentioned 
above extend into the cilia of these parts, and receive impressions 
from the vibrating lymph and dancing otoliths. 



T0B CCCRLEA. 

Otolittafl, otoporui, orenr fLlonen, are oomprv^l of single aad 
agprp^tdl cT)-rfnl» *>r tiirliuntttc of lim<: of (lifl^nMit »iz(* and 
aiigtiljir -^hiijtf^ wlik'h are Ibiind within ihc niemliniDnuA laby- 
rintli- 'Hk minute i>ne« art< iinaCliiclMxl hcnesimt there*, und»rtflne 
writer^ tiinto thai they are iounil oxceplionally ia lie semicircular 
cuialHflnd atclilin. There arc two hr^, white, Oinroid lajwo?* 
of o1ol!lh>i, liaving a tibroii^, ninila^in4>ii^, or ainor|>hoii« oi^anic 
iiiiHli^lhiit ImiIiIa the ery^'^liiJi' tngi'lher; tlu^M^ adhere to the epi- 
thclitini, uue in the iitrlcuInH and th« other In the mccuhi^ iMnt' 
iht-erihHAmi 4|iot#t whore the nervu filoJiient:! terminate in gnAt 

Ttuti iilolith^ M^ve an important p(]r|»^M^ rn naiiition if' ^^vident 
from the fuel, tiiul they exi^l in the cars of many of the lowiT 
ai]tii)=il-H having cxeeJIent hairing. 

Fki. IG. 





TluvAX Otdutuu i-iiiiu TUK V«nmrLX 



The nji^mbmnoiis lubvriatli « completely filleil with a limpid 
skercfiia flaki, alkaline and albuminous, i^llecl the emtolympb 
(liquor 8(*nr|"ie)- O^ HnvMj siak-* that an epieerehra! lymph 
cAvily Bend^ a tiibilar membrane ilin^iif^h llie ii<|mt>dLicLijT4 vcsiS- 
buli to comiiiUDtnilc will) th€ v<9tibiite, uml thiu convey cerebro- 
spiikal AukI (o act a» endelymph, or Eo relieve exc^f^ of ^ndo- 
lymph at any unu^nul incnan*. 

The Cocbleft eon^lfits of a roni<3il axii4 of bone, jnirroundcd by 
a brmy (.^Mtl wouad ^^pimlly around it in d(t:rt*af^inp turnp> frum 
bfl.se to apex, uid the whole k msHsed tc^^clier and covered by 
the temporal bone. It tnk*^ itA numv from it« rtw^inblaixw 1c a 
snail Ahell It fornix the anterior portion of the labyrinth, aad 




60 



TBS BITUAK BAB AN1> il* DUllJlftia. 



irt ^htnti^l fllmnttt hrtrifontally, nntenor lo tUe vi^tibulc lu 
hB5« ]« ikl llko |H)Hif<rK>r, ttini'i' vurrHn; nf the 1om[H^nil bone^ aiul 
ibt apx U dirrHcvl outwarrl, dowjiward, mid a liltlf? furward, 
romin^ upjir tbc ii)-k|ier ftut^^n'or |inrC of tlic inner vnll of tli« 

The axis, mod!u1tiA, at <»oluincUA U n solid, ocuto, cniM-nliapod 
pyrtiiiiil of bonr porfomtM by Hve onnals for the i>A>«ii^e of v«8- 
wU and nerr^^. Ibt Ini^tli im 2 J mui. ; the ilifln]<!UTr of iu huMe 
ix 2 inni.y and itA ap^x J mm. 

The spiral, or oocliloar onnal i* a bony tubu tlmt wIikU cloaely 
ttroum] thi* nxU fri>n) hajT« to ii|X'Xf and 18 divide) by boD« sikI 
membntiie mio tJjrv*; ouii^Im; thi^y nrv tW vwiibuUr Hnnia, the 
lyinpnaic «mbi, and th« ooohlear duct. T1i« lowc^ «nd cif tb« 
tiif>e 1>ogin« bot^vooD tb^ tynipuaic uad viei^tibalar o[>eiiiii]^ of th€ 
cut'iilea, at the i>ut<<T lower corner of tho virvtibuli?, rca^'liiia ihti 
moili<>IiKi, and winds forwurdti and iipwurde, in tben};htwrfroin 
right Id \v-fi, and in tlic Vt^ <?nr in n rovcrw difvotton, two and a 
half limc« around It, KiLob U;m of tlic mnal dimlni6ii«& in 




'nts Cduhlka UliHUori:u (Lriily), — 1. <>wv«»m ivitll or llio cvclika; 2| 
lamiD> itpiriilia ovi-o, nl^ve ; 3. vtn\ *'{ Ihf o>««Mih limiira ; 4. \ f*itt^ of tlio 
uMOiw Umma ; 6> Ummi ipiraiU m^ mhranHtt-w ; 7, eml of lliv ttiMuliraiMas 
Iftmina; %, helioolrcmEV. mv) pa«Mf;«l4) ih« »ili tympini. 

diameter towards the a|)ex,and it ttrrniinatt* by a cloftLx) extn^tnity 
cnllcd tli« cupula, whiob 11^ n^^r the front surface of the tem- 
puml bone, elo»e to tfie cana) of the ten^r lympani musd^^ and 
above tbc a«oi-tidi»jr |>art (if thi- ntnttid k^ual. '(V first turn of 
tJiQ c«iml is n«ar the eurtaoe of the inner lympAnic wall, and 
tuako a prujeution known afi rhc piYKiinntory. 'f li« cuont id 29 






TBI COOOLIA. 



nnit Iwp, aod its greatest diameter 1 mm., and ils \i\M half turn 
diniiTiif(li<9 ^mdoall)' in €ali))re. The t^orliUfa [>roj>er h^ a base 
4 Of 6 mm. in diameter^ and ibf bcight u bIkmiI riic »aiiii\ 

Tbe <i]ii»l ill (he bone varies* in the flim|w of lU transvewe «o* 
tioo. At some places, it iatrian):tilar,^vith the outon^ide convex; 
ftt OlheiH, it ici MHiiieiniilar, ami n^in at ollici^ ovnl. A thin 
bony ehetf of iwo unitE^d ptate» ptvi^L-cte Trom ibe modioliis about 
hAlfwur arnv8 i)ie<«iiul^nud in'tp to divide it iut^twn parallel 
C6oatk the hhIic. Tbis w thc-'^piral luminflp or tanthui spiratis 
tmea; it » 1.2 mm. wide and .^ miii. thick at the Itnver eud^ainJ 
A mm. wide aJid .itj mm. thick at the upjter end. 

riiLiT. 




Thk CocBUBAft Nmvk |Leidi-l.— 1, Trunk of the ncfv^; % mumiirwi 
lm«iliirv viilt meniWkno of Ittlmncr fciiiavDJ , 3, filamenis of tJi« nvrvc |ia4^ 
Inr finin ihr rvkeoiv Umtiiii to iHgwi of Corti ; 4. li#McDtr*ina luAiling tn Ch» 
»(^ IjrmpqaL 

Tbe bmiim Ix^iD^s upoit mid curves ^mcefully svi-ay rroni thij 
wall of tht- V(r4ihu1e to the iiioiUoh)F<, niud^H i«|iirni)y aniiiml iblh, 
like the tbn^ads of a scr^v, ami terminator \n the cupola by a 
flbarp en^tccnllo edge or Itook, mlk^l tlie hnmahir |Troc<.!»». The 
uiKlividcd «ipaci.' between ih\h and the end of the cochlear cannL tt^ 
nUleil ttie infandibalum, or helicixrvnia. Around Uie mudiolu!^^ 
in tlvcbftSGof tbe bmioa. posM^a canal called tUe cemaiis spirafi$ 
Mior/jo/i, BcLwo^n die tvroMirfmyti of the liimina are numeroiu 
radiating canah for the passage of uerve« from the modiolus; 



52 



TOS 



BAft Altl> ITS DI8VAei&* 



thes? o^n upon the side ttv:xi th<r liaw of tlic oochtoi thmugfa 
[H'rrmiljiHL'i ill ill*? "Igt'^ 1^11*^1 Ua' ImlitiiriJa jrtirforaia. 

a» the cttn<ilid r*rt*nicn9y thmii^i OieovaJ f^peiiiiig m Iih aiii^Hur 
u-all JnMtlM? cochlear cnnal, und is cIoH^ly iiltiichtd to tis vaiWn 
hik] taih<* lamina »|iir»ii# throu^himt ihdr exttur. Near ihe 
e^gt of ilie lamina epirali**, Uie membraiioue luyen fnicn it« )<iir^ 
ru<*c# Hppnmrh 4:^u<h other That (vtxvnitfr Uk- ba^l t^urface of 
tlic bmiim, oaJlnl (he rnrtnA/vina AwAirur, niiw Hlralghi nIoDg 
and ncTHiK to the opixwiie wall of tlic cflnil, wht^re il H firmly 
amdiod to tliv bone. The plait- of ;itfnHmK*iil Irt iliickrr than 
<*Iaewheiv, owing to an extra develojiment of" conncciivc tissue, 
Atul hw 1k<<-ii aUk*<l tTir titftrmfytturn npintfr <if Henh'^. Tliid 
tnemhrune completes the partltiou botwwn the tymp«nic «aila 
and l)t^ cYH'hU'jir dii<4, Tint etidnat tli*- hamcilar procew aho\*e, 
ain] forms the ^arp border of itie heiieotrnmi. 1\w meiiitnine 
covering Ihe ftpicu] fliirfiKV of the Ijinilna, Uie membrana tctl'd>uli^ 
becomes iJiH-kcticJ by wnneciivc tis*u^" and vpitlit^lium Ijefoi* 
it rmob^ the bonier of the <H*iaou& Umma, i\\m gradimlly b*- 
a»mc» thinnor^ and Itnalty terminates at the ed^ of the l>onc hy 
trrc^ulur, airtiln^-like, di^fitHte protVMM, wbivli aa* *v)llecti\-c]y 
iiflineil Ihe lamina itetdir^MlaXn. The iniKredg;eof thew pix»cc«8(tf 
is called \\w erida ttpirali^^ sad the proccsM^ thciJiM>U-tii cIk^ aitnl 
teotli. 

The tiH*mbniim (ecrona, or de1icat«f roiff-membriDc, tnk«« its 
origin here, ciicnds jKindlcl with thr rm'inbniiin luL^ilari.'i, a little 
0e{)anit&d fri>m it, a^ far as the hejfinning of the organ of Coftif 
whfjv it l[Tnni»ati> by « f«tlh<^r edge. 

The thickened portion of vestibular membrant? behind the 
denlate pro(tiw<« givot olT at an an^le of 40'^ a delicite iibrous 
aembnne, Hxe membrane of Reiesner, wfiicli goi-s to Imt iitl:irhoil 
to fl <ni^liion of connective tiiwne ujKin tht? outer wall of the 
ocH^jlea, at Mime distance, of course, abovi? the nKinbrsnia bnH* 
laris *hus leaving a spaw? lx"tw<^n ihem, mlled the ducins ooch- 
Icam Thi» duct is taken from the vestibular iM.'^la, liint )>ct4'cefi 
it and the tym|>a«ie *ax\ii^ and iiu^loiii'?* tlip or^n of Cocti- Its 
cuter wall in eovered by tie jibro-verous lining <M>nimon to the 
ft^lie. Tbo membranoH pa^EHJai^ fn»m the lamina fipiralis oasea 
to tJic outer wall of tJie ouoali and ilividiitg it into tliree canak, 



THE COCBLEA. 



63 



are iDentioDed collectively in general anatomy &s the lamina 
spiral id membranacea. 

FlQ, 18. 

S. 




FiHST CocULEiAR CoiL (Biirnctt) (Transverse section X LOO diamet«ra).— 
a, Vestibular lamella of lamina spiralis osaea ; bj ^ origin and attachment of 
Reinner^M membrane, middle portion cut avny ; b, c, crista spiralis; c, procesB 
foruiing one of the anditor? teeth ; d, membrana leotoria ; / p, cushion of con- 
nective tisBUe, called the ligaroentum Hpirale of KolTiker; j?, o, perinateum ; 
h, n. OBsenus wall of the cochlea; i, atria VBHCularis ; j, vas prominent and tiga- 
mentum acceasoriom Hpirale; jt^ buIcu*i spiral ib externuB; I, ligamenlum qpiraie 
of Henl^ ; m, perioBteum ; n, bone ; o, onion of conneclive tissae and periosteum ; 
q, c, zona deniiculata; q, u, nrgnn of Corti ; q, I, zona pectinata and epithelium 
above ; r, region of outer ciliated cells ; r^ l» zona arcuata ; *, thinnest part of 
membrana basilaris; t, r^ion of inner ciliafed cellB; v, habenular perforata, or 
place of nerve entrance ; u^ L, membrana basilaris ; v. buIcua Bplntlin internus ; 
tCj tympanic lamella of lamina spiraliti oesca; z, cochlear nerve fibres; y, dnctos 
cochlearis; bv, scala vestibuli ; st, scala timpani. 



d4 



TUB nUMAV T,AR AND ITS DlSBAAafl. 



The hiiflitrir moml>niD<: Brni mpmliraof? of IWrBner Iinvc mdi- 
at!ii^ tin^ urv oovcnn] by cpitJii^lium, nnd Jiave a glosify, tmn^ 
parent n|)pcaran<«. They iwsv frttm tlic o^^xt^ spira] Inmma to 
thooppotfle vmll of the oocJilear canal, «ad t)»cfc i>ecoi»e coiitin* 
uoua vUli 1(4 fihn>-i*croan liniDg. Tlic ejtiral corhlfor ctinal h 
ihun :<ulidivfc)«l into th« li^miBplrc-rK^I lympmie acnla lieJoM^, the 
imperfect obtuw trbni^nlAr vrntilmW smln above, am) the crimn* 
giilar wxriilcxr Hoct U^twwn ibew, 

Tlic ihrec j>prAl eannl? mil pamllcl to each other froai the 
ImtKt to tJi<; irufHtU of die coclilen, whtre the »ai)w cotniuiitikttte 
by 1li€ bclicotriMiia^ ami tLe oochlnr <1uct cmL* at the liatuular 
j>nxx»« III a bliiHl vxirvmity. 

The oukal l>e)ow tlie buml lamina, when cbo cochlea Ia place<l 
n|Kii) ilf« lia?^ U ihtf wvia l^ni|]ctiii, ur lyMi|Kiiiir miUv. It iit chnvd 
at Ua lower eiivl ity the meiuhmnof the rminJ window of llie 
tyiiiptiDtiiu, Ui«r mi'm^r/rffff tt/mpam imv-nuttitrm of tite frnaftn 
rotuniln^ aituatrtl Ix^hliitl acal below tti« proiaoulocy. The flbro- 
serviM nitfnitimne of tbv oiiU*r wrilf of ihi^ rv^nia fHiA4>t over 1h<r 
inner nirfww of ihiH eeooudary niembRtn^ ami add^ lu iig tbkk- 

D€ft4. 

A liill^ dbtance fVom the lower ^nfl of this aea1«^ and in lU 
wall, tlicm IS a foramen of &c;inal, ihc a<iiur*inctuM oochleat^ whicJi 
passes down through the cempoml bore and opens u|M>n ita Imm' 
just Jni«idu Ihi- carotid i<nnaU It imiisniits ih€ oochK'tir vein to 
the inferior peiro^l siinw, or in some cw^ee to the internal jiigiiUr. 
Tlifrt" an' j«-vend other o]>eiihigH in thi^ part, of \hi* ^-ala, through 
whieh vcsffelpi pnm into the canals of the modiolus. 

The scala tymjiani |)asAe« h) dimriiiAhing tiinn anuind the mo- 
diolufif tcwanW tho apex cf rho cochlea, lis bo-sil wall }» the 
<iocldi3Nr wall proper, unti that towards the ugwx b the kiDina 
ipimlUand int'mliruDa bo^ilarjg, until it reaches and ends in the 
iafiindikuhirnf or eupola. Thm ix merely the nxindcl end of the 
eocblear canal mmmon to both scalse, aa the spiral lamina stops 
before it n^che^ the end mid Uiuh the two Jfcnhi; arv do farther 
divided, 

Tbe0[iar(7 t>etweei] the tennination of the memhninoQS spjra) 
lamina and the cut-de-eac of the cupola may be rq^irded as the 
beginning of the vt^etihnlar ««)a. The base of the Rala ia made 
by the vcAtJbular Janjella of tlje spiral lamina, and by tie mem- 



THs oRciAv or coari. 



55 



bniie of Rciesnpr, em] lis woC hy i\w waill of tlie coc-blear canal 
prttprr. The«mltt ]K»«r;« hy mirrGBfling iurntt nnniiid I^Kt mccli- 
olus p«nillel lo jU c(fiu|f]imvjn townrda ihe bu^o^ aiiJ u|>eiiH dSn^'tl^ 
into iJic vrptiljiiltr bv nti r^vnl opi^miig in il» niKcnor vi%)l,ani) i^ 

Tbr libnt'scmus nicinbnuK- lining tb«.- f>rvlie is ptTicwU'iil in 
obanicttT, «(ivervd bv pivemeut and peuulUir t^pjilieliiini, i^niiii- 
1IUU9 with dmi of x)\v vt^iibi;k\ 

Tbe walte arc flUed by ptrilympti, whirh flovrfl fVrely from tlw 
vttftilvijl^ tlirougli the oval opening abng the v^tibiilar ^cula to 
tbe helinilivniA, and then pa-^fn|z: ^lowtiwiinf^ ovt-r rbi* bnmuliir 
pr»ccm uud f>ickk-0ha|iotL i^il;^ of the dividtnj; m<:mbmiK in the 
f cupola, gi»et t>ackwjm)t< along x\i{i iurn$ of ihc 1yii)|Hmt(T i^^lu to 
the iDDer Hirtace of the menibtunf of the round windoiv of t\ie 
middle tar. 

The tnanf^lar dat-tua ti>d»lcaris bae its hsw? formed by the 
membrana t€cCoria and luembnirm hiLsilar^ \tn outer wall by Ihe 
cochl««r wulL proper, and icfi roof by the mcmbmue of lieiaiDer, 
It dimini5lj€6 the nyifox tliat would othcTwiiie t>e m (Ijv w?aIii vca* 
tibuli. It follows a spiral eoune between the ec-als, and isclo&ed 
at iKiib cnd-4. It ir« liiK^I by pnvemvnt epitbidlnm and !illi<d bya 
Haid fiimilar to the )>erilyrDph. 

The oul^r wall of the duel luu* a vanel poi-^ing along it oflllod 
tbe WW piyMniii4-nv, and between this and the externid arlaehment 
of Keiwiief's membrane i^ fount! ihe ^triie viwtjluri». The ?^ur- 
face or floor of the duct ba^ near the odge of the lioiie a longitu- 
diiml Apa<«, iht' tuicUM tpirali* iiitrmug^ or iatenial i^^pintl groove ; 
at the outer aUadimeni of the membrana basUarife there is another 
JoogtttidiitEil fpt^yXf \Ut mif^tiH tfpirafl^ i^j^^nnw^ or xIk external 
ft]^ral groove. It bt further divided into throe 7/ines, Vvwm the 
criftta fpindi:4 to the outer end of Corti'« or^tn ipf (^llt-d the uma 
dmticuttifa^ from the inner lo the outer eilinlod celJfl, included iu 
Uie former »)De, l^ tlie trnut armafafUnA fn>m the outer borik-r nl" 
the organ of Corti to tbe «tiicu^ tpiraits rjrtemu^ is the zona fKC- 
(intilfi. These names are slightly duft-nptive of the »i»p(<amnc« 
of the pans. 

The Organ of Corti ie a peeu]iar ridge of connective imw\ 
DQcUnln) and dliatud eell», gruuular mattori and nerve fiUmenr>, 



66 



Tfis Doha:* iar and ira disbashb. 



situated npon tUc menibrniui Uii^ilurlH vrithin the diif-tn:* ootb- 
1cnrL-«, W-tW4t:n thr t^lgc oi' tlio liim'ma sjilrulb ohb«ei ani a line 
midway LHftwti;!! it uri<I Ui4? outer w^all ot the duct, ll WM finrt 
dcwnbcd b^- llic Mur«|UtJ« of d^rii^ but otir knowledge of tl bv 
becD gnmtJ/ inercu90il by bwr aiiMlics with the tn!cfwo«|>«^ 




*•■ f > 

Tbk OroajiovCoRTI jBaniAlt) (TraniiTcnfi ArctlimX^Ofl ilion.^— a, CSiv 
|ttinMri*|'irh4<lliiin in ili^tiitiM« *pinJLji Itit^imiui ; 6, munncff of ucchtrBrhorrc; 
4, htmlia |ircKvw n( <l, with (cmiaiilnr mnlti^mUiiit ill* arTV« fliiuixral* { dtliwi«ff 
rHinr^vl 1^1 : '. hfviil of XII iimrr frillnr iiritt Uniilion of rltUnf lanrr UIIaIaI 
^Ib; /. viiHiBiEc or lb« trrli rr>rinc<) by union oltti* tnn«ruiil outer r>iUui,lb« 
U|>|i«T purluiii sf <ino *nA iIk whnle i>f Anoch^r antar jnttor rfiilin^ aWrv f ; f, 
I, J, uour i'iliEitv<l c^ll* ; K A l^mic'h rri>m g; k, monibmui rvtkitUrl* extcmUnn 
hi < ; f, line <J liic Hi[i|Kiri « lU «£eIi li»*r t-iil iiwitj ; m, b«ac* '>f iwv id»cc outer 
riturtvl n>TI« : ri^ ffMiiimUr IsLj^r iif ihr i!iii*m1inin« tuuLUrlo in lh» xAnn |Wrlt- 
nuU; o,yj]cifficif»i>n«oi]ii ]ay«r of aiMinhnint ImdlunM; ;>. Iranjivmc Vrtloc of 
vooseclivo timttv III>rl1lv. niidai^uidynmular proiopljuin in aiemlmn^ of Milt 
I)riu|)an4 ; f, taa uptnilfi; «, ncrTir Hianicat «i<rnifiiig Jtrmai llig tLtt-h of Owtt 
fnmi llu- <->jf:lifr4r Immllc to uk outcf ciliaicd n^fvc; C W« and grnnnUr pnr 
lo[>1iiH(ri jif An innftr pilUr^ u. lh[<-k '>rigln of tli^ inrnibmnit hAMbirin; n, bloed- 
t<Mld«; !!■» pi>HoHr«iim of tnmiQR fiplntlEA inuen: /, ft fKH-icnlua of tliv codilMr 
D9rv« vUhia tlio lun^; y, tTinpNiiIc lip of (ho criiiTn lEiirAlii. 

Tbo riiirikne of th^^ membraua vGeiibull, u]H>n tbe eilge of ihe 
bony lamina spinilits withiQ thn dticlu% iv cuwrt-ti by u lajr^of 
l»rge, plump, columnar epithelial cells arranged vertically. The 
inner ciliited r^lU Htaud m*xt to th<9e outvrurdH ; th<nr cDfiflbtof 
tt single njw of long lar^ cells, with atroag cilia m LuHa above, 



THB 01tOA5 0? CORTt* 



57 



ami their low«-r cttdft l«rrnmauitg in a granular Inyct of inde- 
Irrmiiutr sCnivtun;. TbL* iiUMrr |>illfir> cximi^ tn*xl, TJu'v are a 
ruw (ifMill Itm^-r ttudt-Altnl, jMii-f^iliatviJ tvlh, li^iviiijii; ihfrir lar^ 
baow fixed iif>oii i\M memUmna Utrdlaru*, ati<l (Ik-It upfxT c(i^lH,or 
b^aub* mjLwil with oOH'i'<%ltH fro:u wiclioui, ami wtih iJie meta- 
branoEis byer upt^n tht'iu. A iriungular ?^|>»iv, following tin* 
»p[tml diretilun <>r tlic iluot^ 9ucceixli« lhe»e, ami U limiled out- 
wai\U by » «;cotKJ row 'if Iniij^ iiwdraUiI wllf*, ibf outer |iiMar», 

The inner |jillar* r*st iijioii Uie nienibraiia bu^ilirU, curve m- 
wani tikWJinU thf^ ftpimi Uiniiia, un<l llicir Imuiil h«*iu[-|iii-rv;t Ot 
into a tiepn**iion l>elween the hea^i^ an<l hwul-plaie* of the Inner 
pilbnf, fiirniin^ with thwc lh<; j»lbirH airl iin.'h<w "f Corii. 

T\\e inn«r and rmler tow of pillars and ibe nicrubmna basilam 
thit4 form II trian^ilar tubs, which rum ihe whole kniifth of ihe 
dutliifi <?fK-hleiins and makc^ a foEirlh dn<n in llie cL>chlt^. 

Ttwrc arei«id to In? tliriT ihotiHiuiiJ of tho^'pill.-in*; ihuhoiglit 
of ilie nUngle which they form incrpasfs tfiwanl-* tlie hamuhis. 

The ontcT ^'iliaC«id cclU sUmd i)i;xt to tln' i>(iti.*r pillars and 
parallel with thifm. They <xhihwI of five roww i>f laT^ filiated 
odh, arranged ctoae togelbn* inroWA. Their ba^^eH re«t ii]>on the 
nivintminH lxi<ilari#, und thdr ciliatcil endK arc licid in iht roof 
of the or^n, ailjolning the head-4 of die exlern^il pillars. C)nt- 
nih of lhii4i- i- still niioth«!r row of cvUn pandlet tc these, bnl 
oon-eiltaEed, aod called support celln. 

The nif^mhrana rt-twdlari* is a notUkp layer of oonnoctivc.' 
tissae, whirh eitondn fn>ni the phu^ ivhei^ tlie two ^t* of pJllun 
trejoiiwl tnjcvthw to the row of &up|K>rt wIIh, and cnvcre over 
the intervening Mriiotures, The tufkn of dlia of all the outer 
oilintifl ivWs ill into and pr'jjf^'ct throngh (hL*^ inolic^p and arc 
L>8thed by the fluid of the duotm coohleckriii. The parts of thia 
inembmne aronnd ifae^jiliHKvlctifUiLrieralk'd rii))^,and tJie Fpooee 
bctweHi, phalange. 

The tDomhrsna leetona m ovct the nKmliraiia rdiciihirUaiid 
ciliated tuft*, in Itj^t contact with them, and tcrniirml^ in a thin 
fm eil^ a4 far outwani as the i^tipp^rt ctdln. 

The ultimale GhrcA of th« <x>chlcar nerve [ia>4 ofit of the fora- 
mina in the hittiina ?tpini1ii4 omto-t are diMrihute<l to tJie inner 



58 TBB HTHAK EAB AKD ITS PtSBABBB. 

and outer ciliated cells, and lost in their granular matter and 
nuclei. Their number is estimated at 16,400 filaments. 

The organ of Corti consists simply of rows of ciliated cells, 
supplied by iilamenta from the cochlear nerve, and protected and 
held in pro|>er relationship by membranes and bone. 




Ca3T of Left Labyrintii (Buniett).— a. FeneatraoTalia; 6, nmpulla of 
miperior Hcmidrcular canal ; c, am)iiiLlii of horizontal semicircular canal; d, 
BtraigbC cAnalf Tornied by unioo of Huperior and posterior canaJs; t^ ampuna of 
posterior semicircular ciLnal ; /, fene^tr^ rolumla; g, trac^Lus spiralis foram- 
itiOHU«. 

The Internal Auditory Ueatus is situated in the ^losterior 
surface of the inner third of the petrous portion of the temporal 
bone, near its up|>er edge, and directly over the jugular foramen 
(fossa). It is a funneUshaped opening looking directly inward^ 
and towards its fellow opposite, so that a straw passing from one 
to the other would be about 12 ram, behind the basilar process of 
the occipital bone, and 18 mm. above the anterior border of the 
foramen magnum. The funnel-shaped meatus leads into a cylin- 
droid canal about 3 mm. in diameter^ and 18 mm. in length, which 
leads downward, forward, and outward to the inner wall of the 
labyrinth ; this bottom, or cul-de-sac, is divided by a transverae 
creacentic ridge into a small upper and a large lower portion. 
The upper purt is subdivided by a vertical ridge into two pits. 
The anterior one leads into a canal in the bone, the aqu^ednctus 
Faltopii, which is directeil forward, then turns sharply backward 
and outwanl above the vestibule, and curves downward in the 
inner and posterior wall of the tympanum, to oj)en upon the base 
of the skull just behind the styloid process, as the stylo-mastoid 
foramen. This devious canal transmits the facial oerve, or portio 



TBK IWTKB1T*1- AtDtTOBT MKAXai. 



ilum «f Hk scwntli pair of iiervi*, ni»d i-omc of ie* braudies 
Elirou^'h lh« temporal bone. 

Th*^ IKnUTwdT pit of the upper divlsiim oomaiiH numerviLM 
toramina of caoalf, whidi pa« into the vcsiibHfe, forming near 
tho^liincof tlicorintu vi^tiliuli tli(?*»|writ>ri'ribrirori«ji|Wit ; xhvy 
tran^mil the saperior branch erf the vevtibuljir nerve, and soioe 

The Wer and larger portion of the bottom of the cflnal, below 
iho lniiHViT«' w'j)tniii. Jic it* a(if'-ri<»r (tnntT) »UU*t iHiHyiipii'd by 
l1i^ I«^ nf the niodiolnff, :ind the beginning of the ?j>iral tracts 
It Ih iierTorttlaxI by minute fonLmitki n\' i-mnl^ wliirh pas* into the 
tooikihi*^; w>me follcrw the Umina Hpiratisoweaaroumi (heaxi9; 
other* U-rHl out fr>m thi- asi.^ nt dilVeri-nt beiglit)!>r pLriK-(mit* h^^ 
tw€en th« platen of the lamina, am) open in the performed pla<« 
{<aI]ihI thr biilHnijlft. 

These caiKiU Iraiuiiiit the oochl«iP nerve ami vessels to tlie 
liony ami tiu-fnbntnoui< !>tnjcturrv of the urchK^t. 

One canal in the cnl-de-wio juaft^fs through the wall nf the 
vv*(ibiih- inlft ihc iipfKT |Mirt of the rccawtis cocUleartJi, »iic) forum 
a lens^r eribnforni ►jiot, rhfx>n^h ii\-[ii<Tli a filament of ihe cochlftr 
Dtfrvc f;o<» to tin' M?ptum of the ku-vuIqs in the vislibttlo. 

Thf p^Hlerior Miiin^r) poninit of (lie )ovv<*r «HvtHirm is jxTforaii<<) 
by fomfiiUia of cun:il^ H-liich piias iato the vestibule in the reces- 
A11.4 (tpWrieti^ and form t)M^ middle mbrirorm 4|>4>t for rh^^ niiddle 
(ioreriur) diviMcm of the vratibukr nerve. 

In lite pi»terior wM of the mtia], Ihi^re U si foramen of a small 
Guuil, wbirli ofH^ns by jm-veral foramina in the ampulla of the pos- 
t«riort=iemidrciLlar canal, and furnts rlie itifenor cribrifnrin spot. 
^The pwtcrir>r division of tbc vcstibLilar nerre pa?i8<» by tbi» 

iiifl to ilH diMrihulion. 

A tobnlar process of the dura mater, inclceinK (lie facial and 

Ittory nerves, goc* to Jhf Ixrtlom ->rihL^ int<;rnal :inditury c^iiah 
IB pToliin)i£«d into the a^itiEeduriiia Fallopii^ for the paA^u;e of 
lymph, and to supply tli*r v<tiEibuIe with j»erilymph- 

AlM>n( 6 mm. outride of the internal nientns there is a slithke 
^dcprueion in die lfm[).jrftl lionr. at iheboilOJu of whi*-h iff thi- 
openu»s of the aqiiieductus voetibuli^ vrbich leads into the veMi- 



«0 



tns flOMAl 



rDTSSASKS. 



FeMifib-— Tli«- iiitt^rnal audltorjr urtirv', ii branch of iW Inf^ilar, 
accomjranleA ibe amlihiry ut^rve lo the bottom uf iht? internal 
HudUnry iTaiial. vrliere il divides into the vi.*7«tiln]W iimt iMvlilcar ' 
brandi«!^ The vestibular v«t»el divklw into Heveml branirlieH, 
Vibich pitKf* (bmii|rfi numerous foraminsi unt] the inner v,-a,}\ nf thit 
Vttiihule, and nre di^tribuUKl in a fine capillary OPtn^ork lo the 
hone, ssmxraltM, uCriciilufiy hihI wmtciivular atiiak. 

The cochlcvir v<^*rie1, also, imme*! lately divides into about a 
i]<t]Ei.'n bnindK-^, whidi enUr Ihc r<>raminEi tii th« bd»t- of iIk* mm)* 
loliiA and iractTiA »|jlraliH, mingle wilh tbe nerve Alaments and 
pmci.*ed towards lli€ apex of the cochlea, ffivinf; olT brani'lice, 
which bond outward in die lAminft KjiinilU twca, nnd supply iJia 
boni?, tho 1an»ina epiralii; mcmbranneca^ aind all tbe«oJ) tiiwnee. 
AnaslomtcMft oint U^tvroen the capillary hloixlvn^s^lH r>r the intCN 
na] atid middle ^r, so thai discos may pam I'rom oi»v ]iirt to the 
other. 

The veins of the labyrinth are exofHxIingly irprgaUr. The 
venoiM rodieli^or UivnoU :*triirtnr4ti< "f the vf^tibnleand aemi- 
circular cattaln mostly unite in one trunks thu vc>4ibular v«in, 
which p^Hs^Mnutof the pctfous bone tliroof^li ilw aqiui-rludut* 
vestibuli, aixl emptlej^ into Uie ,mi[>erior |jetra?flt &Jnii^ A tubu- 
lar procufi^ of mcmbmui* from the )!EicciLhmf Hiid aiu>tker from titr 
utrioulu^ unite and form a single menibranom canal, whiirli im> 
ooniptni<« (h« viiwlihiilar vein, and i? >aid to terminals in n blind 
extremity, or <:\tt-de-9ac^ vrithiD tlie dnra mater. Some authors 
cwni^idcr tlii# an open pnxi^ of the durt itiuIlt l> tlw* vi^^libiib?, 
through which the eerebro- spinal fluid flows freely in add out of 
the v<^lil)ii]e fn»iii the hiT^^of the brain. 

A few venou«j mdicles fn:>m tbo V3btibulc paw throii|(h its walk 
into the b»M? uf the coc>bli!a, and Join the venous finas ID the 
spiral canal of the modiolus. Part of the* venoui^ radicleA r>f the 
»fo(l tiftiu&i of the cochlea e.n1«r the lamina spiralis oasea thixHigh 
the foramina ai^m it« Mirfacoi und in the ImUrniihLr, aikd fcru 
(he epirnl venous sinua, which receive the branches from the 
vestibule, CH^pe» fr^m the baw of the csxrhica into the internal 
auditory canal, and, parsing out of its meatus^ joins the inferior 
pelrosil ftiniiA, A few other mdielcfl from (lie t9oH tmucs^ of the 
cochlea form a trunk, which passes out of Che tympanic wmla 



nm TBBSSifl. 



ei 



tbmtigh llir afinmlui-luK codilcic, e»cn|»titf from tli« liiilr iriiifif;ii- 
ilarpjt i][¥>ti tho to^of tlicHknll m rroniof die jugular fomrnoii, 
fmad J4>iii-> tli^ itifmor jietttwil niiiiiH^ or ilio jiigiilnr, A lul>uhir 
m^mbn&e Bccomptinkv this vcflsel rrom the tympanic mslIa to the 
EjoM* of lUe »kn]\, and iH ijoUd to fnrniith an ouilci for tlio Jympli 
of the cot^hlmr carnal, 

Tl)(» the vecilmie «n<l <*oi'hlm Irnvrcttdi twonrt.'* of f-ffrrvnl 
ela, K> thai, fhouM onv set be ob^tructc-d, iHl* other would 
"^liroljably Ixr nbU' to carry offrJie vonoim hlcjiMl, 

Lymfth s^pacivand Jyniphntk^^ hfivc bwti dcmon^tntliM] in Itie 
itertal ear. A tubular proceiM of ilie durn innt^r iKUses tlirougti 
lie aqii^uotus v^ihuli ami divider into (wo Imuoht^; ot\e 
^KiirniiMHiit^^ with tlit- Tirririihi^nm) (he otWr with tlii-i^afxtilti^^ 
EM bcfi^re di¥<rribed ; to that tho cer^bm-fipinul Htiid mn vbb und 
flow fnnu till* ^iirfin^ oi' I'h^ hniiii tn ihc ciivity of the vt^^iibule. 
A lubuUr mcnibraoe i^ proloti^'d from Ihi'diini luatcr into the 
cur%*cd portion of the oqufcdtK'fiiA Fallopii, whii^h U prob«b1y a 
klympb F^pi«c*r of like clianu'ter. The dura mjiter litiiM the internal 
■udflory m<iiiii;«. und is ivmiiiiuoitti wllh the perJ^KltAl lining of 
the ft^niiniiia in the bottom, and wiili that !«?roQtt Euodificatioa 
which divi't^ ihi^ wiil1» of the Inbyrinlhp?K> ihitt the <%Tt^l>ro- 
ffpina) fluid i.-fin flow into the internal athlitnry canal and the 
hibyrinthj bi'Iping to Mipply ihc [KTilyntph^ which Mjrrotiniln the 
cuka and suuicircular ranalii, and filb the »cal£e of tJ>e coch- 
lea. From thr tower ^^nd of the H^hi tymjuni, st UihuW procees 
nf Qiembraue leaiU do\Tn\^anlf* rhn:ingh theaquaNliKtn^ cuchleie 
to the hfl»e of the i^kutl, in front of the jaj^nlar forami'tip uimI ihtM 
fnmiriwct a i-ltannel nf e^^te tor an ovcriUiw of lymph. 

The discovery of [K-rivaficular lymph spoccH arf>uiid (he oepp- 
bral ve»eb,remkrH it probable lh»C they extend intothc iiiteraal 
Mr with it« bloodv^wls; and the lymphalicA found in fhe pia 
tiial#rw«in to iiidimUt that the inlt^iml ear h^ well f<tipplied vnth 
tbem^ though few have be«n yet demoa»tratetl wilJt cvrtninty. 
XervtSL — ^l^he fjKrinl ucrvc iirij*t* l>y a small root fn>ai the gray 
iicleus in tlie floor of the fourth ventricle in the meilulla; it 
otttwan) between the n^lifgrm and olivary bodio^, nnd 
ODites with a lar^ root from the re«liform boiJy. It croed^fs 
the mediilta upon the up)>er ^!de uf tln^ nuditory nerw^ ly^i^g iu 



»«a 



THX Ut'MAZf KAK ANI» ITS Dt«KABX0. 



a dcprvMhioti, pntv borijEJ>ntiillv in a double i^h<^lh with tbo «adi- 
tOTv to tliC iiiiernal autlitory aiualuit, where it la niUi^or to lU 
fclloWf wv\, at the bottom nf th« mnal, ^Is above it. 

A Tew nerv-G filnrtM^ntit coDnncrt ihc ncrvCA ^n the caiMl; the 
ta/na\ nfiw pnMi<v tbmtj^b the loratteti iii l\w jinienor iiit of thr 
superior divi9ii>D ofUii.- lx>ttom (filic r»nnl,niid ln-mU liacik«rard 
ulnng live course of the Aqtit^luctUA Falhrpii. Jw€ hens it k 
iitcrcaMHl in F^ijtr hy tlie aJilitioii afscvrml ncrvoungnfitcliu, wh»cb 
form n nrH<tii>li ^wcllin^ itint h^ caJlal iliv iri/trm««crtf//rr ^mgU- 
/ormu^ Tbifi [Kirl of tlic iierve gfvtv Ui« large |>dn]Mil in^ve to 
tbc ft|ilimo-]uiIjit!nc f^niijj-lion, nnd tbo f^ciuill jtetnmil to tbo ocic 
]^DjU;1ior>, uih) n-cirivcd tht? cxtf^rtkul or Mjpt-rficiAl ^ir(«iJj a tym- 
jwthirlic britDcJi frQin the »ym|iatliGlic pkxu!^ of the grt'tit meniia- 
gwil artvrv. 

Tbc fuoiHl niTvi? iKiw fw>«o4 Fwrkword, uiid fo)tnvF-N ib* "Hinw 
ilowii Ifeliind lite (yjiijjuuuEU- Whi^n U i^L-in oppoflie tin; |jvraiuid 
of the middle iiir, it give* olT n ni>rtr lltHt cntei^ xltv tynijuanuiu 
thnm^cb a forameti in ttn [>Ohivrior wall, »i id divide inio iwu 
1iniJtrlK*Fi, ^vbioh stn; ditlfibiiUnl lo iho tlajN^liuK and iW* hxiUvr 
t]rm|Hitii ruo.4clea ThJA JIbre b sometimes called the t^'rii|nuk 

About G mm. above the M^lo-mttHtoid foramen, tlic Owinl givttt 
ofT the chorda t} aipaui nerve, whioh |iumw« u|»waix] in n s^-jwratc 
cuii&l |xtRtllrI with ibe iHciul ut|ui-<hurt| vutt^n* the tj'Eij|)anijni 
tbrou}cb a romnien in (be |K»iiL'nor wall, m-ar tbc lower outer 
(^orrnT, iiEid [)u:?n:w('xo?vi ihv lyfn|iuni(' innnhr^inf^ uikI (HJI througb 
lb<^ auial of lIujELiier. The external branrlics of ilw fvcml bnvc 
aln.wly \hvu couwdered, 

T/if ivtfntai aitflitorg nfrvr arJ«w hy Qtw root ftviii llie lfun»- 
veree while btriae iu ilie floor of the fourtli vcntriulc, and ftooi 
the i^nty ninUcT uf the iniKlulln^ ami bv anodicr rout frtMn a gray 
uncleus In I hi- eras cerebelli and the n?«tiforrn Ixaiiy; tbijt latter 
ha» a Miiall i^ungliofi upon it. The fibrvn unite, and the iterva i 
parses outran] between the reAtiform and olivary' Uxlit-ft, in llie 
vtKuiv gr«»vi* wiih (bt* facial, but jiwt below it; rbe two iiervea 
are aeparatcd here by a atnall artery of the bulb. The two 
nerves eoon come tof^ber, the facial reeling in a i;roi>ve u|>on 
the auditory, and puss in a double iJiuttb iicfirly horizontally In 



KBEVBS. 



» 



ctitcr Uie tn(Brnnl nuitilorr meaUts, vrhere the ainJiiorj' gets CJC- 
tenal Iptwii^ir) li> iht? fuoia). 

Theamiitory nerve lias a very tliin n^iirilemmn, and is wft and 
gtny. It (lividrrt at tb«* Ijottorii <>f the oitiiil nitti tli<^ ciH'liltrdr and 
VMdbular nerves. 

Tla- vtMiUifjir ni>rv*» prt^^iitx a »mall ganglbn upoD it« rtwt, 
and iEi«] dividei inia three branohe^: a, a Piipemr branrJi, tlie 
Qlaiaetirs nf wliioh |wt;« tliroiijrEi ihi; Hi]H*rior sn)ii|> of torainiria, 
bchiml tlie entmiii'e of the aqiiieduciutt KallD[iii, and enter the 
vi-«ti1»tile thnkiigh the unipcrior rribrifartn npfit, to Ik* dWtnUitvd 
tf> Uiti tiVrirulu^ aod the in^mbmnouft ampullff uf tLe aii|ienor 
nnd borixontal H^tnidrcular canals; h, a mldillc braneli f inferior), 
wliich M'luL^ itt4 filanicntj^ ihroitgh iht |XMrtTior ;^mup ^^f f iraiuina 
below, and through the middle cribriforru q>ri to Mipply the sa^v 
caU]^ ; o, (in infiHor branHi ' |MM<t*rinr)^ whr***- filamriifc* iuWr ihe 
foramina in tJio posterinr wall of the canal, escape from the in- 
ferior eribrilbrin «f>ot and arv di^ribiilix) lo thi* mciiil^ninout^ 
alll|nllla*^f lln'iHwrirW *4etm(ip<'iifar<*anal. The l^riiiinalioaK of 
tbe^Dcrvcfilameal^ ill ItiG membranes liavcfl>ecn II hv.idy described. 
The D<rv<K 6ii:it iti tbi- perilympli in thnr |Ktm(|;4- from tNi' bono 
to their ditttribiilion in the mi'inbrnrnfif, and their einls are ^nked 
in tbc rndolymph, which washes the t'pilh^hum wilhin. 

'nKM^M'hUcir nerve, At the Uittom «f the eaimU^ivesofTa fitnall 
branch, which entcn a foramen, piaft^^s through rhe wall of th4> 
TMibnle, and ^i^-ipes »i ih<- h-«4er oribnforin r«pi>l, io supply the 
inenabrdti€ti« j^ptum between the utriciilits an<i sacculiis Xhe 
main portion of the nerre enters the hui^^ of the modiolua and 
lamina tpSniliff tvw'a, and continues in canak aronnd and thrt>u}!h 
tli« Axut to tlie iiaiiinlHr jtrocv^i, <liriirihijting lihimen(j!i in a radi- 
ating manner outward, liet^'een the bony plates of the lamina 
lipiraliH at&in and tbrrxi^h Ihi* hitlK*nidn perfomla, to pii?w into thft 
dtKTttis i.tXThlcart» and the ot^u of Corti. 

Tliese lihres form a gaiigliated plexua juM Ix^fore pawing out 
of the lamina spiralis, and are divided into an inner fih»)ricnlua for 
the inner ciliated e^Uftof (heorgaii, an<l an outer fiL-^cindn!^ for the 
ooifT rylltt* They pa^ from the habenula tlirongh the gninular 
layer, then etoh filament goot* into the interior of ite cell, and 
the H>fl axi^ 4*ylin<li:r minji^les ib» neunl elements with the nni-leus 
and prDioplafltn. 



M 



THX HUXAS tAB AiSt ITS DIEKASES. 



SjRipvtlictic p«rvt Jibrei from lliv ttupeni^r uervral |!:uuglwa 
>o(Hmi(iany llir vrw^rK inti> the vcvlibiilar nud ccclik^r btructurDBf 

TR<rv/f//rfi/#Hr/<i<:ruf tlie petrous jwrtlon of ilitrl^nqx^nt] boa« 
Us afVL-rvil 4T!4irirly by tlii' (Inni iiwttcr, itti<l thr Uiiigii tibrw of Um: 
teiiioi'iuai an? Hrnily atui(.-heil to Ita upper eilge. 

TIjt Htt|H'rior :iiul iiir<Tii>r |H*1nHml nntiHS itlcirl ibc <i1^ of ll>e 
^KvkTior surface abcve anil below, and join iht^ btcr^l sinus, 

Fio. -Jl, 




inni*; ?t, iriftllHix; 9, MHiiiilirEtim nr mnllxitH; 10, Wmarir ivmfiant uiiivl^; II, 
iyxn|i«min; VI, Hundchinn lobe; 13^ iiificrioir wmlrln:ulur oannl ; t< |x«ierlar 
Atnii(?EmiUr nami; \\ lioriAODlol «4unidm)lftr rtinal ; Ifi, co^iiW; IT, [nuvul 
tilillUirT nwniw and «i|i«l^ IH, ikciJil nerve; IV, JArp; potrvnl Done; Mt, 21, 
iU|ii«iiiii?tiiB l'*itLli>pjL 

which ^mrvtii lUt^pIy towards titc niOAtoid, and tln-ii gom inwnrd 
and downwani to lh€ jujfular vein. The cJcee proximity of 
thiiw largrt vi>H.-U to the <nr and tiiaKtoid rjuij*t *w rrnKmbcnd, 
In onier lo appreciate the danjfer of disease in thow paiH. 

The middle Mk^ itf iW l»riin rcsto in fVoiit upon tli€ i>fftrci»s 
l>ortjoii or the temporal b^oe: the jxieterior lobo ia behbd it^ 



TBB impact's BAi. 



w 



rusting u|>nii llie U-ntoriiim, and tlie lolie of tlie cerctwilum t>elow 
and bthind filU the poetedor fij6^ and Ia snugly ooveml over 

• 

The Inract's Bar difiere considerably frou that of th<^ adult 
whirh ha» jiivt Iweci t^u.si<lfrf<ij. And it ih inipomm to lh<r nuriist 
to know what llieee difttrences are. The younger Ibe |)erwn b, 
ibo niuK rurtiloffo xhttv. U in |*lni*t of oMtooiH utruotiinv and cJi« 
]cs» develo(H:«l are the cavitiftf, iuIhm, and {)ruc«<?K« of the lein- 
p>nl hone. The (\iiipniini i>^ filh-d at birilj by a gi^lalinoue 
!Uib»taiic^, which t^ ^mI ut dl'^ppeiir witiitn tlict ltr<t rrt-Hily-four 
boun or life, and it^; abtHrm^c u oonfiidervd medico-legal evidvnee 
of llvi* birth* 

The bony portion of the external auditavy ranal is ftliort ; the 
jttmi^ fmin tht; ejcteriiul niiditory meatus to the pharii^nj^t^l end 
uf tbe Elu<tucbran tube is nt-arly a «trn)^hl truiiM'erFU.' Iiiu\ iind 
the ni«mbrana tympaiii ifi &o oblitjLie fruin abuvt, inwani. and 
furuiinl^ tL» to MTVO Bl[]i<J«t tM a prolonf^tion nf tin* unti^rior 
»if]>erif4' H^ll of ttie ornaL The tympanum lice miieh nearer the 
sarTai^of llic side of the \ivu\ thnu in tlieudidl, attd ibetbKi<^uf 
bone and cartiliip,'lbat ritirroiiiid tlie eJir, lW miii^oidf nnd ilie 
exterml canal are very diin and delirale and eafiily (aHnnilcd. 

TIk* ma,-«tf>iil |m>ccH C0B8i3>t8 of u group of ^mall ct-IU with 
their lcn)f diameters antero-poHlerior^ifituulci) imna-iliaicly Ixhind 
thelyni|xinum nud ibe auditory amal, and extending' a little above 
and bokjw Hw yn\U of the latter Tbr^ are limikd exn-riiully 
by tbe squamous portion of tJie tem|H>ml bone, anteriorly by the 
(XAterior wall i>f the auditory cnnal, and »u[»eriorly by a pro> 
lon^iioo of the thin acale of hone that fona^ the tympaDLc roof, 
Tlw lowi^j *** )1h tijv a liule below the level nf (he lymimnuin, ard 
seeretiona are apt to cirlle>rc in -them and excite inflaniniation. 
Thvi aitnlonitdd arrangement favorv the de\'elopinenl of i^rira, 
whieb in prone to excite cerebral irritation and dif«?afie by trail** 
mWon u|iw&rdii throiigb the ddieiite tym[>aiji<^ nMit. The indent 
nmstoid of adults is develo|)ed behind and below this pctrtion, and 
it nore liable in mMt of cvies to afiect thu lalcnti sinii» and the 
OGrebelluia. 

Tbe eara of infante and children should be examined with 
extreme care, as aeriouA rcintlla may follow rmtgb or nntikilful 
tttoipuhition* 



TOI UUaAK VAH AlfD ITS DtBlASfB. 



CHAPTER IL 



niVSIOUKiV OF TUB EAB, 



all Uiinffi in natttre, to tticr iorcef which act upon it. A fuiinel- 
sJiU|)ciJ eilcrnnl [wrt con(Vutratc« wiiv4k of iouad, »ml oomlurlt 
[lu'm ro » vilirelorv men]t>ran<^; tliis nM^mhnn^' trnt^mils ilfl 
vibnition* l>y tU'limtcW iKljiMt<^ <m4HHi» Wt-iT* tw another miTn- 
brane. attached to the iun^-r «nd of th^ chain of ik»!c1c9 ; (hwe 
oorr(?^|}'>mHnt; vihrations, lik<' vrhoc^ of tlio fin^t^set in iiuitiixi 
Quid i^iriiain^ in a bonvt^virv beyond tlie meiDbrent', which 
mrrr>nnd» cIcKtd jaiicr, conUiiniti^ tluid. and having niTvo ti-rmi- 
nati<>ii8 projeotiiig in epilheliiim u^ton iheir inner eudWes. 'ftie 
fluid wi[hiii thi' Ixjm? in fnmi of lh<: nict* inww by gvntic wa^-e* 
U|) oni? Hpinil tuW in tbt" ci>c'h]«« and ilown tlii" oihvr, i^Uing 
thmiHindfi of atluned Vvys that lie in the mcmbranos li«lwf«n 
thfrn inift rpiaverv, and bc^tn ami bivalcfi tike mimic* ^nrf ai^iuitft 
the M^i»nd membrane of the iiitcriijJ L^ur, to cxhan^t its fon.^, and 
to <<ounleract o\Wr vibrntimis that <x>me from the &nti membrane 
nenjsa thf tynifknniim inilependent of thf chain of biMira, anil thus 
to jimotber, afl^r proper leinirJ, all the (ones of Aound. 

Dclic«trly and cormllyiJmp^sJ nuricilo« arc a thin^ of bmn^, 
nmi aa aitribule of ndture ami laMe. I-ong, Tlun, c^mrse, dii<^£, 
or m]!<^bapi-n vatv^ f^*n«'rally aux'om)uiiiy faulty dovdupment in 
other jiarts of the body, and are »een in fbe simple, tin* ignoniiit^ 
and bfHkrii^h* The |i07<ili<>]i upon Ihi^ heail, uh(rtb(*r ctoe^ down 
or standing far out, hafi much to do with tln^ imprefwion ihey 
pnxlui-e iijmn thcoUt^rver. I have m^uii tlicni i^uuid out ^ far 
that the auricle was in a direction parallel with tie face, and 
af^uin no flattened as to be barely visible from in front. 

The aiirirlo i» ran.*Iy movabU at will in man. Th*r mu^ot 
atliicbed to the auricle, lK>th exlnnaic atid inlnmicv an^ analogoiw 
:o very uwrful oiio* in the lower ammak AVhethcr civilisation 



PHTdlOLOOr OP TBI BAR, 



«7 



hu cinswd tbcJr partiul atniphy in tli<: yfnu4 hoiao^ I luuvc lovci^ 
of ^f>«><'u]ative jihii()^|>iiy Ui iI(>H'riniiie. 

^fsn nm^i turn hU^ htad in^uml of hie can to catdi tht' tlircc- 
tioti and cluiracterof iliirtil M>iinil< Th« axLriiisic musolet Ad 
involuntxrik to a hU^hi de^c in all |ierRin^ upon liio H|>|iUat- 
don of a i4irouUi^su<-li ^ aa ^anlouche, or a piuj^ge of the 
clc<iri« eurrtnf. Tlii* jtinnu iv<lruwn U|iw»r(l uikJ rorwnrd, it&(l 
upon the ^timuEuf* €(!a9iiig, it goes back to il« proper position, I 
linvi- ocx^^iuilly iM^cn in^rmin-; nic»*i! Xlw pinun voluiitHrily^ imd 
it aJwayij went upward atmngly, a little I'orwunl, and theti back 
to it» pcMiiian. Ic i» probable (lint onmng x}w wivagi; juk] tsoiinwly 
developed races of men llie m[Bck« d the auricle tuay be ^ lar^e, 
tt to raible a voluntAry niovc^ncnt tt( thv jtinmi, limping iiiul di- 
recting it>i Gooeavily towards tiie M^on^e of fioiiud. 

'niiMTurtiUp'tif tl>ea(iridc^'ivw< iti^lm|K'aiKl rliarH<Her, luid tiK* 
auricle stA a whole naiA n^ a re^^nator of wuwi. ]>r Uurnelt Hays, 
''lbrr€gk4iortJ»ili<.dix&ruiitf»r'i»>e9i rwuumi totlicdit*ptrm>tc«|tlie 
antilielix and \t^ firna to ibe iDlermedi^te notes, and the concha 
to tliv bi}«h (lartiul toi)cr<%'' If tht- rL'Fiitionj<i or )«ha[H^ of ll»e <lif- 
fpreni parti* of the auricle are altered anilirtally, ^r hy diM^iu-e* 
thu adion of tlu^ of^iui U tnodilkxl. He i'oiiUniK^f *' riic uuriel^, 
in combimtion with Uie »im^ atuliU/riux, fornix a regonatorof a 
ition- or ICM oonit^l shapc^ ch»s:d at the Ixftlom l>y tlic lucnibninu 
iympaai, [.he special funi4.ion of vrhich is to ^tjenji^heD by re^o- 
natioe ihcwe wavrs of sound whk^li |xitt«<^jvt a sliort wnvc lcn>^th/'* 

The length of higb note wavts correejHMKls closely with ibe 
la>gtJj of th? fncatUA and canal, and af Uiuor noto •vtxxva^ wilh 
Ihb length augr^enlerl by the depth from the liorder of (be meatus 
Ui the outer ulgc of the helix. Tliis di^itb of i^r Jm iiirn*iiiwd and 
tlie vibrati<M» condeni>^ by pulling llieaufiote outward, by hold* 
IQ^ IIm* liund nmund the auricle, luid by the tiw of a trum|>et; 
Xhm the nnttintl rt^^iianoe in greatly iiKrreaxtl hy lboi*c who are 
iltaf or M'lio w!&b to <stc]i feeble soiindc 



* Ibe Ear, lift Atiktcmi.n Phy^olc^, uul DiwwmAv Bj C. 11. Btinmtt, A,M, 
IIJ). n, C LoA^ rhlloiklpbiii, ISTT- Thi> ift b *untlinl K<irk, lo vhtdi 1 aid 



«a 



THE BDJIA3T BAR AUS ITS Dl9Bi8KS. 



The hnire oAcd tm-n about tho mouth of tlic mratwi serve to 
aiiWiti lilt caiiul from dual, uiiJ d>e cKirurni^ji always fciuaJ in a 
limitvtl vrnount in bctilllijr fan lubricates tho i^kin and protMt 
iliv d«*fper parto fmru Jirl, moirttun?, und rude irmdtt. Tfib drio 
Aiid fulUout usubJIv^ if h'i nlonc, a» titc r»i)»l fmin ili<< plnrr of 
i(a aecrelioii alopiA dowmviird ^jh) outward, aud ibe i-|Htbi^tuiu of 
ibr cntiul U fi*ij>f>oivd to move outward during it» gnivtb. 

Tbe audiu>ry (.-aimt Lt (bi- ttrtiall |>jtrt ttC lUe aiiriitdNr iruoipel, 
tud it Aidv ill thiT coiidi-ntiuiiuu of sound a» titx^v^ ili?wnbvd. 

Th« cuewbruiia lycupaiii rvwiva tbe vibruiioivi uf Houod di- 
racttil ttpiiuni ii by the- cxicntnl mr nnd nimd. 

Sutiod in uti InipreMion prtxiui^ei) upon tbe auditors nvrve by 
ilw vibniiioiiiiuf 9(jnoruu» Irxlkv. Tbi ni m(i«p!K*riciitr UiMUilljr 
the medium of transtDiaeioi] for the vtbretiont), or waves of sound. 
Nui^e m II i*cii«iti<m prxxlunxl bv WAVo«of imcquid frugtb ; niuvic 
ii one produced by thoac of e<|ual li-ngih. AH ^khiimU have (tie 
Miine VL-locity in the ^mc to^-dium, but no M)UDd m tninjsinittit) 
in a vacuum, Si>und moves !ii thealrat alem|>tfratiire of til ^ F. 
at thf n\Xv of I U*J feet per second. As ^e ccmpemiurv is lowuntl, 
lh« velocity Jifniiiuiti*^ a foot and a tt*ntb for i-%i-n- dfgroe- Tht 
veliM-it)' of sound in liijuid Ia increa^ over thai in air aliout 
four and u half tim^^ ^"d in solids from fi>ur to »ixti*4;a times. 

t^und bas three fjualities; 

1. Tone, or pitch, in high <.r low ; the mott rapid tbe vibra- 
tions, tbe bij^ber will be the sound, 

2. Tiii<'ik--«ity, or loudnt^dt'|M-iu1-t u{K>n the beigbL of tbe vitua- 
tions ; soundif may bo of tbe mme toiio, but of ihtfcrtot dcgrcca 
of [(Kidn<^^ 

^. tJuaJily U a peculjahty in sound by wbivb one can dis- 
liiigtiirih bvtwc^Tii two ftound:^ having i}w Humc lone nnd intenaily. 
Forimtanw, everybody can tdl the notes of the flute fromUioee 
of lliu cbiriontit. 

Tbe nuniher of vibrAlior§, or waveaof sound, in a second, tliat 
th« buman t^r van appn^iatu, varies from eight to ovit forty 
tbonsaod. The wavee are from .O^S-f to i:i^,7a feet in len|^b ; 
thv length of anavL-, orsonorou)^ vibnittoDf lA t'fpinl to 1 118 fvet. 
tbe di^taiice aouiwI travels in a scrond, divided by the Dumber of 
vibnUioDK in a M'cond* 



pnrsiCLooT op tdr bar< 



69 



Verr rapid vtbratiom^ arc vcfy &€utv in tonc^ and painful to 
ihc car. It ir* pmhatil*' there are ^nnds in natun^ too acute for 
|wiw[Kion by hnmjiii ears, yet, cw^ily reeeivoil by tJic [H*<H]liar 
awlitory appamLiift i>f infu^rrt^ iiml other animalt^. 

The wnvm of houik) are eonHitHedji^inst the ineml>mm lyin- 
{lani, aivl M it into nifiiil vibmlioTis, oonttistinif in rapid depni^ 
eioo and r^toration. Th*we in-:in4-i>iit movettieMr!* of Ihe nunn- 
bniiH> occur regularly, awl remind on* of the oeaflelese Agitation 
of Uie Mirfaee of tlie ooean. Tin: ini'fnhram- bnKI-^ ihe matiit* 
briiioi of tlj* iiiflll'^iL't in jHi^itimi^ am) supports through it tlie 
entire chniD of iimclt^ whieh ttwing |H-ndiiliim-lil<v in tlic t/m* 
jAimtu, anil transmit the vfhrulion<t anvived from thetympank 
fiK'mitniue to ibe niimbnioe in the furHUM-n ovale of the veslibulCj 
to which the ftK»(-p!ate of tlie slapes is altaebed. 

Tlie lympniiie menilkraiie k(H*[H lb<< chain of l)ones in erjiiilib- 
riQin, and prevents tl»em from Iwing; pushed too far in, or draiic^l 
too far out, in onler, that vibmtioiis tnny t«et tht^m into 1o-»iK)-fro 
tmotion with th? g;reate»^ ease^ The merahmne proteeta the 
^aCnirtiir^ of thi^ tymfTanum from fonifi;n eiiMaiktxv and the 
dinwi entrana^ of <tiM air, and Irait^mita vihm:ii>[k-s a]^ to the 
&rr of tJie lytnjKinuni, (o inipinj-c aptinst the niembraLne of tlie 
funin»eo nituothini in iheoorhl^ii. 

TJje owielw of the inr receive vibrations fr»ni the menibrana 
tympani, and traa^^mil iheni to the oval wiekIow. Th<^ir artien- 
latiou and lipiwenM hold thoni in position, am) permit them to 
mov€with great ea^te throu^ha limited ppaet>. They are partially 
ravctoped by a delicate fold of the mtjcvjiij* inwnhnine of tlie 
drum, whieh does not hinder their aetion. 

The tenwT tympnn! miucle 1-4 caii^ to contnH by irntation 
of ibe inferior maiciltary, and the facial nervee, acting through tbu 
o<ie ininiclioci. It h probable ciiai t)ie rauM'le iwV* t)nth inv^lun* 
Ijirily and voluntarily. It draws the mullenn inw^ird and rotates 
fi upon itfi lonjt A^i^ ^* diat it^ poHti^rinr Umler U'fH>ines prooi- 
inunt outward, and the posterior wgtnent of the toembrane ad- 
vanceil, while the inK'nor l*ortirr nmlergixv <Hirn^|H>iiding de- 
pn9«ion with the anterior ptrTtion of the metnbnine. 

Tli« musele atftidieii the naalleua and membmne by itn elastic 
tension, placies t]je laerabmne in the be^t d^ndition for vibniting 



Tn« BDSAK KAR AlTD ITS DlBBABtS. 



to h]]^\\ iiol(%na<l,actiii|r in tini^» with th« imlnml noii^lcH wliicti 
open th«r Hui^larbian uiW^ it a^^tHts probably in chan^in^ tbe Dir 
williii) iIk* lviii|miiuin< Lm^ic IhinlcM b}' <Hjiitnketiii^, il ocooid* 
uKxIatei the membrane lor low Diusiot) Dot««t. 

TIk" !-t!ijR"(liiH inij?tt*lo i» tbc ui)tiigf>nir4t of the tcD*(>r tym{Kiiii ; 
it holds the staj>efi in position, and prevent ite being foiwd into 
tb« ova) window. It (-ontm4'1» with tW lAXfltur tympanv «}wq 
the fap-iAl nervG is irritatiHl, and mVt a.4 n rh«<:k upon the tm^ve* 
nMnttX!^ of tht^ rhuin <>f <>-*iHw. vmi^ by the ;K.*tk)n of the li*n«or 
hmpani, lie^ilts tlte faoial filamenlj it w aaid to rvx^Eve anothef 
from tlie motor jmrt of tlic inferior nmxillarjr nerve, Trodion 
on the etapediu» dmws the bend of the maMetTB inward, and the 
bw*r part of the merjibnimt lyrn|wiiii iiM^vn* nulwnnl. TheMa- 
pedinadrawfi the head of the filape»- bfldvward and outtvaid, «> 
thfti the antirior 4<nd of the Pnrt-pbie movi** 'Micwarrl a littJr, 
the long proeete of the iDcn** is ff^nwl oolWATd and its bead in- 
wanl, ilnt^jiij^ the \i4^i\ of the nvilletiv with it. Thu moves 
the malleus handle outward, and relaxes the membrane for ItrtV 
lom^. I.neie tK-lie\-4?i ihiit when it i»<*onlntrt<<<l it [K-eomnitNlalos 
for hi^li iiniuti^ical Aonnds, The normal mo^i^eiiieiil at the foot- 
plate of the»ta|ntt ii* fnmi ^^ to j\ mm. 

Tlie fixator \msU siap^dt* rtvts to aut^^niro the stapeditis, 
and to [»ri-vefit it I'roin ftrfcin^r the fijut-plattf too far into the o%iil 
window. 

The I:itx:itor lyinfniiii m Mi<I not to |HkMW«s muwc^ulnr flhre*(, ImiI 
to «t1 \>y elastio tension lo hold the niallens in pofiiiioD, relax the 
tympanic membrane, nnil tlint« antng^>nife the tensor tymfttni. 

The niemhra.ne of [he foramen ovale holds the stapes in posi- 
tion, liniiift its niijvetiienis, prevents the <}**»|»c of the |>erihiiipb 
of the vestibule, and transmits to the perilymph the vibratiom 
reeeived from the #la)ie<. 

The membrane of the foramen rotundniu, the mcnibraiia 
fecundnria, rhm* ihe foranwii nf the tyinpanie jv^la and kee|i& 
the ]>erilymph witltin it. It vibratea in utiison with the ovml 
membrane, throut^h irnpalMA reeeivcil from tin- |u*rilym|>h, vhirh 
u eonlinuiiti-s from t)M^ ^paoe around the saecnle^ of the vestibule 
llirougb the«»l»T, but lU cxenr»ron« of from ^^ji to tI|< tnsL 
area little later in time* li vibrulee, al»o, inde|>endeiitly from 



FllOLOOT 01 



fiAa. 



impuUcs received frum Uie membrirta tvmpnm through tiio lir 
ur'iLi-lyiii|ikiium. Tlw5«»mav?*'"t ilin^rtly tiiHin rhi^<NX^hleur Ouid 
nml pnniiiiie mund ihri>u)£li Corti's orj^an. JOich vibrutioii !«• 
watxbi tuny LTOfiie Iwtureen ivro vibratiniiM outwurd^, product by 
llw.' tluHl ftffocttnL by the iniptil^e^ fmm the oval mombnme, be- 
cause iUt vibnuioiift froni cIk^ vi^tibule mii^ti omo liiU^, than 
tlK«e rroeivwj dJrertly tbroUjffh ihe lympatiic air, thouf^h we raiiat 
rcmenili^ thai tliiidHHiiil -«>IuLh CNtmliurt vibratinim much fiutor 
tluiti iIr* uir. ThuA both fein of vibrations would be jiiteDfiilied, 

Lfor a spring moving up or down will hnve iu exciir^ifMi iiK'nsutcd 

Ibyan itiJd»<l fcircv in vilher direction^ as we see when a bu^'- 
9prin^ brctilt!^, whon lh« iiirrUf^i botjy Ixjurnlic npujirdj^ aftirr ttK' 
wli(-ei» JiJivc goiie suddenly inta a deep hollow. If the^e vihra- 
lOQH do not ihn^ uh«rnale luid fit to^'t]L(*r, then tbomr thnt ikuw 
through tile air of the tym|)ai}Uiii pn>Emb[y u^^t as dampeners to 
UiTf^^ the iimvciuynt:! ol" tlw ov;il iiinnbniiie, oiuxtl by ihv l«hy- 
riMhint- skgitatiom, in order, to permit a new set to have full 
Tort ii|>'>n fhenervmt^ »Lp|itimhM. I biivu thought that, |>LThiip<, 

^ the oval and rmird nieiubRtneii acted in uiiir^ondnring tli** jiasaage 
of tl»r rvi^ular periodic vibrutioti« of rousm, and in opiKwition 
during the irre|£iilar ones of rioiiie. 

XIk mn^:ous tnnnbrtinc* of the tympanum covers the tympanic 
wvIIh and ixmlentr^, and ke«p?< thu caviiy niornf, and the |iutl8 
movable. 

Tbo diorda tympant nerve him nothing to do with die audi* 
tory fuiietions, but tncrely poBSet tbroogh the ear to \{» placv of 
dblribulioiL The tkcini nerve 4uppliefl the motor filaments Air 
tlie inuiH^li^ of th'* t}'(i>[Kiniim, and 6Uimibjlily nsiidi^ in Ihi- tym-* 
jjaaio plexiu before de.-'mbed. 

The vU9««fl» of Ihe i*nr titv dovijlwJ ti> the nutritive prt>cet>es, as 
in otl>er parts of the body. 

The niAi^oid iv|lj^ with tlieir large, irreguhir i^pa^K^, aial the 

^tympanic caviiy are 61le<l wilh air, which is sut^ected to vana- 
tioiM of prv»t«ure froai the vibralioiid of ihe miMiihrana tympnnt. 
Low lonefioiuse hrge movementH of the membmnatym|miii, nnd 
t?oitt»idvnilde pn'worv in lUv uir 4T tlie lymgvanuui ; and, as a lai^ 
tympanum would csuhc too much resonance, the inurcoac of c^ 



72 



THS lUHAN BAR AND ITS D1SKASIS, 



[NU'ily ncrr-wwrr for tbt; pftiiwr nvf j>tion of wioli limev b» laade 
in »ueii a waVt ^^ to iiitorfere k'UMt nitli the vilin([ioii».i 

Tbc KiLft.tchmti tabu nnivc/rt air in :ht± iyrn|ntiuiu, hik) iuucui 
oat q{ it. The pliarvn^^l ciouth of lUe Eu^iaiehhu lulw dunng 
r<*piliir rcppiratioa movi.i* » Iink% Uin doiw in»t «>[«■« hy ibvir 
Wbe« tlie vowels are pronounced ilie moTiih oi' Ui€ tabe opras 
i]<>witwunl uikI f»rim on i>b)u)ti^* trimi^W. Sonw nuchorn ilnnk 
th«i]pj>er porTi^nof ilic Kufiiachian 1ub« in a normal n>iKtition 
ri^nL'ua* r^li^blly opvn, thiit tiir may <vc'upc fntm tlic iyin|MLiiufn, 
when the timiwnic membrane it* Micldeuly drivca in by great 
jjrftt^uns Thi-^ jwrmit^ u j*iow inl^r(;hiing<t of ulr tietwwn llw 
throat and ih« tympanum^ Pmfefflor Mon« Iwlicvt-* th^ tnl* 
when ut rt^ \^ cUmnl for twr^-tiitlh'^ it-n li^nglh at i<» narrower fmrti 
and ihis seenas a i^asonable stale for the functional activity of tba 
ttir Tbe whole luU^LHopeneddleswrliaot of swallowing, whi*l> pei^ 
milA nmcns fmm the tympanim) and lube to be worlciil out liy 
cilian «iid muM;ulnraetfon, insures a pn>per intcrehan^of air be- 
tween the tjjroat, tympanutn, iind tRa>^toid ecDs, ami cxertfi cciough 
eoiinkr'piK>sun.'npon the inner wirraec of the lymjNinw'UiembmiH' 
to ker.-pit iiii.HjinlibriLim< The tiit>eopon« when groat and sndden 
t§oun<Ls strike the oaenibrane, and thu4 prevents flhoek mid ii^ury 
to theappaniLiii*. 

The Gtyjo-phatyngeuH^ palato-phurynf^^OiS levator and tvnsor 
palati, flalpiiigO'pharyngeai, superior phar\'ngeal constrictor, and 
the inlernal }>tery)|[oid, are all drinocrnod in opi.*ning UkO KoHtiu'hian 
tul^e. in eomnw^tioM, they raise the uiouth of the tube upward, 
then draw the anterior wall forw^nl, the inferior rlownwnrd, imd 
the posterior l)ackwnid, ard Ihnt o^wn wide the tube. KniinenI 
uuth«»ritii^ ure in (:H:>i]flia m n.^ganJ to the purl of the proei-w [»er- 
fomied by each muscle. It eeems probable they all have mme 
pan to piny in o[H-niiig the tiilH* during f^wanDwin^, but the 
teciBor and levator palad muscles are the mo^t importmt. 

The t^iFior and levator pidiui, acting with the palaUt-pharyit* 
gens, perform a very imporLant lunclioii in drawing tl»e soft 
palate back agAiriAt tJie pharynx, aiu) ihitn Hhuttiiig oil' ilw luuo- 
pharyngml apace from bclow^ so that air may be driven into die 
aan tlirough the now and Eutitiu*hian tube. 

Sound waves are best licflrd whea the tube i» dosed, becuiK 



PHTSEOIOOT or TSB BAR, 



73 



wbra tlnrj rtrikc Uuli kkIw of Ok uL^tuhnmn tvmpiini ibi-y ttt^M^ 
coijAibion iiud M>meliiiU'?^ |)uin. 

Tlic txH'ltliiir wulln jmiiirt imd <<4}t]tuiti thv mint vliibomtr pc^r- 
tiou uf lite argnn uf hvarinji^. The orguii of Corli \9 ihe jeoljaQ 
harp, wbich iviwjmjn lo every vibmlion fjf the membrane lym- 
pani, and fitfniHht>4 the roiisie of the univerBe. The dlbled, or 
hnir-oelln, of tlic Urntiinnl ^hxvs F)f (he cHxrhloar nerve are mav<K] 
Jik€ Uie string of a pintm l>v tlie blow^ nf ^ijiind^, whuh are 
IninsmitCMl tltroitjirh the membmna boj^ibm bv the tluid of ihe 
labyrinrh. The oetU nns gnxijn^l and protecli^i by U»e thr^ 
thoii43nd ar«h«fi <)f Cortif and oaoh one id i^pptised to Iw attun^il 
for the rrcojition of & pnrtK-iilar loms Thcr vibrslionft of iuu?*ic 
sweep owr thwe hair-^IKAAlhe wind swavsthe nodding plumbs 
of 1 wlKtit field; as the pitch ri»», eoiiti|riious f^roupM of cxllil 
are <>xeit«itj and therein n hnrmtinioa^ bl^Ddin^ nf Jmpn^roiif), 
like th« melting c( one tuoe into anotbor^wbi^ the loud pedal uf 
the piano is preA^. 

Tht cocblflw nerve clcment» have Mich dHi«itewn»=ihiliU", ihiit 
expert mmiHant^ ran diMinguiab a diftereDoe bet^veen twa uftleg, 
whoMT rates of vibnuion are ]fJ()0 and ItKH in a H^eond, only 
t^ of a »en:itone> Kvcry mmitd ia rimiint^rd of n numtxT of 
fiartial lon€«f and tfadr Dnint>er and efren^th m^kc the ititlVreiKV 
in aoii>. One of thtMC toneH Ib the fiiuiiaaietitul, and the nvt are 
overtones, or harnionioL ¥.very note aeta in vibratioa that 
fmft of the i>r^an of Uorti bclon^inf^ to it« fiindii men till tone, and 
the otUer parU eorrespnndmg lo iL** jxarttal tones, 

Noiw oon^iT^U of iahurinonions tone«i and it« trn^ulnr vibri- 
fciiMia flc-t ii[i*»n the hai^Hy^tU of ihii^ wonderful ot^n, tut a child 
plays with piano-keys. The hair-cells deliver their tremldings 
of aound 1o the idiimnlc nerve Rlanient^ llmt pafA through the 
babenula perforata and down thi? nKxlioKis to foron the coehkar 
Qer\'e, and dils earrif!^ iL4 [ireciotirt nii*^igc-^ lo the oouaciousnefis. 

The inecnbraLnoiij^ >!hetnidreiilar catuUs and VMtibule Lndoii)>l- 
edly act as a trait^miUtn^ apparatus of ?4ound to the brain. The 
prtMiiov of Hiiid arouml and in»^dc ilie raeralcs nnd oanal^ the 
large dietrihutloti oi nerve tilarnent^ to tlie eiliated oelU, the 
QamwoOB otolitJkE adherent imd lyinpr fr»* tipoti tbei^-, nnd the 



74 



tBE nUMAS KAR AtfD tTS PI6fA8SB. 



rcKuW form &i>d potntiun of llic canuls wouM Mi-rD to indicate 
great and iTiiporliint audirory functions. 

In Ukc Iklf^her Invcncbnititt, tlio or^tit of hearing gmcnUy 
eoQAiBts of a Himple cap^ute, with ihe auditory nerve dJittribuied 
tocili»t(d (pithcliuni upon it» innir «urf«oc, niul coatiiniog oa« 
or mure otoliths; there are no signs of canalA or eochleEi. In 
the Yorlcbmtts, one liodj^ u »mi]ar ctipt^ule (vcslibtile) coiimiiiiftg 
OtoIidifi.correflpoudingloffLe^ntireearof the InterteUrarci*; whik 
the* Twniioirciilnr canuJ^ uppenr^ &nd urtr devc'lojwd nioru iml more 
ID the luceiidiDg ^cale. There are at first in tUhes two imperfect 
HeiDiciirular oaiijiIh (tnitr&ipohmncJtuUe^), theii hi hi|i;hcr lixho 
three {elaMnotrancMaie^), but there are no signs of a cochlea 
eitlicr in livh<9» or bAtructiiuri^. If the cochlea 10 iKvoswiry to 
appreciate piuAfcn) Dotes, 1 vouUt hke to knovr how frogs are 
able to modolAte their merry voices ho hunnoiuoiL^ly us tbty do. 

The ax-hlea lin^L up]>eaTS in rejitiles a^ a i^hgJuly (^irveti caoal 
without any McaliPfCieept in crocottiUa; io binb, it brgias (oforni 
a Rj>iral, hucecedr) in the. lowest of the mainmaU {omiiAarynchus), 
ami reach«ft its highi:«t de\*clapiiient in man. Thei!«mioircaIaf 
auial^ are loii|; and narrow in rjL[Mu'ioii9 hirdi*, um) lai^ and wide 
in singing birds, — sosy nigniftcunt facts in thia oonneetioiL All 
iik^m fac<t« make it certain, \\\i\i the vcTntihule and iwrnictrcmlaT 
canals are very nece^^ury for aiiditiou, however viviaediooiiBta 
may dc«Juec thi? eoutrary fr<.«ii ihetr nitjiilating cxperJnicnts. 

The perSlympb vibrates from impulses rei^^ivedfrom tlie mein- 
hrano of the oval window, iukI wi^ ih^ niemhi-nnoiL" ^aonjles and 
caaals, with their eiidolymph and ololitlii«, into raiponMvo vtbl«- 
tM>iut; Ibe^ ioipre^ the terminal tilamenLs of the v^ibular 
nerve in the awxulcs and ampullv, aad pum alo[»g itft trunk to 
the' brain. 

The vesiibnlar nerve, also, Iransmits to the cenJ>rfil cenlrei 
aezMalions of the cqnilihnum of the head and body, fjcpert- 
mentH upon the lowt^r animnEs nnd man indicutc, that tlic endi>- 
lymph inovc# 111 oertjiin dir£<'tion!tf ntx^nling to the moveioeDta 
of tho head, and impre«t^?« the teririiiuitiinHof (lie veitihalar 
tiervcj ^ that ttie individual \a consciouii of the correct position 
of hifi hizfld, and ra<xliately of his l>ody, in ftpaoe. 

YM/iih fternicircular canal hi» a delintte difection, and the ruos- 



PDr^ioLoor OP tub 



76 



iin7«rt1ie current of Ij-mpli <]c|R'D(h ti|KPti ilii- pluri<r in uliich ibe 
iiead ie inrtieil, uiul iia aiauont of murioi). Injurv of oik- or 
mt^rr of th« n'mk-irculiir nutiils t^i)^^^ n Icrw of luiisuulur ck^hihIi- 
EiuUoii, aud th« victim reeU ami tumbles about iu a [teeuliar 
iDAiinrr. Injury nf n hmiximial rnfinl i^niKt.^ tliv IkmIjt tn tiini 
around lis long axis. Injury of a verii«il canal excHes a nnH'©- 
EDontof the htm] in u vvrlimi ilirvdvMi, f. <?., urounil it* trvnii* 
ver&e axU, Tbffie niotioiit scniEiimei) ocvur in man from <ii^c>ase 
of the intcrnii) mr, Authoriili'* drffi^r <*i>»HjderAljly in their vx- 
phnations of the phenomena, bat, until we have more d<^finit« 
k[>f>wU*>d^t^, the viwtiUile aiid .^uiir-iivuhir ainab must 1>e (*<m* 
akJereJ auditory in function, sj^ we)\ a« 6|k?cuI organs of the n(>w 
stnite of i^iuilibrium. 

11m arulitory ditvo i» oompo^ of fibres mucb lik^ thuw of 
oibirr iM*rvt<, but tnitution of tlx^ni prixliKH-s only ^^msiitioiH of 
bouimI. ilt^ring i& the |ierce[»ti<3n by ihoM-UHorium of vibnitionA 
■0 sound. Tlie entire ear hiut for iu^ obji^it to render the |ini|Hi- 
gatioD of fwnorom vibmtionF< more perfect, and to miiltiply them 
by n^«nan<¥. ^Ve judge tlie direcrtion id tl>€ soun^c of w>und 
bj' cotnptrbon, bawd upon experieace of the iDtenfiity of tlie 
ind in (Wo oir with tlinl of the other. Judgment b«xt»m<« 

^difficult in impairment of heanDg in both ears alike^ and i>f one 
ear inuir tlian the other. The dirc<^tioQ may l>c dctermim\l by 
one ear aloi^, if it be turned so that aoooroua vibrations strike it 

^Bt dilfeirnt aii^l^ oftiv-Mx^utiwIy. liiiftimattim T>«comti« dilTi<-uit, 
rbeu oljects intervene between the hearer and the source of 
Bound, ami more diflicnit, whi*n the obj«x:to ar<t large and pni«-nt 
ay phne ajrlaces. The distance erf the *ourc« is inferred 
the inCemity of the vibr4lii>n.i produced, but tlie imn^tna*- 
tiwi modiEifa theeffGCtof the s^nmtlona in a ra<»»ure. Vibra- 
tjoaa, or thrir molecular changes, continue awhile in the au'Jiti,>ry 
oerveand it« centra altera muuikI ol-usi^, iiud pcrsoDA £uljcc[ed 
to a continuoiu aound for some time, will hear it awhile aftiT the 
cause bat oeaaed to operate 

Uiffcrent pefHons have the auditi^ry appamtua atlunni to notca 
of diSertnt pit^b. One may bcsensidve to feeble tones, and not 
bs al>!e to reeognixe tJ>e munical rektton of sounds, while another, 



76 mB lUHAN BAK AlfP ITS DISBASBB. 

wboec lioarin)c for tccblc tcmn is imperfect, nuiy bnvc n \m\y 
tippTtvmiiun orclU<^>Til ADcl liarnLOitv. 

Ohjcclivc ftOLimU conic from n^llhouT, ixnd pnm to (he Binlilory 
nerve tlmmgh Lbir mr, nnd. rarely, ihrougli the bones of llie l»eai(L 

Stitiji^Eivi? troniJii^ Hn?M-^ J'rri-iii ui[|jiri, as a n?«u1l of irriUiUoD of 
i\w iiervt- fnim »I,]R*r <3i]|Tte« tfiiiii t^wiimjus vibruLtotiH, 

Ordinary aoudiI^ affect ibe nerve mwh like a common sem^ 
itwit mnl allraet litlle ntlcrrtioii ; Ji iminii^) rhvlhiu <iiit9i.-s |»1tnft* 
urx'; an intent lone, pain, and long-cx>Dtiauc<l hjuikIm ppvlaoe 
[MiralvKiH. 

lienrmfi: vBri(*» wiUt thi> tem|>4-rflment of ihe ImUviihiol; the 
cx>rdJtinn of the Kxly, whef her fatiguwl or refrwlicd ; i\w iflate of 
the alHloinifial vi.^r-era ; nml (hr diOVretit t^Enic^ of ilie nirantifihere. 
It ifl ififliienrrcl by reflex action fmm partA remote frcira the car, 
atkt ink|irawloaH isiide iiptm ihi'nmlitory n^Tve ihnMij^h iho ii!>unl 
t'hannct may excite i^flex action in other jiarta of ihe Ix^ly, 

Thp ftuditory iipjitinmm i» nn>re o(>ri|i)ex, even, tlidti the fy©, 
aiul ft« rnnctioiiB awaken admiralicm anH a^Ioitt^hnteDL The 
ear^ are the (HfrtalA of the mind throu^^h which tniu^h knovrlcdgv 
IB gained, and the soul is etirred to decda of viior and to >iong^ 
of pruispH 

ANALOGY or THE EVE AKD EAR. 

Btmcture, — Tfwrc are irrrudn [Hiri* of ihu wir atid ere whi^b, 
iu ftiruLturt aud fuu<Tti[>i), iiuve a *H>n uf a^rrea|ji>odeiiue, Th« 
pntjHTrim of hciiiiid mid light an- titiaki^Li»,Biid vamtioos in the 
two ^roit or]^nQ of apeclal sense adapi them lo the vnrioua 
reqnirciticiitM of the vibnilion)< which n^% upon ihf-itu 

TJie concave Rirface of the anriele, nod tiie cxtcrmJ canal ooU 
ItiOl aud dirvcl the vibruibntt of «oiind to lh« ilrum-^licad, as the 
expanded cornea, aqneouji humor, and pupil gather the uodub- 
tiona of ligiit, and ttansniii them tt> tlie lenfl. 

The auricular curtiJa^, (ntgu^h&tr», and cvnintinoiii« and eeba- 
eer*n» glitnU^ are citnipanible in ilie tareal cartilage:, die cUiBt 
Uic Mcilximiun aud inchrymnl ghuids. 

The elmUarity in the ^ape and functiona of the dmm-heod 
mud the leim in obvious ; uuch conivmratca and tnintnnt- aerial 
undulations; bat the drum-head ami ira chain of bcnes oiuat be 



AVALOQT OF TUB KTB AND BAB. 77 

taken together, as the analogue of the lena and lis capsule, in 
order not to destroy the correspondence of deeper parts. Then 
the bony labyrinth and cochlea, with their inner periosteum, rep- 
reeeot the solerotic and choroid coaU; the peri- and endo-lyniph, 
the vitreous; the membranous labyrinth and organ of Corti, the 
retina. 

The papillary terminations of the vestibular branch of the 
auditory nerve may represent the rods of the retina; and the 
delirate, ciliated cells of the organ of Corti, the cones. 

Functions. — Normal ears are generally capahle of perceiving 
the distance and the source of sound, the direction from which it 
comes, and the position the sound occupies in the musical scale. 
It is well knowQ that some persons are unable to recognize musical 
Dotes. Id common parlancCj '* they do uot know one note from 
another," So the ability to determine the distance, or the direc- 
tion of sound, may be absent, though the deficiency is not so 
readily recognized. 

Normal eyes have also a triple function. The retinie readily 
perceive the distance, the figure, and the color of objects; but 
any one of these functions may be deficient. Persons are some- 
times found with acute vision for objects, but deficient in color 
aeua/Cf so that they cannot recognize one or more of the primary 
colors. 

The analogy of function between the terminal filaments of the 
auditory and optic nerves is thus manifest, in the sensibility of the 
one to the notes of the musical scale^ and of the other to the colon 
of the spectrum ; and this throws some light upon the conception 
of the blind man, who said red was like the sound of a trumpet f 

Much may be detected in the correlation of nerves, iu accord 
with the correlation of forces. 



78 



TUK IIUUAX KAS aHD ITB DISSASIS. 



CHATTER IIL 



KXAHlXATICIff or THIS JUJC 



OiRKAsEf* of ihe <yir In general are ft> oompltoital hy abnf>nnal 
physical fM>nditioiig, «onncLiincH the cause, but cAt^n^r Uic ^oi«^ 
qiK-noe nf tlte ili^eoM*, lliat it b importaDi lo deucrt ihefn^ in order 
to inAiiiine these meihoijfl of mechanical and iiwcnitiM^iiral creat- 
meritf wJ]i<rh long <^x]>0Tit'n<v Iiaf« (li«moiviiniti>d to be vulunMe. 

A moraent'fi examlnution will often l*ad to a more rational 
tn>aUrorit, an<l a more «Lice(«?Eru] mui; in nural ilb<c?tH% Hum th« 
niwt paia^takin^ (collation of t^ubjeetive syraptonH. The nhjec- 
tive ^mptoms, found by a «yr4omatfc ffxuminatioD of the car 
from all HuleB, and nil the Kiitijectivo sen<«cionii, must be onrefiilly 
correln(e<l to ffct the best r^tilta from our thentpcutic measuros; 
for rcme^Mes are oa important as mediciae^ in die treatment of 
aural afiectiona 

A oornpreliiMiaivi* knowlcvlj^ of thu itaitlioloj^iciil cnntlttioii in 
aural dbeases Ls acquired by certain methods of inanipulatioo 
and itwtninJcnlatiim, wlii<"h »Konld Ik? koi^wa by cvw' pIi\'»iciao 
who undertaken to treat dUeases of the ear. 

Thc«? methods are simple find rrfiolrr few inHtriimeniA, and u 
cenain system of exammalion should be follower!, in onler, that 
fvcrythinp^ o^sential muy be e)icit(id, and rerord^ of cu«m noftjr 
be uniform and valuable for future reference. In a<)i)ition to 
the rccon] of tljc csaminution, the iliaf;iio«t4 oU|*ht to hv written 
ont sufficiently full to ^\ve a clear understanding of tbe case, 
and the pn>|rno«i« should be madi^ f^unnlvcily. Never pronii»o 
too much, because experience teaches that, in treatment of ao 
complex an orpin an t\w <<ar, one falU ^hort of th« mark ufteuer 
than one reaches it- Every physician ha* cases drift bock to him^ 
wfaieh he hni; treated years before, and it w oH^n of gr^t im- 
portaaoe to the patient and to fwieDce to have an aocurate de- 
«rriplioo of ju4t what wa« tlie matter, and wluit vim done in the 
early treatment. From the ca'»-bookfi of educated, syfittinatic 



BXAHIlTATlOir OP THE BAR. 79 

practitiooers muet the experience of the oenturies be gathered, 
and the advance of medical scieDce signalized. 

It is well to have a card in the caee-book (untesa one gets a 
caee-book printed with headings), with a skeleton like the one 
below, which can be followed iu making the record — a plan which 
I have fouod conveDient and useful. 

Date, Name. Age. 

SpoDBor. Address. 

1. Histoiy and subjective symptoms, 
2» Hearing; Voice [low, medium, or high]* 
Watch : R. E. Hw. =^ 
L. E. Hw. = 
Tuning-fork ; [meatus, vertex, glabella, mastoid]. 

3. Objective symptoms. 

4. Aural region. 

5. Auricle and meatus, 

6. External canal. 

7. Membrane or middle ear- 

8. Throat 

9. Nose, 

10. Eustachian tube. 

11. Diagnosis. 

12. Prognosis. 

13. Treatment 

14. Result 

Many of these divisions maj be left out in simple cases, as in 
recording attacks of eczema of the auricle, but I advise the sys- 
t«nialjc method to be followed pretty closely, in order to get a 
complete knowledge of the pathological condition. 

It is convenient at the office to seat the patient in a revolving 
cbair^ with his back to a table upon which the light and instni- 
ments are arranged, or the chair may be placed so that daylight 
may be used, and the table be located between the patient and the 
window. A high chair is very convenient for young children. 
A large oil lamp, or gas with the argand burner, furnishes plenty 
of light, and I prefer the latter to all other apparatus, as sufficient 
for thorough examiuatioD, for correct appreciation of tissue 



80 



IDS BDHAV BAR AlfD ITB DESEASS9, 



ohiugeOj urn) Hide injumua to tli« §ut)^ii*fl ev<s. Diiyllghl 
w very ni^rwabU', mid [^vlw tbe Iruc color of ti«ucs when one 
usee a mngnlfyin^ H|>ecLitti[n, mulf \i' om hi inc^linet) to dUpby niKl 
luxury, a Tobolil'K Jani[> witb it« arm mirror and ooodensing 
leitteamn lie. botli omametilal ati^l tiAeful. Hrijifi' t^iitili^ht di- 
rected iuto the m«atu» ii^ now sekJotD employed in aurxl pmetioft, 
la vUiting paticiiL^ At their hc>ina«, one cnn find nourc^ of illiiiui- 
nution tiiiouffb lor nio^ purjviMo. 

It iti l;ctter for Ihe p)i\Nidaii to ^il during Llie examinatioOt 
and tiic light should bv beliind iind bcyot^d tUv palii.<Dt*» hui<l, ito 
thai it rmiy p^m to llie tnirror, anfl be retlccbed at a gcnall anffle 
back into ttccar. 

The history and subjective symplomA 03 gi\'en by tJie patieot 
should be- r«€(>riU<d, und Iho ph\'>«ician should by lauliofp qnan 
tioDH supply mis^r^ link.4 in the chain of tx^timoiiy. The teni* 
iwminonl, oudition (jf i^ncml JK-utth.and the prc'^'iux; of an/ 
dyscrat^ia should be Dotcd belorc prot^^in;^ to tlte more par- 
ticulTLr c'juim illation of thi' uir. AhW id>OLiC ^in; thnxit, coryuu, 
and clirouic minrrlis, ttie u^e of tobacco, and if deafii*%6 b hered- 
itary. 

Objective ^ymptonii should noatt l>e gnlhareiK Tctt iJic bear- 
ing of «ic*i «ir by the voiic, vvatch^ iiud tuuiug-fork, and niake 
a i^iT\-fid fi-tord nx dirocle^l further on. Then loolc cmrcftdly at 
the auricle, meatus and ivgiou about tlie mr, aiid nxrord any- 
ibitiK tliat »*<mis abnaniml ; push ihi; huir » way fmiu orooiid the 
ear, then run the indi>:£ and p^ocood tinker around die atlacJiment 
of ihu aiirk^t.-, prosrting Jirtnly in front of tlw tra^UH, beiwath tiiv 
lobe, and over the mastoid to ^nd if any soroDc»4 is presenL 

If tuiaefaotion ia K*on, tht- prowurv should be iNiratr, and tta 
ouUines and relatione to the meattis or maj^oid proc»« Khoald be 
detormiDHl and r««ninlccL 

The mastoid pnK»«* must be carefully eumincd for teoder* 
no^, reiiueu, sw^tling^ and Mnrs, and sometiiutti it t^ vrcll to 
percu«fi the part vitli one index finger for a plocor, aad theother 
laid fUt LifHjn the l:inne a4 a plexiuiitCT, as therebv deep»Mated 
pain i[kdii.iiuv4.' of disease may be awakened. 

Some entlmsiastfi have claimed to be able to determine ifai; 
couditton of the mastoid ocIIa by percuesion jKinnd», hut caoes 



OT0BGOPK9. 

ihat n-nuM|^vi> any rcApoiiffC fo such Ktrikiri^ f|tir--4tionA orocx- 
eeedinglir rar^. it ia iosimclive to take the atinVle henveeu the 
fin^m and ilonble lUti tup mid tho loLx? lo^-lhi.r H<im*1j, lltvti 
move the whole |»nna and niearim arrtind by a mtnry motion, sa 

i th» ofU'n n!\*cikltf a sorcnws not ol hcnviw lo Ix* di^oovTwl, fyir^ 
nem and pnin may exiTft la and about the aiiriHe from external 
uffijclioDf^, without lheR> being any d<H-iRT tr»ijhk of the mr; 
but, a>Dvenelyj deep diaeaneof iheosr ifi frajitt^nlly a<^>mpaDied 
by i':((ornat »in?n«^« and pain. 

Take the mirifh- hy thi- ujijht part und pull U upward and 
backward, whidi etraightcDA the external ciinaU-oDsideml)ly, th^n 
exainiiN' llir mi-urii^ and cnnal by diix-d. light, and thi.*ti by re- 
Ikvttd light from a niirror. 

Otoscopes. — Tliwe art' j§«v^ral kinckof rcflectin;E mirror^ or 
o<o»^^|te8, in use. They are gcuemlly conmv<^, from 2J to 3} 
ii>ch«s in duim^liT, witlyi central round perforation i'^ to \ of an 
iticb in <liainet4^r, and a focal length of 6 to ) 2 iiiolietk The hand- 
oaimirs urv Krmly «et in a tnotal back, and attached to a wooden 
luukdleb^arorl, RTvw, orfiin^e. I havcono piih-lia>i*d in Berlin, 

rsodiaa is tisedby mo^t cmlit'al men ia Nord»eni (Germany, wliich 
boa a bing«*, and |WL-«ti?*,H*s ^nnv lulv'aiitnp^ ovcpotlicm. Aiwthet 
larger ooe^ bou^bc in Vienna, ha^ the handle flcrrewcd finuly into 
the bock. 

Flo. 21 




H^MD HtnuoA. OH Otokaji-*:. 



A pieoe trf hN>kii]B:-gIft«, u'lth a clear place scratched in the 
iDcrcary> would serve well in an enicrgt^nry. The ophthalmo* 
hlcopic mirror illuminates tolerably, but aooie kind of a hand 
otoscope ifi a neccBsity for every pbyeiriuu who irc&ts i.^tr di:M*iue. 



82 



TB8 IITUAlf lAft AVD its &1B1A3B8. 



In some cawB it is nKCtmry to liave both biiinU JVee Tor 
handlfug imcrrimenU and performii]]; o|)eraticui<4, aDd, yet, one 
must bnvo a ^^ood iJlumiuation of (Ik^ i^-xtcmal cmtwl, lycopaaio 
menibraiif', and, pcrhapA, of the tympaoum. For tbts purTKwe, & 
simDur mirmr to thAt doH^nb(<c) abuve M ftttacbvd l>y boll and 
tocket joint, hiiig^, strew, clamp, or oth^r cootrivanw, t<» n plate, 
ra«ICQ«d iipim an elastic bHnd, which fib- unKim] tlu* ]toa4l. Boine 
of tha»e are nnt perforata) in ihe^ centre, and are to be plawcl in 
thi; intdfiU* rif thi^ forehead ; othtrrs hnng low over the brow, m> 
tbat the ceotral perfomtion !« directly in front of tlieeye. 



Fui. 2a 




A dn^le nairror is now made to serve for botb hand mil b«ad 
otO()cO|M>. A handle i^ Mjrvwnl into a IkiII u|>on it* bwrk for hand 
use, and this is unecrewed and the ball slipped into a sw'kct upoo 
a plate, fa^lefml to an elu»licr Imnd, for head nse. A man baf^ 
in aural practioo will require both kind» a>i K-pitmtt; tiL^ruiD«Dt«. 

The UH' fif nil nt'>fx>]Kt i» fjniple. riu> \>vl illominatjoa will 
be bad when the light is accarately focused upon tlio part that 
one wifilies to examine, and the oljacrveKa eye is placed behiml 
the cciitml bole, through whidi mys return from the object 
There are several other otoeoopes of u«e occasionally. 

Blake's ot<.wrope ha« a lafgc rubber speculum, fitted ^itli a 
prism and wndenaing lens, whieli gives eaxellent iJlunUDatmi, 
m\i permits one to use Ix^th eyvx in direc4 viaion. 

Ilaasenstine's otoscope i» a hard rubber cylinder, with three 
difiereni si^u] tubes for the auditory canal. It baa an opening 



DTOfiOOPB9. 



8S 



in the Bid«, ilirou^rh whioli tJiu lii^ht cnteni, nnd it Reflected by a 
mirror tlirougli tie tube and lene, so that th« eye, plac«d at the 
ejclerDul catJ, receives un enlarged inuig^ of the obj<*ct. 



Fio, 2^- 




j..s^t.,si;'A On^COFK. 



Briiiitoii'fl o<osa>]H* is upon t)w samtj pnuciplc. If is made of 
wlulv uurt4il, nilvi:r uT uiL-ktl plntud; Ijua ihrue ^unlivl*^ll3|fotl 
tnbes of diflerfnt aiws for tlie tneatuv, b magnifytug lye-piwe, 
umI a Urgv^ irijm|ic't-iiiouthcs1 pixijvctioii upon otil* nlde, vrlitdi lhjd-^ 
oentnUes lij^ht upon an obltqu^ly placvd ojirmr xhni vjHwts it 
dowu tlic tube. It i« K Iptidvtonifr iiml owtly iubirunivtJt, but it 




givcB «v««n?nt mngtiifiptt pfctnres of tbe Tt>ombnLna tycipani or 
middle e»r, aiul Is very uHt-fuI in irtudyiog minute chang(« tn die 
tncmbraDa tymjwni and tympaimm. 

For gci>urul ujw ad<I pranticxl ptirpcwcfi, howorerf the KarKl- 
head rotrror Aod tubular epcoula will anawcr, bidoc it ie not so 
diStcult to diftgnrHC oh to properly trcot lair nffV^tionH, 

Th« y^^^tt from tb^ n^irror ?.LouM l>« tlirown 111(0 tb^^ exlernat 
anditorj iii«at«ui; and the pms^cc of aoy cxtrancouH bodicn, 



TUK nCMAK SAR A1TD ItB DISBAS£3. 

in»tt4xi IminKftind hunlcntideemmcnf nnd tlMjixHiJitionoribeskin- 
litim^orthi>oaual?<lhiul<l beuote<l. At^er^xAn]ii»hi<>:Uie outer jiarl 
cif tlir canal, 11 oimicul MilvcT spi-c^ltim, n-jiniKtl ovirr the Hnme in 
nold weather, &hcHiUI be iiilmdiK-ed intu the nii^ttu by turDing it 
ircHind ;iiid jirc^^in^ it inward ^titly by a ^rew taovcmont with 
the tic^rs, wljilc llie aaride Is pullvU upn-nn) hii<I hu'kwnrtl br 
tlic otWr tiumi to Araiglitea tbe oiaaL If the csuud U vcrv nar- 
row, one may have lo taeJi bivalve >ip(<«'u]ani. 

Any iili^triKiufn ni itiu inner tnd Hlimild be examiii«M), and, if 
abnormal, nlioiifd l>e n-miA'ed by »fynii^', i*Jir-^|X}L>n, or furveficf, 
or avokW by lurm'ni^ the speculum ib^ide a liUla. 

The s|*ei-ijjuin slmt]l<J bt» IicM in pwition in tW mestuft belwoea 
Uic Ummb and forcttngcr, the luUt^r pushed well into tite cooebft 



FIO.M. 




ij-imiiritnro thr K^a, 



and the auricle pinclK'd between the foreSni^r and ()ii! oth«r 
fitif^era plaee<l t>ebind it. It can then be pulled upward and back- 
ward to »tnLi^hti?u the cnn»I, and mov(xl about to favor difTt^i^^t 
viewtt thruii^b thei^})erulurii and c^Jial, aa llie lij^bt is rudectcd 
dcqily into tJie ear. It Mrecomme»>ltxl to u«v tbcU^H hand for the 
rigjhi ear, and the ri^dtt hand for ilia K-ft ear : the lad^x Hn^r fits 
tlm« very well into the eoaoha, and tbc* sptrulum and auride can 
be bandied to advantage, but thta has the eerioua di«advtiitA|rc 
aoinetimet of obstructing tlie light from behind, when the miiror 



lAE BPIOOLA. 



86 



na lidd iit the titbM' hittii], Ijul tif cQttt>c llict Mi*r\I ttivl ticctir vrhni 
llic Ii«ul (uirmr b» useil, I urt* ihe right IhimI fur llio rlghc ear, 
and tif? IrH fur the Icfl mr^ vrlii.*n tlir Uaxi*l intrnir i^ vtn- 
pUijrcilf nml Hiuf^ ki.T^p a dear <»iir^ tor Ur- jjofwoj^- ufli^ht from 
Uw flume Ih-IiIim), ;itid fiml ii jiihi iui <^>iivtriiitiui to Jittuil1« the 
•pecolutn mid niindc wi Uy tbtr gld metLotL 

Tbc aiKfliory caiial behig illumitmied, tlie Male of the Mu at 
i\rc luiiiil, llir i-i>)»r, m1iu|x-, iiml cr^Diliiton of tlic tiK'nibmiiik tvra* 
jmtii, iJie iirvs't.'iu't.' of pt^rforaiioHH or polypi, ilie preM^Dce ur ab- 
tfeoet of the CHrtid<*8, mid lli«; amount of vnMuilaniy uf tlitf mrtt, 
cliould be vcrmiiied and rewjrded, with a detailed deacripdcm rf 
tbc pjiihiitnuinil dmug«« vieibK 

E&r SptcuUv. — Ar c^lt <ij)ei'iilijm Ea iieetleil to iHlate the audi* 
lory oiiiaI, rn>wil tmir» out of the tumen, and pu«h th^ tragus for- 
wards. 'llicT are t)f a variety of shn[>ft4, ^mi^, and m«temlfl, 
Somt are iijiwle of hard nihlior, some of porcdain, fin<l oilier* of 
coin silver. The rubLx.T and porc^elniii urc not ^'hhI niummatore, 
but An* iwiKMnical at>d u«efuL when it is nccceeary to make nie- 
dicioal appUoaiJona to Uic deep |»irt4 of tlic ear. 



t^O. 27, 




Wtl,MC^« TiTXtJt-iH Ejia BfrCLVUV. 



The ^Ivvr iipecuU irc the Iwsl illuminatom, and are ttned fc^r 
diagDOrttu pnr]m4<s bjrallspecialists, Spixrula are from an inch to 
an inch and a half in length, Iwivc an opening st (he «nm1kT cnti 
from 3 (o 6 mrn., ami nt the Urger end i'umi 1 2 [o U mm. cr 
more in diainet^r. They liave the shape of a hollow cone, or of 
4 fuDnvl, and DOfnctimi-tt areoonipr<<i4s^ltto ihiM the lumen laoval 
tnat^ad of rounii. The awall end h smooth^ tiie larg« end is 



86 



TBK I1UUAX SAa AND ITfl DIBBA5B6. 



btftUvi], »ikI Ixitb njirfiuxv are bright, thuugli Grubvr has fcBtcrod 
a j«p«xni]ura wiiJi a blaokt^iieil luienur, 

" Wndt;\-<Uiliulnr/^'rntniigtil'^idi^l,Gonk^l,tulver&|>priila, three 
ID a eel^ aiiO Kaap|/s i^ntjel-t«)w|)eit silvrr OdTHs Jn tlitwiu<darr 
the ]mM, Kidicr »et will tw all Uiat a general praciUiotier re- 

Tli*y taku up more Tw>m limn a bh-alve, are apt to woand the 
canal if puiibeii ia n>i]ghlr, ol^eti punb a Hiig of wnini^D ahead 




Kkapt^a Pdnxsl Kak i^pBrru^ 



of ihem, and are not auitott for very crooked caoala, or for thoae 
coinptxawnl fiH^tn front to bark. 

There are Belf-retaininjE spe<?ulai haviriK two valnw, a hin^ 
and screw, which arc very tiecl^il during opcratJoivL, wb<-ii one 
wij^hca t^ tute both hands. Of theae Seer's is dtc ht>i^ 



K]0.t9. 




Swm-s l^nLr-BVTjiff jvo 8nBtn.tW' 



Tliere are bivalve-dilatiog specula with handles, such as Km- 
mer'q and TiemaQn's, used for opening and 4lilating very crooked 



XAR SriCULA. 



BT 



Off iumnm) cmTats. Th^ vfllvra of tJtcsc ahoaM 1>e placed upon 
the Ulterior juhI poHlemr walli^ anJ tlie haoilko compT^^fted 
gcntljr. Tbcflc arc not often rnjuircti, and belong cuore tu tbe 
outfit of A ^>ociiilinC lluiJ Ui iliat uf t-lic fiiiinl^' Jictor, 




KiUKKD^A BfrA.LVK Rptrm'tuf. 

Siegle^ff pttPitmatit^ speculum Is a Hhorl hcllow c^rlimf^r^ having 
thr«c Mo^ of gmiltmtcd tubet f{>r JnaertioD in ihe auditory 
meatiis which screw on to one end. The ntlief crd w rlowd her^ 
nwticany ivy a rhtur glnm k-n«. From the side uf the cyhuder, 
pn>J«ct9 « AhOTt tube, to wbioh in attadied a piece of rubber 
tubii^, vriUi a mouth[>i(*cc orau uir-pump, 

Fra.aL 




Tlie proper gnulimlciJ hibu to Rt the auditory eanal under ex- 
1 amiaatiOQ U sereired on^ and ia introduced air-tighc into the canal. 
niteD this is difficult, a perforated rubber cork fitltug the canal 
tomf be slipped o\-er the tube. The monthpieee is placed in the 
' month, or lh« air-pump hi'ld in tlie hands. Tli« ni^aibrann tTin- 
pitii in now illuminate^lh/lhrowlngthe light from a mirror through 
the lens closed caoal, and tbc air is rareCod by miction of tha 



88 THB HUMAN BAE ABD ITS DIBSASBS. 

mouth or pump. This causes the membrane, if free, to move out- 
wards^ owing t^i the vacuum produced upon its surface. Sometimea 
it is well to iuflate the tympanum before using the speculum. By 
alternately e:thaustiug and condensing air in the canal, a to-and- 
fro movement may be produced in a part or the whole of the 
membrane. With ezhaudtion, the malleus handle goes forward, 
with condensation backward, and its free movement, with that of 
the membrane above the short process, will indicate free move- 
ment of the mallco-incudal articulation, and probably of the chain 
of ossicles. One ran, also, get a tolerably accurate knowledge of 
the amount of depression of the membrane, and tlie adhesions 
present. 

Fio. 32. 




Blare's Mjudlk Ear Mirror. 

I have used this instrument with the mouthpiece, which I 
prefer, to produce the to-and-fro movement in the membrane 
for a minute or two — a kind of aural gymnafitics— and am sat- 
isfied it has aided in breaking up adhesions and improving the 
nutrition of the membrane. The instrument should be used 
cautiously, when perforation of the membrane is suspected, in 
order to avoid drawing mucus or pus into the mouth. 

When the Eustachian tube ia impervious, Siegle's speculum is 
very necessary in making a diagnosis of the pathological changes 
in the membrane and middle ear. 

Blake's middle ear mirror is another instrument recommended 



TBStr^G TDK BKAftlVG. 



89 



ill the examination of ilif;«s»od spots in the auilitory cniiAl and 
mi<Idf^ ear. It comisti of n^tof |)oli.Hh<Hi Mt^\ Diirron fnun 
1} to 3 mm> in diameter, TaBteiied at aa olcuw anjfle to wir&>, 
which when Jieciletl are fix«<l itilo a haodk and ^<**ti«riHl bv a 

The light from lh« h<acl rofrror h r^QtKtei wla th^ Rma)l mir- 
ror and the dt^p parts of the car vxamTU<x)f us ih done by double 
(tion ill otiier re^onfi. The auditory canal muHt he large In 
^permit tlie use of thi* rfifincmcnt, but it may Iw u^M \n n^vpal- 
ing hiddrn gmmlatbn^ die txaot Pcal of a iwlypii:*, or a c^rion^ 
place behind a pr<^ection. 

Testin(f the Hearing— Twer — The auriict le^fw thepnfiwitN 
hearing iiwiirccdy for the voice during couversation as the firet 
•tep of the rxaini nation, though not <k«igTiiDg to do r); but tlii^ 
way b not entin^Iy reliable. It U heal to stand a few feet away 
from the paliv^nt »i>cn the side of (he ear to lie (wii^l, >^ that he 
caniHit see tiie 1]|h move, then afk him (jueatiooH in a low voice. 
If he<«iinothe&r,addrea»liim inu aK<diiiin tone.und if he is 8ttll 
lUttble to lifar what n aald, raise the voice even 1o a ^hout if 
Mcesnry. There are %"arioiH ik-^rxH^?? of hrarin^ for ewh lone, 
but low, medium, and hi^h will be hiifficiejHly eiaet for all 
prvcticttl p;irpcwo»», 

H'atcfi. — ^The watch teA in the moM gGfienilly uwih 1>t>oaiHe 
r can Iwt a watch and leara how far a normal ear can hear its 
ticking, and thiLH ^ tx \mif< for an nr>enmte n*rord. Dne may 
uee a special stop-w&tdi, or an ordinary tim^^^keeper The stop- 
watch ctin l» titop|M*<t mid tief a goin^ ut will, iind i.** viilmibic in 
tfstine children and others, who think they hear when they do 
not, from a wrl nf jM-iNi^ti'itce of sensntion, after iln> \vaXch U cov- 
ered or removed. One can tivre the ordinary' wateh for detection 
aimply turning tli€ back of the hand hiddio]^ it to the car 
Bted. It mitst t>e rera**mb(7rcd that thv auditory nerve some- 
rtimfti eenwefi to reH|>ond — ^loe* not hear for a mr>mt^nt — i>wing to 
&tigue induced hy conataut rupdition of the same sounds. The 
ninlity of the nerve is lomewhai hluuti^l in olil iH^ttpli*. 
The watch must always be hekl by the hand, in tite snme way, 
in making: <«ropAraliv<i teAU. It mnkea ciinsidcmhiff diffirniioif 
whether one hang* the wateh by tJie 6nger, or holds it in the 

7 



90 



THl 



tA8B8. 



Hold tht 



I resonator. 



\)9im oftbc haml with the whale baDd n^ 
watch in tlie palm with it* fncL' Townni?i 
fifl ili^tarii^ tijiii 3)»jm»aHi slowly, ami Ivarn how far hy attnal 
measaremeat all your frieudt« with tKinital vim i^n dbtiii^ij^li 
thu ticking; taki- ilie avemgcof t1it«e cliH&no^ and remember it 
as the normal hearing ili#taace for ilml wAtch, v^ Lkt ii^h] oh llie 
denominator of a fraction, to ex|>rea» ihe b<tiring <<3i]iiu:ity of 
putientfl. Id t«%Ung u [mtienl, hold tli<* vv^tt^b &ix J<*et away from 
the car, having the other ear cloeefi by the finger, a)>|irMicb it 
gnuiunlly until tbu patii^nt t;iiii cutcli the M>iLad, tlien naeMore 
the distance from ttie car by a tape-nieasure. Suppose a watck 
can be beur<1 by most persons at t^ixty incb<is and a [lAlient liean 
it only at twelve; tliia glve^ the deiMHnlnalor Bml iiunietator cf 
the frw-hiin, and the hearing i« ^i, ar ) of iionnal; or mippoae 
the watch is heflnl only six iiwha* ; this givffi bV- Make a rvconA 
R. E. liw, (ri^ht **ur, hi-jirirg ut' waldi — ^f or L. IC iiw, ,V 

Id this way one can record tbe bearing at «ach vbit, and get 
A inatb«Riatical denioiu<trutt<)u of tbi- progress Diadi^^ when tlif^ 
patient makefiany. 

Soiuo dtaf pertfoivj can bear the M^tcli a foot away, and, yet, 
hear only m^tlium tonti» of voice; others mn bear tlie waivh, [mt- 
baps, only eij iache^ yet, underAlniul everything said in a low 
voice. Tim d!lVerca<x' U due to tetni>orsnicat and clr>?«e nEti^nlion. 
It ia not difficult to understand a twnlence if we hear three words 
out of f(.kiir, and know tMmi(_<ihiDg abc^ut the subject; Umg wimlft 
are equal to four or Sve [ihurtomiiUi a deaf peraon. Sometimes a 
|K-n<on getr!i. bowvver, "allatsea" lip-readiiig, I had afiiuiiu«ing 
imtanee ofa deaf [mlicnrt^ pre|)Oiift«iKm of tlie greeting of an ao- 
qtiui»taiiui\ Two hidifsmct. The oneuot deal' shid to ihe other: 
*' Why, when did you return from ihenioLinlikinii?" The deaf one 
replied : " Pn?tty w<ll, I thank you ; Im>w Jo you do?" 

Whea the watch cannot be heard at any dislance, it ahould 
l>c preHcHHl at^uncft the auricle, and, if hcanl then, the rt?conl 
should be made, Uw. =: ^jf (contact). If not heard at all, write 
= ^^ (nothing). Then tlic watch may be pr«wed ui>on iho vertex 
or the forehead to determine roaglly ib«! uondition of the middle 
CUT and tht auditory nerve. 

It inteuttitiw the tick and t««t to let the wideh rtst upon a 



tSB TVKIKO-rOi 



91 



lalile ; ^nd to pnse it against tbe tisFnea firmly, vihen ii is appE kd 
to ibe »kulL If tiw ^mt^h 19 »ot liuHni wfKH ji|>^]]rH] thnn, it ih 
pretty fiupe evideoce that tli^re h <Jb«tfe of the lal>yriiiiii w 
DervLv A watch bus only twc feeble notes ^<^ Dvr\'e Hbrcft for 
tlicH may be injured, and all the ra^c bealtby, m timt (he watch 
ie not iM gwJ a U»t us tli^; (>owerrul vtbnitiuita of n inuaiml 
utning-fork. 

Tunin^/ork. — Any tuning-fork may be used, but Blake's 
luodificurbn of Polirzcr'tt fork, knownoA lti<* Bluke luniog-fork^ 
ban admirable one for eeversl resMina. I prefer iIil^ large ono 
mnrked C. iL liu» a m^tal oJuinp iip-)n die up(>er part of each 
limb, and a hammer, with one etid metal the other nibber, hdd 

Fio, 3a. 




BLAKt'a TCSlKO'rOBK. 



in pcwhion by a long spring handle, fastened by a clamp to the 
fork handle. By movJog ibe elam|K^ tbn jiure douiiimnt tone 
may be bronchi out, and any note of the musical scale produced, 
Similar blovra may )ic.-<tru(-k widi the bunum-r, nm Ehiil noti^^Hund 
test* are aniforni, aoJ oue does not have 10 bang uy the fLiniiture 
as with ibe onlinary fork. The fork am i»e redtioed to a simple 
one for poeral purposes by removing tht; clampe and hammer 
fruni ifac main part of the in«tniiiient. 

When the base of a vibraling tuuing-fork h placed upon the 
nasal glabella, th« vertex of tbe skull, or tho uiaiftoid proucaii, the 
internal ear tieing tmaflected, the vibrationa are tratiamittcd by 
the bones of the ftWnll to the Huid of the labynnch^ which idi- 
prrs^«<^ die lerininal BlamentA c^ tlie auditory nerve, and catifCB 
a KiiKition of tfound. During Ihe vibntt]ou8, if the ■>xt>rrail 
auihtory ateatufi is cloied by ibe 6nger, the sound i& tntenaihed, 

Nov, when the labyrinlli ami auditory nervu arc biulthyi if 
the meatuii or ainal is dimini&bed in ^ize, or closed by a foreign 



93 



TirK irUUAH BAR AITD ITB DtBKASES, 



body, or hrf disefue; if the mecnbrana tympnni b ahnormil, or 
(Ik KaHtat'hiwn tulw oWtnioltxl ; if t\\v rmiroiiff mcmbraiK of the 
Cvmfiamin] i^^ thickened so that ihf. ohaiii of charOi^ anrl tlio ovnl 
or Tonnii nu'nibriirK^ mow sluggishly ; in fiwrt, if anything hin- 
ders the normal tnln?^mi»«iaD of vibraMnnft from the fxtfnu) 
mcAUii^ to the V4>4tihi]liir flui<), the tiinin){-rork, plnced Qpon tlie 
iDiddle lino of ihc 1o|> of the hcacl, or ujion the fordiciu], will 
bi^ hcAnl 1<>uii*T ti[K>n that »i<]e nflbcCet), and b<^ter rhan by the 
nornml ear. If the meattn of Ih^ dif*i'n.'<H iiir in nnv siit-h 

r 

be fttopjK^i by ihr finger, the WHind will Ix? considerably inrrea^eil, 
When tlie sound of a vibmtinir f^^k u[>on ihc vertex <'4in no 
longrr l>c t»en>Wx'fil, if it be iramfxliatcly place<l at the external 
fneiittis and h there heanl, it Ls pror>f of n nomial <i>ndition of 
the canat iiikI tyni|mmim. Whon the sound of the vibrating 
fork can no lon^r be heard at the aK^tiu, if it be immctJiattty 
pltt^ 4i|R»n the vcrtvK and it^ th<.'rc hoard, it i« evidence of an 
iihnormid state of the canal or tynipnniim* 

Tho ptilivot niu^t |Kiy wlrict attention to hm sen^tion^ io 
on]<T to dtHtin^iiiRh Al^Ui iVitXi-nuvi-^, nnd inmi not (v>iir<»tjml 
vibfBtions prcduced in one nerve rhnHigh \Mm condmlion, with 
vibnUioim in tlit- othi^r, imuwd l>y conibirK*d b^nf- oiiwl action nnd 
transmi^ion throii);h the incmhniDa rympani and ossicles. E\<^(n^H 
witji the fork vihnaing upon tho vortex, iMtitnl^ nre npt to bca^^l 
ronsiderable ihroofih the meatufi and middle ear apparata«t, aod 
this will vitiate i^omevfhat thr mum^t of coinpnriif^n of ^twatioo^ 
froTn 01^^*0008 vihratiooA. TatientA will ollten ^y. at 6rst, that 
they hrar the fork vihnilion« htitWrr by the car that tbiy know 
h«ir* th<> Ix^st ptr nitu naturabft, whether they do or nt>t. Thty 
muHt be ur^d to notice tlie seni^tioiw, and make a oareful ooni<- 

Ovfing to the poor oljwrving powerw and Mn|w)>ty of many 
patients, the determination of slight disease of the external canal 
and DiiddiL' car hy ih^ intetwifimtion of Ikmic vibratioiut id diffi- 
cult, but for a clean diai^noflisof the preeeuco of disease in the 
ititf-rnttl <>jir nnd ntiditnry n<-rve, the ttmirig-fork Ui<i m invaliublif. 

A |KTson may be totally deaf in ooe ear to ordinary bounda, 
yet, hi^r tlu- timing-fork, whm vil>rutinj; npns tli4* niiddk* line of 
the (^knll, better with the damnged ear than with the wciad one, 




TBB TUKlKa*FORH, 13 

l>cc»U3>c olwlmctioM to the juuvq^of nouml throuij^h tlie t^rcn- 
piuiiiu] inward, alao, «4 U> pu'vent tU diffb^oji liiiil lofla outward. 

Ihr. furk luiirt l« on (Ijc mi<ldk* iintcro-ptwU^rior line of the 
akull, beiAuae if moved to out: biJe the eouud way go |Mrtly into 
thf inrato^ of the wir of thai pkK*. The vlhrnlinni* will, olwj, 
net htixiu^r uputi th(* ujijAHilt* Euoru (Jibbtut «3ir, b^L-uu># Uiey 
clicfi luoVQ nearer |K'r|H:udicular lo its mcinbniiic, than t]>ry do 
tu the unc u|H>ii (hi; neiir kmK'. TIiuh ilit! JmnviL^e itl' HMiiid Ui 
tliu nmr imr frum pruxiuiiiy, mjiy be <^iunierlxilniicL-<i in iht ilwtunt 
one by appruach to )>tT(H<ti4liutUHrity Ui llie diftviiou of the 
vibnitVuift, 

ir ihv luDUig-furk is hearJ dibiiuutly when vibrating upon 
the nkull, VK amy coudude thnt ihu Inbyrinth and iindilnry iM-rtc 
luv himlihy. Jitat lo proportion lo the diminution in Intensity 
of iht.' Mim»d rmm the uHcvi'onK vihnilioni«, h* tht tli'\t\iTU\TV from 
health of the internal ear or nerve. When the vlhratluns are 
nut )HN^-i*lvnl at all on one Mdu, wc may Lc Hire i>n that side llic 
labyrinth or the amlitory nerve ia fierioTisly diMea^wHi ; and, in 
the nhbJMii^* <ff ivnrbral fryniptomi^, and th*- ahwiwe or j>r*'**.-iieeof 
middle ear di^c^ar^, it m tolerably ocrtain that tJie diM-'iise U in the 
*labyrititb. afTectini;, of coune^ the terminal filumentf^ of the 
nerve, Oirt-hral iliHinrbanee, and abw^niv of uural t^yinptomt*, 
«xc*])C denfnms, indk-^ate di^ieaae of the nerve, the medulla^ or con- 
tjgnoua slrtiaorei^- 

RooAa my^, " CiiiH^ of difteflflefi of the njtddle e^r that are con- 
Dccled with dir^^ww of thi* luLbyriiith^ or vumx in which the irnddlv 
car is Bound on one eide while the nei've is Effected, and just tlie 
oppoHitft #late of ihiiif^ exists on the other side, — that i^ the 
middle ear is di^ea^d and the nerve sound, — will of couiw 
rvoderlhe valne of the Tuning-fork lo3f8 positive, and u difTfi^ 
eutial dia^ncwisdifReuit/'* 

If otw lab\ rinlli or ticrve only should he alfccted^ of counc, the 
vibrations would 1)6 heanl in the other ear. If both bhvrintlm 
or nrrvc« should Ik? alfwTted, thvy would be Ji«ml best in the ear 
laikitdi&etsed, provided there were no tuiddleearorextcrnaJGaiial 

* A Prafik«l IVttatSwo i>n th« iMtcutw of iho Khr, mdndiDjr ilia Aiutomy 
of tht Onnn. By D. B. t^L Jobu Boom, M.A„ MD.. «lc WillutD Wood A. 
Co, Sew YoA City, N. Y., 1871 



94 



TBS IICMAH KAR AttD tT6 DI6EABX8. 



oon<lt)ctin|* fi[>p4intti)9 of one sMq be aflectc), thnl ^klc; ml^hl rr- 

'vr«rc the tnoM alfcctod, for ivo know that obrtructioD outwutls 
iirtenaifim vibnilloDtt llirougli thv (-rajiUI liuitm. 

It ift evident titat cn« ijiu»t tiHve lii» wits a1:H>iit him, lind lie 
ver^' careful ia hU wn? of the tiintng-f^^rk, if iid eiainiiuilkm i» to 
cast lij^Iit u]>on oli^cure t-uHeft- 

Tfu- Atrtijiuifr i« nn iiisinirncnt ix>nf4ratic(l wiiM-vrhiit aAvr 
the pri[ict|>1o oC the BUke fork, ami deaigi^ u> he ii^ed iu lO 
plaot? f"i" Kt^lmg ihc nvrlion of ihc atMliinn- twrvc^ Ukh thnxigli 
the ouihI aiitl by iii«aiiri of the cranial honi^. 

It conKi>t« of a vtttO cylttKlcr, 4 inin. in dianivlvr ami 2S mm. 
long, fesu'ned at right iinglfti co a ^i]L<mnlte cotunioar bodyt 

Ftti. at. 




v)ii<!h IK hold fwtwa>n tht ind^x fingk^ and ihumK Thi*r« in a 
slot in this hody, ft little romov^ from t\\p foot of ihe cylin(J«Tr 
in ivhioli iti(>^V¥( a win? handle of a ^F^el hammer, that strikiw the 
oylinrlpT iKmr itfi i^nd. Tht* nuivrmi<nt t^ thr* hammnr ix nrrMird 
At a certuin point by a shoulder^ so that iWt^ blovre and the soand^ 
it makofi ar^ nnifnrm. Anckthor wtn* nxf, hnving !t dti^b upon 
onof^ml, inL Gtt<9d to the hody at a ri^^hc an^le 1o the hjimmor. 
Tbe difik i* placed a^int^ tlie htaid t« U*1 the hone condnctioD; 
but witkoiiL the liluk th<» idt^tmment fl«rvfti asa produoer of sound 
to tort the tvmpnnic np|>amttis. 

Otoaosing tho E&r. — ^Tho esctomal canal frecjiiently oontains 
dirtp unhctfdlhy oonimvn, epidcrrmic c<<u]<>:, projeuttog hulniy in* 



CHilAHgTVa TiV lAB, 



Bpianml pus «tr. Sometimes ilie oatia] mav he tolerably clwi, 
aru) tt [H-rfiiritH <ir (Anially d<ff!iroyed membrano Iw covered by 
pus, wUk-h dlls i)i« tympanum and hides the paTC5> It is fits 



Via. 3ft. 



"——■"" AOA 



CorttiX QOLUW. 



qnently nwwwary lo n^nov^ mudi nfTensivf? mattrr l^fore a sp«> 
ulum oiii l>e iteeil in the tviinl with any sAlUfnctW^ hik] ihcjiv 



Fici. S6. 






for« cIcHmnt; ni«A£U»fi are oeccflsaiy. Particle and piecc^s elin^ 
in^to thi" oiiiml vmlK liod 'i<^ toi) Inr wilhiu (lie nieit(ij)f, may be 
removed tmder good Ultimination by twisting cotton around th4^ 



Fio. 37, 



«waa&nr*i«A. 



AxftiTLAH Ear Koiurrnw 

rongh^cd ond of the cotton-holder, welting it with glycerine and 
inter, Olid tiirntng it around in the nifiiiK 
The car-«pooii and hookj the angular forwpa, nnd I'omcroy's 



M 



TUB HQUAN KAii AND ITS DtSKABBd. 



forccpi, vnW provQ very uwful m the luimU of ft <l«lic&te aumipa- 
ktor, 

Tlwy mw4 bo umkI v^ry gnatl)' within the nKtttii*, und care be 
tnken not to injure tho epi()<>rmic uud otht>r tissuGB. 

When tho (niDuI u uitjch 4X3oLudc<i^ potiioularly, if llio tube coo- 




tutiis hardened ecnimen or pua in any quuntily, a good syriii>;ing 
vritJi MArm wiiitT will bo nt^ot^rwrv. Any common ^yriDge will 
do ttie work in ilie \mat\s of an iDtoiligcnt pcnoo, bul tlicrc an 
several i^yringiK of ut^pecial Encrit for the nifc of specbli^tA and 
thoee wlio can itfK:>nl them. 

S;niig68. — The ituproviMl founlflin syringe, No. 1, 1 liave 
used with uu^h ^tt^ac'tiorL 1 1 Iiil4 no valves to get out of order, 

Pio. 3». 





ikirAorm ForxTiiy Sruitc^^c. 

Is self-acting, the flow i« utibmkcii &111I ntcmdyi ttad it lujectfl 
DO air« Shut down u c)uui|i uititu IJie lube| lti«u HH th« Lag ttpd 



&YBI?f(JBB. 



vt 



il u|>, the higher tlio mcro force is required; filip in UiO 

Dpvr noz^k, lift ll]« clanipf aiul direct the stream ttX vrill. 

The (liOcminc? httwifcii lu fictioa and that of th^^ oniinary 

pi«toii iiMtninwnl, it similar to that bctwocn n pWid hroolc in a 

DiCfuluw iii]<l till- [virnain uf an oM tuwti |>uui|), Jt is eH|)ccialljr 

'miitabto for ctiiMrcii, who aix* »o cn«ily mtitk frantic by^ an; 

irrt^lar and rncrgctic muvvatentoi about llie eiir. 

The ohvajf Uilbhjfiiii^e uihI the loorc cxpcn^vc DavidfwnN ure 
nexL U> ttit fouuC4iiii fur an-rt- cJcsuiiug ^urpu»«xk Ac my clinic 




lit Um Childre-n's Ito^fiil^l (Twenty-seoond and I^ftcii^t ^tn^te, 
Fbiladelphinl, 1 H!*vt\ u bulb FynDge,ooDDC^'t«'il with another bulb 
hy tubing, so tJial prensiire upon tlie lower one kept up a sloidy 
pBowfrom tlieoozzk-; tlie'CombiDuti'^n sending a continuouriiitmim 
of water, ah ihe doiiblf bulb aUimi£i;r« do of vprajr. The jfla-w 
ayrJnipM are an abominatiou ami a siiare to tlie uniiiitiaUil. A 

Fia. 41. 




limrd rubber j«yrii>^, of omshalf or one ouij^^e capacity, in necessary 
^fiw every vretl-rc^lated family, ami is verv useful in cleani^ng 
the ear. It ia csHenriat to have a anmW tiozjile, so that a tine and 
iforcible stream of ^vate^ ma; l>e tlirown clwe to the i^anal wall 
Ifbr the removal of liardeoed cerumen and foreign bodio^ The 



»6 



TBB U0MA5 BAE AKD 1T6 DlSHABtS, 



oiH I f^rdVr lins n »houkkr for <h« linit two iing«n«, and a ring 
for th« tliumb, ainl cau be easily oiaDaged by i>Dt^ hami, 

KrunH-rV i^yrin^ liiu tiro side nn|-B for Uif? Iirst cvo fingon, a 
piatoQ rtDg for Uie ibumb, and a graduated tKijule for the callieter. 
It h uL-iUy liundlt-<lf and u frivorilc with many mirwU. 

Out of ihL' ifl«t bui>l rubber syringWi fur the cw '» the Uoi- 
ronali ui ounce siyrinj^, wUh a rin^ on the pis^oti for tlic thumb, 
and a |iroj<ft:llii); »houMer at the Im-te for tv«x> fingers It baa a 
varietT "f rnUjtr bthI Cicrmiin silver Ut\Ks^, two of wUivli fit ibc 
outket^r; qmtc a fon^rJble stream mu be tbrown with it, and it 
Lh tlio UKCit itaeful tuntrumcnt for i^'Hcifpug out for^'igii bwliivi, 




Iiupat'tet! ixTiimeii, aad scaten of epid«rmiiL Tlie vulcnnii« ^v- 
ingm nhould hiiVL- oiie bh)iit-i^iu)H.tl iiur^dc for gvncnil user, 

Byrmgmg. — It makes a great deal ^f dtCTer^'iice Iiow one itws 
a Hynn^\ ljt>wns dlrt^ jms m?d*^ mid peUuta of ccniiiK'n arc ro- 
moved fro*u the atiditory canal by siDiply directing tlic* streapn 
from imy «y>[nnian ityriiigr into the nicutu«. When the coatcnttf 
are oltfiiiiate^ and out? has picked out with the &iK>on ami forceps 
all ihut i» rrwVy n:nn-vabk\ thu ''ynngiiti^ nuM l>t vi(^rou* ncid 
tbe »tn^m dir^'t«d trith care, for this purpoee, the kanl rubber 
tyringti with a mmW uo;:xle U the bi<«t. Tin: wntor bod betu-r be 
warni, and he kept in a a[)«eisl vettsel ; the first Hyriikglog should 



ITRI^tdlBTO. 



M 






reiy gentle, and thu prooeHH iif>t loo loog continuec) nt one flit- 
np. It is well lo have a fimall ga^-slove liatKly to h«it wiiWr 
pidly wh^n nee<l«Ml, thoagli not l^x^ f*old water may be iiaed 
it^iout much ri^k of eioiting iDdAnimation, I^it a v\vixn lowel 

iqikI tlie iieck mid hhouMor upcni the Mtje tn l)e ^ruigtd, tiiok- 
ig it in to proavt the pntiL-nt's clothes, 

FiQ, 43- 




EdUhnowL* 



^V Oiv^ Uic patient a fin^r-bowl, a comoiOD china howl^ or tin 
^"tnp, to hold aj^imt tfa« ftide of lb« m^4c, under tljt< eur, to eatrh 
U ieoymping tluifl; an ajststant is needed to ilo ihU if the fNiticnt 
^B a 5ounj( child. TIhtc are tpec'iul c^i^pann r\Hionimei](led, hut 
^Txoept tlif^ one figured ahove ihey are sbomJiiations. 
An ear*t^pout m^y fiometimcs be used to ttdvantej^ 





fe 



Introdnee the nozrte about h^lf an inch into the meatus, direct 
thoatream ot wnu-r into the omal^ and oontinuv injectinf* until 
the canal seems civar. 

It i* b«t lo examine with n|KKiuli]ni and mirror every ntinule 
tw^ «o thai Klioiild oppotiin)r niateriu] lie removed, one may 
^ttop tbe synnjfln^ and prevent injury to tl>e m^^mlmoe. To in- 
aure thoroujch work, dmw the auricle upward and Im'kward lo 
»truij£htea the csnaJ, and direct a etroni; fitream eloee ajcDiDfrt Oh- 
upjier canal wall. This will be ikeccs6ar>', [larticnlarly, for very 



lOU 



TUB BOMAS BAR AEVI 



ISB0. 



Jinn) crniaivti nnd forviga txtdiw, Oa« may u>«i.>^t tbc'it «iil iMxft- 
slooally with ^]xnjii ami furct?|iH; lEieir (mi'ctui tine bi Traqu^^utly 
nucvcwry mul [KTuttF^«lUc, notwiihsTiindiit^ the »(rtiii;^ couiitor- 
tvaoliing of some auUioib, vho ixMKJemu Utia uuinipulaiioii, lie- 
oixm; iiiMtnimeiito in tlir Imniifi i>f ritu^^li and injudidiHu mm 
have done injury lo the amlliory oanal. 

PutientM frwjtienlly Uxt)mc \iTtIgiinHw fmn: Uiu syringing, par- 
ticularly aiW ihe ntenibraue or middle ear rwieives the Mruim 
u»brok(!ii by any imerTOiPiHK*tjlwtenr*i\ nnd, rircly.ii (jall^iit iiiay 
vomit or laint away, so that one must be prepared for squulls, uod 
have A bftjiin ami a rLirJiiiing trliair butuly. T liave ho^l a fevr pa- 
tients who were obligHl to recline during tlm upcnition. 







No perftou can &yriag« hJA ourn tvifH woll, and wlieu himm must 
<if neoe«ity he treated at borne, the operator must be caret^ully in- 
strui^tr^l in tliff deUuU of ihe procedure. Only llie initiat«d flwy 
€!8ed well. 

Attnr Hyringing^ the ear >(heiild K? wifieil with the end of dut 
towM, and u 6nger rov^'nyl with tt pr4>s^(M) ^vi'll into tlie meatti*;, 
the tiefkd being a litfle bent towards the aff<«ted ear, in ordrr to 
absorb the surphiit water If the exiiminnCion through tb& sp«w 
idnm Mhon-ft any remaining wrailer, orthere be t^breda nnd pcuiielw 
of pii!9 refnaining in tlie <*fl.nnt or tympanum, they should h# oar^ 
fully wipnl out with pieces of eotton twinted around the eottoo- 
liohier. Till* alitiM-lMMtt tuttlon of the Ahojin in an exc«l!iTDt artu^U^ 



jjsfihrios 



AUSCtLTATtOTT. 



it grestly iBcilitatfifi thorough cl^nsin^, and ir; now largely usetl 
In Buml prAfiii-e. AfterlliomaghoWn^inir of thorvi^nl^ illtjrni* 
Mte ii well with Ihe mirror and Bpeculutn, and exaiiiine it mrt- 

When the membrana tympanl 10 intact, nnte its color, Intn^ 
pirww'y, tmn^Iiiwni^y, vaiwularity, ruoliilily, adlicAiont^^and o^hfr 
mmlitioiTfi. Thv apiw^nnnrc, po(*ifian. and molMlity of tht- mani3- 
brium of ^e malletifl oinrht to be «ipefully olwer^-ed. The Slcgle 
^|Hvri1tiTn ^-hmild W !ip|>li(sl (o dcrirtninc ttuMnobiltty of the inent- 
brane, and pwition and extent of adhe**ion**- Other tuefinfl and 
imtnrnicnte aix' ncawwrj- to find oiit tlic coiidltjon of the miildl'- 
ear and Eustarlibn ttib<^- 

Inflation and Atucultation,^ Aural patients owe a debt of 
gratitad« Ui I>r. Folilxer, tvlio iiitrodti<^ a simple, painless 
melh'Hl of opening the KuF^tucbian tub^' and filling the mid<)1c 
ear with air. 

Fid. 46. 




Thf PfJtt:^ Ait'intj consists of a firm, coniprcflaiWe rabW baj:» 
either oval or p4ttr-flbap«<), witli a t^mall hclc in the kiM\ and a 
ftlcmk'f noxnk on the opiKR^ite end, which Ls attaehed by a «hon 
piece of rubber tubing to a tubular i]o#i*-piis?c of liard rubber, d 
oai, long and fi mm. in diameter^ and slightly curved at the ilifltal 
end. 

This nowte may be put in tJie inferior meattiA of the nose, but 
patients do not like it, nnd I !<(tt>T<litntc for it an olivo-vbapcd 
hanl niblMT mizzle, or a beak-t*hap»t s}^9fi ooee-piece, which ju^t 
fits the antvrif>r naro^ InHuiit^n i:* jUHt a>t>im^)eMifa] with them 
Bi^ with llic ont'iiiut i»we-pii*cc, iiml then* is no |jain nitjst.d, iw 
neither goes lar enough into the meatus to press afrainst the turbi- 
natnl bone. Som^rtimea during inHutioii a little air got« through 
the lactrymal passage and makes a queer sensation, but I have 



102 THM HUHA5 EAR Alft> 1X9 DISBASB9. 

never known any harm to be done by it. One patient said he 
felt as if his nose waa growing, which led to the diaoovery that 
his left lachrymal eac wae considerably distended at each lofla- 
tion. 

An auscultation tube, for use with the air-bag, or any other 
method of inflation, consists of a piece of soft rubber tubing 
from eight«en to thirty-six inches long, with a small bone, or 
bard rubber perforated tip at each end. One end is placed in the 
patient^s and the other in the sui^eon^s ear. The tips are usually 
straight, but the one for the snigeon's ear should be bent a little, 
so that it may be better retained in position. Dr. Burnett recom- 
mends a tube a yard long, so that one end may be inserted in 

Fio. 47. 




Auscultation Tube, 

one ear of the doctor, and the tube go around back of his neck to 
the opposite eide, and then direct to the patient's ear. A tube 
applied in this way is more liable to remain in position, than when 
entirely upon one side. 

Cover the patient's chest by a towel tucked under the chin, fix 
the auscultation tube in proper position in the ears, give him a 
mouthful of water, and tell hira to hold it and swallow at the 
word. Now push the uoae-piece of the air-bag into one of the 
patient's noBtrils, in the direction of the inferior meatus and a 
little away from the Beptum, hold it firmly in position and close 
the other nostril with the thumb, or press the alie of the noee 
firmly with the thumb and Index finger. Grasp the bag firmly, 
with the thumb placed over the hole in its base, say, "Swallow I'' 
and the next moment compress the air-bag vigorously and notice 
the sounds which come from the auscultation tube^ then take the 



IVPLATtOH AVt AtrBCU1,TATI05. 



103 



thumb from tlie liole and remove ihe nove-pwcc WIihi itiHittioii 
fiocoeacb, there i& ofien a. cliirkin<; sounci mixed with variotifi rditefl^ 
Ihofd by boUi )mticiit luid phynicuLii, imd the loriaiir cxp^Ticiicod 
a fnliKMt in tba caiB. 

I explain tliat 1 mstU to blow u litUumr through thciK>n>nnd 
it witJ not hurt, but only fet*) peculiar. It in well to blow gi:Dtlr 
the first time, c8|)eoifllly vvitlj chthlren, id onl^r to tn&ure oonfi- 
d«no& Both 4*]in« will UAUully be inHutod by thrM niHhod. To 
duninnh action ujxhi ooo ear, ^top itit meatus firmly ivjth the 
tiagtr. Tlw i«*nis to liav<? Mtme cllM by rHlcx actimi in liiivler- 
ing 0|wmng of the Ku^tai'hian Cube. Turning the Ijead towards 
the sliouUkr of Uit M^ you v,is6h to prot«H.*t will sonictiioci du il. 




A oerbkiri way of limit^n;^ th« artion to one «ftr m to inflate 
tliToutrh the EiJHtai'hinn mtheter, nnd ilm will i-tt desimbk- when 
tlic othir ear is in a normal coadition. 

When a [WTM^ti tiwalhiws, the iialatine and pharyiignil itiiwlet, 
not only open the mouth of iho tuW, hut they draw ilie Foft 
palate buek oipiinAt tlie p<iAlerior psirt of (tie ]>har}'nx, and shut 
off die na'My^tharyngtal H{>ace above: from tJte throitt- In a 
Dormal contUtion, air i>nli>rs the ear with each aei of ti\^-al lowing. 
The air from tlie ba^ is condeneed in ttie Qasal fc^se and the 
OBperior portion of the pliarynx, nnd, iitrctehiDf; the w&lle, Utttm 
apart tbo \i{^ of the EtiAiacbmn tiib«s and Truhee throai^ them 



104 TBI HUMAir SAR AHD 1T8 D1BIABSS. 

to fill the tympanum. A blast of air in one nostril ie tikelj to 
affect one ear more than the other. Often thia ia on the Hame aide 
aa the nostril used^ occasionally on the opposite aide, I have 
r<Kin<) dry deghitition, or the swallowing of a little saliva, aome- 
tim^ to insure inflation when swallowing water did not, probably 
owing to a closer contraction of the throat muactea. Instead of 
swallowing, one may use what I call the educational method. Id 
tbis the |mticnt keeps the mouth wide open and the head back, and 
ms ihe lutg is compressed he ejaculates in a guttural manner the 
wonts. Ate, ha^, hocj hvn^^ hapc^ hoc {hick, hank, hunk were the 
words nxx)mniended by the ph^'sician who first suggested this 
methoilV 

Each method may be tried until puoeess erowns the effort 
dttisionally a |taiient will not be able to keep the soft palate 
boi'k £^!Hinst the pharA'nx, but it will yield, burst open, and air 
will di^tem) the chocks am] es^vpe from the mouth, or go down 
the thnittt. Then there is usually a failure to inflate. To obviate 
this I iuak« the i^tient bend the head fiir backwards daring the 
Q» of the bag. If this faiK I have him (am his head sharply 
t^vif'r ttoo shouldor. and give him a blast in both nc^rils as he 
sv^allows; then let him tuni his head over the oth^ shoulder, 
aod eivv him anuher dimble blast. These positions change the 
reUtu'tts (*f ihe trumpet eruls t>f the lubes wiih rrference to the 
piv«mor ttaiY^ By ih^tse ntamieuvres I have oftm succeeded 
'whtn «implor moistirv^ faiUHt, and thus avoided the use of the 
<sih<^oT. which i:^ Si> much dreadctl by uK^l patients.. 

Ttii- ValsAlvian mcihi.vl i« am^hcr way of inflating the middle 
flus. «hk-^ many «ar |vui<>nts will tv foand to know all abont 
Jhi z^z^tcn^ takts a deep itispirati<(^n. oK^iws tbe moath. puflfe out tbe 
K-iirt j^ bv^vds his [K^Hls cK>«*d, aoil lorw* air upwards from tbe 
^.^T^ t: £1j ibe mt^otb. ihrittt, axKi xm?^. This is a convenient 
iaf^L*h-CTVf Ui^^ivvniw. wlH^sbiMiM i^isefvetbe motkio and a|^ieaf^ 
ta« y :*M nK-ml*raiM tympany during: tbe expenineiit. Tbe air 
ix!f ii:c r^ A^ d:Tvvtiy and lorv^blv. and tbe maiMpnvre is not ao 
:wr*b:^~- k: nm-^ring miKti^ dilaiini: ibe tobfs and airing the 
iL>Sd»! fit:-- »> irtK'3 ibc air^vu: ft-J* by a fod^kn blas^ the oaso- 
TdtLn.Te^ i-JiiTEber aihj TympaMu Tbe <vng«f6on of bead and 
flar^. *'»wni£ t. iij^$ia?)y<n^oo<^'res|^rabv«.a'«i>cdme^rQa^ 



inrLATlOEl AVD A1T8CULTATI0V. 



106 



the «ar. It nuy tie uj4ed mivlerately, bowei-er, uiuler the pbvsi- 
ci&n'B directions* but the patietii l^houM be warmd that Im nmy 
iiKTease his fleafne^f if ht* |>er&ii4t±) in the nieoiiijrv by bicn^lf. 

The opemtioD by the air-bag ebouM be repe&tMl (wviTal tinw* 
L&Dtil it » certain the <iirs have been iiiHiitcd. One zau^i judge 
of Ihut hy tbe putient't^ eeosationSf by the itii«!uJtatlon 1iibi\ii»d 
by tbe increased va<ic;i]luri(y am) inipmved |>odiUon cf tlie roem- 
brsnc. He may my be beard a cracking, and that iu« earn foai 
stuOed u[> ; thin ften^utmii <li.sap|)<'iirx ii.'iually ufter ^wallowing. 

When tbe tnenibmne U perforated, !here isiiBuallya bubbling, 
hiaiing, or wbUtUng 9oiind, nH the air CM<npui» through the o|)en- 
iog asd out of tbe eilernat mefiius. 

DoaltotM to IIh.* vt'k^f Aubjtt'tive noihee, etuffincHi or |utm may 
aeaee immediately after a ^uoret^'ul infl^Tion. 

The ftuij^n iiJiould iii^juxTt the membmne^ whirh, if IIk? »|»em' 
tion has succeeded, vitl show le^ depre^ioi^ a R)ore prominent 
umbo, and a reddening of the venclfl xlmig tJiv miuiubriiim of 
tbe malleiM. 

The HUiV!uIutioii tubu wht^ri mvd during inflation will ofim 
determine the r^ii^tion alx^ut tie 6p<'iiiii^ of ibe tulte, uid give 
one nn idea of tbe mjcc ond <7undition of ibe tympaniEm. When 
tbe patient Hwallov.4, the air-lwg Is compTGr«eil <]uiclly, f>r rho 
Valf^lviitn nit-thod in omplDyed, tbe o[>emtor hstciis for any 
fioondi that niay conie to h'l^ car from tbe <wr of tlie paliehL He 
yvill MAietiaMSA dlElinguifih a eoft Lt«w, moi^t eri'pttatioif or bub- 
^f ora loft dry crHJ^lciag, bolb n<'itrai>d dltlanl. When Uie 
are beallliy there in a w>und like whoo in a whi&[>er. If 

> sound in board the Eaiftochian tube is oh^irwHvti in :fonic 
'way. 'n>e soft hisB indicates mueouH ;idli<i?<ion of the KiiHt»<rbian 
ttibu and may bv followed by ir/joo, if the tympflnum i« nearly 
nonnalp or by moist crepitation if there ia eiudation in tbe tym- 
panum. If ^iiiuU nrv clear and o>mi^ <)uiekly, the i^xmhilion i^ 
tlun ; if duller and ilower, it is thick and prohahty in the tube. 
When there i» a dr}'ne^ of the tym]>&num, nmrhylo«Lt of tbe 

BicleSf ftnd §ome movement of the nunibrana tytn pan!, cracking 

priHlncoil by inElutlon. 

In tbe open tubes and dry tyinpnnu of old ]>erwnt< the sr^uada 



106 



TBI BITMAlt lAR AVD ITS DISBASI9. 



ftn rough and nwpin^. Pationtt of OA^ute Mmibittty fro<tiii-iitl]r 
hcftr these soumb durintc iuflaiion. after Uiey get a litde used to 
tlio^odc. 1\w auKtiltution tube is mthcr mora n^iabkwhco 
the inthition tA made 1l]fv>i)|r|] tJ^^ catlit^iiT, 

Vertigo is not utcomnioD afWr intlatioo. Shocks m^j occni 
vflwu i«dh<«iong in rho tympmitim give wfiy, as air U forced rio- 
leiitJy into it lor the first time* A patient once taintc«l in mr 
oSke Trom mc\\ u <!^iivc Kite houn) a tetiriiig muad and telt 
Bharp puin i» the inir. 

In tr«ati[t^ infants, the oar may l>e inBaled easily* A Hmp1« 
rnbber tube with a tiKHith'-pieoe in one «ail nnil a perfomtef) ci|i 
ID the other, much like the diagnofitic lu1>e, should he uhA lO* 
atad of tlie nir-f>ap ii]^jmmtii^ tinvi* tliediild held, lake th« 
mouth-pieee in the mouth and pot the tip in the patient's noHtri), 
<:onipre94i boUi iKrfttriU with lip nHAtnfvI iiihI bl<»w steadily. The 
child will cry^ inhale, choke a little, draw the soft pnlate back, 
thcoi .^walh>w nnd tlie [Kridiar grirgk' will iixliratc thai Ihe <1^ 
is done. One may verify the operation by cJcatniDi;!^ the mem- 
bmoe when pot^ihlc. Older ohiktn-ii will rtmlily aubmit to the 
air-hag after & little coaxing and geDlleneas on the part of the 
pliyAicrian, 

The air*ba^ alone shntil^I m>t he niwd in acute rhinitis, unite 
anginaf ulcerution of tlie naNil (ut^iv or in eleft palate. 

It IB a ble^in^ to the auriftt, at least, that younj;^ children are 
not hroiijjht in orowd^* to be treatt^l for 4^r di^^a-ui^^ bccauw un- 
less (hey are anje^thetized, it requirefi about three pejw>ns to put 
each wie thn>U|;h an orrlinnry exaniiuntioiK It tA a curae to them, 
however, not to be treated, as older patients la clinics and deaf 
aiad dnmh rt^ylum^! j^hmr, 

Ezamination of the Throat.— The Eustacbian tube, uoev, 
pharynx nwl throat ahotild Iw iriKpcct^l in avery case of aaral 
diM^a^- Have the light ntream over the shoulder of the patient 
from behind, put on the head inirror, n'ikvt the liiajht inlo the 
tiin^at, hold the tonj^e down with a tongue deprctE^for m the leA 
)uuid, nnd l<x>k nt evi-ry jtaH of the poAt-oral r^ion. The vutt 
and condition of the totimls, Ihe position und action of the pnlatl^ 
pljaryngcal and |>alato titlul munt^I^^ and the appearanee of the 



IXAMrNATlOTI or TIIH RASO-TUiRTNX. 107 

mucous mcmbmiic niid [^Undfi of tbe throat and pharynx Rho<ild 
be Dolicfil. TcH the plu-iit to ftay at/^ ftnd a little htglM^ view 
of the phAn,'nx niay be ubtainod, but to i9ix tbi? upper ]K>rtion of 
the phannx, ike mouUi-i of the tulx^, and (lie ]xie>tefior parts of 
the naal foasw, a rhiiiotHXtpk mirror miut bit ujmn], A ftct of 
roun<) or oval ^ilwrt^t ^la^ mirrors l^at^k^Kl by oietnl and trow { 
to 1} iQchtt iQ iliamctcr U deeinibk\ Kucli oiirror m utladied 






Rjriwwnnc Vmaosa. 

ftttD ingto of about 120^ to a strong wErfi«tcm,ar'T wh^n oneia 
Deeded It is slipped into a universal bandlo and fastened by a set- 
screw. 

Ex&mlnatioii of the HasoFbarynz, — Seat the pnticnt back 
to the ligUtj M'itb iht; iK^od bent bick wards, nnd re9i*ct it itito his 




thmathy hand or hi«d minttr. Select tlw mirror (o wiit thft 
fMst-j by f^timiiting ilm #pAiT b(*twMfn tlio \'4*1t]in .and ibo phnrynx^ 
and fii it iu (b« handle by the ^i^rew. Tulco it in the right hand, 
as ihe pen in held, WBrm it iflij^htJy by holding th« gljuD snrfnco 
i>ver the burner, to that tiie vapor of the patient'^ breath will 



108 



TflK BDHAH BAR AliD 1T8 DieiABCS. 



not dotiil it, And introduce it into the throat with the anjclu hori* 
sKJQtfiK Have ibe patient bold the too^e by the tip, or with a 



Fio.61. 





toi^a«? iloptHTiutor, ar tlie Hiir^^n nmy hold it n^ith the deprenorJ 
or the liandk of the mirror, Whtii ihc mirror rcachct) the phar-j 




j;nx, hnid it do8i^ to ih^ phnryng^l wall, h<it not l(>ii(*litng, r^ 
AktI the light into it from the large mirror^ turn it apwards 



SXAHIVATION OF TitB ZV ASO- PH ARVIVX, 



109 



ami nnxiDrl in different pooitionM, nnd oWrvcthc pKrttin^ thrmn, 
The luirtirt" *bouM ht h«l<l ««aiiily atwl uot tjtillriic tJic purls or 
gagging will rc4ult. If U>r uviiln ii> too long^ m Mlp ncinmt ithonM 
he p&sB^d Aroiimt it, ihen draw \i rorw^nja and fiiM^i ih^ thnud 
lurtwf^'n thiT iiiriM>r Iwrth; in *omc «w^ it may Iwr tnitofT, If 
the tofiAila olnirtKi tlii.* nvunU cuirrof, Ub« u »mal1 ovul ont. If llic 
piiUtc giA^ biu-k tog much, Iwvi; th<; iwticnt lircnihc oulj^ tlirungh 



Fto.«3. 




KXAMIAEArjOK Xi'JTU l\>SDLl/a Al-l-A«ATn* 



thi* no<c. Thi» i:s difficnlt, bat is facilitated bv ka'pin)^ rhc jaw?; 
very wide 0|>eii, Soni<; tUroatx niv ^> Mnjill il^ to uinko jiikIi 
lit ejumin&tion impossible, but ^erally b tolerably ^ood view 
mav be oblmn<^) of tbi< |»mtt-riiir tmrr^ nnd palaUs die rm>f und 
Mdc^of the pliar\'nx, the muutbs of the EuMu<^'bian tubej^j and 
llie larynx. 

Thf muoons mfnibranc fihmild by carrfuUy cxnTTiinMl for mu- 
GOU3 ma^ees, iMckenin^, ni^^orte bwellin^, eiilargi.'d glonils, ad- 
bmon^t tiilw membrane, uloeniliiinfl and morbid f^^wtlm. Tlic 
(Mtatency and condition of tJie monttin of ilie tubei tihoiiM receive 



110 



THB H01IA» EAa AND ITB DIBBABI8. 



careful attention, id order to judge whether the disorder of hear^ 
iDg 18 due to tubular disease, arising primarily in the pharjDXr 
or to disetise of the tympanum. 

EgaminatJon of l^e No&e. — The nasal foessD may be in Bodi 



Fnj,6i 




FKAKICSL'e NaSAI, SPBCDI.UBI. 



a eondition as to demand treatment, and ehoald be tfaoronghty 
explored. The rhinosoopTC mirror will generally reveal the rtate 
of the tissues in the posterior naree and nasal foeen, and a speca- 



Fio. 65. 





Thudichuu's Nasai, Speculum. 



lum should be introduced into the anterior naree to facilitate 
further examination. The head or hand mirror may be used to 
illuminate. 

There are several specula necessary, Frankel's is a useful 
and convenient one. It is of nickel or silver-plated Bteel^ worka 



XXAHIttATIOll WITH TUH HU8TACU1AX OATHKTER. Ill 

with a Mrrcvr, and kavtn ptcn^ of nwm bctwoen ita branchm 
for flurif ical %rork. 

Til u^iichu en's ooti^Uto of two biviJvco connectcti hy « wire, 
and tba favorite wiUi many apocialinta. Kl»ber^s Is luore of a 
dilatiii^ in:4rutiici]t, It Uai^ thivi^ Knin<4u<?- um) i» L^>nvcni<.^it. 
Zaufal'a loug tuWIur Apot-ala inny l^ u>l*IV]1 id t]L-t«ru>iiiiu]^ ilie 
atali- pf ibc tiiiM>*|ihar^-iigi<»t i^nin\ nml Woiuc u ncrnwily id 
exojnininif «im9 iit wliicli U ia iin)>o»&iblti to gvt a view of tlip 
frnttv^ with ilie (liriKil minx)r, un jiltx^uivI t^f tiarrv^vuevi uf [Ivs 
Bpon-e between tl»u palate out] the poatrior feurfaue tif tJie pharyox. 

Ckn-ful rxplomtioii by tlitr iiidtx liti);[?r juirvnl ibruii^^h tbc 
nouili to ibe mof of iWe pharynx ami, evun, iiiiu ilie dumDie, 
aliould oMifinn tlic pn^ft^cvuf niurbM i^njvrths m Uib rugiijii, 

Flo. 56. 




ooo 



SUnrAL'v TrvCLAn SrKctTLi'x. 



be&jn,- operutloti, lu recy>mmendtd by Li^weEibt-j-^. Tlit fttate of 
the muctHM lUi'mbntnc, nijcc gf th€ pos^agiv, dvformitim nf lli€ 
N:]Hiim and tiirbimiEeil bones, and ilie preAenc*? of iilt^ratioufl, 
Bwell'ii)g« and tumors, ^hollbl iw notjdtl and n^-onlcd. 

Tlie Xfeth should be examined in all oa^3 of pain in the «flr, 
wlien otbor itynipUitim of niirnl (lWw*i< are ntvcnt or mHigniti(<ont, 
SB od<intalgia occsfiitmally cmiiva violeai earache? and even in- 
flantttatkui of the mi<l(]k' ojir ilmMij^Ji tbt* otic giuiglifin and ilte 
aoricular brandies of the tifib nerve. There is no doubt in my 
mind thiit ntimeroufl cn-Ner* of -^abcuriilir and Hirdoic ditteuM* of ihv 
tynipannm art cttTti«tl by dbtiiMxl Ktrth and the various metallic 
fiJbngA put in th^'ju, aa stated by ]>r. tSexlon, I have nevit plenty 
€f caws ID wbich th^ tvidrnc? of thi*^ connwfion wa?? irrtfuiable, 

■xunlnaticn with the Eiutachmzi Catheter, — 'ILtH la an- 
ctlier nieana of diagnosis of naAo-phar^^ngeal^ Utbal, and tym- 
puic tlisorden. 



112 



TUK UUUA:* KAK AKD its Pl^KAASB. 



EnstachUn catlictc^m nrc tsprnnj^ tubcii nluHit fix inohc* t<>a9< 
with A Bll|£ht tun'e nt Hie ritniill viul aD<i a ring upcin llio lai^ 
cixlf in tho «aine plane a^ tlio curve, to show tli<^ |Myiitioti of ihc 
luUer wlien out nf ^ight in the iiosoi. Some ccithf^cera liavas the 
rin^ Qpon ihc nmo s\dt as the CLirvct) h<:n)c, olJicnt upon tbff 
Dp|k(Hzto :ftidc. The HfiitM «ikI shuuH bo u Ilttk rouitded liken 
silrcr prr>1>e, not left «liurp a« §omc arc, and llin HmoKlrr of the 
hir^ eiul ^ItQiiM \k miJTiritnt to take a syringe uuxxlvr, and a 
lapcriD)^ tip froai ibv air-bag. Tliey ara niArilc ^cocnill/ of lunl 

Pio. er. 



C. T/£MAVf JLM; 





3|. 




EciTACBiAir Catbrtkm.— n. Ilnitl rubber ctihMer: ft, SexitfA'ti reh^t-«7ttl { 
caiht;Ur; «, Silver uiiWier, 



ntblier, ami of coin AilverT whi(.-h nuitermU are well adapted to.j 
the purp»sc- chcy hjivc to loii^ served. Every aumt knvirs die 
frujuniey vfith wliich »li^ht bli3tiUii|^ in eau^d \>y the luint i 
ful itiLToductioit cf tltc«c inatrumenu, and I have hwi (Ksowioo 
nmnir tini<3ci to Hie ufT tlie pbarp eilgca nf Uic buk in orw wtK, tn 
order to save the feermiis of \\y |xrr4eiHitivc ]>atieitt4^ aitd to avoid 
ubnuiioiip of the It^udi^r iiuMr-plmryngeail uiuooun mt-uibmut-. Il 
occurn.'d to me Uint a estheter of 9ofi rubber, HiHjcieiitlr Urm to 
atiswi^r inimL piir[Ht*«iTi, uii^ht Ih? ntunurufHiitvil, and owiug to lb* 
mti'l beuk aiiid fa^y ttcxibilily, be iiiMntinl withtfut any of the i 
comfort and dainii^ iiicJ<iMit to the unyielding onw. 

I cx>miDi]riicntcd with Messm. G. Tiemunn <& Co., ibe erDitieot 



EAHflVATTOir WiTfl TBTIBtBrACRlAff CATHETBB. 113 



atifl inf^ious fiurgifal Int^trument ronkt'n* of Ntvr York city, 
who M iniin«diatDly to vork and produced the ioBTmmeat de- 
Bind. 

Thb «aiTcq»nik in whn|>c and dtnioii^iorLs with the medium 
si»p catheter famished in Hets, m ^iW enoiigti to l>e hiiwIM 
eftT^ilyt wnd tn Miiiu (tic noKsile of iUt syringe, or the tip of 
PoHl»»r'f air-bagt y^t, "s so soft and yieldinjf aa to glide over 
oENita<rt«s, ^xtd do no dnni:ig<; in a t^ndiT, ^rftDtdur muooiu iDein- 
braiie. It works wel!, can be made ififler iti lln Mmi^lit |inH. 
by Hli|tpiE)g ii) a wire if thouf^ht Doocs^uLry, and its roeritfi ivill 
comnHiid it (o ?.very on« on^EiaKHi in atirtil pnurtioc. 

Thi' miiiinrrtct«rt'r> will kwp it in stock and d«tiigiiat«it "TTie 
,Klexih]e KuHinrhinn t.'«tlit!k'rH" 

Dr. Sexton, of Nevr York, has invented a catheter, which u 
tnadf^ of sofl hiMbt nnd Nilvnr. U is imlicnl«l hy b. Fig. ST, 
Thv lioKc coobiiit^ of a silver tnbe^ with a ring aimilar to llie 
DUtrr liair or ih<'orrlinjiry silver <<Athrtcr The otli^ half, re- 
mving the distal en<] of the silver tube and ending irk a Capcrini; 
curved beak, is rriiideof soft rnbber, imd nwmblea mine in its 
delicate Univb and wki^. The ba^e ij« «o henvy tluit the instni- 
iQ4'nt 19 troubletome to keep in p<«itioD, and it f^Wp^ ont of tlie 
noee and scparBtes from thi^ rublMT part too eiu^ily. 

The )iard rul>ber calbet^r should Ite li^^l generally, vrheii sieani 
or incdkJnw are appHei] to the F'nslneliian tnlie and ear, a« the 
fiilver ones become heated or comxW. Oathtiem come in wW 
of ibrw in each materialf the Mitx an.> »ma1], mtdiuTn, and lui^e; 
biit cm? ^lit^ild Imvo a nuinlv^r of 'Wit*, m> Jut to have clean oiit^ 
slwayi ready, and to be able to fit odd cases. They should be 
waited after uao in iH^fliiij^ wAler <?ifntAinin^ a little 4^rl>(>lio 
add, in order to prevent carrying diecate from one patient to 
anrth<T, 

Ooca^ionally quite a email catheter may be needed for a child, 
bat the hani nd>lH.T oii«* may be hwititl and bent ('< any ct]r\'e 
to fit fpeoia] cases. It U better to avoid the use of thecatheler 
in children, nnd K* rvly iitM>n lyiUt^i mea«ur». 

IVrhoo^ with a wide brain case often require a much (greater 
curvi' in the catheter, than tlicew with l nnrrow one; not always, 



114 



TBS HUHAEf BAR AND ITS D19EA8B9. 



liuwwer, Ixt^Hw; with tl»c vritte bmiii, <mk ttiny haw ^^rmi mu^ 
cular de^'^'lL'jiiiK-nl sikI u clwo lltitmt; ainl with the uftrruWt 
]Unv|iliiv lUEiFHikfi ittKJ II mjiiuriim^ CHVirtii nf a pliiuyux. 

AD^U>-i:$axojia Jiave broatl c«reUml bamas aikd require, ^eoer- 
uMy, MroEigcr cnrvotL inuTK*(rr> tlititi the liiuins wh4» hnvi- imrrowvr 
omeH. I u.Hually emimate ihe curve of cbe catheter necvwory, 
by Dot)dn>; ihv wuUli of ihu hviul un u Itiie wilh aiid bc)iiii<l the 
ey^f and siicce^ lu seleccing the prog)er inatrumeut jd taoat 
cfM» ihi- tine time. 

Shore thick noees take catheters of large size; long slim tko^ee 
reqnin^ r^iuall onvs ; thi^ inferior iiHtitu» vutjch mufih In ^iiox A 
cbihri cutheter is slender and little curved. The catheter which 
ail] imtcr tW EiisULdnEin iiiheitMily, of oounc, Hhovr^ n|)[>roxh- 
matelj^ the «Be of lU lutoen. 

SeWt Iht jiriip-r ml)ii^4-r, hlowr Uironj^h It U) be Hiro it i^ per- 
viou», ^^-arni it in u bowl ol' hot water or over the gaa-jet, es|»e- 
ei^lly, if it b of iiieial anJ It i» winter vreftihcrp and take it bt' 
twtai the thumb and lir^t twn litters, »« most pt^rtfon^^ hold 4 
pen. Have- tiie pntient dean \m ntit^c ^^11 and hold hb> hmi 
ateadv and erect. Now take hold of his noee with the left band, 
raiife thv tip it liltle niid i»tn>dm*e the kiik of the iii^troiiwJit 
into the nostril haU' an inch or more, with tlie curve direclad 
downn-iml »nd ii Iktltf ihwiird. Uin<oi the {nitient to bnnttie en- 
tirely through the nose in onJer to keep the vdum inimediately 
AWA/ from the posterior pliaryn^'nl wulL KaW tlic c»thrt^*f b> 
nearly a horizontal position vrilh the beak resting upon the l]«or 
of the noivc ni^r tliet«|itum,^ndpu^igeiitly buckwunU until the 
back of the pharynx is resicbed. One can tell tiits by tJie length 
of iIk' <'ftiheter in«*rteil, tlw olji^truction to further ]>rogreBS '^ 
coughing or gagging, ftnd the grimaca of the patient. The in* 
»itniinen1 rtbould hf ht^kl loosely iiml im^ved in gently^ 90 that no 
injury' may be dune, and the in^ttriiment may follow a cmoked 
pawage tf »uch be prc&cnt. I ui^uiUly put the index linger upon 
the outer end, ailur sturiing the ittJ^tnuneril in, and pu^h gently 
and lirmly onward^ allowing free lateral |i1ay, aud ulien the back 
of ibe plwrynx ij4 rcuchcd turn the ring «o that the eorvv within 
stifill be downward. 



EXAMIF&TIOK WITH TBI EUSTACfllAV CATOBTIB. 115 



AA«r reaching the pltarjTDgvail wall, bold ElM*<sthet«r lionsoDtal 
aguiui tlic acpUiv), willwlruw it almut lutJf an iitoli and (uru lUi 
ring about a cjWLrter of m ciivle {90"), to inaiire the (urfiinjf of 
the iuoer irurvud |K>Ttioa outwanLd to (liv same extent, then [Mffh 
a liulv hwkwiinlfl rikI llii' bouk will I'ntvr tlic mouih of iIm 
Ettitacbiai) tuln; i>r elnc tht; fiH«i of Hutwumuller. lu Uii^ Uilvr 
ooae, iho colbvtcr am bo rotated J&rgvly an<) wi)] not rvialn its 
powtii>ii long. Oue blitpuld iIk'ij Jmw it n Ititle firrwunlf kc-cp 
tliv ring (h^wn » little niid ibc lH»k tunin) oiitAunlf pmU tb« 
guccr 4^ui) agaiDAt tlie >«[Huni and die iirairunient baL-kw^niH^ and 
tbe Umk will vlip iiXo lhi7 muuih of i\w HuMiu^hiuu tubu, 

SoBMOiEiitt a wnsatiou aa Ef breakiu>^ llirewlH ia fell and a littk 
blieding U uieimxI^ fmia the giving wiijr of granuUtioiitf us lli« 
bttk b pushed bomc^ The palitle mu^Krlat mnr 111 the beak into 
place very caNty, but contsot of the catheter wiih the velum oflcn 
caiis(£ coodiderabJe \mAn and some bleetliiig. In diflioiih caaas^ 
axk tbi^ puticut toswaUovr and this anion vrill frequently nwinl 
in lifting tlie catheter iDto the tube. After it is in poBiiion, flwal- 
lowin^ will in mu*4 i.tv*vsi move it Bliglitly. It may be ncavtwiiy 
lo tam il»e catJicter and roiieol the akaiitfuilntion nevcml tlaies 
■before jtwill gel into ilje proper plaoe. It aiay be oilvant^^^eous 
||d »ome- caK« to turn it lo an oppwilo dirxKtioti^ make thaw 
[quarters of a revolution, nnd drop tlie beak into the mouth of 
the tube from above. When thi?; i» done, «ome wrih-n dia<<t to 
ht^ the septum with the curveil beak, but the space for operation 
bKitmall Iliat thi« diriKtioci h ifuiRTtbioii». Oocaftiorially the 
cstbeter will he mrned during ioserttofi by die \niUs of the ia-< 
ferior tn^tti» and go directly infj) (be nioutb of ihv \u\x\ 

The [«latn-ph£ryngQal muscles frequently contraot upon tbe 
catfacter and himkr itff insertion. Oncrdiould wait till the patient 
totttbo calmly dirough the do^^ and the Hpasm yields. A little 
liattenc* only h oec^^wryr (he vi'lum will txtxinie |)crtdulou8 And 
tiie coum dear. 

No d^id^ force should be used in introducing a catheter^ as 
aeriowt injury iiuiy iw done lo the mucous iuend>nine. If after 
insertion the catheter caD be rotated but a little, and a cartilaginutis 
grip \A felt al (be inner ewl, one may be 8ure it is in proper posi- 
tion. Introduction of tbe catheter may csum; tickling, or itching 



11« 



THB 8UUA!f SAl 



T>tSBA»B9. 



in die auditory canal, a stopped feeUng in the ear, Foewog, 
cough, cpUvaxiic, ](^l'nL lowing, [;ii|rf;ti)^f nauwSi vumiiin^, Immlng 
pain in the ihniat, neuralgia of bruiielicsor th« filUi m-rvcj and 
injurj K}f thrf iEit>e. The uailK-ur cun lie ufted before h is fixed 
in poeiition, afl an explorer for thickening of the mucoi » meiD- 
brani^nnd the di-tctrtioii of morhkt growthik Koowtedge gained 
in ihirt way, however, is not veiy reliable. 

One can lell th« caihi'ter le id position l>y t1)C clastic cortifag- 
inouH feel, an iaabiilty to rotate it far, hy the position of it^ ring, 
by the ability to inflate the tympanum through it, and hy ocatar 
iaspootion will) the rhinosoipio mirror. I munt mention that the 
poaitioD of the rir^ when thi* o^thirtcr rs m mtu is variable. The 
nile i8 horm>n<al or a liule downwanl^ but it |)oiiit« fa rnx|iK'ntly 
upward and oittwani ; in aiich etwwft, one will Dottcc that ihe auri- 
ele and external nuditory meatus are a little l»eloir the plmn* of 
the nai^t floor. Thrw are mmo taiuy methods of introduciog 
the onlinary eatlieta' that I will not allude to, 

Tlnre are ca^e« of total ul>stnirt ion of oik' wdc of th« now to 
the introduction of the <«therer, which are catised by irn^ilar 
and deformed tttrbiDated booes, lateral displacement of ilie sep- 
tum, ^u-oUcn miK'oiiH menibmne, adht^ionit between it4 wrfacvii 
ami the presence of odenoid, polypoid and o^^eoufi tumors in the 
infffi'ir meata<«anil phnrynx. The^ ol^ructioua i^liould (w re* 
moved uhen pciwibke; and operations upon tbe oanl septom and 
tur1>inn1ol U>n<^ iirr^jnr^iiftuhle and prt>p«>r. 

Tht Eustachian fiilje of one side may be reached, however, 
through the other side of the noee. Dr. No^'fs has invented s 
pair of doublcMHirvi'd calheten* for thiw pnri*ow. The curw 
are in planer at right angles to each oilier, and tJie beak i^ con- 
siderably prolonged. 

Atuic^ation. — It is premised tlrat the catheter is now in 
position; it may be retained by Uunnafont'if noM> clamp; tlte 
patient may keep it in pWe by pinching lh€ nw^ and ^HNiilhir^ 
through the mouth ; or the surgeon amy bold it U^twre^n his 
thumb and forefinger, the riXUtr fingen* resting upon the foi<ehead. 
Oiw lip of the atrMHiitJifion tube T^lioiild now In; pii^h*?*! firmly 
into the corresponding auditory mcatiwof tlic patient and the 
Other into the ^urgeon^e c^r. The anrgcon mny then place bii 



KXAMfXATlOT? WITH TH5 5CSTACBIAW CATBSTIH. 117 



moutli to tlkO mtlieter^ blow quiokty, nn<] lUtsD to llienoumls tiiat 
ne to his attentive eir, ln!>r^il of x]m method of influtmg, 
1% bp^rJD^ tip in iho iiir*bag mjiy be titled Intfy tbi) mtlurli.'r, and 
[air forcKxl through by qui^rk cumprEKsioa of llie air-bog. Another 



Fio.tM. 







wsy is to ofic Toynbee'fl expUireri a nibber tiibe, fittei vrllh a tip 
for tbc dtlivtcr and u nooutb-pit;^* for t\\t> ^ur^oon, the br^th id 
blovro t)ifx>u^b itiinJ the <3ilJieler. Thin nictli<xl mjikt^ luuiih 
Ic6» uoiiw and permits tiie Eoundi through the auscultation tube 



Fio.09, 




AwcvtTATOHV CATHBn-BraATios.— J/niepaiteni; 3, Lli« cathet«r ; 

ti> be more readily ftppref-Iated, ihan wlien the air*ba^ is used. 
If ibe EufitachiaD tube im pervious, air will be forocd into the 
tympanum, an<I tvrljiin m>ijnit» will come thmu^h the auAouIta* 



118 



TB« KUIIA!ff IA» AKB ITS PiaSASIB. 



lioD tube to the «)r|^n'» itir, wliioh he loay ititeq^rei Mcordiog 
to hinCfi previously ^iven. 

ir air mnuoi l>v lieani ni^tliini; <^r ))iihbliii^ tlir^ugli lli« Eub- 
tachian tube and the tymimniim, and tbe patieal does not M 
any fiiliMsw or impnivOEUcnt in his oir tder Acvcral trin^ the 
tube h \m]WTv\om, R(!(lneKs along tbe handle of the malleuB is 
Oceaaioni\l by fxununation of lh« nudiff^ry mntil, mul hy the lee 
of infttriimeLita in ibe throat and about the mouth of ibe tube, 
ami miwt not Im> ron»ider*'d wttficiwit evi*ien<ft of air having 
reached the r.ymi>flniiin» 

Wh^u inl)nti4>n xn nuvh w a tli(Tra|Wiitio mfiiniK, two or ihrw 
bltt^ are suflident ta chan^ the air of the tympinum, but imlf 
a douHi may lu^ miule withoril ihjury> v/Ueu much atimulalioci ia ^ 




ToT^FaKiC* KrrLoaviL 



nctdinJ for diit«fu<cd coiulitionn, and it is d«^rable to cx|)d miiciu, 
anil, especially, when one wishes lo stretch fttid dilate a coatracicd 
ttil>i% 

Bougies, — When obstrtictlons are found in tlic Kit^todiian 
tubci tliey aiTu.tnallvnt thciMhmit:^ orjanctionoftliccttrtilagiiMKia 
with the bony |>uruoo. Several hin<l& of houf^ice arr usfd for 
Uit-ir rr:tni:ivii1. THry nn^ tnadc of ciitgut or ttad mHnl, are longer 
thfui tlic eatheter^ anil should be marked at just tbe kugth of the , 
raihrtrr, an<l thru hnvc nrjoth<T mnrk outi^ldf; of tbiH to iudioite 
the average length of the Kusiachiau tube. One mav know then 
jual how (uiir tlie tyin[)niitiiii thr innlniiiti^jt ih apjirDadiiDg, aa it la | 
poshed through the oaiWler, Tlte bougie is inlrodufcd thraogfa 
the catheter lu iionitioD atiO uwil Hke a ?^oiid to dilate aetivdyf 
bat little force etiould be emploj'cd. 'Ilie laculnaria bougi<» are 



8THFT0US. 



119 



ipwd to diUle stricture and the tubee paa&ivelr, by the Awell- 
which iIm^v un*l<^ri^> wht^n moi<4|<>ii«(|, TJh*y iire in^to of 
taminaria digitaia^ nre ojmificrjblv longrr tlian the En^tftdiiaii 
mtli€t<7f, and altouki he lunrkKl like th(Me of ojHi^at, 

The cath«t«r bcin^ in po^ition^ a bougie of thiB kind \9i iniro- 
dui>al through ll bev'oud die ^u-ieturc atui allowixl to n^maio «ome 
tiio«. After it i^wclU somowhat, the catJiet^ may he removed 
and t}i<* bougie kn aa loDg a.4 con.^idored dfTMtmbEo. f^otuf^times 
flicy havo been broki^n oft', aud pi«<-ef have fimiUy niai|>ed fmm 
the tube with bej^cfit to \\» i^aJibn;^ bat thiA n^n^:^ w hiizardow< sod 

Elndo^mble wqud. 
Bntotlo T«t Of HflUlnff.— Dr. HJn^ ])ro|M>tMH] n f^>inkvi1 t«st 
of the wr. He ooDneded hy riiuu» of nihbf-r tubing, an Kas- 
liu!hiaa catheter in ci'/u with a beU-ehaped collector of ii^mid^ nnd 
tbea i()oke thnxigh it dinytly iiitn the tympmmi. Tho uxt^nml 
meattia should be closed tightly, the patient iJioiitd not t)e (xtr- 
mtltcd towttoli tJneitumL^A lipn^nnil i^liould rcp«it wluithehcure. 
The refiullfi troni thU metliod are of little value, and i present it 
^_hrre iiH.-n.'ly to diow 1ht< vt^'osattlity of tiic Teutonic mind. 
^1 Symptoms. — Di^eA^^tea of the niHlilory npj^unttu^ h^vc u \^mety 
of oommoD sytoptonMu The tnoet fi^oent and noticeable is 
deaTnefw, ami the pitient U nnt ron.4oir>(js of this^ until it ha^ 
rawlied s certain degree, wbcii he ]>erhap6 notioes it by accidcnU 
A peison with normal auditory nppamtti^i oiui lietir an ordinary 
watch four or five fv^^ yet, hifl ht^rinir mny decline imti) be can 
only bear it a foot or less, and he may Ktill hear tlie Wee welt 
eDOUfcb. 

One's friendft nofioe the denund llie twiideratfK' deaf persoo 
makes for a repetition of fcntcnci.'T; for bin uii<ler«t2tiidin^ before 
he do«A biiotelf, and briL<qiie oncfii mwy tell him that tie is ^ttJug 
deaf, while polite ones will «ay nothing, but set him down o^ 
ttq>id, Theiv are many dti)dr<ai and utliiUs credited witli dul- 
Dflsa who are lumply deaf^ and it \s ci^el to reprimnnd and abciJte 
tlicm, when an examination will reveal th^ir alUicLiou, and save 
them much mi^undetvtandinj-and mortificatioD, 

X>etf pentonH li^ani U> watch the li[H of the speaker, and thus 
gather tn ^eoAe, when ^ey oaunot alto}£<ether coinpBfiH the sounds, 
and their defect becomes numifest when circumstancea prevent 



120 



tni HUMAN %At AI 



Utdr lL]>-rLtidin^. Tl» wbtful look in the fece, the ODxktyto 
htsar tt'li;LC bt >;ti() liv rrit^inU, iinil thi; tminmr iluliH^s* ami divcon- 
trni m^mitWod by tunny (J«r perMJiu nrc ilhrtrfveing lo beboli). 

Causes. — It ii» »uir*evuleitL iliat, tlioiigli (NUigt^fiiiwl iIvhTqcm 
niny ix^uh from doftictivp develapmonl or doformiiy, acquired 
deaftaetn b caimed Uy di?*aiAe and Oo)|;enerarJon of tbe auditory 
&|>|Arotu«. T^ti* autuinn, wiQtcT, nnd early tfpriD^ are pn?^HOt 
with clmn^ nf lemperatiire and liunLidity, ami tre fmiif^ui in 
nitivxe iiitluiimiutiniis of the rar, anit nciitc laaccrbatioiis of old 
afl«GtiaiiH. Ill t]iH -Hix moiLtlis of 1hi> ymc in the tem|)enite tun^ 
ctitiirrbid and iTythtmatons di;K^iA&^ hold high cnmtvalf and 
Qiimeraua are ftit! ^nteAofaurat niUchlef Id evert comtnunhr. 
In all dnmp and dian^hle climatcfi or diseaaes are miwli more 
pn-V]d<fnr, than iii wsirrn «r|uaL>k onv^ i 

TofDpETanK'tit Pierci?4cv4 a markod inHuencc upOD tlie geneiis of 
auml diw*aw, TIk* lymplmtic temix-iiimcnt itt Ryu iu Uirc** 
fourths of the easea of diHcase of the middle ear, and in many of I 
the (^3El<»nial o»e?i. It i» iho ieni|H-ntmtriit of ctttarrhts find hotJi 
thesfilJaw-faoed and tte blooEDing bloade are victimfi of iluies 
from the muraau membranes Trom ulmost inappreciable changes. 

Thi- «qkiigiuiii5oijM ivrxi BlHii'tcd ik'xI iiL Ireqm'ni^, hat adtiltM are 
more subject tlianyoaih"!; the ear di«cnw is frequently pljlegmoD- 
au>^ and violi'ut in iU iiaturi*. titnl t<au.4^ great Hutfering and suow 
danger. 

Thi' m<rvi*ti^ an* j&tlai-lcod in ni<Mbrate numlierA ; Uw diiteutt la 
mild and n;ati!]gtttljlc, thr |mtii>nt« cxa^^^L^mtc thcJr sufieriaga 
ami nirilce ItKiil tnim plaints. 

Tbu bilious siiifer U'juit from Kt-riom dwcaM of the ear : tlier 
irv prone to f^utiueute nnd painlow dUorderA, vhieh advaiKC 
sloivly and scent of little iinportann^, until they Ix^in to dimini^ 
ih*: auditory pow^-r. 

Heredity is another i*aute of dcafncv^, and anml distiu^ can 
oiien be tnu^l throu]^h neveral generations. 

Deafni^i aB^lft the young ruore than the ohl, though ocfa 
|>eriod hafi some dUeaAe^jieculiartoit; it U found in mate^ oHtiiwr 
than in fcinnlo, ovrinf^ to tlmv ^rc-<:itcr expi^jre ; il attacks tfaoM 
of impoverished blood and aiHicted by ^ome dyscrasia ; it occom 
in thcKc dovott^d to a life of greM eerebtul adivtly ai>d, bence^ 



DrAOltOSfg, 



and thos) cxpcACd to the hIiocI» of «m-()ivii% tlic 
Ibul air of mines and ^wer^ the whizzin|if and claDging of nia- 
chiiii'fr Add tools, liiiiJ tht? nKiriiii; uf nrtilkry. 

Among exciting cauaes are: cbiltiog some pert af thp head or 
Dwk, w t>^ a <lmtt or oiprt^uro locnid «ir; chilling; the IkhIv OS 
a «hole, e^pectaJly, alter havmg l»een in a warm room, and, per- 
hujH, (K'tHjjirin^ ; eitililenly cooling the c»r ; irritiiting the mcni^ 
brana t^nipaDi, and shockinjif the apparatus by fiivimmin^ and 
divini; jo *cn!t wflter; the ubuiw of (i>Utoc<; in chewin}^ ami xmok* 
ing ; attacks of toikAilliUs, pharyngitis^ diphtheritic, nasal <«tarTbr 
muin^M, niftid'^, uml Mairlutinji; the intnxlucttoo of foreiga 
bwii«&, and vegetable and animal pra&iieA info (he external moa- 
inn; fltuj imuiDjUte injurii:?*, inmi the di^giii^ with a Imlrpin, lo 
fnicture of thetempoi'al bone. Thrae arc the moet common cz- 
dtora of numi dtsruHt-; tiiitf in mnny inAtiim-ii^, strutnu. the rheu- 
malio aiid gouty dialhfses, or the syphilitic contamination of the 
syMem luvc prepannl tlie can for an explosive intlnmniAtion. 

Diagnosis. — The diag:nofii0 of aural discaw must be Ihim^ upon 
an ]K.-curiiv knovrlc<1g«of ihi; nornml aTi|>v«mnc4» and phyi^io- 
logical af^tion of the auditory apgiaram^, a»d tliis, ao easy of 
ocf^uircment, u» jurt what many physimna ncgk'cL Every oppor- 
tunily fihcHild l>e taken to examine the niuinLrana tynipaoi, ita 
Liolur 3nd niovcnK'ntA during inflation find pljon:ilion, (he jtp)>uir- 
anix^ of the osMcleft if visible, and tlie hue of the middle ear. 
Tbi.* nasi^- pharyngeal apacse, the mmitli of tlie KuHtHcbiiin tubo^ 
and the movemendi of the palato-]>)iar>'n^;eal muK^te^ ^Itouldbe 
atudii^ duM-ly by nMrthod^and iiMtrLinK-nt;« aln^y dcKTilMl. 

When a patient omplainsof some functional disturbance of 
the air, u kouwl^gc q( ilic natural conditions will enuhle on^ to 
determine ynth accuracy the oau.'^, oonAequeikce, leaion, and treat* 
mrnu Without this anulyi^ia of a uuc» trvuloient miiHt be irra- 
tional, UDAcientilic, and Iiafanlous. 

Thi' ^Kithutogy* of ihc ear Ubs Iwen so wcil worked up that a 
Bpeeial volume u re()iiified to eonlain it. Very mu<^ of inesti- 
mable value has been garnered from uninviting 6eldfi hy the 
p^ient labors of iK^viil^^l phyMoians btit 1 dr> not h<^tate to say, 
tbat, in tttwivl directions, the advanc*^ an; uscIcmh aiid ih3iiI- 



THE flUNATT lAn AVD ITS DTSBAStJ. 



rexin^^merc curJOfiitic« of lU^K-nce^ and moDum^nte of a>t»<Hpctit 

BiAtiilo^ bsB been a fafih]orisbl« purmiJt during the past d^ 
oade, Ail wA.t oiioc Uio Stnilh S^ cntx« and rfac Tulip iiumta, and 
th<.»ra|>fu(ic» has l>eeu kit to the dra^gUt's apprcDttoe, and tbt 
foaeJJi^ecl ^ra»dnK>lli<ns of [mHlicirjc. Witli * frw ejcctptions, the 
taknt of liolh scliools has he<?« led ea]4ive hy ihc ctmrin^ of 
m)crcHYi|>ir hij^tology and mcdic&l phyai<«, and the full vnlueof 
mcdidnefl in ihv treiiiiiunt of aumi difleuacs rtniairM ia an unde- 
v<^1o|Hil ftjiie, a rcproat^h to Uie sdieQCO of medicbej and to< 
common humiinity. 

Treatment — The treatijient of ear disease tfonsista in ojr 
nM^'^ua.-^ \vlikh cxpcrieiioe hafi pro\^ to be l>(<j)i]ficial ^ in a 
careful Ufiie of ftudi miHlniintH ev< ix>rreH|»ond in their diaraiclertfttic 
symptoms to ihoee of the disf^sc, and in Huob olhcn u^ «3p«ri- 
ence has proved of vnluo m tlic morbid CL^mUtiouH. 

The paucity odJ unreliability of ear symptoius in our [<itiiD- 
l^eDesBi of medicinal make it imperatively noocwary lo resort 
occanonully to nmfidics, whieh hiive only a dinlca) i«ourd to 
anthorize and iudioate t\\w u^cd. 

A medicine havinj? a prithn|T<.'noi» corres|>onding very nearly] 
with the totality of eooF^titntional pymptoms wwry he tli« very b»t 
rcrmetly ior nn mr afTwlum, Iml f^iuvutly tlie symptonw in the 
aural region constitute nearly the entire totality, and a nvort to-l 
the matma nKdi<<tt will xhow little to w>rr«iiKind, In fiuch csum^ 
I lold it fraudultnt to ignore the importaQl symptom* of the ear, 
and to aWniot and iiw ?t pivtcntiotm and di>oeivinic totality from 
the recorded fancies and fuUiee of inia^imtive prowra. Gar 
diMWs oinnot l>e cur^xl in Ihijt maiHicr, and much liettcr n it to 
rdy upon clinical experience for tin.- tniitmeot of ibe^e c^m^ than 
to vrajtie time in followtni^ Will o'the WiNps into the bogs. Ad- 
)H>ren<^« to the prindpli?!^ of treatment prtwntwl in ihia book will 
enable the physic-iun lo treat aund tlUiuHCTi with a fair mvafiuro 
of succ^As, a» tlio experienoeof manyeminvut uurista has bttn 
xl for a ftnijulntion for my own prwtical eontributioiia. 



cpitc 



my ' 



0I6EASB8 OP tnt KTBBNAL KAft. 



CHAPTER IV. 

D£SRA8K8 OF Tltli RXTfiUXAL EAJl. 

UAlfontiatiotu* — Oing^niUhl^ imiwrftrcl}' fcritied nurtclt^ mre 
exoeediii^ly mrv, und usually accompaay deformitiea af tlie tem- 
pi jrn I Imiiii^ 

XW miHcIv luuy htt euiirely abaent or rcptveeiit^O by a ^lunU 
Dudtilc*, K:\-enil mxluU?*, a Sin\t, u enuiiplul di'MorUtl uiarv*, iiu 
hypertrophied and enlarged appendage, or br »«veral rudimeDiaiy 
isuriclev. Tlie nic*utiw k wmxeimv^ filled hj soft Uwuv, cartUo^ 




llicmcmA Aittt ^Eivotnw or twr Uiutm (.SohvArtu).* 



or h€«ic, l4>nvmg a minute canal or none at all. Over tiie*e the 
tin pikw^ i^iiiriotlily or hIiovts a. tilight iltrpn^Msithn. Amnng 
FBAnny tltouTeinl ras** of ear difi^se. I have seen but one iinfor- 

tniiAttfj fl girl nf »ix yi^irn, wilh tUe ri^Ut nir innifornw^l. Thorn 
tma n Alight vmW of <-nrtilj!g€ rcprcK<^«iting Ibe nDtibrliK, rxtnebar 
rand itpino i>r rh^ holix, w!lh a nodule itrojt^^tiag ouiwardii fmm 

* Tbe PAiiioldgloaJ Aaalom<r of the Kar^ Bj llrnnuiti Soliti'anw, M.D., 
VtttScmot in tlw Upivcnilv of ITjiUc ; TinnflJnC^ by' J. Onko Gii*eu, A-M-, 
^ Jl.n,, Atinl SurfonD. RtuioD City Jfapilal. tiU^ UonghUtn, Osgood A Hik, 
dffViMuft., 18T& Thia da»icfcl trmUH uponaimJ t«lho](ifUr,tnvliLoh 
I undtr oUi^tioQ* for several Ifv^atiful pbloi and valuobLo notn, ought to 
I in iho hbrarj d crctj plij^icioji^ 



t24 



Tltft flUHAN RAH AHD ITS DISSASKS. 



the Ifttter. Tlie lower nod pvrterior portion mcr^i>l gnuitmllvl 
into th<^ neck, and ibe iKviitton of the meatufl waa covered bjr a 
thick tipht skin, which yiohlwl VKty UvU* lo pr(#*ure. Tli« tfh 
penda^ occupied tho u^»rnial p<«ition, tbe rtst of the body iras 
well formed, aik] \his chiM inldligi^nt. 

Defective development cf the auricle usually correspouck with 
nulfuriiiaCi<;:i^of tl)C exttrniul inn»l ami otl»er |)artt of tbe Ctf| 




ami operative mc^tires are advi^hle oiily in very exc^ptiuoal 

Dr. F. H» St^hcll, of Chiciiinuti. Ohio, rej^orte a cow of typc^ 
trttphy of the auricle in a boy, tbe other auricle being of Doroial 




CAn-BAIt OF LD-TANtt l^VPSBTROrilY OV KlOHT AUMCLE (Sch^Uttt). 



mMi, Tliig is so nuv, that I npp^nd the ^ubetaDoe of the Uoctor'a 
report. 



VALFORUATIOKS OK TBI IXTKRITAL HAS. 



126 



i 



" Charite L-, aged five years, prtecnlwl the >«ingiilar deformity 
of difft'rcnt siewJ uiincli*. The It'ft i>inj vuw niiidi tJw liir^r ninl 
tiiioker of die Iwo; was very red atd va«culjir, and boraruc more 
soaiHl pQ&y in cxild w«iitlkcr and aOer manipulailon ; it lo|i[)od 
iver, which made it only the more ootitipiruoLU!. The boy* caJIcd 
le poor litdc M\ovv ' lop «r/ uru) ' iimlcy.' 
A dny or two after the chtldV birth, hi*^ parents n^itit^ed a dif- 
ference ia the lise of the earn, aitd diaooveredj aUo, a couple of 




L 



imore in (he scalp above the lartfer one. The larger one grew 
ipidlyp till at fiva yi^ant^ it y/»» ^i iiich^ lo»g» 2j inehaft widej 
aiul proportionately (hick. 

"The afi)cii>tii4 prtn^titn ha<! roti^iilted tnany phy^ieiaoA and 
aunC^QB^ ^'^*^ 1^^ [x;?wrl4d i*} nil kmln tj( Ui-aUuvni , eiitling, 
biHienng, injeiHiona, setons, ato., which did no giK>d, but ie- 
Itroyed the attoll«ikfliau8clc(4ocounting partly furttii! Inpping), act 



126 



tRB aUUAN BAR AlTt) tTI 



up violent uiltAinifulion mi>i] crysfipeiaSi to which ti$e child baJ 
twice nearly ttHTumUxI, and left the «ur covi^rocl with uiM^Ujr 

*'The littli^ tumors in th««n1pWI btrnextirfHitrfl.bat otbet^ 
yriw, MB mi^hl liive l>wn ex|kedei), lljerc waA do improv»*nii'tit it 
tbv hvjKTrlrophicii or^D. At ihiif ntii^^ oC the cu#e I vr»& oon- 
wiUalf and I decided npan an operation to reduce the rin* of (he 
ftiinelt^, tliouffh witli Mom« nii^vi(ig« on looount of tlie miol^r^ 
aoceof manipuUHoQ prwioai^ly mniiirc^tc-ti. At the firF^r 0|VTn»- 
ttoo, t)ie patii^nt hario^ bcTen chtoMformed, I exceed a |M>tiio(i of 




Ths IlTraiTBonttn> ..;. — ^^ ArTKn tux Ot-eiutiov (ScImU). 

the atirkrle, brought down tlie rim, and Kcured the edges fiimlf 
Md aW'iJiW with li:ilf A diiwn wirr niturc* on mA tide. The 
hi!inoiThft)^e vaa <iuite (wpioiks, but eBsiU L-beck«d bv twuting the 
cut 4iide of Ihv artmc». 

^* I tiAed Calendula wafer for spoaging, and gave Aconite for 
arvarti Haya aOcr ili^ opcralion, Tlw wound benkd promptly 
wirhmif BUppuration, or leaving' any coospicootLs oJcatruc behind. 

" Tbi* wvr afti?/ ro:i)\cr\ Mill U^yki^ ihidc and Mtimpy, awl wkooi 
out loo raucli froio the h«ad, to relieve which* I perTormed a 
aKood o)temtiun. 1 tuade an bd^oa id the cuticle of tlie po^ 



SftTTUKUA or THE AUSICLB. 



H 



tenor ntrAioc of Llie aiinVIc ncnrl/ it» ^-Itotc lengtli, atu) as near 
die title of jaDciion with theaoalp aa |>oHsible< I theo joined tl>e 
two emlft of tfait iii^j^ion with nnothtr inmion^ 4rj)ol>v<in^ un i.-Jlij>- 
lical piece of imegximetit, which was exc-i^. I disa>cted np ibe 
whoh' of liin ioU^imenl of tlje birk of Ihe ear lu far ilh ihc ex- 
tPTMikl liorder, and removed a thick Inyer of dense cellular tisfiiw?, 
Uien t>rDUt{ht lie cut -MirOut^ of ih<; iiiti.'giiimnt (ogvtlicr, iwciiral 
thvfli niiJi .Htitun^i, a|))>hed a ooilon divRsin^ and l>amla^'^ and 
prvecribed Ai»tiilt. The «^oami ht^k-d ii^in very kindly by 
fii>4 inn-ntioii, ami the ^nal n^iilt of ihe fi|>eratbn wan exi't'llt^iit. 
Tlw far was etill mmewliat thicker tliun tli« oth^ one, not quite 
no tmTi^Uirt'tiij but otiierwbie »o nearly like it as not to attnu^ any 

Kecial at lent ion," 
Anot)»^r Binironnation rarely ^een h the exiftence of n f^iniis 
ore or \&s deep, situated ju^l in froot of the tragus, aod cnllal 
GstulA. Ilwy arc n>ere cul-de-jww, tir nmy t»mmuni*Tate with 
t]»e tympanum, and are tJioujcht to result from iion-cIoRiire of the 
firet x'iw.tral cleft of wirly foHal developmt^nt. If thought de- 
urablet they may lie obliterated by caulc^rizinj; the lunieo. 

There are acfiuired deformities of the auricle from faulty ways 

of wearing the luiir, vt^ili*^ lx>iine(fs and m|M, which should be a 

warnint; lo molhent ami d»ctijr?<. I «uw a f^cnllctnan with lan^ 

^^Lutl nuri€le<, whiHi pn>]eftod <)irert]y outwani from tlie niiltt of 

^^ftie headf ffo thai ihe Eiiiterior surfanv looked directly forward. 

' The efiVnt w both frvnl and baek view was very ludicrous. 

The auricles may be made t« stand out more from ihe head 
or lu lie vlo^r to it, by ttiejudicioufl um* of el&siio pr<^ore niul a 
[woper arrangemeut of the head dre^Htiig, during the rarly plastic 
period »f infonry. 

XiTtheina of the Auricle.— Thii9 condition li<« between the 
mddy hue of the anride, which ia said lo r«»ult from a pen*oo'tf 
talking about yoL, and ttiiit of trui^' dTfrmnliti^, and is caunnl by 

HDtild, preaaure, frietion, and injuT^', It i^ a -simple hy|ienemia of 
ttie offfan uicliout pain or swt^'lling. Restoration ta a normal 
flOMliltoii mjty M^n Kurt^^l, rtr it may dev^Iope intii a luon- He- 
riotu afToction, uii eczema or erysipelas. When rt oocnrs upon 
tin* |M«tmor sarfaci' of the auricle, and the rnaiioid, it ntna into 
Intertrigo, which may depend upon local irritation. constitQtioovl 



128 



TDt nvxAy fAft Anv its dissasis. 



ilislurUiuce, or temponry paroeis of Uie cervical eyoipftthcHc 
ganglia. 

Tr&Utn^nL — ^The phvfiiciaD i** rareiy called to treat sut-h & 
trifling unW'tioN ; iUe tVwl ^houK) t>e r<^iil»(eci^ niid ihe [>n)|kOT per* 
forinsnoL- of the vcguUittw ruDctmiisptecureil by appropriate iii«dU 
CAtion. A liootliin^ )ncat applifnlioi] may be required, as 0w«etal* 
moiidoil {OK A'fiiff/^hffr ilafea), ix>ld <.*r«uni (fvi^, ^^wV ilo«cp)or 
([uimy tu!f*t] mucilajii^ {Mueiingo Cydoniij. Apin, Arnica, Arsenic, 
BoIliKloniia, IjicJi(.-«U, I'ulfnlilln, Itlius, and Sulphur fibouM lie 
<:OMi|uir<Hi for iQterual medi<'-acioii. 

Brysipelas of the Auricle. — Eo'sipelas is (ianE^miis when ft 
ocriii^ wtuMil tUv ht".i(\, nml in the niirirlo it i» no i'x<^'ption, as it 
may extend into the raealns and thus reach the brain. It is 
ci»L«oil Uy cold, bil«s and M,in^ of in^tpcL^, tmtimuli<^ injuries 
and exteneion from cxmtipucua tissucft. There are the u^iaJ 
nymptitnu of ehtlf, ft*ver, haulai^ho, imd coiiHiiUiHoiial diHUirlv 
Klicc. The auricle liecomes sTttT, deep-reil, glitning, and swollen ; 
thi're i^ iU'biii); mid btiritin^, with exfnlinrioii of ciitide, and, 
m>m*'times, crops of vcsielee and Fmall bli^^ters. In wvcre cofcs* 
ahi^cajvjfi may form in the KiilK-nlanvotiA i^tllulur li^^ueof thcnu* 
ricJe, aa in die phlegmonous erysipelas of other parta, and the 
pnK niiittf. Ih* evfifjiutf^l early to prevent diHiorlJon of ibe i>t^ii. 
The hearing is generally somcwhnt inij)aired. If the difiease 
extnitU into the miiiil, it may leave a dimnic dermatilLt. If ihe 
membrana tymptiDi und tytnpunum an* invadi'd, no acute i»Aaia- 
mation rcfiult^ in oonjcideruUc d^iniuge to llic auditory a|>jiarattn, 
an<l it iH not willimit dan^r 1o tlie bruin, 

Tr^menl — The patient jdiould have good nourishing food; a 
Tn(ulf*rilr quniility of wlrut, if intic-Ti diprisMvl, und \it ki'jil <\au!i 
and nimfortable. Notwithstanding the xrurning of 60me aulbors 
Against rob) applioaiionA to the mr, I vroiild rn?nnmii>nd tin mr* 
ployment of cold filipprry plm {fHrntig/ufun eftnfnm) |xiu1tk«A 
ia ihr aufliUiry region ill ery^ipeW^ m ihe mam sa>n bi*o(ira(« 
warm ; hut the n^t^atiis should be rhiwd by cotton. If the eold 
|M)ii]liiM^> 4iiUT«es more ihim inomL-ntJiry cJiillinew, apply a warm 
one, Rnd iviit^w it iw oOeu as nettf^mr^' lo kvt*p tlw auricle moMl 
and cMtmforiable, 

Another applicnlron that biu; proved beneficial u the bli»e*4?lay 



KRTSTPBLAS Of TUB AURrctB. 



129 



drettiog of Dr. Hev^ton. O>oimoii blue nlnv 114 Ivkcil in an 
ov^), {Hilvumvvl, ami piuwod through a fine sicv«. Make a md 

.pultaoeous mu<l of rliJA by^lirring iii wiiC4>r, HpmKi it upon mlrijw 
ftf miMlin, and apply all around and over the auride. U^new 
the drcoiDg a8 oft^n m it U^eomt^ drv. I hnvo mmtii tldit uppli- 
cation have wcnd?rfully f^ixKl cflivt«, not only in erysipelas, but 
in many otli^r iTuLanKHi-4 di^atter^ dtiriDg my u-nlks willi the dis- 
tinjiTuinhtd mrgCDo in tlw PcDTisylvania ]i<wpital. Wh^i ihc 

' dnasiogn are renewed, lUf^ pom ntumld Ik' wm«h^<d wh)i lA^arm 

Iter, and Htc mcali^s cai^fully cWnoJ of foreign pjirticlc^ 

Bnau few ottsea vrill uot tolerare lliese dreftrJiiii^ but are im- 

l^rovod by Oi€ applioition of cold ox»m, or by du^tting wilh Giie 

starch. Every i»ae ia a law inito it^lf. It an alMoc^ f<>fm§, 

it should be opened froi-lvi cak bein^ excrrtHxl not to out the 

jrieular canilajff. 

Th«>« arc do f;pociuI v^ymptoni^ t\\nm\ rry«i]>vlaj^ of the aiinele 
to cult for a dtfTerent treatment, than for the di^ieafte elwwhere. 
If it occurs with ht'aduc*ht at the cliniac^^Tic, Apia and LiK*h^t« 
may prove vaUiahle. Apn is indicated hy i^lmrp {lainH nnd 
oedema. Aoooiie is Romeiimefl appropmle in the *arly staj^?*, 
b«it lk*IIudonna uii&i ino^l I'W^ UUtrr, An«cnicum, liliui^, uik] 
Salphur are aoionf; the raoei valuable remedies^ and Brvouia, 
Ciadtona, Ferrum, Graphitof, llAj>arp Pulsatilla, and Phiifphonin 
ait oocaaionally indicated. The action of Apts and Rhus Sa some- 
ticnes very gmiifving, 

Wlien the erymfielatoua inflammation eiteade into the auditory 

^Onnul or the tym]jamim, other mrjuKiirts nmy becomi> ncct^rairy. 
Pain should be combatlod by syringing; the ear t^ntly wilh hot 
waU^r for ^me tinie, and hy inrtalin^ tlie middh ear with the 
ajr-bs^. Tbe canal mtiit be kept clrar of pns, cnit»t», and «cale», 
and the dressings may extend into it. 

It may be Decenary t'> \\kvk the wfl ti?«ues of the cnnal, to 
el»evfi tetrion and evacuate pus, EfTuaiim in flie middle («r 
may rail for panus^'ntef^l^ of the mi^mhrane uad othfr prcR^ecdini^, 
de^Ttlted under m-iitt? inflaninuirton of ibe lympannni. In ery- 

^8)pula.s it is dcsimbk: to be vtry goii^^rvative in surgical «>iteTO- 



lao 



TBI RtTHAK lAH iVD 1TB DISfiABSfl. 



Frost Bittea Aarlcles. — T\n' atiridcs y^ fnism Tn^ocntlf in 
oiir Korthi^rn latitml^^, aiul inuHt lie tn^itetl lurefully to svutd 
upbacduff. The}- sn- [)ak% ^tift', L<ot(l, anU iiu(piisilil«r mid tlic 
{Ktiieiit nmv init at Cntt lie cutLStiuuH (here ia anyllnii^ tti« oiativr 
with hi» ciarv. The |Hithofi.vi(»1 4M>n()Jtioci vorJui with iJto nc- 
veritr of the freeKiDg, from d^Tfuatitb lo gangrene and eloughln^, 

JVra/ffwvrf- — Thij Auricle i^Jtoiild bo ruhlird gmtlr wilh ioe- 
vmter, and thtrn ihr U-tn|K*nLiiirc ^tf tlw mtUT gnduiiDy nu«4.<d 
until warm, and Ihe partri become rhawexL Then ii)>p1y a lotion 
of carbonutc of iKoditini (.Sof/u bityirbona^if ,%#. to A pint of water, 
for a few hnui^, and give Aconite for a lime, Spirits of cam- 
pln>r (tS/rfM. C<Tmj)fionr), tnay In* applitil Hi ih« utir]<4u aUniL tlir» 
tiioc^ at interval of tu^veral houtr, and tlu^a the i>am paioiiid 
with tincture ^f lienzoin (TV. Baxiaini), 

If there is M'ven* pain^ifelludonna may be neeful. If vmcloi 
form, and )Ktrliori^ of the pinim look |>tir;>le fttid ^lou^b, ihc part« 
ttlioiild be covered) by vuwUne ointment on ioA liaen^ ami Arwn* 
ioum or RIhih giv(tn iiiternally, Xilric a*^id tn wrviix^blc when 
thcF^kin t»fla[ue&,cnick#, and bleeiJe, ehowiiig ita itapaired vituiitr. 
A|^neii» i» «hid to nrlit^ve itchiog, and cnru the dry Acaly condi- 
tion of ihe rhn>i)ic sta^e. 

Other symptomi4 mu^t b? m«t nccordinjf to (renenil pnneiides. 
Sotnetiintd t^niluginoii^ nodulefl form in the pinna, along vith 
new <*nrtila^, and are qiiiti; »Mwitive to the toudi. When gtD- 
grene aupervetif^ elimvual |>oii]nt¥A and surgical operatiood jnay 
be nccQMiry. In order Ui dimfni^li the AenMbility of the froMd 
car to coMj it L^ reeommendetj to bathe it daily, during the Mtm- 
ttier^ in a ■Miluri'm of jilrini {Ahtmnt), 5w- to A plot of water. 

Eczema of the Auricle. — This is a common dtawawe of tbff 
aiiin, and ism^n ocoa>ibnhJly in the au^d4^nnd nieatuft, where its 
app<^nince nnd course arc somewhat modified, ItMiwen iDoet 
frequently in chlLdre-n atui femnU^; in ihoFv 8utlerii% from gea- 
ernl debility, faulty mitrition, and innervation, and havini; a 
fttrumo]]»« dJalhfttiA. Among tJtDtk* thin, jiaJe, hatf-friini^hed chil- 
dren of the |x>or, who lilt our hunlcM alleyi^ un<l ('luwdi'd ttu^ 
ments, thediAeaae h mo^t prifvaient; but indolent and overfed 
pcracna living ia hjxury art liable to attacks from irritatmn of 
the djme^cary cnnal, and »ubjc«tioa to local injuria, Socne 



BCtKMA OV TUB AUItTCLI. 



131 



writers ibink metif^tnial dbordere, and the upproadi of tbe dmiio- 
pcin=*c are po4i*&t prc<lispofing cnaf^cs. 

The exciting cau^e^ of the atlectron in the aiiriok arc: too 
warm covering; unolc<»nliiJi.-»r4; rubbing^^ratchmg or picking the 
menlUH; and tmtig irritating reni«die8 for €iir-ach«. 

Acute attacks bc^in with h^t, r^nos, a harniog sensation, 
itcbing, omJ swelling. The inJlammatiim i^preufU slowly, ami may 
pan down the canul to the tympanum, and even along the Kua* 
tachiaii luhe to the throat, where Ita chftraii^r liet'omai changed. 

All i-niption of v^iclov fM>on ap]xnrA ii|)on the aurick ; i\w^ 
break early and pour nut tlieir Alieky conrenLs over thi> itiirface, 
whiMX' it (Irks und forms un^]p;htly <calc5 and cni^w. If a cTU«t 
IB reinovtfl, the surface l>enealh will be moj.ft, raw, and ooven^d 
wHh bIwKly wro-puR, und tliiA condition distfnguttth«f eczema 
from many other skin diseases. 

A» the dttwi«? lulvjirKt^, the vru^U hronk and scrum i* poured 
out freely to thicken th(? dingnsting covering, whioh shows deep 
cmvk^orel^ fridion and iic<?]derit nil> themofT and laircji niw, 
w»t fiurfan; witJi l.>I(Mxly points. We must lie careful to disclose 
th\^ c^mditioii from Hvphili#, which it itouiewliat rOHMnhlcs. 

Tti« aurkie ufun its anterior surface is very richly supplied 
witJk MidnriferouA glandit, and here the eczema ]» always more 
nicculi-nt and ^^verc. 

TIw po&terior ftiirface of the auricle is liable to aflect the con- 
ttjplDtHf aurfac« of the mastoid l.>y friction anil c^»ntnct of the dot* 
eharg^, the ekin becomes raw, and, unless groat eare he exeroi:^ 
tn keep the |)orla ee[MLnited by a cloth or powder, the two iturfaccA 
will tinite. I o|>emti^ n{Km a caw of this kind in a little girl, 
in 1^79, where tlic Httachmcnt was so complete, that there was 
merely a trace of a i^uUni^ t>etween the helix and the Ai<le of the 
brad. 

^Vlien eczema auritt has become chronic, the pinna ifl stid", thick, 
at»d miHf>fliupcn from variouH cicatricua, and hyfwrtrophy of tite 
fibrow tiasue. 

ShouM tlie disease extend into the imditory canal, Ihf inflam- 
luaitfry aymptoms will l>e more decided. Tbe skin of the canal 
isr^ddeofd^thc periphery of themcinhrana tympani and bonlers 
of tlie manitl>rium of tlie malleus show iacreased vmscularitj,aDd 



132 



TRB HUUAK BAR AKD ITS mBSAftB«. 



liiinitti«, tttiil slight cli»fti-.<Kt cn«iie. The epkiifTmiii of the {ittrti 
18 rapi^lly foroml, i^levateil iii veiidei, ami exfoliaiMl; tlte rate 
of tlir nUiij, jiml tilt- pvrlo»U'iim <»veTiri^ the bone aiv ihivki?flo], 
aotl dermatitis blemla with |)eriodlili4. The epidtruklc «elti aoou- 
ituiluK? in till* mnitl, (lio unlli* hiv rcivmil l\v nJirwU and Msbv 
Uic m^mbfuiK beoomefidiriy whit« and opaque, and the exvda- 
ti<in of Mvriim oonv^rtj* tliu d&bri« intc a rht'C^fy feCicI nukiB<, wbicfa 
gradually iltle the whole passage, and does eonslderable dam^^ 
If not reii>»vix) fri-qiieiirly. 

The tympanum byaipathiEra by hypenemia and pain vnth the 
contiguous d>!Mxi^e ; the membrane may niptiire^ tnd lii^ Inflitik* 
matTon c-ileDd to the middle ear, Ku^taehiaQ tube, atid pharynx. 
Fornimitely (1h*j*C' couipli^iili^tikj^ of (ht; auricular dii^iiM are tare. 

Trratm^ti-, — ^The h^^iaie of ihe ]iatieiit must be repilatcd, and 
any errt^rn of <li**t <*<)rrtvt*HL Thi' fin*! siKHild be light and «s8il]r, 
djgi-9<i«ci, and acid fruite will pmvo salutary. 

In the ncuU' ^^»)£*\ r}itj']>artH chfuild bf^ boihed with warm water 
and wrap|Hil in ootton. When the pari* bcixwne mi»4t and cico 
riated, remove the eru?<tt< by pitrkiiig. and wa^hin^ with warn 
water, or apply a flaiiteetl poultice. Then bathe in diluted tar 
water {Aqun PiciH ti^ithK); ia u MtlutioD nf borax {Soiiii hi- 
bor<u), 5ij to a pint of water, or in one of German gr^en «oap 
{Sapn viruiu)t %■«. to the [uriL 

Should tlfese meaaurea fail to ameliorate, or should tkere bean 
escesxivc exudnliou of serum, niakinp; the Aidt; of the hmd flitliy, 
in apileof lilt careexerx'-i-.e<J; ii will be beneficial to dii«t over the 
parUi with ii powder uf one jiuTt of oxide of »nc (/rnW arnJtun) 
to seven of line starch or powdered rice [Orjfia), Lotjons of tatd 
th-nter, dihik*d tiuclure of arnica, diluted tiiielLire of <!imtlhuridcd^ 
Bolutiona of curbonaU of potanium or aodiuin ; glyotTinc, oud- 
liver oil, castor oil, vaseline, and oxide of zinc oinlroeiit ha 
bceii extolled by difTorent uutliore. 1 have u«cd tar water, vna^ 
line, and the nnc ointment in ohritinate cnsed with mucit Falisfac- 
t4i>n,buL I prefer the llewnori earlb drtssing lo all other (.'Xteri 
appbcationfi. Clinical ex]jerience proves, that v^ry many 
are made wor*e by o|i.^ginou;( pre|mniticjni4. 

In a very sovere caae, in the practioe of Dr. L. U. Willanl, of 
Allegheny City, Pm,, wh<Te the di«ca8e covered Ib^ tide of the 



: 



IkoiI a»H n^k, after maoj; ejclemal and ifilerDal remedies hod 
faiUif to im|>ruve tli« i<oD(lilioii» a vc^luliofi r>r riitraU of silver 
{Arffent nitfos gr X, Atjwjt dfitU f.^l, was pCRcilled over llie 
inw surface every day^ and brought ubout u »pi%<ly <;un\ This 
experkaoe accnrda with that of Dr Knapp. of New York Cil/^ 
vlio hii« reported a M*VL*re o»»c cured wiih tli« silver ftoluliou^ 
and extole it above every other r^moily. 

WltntcYCT ist ilonc externally, the intcnial treatment rriiijit b« 
penisteut and ihomu^h. Aconite, Apiw, IJcllaiJtmna, Caotharis, 
or Khus vill suit acute Tt^ymptoms of ix;rt^4iii cwr%, Coniura te 
excellent for women with chronic eceema and mensirual diffiouU 
tics. In iny practice, Arwnioum, Cak^nn'n phm., Gniphi(<?«, 
Hepar, Memirius, lihuA, and Sulphur have been hencHcial and 
often eiinUive iit approprinle cose-*, OHier nnxlHiim^ vtov\\\ look- 
ing up are, Croton tigMCalcarra carb., Iria vers., Iodine, Kali 
hydnod., Lycopodium, Muriatic add, Petroleum, und Pulitarilli, 

When tlic dtj^eaee extends into the auditory canal^ the diiily 
attention of the phyAicsan ja necessary to remove the cnjstAand 
dirt by MTin^tn^ and the um of jrL-<1ruinent»^ in order^ to relieve 
from irrirntiiin, nii<l(h(?oliAtruclioii tohearin}r, Tlmwiirni douche 
will ullaytlieitchinj^ and inflaniniHtion,And^i(tnld lieu^l^eveml 
times a day. Pii»b :i htrip of elolb wtt with ^dynfrine and water, 
oramearevl with vii,-^elinc or /iu^ ointuivnl^ a lillle wviy into the 
canuir to wothe the raw (nurfuce. If tlie ulfectioii eiteods deeper, 
Iheeonplicalioaimu^t t>e treated aoxjrdingto principles laid down 
elm where. 

Skin Diaeaaes. — The external ear i» ftuhji^'t to voHous other 
akin di«t«H>L Pemphitrui;, Herpes, and syphilitic Roseola are 
fri<quent, and 0«>ndyloniAtu of the uudilon,- meatus have been 
seen occasionally. I had a case of flyphilitic Paoriasia upon the 
outer aurCuoe of the auricle of a woman, which diMipiR^an^l after 
a ooonie of M«rcuriiLA oorro^i^'ue. Thef;« affet'tionfi should he 
traUnl by the ap|>n>pri3ii<:^ moliun^^, ii« ibcy arp wh-^n !?>ei'n in 
otbcr pait» of the body, and complicatioat^ m[?t by tlie ueuat 
mcwures. One should be excee<lin^ly oareful to cl«inM* instru- 
ments in hot carbolixcd water> after dnauns any purulent ear 
dbttae. 



m 



TBS DUUAV 8AR A!tD 1T8 DTSVASVS, 



PonuicUs. — t'ircumscriliecl inflammations of the fiubcutanvooi 
of-'llular riAGue of theauricleorcanalareclenaminatedboik Tfiev 
Arc tbtmlJy iiidicniivv of improper <lict, :md imfM-tiict Amiaiila- 
tion. Th^y occur tipou the auricle or in the cartilaginoufi portion 
of llio mnul, i;|Mi[> tho pi^^trrior uixJ aiiUrrior wnlJs; flonwtinoi 
one follows another in rapd Huoofwion, and Bo-callGd epidemks 
have Jw-cii nxxmlttl. Thtr arc trc^wcntlv I'lciUyl hy ]ju» ("oiniDg 
from middle car 4i^a^, and by astringent and irritatiii; wssto^ 
and arc occywionni o<.implk*jition!* of w^'wiii. 

The mo^t common kind met with io pruictice are smalt, hnri, 
red, and painful, os[>ecijLtly, if ihrv ocrnjr in llie maal The |«iiti 
isdull, with oiK^onal throbbing^ uud eharpclartint^^atid is made 
worse hj moving tlii' niiride luiil {hit U)veer jaw. Tlie tuusotv 
riptfli slowly, ami tony undergo mtolntion by abAirptton; but 
iisunlly tbey form a dtill ^ray »}>ex, break and disehar^ pii.^ and 
mcrlilicd cellular tiuetiu adicd a core; they dMppuir witb<»ut 
leaving mtK'h r.racv. Others tire hir^^, faiifte coDHdcmble iiwrll- ^ 
iDg and gnm piiin, and destroy ihe symmetry of tlic parlf. ^H 

Thoy may 1>e <li>tinguiiilK<<l from uej«teotj» tumors by tW acuU ^ 
symptoois, the location^ and rapid iucreafie m size. Sometiow* 
the membrana tympiini be(x»nie^ vm- nxl and Awolkn, but the 
hit^ory will diiroronfirtt^ thw from idiopathic myrmpitK 

Upon the auricle, furunolef^ are mana^iblefbiji in the cnrultliey 
often clorte the 0{ivuiiig, in<lu(*e dmfnt^^ and noisiw, cause srmpa* 
thctic swell log tn thv tir^nes and ^ImuU outride, ajxl are tccotopt- 
nR^I by lt>ng, heavy, lulling pain. There i^ f^nuc fi^brile reootioit, 
and tliere may t)e heafla^^he and gmv« cerel^ml dittfnrtnncc t 
have knowD t^wt^I ling just tnfiide tbem'jatiis lo close it, a furuude 
to break tmide tliiis and the coufimtl pm lo prt.^ iiiwardu upon 
the mcmbnuia tympani, so that ^ven; pain, tinnittis, and vertigo 
jwrtiAied, in spite of Ihe uitc of hot douches and poullicen, at^ 
tcniptM to dilate thfr vtii\a.\f active inflation, and the admin^itm* 
tioii of Aconite, Bdliulonna, und HejiiLr. A frvc inciNion of the 
canal over the seat of the phlegmon relieved greatly, and Kali hj- 
drfiML brriu^ht alxitit n i'UrOt tSimist^ E^om^tinuTt nrnjain in t)i47 wall 
of the c»oalj uud gTaniilationfi apring up at tlte opening and 6, 
polypi, 

TrmtmcnL — Belladonna almrts boils if eiveo early, T 
th«dn Willi a drop of pure Carbolic acid often duci tbe fiUOfe 



: 



IRDHOtH. 



135 



Hi'fKir will »metiiiKK tvpcirtiRi a ibrralene<i hvelling, or failing 
in i\m, y/iiU jjnmiitte ri|ki-jiiri^. MiTrnry tH eimIuI for v«ry hArd 
i*liii;^Fil) '(Vrdling ^ith ci iTi^derable |min. 3ili(?ea mav bf needed 
later. Cirbo \t^> ia valuat>lv in gnw« Imbit of boil/ vrilh glul- 
tiiuy. 

A pQuUi«eofl1axAeedmeil(/fiTi»*/crnn<i(Htk(Ki]cI be nppliod over 
ibc nuricJo wbea il aloD€ba0^ted,a»da conkal (XfuUtoe mclcith 
piudwd Id Uiemiiftl, iT iJiecwnal l» th«:scut of tlic i«wdliiig. In 
dllt«rcsDe, tiw whole aural i^ion may be eovend with a pcHiltioe, 
wi tlie danger of injuring the mi^mbniaa tympaiii, or promoting 
thv formation of pr>lypi by their it^e h exaggemtet). I Imve eui* 
plo^eil ibem for six or *ov?n <Ja}» logctlieff and have oover yet 
M!n fi loetnbraae iojured, nor a polypus fwnied by their use. 
Warm doudi«s are v<^ry agrx^eable, and dc3in'!>in^ the cwial wkh 
OOllon on ihe tioldcr, if th^rre in clirfolmrge, may l>e neoesaary. The 
pus Duiat not be permitkHl to reiiiiiiu dnp in the canul and u[»>n 
ibv iMtnibr&ae^ btil all tlie while ahrcda and epi<]ernite acalca mtwt 

Flo, 00. 




ifc.^t>*«*v-il- 



b« ol«ai«d ODt daily. Stttuning th(> eur %n a protentioufi and 
Crottbloome way of applying heat and nioisttitY, but is cx<x-lli'nt 
irhcn tlic patk'iit ia ni>r%-oui<r and the \mn is violent and deep 
within the eir. A pl«ljfi>t of cottQD wet with glycerine ami 
pushtxl in tlw mcutUM will fn^^tiently allay aevert |«in from a 
boil in the canal. 

If it in (K^viible Ui d^«rniino Ihe uodule of infarction, and it 
h bdolent, and will not yield to mcdbinw* in a miwnuble time, 
I iliink it good practice to split it entirtOy through with a curved 
Irialotiry or funincl^ knife, when it will dir^appear promptly; the 
parts should 1>e ilhiniionted ^x.41 by the? hmt iiiirrir during the 
ojttnitiou. The pain from the eutiiuj; i^ endurable, it doee not 
lafit long, and is moru than compeniuited by the relief from die 
dayj^ of nariiag a troubleeouie cuf^oiuer. The bleeding and con- 



ise 



TBI aUUAH BAR IKD ITS DISBASBS, 



iiei|iiciil relief uf the <H>t)gt»liuu ttfleii |)n?^~«c1t Ui« uoctirreiicv of 

irUii* Airunck- is opeiml vhea ite apex iftfurmcdr or il bnvkii 
B|X»nUiueouAl}r, k h welt to aifueeiae out Uie |>u^ and core of ili« 
gdLi^rx-iHiuHcellulur tissue. d|Mi)UumMi« ru|»turc of » furuude 
and (lii^liarge of puti does noi aLwa/5 relieve (wm. It is thc« 
utlvimbk to mukc an mdsion tliroiigli the Hwdling down tii tlit 
cartilLi^ and lH>iie, iu order to ioaure relief from prcwiire, and i 
free tli^'hargo. 

When there are syroptonw of deejwr tKHible. irfiatioti mu«i he 
practicoil once or imix ft day. Tfii» ^iii-ndly dLnaipjiears aitet 
the f^ubtfidenn; of the faruncolar inttamiimtion. 

Aconite and Bttlladniiin arc rM?<|U<futly iiidiniletl earlj ; Hepoi 
ifl m prince among remedies for theae pest?. Arnicft has tJtc npu* 
talion of lirealciiig up tUr funiiK-ular diAltiv^iH. ArseDic, Nitric 
add, Sulphur,and l'ho8phorur acid are I'ecfimmL-nded for tbo Amc 
|>urpo«r. Gninulations sometimes form at the twat of the funin- 
cte, and should lie louirhed with a ^iilutton of niintte of silver, 
X gr». to an uunw of water; a mercurial ointment {H^tmrtf, 
Mid. n(6. gr, x^' Vng, Vasdmis J^) is a good applicnU'>ii to 
gmnuiaiiond. A eour% of aalphuroai or alkaline baths iriU be 
agn-cjble, and of excellent hygienic value. 

Antlirax. — Anlhi^x, or uirhancle, ^luettmes forma id the au- 
ditory- mi-ntuAf oiuM^ terrible suBcring, cndan^^ore lY\4i integrity 
of chc hctLringr and ihreatenK life itself. It consists of a thicks 
bc^g^' swelling of the ^kiu and a^Nulnr timut.% imding iu S|)Iih- 
oeiua of connective ti^^ue, and dift'u^^ oljettnale aliee:>e9. It 
appears as u very pninful bluish swdlin^, which eatendd later- 
ally, with uo etlort towards a conical elevation as la a fumncte. 
There is considcnible coriHtiCulioiial di«ttirl)unre, indicattnl by 
fever^ rfsilemneHs, anxiety, and dcpn««ioD. The dm«jw i» n sign 
of depraved bloocl and loweml vitality^ and ttje adynamia of the 
palieat will enable one to diagnose it, when il oceunt in the audi- 
tory mcatm, more than the local Hyinj>tr>ni», whieh at 6r»t cuh 
not be di^tinguiAhed from th<»e of furnnete. 

The swelling bvcom<« greater, the pain terrtfie, tlie auditory 
meatus eloiied solidly, and delirium with grave cerebral »ymptoii» 
occtira. The enbcutaneoua tionne<!tive tJTMxe uudergoet^ spliacdm, 



AVTBItiX. 



137 



owing (o [lie (W^rivatioo of iiutrithfii hy llie viuleucv v( llie exu* 
dati^ui, iipobf i& tlic »kiii gtv<! vniy frtkrii tVio ^iiitr (-jiiinc*-, mal |hi» 
F«»rapc9 from Mrvcml ojMrniikg^ Tlw di^tlmr^ ui' ptirult'iit muiier, 
bloul. and nilml^ of dcriil cimnncrtivc t»?ctur g<H» oP j«lug^»li]y| 
an[il iIk' tL'jtfiiori [•* nrlit-VLHl, the bi)Liii<l»neH of ihtr lulurctioa are 
n^i^)i an»J n^ioRii t^'oiiMitmiijnsd vigor i*t"j*^ iJir ik^nicttoci. 

IVfotmcHl* — The early fta)£e» of auUmix are »o Minilar lo tliooe 
of funiiiclc, ihiil ihc ttx^itiiimt ixxi^iiiimnultd fiir llir laUi-r ullVir- 
ljf>ii Bijoiild be flm cmplorcnL The aunil region j^Jiould he kept 
CD\'<^rD(l by a ^'nrm l!nx>cxnl |)iitiltjc<% hut a htft Imji jMiuUice 
(7/vmii/iM) salLtrateil witb taudanuni (7r, f>/«j) *h*Hild be «ul»- 
AiiEtitc^l vfh>m tUv }Kiin IH >evcr<'- The s(n.Mi<;[.b (^IkhiIlI 1x- itULiii* 
taineii b)' ilie moHi uutritious fintd, aiid fn'queul dosca of milk 
panch. 

Hie centre of th« ^urellin^ U bumed out witb oiuslic potaj^- 
9t\um\I*tta«triih^iJra«f by jfOtMc practi lionets; othe[>i rcoonimcnd 
hy)x>cli'miic injeelloa^ into tbe luoioni of n iialmioii nf carlvilic 
a<N<i (.4cw/«m GtrMieum), ^r^. x to an oun^^e of water. Two 
Of nh>re deep ind>iioii^ thnnij^h liiv niffclling jdioubJ )>e ma<)e 
parallel and aloh}^ tbe auiLitr>ry CArinl, free bleeibn^ encouraged 
by wu4jin|^ tlv- [)firt» in wirm wnter, nnd a |)OiiU)ce th<TU apjilKHl. 
^Other iatnaiunA iii^ht to be made, if ibe Hnit cIimo up, and tlio 
iyaipUinir^ gron' more vioknl, »n<l tlic region i^lionld lu Jrts|Liently 
twaahed with warm water. 

AoLiniU'r Uelludomia, or llrrpar »ulph. rale, are a^^ftd early in 
Ii0 disease. ArH^iciim i^ a valuable remedv, partinilarly, in 
OLMM rtuirarlirrix^l by i^evert* |>ur>xv'snial pain and uetlienia. Apia 
and Lacbesis are lii^bly taiideti by goine pnuHlfinm-rs. Nitric 
acid a conNdi.Ti*fl a ){i^jd iiK^diritic for tbe uticciion. Ph«wph«irae 
and tiecale cnm. are recommetided when grave <)orcbnd ^'mptoma 
bSij|H'r\'eiie itirly in llie «tt£iek. Carlirr vej;., McTC^unms ami Sili<xii 
have lh*ir advocate. CinWiona or Qiiinia sulph, may tie ad- 
iDifii«4oretl to tbe ilepre«#^-J and feci>b\ itnd Ferrum pliuH. jh Uitb 
nutritive aitd MimuUtiiig to Mtdi [Mitients. 

Ic may Im neoi^wary to {;ive tlw |alu*ii( a fow dvi^« of Mnrpbia 

(Xttrphite nJptiaa), if lite pain is violent, and do»i not yield to 

tJio iKbt-r miawMrva. Chbml iOthntt ftydrntr) U nihtr pri'lVr- 

LAbte lo Moqibta, wlien there ia aineh cerebral <H>ii|i:f?(tion, and il 



13S 



TDR nOMA5 SAH i5D ITS DISBASBB. 



niJiT bv af)mini«loiT4l to an adult in x grain c]o«(«, ^v€ry honr, till 
ivlier f*iiDK^ If fh4' infliiTiimHfion rxu^iils ir> ib<r Ivnijianiirn. 
tlieooiupUcationsBJiould be treated according ta directions gtrea 

Abscess. — Inflafnmatory aB^iona about the ear result fre- 
qiKiitly in ulwi'©*. Diw-ivte of tlu' tympiimini or tif tJie mn^otd 
cellfs tr^u^Dily catlaps an iibeceat behind Ibe auricle, rall«l [K»t 
anrU'ulur hImi-c^s* Tbix stoinKim^ 1>on>ine» ha large n^ n |it|re<}D'd 
eg}-, aiKl nukkes tb« turiek etand out at ft ngbl angle to tJie Me 
of \hi- bind. 

Tlie glands in front and below ibe ^r become AwoMen sjmI 
tender, dnrin^ aiinil and tlirmtt diM.iiseSf aEid ^>nie4iii>es at^fbeQ 
and fonn al^ofm. When in front of the auriofE:, tliey are aeldoo 
Hi^rtou^. A very formidabk nb«v«f occiire ix<«aj<rf>n&lly bfoealh 
tbft stertKi-cleido-masl<*id muw^te, t>elow lh« tuaMoid, eitlier fmm 
intillraluin of |*u»* fnnii ii curioii^t ti-'ingioral boDC, or fruni obrtnK^ 
tion of the lua^loid Vein outside ibe skull, in llie flttsloid, or at 
it^ entrance iuU\ i\w liitrml hieiii^ in (lif> laU«r ercdit, the wliola 
»idi' of the nci'k beoonies swollen, bc^gy, and bard, and ^rsve 
CEMiHlitulioiiHl stymiit^^mTi coexist. 

In a ease which I raw id consultation witb Dr. H. W. Kulton, 
dI' Piltsbui^b, Ph.. there Imd bcon a mild iicut« iaHnmmatiOD of 
the 1vm])ciniim with dinchjir^ <d' jms, and ioon aftertnLnk the 
net'k U'gan to »vclL The Indy Imd tiiid irurefnl nursing and 
n>ni^iitr;d<nl i^fiuri^limenl, and poulticea and ll*e api»ni|>mtv 
nic^lkino bad Ua*u ^■nj()lo}(.'<r The pulwr wai< rapid aiid fceUe, 
theskmnild and clammy, 8j>petite lort^and mit^d dc<4fK>i>d«iil; 
thtre wi\» II little \*U9 in thr niealiw, f>nt nr> oWtnirtion to its ikiw 
ouiwartlr^, and no signs of mastoid disease except the dwelling 
below; tlie ivliok fiiAv of the nec-k fdt like a pieiv of bacon, 
deiL-^r, thick, and don>-ly. The patient was eo a%ak she could 
not sit up long, and suireretl from ei^^-ene h^tidaiTlie and v^niga 
P'lik'luation cx)iihl not \k detected witlj certainty, but an inciaioa 
wa^ imperatively demanded. 

The patient wik ^ivcn an aAiEstl]Ctic,acut t\ix} luchas long and 
one and a half inches deep was loade down to the nuutfind pro- 
ce^ anil, yet, no piu< Tlierv wa» no muntoid diaeaflo at all. 
Fevliag certain there was matter below, the inetdHUi ws» made a 



AB80SS3. 



189 



little doepcr, just bclnn- ihe point of Iht^ ma»toKt/and itt lost 
half A cupr'ul of pus came welling up from the muaouTar inter- 
npftCMoflhc neck, Tlicwomuii rocovcn.^ mpiilly with Ciiii-bonfl, 
milk puucb, ADtl gnod diet. Thiti aa»e oorre»poiidfl nilh fi^itoe 
CUM d«#crjbul in Xhv Archives of <Jiofofftf^ and wa8 uiidoiiljtcdly 
an instance of oocht-^ion of the masioid vein, i'vom pressure in th€ 
tniMtoul procr9«, or nlij^bt otjatruL'tion in the latt:ral Hinua from a 
throinhn^ 

Ti-^ftimaU.—A patient riifTerm^ from an al)«!!€afl fa in health 
beluw |mr, Eind mnsl be fed well nnd^ [>crhHpN. «tlmuhited souw- 
what by good wine and milk piinoli. Apply warm pnnltloes 
over the sM'eliinjj frequently, and wWn the pre»rn<^ of pm k 
diA^DObcd certainly, let it out by a free inci§ion. The preaffiDce 
of pm mny be tleeidnl in doubtful (si^teH hy pnnetiiring the swell* 
inj^ with a hypodermic netdk, and atlemptiog to withdmw w^me 
ill the iiiyriiij^-. Wljen a ht^ [xist-auriimlar ahi«eeHH tik evacuated, 
it in perfectly astonifjiiii}^ what a hanUwalletl, cupped deprcmiou 

knsullA. A(Ut sttfli an operation when 1 wiifiyuuu^rj I feared 

" the wboI« mastoid pnjcess wm gone, 

AlMoiwe» alK>ut tlic ejir nn- j^'uvrally compHcatioM of ear and 
thrtmt diseo^iai, and the medicine must be Aeleeted ac<eording to 

Lthe totality of pymptoin?(. Th!^ ainnot always be done, Ws^ati^ae 

Peettain ear symptoms may lie aWnt in a pathogenesis, tbnt other- 
wise fits the ca«c well. A patient may be taking Mer^uriuff or 
Pulivililb, for a middle ear atleclion, when the tiwellin^ begins. 
If the latter itt aocompoiniul by fymptoms which ovop^liailow 
Iboae of the ear, follow their indications and the charaderiiitic 
symptonu of general di^turbunet^ in prefiTciKM.' to the aaml onea, 
F^ symplofna may call for Calcnrea cnrh., yel, the mperven- 
tioci of a pidu^mon with heat, redncw, thrffbhinf;, and jmin^ ac- 
companicd by full, strong pulae, tlirobbinic carotids, red face, 
l^li^ti^rnn^ cy^, ntvl »e\-erti htwlacbt; will indiuite Belluilouna. 

Belladonna anils more cases of abaceas in the early stnipes, than 
any other QK-dictne, Aconite tji indicated, where there is mttch 
febrile rcttction. Arnic^a or Oinrhona should t>e ^ven in nmrked 
debility. Bryonia i^ u^^ful wben the *»wejling is caused hy ex- 
posure to cold, it is painful in the cold, and tibe throat and cheflt 



140 



TITK II0HA7C HAB AKD VT8 DISBASI8, 



pyiDptoim of the remedy are marked, tiepar comcA m voy 
w)on, jiikI U very I'Xtrnonlimiry in iN ii-Hioii- 

I treatol a d^ntint in 187^, whci Iiad a very rebelliooe inSam- 
maliou of the tympanum, which in f^iiileof tr4«tni<'iit rvouiiKd 
piiriilenl, itaintul, awl threaletiin^. At ihe end of six wieeka, a 
kani tumrtr the size of » pulkl's p^ftf formed just below the ar. 
Poll Uii?i?4 and Aixmite were presL-rihed at firsl with liule benefit, 
then Hepur, a powder fnor timcj^ a day, wa.^ ordered, «»d, in one 
wcf^, ilie hnoor had iliHapptiireil wirliout leaving a tnic^ Aud 
the u]id<lle ear di«ea^ 'wm also curtxl. 

It jteemed altnoet ineredibU that so large and luinl a tumar 
cotild diAnppcur eompletely without supptiralion^ afW one pack- 
1^ of |HfwderA of ihi- tittrd criiiiration. 

Mercuriua is ne^ed when pu^ i» formmg fflowly, and h sanioiia 
and nnheiiklliy, Arwiuo Is capital for broken oonstttiilionfi, nod 
gnn^^reno^is teodeneit?^ 8jlieea will prove vaUtable in c-hronic 
Aiipi^iiration, and .Sul]>litrr i^ indiratedr when alruiua id marked, 
and (he dt^bat^ w profa«tr and illaudjible. 

VasctUar Tumors. — The auriele and external meatm are 
socDetinies the »?at of vaseidar t^rowths and FfnYllinjj^, whieh re- 
<iuire tn^tmi'Dt at the hand-i of the ivurat Mirjrei.>ii. They inolude 
airriplr: :ui^l'im:i, eaveriiou^ fln[;ioma unci othwmfllormi. 

Siniple Angiomata. — The^ tumom conniht of a nae»h of nrlfr- 
rifw and eapilluncT-, numeroiui, dilated, and tortuoiw, which are 
held leather by a^mall c|Uantity of crHiJiecCiv^e and adipore titfvue. 
Their tx^lor \^ genendly vioUh or red, but ia socaetiraof purple or 
blne,aeoerdinKto thecoudition and more or lees stagnation oTibe 
hliKxL 

The tempemtiire of the ekiD over these tiimors is incrwieJ, the 
bhrxl can be mostly pr<^9>t*il out of tbcca, hut returns <)iiiekty. 
They form usually small, su[ierficiaI,Blis;htly elevaU-d imtehvitt 
U-Tirlin^ to ^pn.'nd, and ntoy dtsvelopv into large luoLore. They 
ineluile luevuA and telangiectasis. 

CaTemouB Angiomata. — Thcec ore eou>[X)9wd of venous capilr 
laries nud veins, whieh are dilaietl into alveoli, or s|>aws, lined 
by endodi^*lium. The«e alvroli cumniunimte frt^ly with each 
other, and the growtlia resemble tlie corpus cavernoeum of the 
penis. 



truoits. 



141 



Tbey are nsiuilly filled by voDOiis bloud, and form ercctilt, 
sometinK^ |mUiEtin[^ tvimoix, ilmi^h Hwy niny nMiiiiiii llul, luii 
be IHile e|i>Vfttecl above the wirlUcc of llic skin. 

Tlicy fwl like u bundle of vronoif ; the blooii ojinnot Ix* jmrwed 
out nf tl)«ni ^mirvlyi they look blue, and fi^itently rm'li a 
br^c t<txc. Tlicy inclutk venoiui tumor, t'rc<ttJlvluiuor, and aii«u* 
riftui liv aftiwiomoflia, 

• JWfiJntfuL — Mimymt.xlioiiH^fux-rcnominiNith'iirortltcvctQniorB, 
bit eur*.*fi by ilmm Br^ rare. Aa*nite, Kali hydrioil., Lvo(>|)o<l!uni, 
F)i^|ili(»rttft, Piil?LiiiillrL^ Htn^U', uud Tbtij:i, \i iT«;l]t:v<<r Uaj^ ihv 
iiArc&t cnrrftiiMmding Mmptorns, tray be tried' in appree^labk 
doies bill iifHrrativtr |in><H?i.birr i<1ioulil not be loo long dcliiycd. 
Sui^ical m«i*uiv» are in^eeaar)" in mo&l Ksst^ to get rid of ihene 
bkniL<<lH<«, anti ujion m t^x^m^l a purt na Xht uir one must obooee 
the »|>(.*ratlon caulioii^lv. 

Wlirii the tumor 1:4 ifmu1l,ttie iik't^Ik^ muy be inject^ with 
fluid extrKt of ergot {ErfffittE exi. Jtuid,)^ or persulphate of iron 
(Z.17. Fi'.rri pfTMuiphatU) auJ pfx^uro appHi-d. 

Ad cxeellent meiboil is to heat a needle red hot and phin|^ it 
through th<^ growth in ditierent directions: or, ifagalvano-catilery 
bftttcry Unt lianil, intrmluw it-i nti^llf*, th*;>fl*rF%'^onr^r*f, cloec 
the eircTiit. and war the parts well. After either of these a|)pli- 
c«tion», c>iR< pliixild pmilrtix* the part witli flnxM^ed, or cover it 
vitb cold cream and a iHindatp^. 

SubctitaneouT« li^ition i^ pr4.*f<^lrl4r, \( ihe tumor i^ laty^, 
«ontaim madi blood, or is elevated much above the suriaoa by 
wide dilntatioti of th« vowek 

PaaA a striwir, waxed silk lij^iiture around the growth by a 
DMdlv iiitrodticx<il under tlK^»hin, and pui<hcd through il« punc- 
tures lirice, «o that i>o ^kin tie inelndM) iu (he oireuil ; thvn draw 
tighdyaiM) tie ita cnd^ quickly together. Or, one may divide 
tie tumur into two parta by a douhle li^ralure earritnl dn-ft hiN 
nuoth ii^and then eurronnd each half by \i^ IJgariin? in the u^iual 
matiner. It l*t well to remove lhelijj;alureaAer forty*eight hiMir», 
in order to prevent too much f^longhing and an u^ly mark. 

When the tumor ii* quite large, and whollv beneath (he skio, 
it is »eat practice lo direct up % flap o^'er it, tie all iho vcfwls, 



TBB BUMAM EAB AHD ITS D18BA0tB. 



an<] cut it out Xhm Icsecn^ c^Tatridal coalnctron, and Ifttvet 
almost no Iraw of tht- ojK-nitioti- 

Ynwiiiftr Cumof^ are not ta be trifled with- A bbmiII oiw, if 
treated improperly, may furnish uo obstiinitc and ^hoc^iiig hffD- 
orrhiLge. Trwitmi-nl by cnuttlio or by ncuprefwiire i**, tii geoeml, 
not suitable upon the auricle, because it [D<lua« stoujj^hiii^, and 
knaves nongh, unnt^litly f^^rs. In tuse (he gfovUi is quite lar]ge, 
covofA coDHEderahle area, or involves important part^ a Kcocn) 
Bur^n filiouH Iw invifwl to tike chnn^ ; llir siwiwr^ the better, 
if (he pljy^ician is at all timid, or a bungler in h» use of iD34m- 
ments. 

Othsematomata. — Cluiinal oheierpation and experiment prOY« 
ibat llii--^ t-iLrioii^ tumum ari^ in mo^t cnses from dUhiilutice of 
the circulation anil nutrition of the car, in sym[Mtby nidi abnor- 
mal Hiatcfi of tlie hoH? of the bmin, Traumatro injnr}' ranMsa 
fevrcHscv, IIS in pii^ilistHand cmulatoniftf Pollux and Ilercults. 

Idio{)ath(c cueft have nt first considerable oonf^ivtinn nf the 
head and auride, followed by rapid cft'uj^ioa of blood between 
the auricular iitrlihi^* im<) lis perielnindrintn, with an etrvatinn 
of iheMiiKrriinpwj.'d ti«sti(.f(. TIma happens generally ii[MkR tl>e 
anterior surface, within the conc^ha of either 6ar> and forms a 
oircumhmhed Hwetliii^. The (nmor i^ bunl and hot, of nonoal 
color or purple ; it (1u<Tlual(^« a little u|>on det-p prce^n-, and is 
floi'oniiiaiiiei] by Imriiln^ paim mid a aeosi^ of vrei^bL Tho dt»* 
agrecuijie symptoms «ooti mib^ide, and ilie tumor may remain in- 
dolt-nt for weekti or montha. The blofxl nmy be abetorUii grud* 
ually, leavini^ the auricle not much injured ; it may rupture i» 
ciovenngr< sjioiitaiH^ouHly and ctiiijw ^reat conlnn'tioii und dcfc^rinity 
in healing; or it may produce ulceranon, filon^hinff.aml gan^rreoe 
of the anride. Thft^tt tumor* kwmt fre<|uundy in die imunc, and 
are seen oocasionally in tlie healthy ; they are much naore fr©- 
quently met wilh in men than in wonK-n. 

TrmimnU. — BotTudontia is the remedy par ererffeaof, for the 
early atajijes of thi* dbteiuie; it is especially indicated by the di»- 
turban(« of the circulation and the cerebral symptfMns. Arnira 
m indicated by a bruinni fe^^lio^, and hard, hwt, tchiuing svrclHag 
of the parts, with a tendency to (zanjrrene. ATBenicum will be 
nxiuinil for burning red »]Kit«, blisters, and sloughing, accom- 



TDXORS. 



I 



paniai hy geiMral |>nMtmtir>i>. Hnmnmdi# ii«Miital>li> for «1upor, 
congestioti and tijrht»e*« of i!w? head, a venous Itue of the awi-IU 
iDjE, uid <x>ii>tik'raljk- pn^traUon. Sot^lc is Ix-ttcr wh^e iht 
tamor is dry, cold, bard, and io^naible, of a dark oolor, ftiij Aree 
from nffcDWvo (»br. 

Local treatment in (bete cases is important. The weight uf 
evkkoce is a^int ev«-4iating the blood, as greater defnrniity 
r&u]l»4, llian when ft|>fmlajit^u« al^irptii^n mit^ pluci^ Bum^ 
mlviifefi piiiH-ture^, f>nly when there in great ]mi\. KirkhrJOe 
roeommend* ioe ii the uirly etitf^o^ Ice or ether i*|>i>y ought to 
eootrol paia ualil it h reJiev€<l Uy yielding anU aiiaplalion of t)ie 
tc¥uc« Ui ihc i^xtuliitiuii. It vinM i>e wdl tlK-ii, to Imihe (h« 
auride in diluie Amk-a^ and cover it cimely with coUou, Should 
ulr^mtion, atiNCN^ or f^an^ix-nc mi|Hfrveiu\ Uiey muAt be treuted 
as ill oiler imrtA, protecting ihe ear, and saving as good anatirick 
as |H>»ib]c, 

Other Tumors. — Alma^t any morbid growth that occurti in 
oiker parts of the body may up}>ear in tbc cxt<rrn»l car, but as 
Ui«ir d«w*ription and treatment are fully detailed in work^ of 
general £urgefy, I shall uot eay much about tlieuu 

Oomedonea, — Tln'se hh^nuAhurt are seen iii Ihe concha; the 
ducts of the unn^uailly large wbaceoEis glands liere become in- 
flameil ntui dTlBt<.<<l, and ibctr ^rt^oHv coutrnt^ mixM with <lirt 
They should be rubbed bard every day with a solution of caustie 
|Mjt.-i>H (Pninn^'i Aj/</*'fw) 3j to a pint t)f water. 

86bac€Oua Cjste, — Tlu^^t: growtlta are eausetl by the inflam* 
malory olo^^ini^ of tliv: sclwccoiis duct« ; the deep part of a gland 
beoofneH dilat4*il sm! Iilleil by the constantly rmrreD-Miig Aoba<timit 
Mcret»onf which unflcrgoes fatty degeneration, and resembles d«- 
CompoAing Qhe^sa 

TfwttmetU, — The only tvrlatn way to get rid of thosi? cysts is 
to open them freely, evaluate their contents, and caiiierir^ ibe in* 
ferior of tlK< «ir with acid, or €lwdi«<i(.H't them out aIlo}^tli«-r. 
One may give Arsenicum, Calcarea carb., tlepar, lodinum, Kali 
bidirotii., Ky(Yi|wHthiin. MrnrnriaH,Silji'iti, und Sul[ihiir,[U'<Tirding 
to (he general jiymptonis f*>r Iwth of thoae affecliont^ in order to 
improve tlie nutrition of die skin. 

Tophi. — Toplu are rotigh, paioful nodules sometimes found 



TBI B<F»A?? KAl AlVD ITS 0I8HASIS, 



DDifer tl>e ^kin of ilie niinc1c« in polcentA of a goiity coiiriittilimi. 
TlK*y iiave been aciufvra^cl and fouud to be itfatoof ^Kxlium. Ttie 
miQ^ntf timiy eiHu^i inllammutiofi iirouiui it^ and Is gtnifralJv lu- 
c]<)N.-d in & ibPM of tibroii^ tissue The a|^)rupria(c (suuatUutiooal 
m^lkints sbo^M be ^^iveii ua indirat«tL Simple cerate (CVrol 
fimpffz)f or bclWomm <Hiitnient {('ny. tifltadonn{r) applied Iq 
tbe ban), rough akin over (he coocretioTi^ Hill relieve |iAin. If 
thfy lK!<H>»ie tn>uhli«oii]c iWy can be cut out bv ev«u n novirc hi 
Tn*^\\v\ni'. 

Encbondroniata. — Thow are new fornifltlons of cartila^. 
When ill t)ie aurirle or meata'i, ibey nre ^n<'rrdlj' a>nnt-(?Jtil 
wi(h the (rue fnrtilagc and perlrlion^lniim of the of]gati. Tlicy 
are of .nmall »\rAi ami seUloni ii»iler^r> iinv ile^iierutive ehangvA, 
bm^ in olber g)art« of tb^ hotly^ they reacb a ]E[reater cUvdopracnt, 
ami (inder^ fixity, oaluareoiH. Aiid wmiRo degeneration. 

Trnttm^ni, — It is mil )>n>vtxl ihat any iDtpronl rrtcdicatroo huft 
any efieci ii|>on thft*e gixjvrth*- Thoy are hnrd awl Mlex b luird, 
find fc Hilieca is given empirically, A rational treatment wnnld 
be to piini theni with tinetiire of iodine ( Tr, lodhiii), or apply ait 
if.Kline ointciieut {Inff. lotUnn comp.) aboiU twice a week, for a 
lun^ penixl Wlien iheHkin ovorthem Iw^inio irriliil>le frcim 
pmistirp, coM oreani or vaMftrjio tnay be a^ipHed. When tb^ 
nre unnightly ori:au4LMncoiux'nii-Dfx:or|)Hiii, rli^^y may lieremovvd 
by the knife, care belnj: taken to adjust tbe flape accuratelyi in 
order (i> dtuifTti^li thr i^iir niid dHtnrticm, 

Fibromata. — rsbromala are lutuors composed of a ndwork of 
while liliraiH ti?«ne, ooiiraiuin;: a fuw ycHowela^tir fibrea. Tboy 
are fte*-n mun-^ freqtjeiitly ii[ioij the auri^^le^ than any olber morbid 
growth, bwauj^ ladiefl |>eh*ist in havinjc iheir ears bored for ear- 
rings hy jetveler^ ^tiid oihor*, wlio nre igrionint of aimloniy. In 
(be lobe of (he (^r, at the ^eat of injury, the fibrous tiE^sue under- 
goes hypertrophy, and pnxliux'!^ uiinorii of vuriabte aijte. I lave 
»een tbem from the ti^e of a fKn to that of a beiiV t^. They 
are ollen met with in nc^nn's. I have an t^^'al one, an inch iQ 
dmmeter, and Iwo iix'bcs long, rrmovpd from Ib^ e.ir-lobe of a 
negrcHs W l>r. C\ Mh ThoniaH. i>f Fhibdelphia, Fa,, vrbieh Iwk* 
so exaotly like an unpeeled potato, as to have deceived many per- 
m>m. The oubide i:< rt^di!?Lb brown, the vnlnrgeil folliclea reeeat- 



TDU0R9. 



h\t ^jtn, and the cot face h]i» rhat ^)t«lrning apppfimnce ««q id 
porniofts ftji i*i>ll, jw in wcUotis of white tibroun tiMiie. 

7f"tn/ffW*^ — Tlippe tamoKarc so cloeely inc^rpnratefl wilh (be 
IoIk^p llisc it Lh pmlxiltlc- lliey iiin not l>e renia%'H tlianm^lily eX' 
eitpt \ty the knife. One may try nm-dioini^ u roasotuible lime, us 
filimicb hwf^ Iven niml by mftluiiM** aloiK^, 1 ^juv ii fibroma 
ibr ^ite i>r ihi' fi?^t, tomtcd in iUi^ ri^lit purutid regiait of a la<l, 
ibtit unit mnoviil by Cub'iir^A iixL, pre^ribal by Dr. J, H. 
Mcrk-llaiMl, of Pitt^burgli, P«, 

Ar^*iik'um, Biir^'la carb.^ (■jOnirtii jo<r^ Confiim, Kuli Iiylriod., 
and Silima arc nicdlniit^, wliicli jiroiniAc ninch, nn<l linve cured 
Sfimc «i9P9, Th*?y may be nsccl in mtional cinpiricienv when 
«)'nipti»iiuitolo|;y i)i>n« Dot point ilinvtiy nt thc^ nMiitxIy, 

I have tried i^omc of the^ m<v)icines in Fut-h cbs&^ for aivliil«, 
l>nt my guitiontH bav<rtrithc-r luken Fffnob l«iv<», or I buvo re* 
sorted to operation l>efore they had lost confidence and patience. 

In ofienitttif; upmi the loU-, make n A-Hliii|H^t inn^iou with 
point upwards in the lobule, diawct out the tumoT^nnd rn7>1cn ihf 

-iclg^of iIm nlcin lof^^lbi.r witli pins^nd a lii;iirt'of-ei>;bt li^atnre 
^oortd over llieir eudn, R^-mo^-e ihe pins in ibree or four clays, 
support tht WK>und vt^ilh udhcvive pbi^tri-r, nnd dix^ vrith Himpk 
cerate, Tf care is exercwed. little deformity will result, unlefib 
the j^nwrb 10 <|uite large. 

Fibroma^ in other parts of the auricle are raw ; they are re- 
rnnvn] by ritp-I [ulhrr<'noet"ronf*er\'ativesiir^ry, in order (owve 
as anuc-li of the auricle, and to distort tt, tw little a« pos^iblec 

I^SotnetiniOi tb«9C flbruicb return after removal, beiDff of a fiar- 
comatou^ clmriK-bn'. They luivc reeurred five or six limes anor 
extirpation, however, and have iieeii finally cured. In raTo ca^ea 
of rivtirrence, m^ilij^naiit characteristics liavc dcvelopcnl, and life 
born loHt by extewion of tlicdisALie. For malijrnant ttnnors, 
cKtikal experictMe has demonstrated the value of thorough eoursM 
of Arwninjm, und of Kali bydri<xL, in dmdcd dotted 

Sarcomata. — ^Tbe&e tumors arc fibro-oellnlar ^rrowths with 

^.tnaligiuiDt ct)ira^<^rb(ti<<^. One kind lia^i n |fre]>underance of 

ftound, nudeitcd cells, and i» calletl mund-vellod : anothi^r ia 
moHtly compared of apindle^^haped, nucleated cells, and \s called 
apiiHllc-cellcd ; and sli!l unotbcr ba8 i»uch lar^ suL-culent oellti, 



TSB HtlHASr BAIL ARD ITS DISRISES. 



iu lo merit the iiaai« of glaQt-ooUecl. These \*ftrieUea of tvlla 
ar*' frKjuintly uniHtl iti (he «mw tumor, mni they may be 
mixiHl with pigment and other kimls of normal tissue. Ttiew 
tumof8 are rar« in ihe niirii^le. but uriK* wimctiin^ in or liciteiUi 
the [Kirotul ^land, and grow into Ui(> temporal lone and onlwiinJA 
ib( wcfll. 8cvonil innlrtm'** iin* rijicin reci>r(J, vfliciv *?uch ttinxffV 
haVewnt procewea ihraii^b the (ilaj^eruiii liMiire, iml inviidcd 
und di^troyifi thc<nr, otuHinj^ dt-uth by cerebral compticatinns. 

i'h&ic DKjrEjUl growths are r<^-urrcnt am) RinH^tianl, nuid the 
roi'Mm-ee uf mcdicitav m far, have been of liitle avail in arrestii^ 
tbcir fatal pit^reefi. Their nature cannot be dttenniacd with 
oeniiinty, except by ei^amining a Mvli^n of ibf^ belcn>pl»t uixler 
the niieroftcope; bence, the re|K>rtfi of eurua of Aircoaiaa by nitdi- 
cinu^ when? the dini^nit^in n-»t« i]]K>n ccMin<e, eliaieal cliaTBetere, 
are of doubtful value. 

Trratmmt — I bttve K-cti two attei of j^reoma materially im- 
proveil by theconuuuoijsailmjnititratioa of Arse(ncEjmioil.,»e<Nioil 
deeiniul trilunition, tbr«*c f^raiiiif, tl]n*vtimi<#iiduy, ByiDiprov'cd, 
] metm lliattbesectmlary tutnoraoeased togrow,a[ul Uvameumie- 
wbat ^irunken, while the geuend henllh got much better 1 Iiava 
«ometimtv u^ed Kali hydriofl in the Anic potency aim] doev, for 
a time, vlten the chamcteristie irritation of Araenio baa appeired. 

OjIkt reni<-dii^ nuty be ^iven lUTonlini; in tbo Aymptoms, Ukdl 
Ihe jni%ment and experieiice of the phyaici:jn. 

Mercunus merit* esti.-mk'^l trial, vinct^ wrfain etninr^l firrroan 
phyttieiaiifi bave cured eaneei^ou^ tumore with it, and hold tJie 
theory, (hut all maligniint f;niw(b(>are reinotis dTvetoof ayphiliiv 
Oili^area earb,, Sulphur, and Tencrinni are reported as having 
cured ewtes tn the pruetice of the Uitc lamenleKl Ih, Currull liun- 
liani. 

Ar^enie, Atirum, Belladonna, Conlnni, Calcarea carb., Nux 
vomiea, l^hospboruR, ami Silicta are recommended by \"arioue 
writers, and t^hould be giveu when thi^ir elmruclerii^tic fiymptocoa 
are preiwnL 

When the local Bymf>lomH form almoet the totality, T think ^ 
9tiw)y adhereiiee to ArstMiimm, Kali byilnal^ and Mercnritts 
will (jive the patient the best ehancw for life, 

A^ftOODaaitiaeertaiu thatu turner i.-< tnidigimatfit is considered 



TVK01I9. 



U7 



pructirc to cut tt oot, villi all il9 tmmfduitety <<(mtJgucHM 
tiesn^. Sarcomas sbout tho parLitid nnd ^r have not bi^en rttred 
by tW piwttlurc, btit iiavc gt*iierally ru*iinio<l »m1 (k'rfn»}-tHl the 
patient I leave the propriety of iDtedeirnc^ lo our surgical 
writ4*rs; I would DXtir|xitir nil suApinou« growth-'t Itffoif^ lJi«*y 
b^tifae unmanageable irom size, and while ihvve is a reasonahlc 
prw[iff*t thm lh<^ n-ittem i> IM tTintnmiimkHt 

Epitbeliomata. — Th^^e tumors are compose<i of epithelial cellj^ 
ajnrr^'jrJitt'il iu *htiI<>, finpT Hki* pivHisr*i*i, and glahiilnr maf^fOt, 
lying upon the papitlft of the skiu or niiKX>Uj! fiieiiibmiio. and 
|;pct]^lmting into their fibrous ^tili^lnilii, Kpithelioma la the only 
iligikant disfo^'ie that or^nirs prinwrilv in Ae externat car. It 
^■fitetK Ibe meutuit it-* wi.-ll x<< the »ui-u-]^. mid gciit^mlk nppmrs as 
a noduk or an irritated mole, u|ioi] the skia This bt-gtns to 
r^ffdiiue ivide* and tniKtri, tini\ wlii-» iIht are removed a »H^ht 
moUture^ and some peddeaed papillie are found benc^rh. The 
uWr tfk usually slinllow, and xbt tnlpm nre red, Muiiotis, mid hanl. 
Syphilitic ulceration oeeuw in this region, but can be dmpn*"«!fl 
by ll»e loral appearaneca and hUtory. The ulceration exlencb 
laterally farter limn in depth, and ultimately deetrciip"« the auri- 
ele, and cxletuU throui^li the utnlilury ijtum\ and ear to the brain, 
not arreeted by treatment. The other varieties of oanoer are 
I mre al>out the mr, that I a>fer to works ol" gi^neml Mirger^' for 
Ibdr dc?K.Tipti<7n nod pR>|)er treatment 

Trf'jtf^ent. — The treaLment of epithelioma nhoidd Iw radical 

and ejiergvlio. If the )*yuiptyiii» arc murkvdiy clmniet'.*ri>tie of 

any medicine, it should be tried liiithfullr. If not, as ia frequently 

lie ctt^'jliieloenlftympttimifforni^bifi^tbc sole iiidiiTatimH, Anwn- 

'Ictim iod», *«cond dc<.nmal trituralton, should be given, three 

gn\n%, tlirec Iim4^ a day, ntler ineiiU, until iti* |>e€uli»r [Kithof^ 

oetic syiaptonkA appear in a mild di^ree. If the growth does not 

I be^n to decline, contiiuiv rhe iii«lieinir in smaller do^i'i^jand \^^it 

^B little vfhilc, 

Should the diiK?iu« reznuin stationary, orud\*anorrf try Mcrcunus 
iod, flav., Mvo»d decimal Irittiralioii, in ttie Hime way. If it fuilft, 
(five Krtli hydriwi,, two or tbrn? K'^im, diswivinl in (?on^id<.'ral>l« 
water, three t!m<^ a day, until the di^aite m i*iire<1, or the fuitient 
i§ di«gust4)d with llic [ucdicitH*, and hns reii^n to be. It Ik ad- 



TOE BVMAir EAR AKO TTI DI8IABSB. 



vi^nbTc tlurini; tlio triiil or mnlicifiM to baihe tl»c uimor with t 
M>Uition of cttustic Eocliuit] {Sorfii hydrat), ^T. xx to an ouDce of 
irattT, fliid la kce[> a compn*** wet vrith Xht Mime u|x»d it wliet>- 
twr po««ib1Cp This h said to favor ^xfolatioii, and to amet 
the pen (-(mil on of rlie cellti. Aiirum, Ol^rcn carh., OirboUc 
add, iicpar, i'hoAplmru^, nnd Phytoliiera should t>e Htiidted,«iHl 
ru»y t>c tno<l awhile, provided tlit* liifR^^i? i» luit iimking mpiii 
progr€n9. ^hoiitd this Ue the cae^ at any time, the g:mHl)i and 
tuorhid arxtt nround und bcnctth it should bo (iMroyed hv cnuidit 
pota'^iiim, nilric at id, nilniti^ of rapivury, chloride of ziDf, or the 
g^lvuuf>aiiit<i'y, and (he part poultieod until thoeloiK^h H-piintf*; 
then dr%v4 the wire with carholiwd jrlycerme or litneeH oil (OLj 
Lint) until litak-d. If the f^wlh retiirDT^, repeat the prf>c»«,or| . 
jf it BUpnn theniirii^le, fiin|iula1eenoiL|rhof thift tontnorelM^ODd 
the ^hii(1o\v of a doiilri all the outlyin}; mot'er oells. 

When the dbf^aw I »hh extender] far into the aaililon- mnal, it 
eloiild Iw tn-utcd with wa'rm douehw, poidticcs, atKxIynefi for 
Bevore pain, mid oni* of Flt> mtfiii^in^ momionml aT>m-t. If ifacM 
n]e-ji<urc>i are faithfully followed, the physician will Imve done all 
in the frnwor of man to savi- his ^^ttent. 

iDJurleA.— The nnwle i« ^ulj^tl lo cf^ntuslflii:*, laeentH^ig, ami 
Vinmi« wounds, whieh should be treated iipoir ^neral pnDcipIei»^M 
Arnica, iViIi^iiliiln, Camphor or AK^ilutl, liilotorl hy wuter, makt^H 
good looul applications^ It is l)etter in repairing damaiEce of the 
auriete to une tnterrii[»Ti<d MitoriM nnd piii^, wiih cothxiion cover- 
ing, ini4teud of adhesive plai'ter, a^ the latter is dtfBnill to apply 
to the une^-en psrl>^ nnd dvn not keep in plooe well. Siiiartt 
should ^ entirely lhrt>ugh the auricLlur eartilage if neoenary, as 
they do no serious liarni. 

The (r<>minr>ii(st iiijnry of the auricle h deft loUiIe, from the 
tearing out of oar-rings. The edges of the cleft and ends below 
sliould !>e |>areiJ, Imvliig the (laririg of on<* side attache*) Mon 
for a fliip; the cut »^urfaoe« t^Iiould U< phux-d in ap)K#i(ioii. tliu 
Unp |jlaocd acroai tlie cleft and ovef the other end of the lobule, 
and the parte uiiitnJ by jntterriTptoil sutured upon U>th furfai 
Union will be 8]x^dy and the rt^ull ^i> i^ood, tliai few 
will ever know dmt anything ha^ been done. 

Sometimes lh« auncb 10 ntUiohcd to the mastoid, owingttfi 



PRAOTDRB or TBB AODITOILT PROCSSS. 



149 



led <lurinf;; the healing of a severe ecxema, or the contnurtloua of 
a hnrn. 

I ofiprated upon n child, having from the formrr cait^e the 
iricle, even, lo its ht^lix Tirmly tuiit4*J U> the irm^tokl by iIoim! 
SbfDtK tieeiie, UisMx-tion was carrieJ down to tlie cartihige of 
the iiiDcr prt f>f die n>iKhfl, and iibri^s of Ihc- attolh-rM nnd r^ 
tnhew muscles wero ctit, 'Ylw Aresffin^ were appmpriate, and 
ke}>l cliu nunt^lc uiruy from tttc hcnd, yot^ the cicatrix lifiall}' drew 
tlie tiQride txick uulil it was ti»irly iQ u» fjdid a |>08tlian art iM^forc. 
1 think it woiiUl l>o IkIIct in such cflset to svin^ n narrow Hap of 
ftkin rn}ni ouuide the region inio [he Aiilenii behind Uie auricle, 
Iml i:i»[Unulion mny hi- A'l^iviimivii where it will do \gw harm. 

It >hiiuld be rcniemijeral ihiit auricloH ctitiHy c'lit olVand cold 
have bevn Bttnchcd hy miturrv, havt? iKconie gmiltLally viializtfd 
and uniit-d, and have j^rved a-i gvxvl eirs. In all larp^ incihiona 
of tht.' aEjrick'y ihk- tdgi^ uf ihc wound niUT^t Ik' clwHy littt-d and 
well »utiired, and the auricle kept wrapped cIohcIv in ubr?orbent 
oottoo for many <la)-H, 

The lobnle is mnnetimee much elongated from habitual pulling, 
and from wearing heavy ear-ring8. It may be ^^hortuntil \\iilu>nt 
dan^* In tlio few ctiM>7; where aiiiurW Imve b(^en entirely re- 
moved, itaeema not to have injured tlur he^rin^ miwU. Plastic 
opU«tion» are uadi-sM fr>r mjtkinjf un aiiriole, and artiticial ones 
ore DOW made very beautiful and decdviog. 

Burn.> over the aurii-k, mu«to)d, and in the mcstUflooca^ODally 

'cause hy|>enemia and middle t^r diat'aj^-. The Carron oil| one 
part of linMied oil to two part« of lime water, is nejit to the 
blue elay treatment, the hent Hppli<^itii.in for bnrnft ; CWnphor in 

■ oil of Chatnoraik, ^^ x to an ounrc, !s also nsolul, in relieving 

Lpain and haj«t«ning heiilinfr. Thi'M; Mppliiiition^ an: fur superior 
to the Oantliaridw and Urtica urens trcalment, whioh M>me 
pinrlilionerH ulIvoi'iiIi' sfrcuiinnjfiv. 

Practare of the Auditory Proceas- — A hlow or fall ii|>oii 
Uie heud is followed i!U>metimcM hy a LliMt-harKi* of liloixl and 
ini fmm the auditory rneaturi, IlliNtd may eome fn»m a sim- 

tpU rupture of the nicmbratui tvmpani^ but if it i» followeil by a 
dWhari^ of Mnim, it n prvtiy p>od evidence of a fracture of the 
petrous portion of the temporal bone, Tliia may occur from vio* 



ISO 



tut UtlMiX IjIB A9D IT0 IIISIASK9. 



lenceto (be lovrer jaw, bv which itAcondjlc id upWArd movement 
cnijtht;:) thi: lowvT wall of Ui« t-xtenial uutlitorv ciual, aud ilve 
fnu-turt eileuda tu\o tiit- deeper pariA, Tin* atiditorr procov, 
forminjj; the (H«ctcn<ir irull or tht? gk-noid fiosi, It ulncnt or de- 
feviive in cluIUIiotxl^ uitd bccic>mo& <)iiili* ihiii nihl fru^^ilr in oM 
puoplt; I'mui fritaion of tlii" t\MnJjl<j, i^pt^cinll^'r if iliey urt UmiUi* 
lew. The acddcnt b rare, and it ifl 1o be wond^rrcd ul, nbeit 
fivctumi Jvwq UR- w ii>mjiiiHi, 

7irrrfr«fii^ — When callfti (o irait u fracture of tbU repon, 
wash nsv^y the bh>od dot« by a s^Tinj^v and cold water. If ihc 
l>liH*diii^ U copious, and Ice water doet not ^t>p it, {Ki^^k ibt 
canal with sl^'pLlo cotton, or cnmioon cotttxi Dioiftti'tHt) and 
rolW ia Tannic arid, and confine it by a bandage. ATkt tlw 
bleeding cea^^cfi, ctcan»c the canal with wartD water and the foan- 
lain :«yrin|;i\ wipf; it out mrefuMy witli cotton od the hohlrr, and 
ezannnt? bv ivlk^te-d lights The lower canal wnll will l>p «een 
pnij^irting into the lumeii, and prcoentiag an opening, Ibixnigh 
M'liidi ra^^£^ or loo^* bone can Ik' felt with a probo; the move- 
tuents of the lower jaw will iw very painful. 

The »ipeculum fJionld he worked gradually in, and the mem* 
bntne eiatuined. If it U intact, it \» j>m1>able t}ie |wtnju.s bom 
is not fmctUTxd. If torn, udcI blood or wrura ooecs through th« 
rent, it \^ almost certain tlie iictmiuNuic la fmcturedt rvca, if 
ooreUrat symptoms are not marked. The lower jaw should be 
fixed by wiring tlie tcetli to^^^lhcr, niul by bantluge?! ; the vanal 
pniihed into position if pcta^ihle^ and the ear kept clean by warm 
douditM. The aitppuration ^lould \k guided lo Iiealtliy repair, 
and sequestra should be removes), incising the canal when neceft- 
saiy. Symptoiiirt should l>o trcutid » they utIh* by uppropriiU 
nwdicinea. 

FracliiR» of the amal are imt dangenniH, t)>oii(;li tltcarliculn- 
tion of the jaw \a ^metiaiei roughened ; tliow of ttie i>ein>u» 
portion of ihc l>oiK>! nrc in ino»t cum.^ fatal. 

PerwQS have been &1ahbeil an4l ^iiot directly in tbe aiKljEor^ 
meatujf, A man nHx:ived a bulk't in the meatus, whk-ti wa£ 
found buried in the anterior uiastoid cells ; it was estraeted and 
the patient n*oover(*d. 

Foreigii Bodlea. — Foreign bodies in the esterikal lodilQig! 



m 



PORKIQN BODIU. 



151 



amil, are o£ ljvf|ueui ooi^rr«iiL^t ea}>«<TU1ly, in duMfot), They 
may U.' fliiiJ, wiiii-Mfli^l, or soI'hI ; miinMul^ rt'gv-lflbl^; or niniiuil. 
Bviuc uri^iuAtv within lU*^ vuuul, otJii^m »rv autruiluctil frimi willi- 
out. 

Tin- (*jrmpu>riw vnty fnmi sliglil ijHea%mft« lo alriHrioun jiain. 
Itching^ li^air, ilirubtnii^ piLiii. tiruiiiU!*, uml di^-nfiicw snr ixmiinijii 
nyaijitouu. Tbey m^meiini&t catjf« frriauil ht^tlaclie, luit-nal d«u- 
imlgja uf the h^d ant] neck^ tiaueea, voiuiUng, cou^h, ronvul- 

Amrmg (hose things originating within, are: fluid blood and 
ptK^ epidtrfttlo Acnle^ |;tove-Jlii}^r epid<^rmic o^u of t]i<- oinal, 
epithelial plug?^ haitk-tiixl <?eriinK*n, \tytm.' hiiii>, \i\ot)t\ c-lotii, in- 
^pifibuu^d pu'^, exfi>liaiL-d 1)00^^ tlic a^spergllUks fuuguh, uix) iiiag- 
gote. 

A dillJ ihnl t W3V< frt^tin^ ftrr MiiL^Fold t?Ari<^ ami rniddio ear 
disefiBe, had a Middfii Moppage of ihc canal, which could m^t be 
rciaiMlieit by fivringiiig. J found and removal from th^ bony 
canal a pie<<e of lM>t}e a <|uarter of an innh in diameter, ron^^h and 
full of large cells, and evidently a ni^ntoid M^ijiiwtrum. 

For^ifrn bodid from wtlhotit nre,fluidi4ordin<TCiit kiiid^, |mu^ 
beans, UiwIa, buttons; pieuea of wood, stone, and i»elal ; worms, 
and inwcttfofdiflt^rent j^pcricn. 

Foreign bodies in the tiu' ufliially cnuiie abnormal symptoms, 
and iUvsK arc mere decided the nearer the xnliTitam^ tft in the 
nlrniiui lynipaiii or tympanum, A foreign body from with- 
it may remain de>ep in the canal for yvnn^, and nut itiiiut itny 
' important HynijitomH ihnn il(«fne^ and tinnilus, 0»e lase 
'oorurred io my own praciitt?- A girl, aged ele\eo y\^T%, had 
alwa>H it) Ii4vii deuf in thi. rif^ht ear. ()m< iliiyFilie hml gmln and 
itehin^ in the ear, and wa^ brought for examination* The audi- 
tory ouial wiM lilliil with tolenibly liard, dark cerumen, tirmly 
adberr^nl to the wall. Af^er f^ynnging and some munipulation, 
tbc materiaj whA remove^!, and eiiclo^d in it wn^ found a nmuM 
betn, quite bardj and the color of burnt<<l coffee thixiughnut. It 
had e^'tilrnfly lir^n in the <<aiial for yenr^ a.4 it waa iTSirtiofiizod 
f*nd preserved by ihv cemraenj and Doom- knew wlien it had been 
introdiicod. 

Incredible 3» it may ^etm, a foreign body has remained in the 



152 



TKR IIUMaX KAR A^Z} ITS DIS8A5K9. 



canal fW vixtyycttm with<iiic daing much iliimn)^, ant] thin ithcniM 
be rcQietnbi^rtMl Uy ttyii^h MIjvia, w'ah inappnipriatv infllrunimb^ 
who tlutik n fnrci)^ boHy in ihc cur iri(i«C be rcntuvod nt aU 
Itiuartlfl, ami blimn^ v^inirmg, du gnat dxmage 1o th« cnr. 

In til-: *^rcAiV*i itf 0/yA'A'i^W'if/y <n«i OttUof/tf^ a cww n 
tK»n<q|, ill wliic-h 11 kirxl rii)>EH'r i.-jx-telp pliurtt ill tbv BK'inbnaii 
t/m|kani, ^Itpp*^ tJjrough, aiid reniaintd ia itw tjrmittHQni for 
w-wril ni(iiitli'<, lilt iJicMiUmnv ))<3ilm)( uml during pvrfiiiljr. 
Little irotihle Mi'as txpcricnced from il^e **rmi>g« niiddfei^r ir 
cubu:«, ULiid It \rjiH l«ti.-r?<iii.vi!K«fully 4<x1nicti-d hy iud^ioD thmu^ 
the li»wtr partof Uio membrane. A txKly may p^i inio llie i)^ii 
lnHiiiinif if tlifj iiH-rikbmiiJi tyiii|miii i^ tlw^trvyvnii ; it amy 
Uimugh tb^ membrape by ulceration or violence, or an InamiJoM 
|>hy9kriuri nviy jxtxh it ihroti^lir piThji]w^ destroying cbr nieni' 
branc by his ill-aflvi^^l altejnjiiA ut ren»i>vH Tbiogfl flMialiy 
pesB Uiiiy tlie tym[>:intjm iliri.>U);li tbe external meatus anil tbe 
lucTiibrane, but objec^t^ hnvc rea<*beil it tbmu^h tbr Eii>t'ichia& 
tube, TlK're i» a ('om^' iifKin record of u barbed wlteut-bf?ad hurinf 
\n\i-'^ tbr<iti^b tlie EuMiuhuui lube mid out of tbv extemoj 
meatus, at^er ifreat flulfering, A barley<com, slrawi^, pieces of 
bcii^ii^, and olhtr thini^ luive bivn rorcy.sl iiilo tho &inta<^liiai 
lube, but not f:ir enough to reaoh tbe lympanum. 

Thv eommoii mum! worm,vlj?r(in> furnhncoiiletif h:\» U*ai founi) 
engaged in the KuHlachkn tube, but from wxnQ ca»» rejkorte 
by rcliublG RK^^iinil UKti, il sLvm>^ tbry ^>mt*timi.-7« L<i>ntin»u tiieic 
jifiiriieyjand esca[>e by tbe external ambiory me;Unt^ 

Dr. L. IV. I^ynoid?*, of lli^b Wy(?<mibe, Kitg., rt[>nrt» llu 
ftillowing aHtonJAhiogcaAe, in the i^oudon Lancet (or December,' 

" On March 3d, 1 was called to nee a wr>nian, aged ^mO y<4r«^ 
three or four mouths aflvun(.^d in prt^nanty. SIh^ vriu in a lovr 
nervnuH AEiUe, and ha<l Ikmu ^iifl'oriii^ M»ce ObriHtmas frooi imue 
and vomiting. About two week^ before, she bad vomitvil f^^ver 
mtiud ivorfti.4,Hnd aUnit llie »tame time, ^iiflereil eevcndy frti 
dyt^pnoeur nnd infenM^ puin in the elioit and uMomrn, Sfaoctlj 
before my arrival, i^he hjul vaniiteil two, axnl three more vrtrt 
diHchurged from the ncwiril, ber no«e bleevling firnt for tbree 
houra. 



rORBIO!! BODIES. 



lU 



i 



T ]>rcKrilM.-d four gniion uf Satiloai[K- powder^ to be telrai st 
beil*tiaie: after ukiu;^ wliMi, A>uf womis wen? ij^khciiI por reo- 
tUDi Tor t\w ^f%i tiiuo, Ttie Bantoniiie wm R»Huwt\l next morn- 
ing hy lllleen graiiift of cx;m|JOiiud ^euinaiODy powtki-^ wIh'ii ii 
gROt many morc wen pa»Mxl per rectum. Three or tour Imurs 
AA«r taking the second ptMvder, Amt Jiaving pr^vIouAly KtitToml 
all nigbl from iDtense earache, a neighbor diwovcreil a worm pro- 
tnidiii^ from eiich ear, and both ears bleeding; the name day 
tbrve oclief^ fttme away Trotn llieuan^, twu frum tho IkW, atid oav 
fh>Tii the right. The fo] lowing marnm^, March dth, her liu&band 
dreir aoottKT from lliccar, aiiJ again aiK>t)ier, on Manji tttfa; 
thb lait ivad fotir im-Jies Song, witli the diameter of a small ^i-rkOi^e- 
<)uill. A largi! OEiniber wi*re, iil^, dlHclmrgixI oaoh day t>y tli<J 
bowel, making in all Aeventy-four. 

" On Muith lOth^ und a^in, on March 13lh. my pideat voriH 
iusi a large quantity of djtrk bhxjd, aiul i^>in|ilainotE at tbe WfD6 
time of a feeling of tendernnKA ia tlfb abdornvn for which I gave 
demulcents. On Marcrh 1 7th. in the evening, I wafl «illul lo »«mt 
ber,aml found her perfectly infleti^ibJe, having been so since raid- 
day ; the tempinLtiinj \va& below uornial, but with a fairly good 
pulHo; slio was roiisi^l again aboat niidnighi. The atliick np* 
peanxl to me hystencab From ihU time she hae gradually ita- 
|iroved in tkeaUh, hut has liad occasional attackBof diarfh<m. 

"May P^tli. for the hut few day«> blood has trickk^l from 
ber cnrs and down her tliroat, which she coughs up. On exami- 
nation wiih the auri>*oopCp thi^re ii^ now, m there vw^ in Mnrch, 
eiccriation of either meatu&,an(l a large perforation of boili mem- 
bnina tymjKiDi, hut the i*t'iLse of hi^anng i» very little inijuiin^l. 

" Iteiuarki, — The history of this case appears ac fin^t almost 
incrvdiblc; but there uan bo no doubt the mernbninea were per- 
forated bv tlte passage of che ascaridct. In addition to being 
vomiteil, M>me muH have rntwled up the ii!:^phngu4 into the 
JkoccB, theiice some found tlieir way into the iiaml passages, and 
othcn into the Kn^t^iehian tubo, |M^rfonding the tyinitanio niem- 
bratttf, and being discharged hy the ejtlerJial auditor^' mcatuR." 

Dr. C* S. Tunibnll, of Philadelphia, Pa., in the i*ounw of eor^ 
nspondence with I>r. Reynolds, elieitenl the following additional 
facte : ^' Tlie panuitw were round, with five imnflverw marks, 

11 



IM 



THR HTTHAN BAIt AVD ITf DISKASK8. 



tnfK'rin^ nt diher end, fimr inch«» lotigp the diameter oT a l«]ge- 
BJiwI KiDitachiao <*atheter, hut this was in tli<» dead contrMl^i! 
0Utc. i rq^reL 1 tlul Ttot i<X3iiuine th« peinHitm miero«copicallT,j 
but am certain they were aa^ris lumbriooidei. 

"Thrye iiionitm pn.-vi(mi4 h* the piuwigo of \\v* worms, mj imi* 
KentBiifiemL from deep-4eate<l jaain, ami cracking ?<ej»alions ip 
the can. This vns relievtnj by u |mriilcm ilifx^hurj^* ffm the 
cxtoTTial mnit(i#, a»d at the aime time, a sinttiog; up of a simibr 
dlsc'iiar^. TliiH had n very bad Hindi, and a Inu) tostt^; c^he liua 
Ux*n L>I(.s.^irig IVmii theutmat iittcrvulf; up lo the present time, 
With tlie otoscope can be eeeii in the right ear an oval ajkertnrc 
with puckfToJ ^IgiNf nnd ^luiiitd dsrk from tlw hctnorriia^; a 
loud-tiokingwatdi i^n lie hcarvi only cl^r^e 1o tiietar. Aarifganb 
the li^floLT, evidcnci2 of perforation is still proTWiit^ but the edges 
are id oloF?«r approximation rh.^ii in llic other," 

Dr Jc»bn Dickson, of Bcdfoixl, En^.^in the inscrfforJanttafy- 
1881, rt'fvrring to tljc above, wy**: "Iliave had Utely a m>id« 
what similar ca^c under ray care, In which the right tympaDurp 
(nii^mhniiK^) nun niptnrtH), giving Hav (o a good dral <d' homor^ 
rliage and slight deafnefls, the wormii, three in uumbeTr eseapiE 
by tlie t-Tteri)tl mratii*/' 

Dr W- U. Bennett, of Pliiladelphia, Pa., fiiraishw notes 
another remarkable case : " A. S,, a healthy girl, uraa during It 
fimt half of hereightli y*?»r, i^ubjwt looccnsicmnl flight atl 
of earache, AVheu eight and a half yeara of age, &lie had an at- 
tack of ««rld*r<;vcr, which wa» nol followwl at the time br 
any ear trouble. Aboitt fonr months afl^r her ncoverr (turn 
the fever, i<lie Ix'gan to ha\'e ooc&sional attacks of earache 
ill the left ear, which continued without any IreaiiiieDl at the 
handa of a ]diy»iciun for five months. At the end of thu 
time, -the had a very violent attack, lasting aevenil day^. Thit 
WB« treated by iii^tillntiom of varm oil and laudanum, and the 
exleniut a|»plica:ion of ponltin^. The )min was excrudatin^ 
and seeioal to be inorc^tewl the first day by tJie use of the oil and 
Inildannin, hut on tlie second d:ty it iiimini4lii?i). It waa on llltd 
day tJial 1 t<uw tlic puti>.'nt for the tir^it time, but having no r^pecti- 
lum tiulluriently Hmall willi me, I waf UMbte lo tb mom ihaa 
make aa cxamiiuitioa of the external portion of the meatos. 



rORBlOX BODtVS. 



1W 



Hfrc thcte vna no al^n of inRiunmatioit, biit the m«flCii*i neemoil 
doted by swolkn mu^XHW m^mbmnc. During lite* nliole of tbis 
JuTt Ihi-ri' va:* gnsit itching, »mi towardA evening the vWM 
ctlled to her mother, ^ying cbal there was ^rnetliing crawlmg 
in hcrenr. Brlt're her mnther oanie to her, she )>tit t^^r hiin<) 
under the poultice and pulli<d ^mctliin)^ from her <ur, which 
brok^ ill two while [billing it. She then pulled tbtodkerbalf 
Mil of h<-r cor. 

"The lwo[M«ecs vrcro prtwrvvd »nd ^hown to edc About twenty- 
four hutint sfierwiinLi. Tliey were |)artfi of & lumhnci.>id, itpiwr- 
i-otly uliout two ;ind a hnlf inehi.-9< hm^^. 

''The Hiild hod no further trouble witli her ear, and bail not 
bad «iutv(nineavn iuunib»). 

^The withdrawal of the worm was not aoconijianied by any 
blood. The ear wim exaininiHl a few ilaya alWwnrds by IV. A. 
O, Heyl, who found no evid^nee of {kerforalion. 

"Uaikr the n«e of SimtoniiK the child afterw^ard^ pufM-d a 
Hogle lumbrieoid per anum." 

Dr, TurnlHill'fi skcfitid^m. in r^'fpini lo Dr. KcynoId#'s case, led 
him to publish itf along with tlkt^^e otb<*r!^ and a vuluable r^uni- 
niary upon the subject of luinbricoid wornu, in a J^hiladelpJiia 
jonnui), In whit'h I wmild refer [hone wKo demure Ut pnr^tn* ihi» 
nuhj<H't further.' lie believes that these parasilefl can paAirhr>Uj^h 
the Eusbit'liian tube nud tyaipunum, on ausount of their wonder- 
ful fandtv of diniioithin^ their ^ip by elongatutg their iMHlies, 
and their pawer, ff\}i|U^mly demoiiHtnUdl, of liiHinEiatirt^ luid 
forcing theuieelve* through araall aperluresand pa»aii*s. 

General prjiKiptia will indti'fiti^ the trejUmenl noei-?«ary for Bueh 
Qoiquecafies. 

DrtntfnnU. — Tljc pbyiiioitiu, tHjiwiItwl for Jeafn^fift or dinorder 
of tlie ear, will often liiid tJie exieraal canal occupied by things 
not stupucted, 4\*cn, by the patient, ns in the bean ca^e a1>cve men- 
tioneil. I oaec found a lar^fe, dead lly, imu-onuinj^ in pux, lying 
deep in tlio canal. He will be obliged to remove ihftw oli^rruo- 
tious to view, and the moM of them l>cing fluid or 9emi-«olid can 



* Tht lledical KDcl iJargicaJ Iiv|M^rier. July 9, I38I : Pluludclphia, Pft. 




AVD ITfl DlStASKS. 



be wft^liecl out by a well dfreeled fftre«ri) IVnni (be A/rir^o. TbOi 
dirt, linir>^ epithdUl sc^liv, pellets of cerumen, fluid aod drkd 
puH arifl blood, ami aimll i>L>Jt,vU (tow witb^fut aru rvmovod 
ease and saf«tr. 

TIh) ii>}ni1<Lr forrc|», ll^ liook and car spoon, or the oottoi 
boldtr, Willi a wbpof abeorbont-ootlon, nioist«MHi willi glyceriitt 
and wati*r, iiuiy be tinH^^eary to liHacb aiid draw out tuitrs and aa 
obstinate particle, bow aud then, from the canal ; but, id general, 
in«trunhii(» arc not nn\ch iioor)4:vl,nnd«bimtd onlybu uh.i1 p^nlly 
under thorough illumination wttli the liead mirror So groping 
in darkness with in»triim<'iit« \» aJluwahle, FjII !hc hard rubber 
syringe, and, having pulled the aiinda upward, and hoekward, 
Inject u xtrvatu uf tq>iO \Tntcr furcibly into the canal, olciee agauMi 
the upi»er wall at /init, anJ then again:?^t ibe otlier walb in 8iHy 
oc^ioHr in c>!xlcr to fret Iwhiiid, and not <lrive the 6ubf«tatKMi0 fur^ 
ther inward, and continue injectiag until most or all of tlie oOcnd-, 
ing mat'.-rtal in removed. 

There is generally a chink, or space, between one ^de of ait 
object ui)d tin,* cunal wall fur tlie piuwogtr nf water, Afier lyr- 
in^n^ awhile, it in rtv<^)tJMiily necesory to IrKMi^n M'uIiv, plogA 
and ceninnn from the wallj and thifi may be done safely with lh« 
angular nr I'l^nieroy forceps and llie t^ir HjionD and hook, under 
good illumination. 

In some <ttM», the syringe noesle can be pujthed in beyond the 
object r{<{uir!ng removal, when tJie water will get beliind, and 
exerting nuieli prewupe outward*, mil proUtbly foixit out the 
foreign iHidy. Dr. R. T. Cooper, oTI^Ddua, Eog., haa invented 
a U!fcfu\ Kvrin^ for fonngn U>dle«. The point of ttie noxxle h 
curved slightly, and the lumen for the discharge is eloae behiml 
the point, und upon iht eonvex ]K>rtto». The pcnnt ih iiitroducnl 
beyond ihe object, a light prrSHure keepfl the crook against it and 
I)rc\'cnl? it* movement fjtriher inward, while the ^In^mi flows 
past, and exerts iu preauiure from witliin ootwards ujmo tht 
object.* 



mm 

irtrf 

)So^H 



' 



* ClinL-Al Leo(()r«» upon iDflniEiiiiMlJoii uiid Olh«r DiwjMa of die l^r. Bj 
Robert T. Coupcr, AB^.H-DtPbiiidAn. DiM!Meiof the Ear, ly^ndon lloaitt>- 
puhlc Hutpiuil. lloaiwopftihic Publiahiog Compau^, Londoo, Eog^ I97V^ 



TEKATUBUT OP fC»BVr09 BOD1B0. 



157 



i 



In cape of solid bodies, a stick with one end covered wiih warm 
glue mnv l>o ininxltic^iid i!imtij>'li a ^[Ksntlumnnfl kv{it ai^niniit Uie 
obj«et in lh€ canal UDtil the glue U cold, and the obje^^i ih last^cieil 
lo tL Then the «tick Ami foreign body cftn cAen be mnioved 
logetlier. finudl iDfteeta in the nurlicor^' canal aiv enMW yra^Uetl 
<«t LaTgcontfirequipeahttle extra cottsideration. The«j-called 
forwii; \tayrhpMln] niivJy ^i^ in tlio aire* I have \W\r\ wvrml 
years in the tropicfl and subtropical regions, where iboy are quit* 
nunierr>t))Lr and ni^ver roct with on inj^tniiw of onr entering f ho «ir, 
Tlie beetle (i^iAtoptera), and the bug {hemiptet^o) are ibe {le^ftstbut 
miwl into tbe mcnlU8, dowrr thecunul^ and bitrnping thfnranleniiie 
and h«uU agaiost the membracia lympani, drive the jmlrent nlmc^ 
fhmlk. The more oae trie* t« p-i ifiem out, the iMinUr tijej' hold 
tbecii»elvf0 hy their boohed Ivgs and mandibles; they never go 
hetrkwan! voUiatarilyp and cannot be nuifIvtodo«o,€icept byoust 
Ateel persua^on. 

Whiij an in><ict of one cf tbe«; ortUrft gets in the *ffr, tlie first 
thing is to kill it, as its movemeDts muse aevere pain, and may 
ict ft ebild into i^oiivulsion!^. Fill up the ear with olive oit or 
alcohol. The oil will olog the Apimcl<H and asplivxiate; the 
alcohol will permeate and coa<itringe the (is-'iLies, and proiUice the 
aamv ni^alU Then use the s>'ring? and warm water fiivt, and 
this f^liagp extraet the inAeet with inMratnonl>4. 

Dr. J. S. Boyd, of New SheRif^td, Pa., sent tne a patient from 
iheenTintry, with a dea<] bug ih&t had been in hifi ear t*'o daj"s. 
He lunl vulfered j^*at pain, until he bad drownul the niiiinal in 
eoal oil. A diatrefiainji; tinnitiifi had continue] since, with slight 
pain and lieut in the can I fonnd a beetle at the inner euil of the 
oami, wjlh his head pushed into the an(i:1e of the anterior lower 
wnil and the tyrnpiinio ntcmhmne, Syrin^ini^ faikxl, and iiistm- 
meots were necetisary to detach and remove it. 

lU^^tH lm\"e oft<'n Ijeen developed from c^^ vrilhin a dirty 
suppurating ear. They are ea>4i]y removed bv filling the ear with 
twt«t oil and f^yrinpn^. A German physncian reported a ease in 
which he hod tied a piece of fresh beef ovit the Crar, and in a few 
bours rerfto^^ed the meat, containing all tlje ma^gotH. 

Suppose the Ganal is bloody, excoriated, and swollen from 
attempts of friends, and, perhaps, an incautious phyBioian, to i^ 



lOS 



TBK UUMAl 



IKABB8. 



move a foreign body, wlmt i» lo be done ? Order (lie ear syriDgcd 
throe or four times* a day with lopid wjiUt, np}.il_v u Itghi Itiip 
|>niifcl<'e for juin, give Aif^iiiie, Arnkii, IVlUdonna, or mbaterer 
medidnc msy be indic^UKl by the flvmptoni*, Bttd advise (nticncVL 
Th<- itifliimmuUti'v ivtiction will mxm Miljc^dc, wlien th« menaares 
advii'cxl Ixxfore will probably relieve the sitflbrEr 

In thene cAM^i and in l1ii>^ without auv innAnimatory »yni 
tom^ kIioiiM |RTriij<k'ni i4ynn}{in^ nmi ordinary iD&tniiDentatioa 
not a'lieve, an aural surgeon should be caUetl, who, with grciucr 
ex|wrienct^ and a vinxrialipit's r^ct uf in»tn]n>ciit0^ may make further 
triaJo. A number of very Hue st^l prot>a4« with oi»e end bent 
at a H^bt aitf^le very ^^bort, nrc very ui^ful fbr cxtraeting oljectft 
prf»iilir>g anglofi and deprft^iouji, 

A hani fom)^n body raroly litM the canal c1o<cly, there b a jtap 
anmovvht'ro amiind the peri]>ljery thnni^h which om* of than 
ftlcnd(T ]>roU^ may be piiw<.Tl on (he Hat, tiie crook can then 
turned behind the object, and it moved outwardft. 

F10-8T. 



res 

1 

fcr^ 



Cifcow'a Foacicra. 

Crow'fl forcvpa are Hometinie^ wwfuL 'ilie loojied ends may 
be worked beyond the foreign UKly und then oUj>tccl nnxiti<I it, 
u<'t iiii-nwsin;; it*> thJoknt-^^, uml tljen wiibdrawn. 1 have uf\eii_ 
succeeded by Uicse meau^, when vniaiil ini'thods have fHilcd. Tfa 
patient vnu/ ke«*[> <piiet; a diild ^loutd be ethenunl ; excellenr 
i1Iumii)at]on ly the head mirror i» neccflsiry, and ddkac-y of in*- 
atru mentation a «!nf qnd non. 

The ufie of inntrumcnts ifi ju«ti^able, even, when the fordgQ 
body \\m p;ttcl»e<l the nuddic i-aVy proridrti it nm be m^iu 

AiteinpU to remove objects from tbe car without siting Uico 
are unjustiljahtep and Iuist liad the saddest consequencCA. 
auditory cwial and middle ear are too ae^ the brdntobopui 



CBItDHTV09I8. 



Id9 



nl luiplmmnl. lu « vw}" tVw ctiKc^, *ho M-riti^i\ forr<']j>, liiH>kj!i, 
Ami jimlx^ fail, ami a button, bead, |>ebble, or bean Jefy all 

If tlie m^iiibruiia tyjupatii ia purfvralei], jxiw^rrul iaJlulhms 
ttintiifi-ti Ihr Kiirtimlnfiii niW should Ik* triwd. In cawfof ("jiilurcr, 
JDtrvHluce the i^usiachJan catlwier and iikjei^t HiiU) intn it, iJirou^h 
Ihrlubv, middle i*sr, and rxrrriuil canal. Id both ol'thuw ^f^r% 
tilings have been foni^l r>ut ^f the middle <^r and amlitory eanaL 

:?lH>tild an oltji^ct be fratij^tble, such fu^ a ifry |h.-u, or UiiDf and 
Uruily Hxed iu (KKJiition, 1 vtouhi niHinuniTitl the tiBc of the 
Brwrhct £^w drill, or the Pcntal Kn^n^ cirill^ lo liviik It iip, 
dinduinh \l» mllbre^ or fiiri]i>h jilao^ f(»r honktii^r, aa in jndk-ioiia 
hand&&iich drilling; is leg^ daii^nttia than the remov-al i>r i'JCocj- 
tUKH from llie c^nulp m>w n ret'ii^ni^oii (>|H-ru1ion. 

It Uas been reonrnricfided in diftifultca-'^efl to detach thi.^ auricle 
from the <viml jvm Inhiml \ht concha, turn it tWwanI, und then 
proceed with iufiirumenta to extract the oflendhij^ body. Une 
mt^ht do thin lorn d!i};^r'?i lioiiit iir a pistol-ball, biirk-d in ih« 
Uiiic; but not otli€rwi*«, a*» the arlilioial n|iening funnHhw no 
nor<< mom for manipulation than tho itattirai one, and the ijlood 
ioi^rfcres with [>ropcr \^'ork, to my nothing of the piitient'ft suf- 
ferings. 

irtlii'forctf^b<xly''annot bcnrruovcil byanyof tlut«nioa:<iirM| 
leave it in, and keep the ca.se under oli^ervallon, tjtl 8onie Intnre 
day^ iih<*n it will n>nie out, |K'rha]>«, fmm the i>^iinpU^t mtiL^tirea. 
Kemember the numerous iiHtant^w njion re«>nl, where viirioua 
(liinf^ lia\~e rcmaincl in the canal and, even, the middle ear for 
a long time wiUiovt doing iterious dnniage. 

I know tranwitlantie nuthore teach the use of the ^Hnge almcet 
exdusively lor foreign bodies, and ihaC "all in^itrumenUi are full 
ttf dnnpT." Thi?i i» good advice in general, bnt 1 wmild recoin- 
mead the use of instruments, in removing foreign bodUs, to 
MippleoMMit the «yring<-, and to eupplaot it, aa good judgment 
eliall dictate. 

Cenumnona. — Tliisdii^ease occurs in youths and adults tad 
U rare in children. It aflect^ the clnan and comfortable per^n, 
living ai Gflffi, a« well aa the mechanic, exposed to the Aunt ami 
dirt of work&hopi) and mills. It aocma to be more fre^juent in 



160 



THB BtrUAlt BAR AlfD tT0 DISSASC9. 



the biliom, than in otijer tem[>«rami>ms, and Uof^eii dvmptr>t»itia 
of lymimnic dt!M.*n^. 

formal c«rumeD is composed in 100 parts, of 10 jmri/t 
water, 26 of fal, 52of ati oleatcofpoEai^Mum.iiml 12 of iivtolul>)e 
orgaoic mamr, pontainin^ a little Farli^mnte of catcium atul so- 
dium. TJjc aTumui of ti>o t^ari^n mix«^) proc!u<1 of i'^iiminoefi 
and >iehaceoiis glaociE, with epithelial debrU an;! dirt, W'bcu the 
aeciTtion of otinitnen i» incrotmwl alwvc the nortnal, or il ij*tiii- 
healthy in it» comprHitton, itA removal by de^iocalioo, oontraclioo, 
and fulliof^ out of the RioatUT«, aided by movi'minl^ of Ihc jaw, 
as in lienltli^ dooi not take place rapidly enough to relieve tin 
ear, And it a<^<i]i[itilat(« in tho canal. The aoctimulatioa b tiMiall; 
alow, hut may he very ni{>]d. It formH a liontc^eneous msRS or 
tn aggregation of »i'v«rai layers. The niuM niuy fill x}w lumen 
of the canal ; become augniente<l by dirt, hairs, epithelial »calc«, 
and fibr» of linen fnjin the towel ; work" irwank lowanl 
membrana tymjuinij and, perhaps, take an impreeBiou of JL 

It ntu^v a Mopperl-np fevling in thti ivtr; cnc*king MHii 
Bometini(4i, wken ehewing; an itohin^ ai>d fulness in tbenukal; 
di^tre^^ing tinnitiu^ of^en, by ite procure inwards upon Uh: mem- 
brane and ehaiu of bones ; s^ertigo, siinietinieA of yoara' duration ; 
dry, appjirently <flu»cIo*t ("on^h ; derrnruilis of tlK cinul witfc 
thickening, and is aocumjianied by deafncf« and occasional poin^ 

The padent scratches the nientua with hia finger, a match, pii^ 
or pencil, and causes thicki^ning of the xtcin lining, lie cu 
frequently improve hU hearing by acuvely shaking a filler 
prested in the meatus, eib the cerumen i« often dixpta^'ed, leaving 
fl poMiage (ioviU to tJie nienibnine. A i^aiuage may exist to the 
meinl>rftne when the oanal is nearly full of ccnjm<*n, when t 
movement r>f tlie anricl^ or jaw may e]o»e it, and thua bring on 
audden deafnceg, Outfiide muod^ are eut oil' and internal ono 
intenfiified, m that the eooing nirih of the carotid artery cttrreot^J 
is heard, in sounds nynelironons with the pnl:^. ^^ 

When the wax ia hard, and pre8»eA mueh upon the metnbratie, 
it producer atrophy of its membmna pnjpria, ulcrralioo of iti 
Other layers, perforation into the (ympaiium, the development of 
pulypi, and a long array of (implications ; it (ioti been ktM)wn by 
pressure to cauae absorption of part of tlie bony canal. The 



Cllli:MTlt4>BlB. 



cemmen doee Dot alwavfi take the ^hnpe of a pla^ , but may be 

Jied lalo varioiu sha[>«» ami piHiiiufut liy sm^mpM at relief. 
It may cover th« membrana tympani and tli« walla of the canal 
llk« a cnat^ haid and diffiouU Eo remove, and «)in<:timc» to diag- 
nocw. It29 VanVf soda, and (lolafth may form ooDcMions of stony 
barflne¥«. When Oie rac^tuuH-oii^ gluniU arc more notivf than 
UfittaJ, ihi? c«rum«rn U tight-colored aod Homctiojes fetid. 

An <-xric4«(ivv mnotint of (N^Tunurn iK'cun^ frt«n liypcmtniiaof thi; 
iiiianal from local irritstioa or iuHaniinatioii ; tbi^ coogeatiDD may 
idiojutliic, but it L» ofleovr Aym|itotn]iliR of middle car, and 
throat distaws, 1 have penerally found catarrh of the tympa- 
Diim, cofxt5lin^ with mon* or Ich^ liHtalj^^l hvj>t'nriiua <if the 
linmg of the cuoal ; tliie induce slight iodammatioii of theoeni- 
mmoiTs gJaiidft iinil liy|)i^n^^crttiori. 

Tlio anfttomind n^IacioiH hi*tw<<4-n tJie middle ear ami the ex* 
teraal canal are mcU, as Uf preclude the existence of disease in 
ow*, witl^out »otne disorder in the other. 

A narrow meatus in old j>er3ons, from relax^ auricle, and 
alt'^rrd poeJlion of the Iowct jaw ; a tllt'like maHbroiation with 
very IciHtious cnnal ; aii exct^Uv ^^wth of huir in rbe ra«atii8 ; 
and the ppeetiwe of a tumor; all, by interfering with tbespon- 
taneona falling ocit of iht cenjmeii, Hiiriiig movemcnbi of the 
jaw, frequently cnuf^r €pnimiiH>Mij9 from mechanical olw(ruL<tion. 
I have had »ev«;ral e3:aniple3 of ob^niction and a^umulation of 
,oeriinieu from tlieMT cuu>4C74. A ^ntl(.'man and lii^^ dau^hlf-r have 
tianrov a&d crooked auditory canals, with cerUEnino^iH aad alight 
seconclaty middle ear trouble. 

The age of thecermuinoain can be estimated by the condition 
of the oerumen. If Jt ip glutonin^f Boft^ plastic, and of a li^ht 
eliGHtfmt color, it ha^ accumulated rajiklly, and i» of recent for* 
tnatJoo. If it is diill^ j^nimou^ hanl, LTumhllng, and of a dark 
^flbmnat-color, or even black, auJ €t>ntuin» haiirH, pellicliw of vpi- 
jermii and eoocretions of linie, it haa accumulated alowly and is 
andenL 

TrrahnrnL—Ttid w>ft otrmn<n may he removed by warm 
water injections, aidetl, perhaps^ by the spoon^ or by the cotton 
hoUkr, with ttwi«p of cotton twinU'd iiruund it. The latter is 
necesaary, fi^uencly, whea tlie cerumen forma a ien;icious coat- 



162 



TIJS BCHAN BAR A5P ITS DlSBASBa. 



ing upon the wolltf of tlxr caDAl, liat H mi^ht not to he 
over ()k iiiciii)>r&u«. When pArtL^larly aJJicrcot &nd tllfficOf 
of rvmnvnl] it ict t>uflt to iit«e a .^voliitioti of blcnrlHittiktu ijf tfuiJiuni 
ill )i;lj«erme nnd wnter [Sodii bitarh, gr, zx, Otytxritic^ A^fUtx tiftL 
i» fJ^). Iiicliiic thtr |]MtJriit% liivul t>wunN Oin uiiiHKtiti" itlioiiU 
clert Hit tlietiuiial of ibe £itrt.vt«d car nilLi thU Aolulivti, utid InAd 
it in ft^Rvominotcs every iIav, Continue Uii* Tor vic%fTal dar%J 
tlttii »ynn^ villi tvaria \fat('r, and uee i[)»lriimeubi if ueuded. 

Hiinl pitipt of cvruiuurj fr^|ueii|]y ndWrc cIom-Ijt U* Uic cmnli 
aiii fill it from m oirtila^inuup^ portion to the inmLbrane: On 
M 'ilVeii n»\?vtitiUi.<tl to rrmove iUn^a nt ont< vi:<it. Try nyriiigiiig 
witlt uariii water, then, H ntceff<iiy, use tlie apov>n, prober, umI 
forcx-|H to luupteii uihI bn^ik up the Jtiim. llJnmliuiIt- iIm- mtinl 
willy and bv <<krdul not to injui'e the canal walle, Syringe af^in 
forcibly, iiihI ()!«e (lie ?^M)n and dih>ti,'tl ^tvtrrim* if pitiIihI. By 
wurkin^ with iIk* syringe, ihc minm^ i[i»4iriiuient«, and ibe sol- 
vent, Jur^ mowot of denw cerumen iimy be removed, and the 
<*aiuil ekured ^ntly*, safely, and tbororighty at one Mtlmg. 

Ii iH |{enf!ni]iy better not to lie p«rticiLlar to remove every |iar-1 
tide at tbe lirit ^iice, as fbe lining of the canal U moUc aud 
jrHlnlde, and t-xcvirinlion^ (nvnr ejiflily, Wlien there h no ibec«»- 
9ity f>)r hai^c, let tb« patient use the t^oda-glyceritie eolutioo one 
A ilfty for 11 while, uiid return n^in, 

A llatce upon tbe dnim l^ead will olleti cause a cotktjnuatioci of 
tinnihiA and otbtT »ymptoin8, Allcr rvmovinf; a plug of o(d^ 
dried cerumen^ there b often found <]uite ao acciimuUtion of 
white {)elIiHe« betweetr it and the caniil, luUii-nng luorc or Um 
olof^ly to the latter. They are «piderniic exfoliations in plaques, 
and an; frcfjui-ntly of ii *wapy feeling and njwty ftliil wlor, ThoM 
should be removed with the fon.'epB, If tbey continue to form, 
frcirn hyjH^rirniin or dermic inJIuium&tioii, Ihc uurist should 
bntsJi the canal with spirits of camphor (jfK Ckunphorm), or a 
solution of nitrate of Hiver \ArffnU. nit gr. x^ Agua dfiri. f^), 
and continue the fioda-glycerine instillation once daily at bomei 
Thtsf nioa-iurt^ nill gencriilly eure the «^kiii dbordcr, bat may 
not arrest the hypemecrelion of cerumen. J have painted ths 
cunal with a svJutiDii of nitrate of silver {Artfcnt, nit, gr. V| 



TTEEATMRXT OF ClRrMTVOaTa. 



163 



liM. (^j) with f»irAuec«^«i. 1 Imve ti^ecj Ihe Phoi>o}-Snrlii^u<; 
anOilut^l, In the atme vray, three timeF a w-^tk, with the n^nU of 
ant»tit% in j^niffca^e^, Fh« f'K<M^Lve gfundtilur iK-Lioii- A mer- 
Giiry and vafelia« ointment [Ilyttmrg, oxid. rub. gr, xx, TciJi^w, 
.^j) i^ ■ vtiliaible loctil remedy fur ext^e^ive prmluction of Elit* ko 
bticeoiis gUnds^ fumbliing a pule yi-Iluw fmppy cerumen. At 
tlicuatolini«f I luiv^e ^riven certain medMneu rneE)tioii«HMioli>w. 

When the meiDbraiui lytnpani h«» bcotne involved with the 
mnni wall in a soluK-otc intlAnimaticin, it lias lo^t it£ nonnnl iMiW, 
and iiccoiue ^tmewhat hypcnermio and dqirt^^^'d. Whether this 
oonditt^m dqietuU ti|Hin pn*«un:t of iH*oretionfl in the '-ami or 
tioexifiliuf; middle ear ufTcctium, the rympanurn should be inflated 
fort wcffk or two uftKT removal of the eenim^^n, in owlvr ut re- 
lieve hypen^mia and pn^h the metnbr&na tyiii|xini nnd the t^hatn 
of fiw«iHo4 intn [mi|*er (KMition, iind ihn^ Mlrvt* tho pn^:4<tiri- upon 
Uie lahyrintb, the reHulliug tinniiuH, and other affeclioiLH, 

(.H*CT of eeniminc»i« of not long eontinnunty jirc very nra*n- 
able to trvatniejit, and unk*8 there is some deeper compliirationj 
the rocTivery of anml intc;jrity will bf* perfi-ct. 

CfncAotui prrxItiiTTCju'tivv hvTHTa<ini:i fif ilu- wholes nuditoryap- 
parUiis, aiid ifl ^peeially n^M in cxo4«»ve activity of Oi« ecra- 
inir;o<]F< glamU. I hnvi- il^hI It exdn-MV^'Iy in thiii anV-<-(ion, and 
am Kiti«fi«.ti it a one of the ni>::rtt ii^efu] medicines that we have. 
It K mor« ailapteil to adiittA, where Ihe eernmen \s dark, thi- tem- 
penment bilioiiH, or there is a midanal cnrhcxiti. Ar^ the hyi>ei^ 
«mtA in the canal in mo^t ois^s of cernminoi^iH coexists with (^n- 
|[<9Stion of tlic deeper purVs of the ear and tinnila^, tht relation of 
thr nietliciiM- to snrh nv*'^ is readily appreciated. 

PuUatiUa lias proveil eiir:itn*e in gntlienti^ of lenco-phle^matio 
Ifmix^rameni, *ibji'*t to frt^JiiicTit c«t»rrhnl jittiit^kv, and with the 
oerumen aUmdant, soft, and yellow bi^wa. 

Arw^xKitm. — When tJ»c mntuiS i» dry and i*cnly, the ocnimen 
& dark and forms slowly, and there isdoafneae and sulmcuEc in- 
fljminuilion of lh« middle ear of loii^ duration, An^eniciim long 
CiKniniiiHl. will refttoiT^ the oeruminons glands and Mninu^ of the 
niaituft Ic healthy art ion, acid iHtnclH iIh* tynijmnic atli.'ction. 

Jft'pftr. — In some cases, the eelMceoiia glands are more at fault 
than the cerumiiioiiM^aod the accnmulation in the canal is whitish 



TBB nUHJlN BAR AVD ITfl DIBBAOXS. 



fellow, moiftf unci ft-iid. For thi# coDilKioii, iherois nothinf; hdirt 
than lo give Hepar internally, cleansing the canal with Lkj, Po- 
tJi!«ii upii ootton, ami n|>[i]yiti]£ the menmry nml vii^liDCointmeni 
daily. B^ond these n^medips ] have nothing furlhfr to c0er in 
thM oonneotion. hnt I nsHiire my ii*iu1(m«, tliat the abnonDul tc- 
tivity of the glands of theexlerDal aiidTtory cau&l can be arrertfd 
by |H'r^iMi^nt I^^niI tiD<I irttrrnnl rn>uEnu^it, 

Acute Dennatitu of the External Auditory Camd-— Befiidefl 
t])c niil<i irifliimmution of xU- i-xti-rntil atiditory canal already 
detdibed, there are others peculiar to the rtgion, whidi reqaire 
Special coneidc^tiuD. Acute- donnatilli^, ^njirrJiml inflnmaialioQ 
of t)i« canal, or external otitlg, ie a discA^e s\ti ^enfrh. It is often 
ItEaiiKtl to ihu (iirlilAginoiH )H>rli(>n, bill may txStxt tiic wbok 
catial and the flurrace of the membrana tympani. It is fatiaed by 
€olil» uHlctiooJiof the throat, <rryll)cnintou» d]»ai«C8» eotliug m 
water in the ear, dropping in variouH kinds of lotiotv, scratching, 
picking, and l«>anng the i^kiv by car apoow, stidcB, luir piii^s ^ 
pencils, and by the dcvolo[jmcnt and growth of difiVrcnl x^arictia 
of a riing;ii!icallefl AnpfrfjUfHU. 

lis acriive period \^Xs from three or four days, to two weeks or 
more ; it may become clininic, and i^ontinue for nionllis or years, 
wl^en censed by erythematoiiH di.^en^e, ty]ihm{| fever, and parotitis. 

The diecflse begins with heat, dryno^, fujneea, itchinjti burn- 
ing, and i«li|;hl pain in the external auditor}' canal. An ignomot 
patient will do nlmf^et anythin;^ to rtticve the unnoytnK itching 
ajid humifig, and he ^^rattlu^ and tetira with i\tt (\rs\ thing 
handy, a match or ]>cnnl, or he drops in some cure-all nxxmi- 
memied by Mother Grundy, and iY\\\^ agi^ravaUs tlie diaease. 
Shooting }MiinHj not very wvere %iV persistent, now occur; the 
canal lining l)eoom<s swollen and very wn^^iUvi- to tike t'Hirh ; the 
eanal is dtminislied in diameter, espedally, at its deep portion, so 
that tlie membrana tympani H slint olT from view by folds or 
ridges ; £ind iIktc is flight fever and hftidacJie, AVheii the oGeeoiM 
portion of the canal and surface of the membrane jwrlictpate in 
the inflammation, the pnin is more severe, and there is Itnnitn^ 
vertigo, and deafnc^iA. The B:landH of the <iina! pour out a soA 
yellowtflh'white mixture of cerumen, Hcbnoeous matter, and ttrniDt 
or of creamy pus sometimes showing blood. In soma caiea, the 



ACtTTi MHMATITlfl OF TAB jlUDIlOftT CAffAL. IB/J 



Bero-[>QniIenl diaetiar^ U f|ULtefree. The epithelium iMM.'omes 
>o1>, mnistf and thic^k, and may &c|»anite en masisf from the derinia^ 
r^semMiiigdirtv ivhit«![Miper. SometimGaHulemftj^K^nrej^ynii^cd 
away, that are tdoa^ht by the aDimtiatcd to be wade of paper^ 
vhicii the petieat hjts put lo the oir ami fur^otCeu. Uocwioaalty, 
dark pullac«ous mastfcs or dvnm librillatud «hi^c^ (x>verc«l with 
black Holfi, ding t«iiiiciourtly t^i the canal or meniliranc, ami are 
rcmov«d with difficulty. They arg <?ompo*Lyi of the myoelium 
and frpora of •otnf vnnuty ot Atprrt/ifinf^ n. kin<) nf motiM, which 
has either cauaed the diHeaae, or become developed ia the nidus of 
inflammalory dubiis^ or iti olive oil, dropped in tor earache. 
Wheti lh€ dijciic u ctni^vd \yy the poraMte, it U calted Otomyeonfl, 

If the caoml is cleaned out aiid i*£amin«i ut thi^ stage, the 
waUa are foufnl covered by a thiu epidermic, that in pink in the 
cartilaginnii^ portioo, and cherry red in the cwHX)it» ; the mem- 
hrana 1ym|)ani t» «f dull, ditliLHi^] rc^l, with ve^^^la running upon 
it from the periphery^ and a Htreak of them in the position of the 
malEeim landle^ but the pnx^cw of Ixme oannot be di^lin^uiih^dr 
and the li^ht tnunf^lc }a\s disa[>p<.'urcd. A |)crtbratioD inay eiiait 
in tbe mi>mhnuiv', and the tymfianum Ike dimm^ |iniQanly or 
secondarily to the disease of the canal, cepecially, if tbe patjent 
has sfrrofula. 

The^e eonditions are gicueraliy prc^wnt when the case ha« run 
•evemi ilays without trealnient, and the mixture of H?ro-pua, 
glandular cxiHUliciiis, and epklcnnipti»^u<-had filled the canal and 
jirt^sed inwnrd agaimt the membrane. 

One mtMt look i<liurp af\er granulations, [wlypi^ an<l perfora- 
tionii of the membrane. The bony structure may be inflamed or 
ID a condiliMU of corn's, though ihcau ar« rare oomplicatimid of 
simple attacks In strumoua coastitutions, one may have grave 
)ciionr4 ai>i>miHinyin^, vrhiuh I f^hal) mention later* In inihler 
ca.m», wherethe exudation and exfoliation have not been so great, 
the O6i«ou« portion of the caiml, and tla-: inembrnnc may be only 
t litde liypeneroief die pain trivuil, the mallem aod triangle 
pbuoly visible, and the iK'jrinfi; littlo, if any, aflected. Tho dia* 
iftM racniblea eezeoia Atjuit^wliat, but dtflers from it in ita exuda- 
tion, and lIic ah^noo of vesicular eruption and erust». 

Xbc inBaiunuitiou may »ub8ule fi|iontaueoudly witl^out treat- 



166 



Ta« ncvAir bae akd its msiasbs. 



mem and leave no se^iieltt^ bi]t such a re»uk is eicecdingly nre. 
It has beeD my expcni.<n(^!e t4> 6nd two db^tiiK'tly dvfti>cd morliid 
ooiuliiiocis of the au^litory caital, cleiirly tnio^ble to the excenml 
otitic; one remltiiij^ rnmi rnilil utlat-kn, iiiid anolhcr from iM*\'ert:| 
on«e. Chronic Dermatitis of the tawal is fltiffipiaitly esijraeive 
of one kiniL, ami Chronic Advticid Dermatitis of th« olhi-r. 

Trt<Untent. — The very first thing lo do ts to clear out ihe Aoili* 
toiy oina) by a gi^ntk- and |)roloi]gt*d eynngiii^, wirh a wsmi 
detXKTiiou or hn^ {tfurauluti}. Tim irill ivmnve malerbl iti&i 
ob«tnict« tlic vkWf ami, {HThaps, pnven; upon the nicnibnoa 
IvDipani ; Bootlie the ear ; and relieve oongetliun und jxun. The 
cuniil should Ix* drkd out with ab^rlwnt cottoQ, and a Wttlts roll 
of RiaAlin emeareil with cohl cream, be pre^Mxl tti with u probe. 
'l\m should be n-niovi'd and tlie canal f^^ringed with ihv warm 
hop tni^ throe or four itmeH a <ltiy or otlener, if the \mn or tn* 
flammatory prodacta make it nece»«iry. 

WU«ii ihu pain is iteven, n htn dtvtKriion of poppy httda {/ta-^ 
paver) mny Im? used InslcwL of hops. If pain is ^ilL pcrHstcnt, 
put a grain of Morpliia in a tea^poonfuJ of hot water, und UiiUll 
a few drops every GAeen minute^ or apply a hep poultice wet 
with lauLhukUin over tin* ear, 

ii^hould ttjo Aspergillus fundus be detcctal by the mirroecopel 
in tilt di--i('hargi-Mr and lh<t diNC^uic HH-ni to de|)eiid u|K>n ilj> prn* 
ence, if the Byringing dooa not defitioy it entirely, as it ofioi 
dott<r strong alouhn) mu.^t l>e (Kkured in the ear and allo^^ to 
remain a ^lii.>rt time, or a KuUilimi of hypocJiloratc of lime (CW- 
cfi htfpochhraji gr. ij, A<pia f.^i) may be useil instead. After 
the parasite ia killed^ go on aa usual with tfiv appropriate- treat- 
ment. 

Aconite or Belladouaa* n<Hy>r(ling (o the indirationfi, dioald bel 
pveii freely in water. For an wluU, put ten drops of the tino- 
turo in Imlf a gla-** of water, and give a tea^poonful every hour 
or two, until the pain diminitdios ; then give it lose fn'queutly. 
The patient hhouUl be kept in a warm room, drink 4|inonade 
fretOy, and havo the diet nwtriwod in n-^rtinl to nieiU;^. If tin- 
niliM luid deafntK't are marked, an inflatiou with the air-bag 
ought to bo given, at first, once or twice a dny. The mciubmua 
tympani dJiouId be examined doaely for perforations, beeaaae: 



ACVTI DBRHATtTIf OP TQK ACDIT0R7 CA^TAL. 1Q7 



BOmetimes fliAcoM? of tl>e niuldle ear niay Ix^ Iho caum! of tlie »« 
lenm] irvMiliK^ aiuI an cxcormriri;r fli^c'ltjirgp pafi« outward thrnit^h 
an ob^are perl'onition iti tin* mciithmne, Siirli aat^ ix-fjuirj 
riill^Dt Irontitvpnt, whi<^h will tw^ fvural d^scrib^ under Aculc 
JntUmmatton of ilie Tyiii|Hiiii]m. 

IVr1V»nilU>n4 urifitij; from i\w external Sis^iiue dcmaml raore 
i^rcful Hvrin^ioi^ aud \&h of iu li> ntm tl>c onhviih portion of 
ihie Willi i» not vciy mntitive nor much stvollen, push a piece of 
abMritcnt (.^oitno, t^meurerl with eotd or«in^ iU>\vn lu x\n* racm- 
l>raiie. TliU ki.i^|i« ilio membrane crkTii] ami favors Lisling. In 
one49£^ tivate<t, the roumi |terforati^ti elwwl an^r two Apptim* 
ikitK Tbw piwki"*f \f tif\K\i isiK^cvfeful in clwinc; the hole in the 
cfin>iiic fitage. Small [ht fonitJoiH of the n>eRil>r»nL> shotr a ilnrk 
«pf)4, 1 bole 10 till' membruiief and darkness beyond, like the* pupil 
nf tiw eyv. Ijorge poH'onitionH pi-nnit the nwy niiti ^m^littKtt 
gnuular inixr wall of tJie tympanitm to be treen pbiflly. An 
iticrniHc of [Icnfiie^ and {mlii in^ tlit- cir und vide of (be limd m 
guod evidence thai the middle car is attacheiL 

IVrforalioQ of the meiubrane may be deteelcd, when it con not 
be ^^eeti under good illunnnnttoii through a speculum, by iiitl:i[ing 
with tbe air-bug. If jx^rforACioa exir^t^, th« air will \iW or 
wbi^lte out of the hole. This tan l»e bean!, ui>d thef>rifi<?e frumd, 
\yy obvervin^ tbe membrane while ibe |)uticDt iuftatcs by Vul- 
Ba)va*H nietJHHl. 

Swnetimw the nciite demmtitiSf inslCTd of advanrinj^ inwnivl, 
exteiuU dee}>er into the t^llular tiBHua; the canal lA^alband ^mrM 
jirr>und tbe ntiricle «well non^^idcnibly, and the vti§o advances into 
one of pble^monoiifl inflammaliou. This requires |HiulUoe«, iu* 
Guioi^M, Hepur, Mercury, etc. 

lUtltaitiUa is fin exeollt-nt niedit-ine after ihe primary syruptonis 
of an toute derniattti« huve pii^ved away. It b nenlef) when llie 
inHammatiou has invaded ihe niiddle c^r an<l fbhjat, and tbire is 
a tnie mucous catarrh, indicated by the light blaud dij^cbar^e 
Inmi tbe ear ami pharynx. 

Cfi<imcmiOa. — Wbfu the dij^'hnrge is sli^bl, Ihe imrn nioflerule, 
and llie re6tlesene«e and irritability are out of all proportion to 
the aciml aRectton, a few dt»i'jf of Cliurn'tmilla improve tbe con* 
diiion of the ear, end act like a charm upon the nervous s>*slcni. 



168 



TBH 



UR AKD ItIS DISlASBd. 



Hcpar is ti8t>(\il id Mthqiouh ronMituiIons), where llie iiaeharge 
from the eir causes an inuptioo vf vcvicJr» snd piiT!tiitc», and 
breakft iti tbc »k1o do not heal raulily, hut iarliue tn tilcertto, 

OxAiaroaca^, 19 occoMODalJy iti(lkiUi<d iu ffcruTuIous ptlkttuj 
with mARi^iniL-i, debility, grcnt wniiitiveneea tocokl, and liabiliiy 
to take cold easily. ' 

The oonge^tioti, IncrecL^ed exfoliation of epitheUum^aDd hy|>er- 
Becretion of the gtandi^ ^ruduAllv dimiub^b, if thi* t<amil i» iftmvd 
as detailed, and tbert «tynii^in|f once a day with Hmp]« t«^>iil 
water, and applying a fold of lineo covi-rrdwilb void creooi will 
baitfen the cure, ^loiild ihU and internal laedicatioo not suffice, 
ono may try a lotion of flugar of k^d < Pimtthi acrtwf ^. v, vtyi*o 
ffrjf. I$i)^ ^\val>l>ed over tJie canal with cotton on []>& boMer, 
wbidi 1 have found an cx<«IK<nt fttiniulant to h«-allhy adinn.] 
Thb Diay be wnriucd aod a Httle pounx] ia tlie car with a Ia- 
spooD, and alluwod to rcniuin H*vt'ni] minuliTit bolon; rem'tvul,. 
but, ia case of perfomLJon of tlie nienibrane, tliia la£C method ol 
apf>licttticin for obvious rvu^ons U in?ipproprifltc. 

When ihe wall recnainn hypenemic, the by|>ersecretion and ex- ' 
foliation moileratc, along witli too muoh moisture, a fiolutioD of 
nitmtc of j*ilver (Ar<;mL niL gr. x^ A^\itt iirtt, ISi) ftbotild be 
applied to the walls with ft>tcon or a camdVhair brush, evefj 
day or two^ till ImprLiveiiicnt ts manifest. I'dxUlence in ibej 
mcuaiureE^ laid down will probably cun^ the diasciiaw, but should it 
become chronic, tbc further treatment muet be sought umier tbe 
ebronic forniA mt*EUioiiLH] hv^Iuw, 

Thcfie aUaurkd are frequently indicative of imperfect autritioo, 
and where repuir t^ not pri>ni|>t, and tlu* |iatii*ot doi'H out tttt aivl 
digivt well, X foMjueutly pre^^cribe a little of 8[x^r's Port Wine, 
to be taken with Ihc meal^ 1 bclit-vft t]>e um? of wine in the 
trcatmentof fioniediieoii^bDlh rational and 8cientilic,aJKl though 
my own hnbttH are almost th'>»e of a leeiotaler, I believe tl>e lu- 
fluencc of refurmcd drunkanls in the cm«e of temperatioe has 
scared American nkedj<<al mi^n Into intemperate abr^liuetKie from 
good remedies, which our trnDsatlaxitii; brethren find &o beneficial 
and necvflK-vry in di^ense, 

Ohronic Dermatitis. — This diacafie of the canal u frequently 
a sec[iiela of acut<; dcrmatiliit, aud of vezciuA^ but may arue idio- 



CnnOtftO DKRHATITIB. 



IGU 



pfttliically frofU ayia^mihy willi ruidille cnr iir tlinut iIiNHMr. X 
have ecrn tliU nuMl frvi^iR-nily iu the biliou» iiiitJ L^aiplmlk' ti:ni~ 
|HmitK-»tB^ It IB (Immc.-Len^t.'d by fulircwi, iU:hui|Ci uu^t JiMXiiu- 
rpit ^f the nr ; ihr uir i« siTiMitivrr to cold, and thcii; b dcalncM, 
UoDitAia^ and li)'|Ha-ln>[»}iy, with t^x folia tioit:^ uf tlii^ i^|i)deniiiri. 
Tlw Wfil1« vf tilt; oiual niiiy nhow tljiri ?cu]i> nnd #1)nx]» of cpi- 
<]eniiictitfiie,ai)d email imrudes of dirty white i^ebaceoaswrumca 
ndbvrvnt hcn^ atid ihon-, Inn tiKr^tly nlouf; tli' oirtibgiuous part, 
and ac i& Junctton with the ogr^eouH jwrtiou. Many of the epi- 
demiio shaiJ^ niiiwt be f^^iud by fi>Txii-j>«, iu i>nli.*r to dcfach tlitai, 
aod iliu fn?t|U4?n(Iy Gaust!^ bleeding and severe jtaio, owing to tJie 
oai^tstiioi) mid hy|»eni^rliot» of tb« c^timl. 

Tli«* u]>idi!rml^dcrinif^afidi^ii1>cu(£ueoiifi(,'ellular tif^Bue in some 
CMC* are coo^id^inibly ihickeiiod, Bolhut ihi- canal ia mrrow«l 
into £trictur»f cKpecially^ at tJie juocliotL of the cartjfage with tli« 
boin\ uiid tbo Htirfiice hue a bard, roii^h fut-ling, when a protxr is 
drawn over it, much likt that i<onv«yed to lh« imnd by dnx^tig 
a lead pencil over tho outf^ide of a cloth-covered book. This tru« 
hypnrtiopl»y IooIca simiutliing like ooan»e yHlow iaiiil-pa|>urr is 
moai rebellious to treatment, and takt» the name of Ichthyo^i^ or 
Pteliydermatiti^ 

Hie luembrafiA lympani ap|>earH atxiut the mn^e la tlK< thnHi 
eiagof of dcrmatitiH; it is dirty white, dull, and 0pa4iue; the light 
i^mt t» dimiiii^iod, bioecK^I, or oblitemted , ^><^ mallcuK luw a 
citable It^Ui^h of veweU along iU handle, and around the periphery 
of the whokr fo«mbrai;e a fjdiw areuji scnili* of epidvnuir^ diicken- 
ing is perceived. 

WIn-ii tyiTi|iii»ie di.M^iM' without ]»erfi>nition <Hiexirfe, the nu-iw- 
brane may &bow a dull gleam of maroon color through ilfi postorior 
half, nml be deprftMnl urn), |>tThn|HS di^tortoil in voriouH dc^rrccft. 

When fhis di-tcat^e i*t not treated at all, or is aggravated bv the 
frantic attempts of tlio patient to j<top the itc^hin^, with »,'ar picks, 
ppncili*, tic., or by [louring olive od or glyeerine into the ear 
froia time to time, an accumulation of morbid material otvnn, 
aod bl(M"k» ihr' mniit, f^ lliat the alrcad_v impaired hearing is still 
farther dimioishcd ; but the oaiial \» very dry, utid the product of 
the akin amt glands usually defiiueatea, and shrinks, and aeldom 
amounts to enough to act oe a plug to the meatus. 

12 



170 



THK ntttfAV BAB AKD 



SBASBS. 



Dr^tttmenL — Many works upon the ear do not deign lo mcfh 
tlon or u> givf^ any TrtwtiiM^it for rlitr* ixwiroun <1ii<anler, aod soiDe 
Unit do, rt-Vfsl the [xiverty iri' tlic aiiLliors Uivrapeiitic nmanota. 
The »)nditioii of th« aimil, rniddW uir, and ICti^uu^ibti tube 
should be intcrro^i^ carefolly. OlHrmciions to a vievr of tlif 
membrane shixikt Ix- «}'riiigT^I away by tepid water, and pulled 
amy by Uie angular forceps* The walU and membrane fJiimM 
be el«ane>ct; 4<ofnetiRie$, I wd wtlon on llw holtlcr with glycvrioe 
liiid water^ equal partf^ and wipe them geotly. One caoDot 1« 
too gentle, blxuiiu^e the mcinbniDf; U alway^t very fletk^ilive, aod 
both it and the rni^d lining ai^e hypcTvenaitive in tbv aifettion 
nndcr cfm**idt'ralion. 

If tlie membninir U oparpie and depreeded, or tfa«re are Bymp> 
tom^of middle ear complications^ inflatioQ with the atr-ba^ebwld 
be ^iveii twice n wc<.*k, or dnily, if the symptonu are active atut 
iiuportaDt, 

If the uniml wall ih hy[>enemi<^, o» it Qscially 1% apply aboal 
twice a week, a aUmte of silver solution {Arymt. nit gr. v^ Aq^m 
dt»L fl^j) with a w'cip of cotton, or a camels-Aiatr pencil, to the 
whole diAea^d .ntirfAoe. ThiK reliev«0 the itching, and utimuUlcs 
the i^Uin to healthier action. In the interval of the vWxi^r appl^ 
CHtSoiis, the pntient nmy drop in e<)uat parts of glyoerioe and 
water oniv djtily. VaM^llne U a Ix-ttvr upplicatton, if ibc akin ia 
thickened and roughened by hypertrophy, and not much con- 
geat«d, Jf tl»-re ii* true Iditliyii^is, <lil»t<d liHlim.-(7V, totlinii 
3j, Ale(^hol 5iij) ehoutd l)e ]minted over the thickened part about 
twice a week, and vaseline ruhbcd over nHerwards, Thow local 
mruj^uro^ are necessary to effect a cure, and are all I can recoca- 
uiend from ex[H;neiice. No colion should tie kc[»t in lite trnrs 
ualcea oold air caiiiHisf considerable pain; then it should be rc- 
tnovn] aa soon as the warm liotise is entered, 

Hi'par, — Wlien the car* ache in the ivid, and are very mwf 
tive to touch, the membrane \b opa<)iie and thickened fn>m alt^l 
iaflammaLion of the tympannni, and the throat is frequently a 
little Hore withfiut th«-rrr t^'ing any olijectit'c signaof it, I liave 
found Hepar a most useful meiiicine. Intbtiou should be ptao- 
tioed once or twice a week, or oftener, if the Eustachian ruhe 
does not open treely. Dr. Cooper, of Loudon, has cund snat 



cnitoirro ncitirATiTts. 



171 



ogru« ntfies with Hc|iiar, &« rocortktl in tiis tr^tise, biit I mut^ 
say, Utti m^ f>t>>i'r\'aikiri.4 ii|M>n tliH Applif^tton nf the rtit^iliniK' 
were TCcoriU^I in my ca*e IxM^kn, a year or raort before I had (lie 
plftLMiro of muling Im indlviilufll ^xperf^iut*. Conlirmeil kyy two 
imJopi'iKlf'tit ol^rvDfs, in oameroua cases, tiie medicine ri»» to 
tlie mnk of a ^jietifio. 

CSnchcna. — It has betn ropcatocUy demomtratod titat CiiK-hoim 
pmhirus hypwwHiiu of lhi> midil«ry a|>|uinita^ Gtiidwi by itt 
anral imtbo^nesie, 1 have mw<l it otteii in elimiiic dermatitis of 
ih<i m:ial, vfith nUi€!r WJtive dcti-rnn nation of b!o<Kl to Ibo wull^, 
linnitQfl of lh« ria^ng variety, slight paioit and imlaalionH, and 
an<t>iDforlAl>k' Mti^^iCiiins altoiit the* hniil, 'rh«* dJ4en.H0 is fjiiit^ 
prevalent in ]>cTvon^ living in nialan^il regions, uiid soitk^ of iJie 
«ymiitoin^ einiMK'mU*^! ai^ peritxlically a^^ravated. I cnimot Kiy 
from experknci-V whether br};o lUts^ i»f jjiiinino inktn ft>r af^ic^ 
or tlie niaUrial cachexia often ap)iareDt in the jiatient, la tlie 
cnuBe of the disease in the auditory ramil, but 1 do know, thut 
Oitii;l»ona mid Qiiini;^ i^iilphnle are proi-H n'meilieft in tiiy iiJiridf< 
for itfi cure. The m«liciD« it^ tho ^r^^attjil, the pn?j>Anition n^ 
immatprbl, but tlic qtiufitity raitst 1k' apprc^-iiibicr (o curv this 
mint peniftlfDl aural alTectioti. It Lt a^ttoDisliine; how th(^ f^rand 
cbaractcristios of n remedy will Homuttmue di'scribc a morbid con* 
dition. 

JV«jp roiiiiica.-^rho dii*wwe undt-r eon*idcpat!on oct-ure tiio*t fre- 
riiiHilly in dark biliou-^ indtvidiml-H, w1m> aro hy|>i^Ii^nilriaoAl, irri- 
table, and impulsive. ThL*y have digestive troubles flatulence, 
oorwlipntion, a muddy cxiraploxion, tendency to F^vere neumlgin.'^, 
goaty pains here And th<Tc, firqu^nt c-hi!lrnF«>i, nnd tnniiy of the 
fymptoim detailed above In suoh pernoiifl^ Nux voniitm -Strikes 
the mark !d the centre, and, by improving the general health, and 
»4itunlati(i^ llie vi»o mob^r nervoM of jturelic vc^«iel«,eurc« rlironi^* 
aural dennalitB. 

.Si/tVrt. — When the skin ba;^ l>?come thick and r^URh like hog's 
bide, and partifillyck«ecl iheeanalTSiliceamar be tried, but Ih^ve 
Wi lad nuirb ?ttia\*^ with if. If a stricrnn* <*;c>ht]| in tlie ninal, 
it may be dilaU-d by laminsria {taminaria fliffitatdl tent*, intro- 
dueing a lui^iof m^ i^very day- Ton much kIiouM not be at- 
tempted at once; care mu«t be exercised not to pnah th« lent 



ITS 



THIE OtMAN KAK ATVD IT0 DI9CA8B8. 



Against lliu iiK^mSninc, and it mutt tN> romovc<l for awtiile, if ihe 
pain beci^mcA M^ver^. Itesid^ tlie above medloiiKS, for intenol 
fj^f I hiw^ triisl AiMi'fiiinim, K^ili lfiohmni.f Cnl4«r(ii plios., lod 
Thuja wiUi not eocoum^ng r^ults nnd several others na imer- 
eurn-nr reoiedie?* for lernporary niiKlilionr^ 

1 believe caMuJ attiDiiaii to Ur' local treattnrat, and the per- 
itii^toDt n^ of oti« of the nKxliritic^ mi'jitE«niHl will tn mait two 
brint; about a cure, but dm nifty he ha^teiied by improvod iraar- 
i»hin«m, A trip u> ihc moLiiimiiiH, and l»llli^b^ll*nL of "oirkii^ 
care," 

Chronic Adenoid DermatitiB*— This^lm^aw r&nills grrH-nll; 
fmm an ac-iiic dcrDkatiiirf or ecz^nm, but may occur from Mympa- 
Ihy with inii|(Hi.'i.iir airtifioiM. It t» llw wii^y of tienmitilii 
Bern ID lymphatic lemperanipntfi, and th^ mnimous dialbem 
There i» itvhia^^ fiihic*^, tii](»ituii, nnd datfiiUA*, hue pain b fi-h^ 
or absent, 

Tli« Hurfurc of tin- Kim%\ iincter (Ik- ilU^hiir^ is j^llovij^i f^y, 
or miiy be red, but it in not so nuirb oon^l«l nor ho seofiitive, 
ftBin (hepTec«dii^^4li-i«ifcHo. Soft dirty-wbiti^nhntlTtof oxfoluttd 
epichulium arc found partially delticlied in places, otherA lie loow 
iu the ainal, mingled wiifi pnii, fvtid, Hiooiy, gTttyi^h roftvvfl of 
fiebaci?ou« matter and ct^rumen, ni'ii^teoed by a ftmall qtiantity of 
oivamy \>u». Tlim ^uAV i-iiv<*rs rhir A'all?* v^-llb a. jOAty oxiriiig^ 
acvumnlatof in all tb4> depro^ions. eApedallyr ^^ ^^^ atttirhmeal 
of the nirtila^^'itkoiiA |Mjrtii>ii i%f Lhe nmal to the otveoua priKVfi!^ 
ami may 611 the entii^ canal^ excoriate and cnuM utocntiott of 
tile omul w^lU, and \tTvs.< npon the mombr^ina tympani. 

The membmna tympaoi maybe dull, ojifiqui-, and ibirkened, 
but, if tbv <liMniF« lja.H ejciM^I nome lime witliout proper treatnK-ni, 
it has more the appearance of a piece of miucle. The color i» 
chi*rry redf irnt^idur, find ^trvnky. The handle of tlie malleti* 
am) lijiht triangle have cli^ppL>!ired ; the merubninu mtrt'Cft refj 
elugj^ir^hly during infl:LtIoii of thi^ tympantira of the suction of 
Siegle'a instriiiticnt, and dull tinnituN and d«ftfncn am? raarked- 
With thf^ (Y>nditioii the niitldle ear iL^iially shows a slight ilkllaa^ 
mation, which yiehU rapidly to intlatioo, adcr treatment of the 
eitt-'nial dih^Hf tin.s coiitiaiuxi awhile. 

The sebaoeoutt and reruminoiiA glsiiids produce tlicir morbid 



QKftOHlC AD5BZ0ID DERMATITIS. 



173 



ncrctioDfl very rApi<]ly,&ml wheo ilm m remov^i frequently, ll>e 
lininff of th« canal gete belter vvty toon, so Uiat I am incUoetl to 
oowkltr iboglutulH it-i iltr MHtJiinen^ of il)r Rii>rbii| (?oiiilitioii. 

Schwazbce is unable io ^y wljetljer ibere m |jy|i£-r|>lafiia of the 
f Uml#,oi d«scDCra(ion of the gbuKlii]ar4<i)tlhehtini. Ttic n^amn 
wliy the ^laiulfl are mor^ netive in itii^ alWHon, timu in Uie pre- 
vious o<w, IS round in the diafheMs of ihc patients, wlio art- stm- 
Oftoufl, aimI bave the welt-known T«ndeQcif» lo ^laiulular luSam- 
tnaliufl, 

TrftihnCTi/.- — 'I'bv ilKive <UNTJ|>tLCi» will impn^fl tlie reader 
witii the importatice of rleanainif the ear often, and the adminte- 
IraltOD of a fDcdkini", wbicb ^11 )i«\<e n bx^l actioa upon tbe 
tAT, and a geoeml influemn^ a^inst tb« dialbr^ts. 

Tbt; ctnal i^liould Ih* syrfn^^il and tliomu^hiy HfitiiMMl cHioe 
a (by wiib eqiiu) piartsof v^ntm water mid glyrtTine, aod frag- 
meiiltiof e}Hiheliimi and pieteK of rbe c-b^-eiy fix^relion, tbnt do 
not oome out with tii»^ f^nvnm. flb^uitrl be helped out with ihe n>t- 
IookI Itokler, anguliir forf^eiw, aik) ear stpoon. If ibtf wtiH i« nxl 
and i.'nnpwtwl, a tii'e i^miu solution of nitrate of silver mflv be ap- 
plied, and a tillli^ cvdil rn^m bi- Hmtiirrd iifuin tln^ wall. 

When tlwT^ ifl little roiij^tinn, al^er flie i^nal M i>leanw), 
luiw th4- laltpol midifu* hiH h^ad tiiwanln tbt? wtih- nut iind«r «x- 
aniinalion, till the ear with tar water [Aqwi PirJn tijfuijl4r\ and 
Icavf^ it m Tivc nduuUvL Tht-n M t}i4> patl^r^t ittraiglit/'D tip, 
catcb the lotion iu a mp^ dry the ear with a tnval, and Kmcar 
over tko canal with a litlli.* vna^liue ouituient. All the bafaaiuM 
and turpentioeeexercii^f'onaidi^ralde iutUit-mit u]H>n glanda every- 
where, and lar waltr n*ed In tliis manner ia a powerful adjuvant 
ID dimiui«bio|- e:Koe>tfiv« secretion of ih^ nitditoTj- glandii, anil w> 
storing thiMn to hvaUhy avlion. It exerciser an antiseptic? influ- 
eno; over ihe aecretione, and )ieem« to agrea wilb tb« moniUmna 
1yn3|ianiv as wcril, lu; with tlm ciinal wiill. i bave UMed it very 
fre^iK^nllv' for cao<» of nuxlium gradv, and it iietpc'd to cure many 
of tbcm. 

Id cu» that TVAtai tbia trcatroeot, wbor« tl>e morbid aecr«rti£>ii 
ta siirky and difficult to rcruove, «w« a eolntifm of bicarlranatc of 
mdium (."Wfi hieorb. gr. v, A<itia. {^) aa on injection, and wipe 
out the canal with cotton ; then, if the membrane ia intiK-t, fill 



174 



TBB BOJIAV RAR 4KI> ITfi DlSBAfiI9. 



tUe ear villi a mlntion of Aitgar of lead (PfuntM' <uyto gr. V, 
^T^o fj^\, Imvc it in a few niinutof, tlH^n 1«4 it rao out, siul dnr 
Uw var- Thi^ otit^hl lo be done at l€tti^t ofi<« a d^y. 

For laoTM severe <»«», fiyrinije willi tepid water^ and let the 
iiM injection be of tar wster; ih«fi, atW drjing villi a towel 
over the fin^L-r, prvwcd nut too bard lata the oicoKk^. ^pply hy a 
jinkbe and a>tion a j^ood anting of mercurial oiiitmrnt \ tl^itar^, 
atirL niA. gr. xx, (7j»j. Voidinit i}\ or (Hifdraty, iod, ni&.^. 
V, f 'n^. loAf/inu Sj), all owr tlie walls of the mnal. This 
dres^inf; ought to Ik doov three times a week, or U' the case is 
verj' bad, every day. 

Ulcere shuuld be u'i|wd cli-an and liavv a» «rxtra do9c of the 
f»i)tmenl, oihI, if the>' do not hail^ it msty be neoesaary to bKidi 
ttK'm with A Mfhititm of hitnito uf silver, Gmnulatioo^ eo^l^• 
tiinea spring up along the wall and mMsi be toitched with otlrate 
of silver H>luliiiii, gr. xxx to l^j, or by tlic i^tluciuu of miUuU 
pliiie of iroo i/vi^. fcrri suLiu/phutU). If |)olypt form, extract 
thvm with forcin^,or tbe Wildc-BlnkeSfuirt^and loudi lh« btM» 
with tite iroQ a3JutioQ. 

If the nieoibnuie mid tyro panum arc afiected, a? tlicy frequently 
are, the air-bag inflition fhtiul^) Iw given miklly at every vatilf 
and the throat Ireatrd once a day by a gurgle of a hcapuifc tea- 
it|iounfnl of Aiilt to a pint of water. 

1 have tried nianr mcdiciiies inteniall^r long and fnithfully in 
thU dbcwo, aiu) am Aati^iiei^ that they are impotent, unlen the 
local mesEares arr cnrncd out energetically. Then- are only a 
few that I nm endorw Iiearlily, and these ore more iiidic^ati^ by 
general ihan special ifymptoms. 

Ar-MTti^ivt jW. — ThiM )h a dtH^^idetl anti'MninKta.4 rejiiody, and 
exercivsaiialulary influeoccovcr iLi' nutntion of theskia, Tliere 
Bi roi^hiiuti of ih^ !<kiu fmm M^les of loosened deai eptiWai^ 
and liitlr |«pnl*3i h<Tr urn! thrn? in demerit. Theaivlii'iry niiial 
exfoliates many raobt 8oal«fl; the Bebaeeous BtuGTia not very pro- 
fuse, b«it quite fnoisfi; the mnal fi-d^ hot and rav, and tlie odor 
of tike ear i^decidcflly un])left»iiit. If lh« material ka^ remaiaed 
h)ng III cOfiUi^t with tlir whIIm, nr itK moixturv> oniM out f>f tlui 
meatnflp them iH exroriAlion, and mny be aleeralion. At, the dis- 
ease U deep-rooted and i<low io h-nving, one e* a]4 to g«ft out of 



I 
I 



CaSOSIG ADENOID DBRMAttXrB. 



178 



tk>noc, but tiM flodor mti^ ^tund it, if the puticnt caD^ and 
should bo lirni Attf) [M^m^^fnt in bis prEt^criptiot. 

1 tmtcda ca^' nf ^c^vcral yi'^ir^ Blundin^ftluring three montlis, 
d cuixxloneear, but theotberdid uot^-t any better, Icbanged 
tny prearriplion for mternal mtdieiDe t«veral liinea for goot! rea- 
mtm, hut the mr remained about the sftnic Atler fM)iu^ montba, 
Inhumed again to tht oc iginal medicine, oud tiie l'i^gin|r ear 
was nvtored to hoalth in about two tiiontbe. '' fie aire you are 
right, thiTU pi ah^fiid/' is as good for a doctor oa for u loooinolivo 
enginoor. 

^fe CinnalMir iJia medieinc of niuc^b value in adenoid dcTniatiut^ 
^^ It IS applicable, when tlie selwoeoiis set-refion is coofliderabte, and 
^_ theexfiiliatiim of epitiiTiiiw »*it(;iu, Tlirrc imiy U* iihT-nuion of 
^pithe canal, but there is no burning sensation; the waits bleed 
J fn.'oly when lite eail«s are \>u\M oi\\ or iiu- canal is- nid*^ly 
tourhed by initruments, lodieating a tendeEicy to gmmilatioDH^ 
If uleer» exi^tf lliey feel raw and 8ore, mid bleed, evvii, uhen 
wiped carefully. Then^ may be a Hlnitnous or t»ypbilitic taint in 
the s^iilein, and the deteriorated blood, |ia^ing ihmngh tlie 
jlaodft^ fumishcB unbealtliy [>abulum for the abncrraal i^etv^ 







QiAxmajDAoa. stands third in myestima()on,a«n remedy A>r the 
dueoM. It is fhr fiu(>erior U> (.^Alfarea <^rb.,a»i) ?^om<:(imc8 
improves n variety in which thero is considerable eiud&tion of 
eeriini — a wet kind — timt \fi almost ridorleAa. It in |>artieiilurly 
applicable to thin, pale, stmmous eljildren, with about equal 
quontilieH of wbttiah epidermic waleA and iwtmceoat* multer, 
moists «olV, and paltaceou», lyiiiK in the cflniiL The meaius looks 
red and irrirable ; the <nr i» quite ^enftitive to cold, and the pa- 
tient ho^ iniieou^ and iflandular troubles ^iicrully, 

i/itrie add is f^ometiineB 4&lled for, when the geoeRil flymp- 

iHtf are maeh like tbow* of ('ahiirta pbow., and there is impaired 
Ijj^tion^ eure moutli, mental depreHflion, and eonttidcmble de- 
bility. 

China, Ilepar, Silteen, ant] other medt(^inc4i are tximctimes 
needed for peculiar phu£(% of the diseaw, but their use ia eaffi- 
oiently indicated in otiier places. 

This di^^aae nquires looal trcatmnit for its cure, aiid, if the 



178 



run BOKAff EAR A!VD ITS D13IA9K9. 



treatmcDt I have iniiimteil tic followed cki0oIy,tJtc [>hyBtdan wilJ 
bopnhtit^fl with ihr n^tilrs. 

PhlegmonotLS Inflamm&tion of the ExtenuU Auditor; 
Canal. — Thi;^ di«^?is(- is exceedingly puinfaft ^^^ 1^^ midway 
between fumncle ami anflirux. Thnu^fi it tnay follow gIcmIj-^M 
ti]x>ti the formc^r, a& a dec^per cxtenpfioD and !<fM|uel of Jt, as men*^^ 
tjoned before, that Ih not its uami mole of profttgittioQ. Ii 
«rij*f* more fn^uetiLly de novo^ by a locaiized <o]i^;cEtioi]» cell 
prnli feral ion, infarfrtioD^ and gangrene of the suhoLitaueouii ("ella- 
lar ijj**(ic of fTie cTirEilni^inoun |Kirtton of tho muhtory raual^ not 
exccndiug to ihij ormmjua part, and by its f^ymptomg iadknlce that 
it is a dij'iea-'io worthy of jmljvidoal coii-«iiih*nition« 

It occuTO motit frfcpiently in j)cr^nH uf bilioas teojjicrnnKnt, 
fttmiii; initm-ular dcviOopmcnt, vascular tiirgcecetice, rhfumatico- 
godty tendency, and disiriiiatedp carel«« habits SikJi omsilitii- 
tionv are pmn^* to M^vvre infliimmatory aS^ctions, and tbey arise 
In ih^* ear fmni hU^IiL mjurv by car pickfl, from othir iaflutniM* 
tiouf^ of ihn canal* from tbrout ntTcctions^ parotitis, exposure to 
dmnji^'hE^, ^ven? <nhl, and ni^bt dt-lmtirhcH all al>out town, 

ThiA di^aw li) rarely »eeii in t-bildrcn and women ; tlie fiie£ 
atta<-k<*d arc ^ncrally below par, m to hfulth, if ilii-)- are nol 
ditposeil to I>e irn^ilar and imprudent la their cv\». 

The tntiibli^ Ix-^iiiM with folntrM^ ami iti.-lnn^ in iIr- nR<atiia- 
shooting paioe through the ear and aide of the head, anrl chilly 
MnwitioTi^ ft»llow(d hy roiHuIenibli; fever, Tlie whcdc aural re- 
gion, parricniarly, in front of and l*elow the auricle, is red,^irolIen, 
thn.ibl>iiifr, and painful^ and the pain is incren^ctl grtnlly by. 
moving the aiiricle or iiu^ jaw. The cannl i« ftfon cIohkI by 
the swelling^ whirh ia gencmlly ii(»on ihe loner aird MHerii.Ar jor- 
tion of the canal, and prevents an examination of the membrana 
tymiMini. SomKtm<^ neither t);o Mmi]|<3it xjieeulam nor a Bntall 
prnlx? can l)e passed l>etween the walls of the canal. 

A f*«ni^uin<viU!» H^runi hdoii ht^inii to cini»e from tl»c meatus, 
and pus, working towards the wall of the canal, may break iotoi 
it And flow oulWEinK, hringing ndirJ from ihesc^'crc ftymptoma.' 

This dots not happen very early, lut the ^mptoms increase 
in violence. Thtr ]min ht «ouieliiue» 1*0 f;:i^at in ttir^ whole dde of 
the head, that it re«>enib!es menincitis ; there ia dcafneew, tinnitu^ 



INPLAUHATIOIV Or BXTR8NAL AUDITOftT OA!fAL. 177 



)>otivy tt)rot>(>mg, h<»<liu<)i«, vertigo, photDpliobiA^ 8l4<<}|iUwi)c*«, 
rasleflti^as^ IfKs of appetite, iHinst, ooiwidprable (ever, weaknaa 
ami il«|in>t9ion of mimi T)io <*nvoring 4>f tlio <e^v?o(M f^rul, and 
the merobrana tym|jani is K^neralty liypcnemic, and in some in- 
sianctA Ihhxkhw dccidrilly iiiflatiied, widi jKTfoniUoi* uf lUi' mviiw 
braae, but ihcee chaogeA are recognized vnih difiiculty, owing to 
tbcgTvutawclliiif;. 

There are bnt two diseases liable lo be niif^ken for tJiis — far- 
QQele nnil nntlrtx. The Sn^t will l>c ]imici*d lo oik* pttrt i>r llie 
oanat, and the r^ton flround the nuriole will not be swollen 
much; lh« other wDl have more terrific »ytiiptnmfl and great 
prreirslien of ^trreiigth. 

If the dii4nL>w b leJV to df>mo^tic or miKkfirul ptaetice, afkr 
loii|f snd ii^lean ^uHi^riikij:, a nipture in thtM<ii»ul wall takes place 
and piu '^ diw*liarged ihnjugli the meata«. The pw^ nny, how- 
ever, work its war through lUanres in the anterior portion i^f the 
■unotil.ir t^rtilHg^T, and Qet arrumi Ihc lemjjoro-mjixilUr}' ar- 
ticulation, or between the layent of faittrb in the parotid re^ioo * 
or it niny ptos6 tbroii*^h a ii!«Mure in the posterior AU|>crr!or part of 
the mna) and form an uIif^i^iis upon the nin«toid. 

Gniver aix^idcnte than thof^e happen sometimes, OcQisionally 
gangrene, and iHrnMilembb I>»a of tiMiir ottnir^ witli cIlMniM^ of 
the temporal bonD, und death from c<?rel>ral eonipIi<ntion«. A 
more coniinf>n result of muhrc^tmi^nt, nfiiT a spoiitJint^HjM di>^ 
obnr^ of pus, w the pcrsir^tence of sinuses becenO) ibe Mn of 
tlie^mnal, a formiilion of gniiuilittionit ami |M>lypi iit ih^ir liMu* 
loc» openings, a onntinuoim di^^bnrge of juis from fhe ineatufi, 
per^iiitent swelling, moclt-ntte pain, Itnnttin^ anri tlcafniKH. In 
nthfr worrlo, the difiwiH'^ Wiomfs niild and <'hrrifiif^ and unl«¥i« 
treated in a proper manner, will trouble the pafienl a long tin»e, 
ami then htivp him partlnlly deaf, if iKrthing v/or^ Mi|iepv^nw, 

TV^tttn^Tit — Fn'ini the aUM-e di-wriptinn, the pttuW will jH-r- 
mve that th'f divAAit is wrr^ and d:ingiToiiK, and ilcnianiU 
eiH'rgelie treatment. Kv^lief lau^tt lie luid by tliH patient soon, to 
l«eaeii the Qtxmt Kulffrin^ and prev(<nt dRngeroiiR PomplifntionM, 
In the early sta^«, elc:i^ the external meatns firndy with eotton, 
axul uprny th<< mt^tiix »nd unrmtmding ntiml region, onm tf-vcry 
hour, till the fiaTtB are blanehEH), with a mixture of one part of 



173 



TDB HUHAir BAR KVD ITS DISBABSfl. 



Aoooito tincliire «ih1 two [urta of Sulphuric E4i»cr; f^va 
lemonade treely ; forbid warm tilings geuenillj ; pm eight drops 
oi Aooiiitc tini^urc m ImU' a ^Iosa of vniUr, uml ^>vc a UbVe* 
spoonful every two hours. It will be remembered ttial AoontU 
b n 1<m!q1 itim>j^lliotir mid ]i]itiiihlq;i«ti(.% iiimI m \» t^livr, aikI, 
when applied in lias manner, they will diaiinbh the cong«?<4kBii 
by aciin^ n|Mm ifii* v*vw'l» in front of rJie tmgud wbHi Mipply 
thi- t^na\, and tlm mard the ioflamniAtioD, until tlic intemd 
doM^ft i»f Aconitu nduw vniRiuUr exdlviacnt, and, porha|H, core 
tht* disease, 

Wrilcrh u|H>n diMii>^« <)f th(*<itr nmkiMigtvai bu)Ciibooaboiit 
•pplyin^ cold or poultices to the ear. I thoiij;ht it ^tr^nj^ that' 
inibinimHiion iiUmt ili«i*ar «liotiId roqiiin-nuch ejci^eptiotml tnoi-* 
mcnt, and quee^tioned it at the outlet of my capeer, I have dac- 
wli<-rt^ viati^l tliat pixiltk^ jtidi<nou&ly ciiiptoycd ara not injuriouA 
to ibe f.'xieninl auditory <^nal or membniua tynipani, and I tu>w 
aae^rt tluit uoU applic^tioii» may bo w^l freely alxHit tlw oiT 
withoai danger of injiirtnji; it They are not any mure liable 
injiirf the* ear than a cold j^n;1e. I h:ive iiM'd eold doucbw tujl 
waslu's for the iwnal atiil mldillu air thitosuDdri of times, witb no i 
known ciise of injurious ooosoquenceft^ and have frw|u<jniljr] 
spmvixl i]if exterual otaituR, can&I» and, even, ihe membrane widi 
icv vv:iff-r and elhcr, lieforo o|)cnitioQ4f in ordiT to dinttnUb iWB»i- 
bility, and have had no bad m^naequences beyond a little smart-*! 
Jni^ at tliL' tirm'. I iherefcro recommend the ahove add »j»plicK- 
tion m a remedy aji^ir^t phlt'^nionoiLH Inflammation, I have 
umd it iu ^uvcral cw^es of this diiK!a«e, and of furunviiW iiitliUD* 
mation, holh in the acuto and iliriinir ^lag4*-s ^i>d have found it 
of dwdi^d iK'ticlit, 

The |)at lent with phleB;monouri inflammatioa does tiot applyj 
for tr«atm«nt »oon «^noii|chp After tJie cellular tiwue of tlieaf* 
feoted epot has be^in Ut break down into pu% it i& baldly rational 
to expeel to abort the <3fie, but even tlien the above trealinc^nl is 
fre<)uenily uacful and may be iiua^t^ful. When tbef>e ia dq 
loD^^r hope of arrt^tin^ the phlegmon, nod thr [itttii^nt Lt |»tx>*J 
foundly ^lakeu up, the canal should \}q steamed with a mixture 
of one purl of Acunitc tincture and eight luirtd of water, and a 



INPLAUMATIOK Of EXTBRKAL AUDITORY CAlflAL. 170 



K«?i> ibe cotton lo the ttir, but wet it occasionally with glj-c^riac. 

BcUwloimii is often iiHlicnioil iit tlii?* atuj^ by iW tixul hmt, 
the Uimbbin^, ai>d llie cerebral synipioais. Il should be ^\vea 
111 Antp cioEfCs of tliv ttiieiure every hour. 1 prclVr to ]>tJH|] {he 
Belbdoooa stiviii;;ly, rather iliaii reiorl toOpium^ that moj^ker of 
i^'mplonu uiif] dui))^T, whlt^h Mrnix fj haw littlv cr^.^^ evuii in 
Uixe 4lo0O£) in milij^ting; the Mifleniijics from aural inflaikiniatioti. 
WlM.-u]t <loc»so ju:1, in my opinion, h iiK"iyTfH> thcKcncniUtvcnty 
of tlie Uttoiif). I fi>rmerly om^I Morphia fi'cely in aural intlatiima-* 
tioii^ but tkcithcr from my experience tbeti, nor from tlie rpporta 
of ibi use in Afieoial TrejLfl-*^^ i^at^ 1 (ind n^iilrji that would war* 
rant il* u«j lo tlic ^xclosloti of other mcdieines. When the t^wdl- 
itiiT anJ severe pain persist in spite of the nieafturei nxoranKnded^ 
kmp the boc hop poultice applied over the ear atid aurul f^iou> 
fttwl «lli*rnatL* Hepur wilh the other me<Iicine. ]f the pain con- 
tinnCH unbearable, do iielje ih*; eitr fn-fjuoiilly wiiti a hot dot^odion 
of hoprc, 8ay u tiipful, lo whi<'h mill one tabler^poonful of Opium 
tinrture, and reapply tlie bop poultieos hot. 

After wailiui^ a R^.ionahk time, say twenty-four (t tiiiriy-«ix 
hvitri, if iho pain continues severe nolwitliHtandine: ibe ireutmwt, 
a tiarrow bistoury rth*»iilEl lie |uL^(-d in tla^ niculun half lui ineh 
or more, and one, two, or three incisioiH, according to tlie severity 
and Client of the iul1jiiomnli(>ii. tnatlv in the wall of ihv canal 
Uiri»iJifb the place of ^n:iite«t teudernem and t^wellinjf. Tho 
blonliDg i^boulil W uiK^umgiHl by a warm ilotiche, and when it 
ceaaoi, the poultice be reappliei!. These IneiHioii^i rtlievt- \\%v gn^at 
teiuion idh] congii^ion of lis»u«4, permit tJie cN.*ape of pu^i, if 
any had formed, and redm« (lie violence of the pain and otlier 
»}'n)pto(m. 

Ill some <w»^ the pain ift not severe, ami may be endumlf thi^ 
Uip |>o^llin^ anil inciiiioioiy ^hoidil Ur <?imtinuH| filcadfly p^rvcral 
day^. If neither maturation nor resolution oecmrs, and diecanal 
and mmtutt are swollen, l>oggy, and bnrd, with, perbaj^ one or 
two (jf tli<* cerviwil glamlft ^johirgeil and a little i*i>re, M<Tr(<nriiM 
will lujften matter*; to a cirt^iis, A piiwdr»r nf Mepcnriuft eol. or 
of Mercuriua oorroa. aJiould be given thnn; or Ctiur timts n dny, 
and ih^r po4ilti(« renewed ot^en. 



180 



TBE nUMAlV EAR A9D [TS DISBA8S8. 



Whonovtr pns cl€\'at<« U>c slsin or can be clcti?cted by ita 8tio-| 
tuatiotis tinikr pnl|mtii>n, il ^hoiilii W IH our hy a free [rH*isioit,, 
and a poultice of tlax§cei] meal take the place of the bopfl. As 
«oon a-« MTppiimtion txiiM.v, dlop ponkicing, 4iiul ftyniige tl>c e«r « 
oAen ofi ueeesmry to k«ep it cl^n. 

81imi1c? fitttuloiix i>ponin^ remain, thev niu^t be injodei) 'itSn 
witli clllnted carbolic acid {ArMi, ccrbUirum gr xx, Aijua f^)flr, i 
if thi« failA to care tlictu, a probe enatoit witli oitnitcof mItct 
(mellfs) upon it) should bo pELsb(*d to ibe Tiottom of ihem twice a 
ircek. Granulations and polj^pi !;oinetituc9<iip|tvnr aruund tbcac 
opefiiiipt, and n]U8t lie trenti<d witli tht> aitvcr nilml^ or iroo 
solution, or be removed by instnimfuts, 

Caric^ of tlw wsiNio.<t coiinl ninrly re*4ulta from tbia dBeow; itij 
tnAtmcnl will be found farther on. 

Inf^omv rhfuinatic pcr«o<ir«, with )K>re throAt on gmllowiikg, 
and a r^toppod niinih feeling in the ear, t)H^ dwellioj; aad bo^Q^ 
condition of (he cumil tends lo chnmioity^aAiT (he ncttvc Inmbic 
haA pa.^4uxl. Kali hydriod., ^iven in wator, throe timts a daj, 
will ftir up the morbid tissues in such patients, and |Mt>tiioti) a 
cure &stcr than any other rncdinuc. One otne I n^roemberof 
tills t^ligrffifrh c-harat^ter: af\er trying Ilepar, Kali bich rani,, and 
Merc-iinn*, I gave Kali bydnod. The putirul s^aid at ibe next 
vifiil, '*that medidne did me i^mI — went all through tnv, ind-, 
my eat in botl4*r/^ AOi^r n fi'w day*i, as improvemeDt vraa 
marked, I gave Mercurius, The patient roported next time, that^ 
he wa.s not ^> well. I iht*ii relnnicd to tbr Kali bydriod., (rave 
it Bteadily^and (he ear waa well wiUiin tuo weeke, though the 
man, who wa« a liromunp vfin niueli vxpo^I at night 

In other ea^v^ of l\m eharacter, where th^^re haa boen hefatffll 
and giustric disorder, ils the nsult of iiitempi*run<7e or high livingp 
Kitrio aieid and Nux vomu^a Imve proved moat imernlr ^tn^lyi >» 
imprfivin^ alimentation and helj*inir to r^xp t!w oar- 

Ar^Eiieum, (l^alrareft ph<^., C'liiehona, IVtti murias,aitd I*h»- 
ffrhoruA nmy In? inditvted mrely, and employed to ccMnplota the 
cure. In jill of the«4e cfweHy the patient should have hia diot 
n-giilAtnl, hiM ^^iK-ntl «nrnnniding« Keriil!niMvl and lotnatirr^ if 
necewArVf and the skin kept in good ordei* by oeoaAiotial Uith& 
AhGr the cnnvalestM^ofK' i«#wtabliKbod, if the jiatient eangctavayi 



06TBO*FKBIOflTlTlB ARD EXOSTOSIS. 



181 






■wl 



a febinn;, or go to (lie wwthortf for uwliiK% it will Og hlin a "lirap 

OateO'periofltitu aad ExostooiSu — lu M^^-vral vC tht* RETn'ttoos 
of the canal alrvody dcMTJbcJ, 1 have made lucntioD cf tlie HUper- 
ftctnl iiidiimiiuitiou exlvmling ulon^ th« o»tet>ii» ]H>rii<tn vi ilie 
canal. It mu^ be reoilknl, that tht^ ekiti utid ]KTkwtt.-uni of this 
region an? ¥0 thin unri lirmlj- unit<*d aH tu be pnirtliwlly tma, i<o 
tbat a denuatiiis of the one would be pcnov?titie of the oiht^r, and 
ricf rr^AtU Bv\'<ind <)OE»j£€stion and mwe exfoliattoD of k'jiiili^liura, 
Li ]tari of th« ct^vering of tlw cnnal is uot pmfouDdlj' afllvted 
iu clitr maji;rity of c»fl<>* of dtAoai^ of the rana!, fii* ii uliol^ and 
[Of the mkldie ear. Wliim it d*Kw bax>mv inttamcd either [irmia- 
ily or wxTondarily, tlii.* »ympl4>iiH arc murkcil. Iitllamniacioii of 
the [ni?iiti]A or outer portion of the canal } iDJuries by c^a^^ta^ or 
. iiistnifTient7<; irrilatioii froru lln^dU'lmrgv ofpiw during: *^4ippu- 
ration in ]t>e tympanum; curio of Ihu temporal 1>on€ from ^(Titliita; 
necriftipf from aljmxH<; rfM-iimutidm, gout, and ^ypbiliit; all are 
Giu!H.'» of iii^ pro|>iigation. 

TbediM-aAebtr^iii? with itcIiingtfiiIiie:!«?i,rLHlrH!A^, swelling ; dull, 
heavy, aching [uiin, won^e at ntght ; slij^bt tnijiairmefij of htoinDg, 
aikl tinnitus Xhr* mcinbnLim tympani nwy be hypenemic, tliick- 
eocd, prHorated, or destroyed, aeoording to the cau^ of ihu tlid* 
eavc and its coiDplUmtioJi.><. 

The inflamed jkeriosteum may return toa healthy condition Hpon* 
neomly, or under In-iitnu^til; or it may funii bone Ixneiith it, 
ben tumoK of varioos sliapm ariBe gradually from tliv wjill of 
the canal and tlma diminijdi it# calibre. They are oM-n^onalty 
Been ti|K>fi the upper wall, hut are most frer^nent upon th^ pos- 
terior and auterW walU, an<] may aiiin.*ly iH:<'[u<)e the iHussige to 
tlve drumhead. After they nach a certain ^xe, they prevent the 
falling oatof <pithrlia) iKtbri:*; attain water at the bt^ttrm iy( the 
canal ufl&r washing c-r swimming, and thus caura gradual or sud- 
den deafn^sw. In name eajM^^ tfiene tumon^ ninglv, or multiple, 
cloM" the auditory* canal entirely, and if di^eafee and diflcbarge exist 
within, they will obntruol the outward Row of pn4 ami ntt»e 
daflgerouH, if not latal, cli#i.nue of the tcuijioral bone and bniin. 
Tbc tunsora originating in oateo-i)erio»titU are true bone of 
tmpact tijmie> When an o^ific prctjection, due to localized per^ 



18S 



TiiK hfma:! kah asd its dissasi«. 



io^tili^f forms at ihosrat ornfislula frr>in carioUfl Uvdc, or s ^ETOnp 
of graimlntioan iint)<:rgi>UB cir^iimmtion into bony tinfttic^ftn hocim- 
lim<« happens, the tumor \s of loowr conslmction thtiD imc hone* 

1hc<\i:nitvtnt tumors found in the nxti:rn»1 fttutitnnr ntnnl, (l<9krrv«1 
IDg often the name of ivory ^xontoees, liAve an cntirclv dtlTrrcot] 
hbtlory fntin thnAcr Arbiiiig from peTKh^lml infuinmntinnp Th^j 
are »^n mostly in ihc rhctuiiatic ami gi>uiy, and may roach a l^r^^ 1 
ause withuut ihv nfllict^l ont?lHTiu|rc<>nNCM>uflof ibt-trprenetta;. A 
aoddcn rIcafucM* from clo^inx-of the c&nal by water or <Truma), a 
tonnciouftnatfi of iitiTVamng <luln«;vi of bcnring, or putting the 
fio^rrintolhe cannl to relieve imiatton, may call atlcntioo ta 
oomcdjirig wroiTg, tun] exumiimljon vnll rcvi^il tlkc growths Frc*j 




£xoviD«re ox mv TurrKaioK Walt, or tiik I^KarrExTnutJkL ArummT 
Caxal (E^htvanw}. 



qiicntlvj h<jwcvor^ in tli*w« imj^^-i, thrtv is » hrav^ feeling ia the 
«ar uiid ai<l^ of ilie head aHect^d, impaired hearing, and irrilatioi 
of the eana), with an accnmulalion of dirt inaide the nini4>r. 

The <^uid mSouM U' illutninnteii hv the tnimrraud ^pL-ddum, 
and every part of it serutinifcd carefully by the eye ami probe. 
If tliC! bony vralh &n^ oiHoiia, pariiol^ of tKHie will lie luuod Id 
tha discharge : JistulouM 0[K*fiin}rift may be dbM7'>vcred near rough 
a'^eou^ 'growths, and the probe may be jiOAaed iutoainasefi leading 
to dead bone. 

Tumors IroiD ditfuaed |>er]os1itiB, granulations, rbeuiDati9n,gOQ' 
and layphili" huvc broj*d biwwt and grow very »lowtly. It ia very 
diFQniU to diagnose these, unleis they are very prouinentp ortiave 
rcaeJuMl corir«idcrubIc «\s<s. The wull« appcnr irregular, the canl 
DaiT0W4xl^ and the tumor, in t^^iteriL], rod, hjinl, Hnd tender lo the 
touch of tJie probe. Vna beueaih tlie liuitig of the osinul project* 



03TB0-PBHI08T1T18 AND BX0STO818 



183 



Uk« a lumor, but nmy be iIiiijpioNHl by its yielding to prenurc of 
Uw proix-, while uii op^-oMis ninwr will m>r, Wiurn t[j« ttinmr 
hm bucutitc liirgcf t;tiuu|;li (o ijitt^rlere vtitU ibi; normal m-'liuu of 
tlw ranal^ it isuwiJv nxx^iiiiE^U 

The prngii^ir^ il^iiciKltH n[nm tlie oliaratrter ftni] #i£c ijf ihi; 
groHtltSf lilt' rDUfrtiUirLTiii of tlit^ |jalieuc, Jtiiil (he oaj>ulji]j[ien of 
hi» m«)unl miviwr. It i» j^tvc vfIhmi thrit? in i^ricflf (»r lii^ P^'X* 
Noan U not tliort>u]^-h1_v cducnCcd in fiLii'n] surgery. 

Ji-ai/fru7i/.-^OfiUH>-|imonlitin is InstU-d lii iht; iM-^iuiiiiig the 
aUDO wi5iij)erfioiii1 drnu&titiji of ihc onimlr ii[k>1] wltidi it ^uii-ruUy 
dejM'tidv. Wurm wuU-r irijiiiitui^, viiri<iii-Hly njt<<tii.iitf?<lr tlic liiil 
hop iionUice, and AcoEiiii-, Bvl la^kuiua, eca, uiJI aiiH^lionuc tlie 
Hyaiptomn. A pk\x uf liiu-ii j«mwirrJ witli <wKI 4-nmii ii» very 
agreeahle lo ilie iDdanied surraw, duHog the interval between the 
doarfao)^ If dw [Kun h *H?\rrx* mid mrt r(di<-vi>l \fy ihv iiMinl 
meesnrtt, indee the liQiog dowo lo the bone and coiuinue the 
doachiw. 

If cariefl coexisto, the parte Aould Iw syringed wvpral tlmee 
daily ivitlk wann t»r vatcr, Mqiu^tni uiul !«pieul(i of U>ne nv 
EDOved, and fiMulee injected vith a eoluiion of carbolic Acid, or 
raiitrri/Ad by nitmte of i»itvi.T, aj< before disKrribeJ. T^hllitoted 
patienfitihtiuld ijnnk cream, £d<1 liave e^^, mrc- tHX*f, imtmnd 
mndi, corn cnkcti, and ol1i«r ^ood iJiin^, >^ up piemen ted by a little 
m\e or porter. A ooune of Mi1(dior tiatJiA will provt* vrry bene- 
ficial ; ihe putient'v habits niu>^ be cardully regulated, and an out 
of doorlifi^ ift>iriiiHl u|M)n. 

CiJcarea phoe. is the best medicine for oeteo-|}erioelUia in strum- 
OOA putii'nt^, and hit* helpcil lo min^Hjiny nwc9<of wiriw; in fill 
partfl of the Iwdy, Calcarea iod. i have iih^ed with <ie(ndeil Iwne- 
6t, and, alio, Amcnif^nm iikL, in the >uiin<' clow cifniH.'^. Ferriim 
iod, and Cineliona are indicated, by preference, if there i^ hydneniia 
ami grt^t debility, and 8tliei.>a arul Snlpbiir an- useful in the 
declining stagoa of the disease. 

When rhenmuii^m, gout or f<yphili^s arft at work upon the con* 
BCitution by their specific poiMjns, the treatment should be dmdetlly 
different Suhaonte iniLirnniati^n of the iwrioflUnim is ttllaytxl by 
daily application of a ten grain solution of nitrate of silver on 
bnj^ or cotton. After the ^oreiiem dimini»b&^ TPb' '*^ ^^ 



184 



THE Ut'MA^C BAK ATfD IT« PI«BA0B<. 



tumor Ioclii>e lioctura, or better, rub in ilaily n liltlc i^diDC ocnt^ 
lucat C*"^- lodinii 0>., Orofum SintftUj't oTt 3iv). If (be 
8oft tissue over tbc tumor 10 thickcEicdf nn imiulc of nx-rour^ 
ointciirrit fihiiuld he prt^fL-rnxl {H^ruf^. /chJ. ru&. gr, x, i^<tA9CMe 
J^). Ifany l!u)d or ^lirt U rctJiinocI in the ouul ^y thr- cjinMoui^ 
it Oiiglit to W tttrcTuMy A^nngeJ away, and tli€ ilaiil rcokorecl 
abooriwtit i^ttoD. 

\Vh<M) iUii tumtir Ix^nn to block tliu ronal much, lake A nlii 
plcvH- t*r culf^tit tie diaiuctur uf tbc opening, floicar il wilh vas^ 
litw, ami pii^h it in firmljr; ibiii will nwcll iinJ diluJv l]iet:aaal. 
Ki^ji <>ii inlitxIutiH^ larger \\\iSiXb iivery day, uuili (hi- ]tap«tfl^c Is 
dilutixl tu* tiiticb JLt d«?tinxl, or lui nnidi nn |Hi»ubl<-. A liuk 
voUon ut^y be jrlaeal over liie pieces to bultl iheni iu for from 
four to i^Tiity-fiHir hotin', tiiiltvc* »i-vun; pniii deiuaiKln ll»?ir re- 
moval. Cjilgut is iMuel) Ix-lli^r ibnn l^imiiitirw or prvjuired 
8p«>iig<.<, tKr-ittirv lliefw tiwell 100 rjiiicb uihI l<Hr izuit, ftud ibiiri uue 
itt furevd ui ramove tbeui Itefore ihey liave OUutcxI eiH>i^b. 
Bougiis liavc 1k>c^[i tii«e<l for :bi» piirpuM, but thry mn noi to be 
recommended. 

The diluutioQ do« not influence the bony tumor tnueb, but 
miiiO ttlirirkii^, ntid tlilnnliig of ibv f<ij(>eriiii|KiMHl rKtW ttMaoi^ 
and iJiiu PEilargffi the pa^aag€ to tJie uienibrane. A lltUo mid 
crvam ituiy l>c rubltcd overthum^iUof Uie tuln<^r after ttH:ciUf;iit i« 
removed, and when the sorenem diaappearv, tJi€ iodiDe aolulioo 
or iodine oiiiimcni eJiould he iippliixl to reduce the boiiy cxcre*- 
OGiioe> 

HVlien llio tumor renclKH n %im thut (hn^ten» to oloee tb« 
meatus^ a^iecially, if ih^n is any purufatt disease 0/ tht tnuDfr- 
hnne or middk mr, it rtiu^t be removed by a eurgicnl ojktiiUo<i. 
Tliifl ia done as follows: An ind^on ia tnnde over the eiostosil 
and tfa4i covmri}^ pui^bol iv«i<)L*. Tlicn take the hand drill or Ute 
dental engine and a proper drill, ptcrtM! the tumor throtigh and 
through in Hwerul ilinutioin^, and finUh ite renio\'a] down to lh< 
CAnal ivall with a nmall rhi?4el, tlie maMo)d curette, and bone 
foTcepe. Thcrsi^fl tiis»iK<!S Hhuuld tbcn be smoothod out over the 
wound, and covered by a pioce of lint smeared with simple cerate 

The wound Ahould be cleansed daily by synnging with warm 




1 



OflTflO-PBBlOSTlTlS AKD BXOSTOfllB. 185 

water. Should it not heal kindly, or fungous granulations or 
polypi arise, the part should be brushed with nitrate of silver 
solution or touched by the solid Lunar caustia 

The internal medication will depend upon the local and consti- 
tutional symptoms. 

Aside from medicines indicated by the general symptoms, as 
Bryonia, Colchieum, Nux vomica, Mercuriui^, Kali hydriod*, 
ete., some cases of eburnation related in HdmuOCa Surgery, and 
one case reported by Dr- W. R. Childe, of Pittsburgh, Pa., in the 
TranmcH^ma of the Horn. Med. Soc. of Fennsylvamaf 1879, 
would lead me to employ the remedy they used, t. e., Hecia Uva. 
This seems to exercise a unique influence over exostoses of un- 
usual hardness, and merits extended trial. 

fLali hydriod. is a medicine that has proved curative in numer- 
ous cases of osteo-periostitis, whether idiopathic, or dependent upon 
some vice of the oonstitntiou, and ought to be administered iQ 
decided doses, three times a day. 

Silieea is a medicine that may prove of value in this disease, as 
it is thought to exercise a decided influence upon the nutrition of 
bone, bat I have had little experience with it in the affection 
Dnder consideration, and that not very satisractory. 



13 



TBB BUHAEf SAll AVD ITS HISBASRfi. 



CHAPTEB V. 



IXJl'RIBB AM> MSBASE8 OF THE UEMBRAX& TVMI'ANL 



Tb% JOembrana Tympanic— Thu uj>|ie»ninn^ or liie tvmiioDic 
membnoe viirit.^ with the kind of light employed, Uie deicrce of 
iJltimiiiationr th<r ngs of the ponoD, and the ound^tinn of the far. 
The ^hort white proo&« of the malleus is n^nemHy tbe lim point 
u|>on v-hkU tin* vrc r^U m urn I'xnii it nation. The foldjt cf 
muooiia membrane from tJii8 are aeeo iipoo the iouer fiorfw^ of 
the normal dmni hend, one curvint^ to the anterior, und the othor 
to tiie posterior border^ ^lividin^ the meoihrajie into a sniall upper 
[wrt, like & spherical triangle, chIIkI 8l]ra]i]ieir8 inenibrtir>e, and 
ft \&T^ lovitv henrt-^ha[>e<l flegroeot. The handle of the malleue, 
gcoeruUy yelbulish white, is «e4?n curving from the ,dK>rt procesi, 
slightly luif^kwaril and duwjnvsird, and at itA eml U the apex cf 
the trilv^ white triangle, the hase of wbieh nstj* upon tbe uiUk 
ritjr lnf«nor ])eripb<Ty of liie Tnoinbnine. in amute perwutfi, llie 
bftse does not quite reach tbe border, Th*^ nrnnubriiim end Ifi* 
angle divide the henrt-^haped gxMlioti into an anterior and poMe- 
rior segment, 

Anmitil the [wnjiliery of the membnme, especially, above and 
behind, there is a yellowish border ^ mm. wide, wliieli ts caiMd 
by lliv diflereiil n.-fIwtion» of light from llit membrane aod canal 
walls, by the tliicker peripherj* of the mcmbninCt and by die 
pouches and ehorda tym{iain ntrve matd& ThU sooc is 2 nuD. 
brottd in old age^ of a yellowish pearl color, and m due to degen- 
eratton. It h thu# ait unak>gni^ of the nrccur tratHie of the eonica. 

The child's tym|ianic membrane is plaoKl so obliquely, owing 
to non^development of tbe temporal bonc^ that tbe eurlier the 
a^i the greah^r the difficulty of getting a glimpse of it. Indeed, 
the finit y(*ir it ii< nmrly hori/orilid. ' 

The color of the membrane is light violet, which gmdualty 
ehangcit to tt^ii^^ of roM^ in the adult, and lo Mitiah aod jelhrn- 



THI XBUBAAVA TTMPAIVI^ 



!i 



ish-|>T&y in cilil age. The DieiDt>ninc behiml the lower half of 
the muHea^ handle i* j^omiHim^ in whilt*, yv11owij«h-^my from 
the lijjht reflected from ihe siiriWe of ihe promontDry wilhin. 

'llie hnilthy m^mtinint; thoiiM mIiovt no nmrbljn^, deinl colore, 
or Ktrtation^; it sJiould present to the eje a lively blosh hy Any* 
liglit, whi4*h is toiled olT by gruy, wIk-u artJticial light is ur^od for 
ilIammiLtion. 

timit ilti-mlifjus frr>m tlie altove i»rc*>ocn in cuw^of eu^db^<fl}H.% 
which witi be meniione*! in their pmpr coiiiiecEion, I may way, 
howevjT, that the 4iort prooow d" ihi; mTilleu]^ and it* foMs, and 
the fninubriuin betMtme mrvre Goospieuous with depre^ioD, Biid 
the mantihriura Wks a« if it weiv Hinnlrmnl, The silver ImngJe 
may be divided into an £pi<-a) and a truncated portion; may 
U«e a ]>»rliou of il8 boLse; \n i» MSfiltcred 3<|)om, or Uaw. di-tap- 
pearod entirely. Tl^e colors of the wliole membrane undergo 
many HHnhfKiitiorf*. 

Wht-n Stef>]e*6 h|K^'iiluni is used, and the air is rarefied upon 
lhefflirfai<e of lJ»« membruiw, the i*«|jnienls bulge outward, leav- 
ing; ihe matleuA handle and short procv?^ in a furrow. Tic au- 
lerior j)ortion movn^v^ a ltttk% the pi.>»lerior inUi^h more, ami the 
roanubnum makes a ijuiek fieniluhitu-like movement forward 
and bou^kward, and inward and mitwnrd, 9» the air ij^ ftllernutely 
nrefial and eondensed. 

Thicktuinf; of the nicmbmne, parlJu] aticbyioiiiH of the o^ii^leflp 
and adhteioas within th« tympanum diininibh the mobility. The 
tnemhrane is thio-kified amuml the |jeri|ihery, atrophied and thin 
tn the ceatrc^ and thr bon^^i^ are (Kirttully anchyiri>ed in old aj^ ; 
ito llie Dianuhritim movc^ i^lotvly tlirou^h a limited fii>aoe. and the 
umbo hoiys in and oirt, while ihe anterior aiul iMMterior porlton* 
of the<lnnn-hmd move but little. 

The membrane lof^m it» nuttind funnel ^hnpo with depression, 
And become im^nlnrly (H>LidiiHl tiivvard.and, |)erha|)^« attached 
to the ioDer tym]ianic wall by lihrnUB lmndr<. WIr-u a deprt^^ed 
mtmbmne h dmwn outward, it b«iom«* immviliatdy depref«<<<l 
when auction e«as«d, as the Trhortcnefl tensor tympani mu^le and 
ehi^tio Imtnh dm^r in the inHimbriuni a^in. When adhesion-'t of 
the membrane to the inner wall of tlic tympnnum eii^it* the od- 
bcrvnt portiooA wtl) remain thit ai>d immovable, and little linear 



TBft nVHilN KAB A!rD IT8 Dl&BABBB. 



folds aiid pouches will rise sod fall* aa the paevtmalio spe<rulotii 
i» umi. l\Tfonition» nvt i\tU'i:ied bv diie instnimont, when tbv 
KTiiUiK'hiari tube is not pervious, hy tlie luibbltH of air and liquid 
which cvraif from tlic middl<i cair througb the oppning, 8nuJ1 
perforntioiis look like a linear tear, or n bhirk liitlep ftod larp 
on&» show the re<l or gmnulur^ inii^r wall <*( the tymi^ianQniT 
The gmiitilur tympanum cuii Int dihtinguiehecl frocu a polyi>u« by 
the oiitliri^e and movement of (he latter. 

Injoriea or the Membrane, — Th^ druin-lKVid b n doU 
membruiie strelchetl oLliqiiely acix^ie ibe bottom of the aDdifiOf^ 
canal, wirb air iJ[Km ea<<h ^ideof it^and remiiKls oti« uf Uiom 
papered hoops through wbic^li eque^triant^ itpnit^, h» they ride 
an>iiii<i rhi; ring of u mrcui^. It is ewiily injor^ by chaogoi ifi 
the ^nilibrium of the air upon ita two surfaoes, and by things 
thruKt in tbt^ i.'3cttrn»l fuind. The membrane » torn by bnirpinH, 
knitting newUea, slicks, and ear-apooiw pi^^l^i^ m the ear to relieve 
iu itdiin^ or to rctnnve wax. It w frequiDtly ruptured 
ftitempts of the laity or incautioU8 phy^iciana, to nfniove foraga 
lxHli<^ from the external rumil ; and bv blows upon the nuriole 
from any wurce, ftucli a^i by the haad, a »uow*-b«llr or a wave 
Upon th<T S4.ii-f«hore< 

Blowing Uie rKjr*f, M»w«ifi[;^ coufrfain^f viokiit inflation, v<«n 
itingteiraitgulation by tuiDging, diving froin a high ftlrvx into 
the natf^r, a full ujKin tlva Ik<ju1, tb^ dim^har^ iA' a putol m^ir th« 
ear, or the reporfc of a heavy gun will ii'jmetimcs tear tlie rooiiH 
brane ; but in nui^t of lb(^<c Ki^^, ihi^n^ h di^-^i^L^fe and weakening 
of its layers from aflvction^ of die externjil ^.•amA or of tJiu middle 
ear. 'I'lio membrane m torn by fnbclurt^ of llie temporal booe 
ftB before mentioned, aiid verj- fre<|ueDlly perforated by diAABeol^ 
the CEtcrnul <wnal nnd iym|>anum, 

A person Koinjc up in a ludlooo or upon an inclined plane ii 
Ooa8ciou4 of a di:«n^r(H*able pn^ure and, ±*oRketioiee> pain dt^ in 
the ear. This is occayooed by a difTcreooe b density l^twees 
the air prfNting u]H)n the out^r aad inner fturfacea of the tym- 
ponio membraue. It in mure nmrki.*il in porwaMi who Imve sonu 
i^Neaie of Ibe muc^U!^ membrane of the EaHtadiian tut^p bj 
whicli the air cauuot naidily paw into tbu middle cur to piii^b Um 
memhrane out, and Uitm opj>€«e inoreaflcd external presure; or, 






IffXURtlEB 07 THE HRUnRANE. 



If 



when tmodcUHod m ih« eur, mn not a^ftipe rcnrltly to diminHli 
deouty within to foneflpond with rarefarrtion without. 

In (i^tDtng down otiool' the I'itt^hiiri^li iiu^linccl jilnncft, 640 ff«t 
lon^, at tn angle of 36^ tVom the horizontal, niDQing by a sta- 
tionary €tkgin€ and machinery \>\' winding; wh«lj* above wiih end- 
lees wire rope*, one experiences a hea\7 preestiro ia each cur 
■8 tf a hirg<t bullH tlllot) ilu? cnliro middle ctir <i\(wely^ mnd at the 
same time there U ronrin^ tinuitiis, accompanied by slight giddi- 



Tbe descent fori^es air into the i^Kternal canal agninst tlie mem- 
bruwand t}iu« coiuknfvc^ it; hut, tmU^^ i<^-cial elfort !» made, 
the middle car doce not re<¥LVf c^mclen^ed air, and thiv ecjuilib- 
ritiin U d'Mlmyod, the- mombnino ii« pns^'wd inwards, the middle 
ear befomes congeited, and ihe symptoma are produced. 

TbiK U au cxun)p!f of what oivun* with more povcrily in tbo 
so-call«l caisdOQ dtsea^. In submarine operatiouB, auH) 03 
building the pii^nt of brid];i» in da*i.> wut<-r, it in ridocmsary for 
the rnea lo work in caifiaons, Glletl by condensed air to r^ist the 
inwaril jift-ssiirc of wat(>r, nnd \o m-rvti for rt^pinition. The 
dvi?)ier tbt- c^bAun h below the surface, the ^reati^r h* the p»rc»4ure 
of wHlcTf and Ibo nborc raiist the air withia be cond^itse^l to re^int 
it. The decree of d(>nf4tty may ran^e from twenty ut om? hun- 
dred }»undft or more to ihc TUpmre iuch, above the lif^cea pounds 
to the sqaare inch of normal aimoepherie pre^flure. When the 
haman body, adapted to the lattur pressure, is called ii[>on to eu- 
duvf- a pre<t»ufe much hi^z^hi^r or lower, it is not eurprjj^ini^ that 
ffr«ot di»ttirl)ance« occur in the rrspiratory and VTUK?ular aysiems. 
Karefaocion prodncas surface conife^tion atkI episiaxis, a8 in> many 
have experieocfd, ap!c«rulinir at railrca*! i^peed the eastern s1o|m» of 
the I^icky K[ount&ins. Ooiidcns:iliou caut*ai inlernal eongcKtion 
and inflammatioD. 

Tli4^ mt>mbmna tyaifianj w kef>i in cqiiilibnum in ciondin^ 
air by its frtt? pa'^mt^c through the Eustachian tube to the middle 
«ar. Obktructioo in thin tube, &ri»irig froat flight f^titrrh of the 
mucotia membrane, from itn swoTlin^ and thickening, or fmm 
pharyftgenl *»r middk mr aRo:tion» is u very oommon disordeFf 
kadioft slowly to deafnewi, and often not aimpeeted by the ittr* 
son afflict^xi. When the tube i« olMtrvictcd partially or wholly, 



190 



TRl HUVAIT BAR AffD ITS DT9IABS8. 



the air cannot get into tiK middle ear — bohimJ tlie mcitibrttD^^ 
rewlily, unci ti4:no> ih(i lur of Lli<* mithlU^ vnr ia Xam deii»e rluuk llnrt 
wiibcKit. The general v-a^cular praeure is iocrea^cd by the coiw 
di-ii-^ctl &ir ndiug ti|M>n the ^urrfloe of the body iin<l Juiij^, um) 
the toll tTirgid vessels of the mtdrlle ear, meetina: a w«iik euunier- 
prnffiiire in tlio rcliilivvly rur^'tit^l air tli^rem oontaiJHxl, mpture 
Spontaneously and induce an acnte intlammation. 

When thi- titr of Ih^i miiklle mr ie much mrrflcrl, and the ex- 
ternal air ift very dense, wilh tlic membnina trmjiani RttDewlot 
wcttkcncd by dit>enKe, the prent prtiwurv «pon the nuttr Fur&re 
may cauw a rupture and a rcAtnmlion of efjiiilibrittni. Tlie 6rai 
efli^et of the c<n)den?:cd air of the caWin ujmmi the «*ttr wto to pro- 
duce a stopped feelin)^ and severe pain. When the Eiutaehtin 
tubc9c were ujKrneit hy tho V^ilNilvmu m(.*Ch(>d, U)C ^ymptomd duu^ 
peared. In j>ersonB wilh nornml Ea»taehian ttihecs whicJi ojiened 
wiili the wt of swallowinjf, no di^^^infi^rt wm experienced. 
M^LeR a |teDH>n rertirned fntni the dense air of the eai^oii to the 
ordinnry ntmo«plierc, the eondeiisul air of the mnt aometjous 
eanie from the Eustachian lubes in distinct puds. 

From numerous va»v» of disorder of the car from working in 
cnifeoof), whieh came under theohscrv&licnof experienccil :iurKlSf 
it was ccnduded that tlu^n? was genently some pre-exuUi^ dis- 
ease of the Euatadiian tul)e or middle mr 

Iiiflatti>» by the Valsalvian itiethixJ wa8 of great um to the 
nKii when on duty, and by Policzer's air-beg, during Ihe intvr- 
vals <jf labor whca they e*juhi wx^ llie doetor. The ^in and hy- 
penemia of the ears were thus relieved and aeute indammadon 
prevt*nt<-*L Tliotw who winli to pursue this subject farther will 
find ao cseellent resume in Dr, K'xvm's excellent treatise npOD 
diaeaseA of Lheear. 

Whether the htaUhy membrana tympanl \% niplurcd b)' oooaia- 
sienpi in the atmosphere from dUeharf!:e of fire-arms and artillvtyf 
is a question still stth j\i<iicf. The residing power of a healthy 
mcEiihrane h con»lderahle. Griiber fouud it required a cotumn 
of mercury 143 cm. (oG in.) hi|i:h to rupture the membrane of 
an ear, tlmt hud becti pre^ervt^d in almhol several weeki*. He 
vaa unable to Ui»t a healthy drua>-head by five times the atmoa- 



pherio pnflJS^ilBitt Ihroogh a cnthHcf faitt^iiod in t>ie KuittArliian 
tule. 

The triangiiliir »]w*c iibovc tlic uliort prow»« of the nrnllcii-s, 
csllnl the membriDa flaeciila, or 8hni)>ncir& membrane, \& elastic 
and lee di^tb*'. (hjui the otlirr fiarfit of llie mi^mbniiK^i and y^i'Edft 
GODndenibly U) pressure. The funnel-ehapcd part of the m^m- 
bnuie is made conmve by pnwsuiv fn^m wiUioiit, i*o Omt tins Iri- 
angle of light dUappoars, and this indicate an cIsHtirity of oon- 
Bervntivi* cliAHirkr in i^nddirii rn<kV«'riK'rr/< of tli4^ »tm<v4]ihi!re. The 
oblique poeitioD of tlie membrane, the projecting angle of cariil- 
agaat ihejiimtion nf the i)«M,*iiu>i with titc i^nniluginouM ]Vfnion 
C^ tjie exK^nal c^nal, and the easy patuleoce of the Kuf^taehian 
tube, nil i^ntriUue lo prot<-et lh« membmrm tyitijAtni from viob-iit 
aerial coin root ion j^ 

NercrthelcHfl, it m aomctime^ niptnml by etploHtons of gun- 
powder, in pi^tolf blast, or eaunoo. Yet, the searcity of aiw» 
AmoDj aoldiere luid ftiijlon^, who liavo been cxpc«e<l U: "Jieavy 
Griiij^ all Arouu]/' rendere !t probable, that th<Be who have suf- 
fered ihbaceidenl tiav<rha<lM.'rme rhroiiicdiT^wwof tliet^r, whi<:h 
baa weakened the layet^ of ihe drnm-heiul, nnrl pretllftpotteil it lo 
raptiiro. C^»& nnr on rcf<x>nl in which rent^ have rcsuliG<) frcMn 

[tol-£hot£ near the ear, the explosion of a hand grenade, and 
dif*"'hnr^<' of liwivy ^iiiiH, 

The iymptomfi of concussion without nipttireare^a h«ivyfhiid 
in Ibt' «>ar, n teTii|n>nirv intense ringin);^, some degree of deafntsp, 
and eometimee ^flight liemorrha^ of the m^^mbninv. WIteii a 
rapture ooeani, a fthnrp pain i<|i<ki(j* through the ear afl«r rbe thud, 
a diwbarge of blood appears iu the external nKiitu^ or within 
the vnnal, Uie dfsfne^ is ruore decid^-d, and nir Outteis out freely^ 
when the car tit inflated lhniti(rh the Kustacbian lube 

During a Aervi<« of five yeur^, inclmlin^ the jieriod of tije late 

[«ar for tlie ITnion, as a line oflicer in the IJnitod Stato; ^^^''Y, 

jwcpOBKl with many others to ei grcgit many cfftfu^iii^aiuoH from the 

discharge of )^ut^ ran^ng from 12 pound howitjwnt to the 200 

nod rifled Parrotfl, and the II inch aiul 15 inHi sniooth bore 

ns, I did not bear or know of a tangle case of euch aund in* 
jury- 

At the bftttJe of Buirs Bay, a C, on board tbc U. S. Oai*- 



192 



TBE ItVKAH lAK SHQ 1X8 D18lA0Cft. 



bual OUaivu, a 200 |ktui>(I riDt^ Titrrol, Utkiug a dmr^ of 20 
(K>iii»iT« of p>wihT, «n*l tt p-liHI nf la-i jx^iitid-^nruiwliil »lH>t of 200 
liiJijiiib, wna Hivv] four ur livi' tinit^ an hour Tor thirtjr-^ji Iioiltk 
Dtiriii); iMo?>l of lbi>4 i'ltae, brir»^ Ei<xrutivc OlDorr of ibi- sJtif, I 
n;iiiiiiLieii U|i(m iht liri<]^ wirtim QEWri fuel aftiie ^an, Jin«.-trii^; 
its Hcrvipt', and ihe mmi- mt-ii, with 'lat- or iwo t'sc^'-jjuuo*. ix* 
niuiiitil £t their |x:*4Lb uloee btVide and t)ehiuil tl>e gun csrnayce, 
yrt, iK> win* wtn.' jiijiim] h> thr Uwt of my kn*>ivlitlgu, uml tiat 
of i>r. L. IL Willard, who wo^ Siirj^u of die iihip. 

In the iroD-Hnd !vrvk-t% the Irbl of auditory rcHStancc wn 
even more wvi-nn The ^miih wiiliin the revolving turrets were 
of XI jm-b, and XV inrh t>ore, rpquirin^ charges of Id to 20 
pOEiriflri, aiid3ii to 40 jHinndA of povdfT, iiiul itlidl of 136 pounds, 
nnd lluO pouiifU, or «olid F^hot of 166 pounds, and 400 to 440 
poiioifH nf«|>e(*iiv4-lyi Whiiu) firi^l, thr niuxzlt^of thi> ^r» werv 
run jn>'l even with tiarn>w port-Jiolcr; through the eleveo-incb 
tliii'k turret, nail, tlioti^h the niDcnnsii>n wan grmt^^^t outAiile^ yet, 
owin>: to the confitied t^ncv of thr> lurrtrt it wu i^oDsideisbte 
wiihJD. Thit) hiu) lo lie ettdurt-i) for whole davB at a time, to- 
gether with the fAti^ck^ from nhell nm] shot striking the outrwle 
of tia' turrt^, during lliv freijiie.nt iittac*kE!i upon Arouilrie, Smnt«T, 
and the Omfedorate forts u|ion Morris I&Jand. 

1 wa.s an KnMi};n (hen on Iniard the U> ^ (roDclad Xiihaal, 
and hud ohur^fe of the Xj inch gun, whde Lieut TaJImao com- 
mandeil the XV inrh. Wo M^ere ii!l int^tmrted to keeji the mouth 
0)>eii »t ihe moment ot lirmg, but we sometimes forgot ihewam- 
tng, and our curs would ring h>nd ami dfep ii(i&r a di^inr^- 1 
noti<\<tL uft4T A ii.'w fioiir< firing, the ringing would pemistt per- 
baj^j tiil the next bomlwirdiueiH. 

In tlm exdlenient of action^ vrt >M)nii'liu»M did not get tbe 
muxzles of the guns quite against the ed^ of ibe port-hole^ and 
upon liring, w\- unnld get a t<h<x;k in:>ide the turret, titut would 
m&ke our litauJa Hwim, On <mv ocoosion tbe XV incJi waa hur- 
riedly diaeharged, when the niuzxle wjlh T^veral inch^ii inside ttie 
port-hoJe, and every one of us w^as stunueiJ and knocked over 
by ttie powerful ixm^^u^ion, but no one t^mplmned cif tiie symp- 
totDMof a ruptured memhmna tympunif though »ome had ringing 
tiDnitua and vertigo for aeveral dayis. Uupture of the mecnbrtna 



tHJORTBS OP T9B HRMDBAIVB. 



183 



^iBpaxit \a therefore not easily caused bv artillery conruF^^ions, 
My eji|K.'rii'n<,r iiijroOH with (Jniljer'*. H« *taw a great many pa- 
tkotfi, who imd b(«n in heavy battles^ and found ooly one case of 
rapture of the Jrum-h(^ad, 

I havf recently duninerl an e«r injared by cannon firiag. 
. XfUUL 8ti^>bvnKiti w«» AiijwruiteiKliiig lh« «efvi<!ft of the *• t^A-ainp 
kt^l" in a mar^h before CharIe»ton,£^(^,aDd at one discharge 
he felt a ihud in his right t^r atid a quick »barp [Hiin^ followed 
by a diwliar^ t>f blow! Irom the m(>ati]s. Tiieearilid not iroublo 
btoi afterwards, but b^riog was much imjuiin.'^l, utid hun r^ 
mained defective nnoe- No tfuee of a cicatrix remainiij but the 
membmiK^ ij( opaque, deprased snd adbcveut to the inner wall of 
the tyTikpaRum, aod Hvr. is ^, 

Ob^Tratiim leafl» rac to beliuve that the tulermittiiif; c<rncua- 
I ofartillen' do not cause cbroaieinHamfuatioa of the middle 



Fro. C9. 



Ki«, TO. 





Ft(k<Kl.— (U^rrTRE o? tfik MeaitiaANA Ttmpaki (Sr^IivrimHW^ 
Fio, TO,— Rotran Pekpokatiox or rnv XlicjciiaAXA TvMPA?ti u-mt Cai> 
cmKi> Kmni, TWoCAt^cAiiicor* Si*ot^ a^d ['AncK ricATrtix i8tJiwaruc). 

and internal ft\m, m Kruwi claims, thaug;h the clatter of n^^i?/ 
machinery aix) the elang of the boiler- maker a hammer may do ao- 
SiItilioDM nf eonriiitiity of th<r nu'mbntria Ij'mpiirii hnvf virions 
ahapetJ, and occur in ditTerent l(>catione, wliich arf^ deiM-iulMit upon 
tbo eaiiHi^. Tlu^y aro ftn*n n litlln dUfjimv from thp anterior or 
cterior twrface of the mannKrinm^ or alon}; the |>eriphery ; are 
'Tonitd, 'ival, or irn^^ibir Khnjxtl jxtrforitirfna ; tn the anE<>rlor, 
posterior, or Hirgwri^r Be^menta, Those rei4ii!ring from injury by 
fofrtgn ImkIm>*», by eoii**u9Wu>ns ai\t\ tv<vnt iu*«te <<aTarrhnt infbim- 
mation, are linear rents with ihin rapgpd er)^. Thorte pr^hiced 
fay diita^e are gener^dty rfinnd, uvid, nr kidiif*y aha]>vd, and hava 
thin or thick, inflamed and »*o)etimej: calcified borders. 



194 



THK BUMAK tAR A!VT> IT9 I>l6iAgVS> 



Thert" moy be wvenil j)erfor(itifnw, 8m»lL round perforatiooa, 
one ufx>n each tuie of xhv niunubruitii, resemliJe Uie «yoi of la 
cmbrru clnrk^n, rcrloration^ nuiv U- 1^> ^mall »odIv to be dl^ 
covered by (hf [nii«n^ uf air ttiix>u>rh ihe meiubrane during ift- 
flatJon, or m large that liaitlly a ver4(i^ of the fnecubnne r^maiiif. 
Freqiionlly llw tanliiious ring around the [Mriphery nnd tin'. fmn 
immediately surroundlii)^ the iiuOK-t» arc aU that remain of the 
mcnit>nin& 

Fift, 71. 




III thfve MMiditious, ih<^ handle of the malleus ia dmnii in !rr 
th€ tensor tympani tnudc'le, adherent to tlic promonbny of the 
tympanic wall, and no fonshorten^tl a* to Iw* seon willi difik^nlty. 
In Q(Ii(^r iTWrti, the oeirlea have been broken, dislocattt!, and par- 
tially or wholly diwhargt-d, a;id the eilg:** of the |HTforatiun or 
il^ oif^trix have become adherent more or Icsfi with the mnooufl i 
membrane of the tympanum. 

S<rhwnrijce aays, ' The perforation takes place from witliin out* 
wards, dariDi; purulent o(iliv m(*<lta, iiml fn>m without inwarck 
by piTforatmg idwr, c»r as iho rehult of an abape« of the mvm- 
brane during myringitrs, Variouii fiimlttion^ unite tij prodocr 
Eh^su* pfrfntntions ; inflammaTory sof^ning of the mombraiitf, 
pr**«wiire of *?xiKintion lK*hind it, inul movement iWiif"! by expi- 
ration, A rupture occars, tlie «J^E5* of tbij4 ulcerate (if it do« 
not \ni%l), Hiid a lo*4 of i*ultt*tanee follovi-9. The ejct^nt of lorn of 
<ml>4farioe de|>ends on conHtilulional conditions, nnc( i^ RKMt ni|wl 
nnil di>strui-tive in M^rofala, tnliereruloAU, and esp^aJly in Ararlvt 
fever.'* 

* TliP I'athnldgirDl AriHloifiy of the Eir, pL 79. 



IirjtffllBS OP THE MEMORAni. 






A ni[)Uirc may heal uml lenvc no tnicc, or huve n linear or 
brooirl cicatrix. V^ry large perforaiioDi^ wmeiiniCT clow after maaf 
years ^jcbu^Dce. Iiiixrrtain case^of tiilxil and muldlo v;irdi»CAH^^ 
a perfomijcin materintty iniprovoi the hearing by permiltin^ 
Mund vibmlioiis tu strike dirwtly ii|>oii th<' oval wnd miitid win* 
dovs nf rhe labyrinth. The sixe, nha[M? and jwaitian of ]H?rfora- 
tEoM intTLivoce the d<*gn^ of audition, but no ddinJTc nik« for 
gaidAtice arc yet forcnulaCad. It may be stated in ^neral, that 
^wmW perfomtiona are aocompanicd by |K>un.-r hinrin); t\mn turge 
coies. 

JWtitgnfnl. — Simple rente of the nicmbrun^ hcid irsdily and 

1,ve no si*ar. Wliwi lln^if. in no jiain and di^fiKS* arti-r aii wvi* 
ent from a fon?ign Iwdy or from conoiiwion, JTitlnte the lym- 
pannm ihroiigh the KnMat-liian ttit>e with the air-biig» in onler to 
drivf o(il any blfMl tb*^re may l>e tliercin ; M-ringe the ear i^ently 
with lepJd water, put in a loose vrad of cotton, give a f*^w <^Hes 
of Aconite and kvep th<* fmttent quiet. The mnnbraiM: will 
probably heal in smb oaire«,and leave no trace of the injury. 
Shoubl the jH'rforation be lari^-, and c-oc-xi^linp; with any of the 
diawn^*^ o( (he ctinair mrmbmne or middle car *o commonly ac- 
companying, these roast be crated first, and the meaMurefl adopte^l 
for ihcir cure vfIW bu favorable U> ibc closure of lb*' membrane. 
Tlie roembmna tympani |x>ft*sflp6 great regenerative (wwi^r, and 
lon; than two^thinU of it, indudinf; the malleuM, may be de- 
lyed and oonijflet«Iy restored, even, after a perforation haa ex- 
ited many moTitbi^ 

The membnuia propria of the dram-head is not restored during 
fepinition, bnt a kush of bi^KxIvoww.-!* nin* to t!ie ttlp* of llw 
opening, deposits pabulutUraiid ;l firm whitish dcairix marks the 
plaoc of lew'on. Thi?( i* ileproe?u>tl U'Utw the plane nf ibe nteni* 
brane, but is mmdly eovered by epithcHum upon both tfurlaces* 
CtcatriocM look dark'^r than the ^surrounding memhnuie^ artt more 
able, and may l>e adherent to the long process of the incos, 
or to the iniie-r yrM of the fniddle cair, directly^ or by the inter- 
mAtion of bands of oonnedive tissae. 

It b« bt'tter 10 Wk'p the nu^^tiis cIowhI with atj»H>rlienr mtton, 
daring llie tntervalft of Irfflitment, but a disclian^ing ear should 
not be tbua plumed unte±« tlio phyrtioian mn see the patient often, 



loe 



THV BUHA1V lift AIID ITS D[9«AdB8. 



or tliv luEtcT ciLn l« relied upon todeainso tli^ cnr, snci cbatif^ the 
cotton ofien, Wh^n a merDliraiie u liealing* no i&flatiOKi fhoolii 
be €Qipl(iyctl i>nli::f«< imgjcnilively duinoEidod, »>( forming ciratrion 
tear cosily iuhI clwure m thm arre&ted. It is advisable to avoid 
8yrinj^in|^, ('> cK^jliwv ihe mnal with :itM»rlK*nt f^uw, aad to avoid 
t^movin^ Kate and scalfs from th« pertoration, aa tbe latter 
bridj^ tb^' pip mid favor ciivtriBttiou. 

With aotbiDg to iaterfere with healing except slti^«ib action 
of tiR' incmbrniw, Oliver n *ilver prt-bowidi »oIi(l niimtoof mIvit 
aiul rul) it around the edge of ihe perforation. In i^nch casea^ 
IheontiTftnit iun<T roverinfr^of th«^ druni-hL«d have naJtctl, and 
the opening will remain permanent, nalesa muteriKed and Btimn- 
lat«l to clow*. 

A perforated membrane may become entire by the formatioQ 
of a cioaTriji, lint hnvi' ibc luttfr ovt-reil liy pnv, uninj; to the 
imperteet epiibdium U[>od iDi surface. Thtfie places eIkjuM be 
e1cftn<^l by aU^orbent cotton and bra^hixl vverr day witli t 6v^ 
grain solution of nitrate of silver {Argmi, tuL gp. v. ^71141 deaU 
f^l, and n two-gmin solution of mpiv of lew) (PtHuAi aedoi 
gr. ij, Afjiia dtd, f^j, Hjrioged in tbe ear daily, while OakBica 
pho^ i(f given inUrDully. 

Dr. J> H. Iluffum, of Chiton, Ilk, repona the closure of 
perforfttion^t under pluilf^'ts of cottoa MiiLiirvHl with coMiuilineand 
ki'pt linnly agaiiBt the surface of tbe drum-head for eevenl 
weeks a' a time. I Udcd abvorbcnt cotton iilonc in one cum, tAnt 
touciun^ the edge of tlie perforation with aitrate of ailver, and 
foimd llie opening cbwed at the end of two wveka. It ««» about 
the diameter of a knitting-needle when firet seen. 

It has been nxu^ntly recommend id to apply cUhIca ofpAlkcr and 
pieoea of adh<«iive plaster to perforated membraneft, to protect tbe 
mittditi <far from irritation, and to favor the heaJing prooM. 
Tbpy have not worked well iu practice bo far, and may he re- 
garHwl a> ilic oIlHprin^ of cxtjlR^rnnC thoorixing, 

Hjpercemia of the Membrano, — A membrana tympani ia a 
normal condition iloce not show any pi-roianenl injection of Vt^ 
»clii> U'heii Ihe external canal or tbe mentlmuie b touched 
ronf^bly, tbe ear is intlutcd nrtilictally or by the inbalalmn of a 
strong ba-eae, tbe be«d is acibjected 10 concuflEUoa, the KiiatadiiLD 



VTRINOITIS. 



m 



Cube is irritated by toliacci) or sljglitly ob^tracted ; the fttoRWeh tl 
dbfinliT-il, or'H'TTitin mt<«lrdnv:v an-iulinini»h.'rcd, »iii:b ii« (piiiiine; 
hypenpnila of Ihe druni-heacl and o\' conliguoun \m'V* n^oiltn, 
and ciTtaifi subjovtive Hymptomf appear, Tiwte are«o Iritling as 
hardly to allra^t alteiilirti), but sorue ()erw>nft usk the iloctor 
about tfacQi, gcncTally, from mere curiosity. It is for tbia very 
reason that I deem tlit-m worthy of notitx*. A pt^rHoti 1)uh n md* 
den verj' filight rinj^iiig in the cur^ which la^^t^ a few minul^^, and 
iben oeaMB, to return a^in ^fitr a few lioan or duv->4. Tlie ear 

^Aels'm little full, and the i;xtvrTUil cunul itches; it k t^lightly 
fererisli aud hyiHiracsihetic, ^ iJiat wind blowmg iati>l1ie i?fir feels 
UDcorafortablc, 

If the Diembrnneheexflfnim^d^onefiifiy )ie«nbri^lit rd) »trcnk 
of vissels, intending u|khi the drum Diembrane above tJ>e sljort 

iproeeM of the malleus from the external canal nnd ninuiug 
down along the maaubriiim. Other voa^els are sonnftinics seen 
mnniitg ar<*und the druCD*head uhI inward« to join tlxc^e of tJic 
malli^tiJ^ The nmcous layer may participate and give a deeper 
violet hue to parw of the dnim-hc^ul, TJic hy]R*rpniia fif (be 
ouicr lawr may be so great ^^ to mnlce the nienibnuie of a dit!»^ 
red, ntid to hide the nmllciu; completely from sight, but cliis con- 
dition comes more appropriately under luyrin^itiEi, into which Auy 
hy|Mrnci«in may *.w\y develop. 

JVfahMctU. — Remove tJie cause if still operative. Uae the air- 

hbig once A day for a few time?4; hruKfi the external amai with 

'l^lyeerine ai»d water, cf^iial parts^ ouce a day if needed ; ^r^te 
the throat ever)' night with a Ica^poouful of rait in a j^lus of 
water, if it in irrilatcd ; and t^ive » few dof^cs of Aeonilc, IkOla- 
donna, or China, making the dcae eorre^imnd with tlie innigniG- 
c»ncv of the diwrder, and spetyly euro will probably result. 
Myringitis. — ^This ba name applied toon inAainniation limited 

^tottie mciubraiui tympani. It is rarely seen uncompIic>ated 1^ 
in oiher parts of the ear, and is difficult tjj <tiagiui«% be- 
cawe of the relatlom of the drum-head to the external canal anil 
the lyin|ianum. 

The extennl ntrface of the membrane Is skiD, the internal 
IDI1ODII0 membrane, and a layer of eonnective tissue lies between. 
Thia metnljrana propria has little vascular or uervous supply, 



198 



TK1C HUMAN VAH AND ITS DEdlAflBfi. 



and [icnce iDflammAtion of <h« membrane le g;enemllv an afl^ 
tioii of the skin, or of thir niii<xiu« iDi*inbniii(\orof botli t'^tbor. 
Inflammtition of th« tlerinie layer ifi vef^ comnioD, And hsa bMQ 
mtinliotK^ av» & ivmplicution of fovi>ni] diiwancs almily tk^jribed, 
A di^wwe of the canal may be very fili^ht, yel, produw tticli 
]<xiiliK«nl ififlunimnllon in tliv drimi-l>aul,ii9 to merit its record 
under die title of myringitis. Diseftw of Uie midik emr will 
cauR* iiitlnmmuttor) of Uw luucnus mcmUrane oiv^nng tl*e dram- 
beatif but xrill probably ejc tend beyond its t>oi\k*n« and, henw, 
not nK-ril thiiii^iKviul ik^-igiiatioiu Wboii tin* rimirou--^ nu'mbraiK 
of thd drnm-lead leoom^e fiSeirted secondarily tbrjuj^h iuIIajd- 
nuti'in u{ iIk' dt^nnic layer, it in jkO!«^il>1e and probalde, tJiat the 
dbea^e may not extend to other parte of tbe middle mr; indivl, 
1 tliink ] have Men itevend vuma of Ihitt la^c variety, 

Tbe Rvmptums of myrin^ilie alouv are not ver^' marked ; tfaejr 
1i:>]liiw eJC[HV(iir<* to cold air imd tlraftA, injury by foi^gti bodieB, 
and difi«a8esof tlie external canal. There u ft eVi^Ux jxiiii or 
none at [dl ; the hearing \» i\ little impaire<l, and noi.^es of vaiy- 
iug chiinietiT nither Htnuse than annoy the palieuL There !e no 
co;i?-titiilional di^tnrbatnx*, and many otttta are noC necti by tbt 
pbysk-ian until they have jiossed into tbe chrouic stage. 

When examined, the membraim tymjuiai i« fotind not deprcwed, 
but pfL^ccltx] A lilile outwardly; it i» piuk, nioc<t, iihI uxkinalom 
from swelling ; or, having exfoliated Jtfl epitbetium, m uniformly 
red, owing to tbe cxiio^nrc of the cvtriiitu ; die li^bt triui);le has 
disappeared, the hatdk of the malkns ifr indu^^tini't, and its por- 
tion iit only reeogninud by a few bl'i'HK(<rwlt4 niiudng iu tb^eourafL 
The membrane is soft, rclaaced, and easily tortL The inner end 
of till- tmnal ip< i^mdim(<9« avoUen, «o tliat xht incpibnn^: loolu 
diminished in eixe, Iijflation of the middle ear a geoemlly ^aev 
by any in(tb<K), and ttie uiembraiic u)ov<«, ihouj^h it may be 
filu^islily. The dineaAe may not ^ beyond tliis condition and 
re<.^very follow. It it eoiiliniiC3«, later tu it4 eoany% the mtm* 
brane Ht-eoEiie^ thick^timl, Icatliery, dirly gray and rough, and 
■teeretes a little thiu pu!), the detritus of imperfect epitlkdial for- 
mation* This lernd^ to erosion^ an infiltration of round ix\\»f and 
the formation of grannlatSoos and polypi upon tlie outer 8urfiic«; 
bli«teni may develop and break oulH-an^ abdce«e» arioe iu tbe 



UYR1501TIS, 



cv>nnectiv« ticdm; uiitl btirst, fatt)^ and <xilmr«ou5 dqwDHib occur ia 
the •jubttdnlia propria^ ulceration exmtd <kv|KT and dM-|i(T, atui 
pcrroratiou finally result, in otJier ra«*, tlit- m<rml>mt)u tyiu[iAiii 
may remain IJiick bikj fl^hy, tlie inllamniation exteod deeper 



Fut. n 




IjrrxHixsuoA^ti Avpoctow iir TUK AliuiitiiAflA TvKi-AKi !Sct]waru«i. 



.sod de^>er ta the mucous mentbrane of tlie tympanurDj wbicb 
icaturrlia} and M?rioij«]y damu)^ the hmring. 
TKciAn^n/. — If tJie allaok ia ^«ooiidar\* ro aiiv other aural di^ 
'caw, ircid the luUor iiouordmg to dirvclions clsGwh^ix\ When 
oiyriDgitiH m tlie predarninanl aflVctimij syringe the car ^ntly 
iftvtry Iwf lioam, duri»K th^ acute ista^, willi a wurrn dccuctiou 
^of hop8, and g;tve Aoonit<' or lii^llu<lo(iiin. iiiHaCe the ear with 
ll*c air-Is;;, slid keep the [)atieiit warm and quiet, 

Afiet the arut« 8ynipt<Mii» are )>a4t, if rhe mi^ml>rsne is thick, 

liough, aiid dilTti^wly rciidi-'oeil, brush ovt-r the euHflco with the 

Eeottoned probe, wet with n iHi-|;niin siiliitKin of nilmte ikt'^tver. 

Should thfitL' be ulreratioQ and pus upon the membrane, wash it 

off by aa injection of tepid water, ami drop in once a day a little 

oftlif nctrlalei^f k*ml!rfilutJoi)(/^/un';Ay acdaA^r. ij, A^midfgt. S^), 

Bli^era and ah^ceescs may be opened imrefully with a <:ftt&rACt 

ineedle vr the tnyringototue, and aAtTward^ do vrtM wilh the 

'plambic ww^h. In obt^tinate ea^es, it may be necesHary to npply 

tlie mercury ami va.>k*Iii]<^ oiiitineiit ( Htftlrwtj, oxUL ru4.gr. v, r«*^ 

/me So-) to the surface by the cottoned probe, or smear a piece of 

and puHh ii af^un.-<t the ntembnuK% which Inu^ lont much of 

tita Benibiltty. In (U&e of middle ear oomplkation, it might be 

DCceMary Co puncture the cinjm-heat], but thitt will bi^ cumbered 

tuder diseases of the tympoimai. 



800 



TBI BITMAy KAB A5D FTd &I6KA»$. 



An)nit« «Jioiild Iw ndmini^tcrctl liirlr to bilioiu, pidboric, 
rheiimaMo or ^Uy persons, Arwniojim shouUl be ^bMitiitelv 
isoon as the aUivc syniplonu bavu dUappcnred, wh«u iUk iticm- 
bnne ia scaly. 

OI<«rts |>bOB. hB« proT«l of moch vuluc in & [aUs flnbW lUb 
oT the mefiibraDf, wirh some clUrhai^, nnd soraettniefl blisten or 
ulcere. lle|iiar will be a[»propnatu in nmilar comw, wilh Mfiifr 
tion of oolttncss. 

Silicm li<;)|)« dcAtrimtioD and tbt roroQAtion of dcw epitbfi-^ 
Hum. 

Atrophy of the Membrane.— Tbw «»>««» n«ntially of u 
idiaorption of much of the membrann propria, or coDnective lifr 
sue, t»etvrovn the outi^r nml jdikt hyvr of Ur< uiembraD* tymi 
with some tbinniog of the latter. 

It i-t rart-<4*<l hy pN^iirc «f iwimfn upcm lli« 4lnim-li« 
prolongecl course of intliilion of the tyinpaitam ; loDg-oontJni; 
rarefiu^tir^n of Uic air of tlit? tympnijurn, mi<) the in^nvnl prewar 
of the membrane, owing to conlionous ooelusion of the Eu 
tncbinn tubf?; muf by obronio infliinimutioD of llie roncDiu 
brann of the middle ear 

Th^ m<!mbraDn tynipani I« 04>neiderably tiltertd id color. It b 
ydlowiftb white, yellowish gmy, or like dirty (^hamoU slcin; ha 
■ poftrl-riilrjrctl ring around the jwripSen', and & ccncrv of bluish 
white, Etmie<l slightly witli gray. TItere may be spots of <iA]ca- 
T<x»ii^ ibp.*ticrolioo MiiToumlcd by & border of dark pqgment. The 
membrane is very thin in the ceotre, unri may U^ tt:tm lo move 
Ihrouj^b considerable «pn<», when Si^le'ri tij>ccultiin is i»h1. The 
greatc^it movement lA An^iind Oh- nmtxi; llie mnlletift hfuttile 
moves forward during miction and l^aekward during oompresnoo, 
with a p('[]dNliim-]il«.* movi^'raciit^ Thi- nicmbrtnc ju4 bcliiiid 
the maciiihrium ^n<*h<<^ ouiv^anK and la|)A a liltle over its bo^ 
dcr, and other portions show diflerent shaped fold* when ntovcd 
OOtwardA. 

.If the air of the tymjianum is rarefied, or preesitre Ja madB 
itrontrly by the Hicgirr, die tyiu}wnic meml>rane ftink^ into the 
tympanum, and shovrs by it^ irr^ular surface the p*»ition of the 
OwEolcs and promontory. ^Vhcn tlie membniie ift quiCc thtn aw) 
papery, some of the iutm-tympanic appantua may be seen thrott^b 




ATROPOT OP THt MKVDRji5B, 



it Thu coLlfipw iDu-anJtf » the u»4iul position of an ttropblc 
meabniK^ unlow the p«nM>n has Ittmed lo iiitlaie Iha ean and 
dim ao freqacnti/; Ih^n ite depression is cotibidorublv lv>«. 
M'hcn tli« lvm|mi)uru ia inflated tlLereisaMdY thud of aound^ 
ootiMdcrnUc rraokliii)^, iiiidr perhapv^iL fen- muKX T&h'Ji. 

Tinnilusof varringintpnalyisa frequent symptom of atrophy, 
and, of ouT^r^ Die- lii'Anng m crmi^itk'nibl}' im|ia)n'(J. In my 
Ofiinion t]ie relaxed merobrane^ thoiiglit to be produced by too 
itiucli iifflAtin^ f^( ilir niMdlc air, eiru ^^mrnlly ou*;^ of nlrophy 
of die Bub&tantia proiiria from morbid proceseea ^f loog continu- 
ance within llie tympanum. 

JVeaimmL — Tlicre id not much to be done for an advaTM^ed 
cdst. Any muMtive or coexiAl&ut niinil otrtction fliiiid<i lie 
irmted acoorduig to directions elACwheiv. If die Eustachian tube 
ucl(«nl mill (he tynipEinnni m catnrrhAl, iiiflnic with tW uir-l)«g 
every day, uoiil the tubes are frea and open easily. Collodion 
tuy be m]>plk*d aver the outer vurfaro of th« druni*he(id wHh m 
brufib, or the hisatd inclined and a drop or two allowed to dry 
opOD tJwj flurboe. This nmy ri^nmin » wi^'k or two, and will im- 
prove the bearing teiD|>onirily. An hrtiflml druinlit'ad of cotton 
or rubber, prasnd agninHt the membrane, frequently inc]Ta«<« the 
tieuingf am] doe& no barm if not loA in (fin \M\g at a time. 
Wh«n iUv n-laxation v* con^iderablCf the hearing very defective, 
ftnd tbe tympanum nearly normal oh in aenilc iitniphy, I nialce 
a bori3M>n(:d puncture alx>i]t 2 mm. wide in tbe autiirior and pos- 
terior portions cf llie membrane, u|>oii a level with the end of 
tlie maiiuhrium, and 2 mm. in front and behind it. Thffie eoon 
b«al and the eon<ierj(ient oicalrii'tal u(*ntra<^tion improvt# (fa« ten- 
sion «iirl functi^kiial itt'tion of die membrane. AAer incising 
the membrane, if bWHl &o\vh, it muAt be iiyrini^ei] gently un-uy, 
a pitre of cotton pW^ed loo<-cly in the meatus, and Aconite given 
for a day (W two. I have perfonuwl this opcmtiitti wvnml timc*i, 
have tM had any lad re^nlL-^ from it, and improv^eut in hear- 
jnf^ and diminution of linnitii!* have followid in thi; mnjority of 
GOffB. I liuvo been careful to hare the Eu^tathian iidw.i easily 
dilatable, ami the tynk|KLnuni in pnrtly gtH>d condition before 
operating, and from my reealts, I feel warranteil in recommend- 
ing die procedure to tlie attention of the profft«icD, 

14 



m 



THE HtTtfJl!! BAB AND 1T9 tflSSASSS. 



Hn>«^'>pby of tbe Membrane.— Long-contmned irr! 
or inll:imiiiati^n of the skin pixjdiK-eA Uiirkenlng of the ejiideraiii 
and bj^pt-rCrophy of the mnum aiicl lutK^utancous voiimrlivc ttt- 
eue. The epidermic cells bcoom^ IhlpJceiKt) and their number la 
a given artfl greatly increa^, while Ihoy are rifely ftggttplet 
hito culliHAnd ichtliyoiio-liko |)ntiihea u[K>n i^ie Uiickoned hytr 
of ooooDctive tifflue. 

TTie aanic ctia»e# net similarly U|)on the mucous mctnhraiie, bv«' 
tho r(£ult i^ a little dilfomnt ; the Anhmucoua tisfue becomes h)*- 
j>ertro|ilnfil^ tlie mucrt|>iiri>n.-« glnmls arc^ enlni^ed, the aurfftce gets 
Touf^h and grunular, and tlie fii]|>€nibuiidanco of muooits tvllfi b 
tliron'n off A^ iniicriH or |)ii[4. 

The memhriiiia tympani h composed of ^kiti and mucous itten- 
hfane hack to back, with a mmmon ^^tibcHitAneo-^ubmucouA eon- 
Dectivv ti^ia^ the nitmhmiia projiria hctwrcii. nnd il ii< roncei\-«* 
ble that it may become hypi?rtrophied as well aa atrophied, 

Thii* iw <*xaf'Uj" wlial o<vtin* io *jine «i«e* of <li«eam of the 
leriial canal, olVn In myriDgitis ^iroper, and o^ a con«>n]Ttai]t i 
not a Ak'quid nf lytuimnic diw.'OM', ihou^b many niitliorv iguoir it 
alti^etber. It h what Toynbee meant hy rigidity of the raenw 
braiiia tyinpftiii, atid iff #i.-<n quite frotjuciitly in tlic cld^ the rl 
matic^ and gouty. 

The incmhraDC i* gi-ncrully dull, opii<|tie, dirty white or ydl 
giwy, BOtnetiineB locking like soiled chamom ^kin ; the li^ht << 
is aOQWwhnt allvn-tl ill r«ha(>r< or mitirolv nlMHMit, the <*<ioaU'ity 'i§ 
iiicrcABedj and the hatidkof the malleus swung a little uiw; 
and, |KrrIuij>i«, inviftihief tiii>iigh tlic a^iort pnxn« i« tutially 
proiniuent 

Whitish palchc^ and linc^ an? H)iui-limc»« i«iH;n, whi*rc wllMMaou 
H'ith llic 4^iole$i or proinontorj- have occurrw), aiul othfr *poia 
from depifeits of fat and lime, are HCfittered over tJie luenbram, 
or A^^^n-f^tiil in vari<>u)« sharply oueHik^ |)«lch(#. Deposits of 
carbonate of lime are wry common. They are wkite» speckled 
with bmwn^ b» if dark saud had been shaken upou white papcTp 
and form linear, oval, rcuiid or ereseetitic plaques betwtwn the 
niflllcitH handler an*l the iKirtk-r of the mciiihram". 

Fatty granules are of^n mingled with the ealcifio particles aoil 
give them u ye11owi]<h hue. The lime i$ couHned to Ihe mem' 






eTI'BRTKOPQT OF T0K MSttDRAffr 



203 



brana propria, or involves all Ihe layers of tlie membrane, Th«te 
dc^en«^l1i'm^ may be nutiii^rouR, yet, the njenibmnenrt well,iiiui 
ihe lienrin;; not be much affected. 

Ill Iiy|W4lropIiy of the niemUran**, the henriiig is generally im- 
pur«d, 00 that llio watoh U IieanI only od conbicl or one or two 
iiiicli«« Bwayj and tinnilu* in oct^ionully pn»enl, m » dull mm- 
bh^Dg or roaring. 

^Vliai 8i<^k'i ftpo(.^Glu»i isf UM^, the incinbruiio will he necn to 
move filov'ly, and the iiirurHinn^ of (he manubrium to tje much 
linuiotb liiflatiuti by the cjithetcr and air-bug gives through tlic 
di^no^o tube a dull coar^ craeikUng or low flappings instead 
of tlie ^har|KT ^nnd)^ of thi* normal cDnditlon* 

Th« patient hears a bans voi^ Ust, and hearing i^ l>etler in a 
tioine, as in a currin^c or among moving machine^'. Low tonce 




have longer vibralioa^ and thu$ givo thi^ nlow membrane time lo 
udf nad Doi«a mako the rnvnLbraue more* movable by tvMnniotioo 
of theo^cl». The patient ikf^blij^ topay oloaronir'^ntioii toon<^ 
Mpiakiiig, In order to iindfi>tuml, luid tbii vigilAnc*.- h rjuitti fatigu- 
ing. There U generally anchylwis of the ottKid**! nnd other 
IcAiooi* vritliiu tliv tyia|ianum, which xvill bv ooiiHiderud uudcr 
|>rolifi>ratSvo in flam roar ion, or wlero«!8 of tlie tympanitj raucous 
turrmbnuio. 

Ai^nU* dl^«Qi]E« of tb«? ear may onginato or ooniplicate a hyper- 
tn>j>hy of tb^ nwmbmort tynjimoi; ihv Ittllor is mobt fn:?f^nej:t, 

Th^rre arc few Hymptom? to attmot tho patient's atlc^ntkoa. 
There may be mmt- mucii^ in tho throat, roughnis^B nud Jrj*n«a 
in tho ponKtriflr pharynx, a litllo fulness and tinnitnt n^w and 
then, and a graduul diminution of tht; huiring. Wtiou the aurist 



204 



TAI ItQMAK BAE AXn ITS 1>tSKASS9. 



is O0DSalt«), tlw umy of ol:jecciv« bViii[noim tkrUiik-d abott ii 
fotiml, and the true mndkioD apprebeuded. 

Tr<xiimt^nt. — Aity diwa«« of th« oiitemiil miml or tjnipauiim* 
HQBp<NHHi ^r i^uAtng tho }iy])enrDi)t)T, mast be Ireated aooordiag 
to din_'c-(ionp> tli^rvrhcrc. For a auw jitin? [tiid ■imjilc or, |jerliapi^ 
depend^il upon olmcnre dUoase of tlw l)m|K\num, inflate vith 
ibe uir-luiff till thv tiib^ open tsufWy by Valtalva'-j nttrtliod, bni4 
ov«r (he drum-liejid every tliirxl dny wrtb « five^gniiii wlutioD of 
nitroto of sjIvlt, iiod ^vi^ M<Tciiriui« c«imx^, tvro ^raiiM tlitve 
tinuia a day. 

If Ui^ bfltniig doc» not {mprove in o few Mi^t-k^ bni^^b ii 
the aze of 3 ]wiiny upon th^ ma&toid, a little above and behioli 
Oie niciiUiJ^, ^vidi pure cnrl>olic nndf hiirroumliri^ tin.* iJtin with t 
ring of filive oi), so that the a<Hd will not wbilen more tkiii tbin 
iiitetidtHl. K'^nvw th<vv ap|ili<^rioriH onrc a vock, and outtiDEie 
tbt^ MLTouriuB st^dily> SliouKI ^outy or rbeumatio ^nptonM 
Ih<ooiii^ proniJnt'iie, or uiiy cmnplinition?! ari:<Of ^tve tlie indkalol 
miKlicine, but the jMcrcuriaB ou^tto be tried faitlifully. I dain 
no origiiialilyf^ir iIiih imitmr^nt; il was pnbrii4wl by ibo immortal 
Toynbee, U-fiire I w^a lx)rn, but I Imvo pmveil it lo U' vtry il-*- 
ful in #cvL*nd itiR-^. I have found Kali hydrioiL of i^xcdli 
eervW, wbnredie aftection wss nivooi^iaied wilb a ratarrbnl u-odeneyj 
uihI Iiuvl- rurcxl a kvf ouw witb ^cnuiular lliroatj^ by ■.vii 
AfRnnicnm ulb. and Arsi-nioum iod. 

If tilt* dcafneaa ih very g^cat ^^ tinnitus distrx.'f^iD;^ &Air ot! 
tiling fail, nmkc an iiictsioD ui ihe ilrucn-head with ihe myrich. 
ICotnme, 2 tnm. long, and 2 mm. behind ibe malleus hundl 
ii4^r its lower end. Pain may be MibdiK^i bj Ihr; nuroi douo 
mid ibe admin lAtmt ion of Aconite. If improvemeni folia* 
niaiDtuin nn opening as Iod^ a» po»ibli\ while a wlulion 
pota»iiitm {i'otatm h^rtut. gr. j, Aijiui (^\ ot bicorikouat^ of 
dium iSo^iibic<trb.gT,\'f Aquaf^) i* injectwl daily intotbcca 
and (ymjmmiin, and the pro|>er internal mediuition is otruiumed, 
TbuA in6pifiHaie<i miietis^ pii^^ and blood eat bo cIi»oUx*d out 
of tlio ryiM|ijiinmi, mu\ ntWti'^wv^, pirhA|M, looe^enetl. Suppura- 
tion of the middle ear is not likely to otx^v from |)erfofatioa 
propt'riy [lorfornn^. If tho iiinHioii tcitdn to iJose, a PoLilcer 



IthiV 



■ BUOaHHAO»« l!f TBR H?MfiRAVr 



CTfJet mav be iiiju^ned, or one may dissect out u triait^ulir pi«c« 
of itj<* |KHSTi<»r iulVnor '[Mnilninl, 

ProJficUons of the Membraiie.— Under hypprtropliy ami Bome 
otli«rdi««aH!Sof Uie<lrum-li€ik<[, J have cle^rilxitl ih^jmwions of 
vfttiotM dcgroQft and km<h, lunl now hridiv nicnlton oppiKSitc con* 
dJIionsL 

Myrin^ilM ^lo^^v pu^nt^ of Ui<^^ irpitWrni^ iin<I a ftUj<h1 |>n>* 
jttrtiou of the memhmii«, in front and behind iJie liancH^ of Uie 
nnlleus. 

tiniDiibtions^pnii^ from t!>o papillary connective tiwueof tho 
di>rmii« an^t form nodulc^t and |Mily)>i, whiHi viuvtk* irrogiiliir cWn^ 
tions upon the outer Mirfiice, Alt:(«*i8, heinorrhagf, and tnaioni 
beiwcm the layers of tiie ilnim-hmd gc-ncruUy work outwards 
and nkivc lhe«jiidoni)i». 

AcntL- intlamruaiioD of tho Tnid<1Ie ^r cnuj^rvt n red, cnoiaT, 
sliining balding of (be membrane, luul the inallt-ii?^ ap[><>»r» d^ 
pros tt l. Of al tli€ bottom of a siilous betwcon iJie anterior and 
posterior pr(^eetioiK. 

Exudation, hvm«rrfkage or Uimfire in tlic tympiiani tmy isnue 
a piLiibiiig outwnriU of any ^^gmi^t of the iiutmbninc, t>ut tbc 
poetcrior tuptTior quadrant is mo^t frequently the seat of electionp 

Hemorrhagea in the Membrane. — Snmll «x'byin<i!*iw. «iiptT- 
Sciat extiil»ti*»im, :uid inlibraiions of blwjd ocrur in the meia- 
Imiia tym|iaai fmia various vauM^ Tb<^ niuooLi?( tm-inbrane of 
the lympanmn ia hypenemic, duriniB; mciurjefi, &nialbpox, lyphoid 
fever, dijihtheria, angina and other dinouH^^ and \v pn^tlinpcwed 
to hemorrhage from slight accidents. Uemorrhagcs appear aa 
mund or oval, bbiish-red eles'atioas upon die inner Mirfaoe, and, 
vrivcn eeen through thu tuiiuJ :uk) outer laycn ol' the itK-mbrane, 
they liavea brovrniab color and arc illy defined. 

Et'chynioi'tt and hcniorrha^w jasl lK-iK«(h the epidermic of the 
dnim-bead are deep red and generally round. I have seen them 
at the |>cnphery and at the bordei^ of fN.Tforution4. 

A patient of mine, about wxty yearn old, had dry external 
canal; dry, wbttifili, opafjue, i^li^htly depressed drum-EK-mls; an- 
noyiug tiuniluH, and &clercjsis of the raucous membmne of the 
tuid<lle «*nr> Aftor an untn-Hunlly strong inflation with rhe air- 
bag, I perceived at tbe mai^in of tbe superior posterior quadmut 



ao6 



TIB HruAir Bin avd its ptsfabis. 



a rottiH cxtravuTution of blood beocntb the akin. This dovihdl 
the epidermiH anti in two daya time formed a dependent poadi^ 
whiub 1 jierfbratcd mih u culjintot notdk^oiul from wbieh tloveei 
twvem) drops of mther watery blood. The meiDbraap licatolj 
kindly and no other iK^rideiit bnpjieimi, 

Ki-chymoees beneitb tho epidermu gi>Dcnillj lotf« tkcir u'Ster, 
form HJ]ri\'vllfd clotn, which Onally ander^ fatty degenet^tioQ 
and are absorbed ihiriiig ilwxe cliangi^Wj Uioy move j?(biwly to tlw 
edf[Cof Uie vnoiiif>nui4^, and fliHi oittti^rfb along ttie vb\\ of tlie 
oanaJ. This migration is thought to dejwnd u|wii the growth of 
the epid«rmij4 from tl»c c<-nti^ of the tiieiiibnifi^ outiitinhi, tJioiigh 
Zaiifal believes it is a result of capillary action, 

Tr€afmcut.—'Xh(^ prwcnocof blw.^! Jii ihi* membmne may b«i 
syniptoRi of rmig)i treatment which shoald be stopped, or <d 
grave romtitutjoDal di«eaM) aj^inst which oiir thi-mi^^utic on 
ghoufd be direct<id. 

When th« hlood rcniftiaj« fluid and puints t>r biilgeit into the 
caual, it should be helped out by a puncture. When tiemorrhagv 
Qoeurs without niiy dii^unctive .nnipComH of n mcirbid coodkiOD 
of the ear, and seems connected witlt Purpura, Fernim or Secfllt 
should be odmini^tcrcxl uutil alw>rption tjikG?« \y]mx, ] 

Ar^oicLtm and Pliospliorua are useful in morbid states of tbe 
vnsculnr lUsut.^ 

Epithelioma, cholefltealoma, ami tubercle arc very mn afico- 
tions of the mcmbrana tympani. and exceedingly difhoult to diag- 
nose; tljerdory 1 merely niv-ntiou them henr. Any one duturins 
further information in regard to them may consult Seh^arUeft 
Paitob^cat Anfdonty 0/ (he Ear. 



DlBlAilS or THE MCDDtS tAT,, 



207 



CHAPTER VI- 



D1H£ASI-> OF THK HIDBLB EAIL 



Otalgia. — Earache » one of die cwnmorefit sj-niptoras nwt 
with in pmciitr, *4|Mvi3il1y nmoiigt^l ohlMren, find tlie flcmnmlft 
for relief are geDerallr noisy and imperative. The l#rm is re- 
airioli^ l)y j<)o<nc nitllioiv to u jiimjik' nrtimlgia of tlie i-tir, IJio- 
[tttttic or reflex, imacamiimnieil by the usual symplonB of aural 

1 prtfcr to use it for all sufMen 3i<X7f^ii>ii^ of imin in the «ar, 
vrlkenever it b impoagible toobtnio relinble data for an accurate 
difl^iHwis. (hulgiji nmy then ^iguify n rt^flcx pain frr>ni a (^Honsi 
tooth, or the violeDt lateral headache of licginniag inftaniniaiioii 
ID the lycBpanuiD. 

Faiiift in the KuJitory regioD vary in quality and quantity, as 
ebevhere, according to the part affected, and a little knowledge 
upon the sabject will ik^int in fanning a pn>gu<>KJ% irnrt oiinhle 
one to use therupeiitic m«7aflure>^ to the best advantage. 

Pimple neunilgii of :h*? <*ar is Hiann^h'riKiHi by ]uLiii uf stiddm 
oo!*et, rapid tncfeaae in severity, ami suJden ceasution. It is ir- 
regttlaranJ capridou^, aud darl^t thn^ugh the car viMi lightning 
npwlity. Tliere may be slight dfafceas and a little ttnniius, but 
the canal ami ineinbmir;i tynii>aiu are of nomuLlc^lor, aii<{ the 
EuRlachian tube and middle ear are clear to inflation and free 
from e:sudftli«>M, 

The affection coexists with neuralgia of the trifacial, and occ^ura 
Vfry frci|uen(Iy from a carinuR toolh. I ha<l a ease of thin kind 
recently. The tooth wo^^ badly filled, and a cavity uxi»te<I 1hv> 
Malfa tlie amalgrun. Th>?! pain n-an paroxysmal and most excm- 
oiating. It extended from the tooth to the ear, and down the 
iKok along ihe ocrvicul nerves to the middle of tlio clavicle^ 



aoe 



TBC nvtiiy BAR A5r> [T3 I»I3BA8B1I. 



DuriDg Uti' iiuroxyxmi^ tli^re n-o^ fiilnc»»< ami tlirobbing in tlir 
ear witli slight ringing tinnitus. The iDoth waa troaierf by i 
con)i^t:ti.'titde&[i-^> tlic [rixitx cca^, »■><! ^^^ ^^^ ^"^ iouiul in a 
normal cy>iidition, 

Tlie rArlv Htii^ of a<'nte inflrtmnintioit of lite mtdJIe or turn 
severe pain like neuTBlgm, but it )§ conlimious, increases ut 
wverity, »iut ^prt^utt* over tho *Uh of the Einut. The flirtttt u 
often aUbctcd and the pamg flboot along the Ku^la<Jiiiui tu' 
tJirougli the <Nir wh^n nwuH'wing, There i* ^ncnHy ii Uiaoi 
of expceure ; i«o*iit slight jiuin for a day or two l)efore tlie s^vei 
{Min 1>t^liiA; tho mt>mbmnn tyic|Ki[ii Miow? hy|)eneniia ; ralcstn 
h«ird Ihrongh tlio dinguostio tube, and inftaticn bringa tmnaietu 
or p^rrnmii'nt reli<tf. 

Inflammation in the cnrtilaginous porlioii of tlie auditory canal 
is (sbaiRGtcrizHl by dull tUrobhin^, \\iu\ <<f)iitiniiou7L pAi>>( wi*r« 
at Diglit. Moving tJie anricle h px<x^ii)|;ly [taiuful, and ^*kiw 
swelling cu be detec'tH. Infliunrnatioa of th« osseous i>ortii)Q «f 
the canal it manifested bv a heavy, aching, l^oriug pain in il>t 
ctinji ; redrutt* of it> wnllis tmd inyroawc of Kuffcnii]^ by pron^urt 
In front of the tragic. I>j?^a.s(> of the muiit^fK] i» attended 
licavy, aching, tensive pain in the maj^toid proceee and deep mlina 
the ear; there ia redne^ and avreUing over tlie ntatfttoid^ am) tii« 
constitutional di'^turWncc t^ eonttidenible. 

Chronic inflamniaticn of the middle ear wtthotit a |Krfcii 
drum-head is actxtrnpunitil by a henvy, numb fveling lo t. 
ear, and a dull, not constant, pain. Someliroea the livaring ti^ 
temporarily cxalteil during the pain, whieb shovn ^Muunodic ac- 
tion of the otic mu6clee, or a liyperastlieMa of tlie audilorr 
nerve, 

DijteaAe of the internal ear in not aecx>mpnnicd hy |iaitii, at t«M| , 
there is no iiulhorltutive record of itA prtseooe in iinoomplicaU'^^H 
caaea. ^^ 

TVtyi/nuYi/.— What ehall one do for earache? ** Drop in aUTMC 
oil and laiiilai:iim,''8aya a wt*lt-meanin^ houaewife ; "pulabaig 
of hot salt over the ear," says anotljep; "apply a hot roa&led 
onion nj;ht on the <iir/' rtny^ a third. All g<x>d and ttM-fut w^e- 
tima^— aII failing very frequently, because not pwerned by prn>- 



OtAtOfA. 



20*J 



ciple. Thete art ^mpineai reroediee; x\\e n«w therapcuiic^ of 
spOLHAl kttowlrflgv tnil nion? exact ifjmptoiD »tii<ly hfls sonieihinf; 
better xo offer. 

Itemovc tbv wuw, if stvU operative, infinite t\ie ear throiiffh thif 
CustiU'liiaQ tabe immediiLldy, aiui rxin^w ihiHoeiQ^ioTuilly. Hvfitl- 
Im |^um8 in iiifunto ^lioiitd he lunoxt, and ;core carious twth 
pitlled ont »t all e^. If the memlTnina lynipant U nut (lerfo- 
mt^l, *>Ting(' the i*nr p^"t)y itn miDutf^ (i\"ory hiilf huur witli a 
dram of Aoi>nito tincture in a cruplul of hot wut^r, ami givi' Acrcw 
Dite iulemally. If the monibrane In perfomtcd, atte Imp If^ alone 
for iht' doudiing. If the puin ie not wxmi roJievix), apply a hoi 
liop poultice o\'er the ear, in Hk» iri(<^rvfll» of dontUia^, Thcjvc 
inesvtunif^fftiliiij;, ironthiiiG thv ^yrin^iiig an<l poultidng, ami t^ 
riew the cliaract<^risticH of mctlidncH for eiir dii^^fHi^, 

Fiil-nttlla tJ^ indinU'xJ wlit.'ti thi.* paim nrc fcverr »rul lEiVprmit- 
ling^arid Ihi'iv \si i^ilnrrliof the njis<i-|diarvn^-nl Hpncc-* wtrha hiv- 
lory uf rxpwura to cold, Arscnkiim t« servit^^)le urh«n tbo 
patk'iit i.4 fltibjcot to neurulgtn ahmit tlio h<%% ihti jiaiiiH are pnr- 
oxy*)mBl und exoealiii^ violent; ant], during ihe intervals, thcn- 
U 4HKUsid<:nibU' (^xl]UllMi<kn. Ikdiadonnu U exctlknt when ihtre 
tre^harpscirehing l>aim through tlt« eaT>4, a loud tinnitus, and 
con^d^^rahk ccr<."hnd conpvtioH. Brycnm should be pvm if the 
paiD U mcxkrale, die ihiiMit B liore, and there i^ inuscuhir MitTneA^ 
and i^oimCflK. 

Cinrhona i^ called for in fulness of the ear from e*>ng:p=ition, 
riiigiii); tinniuis and ini.Mk<nitc puin; c«]MX'iuIly, if the |intiait 
ItvcB io a malarial region. 

Kali hydrioil. r^1ie\'i^ rhrohbriig, arhitig, continuoan pciin utn\ 
reduefifi in die cstenial mefltQB^ Mea^uriiie eorros, in the btst 
BiediciiK^ for l*mvy, ucldng, tf-iisive |>iiimh in th<5 mn^f^id and ear. 
I.^F'copodium is reconimended for jwins of moderate degree and 
fitful flmmrter, and Chnmomilln rt-liev^!:* mild <^tnrhc in pi^<vi»h 
and restlffiBohildreii. 

The otalgia )wiiietim<a» conrinues violent in spile of &11 treat- 
nefitf and ^lutioiu of morptntt ami atntpia uro rof.<omrDi:iH)ed 
by some aur»t« to bedrop{H.^I in tho mr. One ^sau of Sulphate 
i«r Morphia, or Sulphate of Atropia may be di^^soK-vd m a lea- 



210 



TBI 



EAR AHD 1T9 DI9IA8S9. 



HjiootiAil of ]xrA urati^r, ai>d tli<^n tlin^ or four drop infilled 
the c^nat, with ihc huad iikHdH to Xhv f>p|K]ic«tlp tfidc. Tti^ 
afilutii^iiii are ilnngefOH^ luid hhould not l>e uaix] tiy an/ but a 
9|KoiBlist, who is certain of the aoundntas of the dmm-heod. 

It ift DGceear/ to aiM a little Mor])hiu to the (Jicrapeaticfl ll 
rare it»!anoe«, to benumb iUe pain, and give tti« patifint neeM 
re^t. An dghtli of a i^rain (%.*t an mlult, every hour till relief b 
ftfTi>rd<x1f ntHiy l>o f;i\'4.*ii with fiufety. I avoid ii»ng it a^ toDg u 
]>'i-iAib]e. Morphia [>eniiml>A [laln, htit it augnienrA cere4>nil coa- 
g«.<»tior), ^nO ttiui^ t^-tKlft to itkcrraiic aiiy t^^ndeacy thtrro may b? 10 
inllammatioD of the ear. It m nitich ioferior to AoHiltc, whkb 
iB% lixml aimwtlietic, and an internal a»tijrh1oj*i^ti<.\ I trvati*c[ for* 
merly manj wvcre earocfiea by the palllaUv^^ hot dotKhe and 
Morphia, but in late yeare have used the Aconite douche for tbt 
ear. iitid Aof>niti' intirrnallv, and theevideikccin favorof the latter 
method i* overwhcltQing. 

It iDU-st be r€inen)I)cred thai earache iflgeiieTallv a premonitory 
symptom of aural mi^hid', and tv^ !>oon 3S symptoms bpoomc 
dfAnite^futthat a true dingno^U can be made, the treatment mUAt 
l>e Aought under the proper i)osolr^i«d name, 

Tinnitas. — Tliij^ ij< a term emplovcd inJMcrimiruitoly for all 
Biihjertive founds, wbicli originate from internal morbid changes, 
and not fn.>in oxtenml aerifil vihniUoiiM, ita in the c«v in aormal 
audition. These fioumis vary from a barely p*roeptible riiigii:^, 
hcuni only vrlicn evorvthin^ i.-^ <[i|]ct, to a Icnid, ooarRC, tiimtil- 
Utoti^ niiuhting, that annoys by day and u very distreasii^ by 
nigh I. 

When a sudden shock as the report of i gun a^cta 
healthy ear, then* i^ a niu'^it^l rin^tng, cleir atui purc^ as If A 
glasa liad been striiek. Tbis in the healthy reaction of the bervE^ 
and is generally the ^und that indngiiratev morbid linnitio* 
though it in ^> trilling ihal it h often di^^r^^ided, til) louder 
whiting and »in^in^ awukcn anxiety for the lH<ar!ii|r, Hitfiog , 
aa of escaping Atecm, cooing, soft gurgling, m^llic riagingj^H 
chirping ax of ericW-S connix-led musical notes, and other liigh^^ 
tona% interchanging, intermittent, or coustautt occur frequently, 
I>:7W frequent are nounJ» like the grating of the loeiist, the buzz- 
ing of the beetle, a dull pouucHng, and the rtariug of fibelbk 



I 



TINXirDS. 



The inienfiicy of tlie eound^ is an ramble rh th^ir qiiulUy oiiJ 
pltcli^ and it to Impowble in many cases io connect ttiem wiih 
Hny tpcdal iBorMd condition, or to d<rrivo from tlicir a^n^iiltrra- 
doD abne anylhing of uiiioh value id a th€rapeutic point af 
view. 

A single Hoiind floraetimes continues without variation a long 
tiaic, wliilo in olhcr ca^jCG there is » tfuucession of flovcml !M>und«j 
formiDg quite a gnmut. It mny he titaled u^ a general rule, that 
delicfltu HHinds indicate «oirie aH'i^ion of the au<litor>' organ or 
the brail), and ccaise oneei, »ira;tioni< of the l>loo<lv(=£«telfi t-otiligu* 
ocu to the €ur. 

Patients ii^mjiare the wuEidi^ to tho^e wtUi whtrli they »re unt^i 
fkmilMir. T^n^y flirscribc ihcm, iw rinij;tfig, singing, hninniinirp 
hittifig, diirping, buExin^, jnundingf grating, rumbling, and 
ronrinf;. Tlie farmer t«pc«lcK of the nimii of inst-cte and falling 
vBtvr ; the dweller in the city, of steam^ machinery, and carriages; 
thesailor, of creaking npcirji, the windrt,and theoano; and iiitui- 
ctaiK even indtfnte the notes of the tniLsical Dcale. 

Tinnittj.4 is cnti.Kefl hj' liyjMrncniin, aniemia, or dWoM^ of the 
labyrinth, by which the norniiil pr^^ure of the emlo- and [>eri" 
lymph ift altcroflr luid the tiTmi nations of the auditory nerve are 
diMurbe<). It b* or^dt'tioiuHl bv funolionat or or^inic changrn in 
the trunk of the auditor}' nerve, the ganglia with which it is 
conaec^r or in ciintigimiis portion>» of lIh? brain. It nnay cod- 
sifit of tin? nurmal rcetpti'in of vilirsitiofie, which oeciir fr<jrn 
movecnenid of the tensor tymjmni, sta|>PiIiiHj i>haryTigeal, or pala- 
tine mnvclcs, of exudations in ttie Euj^iichian tnl>e or middle 
ear, and of blood curn^nts in neigblx>ring vesHelei. 

A foreign body in (lie i-xternul iuinal,di«entfCof the Ana) valU, 
inflation or inflamnmlion of the drum-head, affections of the 
middle ear nnd Eustachian tul^?, ctmtractlon of the tMWor tyiu* 
[4iRi mu^dey neumlgia^i (liMvrdent of the ritoniacrh reflected throtigli 
the inferior eervioil ganglion, and diBlurbaikcefi of the cerebrum 
from medjcines and diHeasc, an* all prolific caiMm of lahyrinlhine 
disorder and tinniiuH, 

Deeaae m tJw labyrinth from rbeumatiflm, gout, syphili?^, and 
other oomtitotioiwl diseiiMM i» ntt«nde^l by local oongv^tionA, ex- 
tnmsaiionA, and elTuflions, and causes so-call^ nervous tinnitUB, 



TCR 1ttJMA!« EAR AND ITS PTSBAfii8. 



ID \Tli)ch tlifi |»er ra^teal henrrtig of th« taDing-fork b nlmijt 

Tha Ullu^imitioiiii^ of tic<iiing, tli« vivid oonMciocvnosi of iODic 
one ntti^nng oiie'fl tiam« when all is quiel^ rhe hearing of wbob 
bars of itin^ur afW n]ir>]>Wy, jihoiiM ull Ik' oUwcd vi-ith cwnoui 
tinnituis b<?ctiir»;(-, if the otic eiid or the trunk of tbe itidiEocy 
nerv£ ia not altccted, the ocrchml |>mri])ient relk ljclo»giiig U atbc 
n«rvc are. 

Mui^iilar tmnitiifl muj 1>c urtr'I (o <Wi^nnto nntindg fWwi 
traction of the muHclefl, connectetl directly or indirectly with Urtj 
oir, hut lIh^ hiinlly d^stM'vcihf imroe of 1mniliiHjx<<niiKeof 1 
loDg intervals b<^t\rt«n fiUcc»«tvo vibrations, llapid ff|WsiDod]c' 
CQi]tnicti'>n->( of the tensor tyitipcini Imvo licvn rc]iorlt?d na giving 
mmst clickifig sounils. The act of swallowii^, hy drawii^ tfat 
walU of %h^ Kti^tftdiiau tube A|^ar1, given rt^e to another kiiiil of 
clicking not fo clear. Nothing is known of the octiou of the. 
i<lii|H^iitH ill oani^ingtirnttuft, 

Va«?ular tinnittts is caused hy the proximity of the interna]] 
jugular vHii and tli<- int<*niii1 t-urotid nrtcry to iht rp-^inanl tj^m- 
panQtn. The internal ju^rnliLr i.^ sometimes coxistrieied hy exce»* 
Mv« d«[H»it»of oMifio mali^rial in dio jiij^lar foMi; tt in fi^ 
qnently dilated abnormally Just beneath the hae& of the »knll, 
owing tit inn«oiiInr dcv-rl<>piiiei]t of the uttsk, and llu: lialiitdof 
the indiv^iclual The carotid artery may he narmired by bony 
emTi>]u-l)inont n|)'>n itn mmil ; h mny k- (liUf^fl ioto an aneoristt 
ijrilhont or within the §kul) ; or its walla may be w degenetltedL 
by cnlcific ile|K)«iT4( in tTii; middle cont, a» to d«*trojr Its i 
even, making it a rigid tnl>e, With any of these x'ariatiotM 
the blood cliniini'lf^ it cnn Ik: readily unJuretood how nt>rfnuJ blood,* 
coursing upwards through tl>e aHery, nnd donnwardri tliroiigb 
thi? vein a( rach h<?nrt throb, niu:<E nec«K»inIy niakt* a fri<tion-| 
sound InudiT than tliat irf health, and thus ennne a tlntiituii i 
uluiont invariabk* quality. I mvr one c<am> In which a ^ncaking 
noUe within tlie eerebral flpaco could Iw heard hy pliwtng one's 
ear upon the patii^nt'Ti temple. It vras thouftht to be anuuriam of 
the eut>tid at its divlniim ju^ti \mf\th tJie itktdl. 

The [KWitiofl of the jugular vein and mmtid arK^ry, so near tol 
the tympanurc, permits tlit* frictioii-Mund of Uie nurmal blood* 



TtlTKlTUS. 



213 



ctirviit to b« lican] W an ov^rsetiFiitive ear, ofi one can ]>rave bjr 
sti^ing the nu^tufi with T.L«5 fjiiger. WJictn Ui«^ Ai>un<is ar^ 
itkCffiiMil hy altmtiou in thv force of tlit? lloffd, or by changctt 
IQ ica coii<intt>cni elentenbi, linntriiA of a niikl (fliaoicter ih pro-* 
iluccd. Tli» !ft, liowovcr, true audition, U9 mticli aa it ia when 
soitodf) pa^ tbrouj^h 1h^ bones cif th« »ku)1 frrim :i tuning-rork, 
vihnihn^ npon the vertex. The coiulitinnf* wlrch caii^ thU 
tianctv of tinnitus «re aiifiMnin, iilKhnrUf am) bmrt ili:>ciu«c-* Thin^ 
wnk vomeD are frf^iient FJiil^.^rc-rs fiMni iinfCHiii*? tinuilits whicli 
B oAeii iacrwHwl hy w>m<? i-atiin-lml <l]w*r<i*.'r of tLc tynijKinum. 
Tlw purplfy&icec], thick-necked hon vivaM is prone to throbbing, 
pl«(honi? linDiiii.i, whrf-li l"* itftcn a [mmionitory «rin|j(om nf apo* 
pifiiii, i\'r^kn« isufTr-riii^ wit^i \iilvular lesion of the hc'nri and 
hypertrophy have an irreg;ular and tnmiillnofL'i oirt-ulation of 
hliMK) an^l rliVthmir tinniUiT<. 

The pvv^Qe^is will dopet>d upon tlie catif^e. When ihi^ can I>g 
removal, of roun^.', it U fiivonibic; it nw bo stxklcd in ^neral, 
tliat the longer tlie noises have existed, the more <jiJlioi]lt wiJl it 
betiifrili>Q(.-« ihcin. 

Ttftttment. — The treatment of tinniEuH i» the removal of its 
cuti)M.%and, hiivtn^ made tho dia|i;no^iA, the measures and tnetli- 
ctnei will N* found nw-ntiimt^d i[i ihv pmptT pliwv. Iti'HK'Vv any- 
tiling foreign or ol)strueuve from the externa) canal, Kustachian 
tube ami tyio|nniiin; inlhilt* the (nr with the air-hsig, and txmt 
diMBSfB of the ear and tliront mv^ujifhtm arfaiu 

Aconite, in luiKlcmlo dowt, i« thv bu^ €v|auli/crof the blood 
drralation. Wlien there are ^ympiomaof vaacniar excitement, 
and hypcn^mniof tliL* bmin and car. fTfpirmlly, when aculo jq- 
flainmation U tlireatened, it will quiet theatorm and relieve the 
tinnittu. 

RellmlouDa \» eqimlly effioicioiifl, wheii tlie conation 18 con- 
Emd to Xh*.' lii'Jid iiml fnct\ unil throbbiEi^ U a timrkcd symptom. 
As a prophylactic of ^tarlatina> it should he preferred, if tinnitus 
oceiira during the progm^ of that evanthtni. 

A 6uddcii Q(XT!aeion of tiuniius. fulnt^is of the eanf. and T^Hjcht 
vedtieninj^ of tiu: mt^nibrana tymp»ni> orviirrinj^ pttrli<;nlarly in a 
patient euhj^ot to torpid liver, who las lived in a malarial ra^on, 
decnands Cinelroiui a» ihe n<0rcst «intilrmum. Tinnitiu% tou- 



214 



TBI BDHAff EAR IVt 1T9 DTSCAIIS. 



iMctcd witli cotarrha] infLimmntioii of the middU ear and Eti»- 
tAf^hinn lultCT, 1* txtfiit trf<iit4-(l Ijy Piilratilla aiui Kali biehTxtra. 

Where tlir attacks aru jwroxysmal, mid Aixom|>ai)iiil by nou- 
mlgin of the lecth^ ear nr fk<v, Amenicura ih llie best nvedicine. 

The reflex Doisa; ami vertigo from j.'ostric troiiblcft ridd to 
ArAt-ni^'iim, Chainomillif Lycopodium, U^rcuriiu, Xux \x>iiiici, 
and PuUatilJa. 

H\dn>lin>[nic ncid litts boeii userf very »iiccef«ftilly in IS^miniin 
Ho^e^, largely dilated in wiiter, l>y Dr. Wocikw, of London. 

TiniiituHT ocx^urritig with in Hmn nation, effu»iou or homorrfaage 
in the internal ear, indioated hy the tuning-fork upon the vertex 
rikI by other 0yniptom«, ojglit tf* lo ta>atLnl hy diH.'}Ku7ling rem- 
edivs. 

If it b nv^ent, Mercuriue cor. or Morciirim sol. ^ould be given 
for rujiny wv^Vk Anotlivr ix^im-dy may U' AtilwtiuiteJ, if ipi|>or- 
tant H>'[Dptoiiifi demand, but one should return as soon as p<.vHb)e 
to the aiitiplj^tic im-rx-iiry. Kali hydricKl, t* prefvmblo fnr loDg- 
standing caees of labyriDlIiine mischief, and follows Mcn:«riD* 
very wrll. 

TiiJnitua, due to Jilleratmnft in the elasticity or calibre of the 
liiq^^ bloo<lvc9ael8 passing tbrougb the tcnipoml boii^, culli^ for 
Aconite. Diijitalifl, Kali hydrkxl., Secale and, in case of aocuri^iD. 
perlmif^ for lii^tiirt' of tbe carotiil artery. Ooropronrion i'f iIm 
carotid upoa the atTet-te-l ^^idi' often :u-restA the noise temporarily. 

Anromia incroows the friction 'WuikIt^ of the bloM) in tlic curo- 
tid, and caii!^ titmittifi of a ct^oiikg or hnmniing sound. One 
cat! arrest it by compressing the arlLTv, ami thij.t i^mtlnn the 
diagn<>Li*L. Attuntioii to the p^neral healtli and the adniinistra- 
lion of Cinchona, Oilcarea phog,, and Fcrrtitti met. will arrut 
tilt uupU^Nkitt^yinpt.oiu, 

Plcihoru cauw# loud, throbbing, thumping runmrn in the tant 
Ihrongh th«^ carotid blood current, and in agnificant of danger. 
A patic-iil (XiDPniluii in<? for such a trouble, and a few wivlw laur 
bad cerebral apoplexia. Be careful of the air-bag and inflate 
gtnrly in th^v ta^^n. Pnt the patient nn low di<'t, and prttcirihe 
li fjliLs* of IVitd rich f hall Bilterwafiser before breokfoBt, ikccaMon- 
ally, altt^rn^tiiig with Menrnriiu Mob until tI»o «iigot:gttl viaxn 



I 



iATlON OF THB TYHfAKPH. 



lire relieved, %i\i the bowek net freely. Tbe« give oilwr imli- 

WIm.-ii iho limiitus triK» froni Irrcgulair va^ular currvntfl, anJ 
cardiac shocks transniilted along ihevei^ls on account of Ii^nrt 
dboABC, mnlinc mctliciiie!4 :iro nc<^«fflryf such a^ AcudIU; l^i^i- 
taitt, and Veratruin vir., to modejatfi tlie circutarioii, and to cou- 
trol ilw ventricular c^ntmctioiiA. 

Many GAfica of tinnitus, w*hiHi M>efn iJe|)e»<]<tTit ii|>oii extm 
nunil niiiit(!^, will Ik* Ibiimt npou uiMtil cxamiiiution ootiiKrtt^d 
with some intra aumi nii^lii^f. For tbia muHoa thfi dmgDo^8 
ntiist l>ecar«fiiny miuio^ ia order to tlinsA to tW pmpt-r Ibota- 
peutic Tvwiir^x-fi. 

Acme Inflammatioii or the Tympanum.— Thi^ in luniimmu- 
tioii of the mucous membrane of the micldte earanJ Kii^tacbiau 
lutie, and v»rieH iu tk'vi-rily with Ib^ oiiu^^. of the aUa4 k. euuI ihi; 
oMKitutifjn of the iodiviJual. it is prolmbli- that M famous in- 
flanunatioriB of the tyaipniuim iirv complimtal by Aoaie oxteiii^on 
of the f)t!<<n«i' along the Eu^^tachian tube, lhou<-b thci\' nrc tubu) 
iotlaDimalion'i in uhidi the iniihlle itir is unt alleoied in a likt; 
tnantH^. MiM catarrhs of the tvnipanum occur very frecjuently 
in our rh:tngi^uble nortliern climam, nnd lUtraca little atteation. 

A pcTM:-n lak^ cold and ha^ coryza or stitthc^a and dryiiffis of 
du" thniaC, for a diiy or two; ihe Kinit&chiaii tulw <^im\^ with u 
rattle when he blows his no^c ; the car feels a little full, contains 
A ecTOUi e3Eiu1ali<>n» niid has<tarl>i of (nm.-«iv-Tit putn; tJie b<:unii^ 
b somewhat liluntc<}, tmd thcrt^ is a mild tiiinttuj^. Tht v(«?«ls 
along die malteus are injected, the inenihrana lymjAni ia a litUe 
rsddened and deprt'ssfd, and the mu<x>uB membmnc of the tym- 
IMnflRi ifl hy|H.<ra-nuc. The cold \j^\» better, tJic morbid >iyn)|K 
loms of the ear diKippear ; or they drag; along mlldlv and cauiie 
obroaic catarrh and dcafti<3§8; or inrrtoj^e in severity and cau«e 
ccMHtitutlona] dl4turb»nce aad SH^vcre otitic. In the early Alage», 
sev«^ml inllations v^ith the air-bag, a hot douche, and il few dc«efl 
of Aconit^^ f'ollowvtl [>y Kali hydrioiL er Put^^illa, nill n^iiially 
favor iCAolulion^ aiid prevent ^nous injury of the vat. 

Severe ca^A may bc^in miklly as 5eroUB catarrh, and gradually 
4evdop ioto miicouH or purulent inflnnimulion; birt tliey art- 
more likely to bt^n middcnly and violently. 



T8B BlTHAlff EAE AlfD ITS DISBA&S9. 



Altaoks «re most Jroqii^nt in Ihc spring luid aatuninr futd dur^ 
ingrl]:t(i);r?« fruni iiiode.nite Ui Hevt-rn wejithctr U i^nircUutt Ixith 
eani arc aflbctecl «imDllaii«>ijRly ; the fitlack b gcnemUy ooaQnoit 
(o Olio <^r at a time. TLf* lell mr w more linblc to be ilMir«d 
than ibo right, becau^* the IcfV Ku^tuchmii tube ami liffk nuttl 
fono Rre^oiicrallv itmaller timi) (he righL I Mieve tiko vomer 
i« ofUiMrr bent in an vWmw totrnnls tho \€U sidi^ thuTt diRiiimh- 
in]£ the lell na^l fa^tia, t>e<^tk'« persons pull Ihi^ tutsiG to the righc 
i^jil^ when ^^tping it with tlio rij^ht hand. Wiping Ihc hfv^^ i& a 
coiiMnnt employment with mati}' pcr^ns in our uoflbern clinma 
(iiirin); half th< ymr. 

Tli<< [talti'nl \\m hi^ eixr »n<\ ttimni ejc[i<^i^Hl li> a ilran '^f air, a 
cold rfotiche in a haith, or in iht «m water wliile swimmiitg and 
diving; or )i« ^tn thoroughly nliillol, tt^fHx-iullvi unur vapor 
tinlhs ami iiiHaTnination locates in the throat, tnW avd car< 

KruplioEM of the twth in inrunc}-, and the wisjrmi ttrlh lutw, 
rarws of lh<^ t^eth. budly lillc-<] 1c(>th, di^L^^v^l ^eufop^, angina, diph- 
tlieria, nhooping-cough, mnmp, ^kin dii^eo£e, syphilis, and exan- 
th<-rnni4H]x uml typhoid fevers an' potent cui»c< of i:ntirrhal in- 
tluoimalbn ofihe Inlko ami tym|>aiium. 

Thv plmn'nf(eul rnc] of the KiMtuchian tube vomHicuce bcconm 
inflamed ami i(5 opening rlt>^l hy towelling of the mmiirua oinu- 
hniEie; lli» prevoLtf^uir pii^in;; iutollie tymjatnim, thi- iilrtlivrviii 
H mrefi^d \iy abACHr^ilioii, Xlxa ilmm-li<4d in pushed mw^afdsT tlie 
mncouH mcrubntitc Ixy^jmis hypeneraic and it* *CCTX?li"iv" in* 
ci'eased, the niucua of the lympaiinm and tahe doat not Cfteajve 
from I he latter, it d<)C^inpi«L'», irrltutcv nod inflamm tlie niidille 
ear, and may pnnh the drumdiead onCvanlA again. Id other 
rtsist%, ihv influmniFili^m dot-d not wait for th-^ tympanic affection 
prixlueed hv cutting oil' its supply of air, but trnvrlx up Iht Kua^ 
tachian nil)e, extendt; along tin* lining of the troipamim, &ikI 
<!ai]Aef4 ci>nA]dembte niueouA (teoreiion. Again, lh« inlluinmatioa 
i^ *rt ^nolenl, that the whole niucfiue tract fn*m th^? pharjn^*) 
4.*iid of tliv tubif to the mn^tf^d c«lU m swollen umultaiKKMDJy, 
the ^jiaces are fillwl with mucus, the thniat is deeply affected, 
iinil the hnid i«yin|4nrii^ (in< severe am) c*ouataiil. llm mueiu of 
thfSie titiaeUA is of complex nature. It may 1m sero-mucaa er 
rouoo- purulent, and, [lerliaps, be aiixeil witJi blood. It u^y eon* 



ACITTS TltPLAMkATIOfT Or TDK TYUPAHDH. 



217 



tnin white and rttl oorpitsolr^r q^ith^Hfil dtbrU, iiml nur|4*Qt€<) 
epithdiuni. it is quile fiaid or very tenacioue, and may adbene 
to UtD Mirfuoc of iJiG ctivitr. In chronic <-ww»j it tiiirkc-n?i iiiul in* 
UstfenB witli the action of the o^ictea. 

11>cecm«>(|Uono(^of the irilliimnisiti(>ii arc ni^hin^ »t>i«» and 
throbbing in the ear, the latter often dimininhed by compr^ng 
the niruliil ; ltcu\y t\rhU}^ pain in xhv 8tde uf tlu* jjntd, uml ^hiitp 
Bhooting pains from the throat ihrougli the car nnd down tht ii€clr, 
iii>iiii'iiin>9iiiiii^tDkciiforncunilgto. The puini'<pro[ioniutiatr(ot]ic 
atDoimt af exudation and swelling of the njucous inexabrane in 
llift ouTow confinM of iho tympanum ; it w more 9KVtte when the 
Ldwoue tewift tD the fornmtion of j>u», and is alw^iyfi worse ut night ; 
'ifatre may l>c hi^h fcvcr^ insit>miit% reittU^nc^i^^ Aiixiefy, I088 of 
apfM.'tite, vcnigo and deliriam ; between the exaoerbations of the 
severe pain, the pationt i^ ^^nenilly wi-nk and dcprcft^l. 

Sotnid acting upon the membnina tyinpaDif movemct»ts of the 
body and [ovi!r jiiw^ talkii% couj^bing, iwet'xing^ 9wiil|ivring, 
lenjctatkiiLn, and prcasun; arotind the auricle and throat tiicnutse 
the pain, ."lomotinit-s, loan almost imbennhl*^ degree. 

Tlw hearing at the t>egiuning of lie dieease is iccreastd, but 
t\%e swelliug and exudation in the tympanum won intLnrfcro 
ally with the action of the dmm-hEad arid ossiciee, and there 
f oon-sidiTidilcdcflfflCttL ThU ob^inirtion in thf; t>ni|inniim to 
th« vibrations of the patjent^B voice prevents thetn from paa^ng 
ofK thro[igI] the cxtfTniil mnal, nnd, 11^ a coik^u«noe, tlie sound 
of Ihf voiix- i;<anj;rovntedf it rebounds Ihrougb the hiutil, and 18 
oftpii heard double- There is a sort of e<4io of eaoh wonl or ita 
klwft RyUablcs^, )hxuuh> the diHCiuH^l car pcr«H.*ive« the Murd a liltio 
later aiul of liieh&r pitth than llie w«]l ear. 

The tinnitus of ucntv intlammiition of the uir is particularly 
diatrc«i?inftt >Lnd at 1irat,coniiiAts of high musical tooca, on account 
implication of tlie oocblin* Lat^r, toti blows Irotn carotid 
ilanttoo are Itear^I, and bubbling, i^raoJciiijd^ rUle* from movo^ 

i of tbe exudation in the tympsinum and tube. 
Thf iPUCUH or |in.s i^oEifinett in the lymfmnnin crovrds into tJie 
cells, pushes out the membnina tymponi, and pri»siii{ 
^ppwards, tlireaters to peiietrnte the brain <iaj)e. 

If now the ear be examined, the speculum will not cau« any 

15 



21 S 



TBR nOUAK KAA kV1> ITS &16EABBS. 



pain whrD it h introduced, unleea Ihecojial Ih indamet), ivhicb k 
seMom ih^r ni>u* ; iIk- iiurictc con bfi inovixl, ami Uk^ aunl n^ioa 
pai]]ia:c<i wLtli Irnpunily. OcvfiMOiiftlly then? will l>c fion^e»sl 
the angle* of the jaw^ if the tbroat is afTeoteti, ami swdlluvfiog 
will cnn,«e ^Imrp !<titc'h<-!4 ihmii^h tho mr itiul neok. The mem- 
brunii lympanj lodke smoky and dull ; it has n lurid n^diMts Tram 
th€ congc^u^tl niLicoiift m^nihrnnf* showing through the other 
Ibvct^^ and from the injected bloodvessels, whidi hid $\ong tlvt 
posterior hordir *A' the uuilleu^ Imiullc, ami pn±B from the canal 
wall all around upon iu periphery, 

KcchymoHCH of 9tnM wc tomolinw* iippoar iu Uie mcmbmnf, 
and upon t]ic inner end of the esteiHial canal, and nro fnsjucm 
in the subepithelial tt^nnwtive ti>>»ucof thctymiKiuuni. Ik-mor- 
rhagc is said to 1^ freqaent during such attojcks, in pnliviits luf- 
feriiig from HriijhtVdiRWc of ihckulncy. 

The triangle of light u altered in shapeor has iliMppe»T«i; 
the pieiubmnc ia more cxmcuvc than u^tiial, in the early sbi^ctt, 
but lulcr bulges out in the part behind tbc malleus and thr«^teiM.J 
to ru|)tnn'. The miiotm in the lytrpannni cnn sometimes be MuT 
tlirough ihe juemhrfkiie, 

In severe cases, and those which bivome purulent, the mem- 
bnne becomes moisit and of a <liflu**ed cherry red, (he ligl>l tri- 
angle and manubrium arc obscureil, and it i» very liftble to ni|»* 
bire^pontaneon-^Jy or from a slight shock »uch aa '^s iviiM-d by 
^tnm* inrtntion or rouph synnj^inp. 

Burnett thinkf^ catarrhal cases do not rupture, M-hilc purulent' 
ones do, and non-fuptuix* and rujiturc are eon&idered diufcno^V 
ugnaof the two varieties. I cannot confirm thi?i uioc diHiincrion. 
The difference between the tnncii* ami put* of acute inflammatJoo 
of the middle ear is more apparent tbao real. Miicine and 
bluinh-^vhite ojr|m?Hile7ir albumen and yellowisli-while corpusolQi^j 
express the relationship and difference* 

The (u«w of nnoomplii^^tci] acute inflaramation of the niddb 
ear with i>erfora!ion of the membrane, which I have bail unilc 
obsiTvalion at the time nf rupture, have nlwa>'H disoharged mucida 
at f]n<t, uiid pMA very -iooti afterwards, unl<S8 recover}- has fol-j 
lowe<l closely after the discdiarf^. 

One can sonietinic« |irx>phc«y from the oonstituticn of the pulieiit 



AOITTf tltPLAMUAtrOir OF TBI TTUPAXTJU. 



219 



uhI iIio ebiiiHCti^r or tlic inflMnmationy whi-thor or not> Uic ili»- 
cbArg« will becotue pnmtent. 

lu hloiKlc, lyrophalif*, min:<mic or 8flr«rnloiw ]M'n*on8 tin* flow 
from the ear is, al fimt, <juile thin mucus, but it soon chaogefi to 
pot. Tlif«c [icuicnts ftirnlHh iniiny jXTforuUKl nicnihrttnt^ nntl 
long, tedious nnd deslrtictive ^up]>itraliona. 

In brun<-UO| bilious, jilvcbont^p mid fibmui' indiTidtialA th(^ Hish 
charge often rem&im tbin nmcme until reccvery ensues, thuugh^ 
of WHjrse, pus m:iy f>llovr. Tljose onn^tilutitift^ hIioiv uiuny i^aipcs 
in vrhicb perforation docs not occur, l>uC chroiiic prolifL^rous in- 
flammalion i!< Hkcly to be leA m a M^u^la. 

In M>nut cases, it socms n£ if the tuon^^nt the nir ^vb*t (o ttii* 
middle ear through the [>errorated tympanic tiieinbrane, the catar- 
rhal Mvretion w chaut^l to [>u». Sofnc-tiini^ one mx» through 
the speculum tlie lower lliirtl of the outer surface of the mem- 




BuLOfpra or tiik MussaiNJ^ TviirAM rKoy ICvl'uattov (Schwartw}, 



brana tynipaui objured by a little pus, which has flowed through 
Aomc minute rent in the mcmhrunc, or lia^^ n>[i]o froiu ninpLUht^tii^ 
disease in the canal. 

Th^r |]o«tcrii>r inferior quadrant of the mcrmbrane miiy bulge 
from the intrd-tympanic pressure, though the anterior infenor 
portion, and llie menibmna flnccida of Shrapuell are ooua^ioimlly 

oewbaC prominent. 

The projecting rone cf the ntcnilmue, mused by mucwi or ])U9 
bchmd it. is a lighter red than other parts «f the mcmbfune. 
Sometimes pure hloal tn tlic tyrnpiiniini ffive^ the whole mem- 
brane a <Jark red <Milon 

Wlu'Ci tlie mi-uibmue mpfun^s, tt flmt become lights tfatn, 
opaque^aud Biially opens byaroumi holc^und the fluwl contained 



S20 



TAB BUVAIV VAft ABD ITf HISBASES. 



in the tyiapanum flows outwanL TI»o ^gf« of Qii- opening; an 
K'l uiui Mvollt-D. and & Httk blootl nfi*! pns* nn? wt-n uj-on ihr 
snrTace and kC ihf IxXtom uf the <an^l. The rnptuiv ovciin 
UsiulIIj in cJie |>oKi(?rior iaferior or aiiUTior Inferior qaodmnt, 
but nccofli^miilly a minute oiK'Hing muyiippnir in Uto flaccid pan, 
above the short process of the malleus. 

Before niptuiv^ tiw di^igiiostrc tiilx* ncd infUtJon will give tnti- 
cxttu r&leflf conHiating of rsttlcs and gurgtefl of UDinifttilaUe 
Jiftfiire, If lliey i*fnjiui denr and *hnrp, iLn<l oomo fjuJi^kly, Uict 
originato in the tympanum ; If the KDiiudis are duller »nd romr 
filovra*, tliey ftrii<e in the KuHlachian tube. AHer a sjnall pcrfo- 
riLtion has (xvurmL the air will Ui^^ iyr wlit?4tle in'<-ly *^\ii of the 
ear «u iulhilion ; if (In- o|>eolnjc is Urge, tliere vrill I* a etara? 
puffing !KiuikI, and some di^har)^* will be forci^l intr tJie exUnul 
(urial. 

The severe symptoois of thitt di«ni^ arc m mpidly amelior- 
ated by the giving way of the tymgiaiiic membrane, tliat mlificda] 
perforaiion i^ now considered a le^ttntate o[H?nuion iu all E^-^-ere 
ca»e»<. It r<*lieve» thi; intense |»»iu in a marvellous manner; 
hastenn ren^liition, und diminUlie.s iIk' danger of perrminent dttA 
ncw», cancv aud other conipli<nti€!i#. Tliu o|)eratK>ii \» aimplf, 
am) the wound oft^[i oIoAea rapidly, 60 (hat generally the tym- 
panLm and raembnuie are I'^tonxl to & normal coriditioti mx>ikt 
and surer, cimn when reliamfr \» placeil upoa the usual treatmeitt, 
nilhoiit the surgical procedure, 

^Vhe[1 rupture doix not orcrir^ and jiaratsentens is not made, 
recovery may take place in a shorter or longer time, Imt if ibiR 
ha."* [iMn mucJj miicii* or hlood in tlie ninpaniim, as recovaj 
take^ plneCf JlA water will be absorbed, niul dry, iklhe^ive^ uon* 
trwHing niftvii^ will elin^; to the i^clcfl and other )xirlB. Tboe 
cau£c adbesioo of the membrane, ati6ncfi« of the os«i<;idnr juinti^ 
and progreBAive^ incurable deafness, so that panic«i]te«i!> in all 
severe caseB b neeeaaiy for the luie^ity of the mr, 

PliTacente?4i8 of ttic membrana tympani is indieated to acute 
icflamniadon of (he tymjmnuni : when the pain in the car b very 
wvere ; llit; drurn-huid hulgi.-« at any ^lart; there is evidence of 
niucaa, pUA or blocxl hmide the membranti ; the Eiiidm lii.iu tube 
18 solidly obi^ructcd ; tlie catarrhal attaelc is graAed upon a ^m- 



ACUTB HfVLAHUATION 07 THE TYUPANUH. 



221 



pftniim in a condition of chronic disease^ and the usual treatment 
does not afford relief to the severe symptomfl. 

Various inatruments have been employed to perforate the 
memhrane, as the actual cautery, galvano-eautery, trocar, hlunt 
probe, bistoury, and lance-shaped IcDife. A linear incision, an 
irr^ularly dissected hole or a round cauterized perforation is 
made, according to the desire of the physician. 

The simplest way is always the best, and I prefer the myriugo- 
tome, a lance-shaped knife with a shoulder, fitted in a straight or 
ID a Weber-Liel handle at an angle, ao that it permits full illu- 
mination of the membrane during the operation. 

The incision should always be made in the inferior half of the 
membrane^ because an incision above this is liable to injure the 
tympanic pouches, cut the chorda tympani, fracture the ossicles^ 

Fig. 75. 




MVR1NI;OTOUB1. 



and excite severe inflammation. The inferior posterior seg- 
ment is the best place for operation, as the membrane here is 
farther removed from the inner wall of the tympanum, than it 
is in front of the manubrium. Fortunately the bulging from 
intra-tym panic pressure occurs here most frequently, though it is 
seen occasionally in front of the manubrium. 

A simple puncture in the prominent part of the membrane or 
au incision of 2 to 3 mm., extending from just behind the end 
of the manubrium to the lower border, may be made. If the 
membrane is depressed, and adherent to the ossicles, or inner 
tympanic wall, it would contra indicate the operation, unless un- 
der very exceptional circumstances. 



222 



Intnxluce a tiard rubber specnilum, put on tJie heul^tniTrorr 
illuminate the- membrane well, and push thv kmfe thrmigh at 
the selEcti^! )>oint to ils MioiiMer, ihE^u reuiove ttiv iuAiruoMnts, 
«yringe gently with warm water, aii<l inflate by the air-b*g ooct 
or twice, with ibc patient'.'* bead bent lovnvrd* tlie ^tde dbcMcd. 
ir thw *ltKS Dot empty tlie tytnpsinum, inject through the opeH' 
ing of the drum-hi^d by a hyfioge wltU a delimte nozxie, twDl 
ttt an un^tc near tbe |ioint. Ac tfie moinont of ]H-Tfanitiag, one 
feeb nfl If cutting thiu parojimeni, and bearri a dclit^&te mitk. IF; 
tbc u%iolc^ and intcruul tyinpunie wall arc not touched^ there ■ 
only ftlifjht j^ain experlenc-ed by tht (Milieat, and very soon > 
blewd relief fnun thtf severe \mu of tbt- otitic Of»mc«. 

Ther^ is ti>willy a Jtow of sanguinr^leut iduoub into ihe (Wtal, 
and th« c<lg«vor tbe i^ut bleed freely for a little while, on 
(Tinint nf tbi? cion^^lion of tbe membrane from tlje dbcao& 

'J'lie next clay, ihe edgef cf Uie wound apjicar fiwollcD, and 
littUt |>tjA ding» to ihem a»d to tb« membrane. A linb m 
pus is u>4ua]ly founi flowing through tbe wound, and more can 
be fitrecd out by IntUtion, if lti<? Ku.Hiaebmii tube i-i |H*rvjoas* If 
recxivery now emuef), the syiuptorns ^tll all ameliorate, tliefnl- 
nv» and di>)churi^< euue, the mcnihrHne c\osg by a slender whi 
cioatricial line, and hearing improve with the rcstoratio* 
health. 

Frequently so bappy a termination is not early altAiiiuhle. 
Thcsyniptom* are likely toeonfiiuie lew severe; the discharge 
becomes purulent luid e^pion^, at>d tbe case drag^ along Aome 
weeks till cured, or it lapses into Chronic Purulent loflamtna- 
tion. 

Tins descrription applies more particularly to perwaii old 
enough lo ^ive ratiomil un^wer^ to questionic, iind who«<.' cars caa 
be examined parlialiy through tlie throat, nml the external audi* 
tory canuK ^J 

Tberc are f^^mo jK-eulinr ftvmptomHnontK'ctcd with actito ctitll^^ 
ID iDfuntj>r which deiuand e*^peeial consideration. A Imbc without 
articulate latijcnage cannot help a pliyitician ton diagnuMa^ any 
lu^re than a wild beast of tlie forst can, and he must use acute 
observation, instead of bi4 UxHd(f cutechi»m, jf he would Gikd 
out what t» the matter with " motlier*^ darlinic/' 



ACUTB IWPLABMJlTlOIf OP THR TTHPAKtV. 



223 



The oanscs of ftcutc intlmnmatioii of the Dii<ldl<^ car abuve 
«!niimenited Are mostly prevalent an<I potent m infaoc^'j ami lh<ip 
eKjL'ts arv mon: ciim^i^ToUH than in ikIuIi.^. 

It ifl Ihp genefnt opinioD of aurul gui^couE, tJiat many cases of 
infiintHe (Aiiif* Arc uim;iN>f;iii3'A.<(l l>y llic fnnitly diKlor, aixj thaX 
the iiltJe patients are treated for everj'thing but the olJlb. 

Frtim the Ktatt^ioiir our d<^f itn<l ilumb nsylum-n, allowing 
the rau^e of dmf mmiflm in a lai^ proportion of the cases lo 
littw IctB r4T;k*clnI rlwi^nw;* of the midrllu car, p<^neri!Jy r^ 
garded a^ curahle if seen early ; aad from tbe mji?terious ccre- 
Imil ivimplicutions Am) iinEU'i^mnlable (leal}!^ of tender bmU of 
promise, it U prol>ablo the opinion i# far from wroog. 

Thenar, an well iw tlie eye, ought to lie eiaminftl in all nwM 
where there are symptoms of cerel>ml irrilutioD, especially in 
chiMren nn»bl<Mo<ron\Hl1y Ick^Ii- their AuHLTlnj^ 

Some children have miming from iLn mr i;very time a looth 
ciit0 throQgh the j^um, owing to irritation trant^mitt^ni to ilit* exr 
through the otir ganglioti. 

ToetJiing om] nnrioiiH Ti^eth freqnentiv <^n.si; sore- giim^^ nlocru 
in iJie montJi and throat, and EWolleaphanr'ngealgtniidH unci ton- 
ails. Tli«se oxcitf di«4^ftHe of tlic^ i*&r vi^ry readily by eontigtiity 
ami 4^ili^sion of the diseflac along the mucoibt monibraiK^ and 
ilie priniiiry cause is liltlesiupoetixl unlewi careful examination i^ 
made 

The vlt}" delicato walNiru) mncoiiK ini'nibmne of the middle 
ear of tlte infant ; the nndevt'li^tei] mu^loid procow, widi the hori- 
zontal (?i>iHnvity below the lympanum for retaining iH-crocionft ; 
the vcim^ fn^m thit region to the lati-ml siTuifi; the liability to 
ouies of die small cells and the roof-pUte just behind and above 
the iniHT end of the exU-rnd (tiil:lI, ii[>»n which tlif? middle loUe 
of the brain re^ts; tlie danger of phlebitis, meningiibi, <^mrl>ml 
abscnw^and pyjemia;alt tlu^si*, make it imiK^ratively tK^et■wea^y to 
tecogniie the disease early and to treat it aclivcly. 

Hie {Hiitwn of mi^Lih^ and Aoarlatiim is frequently climiiiatol 
from children oia^ly by the way of the mucous membrane, in- 
sLnd of by ihe skin; and \h^ eyes, nose, myuih, Ihriirit, Kiisla- 
rhian tubm, and the tympaauni are often in a condition of severe 
cntarrfial inflammation. The amount of fluid diwluirgi^ from 



224 



TDB DQUil 



ITS DI8BABI8. 



4 



tht- nv^eand thirtat in ^ich cnaes is remark^le, aoil rlironio ilis- 
eaaie of tlii^- [furirt i-t a fn-i|n«>t lui^uel. The ciirs arc more liiblv 
to be pcnnuiRiiily injnriHL ihan ihe other organs, because tike cxo- 
ilnUoci ruplun?! ihe iiit-nihrana tyni|nmif und ti fwnniincut puni' 
lent disclmrgtr ie i^ublit^hcil* 

Very often ih« iibriiiiii|r tyrdiral 07Tnptonu<. which ^upvircw 
duriDg the course of an acnte errthematotLi diwase, are tine en- 
Urelv to tiie suddeji onr^ei of iiit1:imrimtio» in the roKltllc mr. 
Tlicnbilit^'todcttt^t fluchcvmi>HL^lion will not only briog relief Ifi 
tlie [mt lent from siiflennganddun^r, htit, ali^o^Ufta UmA of anx* 
let)* t'txtm tlio minds of mtmstcrliig rvlutive^antl givo Uie phy^ionu 
tli:ir mim <-xitilldfrnoi\ whicti omnKisaloiic^ from t]j»Tx)Ufrl| knowledec^^J 

From llie neglect of the family doctor to tfftit siicb caws, th^^| 
ineunible or^^nio lehioim result, atul a foimdation ]» hkl for matrr 
a C0SG of <!cuf- mutism an<l« porltupf?, death, i never sec an in- 
fimtV ear full of [ni^ but I ^timblrr al the ihought gf Uit* p<b!m 
blo conset^uenceft. 

An infhnt manifests febrile ruiciion and restleastieeBy when the 
middle vnv becomes nffecleil, wJietJier ihe inflanainaUon IravcU up 
the EdsiachJao tiibe^ or a1!ecta the tulje and tympanum simuUa- 
iMjoiuly. Thv i^vin and fi;ver arc wopjc at nif^ht, Uit fiiiaJty 
tii]ue throiigb the day, and the imtienl cannot be quieted* 1 
rolls uliout in bod; towci^ Ihc h^d here tkxtd ibcr^; bnriui 
in the pillovr ; carrier one haod new and then to tJ^e top of t 
head^ thi> t^mpb or anml region r>f the afitx-tcd side ; vrMni; 
eryhij; or ^Teaming a J mo^ all tlie linu'. 

In severe caso^, the screams ure piercinj; and bi^rt- rending;, 
re^mibling the cri an^^^phdupic of ineningili^ atxi delirium, spat^ 
modie c^Dntraction of groups of mtisclcs, and, evun, violent ono- 
vuhh>na are not uncommon. It ia next to impoidsible to examine 
Uio niembrane ur the nii^w-phiirynx of bubiof^, btil tlM hiMory irf 
the case, and a vievr of the tliroat will cast wme tight upon lh« 
diBgD0«i». 

If by any management the druin-h«id can be seen, it will be 
fuond di^>r4;<MxI, uiid c»f a iJiilt gray or pink color, and lite uninl 
r^ioA will be a little liypersenj^itivc. When sn»'picioiis of ear 
dittwc, bold die uhildf fill the exteroul canal of tiie iiuif[wctcUi 
ofgHu with quite warm water^ renew every few minutea for half 
nn houfj imd inlhUe the lyiu[uLnuiii S4*v4^ral tim^. 




Acori ikplamuatioti op tiib ttih-ahou- 



2?5 



ir tbe c!ir is atlftcJiCfl, ilic mca^uitft will rt'lkve lli^r ufjn)*t»t>«in, 
piisTi oiii the dnuo-hmd and va^ the (kiIr, as well as confrw a 
fioulxftil (lia^noAtf). Thfi external auditory canal ^hnuld Ik^ ia- 
tfpvctod with speculum uod mirror, jl» tJiu ^n.'tfcm'c nf a miKoiM or 
punileuC flt^hni^ amy aetilp [he <|i]eation instantly, though tliifi 
<loci not f^i>iwrally appvnr until at'UT >Mjmi- diiy^f of rtu&briii^. 

Then the luenihmna tym|>ani bnA ruptured sponiaueouiiily, but 
the opening ui not lat^* motigh,or the ^wi-IIing lui8 oeehidf^ the 
inner «ml of the oinul, k^ ilmt the exadation in still scmcwliat 
imprdoil in tt« oiihvurvl How. 

Whwi the true condition of the ear is ascertsiined, the proper 
IraitnMDt will l>c »hvfoii-'<. I':ink'viit<^i^ of iIk^ Dieiiilimm' should 
iiot be alleniptcd too noon in diildreii ; iiul until all oiiier m«uii» 
of relief have pmvod futile, mid the niiffiTifij^ arc severe. 

After (lie full defiCTiptioi] given of acute inflammation of the 
tjmpanuiDt it b not Dcccssiry to say much in re^rJ to dlaj^ooi^is. 
ll U jteen so uftcti, that (rvery [>liysiGiati ought tii be very familiar 
with its salient pointe. 

The history of the on^^t; the oondilion nf tlie ttiroai and 
inouth of the Eufvlachian tube, ad revealeil by an examiuation 
with llie larvngeui mirror; the appeunuGv of » hy]>erieiii>e, per- 
haps '">^g""ig Of perforated memhrana tynipani ; the deafne^^ 
tinnitus »nd wv<;n? i^ftin^ nil indi*^t<^ tlie mirnl mi;-Huef which id 
brawing, and eall for immediate ami active treatment. 

The pntgi)r>:^]T( n favi>mble, if the patient i* ^^^n 4«rly, hikI the 
physician knows what to do, and how to do it. The hearing in 
mild mj«i 18 twtally fully motored, bm ia wvere oneA ia Aoine- 
limes redueeJ to lieattog the wateh one or two iQc!ia«, which jjcr- 
Biittf ft fttir c«)mpn<heiisi(ui of nieilium voicn; <x>iiversation. Jmli- 
dom Ireitment will generally prevent perfomtion and adli^^ion 
nf the dnim*heafl, and the lym|Hinit And emnial perueptiona^ 
though quite obtuse at fiisl, will Kradually remm. After on« 
«ttiK:k of in^AmniAtion there is Habiliry lo rela{nf', imd fre<|U<<nt 
attacks may totally destroy the membrana tympani, or if ie heals 
readily, raav thicken the inuoou« m<mibmne of the tym|)anum 
over the njund uekI o\*al windon-M^ and stifti-a the joints uf the 
boucseveii toaiK^hylf^iH, t<o that hearing mny hegroitly imjmred. 
For tfaeoe reasons the physicrian mutft be careful to undcr^tid the 



2S6 



TSB HCUAN KAR AND ITS DIHEACBS. 



exact aUte of the oir before giving a decideJ opiniou iti ri^vd la j 
ruturcr limring. 

Tmiiritrnt^ — Tlie early trcntniout of thld dbaue elioiiM do) 
clilTtfr ojaU-nAlIy frfMu that of otalgiti. The |Ailiuiit Hhotihl U 
kept (juiot ill Wfl, iaIiIi the iiaiufitl I'^r iippcroiost, un<1 [Jh- hcvl. 
(3ra ni»il n«"ko>v(-rttJ Uy a \lixiiuv\ «i|» ; be may eftl uiiimUuialloiif^^^ 
drops sIdwIv, have milk ton^t luid cuvrunt joUy, und bu pcnBitte^^^ 
In drink frvtW of oold li^moiijidi^ Heiuuvt? ih*? frsiiirtv ifttjipunnit; ' 
laiKc Hwollcn pifn\ ami luill out painful tci-(h. The infam 
ftlimild be fed wtt!i u .^pooii, auJ »ot allowevl lo mick. Hot a 
f{uurt «kf wiitiT tij u t^-ui|icniuirv of iibotji 100"^ or uiilil it CvA 
dt.vidixt]y w^Ttn lo (lie bare wmi, aa the haniJ i» too mudi 
bIui)li:Kl by i*x|H>furu to iippreristc^^ tlic |iro|HT UMn|K7iitun< ftir mi 
aumi douche, Uw tbe founiaiD fiyrin^ if |M»Uble, and bjett 
Ujc *"iir geritly for live or ten miniil*^, Tlw rtwidy Hove of the 
founuiiD iFi more u{rreeubl« to a painful ear, thau the intenui 
jc-to of IL IuiihI fiyriiigt'- 

Onc may stpatn tJie car with hot water sione or coriainln^ 
liltic viix^r, D^iiig \ht apeolul mcvm apimmtit? hi^uriH) 
Chronic Inflatnmation af the Tynipauimi and Tube, 

In nil va»^f if tho puliCQt is old cnoiii^hf bv qhotihl 
the throat wilh hot water, Ivaving one part of alcohol to Uirte' 
Ihc viitcr, or uitli what i conT^klor bcrlttT, a hat saturAttd boI 
lion of chlorate of potassium. A tablcj^xjotiful of Ciocboi 
lintniirc to a ^ht»* of waivr in ah ellidcnt t^ipioil 0^^*111 of ixumM* 
erable power, when the mucous membrane i* relaied, aud tbo 
vein» an; full. Twenty Lo tbiriy grftin» of Sodiam salic^'luK 
a ^la.« of water should bu preferred, when tlie throat U euflt 
from ,S(iirItttiiiJi or Oiphttieruu 

Gai^ling eauaefl contraction of the tnuwles about the KuHaehtau 
tube and mivJiArumlly ek-ars the* tube of mucui^ it stimutatftf tlM 
mucous menbraue to healthier action, and the alcohol and ehl»- 
rtto of poto^sinm have an antl'teplic iotlucnue ujmci ttn* pam. 
S^praj^ittg die DniK>-phar}-ux with these duida in an atomizer » 
another exix^llent nnjtJuxl of mating tho tube ami esir. 

loBato the cnr with the air-ba^ alone, or, if diftieully is etpe- 
nei>ced auil the patient la old enough, in oonjunction with I 
ootiicter, until it in ocrtaJn the air hai« goue into the Ij^mpan: 



d Ibfl I 

tit ilfl 
ferinS 

chtau 
u rluq ' 



AOCrtB IKfLAMMiTfOit Of THB TYHPAKOH. 



227 



Tbifi Hhoald be Hone several tin>efl a dujr, during Uie acute fltnge, 
ami onw a ihy, during ttic MiilmcuUv 

InBalHrn HUprovcfi the hearing for awhile, relieves pain oHen, 
wparnUs Ui« diitfii^erl Hiiif^X'^ of \)ie tiiiK- iini\ micMlc cnr tcingxi- 
rarilv, (]i*fpTaoes mrioous autflsefiT favors ilischar^ into the pharynx, 
and ]>rtvciiid adlio^oiis, T1iim% i$ no Onnger of Forcing the mUtT" 
rhaJ sooretions into the taafltoUi g«IU, aa once tacght, by mDation 
during ACtitc Aurat mftaianuition. 

^noniVc ifi one of il\e Iwsl medinines for acute in flam mat ion 
aDywlkv^4^ ti u iiidiealcd in ii larg*' pmp<>rtioii of tii<y*c aiw«, u» 
they have ntore or Ic^ vfLHi-jdar cxciiecDMit, and pcciilinr car and 
throat BvniptonLd. Those that I have oontirmod are: Sore throat 
with t^liarp pain ninmng iilong \\n* KiiHiai-bian tnl>c to tho cnr ; 
tfudd«,'n pain in the ear ^th imdd«n deafness; violent pain in the 
Cflr am) all ov^^r the srdir of th^ heiul^ with vt'rti^o, fnlntiK^ iimJ 
fiJtght deltrium; drynes>= aod bumiDg pain in Uie throat, with 
<iaU \min and fulnesa of the i^ar; pnin in the ear and dcafiievi, 
ap|K:nring dnring an exanthcniatous disease, 

iidladimna bm« a wide [>alhogeii4^ia. In a limited nnmtN>T »f 
(Bfica of acute otitis, the localized congestion, pnlf^atiitg carotid.^ 
and ixTchml ex<:iu.'mi*nt vfiII ci-rtairtly lead the philosophtenl 
practitioner to select this medicine. 

[t U doinAitiltxIr when thi* throat is diy, bright red, raw and 
OTmllen; ihere b constriction, constant inclination to swallow, and 
more or lom uii^p^rgement ^f ihvtonr^ili* and lyinphntir ^Inndit, 
The piercing pflioA are inconstant and erratic, ocoumng in the 
external uicatu« and caaBtoid, then .-^booting from the tlircatto 
the ear, and again darting through the tetnporo-oiaxillarj'aiticu- 
UUon^ iht pnniiid, thi^ temple, orbit anii f>cci|>ut. 

Fv^KdiUa dotn excellent e^rvice in milder t^Asits, cumplit^ti-d by 
coondernhle iTatarrb of ibe nof^o-pharynx. One should con^der 
it v1>G3i cbiliiniK^ attenmtx^ with flu^bf;! of licat, and ifonR*timos 
sweat ; there is a raw »>n;uf«i of tJie throat, with %^nous ooiigca- 
tioo uf the [jjiarynx and fnut^ and aoue clinging niuc^iu; fuU 
DGffi of the car; dealnes and tinnitus, accompanied by parox- 
ysmal rtitobf^ of puin through the ^ir^ unil an early dia-cliargc of 
blaad, light colored muco-pu& 

Bry^nUt is u^ful when tlie car afTudion ia lew prominent and 



TBV tlCMAV lAR AND ITS DTSGASBS. 



<x^inpli(*utc:« a gciii'nil rhenm, cliAmcififiueil by ditllfncH, Burfii 
covym, ^re rhnml anil clw^t, niuacular awl articular MirecKa, 
9tiflut^ of the neck, foinv^^p liitiiiiu* aiul dull {luiu in ll>e mr. 

Tbese niAdfdiKH itre ^eet^andwrs in acute otitic, and few caatB 
r(wi«t their bcnefi^^c-nt action^ when i\s(%\ in conjuDcCion vritli otlitr 
n&xtffsay meiu^ures. 

I deprecate a rcs^)!! lo Morphia, nd ]cS8€lfici<riit lliai) tlicsc iimI- 
icines; it U a mere jualllative, that prolongs the diseoae and ifl 
dangi?!Tx>iis to life. 

If mr whilam tVtemlR in (valenic ignoranoe wil} lay a&ide ibcii 
prgudKx^ aud treul a fow eaMK 4>f otitk ntedia witli the lucid; 
tincturnH of the ttow itchool, tli«y will abandon tlw repreesive and^ 
oppr^^ive rnoihndM of tr<9Umviit inculcati*d hy tlicir nuuuon, wlitt 
were once mine, and riae to a higher plane of usefation arooagsl 

AOcr the selected medicines and tli€ abovu mcaHUrea have b«ea 
tried awhile^ if the paiik continues, make a strong bop tea, ba* 
it us hot as cun be home, an<l douche vr «pniy tltv «r gititly wi 
it roir«^vt<nil mimit(:sat a timo. Should tJie pain not beaRieli* 
cmteJ by ihi» in half an hour, and the mfmbrana tytnpaoi be 
intact, put ton drop^ of Aconito linctUH' in a U?u(|KM>nful of hoi 
water, have ilie patit'ut iiu'line his heed towards Lbe well side, 
fill the mral of thr aflcck-d ear with the ililulioi), let it runuuD 
in lill cot) Wr, and tlien renew if nectiaaarjr. Continue tJ>i&, the 
interaal ineiliiTktiun, and the- oo(0ip*)c.>nal infbttiou for Home lioun^ 
wben reliof anri, iH^Hiiiji^, entire arrest of the morbid prooeda may 
reutlt, though tbe drum-head niay niptare in tJitJ interval. If 
fluch a happy result U not attained, tlie symptcmig contione ^Ho- 
Iint, and the niombrana tyaipani ir* bulginjt, be it ovr-r so Utile, a 
boUI jiara^enleiis of it sIiouKI be made, and a light inflation fol-, 
low. Thin ojieratton U ini»re rational and ttifct than n ru^ort U 
Morphia or Atropia, as mofiiioned under Otalgia. Any dieaharge 
into Uie exk'rnal oaiml }» to be wai)h«il out by delictUe syringing 
with the bcp lea, and inflation is to be practiced several timflB a 
day, a.4 long an the di^harge reiiiain^. 

If pain continues after paracentot^is of the membrane, a^tfae 
hop solution hot till it cea^fe^, and lh«n, ox lbe dl^idiarge dimin- 
i8liefl> subfltitiitc a wudh of Alcohol, one teaApoonful to an ouout 



I 



CHRONIC PUAOLRKT IKFLAHU ATtOK OF TYHFAXDM. 229 



of wiLnn watOTt vthkh will simulate the fiiiK?oi» meml>ninc fui<) 
drum-head to recovery, Abovo all do not, yet, u»e astringents, 
itf UiO}' irritiite uiul f&iii:w the iniliimmalion. 

It b altogether probablo that eomr of thuw mciituns employed 
will diitiintdi tlic jtunWin^ anti violencti of the diaea^ie, cuune 
t»rly rcsolutioD, uoJ restore the ur to a wmh\, if not to a perfect 
phyRiologicftl F<lale. 

The aoitc stiLgo [a£ti< frain a few Iiour8 to several day^, aciTord- 
ing iti oirotmiatanow. If the niPuibrana tympaui dcu^s not nip- 
tiuv, uud ijs not artiGnnllj prrfoniK^^I, or tlie iiiflflmmatjon ejc- 
tendfl Co the innsloid eelln, it may be mitoh jiroloiiged. I have 
discossed the latter coinp1i<nti<Ki under mastjoid diii^^iM, in order 
to prtfent t<^her all the varieties of disease of that procesB. 

Soraetrine* Pr'niplomi^ of the deeliuing 4tage denituid other 
medicines. Ilepar U indicated 1^ aching in the ear, worse in the 
ould, n rlisrlmr|re of jfUH, n^lnit^H and swelling of the ma^Uiid, and 
tDmefaction of the lyDiphaiic glnntK Kali liydrioJ. in ncedod 
when the di.'kTiiarge beeonne^ iterouH aud thin, and chiIIiiii?H and 
aural pain threaten a remirrcnco of the acute hymptoms, 

Aft<.T the dirH-lmiyc lioj* t-esLH^I, i^liuuhl the pcrfonttion in the 
menibniiie not heal, it should he treated aecurdiug to tlie dirra- 
tioos under Iiijurii^ «if the Mcmbniua TympEiiii : and the treat- 
ment of sequels, such as Chronic Pumlent Intlamamlion and 
Mastoid Dbn« may be found undfr tlieir ro^pcctive htwting^. 

Chronic Purulent Inflammation of the Tympanum. — Aitacks 
of acuk- iiitlnturiinikifi of ih*: tympanum Jmjuciilly result in per* 
forate roetnbrana lyaipani, and a inn«x>-puruleut dL^diarue, m 
above dti^riU^I. WIk'h llie aontc &>"inj>lom« have piLt.'^-d away, 
htit a r«sU>iutioii %)f the ear to a normal ccndition doa not ensae, 
tod the puml«nt dUchar^ eontiniiet< on week afie.r w^ek, the 
stife or «(alc comtx properly under the title tbat heads this aeo- 
lion. 

This id the aural dieease most frequently seen by tJie iteiiend 
pnKlitioner, who lini^ not |tai<) filtention to car afli.*ctrofi^, is not 
able to cnre the palient ami, hence, readily falls into the old 
women's nolioiti, th^i *'a riinniiig ear muH not bv vt^ppod;" 
^the diseharge will purify the bloodj" and "the afiided ooe 



fiSO 



TBS aiTMA!V KAH Air& lt0 risBAeso, 



m\\ outgrow U alter a wliile/* Every one of ihfse atatementa ia 
fiilsL% and no physkriaii i*lii.niUI K^mJ hU connw^iuincv to th«m. 

DI»caJH^ i}f ill*? ear leJt to ilietuwlves lead lo very had coiw- 
qUQDCM, aside rram tfac oorwtaut menace wbk'h ihi^" arc to tbe 
life of thr imlividii:)]. Many rhiUlren have kA Uieir bomag 
Ibrou^hthe destructive proc<»ws of a curable ear diseajw, and h>vr 
bvcn »ent at lu«t to an nf^yCum fur ikmf mutiny lo be cilu<nt«d, be- 
cause of tbe thoughlleafiinsfi of partnt^f, and tbe cwrcl^fflnca of the 
family dodor. LcHik nt th(% roprtrt^^td inHtUulion^ for deaf mstefi 
and be ^bocked at the number of inmates, M'bo prroent auial coo* 
<)itioiiM now, which dearly nbow th^tt hud tbi-y been trented early, 
tJia ear diFfCn;?efi could have been arrc^tcxl or euredi&lld thc pftlient 
luvo bnd g(XNl (enough b^^rtng fur the purpoMfl of bo^iaessj 
life. 

Ear disiiLse» of every kind and degree ^bonld \v irt'iiicil falu 
fully, and the earlier the better; because scientilic medicine cmto* 
mandfl, niid the re|iurt9 of denf and dumb ai^yluntt uod rvveU-l 
tiouAof thed<»d<hoLi^adi»oi)ifih ila to do60* 

I iJinll never furj-i:*t theanj^ursb of u strong man, wb4>cnnie to' 
consult m<! abfxit hSniH-lf, when lio Wl r^lati:!*! a elear hblory] 
of mastoid difieane, follotving a chronic i^uppunttJon ef ibt^ cnr ifti 
a lady, and A-<kc(1 \vbuf ri\*ufmertt I uoukl baiv advi-'k^l* As l! 
told biin briefly die necessity for trephining to diminirdi pnwturcv 
liberate piM, and prevent cerebral roniplimtioikA, hiA eyet filled 
witb tears, and when 1 had finished, be VrieJ, *'Oiil my God, J 
what my |KH)r wife *iullemi, and how she ww* nultrctttedl 
NDtbin^ l^ut morphia, morphia, morphia, until her dear hmi 
bui^tl" 

1 am not prepare"! to indorse Burnett who says, *' Unloai 
otorrhavi i> ennxl tlie diRii^* will Mircly extend lo t!ie brain. 
it doe» Dot reach the bmin» it will l>e becnuw tbc palient will dil 
of pyrtrrainand metu^ttiait^ nbsoe^^ Ijefore the oentral orgaa ia 
ttie flkull b reached/'^ 

Thi» is too pes*iimi*tic, and i# enipbnticully oontnwlkted by ex- 
p<>rience. I have seen cawa of suppurative inBamination of ibf 
tympuiium of forty ymn^ duratkm, niih the beftriog aaffioic 



* Tile Krt, Ita Aruitomy, rhyt\c\ogy and Di»CBt > , Burue;!, p. • 



0BR03IIC PURDtKIft iKPtAMVjiTIDK OF TTUPAVUM, SSI 



good for enjoymenl ofoonversnlion^ niii»CtCt<\ There are pltnly 
of CMK ipplying for tn^tm^ot with otorrhceos of from fiv€ 
lo Un years duration ami hi^riag (oJur^ibly gooi), ami ditilhs 
front aitral dufcasc art' not v<^ry cooimon, eveiif when tfie patieDt 
has had no treatment wlmlftvrr. ft i« now WIn-od, howtver, 
tkiit nuny rcporttrd dtath^ from cerebral disease, pyaemia, etc, 
were, in truth, oati»>d hy n ti<m-^iiHptv?tod or tmiwaUHl vtir diwnM^ 
I Uiink it would be wove r^oBonMe and correct to say, that sap- 
pursitive tuflaiTimHtioiH nf tlnr lymjiniuim ftrvofleu^vc and (nji;- 
bl4;WinC| art; slowly d(«lru(*tiv€ of tlie auditor}' apparatuii au! 
hiring, and itometinies prove dung<*rotts lo life itiwlf- From tlicM 
fact# it follows, that tnvtnwnt should bo thormigh and peraisteiit 
till cure results. 

Thccsuseafof <;hroni<; purulent infiammationof iIm; tycnpanuro 
lie behind tliow of acatc tympanic iriflnmmAtionf aiul nro c^Miii^i- 
tattouai, euch aescrofatuj which influ^ticxs the i^racter and de- 
gree of lh« affection, u before menlion^l; and morlml, «itch as 
Um: prcfience in the system of the diphtheritic, morbillouftj ficar- 
latiual, \'nriolou5, tiyphilkio, and typhoid poUons, 

Wtiatever the omdilion of the blocwl in the exanthcmntoas 
diitnM'S, tlioy at) «xpr«M thnii^lvci^ by infiainniatory pro<x»^<it of 
the akia nud mu«ms membrane. These bIioiiM he affedx^l in a 
c«rtaiu proportion, if (he dif^vaa* foUowi< u natural ^ourH.% but tbb 
18 not always the oidC, as every physician knowa ta his sorrow. 
Thv analoi^t^ between the inner lining; and tlie outer envelope 
are ^udi in auatomy and phy&iolt^, and tlieir vioarioim action is 
80 «tty, tliat we i<an uudcr^tiind how a morbid lluxion may \U 
l)nite beivra4;n tljeni, now affectinx one and now the other, with 
t&ore than itfi sliare of th^ tii«k of elimination. 

T)>e nature, am) situation of [he maeou^ aumibrane in the naf^o- 
pharyni, KuUaohUn tube and middle &ar render ita inflammft- 
lion there especially injurious to structure and funi-tion* On*^ 
can now uiKJerstand h»w, when nMaaloa, scarlatina, etc., do not 
tie\xlop thdr characterifttic eruptions ti|>on (he r^kin, they nmy 
prodtice sevenf nu<l dsni!;f^rous inflarnniaii^m of mm^oiis nurfaees, 
which in the liar doiTK not always terminate witli theexanthemand 
the acute attack, but eontimieB as a chronio purulent disease of 
great o)»tioa^- 1 look upon some of thca^c purulent otorrha?44 



TUIt UVMAH KAR AND ITS MSKASSS. 



of recent origin, as moH>id fbnntAin^ of eliminAtioa for di 
^rnm or j»r<KiiK*Ij*, wliicti fwivc not Uhjii *.'xtrii(le<i from Uk 
leu) during the acute exunthem ; but later, thev are bofh 
•jid ix»nw(|umci' of thdr oivii cjcit^cjioc — tlu? flmn^ctl muoDOll 
tnembnoe k^epa up the morbid divbarge, and tbt8 irritaUe ul 
sustains the dlftc^ane of lti« tymjiamim. 

The rclutjon bctw^^pQ aenu* di>wnsc« lod dironir paruknt ti 
flaninaations of the tynipftnnnt may be neen froni jieveDty 
of tlifi latter, treated by tnmlf during tlio bist thr€i> ycfli«^<f 
which careftil rei^onU have been ke)>t. Of them, ooe was caused 
by variola^ two by diphtheria, two l^ typhoJd fever, niuc by 
DK^iL^IiTi, nitKrUreik l»y )<n(r1»UiD», and tliirty-«;veji by <v\tU. 

Colds iiiflanir the naso-pliaryui in many case^ am) by exten^j 
tiOD of the infill mnmr ion to th« tympniun, cnusc the gmtlcfl^H 
naillber of chronic *uppuratioDH of the lympajiuin. ^^ 

ArarlatiiiA i^ tbt.< m-xt imM [»roHtlc cnnvG, layti this U c^Lidlf 
witat one would cxpi-ct who r«mcnil)Gn th« ^vere angirm with 
which Uiia formidable exanthem 18 nrnmlly ii^borcvl in. IV 
tliront iiitlatrmation U limiky] in area and itttcnfiitied.and lemb 
to infarction niid pld«^nionouA wvelljngof the conniHr^ivc tismc- 
Th««c greatly interfere with the funettottfi of tfie giarta and dia^f- 
pftftrF*h*wly. 

Measles diflerH from M?]ir1fltiiia in ite afEnitiee and p«thol- 
o^y. The muciou.>4 nioml>rAne of the lyc*, noM^ throaty latyu, 
trachea aad bronchial tnbcfi are irritated and iDtlamefl; the 
morbid iiiflotiniv t» iIiil^ ditltisefl nnd r\*ade.red milder, so tint, 
with profuM niucoua discharge, the danger of lofal disoaae is 
dtminih)i<.Hl, and amelioration ^;oon foUowiL Mcflal^ probably 
fiiU5(« more inflammations of the tympannm than acarlatiDa, bat 
they are milder. Many temiiriate without rupture of the raeuh 
brona tympani, and ibuaihe proportion of cliromeguppuratioos 
in lew*, juhI thosti which do appear are more mana^;eabte. 

From the few rejkorled cases of chronic mippurstJoo caoficd b^ 
typhoid fever, variola, nad diphtlieria, one would conclude that 
they eicrciiw little infiticnrc u|x>n the vur. Probably the eta- 
tii^ticA of other dir^ean-M, .«ijrh n.4 rlieLimati^m, pleuiiay or tuher- 
cuIo»i« woidd shovr as many, ao that one would wppow them la 



C&RQjriO PCItULITIT ItrFLAUXATIOK OF TTMPAKOH. 233 



be acridcBlA), ratLcr thjiii cuDAative* StotJslics are ooioeliiuafl 

TyplioiJ JVvcr nOTcctft lli« iatogrlty of ihc ear very var\y m ita 
oountc!, aiiJ vxr.ty practil<uiiic*r kncjw5 huvr tlic lintnng iliiciiniehus 
as Uio iiK'iitiil Ill-tit.' I (kIl- iDd^^oeai. This Iiha beeu L-Iiai^1 lu 
t4jr|ur of llwj T^ciimiriiiiu, jluJ Ui inv»iuii of ihc lubyritilh by iJiv 
lUumtl Mitr-urrhcbuoMl fluid, |>as6ii);c Uiroui^b ihti aquA^udua vcft- 
tibuli uihL tilt; |KfriiH sicititiajn. Wliile llie^^ HUtr(iirolT< lin? nn* 
mnflbU*, nud in luxoixi wUli KLnciittfic inv«;9ti)^tjuu, ubH^rvalioit 
haa inaJti pn>ajiiieQL Lliu f»iTt, Ujat llie iiJiLkile tur b mut^li mort- 
fpequently ii0L-('k-d diinu^ ilic counsc of typhoid iVver th:in for- 
Qierly mi|i[xjhaI, uikI tbai dumti of ilie Ji-afiiem — tu npciik guuni* 
edly — ob»:r\-^ in tbeOUeow, dupciiJi; upon morbid pru<i&#c« la 
tl>e tyinpiiufo, 

A considerable nurnber of my pationte have doted their aural 
IcBtioDM rn>m attai^kH of lyphind iVvvtr^ and nmrly all of llnsw 
bave beaid tbe fork ndl, when pJoced in vibration upon tbo 
vcrti^x, aiid prenenieii ^yaiptoni!* of dL-^f^se of the tynifHtnom. 

I called ihe atttntion of Or. \V, J, Marlio, of Piit^-burgh, I'a*, 
to this subject, during au cpidtmlc of typhokl fcvi^ in lii^ ueigli- 
Liorhomt, nud requcatetl hJm to uialtc certinu ob.-Ktrv»lionM, He 
kiodly consented, and furoiiihed mo with valuable dat^i. 

In A iK'riod of twelve weelt^r Um: doctor iretited iwveiily-two 
caiiea of typhoid. He t^aya : 'There were fifteen casea that tnigbt 
beaillcd light, having no delirium, diarrbtru nfir any l>nd «ytup- 
toina; tlic temjierature nevi>r getting above lOit''. ^'oneof these 
caan bad any duafnew or disttase of tbo eaiv. 

'The otiier lifiy-*ievei] ojl'ws might be t^la^sed as Bevcre, and 
very iwvert, 13y the luttcTr I mmo trasw m wlnth ibv li'm[H*ra- 
turc ropc above lOS^, and there were marked eerebral Bytuptoms, 
with inli5*liniil or «ierinc lieiilorrltage. Of tb«*e firty-^evtn iwww, 
tweaiy were more or le?fi deaf; five were very deaf, even to loud 
eJiotiting. 

'Tbew five jiati^ntii had tlw longest continaed high tempera- 
ture, ninirfng from 105° to 1061*^ F. Tbe dctifnw^ tncrtustd 
with t)ie (tiniperature, beeotniag marked a1\er the patleDtA had 
li»d a tenipemttire of l(H^ F. for several Jays; in most casos, It 
diroinudied witli the declJn« of tJio di^eo^c. 

16 



884 



TB8 HVUAX fCAH A5D ITS DtaiA$|«, 



*It [>er9bil«d in tk few penvons in n mcNlemte tlcgrtVp and il 
jnkticnlf markedly M»iue time aftor cLc t«n)|>eralur« Lad beamP 

* Tbc [>at)cnt0 coniplumcxl g<^«Tiilly t>( a roanug la tli« httui 
like (hr ."loumi of water fDllkTig over n |irc\^i|ikc, 

' 'rii<]&t' liaviti^' il«anM«« weiv uot ail ileiinoufl, aur w<rre uH llif 
dvliriotiK patM-nt!* doif. The isrrcbml typo of the fciror fantbliad 
OkObt ca^fSi When alKloiiiliiMl !-viu[>laiiiH iirtiUHuiriaK-tl, di^nfm^ 
vriA \v» fn^jiJt'ut luiiJ U;» M^vcru. T ihiuk the iwaity otMn witii . 
d^fofw were more Merkiu^ly II), Ihau iJie Uilny^ecveu vrilhouL 

'All my Cvvvt cwmt ru'^wrn:*! rxn:pt odc-, a woDian who bal^ 
b«ai dt'Uriirtis and dt-af ; aAer I'wtivery frocu the fever, the i 
of giLii);n^iH* (if i\w Mi wdo of thr fnw.* 

*Iii answer <o <|uestioiifi propoanded, I received some additi'insl 
infcHinatioii. All Ihc pcnwiifi with :itind wyinploiuTi comklend 
tlieir h^rlag good before the fever oininieiKedj ihough two had 
aonie vsiv diMime. 

* Two patieafa became deaf tm one side only and tJiat the rig 
Uie others hm) liorli r-'ir^ c'i|ii:il]y n!!WM<<ii 

*NoDe had noticed any noia^ or Jteliipg In theearH before ibey 
were pro^trutcd hy fovcr Aboul balf of the piit£i*ntji lould hmr 
medium voice, Uie n^i loud vok^. 

'Several hod otalgia flccompunyitig eJiglU flcafiHiS; two bad 
Bicute inflaEUfnation of tlie tytnpHnutn, with piimlent dbdiarge 
from th(^ irimtup*. Five perrons tvmaiite<l rh-nf during oonva- 
leeoence, later tite Dumber was rediioil to Ihree. Of these, odc 
l\s» n puruknt diw^iarge from the «ar, and the otlier twt> Uv« 
duonic ioflammJitLOii of the tyiupaiuim. All the other patkotf 
€cm»(Ier Uii-ir Ik-^Hd^ u.t ^kI jv-> pn^viotm to tlieir iIIik^/ 

It b evident that typhoid fever furnisher a connderable ptf^ 
ceottt^ of f-nr dihCflAe^ thott^b mil nearly tw m^ny a^ the eiaa* 
thematous fevers. In a fair pn>porti4>D of oim^, tJic tym|WJimD 
i» th<t {Kirt atCarked ; otlier <«i^es wjwially, with biiiauml deaf- 
nesE^ eorresponding in severity with the diacuw* and the iiKmiv^ 
of tempemture, ntid diE^{f[>CArLiig dunng or »oon afkr I'oa^'a- 
leficeaov, are due to dei>r(¥fiioD ol the nervous system, aDd alK^a- 
t«un ill the ([iiulity of the «tib-anu*hiioid and labyrinthine fluid. 

It i*i rather remarkable tliat diphtheria^ tnaDifotitig its uorbidj 



CIlRONir PORCLBEVT I^eriA Ull ATIOTT OP TTHPA!Cntf. 235 



ftcliOD in tho throat, does not ad^t tJie ears nort freqaefflly, but 
the r^wn nmy t>e foiiiKl in th(- |>oAition^ t^\' tliv Ri^'mlimn^HH Tor- 
iuatlua% which are generally upon the »cfl palate, the pahtioe 
archer, anil tonvihf. 

What«'€r the primary' caow of (he auntl JntlnnimattoTi, the 
stmiuous coiifitittiiioD pn^wmte the dt^fcctivc blocxi and uiidi*r\'K 
talixed tfcvtiei, vhieh ^UAtaio the morhid notion, Donrinh al^iornul 
growtli^and fnvor dtttnictivc proctis««, >oii-«(<rofiilou)« cuttcA 
tin> itoim cun^I or dmit^ hut ^r<tfiiloii.4 r>iie4 tax fho rti^Mirc«» of 
tht malaria mcdir^ Ami niixlk^nt j^kill to the ntmo^t. 

A [WT9011 with a E«ii[>pnratin^ ear U likdy to l)e dall, depres^eJ^ 
mtlancholy, taciturn, tbr^t^trul. idh-, la^, |>flrtia[ly deaf, and iu- 
CA]«1>1e of proper ti«.' of his inttdl^^-twil fai.nltitw. Manyc-hildren, 
and atlalte tf>o, are thought stupid, igiioraot, and oUiinatie, be- 
cane thvir hcnriii]; powt.T in im^KuiYil, and (he bmin nml txtdy 
are irritated and weakened hy the cxistaict of a purulent inflam- 
nuition in tlte middle ear, 

Kramer believed that ear diMaco^ were almor^t alwayi; local^ 
but wid<.T eigx-ricac^ and knowJwtg*^ prijve th<^m laib'pcnd, iu 
tTkuny iii7<ranN«^ upon a <YiRititutioDal dywi'a^ta, mah st^ ^crofub, 
it)eitmatL*m or gont 

One patient niay look robust, but be consrfous of ^reabnaa 
and malatM; aHrrr oxcnion, and feel m<-ii(iil latior Un> Uttwy a 
burden. Another may be tolerably healthy in appearance, have 
dbturltfd dfj^wlion. pidpil^Llion of the h^art, roa^^tilar fh^hility 
ami loss of encrg\\ Another, still, may be nnremie^ pale and 
thin, luive w«ik pulw, alullow ri^piration, loss of appetite, diagmt 
for fatly food, ^^rent vrealcnee^, alternately pale and flti»<ihed face^ 
and Ut^ntc of rluIN, fevir^ dolJntnn, and niglit-Aircatti. 

Albuminuria IB fouad in nuniy ucute and chronic di!<ca.sc<, and w 
pnvT'nt in ^nrnc ea<M of daxmic ^ippnration of the tympanum. 
This ia prolMb^f a were coincidence, the diswiw of thc^ ear and 
the irritaiion of t^ie killing' being M^qaelie of some one of the 
exaathetnatnuH diseases. 

The ptieat nitli puriiWt inflamniation h alvraya Iwlow par, 
and the f-biXv of hcalUj w p.*ri<!rally ttT»r«.% tlie gniater thi: amount 
orauppuretion. 

Children furaidi more caacs than adult»; eo't^^">^*^<^ '^^ 



Z36 



TIfl 



AKD ITS tll5BA8Ke. 



eases prwluce many, whidi get well ajKuntaQeoiifllj^ or are cured 
hv |in)|HT in-nlnieiit in y<>i:tl)^ tlcirufuU^I Tronj plivriciaiis \rf 
anxious ntcribera. AJiili mK« are Lhe survivals of the llttal 
UiUsl riiilrt-jiUtti iiii<3 Uie sW|Uo1ii; uf <*j»1<]i« froiu rx[KM<u[v to ill 
WPflilienf, ctitnc^, nml udvur^' cimiiastaiices. Mnles arv luon 
nfHicUnl llmi females^ Ixrili early aitil Ule in life, KKimjic care- 
less of tbi'ir licalEJi ntiU, <»|)ccJu)ty, of their t^m al all tiinau 

Tlii^ (lEaeane de]>encI!^ upon the cori^tfiulfon nf Llie patieiii (tts 
its graite of »yniplom^ jiu^t us doc« ncutc iiifijiinmntkvii of the 
tympanum^ where tliee^uMon withmtheenr may be ttenitj^, miuct; 
or purulent. ClinuTa! i^xpcriencc of thi« nKwt common ufTeetkiic 
In the whole rarge of aural diiteaitefl deniandn a reeogiiiLtoD n( 
tU*iw gmdcKf in order Ic* arrive nt a R-ientilir aixl frticcoseful trai- 
luent. For descripdve purp<»e>^, I eons^irler there are lhr» oowlt- 
liotijs which r^.piire indiviJtinlizution, tlioiigfa of oonnse tlH>n>are 
maity intermediate. 

1. Inllnmniutioii oharadcriind by a very flight secrolini] of 
miico-piis, not enough to flow out of the <umil, but ftuffictent to^ 
accuiiuilute in thtr Ktw mid cvmal, and lorni closely ai]hei>.-nt IHn 
cniata. These irritate the parta iu eonl^'t, caqm; #iniill i^ranul; 
tious, oontittctioii>«^ iind adhevioiiis; dtiuinish the hearing ; indiuv 
tenderness and oocasional paina, nnd [>redt'^]K^>M^ to a<ruti> exft^vr^ 
btttionif* 

2. iDflammation attended by a moderate flow of t'^tftTtbl 
bcBlthy pu» out of Iho external nitialiis, var^'in^ in quantity froii 
a few minims to a leaApoonful or two in \hr iwejity-fmir Win^r 
nifdinm*ai»xl ^mnulutionfi and. perhupfi, the tirmer kind of polyp 
in the tympanum ; variations in the lit'nnng, d<-txrnd<'nt uponth^ 
quantity of pvjr* in the «ir, and llie degree of moisture in tli« al- 
mi)«>pliere ; a tendency to alow hypertrophy of tlie aural tiffita 
witJiont acute pyinpEum^, and a liat^llcy to aggravatjoae and oui*- 
Uiid dlsea^. 

3. InHamnmlbn, causing a profuse flow of illandable, ftfrid. 
yc'Ihiwi^h-^reen pu,^^ oftea containing blood and bn>wntT(h parti- 
cles of bone, which excoriate the luwer vail of the canal anii 
lueutu.^ hi/aUHtt* mpid nliX-nition otmfl ibatii^tuid^^uwi'i 
caries of tlie bone, paraly^ of Hig facial nerve, tlie forniatioo 
flabby gRtnuIation^ an<I Urge mH l>olypi, and grtatly dtiaiaisl 



C0RO!(rC PURULENT iSfLA M M ATION OP TTMI^AXUV. 237 



the liGariiig power. This variety U very common, ^liflicolt to 
euro because gmHed upon a fitrumoiiA conntitiition, freqiienUy 
itnn^roti^ to life, niwl mukc« ftiiral liiir^Tv u iiecvaiity. 

The local sympiom** vary with the patboln^ical coudltions of 
the cflir. 11k- profniEient on« ato tld^ncM of «oiiio dcjo'c^i tiic 
pnsenoe of diaagreeahle f*me]Im^ pn^ in (he ear, inrreahoci ^wi* 
tiveiHW of the cxti^rDal aiiflitory rnnnlf »onio «or(ftieti0, o^K^asiooal 
ilfltta i>f pain dircktij^Ii the aural r^km, flight and tcnipi>rafy 
a(l:irks (if vertigo, Utcntl iuadjLoltfTf, and, pcritap^, fever aod 
delirium* 

TIr' lii^nriiig 11* aXvr^yr^ d<«fcclive, and T«hon1d be ivs^ed by voice, 
watch, atui tuning'fork. IjiterrofatJODfi nf a patient'}^ |)eroe]>tioii8 
of i)t« tUDiJi^'fork, vibrating upon the verUtx, ujI! brii^ an- 
ffwere in re^iartl to the condition of the labyrinth. If thediaetf^e 
Imtf merely cuuMud hypcjtemifi of tho intcmftl mr, tJic- sr>uiid of 
the fork vill be heard somewhat muffled. If the labyrinth b 
nrrif«i*ly affVvIed by extension of the lytnpiinie diMifMMnwank 
tbmugli the many i^hiiniieU of intercmirse, ih^ hcjiring will I>e, of 
eourACidimiiiifhod proporttr-oaipty or, jiorhape, entirety annulled. 

AVhcn tlie labyrinth rettpomls well to the vibrations of sound 
tlimugii the r.nintnl Ix>nr>i, thmigh thi- tympaiiLini iimy lH*ooibtid- 
ofwbty diseasxb the patient may Inwir lb© wati^h fr*>ra three to 
ihirry inch^-A. Wtib good rrrmhil pereipfion, and a he(»ring 
[K>wermmgocniflionally to (wo or three feet, one mnpromiriea 
reBlonilicKi >tuflic*itf>iit for tlu* u*iial d^^miindft of mitnilaiit^ ex]»t* 
enrr, provnlei:! (he morbid cli«-harge ran Iw arretted, 

A thiHi «1owly thiwing j^ua, it-nding to form c^lot^i and orasts, 
to rHnrd tfu* diwh:trge of f»|>id<-rmir- kIitviIa, and to nfK-umiihU^ 
dnM and forvi^^n lnKlii'-i; (.y^nHidembttf^ (<ongi-^lion and rhir*kening 
f>f thi> miir<ui9 m^mbrant*; an exnU^mnt. formation of V|t»ngy 
gmntitationa aod, pj^rbupa, polypi; a amall perforadon of the 
itM'fnbrinf- irtAinincr in^piu^itf-d pu^ in tb^ tympannm ; f^loautre of 
the EtHtaphiun lubu, u rumblttig r>r rbytbniie tinnitus, and damp 
\r<?iuh€r, nil ditninKb audition, and mott *yf tWm favor dfvtruo* 
tiveand daogerottiComplioationH. 

The exteniAl meatos or the canal rieeper in rt^nlain>i pnu. It 
i» thin, cnniniy or Jdly'-liki*; AtHngy and ihioJc, blnifih-vbite, 
ye)lowi:;h-white, yellowidh-green or gniy and «iniouK. The 



S3S 



TSE Smiy EAB ADD IT£ DIBIABKS. 



jrfiinger llio patienl, tlie lighter ihe oocnplexioD, antt Uie man 
reccm the ivscnm, the more copious will be UieKuiiply. Tii^di^ 
clinrge \» g<!neraily ^li^hl oml tliok Id adults, likely to fofin 
DiussGA And to ;ulh<-rc to the borJcr of the <lniin-l>eflu] nt»d Ui« 
vnk\h of the canal and tyjn|>nnum, ami lliiis ob&truct ibe oulwAnl 
flow- 

The dbdiai^ may !mve a fabtly disagre^le earthy odor or 
be &hy, foul, dtfgusttn^, and connive In ciith*^ of the teni- 
pomi bone, the ^uifll of the di^char^ is RickenioK At><l almost 
diugno^ic of the roiidition. Cleaning (ho «ir fn.*ipnrnrJy will 
diminish tlie foul ne^ of a necrotic cliacharg?, btit d«ep vriping 
^th cotton vrill bring out IL ^t^lIc of rotTcnn(«», offciuite enoa^ 
in odor. 

Red batr«xl struma ia.k& the prcmiiim for illauilubl^ puif, vrliidi 
often nuis&4 coa'^idemtle de^ructbii of th« skin itr and around 
tlio can The woi«t nuppurution^ nn^ thwi; fallowing AcarlatiDa 
aud uienhlc^, hut the <:on»litutiou mo<liGtA it iwich. 

A ^oluliou i>( sul^ectate of leiul i^ blucki^ricid by this pus, OD 
•oeount of \ht' xulphiir tlint it cimtniiiH, i\Ui\ ii ^(ulphiih* of liwl U 
formed. Coni;c?^tion of llie [ympauuTii of^^^n iftvt^ the pu>> a pul- 
tfalin^ motion. )<yiichrai)oii5 with the fiction of thf l^^rL 

The pumlent dl»eliai>:e of ordinary oa>i^ contains pusoella. 
frx^eand jig^ri'^itt^^l in i)iii;*Hf« ; rom^nid gnttiulo uelitt nad r^hrvdx; 
oniBts of dried pUB and epilheimm ; haire and altered oemmen; 
di]i«4 nnd dirt from without, nnd, pi-rha^is, blood and partielcA of 
bone. Blood is ^«en mixed with pus, when a piirnleDt lympauum 
U wipi'd out by xhe f>otloni\] proUv and iIk^ d*;bri« of bone fpoca 
caries api>eEir» a^ Ittlle brown particles If the ear ba*^ do4 bem 
t^li'vintHl for o \ong (irne, fatty pu« ci'IU, chohstterini'er^-Btalaiaild 
flski^ of cpithdiuTn aie found in the tympanum, din^n; teiM' 
ciouHly to the dcpr(4>«ion» and openings. 

Tinnitus ia not very coninion in thi?( diwaite. WHhmi llie mnal 
walU are congested, swollen, and narrowed; maftyeti of ptis and 
epitheliom have aei?nmulnfi-d ; eni^tA, exuberant gnvnulatiom «ic 
polypi blooh the lun)<>n : th4> drum-hond ba>4 a small [Mrfonilano, 
Witt) puft ttehiiid it : or lhen> l* Kimv. fLinrri^injU <ir or^ric rJmn^ 
n the gr^l vefieels oorftij^inus to the ear, there ia likely to ht 
linaitUH of varying <|U]ilily Hnd inienntty. 



0DBO»[0 PURVLKKT IKPLAMMATI05 OF TTMPANUM. S88 



Puin of son>c kind U pn'.^nl 'm »bt>itt linlf tlio WMr^ Tbvrc 
may be merely soreoeaa to tbo toudi, capccmlly, if tlie parte have 
nuccmUx) in the ptis for «om(* (iinc. Wbri) lliv di^^i'^tT i« of long 
BttDclfng, ttsi] till- ili«chargc \s only mtlicicnt to fill the tympanum 
anfl form crusts by ilryiug, the pain on contact is twoielimes bx- 
cmcntiiig. Sharp ictttclie« HomclinKM shoot throtigb t\w di^-u:^ 
ear; moderate fUeady pain aoonmpauiefl caries of tlie temporal 
booe; aii<I ihc siAv of tbij tntx \s Homitinie« distorted from |mml* 
ysiH of the facial ner%'e. 

Oue» of chronic purulent dUaiuw of the tympanum nn> subject 
to acule euuierbatioRs ai times, tbc pain tuay bec^ome severe 
and [>crci>4(iit, and then? may lie mnny of the ^yinphjm.s of an 
ftcfite primarj' iDflamuutioD. Ut-'lief is a0br»]ed by giving ibe in- 
dicated medicine, and by clearing u ps^ea^ for (lie pus out of the 
cxu--riial nittUim^ iw H rarely t'-i^jijKs from die ear Ijy the route of 
tiie Eu^tacliiflit tube, 

Trmli<rnit«4 and pain are uxpericnced in front of the tragufs 
below the auricle, iu the tnaatoid prociea, or in some of tlie cer- 
vical lyniphatic glaml^ if tln're are nny cumpliaition^^ When 
tlie earache is acei>iapaQie<l by ^milateral or general headache, 
the case d^^matids oriiivt alt^^ntion. 

The mi>«tt»and external andiCory c^nal must be irjrriDged oat 
vrith warm wnter, and cleaned uiki ilrkxl with tho cotton ho1d€r 
before iiupec^ion. It ia often neoe^tiary afcffr !^rinp;ing qnite 
forcibly widi a vcll-eUvalcd focintatn or a bard ruU>er ^yriii^^, 
(u wipe the dei'tli of the runal, and tlie tympanum if ex|Kttcd, 
over and over a^in, in onlftr to remove the udbcvivo pua, scales, 
and eniiili<, aihl to ^t a isood view of the p^rLn. Then the »![ieo* 
alum und uto^oope should bu u-■^<ll to nuike a c^rv^ful dui|(ao«ijt of 
th« dWascd condition-^ The skin nf tlie canal will be found 
more or Ic*k couge»;U^I« nildcnul, atid swollen. When the pun 
hi MVpious the iirjacernU?d aud Awollcn epidermis resembles Urt 
skin of |)eir1xiiliHl \j*:iin<, titui i» tullurrvnt in t^me places and do* 
Cached in. others, lianging !□ dirty-white ehreda to the acarlet 
n^. The blowlveSM-lw of the TvU: nn- di!at***l, nnd the or)nDC^ 
%i\is lis^ae is infiltrated with Benin], lyDipb cells, and sometimea 
extfavantfNl blocMl. TUvs^ itujr&^M: the ihickuraa of tlie aofl 
tbuic wall, especially the posterior portion, and diminish the 



240 



THE UrStAH EAR AND ITU Dt5BAfll0. 



oilihr^ of the can?i1, bo that in some caice it » cxoecditigly diffi- 
oult to peroeivi^ tJie enact ci>mlitioTi of the dt«per pares. Tbp 
skin ever the bonjr |>ortion of tlio canul fr«]u?i)tlv Miefns bjrito 
velvHy .furiiiee and fn^ i<i?t'TM^]oii to take on a pathokigieal char- 
sotcr, rcscmljling the normal miicouH mombmtif. In x'cry wrof> 
ulous patients, the {hi8 I« so ntihoshhy and corrosive, »# to d^- 
fltroy th( Mn upnii llie floor of ihe canal, ia Ibe buIcik, aE>d 
upon the lobe of the auricler so that it is di^rliurgcd along a 
dmufiL-l of niw-eiljjt.^1 angry *kin. 

In rare and anneut cases of purulent influnitnatinD^ exctFtoWi 
of the IxJiiy oanal ans w«n, jtrej^ntiiiK hawi, unyiddin^, niuniled 
elevation; into the canal which n.trrc*w its 1uBK?ti. Cari<v and 
necroEiUor tlie bone are oi^tii?ii<>nnlly fotiml^K-viialiDg tlt<^tr piv^^eocc 
by swelling, aibsccM or a sinus of the soft tiwu«« ncsr the vcat of 
the destruetivo prowwi; anil pnpalyHi?* of tlie facial nerve oocars 
from 'mvoMisn of llic Fallopian cannl. 

Perforalion of the Dieoibrana tynipniii acvonipaniea punilcmt 
inflammation of the tympanum, immcHlIately or remotely follcw- 
inp acute inflammation^ It may Iiavo resulted from ul<H?ration 
of the LMlgea and enlargement of a panKvni«Ms, diiriug tin; ac'ate 
atta<'k; or from a rent, rnpturf or uIccratioD, occurring from 
ifltra-tyin[»aaie pre^t^uri' ihiriii^ the ri"ir*i' of the tliv^iisc. To 
find out lis naturv ami extent, after cIcanHn^ the canal and 
membrane thoroughly, in«[>ect the imrth wilh ihv roirror and 
api?ruliinh 

Noie the position and eictent of thedruin*hcad, llwsise and 
«hape of the perforation, the presence or ab««nce of (he omdtBt 
and the mo\'<fment» diirinL; a Vakilvian inflation. If the Eujiu 
tadiian tube opens with diiScully, use the calheler and air-bag aa 
beft>re described. 

When th^* tympanum ifi tolerably dry, there will be a slight 
whiiT or whittle thR)Li^h the opcniDg' Should it contain muco- 
pu^ thi- twund will be muffled to a \u^ or gnrgle, and a little 
secretion will oosee out and run dowa th«^-drum-)K-»d. The mcra* 
bnme may be wen to move and the senelion to stnrt out in msofe 
cfii*^, during llie u»c of Sleg!e's»puculum. Wht-n the opening 
m obscured by pus or it la Ur^ and the tymj>anum codtalitf 
conaiderable of il, inflation will cxxvse a bubbling scnnid, and 



I 



i 



CBR01V1C FORULIST IKPLlltMATIOH OP TTUFATTUH. 241 

f;lol>u]ei4 of air may be »c«i] to bubble tlirotigli tb& liquid in mpit) 
raceoasion. Id liypertemia of tlit? rympaciiim, pu-* o»)ntaiiiefl 
ihcfctn way piilsato t^nchri^nourfly with ihc carotid arteries. In 
rare ca^ a polypes may projcet ^ut ofti {H^rTomtioii and otiA<Hire 
it, but it can l>c movol by a probe, ainl ttiua lis rtlalion (o tbe 
parts cli^covered- 

l( the ptis 10 oi>linary cclort it iJiowb tytnpsnic granulations ; 
if it ift dark and ooeih^ fn>in ak»ve «r behind, it indicatt^ ibe 
pftticiicfi of earics. 

I had 0D6 c&Me in wliich tiiflalion aiUfcA a <]ro]i of hrovDifth 
piw to BoH" from within, over tbe upper posl<»nor border of tim 
drutn-hnul. A bent pmJN^ rcvcalod tlic prt^cnKw of <^ri<s of ll>e 
roof of ibe tympanum and [xirdtr of the a»nnlti». 

Sotti€lim«4 wilh pcrfonUton llitre i^ d(.-[>r4«ioD ; tbe nifnibrai>c 
is irref:alar, lU outer »^urfare k ^raniilar and covered with pus ; 
the ninllcLis hamllo i^; alkcckrbc^l or tMckenoil and iDvi«ibk\ uihI it 
is \'c-ry diffi<:ult to dis«jver lb<^ ineiid>nu]o at all. 

I hw] a vhm: that I conndcrcd purtd<fat otitif), with dc^tructlouof 
the membrajio, and adhi'^inn if the mamibrinm (n iho promon- 
tory. I was surprised lo hear a sharp musioil whistle during 
inflation, umt, Mratebing more can^fu]ly duriojr VulHaKitV infla- 
tion, I di^jovercd a perforata dnim-bfud, dusturlvd iind diiw 
gui^nl by ndhe^ionx, gfranulation.s itilhcront ]K>ltiole^ ami pit;^ 

Tlic nvl tumefied appenranee of an acute porfumtion, with ib§ 
raw and blo>:H)y odgtr^ i^i>i>r piL-M*^ iiwiiy ; n izray idi^cmtlon eatH 
away the borders and cnlar^^ tbe opening: or the Hjv* of the 
openii^ airta littlr^ and Ikvouio yc-ltowl-^h-gray, thtn and librouB. 
lAter, tliey may take on a cartilaginonj; apj>«iraDa% und nsceive 
depiniL* uf airtninan* ftf \lux*\ 

The surface of tlio membrane will look white whore elevated, 
and dark wht^re dqm«Hlom ^^xi^tf. If tht^ [u^rfonition ia small, 
the tymf*nnm rtinnot be illiiminatcf), and the wjM-mng look?* 
dark ; if larger, one sei* tbe nnioiMw mf^mbrnno bright rel in tic 
flimlc Kt»g<^, dcepor n^I atu! granular in the rlimnto rnndilinn, 
TJir perforation may be very niinnte, or so larg* as only lo leavo 
a rim of mitnbrAno amiind thi^ wnll or a loi)gfi<Mdi»|H><l pin^ 
along tJic manubrium. Sometimes tbe lower lialf Is g^uoj and 



243 



TBI HDUAEV BAR AVD TT8 



Uie iii»[KT U>nkT i« rormcd bj the UAd» rrom th« sborl prooMi 
cxl(.-ti<liD|i; to the anterior and pn^iertor walK 

The eigfiA of Uio TiK^nbniim tytn[»ini arc often MJIieroit to the 
wallft of the ^^nal aD<j t/Dipanuni, and to the ceaicl^s, becana 
tJie X^n^r l^m]4im nit»clc hiiA druf^rd in tJic loimtibriiiia amI 
fuvoml the mfllpodtJocL 

Xlie mnimbrJuQi is goii«rally won as a wbiti^b-gtuy »trcnk in 
the mombrane^ but it mtky be ao obaciired by sivelling, as to hive 
its pwitiun rocogotjced ocdv by »l(-»4h of'rirongly inji^'tctl vo«eK 
It i« ircqu^tly dragged inward, upward and backward, touches 
the ipiier vfM uf the lvni|)uniini, ntid i» m fun^hortnicd oa h) be 
feoognizcd with illHiculty. It may uilhere to tUv ]oiy^ pnHxw of 
the ioctts, and tJiis, iaUrr Uv dmwn :vgiiiiir4t the lynn^aiin wall. 
Jt i« »oinotim<» ab(M>rbed, presenting to view only the buttoa 
the short process. Tbt! tiuilltnm nml incuA are generally nlieient 
in lai^i* perforations, and the tyiujiaimm can be inspwrtwl «ialy, 

Tlie |m>iuontoiy ii* iisu-'illy ]kiIcp ihnii oiIht fmrtst of the dniin, 
but the raucous membrane over it may l>e so swollen, as lo Ic*! 
one to believe a polypus projwi** from Ih^' inner wull. When the 
ni^Ilf^itfl 'ps ab&ent, only die longpnu^efiaof the iDcm,am], [Hj'hape, 
a braiieli of the t4jipt» can be mxn oa ycllowudi abj«ctff u]K>n the 
red background. When the ineuA i» gone, at the iiU|>erior [>r*iie- 
rior tlurd of the inner tynipauic wall, behind the prunKintory, 
one may see the yellow aidorior bnineh of llie stApet, txientUi^ 
from bdiind lioriiEontally forward and inward, llie other arm 
be^ng hidden above tJnr Kvol of tlic poetcrior isuperior cdj;c of 
theaiinuluti iym|)nnkua. Brunton'» otoscope \b nece^eary to nukv 
out tlK" drlniK-i of tlii8 mtmite aimlomy, nitd one iou)<t iiHiiie the 
patient'^ heajd towards the opposite shoulder aiwi lo<»k towards 
tJiu toof of the tympanum, iu ordvr to wx! tlw u^skdes when 
present. 

A perforated mcmbraDa tympani eaniiot hcfti p«rDiBDeiil 
until t}i<! nuiix>u8 meml>rane i-^ reitored aearly to a oormnl stalb 
Tlie smaller tlic perforation, the more n%i*iit the srklatiom uf con- 
tinuity, and the le^lhedi-Hdiar^of pui^tbe f^rcater is the eliance 
of clormrc; large cJironio perforations, with abscooe uf the oxi- 
des, aud profound dter?itiim of the mucous membrane are obeii- 
nate and can twldom be cloeed. 






fi 



■ 



CDKOirro PvatLCifT T!vrLAU»ATio!r or TTMPArroH. 

When a perforation clo6es by granulation of It» Jip8, there b 
not a rf^omliun of the thn^i* luyi^rv uf Ok- normul druni-lK-acl| 
but a formation of true oloitncial tiewuf. The cinatrix in thin, 
wrmklo.l, uihJ dvpn^^-d, iintj (rvv\y niovuhlu hy ]nfl;!ttiou or hj 
tlw iis^ of !Sie|^)i^'A ^pooiiluni. 

After a perforation hasclcsctl properly, niptur** of tlic cicatrix 
may <w€Ur eaiiily from hyiwrswrclion of a ptrsisttntly morbid 
miKXMM memWuDCf from acute inflammation of tlie EiiHtuekiaQ 
tube and tympaJiuiu, or from occidental extremes of atrial pr«s* 

The miHOifi membrane of Ihe tvmpaDum ia in ecKne ca>«s in a 
atate of mild i^ubo^utc inflammation without ^rHiitiliilivin^, »iul 
aecretes »o little uiueo^pu? iLit it dm'?i not llow out h( ihe canal, 
but bccoin«« infipisBated and forms thin c7CL»te, which UlocV up 
tlie tyiiijkannm ami innr-r canal, ami iiu|M?de the itclion of the 
omielcs and the frfigment of mcmbraue that mixy bo prui^*nt. 

(n orlier (wtitMUK^ iIk* intictHm nietnhmne ifl more inllamod, 
covered witli minute granulations, and secretes coneiderable laud- 
flhk niiH^nH, wWiAi f!oiL>i outof ihr «ii«il from the nkownienta 
of riie jaw and the inilivMiinl, ImU Ih liki>ly to cling to the irrog* 
ularili&i of (iie tym|tamim and inner end of the canul, undergo 
&tlyd^^^^cratinn, unite with the pellicles of exfoliat^il cpirhc- 
lirno, ftud form ma'^^^ of a dirty^white cheesy ap[>earance very 
difEeult to dir^lodgo, and, yi't, daiiji^rou^ to let remain. 

Id otiier caw^i, t)ie lining mucous membrane h rhU-l<ene<) and 
hypcrtrophicd, and thf; membmnc of the round and ^vul win- 
dows becomes too Miff to move mucli. Tlie siibmucouB conneo- 
Xive tiiwue \s filltxl with leucocytes; tlie bloixl and lympth vCMela 
are dilated, multiplied and eon^restinl, and the epithelial surface Is 
cvn'eti^ with ^mulalJoPH, villous and |iupillury ^rowlh#, aiul 
rounded or pedunculated polypi. The surEoee is ^acculcDt and 
hv|»er«"anc nnil bh-tiU easily, the mKrclioii iB mtlcr profu-W, free 
Sowing and fetid, and may l)e creamy and uorrosive or dark» 
aOLniou»,and oQen^iv^ 

The intrinsic mu.'if^-lcs of the car eome^mes andergo byper- 
ploria, thiekenin^f and shortetiioif, bat they fEeoenally melt away 
and are destroyed by ulceration. 

Ulceration of the mucoua membrane sometimea oecitre, and 



2U 



TOB HUMAfr tAt AKD tT8 D18BABB0. 



caricfi of th« osiclcfi and various portioDH of the ^mpanie wiIJ* 
ispeciftllr Hie w^f, mny wtij^^rvitne in curi**<<jtK-nce» 

The diorda timpani nerve U irritated or destroyed, and the 
Fnllopmii (<diMil t» 4>cca4ioiuil ly iuvnck^d by the intlaniiuatory |ir>- 
cessL, rfi^ulUng in [Kiralws of the faoial nerve, 

Ex'^t«sf<# nrff^c U^nuiTh t]ic diecai^ membrane from iLe co- 
existing peno^tici^ and oMeiirs. nnd nmy fill a gprut port of tbe 
h'tapanum. The dura mater over the car b frcqaenlly tbickeood 
by liie c»nt]^ij(>n> diH-aM\ abnonnnlty ndhi^T^nt cht IoohskmI from 
the roof, and raay be eovere*] wiih particles of pus, 

The tnflarnmntton nnt] morbM produeL» niny cxti'nci ii>ln the 
mastoid celk and cau^-e maMoid disease; and into tlw? Bustacbiui 
lube ami tla- |uis fluw into llie pharynx, bnt thtK m tmcommon. 

Croni>ou£ and diphtlieritio aieiubranea ha\'e l>een fc-rmed rarely 
ov^r ihe lympunurn, and tuljcrciilons and caleilio depfwll^ aif 
soraetimes feen in mucous niemhranw aflected by pumleal dis- 

The wliole tenipom! bone around the ear ia more or lea 
RWte^l and iw periosteum tiypenemic^ ^n thul ihc morbid ]>roccsr' 
ean ea.^ity re^irii the blixxlvi'^K^-lH or the bniia and de^roy lifoL 

Dr. Rooi^i Bays, "The cavity of the tympanum i« covertd 
abfive by a ihin, rarefied bimv plaf^, whieh t m direct oommtmi* 
oBtion with the ctrebnil nicnirii^ ; thi; floor ift ckwe to th* gnal 
jn^ilar. II5 internal wall is the labyrinth wall, vitb its two 
fcnujjlnc, covere*! only by thin membrane nnd opening into the 
TnmifientionH of tfi<j ao^tistio nerve and the fluid which is eon* 
tiiniou^ with that of the Hub-aTacIinoid spuoc; while cxtrnially 
we have a membrane of atiout the thioknef^^ of leiter^papen"* 

To contemplate such senQUs di^cas: in lhi» r«*gton m I Inve 
deMmlKHJ runs** anxiety; to see the di**inictive proceflses jcoing 
on day by day in a confiding patient, ignorant of the danger, 
awaketi^ thir gnivi.wt apprclH-iision, 

The prot^o^is will depend upoa the confitilution of the {Hitient 
and the t^ndition of tJie ear, ah revealed by a earefid insi^ection 
of th« tympanum al*lcr it ha£ bei-n thoroughly cleaned^ and the 
following statemeati^ arc proved eliniciLlly : 



1 



* A iVactica] Trentise on Dbe«fl« of the Ku- Room, p. 3TZ 



VVAOfflO ?Dt01tttr INFLAUMATION OF TTMPANUU. 245 

Wlwn the mning-fork U heard well, vibrating upon Uw 
v^'rtirx, the f^-rft^nition i« .-^iimll^ ciirulclcniblo niciiibniiK? renisnin 
altnch«<] lu iIh? mnniibntiiii, ami ibc tDiloous Enembmni? U luenl)' 
inlliimixl flinl iiyt (li-geiwraUiJ, (he diuiiot^ of huilitig ihu druDi* 
h43i'l anci improvin^^ ihc lit^aritig may be con^Ukn^l fkvomble. 

When eniDiul pi.Tcvptiau of the fork is gooJ, ihi; iwrfonition U 
ignite lar^ and impo^iblo to cloae, die ossiclefi are {vartiallyor 
entirely |rune, but tie iniicouit HnirTg i8 in u ?^ie of ^lUicutc 
infUmmatioa witbouc much grauulation, the dibchnrg^ may be 
arrrrtlttl, and the nxn^ of bciiriflg m<ri><(u^?d tfl a niLHltniUr de- 
gree; tJiQ latter cnn be slightly au^ment^d by wearing a cotton 
dnim-hcaf) or TovnbocN ftrtifiml mirmbmnn tympam. 

Wlieu th<^ jxirukiiL iuEhmimalioD Ikb exi-Hit^d nionthfl cr year?; 
Uie perfonUioa Js Iat^^; the ^r^ickv< are at>»cut, djiipla4.-iit or oii- 
Hiyla^4ed: the miiL^iia membrane i* (irofouii<ily discaaal ; la^e 
granubilljQ^ or p(jlyj>i urcpR^^ni; thcpu^ U illumliiblc and evr- 
tosive of Bo(i portfi, perhaps^ (H>ntaining Htnall particles of bone ; 
the eunsttl niton U .stniiEnkuA ami feeble, aiui iii« vibrating fork 
Ujion the vertex is not well hearJ, a guardnl, nod gcnomlly an 
uniavorablc progiK>7«U na 1o hearing uml, even, to life itself should 
\k given, and ttv^itmcnt energetioilty adviiwd, 

Tlw exi»toii<?v of pulypi within the tynipiinnnj, parnlvi-iw i>f the 
fiirial nerve, carles and neeroeis of die temporal bone, and ma^ 
toid diMewfc, are gruvc and threufentng couiplteation^ of pnnilcnt 
inAaniniatioD, Tho aural surgeon knows from experience how 
«uddetdy lUnxh ni;iy <S)t\t^ in M>nic of th<i*o t-a^Hs, mwi will be on 
im guard in prognosis, whether the patient k u<^Iuctod or tn:a1ed 
in a thoroughly (Hienfific inanxier, 

I Bhall consider liere Uie measures to be adopted for ordinary 
owce, and mention <ompluuitiom of the diKeme uiideT eeparutc 
divisions. 

Trfoimntt — The tix-JittiRriit of chronic pnrnlcnl iiiHamniation 
of the tym|:ianam is looil, surgical, and medical Of tlie three, 
the lo«l in the mcst important, thuugh tlte i^urgicid may in tfome 
caseft be of equal value. 

Washing out u ebrooic KU}>puruling v\r pro]^R-rIy ^eeinii t^uch 
a simple thing that every one thinks he can do it easily. Ther« 
never waM a gnmtcr miifUike. It i^ diflicult for the uurul Mirg«ou 



948 



TSB BUMAN BAR Aim ITS D[8EA6R8. 



hiniseir, and it may be »ifely .MaM, tluit no uainetnict«d 
can do it gfrundNm artfm. I would refer \\ie ix«tN-r li> whal T 
)uivc writU'Q eWwIiore u|>on tbis subj^t, and here erapliaitK 
mme points of importance 

The f«^n^U>iiity h m grrjil in mroe of tbcsc casra, thil iliej 
syringing tnuHt be very gentle. Tliejet of thf frntntain MTtftgei 
mn Ik fni 4rA:tily tc^mgioivil to tlie fci'lings by raidioK or lo\rtaug ^ 
ihtf txtg, that it flhmild he preferred for very Mw^itive cases, Tlie 
diviilci) jet i»4 tlien, Mho, pridcrablc to the t^ingk one, as it bmila 
tile force of cli^ water. Af^or a fvw vittiis the baud :<yrii>g« a 
be lifted «ven forcibly. 

OUtrcssing vertigo ia soueiiinai mnwd by (tyringing. 1 bJv? 
bad »«v«ral piitieiit^, vrho vrcre t^ligcd to li« down immedi- 
ately to prevent fainting, and hm fell insemiible otit of the 
cbair from forcibly injecting wiitcr into the onr ivith the univeiml 
.syring«>. Thifi idioNyncra.Hy u-hiiaIIv <tiTAp|>enr9j a>t the |min doe#, 
after a ftw treatratnte^ thougfa it may always be a distressiog i 
com]iiiiiimonL In ^uoh dilemmjLs, have ihe patieitt rei'line during 
tbf doucltG vrith the fountiun, dimirifih its fcrce to the mininiaiB, 
and im-rwL-H- \t gnulu^lly ^ if «ia he liorne. 

When the divided jet cannot be toleratKl at all, let the patient 
redini* in nn eib<y chair, fill tht- diM-n.'^ed mr, whii-h should Im 
np[kermo§t, with trarm wutcr, and swab it out with the ooUoned 
lH>!d<^p If ihb doa* not t^tmnw the ioir, lill it with a Milutton of] 
bimrl-onale of Milium [SocfH bk^j-h, gr. xx, Aqtut f^)t Unvt it 
in fur fire or Utu minute, then wipe ami dri' the (larb^ with ab* 
Borlient cotton until every pnrticic of mueuHf pu£, scab and scnle 
u remov^nh Ouly then, should medtdnal Agents he a]>plia] 
locally. Of course, if the hole in tlie drum-bead i« fiomll, wipinj- 
otit the tyi]>|mnura will l>e out of tlie qui^tion. The tynijunnm 
can occaflionally be cleansed by injeotiiig ihrou)>h the catheter ia , 
position in the Ki^^tatJiian tube. TbU in a prefi^rable method ia 
vcrtiuiuous caftp», bul is inapplicable to children. Th« iMad 
should lie incliiiftl lowan):* the affecttftl »idc» the iwtJwtcr intro* 
tiuviiti, the [^yringc fitted dowly into iti* end, and the 6u!d fopwd 
slowly and >1(.<jHlily through aiid luught iu a bowl held bvUnr the 
ear. Some writers are enthusiastie over tJiia method^ b«it la a 



ORAOKtC PtJftCLBNT tNrLAMUATION OF TYIIPAXDU. 247 



Ur^ iim)frrjly of <aw» ibe Quid will uot paM, but ^ down ttie 
ibroat. 

If Uit- ^ugr]luruLIou cftiinut he Jirrvfitcd hy tlie U'fitnl tnalmerLt, 
the perforation of tJio nK-rgbmnc iilu«1 bt< ^aibLi^tl, rK> tli»t lltv 
tnnimnttm <an Ixt morr- l,]iunHiiz;)]K' trii^tHlp The t-ti)tir^'riieiit of 
the pcrfofatioo and free liberauoii of the dii^hnri^c u^^ually in- 
cnaww tlir hmrin|;ooii-<i«kniljly, SomKimi^ tl)cdi-<?luir^* av4Ct« 
lo flow oiilwTitdSf ronsiderable paiti is fcLt in tlit* cnr imd sirJe of 
iIh' hiwt, iirtiJ thvn* i.^ hueiiu fc^'^n^h dbturbanct', owiii^ Ui <Tiikii]g 
of the matter at ih« Innar vud of thir ontml, And ctoAiirt: of its 
lum^^n. The olmtnuiioii must Iw ijimuH]Lni«ly roEn4>vc<l. Th« 
preEfiur^ of pan behind fiuch an ob^tructioD canse^ f^pilcptnid 
atlwk# in palicnlH ((iiil<< fnxpitntty. 

Ttwre are cafte^ of chronic purulent oiitU that should not bo 
&\-rini^ at oNp Thn' arc in the Wrst iJiv»ion ^ nbovv, whore 
Uiv. drain-hciul ha^^ u iiLiiti*m(i' i<y£Vt\ iH^fcimtim)^ th<? dm hur^ is 
ali^t, and it inepisHite^ and iWrus a few ycJlowitdi-bronni rrusts 
in ibe i<iiiml ar ii]i'>ii the nKmlirftn«. 

KcDiovc these by tino luioUfi^ a canwl-hair bniflh wet with 
glycerine, and the cotti.>mjd holder dry <tT nmHti'Ui.ii with water. 
One can, under (^*od iUiimination by hond-^niirroranfl ^)>ecu]um^ 
grt lh'> siirft^MM ck-iiu enough fur the rvcvption <if the mild reme- 
dies indiutlcd. 

In iDotli^ variety or fttngc of th4' disea^w, wlii^ro tfie ]>erroni- 
tion of iho tyrapnuum U of medium f'lyj^ and the tymjianum iA 
iDcrcly tnf.»i&l and ^lintenin;;, cr tht' mucous mtmbranr ii* eovrrerl 
by n tjitu coating of creamy latidable pu8, though not cnmigh is 
eecretnl to run ootHiird*, it is bct^t t«> l>e nonlM.■^vn(iv^ Clciin»« 
tfao tyrojKUiio mucous mentbRine with ahsorbcDt cx>ttoD ou the 
huldcTt uihI apply only the iniUlc^t nrnic^liGft. 

WhM> in either of these stMa<, scab^ form upon the nic^mhrane 
ftround the |ierfc>Rttiun, ixTba|>i*L, over it, in an attcnipt lo cIo(<o and 
bcnl i(, ai^ thu9 protect the tymptuiuru from cxpnsure to the 
BtmoAplicrc, one j^honhl favoo* the pn>ces)S an<l be chary of douohesi 
and iaMJUation^ 

In tiic o4lM:r divisions of thiff disiiisr, and in its coinplicutioii«, 
I doticbe of a pint of n-Jirni water Abouhl he injevted in the mr 
'oooe or twiee a day according to twccesily^ and then tlie proper 



S4d 



TDB BCMAK SIR AKD IT8 P16SA8E5. 



WAfili bcdropjidcl in tilWr drying. Tlii« will gnoi-nillv Iw ag 
eituil trtAttiK'iit at home, and [lit; aun»c ouglit to is&! itte patknll 
v\Kr\ filter (111/ wr wi^y tliirj <liiy nt thu Ivitgni, wlwtii Jit- olrauli] 
cl«ao4e tbe i^ar tlHirougbly by douche and coKoDcd holder, and 
niakr the iipproiirhitc iinti«'|Ttio, iw(rinfii;rit or mu-Hic tt]<idk!iLii(iti> 

When tlie ear and iu eecretious aoieU badly, 1 add Tar riocfan , 
or Phenol Soili^uc, fjij to a dou^Iut of n pint of wann vraUTi^ 
as au amifieptic siimulanl. Kitherof ihe^de^Dbes andimpro^'d' 
the eomlilioii of tlic d»i^iiM-d nmajia?^ mc;nibrunc. AUtt tbc 
dciicbe, It U nectssary to dry onl the ear with the towel, re- 
nio\*e cvtTy piiriiclc of mntior with coitoii| uid QppTy llio Ioca) 
inedh^lioii. 

Alum, siilphale of nnc, niJphate of copper, acetate of lead, 
oitntc uT lend, Hubaulphjitc of iron, nitnite of uh'er, pcrn^axi- 
ganute of pnta^iuni^ iatoform, 8ali<^'lio add, silicj'late of sodiuai, 
cliloriuc water, r<pirib<; of turpentine, gly<.yriiio, lu^eticaoid, bomck 
acid, chromic acid» tannic add, tiDdure of iodine, carbolkr add, 
chloTo-^KTftio and, siiid nitric acid urotbi.- m<.K<l pronijni'ni AgetU» 
employed ia tho iucal Irealmeut of puriUcat inHumuiauoD of tbd, 
ear- 
Then^ iM too niudi rontiiie work in the use of tli*^in in cveiy- 
body's practice, and a reform in tliis direction is greatly needed. 

Tbe sclcciion of the mwl vnitablc topical ieiui.tlv for a given 
ai»t iit not eaf^y, because of the absence of exfici obserratiotu of 
diBtsiMxl conditions, and the dfectH ubicli individiial subriAiicei 
bavc u]K>n them. 

Lovul applicaciorw are imde to a aiippnrating t)-m|uiDuia Id 
astringe rehixed tiAaue, to destroy morbid aiid uD^ltrviLalixecI 
growlbsj to dimiuish the discharge, to sticuulate to btaltby acboo, 
to have an unti^ptii; infliienoc, and, through most or all of thoff 
eBect0, to fas'or and Iiafiten tbe curative pTX)ceB&. 

The agents thzit have proved nir)»t efticient in bringing iboat^ 
these re&tilta have been enumerated above, and 1 Uiall mm uj lu 
indicate a» well &« I can front the data at my disposal, the guiding 
principles of telec^tion. 

It is liie prevailing opinion of aura! Mirgeons, that the veg^^ 
table BdtringeiiUt are foT inferior to tlie mineral, in AuppumtJua < 
the tympanum, and the latter will be first considered. 



CBR05IC PUBULIKT TXrLAMUATTO!T OF TXMfATSVV, 249 

Oillen mill, "asctringfnljt prrHluco contnuHion mid coikdonn- 
tioD of the soft solicb, and Iherehy inerea^ Their density and n»* 
lusaon/* Boorfiaave mU, ** they cau^e thu psirietefi of the blood- 
voneJa to fl)>pro«?h one aiiofher, c\<m th^se tube* when open, in- 
cn^wt* the istrpn^h and rigidity of the fibres, and restore ^niuiess 
to relaxe<l tbwje^.^ 

WhHi the atonio condition of the mocous membrane of the 
middle onr in dironic suppnmtion is rovicwvd, it t« i*vidcnt that 
theeffiwtBof ii&triai^ntfl described in these ivro masterly dt:'E)iii- 
tions sne jiut the oxMt^ desirable to bring aboiii in liie morbitl 
tiffiuoft; ftod, that, inducing tliefio, BU(.'h a trdn of salutary oolla^* 
qoencea will ru1Ii>vVf fJiiil tlict pcilieat will he put upon tlio high 
romi to recovery. 

An >fttringi>iit then i:^ oHen o Atnf q\t4 nfnif huL which one of 
Uio Ruuiy ofTirvfl i« t)jc qwi^iio rtxaku Th^re arc ifomc other local 
agents beside n>^lringi;nte lli^Lt iire r>f ti><e, 

An4w«>r» to some of the queries of auml practice may be found 
below, ami it i:» to be iKtped, ihat olo^ obaen'ttion will evoori in- 
cr«iiie the d»<a which I prc«;nt. 

AlHiMtTK \a slightly antiprcptic, agtringeut, sciiDulaiit, irritaot, 
tioor Mnuiiitic, necorilinE; uh it UumhI. Il i* ii'>l^pliftr[> iu \\ji 

ion d« zino, but !« more adive ibat lcad> Il b con&idered 
auttsjiajinjodic, aitd roiglit prove ti^iil, wht*ii the teniwr tym|iaoi 
mii^leaotit im^xulnrly. In hcmi'rrrlmKt% u Fatiinitcil dilution or 
Ifae crude powder <{iiiokIy arrcitii ^u anltnary flow of Moth), il8 it 
\ II strong htyplie, Tliv alumen cxi^iccatum, or dried burnt aUim, 
is a mild man^;eAble i^auiitic, and qni<;kly dertroys granulalionA 
in the tynigmiium. It ^houhl l.v blown iipr>n thcdiEicn%<l surface 
by an ict^ufElator. A piece of rubber ttibiii^ wilh a mouthpiece 
at onv end oik) a cut y^M^ quill, a hard rubber or itlaw tube ut 
(he ntiRr t« very lisfidy ; :i Inrj^e Eu»tucliiarj eathoter will answer 
tiic p>ir|«»*c 'v^Tv well ; but llit powder-bluwcr figured elsewhere 
is the best instrument for Uie purpoM* 

Tbi-"* ri-:mily i>* *»ilnbli- in nw; (T litr^i' perroratiiin* in llic 
meinbrsne; cxubemiit Habby (^nuiLtlutinns in t-he tyni[*aiiuiii ; a 
pale vtiuditioa of ilie tmicouji nicmbruie with, perkaii^ ulani^ 

17 



3«0 



TDK HTMAN lAB AND 1» DtBBASBS. 



tion; ahsenc<e of hyponrmiii omliKiiD; ii copious diMJmrge of foiM 
nuK'opiis anti a general atonio siaie of Oie parts. 

If ther^ is evHeiiceof eomulembl^ ]rriuuio»,uJmn should tioc^ 
be uiwilf HH it Axdt«s inflttrnmatioii readily, and b m\d to 
fiirniiHc^ in the cartild^inuua poriion of tlw audirory uiaal. If 
doziidoti action Li di^ired, a ^rflin <»r (wo of the crude ))Oi>rd«r^ 
may iw blown iuto tbe lympamitn twice or tliree tiiiw« a tt-eeV, « 
a tiutiamled ^alutioii can he iu^tilli^l <mi(*o u day. Bctmx-u vwli 
atid rt>r ^rttrrul use al bonu', n solution f>r five to Ufi ^liu 
ihefiattto a fluid ottnee of vrat^r diould be us^ momiDg 
evening after t^irefitlly cleansing iha mr, 

Borftcic Aci<i. — This acid U prepared from 1>oras, a bit 
of sodium, by ii\«tiiig a hot w>liirion with MilpUurw w¥i. Thai 
product is various sii^ed white cryMahf whkh have the fed of 
Boapt^tone. Tl>cy tdiould bo (miA'dered for ii^e in ll»c emdo 
bnt this i^ Dot ncocw^r}' ri>r tnlulions, 

The fashion of the hour is to aiwribe nearly every diivtiw ta 
the genomtion and laultiplicAtioii of baetorin, and, fu boracic Acnl 
hoH iJte prik|)erly of a hacteriaeide, ibc proft^erion h^ bocomv 
eitr&vagant in Its new -and praise?^ just a& il wuf^ ten years ago 
about cnrbfjiicadd, I am not a MJever in the [Mirasitic origiai 
of eoosiiiulioiml dl^t^Hi^, aud, iherefoiv^ so'iitini^ (he action ' 
M^-calknl pant^itiridt? rcmnliw wirh unbiaiH^^I jiid);fin*nt, 

Boracio acid in deter^nt, antiphlogistic, and anti'feptie, and is 
lart^i'ly umxl in a crude :ftntc lo puniU-nl iiillamiaiiiinn of tir 
middle ear. It is applied to the cleaned dift^isod mucou§ mem- 
bmnk*by the j^owdcr-blower, and it %» a^omary lo fill fJie wbob 
tympniHiiu with it. The meatus should be elwed with cotti 
and the c.ir rt^main in tttUfi quo until ib^-re i,'^ cvideiioc of ' 
presence of purulent products, wben the parw mitet be el 
liiomuphly apur)^ and the p<>wder be reapiiliftl The mH IS 
iilfio, uHeil in a solution of from ten j^rain^ to >atun[itioD, as & de* 
t<'i^nt rtnli'*t-ptiu wash of *xini*idend>le valoe. 

The crude |Kiwder is indicated wben tbe miR-oun meiubraDcj 
amooth, reddentji), and .si^*n'ti\4 a moilerate ipuintity of Inrtll? 
amellin^ pus. The membrane is not granular or related, btt 
Hcema much congi^^teil and thri^alening periotUiti& Tbe tempiT- 



CHR05I0 PURDLEIIT IKPLAMUATIOSI Or TTUPAXCM. 2SI 

atufe of tJie cj|vU]r will be louiul above Mcmk] Ii«a1, |1i« flemitivc*- 
I incrfn^f and paio frequenl, o«|>ecially at night. 

The ("oiwliiion oliwcly ii^pmtimittt^ Ibiit ix^iuiring iiitniti! of 
silver. There is not w> much paiu on couUcc aa witJi the silver, 
ftiid tlu* niicouA jnetnUnino j^ 8iaooihcT, 

SoUtione of the acid are valuable for cleausing and antiseptio 
pfir|MWW, before tho iim> of otiier tm^re iH<ti\*e ugt^iH^, In |»urtiii-iit 
iDdammalion of the tympaniini, mastoid cIi»«eaM?« and rsirm of ibe 
tompnrvl Ihkkv The vrvak i^alnliom arcr I^Micfiml urut <'\t*it t^im- 
tive for mild degrees of ninccus inliatiiniMion, but both wlntioiia 
Aod the oiide poirdtr have provnl m'c\>ii4lai7 to otlit-r n,'iTHslii.<^ 
in my pniciice, 

i^xtif^tt of Zinc vi a^riiij^^Ht, irritant and rtyptia It in more 
active than alum, and suitable for purulent inflaromatton of the 
CHrin ^Tfnk eDn?>titiilionft; wlit^n tliciv is an fitonio oi)n(lili<vn of 
the middle *ftr; the rmicons mpnobraiKJ in pito, covered by pale, 
easily blucding gTunnlstii>i]^ an'l, ]>crljap«, oik- or two jKilypi ; it 
ffhowa a s|x>t or two of inrli.>Ient tilc<emtioi), nml considerable 
m uco-| 111 ni lent diach^iri^. The rcmcilv f^liould be Uftvl in (>o1u- 
liona of tvro 1o five grains* lo n fluid ounce of water, irt^tillcxl in 
the ear once or twiee daily. 

Sufphntc of fhpprr^ v^nuh; \9 n mild f^ustio, but i» mroly iiM*d 
IV such in the ear. In ^littion^ it b con^dered an a^lrinijeiit 
tonic to the mueoui^ membruni.-, nither monr irritant than xinc 
fiuljdiKtt^ It has decided anlispaflmodic t^ualitij^, wliich make it 
iipplicubic to cuppnratious of tho ear, aocom|>aiiicd by «pfu«aio(lif; 
nnion of iho ryinjianic, throat or fmrial iim'^clea. Il it^ suitable 
for the atoQte, gmonlKr and ulctnit^xl phu#cff dc«eribcd uiider 
RDi^ «epecially, when there i» cnries or necrosB of the tempoml 



It 19 ased in Aoluliona of two to livfr f^ins to the fluid onn<^ 
nf wiiti*r, <m€-f! or twinp a dn\\ atid mtisf, In* wnsln.**! oft' ih*^ mtviiiH 
by simple vmter s^ it is apt to discolor the skin wimcwhat, 

II may be ent|kloyrtl ax an intemirrent Applimtion with grt-At 
Aidrftntaf^, where other reruHhe^ r^ecni Co have little eflccL After 
U* iiMc, tW cnnni U mtm^^tmt^ of a blnivli tirge. 

ArHnt^ of l^ftut » a mild a^tring^nt of ooofflderable valtie 
in ftorac c!tL4«. It ih ^>dativ«« nnd cooling, awl joat thi* thin^ for 



S62 



rnC 0UUAN HAR AKI> IT6 1M31A8E3. 



diroDio punitcrnt otitic with onn^iicruMe bfac, hypcra^miii, nnd 
fn-()i]t<iit pAins. It i? Cipi^^inlly useful during xctitc* exAoerfai' 
ticas ^'^'^ ^^y ^ ^^ At ^^J atik^ of iDflAiiimalMMi willi benefit- 

Nifnxtf of Laid is prcf«niljl« for oiu?v« vririi ulccraiion and f«y 
ofi(-mive di^bai^, a^^ it unites with the eiitli>hur of BulphufvtlHl 
bjfdrogcn, deo<>m|>iV4» th«r ^l*, and demlurifci^ the muco-pus. 

Both tli«^ salts are employed in boIiuIoos of from two to tec 
j^iD» Co tbe Ouiil otince of wnt^r, twice a day, bttt should not 
belong contintifxl, m the lead Is prone to unite with tlif &lbua>en 
of the ttAniie^ and fgrm an irrcmediahlo cnthttiif;, n« vhvn Applkd 
to 0O]ution« kX coDtinuity in the comoa. AAer an inslillalioci, 
the tympaTiitm Uiok» white, but it itoon becomi^ durkor fnmi the 
formation of ]eud sulphide. 

Solution of Su&»ulj}haie of Inm U An aqiu-ong Mhition of (he 
iron, employed ooc^iuionnlly a^ an nvf rint^nt, styptic and cauteianL 
In a pure Btate, it \» soeond only la Mon-^elt's 8;ill n» a becraiAftatk 
in hemorrhage. It stimulatos and tone« up an aid siippurating 
niucoufi Burfaee, ftn4t deatroye granuUtions and polypi in a re* 
nuirkab!« manner, 

III !^mrriou?« jHitientM, having Huhhy grun jIutioaM and the oofhr 
polypi in the tympanuTn» the rem^y in full strength should be 
in^lilhH) or upplicd upon i^rttoii lo iIk* growths oac« a lUy. A 
few applications will fre<picntly aiuw them to ahrink op and 
di^ppear, the mtir?ouf4 nieinbmne at tlie ^nr to lieeonae i^mootbtf 
and lLoallhicr,and thus favor the <'imili\*i.-proceM, Active hypier- 
£&inla eontra-iadicatds \U use^ ns it is somewhat irritant, hut dork 
paMtvc C(>agi*4tiou !» a symptom demanding it. After its appli< 
ention tho tymixinum Wk^ green i*ih-hpo^Tn or likrk. Itj» tt« 
iniij^t bo wutohcilt as jt U likely t<^ form iron cru«t0 and mflKHtf of 
ooagiilated pug and fibrin. 

IfiinUe of SUvrt' is >tyj>tie, but i» rarely u»«l for that quollti. 
It U aftringentf slimLilanl, allerotive, anti^ptle, aiitijdih>^Utk' 
and eauB^c, a^x^rirdinj^ n» It ix emplim^l. The remitly >shuul3 
never be u»ed in the ear in ltd crude state, but in «olnlit»ci$ 
of various Ha'n)jrth>. It nuMct^ linU^ pAin, m1« qiiita saiH^rRriallv, 
as it IS deoompo^ by the ti^ues with which it oomes iu Lx>ri1aa, 
and may l)e ni^i with advnutii^e nml i^ifcty in any Htaffc of in* 
6animalion. It hafl a juirciaitar affinity for morbid tissue, wbidi 



CffROKlC fDltOLBVT I!VPLAHUATIQK OP TIMPAXUH. 253 

it dtttro^'s, IcftviQg th« liealthicr imnm aroutid aad bcncatli. 
Thnteare slimiilatM, cicftiiscd, mid altered to a lielier Male of 
niitrition by th« action of clii' silver salt, sp^ily tiikf; on n 
healtbier acfiot), and re|irur aity daninge to tlieir eantinuity. 

A profuse fDiico-i>Qru]eat diwhai^ from ibi* tympanic mucous 
membnuie, with or witlmnt uloenktion ; tlie presence of grauuU- 
tiona or ^mall polyp]; a cx^tiditioti of Iiy|K.'ntmiiif with 0(<cu»ioQal 
pain, Uir«at«iiiDg at^ute exacerbation ; a ^roit deal of painful st^- 
ail^itily on <x>nt:tpt, and^ i!fi|Kciully, c^^o^ t}i3t do Dot improvo 
und^r otU*?r apiiik-ation?^ require nitrate of mlver, 

Tlicir arr aurif^ls, who lisc tim rvnicdy for any and even" oiwo 
of purulent in^ammalion of tlie tympauura : bill as fiome other 
tuitlieiD^v aJniuIy tutnltoncd cure <u»ilyr and Hi'\» it li^iblf (o T^uin 
the aurick of the patient and the handa of ihe cperator, it should 
only be reKtnvtl to, whc*D it* special syiitptouis are pr«deiu or 
other agents fail. 

The fused Mick nttnitc is impure, and the <rryfttiili* «hotdd b© 
employc-d^ dissolved for ohvions reasotw in pure distilled water. 

Ta on) ill ary ca^^, a solution of live to ten grains of the ftaU to a 
fiuid ounce of water is sufficiently strong, but when the diseo^ 

I oxisted a long tjroe, and the tij«u« arc profoundly altered, 
Iwentj' to forty f^rains to the ounce or a saturated sohition ccay 
tw i»eeebL«ry. \"ery fjivor^blo reports nf tliv action of ilte »tn>ii>^r 
solutiocu have been made by reliable physjciana. There la dan- 
ger of pamlyi^tH of die faciiil nLT\N; with thǤe stron); ^IniionB 
^when carieB exists, and cbey should tlien 1>e used eauliou&ly upon 

Iton or n<Jt ut all. 

The applicalion should not he intrustwl to the patient or hta 
^fricndn, but b*' made by the ph>'^iciun hiin^lf^ every ibiy for llio 
mild ^diitton^^ au<l every second or tiurd day for die Btronj^r 
ooce. 

After clcnni^nir ihorouglily, the Kjliitinn fihoiild be put in llw 
car with a dropper, and utfUtralized in a ftwminuloB by a syringe 
itrcam of mild fialt {twlium chloridnm) and water, m thjit tlw 
luriclo vill nut boLHjme stained. 

This need not be tliruwn into llie tympanam, bat played u]x>ti 
tlic ni«atu«, A> n» to unite with the ^h<er solutioQp as t)>e Inad 
ii incliocd and it flowa into a bowl or other rooeptacle. Uokaa 



254 



TDl HUMAN BAft AHD ITS LUSEASSS. 



this is done, the sulcus and lol>e of the auricle will be itimd 
browu in a few hours^ and Ute paUent w\\\ \}e justly iodtgnint, 
oepccially if a lady, 

Ac the time of nppliaition, the patienl will experience a ivirm 
emurting sensntion m the onr, ami If the E'lstaA-'hiiiti tlllri^ i^ per* 
viou^ may have an acrid taMe froca leakage into the pbarynr. 
I have hail u [mttcnt immedmleh' <lro|} lliC bead forwurd ind 
blow a drop or two from rhe na^o, getting thereby a disagreeabk 
oliicUyry w.*n«Ltinri and a MniiiL*d hundkerrhit-f. 

If the tyinpaiJum Ije exaniint'd atVer instillation ^^f the remedy, 
it will ?<hovr n ^v^ite coat of ihc cliloridc or albnininnte of itilrer* 
Thif* iuTu^ brown and th^n blac-lc ia a few hours fruro the fortnft- 
tiun cjf uxifle of ^silvcr^ an<l inuM not Ix? taUlnkeii for nvipiM pio*j 
dQ£!tA, or an aceii inula tion of eerumen, 

PerjnanffonaU of Po(amum if* n remedy of mndi valiw In 
dironie ftuppumtion of tlie car. It dtiisolve^ punileut inaaF«a, 
deodorize and diiinfecto fetid di«^har^;ui;, e1flinw«;and jw<jlhefttb4 
niueoi]8 menibnine, KtiiEiukli-ri tihwraltd Autfacv^ oiid faviirs and 
hasteni^ a cure. It is equally applicable to catarrh of the oucwand 
pharynx, and is exc^ellent in oztnia. 

In ordinary ca»ea nf 8uppomlioo in ibe tvnipnuni, a Mdiilion i 
often to Iwenly E^minif to the flnid winrr of water »» it^inircd. 
onoe or twice daily, A tendency of tlie discltarKe to form fii^lat-j 
incus lump aii<l '<tnn|T>' tiflbmive niu;«9t^, and tlic pru^^ncc of i 
foi]l odor coll for ibifl Halt once or twire a day. 

loiioforia hw^ won u d<!#crved repntntion for ill-oonditiode 
uleer^ in other partA of the bcnly, and is ±»oinewhnt l^etM^tWial in^ 
th€ dieetiM.' und«r eon^^ldenition. It tft tiou-irritunt, aiue^thetic* 
anodyne, alterative and disinfecting, and niny be tri«fl in olvti* 
natc ca«4», wbvrc other ngi'nt* have failtiL 

The flyraptonm demanding it are, pale mucous niembmno! with^ 
granulations; weak, indolent gray nlevmtion: a fetid dindiargeDr' 
light-colored pue, and a scrofidous i-on*<iirution. 'fl>e frudr pow- 
der or a mixture of equal parte of iodoform and tannic acid nuy 
l>e blown upon the diseased sarface onee a day, and peraiined In 
remain until tlie aext sj*ringing. 

Tan^ia At^ifi m a v^tahle aiitnngent, Rometimes reroninM^ndrtl < 
for mppnniting '.^u[>. It ik irritating, bulky, dirty, and, aom^ 



say, nonrly inert for puniknt cai^eH, It might h^ untsA s# aii inter*- 
ciirn.-nt rvnitxlv, in oWtinalc atev*, in solutions of ten to twenly 
grains to a fluid ouiioie of vraler. lu powilcr or fuitumtiHl f^olu^ 
ticw, it i« UD oxix*1lcnt i^typtic. jir^^R'nibk to iroo to arreei hemor- 
rhage aAer polypiiii extmc-iioD, caries of tlie temjiorQ] bone, ati<) 
other fcviop^ 

Ilaritaniefy and Hytradm owe their a^lrtng&nt virtiiuA to the 
tannic? ackl they coutnin ; they am inliTiar to the pure sub- 
stance, ami I wHiId not rocoinnieixl tlieni fi^r 1>>cilI ajtfilicittiom^. 

Ateohf)l \if antijM^ptic^ iUftritig^nt un<l stimulattDg, and exGrcifi«« 
a curativf} iiiflnctue upon flahtfy irmniilaLioiit luu] alcvtativi* pro- 
CC9MH. It whili^n« the ^mntilation^, constringps the tissitfis and 
voBelft, ccicii;titjL(e^ tht: Noik), utid intcrrupljf tliv iTtar1)i<l proccM, 

Granulations and mu<«u*i polypi soon fihnnk and disappiar 
umleriLaapi>lict&hi>n, and fibrottsfrrvwlh^, tlvuigh Diurv olMlttiate, 
are frequently defltroyed, Sei'cral weeks or monlhs will be ne- 
ocawrr to n-RloR' tJnr nun'oii* mendiranc to a henltJiy conditioii 
and to effect a cure. It m applied ililitei and even pure. 

lodhtrM K»mrtinK>:' U'^-fol inn ^mniilur, in:i>^t!vr srnti' of Mk lyni- 
paaic nienihmiie, ncofim|tanie<l by nwollen lymplialit^ j^lands, ;uid a 
fftnimous cnnstiEutton. I itm a eolittion, 03ntainiit^ iodinr.' twenty 
grains, ioilid^' of prtivt^ium twc[ilyg;ruin.sitiul^tyrx'rmei'ony^itk.4. 
This m caustic, and should Ixt appli^l to gran u hit iutiH by u cumel* 
hair hnish cr a rottoned holder, and wa>^iked away in five minutea 
by a syriQgefnl of water. Add an equal quantity of water to thin 
formula, and ihi- flnid m\\ I>e suitable for Instillation, and stiniu- 
latton of rho mucous lining of llic tympannm, EusUichian tube, 
sod tbmat. Iixline solution should be uKed cantiously in the 
tymitanum, &» the \*apor i>^ very ticiictmting and aliraulatio^ and 
niay exi-ite ac«tc ejcawrhalions. 

I BocnHiDit'e «pray the iiu<lille ear with twrnh- drofM of lite iin- 
diloU-d wixuire to a fluid ounce of waler, and ibink I have i^en 
benefit fronj it^ u*e- Even' oOicr ilay ir^ ofieji enough tu nitiko 
lue of any of these iiidine soliitions. 

Spiritit nf Titrjtcntinr w n nip nisien tali ve at the lia!AanL<^ ami like 
all of them has an anti^ptic, fitimulating, and sanitary tuRuenoQ 
Qpnn the niui^iH membrant^ Ten to twenty niinini-^ in a fluid 
ounee of water, instilled into a cleansed but chronieally suppu- 



256 



TBI flrUAV BAR AFD TTB mBtASSC. 



ndng t/fnpanum^ with blui^i vonom cnng«#iEon, will d«stro;r ilte 
fvtoT. diminish (he puniknt dittcharne, and Btiiuulale ilic «i)rboci 
to iK^lllik^r urticii. Kernel wrfHe, " Trrrhinihinn mfrftieif^ m^Bk^ 
diveutit, (ergU^ txpurgai; olMfiAcixQui!^ toUU, <t angtutos mrahu 

Salicylic acid, salicylate of Kodiam^ cblorine*water, gimrioe 
and lUAuy other reinetli<« are |)mi^*d forUieir virtues lu piiruleot 
cMJti«y but ilieir qualities are known by all phyeidanf, tlM'^ir value 
id aecondary to the iLp-nU already viiutn^rmi'M), and I t^iall not 
conaiider them furtlier in this councctiuii. 



Tbc tympfmum and auditory canal Ijavin^ been cleannd by 
lEijectioas and aborbc^iil ix>ttoD iiputi ilie bokktr, aihl Uie Kii»- 
(nebiaa tul)«; ckuivd by a strong inflation^ the n^mviliu 1 hare 
ju^t QRiffioiiod uv&y be intnxltKed, if fluid by tlie syringe, a ten- 
tipoi^u or a dro|i]K'r, 

Tuck a towel c\(xe around the ncok of ihe |xitient, orer the 
^huuklorof Ihe sidu Ibut is Imng tmili^d, incline tb€ patitnt's 
h«ad towards tbt op{Kbiitc hlionhb-r and put in Ihi^ M>liitiotL Ijst 
UiG patient keep quiet and retain the reoiedy for five minutcb at 
IvoMf and prKtRs: Val»{ulva'» iuflatiun onuv or wim to favtir 
the ])u«Rigc of the [liiid mio and tlirough the KaBtaohian tube. 
If llie patumt ciuinLJt open the (ube^ itM llic ai^bn]; without or 
with thv (^theter. 

Tl^n nt thi- <'Vpirntion of tbc tinii^, pbio:* a injp uiiilcr the af- 
fected ear, bend the palieot*fl head towaitU it, cali-b Ihe outward 
flow, atid dry the meatus, auricle and nock with tlic towel. 

Wbcit one ii^oa nitrate of silver, the aeutraltJiiag «ft]t eolotioii 
ii" to l)u thrown upuu the Iuwxt wall of ihts uitslus, as H\q pa- 
tient alters the iKnition of the head, and a warm douche ought 
to be UBe<l aHerwarils to remove tiie white ooe^uhitn of eidwde 
of silver. This tn^tmeut, cx<^y.'pt diut with nilmtc of silver 
and the air-lM^^, should he tuiight to the juticat'e A^t<atil or 
uun^, and bo followed closely at home. Inflntioa \yy Vabalva'a 
method sboulil be inBtstetl upon every time the in-^tilhition of the 
astringent iif nntde, a» it i;li'-ani^C5 the Ku^taibtou tuU', drives the 
pus outwardt^r and jicrmits the mediciae to reueb iIk* diMvuc ai<tni 
ihorougHly. 



OBB09EC PtrnrtSNT iXrtAMMATIOK OP TT1IP&KI7M. 



(>nc or two drewiagiidiuly will aoc^omplb^i aJI Uiegood of hnlf 
A xloneUf becaiii<e reai^ioti ia th« ti^uo^ must be ostiibliffJiod !>v* 
twoeii time*. Tlic uj»c of pawdi-f^ Iiil^ ]>e(tn de^ribed mider atu- 
tntn, d ^, The syrmging, cleanHofr^ nnJ nKditntion mn^t dt* 
ininUh jmiW /matu with lhf» di^ii^, until one trfalmeni a dn^, tiii« 
in two da}*5, and finally ilropping iu the i»i*Uidn« alone ever^ 
olh<^r day will t)e MiJlirmit, 

AnoUior method of Ireatment boB ixvroe into fuvor of Into for 
those GOM^. whii h taii vi«it th«- aumt once or twice a day* It 
torny be called tlj« dry tfEatment, and C'omipiU iii rlniii^ing lh« 
car thoroughly with tiaft iiRinr tuA of ah«orlKaU eollon, and the 
a[»f>l tout ion of medicated cotton, or tlie u^uiil m^Klimted soluttoDt 
or powderaaiit^manift. 

Thin makctf nmcli work for tlie phyeifrinn tuitl larger fee*, but 
ID my opinirm ]]ah no mlvaritiigt- over U«c net method. It id 
vt-ry difliinilt, not To my Tm|H^ibic, U> chtm a suppurating var 
(liorouj^ldy with eotcon ])ledyeLs and iV-w patient^) van endure the 
fieoeiaarily cl<tte wiping of thu hy|H.TH'n«itivc lympnniun. I 
have tried the innr>;^lIon and abandoned it, except in peculiar 
ca^H^f iLc of doiiblfu) utility, and throw the biuMcn of pnjof of 
il5 superiority U]M>n itn cntbiwiiiKtic votwrio:-, 

Tbiav tfi no proof that u>oilerate Kynn^cin^of asuppurstiDg 

' to get rid of ll)« piiH and ^\v\^rh jncrv.iM.?^ tliv di«<ftM one iota ; 
on tlie contrary^ long experi«ne« approvef this method of cl^us- 
in^, and it \» c^hninlT ]cr« irritnlinp to the miicon^ inntibmne 
than dry wiping. Probjibly the rigidly dry nielhod will in lh« 
fattire he nientiuoed a^^a c*nrioHity, art an> now th^- aural di>ucli<4 
fOf B pailful of water at a time^ ntt^jmrnendod by Itard, 

WhcD the ^eeretion of xlw tympanic mucous lininjc has been 

hreotored to nearly a nomiul f^nnliLion, eflorlii nm^t \je made to 

lAlowe thf |)€rfonittonf a& detailed under injurivs of (be ni4rnibinna 

tympani; or failing in thl'i, an artifiviat dnim*bcad nniy b« ad- 

ju«tt?cl to the peripheric remains of the menibrane, or to th^ iimer 

of the caaal, aa direcled under artiftc-ial m<-mbnum tymimni, 

to which the reader ia raferriHl. 

Wiieii a^uppurotion has been arrefited, the ear will prevent one 
of the three following conditions: 




208 THE HCHA?: lAR tlTI> ITS DISKASBS. 

• 

1 . llie meinliraiia may l)e I'lcAecl hy a ciontrix, aod the muixtiii 
ntcmtinin(> of tht^ tymitAunm be hcaltby. 

2. The nembnine mnyr«bowa jtmall or mvftmm |>orfonttioB, 
nm\ ibc mucous mt^mbratic bo a IJllle bj-penemic aud moistcr 
tlian imiuL 

^ There mny Wu br^'pcrJ(>rfltioii,anfl the mucou? ittembnne 
loob pale, thick, ami dry from an 4-xU;ii^toD of tli€ eitiiteium i>f 
tilt canfti into iht* (ynipai)um. so that the liniog is wry miKh liko 
tii« skill. Thit< (terruio tnm^formaEioii kh (.'■m^'idrnilth' )»rr>ir<!tioii 
nguiiift future attacks oi supjmraiive inthinimAtion, and laldy 
attfrrnptt^ hiiw bt^-n nisdo lo induce thi?« cbaii}<t^' by phoing ff^RE 
of skin u[iiin thegmnitliir miuxiiiK nutmbninc. 

There are Reveral iiHds employed for cnuleriKing po' 
wtiirh ituy aft well he mei)tii>iied in this placer* Tbv}* arc iu?edcv 
ohromio, carbolic, cbkiro-a^^lm urnl nitric AoiiL< 

^cf'io Acid ifi cooling, astringent, etimulatingj nod oiustic; 
it lias a destructive acliou tipnti ntorUul liN^uffi, and an aflSnily 
for the wllubir stnictur^ of mali;jnant growths It dom not 
cairM> iiiiifh jHiin, but is not tisvt\ iv^ mtich na formerly, 

Nii^'w Acid is a severe oiiistic, caiustng dp<^p, persistpnt ulccrm- 
tioti uiul M'vcn? pain. It dCT=troyfi jTmntilation* nnd pulypi mpidlyj 
iti thought ii> cxt^rci-^e a tnnie inRuenre iipn t^tirroiindiDg li»4t«t 
but niui^t bi* {}i*nl Mpunnglv, and fhoM aU-uyi^ be nei]tr?lij:ed by 
a sahiiion of the hydmle or mrUiimle of jwtaAfiium. 

Vli!oro'<iMi'* Aart haj* all lb<r vjrtin^ of uodH^ arid, i* rather 
mor«^ antiseptic, and oauafs only slifzht and tmnfient pain, quii^kly 
n*movcd by an iiyMion of wunn waltT, It Ua favorite a^^cnt 
for tilt- defiCnicfioa of i^ranulatioriA ami soft (»oIypi in tl»e car. 

Otrbolie A(^ul \ms not btrii <'mplm-«id in tympanic MippUTBtioR 
m much a« its merit demands. It is 6timiilatinfC, 6troiij:lj auu*- 
septio ami di^j^ijifi^ctnnt, cuiir^it Uk-h] hmt^hva^, ami is. in n^ 
opinK>n, the very best of thi^ group of i<omef)iea for csuteriiEini; 
fungous ;;mnnlationf^ and »oft polypi. I utw tbtf puredeliqu 
crj-HtaU on cotton for lids purp<t-e, inject warm water anerwiutlt« 
atnl dry tint ilie <-4r <«n:fully. 

It should have the prHmnirc ia all caaca acvvmipaakd bjr 
fiinl uJor, aad by caries or necrosis, and may be employed with 



I 



CDftONfC PORlILK!CT IVFtA»U ATIOIT OF TTVPIVCTM. 

AdvaiiUigQ 8fi a daily cleansing injection^ id iho proportion of live 
toiDims lo a fltiid oiince of wAter. 'I'lie pun^ acid is, also, an 
agreeable, maoagoabk, efbciait afpunt with which to irritate or 
b]i>(tcr llie ftitfiKi' of the ttiit^tcml proi^^, if an exigency aljoiild 
lo domaml ihia procedure. 
Chromic Add i$ a uion* |H)Wi*rfiil <schumtio tlntn Any nf ihoite 
menticHied. It ib slow, deep, and pcrvi^ttint in actioo, and jii^tty 
htt« till- prcfvrcfK?c for the di^^lruction of dense, filjrf>id polypi, or 
tli*ir ronlfl reamiiiiiig alrcr alisciwiion. A few orvstat-i ami a few 
drops of w^I<^r, or nlnnif ont? ptirt r>f tliv iidd lo four of water, 
give a t^iiituMo Holution for rant^ri7utii>n, Th^ morbid growthn 
alone .^honld reo^iv* ifu^ i^iiMtii- ; the ai-tlon idii^lI Im? uiif^'fi^y) 
and the jkHd inMitralucd by a hvdratc of j^jta^iuin or carbonate 
[>r iiotliiiin Aoltilioii, when it Ii&h gone far i^ioiif^b. BLirnctt. ^y^f 
** Under no otiiir applinition dtx^ thu rcmTinnl of iW pL-dicle of 
a ]3ol}'pii9 disappear no atir^ly and 8o rapidly/* 



iUtJI 

Km 



The fiielliod of applyiit|r rhe^^ pow*'rful reincdl*** in to twi^tt 
a email tuft of nbrarbcnl cotton upon the end of n rfiii^hened 
silver pn>l>e, am) rimkr n niiniutiirt* brii^h ; the bnisti purl i^hould 
be about fonr millimeters in length titul diameter. Dip thiA into 
Ibe add and prcw the surplus out upon the itcck of the lx>ttTer or 
upon a liny dish, then under goo<l illu(uinalir>!] with (he head 
mirror and nibbcr n^Kruliim, touch tbe dL*casf<J pljKHr fimily aikI 
lOVe d>e probe. This should l>e done twice nr three times a 
«k for gnuiulutioii-s, but in wiw? of polypi or their remairm, the 

ration sl»ould be perfornkcd everj day. Between timed, a 
pled^t ef cotton »licn)d be kept in the m^Uu!; to catch tbe drain, 
and a simple u^roi douche emplov^t to n>niove pun nnd debris. 

When ihu caustic i* no lonj^T nw*i'«*iiry, ihe awlrini^nt i^ttinu- 
lanta flbculd \te commenced and continued till > cure n>hult». 
TiffiH^M f>ct accu«b>mf^ to a rcrnt^dy after proloik^^ use, and it is 
well to change to another and a;iot[i<^r, till ihe proper orn^ fan'». 
The «tAte of the liaiuc>i will be a ^uidc to the selection. The 
tooclilnganil medicafjon should l>e iliminishetl gra^lunlly iu4 ihts 
diseaae dsappuan. 

Tbe |>f«8enceof trrannlationsof moderate si»e upon the muooui) 
membrane of the di^tnwMl tymjiafiuin is not a complication of tbe 



260 



TttR HDUAEf tAA Jk»D ITS DIS1A8EA, 



disease, bat an ordinary eonramilant, and will itot bo gircn & 
^icoia) divi^^tuii, Xh^^ granulation:* vury iu ili*n»iiy tuk! fnn, 
and predii^|)06e to the fommdon of polypi by iocitaaJBg tlie qou* 
tity of tlhsc'lmrgc 

Xhty miiy be so solid, that wiping tb^m with a bird coKmri 
probe wjtl merely P.HUk'» ibein; or m »oUy mocnhin, aod tsa- 
miMT, that ihej- will bleed frwiy from mere UHKhing. Hit 
former will ri'r|uirv Uie Wronger npplk'utioiiA fttid ibe latter the 
wi^kor, Sonictimct one application will destroy tbeni, but prti- 
erally coufsidvnible In^tmcrit with botb a twitftio np(ili<ntio» am! 
an ai^trtiigent ^vadi will be netx^teary, Tbe clearer tlie lyinjiaoum 
19 kcpi «f pn» III? wotitT tfacr will vnnir^h. 

I fiitve ipr^iJ^U1l Lt[>oti inllution Uforv und during tlio dmsiags 
of the ear by the physi<^ian and by the patient, id order to drivt 
all of titr jm^ out of the Eu^tncbiAii lube iirid lymjuiiiuin, and to 
permit tbe tlow of the medicated Mlution into ilw ttibc and 
pliarynx, Thia* happeiut in a majority of the cases, lliough the 
flow of pus tbrougb to tbe tliroat is rare. When tbe air [ttwe» 
Uirough the 1ul>c with dilliculty, or nut at all, th« fuedtcti>e ought 
to reicji the tubal lining. 

To effect thin, eleau ihe tympnoum, inlroJocc n rubber stopper 
closely info the nietiluM, hjivinj; a perforation ir tbe centre for the 
Uffzzh of tlie hand M'ringe ; fill the tvrinRf with *alt walor, [iroas 
it lightly into tlic perfurution, iiidin^Mhe hod forwards, aju) with 
firm pTv««ure send tlie pieton homu, Tbe filter may ^pray all 
over ib^ pntioiit and lli*j <'iK'mt<*r tinless lie is careful^ but it may 
go throii);b die ttiU: to tbo tbront and drt>p or flow fVom ibe dose. 
Then U6e a little of tb^ m<Hlicated M>Iution in the same way, bat 
do not try nitrate of silver for obvioup^ reaisoni^ unl<w the Euba 
b very free, whew il should l>e droppetl inio ih^ canal ii^eide tbe 
atopper, and forcod through by a plain wao^r injection. 

AnotWr mvtb'xl iti' oloaniiig and medicalin^^ tJiv tul»l mnoooi 
membi'fmc is by injeeting through a Kiij^tachian cather«r in nltf| 
but though n]>|Hirencly *in»y\ this is really difficult, aud iwl M 
comfortable for the patient, who swallows tJic Ictkiigo from tb0 
inner end of ilie rfllJiHer. Both melbods should b© cinplo}-«d 
when tho tube is obslrudcd, and both vud» tbuA medioatnl. 

Mo^l of ibe medioited ^liitions may be u»od for the Eutt^ 



CBEO:vtC PDRtTLBHT INPLAMMATTOV 07 TTUPANUH. 



chun lube, that arc rccomoKnflix) for th^; tympuiium. In eomft 
co.'VH, 1 htivf: \wfn able to foive fluid from tlie tviii|iai)uin Uirotigh 
. tbe tul»e, auJ unable to rcvci^e tho proo.'^ thruugh iIil* catheter^ 
liougb the jKksilH^n of tJie latter in the tube n^as verified by the 
n^nul t<Hts, an^l nn in^^Kvtioi of it» itmcr vnit by ni<T\ni of a 
throat niirrtir. It id pmhablo that a relaxed mucuna mem- 
bnuiPclowl the tube, nr the force of injei^ing inio the catheter 
3(1 iM inner un<t too hnH u^imt the »id(f of the Inlie. 
Th« Irol moa^ureA oiiflinetialiove should beoonlinned ]>eraiat- 
€iitly by the physicinn, ok^jinUhJ by the- piitif^nt nnit ntteiidiinl, do 
DiUcr vilmt llje weming diih<our^m«nt. 

It will Iw diHicult to ^i thv homo tn>atnieiit done ctysttfcniti- 
cnlly, aii'l ihc jibypimii inu^t be vi^lant in finding out how bis 
orders are executed, and insist upon thorough' vork. 

A i^rf ftil diaj^uHis of thft morbid ftUit«, good jmt^imnit in rcf- 
erenoe to the selection of the local appltcatloits^ and the intelli- 
gent oo-niKrrmtion of the patient will do wondera in purnlt^it 
otitis. The hygionc of thi* ptient iind internal medication mu&t 
aot Iw fifglectfd. 

Thesorgkal treatment in a given ea^ will depenri upon the 

oouiplimtiootf, Aflcotions of the auditory canal and tymjranio 

[Humbmni; Imve been alr<<ady dLseun^^cd. OiH'mlivo pro<M*oding« 

[■for polypi) ^xeBtaseSf cnriuSf Dcc'ru»i» and miiftioid diwa^c will be 

sidered in u aeparat^ cbaplcr, under com|ili<^icionf( of pnniU*nt 

inflamTii-ition of ihe tympanum. 

Tk' hygienic and nmlical treatm«>nt munt iwvr cnpip* (he at- 
tention. The fialicnt cHight (olive in a dry non-malaria) region, 
havei^ixxl nulritioua foofi, and clothing apprx>|>ritite u> the tva* 
•on. lloinr, river, and ^^ iMlliti may Ijo taki'n In moderation, 
■bot reaction nuU Im< (>4iAbtiiihtx] by wiping Ihc bckty dry and 
red ; the hair shoTitd l>e kept ;uf dry ah pom^ible, and the ears 
should bt^ <'h«ed (emporarily by bita of cotton. This may pre* 
vent heiriag * what Hh- vrih) wave^ ore miying,' but it nill pre- 
vent caraehe. Water in ilieear lh likdy to ]a>creaw the inita- 
lion, eN{)ecially aca-wittr, and expiwunr may ^ve tbe aio$t c&ro- 
fui tjaihitr a ooryn or sore throat, which may a^ra\-a(e tlie tyni* 
panic diMnsG. iiuthi* are quite beneficial to the eeneral health* 
but ahould be indulged in with eaution, especially, if the paliciil 



362 



TflE HUHAIV EAR AHD [T6 DTSBA8S5, 



itfftnttaik' unJ putHUMvd of little reuclivo power. Warm bn&c 
Uuibn ufv more stiitad^lv to Uiia clato of )Kiifuu&. 

ScmlalouM pvr»on:f, w^-ll roiindi^i by l«l aad niuficEv, and hav- 
ing gftod appetiti' mid di^tt^tbii, improve thi^r miirol uffccUom by 
a short «t]miu(*r vieit to the «ca-«lioiv ; but the pak, thin, ynnk- 
Jlng Unda thfi water too cold, ilie winck too i^imi)^, liie dnrapoew 
ton f^rtrattp and very oflen coiiksa home with b«oltli unimpnnrvd, 
and thecardlBt-asp, ifnotft'oree, at lea?(tnr> better Tbi."*U(t':Trl«e 
do bt^i In th^ <lry. ntrrfittd atiuiMphcre of llie tuountaios, wbora bal- 
Bamic airs and deep fragrant woods soothe the nervmiei i<rstein; 
tttid stjrtitibto the miiL^miM tncitibniii«8 to bt^Lltby aclivicj. 

Cre^on Springs, I'a., is a very ealubriouB place for theso pi- 
tic-iiEjs but iUa ehiilyKnto wciter lOioukl be mkcJi, tf at all, otily 
in sQiall dosfs. The cakic mdphur water of tJie Yellow Sulphar 
SpriiiK!^, ihf trtm »Md alum watiT of Riirkliri<)pi Alum Spriuip^ 
Va,, and the sulphur water of Jleilford, Pa,, are appmprbtir lor 
«cruDiou» enr <«Mcs. 

Syphilitic, rheumatic, aod gouty imtienU oAen derive tiiaeJi 
benefit from short vinils tu Mine of the numerous flpritigs with 
vrhic^i our cotmtry b favarvHl. It ia fa^^hiorrnhfe ttiul |ift)iM?f to 
take A VBcatioQ in tlie j^ummer, and thwe patieitlfi who c^n gel 
avftLj fihotili iiot wander airuleady about, but by pby^iciati'd di* 
rectioti i-HM;k the plfta' nioi^t favorable to tJieir cure. 

The iiot Springs of Arkaoflaa have a deserved n^pulatioci in 
fivphilttu' ^jtHu-xia, whid) nitist In* reniovixi and tJic blood part- 
fled l/efore a permaueat euro of &j>ecilic aural deease <na lie e:v- 
pectcd. 

The rheiini^iticaad gouty diatJieses are f&vorably iU4^J!&ed lir 
the Maltrri of lleilford Spring; proper, of the Coii^rcH9 and Gey- 
ser, at Saratoga, H. Y., and of ^iiit (.^atherine^s VVell^ Canoda ; 
and the pW-<ijrc« of u two weeks [*ojiHirri at auy of these chana- 
iu^ places will do mon? than the watei^ to invigoiate a jatW and 
deprL^^H-<l vitiilily, and Ukim promote heullhier actio*! iit a di-4ea0ed 
niueoEis membrane, 

Mci^t <»f llitw.- iiuEKTal w^iterecttii be procured uti draurhl or 
bottled at the pharmacies, sn tliat they may be ciuployei), if 
tJiought desirable, without goloj: away from booie. 

The medtcines of value in purulent iuAamuuilloti of the tax 



CllR05tC PVBtLSlft tKFLAHHATfOir 07 TYUPANUM. 363 



arc (vfr, sihI I ^hall not devote much t^yaicc to ih^rir conskkralioti. 
In Jioite <>xa(^rbaltons, Aeoniio, ndlaclonnn, <^hamom»Jla, Pulsa* 
lillu, imj oih^'Hi mcDtioiii^l unilcr ucua- induiiinmlion of tlie tvm- 
pouiiiaif should be reviewed, and douf^bei, ^t^lee and inflaiions 
nude u usual, unlil lulivc ^^ynipCorm Hubsidc. TJx* r^iml 7ind 
tvmiiannm are to be cleanal out ihoroiighlv, as obilnictton to the 
outniird flow of pu4 U ofleuer the (Tauw td^ puin, tliEitt nciilc in- 
flamnuLtioiK 

M'^1 ol' the itijld C3st^ DiOTitioned under ntimlier one nnd two^ 
in my division ai the beginuing of lhi?i article, nuiy reijuire Ar- 
! Miikuio, China^ Hepnr, KaJi hichrotiip, KaJi hydriod., Mvrciirjuji, 
Khii* or Silicea. Some few <>f nunilirr twr, with tho^- of niim- 
Wt tliTtv »iid varieties, are Ixst tn^ktl by Anruni, Uflhr. phoi;., 
Calc. carb., Utic. iod., F«rriini iod- and 'renthitilhinn. TU'ii^ Ia a 
gt^ocfsL statccK^t, si[ljt.-Li to fDiiny L^xft^piions, as will be ccea 
from U»e Hyni{>t<>in^ nndta iiidtviilual ineilidn^^ 

Anmiicvm Afijum i» indiculod, when ihcro is auromia^ localized 
rudeom, weakness, ai»d renal irriratton from erj'tJienialoii-H di»* 
CVC'. Pt^TMiw of i»biir^t hi-dLlthf ^-xccf)! in the ctir, having a ten- 
dency to vesicular, {uistular or phh^ motions eru|Jtiotk^^ <«{h*cihllyr 
in and about the air, un^ f^noitly benciitt^ hy the mucdy. I 
Itavc not been nalbHeil with Its action hi iho$e oa^^&i id' inteJifte 
Mnima, wlicre tlic druTn-li^iiil and os(Jclu« oielt away in the pro- 
file ^ip juration. 

Wliea lli« thi>jat is roughs dry and ^^ranular, tbcro ia buTving 
and MOrOfio«ft d»rin<^ s^walhmin^, the expectoration ia flight aiid 
VMCf<], inflation is easily, almost noi»o]c«Elyaccoroplitflu<J.nnd the 
cuTvirvil gl.-inda are a liitle liardentnl by infiltration, Areenic is very 
UM-fuh 

Tlie special ear symptoms calling lor it arc: jmrulent itiUnni- 
tnatton of (he tyin|ftinum of niodet\ile dt^rce ; the pii^ is iehorons 
and irritates ports with whidi it comes in couliict; I he omul in 
roujch and twnly ; tin; mucoiie* niembnine U rcl, shining and dry 
in plac«B, bas&niatl denae gmnulatmns or polypi not inclined to 
bV^otl ; th*Te w much 9cnutivene» to coutaot, and a tendency to 
hypeniophic proc^eaea in tbe mucoua mcnbrane, ribrou?^ tt^iK, 
uimI intrimic mi38cJ«. 



264 



TH8 ntriiAv CAa and ita disbasbs. 



iluram,— ^The pnthogci)c«ii* of j;i»li) U rcmnrkaUydilutf^cl.juiil 
ri-ti«1>k- intlicnlions for its admiaisimeion r^oirw. It waa Ioi^ ago 
reiv>mruakil<Kl lii<^1ilv for wrontloiu iim) fiyi>hiUlic ilit!CfiiN», but, 
abandon^'] b^-rau^tf oilier modicmfs were supenor to it- The p«' 
tienl rei)iiiring it U ]ti*vvii«1t, <i('i>rcwcd tm<\ rnobiifholy; feU 
weary aud worn; u over-seDailtve to touch ani nxiitaii; ilic 
boiMM adto and ibe jointe arc ftorv and fitiQ'; ibe ^km may «liuv 
Bom« slight eruption, ar the siihcutiincoufi tissue of ihtr lov«ri 
IJmlM l>o a^icniat'm«. The di^^ivo and unnorr tmrt^ art* irri- 
t&(ad and dUordered; the uritie and in^en^ible per^pimlHin are 
iiK-ronf«4Hl ; ilic h<ttrt'« action i« augmtoted mid diJ^turbiTl, &nd 
titfiil feverish fiviiiplonifl may eusiie. 

Th^ iyC9<art? tHinit^limiM in a condition of cljronic conjunct! vittf* ' 
nesral^a shoots about flie !a<<e, the orbital ami cranial bonea are 
«orc^ to ibe toiicb^ and mziy be affected by caries or nodes. 

Th^re may be con^za, sneezing, and miicx^n^ diachai^ge ; chronic 
na«nl <nturrh viith an exciwivoly fetid and ofTen^ve discbarj^of 
m^ts and pus; ulceration, pain and c^lorture of the nofe; <nri» 
of tbc nanil bon4«, btndcrn^ss of the nose and forvboad, wjlhj 
)M;\tre lii^idiichc between and over the uycK. 

Thf^ throat U rou;-h nnd granular, tlie towils are sirollcn audi 
Iiy|iortn>|>tii<Hl,»vmllcrwing may rutuc painiAnd tlie palatine bouai 
l>e eariouft. 

The ccTvit-nl ghnvl* below the car are cnlur^red ; offi^iKKive. yet 
lowish-whito jHis llon-fi from the uudilorj eanal ; the metnbnna 
tymiMmi i* largely j>erforit*^I ; thr '.i«f<tcle»» have mostly disap- 
peared; a polypus may fill the middle ear; th^ trmpotiic mcra- 
bnine i-s geiterally pale and llahby, and may t;how to tlie probe 
one or two fiiniisee, op there may be exo^tmeci beneath it, 

C»ric*of the roof and |K>^terior external portion of the Q^m-J 
panie vnkll, extending to the mtu^toid, with a linm diArbari^itig 
dark ^xif bL-bind ihr: car^ is a uomnum crMidittun. The puaof 
carles, whether from the sings or from tlie meatus, is grtierally 
of mahogtmy mlfir, owing to t)ie iidmixUire of blooil utid little] 
partidts of dead bone. It is not infrequent to bavea1];;ht pn^frnm 
the meHtii!>r and a dark pnrt frt>m the ntastoul nnus^ or rii-r r<r«d ; 
the fool odor of the darker is atmofrt pathognomonio of oecmosis 
and grave drJK^se. Tliere is ^nerally 8ome tension and pain in 



OlIROKIC rUftULftVT INFLZi 



the mastoid jml around the auditor}' canal ; ibeo^^rlving tMi^ucfl 
um ird, hog^y a»<I c^emaious fVom infintnmatioti, and (ticrc U 
great wiifilivoww^lomW. 

Such arc the leaJiiig fivniptome nccrcdilid to Auruiu. I^ thun 
not lend nwuv irttm utliiT medicines, that Iinve Ixvn iK^LU^r provud 
and have rarely- disappoiate^L 

CtiKAona is ftomelimv^ rcv|inrvd in puruK^nt otitUt. Il 'm d«- 
raandid by torpor of the vegetative fanctioi)3, confusion of the 
miiidi dc-Ulity, grmt ^^inihihly to ivltl, aad fitrul fcvvriH)! :<%'mp- 
toiQs; by rough fiore tijroat, [laiu on Bwalbvriag, awollen aiil>- 
nuiilhty f;land«, and \K^\i and wiMtivciic^ itj the uaral regiou. 

Thenar symptoim demaiidiug Cmchona are. jDCermUsiuus in 
tbo Hcvvnty of the m tl]ptl>m^* ; rm^iiijr, rournt^ or ruinhhii^ lin- 
nitQa; a f^topped, t'uil leetJDg iXL (he ear; neuralgk paroxysms 
in th(> t^ir, tiidc 'vf thu- hmd, and otHMjitil ; a lo/Hti^riiio su|k|mfutii>ti 
of the tym|uinam, the ^ur^prr^mocimf:^ mixed wjih biood; conoid*- 
^ntblc bri^Jt rctlia^"^ and he^it of tlie iiudttory canal ; h tiinooth 
CTtmBon intlamiDaiion of the matxjus membmno, without granu- 
Jation^ or [Hjlyin, but with e3C(^?»<ive ^jMiiiiJiiy to U>UL^h. 

Oeca&ionally the di^'har^e diaihii^hes, the [)al!ent has a light 
rhill followtti by red rheek« and eligbt fcviT^ whurh diNij>|>enn« 
whttk the <iiAcharge becomes free again. As an intei^current « 
remedy iti beil ic, cmuKd by caries of llic teia{K>raI bone, tliii* 
medi(*tne lia.^* no rival. 

Crdcarra Pftoiij.Jiori(xi Un nntritivi' ^litnidant, wbieli rxtn*!^** 
marktd tntluenci: over i:elhi!ar prwe^^^es, arui ha-s a da.jded af- 
finity for gUnduhir nnf) ifs«eouo tiHsii»T »o that it u very applica- 
c»ble lo |>nnjlent otorrhn^a in flcrofulou?^ aubjecls. 

Id aniomie and i-aclieetiij p^tieute, witli long-stiLnding profuse 
BU|3piinitiou, nitn-li debility, and feeble cjrctilalionp it fu>melinicA 
does woinlei?*- 

Tht purttruIar&ymptomA demantiiii^ the medicine are, currjcu 
[id dry mre thnnit, a>n[ii<Ionib]e mtiooiiK Keejvtion, and pain wbou 
vallowi^ig j the KiiAtiu!liian tube ui full of mtK^uA and iaflatc^ 
ritb diflicuhy. There is dnhjc^ of hearing, tinnitus of var>*ing 
l|tutity, coliliie?E< of t)i(; uiiri<:lm, M'jt.HiMlity of (fie ^r^ to tvjld air 
and drsAfl, wrench on pn^ure in tvont of the traigu^ and under 
Lh« auricle, aud a eopiouK flow of i4mH'Hx>lorc*il olR-UKive pu^ 

U 



m 



TDK HtTMAX BAR 4»D 1TB DrSIABlS. 



Tli« t»ii€ou! membrane of Hk Xymy^num im lii^lit nxl, ^pon^, 
covered by lat^ftuoculcntg^rsnulation.'^, and, perhaps, ehowfiittcvf- 
ation; thenuiclos arc }^*ncrHl!v gom-; tlk- tymfian!c cormlnno 
has A 1a^ perforation, and otrit?* of the lf^in[H>niI l>one may oci^ ; 
a 611111^ may be open upon tho maMoIci^ and disr^Finrp? the Mine 
ktml ijf pusi, ountiiniiiip littb^ )iiinieIi?A nf bniie, afi in caries of tlir 
meatm; the facial nirve rnay Iw jumlyzH], ftnd tbf^ fiw^v di>*irir(iJ- 

Dfslruotive tilceratKni \* likely to exl^t, niul rW covk^iutioo to 
show the pflects nf the di^a^^ by well-marked hedtc fi*\'er. 

CWwrrvi C>ir6(mwi i* lik«-(l)(- phoe*|»hnto a nnlrilive agait,l«t 
does not stimulate io the true denec of the ivord. It nidn tbv 
oi^;anio procef^^^A, ard ha^ afBnili<^ for the i^landft, lig;aments and 
botiefi, Th»e ppopcrlies tnake it an i(i][)ortaiit agent in the rati' 
nutrition of skrrofnla, and ettiinenlly lit it for casi^ of chnwie 
snppURitlon of the ear in strumous per^nna 

ll i*f ^niuMe for tii<-!*e, when (he [wlteni (Ailt« and i^weats 
Cftsily; tbem i* liypcrnesthosia of the skia, ecJBcmalona «rup<>ufl», 
swollen lymphatic glaiid^ and, [>erhflptii, |)am|]()fl, irrtt^de wned- 
live '^yw, mn- nUvnxvA nwe either ver>' dry or fiwoflen and 
plu^-d by ikt'oiujut^ing riiLi<-U!<, imiiuirt>d rii« of «iim_dlf and 
occasiooal cpistaxis. 

The iniKiuw im^nibnincof the throat and miw>-pharynx i* eon* 
psted, oxlemaloas, and rehtxed, and M^eretc^ a htrj!:<e ijiiaiUitr of 
dirty whito mucus. TWre i» burning id the tlmrat, a ^nsatioQ of 
a Intap wSlh fec^lin^ of oonKtHotion ; siivallowinj; h siimHtnKft 
painfbt, pains shoot tlipouffh the Eustachian tube, the necl i» 
rtifl", and on inftation lottt^^ mucoiH rfilw are hciinJ, 

There muy he a course soundiDt^tinnitti^ of n rhythmic v^ariely^ 
onip^to the puli^tiouR of counted v<««ielti In the tT'iipanttinaiKl 
adjdtvut to it ; the firofn)*c dixluirge frrjm the our is whito. flaky, 
and cafieoufi, of a cheesy odor, nnd the walls of tlie mnt^ are 
white and macerated* 

The Dienibmnc UAimlly presents n large |HTfom< ion; tlioatwdM 
are carious orabf^ent; the iy?tipanie mueouM membrane when 
dmned looks pink and flabhy, and jirewnlA lar^ \tti\e gnuinla- 
tious or polypi, n-bich bleed easily when touche<l ; tlicrvncoimilef* 
able scDsitiveneBH to contact, but )ittle aorencH around the wiri- 



cnnoicic pcntLMT in^lammatioh op lYMPiSUM, M7 



ole; aWralion of the miicora, ami caries arc frpqnenlly prescof, 
ftDil iIm* [mticnt prc^ntA rhi^ a|ipt>Aninoe of markl^fl dvAcm^ia. 

Vai'Strfa lotlida 19 another limo nicciioiDc, whk*h i& apprcprtat© 
for the fame ria*4^ of nu*t^ ns ihe pli^v^jihau^ nud ivirlntnafc. I 
hnvc u«<l it nfter s lon^ trial with the Iiittm*, when rlic ditteaso 
£«eD)cd if* \te at B M(an«i4till, and thf* maoon,^ liiiiDg of the 
tympauum wAd indolcDL A more acrid p«s apt! irrpaier Bwell- 
inf^ of the lyrophntic gluntU, fHnirritig iu 11 thin, iliirk patient, 
hnve toil nte to employ it, ami it h^ frefiueiitJy proved its cura- 
live pottcp, 

Chp&kit«^ ha^ patho^^iR^ic outlines clowly rrm'niMinf; the 
nHvre aoiite symplorafl of the dirtmw under trt-atracnt. Symp- 
toms cleniHndin^ its cmploymeot are, neumlgic paitiB, lattral 
Ibaodootif of (,'rciit wvf-ritVt nnd chilly sen^iIoiH followeil by 
feT«r. 

Tliore is i\fL^\ f«iftrrii, aicutfi or (^hnxiie ; a dark red, inflamed 
thnmt, v^Wwh burn** and *lui^, imd ftxU wnrtrn-tod on swallow- 
iDg, and may ^nw a little ulceration. Tho Eufifaehian tubes 
op^n freely, but mflstion cuut(C9< ptim from the throtit thmti|;h tlic 

CAT. 

The auditory fanal is reddened, the nipmbmnc is perfonil<xl^ 
Ihr (wHKr1i-M iniiy be padinlly dft*Imml, tlw' lynipanum contains a 
Utile piu, and ift hot, r&i and [emien Movement of tht- ^luricle 
faaseft con^iflerable pain ; the iniurtfiid w ^^^^^ hot, sie[MUivi% ami 
Mwollen; the whole wdc of the bend aches violently^ and binrpa 
he patient rwcrb^e, fpvm*h, nnd. [M*rlin|»*, clelirioiw. 

Thi« ine<?i<'iiiL* is hij^hly t"eiY>nimGnd«l by Dr IL fi Houghton, 
of New York city» in lU'ttto exjuTrl>«tion ami Miiddo.n n:icti*nftion 
of old rhronl** iMflamTnali'>n of tho tympanum to thf mantoid 
rrlU, Ho hn* rr-port^l nnmfntii* m«fw of irnmiKt:ilcnt>lr miutnid 
inftanimiKlion, which huve rapidly anb^ided aft^r the adminifitra- 
tinn <if rtifWM-um, Aftrr thf rvidi^niv pn-H^^nlM by mi (?hwe wnd 
conwierilious ttn olwerver as Dr llougbton, thia medicine f^honld 
be* givrn tho finBi plnrt^ m ibc i^nrly ftfiigiHi nf nifi^toid mflakn* 
malton, vrhcthf-r it be perioflt^l or intni-oelUitar, 

My e:tp<^rieiieo with it in limited, and though I feel hound to 
try it upon suitable cti»e«, I fM loth t<» permit >t io take lh4i 
plaiCMt of ftUrh wdt-provud rtMn«<It4v &■ Aconite^ BLdltiJonna, Kali 



2U 



TDB BUUAM KAR'AffD IT8 OlfiBASVS. 



1 



brom.^ A[k(l ]l4-|iar, liccuttHC in ooiijutK-tiofi with ticois^ir>' t>|iN^ 
tjoosthey liavf^ served me wcM, 

i^fnrNr/i IttfiitUun in wl*H cuhiiiti'cl to m«c« of aiuomm ftom dft> 
fective digizfilion, malnfisimilation. ami projound de p r coa iQii of the 
viOal [)owcn*, imlutTH \nrt\y by lliv fmifnw «u]>]>iimiif»n. M'bm 
Uie iympbaljc aod lon^illflr glands urp in aooiHlJiioD of dirunic 
tingorgcment nnd inflmuamtufit, tJie \Ai* fnuii tliv «*jtr in tfiiu aim) 
bluish, or r«ddUh from Ih^ pra«enoc of bJood ; the i^mpanic cm- 
cous iiu-Ribrftf)o If titivmtM, ittid th'- lMti|kofiil IxvKM^iHiytK*, thU 
allfnilivt^ lujlrii-nt will sometimes arr*sl the lUsiriMiw pixxea, 
udJ uitl in n-«tonii|* the patient to hmltli. Thvrc is tcrv little 
pain, aural hemorrha^, and be^lic, as antier (.^aohotia, but an 
aliM:u<^^' of rt-activi- *ymiit<»n»j», lx.Mai>c the |iowcr> of the nyMrai 
atv at too low an ebb. 

IlcpfiT Suij'L Cah. i* itivuliijiblr in donii^ of the i iik*!* nnilcr 
i^onn'iidf^ration. When there is la^tude, Meaknea», irritabilitv, 
vhillini.'^ eliglkt ft'vrr* varioiitf i-i'Uplionc not hi^tUn^ rendily, 
influiiiination of th^^ lym|)hatie glamla of ih^* neek^ lateral or 
froDtnl h('a<]u€hi.\ ati4l jK>tv i-y»j in ^tnimouEt |>atient«^ tliis agcM 

It is iMpccially rrtjiiiHitt', when Ibc thrmt A.tU dn*aiiil M-rupeil, ^H 
the Innpiils •■ir<? hy[H'rlr<>j>hit.'d, ^bar]! \m\\u^ oxteml fnim tJti' ihMOl ^\ 
to tbi.' i-ur, Xhvx^ i» c»n^latit banking of nuicus; the- external otr 
anil mt'atuH are ildiiiig, rc-il, hot, and buminj^ ; a ve^ii-uhir ctup- 
lii}h covers thr uiinrle, the- ii=Tinm*n jj< itii^rbld »ind excxsnivfi, mkI 
the Kur^Uichiai) tube njicn» luiperfi.'ctly. There i# usually a di^ 
dinrgeof thin ycllotvift|i*nbit^, o)K^^y, fdtd pim fnim iWar; a 
pink, Diaceiat«l api>eat^ncc of the canal M-all^, and a reddened 
ina-^loid ; lu bing in \\w ear and whole side of the hfjui^ wooi» ia 
tlie cold and at night, with painful fusibility wb€rn touched. TTic 
iiinal i^ uffMi anrnivri-il by ii\^t-Uing nf itc^ tvnIU, m that (he tym- 
panic inembraiip and midtlle ear arc invisible; the mt'inbrane is 
l>crforat<ilf bnl intlalion fn^piendy r»il^ t^^ force air oatw^nl.And 
Cfiuaes considerable pain. The more acute symploon iiJtuttoa«d 

an.' |»rt.^*'i>t ill \\\v tiirly sta^i?) uf pnnilvnl intb mlhui iif lb* 

tymimnnm, and in acnle exneerbation^ (!urin^ tht^ irinr>H? of the 
chronic di»^-(i»<e. For i^nch iitla^-k», tlii« tiietlicitw will bo found 
more appropriate than lor the sK>w jiaialt^^ »ihacEUe eoaditn>iu<. 



Cirit«>VrC ??fttrLB!(T tnrLAMVATtOX OP TTHPANUU. 269 



itc 

i 



KaH Hir/iivmirtiin U highly reoommeiitli.'tl in tlii?<i1ii^iu^\ 1>ut 
ly exfiericiKX' with it hii* Ux-ii very iinsatisfartory. It h appro- 
mtc fnr i.<».^<s <>r fiiilil inn»niinntinn <A' the now, ntun-phan-n3C> 
Ki»t:irhi:in liit« ami trmpaiium, with u diK^har^ mort tcuroid 
lAu purulent, tuogh, wliitLnh-yeilow iiml t<*niicioiiM - it i>l^ruclK 
ic Eit^tschinn tube at timo« m> tliut air cainnot be forc^ through 
tt, anil I'lin^ to th*' flirmt juiJ trnijuutturi in jinUrhi* nnO ifhntli*, 
blii^ a false mciDbraue. 
Tht pain in the n\r ij< MJi^flii sitnl iiKH>ni(nnt» ncc>m[>nnif<l W 
itcbtQg and irarmth, and it shoots llirrm)^li the o;ir ami about the 
aQg]« of the juvf. 1\w luiditory canal U nt-nriy uf norinitl color, 
IP (Imnvh^ad ha^ a small i>epfnration, the mucoufl membrane of 
lympuitim i* pink nml inactive, uiul may ^I^^)W ii few graim- 
tionft and ehalloTv, indolent ulcer;iiionfl- 

Thi* OKHliWne if» ni<i^t aiipixtpriHte for wry mild inflammations 
of lh« ear, and for rlironie caflstt that are approaching a eiipe, juttt 
ttiareGnipliilrfi, Pnl^itilK 'IV-llnritim, and iilht?tK 

KaH ff^riodicum is an anitplaAtic of decided power, and it 
pn^'iib^ ioline lo thf .^yMi'in in cticnf iln b-ji«f irritalinj; eomb:- 
naiions. It has affinities fytr (be macoiu mern1>mni.?i :iud glarxls, 
whk'h retidiT it mrotive in mnny morbid f-ondition«, It i^ likely^ 
in bf^ doees, to irritate the Atomaeh and kidne\'-* ami induce a 
bydnvmia, wbirh U »p|HjMtl tu hiTtkb)' nittriiion. ami, tlicrdorCf 
muMt he ffiven in ^mall dosea well diluteil in water. 

Il in frerptently valniible wlicu Ibert art' pains of the musclw, 
menif and Inmeft, nggravafed at ni^-ht ; hard knotty lym- 
itit'^nellin^ and nnk'nia, ^ind pjsttjlar iuhI fumnnilar erup* 
ins. Tliere muv l>e aeiiie or ehronie nawil eatiu-rli, aneoaipanied 
y (Itill )>ain ; [nflnnimution of the phnrynircul follicles and the 
|Ela»ib< in tlii' na-'^it-ptian'nx ; liyp(Ttrnphi<>d IoiimU; i-alarrbcd in* 
^animation bf tht* Eu«tirhian Lube, indimtnl by noi>y inflation 
iir imal nhr^trndifin ; i^wi'Uiug of the Mubmaxilbiry iind eervi<7il 
lancb; heiit. rtsintw^ and a. K»ly state of the niKlitory canftl, 
i(*tjnii^, Hii-om|innMl by phle^tmonoiift svi^llingi* ; periontiti^iaad 
vere pnin ; mrie* and wtv*jh; p!imly*i* ni'thv facial nerve ; a 
iniall or it»editnn ^Hrforntion tti' the (Innn-bejid; nniJ-iv purulent 
difieharge of Hmall quantity and variable appeviranee; cviiM^ and 




270 



TUK UUHilK KAK AtfD tTS DISEASES. 



8i3ili^ jtJberiii^ tu tbe (verfonitioii aiid to tbc hmmilb, r«d, nwilec- 
nU'Iy inltariKtl ukH'uiia nicn)t>nuH% 

Thoiv rtvui|jl<im4 laill lor tln^ txJitbilioij uf Uiift iu«djctDCr *<^| 
cially, vtbcii tJic imlic-oi m uf h rlit-uinatic or ^»ty tJistbetiiatrOr] 

. Knfi Hi')ftpfwn€um \» a new iiK^icmt; fur »u|)]iuralivc <ti'jh, 
iiitruJuuHl lo Ui€ |irufvAhiou by Dr. ilouglitout U> vfhoai we air 
iiUK'b iixKl^tod fur futv-fnl sUidii^ in mini ilK^ni|x.-nik?v He 
qiinics ilie fcllowing H^mptom^, arraugol by l>r, Walkor: 
*' Breath olTi'tisivc^itiid; loii^no couU^d likebrcnviiLJi lii|u>d uuh-J 
lard; diarrheal foul, if accoiupaoying anv oih^r diKOvc, viih 
putrid cvacualmus; dy?^iilury, with |)iitru) wry offiiipivi* ^ovIk; 
evacuatioDs pulrid, very oflUuMve euiell; jiiteniiilU-'nt f^'crj !'«>•] 
fbsc, fHid jwripimtion; ili^btliuiling ma^iUiH; If tlie pus ifl 
browiiif li, dirty Ifxiking, w[(h Iwdvy o<J<jr; E«u|>|)unitionH dirtVj foul 
oialtcr wiUi o^Witiive odor ; loodiaclic wiih c£^»ly blutling f^unus.] 
In tliu iini.Hdo ivll[<, fiLKy mHfiriiorpliuifi;* ; in ihv iiiu^iitiir juicTi] 
or myofiiij, putrid de^jnipoaition ; in the blood oorpuwd^^ rapkll 
tlL'v'onipwition ; it <'urw ?^>;pticoi>tiditi<>n«, w^orbutio bU*t*dii»(^^ mor- 
tifiealioD, pLitn<l »imlling diarrhrea^ and a dyuamic typbuid ooo- 
dilioi)/' 

Dr. Houghton aays^ " t]ie dark mlor and oflenaive smell of tbe' 
diacbargc are tbe cbaraotcri^ic features 1 Imvi; uml )>ocuh in 
many cartes having tbe alxivi* indioatioii^, and am gratified at the 
n»u]lH obfftjfiULl. In otiiit» c^itcrna, tho epidcrmi.-* u* niotAt, oniMl 
form and acale o% Imving tJiecanul i^etl aud shimng, but a fe 
daj^fi «uf^oc to form similar cirust« ; the iDn<T third of tbe voial 
find iDeinbmiie i^^ (-ither filleil or the walb am ahundnnlly covered 
with tbiek, durk-euJoii'd pii^, fetid and eoriidinK^ |froit»ouH ur 
gruniilous ; the tl«<ueA wbon eleaneil are roughs easily blecidii^ or 
coveRxl with small grniiulatioDs, in otitis meilia, tlvu laciabraiK' 
of llie tympanic <^ttvily tukes on the- ftwne ty|>c uud ^Wta a [Hirti' , 
lent product fre^* from mucus; tli^ bloodvtefifiels rupturt? twriJvaJ 
and jilight oozing of bloiid will oOen follow tlie mo6H i^rrful 
cluitii^in^ v^ith absorbent cottoa^ but if the car is kept dry by- 
daily u^ of t\w ootton, and the remedy is given two or three timcfll 
daily, a chunge for the better i» soon olffiiTvcd, 1 jt>dg« the effim 
of the salt to be that of removing morbid ooiiilitioua of the mi- 



OBROKIC PURtLKHT INrLAUMATlON OF TYMFAIJCH. ?! 
out€ bloodvoa^elst thiu pi'eparJQg the way far tiiicb a rein<Hly ih 

It £9 apparent lliat Kali phoa. is applicable to much iht anme 
kiiii) of i:n«t9« ii» C^la phoff. I hav^ no eipcrieoce with the for- 
mer but -^lall I« inclined to u«e it in tiun-fttrmnous [Kilitiit.'^ la- 
stcad of tho Ciic- phoft,, which i£ so vjilunble in strumous con- 
stitutions. 

MaruritM invudiv all tlie ti«»uos, increases the secretions, 
favors eliiiiiDiitioii. rkitmf»mt<s the blotwl, oiibCft hemi>rrhaKC*, 
and frofieus, ulcerate and breaks down the aoJid stmctura^ of the 
bodr. It MrikeA at the uiimiul My»li*in l>y t1:4 powerful a<^ioi] 
upon the Vi-g<Ttiitivc, and pvtn a Jife-like picture of soorbutiis, 
Whtfti it t^ iiidicait-d, the i»U!?<Hw of the iicek arc »arc niul >{iS\ 
and the bonw are afiectcd by perioc^titie, nodes, caries and ofr- 
oroetA. 

The «kui h of a i^llow earthy hue, and excoriates an<i ulcir- 
uC«» easily; the oer^'ical lyiapbntie^ are »wr)[len or uh?enited, and 
the throat is painful to prepare. The naKtl fo»(4e prL^^cnt tlie 
ilJ1ti.-renr Mugt^ of intlatnmntion Keen ill chronic Mi^til catHrrb ; 
tlie dt^'hin;^ in tliiek, ."tc^lby and font; tiie pharynx Sb rough, 
tumid imd vu?cutur from the constant irritation of tbedjH-hurge; 
the Eustachian tut>e opeug with a noipy rattle, owing lo relaxation 
of the mucous menibranu and tlic profit^.* di«L'hur|^* ; t)ie thniat U 
dark red, it^ liaeues Ihiekenetl and relaxed, and it secieta^ much 
mueo- purulent matter 

Then* are dull paiiir" Jibout (lie aiiriolo and njiddleear; oeca* 
(iiufuil f^hooting [mins in the wbcle aural region ; tlic di^lmrge 
from the car is yellowi.<«b-^my pus, tuixod with bTo<^ and debrit^ 
of ido^rated tisbue^; the auditory canal is [jak and ittf tilling 
puBy and rnoi^t frum the eon^lanl flow of purulent nmtter; tlie 
nieipbraua lymiKini looks like chamois skin, and j^hows a large 
perffKTtUon; the tympanum i?t u^imlly full of inF^pl^^ialed pu#, 
formiu)^ adhesive uaseoue jmchcs; when this is cleaned onl, the 
nmoon ii* «eeii to be |>ftW letl and fliibl»y, and [in^iiLi large. 



* KftlL Fti«p1uiricuin ia^uppiintttrcOiitii. B^ Ucnr^ LMIouglitni^ M.D.,. 

Ifvv Ytnk Hlr, N. Y. TnUi*4icii(riiiivf ikw AiiirncAu liKlitLiteirf J tiiuuiFir|;iMbjp 

618, 



273 



T9« ntUATf BAft A9D ITB HISBASVB. 






Hpon^, vwculnr gratmlatioits, wh!cb Mt^cd upon the sli^cil 
touch. TfuTf m»y ho uWtjUioita und smu!H>» in tht nkUOM» I10- 
itig, kfldin^ mwartlii ami outtt'arrlH to carious bone, or it maj U 
4>lc\'At«tl by ijiwiw licncjitb il, or by p(Jypi Kfirin^ng fnwn i* 
ifurfftce. 

For rcocnl nnd severe cii»c«, I l«ivi* TouikI MppciirSiui cmttA 
most officii nu In ihoe* of slower pi-ogrese witli pla^ti^- exadii- 
(ion »nd Jiyportropliy, wlnt-li it i-* (ii'wimble (o remoirtf, tlw Me 
im\. Rav. !s }>cticr. For mild msc? villiouc anv tendoncr ti 
hy[KTtri.iphy or dwlnictivc ukrrntioH, the Merc *oI. w cffimnt, 
nnd it is the moi^l s^^iiiritblo for AtlmtnUtratioD iu jKiwder^ I ^eo- 
endly rely on tbi.w tlirtr prvpwmtiom, nml U-Sk^v*: tb<"r will suf- 
ii<« for most cases in which Mer^iry is lieneticml nnd ruralivt 
Mereury ^lionhl \n: pushed fttr soini.^ lime, vrbeii thi.^ mr di; 
hA£ been cauwd by ^yphili^ 

Xitrii}. AcU! is charactcriztd by prostmti'»n, cxtiniL^tickn^ vnaii 
n«^, Irembliii^ of ibt- Hmb^, ntifl'ii'.'^ and M>reneM of tlie miiida^ 
and [mn ia th<? joiiitj^ and booiM. Thvro is gn^nt 9«cn»ibilily to 
ct>ld, chillincfti, flawbe* of heat, and itchinjf eraplions of rari- 
008 kintU upon Ibe skin. The toa^ue U oKitul white, (he breathy 
foal, the )<toit]arh and boweh irritated, aiMi iho Btm of nrinr l 
i^'a*cd. The glim** and mouth become bop?, sativation is i 
cTiiMib lh>_' throat 5or<.-, the toaifiU 'nvoller, and t)>(r iuimI fc 
affe<rred by chronic caliirrh ia all fltagea, from dry irritation to ibe 
foul oHensive uln^ration of oKienu, Tlie iiaM^ptiarvnx in ^lon* 
lar arnl rcihleiK^l, owing lo the na^al ^lime that flow* over it, 
the t^UiHEncliinn tul>cs opea with dift)eulty <>r not at alK 

The auditory canal b aarrowei:! from swcllinfl of its watb 
thill yellow or brownii-h piw tilU ihe (KUJ^dL^; the dnim-h 
showe a large |>erforation : tlie ovwicica are cnriotts or have 
di^iiar^d; ibe mu<!<iMi< inemlimne of the middle ear ift pAl«» 
granular and flabby, and cTiricH of the tcmponi] boDC may cziett 
with ^liootitij: |i:iin.-i ami tcatleniff^^ tn the toach. The carm 19 
likely to cxtt^nd nlong the roof of the c«nal and through tbfr 
ma^C^id process, revealiu;r its prwence by an abec«s& or fin 
behind Ibe auricli-, and n rough fisrling of bare bone to I 
pmbe. This lesion is suppoeed to he the result of an abuse 





CHROTIIC PCRtTLKST IS^LAMVATtOX Or TYMPAXnM. 27:1 



Morciinr, or of oormtitutioiuil fiyptiilU, but tlie cotinection cannot 
be i»mve<]. 

Caries of th* ma^ojd ppora« is in mret cawn the rcwilt of 
nejjlM*.-<i <K*i.'aj»r <?f tlio niiEtdU- (tir, ami may ulTct'l l]ic m«5t 
lobn^ eonslilulton, though actaftiU pre<li.'i|K)p4<« greatly to it, fts 
It J<H7^ to maoy othtT boiiu Jiwitst^ 

fthtis Toxicodfndroit ^«eias to fill a ^\t in therapeutic^ that 
no othfT mcdiciiic can. I shoithl »vk far Ix-forv employing it in 
|»urii)ont otilU, oKvurrlng infttniriiiKiiL rj^uHtittitictn^; hut iii Miv>n^, 
xveIU!rvHopt*<J |wr<ons of bilioim icnipcramcnt, fiuffcriojj froin 
the difieasc, it is oc(*a.*ic>n(illy very useful. 

T)m> fiym|>liimt^ that «ill for it may b? hriHIy statpd, Thyw is 
a sore hrui^ fwlin^f in ihe miiftf*lns, with fliiHuetw imd pain about 
th<*j<.«nfc*. The skill of the fuw t« dusky rvtl, the arterial capil- 
laries of ilie cheeks and side of the nose iire dilalecJ. Rry8i|>ela- 
tocu inflammation ocruri^ <K«fl.siormlly upjti the face- and lir'ad, 
aoGompanted by Vteidos pustule and »rdemn; iln^ auricle may 
I>e thw'k«(ic<l Aii<l jftiflT and the Ii>b<* tnm^^fiwl ; the tnomoid rwl 
ami tender, and the cprvif^l glands imd parotid.4 swolk'n. 

The throat is dry, red. thickened, and eorc; ssrallowing^ ift dif- 
fleull; »0i4rp |nin,4 hIiooe f?nm llii^ thmat to iIiet I'fir nnd neck; 
the EiiAtaehian tobo np^rw t'fwlv to inflation, but the n|>eration 
i?au!«e«i f-on^iilombhr juiin in the thiviat and oar. The ptimlonL 
dUcharg^ is Fmall and raker; ^omevhat in the rym|inniim; tlH^ 
external oinal i< n-d and at^Ay; the nM^mbmn* ahowft a mnd«tiilis- 
«isi^ perforHlion^ and the mncoiis nii»ml>ran** npj'H'JTr* Hmnoth, 
viLi^-iilar und sliinirkg attJ?r the pn% huA be^n rE'mtivcd. 

TlkOpntie^itjcHrcof n rh[*iM]i!kHf-or^>iity diathft^iA, nftt^n hmkt-ii 
m health frotii intcmiMTinoe ntid cxpo'^nre, and suffer in various 
way* finring damp nr tndefnr-ul w<virhiT. 

SHicea acts upon the skin, mufious meTTkbraneA^ glands and 
honmi. Among nyinptom* d<*nmndin>f it* uw* nn% wuiknCMtj 
kcvviness and pain in the limbs; a le^lin^ of general wearineA 
snd dehiTity; Mrn^itivi^n^stt tn <vdd ; idiglit ft<brik ftymptoma; 
kaai]ftrti<>, arf^ing in tU* luvU nnd ocfripitt and rrxti-nding for* 
leards to ihe rijfht eye, and miieh swestinp of th** head. 

Tbr nkln U iinlu>i«hhy, pn>ne lo ortiptionH that HUpptirate e«- 
<tfwiveiyj and «hoiv lilile disposition to hml. The mmcle^ are 



274 



ini 



EAK AVD ITS DISVASBS, 



HtifT sihI eore^ and the hom^ saiavilmva affbcled by pcriwtitff, 
elmrniition, ii^xlt^ aiul c^riiTi. 

The iiiiee aod ua/^o-pliurritx am in a cundiuon of calarrtia. 
intljiinirmioti ; c1i« lliroat anil jihiiryiix src dry and liypcmwuc}' 
cnisfj^ of altered mucus from the pcwtcrior nares, pamdc down * 
the phjkf^'iix nnd Icee]t Ic Irrttiued; Awallowing may t)tf paioftil 
and cau^ «liootings into tiiQ car; tho EuKlachian tube open 
noisily iiiid with dlfHoulty. The atirlde ai^ iiural n^ton miy 
pr^cnc an eoj&?maUnifl eruption, which Ims arbcn rf* noro, or has 
burn cuuwd by )>eni]tttiM^ di.-4'harg<^ fpun Itii* middle «Br Wij 
oonie in contac-t vr'ith the parU ; Uh? aoditory oinal itclice lad * 
l>urm; it* eiiidermis* b* partially mnix^mtftl and r-hrcddy; ibel 
surtace beneath i^^ pink, and a thin ur ihiolc yellow li^h-vhiic ptx\^ 
<X)nt»Lning pii^R'n' \>w&^ of cpiUidium^ fills tli4! pius<agc. Tbt 
dnim-lk'ad is lar^'ciy ptrforatnl ; the oxides genendly d(*iroyft3; , 
the muu>u« nioinbninc \j^ pink and {granular, pertia|>!«, ?Lowinj 
ulcers or a |K>lypLis; carica may exist lo the walU of the tympa- 
miTti, thr roof of tk* (.-nnal^ and tJie niAJ4toi<i procew, aiid the 
facial nerve lie paralyzed. 

According to tlie pathoge]]f5i^ Silicea finds il» spln-rc of aclioai 
iuscrufiilouft patieim, in whom puruU'JUMippumlion of tltf^ tym-] 
panuni frcifueutly runji a very dt^tmotive pourw. 

Dr llonghlt^n thinkn f^ili<M.:a ad-^ ujioji ttie ^ulMfaiicia propria,] 
or the librou8 middle layer, of the meobmna tympani, and favon^ 
the hi'jdinjf of p^-rfiiiitlionH, 

Siilphftr bu^ a parhogcueJiL^ wliioh re^iembleA that of Silicea in j 
Bome n?flpects, and it may t>e given as an iiilercurrutt remedy iaj 
aooie viKtL-r^ of ditK di»iUR\ 

Terfbinlhhui hoH been lauded el.iewhere «d a locml npplicAtioivJ 
and should be given intcmallyoftcner than it i& It pog aoofl tha 
atjmulatiu^, yet, ."^oothing pro{>erli4<^ of a bnUim, aitd luu^ a Mniag 
affinity for the miicou£ mmibmnefi. 

It is of value in general ikbility, h^vincflA Slid MiniicMi of tJie 
lioibn; irrilation of the dij;t«tive and urinary tracts ; ecs^niatoua j 
eruptions upon (he ttkin; tijight fewriHh rc^iion, |»oovi>ihn(M' 
and nstk^T'inwi': Fulnc® of the head and eate; hyperseraia of the 
naaal muoous menibratie with n^is^o bleed; roughntm aiid dryiwM 
of the throat; burning j^oreiiess and swelling of Ibe guma; diffi- 




TnS ARTfPIOIAL MS)rBRA?VA TTHPAHf, 275 

t*iih ili*ntidon of chiLdnrtt, ami n m<xlcnUc flow of itiin yi'llowi^ 
pug ffiim llie ear» whtcti alt«riiMei Mimecimc^ vfith an e<-2£nkiLTuu$ 
eruptiuii on ilit- hcml. 

Tiie ccj!eut& may hav<^ exU^ndeO into the auditary canals and 
n»?^.-(l iil(?L'nilioD of the JniMi<lK*flcl, and puruk-nt iuflaimnatioD 
of tbe tynijiaiium. The [K^rfitraiiou in of nimlerule M^e ; iha iiiti* 
cou« membmue ^ithio r«d, shining aD<l smooth, and the osgiolfs 
are fre(jn«uly nnatfct^tvd, J>r< Cooj^t, of )>in(]on, England^ 
recotaruffmU tJm medirinc strongly for infanUle cases, vrliere deoti- 
tion, rital<^Uj mid [itirnli'nt innafuitiJition ituikc Uie uKirMd picture. 

tjuit« a number of other medians liave been recommended 
for this diAiw, bill tiw symj>li)nistlmf huvi? Iwl to ihcir :<L'kTtioD 
havf lu't Ixten i^k^irly ^lat^^, and until Hit-y are, r^iiume had beE- 
ter be placed upon ihwt; mcutioual. 

It i* n^sx^^iry Ici rti»i>rt to miHliciiic^, nott 1 inuicr unile in- 
flammation of the if nipanum, in case violent Aym|>toin^ mi]>e> 
venc at any- time from cold, olKtrut^tioiiT tito. WJieij iht* ]mriikut 
indanimation is greatly diminished, and the disease approqcljes a 
cure, higher pt>i»i)CEi'^ Ttliould Ik k'v^ii, until the la»t trucv of dtf- 
(SJH.' that U earable has viminh^H). 

The Artificial Membraua Tympani. — An artilicinl meni- 
brana tymiKiai^ ^>v driim-bciid, hws Uvn c-rnplcyiHl for a long tiiuc 



Flo. T6. 



4 



Tovsi'iikk'n AKTirtciAL UricniuNA TvMrAXi. 

in anral practice. An American discovered that a piere of |)aper 
pufibi*d in bi^ di^jfrcd mn improved \m hmring. Dr. Year^ky, 
an Kn^^Hnhnian, took tbe hint from the geriit^man, Htil><ittntcil a 
ixrikt of ijtAuyti for the pu^n-r, and tnt.riHliKvd thi: nKlbtxl to tliv 
profession. 

Mr Toynks- inipnt\-e<1 u|w>ii ihi.n idoji und invriUed tht* in^ru- 
incut which bears his name. Jt consists of a thin, fh^xible rut>- 
ber dUk having a c^nrml tfvHot plale of silver, in whit'h i* in- 
aertitl lb»-4>tKl of a whorl sknd^T wire. The Inller ii* mrrcly for 
the purpo^ of placing it in po«ilioij and withdrawing it at 



276 THE EJ3MAS SAR AND ITB DIBBASBS. 

pleasure. A^arioa^ modificatioDS of this instrument have been 
BUggoste<l by aura! snrgeona, but it remains to-day the favorite 
apparatus for the purpose for which it was invented. 

The extemporized drum-head, be it cotton or a disk of rubber, 
subserves two purposes : it protects the tympanum from dirt and 
air, and concentrates and transmits vibrations to the parts within. 
The mucous membrane is kept in nearly a normat couditiw, 
and the hearing power may be considerably increased* 

The conditions in which an artiticial drum^head may be used 
with benefit are : 

1. In cases of ]x^rforation of the membrana tympani, eveiij 
when ooly a mere rim remains around the periphery, 

2. When the handle of the malleus or its short process, with 
a little triangle of the membrane is still in connection with the 
chain of l)onea» 

3. When the malleus is lo'^t, and the incus and stapes areitin 
in pro|>er position. 

4. When the incus and, perha|>fi, part of the stapes have bwfl 
destroyed^ but the plate of the stnpcs is still movable in the oval 
foramen, and more or less of its linibn project outwards, 

5. Ju some exceptional cases of relaxation and pouching oat- 
wanls <if the drum-hciid. 

An artificial druru-head la contra-iiKUcate<i : • 

1, When the ossicles, with the ex<'eption of the foot-plate of 
the stapes, arc al>scnt, and the tympanic mucous membrane is 
thickejied and dej;enerate<L 

2, When the ossicles are immovably anchylosed, 

3, When the remainder of a damageii membrana tyrapani is 
firmly a<lherent to (he ossicles and inner wall of the tympanum- 

4, Wlieu there i,s |>aratysis of the auditory nerve. 

5, Wfit'ii the patient does not exercise great care to keep llif 
ears clean, and the drum-head properly adjusted, 

6, When it reuses much irritation, and does not improve tfe 
hearing. 

Ajfp/ir/ition of the CoUon Drum-hetKL — A little wad of c1*>b 
absorbent cotton should Ik' moulded into a disk of the dion^^^ 
of the inner end of the auditory canal, and moistened with eqnal 
l>art4* of glycerine and water or smcanxl with vaseline. 



THE ARTiTTcTAL HIUBBAIIA TTMPANI, 



Tike mt littotiUl cl 



KTI 



Ul« «MtoD taken Uy ihe 



be illiinuniAUHl l>y iIil- txiKl niirror, aiid 

&mall angular foivci 



ejK* an<l plaoixi JirwUy 



apoD tlif- |Kiri!H jii i^>ntiiiuicjr with ttn* ^EnjKv. It may n.Mt |][K)D 
tliu stxpG^, ino^us nmllnuf or m^mbnuia tympsni, or fragraente of 
one af them ; anil by re|ieiiU-<l t-tiaii^(i»4 of ilfi ixHiiioii mid \tnsh 
mtrr, on*.- mtift d^Urniitie where it ^b>uld be to improve the hear- 
ing ihe moe4. Sc>iiielini4^ it .sliutilil r^i lightly upon )t$ sup]iort« ; 
flpiin it irhould Iw preffifd down into a iirni compact layer. No 
debcriptioii can ronvey no C3cact idi>a i»f ihi- miinipufaEioii noc^A- 
Kary, a^ the rvijuireDientfl of casts are ec diOerent. 

It jft lidtit to tuc Uiv |i)cdgirl iif (<t>lU>n in nil vu^ic* iiotil tlic 
|i*rt* bisx>iii>v aecuotoiDcd to the prcwDce of a forei^i body; 
th^n (lie nibbt^r tnembmne may be appliH, if diH'fpi*<l u|)|j)icvbltf. 

Wiwn the ear if running it t^hould be Evrinj^ed, Imvr an a^- 
ttiDgent wash ajiplinj, and a fn-.Hh pu^ce of LMlton infttwlaecd 
oow ft <lay. WhtJj it i^ dry tlie coiton should be clian^ oncea 
vrcek. 

Afler tctcratimi w establihhcd, it may be leA in position longer, 
but ihe patient should n^jiort to tlii' phj^'^mn if Jic fcrli^ ai>y di»* 
comfort in the ear, in order that pn>{>er treatment may be irraci* 

tUtiHl 

The physician ought to aj^dy the dnim-faeud for a tlm«, 
during wbii-h he ktTpH watj;h of the i^i*c, and if all got^ well, 
instruct the |arienl how lo udjitKt the Thing binisi-1f, 

Ajiylitydioa of To^hbet* Artificiat Sfemttraua 7}/»rt^KiHi. — The 
rnbber dUk Is much toL^ier placal m projicr rtdation with llie 
parte than the cotton plcttget, h is geniTnlly t»>o large, as fur- 
lusbed by tlie in8Cnimi^n(-nmk4-i>, mid h to bi- trirtimtil uilli tht; 
acoaftOmtu fit the inner end of tJie canal as cliificly a* possible. 
Take it by the wire stem and pu.'^h it into tlic imnal until by m* 
spcctioji and rcKielance it is known to rest upon the danmged 
n^embrana tympani or ruAicles. Tbeii turn il around a little, 
pra« it up, dott-n or horizirntally till hearing impmvts. Tho 
pati^t ought to be inj^lru(.<t<t] <!nrly how to place it iii pcwitioc, 
■ml ilicidd nrmovc il every ni^ht, for a week or two, lu liwiMi 
the irritation. Hi- i«hou1d ktx'p tht* oinal ^crupuloufly clean, and 
ought to cbftn^ tbe instrument for a new one every inontb^ n^ it 
^iriveU and hanleiiv^ in dry car* if left too long. 



S78 



TUB nUllATt BAR A?I1> tT« C»tSKA8BS. 



Tbe artifiml dnim-h^d roc^ivefi all the vibratkms of gduqiI 
whidi <^*nt<-r t)i(^ »u()itoiT ninul, unci rcfdiii? i]|"iTi n pfirf <>r rlie iBoD* 
brana lynipani,i>iioor iiiore<bHAiule«i,DriLrm^riien[oraiM-of tbiHti. 
it aiignutiiU Ihc n.*c<.'|>live ami tmD;niiittiD^ power and the ^^' m 
tion of the contents of the Iflbvrinih. ^H 

It pre»*i^ tin? ii^!<iHts tc>p.'ltK'r, whrn from any cwiw their t^^^ 
amontfi arc rela?^(^l nnd ortinilnr luirlA B«paratcd, anil ^tfadifs ^dA 
supporliia nitfmbruno, fhinn^l byalropliynii<l imprtipw mflstioo* 

II protects tho es|Kw«l tymptinLim from extmneoiifl ^ubstanoff 
and Hmn^'f* of tt'mpcratii r^, relieve* pninful ^.-n^iiljility, Aod i* 
tlionL^lil tn favor the oiire of pnriilonT itifiamniaCion. 

It tmj>n>vis ihj; Itourmg fn.'<(nciilly by concf^ntnitinf? vihratioos^ 
upon the uva! and round vrhhlu^'s of tli« labvriiith, whriii iriib- 
out its intorvontioii ivoiild he «Atteri?d iind loet in a niCBMit 
ii|iou tW ualU ^f an in^ennilive and inappreciat^ve tyrapanum. 

It i^ udvii^jible to apply En nrtiUcial dnini-hraid tcatalivolr <a< 
evi'iy case of deafni?rti where it neenLi applicable. ludeed, 
mnii^ iji.1^% of daifr(3«, the hearing h» iniprc^viMl by it, when I 
oonditions would lea*! one to suppose it could noi i<^i!er tn; 
servicer A mreful trial can do no tmrm^ and tbe atHictod («■ 
tients nhould Ih- f^vtm all the ehuoco. 

It isn moGterl fpipwtloii, whether it i.^ advi«ab!e to entployaa 
urtiflrial druiivlii.<jid in chronic purulvut inQamniatiDti of dit 
tympanum, for the purpcx<e of increa^iing the hearii^. It cwtftf 
soiiK! irriuaion^ i>b»*truut» tfic oiitwanl fluw of puM, iolerren^ wili 
tbe iuteri'hanire of ^"^^ and liinders n^jntion and oxidatioo. 

Th<t«it^- are all effects nbich tend to atruravate the diMttM in- 
stead of promoting a cnrv, n-* Tiia]ntaine<l by some authof^ 

On the contrary, the hearing- is improved more or IcvA, 
ing to the oondJUon uf iht; tympiinnm. 

An intelli|:ent {laticnt n'ith troLiblcMrnicdcafotftt, wh<wc 
iug and cliaui'*^ of livelihood are improved by a cotton i 
bead, may use one^ providc<l b^ clcnnj^^M the car tliorongtily* 
a^plie^ an astringenl yvstih, anti iotroduces a frefih piece of cctto^ 
every day, A piece of abwirbenl cotton, wet wilb fiunl |K*n5 «►' 
glycerine and water, or iM.>mctinK*» with undiluted irlyc«riDe, i^ 
generally used, and cases are on record In which it has pcoveiJ 
very effectuji! in impnjving Ihe bcnriitg. 




THE ARTIFIOIAL HBUBBAKA TTHPAKI. 279 

The hearing is better ic mo^t purulent otorrhoea% when the 
discharge ie thin and copious* Let the matter become inspissated 
and the tympanum a Uttle dry, and the hearing will decline. The 
nturating fluid used with the cotton probably causes a freer and 
thinner discharge by stimulating the mucous membrane, which 
becomes more flexible; the round and oval foramina membraoes 
then act with greater freedom. 

Ad intelligent consideration of the prmoiples enunciated, and 
a careful adherence to means and methods described, will enable 
one to improve the hearing by the artificial membrana tympaui 
in a limited number of cases. 



280 THB HVUAN BAB AND ITS DISBA8KS. 



CHAPTER VII. 

COMPLICATIONS OP CHRONIC PURULENT INFLAMMATION OF 

THE TYMPANUM, 

Polypi. — In a previous section, it has been stated, that granuU- 
tioDs and polypi arise very frequently upon the tympanic mucoua 
membrane of a suppurating ear, especially, when the ear has not 
been treated, and the parts have been for a long time soaking in 
decomposing pus and inflammatory debris. Folypi seldom arise 
when the parts are kept clean by frequent syringing, even, with 
simple water, 

Granulatians are exceedingly common, but the larger granula- 
tions and distinct tumors, which have been dignified by the title 
of polypi on account of their fancied rEif^emblanee to animals of 
the suh-kingdom of ccelenterate radiates, are not common. 

In the seventy aides of purulent otitis, that have been under 
my treatment during the last three years, only six were cx^mpli- 
cated by polypus. 'Two were of the firm fibrous kind, and the 
other four were of the mucous variety. 

Polypi vary in size from that of a grain of rice to the diameter 
of the meatus, and may be increased in length to that of the audi- 
tory caual. 

They are most fre<juently seen upon tlie anterior half of the 
inner wall of the tympanum, near the opening of the Eustachian 
tube, and this elective preference, so favorable to a continuation 
of the functions of the rbund and oval membranes and ossicles, ie 
due to the fact, that the muciparous glands of this r^ion are 
much lai^r than in any other part of the mucous lining. Polypi 
may spring, however, from any part of the tympanum, from the 
walls, the tympanic mouth of the Eustachian tube, the mastoid 
cells, the surface of one of the ossicles, the inner surface of the 
nicmbrana tyinpani, the edge of its perforation, and breaks in 
the continuity of tlie skin of the auditory canal. A case is re- 
corded, in which the movement of a polypus in the tympanum 




E PROPtiRTY OF 

lalMiu txM CoUiie of (lie Facii;. 



POLTpr. 



281 



t^U9«d bUral movements of tlie eyes, ami it was Gnjpi>osGd- to be 
irontMcteil vfitb iJk* dura makT, probably througli u fiiWiurc in tbtt 
poof, or aD urinauiral pal^Dcy of tile pe(ro3o-&quaTiioeal fiuhire. 

Polypi gtm'niily olxut singly, but tlicrc may Ixr ijuik* a grutip 
of \~arjou5mKfir crowding each other for space and ponrifibmenL 
TIm*t tJikc liiilcr^Eil !«h]i|t(.9, raimd, club, <in<l Iwtllu-ttliiipcdj a^ 
cordiDg to coniliiions aroooi). They may lie closely in depres- 
^n^t or ]>P03(*ct in diflV^rcnt dinvtums; tJit^y frccjutnUy extend 
onl^vrds through a pcrfonuioa in the nicmbmnc^ occasionally, 
incltMjin^ one of the OH^id^, till ibe entire tynifianum, (ib|>lA<« 
tlie OMiclc«, occlude tbo eaoal and mcatUH, and inny exercise suf- 
fidcnt prvNttire to enlari^ Uiti Oitscou^ or eartikginoMfi ]>ortioii of 
tl»e canal. 

Polypi interfere with f^oniMl vil>nilioii>i, i?aiiMt a HtopjxHl f»el* 
log, and injore (he hearing. They are often aceom^nied by 
pnUaliikg tioiiitiis froiu eim);r>ition» luiLvy tti^Jiil. vi*rti|^ir, ntm- 
Bfa, and puin in th^ head, Vfhich exieniLn down the side of the 
ntvlc and along ihe^ iirm. Th^y htivn prodiico^l h«*(niplegiu, but 
often pre^nt few Mr-mptoma ; they increai^ the irritation and dis- 
eharge, prvv<mt propter trip.'4ttnf*(i£ i>r the iliivnAfv) mnmtiK mem- 
brani^, and siomolimf?* of^rruet the oiitward flow of pus, whieli, 
M«ln»g an oiitl(*t, nuiy got into the mnjdoid ocIIk, the liitttrul sliiun 
or the brain ciwe, acid cause f^tal dip^^at^e. 

Tbirre arc four kimU uf auml polyiMt; two sw rare ha to be 
coriwn tint, and tworommon and well kaowu to ntiral «nrg<<i>»A. 
Tbe varieties an^ the Aunriooui, Myxoma, Fibroma, and the Mii- 

Anffiomaa aresof), red, irregular-^haped ^^rowthe, ariiiing in the 
mucvm^ incmltnLrwT af the tymjKinittn ; thi*y an" o<impoMil nf a 
iMwly formtHl network, or iwo^h uf bioodve*iels, held toj^1i«r 
b)' cotidd«nibl« connwtivc tissue ; contain blood corpuwtoH in tho 
a|»rciif and are cuvtred hv pavciuviit epilhtlium. VonoiHtuaior, 
or v«0oiilajr lunvui, ofa IduUh hoe nnd little rU'vaW hiiK boon 
Hoen u|ton tl^ inner wall of ihe tympuuuui. When (hei»e growths 
aro |innc4urGd or torn, cinpioufi and tdorming hemorrhage ittjniu- 
timuB i^a^vfi, und tho phyaioian mast be prepared to contbait tl, 
Thi« varif^y in foriiitintcly wry mro, only two or thrcau autii 
havings ttb yet, been rt^orted. 



3it3 



THE QFUAN SAR AND ITS III9RA5K9. 



JfjytMfliku resemble \u Uieir (XMrw tt;p<wt» the ordinary m 
eou« p>lypi> and the inicr^sooptr must be brought to bear apon & 
H^tion licforca certain clU^noeifi can be mikk-. Mrxomiu id 
l^mpantini conaist of stnictiirelf^ mucin jell^, held tog^hcr I 
no uniL^ojnoHng network of )C|)in(lloflnd irregular lOi^Dato m:I 
and ft lilx-nil interniiKlure of liner Rbn^; thov have a few bloo^ 
vea^ls, ooiiiain some Krund, ^imlar< nuclmt^d cells like lymfk 
corpU0«l«9; arc coven>d hy [wveinent epithelium^ aiid foe) aofi 
udamootli, 

Schwarire tbmkri th<^« lumora inajr ijt developed rr>m iht 
mu<y>u« tisfiie/known to liil the tympaDum at birth, tiader tbe 
slimulaiion of rympanio diiimse to which rbe infant ia «o niLfCCt 
Tlicy urc vtTy r,ircaiid ousily mi'staken. 

l^\br<moJt originate in the perk«teum of the tympanum, and 
puf*Ii the Miurmi-s m^m[Tnit»e tmtwfiril as [lity ^m-clop. Tlicj- atr 
4Xi3apo«4dof denwcoant^tivct]>«uu fibres, witli anaslomosii^ det- 
lateandApindk-c'i^lU; iirc*. sparingly supplied vriEhhloodva«eb,anii 
covered byscvtml l^iyentof puvementepitbcliuiii,iDtowhicfafibfou5 
pApiltii' project OA jn the ^kJu. They do not nliow pnpillw iipma 
the surface, but look bkiisb-gmy, smooth and toug^h like ealloui 
akin. No gUn^^ or ^yi<ta are fotitid within iboH* growth?, tbt 
glands of the ex[nii]ded nnd thinned muooiifi membmne hariDi 
been dtmngletl liy ih*' prv>*ur<: t}\' the iKilv tibroit?^ ti*«me. 

This variety of tumor m eeeii next in frefgucncy to the uufoai 
polypus, and ifl coi^ly recognized after rli^ning by the rulor.nxi 
flirtescy and dry-looking surface. They resist WUde-BlakeV 
<iiaie, and I Ijave known lastancot wherv the U9ual ailver wire 
was broken b attempts to cut them lhrou|-h a tittle euuide 
the bxf^. 'Vht*y nfli^^t rheumatic and goiiiy |iaticnta by 
enoe, and grow very slowly. 

Mucom [kolypi arv gmniilntions nin riot, and they are mm 
frequently seen thai^ the ibrcc previous kinds aitcqc^htr. Tbcy 
are pur|>le, [wle pink, bltil'Ji-riHl, nispberr>'-rcd or crimmi b 
color ; (heir surface is ^mootb and (^li^tcTiin^, a little papiUajytir 
lobulated: it \s covered at the Liose with evlindrirtil, acptnetiiocs 
califtted epitiidiimi, and on o(her portions of the surfiice by dal 
of the pavement variety. This ia many layera tbiak^aivJ herr 
ami there 8end.i tubular |m>ec»t<C4 of e|>ilhclial veils into the UinK>r. 



ft 

I- ' 
V 
tr wire 



POLT?I. 



283 



80 Ihatft wct!on lus nii nppcanncc ff>cn«thing like timt of an 
epithclbma. Tli^ee tabular prooeatr^ arr hyporpWtic A>rmatioTis 
of tbt' fT)ati<]ii of the tympanic mu<miA membrane. 

Cystfi, lined aiMi filled by epilheliuni and mucous fluid, some- 
timci exist inth<«cpolr|»|Owing1ooIodareQf tJie lubul^irglmidfl, 
thus forming true retention cysw. 

The juiljrttaiw^r of the gnjwdi!* coiiftiflto cf ivnlinary loow oon- 
n^v^ve tifiaue, with spindle and stolbte ccIIj*, contajDing !q the 
iiili-f^pitn^ many grnniilnr oelt^ nnd mwrh muHn. ItiootJveit^ln 
enter the base of polypi) run tbrotigli thi* ocntir, ai>d dt^ributc 
bnindiet to all S]df!« quite freely, fto that iiiion removal (here !fi 
frvquently a copious hcmorrliage- These tumon* grow very fast, 
and sjiring tip mpidly afler removal ; they oDeri uleernle i:]>on 
the outer extremity, and arc the kind gi-nerally found in di»- 
ea^ ear« of scroftiloufi patients 

The diaj*TK»is of a polypn^ jp^ f^nerally an v^y afiiiir. The 
ear should be syringed and wipe^l cl^n, a efpcctdum iLitnidueod, 
a&d the pnrls illuminateiland cxamin^. A fine probe or a plat' 
inum wire lorip will inform one of tlio coiulMeDce, mobility, sa»e 
and atucbmeni of the jfrowth, as it «m l«? pushed between (he 
tumor and the camd wnIK nnd moved nUmi fraily in mort cnMi, 
The s|K)t from which the growth sprinj^s should be determined 
dsi nearly an ponEtible, »a ihaL n nuHre for removal mflv be applied 
properly. OcenflioEially it is difflcalt to find out the exact spot of 
implantation. Polypi liave arli^n intlirr ntnal, evten<lcd into the 
tympanuiu, and }ierforat«I the windows of the labyrinth* and the 
mafftOH) anlram ; but tlicy arc eenemlly rooted in n d«e|>er ihwl- 
lion than llwir projecting surface, 

TnatmatL — Aural pc.lypi sliould Iro removed aB fi&m iwdis- 
covcrftl and w often a* ihey recur. Unio© thi* is done, it will 
be impoHsible to cure the difieased mucous membmne, cr to inBure 
the safety nf rhe pritit nt. 

The growtlifi are somelimes constricted and cut off by the edjfe 
of a perforation in the mcmbmne, and the pressure of pus behind, 
aud tlirrcie no doubt tliey somelim^ undergo ulceration at the 
tasc, aa they do u\^n the imtwani aspect, and are thii?* diw^harged 
fpODtaneoutdy or upon the first attempt at syringirk^, Tht«e 
resolta are rare, however, but when they do occur, they Bliould 



THS BFMAir BAR AKD ITS &I3IABI9, 



not be accredited to llie action of any ruedieine givcti iolvniallyt 
ft7< hns been done br iM^nic wnt<-n< witti more crcdulhy than Kicn- 
tifte knowled^. 

There itre three methock of removing polypi from tbe cufr 
which ] vrill JcsfgnatQ as th« desiccatiDg, the aitiKTizmg, aud lIk 
^urgind. Thi^ imgiomiuf aad myxomiu are to teldooi encotrntotd, 
that in treatment I will oiastder th«ni with the mucot» grovtltti 
tun 8oft polyjii, aiid will call the Abrocnas tlie fibrous potjrpL It i> 
well to be prepared vritb hiciuoetatics at all times, but, especially, 
when rtRioviri); an an^iomn, or i»t:vii^, va copious hfoiorrh 
may bo cxpodcd, tJiat is somolimes very oh^iimte. 

K^^urrciit'o inny bt^ predicated of the myxomas, but all 
an.' likely to sprout up again aft«r nnioviil, 00 that in all cafiCi' 
tlie total d^tniction of the morlMd growths sbi>uld lie in^ttrcd. 

Soft polypi of small mzc may frctiucncly \k made to disappear 
under (lie coutiuuouA action of aAtringcnl solutions, iustillcd daily,. 
The remedy constriit^ tbe tuwuo and vcEfiels of tbe growth, whi< 
d^oenU^, alirivela and linally disappears, while at tlw same lime 
the solution ciiuBQt gruuuIiicioiiH to undergo tlie same proc^w, and 
the iiiucouA memhran<! to bkkcon a lit:;ihhicr ikIhv), 

Alum, aulpliab! of xinc or sulphate of ropper, in aoltitions of 
ten to fifloen graiji^ to tlie ounce of water, may be instilled in the 
car twice a <Iay under the phy«iciaii'rt aupervigjon, until tlic olijeet 
U eRectedf or it bcoomof evident that the growths cannot be re- 
mi)vt*d in thi.H mnniier. Tbe ^lrcnj>th of the c^iolution must be 
dimini^LcdT &bould too muck irriiatiou emne; tbe action upon 
a tnnior may be increased by priching itwitb a cataract needle ai 
»u.^>i;<.^tal by Dr. Koo«a. Tins clcaccatiug method b very iiuita* 
ble for fnlctiouii children, and ought to be tri<Ml !n mutable cosck. 

Soft polypi of modcrute size may often be dwtroyed rapidly 
by caustic ttpplienttons made by tlie phyntcian. Tlie pure »olu* 
tion of MiUulphuto of iron, a oatunU^^^ solution of nitrate of 
silver, chromic or nitric aeid» and burnt alum, are mo»t appro- 
priate for tho pur|Hne* Th^ h^t remedy ought to be blown or 
placed upon the mmor every day, and kept there in the imcrvaU 
of application by a j)U*dgct of o>tton* The other agents «houU 
be applies) by a lufl of ootton upon the hotddTj as already de- 
scribed, and, aAiT a few minutt^ interval, the cor should be 
syringed with tepid water, dried carefully with cotton^ atui a. 



POLTPT. 



285 



. of cotton led in the enr to mtch the dmtniLgc from t)i€ 
slongb, vhi^rh will othf^rwise excoriate the meatos; the wami 
doucbe 8boiiM ixs Li*r-l rivijutnily to<*lwin'«; the parte. 

Fngne^its of a polypus rauy be removed by forceps, llic root« 
of iIh> growth CAuTcrinid till alldi^^ppmrrnnd tli4m tho Irmtnwnt 
adnpled to tho conditioD of tJie muooua membniQe carried on to 

When tt polypus cannot be removed in any of thcw ways; 
wIhtd it it} of goodly hize and eit^ily seized^ €iup«rtally. if it \j* of 
the iibrouA MirTety^ niid ihc p!tlit-nl t^ old onoiigh to be managed 
easily, it » better to resort to surgical nu'ii&iire?. 

The in^trumpnU iiH^?i«*ary an; f^w ainl iuoxpeiiHve; Ttw an- 
gular forocpe, and thePonicro^forccpehavc been already ftgnrcd. 




Hnrrov's Polttu* Fobtrp*. 

Hiaton'ft rinj^ polypus foi-oi>jM hstve lite bla<]efi fenaitrated ; tliny 
do not slip vhen the grumh i^ ^ei^*d» atid ihey arc bent at an 
ai^li^ like tiic otlien, so that tlie hand does not interfere with 
illtiminution. 

The polypus artd surrounding parts should be well lighted up 
by the hiTfld-niirror. E-mail polypi may be pinohfd and t\Tieted 
off by Uift looting fon.'^^ijs. Ijurgcr ones, llfttj round or ovil^ 
«J>ould W m\7A}d and crumlittl with the Pomeroy or Hinton for- 
wps, and iwiste<! around and fre<^I from their ba^ by the exeroi**e 
of a littb- diictt-rity^ wiihont nMnoving the Hnrromidin^ litwu^ to 
an injurious extent. A little more care must be exercised io ex- 
tirpating the Rhrou)^ KroHth^ tu^ ihcy have dctp and «trong iittiKh' 
ment^. Mo^t £braua pulypi and nctii [Mtlypi of flueh a shape and 
eize, that a loop of wire am Ik* ^^lipp^.'d f>vor tlicin down to the 
base, ought to be cut off by the Wilde-Blake snare. 



286 



THB HD»A3t lAH A5I» ITS DieiASIB. 



ThIacoAabia of Agnail Mjiiaiv rot) ori^ocl, witli t fixixl rin^ iipcn 
one I'IkI Tor iia: thumbs utid n racket in Ui€ oiher, into which fife 
a£ an nfuuAe an^^le a Blemli-r ^ii^'l tulje. CiiOB Ute JHjttiUC rod b 
a Alkling mnulo, tiavlug u ring for the forefingor beoeatfa, and 
a buiion ahovo, co vrhich ih faAiened Uie enis of a fioe silver win. 



Fio. 78. 



^ Zi£MA//i^ AC^ 




WXLOZ'UtXKVfS 83(AAK. 



TliiH rlniiMo wire ]iGMi.% tUn»Af)% the tube ami pnij«rU in ftl 
Trom tho distal end. AVlien ihe instrumeDi U hold proper1ir,a 
the forefinger U drawn towards tic pnim of the Iiaik), lu in |iull- 
\n^ the tri^p.T of a piste], tho wire is dr^wu upon, and the locf 
made feuiaUer. Whwi the loop w nroiiQtl a polypcg, ttiis ftdion 
will out it off c:loaii, and brui^ the baf« eooDgli tc liioit tk 
bemorrhogo* 

Fio, m 




To remove a polypiiB with thin admirable iiiHtrairK^t, iHatni- 
imte llic [mrl-i by the niirn^r^ ^-ithout iutrodiicirig the fi««tilooi, 
slip tb? wire loop far in <jv«r lie growth, with the tube upoai tbf 
eide where tliere is most rooDi^ hold the instniment firrolr.w^ 
pull the aiiiuia tht^ toward* ihe band hy the forefinger. Tb* 
will gciiarally cut the polypus off at its bcase, and il will fall oBtj 
as the iiiHtnifnent is withdniwii. 

Some fibrous polypi break the wire of the snai?, and dr >*| 
dense and tougb^ tliat ihvy require removal pieceta«a] by fottefh ■ 



»EC« TOHORB. 






koife, and blujil pointoclaciSBore. A special pnir of »i3&ore with 

blunt, ourvifil Macl^ will [>rovi- m*iUi\ ona^iniLillw 

I'olypi arcicscnffitivpgrowtiis,and Ihcrt will iHiljttlepaiDfrom 
liii^or«utiiRg Ui^'Uipbiitthci^'Limlnnii ivm^Riiiiim are hyper- 

seoMtivi'r Au<i thf* laanipEilatioa for tins and oth^r n^o^ns «liould 

be very ffWiUc 

^ Hemorrhage aiW abdci^^ion or removal by other mcQiis is gen* 
^Bpallf »JighL I usually injcrt tlio cnr wJlh cvhl water, iinlil the 
^^lood ooascB to flow, ihea drj' the ear with absorbent cotton, and 
I touch tho base of the (tolypu^, ami any lari^e j^rarmlaiion^ that 

nuiy be d^ht, with one of the caiitei^afits previoufily mentioned. 

Th*^ ^:icc» of this i?* to be wa,*bi.il iiwny, ibo «iJml Hgnin drierl, 
^^nd a tnfl of abaorbent cotton puabal in ^ a protection from cold 
^^faid drainage, 
^^ The roots, or ba3e, mustbecauteruedtmtll tbefiurrac^isHmooth 

lod the lenduDcy to relapse ia arrowed, and it ia belter to tixv »^im- 

1^ water doudieA, three or four i\mt*< a day, to remove slouch 

anil iiiRttcr, ait It^ng as the N*ver<* tneajsurw are n^jcs/^ry. Ijitcr, 

the afltnn^ntfi and ntimtilaal^i a]>propnate ti> the oue, and the 

meMorffi described under chroniu purulent inflammation are to 

bi <mplo)'0(l 

^^L Id caae heniorrhajiȴ should persist afier the removal of a poly- 
H^hs, plug the ear tightly u ich i^yptic cotton afid apply a pri*^ure 

banda^. If tlia should not arrefit the blond, a ^luiikted eoIu- 
t tion of tannic ftcid, or the oflioinal solution of flubeulphalc of 
^^oa may be injecited into the ear. 

^^ Id a SAvere cam, occurring in a plethoric patient at my elinii; 
P atl^ Pitt&hnT):h Ilo^piial from removal f>( a mueoua polypus 
} after tlxvc nii<a:<un» had all failed, and the [Nilteut had lo«t half a 

pint of blood, I arretted the flow by tamponing the canal mth 
I wadt of nkmt cotton, rolled in pure tj^niiic udd, TheM vera 

removed the next day, a cautemnt applied, and the woman waa 
I finally dtT^-har^Kl mr^h 
I Other Tumors. — There are other frrowtha cNxa&ionally fieen in 

thrr tyn){>annm aod temporal bone during purulent inflmnrnatiou, 

either as the consequenoe or the cau^e of it. 

CHokaUaicma may ariso in the tempoml bouo or lympanio 



m 



TffK RtfUA!r BAR A5D ITS DlflSiSlS. 



iiii]ei>ii$ mcmkmnc, aiw! n|>|Ktir a.h snirtU pearly gmy tumors wbid ' 
gi'iulually increa^, extend Inlo ^urroumlm^ pArte nm) pnjeri 
OUtwanU mio rlio miml, !uf>kLtig not unlike a fibroas poIrpuB, 

The tumop conj^ifete of a loo« maflaoffiiUy epithelium, chol» 
terioe crj'r^UiK Ehnnuln of fiingos puH eelis, and ioflammatrirr 
d^briif. ThUca^eou^ matter increa«o« npiilly; mtitiiniftt jieoe- 
iTaU» the nuutoid celU, llic FallnptAii canal, the labyrinth, flod 
the intornal auditory mGatQj^ caufiing pnralysia i>f individtial 
nerves and it^enin^ili^, 

Epithdmma !« the lurist common of oil the malignaDt diwmi 
of die 1yni[Taniim, mid arl^^f^ from purulent djsea^ of the muooin 
mcmbnne. This is another fact that shows the ncctwtty of local 
treatment In nil ^iieh rw^ca^. 

Coroinoma and Sarcoma, — Medullary and t^cirrlius carctnomtJV 
and S|HiidItM>-llcd »tid ostwiid :<mH>ma.H ariw? witliiii the ear, iod 
invade and d^lroy the interim! ear ami mastoid cells; i>r tbty 
may originate* iu the parotid, in a crervkral f^land, or in the tiann 
fiTouud the auricle, and extend into the tem|>oml bono and bnun, 
cauaing destruction of the ear, juid fiifjil (Trebnil dltaifle. 

Treaimftd. — Th<r tn-Atmenl of these nilventitioua growths niiwt 
be aetivo and radicfll. Kxtirpatt! all of the morhid tamor poM- 
ble, cauleri^^e ihe wnnnd with one of the acida or the actual «ii- 
ti^ry, U(x-p (he parts wet with a r!;olution of nu'liolto and and 
glycerine, one part to sixfj", and treat morbid oonstitutionat symp- 
tom,^ DJ* expeditiously nw |HWMl>le, 

Arseiiii*tim !(>d< and Kuli liydrliHl.arecanddet^the moetii8&. 
fill ri'Tnudk-j« aj^inrrt malif^nnnl }:;r(i\vtl)9. 

Exostoses, — Exoftfosej-ooeiir upon thocwiclw and the t>Tnpttnif 
wall* oc^-aHonally, durinp the istwx^ tif n purulent intlanimalicnif 
Lliough thi-ir ii.tiial ^*at in upon tlie wall of the external <:aiia]< It 
mui^t be remembered, thatthc diuoou« mcmhmncof the tym|nuiiia 
and its perioi<toum are !k> intimately blended, aa to form pmcticatU 
one covering for the bone, and naerioiiji inrtamnHiiionof ihisdani 
luerabrune ineludt^ two prooefisPS ; a superficial aifertioQ with m- 
creased Berrr?t[r>njand a pcrio»titi}t with a tendency to ossiOodepofil 
u|>on the hone. 

In every kind of inflammation of tlie middle ear, there ii a 



lYOSTOtTS. 



989 



tialjilily to )iypcroAb»m or exottlofiiA, and iih probable ^me slight 
inCTcai^ of the hone takffl place in most ca^c?, though it in often 
impoe^iblc to rccfjgniKC iU It 1^ only when th4> defKX'iit U oonaid- 
«nil)k* in amouDt,or <»ccur«in &maU circiiniifcrib^l itwclling^, nod* 
iites or ftpkulw, tliat one oin make a positive din^no^s. Even 
ihcn ono must »tiif]y tW history, and rcmt^mbiT that ttiey may 
Dot be Dew, for Ixmy tumont of all air^ii, even^ Jilling tJi« «Dtir6 
tympanum, ar« ocvu«ronal!y coDj^uitnU 

Thm<e is gea«futly a hmvy, filop]>ed feeling ut tlie ear ; dimin- 
ii^ml beuringf and if inHarumation «xi«tA, a dull throbbing iiain. 

The tumors are generalty phikiBh or yeDowBh-whJte, Btnooth 
aod fthitimg, and, if ihir finru art; cliTttii, ihvy uttnwt tlio attciitioa 
inirmiiutdy. They occur mosi frequently in scrofiiloafl coiutitu- 
tiorts, mid are often ruiixmi\yan\ed hy chronic ^uppumtion of the 
miii\>i]j« mi^mbrani.', aiu) liAtuloiiB opening leading to cnrious bono, 

I hod A boy undf r tr<^tin<Tnt fi»r rhroni<^ purulent inlhininintion 
of lx)th cans ^f st^veo years durati<*n, faulting from scarlatina. 
The ilrum^he^ii^ and o^Si^Icm ViX^tx^ ^ne^ the miHHiu^ membrane 
wa# t^tKxrnlert and granular, and nodnlar csoetoBes projecCed from 
the inn«r vrt\\l and the flcrorof eath tar, tlius diminishing^ tJie 
cavities con^idenilly. The vK\xWh <H)ii]d not Ix: hoird on contoel, 
bill loud voice ami the fork were appreciated, and inflation eaused 
a low hw from e<i<'h cur, Tkriv ww* pmn and iwitlenitw^f but 
tio liAtaln Dor caries 

ItbcumatJ^m and fj^out are^ eh»T}r<>d with pronioti:ig the |;rowth 
of thetc tumors, and it is ver^- natural to conclude, that diatheses 
which arc recognized by intlainmatory tendencies of Slirou;i tiw^iu^, 
thi; piTio^tenm, faM-ia?, ligamcntf;, tendone, etc., i^houtd not leiivc 
Ihe middle ear unaReHed. I have atniafly mentioned tbat they 
promoTc the p;rowth of fibrous polypi m punitent otitis, and thia 
kypeflropliy of fibrous tiwtie outwardtt ma^ l>e acuom|Minied by 
more or k** oj<«Ih' rlfpo*it Ix-neuth. 

In the oclerosis of the tympanic mucous membrane, and tlie hy- 
pertrophy which accompanies this condition and chronic catarrh 
of tin- tyrnpnmuti ni)d ttilx^ hyp<>rf>Hto[?hU in ii fr<<q il cut occur rence, 
and often render* eflortn for the restoration of bearing nug^itory. 

Sometime* tliiA bypero!^to«i-t entirely «olidifio« th« ma^oid cells, 
and consolidates the proems into a condition of ebnrnatiou. The 
iDo«t ri'tttarkablo cftse of intra-tympunic exo«lO)<ia 1 have ever 



890 



TAB HUMAH BAH Al 



IBAEK6. 



Hi#. She wii» well il«velii]>cil, fl<;tlij, viid pk(lK»rt<^; af iterro 

t^ie had bceu tuiirrietl ugLt vcjir^ wiilioiic }iavin|^ coDCOTn), 
owiiig probably to conical cervix and niirrow oa tmcK, ami rtir 
fered O'eqiiently from (li^nJi-mJ digestion, and rbeuotaifc (ifiiu 
in Uie cxii^mities. 

8l]<f bul Iiud Knrlfttina in infaiif^y r<>inp1i(.-ji»x] by purulent fo' 
flamTDation of tbe mlddJeears, which had oontinuod tiom« moathi 
and llien cmaed apontniiouTily. 

Upon examiDation, 1 found H. E. Hw. ^ ; Lu E. /|. Tb« 
pAticLit hc^rd loud voicr, and Uic fork upon the vtttcx wu beu^ 
dearly, aod best oa the kfc ude. 

Tlw rj|;^it auditory onial wut dry and nuarly Dormal. Tl 
dfum-h?ad was whilifih-gray, much deprefti«l, irregularly vrriiW 
kltxl, and adljetvnt to Ui« proiuou lory around lire foit?<hi 
and lirmly iixod roalteus handle. 

It3 peri]>hery had a wide ^"irderof j-ellow fibnms llii<'ki 
and dc^Dcration, and two dib-tiurtf stonH round exostoeasoof 
from aljovfT tli€ oval wimlow, tlie otiwr from Ix'low nnd in front 
of the promontory, pushed (he drum-head otitvrard, A ballooa 
of inembmne the ^ixo of half a gtain of Hce^ f^ifuated U-Iowand 
behind the proDiontory, ww^ litVd by inflation, »hovriog that Um 
EiiAbu^liiaii tube wm jiervioiu and the tym)Kinum uo4 euiireJ; 
obliterated. 

The condition upon tlio Icfl side ifOA even more mnarkable. 
The canal vas dry aiul without ccnincn, but tolerably hcaUliy; 
(Ik* driiru-hi-jv1 wil^ ftiuoorh nnd dirty whih>, exoi^pt a anal) per^ 
pondiculur bund of gray alun^ the niuUeuM hniidk and utouimI 
the »hor( proce«i£t. Jt vrm lirmly adherent throughout iU 
Un tlie inner tympanic wall, and strong iaflation did not 
fibre. The adh^Lon over (he promontory embraced in i solcoi 
the dinpluanl malleus. The anti-nor And |>o«tL'rior [Htrtioiu of tbf 
tympanum were each filled by a yellowudi-white, ^Dootb^ rather 
llAli<x4K<litsLj^,)tiir)n^ingfrumlhcinrer wall and rx(fndinf;i>iUvinl« 
Co the inner end of the auditcry canal, and iiavin^ tlie re^wc- 
tire scgmentii of Uk drum-head »tretd)od lirnily ov^r ibcm. Tbr 
outer surfaces of these growdi»i were inclinpd tovards each otbcr 






MtALTSIB or TUB FAClAt 5SnVB, 



291 



Dearly at a right uagle, the cEDtml tliiotier portiom forriKH) fbe 
bonier of Umt vertioAl sulcim of gray membrhim ty(ii|ukiii Tieforc 
mvtition«d. A probe poascx! ulong tbo anterior and ixwtcrior 
vuIIr of ihe fliulitory miial .struck the tumors upoD a level with 
tliv fltmtiluH ; wbvn inovcyl to tl»v centre of the ouial, i( ]]iuh«c1 
deeper until arre&t«d by the aiembrtine and maDeu^ in the ^Icua 
between tiw Uitaor^ aotl upon Ihv inn<.T tyni[>anic wall. 

fixoitoees ID the tympanum amy attain a i.'erlain *i\iaj und be- 
come i^tationary, or iDcrcof^ until they destroy the comlucting 
ii])paratUM aiul oaui^ total de^-ifne^. They nrc dan^-n^ti^ wheji 
iBBOciatcd with ptirulcnt inflainmatioo, as thoy may oiistmot the 
ouivnud flow of ptLH, and indnr^ mjiHtoJd and t^*rel>mJ di:^*a,<*. 

Trtf^ment. — rrcatmcut is of little: aivail lor tho removal of 
€xn«toNft4 in llie tympanum, and he would be a ra.<h j^urgeon^ who 
AbunM uttompt it by mtxhauicaJ means, uiilesi it vrm a qucfition 
of life or death. 

It niigbt boo(inK< nccewury to bore through or chisel away ao 
obstruction, when a clof^e Atiidy of the eomlitioiiH, an<l the princi*- 
pl€« of conservative i^urgeJ-y inui^t gindt.- iUt man upon whom 
the great re^jMmsibility fall^. ForLunal^^ly the oecAAlon 'm ex- 
tremely rare. 

Any disease of the ear should be treated acmrding to dired- 
lioQS given ehtcvbcre, and (he diathesis of tlie i>atient should be 
dulv considered in the fieleetioa of tnedieinee. 

The niuler is rofcnod to the article upon exoMtOSM in the ex- 
ternal auditory canal, 

FaraJysis of the Facial Nerre*— riu> eomplicatiou oocars 
ooi^sloDalty in di,'*eftiAe ol' llie ear. Thi» nerve paases through the 
Fallopian amal in su^^h clo«e proximity to the tyenpunum, an- 
trum, anil n^«toid ecllA, thiit IciRammation in thfse eavilie^^ elTa- 
aiotifl into the cellular spacer, and caries of the temporal bone are 
liable to txert pr<*Kure ui>on it^ fibro, and^ even, to dctttroy tbeir 
cominaity, 

PerioMlitiH and exo^to^m, uffvciin^ tlic internal auditory mcatui^ 
or ttie Fallopian canal ; the use of strong oaastiiB in tlie tympa- 
num, when the nerve trunk \n cx)h>^h] bycari<s; traunmtic in- 
jurj" of the bone; ecM>mldi^j£er and Lumon have caused jiaral- 
ysis of the &eial nerve. 



292 



THB QCUAK BAft AKD ITS PISEASSS. 



Tbo syniptOEDft of poraljTSM arc cosily rraogniisedr %m\ varit- 
tionn in them enable one to determine with con^dorabk certaint; 
the locality of the morbid process upon which tlic U^od deprail*> 

Hie general ffrmptoms nre pnnilj'hia of tJie flide of th« ftfe'i 
immobility of the fealurce of tlic one, in stmnge coiirast to tbt 
mabiHty nnd itxprt^ioii of tfio other i^ide; inability lodoae tb« 
eyelids, the mouth drawn to Ihe opposite aid*, the chMk ft- 
l&JCed HO that food remainA helwiMrti it and the teeth ; oocasion- 
ally, drooping of on^half the velum jtahiti, poiatin^; uf thr 
uvuk to tli<* [mmlyzi.ll mh*, iiikI ftnglin^ imil defanive j^^ral 
and ftpocial ^m^iltility in the hilenil portion of tlie tongue. To 
thase nitty hf atUM dvu^iuc!^, tinnini-soni] a heavy fcelii^ in one* 
hair of the head. 

IntrA*cranial (li»i<axc ftiTw^ting th<? facial vrill,al40^ inj»re lb« 
softer auditory nerve. There will th^n l>e paralysia of the ste- 
pcdiuii muM'le ; Honio daifniiw nnd. piThujm, tinnitus, from a dia- 
titrbflnco of the correlate action of this and the tcni^jr tyiDpaju 
maaole ; relaxation ut the mi\ pi*Iatc, pamlji*is of the choftU 
tynipanif with its phenomena of numbne^, Beml-lat^ral Ion of 
taMCf and itKToiMed enlivary secretion - and immobiljly of the 
auricular, farial and other nni^^Io^ to which the fibres of the por- 
tio dura an.- distributed. 

IjCt^ion of the ninlitnry ntrx'c will l^e apparent by partial or 
complete !«« of hc^ng of the tuninjc-fork, vibrating upon tbt 
m^loid and vertex. To thew ftignilirant :jiyrnptoniA will W- adikd 
pamlyTtiA of other ltudluI nerves, or such di&turbuuec^ of ccrcbnii 
ftinctioDs aa to render the diBg:noitia ewiy. 

Whoii the facial and auditory nerves furaif^h tlic charactervtic 
ayTDptOGifi of paralyaia, without any aignti of oeretiml cUiOi4ef| 
lJ>e \t^\on will proliably be found iu tlie inKmal nuditory mi 

When the auditory nerve is little aflectcd, as shown bytlit 
tnain^'fork, an<l the fheial wilh iu: chorda tympani h lumlyml, 
the l&*ion will be in the Fallopian <7in]ilr between the inleml 
auditor/ meatus and the [Aws- ^rhere the chorda in f^veu oK 

When Arith immly^i^ of tie hcc, tho chorda tynif«uii te naaf* 
fected, the lesion will be found below the plaoe where it Icava 
the fneial. 

The facial ia sometimes tempcurarily paralyzed by e3i|JOctui«Eo 




MASTOID DiSlAei. 



i«oU, m vhich peripheral fibres only Ate suppoeed b> be 
fid DO afTe^tton of iho bone <mi l»e dwoynstrut^^. There in 
no doulH c'onj^rtittoi) uf thu pcTincuritim or of the ])en05teuiD in tJie 
n}:i»ioid, ^bkh causes prcB&urc upon tlie nerveat (li« f^tylo^iaa^ioid 
roniiiieo, <ir a Ullle w»>h up tht> Fnllopiaa canal. Tbepro^iio6i« <li^ 
pcnilii much upon the cuM^e of the paralvHb, but, in general, b 
Hkore fiLVomttlu in rixxnt tlun in <1minic cnj!«H^ m youHi Uiim in 
tnoture age, in the strong and heal1h>\ than in the Btmmons and 
feeble. r»ndv-sifl from cfild^ uail^r mfljimmattoti in the tynipa* 
nuni and mastoid cells, and application of strong caustics is more 
nmetiiible Lo treaLnicnt, thiin tlmt ocnu^ioncd hy tmumu,mrleA,and 
iDtnt-cmnial di«.^Lse, 

TmitnKwt. — No ^{KMriid treatment U4 ret^ommemled for the 
nerve, but that moet appropriate for the morbid conclition cou- 
ni.x*t(*'l wilh thi- pnmiyf*iH ofli-rs the iK-st pnkf4[M%i of a eure. 

Mastoid Dis«a3d. — The mastoid procese in the adult con«i»to 
of a tAiM of co[i)]t»(^ bone, iiicloMi^ a K^^I* ^^ '^^'g*^ commuui- 
eating cells, wlticb extend above, I>ebind, below, and outeidc of 
tiw middle ear adi) the inner en<l of die external f^nal. The 
cell^ on a level with tlie tympanum Are horixonLal, and tlio^ be- 
low tlitm an* urran^l pcTpcndiculurly. 

The eompact tissue is coven^ ouL^^ide by perioateum^ and tbe 
cellular i4[«c!eH are lined ity a {M-riiij^uiJ mucous nu mbiune, ooD* 
tinuouG with thai of the tiF'mpanum through Ihe antnim and 
o*hrr openings in the poslt'nor wnlK Thi* wutinuily of mueous 
snrface rendera the mastoid ccll^; liable to inflammation, when- 
ever the tympanum » thus affiXTtcd, Probably tticyarc inflamed 
to mtttt di^ree in all .^vere eas«^, as ma^Uiid di-'^one has ocx!urred 
rarely vrith the membrunu tympani intacrt, but the (rcatmcut in- 
stituted for the middle ear di-tea,"^ umially rdiev^ the mastoid 
cocDplication before it has reached a stage To give characterwdo 
eympromtt, or lo require pitrtieular attenlion. The n.-«<ill« arc 
Dol alway*i so linppy, however, and the secoadary inflainmation 
goes on until it merits a special designation, aft ma^id diMaftc. 
Owjnjf to a rudimentary i.'onditioQ of thi? mastoid in childrcD, 
they are sabjcet to a le^ dangerouri aifeetion dian grown pcHjple, 
whirh UMaally ends in caries above nnd behind the exlemil 
roeatua. 



3M 



TffE aCUAN EAB AE1D tTS tISBASKS. 




h oinnot be ftfBraicd vritli cfrtainty, tti«t infliuninution of Af 
mastoiil oel!§ ever occurs diBTODuected from a HKH^kl state of thf 
CympRimin, Imt thin mn^Iition may vury grmtly in ilifivrrDt m- 
dividoale, and caries of the temporal bone exist, even, vilhooi 
tbc membmna tympuni being ])crfDratecL 

One may enumerate a^ eanses of mastoid disease : acute J 
inntii>n of th<^ lyin[iaiiLjm ; aciuc exitficrtMitloD of chroole inflam*' 
maUon ; stuffing of the cell^ with pus and the debris of cyiuptme 
HuppiiratioQ ; purulent inflaumatJon of th<^ middle mr^ witli ob- 
fltruclion in tlie vxtemal ranal la the escnpe of pos on aooouat of 
a polypu^ a H?(|U6»;tram of boiw, an acuto swelling or f'Jtoslom; 
and imri<^orUielHine,arL'iingin broken or stramousooaitimtiooa. 

The #ymptoim of mastoid di^caK are sufficiently wtll markcJ 
to attract early attention. I>urinj£ the mur^ of ooe of tbeauni 
diwflsCB above mcmioocd, ovinii; to cipoiure to cold, tiio Ktnwg 
an instillalioQ in the far, n blow u]x>n the head, or sonve of tk 
locail onnilition^ mcntioix'^I, incrva^ed cx^n^^ioii of tlie macmo 
membrane of the tympanum and mafitoid cells supeni^ewfi. Am 
di9dnrgc that htm prcvioitdy uxii^litl fnim the aadilovycand 
dinuniflkeA or i^-«^e«. not alvniys, bovever ; a lieavt ochti^ pan 
U'j^ins deep in the ear and mastoid, and extends to the occiput; 
tdiarp tntermitllo^ jiiiiiiH vhoot through the 8idc of tbe head ; tbi 
fikin ov€r tbe m&aloid liwomtis rod. slightly swollen, and a'DSliT? 
lo tli<' loucb, and the patient fooU diilly, urionjiforiable and ncL 

Tbe simaa of aeute diwafw may now suUide, ovrinj^ fn HiKcila- 
ncous tvini^vnl ^f the cuu^e, or (o the general treat4ncnt adopted; 
the tiseues behind the auricle may U&e their conf^ion, and tbi 
milde]-KymptL>ni» of tlie priniarily affected t»4ue» become pioa- 
inent. 

A free incision thniugh tlie tifflue« over the mastoid mar 
empty the engorged veaeels, and relieve the comprosnon of tht 
nnyir-lding pi-riiKlciimr mo tbut nmcliomtion of l]ii- !«ymptnina may 
ensue, aud the masloict eomplications gradually diaapp^r, 

Tlie aymptoma may not rcacb a higher grade tlian I ham 
nientinned. Th*i romimrt etjrffi^v of the mammillatod proc»« may 
yield Vi file preA^ure from tlie exudation within tlie oelbi, tiif 
painful and danf^rou^ symptoms dLsa[^>e«r, a Rmall 1rar4 of bpat 
Ivvy^me earions tho punilent producii puiw through tlie pofiterior 



wsll of th« auditory canal nml run out of thi? mcatos, or distend 
the tisBUce upon and belovr the raa.''toid, and forra a |Kiet-Auricular 
abonaa, which may opon spontEincomlyf or soon attmct Uie mt' 

IJnfortunately «oni^ nuica do not follow anr of the hcnlgQ 
€Our«»< sk€t<:liiHl, but {>rorcMl in n miu^t in:di^nant uml dung^rcwft 
vay. Tbe li^iie* behind the ear and upon the aide of the neck 
swell mon.' and more; the ^kJn bociMiR*!^ deep red, ftbining aud 
ffidcaualoiis ; the \mris feel doughy, have a laUe llucluation on 
deep proMire, uvrin^ to droj^y of the oolluTar tiiwue, and the 
aurkde b puHhecI out from the head fiomfHmi^ to a rlglit angle. 

The pain bc?oomc» wry »;VLTe, e^|K<*iaily at night ; »ltaqi par- 
oxysmal |>uiua shoot over the hcail and down tlie neck; the 
&dal nerve »oineti(ni-» t>ccK»miM jtantlyzed ; the alR-etLxl r^ide of the 
lica^l U hot and wnsiitve to the touch ; the ei-es are re^ll(^^ and 
unnatumlly brilltnnt; lite )ritieiit Pixels chilly and fr;vert»b by 
lums, and is often coveretl by ixipions sweat ; tlie pulse, respira- 
tion fiiidteinpenlun!ftn.M'i<^rc'j»*ctl; the mouth i« dry and fanbi:*!; 
there » vertigo, nausea, and sometinuM vomiting; the inlellM 
becomes clouded by day^and delirium lends iu tern>rs to the vain 
attempts CO sleep; thromUisia, pyieniia, nkenin^itb or oerebral 
abeea*^ may add Ihcir c-lmnofemtie ^ytDjitonus to die UnU en^rx^ 
bU; the vital |iowers gradually sink ; a lorpw creeps ever tlie 
iTDHCtt; c*onviil;4on^ nn<I f^nma follow, und d^aCh bnngs a blcas4)d 
relief to the nqfl&Hed fluflerer 

Th«ac w«i* of atrtxaoa-* snflvring are most common in adulta, 
because in children the outer gfiell of the mastoid is Boft and thin 
and givea w'ay *oon, while in mature a^ it 19 hard, thick and 
compact, and will not yield to prefigure. 

Thef«evere ^ymptonis an? i^tLsi}d l^y llie ever>inc*nivj^nj^ inllam- 
tnatofy exudation ami rruppuration within the nxt^toid cells seek- 
intr to forrie a free outlet through the hone. This matler oon.sist.% 
in tlte early fta^<» of the inRnmruttton, of |{vlatinous mucus and 
std pulpy auhHlance, or of muocwpna; then m the cells broik 
doirn, trranular matter, »ea)(s and particW of bone are found 
n]ingl<:d with it. 

Tlierv may be mil<l cfiS6« of mx^toid difcoj^c without injury to 
thcboaydb*<«pimcnt«or the proce^, but usaally lliere ensues a 



fl86 



TUB QUUA:f BAR AKD Tt0 mSCASBS. 



ti€crcets, ranging in severitr from liie (teEtmnion of a few otih, 
to a cTurnbliiif^ clywn of lliv wliolc U'ny n|ii)|iTiv>iK. 

The ftiiflaaiiEiatorv exiidation ill the cvlhilur Hpa€«fl seeks and omsi 
have un wulw. It proww in vvtrry ilireetion with vvet^increftring 
force. Thi4 cAuaFSthcingtufulenllVnng, iindcDmCitutus the dan- 
ger. Failing to perforate the ma^ioid outwaitU bj oarioufl de- 
sUuoiion of Uw liono, it can pnsn inwards hi ihc latent or prtrooJ 
ainu.s and cauM! thrombosis or pya?mia, or hacrkward and upvani 
and pro(Iu<.x- mi^ningitb, cvrcbclliir or uerebraJ alxMVfi, 

Thffic complicaiioDH are ueuaL)/ fata), and itwir diaraoteriBtk 
eyoiptoiritt uiiglit to In; (juiddy Krognix^l, in ordt;r, to make n 
progaosis, and to favor au unavoidable euthanasia. 

The proximity of tlie mastoid ccll« to iho Inteni) einus, atid Uk 
emptying of the mastoid vein aud other venous radid&i into the 
sigmoid portion of tlHdgi>^t hk-od i-hannel, t^endir the pungeof 
inQamrmitory produt^tti mio it un t-d^y matter. A fordga body 
inlroduoed Into a bloodvetucl iudui.^71 cinifrijiation of liic IiIcnkJ 
and iaHammatLon of i\K ^'ndoth^lium, Phlebitis and tlironihoEis 
ar? thus produinK) near the pUce of entrance, and emlkoli idhv be 
vashod onwards by tlic vital fluid and et^ up dccompo^lioa and 
aepdcvemia, while infarrted capillarieA will be surrouudivJ hy py* 
iMoic abewc«!M> in Uif: ar«a wlich tlicy supply, in tbc brain, lungs, 
liver, ttpleen, joinU, or dttewliore. 

Pfii.£DiTifiand throniboeis ol the lateral sinus socnetimefi 
vdop from inflaoimatiim of the middle ear, without tlio nuustoidl 
celU being alfectcd, though di^eajw of the prooea» is the a snatJ 
oauae. 

TI1C chanuileristtc 9ymptoau are red, |>aiuful. dense infillratio57 
and cedematouB awelling Ujion and behind the rniuloid nud down , 
the niclc of the Dock, There is tendernms, pain, oxlenia and 
swelling ali>ng the jtigulnr vein ; the enbmaiillary glands tiY 
BotncliTiieis swollt-n, the throat sore, and swallowing painful I*u» 
forrm deep in the liE^ni», and burrows beinatli the musclffi and 
faM*)a of thi' n«*lc, eyvv^ as low as llie clavicle. Tlie eyelitU, fore- 
head and face of the afle<:Ci<4] ptdc st>inetim<» b(x*ome atlematou« 
or try^ipcialous ; the eyeball becomes inHamei], the pnpil dihitcd, 
and the ojitic nerve aIlows choked dij«k. Should the neck be 
little affected and these eye aymptoms present, it woukl be resAAO- 



MASTOID tlSBASI. 



297 



> 



able tu suppose tho phtcbitii<('oiifiiR*d to one or both of tbe pe- 
tioaa] 2iL]ifU:WH. If the lau^ral and jKHro^l htnu^ti^ are )><)tb diJt* 
tiftec<l» lh« ocuhr t-igits ouglit to l>c nmrktHlly innrasix}* TJie 
geoerat Rvmploni.^of tht^ooai}>!i<^t)OQ would be intcnm; pain in 
Ibc fMc ol' iW bfsul, vcrrtigo, dulinum, natu^iif vomit) ng, grcAt 
rttitli^AAneH*, anxiety, and ejchaiBtion, 

Pv.cuJA conjpli^lw nioel caftc* of pliteWtia very early, so tbat 
their ^yruptODH become mixed. The deeumprMtid inuUrr whidi 
liM exdud diwuw in u vinuH may |hu« on with the blooil cur- 
rent; olber inlectious pnrtirleA may enter oUkt vt^ttb dintiigb 
Uit' inAnr cluintioU of cooimuniuition betwe^^n tii<*m and the dia- 
msed centre; emlioli may be bi^okcn from » ihniiiiitUHuitil wiulutl 
DDWard«^ and tlip lyinpliulicKof Uie vnr nnd iKrk may stKk up the 
tnorbNl juices, and ^wry them down to miugle with the pur* 
pk> current of rhe vcnu cava, 

Then .shtvent ereep over tie body; tJiere are l1a.Hhe?4of huit, 
with brigld-n?d clkcvlu and hot h<nd, followed by cold drem^liing 
Kw«iit?i; theiv ia loss of npp<-tlte, great thintl, dry rongue nnd 
roauth, an eartliy jaundioixt skin, and the Htupor of typhoid 
ftxcT. Sudden dy^pmru indicant llic lotlgemoit of an embolus 
in llie lunift; eharp pains in the brain, liver, spleen and iiiuMe^, 
and Uie npiM]»raiH<« of purpuric ^poi^ tijH-fn Uie fiuv, luvk and 
imok arc a^s of ob-itruttt'd rapil!arie» by the emboli. The 
wtrwigtJi npidly d<wlines; u btwy mild ilelinnm Mijmrvcnes; the 
(Hilae becomes thready; the stupor mei^e^ inio eoma, and clnuh 
claiiDB the miflerer. 

McMXQrns it* n m^^rc fre«]ui^nt attemlunt of ntr difwaire than 
phlebitis or pyiemia, and \ery often accompauiee them eomplirn- 
tioJik 

Simple nHuiiigitifi from ear difioast?, unattendeil by pidebitu, 
thmmhu^U niut pywrntAp in much more frequent in rhi[dn.^n than 
tn adults ; probably on account of the tender sensibiUly of a 
vhild'd netvouH^yTiU.*m| and the slight lKirner> l>Hwe<_-t] his lym- 
pinfun and i\w dura mater covering tlje temjioral bone. It b 
ofleo a i^ecptcla of caries, and thiti is tuost comtnon in chiklren, 
who fnrniHh th^ greatest [XtiXH^nta^e of ;«cnrfu!oiH and t'lifeibUtl 
oaofltitutkrns. Before adult liJ'f is reach^, di^^eajw has decimated 



TDE nPMAir BAR AV? 170 DISHASn, 



tlieir nink«, nrx] ooiL^i|nm) ii lui^^ pn>[>nrrii>n io fllwp lieofaih M 

fn ni'-r^*0Lift, biH(»ifl, And mlHt^t in4ivfiluu^ itiAanimatorjrfVD* 
cluctA ccmsnlidAte readily by thu fibrin tb^ coDUtm, and tliu» lie 
(iucH Are (<ov€red, nml Hiannel-i of fraitsmi^i^^Q to oUkt t»rtj m 
dosed, so tbiit diM'a^' u« ronlintxl to zi limited area. This 'vi 
[irored by tlie many at^*t» of [tnnilent mitldlc i*ar dJMOW in kkIi 
cotiistitittioru^ wliidi cKi«t for yr^nt witlioni doing mixch dtaodift 
to nt^glilvoring ti^n^. In t^tik-t^blcd nihl xtnimouA |)em>i«ttW 
blood b detioieut in fibriu, pr (he fibrin ba? lost its plasrictiy anl 
powor of libriJtAlion ; H![ti»inn$ iiml inlftimmatorv cxiidatiocw 
juaio lK|Uid and gelatinom; th^^y readily deiiompoee, and, 
otdy, do not eln»e ttmu«« and vf««c1»f u;,'miDHt abmrptioo, Imt 
gf.neralo and augment the purulent prodacts^ and incfcase tfe 
meaDH and the dan^ur of inttrtion. 

MeningitiH kH itTihend in by ngurHOroonvuliiioRA; ihetft hvef- 
tig^, irritability, lestltfencAs, tntcmo throbbing h^wbdie, sttui 
violent delirium; the face m att^nately i^ and pak; ihefe ii^ 
painful fipniribility To Jip;hc »nd i«oi)nd; the teeth ura grouad 1^ 
gether ; the i-y<!4 arv ml, bntliftnl, Mnrin^, nnd ^^ometime^ crossed; 
the pupils are coatractodf and tho o|>[itlia]m<'MLX>|.io ehovr^ chulc 
di»k or nnirtk-n-tiniU"*, 'J'he-re it* fnll Imrd pul^?, retraoled al 
mon with cx>n>^tijVktron, mu»culnr Iwitiihtng^ nnd Miflnow ot 1 
neck and liniUi, <\>n-'ii4erable fever^ and the cri encejJtttluiae. 

The cerebral symptoms incruMe in vioU-iioc, exbnu«tion rapid 
ensues, a -<iipor mt-'ps over the senses, ei>Ila|>^ and oaraa su 
vene^ and a convulsioa genorally marks tlio close of lift. 

Cehsbral ABSCE:$^'i an-<«(:?< from piirtdent inflammalion of lliip 
ear ofttner than from any other cause. About onc-thinl of 0; 
ra^es havi' thiM origin, and cnrk? uf the tem|K»niI bone fm^ttent 
aecom])anies. Cases may occur witJi ear disease, but iodepeni 
tally of it, a« from a blow or injury of Ih* skull 

The abeceas may be in tJio pons, p«lunele, cen^bcllum or oere* 
brum. A ewreful com|niri*M>n of tf>e pbywiology of Hw ocrvnoB 
Hyntem, with the neural flymptoms present, may sometimes pikle 
ouc to the wait of the UT*ion. In matiy caiteii, the M-ni of an ab* 
areas can tinlj be surraWI, even, when the symptorua are ooacltt- 
«ivcof the presence of one in tbcbmtn cuse* An ab§ce8B of Izupe 



lad 



HP 

H 



MASTOID DtSEASB, 



299 



eisG IDA}' exhi in the brain anil give few fli^nii of its preiciioc. A 
whole- hcmf^phcrc Um» been occupJLHl by one, yet, the victim has 
been iible to go about h'\» buAinefti as uauol^ until tlit? miililcn taking 
oK 

Thr *kynit>toiaH of the imo^ nuiy develop ;4luw1y nrMU{l()<?nIy« 
I will meittion the most important. These are rigor?, malaiae, 
fimiKiAlion, DAUS«,vomiting,nttiu*k]4{>f Hyncvpc-; hIow full puU^, 
inteirmittingorpersUteiit; deep pain in thohea<i, impairefl inlellec- 
tiulicMi^ dilatol or irnmovabte |inpl>&, impainid hcurtTij; funl ^i^i^ht, 
oppKwon, Htnpnr, ileliriuiu, wt-aknet^of limlj»; increase of earthy 
and alkaline phiMpliatcai, and diminution of the chlorides in thfi 
urine; paralymofone or more oerebral nervf-s; hemiplegia or 
pamplefpa; and eonvi]l:<iioDis cn^aia, oi>llap«c and di-ath. 

OJiigriOHiA of nift^toid di^ea^ caanot be diffitnilt to one who Iulh 
followed my de^ription* The pain i& docp, i^evcre, and ntdiat- 
iog; 1)m tiaAMi^ over tbo tnaMoid may i)e not ma<*h alftvtal^ bot 
generally jLro bo^g}- and eenfiitivi^'; the din^'hnrgt from a «uppti- 
niting tympanum rrerpiently cea.'^(!A almost entirely with the onaet 
of tile aeuK; eomplicnlion ; the cuD»titutional di^turbtinoe \b 
marked ; ih*.' subjwtivt ^ymjUora^ arc ofti.-ii iiion? ?«:»vcrc I hjin tJie 
objective would *eem to warrant* When relief from stvere pain 
doea fkot fidlow from a wHrrn d<inoiit' and n pro|KT pinuvnlt^mof 
tbe drum-head, durin]^ an acute intlammation of ihc tympanum, 
aad there i« no jminful iiifbtmmation of ibe auditory canal, one 
is ju§t)fie4t in a dia^^nosi^ of mastoid di^M^av*. 

DratmertL — Tiic iiuditorv f^aiial ^liould be examined and any 
obstruction to the outward flow of pus from the tympanum re- 
moved in nil can^. A \i<ii aural douche with the fountain flyrin^ 
ftbould U* ifiven, and Aeonite tineturc admini'lcrcd internally, a 
drop c^'cry hour, till n"Ii<'f romft*, or it* patho^netie Hyraptomfl 
arc prodaced. Th^ palient jfhould be kept wnnn and quiH in 
b«d, 

<^|)eicuDi has l>een hii:hly extolled for early »tag<« of mastoid 
diacttc^ bat t think it should only tiike ibe place of Aconite in 
tlK* fnilder cases. Belladonna will be found fnK|ncntly indicTntcx). 
If the rn'clling U fili^ht, wrap the Milr of rhe head with sheet 
«it(oa; if it is cunsiderable, apply a wann JlaxeGod-m«nl poiiU 
Hce, and wait, wqwcially, if fbi' iiatk^nt l>e youn^ and strnmoup. 



300 



THE l]U3IA3( BAR AND ITS DISKA8IS, 



^ODiti iff tbew (lUNav uiK)vrgi> n^oluttciii ni|ji()ljr, li rv<|a: 
wund juO>;mvitt Ui JckTiuiiie hirv loiig la dcfcT «ijrgi<u] relt 
ami wUt'u it IB impuralivd^' utivTi-tir^'. I>urJng the |jifnuil 
dd&>'f ttic tiiciliciiM»f Uir eyn^pMnntolojO' of wLicb has bcoi 
already outlined, t^fiouM be ugnij^nK], and Uit« iivireHt 9jrmpioa> 
pf <li--muw iTtimbaUx) by (hi;m. 

ir llie »yinptoaiH mcreode in vlolcuue, the rcdi^tibu uihI sirftliBf; 
uv^T tfie fiia><tiiid niif;rnt;ia, aud thi- siiOVnEig bert^tDtv uiibmroL^ 
dn [loi moAk It by ihedangt-rniia narcoLiiiiuof Mcr(>hIaorClik>n(, 
but aiiju<tb<jti£i* itio ptttk'nl, ;4ml inukc an incwon down n ik 
bone. Tills should be from half an inch to sn inch niul a ialf 
touff. ac(Y>r(I]ng tu the tLioki)»$ uf rbe ti«ncH, poiulld tu tJir ■!< 
lachmeni of the auricle, aiul over the roiioded |in^e<lifiti <jf 
mo^toii and the ^umnnt of the fc-welHng. It shotild bc^in on 
levH v:\\\[ llic- upper alincbmeEii of ihe auricle, and exu^itl doun 
warcU in Che direction of th^* Titerno-t^ldd^oiiUttoid niiisrie. 

The tiiKiuca are generally cjiiiie thick, and a unali bbtixiry » 
Ahno<t huriwl lx*f'?r^* the bone i» rwirhoJ. Cut deep, bill tw* 
below the mastoid except for an ali^ce^. Then aieoura^ fm 
bleeding: compres or practice tendon on the postericr nurkuUt 
iirtery, if it bapf>eiJ.>i to l>e cut nnd btwfU loo freely; wb*U ihl 
parts cli^n, cxuminc the bone, i>ut a tent nf twisted linl di| 
in rarboliKe<l oil [Aetd* OirloL gr. v., (Jt. (Mivm ^) in the vtvaai, 
if thought nec<*H(ury, nnd ei>v<^ by n Hax^etnl [toulttei;. 

I do not Hke leechcg; I think they do harm by thdr worn 
of the skin, ami the li>vl irritation thus produced, Xbeir adiol'' 
U not profound enough to Jiifluence the true Heat of tli« dbcaet 
'Hk incision rcvcaTs the condition cf the bone, relicvee temwt, 
and di^nitklHtK^ the coti^^vtion without und within the [>rooc»^ 

In caw ther€ is only a perioatitis of the outer surface of ibt 
niivHtiiiil, reiLdtly roc^ognir^ by ibi* n^d or bluish congefitn^ oft 
periotiteum^ and its loose atlacbment to the bone, or Ibi^ 
tinited to iuflaiiimEition within the t^ell^, the dtnjintebed 
tion from the bleeding, and the relief of tension from ciiltiqg 
through the jkerio^teum, a.4.^^rcl by poulticing and th<? ap[iri>- 
printu medicine may eaiise the disea^* to wheide. Aguin, there 
may be a poet-aurteular alMcew and nccnwis of the outer stir&ee 
of the apophysis, and a discharge of pus and piecea of booe from 



1 



i 01 lur 

noftM 
HUte^H 



UASTOID DiSBiSB. 



301 



the incision, and proper mMK^iion may induoe cp^^lion of the 
•cvcre »yin]itom» ami ircovcry^ 

Siinetin»e^ after (he abspnsji hns been evncijaled, ii probe will 
demoD£(ra1o a cnrioiu tnict, Uii<1Ui;^ from tliu surface.' into t\w 
inner cnil of lljc RUiIilory canul or tbe tynijiatjum. Then (l» 
dangerous symptoms uill tli^ppcar, and one should drill and 
•ompo o«l the ii*'(nl U»Dr, imihtt n frw CfrminiiEiir.^tii.<n nifli (Ik? 
can*! or rar^ ujw niitiwptic injections, and jjo on with i\%e local 
nnd <v>nsliiulioiiaJ tri'fktnienl. 

Till' clinical reports appcEidcd to (hia article will throw furltier 
liglit ii|)0& tlie variant ptinitc^ of muMoid dt'H'iuH^ I romc now to 
<x>n«idcr thofic ca>^?J4, nhere ndth<>r tlie incision nor any treatment 
sketc'hal almve will relim-e the w*vere i*>'inptoms, wliidi evidently 
depend u|)on inilamnmtion within the nuistoiil itM^. 

Tlic penl-'up fluid within the lionc mut^t have an nrtiReial out- 
Iftt or it will make one, probably, iowanU a» already described. 
Natnixt liiiA eilion-n ilh by i^rioii^ opening mit thmugh llie tnii^ 
toid tile proper thin^ to Jo — tu perforate the compact surface by 
Iciiife, lifill or ti>-)^hin4-^ and tlitiH iinich nml litx-mte the im(>ru>- 
ocied exudation. The opt^ralion lh an e^^tahlished one, nnd ttn 
bcntficini results beyond question, yet, as Burnett so eloquently 
aay&."S[eD have \teen allowed to die with ao better effort for 
their rti*riie, than a poiiltti^* lioimd over (1i<t bony cuvitie** in whieh 
lay the cause of ihi^ir dissolution." 

Th« mastoid should be tn.'phintd in all easti^ in whieli it^ cuter 
surface 18 intact, and the severe symptoms f'ontinue after a free 
ilu^i«ion linH l>n*n inndc. The jmticnl tmir^t bi- profonmlly nnirv^ 
tlietJKe<K The ineiriion luivin;; pr»^v(r>usly Imhu made, it mnsl be 
enljirgi'd if thought ncc**Miry, and ih*' |>crin*teiim diswH'tOfl up 
from the Iwine at and iirniind thr plar^* -.i^Iecleil for perforating it, 

Thr* oxitet spot for iht^ point of the in«tnim(»nf vhoiild lie on n 
level with llu' npp^T w«ll of thf exlenml amlitory mo«l«f*, <*nf*- 
quarter *>f an inch l>eljind (he al(»ehment of iheauriole. If the 
p«lH>nt is yoMhg, or the miiHloid i* *ot^on«l by iliiu>nn^, A firm- 
blftd^ niatloid knife may l>e tullicicnt to pierce tho bf^o, and a 
prf>be will brvitk u |Wi«ng<; inward* to th<? untrnm. In otbvr *iurei* 
fi<tck*i4 trephine and drills will be found neoeesary. 

The mdea of the wnnrnJ t^hmild be hold npiirt b^ retruHorv. 



W3 



TBI BUHAV VAB AW ITS DI9IA8I5. 



TtH? irvjiliinc ^liould bo direetei] ini^'aril, forvnrd and apwanl 
against the bone, and be workE!i(11Qnu1y anJ t^ntly aotil n yitii- 
ing h felt to \h^ bonng* Then .MitKitiEufe one of cbe drilb for 
tbv civphinc unf) jiruct'cd c^utiou^ly. In a lum ur tvro^ tl^ cvlb 



Fia. so. 




MiKTiiiD KsriFr 



will lH-o]icn<.^1. litul tt red |iulpy fuUtanoe or |ius eBcii|M', nr, per- 
hapjs nolbin^ at all. 

Tw4f HiviJiTitii itre to bo Appn^li^nded ; opesiinj^ ilitf^Uti^ml /iiui*, 
if the instrunient f^^es^ loo low and di^^tp^or th^re ih a malptyjirpoti 



Flo, «1. 




BocK'ft TlKtViyS AVD IhtrLUL 



of the blood channd ; opening the middle cerrlnvl fc^m ajid In- 
jiiHiig the niemhriLiioi of the brain, iftliein^truoientgoeg t<ko hi^h 
or deep. The diivctiona for u^ing the ioHtruoicni wxv^i be ft^l- 
lowcd cl<>oe]>% thrri <mit will have only a malfnniiatjoa lo fear. 
The lateral sinus m higher than the uornul poeation b only two 



MASTOID D19BA5B. 



303 



nr ihree percent, of nkulla, »o lit?, dimiciee of jwrfuraling itl>yan 
urK-ratioii such as ckficribcti is rare. 

The tbt^^lcDtta of tlie compoot substance of tlie mastoid at the 
ftomt o4' operatioD avengi» in odult life onisliAh of an iudi, but 
It may be muoli thic-ker, cApoaiallv, if there U hyiierostiBis or 
f4d(rcisu(^ In childnu the ^hell i» thin, th<* o<^l]« stiuill, and the 
|)rocGE>4 undeveloped, fio lliat tlie opt-ration b vcr)' rarely rt^uired. 

After thi? ^iK'-ning has I>coti made* into the cells, whether or not 
lh«re U any iliK^hurge, iiijfi't tlieri jjenlly with a little warm water 
tuti(liaiti.-«i Lpv u low dropd of ^.-arfiolic Jidd, in f)nhr to wll^ll out 
inOammatory product^ and to olear u fn>e passage from the mas- 
toid ojicnih;; thnjuj^h tJii? c^^llf; and middle o^t to tbe auditory 
fniMil. lnjrttir»n-' ji*ii»«ld \nc mmlt: \vur n day, if tiiere b con- 
siderable discharge from tlie parts. The Gmt injection mwy not 
|iiuv< dirx^iigh to the K^ir, hiit tht^ »i^i»nd iT third pmlmhly will, 
and the tluid ocx^asionally may flow through the Eufitacltian ti]be 
to the ihroAl. Tbe prr^ure of the wiiter idlen muHi^ jKhiii and 

(igo of transicftt duration ; thf»e symptoms should caution the 

entlor to be aioro j^entle. If iiv^pHtiihled putt, graaular matter or 
jiorticles of hone block the ]mi*^ge, remove them by a pnjhe and 
(^rtrttc, find iK'-ni]>o out and remove any di-ad bone or <v;ll wnlla 
that obatruci the di§(rhar^. A eurette that I designed and had 
iuo>\v to onk-r by i.Uti, Ticiuanu & (>X| New York city, Im^ 
|irovod very ser\nireable. 

rto. «! 



MA^TOtt) Cl-HKTTK (liUf idte), 



Keep a ti^nt of Itnt wet with carlK>liicd oil in the wound, cover 
~Uie mastoid rpgiouliy a warm |]uxMM.-d jx^ullkf*, Hiojitht iitiinndietit', 
and by keeping tJic room dark and silent, encourage that blessed 
aleep which fre<|ueDtly follows ana>ithoaia. 

The (Mlienl ought to lie with tliu hvad turned toniircl llie dis- 
maetoMl to faver di^harge ; he eiliotil^l be prntootetl from all 
byekvl UhI ntenEul excittmeut, and, if c^Tebral symptoms do aot 
forbid, have a comfortable do«*e of milk putsch. 

I take it for graoti^, that relief from the severe and dangeroua 



M4 



THE nCHAIf VilR AVD TT8 D[ft8A8S9. 



sjrtDptomit follow (lie o[*cmlifliu Ptiriiij* tti* les! KCtivi> Ireainn^at, ; 
CiDchona, Calcarea phos,, llepar. Kali hydriorf,, Mercuniis,j 
Rili<<ca i^liijuld tT<r<*oni|>a[y<c],an(l tiK- mcMt upproprinir tiKtlicinefar' 
thcoasf- admiiiT^ered. VVheii there are do loog^r aay£igi6«f 
098001)3 di^iL^e, LlicAwdliiig lin* all »*oU*itl<'(!. ll)einj<*cti<>n rnam* 
clean from the masiuKl, ami the middle ear di^^efec^ U dmng vell^ 
the op^nifi;^ in t!ie \}ouv ntui ftoft tiwuM should \» rnootiragctl Ml 
heal by ku'iii^ olT the pouUiceft, and applying aAtringeal aif-| 
«itfiDiilal)nf!: wa^hr^ 

Jf tlio o|>cmtion do^ not bring relief from the terrible sufler- 
ing, it \b jufil to conclude^ that out or mnrc of (he compUmlioa 
already dei^Tibe*] exists, A (careful (Y>nM'(iemtioEi of the tnorbill 
ftyiii[>loiii-"* pni^^'UK**! will prolwibly kwl (on correct rIbigiHeiis 
phlebitifr, pyemia, c^rebnil al>^ti^Ks or inaiingilis, and a vtay grtvi 

Here, the better ediic^tiM I ih<*pht'8JGiait, thedef^jx^doc^ihoiroa 
cnlor liLA ^on\, because of th<> (Kiwcrleisiieis of tn^icxil mean 
and art in tlu- prewncc of dratli. He am lift|w 0fpiiD:^t ho^w^jn^l 
di) something far his patient, even, if it be but tOAmootb tlie patb-j 
way liwivenward, 

PhlebitH nnd tlironilK»v0 moilifv tlio aural in-mplonu to u 
require Hjwcial cjiimderalinD. In ihc early stages, Belladoana i 
Bait the to(aliCy of symptoms adiinnth1y> ami should )x pvtn 
full do«es of the tincture, Ilepar la aseful wWn the oerebnl 
HvmplnnkAar^ mildt the tiwacwof (he ntvk are hL>g;gy, mid d-od- 
iii;^ to tuppumte ; |)ur ahonid be libci-ated by iocisi^m ae Boun at 
detectofi. If dirn? ii* uvideacw of much obHtriictiun, w vhoini by 
(edetna about the face and side of the neck, Meretirius Ehouk) be 
administeR^il freely, on a«xxjiint of ihe pla^Htie dep'wit «n>f] th* ic- 
comiiatiyiiis: neuro-retinilin. When erv&i|wl3ft oeeurR, or typhoid 
eyraptoms heeonic prominent, Rhus tox. tincture, a drop evfr 
hour or two, and liberal doN?8 of mtik punch may hdp tbc p^ 
tieril in \m terrible t-xtremity, 

When pyftniia ndd» ib« symptoms to those of phlebitis, i 8ut 
porting tn'jil iiH'iil by ooneenlratnl l>rrftaiand milk punch 
com** iftill more necewary. For internal ni<*di<'iii<5*, I would rtl 
upon Arsenienm, Arni(?a, Cinchona, Croiala^ Lachenis and Rhus, 
with an iDlerTCumcnt medicine now and then for aptictttl 7iyin[>4iimi 



OARICfl OF TB8 TSSIPOHAL BOHg. 



305 




region. The p™roic fermentaiion ia analngoiia la tiose proocees 
h pruiliitfvtl in tlio l)lood t>v llic introduction <»t eiiakc poisouM, nnrf, 
^^^ it iH nntikely that two IVrrmenlative proceasos can exist at ihe 
^Bnu Um«, kj* the vinous itml ftcctou^, for instoDCc; It » probable 
^^mat ID aD animal vinifl will in? found the antidote to pynemia. 
"^'iKxi ftlicmpts to ■rn.st pywiniu Uy odurr mwlirim^ gcjieiully fiiil^ 
vcHitd be proper to experiment in tbia directioa. 

nt-iii^ ^lioiiM ix" Iniited with i(\t-cnf>.4, fnui the piuiint kepi 

^qaictf dimlr lighicd room. Belladonna is the most UMrfnl 

nwHtcJne in thr ctirly M4^ct, Bryonia ii* reqniretl wlicn stupor 

and other eigns of cerebral effusion appear, and Apis is, also, 

[ reoommeiuleiL M^rrnrinHKliould be givwi,wli(*« lb*- severe syinp- 

1 tome Are mitigiitet], a^ it has tbe reputation of beini; the only 

I raedidiic (faat hu vui^l giMiuiric momngiti^ Prof, A1fre<l StillO, 

of tbe Tniversity of Pennsylvania, teaches that caHW of menin- 

^\tn all die ; if a «wc recovers. h'_* Miovc* the d'uignoitH hiw hero 

incorrect- This tsan exlremc viow, bet^ause pfvt-mortema, after 

divKb fn>tn other disoisf^, rn^i^Lwntly show traces of old menin- 

K'tk 
Cerelielbir and wrehral abec<ss(sare verj' diiHoult of drngTintus; 
« hen thinr pn-j^cnw ih rt^coguiwvJ, one onn only follow nn exporfant 
cntirse, a.4 far ai ibey are concerned, and preA^rllw^ lb« ni4>dli(-nn4f 
and adopt the lof^l Irt^tmnit indicuUnl by tbe totality- of sym|>- 
tocD«, Hepar, Mereuriiis, Phospborus, and Si)i«<dn would weera 
BMpo^t -II ppl iffibb*. 

^B In the verrible safTeringfl of mastoid difVase and its coinpliea* 

[ tTonft, if it itt fonnd nivovuiry trt nw an anfKlTp'ne, T would prefer 

TTs'dmti* of cbhtral ( f^hiomf fit/ilrntr)^ In r«fM*!i(etl do*rnof 10 grw-, 

Jved in Syrnp of lemons {l^\frtTptui Linjonia), to Opiitm or 

if of lU preparatioDN. Chloral oiu^us anoMiiia of the broluj and 

ly thuA lesvn inflammftiii^n, while Opiiini produfVK hy|>cr^mia 

<1 venouA qtn^iiHtion^ which would nggnivate llie diiieai*e. 

Caries of the Temporal Bone. — Can&i t» MnmW.im»c a c^tuur, 

at>tDetime» a eonac<]iience of mastoid disease, and is naturally 

RAQodaled witb It ; but Ix^ruun; il ocvmrs in all partM of th« Utiq^ 

ral booe, I have gl von it a separate article. The ditxttui^ dJQ^ni 




8M 



TtlK HUUi:! WAR AHD IT9 DtSKAfllA. 



it dESkrart Igci^ OD account of variations iu tlte developnicM 
and deosity of the boDf!^ aoJ i« common in chiMliool, miv in 
iMlnIt lif«. In u pnvulc niul l^iMpilal tur pnttioe of ten yvAOt 
1 bave seen oul)^ about half a doaen casos in adahi^ 

Scrofula u geiwnilly liie jHKidiapoaing cotise, uiui iiU[iparaiM 
in the tympaRum the eliciting one. DeconapoRDg pus, n^uaiaiaf 
in iijntiL(?1 ivith th^ muotitw membratic of tho tympamitD, aitj^ 
caoiie iiIoen«lu>n and cari« of the iwflicks and of any pan of tte 
lynapauic walk. Matter pauA aceesf^ to the niibitoid cvlb frus 
the middk e&r, E^pedaUy, in ohildreci, and renraiitt there uoUl 
the bono b4HM>iiM3« diM!a<«cd, H'h<c it eaiBpeA. h>{i«^ially ia th» 
tlie ctmc, when inapis&atnl pue^ a n^rly intact or adherent dma- 
hii»lj u |iolypu.-s an cxo.-^((AiU or a^*uU^ >vrvllinif in th« audi 
canal prex^^iic t}i« free «M-ape of tympanii; products. 

In other ca»x, the tcmpomi hone (jAU in its nutjition, 
celU break do\tn and cau^ purulent inHarnmation benea^b au^ 
iu the covering mncou)* mcini>ninc and pcrii«>tcum. 

In rare inataucesir cari<« may exist in tlie vralls of the tym- 
ponum, with llit^drum^hciMl inipcTfomtc nnd liiiiUhy. 

T)k^ liiiM^fu^ KoiiK'CiiiM^ gix"^ on in dK- l>one, producing liyjicr* 
trophy and thickening of the overlying nieR]hraj»3»,utKl w)ens« 
nf ni'i;r|,|)i>f|i)^ \x\tIj'^ Kv<-nlu:dly ajiogiening occurs 6o>newhen^ 
and the nW-mtion products, eonfriHting of pu^^^ fJinxU of tiwuv 
and jiarticloft of bone, are diR-harged outward through the tyio- 
piinum and auditory canul^ ihr^u^'b the i^urface of the tcmponl 
bone, or inn-nnU to the nina^^ and brain. 

A rich development of grunulatioti tirtuit aonwtlmos witk 
polypi ttcconipanics <^rie9, often fdling the cavitiGB with re! 
maSMa balked in pus, 

H Oiri«< v<^-urH in the wiiUif, ila: roof and ^oor of the tytn|MtiwoBH 
In the inner wall, it wmetJniefl set£ the stupes frcc^ inverts 
ihc iorauKn ovule and rotiinduni into one lar^c ra^jrtd hole, 
breaks down tlie looee cellular lia&uc nr^und tlwr denser bony 
labyrinth und furoH it into «ine or »M>re flequeaira, and promiKut 
llieir dbteharge imtwards. Tlve cochlra, the whole Ink-mil mr* 
and. Indeed, the major part of ihc tcm|x>ni] b<jiii Itave Iwen c^ 
nvoved by (he ulcerative |m)eei« in the oaseous and soft liaNKt. 

Of courac, phlcbitii^i thromboaim, pyiemiu, meningitis, and cer^ 




I 



flimilS or THt TBVPORAL &OHB. 



307 



Pt,' 



belUr and cerebral abaoce^ are fretjuent complk^tiofiii of such 

Deafocefi h marked in casefi frhcre the cochlea has alone been 
exroliulef], and m total, when the labyrinth hu^ btvoinu u S(H(U««» 
tmm or haa been extruded. 

Oiriw of ilw iMiflhTi'T iw>rlKir of tin; (ym|vinum Trcfjupritly 
iwe*i paralv'siH ot" tb*? farial nerve by pre**^iire aofi neuritun; yet 
\cxmvc uksirnition of tlit- hoiui about the nerve may eicmt, and 
,e Fallofiian canal lose niiich of its if^olsilinii; walU without 
I'rtini; tlw stnjclarc or function of lliu nerve. 
The floor of the tyrapaouni U rarely attacked by airiea, but 
caw>* %Ti* upon rveijnl, which have resulted in ulcerution into the 
carotid cvmal, and the juj^ular fo^a, and have caused death by 
bL-niorrhjif^. 




Cauv» or Tus TcMFoBAL Bo!fB (Tayiibc«), 

^A favcwtte place for csritss h io the Uaiella of booe above llie 

^in|iiinic mtmhniiK*, IxrtwLvii the hi-ad of the malleus and the 

_external oiiiaK X lately had a case of tJiis kind in a youth of 

rcsitLvn yuLnt. When hi- inHattrtl the v«r, a drop of niuoo-puj« 

bubbled over tlie upper ^)£^ of the membraDe, behind the short 

Tiwwof the ninllcuK. A Umt proW *bowwi a very mujiII <^n- 

L cavity Jim above^ and invclving the annulue tympanicoa. 

Tl>c Fallopian mtie an<) the interral andiicry meatus arc ooca- 

siooally the seals of rai-ics. 

The horizontal celb of the uiid<<vvlopc(i uaatoid pnMen of 



soa 



THE OtMAK fCAR A»I> ITS DISSASlB. 



inraobf an^ frcqucntty nffectcd by cnnc^ unci an opiiii^ likes p\act 
iivunlly in the^uauiotie portion of the bone, above and behind 
the nKatiifl. The iipp<T boundary of those cells, contimioos ■■ilh 
the r(K>f of the mi4)dle ear, U t^nWe thin and prone to ulcgratiggi 
whi<'h frequently causea menin^tis and cerebral abwie«& 

AiiotliiT fuviirid? curious outlet is f<»r^r»rtl ibrr^iigh the tw 
portion of Ihe (>rteterior wall of the auditory oaiml. The bony 
w«n of Iho cttTittI ykbij*. purt burnt* Iho dermic oovi^ritig iiul run* 
out of llie exterufll mcatiia, leading one to believe it comes from 
ordiiiftry .Mippiir^tion of Ihe tympanum. 

Tho mof^loid protv^s of adults, oont^Hlint^ of rowdof bonBOatftl 
«etl8 above and vertical celk l>elon', becomes carious from arat* 
inflamimlion irithin the ccl1«, fn>ni Uie kIow ini|>crfcct sDlxwotr 
inflariiiiiEktion of ^rofula or lubetvuloHi^, and from pcrio^ilUof 
tha oiJttT Mirfhct. Portions of the bone or« tfiirrouiidcd or 
off from Tiutrilion by the ulcerative proccas; they become nt- 
croMd and form Kcqii<-«tm. wlMi iindcri^ ftTow alMOrption,orjiff 
d!Krharge<) through flinaees or abfir<?sses, 

TIk/ ?«i/ea>id vliape of ^qucstm will sometiini'« indinute thnr 
origin. When the outer compact tmie will not yield, t1>R eui- 
OUI4 proccffi with it« pu« and debris may work in othirr direetiofl^ 
and pro4lu(!e <me or more of the terrible compliontion!! mcjitiotied 
under maj^told disease. 

The bone soaiettm<^ ander^oejtea^eottAth^cnemtion, aiktl ifaoagh 
proBeftting the outwar^l form, U enrfily cot; the ain€«4 may om- 
tinne for n Inn^ time, and ihE^ l>one gradually tJiritik from 
molecular diftint^grjitinn ; or a i«*<]ncs(rum msy be isolnlnl naJ 
dist^har^l, aiul receveiy follow rapidly, 

Rqwiir licginrt by grttnuUtti^n* filling tip tbvrtivilirs: tb^Mde* 
velop inJo cicntrinat connective tlaRue, which gnidiially rlianpi 
into drnsc pbornHtr-cl o>wcinH »triictnn' by drpikuJtion of lime-dialts 
and a ilcprc^^ion remains In rhe bone, if the opening Iium b^a 
outn-nnV SoaiAtimrA iUo rhannrU j\n*\ ctiviIi*^ fornipil by the 
di«ea^ jH^rskAt, and b^^-ome lined by a nmooth noti-»coreting mcn»- 
bmnr , rrvrmbling an irigntwfb of flcin tiu-h uf i» u>pn in tliif Crm* 
panurn of Aomrr vxirii] mKns nf purulrnt inffammnlion. 

The eymptoma of cari«H of tbe temporal lx>ne vary with tbr 
part :iI1;iekcfl, and ^>mi^ of tbt^m have \nwn f^ntimcratetl in tbf 
fon.-going paragrapliR. In mo8t caaea, punileal inflammation of 




1 



OiBTB8 OP TUB TRUPORAL BOMB. 



309 



the t^-nipinuni ia pn»^nt etnd msskB the mild caries witlim Llie 
tympanum or ertcrniil <mnaK Curi(S of ihc iniuT tympnnic wall 
htt0 bvcn rccogoized Lbruugh a healthy atid irojferrur&te mem- 
braaa l/iupani. 

If the T^'atoflhe disease can he j^t^n, one vrilli]vti<ie nii uiocnt- 
tion, bonlcml hy raii^ixl «xlgcH urtd tarj^ granulations. A probe 
paned over th« liaae of the ukvrp or pohhifil itiloa TisttLila tJiat 
may open into il, Hill tmnimiit the rough, gmtlag feeling of dis- 
ewMsl bono. When ihe locality of th^^ knlon li^ Mi^jx.-oted, l>ut 
cADDot be aeen, » pnjhe \mil at ditUrtiit ungW niay Ix; gnitly 
uppltcd to various parte in exploration* Probing in llie lym- 
panum t^ ddicale bii^im^ tiw\ i^hould only k* ftttfrmpti^ iinik^ 
good ilhiiniiutiou by oni irho knows iho cJaogcr^. 

The dim^harge from t^rioiH bon« is tmtwii an<l offensive, and 
it contain* Jiltle durk or^«.H>t]8 purtk^luf, which may be recc^iased 
hy the nifcpow?i>jM\ 

Xn coar^ carke, ulceration, fi^luk, and abacefifl, the ea^ly felt 
en^itlation of tlie pnibc t]i>on \h* bono, and, perhaps, the prc^*- 
ence of a mo\'ahk* hequefitriim are [latbogDODioDic iiyiiij>toiD3, 

There b some fever and evidence of constitutional irritation io 
most cttBM of onrie». Tlic cIkkIui show ruA m ^iirraumlinj; p(ili>- 
DCfis; the side of the bead i^ hot ; chtlline«», 3in^bi:s of b«it, and 
copicMifl ffiveols alternate ; Iho mind in [>eevi>ih, and ^leep uneasy. 
A flight pain or deep hvary nching in felt in lh<r HumI tx<gii>ii ; 
deafa^sh in .^ine d(^[ree exbtm; tiiinilu% ihrc^bblng, aud vertigo 
may occur ; die mastoid process and auditory anial lM*i^riM*»i rvd, 
t4-Dder notl ciideniatous ; and to th«w may be added any of the 
grave fiymg^toiius mentioned under ma*<toid dl-M^u^H.- and ite compli- 
cations. 

The prognosis ^vill depend ti\vm the a^ of the piticnt, and 
ihi: Hitimtion and itiit-tti of the uaina^ Children ol^on llirow off 
larfie pitxvs of nccroM*«l bone, and liavu die diAvise for a Ion;; 
i\tm\ yi't, finuMy Hniovvr 

Adults tlie from )cee. The>' un? more liable to complicattons. 
Tlie(kc|iCT tlie carias exttnd"* into the bone, the (greater thedang^ 
Io aaditioQ and life. The uutWk \» alwayv iiiiprontitting, aud a 
guarded opinion should be given. 

Trfotmmt. — In ul\ «ls*w of (hiri diw<ifc<^r ^'^'X ^'^1 constant 
tieatment ia imperatively deutaoded. Though cariua ewiictinitt 



310 



TBV BUMAIV BAR AHD ITi DlSf ASBl 



oonir^ In rljo Icmporal bone primarily without nny dbeoae of Uw 
effkT, and. agnin, during tlie proper treatment of an aural sflbctioDi 
as tilr<?uly TiiftiitioiK<il ; n hiv^ majority f>f lh« cases arise fnm 
chronic purulent inJlammation of th« tymjniiafn, wliidi btwniH 
1>oe.n tniiled m nll^ or in such a filip^hod maQUcr as to have hul 
liulc eCTvct ill cliLt^m^ tho di^fiu^c. 

The auditory canal should 1>e cleared of all ob^tniclions; sinm 
enlarged, if iu»M»!<Hry^ and «'(iiptii.Hl or iuH|)i>^«ti:d|>ii««nd d6bHi 
of oaBemis ciafiuc; the mcmbraEia tympaoi incUed freely, if U i* 
retaining inflamumlon'/prodticte in ihv lyn>]KU)um or Hia^Etood 
celle; large granulatioiiH and polypi twiatetl off or e\'ulfi«d ; ab- 
8CQWC8 loucct] and evairuatcd, mid niovnljk' sequestra ^nllj t^ 
moved. A douche of warm oirboli^ed water should t)e directed 
into the auditory canal, »inusc«, and rurious cavitictt of tlic boot*, 
until every [mrticle of matter, bIcKkd or toocw ceaeoun tu«ue m 
tnubcd awJiy. 

When tlie fteat of caries can be reached, atid the anau>mi<sl 
relatiooH d<] not forhid^ thi> ileod bone should l«e «'nt|)<d ai^-ay hr 
the mastoid curette^ until the healthy bone is rcatlied, iSmatl 
apolB of cari(9 upon the wall of the lyoipanQoi vkm\ in Uh? 
canal, treated in this manner, and then touched wi th a littk pore 
<»rbolic ad^lf granulat^^ and cloe^ reudily. When there t^ cones 
of tlic j^rfacuof thL* mastoid, with aHiutu Jnvmnl or furwani, » 
free njiening should be maintained Ihrough the $ofi ciwuei,tb« 
dead bone scraped out as much as ta oonsi<lcre<J &ifp, and a i*mbi 
paemd enntioit-'^Iy in diiU-ri*iit dir^K^tionn (onarvlH the tympciniim, 
and the bony portion of the external canal. In tnwt caaes, the 
ainuH will bo found to rommuni^^^to with on^ or thi* rxlicr of ihe^ 
generally, the latter, and nwiveinent of the pmV>e will cnlarp? it 
Homcwhat, HO that the iuHamniEttory wa«te may l>e washed botli 
wayrf, and the |>artd thoroughly cleaned. 

If the poHt^rior wall of the omooha portion of tttf eanal is red 
and lender and a pn>l>e intrtxluotyl into a carious oiji^tokl Icodi 
ticarly tn tliif; surface, I think it would be advi^ble to bieak 
down the tliin hirrior^ in order to facilitate thorough clmmiDg, 
pnjmutc on^y elimination of morbid products, and diminiah tht 
danger of PXteURion of the caries inwani and upward. 

A flaxit^*<xi poultice ought to be kept ui>on the nuij^toid, an 
piece of ab^rbent cotton in the auditory meatu«» hutiyric 



ifAKlfLB Of TH« TRMPO&At BONff. 



311 



iumI wiping wirh wi^psofwmon muF;£ be done often enno^h to [ire- 
vent uny (it>ji*i*t4nil>k' iif'Tiiin Illation of p»i^ A^i im|irovom<'iit of 
The local comlition en^c^, I tuitelittiie fr>r the cfirholixod water, a 
mixture of oiw u-iw|ioonful of Tur tinctiirv to half n cupful of 
water, and inject Hiis freelj^ into the OiseoAOii p!iu«<. This is 
antuepticami ictimiilaiinj^. 

With lbedea<i bonescmpMl aWTiy ; sequestra removetl by gentle 
InclioR^ imd nn intnfiion nude, if ncecmtty; the part« dmnwtl 
and dtHnfected daily ; appropriate mGdi<nne< prcs^rilx'il ; and Hie 
f^encraJ )H?«lth imprr»vf»l, tfie jmtient i* lokmbly afc, nnd nscuvery 
may be experted .sooner or later. Of routM, di6eA»! of the mid- 
dle car if pr^^eiit w to lie lix-atwl ivx*ordin^ to diref'liww alprtwly 
pveo, aiwi the H|>e«:ial n»taaur(« made Deccssary by diHpase of the 
iMfeoQA siintiiindtiigs arc to be siipj^l^rm^Llnry, What has been 
presented umler complications of mof^toid dir^etise Applicfi with 
equal foroe to carit^ becaii^ the furoier b both caoiie and conee- 
tptemv of tlH? IfittiT. 

^Icningitiii and pynemia are more frequently sepn a** a result of 
<nirH7<r (ban the other afTcctions mefittoned. The priDciple^ of 
lreiitm<^nt have him\ dlrvudy formrdutwl, 

PatieutM Hutteriiig from caries shoijld be well clothed, fed, and 
ho«i*ed, ju*»t whni niatiy poor <'hiIdrL-n utiitiot g«t> Freqiiyiil 
Ailt batlis, woollen underclollu^, and a dry residence; a strong 
diet of oatmiml, corn and wlti^t bread, milk, 6{^> i^nd mcat^ 
with tv>o or tlircc doic^ of rud-livcr oil [OleuM iforrktueffk day; 
pefBHiteiit an<l rytn-^i^iontious lomi treecnjenl, nnd tbe adminiBtra- 
tioo of indicated rcmnlics, will in tnoei cases bring about a cure. 

Anteniouni, Uellailonna, Cincliona, Calean^u phoiH,, Kt^rrnm 
icmI., Ilepar, Mercariuj^ Nitric acid, lihus tox.^ and Sibcca are 
arc (lie tn<mi appropriate medicines for die 4Mn<liiiona one h called 
apon to treat, but unui^ual phaFcs of the diMnsc may demand 
txhem, Ttut reader in refern^I to ihr inciiicrines mentioned under 
chronic purulent inflammation of the tympanum for th^r liMidmg 
characterL^ciiv. 

I present a few typical casea from my prnetice, illuAtratjve of 
oaricd and nia^Htoid iH-M^L-e. 

Cask L — A iprl thirteen years of age, blonde, thin^ palcj ani) 
aoKnie^ vfm brouglit to my Kye and Kar Clinic at the Children's 



318 



TBS nUUAN EAR AKD ITS D18IAS83. 



II<«|iiraI, Pliiladcljihiar ihoagh »hc wba honlljr £t (O be oul «f 
1>n). f^li<^ lioO HufTfretl fixiiu nrver^ ncarlalida u ytnr before, ildr- 
jiig ibc course oi whtcli an acute i n fin m matt oo of the mitUiv a/ 
hud dcvdo^Kx^, niUNOg rnptvrc of tlit- tympiujw mvoibnuK siul 
li fli>w (ff {um, wliidi liml cufitiuutxl uulil tbrce dayb Urfon?, ^ii* 
hud \\Ktx uAvti i-old, UJid lud juiiii in the right cur, wilh UtcnJ^ 
hisdjtolie aitd ft;\cr. TUa n^xi da^ ulie vrtts belter, but a awellip 
WM noticed behind ihviiuiide*. TlK-modwrntnleil th.-itj tbt'oi^l^ 
^M^fore 1 ^w her, the patieul complaiaed mucb of |»ftin atxrul tlvi 
car and i»id<: of tlio hiad ; wnf* vury rrnxUtve to iK>i^ simJ M^t,\ 
faxt^rnhf rc^tle^,and sHglitJ/ delirious. She bad etaggtred vbeo 
ahegottipin the morning. And liud Imcr voroUcd some of ]iaj 
brcnkfiiM. 

I found tbc patk'nt's pulso, n^vpimdou ami tcnipcralure 
ormsed ; sIk; i^brank front briglit liglii, MJd not^f^ hurt hvr limd|1 
staggered a link' in w»tking, and compUtm-d Ibat tiK- wliolci 
of ber head hurt her dreadfully. 

The cjctirrnal nitdilory motUu wni4 fill«d with dcccmposiog pDf 
and large graaulalions, and the auricle Mood off from tlft« Aide *ji 
the bead, owing to & fluctuating sw^Uing tbef^ixe of aptilWscgg 
m'cr tlifi mcbttoiil. riii' uhol<> &uml tv^mi woa exqiiiiiiicljr i 
live, and uhoa 1 injected warm water gently into tlie c»r, >hc^ 
almcMt fell ofl' the olmir. Here wah a I'ondition nf ivtvbml hy- 
pencrnia Iwrdenng upon meningItU, dependent upon oonfini^pu^ 
ami inai^toid dij^ctm;. 

I etherised the patient, extracted a buncli of poljrpi from tb< 
tympniim, tbcn made a lonj; inciMOn over llic imuLtf>id, ami IP^ 
emted over half an mnice of pun. Tbis vra^ my first mw irf 
miL^toid dJM^nve and ] vit\s mmiiwhnt anxious Al>ont it. The ti*- 
aueB around the absccBa were thick and boggy, aihl after 1 iai 
eMtciinlod the pui^, Ibe thin innWd iwrtion mnk hi to navh a d«^ 
gree, that I feared the whole mastoid was gone, aod I tiad opened 
into liiv brain <il'^* Cautious o:cpiomt!ou witli the romfiagci 
Boon revealed the state of the case, and restored my ecjuaiiiicityJ 
There was a |KTfonLtioii in the J^uHhec of tin; iua9<iloid, it» n^llt 
were carioui^ and broken, and I pa^wd a probe inward wid for^l 
word until it entered the inner jiortioa uf the auditory canl,aikl 
clicked against another introduced through the meatiu. Wans 



OJlVlHS OP TBI TCMPO^tAL BOKB. 



carholiMMl water wmi iojocuil iDto tlic r]iMU>iJ upentnj^ and out 
of the m^tud, a t«nt of iwist^ lint waa piishoil into the incisiofi, 
a flaxsevil [toultiot^ onlen^ uiipHcil^ jtiul Kali l>roiu. gr. v, db* 
solved ID water, given every three hoitre. 

The next (lay 1 visited the |HitItfiit at her honn^, »nd fouml hrr 
rc^hcvod from hereuQeringMund rtangiTou?^ s>'mj)tomf4, TIh- local 
treatracnt was ajnlmued, and cotMlver oil ordt^n?d. Hlie uunie 
tothcdinic after afGwday»;,und through systematic UKuliuidt^n- 
tidUilloruil 1n?ntment the diaehar^ dedint^l and finally i<<>fL'«(l^ 
the *inuj<c4 iKJili^d, the middle our di^^iMr yidiknl, aad her heidth 
liecame fully restor«J. 

OAiiG 11. — A girl,eij:Iit ywirs oKl, liiid rlironir puniletU iw- 
tbrnouitiun of the tymitanunif a vt-«^u<?la of ^carlutJnUf for eight 
months^ (>iie day ilic diM^hai^e from the nieatuA ix^a-^, severe 
IKiin in and al>oLit the cur omiii'd, ;Ltid r-Ue wa» btx»ught to the 
hoepitui for treatment, 

I extractcxi a fragment of bone from Ihc external caaaJ the 
siceof a Miiall benn^ evidently a (livec of the telhilar mastoid, 
found tho i)a*tcrior c^Da) wall oariout, scraj>e<l ont n few Brales of 
bone, and inj<xtc<l warm curbolizid water, AUer several weeka 
tn^tmentof tlvc naries and the f^oexi^tiiig puntkiit otitii*, and 
improwmvnt of iho gcncrul healtli^ tlie patient entirely reix>vered. 

('ahi: hi. — Anoihor gii-t, aged nine ymis, thin, nria-mii? ami 
HCffoftilouiK, Imd scarlatina and chronic purulent otitia. The UD- 
beollhy ptj!i UtendtyMiviinie<I from her«ar. I never miwm> copious 
a dUchar^ from the mcatu?^. 

Tike family doctor had told tite mnthrr thv pntlmt would oti^ 
grow the diwaw, and it would be dangerous u> interfere. A 
painful swelling h:td itpjHjun^d ovi-r the mastoid procvss, which 
led to her consnlticg me. 

I fouiul a poHt-:Lunciilar aW^ovai, eut dowii, ovacuat4tI die puM, 
and removed the whole outer shell of the mastoid proce^, which 
wttfl locHe nnd ni-<*rft<<<(i. 'J'he patient wilm much iniprovctJ by tlic 
txe3jmi>Dt adopted^ but cca^ lier vifiit^aJW four naontha 

Ca^e IV,*— a Ixiy, nine yi^rs uld^ of lymphatic tempirAmcnt 
had a li(;bt attack of nNaalea and a concurrent otitis media, which 
nsulted in perlbration of the tyin|uu]ic tDembrune and a purulent 
diftchar^ge. The patient was scrofulous, tlie ear affection fell into 

21 



314 



ins UVVAH SJIH A!tl> ITS l>tSSAftB3. 






lli0 chronic 6tjLj£i?. ami fetid pii^ flunrcd Troni tltf du^im in mcd- 
erftte^uanlily f^niiniially. He hm) K^veml anile exaoerbat^xOk 
during; vxw of wl)idi tbe mmtuKi ti^uc4 bci^nuic swolkn, formcid 
an Aljsoc?<iJ«^ Aii<l o)i^ii<.*d j^ontanvously bcbind tho iiuriclc. Thft 
0|>enin^li:ii| pr^I^cd, and froniilcame a incwieratc? ilUcliar^^e. Id 
sevx*nil tulm^u<.'r£ acute cxnccrLtationii, ho bail ^ullirod Mrvrdj 
from IfttemI lu^iulaHio and cerehral «xrit<>mentj and ii|hhi otodo- 
casion he be<time deltriom, and so ilt that hb lif« was dcspaind 
of, niifi hi** phywit'ian, who had hrfTt frfntinff him *i y/rir with nolh- 
ing but potstiern iii/<r«fi//yj reaiaio(!d in aluicst oonetant atieocU^ 
for (hn'i* day!*. 

It wa5dfirJn^anotlkorA>vereattftrk rhat T was tilled to bis 
I found tlic boy in bt;;h fi^riT, \rrth seven* lateral and fmaUl 
bcadache, niid aome cl<!^lirittin, Thi^i^ waA very tittle diK'birp 
fmnt fli? mastoid smiis or the meQin*^; die ma^oid w^ Awolks 
am) ten<b-r^ and a huff^ miK^fjiiT; polypus almortl i^Jitin^ly occluded 
the auditory m«!atU3, I reniovi?d the polyptif, loucbed iti» bdw 
with Nilrir acid, enhirKt-d tlu* npi^ning liebimi llie mr, eiMelal 
several pleee^of dmd bone, injected a warm anti^ttie ftilatict 
tliroiif^h tho itia>iU>id and out of tbu m<n(iH,ai]i gave Iklladcautt 
tinctarcMn water. 

The relief was alnioM niaii^inil, and, tlie nest day, I foiim 
imiiaU playinj^ arutind the mom entirely fa»e from pain. 1 
cleaned the oar and maHtnul daily, ordered injertionflof asolutioo 
of Sulphoearholate of zinc {^inci gwlpho'eatMuM gr. x, A^ 
n\i}, three tihKs aday. 1u fourdaya, tbemastoid sinus had lumlfd,^^ 
and oidy a i<ili^hl «how of puj^ I{ow<m) from the maUua. ^| 

The IiM^al tpeatnw^nt of the middle ear H'as eontiDued, vaniMg ■ 
ih*; w^tringcnt injection nomowhatf Citlcarea curb- niw piven ia- 
t«rnally, and» ht -<]% wei'k^, the ^latient was dbcbar^ctl aiml, 
and able to hear the watch two inchefu 

Caj4K \^ — A boy» lldrtei-n yours of a^^ce, of nervo-fibrous tct>^ 
peraiuviit, find ^ii^ered four years from cbnmio panil^nt influa* 
nmtion of the tympantjm, a w^pitla of diphtheritic pharyaii:!!^ 
Hia health wm ^oikI and the di^hnrge from the cnr i<lipht> Uf 
had been inuhT hom<eopiitliic trwitnient m the early period, und 
latterly under none. He had taken eold, nn<l hud wvcre tonsil- 
litis and ffreat paiD i:i the car am] maatokl I found a little 



id4aHtt ■ 



« 



CARIBB OF THS TBMPOBAL BOTTS. 316 

diecbai^ from the ear, and a polypus in the tympanum, extend- 
ing into the canal, I twUted this oflF with forceps, ordered hot- 
water injections, and gave Aconite tincture in water. The next 
day the pain about the mastoid was severe, there was less dis- 
diat^ from the ear, and considerable fever. The medicine was 
<!ODtinued, and a poultice applied to the post^auricular region. 
The next morning the patient was doing well, but towards even- 
ing he became much worse. The discharge had not increased; 
the mastoid region was swollen, hard and sensitive^ there was 
severe lateral headache, vertigo, and hypereesthesia to sound and 
light, 

I considered action imperative, anfeathetized the patient, cut 
down upon the mastoid, and, using a small trephine soon made 
a bole into its cells, and liberated about half a tcnspoonful of 
pus. A clear channel was made by a probe through broken- 
down bone cells into the tympauum, and the usual treatment 
instituted. The pain and threatening symptoms disappeared 
under Kali bromidum; Cod-liver oil, Cinchona and Fernim iod, 
were given internally later; the mastoid wound healed rapidly, 
and the discharge was arrested by nitrate of silver, and alum in- 
jections, in about two months, when he was dismissed cured. 
During two years that I watched this case, the ear gave no far- 
ther trouble* 



316 



Til BrUAlV BlEt AKD tTS VISBABBS. 



CHAPTER VIII. 

CUROXIC ntPLAUMATlON «K TIIK EUSTACHIAN TUBE AJP 
TYMPAM'M. 



T iiAVR, in another HiApt^r, united ticui& mtarrhal and «Alr 
purulent inflammation of tJie tynnpQnttm, consttlirrini; it iinidri*- 
able for pra<'tical purpa^tv^t, to ^<paratc (wo phaaeA of an iDfiun- 
raatt(vn, that differ so little in symptoms, ixmrFe^ and trttitnHrot 

I slinll «kn»id#rrliri>mr <.*aCArr)iJtI tnflainnmlion of die Kii!itacb- 
inu tutx\ and of iKo tympanimi, aud the so-mtlcd proUfc-rous io- 
flammation, umler tlic above caption, bclie\'ing of Uift fir^t iw<v 
that «ich is !>oth caaee and eonseqnente of the other, ai»d tW' 
llie la^t IS a late iKUhoIi»pcal chani^ [b-pi nding Op(.»a th'^tn. 

Catarrhal Inflammation of the Tube and Trmpantim.— 
TU'if' t'<»ninion <lf^(.'ajM.* ih <:lmm<"UTii:e'l by i.^to«di-nibie .»»n>-iutirti» 
dischargG from thf mtiooa^ iiic:nibrnne of the Eu^cacjilan tube 
aH<] miildli; var, with more or ies^ diiGn^o iu tlic nado-pbar^ogttl 
Gpa<^ and thmaL At kast one^hatf die diflea^en of tlie ear tbt 
apply for treaEnicnt art; of tbi^ kind, and unfortunately mo^t of 
pati«ntH di> not realize their oondilion, nor soek medical aid, on' 
tht' patbological proocss ig far ndvanceil.and tliv dclimto anditoij 
apimniliiA h jitfHoosly injured. TIi<t dir^ca-^ ha^ Ijeitrtme ^hroait^ 
IikchI, and prngrfsiiup, ptrhaiw, without <»vw hjiving l)wn amte 
either liaving bni) im tn^^Umi'iit, ar tho <H>4ldling, iitt^fliesmt, Cli 
Ffriotitilic^ menHire8 rf<oom mended by gossiping i>irighboi^ and cmre- 
Itflfl physitfian:*. 

Pf^rHonjq with normnl enm ran hear a rommon wAtHi livi^ or m: 
fe^^t. Thty i^m hdir ortlimiry (umverftuti^m, when the audjtocj' 
power hsH dimininhed so that they ran iinly limr the isamn vr^tA 
fourtoftix iiiHi<^ Ak mn«t of th« ^oiintU e^^ential for one U 
h«araro au loud a^ metlium voic^^and cofwvntrali^d attrtitlon will 
improve auditioQ in aome dogrt^e, jtatieiits, who have lo^t 
]v>w«r of hp.iring ihe mili^Ei nt vnrioiiit <li)c1niu<t« Iwlwet^n (t 
inchott andfliv feet, will uot ^:euerally beeonsolouaof theirdefrrti 



I 



CATARBRAL IKFLAWMITTOW OT THBl ASU TTMrA!Br«, 317 



ttnlil nori<l«nt or a compamtive IkC revmU tliem. I>r. llfKMa 
hu V4;rv huppily c^lk-d this " «iip«rili.ioii^ h^iLrin^/' und tays, 
" peopk who ^|wti<l many lw>urs of the day in noi^y plact^ » - • , 
nay Itwc very muvh of (heir hciiring powtr before tbcv are aware 
or il/' 

Every aurist kno>vs, that nvmv pL*r»i>ti'(. nlio <)o not coraidcr 
themselviv d«ttf at nil, <:sinnr>t licur a wnlrli lU n foot distance. A 
gcntkmiin brought his vi\(e to me for ln?atnK-nt of a purulent 
LJ(^ Hint H;ilfl Iii-4 own lic^urm^ vrits ox^vlU^nl. I U^iihI Iii.4 e«r« 
found R, K. IIw.JJ, Lh E. Hw.^g; thus showing a dec-line 
itiiiii iIim; to t)i(f di^A^' alitrnt wliiHi I nm wriling^ Th]» 
w only one of many snch incident*^ that hare occurred in my 
nal <-x|>rricnrr. 
Among lh« prodiB|Ki?iuff oau^ttof thifl disease, ihe most promi- 
nent ifi a cntiirrljJil iltallKr^iH. Thm I Imvc foiinil more common 
in fitruraous persofis, wiUi light hair, Wne eyes, ihin hkiOj and 
deli<atf mn<<oi]« mcaibnino; but tht' dcirk lyE>c^ of wrfitub fur- 
fell many <»ses, and rhf^umatic and gouty jierson^ have a por- 
ion, The inveterate and disappointing taa^s, those in which 
LreatmeDl long continueii and *oientifiailly applied has very little 
in arruftin^ tlK< profu-^c dii^harirtv though lh<< hearing may 
improved a little, are in 1ymj)hfltt<: and sori^fulous oonstitu- 
tionj>> Khvtimalio nnrl j^^niy iM-^^on.'^ nn^ nM ^i liabKf to exoe^ive 
diBcharg«Sf bittit Uaqustiou whether this ianotoouDterbuIanced 
hy ihcir ten<kn<-i<^ 1o hy|M>rt rophy, liyt>er[ila^tn, and cnlnticatioD. 
Thevc constitutional diatlin^es are tiansruitttsJ from generation to 
S^'nenirion, and thtu her<nii[,y fnu^C Iw im-ntionc<l hh a prcflisiHietin^ 
cait^. J have had historic of deafne» in three ^nerations of 
family and treated menibeis ^^f \\w Iilh two. The diatlic^i^ 

arthritic and the temperament hiJiou^. 
YoutltH and middle-aged |)en»onA are rnorv i>Acn atHicterl byca- 
rh than the aged, who pri.«ent the greater nutuber of prolifer- 
vecascs. In my exiieriem^e, the female M'X ha?< forni^luHl mon* 
of both varielie* of the diecnse than the male, but this may 
because females fnnM The do(-tor for every ailmeiit ttnieker and 

ler than male» do. 
Aq cnfeetdecl AtJitc of the body (mm the pn^^cnoeof diMAie, 
instance, chloro^^, leucoeythiemia* asthma, tuheivulosis and 



ijel 
^Ttoi 

r^e in 



318 



TOE nCHAlf VAR AKD ITS BtBIABie. 



thOM 

M 



8}^pliili4, or followinfr any sevtro afEGction, snob &» dipbUKrii, 
the eTiiaUiemam, an«l coininiioiw and inalimut revere, pn^isfiom 
to chruQic thrcHit and ^r ()i§^asea. 

Defealve peixinal hygii?n<;; tiof^lrct of baths; luulRekfiL 
cloUiing; ba<)]y veotilattd, t-old^ damp homcA; exposQi% m oc- 
ctipalioii to ilraflit, tirn>ng wimU, and w«ttiiig«; irr^rular liotjrf 
ami dis4i[mtioD; contraoced na»al foSBie, Dece^itating br^lking 
with the moulh i^jM^n, mav iilL Ik- niC'iitiotittt xl^ jiredbipo^itigcnitfa. 

The txciling cuui^es aro multiple; Ihey incJade'many of thoM 
wliidi proilucc a€iit« inHAinimtion in tlk& n>giun, ami i 
slower but not 1^^ certain iti tlietr aclioo. 

Sijttitt of thi]^N> iifllvt rho t^r ajf|iari'ntly tlirough the Die 
atiilitory canal and [iH'mbraiui tynipnni, aiid extend ^^cuikI 
to the Ku-Hiachian hihc; ollif^r^ aoL upon tJie iioae, pharynx and 
tliroat, nrnl produce in da mm at ion of thir Kuiila(*hian tuU', whicb 
aliut^ oiY ilk- air from tlit^ lyiiipflnura, ami tJiiLn inaugurat«ai 
morbid proccm thcnrinr or wliicli crte^M along the miteoud tnoia- 
bninetill it reaches and involves tJie lining of the middk ear 
and ina7<1oid ci^lU. 

I will Jiral enitmerate ttioae cau^^, which have appeared to ok 
to nf!cot ihe mr primarily through tlic niembninc, <.K*tting yvhtn 
m the canal from carelcaa wn^hmg; dipping tbe bead uikdef 
water, piirrioularlyaAcr Wing heated ; wetting eIic hair rro<]u«itl]r 
to make it lay well after combing; cutting the Iiair close in cM 
wtatlKT ; Lvwring ihe *^i\t6 will the hair at one tioic, and loaviif 
them exp>.)°e<I at another ; ^^tiiflmg the auditory <3Uil habituilty 
with cotton ; an 4<.'ciimulatioi] of cx'Tiiiteii and dirt from an exccM 
of haiminthe meatus; acratching, serapin^ and dicing in lltf 
€tmt 1o rtOievi* itdiiiig an<I to n^move cxTunK-u; »[>eiHling niany 
hour4 daily in noisy worksho|>s and niillB ; an attack of munips; 
Qcxoniaof ihoi^uml and membraiitt ; furundot uml alMxaan in 
the canal ; foreign bodies in the canal ; mechanical injury of the 
drum-head, uikI medicinal iM)lniiiiii.-t dropiM^l in the ear forcar^ 
ache fi-oin neiimlgia of the trifacial nerve. 

Utht^r eanMs, i^omK^led wilh morbid states of tlie noatr pbfr- 
rynx, and throat, cxciti^ inflamukalioD in the Eustachian tabcv 
vrbicli extendi quickly into the tym)miiuio, a« in ix>ryxa, hay 
ferer, etc, or creeps elowly along the mucous membrane ialo the 



ACtTB pnAnryotTts. 



319 



I mi 




kvily. It fi}iute off tlii^ uir rmin the Ivmpanum frequently, ami 
thti^ inan^ucutei a subacute iDQammiitiun !n itd mitoom mero- 

Cuys&i influenza, and liav fever bc^^in by aniile inflttnim^tlloti 
of tli« DiMui mucuu.s uicmbmne, which geoemlly oxUrocU iDU> 
ihi* phnrynx, and frequently idvoIvcm the Imiogof th« Eii»tadiiiD 
lube and tytnpanuiTi. 

'i'hc Sc^iintidtrian membrane tingles as if batbed in \vmk am- 
^onm ; «iwxing i)* frti^ncni j (here U ft dry MiiRiJtl ft?eling in the 
and frontfti i^inusea from congiottion ; clear TH^ruiii soon bo- 
^BA to fluw from the nuoo, and bniidlccndiicfs nrc Mtiirnlcd mp* 
lly; llicro i» diminution of Hmell and taste; a na.^1 tc>nc to ilie 
Diw, and some ftbnlc mirtiou. Whi'a dio trouble ri^acbcB 
fiiilbor» the thrift ia a little aore, there is fi^eijuent awidlotving to 
remove dir^coniforl and n fecliii;; of U-nr*i<>ii at tlit* tiioatb* of tliir 
Ka-<tB<^-htnn lubps. The inflammation may affect the lulie?^, fill 
thf'ir lumen and the tym|ianum wiUi mu^ni^, auir^< dulnc^ of 
hmrintc and rAles on inflation, and, perhaps, some pain ihrough 
the aural repon. 

Thi:^ ronibfion may develop acute inilamnmtjon of the tym* 
I iwntini, as Iwfore mentioned, but U more likely to suUide, l«av- 
■bg tnuH^suf the Eiinrm alon^ the mutatis traet. Olfier attacks 
^Houie to aujfinent tlie mischief, and eliroiiicdiM'afie becnuu'ri firmly 
^KBted in tlie ti^xuciit of the tube and lymjianum, ua> well wi in the 
^Bmic and pharynx. 

^^ The niiKVir* menibmue of tin* iwwt' during the aeittc f^tage is 
■ inoist, red, velvety, and tumefied, GILficaint; [*nim and [iinutl 
^Bpitcheft of adht^ivo mucu» cover Uie surfacH:^ nnd the swelliDfc 
^^ftim prevents nosal reHpinition, and hides ihe dqiru?«4ionff uiul 
^bctoIIh of the turbinate*! botn-s, 

^B Acut« Pharyngitis arises ol^en from the same aui^nmivirynt 
^snH frequently (ymiplirat*^ ii. It is an inflammation of liie 
murrvtH membrane of the buccal pharynx, i^crendly involving 
the niL<0'|>harynx, th« y»ift peddle, nn<l the ptlkn; of the fauom, 
nml frpqtiefirly extends to the larynx. It in nanally a rv>nimon 
norr ihnxit from Uikiog mid, but may Ite a UkiiI inanjfi'j^tiition of 
erysipelas, diphtheria^ measles, scarlatina, smnll-pox or syphilis. 



320 



THB nUUAIV BAR AVD TTO DI8BA8S8. 



It U pn^ccilocl by mnluiiM^ jind di-prewion of spirits, oikl b 
mhered in by a Hiill ; fever follmrA, and the throat GynapMtt 
ooon bccomt- (fiTiik^d. The throsu itc-hc^;^, tkinl fit^U do', rougli, 
flwoUen, and painful; ^wallowfDg causes more tff \em tme ami 
fiharp durlinf< pnin in th<- tlinvit, olUiii I'xUniding U> xhv vat ami 
<Kiwn Uie sule of the neck ; rho throat outnide jn siznsitive, sooie- 
timcti swollen, nml some of thi* eabmuxtllary gknds nn; cn^rgvl 
and teiidt^r. 

InnpectJon of the throal Tvvcaln d<«p redncRs, cong^ioa ami 
snwllingof the mu^ta^ ncmbmnc; the uvuU \» often cBdcak>< 
toQH and elonpiled ; the tonsils more or lc«S flwolTen, nnd the 
^iglottr^ tlii<-hriit-tl Jiml rif^id. 

If Che bn-n^eal mirror be U6f?df tbe naao-phaiyDX, pofiterior 
nares and larynx vviJI be fotinil fni^mrotlj^ tij participBtt^in tbt 
miK-ous inllttmmfitioii. If the t\o^ is aflcctcdf nasal respiraiioa 
wilt be interfered with, the aenHc of ameU and tasl« blunted, Ihe 
voice altered, nnd i^mc otin-r inrmptoms of con'aea present. 

T\iG KtiatacJiian tube and mi<!dle ear are fn^uently AfRTteii brrj 
tho diFrni>c ; then there t» follies, tinnitus, dcafaei^s, mucous rUm^ 
and [^in stiootini; alimg the lube 1» tlje car. 

In eimpio €as&^ the hyperwrnia and swelluag of the repoo sonn 
cause inf"reflj*ed sc'c-rf^tion; there iJ^Hcopioii* di*rharjj<' of MTwm 
from Ihe dilated vessels, and of tnucus from tj>e irriUiied follicle; 
t)i« swelltn^^ t^Hiiltinlly melti* awaj^ luid the thrttut returns lo a 
normal condition, or, here and there, traoen of tbe attack may 
remain in patrbi*^ of tJiickoiit^l or ntrophkyl iniicfinfl membntiK^ 
enlarged follicles, hypcrtniphied totitiiI«, and Kubucule catarrh rf 
iht EiwtiM'hiaii ItilK^and lympatinm. 

Whenever pharyn^tifi ha» a »|Mx'itic esu^i', luch as diphtheria. 
»y|)hiliM orun e.TCAnthematoii.'i diseafie, the i^*mptODifi are sawn, 
prolon^l^ and uodilied by tlie lurlicnlar affMioii cxiciijilifig- 
Then great injury to strncture and funotions endues, and the as* 
ditor}' apiuinitua freqiionlly i^LjtVer^ j^frvcroly. 

Uloeration, a1vee»ti, sloughing, and gangrene in tbe nuo^ 
pharynx aiul thnxit dci^roy and distort the tif^ic^. and oro fol- 
lowed by cicatricial adhesions and contfactions, which inteifcn; 
with or pivvent the normal action of tlw tnii?rclutiL of llie pbaf>-Di 
and [mlate. 



I 



OnnOKTC NA6At OATAKRlt, 



351 



' t have bfid two iralients with a pprman^iit roand perfonlion, 
"the dmnu-t^r of a Kinl-p-nfil, tlimii^Ji die wliim bplween tUe 
uvula and ton«i], tviAiltiiii; from st^rlutma. ^e\H^rul tethers have 
had miititfti^ suH pafarcs, with portioDs firmW attad>oil to flt« 
poaterior aiid lateral wulU of the phaiynx. 8om» were <^ii4«d 
by !rarblinaf olheni hy diphtheria. 

L^ypliili^ cnuwv rnghtfnl nivup% in the eofl uiirl hard palate^ 
phan'iix and Inrynx, Tlie worst awe I have Gvtr sepn i-aiiie to 
till- PitUhiiryh Hik«pilnl for treutment. the juilatinc prwxvs of 
the superior maxijlarv% the palate bon^!^ an<l vomt^r, with rhrir 
soft liesa«0, wore cgmplctcJy dcalroyed W syphilis, Iraviii^ a 
jravning mv«n) behind the* alvi-olar aHi mid na«il <wrtil]ij^ tip 
to the btts? of the ^kiill, in which one vould have buried a Bst, 
The moutlis of the KiiAtaeliian luh<s ootild be plainly Men; th« 
pharyii;^itl raucoa^ menibrano wnr^ thickoned and granular^ and 
the tubes and tympana were in an a<lvariceil xUige of dironi^.' 
mlarrliAl inthminatton. 

Besides the acute and chronic inflammarioiu excited in Uie 
Eu^tK^htaii tube by llir* putlKd"i^iral conditions mentiooed above, 
CMitttricial closure of thr^ Kui'tm-hian tube o<viir^ <Nxa8ioiuilly tVom 
nicvration of tJie phaf5-iip:wil openinjr or of the pharynx imni&* 
diateiy Mirroundin; it. It is fteen, also, vrifhin thi' tiib<?, ait<) i» 
said hy Sehwartxe to be frequent at the Ijiopatiio eud, ovrioic u> 
cnrH!* of the teiupnral bone. 

Chronic Nasal Catarrh is nsually nn^mpanied bychmnit^ 
innAnimaiion of thr i)ivsf)-p]uirvjix niid p)iJiryiip.<iil tonsil. It re- 
sults from repcate^l attacks of con'za, or cold in the lieafl^ and 
becomes a aerioos din-jwe, when tiie subject i^ »truTO0\u or syph- 
ilitic. 

The nofte and pharynx feel allemntcly dry «"<! moiat ; dry 
when indoope and in a mrm atmosphere, moiet and discharging 
»ero-rniiciw when in Mr* cfjld. The now bwt^jiTu^ !<tj.>ppod in aome 
patients during the night, or ie oraluded all the time by flwclU 
iDgsi, iMab<( and rru^ls; respiration takw plaecs thn>ugh the mouth, 
nod the throat becomes dry snd rough. 

Id the morning, there is usually a clearing Hpell; blowing 
anterior, taking strong inspirationh, and hawking out rauco-pus 



TUB nCMAEf KAR A!fD TT5 VISBASfES. 



from the fiEi^o-pharynx. Tho fronlnl bJhums feet fulJ, iht hr^ 
head ami eyes strained and iiim^nifortaljle; the lachrymal eMuli 
an: o»nKlini'» olMtriicted, ami tin* cy^^ waier; t}ra cydhh often 
Ivitch, ta^te and smell am blumod, the r^ipired air has a d»- 
Bgrtt<iil>le orlor, the voire hi4^ u iioail «ouod, and aitcm|»l)!; to Kpeik 
long or to sing, are soTneiiincs interrupted by fetid mucus drop- 
ping frcini tilt [njHterior njins into llic ihrvot. 

ITiere 16 generally a kIow procGssion of stringy mnccK down 
the pa'iU-rtor pli:iryn^l nail ; and ia »vere au*e^, <mlJ4xl nuent, 
Mood and foul ni£Lti»<?&of inspissati'd mneo-puFi and criist?, eiiapod 
into ca-4t9 of the cavity, w^Kre they have bt-en retained and liavt 
d^en<rF£ited, appt^r in the throat and are remo\*td by the fiagvf 
or puw titiwu iiilo the stoiuaL'h* 

Tlie aasal and pharj-n^l mticous mcmbmne, in inild ca«» ui 
ohronie cularrhr ii^ deep rofl ; the epithelium ia tiaoculcnt and 
granular; the submucous ti?wno inliltrated, hypertrophifdr lad 
ii^lentatoijtf. In other caxs*, Uii;* hyjiertrophy ifl aeci^mjiQDtcd bj 
atrophy; die epithelium has dissppeared in pUoes; the nwa- 
hrane i« pinki?«h, thin and c](Mely adherent to the canil«|^ a&d 
boifies ; finalljT) tiiu naml [ja^Mageii t>ecome enlai^^ from atrDfibf 
of tho mucoua meaibraae and epoD^ bones, Ulcere in> km 
here and there; luuous, pn^r and ili^u9tingbrownbh*green ctuffi 
cKn^ lo the dL-presfiions ; ihc expinnl uir iH,-^ioh(-ni[i|r jn n<)iNr,aaii 
in Home eaaoH tlic diiteajw is contagious. Patienta ahonld b««aa- 
tioncd not to let other per»on>f use their toilet artidci. 

When there k a viltaled constitution, the ulceration may gv 
dec]>or, tlie boncA become canoii^r aiuj frightful mvai^ occur is 
tlie palate?, n<^ and face. The na^o-phar^'ugea) inucoas mem- 
brane is in i^vDipathy with tho morbid ^U\\i> of tlic tia^l foffVi 
it proaeuta the sim^ hypertrophy, atrophy and iklotration a£ 
Men in the iio?^, and itit diseuM* u» a^gniva1i<3 hy tJto foal dii 
cJiar|i;e that in almost eonaUintly in contact wiih it, being irreitl; 
auj^eiitcd by hypet%ccn;tion of iIk^ pharyngeal toiinh Thia 
aheet of ii|ion^- glandular liii8ue is in aomeof tbeee ca^ea swcJkt 
to an inch in thickness, and, not only, fumiidK-f} conadetibU 
aeeretton, but, al^, oljAtnict'i In a measure the poet^or oarcVi 
And, even, the mouths of the Eustuchiau tubci. Tlieae buteraR 



I 



am' 



POITPUS. 



323 



irrljiin to IrtfBMhliUfcflNliI b^' tiie pUiiTyn'^vn.1 compHcatioD, if not 
by ob^mcUon, aoct tliiis tuba) and tympanic di&oixlem originate. 

Folypua of i\k mom; and tuiw>*pbAryox <HnLMuimlly uhj^cv de 
now^ AT ii? an a4xx>nipammenl of mtarrlal inHamniation. In 
nusal cQtarrli, Uif co\'«nng of the turbinated lK>nt« e^>moiim«( 
becomes so dropaieal, as to project and much rtfierable a mucous 
pol^lftus. Muooas cyeta filled with fluid or glandular »('<-rrti^ii> 
are 4eea occ«Kioniilly in the tick^e. Miieana aikd fibroid polypi 
spring from th<^ niif^us membrane, and are more frequently 
locati^ in thi- pov<tc-ri<»r |Mirti«)n of thf naaal foaSK than elwwhere. 
True polypi arise rarely from tbc wall of the phiirynx. 

The first symptcrm Ut attract attention ia fivcjuent tnuftirj; to 
free (he inferior ineutuH'7« from a MtufftHl feelinj;; later, grt^ater 
obetrueiion i.^ felt on claiap day», ou'ing to greater awelliag, aod 
finally to tolal oo-^lmton from increu^ |rrowth. Tht^re ia u 
naucouA di^hargi> AoniiMiuu'^^ mlxtvl witli blood from the anterior 
and posterior naivs; tbe r«&pimtion i» )>artiiiI1y by tlie mouth, 
vrhkh ilri^ tJtc phairynx and iiidm^^i diHorder ; asthmatic aymp- 
tooiH arc not infre^itient; the voice h&fl a nBm\ tone, and eoma 
deafncM if* noticeable. 

The mucous tutaors are bright red, fimooth^ n^fl, elastic luid 
tiitiDiilent. They ^^ary from iIih ttixe of a grain of nr« to that cf 
tbo fi»t» K^ncrally occur in groups are usually kucb-like or pc- 
duneukied in f-liajie, readily inainuati^ thomjt^lvefi into depreE- 
siom and trnvitius, and sometimes pTX)ve dangerous to life. 

The GbrotiA polypi are pinkUh, smooth or Luberculatei], of 
firm eoosifrleticy and Juodemte siie. They do not swell in dnmp 
we:^t)»er, bat grow slowly, and are generally .solitary, Th*?y 
spring from the submueouB tissue, arc very firmly attached to the 
cartila^ or bone, diilicull to remove entirely, and, therefore, prone 
to ri'Upw, 

Polypi may l^e dla^iiived by dllatintf the anterior narea with 
Fnuikd'H K|>cvii1um. by tin* laryn^^cnl njirror behind tlic palat^ 
and by palpation ivitli probeand index linger. Fortunatttly otlH^r 
Itimon* are ntre in tbiM region, but enchonikoma^, mrcomus, and 
carcinomas have been encouiitered. 

Polypi may bu thec^uj^oreonsitjuenccarclirotiiccatjirrhof tiia 



T&B BITBlATf KAR A5D ITS PI8KA6EB. 



tifie9 and phan^nXi amt this is prone to aflect Ihc iDtcfrrity of (lir 
Kir^.-K-hian tiifx^, tf ih^ mecbftnicftl irritation froni ihe pmcBce 
of a polypus Di?flr or agflinet the ripening of Lhc tuljo doefl M. 
In totnl oh*tnii4iori of i\w nfb«e, tlie ftir iloet not find rcodj ocoob 
to Ihe tympaitum, mrcfadiou of the air tbemn occurs^ and or 
diisca*** is exri(o(I> 

AdCDOid Tamors art* benign ^owths, whicb artsG in th*^ upper 
pharviii of ]>crson.4 of a l^mpliatto temperament, owing to bTpe^ 
tri>phy of tho plmrvn^i?»l t^kfi^H. Tlii^ or^n raosuts of a dieci 
of glandular tiRMict, wliieli exlonds from one Eustadiiaii tnbettf 
the other, over the ftidcs, bflck atid vault of the pbar^'oXp ami 
tlif«e tumors spring from itH utromft. Thr^y \farj in sice (roa 
m?re granulations, to thickenings and growths that till the vanli 
iiTid totally obr^tract the |>o&t4!rior nares. When loeaiteil upon ibe 
lateral walls, (hey are dJsk«like and scssik*, but in lh« roof air 
coni<iil, Imf-liket flank !4liap<:il, and pediiiKmlate^l. 

They eoneist of a net of jibroufi li*«ue 6Iled with lymph oelli 
aud nmny vesi^U; are flovcred vitJi cylindrioi)epitli«)ium,ii)0Al7 
ciliated, and bleed easily whra touc^hed by the finger or&n infitni- 
mciit. 

The preacnw of ^hef^^ luraorH cawiai ineehanioal imtiltOD, con- 
gtvtioii »nd cutarrh of the noM, phar>'nx, iiml EuT^tuchpan taW; 
there in a eoplooa secretion of {Ei'^^it^h-yellow mncu-i ; (limini?^l*«d 
»mcl] and taj<1e; ft »mothfrred trvnc of vo!<w; a 9top|KHl fe«lin^ in 
the e&n yf'\th i^fn&m; obstrtietion of the noee, with hmiihitii; 
through the mooth ; anoring at nTj3:ht; drynctta and digoornfort of 
tlie fhrixit ; !«omH3tnes enlarr^eil tonniK «nd a pinched, Mapid 
pre#eion rtf countenance, owing: to fallinjf inwards of tbe nnse, 
tlie almoflt coaatancly cpe» month. 

The»? tumor>« are not 5o eonimon in thb country ok in Eorofja. 
They arc seen in childhot)d ajid youth more frequently tluin in 
wtolts, and arc thought to disappear Kpontaneou^ly very oAen, ii 
^le advanoes, The diwrders whuh they f^xeite in n<Tighbflrtii( 
parts render it necessary to tiXTit ibem early and actively. 

Dr, I>pwenbcrg, in Iiih monograph. Lot Tttjn^ir^ ,4rf. 
dtt Plhinynx Xtt^U, sar» : ** iVou^yTroifon* d/ ntitr^ devoir d'apptb^* 



4 



ADSS?OID TCMOU. 



325 



iri»-/r^UfmmfjU ^ quf, inatgH rtnatmtU tria-frappant dt^ Bymp- 
t6mi» canth^ par la prftfcnee de$ (umeur^ atiAttQvUn phartpufimju^f 
its t^abia cavset du imd soni <jhihutert%ent cher*Aie9 aUkun, 4u 
fframl tfHrimail ila maiad^f aiim tpu noit^ Vavimt eofuAaii maniLm 
<f mainUa ftm,*' 

The dia^iinAtft may be lotcmtily oertain from the syniplom^ 
ttnumrrutcd, Iml should always be confiraied by ocular in^pectioa 
viib die Wyngval mirror, »Tid by |ial|>iAtiou witli tbc jirolxv 
<iitti«ter and fingers, 

fidaides tlte danger tii briiring from oxloiMk^u of lite inRiimnift* 
tioft of ibe mucotu nuMiibrnncof die pliarynx to tliut of tli« Eu»< 
tftdiinn lube, and from o(i?afnonaI oltetru^tion of tie tube I>y 
proxiiuity of a tumor, oocIu-^kph *>( tiu* iiom> {irevetiU i>ro|>er 
AcniUofi i)f tbe tyiDpuiuim, and tbu^c&Lifiei wbat may be^^Uod a 
diBeflae in raeuo. Thin lia.s oo nvc«i«uiry oonnection vitJi tho 
cnu«c of <»bBtruction, wlicli may be from chronic catarrhal in- 
, fl ammation, |>oIy|Hii< or adcnonu imlilFervntly. Tb<r Mibjwt w 
^B> importaolf that I give an outline of its mecbanifini and geneaid. 
^H In tlie lU't of jiwallowlngr lli^^ pAUtu-pb^iryngml foItU und tJie 
^Bof^ palate are drawn l>nekisuz-d and upward againM ibe posterior 
wall of tU- pbnryiix, and »liut oil' lUt niitio-pharynx from the 

IUnoat, In a n^krmal slate of tbe parts, tiie air above th* jmlate 
lA aomewlmt (^improftK-d» and ru»hi.-« into ihe Enr^Carbian tubes 
wliicb are opened by deglutition, and into the nasal foasie, while 
flOOiQ of tfieair below ^'» int>i th<: Mctniiub. -An Ibe veil of the 
pHhle falU down to it^ mual pendulous pcwition, ihough this 
aotioii is »oniew]iat linkilivl by ^-tjiuslie (x>ntr»>ction in ol<l uuH^^a 
«fi^bt rardsKlion of th« air is produced above it, and air pofieos 
in liinuieti ihe wttK* and ^oiuctimf?! through ibo mouth t€ n^tore 
the equiHl>rinm. Tho action of the palate and p<«terior pillars 
cf tlic fuij<'C^ can \io rKudily t^tti during trigging. 

Now Viheu the nose h Kloppe«l and the air supply is cut oflT 
anterior, the IjiaokwanI and iifnviuxl movement of the imsterior 
pilUfA and K>ft |>a]ab^ compreaeiics Ibe air in the nnso-pfunyiix, 
p,^nunilly dituinir^bed in F^irc from diseaiw, and, a^ the palate falla, 
agrealc^r rantrailion vnvon* than in the ni)ntuil niatc, btKau^c no 
air can come through the aoee^ and this is bereaved greatly by 
attenuation of the air in the throat produced by i^^-aliowing. 



TfiB QGUA?; EAR AKD ITS DH^KAfiBS, 



A^ ill gsAW follow the I&w of ilifTuFciun, the di?n«Dr air i« ifiickcH 
JiiAfiinlarieotii^ly cut of Uie tvnipanum to refitore «jii!lihrii]ni,}ti(i 
tlic KtLemchian tube clo«». The rnrcfnotion in the ttirfmt i« odI* 
mrvmentary, ))e«2auAe air rnsbos up from tlie lungs aiicl in at iIk 
mouth, which is gfrnenJIy o|)4!ncd immtxliiUclr after svallowiiig 
to relieve the www of ftafTocalioii, catised l^ sitapenaon of rcRpi- 
ration, even, the few secoQcb mjniml for swdlowio^ — trat fAt 
Eii^tnc/dan tubf irmaint (^cwrf ami tf*r ttfrnptmic oir rarrfiM. 

Everyone is fiinji!iarwith the fact^thut airof ni«lerate Jeiwtyl 
opens tlic £uHtB<^^Uiun tulx*?* Jiml rst^ijn^ wiitil/j hwt nm'Jirtl air 
caonot, vhite it recjuirea oonsidorahle comlen^tiot) to open tb« 
tubes anil inflate the *^r by the ViiUilviaii rnvthnt. Thu air in 
Ihe tympanuQi tlierefore rcmaiitfi rareliecl, uiile^ th? ^ar i^ inflated 
ftrtiflcinlly, bccauae the prcseuro of ordinary »ir eannot open tbc 
Kusiachian tube, and every act of swallowing renews the mrvfae- 
tion, if it cIoe« not incjea^* it. .\v u rc?cult of thije, Ihe tynapuiio 
membrane is puahei! inward by the greater pr^stare of air opm 
its cxtenifil surface, and the tympanum in prepared for a morbwl 
proeCHA. Thus an oeehidetl noae may alone ejceiic varioiu difl^^ 
ea«iGS of the middle ear. 

Enlarged Tonsila — Acute inflaniinattoD of the ton-sib do-f 
n)ati<N i}0 i>llie.r considrrar.icn I'rooi loe. than that inven tmcbl* 
acute pKaryng:itiB. Chronic inHammalioa, or hy|>ertrophy, of tli^J 
tonsils vv-a» thought formerly lo l>o a direct cauw of ilmfne«, bf J 
jndiieinjc meehatieal pre6Kur*> upon the l^Ufifachian luhca. Miirt 
exact dinicul nWrvnlion liaitdemon.^-trAtul thi^ li> lie nil error.and 
fiaa proved ear di«enfii<j« jn eonnection vrith tonsillar hypcrtmphy 1 
de{>eml e;enerally upou mortHcl «tale< of tlie pharynx. Ijamrm- 
tcrp believes that many ea^tec of deafnew, reported as ran«tl by^ 
eiilara:ei] t<»tiHiU, were in rimlitydue to adenoi<l tumors in llw_ 
naso- pharynx. 

Ki]lart^-d tonsils rarely ■.'Xfit without some disease of 
ptiarynx, whioh roay be secondary on aivonot of the Irritaltofl^ 
caiisvfl hy th« i;1aodular hyp<'rplnHia f>ti^[iing the posterior pilhn 
of tJie faoccfi Imckward and up^^ard, niid, alw>, by if« mrvinir 
ftrrjiind the veUmi into the nii:«o-pbar>'n;t, n« I have seen ia eomc 
in»tance5. In mos^t cases, the picture presented <!linieally l<* one of 



CHRONIC PBARTNdlTte. 



327 



chronic pharrngi tie and cnliirf^Kl tunsi^ nml \i id tinimj>oHant 
aiiil 00^*11 iin{t()9^ili]c tn nay whtcU Jins heun ilic primjirv atfecilon. 

Kn1ar^;(d tonsiU cause difficulty of f^wallowing, thick imper- 
fect anieulalion, inubilit}' to utter high tAiici^ ouciuioiiiil hotr^e* 
Dce^ noisy r<^>iratiofi especially at aight, son>ctimes a fickJing 
cough, ami IH^jiK^nt liawkinjr nni cWnng tlic thrunt of thick 
muctu, 'Die tcu^il K roughf u»n*cn, tubcrciilaled a&<l palo or 
red ; it hm Hght slreak^ of cicatricJal and hvpt^nruphii^d rx>iineor 
tiv« tiiKuc ; the folIiclL^ arc deep &nd darfc between the protuber- 
ances, or fthovv as while ^{loB ci aiBtmis tia^retion ami <^)mefim<H 
ulr^ration, 'Jliis condition of ihe gUnd readers it lialle to acute 
eida-fliatjom of inllanimatton upou altgljt exjKeure which Mill 
further incrrea^ (ht; organ. 

ChiMrt^n nrc inore t^ubjeot lo tlit^i dLHefl.4e thai adtilt^^^ and in 
rare caae^ €nlargc<l tonsih »«hrink with the cstabli&hracnt of 
^ul>erty. 

Whfn & lonail has reached a &\te vhicJi makes it interfere with 
lie phyni<] logical action of the [lalate, thn^it and larynx, it fihouUI 
be redi»*d by medicines or by a surgical operation. 

Chroaic thBTjngiiis. — Immcdiiitcly following lie redoees, 
conation and swelling of the pbaryogenl miioottrf membmne 
from acute disca^, or dcvolopin*; «lowly a» the result of irrita- 
tioii, ex[KBiire, aiid bad treatmcni, the pharynx pre^^ntfl several 
varietks of cbronic inflammation, which musc be di^crentiated in 
order to tn*nt them nkitoiially. They are di-'^ungui^hcil froai 
each other by their objective, rather (Jian their Eubjcctivc eymp- 
toms and tlnHigb the vari«ti(« rnn into citch otlier, the apjKnr- 
mtm are sufficiently di^tiDCt to warrant separate conftideratioD. 

B^idftf the c&tuaeH of c^hronic pharyngitU found in diseases^ of 
the Tiaaal foane, n»o-pharynx and throat, from general or speeilio 
iDflucnoc?!* there arc T*ome other* worth mcntiomni^. The phari'nx 
is admirably sitaated to calch the particles of dust and dirt that 
pa^ through the imrt^, u>i tvi'l), elh tha'^t^ that enter the thniat 
during temporary or permanent respiration tfirough the mouth. 
In atnnj?>]i!n'rej^ loaded wltli inoi^inti^ and organic matter, the 
mucou.^ membrane of its poelerior wall is kept in a state of oon- 
sFanl irritation. 



826 



TBI BimAN BAE iTfD ITS DI6KABBS. 



Milliuew uf mU-rokJii^ tnuiiAJs, bocrtvrin, liumiwdi*-^ r^^nnst 
iungi, gralrib uC po!lt?n, wliolt; al^, ur^faiiic tl^brb, aud ml 
{jiiirtidt^ aw viKvo in lIic lur wv breathe ; in it otiy wvi^iler cImI lli 
(iltarypx &Jiould become dlseoMd, when currenta of air luaikil 
with thU mattur vnti-r by Uif- nioiiUi, tiru] miih« Miicb (le{KMi 
upon the tender epithelium? 

BuuuJ rc!^f>imtiiJii )mi> « very ilclctertous liiftit«ni« upon Ui«r, 
piturynx. Wbtn air enters the- luii^ hy way of Uic nxxitli, il 
oooIh the mtirom membnitie of the tliroat, except in exccplion&llf 
high cjttonisJ ie[ii|K'rHtnn.-3^ and ubvtractn iDoi«tijr<; frcwo it^ 
that di^'nt^ ami roii^^hni^ are fell In dvallomn^, axid iDftantni; 
tioD totm ensuce. 

Takbg Iced drinks aiKl U-^ in esoetti, aud [>neti io altvmtlioB 
with hot beverages and Toed; for iiistuioc, i<<e maur or ked tea 
at dinner, ice cream tntlowed by b*>t t^fflee, ete<, as sgcd fit- 
(|ueiit]y among intelligent peoptcraiid even in phjr^iciuns'faiililie, 
excilea elironic diaease of the tiircat. 

In my opinion it is M'liat goes doKvn th^ throaty imd not gtfi 
regurgttjitisl Unnly and sy[n[Kithy, that proclucvs the 90-<ttl1ed^^ 
trie pharyDgitiH. l^rmking ^ptrimonii liquors tindilut^d; swal- 
Ifiwiiigiwxidonlally hot or o>rr<»ive h'piids; ii^iag iipicos in «- 
«Ms; i^moking and chewing tobacco; breathing diy stove, fnrmct, 
Huil foul nir; vjKcrting tlie vokv gnalty in ^ngji^ and |>uhlir 
speaking; aJI the^e, cauj^e irritation vt' dte pharynx, and vanouft 
ik'^rcH*** of inlliiiii mutton. 

I'haryn^itb pre^-nt^ tlirii^ welNnmrked phaaca^ which 1^^ 
designate a8 the hypertrophic, fitrophiCf and gninuUir, 

JlifjMTirajihif^ Pltaryn^lti* hsih fulne^ and rotigbiMSB 
throat,a twnsatiiio that excitai to frequent hawking or amllowi 
to eaae the parta; coughing, gagging and expectoration of odh 
^demblc whitisJi-yellow mucus; oocaeional Horene« after eapo- 
aareand during cold Morrny wtather; .niigti Jioancncivi and ina- 
bility to u»e llie voice long without eougbiiig oud oltaringotit tbr 
niucu«; more' or lew catarrh of tie now ; j$oake degree of deaf" 
iifr^ and, perhaps, tinnitus. 

Tbe mti<x>n» oicinbrane of thclhrunt and pharynx ta of u cnm^ 
aon eolor, rough, swollen and e>uet<ulent^ hat the vtscf^ls are aoi 
to be acen tn the gencml (^onge^ttiou. The folltculur glaitda par- 



lowing 



CHAOHtC PIIAHTKQltt0. 



ticipato in the general infiammAtion and hypcrpliiaia or the mu- 
oou-'« [nvni1>mn<!r an<) i*ahnin(H>u» (^>nn<*cfivv Iwj'uo. I>ut an; little 
difltinguifibcfl in the general tuniefactioTi. The soA palate is hy- 
penvDitc and tliickoneiU tlio uvulu i;^ ivclcfnt4lciii;t, aad citlicr 
^loognted or thick ami knohhy; the pillatH of the fauces BtancI 
out in greil inaji«ive rolU (luring gnf^iiif^, anil tfio whole IjowaI 
phAn-ux fills the spnoe Mwecn with a memhmne, ridged ami 
ron^h with etilar^l papllht^ and ncinoa^ f^land^, fre^tiiinll}' 
liBvinj^ clots of jclly-likf mttcitH clinpng to the surfaoe, aad, per- 
haps, eJCtendiag up Ix^himl the veil of the palate. 

The ^uicc between Wiv \m\tKtv And the posterior phuryn^l vrall 
iasomucbdiEainishodby the^welliug^atid tltethn^l issii^^Dsiltve 
to the touch of ifi^lniim-til^f tlmt it H vcrv ditlicizlt to see the <tod* 
ditionof the mouths of the Eustachian tnbe^T^Dd the oaso-pharyox, 
biit Urn may \w Aurnilsi^l fmrti thi^ i^Iatf of tlie (larTs ht'lrtw, uiid 
nadecertain by using ihecatheter^ Zaiifal's fipeciilum, and the (in;ier. 

This particular form of pharyiigitift otxtxrn m children and 
adults othervp'ise healthy, and is comDioo in persons who iiw to- 
Ineiti and diHilli'il litiuon^ frx*ciy. It is* gi^ncmlly aceiinipunicil 
by Ci}n<^idrnfthlc uUurrhal inflammation of tJie t^ti^ttachJan tulw 
and tympanum, and recpjires a well-re|;ulated hvgit-ne aad per- 
flidtent tn'fttmcnt f<>r il« <'urv. 

Atrophic J'haryr\ffULa Is the opposite of the hypeitmphic. The 
mticDtii^ membrane of the whole pharynx and gert^tally of the 
posterior portion of the na*al fosma; ia invoKed in the morbid 
proocw, but t1ie»on |ialate and lonntU are only ^lightiy idltvtetl. 

There b dryDe^rongbn«fia, itching and burning of the throat; 
oacui<vial attnrki* of hni^kiness of vour, when spetiiking or *ing- 
iog, folio ued by swallowing or hawking out raucufi; droppiiig 
of mucus into iho itiroat from the nHm^^^pharynx, when the head 
b iuelinef) backward ; s^light snreneH?^ in the throat during damp 
or cold weather; titillatiuni^ in the thront i^iiUMing dry ^(hulh.iw 
0011^ ; rattling in the e^rs when blowing tb<! no«(^ line ringing 
linnitm^ and iwme di^ree of deAfne^. 

The mucx>us inembmne of the lhn>at show» patchertof |mlc 
pink^ y4'lktwirih-|rmy, tind deep ml. It npjK'ar4 tbia, tramlucent, 
and &hinii^; clings clofwly to the Hiiccid and blender mu^lcf l>e- 
nolii and upon the wulU of the phnrynx; is iiprinkled with 



TnV nTJMAX ElB AVD ITS DliEASBS, 



A few rounded clevntion^ caums) by iMtlui^l mDcoQS glsodflaad 
papillic^ among ivhidi dilnU^ arul torUiotis venous r»tl»clc«uid 
arti^riaV tvng^ may be aeeii meaadfriiig. Jler& ami tbfi^, gr«ip£ 
of IsiTgi^ glnnds und papillier and arcai^ of lom) byprncinni Tom 
a rf>diler, tliirk'T ponion, whii^h is in tbe condiuoo of chronic 
iiiflitiiinuition, which prco^IcK ibe atrophic KUite »hovro by the 
Hurrounding ]>a!«jr membrane, 

Soroc of tbfr folliniltirnnd nux-znow g]aiid» have dMjipmreJ 
and left lilUe sjiotA of ulcemiion or ahiaII, smooth, cicatricial d^ 
prc^ioHT^; o(hrr« arc enlarged the h'lXK of bird-«ltot, aod (vnn 
pale, gray, rounded promhience^; again, a few may show vpeo 
mouths, wtwffbd wtlh rdaifi<.si grayish fatly !*ccfftioii. 

The vault of tlie pbaryux U moUler than (t»> parts bdov, 
owing to tlie l]y]>crM?rreti<»n of Ibe adtnoid lu^sue, wliieh ^ow» ib 
ridgid pink and jnicy, 

Th<f j^n|T» of large glmuU about the rooutlia of tlie Cu8tachp 
tubes and the chain that reaches beti^^een them are generally ^tii 
promitic'nt and prt^nant with glandular secretion. Slmilit ai 
strings of teniicioua macuB ore n&^n adb&ring to tbc walla of 
phatynx Jind working slowly down its postmcr surface, wM 
Jelly<*likG clotH lie in the deprfaaions about the tulxs and in tbe 
fo6HL< orRoswiuniillcr, 

The uvula i^ r>fU'n elongates) and f<Iender, and nsts upon tie 
base of the tongue or adheres to the right or left aicli of tk 
velum, as if devoid of ma^^oular [>ower — a thing the ^port of nt- 
ciiioflauee*. The veil of the palate ]« (fomotinK^ vriy dcc|> fron 
relaialion or paresifi, and occasionally one aide hat]g>i lower tiiaa 
the other Trom the latter ojiu«.*, va emphasizjed by l>r. Wcakca. 

During a recent visit (1881) to London^ I had Lite plcoftirfr 
examining with Pr, WoaUoj^ at the Ijonilon Throat Hospii 
8ome of tlie typical eases of paresis of the palate described 
bim. Tliei^>U fHttulc-A <]roo|Kt1 exec4e»iv<4y; tome of them bui 
at least two inches lielow the palate bones, but they seemed tD 
lierforra their funcliond well. All of tlie pcitienfs had impairei 
hearing, but they pre^enledT also, conditions of pharyDgitis aoJ 
chroiiie infhintmatiiui of the midtllc itiv. 

I wai; not couviuced tbac the parfsis canned the deafneasi 




CnHONIC rDARYNOtTlft. 



331 



'Jil^tfdel it aa a coDcomitant nithcr tlmn a cniiw of th« numl ton- 
di(ica. I mitfit 8aj that a clear iiai^tic coDditiott of the palatoi 
ttfich aa dc^ertbed and tlieori^tcd iilK>ut«oGxquiFiiU'ly l>y ourTmnft* 
atlaiiti^ (^ii.HiD, U exoi^lin^ly rare hi the United Stat^a 

Tho miBcl«« of the tliruil and pharynx^ thmi^h evidently par- 
tmlly nirophiM niid, therefore, weak, act with ^reat prompiii^^ 
and efficiency in muny iLnsef. During exnminntion, tlic itp^rurd 
morement of the reluin is oAen »o f:reat, as to clearly show tlie 
pwition of thv piwttTior bortlrr of (li<? paUto boi]<9, 

Tlie palato-fi:loaaua and palaio-pharynf^eibi stand out like lh!n 
ribboDt> during gating, And the wcukncwt of the latter nnd the 
palate mutclts ia made apgxireitt by attempts to inflate the earn 
wiUi the air-hctg during tbe act of givallowm^. A moiK'ratc 
puff will htir>t rt|»eN the partition betwci^n the na.'^O' pharynx nod 
throat, the cheeks will bulge otilward, and tlie air c«cspc hy (he 
rm»iitli. 

Tills wtakQeffl is again proved In sorac casm by iiifi p«i»Mi^ of 
food, during an ot)ierwi.'«e nornial de^lutitfon, trom the throat up 
into th<- vault of the pharynx, and into the niuwl fo»i[e. J have 
notioed thi.'i in »ev£^nil patient>u A lady ate pudding, and some 
unchened niisitts, a little vrhilv aflerwardfl. were blown out of tlie 
aoae. Another ate sk>mfi grapeti, and, Aoine hnura later, one wra 
refiiov«xl from the nnterioir narea Otherr; liavu cttmplntn«l to 
me uf bread and apples |iasaiDg in this malapropos way. Id 
ovtry QiKv the patient weih tinoonMoiid of the re\*er»ion of nutri- 
nc^t nntil it appcaretl in the handkerchief. 1 think the debility 
of tfie inndclus ^ill acMxinnt for nirjnt of tlie^ plienoniena. 

The velum i«w>nietimespJLnilyzcd uflcr diphtheria; Awvllowing 
is clammily performed; the local sensibility is impaired; the voice 
i» imjx-rAvl ivnd hw a nasal tene, and the <.Hi»s(7naiil.H 6, d and ^ 
are pronounced m, n and n^. The tensor and levator palati and 
the pharyngeal comtrietor nittsdea are [Kin-tic, and 8yni|>Coin;t of 
car disorder appear, if the lesion lasts very long. 

Atro|>hic pharyngitijt deniiindA earrj««t attention, her^ouHC it in- 
terferes with i\\e pliy^iolfi^i^Til notion of the Fivitacliian tiilto. and 
ttiuH tnf-n:uiw iho inti^rity of lh<* miildh-i-ar. ThiMkiiid of pbv- 
yngitis ia rare in children, advances slowly and insidiously in 



332 



THR niTUAff 9AK AVD ITS DIfiKABIS. 



5m 



Htmmoiis and to l>crculoi» youths and iulult9,aiKl is rreqiKnth 
seen in old petipk. 

6'y7n?i/'F]- Phari/nffitis is intcr[n«tlmt€ m symptoms Ami pa- 
tliolcgy with Iho hr[)ertra|)hie nrnl ftlrophiu vftriettc?^ and )8 vetr 
«ommoD and very ob^tinnte to tr«ri* There b no atroptiy, snl 
v^-ry little hyiH'rtrophy- The iiyni|«nTnft an* not very nuirkci), 
and iDcludc ninny of (hoAcenumt^rated already. Thi^rc ia dn- 
nft« nnd it mm^ of tViMrtMnfun. in (hr rhroat, and tori^li pi«<»# of 
naucus ai% hawked nni fr?(]ueut]y. T1i« i^uipnl is likely to Inve 
astopped nose (hiring ^leep^ and to hmit)]<.' thmugh U>(^ moail, 
m that th(^ thro&t be(?on>e» {Arrlied and nn^kens him. Acntr 
exfttt^rljrttiont* of inflnmniatjonr ^m«timcfl accon>iKini*?d hy tondi* 
littfl itni lunngitis. are mthcr frequent, and each attack ft^lgn- 
vat.<=9 the cxJHiing congf^ti^n, ami leavi^ it worse than befoiv. 
The throat, pharynx, and posterior nurti« are of a ttnif'^rm 
pink or florid hue ; thr^re i.4 an active hy)>eneniiji nf the m 
mcmhranc; its epithelium m thirk and velvdy; thL- monni 
gbmU nmt piipiltiv of the Rides and bacrk of the phar^'nx are Ah- 
tinct, and grttilly enlarpnl ; iwji*iic ami iH*dijnrtilatcd tumar^ 
formed hy hy|K-Krophii*(i j^lanti^ ami t'niii^tiil gmniilntioctf, an 
8ecn here and there, causing irrilatinn and rncrRbocil i«i-trtjooc^ 
filiiny miHiis; llie ;r|an<!r( of tlie anienor flurfa<'e of thi' velora 
show u« [fmall point^f^ nnrl r^omdhiR? injcctcil arterial tvrigs 
seen exUiiding even Ui the roof of the moulh. 

The tonsilfl are of natural eixe or enlan^ed; the vctara 
pillaryof the fancos an; of normal thirkn^^; Iher^ » noappii 
thickening of the inusel<« and »^biTimH>TueQnneetivc ti^MHV 
the parte act well during respiration nnd <)eglutiCion. ThemncwP 
membrane is priuci|>ally afilx'led, and its ^i^mtlar surEicr SJ»1 
hy|M^r*^<?refio:i cujnittiliLtt^ (he mli«nt ^(ymptoni*. The disease ma v 
pafis inio the hypertrophic or tike atrophia* varielyr bnl unMlly it 
remains with Uttlo cbjtnp' for « bmg tinjf\ the common propertf 
of tlie inhahitjints of oolii and inhoflpit;ible climatt's. 

Thisromlttion of the thmat \a men in a tarf^ proportion 1/ 
the Qt«ieA of chronic inflammation of the I^uf^tachian inhe anJ 
tymparuni* and the {)fltim1e ar^ mostly adults, 

PoAt'Pharynffeal Abficeaa.— Thi^ cofwiDts tit ft nJbvtioD f/ 
pus beneath tiie muooun membrane at the l)Ack of the phar\'ai. 




CHRONIC IKFLAUHATIOSC Qf THE SrSTACHIAN TVBI. 333 



in Uic middle or upoo onv sido. Tbc ido»I fre^iueat cauita^ of 
thist aocLinuiIaliim u iafbinmation of the Buhmncooi; cuiii>ectivo 
li»u<f, artsitm^ idtofxithically in «lrumo»» or dnbilttalvd orkiiHtitu- 
lion^ or or^inating in ilineaiie of ilie throat, A smali perocntage 
of caM« an; Mqucl^e of tiurrouittg Ocrvicnl iiI>ak^(j^%» ami diisctue 
of tbe cervii^l v<trl<^l>raj. 

A email, rotiiul or ov*nl rumor <leveIo)» in the phnryiix, aoc«>ni- 
pauied by aym|iIomA of the niorhid condition upoo wbicli it de- 
pi'udji. It if oActnnT tfivn iipim tW Bi^k' jusl Wiiiid lUtt tniiHil^ 
ihai) in tbe middle of liie pharynx. It projects fonTOrd, inter- 
£in» with rT«pinitioii and do};lutition, onru^ionaUy mu^en .Huf- 
focative sympionifl, <^an be seen and felt in the pJiarj-ar, and 
HonieeinKt^ detet'U^i] by |)Al[Mttion at tli« uigle of die juw. 

The pro^oeis is good, when the aflktion do*s not arise from 
diMWM? of iJhj vcrlebra^ but iht \>i\n muKt \k tvncimteJ early, m 
it may burrow down the neck or burst iincxpecU<dIy into the 
tneliot Of 141 >.-uw*j4 from \-nriou^ cau^4 iii children, ismleA 
by Pr, Bokai, of Pefith, Austria, die mortality was cloven.* 

Tlic iiLe<li(»l in^ilmi'Tit of thin ntl'Mioii nai^t 1m; cMctrmined by 
ike morbid cxindiliain ihut nttt^nd it. 'i'ht? abrtL^eu mix^i bt'evacu- 
Atixl by tbe uj^pinitor or a long bistoury, w& twon &» flia'tuitttoa is 
detettel. 

aiuronic Inflammation of the EmtachiaD Tube, of moderate 
d«fcrec, often exUtH in |i;tti(Mit< vriUi very little tniplieaiion of tJjc 
IftDpiioiini. Aiter it has continiieil a while tintniited, or has 
pMsed a oertain sta^, the middle <^r l»ccom&i involvetl in the 
morbid proccvs, and the Aural fa-ymptonif^ incrttuw in prominence, 
Ttie mucous nwnibtune of the mouth of the tube beeonic^ con* 
I and awollian, in aympathy cr oonncction with ^me of thn 
in aflMieiatfi jiartK. The inHammalion extendi along the 
lining towards the tym|Hinum. bnt ie; limited for flome 
iIhi oarril%iritm.< ]x>Hio]i of the liit>£-, iw th« f^ymp(oniA 
indjmtly tJWtify. Thrse Bymptoms remain after acute ones 
have dtaapp^nred, or com^ on m in^tidioufily aii to attnul little 
afl«*nlhiii. 

There is iiftually aitlight Ayropathi^rr uniw«tn«w in IIto tf^itt^rnal 
auditory i-atvii, Tho membrane if) of normal color or a little 

* ArvhWeior Otolvfor^ :few Turk CHj, If. t.; 1S8L 




TOR QtUAK SAR AKD ITH DISSASBS. 



re(M«r lliftit usiml ultviip; the malleus liaiulle. The patient fin^i* 
it neceflsary to cimr mucus from hU tJiriat ofl^n, aacj ii:L4 toiw 
of the »Ym|»torntt given under tiA»al nnd pluiryngval diseesM, H* 
hears a ^oH click and miicoim rflUling, iviUi a nuh of air iftto 
the iDidJIcc^Lr, when hct blowe his doao. The click mcuuiKl U 
Bc^xiration t>f die adhering muoon^ mirfarc^, a.4 the air foroea tfaea 
aiiart, aiul tlic rattling bjr the sero-mucus in thr tube. 

There haA Ix^enalirde ringing in tlie car which hannowceiaed; 
the ran^ Ti.'el (aW a little while, becattse the walls of the tuht 
being swollen and Mnok together by muau^, die esoeie of iatia- 
tymjianic air ctinnot iinincilintely owttpcaivl nstore e<)ai)ibr»iaL 
The hearinjr is dulled at first from this ovcaMJistenuon of the 
tympuntim, but improves^ as iitv cx<H^3»^ of air i* al»orl>itJf or as i\ 
eaQa|iefl by prcsfliiig tlie tube open, when assisted by swallovring, 
by a Jar of iha bcnly, 'or by movements of die lowr jaw, Vnl- 
mlvian inflation produoe^ similar Hvniptani», but BoraetimeF when 
there is much swelling or tDucu?^^ \his d^JCi not ^uecvoil, ami 
it M hard to inflate, even, with the air*ba; and eatlicier. The 
mouth of the tuU^' i^ oli^tructeil and inflation tlifliridl, aUo, vhee 
there l-< relaxation ar [lareiiKof the )>iiliiii>-tidxi! luuricleaL If tb« 
patient sw&IIows during (he net of inflation, it will aid consider* 
ably in opening the tul>e, Inti'odiielion of the catheter will 
KHuetimc^t <ttu4e much puin and some hemorrhu^ fn>Di the eoU' 
oous membrane. This comes fram spasm of the musdts, omsinf! 
the |)ahie« to contnu't upon the end of the ait)icti*r, nntl may b( 
preveuted hy bavintc the patient breathe all the time tbrongh tht 

The auscultation tube in position, when inflation succeeds, will 
bring to tJje c-xfimhier^^ ear the wund of disUjiat ritlftfr. TbCA 
may be ^lomh of simple moi^t bultblint^ or loud^ coorae lutiliiig, 
owing to the lube b^'ing <]uite full of secretion. TliiM latn-r cun- 
ditioa h common in children witii enlarged tonsils and granular 
phorynKititi. 

The hearin^^ should be tested by the WHt^-lk hotii lieforc and 
af^er inflation, in order to di'tcrminc it« efieei. Tlie waidi tod 
fork are heard in mild t^H&ts ulnKwt as wtll as in tlie 
et&te. 

Five or six inflations »houl9 l>e made the fint vbit, to i 



I 



tUSTAOBUK TUBE. 3:^6 



1 « 



IDUCU5 from Uie tube, before the (liera|>cuCKT value of t]iG avtix^u 
mn Lh- known. There i^ no danger of forcing niucus into tbe 
tynijiaiiuoi, oa it cWnga to the utaIIa of tlie tul>e, not} pt-rmiu the 
air :o pft» by or through it Too frcqaent inflaiimi is injurious, 
but il dhoiild be clone us often as needed, elm mi«cli[«f will cnMc. 
If location Micceedd ami the hearing doei not Improve, one ain 
Ik cntain of diitcoM- iii other furtB of tlio fiuditcry nppantiis. 

There B no pain in simple tubal catiirrh bul in acute cxaiHrr- 
bation« or ulct*rac«tl t*otic1ilionis it may h^ t-f modcntc dt'gtte. 
Damp and <^>Id weatlier incnuMs tlietiymiiinnmr iLnd dry wann 
weather ameliorates Uicm. Anything thai irritates the throat, as 
fl[Hoe#, ApiritiKHtR lit^nf^ri nnri t»linfX!Orii|^mval<« the iVm^oM^ Tlw 
patient i^ hardly (x>n%ious of any ohango in hi« hearing fntia 
tliiw, iinlui«« thu morbid slat^ i# «^vere. 

The laryngeal mirror will reveal tl>e romlition of the nnftt- 
pharynxandnioittliAof tbetuU-H. lusom^ piitteatj«, tht^sliorldiit'* 
tniioftjetveea the ))aliiteaud posterior pharyngeal wall or the great 
sensibility of tbL< thrmt will [fre\'enC an exnniiii^tion willi th« 
mirror. The index linger may be pa£sed up behind the palate 
and give a good idea of the oonUitions* A glimpw miiy b« 
MimciiiDcsf piined through the tuiAal fotna by a '//luhV^ apeculutn, 
but this is necessarily imperfect knowledge of doubtiul \-Tilue. 
A tolondily accurate *n'iui(r|i(ion nf the di«e«M ain l>e liad froin 
the totality of eyrnptomri attainable, 

ri^l-niort<^m i'jcaminnEi^m^ at dilferent stages of tubal disease 
lave dranxJ up the pattiok^gj" of the region. 

The mueouB membrane of the tube may be pink, relaxed^ and 
fovtrred with a m^i»t «limt*, in mild avu^ \ in otlien^ it im in a 
conililion of cellular inliltration and congestion, This ui of dif- 
fen^t dcgrect<, from a delicate capillary injection, to an enlargixl 
■elwork of arteries and vein.^, whidi ejcteiid <uii of tiie tuike and 
apuQ the pluryngoil walL In the mesbe^f tliere may Iw minute 
bemorriiagcfi, or large eitniva<<ationA from ruptured ve^els, aixl, 
if these arc old, they will appear as gray and grayt^h-btaek pig- 
ment «|>ot8. The lumen of the IuIk- ooauiooally contains blood 
cIot5» 

Hypt-nnmia, originating in the phnryax and mouth of the Uibe, 
diminijiheE as it approaehes the tympanum. When the hypera^ 



£» 



TB8 BVVAH EATt AND 1TB DISKASIB. 



mu urigitmUv ia Uiv tytupmunif it tnuy dlmiimh lu tlie tube 
l4>\varJa tiie pliarvns. 

The tiiUr (TODUtEiiA iiK^ru or luw niuruj« mixiHl witli fnt: ctlwI«J 
epiclielial uellti. Thm may be quite fliiidi ovrtn^ to u Urp^ prv- 
pirlHMi ofrKTuiii pn^'til, i^r liki'jdlv fiwn (liintiitiUoD uf iL lii 
the laiter form, it con^lidatcs iulo ptitlelfi aod struigH, «x:luJe* ' 
th^: cnnal, iiiul plu^ tJn/ ph^ir/ngual <>|K.'niiig, 

In lh^ graver varieties of Kueiactiian inflanuimttoii, then: b 
hy}>erplMin uf Ui<^8utjmti(»i]A ooiinwtlvc tlMtiio; the miiciparoui 
glands become Iiypertrophie*]^ and the fiurfiace of (hv maoon, 
rDugh^gmiiulnr^&ml ckvuk-tl intoloii^'itutliiknl wnnkli^. $well- 
ing is tape in ihe otseous portion of the tube, incresses towanlc 
t)io phnryiix, olWn tAo»^ the tulx; At tlic i->thiiiu«, imd coovms 
the opening to a mere filit. Of course, the difficulty of ioHatioo 
and n(}i4T tn-utm^ii increases with rhe c)iM^<^'. 

[;loeralion takes plat^ in all parts of tbe tube, affeciing by 
preference the pharvn^;^! exfremilv, and (bcvtmtncu tbut nttull 
frequently comtrld and even vhut up the canal 

FtbroiH adlie^^ion.^ ami bands hiive been fotiiHl in the tube, tf 
a re^ilt of chronic infiamtnalioD ; e&pectally, at the ^mpanie €Oil| 
when ditrnw of the tynipaniim or temporal bone liiu coexir^itd. 
I'niyptid anil other tumors very seldom appear, atwi foreign boditf 
■re nircly found in tJie tube. Such vsiBm arc turiiinilicH of aiinl 
literature. 

Thi^rc nre other »wunHw of cOD^itTicCion or stenom of the tobc ' 
tidkwjirl;»^ itit^nlionsi anfetua of tlie month of tb<; lolnMltiring foa- 
gestion of the superior vena cnva; int^nffieiency of the polMo- 
tubiil inu^rlc^ in JisHure of the palate ; and hyperoF4to?il4 ikat the 
tymiraniv orilkv. HeMiy*: **8teno»ift id i]w middle portiou of 
the canal appears to be extremely rare. It is in practice, from 
inescact observation, tliouglit to be much more common tli^ui it H i 
in reality. Not ii)fre(jt>ently an angular bend in the course of thai 
tube, or a projection of the carotid canal into tbc Offcoua tube it ' 
niUtJilteii for sEenn««l'< on attempting to pa^s a bougie. Iteiil .stric- 
tures in the §enee in whieb urethra! strictares are formed, l>y 
thk^ki^ning jtnO ntmjdnc HliorCenliig of the tiwues, appciira not to i 
occur in the Eustachian ttibe,"* 

* Tilt; Phthologlcal Anatooa^ af ibe Ev, Schnnar. p, ISi. 



CflftOHIC IirrLAllMAtlOK Of TUB EUStAOBlA^V TtntK. 337 



TbcslR>plii(.%>;clcrot)Cr proliferative iofliimniationof thcKusti- 
chiaD lul>i^ differs wickl)' rn>ni tlie <^itArrhuL ll ik n He^uda i>f 
thi! latlor in sori« cus<if; in othere, it seQDia to nsult from a »loiv 
subficaie inflammation, or fmni the Atrophic elmnge^ of senility. 
TIktc ifl utrophy of mn^clfs, glan^Ii^, and c-pithirlitim, ami diniinn- 
tioo vtf secretion; hanlnf"^ an<l drvnp^ of cellular denieDts, with 
by[>i>rpla'*Jii cf tlie MibniiK^rms i.T»rnuctive tiwue. 

The mucous roembraike flometiraet* loflea ils folds, or rugffi, and 
qtitlii'iiLim, iukI prwents a fiiii<j*>tli, inuttivc ^urfao**. 

n>e pharynx may l>e eomimralivdy healiby, espei-iaUy iii old 
people, but in m<}«t cahh either tbo granular or ulrophii.^ phuryn* 
gititf will 1)6 prceent. Tlie tulie can generally bo easily inflated 
by any of the metbodfl de^rribul, iiml the |>ututrjt will ildUy ex- 
hibit hU M\] ID the Vnlsalvian method, and dcclai'e ibut bi» 
€ftra ought tc be all rl^ht, f^'tnve hv. ran blow iheni ^ul ^o easily. 
The hfurini^ for tlic ^vaU'b is climini^hed, owing to the cxittteiiw 
od' the name proltferative di.>4oa»o in Uic tym|>aiiuni, and the fork 
upon thr vertex ih uot heard quite as well as in normal cur#. 

\l'hen the lympannm m iiiflntetl through the mtbcter, one henm 
tliro[|gii the au^-ultation tube a rushing sound of &ir pacing 
ttiniiigh the tube, ending mn high tonod tliud or nittk, hm the 
taerabrLinsL tympnni fliips outwani. The patient heam the rushing 
and bl"w upon the tym|>anic wullpTmid i« (M>n»<;i*ju.'* of prr-viure in 
tile ear, but this ieonly momentary, because iheexceas of air es«ipM 
a# jimme, throuf^b ibo jmli'iit ortiiftily ililnfed ttdw- In ^mecfisea 
that have been preceded by severe catarrh, and in othew where 
thert: in a gouty dintlit^ii^, Ehe tnlw i* ^imellm^f* narrowe*! and 
e\*eu closed by fibrous membrane, and thus inflation is hindered 
cr entirely prevonie<l. 

The lobe is generally enlarged to tliree or four times its normal 
sixe, di account of atrophy of its 90IY tiM^ue^ and oH^eoun walb; 
tiie pharyngeal opening is gaping and deep, and lia eortilaginoiis 
ring i*hi>w,i very plainly, and pnij^t'tj* lonsidi'iably above the sur- 
face of th« pliarynxp so that a doeidiHl ridge \» felt in manipulating 
Witt tlie calb^.'ltT. 

Very Ijttli- trt'atnient in m|uirei) for thiK tv>ndilion of the tube 
differept from that adrtpted for the tympanum, unless obetrut-^tion 



338 



TUB HUMAN BAH AVD ITS DtSBASBS. 



iakts pincy; from local iutratubuW hyperplaiiia, wlncli vrill Ji^ 
maud lite u^ of biiugief. 

Another coQililiou of thi^ KiittUidjiuii IuIkv mu^iL be conflkleraJ, 
vrliere rdaxatiori or p&ruii» of the rwft palate «ii«J |nilQlo-mlnl 
tauvclcH oonirv fmin culiiiui-ttoi] of tlic viul powers, lucutal er 
ph^eicft] iU.mIii, autt ^m-ml ci.»riHtitijtiutuil <3iM<ii»c 

DistuiK lit die DMociiUc |NirU4 U Dot cswiitial to thts coodilraB, 
biit thtfTi; la uttunll}' i [>a]f^f llabb^' ^(:<t(;T uf tin; iiiuiTfi2--i nicmbimnc 
iiuil initNclt^s Budi tvi ilt'Bcribctl umlcr atrophic pharj^pgiii^, bui 
caiarrh \b not a jirumiiient rij-nijitom. Tbviv arv r>;w digits vCfv 
UQuble. There is ahseDce &f tinDitUB and vcriigOr bui a slight 
4]eafiiC7«< Tf< gvncniUy pjT<8(-iitf wliich may liavo come on rta^McolT. 
Tbifi vari^fr eon^iderably^ being iiutroaBed whon tlie palicm U 
fati|^<K<<), iirid diminished when rtvUtlf »nd nft^T a night's i^c«|>- 
The d^nfnc^ U not progreeive, aind ihe locinbmnA lyinpaitt is 
UtEkMillWrlixl, Thti vduni drotipw low ujKjri one nr both »i(l»; 
the ear can wldora be inflami bv ihe VaUAlviaD metbodr ur bv 
t\w ntrAtii^^ exapt through the cathi'trr, ami then the souub 
heard with the auactiltatioQ tube arv a 5o1l dick as the tube opeitt^ 
aocompanied by more or leas weak r&ks, aisd a craeklbg as the 
RK-mhmnc raov<» outwiinl. 

The neceaaily of the catheter for iniation is considerwl by Dr. 
Wonk«ff, a^ diagno0tie of panrtje obetruotion, but lhi« muM be 
ijualifkd, as sevcraL other conditions of the tube require the use of 
the itudrument bofan* air can be Ibrrcd into the ear. The uvula 
is ^lort and |>oit:itA ftr Is adhoffiit tf> Ihe lielti^r side, tbt one not 
paretic &r the least Aflbct«d, which is gencmlly tJic right; bM 
It may be mieaiatou.4, hang sTrait^hL down, and irst ujH>n tlie ban 
of the tongue* The pillar* of the fauces are flatteiuxl and relaifd, 
ami the [HirtM are pjirtiuMv or entirely in^nsihle to tonvh. 

Dr. Woakes believes, in these cases, the salpiD^ro-pfaarynjeoi 
and ialcrual pterygoid muKclcti, »iip|>li<-d ri«{Kx-livitly by llicgl<Ai^ 
|>liaryn}^l and the ihml division of the fifth nerves, open tii* 
Eustaehiun tube and keep the tympanum aenilol. Hu thtaks^ 
tlut the leiit^or pjilad and tensor tympani muscles, reoeiving ner- 
vous influence fr^Mn a common Kourci% the otic franglion, ir« itn* 
able to perform their physiological funodonci, by which there ii 
relaxation of the muFiciGS around the mouth of tl>c Eu^tacbiftii 



I 

1 

I 





ftD(l 



nUWO TfirLA»MAT105 OF TffR TTMFAK17H. 



tube, and (lie ilrum-head ifi not lielO in that cHicate etato of ten-* 
sioa And ihcconiiiHxtntion jhxu in iho normal «tute. 

Wcber-liiel aawrU tlmt the jianilysJA or ttie jmblc muwles m 
accocn|]aiiicd by un uituf^niMic «i)iu«ui of the k-n^r lympAni, 
and lliifl cnutiesi iL4^pre<«^on of rhe itienibmna t}'Qi{>Am and dcaf- 
DOtf, Tliis is not reasonable, and I think c^nuot hv dciD<iii- 
strsted. 

Tli« Jack of muscular tonus csiusa the fiymptom^ given al>ovc, 
and, if thr li^um {KTrithLs Intig unti'i'ali'il, orgimir diN^'^ of the 
mucous membmjte of the tube aihl middle ear may fiuiwrvcoc. 

111? ftiinr(7< <'f u dnim an.' drawn aocordtng to the pitch dcwirwl by 
player. Tlte drum-bead of the ear ia adJiL'iled to s-nuiul by lli« 
Iduor (yri»|inni nui)«clc, and its parwia cuii^«i coiiaidcrahlo deaf- 
Deea. The Eustaduan tube inuAt be kept open and thetympaaum 
fttll of flir^ until medical an^l other means tUiall n^stonj the nerveB 
to Uieir normal ncEiviiy, 

ChroDic Inflamnuition of the Tympantim<--C(irotiic influm* 
malion of the lulie niul tyni|mt)um ari^efl flimultaoeously from a 
oooimon oatiM*, and coiiiinutv as an entity, th^* morbid fondilJoa 
of cadi pari reft<-ting U|kon tbi> othtr, Cliroitii^ iidlaaimalioo of 
tfae Eustiiehiaii tube of long duration or eoiuiderahlo severity 
lloalty involvtttttirtyin|iiiniiiii, Chmnic inflamniationof dietym- 
panum originalea in ik^me afflclion of tiie external caiml and 
drufii*li«wl| or fron) a gi^rioral ca»i*e opi^nititig dirou^h ihctftt 
as the rbetimatic or gouty diathc^id or the degenc-ratioiiH of 
ienility- It may oonliniie liinilvd u^ the niMldlv i^ir, n?< found in 
a few casea of proliferation and lacleroei^, but the affection gen- 
erally extends along tlie Ku-4taA?hia!) tube ro its pharyngeal ex- 
tremity. 

Chronic inflammation uf the lynipaiinm of Uie catarrhal vari- 
ety ts invariably eonneoted vi'iib the ^me disease in the tube. 
Tbcrv ia »ulxLCut<T iiinanimnticn of Ihe miicouH ni»;ml>rane, with 
iBQKased secretion of sero-mucus,and fonndcrahle impairment of 
bearing. Thtipntientha#beci>nie]fuddenlycon«;ioiiaiirhiftinlirniiLy 
b one or boUi ears, on account of an increiu^ of ftymploma or 
baving ht< alliiitioTi called to thoear« in some way, or tw Iiom knovm 
that bis throat ami ears have been in an unoomfortable conniition 



n-io 



TDH BCUAff BAA AIV1» ITS DISKASBi. 



fOTAoiiK^ lime. H« may trace the afffiction to mme spectal coU 
lie lui« tAkcu or to reiH«t«d colcb ai iDt^rvub, liut fmjunitly ibc 
disease ha^ advanced so stceltbUy, eepeoiallj^, wheu ihe ptianrm 
is in ji morbid fitate, that tlic boginamj^ cannot ho a|>]>roxiinati'lv 
stated. The [laTmit In eonmriouii )ii^ has mx^ owing lo a aeifie of 
fulncw cr a slopped Teelii^ in them. Hi* ohn locate thi# d«cp 
within. It ifl noL a ieDMition of external canaJ obstruction, but 
Ofpra^iinr somewhere b<;tw<^iMi tiiviraiKiI d^nd ihrotU. The $cnw* 
ticHi vario) from a t^li^htly thick feeling to od-? of considemble ten- 
sion. Old air, damp wmther, a gls^ of tH.<«:-r or wjno^ imjokinf^ 
a cigsr, and the Iiorizoiilnl position will increase the fulne» and 
alti-n<;t Attention. vVt the immc time, u t]nnttii>< which p^ pre^nl in 
mcst CAsefi increases. It is fre<|ueiu[y u fiae ringing, and tba 
Ihi« a rbrthrti of inerea^ And dccresMc ffyaobroDocK with tLc or* 
ottd iiutmlmn> Ocicasimially the voice resounck in the car ia a 
di?<(rt^iiH^ nninncr every tinit tlie fmtieiit ^jieake. The tiiiniUis 
may be biasing, whiffing, rushing, roaring, mmb|]i^,etc*,accofd-- 
ing to thi> f^nule of the dii^-siJ^c. It i« nii;*^ a note or two »oine^ 
times, when the lower Jaw is moved in chewing. It may ccan 
entirely at time«, and then come on rriiddenly and deetdftlly. It 
may bo eo feeble in lone^ that :^lenoe id ueceisaiy for the jttticiit 
to tell whether or not it if^ pr^^nt, or it may be m loud the 
patient cannot sli'ep i»r {n-rrorm menial bbor well. When it 
increases with fatigue, and the fork indicatea diminished eranitl 
[Ten-eptii-n, the Inhyrimh is i^eaerally di»iviiMHL Pcrforattoa of 
the tncmbiuna lynipaui may cau&e it to oeaso for a tin» or 
increii^ \i» volnme. If the tyrnpnnum becomes) fll)«d with mii- 
eup, it often ceafiee altogether or become coar^ and rhythmic. It 
incn'iiHCf^ wilh the dwwete, and ofieu i^itHvn in lute stages Inrta* 
tio[i of the ful)e and ear with the air-big often catit6e« it to disap* 
j>ear for hours or days, luitftlion ia the moat ttfieatial nicasuTe 
for iti pc'rman<^nt reiiio%'al. 

There is occasionally a soft clicking heard, such as oae oaa 
make with t]>e tongue against the roof of the mouth, or^a^iooed 
by the opening of tlie Kustachian tube, owing toepasinodiriu?tioB 
of the |mlato-tulml muscles. Cracking ifi heard in spasmodic 
contractions of tJie tenaor tyrapam, aeitng upon the mcmbmbL 
In drier ca«:», cnicklioK 10 produced by movemcnta of the suM^ 



OBHOltTC 1!rn.AUVATI0r{ 07 THE TTMPAKOM. 341 






hen the air gr>efl in, utui n^\iu whvo it tiM^pcf^ Tlicre are mu-* 

Ufl rAk» io the tube and drum ilurtng ^wallowmg, but tlie gir 

loei ii9t mnke n i)i»tmcl crftc^klin^ in tiit- ear, a» wIicd the partfi 

are healthy. The patient la morbidly ^n^itive about Mh dmf- 

neas, mid will fn^qiientlj deny it fttoatly; he thinks persona 

aroimd him ^tpeak very tow. 

Th« h<iinfig ij^ cotiHuionibly dim!iiit>hcH], the watch can be 
h«ard ooly a few indie^p the fork vibrating u[h>ii ihe vertex is 
not livtrd Wfll, voif^> fu>uik1 miiflk-d^ tht'iv is inuliilily to caloh 
certain letters and sylhtbtes, and the patient Ih obligi**] Ut uA for 
ibe rej>ctition of wortin and scnti'nc*-*. 

The vowel sounds are&^oIWi mii^takeo aa the cotK^nunlA. In 
a CA^c with II w> A%.it wosilifiinjlt todu>'tit]guiii;hbc^tH'ecnri8nd X% 
t and ^^.^^ and ^9 and ;, t and r^j and ^\m and m, />aiKl /, ^ and 
r, and fj an<I n, 

Andition variai with the plm^c^of the ili?<iii»e, tiK' pi.Tfnvtibil- 
ity of tlieKiiHfai.hiaiiEnlje, and tbedf^^rt-eoraeralioii of th^Miiiddh- 
Gi-ncrally tliC! watch cnn bo hivrd a few inches; in Home 
'cfiM?4, not on oontAct. Inflation often Iej]gtben8 the Iieannjj; div- 
tanoe ; bnt it may shorten it exceptionally by forcing mnoiis from 
ifttube intoilic ear, by di^tendin^ tlm mrmbnmetoo much, aad by 
id;; tliic-kcr macu>^ into improper relatione with the chain of 

iiHe<»r^d the inner memliranv. InJiution rnayn^tchan^itatall, 
because a shvjIIcd tube may prevent the entrance cf air into the 
mr, or the tobi; and tymimnun] suitlt^f] with niiiciiH caimoi rc<*eive 

lOiish '^'^ to act npou the partA. 

In dri<-r ru^ncn of rhronie inflammation, henrin^ U often better 
in a noise. The ^titfened articulations of tlte oahicIcs, and the 
thickened membrfin*^ of the round anil oval windowii are eup- 
to be limbered up and loosened by the strong vibrations of 

tid aound^, fny that feebler onea adjntr hurmonioiiAly with them 
percoivcd by the auditor^' filaments* Tbe latter effects may 
]>c e«>m|iured Io the air of a tnehidy, liuklin^ in <lnlcet toncJ4 
through und above the louder and more powerful tones of varia- 

ns. 

Xotwitli^nding the diminution uf uuditory i>ower, the patient 
mach of tlie lime h» a wnj*ation an if his bearing were exoeed- 
ingty acute- There is a hypencsthesia of the uuditory nerxT, m 



343 



rns niTUJiN bae akd tt9 di9ba6B8, 



morbid 9cmit>ility to all 80undH; Iho cnn art on tlie fjvi tm 
for any un<] ev^ry sound EirounJ, nnd ihose uiw^cpcctvd or 
louder Umn tmunl, ciuiw dbcuniforl iu the ear clo«ely iillied (o 
pain, Indixtl, inin itt ovmsionully <»u)i^ in this du<ca0e by load 
«oiinda 

Ttic oxtornal <^t k liyprrremHilivc (o toucb Mnd druH^ uf lun 
The (Kilieiit muuil'i^ta much timidity during examituuion, and 
fihrinkx at (Im- touch of fingt-ni and ^jitculuiii. There id diwom- 
fort in the external ear from expo^ui^ lo dampness, eold air or 
wind. This incrt^oMv to a «tight iichin^ in the car, with ooca- 
bwub] dtirt« of pnia along the EuAtiu^hian lube to the Ihrott, 
which IS oft^n tt little son? upon ono or Iwtli fi^im. This vopcDcn 
is ooRimon ill (he moniing nftc-r 4>;t|>a!mrv to nighUair, IkiI dinp- 
peant soon after breakfasl. PaCieotfl say they cannot eit out of 
doors M.ti^T dark in iiiimmcr ar talfo n ndc in the wind without 
the eara aching, unless tliey wrap up the bead or atop the mn _ 
with cotton or wi>oL 

Verti^ m another eymptom in tliiw di«cfk5^, though it iz* 0iim&- 
tini<s alkvnt. It is genemtly iiiihl and iniyiastiinl, hut may be 
severe enough to make the patient stagger, and g(u«jp hold of 
aometljing to prevent falling, 

Seterv attacks of vertigo are occastoiially oauaett by dij^rder of 
thf !«torTiai*h, atid arc mnomiiani^Hl by Satulence, nauTH<a, incrcawd 
tinnitus, ami cleafne^s. 

IVriplicral irritatmn of the pn*nimo^.'*lrir ncr%'e in thr fctouiAt'b 
paHe» by u branch from tbc tnmh to The inferior cervical sympa* 
ehetja ganglion; this ^v«s voHi-motor nerves to the ctrelml 
arterit':', winch Ana^tomom^ with the vessveU of tbc labyrinUi, 
ajid the^c with ibo^ of the tympanum. The ^nglioii, alaOf 
giveAoR'lbe inferior cardiac branches. Throitj;h thitt ganglion 
thv circulation of blood in the ear, already disturbed by tbc aural 
difluiAo, Ia further disordered ; tbe UbyriotlnncprcKftire is altered, 
and vtfligo results. 

QiddiacsB oomea on fre(|acnt!y from variationa id the hilra- 
tympanic pressure. When the Ku'^ta<-hianiubeis obstructed, and 
the air of the tyiii|>anum is mrelk^J, ihi* external air pnssna the 
membrnna tympani inward, and the onioles transmit (his prca- 
aurc to tlie membi'ane of the foramen ovale and the labyrinthiae 



CDROinO 1!TrLAMUATlOK OF TDK TTHPAXUU. 343 



lutiL TiiiM comlition prcdiKpiMrs to tinnlliis iipn slight plus or 
minus variations of pressure, oocaeti^iic^l hy tciii[H.>n(ry unieiniii or 
hy{>L-npmiQ, ami b)' iierial aiul mechanical changes in tlie tym- 
panum. Tb^ simple prcstur^ comc« on 80 ^niluully, thai Ute 
auditory filaments bo«ome nocustomcd to it, and re*^uire a pcrtur- 
bstaoo of mme sort to excito the vvrif|^. Thf cochlear nerves 
raB|K>n(l to the fluid jigimtion by tinnitus, and the veetibular by 
rotiiting afii^lioJtjf of tlii^ body's^ cquilihnum. 

Sudden niovemtnlri of rcuciin in the tymjuuium, brought about 
by action of tbt* nK^nibmna tyni|iuiit, tlic l(-n?H>r lympuni mii»M-lc^ 
or |)k tUislAchian tube, often furuifilr ao exdting cause of vertigo. 
Moderate infLution?^ do not tonally cau^* vcrlii^, lM>cau'4t: the air 
gocA into the tytujiaDLim, Hlrikes aud puaiie^ the druni^liead out 
and the foramen mtundiim io, and thus iu a ineaKurt'^ fonKis the 
ttapcs oiilvrnnl^, and <.'ountem<^tfl ttiedirect pressure of theairujK>u 
the foot-plate aud ltd contwqucntactiou upou the vt^stibular cur- 

Wfaen th& drum-head h thick and rip^id and the c««iclcs an-^ 
diylo^eil, inllnliou will often euu.^e disti'cfeintr veriij^. ToMerful 
inflations of air, by over-difilcnditigthc tympainram, tearing adhe- 
»ioi», ami pr*^in^ vioU'-utly upon the j<tapft*aJid round window, 
may cause vertigo, svncope, and unconseiousiiess. 

Abdypoitetithud depressed and iulht>rc[ic drum-head, stitK-ning 
ortheHrtieulAti(>nriortb4;oaAlc)e9,andoanBiderabletymjKiiucriiii<K)uif 
secretiou. I inflated very strongly through a catheter, she turned 
paK fainted, and I euught her an she full oH' the clmir, and placi*d 
her upon a Ioudj^ The pulse wn^ very feeble and fare j^luifitly. 
I put Spirit* of Ammonia to her no^triU, atid balh^t] the face in 
Spirits of Camphor until she became couscious; then^ as the de- 
prefnioQ ooittimied, 1 gttve her a few dn>p& of ComiKfund Spirits 
of Edier, It vfos half an hoTir before s)ie vfhA able to go 
home, aiul ^veral hoiir^ befon^ ^he felt all njLrht a;j:a.rn. She mtd, 
that when 1 oonipressed the air-hog, ^he felt a sudden load report 
in the aflecrted tar, and tlien darkiie^ and e^ileuce reigned. When 
I exiiminevl tb(r membranp, I tlwngbt it move<l outw»nl mther 
more Ehau before, under the inHuenoeof Seigle'n agiecuhim, uiul 
oonc1ud«d an adhc^trvc bnnd or an auchyloHt« luul given way 
from the violent inflation. I do not inflate very strongly new. 



844 



TR8 aVUiV tAR J19D TT8 MfiBASBS. 



Dokfti villi the iletugn of freeing the membrane or making xht 
cbaio of boo<^ mon* eqpple. 

]>ra* RiKMia ami Ely tmve reported a very aUrming mw of mn 
cope from ^ringing and cleamng the car, in the case of a genile- 
maii with ptmUctit dt:<ai«e of tiie tympaDum. 

1 shall treat of the ^'ertigo of M^tii^re'B disease ele^wbere. 
The gympiumfi of dbea.4C id the Gwtadiifui ruU^ pharynx, anj 
aasociate pam havcj be«] already presented ia previooa pagE«,aBl 
abouUl l>c referred to by the rwler. 

The voioe b fre^ueatly affected in chronic inflammauon 
of tlie tyni|>n»ujn and lube* It 1(mk* itM elearofvv and roUnic 
and cannot esprf*s the higher notes of the mnfiical scale v'nh- 
out gixsit elfort, anil then only for a ^l»**^t tirm*. The \x»i<r 
etackSf broik^ and becomes hoarve or squeaking, when an ati«n(« 
t« mule lo fiing hi}^) iiote^, or when the effort m puAuut^l. A 
slight exao^rlation of moderate and un»u«pecte<] tubal and tyin- 
[Xinic inllammatbii with lillle throdit affectioft in a ^n^x, bmkr hii 
voice >M3 that ho could not sing within nc^'cml notes of his aocoA- 
lomed plaoe. Trying in my presence, he dang up tl>L- nnle at 
ttanalr but could not maiDtain nor give volume to the U|)per 
notc», and mou began to cough. He said the rthri mode bii 
larynx ach^, anil the anterior munrles of the nec^k vct}' tired 
The lar)'n):cal mueoiis membrani* wa£ a little bypeneaito, eiud the 
pofit«rior pharvDr roughcucd. A few weeks treatment of tb; 
threat ami ars n^i'm*-! ht» voice to ii& former mnge. 

Another patient, wiih chronic aural diseaae of Aon>e wvtriiy 
am) long continuance, wit« dtMrcsMn) bemuM Ike could no Ina; 
epeaborsingatprayer-meetJDg. lie had Hw.eV^<l>7<^<v^i^' 
of the tuU« am) lynipanu, and a r«li^htly granular phanm^ 
When he talked or sang a few moments, his vom would berocne 
har^hf hid ihroat itch, and a dry, liacking oiti^^h would force him 
to cease. The mucous membrane of the larynx was nomutl,ai»l 
the muscle* aeted harmomoiwly, Trcntment hr a year impro\^ 
the hearing a little, smoothed the pharynx, and perfedly r&^oml 
tJje vo<^d i^oHvm. 

As deufnos increos^. ihe patient loses that nice distiDctioo of 
tonefl by which he regulacen the)*moothue:ttand volunwuf voisdi- 
tsation; thevoicegradnallybecomesunrhythmralatid onintifkal, 







CRIlOVtC INPLAUMATIOK Or TBB TVUPATftH. ^16 



ai>d UikcHa Mmrpen«<l or ([iiGrLi!f)U8 tone, anvthlng but pK'OHiiit 
for the lihti'ncr%. It tuL!< l>c(rn my fortuoc net'or to have tiacl but 
one palicnt, wIki wan totally ileaf iiu\i nut duniK Hr vriis « 
pon'crful &ih1 tifnrty blackf^tuitli, 5t» ycai^ old ; h€ could not din- 
tiugtiii^h f^houtetl vrortU, and clamed a ^laie hihI [K'hciL Tbci 
QujiubTunjc tjrmf)aiiorum were eDtiivIy mlhercut to the ioDcr milk 
of tiieeam; inlialton pruih)oe<l do etfix't, and tJio tuning-fork on 
tfa« vertex und maj^toid was heird ooly famtlr. Ti)e iJiscaw had 
existed for 6Uecn years, and waii rauiicd by dipping the hoid in 
irvtix ulicti «wi:]itiiig. Tlic Eriini|>d, Jtnii c'X)ni*erl dcutaphono were, 
of couiBo, luelcfis, aiitl t^Tittng and «ign& were my only rneariB of 
ciomniuni<ali<in wlEli htiti, btU lie a>ii]d M|>CAk readily t*miuf;li, 
Uis artiniliitioii waa loud, hareh, of variable volucrie, and in 
insular jerky tonc!<. 

Afltetionjs of the voice in chronk* infliimnififioa of tbe tytn- 
panum d«<pend, in a large nmjorlly of (.u?;t.7f upon ooagc^tion 
or inftamuiatioD of the mucoos membrane of the larynx, orig- 
inating independently, or cuiimhI by ibc pli:iryngefil anJ thrvat 
diseases m ccminonly present. Weber-Liel ami \Voaktt^ btlieve 
tbat the laryngeal trouble may arise through rifles :tct]on from 
tbo ear. The auricular hmnHj of tlie pueumogiiMlriL' nerve Imiu^ 
iD]t» an imprc?Kion from the external audiiorr canal to the iruikk 
of the x'aj^tis^ and itA Mifitnor I^iryn^-al bmiioh excite* the rt-^pi- 
ratory centre in the medulla ohlongata, and causes coDtraetioo of 
llie cTMHthyroul nuii«cle. 

Theauricnlar irritatiou pa»e«, alfio, tljrough the inferior gan- 
glion of the vagus and a oommunimtiug Der\'e filament to the 
Doperior rer\'i(jal sympathetic gangiimi, which supplies vaso-raotor 
nervcsi to the ciretid hnu)i*hi>ri chat iiourl>^h the ti-^ue^ of the 
larynx. The tympanic bnmch of the gloMro-phoryngcal and Jt» 
main trunk Aoaitomo^ with the vaguit und i\^ Huricuiarbrftn<*h, 
and with the superior ecrvical sympathetic ganglion, and bring 
tiie tyin|niniim into nervou.sc*oinniunio£LCion with the niu>c'le.-^ and 
mucouf membrane of the pharynx and larynx. The ear is thua 
hrongbt into intinmli- r^latmn-ihip with the oipin of voice. 

Disorders of function and nutrition in one part may bring on 
aympatlietio uBcctioii in the other. The larynx muy UxsKae 

23 



349 



tni ncuAS eih akd its DiSEASifl. 



aSkrtec] by ear disesuie, and the ear may become alfecieil frooi 
laryngeal dUcasc. vV tiimf;n body in tlii^ <!iir may oiiive coagliiog 
and anefjtifig ; l>lowin^ in tht mealud induce nausea and vocirl- 
iiig; n<x>ld bWt iE> the car cxoltc caUirrh and croup; a boagw 
piBhe<i into the iatlimas of the ICostaehian Lube produce lanro- 
gcal pJiin ; and dUc^c of the middle ear develop laryngeal con- 
gestion and iu(Unimation> 

AcuU^ iTiflammutioTi of xhv larynx cattR*)^ otnlgii and actit^ Jn- 
fUmmatioD of the tympaJMim ; perichondritU of the ciico-aiTt^ 
tiord cjirlilagf? is a(X'oTi)|Kini(.d I:))' utal^ia; a»flhma n folloirod hj 
dfukfEieHs; tuberculoufl di?%ase of the larynx is coniplicaled In 
pnn>I<;rii tiifla^nmatlon uf thi< middle car; and a bniidcd latyax 
prodiK^ei deafnei^ and tM>m<^tiniei unconaciQU5JtfS& 

Hiirnctt qt]i)t(<A a <%m from the ttcordM of the Academy td 
Sc-iGUccfl, of Paris, 1705, '* A young man, twenty years oH, lusd 
both h<_'aring and spetx^h, aft«:r his lar^-nr had been sqnecsod by 
a strong man in a %ht. All rocanfi triod for tlie restoratJoa nt 
hiariEig failfxl in lhif« case " 

1 ^iw a ^imihir <niAe in 1879, through the kitittness of Dr J. 
H. McClollamL A middlc-apjd labortr in a rolliitg-tnill had 
beeii grasped fiercely by the tJiroat ntid tlir^ut to one Mn In' n 
fellovr-vrorkman. The pulicnt um£ recumbent, pale and feeble; 
hi* pupiin were dilated, niid Uh heimrg d^-flcietiL He oonid not 
a|>eak, nor awliIIow, cxcfcpt a few drop4 of urater at a time, and 
Gurh EitCempt hroughl on dintreflaln^ (.rhtphluz, owing to pamii tjf 
ttome of the thruut niu:fck-« and «pa»m of othcrrc. Tlic ditsnow 
waa shock and bruising of the cervical &ym|»alhetic gan^^ln. 
Ignatia was given, and tlic man recovered perfectly ia two or 
tlirte dayo. 

Sneezing is a veiy common symptom in catarrhal otitis and 
dcpemlif, da miicli upon increnHed eeni^lMlItyfoeold, aa upon Idtsl 
irritation. It may occ\ir in single explosions, but is offcener b 
paroxynnii* during ihv night or (^nrly part of the day. The aoil 
trifling exposure or irritation will often cau^ from one to a doxea 
Antv/i:Mr somrtimiTf violent ennngh to i&liiikc the mndows. Tbr 
outburst is followe<l by a flow of aenini frora the noae. and a«i- 
eatiotiM of tttuHing and rattling in the cam. Every one lta« Umri 
thejolceal)ont a (keison taking eold from a draft through a key- 



OIHONIO INFLAUHATION OF TUB TYUPA^IDM* 317 



liolc, ap'l froni Imvuij^ \i\e pt^vr Amt 0)>en in churcti. I um nl- 
Enoat ready to believe, that bypera^tbetic victlena of catarrhal 
oiitif^ huve fjrDUhctl i'VHli*nc4* ii\Kyn wliict^ such ft£oni.>s are prcJi- 
cateil. I have known (KilieRtd sm HoantUve thi-y m-i^uLI Mii*eze 
repcutnlly from expoauro to a bn^itb of cild air upon tli^ h^snd, 
totiehinji a cold object, leaving off a eiilT or <^IIar, <'haj>^iiii; to 
li)^liU,T ahoc« orii <)res?^ni; gown though rciDuinit);; in a warm 
room, aud from taking cold water or ice cream. 

The ns(Hralf>ry ceiiln* w ibo rnmhtlla oblnn^tn r<*oeivc*cxci- 
tatjoofi fnun the nerves of general «^mibility upon the surface of 
tbt liofiy, <T*[>ccially the trifiu^ial, fn>ni the piicuinoga.«tric nerve, 
and the &ympalbetic system. Aural conditioufi intlucnoe the 
medulla thmiigh ihenunculnr brunch of the pri€umopa«tric, the 
auricnio-ieraporal branch of the trifacta), and the tympanic branch 
of the gIoeeo-pIiar>'n;jcaI ntrrves. The re«pIratory centre fltnds a 
motor impulse alon^ the respiratory motor nerves, the &cial, 
IioviiUii^.t'Jini', jfpiiml »(xt<>*»i»r>', iutcrcostal^, etc, ; b doop inspim- 
tion 19 followci) by drawing together of the pillart of the faw-es 
over the buM.* uf iIr- longuc, und n violent ixpulKJouofairthrvrngh 
the nc^. The dhix^k often foroi^ (lie velutn upward, and ijiake^ 
tlie macoiis membrane i'^i rougli and nucomfortable. even, aft far 
forvmrd ieh the middle of the? nxif of tht* mouth, Snov.in^ wiiniH 
the ^jfltient of danger to ihe eare by increise of the catarrhal 
proiTMt, :tml iiidHiLt4^ u dehilitntcrl Htati; of th^^ hridth- 

Olher re^idtfi of reflex action in aural dittea^e, especially, In the 
eHmiilc hind I nm diH^'iisiviTigr iint Mu*r in tiirTt>iuu>d vaw*nlnrity, 
altered sensibdity, and mu^nlar >}pd4m of the jiartA. 

The niiricle, *idt* of ihp he^id, on** HiH^-k^ the iwek^ nnd, evw>, 
fhechwl »ml li^ek nmy l>Pcomeof amrrtihii^hitr*; fho rTitpi1larie!«nre 
liinlendc-vl with hhK>i!, and thetcin|N'mMirc in miM^il^nH in bhiMhing 
or the eairly stage af erj'thema. The **r>lnr of the Huricle in aome 
placeH d*tpMi* tit orimMtn and, <*von, ptirj>lo withmtc rnnniog 
into inflammation, aod linmciu supervenes, or if thia ha^ exittted 
previeutily, it i* conttidcnd>Iy incrc'jMMl. The altnrkit are noually 
sudden &nd transitory ; all the morbid symptoms depart aa 
quic^kly tut they have ap|Kiirod ; only to i^tum ugnii^ when loenl 
irritation w any emotional excitement funiUhea the impvtiu. 



Ma 



tns BDMAH BAH AUD 1T6 msVASBA. 



Experimental and foUholdgicfll lesions of tlie corvical 
tlieltc gangltn prrxliioe <H>iTeflpondiDg ^^vmptom* lo the abov«i iiMi 
render tt CBrtain^ Uiat i\v*y arc |rmduc<efl through und hf iht 
va^o-motor nervi^ of the syrapathelkr M*»tera. The auricular 
bmneh of die pneumo^tric and the trifacial, and the tytnpsnio 
brunch of tiia gUti5*ti-pharyiigv*al join Ums iiU|n^rior rt^vical ,*Tm- 
pathdlc ganglion, und brin^ tbt* GXternnl auditory ranal and 
midfllo i'fir into dtrettt oonne^tinn with one of ihe chain of wga- 
latore of tlic vaariilnr ripply nf the hfad and i>eck, miul Huffi- 
cicntly eiplaiii tie above pKtiiomeLia. 

Sore f(pot0 ara fdt \^\mn th« h<nd, nerk, siiouldcr, and cJieM, 
Ikcre and tln^ro, and neuralgic ghookg and pains «^lioot aIoi^Uk 
coLin^ of ncrvGs upon the mme side ai« tlw di^cuscd ear. It b doI 
uncommon lo find itoreiw^^ in tiie n!gioii of ih^ inferior acniicir- 
citlar Hdgo of the occipital bono, over the iMirictal prolabcraoiv^ 
in the temple, and alon^ th(> ^ide of the neck in fnint aiid heliiad 
the ^lerucKeleiilo-miLFitoid aiit«clf<-, Neundgta ift Mil1m*d outttt frv- 
quontly in acul<3 disca*c of the car, but may be present in ihe 
chronic stage- Pain drifts fri>m thi^ ojir lo tin: EhmiLi, In tin' ooci* 
put, to the vertei, into one eye, into the toeth, and down the 
It iwmtfime!* takf a reverse co»r«x 

One of my pari^mts had a st-vere pain in the teeth of the rr 
lower jaM% in the i-ar, auU- of the neck, and middle of the eluvi- 
de. Till: pain over the clavicle was as severe as in the ear or 
teeth, and 1 tnK^nl out the oonnot'tion from a newly lilU^l ulcmt- 
inz toocb. alonp the inferior dental to Ibo auriculo-temponl 
branch of the trifacial ; by nnn.itomocr'iA of ihi.^, to the facial, &di1 
along the luttvr lo tlie auricular branch of tlie auticularis mafiHis 
of the third cervieal, which transmitted tlieirntution by commb- 
mrc lo the fourtli cervical nerve, giving off the eu pra-cla yi cnlar 
tostipply the clavicular region where ihe pain i<n<led. 

The reader may trace the conrec of reflex actlou in a!»y 
neuralgia with interfiling nad AatJAlying oerlainty, if lir 
inclined. 

MiiacEiIar spa^m ta another aymptoni of aoi infrcqiirni oecQ 
renoc, when the car is in a morhid state* The coittractioD i* 
limited U> a few jibns, or involves the whole iHtndlc forming tka 




CBKOVIO IMPLAMHATtOW OP TBS TTMPASUM. Slj 



mn«:le. it occurs ia the mwicJeci of the lace, n^k, and throat, 
ukJ i.'i tfOdLiionaHy ft<!0om)utnit4t by objeelive ^naij[)iiig iK-i^^ei. 

I havetutil oDGcase Homewbatsiinilar t^J Leudets, r«|w>rtwi by 
BnrndL The iwtiont wili a Mrutiioii* youth, 13 ytars old, of 
fair <lc\*elopment and growtlj, but enaUy exhausted, subject to 
■udden f!]i>ttric dHtuHjniias and c^ovcre hcwlarh*^ and Jtavbg 
wnpicioits f^tmnpy idcisot teeth. He yrna a little deAl', and had u 
modernleua^o-phnrj-ujrual rutnrrh^ whit^h I did nor consider at 
first, 9B he ysoA brought lo roe for eye treutnji!nt> I fo^iiid both 
the comQ£ ^my wilh inter^tilial ki^f^liti^, ainl vititoii rcduoed to 
cimtitmg liti^'tv at onu foot The purcrate wn; roba^t, benltby 
people widi m« s()ecil](T liistr>rv' or p^ymptonis. I was rather sus- 
picious or lfa<- fuilitT^ Vi*raoity, UiniiiM* hv ilUphyvtl ^o much 
aniiety iu r^rd to the boy's oondition, and asked so mauy (luts- 
tiou aboot llie di«i.'aA>, iH ^robubli^ C3ij!«c and progr(9«. The cyo 
afiectton yielded rapidly totrcatmcut, and some six weeks afler 
tb« fiM vmi, I cxumip<.-d the mrf, removcil mnsM^ of altered 
OiTumeu and epidermic shrvtU, and diagnosed cbroiui', rather dry, 
«alarrb:il inllanimation of tUv: lymjiaiui, I uppIto<l ^lycrrine and 
waltrto thuf^xterual <-aiiiilr«, hitbied ibc eara with ihe air-bag^ 
aikI ordi'fcd a silt-walcr gargle, coniinuittg the eye trc^atmHit of 
merwiry a.-* Imfurit. Aft'tr t^relv<T dajft CreutmenC, be returned 
UDGXpeetcdly, nnd bi^ fathiT said he was afraid fometbio^ j^tJouh 
was tJw matter with iUe boy, &a he had jerking under the jiw of 
thi' ri(;bt M(k\ There wcr* clonic inuwcular jspju'^ins, at tbf rate 
of tive or six a minule. Mow ihe right jaw, and in fn>nt of the 
itcn]OH;lvido-na»Lti>id fnll^Cik<, in the superior ecrvic&l trijiiij;le. 

They had app«in?d two daya before, and had Iteen coiitiououd 
durip^ ti-nking hunr?^ There wa8 mv patii connected wiib thenij 
DO abnormal fBcnKUtion^ to lb« right ear, nor any cerebral aymp- 
tofna vhatever. 

Th«re bml bi-en Iiefwinche^ \-crtigo, and nausea one afternoon, 
due to a fre«h pork dinner and violent excrci!M> immixliatHy after 
ID playing ba^*l)all ; but I thought this coidd not he oiusalive 
of the pbcnonienon. The ini'mbnina tynipani prc:w^nl(.<il the diiM 
gray, opaque color of chronic iuHankiitation of the tympanum 
ootiixd at the first ejtaininution, but there wna added lo tikv pra- 



sed 



T0S nUMAN BAR ATtD 1TI DtSBASBS. 



TiOQl coodilion a marked injeclbn of l>1oodvemel8 aW{ ik 
b&Dclle of thi- nmlluuv^. 

During the spasm, the (iepne^ioD between the laiynz tin] 
angk of the jaw wa^ clcvflti^^ pueJiud outwurd Isiernll^^ obouf 
oiie-foiirth of an moh ; the ioferior maxilla was at the Fame ItcDf 
drawn downward abont th<? ^me itttftancc, and I oculd feci tlie 
tone of firm contraction icmler my flngenif prewted ipon the id- 
ferior nmsillflry ro^ion, Tlic movcmL^nt wiu immLtlbU'ly M* 
\4>vfiA hy rclEixiitioii, tjic jnw n^luriH^ to it8 projier poeilioc 
against the upper ooe, and the lime occupied fr<>m beginning to 
eml WAA not over two aecordi^ while the interval between thf 
aposiiiB avera^d tive g^^^nd;^ 

Cl<i^inj^ the jaw firmly, ilcpn^^iii}; it to its full ojclcnt^ moving 
it to one sicli^ and tlie other, and prcs^in^ firmly upiMi the mus- 
cle* Imd no effect in diminishing; the frpqiKU-y or force of the 
ftpaFim, iLflation xros casilyacoompli&htjdiand k«4cnecl thcDii>a*^^ 
ber nf the c?i>ntnictJonfi immediately. ^H 

A careful i<tiidy of thesymptom* of thi» intonating «we rcn- * 
derni it certain, that the tipasmH were confined to the diga^ric anil 
etylo-hyr>id muscles of (he nght side, and I was gratififxl lo fittA 
an analom!<^l reo^^oa for tliis in the distribation of nervf& 

Theee miifwlcfi are under the infiueace of a filun>i.^)t given 
by the facial nerve after il£ emergeace from the stylo- 
foramen, and, in my opinion, xhtn aerve w&m irritated b}- the mild 
exaoerbatlon of inflammation In the tympanum. This wimid 
nem rewonabte, because a genera] trcatwcrl of tlie annil 
cured the spaiim. 

Ij^t «!* *ice liow this might occur. There art* ^.Mi'orftl aratftfw 
moM's between the nervpji of the tyrapnmim and the fada), bat 1 
ehnll nlludc odIv to th»?w tliut setmi to tiav(,*tniiv4mitt4*d tlie mor^ 
bid iinpuliw ill this itL^^. The tympante ner\'e, a branch of lh« 
gloBSO-pharynf^^l, h the i;reftt wn^tive ni'r\'e '>f th<- middle ear. 
It gives oFT from itd plexus in the tympanum a filanicnl, fbat 
QDitcs with one from the facial nerve to make tJje Muall tM][>ef- 
flcial petrosal, whtrh gof^ to the nii<? ^n^lion. The glosso- 
pharyngeal filament trauKmit^ irritation from the diwa^vtl tympa* 
num to the ganglion. ThtA relieetA the wavcfi of irtitation lack 
along the facid filaments of the small petrosal to llie trunk of 



d lo find ,., 

given f>i^| 
-mafitotd-^^ 

;he mild 

4 would 



iriAUMATTox or rns tTupAttchf. 36^ 



Boll] 






fMdu!, just where its intunKfirentia ganglion reinf'ircxs its 
iwersndaiiU tn coiirnillin^ iLs fitmliimH, and ffxim tiei-e ike 
iropulw pTt!wv« iJuwn tite nervctu iIk' flhiuiriit lliui T4iii>j>]k^ inulur 
impiilw 1o Uiu Mvtt^'hvoiil uuil iJi^sirk' muK.le^ Ii iri probable 
lliai oilK^r ntii»7lcfi ^applicrl hy tbt^ fnciul wrre influfikcod in a k<«« 
fkgre€, and I ilkl not norif^' tbeir ai^Uon, fc)CC'fiiiw I was not fiiWy 
foeiuxi upon tJic neurolo^^icol n^lations of the phciM>moaon. 

8pa.Hm>i of cbe ietL4f>r iym|>ani aai) palnto-iiilnai niuAclef^ are 
ite fre(]Li«ntly meutionEsi in oIoIo^icaI wrltnigs. It U cvrrrain 
that fiposra of the toitsur tym|Mii)i <wi'iirK jio- w, iiml may }m in- 
iltinCiiry or, rari'l^, proJu<^ at witL It is M.'lclom attcD<kHt by 
iga Thifi miLscle hn.^ a lonits wliich kee|A iho memhrana 
tymjiiaiii at a certain ton»ion for the i^t^cption of^fund vibralluiH, 
but Iheckgrec Is aUored volnntarily, nhen the mind i& conoen- 
iraud upon imilitory H-n^ilbii!^ in expectant nItcntioUp 

Ad irritation In ifieexio.nial incaUii^ ori^iiaf, tn r!ie tympanum, 
Ibc Eustachian Cube, phzirynx or lar^'nx can KMich tht olic goD-' 
glion of tli4^ ^me mii- tbmu^h .tome of ibe nervous chaiQ»already 
tTac«l,anil thi)« muy cauw if)>a»m of the t«'n?»jr tym{mni aloiu; 
or arconipanii^d by coiilraolion of lh« lenftor paluti and other 
muscle«. The dnioi-liefld in fbt^c ca»s mnv^ in and out with 
the abnormal oontrarlion and ndaxation of the tensor tjmpani, 
as can tK* scon tind«r inu(niaation,aikl tlcmoiifilrattxl by Politnrr'H 
manometer. 

The \*eLum tiiov« backward and upward, tlitn r^turnft to it^ 
projber pendant [tositiun, ha tlie tensor palati and other palate 
mit«ol<» of^ntnu^t and relax. 

These mu^^mlar a^tiona are ow^onallv awompanied by an 
jjortivo clicking wund, which may be heard near th<; putii'nt, 
!t iwmetlmi^, even, at n dijilonce of wvejal feel. It varies in 
^uiu-ti.Tf and n?9&mble» the rattle of parrlimcntf the cracking of 
the finger- naiK a low chicking like that pnxlticeid by drawing 
the loiigur away from the roof of the mouth, or t)ic thud pro<lrioul 
by Bitapping the thumb and »ec-ond finger. The aound hi uot 
constant in rhythm ; it may be i^yuchronoiis with the puIfiG, rapid 
aad tntermitleni, or inrr(ii>ied to &* many m 140 elickn a minute. 
In a ease recordctl hy Burneil, swallowing, breathing, and 
ed the no(.-«e: rapid rtM|iinition incn*a:9i^ it froai 



352 



TDK Itl'HATT BAR A!Vt> ITS DISBA683. 



tirifiij^ ta thirty sDftppings n micult!. Tli« uintng-rork nw In 
\nu\i with every A|tu»nr 

The voIuBtarr production of the eoiind h» genenlly been iD 
ears that were in a normal state, but lh« iavoluoiafy in thfls 
Ihut wore affi.rt«l hy vsiiimw dej^rcMw of Hubimiic inflnnmiotto 
liornott mejitioiifi instances of bilateral ani! of unllatenl roDttw- 
lioD of tlic leiiifor Cympani in noi-nial caiy, Mlii^^b vren.- under 
voluntary oontrol. Tb^ iRVoluDinrycftw4i<if ll»e phenocuciMA an 
upon one or \jtAh t^ulcH, a«^y>ixlin;^ »?} one or both 6ar» arc d 
eflwd ; but it is not impo^ibl^^ that tlif^ ponvr of the wiJl sU^ju 
be €xi^HtH.^ upon tlie t«iij«or tytnjrani aiKl palato-tabal miMckft In 
prodtioo the siuiiulf evtu, ^vli^n dit^ea^ » pre^ot in the lubeanJ 
«ir. The sound originati^s from tDuseuIar ooclmetioti, but i* 
in the inii.«cle tthHf, but in the pnrlTf moveil by tJte muflde. W 
the tL*ii»or tyinpani contmcts ^piD^nnNltcul ly ^ lhoi>^ 14 a npi 
tuovetDcnt of clie drum-hcod invv^rd aud otitnard, and tim pro 
diiCK^ a cmckk or rattle like that whieh leniiinnt«« tbc sound 
of inflation iu ohi people*, with laf^, dry Kii^tatHiian tube«ianil 
lym)>anii. When tlie pulnto-tubiil inu«ik*« are the iKtit of vjiu- 
nioilic iieti<tn, iho wilU of the Kij$tAi.*hbn tube ire more or km 
Mpomttci) by cni^h mtuiculiir spasm, iitul the wrlt-lctiowo iuui|l-^| 
ping op clucking sound is h^ri, followed by a thod and etack-^^ 
ing, if air juiN-ft- into the tympitnuni. 

I hare had only one case baring npon this fiubjecL A gm- 
th^injut, iiixCy yearn of age, hftd pintifirnitive iuflnminatiori of the 
tympanum, and a loud snapping duriu]; suraUowing, per«eptibfe 
A foot away fn>m him. The no!^ could be heard Ihrougli tbt 
mouth and cur, and eamddont with it, the handle of the ruallcw 
and rhe memtrahc moved inwnrtl. J conifidered tlii«<]ue to speuei 
of the tensor tympnni ai»d eicaggcratcd action of the palato-bibal 
njuiielcfl, irduc^^ by the mH of Kwallowtn^. The AOiind mud 
alUT a few weeks tr^ttnent of t!w chronic ioSftininatio& in tbo 
ear. 

Bnrnett -wm able I0 stop tlie sounds in one of bis patienta bf 
preasing upon the velum, and ihrou^^h thi^ u|ion the Ku^Uclufli 
U}l)e, thouffh lie IV'It (he ma^r-alur ajKumi^ ;;u on regularly beottlb 
bis finger. AfW spontaneous perforation of tlic mcuibimu 
tympani in thmea^e, the uui«:7» and the i^posms ceased entirely. 



CmtOKIC HfPliAMUATlOX OF TBB TYHPA^PH. 303 






MCDunt a( tlii« ihi* mit)j<ir iXMX)iinnmiU '* iirtilicijil iivrfurmlioD 

the Jrura-heBid in any similar <aae^ if relief from iJ>e fi^mplocoB 

uhl Iw urp-ntlv nrjiiirrd." Tlw iiiiluii.nl c-iirrciil, iipfilifil to 
velum and Kaniai'liiaD tube, Iivt cukhI home ca&ai, and may 

triint in <vMiihvl.ir>ii with tim tn^tTiK^il for any OiM^cifv tliat nuy 

JH in ilwf r^ioit. 

MonUil i)i«ea«j is not inffVf|U(rnl in (-tironic in llHtnf nation of tJic 
tymjmniim. It h renftonable timt the brain ^hniild flufFer from 
retir X ailinn, na do ofhcr jiarU about \he mr, ^iikh; tt r<>ii}>i-'<tji of 
Dervoua matter — great gaiijiliu — i^onsoimis of all bodily conditions 
aru) omnijKitent over all. I'atienis complain of u dntwtni^, 
flirsined fe*,ding in the head, ■» if thoHoalp w^re tired and the 
eurfacc of the brain cotapreBsed. The wits arc WiXjl-^t hiring^ 
and thought Tviindn^ pur|>ot«elcs^ fmni ^nhjet^L t4j iwbject without 
continuity or ni!iAt€i-ty Kra>|i. The tncinory Is dt'lbcthv, c-ont'on* 
traiion of iit<- nniul upon a ^nhjeot ia exneerlingly diQjcnlt^ menial 
Ubor must bo fi>rcv»<l^ and causes gt^jiGral fatigue. 

When linnitufi is present, nervoiisneas ia marked ; the patient 
0tart» nl <rv4Ty unti7<iial or loud notw; is timid in fkrkne^; 
afraid in omwd^ and crowded tborotiglifamt, and a]inthvtic snd 
eeaaJDgly stunned in placut thut require solf-pos^eaeion and <)uick 

ion. 

Vertigo cxiniet} aow aad then to disturb tlie equilibrium tad 
destroy courage, and, if i^a^stric difiorder exifltx, and aildit it±( tar* 
diao and ccn*bnil distnrbanns V> thu piotnre, th^* patient may 
have severe occipital jiainti and laimbtK^ fit iinilr^, ami ntay whirl 
arouiM] and &II down, conftcioa^i, but utterly deinorolitiiMl. 
j Of course, the above are arcngly draun synijitoiUB of extretne 

I OttM. A patii^nt nuiy liavc odc or more of them, mild and ea- 
dumble^ in connection with the aural diaease, while another may 
have mty^X or all of thcni, and 1>c thoroughly mt^CTable. 

^Wl^n it is remembered that penwna have become inaane from 
I prmc^Etw of ioiimottt) fvnimen in the external caral, and 
i€Tft have blown their braine out under the torture of a con- 
nt tmnitus, the abov'e de^Ttptton will not Meni cxaggomted. 
The objective Bymptom.sand pathology of the catarrhal variety 
chronic aurul iiitiamnrntion arc mo diflV-rent from tlione of Uic 



m 



su 



TBE iiuuAH nil 



Bias 88.. 



ptDli^erat]^'e, lEint tbe^' nmst be deparateJ in order to avoU coihi 
fusion. 

A «afc of excessive rongesiion and wcretKHi is charadiTtrtir vi 
ooarn (^T:trrhiil m^v^^ and iJki iiymptoma tonutTtcd wiili ihiH diflfcr 
intidi from tbo«e given ia tea^tbooks tipon ear diaeoscs. It b do 
early stage of cbro»k anral Enfloinmntimi, xrMeh 1ft not olUi^^ 
brought to the aurist's attention. It i^, also, a cbroDJC co<Klhu^^| 
In r^nif^ (Hiiieiit^r ^lii<rh ifwnia to Imvo cecuiK^d th^ jitmidon of 
audi celebrated writers as Tf»yiil>i?e, Kooki and Bumett. 

Thv extenml Midit^ry oinal in tlic curly <t4igc i» cDtt^icd and 
tlchy, and cx>nlnins an Qxces» of cefuraen, mixed vilh lUnr wliitc 
atire(lt« <if cxfo1iau<d <'|HtlK'1iuni, TiHKto hfiir« and dirt. Ttiii> cf^llec- 
tion may bft ^ultic-ient In amount tc clof^ the ennui, or only eiXLUgh 
to lill iU depm«<j(>nH arM) oWtruut tlit^ $|HX'uIum^ as it U pudu 
intopoBitiou for ocular examrnation. Th« memi>ranntym|Kiniiiiii 
»ncli <u'^t» rorty or ilull rinl ; if.s vc?u^d» mny not Ih> vt.iiUle^ or moia 
will be ^eea pa^Hing from the canal upon tlie membrane towinb 
its creutre, Hn<i olIjtTs rtmnini; from nbo^'C down aloi^ (be 
rior border of (lie malleua handle to the uuil)o. 'lliere may 
cicatrice cf healed pcrroratiotiJ^ visible. The light triangle 
dimmed lu lurttre, (limini^hed iu mju*, clongiiled, hiscrtedp or eo- 
iiTGiy absent. 

In mre i^^ the membraae will )>&rniit one to ere the lev^el of 
n t!ccrction or of blood in the tympAnam^ and thof^e ouexist vntk 
MpliihH, Ijfvirr dinrfltt, lung iilTw^tiuni*, ami Brigbt'j* dij^tiw; hul, 
gcDeratly, there is so much opacity tliat nothing cam Iw seen 
wiUiin, The mnnuhrium of Hi- niDlIouH h olxHctired or diovs 
yellow knob on the lower eiitl^ atid the ^ncr^I thickening 
0Oggim^ of the drum-heiuJ interfcrt with ttj^ ebtitiiriiy and mo 
biii^, 50 that it moves outward and the malleus handle aiovt» 
forwanl very *(low!y, wheo Sfigle*.-* i^i^ox^ulura i^ openitevl or i»fl»' 
tion is performed. ^J 

Then! !h Httle depm«iion in tlii.'^ disca'^e. Greater prcwure i^| 
require to puab a thicker membrane inwards. There b so moob 
fiero-mticuH in the tympamini that it acto by counter pre«are» nai 
nir goes through the oiuclih in ihctul)e to the tympanum tonme 
eitent to augmeaf this, and prevent dial inurk<x) dcprcMOn Mca 
ID later and drier Mages. 



Bct-n 
mo^ 




COROTltC IVFlAKMAtrOV OF mi! TTHPA9UV. Z^ 



The Cyaipanum, mastoid cel^niirl KtiMAclnaii tube arc par- 
tially or enlirely fllled wilh Hear or yellowish flGm-mumi*, mn\fs^ 
tiinw recltlcncd by L^xudcd blood; lliicker muruA rtJngs to iJie 
ftDglee Kttd 4lepre.>«4ion9 ; tlie oa&iclf!fi and tensor tymitani arc 
oloi;^ by il; the foot-'i>!ato of (!»*^ iif«|H» tind its oval tnem- 
branc, and ike membrane of Iho round window arc pti»)icd Jn- 
M-Jiriljt, and niij^cDt the proesnrt' of tlir lubyriacbitic fluid. Con- 
stant pressure of mneu» agninat the mcmbrana tyrapani i« likely 
1o mutM^ thinning, and this proili«po»oi4 to i<iiHy niptnre. 

Intlation \a oRf^n ui^t felt in Hie fiirs, and the EU^tdiAtion tube 
will IvAve one in donht whether he has heunJ ri\U«, though a few 
bubbling one* tiin ct^ncrnlly U^ dir-linpiisLed. Swallowing duriniB: 
thcnctnf inflation will aij in opening tht-ttibo. 'J he middle car ij< 
ftlufled with Aoeretion, and while the fork on the vertex h heard 
nther exa^r^ratixl^ the wateli may tot fitmtsh any Kound to the 
expectant t*nr. 

The mucoas membrane of tite tympanum, mastoid celU and 
EiMftchian tiibir i^ di'ep red ur purpli-shf !<n<videiit and velvety. 
The vpithriiiim is Bpon^y, and hetv and thoro presents gramitar 
jutohi^and vinuiiH|irooe«Ms; thervjspa»ivec<JDpc*ti(m; the bk>od 
moves alowly; the veins are distended and show elongation and 
varied^ ^'wellrnp*; t*rchyn>osc» are in>t nneommon ; the submu- 
cous conneetive i\f»iiQ i.4 hypertrophi<il, and \U mt^he^ Ulltfl with 
Icooocy Uw ; ibc lubulnr and rscemofse ^laadti are hypertmphted 
flDx] dilated; and the mn^-tirtii pt^n*>rally thJrkenwl. This is 
limited Ut iXTUxin fmrtj^^ to the lirum-liead^ the artienlations of the 
oviclefi, anr) the round window, or is more general over the whole 
nrrnoe of the limiting bone. It diminii^he^ the »i»> of the tym- 
panum, and may be so considerable a.^^ to obliterate the entire 
oavity. If the dij<(Taj<>! continuLv; any len^h of time, baniU and 
new mcmbraoes are produc'e<l, aud contraetianA and a<lbc^iou» 
supervene. 

Thitf wet fortn of ehrouie inflammataon of the midflle car re- 
mains wet for a long time, \s obnoxious to treatment, and very 
dioooura^ng to both j>atii?ntand physician ; but it m surely tends 
to sclerotic and proliferative proccfisos, and destruetion of the 
hearing power, thai eontinuoui^ and <'nerg<'tic trentm^nt is impev- 



306 



THl eUHAK BAR ATTD ItQ DlBtASBS. 



ative. The mild c4iMfl and, even^ nmne of ibe worst oofs EOlD^>^ 
tines g^ well, and ft)1 <»» \k* ^reitljr improvo<l. 

Schwanze sav» ; '* 'J'he very higticst de^reefi of catarrhal ftwdl- 
ii>g of till! lyiiij^iiic iiiu<!(>iiK membmiic ure capable of CDmpMi 
retragreaibitj Uie membrane resuming ita cobm.>l>-)lke (IdKBrr, 
and moulding; OjhiK nocunitdy to t.h« o«»<y)U^ wtttU and coiuoib 
of the lympanic cavity. The cellular intiUmtioti of llR'»ibopitlfr 
lial uonnwtivc liwsue (li«i|>i>i7ir* \yy f*lty di^jtmeration and dear, 
and possiMy, in pari, by being abaorb^ into i!ig lymph vemfc. 
For IhU puqjow woekA are tieiTK^ry. 1 n many co^es, bovre%'c?, 
rctrograssiou is int<om]ilet^ and tliere remain prvj«<-tion» ud 
duplicaturea of Che iniKH>u4 mombmnn in itio form of p^tudo- 
inembianufl op dyi>e(*biee, by whicli ditlereut pirts uf the me »» 
ttbnonnftlly adliiMx>nt, or Um? tympanic cavity i* permanently 
aflected in its size and form,"* 

McKleniU- »ix^retioii in th<r tym|iimiim and lube and an ah^aice 
4>{ oon^eslion uhantcterize the Hrcond stage of aomc scqlc inOm- 
tnAlianrt of the middle' ear without perfonUioti of tho dmm-iK*l, 
as wellf a» subacrote iatlammnliona priiBarily sciximi»iak-d \sy ci- 
reaszve soc^retioiif some primary sohucute luflamDiations of tlie 
lymimniiia^ und vinom^ miirlid pn)ce<«w« ariwog ilirrdu frotn 
tubal dneoAe. The t^vmploms nf this ^lateart very diffetwit frwn 
xlufi^i ja*t pven. it i» the morbid condilimi fiiUy d(?M!ribe<l in 
mofit textbooks upon ain^l disease, as ehtonic catarrhal tnSa&i* 
iijiition cif (lie middfv fan It i--< the one im«U fre4|tii<Titly m^*u in 
practice, because pereonsallacked with aural catarrh do not gcocr- 
ftlly apply for trattment until dt^genemtionR have otTurml, tad 
deafnew and tinnitus have awahenpd anxiety. It properly in* 
<.'Un\i» both mild cjiturrtiul ami pmlilmtivo t«itC9. 

The exlemal auditory canal, in the lo^ humid inflammiticci, 
is ycIlowifh-vrhiCo mixed with gray, It isdry^Knily, itchy 
tains little or no cenimen ; iri sensitive Co ooltl, and in eyropal 
with the morbid chiinp!* within, 

Tlie membrana tyint>ani is thickened, and lias lost ib data, 
healthy, bhiinh-^y Univr. It \-Ari<« in color from opaqM 



ticffl^ 
3^ 



* Tl» Piihtitogical AoBiomy oS ih# E^r, Stfbwaruct p. IMl 



OHSOyiO IKfLAUMATrON OF Till TYHPAHtrM. 3^ 



GTonmr yellov to dull gray, nml iu peripbery oOen slvows a rei- 
lowi»b-whitc riDK *jf thkUvntng. 

Tlie light Lriangie vhen present ia dimmed, po that it is difE- 
cnlt to determine wlier? th^ canal ends asd tlie mcmbmne begins ; 
tlie cii!r>r ir^ like anbi^toA, blue ]^ run lie, or gmund glui. Iia 
%rcm is* diraini&hFd and idiapc altcr^. It miiy 1h} elungntcd inlo 
a Blender line ; bi^ectd) lioHjuintiUly, r^> iluit it t^howH a f^rc^^^nt 
at tlic boM and a point of light jiear the umbo ; broadened atid 
»boneneil in a blunt i»ne; ^c^itU'n-d in thn^^ nr iWur It^'lit p>intfi ; 
or entirely blotted out One or more dirty \\bitc spote of raU*- 
reoui deg^»mUioii may be wjcn in the incnibninc, for the tno»1 
part, in tbe middle portion, though, raiely, they extend in cres- 
cenlic fon» along the jwriplicry. Old cittitriow when present 
andflmall »;bow lu; j^my or yellowish-while marks, a litllo depr^Mcd 
below the Hurlnce, And mny prc^et't oiilvmnl like little blister, 
when inthition is perfonued. When tb*y are lai^, they are 
darker tlmn tlte r^t of the druin-be^d. 

The manubrium of tlie malleus lias a yellowisb-gniy color, its 
edges s««ni to luive additionHL of nirlilii^\ »nd there t^ ti mri of di^k 
of the same color around the lower end which ^ivos its knol>Iikeap- 
pearance. A few vu<n,*1s mnyoour^ciiloijgit>siKjKt«rior bonier and 
ftbove the abort proce«. The «hort procosB prDJeote above the 
ftirfa<*i% ju a ytUowt^h-whitc button that catcbea the eye v{ukkly, 
and from thi^ th^ anterior and po^tiTior fold» of mucoid mem- 
hrone npon tbe inner surface of the dnim-heiul can be eeen, paas- 
iaK to tbe periphery in »hiiq>ly Jniwn Iioes, The greater the 
retraction of tlie malleus handle^ nnd di-pni»$ion of ihe mi-inlfnitia 
^mpani, lh<! more notieeabte tbe^ folda and llie short proeCES 
beoome, 

Tlie tympanic changes and tlie oh^nictioai of the CiiAtnobian 
tijl» rarefy the air in the ear, and the air pressing npoa the outer 
Mirface of ilu- drum-lK^d foree^ it inward. 

The handle of the miilletis U drawn inward by tb« tenaor 
lympnni aiuAcle, and piu^hei in by atmospheric depreeeJon of the 
drnm-bead, in variouii degrees. It may hang Dtarly in prt»|KT 
po&jtioQ, or he drawn or pres6e<^l inwun! fuid boekwaixl, until, in 
the for«flhottcnGd view, itJK length MKirnut dimim^bod more than 
one-half- 



TRfi BTMAK bar AtCD ITS DfSlASSS, 



It irt RoC oerlAin timt the ttiuwr tympani is in a state or MiMt, 
in evt^ry case of ilepnwiuD of the dnim-hcad, 1 hav« hgcq ftvn 
of air-il<"i>rt**«i inemljnim'j where llw plane of tfiij ouler mi6et 
ol' the tnaBubrium rcmaiDc^ iK^irly in tlic same plaoe mih tk 
membrane, aiul it wan eviileat from this, Am) tlio t%slontioa if 
both to the nunnal position hy ioflation and other tRatmol, 
thnt the tt'iiiiur tym|iaiii wm not ^inW^toti. It oth«f eaiKtofd^ 
pressioti, the ttDltrrior ixlgt- of the nianut>riuDi wa^ turned ^harplr 
iim^nl, and the posterior border made a ^larp lioe ovvr wh\A 
tliu dnitn-hoad M^^iiiitl dmvvn tightly, making a toleiahlv pUar 
suffaoe of membraEie behind, and a dwp dark pocket id front 
Tli«m could not 1>e rt^iorvd by inflation aitd tTcaUii«nt> probibW 
because the tcoHor tympaoi was in a fitate of spastic eo&traoUon 
or rigidity. 

Weber-I^il thinks the tonfior tympani is continuous with Oie 
palat'>*1uhHl mnM(dt^ and, wiieii the latter becotnc di«i*iijwl and 
relaxed, tho former becomes coatnurted aatagoaUtieally. Tliis b 
mere theury, ami tlicre are a groat many facta to render it oo* 
tenable. 

ThecaujfC ofrtfttiiction ^f the manubrium is of value in prog- 
U(t?ii?^,ai]d haiia bearing upon the ojieration of tenotomy <>f the ttnaot 
tym|Jani. Wlien the drum-head is d< prraiQcd »r retraeied, ir be- 
come more ecmave and of very irro^^nlar ^urfiKT. If it ia chifi 
and partially tran!Simrent> tln^ long pmtHw* of the incita, the pink- 
iscli-whiti^ promontory, riocs of mutuii and bloody and air-bitbblQi 
may occa^ionidly bc?fein thnmgh it. 

Adhesions of the menilirane to tlie inner wall of the tyini»uiui& 
are bluiflh or yellowirfh-wbite, an<l do not move during infiation, 
by whidi ihcy can be distinguished i'rom ci<«tri(^. [nflatiofi 
moves tlie drum-hi^d (.^on-^idorably outwards when Act adherent, 
and oiuacsi irierea^ied redneiM around the up|)er \mn of tlie niallcw 
liandte. These ch^mgis are to be obcwrv«d when the patieol 
pmctic^es the Valaalviao niethoi] of inflation, and the aiirttt illu 
nates aud watches the membrane. 

ir the fisf^idi^ are fixed and the mall€u» handle and portioM^ 
of the merabraue adherent direct or throush the iutenenlioo 
bands, portions of tlic membmuc will move out in bulbatifl 



cbhontc fVPLAit»ATioK or ras tVupAivutf, 390 



ballooD*like [iroceA-'iEs, while the other parUi will darken aad re- 
tUftiD immDvablc. Willi Skate's »p^-uhiiu on<* ain <lruw iUtste 
looAe p\B/CGA out uml ^liow their diaracler aDcl exteat per- 
fectly. 

U would l>e 11 tetUoiia and u-selcae hibor to defiT?nlv the vaiious 
picture* of d]8tortol mcmbraii<» mi-t with in thi8 di7M:as<:. Thi^y 
are as uumeroiiti ntid «iirii>u.s aa tiie Hj^ure^ in a kaleidori(Xk{)e, ami 
«liouhl 1 vrriti* down all the varieties I have ttGou, I would have 
to add U) them dajr by lUy m* patient'i prf^i'iit^l. 

Authors state that, id rare caat*, (he tyini>anic membrane loses 
it9 oomial a>lor nnil traiiH)>arencv, without Uiere being iiuy di»- 
case in the middle car Of course^ this inigbt hapi>eQ from the 
d^nif«tic treaunetit of eaniche, or from disease conliiied to the 
0kecvbru]& 

No one w All Id make a diagnorti^of chmnic intlammation of 
the tynipaDum from these drnm-h^'Ad fl}'niptonLs alone. 

lu other patients with the tym[Kii>ic disease under consideni- 
tion, the menibiuDt^ may be normal in appo^mnce, Urcau^c other 
portions of tlit' mnrotia metnhniiie are atleeted^and rhnt <M>ver- 
iag the inner surface of the drum-head Ims escaped. The mem- 
l>niiie RMv prcNfnt any of iho above coii<lition^ in the dry pro- 
liferative fitajre, and the strlerotio and'atrophie chanjjc^ of Ktnility- 
Then it may (k* thinnod by atruphy, and fliip In and out like 
ibe maina&il of a ^choontr lyiu|( head to the wind. 

In the fita)^ of tyntpuni*^ inttnmamtion under c-on^idc'ratioa, 
the sotmdfl hoard through the auscultatifHi tube darinic inSation 
vary with llie eoDditiun of the KiiMnrhian ttibc, Val«ilra'« 
aetbod ifivo* the pun.-«t gonnd, and should be preferred in test- 
ing. Sonietinieft the lul>e i^ olKlruetijtJ hy phjg» of mnnts swcIU 
JDgs 6brou» menibraue8 or band^, and exostoses; then nothing is 
penxivcd dnring inflation but the wKiiid of the vclum'i roove- 
menL It such an ev^nt, introduce a catheter and try again. If 
not iucccwful, rotute the mthelrr a little, a» it may have got inta 
a follicle or aguinf^t a fold of the mucous membntne from which 
a little manipulation nuiy free- it. The ^nnd thr>ut;h a small 
mtliRler ts fai]j;her than ihroagh a large une, and should Ik- rux^- 
nixed apart from tbe tubal and tympanic noises. The catheter 



SCO 



Tltfi BVHi!? VAR AKD ITS DI8BA88S. 



wliisrie BliDuId be Ieam4^d by tVircing tir through it iriUi ihe ut- 
bRg before tHiTifr it in ihcuir. 

If obetruccion per^istH, pass a bougie ameftred with cold crtftm 
through ibe caUif^ter down lo U, aud [iiuh gently onwurck, Urm* 
ing it tuivr :iif 1 then till a tmUli^n frctdom U Mi as it culen thfi 
iytnyixniim. To guard agntiu^l ermr ami injury, it is well lo 
meagre tht- l^n^^tJi of lh« cntbelcT upoQ tbi.' bougie, add totU 
tbe estimated length of the KuAta^hian lube and taurk botb phm 
upon the boti^^ie, thLO piixh tt tlimuf^b lli€ catheter into tht tab* 
until the out4rr mark Ur^^adm), and the ot^lruclioit i^piatib^d, Ooh 
a v^T>- mo(lorflt« degree of fon^e ii< \wTmm\hUs ; inflaCioQ may U 
[KHbmied the next day after the tube is made pervious, but M 
the anmo ilayron account of the daugtr of fjroduojng i^niphyM-niii* 

There ia a good deal of bugbear about thia danger, becaiuea 
travelling (|unoki>i)ci-|>r(Hhti.iHl it by iipplyiug nn air (furoe) (ramp 
to tJie tulx"-. Ordinary iiLllatioii uiU never prodace eraphywiBit 
unk>^ ini^lniiuent^ have lora tlio DtiHx>U4 iiiembnno of the £u 
tachiantube boforehaud. 

When iiiflAtioa E4ii4XH<edM, mtlier loud rftli* Jirrr heard, rnin^^o 
with Clacking and snapping, and the u^tial thud. X momet^l (irl 
tvo aHer JLiflalioii^ the patient anmetimee Ih^tb a cnu^kiitg n-i wnH'^ 
air c»cu[H<J4 into thtr throat ; the sensation of fuln^wt pvs awtf 
from llie ear, and the meoibr^na tymiuni talis iaward& to a iUH 
of equilibrium. 

When the tyiii]>amim and tube are dry, and the latlir S 
largid, as in many riw» uf proliti^riUive ititlainmatiou and ^nilll 
ftlrophy^ the nir by VAlfialva'a or Politzer's method goo^i iiito thi 
i^ir will] a loud rush and -^rm'kmg rRfuntl. The membrane, i 
free ami thin, H:i()4 outward and makes a n:>iH> that can 
ally be heard by aii ok^erver at several feet diAtoaeib 

Inlljitioi] nmy Hoinetimi^s (*auM; tinnitus tuceaflu, but it| 
ally only elevates it^ tone, aii<l reddens tlie drum-head along thi ' 
handle of the mitUvu?, t<howing nn in<lueeil bypciTemia. 

The muooua mea)brane of the midtlle oar psssea gradiallj 
from the ftlate of congestion iiml swelling to that of hyiiertiupli} 
of the conneiiive tissue, and development of fibr^ hands, ami 
falfte membranes The glands aredestroycil by incn-affc and con 
tnction uf the eotuioetiv« tittue in which they lie; tbe vtSKb 



CRROHIC iSFLAMUAXrOJC OF THE TTMPAST7M. 3fll 



ftiiiUUeil in Aws niu\ iinmt>er, and nli^orption !« fito[t)i«d ; 
the eecTftion is firel tnorbi J, ilicn dimint«h«l, and fipally- arretted; 
miuHi^ or iii^pimntis) inunLs mitij^Irt! with »hn.H].4 uf AUriu diti^ 
to the lyfiii>anic walla and the oseidcs; ilic cavilv bGOooK^ un- 
iiatuniliy dry, and (he iimvublr }rurta* rigid. 

ThiTf ]iath<>logirn1 obangi- i^ ii'>t imilVirm, difien^it purt^ af the 
miicosii t^how ditfcivnl st^igca of the priKtfis, ju»t as di« StrbiTvi* 
(Ivmn mi.*mbnine dow in idimnir nHNil <nlurrh. 

TItc mcmbniue ii|)on the inner ^iirf:u\<ur i)k^ ^Jnini-hcud or 
overlhe proinonfory may be non -secretory , dry and f^lilt; wliitft 
in the antnim, imd aruund i\\^ vntraitcc of the ICiutachiaii lube, 
tl Rjiy dmw Mimfi <«ng;esit(jn an^l M*t'reT.ion. 

• Tbo pieces of dried luiRUi^ phi^ tlio mastoid cells, lill depres- 
MOtiSp cling to the feJU^lnv, Hurroand and clog ttit^ 'x^idc^, und 
sometimes remain Im in the travity, to Imvcl about when the 
patient tnake< uimsual movL^menlK 

Two paiietits ^'rifTcriii)^ with cbmnic inflammation of the drum 
reported that they felt sometliing fall in the ear, ami hail i^vta^t 
tinnitus when thi^ im'lin<?il the bofly forwartUp Another Itad 
iiKTOi^e of tianitiL^nnd a.-<ti>ppi>I fi^4iii^ in the car afleraaud- 
deo jflf, IL4 in makinjt a mi^^tep, H'hidi Avnipt^^niM wctc relieved 
by Urndini^ the tHxIy forward aJ9 in n Turkish salaam. Some 
patients have beard bf^lcer when lyin^ liown ; others in tJie «roct 
po»iti<if], probably from dii^pIaciMncnt of mucutf. Theae mueous 
masses mast neoesBanly interfere considembty with the pn>per 
oction of tl>e auditory appuiatiLs nni) the h(.^riiig will bir made 
variable or very defective, accordiiig to their (puntity and loca- 
tion. 

In rare c^f^t^, blood is extravawtefl into the tympannm Kpon- 
tan<^ou^iy "tn diphtheria and Bngbt*» dii^ease, and. as a result of 
Mnin]|z;iilalioti, vomitiag^ aa<) violent i^tmghing. It appcAj« 
through the drum-hcnd bliii^b-rcd or bWk, and may rhanf!:e ttn 
levd, nst tlie lietu) i.s iKnt forvranUor Imrkwanlri. If it dca-H not 
caurw punilcnt inflfimmation and rupture of tlie membrana tym- 
pdtni, it m:iy be reab^>rl>eil » t>rform a<lrydol of ob^ttruetion, and 
IMTtducc iIjc s?imc trouble a?t a r^:v^ of niucu9. 

Atlluidotis octnir l>etwi^]i tJie membratm tympani and thf? long 
process of the incus, the stapes, and the inner wall of tlie lympa- 

24 



362 



TSB BtTMAIT IIR AUD ITS D18EASS9. 



ntim ; the anterior half of the tyiupunie mvUy inay be septtMni 
from (he posterior, the upper from the lower, formii^ q«k 
ftpiu?<s. Narrow tyiuptum wn* ttijw^mllywibjert Ii>m»Hi aifltfewn^ 
Firm grayish-whue tbrcadg and bauds of ronm^ive tittmtan 
dtrvclupcd Iwtwtiin muaius !*urfiw^, aini oitend i'mm the dram- 
lK«d ro the wuUb and the o^k'K*. They re^uh frstm inlaniniaiua 
of ihe mucous membraiie, the cirgunixation uf l)lco<l <:lot», aiw] chr 
retrogr(»*Jon of rauciMift lisnue, wlik^h normal in fu?lal Ufe, sook- 
times remaiuti unabsorbo^I atW birth. Th^r handlu of Uie ^ll^ 
]ca-« i^ nilen l>ound to the pmmontory ; the long proceee of the 
, incus to tbe posterior wall ; an urm of the «tapus tu ihe tidnkr of 
tlie oval window^ mid ttie tejidon of the teiifior tynipani to tW 
roof 

A thkk librouTi membrane may cover the walb, obliler&te At 
fiimmen rotnndum, oloetc (he Kimtnehian tubi* and anlruni^ ftiid^H 
even, fill the whole midille ear with dentie libroii^ tt^ue. ^^ 

Toyubeo found ibcM* advcnutiouH hamU in t^-enty ftr c«aI. cT 
casf'S exnniiiiviK The pa^^ition of ihirM? growlbi^ d^t^rmine^ the 
impairmt^nt nf hi^arinjj;; upon the stnfK^ aiul vibniliiit; men- 
liniiK-s, thi-y are much nuire injurium Ihiiii u[ion other |mrtft 

Atrophy may be prodaoel by inHatioo^ &nd by ^^nile ebaa^ 
l^mU may hr^omi^ thrt'ai^ a llireuil may pull away from lb» 
drum-hi'iLiI and leave a pcrforfitiou. 

Pmgre*»ive hypertrophy niuy go on, lavorwl Ijy the exulterant 
life of youth and midrllc a^, and by cxatvrlmtioiiH of tym)ianK' 
in flam mat ion. Like all tiuch pathological new foroiatioiks, the^ 
arc subject to fatty de^^neratJoUj M-lenMift, eonlraclion^ mldfioi- 
tion, and oA^iliojition. 

The tensor tym|Kuu mu4ulc U oOen shortened, its mu«ruhr 
tibreH l>erome fatly, tibrouii er ahaorbed, and ita tendon .^irnuiiMlod 
by a thickener) ^licnth, j^i^uerally bound to thv ^ralU or ooJolcshy 
banrlR or libri?H, thuft preventlufl; aetion. ^^A 

I)o)Kwilion of lime witu in tbe niombrana tym|iani frtviuentQ^ 
fXkexLHtA with hyf>erofttit^iii of the external auditory cmnal, the 
uaaieles, walU of the Eu^taehian tube and tyni]>anmn, au<] crIU 
of the mastoid pro<'ef«. 

Tbe ossicles beeonic di<))lnced by t]i« adhcsiontf and contmttion* 
of the membrana tymiiani, the niucona meiubruH, and the 6bro«>^ 



CnROSTK IKPtAMMATrON OF TUK TT«PATCCM. 583 



TIk^ ciiaIIciw mill int'U^ nt^ H>in<rtime« iinitinl :o tlie roor 
flf the «ir by oeaifimtion. 

'Hh' L-«p*«!e uf liiu iimnlo-!<l[i|Mx]iul nrUi'iilaltivii relnxw «ccft- 
Biofially, ili<^ incus h pu-'^lK^d a^tAc-t ami the artiriilar nnrface of ilie 
Blapcs is Mcn with the drum-hcflil 'Imwii tifrhtlyovcr it. ItH 
ruiiU|ilAl4> may be nt tlio name lime fixed tmmovHtily in the oval 
win<iow by o«epieoii8 depofriK twiwciii! ly, \u uM ii*^-; iiiiJ hy|n*rn?- 
tofiis af the base cause a pmje<^iion into the vestibule. After 
ftyaofitosis hiuf cxt^tm] a lonji? time, the crnm ntrophy ami beconw 
very fragile. 

The nialliN>-ifin]dal and ineudo^^slnpeilial ariiailiiTioiii bo«v>iiie 
rigid, owing to thiekening; and calcifieaiion of ihe capeutcs and 
Mirp>iindiDj^ tis«iK% and tlie consulidatc^l chain ivprt-'Mtiilj^ thi< ciA- 
umelta, a -linfjle bone ihaC pertormFt the J'liticlJons of a chain, bc- 
tvreen the membrnna iym|miii and the vevtilnik- in the cam of 
Siiirian^. 

nypero^cosia due to pcrio«titi« ocmin^ frequently nixm the otti* 
deft and vnvlU of the* tynifmnnm, and o:<h!(>[|A bridges extend from 
port to iiarc, atiJ (>rcatly hiiidtr the fmitFrniv^ion n( vibrationK. 
The pyramidal vmin^iKt: may he coniicctLMj u-ith the forumt^i 
ovale; the crura of the ^tapc^ with the ed^ of the vej^tihuUr 
fomminsi, and the fwM-piatr with the |m>ru"ntory. The fi>nimen 
rotuudao) if* ftometime^ closed In a mirre !«lit by liypcrri^td^H i>f 
the tyin]^nt€ wall, und the mastoid cvlle are en<^i^!irhivl upon 
and oflt'n filled by a new ^ftwth of U^t\^', which ifl Hometiiovs 
w> dcnA*. that it is dcsifTiiatcd pbTtrnatioit, or ivory o3Ci:gta»i». 

In taleiAration, ili«^ lime .calu are de]io?iireil in gninular ina»««H 
in Ihc tneshc!^ of the tniv ami laW connective tisue ; in oniGca- 
lioR. lamt^lti^ and r^pjealie of bitnr nn< fi>TiTid in tht* wiine tiwa*** 
rather n«iircr the bone: while iu hy|>ero'Jroi4JK slid exostosis the 
il«vvtlopni«nt \^ U^nmih the i^^imiective tit«iiie and np<Mi the aiir^ 
face of th« bone. 

DiafCfUMU and prtignoAi^ are nm diffirult ia tbU tHnmt^, Tbr^ 
inKtnimcntHfiml rndthoclv of examination of the enr, thrnnr, phar- 
ynx, and notie have lieen aTmidy di-!4(-ril>ed. C^n*fn1 irtmAJdefiL- 
tinn oflhc pcithologirjjl rhangm apjmrent tn the «n.'C«of lh« renidth 
of inflation and raTheterimiion, and of ih? viibj^<i?tivi* Ayntptonu 
Hietti'cl fn>ni the pnti^nt, will enahlp ibp ^indent rif aiiml diAeav 



364 



TUK m7MA9 fAR A5D IT6 DtSKASBS. 



i 



lo fi>rm a Inferably correct opinion i>f the macrtMcopic appemmi 
in tlw tympanum autl tdU*, and tn imikc u tru«! <iiiigiia<:<, Sioiih 
iiig tlie ^r tltmugli the catheter a tew time^ and tisin^tlieair 
bag awhile will briug curly injpn>vcTiM"iit, if tl»e mtrnliniws 'rf 
the Teiifstne of the IftbyriDtb are not afleelccL If no ioiiwivr^ 
ni6Dt follows, llicy am tliickcnal or itrt'^rreil over, and ainelion- 
lio» of the hearing: will be doubtful. 

When the mixo-pbiirynx mn \tc brwighl ion tolerably heaiiKt 
^tale, and iti^ exee^ve secretion reducet) nearly i*> tiw niirval 
unioutil; if rtrluxefl utkI [urcdr rnii^-k^ <:iLn lie nr^lonic) li>alair 
drgr^eof amivity, and net orgnoic olt^tnictioiisexiBt; infiammi- 
tioti of ilm £ii!4t;ichijn tul^c may be lci4«eneil or nmd^ and £i- 
inac in lie tym[Kinum greatly dimiaj-^he^i, and, in many ctmi 
])ermancntly arretted. 

The prcF^i(«i?i i^, however^ mueh ltiflu4'mx*d \*y l]\n ageoftbf 
patient and fyitkff^ of tlie disc^i^. Id childhood and yoatliT 'I*' 
|>ri^|»ni.Hsi\- miieh morefiivomhle thnii in the middle lad 1ll^ 
elininff |3erioJs of life. The trouble is, that patients delay api'l^" 
inp Tor Imilrncnt fur yiiii>. and ihen Jtiicli ftltA^mtiniii in iKat 
ami ftincrlmi h.-tve (>[!airrtil, llmt no |kOW<fr ^ort of DQincDloiff 
can iTT^torc them to ti^'fiil hairing. Prolonged trmlment in tav» 
where the membrane h not mnch iUstorteil, an<I llie Ru«ladiiAa 
tube ie |K^vioufs fr<*<in<nlly luicvinplbhcn wiwdcre; and lb* 
should encourage both patient and physiciati lo a faithfol ini of 
all the miTin^ which ihr <>arcful study <^ uural d«cttM hm >*- 
dor&ed of late yeiAT^ as ecientilic and rational. 

Griimtl TrrtUmmt of (Jm-^i'ik" Infinmwttum ef fA* 7W aaJ 
J^npanum. — It is hesl, by questionlug the patient cttteeofi^llyr| 
to get (W eonipb'fe u InAt^ry a.* i^tswiblc of heri<<li(nry ti-mUiu0, 
the previous and present condition of health, and tlie exisUnct 
of any di»lh<vM or dyvicTmnia. | 

Itecoi-d a succinct accoant of the onset ai»d progreeof ik* 
affection in the ear and iMWciato p(\rts, and tr>* to deCerniiH ^^^ 
<%u^ or eauaes of \L Get all the ftubjo^ive «ymptomi in |>ro)i4^H 
nfrler, prfXHx^lin^ from IIm' cjclprnal ear, tliroiigh the »ymt«iifini '' 
and tnbe, to [be |4i;trynx, tlirorit, and m>«e Thi^n ttknku a <mre-, 
fill eKaminatinn nf the fainetionfi nod pathi^logical enckditin 
whieh win iiidintti- the oiinr«A of tr^-atmtrnt to l»e pantauL 



lirPiANIlATION OP TUB TUIV AKD TTHFlNCtM. S6^ 



ho XitM t>nrkiivon« have of>i?n fiiil<*(l l» impitwe tW heHriiig li 
anml disease, Ix^^^iise the dinfCiic^^U has lacked prrcisioci, and 
^TALnrrlml :ini| [mtlilVnUivx' cui^j?i^ Imvo iM-i-ri tre^te^l jii^c alike. 

The general health of the patieat t;]]0tt1d tw mad^a^ iicarlr 
|H'rfot it» ]¥M*ilj)<r bv ^"an^rid rr^nlnti<»n of tie Unlily fuTwiifnia 
and the (lersonal and doDieatk' liy^ieni'i and hy uvoidmi<^r of 
ihoee tiling, iinjH, am) (;x[i<>!iun«, vhiHi ure ktiavfo 10 ag);mvale 
Ihc aural disonler. 

The inlkiit tinmi lirivt whalj*«ime r<>o<l at pnijier mterval!), 
frMjuent baths^ oomfonable clorhiii^, daily exiTCtte out of <UKir*^ 
Bufficiem r^ilaral^ep in a velUvenlilaled room, and a com]mra- 
tivt'ly limllhy occiipntion. Thr hiiir i^hoiild nn\*ly bo niM, aihI 
never in oold weather; water and tioaiifudd imiwt be kept ffom 
entvrin^ the txtcrnnl cuiml fUiring waj^hinp; a wet towel over 
tlie 6ngcr *'iU cleflu rh(* meatus sufficiently ; no («l,ton, w<»ot or 
othiT M|[if<tJAiMX' ]<liotil<l Ik' kept per«i-*lt'nlly m tht: ear tu protect 
from cold ; ear-1a]tri, mulller», eic, may be worn if neceasar}' ; oil, 
glj'oerine, hnulanuni, ear-tiroiM and oih^r domt-rilic renie<lieA fof 
itchitif^ and a^'hing ougiit to be 1abooc<1 ; the clorhinji- i^boiilil ho 
Ioo0e about ihi? nrxrk, and a Imid hf^id ki^pt (i>vi-ro<l frotn the cold. 

Kespiralion throagh the mouth; the use of tobacco, strong 
liqiion< and oon<)im<-ntT^; exposure (o wnlinmni!* loud noi^"^ atid 
explckhiou^, Ui dnifm, ts>U\ wind^, suddei) cbangPB of tcmperslure, 
and impure air should be avoided. 

Intense mental tkpplicatton eongeels the h«id and ag^v*at» 
aural <lis4-aK', and lon^-<HjTihniJM] cxercm* af Ihi* aitdil»ry i*o«*r 
briD|;^exhaUfi(ton to the tyropaniemtisicle^and ilie auditory nerve, 
and htnh ^hiud<) Ix* prtvent<yl. 

The causes of ilic morbid condition shonld be removed when 
poeeible; the txtenial may not bo dT7<{)Ovi.<Tabk or o[)^-nitive ; thu 
internal may \ie i^im|ily loc-al, in ihe nose, pharynx and ihroat ; or 
Cfmi^titiitional, consislin}^ of dintbotie oonditioni>, i:*mbraa>d in 
Btrama, rheuni&tiflm, gout, malarial poiKrning, and syphilis. 

A» oxtemal euu)M» vhouM Ikt n^tnoved when diw^ovcrabk-, so 
th^^ dvircrafiif^, U[>on whi^^h many cases of ebTonie inRammation 
of l)ie tympanum di']>end, oii^hl lo U< lalceii Into <x>n4id(^ratioii 
when one itreecribes for the aiiml disease. 
iVtry frc^ftk^ntly the »ymptoiiu of the 4%t and throat are m 



THK ntMAil lAB AND ITC PISIABBfl. 



few nnci iii]hi))H>rui)l, tlmt ilic pliyftitnnn wouM lie nt a ICttS vUi 
mefticine to give, did he Dot eousMer dtslurbauctB sik] iodkatioM 
in (111? general »>'!*u?in, 

A^n tlie auiul symptoois may be the only oiKtf that caun be 
|tenHnv<fl np<iii tlk* moist Attirt^liiiij; ^^xamitiaimt), biH <Hir knowl- 
edge of therapeiitJCB as applied to the ear is now GMKiderabtc, 
«nd i» Iwiug iiicresscd coniinuallv' by niiKribuiiom fnim iW- 
(wiplily educated spf-cialisls. so that only the igtinram ami laijr 
gro|iQ in liarkncw. Spcojal treatment MrilL be foiittd npoo ju^c 

-119 ^ AV/. 

TVcofm^f 4>/ f 'on/:/!, ai»d infliienEa, or epidemic f^tarrli, oo4 
ROW be cf>H»iikr«i. Wb<-n Uw imtifrnt i* w*eii eTirly, nrder a hoi 
foot4)atIi and frefjuent libations of hot lemonade, ooDtaiom^ or 
iiDt ft towpoooful or two of whiskey, ami iM>nfine bim to a «va 
n>r»ni if )Kf!wi1>]& The diet should l>e mild and noumbiiig, *«rlj 
ttrtoatiiK-al porridg4\ botkd rioi', milk U.vxf^t and jdly^ niUky berf- 

f^jn^jor may Im? given viTy wirly in Ibr niTwiioii, Imu gci>«- 
aJly thediRomie Ia fully under way before tbe (wtieat sppliee U 
treatment* 

Aconite i^ thi- n^riiHly fxir rxcff/rnce-, and tibtHlId Ire given ia 
water every half hoor or every haur, tmlil ameliomtioa Qoru^^ 
or tho dry irriubb' intmlicioiL of div muoiiua luembnitw, iIm 
Anee^ing and oppression of the head, the ehillinetfi and floflho oT 
heat or cM>ntiniiouff fevt-r \yags away, iih cx>p!i.>m ^^Ti-tK.tD 16 r«lal>- 
livhed. The g^if ient should ^mtW up or doiuhe the wi^ frequently 
with water heated to 100° F., and coDtAiiiing a tal>lt»«poonful if 
glya^riiK- uiul »ii i^-rn leuhpuonftii of salt lo tlie pint Ten 
dropi^ of C^mphoi tincture [Tr, Ctimphoi'a) to an oaDce of wtter 
»«,al»o, ail excellent Mimtilant for tbiH mndilion. 

If the phar>'nx is, alsu, alTecteJ^ gsirple the threat wilh the stk 
m>hit)on, holdiiij; llie hea^l bui^k h<rnicoiiiany ^t that tlie flimi wiB 
reach up liehind the palate. Borne pci^ns cuu garglv m «ell| 
(hut they mo cj<<f-t tW fltiid from the noae* 

When tlie l^u^laohiaii [ube g\yt» jfym\ilom$ of obAruftioo 
itivolvemctit, iotlatc gnitly witli the Atr-hai; oocc Of Iwirr daily. 
AticT the wm-mnouA diminiRhc^ (^mewbat, I ^op (he aalt aiIii* 
tioQ and spray the nu^ aurl phutynx witlt a teii^>ooiinii of Tj 



"1 

Id ' 



TABATMRNT OP COATIA. 



387 



tincture (TV. Pkin Hijuitltn) iii viw ur in-o ouiioen uf vrina naUr. 
Tbiv slimtilnlf^ lliv relaxed vcw^b, aiul Tsvois thi'ir rvturn to m 
nonua) (:ulit»r\-< 

In my rx|ic*rkm<r| Kilutions uf <^uintnc {(^linia Sufpfuui), ami 
Oiirl>ol!c aud (Achf. CurMirum) li^vc had llttli? beijt/iml iullu- 
emT? u|Mm iJii^ oiUrrljii} pnn.-i.'W in voryf.n or hay fi-vt-r. 

Children ftre ofteQ relwliioub to treatment wilh douche or 
iipniy^ but may Im; d.wx[.iI tiy bri^irlw wiciim fruiLi tmv uf ttii* 
above sohinooo, healed and expired in a portiiUly covemi bowL 
Smokent derive cumtVirt iVorti u^iiig cu1k'1> dguretlt^, but tol>fli(?oo 
ht Wo irrimting and dcbiliuiting, und should be forbiddai, 

liellijttoima may Iw reigiiirc-d t'jirly in !t<iuie fi'W cuAet<, aiid id a 
trmji^ient pha«- of corvzu or tiilliicDr^ ; o|x^t:ian}% if the phurynx 
and brofiL-hfat lutx^ are h)vi>lved in die di^eiise. ronge^tion lo 
HiL- h<^d and fRco, hot xnaii^t i<hin, t>on-, raw reeling in the notw 
and ihruai, and oppretiHion L>f the clieet, call for iu adniinUtra- 
tiim. 

Jnwn''-uT/t i?» a n^nie^ly ihat. MinH^sne.xl to Aconite id effldenoy. 
Tlie s>'f»|)toiii»» lack tlie fever of A<x>nite. There b frontal head- 
ache and fiilne^ of Llie froiitul ^nu»e>» ; n copious, wntcry, cxcd- 
naling seerelion frota the no»e and eyeei; hoarsene^ debility^ 
n|^d piiW, i^tle^K-^ii, nigJit exat^rbuttoDs, and relief from 
warmth. 

AVi/ncm artmmnfum ooven* vcr^- nuieh the «irnc grc^p of 
syiDptoms and hap a perfeeily reliable pathogenesis made by 
IWDvers ill Albtgheny C<iunty, I'li., wlie to 1l>i« day snflrr from 
their heroic Feir-auxifidng ellbrta to give a true pietare of drug- 
aotiou to Ihe profitwioEi. 

Atiittm eepa is a favorite reme*iy for acute calanh. The difr- 
tinctive symptontM dernanding it &n>: hmdaclie and ]>ain about 
the tcmpio* ; profuse iachrymation of a nen-irrilatlDg eharactef ; 
a liltJe etnarting of Ukj ejclHls; an aerid di«rhar|£e from liw* 
no«e. wilh violent ^neeiing : pain io the larynx ; hoarse, mugh 
eougli ; aggmvalion in rt warm room, ami umelioration iii tJic 
open air. 

I'Mjihrfntia In »iiitubk% when there is photophobia, presrtiire and 
liuniing in the eye% red, swollen eyelidA, Molding lachrymation, 
a co)>iou3 Bow of bland ^crum fr^m the notfc, frequent sneezing 



368 



TBB HCHAK BAR A7CD ITS Dl9IA?B$. 



and (on^hin^, hoarH:n«?w and profufw cx|K>ctorB(»>o, f^^gnvitka 

E*ip<dijr'mm \A uu uKI ii^liubli; domci^tiV reincdy, mncli nsol in 
<(cinxtion uT ihc herb far miurrh", nvhing civcr tl>e wlwie Wv, 
aiul cli« g^iKTvl ajmptoDis of a cx»UL In liiKdifo, U ucl^ fiorW 
iti niilO c-tuHV, nuJ i^iouUI uot U? lu^glcvUt]. TW L-JitinirterpCic 
»)-ui|}(oiD0 are: aorcDev of Ui« eyebalb, hcw]acl»o^ vreifsbt in tlw 

fever. 

Tfumfj; ifl bij;bl5 rcromnHMiclf<l in biiiciiichOp <lul1 aHiing uf ibt 
eyeball^ fluent ooxyz^j ^eeztnjf, raw fttelfng in ihe iwec ui<l 
iJinwit, J^yll^!1^o^tht'omHl-Jlha^'nx^muc<rt^Hexperto^ltwn,l«■^J>p- 
n(«f^, nwncfia and |>Jiin in llie larynx, tickling fatiguing ood|£|i. 
«cnfiitivi-nf«» in ilio r>jK-n uir, agj;nivation ut ntglit, on lying dowB, 
and in raw uoltl wejiltipr, 

Ac/t A^'^rt'3</. ijhckuM he irit^tf when there ii* liHuliK'he, fubtes 
at the rootof tlie a<Hit>,c(mjun<riivitiA,a6teftdyflovr of acrid Bcttr* 
tion from the noflc, frequtnt ami violent sucTKing. p*in'ml Hnlii- 
nciw, ^orenc^ of the noAf-^ n ]ni^n<<jii liCopiKiJ feehn^z of \he t^ost^ ^ 
roughness of the throat and larj^nx with dry cough, Tattling il 
the EiL>4tj»chian tub^, ft]gitiv4.>])ftinif in the joint's iiiid ^ »truR>oLu^| 
rbeumatio or go4i1y terdenoy. , I lia^'e found Kali btdirt>micuB 
more t;uitahle for the ndvanced stago of this dtM-afte* 

Mfrmrim '\ft one of tlio nuv^l uM-inl nit^icines for tJje later^ 
atagosorthe Bflbction. It should be ^cleekiJ for fronlal head* 
ache, ftorenesaof the caHal bone^, ooiijunclivitiA wiih oxooriatiDi^ 
lachrynmtion nnd phoU^phobiu ; n iiindemtconmN<ive i«ro-miionQ« 
difloharge from the nose, much sneezing, qiistasisat night, reUxa- 
tion nml tpon^;inw*H uf th;* S*hnei<lermn miicoufl nn»nibmtK'; dn 
iftore throat ivtih sticking pitind,tinD]tud, rdles in the Eti^tachioi 
tubee, and deufmvKja xlimy tongue and mouth, i;-:nenil wmknee, 
and profuse acur sweat at night. In both stnimous »nd syphJlitiOj 
CUGSr it iiotDftimcM improvi^ the coiiditinrt of ll>e |)atifiiit in 
abort time, 

Ilrptirj MeKtreum, Kilric aetd^SanginniLriii, mid a few ocbcr 
remedies are occaHtonally useful in the disease under coasiden- 
tion. 

Epidemic influenza requires no diflrrent tfcatmcnt In tliv* 



TREATHKVT OP ACUTB ?» AATKOITia. 



369 



stigw. Its priTifi|>nl fiymptonis corrr»|K>n(t with thmta ofrmya. 
The imlierii alioiilO Jiave n-M fmrn jiU huf^iu*^ vare, a iiii]<) «aellv 
tligmlol (livl, unil lJjc in«dk*itio intti^^lixl by tin? iinpurlant fi/m[^ 
tofna. 

The QiftlKincs tbnt linve htid a giiliitary effect upon the morbid 
proecaaftre, Aooniie, Arf^iiirimj iilbiim, Bryonia, Natrum srsen- 
ioDsuDi, Kali byt)no<I., Mn^nc^ia eiilphftte, Nux vi>roirb, PJio^ 
pboniS Kliiis, and Vexairuin. Some medlolnca that are butitfiriul 
onCBCvon arc of no iiw thy next 

DrttUmmt of AeuU Pharpt^itk^ or oomnicn sare throat, vario- 
with the Y\ix\^ iiRl-dcd. In the licginnin};^ a hot fiKK-lwth^ lem- 








l*iutPCMS Atoxjkui. 



Tip, etc.. shoiiitl boorJ^rmd ; llicmcch i»ijrrDiirMl<Nlvrilh flannel; 
the throat garglcvl or Bpraycd every hour ni* iwo wUli si wiirni 
a^tieoufi wiution of Knii mor, {FoUmi't chhrm grft, xvt, Jgrtwc 
fSj\ iiml AconiU! or BellaJonna adininifitered itiUTnally. 




Of all topical remedi€*4, a warm wlulion of cJjIorate of potafifiium 
K th^ Wt, ltilimim»;iu« the t^origcetton and licfll^ nioJsteiw tiii* 
{lart^, (ltnbolvo-'« thickeii4K] mumi.^ ami acIm hi mi nnli-'^ptic. It 
will greally iliniiniiih the danger in Jipluheria, umj if uAttJ early 
«Doti^h will generally abort the dif^ea^e. The solution *yin bt' 
pplicd to the parts vt;ry cGcctuallj by an utomicer. 



370 



THE nrUAK BJIV AND ITS DIBSASBS. 



11k VvrfixuK XumutKr in a dicup ioslriiment with melsl tubes 
!4uilat>ltt lo |iut in (In; lmii(].-4 of tU<* [mltf*nt or ntir««, Rnif^hrA ^m 
AtomiKiT U & very useful ofllce instnuxeiit, hnving mrtal IhIm» ^M 
ffir »pniyin;7 (bi? bu(.y»l phriryiix and oiiee. Newmao'e Atomtvr 



Fi«v.0A. 



FW.07, 







RKTnSBLB ATOVltEB. 



19 a very good one TJie Ittvcwilile Atoruiicr w firmly conoeriof \ 
in nil iu pui'bs, wlik-li at^ mnilc of metal, arxl ctirreoii can k 
aciit upvuH» dowuwani, ami laterally, wiUioiil rcaioving tke tnbt 
fnjio the thri>at Ricbai-tleon^s rcvcTwblc jrt ap|«ratua, wilb 




N'ka'mak'a Atouikei. 

hftnl rubier tri^KH, luui rcvcmUife cunvnta, and ta ufii injured 
nitHlimvxl ^Iiitiun?. Tt is ihv most generally uttTuI oi' any I 
urcd and U not very i<xpeiiHivi^ 



TRKATMBKT OP AOUTI PH ARTrtOlTia. 



371 



^Tbe hami aturutten^ hnvc one or two mbUT Utlb^^ cotini^dttl 
rubber tubing wiiblhe buiu? of arulieivliioh bdp formtbealo- 
niizing np^KimiK ^Vbc-n i-ilh^r rubber bulb 10 1'OfnptfatiK'd, air in 
fyrcvi along theiub^ acroM tbccapilUrv point of another tube, pro- 
during a |Mirlbl vii(?uum llurein, TIh: lluiii tiAvinj; liei-n intro- 
duuxi into the bottle, m^befi up and along thia aeconcl Eab«, ea- 
«pe» at the |ioint, ih broken bun u fuw »|>ny, aiiJ driven ofivroid 
by the current of air. When the bulb near the b":ittle is 00m- 
prcfHod, an intemiptislf wbtii the furcbcr i^xw^ it <*ontinijoiJ3« fii>niy 
is produced. 




Iit9 combined tongue de|>rcftu>r and Atomintr, lately invental 
by u diKtin^^ui^K'd naval mirf;con. is admirably adapted I0 kc«|i 
the mouth open, ti\& tontine down, and the ^pruy in the pmper 
diirriioii. The ixrveraible atontizrr oio I* fixel in the botllv, 
and then the Hpray can be used more eifeetiially- The fiteam 
atoinirer biL^ £;la^ alomi/ing tubc^, imd the fi^m fmin ii» boiW 
takes tJie place of the air currenL It is l>etter to ctie ibis in the 




372 



tHi 



Dl8RAeS0- 



carlUr eUgc^ of acute diH^iM^ luxl -whvn fabe mrmbiftooi wot im* 
be dctar}i<HL 

Mcdi<iiH« m wlutioii Are intrtxlutcd i»to the bottle of At 
han^l Atoniixrr, and into a cup upon the »Uh of th<; ^tcato opfw- 
nUus. Tliose cootaiuin^ gunid tuid reBine aoon clog tlic fine diIk*. 

Fio. 90. 




Th(» fluiil »ljoulfl J»p filwvo the lon^r «xl ijf llio talM* wiiJiin tn 
botlli^ or uup. TIk* oii|jil]iirv points ahotilJ bo iltrei-^te*! tuwtnJ^ 
tbo Mirfa<H?t« he iiKMliciitifl, nml flit* pfi^A'rml linlb coraprcnaftd 
Arml;r« The applioili^n niuet be iiiterniptixt frM|ueiitlv, til| 
npmvinj^ ihi* mtfitiAtnl ihrunf , in ortfur to gtv« tho pAlwtit n chuncv ' 
U> brvallic. 

Ph^ lhi> ntomiK^r tul>c finit into one ncfitnl, and th(^n t1>o otKur, 
and spray tbo nn»o-pharynx ; tlion hav<^ the moiilh wel) o|>0Brd. 
hold tlio t>>ngiiu <]rjwn with » tougitc? dfrprcwnr, nncl 'pni}^ 1^"* 
bu(H<al [ilinryiiic imd tbront abovo And below. Quite youi>|F Ml* 
dreti, hnndlM ^trnllv, will <-ndtitv tliis mctluHl, wht*n llwy orVi 
imtipiihlo of gm^ltTi^, und will not Btibnnt to th<f Htmni aiomittr. I 

The dlcani atamizt^r may icnmctlmcs tic craptoyrd, Itut il» oniftl * 
tube miiAt lie cbmigiHl for larger ouea, lu ordei-to ^pny the mw*- 
pharyna;* 

In mild cftscft, a elation of Borax {Sodii bU/ontJi gr. v, Afit^^ 
f.^) in a Mxnhin^ aiid crTiitcut spray or gurgle. Powdcn of llii* 
fin^t dcvimid tritiLmtiim of Knli mnnKfl are u goo<) local rvmrdv', 
and inuy be given w»t1t directions (o let cadi powder diM^Jw 
upoo the tongue, tind then i»wnllaw niovrly. 



TRRATMBKT 07 AOtTB PH ARY NOITTB. 



373 



Chlumte of ixitttili lon^iij^ may l>e ufwd iii tlie mme iniy, and 
&n infaut m\\ tnk^ a quarter or Imlf of one-, now and thetif wilb 
tnut-*h hf'nefti to the tliroat* roUuih MittR ure antiiilii^tic ; wIkii 
abwrlxd into the b]ix>d,tbevcli[ninishfibrino^enoutiolementA,iavor 
rrecexuftntion iu ninor>it.< tnmilinim*!% auti f]iniiiil<li (liv tciuk-ncy 
to pWlic cleiMwilfl. 

Taiinir n<Tui i* fmiiuMilly u«il in *pray, and as a ^irgle. A 
dmehm of the powder, diasDlv^ in an ounce of jclycerine ard 
titrvi: ounctT^ of wakr, miil;i^?< a uipiail ajipluntion of vtilue in 
Muxch) tnii<!i>ti?i memlkranc^i and oxiema of llic uvtda, ^tU-r llie 
acute iiillamniatioii hw rsi>mcwliat F-LibAitlod. luetic acid in auIu- 
tioti[^l/.^V/, Jjtu'tif'um ^T. xXf y1'/ufif$])Hanexi^lIont]o(-alapp|]ca< 
t!on in diplithcria, and diluted Chlorine wotLT [Afftta i^hn7*t 
f^j,A<inftf^})hstei{t^ii intirh liuiJ<x) in iho^fflmedim'iL^. Vii]>or 
of liiiM^-tralvr, inhnlcHl from a V€flflel a^ lime is sWkinif, often 
fintvt^ I'fTiH-ltml in 6>xpelling ful^c meml>nni«, 

Waior conlaining Alcohol, CajKimini* Carbolic aoid, AUinip 
^nlphiUe of Ktn(% Stilphain of ix)i>|>er, ett:., are reconimGiiiled by 
author^ but arc )c^ c^cncious than thivw romcdiee mention«] 
above, anil »i>mc nf them an^ Jmilivll} object iona bio on account 
of tlieir efft-ctd !ipoo the tectli and the funeral ayHteni. 

I u>ar ihf TtpnvyH quite warm, and ordi^r fbcgjirgbw to hp tiken 
ill tlieaame way, wlien pft^sihle. CM aolutionSf howover,do very 
wellf and are nfton prcftrnii \>y |)uiii*iiU. 

It will frequently he nc>»«Hary to combine the looal treafment 
for Pory/T<, Vp'ith tbat of nratc plaryngil.is, r*popiaily, iht> iiw i>f 
a warm m^bmted F^olution by tiinilfin;^, or by the na.Hnl dom<lie. 
A vligkt fidiH^u in ilw rmri4, an uutUEial rA(nn;mr<* of Nonml wb«n 
iijMailcing, and ratftin^of ntu('ii>i in th^ Eustachian tiiljc^ urhen 
blowii^g tbn niva*^ inrllfnlt^ the iiiH-itiwity of gi*nllr inFlalinn. This 
ttlioald bo done as often aa the wmptoms reonr, bnt probably oiico 
OP twi<'p a dur will pmvp laiiilioi^nt, 

Ae^niU i^ o4i>ful M tbo oiMCt of the dii^ease lo reduce the gea- 
cral f<»vi>r, ami (iimintxb thi; ROiigration of ihc throat. ChilHncfvt, 
fullowtd by d^-idod fi^i'tir, reAtlcf^noft^ and anxiety; |)aiatVi] di^* 
glutilion ; burnings, idinging jiain in tho throat, UM^It and i^r; 
mindOtt rolor of lUc fau«v^ aud plxarynsc; bwoIIou tufiBJlH, and 
full reeling in tho dirnatf oall for ilfl ti^e. 



874 



TiB ]ll'MA» RAR AVD 1T§ DI8KASKS. 



Api$ b gtvtm for ilrvntt^, buramg ami fiUf^ing in tli<^ thnnt, 
ma»t! of constriction, iliHioiilt ^wnl lowing, sn^llvfi ur uluented 
ton^lii, (wlemalons ewolling of the throat and neckr and enjjorp^-j 
meot of the submnxillnrv j^laiiO^. 

Acid. Xitrieum is a most excellent remedy in diphtliem of Ui| 
lbrori(, witli luwmwt of fhc nose, Hvid «wcllin^ of the throaty' 
great tumefaction of the tousiU am) submaxillary glanrb, larp; ffv- 
mation of fft W inembrane* nii<l afotiJjf;niy,HUmydUcliftr|^froiB 
the throat and now, 

PtiUufUiit f(itil» iitihi c-a:^«» of 0ore throit, vith implicatioa of , 
the EnMacluan tube^andcai^, iii<*hildrenand penton-iofcttmnioiial 
an<1 )y[i)]>h:itic oi'rEi^litutiontc. 

The iniUmniatioLi of the mucous membroiie in such (KilM-nt*, 
ri'fult^ in iin lurly and uopioit* fluw of »i<rx^muciis, and reH>hiuon 
follows soon, or a dironic disirder of a mili chuRurCirr rcftitiiK 

lifilnilotmti h ft Hjiecifie for many cum* of sore tbroal, and 
benefit is derived from its Ufe in the eftrly atagos of the "Up 
Afler forty-eij^ht hour>, another remedy will gfuemliy he foaod 
to iiuti the oiEe belter. Tt relieves the |nin aixl swelling fd 
(iharrn^fitis and tonsillitis sometimes in a surprLiing maniMr, A^ 
lady hud quinsy, tJie ihrnaC wji» iHr^irly do^^ botli toasik in- 
tnensely swollen, only a few dro^M of water eiMilii Ik? mvallov 
at a time, eon4tit»EijiiLaI dinturbuneo was great, and the patieel^ 
mnidi ularmeil. Bidlsidonn^ intenuilly fi^r twimty-fonr hoaf« 
hiui not relievcth I amtiiiuiHl l)i« mediei&c, but supjilemt-nln! 
it by a two-ineli wide belladonna planter, 4*Ktejiding ovt*r lh» 
lonAJlH friim eiir to esir. ItctlW without HUppimttion i<ninc- in 
twelve hours and restoration to health M>on follouri-d wftliont 
any nther medi(*ine. 

The Hympt<inifi demanding; this miMtiriiw are; lu'tlve cong«^ , 
tion of the hr*ad ; Iiol, numt Ma ; ittkn^iiciw^ fiilnew and <wn9tricw| 
tion m the Thmut; painfnl Aivallowlng with frer|iu>nt inelinntioa; 
throat dry, rnit)^hf bitrniiigf bright n-tl, hwoIIho and p&iDUit: 
tonsils and ^rtbmaxiltary glnndn offten swollen; vbnrp }tata« 
through the throat uiid KuHrnrhiuTi uiU\ n^\M^in\]y when A^k«<J 
ing; thf nry.k •u^nsltivci ra toiioh. and the eara iVo<|ucnlly af!<rtc«M 
by AilncaA, tinnit(i<i, deafm^xH and puin. 

iffrr-uritut vtnndn noxt in efftcieney^ if it do« not a)phal>eti<«lly, 
pAHjcularTy, if iht |ntiait hnji ttvphiliji. It ti indi<?a1ed wbon tbor* 



TRIATMRST OF ACDTI PH AR YKOITIS. 



S75 



breailns ftrtlil and olfcn^jve; the tongue m pallu! and swollen; 
Uii'n: JHU filling ^<x-r(aioi) in the mouth und Tuikt^; the miio(>ii» 
roembrone of llie faiieer* and pharynx is deep red, sore, swollen 
ami iiU«nitcd ; faUc niti'inhRino^ ^nmctiaio^ Ujipmr; ihv uvula t« 
elona;ated and trdematouA; the tonRiln are hlnUh or cbrk i«d, 
tiiii»tit.tl,uicvr!itFdf atu] UictH^ut oftlirobbiiLjr, fifin^ing jKiint) ; tW 
f4[ihfnAxillary gUmls are en}E;org«c) ; the Ku^lmrhi^in tubcA are 
obfttmctcd; jiaio!) Hhoot throii;;h tlte throat nnd neck; (he larynx 
U inflamed ranging hoarseness, and l!ie na-k i^ jiainfully M^ittttivi^ 
to tmiofi iiod motigD, 

The^ ivroptftms threaten Bnppnration of the tonsilti or sub- 
maxillBry j^l&nd^y uml tlii?t may be otu^nnrrotcdhy steady admm- 
ifltratton of the loedioine tor some <]avsp The tJmc Tor the ad- 
mi nL-«t ration of Mer<ruriu'* is Intvr tluin that for Bclladomw, ptv- 
eibly after this has failed ; and ih<^ jtain i» not so severe as when 
Belladonna ti* suitable. Tli<- sthr^no i<Ut^' of Iti>lbdi»ana tuv^ 
pamed, and asthenia bqnins to appear in llie marked alteration of 
the SLNTt'tioiw nnd Uio failnreof Ktivngth, »*> conmiojily ^a-ii in 
proving of Slipreurv- JbrrtMirius wirmwL and Mprctirias golubitii; 
are good prr-|Htmtiona4 to nee, but many pnLotitionerB prefer Merr^ 
iw). rub., MiTi". oKid. ruK, and Mure. eyuiti<h fur throat afftt*- 
lioQfi, 

Lycopctliutn i* n>it'ftil only in a limited numbt^ of cnwM. Il 
i*i given vet^' often^ however, for Hor*' ibroat n(*iiti the right side. 
yr\wn t)ie tiJtality of styiupComs, and, even, the load oned posi- 
tively contmimlicate it. Among reliable indications for its ad- 
01 inij<t ration arc: confiiMon of mind, meluneholia, vertij?*^ hend- 
aehe, ]iat|ntA£ion of iJie heart, attacks of dyspniea, excessive flatu- 
lence, irritation of the mucutr?* niernbraiies ev<.Tywhere, c^nryxa 
wilb acrid diflcharf^ h\-lker9estha^ia and noisfe in the ear; super- 
fieifil infl^Lmmation of tlk* pharynx and fauL-cs, imlicnf^l by burn- 
inf:, rawni?H.s [laiii on ^tvallowing, and tnwny rtvliK^s; moderate 
Mwcllin^ of ibe toi^ila, and some sorem»s to tin- touch below the 
anid;le of ihejaiv. 

LatAcais bas a preeiouH liift of eyn^ptoms, and is lbou{j;ht to 
have an affinity for the leH «ide of tlie Ixxly, and thus i;* a boH 
<>f antithesis of Lycopodium. 



70 



TBI BCMAN BAR A^TD 178 PtSSASBH, 



f 



1 n'it» in^tinp, in 1 &7S, n severe ca»c ordipIiU^eria, irilli Ni: 
ancl> The in^c had impmvcd niueh, tti« thront, tliangh bdtiff 
dian at first, had h^u at a stamUtil) for seveml dnv^, !?trp^h 
wiu4 fniliii|^ fuM. [ i.-iiLn|irir(v) ?i;ym}>tom:» 3>^Dr ^^*' i^uW upoa 
the acid, which was noniiniicd. The next diiv the nKmhnnc. 
ii|u>ii i\w M\ r'Ulv lm\ dimirii.^hed, and a fmt:;h hfid ]ip]>cand upoo 
the hitherto cleao right side, I said to ovself, '* that'-i u I^<n» 
inriiiptoin." I ciincUiiled to wiiit utnoth^ day at« Ihe Lor m*md 
M little belter, and the other fympiftm^ were not very charnctenelir 
Ijctwwjfj thu iwn iiJoilicintw, The intact day the incmhnDevi* 
gone Trom the right side, tlie Iray was bctler, Uie Nitric acid w 
<*oiifiniioil, iin<l ill a ^hort time my ptUical wb* wulh 

li' I had Hiaaged to I^che^i^ at the linie I saw its |>efiditf 
ftyiTi|)lom, the boy might Iiav^ dit*J, or th^r souke vlruf bnv'en- 
reived upckeerved credit. 

SymploniH which flhould vM ntleDtion tn [^lu^hi^d nre: gresL 
dq>r««6bn of viiul pow^r, gray sickly pallor of the face, ixi«Md 
«>xhaii8tioii. pnc<iirdial difttpesjt, iialpjtntion of the heart, oppw- 
sioD of thochwf, ewellioj: of the sulimaxiilary kI^^<1^ wcltJiDJ 
throat- Thi' IoumI^ aro livid red, thrcateninj; j^nj^rvfie; aooe- 
tini<s ulceration i^ already |iroBCiit; theT*> arr chokirg scmutioitf; 
»hootiii(; puiii» in tht'tfirrtHt^extendinc: along the Eustachian tcW^ 
Uniiitu^and pciiiiin the^^ir; roiighmw^anilioniitimorihclno'ni 
hoareenesfi, spai^m^ of the iclottts, hacbint; cough, and ^freat frn-] 
mlivencvtf in tlio hitU iind larynx to outride |>RS»ur\\ The pii 
ture is oncof adynamia, and is »een in exaDtfaeauloiu fevers 
frequently, 

l^h^dixtra ha^ proved of ooneiiderahle \*alue in acute phaiyn- 
gitis CT^pcrially, in the curly ^tagcif, and whcrr tlte attack is fn i 
rhi-Liiiiutlc »r ^phililimiilijet^t. Thi'^^yznptoroa that call for iti 
it<hniuUr ration arc: general debility, nau^^a, and ^vere hrod- 
acbe; Atlffnes^ and ^in-iKsn of tht^ mrist^h^; rhcumalie and iic-ti- 
mlgic poinrt in viiri^»iJi« jwirl* of the l.-ody : swelling of ibe lyni-^ji 
l>hntic and other ^]and», and irritalion of the eyeft and ncwc. Tb^^f 
longiio w mngh and snpe on the 04i|^^ verj- rnd at ih^ tip, with "' 
Mvere pain ai the root ; thf^ ihrctat ffndH full, Ar\% ro«i);h am 
snianing; the mII jialate and ton^iU are swollen; the mu 



TRBJITHBVT 0? ACCTR Pn AILT Ve!Tlff. 



rocmbraiK' of the throat h dark red, sometime ulcerated, or there 
isi a Hurk f^-iiOo-oK^mbnim* Mjmn it.; n thick ti.*ii«Hoii« jfativa 
fills the r^iLicc^, t^iuini; hawking and cough ; fvfallowing hringn a 
t'cclini; of K limtp m tbc tlinmt, ami severe puifi thai jdioolH aIo^i^ 
Ihe Kiu-tachian tubes tlirough the earfl. 

Ff^k^-ruot u« has u guod rL-pitiitiOTi, vrhvrv the plunt iti iiidi]!^- 
nous, OjT the cure cf rheiimatifim, and the refined medicine prc- 
|iared for u.^ \im a snrt of ^[Kvlfii* innncncM^ tijxin very )>iLiiiftil 
allacksf which are mmetimeH called rheumatic, i<ojnetimcfi erysipel- 
atous tv»r^ thniat. 

lihuM ((ucicTMifndron corrcs]>ondf) witli Phytolacca in many ol" 
ila J4ytn|>l*nn?i, ami tn it prxfioin nK'di<^iTi(*, r(?*i*u*-d frifm the ob*cii- 
rtty into uhich it hail been cast by materia meilica autliora, One 
ftbould re^>rt to iT, when there Li great |»ro»itnilir)ii, chillinr^ and 
fever; gmit n>lff«!nc«s and inRa^incz^^ ; anxiety^ vcrtij^o, and 
roental disturbance; paJpitatlon of the heart, opprcflsion and sore- 
ncm of tlie chest, »or?n^ uf the J&ryr»x, with hoancnt^ and 
cough ; paralytic H^eaknc^ and aching of the limbic; numbness, 
pricking; and lren)T>linj;?wnNittons; Mitclnu^ pim and cnjinp jti 
difierent |iart8 <rf the body; Htifrnet^, E^>ren»<s, and tetmion of 
rnusc1<»aiid jointly; eczcmutcHM and eryi^ipclutotis eru[)tion»f cfl- 
ptcially, upoa tlie face; AwelUng ^nd ^iippumtion of f^IjuicU. 

The fyCM and now* arc variously afTwlcd ; ihc tongue is sore, 
fvd, and somerimcA crj<!ked; ther^ i^ tliint, bud taste, and foul 
brcnch ; the mouth and tliriHit nrr di^' : ihc mttcoit* membrane if 
dark rc<l or bbii-nli pnrple, turgid \iitli vcnrnm Idood, and may 
%hoyr ulecnition or f:il?w menilirDiH*; there is swelling of the 
thmat, (otL^iU, submaxillary ^damls, and cellular tissue of the 
mvk; the j>arl)4 are eorc rtnil r^uff; «)iur|> |>Etitis dart through the 
ihroAt and neck, and ftwatlowiiif^ Ia iltflieidt and very {laiafuL 
The mixlicinc f>^v:ms more Muitabic fur diffused sort iliroat than 
tonsillitis, and for that ])articiilar kind, tJial orxur« in plelLoric 
(Nrnutis of inlemgicrutc liabitSt widi a rheumatic, gouty or ayphi- 
liticdiathe^iU. 

Kaii iticfiromi^tui actfl powerfully upon the ihugoik mcinbran^, 
and 18 a<lapteil to IfOth aouti:- and chronit^ pharynj^ti^. It \h tndi- 
C9(c<l by prostnition ; nchiDg in the bones ; fu^^tivc p^iiH ; pale 
face; ditwrder of the stomach and iatefrtinos; oppr^^ion of the 

'2^ 



S78 



THB UOUi!l BAR A5D ITS IlfS8A9ll9. 



chesl; hooraeneffi and cough; conjUDCtival inflammnlttiD; coryn 
tvr chroDic nju«uL oitarrli ; i\-(1 rotiL^tir*, ooatal wbiti&h-ydlow ai 
Uie base; clr^nea^ of the mouth ; ihick, lough, vi8ckl, iitrjap 
tniK>iK8 in th€ iiom>, throat niic] ^iirvnx ; ftiliio^ burning oimI nv- 
iKflB of the tliroat, eictending dowD the asanphagtin ; AorenoAavl 
shooting i^inK thnmgli the tomih, thrml and car; the aiucow 
membrsDC U red and tumid, or vehovriOi-nKl, relaxecl and tikof< 
at^; the tonsriiU tro u1ci>ntt<Tc[ in i<potM, or red, EuniciMi ami 
threatening tsuppimtiou; ulcers when visihlo sluiw ati (imTiM 
yellowish liu*.' and rwi bonkrn*; one i« Mtnick hv the appantni 
took of vital reactioD against the niorbid 4s>i>ditL<in. 

8(tn^iinarut may Iw of lx>nefit. tlmugh its f^yniptoms pemii^- 
iflg to Uie ihmat are not vt-ry rlMrnrterutk. Hi.^<hirhe, vcrli^ 
tionitnfi, pain in the throat and ear?; drr, mw throat; fobv 
and choking »ci»nlion whilr }<wulh>tviiitr; inthimniurMiitnml ulor- 
atioo of tbc mucoos membrane, with pearly diphthcrilic exixU- 
tions; dry oougli and dyMpnv«; rhilluifw nnd fi-v^r, ami lurpiil 
lunguoT and w<*aknew, nn? rcgnrdcd Jt^ diaracteristic f^mptofu 
for tlie enkployment of tlii^ ntcilicine. 

Ilrpar f^vlpli, cah. w of Hxwndary value in the early stages fl' 
pharyn);iti« to sornr* of the mfHli<-inc« alrmly nienii<»M>], batn 
generally required when FfupptJration ihreatciH. It should ht 
I'ODMdt^ri'tl, wlh-n llirri; U li^t^Autiv, fiiintin*; H|n<IU, great fast 
tivciKqw in the o|>en air, chilly (rengalione and Hit^heB of Imt fol 
lowed by 4*aAyHweiLting,Mitrliing pains over the tHxIy, ^vrelliDg 
tbi- glandrf, vLTligo, and liea(hi(bo. The eyiv may W irnlatfd 
(H>re; the nose affected by t^tarrh, and tlie larynx, trachea and 
brouehi inflamed, i«u»dng dy!4pna% ho«nwne9i!<, and harsh coi^. 
The throat ha^i a dry, M;ra[ivd, sore feeling; the muooini laeoh 
bmne is rtxj und granular or ulcemted; sharp paina shoi4 
through the throat and neok, and exti-ml along the KuMactiun 
tube to the tar : tbej^ubmajcilUrr gluudv are turnetiiti, and the ton* 
mh swollen. The whole tonnil or the part over the atiAraas furni 
a pyramidal or raunded prominenee, projtTting into the faii< 
but sometimes tbc suvclling w very irre^lar, and tbe aUcen 
of iijght bi'hiri<i it. 

It 16 desirable toaliorta suppuration, or, if this cnnnfit bedocie, 
to haMen tJje proeettc T'he fL>rmer work ah l» bft«l ucconjplidicil 



'i 



irrt i I 



TRBATVRffT OP CffBOXIC KAS4L CATARRR. 



379 



06 oftbe above remedies; Ibe lalter bv the adrnjobtratMiii 
^Kepntr winch h:L4 a ^|>e<'i6o inf1i>cn«« upoD the fnrmatUm ol' 






/ociWaa. — When the ton.-iil i:^ enormously svrolleii, Iheswalloir-^ 

t^ vm' difficult or impoMible, And «iifTlK«tivc Kpc1lg fnx|iicnt, 

lie Hnm\ mt^il in be iodsed in several plaM><), »o tbiLt it mtty 

hIpuH'nrly; bat the abmeM elioulil t>e opened bjr preference in 

all eaitcA^ when jKeniblc wilhmit too much ritilc. 

A long-haodled bistoury. Imving ihe b\tu\e woimd by tape m> 
that only half an iwli of the |>innt i?* urioiAvreii. tn «ifi: ami ^^fli- 
oieot for ^cariflf^tion. Heat the pntienl wilh the h^nd against a 
i*np|»ftrf ; illnmimito ihetbroitt bydircol orrpflort^I light ; dvpiXTt* 
the tongue, mid pnl a cork iK'tweou ihe leelh ii> hold ihe jau'R 
A|wrt irii>e«ciNiry ; paw cbv knife dirM-ny bni?kwnrd», with th« 
mtting edge directed ini^arrf;* upon ibe atfectod side; piinh tiio 
|KHn1 intn the liimnr in»fidt' thr pnlato-ghj^iUH mi^clc, prufcniWy 
into the inner hair of the swelling, and cut towards ibe middle 
jut* of the Uidy. 

Make Iia'o or three incisions a tittle distance apart, or push the 
knife into an abirreas ; (hen ii^ive the ))atienc warm water as a 
^rgle, and let him lioM hii^ bmd forward, «o the blixitl **r pint 
may run out anteriorly. The onlydantrer is of wonndin^ th** 
tid artrry, w hi^h omir*f>* up^nrxtn jn"t a( tho Uttc of tht' ti>ri- 
8welling sometimes dbpbces the ve*»el and renders itft exact 
"rtlatioo tj> the tonsil doiiUfiilf hut, if the nbovG dircdiona ore 
^^;filow«d, no diHoster need L>e apprehended. 

^B Trwfma\t of Ckroni*^ Xtijutf Ottan'h.—T]i\ii< !« one of the mo^ 

^^ulinaie disease the physician is called upon t<> trcnt. In many 

^^B«* of aonil diMtiw.% the S<'bni'wlerion murous mcmbniTit- nui^l l>e 

brought tft a bealihier stale, or the car trouble cannot be removed. 

The frt^qiicnt pnrtinl n^ well h> total interruptii.-n to rc^plmtion 

y^rungh ibe noM^, and the almost consfani irritation maiutained 

^fti the noitO'phflryii'c by tbc morbid di>«rha^^^ prevent tlift nornml 

ar^tion of tl>e Rutiiaehian tubes ja neratintr the tym|ianiinv aad 

support tlic diitaiM)<l condition of lh<' tuUil and tyfn|mnic mucoiu 

membra lie. 

Proper Irwitmcnt of the mwe nn*i phnrynx will do more t;condt 
neglect of th<^«, and th« m<»t thorough measiir«* direNed to 



kn 

ma, 

^^uncti' 



Tm eCHAff BAB AffD TT9 DtSRASBS. 



the ear. Th« patient inuM ohAerv-e all tlie hygienic mrasum, 
vhich IcDgobwrk'ntronunil cxprrk'tKH- Juivcfth<>wii tft tw :«Hiaib1e, 
acieittifici aod cy>[tflunv& <o tJie beat health c<f man. Evcr^tliiiii; 
calcukted to oMm* rrcqt>L*ri irritation in the no^l miioouA mem* 
brane ought Eu !>? uvoided ; rlnrrefun*, vrorking ilaily in u duMf 
atsKQphefe, itLJiij; nnlftrrh ^iiutl-snttd i^inoklngciihehflaDd lokiaoco 
should he Ihrbiddcn. In ihe early RiagPt '^ K'^^^ ^^1 ^'i brdoof 
hy prevent rrif; <-ri]i!t(, iind ircifLtin^ thoM ihut ooTur gt-mly hut pe^ 
ftiHteotly. After the iDU(.v>us memt>niiic haM btvocne thick^uH, 
a1ro|)hkHl^ and nli^mled in |>luiy^, 1 think oohLn tn the head ajv 
not frequent, exposure being more likely to cauec inftainniilMMof 
th<< hiryux nml hntm-hi, I iiin only ^iximiijI for thif^ by fiupf«3^ 
in^, tlial the nmHMd slate of theSohneiderian mcnibninc-n.<f)det*ti 
inrujmbli* of tliotfc profu^i- «cri>*mucou« fluxes to whi<fli it b aoaab- 
JL-('t when htailhVian^l^ liint II moderately inereasciln^iKH>upfdM'hur;^ 
ocvunt in theijo^froruncold,but the majorirorkof climinatioa— 
if void ifiUfieH elimination of juHue morbid pnxtuetof the UixhI— > 
MB don<T by healthier mucous mc&ibninc iu the brynx and hronclii. 

When iK'ule attacks hnve E^iiUfided, and llie nasal lining kvvpi 
up a rather free dt^t^harge too I^ng ; especially, if the dtscbargt 
«how»A littlfr Idoixly, or tl>e ptitieiu lia« ocoMional altadn af cp- 
ifltftxie from slight caUAed, th«n \» the golden opponunity to nip 
tlic flUfTdiori in the bud, Thi^e patients aro g«ner.iUy Hiihln^ 
or adolcsoentA, adiiltfi |>n*^]]tmg more otlvjknoed dbeof^; but 
oecasionally a iiiii1dUHi)7(^) p<.'n^un, who is in iW\>W hmltJi^ furtiitlMi 
evidence of thie incipient ^ta^e. [n tJie milder pbasee, I 
direct a warm iiolminn or an k-\^*u ti^Taxpoouful of ^h to a pint of 
water to be snufied well into the nose, and u^ bs a gargle evtry 
day. 

Pnl^titla ifi the mofjt valuable remedy ia the materia oiedia g 
for thiitirtuEtr, but ouirht to 1m given in tin<tun\ If tlu* imtlnH^H 
JH Atrumou^, or of very light anguine tempemment, Cslcarei^^ 
carb, may be ^iv>M>, but 1 jia^fer thi> CaK'Ar*.^ pho«., wbirb in tar 
«xporienoc has pnive<l very &Aii.nent in all eoAOi where the car- 
honatv MTcmcd indii:a1c<L 

I f the ayraptonia do not improve, it is advi<uible togive Araeni 
cum iod.j nrid have thi^ |iati4*nt, in addition to tlwuxnal mlt-watoi 
doucheft, draw in the no^ lm*x or three timen a week, the etean 



TiEATUB!9T OF CHROKEC VASAL CATAHRQ. 



381 



from ft piDt boir] of liot water, in whkh a tctL^jxHinful of Tvre* 
biiilliiiiEiCirklun} ha^ t>eer)<litruM.Hl. AHf-rttircfully following this 
treatment tor some weck-s, if Ihe cfttarrh anil bloody »how Attll 
continue, I bcliov<' it advisablv to spray or douche the noM* twice 
a week wUh a warm niixlure of a tcnMivoonful of Tar tinrttire 
in a flint of >^ihvti waiter. 

Geiu-r^illycbt^*^ meflsuryw will rrstore (Ik' integrity of the inin'oiift 
iDCfiibrane, but in olMtiiiate case^ bogiiles eoostitutiooal medica- 
tion, it fuay l>e TMSf«<Hary lo u»f* a «|>my or doiiolic of livr ^mint4 
of Alunicn or of Zinc sulphate to a fluid ounce of warm water, 
to otttHuge and torn? up 1 tit' n^liiu-^l nuic«us lu<^nl^rail4;. TbtHe 
mill) caacA, which generally precede for awhile the graver one*, 
are.'«Mi by lhcgi>n<*nil iiniclitiotn^^r much more fn'^^neatly (ban 
by tbe fip^ciali.H] ; and the former, therefore, should bo luore in- 
tuftf^Unl in profihyluxiH a^^in^ the )>cvtirc ua^il catnrrhii. 

When r^hronie nawal fatarrh has reached the secondary t/ijige, 
<*huractenjK-<l by thick dischurgc :ind some dcgcncmtion of tkc 
8ehneideriAf] mrmbrancthe iiio.'d iin[H)rtant mi^Mire fcir the com- 
fort of the prttk^nt, for imiffovinjr or ciiriiii^ (he die«iH>, und pre- 
venting or cariDg Eu^ilaohijin tube or middluttir cfjrnpliiiitiona, ia 
lo keep the naaal labyrinth and naso-pharynx clean and free fruin 



¥m.9U 




VowT'iSAtxL Srai?'u£, 



the morhid necretioni^ of (he part^ At thesame time certain local 
niedicamenlB mupit be applied nffnntlum arfnn, while the proper 
internal n^nnnly in taken continuously. 

There are (Several ways of cloinmini^ the nawil mcatii^. Fluid 
may b« icimfled into t\w na^ fn}m the hollow hand or fnmi a 
vo*i*>l. The (Kiliefit should be directed to bpinithc only lhnnii;h 
the mouth, and to hold it very wido o|»en dnriiig the pn.KvJnr(*, 
to pTtvent waahiDK secretions Jown the throat. 

Thb method fail*^ io clean>H? tJte dcvimt^ pu««^ in a thormgh 



Til B11UAV BAR AND ITS DIBBABRS, 

iDaniK^r, ami, lii^nrt^ m only u|ipli<*ahli- ftluQC, ythen tiio dbiwe m 
mikl, am) oiiit;i]ed la the inferior and middle matos of the Don^ 
It is vrry uti.'riil, however, to combine ihi^i in nmnv CMf^, vitk 
tnjeclion^ ilm^iij^h vnch Aide of tlie iHjete from lh« pmterior oarcs 
by moans of the post-nnsal syriQge already meiitionctL h 10 not 
needed vk'hen the dniioht^ bt employed. 

Th^* ]irKt*nai<ai i^yrinj^e i;* of hunl rubber, hflu a itpool-aJidpnl 
butir so that it cau be readily held between the iiidex dad middle 
AD|*er^, whilr ih<- thumb in ttic ring works lh« pijilon. Thein- 
stfumetkl 19 operated with one hand, ihe t'.vrviMl and much-fcr* 
fonited nozzle iii ]iafeed up and huoked behind the palatine arch 
of each &ide in sut^CHition, wliili^ the tuiM^nr U lU^|h^?c«e<l, ami At 
Uirutt W ktpt in view under direct or reflecled light 

When the injectionttare made, it is well t^ uover tlie paticnf* 
ebtvt with a long towel, and direct bim to iucline tb«lMadali:t)t 




Tua Pi>&milt>a NaueSl Etc. p;84-iET4>, — L. l'U« aani v^um; ^ iBTfrtf 

tul«: '}. KoHHiiiiuP]«r*B fund; 10. udv of the pharvni; It. iJic 
tovil; 1% vvlum ai \hv \ainw. 



forwards, m thnt the tliiid fmm the dom may run into a v^mtl 
and not over )m clotbcs and Ihe il*>or lie mu^t be directfil to 
k4:*ep hin mutith o[ic(i, and to bmulie thniui^h ii, mid bv csiutJoiwvl 
not to&tartlfaok when lheinj^\<iiimLsin pi^gre»i. 1 f deftly (kne, 
Ihc whole lluid drawn Lip by the syringe and injected, sbonldnia 
out of the anterior narls of the m\t! ujkhi which th« injectkia 




TRBATMBXT OP CUftONIO KA3A1. OATARRn. 



383 



liiw htea maule. Somirtiinet owin^ lu iiontrntion of the pharyni 
uod dipipl^Lcement of Die noix.h, the fluid wilt esca^ie from both 
tKwttniK 

This IS g^n^mlly the ca*e, when Uk fluid is injected mf^rely 
into like iitL4ii'])tiarviix, ami indicates the ne<«ftiity of carrying the 
iKixjik' )nf*hcr, in onlcr to clUvttially c}mn hoth nit^attiscfk 

If the reshder will note the dirtHjtiou of the turbinjitiKl honw, 
ukJ thr pai!«fl};i-s of iJic upj^T [Kirtion of Uio dom;, he vrill »ce 
that an ii^jiH^-tion ftxmi iK'hiiid wilt p^f^ into [im^e^ that aiiinut K* 
reached from ibc anterior Dare* cxw[>t with iht- douehe, and iheu 
only vrl>en llie ii|i|ier i)an of iho iiw*e U harmoniously ikve1o]>ed 
jmd thr pnKKi)^ Iat^. 

Th(r:iUfirriurim«liK (if the no*« U din'cte^] obliiucty down- 
ward and backward towards the phannx ; it communicAtes above 
vith itii* mirlilli* and |K»!4ti-mr nhnioidul Klniiwsf, and bi.<hind with 
tlie«|)hcti«(kUl Slum, Its anterior coiDmunicnr ion with the middle 
metttiis ill fn'^iiciitlych)eMHl by irn-gnliirity in i«M»U£ di-vclopmcnt 
and by disease- 

Thviniddhr mf^'Rtii# i«dim't^^^^«^eItnnl^da^dulittlvdo^^■nw■a^^ 
The anterior ethmoid a!, and thi* fri^ntal mnii^^ (>pL*n into Jt^ i]|i|ht 
anicrior portion, and the maxillary B\nm into itH middle jmrt 
beneath the mkldle turbinated bone, 

'llie inferioi- meatus klow tlic true lurbinaiH] bone \s diri<ctod 
hortxooCatly backward^ and receives in its aaterior |x>rtion the 
l3ie-hryini>-nAnal diK^U 

The problem in chronie fat^rrh i« to cleanse and modicale all 
this labyrinth. It i.Huppiin-jit thai ihn<l intrvHh)o<*iI by (he anterior 
naws will readily flow into the inferior and middle mealUAOs, but 
will |MVA willi diffir'ulty.or not at all, inki theHniHTLornionttuand 
it« diverticula, II in evident that a t^treaoi of thiid thrown forward 
mid upward from behind will reiieh tlie superior meatus and its 
^nnaes very ea^nlly, and it \^ bw^nw^ thiit fail ia not refnvrnber^sl, 
and iUt }w«t-na»al riyrin^'e k not uHC-d in eonjnnetiou with the 
ilonehe, that fK> many ea^eii of ojironic niflal utarrh resist trmt- 
ment. 1 rcvomnwDd, therefore, the use of the syrin^ to ctt^n^e 
the^np|)er|3QASttge^ inull but tlK-inihl^tcasciiof chmniccjilairii, 
und onnt^ider it a sint gud von for severe ooce. In cotijuiKAir^ 
witii snuHing and anterior lajcclionTt, it oia^-sufliccand the 



SS4 



T1IK UtTUAS BAR A5D ITS BISBASB8. 



HMiy be n^lcded, in t^ws where the use of the l&U«r u nut ctm- 




Vehtkal 8wti*>jii ok Tin: l"_vrfc a»i> Spck I L^^),— t, OtiI CBJlih|e 
of K'fE niHlrit : *i> iriaii^uhr oiriilngv; 3^ tine of tBt|Aintk«i ; 4. ptnlia^lWi 
of ovnl coTiiln^i.' fildng ifio n««hl i-olnmni ; A, fupi;riur iumI ineMnt; 0> aiidAs 
mcalut: T. inferior mcdtua^ it, tphfrm-icfol nnn*: 9, bM«i^ p^iMofW DATii; I 
mi^iiib of KiMDriiijiri tube: II. niwo-phnrrnx; 12. wD palnl* ind iituU; IX 
poal^lnbinJ region : H. root of month ujifl hard pslotc; ]5i niMimiiQiaiiJno W- 
Urcen lh« bu^-n-^Jmlal «|iui:c ind month; I4l, ton^iir; IT, AlironB tvpuin (^ 
lon^c; 1$, gL-tii^]i)Hnii niuMcJr; Id.gvnLu-htvidmiiBcIc; ZU, inj^ki-hTasdaiur 
cl«j 31, anicrW lintf nrvh nfthv (ttJutc ; 3!f, poirt«rI<tf h4irnri?h nf iIk palAi*: 
23.UknEiil:24.2fi. DoororLhefuiicwicSA. 27, pharynx: 2S, <^iiHljro/ih*lw7M; 
29^ vcmH^le of Ihe lirrnx trnA voenl cordu; 30, cpii^louiii; 3), byoH bocicl 
:I2, 33, thjrroid nirtil&ge : 34, ihyn>-liyuid mcitibrftnc ; 33^ 30^ crkoid csrtilagtt 
37. vlcrnu tixyroid moiMrk. 

Ctnibcr hnfl given rLiret-tiom for !iiJ4«t!tig th^ now fiiiteriorly, Rtr 



H 



TSBATUBHT OF CHRONIC STASAL CATARRIT. 



dss 



ing tl»c Ku^a<'Iiian (uIh?^ A two't^uncv^ syrin(r«> with ft n>un<lofl 
w^zde in JiHol with the fluid desired, pre^Wf^J info one nontril, »nd 
quickly inj«^l4Hl. If i1 ih ivijuin^l rocrely ti^ cl4-afi»c the mUfO- 
pharyDx, the other nnstri} is IHY open, n»d the lluicl oaipi^ there- 
by ; if to forct (he fliii<l into tJie tu1>e«4, tt is partially or wholly 
doMtl for an instant. Ko din^ilbits lire given tht- patient ui>oitt 
brealhmg, reliance \mng placeil cu the instinctive aclion of the 
bikM of the tongne nnH mi\ [MiiMt: to :«hiit off tli& iipfHT pharynx 
from theihroot- I think the pnfieni£hoiiId be instruelcd lo keop 
hi» moulb wl-11 opcn^ and to hnvthr ihnjugh it, us J haw triti] 
the method of the distingiu^ied proJetD&or several times, and in- 
8liiirt fuilet] «o igDominiou^ly, that the whole injeclion went into 
the fltomueh. 

TiKfrc i« considerable ditlerenc^ of opinion among nulbor^ In 
r^rd to theadvi^bilily of a^ing iho mL^il dourh**. Fmni oIk 
SAervation and experience, I am Inclin^I to the liclrcf, that the 
iQiftntment U not iDJtirions to the ear wheii tv^A in a proper 
manner. I have known inanv i^m.-^ of nn.'^O'plmrviigi-'^l f^tarrh 
treated by lire douche, without injnrj' to the eam, even when 
(lUeni^ird, and I iii?e it fret^uently in my practlt^ with the be*^t 
r^nlts. 

There nrc several kinds of doache, in the nuirket, but I shall 
allude to only x\\i>, the fiphen, and the tnodiflul Thiidicum 
douclies. 

The siphon dcmehe ennmij*lit «f u pia*e fif j»impTe rublier tuhinjs, 
fitted with a gf^od M7td nipple or olive-*ihapeiI, holl<»w iiose-piece 
at one fud, ami a perfnrnted. henii-*pherieal, nickel-platwl weight 
at the other. The base of the lalter has an elevated scollopwl 
rim artiund the Hn-utnferen(*e, .-«'^ thut whfu it n^x* ki-^e ditwn- 
wardd, the 6ui<l can flow freely to tlie central hole, which oora- 
muni<^it<^ nith the tube uf>on the upper atdc^ Any vcmmI, pre- 
ferably A pint tioeup, conipleleri the ap^nratav 

The ve*^I should he fillwl with the desired solution ; then put 
the instrument into it until the tube m filled, cloee the noAe-piece 
litrhtly with the finger, niul remove all of the tulx? exeept enmigh 
to leave the weight upon the biMtoni of Uie n^^epinele, nnd it ia 
rettdy for uj% 

The modiliedThudicum douche, a** reeommended bv I>r. Sailer, 



386 



TlIB UUUAK bar KSJ} 1TB DISKASSS. 



consists of a nora-pi^ce ind length of niUher tabtng, cwinectal 
vfitb a pint tiru-np l>v a tiilK* soldered into & hole nmr the bnUom. 
When HiiM U plnocd in iheoit]), umJ iJie tjibe bhdd bp]oV|tlii 
Him- (mm iln- noi^e-iiiof* iruinocliaHv lx]^iiu< 

A tincup IE preftmble (o a crockery ^^r ^lae?* bo^Tl, bcciasr 3] 
will Dol bn«k, ftti<l i^ iTK^xix^iimc* 1 prcfi^r tW NplioD vpfwiatuf 
and a gla» Iwwl, however, for medicated salutions, as Ihe ttn U- 
tu^TiJCA oxiJixied luul tlie iron nufly frain Uie dtcmitnl JictkiD of 
oerlsin rometiics, 

TIte phv^iijaii before applying the nasal doiicbc should Dole if 
the patient can brcutltv fn?c*ly thrutLj^li both MiM of tlir iMw^aiHl 



Pio- W. 



Kio. 9^S. 




tOMUH ft McftMrf . 




Stnicx UocctiB. 



SiniOX DotVllft OlMTLKV. 



examine both nasal foa^ueatiteriorandpAc^erior, tobeoeriAiii ibrn 
is no ohj!(tru(-lioi] «ullidcnt to prc\TJit the 1lf>w of fluid botli wsA 

If olistmcticin is foundj tlie douche should not be iriwL Ifo* 
olH«tH(.'lv cxiH6<, he 3<}iou1<l then tLiMnirt (be puticnt to braib? 
through his mouth, keep this wide open, and tneline his hewl i 
very link' forwanlis tihivt* a nHH*ptn<"!c. The cMht'* should te 
covered with a lowel or rublier apron, and the patient efwii 
to keep quiet Aud obey onlers*. 

The Hidiition li:ivifif: Ifcen prc-panil nod put in the mp, the 
pi<?c<' \^ poa]j<d into tlie uocfril mid held so ns lo elo^e it, the 
tient caiicional to watch )iir^ bTcailiin^, and the euji Mrudily ntwd 
tjll its liottoin h u|K)U a level with the eychro\rs. As the Snd | 
How4 ihrodgli ibe (n<*Htu», arottiid Ihe nai^n-pbar^'tix and ^-pliiB, 
and out of the other DOfetril, and the patient gets accustomed to i 
the new sen.<4a1Ionei, tlic cup iiiay be elev»ti<d one or two indrt^H 
higher ; but under no druumstanoca ^ould it be raised above tb^^ 



111(1 n 

UllO^l 

leSS^H 



TBSATHBUT Or CUftONIC KASAt CATjIBRB. 



hcad^ as the iiKi%a»ed preeeure will force the fiiiicl into thr Eit»- 
UchmnliibcRpfnnUftl^iiiiiM^y diidcven iJkrther, and [>rodi)<<e Morbus 

The 6tU upplinirion ^houl<l be ahort, ^ml haJf a (>im of fluid 
is lufficitnc for it. Th« qtifintity may be increasetlr a« th<* ]>atieiil 
beeomeft d^MUMtoinml Ut rho tn^atmcnt, tiiitil n )>]»t or niont i^ pibtr^ 
throu^i tlic circuit. The patient may l)c instruotefl how lo ii»o 
t)i« (liMidi^ by ou^ or two otH^n* aj){>i)4^tion#, iiimI thni <il»>iiit4iii); 
aod topical medicinal trctif merit ntAybccarriciloaby himnt home; 
the phywtflii^ h<>w<,'Vi^r, -*houM riol nmit Iiih ntlontii>ii* on thU 
Mooountf IhU tfcsc th« in^itrumGnt upon the pHtient several timi-s a 
w^k, in <M>njiiriciioii wltii tliv p<}iit<i'ior nA^al ^Jiyringe, in order to 
inifurc tlioroagh work, 

AH Hnidit iiilrotlu<'(*d iiUn the none ought to bo mml to n tem- 
pcralare agreeable lo the patient. This will \*e a lidle Mow 

r<d hmt^anil nmy Iw iipproximLtcly (Ictt'rriiiiiol hy dipping; 
back of the hnnd in tlie sulutionj or patting a few dn>ps in 
the |)alin. The firHi lillint; of tliu »yrin^ or douche i^liould l>e 
waHictI, 4$jH«inlly in cold wcAthcf, »9 iLh heat is abstracted by the 
coki int?trunieiit. 

Attnthcr imjxvrtaiit rnaticr i?« the H|iecilic gruvily uf ihc flui<). 

Simple warm walcr hh adviRcd by many persons i^ po^ilis'ety in- 

juriotiH t^»tbcniw;il mncinif mcmbrafic. TlR-iloiteht niUf-tbeaftbe 

Kmc density as the bcnim of the blrxxl, or a^iinotlc effects will be 

protlunril. 

When warm water, or a Siiid of \i'f& density than the blood 
Mjruin, i< brought in atntact with the naad iinin^, ^ndrjamot^iM 
will take place, ihennmerous capillaries will become eni£orge<l, 
and fnin i[Kin<t-d. 

WbcD a fluid of (;;rci&ter density than the blood ^criim i» em* 
ployi^d, «xwniofl» will occur, the biood corpuscles, deprived of 
|*rt ef the Injuor mkiijriiiciiH in which they fl<wil, will ;iirumulate 
and *4Ut)Enutf in ibe cajullarie^, and caii^ irriiation and burnitig 
|iain. 

A solution of 56 fffain^ of common table salt in a pint of 
water will neilher i^well nor creiiate the red blood c\>rpusclo, und 
ha, thfirefoTt', of the tuime d<*nj>jty ils thir hkuid :^-rum. This prop- 
efty, and the well-kaown antiseptic tuiture of chloride of MiKlium, 



^•^ 



TBI HUMAN BAR ATD ITS Df&tA9l6* 



irmfcr 1hi» liijiiitt ^xivlk^nl for deainiig pq^MtH, aim] tl am li 
uied as a vehicle tor medicinal subsUnc-cv with which it is noil 
chomiciilly ineinnpaitihlo. In Mich iii>lfln(\% thequaiuily <rfi 
must be diminishef] in proportion, us other ;«ulMtaiHM» arc i 
ill onier l-> pnsiTv* i\ Kpwific gnivtty of lOW. 

The solution may he made near enough for jiracHtcal purpiM^ 
by nJdin^ an c^-t-n tcii^pooiiful of lahlo Kilt to a pint of warn 
water. Sea ^all, sold by dniggistb for bathing ptirpuw#, i» aifrrt- 
Me for tMm\\ flpphcutiuEitt, and nuiy be substituted tor the cuni- 
mon article. ^^ 

AOer wurm di>ud)e« and warm flprayiitg, n patient ought i**^! 
to go out of (Joors for Home timt, especially, in Uie ctAd »enMn;^i 
und in :ill ?-(-fLM>im Iw t^hould he careful of exposure to dnifti ai>l 
dump pJacvfi, I have geen em-at stNod in great bends ii|m>ii tlie 
forciiead «f(er u nic>denitt'Iy warm iinflal douche, and one of »)" 
patjents look a severe cold fram making a <3iJl voim ailrr an >|>- 
|)l)ciilion, h]ivii]|r iK^-n oblig4*<l to Htarnl Aome minittvA wailing it 
tbe door for a kxy servant to let him in. 

The poHt-imr^l >yiingi' and the nci^nl ilotiohe are to be owl 
with rhif Ailt i^ohjtion to rWnst' the no^e and phannx whenever 
required. It may Iw neoeaiary at first to do this twice ftd*y» 
but una' daily iN pcnendly *tjffi(-i*ii;t. The (Mtteat aiu^vi (<OH>pcf- 
ale in the treatnu-iit by blowing (he ijc«e hard, and by laki 
forced nasal iuhalations, in ordt^r to ri'inove all niorhiO ^"crrti' 
A j;ihk1 tU-}\\ tt( tnxible i* n«*ew*ary ooeaaionally. panicu! 
when the patient is tint .neen, to dislodfce the foul crii»ts and ik^^ 
which clinj; to the narrow pnMif^ rf Uic no*« ; but by n^pratii) 
snuffing, blowing, iynn(j;ing, and douching fiuccess ts jrained, ani 
if proper nieasureH are adopted, tliey will not accuiuiilale ia 
quaality nf^jdii. 

iDHatioQ witli the air-bag aids In dc-aring the paMac«S,aQ^H 
will often ix^move tb<: drf-'jidfitl frontal hcada<?he that oomes trm^ 
fitufled fLinu*i^f«t. 

AfU'r the »a^ftl jHimtgefL Jiro el«ir and eleaii, it is desirable at 
least oitoe a rlay to apply anli^ptic and mctUcinal (coiutions totbe 
niucoui^ membnine. Thi» may \x done with the syrinire, dociobe 
or atomi/er. One of the best lotions after clmnMing ia a warm 
iwlutioaofMuriuteof ammonium (^inTm>iiuiiuirv2A5ijt Aqita(^U 



FiliTHBlff or CRR0!V1C TVASAL CATARRH. 



389 



iipplirdwilhciiepoF^t-fia^Uyrin^^orby llielmnJ atomiser through 
the DosiriU and Ih^ tliront. Tlir «ainc solution way be rnjc«-tal 
llirough the mtlieltier into tlie Eu^taclilaii tubes, if thcj' are much 
aSeeied. Uorax, bicarbonate ot* »odJiiin, and cblorate of potu- 
Hium arc tiAed in the tome propartion, and are nearly a*i eltideiil. 

If there is ulciTution and u vi-ry luul odor to the cli«churge, 
(lilorine irater (Aq~ C/t(orim)^ oni^ tjib]o«{ioonl'ul to it pint of 
wnrm irater, nprayed into the pharynx and Ttantd fonte^ will 
prove va1iJabk\ The dttnlion mixy be iiwd ol^n ft? n gargle, 
vrhcii tbe throat is foul and di^iea^sei), as in diphtheria and malig* 
ftant scarlatina* It doodoriiwit and di^inlectd tlio morbid ^u- 
date9 nnd th« mitcou^ incnkhraiie, And Mlimuliiti^ the tiwui^ 
totrards ti^lthy adioti. 

A Holution of iVTmungkuiatc of poliw^Juni [Potn»su prrman- 
ganoA gr. x to xx, Atfi^ f.^j) iri anti^ptic and mtldly stimiilatmg, 
and may oltcn be iiHi^iI with advantoi^e. 

Sevart cne^ of clironlc oatarrh, deiiominidiyl O/juna, fwnio- 
titnes Itavc a sickening: i^mcll, and nxjuirc a Htrong^r dt'odorfzinif, 
diMinfi^ctiii^i and stimulating remedy. This b I'ound in Onrholic 
acid, which elionld be used as a fipray and gtrgle in the propor- 
tion of five gmimi to the Ituid ounce oP water A lcu!!<|KK>nfuI of 
glycerine added to the solution will make it more agreeable and 
more effoctivc, i5»pivml|y, when thi- i^rnMn nn*I t^ertnin |mrt^ of ibe 
Sctineiderian membrane are rather dry, and tlie former cling 
lenjicioii'*lv. 

Many practitioners may be content to rest the local treatment 
here, keeping th^ nfwal fo<«wand pharynx »enipi]lonAlycluanand 
9weet, and relyinjf tipon the m vte^it^trix taUttrxe an<l internal 
medication to i'fft't^t a care> Some iiatiotit« may recover aAer 
awhile ; others will l>e greatly impnived, but will need a.strin^at 
and Mimnlatin^ applicationH applied to the nn^o-pharyn^cenl mu- 
cous membrane. 

Jhnnic ociV/j commonly callett tannin, ifl a pure astrin^ntp 
bai'iu^Mimulatinj^or irritmit pmperticsac^K>idingt'j the ntrt'ii^li 
of the ?H>I[)tion of it employed. It ifimiicb&tipen<rrtoIIydfa&tiaand 
Hanmmeli^ for topical H?*e. iw lhc*e contain dcle(eri^Jua vegetable 
matters mixed with tlie tannic- acid ii|)on whidi their valu« 
depends. 



390 



IDS BITMA5 «AA AVD TT8 D18fA«K8. 



The mucous in4'mbmni> of the Do$e and pharynx, in th« vm 
htimiil itif^i^ of Hironi^ ititaxrh, be^oni^ relaxoil ami tnieniatov. 
upon the anterior and posterior etuis of the inferior torbinsti^l 
boDC?4f it i» n-ot'i, moist, glifttMiing;, ^nvoIUfti, and lioffi Jovravrinls 
m llial it ia »>m^ime« iliEficiilc to diSiT^nliate the ctisliiooft rrrua 
muoHi^ [>oIypL 

litis <*on()ition is generally cntocident with elongul4<t] uruhj 
lownlroopiij;; iin"h«i of llw jKilnte, ami liypcrttxjphie pharj-o^tii 
A !^luito!i of tannin {ArhL Tftnniei gr XX to xxx, J 
f"!^), appli'.il to the (Kins with the utorniwr, w»fnehnv 
nietitc-d by the pcwt-naKil syringe, contracts the distcndeil capll 
ries, proniot<^ .•ilkM>rptioti of the i4uliinu«t»i# elVn^ioii, and rtimiH 
lalee Irt hcilttiy action- 

TliU solution rA excellent for iniUl ms(» of epUlaxiSf occurrio^ 
during the course of the difumsc. 

Tannin in glycerine !» much eaiployi^d in tlirout prai-tii!e, aod 
IB frequently beiicSctal, hut iflionid not bo u^ for tbn nh(M 
symptoms. 'Die lUjnefHu «olmion \h better adapted to the oua- 
(Jitioiis, and il Bii!t» fiore throat in ireneral better than the glyc- 
erite. 

Bidphftti *^ tine is preferahle to Uinnin, wheu tberv b no 
Itemorrliaj;:^, and rather morfr stimulation is derfirnblp. It my 
be tmjjtim^I tor the OHlenuitous symptom.'^ of naAil nitarrh, ai 
well as for an atontc, ^raaulur, and ulocrat^ state of tbe Schnei- 
dcrian nKmbmnr. Whrn dr^iii-sin^ and tlie iiUive applications 
Hccm to have done all tht* good they will^ and the raucous Imii^ 
ap|i«ar¥^ hen* pate, then; ml and rr>ugb, |>eHm|iA, inaiMth^ plat* 
showing iilinllow, broad ulceration, a zinc ailiition (Zintd SvifAoM 
gr. X to XX, Atjva tkjtt. f^)), applied Iwicv or throe lim« a rt^cA, 
awakrti9 the ilommnt ener^ of tlie ti^fiue^ and \noiuoUs» ImdUgtf 
action. 

Tbc lar-vTHtor liefore mentioned t« a mild nnd agraeabJv 
idani, that nmy he u^ alone or in altematioti with an attris:, 
gent renuHly. 1 1 can Im lulrled to thi- offioinnl xalt Aohttion 
daily cleansing pnrpoMn with ndvnnts^. Tf iho fniHvius oii 
hrare in very dry, a ilrr^p^ting of <*<|ua1 pflrix of glyrvrine 
urater is demanded. Glyc^erine may be added to aoai4- of tin 
nDpflirxterl Mohitinnft vrheii ilua^rntil advittbl«L 




TtBATMVKT OF CHUOMC KAflAL CATARRH. 



3di 



lb 



IftiraU o/ 94/vcr '» uhviiVT U)\tU^\ ti|i|f1ic»tinii Arr tlii^ dtsoriv 



iftit nnylbiii)^ y 



anil niitL|»ljlo]^4tir to nclivc iiiHummuiHin ; 



It Li i«iuilliin^ anil niitL|»ljlo]^4tir to nclivc iiiHummuiHin ; it 
a«tringw ami corns up rclaxalTaa, causing veaseU to cNiiunict aiid 
rcsiirn*- itirir wonttvl m'tivity ; ir IruniA a HiJ^icrRcial lili'ii^h u|h>ii 
spow of ulccratifni, ami exercises a mysterious alicrativo power 
over tiMiii« nmrbiilTy aj«triiy ; it HbirtJt all the fiarbt iiito iitiire 
nutritive change, whidi, akltw! and giiuied, will lead to a condi- 
tioti^oclttvely upproacimatin^ licniih, timt biith putj^nt and phy- 
sician wiil beaacJAltM. 

F**T ^ncral t1inuilaiiii;r, a^trin^ing, anti alcerutivc purpoM^, ii 
five or ten grain aidutioti of iiiunitt i>f ysiilver {Ar^rU. riiL gr. v 
tn X, Aqua rfirW- l^j), lOjonltj be spraywl into (he anUTior nrd 
posterior nares every second or third day, according to ibe severity 
of lhi> CAW, after the pcirts have bcvn thoroughly cIcAr»iHl| am) n 
last wa^ of Sodium t>i4rarboftat« han l>6e» iimmI. 

Solutioaj^ of twriHy, thirty or forty grains to the ounec of 
vater may be nppUed by a oannl-hair iirn^b, a special flexible 
tiiraat-bnu<Ji. a \ii(i\l tiift of cotton on the holder^ or, nirrly, by 
a small bit of A[ionge in a ^|»or|rc-hohl( r, Tlu>^ Atrengtbs Atim- 

tnlale Htrunglv^ and canterfz"? lender s[>ots and uleer* Miporticiflllr. 
:^ 
tE 



Fro, OS. 



WftOffEa'B HAfftiiJ! ksrri Banntm 



If it is desired to uipply the vtAUi cnusiic, melt some crystals nf 
thi! pure Mill in a little ]>orcelmn c-a]iM]le or a platiaiim cup nneh 
as is used in chcniifttry an<l mHalhirto', dip into it when melted 
tlieend of a flexible silver probe^ then withdraw it and let it 
cool- The prolx! can l»o l*ent to nny dcsireil angle, and ulci-ratwl 
mir&ccs cauterized- Several m-vftil but cxpcnave porte-raiis- 
tiqtm hftvebfOD invented for thi» purpoetc* 

In these applirati<ins to particular spots, good itlutDination 



398 



THB RUMAl 



ABtD ITS M»48BS. 



m(»ttwh}Kl witli lilt* biiul-mirrur, nriil tlw throac-TnirroT vthat 
th!C&ti3iry, and a 4}H.vulmii amy be ijettleJ m dilute \hv siiU-nnr 
tutrix. It i.i t]if>M'u1l to niukc HitliUhI n|>[>lic:titioti8 in ihe [nelr- 
rior DunT> uml jiatio-|)luiryiJ3C, tjuoitLstr the \Kk\aus ruiuiclet cnuinici 
ifn^ilv, (mr^li UicK ilie mirrnr, uikI, ^r»H|>in^ tin; inHltuinriit, Uir 
niiiix>tL?i iiKiutfCUtir ^Kt» wt^li cniitiTict'J wh^u il is vritiidrawn. 
To obviute thU, pa» a loup of silk aruuocl Uie iivuIk, draw il 
forwurd, fAStrn ttiu ^llk bi'twivii xbv patirrit's front letch, and have 
the pticieni brriiclke Hilir<-!y tlirou>^'h the n*K*c. If (hi> (unitiiC U' 
endurerl, or i^not succa^sfiil in keejking the palate ava^' fmm ihc 
ptiurrnx, and ori4*mimot|;iitd^* atihcjilht^d (9iii!<lir holdi-r ttt th«9]Kii 
upon the index finger, ihe cotton vrbp or sponge in ti>e hnldef 

Fio. OT. 




QtiAXOcn's SpoarnK-IIoMJn- 



mu7i£ be* M'^l Willi niihl oiiiiU'rizing ^hjllonic I Ikivc htfft 
obli|C«d to de|)t.*n<l ujinn (he spon^fe-holder oftener than de^ni^rk. 

Kor t)ie tiiiki^ of prnviutiitn, nfter applying a vnry stntiig i*olutkiD 
orlti^soHd <nu»tic, find wailing a few minuter, thi? |»atietit slwakl 
gargk' llie ihivjat and dt:>u<hi^ the iioite with the UMial tail koIq* 
tion, in onlor to neulnlix^ any excc« of silver nitrate that if 
likely to Dow down x\\^ pharynx and do injury in it9 courw. 
Spraying of flVTiiigiu^f with the same will suffice, if the other 
mau<.nn9 nrt^ irinpi^rulivc. 

Oartain powilf'm are Hom^timei beneKnial in ozAua. hot I have 
hnd too Eittir rxprn('n<>v with thtrm t<f wnrnmt giving itn opinion. 
Blsinath finbnitrate, I^ranic afid, (■iiljelw [Hiwder, liKluform, 
Hiul Magnotiiimrarh. may hci^nuffbd or hlowii into ilim nose aftrr 
cleansing it. Two very oonvenif-nt jtowder blowerfr arc> ti^in<d. 
Thi*y an< nw^fnl iii tliix i^f^nnrirtum, nnd far applying powiler^ to a 
an ppu ra li n^; ty ni ^ul n u i n . 

A n;of'nt writp.r f-laim*^ to hnv4> iMire<l fcrv<*ra1 vnrtm of nnena in 



TBKATMBXT Of COKOKIO SA3AL CATABRIK 



tin 



Fm. tS. 



twove«k»,with£nufreoni|)u^c<ii>rio{lofr>rm two {mnfiand Afada 
powder ten pnrb^ «^>pHi-i] iliro** (o -"tix tiiue^ a dar. Others pmne 
lodofomi, Mrtijury, etc, oomlnn«i witli va«*liiic or ccUi irream. 
Dr, Wu»kea roct-fiimctidi* i}K «*«.• ^f various kintls of nii^icatcd 
c>(>Uiiii, packed in the nn-ml fcMsf^, 

Illenjorrhaj^ of a uilld clpj^rce ts froqiK^nl in na^l catarrh, aiul 
I Ut «rn'«ii<tl gi.<n«r&liy by thv ^U wntcr or uiie of ihv a.-ilriii- 

gcnt Kokiti^MiiL Sometime? the hlci^in^ pcrabtH in :<pjlc of iIjcm, 
jumJ otiier r^mcdlcM iDimt Lx: tri^d. The jJUii^rtiD should be a^ai-ed 
thvrr ill iiu daiiji^cr, and W kqit quiet ond calm, biltiug tnit In aii 
aniHiuur, irfuiiujtig occurs, the chuir aiid patient c«ii tsmily 
he muliiied bockvrardn Jtwbilc- WhcD the iiahqI domeaiiu methods 

Pio, W. 



TimAyH'l FuWIfl^R-BLOWBIL 





lor u-raeiin}; nosebl^e^] hnv(» n^t hf'cn Iriiil, if (he flow !■* not 
excesadvt^ they may be t<*ltiL ITdd the ri^ht arm up pprpon- 
dicular, |»iit a piece of <vwrw pn]>i>r nmW thr^ tongne, diuli cold 
walCfT in ihv feirr, «nd wnuff it up ihe now^ jm! 9 wH pnmprew 
or a pkve of loe wnppcd in a lAvrel Li|K*n ihe nape of tUt ntTok, 
aitd bold !»* in iKe iDonth. Thm^ fiiiltng, prtvM \ht nidee of the 
DOM fipn»ly t/igedier, «nd apply prffisure over the &ci[|] urtcrioi 
tipon tliD KujH-rior mftxilkriiv, juKt finbtute th<t nlio of the no^e. 

Should die^cpro^'cvdin^^ fftil^dtlatvlho iK^inlrt tvith a Fmnkel^ 
•paculnm, ami cjcamire lh« lUuminutcd foiwio for tira source of 



THB l1U)fA5 BAB AKll ITS DISBASB9, 



ll»e heruorrhage. If thfd invisible in ni[iUir«d or ulcen(«il w- 
»t^ or fiJiigon» ({mni]lationj<^ wi|»c lb<' |inrt dnin and blnw pon- 
dered tannin upon il, or ap|>ty a poiiU of nitrate of ^'Ivn'. 

I stopped immediately and permaoeniiy an obstinate, rtcur- 
rtjir, and iilHrmiit;^ hcmorrhn^ from {^mnulaliou^ in a aie<'f 
ox«ma, by ofie application of lunar caustic to a fungoid excnt- 
cenoc. 

If the source can only be approximately determined, BtaffttK 
aHectcd Aide tinnf)' by n ]»n)tK'iii]d tinpT with non-alM^rU^r^i n^ 
toa All intelti^j^t pnticut can lualcrially ahni^t in packing thi* 
into ihii crevi<?e» and emniiic^ or the ncm, Ixt the }ntieii: onw 
judine the face a lillJc for^-ard and await n^ilui. If bit**! 
cAnp<« by the sidt- of tlm (titlon or goes JulO' the liiniar. reiu(«^v 
the' cotton, and douche find syringe the oofle thoroughly with itit- 
water. Hot water may Ix' triril insmu) of tlic cold in ttumw 
persons If thjR do«s not •succeed, sulistitule a cold saturitdl 
Koluticii of tnniiiu for the v-uier, nnd wnil> 1 have great faitli m 
this; it docfi not Rtaiii nor excite in Bam mat ion, and I have ms 
c«Jwl in Mnppiii^ dim^TOLiH epi^axi.^ with it in lwoca*oviift?r 
throng mm ^Aiiiioa^ \iiu\ fiulcd. I depretnte the uiae of iro4i soh- 
tions ; (bey stain e\-erylhirg with which they come tn coHt»rt» 
and K'auM- iiillammatlon and niiuJi liiMre^ to the jiati^jit. ' Hot* 
6eVfi solution {Liq, ^frri mbgulphiUxs] U usaally eai(rfuy(<d n 
thi« c*)unLiy, and may Iw oprayed, *yrii>j:eil or dow^K'd tnlodr 
noae in various dilutions, Oae tea«|inonful to an ounce of wjHf 
flhould U.< tri^ at first, and dicri iT ncoe^tiary (be strength n^ 
be increamxl until equal parts are used. Tincture of iron {T'^' 
Fcni ckhritlx) nnd watcr^ equal parlr^, t» highly prubeil, and b^ 
ihc ailvantage of being msily prccured. 

A plodgri of Uiil wet wiih i^pinlH of lurjienline nud introdDotil 
into the nose has arreBteil epistaxis after many other tnethoda hiw 
foiled. K^lls of chiton or Hiu^t^, motHiethnI iA*iih water, rolled in 
tannin, and |>aeked into the now, have been very cffojt aal g 
MomeraMA, 

I>unn;f ilda aelive local trBnlmenl, there ntay Iw oppor 
and iKCi^^ity for iciLernal medieailoa. Vawular exeitemoit J 
tendency of blood to tlie heiid require Ai^onile, BelMooiH tf 
Venitnini viride. Depressed circulation and tlebility dcflupl 



TaSATUBNT or CnKOMlC 11ASAL CATAltRn. 



395 



Arainonium cnrK, Cflmphorn, Cinchona, OigitJiIis Fi-rrum, Nux 
vomica, and Pho^fihoriu. 

In mn Jni^HM<x4, tlie Innnofrhaj;!.' ^111 ooiitinnv in tijitlo of 
©verylhing inenutmed, and the anleriar ami pft^terii>r nareii most 
lie pluggod: Make two cotton fx>llcr UinJu^ tin indi lon^ nnd 
tlt^«l^^uarteJs cf nn luch In Juimett^r, and lie a j^rong siring 
iiriMtnd Ihe niidJIe uf taoh. Make hvn ifinalkT rolk-o, \mi \nr^ 
€tioii^h to close the aaterior nares, IntTodnce Bellocq's oauuin 
through the one ^idi' or Hig nam to the- [ilmrynx, pj^^h tn tho 
piflUiR, am] the knobbed tipnng vill appear curving fortvard in 
the (iHxith. 




Spwirc the strini^ «f one rolkr to llie Iwh- in the knoli, draw 
in tkecpriof^, withdntw the oanula and lltroaiL Pnx*eed in t)»e 
niDC manner with the rpMn'r »ide "f tlw ruwu, Tii«rc will iitjw 
be a Btrinjf from each no&tril, with the otiier enda lo whli:h ihe 
ro)l« an< altuoht^d haiij^ng out of the month. N'lw \m\\ ri|>&i) 
the £lrinj{fi from ihe no^, and draw [he rulla into the throat, nml 
Chen riTiid)' into the poc-^lcmr iMirc-«, Guide them in the tbnttt 
with tlie index fitiifer, go the length will he vertical. To the 
fitrtng« from the noxtriU fWen the- »innl1 rollr^ ^Bj^Uy make i^mrh 
ua^id toe^A a closed ravity. 

It may be ncnwarv to pluj; only one side. If the ble&ling is 
confined lo it. In inHc^of dmiht,-i»r whrn iho »ufptiim i^ per* 
foraled. lK>th mu»'f be closed up- Remove the pkig^ in ftom one 
to idrn- dnyn, wjwh out i\w cio1.-< anil wri^rrtiim-s, and iip[dy enr- 
bolixd] water for a dav or two to correr?t fetor and decomposition, 
then go ikii with ihi* uKiial treutmi'nl of thif rw^. 

Internal medicaiton Jn chronic nasal catarrh ls an important 
poirt of thcr tT(^itTn<^nt> and xhonld W |M*ndKtent}y kept up ilh hing 
a& tJie disease exists. It may be snflic^ient lo effect a cure in naild 



VOB nVMAS BAR AVt TT9 DTSflAflKS. 



Aiui vtwni uuAM wJtiicHit titu aid of Ick^I traitmcnt, but ia ^wn 
and Icng-Mariditii; omi^, it will nul au'h^^hI atone^ und llitr phy^i- 
CLuii «1k>uI(I not dt^luy to institub? tlie KxaJ tn^tment described. 

Tbe ^ekwtkfii it' l\w nu«ltcin4' m iniule froni u isrvTuI coit»itf<^ I 
tttionof the<.<on%ciliinonal and local 4yni|>U>ms. A ^rmt imny 
renutiira nre i\'(H«»m<T(idtii fi>r tin tn^tmctil of <^hr«mir i.^tJirrii, ' 
which arc practirally iii4el(«^ ami consuniefB of valtuble tiiwt^ 
HjiJE' the >i^^t» of tbt^ niatorin imilioii nmy b^. n«oGs<ary to tmi 
di^orlcr^ that arrHe in \he syDtoni ot' a jintitrnt H-ilh fittaal cAfarrh; 
bill tlu-wtiu' i]4sx7t*.Lty oMainif in f'tliiT |>atii<Tiis withour tatarrk, 
and the meilinDes ^Itould not therefore be 4*laB»«4l uiirkr «Tatarrl»] 
romcdi**. 

A lar^ majority of the |iatiena» are Btniinousr a ievr ath hj\ 
ililic, und ihc bnl»nci' rberimiitte or gouty. Tli<!c« diathetic coo- 
ditione funiisli l>oM tiiilii-attona for <«rt^D groups of mcdicniak 
and from furh );rorip nmy be iwk'oti.'d the one L^jiemlly sdaptnt 
totlie IiX!al Hyoiplouiri. 

The following list enibraeL'^ moKt of the mixlidne;, whoec rail* 
able palliogene^ea and cUiiival liisiiirii*^ ^how ih«^fii to be vutimbk 
in thi:s di^eave: Araenic-iiru iov).^ Aurum mur., CalcAitA phos, 
Kcrnin) UKi.f H«-|mr m\ph, nilc, lo<lini(ini, K»li bichtoin., Ki 
bydnod., MerciiriuH, And. Nitricuin, I^tatilla, Saoguin 
Silictti, uiid i^ulpliiir 

At'M^iicum tW. I pnrfer to any otbi*r prfjiaratioii nf tlic metal 
for strumoti* pitticiitf^, witL pnle mncoii^ nieaibraitu^, aul mbI; 
empLionfl ugion die ffti^ t»r beiKl. Tbe cli:^'har£e fn>m (lie no 
iff ratbrr vutm' and irritjitiD^: the upper lip ami nnstril^ iff 
Tet)<)eD«il and ej(<y>riat«il ; the Selmeidcriaii membrane bt ridax«df^ 
ivdemiitous i^miinlnr, iiipensitive aDil, |KT)m|><i, ulcemtetl. 
pharynx tiMiiilly hIlovt^ llie ^mimlar nr hytH-Ttrojibie diaagi^j 
there 18 burning ruwnefiM and flight soreiieo in the ihrral; ih 
ton^liK ari' enlar^-il ; Imwkiiig to dm ihi.? tlironl i)^ fivqiicnl; 
tiniiiliM Atid |mi» lu the ear noi infrequent. The faiv has •_ 
maddy eoW: the pntient i?* wi^uk and «iL^ily cxliati^ted ; fugttiv 
|«urL4 in tbe Hj4«t, r4ore]i«»« at the roo4 of tlie lunj^, and 
sional bwin^ncsH nliow a t^'jiilcury to tubvTciiUir diri»o«itnMi- 
liuvc »ecn tb«e ^laptom^ ameliorated io a woud^rfal aiauner bfjj 
steady a<lminUtmti4fD of thir^ in<^dieine. 



TKKAT3iBST OF OQAOfflO KASAL CATARfLH, 



39T 



HffMr fMijJt. ctfi^. m\\s tm^^ of l«w$ lu^ivc wymiKomsi, in much 
IW same coaflcitiitions, ■ When indioaledt the naw-plianrBgeit 
mctiihniiic ft^is t&w uek) rwi^ti, !tn<l F<m:trtA i^iarply during; inspi- 
ration of n-inln air; rlieili^rharge U muoo'|>iiriiU'h(,^onK-limf« 
bloody, and not vory c?opioLifi; the »enf« of ftmoll i» frequently 
veryactile; (he now Ki(*OTiifs *t"pj»e"l hy ^wi'Ilir^ urn! rniHlj* of 
bad odor ; the e^'cs an? irritable ; Iherp is pain ami FcnHon in the 
frontal »tiiiW4 ; Ihc^ na^l boiHs nre Dore to tti4» tottch ; the upper 
lip k PtwriaUd aiKl swollcu ; (lie D<«tr[I« and insifk- ff \hv n***c 
are olVn tMveroil ^vith nmjiy liiyen of r^'^ib, uliiHi luiike the 
ptirt4 ri)zi<) and ibepassaires im]>erv]<^us: the ((msiUaml i^ulxuaz- 
illary ghind?! arc vnUiraUtl hy i-hn>iiie hyperplftiiia ; the EuBtft- 
chiuii iahiii are affctHei!, sn (he eari^ feci full nnd thi^re \9 rattling 
on Mowing (Iw- ii'w; ravt^tmus him^i:er :iIt(Tnn(c?i with indifferent 
appetite and the patient pre«;ontti a picture uJ' iniiliiulrttinii and 
feeblent^tH. 

Jin/i bicArom. ts ilemnnHtHl, when there in frftnhd lieailai'he, 
pain aera*w t\w l>n<l^ of (ho no*ie, jin^iwure and soreness of the 
nual bones; mre nostrils, climinbhe*] jiovn-r of tn^ll. irritahHiry 
of the eyes; thiek, tcnacioiH, uttcfnts (liM^har^, with <ni*ii.'i<ional 
eruata and binnd ; r^>nsi<h'fable drytifna an<l ^reat ^oreaesfi of the 
naw- pharyngeal mnwns mpmhi-nne. with ehi«elled-rtnt itU-erx herv 
and Owr*-; nli'«*n* mvi-n-d \iy w*jiIh iijion lli*- Hejirnra* with ]jerfo- 
ntion or tti<lertpr«id detitrnetinn. of tW curtilage; swelling of 
tliff lyniphutiDglnndit; muetnix mttliiig in th<* KnH(m*hian lube*, 
and linnitnix: rmif;hnew of the thrnal wijTi ho!irwn<'j«A, The 
n*mMly ift latitlfrl iW il« nnitKy|)hi1itiL' virlues, biif Kali hydrtorL 
i^ ]iriihAb]y more efl7raei<>iiH. The potash kmIu moKt ho iisvd 
Hparinj^ty tn anwoiia, as tliey are very d«4traetive to tlie blood 
fAajmm, 

Avrwn niur. U usaI in graver utate^ of uleeralion of (he mii- 
cou« manihriinir and ntrtiU^, aii'l in inirip< nf the tulcjiI honi<» 
froin eypliilie. The Oueharge ta greenish -yellow or y^llciw, eon- 
tnining dark gmrtif^lr*; fmit Ktringx, rriuitiL,niirl ivfib* arft n^mov^ 
from t bo anterior and por-lerior narw; respiration Sa oflen ini- 
prH«l ; the tvtiM} of nmrtll \s. hypprftpnieitis'tr or lo«t; the iiive iK 
Hiivulliju both inside and oat ; (he boQea ar« very ^nfliti veto pres- 
sure; di«oMe of the laehrvmal appamtn* <*wor* frnm obotruiHion 



398 



181 HUVAtl KAH A5D ITS DIBIASV2T. 



of th« dovmwun) flow of tuan ; Uic »r» urv HfToclal by cbrwic 
oatdrrb cr punituii di^aiae; aiid the palitnt is apprehcc»ite ind 
morwe, ^Vhv ehouki goM curedi«cn*e? Nothing in itjf phys^^ 
kul propcrti^iEi woiitd lead \is to suppose it trouli), So we mi^bt , 
my of lui^n^ur;, ziuc, and oo|)pcT, yt-t, cx|H-rivni!« ha>f prurcd 1I1& I 
value of all four nielaU in di^vmse, 

MercuritM tony he Twvit^wnry in graw d^-iiruHi-m <»f ihe nwd ' 
mucoiiH ineiabnine, tarlih^ and bones* II aiita milder c$ffv^ 
\}cAih-^, yvh'-n ihe mucous m':n»trane i« pnlcp gniy, flabby^ «1«t* 
at»I niHl lilMds ftLsily, an<) (he nostriU arc scurfy and sotp; th< 
DAHil bones are tender^ the Ea^taehian ttibe* filled wiih louciu; 
t)H' tlimiit !i1iiny^wiid Ihc niuoouA diftcharge grajrbb, felid, and. 
ruecaltic. 

A<jid. Niiriir^im. — It vnu an oM jokfi, thai the pmfe^»orai iht 
University of Penmylvania related aiioually to the claw about 
Ihi* elimtiiation of nitric ai'id. He siaid a eountn' dorcor gare 
nitrieaeid to hi^ patietit fo tftron^, thai when he blt^w h» uom* 
tlie mtienA bnmeil holes in hiA handkerchief. That*a a yeg for 
tnith to bang npoii. Xitrie add iff n-fjuired, when there is eojiimu 
acrid, bloody discharge from the na^' : die miKiiiM nieuiUmnt: U 
raw, i^roaular and tdeenited ; tbiek mucin streaked with bloiid in 
bluwn from the wtsQ or hawkeil oat of the throat ; faW. eaatily 
ext'olijiting ineriibruni*^ form in the (broat and n^ve ; the bontf of , 
itie nose and faoe are sore ; the ^rs are in a condiliori of ehron 
cfltirrfi, and tberc w dcafncH» and occasional otul^a. 

There may be defllruclive ideeration of tbe canil^^ri^ ant) booe^ , 
of the no!W from syphilis ; and tlte patient may tie sulferiai; fruia^ 
the memirio-^yphilitic eacbexia, aad be weak, peevinb aad de. 
prG«i9ed. In p^aeh ea?M^, nitric acid^ by furn^bing oxyifen to lliv 
!iy^iteni, Hliniulaie.^ the morbid tii*Mi» to healfhier artM>n, itn^ u|i 
the general system, and aids in eliminatini; Ixilb tbe Eyphitilir and 
the metallic p4:iiaoni^, 

Kfi!i hi/dri'i'l. ]» not U4ed half enough in Danl catarrh. Ii 
good conHtittitioDB, having a rheumatic or gouty diatbe^ it k 
reiiuirrtl for nas»I iniiirrb. wlih alt«rnatioiM of acri*l watery iW ' 
charge, and of thick yeUo^v macu»4. Tbe taucom membrane of 
the throAt u miially in the hyiMirlropliio or granular stage; thai 
of tbe nose h deep red, glistening and <edenuitoa>t ; uaea] ruqnta* 



TKB4TIS1XT OP CHROIfEr^ VAflAL OATAKRR. 



sm 



ikm ifi Alternately obstructed and free ; ihtt EuMadiJaii titbct! and 
€trs4 an> wimi.'U'hat EifTvc-ti.^] ; thi* (iatH:nt h foiitl of Hie table, and, 
if a man, sinokc^ aiid^ perhajH. tirinkft liquors* 

A Duiu I was trwiting for Wright's ili^ease, received Kali Ay^ 
JriW. for Minie weeks, «ii<) wiii* rijro<i tif n olinmit? i»ii«il ctitat-rh, 
and (kUdruc^lion of the riglit i^ide of the no^, which he assured roe 
Ik ind liad lor twecity-two years, I'he man s dmnicteT iva$ 5uc!i 
as til rendi^r hi^eviieMoe ivr^rtWEly reliable. The renutly ni&y be 
lued Ff)jurin^ly in f^rrunta with HWoHen j^tandp^ uod will be fouml 
very eiHt'acioLis In all syphililit^ cises. Iodine U snltable lo (lie 
sirumoiip^ jind ftyphilihc puticnts but not to the rheumatic or 
gouty. 

Ptdtatilta \\^^ iHvn mentioned, as snited to mild ca?<» ofchmniic 
catarHt. It i^ i*A|iecrially adapted to leiK^o-phlf^matii: palit^nU, 
with pale, atonic^ nnd nlot^nttud ninc<»ii^ m<^^ml)ni)ic ; it bland yd- 
lowidi-green miksius dimiharge of ctflen-iive cheeky odor ; fiilne«t 
al the root of the nose; rawneetf of tJie threat; fulneaa of tlie 
4^ans nod oenmonul ttntiiluf^with hc4u)achi\ In womciif the na^t 
€iUrrh H better during: men^^truaiioii, and the disrhar^^ aliTifMt 
Cflaaea, only to b? grcutly incrcawd dnring the interval. When 
tbeiliecbarge i# profiist\ the* paliont feels hntigrynll the ixva^ 
and will want something to cat a few minutes atW finishing a 
Imrty dinner. Siich hlh** anr grwitly btn<-fitcd by thii4 fn4?ili* 
€Jne. 

Oii<^trfi ji^fw, itt ]in)l>nbly the niOf*l UM^ful rpmody for struin'HM 
ca.ses, Jtconibinei the nounnhin^ and iiltumtive pn>(>erlieA of 
linii.\ and the niilritrve and etiroulatinf^ projkerties of plKiaphorus, 
and ntay l>e employee) where the vymptwnM (n>rr-tvpoiid with 
tiwfW of OilcunuL <urh. and i^hu^phom^ In many ca-se^ of 
diaeaiw, wl>ere (lalcarea carb. feemH a|^>ropnate^ and, yet^ then.^ 
eii«l« a fi;rent d<:al of ann^mui an<l ncrv-'oui^ imtubility, tliv phos- 
phate will do much bttter tlian the oirbonate. 

The syttiptom^ ^.iillin^ for it» odmini^tintion are ; malniitritioo 
of the oweoufl tl^^uc^; impericct digestion; frontal h««djiehe; 
|)RK6Un? at the rtmt of the no«i- ; F^upra-orbilal pain on one or 
botli »idci* ; a inihl initmMH du^har^, inlxftl AVitli ofit.4b< and, oc- 
casionally, with blood ; roti;;hnew of tht throAt : downward paa- 
Wgeof Mcabs in the pharynx; niure or Iea« obstruction of the 



400 



TniE BGUAX CAR AUD tTfl PtfliASVS, 



KtihUUThiiiii lubcn, wllli tiimiliitf und ilmftHMw Ttie nvani ui/tm- 
hnnv is |>^le, fiiiij^i-tuj^, fUbW arHl ulcerulvd; iUv ilirimt »liov>< 
ihv ulriipljic {>ltiiryiJgiri^ : the pulalv in rn<|U(^illv r\-ljtAtUj «aii 
tJ>o e^rs full and ringing, 

as Calcatra pbo^, but movt- iiank-ularly itididititt, Kvlnn tbv' 
aiueniia i^ pruAHiiiil, aiul tito |K>wcrH of cli^;otitjo and smimilatioiij 
UfT tnudi wirtLkrutnl. Thi-n- in iK»t u nliAil^iw ivf ti iloitlft iiUiul 
itvn enriching tiiu blooJ, wIr^ii julniimi^ciTid in Mnail dae«9, 

Wlicfi iK' HyMi-m will not nUtnurt iixki frtmi ToihI, tt will tv- 
crivi* und rvtiLiti it from mintik* d"«c»j buanise of «orac myr^tc- 
riouh tonic iullui^nix; til*" tiit^tul m.-eti)H lu exerl fipon ihv ■tioiimcli < 
unil Hbc^rbt Jit »y>ttvni. The kxIiiUT in tliiji [fn|iiirati«>n i'xerdwfl 
it& umtal ahcraiive Inilueoce upon morbht tiflsnea luid glandulov 
ttililtnition^ T^'> ihut thv nrm^siy is 4uit(d to chronic nasal (ttUrrti 
In strumous |>frM>iiH. 

It ntiouM be administvrrd witm there is anicniui, wtvlcnen* 
glandukr enlargement, rougfanf^s of the tliroat, hnnrsejie«, niw 
sore fcclin;^ ill 1)kmiii»€, <H»nlinuotL<< ihiu uiticoti^f di«cbin^ l>»n} 
Ihc DO^r ftni) thnuit, i^^Iuxalion am! ulfcmtiiMk of the ScJinvitb 
ninc>ou& metnbranei and tlm rariuble «ymptciiiK of the nanl 
dij«onr«- 

Satiffuinaria h^ a limited range of tuition in tliw diEcaa^ I 
ie better for t ho acute stage. It b said to promott^ the absorptioii \ 
of polypu^f but the cvidt^noc af thlri power i« not volumiDfias. 

StitjJiur may IjG ue^W ikhuu iutKniirreiii r^jiifuly, but ctuioc 
be regarded as having any specific udioa upon th« discaso or thi i 
€OD0titutii»nHl ?-lnlv which acn^mpuniv^ )1. 

Silicfa has ati inipo^ng pathogenesis, but it is dil1i<^uU lo aajr lioir 
much i.4reEiHb}e. Thi^KymptornMCttUiiig ror^jlicman: be 
bruificd p»in over ili« ej'es, irritation and infjatumfltion of the 1 
vyi»; eueexing, ivilh dryiii'^uf the na^il (nt]i*oii» cncmbmiK or 
an acrid corraling di^'hurge; oc-casinnal bleeding of thf nuar; 
pricking anil Mf)rHK-4< of thr thnxil ; tiniiitiiiip fuliK««, und pain in 
tlie ears; Ijoareenet^^^, and dry haekiujr eough. I cannot a^ooin-; 
mcndi«ili(X'aeMhiiKnu4lii.<ally, a« it ha.Hdi.^pjH>intitl in<^fn?queatlf.' 
I liiink some of the other ni«dicitiefi mentioned above will provr 
more t«atij!LnKHory» 



TRBATMBWT 07 POLYPUS. 



401 



Tytaifnaito/ /'*>/y;>u«.— Th^iw litmonf nivcr exist in the new 
or phamix wiih<»ut some d*gr**? of <:ararrh, ftnd, indeed, hpc 
P'tit'nilly im-ix.tliHi by i(, to timl ihc pn.>|rer mciLicine for lh€ 
catarrb wjU l>& the moet ajipropriate for the nMiiovnl of the 
(lotyptiH, Ualcurca r^rb, Ksli bjchmm., Hu)i<atills, rho4]>horas» 
fSaogumaria, t^ulphur, and 'letierium are tfH)nHul^reid jxiiterfiil 
Kmctlifii fur rtinovinif tliu ^xemM^frfiow, 

That internal mediHnaJ trentfuent haa eurnl |>olypi^teem^lobc 
Hv!l r?<|ftlitislnil, nid in nil oiwtf one may tn*»t Uiv jmlk^nt m- 
lercally, while tarrying on die local treatment iiKJii-nled. Whm 
nmi» for tho npcvdycuTv of p'>ly[>iH&rt'at hftml^ [ihJukit vouM 
be im]>ro|K.-r, lo ^y ilie I«iM, fo |»W(M)ne their iise until a Kin^ 
courvoof inlcrrtil mi^iiciLtion hii^ imnn trii^L 

In addition to the eleflHAiiig ajul medimtecl Htjidn empliyi'tl for 
thi.*coiidTti(mnc(H>inpanying jjolypoid tumoru, 1 wonid ndvi^ the 
application of ittroiig >iiiUuioii^r and, even, ermle ttitl^sitAiK^^ di- 
mnly lo ihe morbid growth, whenever it can be seen or felt. 

The fluid Hj>[ilii'At]onH should he mmle :villi u bruHl or a ^mnll 
pierc (►f !|K>nge in a holder. Tlic handle should ho fli-xihle, t*t> 
it can \k bent to n^ach the growth through ttie nc«tril or up lie- 
liiniJ tfw' [Mdm- ru* iloirttd. In t\m hitter <tiw?, it will Iw nei-^s^iry 
lo n^ the throal-mirror to direct the in^criinient or to employ the 
flngvr nj» ii guide ^ir n ^\>vi'\i\\ inr^lrunn-nt. 

I ha\'e devised one, which I call the (iuanle<l Sponge-holdtr; 
!t trrminut"'?* in ii tiny cup, holditij^i ^m»ll 6ponj^* iittuebed to a 
di^k, dial <^n W projected and retratrtcd at pleasure by a ptstmi 
workiiii; in ihv hollow r«tiMii. 

The cnp limits die apptiestian to the |>arl touched by die 
sponge; thr «pon'^- i» pull(^d hiit:k mm the cup ufti-r ils fluid i^ 
»()ttee^ ont by flii^ pUlon, aiul ihe \\\Mth \^ withdnivrn M-ithoot 
aiedicstinj; any other than the |iarr intended. 

Aoelicanid iAci't. .^<v/lV«7rt^, TindurtMif iTwnfTr- /V/ri eJi/or.), 
lohUttin of Snbsidphnte of iron (Liq. Fmi mtbaiUph^hfAxxiio^ of 
Kinc MilpliJiIe [Zmvi ittJph, .*^, Aijun dcM. f^), and ?iolntiL>n of 
Kilrale of silver [Argtnt ni?. ^, xl, At/ua ilett. f^) are the 
Siiidf I c^nploy for |xityptiJ» and ihu {leiruliar adenoid tumors id* 
the naao-phar}-n3C. 

One nni?it be ear^'fiil not to Inke tip too much fluid upon the 



40S 



TUB HrMAH VAft ATID ITS DldfASKft. 



JnBiriim«nt, and lUen ilrop it upon oilier parte Uian tlioee ilmin^. 
Il is mfliciout to JippJy "»^* "C iJittW l'> tint Mirmjr, iwk^ or Uitce 
tim^'i) a week, and tbe uthcr local measure should be carrittl on^ 
as tt«u»t. 

The hyptKlermif fivring^- may bccmptoyod to iiy^t ont^ of Ar 
above rcim-iliv^r pn^ferahlv the Aoefic a^id, vrlivii tlie tumor b 
(^LHily re^'hecl ; there is mk of cau^iu]^ etnbolUm if the tumor b 
very vu#7iilur^ mid tliir melhod t^ not nHxim mended ia .such caw^, 

Ur V. K, Tpsoii, of Atlanta, Ua<, has invcnttd a very iiwftil 
ftvringc tor injecting uiul dt^tmyiug turiiL'>rs in the na^to-pharrDi 
niu] Un'nx. 

" h consists of an ordinary hyjxxWrmic 8yriiii:i% jn^ividni willi 
a long liitllow nii-dk-, \v\m\i \» pa^Aed through a ^^ilver t^inila 
properly curved at its cxtrvmity. Tlw* otiter vurfiLre <)f tli* ii«eille, 



:^ 



Pi(«, lOL 



%jA^\UX1«^^«« 



Urwx'H TvxOH Syuixiiic 




a fihorC distance from its attachment to the s^rin^, hu eot | 
npr»n iti^ ?(urrnrc a aM^row-lhrcacI, whldi is fitted witli a trav«na 
nut, to r^nlate the depth of punctnre of tW growlh. Two 
sh:inki4, witli fingcr-rcKts at one end, arc pa^&eil through riugson 
the Mde of ih^^ svringe, and iittw^hiH] M ilmr oihtr extrcintly hy 
m<9n# of iK-t-*KTL'Wif to the canula, to enable tho sui^^n to ojx^ratc^^ 
the instniment with one hand. The flut vringa at the end of the^H 
»yrinf;e .Tcrve a-* lbnmt>-r(«ti^ The lip of the canula » mwAr to ■ 
un»crew, and in its plaee nan hi* ftttod die Hm- »(|»my-ji^ wliHi 
aoronipHiiicf the im^trumcnt With this jet, applieulii>ii.'< of *oy 
di'sireil medlcamt^nt can \k iiuidt wtlier to llie pharynx or loryni. 
"Tlie modtin 0|}crandi of the instrument h briefly de^criUd. 
Fit^ cbirj^ the 9) riugt- with tb<^ dc»tri^ quantity of tbe faolmioii 
to be injwt«d — say Aceiic acid, gtt- x-xv ; then pliw^e t)i€ {Mticnl 
ID a good light—either direct or reflected — draw forward sad 



tUBATMMT OP POITPU5, 

ilepre^ the tfm^ue with a pra|icr instrunintt, whirh m&T be iii- 
tni»tL-d t» the fi»tieiif to holtl, or ibc ti|> uf iUa Umgne^ nmy tie 
covered with a napkin, <imwD forward, aud leM out ol" the way 
by the putii^nt. Afior euiitioning itifr pt^ticnt t^« Uirnlhi* i]uivtly 
throQgh iIk; no^, introdunc the rhinoAcapic mirror beJow and a 
little back of iht' |niluk<, und^ xvi »ix>n as yai i^t^^tire a ijEood image 
of tbe grrwtlt hx the mirror, introduce the ca»ula with th« free 
hand, project the n«odlo the de^^irvd dopth into the f;n>vvlh, move 
the tlitiinb iMck from il.'^ ne^^l to lie pi^ton^ and slowly injeet tlie 
contfiitfi of the syringe inio the tumor," 

Tannin, Ahimen cx^t(i;iitiini, Cid>chc»r Auitruhana, luul Tou- 
rtium are ofien used in powd#?r, aod snuffWJ in the note or blown 
npun the €Xcro*am<*<i. 'YUta latter \h nnich the Uttter metiiu) of 
procedure, as tbe sub^taiic^ can dms be in a measure limited to 
the growlli. A powder-blower i^ the U^sH In iii^e for lhi'« puriKMc* 

Ascertain firel thai the tumor can be reaebed, ihea take a little 
of tlx* puwdiT ia the lulx\ |>lA<e iw di^^ttl end agaitivt ihe tumor, 
«iid blow Ihe powder out. It doea not laatli^r whether yot; do 



f^o, IDS: 



V 






thK by conno?tin^ m rubfK-r tubcoran ftir-bng with Ihe blower, 
though lh« latter w niore agreeable. AtUr *ucJj an appliealioii, 
it ie bcftt to f^UF^i^cnd othcT local treatment for a d^iy or two and 
mteh its effivt. 

When the tumor 11^ quite lar^, and local manures and internal 
incdiratioD have been fairly tried without »u<.^?e»!f, ^urgieal tn;ttt^ 
ment mu«t be raiayeil. 

The problem is to remove mt-r^hani^-ally a tumor from the nBfa\ 
fod«a or up}KT p1mr)*n)c. The u^ual meElioda are by ligaiitre and 
by forceps. Whenever the |iolypiu« is within n-adi, and of audi 
a «hape that a ligature can \v tliniwn around it, I prefer llie oord 
or wire to the roreei>j<. 

In applying a ligature, a great deal of patience and maniea* 
veriiigisol^eD n cccwa ry. Insomeca^es^thewireloopof theWitde- 



404 



Till UrSIA}: lAR An^ TTS DfftlASS^. 



niake snare or of (lie nasal pal_vj>ufl canola can 1» di)i(>eil orer 
tV- grrtwih luid tlio lliitit^ rut off in a frioe. 

Id others, n silk or wire lij^atiirc must be pe««ec) around tbv 
Uinior by t)ie aid »f prolte, fonvpis arieiinKni iii«dlc or B^Uoci|a 
I'&DiiU, One must lodk, and work, mu) fake i^v^fulW, in ard«r 
to W siiot'OiwitiL 

When llir ligature us once iroum], it sliould he pwhcd imt 
tli« podiole, ^ravrn tight, and twiftcH and pulU<d until tlif^ grcmih 
<N>mffi avray. [l is not Af^reonble 1l> ti« ami Iwvp il iit pcrtiiiim 
iintit alotiglitng CHVUis. HifOiorrhft^ U ti^tuilty ftltght, jtml ctisily 
controlM by cold w&t4_-r or nn aslringvnl, 

Some years aga, I liad a ljir|rt' pyrtform iinlypus in ivmi>v«> 
from the imt^tcrior rmrcs. The ^rovrtli ypr-ang from tliv f-[>bt-noiJal 
re^oDf and hung ilown into tlit^ na^o-phurynx. 1 failed In |xi>ti | 
a loop around It, Eind iiip|»e<l it with fohvjB fio tliat it bled pro* 
Ai»t-ly. I did not like that n<T the prOKpt^ct of alnrndnnt licmfif* 
rha^e in ihe repon, m 1 workod away with a lij^ailure. Finally 
I ^Ki9asl Bc1l'>cq*^ iiiMnimf^t UfK>u th^ <Hilcr fiileof ihe tufiior, 
and drew a Mrinjc tlimiiffh the mwo; then having; reintn>tnwl 
the instrument, 1 ^uccx^ifk-d by (ririiiu^ iho lH*ak of tlit* caniiU 
nroatid the vomer in f^ettinfranoduTnonl through iht--4fttnr' meiilns 
inftiiie tlw morbid prou'tb, I knotted the two cords from the 
mouth lo^^thcr, dix*w tin* In^y hm^kwiird tttid tirjwani by pulling 
upon the other ends, and slipped it over the tumor, liken I 
twirtTfMl thiT ci»rd» to^rthir hiin), pulk-d imHlrrarcly, atui hid tbn 
siti-^factioD of drawing a rather firm mucx>u§ palyptts o«t of llw 
nof*e. 

Many iurgeons prefer to use the forOTp« for ibc removal of , 
mt< find polypi, nnd thi» ii* th** niM*P'*li*'!it and imwl bHIIiiuil 
methoii of of>eratiiig. The |>attent shoidi bo wated in a good 
din.*ct or rt'ilwtwl light with the hftad ihrfiwn a little Wk bchidsI 
a. firm sup|>ort. In npemtin^ through the throat, a slip-noow 
^'hould be put iiri>iifi<1 the uvnin, fh^ Mift fidilute drawn forwuid 
by it* the string fastened between the front t<Nftb, and n ccdf 
pl:wyy! he1w**('n lh<' jhwh In k<Tp them ft]*<*n. Removal <if n pJere 
of th(- inferii)r tJirhimiHil hone and a ]>r'iirt tiiijc side of the se}ftmn 
hnfl been ndvi^. The pntient should Ik? n^qiitn^l tbiring th** 
opf^nition Ui hnwtht' thmngli tbi* ncwe if |M»flihlo. This will gite 



tRRAt»B3fT 09 rotTPCrtt, 



40fi 



inorv room to work. Tlie UiraaMDtniir anil index finger afx< 



Kh.. 100, 




The loi^tion of tHo ttimor kavmg l>eon nHrrrniiicd, ft p<iir of 

Fto. 1M. 




^i!v"«^* 



the nostril of wliidimdiUtL'dbr a ppiviiliim.ori'Uenp Ijctiimlthr 
jralaU; the j^wth slioulil lie wiaeH Ormly, iwUed oj? much &« 
{jottiiblr u'itli till- iiki4rumcn(T torn oir, uml removvJ. 




Fai^wCm FoBCsn. 



Vftrintu iiJiikpcfll iftotrumenM are necofleftrv to tii«<H ihi? trains 
AenlB <^ nil difbw, htii the tncnt gosenll; tucful u ^urock'n 
forottp*. 



TSV nUMAV B4R A9D TTB DlflEAflKfl. 

Tiic«e are ntij^ular »t ihvjiiDi^ion or the blades and lianiUcs 
aod bavi* feuestmted, &ermt«l b1acluft> 

Kaimx'IV ]vilv|Hi< ron^dp!* Jirv strongly curved ami adifiUdl 
both iiaso-phar^nx and laryox. 



Fio. lOSu 



ij^i:t*j.*n ID 




Novo'?- Pot-vpc* FoiKiicP^ 

Aficr till' liinioT has b^n remnv^eil a.-^ thoroughly a^ pcKisiUt 
control (he bltx^Jing bv gargling^ syringing, aod douirbing vith 
cold water or a^tringt^ulK wlimi m^oe^^ry, ami coatinue the tmnl' 
nifitit proper for the discas^ niui^^us lucrnbraiH.*. 

Fttr thi> tturgu'iil Ircalnient of M^'cre or comp1i<:ated cases, Uk 
reader tnuiil refer to works npon general surgeiy. Dr. Htrlmtitb 
hit^ a full oxpt>!*ition of tbc«u1i]cct iu lii* SyM^m of Surg^^^ 
give^ an exoelleot r^iiime of an operation for resection of ll 
now for the reoioval of polypos, 

TretUment of AtfcRoi<i 7\tmor9, — Tliew growths in thi? 
pharynx are trcuu*<1 niiirh the «amc* m polypi, for whtuh the^ ; 
genenilly mistnkeih Having made out ihe sue, sbapf, n>lc 
<\>n9!ii:4Km'y, |>o»ition^ and attiu'hinvnt of llie morbicl growtl^ I 
|xil|)at]»n ami ius|>ecti<in uitli the miri-or, the condition of dte tnd« 
^H>iir4 mfmliruiU'of Tbeihiifimr rthimld bt* oWrved, and the treal< 
m«nt determined. The medicines iLN:d for polypus, and Bono < 
thoM under <'hn>n;r' iitim! <iHarrh i*Ijonld be Mudi«d, and 
indieated Iri^l awhile. They will probably pruv^ itfielcas,AD 
local tn*atnieat mu«t be iidoptod to ofTeti a cure. 

When the lumoni nre flat, £>e^[Ie, rather smoolbt anil nulnc^ 
oils, tht*y [»u«t be Ircaled by oittrinjjeiiL** and cscharolii^ a* 
tempt?4 lo remove them by iriAtrunienta would injure tlic miic 
membrane and cau^ unfortunate cicatriot^ 

Thi> lULKid doiii'lK-, poHt-na.'wl HyrinKe^ ^^ alomieer, 
the Mdutionn of ^tt, muriatic of ammonium or vhlomlc of 
flium i^hoald be nfuai ituWy to cleanse the part$ from the mor 
diBohargeK^fierally present; tliena mlution uf Ziiic^lphate grJ 



TKSATUBjVt OP ADKHOID TPHOHS. 



Xf of ^^ilvcT minitegT. xx, or ai dilution of tiriirliirc of CI]lorii)«' 
, iTy)r lo i?y f>f watar, shouM be sprayed in:o ihe pliaryug^aJ 
\t upon llii; tumom ^vcrv day, aind a i^rgk of nn o^vn tei- 
tpoonfal of ttilt to n pinr, nf wat^^r n^ Hoon aflerwartU, 

Tw'W* a m?ck tho morbid ^roAVthe should l»c touchwl with a 
bnisJi or rbir ttponj^c in M holder, wet with Silver nilrate gr. xl 
ill dwHIIH water fi^, or with t!m pore tiDcture of Chloride of 
iron, And after waiting (he miniiti*^ for the ivmtHly to ad, a 
mh wafer gurgling and synnging or douohtiig mutt be hud to 

ILiniJl ejtterwioti of the aetive j^^nt eniploye^l, 
I If tbeee nuttsuna with hygienic iv^ulatiumand internal oiedl- 
mne) do tif>1 make tlie adenoid liyikerrmphy ditnininh, und give 
Ugns vi (itsappeariog in a few week>4, It would Ite propee lo a\*p^y 
pure binar caustic to the outgrowths. 
A ^ih'tr pmlw* lient ti> (he dcnireil degrt*<* shoiibi Im> <lip]K>d in 
fu«<tl pure nitrate of silver mid eooled. Then the uvula rihonid 
be dntvrn forward aixl fnAKiiocI, the [mlient mrtlriKled lo breathe 
tbn3Ugh the nose, the tungiie hdd down, the throal-mirror warmed 
Knd intfvNiiiPed, the prol)e mrrictl inlo proper i>winon «w styn in 
the illuminateil mirror, and itA CAtislio rubbttl bmkly upon the 
tumoi%, Ic is impurtant to uae agargle and douche of suit water 
five niinnloft aOer thi:* applK<alioti, ii?4 the eaiiftti^" di^dlvii^ in the 
mueons diM-liarge about it, and, iinle^ neutral! awl, will run J«wn 
tlie pharynx and excite ioHiunmatiou in it, th<f fir^iphagiiH, and, 
I>erli»gis, the lar}"iii. In the iniervalti l)elween the ctiuBtie nppli- 
catt'^n?, the f-anie eleani^ing and o^trUigerit ireulinefit sluHild l>e 
followed as deuribed above. 

When the tumors are nodulur, pedunruhikHl, pynfono or 
rougli and JAgg<^l like (be cM^mb of tlie cock, and astringent and 
cauAtic trmtmcnc dooE not remove thcin, it will be uecowary to 
retkorc Xu L'[M«on*s inj<<*ting, to ligatlivn, oniAliing* aiid iwUtiiig oS 
with r«n:«p«f or to ablation with cutting; lostuioicntM. 

I^arg^ tumom may he !njei*ter] with nretie aeid by I'jkMn'A ny- 
rioge. Tbe hgatuie and »naro are seldom ap|dicable, and thtir 
use re<]iiireH DO der^TJptioti beyond tli^t j^ven under tbe treat- 
ment of polypi. Forcepjs of proper »bape giiidt^l by tlic finger 
or mirror may be pa^^^ed tbmujcb the ii;\aal meatus or up l>ehijid 
le palate, and a tumor ^izcd aad twisted out of the pharyn- 



40ft 



TBB HUVAir lAR AEfD ITS DI8I49H. 



(*nl vftiilt, <»r cmtfbcti bo tlijil it viitt plough Rway ; bat tbe 
oi>erarmEi is difficult iinlefe the e^ccresceooe ih quite lar^ and «Mi)y 
rca<^h«d. 

A timing iQsmimi'nl ie* generally nectM^jirjr, l>eweiibefgr»- ' 
oi>mmen<li> ti nuitulily ciirvcJ curcttej wilh which ibe (iimon* can 
frequently be scraped ^way. ThD u^/e, however, is difljnill, uiil 
he- (uvfers a cutting fortvps of his osrn invcDtioD, I tnnhbrv 
hifi dfsctiption of the inxUuni«ikl ami hi.'* niclliud of using it 




LcxwK^juKMi'a UcHTKti L'vmso froiicsn^ 



" It iii a (oTxxpSi tenuiiiated liy two cuKiiig bladw of wbich^ 
tlte sharp edges aro applied ii^iriii-t cud) uHkt w]i<*ti the itietra-' 
mcnt ]» cJoo<ed. U pavtc?v<i.^ a ilotible curvature in S. The Jdvt ^ 



t'lo-lO*. 




IxKWKKarnoV Aicoui-Aft Ci^rnvo Pobcicml 

ia placed near tbe bite iu ord^ to prcs^rv*' a grvat lenKlk of 
limnohw, which ^vw n p<>worf«I l^vcrajire arwl iwrinil^m^y nil- 
tine. The beaka cut by closing. Tbiy arc slightly rouDded ami 
excavated on their inner faoe. 

" Thi» U how wo enipW i>nr inMniment: Guided by llie rii^ 
iiottcopic mirror r>r by the left uukx lingvr. ww inlrocinc«8 ibe 
forcepr; cki^od^ tJicn one opciM thcni and euta tlie vegetation tbe 
n<<iin>t p<v^ib1o to itH hi^. 

"A single cut !j« i^uflicient for a -dender pedicle or the haat of 
n Maftile vejretation of mnall dimensions; the voltiminotis tumorf 
demand iiutarally itionr cuts of ihc instniinenL It in tlie amiefor 



% 



THBATUVfTT OF SNLARGSD TOXSILB. 



409 



Uiv tniv |Kily|]tp llmt miv cuii o\KTi\Us upoii tniuuliv well hy uk'sup 
of our bi^iruiuenu*^ * 

Tlicp; It hIwavs mi>rt; iir )«« heiuoi'Hin^ iiAer iiinlruiiieuU) 
reiuovul of cli^sc UiiiicrH, auil a coM vrali:r or ustrin^ciit Joucbe 
iir iitjiH't ion tiiu.-ii 1h* t-iii]i)ii}-cil. Iij flevvre uadtH^ [auiitu or ]h>w- 
d<rn>) niutu may bu blown upon Iht* bkiiLini^ »iirJitc\^ ur a large 
tuoM coiu[>i'&«i nilled Jii i^kber ut'if^liX be hM Hgaintit tlie vaulL 
of the |ihur)'ii3c by a striug ppswd ihroui^h tliti now, 

Vheti iti€ mlf^ooEd, tuntoTH or |u>]y|)L prevent reii[)traiion 
thrush the iioM after Ihe pas§agef4 are cleareti, tJjp Kii^tachiaD 
tiibet and miildlv v^r mimt k* ojK-ni^I, and ihv mucri.^ dru'cn out 
by re|>eited strong inflaciDDH with the air-bsg. The same system 
uf dentiiiitig xim plmryiix aikI iiiakitig topkiil ti)t]>li<3itionrt nuU- 
mWe to the morbid conditions mast bo continued, awordiiig to 
principles alnfldy laid down. 

Tr^atitiTfti of EnUtrtj<^ TonsUs^ — This ifi generally associated 
with that of c-hmnie phAryii^tti-S Imt I ihink it better to keep 
Ihc idRvtion?* dt?(tinrt. 

Hy|>erin:»phy of tlie tonsil \a easily airwl in chihlren^ ia«aid 
\f> dimppcar »pontaDeoUHly with the advent of puberty, but is 
rtfmt^tory iu adults^ 

(iiandular hypertrophy indioatm debility, aitd every means 
DU^ht to U^ w^Hl to improver tf^e geucml heailth of tlie patient, 
Tbc throat sboukl be gargled evoiy morning and evening with a 
Bolutioo of an even tt^^pooufiil of ouoiiiion mlt in a pint of 
water. If the patient \» loo *mall to gargle, the solution may 
ht applinl to the thmnt wlili nn atomiix-r When th4< tout^ili^ arc 
nd, tender, and nl-crated, a &obUioii of ehloralo of pota^ium, 
gr, xvi iu an ounce of water, will \m\vi! mueb more efticieiit 
Ihan tJie salt, and raay be »ipmye() upon thr^ glands three or four 
timc» diily. Another topical application of decided value is tar 
tinelLtre, f5j in a» oniu?e of water, uwi in the ^nie manner. A 
Holution of nitmto of mlver, gr. xx inan ouuoe of dbitilled water, 
appIitHl to the tonitil?^ by a bnish or tuft of cotton on tlie holder, 

* Lea Tumcimt Ad^ncjUld Uii I'liarviii Nanat; L«ur ludutMku^ bur I'AudE- 

tnUrjf ; V. Adrii^ii r>«Uluy« ^ L1«. Llbniirt-fEdilMirt, ?lA(«de I'^xite de 




410 



TUB HDMAV BAR kVT^ m t>lgBABS9. 



every otli^r day for nmny wrecks, vnW caiik a diminiicioti in auc 
The loiiguo ali(iiil(1 !>v hi:ld dowu lor a few nsmutes, iumI ibni & 
nail ftoliitioii »pj>ltcd to DciiUnlixe niuJ ^mii the ftctinn ot tbt 
reruedv. K^jual |ur(ii uf gljoeriiiti urul titic-lare uf uvliiie orvT 
^ya*riite aiiil tiii«:tun- iif tl»e ddoridi- of ip>if, u|i|flk-*l tn di« 
auue iiLaiJuer, art; a^ vQit-ifiil a(h1 mtht^r moi-c< o^^rvi-ablt* to Uv 
patient njjd ph/^idnn than tlie niver mlulioa. A »hurt tiov 
lifter i\iv upplluitioii lijtf uiuulh ^liuuld be riuwd with wajer. 

A nwnt writer uwcTtfl, lliut etiliirjj;vd toruuht may be cauaHit* 
uiiderg^i .slirinkiitg bv a[)jdyitig to them <-very day nr two cnjife 
Lacftrboriate of i^odmm. 

Amilhi-r ttuitlifKl of Itidudtig retiu^fude neiaii]fir|)t]«viu Si lo 
inject ](xlinc itico th« glaDd. Tiilj* j» \\us iiicwt i*t1r<-lu:il way uf 
shrinking an enlar^l uiDfiil, and may bo tried before rcj^rtlo^ 
to ablaiion. Mix live pariT^ of liitdurc of iodiiio with finecn of 
al<:o)iof, dmw thi^ee or four dmpA inc^i a by^Kxlennic or tl>e Upeoa 
ayrioge, pusli the eyriiigc ntvdk' half an inch mtt> tho lomi, Una 
vfitlidmw one-f<nirth of nn inch, and injwi the eonti-niii iiittv ih* 
Ciesue, Tbrte or four Lfijcctione in a month will be* KulFicien^ 
and jmjirovoinait may be confidently expected vxctpi b llie 
oldest and worst cases. 

The admiiiiftration of mcclictne« i^hotikl commence with tte 
gargling nud ^prayin^, and the mlver or iodine ought not to ba 
resOTlisl to until the iRtcrmil n:me<.li<vf have hail a fair diaoee tP 
ciire, and liave foilKl. Two or thive months trenlmenl will abtjf 
whether {\k ton?<illardJiB(.ih7(c in ytelding to Ihe wcrot anil iaeU- 
iouAaolion of the internal i^nt. 

A^u/phur in njeoninK-mk'd f'>r n^-nt hy|MTlrophyj when thf 
tonsil i^ «4vo]lpn by the remains of inflfmimalory exudation, raliiif 
tlian by }&yp(Tli-r>pliy of r.he pn>)H^r tift^iie elcnieniif, 

JtlcrcuriUM is more valuabk> than SnJphnr in ttib same K%mi> 
tion, espeeially, in young t^uhjei fit, mid ^Ijould be given roratiiM 
ID the early treatment of all but the old caMs. 

Bargtxi carh. in highly praihcd \ty autliorH, for patients with t 
tendency to acutcr exacerbations of tonsillitis, ronsiderabte limi- 
ne^ of the gland, and [mrc^ii^ of the tliroat EniiM-lc«. I believ*? 
itB virtuefi are very much ovcr^itimated^ 

Calciirfa phot, hiis :i ik^'idwily iKriiefinal netion n|>on enlarged 
tonfiilH,aE upon swollen glands elsewhere. It b inditaKxl when 



TBBATMBNt OP KKLAI10B& TOKSfiS. 



411 



tJio ^land is Urge, pate, flabby aiicl^ p^rliap^, nlotratetl in pbov. 
Id all jUnimotis ch^ca in voiiiig [>en^ii:«, a eourw of Phi>flT)!iale of 
liin« (limtnifiha glandular hypctlrophy ftnA improves the gtuK^rsI 
health in a ^nq>riMng mnnner. 

Calcarfa t^ tA a valuuhl? medicine (or hypertrophiett tonsilsi 
wh€ii they forna red^ no<]iilar liimors of 4Y>n^i<^'raMe hardoeas, 
«14] dt^re itt much ratarrli uf tlie ttmiaf, with frequent attaclw of 
hoars4>ne88. 

Whon I ical mwisum* nnfl intornal m«Ii«ilion have had a fair 
iruil, and hftvu failrii Uy diuniiMi fonjijltar Ijvim rti\>i>li)- 10 a aiue 
oMi^^ifitcnt with comfort and health ] whea i^nc or botli of tho 
tonsils ia quite large, very finn^ anil u iwrhu* ol)»tucle to the 
pfayaological action of llie lliroat, then a 9urgtml <>]>eralioa is 
di^raandcd. 

It U not Recef»ary to remove the whole (onMil. Kxfierienoe 
lia» provcid, that if ^liberal ^lic(! be taken from the gland, the re- 
mainder will shrivel and Hhririk lo a modemte i^i^^. The (latioat 
should lie seated en^'ct in a j*ood li^ht, the mouth held wide open 
by a cork between the molar teeth of '^ik- t^ide, and the toujcu^ 
Iw^ld down by a depressor. Then pa^s Fahn^^toclc's tonaillotome 
back to tilt UimW ; ctfirry it9 riuf!^ over tlic t^laad Lintil a» much ik 
through OS it ia considered deeirable to cut off; push the altarp 
reljitncr through the ton^l ; dniw tlic circular knifo outwardtf, 
and rvtnoxT tlie instrument. The piece removed will beapitted 
upon the nttAitMU*. Tho pain fruru the proccdnre i» very liuk, 
and children bear it very well. 




FAn!«i>rTocK*« ToxanxoTOkrv; 



There are two movements oaimeoted wirli tlie insrrumej»ta! 
manipulation, pushing in the retaining needle, and dmwing hack 
the iLnnular knife. To ftimpljfy ihe manoeuvre, KillintcB tousil- 
lotome was invented. It cousists of a pair of mke-tooth forcciw, 
placed over the oval oi>ening: for the amygdala. A chiael-like 



TUE BUIIATt KAK A»D tT9 DlSBAaftS. 



ktiifv sliduf Icn^wisc of the o\-o\, between llie cluvo uvi th' 
body (if i]i«! in.-^tnimeiiL 

The* Hm two (higt-n are ]»ui«e<l into aide niiga tipoti tlitr bod^ 
■Dd ibv thumb into llm Hrijr u|k)u the pfifXifiial eiul. Tliv to- 
struimut is »p[>1iec[ with ibt* ctawtj inwiinU; (ntou<;b |4>jiki1 I« 
worki.Hl tbrou^li the ovul ; lh<; in^nimeitt i^ held hieadf Jj-, aD4 
the thumb jni^h^ the cbbiel bkde baokvardfi and hiMiiv, TUf 
movemLml cau)(i« the dnw« to ^n\xp (he tonsil, )in<1 dntg U tbrou^ 
somf>what, oo Uiat tlw cbin?! knife cuts it ofl' with Ji bI(i|W o«i- 
ward aud backward, <x>nx^|K>ndmg with Ibe iiatural outlfoeff 
the throat id this part Thus one movement «?*nin> uml fi'inOTtf 
the i>k>a; i>f toi)»il, And ru»hioii» th« rcmninde-r; Ute ia^rumctt 
i^, tlM^iefore, preferable to Fahneetock's* 

Flu, 130. 




e 




Thf )i(.iiKirrbugi* fn»a llie opraiuwi it geuunilly viligbl nvt 
caai)^ jurreelixl by ai |^i^Eo of coM WAter; or^ iitcasM of ii(H.iV6itv, 
hy a wibitii^n \.tC Uinniii. Wli«u it cx>iituiiH7i noLwitlLiintwlii^ 
iboee, a tufi of al»orbL-iit ootton or n runx^Uluiir bni«ii stioiiU br 
(li|T|HHl ]n trtm tiinrtiin; or ii xx gr. tMjIutiou of mtnite of vUvtr, 
and tlie cut AurJuct- |iatnt4xl i'nc]y. 

Dr. Scilt^r ^vff, '' I aui in the liabit of alwuya jiiuutiitg tlw <^ 
ffiirikt^ will] rtitruiL- of silver volutiun, muop it weemn to sIATt tb 
pnxreM of refiali- at <jii<-e, anil at t)i« »ariie time protettA tbe wimnl 
from the intlueHoe of the air/'* 

In very nircniw-**, it amy Int iiec0k«ry to makit prc^uTv apou 
the cut etirfacc with ib« fln^r, or, evi'n, ta twist the open eod of 
a ri^id \tr4r^-\ to arrest olMituaie beniorrhage. 

TJiere la no danger in removing; a piecie of tbe timtiil, if iU 
instruments an- nwd awonlini; to dir<.Tlioa-"*. The earotid artcrr 
ittvendf^juM oiiLiuk' Uit- ti>i)Hil,aiid a very deep uit or an mtetapi 
to operate with a tenaonlnio and bi^tour^' might be dangn^uiL 

■ FlAmt-Boot of T>in4tinAi« And Trcumeat of HvAuw of lh« Thttiil asd 
}tfm] llftviUM. hj- Ctrl Soiler, M.a.dc. H. C Lw A Os PbUwldf4i>. 



TRSATUSTIT OP OnAOVIC PnAnTtfOtTIS, 413 

The wounJ giflzcat over «oon ami IktjiIs j^nenilly witliii) 9 wodc^ 
(turin^ which tirvc the pcttk^nt should t»kc Huid mid »f>il food, 
and abstain from imtant». MMlicinefi may be given recording 
to uny ^pecml in<li<»Cionj4 pr««crjt. 

T^rnimrnt of Chronic Pftart/t^tptiM, — Thb must lie ^ti«nil for 
all varieti««, mclading every hygienic measure for iiuproting 
tlpe Iieallh of ih*^ |mfieiit ; nnd itptt^iiif, inrhi<)iiig 1<k«I umi inter- 
nal remedies for the three phaaefl of the disease which 1 have 
prewDt^d. Th<* ilixiisc may Ih* riiml : Km, tailiiif^ in mrJn^, it 
nay be bo greatly iliminiflhod, that no diftcomfort or injury will 
be vxpcrietioed through life. Nearly every on« in the t<Mii])oni1& 
KODe has some pharyngtlK Until it reacha* a certain grade it 
(IcHS little iiarin. It rnurft he kc|it within niirrow limits. 

The sabject of chronica pliarj'ngitiii ought to live in a dry c-li- 
nuUc, prr<feml>Iy upon hif^h ground, io a nrclUvenlilnud and 
properly heated dwelling. He should keep the shin aciive by 
frvqimil liftthtt ; Imthc the ncuk (*vcry morniaj; and evrnin^ in cold 
walcf, and rob dry with a crash to*el ; wear merino liaderclothes 
En nimmiT, unJ t!annel in wint<T ; avoid dniftt an<l in.'CtlIc!J44 ex- 
pcmre lo biul wrather, ami lakfi projier exerf>i»e in llie o|>eii air 
daily. 

R«?4pin\tion rthotitd l>e thron^h the r\<v^ when prx^ble; tbc 
mouth onf>ht lo he kept closed the most of the time, esi>ecinlly^ 
in foul, diwty or cold uir ; tho itwnllowing of very hot and very 
ec»ld ihiri)^ at the same meal most be forbiddco ; good plain food 
only should l)e pexaiitted ; spi<*tsi, ^tron^ liquors and t<|[)acMrti arv 
vtry irritatiof^ to tbe throat and should be avoided ; and using the 
voioe in either singing or s|)eak]nir rtwliiocd to a minimum. It 
Es beiMjfirial for every person affliotdl with pharyngitU lo KQricle 
tborouijchly every time he takes a drink of water. This removes 
flupcrfluouft muoQ», cools and »timulateM the mucous membnui^ 
and ]mprt>vcs the state of the throat and Eustachian tubM by (he 
miLscular fif^tiim that ensiitTr^ 

The Eustachian tubas and middle ears ought lo l)e inHated by 
the air-bajc or Vakdvian metluxl, a.'^ of^t.-n a* tho c^vinptoni^ of 
fblncas, rtlra, and tinnitus indicate obstrnctjon to the entrance of 
■IT. The fre4iutncy of the demaiul will vary from oiioe or twice 




414 



TOV nVMAK BAR AND ITS DlSBMBk 



A day, CO ^iivo or tvrico a wbtfh, ucKKuxling to U>c ext^ai and s& 
verity of tliedtfenAe, 

Tr-r^z^trrtf o/" HypfrtropItM P/uir^n^jV inotmlffi other gargles 
besides oolcl water. An even ceaspoonfiil of salt lo a pimof watii- 
iH om* of (hit U<fiL ft itiiodc) Ik* iivod as agur);lo Uk^ tii>l thing in iL? 
inornjiig auci th« laat thing at night, and coutioued oiajiy wttb, 
or until HiQ {iburyngitis is Altctrcs] in elutractcr or cured. Chlo- 
rate of poEaa&ium ia the same proportion is better than ibe ^t, 
if there ij4 miiuJi ^MiHittv<iK:w. The |>h»rynx»fliou1d bv ^prayd 
daily with tar-water [IV, Fmaliq. f,>j, AqMa f^), and iheau«a- 
itiDg tulw mu^ he pNif0i4 deeply ioto tlie throat, uod throu^ 
eieii nc8trllf In order to reach all \^xxa of the vault 

If the (^iiKlitiifn i>r tliu mtiMtu!^ inciribmnu dm^ not improve 
in tinte under th&4e topical applioaticns and the internal medica- 
tion, aftohitiun i>r '«ii](»barc' of im^ [Zirtci miiph. gr. XtAquaiid. 
f,^)»lionld be BuUtituteci for the tar- water, and die Iroit 
oontinncd. Thi# failing, nitmto of silver soltition {Arycnt ni 
gr. Xj Aqua f^J i^hoiild in turn replace the kioc, and care be takfS^ 

Flo. lit. 




UvrLA BciasOBSu 



to linut the application to tbt? disfcn^od parts, uid not toi 
norma) ti^^UL*?^ ur the clotheE. It is \Tell soon aftorvnirdi (o bavfj 
the throat gargled with s^lt water, in order to prevent ttie sDi 
getting duwii tliv ce^iphi^us and into die mouth. 

If there i.s swelling alHjnt tbe Ku»tacbinn titbcft, cbeBttvereo-j 
Itition may bi- applfcil witb a throat-bnuh or sponge in boId«rj| 
and a drop or two of tbii« f^r Aoni*; other agent can be injcct<d!{ 
tbrotigh the t'atteter. Inflation with the air-hai^ .nhoald not be 
forgotten in caw of ob^trnctiijEi to the eDlrnnev ol' uir to.tlH* 
tym]^num. 

When the uvula i» cb)iignted m that Et rc«b upon the base of 




THBATHC5T OF CDEtOHrC PH ARTKHITTS. 



%lw tongue UD(1 aiut«v fnyjtiefit <*oO}^l]>ng cuhI figging, if it tlom 
tMt retraiH under the sine or tiilver npplicationa, it ^hoiild be 
9ei2€il ttiid iu cc^lcmutouv ]M>inl cut olT wiLh thi' uvtiln lu^i^^ra. 
Tite btler have the hflodle^ bent so the hand will not obHtract 
the Mglil^aDd bvnnith the Mad(?i, n ruki^-looth fon^'iK^ '» tnUtchd 
whidi seizes the amputated pvxe. 

Oilcarca phiM, ii^ the he*t nirrlioine for Jijr[n*rlr(>phk' phar- 
yngitis, in youDg peptfonsof &tnimoii8 or lymphatic coiistilutiooa, 
o<fM>citilly, wlicn tho tonnlU rirL* i-ulur^l an*l the <^tr alTi*<1<.<4], 
Under ilfl conlinuons admin istrai ion, an*.l daily spraying ivith the 
tar-wa(«r^ I Imve Sdcn the niuoiju^ lining; of tlic throat U*r»iuc 
lighter and thinoer, and the glands much diminished in volume. 

FfrrMn (W, i* a mu*t vahinbh^ tiyent Jor the t«inie ela*s of pn- 
tienCB, when lymphutit? ^lund» hurdi-n a littlt, ttnd aiitcniia and 
debility are noticeable. A few drops should 1>e given iu water 
after tnral^ in order h> avofil any iinplramnl ^lomach wDsatjonA. 

.l/rrcurifM 19 very usefulf when the ^ums and tongue tire (lobby 
and softened; the tunf^ut; i^ <vuttixl at Ota hir^i'; u thicic Hticky 
tfocrc'tion clings in the throal ; there are, perlui]i8, spotjs of ntvcfu* 
tku); tlie tonsils arc cnlargi.Hl ami HubnmvilWy g]u»d» ffwollen; 
the &p|>Mite and digestion are iinptiired } the taste and breath aiv 
fonl^ and ihc patient is m bad JKviIth. It in fr^Hjuently indleated 
in the i^rly fita^^ ikf a f^ne, when th^re is lintiilu^ ami tul»il ob- 
struction, but other inrdieiDcs* »tiit later vtageft better. I give 
Uftually lUi; MercuruH mA, in powders or Miarrnnu'i cornnt. dit»- 
aolved in water. Merc, iod is pa-fer^blc, if there w suapiciun of 
a/phili*. 

Kali hytirioiL in ji capital remetly f^r hypertrophic pfaatyngitia. 
In atom plethorie person^ who are tons vivrtut» am) do not eurb 
ibeirepictir^n dc*ire7^, Sometinu^llterc isa|K-r«istintBoreneflaof 
tbcthfxttt,and moie't mucoua riles in ihetulie^anilear^conncetcd 
with tl>e eon;£<(T«tion and hy|)ertrophy, whieh i^ auppo^ed io d^ 
penil M[tMU a rhtumatie or gouty dialheKi.^H There nmy l>c Htiff- 
iMflBof aomc of tlje jointj^, and dull pain lu the Qiu^len. In 
mch cniMS. the ])0E£U4hA:ilt Uvery etlicientin removing (he ^^neral 
morbid eymptom^, and euriii^ the pharyngitis. 

lYiLT fomica h indicated, when the ap)>etite and digration ara 
poor ; the tbruat is full and dimy ; there i» decided tinnitus and 



416 



TDK HUMAN BAR AVD ITS DISSAeiS. 



oceoflianal ctal^u; muotAcItngstotho poffti>rior wall ufllio 
mitt phnryiix, aiii-^iing l're(|i]cnl hawking aixl {rnggiug, odij the 
pulieat tnny have bcvu in ihc hubit of using li<|Uore or IoImgdo ju 

TVraftriCTif o/ vtfro/>Ai'^ Pharyn^HU diRcn from the hypcrtm- 
plii<^ oorisideralily. TJie usual nail gargle agrees very welt milli 
some patteiitfi, but ifl too irritntinf; am) drying for olhere. If 
tliv miu^m membrnne \» linmld am) elie serrflioai oolive^ it 
will pruvt* boni'fi4<in)p W^ien Ui^r*; iti only a mixierate aeavtioo 
of niiioaft, Hud tfie niiK'oijA ineml)ran<! Lk h«re ami lliere dry 
and glared, a glycerine k^i^Io (<?/y«rjBum fJ^^ --l^uu fSg)i9 
far prv^ffniMe, mid Ittirnn;: a little ^mHrtinj;, \» vxrw:%\m^\y plfm^ 
ant %o the paticDt It is well for (he physician to spniy tijtf 
pharynx with thi- «iin<* mixlure for awhile^ until it bcwomw tri* 
d<^i»l other topi<^ rerawiies are necessary. It may be eiiiploynl 
until till? mucous niombranc taku« on adifiercnt aoHoo and r^* 
malna moLsr. and ih^n the tur-walcr nhonld \k \i^ in altcriiuliftt 
wtib or instend of it. ThJH aj^nt stimuUtm and toms up the 
membrane, am] cleans and favors t\\*^ liealiri; rif nlcemliOM, 

Anotlier spray that i** of decided benefit in some vbms^ ii »^j 
aohition of tafinin in glyvriiK- ari<J wator {AtkL iannicstm gr. I^^H 

Bi'hixtNl tiwiKrt, diUtinl v^wscln, mXeam of Ihc uvula, anJ 
spots of gray ulceration demand this remedy. 

In (?ax-s widi wealcm^H and lULret^in nf tlie tliroflU mtiKliv^, when 
the tar secnis to have exhausted its power, a dtkcliona spruy (?V, ^ 
Chxt^^iQWF \7iif A^wt f,\j) is aotiii-iimoi tix>ni)eri^illy rHicicnt. 1*^^ 
improves the condition of the mucous mcmbraDepand bein^ab- 
«orbeil prumou* tlM^ nulrilimi and forw <if thr mttiiolt:*. 

It may be neoeesarj* to treat congested, granular or ulcerated 
portions of the pharynx to brui^hpiig^ of nitrate of aijver. 1 <lo 
not r^iommenJ Ihc use of lhi>* ag^nt fnxdy in atrophic- pbaTyn* 
gilis*. It ii* lietti.T to apply a tweiiiy-griiin solution )ty Imulii 
cotton or sponge to the particular parts needing it, taking care 
not to ht n nHelcfts surplus run upon other [Kirtr; of different 
pathrilogi«il natitre. Thus coarse granulaiions, spongy n>nges- 
tionii, und id'vraffHi plwnv, which n^sist tlif gnfglin^, sprayinig, 
and cDnstitutinnal treatment, will of^ea require mihl mnt^Hxalion 



I 



TftKATVEBCT t>P CUROiriC PJUftT50TTl6. 



417 



with lulver nitrnto. The !<alt ftafety Rar^le oit;fl)t to be used n fevr 
ToiDHtes after applying (he silver, udiI tlwii ihc umal oourseof 
trratiiu-iit coDlintiol Ufttil othor nica^iin?^ am nQcen^ary, It may 
be advbabit? to ampiila[<:t ttie iivnlo, niid tn inlliifL' ihv miilillc mr 
often. 

Arufnintm torf, Ia one r>f the mfwt [^j\ro!iHijr» 'Wp^icUng, uml 
ciBoii'nt iviiif(lt<!s for tim kind of f>li;tn'n;^'ti!^. Ai>iciiic is an 
■heradve OHiic, ami itidine an alteralive ahewrbont, iwd t)i« ele* 
mintM oomliined nHuin llcir pjwtT liltlc cbun)^. 

Oiicarat »wi, is a nutrilive alterative of great irabie in ihiA 
<]i.-<ciL«c\ (^|K?inalIy in j^hildrtrn with ruchitiff bdcI other ^rumoafi 
dieorders. Lime in an A«^ntial element In tl«e tir^uct, and tlie 
urimiUling iki^^h-t fnr It *t^*Ttvi to t>i? clefim'nt iti tfcmfuluuTS 
patientiT, wilb atrophic and parelio conditions of the plinr\'nx, 
ACDomiianied often by <*hroni<^? nam] cnlarrli. Oilr^rcft loii. muy 
be administers mueh lonG:er thnnthe Af^cniciim iorl., nnd in the 
8nmv oT Inr^r dosts. It will take the pEaoe of ibe latter vety 
veil, when it iii dt^inihle to Mop it for uwhilo. 

Cfiieiu'fti phos. \^ vtfy well indicated in »ome of these stnimou^ 
<awK^ ^^juviwlly, when lire tomiU arc bypt^rtrrjphicd and other 
glancU enlarged. 

Cinehtft\ri i>; gnod both iw n lorjd aofl int<*mul remedy- It 
slimulatei the nii>(>:»UA membnin4! t<> lieiter n<-iion, ni»d m an irri' 
tanl tc> thtr miiKrtiw. It prndn<><vi mii:«eiil]tr tri.^tnhliu}r, %\\U'. to ita 
infiufiDrfi uiion mn9('T« fibre, and not to action upon tite ncrvQ», 
njwl ift, ihurefore, an ■i|ipn>pri!itr mftlWrie r»r ulropbir pharyngitis 
with U'oakiHW of the mtioi^teflf variable bparing, eun^Mlcnibln tia- 
Tiiliw, itml ^Mfml di^hilily. 

Femtm ioii. is ow^wion^lly n'wde*! iri the nlrrVphir phahe ot' 
l^mryngiltMj h* in the InjM-rtnvphir, Pnl<', tliii>, aiiwmie, dohih- 
tated patients are much hrnr»firrd in geiufntl health by it« ndmin- 
ittmlion^ iind ihfro (he f hnvkF nml j^UridiiTar imptiralionR im[m3ve . 

AVi/i hifhrofti^ hnn an nilinity fur tfit^ inur^rHiM inembmneA, ard 
\% oocfuionally needed in ntrnphie pharyngitis, compltoateH or not 
by niuud cntarrh. The ^yniptonu (^alltitg for its ndmirii<4trAt.Ton 
are : A yeMnirisli-reil or tawny mlrar of th^^ pliarynv : r(*tuxnlicn 
of till* pnliite, omi ledirmft uf tlie iivida : ^fiallow grayish tiloora* 
tton. nhowing no dnpo«ition to hwil ; n^^l, swollen nr ulc^ntted 



418 



rai BDUAff BAR A11I> ITS D13BA9KS. 



UiiiMih ; (Irynt^ »iid itttraiOM of the po^Urior Mtrfflicc of tiki; mti 
palate; hanking af ihJck tenacious niiicas, difficult to dbloc^; 
aod nuoaus rA1(is in iht* Eu^tachuiD tube and cai\ 

fSic^w may be r^ulrecl as an intcreurrent reru«dv, but ^hoild 
tif>1 h^ given long or rolii^d iiprjn tn cnriv It in iii<li<:at^l bv :liv 
atrophic couliiion of the mucoua m^mbrune, aud pronuoenoeot' 
the folJiaiUr ^limdn; doifbMs Rnd tinnihrn; rongli, dry, im 
throat; a slight srcretioD of mucus, atHl evreUing of die subtnax- 
ilJary gUtuJH. 

TViofmfnt of GfHtnular PharyngiUs comtBta i« Bome of dw 
tucitniruM nihl mmiMliiM empl(»>'<il in the otiter twovaricCiMof 
phar>-ngiiifi. The ailt gargle morning and evening t&A neccBsinr, 
and, nt atma, u fpmy t>f itir-wnter, or d' viiur .sulphate or tao- 
nin iu gl^cennc ami vrater, an described above, should be tp- 
phe\l fn'ely in thr Mmxit lunl nmfo-pbaryiix. Shimid the trrat- 
tntfut not irnpruve the conilitioii of titc nitioous lUi-nibtaiU! after a 
fair Irialf a ten-gniin solution of nilmte of silver &hoald be ap- 
plied wilh n bruifli to tbe entire di-'<wLse*l i*iirtiice, oiKe or Iwic* a 
w^kp for a tittle while, tbe olber treaiment being oootiDued. 
This will &tiamlale the ruuoous Dieiuhrane to healthier action bikI 
mid the cure. The region of the Eui<ttichiaii tubes aliotild nccivc 
apecial attention, and, if it caanot be touched b^ tbe bniahta 
spoDgi;^ in tlio holdtrr ttmy be UMi) iiiHt«iul 

The int4:riial taKJiciDes aduptcd to tbtfl kind of [dKin-itgitii 
mtii<l be Kt-krC(^l hy aoniiiptLri-^m of ihv symptoms of tiiore nlmidT 
given. 1 hiive found Arsenicum iod., Mcrcuniis, Kali hydriciL, 
Kali bichru»L,iuiJ Sulpburttl>e moAt eOieientagabst tbe roorbid 
iXHidition. 

The bypertritpbiecl folliclt^ large ^iougy granulatiorui, nih) 
8tnall polypi seen upon the ^^mll of the phuryux on a le^'d 
with iiid alxtviT the paliiliije aroh^ mu»t be deslro^'ed by rau-slio^ 
or cautery. A proU- uoattxl ^vith nitrate of #JU'€r nuiy br )m»i*d 
a^ntit tiie smaller growths and a Halt gargle or ^pray useil <^t*a 
aft^rwarda to neutraliac excctss. A cottoned jwobc wet vrilh 
ddonj-acvtifT twnl ntay Ut- applied in the same manner, and n gar- 
gle or s[>ray of ample WAtur \i^*A in^t^^itd of tJie salt ifjolution. 
Loi^r excrcvct^cet may be Dip|>ed olf by catting forc€[B, A i 
preferable method ia to apply a bnllet-pointcd electrode of & 



Cnit05rC ITfPLAHUATtOff CP TRB lUSTACHIAlT TUBB, 411) 



^Ivarvo-cHulefT ami Imrn ihe growtli3 totlidr htuea. A cold- 
watBT ^r<;k- m»y be um.^ tor a tVvr dav^, and th<ia the Dttior trmt- 
meot coDlinueil. 

TVaxtmnU of Otronic Jnftammaiion of the M^iutachian Tube, 
It m taken Ibr granteil, that morbid Mates, of llie nose, i>har- 
ynx, and ihrcicit will \hj ln*utvi] iiivionliiig lo (Iirecliori?t iilrt-wly 
given, the mouths of the KusUichfan tubes m^y re<juirc a little 
extra Btteiition. (EdvniatouK «wUiiig of itic Jipr4 mii^ be cpfayed 
or bniehcd daily with a leu-grain Aotiition of tflnnic ncid oracinc 
SulpliaR-. 

A granLiUr ^pong}* state of the inucoiB membrane will Det<I 
brushing rvtrv (vvf thiyr^ with u k^a or twcaly grain wlatton of 
6ilv«rr oitmte, and this i^^ the beat topical r€ti>edy for ulc^nitioQ. 
lU'laSQtioQ or pun^iA of \hv pnlutO'-tiiUil nui:tc]<s, cvIlnpM; of tJic 
]:4rietes of liie mouth of the tube, and aton; of the parts demand 
Uw Ciiu'lKiiifl (7^". OncAffrwr f5j, Affta fjj) or llie tarqjniy (7^, 
/*icw liff. f7^, Aqwi fi>j), to be appHerl tvricea day. 

If improvomi^t ia not tfooii apparent tk'vtricily may be, also, 
applie<j, Piat-e a blunt electrode upon the posterior surtace of the 
velum of the pzilate, and the other |>ole, sponge-covered and 
inni»t«iieil, over the superior cer\'ical ganj^lion behind ilie iingic 
of the jaw ; then apply a weak induced current, and t^mduaJly 
iaoTftttc \U ^livngth, until lively ^nisiitiiuiM nr« pr<Klur(-iU 

A E^tachian elfctnxlc, connoting of a wire nearly covered by 
a )uml nd>ber Ku-'itaehiau catlieter, ia introduced through iW 
DOSe into tlie tube, tbci^ponge elecrtpjdc is placed over the mufitoid 
|)r00Gfla, and the Faradic eurrent la tJins «^iit through the ear> A 
seance of five totvn niinuk:^ every <Uy, of axattionally interrupted 
eleclrixaliou^ is sufficient for all cases, Klectricily in my opinion 
u vuluel<?ti in humid infliminution of llw lubc#; w vometiuiiA 
beneficial in the prulifervdve ooadition ; but iinda its true sphere 
in ncnk and [xiretic slater of tnbul and tyin[mnic muiwlei». 

Inflation of the ear by meains of the air-bag, without or with 
the cutiK*ttr, \» #onietin>^ useful in proliferative cti^e« \ of signal 
benefit, where there b much tecrttiou of mucus, and mdi>ij>enBa- 
Uc in paretic »tAt^ oi the palato-tubul ruu^^W. The sudden 
distention of the tube separates tlie moist walla, breaks up adhd- 
sons, iDcrcaMM the cttlibre, drivui out :<njK'rlluouft fuucus, aerati« 



430 



tRi 0UUAIV lAR iVB 1T0 DISVA8BS. 



tho tympumim, nrd #timu1at4» tli« inucoui mvoibrnne &n<I CDOft- 
c1e*i lo noriaai action. Ic will be m^^f^-mr*^ to tM* lh« catbocf 
willi tho AiT-tKigf wbfrnever inflfltioD cannot be accomplbhecl bv 
the latter alone; and tlib will occur, when Uie liibc U blocked by 
tliickcni4 nmctiB, swelling of the mucous walls or lips, dcnEtidal 
contractii)iij« of the pam, relaxuttoji or paresis of Uio musdo, 
^wth of large ^nulations or polypi, ami hypf-roetogis of the 

\t is ix>nsi(leretl owiffisary lo use tho caliieter, when it ifl de- 
sirable Ui affect one car onlvj ihe other U^ing hi?althy. Such 
cav» occur frequejitly. I had a patient under my diarge for 
doafueas of one ear, mii^^ by ttcuU: iuHaiuniation several moiitk 
before, wbc»e other ear showed no ni^na of diaeaae, aod had a 
hearinj^ power of JJ« It would oof have been proper lo this vase 
to ^ive a j^oeral inflation I'f l>i>tii eam n*ery time the disewed oae 
necdi^Iair. I, tlK'R'ft>ref limited the inflation to tbediaeoaed ear bf 
employing tlie catiieUfr. A tumh^nuo artifioia) inflatioD of a 
healthy car occueioniLHy^ generally docs no liartn, but the risk of 
exciting a morbid state hml better I>e uvoidoJ. 

lu mauy persona who apply for treatineut of one tube or <ar. 
tile otlier will be found nffeeletl in «onw dc^^vv, and it b notoe 
cea=ary to W so particular, hut d>en, even, ih^re must be some 
limilniion, Ikn:iiiim} different j*lng^'* of A di»urder n^purv diffvnritf 
treatment. Very oflen the fhape of the nasal paaaigea is mich, 
that tbey fnvor the imtnUKv nf air into one Eu§tachian tube in 
preference to the other. The following variadooa arc observed 
frequently : 

L Inflation by tlie air-bag through either nostril will act upoa 
the tub(^ uf both t^U\<#, 

2, Inflation tljrou^h one nostril will act only upon the tobc 
n|wn it4t own rtide. 

3, Inflatinn throuji^h one nostril will act only np^Hi the tabe 
u|>un the ojipit^ite *»ide. 

4, Inflation through either nostril will not dilate eiltwr tt^,] 
but tlie air will [mxi iiiu» the ^toinudi, or buT^ op<^i ihc palat^^ 
and e»ca|>n by iht^ uututh. 

Violent inflations and those which but^t t^n the |iaLsle mikc 
the pharyngeal inii^,ler< Ukine, and jiatienU will complain, after a 



QUROVIO IKF1.AVUATI0N 0? THB BDSTACBUy tUBB. 421 

feirt- ilayi* trfvmni'Ut, of «rjiv ilu'oat,*ifpfndinff up(m muscular strain^ 
Thifi kind of «ore throat I think hns not Iwforo been mentioned 
ID mnlkail ItUrraturt ; Ow phy^idun r^lioiilil iliffbf^iittate it from 
tAher raric^ies. The proper remedy for it is to cx>mjm*^ thu lUr- 
hag with IcHK forct^ and rapidity. 




ImIIAI-KU NOmTU'EI. 



Quile a variety of noie/lc» for the air-bsg arc neciMMvy to «uit 
iM Dosea* Many cannot tiulure tiie Itard rubber tube or th« 
olive-shiiiH-d nozzle ; tl>e glass ones that fit into the nostril, aad 
do not enter tiic nn^l nicAtui« nuictt will prove more agreeable. A 



Fi<t. 113. 




rnblkcT or gl^M n^mxli^ erf upjiropmto tilne, contAining a piece of 
epoDge, t6 atloohcd to rlic air-bti^ tube, whon vapor ia to b« furred 
into the Eotiiscliian tube or cur by the blunt uf nir. A Ikhia or vul- 
canite tip replacee the noK^le, when calhctcriialioQ b porfomi«d. 



422 



TOB nVUAV lAft AKD ITS DISIASfiS. 



A ^Iver catheter shcmld be employed for inBating, aikl georr- 
■lljrfor medicatiDg the KuEtadiian tube ami ear. It conducts 
readily, it is eiu^ily definftl lumI Oij^mf^xlvfl, it HopAmtc^ o^u- 
tintttod suffftctif, cools and stnutilfitt^ tlie mucous mcmt^ranc, fitait^ 
tbc' mii.4cIcH intfj action, aictt ia the expiiUi^iu of mui-iiH, uim] ex- 
crdpM_'« tlic ^mc itifliience over tli« morbid cooditioo of the tilie 
tliat liie ioum) do(s^ tn gleft. 

Roofin eay», " Wc may oft«i reiy much improve the hearing 
[lowiT of a palu-nt lij' tin? iiitriMliictionof the imtnintotit lietwoeo 
the lip of iho tube, e%'en, when iio air, vapor, or Huic) is pMwri 
through iu" 

The stafemenEs made alwve explain why. TTi« catheter sboulil 
be 11^1 with tl)(* air-baj; tht'n, in u hin^o number of ouci!^ The 
air bag should be used, also, where one sound ear does not forbid, 
berauM an air Eihu^t into tl)e iinj^i-|iharyiix, ?4!nml&te« llie taucow 
membrane, exerd&es the palato-tubal and throat mQ^les, and »d» 
in the exjmUion of nuicus. 

The severity of the di^ase will determine the number of m- 
flatioti^ 1o be mnde at one ^ittiri^, the Dumber per w««k, ai>d> 
ct>iJi*cqi»ently, the numUr of tralU ti|Mm tho physimo. I'^licnt» 
are unwillius iind often unable to visit a physician as freqaeoOr 
Art Ih^ry MiOLiId. A few inL-*i*ft of ehrf>nir* inflafiimntioti of the 
tuW and tympanum ncod to be seen and trailed daily. TIkt 
arc the humid oni^'i, charact<'firJ^] hy a Brreat deal of maooua ag- 
i:retion lu the phar>'iix, tubes and tympana. 

Air cannot gi-t iritn the lym|UTHim throng awatlowing, move- 
mcat» of the jaw, bl(.>w[n^ the now, a&d the Val^alvian mctliod; 
thoujih rflle* may be heani from the Mi|>erabundaiit mucuA vhich 
«tuiTs and olo^ cvcrytbinj^. Inflation aikd mthi't<,'riz<aion are 9e> 
c<«jarv daily, to clear out the mucus aad hinder degenerative 
changi.-K, Hud a«tring<-nt ^timulant^ should t)e applietl nj4 often. 

Rarely can n patient with profuse catarrh open tbe tubts anil 
inflate- bic^ ov^n e»rx. If lie cniinut comr lu the office tjuily, hi' 
may try the Val^lvian niethn<t once a day at home; failing in 
tJiis, if be i« obligifd to remain uwuy I'mni theauri^t for dayv at 
a time, he onifht to be furniehed with an air-bag, instrocto] ban 
to urw tt, and directed to employ it once a day. This will oaly 
help a !i(tle. because auto-inflation is always defective, and «If- 



CBtOKlO !!iriANItATlOlT OF TUB SUSFACUUV TDDR. 423 



fatlictcrizition ]» not pmdirable. I bclicvo iIj«mc ctb^es will not 
im|ifx>v<^, iinU'ttA tmtuil bv rlu^ mtxltoal aifonilimt at lensl tvfieeit 
wcwk. Four to six iutiiuioiiB t^hould be niadc at a sitting, iq 
onlcr (o a^iiKkvi^ all tTif* mucit^ )>0HAiblc, Htretcb the nibc open, get 
tome air into ibe tynipmium, anil drive the bloud oowards from 
tin* rc>i)g«rt4*ri vcw^I*. 

MiMf^r catarHin) ra;^ in which inflation snnietimee occurs 
^KiDliLn<H>ibJ<Iy, ouffht In \m\-v. ni^ical flit«n4bn<« ovQtry two, throe 
or tour il&yfi. if i\w inlervnl botwcr^n visit? is lon<z^r, the Iresl- 
ment will U^ in^zv pnitnu'tnl. 1 b^ive loiniiJ bv ibj[|>enence, that 
once a w«ek is not oit^n enough to ax- fiiicJi ca^es. 

Two or ilin"*'. inHntioiiM aC eflch %'it<il an .Milht^i-iiL Wb<Mi rbe 
tubf opeiu eatiily, and lie tvmpuauin fcvls very full after mfla- 
tiott, oiM> modtrate ptilf with ihc air-ba^^ ^rill s»nic«. It re* 
quires x\\<^ d»Timiikalion to know just wliat i* enough. It 
dioald bu borne in mim! timr InHalJon fuaj injurt' t\w ht-nrin^, 
when tin? tiibe opens ca&ily an<l air g^B into tlie tymjiaimm 
freely- The incnibrjuui lyHi|iaiii in puKlutl out foix-iljly aud itn 
ebuticity dcalroyetl by too strong and too frequent inflation. 

laflation is gcnenilly required in closure of ihe Euritachian 
tube from rdaxatlon or [wreftis of the nauw-lcR, about ft» «>Oeii OS 
in milJ catarrh, which, indeed, very frequently accompanies it. 
Tbr cnihrtcr ifi |^-nend)y iioce^^ary a» ii tiifcliamoil atvxwory, lu" 
well as for \l» thcmp«ulic influence; l>ceause fllliii;^ the pharynx 
vitli a pufT from Ibe air-bag alone of^en pre^j^^s the lipA of die 
tube ckiwr toge(hcr 

Proliferative ea^ea EH?ed the air-bag and eatheter about twice m 
vi^k in tlie ^itrlyMtuf^. tocxpirl mucus and Mtimulntc i\w tii<suc»; 
in the later stages, to prevent or break up adtieaiona, hinder coa- 
trmrtioD, prew th<^ blood along in chc dilatcil nnd inactive vci^>I«, 
and to favor retrograde cbangee in the thickeued a»<l sclerosed 
tiwuc». 

The air-bag will be miflHcnt without tlie catheter in many of 
these tanw, ii» tlio di»eaic k frequently bilateral, and air passes 
thrtmE:!i the f.ul)o freely, e»pecmlly, in ngwJ |K-rH)nn. Oin* muKi 
then W taken not lo drive air into the fym|ianum too forribly 
and thus tnjttre the claMir* tension of tlie drum*bcttd. Pei^tons 
who have procrtiood the Valsalvian inflation frequendy, furni«h 



424 



TUB nuMArr rak axd itb diakasbs. 



exam|>lcs <*? UntsAd mciu1>rcirGA. 80 Uo utlicnt wlio olis^ni 
U08lnl3 UK> uiucli wbvn 1]|{>wing tJiu noevv If ootnc cnnco Uoo&aw 
woncc tiAor c«inirj)cncin^ treatmcut^ lh«8C causes iitt^ l>o sn«pccuil, 
When aclK<6iODFi or obtitructionA cjciivC, of countc, o^orc foroe inaj 
be <*jcpcnilr(lr l>iit i»Jl:ition »lit>u1il not be (Halted to cauae y^rUff>, 

Tlj«ri- muv [k tAte^rutdloit to iiiflntion from ]Jugh of mocud anil 
oxfoltntcd j^lircilA of mciubrane. These y\e\d to well-ftircdml 
eflbrbi at iiittatioii, mi<l cnai|w Inio the pluinrttx, AJ\rr scvcml 
imsuocasfuL tnuJs, a fe^ Orop»^ uf n i^uriu MflulJvu 'jf t^ti^ic po* 
l«muiu (P<a£u««(( h^rtu. gr. j, vl'/u<i i/«'. f.^ ), 1^ uT UtArlfuntiie of 
0n-1iijm [Jiixiii bii^trd. ^t. v» Ji/}»i ilr^U ft^) flhonlil be introducnl 
intQ ihc cnih«ivr c» «r'i« by n dropper, the air*baf^ oouD«ctcd inth , 
it by a luU* »D(i proper tip, nuJ tli<? HuiJ blown into tlie tttbcl 
The injection may be favorer! by inclining ihc hcwl to the M*\t of 
tlm ear vrhich It* l>c^iiig tn^t^^d, and luuking tlie |Hitic-iil frviiiUufr 
Miliva or water Ju«L a« tlic ha^ u compressed. Thi« injection will 
ditfolve iKispittated ajuetia u»d cJear a way, aAer one or luorc 
apl>tic<i^on«. 

Aiiotlter <x}Tnmf'ii eausv of tubal vccluniifii ia tbc cttagartioD 
and hwellliig of the tnucous membraue, Tiiisdiniinisbslniiiio* 
dblvly EtHcr iiijei^^H«rul inllution, which muv l>c nlonc truflicinnl m 
uiild caheaui vHei:! a rure,its 1 have siaiut el-^ewhere; but geatf- 
ally voniti ilcgnx* nf inllainiUBlioii will pi:n*it<t iiiuij cilhvr mt'thiMii j 
of disBipatiag it have U^en Miiployed. In such a Aiaie, tlie air' 
will piim tfiroLigh tbe tut>e in u l^iic j^tixsiii, it will bo felt in Um 
4*ar by the patient, and beard by ihe physicSan widi the aueculla- 
ti<m luKs l>iit the mhihO will l»o slight and imi<-fiiiitj% uitliniit erj 
with weak rAle^, and ihe patient will not fc^l tliat decided thud' 
Slid fiilnesi^ \tbich indi<-ate n gotxl inllntioii. 

For tbifi coDdilion, a few drops of a warm luilution of borai 
{Sodii b\b<frai*. ^v. v^Aipuidf/ft, r5j)bloxinUi ihnmgh thocatlieiar 
18 most appropmte. It i^ a ^ood folvcni ter mucus ; it ooola and 
KOfil)]^ tbe bypiTieinic mi-tuhraiiet aiid favors au exiidatioti, tliai 
relieves the engorged tii^uee and wajihes out the lube. 

After tbiJi I like n warm .iithirifiii i>f tar (7>'. Pidn fii^. ijjlxx, 
A^wi dent, f^j). 'Ihia contaim ju^t viiough of tbe alcobolio aod 
ImlHiinic pr<>perticf= to t^timulatv nm) tone up tlie muniu» ama- 
brane, and betp it back to a heaJtby ^le. When tbe thtckening. 



COItOEVtC IKPLAMMATI05 OP t&K BUSTAC11U5 TUDV, 425 



don not diminmh, nor the possHge yield lo pcnisteat treatment 
of tbiH kiml ; abos'^ all, if iti€ pharvnx U hy|>enro[)hic or j^mn- 
ular. and blood is ^'^xT^ upon ufkI in the dijtal etui of tli€ catheter 
after gentle iowrlioD, 1 think time may l>e itaved, and Die pAticnl 
iii&t«rially bcncfiUxI by rfTtortinjj; to astringent injeotionft. 

Of tliene, a witrni M>iuCiori «f '/Anc Mil(>halo i-* the bt^ftt (2*mn 
wilph, p-, ij, J^iw (/rt/, f ?^j), acconlinjf to my *x|>?rieDc^- Uiliiled 
tinettire of Cliloride of iron (TV. Frrri cfdor. flRxx, Aqua '/^Af5j)t 
A solution of Zinc chloride (^iW* vhlm'.^r.v^ Af}tia drgt, f,^). and 
one rtf Silver nitrate (j4i"f;*i^f. nii. gr. \\ Atfifi flf*t. fSjj are Sfinu'- 
t]nia< uwd instead of the £inc Wphate, but have ik» advantA^ 
over it. In M>ine obstinate va^e^ the silver may be tried. The 
fjQantit)* of any of th?!e Ebould always l>e small 

No one nnd l>c afmtd thut theve flpplicationn will ilumti^* i\w 
€ar, even, if the afllringeot doc** |>onetrate &o Ear, I am ^(Ifiied, 
if one fTin jiidf^- from objective and r^ubjodivc »yniptvni.<s that I 
hive driven a drop or two of several of the above- meat ion«d 
topkiU remcdt<.*« into tJic tympanum time and time o^in without 
f^iisihj; inflammation in a ^iii^le vutte. 

When Ether and Chlorororm excite so litlle reaction in the 
niddio ear, it In non^ento to aMcrt, thnt tlic weak Kohtttonsor 
needed remedies recommended are pernieious. I use them con- 
ftianlly with Wnefit t4j my KraiK^, notwitlislandin^ tlie L^uMlt-mnn- 
tion of eertain authors upon aural diM«>e, and I dn not believe 
any one can treat chronic catarrh of tlie tube and tympanum snc- 
coi^rully witliont them. 

In obstinate caH9, the mthetcr, and tlie sine sohttiun ought to b® 
umkI ev-eiy day ; then^ an the Itimen of the tube iiioren^^es and tlic 
iaftammatory ihioketiinj; subsKles, one of the other fluids may he 
suhcitituted. I di'iprt^iitr n.'>ort to the bougio until time and 
paticn<T have been consumed in the way I have imticaled, I do 
not approve of mitam r»r m4Hli<<nt«*il vapr^r« for humid iiil!nmmfi- 
tioo of the tubes. 

It mu.«t be e\'ide-iit to ihr rrnder, th^kt the mirltjle car will ^iftm 
fW!«iv^ treat jaent alnr^ with the KtiMnchian tube, owin^ to tlie 
Uim\ and m<>elianirail mnsinfi c*niployi«d. In nviwt. injttanoi^r the* 
tubal treatment h, nlso, appropriate to the Auml eunditiofi. 
Whether it in or not, it mnxt tnkr- pnv«'ileiu«\ l>prflitiVT ila difl-fiMi^ 



4S» 



TQS 0UUAK EAR iTfD IT8 tUSKABBS. 



► 3^ra\*fiteE, if it does not (aii&e the tympanic clbcaw, and uiie<i]i- 
not tnut the middle uir until iIktc i« frc« acc^A (o it tjirough ik 
tube. 

Die BukIsgIiulq tube U occsf^ionally fouiul imporviouA^ mul i^ 
iiminfl ra aOer employinont of the Air4)ag, Aitbeter and tMnlta* 
m^i^tff, aud one* U unable to say^ without furtlMrr oxplunitioa, 
wheni jintl \«liut the oi)Mracii«>ii is The jKLvuLg^ may he mudi 
c«>ntractH], and seem clt^wd when it b not. In case of dmibl, a 
fevt dni[i;t tif (lit<»nff<ti-rii Hhould he ]iur in thr sjHin^' mP t)iv ii>- 
halor nozzle, and blown into the tube witli the air-ljog ju*l tm tlw 
puticnl (twullowe. The viipor vrill pvn«lrn1<* lo llic mi«)d1«nr, 
wli^n un inflation of' air will give no ^gii, aiid rkua olenr up a 
dtHibltuI dia]{uo8t5, The fuitierit'F wnHitK>n» of vinldni futmi« 
aittl lively pain m the <tar vrill be evidence that tho chloroform 
ha§ r&ichcd the tympanum. When itvnter^ tliv tubv ontyn littlu 
way, there will (ro i^oolnt^^ and smarting felr. in iJie tube and 
upper pliaryni, with, perlmps a liule rran^ient dyspn'ra, Hwo 
total ofxilu?40ii of ihii lulw l>eing ocrUiiii, n^vrl must he had to 
bou|z;ie&. i 

Doujcim arc not to be resorted to hastily, Im^hu^c their nw i 
fmught with fiome d&O]^. Emph^^M^ma uf the neck, Ibmt, 
atKl larynx hit* iKrn <*aii¥(fl in numcmu)* iiMtaneei^ by (Uk i 
vtrtimetit, and, even, d(^(li lata resulted frnsa its carek^ nuini|Ki 
Ifttion. 

Spi'tn^'y grHiiututir>nH nnd polyt>r>id excr»icen<H^ at the mout 
of tho tube miit^t be removed by a«trin;^nt8, cfltL^ricvv and iriMm 
meuiA, a« di^^rttu-il aOMeH'lK-rt>. Tlu^y ftoiui-iitneA tnsy lio pniJud 
aside by the catheter, sty that in^ation can be accomplished. Re- 
laxntiim anil |iiin<fitK of The [nilato-EiiUd mtiM^Irs ott^n nrooviitaiA 
a little mano^iivt^in^p in order to iiiserl the cailhetcr. Adhesionft^a 
and ciesitriciul coatrai^tionji of th(* A]H*ning yiehl tiomHinK* in th^^| 
eatlieter and boii^^ie. Tn mre eases, on« might b^ ju^ified in^^ 
attitpiptiiig Ui rtit n brid^ nf r.imut> nr n H^cl Innd, and I liarc 
been inelined to operate u|K>n Aom« eaaeaof dif^torted Mifc jialatefi; 
ID whti^h till* teriKTir and hrviilor palikti diiiapIi'i4 wi-n* i^nidnuwd 
and dif^plaeed. Rarh ease is a Inw unto iDvetf, and enrgiml pria* 
dpleit and eaiitioui^ jadginimt miiHt itcdde ihe operation. Ob* 



CHRafClC INFLAHMATIOH Of TBB BU3TACBIA5 TUBB. 127 



Btruciion of the tube is gcncnllT xl its bllimuft, simJ ilic cuiim> 
can "Illy be it|iprt>xi[nately Jel^rmiuctl. 

Tumors are rare within the c-uiial, unJ grantilatiorL'* eoon yidd 
to the liYutfiieiic by Intluiion uml iujectioa4, ^ that in a» obflti- 
luile caae one may aardy ranchiik, tiiat adbceionsp contmcTliuu or 
hyp^roMtotu is th«;oaui« nf ofK-hiKioii. Of the^^, the lahl i» trre- 
QiediiibW. 

To t««.t, Ami Aonii*tiimA to ov^n^onie tlur iiliAriii:!^'^ a giiod-aizeicl 
mtheter to euit the )iat}cnt'[? anatomy shauM be iK^Wtctt, it^ di«tal 
eml filled nnii HiiicnrLHt with vaiwIiiH*^ iitid then ]>hi<:'^L in {HHlttoa. 
A catifiit boujfie, (^lightly tnperinji: at the point, and rnurk^l ui 
previously d]re<l4xl, elioiild l>c pushed through Uk- miUiftcr until 
th<: obstrnolion ii* wytcluvl. Try to fon-e thU by gentle preteiire, 
Withdrflvr the bougie a little and ad\~an(% it n<^tn, turn tt 
imvtind. liiive the |vitient i^wallow i^eveml times, vhtle slcndy pres- 
surt' is muiDtuini.x] ; 1)e putif-mt^ light handed* and ]>ci>eviTin^, um 
in diIjil{Fi£ a uivlliral .Mrk'turci, ami ^mve^n may follow. 

If out- Ijougiu does not succeed, try u f^malJer one, and a^in a 
Hmaller mitil tin- filiform i»n«' fuiK TIk^ii give it iifi uutil the 
tube ba^ been treata) awhile with eiiic injections and attempts at 
iDfltUion. 

Siip;«w, afi ifi untal, the ob^truf^ion yitltU a little, what is to 
lie dom-? I'uMi lh(? bougie in linaly, leiive it l^n miuittc^ and 
then withdraw it, Pu&h it a little farther nest day, leave it lo 
awhil<>, aati m continue until the cUj^ pfirt yields, or it \» fouiKl 
iiDpnwible to prooeed farther. It h noi ^aft ^nerally lo try to 
punii tliivrugh Ik rhiPM'^l taln^ all M nnrf.\ 

When the bougie euierfi almost to tlin mark iudit^tinj^ itn noir 
AppriMirh lo the tyfn|H4niim» gr^Mit rjir^ iDU&t be exemeed not tr» 
advance it rashly. 

Th^ itiMtranmnt should Im- piiKliivl gently and rtftniioiHly ooi- 
wanlflday by day^ until a ^ij<1d^ii yir'tding i>f ch<* nrsirlanf^t* ^^ivtH 
evh]t*ntt\ that it hftM |>nMUHl tlir [iluilnirtion Dr nnltrcvt ihr^ tym- 
pannm. It onght not to be pushed far intn the Lyiiipnnum for 
fnir of injuring it. End^nw^ [miit ami punili>nt inflarnmntion of 
tKp mfilcll^ car have been cauaoH by doing ^o. 

When ail uliHtrtiilii>u i* onea^ |Hiiaa*d, leiivo tlio bong;io in pou- 
tion awhile, then remove it, and try it again tKe next day. 



428 



TAB BCMA!V BAR AKD ITS DI8tASR6. 



W))ilr t>iJ^ <liIiiCaliaii iM^>ifi^oti,th«^ lr)[Mail applimUon UiotiM 
becontiniml llirougb the catheter od aLteroate day& The linr 
HuInltiMi follow* tb4* lM>U)fio very wflL 

Inflation mu^ not be atloiii|it«il the same dav, afW the bougie 
litm Imx*i) iiw) for U^r ot |>nxlumng rniphmnm. I f tbU happciv 
throni^h cnrelossu^fis or ignorance, ibe throat ai»d iarrnr imisl hr 
itiri'fnlly t<xiiiiiin<H), imil ibo M:aC of <)k* f«abmaooii« air ToiiiuJ. 
Tbe mucous inembraiie over it miist be saipped witb the sdasors 
ar punriiinil fnx*ly willi n hiMoury, 

Etuphy^uia of the larynx ih ni08t daugeroos, because cIoajr 
of t)i« glniti* it« imminent from i^ aiiJ it m clifEcult to rocb itti 
sent. CCikma of the glot(is is, also, Dot very rare in prartkv. 
A «|Rriiil instrunKrnt ie n«ces3try to Iruil Uipt^' two alTi^cdKuitf, ml 
nu^bt tol>e ID every pbysiiclunV oiiltit^ 'Iol>*>ld*H laryn^r^l lancet 
is well ftdaptcil to the purpose. It cy>iwif^ of u rurvud \iiitl wiili 
A liandle, and a t^hort, i^hiirp, Aheatbed, oulting |M>l»t. 



Fio-Jl*. 




Q, 



0,n£4fAMV A CO 



u 



TfiTVlt,1>'H T.4RirK4lKAl, I.AItCI 



A etronfrly curvtd bi»t^tir>' witii the binder Vp*nip|>nl vrilh Upe 
nearly to the |>oint lia§ t>eeri uem^^ wliea notJiiD^ more suitable 
<*ould be procurL'd. ' 

As5oon aA tbo dir^ri^ONM i^ Diack, the paiiept U to be anlfd 
erect, the hcud (Supported, the tbroiil illuniiniiKtl, aiid the tongiie 
deprc«^ieiL Tin* Lii.-«irinut^iil, ^iitiW by the view io (he laryiitEmJ 
mirror or by the 6ii^r, sliould he passed down to the disiendid 
tiA^iii'^, and ibi- imiroiw int'intHraiie freely amriBed. Tbe synop- 
toiRH dii4ap|>ear, as goon as tbe air aicapes from tbe cellular ttSRM^ 
and ^*fii*i-ally no further tmitmi-iu m ncoesanry. IiitUtiijn thooM 
Iw omittal for a few tlavs for fear of a recurreocc of tbe acetddil- 



CHROnrO iWFLAHJirATlOSI OP TBa ECSTACOrAK TUDf. 



'tba EiKlJIcliian tube rc<|iiire topical applioatioDfl (lif!er^nt from 
IhtMe applM to tlir Jiimiid liithmmBtmnK. Thv. Hinds an*) vapore 
that BTe gf benelil in such ooudilions f)f Che tube ai« ik>1 ono- 
traimlk-atod, vrhi^ti the t^m|>aniiiti h ut fhi* wmii' time aI^vCchI in 
u ^innlar niaaiicr, na is iiwal. This ia Icfitanate, becauw in tiiudv 
ca^ca tbe Kii>itiiolimn tube |>t.-rnitto & froc |tt9HgeluHic middle 
car, afiil in old people it is rath«r too fre«. When a diafpoals of 
n-Beorelocjr, Iff prolJlVrutivo iiiHamtuiition^ iit imtdc, the AUriai 

Fio. nn. 




l^B Linvyx. 

may iaiBai^ it^ dinvtnl almre, u^ the kou^if* if f^turul twc^vmrjr 
inj^y^t m^^ieinsl snluFJi^tix ttm>iigli tW c^nth^ter, and rawrt to Maun 
od m4M)iptitrt1 vApirx* 

(jlyceriiw U one of tho mowt vultniMo ai^crvtR for drj-new* of the 
iTitmuiM nu<mhmti^, which oflen exists with ibf^ gr&tiuhir nnd 
tttrophio (>hj»rynjfitift. It kr'<*|vt tlui juirts wilh whl-h it <vini« in 
(Hjcitn^t "H^lt nn-J inoifJl ; dtv*nlvoji ini4pihMiirf*il iiiurtiH; HliiiitjlnUv 
the mncom memhranc to hcultliH^ »rrion ; favnr* copiUnrv drniTw 
»g<* iMul ^pilliiOiid «-xri>linlio(] ; |>orin<^t1[-4 am] rc^iukrs t1i>i^ih]i' th^ 
limio-iioo']. the nrtiMil til ions of ihp n*iiiirl*N, and ai^lvfjililioua 
iMtmU; ii\t\rt %iw im>veinent4of thv ma^oWLDtlicirdelWlcMlicathn, 
tttid improve the hmring. 

It m:iy Im iiMvl uiidLlui4H], Hiid tlnijjjtod upon a tliiclcMivt] inorD- 
l>miiu IviTtjiani, wbilc fhi* hi?a(] ts h«ld for sofii« tutnutiM huDt to 
til« oppfvilt' pIiIl- } und bi* itprtvCfl, bruvh«l or injected tnVy lh<> 
moittb of ih4? Euali^diian ttilx-, I ptofar a coixtnre of equal [inrtH 
of' glj'cerifKf and wtiivr for cbc^c purpQ»08f aud lo \tt}^i into tlic 
ibc uid tympiuium. I Kuvv pri>v<xl il to bv « bcitcHeiiil iiA tlie 



430 THE RUMATV BAR AND ITS DIBBASBB. 

undilut^, and it is mucK easier atomized and iojected throogh 
the catheter In the cases I am considering^ it ought to be ap- 
plied to the drum-head and blown through tlie catheter into the 
tube at every visit until improvement ceases; then it should be 
used once a week in alternation with other local remedied. 

Muriate of ammonium in sohition (Ammon. murias gr. x, Aqua 
dest. f t5j) is an excellent solvent of dried mucus, and stimulant 
of the mucous lining of the tabes. It accelerates the nutritive 
changes in the tissues, the exfoliation of abnormal epitheliuiOt 
and the fsecretion of mucuH, and thus diminishes the thickening, 
hypertrophy, and adhesions, which are present in sclerosis. It 
is notsuitable for the dnim-head, but should be introduced through 
the catheter by a puff of the air-bag. This ought to be done 
every two or three days for many, weeks, perhaps, months ; until 
it is evident that no further effects can be expected ; but a glycer- 
ine injection should, also, be made onoe a week, to keep the parts 
sofi and flexible and the hearing improved. 

An Iodine and Ammimium mixture (TV. JWinnTT^x, AquaAni' 
mon. nj^v, Afjttadeftt, f Sj) possesses greater stimulating and altera- 
tive powers tlian any topiad remedy yet mentioned. The am- 
monium dijssolvesthickeneil nmcus, increases the mucous secretion, 
and aicls e]*itIieUal growth- Thu imiine is stimulating to the 
mucous meml>rane of the tube and ear, but its value depends 
upon its alterative propertit^, by wliidi it promotes the degenera- 
tion ami absorption <if morbid dcpo^it«. Th:s mixture is a verj' 
good one for the exhil>ilion of i^KHne in solution, and a few drops 
j^liould lie fora-d into the tube through a rubber catheter at tach 
fiiUing, In some nises^ it will resich the tympanum and affect its 
Hninj:, !is it does tliat of the tube. Like the other remedies, it 

must be use<l for fconie time before unv deeide<l effects will be 

■ 

noticed, 

IJiiLsams exert a soothing and stimulating influence upon the 
mua>us membrane. Tliey are fri^uently useful in proliferative 
clianges in the tube, when the disea?^ is not far advanced ; and, 
especially, in senile cases, where the lubes are somewhat enlarged 
and the socretion almost notliing. 

A balsjunic solution may be alternated with the dilute*! glycer- 
ine with advantage. 



CHROffrr 1HPLAMMATI05 Of TTTS 8U9TACItlAN THIIB. 4' 



Tbt* liir ]«o]iJtioii jmiy bo uwil at ttmc^, but X prefer a oombtra- 
tioQ wlik-h 1 saw useil in l^arU. 1 c^ll it tlie lleim^n mixture. 
It a>n'<ii^ts i)\ (R'rm>in, loin, myrrU, niic) wnttT ( TV< Baiznini 5iij, 
Tf- 7Vu/^m'5ij. 7*"^. jVyrrfcr 5j)- Tlte mixlun-Hlioiilii Ix^kvpl at 
hnn'l. ami f)vi^<lru[is adil^l to a tca?|>oout'r]) of waffrr^ when one 
wUliei to u^ it. Soaiti of ihi^ i^ to Ut intnxltio'i) (n* ii |>i|>eit« 
inio \X\i\ ratlK'tcr jit ]fQ»ition, and then forced in as ut^ual willi tli€ 
air-lttg. 

It nmy, al^, b« H|>m*oil a^iinf^t the mouth ofth^ tube, (hough 
the |>nx'i|iitnt*' nf guiu in Ihtr wati-r gi^ntrallj dt^ the i^ipilliiry 
ttibfs aftor aM'hile. 

TIk-4t ilh' ;iI1 ttic flmd applications that I can Tecf>inm<*nd in 
the prolifeniiive Mat*'. 

HK*am i» rt«i>mm«nclof] by some authors anil cittKlomncil by 
otbefs, a^ a retncfly for rliroriir infirimmAtifini of tbt- 1iil)«^ I 
hftvr employiM) it <)uito frequently in the lon^-stamljug prolifera- 
tive ca»«s, liiiviog ncHHTiioiiA f>r tbv monjbran« 1ym))iiiii, dry ^cvt\y 
oiKtcTnal raiinl, coti^rderaMp »^]upaliing orm^pioj; tinDitns* and per- 
vious En^tai'liiari iiiIh^ vrtfh dry lining, iridiniti^l by an iit>fteiK-4< 
of moist riles, and a nosirly ht'alFliy pharynx. Sieam ifl of de- 
ddi-d biftHit to ^timntat? till- mut'ouM membrane ntid runtorc it^ 
acdMinn. \i may bf applies! twice a Wf-ek, alone, but I prefer 
otternatini; it wiih tbi.' gUxTrinc injection, tbt>Li};h the xm^. of (li« 
latter will vitiate, of course, the evidence in reK^ril to tiie value of 
\)\v vii|>or 

A .Hf^tHrinl uppnniiH is n^'cv^v^ry tn ^(f^ain x\\\^ Ciir. A ^innll 
FIorefiiT fln^k wiih a rather lar^e openinj; shonUI Ik.- ti^'hlly 
fit(«.><l Willi a nild>er Mrjiin^r, perloral'-d by three small metal 
tijl>es, A piece of rubber tubioif &I1011 Id t.^ooucil one of tht* metal 
tubc^ with a Politzorair-lwig; jinoiber pie^-t? of tubing ^Jioabl *Hm- 
nec-t anotli4>r lube with a suitable nibher catheter by a ^nilcanite 
or Ixwiy lip littinj; into it, w) that it may U- diMwiimH-tfd at pb'«- 
ctUfi-; the thin) lulie is lo be used fiir the introduf^tiim nf fluid 
aod the escape of rteam, during the generation of m^hich it miiri 
In- rIosi*d by a (lork wiih 11 line hole in it, Tlie flank is lo l»e fWip-r 
porteni by a stand upt>n u l^bic, and h^ted by an alcohol lamp 
ril^ m«v)iuiii-4>i]£Vit fl.iini', which mtiM not t-onie nt»ov« llie level of 
the uraier, or the glafv^ vcwvl tuny bv broken. 



TH8 RCMAN BAH AKD ITB DTBtiaSf. 

Wli<-a )<tcttm muts from tbo falHy^tuW^ ihc airlxig should W 
eompr&Hed several time^ until k escapea from the tip in jfsO^ 
T6ui 11 vt]k>;i[iiK* ruiljour Imvifi^ Ikh^i inuxxluccd, as • uvul 
one became too hot, \he tip is oonnected vritb it, and il>eiur-| 
bug c[>m|m^M(d ^mr]>ly. Th« tip mitst U' imim^liaMy <Ujki30-' 
Deot^ a few jnoRj^at^ then connected a^D and another puff ' 
given^ and tJiis may be dooo faalf a doKun tlintv or more. U 

Pio. 116. 




fiTV4UtK» APt-ARxTi<: 



tli»f^ JirodiofA are follovo^l, tlioiv* need be no fear of iraldi>igl 
xIk i>lmi'ynx. Tlu> otUlKtlt^r und apparalua are tlieu to be bud 
aside, and the patient permittod to cool off awhtl«; hoforv piog 
into the open air. 

Every inun who iinj< tht' knovrhn])^'. M\\, and |xilivmv lo Imt 
aiinil di'fe&w^ will bv ing^iiiouA enough toctjaftruci a Bt^am a]>pa- 
mUtii fi't himfti?ir. 

Clilonitortii nnrl Kthf^r mn Iw introduwd into the tubes fron 
the Ap|KirafiiA, o)inu« the Ump, and tlit^ %'np<>r of ioilitie, catnplior 
or luetic Arid, aIW tli(*np|dif^tiLin of ^utte licat> 



tan BrstAcni 



Jn. 433 



TI«i 



Cliloroform ia diagnost: 



u 



% bt«D tDenlioDPfl ; il 10 
i9n}>lovn] K» a nmil«.il L*xu-iit Tt iu Hiinuiliitin^ |inj|K'rli<». Ec1«t 
iR prtiWixiM*^ M iblorofonii coKiirmilate tin.' mtii*c>iiH ineinbraoej 
and to diminish uttiJ miti^ti- rcMlbtu utid distn^wiog litiniutu, 
Tiacture of Ciiniphor, and Aovtu* acid aro tist^d Tor iIm- ^mitr pur- 
post, TjQcturcor Iodine i« iiitiXHlucnl as a Htimubtin^ altvrs- 
live 

The inhaJcr uoiale wilh uir-bag u a mtich los cumbersome 
ipfKirutiiTi Uf a{>[>ly th^si^ modktnid vap^m, than U11? i^Wunx uppi- 
ratus, and will ati^^'wer every [>iir(>a^, provided ihere b no objco- 
tio4i tolhvvni>or <ptiLuigi»oontarl witJitbe St^hiuidtrriun mucous 
membra DC. 

;\ liEtk- uf the ffi^kileii llitkl is drop^xnl iij>oii Uie spon^-, tliv 
otyn}^ t« fitttil into one dohiHI, both no^triU arc clonal cigbtTy by 
ibe fingers, aiid llic air-bag ts cK»r«i*re*<ii once or iwU^ as tiie 
puticDt »WHlbiv?i. Tliis i'ori'u^ the nmlioiCoJ air into tlicnon:, 
DaWH|>luirynx, Euutacbiaa tul)0, and tlie rokldle ear. 

Tbc i-tnploymenL of fluids and vApor>« !q the itiunner dcv^Tibed 
mufit not be oon^idered a sntx^tilute for iaHulkm. The air-bag 
rftoiild be ii**od as dimrtcd^ ju^t befoa* applyin^^ a loal renii^dy, 
in order to clear tlic lubi> «« muoti n* p'velbk, tliat Die luedictue 
may oomc in direct contact with the di«ea»cd membrnuc. 

Till' Jnh'riiid iiKtlk^l iivjLtnunr of rtironio inflammation of lb« 
tube i« modiJjH] by morbid t^tJAtcv in as^ocntv imrte. 

niMtiM^ iif ibe uon*., pliaiynt or tliroat will often present indi- 
cations for oji^licines, whicli ovcn<bado^' tbc tubal s^vnipromti.And 
muKt not be diaregarded. I have clsewbeie slated, ttiat these 
partfi niurt hv approximated to the tiormul condition, before one 
ntti expi.'<-t 111 diiniiiihli mtirb or to Hi*re^ inflummanon in ibe 
mbve and tympaua> The proper medicine abould be eolecled 
from a coDfiiderahon of tlicHe j^iven umler the prBdoinicajK diif* 



^. 



In anme few casea, the sympconm and jkalbologii^al s<lale con- 
nect with tubul and tympanio dt^^aw will bv prominent, wliE^n 
the noM* and throat fiLrnieli norhirij; defmilc in relation to internal 
nmedie^. The [mrtKiular imltcatioft:^ for Iheni' I fuive irrtJU]>tHJ 
under tlie treatment cif (lie t>-mpUD!c disease, which must now be 
conflklered. 




434 THE HtJyAN lAlt AHD ITS DISflABSa. 

Treaiment of Oironic Inflammation of the Tympanum has beea 
in a great measure disposed of in treatment of chronic iDflam- 
ination of the Eustachian tube. The chronic catarrhal and pro- 
liferative inflammations of the middle ear demand the use of the 
air-hagf the catheter^ and the local emolllentf etimulaDt, astriii' 
gent, and alterative vapors and Auids given in the previous sec- 
tion. 

They should be applied with the same frequency and forwas 
there reconimendedj and the remedies ahoutd be of the saoie 
strength. The physician should pay particular attention to the 
variety of the inflammation, and give each state its own proper 
remedies. 

It is an estabh'shed fact, that vapors and fluids can be intro- 
duced into the tympanum through the catheter in the manner 
described when the Eustachian tube is pervious^ and clinical eX' 
perience has demonstrated that they exercise a marked salutary 
influence upon the diseased mucous membrane and the &ubmut-ou$ 
tissues. Roosa approves heartily of this method of treating the 
disea^ middle enr^ and haa no doubt of the entrance of medica- 
ments therein, though his therapeutics are somewhat limited. 
Burnett echoes the opinions of his German teachers against the 
use of fluid applicatidn:^ in the interior of the tube and tympanunk^ 
expresses iloubt about their getting so far as the latter plaw, and 
thinks, if they did^ they would do more harm than gt->od, as it is 
^'an air eavitv, and n-sents the pre>enee of fluids.'* He approves 
faintly of the use of the vapor of chloroform, ether, and iodine, 

I prefer the therapeutic boldness of Roosa, to the p;itho!t^i*ikl 
niliiiism of Burnett^ and, early convinced by precept and example 
of the value of topical meili<'ytion of the tympanic lining, and 
the feasibility of intro<lucitjg vapors and fluids into the cavity, I 
have employed them with etrnfldence and success. They can be 
intrixlueed J they will do gtHxi ; they may oiK^asionally cause a 
little fulness and [wiin, rarely, more serious symptoms. 

There is another use for an injection into the tympanum, which 
has not been mentione<l in this connection. It is for the purpose 
of softening and washing out deleterious matter. In rare in- 
stances, peculiar symptoms, as variations of hearing, sudden and 
distressing tinnitus, and dropping sensations in the ears will in- 



CnROmC I!CPLAM»ATIOK OP TVS TrsdPANUM. 438 



be Dxi^^ncc of ^ritmonrt flini), dotted bloorl, dn'od mu- 
f?aH or orgnnixjM fibrin iu tlie iyra|i:knuTn; and, occaHiopally, 
0hurp cye'ii^lit niiiy dt^'tcct it throiigli li nut nuioli ult^roi) mifa- 
bmiiu iym]i[nrn, 

WImtei MKiking tfi4^ mL-tnbraiK- iu frlyc^riiH* iin'l wntcr t'*n mln- 
nl*^, rfio inlrxitunion of steam and dilute y:lyccrii»e, and sirong 
iiitbtion riit tlii.- tuU'^ i^vcry <lay for ^w lifne, fail In remove 
l)u* ofli'fMltng MjUltkiic^a vertical ind<)ion, 3 to 5 ntm. Mug, 
ttftiiutd lit'mu<l(- with (he triynnpr»t<»nn" in \ht* (Kirirrior infrrW 
({UTnlmnt ikf (Ii4^ drniii-h<?td, Liking <nTv ihft (0 gt* (ler|ily emnigh 
to injure t)i« inner wall of ih^ tympanum. 

If tin- i'(d>»1aru'c lia** tt>n*i<UT«l*l<? i-oriMKliinT^ «-■* a l>lood*<'tiTt 
or drieil aiucii«',aii<] tbcre aro noaQaiomi^l rtationdairiinst ii, tlw 
iiKtTLion muy Uc mudv at iU lin'ution. In f^i«*nil, iliif c«niv)t bo 
detc-rmtncil, when ihe pivvi^iiH direciiiins had l^ottcr be i»bservci]> 
An<T th<* in^nMcm, (hv <^Lr miiKt Ih^ Hynn<^sl gi^llv with tepid 
wat«r, aikI a catheter full Ibrcwl ihrouj;)! ilie tube ami cur into 
the external mniil Kr a fuw bla^l:^ <»f tin* nir-bng. 

This o|»enition ^muld be repnaltd thiily a fi-w tin«, and, if 
tlic MiljnIiiQce t« m»t thiir^ removed, the ^iHliiun or polH;ffiium ela- 
tion fthotild l>e iajedi.ll through llu' KuMiirhiaii tulie, and s)T!n^e() 
through the externjd raiiid- The dilnte pty**eriiR- may be a|>[>lra) 
IB llie Tfiinie marnii-r alWwai'd^ ^Hhouhl the i^hc pmve refni^rtory. 
If thi^ opening rcmaJtw awlij]^ advuiitn]^ may he tuken (H* it to 
iDtrodtiee appro^inate nmlinm^i for the ilbif^nded ninfoiiH mem- 
brane. 

Solutions of r^iilphntc^ of xi lie, and niinUeof^ilveMnxltbediluttd 
tartineture are suitable for the humi^l ; nnddifnt^tl );:lyo(*niK% and 
Holittmii.4 ii( mtiriate of aminaniiim, iiwlim-, unil lieaicoin for the pro- 
liferative cft^e^. The |iro[>(»rtio[is ongbt to be the «arue susalrnuly 
ritnriiluti^l for nfie tbrf>iig1] the enthcter. 

The ineisiiin in (he raembranc wilt ^aerally fMX>n b«al, and 
then tljc ui*ual trriitmi'nt nmy \k o*nliniiMl, 

SonKtimca aeute in^airnnalion may bv vxettc^l by tbt^M? Ux-a] 
Applinilionn, nnd it.^ Irealnient mnai be HuUiitulo<), If thtfl (ep- 
minst^ wiihotK fM.'^iiihr, it will Ixr fmind tlinJ (he ohroiiic tnaibfe 
bas \ieen con-iderahly ameliorated by the intTeawd secretion oiid 
l»|nelWEi4)n iu the tyin|)miuin> 



496 



TBB nrUAN SJIR AVD ITS DIS<ASB9. 



Tlu^ mtnjhniKA ivm|ioiii in «» thin, it Mum rawonctblit tktf 
rnetliniied Hiiidrt t^hould pa.'K ihrcmgh it and aSect the Hniriff «f 
IJK' lym|i»nuni. Glyn^niiL' bolti ditiitcil imtl pun* Utv* Im^ii 3|»plml 
to the dran-hcad id many v^s^ of chronic deaiiieas with gvKd 
vtTcvL It lA t>4it ^(lilod til till* Iiiihik] iiilliimnuitivtiii, but to tk 
pToliremtivc and dt>- cases. 

\Vhi*n tht^ nxtrni;)l (iiiial JA dry and itf4 ocrum^n tlinimi^bnl; 
when the dnim-heai ia dry, thick, opaque, and dihiorted by ad- 
htrtioiw and ocmtni(tti>ii^, and then^ hf a f^i»[>iciori ot itiwvat 
niaaMfl within the lymixiimni, warm glycerine and water slioulil 
b« droppc^d iu tb<r «^r iliiily, and alti^wed to n-iiuiii) for ten 
itiintile& 

A little vufcUiw Hinciirc^i ujh^i the cniMil wuIN t» thr brU rrp- 
nsentttttve of cerumen. It soflenfi and soothes the scaly fikin* 
krcp* out dirt, and T^hould be rctK^wi'-l otUii, 

Tlic presence of a great deal of secretioo in the tympttftaa 
and tube with a ^^f^fgy and Cijni;c«l«d dmni-hciid Um bevo taeo- 
lioncd tn st^nn^ ca^eA of i^aianbal intlamniation. The amouU of 
Accretion can be diminmhi?iJ, luid the tyai|)iinir dtmiu^c modifiidi 
tavorably witboiit injury to the dninidtciul, by inritil]ati«>n of fii 
or ten grain m>lutioQ9 nf linc sulphate. Ttiifl Htreogtb is 
flmy to jvi up decidiril tt^^moFif* lurreiit:*. 1 urn i^|>crimeDtUl 
with other rcmeilics, intmduccil into the lytupnum by Oiov 
and hope to pnrviit MTvtccttlA' iiidK^lioon and reliable statislio 
at mmtt: furna' tiuae. 

I warm a c^mmvin dro^jptr over tie argnud burner, fill it half 
full of the denired solution, warm it a^uio unltl u drop oxikIm 
from the iK>iiLt, dr^> a little in tho |Kdm of the hand Ui wt 
ti^rjijieralure, incline the |uiticntfi head so that the trrtiti«d car 
U[iward, uiul dnip the Huid into tlie mcatuh. I leasee the remedy 
in from Ave to ten tvinutes, tbenholdasmalleiip niHlertlieatirirb 
tip the head tovnird^ thiM ^do» cntcb iIm; ctwaping Axiii, nai mf 
the ear and neck utih a toweL 

Infl:ilioiif^ of the (ym|ianiinj by tlif air-lxiir witlxmt and irili 
tho ciUhoter piny an important rAlc ta treacment. Their uw iil 
aerating; the cavity, cjc[>cllinj^ iDUcurt, forcing iu nK<diruti>l vupon 
:ind (luid8, rc^torin^ the plane aim) mobility of the meoihnm> 



OPKRATlOHd OMH THR UVUDRAKi TTHPAMI. 437 



■nitroi 



lympani, ftiding the hearing, and pminntiti;^ contive action, hiw 
been dwelt upon in Iri-utnietit of the ICu^cbian tutic. 

Th<*re lire other elTeHH nf inflAtion^, whiHi are I»>o im]>or1ant 
to be neglw^cd- Thoy relieve the nucnmfort-ihk' fulnctu in iho 
^flr, milignle or claeck tifinittus, hmiirtli vcrttj^i, <?nlni i^ervotis irri- 

tun, iinJ TinK'Iiomte a dtfitnicUHl mentsl f^IuU*. M^xteratcly 
rg iiil^atiiHi.H Imve a mcM:liai)i<al uHion not 1o l>c i^n<tred. 
Th*'/ exerow oompr^aaion ujwn the dilat^l vcsseJe of the tympa- 
nam, ami forx^ <^rtira<'(ion ; t>re:ik libn-s iirul hnmln of inlhim- 
matcry formHtion; tear adhesions betvi^a the drum-heid and 
(loMichivt, am) walU of ihe oar; fiw and utrctrh hatti|)t'n^ and 
Qontraded nm^W ; Iooshi ihefltilTened artinilalioii^, and brodc 
tip uni.*liylo«iL*#. Thit^i: cnnditi[*n» ur? pn-ccnt tn nuiny c^umh ^ 
lon^-Ktsndin^ aural inHaniniation, ibijiecially, in th« proliferative 
Htftiff or vnrldy, and ii|>r)n their lN^t1«*rm<-nt or n^mnvnl d«|ieQdii 
to a L-ertain extent tlie ioii>ri>vement of the hetria^. 

^VhrIl liie '»Micli<^ nre iiniaovable. Uio injvc1«d air m\l act with 
tcrvater force llian nF^ual upon the s^irmenlfi of tJie n>etnl>niiia 
tycD|MUii, ami the |>hyT;ician r^ihouli] not Cimtinuc hi« inflatmh 
too long nor make lh<-in Iiki (Xiwcrfnl, fur fc»r of il^troyinf^ iif> 
phaticity or rupturing »o[xiethinne<l and atrophic portion. 

Sev-cnil inflailimH KhonlrJ Ik? Miftd<* at <iiHi vmU once or twice a 
week, and the other treatment isteailily and hopcfi/lly i^iatiniUN). 
SiiGfcle*s infitrunKPt, so nt<eful in dio^oaipg adhesions and fr«c 
wgRHMita of tho ninnbrana tympuni, is eomelime* applttHl ft>r th«r 
purpose of r»tnrini; the: drum-head fo \t^ |)ro|>er position, and 
brrnking up adh^'TtionH in thr inithlh* ntr, ll \s vi-ry trmiMestnnu?, 
ami entirely ioadeqoate for the purpose, notwithntandiiig the en- 
«ominniH nf iv^mo anlhars, 

Opi-:KA-rn>\n upon and throuf^b the tnenil>raoa tympani are 
orrMvinnally pcrformod fnr thon>1ipf r>f prof^iVA)Lii'dh*fifiinw, and 
{"hrooie inflammation of rbe tympanum. 

CVrtiin npprovrd mirgirat m(>iii;nrpp; must tu>iv hv rv>ii«icl^rcd 
Tor distoriionr depm4<ion, and wlhc^ion of the membrane, and 
ponlniHion <>( tii<j (entor tympjuii muitt^h-, 

Aoevdental niptur^ of the menibraoa tyiTij>ani in stome i.'a3i^ vf 
4fliroai<* d4*nfnnu vru* oliMcrvnl by pby«i««ian*; of lh(» lant ctf>iitnry 
to improve ibe hearing, and ihia improvement eonlinued ^ long 



489 



TBI UUMAK KAR ASD 1TB DI8BASKS. 



aa the opening remaintxi. It was & natural oofK'lufiiau, tint aiti- 
liciul fH.-rfuniti'>n of (lie dniiii^Heiu) in ^imihir <vm# wi>ii)d Idvr 
thi- HJiRie efTecl ax llie acciJciital, and w it proied. The exaRi|klr 
rurnj^hcd l>y nntiirr wain imituU^l l>r srt ; tlic DJcmtinita iTrnfaAi 
was iiM^ified tnr cleaTuGGb liv regulars aDc) ciiarlalans, and occiikfrt 
tbik?^ fnTiii4h<.Hl ni> c«tablij4Ktl operation in Mir^^rj, s» i: Iiit* ilnnt 
in manv oiher iastanc^. Tljer^ wus very little attention (akl tu 
diagnwis of 1I14: aural condition di'imijidin}; jHTfonilinn 6f tl>t 
niomSrane, SorgetMLs w<Te ignorant of tl»e melhodf of c]iii^iM» 
and of tbe ri6ni.<nK-iii» of anml pathoIn^% which tn»k^ modeni 
pnK'tico nearly an exact tciew^e ; and, heuce, any and ev«fy nse 
of deafiiCfv WUJ4 trratcd hy [nimrtiirmg ihr nKmi>nin«-. A# <^nli 
fi very few ease« ^vere uiiii^nable to m}c\\ treatment, miuv 
ftHkirc^ toimpro%'i' the hiariag R^ulk^il; the o[H-mtirkii full intu 
dirirepute amon}^t ediK'ate4l Mirj;(f«in&, and was Sot awhile |h 
foriukxl only l>y iho di*>n.'piitnbli; and dislioii^?^. 

Inerea.sc\t knowledj^e of the aiiali>Qiy and pliys^olc^' of At 
ear, nivl ^n.*»t no[>rovenicat in methodic of diagiiit«ing [«itholo*ic^ 
»lale?> liavt? eitabW rai^iern )>nietitioner8 to eotsUiab data If 
wiiii.'li one inny tlmdc' ibc fttJiHituliry Df an <^ratkiii, ar 
(kml^abllity of impn>viii^ audition. 

InduutionH for opei^ition in rhronir pr4)gnssi^"G intiammatifn 
of tlie iym|Mabijiit, when other treaLrnent fails to improve tl»j 
bcariii)^ and it> r^li<.'ve di»s>nfort, an: a<T follows ; 

1. The Eiutachinn tutro renuiina eloMxl in apiU! <>f irvaXnifnU 
the druui-hvttrl bemg dvprcawd, and rtiorlMd auml ^yitiploOH 
prominent. 

2. The pre«er)ce of niuoit«, blood, fibrin or a fcMeign body rn 
the tympanum. 

^ Atn>i>liii^ thiniiiogand pniicli*likrbitl^ng of portions ' 
membrane. 

1. Tliirkeiiiii;^, liiLrxinfTu^p MifTiif^vt, qikI 4ight mobih'ty 
membr&ne. 

5. Citntric-iii] fold^, ranging rr»n1niet!on and diMortinn of fbr 
membrane^ diminntion of its mobility, and fVequent altv?l(s ti 
hyfUTMtmtJi. 

6. Prominence of the anterior and pusieriof fold:*; deprafiuoa 



OPIEATIONS CrPON THE MBUBRANA TTMPABTt, i39 



of Ihc iiH^nibnitie, vritli iulli«4Hm to llic o^iclcrt or L)i<f inner wall 
of ihe tympaimm. 

7. M{il|>o><ili(ia of file ossii^K^^ rind iiiirortiinatc at1n<'hrui'iita of 
a perforated ih'um-liead, euiiMng tiiniiuia^ vertigo, am) l'n^ili\'e 
|niiu. 

8. DiMn^aiing Imnitun whlcli all Uie rc^tournt^of art i!ann<it 
<nhcrwift<^ irlievc- 

9. Conlracfion nml ri^i<li[y nf llie leiHor tyrujuini niii-^cte, with 
iK|fcrr*«J?>n of the mcrabrane, and Kymploim of pressure upon the 
Ifibyrinll). 

Coll till! ml i<:nt[onS for npcration arc m^ follovra : 

1. The Qienil>rui^a 1yni|Ktiii is almaM erilir<1y itilhercnl 1o t1i« 
inner ttull of Ihir lynipuiinm, »o that tliere \>i no outward move* 
n>efit diirinjj; inflation ami tlie il^ of Sie}fle*H Hpemilum. 

2. Tb'^ d<<iifm<fw )ia0 ri-!<iillcd from ccn^liro-t^piiml Jisooiic, and 
(Ik tyiupaiium is little altK-ted. 

3. The timing' fork, vibnilin^ upon tliQ vertex, ehovm grett 
impairment cr total iiarnlynU of the au<1itory nerve, 

4* Thi' jJilii.'Ht i^ {'*j6hh from il]-h«ailth cr ifid a^^e, 

fi. The diM-j>-.' i* hei».Hlifar}\ of very long continuance, and 
there arc tinnijetakabk ti^m of advanc^ selero^is, with liy;>oroft« 
lOMt^of llie triiLfM>nl Ikjiic* 

It is plain enoiiifb tliat an exact dlagnonis of the aural a>tidi- 
tion mti^t lie mjide, jiik) ii ek'or iiliti nf vrbnt tiMsiio( need eulttng 
to ifive ifrvatcr frealoni of aolion to the auditory apparatus, before 
tlie knife «houkl \h: Ukvii in hand. 

The simple iad^on in the interior, anterior or posterior quad- 
rant of the dnim-heiitl, iti let \n air, favor tlie cvcajje of improi»r 
aiibitam'f^ or dimiutsh atriTphie rbtnniiig and pouehiog, (should 
be made under gofxl illumitiuliou from the btud-mirmr, through 
A ttiiu luird rubber ^peL^ulum, by mean^ of the aiyringotrtmep 
fixed at an angle in a Welwr-I-id hantlh*. Thr* ml nhnuld !»e 
flhoLt 2 mm. long, ami 2 fUfU. di.'itant from the manubriaiu, but 
its height nmy he varied oecording to cireuniManeeR 

Cicatri<<iiil f»hU iind UuuU rhat dtrctort rli<* inembmno and drag 
apoa the mannbriom i4hnii1d he eut arnvw thdr lonjf axi:^. The 
pCMrtMior foldf betwe<-ii ilii- ichort fmHvrwt of the rmdfviiti &nd the 
pi!n|ibery, lM<w>m<^ [in>niin4>nt ami rigiil whrn the membrane id 



440 



TUB nDMAH EAR AKD 1T< DIfiBASIS. 



much d^pn^^fied, aiKl both Liioae and Polttsor rM^ominoid lint 
it dimiKI Uf iriHfied lratuv»jr*ely, A fiii^klc-itluited ntjedle, ftifd 
in a WVhcr-LiGl handle wUli the cnttin^f pdg? ttpwanK hbcoM 
l>e |»4^e<] ttinmgli the dmiii^hotul l>elnw Ihe fold, and the cut 
madp upwftix}ft to nvo\<l Injuring tho cfaordx tynipini nerve. 

Thii-keniiig and .-i^'h'rijrtm of tin* tmmhrane, periiianoni ocdu-j 
^m\ ttf t)k* Enr^tachian (uIk-, and di?4r«ffiin);, obMinute tirinilt]%l 
require an Jnrmioii in th«* inferior fuiAim*ir quadnnt, 2 mm. long, 
inralk'l with and 2 mm. behind the mnnubritim. If ptiii oetmn 
And iiktl^mrnation tfirt^lenA nfler innkiiig an o|i«*-rarioit, the hot 
douche fibould be ufied, and Aconite Bilrainifttered intemulK'. 

It in desirable and |renf*mlly newft^ary to k«?|> ihft |>err>ralioT» 
from cJcwini;, an<l mmiy mc*i bod^ linvv bc«n in vo^ue to preri^il it. 
One wayistodittsecioiit a tritintnil^r Moment of lb<> inembraxie — 
a diflivultf severe, and wntelimts danji^rmis o|y^rniinn. One in- 
ciflion in madf from Ihi^ umbo at tlir maniilfriiim doirn tn 
lower niAr^in of tbi- menibriine, another fmm the umb^i to tUj 
poiterior margin ; lint flup i:* then mxt\l by <leliACe angitUr fo 

Fia lir. 



KixnocK** Al'kal Scubou. 



oep^t and <«(:p(imtiHl from tin |>cTiplieral attaobfoent hy SimrockV . 
tfCMionf, or by a probe-poiiiteiil knife 6xed in a Wcbcr-Licl handle 
Tin's myringodcotoniy i>f Orubrr in coad<;niacd by V<>ltoliai, who 
ntJker <'jrn£^tati« its dangere. 

Ill n ciLsc opcmU'cl upoa by the fomicrdi^cingiiinbcd author, the 
optrning reaiained uftor a period of fiw moutlis. 

Aiioth<*r method of mnintaiiiing an o|>cning Lh by aiapntaliD 
iht? bundle of the niullf-Hin, an pri>[x>B(xl by Wix^dta, but the i 
ration 10 tinjubliliitblef and 1 will not dea^^ibe it. 

Ctatgui Ixiui^it^, iiikd l[iri)iti.-irijiHtidi<(if>ngr*tt-.i)U>p plaLttl jtilhvlS* 
dtJofi la keep it fn^ni lUk^Iii^ bav« had ibelr advocates, bui tbcyi 
nrv HOW conni4k-rt<<) iinpnuHmibh-, 



0PBSLiTrO58 VTOy TBB ME»ltR/Ki TYHrANI. 441 



PolitKet's eyelet in the bofftiiTuI only thing now u&wl for nmin- 
t^ning nn f>]y^iHii^ in llie inemHrniK;, It i^ iiuule of h:m1 nibber 
or OKtilr ia spool-ihapttl, pcrf^jraUHl Joiipitu^iually, :ii»l has a 
piece of »ilk uttiufhed to it witli whirti Ij> dniw^ it <mU It i»bti[- 
toned iiitoiiHn^lc incUimi Ix-liind the mallea^f and the nlk b 
left in theexiernni caDal. Polilxer ha^ invetitetl a ili'ltoAte and 
pM'uliur angular forceps to 6x iht- eyelet iu positToii, The eye- 
let upon ih« fon-eftf in ploonl in i1k- incii*ion, ami n !<liglit prc»- 
HQre of the angle of the forcepi^ liberates and leaves jt secure. 




The cycle* must Iw pluooJ In pa<^tion gently, else injury may 
be tli>nc to the o^iele^ and adhe^ioaa favored between the nieiii* 
brane, the os6id», snd the wnlU of ihe tymi>aiiiini. If the e}'cIoC 
does not toudi the inner vmtl of (lie tympanum, itoause^ iio [lain; 
OtberwiiH? H?vcrv pnin may aifuc. TIil* mt-iulinini^ bofjnkiv red, 
pas s]iowj!f nnnind the fon-i^n body, the lip of llie wound tighten 
around tlie eyekl nml hold it IW; but in flam mat ion may follow 
in th« uiiiidlt car, and pu^ ^ow out of the opening. A drop of 
glyceriDe in tho eyelet vrill dissolve away plug)* of pus and cpi- 
tbelial dctm^ ami niil in keeping the o{H^ning free. 

The QonBci^nent indammation mujst be treated in the usual 
manner, and Uttwtvn the times of draiungs m [ih'^l'^'t of coKou 
muat be placed a;^D»t the eydot to keep it from betnic pushed 
OQtvran]><. Not nnfmiuontly iL is dUplaot^l untwtinl by tiw flow 
of pus, and by Wowin^f the nose. After the reactive symptoms 
havcHubNdcd, the e)-ektollvii imptovet the heanni; and arre^ta 
tinoituK 

It is ditTicuU to fix the cj^clct in ])laoc*, more difficult to main- 
tain it in jMwitiou, and most difficult to keep its openiujc clear of 
mucus and c]Mtbelium. It sometimes ooowions iwvcre iteunlgic 

S0 



TBV BUMi5 VAR A11I> ITS DTSBASRfl. 



prnti, uihI iniiv full uMo thi> lyroptmun] ami excite violent iiiSsoi' 
ination. For thcue reasom Folitxer's liule invention is new ael- 
doiu U^ltl, 

A membrane perforated by diseafae souictim^ bcals am) b^ 
roinrgi< a(Jh<rrt*nE ro llie osHidcs und inn«T wiill of Die tymjiADajii in 
such a manner, bb to c^u^ diatreeeipg symptoms and require «n 
opeiulion for nOief, 

An imperfoiate membrane itometimcs forms adhcdions wilh ttie 
ceeiclw »nd promontory of such n nature, Uuii «ii opcntion 
would Beem Co [H^mise an improvement of the condition and tbe 
bearii]|;. • 

Th«4e nperatiotiA, whicl^ c<oii<Ht in diHftoctiRg iht laernhnof 
frmn itH abnormal utlscliments^ necessitate epcdal itkstrunietitauid^ 
great skill in manipnialion, 

Dr» Protit, of Brooklyn, N. Y., wbowcotirsc of lecture* npon 
aural diseases 1 hiid tiie pleiLMire of fltrending in 1869, baft fti- 
formed several o|>cralit>ns of this chanirrter; but so skilful an 
oiHifittor nmy do »4Lir^icid operalioiiif, thiU many oM^ns ftliould only 
think about. 

He makc^ use of n very Sfiiall knife which bcdcscribesi "Tbe 
blade is bent on llie flat at an an^le of forty-five dt^nc? ; il ii 
trianpibtr in »bapo, about one and a half lmc!« lon^, iind cbiee- 
foiirlb^ of a line br«:^id, sharp at the point anrl cutting at both 
<*d^;nc The Hiank U thn:e inches lon^^, of which the incji next 
tiif handle ii* not Ieni|>eredf that it may be bent 1o any d<!sir«d 
niT^ie, Tho handle k eight-sided, timt it may be rotated bctmeo 
the tJinmb and Ri];E;er in imng it, am] i^ fwo invbo lon^** 

The jiiitient h etherized, the head »up|>orted, tbe membrane 
illuininateil by the heati- mirror, lhi> knife tiluink bent at an anKh\ 
and il4 blade drawn around adhesions until all obnoxious bawk 
are ineised and thi.^ membrane i:* fust. Blake'ii middle-ear syrinite 
will bo fotind useful in washing out the tympannm in ibis tod 
olher ojKraifons ii|>on (he meiuhniii(.\ 

Que patient before operation had unlK^rahletinnitwnnd littrd 
meilium voice tU leu ftvl, Inimulijifely after the operation^ the 
tinnitus had ceased, and ."ihe lumrd meilium voice at tiiirty fttc* 
The not KTiTc pain was relievetl by tbe warm dotxrh^ and a 



0PERATIOX9 VT01X THE MFMBRATTA TTMPANf. 448 



flight purtilofit ii)flammatton Tor a tvoek Qnorvranl^ wms tixutnl 

io tlic usual manner, 

One ymr \i(wr Uic opemtion, the o|Mvinii(; in ttiu membmnc m- 

n:ainviJ, tlic muidle car w^ cir)% and uicdiiiin voice waa easily 

lieanl aX twenty feeL 

Fm. 119. 




Bl.AKR'f MlPPr.^XAS HTKlirOR. 



Orw^ cftRiiot €xppct mioh a good renaU in nit hlkcv, Iiut vrhon 
everythiiig ebft hoH fuilod bi givo r«^)ifr nnd fiymplnim di^iitand 
interference, it ih cnmWHng tn feel tlint nil U<)p«' Ik not lost, and 
tluit tl U ]>rf)]H'r li> vrMlurf upon (hi^i cMic^tr oprmlKviu 

The tiM^wr tympani muscle hns a tonim and oonlraHinty Likf) 
other tmuvrh^i. It tit Aulijivt Uy pafVAiii f>r piirulyciri, in orr>nnr>ptlon 
with thf> wimo a^ection in ihe palAlf>ttibal ii^u^ofc^^ and tynn be 
riX'iigtitXfHl hy <Jt*nfn<r«*, und frc^ nwlngiiif^ of th** ninllrUK iind 
Hnim-hi-nd. The muMoTe becomes contraoted lemporaHly or per- 
mani^iiVJy tn many t-am^ of c?hroiii<* tii^mmatuin of tUa tympn- 
niitD. IrHlAtion tn the tynipanum, Ku^Uchian tnbe^ pharynx 
Hoii pulai4\ and, probably, in <>tlior pttrb oxcitM rroi)u<Tnt contnc* 
tion of thi^ dclicale iriu^ole. Continued irriTAtion and frequeot 
oofitraction letd to hypL^rtrophy, tonic ttpnjtrti^ pcrrmunuat vJiorteit*- 
iD^f r\ffniiiy, and, finally, to futCy degeneration. 

Thtfoe cDrtditit>Dn arc favored by olasuiv of tb« KuAtaohian 
tiib«, the con^'e<)uent rarefaction in the tympanum, invarj prctt- 
aureof the uK-iubmim tyin|Kin]f and the Jt^PHcr ulr upon itji cz- 
l^rnud niirfiicc; but th«y occur without thc*ic oi<U, the jwwyigo of 
air ttirongh llie tubo to the drum beiii^ unobpsrruoted. Thi-y ure, 
kImo, favomd by gmduiit i^>ntrncTtJon nf tho iibrr* ai>d banda of 
nmrUd ooaneetivL* li^ijo in the Lymjwnum, which drug the drum- 



44i THE HDMAN EAR A5D ITS SIBEA6E3. 

hcail inwards^ clog and hamper the action of the ossidfs, and en- 
velop aud hinder the movements of the slender tendon of the 
tensor. It is probable that simple closure of the tube alone^ bb 
well, as prolifcmiive changes in the tympamim, could they exist 
without other morbid changes^ would itkdnce shorteniog and 
rigidity of the tensor tyrapini. 

It is certain that thid little muscle drags in the manubriam, 
destroys the harmonious action of the ossicles, induces catarrh ot 
the mucous membrane, increases the intra- labyrinthine pressure, 
causes deafness^ distressing tinnitus, vertigo, and ultimate atrophy 
of the terminal filaments of the auditory nerve. 

Cutting its tendon has, therefore^ become a I^ttimate opera* 
tion in surgery, after other means of relief have been tried with 
indifferent success. If inflation will restore temporarily the 
malleus handle to a normal position^ of course, one should per- 
severe in the usual methods of treatment, leaving tenotomy as a 
dernier ressort. 

The manubrium is pressed or dragged inwards in various ways, 
■which have been sufficiently dwelt upon. It is necefisary to diag- 
nose depression due to contraction of the tensor tympani, from 
that depending upon other causes, before procootUti^ to o|>erate. 

The reader will remember that the tendon of the tensor tym- 
pani niusfile leaves the ostium of the processus cochleariformls, 
passes aero!^ the tympanum high up, aud is inserted into the an- 
terior, inner edge of the manubrium. AVhcn the muscle is con- 
tracted, the malleus handle is drawn Imviinls and twisted upon 
its long axis; the posterior border is sharp and prominent ; the 
short prooe^H stands out boldly ; the posterior and anterior folds 
show cord-like; the membrane behind the manubrium is nearly 
in the »ame plane as the bone ; but anterior it is depressed, and 
forms a dark concavity, that resembles a perforation. It is 
easy to recognize the difference between this sharp-edged, fore- 
shortened manubrium, aud the broad^ flat, thickened appearance 
seen in depression from non-muscular causes ; but frequently both 
inflammatory adhesion, and contraction of the muscle exist to- 
gether, and then diagnosis is difficult. 

Tenotomy of the tensor tympani muscle was su^ested by 
HyrtI, and first performed by Weber-Liel, who has an exalted 



OPBRATIOTTS' UPON THE UEMBRANA TYMVkVl. 445 

opinion of its benefits, not universally ngreed to upon this siile 
oP the water. His method of operating is rational. 

The head is fixed in' proper position by a head- rest ; a thin 
rubber speculum is inserted in the canal, and the parts arc well illu- 
minated. Ad anesthetic is not eonriidered necessary, as the pain 
is not severe, \Veber-Liel*e peculiar tenotome is introduced down 
to the membrana tympani^ its hooked blade is passed through the 
membrane about 1 to 1^ mm, downward and forward from the 
short process of the malleus. The instrument is then pushed a 
little inward, its handle moved downward and forward, and the 
hook grasps the tendon. The handle is now turned a little more 
towards the patient's face; a gentle pressure is exerted upon its 

Fiu. 120. 




Webkr-Llel's Tesotome. 

hook ; the button connected with the c<^ is slippe<l along enough 
to turn the hooked blade one-quarter around its axis; and a 
crackling and yielding will indicate that the tendon has been cut. 

The button is then slipped back to its former position, which 
turns the knife, and the instrument is cautiously withdrawn. 
Care should be exercised to keep the hooked blade in the anterior 
portion of the tympanum, close to the inner surface of the manu- 
brium, and upon a level with the incision, in order to avoid in- 
jury to the diain of ossicles, the chorda tympani nerve, and the 
inner wall of the tympanum. 

Dr> Weber-Liel has performed the operation more than 300 
timeft. 



THS arUA9 BAB AlfD ITS DrSSAflM. 



Dr. Burncit sny^: " 1 Ivivc Inul th« grnit plcasuiv, a9 well n 
the privilege, of Aeomg X>r. Weber-Lid perform Ui» opcnttiDQ* 
and tllhougb lU iK'HWrmniic^ with th« iuv4:ntor*9 infltnioteot 
Bceme to have beeii difficult for most of those who have attcmptol 
it, Dr. Wcbcr-Liul cpriflinly p<Tforii» tlic oporntioo with ose, 
• , • . lie ioaisls on the neCTssily of the gi^lcflt previous pnic- 
tic-e on till' nuthivcr hvfvra (he ojicrutioii if ii(ten)pC«<l on tbe livia^ 
eubject He ri?jcct6 the ^iSBertionfi that the opemcioo b in toy 
WA/ daiigiTfttiH (o life or ilHriimmlii] to thv iimmjnt of hciriftg 
Mill existing anterior to llie opemtion. The \yi.'< rL^tilt of ibc 
operaTioii, ho tliink^, hit^ twenlhf quelling of the tinnitus aurium; 
grcatEr lienelic to hearing would accrue, If the tenclon wen? nil 
at a much *arliLT6Uige thuu Lorctoforu dcomcij «uy**«on"-"* 

In mobt cases thi^ operation U imprdctiGable,becau^ iho nifin- 
bmim tvnijmni istfo (Iopnv«c«) in front of the nianubriiim, thii 
it cannot be {>erforaiJ^ wilhont itijuring the inner wall o( tbe 
car. 

Dr. Frank ]<ubi«titLitC(] a t^imple knife, Gtced at an an^le into a 
W<^ber-Liel handle, for cases in whiHi tbt; ontonor wall of the 
extcrnfil canal cnrved bjtckwardi? much, aad purmiued oaly a xerr 
limited view of tht^ luiterlor [)ortion of the drum-huAd. A carrtd 
Hic'Icl(>iEhaped knife b used now in prcfvrvnoc ti> the ruiDbentoiiie 
iuMrumeiit of Wubcr-LId, 

Eaoh operator haa a knife fashioned ac*^ording to hi* own ao- 
tioi), but geni^nilly it i^ some modilication of that \mti #o AS 
fully by Professor Grnbcr 

Mciit tenotome have unneoe»isarily sharp points for p«rfonli&g 
thi* meml>ninc ; Ihey endanger dcijtcr stnidures An<l I bav« 
alwavs dreaded to use them. 

Dr. Ort?i-[i^ of Button. Maa^. must luive liad ihUsume faelii^, 
for he has had a sabre-likf knife made, curved a Utile on the flat, 
ami having a rounded blunt end. 

Dr. lliirlmann, of Birlin, m^es a »ckle-«haped tenolomt^ 
strongly curved on the ilat» and fitted into the Weber^I-iel handle 

It is nef^esMuy for ubvinm reaK»iM to have a pair, eunrcd is 



1 
I 



* The Kftr; Tti Annuvny, Phjiiologr and Diftcaaf*. C It. IHonelK AJIj 



OFERATtOlTS rrOff TQB 3fEMBRAKA TVXPAKI. ^147 



o^pwite directions, vrilh tlie cutting edge upwnnl or downvrard, 
according to the opemticn di-tf.'rmiiicd upGD. I think tliis knife 
buil?( Lhr n:<qairoiu^titd Ih^I, Init 1 Ituve lia<l uiiiie iniule wftli dulled 
points, to lesEen Uie mk o( injury to other pnrri? t\rdu th<M« lo- 
teixleil, uDd I muk«> tliv iiK^mino in Uic mL*iubr^[ie with a inyringo- 
lome or^a cataract ni^edle l>«^rore introducing the tenotomCj a4 
pnKtioed b; Subwartz«. 

Fio. 121. 




I. GniUr'i; % Grvea**. 



Professor Gru I itT early m<x1ili<ul the ini-thw) of Wel)Or*[iiel, 
nnd otb^re hnvc ToIIowikI hm txample. 

Dr. tireeu )jrefera to i[ici.-9e die nii^mbrane behind tlie malleuB 
near tlje short piHxvsM, niul to cut upwards, 

iJr. Fomeroy nrnki'^ an ind.'iion near the <mi<I of the manubrium^ 
and, alio, mils upwards until the tendon is reached and seveped. 

Durnclt biw sumumrizt-tl Oruber'« niUM>n» for (h<»e diSl'rent 
methods. "The roetrtim of the t^niconaila mvKuli tfiMsoria tt/jt^ 
pani vnrii^ in its poi^iiJou in tlie ryuipantiiii, being HometiniM 
over die anterior segment of the upper areh of the oval window 
(or it may bt'over the windAJwi^an*! in nonie rastv it may be ox'cr 
die posterior seirmtnt of the o\-al window. The dirwrtion of the 
tendon, aj* it pa?^?» from the rontraitt rtwA?<y/rr to the hinidle of 
tha hammer, must vary grvatly, according to the |to^lion of the 
former bony proeet^ and accordingly the haniHe of the hammer, 




448 TUB HUMAN EAB AKD ITB t>I9BABES. 

in cases of retraction, will have a variable appearance. If tbe 
rostrum cot^hleare is placed far backward, the hammer will appear 
drawn more backward and inward, than if the rostnim is situate 
further forwanl^ when the handle of the hammer will appear to 
be drawn directly inward. In the latter ease, the anterior seg- 
ment of the mcmbrana tympnni will not appear to be as large, 
as it does in the former case, where the handle is apparently 
drawn far backward and npward. 

*^ Hence, Gruber concludes, that no positive rule can be estab- 
lished respecting the choice of a point for incision most likely to 
reach the tendon of the tensor tympani muscle; but the variable 
relations of the mcmbrana tympani, and, especially, the position 
of the maiuibrium of tJie malleus, must aid in deciding where tbe 
incision should be made."* 

In performing the operation, the head should be firmly sap- 
ported, a £«lf-retaining speculum adjusted, the membrana tym- 
pani illuminated by the head-mirror, and an incision made with 
the myringotome, 2 mm. long, a little below and Just behind the 
short process of the malleus. Hartmann^s tenotome, with the 
point blunted, should then be inserted through the wound, having 
its concavity towards and hugging the manubrium, and its cutting 
edge turned upwar<ls. A slight pressure and gentle sawing, 
dniwinir motion will cut (he tcudoji, and the chorda tvmpaui if 
reafht'd will be pushes! upw:trd aud remain uninjuroil, provided 
the pressure and movenjcnt of the instrument is arres^tci, as soon 
as the snapj)ing sound caused by the tenotomy is heard. It 
matters very little if the nerve be cut, as its function js uot im- 
portant, aud its abolition causes no apparent diriturbauco. 

I cut the nerve once in an n]>cr.itiou for caries, and the t^ymp- 
toms which cn.sued, co^^(^=pondt4l with those recordtJ bv several 
authors. There was momentary lingual shock followed by tin- 
gling and nnrobncss in the corresponding side of the tongue 
whi<'h continued some lunirs, Sajjid sul)stanccM, as boras, salt, 
and sugar were felt when plufcd u|jon the paretic border of the 
tongue, but could not Ije distinguished one from the otlier, even, 

* TJie Ejir; 11=^ Anatomy, Phyr^iology nnd Di&ea3o:<. C If. Bumetti A-M^ 
M.D., etc.; i.p. 4i:;i-42l. 



0P&KATION8 DPOZr THB MBMBRANA TTMPAKI. 449 

when entirely dissolved. Slight numbness continued three days, 
then gradually disappeared ; the taste remained in alx^yance upon 
the side of the tongue for a long time, but the patient woj^ uncon- 
seions of its loss- 

Grea.t caution should always be exercised in every operation 
upon (be drum-head. AVben the incision is made in front of the 
maDubrium, there is liability of injuring the ossicles; when behind, 
the stapes may be broken, the foramen ovale perforated, or the 
carotid arlery cut, if its osseous canal is incomplete^ as occasioa* 
ally happens. 

Immediately after the operation^ blood runs down the mem- 
brane outside and in, and in some cases may be seen through 
it. In favorable cases, the manubrium will spring outwards; 
the membrane become more mobile; tinnitus, vertigo and cere- 
bral disturbance cease, and the hearing improve, especially after 
two or three inflations. 

The after-treatment for all operations upon the membrane 
should be the warm douche to allay pain and wash out the blood, 
a tuft of cotton in the meatus, the administration of a few doees 
of Aconite, daily inflations with the air-l>ag, and, after inflam- 
matory reaction subsides, energetic general treatment for the aural 
condition. 

The restorative power of the membrana tjmpani is wonderful 
and the perforation generally closes soon, unless enei^tic efforte 
are made to keep it opcu, 

I have attempted to cut the tensor tyrapani in seven patients. 
In two cases, I was oblige<l to delist because of the pain and re- 
bellion of the fiutferers. Three other patients derived no benefit 
from the operation, one having acute inflammation of the tym- 
panum for some weeks aftorwanls. Two oases out of the seven 
were materiaUy benefited. One was relieved of a dij>tr«-sing, 
hissing tinnitus, and occasional attacks of vertigo, whereby the 
hearing for the voice was somewhat Improved ; the other lost a 
loud pulsating tinnitus, which had often kept him awake at night, 
and gained considerable audition, after a few weeks trealmenL I 
must confess, I felt serious misgivings at undertaking this opera- 
tioD, and I believe some of the above oases were not diagnosed 



4G0 TAB HtrUAH BAR AVD ITB D[BlAfiB«. 

carefully enough froca adhesive ludainmHtiuu uf tlic luembniu 
t^-m|)ani and o-vii<*lt^ 

I do noC coiWdcr th^ operation to diHicult for xhn wcll-tmiDcd 
aurat, whu tiaa a steady hand, autl I do not hav<- ihc dinciHiraging 
idctti^r i(, ihat Dr, Burnett dw^ I lK<li<*\T id ihc opiiminDi c-f 
Rooiaj who ftay**: "It having been dt'uiontlntted Uml iln^uijem- 
li<iD B a safe one, and ihni il u^Minlly [i» u tcmimmry brnHicul 
eOect, eepocially ih dluiluiaUmg tUi: iluuitUH aurium, atiil diat it 
aofiictiiiitts due? .ttiUttJuitml l>cncfii, stv Juu/t I iliink, bojm more 
fWm k !u tJie future, wlivii It will be uodertakoti at an earlier 
tfldge of the duresse of the- middle car. If (bus performed, and 
followed up by tn^tintiitof tJie middle ear through tlie Eu^a- 
cbiap tube, I think we lua; hope for siibEUintial r^altn froea it,"* 

MRDf<:iM»flbould be ^ivco iDlcmallyforthcdiflercTU varwlia 
of chr(>i:io inflummatioii of the tube and tyutpunum, ju«it aa for 
diwiwc cl^cn'bcTG. t have iadicatc<l tho peciilinr clkaracterttda 
ol oertaiii luetlicbie-H, ^bich rt:ndt:r (hetn urvcful in auml dUeiue, 
and refer ihc render for Boroc poiulf^, to wlial I have nrriUeu ia 
oUrt iKxrt^ of the* biHik upoti muteria tucOica aud tlK'rapetitka. 

The iueabuitsi luHtiiiited mtijrdiDg to thr lawn nf phy^iirv and 
t^urgcry nrr- |«inkMj<juut, uud the topicul application of eheaakaJ 
and luedlcinal sub^lauix^ is a grtat neecwity In in.Tiiiag dinBe 
of tbeenr; but une may, also, derive tiomc good from tUTernal 
tnedicatioDp 

It IV noci-Kiury to diiR^R^utiatc tlic varietlcfl of dironic inflam- 
tuation of th« tympanum aod tube. The humid, the dryer^ lod 
tbu prolifi'nitive ]dijt7(c<s of ihc ad'ection require iHSbr^m tnedi* 

JhiftatU/a h a good tncdiciDe for mild^ moiat iufiammaUoo d 
tlip luWand tynijiaiium, wln^ii ii {h\a not cxist^nl very loag^aod 
evi<Ienoe of deep orgunio alteratioa iu the mncooa nietnbrain b 
absent. 

Pulsatilla IB a swe^t wcrd, and jts ortlic^jpaf hy alaioet conveyi 
an idea of those yellow-buirttl, blue-eyed, jxitivfacedf MtbnifH 
aivep«fn«itive,teiirfu], louder creatures flofra^uently seen in "oni 

* A PnfHic^] Tt^Aliw <iu %hb DiMHKea of Uie Ear. InetiKtSfi^ Ui* AikIdrj 
oflli^OrKun. IK ligt.Jo^ Bouu. M.A., M U, fflo-; p.m. 



CQRONIO IKFLAUKATIO?) OP TDB TTVPAKDM. 45t 



gIrU" Tlw RiftltriDC ncin bust iipoD thi» ty(N^ or iDdividiml, but 
I have fouDd it valuable for auful afTcctions m other tempen- 

It is 8iiilahle for itching and tlrynew of the external cBaal ; % 
taoi«t, r»]dij9h or ycUow»li,^ikcd Api>^nLnceof tlednim-boid; 
trarmioiit or permanent ftjliie.^ aiKl tincn^ncw in Ibh i^r; ilulnt«<4 
of lii^irnig, toucotu rfilc« during bluwiag the noee and artiticial 
iaflation, oocaslcHial darts (rf pain through the ear, inooa^tant 
riofpng or ru^hin^ tionitUH, ocGa»ional attacks of verti)^, ilabbi- 
nem and hypen^'retion of the pharynx, and cuDi^iJeruble bland 
muoouR (lificJuir^e. 

Ktiii hjfdrioiL tA an efTicicfitii^utforcn^cs rhiknicteriTx^d hv irt- 
fluiDtnjLttotif with a profuse wrrvmucouB dischar^ obstnictioK llie 
tube amllynL[)utiiim,imdaocTiiniuIatin}>;(XinstAntIy in Ihrr pharynx, 
TIh! cure feel stufled, the hearing is hluuted, and occasional pains 
and ronrs^ir tinnitus are prctent. ThG external canal !»■ p^ncrally 
moiM from hypersecretion of ihin o^riimea ; the ineinbrana tym- 
pani i« ref), congeetr'd. aud thiehened: inllation is accomplii<.h(Nl 
with difhmfty i»r i>f»t at ntl, owiii^j Ut spongy xvreUing or mni- 
fneDcint; proliferative rhanj:*^. If rilK-s are heard, they arc motst 
and Inibhting ; the pliarynx i« very Hensitivc* and bicnis tn^xly 
upon contact; it ofivn preseaU the symplflrns of hyperlropliic 
pharyngiti:^, and profiiKf coryias tx.v\ir fn*i^u?otIy. Tlwwc* jiynip- 
toms arc most fre<itienily oiieoumered in persons of eangnincoua 
ton]f»cmmi*nt, with difwipntcd babibf, syphilitic dvi^era^ia, and il»e 
rfaeamatic or jfonly <hafh«r(iA. 

Steady luhiiitiiKtmlion nf the mfxlirinc will impn^ve tlie ra- 
farriial condition, and arrest the proliferation, which left untrpated 
pruilnet^ irri'mittiahtf-and mfwt diHln^fiKin^ drnfneMkk It iihouhl tie 
Ufcd ^iar\ng\y, wlicn there in ana^inli and weakness; U is more 
ulapteil to robiiAt imi olherwiiU' In-idthy ffenionft. 

Katrun artimimfntTft is another rrmeily, whose pathoffenesis 
points direetly to pntfLM^ attarrh i»f ihi- pharynx, taW nnd tym- 
pfinam. It v^ particularly applicable, when the fiatient is siib- 
jeet to severe ooryia nn<\ epidemic intluenja, and a rheumalie or 
gotity diath<*i«predoininate*i. Thereifigreatsenulbility to roldand 
exposure to cool air or a draft ; eontaet with cold olgeetf, and 
taking irefl lir^vmigibt nr fncH] will esn^ the niwf to cJrip itvnifn, 



452 TSS BCUAN BAR AND ITS DTSBASia, 

and violent sneezing to ensue. The menihrana tympani is red- 
dened ; there is fnlncss, tinnitus, doafness^ and slight pain ; fnfla- 
tioti is diffinil(, but noisy when it succeeds; the phar>-nx and 
nose are often congested or inflamed, and the disease is rather 
recent. The medicine ought to be given in water, but should not 
be continued very long for obvious reasons, 

Mercuriits corros. is one of the best medicines with which to 
begin the treatment of long-standing, profusely humid catarrhs, 
with succulent swelling of the mucous membranes. It should 
be administered in all cases which r^ult from syphilis. The 
external canal is generally moist with excess of eenimcD ; the 
membrane is reddened and thickened, and moves very little when 
the pneumatic speculum is used ; there is coarse tinnitus, dulaecs 
of hearing, and a stuffed numb feeling in the ear. Inflation does 
not make ihe usual subjective or objective symptoms, because the 
air cannot get into the tympanum. 

The pharyngeal walls are red, tumid, and stifp, espedally, abont 
the orilice of the Eustachian tube; the tonsils are large and 
.flabby; a nasty slimy ex|^ecto^ation is freqiientj the throat ifl 
often sore at night, and there are spclU of dull aching in tlie 
tympanum, especially, at night and in damp weather. Mercury 
is the I'omedy jtar exceflenre for sanguineous temperaments; for 
good c<jnstitiitions with a plus of vitality ; for coarse fihrwl and 
rough individuals, attlidt^d with cbronir tym|>;unV <'atarrh, 

Jihvt^ (o^. is eflit-'ient in certain klmls of rhcuniatisni, and is 
serviceable in cbroniii inflammation of the aunil mucous tract, in 
persons of a rheumatic or gouty diathesis*. The disitinctive Fvrap- 
tonis are : rboumatic pains and stiUncss in the muscles and joints; 
the face is florid and disposcil to erysipelas; the external auditory 
canal is redilene<l and scaly ; the membrana tym|>ani is yellowish- 
gray, thickened, dis^tortal, and often adherent to the promontory. 

There is consiiiiTjihle fulness, dcafnc^f^, and loud tinnitus; (he 
cerebral circulation is exng^^Tuted above the Dormalj and vertigo 
common and sometimes alarming, * 

Inflation ^ronerally f^uccecfls and causes loud rjVles ;.the pharyns 
is Ijyporlrophic, und llie secretion in the ear and throat is co]>ious 
and ratfier thin. Along with these symptoms, there will gener- 
ally be imperfect digestion, sluggish liver and kidneys, and a 



CBROKIO IVriAVUATIOSi OP TBff TTIiri!tD», 453 



oopuHts dc-jtoMt f)f t)ric Acid aiid unit»i lU^r tlw urinv lia» coolod. 
Uliiis canuot Iw rt^Iio'l u[Kia Ui eiirc, ouly to imprgve, and other 
metlh^it^ miiHi ^luxveil it, a*: a rub. 

AW cwffiKvi hatf prt^viiJ of dcdiled value in soaw few cases in< 
apirit-Klriiikor^, whli ljy|it*rtri>f>hic pli&ryn^itu), avvcix; liuiud in- 
Bamtiiation, aiiJ 4li4tnwing linniUtP^f dufi proUibly to JilaUtion of 
Uie lycDftanic ve^^U from iiutx^Ih h{ the vii^i-ntut^ir hlt^'cs. Tlwy 
are characterized by gastric irritation, flushed face, ami vextigi- 
iv.iu^ uftai-kn tlimittnihg apoplexy. 

Kfili ttichrcm. Umiitcd tochroaio caturrhsof lesflBevtrity, when 
tlie incretiou u thicker, tlw Euatacliiati tulw patulotw, oiid Umj 
fKinrvDiL ^.LV, a« in atropine p)iar)'n^itb. The externid caniil is 
geaerally Kttly mid hyper^emlc, and may coiitaia a little moidt 
cerumen- the mcmbrutiu liaH a piok or yellowisli-gray color; 
it shows dilatal veflecUaloDgtlitiQaQMUriunip mid i^deprvAsed^ dis- 
torted or adherent. There IS ring]i% hissing or humtQiag tii>' 
nittu; cnmidemble ini|mirQient ol' audition, mui oociuioaal ye> 
iigo. Inflatioii will hiil^ tlic ntecnbnuia tytupHtii outward^^ 
rcliti7e the wiise of fuliia^ifi, and caa**e dcvidtd riles. Tht^re ia 
Dot nmeh secretion in the tube or tympaimm, and it has mow 
ouosistcrK-y und ndh^lveirtu^^, Lliiui in t^^a mjuirini^ Knli hydriod.. 
The moath of tlw Ui\k iis more Hkdy to be soft and relaxed, dian 
tenddy iwoMeu; and ihi^, with wtokii^^ of ihe jjiiburj-tiilml 
muwleifi, may noccssitale die tu^ of the catheter for iDflatioo. 
The niM> and phnryux nrt iit^irty always di;«cascd, when this 
medicaiKr ie ]ndicatid,an<l debility fix>tn malnutrition or, perhaps, 
ft Mnitii*)UH cvichexifl will guide the phyaciau to the remedy, 

JirparmUph.cak. \iajr ai-urativc laflitt^nce upon (hisdiMzaa?, TIk 
phle^ui:itic and ^n|£uin<-onii teiii|wraiueBtd ikre most miweptible tt» 
ita power, and it is especially valimble in i^truma^ Th« eympLoma 
whidi have let] rnctoinwitnrefevr. Tbe«kiQ iitlhinaiKl rough, 
and prone to ecz^^matouB aih] runinculareruption^ particularly in 
tlie canal, Th^re nrt tcmler Aj>oif^ tipi,»u ihi- ^ucalp ; ihe f^r ia 
unui^ually semitive to wind aud cold ; the canal it» pink and flcaly, 
luut had all e3(^H.<!tt of o^rumt'u ; clt*^ hkiii i.^ m thin that abru'^iona 
occur etMily, and (ceutle matiiptiiatiouH cause couiiderabte auffer- 
tBg' The iwtierit dreads to Irnve (he anriule^ touched, and shrinka 
in fear when the epeculum U introduced, 



THK nCUAV «AE A5D tTfl DISBABKS. 



The ntcmbrtiui t^^mpani m often f^y and dry ; it show^ a ic^ 
congested v«ar»el^, anil H lirnit^Ml in mr>htliry nvrin|; to ilc^prCMon 
or [idh<^ton. Tlicrc h geaerAlly a flight tiiiniti^, dimini^hfd 
hearing, aii<! paroxy!tmal fulre»i iinrl mttlvng in the lube iluring 
iiifi.ilion, which is cai^ily ttouornp!l»licd. 

The tube and ljrru|iianum ooiituin only a i»otlorat« quantitv of 
mtica^ wtiidi UH of xympy <yTn!*j*lcncyT And not tcnaciouA. Tbe 
phalangeal opening ol' Uic tube is generaJly oi' fair Aisee^ and an- 
obAtruotol ; th(< plmryni^vii] niiiroii:* mernbmTie ]v roiij^li and inoH- 
eralely hypcraeraic; soignee of the lliroai, glandular swellings, 
ftn<l nruiid HLtnirli ur? not nnciimnion Ayin[»iutn« demiUKltng lhi« 
remedy. 

C^ikvtTf^. ph(m. m oife of the boHt modicio^ for tnbnl and 
tympanic catarrli^ in cliiidren and »frum<H» youlhii. Tl^e picture 
of dis^tixe in ii vory (vtminon one, and cnn bo iradily rrcognixvd. 
The patient has a lymphatic constitution ; the tdtin and naucoas 
ni«inbnin(^ an? tliin^ and proiM* ro intLitne from flight «biwc»; 
tlierc ifi in^rrca^ H?eretJon from the nose, throat, and oeru- 
ininou» gliuid^ ; lh<» «xti>rnnt mmil ii^ inoi»t, nftrn niniost oc- 
cluded hy excess of soft, tawny cerumen ; the mcinbnuia Ivio- 
poni is citliiT pink ordirry buff; it is depress^, but m ewily 
tvfltorKl by inflation, 

Th<:*rT i?( a ^IuHlhI fLi-ling in thecAte v!ih considerable deAfnesSp 
but rai'ely any linnitna. Indallnn i^iaoof^mptlHlied en^ily, und caums 
bubbling rSK*^and immciltiitcimprovcineut in the hearing. The 
toiiHils are enlargixl and fiabhy, iheir rnpLs wale atid deep, lUid 
the pharyiii \s in u Mate of granular or hy|>errn>phic pharyniptifl. 
1 feel Haii^litnl rhat the ph(xphr>nts of iWiH i^oroponnd cxcrristK a 
poH^erful inlluL-ncc upon Ihe^ vam^t but triiether by improving 
gentfral nutrition or hy 8]»-<-ilic ai^tlon, I vritl not venliin* to mj, 
TliG medicine must be giveD for a loni; time, durinfc wbidi 
lotvl muluK'^ii of (li(> thrciat »Tid rar should be pursued, in onkr 
to injure the b»t resulttf. 

fen-UTn iod, cnn hardly U*di?ipen)inl with in ftlmmoiift cdMSof 
eatarrha] otitis, acconifwuied by anaMni^i, defective assimilatinQ of 
food, and eousiderabk ftrhlene^. It enriohcR th« blood, ai>d, at 
the name time, iiids in eliminatiti}; through its Iodine, the nwrM 
prlnciplfs lu the fluid and mVul Xmu/& of the Ixxty. Ita aural 



flyniptoms are vague, but are much the same as thoec of Culca- 
.