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AN  ESSAY
PRESENT  STATE
AURAL MEDICINE AND SURGERY.
J. P. COLGAN, M. D
-'Si
         BROOKLYN:
W. n. Ilogan, Printer, (torn, No. 6, Montague Hall.
           1858.
 'A
1$ 
 
AN  APPEAL
MEDICAL PROFESSION IN BROOKLYN,
IN BEHALF OF THOSE AFFLICTED WITH
DEAFNESS
AND OTHER
DISEASES  OF  THE  E
AN ESSAY
READ FEJ"ORE THE "MEDICO O^IKURGICAL SOCIETY,'"
            August 24th, 1357\
     BY JOSEPH P. COLGAN, M. D.
             &c.  &c  &c.        ^-""T.

?ra^:
          BROOKLYN:
PRINTED  BY  W .  H.  flOGAN,
           MONTAGUS HALL,
            1858. 
 
INTRODUCTION.
       Mr. President and Gentlemen of "The Brooklyn
    Medical  Society"—Your society,  the  only one, I be-
    lieve, at present existing in our city, at least actively—
    although the number of  medical men who dwell therein
    would lead a person to suppose the existence of many—
    was founded, if I mistake not, for the purpose of cultivat-
    ing : First, and before all other objects, peace and good
    will amongst its members; and, secondly, for the accumu-
.^Hrtriation of medical facts and the advancement of medical
    science; and, lastly, for the diffusion of the medics know-
    ledge deduced  from  these accumulated  facts.   Its  mis-
    sion is a noble, responsible,  and highly essential mission,
    for no individual experience or observation was yet ever
    sufficient to perfect the physician.   There must be a place
    to deposit facts, and compare them, separate the truths
    from the falsehoods;  and, there must be some point from
    which these truths shall radiate, like so many  rays of
    light, to  guide  each member of  the  profession in his
    toilsome, and  often,  for the want of the light of such
    facts, doubtful path.
      We have an hospital,  it is true, a monument  of the
    kindly feelings of our more  prosperous citizens  to  the
    wants of the less favored portion, which ought to fulfil
    much of this mission.   But this  institution i6 a sealed 
4
INTRODUCTION.
book, as far as t'ne profession  or the public generally are
concerned;  for neither  the  profession,  nor the public
through it, receive any benefit from the vast experience
which should accumulate within its walls.   No clinical
instruction.  No statistics of disease  or  result of treat-
ment, or pathological discovery.  No doubtful state of
diagnosis  reduced to certainty, as far as I have  been
able to learn, have as yet been  given  to  the profession
by its faculty.
  " I have," says Dr. Latham, in his lectures on sub-
jects  connected with  clinical  medicine,—Philadelphia
edition, Lecture 2, p. 22—" always  thought that hos-
pitals are not converted to half  the good they are cal-
culated to serve as schools of medicine—and I think  so
still.
  " I have always thought that, in hospitals knowledge
is perpetually  running  to waste for want  of laborers
to gather it,—and I think so still.''
  " I have always thought that, in  our schools every
mode of lecturing has been unduly  exalted  above cli-
nical lecturing ; and every place where knowledge is to
be had, or is supposed to be had, has been  unduly pre-
ferred to the bed-side—and I continue to think this."
  None of the gifted and venerable  gentlemen—vener-
able in consequence of the position they occupy in con-
nection with it—which implies, as in the case of Mutter,
Meigs and  Bell—Mott, Clarke and Charnocan—Cooper,
Latham  and  Brodie—Stokes   and   Graves—Velpeau,
Laennec and Louise, comprehensive  and liberal minds, 
INTRODUCTION.
5
  lengthened observation, vast experience, profound know-
  ledge, and an acquaintance with every thing done and do-
  ing in the various countries, have as  yet  been much of
  a benefactor to the younger branch of the profession by
  clinical instruction, the only instruction of real practical
  utility to the  medical student, and the greatest benefit
  hospitals confer upon mankind.
    "I have," says one  of the distinguished  gentlemen
  mentioned above, "  considered my business  to be  ex-
  pressly in the wards of the hospital;  and  I have thought
  myself expressly placed  there to  be  a demonstrator
  of medical facts.  I use the term demonstrator, because
  it will at once carry my meaning to your  minds ; which
  is, that I have looked upon myself as engaged to direct
  the student where to look  for,  and how to detect,  the
  object which he  ought  to know ;  and the object  be-
  ing known, to point out the value of  it in itself and in
  all its relations. "
    Thus, we see, that an hospital is a spring  from  which
  ought to flow clear  and limpid streams of  truth and
  science,  from  which every member of  the  profession
  might drink and be  refreshed.  It is  not the property
  of those  gifted gentlemen immediately in charge of it;
  they are, or should be, only the  custodians, the skilful
  gardeners, as it were, to plant,  cultivate, mature  and
  distribute.    They should  consider themselves as  ex-
  pressly  PLACED  THERE TO  BE  DEMONSTRATORS  OF
*" medical facts    ....  which means that
  they are engaged to direct the student where to look for, 
6
IN TROD UCTION.
 and how to detect, the object which he ought to know,
 and, the object being known, to point out the  value  of
 it.in itself and in all its relations.
   Have not you, Mr. President, and I, and every mem-
 ber of the profession, and through us, every patient we
 have had in charge,  been benefitted  by the  existence  of
 St.  Bartholomew's and  the  Meath  Hospitals,  (to in-
 stance cases at a distance as of more force than those
 at  hand,) as the poor that were  received  within their
 halls and cared for;  and as the medical men have been,
 who listened in the wards  of these famous establish-
 ments, to  the distinguished and pre-eminently practical
 lectures of Dr. Latham, on the heart, and on acute rheu-
 matism ; and to the no less distinguished lectures of Drs.
 Stokes and  Graves.   Who of us  have not been vastly
 instructed by the study of the London Hospital reports;
 the Dublin Hospital reports; Marsh's reports, and by the
 clinical lectures oi Goddard, Bell, Latham and Bouil-
 laud ?   This, sir, is not said by the way of complaint;
for, in our infant state, much could not be expe:ted, but
it is to remind us, that  although in infancy it is per-
 mitted us  to act like infants,—in our manhood  it is ex-
pected that we should act like men   It is to remind us,
that, it is nigh  time to  put  off our  swaddling  clothes,
and  indicate to  those  in charge of the City Hospital,
that it is the vast seminary where  the younger members
of  the profession should be taught to  develope  that
knowledge,  which will qualify them to give to the pub-
lic, from whom they expect support, the benefit of it« 
               INTRODUCTION.                i

vast experience,  as  well as of all the  recent improve-
ments  in  medical science.    "My  business," says  a
gentleman, addressing a class in the wards  of St. Bar-
tholomew's,  "is with the few individual patients be-
fore me ;  and whatever good  or whatever evil  I do,
would  be strictly limited to them  but  for your pre-
sence.   Yes, you are there  to take  ncte of  the  errors
into which I may fall, that you may  avoid them, and so
restrict the  mischief within its present sphere;  and
you are there to take  note, also, of the good which I
may do, and learn the method of doing it, and make it
your own, and carry it abroad with you, that it may
bear fruit a  hundred  fold, and be multiplied among all
mankind."  But as matters now stand,  there is no chan-
nel in this city through which an exchange of medical
sentiment can flow, or the voice of those asking for in-
formation be heard.   There  is no place, whence a truth
discovered, can be propagated, or an error detected can
be exposed, but through your society.  Then, sir,  I was
right in saying your mission was an  essential one.  We
will cultivate good will amongst ourselves, by comming-
ling of mind with mind, so that each  member of this so-
ciety will be, as it were, the depository of all the know-
ledge, and all the experience of all  the other members,
each freely communicating whatever  information he may
have acquired by study, or  by  observation  in his pro-
fessional avocations.
  But this society is benevolent, as  well as philanthro*
pic and scientific ; for the information thus stored up in 
8
INTRODUCTION.
the mind of each,  is to be distributed  as opportunity
offers,  for the  alleviation of the sufferings and ills to
which our poor fallen human nature is subject.  These
desirable objects,  however, can be perfected by this so-
ciety only, by  the individual co-operation of  its mem-
bers, by each member feeling it his duty to bear a por-
tion of the burden,  and participate in its labors.  It is
those feelings that  prompt me in accordance with the
sense of the responsibilities which my membership im-
poses on me, to lay  aside for awhile the great antipathy
I have ever felt to appear, unsolicited, in  the front ranks
of any movement, and take myself from my retirement,
to plead before your society, and through it, before the
profession, the  cause of a class of sufferers that is very
numerous, and whose affections have not, up to this
time, received from the profession in our city, that at-
tention  which their importance demands—I allude to
diseases of the organ of hearing.
  I must confess, that for the  honor of our city, and of
the profession  of which I am an humble member, I
have often blushed to think that in Brooklyn, up to this
time,  not a medical  society has prospered;  while in
every city in Europe, half the  size of it, and  with less
than a  tenth of its prosperity—even  in the little city of
Dublin—not to mention Paris, London, Berlin  or Vien-
na,  several medical  societies exist, where medical facts,
and pathological  phenomena are  accumulated and veri-
fied, to be  transmitted throughout  the world   as a por-
tion of a debt which medical men in that quarter con- 
INTRODUCTION.
9
sider  they  contracted,  and  are  bound to pay to the
general fund, when admitted  to  " the ranks of a pro-
fession  which,  even  in its infancy—when  the  world
was in darkness—was a glorious science, when compared
with its contemporaries."  It is to the zeal, the enthusi-
asm with which  these societies* and hospitals are upheld,
that,  that little  city is indebted for the brilliant position
she occupies in  the medical firmament,—that she is in-
debted  for  the production of such men  as  Wilde and
Jacobs, Graves  and Stokes, Crampton and Carmichael,
Churchill and Gregory, Collins and Kennedy, and the
profound Coirigan, and a host of ethers who have shed
so much lustre on their  native city, and benefit on the
medical world.   In other places, the minds of the mem-
bers of the profession  are  united as if  one, for the ad-
vancement of their loved science,   nere, it would  seem
that heretofore,  at least, each member was a system in
himself, separated from all other  interests.   Here, each
member seems to be a positive charged electric, the in-
stant he approaches his fellow—they  repel each other.
   Sir, let the cause be what it may—however painful—
truth compels us to acknowledge that this state exists,
or has existed  in  Brooklyn—and it is  only  mentioned
and  the  comparison alluded to, in order to rouse us to
an effort for its removal.
  * Incredible as it may appear, there are no less than thity-three
Medical Institutions in and  about the city of Dublin.   Six lying in
hospitals, three fever hospitals, infirmaries, &c, in all of which clinical
medicine is taught. 
10
INTRODUCTION.
  A word now as to the reasons for devoting my atten-
tion to the production of the present paper, in prefer-
ence to one of a more popular and attractive nature.
When a student of medicine, during a strict attendance
on medical lectures, my attention was never directed to
the investigation of the  pathological  changes  taking
place in the auditory apparatus.   Not even in the wards
of the hospital, during a long course of clinical instruc-
tion, did I ever receive a hint that the ear and  its tis-
sues were obnoxious to inflammatory affections,  as well
as other organs and tissues of the body.  In the anatomi-
cal and physiological courses, I was, in common  with
other tyros in the  art,  taught that there was  such an
organ in the human body as the ear, and that in a cer-
tain portion of the temporal bone were contained the parts
connected with the faculty of hearing.  I was,  it is also
true told, that there was an external auditory passage lined
with a delicate  membrane, liberally  supplied with  fol-
licles or cerumenous glands ; that the portion of mem-
brane lining the bottom of this passage, was called the
membrana tympani.  I was also told of the middle and
internal portions—of the semicircular carals, of the la-
byrinth, of  the  ossicula auditus,  and of the auditory
nerve,  and of the nerves of sensation and motion.  I was
further informed  of the existence of an internal passage,
having  its entrance in the  throat, and called after its
discoverer, the Eustachian tube.   And then I was cau-
tioned, if disease occurred in  these parts, to be  careful
how I interfered with it. 
INTRODUCTION.
11
  Now, this is about the entire  information conveyed on
this organ pathologically, physiologically  or therapeuti-
cally, during a four month's course of lectures, repeated
term after term ;  whereas three or four weeks are often
devoted to speculations on the seat and cause of fevers ;
on  the identity of, or difference between typhoid and
typhus ; and sometimes a like  portion of time as  fruit-
lessly consumed in teaching the mystery and art of per-
cussion and  auscultation, and  all the physical  signs of
disease of the heart and lungs, with  all the bruite and
rale,  by tapping  and auscultating the  lecturer's  desk.
Not a word on the pathology of the affections of the ear,
or of the therapeutical method  of relief.  Not a word of
admonition as to the danger of incipient inflammation
in any of these tissues.  Not a  word as to  the frequency
of obstruction  in the Eustachian tube in certain affec-
tions ; or of an accumulation of cerumen in the  external
auditory passage ; or of thickening; or opacity of the
membrane of the tympanum ;  or of polypus; or of ab-
normal  growth of hair—all the result of inflammation,
and the sure precursors of deafness.  I was told nothing
of all this.
   Who has not felt,  before he had been long in the prac-
tical discharge of his professional duties, the deficiency of
such an education in relation to the affections of so im-
portant an organ ?   Who, that has been  to any extent
engaged in  the management of infants,  has  not wit-
nessed twitchings and spasms, and even convulsions, for
which it was  impossible to find a cause or  a remedy, 
12
INTRODUCTION.
until the membrane  of the tympanum gave way from
pressure  behind,  and  allowed  the  discharge of puss
through the external ear, which suddenly explained  the
cause, and removed the spasms and convulsions ?  Who
can explain the perplexity of the young physician,  who
heretofore looked upon his teachers  and class-books as
complete and infallible, when he looks over his note-
book to find what the  professors taught him on this
class of affections ; and consults his class-books, one after
the other, with the  bitter mortification of finding one
and the other silent;  nay, worse than silent, on the mat-
ter.  In  the writings of Cooper, (both Sir Astley and
Samuel)  Druit, Saunders and  the  like, instead of  in-
structions he meets with lamentations over the  neglect
paid by practitioners to this branch of pathology.
  But this did not  de'er me,—I  sought information
from this physician and that, whose position and talent
would presuppose extensive information on all medical
Bubjects, and received in reply, that " Aural  medicine
was not  appreciated!"  "would  not pay!!"  Yet, I
determined still  to seek, and  had the gratification to
find that there were in the ranks of  the profession a few
investigators, more intent on the advancement of medical
science, and benefit!ing mankind, than the accumulation
of sordid wealth; who devoted the energies of great and
exalted minds to the special  investigation  of the  Ear
and its diseases ; and that in many cities of Europe, and
in Russia, aural medicine is as well cultivated  a oph-
thalmic  surgery  is  amongst  us.   The   work  of  Dr. 
INTRODUCTION.
13
Kramer,  of Berlin, on "the Nature and Treatment of
diseases of the Ear," which was republished  in Philadel-
phia in  1838, had the merit of first directing the attention
of the profession in this country to  the  study of Aural
Medicine and Surgery, but I regret to say that the num-
ber who applied themselves to  these investigations, was
very limited, and the zeal with which  the subject was pur-
sued  was not of the most enthusiastic nature, nor com-
mensurate with its  importance ; however, it roused the
Aural Pathologists of Europe to increased efforts for the
improvement of that branch of our art; and dispensaries,
for ,the treatment  of diseases  of the Ear, were  soon
founded in all the chief cities of England and  Ireland.
In  this  paper I  shall direct attention to  the  neglect
which aural affections  have received  from the profes-
sion  generally,  and  the consequences of that neglect;
also, to  the labor bestowed on them by some of the most
able investigators, and the benefits resulting from  that
labor; but I shall first show that the improvements in
the various branches of pathological  science are due to
special investigation directed to the state of particular
organs in  health and disease, and that without special
attention they would have remained in that doubt as to
diagnosis and treatment, in which they were but a short
time ago involved,  and  ,in  which aural affections  are
still involved for the want of that investigation.  ;  ,

  ii Myrtle Avenue,
     Brooklyn, March 1858. 
 
AN  ESSAY
                         ON

  DISEASES   OF   THE    EAR.


  Since the days of Hunter, Physiologists and Patholo-
gists have done much for the advancement  of the diag-
nostic, therapeutic  and symptomatic branches of our
profession.  The viscera of the thorax, abdomen, and
pelvis have each been submitted to the  special and
thorough investigation of pathologists, and the fruit of
these investigations  are immeasurable.  Opthalmic and
Dental  Surgery and Medicine, have, since that time,
almost,  become distinct  arts, although both  physi-
cians and surgeons in general are well informed on all
the pathological changes to which the organ of vision
is obnoxious, as well  as  of the improved method  of
treating them;  but the affections of  the auditory  appa-
ratus,  although meeting with  marked attention  lately
from a few able and indefatigable investigators, have not
been cultivated by the members of the medical profes-
sion, generally, or by physiologists.  The same obscurity
now exists in regard to diseases of the  Ear (speaking
of the auditory apparatus  as a whole) that twenty  or
thirty years ago existed as to disease of the heart, lungs,
or alimentary canal.  Yet, the diseases of all these parts
are now well understood,  and the mode of treatment
much more certain and reliable.  To  point out  some of
these changes will be the chief aim of this paper.
  Laennec first taught  us the use of our Ears and 
16
AN  ESSAY  ON
other acoustic instruments  in the  diagnosis of disease
of the chest, but more especially in those of the heart.
Whilst we acknowledge, with gratitude, the great bene-
fit  thus  conferred  upon  our  art; and  that  we  could
never have arrived at the perfection we have now at-
tained in our diagnosis  of  the  dynamic or functional
and organic diseases of the important organs, within this
cavity, without  the aid  of his  splendid discovery, it
must not be concealed that had we continued to receive
his teachings in full as infallible, and as'admittingno fur-
ther investigation, we never could have  deduced there-
from practical  results commensurate with the hopes they
had given rise to.   On his authority, it will be remem-
bered, we  were taught to believe, and some  do still
believe, that the  second sound of the heart was  caused
by the contraction of the auricle, and he  made all mur-
murs coincident  with this sound of the heart or  con.
traction of the auricle, to denote disease of the valves,
which immediately  succeed the auricle in the course of
the circulation.   And  as  a  consequence  of this error he
taught us another—namely,  that the contraction of each
cavity of the heart was the cause of  the  murmur which
proceede dfrom  the injured valve immediately beyond
itself.  The systole of  the  left  ventricle produced the
murmur when the aortic valve was injured ;  the  systole
of the left auricle when  the mitral valve was diseased.
But pathologists  did not sit down content with the  mere
theory of the immortal Laennec, nor did they dispair when
they followed the subject to the dissecting table and found
the results contradict the theory, but pursued the in-
vestigation, until Stokes, of Dublin, to his honor  be it
confessed,  showed  us in  addition to the distinguishing
marks between   disease of the  internal and external
membrane  of  the heart,  that, a valve partially closed
that  ought to be wholly closed, or partially open that 
          DISEASES  OF  THE  EAR.        17

ought to be entirely open, not only admits a sound  by
the current in its onward course, but in its return also ;
hence, the murmur of regurgitation.
   The Eustachian   tube, the  cerumenous  glands,  or
the ossicula  auditus, are not more distant from our view,
nor obscure, than the aortic valve, or the mitral, and as
industrious  investigation has  removed a  portion  of
the obscurity in which affections of the valves were  in-
volved, industrious and scientific investigation can, and
will remove, the physiological obscurity in which those
parts are involved,  if the  attention of  those qualified
can be brought to  a sense of the importance  of such
investigations.
   A few years ago, the most eminent in zeal and talent
were  unable to distinguish  between endo-carditis and
peri-carditis ; were  unable to anticipate their approach,
or recognise their presence in acute rheumatism.  Phy-
sicians  could say that  trouble existed in or about  the
heart, that its functions were impeded, but of its exact
nature or seat  our  ideas were  confused  and uncertain.
We heard sounds, other than those we  were accustomed
to call first and  second sound?,  and  synchronous with
the systole or  with the  dyastole, and  we called them
hard  unpronounceable names, in a strange  tongue; to
make the mystery  doubly  mysterious,  we called them
bruit and ral6, (bruit de rape, bruit de scie, ou bruit de
soufflet.) blowing  and rubbing, cooing  and whistling,
but whether any and which of these  sounds indicated
disease  of the external or  of the  internal membrane
of the heart, who could say ?  Indeed, no body knew,
until Dr. Latham  taught  the  fact, that whenever  the
heart was affected-in acute rheumatism,  which occurred
in 90 cases  out of 136, a sound, different from the sound
of health, always accompanied its contractions.   Eid  Dr.
Latham, by this, discover a new  disease?  No;  he only 
IS
AN  ESSAY  ON
by close clinical  observation, made evident, what  had
been for the very want  of that observation, hidden—in
his own words, " made that the subject of sure diagnosis
which was before hit upon by chance."
  Here is  great fruit produced from paying special at-
tention to a special organ, and to its special changes in
a special disease.  The  Ear,  certainly, is not more hid-
den than the heart's investments, and  the  same atten-
tion  to its  first  admonitions  of  disease may  prevent
future mischief to the organ.
  It was not until Bouillaud  taught us,  we were able to
attribute the bellows or  blowing sound of  the heart as
pathognomonic of inflammation or irritation of its lining
membrane.  And how did Bouillaud make  this import-
ant discovery?  Was it by denouncing  specialities, as
some gentlemen are pleased to term such investigations ?
He says—"That we have attentively sought peri-carditis
and endo-carditis, and that others have  not sought them.
And certainly to  find we must seek, and  seek with
much care, and with a perseverance that  no hing  can
weary or divert from its purpose."   Nor could we, till
Drs.  Stokes and Watson, for both, about the same time,
and seemingly without the knowledge of  each  other's
investigations, separated  the blowing and rubbing sounds
of the heart from each other, and analyzed them apart.
These indefatigable and  gifted men,  by persevering in-
dustry, and close and long continued observation, directed
to a special object, showed  that the  attrition sound
of the  heart was produced by two surfaces moving to-
and-fro upon each other, and traced them home to their
local origin the pericardium.   How easy it is  now for
the attentive student to  master, by  ordinary  iadustry,
this formerly so difficult  a subject.   He need not trouble
himself about the cooing,  the bellows,  the  whistling
sounds, the bleating, the rasping,  the sawing, the to- 
          DISEASES  OF  THE  EAR.        19

and-fro sounds, he has only to bear  in mind that blow-
ing or puffing, or  the like,  no  matter  the key or the
rariety, so as it is blowing or puffing is pathognomonic
)f endocardial  trouble ; and that rubbing or rasping, or
to-and-fro sound, is as indicative of  pericardial trouble;
md, that where a  mixture of those exists  there exists,
ilso, a mixture of endo-cardial and pericardial disease;
but in the case  of either he can say, here we have endo-
carditis—there, we have peri-carditis.
  With the same amount of industry,  and  even less
talent, may we not hope to see some future physiologist
or pathologist  reduce the  symptoms of  affections of
the auditory apparatus to the  same results  as those
of the heart.   Surely the membrana tympani is  not
more concealed than the peri or endo-cardium,  and yet,
little in general,  is  understood of affections  of  the
former membrane.
  We have  not only learned to detect the  presence of
peri and  endo-carditis  in acute rheumatism, but we
have, by  the industry  of Bouillaud, arrived  at  the
probable cause  of that occurrence.  M. Chomel, in  an
essay,  denied the  termination of articular  rheumatism
by  suppuration.   This called special attention to the
subject, the consequence  of  which was, that Bouillaud
found that M.  Rasibroski had reported one  case that
had  so terminated;  M.  Moreau,  two cases;  M.  Cru-
veilhier, in his  paper on  puerperal rheumatism, re-
ported three cases, and  Bouillaud, himself, .two cases
of acute rheumatism that terminated by  suppuration.
The practical  deduction  from  these  facts is, as  the
latter seems to indicate,  that the true  and  chief  seat
of acute rheumatism is in  the serous or  synovial mem-
brane  of  the joints; hence the susceptibility of the
serous investments of the heart to take on inflamma- 
20
AN  ESSAY  ON
tion,  or some  painful  affection in  acute rheumatism,
through sympathy of tissue.
  Again we find that,  that peculiar and  interesting
pulse called, "bis  ferians,  or  dicrotic,  or reflux,  or
venous pulse,"  so long a  subject of  doubt  and per-
plexity  to  pathologists, has  been  brought to a state
of probable certainty, by the labors of Bouillaud,  whose
motto is, that  in order  "to find  we  must seek,  and
seek  with  much care,  and  with a  perseverance that
nothing can weary or divert from its purpose."
  In  a  patient in whom this  reflux or  venous pulse
was  distinctly  marked, he  not only  felt this  double
movement  in the radial  artery, but traced it  to the
arch of  the aorta, where it was evident at  the hollow
of the sternum.  He saw  the column of blood  in the
jugular  vein descending during the diastole of  the right
ventricle, then reflowing into the vein during the  systole
of the same ventricle, the valve of which was defective ;
from which he  conjectures  that, it might be produced by
what he calls •« the aspiration" of a certain quantity  of
arterial ^blood  during the  diastole of the left  ventricle,
allowed by the  insufficiency of the aortic  valves.  This
conjecture, it will be recollected,  is in harmony with
Dr.   Stokes' theory  of  the murmur  of  regurgitation,
but it is only a conjecture and not sufficiently  tested,
or sanctioned by other pathologists, it is only alluded to,
to show that it has  been considered worthy of special
investigation by that eminent physician.
   Broussais was not always right, the principals  he in-
culcated were  not  always founded  on facts,  and were
not staple; but who will deny him the credit  of  having
indicated the way  to  a just  and scientific practice  in
gastro-enteritic diseases.   He was the  means  of  direct-
ing the  attention of impartial and scientific investigators
in the  right direction ; and  it  must be  admited that, 
          DI8 RASES  OF  THE  EAR.         21

the subsequent investigations of many pathologists have
proved many of his theories, which were at the time
disputed,  as  regards the diseases  of those viscera in
fever—correct.   Who now thinks of treating flatulency,
constipation, dyspepsia, biliousness, and acidity, (terms
until lately used as masks for ignorance) as  idiopathic
diseases ?  They  are, by the advance  made  by patho-
logists in this  special  branch  of  medical science,  as-
signed by all well  educated  medical men as  symptoms
or effects of disease, rather than disease itself, and the
cause sought out  and removed.   Would not a medical
man be  deserving of something more  than  contempt
who should, in the present  state  of our pathological
knowledge of the  alimentary  canal and its  diseases,
attempt  to remove constipation by drastic purgatives,
acidity  or  gastric irritability  by   emetics,  flatulency
by carminatives,  without  troubling himself to  know
whether the constipation,  acidity, vomiting  or flatu-
lency was the result of inflammation, irritation, debility,
sympathy or nervous torpor ?  But such  things  were,
and might have continued to be, had not the attention
of pathologists  been turned in this  special  direc-
tion.        r
   Are not the parts concerned in the functions of hear-
ing  as cognizant  to  our senses, as  the  parts concerned
in the functions of digestion ; and  if the same amount
of interest be manifested in investigating some abnormal
symptoms of affections  of the Ear,  as tinnitus, dullness
of hearing, &c, may not the true cause  of these symp-
toms be discovered,  and thereby a  key to their cure ?
   Another subject of  much  interest and importance,
long in doubt an 1 uncertainty, seems to have,  in con-
sequence of the attention given to  the subject by  some
of our best observers, and most zealous and successful
pathologists,  made some  advance towards  certainty, 
wfil&Wv
 22               AN  ES'8 AY   ON

 namely, the recognition of some reliable symptom indi-
 cative of the  proper time and  mode  of administering
 wine and other nutritious  articles, in fevers and febrile
 diseases. Up to a very late period, it is strange to say, that
 the directions given by Hippocrates twenty two  or three
 hundred years ago, had  the advantage of being more
 intelligent and simple, if nst more reliable than any to
 be met within modern books, which  were,  "that  we
 were to be guided by the state of the sputa and  urinary
 sediments ; that is when the sputa put on  a purulent
 appearance, and the urinary deposits become copious
 and reddish."
   Dr. Tweedie, certainly one of the most distinguished
 of modern authorities, recommends us to  be  guided
 principally by a cool skin, and soft pulse when combined
 with debility.
   In regard to the cool skin it may be interesting and
 instructive to hear  how  " the Father  of  medicine"
 holds this symptom up as fallacious and unreliable.   He
 says :—
   " When  the feet  are cold,  give  neither drink nor
 ptisan, nor anything else of the kind,  but reckon it an
 important rule to  refrain until they become  warm, and
 then you may  administer them with advantage.  .  .   .
 For the most part, coldness is a symptom of a paroxysm
 of the fever  coming on ; and if at such a season you ap-
 ply these things, you  will commit the greatest possible
 mistake, for you will  augment  the disease in no small
 degree."—(Works  of Hippocrates  Sydenham  Society,
 vol. 1 p. 318).
   And now in regard to  the pulse, the other indication of
 Dr. Tweedie, it may be  no less  interesting and  instruc-
 tive to quote the manner in which Celsus,  who, like the
former authority, is venerable for its  antiquity, rebukes 
          DISEASES  07  THE  EAR.         23

those of his day who trusted to  that  symptom as a reli •
able indication.
  In speaking of the proper time] for the administration
of drinks, &c, in fever, Celsus says :
   "We  principally trust  the  pulse—a  most fallacious
mark (venis enim maxime credimus, fallacissimse rei)—
because this  is often  slower or quick from the age,  and
sex, and difference of constitution—and generally when
the body is  in pretty good health,  if the  stomach be
weak; sometimes, also,  in the beginning of  a  fever it
rises and  sinks,  so that a person may seem  to be weak,
when he can  very well stand a  severe fit that is  just ap-
proaching.  On the other hand, the pulse is often raised
and the vessels relaxed by  the  influence of the sun,  and
of the bath, and exercise,  and fear, and anger, and any
other passion of the mind ; so that when  a physician
first comes in,  the  anxiety of  the patient, doubtful
how he may think him, accelerates the pulse.  Now, if
the sight of the physician quickens the pulse, how easily
may a thousand other accidents disorder it."—(A Corn.
Celsi Medicinse, Lib. vi  p  74.)
   Fortunately for the credit  of our modern school,  in
this instance, we are not called upon to decide  between
Hippocrates and Celsus on the one hand, and Dr. Tweedie
on the  other ; for  M. Littre lately  called  attention to
another indication, which Mr. Francis Smith, the excel-
lent translator and annotator of the " Genuine Works of
Hippocrates'' for the Sydenham Society, called a most
important one, provided it  was confirmed by time and ex-
perience.  It is an auscultatory sign laid down  by Dr.
William Stokes, of Dublin, and is,  " that when the im-
pulse of the  heart  is abnormally weak,  and when there
is  a diminution of  the  proportion  between the  two
sounds,  wine may be freely administered."'
   We  have already acknowledged  our  indebtedness to 
24
AN  ESSAY  ON
 Dr. Latham "for having taught us not only when to sus
 pect the approach, but how to recognize the presence of,
 endocardial or  exocardial disease  in acute rheumatism,
 and how to distinguish the one from the other.   We have
 now to pay a like acknowledgment to Dr. William Stokes,
 for the zeal and success with which  he has  for  a whole
 year devoted his great energies to discover the symptoms
 of the heart occurring as the  secondary local lesions of
 typhus.   He has taught us by these experiments that to
 discover these local lesions the  pulse is  an  uncertain
 guide, and that while the application of the  hand and
 the stethoscope are both indispensable to detect them,
 either by itselfis defective.   He has taught us that soft-
 ening of  the heart seems to be one of the secondary local
 lesions of typhus.  How  that  softening is to be recog-
 nized by diminished impulse,  or a complete absence of
 impulse__by a diminished first sound, or even an absence
 of the first sound—that in most cases the diminution of
 the impulse and first sound co-exist, yet that impulse
 may exist without corresponding first sound,  and con-
 versely, the first sound  may be heard, although unac-
 companied by impulse—these phenomena  are most evi-
 dent, as connected with the left side of tbe heart.
  Dental Surgery is a new branch of medical  science.  It
 has been taken possession of by a class of men by talent,
 by education, and  by special study, every way qualified
 to advance it to the rank of a science—men  who devote
 their whole time and attention to its improvement,  and
 whom it rewards  with its  golden harvest.   Yet, we
 know that what existed of it a few years ago was nothing
 more than  a  mechanical  art,  little understood  and
 practiced.  Fifty years ago, if a person lost a tooth, it
 was no easy or trifling circumstance to supply the defi-
 ciency, and it  was to the shop of the jeweller  he was
most likely to apply for a substitute; but now any num. 
          DISEASES   OF   THE   EAR.        25

ber of  teeth  may  be supplied at a moderate  cost, that
perform all the offices and functions of—and  not to be
distinguished  even  by the  wearer  from—the  natural
teeth, and by well-educated physicians.  If further evi-
dence be wanted of the utility of  paying special atten-
tion to a special branch of the medical art,  I need only
refer to the ease with which that deformity,  arising from
the irregularity of the teeth, particularly the incisors and
the cuspidati, is now, by the skill and dexterity of the
well-educated dental surgeon, removed without extract-
ion, and almost without  pain.  I saw in the office of a
dental surgeon some time since two models of the teeth
und gums of a gentleman's lower jaw—one  representing
the  form and "position of the teeth before an operation,
with the teeth riding one above another—and the other
representing the same after the operation, with the irre-
gulaiiiies removed, nnd each tooth in its  natural posi-
tion.  A tooth lost or misshaped is a greater drawback
to personal appearance than dullness of hearing or tin-
nitus ; hence, in addition to the greater profit to be de-
rived from dental  than aural surgery,  the  influence of
personal appearance is brought to bear to favor the culti-
vation of the former.
   The  voluminous works of the highest order of merit
that teem almost  monthly from the medical press, and
fill our medical  periodicals, are evidence  sufficient that
opthalmic  medicine is not neglected,  but  receives that
attention which so important a branch of medical science
merits, not only from  its special devotees, but from the
members of the profession generally and from the public.
   The truth of these remarks will appear evident when
we consider the number of cases of loss of vision  that was
formerly attributed to what was  called gutta serena,  a
term now  scarcely  to be met with  in modern books.
After this,  it will be recollected, we had glaucoma as a 
26
AN  KSSAY  )S
frequent cause of blindness, although  such writers as
Tyrrell, Lawrence, Mackenzie, Jacob, and Walton differed
from each other as to its scat and nature.  At a later date
we had, in consequence of the improved method of obser-
vation, reduced both of these affections to a very  small
compass, under the title of  amaurosis ;  and still f s  our
knowledge increased  with experience and observation,
and as physicians became  familiar with the  different
forms of congestions aud other  diseases of the  choroid ;
and the latent inflammations which occur in  the various
tunics of the eye amaurosis itself became less frequent,
so that at this  date, owing  to our  improved pathology
and diagnosis, true, uncomplicated amaurosis, not result-
ing from disease of the brain or tumors within the orbit,
is said to be of i are occurrence.
  I might, if I did not  fear to swell this paper to  too
great a length,  direct  attention to the improvements
taken place in  the pathology, diagnosis, and treatment
of affections of the kidneys,  liver, gestative  and  urinary
organs, but it is sufficient for my purpose  to direct at-
tention  to  the  fact,  that whatever  improvement  has
been effected in these and  other organs is due, and  due
solely, to the special investigations  bestowed upon each,
and  that  the improvement is  in  proportion to  the
amount of industry displayed; and, further, that  if the
affections of other  organs and  tissues   are still in
doubt  and uncertainty,  that that doubt and  uncertainty
is  also  in  proportion to the neglect with which  such
organs have been treated.
  Thus by care, close observation, and special  attention
to special organs, we have  advanced our knowledge of
the symptoms and treatment of the  circulatory,  res-
piratory,  masticatory,  visual,   and  digestive  systems
Not  only the stethoscope, organic  and in-organic che-
mistry, but the microscope  have been made subservient 
           DISEASES   OF   THE  EAR.        2T

to our use in the  diagnosis of  affections of those and
kindred organs.
  But  there is one organ of the body—The  Ear—the
physiology of whose parts is but little understood, and
the affections of which have received no consideration from
the profession.  Magendie  says—" This organ is very
complicated; at present  we know but little of the uses
of the different parts that constitute this apparatus."  It
may, I think, be laid down as a rule in medicine, that in
proportion as our knowledge of  the physiology  of  an
organ  advances to certainty,  does  our diagnosis and
therapeutics become settled and successful; for, as the
pathological state  of an organ increases in proportion as
it deviates from its physiological condition, itmust appear
evident that we  must know  what  that condition  is,
in order to preserve it in its integrity, and aid it in re-
gaining its original position.
  Mr. Wakelcy, in a clinical lecture on Glycirine Lancet,
Lon.,  1851., v. 1, p. 291, says :—
   " In the treatment of deafness,  failures of new  re-
medies are the more likely to happen  as aural maladies
find no favor with the majority of the profession.   Many
empirics owe all their success and ill-acquired wealth
to this cause."
   These opinions are further supported by an eminent
authority, who  writes:—"It is  not  many years  since
diseases of the ear were a subject on which the greatest
ignorance,  and  the most  mistaken opinions,  prevailed,
and indeed  how  could any correct pathological  infor-
mation be  expected when anatomists had not given a
complete and accurate description  of the  organ  itself;
also, notwithstanding what has  now  been made out  re-
specting  disorders of the Ear, it is generally admitted
that they require  further investigation and renewed  in-
dustry."—(Cooper's Surgical Dictionary—Article Ear.) 
28
AN  ESSAY  ON
  I am lead to suppose  that  this society,  indeed the
profession generally, view this  subject as devoid of in-
terest and unimportant—I cannot believe it.  How can
a class of men, who individually and collectively have
ever been formost in the ranks of science, as well as  in
soothing the sorrows  of  our  poor  human  nature, be
without interest in a question in which so large a num-
ber of  our fellow creatures is so  deeply interested, as I
shall show by-and-by, by a reference to the  statistics  of
institutions  established in various parts of Europe, for
the cure or alleviation  of those  unfortunates, deprived
in part, or in whole, of the most  intellectual, if not the
most prominent and useful of all our senses—hearing-
I know by close observation for the last few  years—it  is
incredible to a person who has not given special atten-
tion to the  subject, the  great number to be met with
(even  in this community)—laboring  under deafness,  o?
dullness of hearing, or some disease of the Ear, which if
'eft  unchecked, or to the  management  cf ignorant
quacks or  nostrum venders,  is  sure to lead thereto.
Devoid of interest!   It is deserving of our  highest con-
sideration, in ss much as affections cf the organ of hear-
ing  are,  when  treated  in time and with judgment,
which is not just now always the case, as tubject to the
rules of a rational  and scientific  pathology and thera-
peutics for  their prevention and cure  as the affections
of any other organ in the animal  economy.
  As a proof that I am not  alone in this view, I shall
take the liberty of introducing a  few eminent witnesses
to testify on this head   .
  Druit,  in his  excellent  work,  " The Surgeons' Vade
Mecum," says.
  " That deafness  is so common and so distressing an
infirmity, and, when of long standing,  is so incurable,
that we cannot too  stscrgly urge upon  medical practi 
          DISEASES  OF  THE   EAR.        29

tioners to make themselves familiar with the treatment
of diseases of the Ear.  They should also encourage their
patients to 'apply to them  for the relief of slight and in.
cipient ailments in this organ, instead of allowing them
to go on till they get permanently deaf, and then letting
them fruitlessly seek relief from ignorant and mercenary
quacks."
  And Mr., afterwards Sir Astley Cooper, in an Essay
published in 1801,  on the perforation of the  membrana
tympani, thus expresses himself:
  " I hope others will be induced to  second  my feeble
effort, and to cirect their attention to  the subject  which
appears to  be  of the  highest importance, and to have
been too much  neglected by medical  men ; for a
knowledge  of the structure of the Ear is by no means
general in the  profession,  and still less are its diseases
understood.  A  prejudice  has  prevailed that the Ear is
too delicate  an organ  to be operated  upon, or, as it  is
commonly expressed, * tampered with ;' and  thousands
have thus remained deaf  for the  rest  of their lives who
might have been restored  to  their hearing  had proper
assistance been early applied,"
  A more modern, but not less eminent, authority says :
"Mankind  have often imposed on themselves  the  un-
grateful task of  complaining of the neglect with which
diseases of the  Ear have,  up to the present time, been
treated, both by authors and practitioners.  There was,
indeed, good ground for such complaints, when one com-
pared the number and utility of the works that treat  of
diseases of the Ear on the one hand, and those 0*" the
Eye  on the other.   And  the  very disproportionate su-
periority of the latter was remarked, when  further,
it was considered that the organ of sight in its  influence
on the mental and intellectual life of man is  certain'y 
30
AN  ESSAY  ON
 rather inferior  than even  equal  to that of  hearing."
 —Dr. Kramer's  "Diseases of the .Ear;"  Dr.  Bennett's
 Translation, p. 1.
   Mr. Pilcher, in the introduction  to his  Prize Essay on
 the " Structure,  Economy, and Diseases of the Ear,"
 for which the Fothergillian Gold Medal was awarded in
 1842, uses the  following emphatic words :
   " It might have been anticipated  that the immense
 improvements  which have been introduced into opthal-
 mic surgery by the labors of  some of the most distin-
 guished of our profession, would have induced the edu-
 cated practitioner to  investigate those numerous diseases
 of which  the  ear  is obnoxious—such  unhappily for
 mankind has not been  the result,  and thus it  happens
 that even at the present time—in this country at least—
 Aural Surgery is either  almost entirely neglected, or, for
 the most part,  is left in the hands  of the  ignorant em-
 piric.  In consequence,  therefore,  of what must be con-
 sidered a dereliction of duty of the English surgeon, the
 unfortunate sufferers from these distressing maladies are,
 in many instances, abandoned to their fate, or compelled
 to seek relief from the employment  of nostrums which it
 would be but too charitable to regard as  being merely
 harmless in their operation.
   " It is not too much to affirm, that until the morbid
 affections of the Eai- be  treated according to the  general
 principles of pathology,  ' and more especially until the
 study of these  affections be  regarded as constituting a
 necessary and  essential part of medical   education,  it
 would be vain to hope for any considerable extension  of
 the very limited knowledge which is  at present pos-
 sessed on this interesting class  of diseases. ' "
   We have special works on diseases of the larynx,
trachia, bronchia, on  rupture, liver, kidneys, generative
organs, and even on the rectum. So we have, it may be 
          diseases  of  the  ear.        31

 answered, on the  Ear.  True, as I shall show  by-and
 by—still there is a difference—this marked and impor-
 tant difference—no physician who lays claim to the title
 of general practitioner would  presume to acknowledge
 himself totally ignorant  of, or incapable to treat, affec-
 tions of these organs •, but not so with affections of the
 organ of hearing,  as we have seen from  the eminent
 authorities quoted, and shall again see  from others jet
 to be cited.   Physicians  justly considered eminent, and
 some occupying high places in our medical seminaries,
 think it no dereliction of duty to neglect the study of the
 pathology of affections of this  organ, and will not  hesi-
 tate to acknowledge without a blush that they never treat
 disorders of  the Ear, or if they do,  that  they confine
 their treatment to simple  washing with Castile cr  other
 soap, and a drop or two of almond oil  into the meatus,
 never troubling themselves to find out whether the affec-
 tion is the result of interruption in the Eustachian  tube,
 ulceration in  the middle Ear, or opacity or thickening of
 the membrane of the tympanum or other integuments of
 the external  meatus,  in any of which cases these reme-
 dies are not only  useless but  injurious.  How  few, in
 affections of  the external meatus, ever take the trouble
 to examine the  state  of that passage ?—yet obstructions
 in it are a  very  frequent cause of deafness, and it is as
 much under  view with tic proper speculum as the os or
 cervix uteri; and  the information to be derived from in-
 spection  in the former more certain and satisfactory than
 in the lat^r,  and the indications,  to say the least  of it,
 as reliable.
  Let us state a case by way of elucidation.  Two young
 ladies wait on their medical advisers—the one complains
 cf pains or weakness  in  the back,  irregularities in the
 menstrual flow,  palpitations,  &c.   The other of a con •
fused  sensation in  her ears, dulness in one or both ears, 
32
AN  ESSAY  ON
with occasional pain or itching in the external canal, or
perhaps a throbbing sensation between the  angle  of the
jaw and  the mastoid  process, since her last  attack of
tonsilitis  or  rheumatism.  Now, what is done in each
particular case ?   In the former, the generative organs
are subjected to  ocular  inspection, and  if insipient in-
flammation,  or  even  irritation  be  there discovered,
remedies are instantly applied for its  subjugation, least
it run on to disorganization  of  the parts.  And  in the
latter—in the latter  case what is done?  Why it  is
exactly let run on to disorganization of the parts !  No
inspection of the external meatus to  discover the state
of that passage,  although Dr. Wild reports in his book
on "Diseases of the Ear,"  579  cases of impaired hear-
ing,  produced by impaction of the  external  auditory
passage with cerumen, the removal of which restored the
organs to their integrity  and the patients to their hearing;
and although Celsus, eighteen hundred  years ago,  Hil-
danus  and Nuck, two centuries ago, recommended and
practised ocular inspection of that passage.  No exami-
nation of the Eustachian  tube,  although Dr. Kramer
demonstrated that obstruction  in that passage is  a most
fruitful cause of deafness;  and although  it is now one
hundred  and thirty-four years since Guyot, of Versailles,
suggested the introduction of  a flexible  tube into the
Eustachian  canal through the mouth ; and one hundred
and twelve years since Clelland  taught us to introduce a
catherter into the  same passage through the nose, and
remove its obstructions by aqueous injections ;»and as if
Itard, Deleau, and Kramer had not improved and sim-
plified that  operation.   Thus multitudes  are permitted
to lose the greatest  gift  of  the  Creator  to his creature
for the want of the same precaution that is used to pre-
serve other  organs.  Is not  insipient inflammation and
irritation subject to the  same laws of  treatment for their 
         diseases   of  the  ear.          »*

reduction in the Ear as in other parts  of the animal
economy ?
  The  following quotations prove that they are.  Mr.
Wilde  says:
           " Yet  I fear not to reiterate  the  assertion
which I made upon several former occasions, that if dis-
eases of the  Ear were as well studied by the generality
of practitioners,  and as early attended to as the diseases
of the  eye, it would be found that they were  as much
within the pale of  scientific treatment."—(Wilde on the
Ear, p. 21.)
  "My  opinion,"   says  Dr. Kramer,   "regarding the
curability of diseases of the Ear in general,  is founded on
the  results of 300 cases, as they have been recorded in my
journal, &c.
  " Of these 300, 104 were found to be quite incurable,
incapable of being at all relieved, and with the treatment
of which, therefore,  I  took no trouble ;  the proportion,
therefore, is  one to three.   On  the other  hand, 188
were completely cured or relieved by treatment, whilst
only eight of those who  were actually put under treat-
ment were obliged to be left unrelieved,  in  spite of all the
pains and care bestowed.
  " Of the incurable patients, and those who derived but
little benefit, the greater number certainly would have
had a more favorable, or even an altogether happy lot,
had they only submitted themselves in time.  .  .   to
proper treatment, or even  if they had  not been subject
to treatment so improper."—(Kramer's Diseases of the
Ear, &c, p. 25.)
  How  is it, then, may I  be  permitted to  ask, that
f.liy siology  and pathology have done so much for the
prevention and cure of the diseases of other organs,  and
t.o little  for  the  prevention  and cure of diseases of the 
34
AN  ESSAY  ON
Ear.  Some answer, the organ  is  so  delicate in struc-
ture, so intricate, and  its maladies  so insidious and in-
curable that it is bad to " tamper with it."  All this, be
it remembered,  may and has been said of the eye.   Yet,
who of us now will neglect or delay the reduction of the
most trifling inflammation of its tunics, knowing that if
it be neglected in its earlier or insipient state, it may and
will progress from tissue to  tissue,  until it ultimately
reaches  the  cornea,  retina, and  optic   nerve,  and
destroys>ll visual intercourse with  the external world.
Will not catarrhal affections of the internal and external
Ear,  interruption  in  the Eustachian tube,  edima or
ulceration  of  its meatus, caused  by Aphta in infancy,
Tonsilitisor Parotitis,  Measels or Scarlet Fever in child-
hood,  will not inflammation of the  membrana tynipani,
a collection of cerumen in the  external meatus?—will
not all, or each, or any of these lead to dulness of hear-
ing, ringing or noise in the Ear,  or finally to irremediable
injury to the  auditory nerve, and  its inevitable conse-
quence—deafness ?   And are they  not all under  the
control of our art, if that art be timely and judiciously
employed in their first stages, as if occurring in any other
organ ?  The experience of  all  those qualified to judge
in  the  matter,'; answer  emphatically that they  are;
yet, who in the regular ordinary course  of his  profes-
sional duties  ever thinks  of examining  the external
meatus with the aural speculum, injecting the Eustachian
tube, and applying the autoscope to know the state of
those parts ; and  yet the early neglect of such precaution
subjects the patient to  the risk of losing his hearing be-
yond remedy. Dr. Roget says, Outlines Physiol, p. 274:
   " Hearing is always much impaired, if from any cause
the Eustachian tube is obstructed, as it sometimes is, by
a common cold, which then produces a temporary deaf-
ness." 
          DISEASES  of  the  ear.        35

  '* There are many pathological facts  which prove that
the integrity of the Eustachian  tube is essential to the
perfect function of the Ear.  When, from any cause, this
passsage  becomes  closed  or obstructed, the hearing  is
very materially impaired, while  it is restored by remov-
ing the obstruction."—(Dr. Bostock's  Elementary  Syst.
Physiol., 4 Ed. Lou., p. 720.)
  " ' This canal  (Eustachiau),' " which is  of great im-
portance in surgical practice, on account of the frequency
of its diseases,  and the operations  which they require.
   .   .   Its internal membrane is a continuation of that
of the pharynx, and its nature renders it susceptible  of
the same diseases  with the mucous membrane of the
pharynx."—(Velpcau's Surgical  Anatomy, Vol. 1 p. 28.)
   "  ' The delicate membrane,' says Dr. Velpeau, ' lining
the  auricle,   encloses  numerous  follicles,  in  which
sabaceous matter sometimes accumulates and concretes,
forming small encysted tumors (loupes), known by the
name of tannes (acne punctata).   There is a  cellulo-
fibrous layer, very dense, but lamellated, separated from
the cutaneous envelope by a more supple cellular tissue.
When small purulent abscesses form in this last  layer,
they excite but  little pain,  but  sometimes  burrow  with
great rapidity under the skin,  giving rise to intractable
Binous ulcers.  When, these abscesses are developed  in
the  former tissue, they occasion very acute pain, and
sometimes  very  formidable symptoms.' "—(Velpeau's
Surgical Anat., Vol. 1 p.  24.)
   The  lymphatics of the Ear,  according to Mascagni
and Cruikshank, pass to the parotideal absorbent glands,
and the swelling which takes place in  these glands,  in
consequence  of  certain  diseases  of the external  Ear,
seems to support this opinion ; and  it wouid seem  to  bo
still  further  supported by the following case stated by 
36               AN  ESS AY  ON
Velpeau:—' A man who had labored under pustular in-
flammation of  the  intestines during twenty-six  days,
was attacked by parotitis,  and six  days afterwards the
matter made its way into the Ear through the fissure of
Santorini.' "—(Sur. Anat., vol. i. p. 26.)
  "The obliteration  of this tube (Eustachian) is a fre-
quent  cause  of deafness."—(Magendie's  Elem.  Trea.
Human Physiol., p. 87.)
  " The Eustachian tube," says Miiller, " is never ab-
sent when the tympanum  exists.  Its great importance
in rendering hearing perfect is proved  by the  circum-
stance ci its occlusion as a consequence of disease, being
always attended with deafness and tinnitus."—Elements
Human Physiol., p. 760.)
  And again :—" All the provisions  by which the tym-
panum has been adapted  to the better propagation of
sound  would  be rendered unavailing if it were  to be-
come filled with mucous."—(Op. Cit.)
  The ancients were not ignorant of the frequent occur-
rence  of inflammation in the Ear, nor of the necessity of
paying immediate  attention to the first admonitions of
disease in that organ, nor of the dangers  to be appre-
hended from the neglect of such admonitions, notwith-
standing it is the  fashion with  some writers to decry
everything coming from our predecessors as worthless, of
no practical value, as if  truth  ever grows old.   These
writers, no doubt, are ignorant of the fact, that if their
own pages were divested of all the matter pilfered from
ancient  authors   without  acknowledgment,   they
would no  more  resemble their  present form than the
strong intellectual man, from whom the immortal spirit
had fled, resembles  the lump of mouldering clay that  is
left without life or uselfulness.
  Celsus thus directs  attention to  be given to  the first
symptoms of diseases of the Ear, in consequence of the 
          diseases  o f  t h e  ear.        37

danger to be  apprehended  from  delay.  He  says:—
" Aurium  inflammationes doloresque, interdum  etiam
ad  dementiam mortemque  praecipitant.   Quo  magis
inter initia  protinus succurrendum est, ne majori peri-
culo locus sit."—(A.  Corn. Celsi,  Medicinse,  lib.  vi.
c. vii., De aurium morbis.
  It is only a few  years since the wisdom and necessity
of such precaution have been fully demonstrated.
  Mr. Toynbee, in 1851, read a paper before the  Medico-
Chirurgical Society of London, recording 41  cases of
fatal  cerebral disease,  originating  in  the  tympanic
cavity,  in most  of which discharge from  the  external
meatus had been for many years the only symptom.
  Mr. Part read  a paper before the London  Medical
Society, detailing a case cf a similar  nature, and con-
cluded, almost in the  words of Celsus, by calling  the
attention of the Society to the  importance of  attend-
ing to cases of this description in the early stages, when
the discharge,  often unattended with pain, is the only
symptom which the surgeon or  physician has to guide
him__(London Lancet, 1854, vol. 1 p. 172.)
  The following passage is strongly in support of these
views :
  '« The apparatus of  hearing is simple,  very  securely
placed, and much less prone to disease than  that of
vision.  Its morbid conditions,  however, are much  less
within the control °of  art.   The cerumen sometimes be-
comes inspissated, and accumulated in such quantity as
to close up the  external opening,  and cause deafness.
Perhaps the most common disorder of this apparatus is
obstruction of the Eustachian tube. Catarrhal affections,
which are so common in all climates and classes of per-
sons, are generally  attended with  more or less inflam-
mation of the  posterior fauces.  The inflammation is
apt to extend up the lining of the Eustachian tube, and 
38
AN  ESSAY  OH
 from the consequent tumefaction or  morbid secretior,
 the tube becomes obstructed and the air confined  in the
 cavity of the  tympanum.  Thus the  free oscillatory
 movements of the tympanum are impeded, and deafness
 produced."—(Magendie's  Human Physiology, by Dr.
 Revere, N. Y., p. 90.)
   Before I direct attention to the successful results of
 the treatment of  affections of the  Ear,  as  presented to
 our view in  the  statistics published by gentlemen in
 charge of public  institutions for the treatment of those
 affections, I shall quote the manner in which a celebrated
 Surgeon and Aurist spoke of  the neglect of those affec-
 tions fifty years ago,  and of the manner of remedying
 them:
   "Few attempts have hitherto been  made by  anato-
 mists to  investigate the morbid changes to which the
 Ear is liable.  On this head we are almost destitute of
 information, at a period when by their labors the diseases
 of the  other  organ 3 of  the body have  been  ascertained
 and the symptoms which  accompanied  them recorded.
 But our ignorance will soon cease to be the cause of as-
 tonishment, if we  reflect on the  obstacles which oppose
 our inquiries.  These are almost insuperable.  Nature
 has placed the greatest part of the Ear in a situation ab-
 solutely bej ond the reach of examination in the  living
 body;  and as its diseases are rarely, if ever,  mortal,
 morbid  ears are seldom dissected in  the  dead.
 Such observations as are related have mostly been made
on subjects that have  casually fallen into the hands of
the dissector, and the history of the case is unknown.
But it  would not suffice  if anatomy were able to develope
every morbid alteration of structure of which this  organ
is susceptible.  A great object would, indeed, be gained,
but  a greater  would  still remain   unaccomplished.
Before the mind of  the practitioner can be  directed to 
DISEASES   OF   THE   EAR.        39
any determinate object, a history of  symptoms must be
sufficiently distinct.  This  demands a multitude of dis-
sections and a series of attentive observations.
  " Here,  then, the labor and the difficulty commences,
but the field is open.   Anatomists have, to the present
day, avoided this subject,  some  doubtless convinced  of
the impracticability, and others  disgusted at the diffi-
culty of the inquiry.  As anatomists have neglected the
investigation  of these diseases, so practitioners have
either abandoned such patients to quacks,  or consigned
them to the care of Providence.
   " But although I admit  the  difficulty in all instances,
and in many our total inability  to obtain an adequate
knowledge yet I must differ from those who thiDk that
such  cases should  be abandoned. I am convinced that
the subject may be very much elucidated, if many indi-
viduals, having great  opportunities  of examining  dead
bodies, and animated  with proper zeal in the  inquiry,
would employ some portion of their time in the dissection
of such diseased Ears as  chance may subject to their in-
spection.   By  this proceeding many facts  respecting
defects or diseased changes of structure  in the Ear may
soon be obtained.   In  many instances, where a previous
acquaintance with the patient affords the opportunty,
the attendant symptoms may be ascertained.  Thus the
observer,  combining in one  view  the  cause  and  the
effect, may be capable,  in  many instances, of inventing
means  of relief."—(Anatomy and Diseases of the Ear,
By J. C.  Saunders, Demonstrator  of Anatomy in St.
Thomas's Hospital,  and Surgeon to the London  Dispen-
sary for Diseases of the Eye and Ear.  Lon. Fol., p. 21.)
   Instead of apologizing for this long quotation,  I  ask
for it special  attention.   Mr.  Saunders' book—valu-
able, as it is, to the student  of aural pathology, may
not be within the reach of all.   It is due, as a matter of 
40
AN  ESSAT   ON
justice to its author, that a passage that  so clearly indi-
cates the way to all the improvements that have since
taken place, and the method of effecting them,  should
be generally  known, that we may render unto  Caesar
the things that are Csesar's.  Whether we refer  to  the
physiological  investigations of Magendie  or MuUer; to
the pathological  of Itard,  Himly,  or Deleau,  to the
diagnostic or statistical of Kramer, Wilde, or Tscharner
or the dissections  of  Toynbee—all, all are clearly indi-
cated  in the above citation.
\  Mr. Wilde says  :
  " I do not profess to invent or introduce new remedies.
I try to make the  well-established  rules of practice in
the treatment of other organs applicable to the manage-
ment  of aural diseases.   Like  most students,  I was
taught during my apprenticeship theoretically to believe,
and practically to observe, that  we  ' knew nothing
about diseases of the organs of hearing.'   This was the
dictum honestly expressed by the ' heads of  the pro-
fession.'"—(Wilde's Treat. Diseases of Ear, p.  18.)
  Having directed attention to the apathy with  which
the profession has heretofore  treated affections  of  the
auditory apparatus, and urged, with all the force I was
capable of, the necessity of increased  zeal and  attention
to those affections,  I next proceed  to give the  result of
Mr. ToynbeCs dissections.
  Mr. Toynbee dissected the Ears of 750 persons.  He
published the result of the examination of 915 Ears.  Of
these, 303 were  in a healthy state.   Of  the remaining
612, 184 belonged  to persons  who  were known  during
life to have been deaf.   70 others showed such traces of
disease  as  left little doubt  of  defective  hearing  during
life ; and the remaining  were believed by Mr. Toynbee
to be in a state of insipient deafness.
  The external meatus was diseased in 80, or nearly 1
in I0J. 
DISEASES  OF  THE  EAR.         41
  Of these, 58 consisted of collection of cerumen and epi-
thelium ; 13  consisted of  collection of pus and epithe-
lium ;  9 consisted of contraction  of  the canal,  with
alterations in its lining membrane and osseous parieties.
  The membrana tympani was diseased in 209,  or nearly
1 in every 3.
  Of  these, 52 had the membrane white, thickened,  or
vascular ; 15 had the membrane concave externally or
flat ; 21 had the membrane concave, and adhering to the
promontory ;  4 had  the  membrane concave, with de-
posits of calcarious matter ; 51 had the membrane per-
forated, or altogether destroyed ; 66 had the membrane
adherent to,  or connected by bands with,  the ossicula or
promontory.
  The cavitus tympani presented evidence of disease  by
morbid collections in  107, or 1 in 6.
  Of these,  43 had collection of mucous,  with lining
membrane healthy ; 5 had collection ef  mucous,  with
membrane thickened ;  2 were filled  with  portions of
cerumen and  epithelium scales, the result  of perforation
or destruction of the membrana tympani;  15  had a col-
lection of pus, with membrana thickened ; 4 were filled
with blood ; 10 with serum or lymph ; 20 with  scrofu-
lous matter ;  1  with  oily  matter; 7 with calcareous
matter.
   The  mucous membrane of the  cavitas tympani was
diseased in 310, or a  little more than one-half of those
examined.
   In 66, the merrbrane was more vascular than natural;
 179, the membrane   was  thickened; 22,  the  membrane
was so thickened  as to bury the whole of the stapes ;
3, the  membrane was so thick as to fill the tympanum;
5, the  membrane was  pulpy ;  20, thickened and ulcer-
ated ;  2,  it  had black pigment  secreted  beneath;  8, it
had blood vessels under it; and in 1, serum under it. 
 **               AN  ESSAY   ON

   Bands of adhesion  were found to  exist in the cavity
 of the tympanum in 279, or 1 in nearly 3j.
   Of these,  in  130, the bands   passed  between  the
 stapes and the promontory ; 8, the bands were connected
 with the incus,   stapes,  and promontory,  12, the bands
joined the malleus with the surrounding parts ;  13, they
 connected  at the ossicles;  in  9, they connected the
 ossicles with the promontory ; 3,  they united the tensor
 tympani muscle and the stapes ;  4,  they united the
 chorda tympani nerve with the adjacent parts.
   The ossicles  were diseased or  displaced in  61, or 1
in 10.
   Disease of  the bony parietes occurred in 82 cases, or
nearly 1 in 7j.
   The membrane of the  fenistra rotunda was diseased in
5, the tensor tympani muscle atrophied  in  7, and at-
tached to the stapes in 1.
   The Eustachian tube presented  symptoms of disease in
21 cases, or 1 in 29.  The upper  part of this tube only
was  submitted to examination.   In  10, i* contained
mucous ; 8, its  lining membrane was thickened, vascular,
or congested ; 3, it had  bands connecting its parietes.
   The internal  Ear was diseased in 21, of which 4 had
thfe membranous labyrinth thickened , 6, atrophied ; 8,
the fluids of the labyrinth were deficient"; 1, the vestibule
and cochlea contained bloody serum ;  1, pus; 1, a  band
across the  vestibule.
   Mr. Toynbee makes the following  remarks on those
dissections:
   " The fact of a thickened  or otherwise deranged state
of the mucous  membrane lining  the  tympanic cavity,
being one of the most common pathological conditions of
the organ  of hearing, is the broadest general results of
the dissections ; and as cases carefully  examined,  noted,
and studied as they have arisen  in practice, lead to the 
         DISEASES  OF  THE  EAR.        43

same conclusion,  I have little hesitation in stating dis-
ease of  that  membrane  to be the  most usual cause of
deafness.   What  are the history and symptoms of the
great majority of cases of deafness unattended by  dis-
charge ? Cold has  been caught, uneasiness  has been
felt, renewed attacks of cold have added to the severity
of the symptoms, advice is at length sought, and exami-
nation shows the external meatus deprived  of  cerumeD.
and frequently  deficient in natural sensibility, while
towards the membrana tampani, its appearance is red
and smooth, the membrana tympani is entire, its surface
shines, but it is hazy, apaque, or as white as parchment,
and, consequently, the handle of the malleus may be dis-
cerned with varying  degrees of distinctnsss, or cease to
be visible at all.   Upon a further  expiration with closed
nostrils, the air, by  means of the otoscope, can almost
always  be heard to enter the tympanum, not gradually,
however, as when the organ is healty, but with a puff-
ing, bubbling, or cracking sound, as though impeded
in its progress."
   The following statistics which could be much enlarged,
if necessary, will show the .correctness of the  assertion,
that affections of  the Ear are as curable as the affections
of other organs, if treated with the same judgment and
in time:
   Out of 2,385 cases of disease of the Ear  recorded in
Mr. Wilde's book, 579 were simply cases of  impaired
hearing produced by impaction of the external auditory
passage with cerumen ; 114,  of what, for a better  name,
were called nervous  deafness ; 25, tinnitus aurium, un-
accompanied  at the  time by deafness or any apparent
disease; 14, otalgia ; 7 of deaf dumbness ; 2 of acciden-
tal hemorrhage from  the tympanal cavity ; 7 of congeni
tal malformation :  20 of collapsed membrana  tympani,
and 2 of tumor in auricle—making in all, after giving 
^*
*4               ANE8SAY0N

the largest margin, but 770 cases of diseases of the Ear
out of 2,385 cases not directly traceable to inflammation
or its effects; or, in other words.  1,615 cases of inflam-
matory  affections of the organs of hearing, which, if ne-
glected  in the first  stage, or what is still worse, if left  in
the hands of quacks, or improperly treated, might ter-
minate  in the loss of hearing,
  Mr. Wilde says:
  "In  the first portion of the table, out of 706 recorded
cases, 85 were set down to ' nervous deafness,' which I
am inclined to think was an exaggeration, as by a more
carefully conducted examination,  and with increased ex-
perience, I found but 18 cases out of 1,679 in the second
period."
  Diseases of the auricle and external meatus amounted
to nearly one-half of the entire.
  Affections of the membrana tympani, exclusive of col-
lapse, number 219, or nearly one-third of the entire.
  Diseases of the middle Ear amount to 101, or about
one twenty-third of the whole.
  " When I first  commenced  the study of aural dis-
eases," says Wilde,  " I believed that in most cases where
I had no positive evidence of disease in the meatus  or
membrana tympani,  the deafness  and  tinnitus were
caused by some defect in  the nerve of hearing, or what
is termed  'nervous deafness.'  As, however, my field  of
observation  extended,  and as  my  knowledge  of the
healthy  and morbid appearances of the  membrane im-
proved,  I gradually began to find that  the instances  of
deafness with  perfectly  healthy  tympanal mem-
branes which fell under my observation were compara-
tively few,  while  I daily  became  familiarized with a
variety  of pathological appearances in these structures,
which I was soon convinced were  the result of different
forms of inflammation of an acute or chronic nature, 
          diseases  of  the  ear.        45

arising from some idiopathic or specific cause.  These
appearances naturally led me to pay particular attention
to those diseases in their early stages, the only period at
which, in most of  them,  art can  be of any avail."
(p.  105.)
  In  the Ophthalmic branch of the Hospital to which
Mr. Wilde  is  attached, there  were registered  11,233
cases of disease of the Eye, of which 857 were diseases
of the retina  and optic nerve, and only 341  of  these
were instances of uncomplicated amaurosis, or about I to
every 33 of the entire; whereas  in  the Ear diseases, as
seen above, the proportion  of nervous diseases,  although
the proportion is much exaggerated,  was only 1 to 21.
  Dr. Kramer, although be classes  1,028 out  of 2,000
cases as nervous disease, yet it will  strike mos,t persons
who carefully study  his tables, that  these nervous affec-
tions might, and probably did, originate in inflammation.
Of the 2,000  cases, 442, or  something less than one-
fourth of the whole,  were inflammation of the tympanal
membrane—of these 45 were acute, and 397  chronic;
154, or nearly one-twelfth of the  whole, were inflamma-
tion of the middle Ear, 30 of alterations in the Eusta •
chian tube; 28 of stricture, and  2 of occlusion ;  4  in-
flammation  of  the periosteum of the cavity__in all 198
cases of disease of the Middle Ear.
  Mr. Harvey says :—" Nervous  Deafness, so called, is
too often regarded as a weakness or defect of the  audi-
tory nerves, whereas it is frequently dependent  upon
some latent  disorder of  the general  health,  not always
complained  of  by the  patient, but  which will readily
yield to medical treatment,  as will with it the  local de-
fect of hearing," and he is certainly supported by the
evidence furnished  by the following statistics :
  Dr. Tscharner of  Berne  published the result of 200
cases—115  men and 85 women.  Of these, both Ears 
46
AN  ESSAY  ON
were affected in 158 cases—the right in 22, the left in
20.  The auricle was diseased in 10 :  the external meatus
and auditory canal.  163 :  the membrana tympani, 122 :
the cavitas  tympani, 79:  the Eustachian  tube,  74, and
the labyrinth, 72, but the  disease co-existed in several
of these parts.
  Of  2,500 cases treated in the London  Royal Dis-
pensary for  Diseases of the .Ear, about 1,000 proved to
be curable, or 1 in lj, and Mr. Harvey, surgeon to the
institution, remarks:  "These included many cases ap-
parently of the most hopeless character and protracted
duration.   It must, however, be understood that the
prospect of recovery will  very much  depend upon the
right moment of time being selected for the treatment;
and it too often happens that, through the neglect of the
patient and  -mistaken views, the disease; is, in  the first
instance, either allowed to run its course unchecked, or
is rendered incurable by mismanagement.    Patients are
too often  induced "to expect that a disease unattended
with pain  will  disappear without any assistance from
art.  Many imagine that a discharge from  the Ear,  in-
stead of being, as it often  proves, a symptom of danger-
ous disease, is  in  fact  salutary, and ought not to  be
checked ;  others do not notice the gradual  approach of
imperfection in their hearing until  it has  become very
obvious to their friends ;  and in both cases the proper
treatment  is neglected, valuable time is  lost, and at
length organic changes are established which no surgical
or medical art can reach or modify.  It is  much to be
regretted that,  in some instances, this neglect has been
in some degree sanctioned by timid  practitioners declin-
ing to interfere, and thus  leaving  the patient either to
despair, or to throw himself into the arms  of the numer-
ous advertising quacks, or else inducing him to hope for
a spontaneous  recovery from  a disease, which in fact,
requires for its successful treatment the  resources of 
            £ I S E A S E S 0*F T H E E A r\         47

medicine and surgery in their more modern and advanced
stage of cultivation."  (Harvey on the' Ear in Health
and Disease, pp. 36, 37, 2d Ed., Lon. 1856 )
  In the foregoing  pages I have shown the difficulties
attending the cultivation of Aural Medicine, and urged
on the profession the necessity of a general movement to
overcome these difficulties.   I have  not let  a single
point in this paper rest entirely on my own reasoning, no
matter how  conclusive that reasoning seemed to be,  but
quoted authorities of the highest standing in  the profes-
sion, and of universal renown, in support of every posi-
tion I have  taken.  Indeed  the danger is,  that I may
have  fatigued by too many quotations.   There is  one
more  point to which  I will  take  the  liberty to allude.
There may not be encouragement enough to physicians
to devote sufficient time  to the acquisition of the neces-
sary knowledge for the successful cultivation of Aural Me-
dicine. Saunders and Cooper commenced its practice with
talents and zeal commensurate with its importance,  but
soon forsook it for more congenial or more profitable pur-
suits. It requires, in consequence of the obscurity in which
physiologists and pathologists have left this organ and its
 affections, long and closeapplication for its thorough under-
 standing and successful practice.  As Dr. Kramer re-
 marks :—" It is of the utmost importance to every  me-
 dical  practitioner who wishes  to make  himself familiar
 with the manual part of Acoustic Medicine, and without
 the most accurate knowledge of the  manual  part,  he
 OUGHT  NOT TO TREAT  ANY DISEASES OF THE EAR, if
 he would avoid doing injury when he cannot render aid."
 Moreover, we have seen  that affections  of this organ are
 often insidious and painless in their approach, no defect
 to personal appearance,  hence  are neglected by the
 sufferer in their easily  curable stage.   If the organ of
 hearing was as prominent as the eye or the  teeth—if its
 integrity was as important to our  personal  appearance, 
43
AN  essay  on
the'multitude would be more solicitous for its preserva-
tion—it would claim and obtain their most serious con-
sideration in its  first and easily curable stage ; and then
would, like dental and ophthalmic surgery become, from
the multitude seeking relief—Lucrati7e—and  being
lucrative, it would merit and obtain from mankind—and,
Doctors,  according to Cuvier, belong to the genus homo
—that attention which profitable pursuits always obtain,
and many an unhappy, victim would  be rescued from
a most pitiable condition.
  If only a  part of what has been said be true, that dis-
eases of the  Ear are numerous,  and in  their incipient
state as much under the control of the physician's skill
as any other class of maladies—that when of long stand-
ing they are seldom, or with difficulty, curable—that in
no branch of medical science are there required greater
tact, longer  and closer study, quicker discernment, than
in the skillful management of diseases of the Ear, and
yet that it is an indisputable fact—it is an admitted fact,
that medical practitioners in general are unacquainted, or
at most but partially acquainted with them.  A gentleman
in this city has  told me that he  suffered  for some time
with a rushing, rolling noise, as he termed it, in his Ears,
with dulness of hearing in one Ear, for which he con-
sulted several of our Head Doctors, by whom he was,
in turn, blistered, and syringed, and stuffed with oil and
black cotton without  any benefit.   He was at  length
induced to consult a dentist, who, recollecting the fable
of the tow n  in danger of being besieged, told him  his Ear
affection was the result of a hole in one of his teeth, by
which operation he lost what he considered a good tooth
and increased his deafness.  Now this gentleman's case
was very simple as the  sequel shows, for about a .year
from this time  his deafness left him, with a crack, and
a  discharge  of  a piece of dried skin.  The crack was
nothing more than the oscillations of sound reaching the 
                 DISEASES  OF  THE  EAR.        49

       drum of the Ear suddenly, which was before prevented
       from  doing  so by  this dried wax,  or  membrane, and
       which any person acquainted with the improvements  in
f-i     Aural Medicine could have removed in a few seconds  I
       say if only a part of all this be true, it is sufficient apo-
       logy for bringing before this society the subject of Aural
       Medicine  and Surgery, with a hope that these defects
       m:iy be removed from this community, and that we may,
       in imitation of our brethren in other parts, open  public
       institutions  for the proper  cultivation and  treatment of
       Aural affections.  In a future essay, I shall  trace the
       history of the treatment of diseases of the Ear from the
       earliest period in the correct history of our art, marking
       our advance and to whom  we are indebted  for such ad-
       vance : and a third paper shall be devoted to the anatomy,
       physiology,  pathology and  therapeutics of diseases of the
       Ear, as at present understood and practiced by our best
       Aura] Pathologists.
          I have only to regret that I cannot bring to the subject
       the abilities and experience which its importance de-
       mands: but  as the snow-ball increases in bulk by every
       revolution as the little  innocent  urchin rolls it along  in
       his path, so  in  this instance a feeble effort  when' put
       forth with good  intentions in so meritorious a cause, is
       better than  no effort at all, and may be kept in motion
       by the generous effort of some more powerful advocate,
       until at last Brooklyn can  boast of an institution for the
       relief of so  numerous  a class of our citizens at present
       entirely neglected.
          Permit me to say, in conclusion, that I shall be amply
       compensated for the labor devoted to the production of
       this appeal,  if only through it I be  the means of rousing
       my brethren of the profession to a sense of their respon-
       sibilities on this important branch of our glorious science,
       and if I   be  the humble instrument of calling the.atten-
       tion of some more competent to the subject.