With the Compliments of the Author. 
1208 Spruce St., Phila. 
REPORT 
OF 
SIX HUNDRED CASES OF DISEASES DP THE EAR, 
LAWRENCE TURNBULL. *[. D„ 
PHYSICIAN TO THE DEPARTMENT OP DISEASES OF THE EYE AND EAR IN THE HOWARD 
HOSPITAL, PHILADELPHIA. 
(Read before the Medical Society of the State of Pennsylvania, at its 
meeting at Williamsport, June 14th, 1871.) 
Diseases of the human ear, causing deafness, are more frequent 
in males than females; this is to be accounted for by the fact, that 
the male is more exposed to the vicissitudes of the atmosphere. In 
the record kept by the author of six hundred cases, there were 
three hundred and seventy-four males, and two hundred and twenty- 
six females. This differs somewhat from the statistics furnished by 
European observers, but the slight disproportion in this country 
between the sexes arises, no doubt, from the present style of head- 
gear worn by the ladies in the streets during cold weather, exposing 
the ear to every variety of temperature. Cold, producing catarrh 
in its various forms, and dentition and its consequences, are the 
predisposing causes of deafness in childhood, and their effects arc 
seen throughout all the stages of life. 
Diseases of the ear are often the result of constitutional disor- 
ders, as, for instance, gout, rheumatism, scrofula, tubercles, syphilis, 
and cancer. Age is also a frequent cause of deafness ; and so good 
an authority as Yon Trollsch asserts that not more than one out 
of three persons, from twenty to forty years of age, possesses good 
and normal hearing. In our own investigations, we have found 
that the larger number of persons lose the hearing of one ear, and 
sometimes of both; this occurs at all ages. About one-fifth of 
the cases of disease of the ear are hereditary, or communicated 
from progenitors, families having two, three, four, or even six 
members deaf and dumb; this is owing to too close consanguinity of 
parents. Then follow next in order as a cause, the exanthematous 2 
disorders, scarlet fever, measles, and smallpox. The other causes 
are mumps, quinsy, with acute and chronic inflammation of the 
throat, nasal passages, and middle ear. There is another form of 
deafness caused by intermittent, typhoid, and typhus fevers, in 
which the labyrinth, auditory nerve, and the brain are the parts 
generally affected, which, for want of a better name, we call nervous 
deafness. 
We shall now take a hasty glance at the table, and give a resume 
of the treatment which was considered the simplest and the most 
effectual in their management. 
A TABLE' 
Of Six Hundred Cases of Diseases of the Ear, from Dr. Turnbull, occurring 
during 1868, 1869, and 1870, Howard Hospital and Private Practice 
Male. 
Female. 
Whole No. 
Cured. 
Improved. 
Unimproved. 
Died. 
Not treated. 
Injured auricle ..... 
1 
3 
4 
4 
Foreign body in external canal . 
2 
3 
5 
5 
Eczema auriculae, acute and chronic . 
6 
14 
20 
12 
6 
2 
Inspissated cerumen .... 
65 
48 
113 
73 
35 
5 
Furunculous abscess meat. ext. 
18 
12 
30 
30 
Otitis externa ..... 
12 
18 
30 
16 
12 
2 
Otitis interna, pur. perf. (chronic) 
2 
3 
5 
2 
1 
2 
Catarrh, aur. media, acute, perf. 
68 
31 
99 
37 
25 
36 
1 
“ “ “ chronic 
63 
48 
111 
12 
51 
39 
9 
Otitis media, inflam, mastoid process 
18 
17 
35 
10 
13 
8 
4 
“ “ chronic, with caries 
6 
4 
10 
2 
6 
2 
“ “ syphilitica 
9 
9 
18 
2 
14 
1 
1 
“ “ with polypi . 
9‘ 
9 
18 
14 
3 
1 
Periostitis, with abscess (cerebral) . 
Neuralgia, plex. tymp. 
2 
4 
6 
1 
2 
3 
2 
3 
5 
2 
2 
1 
Effusion of blood, memb. tympani 
2 
1 
3 
3 
“ “ “ middle ear 
1 
1 
2 
1 
1 
“ “ serum “ “ 
3 
1 
4 
2 
2 
Cophosis nervosa, caused by concus- 
sion, typhoid, scarlet, and bilious 
fevers, etc. ..... 
5 
16 
21 
2 
19 
Perforation membrana tympani by blow 
3 
1 
4 
3 
1 
luflammat’n membrana tympani, acute 
“ “ “ chronic 
2 
1 
3 
1 
2 
18 
19 
37 
11 
13 
13 
“ of Eustachian tube 
7 
3 
10 
3 
7 
Deaf mutes ..... 
4 
3 
7 
1 
6 
... 
328 
272 
600 
241 
194 
143 
13 
9 
Injured auricle or external ear was treated on general surgical 
principles, avoiding the cartilages in passing ligatures, and support- 
1 From Clinical Manual of Diseases of the Ear, by L. Turnbull, M. D. ; Bvo., 
with over one hundred illustrations. J. B. Lippiucott& Co., Philadelphia, 1871. 3 
ing the stitches by means of a pad of cork, or some other agent. 
These cases, however, are not numerous. 
Foreign bodies in the external canal; these were almost always 
washed out near to the orifice of the meatus b}r the syringe, and 
then removed by a soft silver curette or angular forceps. 
Eczema auriculae, acute and chronic. This troublesome affection 
was treated in its acute form, by soothing applications of bland 
fluids, the ear being covered with oil silk; and internal tonics were 
administered, with alteratives of iron, arsenic, or mercury. In the 
chronic form, the ointments of the protonitrate of mercury, or the 
benzoated oxide of zinc, were used. Internal treatment. Fowler’s 
solution, or the solution of the bichloride of mercury. 
Inspissated cerumen.—Soft cerumen should be broken up and 
removed by the curette, but if hard it must be softened by a warm 
solution of bicarbonate of soda in rose water (1 gr. x and 
then removed by the syringe or curette. This will not always 
relieve the hearing, as attention must be given to the condition of 
the lining membrane of the auditor}- canal, membrana tympani, and 
middle ear; and applications are often necessary of astringents and 
alteratives, with the use of the air douche of Politzer, or the 
Eustachian catheter. 
By a reference to the table it will be seen that the whole number 
treated was 113, and of these 13 were cured, that is their hearing 
was entirely restored; 35 were improved, and in sno improvement 
followed the removal of the apparent cause. 
Accumulation of cerumen accompanies a large number of perma- 
nent defects in hearing, followed by and being the cause of deafness, 
producing pressure on the membrana tympani, the delicate bones 
of the ear, affecting the labyrinth, semicircular canal, and cochlea, 
which latter, as you know, contains the nerve of hearing. 
Furunculous abscess in the external meatus.—These abscesses are 
most exquisitely painful, slow in development, and form a core 
which is discharged with difficulty. There is also a plugging up 
of the canal by a swelling of its tissues. The most successful treat- 
ment has been the application of moist warmth to the parts and a 
free incision into the abscess as soon as its presenting point could 
be determined. 
Otitis externa.—This was supposed to be the most frequent 
form of affection of the ear, but we now know that it is rather rare, 
and it will be seen there were only 30 in 600 cases. It extends 
from the orifice of the auditory canal to the external surface of the 
membrana tympani, and is apt to follow violence to the ear, foreign 4 
bodies, abscesses, &c. The most successful treatment was proper 
counter-irritation, b}r means of small blisters, croton oil, or tincture 
of iodine, keeping the parts cleansed daily by the use of a mild 
astringent wash. 
Purulent otitis intern a, with perforation.—ln the acute form this 
occurs in children, and presents all the sjuxiptoms of meningitis, 
but is distinguished from the latter disease by the labyrinth alone 
being alfected and not the meninges. It is apt to terminate fatally, 
and is almost always followed by complete deafness. The treat- 
ment should be counter-irritation by tincture of iodine, the internal 
use of the bromides of sodium or potassium, with the tincture of 
the sesquichloride of iron. It will be noticed that, of five cases, two 
died, two chronic cases were improved, and one, being unimproved, 
was sent to a deaf and dumb institution. 
Acute aural catarrh of the middle ear, with perforation.—The 
treatment of this affection consists in keeping the parts cleansed 
by Clark’s or Thudicum’s douche, with astringents, tonics, and 
counter-irritation, with occasional depletion by leeches or small 
cups. 
This is an affection usually amenable to treatment, and to it the 
term otorrhcca is given. Of ninety-nine cases, thirty-seven were 
cured, that is, the discharge was checked, but the hearing was not 
restored in all of them to the normal standard. We, however, 
save the patient’s life by checking the discharge and relieving the 
inflammation. 
We now come to the most tedious affection of the human ear, 
the most frequent cause of deafness, and the most difficult to cure 
if neglected in its early stage, viz:— 
Chronic catarrh of the middle ear, with or without perforation 
of the membrana tympani. If the membrane be perforated, we can 
cure the noises and discharge more effectually than if it be thick- 
ened and the cavity filled with mucus. Treatment of the open mem- 
brana tympani : Apply agents in solution or vapor of iodine to give 
tone to the parts, removing any excessive discharge bjr a post-nasal 
syringe every daj*, and employing tonics and alteratives, with good 
diet to build up the system. 
If the cavity of the middle ear is closed by thickened membrana 
tympani accompanied by various kinds of moist or dry sounds with 
deafness, artificial perforation of the membrane will be found in 
some cases successful, driving out from the middle ear by the 
Eustachian catheter or air-douche the accumulation of mucus, pus, 
etc.; and subsequently wre should slightly stimulating and 5 
astringent washes of zinc, alum, and now and then a solution of 
caustic potash or bicarbonate of soda, etc. (a few grains to f3i of 
water in the form of spra}r). 
By this and various other means which we cannot enter into in 
so brief a paper, we may be able to improve our cases; but if not 
taken in their early stage, the number of cures will be compara- 
tively small, say only twelve out of one hundred and eleven. In 
the table as shown, fifty-one, or nearly one-half, were improved. 
Otitis media, with inflammation of the mastoid cells, is generally 
the result of pus being retained in the middle ear (from inflamma- 
tion), which, seeking an outlet by the internal trackwhich it inflames, 
softens and ultimately ulcerates these soft cells; and unless the 
inflammation is relieved, or a new outlet made b}r means of an in- 
cision over the mastoid process, the results are always very serious. 
This in some cases is all the treatment that is necessary; but in 
more severe cases, the bone was broken down and the outlet made 
larger means of a gouge or chisel. In some instances this lias 
been neglected, and, as a consequence, extensive caries ensued 
which no treatment of ours could cure; still, in some few insstance, 
by removal of part or a whole of the dead bone, the patient’s life 
was saved. Another complication, which in some instances is 
hereditary, is syphilitic otitis; this requires a protracted and specific 
treatment, which, as may be seen in our table, is far from being 
satisfactory, only two being cured of ten cases. In the complica- 
tion otitis media with polypi, the results are more satisfactory, four- 
teen cases being cured out of eighteen. The treatment was removal 
by Wilde’s snare, or caustic potash, which was continued until the 
mucous membrane was in a healthy state. 
Periostitis, with cerebral abscess, is almost invariably fatal, j’et 
in one case we had all the symptoms in the case, and notwithstand- 
ing it recovered. 
Neuralgia of the plexus tympani is a very protracted disease. It 
was treated by sedatives of opium, belladonna, and tonics of mix 
vomica with quinine, to give tone and vigor to the nervous system. 
Effusion of blood upon the mernhrana tympani is generally the 
result of an exudating process, with the development of a glove- 
like cast of thickened epithelium, and in other cases is the result of 
a blow or fall on the side of the head. In three cases there was 
no perforation; in the fourth there was perforation with discharge 
of serum for some weeks, with attachment of the membrana t}rm- 
pani to the promontory, and entire loss of hearing on one side. In 
the three cases the blood was removed, and the membrane restored 
to a state of health. 6 
Effusion of serum into the tympanic cavity or middle ear.—lnstead 
of the usual mucous secretions, there are changes in the layers of 
the coats of the membrana tympani, causing opacity; or in some 
instances the membrane is so clear that one-half of it appears of a 
lighter shade than the lower part, which is of a dark gra}r. The 
boundary between the two is marked with a dark blue line; this 
line, according to Politzer, has the appearance of a black hair lying 
upon the membrane. The treatment was the air-douche, used every 
second day, with restoration of the mucous membrane of the nares 
and pharynx to a health}'- condition. 
Nervous deafness results from disease or injury of the internal 
ear, affecting the auditory nerve. The results of treatment are in 
the main the same as in similar affections of the optic nerve; 
treatment, galvanic current and the hypodermic use of strychnia 
or its salts. In sixteen cases, only two were improved. 
Perforation of the membrana tympani, by blows or foreign bodies, 
usually heals readily, if treated with care and without irritating 
applications. If of long standing, with edges covered with granu- 
lations, it is difficult to cure. Use a solution of nitrate of silver 
xx. to xl. grains to the ounce of water, the parts being cleansed 
with tepid water, and air introduced by the Eustachian catheter to 
rid the middle ear of any accumulation. 
Acute inf animation of the membrana, tympani.—This affection is 
accompanied with violent pains in the ear, occurring suddenly with 
more or less fever and suppuration. Meatus dry, membrana tym- 
pani much inflamed, sensitive, opaque, dull, flat, and thickened. 
Prognosis favorable, if treated promptly. Perforation one of the 
results, but this heals with care and perseverance. Our treatment 
is perfect rest, free leeching, cupping, or bleeding from the arm, 
with injections of warm water, glycerine, or opium ; and towards 
the termination, mild astringents, and counter-irritation with the 
use of the air-douche. 
In chronic inflammation of the membrana tympani there is no 
fever, and so little pain that the patient is not aware of his disease 
except by loss of hearing. There is no secretion of cerumen; the 
membrana tympani is more or less red, or very opaque, dense, with 
polypi or granulations upon it. Prognosis not favorable. Local 
and general treatment. The mucous membrane of the nares, pha- 
rynx, and Eustachian tube is in almost every case more or less 
softened, and secretes abundantly. A portion of tannic acid or pul- 
verized alum is blown in through a rubber tube of the size of a 
large catheter, which is introduced into the pharyngeal space, in 
the neighborhood of the Eustachian tube, through the lower nasa 7 
opening. Instillation of solution of sulphate of zinc, or powders 
of protochloride of mercury are blown upon the membrane, while 
the patient is given iodide of potassium or bichloride of mercury ; 
the Eustachian catheter or Politzer’s air-douche being employed 
every second or third day. Inflammation of the Eustachian tube 
was treated by the means already spoken of under the head of 
acute aural catarrh ; and the chronic form under that of chronic 
catarrh of the middle ear, with or without perforation. There are 
numerous kinds of apparatus, by means of which this portion of 
the ear is reached, and applications made which will be found in 
the author’s work upon this subject. 
The treatment of deaf muteism is a subject of much interest to 
the physician and philanthropist, and numerous means are now 
emplo3red to improve their intercourse with their fellows; but we 
cannot enter upon this subject at this time, but hope to do so at 
some future meeting of the Society.