REPOR T 
ON TIIE 
Progress oe Otology. 
BY 
C. H. BURNETT, M. D., 
AN1> 
CLARENCE J. BLAKE, M.D. 
REPRINTED FROM TIIE 
TRANSACTIONS OF THE AMERICAN 0T0L0GICAL SOCIETY, 
For 1874. 
BOSTON: 
ALFRED MUDGE & SON, PRINTERS, 34 SCHOOL STREET. 
1 874. REPOE T 
ON TIIE 
Progress of Otology. 
BV 
C. H. BURNETT, M. D., 
ANI) 
CLARENCE J. BLAKE, M.D. 
RfcPHfNTED FROM TIIE 
TRANSACTIONS OF THE AMERICAN 0T0L0GICAL SOCIETY 
For 1874. 
BOSTON: 
ALFRED MUDGE & SON, PRINTERS, 34 SCHOOL STREET. 
1 874. REPORT ON THE PROGRESS OF OTOLOGY. 
BY C. II BURNETT, M. D., AND C J. BLAKE, M. D. 
The preparation of the Report on the Progress of Otology 
during the year that has passed has been shared by a com- 
mittee of two, in accordance with a suggestion made by the 
committee of last year. The Report is divided into three 
parts: I. Anatomy and Physiology, by Dr. Burnett; II. 
Pathology and Therapeutics, by Dr. Blake; and III. Re- 
views and Book Notices, by each member of the committee. 
There is a bibliographical record for the year appended 
to the Report, in which the articles forming the basis of the 
Report may be readily found by the alphabetical arrangement 
of the authors’ names. 
With the hope that it may prove acceptable to the Society, 
and all other readers, the following report is respectfully 
submitted by the committee: — 
I. 
ANATOMY AND PHYSIOLOGY. 
1 Prof. Gruber luis extended his investigations concerning 
anomalies in the connection between the malleus and the 
membrana tympani, describing three more varieties of ab- 
normal connection. 
The tirst consists in a round vesicle extending over the 
upper part of the manubrium of the malleus and the antero- 
superior segment of the membrana tympani. This vesicle is 
nothing more than the result of a collection of fluid induced 
by hyperannia or inflammation in the membrana tympani. 
The second anomaly is only a higher grade of the first; 
u is of rare occurrence. 
By an extension of the vesicle downwards, parallel with 2 
BURNETT AND BLAKE. 
the handle of the malleus, the latter appears doubled. In 
such cases, Gruber thinks that the cartilage of the anterior 
portion of the manubrium of the malleus is loosened and 
pushed out of position. 
The third form of anomaly is considered to be a combined 
result of the tirst two forms already mentioned. 
In this form the short process appears dislocated upwards 
in a few cases, but more usually downwards and upon the 
posterior surface of the manubrium of the malleus. "Of 
course,” says Gruber, "this is not a dislocation of the short 
process, but simply one of the upper end of the cartilage in 
connection with it.” This dislocation, the author says, he has 
seen as a sequel of hypertrophic inflammatory processes in 
the mucous membrane of the middle ear. This condition is 
attended, furthermore, with alterations in the position of the 
membrana tympani and ossicles, viz. a retraction and simul- 
taneous turning of the malleus about its long axis. 
Prof. Gruber also calls attention to another change in ap- 
pearance he has observed in cases of the abnormal position 
of the malleus just described. He says, "It appears as if the 
cartilaginous segment, extending from beneath the short pro- 
cess to the end of the manubrium of the malleus, were raised 
up and shrunken. The outermost edge of the manubrium 
in such cases assumes a wavy appearance.” 
Prof. Voltolini again calls our attention to his pneumatic 
aural speculum and its advantages. His first statement is 
that the usual aural mirror, which reflects ordinary sunlight 
into the meatus, is only of use to short-sighted aurists, whereas 
his speculum, in which the reflecting plane-mirror is oidy 
3" from the membrana tympani, can be used by direct sun- 
light, as well as with simple daylight, by every eye. 
He furthermore claims that with his speculum we arc better 
able to see both the normal appearances and the manifold va- 
riations of the pyramid of light, all of which only serve as 
proof that the funnel shape of the membrana tympani causes 
the pyramid of light and not the inclination of the membrane 
to the axis of the meatus. REPORT ON THE PROGRESS OF OTOLOGY. 
3 
Its pyramidal shape is due to the fact that the membraua 
tympani, which in this connection must be regarded as a con- 
cave mirror, becomes smaller towards the centre, and there- 
fore the reflected image, i. e. the parts of the pyramid of 
light, becomp smaller towards the centre of the mirror, i. e. 
of the membrane. In this article, Voltolini likens the incin- 
brana tympani to the tapetum of the choroid, which is prac- 
tically a concave mirror, and reflects a minimum of the light 
falling into the eye. We have consequently a pyramid of 
light in the eye as wrell as in the ear, and our author says 
we may speak of "shining ears” as well as of "shining 
eyes.” 
Among the practical advantages of this speculum, we find 
that the author claims that if by its use we are unable to alter 
the appearance of the pyramid of light, we may safely con- 
clude that the membrana tympani is adherent throughout its 
entire extent. 
In the same article, Voltolini says that the normal color of 
the membrana tympani is pearl gray (a merely confirmatory 
statement of the observations of others), and that the mem- 
brane in its normal condition is only translucent, not trans- 
parent, even in the brightest sunlight. 
In those cases where the contents of the tympanum are 
visible through the membrana tympani, we may conclude that 
the latter is more or less atrophied. 
This speculum will also enable us to tell whether the mem- 
brana tympani is perforated, and if it be, we can by its use 
empty the tympanum of its fluid contents by suction ; but 
the last two ends may be gained equally well by Sigle’s pneu- 
matic speculum. 
The operations for tenotomy of the tensor tympani and 
loosening the adherent membrana tympani from the inner 
wall of the tympanum, may be performed by the aid of this 
speculum. Dr. Trautmann has investigated most thoroughly 
the optical causes of the "triangular shining spot,” or the 
pyramid of light, on the membrana tympani, in an article 
which he calls " The Shining Spots of the Membrana Tym- 4 
BURNETT AND BLAKE. 
pani” ("Lichtreflexe des Troramelfelles ”). This paper is 
admirably illustrated by nineteen diagrams explanatory of 
the optics of concave and convex mirrors, as well as the 
"shining spots” upon the inner and outer parts of the sur- 
face of the funnel or concave mirror formed by the natural 
membrana tympani. 
Under the third head of this paper, the author sums up the 
following reasons for the "spots of light” (Lichtreflexe) 
which usually occur in membrana tympani. 
He says, "The normal membrana tympani has quite a high 
degree of superficial lustre, is inclined at an angle of 45° in 
its vertical plane, and in its horizontal plane it is inclined 
10° towards the right on the right side, and 10° towards the 
left on the left side. Furthermore, it is drawn inwards so as 
to form a funnel, the point or apex of which lies in the cen- 
tre of the anterior periphery of the yellow, sickle-shaped 
expansion at the end of the anterior edge of the manubrium 
of the malleus; the angle at which the walls of the funnel 
meet is greater than a right angle, the depth of the funnel is 
equal to about 2mm. and the distance from the apex to the 
periphery is 2^—3mm. anteriorly, and 3mm. posteriorly. 
Therefore a " spot of light” or a reflection of light from 
the plane surfaces of the membrana tympani cannot reach the 
eye of an observer, because the rays of light from without, 
on account of the inclination of the membrana tympani, fall 
upon the plane surfaces of the same, at a very acute angle. 
Since the angle of reflection is equal to the angle of inci- 
dence, the rays of light from the planes of the membrane 
which has an inclination of 45°, must strike the inferior wall 
of the external auditory meatus, and are in consequence un- 
able to reach the eye of the observer. 
The relations are, however, different, when we consider 
the " reflection of light ” which is found in a funnel-shaped 
spot. On account of the vertical inclination of 45° of the 
membrana tympani and of its horizontal inclination of 10°, 
the antero-inferior quadrant of the membrana tympani is 
at right angles to the illuminating object. Since, now, REPORT ON THE PROGRESS OF OTOLOGY. 
5 
the illuminating hotly and the eye are in the same line,* 
the rays of light which fall perpendicularly upon the an- 
tero-infcrior quadrant must reach the eye, and therefore 
the eye sees a " reflection of light” only in the antero-in- 
ferior quadrant, the reasons of which are more fully ex- 
plained by the author under the second part of his paper. 
Since the walls of the funnel meet at an angle greater than 
a right angle, this triangular reflection is a direct one, as is 
fully explained under the aforesaid second part, which treats 
of the physical reasons for all prominent reflections of light 
(sicli abhebende Lichtreflcxe) occurring on shining or pol- 
ished surfaces. 
A number of anatomical modifications of the temporal bone 
have been pointed out by Zuckerkandl. 
These modifications are shown to be the result of an ex- 
traordinary development of vessels which are usually small 
and insignificant, but which, by the aforesaid development, 
alter the structure of the temporal bone,— a fact of such im- 
portance that an investigation of two hundred and eighty 
skulls was made in order to arrive at some conclusion 
respecting the causes of these important modifications of the 
temporal bone. 
The first modification is termed the sinus petrosquamosus, 
and is produced by a semi-canal in the line of the fissura 
petroso-squamosa, and connects, by means of a largely-de- 
veloped vein, one of the middle meningeal veins with the 
sigmoid sinus. 
The sinus petrososquamosus may be ambilateral or unilat- 
eral. That portion of it usually found on the anterior 
aspect of the temporal bone may be wanting as far as the 
canal of the posterior part of the petrous bone. 
A converse modification is seen where the canal usually 
passing over the posterior part of the petrous bone to join 
the sinus petrosquamosus is wanting. 
* The externa! auditory meatus is so narrow, that the observer and the 
source of illumination had better be in the same line, in order to obtain 
the best possible illumination of the membrana tympani. 6 
BURNETT AND BLAKE. 
This sinus may be very short, emptying into the sinus 
pctrosus superior, instead of passing backwards as far as the 
sigmoid sinus. 
In the second part of his paper, Zuckerkandl has pointed out 
some features of the sulcus pctrosus superior, which give it 
the character of a diploetic vein of the petrous bone. In the 
same division of this article he alludes to the modifications of 
the sigmoid sinus, and that portion of it denominated the 
bulbils of the sigmoid sinus. 
This latter anomaly, says our author, in some few cases 
may assume a dangerous character by causing a thinning of 
the mastoid portion of the temporal bone lying over the 
aforesaid bulbus of the sigmoid sinus. 
In one instance he found the soft parts of the scalp at one 
point separated from the bulbus of the sigmoid sinus by a 
layer of bone as thin as paper ; and at another point the soft 
parts of the scalp were in direct contact with the bulbus of 
the sigmoid sinus. 
In the third portion of the paper on "Anomalies of Devel- 
opment in the Petrous Bone,” we find the following remarks 
on the anastomosis of the arteries of the labyrinth: "After 
the vestibular artery reaches its destination, it divides at the 
posterior wall of the vestibule into several branches which 
arch towards the outer wall of the vestibule. We possess no 
information respecting the connection between these vessels 
and the of those cochlea, although the anastomosis of these 
vessels can be seen by the removal of the anterior wall of the 
vestibule in any well-injected preparation of the temporal 
bone. 
"The cochlear artery, which alone gives off 15 or 20 arter- 
ioles to the membranous portions of the cochlea, gives origin 
to a large branch, passing through the lamina spiralis ossea, 
via the modiolus, into the vestibule. 
" This branch gives off three other branches : — 
" 1. One to that portion of the lamina spiralis membrana- 
cca et ossea lying behind the promontory. 
"2. One to the superior wall of and REPORT ON TIIE PROGRESS OF OTOLOGY. 
7 
" 3. A branch which anastomoses with the branches of the 
artery of the vestibule. 
" Hence, we see that the arteria auditiva, whose connection 
with the ostium of the tympanum has never yet been demon- 
strated, forms a completely closed net in itself. 
" The diploetic substance which surrounds the labyrinth 
shows a similar richness in Larger arteries.” 
Zuckerkandl has also described a constant and peculiar 
anatomical connection between the Eustachian tube and the 
constrictors of the pharynx, under the name of the liga- 
menta salpingo-pharyngea. lie states that " upon opening 
the posterior wall of the pharynx and dissecting oil' the 
mucous membrane, along the periphery of the pharyngeal 
opening of the Eustachian tube and adjacent parts, we shall 
find three, four, or five or even more tendinous, rarely clastic 
cords attached to the pharyngeal end of the hooked cartilage 
of the Eustachian tube, and the outer wall of the same, 
which, in their fullest development, the author likens to the 
tendinous cords connected with the valves of the ventricles 
of (he heart. 
"This anatomical arrangement produces a free opening of 
the Eustachian tube at each contraction of the superior and 
middle constrictor of the pharynx.” 
AVe are also informed that "if the cavity of the tympanum 
is laid open, in a perfectly fresh specimen, the ligamenta 
salpingo-pharyngea of which have been dissected, we shall 
find upon stretching these cords downwards that the ossicles 
of hearing will be visibly moved, and that alterations of at- 
titude in a drop of water placed in the cavity of the tympa- 
num will also be produced.” A similar natural tension is 
produced in these "tendinous cords” by the action of the 
arcus palato-glassus brought about by opening the mouth 
very widely. 
At a meeting of the Boston Society for the Advancement 
of Medical Science, Dr. Blake described a peculiarity ob- 
served by Prof. Wyman first in the crania of Hawaiian 
Islanders, and subsequently in the crania of ancient Peru- 8 
BURNETT AND BLAKE. 
vians, consisting of exostoses of the external auditory meatus 
occurring uniformly on the superior and inferior lips of the 
lamina forming the posterior wall of the passage, the same 
peculiar growth being described by Welker as occurring in 
the crania of American Indians. Out of three hundred and 
thirty-four Peruvian crania examined by Prof. Wyman, these 
growths were found in six, and in various degrees, from a 
small pedunculated growth on the superior lip of the lamina 
to double growths on both lips nearly occluding the orifice of 
the passage. It was noticeable, moreover, that these growths 
were nearly uniform in size and shape on both sides. Out 
of eight Peruvian crania, belonging to the collection of Mr. 
Blake, in the Warren Museum, but one presented this pecu- 
liarity, and then only in the form of an elongated ridge upon 
the posterior wall of the meatus on one side. The supposi- 
tion that aquatic habits might have to do with the presence of 
these growths, though applicable in the case of the Hawaiian 
Islanders, would not apply to the Peruvians, living as they 
did in a tract of country remote from the sea and remarka- 
ble for its aridity. That the occurrence of these growths is 
coincident with the development of the wall of the osseous 
meatus, as suggested by Dr. J. O. Green, is further sup- 
ported by the fact that the location of the growths was a 
constant one. 
Dr. Hasse has continued his researches into the "general 
plan upon which the peri- and endo-lymph of the inner ear 
is renewed.” The results of his investigations upon this 
subject, in connection with all classes of vertebrates, I shall 
give to you in the author’s oavh words, which may be found 
on page 7(58 of his "Anatomical Studies,” No. xix : — 
" All vertebrates possess a duct which originates in the 
vestibule; and in all animals, with the exception of the Pla- 
giostomes, in which it passes directly to the surface of the 
skull, this duct enters the cavity of the cranium and there 
terminates either in a closed sac at the coniines of an epicere- 
bral lymph-cavity, or opens into the same. This is the 
ductus endolymphaticus or the aquoeductus vestibuli with the RETORT ON TIIE PROGRESS OF OTOLOGY. 
9 
saccus cndolymphaticus, the former of which, in most verte- 
brates, arises from the sacculus, that is, from the inferior 
portion of the vestibule. In fishes, the perilymphatic fluid 
is poured into the cavity of the skull without any special 
conduit, and empties into the epicerebral chamber; in Pla- 
giostomes, it is excreted directly upon the skull; and in 
other vertebrates, a special way of excretion of the peri-lymph 
exists by means of a narrow canal, which empties either into 
the epicerebral lymph-chamber, or passes into a lymph-sac 
which lies in the foramen jugulare, which sac terminates on 
one side in a peripheral lymphatic duct, and on the other- 
side passes into the epicerebral lymphatic space. This canal 
is the canal is s. ductus pcrilymphaticus with the saccus pcri- 
lymphaticus, which leaves the auditory capsule (Gchorkapsel) 
either through the foramen rotundum or through the so-called 
apcrtura aqmeductus cocldcte, and conveys the perilymph 
from the auditory capsule to the periphery.” 
After tracing the aqmeductus vestibuli through all classes 
of vertebrates, and having established the existence of one 
simple fundamental form for all, the author then endeavors to 
explain the physiological function of this organ. lie lays down 
three probable functions of this structure. 1. The endo- 
lymphatic duct and its sac are the source of the endolym- 
phatic fluid in embryonal life. In this capacity the sac plays 
the more important part, through its epithelium and the ves- 
sels which arc distributed to it, forming a kind of gland. 
2. The aquneductus vestibuli, in adult life, may act as a 
conveyer of new material to the endolymph, either by means 
of endosmosis from the epicerebral cavities in those instances 
where the sac is closed, or by means of a direct current where 
the saccus is open. 
3. AVre might reasonably suppose that the sac was useful 
as a reservoir for the liquor endolymphaticus in any case 
Avhere the intra-labyrinthal pressure attains an excessive 
height. By the reception of the fluid into the sac in such a 
case the pressure would be reduced in the labyrinth. 
The author also gives the following reasons for what he 10 
BURNETT AND BLAKE. 
considers an uncommon practical importance in the ductus 
cndolymphaticus : — 
"Every increased or diminished pressure of the fluid of 
the liquor cerebrospinalis in the subarachnoidal cavity will 
make itself felt per continuitatem through the saccus and the 
ductus cndolymphaticus, in the interior of the auditory appa- 
ratus, in the endolymphatic cavity and upon the terminal ap- 
paratus of the auditory nerve found therein. We may thus 
explain most easily the impairment of hearing for high tones 
in cases of increased pressure.” 
Furthermore, pathological processes in the subarachnoidal 
space are conveyed either by continuity or contiguity through 
the saccus and ductus cndolymphaticus into the interior of the 
labyrinth, and vice versa, the latter instance, of course, being 
the rarer from the deep-seated position of the inner car. 
Thus every alteration in the chemical constitution of the 
cerebro-spinal fluid necessarily produces a change in the 
liquor endolymphaticus, which alteration must exercise some 
influence in the occurrence of subjective acoustic perceptions 
as a result of disturbed nutrition ; in any event it must have 
an effect upon the composition of the liquor endolymphati- 
cus. 
That portion of the treatise which traces out the compara- 
tive relations of the aqiueductus cochlea! in the vertebrates 
closes with the following remarks by the author on the phys- 
iological importance of the perilymphatic cavity : — 
"The cavum perilymphaticum is inserted into the lymphatic 
tract of all the vertebrates and is connected with the suba- 
rachnoidal cavity by means of the foramina acustica, and 
thence indirectly with the peripheric lymphatics, which in 
connection with the large nerve-trunks pass from the peri- 
lymphatic cavity by means of the ductus and saccus pcrilym- 
phaticus. We can therefore perceive that all changes expe- 
rienced by the liquor cerebro-spinalis, whether they be of a 
chemical or physical nature, must act upon the liquor peri- 
lymphaticus and thence upon the organ of hearing, causing 
subjective perceptions of sound. REPORT ON THE PROGRESS OF OTOLOGY. 
11 
" On tlio other hand, pathological processes which could 
transmit themselves, through the ductus cndolymphaticus, 
from the cavum subaraclinoideale into the interior of the 
membranous labyrinth, by virtue of their continuity or con- 
tiguity, could also exercise an influence in the cavum peri- 
lymphaticum, thus furnishing a not unsound anatomical basis 
for the elucidation of morbid conditions of the inner ear. 
"This relationship between the liquor perilymphaticus and 
1. cndolymphaticus supplies the possibility of an afflux and 
efflux of the fluid element, a renewal of the same, and the 
removal of the products of retrograde metamorphosis, and 
we are therefore justified in supposing that there is a con- 
stant circulation of lymph in the inner chambers of the mem- 
branous labyrinth as well as in the space between the mem- 
branous labyrinth and the auditory capsule (Gehbrkapsel). 
The rapidity of this current is equal to that of the lymphatic 
stream in the lymphatic cavities with which it is connected, 
chiefly to that of the cavum subaraclinoideale, perhaps less 
rapid. The consequences of this relationship will be shown 
in a forthcoming treatise.” 
This work of Prof. Ilasse on the lymphatic system of the 
inner ear is based upon a series of observations on all classes 
of vertebrates, and from time to time he has published, in 
separate form, investigations on the auditory apparatus of a 
species which are now woven into the complete chain of 
reasoning which ho has laid before the world of science. 
Dr. Ilasse alludes to the important aid he has derived 
from his predecessors in this field of study; especially prom- 
inent are the names of Cotugno, Meckel, Breschet, Wind- 
ischmann, and Rathke. 
The contemporaneous writers alluded to by Dr. Ilasse are 
Clason, Ketel, Schwalbe, and Bottcher, from whose labors 
Dr. Ilasse has gleaned, as lie states, much that is of great 
value in carrying on his investigations, which have formed 
the basis of the theory contained in his new work. How- 
ever, our author says, he does not claim to have established 
a positive and complete theory, — " On the contrary, it is only 12 
BURNETT AND BLAKE. 
a further developed investigation which is still under consid- 
eration, and does not chum to be a complete theory.” "If 
it will stimulate others to produce something more complete, 
then my principal object will be attained,” savs this distin- 
guished writer on the comparative anatomy of the auditory 
apparatus. 
Dr. Curschmann has performed a series of experiments 
upon the relation existing between the semicircular canals 
and the equilibrium of the body. He has kept in view the 
following cautionary rules : — 
1. The least possible destruction of tissue in the expos- 
ure of the semicircular canal. 
2. Careful avoidance of excessive hemorrhage, especia ny 
from the venous sinus which accompanies the semicircular 
canals. 
3. The least possible- injury to the bony canals, since, 
from their intimate relation to the cavity of the cranium, 
they cannot be destroyed without a previous opening of the 
cranial cavity, with an immediate or secondary injury of 
the cerebellum. 
With these precautions, after the bony canals were laid 
bare, small openings were made in the canals, and either the 
entire membranous canals, or pieces of them, were removed 
by means of the forceps. 
The author draws the following conclusions from his 
experiments : — 
(1.) Injuries of the semicircular canals produce special 
disturbances in the equilibrium of the body. It is entirely 
incorrect to attribute the latter to the attendant injury of 
other parts. 
(2.) The manifestations produced by the lesions are, in 
general, proportional to the extent of the same. 
(3.) In all cases of disturbance in the equilibrium of the 
body of the animals experimented upon, we are not to con- 
sider the motor paralysis or spasmodic conditions, but we 
must always consider the disturbances in the accommodation 
oj muscular action. This is usually denominated vertigo in 
the animals experimented upon. RETORT ON THE PROGRESS OF OTOLOGY. 
13 
(4.) According to the injuries inflicted upon the separate 
semicircular canals of the pigeon, we observe characteristic 
differences in resultant manifestations. Jt makes, also, a 
great difference, whether the structures upon only one or 
upon both sides are destroyed. 
(5.) Regardless of the extent of the lesion, all the mani- 
festations are more intense and more distinct, the more ener- 
getically the animal moves; so that in cases of the slightest 
injuries (simple section of the canal on one side of the body) 
the characteristic symptoms arc seen only when the animal 
makes a vehement motion, whereas these motions are scarce- 
ly perceptible or may be overlooked when the animal is at 
rest or is performing ordinary acts of locomotion. 
(6.) These manifestations of altered co-ordination in mus- 
cular motion are observed in the head, in the trunk, and in 
the extremities. 
(7.) The supposition that the disturbances in the motions 
of the trunk are due to the defective equilibrium or defective 
position of the head is to he rejected for the following 
reasons; — 
(a.) Because disturbances in the equilibrium of the body 
occur in cases of injury to the semicircular canals on one 
side, in which, as has been already stated, the pose and 
movement of the head arc not materially altered. 
(6.) Because that supposition would explain only general 
manifestations of vertigo, but it would not explain the char- 
acteristic partial disturbances in equilibrium which arise in 
connection with injury to separate'semicircular canals ; and — 
(c.) Because certain experiments not described here, 
militate directly against such a theory. 
Even after complete ablation of all three of the membran- 
ous semicircular canals, upon both sides, pigeons do not ap- 
pear to be deprived of all power of directing their bodies. 
Strong animals of this class regain, to a certain extent, 
while at rest or when moving very slowly, the power of 
posing their bodies. 
(9.) After a simple section of a single canal, the resultant 14 
BURNETT AND BLAKE. 
symptoms vanish in from four to five days, unless the struc- 
ture becomes secondarily diseased, which is hardly ever the 
case, if the experiment has been made with care. In these 
cases, however, a restitutio ad integrum does not always 
occur in the anatomical relations of the parts implicated. If 
only small pieces of the semicircular canals are removed, a 
marked recovery may ensue, more readily, however, for cer- 
tain reasons, when the lesion occurs in a vertical canal than 
when it occurs in the horizontal canal. 
(10.) The almost constant increment and frequent altera- 
tions in the original symptoms, which follow a large injury of 
the canals, are due to subsequent disease of the remnants of 
the wounded canals or to secondary alterations in the parts 
of the canals left intact. 
(11.) The author is unable to give a comprehensive 
theory of the mechanism by which the semicircular canals 
exert this influence, which he has portrayed as occurring in 
cases of injury or disease. 
The various hypotheses which have heretofore been offered 
in explanation of these symptoms are not tenable, in his 
opinion. 
It is especially incorrect, in his estimation, to regard the 
semicircular canals as a kind of " organ of sense” for the 
equilibrium of the body. 
(12.) The symptoms are the result of a cessation of func- 
tion, not a result of an irritation, certainly not of a specific 
irritation of the acoustic nerve. 
(13.) We are not to conclude, that, since the hearing is 
not materially altered by a removal of the semicircular 
canals, they are not correlated to it. 
The anatomical and the physiological facts would show 
that they are connected with the function of hearing. 
Prof. Lucie, to whoso able resume of Curschmann’s experi- 
ments I am indebted for the facts I have presented here, 
states that the various disturbances in equilibrium, produced 
in accordance with a section of the horizontal or vertical 
semicircular canal, were accurately demonstrated by the REPORT ON TIIE PROGRESS OF OTOLOGY. 
15 
author before the Medico-Psychological Society of Berlin, 
when Prof. Lucao was present. 
The results of Prof. Cyon’s investigations concerning the 
function of the semicircular canals are thus given in the M. 
F. O., December, 1873 : — 
(1.) In order to preserve the equilibrium, it is necessary 
that an animal have the correct conception of the position of 
his head. 
(2.) The function of the semicircular canals is to inform 
the animal, by means of a series of unconscious (acoustic?) 
perceptions, of the correct position of its head in space, and 
for this purpose each semicircular canal has an exactly de- 
termined relation to a dimension of space. 
(3.) The disturbances in motion, which occur after sec- 
tion of the semicircular canals, are of three kinds. 
(a.) Disturbances in equilibrium as direct results of the 
artificial injury. 
(b.) Involuntary movements, as results of the irritation 
of abnormal acoustic perceptions produced by this injury, 
and 
(c.) Consecutive manifestations produced by the inflam- 
mation of the. cerebellum, which sets in a few days after 
the operation. 
Cyon has shown that a pigeon, in which both horizontal 
semicircular canals have been severed, will perform regular 
oscillations of its head in a horizontal plane. On the other 
hand, a pigeon in which the vertical semicircular has been 
severed will perform similar oscillations of its head in a ver- 
tical plane. 
Dr. J. Breuer has published a very interesting and im- 
portant work, concerning the functions of the semicircular 
canals of the labyrinth. Prof. Mach has published the re- 
sults of his investigations into the same subject, and has 
come to nearly the conclusions as Breuer. The results ob- 
tained by both of these investigators are confirmatory of the 
well-known theories of Flourens and of Goltz. (Archiv fur 
Physiol. 1870.) The theory may be again stated in these 16 
BUIINETT AND BLAKE. 
words: "The semicircular canals are organs of the sense of 
equilibrium of the head and mediately of that of the entire 
body.” 
The experiments to illustrate the physical phenomena of 
the semicircular apparatus are given in the author’s (Bren- 
er’s) own words : — 
"A system of three tubular rings, at right angles to each 
other, are filled with fluid. AVe thus gain a fair representa- 
tion of the semicircular canals. In such a system we shall 
find that with every rotary motion of the entire system («. e. 
the head) currents of the contained fluid will occur in a di- 
rection opposite to that of the rotary motion of the head. 
The measure of this current in each canal depends upon the 
plane in which the head is turned, and upon the amount of 
rotation. Between the rotation of the head and the move- 
ments of the enclosed fluids, fixed relations exist. If the 
movements of the fluid are perceived, they will of course 
furnish exact information concerning every turning of the 
head.” The acoustic hairs (Horlniare) are brought forward 
as the possible perceptive apparatus of this movement, for 
they are situated at a broad, smooth spot in the canal and 
project at right angles into its calibre. Thus from their posi- 
tion they would be especially sensitive to the variations of the 
currents in the endolymph, and we know that they are con- 
nected with nerves, the terminations of which they repre- 
sent. 
The analogous terminal nervous apparatus in " the lateral 
organ ” of the fish appears to act the part of an analogous 
organ of perception for the currents, resistances, etc., in the 
surrounding water. (F. E. Schulze.) 
" If we wish to harmonize both of these facts with Goltz’s 
theory we must assume that every current of the endolymph 
is perceived by the nerves of the ampulhe, and that it pro- 
duces an idea of the rotation of the head in the plane of the 
semicircular canal most implicated, and in a direction oppo- 
site to the current; but that the perceptions of the six 
ampulhe of both labyrinths unite in forming a joint con- 
ception.” (Breuer.) REPORT ON THE PROGRESS OF OTOLOGY. 
17 
Prof. E. Mach has contributed additional corroboration of 
the theories of Goltz and Breuer by a series of novel experi- 
ments upon man, which were published a short time before the 
results of Breuer’s labors. I think I cannot do better than 
to give the description of these experiments in the words 
of Prof. Pick (Archiv. f. O. N. F. Band II, II. 4) : — 
" Mach suspended a chair in which a man could sit with 
ease, in a frame-work, so that the chair could be revolved 
about a horizontal axis and fixed at any inclination. In addi- 
tion, the entire frame-work with the chair could be revolved 
about.a vertical axis. In many of the experiments the chair 
was covered by a paper box, which, following all the motions 
of the chair, prevented the person sitting in it from observing 
with his eye the motions of the apparatus in which he was 
seated. 
"The principal results of the experiments with this appa- 
ratus were the following : — 
"A revolution about the peculiar vertical axis of the body 
is perceived by the person experimented upon only so long 
as it is accelerated. 
"A continued and constant revolution is not perceived. 
"Retardation of the revolution is perceived as a revolu- 
tion in the opposite direction.” 
" It is apparent that these facts agree with the theories of 
Breuer. The sensation of revolution in the opposite direc- 
tion is converted into the sensation of motion in the true 
direction, in two seconds, by a renewed acceleration of the 
original motion. This sensaiion, therefore, must continue a 
few seconds longer than the cessation of the retardation; for 
otherwise, the new acceleration should produce immediately 
a sensation of revolution in the original direction. If we 
accept Breuer’s hypothesis, we must suppose that by the law 
of inertia the currents produced in the semicircular canals 
continue some seconds after the force producing them has 
ceased. 
If during the revolution about the vertical axis the head 
is inclined forward and then suddenly elevated at the mo- 18 
BURNETT AND BLAKE. 
mcnt the revolution ceases, in those cases where the revolu- 
tion has occurred from the left, forwards and towards the 
right, an impression will he gained that a revolution is oc- 
curring from the right, upwards and towards the left, and 
the person thus experimented upon will fear that he is about 
to fall towards the left. This fact is also in harmony with 
the hypothesis of Breuer, and proves most strikingly that 
the position of the head is a measure of the sensations of 
revolution, and that the organ of these sensations must he 
found in the head. These two fundamental facts have already 
been observed by Purkiuje, but with less exactitude than by 
Mach. Furthermore, Mach has established, by the aid of 
his apparatus, the fact that we have, either with the body at 
rest or revolved with a constant velocity, a distinct con- 
sciousness of the direction of the resultant accelerating force 
without the assistance of the eyes. A man sitting in the 
chair was able to give, by means of an indicator projecting 
from the case, a tolerably correct statement as to the vertical 
direction in any of the variously inclined positions of the 
chair. 
When the case containing the chair was revolved about a 
vertical axis situate at some distance from the chair, like the 
well-known " caroussel toy,” and when the face of the one 
experimented with was turned towards this axis, the axis then 
given by him as the vertical one was in reality one inclined 
diagonally downwards from the axis corresponding to the 
resultant of the centrifugal force produced by the revolution 
with constant velocity, and the weight of the body revolved. 
Certain facts of a similar nature, perceived prior to this, 
induced Breuer to add to his hypothesis already described, 
the supposition that we should consider the macula acustica 
with the otoliths as possibly an organ for the perception of 
the position of the head at rest, in respect to the direction of 
the resultant accelerating forces and the rectilinear motions. 
In this portion of the acoustic apparatus he perceives the 
fulfilment of the necessary conditions. lie thinks we arc 
justified in assuming that the otoliths are specifically heavier REPORT ON THE PROGRESS OF OTOLOGY. 
19 
than the endolymph, and that they consequently have a ten- 
dency to sink in it in the direction of the resultant acceler- 
ating force. According to the direction of this force in the 
head, the otoliths would drag, in various ways, upon the 
hairs with which they are connected, and thus produce a 
varied excitation of the terminal nervous apparatus. 
In addition to this, the specifically heavier otoliths would 
have, at the beginning of a rectilinear motion, a tendency to 
remain behind the endolymph, and at the cessation of the 
same they would go in advance of it, and therefore they 
would, by mechanical action upon the cilia, produce a per- 
ceptive sensation. 
Dr. A. II. Buck has written a brochure on the mechanism 
of hearing, in which he advances a new theory. lie says : 
" My own investigations, so far as they go, favor the view 
that no communication exists between the two scalre in the 
immediate vicinity of the cupola, unless the opening (heli- 
cotrema) spoken of so vaguely by the authors, be micro- 
scopic in size.” Dr. Buck shows that a force applied to the 
fluid contents of the scala vestibuli, will be communicated 
to Ileissner’s membrane, and thence to the membrana basi- 
laris. The displacement of the contents of the scala tym- 
pani, caused by the depression of the entire membrana basi- 
laris, is provided for by the presence of an elastic membrane, 
the membrana tympani secundaria. 
The author then goes on to say, that "the entire membrana 
busilaris, including high and low notes alike, is obliged to 
perform all the excursions which may be communicated to 
the stirrup or the membrana tympani by sonorous vibrations ; 
or, to speak more minutely, with every tone, sounded, every 
' organ of Corti ’ must perform the excursions which belong 
to that particular tone. 
"Although it must be true that, with every note sounded, 
all the organs of Corti must perform the excursions belong- 
ing to that note, yet it must be remembered that the semi- 
gelatinous membrana tectoria, which rests upon the cilia of 
the hearing-cells, will likewise be obliged to perform these 
same excursions.” 20 
BURNETT AND BLAKE. 
"Over one particular region, however, of the membrana 
basilaris, this will not be the ease, namely, in that portion 
where the thirty or more basilaris fibres are tuned to vibrate 
in sympathy with the note sounded. At this point the vibra- 
tions will be of sufficient vigor to throw off the membrana 
tectoria. So long, then, as that particular note is sounded, 
the cilia of the hearing-cells, in the region referred to, will 
receive a succession of taps from the membrana tectoria, or, 
to speak more strictly, will strike against this membrane.” 
These blows, Dr. Buck says, constitute the true irritation 
of the auditory nerve. "Wherever the blows do not take 
place, although the auditory nerve-filaments may be agitated 
in a direction at right angles to their length, then no sensa- 
tions of sound will be communicated to the brain.” 
Dr. Buck also suggests an explanation of the function of 
the semicircular canals. lie rejects the theory of Flourens 
and Goltz, and says : "The first thing that attracts our atten- 
tion in the anatomy of these organs is the peculiar relation 
of the membranous to the bony canals, the former occupying 
scarcely a third of the calibre of the latter. Then, in the 
next place, the space between the membranous canal and the 
bony walls is filled, not with free fluid, as is the case, for 
example, in the cochlea, but with a reticulated connective 
tissue, rich in blood-vessels and made up of large meshes 
containing fluid. In the vicinity of the mouths of these 
canals, however, it should be noticed that the membranous 
tubes hug the bone more closely. If we examine the mode 
of construction of the membranous canals, we find that the 
outer elastic wall is lined with a sort of mucous membrane 
whose free surface undulates or is thrown into mounds, and 
carries a lining of ordinary pavement epithelium. Another 
point worthy of notice is the absence of the undulations or 
mounds on that "side of the canal which lies next to the bone, 
the side where dilatation cannot take place. These ana- 
tomical relations and the absence of nerves are certainly sug- 
gestive of the thought that the function of these canals must 
be a mechanical one. Is not their function, we would ask, REPORT ON TIIE PROGRESS OF OTOLOGY. 
21 
to protect the ductus cochlearis and the organs of Corti from 
injury in eases where the stirrup is driven too violently into 
the oval window ? Any pressure made upon the utriculus 
can only find a yielding point in the elastic Avails of the 
membranous semicircular canals; and furthermore, if the 
latter were lined with a smooth instead of an undulating 
epithelial surface, the distension would he followed by a rup- 
ture of the epithelial lining. Any sudden and loud noise, 
like the report of a cannon or a peal of thunder, would be 
likely to injure the cochlear structures, were not some pro- 
vision made in the labyrinth for emergencies of this kind. 
As we have shown, the semicircular canals are not only ad- 
mirably fitted to serve in the capacity of safety-valves, but 
their entire mode of construction, especially the absence of 
all nervous structures, would seem to exclude them from any 
higher office in the mechanism of hearing.” 
We presume that by the term semicircular canal Dr. Buck 
alludes to that portion of the canals above the usually in- 
cluded ampullae; otherwise, his statement, that there is "an 
absence of all nervous structures” in these canals, would not 
be strictly correct. Granted, that the function of the major 
portion of each semicircular canal is to act as a safety-valve 
in cases of undue pressure upon the labyrinthine fluid, it 
seems that such function must be just as advantageous to the 
proximal nervous structures in the ampullae as to those in the 
more remote cochlea. Possibly more so, if the nerves of 
the ampullae are intended to receive the impressions pro- 
duced in the air by the long, powerful waves of ordinary 
noises. 
Furthermore, if the theories of Flourens and Goeltz, and 
latterly of Brener and Mach, that the function of the semi- 
circular canals, i.e. of their nervous contents, is to preside 
over the sense of equilibrium, be correct, a safety-valve may 
be all the more necessary in connection with the important 
nerves at their mouth. 
Dr. Victor Urbantschitsch has pointed.,out the physiologi- 
cal nature of certain membranous and cord-like adhesions in 22 
BURNETT AND BLAKE. 
the cavity of the tympanum, which have heretofore been con- 
sidered pathological. As the author states, Prof. Politzer 
was the first to express the opinion that such might be the 
case, and our author has verified this opinion by a series of 
careful and copious investigations on the cadaver of embryos, 
new-born children, and adults. 
This writer has frequently found in the new-born child, 
membranous and cord-like connections between the inner 
side of the vertical shaft of the incus and the inner wall of 
the tympanum. This has been considered pathological by 
Toynbee and other authors ; but Urbantschitsch has shown 
that these formations are remnants of an embryonic fold, 
running from the vertical ramus of the incus to the inner 
wall of the tympanum, enclosing entirely the stapes. This 
was seen eight times in embryos, fifty times in the new-born 
child, and sixteen times in fifty examinations of the tympanic 
cavity in the adult. 
There is also an embryonal stapedial fold which sometimes 
leaves as residue small membranes or cords passing from the 
head and shafts of the stapes. But the writer docs not 
assert that all of the connecting bands or membranes which 
he has described are always of a physiological nature; 
he believes that their occurrence, without any morbid 
changes in the tympanic cavity, would not justify the conclu- 
sion that pathological process preceded their formation. 
Similar connections between the posterior, anterior, and 
exterior surface of the vertical ramus of the incus with the 
structures of the tympanum are shown to be normal. The 
first point agrees with the investigations of Lincke; the 
second point agrees with the statement of v. Troeltsch. 
The horizontal ramus of the incus may be joined to the 
external wall of the tympanum, and with the mastoid cells, 
by similar membranous connection. The union with the 
outer wall has already been shown by Zaufal to be a normal 
one. This was found by Urbantschitsch in 80 per cent of all 
the adults examined. 
The membrane so frequently found between the tendon of RETORT ON THE TROGKESS OF OTOLOGY. 
23 
the tensor tympani and the antero-superior wall of the tym- 
panum, as described by Prussak, Gruber, and Zaufal, has been 
observed in adults by Urbantschitsch, sometimes as a per- 
fect membrane, and sometimes perforated in the middle or 
represented only by a few adhesive bands. 
Hy rtl’s discovery that osteophytes are regularly found in 
the tympanum of many of the mammals, is carried still fur- 
ther by our author, who shows that there is in the tympanum 
of man a scries of membranous bands containing structures 
similar to osteophytes which are of a physiological nature. 
They were found in one third of all the adult tympana 
examined. 
Hyrtl says that these osteophytes are formed in the tym- 
pana of animals during the early years of life ; our author 
has found them in the tympanum of the new-born child 
sixteen times in fifty examinations. 
These are usually found on the eminentia pyramidalis. 
They may also be found on the posterior-exterior wall of the 
tympanum, and on the border of the round window. 
They are usually in connection with a membranous or 
cord-like structure. Meckel has described a bony bridge 
between the eminentia pyramidalis and the oval window. 
In one case, among fifty examined, Urbantschitsch found a 
bony growth from the eminentia py ramidalis to the inner wall 
of the tympanum. 
The posterior wall of the tympanum often contains a bony 
formation resembling a lamella. "This forms, either alone 
or in combination with membranes, a partition which divides 
the posterior portion of the tympanic cavity into a superior, 
larger space, and an inferior, smaller one.” 
Dr. Kiipper has related a curious case of clonic spasm ot 
the muscles of deglutition accompanied by a peculiar objec- 
tive noise in both ears. The friends of the patient could 
easily hear this noise, which occurred as frequently as one 
hundred and forty times in a minute, and closely resembled 
the snapping of the finger-nails. The noise would sometimes 
cease on one side, continuing on the other, and the noise in 24 
BURNETT AND BLAKE. 
at least one ear continued during sleep. The spasms of the 
muscles of deglutition continued without any remission. The 
hearing was not affected, the Eustachian tubes were pervious 
to the air-douche, but the mucous membrane of the nose and 
pharynx was greatly congested. 
The membrana tympani is said to have shown no alteration 
in its curvature or position during the occurrence of the 
peculiar noises. 
Mach and Kessel have performed experiments upon the 
" accommodation of the ear,” the chief point in their investi- 
gations being a determination of the question " whether a 
traction upon the muscles of the tympanum will produce an 
alteration in the consonance of the auditory apparatus, for 
notes of various pitches.” 
The experiments performed were of two kinds : first, upon 
the cadaver, and second, upon the normal ear of living men. 
The authors say : " Our results are in unison with those of 
former investigators. All observers agree that contraction 
of the tensor tympani, whether produced artificially or by 
natural causes, will render high notes more audible than the 
low ones.” The experiments of Politzer show this. The ex- 
periments of Schrapinger are also in harmony with those of 
Mach and Kessel; for when S. shows that the voluntary con- 
traction of the tensor tympani will render all tones less 
intense, ho likewise admits that the prominence of the 
over-tones is only relative, since they are less affected by this 
contraction of the tensor than the lower ones. 
Kcssel’s investigations concerning the influence of the 
muscles in the tympanum upon the movements and vibrations 
of the membrana tympani, in the cadaver, are divided into 
the following heads : — 
I. The action of the muscles of the tympanum produced 
by traction upon them. 
II. The stroboscopic movements of vibrating membrame 
tympani during a note of constant pitch. 
III. The stroboscopic motions of the membrana tympani, 
vibrating with a fundamental note and its octave. liEPOKT OX TIIE PROGRESS OF OTOLOGY. 
25 
In the first part of this paper the author divides the mem- 
brana tympani into various sectors and segments, as follows : 
1. Into two grand divisions, the upper and the lower, 
the dividing line being the one made by the two folds of the 
membrane. The upper division, i. e. above the line of the 
"folds,” is subdivided into three sectors, while the lower di- 
vision is subdivided into two segments. The three sectors of 
the upper division lie as follows : one between the anterior 
fold and the anterior suspensory ligament of the malleus, 
naturally termed the anterior sector, the middle sector, lying 
between the suspensory ligaments of the malleus, and the 
posterior sector, lying between the posterior suspensory lig- 
ament and the posterior fold of the membrana tympani. 
In the inferior division of the membrana tympani the pos- 
terior segment lies behind the .malleus, while the anterior 
segment lies in front of the malleus. 
We are also informed that the radial fibres pass in two 
directions from the anterior suspensory ligament, increasing 
in their length. These pass upwards over the sectors and 
downwards from the anterior to the posterior segment of 
the membrana tympani. Hence we have in this case, two 
angular membranes connected with each other, and subdi- 
vided into unequal divisions. 
In the inferior division the radial fibres are drawn into a 
convexity towards the meatus by means of the circular fibres, 
and they are maintained by the same means, according to 
Helmholtz, in a condition of tension and prominence. 
At the umbo the circular fibres are not found, and Ivessel 
calls this point the free, central portion of the radial fibres. 
The circular fibres are also wanting in the upper division 
(which is flat, excepting at the middle sector, which is some- 
what concave) at the foramen of Rivini. 
By means of Sigle’s pneumatic speculum Ivessel has deter- 
mined the various degrees of tension in the different parts of 
the membrana tympani. He has found that the movements 
of the anterior and posterior segments of the membrana 
tympani are directly proportional to the length of the radial 26 
BURNETT AND BLAKE. 
fibres. In a positive pressure of air upon the membrane the 
manubrium of the malleus is enabled to revolve. 
In a case of similar atmospheric pressure, the middle sec- 
tor is seen to be more depressed than the other two. 
In a case of negative pressure the converse of this is true. 
During rarefaction of the air in the auditory meatus the ma- 
nubrium of the malleus moves not only outward and for- 
ward, but it moves so that the processus brevis is advanced 
upward and forward, and at the same time it makes a dis- 
tinct rotation accompanied by a marked tension of the pos- 
terior suspensory ligament. 
E. Mach and J. Kessel have performed a series of experi- 
ments upon the function of the cavum tympani and the 
Eustachian tube. Although their experiments were pub- 
lished in 1872, it is eminently proper to notice them here, 
for they are among important investigations which have 
not heretofore been brought directly before the Society. 
I'hc first proposition stated by these investigators is the 
following. I quote from, the Archiv. f. Ohrenh. N. F. B. 
II, pp. 116, 121 : " The waves of sound will produce the best 
effects upon the membrana tympani when it is unexposed on 
one side to the sound waves, i. e. when the Eustachian tube 
is closed.” 
On the other hand we must remember that a difference in 
the atmospheric pressure on both sides of the membrana tym- 
pani is a serious interference in the mobility of the mem- 
brane. Therefore, the Eustachian tube must be opened now 
and then in order to restore the equilibrium in the pressure 
of the air on each side of the membrane, which may have 
been interfered with by various physical causes. 
The capacity of the tympanum must not sink below a 
certain limit, if variations in pressure of a certain amount 
are to produce vibrations of the membrana tympani of a cer- 
tain amount; for if the capacity of the tympanum is small, 
then very slight excursions of the membrana tympani will 
produce considerable expansive power of the enclosed air, 
which will operate against further increase in the vibrations. HEPOIIT ON THE PROGRESS OF OTOLOGY. 
27 
This is a very important circumstance in the consideration 
of the excursions produced by deep tones. In order that the 
latter may be received, the tympanum must have a certain 
depth and a generous capacity. Therefore the tympanum is 
in connection with the cavities of the mastoid process, and 
those of other portions of bone. A larger tympanum with 
perfectly regular outline and form would be impracticable 
from its great resonance. Therefore, the irregular, spongy, 
bony cavities, with which the ear is connected, appear of 
the greatest advantage. 
Therefore, three conditions are favorable to the production 
of the largest possible excursions of the meinbrana tympani, 
by the waves of sound. 
a. The Eustachian tube must be usually closed. 
b. It must also be opened occasionally for purposes of 
ventilation. 
c. The tympanum should be in connection with large, 
irregular cavities. 
The first experiment was instituted to discover whether 
the Eustachian tube is closed. This was accomplished by 
the observer’s placing himself in an air-tight box, in which 
the atmospheric pressure could be increased or diminished 
at will. 
The alterations of the pressure within the box produced a 
distinct inward and outward movement of the membrana 
tympani, which is claimed as a proof that the Eustachian 
tube is usually closed. 
The greatest differences in pressure which could be pro- 
duced in the aforesaid box seemed to prove that, in the case 
of one of the observers, the tube was pervious ; for the mem- 
branse tympani always gradually returned to their normal 
position, notwithstanding the continuation of any alteration 
in the pressure, and without any voluntary act on the part 
of the observer. 
During these experiments other very interesting observa- 
tions were made concerning the effect of augmented tension 
of the membrana tympani. 28 
BURNETT AND BLAKE. 
It was observed that during the increased tension of the 
raerabrana, deep notes, produced by organ-pipes, outside or 
the air chamber, or by the interruption tuning-fork, placed 
upon the air-chamber, disappeared or grew fainter in com- 
parison to the higher notes. 
In one instance the fundamental note was weakened, and 
the over-tones became very prominent. 
Of course, the act of swallowing, during these experiments, 
would open the Eustachian tube and equalize the pressure on 
either side of the membrana tympani. 
The third portion of the paper treats of the benefits of the 
closed Eustachian tube upon the amplification of the vibra- 
tions of the membrana tympani. Experiments showed that, 
if sound is conducted to the tympanum by means of the au- 
ditory meatus and the Eustachian tube at the same moment, 
the ossicles remain quiet; but if the sound-waves are sud- 
denly cut off from the Eustachian tube, vibrations in the 
ossicles are instantly produced by the sounds conducted to 
them through the external auditory meatus. The unilateral 
conduction of sound appears to be, in general, necessary 
where vibrations of sound in an unlimited medium are 
expected to produce a stronger or amplified effect. Such, 
apparently, is the function of the natatory bladder of the 
fish, which, probably, represents the tympanic cavities. The 
communication of the air of the tympanum with that of the 
mastoid cells was demonstrated by means of an experiment 
devised by Kessel. The external surface of the mastoid 
process is bored through, and a T-shaped tube is placed in 
the hole thus formed. One of the arms of the T-shaped 
tube is drawn out into a point. Through the other arm 
ordinary burning gas is conducted, and lighted at the afore- 
said pointed arm. 
If, now, the membrana tympani be perforated, and the 
Eustachian tube closed, a gentle note from the organ-pipe, 
conducted into the meatus externus, will extinguish the 
flame. This latter fact shows that not only the vibrations 
are conducted to the mastoid cells, but that the latter are in REPORT ON TIIE PROGRESS OF OTOLOGY. 
29 
perfect communication with each other and the tympanum. 
If the membraua tympani lay too near the closed end of a 
tube, the other end of which is open, the relation would he 
similar to that of a membrane at the closed end of an organ- 
pipe, which shows no perceptible excursions. The latter 
will not appear until the membrane assumes a position at the 
open end of the pipe. It is manifest, therefore, that the 
considerable space behind the membrana tympani, viz. the 
cavum tympani, and the cavities connected with it, are of 
the greatest importance. 
Rudinger’s endeavor to show that the Eustachian tube is 
always open by means of a capillary cleft in the superior part 
of the tube (the so-called " Sicherheitsrohre,” or safety 
tube) is regarded with a certain amount of doubt by Mach 
and Kessel. It is regarded by them as a capillary tube 
tilled with the secretion from the tympanum, and not as a 
conveyer of air. Since the air in the faucial extremity of 
the tube is alternately rarefied and condensed by the acts of 
respiration, the column of fluid contained in the aforesaid 
capillary tube (Sicherheitsrohre) will necessarily move in- 
ward and outward, causing similar motions on the part of 
the membrana tympani. These motions have been supposed 
by Lucae and Schwartze to be caused by the direct aerial 
communication between the tympanum and the fauces, i. e. by 
the opening of the Eustachian tube at each respiratory act. 
The majority of physicians suppose that the Eustachian 
tube is usually closed, being opened only at the act of swal- 
lowing, a view which is supported by Politzer. 
The " Mechanism of Opening and Closing,the Eustachian 
Tube,” by C. J. F. Yule, is thus reviewed by Win. Sterling, 
M. b., in the "London Medical Record,” Feb. 18, 1874: 
"The author had a catheter passed into his Eustachian tube 
in order to compare the sensations felt in the normal ear 
with those in the catheterized one. lie found that the 
sounds produced in the larynx were rendered very much 
louder. That the Eustachian tube opens during the act of 
swallowing is well known. The mechanism of the opening 30 
BURNETT AND BLAKE. 
of the Eustachian tube, when not complicated by swallow- 
ing, the author, experimenting upon himself, finds to be the 
following: — 
" First, During the contraction for opening the tube, the 
velum palati does not change either its position or its shape ; 
in fact, it remains unmoved, and further, it does not become 
tense, but hangs as soft and flaccid to the touch as at ordi- 
nary times of rest. (The tensor and levator palati muscles 
do not, therefore, participate in the opening of the tube.) 
" /Second, The only parts which do move are the posterior 
pillars of the pharynx ; they both move inward simultane- 
ously towards the middle line, moving from their old posi- 
tion from one half to three quarters of an inch. The action 
is steady and not spasmodic, and can be sustained for some 
considerable time at will. (The muscles most evidently 
concerned are the palato-pharyngei.) The sound which ac- 
companies the opening of the tube is sharp and crackling, 
and is referred to some part of the tympanum, or, perhaps, 
the membrane itself. It can be easily imitated on the sheep. 
Then follows an anatomical description of the muscles in- 
volved. 
II. 
PATHOLOGY AND THERAPEUTICS. 
Dr. Phillimore, in a scries of remarks upon the occur 
rence of hsematoma, observes that he has never found this 
disease unaccompanied by disease of the brain or its mem- 
branes, and furthermore, with regard to its location in 
the auricle, that in none of the cases under his observa- 
tion has the tumor included the posterior surface of the 
pinna or the lobule. The note from which the above is 
taken appears in the "British Medical Journal ” of April, 
1874, and is called forth by a paper by Mr. Cobbold, which 
was published in the same journal in October, 1873, in 
which the author determined the presence of ossification 
and a series of Haversian canals in an ear examined by him REPORT ON TIIE PROGRESS OF OTOLOGY. 
31 
and affording the material for his paper. The observa- 
tions of Mr. Cobbold in this respect are of interest as con- 
firming those made by Mr. Toynbee as early as 1860, and 
reported in that year to the Pathological Society, substan- 
tially as follows : "The right ear was so very much thick- 
ened as to have lost its normal appearance, the only por- 
tions of cartilage which were not greatly thickened being the 
tragus and the thin narrow slip at the posterior portion 
forming the helix. Upon making a section of the cartilage 
it was found in some places half an inch in thickness, but 
not harder than natural. This thick portion of the cartilage 
presented no appearance of a cyst, and under the microscope 
was observed to consist of hypertrophied cartilage cells and 
intercellular matter. In some parts it was converted into 
true bone containing Haversian canals and well defined 
cells. This ossific matter was also found in the left ear, which 
was scarcely at all deformed, and had not passed through the 
cystic stage of the disease. 
Dr. Harlan reports a case of malignant disease of the ear 
in the form of a round-celled sarcoma occurring in a girl 
three years of age. Two months before examination a bloody 
discharge was observed from the left ear, followed by pain 
on swallowing, and swelling about the car, the face being 
drawn to the right. The appetite gradually failed from the 
time of the first appearance of discharge, and the child be- 
came feeble. 
On examination the auditory canal was found to be closed 
by a firm globular polypus, with a fluctuating swelling below' 
and behind the auricle. The removal of the polypus and a 
free incision behind the ear gave a discharge of sanious pus, 
but no dead bone could be detected ; the left side of the face 
was much swollen, and the mouth drawn to the right on cry- 
ing. The left half of the tongue was much swollen, and 
rough as contrasted with the right, which was normal. 
The left eye was never closed, even in sleep ; there was no 
congestion of the conjunctiva ; the pupil vras movable and 
the cornea clear and bright. The polypus was twice removed 32 
BURNETT AND BLAKE. 
subsequently, and the discharge from the swelling behind the 
ear continued. Twenty-eight days after the first examina- 
tion this tumor was of the size of a hen’s egg, lobulatcd, and 
having a bright red granular surface. 
The upper lid of the left eye covered the eye almost en- 
tirely ; the conjunctiva was congested ; the whole cornea was 
hazy and its lower fourth infiltrated ; there was also free 
sanious discharge from the right nostril. Seventeen days 
later there was a penetrating ulcer of the cornea with pro- 
trusion of the iris ; the breathing through the mouth and right 
nostril had become laborious ; and at the end of a week the 
patient died, apparently from exhaustion. There had been 
in addition to the other symptoms double convergent strabis- 
mus, which, however, diminished as the disease progressed, 
and had nearly disappeared on the twenty-sixth day after its 
appearance. After death, on removing the tumor behind the 
ear, the bone at its base was found roughened and eroded. 
The train of nervous symptoms in this case of Dr. Harlan’s, 
taken in connection with the results of the autopsy, give it a 
special interest. Destruction of the inner tympanic wall 
and implication of the portio dura caused the earliest symp- 
tom. Paralysis of the sixth nerve increased the convergent 
strabismus, which was corrected, and the ball rendered im- 
movable when the disease extended to the third nerve. The 
levator palpabrae was at the same time involved, and the eye, 
which had been widely opened, in consequence of paralysis 
of the orbicularis, was closed by the falling of the lid. In- 
flammation of the conjunctiva ami cornea presented a typical 
case of neuro-paralytic ophthalmia due to paralysis of the 
fifth or its optic branch. The destructive inflammation, it is in 
this connection worthy of note, did not commence until after 
the closure of the eye from ptosis. 
Prof. AVernher, of Giessen, reports at length a very rare 
and interesting case of pneumatocele cranii in a man twenty 
years of age. Four years previously, following an attack of 
forcible sneezing, a tmnor about the size of a pigeon’s egg 
appeared behind the right ear upon the upper portion of the REPORT ON THE PROGRESS OF OTOLOGY. 
33 
mastoid process. Slight pressure was sufficient to reduce the 
tumor, but it immediately returned when the pressure was 
removed, and seemed to till with each expiratory movement. 
It increased very slowly, and when about the size of the fist 
could be only partially reduced. The tumor continued to 
enlarge, and at the time of the patient’s admission to the 
Academic'Hospital the whole of the right side of the scalp 
presented an enormous swelling, extending from the fore- 
head over the temporal to about the centre of the ossipital 
bone, measuring in this direction 28-c.m., laterally it meas- 
ured 27-c.m., and extended from the upper portion of the 
right mastoid process to a point beyond the vertex. The 
base of the tumor was broad, and its upper surface divided 
into three rounded prominences, at the thickest portion of 
the tumor the scalp being raised from the bone for a distance 
of from V," to 2". 
The tumor was entirely painless and could be compressed 
by the finger, and the underlying bone plainly felt; on percus- 
sion it gave tympanic resonance ; the movability and resonance 
of the tumor showed plainly that it must contain atmospheric 
air, as the duration of the tumor precluded the idea of spon- 
taneously generated gas ; auscultation, furthermore, gave a free 
blowing sound, but no emphysematous crackle. On Valsal- 
vian inflation, the tumor slowly expanded and became more 
tense. The size of the tumor could be somewhat diminished 
by tight bandages, but always returned to its former size. 
The outer and middle ears were nearly normal, and the hear- 
ing not very much diminished. 
The treatment consisted in the continued application of 
an elastic bandage, which so far diminished the tumor that 
a further examination of the underlying bone could be made, 
and this examination revealed an opening in the superior por- 
tion of the mastoid through which air made its way from the 
middle ear. The first active treatment was directed to the 
closure of this opening, which was done by including by press 
ure this portion of the tumor and injecting iodine. Other 
portions were subsequently treated in the same way, and 34 
BUENETT AND BLAKE. 
twenty-five days later the patient was discharged with the 
tumor entirely gone and the integument everywhere in close 
contact with the cranium. Very little pain or irritation fol- 
lowed the use of the iodine. 
Zaufal publishes an extended report of thirteen cases of 
traumatic injury of the membrana tympani, the paper being 
characterized by the careful analysis of the causes and symp- 
toms in each case, with the conclusions to be drawn there- 
from. These may be best cited in part in the author’s own 
words : — 
The injuries of the membrana tympani result either from 
the action of direct or indirect force : the former are induced 
by direct contact of the substance causing the injury with 
the membrana tympani; the latter are induced by the rare- 
faction or condensation of the body of air on either side of 
the membrana tympani, or by the communication of shock 
transmitted through the bones of the head. The results of 
direct injury are excoriations of the outer or inner coats of 
the membrana tympani, or a solution of continuity of all the 
coats, as in rupture of the drum-head ; and the results of in- 
direct injury are found also in the consequent inflammation 
of the membrana tympani, extravasation of blood upon the 
surface or within the inner coats, and subsequent rupture. 
The location, size, and form of the injuries resulting from 
direct force are dependent upon the character of the instru- 
ment, the curvature of the membrana tympani, and its incli- 
nation to the walls of the auditory canal. Excoriations are 
found most frequently upon the posterior and inferior por- 
tions of the membrane and directed forward and inward. 
The majority of the ruptures resulting from direct force 
are found in the anterior half of the membrana tympani; 
this was the case in six out of seven, and Shaw * found the 
same in each of three cases reported by him and Gruber, 
once in two cases mentioned in his " Lehrbuch der Ohrenheil- 
kunde ” Sharp-pointed instruments thrust quickly into the 
* Shaw. Boston Med. and Surg. Journal, Nov. 18G8. RETORT ON TIIE PROGRESS OF OTOLOGY. 
35 
ear may either cause a small perforation or an extensive rup- 
ture of the drum-head; but the latter form of injury is more 
common where the instrument is blunt. In size the rupture 
may vary considerably, and where the opening is a large one, 
it not uncommonly becomes bridged over by new growth, 
leaving several smaller openings. 
Injuries of the membrana tympani by indirect force are 
most commonly caused by excessive positive and negative 
variations in the atmospheric pressure. Commotio membra- 
ne tympani with consecutive meningitis is very difficult of 
diagnosis where there are no immediate signs of violence. 
Ecchymoses may occur only secondarily ; or where they 
occur as an immediate result of the injury, may come from 
the bursting of a superficial or interlamellar blood-vessel, 
with corresponding differences in appearance, and in subse- 
quent effect upon the condition of the membrane ; the former 
dry, and are removed by natural processes with the dermoid 
coat, often leaving, however, an excoriation which persists for 
some time. 
Free extravasation of blood is found mostly upon the mu- 
cous coat, showing a bright red color through the membrane 
under good illumination, and varying in outline according to 
their position. 
Interlamellar blood extravasations are generally flattened, 
but s nnetimes appear as a minute point, or as a line follow- 
ing the distribution of the fibres of one or the other layer of 
the membrana propria. 
The location of ruptures of the membrana tympani result- 
ing from indirect force is determined by the locus minoris 
resistentife; cicatrices, partial atrophy, and other pathologi- 
cal changes which invalidate the elasticity and resistance of 
the membrane often locate the rupture, and in but one of 
Zaufal’s cases could no predisposing pathological change be 
discovered. 
The left membrana tympani was the more commonly rup- 
tured, corresponding more conveniently to the aggressive 
right hand which inflicted the injury. When the right 36 
BURNETT AND BLAKE. 
membrana tympani was ruptured, the aggressor either stood 
behind his victim, or was left-handed. In a series of exper- 
iments on the cadaver, where the air in the auditory canal 
was compressed by means of a rubber bag, the normal mem- 
brana tympani was rarely ruptured, but frequently so where 
the membrane had been affected by previous disease. 
The ruptures found after death by hanging, and described 
by Wilde, Ogston, and Littre, may also be included under 
the heading of injury from indirect force, because, according 
to Ecker’s observations in these cases, the soft palate and 
tongue are driven so far backward and upward into the naso- 
pharyngeal space as to nearly till it, producing an intra-tym- 
panic pressure commensurate with the weight of the body. 
The length of the fall, the suddenness of the shock with 
which the noose closes around the throat, would be sufficient 
to produce extensive rupture. This may explain the rarity 
of rupture of the membrana tympani in cases of suicide by 
hanging, as in many of the latter cases the victim dies by 
strangulation, and not, as in judicial hanging, from the appli- 
cation of sudden force. 
The form of the rupture varies, being either a narrow slit 
or a gaping opening; according to both Politzer and Zaufal, 
the latter is the more frequent form. Contrary to the gen- 
erally received opinion, the amount of heemorrhage is very 
small; where it is at all excessive, it is usually the result of 
accompanying injury of the tympanic mucous membrane, or, 
as Zaufal found in a case of fracture of the skull from a fall 
upon the head, from the rupture of large veins and arteries 
of the dura mater, the art. meningea media especially con- 
tributing to profuse arterial lnemorrhage from the ear. In 
regard to the cicatrization of the large openings, Zaufal is 
unable to confirm Pulitzer’s observation of the projection of 
a cicatricial membrane from the mucous coat of the mem- 
brana tympani, and is inclined to the belief that the closure 
of the opening occurred from without. In this connection 
may be mentioned the observations of Gruber,* to which 
* Lehrbuch der Ohrenheilkunde, p. 365. REPORT ON THE PROGRESS OF OTOLOGY. 
37 
Z:iuf;il does not refer, in which the cicatrix is formed by 
growth of both the mucous and dermoid coats, a microscopic 
examination of the cicatrix, while showing an equal repro- 
duction of these two coats, giving evidence of the absence 
of anything resembling a fibrous structure. 
A rupture of the membrana tympani is in and for itself a 
slight injury, and may become a serious matter only through 
the occurrence of such complications as a suppurative inflam- 
mation of the middle ear or an injury to the labyrinth ; and 
it should be borne in mind that the former complication fol- 
lowing a rupture of the membrana tympani from indirect 
force is almost always the result of an unfavorable condition 
of the patient or improper treatment on the part of the sur- 
geon. 
Trautmann also reports a case of rupture of the left mem- 
brana tympani resulting from a fall from a horse, the patient 
striking upon his head upon the pavement, being taken up 
senseless with profuse haemorrhage from the nose and left ear 
and dying in a few minutes. An examination with the aural 
speculum showed the posterior-inferior portion of the mem- 
brana tympani pressed outward and of a dark reddish color, 
and posteriorly to the malleus, beginning at the lower end of 
the manubrium and extending upward and backward, a fis- 
sure about 2£ ram. long, through which oozed a bloody 
serum. The right membrana tympani was normal. In 
default of a further examination, which was not permitted, 
Trautmann concluded that a fracture of the base of the skull 
had occurred, with division of the internal carotid, the blood 
escaping through the rupture in the membrana tympani ; in 
this connection the reader is referred to the observations of 
Lc Bail already cited. Another rupture of the membrana 
tympani, reported by the same author, occurred in a young 
man who shot himself in the mouth, with the so-called water 
bullet, water being substituted for the ordinary missile. 
Aside from the injury observed in the membrana tympani, 
the post-mortem examination gave evidence of the destruc- 
tiveness of the means employed to destroy life. The left 38 
BURNETT AND BLAKE. 
temporal bone was so entirely fractured that only a portion 
of the upper wall of the external meatus remained attached 
to the squamous portion ; the remainder of the bone was dis- 
tributed in splinters throughout the brain substance. The 
right temporal bone presented the following appearance : the 
tegmen tympani with the entire labyrinth wall were blown 
away, giving a clear view of the membrana tympani; the 
malleus and incus were in position, the stapes destroyed, 
with exception of the head and a portion of the posterior 
crus, with the museulus stapedius ; the articulation with the 
incus remained, and in the membrana tympani a rupture ex- 
tended from the lower end of the manubrium mallei upward 
to the periphery, A mm. in width at its lower and 2 mm. in 
width at its upper end. 
In the floor of the osseus meatus, close to the membrana 
tympani, was a nearly circular opening about the size of a 
Pea- 
Dr. Chimani makes an addition to the list of diseases of 
the external ear under the title " Aneurysma Cirsoideum of the 
Auricle and Meatus.” Shortly after the birth of the patient, 
who was a strong, healthy boy, his mother noticed a small 
swelling, about 2 c.m. in diameter, in front of the left ear; 
it was soft and of a reddish-blue color. At five years of 
age the tumor had become as large as a walnut, and from that 
time until his fourteenth year increased rapidly in size, press- 
ure and external application of astringents were of no effect, 
and at fifteen years of age the patient was brought to the 
Josephenum clinic for treatment. The tumor included the 
greater portion of the left half,of the scalp, was soft, elastic, 
and slightly fluctuating, painless, pulsated distinctly, and 
could be diminished in size by pressure. 
The integument covering it was of a bright red color and 
of a higher temperature than adjacent parts. The diagnosis 
was aneurysma cirsoideum of the Art. temporalis, occipitalis 
and posterior branch of the Art. auricularis posterior. 
Long-continued pressure and application of astringents 
having proved ineffectual, repeated injections of iron chlo- REPORT ON THE PROGRESS OF OTOLOGY. 
39 
ride, some twenty in number, were made, and within a year 
the swelling had so far disappeared that the patient was dis- 
charged as cured. A short time thereafter, however, the 
temperature of the left auricle increased ; it became some- 
what swollen and pulsated slightly at various points. This 
continued until, four years later, the swelling on the posterior 
portion of the auricle and the subjective symptoms had so 
far increased that the patient again applied for relief. For 
his age, nineteen years, he was well and strongly developed, 
and with exception of the local trouble, in excellent health. 
The left auricle was nearly double the size of the right, of a 
pale red color, with exception of the more prominent por- 
tions, which were reddish-blue and dotted with small deep- 
red spots; the enlargement was principally an increase in 
thickness, the posterior surface especially being elevated 
above the cartilaginous base of the auricle. 
The walls of the meatus were swollen, of a pale red color, 
and marked by dots and lines of a deeper red. The tem- 
perature of both auricle and meatus was considerably above 
the normal degree. By means of a stethoscope, pulsation 
could be plainly heard, and the Art. auric, ant. cap., the Art. 
auric, ant. inf., and the Art. auric, post, were enlarged, tor- 
tuous, and forcibly pulsating. The subjective symptoms 
consisted of headache confined to the left side, diminution of 
hearing in the left ear, continuous tinnitus aurium, and a 
sensation of heat and pulsation in the ear. The use of iron 
chloride being decided upon, an injection was slowly made, 
by means of a Pravaz syringe, of twelve drops of the fluid, 
to which was added soda carbonate, the point chosen for the 
puncture being the swelling behind the auricle. Considera- 
ble pain accompanied and followed the injection, requiring 
subcutaneous administration of morphine for relief. 
The tumor became livid, and then of a deep-blue color. 
On the second day the pain ceased; on the fourth day a 
hard, black eschar had formed, which came away easily on 
the fifteenth day, leaving a deep furrow, the edges of which 
approximated and closed in a very short time. During the 40 
BURNETT AND BLAKE. 
following month two injections were made in the remaining 
portions of the tumor with like results, and the injection of 
one drop only of the fluid was then made in the meatus. 
This last application was followed by some inflammation of 
the lining membranes of the canal and the dermoid coat of 
the membrana tympani, but subsided under warm astringent 
instillations, phlebotomy being contra-indicated. The swell- 
ing on the upper portion of the canal was removed with the 
knife, and followed by polypoid granulations, very soft and 
bleeding easily; these were again removed and cauterized, 
and at the end of four months the patient discharged relieved 
of his subjective symptoms, and with considerable improve- 
ment of hearing. 
Dr. C. Bail publishes an interesting monograph on the 
semeiological value of traumatic otorrhagia, and the conclu- 
sions at which he arrives may be briefly stated as follows: — 
I. In injuries of the head the discharge of blood from 
the ear is by no means pathognomonic, and has absolutely 
no relative diagnostic value. 
II. This discharge is a symptom common to several lesions 
of the organ of hearing, which differ as to cause, and are 
more or less serious in character. 
These lesions are: a. Wounds of the external auditory canal, 
which generally accompany injuries to the face or lower jaw. 
The history of the case, the condition of the inferior maxil- 
lary articulation, and of the membrana tympani, and the integ- 
rity of the tympanic cavity, guide the surgeon in his diagnosis. 
b. Injuries of the membrana tympani and mucous mem- 
brane of the tympanic cavity, which are a common accom- 
paniment of injuries of the head, and are the result of either 
direct or indirect force. In these cases the progress of the 
symptoms enables the surgeon to decide as to whether he 
has to deal with a fracture, or with a simple injury of the 
middle ear. 
c. Fractures of the petrous bone, which are accompanied 
ordinarily by a discharge of blood from the ear. A discharge 
which is in itself not pathognomonic, but which may present REPORT OX TIIE PROGRESS OF OTOLOGY. 
41 
peculiar conditions as to duration, intermittence, and repeti- 
tion which in themselves arc of great diagnostic importance. 
Dr. II D. Noyes reports a case of cerebral trouble follow- 
ing otitis media in a man ait. forty-five, who received an in- 
jury upon the side of the head three weeks before his admis- 
sion to hospital, and complained of severe pain in the ear. 
After admission he had otitis media which soon spread to 
the mastoid cells ; an opening was made into the mastoid fol- 
lowed by the discharge of pus. At the end of a month the 
patient was much improved, when brain symptoms set in, and 
he died after being comatose several days. On examination 
an abscess was found in the left middle lobe, which on being 
opened gave exit to a considerable quantity of thick greenish 
pus ; throughout the whole left hemisphere at its base was 
marked pachymeningitis and a small, oblong, yellowish white 
growth attached to the dura mater over the outer part of the 
petrous portion of the temporal bone. Over this region the 
membrane was loosened from the bone. Section of the brain 
showed pus breaking into the lateral ventricles destroying the 
septum lucidum, and entering the lateral ventricle of the right 
side. The primary abscess was situated beneath the outer and 
posterior border of the left thalamus opticus. The brain sub- 
stance was everywhere pale and flabby, and at many points 
almost diffluent. There was also extensive caries of the 
inner portion of the petrous bone, and the outer surface of 
its inner half was irregular with several small perforations. 
In a lecture delivered at St. George’s Hospital, Mr. Dalby 
presented the case of a boy ten years of age, who was ad- 
mitted to the hospital suffering from a discharge from the 
left ear. lie had been supposed to have been suffering from 
ague, and was admitted to the hospital on that account. 
Three months before, in ordinarily good health, in conse- 
quence of a severe cold, he became deaf in the left ear. He 
continued pretty well, with exception of the deafness, until 
two weeks before admission, when he had an attack of pain 
in the left ear, lasting for two or three days and followed by 
discharge, and relief from the pain. Three days later he had 42 
BURNETT AND BLAKE. 
a shivering fit, and this was repeated each day for a week. 
Shortly after the first shivering the pain in the ear returned 
and soon involved the side of the head. On examination 
there was purulent discharge from the left ear with almost 
entire destruction of the membrana tympani. There was 
much pain, especially in the region of the ear; extreme ten- 
derness on deep pressure over the mastoid ; some redness but 
no swelling, and no tenderness in the course of the carotid 
sheath. Pulse 128, temperature 99.8, tongue brown and dry. 
Had had little or no sleep, and lay moaning, with his hand to 
his head, and every appearance of blood poisoning. There 
was an occasional dry cough, but no abnormal sounds in the 
chest except harsh respiration and increased voice sounds at 
the apex of the right lung. On the following day the pain in 
the head was so severe and the tenderness over the mastoid 
so much increased that, notwithstanding the absence of other 
local signs, an incision was made half an inch behind the ear. 
The periosteum and bone beneath were healthy. A small 
opening was then made through the bone, and a probe passed 
freely into the mastoid cells. No discharge of pus occurred 
at this time, or subsequently. On the day following the 
pain was less, but the general condition remained unchanged. 
There was more shivering and an occasional cough ; signs of 
fluid in the right pleura developed, and the boy died sixteen 
days later. On examination, the anterior two thirds of the 
r. pleura were filled with pus containing flakes of lymph ; 
in the lower lobes of the right lung were several abscesses 
with ragged walls tilled with foul pus. The surface of the 
brain was somewhat congested, but otherwise healthy ; there 
was no thrombus of the lateral sinus. Between the roof of the 
left tympanum and the dura mater was a small quantity of 
tough lymph. The membrana tympani was gone ; the tym- 
panic cavity filled with thick pus ; the ossicles necrosed and 
lying loose. The roof of the tympanum was carious on either 
surface, and the roughness on the cranial surface extended 
back to the sulcus for the lateral sinus, — the symptoms and 
the subsequent examination plainly pointing to pyaemia, the REPORT ON THE PROGRESS OF OTOLOGY. 
43 
starting-point for which was a suppurating surface in the 
tympanic cavity. 
Meniere is of the opinion that in all cases of otorrhcea 
great attention must he paid to the constitution, so that 
scrofula, syphilis, or other constitutional disease should be 
treated by appropriate general measures In this lies an 
essential element of success in all instances. Cleanliness is 
a capital point, and nothing is hotter for this purpose than 
pure warm water injected with moderate force. In the 
early stage, when pain is present, Dr. M. suggests the use 
of a warm decoction of marsh mallow and poppy heads, and 
the application of leeches, and sometimes the application of a 
poultice. Later in the disease the usual astringents are 
employed. M. Giampietre recommends in case of pain in 
such cases the instillation of a fluid containing one sixth err. 
© © 
of aconitia to the ounce. 
J. Patterson CasseIs contributes a paper "On a Form of 
Disease of the Middle Ear in which the use of Alcohol is 
especially serviceable.” 
To Dr. Ldwenberg, of Paris, belongs the merit of having 
first recommended the use of alcohol as a local application in 
certain diseases of the tympanic cavity.* From an ex- 
perience of two years in the use of this remedy in catarrhal 
and inflammatory affections of the tymp., Dr. Cassells is in- 
clined to confirm all that Dr. Ldwenberg has claimed, but 
especially in the more advanced stages of simple catarrh when 
there is a lesion of the membrana tvmpani. This affection, 
according to the author, consists in a hyper-secretion by the 
lining membrane of the tymp. cavity unduly stimulated to 
increased action through causes that determine an over-abun- 
dant flow of blood to it. Under favorable conditions this 
condition terminates in resolution, but the hyperamna con- 
tinuing, the discharge becomes more abundant, and finally, 
bursting through the membrana tympani, makes its appear- 
ance as a catarrhal otorrhcea. At this stage the mucous mem- 
* El. Pubellon Medico, Madrid, 1870. 44 
BURNETT AND BLAKE. 
brane of the tympanum is highly congested, and also hyper- 
trophied and villous. To this condition Dr. C. gives the 
name polypous hypertrophy as best describing its appear- 
ance, and it is in this condition in which he has found the 
use of alcohol almost specific. The use of silver, as 
recommended by Schwartze, he considers as better adapted 
to more chronic cases. 
Bezold contributes a comprehensive review of the various 
investigations on the subject of parasitic growths in the hu- 
man ear; as necessary causes of these accumulations, there 
must be the introduction of the spores of the plants either 
directly from the air, or by means of the instillation of some 
medicament or introduction of some foreign body carrying 
the spores upon it; and in addition, as a still more important 
factor, there must exist a condition of the parts of the meatus 
and membr. tymp. favorable to the growth of the plant. 
That this proper condition is a rare one, is proved by the 
small number of cases of Otomykosis as compared with the 
extensive distribution throughout the atmosphere of the 
spores of such plants as are occasionally found growing in 
the ear. 
Wreden * found that in fifty per cent of his cases the Oto- 
mykosis had been preceded by an exudative inflammation of 
the meatus or middle ear. Active discharge Wreden remarks 
is unfavorable to parasitic growth, a fact easily explainable 
on two grounds : firstly, that such soil is unfavorable to the 
development of the spores; and secondly, that they are 
washed away by the continued discharge. Schwartze f and 
Weber X both agree with the statements of Wrcdcn, but take 
a broader ground in considering any moist ceruminal or epi- 
dermal surface where the changes of decomposition have set 
in or occurred as affording favorable soil; and Mayer || pre- 
sents the question as to whether the mykosis may not follow 
* Myringomykosis aspergillina. St. Petersburg, 18G8. 
t Schwartze Arch. f. Ohrenheilkunde 11, p. 61. 
j Weber. Monatschr. f. Ohrenheilkunde 11, 1. 
Miillers Archiv. 1884, p. 404. REPORT ON TIIE PROGRESS OF OTOLOGY 
45 
fermentation and decomposition of the cerumen, or the ap- 
plication of fatty substances to the ear. 
Mayer has further proposed as a possible origin of ex- 
tended Otomykosis the occurrence of cysts containing para- 
sitic plants which served as the point of origin. 
In the ten cases which Bezold has observed since his pre- 
vious publication,* it was a noticeable point in the his- 
tory that in seven cases oil had been employed as an applica- 
tion to the ear either recently or at some time before the ap- 
pearance of the characteristic symptoms of the growth. In 
several of these cases oil was plainly discoverable at the time 
of the examination, and furthermore oil globules were found, 
on microscopic examination, not only enclosed in the meshes 
of the mycelium, but also within tlu delicate mycelial fibres. 
Wreden’s twenty-four cases occurred in a clientele of 1,600, 
while the ten cases of Bezold occurred in a clientele of only 
five hundred patients. This increased percentage Bezold 
considers as largely due to the recent popularity of oleagi- 
nous applications advertised as remedies for deafness. As 
the oil becomes rancid it affords an excellent soil for micro- 
scopic plants, as shown by Prof. Ilossling in his investigations 
upon articles of food, in which he found a series of growths 
in almond, olive, and salad oils. Boke, quoted by Bezold, 
lately reported two cases of Otomykosis, in both of which 
oil had previously been applied. In one case the patient had 
applied a popular remedy, a microscopic examination of 
which showed well-marked spores of the plant which finally 
attained its perfect growth in the ear. Concerning the ex- 
tension of the growth to the epidermis and the excitation of 
the well-known symptoms which mark the true parasitic dis- 
ease, Bezold agrees with other writers upon this subject who 
consider the initial stages as those of a saprophytous forma- 
tion (analogous to the parasitic growths described by Vir- 
chon and others in gangrene of the lung), as the plant first 
fastens itself upon the effete epidermis and secretion in the 
* Archlv. f. Ohreuhcilkuude Baud v. Ileft 111, p. K>7. 46 
BURNETT AND BLAKE. 
ear, and finally pushes its roots deeper into the true lining of 
the canal. 
This view is especially supported by observation of the 
progress of a case of Otomykosis in which the removal of the 
growth in the later stages of the disease leaves the surface 
beneath red, swollen, and often excoriated. The form of 
the plant in the majority of Bezold’s cases was well-marked 
aspergillus, and the treatment employed consisted in the care- 
ful and repeated removal of the growth, and the use of car- 
bolic acid as a parasiticide. As a review of the subject of 
Otomykosis, Dr. Bezold’s paper is very thorough, and with 
the especial [joint in view of considerable practical value. 
Wendt describes, as frequently found in his post-mortem 
examinations of the middle ear, a condition which he de- 
scribes as polypoid hypertrophy of the mucous membrane. 
This condition occurs as the accompaniment of a mucous 
catarrh, in the course of which a hypertrophic condition of 
the mucous membrane of the tympanum is developed, ac- 
companied by the formation of numberless polypoid growths 
of microscopic size, and the greatest variety of form, being 
of every shape, from a slight rounded elevation above the 
general surface, to a rounded body connected with the 
mucous membrane by a well-marked neck. The periosteal 
coat of the lining membrane was not, as a whole, hypertro- 
phied, but the sub-epithelial coat was swollen and more or 
less rich in lymphoid cells ; at some points cysts and cavities 
were discoverable, filled with fluid mucus. The polypoid 
prominences originated in the sub-epithelial coat. Wendt 
is of the opinion that these growths, when they do not sub- 
side spontaneously (several of those examined seemed to be 
undergoing that process), may increase until the whole cavity 
is filled, or, uniting in their growth, may give rise to the 
fibre and thread like growths which he describes in another 
article, being the case of a man in whom death resulted from 
miliary tubercle, and who had been exceedingly deaf for two 
months preceding his death. The examination showed that 
there had been a general inflammatory affection of the mid- REPORT ON TTTE PROGRESS OF OTOLOGY. 
47 
die ear, of long standing, resulting in partial destruction of 
the membrana tympani, and in the tympanic cavity general 
thickening of the mucous membrane especially about the 
fossa of the fenestra ovalis and upon the membrane of the 
fenestra rotunda; there was, furthermore, union between the 
tympanic walls, the membrana tympani, and ossicula by 
means of strong bands to such an extent that the upper por- 
tion of the cavity was almost entirely isolated from the 
lower; the ossicula were also united to each other and to 
the surrounding parts by firm bands. A microscopic exami- 
nation of the membrana tympani showed calcification in sev- 
eral places in the fibrous and dermoid coats and cellular 
infiltration of the mucous coat. The tympanic mucous mem- 
brane exhibited, in addition to more or less infiltration, sim- 
ple hypertrophy of the connective tissue, accompanied by 
cystic cavities, and also general calcification, including the 
covering of the membrane of the fenestra ovalis and ossicula. 
The same author presents an equally interesting observa- 
tion, which has its bearing especially in the support of his 
opinion that embolism in the mucous membrane of the tym- 
panic cavity may be the cause of sudden deafness. The case 
quoted was that of a girl who developed symptoms of pvse- 
mia after an operation, and live days before death became 
suddenly deaf in the right ear, and two days before death 
lost the hearing of the left ear also. 
A post-mortem examination showed that the labyrinth, 
auditory nerve, and internal auditory artery were in normal 
condition. There were some changes in the middle ear due 
to chronic trouble which would diminish the hearing some- 
what, but not in so great a degree as was noticeable during 
the few days preceding death. There were, however, recent 
changes in that portion of both tympanic cavities which is 
most important to the transmission of sound, including the 
fenestra ovalis and fenestra rotunda, which would serve to 
account for the later deafness. 
The epithelium was opaque and swollen, and discolored by 
the imbibition of the coloring matter of the blood, and eon- 48 
BURNETT AND BLAKE. 
taming numberless red blood-corpuscles. The stapes was 
buried in the swollen mucous membrane, which covered 
also the membrana tympana secondaria. The remaining 
mucous membrane was hypenemic and cedematous. Wendt 
considers embolism of a tympanic artery as the most rational 
explanation of these recent changes, a view which, even in 
default of the discovery of an embolus, is certainly sup- 
ported by the character of the change observed, especially 
in the region of the fenestra ovalis and fenestra rotunda. 
Dr. Frank, of Wurtemberg, supports the views advanced 
by Weber-Liel in his work on progressive deafness by the 
results of an operation for cleft palate, and especially with 
reference to the secondary catarrhal inflammation of the mid- 
dle ear, concavity of the membrana tympani, and contact of 
the tubal walls in consequence of relaxation of the tensor veli. 
The patient, a boy sixteen years of age, had a congenital 
fissure of the soft palate, and suffered frequently from sub- 
acute catarrh of the middle ear. The fissure was triangular 
in form, and extended forward to the hard palate. The 
right membrana tympani was nearly normal but concave 
and immovable. The left membrana tympani was still more 
concave and also immovable. The operation completed by 
Dr. Frank was successful not only in closing the fissure of 
the palate, but also, as a secondary result, in so far restoring 
the normal action of the palatal muscles as to free the Eusta- 
chian tube, as was shown by the consequent mobility of the 
membrana tympani, and an increase of the hearing from a 
few centimetres to a full metre. 
Voltoliui has had opportunity to confirm the results of his 
previous experiments on Emphysema, resulting from cathe- 
terization of the Eustachian tube, in which he referred the fatal 
cases of Turnbull to the occurrence of Emphysema glottidis. 
The patient was a stout, full-blooded woman of forty-four 
years of age, who had been deaf for several years and suf- 
fered from severe tinnitus aurium, for relief from which she 
came under treatment, which consisted in the use of Weber- 
Liel’s tympanic catheter with morphine solution. On one 49 
REPORT ON THE PROGRESS OF OTOLOGY. 
occasion considerable resistance was offered to the passage 
of the catheter on the left side, and it was therefore repeat- 
edly withdrawn and re-introduced, and finally followed by the 
air-douche, whereupon the left side of the face became sud- 
denly swollen, and an examination gave emphysematous 
crackling over the left side of the face and neck down to 
the clavicle and especially below and behind the left ear. 
Examination with rhinoscope and laryngoscope showed the 
following condition : The left velum was swollen from the 
uvula outward; the left tubal orifice was invisible on ac- 
count of the swelling of the mucous membrane of the lateral 
pharynx wall; the left sinus pyriformis was scarcely visible ; 
and the lateral glosso-epiglottic ligament much swollen ; there 
Avas also slight swelling of the left vocal chord. On the fol- 
lowing day the symptoms had not entirely disappeared, and 
the patient still complained of the sensation of pressure 
about the throat. 
Voltolini also reports a case of living larvae in the ear, in 
which considerable difficulty was experienced in their re- 
moval on account of the firm hold afforded by the mandibles 
of the larvae ; they were finally destroyed by instillation ot 
a strong solution of alum and then taken out with the 
forceps. 
Dr. Bing, in reviewing the location of perforations of the 
mombrana tympani, has been led to certain conclusions as 
to the causes of the frequency of perforation of the inferior 
and anterior segments. The Solution given by Toynbee, 
namely, the effect of pressure of air forced through the 
Eustachian tube as a predisposing cause of this peculiarity, 
is set aside by the author for a much more rational and satis- 
factory explanation of his own, which may be briefly stated 
as follows: Accumulation of secretion in the ear would 
exert pressure upon the mombrana tympani; the shape ot 
the tympanic cavity, narrowing towards its floor, and the 
angle of inclination of the membrana tympani, would bring 
the greatest pressure upon the inferior portion of the mem- 
brane, which, being extensible, would be pressed downward 50 
BURNETT AND BLAKE. 
in a horizontal direction, thus subjecting it to still greater 
pressure, which, as the membrana tympani is implicated in 
the inflammatory process, would place that portion under a 
condition more favorable to ulceration and final perforation. 
To the long list of attempts at maintaining an artificial 
perforation of the membrana tympani, is to be added that of 
Yoltolini, who replaces the eyelet of Politzer by a ring- 
shaped canula opened on two opposite sides, — on one side 
the ring being completely divided, and on the other con- 
nected by a slight bridge or band. Two incisions are made, 
one in front of and the other behind the malleus. The two 
open ends of the ring are then passed through the openings, 
and by pressing the two halves of the ring together, it is 
made to enclose the malleus and keep itself in place. The 
two inner ends of the ring do not completely appose, and 
the opening in the outer half of the ring permits the passage 
of the sound waves to the air within the tympanic cavity. 
Of the conditions which render this operation difficult of 
performance, and of the accidents which may occur in its 
execution, Yoltolini speaks at length in his two later papers 
upon the subject. In the last communication is the descrip- 
tion of the ease operated upon eight months after the 
operation, the canula being firmly in place, without sign of 
any unfavorable change in the malleus or membrana tjm- 
pani, and with considerable improvement in the hearing. 
Weber-Liel presented before the Berliner Medicinische 
Yerein in December last, a case of inflammation of the mastoid 
cavity, which is of especial interest, not only for the method of 
the operation undertaken for the relief of the patient, but also 
on account of the symptoms accompanying the course of the 
disease. The patient was a man 40 years of age, who had suf- 
fered from severe pain, especially at night, during six weeks. 
During the day the pain diminished, but was replaced by sen- 
sation of fulness in the right car, and vertigo. The whole 
region of the ear was tender; there was tinnitus aurium, a 
high grade of deafness, and a slight purulent discharge from 
the ear. The posterior wall of the right external auditory REPORT ON THE PROGRESS OF OTOLOGY. 
51 
canal was reddened, swollen, and very tender upon pressure; 
a small quantity of ill-odorcd pus oozed through a narrow 
slit. There was no pharyngeal catarrh, hut the walls of the 
tube appeared to have collapsed, as it was only possible to 
force air into the middle car by the use of the tympanic 
catheter, which gave a distinct perforation sound, and forced 
a quantity of their purulent fluid through the small opening 
in the meatus. It is evident that while there existed a per- 
foration of the membruna tympani, this opening was not of 
sufficient size to allow the passage of all the secretion accu- 
mulating in the middle car; the swelling of the meatus 
presented a further obstacle, and as a consequence, the 
inflammation had extended to the mastoid cells. No im- 
provement having been attained by ordinary treatment 
during a period of eight days, and the pain steadily increas- 
ing in severity, it was decided to perforate the mastoid ; and 
following a suggestion of Prof. Rtidinger, the point chosen 
for the incision was the posterior wall of the meatus, at 
the junction of the cartilaginous and osseous portions of the 
canal, at which point there was the greatest tenderness and 
swelling. A stout cartilage knife was employed, and easily 
pushed into the mastoid cavity, its withdrawal being fol- 
lowed by the liberation of a large quantity of most offensive 
pus, with great relief to the patient. The improvement, 
however, did not continue ; on the following night the pain 
was again severe and the purulent discharge had diminished. 
The perforation Avas tilled with a yellowish-white mass, the 
attempt to remove which with the forceps caused great pain ; 
those portions removed resembled the coats of the so-called 
cholesteatoma. This mass was Anally removed after patient 
bathing with soap-suds : syringing could not be borne on 
account of the resultant vertigo. With the continued dis- 
charge from the mastoid, the inflammatory symptoms 
gradually subsided, and during the day the patient was com- 
paratively comfortable, the pain and other subjective symp- 
toms having greatly diminished. At night, however, the 
pain increased, and continued until about 5 a. m. This con- 52 
BURNETT AND BLAKE. 
dition continued day after day, and a closer examination of 
the patient developed the fact that the advent of the pain in 
the evening was accompanied by a chill, and that the patient 
was subject to malarial fever. This, together with a further 
consideration of symptoms, led to the administration of 
quinine in 6 gr. doses at night, and the final cessation of 
the pain, and discharge of the patient. 
Dr. J. Orne Green, whose observations on mastoid inflam- 
mation, published at various times, are of great interest, 
makes a further contribution in the report of three cases, read 
before the Boston Society for Medical Observation. The 
cases themselves, and the remarks appended to the report, 
are of sufficient value to warrant their being given in full. 
I. —F. E., aged eight years, was seen on July 3d, 1871, 
at the request of Dr. E. II. Clarke, who was unable to visit 
her when first called. The patient, whose mother had died 
of phthisis, had been considered well, with the exception of 
slight occasional otorrhcea on each side, till some four weeks 
before, when she had an attack of intense inffanimation of 
the left ear, followed by high fever, great prostration, and 
violent chills, which had continued daily, with increasing 
severity, for seventeen days. Intermittent fever had been 
diagnosticated, and she had been on low diet, pilules and 
quinine, without relief. No attention had been paid to the 
ear, till a gradually increasing swelling over the mastoid 
forced that organ on the attention of the parents. 
At my visit, she was in bed, so weak that she could 
not move; extremely emaciated; moaning continually and 
screaming at the least noise or light; intelligence good; 
pulse 130, weak; skin hot and dry; tongue coated. Behind 
the left ear was a large, diffuse abscess ; the left meatus was 
filled with pus. Under ether, and with the assistance of Dr. 
Mann, who saw her then for the fir.-t time, an incision, two 
inches long, was made over the mastoid, and six ounces of 
thin and most offensive pus were evacuated. The whole 
bone was denuded for four inches towards the vertex and 
one inch behind the mastoid, but was not softened at any REPORT ON THE PROGRESS OF OTOLOGY. 
53 
spot. A cloth tent was inserted, and stimulants and narcotics 
ordered. Examination of the ears showed both drum-mem- 
branes completely destroyed, hut the tympana were free from 
granulations or caries, as far as could be ascertained by the 
probe. 
For the next week she improved slowly; the chills re- 
curred but once, although there were several times a day 
exacerbations of fever; the appetite improved and the pulse 
came down to 100. A small abscess formed over the left 
scapula, and was opened. On July 11th, there was a recur- 
rence of chills, not severe, with cough and brownish expec- 
toration, rapid respiration and accelerated pulse, apparently 
relieved the next day by extending the original incision 
downwards and evacuating the pus which had formed there. 
A few days afterwards, great puffiness of the eyelids and a 
diffuse swelling over back of neck showed themselves ; this 
swelling of the neck gradually extended over the left side, 
and, after five days, an abscess formed on the side of the 
neck and broke. This swelling of the neck was followed by 
extreme distension of all the superficial veins of the face, 
neck, and chest, which still remains, more than two years 
afterwards. An attack of pneumonia now supervened, but, 
fortunately, was not severe; and this was followed by a 
post-pharyngeal abscess, which burst, and by abscesses on 
the opposite side of the neck, the occiput, and temple, and 
by facial erysipelas. The wound over the mastoid healed, 
but had to be opened twice, under ether, on account of fresh 
collections of pus ; the bone was not found softened at any 
time. Notwithstanding all of these complications, the pa- 
tient gradually improved, and, early in September, I ceased 
regular attendance. On October 20th she was brought to 
my office; she had had, in the mean time, partial hemiplegia 
on the right side, the opposite side from the ear-disease, to- 
gether with ptosis of the right eyelid ; she was then recover- 
ing from both, but there was still very perceptible weakness 
of the right arm and leg. She was in good health, and more 
fleshy than ever before. The ri<rht side of the face was 54 
BURNETT AND BLAKE. 
much fuller than the left, and the superficial veins were very 
much enlarged ; there was a fistula over the mastoid, with 
some discharge, but no bare bone could be detected. The 
fistula continued to discharge, and on January 9, 1872, the 
consented to an operation, when, with the assistance 
of Dr. John Homans, the mastoid was exposed by an inci- 
sion through the fistula, and a small opening found to com- 
municate with the cells; the walls of this opening were 
carious, and at the depth of an inch, on the inner wall of 
the cells, bare hone could be felt. The carious walls of the 
fistulous opening were removed with a gouge, and warm 
water syringed through the tympanum ; the inner wall of 
the cells was not touched. From this time, everything went 
smoothly ; no bad symptoms followed the operation, and in 
ten days the wound had entirely healed, and the patient has 
remained well to the present time, as far as the mastoid is 
concerned ; the tympana remain in the same condition as at 
the first report, both of the membranes being lost; and the 
child is subject, when she takes cold, to a slight discharge 
from the exposed mucous membrane. 
II. Mastoid Inflammation; Tiephining of the Healthy 
Bone on account of Dangerous /Symptoms; Recovery. 
A. A., aged sixty-five, sister of charity, seen in consulta- 
tion with Dr. Geo. S. Hyde, on the 8th of June, 1872, 
began to suffer with severe pain in the left ear six weeks pre- 
viously; one week after the pain began, a free discharge 
from the meatus showed itself, and continued up to the time 
I saw her. The severe pain in the ear was hut little relieved 
by the discharge, and she suffered constantly with pain, re- 
ferred chiefly to the mastoid, but extending somewhat over 
the left side of the head; with this, there had been marked 
constitutional disturbance, high pulse, hot, dry skin, anor- 
exia, and, within a fortnight, frequent nausea and occasional 
vomiting. At no time had there been marked swelling 
around the ear, or headache, other than nervous, to which REPORT ON TIIE PROGRESS OF OTOLOGV. 
55 
she had been subject for years. There were no chills. 
During the whole disease, the patient had been confined to 
her bed, and was extremely prostrated. 
Examination showed an abundant purulent discharge from 
the left meatus, the left membrana tympani swollen and 
inflamed, with a large perforation on the posterior segment, 
equal to one fourth of the whole membrane. The tympanic 
mucous membrane was granular; by Valsalva’s inflation, air 
was readily forced through the perforation. There was no 
swelling, or even tenderness, around the car or over the 
mastoid. The pain, which was described as dull and heavy 
with an occasional lancinating shoot, was referred to the 
mastoid. Hearing was completely lost for both watch and 
voice. The skin was hot and dry, the tongue coated, the 
pulse 120, and weak. 
The severe pain in the ear and the marked constitutional 
disturbance pointed to an active inflammation still going on 
in that organ ; the large perforation of the membrana tym- 
pani and the pervious condition of the Eustachian tube 
precluded the tympanum proper from being the scat of re- 
tained pus, and the mastoid cells were alone left as the seat 
of the disease. The prostration of the patient demanded im- 
mediate relief, and 1 advised perforation of the mastoid 
cells. 
June 9th. — With the assistance of Drs. John Homans 
and G. S. Hyde, the patient was etherized, and a perpen- 
dicular incision, one and a half inches long, made over the 
mastoid to the bone. The tissues were of their normal 
thickness and not cedematous; the bone normal and without 
any sinus. After incising the periosteum, it was scraped 
a.-ide, so as to expose the bone, and a few minute vessels 
were compressed and a ligature applied to the posterior 
auricular artery. With a triangular borer, five thirty- 
seconds of an inch in diameter, I then perforated the bone, 
on a level with the middle of the meatus, to the depth of 
one third of an inch, before I felt it enter the cells; on with- 
drawing it, about two drachms of inoffensive pus were 56 
BURNETT AND BLAKE. 
evacuated. With a small-pointed syringe, warm water was 
forced through the perforation in the hone and returned 
through the meatus, and this was repeated till the cavity was 
cleansed. A cloth tent was inserted in the opening, and the 
wound covered with a Avet compress. 
Six hours after the operation the patient was very nervous 
from the ether, and complained of some pain in the ear; hut 
the pulse had come down from 120 to 108. Ordered chloro- 
form, gtt. xx. 
June 10th. — Slept well, Avithout pain; felt much better. 
Pulse 88. Skin cool and moist. Appetite much improved. 
Typanum syringed through wound and meatus. Allowed 
beef tea and an egg. 
June 11th.— Passed a " delightful ” night, free from all 
pain, except an occasional dart; took no chloroform. Pulse 
88. Slight discharge of pus from Avound. Tympanum 
syringed as before. 
June 12th.—Yesterday afternoon sharp pain, as of old, 
felt in the ear, which continued through the night, requiring 
chloroform, hut it passed oft’towards morning. Puls * 88. 
June 13th. —Passed a good night; no return of the pain 
Pulse 88; tongue clean. Appetite good. Directed the 
tympanum to be syringed with warm Avater three times a 
day. 
June 15th.— No pain, except for three hours last night. 
Discharge from both meatus and Avound slight. Sat up to- 
day for the first time for seven weeks. Directed that the 
ear be syringed twice a day, and a solution of sulphate of 
zinc (gr. i. to 1 i.) be instilled at night. 
June 18th.— Patient reported that on the 16th pain re- 
turned in the ear, accompanied by a singing; at the same 
time there was severe pain in the frontal region and left eye. 
These pains continued through the 17th. On examination, 
the discharge Avas found to be much increased in quantity. 
The Avound Avas looking well, hut some fibrous tissue Avas 
sloughing; tongue clean ; pulse 84 ; abdomen tympanitic 
from flatus ; watch not heard on contact. Omitted the in- 57 
REPORT ON TIIE PROGRESS OF OTOLOGY 
stillation of zinc, and ordered poultice to wound, and two 
cathartic pills. 
June 19th.— Free from pain ; slept well, and this morning 
bright and cheerful. Pulse 82. To douche the tympanum 
three times a day with warm salt water. R. Quinice sulph., 
gr. i., ter die. 
June 20th.— Sat up all day; some pain in the ear and 
through the back of head and left eye for several hours, not 
so severe as before. Fulse 72. Appetite and strength 
improving. 
June 23d.— Quinine omitted, on account of headache and 
ringing in both ears ; ligature removed and poultice omitted. 
Ordered iron. 
June 26th.— Discharge from wound and meatus dimin- 
ishing ; scarcely a twinge of pain. 
July 7th.— Rode out for the first time. No pain; very 
little discharge. Mcmbrana tympani less swollen and gran- 
ulations diminishing. 
July 19th.— Occasionally slight pain in ear; no discharge 
from meatus, and the perforation healing. Wound healed, 
except a small fistula, which still discharged considerably, 
and through which bare bone could be felt. W. 1. on 
contact. 
From this time the ear-disease progressed favorably. The 
mcmbrana tympani healed perfectly, and the discharge from 
the mastoid opening gradually ceased. The hearing, by the 
first of August, had improved to W. 1. V. 1. 10b During 
the latter part of August, there were nausea and vomiting 
several times, with occasional vertigo, pain in the stomach, 
back, and lumbar region, and some swelling of the feet, but 
the patient had been subject to such attacks for years, and 
no disease was discovered ; an analysis of the urine afforded 
no explanation. During these attacks of vomiting, there was 
a discharge of blood, in small amount, from the mastoid 
sinus. 
I did not see the patient again till October 22d, 1873, 
nearly fourteen months afterwards, when she was complain- 58 
BURNETT AND BLAKE. 
ing of pain in the ear, due to a slight cold, and which soon 
passed off without treatment. She reported that, during the 
year, she had had no trouble with the ear, except slight and 
constant subjective noises. Her health had been about as 
good as usual; she had occasional sick headaches as ever, 
some chronic bronchitis, and, occasionally, a great deter- 
mination of blood to the head, without known cause. Dur- 
ing severe vomiting she had sometimes slight bleeding from 
the mastoid opening. Examination showed the membrana 
tympani without cicatrix, very much thickened, and drawn 
in and immovable. Over the mastoid was an opening half 
an inch deep and one eighth of an inch in diameter, lined 
with a continuation of the outer skin, which became in the 
deeper ["parts very delicate, and resembled mucous mem- 
brane ; no opening existed through this into the mastoid 
cells. W. 1. f" V. 1. 8'. 
III. — Mastoid Inflammation; Fistulous Opening through 
the Bone; Wilde’s Incision; Rapid Recovery.— C. G.,aged 
15, was sent to me on July 24th, 1872, with the history that 
two months before, during an influenza, he had had acute in- 
flammation of the car, with discharge. Since that time, the 
discharge had continued with a constant but slight pain in the 
ear, annoying tinnitus, and slight, constant vertigo till yester- 
day, when nausea and vomiting followed a marked increase-in 
the vertigo ; there had been no headache. When I saw him, the 
only symptoms complained of were a slight, almost constant 
pain in the left mastoid, with an occasional slight dart into the 
ear, a staggering gait, with a marked tendency to fall to- 
wards the right side, constant nausea, and occasional vomit- 
ing. The countenance was anxious; pulse 120, of fair 
strength ; tongue clean. Examination of the ear showed a 
purulent inflammation of the tympanum and a perforation of 
the drum-membrane, with large polypoid granulations on 
its edges; the mastoid not red or swollen to the eye, but to 
the touch slightly fluctuating and a little tender. Watch 
not heard on contact. Extreme vertigo, with vomiting, re- 
sulted directly from the examination. REPORT OX TIIE PROGRESS OF OTOLOGY. 
59 
Under ether, the tissues over the mastoid were freely in- 
cised through the periosteum, and at the extreme lower part 
of the bone, a small fistulous opening passed into the mastoid 
cells ; through this, thick grumous pus ran out. A tent was 
inserted in the wound, and douching of meatus and wound 
with warm water was advised. The vertigo and vomiting 
were immediately and entirely relieved; the pulse became 
normal within twenty-four hours. Four days after the oper- 
ation, the patient not having been under observation, the 
wound was found to have healed, and the pain in the mas- 
toid was slightly increased. On this account the tissues 
were again incised, under ether, and the bone, which had 
softened around the previous fistula, was cut through with a 
knife, opening the cells for a distance of a quarter of an inch ; 
the tympanum was then syringed through the fistula. Ex- 
amination of the ear, at this time, showed that the inflam- 
mation of the drum-membrane was much less, and the 
polypoid granulations had disappeared. W. 1. . 
From this time, the recovery was rapid; two days after, 
the discharge, both from the wound and meatus, had ceased, 
and the perforation of the membrane was found to have 
healed. W. 1. 3". 
Six days after, all pain and subjective noises had ceased, 
and the hearing was rapidly improving. W. 1. 20". 
I have selected these three cases as illustrative of the more 
serious forms of mastoid disease; they show the course which 
the disease may take, and the way nature seeks to relieve 
herself, and thus point out the line of treatment. 
Mastoid inflammation, although never primary, is now 
very properly described as a distinct disease, as it is always 
serious, and not uncommonly fatal, from involving the brain. 
The mastoid cells are but a part of the tympanic cavity, 
lined, like the rest of the cavity, by a delicate mucous mem- 
brane, which is in such close connection with the periosteum 
that the two cannot be separated or even distinguished. An 60 
BUliXETT AND BLAKE. 
inflammation of the tympanum proper usually implies, also, 
an inflammation of the mastoid cells of a greater or less in- 
tensity, and if this inflammation is so severe as to cause an 
abundant secretion of pus, an outlet for the matter from the 
cells can only occur by its breaking through the bone, either 
externally or internally, while the matter in the tympanum 
proper only requires to break through the delicate drum- 
membrane. In the majority of cases the inflammation sub- 
sides and the pus is absorbed, but in some cases the 
inflammation is too intense for this to occur without the 
evacuation of the pus, and then nature attempts to form an 
outlet, as is seen in the first and third cases. 
An examination of macerated bones shows, on the outer 
surface of the mastoid, numerous openings which serve for 
the passage of blood-vessels into the bone, and some of these 
undoubtedly arc in communication with the circulation of the 
mucous membrane. Along these vessels the inflammation is 
transmitted from within to the external periosteum, and, as 
pus is only formed in the later stages of an inflammation, 
the first pus formed here will be next the bone where the 
inflammation is oldest. The pus having formed on the ex- 
ternal surface of the bone, it meets with very firm obstacles 
to reaching the skin, for the whole mastoid serves for the 
attachment of the sternomastoid tendon, and the pus must 
work its way through this very firm fibrous tissue before 
coming to the subcutaneous tissue. This accounts for the 
very extensive burrowing of pus in the first case, for three 
weeks, without its having formed an outlet. 
In examining a large number of temporal bones, it will be 
seen that the thickness and consistency of the mastoid varies 
very much, and also that, in some, the openings on the ex- 
ternal surface are much larger and more numerous than in 
others. In some bones, it is impossible to see any of these 
foramina. Thus another obstacle exists here to the exit of 
the pus ; for while, in the cases just spoken of, the bone be- 
comes inflamed, softened, and disintegrated around the open- 
ing through which the inflamed vessel or vessels pass, in the REPORT ON TIIE PROGRESS OF OTOLOGY. 
61 
latter cases a new opening must be formed, a longer time is 
required, and the patient is consequently longer exposed to 
the risks of retained pus. In the second ease reported, it is 
probable that the unusual thickness of the bone (one third 
of an inch) and the absence or very small size of these for- 
amina, prevented any external inflammation; and it is also 
probable that this is the explanation of those cases in which, 
after death, the inner wall of the cells next the brain is found 
carious, while the external wall is healthy. This second case 
is also peculiar, from the fact that there was no tenderness 
on pressure of the bone, which I can only explain by suppos- 
ing that the bone was so very solid that it had not become 
inflamed. The operation of trephining under these circum- 
stances is, I believe, new ; but the condition of the patient 
was so critical that I had no hesitation in advising it. In 
the first case, I have no doubt that weeks of suffering and 
danger would have been avoided if consent could have been 
obtained to a similar operation. 
In the treatment of recent mastoid inflammation, we can 
generally hope for the subsidence of the disease by the local 
abstraction of blood and by appropriate treatment to the 
original cause of the trouble, the inflammation of the tympa- 
num proper. Two to four leeches over the mastoid will 
often so reduce the congestion that the disease subsides, and 
warm fomentations to the bone will help the resolution. At 
the same time, if the tympanum contains pus, this should be 
evacuated. As a rule, the drum-membrane will rupture of 
itself in a short time ; but if such a rupture does not take 
place, the membrane should be incised to give an exit to the 
pus, and the drum-membrane and tympanum treated by 
douching with warm water and by the use of the air-douche, 
to keep the tympanum free from the irritating matter. 
If, however, an external periostitis has been set up, a free 
incision should be made down to the bone, for, if pus has 
already formed, it should be evacuated as soon as possible to 
prevent unnecessary injury to the bone; and if no pus has 
formed, the relaxation of the swollen tissues and the bleed- 62 
BURNETT AND BLAKE. 
ing from the incision both relieve the pain and assist in caus- 
ing the inflammation within the cells to subside. At the 
time of the incision, the bone should be examined to see if 
any fistula exists in it, and if such is found it should be ex- 
posed and thoroughly syringed out. The place at which this 
fistula commonly forms is of considerable importance in aid- 
ing us in our search and also in deciding where the bone 
ought to be trephined, in case such an operation becomes 
necessary. In most of the cases which I have seen, this fistula 
has been nearly in the middle of the mastoid, not at the 
extreme tip or at the extreme upper part, although in both 
of these places the bone is very thin. 
While the fistula is being sought, the bone should be 
tested, and it will frequently be found to be so softened that 
a probe, director, or even a knife can be thrust through into 
the cells, thus evacuating the pus. If the bone around the 
fistula is softened, the opening should be enlarged till healthy 
bone is reached. The first case is interesting as showing 
how necessary the removal of the softened bone is for a cure ; 
for here the disintegrated bone, although so fine as to escape 
observation with a probe, kept the wound open for several 
months, while the removal of the affected bone with a gouge 
resulted in a cure within ten days. The second case shows 
how long the mastoid cells may be intensely inflamed without 
affecting the bone, and in these cases the operation of, tre- 
phining is especially indicated, as the pus, if meeting with 
unusual obstacles to its escape externally, is more apt to 
affect the other walls of Che cells and cause fatal disease of 
the brain. 
The great object of treatment in mastoid inflammation is, 
then, ihe fulfilment of the well-recognized law of surgery to 
give free exit to the pus. REVIEWS AND BOOK NOTICES. 
63 
III. 
reviews and book notices. 
A Practical Treatise on tiie Diseases of the Ear, in- 
cluding the Anatomy of the Organ. By D. B. St. 
John Roosa, M. A., M. D. Illustrated by Wood-En- 
gravings and Chromo-Lithographs. New York: William 
Wood & Co. 1873. 
" This work is intended to be a guide to those who wish to 
treat diseases of the ear.” 
These are the words which open the preface to this very 
valuable work; and after a careful examination, we believe 
the intention of the author has been ably carried out. The 
work contains live hundred and thirty-five pages, and is 
divided into four parts, which treat respectively of the ex- 
ternal ear, the middle ear, the internal ear, and deaf-mute- 
ness and hearing-trumpets. There is also a very interesting 
and accurate history of the progress of Otology from the 
year 4G0 B. C. to the present time, which precedes the de- 
scription of the anatomy of the auricle and external auditory 
meatus. 
The directions for examining aural patients are very ex- 
plicit, and the chromo-lithographs illustrative of the appear- 
ance of the membrana tympani are exceptionally good. The 
perspective of the lithographs in this work is strikingly 
brought out by viewing them through any short tube, but 
preferably with the ordinary aural speculum. 
Among the various methods of removal of foreign bodies 
from the external ear the "agglutinative method,” recently 
revived by Lowenberg in Paris, is mentioned. This method 
has been very erroneously ascribed lately to Dr. Lowenberg, 
whereas the method is lpost explicitly given by Riverius and 
Celsus, and has been put into practice in a particular instance 
by a layman, Mr. Eli Whitney Blake, of Whitneyville, Conn., 
upon a boy employed in his carriage factory. (C. Hooker, 
M. D., Boston Journal, 1834.) 64 
BURNETT AND BLAKE. 
Riverius (Riverii Op. Med. Francofurti, M. DC. LXXIY., 
Cap. cle Surditate, p. 2(51) says: "Si auriscalpium intro- 
mitti nequeat specillum cotone involvatur in extima sna 
parte, deinde immergatur in terebinthinam, aut in aliquod 
aliud viscidum : post inmiitatur in aurem, ut agglutinet id, 
quod obstruit.” 
Celsus (edition of his works published at Strasbourg, 180(5, 
p.342) says: "Specillum lana involution in refinam quam 
glutinosissimam, maximeque terebinthinam dcmittcndum, 
idque in aurem conjiciendum, ibique vertendum est; utique 
enim comprehendet et eximet.” These facts surely place the 
discovery of this method far beyond all modern claims. 
Otitis parasitica, a disease which appears to be more com- 
mon than heretofore supposed, is thoroughly explained by 
accurate wood-cuts and a fully-condensed experience of au- 
thors on this topic. 
The chapter on Injuries of the Membrana Tympani shows 
that, although many injuries to this part of the ear arise from 
unavoidable causes, unskilled manipulation on the part of 
the laity, in their anxiety to relieve the patient, may perfor- 
ate or destrojr this delicate membrane, which might have 
been saved had the surgeon been called upon for relief. The 
chapters of this work which contain the author’s experience 
and views upon chronic noil-suppurative inflammation of the 
middle ear are the prominent feature of this treatise. The 
author divides the so-called chronic catarrh of the middle 
car, or chronic lion-suppurative inflammation of the middle 
ear, into — 1, chronic catarrhal inflammation, nwd, 2, pro- 
liferous inflammation. The latter term is original with the 
author, or rather it is, as Dr. Roosa says, an original transla- 
tion of the German word Wucherung. 
This endeavor of the author to differentiate the forms of 
chronic disease of the middle ear is in perfect harmony with 
similar endeavors of Politzer, Gruber, Weber-Liel, and 
others, the first-named of whom divides chronic catarrhal 
diseases of the middle ear into secretory and lion-secretory 
forms ; the second authority has described an otitis media REVIEWS AND BOOK NOTICES. 
65 
hypertrophica; and the last-named writer has recently pub- 
lished his well-known work " On the Nature and Remediabil- 
ity of the Most Common Form of Progressive Hardness of 
Hearing,” which malady, he says, cannot be referred to 
catarrhal causes, but even as a primary disease must be con- 
sidered as a disease of the structures of the middle ear de- 
pendent upon " affections of the nerves which supply, and 
which stand in close relation to, the middle ear.” In this 
attempt on all sides to describe a separate chronic disease of 
the middle ear, based upon a special group of pathological 
alterations of the component parts of the tympanum, we 
recognize the fact that there is a frequent form of deafness 
which cannot be referred to catarrhal causes at all. There- 
fore, Ur. Roosa endeavors to describe "a form of inflamma- 
tion which shows a higher formation than the catarrhal,” and, 
while admitting that catarrhal symptoms may precede this 
form of disease, he shows that there is a disease of the ear 
which tends towards a chronic progress, and which he has 
"ventured to designate tli a proliferous form” 
These views of the author are based upon twelve varieties 
of tissue-changes which have been frequently found as a con- 
sequence of this form of ear disease, and in them we find 
that the prominent feature of the pathological processes is 
the formation of new tissue ; and it is this fact that has in- 
duced and really warrants the application of the word "pro- 
liferous ” to this form of ear-disease. 
In the chapter on the Treatment of Chronic Non-suppura- 
tive Inflammation of the INIiddle Ear, Dr. Roosa says, " In 
one respect the treatment of the catarrhal may be fairly dis- 
tinguished from that of the proliferous form. In the catar- 
rhal form we must give a great deal of attention to the naso- 
pharyngeal space, while in the other we need to pay very 
little to it.” With this exception, the outline of treatment 
for both forms of the disease may be the following: constitu- 
tional and hygienic, local blood-letting, applications to the 
Eustachian tube, applications to the cavity of the tympanum, 66 
BURNETT AND BLAKE. 
and cutting operations upon the mcmhrana tympani and the 
ossicula. 
Under the head of the nasal douche the author expresses 
his views against its use, since he has found it to be " some- 
times a troublesome and dangerous appliance.” 
This surely will be the case if the instrument is improp- 
erly used; but if the fluid injected into the nares be warm, 
if the vessel containing the fluid be not higher than the patient's 
forehead, and if after using the douche the patient do not 
leave his room for at least fifteen minutes, ice have yet to hear 
of any accident such as Dr. Iioosa depicts. 
It is not stated, in the table which is given by the author 
to show the danger of the application of the nasal douche, 
whether all these rules were observed ; and although it is 
implied that they were, still it is not clearly shown ; for the 
instructor in the use of the douche, in thirteen cases of the 
sixteen unfortunate ones, is either unnamed or " unknown,” 
and in several cases the nature and temperature of the fluid 
injected are also " unknown,” except in one case, — that of 
Dr. Frank, — in which it is distinctly admitted that the in- 
jected fluid was cold, and, as we are prepared to hear, the 
result was an acute otitis media. 
We cannot admit, as Dr. Roosa docs, the statement that 
" the instructor in the use of the douche was a physician ” as 
a sufficient guarantee of the correctness of the instruction, 
for our experience shows that as a rule the patients have 
failed to receive all ot the aforesaid precautions. And even 
if the physicians who instruct the patients in the use of the 
douche give proper instruction, the patients themselves may 
fail to follow their directions. It is obvious where the blame 
rests in such cases. 
Operations upon and through the membrana tympani, which 
now form some of the most important operations in surgery, 
are illustrated by history, cases, and wood-cuts of the vari- 
ous instruments employed, from " Chesehlcn’s Experiments 
on Dogs to Weber-Liel’s Operation upon the Tensor Tympani 
Muscle.” REVIEWS AND BOOK NOTICES. 
67 
At the end of the fourteenth chapter we find a table show- 
ing the results of treatment of chronic non-suppurative inflam- 
mation of the middle car, based on the observations of four 
observers, of whom Professor lioosa is one. In commenting 
on this table, Professor lioosa says, " I can only account for 
the fact that my percentage of cures is less than the others 
from the supposition that I have seen a proportionately larger 
number of neglected cases than falls to the lot of other prac- 
titioners.” 
We note, however, that the percentage of improvement in 
our author’s cases is greater than that of the others. Dr. 
lioosa also states that he has made the standard of cure very 
high, and has not called a case " cured ” which has only been 
greatly improved. 
The chapter on Acute Suppuration of the Middle Ear 
serves to mark an era in the treatment of disease in general. 
Our author, firmly supported by the experience of modern 
Otology, shows that the treatment of this form of car-disease 
is not only rational and successful, but is demanded, by the 
exigencies of the case and the evils of neglect, from every 
intelligent and conscientious physician. If any one should 
doubt the desirability of treatment in acute Otitis media, he 
has but to peruse the chapter on Chronic Suppuration of the 
Middle Ear and its fatal consequences, in order to have a 
good reason for changing his opinion. 
" The general health of a patient affected with chronic sup- 
puration of the middle ear is usually impaired, even if none 
of the serious consequences have occurred. Such a drain is 
not tolerated with equanimity by nature ” 
"I)r. Ilackley has found albuminuria in a number of cases 
of chronic suppuration of the middle ear, where there was 
no apparent cause for the disease except the long-continued 
secretion of pus from the tympanic cavity.” 
One hundred pages are devoted to a consideration of the 
consequences of chronic purulent discharges from the tym- 
panum, and the treatment in these very grave cases. 
To this portion of the treatise Dr. lioosa has appended a 68 
BURNETT AND BLAKE. 
table, "compiled from various sources, which illustrates in a 
striking manner the fatal consequences of some cases of aural 
disease.” 
The portion of the work which treats of the middle ear 
and its diseases closes with these words, in reference espe- 
cially to the table of cases already alluded to: "Taken in 
connection with the fact already stated, that suppuration of 
the ear is more frequently the cause of cerebral abscess than 
any other one disease, these cases form a complete justifica- 
tion, if one were needed, for the giving up so much space to 
the consequences of chronic suppuration of the middle ear. 
If the table should startle some mind hitherto inattentive to 
this subject into a realization of its grave importance, and 
lead to a more careful consideration of an ulcerated middle 
ear, it will have accomplished its object.” The remaining 
pages of the book are devoted to the anatomy and diseases of 
the internal ear, and to deaf-muteness and hearing-trumpets. 
True nervous deafness, " a primary affection of the audi- 
tory nerve or labyrinth, or of both,” is said to be a rare dis- 
ease. In fifteen hundred cases of aural disease observed by 
the author, only fifty-seven could be fairly considered as 
primary diseases of the internal ear. C. II. B. 
Diseases and Injuries of tiie Ear. By W. B. Dalby, 
F. li. C. S., M. B. Cantab., Aural Surgeon to St. George’s 
Hospital. 
This book, of little more than two hundred pages, is di- 
vided into eleven short lectures on the more important fea- 
tures of "Diseases and Injuries of the Ear.” Among the 
lectures we would single out the fifth as the best, if called 
upon to make any distinction; but they are all very good, 
and contain the substance of the diagnostic and therapeuti- 
cal knowledge of the day so far as it pertains to Otology. 
The anatomical and physiological facts are but lightly touched 
upon; we suppose, because the author relics upon a prelim- 
inary knowledge on the part of those who constitute the class 
at St. George’s Hospital. REVIEWS AND BOOK NOTICES. 
69 
In the fifth lecture, already mentioned, the diagnosis and 
treatment of non-purulent catarrh of the middle ear are care- 
fully and clearly set forth, and furnish, therefore, a very 
valuable guide to any one who has to treat a case of this dis- 
ease. 
The subject of aural polypi is very thoroughly treated in 
the seventh lecture, accompanied by some " beautifully exe- 
cuted drawings, showing the structure of these bodies, by 
Dr. Whipham.” Under this head we notice that Dr. Dalby 
recommends the use of " fine fishing-gimp ” instead of wire 
in the formation of the snare in Wilde’s instrument. "After 
the removal of the polypus,” Dr. Dalby says, " I am in the 
habit of using chloroacetic acid on a small camel-hair brush, 
and apply it very freely. At the same time, care must be 
taken not to touch any part of the meatus.” 
Those parts of the book which relate to mastoid diseases, 
to the obscure nervous affections of the auditory apparatus, 
both acquired and inherited, and to deaf-muteness, are full of 
interest; but we think more should be said concerning mas- 
toid disease and its treatment, even at the expense of space 
which is given to deaf-muteness. So much has been done 
for the relief of mastoid disease, and it now constitutes so 
important a part of the aural surgeon’s work, that no book 
on diseases of the ear is complete without a very thorough 
review of the diagnosis and treatment of this important and 
tractable malady, while deaf-muteness hardly falls within the 
province of the aural surgeon, at least not to the exclusion of 
more remediable troubles of the ear. 
The great importance of chronic discharge from the ear is 
acknowledged and most forcibly enjoined in the following 
words, which close the eighth chapter: — 
" But inattention to the discharge may at any time place 
the patient in a position of great peril. For this reason I 
believe that a discharge from the ear is regarded by insur- 
ance companies as an element against granting a policy, or, 
at any rate, demanding an increased premium. I can only 
say that, if it is not so regarded, it would be, if the com- 
panies consulted their own interests.” 70 
BURNETT AND BLAKE. 
We can but terminate this short sketch by saying that 
the perusal of this book has been not only instructive but 
extremely pleasurable, and we are glad to acknowledge the 
addition of such a volume to the literature pertaining to 
Otology. C. II. 13. 
Die Corrosions Anatomie und hire Ergebnisse. Hyrtl. 
Vienna, 1873. 
Hyrtl describes the casts taken from the labyrinths ot a 
variety of animals. 
1. That of Troglodytes Grilla is remarkable for the size 
of its posterior semicircular canal and ampulla; it resem- 
bles very closely that of the orang. 
2. The Age-Age (Chiromys madagascariensis) is com- 
monly classed with the scinrkke; but its labyrinth is so en- 
tirely like that of the lemnridie that Hyrtl does not hesitate 
to place it in the latter class. 
3. Ursus spelceus, the cave-bear of the glacial drift. 
There is great difficulty in getting rid of the clay and sand 
that is packed into the aural cavities of prc-historic animals. 
II. boils the temporal bones in vinegar for several hours, 
then dries them by a strong heat, and pounds the bone on 
some hard object to get the fragments out; this process must 
be repeated three or four times. The cavities are then to be 
cleaned by means of bristles, for introducing which he makes 
artificial openings at the cupola of the cochlea and the middle 
of the semicircular canals. The labyrinth of this bear is 
only distinguished by its size from that of the modern brown 
bear (U. arctos). 
4. Ilycena spelcea, the cave-hysena. Its labyrinth unites 
the characteristics of the viverrse and the cats. 
5. Trichecus rosmarus, the walrus. The labyrinth 
differs from those of the other pahnipeda in being somewhat 
smaller; it has much wider semicircular canals, and a mon- 
strous, broad, low cochlea, with rather less than 21 turns. 
6. Lcitax stelleri. The labyrinth is widely different from REVIEWS AND BOOK NOTICES. 
71 
<hat commonly found in seals; the semicircular canals are 
very narrow, and are placed somewhat as in the fish-otter. 
7. Rhinoceros tichorhinus. There is only one point of 
distinction between this labyrinth and that of Rh. africanus, 
namely, the corkscrew shape of the aquaeductus and coch- 
lea ; there is also great similarity to that of the one-horned 
Rh. indicus. 
8. Camelopardalis giraffa. Very close resemblance to 
the cervina ; much less to the antelopes. The preparation in 
the Musee Orfila at Paris shows an S-shaped bend of the 
upper canalis semi-circularis, which has been found to he due 
to the distorting effect of the acid used for corroding the 
preparation. 
0. C/telonicus gigas. The organ of hearing is exactly 
like that of the armadillos ; the labyrinth shows also an affin- 
ity with that of the hedge-hog. 
10. Physeter macrocephalus, the sperm-whale. The 
labyrinth combines the peculiarities of the herbivorous 
sirenidte and of the pliocae; it is totally unlike that of the 
great baleen whales, and in all respects smaller than that of 
Balaam mysticetus. 
11. Orcinus orca. This creature is ranked with the 
phoeamae, hut possesses the labyrinth of the narwhal ; there 
is a great resemblance between this specimen and the laby- 
rinth of the delphinidie. 
12. Palcena mysticetus, right-whale. The cochlea is the 
largest in Ilyrtl’s possession, though it must be called small 
in comparison with the gigantic size of the beast. It makes 
two turns, not touching one another, in the same plane. The 
modiolus is excessively thick, and its axis points directly 
downwards, which is the case with no other order of mam- 
mals. The canales semi-circulares are proportionally very 
small, not larger than in the domestic rat. It is a general 
law that their size is inversely proportional to the density of 
the temporal hone, and this bone, in the case of the right- 
whale, is hard enough to give a spark with steel, and is per- 
fectly inaccessible to the ordinary methods of anatomical 
research with knife and chisel. C. J. Blake. 72 
BURNETT AND BLAKE. 
Index to the articles mentioned in the Report, arranged in 
alphabetical order of the authors' names. 
INDEX TO PART I. 
Blake, C. J. Description of a peculiarity observed by Prof. Wyman 
in the crania of Hawaiian Islanders and Peruvians. Boston Society for 
Advancement of Medical Science. 
Breuer, J. “Ueber die Bogengange des Labyrinths.” Anzeiger der 
Ges. der Aertze in Wien. Nov. 20, 1873. 
Breuer, J. Ueber die Function der Bogengauge des Ohr-labyrinths. 
Wiener med Jahrb. 1874. Heft 1. 
Buck, A. II. “On the Mechanism of Hearing.” Prize essay of the 
Alumni Association of the College of Physicians and Surgeons, New York, 
March, 1874. Published in New York ‘‘ Medical J mrnal," June, 1874. 
Burnett, Charles H The Resonant Functions of the External Ear. Phila. 
“ Med. Times,” No. 127, Yol. IV, 1874. 
Burnett, Charles II. The External Ear a Synthetic Ilesorator. Phila. 
“ Med. Times,” No. 101, Vol. IV, 1873. 
Curschmann, K. Ueber das Verhiiltniss der Ilalbcirkelformigen Canale 
des Ohr-Labyrinths zum Korpergleichgewlcht. Vorliiullge Mittheilung. 
Deutsche Kiinlk, No. 3, 1874. 
Cyon. Ueber die Function der halbeirkelformigen Canale. (Archlv fur 
Physlologie von Pfliiger. Dec. 1873. Bd 8. Heft 6 u 7.) 
Gruber, Prof. J. Ueber Anomalien in der Verbindung des Hammers mit 
dem Trommelfell. M. f. O. April, 1874. 
Ilasse C. Die Lymphbahnen des inneren Ohres der Wirbelthiere. 
Kupper. Ueber clonische Krampfe der Schlingmuskeln. (Quoted from 
M. f. O. No. 9, 1873.) 
Kessel. Ueber den Einfluss der Binnenmuskeln der Paukenhohle auf die 
Bewegungen uml Schwingungen des Trommelfells am todten Olire. 
Archiv. f. O. N. F. Band II, p. 80. 
Lucce, A. The Power of Accommodation of the Ear and its Disturbances. 
Berlin Klin. Wochensch. No. 14. 
Mach unit Kessel. Die Function der Trommelhohle und der Tuba 
Eustachii. Sitzb. d. k. k. Akad. d. Wlss. J. 1872. 
Mach und Kessel Versuche iiber Accomodation des Ohres. Sitzb. der 
k. k. Akad. der Wiss. Jahrg. 1872. 
Mach, Ernst. Gleichgewichtssinn des Menschen. Wiener Sitzungs- 
berichte. Nov. 6, 1873. 
Mayer, Prof. A. M 1. Functions and Mechanism of Audition. 2. Dura- 
tion of the Sensation of Sound. 3. Reflection of Sound from Flames and 
Heated Gases. Proceedings of the Academy of Sciences. Washington, 
April 21, 1874. 
Michel, C. Das Verhiiltniss der Tubeumiindung zum Gaumensegel, am 
Lebenden betrachtet durch die Nase. 
Trautmann. Die Lichtreflexe des Trommelfells. Archiv. f. 0. N. F. 
B. II. p. 1. 1873. INDEX TO REPORT ON OTOLOGY. 
73 
Urbantschitsch. Beitriige zur Anatomie der Paukenhohle. Archiv. f. O. 
N. F. Band II. p. 50. 1873. 
Voltolini, II. Zur pneumatischen Ohren-Lupe. No. 2. M. f. O. Dec. 
1873. 
Yule, C. J. F. Mechanism of Opening and Closing the Eustachian Tube 
Journal of Anatomy and Physiology, by Humphrey and Turner. No. XIII. 
Nov. 1873. 
Zuckerkandl. Beitrag zur Anatomie des Schlafebeius. M. f. O. Sept. 
1873. 
Zuckerkandl. Zur Anatomie und Physiologie der Tuba Eustachiana. 
M. f. O. Dec. 1873. 
Bezold. Pilzbildung im Ohre. Monatschrift f. Ohrenheilk. July, 1873. 
Bing. Zur perforation des Trommelfells. Wien Med. Zeitung. No. 
35. 1873. 
Cassels, J. P. Alcohol in Otitis Media. “ London Lancet.” April, 1874. 
Dalby. Cerebral Abscess from Otitis Media Purulenta. British Med. 
Journal. Mar. 1874. 
Frank. Schwerhbrigkelt geheilt durch Staphyloraphie. Monatschr. f. 
Ohrenheilk. Aug. 1873. 
Green, J. Orne. Mastoid inflammation. Boston “ Med. and Surg. 
Journal ” 
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Voltolini. Emphysem bei Catheterismus. Monatschrift f. Ohrenheilk. 
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Voltolini. Lebende Larvae im Ohre. Monatschr. f. Ohrenheilk. Nov. 
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Voltolini. Die Ringfdrmige Canula zum offenhaltung kunstliche Penoi- 
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Wendt. Secundiire Veranderungen der Schleimhaut im Mittelohr. Ibid. 
Wendt Ueber elnen wahrscheinlich Embolischen vorgang in der 
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Wernher. Pneumatocele Cranii. Zeitschrift fur Chirurgie. Dec. 1873. 
INDEX TO PART II.