[Reprinted from The Medical News, April 27, 1895.] 
EVACUATION OF THE TYMPANUM. 
By DONALD B. FRASEJt, M.B., M.R.C.S. Eng., 
PROFESSOR OF PATHOLOGY■ RWIThiSTOLOGY, WESTERN UNIVERSITY, 
LONDON, ONTARIO. 
Early in 1891 I suffered from an abscess of the 
tympanum in connection with an attack of influenza, 
attended by sore-throat and cold in the head. While 
using an atomizer with Dobell’s solution I felt a 
stream of water pass through the Eustachian tubes 
into the tympanic cavity, followed by a sensation 
of churning, as if air and mucous fluid were being 
intermixed. At first there was not much pain, but 
a feeling of uncomfortable fulness soon followed. 
My first thought was to evacuate the tympanic cavity, 
but I could not do it. All authors recommended 
the Valsalva or Politzer plan of treatment, i. e., 
inflation of the middle-ear cavity. I followed faith- 
fully the directions, but with no result. Pain in- 
creased, and became at times very severe. The 
inflation of the cavity at times became so painful 
that I had to give it up, and I felt that it was wrong 
treatment. An abscess formed, and, after some 
weeks, it burst and gave me relief. I remained 
five days off duty after this, and then resumed 
practice. 
Exactly four weeks from this date I was seized 
with a sudden, severe, and persistent pain behind 
the left ear and over the mastoid cells. This attack 2 
occurred in my office while attending to a patient. 
A few hours later I had the Wilde incision made 
over the mastoid cells down to the bone, and with- 
out any effect.' Next morning I felt a steady pain 
over the left temple, behind the left eye, and at the 
angle of the jaw, in addition to that at the seat of 
disease; the only relief I got was from leeching, 
applying half a dozen leeches once or twice a day. 
The stiffness of the neck was slightly relieved by 
2y2 grains of quinin, 2)4 grains of caffein, and 5 
grains of antipyrin taken two or three times a day. 
Sleep was got by using from % to )4 grain of mor- 
phin at bedtime, and hot applications in the form of 
hot water in a rubber bottle were acceptable. The 
disease continued for about two weeks, when I con- 
sulted an aurist, who diagnosticated the case as 
“ mastoid abscess ” that might require an operation. 
Another week passed, and my. sufferings became 
almost unbearable, when an operation was performed 
to give vent to the pus. It was successful, the chisel 
was used, and in three weeks the wound healed, my 
hearing returned, and I was cured. The specialist 
who operated made a second visit, and I was then 
feeling well enough to discuss the case with him. 
I asked was there no way of emptying the middle 
ear instead of inflating it, adding at the same time 
that I felt that if I could have performed evacuation 
instead of inflation I did not think I would have an 
abscess, and remarked that during acute congestion 
in the early stage of the trouble inflation was wrong 
as it was so painful, and seemed to me to over-dis- 
tend a cavity already too much distended. My 
feeling, I stated, called for evacuation to relieve the 3 
tension. My esteemed and kind friend answered 
that he knew of no treatment that would accomplish 
“ evacuation of the tympanic cavity,” and indorsed 
and recommended the Valsalva and Politzer plan of 
inflation. 
There the matter lay for three years, and the idea 
never again occurred to me until about one year 
ago, when I had a severe pain in the right ear after 
a twenty-five-mile drive (without my fur cap) on a 
windy and blustering day, and at the same time I 
was again suffering from influenza, with sore-throat 
and a “ stuffed ” head. The Eustachian tubes were 
difficult to open, and the air-bag caused me great 
pain, so much so that I gave it up, as the pain was 
aggravated by it. I was in great distress, and feared 
a repetition of my old trouble in the other ear. 
Inflation was out of the question on account of the 
pain it caused. The old thought of emptying the 
tympanic cavity recurred to me and remained upper- 
most in my mind, but I did not know how to ac- 
complish it. 
At last it struck me to reverse the process in work- 
ing the Politzer air-bag, viz.: Collapse the bulb by 
squeezing it tightly, applying the nozzle, as in the 
Politzer plan, to one nostril, closing the other tightly, 
shutting the mouth and let go the bulb. I felt a 
slight feeling of collapse at the mouths of the Eus- 
tachian tubes, a new sensation, but no relief from 
pain. I was encouraged to proceed. 
I thought of using the Eustachian catheter, apply- 
ing it to an air-pump, and thereby get a vacuum ; I 
was afraid I might injure the delicate ear-structures, 
and desisted. 4 
While practising the old plan of drawing mucus 
from the back of the nose into the back of the 
mouth by short inspiratory jerks, I suddenly and 
accidentally pinched tight the nostrils and felt dis- 
tinctly a collapse of the mouths of the Eustachian 
tubes. I said “ Eureka !” and kept up this practice 
while I could detect distinctly a feeling of collapse of 
the Eustachian tubes and tympanic cavity. I kept up 
evacuation of the tympanum about half an hour, and 
found the pain almost gone, enabling me to attend 
to my patients in comfort. The following night I 
had good rest and sleep ; for ten days I had a severe 
attack of catarrh of the Eustachian tubes and tym- 
panic cavity, with a daily discharge of bloody mucus 
from the right nostril. I practised daily two or 
three times evacuation of the middle ear without 
discomfort. 
Of course, the tubes must be inflated before one 
can perform evacuation of the cavity. I could only 
hear the watch an inch from the ear at the begin- 
ning of the attack, and after about ten days I could 
hear it from one to two feet away. 
During acute congestion, the stage of threatened 
abscess, when inflation of the tubes and cavity is 
attended with great pain, one should discontinue it 
and use evacuation, which is not painful. A vacuum 
is thus produced that allows the over-distended ves- 
sels to empty themselves and thus restore to a great 
extent the equilibrium of the circulation. It assists 
in draining the middle-ear cavity after the abscess has 
burst or been opened. In association with inflam- 
mation it will be useful in the treatment of nearly 
all middle-ear troubles; I have no doubt it will 5 
abort threatened abscess if used properly, as I feel 
it did in my own case. 
A strong Politzer air-bag can be utilized for 
evacuation of the tympanum by reversing the pro- 
cess used in inflation. Inflation is practised during 
expiration, evacuation during inspiration. Inflating 
the tympanic cavity is performed in the first half of 
treatment, evacuation in the second half. Evacuation 
is the converse or complement of inflation ; they 
work in harmony, and do not antagonize each other. 
In some cases inflation is used with benefit, and in 
others evacuation with equally happy results. In 
many cases one may combine the two. Evacua- 
tion is especially indicated in early stages of acute 
congestion attended with great pain and when 
there is over-distention from fluid passing through 
the Eustachian tubes into the middle-ear cavity. In 
such cases evacuation will often abort an abscess it 
done early and thoroughly. When the tubes are 
closed it will be necessary in all cases to open them 
up by inflation either by the Valsalva or the Politzer 
plan of treatment. No air-bag is needed, as a rule, 
but when required it should be made of strong 
rubber, or it will not produce a vacuum. 
Without an air-bag my directions are as follows, 
viz. : close tightly the nostrils and mouth and fill 
the lungs with air, and as it does not come from 
without it comes from the back of the mouth, the 
throat, Eustachian tubes, and tympanic cavity. Some 
patients do not get the. idea, and I ask them to try 
the Valsalva inflation, and draw their attention to 
the fact that in inflation the air is forced against the 
thumb and finger and in evacuation the process is 6 
reversed, drawing the air from the thumb and finger ; 
by this expedient most patients succeed. The drum- 
membrane can be felt to bulge inward, and a col- 
lapse of the tubes and cavity is produced. In many 
cases before hearing is regained inflation of the tubes 
and cavity has to be performed. The air-bag pro- 
duces a vacuum, but one has to spend a good deal 
of time in showing how to work it, and the simple 
plan is the best. 
In drawing attention to the evacuation-plan of 
treatment, allow me to say that I was seeking relief 
from severe pain, and the old adage was again illus- 
trated that “ Necessity is the mother of invention.” 
If others are relieved as I was, I shall feel amply com- 
pensated for bringing this matter to the notice of 
the profession. I feel that an abscess was aborted 
by the timely evacuation of the tympanic cavity. In 
suitable cases I find patients much benefited, pain 
relieved, and in no case is it exaggerated as in the 
inflation treatment. All medical men who have 
discussed it with me are favorably impressed, and 
all say it is common sense to evacuate an abscess or 
relieve tension when one is threatened or existing. 
It is nature’s plan of treatment: open the abscess, 
remove tension, cause a vacuum, restore the im- 
peded circulation, and get the parts back to a healthy 
condition. 
I am under a deep obligation to Dr. McCallum, 
of London, for assistance given me.