REPORT ON OTOLOGY. 
By J. Orne vxreen, M.D. 
Anatomy and Physiology. 
Ruedinger.—Beitriige zur Ilistologie des Mittlcren Ohros. Miinchen. 
1873. 
Burnett.—Bloodvessels of the Membrana Tympani. Amer. Jour. 
Med. Sciences. Jan., 1873. 
Zuckerkandi.—Ueber die Arteria Stapedia des Menschen. Mo- 
natschrift fur Ohrenheilkunde. Jan., 1873. 
Weber, F. E.—Der Musculus Tensor Tympani. Idem. Oct., 1872. 
Mack.—Zur Theorie des Gehororgans. Prag. 1872. 
Luc^:.—Zur Diagnostichen Verwerthung der Schalleitung durch die 
Kopfknochen. Berliner Klin. Wochenschrift. 1871. 
Luc,e.—Maximal Phonometer. Idem. 1872. 
Berthold.—Taube Puncte des Ohres. Idem. 1872. 
The histology of the middle ear has been made the subject of minute 
study by Rudinger for a long time, and the observations of so accom- 
plished an anatomist are worthy of more extended notice than is here 
possible. But a few of his observations, more especially on some of 
the points of controversy which have arisen of late years, can be men- 
tioned in this paper. 
The surface of the ossicula consists of general lamellae, which enclose 
bone-corpuscles throughout, and, in their deeper layers, also, groups of 
so-called giant cells. The canals of Havers resemble those in the short 
bones of the extremities and unite in a large central cavity, the medul- 
lary cavity. Specimens of osteophorosis and of osteosclerosis were 
also found. The cartilaginous layer over the hammer, which was first 
described by Gruber as a distinct tissue, and one which played an 
important role in the movements of that bone, but which has been 
considered by Prussak and others as merely belonging to the perioste- 
um, Rudinger allows to be distinct from the hammer, but describes it 
somewhat differently from Gruber. At the lower end of the manu- 
brium, the layers covering the hammer are a fibrous tissue containing 
cartilage cells, which he calls fibrous cartilage ; within this, and 
closely surrounding the whole hammer, is a layer of pure hyaline 
cartilage, the boundary between the two forms of cartilage being very 
distinct. This hyaline cartilage, Rudinger acknowledges, may be the 
remains of the foetal cartilaginous hammer, but, as Gruber says, it 
persists through life. The resemblance of these cartilaginous layers 
on the hammer to the cartilages seen in the joints of the ossicula, lead 
Rudinger to think that they are special histological media for the 
transmission of sound-waves. The cartilaginous layers are still found 
the same, but varying a little in thickness as we pass up the hammer, 
but that bone itself is more and more isolated from the membrana 
tympani. As we approach the short process, the layer of hyaline car- 
tilage becomes gradually thicker on the external edge of the hammer, 
and thinner on the other surfaces, till, at the point of the short process, 
it has entirely disappeared, except externally, where it forms a thick 2 
bolster closely attached to the bone. The space between this carti- 
laginous bolster and the short process, which Gruber describes, could 
not be found by Riidinger, but on each side of the cartilage is an angle, 
filled in with connective tissue, in which spaces exist, the walls of which 
are of variable thickness. These spaces he considers to be vessels and 
not a discontinuity between the cartilage and the membrana tympani. 
The pouches of the membrana tympani, described by Troeltsch as 
duplicatures of the membrana propria, but by Gruber and Ilenle as 
simply folds of the mucous membrane, Riidinger says contain a strong 
layer of parallel fibres, resembling the radial fibres of the membrane, 
and serve as ligaments to hold the hammer, on which account he has 
named them the pouch-ligaments of the membrana tympani. The 
other ligaments he has described nearly as given by other authors. 
The ring in which the membrana tympani is inserted, called by older 
writers the annulus cartilaginous, contains, in the human being, no 
cartilage, but is composed of fibrous tissue, a continuation of the 
periosteum, and, therefore, named by Riidinger the annulus fibrosus. 
After careful study of the articulations of the ossicula, Riidinger re- 
asserts what he has already published (Virchow’s Archiv, 1860). Both 
in the articulation between the malleus and incus, the incus and pro- 
cessus lenticularis and the processus lenticularis and stapes, a freely 
movable meniscus of cartilage is found, thus making a joint of two 
chambers as is found at the clavicle. The tendon of the stapedius 
muscle is attached not only to the stapes but also to the capsule of the 
joint and the processus lenticularis. 
By means of preparations colored with chloride of gold, Burnett 
has studied the arrangement of the bloodvessels and nerves of the 
membrana tympani in different animals, and finds that they vary 
somewhat from the arrangement found in the human membrane. In 
the dog, cat, goat and rabbit, small vessels pass from the periphery 
towards the manubrium, and, also, from the manubrium towards the 
periphery, at nearly equal distances from each other; and then turn 
abruptly towards their starting point, thus forming a series of vascular 
loops. In the Guinea-pig, however, the vessels form a net-work of 
coarse quadrangular or pentagonal meshes, an arrangement similar to 
that in man, except that the meshes are coarser and the vessels finer. 
These arrangements of the vessels Burnett has found constant and 
peculiar to these animals. 
The arteria stapedia, generally described as abnormal, Zuckerkandi 
affirms to be constant, taking its origin from the arteria stylo-mastoidea 
which enters the tympanum above the foramen ovale. It gives off a 
branch to each arm of the stapes and one to the base of that bone, and 
anastomoses with a branch of the arteria nerv. tympani comitans, or 
else with the arterial plexus of the promontory. 
The tensor tympani muscle is surrounded throughout its entire 
course by a fibrous sheath, arising from the roof of the tubal cartilage 
and from the edge of the fibro-cartilago basilaris and passing along the 
entire muscle. The tympanic sheath of the muscle which has been 
considered to be mucous membrane, Weber has found to be fibrous 
tissue, a continuation of the sheath covering the muscle within the 
osseous canal. The muscle itself takes its origin only from the poste- 
rior cartilage of the Eustachian tube and three bundles of fibres, an 
outer, middle and inner, arise from this tissue to form the muscle. The 3 
length of the tendon of the muscle, from the rostrum cochleare to its 
insertion on the hammer, Weber gives at two and one-fourth millimetres, 
and its direction somewhat forwards and downwards. Its insertion on 
the hammer is three and three-fourths millimetres above the end of the 
manubrium, and four and one-half millimetres below the top of the 
hammer. 
Mach agrees with Helmholtz that the conduction of sound to the 
labyrinth-water takes place by vibrations of the ossicula as solid bodies, 
and not by vibration of the separate molecules composing them ; and 
also with the theory of Seebach in regard to the manner in which the 
tympanic apparatus is enabled to conduct oscillations of various dura- 
tions equally well. lie then considers the question of how the arrange- 
ment of the tympanic apparatus in separate masses, each of which 
possesses special elastic power, must act, and by calculation concludes 
that this arrangement must increase or diminish the tones according 
to the condition of these masses. The tympanic apparatus, then, does 
not conduct all tones equally well, but rather always favors some 
particular part of the scale of notes, the part favored, however, depend- 
ing on the tension of the tensor tympani muscle. In addition to the 
accommodative function of the tensor tympani muscle in varying the 
tension of the membrana tympani, Mach would thus assign to this 
muscle the ability to change the conducting power of the whole tym- 
panic apparatus. 
In explanation of the established fact that, when a vibrating tuning- 
fork is placed against the bones of the skull and one ear is tightly 
closed, the fundamental tone of the fork will be heard louder in the 
closed than in the open ear, Mach had advanced the theory that a 
certain amount of the sound which generally passed out of the meatus 
and was lost to our perception was, by the closure of the meatus, 
reflected back on to the labyrinth, and thus produced a greater im- 
pression on the closed than on the open ear. This idea was based on the 
theory of Duhamel that the force of a sound is always measured by the 
difference between the influx and efflux, and must vary whenever the in- 
flux or efflux is disturbed. Lucte, however, considers himself justified, 
from experiments, in denying any such efflux of the sound, and affirms, 
moreover, that the reinforcement of the tone is entirely dependent on the 
length of the column of air in the closed ear, i.e. on the proportion exist- 
ing between the length of the air-column and the length of the waves of the 
tone employed. If the tone c' is used and the length of the meatus is in- 
creased by the insertion of a rubber tube eleven inches long, thus making 
the column of air one-fourth the length of the sound-wave, the fundamen- 
tal tone is deadened and its octave is heard distinctly ; if the column 
of air is increased to twenty-four inches, the fundamental tone is 
again reinforced, since the course of the reflected waves is equal to 
the whole length of a wave of the tone c\ 
Other observations of Lucee on the influence which the direction of 
the vibrations in the bones of the skull exert on the amplitude of the 
vibrations of the membrana tympani show that the vibrations of the 
membrane are greatest when the waves of sound strike perpendicularly 
to the plane of the membrane. This fact can be demonstrated by 
closing both car-passages and placing a deep tuning-fork on the centre 
of the head; the tone will then be perceived equally strong in each 
ear. If the fork is now moved to one side, to a point perpendicular to 4 
the plane of the opposite membrane of the drum, the tone will be heard 
strongly and almost entirely in that ear. 
Lucas has constructed an instrument for the purpose of measuring 
)xactly the pressure of the breath exerted in speaking, i.e. the intensity 
of the speech. It consists of a paste-board cylinder, 190 millimetres 
long and 48 millimetres in diameter, one end of which is funnel-shaped, 
and covered at the edge with a roller of rubber so that it can be applied 
tightly over the mouth. The other end is closed by a membrane of 
rubber, so stretched that the slightest compression of the air in the 
tube will move it. On the edge of the tube a light metallic lever is 
attached, the lower end resting on the centre of the rubber membrane, 
and the upper end moving over a quadrant marked in degrees and 
attached to the body of the instrument. Any word then spoken into 
the tube presses the rubber membrane, and with it the lower end of 
the lever, outwards, while the upper end of the lever is pressed in the 
opposite direction over the quadrant on which the extent of its motion 
can be measured. A very light spiral-spring presses the lever against 
the quadrant so that it remains at the point of maximum motion. The 
instrument has the practical value of determining empirically the in- 
tensity of one and the same spoken word, and, therefore, gives a more 
exact test of the hearing for language than was before possible. 
In regard to the alphabet, it is found that the maximal intensity is 
greatest for the explosives B, G, D, P, K, T (18°-38°); least for the 
letters S, W, C, Z, I, L, F, V and R (2°-12°), while the vowels have 
a value of 9°-15°, and Sch, X and H a value of 14°-19°. 
These values are not, however, proportional to the ease with which 
the letter is perceived by the ear, with the exception of the letters P, 
T, B, I, for the instrument can merely measure the pressure of the air 
used in forming a letter, while certain letters, especially the vowels, 
and the consonants F, Sch, Ch and S before a vowel, are increased in 
intensity by the resonance of the cavity of the mouth without a great 
pressure of air, consequently their intensity is greater for the ear than 
for the phonometer. 
Pathology and Therapeutics. 
Luc^:.—Die so-genannten Corpora Amylacea. Virchow’s Arch. 1872. 
Fuerstner.—Othfematoma. Archiv fur Psychiatric, iii. 
Buck.—Unusual Cases. New York Medical Record, Dec., 1872. 
Wendt.—Ueber das Verhalten des Gehororgans bei Variola. Ar- 
chiv der Ileilkunde, 1872. 
Politzer.—Ueber Traumatische Trommelfellrupturen mit besonderer 
Riicksicht auf die forensische Praxis. Wiener Med. Wochenschr. 
1872. 
Blake.—Perception of high musical Notes. Transactions of Amer. 
Otological Society. 1872. 
Gruber.—Zur Entfernung fremder Korper. Allg. Wiener Med. 
Zeitung. 1872. 
Jacoby.—Behandlungresultate bei complizirten Otorrhceen. Archiv 
f. Ohrenheilk., vol. vi. 
Schultze.—Ein Beitrag zur Technik des Nasen-douche. Idem. 
Luoe.—Ueber locale Anwendung des Chloral Hydrats. Berliner 
Klin. Wochenschr. 1872. 
Weber.—Krankheiten der Muskeln. Berliner Klin. Wochenschr., 
No. 32, 1872. 5 
Bottcher.—Vcrandervmgen dcr Netzhaut und des Labyrinthcs 
bei Fibro-sarcoma des Nerv. Acust. Archiv f. Oph. and Otol. 
Boke.—Caries des Felsenbeines. Archiv f. Ohrenheilk., 1872. 
Volkman.—Caries des Processus Mastoideus. llabilitations-schrift 
von Dr. Scheie. Ilalle. 1872. 
Lucse re-asserts that the so-called corpora amylacea of the membra- 
nous semi-circular canals are a pathological formation peculiar to the 
adult human being. He has never found them in the new-born child, 
but considers them to be produced either by local disturbances or gene- 
ral disease. He has found them in gray degeneration of the spinal 
cord, typhus and typhoid fever, tumor of the brain, tuberculosis, 
Bright’s disease, chronic ulcer of the stomach, and also in cases where 
there was a disease of the ear at time of death, as, for instance, otitis media. 
Riidinger, on the contrary, asserts that he has always been able to 
find them, at least partially developed, in man, and that, therefore, 
they are natural structures; their reaction with iodine is the same, he 
"ays, as that shown by the tunica propria and other tissues in which 
ao starch exists. He considers them papillary prominences on the 
inner surface of the tunica propria of the membranous canal, their 
function possibly being to supply a large secreting surface. 
In order to determine the cause of othematoma, Fiirstner has exa- 
mined the auricles taken from one hundred and thirty individuals of 
all ages, without reference to the cause of death, and arrived at the 
following conclusions. In opposition to the conclusions of other in- 
vestigators, he asserts that the cartilage itself contains no vessels, but 
that conical projections of perichondrium, with their vessels, run into 
its substance. Often in early life, and always in old age, the cartilage 
of the auricle undergoes the same changes which have been observed 
in other cartilages, namely, a softening consisting of three stages— 
the hyaline metamorphosis, the fibrillary and granular destruction, and, 
finally, the liquefaction of the cartilage, with the formation of cavi- 
ties. The cavities so formed contain fluid, reacting like mucin, and 
frequently occupy the whole thickness of the cartilage, presenting 
the appearance of a line of fracture ; the absence of pigment and 
hsematoidin crystals proves, however, that no fracture has taken place. 
Other changes in the cartilage of the auricle consist of new-forma- 
tions ; enchondroses, in which, by a retrograde metamorphosis, cavi- 
ties are formed, or calcification or ossification may take place ; and 
enchondromse, which Fiirstner found to be rare. 
Othiematoma he regards as always of traumatic origin, favored, per- 
haps, by some of these chronic changes in the cartilage ; the possi- 
bility of their spontaneous development from some peculiarity of the 
vessels, he absolutely denies. One preparation of an othaematoma 
showed distinctly the results of an injury, together with the preceding 
chronic process of degeneration. If, as has been so often asserted, 
this disease is much more frequent in the insane than in healthy per- 
sons, Fiirstner would assign as the reason the greater liability of such 
persons to injury. 
An unusual malformation of the hammer is described by Buck, the 
tip of the manubrium being bent forwards upon itself in the plane of 
the membrana tympani, so as to form a regular hook. 
In an exhaustive article of 100 pages, Wendt gives the results of 6 
his dissections of one hundred and sixty-eight ears taken from persons 
who died of variola, vera and hsemorrhagica. The investigations were 
undertaken with the view of determining (1) the results of the disease 
on the ear, and in how far the ear-disease was the cause of other 
diseases ; (2) the existence of the more minute tissue changes ; (3) the 
anatomical cause of the functional disturbances observed during life; (4) 
to compare the appearances during life with the results of the dissection. 
Heretofore, the difficulty of removing all the parts without disfigur- 
ing the body has been a serious obstacle, but Wendt proposes a new 
and simple method. After opening the head, a broad chisel is driven 
perpendicularly downwards, a short distance in front of the anterior 
edge of the body of the sphenoid (one and a half centimetres in front 
of a line drawn from the outer ends of the lesser wings). In this open- 
ing a narrow saw is inserted, and worked perpendicularly in a convex 
line through the lesser and greater sphenoid wings, the horizontal part 
of the temporal bone close to the vertical portion, then obliquely 
through the posterior part of the mastoid, and, finally, through the 
posterior end of the crista ossis petrosi. The remaining parts, to the 
anterior edge of the foramen magnum, are then broken through with a 
chisel, and the whole separated by the knife. The whole ear, with the 
entire Eustachian tube, is thus removed and the naso-pharyngeal cavi- 
ty exposed. 
The pathological changes found were some of them identical with 
the variolous disease, or closely related to it, while others were such as 
are found with other general or local diseases. Pustules were seen 
frequently on the auricle, occasionally in the caitilaginous, but never 
in the osseous meatus, while hyperemia and swelling of the corium, 
serous infiltration of the epithelium, with swelling of the rete Malpi- 
ghii, were not infrequent in the osseous portion of the passage. The 
same changes were found in the orifice and lower portion of the Eusta- 
chian tube which were seen in the nasal cavity, hyperaemia, haemor- 
rhage, diffuse swelling, with deposition of pus corpuscles, either be- 
tween the epithelial cells or in distinct collections and ulcerations, 
only extending, however, through the epithelium. Purulent infiltra- 
tion, with some thickening of the epithelium, was occasionally found 
in the middle ear. 
The other changes, which are not of a specific character, but such 
as are found in many diseases, were, hyperaemia, diffuse and circum- 
scribed haemorrhage, swelling and abnormal secretion of the mucous 
membrane lining the middle ear. In the few cases in which the laby- 
rinth was examined, marked hyperaemia was found in those cases where 
there was a general hyperaemia of the brain. 
From the cases examined, both before and after death, Wendt con- 
cludes that hyperaemia of the mucous membrane of the middle ear has 
little or no influence on the hearing. The interference with the hear- 
ing-power from secretion in the tympanic cavity is variable, but not 
extreme, depending on the consistence of the fluid ; the swelling of 
the mucous membrane, however, from diminishing the normal mobility 
of the conducting apparatus, and from causing abnormal connections 
between its parts, may interfere very seriously with the functions of 
the ear, and the retrogressive metamorphoses of this swelling may re- 
sult in a permanent diminution of the vibratory power of these parts. 7 
The variolous processes proper, "Wendt considers, heal -without inju- 
rious effect on the ear, as he has never found stricture, contraction or 
obliteration in the tube as the result of that process. The other pa- 
thological processes, however, which are not characteristic of variola, 
may produce the same changes as result from catarrhal inflammations 
in many general diseases, and one of the most interesting results of 
his observations is the minute and accurate description of the condition 
of each part of the ear in these catarrhal inflammations. 
Politzer gives the results of his experience in accidental ruptures of 
the membrana tympani, more especially in those caused by a blow on 
the ear, calling attention to the importance of these cases in medico- 
legal medicine and the little that is said on the subject in forensic 
works. The early examination of the membrane is of the greatest 
importance, as the appearance of the opening is so characteristic that 
it can be determined from that alone whether the opening is the result 
of injury or of disease. Ruptures from injury have been generally 
described as a simple tearing of the membrane on the posterior segment, 
parallel with the manubrium, the edges lying in contact and only sepa- 
rating when air was forced through. Politzer, however, considers that 
such a condition is the exception, for in most of his cases there was a 
wide opening, owing to the retraction of the fibres. The position of 
the rupture was more frequent on the posterior and lower than on the 
anterior half of the membrane, and usually midway between the hammer 
and tendinous ring; its form, either round or oval. The remainder of 
the membrane, with the exception of a slight congestion along the 
hammer, is normal. The resulting deafness is variable ; most marked 
when the labyrinth has also suffered from the concussion. 
Where the membrane alone has suffered, the deafness is slight, the 
watch and voice are heard fairly, the tuning-fork on the head is heard 
only in the injured ear and subjective noises are wanting. It some- 
times happens that the force of the blow is expended on the labyrinth 
without injuring the membrana tympani, and in these cases, which 
are much more unfavorable, there is a great degree of deafness, violent 
subjective noises, and the tuning-fork is heard in the uninjured ear. 
Occasionally, rupture of the membrane is combined with concussion 
of the labyrinth. 
One characteristic of a rupture from injury, as distinguished from 
one from disease, is the perforation whistle when air is blown through. 
In a traumatic rupture, the air passes through with a broad, deep 
sound, but in a pathological perforation with a sharp whistling ; the 
force necessary to produce the sound is also much less in the former 
than in the latter case. The course of the injury, where the labyrinth 
is unaffected, is generally favorable, the opening closing without 
marked inflammatory reaction, as Politzer says, generally by a growth 
from the inner layer of the membrane first. Some days after the injury, 
a greyish-yellow membrane is seen to be “pushed over” the rupture 
from the inside, and, after this membrane has entirely closed the open- 
ing, the torn edges of the cutis can still be seen for several weeks. A 
suppurative inflammation of the membrana tympani or middle ear is 
occasionally seen after a traumatic rupture, but is, according to Polit- 
zer, usually the result of an irritating treatment, such as instillations. 
The restoration in these cases is often perfect, but occasionally the 
inflammation becomes chronic, and a permanent opening, with greater 
or less deafness, remains. 8 
In the majority of ruptured membranes, the functions of the ear are 
completely restored. Where changes have taken place in the middle 
ear as the result of suppuration, or where the labyrinth has suffered 
from severe concussion, deafness of variable degree may remain. In 
concussion of the labyrinth, the hearing may be restored, even after 
weeks, but more frequently some disturbances of the ear remain for 
life. 
The treatment of these ruptures is simple : local applications and 
syringing are to be avoided ; the exposed mucous membrane of the 
tympanum should be protected by excluding the air. In concussion 
of the labyrinth, Politzer claims to have improved the hearing by the 
constant electric current. 
In a legal point of view, it is all important that an examination of 
the affected ear should take place within a few days of the injury, for 
after that time, as cicatrization may have taken place, it may be impos- 
sible to say whether rupture had existed or whether any existing deaf- 
ness is due to the injury. A suppurative inflammation from an injury 
cannot be distinguished from a primary suppuration. 
The degree of injury to the ear may be regarded as slight when the 
labyrinth has escaped concussion and when the rupture heals so that 
the hearing is perfectly restored ; as severe when the labyrinth has 
suffered, and when, after cicatrization has taken place, repeated ex- 
aminations during several months still show some disturbance of func- 
tion. The injury may also be called severe when suppuration has su- 
pervened and permanent changes in the middle ear, such as adhesions, 
have resulted therefrom. An observation of, at least, three months, 
may, in some cases, be necessary before testimony could be given in 
regard to the permanency of pathological changes, as the ear may 
require that time to recover from a concussion of the labyrinth. 
Concussion of the labyrinth without injury to the membrana tym- 
pani gives no objective appearances, and it is impossible, from the 
examination, to decide whether an injury is the cause of the existing 
disease in the ear. 
The investigations of Blake are of interest, both from a physiological 
and pathological point of view. They were undertaken with a series 
of Konig’s steel rods, and carefully carried out. From them it would 
seem that the perception of high musical notes depends on the con- 
ducting rather than the perceptive apparatus of the ear, and varies, 
diminishing with increasing age or with thickening of the mucous 
membrane of the tympanum, but increasing with increased tension of 
the membrana tympani. In perforations of the membrane, the per- 
ception for high notes increased, but varied somewhat according to 
the size and seat of the opening, and the tension of the conducting 
apparatus, being greatest where the perforation was on the posterior 
part of the membrane and of large size. A number of cases where it 
was necessary to make an artificial opening in the membranes were 
used for testing the truth of the observations, with the result of an im- 
proved perception for the notes, after the operation, the increase in one 
case being from 35,000 to 80,000 vibrations. In most cases of chronic 
catarrhal inflammation of the middle ear, the limit of perception was 
35,000 vibrations, but it occasionally reached 40,000 and 50,000 ; in these 
latter cases, however, the membrana tympani was much drawn inwards 
and consequently very tense. Two cases of voluntary contraction of 9 
the tensor tympani muscle showed clearly the improved perception 
from increased tension of the membrane, the hearing for high notes 
increasing in one case by 5000, in the other by 10,000 vibrations, 
during the contraction of the muscle. 
Gruber was led, from the difficulty which he experienced in remov- 
ing a bean from the ear, to experiment on the possibility of causing 
such swollen vegetable substances to shrivel up so that they could be 
more easily removed. After trying a large number of solutions, the 
only effectual ones for this purpose were found to be sulphate of zinc 
(0.2 to 30) and lime water (10 to 30). In the case in which a bean 
had been impacted and become so swollen that it could not be removed, 
he was, by means of an instillation of sulphate of zinc, enabled so to 
reduce its size that removal was very easy. 
Jacoby publishes a series of fifteen cases of otorrhcea, treated by 
means of galvano-caustic, in addition to the four already published by 
him; all of them were complicated by polypoid granulations, or by 
polypi, and the results of the treatment were very favorable, although 
he fails to show that the same results could not have been obtained by 
other caustics. 
For the purpose of more thoroughly cleansing the posterior nares 
than is possible by the common form of the nasal douche, Schultze 
uses a metallic tube, resembling an Eustachian catheter, closed at the 
end and with numerous perforations. This being attached to a com- 
mon douche, it is possible, by turning the instrument, to shower any 
part of the cavity desired. 
In cases of so-called chronic dry catarrh of the tympanum, in which 
no marked changes in the curvature of the membrana tympani were 
visible, Lucse has used, with good effect, injections of chloral hydrate 
(1.0 to 30.0). A few drops of the fluid were injected through the 
catheter every third or fourth day, and in those cases where the treat- 
ment was of avail an improvement was noticed after the second or 
third injection. The action of the medicine is that of an irritant, and 
the reaction from the injection may be quite severe, but is of short 
duration. 
In eleven per cent, of his cases, there was a very marked improve- 
ment of the hearing, and in twenty-five per cent, a slight improvement. 
The results gained by the use of this solution he has found to be 
more permanent than those obtained by other means. 
Weber considers that in many of the hitherto incurable forms of chro- 
nic catarrh of the middle ear, the primary trouble is a disease of the 
muscles of the Eustachian tube and middle ear. The cases are those of 
gradually progressive deafness, associated frequently, but not necessa- 
rily, with a catarrhal inflammation of the naso-pharyngeal mucous mem- 
brane ; beginning on one side, most frequently on the left, with subjec- 
tive noises, but without other symptoms, and going on to almost com- 
plete loss of hearing. He thinks that, as far as the membrana tympa- 
ni and chain of ossicles are concerned, it depends chiefly on those 
muscles which bring the parts in contact with the labyrinth whether we 
hear well or not, and whether the labyrinth is pressed upon abnormally. 
It is also well known that the palatine and tubal muscles serve to ven- 
tilate the tympanum, and that the tensor tympani muscle is in close 
relation with the tensor veli palati. If, then, the tubal muscles are 
diseased, especially the tensor veli, he considers that the tympanic 10 
muscle also suffers, and the whole mechanism of the acoustic apparatus 
is affected. 
The disease of the mxiscles consists in a weakness or complete pa- 
ralysis, or else in a spasmodic contraction, and may be caused either 
by general disease, such as chlorosis, anaemia, hysteria, or by local 
hyperaemia or inflammation set up from the inflammation of the mu- 
cous membrane. 
The ti’eatment which "Weber claims to have used with marked effect, 
is, first, to remove the inflammation of the naso-pharyngeal mucous 
membrane, and then to treat the disease of the muscles by electricity. 
For this purpose he considers it necessary to apply both the constant 
and the induced current along the course of the muscles. This he 
does by inserting one electrode directly in the Eustachian tube by 
means of an elastic rubber catheter, and the other in the pharynx, 
uvula, side of the neck, or vertebral column. The electric current re- 
quires to be used with care, and not applied frequently or strong 
enough to produce much irritation. One of the first effects is a com- 
plete cessation of the noises for a short time, and then for longer and 
longer intervals. The earlier this treatment is used, the better and 
quicker is the result. 
These views of Weber’s on the pathology of this disease are based 
on a number of dissections published by him in the Monatschr. f. Oh- 
renheilk., in which the only disease found was a fatty degeneration of 
the muscles of the tympanum. 
In a case of fibro-sarcoma of the brain with consecutive blindness, 
deafness, perverted taste and other functional disturbances, Bottcher 
found that the tumor extended to the labyrinth through the porus 
acusticus internus. The acoustic and facial nerves retained their 
outward form, but the nerve-sheath was imperfect, being broken 
irregularly into scales. All the canals of the modiolus, through which 
the nerves normally pass, were filled with a nucleated connective tissue 
and a large number of bloodvessels, and around the vessels was much 
brown pigment enclosed in caudate cells. No signs of any nerve 
elements could be found in the whole modiolus, and the lamellae of the 
lamina spiralis ossea were filled with a transparent nucleated connec- 
tive tissue. The inner and outer hair-cells were atrophied, but the 
other portions of the cochlea remained intact. The nerve fibres of the 
vestibule could not be found, and there was a marked atrophy of the 
ganglion geniculi of the facial nerve. 
At the Naturforscher-Versammlung, Boke showed a number of inter- 
esting and new preparations of caries of the petrous bone. In one, 
the tympanum and external meatus were converted into one large 
carious cavity, the roof of the tympanum was largely destroyed, the 
fossa sigmoidea and incisura mastoidea were perforated, and yet the 
external lamella of the mastoid process remained intact. The patient 
had had an otorrhcea for years, and finally died with the symptoms of 
tuberculosis of the lungs. A paralysis of the facial nerve appeared a 
few weeks before death. The autopsy revealed an abscess of the 
middle lobe of the brain on the same side as the ear disease. In a 
second preparation, the fossa sigmoidea was perforated; other parts 
were free from caries. The otorrhcea was of two years’ duration; brain 
symptoms showed themselves six days before death, and the autopsy 
revealed an abscess of the brain, which communicated with the ven- 11 
tricle on the same side as the ear disease. A third preparation showed 
cicatrices on the membrana tympani and the mastoid cells, filled up 
with a compact, newly-formed mass of bone, the result of a long-con- 
tinued otitis media. Several cases were related of otitis media without 
caries, in which death occurred from abscess of the brain. 
The result of Boke’s observations is that in long-continued otorrhoea 
it is impossible to determine with what deep changes we have to deal; 
in many cases the external ear shows no disease, when the bone and 
even the brain may be already affected. 
In caries of the petrous bone, the symptoms during life are by no 
means proportional to the anatomical changes found, and a precise 
method of treatment cannot be given. Boke has found that in most 
cases astringents and caustics increase the acute symptoms and do not 
diminish the otorrhoea. He advises merely the removal of the dis- 
charge by warm water injections ; polypoid growths should be removed 
with the greatest care, as frequently carious bone lies behind them, 
which may cause serious trouble. Abscesses over the mastoid should 
be opened, and if the bone is found softened and carious it should be 
removed; he does not approve, however, of trephining the healthy bone. 
In five cases in which the mastoid process was found to be either 
distinctly carious or much softened, Yolkmann laid bare the bone, and 
the carious portions were scraped out with a sharp spoon. In from 
three to ten weeks, cure of the caries resulted in all the cases. In one 
case, it was necessary to repeat the operation once.