of bitters," lest the affection might be "owing to the stomach." The human stomach has much to answer for in deranging the system generally, no doubt; but the mischief of which it is daily accused, as every one extensively engaged in practice is well aware, is beyond belief. There is scarcely a disease which we treat, no matter how local, upon which, if we question the patient as to its duration, that he will not say, "Oh! it is, indeed, of pretty long standing, but I was waiting to have my stomach put to rights, as I am told I am very bilious." Next in order, blistering behind the ears is tried, in order to draw away some peccant humour that had, perhaps, accumulated round the delicate organ of hearing. These and such like methods failing to give relief, stimulants, often of a very acrid nature, are poured into the external auditory passages, either to restore the secretion,-under the impression that what is a mere attending symptom is the disease, or to excite or rouse the dormant nervous power; and hot tinctures, turpentine, creasote, and pungent essential oils are applied to the external surface of the tympanal membrane without mercy. Some practitioners resort to more palliative means, recommending some warm almond oil to be dropped into the ear at bedtime, or eau de Cologne to be rubbed upon the side of the cheek adjoining the auricle, at the same time advising a little black wool to be retained in the meatus, in order to preserve the organ from cold. To give, however, fair play to the latter remedy, it should be prescribed in full, and according to the old popular superstition, but one which is still extensively resorted to, the wool should be procured from the left fore-foot of a six years' old black ram! Some advise a slice of fat bacon to be inserted into the meatus every second night; and glycerine is now the fashionable remedy. All these means having failed to give relief, the patient is frequently recommended-an easy mode of getting rid of him-to give galvanism and electricity. a fair trial; and if they do not succeed, change of air and scene, sea-bathing, or a course of waters" at some of the fashionable places of resort for that purpose is prescribed. Despairing of relief from the legalized practitioner, and getting disheartening

This work is the result of the experience thus acquired. Detached portions of it, clinical lectures, and cases observed at St. Mark's Hospital, have already appeared in the periodicals of this country, and some of these essays have been translated and published separately on the Continent. All these, together with much additional information gleaned since their publication, are embodied in this book, which does not profess to be a complete system of Aural Surgery, giving a full description of all the diseases of the Ear which have been recorded by authors; but is intended to supply the reader with a practical treatise on the most frequent and urgent affections of the organ of hearing, and those that I myself am best acquainted with. It may, therefore, be regarded somewhat in the light of a monograph, a form of publication peculiar to this School, and one generally containing more useful and practical information than either a large systematic work or a manual.

In studying the diseases of the Ear, my object has been to take as a basis the principles of pathology: and to reduce their treatment, local as well as general, to the recognised rules of modern therapeutics and scientific surgery; but, above all, I have laboured to divest this branch of medicine of that shroud of quackery, medical as well as popular, with which, until lately, it has been encompassed.

Country friends often ask me, "Have you found out any new cure for deafness?" I do not profess to invent or introduce new remedies. I try to make the well-established rules of practice in the treatment of other organs applicable to the management of aural diseases. Like most students, I was taught during my apprenticeship theoretically to believe, and practically to observe, that we knew nothing about the diseases of the organs of hearing." This was the dictum honestly expressed by the "heads of the Profession,"-men from whom the public were willing to receive a fearless, candid opinion, either immediately on being consulted, or after a few trials of the "ordinary means;" to wit, syringing with hot water and soap, either Castile, soft, yellow, or old brown Windsor, in the hope that the deafness or the noise in the ears might arise from a collection of hardened wax ;-then setting the digestive organs to rights by purgation, and a "course

of bitters," lest the affection might be "owing to the stomach." The human stomach has much to answer for in deranging the system generally, no doubt; but the mischief of which it is daily accused, as every one extensively engaged in practice is well aware, is beyond belief. There is scarcely a disease which we treat, no matter how local, upon which, if we question the patient as to its duration, that he will not say, "Oh! it is, indeed, of pretty long standing, but I was waiting to have my stomach put to rights, as I am told I am very bilious." Next in order, blistering behind the ears is tried, in order to draw away some peccant humour that had, perhaps, accumulated round the delicate organ of hearing. These and such like methods failing to give relief, stimulants, often of a very acrid nature, are poured into the external auditory passages, either to restore the secretion,-under the impression that what is a mere attending symptom is the disease, or to excite or rouse the dormant nervous power; and hot tinctures, turpentine, creasote, and pungent essential oils are applied to the external surface of the tympanal membrane without mercy. Some practitioners resort to more palliative means, recommending some warm almond oil to be dropped into the ear at bedtime, or eau de Cologne to be rubbed upon the side of the cheek adjoining the auricle, at the same time advising a little black wool to be retained in the meatus, in order to preserve the organ from cold. To give, however, fair play to the latter remedy, it should be prescribed in full, and according to the old popular superstition, but one which is still extensively resorted to,—the wool should be procured from the left fore-foot of a six years' old black ram! Some advise a slice of fat bacon to be inserted into the meatus every second night; and glycerine is now the fashionable remedy. All these means having failed to give relief, the patient is frequently recommended—an easy mode of getting rid of him-to give galvanism and electricity a fair trial; and if they do not succeed, change of air and scene, sea-bathing, or a course of waters" at some of the fashionable places of resort for that purpose is prescribed. Despairing of relief from the legalized practitioner, and getting disheartening

opinions from men of eminence and repute, we need not wonder that suffering patients throw themselves into the hands of quacks and nostrum-mongers.

Moreover, the difficulties which beset the student in acquiring a knowledge of the anatomy of the ear, owing to the exceeding minuteness of the organ itself, the great difficulty of dissecting it, from its depth, the complexity of its structure, and the small, hard bone in which it is placed, as well as the number of crabbed names attached to its different parts, all of which have made it a sort of anatomical crux, which no one wishes to remember longer than the day after he has passed his examination, have conduced not a little to strengthen the belief in the doctrine promulgated by his instructors, that little or nothing could be done to reach the diseases of so delicate and intricate an organ.

Now, notwithstanding the remarks which we hear daily in society, or which we meet with in the periodic and "manual" literature of the day,-that the treatment of diseases of the ear is an opprobrium to medicine,-the progress which this branch of medical science is making is in all probability as rapid as that in any other department of the healing art. Among the many causes from which this opinion has arisen, there are two which must pre-eminently attract the attention of any person conversant with the subject, or who will calmly examine into the question. The first is, that heretofore the treatment of those diseases has been committed to the hands of the most uneducated quacks and charlatans, male and female,-persons totally unacquainted with the first rudiments of medical knowledge; the second, that medical men themselves-most astute and practical physicians and surgeons in all other respects-treat diseases of the ear certainly in a manner that savours of empiricism, by prescribing nostrums, of both a local and general character, which we know they would never think of using in similar forms of disease in any of the other organs of the body. This latter cause evidently results from want of proper attention to the subject in our schools, and from the practice of prescribing at random for diseases, the diagnosis and pathology of which are generally unknown.

To both these causes may be added others that, to a certain degree, serve to bias the public mind against the treatment of aural diseases. In many cases, there is either an unconsciousness of the insidious approaches of deafness, or an unwillingness to admit even the possibility of such an occurrence; or, again, there is an apathy, to a greater or less degree, on the part of those affected with deafness, and a delay in seeking advice, which is scarcely credible. Persons who, if they suffer the least inconvenience in any of their functions, or the slightest interference with the due exercise or healthy condition of any of the other organs of sense, would immediately apply for medical relief, and submit to any, even the most severe form of treatment, will patiently permit the sense of hearing to be greatly impaired, nay, even lost on one side, without making any effort for its restoration. When the lapse of months, and even years, have contributed to confirm disease and render such persons incurable, they generally respond to inquiries with regard to previous treatment, that they did not like to be "tampering" with their ears, or, that they were told nothing could be done for them.

It would in no wise conduce to the practical effect to which I hope this work may tend, to inquire into all the causes of these results: I may, however, mention, that medical men themselves have in part conduced to produce this want of faith on the part of the public, either by direct opinion as to the incurable nature of the disease or diseases known by the symptom of deafness, or by such futile treatment as broke down the confidence of the patient in any remedy for diseases of the organs of hearing. It is true that cases of what are termed "nervous deafness," that is, of defect in the hearing function of the acoustic nerve in any part of the internal ear, from paralysis or other causes,- -or of those portions of the brain which preside over the faculty of hearing, or give origin to, or are connected with the portio mollis of the seventh pair of nerves,-in fact, such cases as are analogous to amaurosis,—are as intractable as that disease of the eye;-yet I fear not to reiterate the assertion which I made upon several former occasions, that if the diseases of the ear were as well studied or understood by the generality of practitioners, and as early at