a knowledge of aural anatomy and surgery in England; for his book, which was published in Paris in 1683, was translated into English after his death, and published in London in 1737, being thus, though a translation, the first special treatise in point of time upon aural medicine or surgery in our language. This is now very scarce, yet there can, I think, be little doubt but that Mr. Saunders availed himself largely of it. However, to Du Verney, and not to Lallemand and Itard, we are indebted for the prejudice that up to this day exists with regard to the treatment of otorrhoea. But the latter were the more reprehensible, as from the age in which they lived, and the giant growth of medical knowledge subsequent to the time of the former, they should have known better; but I believe, like many modern practitioners, they chose rather to transmit the prejudices of one hundred and fifty years before, than take the trouble of investigating for themselves.

Without entering minutely into the history of aural medicine during the latter part of the seventeenth century, which, after all, would consist in the enumeration of the Latin writings of various Continental authors, more curious than instructive, let us pass on to the penultimate century of our own period, when aural medicine first dawned in Great Britain.

In 1713, Peter Kennedy published in London a little work styled "Ophthalmographia, or, a Treatise on the Eye," to which is added an Appendix of some of the diseases of the ear, wherein is observed the communication between these two organs; the latter part consists of about ten pages.

It is remarkable, that the discovery which Eustachius made of the tube which bears his name had no practical influence upon this branch of medicine, and that for nearly two hundred years surgery made no effort at availing itself of this knowledge, for the purpose of remedying diseases of the ear. In 1724, M. Guyot, a postmaster of Versailles, proposed to the Parisian Academy of Sciences to inject the Eustachian tube, by means of a catheter introduced through the mouth, for the removal of obstructions in that canal, and also in the middle ear. It seems, however, that the French academicians were not sufficiently aware of his valuable discovery, or at least proposal, for it is a question whether he ever performed the operation himself.

In 1741, Archibald Cleland, an English army surgeon, published in the Philosophical Transactions an account of "instruments proposed to remedy some kinds of deafness, proceeding from obstructions in the external and internal auditory passages." The first of these consisted of a convex glass, three inches in diameter, fixed in a handle, into which is lodged some wax candle, which when lighted will dart the collected rays of light into the bottom of the ear, or to the bottom of any cavity that can be brought into a straight line." Insignificant and incomplete as this instrument of Cleland undoubtedly was, it is, nevertheless, deserving of our attention, inasmuch as to it may be traced the subsequent inspector auris of Deleau, of Itard, Buchanan, and Kramer. The principal object of Cleland's inspector for throwing a stream of artificial light into the meatus was for the purpose of discovering the presence of hardened cerumen, which he removed by means of a jet of medicated steam, "but if," says he, "this has not the desired effect, and the person still remains deaf, the following instruments are made to open the Eustachian tube; if upon trial it should be found to be obstructed, the passage is to be lubricated by throwing a little warm water into it, by a syringe joined to a flexible silver tube, which is introduced through the nose into the oval opening of the duct, at the posterior opening of the nares, towards the arch of the palate." This catheter had affixed to it a sheep's ureter, to the other end of which was attached the syringe, "whereby warm water may be injected; or they will admit to blow into the Eustachian tube, and so force the air into the barrel of the ear, and dilate the tube sufficiently for the discharge of the excrementitious matter that may be lodged there." He likewise used probes, of the same size as the catheters, to explore the tube. Cleland was either unaware of, or disbelieved, the account of Guyot's having introduced an instrument into his own Eustachian tube through the mouth, nineteen years before; for in his essay in the Philosophical Transactions he does not once allude to the circumstance. To the English surgeon, however, is undoubtedly due the merit of having first introduced a catheter into the Eustachian tube through the nose, the only certain way, I believe, of performing such an operation.

In May, 1755, Mr. Jonathan Wathan published a more de

tailed essay in the Philosophical Transactions, on "a method proposed to restore the hearing when injured from an obstruction of the tuba Eustachiana. This gentleman, who seems to have been a good practical anatomist, as well as a dexterous surgeon, had an opportunity of making a post-mortem examination in a case of deafness, wherein it was found that both Eustachian tubes were "stuffed quite full of congealed mucus." If Cleland overlooked, or was unacquainted with the proposed operation of the Versailles postmaster, Wathan seems to have completely overlooked the more recent and effectual discovery of Cleland; but in allusion to the post-mortem examination to which I have just referred, he says, in the commencement of his very admirable essay: "As all these concurring circumstances strengthen me in my opinion, they likewise incited me to make trial of an operation that was some time ago proposed to the Academy of Sciences by M. Guyot, but the author having never practised it, he wanted the recommendation of facts to support and enforce it, it was, therefore, rejected by them as impracticable." And in a note, he adds, that Guyot having recommended the introduction of it through the mouth, which is quite impossible, "Petit proposed, and that learned and skilful anatomist, Mr. John Douglas, first demonstrated the possibility of passing the probe through the nose into the Eustachian tube, and to him I freely acknowledge myself indebted for the hint." The catheter used by Mr. Wathan was not much larger than a common-sized probe, and was bent a little at the end, very nearly in the same form as that used by Kramer, the distinguished Prussian aurist; and with this and a syringe he injected and washed out the Eustachian tube and middle ear. There can be no mistake about the mode of Wathan's proceeding, for he has given a very good representation of the operation in a plate attached to his essay in the Philosophical Transactions.

I have dwelt thus long upon the introduction of instruments into the Eustachian tube, as that operation formed the second, and, perhaps, one of the greatest epochs in the history of this art, because the merit is due to our own countrymen, and because the English works upon aural surgery are not sufficiently explicit upon this point, and many of the Continental ones are altogether

uninformed with regard to it,-Dr. Kramer, in his critical literary review, being under the impression that Guyot had really introduced the catheter through the mouth.

The essays of Cleland and Wathan, imperfect as they were, were decidedly the greatest addition to aural surgery made in the eighteenth century, and had the discoveries and valuable observations of these practical men been followed up in England, it is probable we would now be far in advance of our Continental neighbours. I would strongly recommend a perusal of Wathan's paper, as the cases he describes are most valuable in the diagnosis of obstruction of the Eustachian tube.

So early as 1842 I was familiar with, and have since frequently pointed out to many of my medical friends and pupils a peculiar form of deafness, in which the membrani tympani had fallen in towards the inner wall of the middle ear,-had lost much of its vibratory power, and in which, when examined under a good light, the handle of the malleus may be seen appearing to press outwards in strong relief. In this affection, which, I have reason to believe, is very often mistaken for nervous deafness, we have what may be termed short hearing, from an alteration in the vibratory membrane of the ear, in like manner as we have short sightedness, or myopia, sometimes arising from a peculiar alteration in the curve of the cornea. I find, however, upon carefully perusing the paper of Cleland, that he had some idea of what I have here described, and of its being produced, as I have known it to be in some cases, by accident. "There is," he says, "another kind of deafness, which proceeds from a violent clap of thunder, noise of a cannon, or the like. In this case it is probable that the position. of the membrana tympani is altered, being forced inwards upon the small bones, and so becomes concave outwardly. In this case no vibration of sound will be communicated to the drum until the membrane has recovered its natural position."*

During the remaining half of the eighteenth century I have little to record; the art does not appear to have advanced a single step, either in Britain or any other part of Europe, Books and

Philosophical Transactions, vol. xli. part. ii. p. 850.

essays were written, no doubt, but their authors added little to the labours of their predecessors. The great majority of these writings emanated from the German press, as, for instance, those of Gniditsch, Wildberg, Milloradovics, Kritter, Arnemann, and Lentin. Of the French school may be mentioned Desmonceaux and Leschevin; the writings of the latter will be found in the Memoirs of the Royal Academy of Surgery of Paris for 1763. Having lately had occasion to examine this dissertation, which was undoubtedly the best of its day, I am bound to say that the lavish praise bestowed upon it by the French, and the severe criticisms of the German writers, within the last few years, were alike unmerited.

Up to the close of the eighteenth century no special work upon the diseases of the ear had appeared in England, with the exception of the translation of Du Verney, to which I have already alluded. English works have, it is true, been enumerated by foreign writers, but they were not written upon the diseases, properly so called, but on the congenital defects of the organs of hearing. These I have specified in that portion of the work relating to the instruction of the deaf and dumb.

In 1788 Dr. Peter Degravers, who styled himself Professor of Anatomy and Physiology, published in Edinburgh "A Treatise on the Human Ear," as an Addenda to the second edition of his "Physico-Medical and Chirurgical Treatise on the Human Eye." This tract consists of 62 pages, and is divided into three Parts :-The Anatomical Exposition; The Physiological Inquiry into the Origin of Sounds; and the external and internal Disorders of the Ear. The work, though very much beneath that of the author's Observations on the Diseases and Operations of the Eye, is yet intelligible enough, and came up fully to the state of knowledge on aural surgery at that time. It is generally believed that Sir Astley Cooper was the first person who perforated the membrana tympani. Degravers, however, tells us in his essay that he completely removed the tympanal membrane in one case; and again he says: "I incised the membrana tympani of the right ear with a sharp, long, but small lancet. I left the patient in that state for