some time, and afterwards observed that it had re-united...

I incised again the membrani tympani of the right ear but crucially; and on removing the parts of the membrane incised, I discovered some of the ossicula, which I brought out."

During the eighteenth century the anatomy of the organ of hearing was further studied by Valsalva, in his work "De Aure Humana Tractatus," published at Bonn in 1704; and by I. F. Cassebohm, whose book, "Tractatus Quatuor Anatomici De Aure Humana, Tribus Figurarum Tabulis Illustrati," appeared in 1734. These writings, with subsequently those of Scarpa, Soemmering, and, in later times, of Arnold, have rendered the anatomy of the organ of hearing very complete. Mr. T. Wharton Jones has embodied all that was known upon the subject when he wrote the article "Organ of Hearing" in the Cyclopædia of Anatomy in 1838.

The members of the Medical Society of London, instituted in 1773, and composed of the physicians, surgeons, and apothecaries of that time, were not insensible to the low condition in which aural medicine stood toward the end of the last century, and in their valuable memoirs will be found some scattered notices upon the diseases of the ear, from the pens of the president, Dr. Sims, as well as from Mr. Houghton, Dr. Zeucker, a Prussian, and Dr. Roslet of Ostend. Most of these papers contained post-mortem examinations of cases of deafness, a practice that, with the honourable exception of Mr. Toynbee, has not, I regret to say, been followed up, and very much to the detriment of aural medicine. In Dr. Sims' essay he entered into a physiological discussion regarding the nature of the Eustachian tube, the object of which was to show, that while we heard all external sounds through the meatus externus, we were conscious of our own voice only through the Eustachian tube. The practical part of his paper is, however, exceedingly valuable, particularly with respect to the manner of pressing air through the tube into the middle ear, by closing the mouth and external nares, and then making a forced expiration; but this had been already explained by Cleland in 1741.

In 1775 James Graham published in London "Thoughts on the Present State of the Practice in Disorders of the Eye and Ear,”

8vo.; and in 1780 J. Elliot made his "Philosophical Observations on the Senses of Vision and Hearing." Still, at the conclusion of the last, and about the beginning of this century, aural surgery and medicine were at a very low ebb, particularly in Great Britain. This want of knowledge by the regular practitioner upon the subject of diseases of the ear was, however, soon taken advantage of, not only by professed quacks and nostrum-mongers, but by the electrical, galvanic, and magnetic doctors of that day, who corresponded to the homœopaths, hydropaths, and mesmerisers of the present. At the period to which I allude, galvanism, magnetism, and electricity, together with the celebrated metallic tractors, were applied to the ears of persons labouring under deafness, and numerous and wonderful were the cures vaunted in the periodicals of the day, as having been effected by these remedies;

-cures almost equalling those lately said to be performed on the eye by prussic acid: while secret, but never-failing acoustic drops, stimulating embrocations, and the like impostures, were pawned upon the public by all those who had ingenuity and effrontery enough to make money after that fashion. And here let us for a moment digress from the direct course of our subject to answer a question that is often propounded-Why is it that the empiric and the pretender, either licensed or unlicensed,-for in these days there are as many and as impudent quacks with as without diplomas,-why is it, one is often asked, that the charlatan frequently succeeds in practice better than the honest practitioner? By the term success, we do not mean professional success in his art, but pecuniary success in life, and esteem among those with whom money "makes the man." Now although we cannot always answer this query, nor would the same explanation be applicable to every instance, we can, however, assert one fact, which in a great measure contributes to the success of the quack, and it is this,—the hearty response of his patients to the lesson picked up from the showman-" speak a good word to your friends outside." Let any well-educated, honest practitioner be called on to treat an urgent and alarmingly dangerous case, where insidious death stands at the sick man's door-let him bring all the powerful acquirements of long years of patient study and observation

C

of disease—his anatomical and pathological knowledge-an eye practised to disease, and a head stored with the sound, rational, scientific, practical principles of his art-let him add to this the kindness of a friend, nay, often the benevolence of a benefactor— let him pass anxious days and sleepless nights watching each turn of disease in his patient, and ministering to every of the many wants that attend the bed of lingering sickness-let him do all this, and finally (under Providence) restore the patient to health and to his friends-stand, as we may say, between the living and the dead, beckon back the approaching king of terrors, and give again to society a valuable life, and to the trembling, anxious family their only earthly means of support-what is his reward? He is, generally at least, paid his fee, and the patient and his friends are generous enough to say they feel grateful for all his kind attention, for we will not curtail it of whatever good feeling may be shown on the occasion. But compare this with a patient who imagines he is cured of an imaginary disease by a water doctor, or an atom doctor, an electro-biologist, a mesmeriser, or a magnetiser, is he not immediately converted into a partisan? -does he not become a missionary for the nostrum-monger?— does he not go about from house to house detailing the miracle of his cure, the skill of the doctor, the horrors of the regular practitioner, and the great benefit conferred upon mankind by being converted into hydraulic machines; or expressing his surprise that people will go about their ordinary business "clothed and in their right mind," like the man from whom the seven devils were cast out, instead of being wrapped in a wet sheet, or enjoying a sitz-bath for ten hours a day; while others will wait upon you specially, to beg and entreat you will not convert your poor stomach into an apothecary's shop by taking all that "doctor's stuff," instead of procuring rest and ease to all your ills by just such an anodyne as would be formed by pouring one drop of laudanum into the Bosphorus, where it leaves the Euxine, and drinking a thimble-full of the same water where it enters the Mediterranean! But, not content with this, these medical missionaries abuse all regular practitioners, and often force (for humanity's sake, as they say) the charlatan upon the patient, who then trusts to his address for future fame and profit.

In 1793 Jasser revived the old operation of perforation of the mastoid process for the purpose of injecting the middle ear; but as the success attending this procedure must be very doubtful, and the hazard very great, it is never resorted to in the present day.

Several experiments had been tried by anatomists and physiologists upon dogs and other animals, in order to discover whether the function of hearing could be carried on with a perforate, or imperfect membrana tympani. These investigations upon the lower animals being deemed inconclusive, Mr. Cheselden, the father of English surgery, proposed to experiment in this matter upon the living human subject, and for this purpose a condemned criminal was pardoned, on condition of submitting to the operation! but a popular outcry prevented its being put in force!* Some years afterwards, Sir Everard Home, in his article upon the muscularity of the membrana tympani, having expressed his desire to know the result of perforation or destruction of this membrane, Mr., afterwards Sir Astley, Cooper, published a letter in the Philosophical Transactions for the year 1800, entitled, "Observations on the Effects which take place from the Destruction of the Membrana Tympani of the Ear." Although this paper did not advance our practical knowledge upon the subject, yet it called the attention of British surgeons to the treatment of this important organ, and put an end to a very generally received notion among the profession, that hearing would be totally lost on the opening of the membrana tympani; notwithstanding that a couple of hundred years ago it was believed by anatomists that an aperture existed in this structure, as a normal condition during life.

In the following year Cooper published an essay in the same work on the perforation of the membrana tympani, as a means of removing deafness caused by obstruction of the Eustachian tube,

• This case is referred to in Walpole's Reminiscences, where it is stated that the criminal was Cheselden's cousin, and that he was pardoned at the intercession of Lady Suffolk (mistress to George II.), who, being herself deaf, wished to have the experiment tried. The surgeon lost the royal favour, it is said, by the circumstance. This story may, however, be but one of the petty scandals of the day.

and a consequent want of vibration in the tympanal membrane. This paper commenced a new era, and opened up a wide field in aural surgery. Like all discoveries in medicine, however, it was at the time, and in other hands, too frequently had recourse to, and often misapplied. The brilliancy of this operation, and, in some instances, its instantaneous effects, urged men to employ it who were totally ignorant of its application, as well as of the structures and diseases of the organs of hearing generally; so that it soon fell into disuse, and although recommended by this high authority, the superior instruments we now possess of diagnosing with greater accuracy the condition of the middle ear, and its internal faucial aperture, by means of the air-douche, and also owing to the comparatively few cases of deafness solely depending on closure or stricture of the Eustachian tube, have rendered its performance much less frequently necessary than was at first supposed. Himley, Itard, Deleau, Fabrigi, and others, improved and modified the instruments and the operation of Cooper. This may be termed the third epoch in our art; the two first being the application of the speculum by Fabricius, and the introduction of Eustachian catheterism by Cleland.

I cannot conclude this notice of Sir Astley's improvement, without quoting the pertinent and judicious remarks with which he closes his memoir-advice and remarks which, I regret to add, have been but little attended to, but which are as applicable to the present time as they were to the period when they were written.

"I hope others will be induced," he says, in alluding to the success of his operation, "to second my feeble efforts, and to direct their attention to a subject which appears to be of the highest importance, and to have been too much neglected by medical men; for a knowledge of the structure of the ear is by no means general in the profession, and still less are its diseases understood. A prejudice has prevailed that the ear is too delicate an organ to be operated upon, or, as it is commonly expressed, tampered with; and thousands have thus remained deaf for the rest of their lives, who might have been restored to their hearing had proper assistance been early applied."

Not to burden the reader with too minute and extended a