nerve, expanded within the membranous labyrinth, the cochlea, and semicircular canals, is functionally diseased-atrophied, or, as some writers term it, "paralyzed;" and, with the exception of a deficiency of cerumenous secretion in the external meatus, said to attend this disease, all the other parts of the ear-the membrana tympani, and the mucous lining of the cavity of the tympanum and Eustachian tube-are healthy. Gas, or medicated vapour of some description, is applied to the middle ear for the purpose of stimulating or renovating the dormant action of the parts contained within the cavity of the labyrinth,-just as, a few years ago, we heard the virtues of the vapour of Prussic acid, when applied to the conjunctiva, cornea, and eyelids, extolled as a cure for amaurosis and cataract. It is really preposterous to imagine how such an effect could be anticipated; and one would be inclined to call in question the common sense of the proposers, but that a solution may be offered, at least in Dr. Kramer's case, by a perusal of the following paragraph from his book:—“ It must always be kept in view, that the cavity of the tympanum, which first receives the etherous vapour, is extremely small, and that even when the va pour passes through this cavity into the labyrinth, by means of the foramen ovale, it has to fill an equally small, or even still smaller, space than that formed by the cavity of the tympanum!" Can it be that Dr. Kramer has forgotten his anatomy, or that the school of Johannes Müller credits the assertion, that, in an ear where the structures of the tympanum are perfect, vapour passes through the foramen ovale, closed by the base of the stapes and its surrounding membrane and ligaments? or, does endosmose, the only principle on which a plausible explanation can be offered, really exert such an influence as that here alluded to? If this be the principle (although he does not make any allusion to it) by which Dr. Kramer would account for the action of his favourite remedy, one would have thought, from a knowledge of the anatomy of the parts, that the membrane closing the foramen rotundum would be a better medium for the passage of the gas than the base of the stirrup bone. But yet this is not all; the vapour is to fill the cavity of the labyrinth, thus replacing the perilymph, in order to come in contact with the expansion of the auditory nerve! This

opinion is, however, on a par with the proposition made by the same author, and to which I have adverted at page 105,-to judge of the state of the auditory nerve by the introduction of a catgut, an ivory, or a whalebone bougie into the cavity of the tympanum. Mr. Jones has, in his essay already referred to at page 32, reiterated all these absurd opinions regarding nervous deafness, not, however, as expressing his own ideas on the subject, but prefaced by this careful proem,-" The following is a sketch of 'Nervous Deafness' as commonly drawn by authors."

To these objections it may be urged, that several cases have been cured. Granting that some such instances have been recorded, it in no wise follows that the disease in such cases was one of pure nervous deafness. On the contrary, I believe that, where benefit has been derived, the cause of deafness was originally chronic inflammation, and, subsequently, thickening of the mucous membrane of the cavitas tympani-a part highly endowed with nerves, the diseased condition of which, as already pointed out by Mr. Swan, must materially impair hearing.

Mr. Pilcher has recorded, under the head of" Nervous Diseases of the Ear," a case of "torpid functional derangement," of which the following are the particulars, as given at page 318 of his book, and afforded partly by the patient and partly by the author: and which I have selected, not in a spirit of hypercriticism of a really useful work, but in the hope of correcting what I believe to be an error arising out of the too hasty acceptance of a particular doctrine. A clergyman says,-" At the age of sixteen my sense of hearing was severely injured by a succession of violent inflammatory attacks in my ears. About thirty-four years have elapsed since that period; and, during all that time, I have been almost entirely deprived of the use of my right ear, and have had but an imperfect use of my left... In the course of last winter I was afflicted by a severe and obstinate attack of quinsy, which, as usual, very much affected my hearing." The increased deafness thus occasioned continuing some months after his recovery from this attack, he was induced to submit to medical treatment, and says, "I soon began to experience surprising benefit, particularly in my right, which, for the greater part of my life, had

been entirely useless." He concludes by stating, that his hearing has been perfectly recovered. The only record given of the objective symptoms in this case are as follows: "The lining membrane of the external ears of this gentleman is dry and scaly; the Eustachian tubes are large and pervious, and the symptoms denote a torpid condition of the acoustic nerve, attended with occasional tinnitus aurium." A diseased condition of the mucous membrane of the left nostril presented difficulties to the introduction of the catheter upon that side. Not one word is stated as to the condition of the meatus, the state of the membrana tympani, or the sounds produced in the cavity of the tympanum by the air douche in this disease, which the patient himself, it must be remembered, attributed, and I think most correctly, to a succession of violent inflammatory attacks in his ears;-neither is the hearing distance upon either side recorded at the time when the treatment commenced, or at any subsequent period. "The treatment," says the author, “pursued in this case was, the application of the vapour of acetous ether two, and sometimes three, times a week, the patient's avocations not permitting the more frequent use of the remedy; when the vapour did not produce a sensible effect, the much diluted mixture of ether and water was injected." Now, I challenge the whole array in this case, and protest against its being, with the defective details above stated, allowed to remain upon the record of British medical literature as an instance of nervous deafness from torpid functional derangement. But the same difficulties, the like defective details, and illogical reasoning, pervade every department of medical literature, as must be experienced by those who for any particular purpose have occasion to search books and periodicals for cases bearing on any special subject. Their path is beset with difficulties; the cases which they have seen quoted as proofs of a particular doctrine turn out, when they come carefully to examine them in the original, to be either altogether defective, or by no means proving the position for which they had long been employed. I have often thought it would tend to bring medicine up to the state of a more exact science, if some one with sufficient knowledge, honesty, and common sense, and having time at command, would search out and carefully analyze from year to year, or in

particular branches of medical science, the remarkable cases that are continually put forth, and thus purge our literature of those which I will not say are unworthy of credit, but which certainly do not afford proof of that for which they were related by their authors. Mr. Pilcher has also propounded a doctrine to which I cannot assent; it is that of deafness occurring from a person having neglected to use the ear. I cannot well understand how, except by stopping the meatus, any one can neglect to use the ear.

It may be asked, before concluding this Chapter upon Diseases of the Internal Ear, whether I have nothing to offer but criticism of other men's statements and opinions with respect to the cure of nervous deafness? For confirmed cases of such, particularly when of an hereditary nature, I have nothing to offer but an ear-trumpet, and a strong recommendation not to quack. For incipient nervous deafness much may be done, if not to restore perfect hearing, at least to arrest the further progress of the disease, and avert a condition to which, sooner or later, the unhappy patient may be reduced. Counter-irritation, long kept up; the judicious use of mercurials adapted to the age, circumstances, and condition of the patient, and persevered in for months; relieving the person from any exciting cause, whether connected with plethora or debility, which may appear to hasten the catastrophe; and, in one word, by improving the general health by such means as any experienced physician or surgeon can apply, will, and often does, avert complete nervous deafness. Finally, with the exception of counter-irritation behind the ears, I would entreat my readers carefully to abstain from all topical applications.

Of cerebral deafness, or that arising from chronic disease of the brain or its coverings, and which is usually accompanied with giddiness, derangement of the stomach, and a manifest impression upon the general health, a good example is afforded in the case of the celebrated Dean Swift, on which I have already remarked.* For such cases an issue in the nape of the neck is the best treat

ment.

See "The Closing Years of Dean Swift's Life."

394

CHAPTER VIII.

OTORRHOEA.

Otorrhea: Statistics of; Forms of Disease, and Parts engaged; Causes; Prejudices against Healing; Metastasis.—Characters of Discharge.—Simple Catarrhal Otorrbœa: its Treatment, Local and General.—Astringent Lotions.-Periosteal Inflammation.— Complications of Otorrhoea: Tympanic, with Perforate Membrane-Granulations.— Fungi. Polypi: their Varieties; Treatment: Excision; Escharotics; The Snare.Consequences of Otorrhoea.-Caries of Mastoid Process.-Facial Paralysis; Double and Single. Discharge from Internal Ear.-Cerebral Affections consequent upon Otorrhoea; their Fatal Character: Abscess in the Neck; Purulent Infection of the Lungs.-Ear Trumpets.

S the great majority of the inflammatory affections of the ear described in the previous chapters of this work may, and do frequently, terminate either in suppuration, or in effusions of serum, mucous, or muco-purulent fluid, it necessarily follows, that otorrhoea, or a discharge from the ear, must be a very frequent disease. A reference to the Nosological Table, at page 147, will show many, though not all, of the affections which may end thus; for frequently "a running" from the external meatus commences without any previous warning, the lining of that tube passing imperceptibly from a cuticular to a muco-secreting surface; although I believe, if carefully examined at the moment, it would be found to result from slight and painless inflammatory action in the part. Although otorrhoea is not, properly speaking, a disease, but the result of several diseases, yet, from its importance, its frequency, its constitutional character, and the many serious diseases which it originates, I have here, in addition to the different notices of it throughout this book, devoted a special chapter to its consideration.

"A discharge from the ear" is by far the most frequent aural disease of these countries; but, whether owing to the variableness and humidity of our climate, the prevalence of scrofula, or to neglect, it is difficult to say. As may be seen by the Table given at page